One year of free school fruit in Norway-7 years of follow-up

Background: It is important that health-promoting efforts result in sustained behavioural changes, preferably throughout life. However, only a very few intervention studies evaluate long term follow up. Objective: The aim of the present study is to evaluate the overall and up to seven years effect of providing daily one piece of fruit or vegetable (FV) for free for one school year. Methods: A total of 38 randomly drawn elementary schools from two counties in Norway participated in the Fruit and Vegetables Make the Marks project. Baseline (2001) and follow-up surveys were conducted in May 2002, 2005 and 2009 (n = 320 with complete data) to assess FV and unhealthy snack intake. Mixed models were used to analyze the data. Results: Statistically significant adjusted overall effects of the intervention were revealed for FV intake (1.52 times/day) but this weakened over time. A significant adjusted overall effect (-1.54 consumptions/week) and a significant seven-year-follow-up effect (-2.02 consumptions/week) was found for consumption of unhealthy snacks for pupils of parents without higher education. Conclusion: One year of free school fruit resulted in higher FV intake and lower unhealthy snack intake, however this weakened over time for FV intake and became stronger for snack intake. More follow-up studies with larger samples and lower attrition rates are needed in order to further evaluate the long-term effect.