Fruits and vegetables are an important part of a healthy diet, yet children and adolescents in the United States still do not consume enough of them. The objectives of this project were to examine the reporting and potential individual, household, and Census tract level determinants of fruit and vegetable intake in children and adolescents.

Data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative household sample of the US population, were used for this project. The Method of Triads was used to examine agreement of fruit and vegetable reporting among serum carotenoids, two 24-hour recalls, and a food frequency questionnaire. Next, multilevel analysis was used to quantify the variance in fruit and vegetable intake at the individual, household, and Census tract level and to identify significant determinants of intake at each level. Finally, logistic regression was used to examine the effect of food insecurity on fruit and vegetable intake.

Children and adolescents were fairly good reporters of fruit but demonstrated poorer agreement of vegetable reporting. Adolescents were somewhat better reporters of vegetable intake than younger children. Census tracts accounted for 3% of total variation in intake, whereas family groups accounted for approximately 24 percent and child-level factors accounted for 73 percent. Young children (β=0.14, p=0.02) and those with household adults reporting greater fruit and vegetable intake had higher intakes (β=0.16, p=<0.001). Adult smoking was significantly negatively associated with child intake after control for other variables (β=−0.15, p=0.001). Food insecurity was associated with low vegetable intake among non-Hispanic white children and children living in an owned home, and with low fruit intake among children living in a home with an adult smoker.

These results indicate that fruit and vegetable intake in children is reasonably reported as part of a large, national survey. A moderate amount of variation in intake is attributable to the household level. Certain parental or household-level characteristics, particularly adult fruit and vegetable intake and smoking may provide important factors for interventions to improve intake in children. Future studies of fruit and vegetable intake of children and adolescents should strive to incorporate determinants on multiple levels.