To describe the case of Congo as an example of the assessment and appropriateness of donor operational and sectoral strategies in a complex emergency.

The paper reports the findings of an external evaluation of operations financed by the European Commission Humanitarian Office in the Democratic Republic of Congo (DRC).

The Congolese health system is suffering from severe deterioration. What is functioning in the public health context is donor-dependent with high costs and limited coverage. Despite a relatively favourable agro-climatic situation, food shortage and famine severely affect the nutritional status of large population groups. In this context, humanitarian programmes have generally improved access to health care and the nutritional status of beneficiaries. The reduction of malnutrition in project areas is often demonstrated even though the context did not permit consolidation of these results. Malnutrition continues to claim a massive cost of lives owing to the effect of widespread food insecurity that follows a circular cause-and-effect pattern of very low food production and extreme poverty.

The current context in DRC does not correspond yet to ‘post-crisis’: neither at population level with regard to indicators of poverty, malnutrition, disease and death, nor at institutional level, with regard to state support to institutions. In these situations, the international community is often called upon to replace the state as service provider. Integrated humanitarian actions should be the future of relief projects in DRC. Health, nutrition and food security components should be considered a standard public health intervention strategy representing the most sensible approach to address the needs of the affected population.

To understand how mothers who recently migrated from Central America to the USA feed their children in a neighbourhood saturated with unhealthful food choices (‘food swamp’) and to formulate a mother-driven plan of action to facilitate their acquisition of foods.

We purposively sampled mothers with children (<10 years old) who were recent immigrants/refugees from Central America and lived in a ‘food swamp’ neighbourhood. We used the photovoice approach to elicit textual data from thirty in-depth interviews, a participatory workshop, and visual data from photographs. Analyses were guided by the Social Ecological Framework and Social Cognitive Theory to identify barriers, facilitators and strategies that support parents in feeding their children.

Mothers valued foods that they considered to be ‘traditional’ and ‘healthful’. They navigated their food retail environment looking for these foods (of good quality and well-priced). Food values were reinforced by pre-migration food customs and culture, health professionals’ advice and, in some cases, by the desire to avoid conflict with their children. The neighbourhood food environment could directly influence children’s food preferences and often created conflict between what the child wanted to eat and the foods that mothers valued. Mothers in this ‘food swamp’ wanted to be engaged in addressing the selection of foods offered in schools and in neighbourhood food venues to reflect their own food values.

These mothers’ feeding choices were influenced directly by their food values, and indirectly by the neighbourhood and school food environments via their children’s preferences.

To examine perspectives on food access among low-income families participating in a cost-offset community-supported agriculture (CO-CSA) programme.

Farm Fresh Foods for Healthy Kids (F3HK) is a multicentre randomized intervention trial assessing the effect of CO-CSA on dietary intake and quality among children from low-income families. Focus groups were conducted at the end of the first CO-CSA season. Participants were interviewed about programme experiences, framed by five dimensions of food access: availability, accessibility, affordability, acceptability and accommodation. Transcribed data were coded on these dimensions plus emergent themes.

Nine communities in the US states of New York, North Carolina, Washington and Vermont.

Fifty-three F3HK adults with children.

CSA models were structured by partner farms. Produce quantity was abundant; however, availability was enhanced for participants who were able to select their own produce items. Flexible CSA pick-up times and locations made produce pick-up more accessible. Despite being affordable to most, payment timing was a barrier for some. Unfamiliar foods and quick spoilage hindered acceptability through challenging meal planning, despite accommodations that included preparation advice.

Although CO-CSA may facilitate increased access to fruits and vegetables for low-income families, perceptions of positive diet change may be limited by the ability to incorporate share pick-up into regular travel patterns and meal planning. Food waste concerns may be particularly acute for families with constrained resources. Future research should examine whether CO-CSA with flexible logistics and produce self-selection are sustainable for low-income families and CSA farms.

Little is known about how public entities can partner with industry to achieve public health goals. We investigated industry's perspective of factors that influenced their adoption and implementation of voluntary, government-issued nutrition guidelines (Alberta Nutrition Guidelines for Children and Youth, ANGCY) in recreational facilities.

In-depth semi-structured interviews were conducted. Data were analysed using directed content analysis.

Food services in recreational facilities.

Seven managers from industry participated; five from companies that had adopted and implemented the ANGCY (adopters) in recreational facilities and two from companies that had not (non-adopters).

Industry views nutrition guidelines through the lens of profitability. Non-adopters were unwilling to implement the ANGCY for fear of sacrificing short-term profitability, whereas adopters adhered to them in an attempt to position themselves for long-term profitability. Adopters faced barriers including few resources, no training, complex guidelines, low availability of and demand for ANGCY-compliant products, competitive pressures and substantial declines in revenue. Managers believed widespread voluntary adoption of the ANGCY was unlikely without government incentives and/or a mandate, as the environmental context for voluntary action was poor. All managers supported government-mandated implementation of the ANGCY to level the playing field upon which companies compete.

Public–private partnerships in recreational facilities can embrace public health goals in the short term, provided industry perceives potential for long-term financial gain. Widespread uptake of voluntary nutrition guidelines in this setting is unlikely, however, as market mechanisms do not encourage industry to sell and promote healthier options. Government legislation may therefore be warranted.

To examine the relationships between alcohol consumption and a range of nutrient intakes and blood status indices in older people.

National Diet and Nutrition Survey: cross-sectional survey of nationally representative sample of people aged 65 years or over.

Mainland Britain during 1994/5.

1198 people (623 males, 575 females) aged 65 years or over, of whom 925 were living in private households and 273 were living in institutions.

Intermediate alcohol consumption (particularly 0.1–14 units week−1; 1 unit = 8g) derived from a 4-day diet diary or a 12-month recall questionnaire, was associated with higher intakes of vitamins C, E, B1, iron, calcium, energy from food, carbohydrate and non-starch polysaccharides than heavy alcohol consumption (28 + units week−1) or abstinence, after adjustment for a number of factors (age, sex, domicile, social class, cigarette smoking, self-reported health, grip strength and total energy intake). Intermediate alcohol consumption was also associated with higher blood concentrations (independent of intake) of vitamin C, β-cryptoxanthin, lutein and calcium, with the lowest concentrations being found in heavy alcohol users. The lowest concentrations of serum ferritin were found in light drinkers and the highest levels in heavier alcohol drinkers. Alcohol consumption ranging from 0.1 to > 28 units week−1 was directly correlated with intakes of B vitamins, total energy and fat, with blood concentrations (independent of intake) of lycopene. high density lipoprotein (HDL)-cholesterol, plasma pyridoxal phosphate and retinol, and with blood pressure and grip strength.

Compared with abstinence and heavy drinking, light to moderate alcohol consumption in older people is associated with higher intakes of certain nutrients, and higher blood concentrations (independent of intake) of some micronutrient status indices, including antioxidants. The explanation for the latter associations remains unclear and further investigation is recommended. Heavier alcohol consumption is associated with both beneficial and adverse effects with respect to nutrient intakes and health status.

To compare the relationships between food (nutrient) intakes and biochemical markers of nutritional status of asymptomatic HIV-infected with HIV-uninfected subjects, to gain more information on the appropriate diet for HIV-infected persons at an early stage of infection.

Cross-sectional population-based survey.

North West Province, South Africa.

Two hundred and sixteen asymptomatic HIV-infected and 1550 HIV-uninfected men and women volunteers aged 15 years and older, recruited as ‘apparently healthy’ subjects from 37 randomly selected sites.

Food and nutrient intakes, measured with a validated food-frequency questionnaire, and nutritional status indicated by anthropometric and biochemical variables, measured by a standardised methodology.

The prevalence of HIV infection in the study population was 11.9%. The anthropometric indices and nutrient intakes of HIV-infected and uninfected subjects did not differ significantly, indicating that these 216 HIV-infected subjects were at an early stage of infection. Of the biochemical nutritional status variables, high-density lipoprotein cholesterol and total cholesterol, haemoglobin, albumin and triglycerides were significantly lower in infected subjects. They also had higher globulin and liver enzyme levels than uninfected subjects. In infected subjects, serum albumin correlated significantly with serum lipids, serum vitamin A, serum vitamin E, serum iron, total iron-binding capacity and haemoglobin. The significant positive correlations of the liver enzymes with serum lipids, albumin, vitamin A and iron, observed in HIV-uninfected subjects, disappeared in the infected subjects. Polyunsaturated fat intake showed significant positive correlations with the increased liver enzymes in infected subjects. A principal components analysis indicated that, in infected subjects, increased liver enzymes correlated with higher consumption of maize meal and lower consumption of meat and vegetables.

This survey indicated that asymptomatic HIV-infected subjects who followed a diet rich in animal foods had smaller decreases in serum albumin, haemoglobin and lipid variables, and smaller increases in liver enzymes, than those who consumed a diet based on staple foods. This suggests that animal foods are associated with improved nutritional status in HIV-infected persons. These results should be confirmed with intervention studies before dietary recommendations for asymptomatic HIV-infected individuals can be made.

To compare the general adiposity index (BMI) with abdominal obesity indices (waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR)) in order to examine the best predictor of cardiometabolic risk factors among Hispanics living in Puerto Rico.

Secondary analysis of measurements taken from a representative sample of adults. Logistic regression models (prevalence odds ratios (POR)), partial Pearson's correlations (controlling for age and sex) and receiver-operating characteristic (ROC) curves were calculated between indices of obesity (BMI, WC, WHR and WHtR) and blood pressure, HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), total cholesterol (TC):HDL-C, TAG, fasting blood glucose, glycosylated Hb, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and an aggregated measure of cardiometabolic risk.

Household study conducted between 2005 and 2007 in the San Juan Metropolitan Area in Puerto Rico.

A representative sample of 858 non-institutionalized adults.

All four obesity indices significantly correlated with the cardiometabolic risk factors. WHtR had the highest POR for high TC:HDL-C, blood pressure, hs-CRP, fibrinogen and PAI-1; WC had the highest POR for low HDL-C and high LDL-C and fasting blood glucose; WHR had the highest POR for overall cardiometabolic risk, TAG and glycosylated Hb. BMI had the lowest POR for most risk factors and smallest ROC curve for overall cardiometabolic risk.

The findings of the study suggest that general adiposity and abdominal adiposity are both associated with cardiometabolic risk in this population, although WC, WHR and WHtR appear to be slightly better predictors than BMI.

To examine the potential links between activity spaces, the food retail environment and food shopping behaviours for the population of young, urban adults.

Participants took part in the Canada Food Study, which collected information on demographics, food behaviour, diet and health, as well as an additional smartphone study that included a seven-day period of logging GPS (global positioning system) location and food purchases. Using a time-weighted, continuous representation of participant activity spaces generated from GPS trajectory data, the locations of food purchases and a geocoded food retail data set, negative binomial regression models were used to explore what types of food retailers participants were exposed to and where food purchases were made.

Toronto, Montreal, Vancouver, Edmonton and Halifax, Canada.

Young adults aged 16–30 years (n 496). These participants were a subset of the larger Canada Food Study.

Demographics, household food shopper status and city of residence were significantly associated with different levels of exposure to various types of food retailers. Food shopping behaviours were also statistically significantly associated with demographics, the activity space-based food environment, self-reported health and city of residence.

The study confirms that food behaviours are related to activity space-based food environment measures, which provide a more comprehensive accounting of food retail exposure than home-based measures. In addition, exposure to food retail and food purchasing behaviours of an understudied population are described.

To examine associations between students’ socio-economic status (SES) and school-day dietary intake, and the roles of parents and peers in shaping these associations.

A cross-sectional survey measured school-day intake of vegetables, whole grains, low-fat milk, packaged snack foods and sugar-sweetened beverages. Logistic regression models examined associations between SES (parental education and food insecurity status) and dietary outcomes during or en route to or from school, and examined whether peer modelling or parental norms potentially mediated the associations between SES and dietary outcomes.

Twenty-six public schools in Vancouver, Canada in 2012.

Nine hundred and fifty students in grades 5–8.

Students whose parents completed some college, compared with those completing high school or less, were significantly more likely to consume vegetables daily (unadjusted OR=1·85; 95 % CI 1·06, 3·22) and students whose parents completed college or university were significantly less likely to consume sugar-sweetened beverages daily (unadjusted OR=0·67; 95 % CI 0·47, 0·94). Food secure students were also significantly less likely to consume sugar-sweetened beverages daily compared with food insecure students (unadjusted OR=0·52; 95 % CI 0·29, 0·92). Parental norms, but not peer modelling, emerged as a potential mediator of the association between SES and vegetable intake. SES was not significantly associated with the remaining dietary outcomes.

Higher SES was significantly associated with two of five school-day dietary outcomes and predicted higher likelihood of daily nutritious food choices at school. The present study suggests that there is room for improvement in school-day dietary quality for students from all SES backgrounds in Vancouver.

To indicate why the world's most powerful nation state and one powerful sector of the food and drink production and manufacturing industry are determined to demolish the 2004 WHO (World Health Organization) global strategy on diet, physical activity and health, and to disassociate it from the 2003 WHO/FAO (Food and Agriculture Organization) expert report on diet, nutrition and the prevention of chronic diseases, which with its background papers is the immediate scientific basis for the strategy. To encourage representatives of nation states at the 2004 WHO World Health Assembly to support the strategy together with the report, so that the strategy is explicit and quantified, and responds to the need expressed by member states at the 2002 World Health Assembly. This is for an effective global strategy to prevent and control chronic diseases whose prevalence is increased by nutrient-poor food low in vegetables and fruits and high in energy-dense fatty, sugary and/or salty foods and drinks and also by physical inactivity. Of these diseases, obesity, diabetes, cardiovascular diseases and cancers of several sites are now the chief causes of morbidity and mortality in most countries in the world.

A summary of the global strategy and its roots in scientific knowledge accumulated over the last half-century. Reasons why the global strategy and the expert report are opposed by the current US government and the world sugar industry, with some reference to modern historical context. A summary of the trajectory of the global strategy since its first draft made in early 2003, and a further summary of its weaknesses, strengths and potential.

The 2004 WHO global strategy and the 2003 WHO/FAO expert report are perceived by the current US administration as an impediment to US trade and international policy, within a general context of current US government hostility to the UN (United Nations) system as a brake on the exercise of its power as the world's dominant nation. Policy-makers throughout the world should be aware of the contexts of current pressures put on them by powerful nation states and sectors of industry whose ideologies and commercial interests are challenged by international initiatives designed to improve public health and to leave a better legacy for future generations.

To assess the dietary pattern associated with hypertension and pre-hypertension among Korean male and female adults.

Cross-sectional study from a representative sample of the Korean population.

The Korea National Health and Nutrition Examination Survey IV, which was conducted in 2007 and 2008.

Males and females (n 5308) over the age of 20 years.

Scores for three major dietary patterns (‘whole food’, ‘Western’ and ‘drinking’) were generated using a factor analysis of thirty predefined food groups based on the food items consumed. We used polytomous logistic regression analyses to obtain odds ratios and 95 % confidence intervals for pre-hypertension and hypertension. Participants with a high drinking pattern score (moderate to high alcohol intake, salted fermented seafood intake) had a significantly higher prevalence of pre-hypertension or hypertension than those with a lower drinking pattern score; odds for the top quintile v. the bottom quintile were OR = 1·56 (95 % CI 1·23, 1·99; P trend = 0·001) for pre-hypertension and OR = 3·05 (95 % CI 2·12, 4·40; P trend < 0·001) for hypertension. The whole food pattern was not associated with either pre-hypertension or hypertension, while the Western pattern was associated with the prevalence of hypertension only among men.

Our finding warrants further prospective studies to examine whether alcohol drinking and salty food consumption increase the risk of developing hypertension in Koreans.

Food security (FS) exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their needs. The present research sought to determine whether students from households experiencing moderate or severe food insecurity (FI) had poorer diet quality, higher body weights and poorer psychosocial outcomes than students from households classed as having high FS or marginal FI status.

Population-based survey conducted in schools. Multiple regression analysis was used to explore associations between FS status (high FS; marginal, moderate, severe FI), dietary behaviours and intake, and health-related outcomes (body weight, quality of life, mood, peer relationships, externalizing problems).

Nova Scotia, Canada.

Grade 5 students (n 5853), aged 10–11 years, with complete information on FS status and student outcomes.

In this sample, rates of household FS were 73·5 % (high FS), 8·3 % (marginal FI) 10·2 % (moderate FI) and 7·1 % (severe FI status). Students living in households experiencing moderate or severe FI had poorer diet quality, higher BMI and poorer psychosocial outcomes than students classed as having high FS or marginal FI.

These findings provide important evidence for policy makers on the prevalence of FI among families in Nova Scotia with grade 5 children and its relationship with childhood nutrition, psychosocial and quality of life factors, and weight status.

To study the ecological variation of intake of cassava foods and dietary cyanide load.

Ecological study design.

Five communities in south-western Nigeria where tropical ataxic neuropathy (TAN) was described as endemic (area A), 11 communities in south-western Nigeria where TAN was described as absent (area B), and five communities in northern Nigeria (area C).

Subjects were randomly sampled from selected communities. Intake of cassava foods was estimated from dietary history and dietary cyanide load was estimated from urine thiocyanate concentrations. Residual cyanogens in cassava food samples from the community markets were determined.

In total, 1272 subjects from 21 communities – 238 from area A, 659 from area B and 375 from area C – were selected. Intake of cassava food per person per week was 17 meals in area A, 10 meals in area B, and one meal in area C. Geometrical mean urine thiocyanate concentrations were 73 μmol l−1, 51 μmol l−1 and 17 μmol l−1 in areas A, B and C, respectively. Mean residual cyanogen content in cassava food samples was 16 mg HCN eq kg−1 (confidence interval (CI) 13–18) in area A, and 13 mg HCN eq kg−1 in area B (CI 11–14).

This study shows that the intake of cassava foods and dietary cyanide load is high in several communities in south-western Nigeria, predominantly in communities where TAN has been reported. Dietary cyanide load in these communities appears to be determined by the combination of frequency of intake and cyanogen content of cassava foods. Measures to improve the effectiveness of removal of cyanogen from cassava roots during processing are needed in the affected communities.

A food-frequency questionnaire (FFQ) was developed to assess habitual dietary intake in the Southern Community Cohort Study (SCCS), a prospective epidemiological study to analyse disparities in cancer and other chronic diseases between African-Americans and Whites.

Frequency and portion size estimates were obtained for each of 104 foods. Daily intakes of 13 food groups, energy and 18 nutrients were computed. Each participant's rank and quintile classification of nutrient intakes was determined with and without the use of the subject's reported portion size.

The sample was obtained from the SCCS pilot study conducted in Tennessee, Mississippi and Florida, and consisted of 209 adults, 54% African-American, with a mean (standard deviation) age of 57.1 (12.5) years.

Correlations between the ranks from the two methods of estimation were high, ranging from 0.66 to 0.94 for food groups and 0.81 to 0.94 for nutrients. Pearson correlations were similarly high for food groups and nutrients. Concordance in exact quintile rank across the nutrient indices ranged from 52 to 70%, rising to 90–99% for concordance within adjacent quintiles.

To reduce the respondents' burden and to increase data completeness, the assignment of a uniform portion size when scoring the SCCS FFQ was considered acceptable.

To examine the relationship between television (TV) viewing and body mass index (BMI) among adolescents in a region of mainland China.

Population-based cross-sectional study, conducted between September and November of 2004, on a sample of enrolled high-school students aged 12–18 years.

One hundred and sixty-eight classes randomly selected from both urban and rural areas and belonging to 15 senior and 41 junior high schools in Nanjing, China, with a regional population of 6·0 million.

In total 6848 students participated; 47·7 % from urban and 52·3 % from rural areas; 49·0 % male and 51·0 % female. The response rate among eligible participants was 89·3 %.

The proportion of overweight was 6·6 % according to the criteria of overweight recommended for Chinese adolescents. Boys than girls (8·9 % vs. 4·4 %) had higher odds of being overweight (odds ratio (OR) 2·12, 95 % confidence interval (CI) 1·74, 2·60), while the proportion of overweight was significantly lower among rural students than urban students (4·5 % vs. 8·9 %; OR 0·49, 95 % CI 0·40, 0·60). Those students who watched TV for more than 7 h/week had a 1·5 times greater odds of being overweight relative to their counterparts who watched TV for 7 h/week or less (adjusted OR 1·51, 95 % CI 1·24, 1·82). Furthermore, there was a positive linear relationship between TV viewing time and BMI, even after adjusting for age, gender, residence area, time spent in study, in sleeping and in physical activity, and monthly pocket money.

Viewing TV might increase the likelihood of being overweight for Chinese adolescents in China.

To examine the associations between parental feeding styles and children’s dietary intakes and the modifying effect of maternal education and children’s ethnicity on these associations.

Cross-sectional study of parental feeding styles, assessed by the Parental Feeding Style Questionnaire, and children’s dietary intakes. Multiple regression analyses were carried out to assess the associations between the parental feeding styles studied (‘control’, ‘emotional feeding’, ‘encouragement to eat’ and ‘instrumental feeding’) and children’s dietary intakes (consumption of fruit, vegetables, water and sugar-sweetened beverages (SSB)). The modifying effect of maternal education and children’s ethnicity on these associations was explored.

North-western part of the Netherlands.

Children aged 3–7 years (n 5926).

Both ‘encouragement’ and ‘control’ were associated with higher consumption of vegetables and lower consumption of SSB, but only ‘encouragement’ was positively associated with fruit and water intakes. ‘Instrumental feeding’ showed a positive association with SSB and negative associations with fruit, vegetable and water consumption. No significant associations were found for ‘emotional feeding’. Maternal educational level and children’s ethnicity moderated some associations; for example, ‘control’ was beneficial for vegetable intake in all subgroups, whereas the association with SSB was beneficial only in highly educated mothers.

The study shows that both encouraging and controlling feeding styles may improve children’s dietary behaviour, while ‘instrumental feeding’ may have a detrimental effect. Furthermore, maternal educational level and children’s ethnicity influence these associations. The study’s findings could provide a basis for development of interventions to improve parental feeding styles.

Weight self-perceptions, or how a person perceives his/her weight status, may affect weight outcomes. We use nationally representative data from 1988–1994 and 1999–2008 to examine racial/ethnic disparities in weight self-perceptions and understand how disparities have changed over time.

Using data from two time periods, 1988–1994 and 1999–2008, we calculated descriptive statistics, multivariate logistic regression models and predicted probabilities to examine trends in weight self-perceptions among Whites, Blacks, US-born Mexican Americans and Mexican immigrants to the USA.

National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and continuous NHANES (1999–2008).

Adult NHANES participants aged 18 years and older (n 37 050).

The likelihood of self-classifying as overweight declined between 1988–1994 and 1999–2008 among all US adults, despite significant increases in mean BMI and overweight prevalence. Trends in weight self-perceptions varied by gender and between racial/ethnic groups. Whites in both time periods were more likely than racial/ethnic minorities to perceive themselves as overweight. After adjustment for other factors, disparities in weight self-perceptions between Whites and Blacks of both genders grew between survey periods (P<0·05), but differences between overweight White women and Mexican immigrants decreased (P<0·05).

Weight self-perceptions have changed during the obesity epidemic in the USA, but changes have not been consistent across racial/ethnic groups. Secular declines in the likelihood of self-classifying as overweight, particularly among Blacks, are troubling because weight self-perceptions may affect weight-loss efforts and obesity outcomes.

To define the Mediterranean diet model inside a Mediterranean social and cultural food framework and from the perspective of a local model of consumption.

Reflexion and review of literature available in relation to the Mediterranean diet, locality and proximity.

Mediterranean region and its populations.

The Mediterranean local food system under the term Mediterranean diet encourages local production and local consumption. From this perspective, this model takes part of every local Mediterranean lifestyles and encourages sustainability.

From a local Mediterranean point of view and as a proximity model of consumption, Mediterranean food and diet can be a sustainable resource for the Mediterranean area.

In 2001 the UK Department of Health funded pilot community-based interventions to improve fruit and vegetable intakes in five economically deprived areas of England. The effectiveness of the programme and the use of a brief tool for evaluating community interventions are reported here.

Data on intakes of and beliefs about fruit and vegetables were collected by a short postal questionnaire (FACET – Five-a-day Community Evaluation Tool) simultaneously from 810 individuals living in the pilot communities and 270 individuals who were participating in an unrelated observational study (controls). Data were collected before and after a 12-month intervention period. Quantitative dietary data derived from 7-day food diaries available for control subjects were used to assess the ability of the FACET questionnaire to estimate fruit and vegetable intakes.

Compared with controls, the intervention group significantly increased their knowledge of the 5-a-day optimum (P < 0.01) and reported increased access to fruits and vegetables (P < 0.001). Overall, the intervention had no demonstrable effect on total fruit and vegetable intakes as measured by FACET. However, smoking habit strongly predicted change in fruit and vegetable intakes (P < 0.01) in the intervention group. Opposite trends were observed in the two groups, with ‘smokers’ and ‘non-smokers’ in the intervention and control groups respectively reducing their fruit and vegetable intakes. The FACET questionnaire agreed with food diary estimates of fruit and vegetable intakes in 56% of cases.

Community-based interventions can produce important changes in knowledge of and access to fruit and vegetables. However, in this study change in fruit and vegetable intakes was strongly influenced by smoking habit. This bias needs to be considered in planning future intervention and evaluation programmes. The FACET questionnaire provides acceptable estimates of fruit and vegetable intakes which may be used for grading intake in large community-based projects.