Research Original Research: Brief| Volume 118, ISSUE 9, P1700-1710.e2, September 2018

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Validation of a Questionnaire to Measure Fruits and Vegetables Selected and Consumed at School Lunch among Second- and Third-Grade Students



      Interventions designed to encourage fruit and vegetable (F/V) consumption within schools are increasingly common. Thus, there is a need for valid, practical dietary assessment instruments to evaluate their effectiveness.


      The aim of this study was to examine the validity of a group-administered, paper-and-pencil questionnaire to assess F/V selection and consumption at school lunch relative to digital photography.


      This was a five-phase, method-comparison study in which the questionnaire was iteratively modified between each phase.


      The study examined sets of questionnaires and photographs of lunch trays (n=1,213) collected on 44 days between May 2015 and June 2016 among second-grade students from three New York City schools (phases 1 to 4) and second- and third-grade students from 20 schools across eight states (phase 5).

      Main outcome measures

      Outcomes assessed were selection, amount eaten, preference, and intention to consume F/V.

      Statistical analyses performed

      Validity was assessed by percent agreement (categorized as “match, omission, or intrusion” for items on or off tray and “match, overestimation, or underestimation” for amount eaten), Spearman correlation coefficients, and intraclass correlation coefficients (ICC).


      The total match rate for items on tray was substantial (phases 1 to 5: 83%, 84%, 92%, 93%, and 89%), with items more frequently intruded than omitted. For amounts eaten, the total match rates were moderate, but generally improved throughout the study (phases 1 to 5: 65%, 64%, 83%, 83%, and 76%), with overestimations more frequent than underestimations. There was good correspondence between methods in the estimates of amount eaten in a quantitative, cup equivalent amount (fruit ICC=0.61; vegetables ICC=0.64). Significant differences (α=.05) were not observed between second- and third-grade students, respectively, in the match rate for fruits (86% and 89%) or vegetable (89% and 86%) items on tray or fruit (69% and 73%) and vegetables (74% and 76%) amount eaten. Excellent correlations were observed between amount eaten and preference for fruit (r=0.91) and vegetables (r=0.93).


      The questionnaire offers a feasible, valid instrument for assessing F/V selection and consumption among elementary students in schools participating in the National School Lunch Program. Additional research is recommended to test the instrument’s sensitivity and to reproduce these findings using an alternative reference method, such as direct observations.


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      M. M. Graziose is a graduate research assistant, Department of Health and Behavior Studies Program in Nutrition, Teachers College Columbia University, New York, NY.


      R. L. Wolf is associate professor of human nutrition, Ella McCollum Vahlteich Endowment, Department of Health and Behavior Studies Program in Nutrition, Teachers College Columbia University, New York, NY.


      P. A. Koch is executive director, Laurie M. Tisch Center for Food, Education and Policy, and associate research professor, Department of Health and Behavior Studies Program in Nutrition, Teachers College Columbia University, New York, NY.


      I. R. Contento is the Mary Swartz Rose Professor of Nutrition and Education, Department of Health and Behavior Studies Program in Nutrition, Teachers College Columbia University, New York, NY.


      H. L. Gray is an assistant professor, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa.