The health benefits of consuming recommended amounts of fruits and vegetables are well recognized and include reduced risk of chronic non-communicable diseases, such as cardiovascular disease, stroke, and cancer [1]. However, the vast majority of children, adolescents, and adults in the United States (US) do not meet the Dietary Guidelines for Americans 2015–2020 recommendations for fruit and vegetable intake (2 and 2.5 cup-equivalents, respectively, for an adult consuming 2,000 calories per day) to promote health and prevent chronic disease [2]. Research suggests that large-scale interventions, including mass media and marketing campaigns, have potential to increase population fruit and vegetable intake [3]. Unfortunately, previous large-scale US public health campaigns that used rational, informational and educational approaches for fruit and vegetable promotion have not demonstrated meaningful and sustained improvements in consumption patterns [4]. US commercial marketing campaigns that promote specific fruit and vegetable products, such as mandarin oranges [5] and baby carrots [6], have reported positive impacts on consumer demand but data on dietary intake and health outcomes from empirical evaluations have not been published.
Some researchers have called for a shift towards positive promotional approaches common in commercial marketing practices to encourage healthy food-related behaviors, away from the practices in traditional information-based campaigns [4, 7–9]. Commercial food and beverage marketing communications often feature creative, humorous, and emotional appeals designed to attract consumers’ attention and elicit positive affective and cognitive responses and associations with brands and products; these positive associations can interact with a consumer’s experience to influence their behavior [10]. Proponents of commercial marketing approaches highlight the potential to achieve mutually beneficial outcomes relevant to stakeholders’ interests from the private- (e.g., farmers, producers, processors, retailers) and public health sectors (e.g., individuals, government, society) [7, 11]. The Partnership for a Healthier America (PHA), a US non-profit aimed at combating childhood obesity through collaboration with the private sector, has emphasized these benefits and leveraged support for marketing initiatives designed to increase consumer demand for healthy foods and beverages [12].
In 2015, the PHA announced that it was launching the branded Fruits & Veggies (FNV) Campaign in Fresno, California (CA) and Hampton Roads, Virginia (VA) to promote sales and intake of fruits and vegetables among targeted teen and mom audiences [13, 14]. In contrast to previous theory-based US fruit and vegetable campaigns that received support from public health agencies, such as Fruits and Veggies–More Matters and Five a Day [15], the FNV Campaign was intentionally designed without health-based rational appeals and instead focused on affective appeals commonly used in commercial marketing [7].
FNV Campaign Strategy
The creative advertising firm, Victor & Spoils, designed the FNV Campaign strategy that was “inspired by big consumer brands, whose tactics are relentless, compelling, catchy, and drive an emotional connection with their products” [13]. The FNV Campaign strategy was oriented around an integrated marketing communication (IMC) approach to reach and engage target audiences with creative and humorous content to build positive associations and connections with the FNV brand and fruits and vegetables. Marketers use IMC with the aim of maximizing impact through targeted and synergized exposure to multiple marketing communications strategies and tactics [16]. The messaging content featured was designed to elicit affective responses among consumers to build positive associations with the FNV brand and fruits and vegetables. The advertisements used visually appealing graphics and pro bono celebrity endorsers throughout IMC promotions, including multi-media advertising, public relations and event appearances, on the basis that celebrity endorsers could positively influence fruit and vegetable attitudes and behaviors of consumers [13, 14]. Examples of marketing promotions and links to FNV social media accounts can be viewed at the FNV Campaign website (https://fnv.com/).
Local FNV Campaign execution began in June 2015 and included television, radio, print, in-store, and billboard advertising in the two media markets [12]. Additionally, the FNV Campaign sponsored community events including branded mobile markets to sell produce in both Norfolk, VA [17] and Fresno, CA [18].The November launch event in Norfolk, VA was one of the most notable local activities, gaining national attention with the participation of First Lady Michelle Obama and other celebrity endorsers [19]. Digital and social media complemented the local execution but also reached a wider audience and received national earned media attention.
The PHA aimed to pilot the FNV Campaign in two racially and ethnically diverse markets over the first year to inform future efforts and leverage partnerships and support for further expansion [20]. Over half of the Fresno County, CA population is of Hispanic ethnicity (52%) [21], which is about three times higher than the national population; while the Hampton Roads, VA metropolitan area has more than double the proportion of Black or African American residents (31%) than the national population [22]. These demographic segments are of particular interest for public health intervention as research has shown that Black or African American and Hispanic youth are disproportionately targeted by creative marketing promotions for nutritionally poor foods and beverages, which influence dietary behaviors and ultimately health outcomes [23, 24].
One year after the 2015 launch, the PHA reported that the FNV Campaign garnered over 650 million impressions through earned media and 350 million impressions through social media, though the reach of paid media advertisements were not publicly reported [25]. Engagement rates and examples of the FNV Campaign content were reported for its entry in a social media contest [26]. Sales of fruits and vegetables among Farm Fresh retailers reportedly increased by 2.5% across stores where the FNV Campaign was implemented [27]. Additional outcomes were reported for positive shifts in attitudes, intentions and consumption of fruits and vegetables among those exposed to the FNV Campaign [12, 25], but not from empirical and independent evaluations.
In 2016, the PHA announced that the FNV Campaign would expand nationally through community and state partnerships and continue efforts in the Fresno, CA and Hampton Roads, VA markets where it was first launched [28, 29]. By 2017, the PHA had engaged over 80 celebrity athletes and entertainers in FNV Campaign IMC promotions in the national markets [12]. As a social marketing campaign aimed at increasing fruit and vegetable consumption, the FNV Campaign has partnered with numerous public health organizations as it has been scaled-up [30]. The FNV Campaign has been included as a social marketing and Policy, Systems and Environmental (PSE) intervention in the Supplemental Nutrition Assistance Program-Education (SNAP-ED) Toolkit, which lists the Campaign as an emerging evidence-based approach that requires further evaluation. As the FNV Campaign marketing strategy was not designed around a traditional health behavior theory and promoted fruit and vegetable products broadly, it is important to evaluate and understand the potential of this novel strategy to positively influence target audiences’ diet-related fruit and vegetable outcomes. Understanding the cognitive, affective, and behavioral outcomes of target audiences in the two pilot markets can inform the refinement and effectiveness of the FNV Campaign as it expands to new markets. This is particularly important as there is no evidence available on the formative research used to develop the FNV brand and messaging content or detailed information on the reach, engagement, influence and timeline of marketing elements implemented in the two pilot markets.
Understanding outcomes in the context of the two markets where the FNV Campaign was launched can guide future research and practice to advance the body of evidence available for large-scale approaches to improve consumers’ fruit and vegetable intake and public health. The purpose of this study was to examine whether awareness of the FNV Campaign was associated with differences in fruit- and vegetable-related outcomes for attitudes, beliefs, intentions, and behaviors among the target audiences in the Fresno and Hampton Roads markets.