Systematic Review

Environmental determinants of fruit and vegetable consumption among adults: a systematic review

Carlijn B. M. Kamphuisa1 c1, Katrina Giskesa1, Gert-Jan de Bruijna2, Wanda Wendel-Vosa3, Johannes Bruga1 and Frank J. van Lenthea1

a1 Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands

a2 Department of Health Education and Health Promotion, Maastricht University, The Netherlands

a3 Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands


The current ecological approach in health behaviour research recognises that health behaviour needs to be understood in a broad environmental context. This has led to an exponential increase in the number of studies on this topic. It is the aim of this systematic review to summarise the existing empirical evidence pertaining to environmental influences on fruit and vegetable (FV) consumption. The environment was defined as ‘all factors external to the individual’. Scientific databases and reference lists of selected papers were systematically searched for observational studies among adults (18–60 years old), published in English between 1 January 1980 and 31 December 2004, with environmental factor(s) as independent factor(s), and fruit intake, vegetable intake or FV intake combined as one outcome measure as dependent factor(s). Findings showed there was a great diversity in the environmental factors studied, but that the number of replicated studies for each determinant was limited. Most evidence was found for household income, as people with lower household incomes consistently had a lower FV consumption. Married people had higher intakes than those who were single, whereas having children showed mixed results. Good local availability (e.g. access to one's own vegetable garden, having low food insecurity) seemed to exert a positive influence on intake. Regarding the development of interventions, improved opportunities for sufficient FV consumption among low-income households are likely to lead to improved intakes. For all other environmental factors, more replicated studies are required to examine their influence on FV intake.

(Received January 19 2006)

(Revised May 24 2006)

(Accepted June 05 2006)


c1 *Corresponding author: Carlijn B. M. Kamphuis, fax +31 10 4089455, email