School-Based Rescued Produce Distribution, and Changes in Parental Fruit Intake and Household Dietary Behaviors: A...

Background/Objectives: Fruit and vegetable intake remains below recommended levels, particularly among families facing socioeconomic constraints. School-based food access interventions may improve household dietary behaviors. This study evaluated the association between participation in the "Leket Health" school-based rescued produce distribution program and changes in parental fruit and vegetable intake, nutrition-related parenting practices, and household food security. Children's fruit and vegetables intake was assessed as a secondary exploratory outcome. Methods: A non-randomized controlled cluster trial was conducted among parents (n = 281) of 4th-5th-grade students at three elementary schools in a peripheral town in Israel, with one school per study arm (three clusters in total). Schools were assigned to full intervention (biweekly fruit and vegetable boxes and nutrition education), partial intervention (boxes only), or control. Parent data were collected at baseline and after 7 months using both self-reported fruit and vegetable portions and a validated food frequency questionnaire (FFQ), food security questionnaire, and parental behavior questionnaire. Child intake was assessed using a study-specific FFQ. Primary analyses used a complete-case approach, supplemented by an allocation-based multiple-imputation sensitivity analysis among 269 identifiable participants. The trial was not registered in a public registry. Results: A total of 70% of enrolled participants completed the study. The two parental intake measures yielded discordant findings: categorical changes in parent-reported daily fruit servings differed across study groups in the complete-case analysis (p = 0.028), whereas FFQ-derived fruit and vegetable intake (g/day) showed no statistically significant between-group differences. The overall parenting-practices score showed no statistically significant change (p = 0.770) or between-group difference (p = 0.297). Household food insecurity increased from 8.7% to 14.3% and worsened across all study arms, with no significant between-group difference in deterioration (p = 0.810). No primary dietary endpoint was prespecified. In the allocation-based multiple-imputation analysis, adjusted follow-up fruit intake was higher than control by 0.38 portions/day (95% CI 0.04-0.71) in the full-intervention arm and 0.25 portions/day (95% CI -0.10 to 0.61) in the partial-intervention arm; estimates were attenuated under more adverse assumptions regarding missing outcomes. In an exploratory post-allocation adherence analysis, each additional produce box collected was associated with 6.7% higher odds of a parent-reported increase in fruit intake (OR = 1.067, 95% CI 1.003-1.135; p = 0.040). Among intervention participants, parent-reported improvements in nutrition-related parenting practices were associated with parent-reported increases in household vegetable variety (OR = 2.219, 95% CI 1.057-4.656; p = 0.035). These exploratory associations do not establish intervention effects. The overall parenting-practices score showed no statistically significant change (p = 0.770) or between-group difference (p = 0.297). Household food insecurity increased from 8.7% to 14.3% and worsened across all study arms, with no significant between-group difference in deterioration (p = 0.810). Among children, no significant changes were observed in FFQ-derived intake. Conclusions: Program participation was associated with higher parent-reported fruit servings, although the magnitude of between-arm differences varied across missing-data assumptions. No significant changes were observed in parental vegetable servings or FFQ-derived fruit and vegetable intake among parents or children. Given the single-school-per-arm design, these findings should be interpreted as exploratory and require confirmation in studies with multiple schools per arm.