Impact of Garden-Based Youth Nutrition Intervention Programs: A Review

Implementation and Impact of Health Care Gardens: A Systematic Scoping Review

Background: In community and school settings, gardens and garden interventions have been shown to confer several psychosocial, physiological, and nutritional benefits. However, little is known about the implementation and impact of health care gardens on patients, visitors, and staff health and well-being. The primary aim of this review is to identify and describe the types of gardens and common design elements implemented in health care settings and the impact these gardens have on the health and well-being of patients, visitors, and staff. A secondary aim is to assess the quality of available evidence. Methods: PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched on October 28, 2022. Primary qualitative and quantitative studies (excluding case reports and studies) were eligible for inclusion if they described the types of gardens and common design elements implemented in health care settings (hospitals, aged care, rehabilitation facilities, and medical centers) and/or assessed the impact of garden interventions on the health and well-being of patients, visitors, and staff. Review, selection, and data extraction were conducted by two independent researchers, with findings synthesized and presented in narrative form. Articles were critically appraised using the mixed methods appraisal tool (MMAT). Results: Eighteen articles were included. Eight studies provided detailed descriptions of the types of gardens implemented in health care settings (healing [n = 3], therapeutic [n = 2], sensory [n = 2], children's fairy gardens [n = 1], and enriched [n = 1] gardens). Studies examining the psychosocial impacts of gardens were most frequently reported (n = 16), followed by physical (n = 4) and nutritional (n = 2). A wide range of positive outcomes, predominantly relating to patients (n = 12), were reported, including improvements in stress, quality of life (QOL), cognitive function, physical activity, and fruit and vegetable intake. The evidence was heterogeneous and low-medium quality. Conclusions: The findings suggest that implementing gardens and garden interventions in health care settings may positively impact the health and well-being of patients, visitors, and staff. Most studies related to the impact of gardens on patients' mental health and QOL, indicating the need for further research to explore physical and nutritional outcomes, as well as health outcomes of staff and visitors. Findings also suggest the need for high-quality study designs (e.g., cluster control trials) and standardized measurement tools.

Development of food literacy in children and adolescents: implications for the design of strategies to promote healthier and more sustainable diets

Food literacy has emerged as a key individual trait to promote the transformation of food systems toward healthy and sustainable diets. Childhood and adolescence are key periods for establishing the foundations of eating habits. Different food literacy competencies are acquired as children develop different cognitive abilities, skills, and experiences, contributing to the development of critical tools that allow them to navigate a complex food system. Thus, the design and implementation of programs to support the development of food literacy from early childhood can contribute to healthier and more sustainable eating habits. In this context, the aim of the present narrative review is to provide an in-depth description of how different food literacy competencies are developed in childhood and adolescence, integrating the extensive body of evidence on cognitive, social, and food-related development. Implications for the development of multisectoral strategies to target the multidimensional nature of food literacy and promote the development of the 3 types of competencies (relational, functional, and critical) are discussed.

Plant-based recovery from restrictive eating disorder: A qualitative enquiry

OBJECTIVES

Plant-based/vegan diets are growing in popularity. There are growing numbers of individuals adopting plant-based diets and there are legitimate concerns from professionals that this can enable food restriction or mask disordered eating. The aim of this study was to examine the role a plant-based diet can play for those in recovery from restrictive eating disorders (anorexia and bulimia nervosa).

METHODS

Interviews conducted with fourteen individuals who identified as having a restrictive eating disorder for which a plant-based diet played/plays an important part in their recovery. Semi-structured interviews explored the individual's lived experiences and motivations of adopting a plant-based diet, and perceptions of the role it played in recovery. Data was transcribed verbatim and analyzed using thematic analysis (Braun & Clarke, 2006).

RESULTS

Three key themes with six contributory subthemes were identified. Key themes were plant-based as a gateway to recovery, the changing value of food, and the function of control. Theme content highlighted an evolving role of identity and community, with a shift in meaning and value of food described, and for some, the development of a new relationship with their body. This facilitated a de-coupling of anxieties about food and promoted positive experiences of eating, esteem and empowerment.

CONCLUSIONS

These findings present a unique insight into the role that plant-based eating may play in recovery for some restrictive eating disorders. The data demonstrated that motivations to control food intake may contribute to the decision to eat plant-based. However, for these individuals it provided a "gateway" to a new more meaningful relationship with food. These findings highlight some of the risks and benefits of eating plant-based in recovery and an important role for health professionals in understanding/supporting individuals during recovery. w/c 280.

Process evaluation of the Yéego! Program to increase healthy eating and gardening among American Indian elementary school children

BACKGROUND

American Indian children are at increased risk for obesity and diabetes. School-based health promotion interventions are one approach to promoting healthy behaviors to reduce this risk, yet few studies have described their implementation and fidelity. We conducted a qualitative process evaluation of the Yéego! Healthy Eating and Gardening Program, a school-based intervention to promote healthy eating among Navajo elementary school children. The intervention included a yearlong integrated curriculum, as well as the construction and maintenance of a school-based garden.

METHODS

Our process evaluation included fidelity checklists completed by program staff and qualitative interviews with program staff and classroom teachers after the intervention was implemented. We used content analysis to identify themes.

RESULTS

We identified several themes related to evidence of delivery adherence, program satisfaction, and lessons learned about delivery. Intervention staff followed similar procedures to prepare for and deliver lessons, but timing, teaching styles, and school-level factors also impacted overall implementation fidelity. Teachers and students had positive perceptions of the program, especially lessons that were highly visual, experiential, and connected to Navajo culture and the surrounding community. Teachers and program staff identified ways to enhance the usability of the curriculum by narrowing the scope, relating content to student experiences, and aligning content with school curriculum standards.

CONCLUSIONS

The program was implemented with moderately high fidelity across contexts. We identified areas where modifications could improve engagement, acceptability, efficacy, and sustainability of the program. Our results have implications for the evaluation and dissemination of school-based health interventions to promote healthy eating among children, especially in American Indian communities.

Participant Perspectives on the Impact of a School-Based, Experiential Food Education Program Across Childhood, Adolescence, and Young Adulthood

OBJECTIVE

Explore participant perceptions of involvement in an experiential food education program during elementary school and the scope and extent of program influence on food decisions.

DESIGN

Focus groups with current participants and program alumni.

SETTING

Washington, DC.

PARTICIPANTS

Thirty-nine elementary school students and 39 program alumni ranging from middle school through university students.

PHENOMENON OF INTEREST

Participant perceptions of program impact from childhood into adolescence and young adulthood.

ANALYSIS

Inductive thematic analysis.

RESULTS

Nine emergent themes were identified, spread over 3 categories of program impact: immediate, beyond the classroom, and sustained. Immediate program impact themes came from all participants and included enjoyment, hands-on learning, and fostering connection. Beyond the classroom, older elementary students and alumni expressed perceived shifts in individual and family food intake, involvement in household food practices, and desire for fresh food options at school. Themes of sustained program impact among alumni participants were an appreciation for fresh food, openness to trying new foods, and confidence to make informed food decisions.

CONCLUSIONS AND IMPLICATIONS

Findings provide a deeper understanding of participant perspectives on the impact of participation in a school-based experiential food education program and a basis for further research on the role of early exposure to food education in influencing food decisions as children grow older.

A Century of Influences on Parental Feeding in America

PURPOSE OF REVIEW

Childhood obesity, food deserts, food prices, and a lack of nutritional knowledge are rising concerns in the USA. Parental feeding goals and practices have shifted greatly in the past century and families now rely almost solely on the corporate food industry. Industrial farming and corporate production of food stuffs can be damaging to the environment, animal ethics, and the health of children and families. This review examines how the history of the USA intertwines with parental feeding along with maternal and child health and well-being.

RECENT FINDINGS

Grass roots efforts are underway to educate the public in nutrition and gardening. Knowledge of food basics, cooking, and animal husbandry can have a positive influence on the health of children and families, especially those living in food deserts. The proliferation of farmers' markets may provide a safe-hold for those wishing to feed local, ethically produced foods to their families. Historical information on how US families became dependent upon factory farmed foods and lost their knowledge of food growth may help guide future communities on educational programming. Children who are educated on healthy foods have more interest in eating nourishing, clean foods. Family education and school programming on nutrition and gardening may work to ease absolute dependence on factory farmed foods and help to lower childhood obesity and related diseases.

Dietary Psychosocial Mediators of Vegetable Intake in Schoolchildren From Low-Income and Racial and Ethnic Minority US Families: Findings From the Texas Sprouts Intervention

BACKGROUND

Numerous school-based interventions have used cooking and gardening approaches to improve dietary intake; however, research is limited on the mediation effect of dietary psychosocial factors on the link between the intervention and increased vegetable intake, particularly in children from low-income and racial and ethnic minority US families.

OBJECTIVE

Our aim was to examine the effects of the Texas Sprouts intervention on dietary psychosocial factors related to intake of vegetables, and whether these psychosocial factors mediate the link between the intervention and increased intake of vegetables in schoolchildren from low-income and racial and ethnic minority US families.

DESIGN

This was an analysis of data on secondary outcomes from the Texas Sprouts program, a 1-year school-based gardening, nutrition, and cooking cluster randomized controlled trial consisting of elementary schools that were randomly assigned to either the Texas Sprouts intervention or to control.

PARTICIPANTS/SETTING

Participants were 2,414 third- through fifth-grade students from low-income and racial and ethnic minority US families from 16 schools (8 intervention and 8 control) in Austin, TX.

INTERVENTION

The intervention group received eighteen 60-minute gardening, nutrition, and cooking student lessons in an outdoor teaching garden and 9 monthly parent lessons throughout the academic year.

MAIN OUTCOME MEASURES

Child psychosocial and dietary measures were collected at baseline and post intervention via validated questionnaires.

STATISTICAL ANALYSES PERFORMED

Generalized linear mixed models assessed the intervention effects on dietary psychosocial factors. Mediation analyses examined whether these psychosocial factors mediated the link between the intervention and increased child vegetable intake.

RESULTS

Children in Texas Sprouts, compared with controls, showed significant increases in the mean scores of gardening attitudes, cooking self-efficacy, gardening self-efficacy, nutrition and gardening knowledge, and preferences for fruit and vegetables (all, P < .001). Each of the dietary psychosocial factors mediated the association between the Texas Sprouts intervention and child vegetable intake.

CONCLUSIONS

Besides targeting dietary behaviors, future school-based interventions should also focus on understanding the mechanisms through which teaching children to cook and garden influence dietary psychosocial factors as mediators of change in healthy eating behaviors.

Effectiveness of Gardening-Only, Cooking-Only and Combined Cooking and Gardening Programs in Elementary Schools to Improve Fruit and Vegetable Intake: A Systematic Review

The objective is to compare the gardening, cooking, and combined cooking and gardening programs in elementary schools from the past decade (2011-2022) in improving six psychosocial and behavioral outcomes related to fruit and vegetable intake. This review was conducted following the PRISMA guidelines. Five scientific databases were searched to identify 4763 potential articles, 44 articles were retained after screening the studies' abstract, and 36 articles were included after further investigation into each intervention. This review included 9 gardening-only programs, 8 cooking-only programs, and 19 combined cooking and gardening programs. The included studies were from 14 different countries with half of these studies took place in the United States (n = 18). Of the outcomes assessed, 100% (10/10) of the studies were effective in improving knowledge/skills, 90% effective in improving attitudes and self-efficacy to consume F and V (9/10), 80% produced significant results for gardening and cooking attitudes/behaviors (8/10) and willingness to try F and V (4/5), 68% (11/16) programs resulted in increase in F and V intake, and 62% (10/16) programs improved F and V preference. This review suggests that gardening-only programs (89%) and cooking-only programs (88%) were slightly more effective in producing significant findings compared to combined programs (84%), but more high-quality interventions are needed to confirm these findings.

The Effects of a Multi-Component School-Based Nutrition Education Intervention on Children's Determinants of Fruit and Vegetable Intake

Evidence suggests that multi-component school-based health-promoting interventions have great potential to improve children's fruit and vegetable intake. However, interventions that combine classroom-based curricula with experiential learning strategies (e.g., cooking) are relatively seldom described. This study investigates the short-term and longer-term effects of a multi-component school-based nutrition education intervention combining classroom-based and experiential learning strategies on children's determinants of their fruit and vegetable intake (knowledge, taste preferences, attitudes, and intention). Using a comparative quasi-experimental study design, data were collected, via child-reported questionnaires, at the baseline, directly after the intervention, and three months after the intervention from 4 control and 15 intervention classes from Dutch primary schools. A total of 192 children in grades three and four (aged 8-10 years) constituted the participants. After correction for the baseline, sex, age, and the fruit or vegetable product assessed in the questionnaire; the intervention group showed a significant increase in knowledge (p = 0.001; standardized effect size (ES = 0.60), taste preference (p = 0.002; ES = 0.52), attitude towards the assessed fruit or vegetable product (p = 0.004; ES = 0.48), and general attitude towards healthy products (p = 0.01; ES = 0.39) over the short term, when compared to the control group. The effects of the intervention did not continue to be significant over the longer term. The findings implicate short-term intervention success, although more research and intervention adaptations are recommended to increase the impact of such programs, especially over the long term.

Effects of school-based interventions on Food and Nutrition Literacy (FNLIT) in primary-school-age children: a systematic review

This study systematically reviewed the evidence on interventions seeking to improve Food and Nutrition Literacy (FNLIT) functional, interactive and critical skills in primary school-aged children. Electronic databases, including PubMed/MEDLINE, SCOPUS, Web of Science, Cochrane, Pro-Quest and Google Scholar were systematically searched. Randomised and non-randomised controlled trials, pre-/post-test and case-control designs were included. The primary outcomes were three levels of FNLIT: functional, interactive and critical. All citations, full-text articles and abstract data were screened by two independent reviewers. Any conflicts were then resolved through discussion. The quality of the included studies was individually evaluated using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Two reviewers extracted data from the included studies, and a descriptive analysis was performed. The quality of all eligible studies (n 19) was rated as moderate/weak. A wide variety of skill-building activities were introduced by programmes, including recipe skills/food preparation, food label literacy, food tasting, gardening harvesting, and supporting cultural practices and ethnic foods. Only four studies measured food literacy (FL) (food label literacy) via a valid measure. Most interventions focused on the functional level of FL, except for two programmes (one scored weak and one scored moderate). In most of the studies, delivery of intervention content was facilitated by teachers (n 15). Promising interventions were tailored to the needs and interests of students, incorporated into the existing curriculum and facilitated by teachers. The successful intervention strategies led to improvements in functional, partly interactive and critical skills. Future interventions should focus, holistically, on all aspects of FNLIT, especially interactive and critical skills.

Relationships between Food Production Experience and the Behavior, Attitude, and Knowledge of Dietary Recommendations among Japanese Adults: A Cross-Sectional Study

The Japanese Ministry of Agriculture, Forestry, and Fisheries proposed to educate more people in food production as one of the objectives of the Basic Plan for Food and Nutrition Education Promotion. This cross-sectional study aims to elucidate the relationship between food production experience (agricultural, forestry, and fishery experiences) and the behavior, attitude, and knowledge of dietary recommendations among Japanese adults. This study was conducted using data obtained from the “Survey on Dietary Habits and Agriculture, Forestry, and Fishery Experiences (2019)”. This survey was conducted by mailing paper questionnaires to respondents aged 20–69 years living in 17 regions across Japan. The independent variable was food production experience. The dependent variables were each of the 13 goals of the dietary guidelines in Japan, the total score for adherence to the 13 items (low scores indicate good adherence), adherence to a Japanese-style diet, and four items on the attitude and knowledge of dietary recommendations. I also examined the association between the point in life the food production experience occurred and the above outcomes. The data obtained from 3461 participants aged 20 to 69 years were used for multivariate logistic and linear regression analyses. Food production experience was positively associated with an improved behavior, attitude, and knowledge of dietary recommendations among adults in Japan. The study found a strong relationship with food production experiences in adulthood.

Influence of Prefecture-Level Yield of Not-for-Sale Vegetables on Vegetable Intake in Japan: A Natural Experiment

Increased vegetable intake contributes to better health for people. The distribution of not-for-sale vegetables is an important source of vegetable intake in Japan. This study examined the impact of prefecture-level yield of not-for-sale vegetables on vegetable intake in Japan. This study regarded the increase in yield of not-for-sale Chinese cabbage in Nagano Prefecture in 2012 as a natural experiment. The years 2012 and 2016 were the large-scale survey years of the Japanese National Health and Nutrition Survey. Therefore, the effect of the change in prefecture-level yield of not-for-sale vegetables on vegetable intake was evaluated by comparing the changes in Chinese cabbage intake in Nagano between 2012 and 2016 with those of other prefectures classified in the same regional block as Nagano. Statistical analysis was performed using general linear models to examine the interaction of year and prefecture with Chinese cabbage intake. Consequently, the regression coefficient for the interaction term was −3.38 (95% CI, −9.59–2.83), that of the model adjusted for basic characteristics and energy intake was −2.99 (95% CI, −9.22–3.24), and that of the model adding health-related variables was −5.03 (95% CI, −12.40–2.34). The prefecture-level yield of not-for-sale vegetables typically had a minor effect on vegetable intake.

Community gardens and their effects on diet, health, psychosocial and community outcomes: a systematic review

Background

We systematically reviewed the effects of community gardens on physical and psychosocial health, health behaviors and community outcomes.

Methods

Quantitative studies that examined associations of health, psychosocial or community outcomes with community gardens were included in the review. Studies up to December 2020 were captured from searches of Medline, Web of Science, PsycInfo, EBSCOHost and CAB Abstracts. Data were extracted and study quality including risk of bias was examined.

Results

There were 53 studies that met the inclusion criteria. Studies examining associations between community gardens and nutrition or food security were most frequently reported (k = 23). Other factors examined for associations with community gardens were health (k = 16), psychosocial (k = 16) and community outcomes (k = 7). Effects appeared positive for fruit and vegetable intake, some psychosocial and community outcomes, but mixed for physical health outcomes. Evidence quality overall was low.

Conclusions

Community gardening was associated with higher fruit and vegetable intake, positive psychosocial and community outcomes, but poor evidence quality suggests the effects of community gardening may be overestimated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13591-1.

Educational Gardens and Climate Change Education: An Analysis of Spanish Preservice Teachers’ Perceptions

Educational gardens are powerful outdoor learning environments to address the subject of climate change and foster climate action. Using an online questionnaire, this study examines the influence of the main sociodemographic and academic factors, and the role of connectedness to nature, on the perception of educational gardens as contexts of climate change education (CCE) among Spanish preservice teachers (PSTs). The sample consisted of 889 PSTs enrolled in 9 university campuses of Spain. The statistical analyses performed evidenced that women are more likely to use educational gardens than men and that there is a progressive decrease in the positive perception of PSTs about the usefulness of gardens for CCE as the educational level at which they are being trained increases. Statistics also revealed that the variable connectedness to nature and the rating of the importance of educational gardens in CCE are not significantly related. Nevertheless, the Mann–Whitney U test indicated that PSTs who scored higher on connection to nature wished to broaden their knowledge of sustainable agriculture and, thus, connectedness to nature could be considered a predictor of environmental attitudes, each influencing the other. Based on these findings, recommendations for PSTs’ training in the CCE context are provided.

How Primary School Curriculums in 11 Countries around the World Deliver Food Education and Address Food Literacy: A Policy Analysis

(1) Background: As one of the biggest drivers of health and climate change, the food system has unrealised potential to influence consumption toward affordable, healthy, sustainable diets. A range of policy levers, including mandating food education, are needed. Schools are considered the best place for food education and childhood is a crucial period when eating habits that persist into adulthood are formed. Food education as part of the curriculum is crucial in generating population shifts in food systems improvements. The purpose of this policy analysis was to analyse mandatory curriculums in different countries to explore the ways in which primary school food education addresses food literacy. (2) Methods: This study analyses how food education within primary school education policy, in 11 countries, addresses Food Literacy (FL). It is the first study of this kind. A case study methodology was employed, and curriculum policy content analysis was conducted using a Food Literacy framework. (3) Results: Each country has a curriculum dedicated to food education, supported by food education in non-food curriculums. There is no standardized approach to primary school food education policy, no consensus in primary food education nomenclature or what curriculums constitute. Curriculums focus on cooking and health topics, but significantly less on social-cultural, equity, and sustainability issues. (4) Conclusion: How primary curriculums around the world deliver food education policy to address FL varies enormously. All 11 countries have dedicated food curriculums, supported by non-food curriculums, but there is no consensus as to what food education is called or constitutes. Countries rarely deal with FL comprehensively. The most comprehensive are single, detailed food curriculums, complemented by non-food curriculums where food knowledge and skills progress clearly and are the intended learning outcome.

Research Design, Protocol, and Participant Characteristics of COLEAFS: A Cluster Randomized Controlled Trial of a Childcare Garden Intervention

Childcare garden interventions may be an effective strategy to increase fruit and vegetable (FV) consumption and physical activity among young children. The objective of this paper is to describe the research design, protocol, outcome measures, and baseline characteristics of participants in the Childcare Outdoor Learning Environments as Active Food Systems (“COLEAFS”) study, a cluster randomized controlled trial (RCT) examining the effect of a garden intervention on outcomes related to diet and physical activity. Fifteen childcare centers in low-income areas were randomly assigned to intervention (to receive garden intervention in Year 1), waitlist control (to receive garden intervention in Year 2), and control group (no intervention). The garden intervention comprised six raised beds planted with warm-season vegetables and fruits, and a garden activity booklet presenting 12 gardening activities. FV knowledge and FV liking were measured using a tablet-enabled protocol. FV consumption was measured by weighing FV before and after a snack session. Physical activity was measured using Actigraph GT3x+ worn by children for three consecutive days while at the childcare center. Of the 543 eligible children from the 15 childcare centers, 250 children aged 3–5 years received parental consent, assented, and participated in baseline data collection. By employing an RCT to examine the effect of a garden intervention on diet and physical activity among young children attending childcare centers within low-income communities, this study offers compelling research design and methods, addresses a critical gap in the empirical literature, and is a step toward evidence-based regulations to promote early childhood healthy habits.

Garden Access, Race and Vegetable Acquisition among U.S. Adults: Findings from a National Survey

With the majority of U.S. adults not meeting recommended vegetable intakes and well-documented racial and ethnic disparities in fruit and vegetable consumption, various approaches to increase vegetable consumption have been implemented. Gardening is one approach that has been associated with increased vegetable consumption in various subpopulations; however, limited national data exist examining this relationship. Since vegetable acquisition is a necessary antecedent to increased vegetable consumption, this study examines if garden access is associated with vegetable acquisition among adults in a nationally representative sample of U.S. households. Data come from the National Food Acquisition and Purchasing Survey (FAPS), a survey of 4826 US households. Descriptive analysis and modified Poisson regressions were performed to examine associations between household garden access and vegetable acquisition amongst the total population and by race. Results indicate that for foods for at-home consumption, respondents with their own garden had a 30% greater prevalence (PR: 1.30, 95% CI: 1.01, 1.64) of acquiring enough vegetables to meet USDA recommendations compared to respondents in households without access to any gardens. Among Black respondents, those with access to their own garden had over two times increased prevalence (PR: 2.35, 95% CI: 1.10, 5.01) of acquiring enough vegetables to meet recommended consumption amounts, compared to Black respondents without any access to a garden. No relationships between garden access and vegetable acquisition were observed for White or Asian respondents. This information may contribute to the body of evidence on strategies for increasing vegetable consumption among U.S. adults.

Relationship between Prefecture-Level Yield of Not-for-Sale Fruits and Vegetables and Individual-Level Fruit and Vegetable Intake in Japan: A Cross-Sectional Study

This study investigated the relationship between prefecture-level yield of not-for-sale fruits and vegetables and individual-level fruit and vegetable intake in Japan. Data were drawn from the Japanese National Health and Nutrition Survey and National Crop Survey of 2016. Random intercept models were used for the analyses. Individual-level fruit and vegetable intake was used for the dependent variable, and prefecture-level yield of not-for-sale fruits and vegetables was used for the independent variable as a fixed effect. In addition, participants’ characteristics and health-related factors at the individual level were also put into independent variables as fixed effects. The prefectures were used as random intercepts. It was found that prefecture-level yield of not-for-sale fruits and vegetables was significantly related to individual-level fruit and vegetable intake (vegetable: B = 0.390, p < 0.001; fruit: B = 0.268, p = 0.003; fruits and vegetables: B = 0.357, p < 0.001). These relationships were also significant in the gender-specific analysis. Thus, the yield of not-for-sale fruits and vegetables might contribute to the intake of fruits and vegetables in Japan.

Impact of a School-Based Gardening, Cooking, Nutrition Intervention on Diet Intake and Quality: The TX Sprouts Randomized Controlled Trial

School gardens have become common school-based health promotion strategies to enhance dietary behaviors in the United States. The goal of this study was to examine the effects of TX Sprouts, a one-year school-based gardening, cooking, and nutrition cluster randomized controlled trial, on students' dietary intake and quality. Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to control (i.e., delayed intervention) over three years (2016-2019). The intervention arm received: formation and training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly in the teaching garden during school hours; and nine parent lessons, taught monthly. Dietary intake data via two 24 h dietary recalls (24 hDR) were collected on a random subsample (n = 468). Dietary quality was calculated using the Healthy Eating Index 2015 (HEI-2015). The intervention group compared to control resulted in a modest increase in protein intake as a percentage of total energy (0.4% vs. -0.3%, p = 0.021) and in HEI-2015 total vegetables component scores (+4% vs. -2%, p = 0.003). When stratified by ethnicity/race, non-Hispanic children had a significant increase in HEI-2015 total vegetable scores in the intervention group compared to the control group (+4% vs. -8%, p = 0.026). Both the intervention and control groups increased added sugar intake; however, to a lesser extent within the intervention group (0.3 vs. 2.6 g/day, p = 0.050). School-based gardening, cooking, and nutrition interventions can result in significant improvements in dietary intake. Further research on ways to scale and sustain nutrition education programs in schools is warranted. The trial is registered at ClinicalTrials.gov (NCT02668744).

A Qualitative Study: Perceived Barriers and Facilitators to Nutrition Standard Adherence by In-home Childcare Providers

BACKGROUND

The Child and Adult Care Food Program (CACFP) nutrition standards may present food purchasing, preparation, and feeding challenges for caregivers of young children.

OBJECTIVE

To elucidate perceived barriers and facilitators faced by in-home childcare providers to following the CACFP food and beverage nutrition standards.

DESIGN

Virtual, semistructured individual interviews elicited perceptions from a cross section of low-income, in-home childcare providers in Michigan.

PARTICIPANTS/SETTINGS

Twenty childcare providers of various races, ethnicity, urban and rural residence, and licensure status.

ANALYSIS

Thematic coding analysis with NVivo (ver12.0) to organize and interpret data.

RESULTS

Four primary barriers to adhering to the CACFP nutrition standards emerged including (1) noncompliant food preferences of children and providers; (2) higher cost and lower availability of CACFP-approved items; (3) celebrations and food rewards; (4) excessive time and effort needed to prepare foods and beverages, especially with dietary restrictions for some children. Ten perceived facilitators included (1) using nutrition education available through community organizations; (2) finding convenient and easy ways to prepare foods and beverages; (3) using CACFP and Special Supplemental Nutrition Program for Women, Infants, and Children guidelines and funding; (4) increasing variety of foods and beverages by using a menu or recalling items recently served; (5) modeling eating healthful foods and encouraging sampling of new foods and beverages; (6) mixing preferred foods/beverages with less preferred; (7) using nutrition information available from social media and from peers; (8) allowing children to choose foods and beverages; (9) serving the same eligible food and beverages to all children; and (10) provider concern about impact of foods and beverages on children's health and behavior.

CONCLUSIONS

Results from this study can inform nutrition education from community organizations that occurs in tandem with CACFP sponsor organizations. In addition, they can be utilized to address state-level licensure regulations and quality improvement rating systems that include nutrition standards childcare providers are encouraged or required to follow.

The Effects of Horticultural Activity Program on Vegetable Preference of Elementary School Students

This study was conducted to investigate effects of a horticultural activity program based on a mediating variable model for improving vegetable preference among elementary students. A quasi-experimental design was employed with 136 students and 136 primary carers in Seoul, South Korea. Based on the mediation model for improving children’s vegetable preference, 12 sessions were conducted, including gardening, nutrition education, and cooking activities using harvests. The program was conducted weekly for 12 weeks from March to July 2019. To investigate the effect of this program, mediating factors of the children were evaluated before and after the program. Pearson correlation analysis was used to identify the mediating factors. The nutrition index, attitude, knowledge, and eating habits of the primary carers were evaluated. Results showed children’s nutrition and gardening knowledge, dietary self-efficacy, outcome expectancies, and vegetable preference were significantly improved (p < 0.001). Primary carers showed significant improvement in the nutrition index, knowledge, and attitude (p < 0.05). The correlation analysis confirmed that most of the mediating factors had significant correlations (p < 0.05). Therefore, administering a structured program involving horticultural activities and nutrition education as mediating factors for 12 sessions was effective in improving eating behavior for vegetables elementary school students and primary carers.

Child Involvement in Choosing a Recipe, Purchasing Ingredients, and Cooking at School Increases Willingness to Try New Foods and Reduces Food Neophobia

OBJECTIVE

To investigate the effect of involving children in their feeding process (choosing a recipe, purchasing the ingredients, and cooking) on their lunch food choice in a school environment.

DESIGN

Quasi-experimental.

SETTING

Two schools in Bilbao, Spain.

PARTICIPANTS

A total of 202 children (aged 8-9 years) participated in the study (43% girls), with 99 in the nutrition education (NE) group and 103 in the hands-on (HO) group.

INTERVENTION

Three 1-hour workshops (1 workshop/wk), different for each group: HO, cooking-related activities, and NE, healthy habits promotion through nutrition education activities.

MAIN OUTCOME MEASURES

Food neophobia, diet quality, cooking self-efficacy and attitudes toward cooking, and food intake and selection of the experimental lunches.

ANALYSIS

Chi-square test of independence, ANCOVA, and t tests were performed.

RESULTS

Students from the HO group selected and ate more spinach/broccoli (P < 0.001 and P = 0.02, respectively) for the first lunch; and selected more spinach/broccoli (P = 0.04) for the second lunch. After the intervention, improvements were observed for spinach liking and neophobia for the HO group and cooking self-efficacy and KidMed score for both groups.

CONCLUSIONS AND IMPLICATIONS

Both interventions succeeded in improving children's diet quality, but only the HO group reduced food neophobia levels. Therefore, involving children in choosing a recipe, purchasing ingredients, and cooking may promote changing eating behaviors toward healthy habits such as increasing vegetable consumption.

Balance Nutrition Messages Are Still Implemented in Preschools One Year Postintervention: Case Studies in Subang District, West Java, Indonesia

Thirty-two teachers from 10 preschools in Cisalak subdistrict, Subang district, West Java province, Indonesia, received a two-day training on Balance Nutrition and My Plate in February 2018. The main messages underlined in the training were consume a variety of foods, drink enough water daily, wash your hands with soap, be physically active, and monitor your body weight. The training was followed by an eight-week implementation period to preschoolers aged 3 to 6 y. The knowledge of the teachers increased by up to 33 percentage points (average score: 69 to 82 pre- vs. posttest) after training, and the teachers answered correctly to the same questions 15 mo later. The mothers' knowledge increased by up to 37 percentage points after parenting sessions. All seven teaching aids provided were used by end-line, but their usage decreased after seven months (range: 2 to 7) and further decreased by 12 mo postintervention (range: 2 to 5). A teacher's handbook and a flipchart were the two aids persistently used. The practices of washing hands with soap, bringing healthy packed lunches, and monitoring weight and height continued after 12 mo postintervention. Dissemination of Balance Nutrition knowledge to fellow teachers of the same school, colleagues from different schools, or to representatives of preschool associations was evident. Training should be scaled up to the district level, using trained teachers as trainers and adopting a cascade training method. National roll-out by teachers' associations, in collaboration with the Ministry of Education and the Ministry of Health, could improve the knowledge of over 200,000 preschool teachers and potentially improve the nutrition of 19 million preschoolers.

The taste of biodiversity: science and sensory education with different varieties of a vegetable to promote acceptance among primary school children

OBJECTIVE

To determine the impact of an educational programme for primary schools that explored the biodiversity of tomato, by promoting science and sensory education with three distinct varieties of it, in the acceptance of vegetables.

DESIGN

A randomised controlled study in which children were exposed to the educational programme (intervention group) or remained in the class, as usual (control group). The educational programme consisted of three sessions where children explained the observed differences between the three varieties of tomato and individual perceptions of their flavours based on sensory-based food education and by planning and implementing experiments to explain those differences. We tested the effects on both children's willingness to try and their liking for tomato, and for lettuce and cabbage to study the carry-over effect, compared with the control group (Mann-Whitney U test; P < 0·05).

SETTING

The study took place in public primary schools in Porto, Portugal.

PARTICIPANTS

Children in the third grade (8-13-year-old children) (n 136) were randomly assigned to intervention or control group.

RESULTS

Children in the intervention group reported significant increases in their willingness to try and liking for tomato compared to the control group (P < 0·05), but not for lettuce and cabbage (P > 0·05).

CONCLUSIONS

These results highlight the potential for fostering children's acceptance of a vegetable by exploring biodiversity through science education. Further work may clarify the effects of exploring biodiversity on the consumption of vegetables and establish whether the results are stable over time and replicable across contexts and populations.

Nutrition Education Intervention Increases Fish Consumption among School Children in Indonesia: Results from Behavioral Based Randomized Control Trial

This study aimed to analyze the effectiveness of behavioral-based nutrition education to increase fish consumption among school children using a raised bed pool. This was a randomized control trial study with a 3-months nutrition education intervention using a raised bed pool, as a medium to improve their internalization to increase fish consumption behavior. A paired t-test was used to calculate the difference in the increase of fish consumption, knowledge, attitude, perceived behavioral control, subjective norm, and intention. This study took place in a majority of low to medium urban households in Surabaya in Sidotopo Wetan I and Sidotopo Wetan II elementary school. Elementary school children at 4th and 5th grade and mother of elementary school children with 104 children were eligible and willing to participate. After the completion of interventions, significant improvement in delta-mean and effectiveness observed in attitude, subjective norm, perceived behavioral control, intention, knowledge, and fish consumption (p < 0.001). The 3 months of nutrition education intervention based on the theory of planned behavior significantly increase fish consumption among elementary school children. The increased consumption was believed to be related to the increase in children’s knowledge and attitude towards consuming fish.

Garden-based interventions and early childhood health: an umbrella review

BACKGROUND

Garden-based interventions show promise for improving not only child nutrition, but other indicators of child health. Yet, existing systematic reviews of garden-based interventions often focus on one particular health outcome or setting, creating a need to holistically summarize review-level evidence on the role of garden-based interventions in early childhood. To fill this gap, we performed an umbrella review of garden-based interventions to examine their role in early childhood health promotion for children ages 6 years and younger, examining effective components of garden-based interventions and critically evaluating existing evidence.

METHODS

We searched the following databases: PubMed, PubMed, PsycINFO, ERIC, CINAHL, Embase, Scopus, OVID-Agricola, and CAB Direct, limiting to reviews published from 1990 to August 2019. Of the 9457 references identified, we included a total of 16 unique reviews for analysis.

RESULTS

Across reviews, garden based-interventions were most effective at improving nutrition-related outcomes for children, including nutritional status and fruit and vegetable consumption. Few reviews examined child health outcomes of garden-based interventions that were not nutrition related, such as physical activity, or academic performance. Across settings, there was the most evidence in support of garden-based interventions conducted in home gardens, compared to evidence from early care and education or community settings. We were unable to report on most effective components of garden-based interventions due to limitations of included reviews.

CONCLUSIONS

Existing evidence is difficult to interpret due to methodological limitations at both the review and primary study level. Therefore, the lack of evidence for certain child health outcomes should not necessarily be interpreted as an absence of an effect of garden-based interventions for specific outcomes, but as a product of these limitations. Given the breadth of evidence for garden-based interventions to improve a number of dimensions of health with older children and adult populations, we highlight areas of future research to address evidence gaps identified in this umbrella review. Further research on the role of garden-based interventions, including their impact on non-nutrition early childhood health outcomes and how effectiveness differs by setting type is necessary to fully understand their role in early childhood health promotion.

PROSPERO REGISTRATION

CRD42019106848 .

Impact of a Gardening and Physical Activity Intervention in Title 1 Schools: The TGEG Study

Background: The purpose of the Texas!Grow!Eat!Go! (TGEG) study was to assess individual and combined effects of school-based gardening and physical activity (PA) interventions on children's eating and PA behaviors and obesity status. Methods: Using a 2 × 2 design, 28 low-income schools in Texas were randomized to 1 of 4 conditions: (1) School Garden intervention (Learn!Grow!Eat!Go! [LGEG]), (2) PA intervention (Walk Across Texas [WAT!]), (3) both Garden and PA intervention (Combined), or (4) neither Garden nor PA intervention (Control). Participants included 1326 third grade students and parents (42% Hispanic; 78% free/reduced lunch). Student and parent data were collected at the beginning and end of the school year. Two different sets of analyses measuring pre-post changes in outcomes within and across conditions were estimated by factorial ANOVAs using mixed models adjusted for demographics. Results: Main effect analyses indicate that relative to children at schools that did not receive LGEG, children at schools that received LGEG, either individually or in combination with WAT!, showed significant increases in Nutrition knowledge, Vegetable preference, and Vegetable tasted (p < 0.001 in all cases). Within-group analyses show that compared to Comparison, children in the WAT! group significantly increased in the amount of time parents and children were active together (p = 0.038). In addition, children in LGEG and WAT! schools significantly decreased BMI percentile (p = 0.042, p = 0.039, respectively), relative to children in Comparison schools. Conclusions: Both the garden and PA interventions independently produced significant changes related to healthy lifestyle behaviors. However, combining the two interventions did not show greater impact than the single interventions, underscoring the need for more research to determine how to better implement comprehensive interventions at schools.

What is the evidence for the impact of gardens and gardening on health and well-being: a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription

OBJECTIVE

To systematically identify and describe studies that have evaluated the impact of gardens and gardening on health and well-being. A secondary objective was to use this evidence to build evidence-based logic models to guide health strategy decision making about gardens and gardening as a non-medical, social prescription.

DESIGN

Scoping review of the impact of gardens and gardening on health and well-being. Gardens include private spaces and those open to the public or part of hospitals, care homes, hospices or third sector organisations.

DATA SOURCES

A range of biomedical and health management journals was searched including Medline, CINAHL, Psychinfo, Web of Knowledge, ASSIA, Cochrane, Joanna Briggs, Greenfile, Environment Complete and a number of indicative websites were searched to locate context-specific data and grey literature. We searched from 1990 to November 2019.

ELIGIBILITY CRITERIA

We included research studies (including systematic reviews) that assessed the effect, value or impact of any garden that met the gardening definition.

DATA EXTRACTION AND SYNTHESIS

Three reviewers jointly screened 50 records by titles and abstracts to ensure calibration. Each record title was screened independently by 2 out of 3 members of the project team and each abstract was screened by 1 member of a team of 3. Random checks on abstract and full-text screening were conducted by a fourth member of the team and any discrepancies were resolved through double-checking and discussion.

RESULTS

From the 8896 papers located, a total of 77* studies was included. Over 35 validated health, well-being and functional biometric outcome measures were reported. Interventions ranged from viewing gardens, taking part in gardening or undertaking therapeutic activities. The findings demonstrated links between gardens and improved mental well-being, increased physical activity and a reduction in social isolation enabling the development of 2 logic models.

CONCLUSIONS

Gardens and gardening can improve the health and well-being for people with a range of health and social needs. The benefits of gardens and gardening could be used as a 'social prescription' globally, for people with long-term conditions (LTCs). Our logic models provide an evidence-based illustration that can guide health strategy decision making about the referral of people with LTCs to socially prescribed, non-medical interventions involving gardens and gardening.

Evaluation of the Impact of School Garden Exposure on Youth Outlook and Behaviors toward Vegetables in Southern Arizona

BACKGROUND

Our objective was to evaluate the effect of garden-based learning on outlook and behaviors toward vegetables among primarily Latinx students. An educational strategy, garden-based learning is a teaching tool that complements other disciplines.

METHODS

Third- and fourth-grade students at 4 elementary schools with different garden programs completed a bingo survey and participated in class discussions to measure outlook and behaviors toward vegetables.

RESULTS

Students in schools with more garden exposure were more likely to answer "Yes" to survey questions reflecting a positive attitude and behaviors toward vegetables. In class discussions, students most often mentioned vegetables grown in the school garden as their favorite vegetables.

CONCLUSION

For third- and fourth-grade students, the length of exposure to a school garden appears to have a positive impact on both perceptions of and desire to consume vegetables. Other studies have shown that positive outlook and behaviors toward vegetables can change vegetable consumption habits in children. Integrating garden-based learning into the school curriculum may positively influence eating behaviors over the long-term future.

Investing in Public School Kitchens and Equipment as a Pathway to Healthy Eating and Equitable Access to Healthy Food

BACKGROUND

We gathered baseline data about student need of healthy, free school food, and if current school meal programming serves students in need of healthy free school food, in anticipation of the completion of a district-wide kitchen infrastructure and educational farm project in a high-poverty urban school district.

METHODS

We used mixed methods to assess student hunger, whether the school meal program met student needs, and to determine associations between presence of a cooking kitchen and perceptions of healthy food. Participants included 72 staff, 143 parents, and 6437 K-5 students in the qualitative component, and 9078 parents and 1693 staff in the quantitative component.

RESULTS

Staff participants stated packaging and reheating food influenced student consumption. During observations, students at seven of nine high poverty sites with packaged reheated food did not eat school meals, but this was not true at four out of four high-poverty sites with unpackaged fresh food. Parents (OR = 1.17, 95% CI 1.00-1.39) and staff (OR = 1.58, 95% CI 1.15-2.17) from schools with a cooking kitchen were more likely to perceive school lunch as healthy in adjusted models.

CONCLUSIONS

Food preparation and presentation appears to influence student consumption of school food and adult perception of school meal quality.

School Gardening Activities Aimed at Obesity Prevention Improve Body Mass Index and Waist Circumference Parameters in School-Aged Children: A Systematic Review and Meta-Analysis

Background: Childhood obesity, due to its increasing prevalence, is one of the most challenging problems in public health and prevention. Recent strategies have been implemented to tackle this trend, including school gardening projects. This systematic review analyzes the main elements of school gardening with a specific meta-analysis about its impact on anthropometric parameters. Materials and Methods: We searched studies in PubMed, EMBASE, and Cochrane Library on school gardening projects carried out until February 2019 and addressed to children aged 6 to 13 years. Results: Thirty-three studies passed the screening selection. Outcomes analyzed were fruits and vegetables consumption/knowledge, nutritional attitudes and behavior, anthropometric outcomes (i.e., BMI, waist circumference-WC) and other outcomes (i.e., blood pressure, science achievement, and physical activity). We performed descriptive analyses of these outcomes and found a general benefit from school gardening projects. We subsequently performed a meta-analysis on anthropometric outcomes, highlighting a significant reduction of both BMI percentile (%) (-1.37%) and WC (-1.30 cm). Conclusions: Although more high-quality studies are needed on this topic, along with a greater homogeneity of anthropometric measurements, the results of our article show a modest but positive impact of school gardening projects on anthropometric measures and more generally on children's health.

Garden-Based Integrated Intervention for Improving Children's Eating Behavior for Vegetables

This study was conducted to develop and verify the effects of a garden-based integrated intervention for improving children’s eating behavior for vegetables. A pre-post-test experimental design was employed. The participants were 202 elementary school students (average age: 11.6 ± 1.5 years). The garden-based integrated intervention program was conducted during regular school hours for a total of 12 weeks. The program, based on a mediator model for improving children’s eating behavior, included gardening, nutritional education, and cooking activities utilizing harvests. In order to examine effects of the program, the mediating factors related to children’s eating behavior were evaluated using pre-post questionnaires. As a result of the program, dietary self-efficacy, outcome expectancies, gardening knowledge, nutrition knowledge, vegetable preference, and vegetable consumption were significantly increased, and food neophobia was significantly decreased. In addition, there were positive correlations between most mediating factors. Thus, the garden-based integrated intervention developed in this study was effective in improving children’s eating behavior for vegetables.

The Influence of Food Production Experience on Dietary Knowledge, Awareness, Behaviors, and Health among Japanese: A Systematic Review

This study aimed to reveal the influence of food production experience on dietary knowledge, dietary awareness, dietary behaviors, and health among Japanese populations. We conducted a systematic review of articles published between January 2000 and September 2018 (PROSPERO registration number: CRD42019117163) using the following four databases: PubMed, Web of Science, CiNii, and ICHUSHI. The search formulas were created by combining search terms “agricultural experience,” “garden,” “diet,” “food,” “physical activity,” “health,” and “well-being.” The articles were identified by titles, abstracts, and whole texts. We evaluated the content of the articles that met the adoption criteria. We included original articles from peer-reviewed scientific journals, articles written in Japanese or English, observational or interventional studies with statistical analyses, and articles targeting general Japanese people (except for those targeting patients or disabled) to examine the relationship according to the purpose of this review. Nineteen articles met the study criteria, including 10 cross-sectional studies, one retrospective study, seven pre–post studies, and three non-randomized controlled trials. Two studies combined multiple research designs. Thus, food production experiences were suggested to have a positive influence on dietary knowledge, dietary awareness, food preference, dietary behaviors, and mental health among the Japanese. However, the overall quality of the included studies was low. Further verification with randomized controlled trials and prospective cohort studies is required.

Garden-based interventions and early childhood health: a protocol for an umbrella review

BACKGROUND

Garden-based interventions have the potential to impact young children's health in a number of ways, including enhancing dietary intake, increasing outdoor physical activity, diversifying the gut microbiome, and promoting general wellbeing. A number of recent systematic reviews have either included or focused on garden-based interventions for young children. However, most prior reviews including young children only focus on one health outcome or one setting, making a full summary of prior research assessing the impact of garden-based interventions nonexistent. As such, this umbrella systematic review aims to synthesize the literature on health outcomes of garden-based interventions for young children.

METHODS

This protocol outlines the systematic steps we will take to conduct an umbrella review on health-related outcomes of garden-based interventions in children younger than 6 years of age. We will systematically search PubMed, PsycINFO, ERIC, CINAHL, Embase, Scopus, OVID-Agricola, and CAB Direct, including all systematic reviews and meta-analyses fitting the pre-determined inclusion/exclusion criteria. We will double screen at each phase of the review: title/abstract, full text, data extraction, and quality appraisal. We will assess the quality of included reviews using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). Based on the potential for stark variability in what how reviews report child health outcomes, we will analyze the reviews both narratively and quantitatively, reporting summary of findings tables and iteratively mapping the results. This protocol aligns with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement (PRISMA-P).

DISCUSSION

This umbrella review aims to summarize the role that garden-based interventions play in health promotion for young children. We will focus on a number of diverse child health outcomes in an effort to comprehensively synthesize the evidence to inform future garden-based interventions, research, and policy.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019106848.

Perceived Barriers to Fruit and Vegetable Gardens in Early Years Settings in England: Results from a Cross-Sectional Survey of Nurseries

Garden-based interventions may increase child intake of fruits and vegetables and offset food costs, but few have been conducted in early care and education (ECE). This study assessed whether nurseries were interested in and perceived any barriers to growing fruits and vegetables. Surveys were mailed to a cross-sectional sample of nurseries in 2012–2013 throughout England. Nurseries were stratified based on socioeconomic status as most, middle, or least deprived areas. We fit logistic regression models to assess the odds of nurseries interested in growing fruits and vegetables and perceiving any barriers, by deprivation tertile. A total of 851 surveys were returned (54% response). Most nurseries (81%) were interested in growing fruits and vegetables. After adjustment, there was no difference in interest in the middle (OR 1.55; CI 0.84, 2.78; p = 0.16) or most (OR 1.05; CI 0.62, 1.78; p = 0.87) deprived areas, compared to the least deprived. Nurseries reported barriers to growing fruits and vegetables, including space (42%), expertise (26%), and time (16%). Those in the most deprived areas were more likely to report space as a barrier (OR 2.02; 95% CI 1.12, 3.66; p = 0.02). Nurseries in the most deprived areas may need creative solutions for growing fruits and vegetables in small spaces.

Farm-to-school education grants reach low-income children and encourage them to learn about fruits and vegetables

Oregon’s Farm to School Education Grant Program reached students in low-income districts, enabled districts to conduct farm to school educational activities, and allowed children to learn about local produce.

Healthy eating promoting in a Brazilian sports-oriented school: a pilot study

BACKGROUND

Adolescents, particularly athletes, have high exposure to ultra-processed foods, which could be harmful to their health and physical performance. School environments are capable of improving eating patterns. Our study is aimed at capturing changes in students' food consumption three years after they enrolled at an experimental school, considered a model of health promotion in Rio de Janeiro city. We also aimed to depict the promising nature of the healthy eating promotion program implemented in the school and share the learnings from its implementation.

METHODS

Our pilot study was a follow-up on the implementation of a school garden, experimental kitchen activities, and health promotion classes. We evaluated 83 adolescent athletes' food consumption twice during the study: at its beginning (2013) and end (2016), by administering a food frequency questionnaire (FFQ) that inquired about the frequency of foods consumed in the past week. To evaluate how effectively the activities were established, integrated, and sustained in schools, the Garden Resources, Education, and Environment Nexus (GREEN) tool was used, and the school's adherence to the school garden program was classified as high (scored 47 points out of 57).

RESULTS

In 2013, 89 adolescents (mean ± SD 11.9 ± 0.4 years, 54% male) participated in the study, of which 83 continued until 2016 (14.8 ± 0.5 years, 55% male). In 2013, the mean frequency of raw salad and fruits consumption was 1.4 (CI [1.0-1.9]) and 4.3 (CI [3.8-4.9]) days per week, respectively. Three years later, the frequency of raw salad and fruits consumption was 2.2 (CI [1.6-2.7]) and 5.0 (4.5-5.5), respectively. Considering that five meals were offered at school (five days/week), it may be possible to assume that the program raised awareness on the importance of healthy eating.

CONCLUSION

Our results suggest that such integrated healthy eating promotion programs may improve adolescent athletes' eating habits, by increasing the frequency of their consumption of unprocessed foods. This pilot study's results inspired us to implement an expanded project at the municipal level. Since 2018, teachers who participated in this program are working with Rio de Janeiro's Municipal Secretary of Education for Coordination of Curricular Projects. Some learnings from this pilot study on implementing the garden/experimental kitchen project in this school are being applied in 65 schools of the municipal network: joint activities must be fostered among students, teachers, and parents; healthy eating needs to be a respected value among adolescent athletes and become an example for parents and teachers.

Food literacy programmes in secondary schools: a systematic literature review and narrative synthesis of quantitative and qualitative evidence

OBJECTIVE

The current review aimed to synthesise the literature on food literacy interventions among adolescents in secondary schools, the attitudes and perceptions of food literacy interventions in secondary schools, and their effects on dietary outcomes.

DESIGN

The systematic review searched five electronic databases from the earliest record to present.

SETTING

The studies selected for the review were from sixteen countries: Australia (n 10), Canada (n 1), China (n 1), France (n 1), Greece (n 2), Iran (n 1), South Africa (n 1), South India (n 1), Kenya (n 1), Norway (n 2), Portugal (n 1), Denmark (n 1), Northern Ireland (n 1), USA (n 17), UK (n 1) and Sweden (n 2).

PARTICIPANTS

Adolescents aged 10-19 years.

RESULTS

Forty-four studies were eligible for inclusion. Adolescents with greater nutritional knowledge and food skills showed healthier dietary practices. Studies found a mixed association between food literacy and long-term healthy dietary behaviour. Two studies showed an improvement in adolescents' cooking skills and food safety knowledge; six studies showed an improvement in overall food safety knowledge; six studies showed an improvement in overall food and nutritional knowledge; and two studies showed an improvement in short-term healthy dietary behaviour.

CONCLUSIONS

Food literacy interventions conducted in a secondary-school setting have demonstrated a positive impact on healthy food and nutritional knowledge. However, there appears to be limited evidence supporting food literacy interventions and long-term dietary behaviours in adolescents. More evidence-based research is required to adequately measure all domains of food literacy and more age-specific food literacy interventions.

Cooking and Gardening Behaviors and Improvements in Dietary Intake in Hispanic/Latino Youth

Background: School gardening interventions typically include cooking and gardening (CG) components; however, few studies have examined associations between CG psychosocial behaviors (attitudes, self-efficacy, and motivation), dietary intake, and obesity parameters. This study assessed the association between changes in CG behaviors with changes in dietary intake and obesity in participants of the LA Sprouts study, an after-school, 12-week, randomized controlled CG intervention conducted in four inner-city elementary schools in Los Angeles. Methods: Process analysis using data from 290 low-income, primarily Hispanic/Latino third through fifth-grade students who were randomized to either the LA Sprouts intervention (n = 160) or control group (n = 130). Height, weight, waist circumference, dietary intake via questionnaire, and CG behaviors were collected at baseline and postintervention. Linear regressions determined whether changes in CG behaviors predicted changes in dietary intake and obesity outcomes. Results: There were no differences in changes in CG psychosocial behaviors between intervention and control groups, therefore groups were combined. Participants were 49% male, 87% Hispanic/Latino, and an average age of nine. Increases in cooking behaviors significantly predicted increases in dietary fiber intake (p = 0.004) and increases in vegetable intake (p = 0.03). Increases in gardening behaviors significantly predicted increased intake of dietary fiber (p = 0.02). Changes in CG behaviors were not associated with changes in BMI z-score or waist circumference. Conclusions: Results from this study suggest that school-based interventions should incorporate CG components, despite their potentially costly and time-intensive nature, as these behaviors may be responsible for improvements in dietary intake of high-risk minority youth.

School Gardens in the United States: Current Barriers to Integration and Sustainability

OBJECTIVES

To elucidate details about the barriers (time, funding, staffing, and space) to integrating and sustaining school gardens.

METHODS

A total of 99 school gardeners from 15 states participated in an online survey in June 2017. The 29-item survey contained qualitative and quantitative items that we analyzed using descriptive statistics and inductive content analysis.

RESULTS

In order of greatest to least barrier, gardeners ranked time, staff, funding, curriculum, and space. Time for classes to use the garden (66% of respondents) and time for staff training (62%) were the most frequently listed time-related challenges. Respondents also reported low engagement within the school community. An overall lack of funding was the most common funding-related barrier, and gardeners were unaware of how to obtain more funding.

CONCLUSIONS

We identified 3 aspects of school gardens as opportunities to address time- and staff-related issues: strengthening of garden committees, professional development, and community outreach. Better channels are needed to disseminate funding opportunities within schools and to communicate with communities at large. Ultimately, doing so will strengthen existing school gardens as a vehicle to promote dietary, physical, and social health within communities.

Cultivating healthy trajectories: An experimental study of community gardening and health

Advances in behavioral medicine suggest that optimal solutions to modern health challenges should be multifaceted, targeting multiple cognitions and behaviors simultaneously. Community gardening holds great promise as one such multifaceted intervention but lacks rigorous evidence of efficacy. We present one of the first experimental studies on the topic. The results revealed promise for aspects of community gardening, but also suggest the necessity for the use of rigorous methodologies moving forward. In addition, this article provides a framework for studying the effects of community gardening and similar multifaceted health promotion efforts.

Impacts of a Vegetable Cooking Skills Program Among Low-Income Parents and Children

OBJECTIVE

To evaluate the impact of a vegetable-focused cooking skills and nutrition program on parent and child psychosocial measures, vegetable liking, variety, and home availability.

DESIGN

Baseline and postcourse surveys collected 1-week after the course.

SETTING

Low-income communities in Minneapolis-St Paul.

PARTICIPANTS

Parent-child dyads (n = 89; one third each Hispanic, African American, and white) with complete pre-post course data; flyer and e-mail recruitment.

INTERVENTION(S)

Six 2-hour-weekly sessions including demonstration, food preparation, nutrition education lessons, and a meal.

MAIN OUTCOME MEASURES

Parental cooking confidence and barriers, food preparation/resource management, child self-efficacy and cooking attitudes, vegetable liking, vegetable variety, and vegetable home availability.

ANALYSIS

Pre-post changes analyzed with paired t test or Wilcoxon signed-rank tests. Results were significant at P < .05.

RESULTS

Increased parental cooking confidence (4.0 to 4.4/5.0), healthy food preparation (3.6 to 3.9/5.0), child self-efficacy (14.8 to 12.4; lower score = greater self-efficacy), vegetable variety (30 to 32/37 for parent, 22 to 24/37 for child), and home vegetable availability (16 to 18/35) (all P < .05).

CONCLUSIONS AND IMPLICATIONS

A short-term evaluation of a vegetable-focused cooking and nutrition program for parents and children showed improvements in psychosocial factors, variety, and home availability.

Development of iGrow: A Curriculum for Youth/Adult Dyads to Increase Gardening Skills, Culinary Competence, and Family Meal Time for Youths and Their Adult Caregivers

This manuscript describes the development of a “learn by actively participating” curriculum for youth and their adult caregivers (dyad pair) to increase gardening skills, culinary competence, and family meal time. The curriculum was developed by integrating “iCook 4-H” and Junior Masters Gardener “Health and Nutrition from the Garden”, and “Essential Elements of 4-H Youth Development” curriculums with additional resources for gardening activities from the USDA’s My Plate and garden-based recipes. Expert reviewers (n = 11) provided feedback on the curriculum content, session structure, dosage, age appropriateness, and balance of the three focused areas. Seven family dyads (n = 14) participated in focus groups about understanding of need, interest, barriers, and potential engagement. A 10-week curriculum was developed and named: iGrow. The curriculum is a hands on, active learning program delivered through five, two-hour sessions using a family dyad model. Three main focus areas included gardening, culinary skills, and family conversation/interaction that all focused on togetherness. For the final iGrow curriculum, expert-level content review and feedback from focus group dyad pairs was used to revise the curriculum which further enhanced the approach and balance of the curriculum content. Focus group feedback supported appropriateness, dosage and learning objectives, and content depth. This curriculum has been developed to provide knowledge of gardening and culinary skills with the goal of increased consumption of fruit and vegetables.

The carry-over effects of school gardens on fruit and vegetable availability at home: A randomized controlled trial with low-income elementary schools

This group-randomized controlled trial examines the effects of a school garden intervention on availability of fruits and vegetables (FV) in elementary school children's homes. Within each region, low income U.S. schools in Arkansas, Iowa, New York, and Washington State were randomly assigned to intervention group (n = 24) or waitlist control group (n = 22). Children were in grades 2, 4, and 5 at baseline (n = 2768). The garden intervention consisted of both raised-bed garden kits and a series of grade-appropriate lessons. FV availability at home was measured with a modified version of the GEMS FJV Availability Questionnaire. The instrument was administered at baseline (Fall 2011) and throughout the intervention (Spring 2012, Fall 2012, Spring 2013). Analyses were completed using general linear mixed models. The garden intervention led to an overall increase in availability of low-fat vegetables at home. Among younger children (2nd grade at baseline), the garden intervention led to greater home availability of vegetables, especially, low-fat vegetables. Moreover, for the younger group, garden intervention fidelity (GIF) or robustness predicted home availability of fruit, vegetables, and low-fat vegetables. School gardens have potential to affect FV availability in the home environment.

Perceptions of School-Based Kitchen Garden Programs in Low-Income, African American Communities

Introduction. While school-based kitchen garden programs are shown to improve fruit and vegetable consumption and knowledge among children, there has been little research on participant perceptions of these programs, specifically among minority populations that are disproportionately affected by and at high risk for overweight and obesity. This qualitative study examined the perceptions of and values associated with participation in school-based kitchen garden programs implemented through Edible Schoolyard New Orleans in low-income, predominantly African American schools in New Orleans, Louisiana. Method. Qualitative data were collected through semistructured focus group discussions with key stakeholder groups at schools offering Edible Schoolyard New Orleans. Results. A total of 10 focus groups were conducted across 4 middle schools with students (n = 27), parents (n = 17), and teachers (n = 17). Four primary themes emerged during data analysis: development of life skills, food and health, family and community, and experiential and participatory learning. Conclusions. To strengthen the sustainability and potential impact of school-based kitchen garden programs, future intervention strategies should place specific emphasis on the themes that emerged from this study. School-based kitchen garden programs may be a promising strategy to positively influence the individual, social, and physical environmental factors that contribute to overweight and obesity in low-income, African American communities.

Indicators to support healthy urban gardening in urban management

Urban gardening is part of a trend towards more parks and green areas in cities, consumption of organic, locally grown products, and a closer relationship with one's own living environment. Our literature review shows that urban gardens provide opportunities for physical activity and allow people to consume homegrown fruit and vegetables. Urban gardens may also reduce stress levels of gardeners and improve social cohesion. In this way, they can help to prevent health problems. Good quality of urban soil and the functioning of soil ecosystems are indispensable prerequisites for these. We developed a framework that shows how ecosystem health and human health are interconnected in urban gardening, by placing it in the context of urban green space management and valuation. This study yields a set of indicators, which can be used to assess soil ecosystem services and health impacts. They may provide a basis for the evolving dialogue in decision-making processes and partnership activities in urban management. Recognizing the potential effects and discussing what is important to whom, might be enough to find synergies. Importantly, the initiators of urban gardens are often citizens, who seek support from other stakeholders. The social network established by gardens may contribute to health-enabling, cohesive communities involved with their living environment. To maximize health benefits, it is useful to make the urban gardens accessible to many people. This study suggests that urban gardens deserve a position in urban green space management as they may help to address societal challenges like urbanization, health and well-being in aging populations and climate adaptation.