Volume 38, Issue 1, Spring 2014 - Cirignano, Fitzgerald, Hughes, Savoca, Morgan, Grenci

In-Classroom Fruit and Vegetable Tastings Offer Potential for Increasing Consumption among Third through Sixth Grade Children

Sherri M. Cirignano, MS, RD, LDN; Nurgul Fitzgerald, PhD, MS, RD;
Luanne J. Hughes, MS, RD, LDN; LeeAnne Savoca, MS, RD; 
Kathleen Morgan, DrMH, DTR;  Alexandra Grenci, MS, RD, LDN, CDE

ABSTRACT

Purpose/Objectives
The purpose of this study was to examine the effect of coordinated in-classroom education and taste-testing activities on fruit and vegetable acceptance in a state-wide sample of third through sixth grade children.

Methods
Two taste-testing sessions were a part of six nutrition lessons that were implemented in nine elementary schools in New Jersey. The pre- and post-tasting surveys included seven questions (e.g., ever had the food before, like the food, willing to taste the food, will eat the food again) and were completed by 2,945 children. Chi square and McNemar tests were used to analyze the data.

Results
A large proportion of the children (43%) had not tried the foods prior to the taste-testing; this percentage was higher among third graders. Although 33.6% of children reported not liking the food before the tasting, 94% of the children tasted the foods.  The percentage of those who reported liking the test-food significantly increased from 55.8% to 65.2% after tasting (p<0.001). Children who were familiar with the foods before the tasting were more likely to accept the foods, but even among those who had not tried or liked the foods before, acceptance increased after the tasting event.

Applications to Child Nutrition Professionals
For the potential increase of fruit and vegetable intake in the cafeteria and increased acceptance of new menu items, child nutrition professionals may benefit from including taste-testing activities before adding new items.

Keywords: food tasting; Healthy, Hunger-Free Kids Act; school wellness; child nutrition; fruits and vegetables

INTRODUCTION

As a result of the Healthy, Hunger-Free Kids Act (HHFKA) of 2010, new nutrition standards have been set for schools, including requiring child nutrition professionals (CNP) to serve a greater variety and quantity of fruits and vegetables (Healthy, Hunger-Free Kids Act of 2010, 2010). These mandates are largely due to childhood obesity rates that, although leveling off, continue to be of concern (Ogden, Carroll, Kit, & Flegal, 2012). The positive health effects of a diet high in plant foods are well known (U.S. Department of Agriculture [USDA] & U.S. Department of Health and Human Services [USDHHS], 2010).  Although attempts to increase fruits and vegetables in schools are occurring (USDHHS & Centers for Disease Control and Prevention, 2013), recommended intakes for children of all ages continue to be unmet. National data from 2011 indicate that over one-third of adolescents report consuming fruits and vegetables an average of less than one time daily (USDHHS, 2013).

Comprehensive, integrated nutrition services in schools can improve the nutritional status, health, and academic performance of children (American Dietetic Association, Society of Nutrition Education & School Nutrition Association, 2010).  Implementing changes in school cafeterias can result in increased fruit and vegetable consumption, especially when employing creative tactics (Hanks, Just, Smith &, Wansink, 2012).  Taste-testing is one tool CNPs can use to support making healthy changes to menus.  Tastings offer insights into which foods to offer and how to present and prepare them for acceptance by students.  They can be conducted with relatively minimal cost and enable CNPs to assess marketability of new foods before adding them to the menu.

Students require some "experience" with food; they can be hesitant to try new foods in the school lunch line when there is barely enough time to get food and eat, much less be introduced to a new food item. Participating in tasting programs, especially repeated tastings, in school cafeterias can be an effective way to improve children's acceptance of foods that were previously not accepted (Lakkakula, Geaghan, Zanovec, Pierce, & Tuuri, 2010). With younger students (preschool through sixth grade), in particular, repeated tastings of foods have been associated with high acceptability of fruits and vegetables (Kaiser et al., 2012).

Given limitations of budgets, staffing and cafeteria operating time, successful implementation and outcomes of taste-testing activities will benefit from buy-in and collaboration from the whole school community.  Interventions that utilize a multi-faceted approach, including the classroom, families, CNPs, and community organizations, for implementation have been shown to best promote children's intakes of fruits and vegetables (Blanchette & Brug, 2005). With time constraints, even the most creative CNPs have difficulty changing students' food preferences without education (Hakanson, 2012). Utilizing Extension educators to support in-classroom tastings and including nutrition education to support the tastings is an option for schools to consider (Grenci, Hughes, & Savoca, 2011).

Conducting tastings in classrooms, as part of an over-arching educational initiative that ties the classroom to the cafeteria to increase student familiarity with and acceptance of new foods could result in a better tasting experience and, ultimately, stronger results. Previous studies investigating the outcomes of taste-testing activities show some success, but some of these results have been based on small to medium size samples (Hanks et al., 2012; Lakkakula et al., 2010). In addition, a majority of the studies did not include a coordinated approach to connect classroom education with acceptance of new foods through the taste-testing interventions. Large-scale interventions to provide more reliable results have been scarce, although a state-wide intervention was implemented in California in 2010-2011 with promising results (Kaiser et al., 2012). The aim of the Grow Healthyproject was to examine willingness to taste and acceptance of fruits and vegetables after the implementation of paired nutrition education and taste-testing activities in a large, state-wide sample of 3rd to 6th grade students. 

METHODOLOGY

As part of a USDA Team Nutrition grant received by the Family & Community Health Sciences (FCHS) Department of  Rutgers Cooperative Extension through the New Jersey Department of Agriculture, the project Grow Healthy was initiated.  Grow Healthy is a state-wide school wellness collaboration between CNPs, teachers, and Cooperative Extension educators that combines nutrition lessons with taste-testing activities, and aims to demonstrate student acceptance of fruits and vegetables in the classroom and cafeteria. During the 2011-2012 school year, school-wide tastings were conducted at nine pilot schools. Participating schools received six garden-enhanced nutrition lessons throughout the school year. The interactive lesson content included ways to increase consumption of a variety of fruits and vegetables, benefits of choosing locally grown produce, understanding local food systems, seasonal eating, MyPlate, and related basic nutrition concepts. FCHS educators, trained FCHS volunteers and teachers each presented two 30-40 minute lessons. A total of 3,116 children in grades 3 to 6 participated in the program. The project was approved by the Rutgers University Institutional Review Board.

Two tastings were conducted as the final activity in the two lessons presented by volunteers. Tastings were unique to each school with each school selecting a fresh vegetable or fruit to taste and determining how to prepare and serve it. Schools were encouraged to select a vegetable or fruit that complemented the lesson and was an item that they would like to add to their menus to support changes outlined in the HHFKA.  A collective list of selected foods included green beans, canned chick peas, snow peas, sugar snap peas, spaghetti squash, baby spinach, zucchini, butternut squash, sweet potatoes, and cantaloupes.  Each school tested only two foods from this list. School nutrition personnel prepared the food and assisted with delivery and service in each classroom.  FCHS educators directed the tastings, with support from volunteers, teachers and aides (the Grow HealthyTeam). Food safety and food allergy protocols were followed. 

Outcome measures
Tasting cards were developed by a committee of FCHS educators for evaluation of the tastings. Card design was modeled after the Rutgers Cooperative Extension Youth Program Evaluation forms used by 4-H to reach younger audiences.  Visual prompts were included for younger children (K-2) and written text for older children (3-6). Card content was designed to be brief, so the tasting and completion of the cards could be incorporated into a 30- to 40-minute lesson. Students completed information on the card including school name, grade and food tasted and answered four questions on the front of the card. "How willing are you to taste this food today?"  required answers of "very willing", "willing", or "not willing."  Questions of "Have you ever had this food before?", "Do you like this food?", and "Did your school have this food growing in the school garden this year?" required answers of "yes" or "no."

Once all students completed the front of the card, they were offered the food to be tasted, with the freedom to decline if they were "not willing" to taste it. Then all students were instructed to turn the tasting card over and answer three questions that required "yes" or "no" answers on the back of the card: "Did you taste the food?", "Did you like it?", and "Will you eat it again?"

Tasting cards were collected and reviewed by FCHS educators. Data were entered into spreadsheets by an administrative assistant and student, all of whom completed the Rutgers University Human Subjects Certification course and were trained on data collection and entry procedures. 

Statistical Analyses
Data were analyzed using IBM SPSS Statistics for Windows version 21.0 (Armonk, NY: IBM Corp). Out of 3,116 participants, 2,945 children (94.5%) who answered all of the outcome measures (tasting the food, liking the food after the taste-test, willingness to eat it again) were included in the analyses. McNemar test was used to compare liking the food before versus after the tasting.  A Chi Square test was used to compare differences by grade, prior familiarity or liking the food, and by participation status in the taste-test.  Statistical significance level was set at p <0.05.

RESULTS AND DISCUSSION

Of the 2,945 children, 969 (32.9%) were in third grade, 917 (31.1%) were in fourth, 702 (23.8%) were in fifth, and 357 (12.1%) were in sixth grade.

Before the Taste-testing
A substantial proportion of the children (43.3%) had not tried the test foods before the taste-testing activity. Greater percentages of children in the higher grades had tried the foods before (49.3% of third graders, 57.1% of fourth graders, 62.0% of fifth graders and 60.2% of sixth graders; p<0.0001). 

Spaghetti squash, butternut squash, summer squash, and snow peas were among the foods that were least tried prior to taste-testing.  More than 58% of the children, in schools where these vegetables were used, reported not eating these foods before the taste-testing. A similar trend of greater exposure to fruits than vegetables prior to tastings has been reported by others (Lakkakula et al., 2010; Kaiser et al., 2012).

Most of the students (55.8%) stated that they liked the test foods prior to tasting.  Although one in three students (33.6%) reported not liking the food, 86.0% of the children overall stated that they were willing or very willing to taste the food. This finding is consistent with other studies, which suggest that the majority of children in this age group may be receptive to trying new foods in the school environment (Kaiser et al., 2012; Lakkakula et al., 2010).  

After the Taste-testing
Overall, a significantly higher percentage of children reported liking the food after the taste-testing when compared with before (65.2% versus 55.8%, respectively, p<0.0001).  Most of the children (65.5%) stated that they would eat the test food again.

The vast majority of the children (n=2,761, 93.8%) tasted the foods. Study outcomes by the taste-testing status of the children are shown in Table 1. Significantly higher proportions of children who tasted (versus who did not taste) the foods reported liking the foods and were willing to eat the food again (p<0.0001).  Similar to the overall increase in liking the foods after the taste-testing, there was a 10% increase (from 58.9% to 69.0%) in liking the foods among children who actually taste-tested the foods, and 69.3% stated that they would eat it again. A similar study by Kaiser et al. (2012), using a post/pre format, indicated that willingness to try tasted foods again after a taste-testing remained significantly high until after the sixth grade.

Table 1Liking and Willingness to Eat the Food Again by Participation in the Taste-testing of Fruits and Vegetables among School Children in Grades 3-6. (N =2,945)
  Participated in Tasting p2
Yes No
n %1 n %1
Liked the food before tasting Yes 1,626 58.9 18 9.8 <0.0001
No 831 30.1 159 86.4  
Liked the food after tasting Yes 1,906 69.0 14 7.6 <0.0001
No 855 31.0 170 92.4  
Will eat the food again Yes 1,914 69.3 15 8.2 <0.0001
No 847 30.7 169 91.8  
1 Percentages are of "participation in the food-tasting" and may not add up to 100% because of missing data.
2 Differences between Yes/No groups determined by Chi Square test.

 

Table 2.  Willingness to Taste, Liking, and Tasting by Prior Familiarity with Test Fruits or Vegetables among School Children in Grades 3-6  (N = 2,945)
  Ever Had the Food Before p2
Yes No
n %1 n %1
Willing to taste the food Very willing/willing 1489 90.1 1030 80.7 <0.0001
Not willing 129 7.8 212 16.6  
Liked the food before tasting Yes 1307 79.1 335 26.3 <0.0001
No 316 19.1 671 52.6  
Participated in the taste-testing Yes 1593 96.4 1151 90.2 <0.0001
No 59 3.6 125 9.8  
Liked the food after tasting Yes 1298 78.6 611 47.9 0.0001
No 354 21.4 665 52.1  
Will eat the food again Yes 1322 80.0 597 46.8 <0.0001
No 330 20.0 679 53.2  
Percentages are of "ever had the food before" and may not add up to 100 because of missing data.
2 Differences between Yes/No groups determined by Chi Square test.

In this study, even among children who tasted the foods but did not like the foods before taste-testing (n=831), 25.9% reported liking them afterwards, and 30.0% said that they would eat the tasted food again. In addition, and as seen in Table 2, close to about half of all children who had never tried the food before reported that they liked the food after the taste-test and would eat it again. This number would be expected to increase with additional exposures. Lakkakula et al. (2010) found in a ten week tasting study that acceptance was greater after eight to nine taste exposures of vegetables that were previously disliked. These results suggest a need to introduce foods to children a number of times to gain acceptance.  However, in this study, increased acceptability after just one tasting points out that a smaller investment of time and resources may generate substantial changes in acceptance.  Given the time and financial limitations faced by schools and CNPs alike, this finding is important.

Significantly higher proportions of children who had tried the food before taste-testing (versus those who had not) stated that they liked the food before, were willing to taste it, and actually tried the food during the taste-testing.  Higher percentages also reported that they liked the food after the taste-test and will eat it again (p<0001, Table 2). This is consistent with past findings with regard to fruit and vegetable consumption and taste preferences (Blanchette & Brug, 2005).

CONCLUSIONS AND APPLICATION

This study offers insight into the potential impact of a coordinated intervention, including classroom education and taste-testing, on children's fruit and vegetable acceptance. Taste-testing activities as a part of a 6-lesson classroom education program among third to sixth grade children in a state-wide sample were positively associated with increased liking and willingness to eat the tasted foods again. O'Connell, Henderson, Luedicke, and Schwartz (2012) found that repeated exposures to vegetables in the preschool setting did not consistently correlate with increased consumption.  However, results of this study showing greater willingness of children to eat foods after tasting activities are consistent with other reports (Kaiser et al., 2012; Hanks et al., 2012; Lakkakula et al., 2010). The current study results provide further confirmation based on a large, state-wide sample of children. 

A unique contribution of this study is the in-depth examination of the results according to children's prior liking and familiarity with the tasted foods.  Large numbers of children who had not tried or liked the tested foods before reported liking the foods after and stated that they would eat the foods again. These results suggest that similar interventions could successfully change preferences among children who already have established dislikes about certain foods. Successful results and the large sample size of this project make it possible to implement similar programs in other populations to improve students' food acceptance in schools.

Children who had previously tried the taste-tested foods were more likely to accept these foods. However, many of the children (43% overall), especially those in the earlier grades, had not tried the test-foods before.  This can be an obstacle when CNPs attempt to introduce new foods into school cafeterias, where children are faced with limited time and are likely to be hesitant to try new foods on the lunch line. Because of children's less familiarity with the test-foods in the earlier grades, it seems even more important to expose young children to new foods through similar programs to improve food acceptance. Classroom-based lessons with tastings offer the opportunity to introduce new foods in the classroom where students have the opportunity to sample, evaluate and express their opinions about the acceptability of a new food and provide directions for the cafeteria menu.

A limitation of this study was the absence of an assessment of how the results impacted cafeteria menus or students' food intake in the cafeteria.  While students reported close to a 10% increase (pre to post) in liking the tasted foods, and more than 65% said they would eat the tasted food again, there is only anecdotal data from two schools which indicated that these foods were added to cafeteria menus. Future studies to assess whether results from tastings can result in successful changes to menus or changes in children's food consumption are warranted.

A variety of factors could have impacted the study results. Positive results, such as liking the food and willingness to eat the food again, were significantly low (i.e., less than 10%) among the children who did not taste the foods, but the potential influence of the lessons or social desirability bias on the tasting outcomes cannot be ruled out. Since students were able to view others' responses, it is possible that they could have been influenced from their peers' responses or facial reactions. The effects of social norm and peer influence on eating behaviors and acceptance of food have been documented in the school setting (Krolner et al., 2011; Miller, Abdel-Maksoud, Crane, Marcus, & Byers, 2008; Thompson, Bachman, & Baranowski, 2007).  Future studies that focus on testing peer influence and social norms to determine how they impact willingness to taste and eat new foods could be helpful. In addition to the taste-testing, it is possible that the children's responses could be influenced by nutrition lessons. Future studies with a control group who do not receive lessons and follow-up surveys may be useful to differentiate these possible effects.

Overall, this study suggests that classroom-based exposure paired with education can offer insights into students' food preferences and improve their food acceptance. A disconcerting 43% of all students in this study had not tried the foods prior to the tastings. This percentage was higher among younger students, suggesting a need for early introduction of foods to students; the earlier the better.  Students cannot be expected to embrace new foods without education, exposure and positive tasting experiences. Classroom-based projects that pair exposure and education about fruits and vegetables and involve a team that supports CNPs offer potential to expand students' food repertoires and the cafeteria menu. In addition, tastings that precede additions to the menu may lead to increased food acceptance. This, in turn, may lead to cost savings associated with reduced food waste.

While projects such as these offer potential cost savings and improved student acceptance of new foods, they can be time-consuming and cumbersome for CNPs to implement. This program was successfully implemented through a collaboration between nine schools across the state and Extension educators. Similar collaborative approaches involving classroom education and food exposure offer CNPs the opportunity to take part in these initiatives with less time, work and expense. By partnering with community organizations such as Cooperative Extension, CNPs can work together to identify educational needs and develop tastings that enable them to enhance menus. Tastings can be conducted to select new foods for the menu, to identify new preparation methods, to incorporate favorite recipes, and to increase variety and meet vegetable sub-group requirements. Conversely, tastings could also be used to identify foods, recipes or preparation methods to removefrom the menu. Additionally, collaborative projects such as this offer the potential to further investigate the individual and peer-level influences (e.g., self-efficacy, social norms) on fruit and vegetable consumption in a school setting.

ACKNOWLEDGEMENTS

This study was funded by a USDA Team Nutrition Grant through the New Jersey Department of Agriculture.

REFERENCES

American Dietetic Association, School Nutrition Association, & Society for Nutrition Education. (2010). Joint position of the American Dietetic Association, School Nutrition Association and Society for Nutrition Education: Comprehensive school nutrition services. Journal of the American Dietetic Association, 110(11), 1738-1749.doi:10.1016/j.jada.2010.08.035

Blanchette, L., & Brug, J. (2005). Determinants of fruit and vegetable consumption among 6-12-year-old children and effective interventions to increase consumption. Journal of Human Nutrition and Dietetics, 18(6), 431-443.  doi 10.1111/j.1365-277X.2005.00648.x

Grenci, A., Hughes, L. J., & Savoca, L. (2011). Connecting classroom and cafeteria in a school wellness initiative. Journal of Child Nutrition & Management, 35(1). Retrieved from http://www.schoolnutrition.org

Hakanson, C. (2012).  Best practices in creating a healthy school lunch program. (Master's thesis).  Retrieved from  http://sophia.stkate.edu/cgi/viewcontent.cgi?article=1011&context=maol_theses

Hanks, A. S., Just, D. R., Smith, L. E., &Wansink, B. (2012). Healthy convenience: Nudging students toward healthier choices in the lunchroom. Journal of Public Health, 34(3), 370-376. doi:10.1093/pubmed/fds003  

Healthy, Hunger-Free Kids Act of 2010, 42 U.S.C. § 1751 et seq. (2010). Retrieved from http://www.fns.usda.gov/cnd/Governance/Legislation/CNR_2010.htm

Kaiser, L. L., Schneider, C., Mendoza, C., George, G., Neelon, M., Roche, B., & Ginsburg, D. (2012). Development and use of an evaluation tool for taste-testing activities by school-aged children. Journal of the Academy of Nutrition and Dietetics, 112(12), 2028-2034. 
doi:10.1016/j.jand.2012.07.006

Krolner, R., Rasmussen, M., Brug, J., Klepp, K. I., Wind, M., & Due, P. (2011). Determinants of fruit and vegetable consumption among children and adolescents: A review of the literature. Part II: Qualitative studies. International Journal of Behavioral Nutrition and Physical Activity, 8(112). Retrieved from http://www.ijbnpa.org/content/pdf/1479-5868-8-112.pdf

Lakkakula, A., Geaghan, J., Zanovec, M., Pierce, S., & Tuuri, G. (2010). Repeated taste exposure increases liking for vegetables by low-income elementary school children. Appetite, 55, 226-231.  doi:10.1016/j.appet.2010.06.003

Miller, T. M., Abdel-Maksoud, M. F., Crane, L. A., Marcus, A. C., & Byers, T. E. (2008). Effects of social approval bias on self-reported fruit and vegetable consumption: a randomized controlled trial.Nutrition Journal, 7(18). Retrieved from  http://www.nutritionj.com/content/pdf/1475-2891-7-18.pdf 

O'Connell, M. L., Henderson, K. E., Luedicke, J., & Schwartz, M. B. (2012). Repeated exposure in a natural setting: A preschool intervention to increase vegetable consumption. Journal of the Academy of Nutrition and Dietetics, 112(2), 235-245.  doi:10.1016/j.jada.2011.10.003

Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity and trends in body mass index among U.S. children and adolescents, 1999–2010. Journal of the American Medical Association, 307(5), 483–90.  doi:10.1001/jama.2009.2012

Thompson, V. J., Bachman, C. M., & Baranowski, T. (2007). Self-efficacy and norm measures for lunch fruit and vegetable consumption are reliable and valid among fifth grade students. Journal of Nutrition Education and Behavior, 39(1), 2-7.  doi:10.1016/j.jneb.2006.06.006

U.S. Department of Agriculture, & U.S. Department of Health and Human Services. (2010). Dietary Guidelines for Americans, 2010.  Washington, DC: Government Printing Office. Retrieved from http://www.cnpp.usda.gov/DietaryGuidelines.htm

U.S. Department of Health and Human Services, & Centers for Disease Control and Prevention. (2013). State indicator report on fruits and vegetables, 2013. Retrieved from http://www.cdc.gov/nutrition/downloads/State-Indicator-Report-Fruits-Vegetables-2013.pdf

BIOGRAPHY

Cirignano, Hughes, Savoca, Morgan, and Grenci are respectively Family and Community Health Sciences Educator/Assistant Professor; Family and Community Health Sciences Educator/ Associate Professor; Family and Community Health Sciences Regional Coordinator; Chair of Family and Community Health Sciences; and Family and Community Health Sciences Educator/Associate Professor at Rutgers Cooperative Extension in New Jersey.  Fitzgerald is Assistant Professor of Nutritional Sciences at Rutgers, The State University of New Jersey

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