Characteristics and Dietary Patterns of Adolescents Who Value Eating Locally Grown, Organic, Nongenetically Engineered, and Nonprocessed Food

Article Outline

• Abstract
• Introduction
• Methods
  • Study Design and Sample
  • Measures
    • Survey measures
    • Attitudes about alternative food production practices
    • Dietary quality and fast-food use
    • Attitudes about personal health
    • Demographics
    • Weight status
    • Vegetarian status
  • Data Analysis
• Results
  • Attitudes about Alternative Food Production Practices
  • Associations with Dietary Quality, Fast-food Use, and Personal Health Attitudes
• Discussion
• Implications for Research and Practice
• Acknowledgments
• References
• Copyright

Abstract 

Objective

To examine characteristics of adolescents who value eating locally grown, organic, nongenetically engineered, and/or nonprocessed food and whether they are more likely than their peers to meet Healthy People 2010 dietary objectives.

Design

Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT: Eating Among Teens).

Setting

Participants completed a mailed survey and food frequency questionnaire in 2004.

Participants

Males and females (N = 2516), ages 15-23 years.

Main Outcome Measures

Dietary intake of fruit, vegetables, fat, grains, calcium, and fast food.

Analysis

Chi-square tests, logistic regression models adjusting for race/ethnicity, socioeconomic status, and vegetarian status.

Results

Percentages of adolescents who reported that it was somewhat or very important that their food be locally grown, organic, nongenetically engineered, and nonprocessed were 20.9%, 23.2%, 34.1%, and 29.8%, respectively. Those who valued each practice were more likely than their peers to be nonwhite (P < .001) and have a low socioeconomic status (P < .001). Adolescents who valued ≥ 2 practices were more likely than their peers to have a dietary pattern consistent with the Healthy People 2010 objectives (P < .001) for fruit, vegetable, and fat intake.

Conclusions and Implications

It may beneficial to discuss alternative food production practices as part of nutrition education programs for adolescents.

Key Words: adolescent nutrition, nutrition survey, food, genetically modified, organic food, local food, sustainable agriculture

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Introduction 

Nutritional intake impacts the health and well-being of our nation's youth. A national initiative designed to promote heath and prevent disease, Healthy People 2010, has identified specific areas of importance related to healthful nutrition.¹ Of particular concern is the consumption of too much fat and saturated fat and too few vegetables, fruits, grains, and calcium-rich food. Dietary goals identified by Healthy People 2010 include increasing the proportion of youth who meet the daily intake recommendations for fruits, vegetables, grains, fat and saturated fat, and calcium.¹

The majority of adolescents do not meet national dietary guidelines, and obesity rates among youth are increasing.² Research has shown that nutrition education directly targeting youth might be most effective in promoting the development of a lifetime of healthful dietary behaviors.¹ Identifying effective nutrition intervention strategies, which lead to improvements in child and adolescent dietary intake, is a national priority and requires a comprehensive understanding of the various influences on food choices. Although a variety of influences on dietary intake have been identified,³, ⁴ investigation identifying additional predictive factors is required, as most models testing psychosocial correlates account for less than 30% of the variability in dietary behavior.⁴

The development and refinement of successful nutrition education messages will benefit from research identifying additional motivating factors predictive of healthful dietary intake among adolescents. It is an opportune time to investigate whether adolescent attitudes about food production practices are associated with healthful eating, as nutrition educators are increasingly considering enhancing nutrition education messages with a discussion about food systems and implications of food production practices as a strategy to promote healthful intake.⁵, ⁶

At present, it is not apparent whether attitudes or practices in support of alternative food production practices are associated with healthful dietary intake. Previous research has indicated that adolescents express concern about how and where food is produced, but they may have limited ability, knowledge, or intention to modify their food choices based on these attitudes.⁷, ⁸ Bissonnette and Contento surveyed adolescents and found that the majority believed local and organic food should be available to them, yet most adolescents did not feel it was personally important that their food was grown organically or nearby.⁸ Harmon and Maretzki reported that adolescents may hold supportive attitudes about local food systems but may not be sure how to translate these attitudes into food choice behaviors.⁷ Wilkins and colleagues found that the majority of university students they surveyed were somewhat familiar with the terms seasonal and local, although far fewer reported using the terms themselves.⁹ Consumer research in adults suggests that support for organic, locally produced, and minimally processed food is on the rise.¹⁰, ¹¹, ¹² This finding is evidenced, in part, by the increased media attention and growing success of natural food grocery stores, food cooperatives, community-supported agriculture farms, and farmers' markets as well as the inclusion of “natural” and “organic” food sections within mainstream grocery stores. Adolescents may also be adopting values reflective of parental beliefs and societal trends in support of these practices.

Although it is unclear whether adolescent attitudes in support of local, organic, and nonprocessed food are associated with healthful food choice behaviors, nutrition professionals are increasingly considering the important connection between health and local food systems.⁵, ⁶, ⁷, ⁸, ⁹ In recent years, nutrition professionals have been expanding their educational messages to include topics relating to the food system and implications of food production practices.⁵, ¹³ Additionally, there is growing support for the inclusion of discussions about how and where food is produced and food environmental issues as a part of educational content in schools.⁵, ⁶ With the establishment of the National Farm to School Program in 2000, a variety of nutrition education initiatives designed to connect schools with local farmers and stimulate discussion about food systems have been implemented within United States (US) schools.⁶ Therefore, it is important to understand if attitudes about alternative food production practices are related to dietary intake among adolescents. Further elucidating motivational factors impacting adolescent food choices will allow for future refinement of nutrition intervention strategies.⁴

The purpose of the present investigation was to examine demographic characteristics of adolescents who reported the importance of eating locally grown, organic, nongenetically engineered, and nonprocessed food and determine whether they were more likely than their peers to meet the Healthy People 2010 dietary objectives. Identifying the extent to which adolescents value these alternative production practices and associations between these attitudes and healthful dietary intake may help to inform nutrition education interventions targeted to youth.

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Methods 

Study Design and Sample 

The current cross-sectional study includes data collected from 2516 adolescents who participated in Project EAT-II. Project EAT-II is a follow-up study of Project EAT-I, a study of the socioenvironmental, personal, and behavioral determinants of dietary intake and weight status in adolescents.³, ¹⁴ In Project EAT-I, middle school and high school students from 31 Minnesota schools completed in-class surveys, food frequency questionnaires, and anthropometric measures during the 1998–1999 academic year (81.5% response rate). Schools serving ethnically and socioeconomically diverse populations were invited to participate in the study. Project EAT-II aimed to resurvey all original participants by mail to examine changes in their eating patterns and weight status 5 years later (2003-2004).

Project EAT-II surveys were mailed to the address provided by the participant during Project EAT-I. Internet tracking services were employed when mail was returned because of an incorrect address. In Project EAT-II, parents of adolescents younger than 18 years old were sent a consent form before sending out the surveys; surveys were not sent to adolescents whose parents mailed back a signed consent form indicating their refusal to have their child participate. Adolescents were then sent an assent form with the survey and asked to sign and return the form if they were not interested in study participation. For adolescents age 18 years or older, completion of the EAT-II survey implied written consent. Within the survey cover letter, participants were informed that an incentive would be provided on completion of the questionnaire, and explicit instructions were included requesting that the same person who completed the EAT-I survey complete the EAT-II survey. Of the original study population (N = 4746), 1074 (22.6%) were lost to follow-up for various reasons, primarily missing contact information at EAT-I (n = 411) and no address found at follow-up (n = 591). Of the remaining 3672 participants contacted by mail, 2516 completed surveys, representing 53.0% of the original cohort and 68.4% of participants who could be contacted for Project EAT-II. The current cross-sectional analysis consisted of 1130 males (44.9%) and 1386 females (55.1%) who completed surveys for both EAT-I (Time 1) and EAT-II (Time 2). The University of Minnesota's Institutional Review Board Human Subjects Committee approved all study protocols.

Measures 

As a result of focus group discussions during Project EAT-II, survey items addressing support for locally grown, organic, nongenetically engineered, and nonprocessed food were added to the Project EAT-II survey. The present cross-sectional investigation included 2 separate surveys, 1 completed by the younger cohort (mean age = 17.2 ± 0.6 years) and 1 completed by the older cohort (mean age = 20.4 ± 0.8 years). Project EAT-II surveys retained more than half of the items from the Project EAT-I survey without modification. However, revisions were made to improve the relevance of items for EAT-II participants based on a literature review and pilot-testing of the survey in focus groups.

Study participants were asked to report on the importance of 4 food production practices. They were asked: “How important is it to you that your food is: a) organic, b) not processed, c) locally grown, and d) not genetically engineered?” Response categories included: not at all important, a little, somewhat, and very important.

The self-administered Youth and Adolescent Food Frequency Questionnaire (YAQ) was used to assess dietary intake.¹⁵, ¹⁶, ¹⁷ Usual intakes were determined by Channing Laboratory in May 2006 using specially designed food composition databases.¹⁸ The food composition database is based on the United States Department of Agriculture's Nutrient Database for Standard Reference (Release 16),¹⁹ with additional information from McCance and Widdowson's The Composition of Foods,²⁰, ²¹ journals, and manufacturers. Dietary intake was examined relative to the Healthy People 2010 objectives. Dietary intake of total fat (≤30% of calories from fat), saturated fat (<10% of calories from saturated fat), calcium (≥1300 mg/day, mid-adolescence; ≥1000 mg/day, late-adolescence), fruit (≥2 daily servings), vegetables (≥3 daily servings), and grains (≥6 daily servings) were assessed. Participants were excluded if they reported a biologically implausible level of energy intake (defined a priori as <400 kcal/day or >7000 kcal/day) (n = 22). Frequency of fast-food restaurant use was also assessed with the question: “In the past week, how often did you eat something from a fast-food restaurant (eg, McDonalds, Burger King, Hardee's)?” Six response categories ranged from never to more than 7 times.²² The cutoff for fast-food intake was determined based on the fast-food intake distribution in the study sample. Based on study sample findings for fast food intake, the authors determined what would be considered high vs more typical. As only 7.7% of the study sample reported having fast food more than 3 or 4 times in the past week, response categories were dichotomized to represent eating fast food <3 times per week or ≥3 times per week.

Participants were asked: “How much do you care about a) eating healthful food and b) being healthy?” Response options included not at all, a little bit, somewhat, and very much. Responses were dichotomized to represent caring (somewhat, very much) and not caring (not at all, a little bit) about eating healthfully and being healthy.

Gender, age level, race/ethnicity, and socioeconomic status were based on self-report. Socioeconomic status (SES) was based primarily on reports of parental education level, defined as the highest level of educational attainment of either parent at the time the Project EAT-I survey was completed.²³, ²⁴ When determining SES, an algorithm was developed to take into consideration family eligibility for public assistance, eligibility for free or reduced-cost school meals, and employment status of the mother and father.²³

Self-reported height and weight were used to determine body mass index (BMI; kg/m²). Weight status classification categories are reported in accordance with Must and colleagues, who provide a range of values for individuals 6-74 years of age.²⁵ Participants were classified as overweight if BMI values were ≥ 85^th percentile for sex and age.

Vegetarian status was self-reported and determined by response to the question, “Are you a vegetarian now? 1) Yes; 2) No.” On the survey, additional questions were included to provide further information on those who perceived themselves to be vegetarian. Of those who perceived themselves as vegetarian: 94.3% reported consuming milk products, 87.3% reported consuming eggs, 46% reported consuming fish, and 25.1% reported consuming chicken.

Data Analysis 

Descriptive statistics (percentages) were calculated to examine the reported importance of each individual food production practice. Chi-square analyses were used to examine associations between participant characteristics and reported importance that food is locally grown, organic, not genetically engineered, and not processed.

Attitudes about each individual food production practice were examined and were highly correlated (Cronbach α = 0.86); therefore, for purposes of this paper, the authors combined these items for further statistical analysis and identified them collectively as alternative production practices. Individuals were identified as “supporters” if they reported that 2 or more of these production practices were somewhat or very important and “nonsupporters” if they reported 1 or no practice as somewhat or very important. Logistic regression analyses were conducted to test for significant differences between comparison groups (supporters and nonsupporters of alternative food production practices), adjusting for race/ethnicity, SES, and vegetarian status. Previous research has shown that adolescent vegetarians have a dietary pattern that is more likely than nonvegetarians to meet the Healthy People 2010 objectives²⁶; thus the authors included vegetarian status as a covariate. Percentages of supporters and nonsupporters of alternative food production practices who complied with the Healthy People 2010 dietary objectives and limited fast-food use to fewer than 3 times per week were identified. Logistic regression analyses were also conducted to identify differences between supporters and nonsupporters with regard to attitudes about eating healthfully and being healthy.

Because of attrition between Project EAT-I (1999) and Project EAT-II (2004), the Project EAT-II sample was less ethnically diverse and had a higher proportion of females than the original Project EAT-I sample, which was more representative of the adolescents in the Minneapolis-St. Paul metropolitan area. For purposes of generalizability to the EAT-I population, which was a population-based sample, data were weighted to adjust for differential response rates to Project EAT-I and Project EAT-II using the response propensity method,²⁷ in which the inverse of the estimated probability that an individual responded on Project EAT-II was used as the weight. The ethnic/racial status of the weighted sample was 48.3% white, 18.9% African American, 5.8% Hispanic, 19.6% Asian, 3.6% Native American, and 3.8% mixed or other race. Of the 19.6% who reported their race as Asian, 70.1% reported Hmong background. The SES of the weighted sample was 17.8% low, 18.9% middle-low, 26.7% middle, 23.3% middle-high, and 13.3% high. All analyses were conducted with SAS statistical software (SAS Institute, Cary, NC, version 8.2, 2001). Error rate was set at 5%.

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Results 

Attitudes about Alternative Food Production Practices 

The percentages of adolescents who reported that it was important (somewhat or very) for their food to be locally grown, organic, nongenetically engineered, or nonprocessed ranged from 20.9% to 34.1% (Table 1). The greatest proportion of adolescents indicated that it was important that their food was not genetically engineered, and the smallest proportion thought it was important to have locally grown food.

Table 1. Adolescents' Reported Importance That Their Food is Locally Grown, Organic, Not Genetically Engineered, and Not Processed

Percentages of adolescents indicating support for each of the practices were significantly higher among those who reported a race/ethnicity other than white, identified as having a low/low-middle SES, and were vegetarians (Table 2). Additionally, percentages of adolescents indicating support for nongenetically engineered food and nonprocessed food were higher among females than males, the percentage indicating support for organic food was higher among nonoverweight than overweight adolescents, and the percentage indicating support for nongenetically engineered food was higher among overweight than nonoverweight adolescents. Age cohort (middle and late adolescence) was not found to be associated with any of the alternative production practices.

Table 2. Percentage of Adolescents Who Reported It Is Important (Somewhat or Very) That Their Food Is Locally Grown, Organic, Not Genetically Engineered, and Not Processed^a

Adolescent Characteristics	nb	Locally Grown (%)	Organic (%)	Not Genetically Engineered (%)	Not Processed (%)
Total (N)	2516	20.9	23.2	34.1	29.8
Gender (n)
Male	1130	19.7	22.3	29.8	27.0
Female	1386	21.9	23.9	37.6	32.1
P Value		P = 0.175	P = .358	P < .001	P = .006
Race (n)
White	1202	13.5	16.7	27.1	23.1
African American	465	23.9	25.0	40.8	34.0
Asian	477	35.6	37.3	41.8	40.7
Other	341	21.0	22.8	37.6	31.2
P Value		P < .001	P < .001	P < .001	P < .001
Age cohort (n)
Mid-adolescence (high school)	807	21.9	24.9	36.3	31.2
Late-adolescence (post-high school)	1709	20.5	22.4	33.0	29.2
P Value		P = .412	P = .174	P = .114	P = .311
Socioeconomic status (n)
Low	429	31.5	32.2	43.1	39.8
Lower-Middle	459	22.9	25.5	37.6	30.4
Middle	647	17.2	17.4	32.5	26.7
Upper-Middle	567	16.0	21.4	28.7	25.6
High	323	16.6	20.8	30.2	28.0
P Value		P < .001	P < .001	P < .001	P < .001
Weight Status (BMI) (n)
Not overweight (BMI < 85th percentile)	1790	20.5	24.5	32.9	30.2
overweight (BMI ≥ 85th percentile)	645	22.6	20.1	37.8	29.0
P Value		P = .278	P = .023	P = .025	P = .578
Vegetarian status (n)
Not vegetarian	2327	19.8	21.4	32.6	28.2
Vegetarian	117	35.2	53.7	58.4	56.1
P Value		P < .001	P < .001	P < .001	P < .001

BMI indicates body mass index.

Associations with Dietary Quality, Fast-food Use, and Personal Health Attitudes 

Nearly one third (30.5%) of adolescents reported that 2 or more alternative food production practices were somewhat or very important to them (Table 3). Adolescents identified as supporters were more likely than their peers to meet most of the Healthy People 2010 objectives and more likely to limit their fast-food use (Table 3). Supporters were significantly more likely (P < .001) than nonsupporters to meet the Healthy People 2010 dietary guidelines for lower fat consumption (55% vs 44% had ≤30% calories from fat), lower saturated fat consumption (49% vs 39% had <10% of calories from saturated fat), daily servings of fruit (41% vs 29%), daily servings of vegetables (17% vs 9%), and 5 or more daily servings of fruits and vegetables (26% vs 16%). No differences were found for grain or calcium intakes. Additionally, significantly more (P < .001) adolescent supporters limited fast-food use compared to their peers (79% vs 69%). Survey results also indicated that supporters were more likely (P < .001) to care about eating healthful food (89% vs 75%) and being healthy (95% vs 88%); results are not shown in the table.

Table 3. Adjusted Percentages of Adolescents Meeting the Healthy People 2010 Objectives and Limiting Fast Food Use According to Level of Support for Alternative Production Practices^ab

Healthy People 2010 Objectives and Fast Food Intake Frequency	Supportersc (%) n = 743 (30.5)	Nonsupportersd (%) n = 1689 (69.5)	P Value
Fat intake
≤ 30% of calories from fat	54.5	44.4	< .001
< 10% of calories from saturated fat	49.4	39.0	< .001
Fruit and vegetable intake
≥ 2 servings of fruit	41.0	29.4	< .001
≥ 3 servings of vegetables	17.3	9.0	< .001
≥ 3 servings of vegetables of which at least 1 is yellow or green	10.2	3.7	< .001
≥ 5 servings of fruits or vegetables	26.1	15.8	< .001
Grain intake
≥ 6 servings of grains	37.3	38.5	.598
Calcium intake, mg
≥ 1300 (mid-adolescence)	29.6	29.0	.885
≥ 1000 (late-adolescence)	33.8	33.7	.961
Fast-food intake frequency
< 3 times per week	78.6	68.7	< .001

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Discussion 

Results from this study indicate that a sizable proportion of the adolescents surveyed valued alternative production practices when making food choices. Nearly 1 in 3 adolescents indicated that 2 or more of the alternative food production practices were somewhat or very important. On the whole, adolescents who held supportive attitudes about locally grown, organic, nongenetically engineered, and nonprocessed food appeared to have a more healthful diet quality and care more about their personal health and eating healthfully. Adolescents who reported attitudes in support of each of the 4 alternative production practices were more likely than their peers to be nonwhite, have a low SES, and practice vegetarianism.

The percentages of adolescents who held attitudes in support of locally grown, organic, nongenetically engineered, and nonprocessed food ranged form 20.9% to 34.1%. Although each of these agricultural practices is distinctly different, the authors found them to be highly correlated. These correlations suggest that if an individual values one of these practices, he or she is more likely to value the others. Reasons for the high correlations among these practices may include concern for the environmental implications of food choices. These adolescents may have a greater concern for their health, as well as a greater concern for environmental protection. Previous research has shown that adolescents view organically and locally produced food to have less of a negative impact on the environment than food produced with pesticides and herbicides or food that is required to be transported long distances.⁸ Furthermore, adolescents who reported valuing locally grown, organic, nongenetically engineered, and nonprocessed food may be more knowledgeable about the environmental impact of agricultural practices. Previous research has shown that adolescents with gardening, farming, and hands-on food system experiences reported higher food system knowledge and attitudes supportive of sustaining the local food system.⁷

Findings related to race/ethnicity and SES are somewhat unexpected and contrary to the conventional belief that supporters of alternative production practices tend to be highly educated, high-income, Caucasian females. However, the present findings are consistent with recent consumer research by the Hartman Group, a nationally recognized consumer market research firm, which reports that Asian Americans and Latino Americans are relatively more likely than Caucasian Americans to purchase organics.¹⁰ It is also noteworthy that adolescents identified as Asian in the present survey included a sizeable proportion (70%) of Hmong Americans. The Hmong community within the Minneapolis/St. Paul metro area has a strong heritage of growing food for sustenance. In Minnesota, there are many Hmong farmers who sell food at local farmers' markets.²⁸ Furthermore, Stang and colleagues reported that Hmong adolescents more frequently participated in family meals and were more involved with food shopping and meal preparation than white teens.²⁹ These factors may have played a role in the finding that Asians were the most likely group to support each of the 4 alternative food production practices.

Traditional cultural heritage may play a particularly strong role in agricultural views among Hmong and Hispanic youth, as they may be more likely to have a connection to farming and growing food³⁰, ³¹ and possibly higher concern for use of chemicals in farming. Research indicates that agricultural practices of the Hmong in the United States commonly have involved limited use of chemicals and machines, which suggests that they may not see the necessity for pesticides in smaller-scale food production.³⁰ Furthermore, research suggests that Hispanic youth may have an increased level of awareness of pesticide use in agriculture. Findings from focus groups with Hispanic adolescent farm workers indicate that they are aware of the risks of pesticide exposure and consider sickness resulting from pesticide exposure an inevitable by-product of farming.³¹ Finally, there may be an increased level of distrust among nonwhites with regard to environmental practices of large-production agriculture systems. Some research suggests that nonwhite adults are less likely to accept genetically modified food products, which may be owing in part to a mistrust of scientists, industry, and government.³²

Findings from the present study also indicated that adolescent vegetarians were more likely than nonvegetarians to support each of the alternative production practices investigated. This finding suggests that adolescents who reported being vegetarians and adolescents who reported valuing alternative food production practices may share similar underlying values, which promote an interest in maintaining a more healthful diet.³³ Adolescents may have supportive attitudes because they believe food produced with alternative production practices positively impact personal health as well as the health of the environment and larger community. Bissonette and colleagues found that about three quarters of adolescents surveyed believed that organic food was better for personal health and the environment, whereas approximately half believed that locally grown food produces less pollution.⁸ Future research could further investigate reasons adolescents hold attitudes supportive of alternative production practices and implications these attitudes have on healthful food choices.

Strengths of this study included the large representative sample of adolescents from a multiethnic population, which provided an opportunity to evaluate differences by various demographic characteristics. Additionally, the authors were able to look at a number of indicators of a healthful diet as they relate to a national health promotion initiative. Results from this study add to the limited body of research assessing adolescent attitudes about alternative production practices and provide valuable information about the characteristics and dietary patterns of adolescents who value eating locally grown, organic, nongenetically engineered, and nonprocessed food.

This study also has limitations, which need to be considered when interpreting results. Attitudes about each of the alternative production practices were assessed via a single question; therefore, multiple items describing each practice to form scaled variables might provide further insight. Additionally, our cross-sectional analysis is limited in that it can provide evidence only for associations of positive attitudes about alternative production practices and healthful dietary intake, but it does not allow for claims of temporal causality.

The present investigation suggests an association between healthful food intake and attitudes in support of local, organic, and nonprocessed food. Concern for alternative production practices may be a motivational factor influencing food choices among a subgroup of adolescents. These findings provide initial support for the inclusion of discussions about how and where food is produced when implementing nutrition intervention programs in schools.

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Implications for Research and Practice 

To further explore associations identified within the current study, future survey research should include a more comprehensive set of questions designed to further elucidate adolescent knowledge as well as beliefs, attitudes, and reasons why they support a full range of alternative food production practices. Questions should also be included to assess actual intake of locally grown, organic, nongenetically engineered, and nonprocessed food to more fully examine associations between intake patterns and dietary quality. Qualitative research exploring adolescents' understanding of terms such as genetically engineered and organic is also worthwhile, given that different perceptions and interpretations of these terms are likely. Furthermore, intervention research should examine the feasibility and effectiveness of educational programs that include discussion about the food system and alternative food production practices. Finally, additional experimental intervention research is needed to identify whether education about alternative production practices leads to more healthful eating.

There is presently an opportunity for schools to reconsider and enhance the type of nutrition education offered to youth as a result of recently passed legislation.³⁴ The Child Nutrition and WIC Reauthorization Act of 2004 requires that schools participating in the National School Lunch and School Breakfast programs establish wellness policies with goals for nutrition education, physical activity, and nutrition guidelines for all food available on each school campus.³⁴ Nutrition educators have an opportunity to consider enhancing nutrition education messages with discussion related to the food system and implications of food production practices. Some nutritionists are considering the possibility that cultivating connections with local farmers might stimulate this discussion and help youth more fully understand the food system and how food choices can impact personal health and the larger community.⁵, ⁶ If adolescents had additional opportunities to acquire hands-on food system experiences, such as visits to local farms and farmers' markets, they may develop a greater ability to make more fully informed food choices. Presently, The National Farm to School Program, initiated in 2000, is working to incorporate healthful, nutritious produce into school lunches, snacks, and salad bars.³⁵ These efforts, combined with nutrition education, farm visits, school gardens, and classroom education are designed to promote a lifetime of healthful eating habits.³⁵ Several farm-to-school initiatives have been successfully implemented in public schools throughout the nation, and preliminary impact evaluations suggest that students exposed to such programs may increase fruit and vegetable consumption and participation in the school lunch program.⁵, ⁶

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Acknowledgments 

Data collection was supported by grant R40 MC 00319 (D.N.-S., principal investigator) from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Service Administration, and the US Department of Health and Human Services. Analyses were supported in part by the Adolescent Health Protection Program (School of Nursing, University of Minnesota) grant number T01-DP000112 (PI: Bearinger) from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

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