Research Original Research| Volume 120, ISSUE 11, P1834-1846, November 2020

Download started.


Qualitative Research in Phoenix, AZ, Exploring Support for Public–Private Partnerships to Expand the Reach of the Fresh Fruit and Vegetable Program



      Fruit and vegetable (F/V) consumption among school-aged children falls short of current recommendations. The development of public–private partnerships (PPPs) has been suggested as an effective approach to address a number of public health concerns, including inadequate F/V consumption. The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) provides F/V as snacks at least twice per week in low-income elementary schools. In addition to increasing F/V consumption behaviors at school, children participating in the FFVP make more requests for F/V in grocery stores and at home, suggesting the impact of the program extends beyond school settings.


      This study explored the potential for establishing successful PPPs between schools and food retailers to promote the sales of F/V in low-income communities.


      Semi-structured interviews and focus groups were conducted with participants from 4 groups of stakeholders.


      Grocery store and produce managers from 10 grocery stores, FFVP personnel from 5 school districts and 12 schools, and parents of children attending 3 different FFVP-participating schools, all in the Phoenix, AZ, metropolitan area participated in interviews and focus groups.

      Statistical analyses performed

      Data were analyzed using a directed content analysis approach to examine benefits, barriers, and strategies for developing a PPP.


      Key perceived benefits of creating a PPP included the potential to increase store sales, to enhance public relations with the community, and to extend the impact of the FFVP to settings outside of schools. Barriers included offering expensive produce through the FFVP and the potential lack of communication among partners. Strategies for developing a PPP included using seasonal produce and having clear instructions for teachers and staff. Parents reported their children requesting more F/V as a result of FFVP participation.


      Stakeholders support forming PPPs. Partnerships between FFVP schools and retailers can be mutually beneficial and have a positive impact on children and their families.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bradlee M.L.
        • Singer M.R.
        • Qureshi M.M.
        • Moore L.L.
        Food group intake and central obesity among children and adolescents in the Third National Health and Nutrition Examination Survey (NHANES III).
        Public Health Nutr. 2010; 13: 797-805
        • Hu D.
        • Huang J.
        • Wang Y.
        • Zhang D.
        • Qu Y.
        Fruits and vegetables consumption and risk of stroke: A meta-analysis of prospective cohort studies.
        Stroke. 2014; 45: 1613-1619
        • Gan Y.
        • Tong X.
        • Li L.
        • et al.
        Consumption of fruit and vegetable and risk of coronary heart disease: A meta-analysis of prospective cohort studies.
        Int J Cardiol. 2015; 183: 129-137
        • Prentice A.
        • Schoenmakers I.
        • Laskey M.A.
        • de Bono S.
        • Ginty F.
        • Goldberg G.R.
        Symposium on ‘Nutrition and health in children and adolescents’ Session 1: Nutrition in growth and development, nutrition and bone growth and development.
        Proc Nutr Soc. 2006; 65: 348-360
        • Septembre-Malaterre A.
        • Remize F.
        • Poucheret P.
        Fruits and vegetables, as a source of nutritional compounds and phytochemicals: Changes in bioactive compounds during lactic fermentation.
        Food Res Int. 2018; 104: 86-99
        • McGuire S.
        • Scientific Report of the 2015 Dietary Guidelines Advisory Committee
        Washington, DC: US Departments of Agriculture and Health and Human Services, 2015.
        Adv Nutr. 2016; 7: 202-204
        • Lorson B.A.
        • Melgar-Quinonez H.R.
        • Taylor C.A.
        Correlates of fruit and vegetable intakes in US children.
        J Am Diet Assoc. 2009; 109: 474-478
        • Grimm K.A.
        • Foltz J.L.
        • Blanck H.M.
        • Scanlon K.S.
        Household income disparities in fruit and vegetable consumption by state and territory: Results of the 2009 Behavioral Risk Factor Surveillance System.
        J Acad Nutr Diet. 2012; 112: 2014-2021
        • Jamelske E.
        • Bica L.A.
        • McCarty D.J.
        • Meinen A.
        Preliminary findings from an evaluation of the USDA Fresh Fruit and Vegetable Program in Wisconsin schools.
        Wis Med J. 2008; 107: 225-230
        • Cullen K.W.
        • Baranowski T.
        • Klesges L.M.
        • et al.
        Anthropometric, parental, and psychosocial correlates of dietary intake of African-American girls.
        Obes Res. 2004; 12: 20S-31S
        • US Census Bureau
        Table 1. Enrollment status of the population 3 years old and over, by sex, age, race, Hispanic origin, foreign born, and foreign-born parentage.
        (Published August 23, 2017. Revised February 8, 2018. Accessed October 7, 2019)
        • Institute of Medicine
        Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth.
        The National Academies Press, Washington, DC2007
        • Hartstein J.
        • Cullen K.W.
        • Reynolds K.D.
        • Harrell J.
        • Resnicow K.
        • Kennel P.
        Impact of portion-size control for school a la carte items: Changes in kilocalories and macronutrients purchased by middle school students.
        J Am Diet Assoc. 2008; 108: 140-144
        • Wordell D.
        • Daratha K.
        • Mandal B.
        • Bindler R.
        • Nicholson Butkus S.
        Changes in a middle school food environment affect food behavior and food choices.
        J Acad Nutr Diet. 2012; 112: 137-141
        • Ochoa-Avilés A.
        • Verstraeten R.
        • Huybregts L.
        • et al.
        A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: A cluster randomized controlled trial.
        Nutr J. 2017; 16
        • Knai C.
        • Pomerleau J.
        • Lock K.
        • McKee M.
        Getting children to eat more fruit and vegetables: A systematic review.
        Prev Med. 2006; 42: 85-95
      1. US Department of Agriculture. Fresh Fruit and Vegetable Program: A Handbook for Schools. Published December, 2010. Accessed October 7, 2019.

        • US Department of Agriculture
        The Fresh Fruit and Vegetable Program.
        (Updated December, 2017. Accessed October 7, 2019)
        • US Department of Agriculture Food and Nutrition Service
        Fresh Fruit and Vegetable Program Allocation of Funds for Fiscal Year 2019. fns-prod.
        (Published May 25, 2018. Accessed October 7, 2019)
        • United Fresh Produce Association
        The Fresh Fruit and Vegetable Program: A Win for Children, Schools, Public Health and Agriculture.
        • Bartlett S.
        • Olsho L.
        • Klerman J.
        • Patlan K.L.
        • Blocklin M.
        • Connor P.
        Evaluation of the Fresh Fruit and Vegetable Program (FFVP): Final evaluation report.
        (Prepared by Abt Associates under Contract No. AG-3198-D-09- 0053. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service. Project Officers: Karen Castellano-Brown and Allison Magness) (Published 2013. Accessed October 7, 2019)
        • Ohri-Vachaspati P.
        • Dachenhaus E.
        • Gruner J.
        • Mollner K.
        • Hekler E.B.
        • Todd M.
        Fresh Fruit and Vegetable Program and requests for fruits and vegetables outside school settings.
        J Acad Nutr Diet. 2018; 118: 1408-1416
        • Olsho L.E.W.
        • Klerman J.A.
        • Ritchie L.
        • Wakimoto P.
        • Webb K.L.
        • Bartlett S.
        Increasing child fruit and vegetable intake: Findings from the US Department of Agriculture Fresh Fruit and Vegetable Program.
        J Acad Nutr Diet. 2015; 115: 1283-1290
        • Mollner K.
        • Gruner J.
        • Dachenhaus E.
        • Ohri-Vachaspati P.
        The Fresh Fruit and Vegetable Program: Does it promote nagging for fruits and vegetables at the store and at home? Arizona State University Food Policy and Environment Research Group website.
        (Published July 2016. Accessed October 7, 2019)
        • Waterlander W.E.
        • de Boer M.R.
        • Schuit A.J.
        • Seidell J.C.
        • Steenhuis I.H.
        Price discounts significantly enhance fruit and vegetable purchases when combined with nutrition education: A randomized controlled supermarket trial.
        Am J Clin Nutr. 2013; 97: 886-895
        • Glanz K.
        Strategies for increasing fruit and vegetable intake in grocery stores and communities: Policy, pricing, and environmental change.
        Prev Med. 2004; 39: 75-80
        • Beets M.W.
        • Brazendale K.
        • Weaver R.G.
        • Armstrong B.
        Rethinking behavioral approaches to compliment biological advances to understand the etiology, prevention, and treatment of childhood obesity.
        Child Obes. 2019; 15: 353-358
        • Wang Y.C.
        • Vine S.
        • Hsiao A.
        • Rundle A.
        • Goldsmith J.
        Weight-related behaviors when children are in school versus on summer breaks: Does income matter?.
        J School Health. 2015; 85: 458-466
        • Staiano A.
        • Broyles S.
        • Katzmarzyk P.
        School term vs. school holiday: Associations with children’s physical activity, screen-time, diet and sleep.
        Int J Environ Res Health Public Health. 2015; 12: 8861-8870
      2. Ferlie E. Lynn L.E. Pollitt C. The Oxford Handbook of Public Management. Oxford University Press, Oxford, UK2005
        • Nishtar S.
        Public–private “partnerships” in health—A global call to action.
        Health Res Policy Sys. 2004; 2: 5
        • Arizona Department of Education Health and Nutrition Services
        Fresh Fruit & Vegetable Program.
        (Published 2019. Accessed October 7, 2019)
        • Miles M.B.
        • Huberman A.M.
        • Saldaña J.
        Qualitative Data Analysis: A Methods Sourcebook.
        Third Edition. Sage Publications, Inc, Thousand Oaks, CA2014
        • Hsieh H.-F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
      3. MAXQDA 12 [computer program]. VERBI Software, Berlin2015
        • Payne C.R.
        • Niculescu M.
        • Just D.R.
        • Kelly M.P.
        Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets.
        Prev Med Rep. 2015; 2: 287-291
        • Kamran-Disfani O.
        • Mantrala M.K.
        • Izquierdo-Yusta A.
        • Martínez-Ruiz M.P.
        The impact of retail store format on the satisfaction-loyalty link: An empirical investigation.
        J Bus Res. 2017; 77: 14-22
        • Carroll A.B.
        • Shabana K.M.
        The business case for corporate social responsibility: A review of concepts, research and practice.
        Int J Manage Rev. 2010; 12: 85-105
        • Coulthard H.
        • Ahmed S.
        Non taste exposure techniques to increase fruit and vegetable acceptance in children: Effects of task and stimulus type.
        Food Qual Prefer. 2017; 61: 50-54
        • Laureati M.
        • Bergamaschi V.
        • Pagliarini E.
        School-based intervention with children. Peer-modeling, reward and repeated exposure reduce food neophobia and increase liking of fruits and vegetables.
        Appetite. 2014; 83: 26-32
        • Glanz K.
        • Basil M.
        • Maibach E.
        • Goldberg J.
        • Snyder D.
        Why Americans eat what they do.
        J Am Diet Assoc. 1998; 98: 1118-1126
        • Anguah K.
        • Lovejoy J.
        • Craig B.
        • et al.
        Can the palatability of healthy, satiety-promoting foods increase with repeated exposure during weight loss?.
        Foods. 2017; 6: 16
        • Lakkakula A.
        • Geaghan J.
        • Zanovec M.
        • Pierce S.
        • Tuuri G.
        Repeated taste exposure increases liking for vegetables by low-income elementary school children.
        Appetite. 2010; 55: 226-231
        • Dubowitz T.
        • Ghosh-Dastidar M.
        • Cohen D.
        • et al.
        A New Supermarket in a Food Desert: Is Better Health in Store? Document Number RB-9874.
        RAND Corporation, Santa Monica, CA2015
        • Elias R.R.
        Three takeaways for the field: Grocery stores as community development. Build Heathy Places Network website.
        (Published December 10, 2015. Accessed October 7, 2019)
        • Chapman K.
        • Goldsbury D.
        • Watson W.
        • et al.
        Exploring perceptions and beliefs about the cost of fruit and vegetables and whether they are barriers to higher consumption.
        Appetite. 2017; 113: 310-319
        • Kidger J.
        • Brockman R.
        • Tilling K.
        • et al.
        Teachers’ wellbeing and depressive symptoms, and associated risk factors: A large cross sectional study in English secondary schools.
        J Affect Disord. 2016; 192: 76-82
        • Gray C.
        • Wilcox G.
        • Nordstokke D.
        Teacher mental health, school climate, inclusive education and student learning: A review.
        Can Psychol. 2017; 58: 203-210
        • Collie R.J.
        • Shapka J.D.
        • Perry N.E.
        School climate and social–emotional learning: Predicting teacher stress, job satisfaction, and teaching efficacy.
        J Educ Psychol. 2012; 104: 1189-1204


      J. Gruner is director of community innovations, Pinnacle Prevention, Chandler, AZ; at the time of study, she was a doctoral candidate, Arizona State University, School of Nutrition and Health Promotion, Phoenix.


      R. S. DeWeese is a research assistant professor, Arizona State University, College of Health Solutions, Phoenix.


      M. Bruening is an associate professor, Arizona State University, College of Health Solutions, Phoenix.


      P. Ohri-Vachaspati is a professor, Arizona State University, College of Health Solutions, Phoenix.


      B. Evans is a professor, Edson College of Nursing & Health Innovation, Phoenix, AZ.


      M. Acosta-Ortiz, is a program coordinator, SNAP-Ed Food Systems, Phoenix, AZ.


      K. Mollner is a community dietitian, Maricopa County Department of Public Health, Phoenix, AZ.


      G. Lacagnina is a food systems coordinator, Maricopa County Department of Public Health, Office of Community Health Innovation, Phoenix, AZ.