The 2015–2020 Dietary Guidelines for Americans recommend that Americans consume more fruits and vegetables as part of an overall dietary pattern to reduce the risk for diet-related chronic diseases such as cardiovascular disease, type 2 diabetes, some cancers, and obesity (1). Adults should consume 1.5–2.0 cup equivalents of fruits and 2.0–3.0 cups of vegetables per day.* Overall, few adults in each state met intake recommendations according to 2013 Behavioral Risk Factor Surveillance System (BRFSS) data; however, sociodemographic characteristics known to be associated with fruit and vegetable consumption were not examined (2). CDC used data from the 2015 BRFSS to update the 2013 report and to estimate the percentage of each state’s population meeting intake recommendations by age, sex, race/ethnicity, and income-to-poverty ratio (IPR) for the 50 states and District of Columbia (DC). Overall, 12.2% of adults met fruit recommendations ranging from 7.3% in West Virginia to 15.5% in DC, and 9.3% met vegetable recommendations, ranging from 5.8% in West Virginia to 12.0% in Alaska. Intake was low across all socioeconomic groups. Overall, the prevalence of meeting the fruit intake recommendation was highest among women (15.1%), adults aged 31–50 years (13.8%), and Hispanics (15.7%); the prevalence of meeting the vegetable intake recommendation was highest among women (10.9%), adults aged ≥51 years (10.9%), and persons in the highest income group (11.4%). Evidence-based strategies that address barriers to fruit and vegetable consumption such as cost or limited availability could improve consumption and help prevent diet-related chronic disease.

BRFSS conducts an annual, state-based, random-digit–dialed landline and cellular telephone household survey of noninstitutionalized, civilian U.S. adults aged ≥18 years to collect data on health and health risk behaviors related to chronic disease. BRFSS uses a complex multistage cluster sampling design and weights by iterative proportional fitting to adjust for nonresponse, noncoverage, and selection bias (3). In 2015, BRFSS asked six questions to assess how many times per day, week, or month the participants consumed 1) 100% fruit juice, 2) whole fruit, 3) dried beans, 4) dark green vegetables, 5) orange vegetables, and 6) other vegetables, during the previous month. Daily frequency of intake was calculated by dividing reported intake by 7 for intake reported by week, and by 30 for intake reported by month. To estimate the percentage of each state’s population meeting fruit and vegetable intake recommendations by demographic characteristics, previously developed scoring algorithms derived from the National Health and Nutrition Examination Survey (NHANES) were used to predict whether a respondent met fruit and vegetable recommendations for their age and sex based on the number of times per day they reported consuming fruits and vegetables separately, accounting for race/ethnicity and IPR (poverty defined according to federal poverty guidelines†), updated with 2015 Poverty Guidelines for the 48 contiguous states and DC. IPR was calculated following the previous study methods (4) using the midpoint of reported household income for persons who reported their household income; household size was assumed to equal one for participants who did not report the number of persons residing in the household. Individual predicted probabilities of meeting recommendations were averaged to obtain sociodemographic-specific estimates. Intake recommendations were based on the 2015–2020 Dietary Guidelines for Americans (1) and used the age- and sex-specific recommendations for adults who engage in <30 minutes of moderate physical activity daily. BRFSS respondents’ race/ethnicity (Hispanic, non-Hispanic black [black], non-Hispanic white [white], and all others) and IPR (<1.25, 1.25%–3.49%, and >3.49) were defined consistent with definitions in previous analyses (5). Estimates for the racial/ethnic group “other” are not presented because of the small sample sizes and difficulties in providing meaningful interpretation, but are included in overall estimates and those by age, sex, and IPR. Among 441,456 respondents, 122,041 (28%) were excluded, including 5,074 who did not reside in the 50 states or DC (because the scoring algorithm is derived from NHANES, which excluded territories), 58,949 who did not answer all six questions on fruit and vegetable intake, 127 who had implausible values of reported intake of fruit more than 16 times per day or vegetables more than 23 times per day (4), and 55,891 who had missing values for income, resulting in a final analytic sample of 319,415. The median response rate for 2015 BRFSS§ was 47.2% for the 50 states and DC (range = 33.9%–61.1%). T-tests were used to compare differences by demographic groups. Statistical analyses were performed to account for the complex survey design and nonresponse. Balanced repeated replication technique, replicate weights, and Taylor linearization were used to calculate standard errors and confidence intervals, consistent with the previous study (2).

In 2015, the median frequency of reported intake among all respondents was one time per day for fruit and 1.7 times per day for vegetables (Table 1). Among all respondents, 12.2% met fruit intake recommendations, ranging from 7.3% in West Virginia to 15.5% in DC, and 9.3% met vegetable intake recommendations, ranging from 5.8% in West Virginia to 12.0% in Alaska (Table 1). Overall in 2015, the percentage of adults meeting fruit and vegetable recommendations varied by selected characteristics (Table 2) (Table 3). A higher proportion of women met both fruit and vegetable recommendations (15.1% and 10.9%, respectively) than did men (9.2% and 7.6%, respectively), and a higher proportion of women met recommendations in most states. By age group, young adults aged 18–30 years accounted for the lowest proportion of persons meeting recommendations for fruit and vegetable intake (9.2% and 6.7%, respectively); this proportion was significantly different from the referent group of adults aged ≥51 years, 12.4% and 10.9% of whom met intake recommendations for fruit and vegetables, respectively. Findings varied by state; in 41 states, a significantly lower percentage of young adults met recommendations for vegetable intake than did older adults, whereas this pattern was only observed for fruit intake in 18 states. A significantly higher proportion of Hispanics and blacks met recommendations for fruit intake than did whites; however, these differences were only significant in 10 states (Table 2). There were no significant differences in meeting recommendations for vegetable intake by race/ethnicity. In general, by state, lower percentages of blacks met recommendation for vegetable intake than did whites and Hispanics. Overall, a significantly higher percentage of persons with IPR >3.49 met recommendations for vegetable intake than did those with IPR ≤3.49, although no significant differences for meeting recommendations for fruit intake by IPR were observed. By state, a higher percentage of persons living in households with incomes in the highest category (IPR >3.49) met the recommendation for vegetable intake than did persons living below or close to the poverty level (IPR <1.25); these differences were significant in four states for fruits and 35 states for vegetables.