Evaluating a Smoothie-Based Nutrition Education Program to Improve Nutrition Security in Rural Adolescents

Background/Objective: Nutrition security, defined as consistent access to and consumption of nutritious foods that support health, remains a persistent challenge in rural populations. The HEALTHY (Helping Early Adolescents Live Their Healthiest Youth) program aimed to improve rural adolescents' nutrition security through school-based strategies. This study evaluated its effectiveness by examining changes in fruit consumption, fruit waste, and skin carotenoid levels. Methods: A quasi-experimental, pre-post program was assessed in five rural middle schools (two experimental sites, three comparison sites). The programming paired four biweekly smoothie taste tests with nutrition education grounded in Social Cognitive Theory and Choice Architecture. Students in grades 3-8 (N = 149) participated. Digital tray photographs quantified selection and waste. The Veggie Meter^® assessed skin carotenoids on a scale from 0 to 800. Surveys captured perceptions and self-reported intakes. Analyses included χ², McNemar's, GLMM, paired t-tests, and ANCOVA. Significance was set at p < 0.005. Results: At post-program, 98.3% of experimental trays contained the standard fruit option and/or a smoothie, compared with 41.0% of comparison trays (χ² = 41.66, p < 0.001). Fruit selection odds were 16.22 times higher in experimental schools (95% CI: 6.30-41.77, p < 0.001). Among trays with both (n = 39), smoothie waste was lower than the standard fruit option waste (t(38) = -7.10, p < 0.001, d = 1.14), resulting in greater estimated consumption (~0.43 vs. ~0.15 cups). Skin carotenoids increased in both groups, with greater improvement among experimental students in the lowest baseline quartile, F (1,19) = 9.20, p = 0.007, partial η² = 0.326. Conclusions: The HEALTHY program, which paired frozen-fruit smoothies with nutrition education, may offer a feasible and scalable approach to improving nutrition security among rural adolescents.