Farm to School as a strategy to increase children's fruit and vegetable consumption in the United States: Research and recommendations

The majority of children in the United States (US) do not consume the recommended amounts of fruits and vegetables for their age and gender. Farm to School (FTS) has been promoted as a strategy to increase consumption of these foods among US schoolchildren in primary and secondary schools (ages 5-19). FTS programmes connect schools to farmers and locally grown foods through a variety of activities that provide nutrition education and exposure to fruits and vegetables. This paper reviews the literature assessing the impact of these programmes on fruit and vegetable consumption among children in the US and makes recommendations for future research to improve knowledge of the efficacy of such approaches. While FTS programmes are becoming increasingly popular in the US, there is a paucity of peer-reviewed research assessing its overall impact on children's actual consumption of fruits and vegetables. Instead, the majority of literature on FTS has focused on school lunch participation rates and self-reported intake or selection of fruits and vegetables in programme evaluations that are usually self-conducted by individual FTS programmes. These studies tended to use surveys that have not been validated against actual fruit and vegetable consumption and so are not necessarily representative of actual consumption. To a lesser extent, validated self-report dietary assessment methods have been used but these methods are subject to children's misreporting. Based on the types of methods used in most of the current literature on FTS, it is difficult to draw conclusions about its true impact on children's fruit and vegetable consumption. However, continued implementation of FTS is encouraged based on the positive outcomes observed in other school interventions with similarities to FTS. Future studies assessing the impact of FTS on children's dietary behaviour should adopt validated dietary assessment methods to measure fruit and vegetable consumption, especially those that require observation of children's actual intake in order to eliminate errors from children's self-report.