Effekt av innføring av gratis skolefrukt
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1 Effekt av innføring av gratis skolefrukt Elling Bere Førsteamanuensis Universitetet i Agder elling.bere@uia.no Subscription program The Norwegian School Fruit Program Offered to all Norwegian elementary schools Cost: NOK 2.50 per school day (approximately EUR 0.30) Subsidised by the Norwegian Government by NOK 1.00 per pupil per school day 1
2 The FVMM project 38 schools, th and 7th graders School fruit intervention (October 01 June 02): Free school fruit: 9 schools Subscription program: 9 schools No program: 20 schools Data collections: Baseline (September 01) Follow-up (May 02) Follow-up (May 05) 2
3 1 was much more effective in increasing children s fruit and vegetable intake than the existing subscription program Main challenge with existing subscription program Low participation (spring 2006) 41% of the schools participated 28% of the pupils at participating schools subscribed 12% of Norwegian 1st to 10th graders 3
4 Existing subscription program Increased FV intake at school FV at school (portions/day) 1,2 0,8 0,4 Subscription No program =0.2, p=0.003* 0 sep.01 may 02 Bere et al., Preventive Medicine, 2005 More effective than subscription program FV at school (portions/day) 1,2 0,8 0,4 Subscription No program =0.8, p<0.001 =0.2, p= sep.01 may 02 Bere et al., Preventive Medicine,
5 2 showed long term effects Showed long term effect 2,5 Control FV all day (portions/day) 2 1,5 1 sep.01 may 02 may 05 Effect: 0.69, p< , p<0.001 Bere et al., International Journal of Behavioral Nutrition and Physical Activity,
6 De som fikk gratis skolefrukt i 01/02 abonnerte oftere senere % av gratis skolefruktelever (3 av 9 skoler) 7% av kontrollelever (2 av 10 skoler) % av gratis skolefruktelever (2 av 9 skoler) 1% av kontrollelever (1 av 25 skoler) Cost-benefit analysis Free school fruit for all (10 years) is economically profitable if: Mean lifelong FV intake increase 2,5 grams 6
7 3 Increased fruit and vegetable intake reduced consumption of unhealthy snacks Reduced consumption of unhealthy snacks 8 Unhealthy snacks (times/week) 7 6 Control HIGH SES LOW SES 5 Sept. 01 May 02 Bere and Klepp, poster EGEA III, 2005 (and Bere et al., Preventive Medicine, 2005) 7
8 4 The existing subscription program increase, while free fruit tended to decrease social inequalities, in FV intake Subscription program Subscribers are different Nonsubscribers Subscribers p-value Gender (female) 46% 59% 0.05 Education plans (plans of college/university edu.) 49% 68% BMI (mean) FV all day (portions/day, 24-h recall) <0.001 Soda/candy/chips (times/week) Ate breakfast yesterday 75% 92% <0.001 Bere and Klepp, in: Ethics and the politics of food, 2006; (and Bere et al., Preventive Medicine, 2005) 8
9 Subscription program Subscribers parents are different Nonsubscribers parents Subscribers parents p-value Age (years) Household income (in upper half) 47% 65% 0.02 FV all day (portions/day, 24-h recall) TV watching (hours/day) Smokers 38% 23% 0.03 Bere and Klepp, in: Ethics and the politics of food, 2006; (and Bere et al., Preventive Medicine, 2005) Norwegian School Fruit Programme Hypothetical subscription% vs. price Kumulativ prosent 40 3,50 kr (usubs.) 3,00 kr 2,50 kr 2,00 kr 1,50 kr 1,00 kr 0,50 kr Gratis Elling Bere 9
10 Subscription program Increases sosial inequality in FV intake 25 Non-subscribers May 05 Usual FV intake (times/week) =3.1 p=0.001 Subscribers May 05 =6.0 p< sep.01 may 05 NO program Subscription program Bere and Klepp, in: Ethics and the politics of food, 2006 Decreases social inequality in FV intake 25 Non-subscribers May 05 Usual FV intake (times/week) =3.1 p=0.001 =1.9 p=0.03 Subscribers May 05 =6.0 p< sep.01 may 02 may 05 NO program FREE fruit Subscription program Bere and Klepp, in: Ethics and the politics of food,
11 Subscribers vs. non-subscribers 1,2 FV at school (portions/day) 0,8 0,4 0 Non-subscribers May 05 Subscribers May 05 sep.01 may 02 may 05 NO program FREE fruit Subscription program Habitual FV intake 1,2 1 Control 0,8 0,6 0,4 0,2 0 HIGH LOW Sept. 01 May 02 11
12 Free Fruit Gender 1,2 1 Control 0,8 0,6 0,4 0,2 0 GIRLS BOYS Sept. 01 May 02 Socioeconomic status 1,2 1 Control 0,8 0,6 0,4 0,2 0 HIGH SES LOW SES Sept. 01 May 02 12
13 Conclusion Free school fruit is more effective than the existing subscription program Free school fruit show long-term effects Free school fruit decrease consumption of unhealthy snacks Free school fruit tend to reduce social inequalities Bere and Klepp, Norsk tidsskrift for ernæring, 2007 Now: Free school fruit for all schoolchlidren in grades
14 14
15 Noen nye resultat fra FVMM prosjektet 15
16 SEX disparity Boys 11.9, girls 14.5 times/week Mediators of sex disparity: Preferences explained uniquely 25% Accessibility explained 10% Modelling, intention, self-efficacy, knowledge did not explain much Bere et al., Public Health Nutrition, 2008a SES disparity Parental education FV intake LOW HIGH diff. p-value <0.001 Mediators of SES disparity Accessibility at home explained 45% in 2002 and 14% in 2005 Preferences, modelling, intention, selfefficacy, knowledge did not explain much Bere et al., European Journal of Public Health, in press 16
17 Perceived accessibility at home Home accessibility of fruits and vegetables (range: -10/10) Boys Girls P-value Adolescents reports <0.001 Parental reports LOW parental edu. HIGH parental edu. P-value < <0.001 I 2007 var det 130 tusen aktive mannlige jegere i Norge mot kun 7000 kvinnlige 17
18 Brusdrikking u.skoleelever TOTALT INNTAK (2 ganger/uke eller mer) Brus med sukker Gutter vs jenter: OR=2.1 Lav vs høy SES: OR=1.5 Lettbrus Gutter vs jenter: OR=0.8 Lav vs høy SES: OR=1.4 PÅ SKOLEN (1 gang i uken eller mer) Brus med sukker Gutter vs jenter: OR=4.4 Lav vs høy SES: OR=1.9 Lettbrus Gutter vs jenter: OR=1.7 Lav vs høy SES: OR=1.9 Bere et al., Public Health Nutrition, 2008b 24-h recall Sweet bakeries Candy/chips Hva spises på skolen? Upubliserte data fra FVMM Did you eat/drink... at school yesterday? Lunch Fruit Vegetable Water Soda with sugar Soda without sugar Instant noodles Overall mean 88 % 20 % 12 % 49 % 11 % 2 % 1 % 15 % 14 % School range min 77 % 5 % 5 % 16 % 4 % 0 % 0 % 0 % 0 % max 96 % 41 % 46 % 68 % 37 % 6 % 7 % 31 % 78 % 2006 Elling Bere 18
19 Hva spises på skolen? Upubliserte data fra FVMM FFQ (n=2870) Eating/drinking... once a week or more at school Fruits and vegetables Candy/chips Instant noodles Sweet bakeries Soda with sugar Soda without sugar Water Overall mean 40 % 33 % 5 % 36 % 24 % 8 % 79 % School range min max 16 % 79 % 9 % 93 % 0 % 23 % 18 % 61 % 6 % 67 % 0 % 21 % 55 % 97 % 2006 Elling Bere Grønnsaker til middag I GÅR: (6 og 7 klassinger) SES: Kjønn: Lav SES: 33% Høy SES: 47% Gutter: 34% Jenter: 43% Lav SES gutter: Høy SES jenter: 29% 53% Vejrup et al., Appetite,
20 FV are expensive! 2006 Elling Bere Drewnowski et al., AJPH, 2004 Dessert at McDonald s? Sundae m/karamell Donuts m/sjokolade Eplepai McFlurry m/daim Is i kjeks Fruit & Yogurt Fruktpose 0 Price (NOK) 2006 Elling Bere 20
21 Dessert at McDonald s? Sundae m/karamell Donuts m/sjokolade Eplepai McFlurry m/daim Is i kjeks Fruit & Yogurt Fruktpose 0 Price (NOK) / 9,5MJ 2006 Elling Bere 2006 Elling Bere 21
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