The Effects of the Healthy Primary School of the Future on Children's Fruit and Vegetable Preferences, Familiarity and Intake

Marla T H Hahnraths, Maartje Willeboordse, Patricia van Assema, Bjorn Winkens, Constant P van Schayck, Marla T H Hahnraths, Maartje Willeboordse, Patricia van Assema, Bjorn Winkens, Constant P van Schayck

Abstract

Mere exposure is an often-described strategy to increase children's food familiarity, preferences, and intake. Research investigating this method in less controlled settings is scarce. This study investigates the effects of repeated fruit and vegetable (FV) exposure through the Healthy Primary School of the Future (HPSF) on children's FV familiarity, preferences, and intake. The study had a longitudinal quasi-experimental design comparing two full HPSFs (focus: nutrition and physical activity) with two partial HPSFs (focus: physical activity) in the Netherlands. Annual measurements (child-reported questionnaires) were conducted during 2015-2019 in 833 7-12-year-old children. The study was registered on ClinicalTrials.gov (NCT02800616). After correction for baseline, full HPSFs had, on average, a lower number of unfamiliar vegetable items after one (effect size (ES) = -0.28) and three years (ES = -0.35) and a higher number of disliked vegetable items after one year (ES = 0.24) than partial HPSFs. Unfavorable intervention effects were observed for fruit intake after one (odds ratio (OR) = 0.609) and four years (OR = 0.451). Repeated FV exposure had limited effects on children's FV familiarity, preferences, and intake, likely due to insufficient taste exposure. Considering the widespread implementation of school-based mere exposure efforts, it is highly relevant to further investigate under which circumstances mere exposure effectively contributes to improvements in (determinants of) FV intake.

Keywords: eating habits; familiarity; health promoting school; nutrition; primary school; repeated exposure; taste preferences.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hypothesized working mechanism of the full HPSF intervention. + Indicates a positive relationship between the concepts.
Figure 2
Figure 2
Estimated means of children’s fruit and vegetable familiarity at T0–T4: (a) Number of unfamiliar fruit items; (b) Number of unfamiliar vegetable items. Note. All analyses were adjusted for sex, study year at T0, SES, and ethnicity. Abbreviations: HPSF, Healthy Primary School of the Future. ★ Significant (≤0.05) difference between full and partial HPSF after correction for baseline.
Figure 3
Figure 3
Estimated means of children’s fruit and vegetable preferences at T0–T4: (a) Number of disliked fruit items; (b) Number of disliked vegetable items. Note. All analyses were adjusted for sex, study year at T0, SES, and ethnicity. Abbreviations: HPSF, Healthy Primary School of the Future. ★ Significant (≤0.05) difference between full and partial HPSF after correction for baseline.

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