LA Sprouts: A 12-Week Gardening, Nutrition, and Cooking Randomized Control Trial Improves Determinants of Dietary Behaviors

Urban indoor gardening enhances immune regulation and diversifies skin microbiota - A placebo-controlled double-blinded intervention study

According to the hygiene and biodiversity hypotheses, frequent exposure to environmental microbiota, especially through soil contact, diversifies commensal microbiota, enhances immune modulation, and ultimately lowers the risk of immune-mediated diseases. Here we test the underlying assumption of the hygiene and biodiversity hypotheses by instructing volunteers to grow edible plants indoors during the winter season when natural exposure to environmental microbiota is low. The one-month randomized, placebo-controlled double-blind trial consisted of two treatments: participants received either microbially diverse growing medium or visually similar but microbially poor growing medium. Skin microbiota and a panel of seven immune markers were analyzed in the beginning of the trial and after one month. The diversity of five bacterial phyla (Bacteroidetes, Planctomycetes, Proteobacteria, Cyanobacteria, and Verrucomicrobia) and one class (Bacteroidia) increased on the skin of participants in the intervention group while no changes were observed in the placebo group. The number of nodes and edges in the co-occurrence networks of the skin bacteria increased on average three times more in the intervention group than in the placebo group. The plasma levels of the immunomodulatory cytokine interleukin 10 (IL-10) increased in the intervention group when compared with the placebo group. A similar trend was observed in the interleukin 17A (IL-17A) levels and in the IL-10:IL-17A ratios. Participants in both groups reported high satisfaction and adherence to the trial. The current study provides evidence in support of the core assumption of the hygiene and biodiversity hypotheses of immune-mediated diseases. Indoor urban gardening offers a meaningful and convenient approach for increasing year-round exposure to environmental microbiota, paving the way for other prophylactic practices that might help prevent immune-mediated diseases.

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.

Testing the Effects of Two Field-to-Fork Programs on the Nutritional Outcomes of Elementary School Students From Diverse and Lower-Income Communities

The purpose of this quasi-experimental study was to evaluate the effects of two farm-to-school programs, specifically the Field-to-Fork Multi-visit Program (N  =  264) and the Field-to-Fork After-school Club (N  =  56), on nutritional outcomes of elementary school students (third to fifth grade) from urban, diverse, and lower-income communities. Data were collected via self-report surveys measuring: (a) knowledge of recommendations for daily fruit and vegetable intake; (b) fruit and vegetable consumption; (c) knowledge of cooking a healthy recipe using vegetables; and (d) desire for farm fresh foods at school. Statistical analyses included McNemar's and Wilcoxon signed rank tests. The proportion of students knowing how to cook a vegetable rich recipe increased with both programs (Multi-visit Program p < .001; After-school Club p  =  .002). Vegetable consumption increased with the After-school Club (p  =  .002). Farm-to-school programming can increase knowledge of cooking vegetable rich recipes and vegetable intake among elementary school students from diverse, urban, and lower-income communities.

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.

A home gardening intervention to improve vegetable consumption among urban poor children: A study protocol for randomised controlled trial

Background: One of the key importance of vegetable consumption is to obtain sufficient micronutrients, dietary fibre, and for the prevention of childhood obesity. Most Malaysian children did not meet the recommended intake of vegetable consumption, and this is especially vulnerable among the urban poor population due to food insecurity. Efforts are needed to promote vegetable consumption that fall short of the recommended intake level. Aim: This trial aims to examine the effectiveness of the "GrowEat" project, as a nutrition intervention programme integrated with home gardening activities to improve vegetable consumption among urban poor children in Kuala Lumpur, Malaysia. Methods: This is a single-blinded parallel two-arm cluster randomised controlled trial (RCT) that include 134 children. Two zones in Kuala Lumpur will be randomly selected, and three low-cost housing flats from each zone will be selected as the intervention and control groups respectively. The trial is designed based on the social cognitive theory (SCT). Children from the intervention group (n = 67) will attend a 12-week programme, which consists of home garden-based activities, gardening and nutrition education session. Assessment will be conducted for both groups at three time points: baseline, post-intervention and follow-up phase at 3 months after the intervention. Conclusion: We anticipate positive changes in vegetable consumption and its related factors after the implementation of the "GrowEat" project. The current intervention may also serve as a model and can be extended to other urban poor population for similar interventions in the future to improve vegetable consumption, agriculture and nutrition awareness.

School Gardening and Health and Well-Being of School-Aged Children: A Realist Synthesis

School environments can create healthy settings to foster children's health and well-being. School gardening is gaining popularity as an intervention for healthier eating and increased physical activity. We used a systematic realist approach to investigate how school gardens improve health and well-being outcomes for school-aged children, why, and in what circumstances. The context and mechanisms of the specific school gardening interventions (n = 24) leading to positive health and well-being outcomes for school-aged children were assessed. The impetus of many interventions was to increase fruit and vegetable intake and address the prevention of childhood obesity. Most interventions were conducted at primary schools with participating children in Grades 2 through 6. Types of positive outcomes included increased fruit and vegetable consumption, dietary fiber and vitamins A and C, improved body mass index, and improved well-being of children. Key mechanisms included embedding nutrition-based and garden-based education in the curriculum; experiential learning opportunities; family engagement and participation; authority figure engagement; cultural context; use of multi-prong approaches; and reinforcement of activities during implementation. This review shows that a combination of mechanisms works mutually through school gardening programs leading to improved health and well-being outcomes for school-aged children.

School Gardening, Cooking and Sports Participation Intervention to Improve Fruits and Vegetables Intake and Moderate-to-Vigorous Physical Activity among Chinese Children: Study Protocol for a Cluster Randomized Controlled Trial

Inadequate intake of fruits and vegetables (FV) and moderate-to-vigorous physical activity (MVPA) in children has become a global public health problem. Therefore, school-based gardening and cooking (SGC) and sports participation (SP) interventions may be effective in improving children's FV intake and MVPA. The aim of this study is to develop and evaluate the effectiveness of SGC and SP interventions on FV intake and MVPA among Chinese children. In this cluster randomized controlled trial study, 237 children in grades 4-5 from six public primary schools from Changsha, Hunan Province, China will be randomly assigned to: (1) a SGC and SP combined intervention group; (2) a SP intervention group; (3) a regular practice group. The intervention clusters will be implemented for a period of 6 months and follow up will be carried out after 12 months. The outcome will be collected using a combination of self-reported and objective measures. Primary outcomes will include children's FV intake and duration of MVPA per day, and secondary outcomes will included frequency and attitudes of FV intake and SP, in addition to other measures. Finally, a process evaluation will be used to analyze the facilitators and barriers to intervention implementation. Trial Registration: (Registration Number: ChiCTR2200064141).

Fruit and Vegetable Intake Is Associated with Food Knowledge among Children Aged 9–14 Years in Southwestern Ontario, Canada

Interventions to improve dietary quality and intake of fruits and vegetables (FV) among Canadian children have had modest success, and it has been suggested that food knowledge could be key to improvement. Programs have been criticized for insufficiently connecting food knowledge with food skills and decision making about dietary intake. The objective of this study was to investigate factors associated with FV consumption by elementary school children, aged 9–14 years, in Ontario, Canada, including food knowledge, socioeconomic status, sociodemographic characteristics, and the food environment. In 2017–2019, a cross-sectional survey was administered to 2443 students at 60 elementary schools across Southwestern Ontario (SWO), Canada. A parent survey was used to validate self-reported sociodemographic variables. The mean intake of FV reported by these participants was 2.6 (SD 1.1) and 2.4 (SD 1.2) servings/day, respectively. A FV intake below WHO guidelines was reported by 40.7% of respondents. Knowledge score, child age, and parent employment status significantly predicted higher reported intake of FV. This study shows that FV intake among this population group is low, and increased intake is associated with higher food knowledge. To encourage healthy eating, school-based food and nutrition programs that incorporate multiple components and emphasize food literacy are needed.

Harvest for Health, a Randomized Controlled Trial Testing a Home-Based, Vegetable Gardening Intervention Among Older Cancer Survivors Across Alabama: An Analysis of Accrual and Modifications Made in Intervention Delivery and Assessment During COVID-19

BACKGROUND

Accelerated functional decline is a concern among older cancer survivors that threatens independence and quality of life. Pilot studies suggest that vegetable gardening interventions ameliorate functional decline through improved diet and physical activity.

OBJECTIVE

The aim of this article was to describe the rationale, recruitment challenges, and enrollment for the Harvest for Health randomized controlled trial (RCT), which will test the impact of a home-based, vegetable gardening intervention on vegetable and fruit consumption, physical activity, and physical functioning among older cancer survivors. Modifications made to the intervention and assessments to assure safety and continuity of the RCT throughout the COVID-19 pandemic also are reported.

DESIGN

Harvest for Health is a 2-year, 2-arm, single-blinded, wait-list controlled RCT with cross-over.

PARTICIPANTS/SETTING

Medicare-eligible survivors of cancers with ≥60% 5-year survival were recruited across Alabama from October 1, 2016 to February 8, 2021.

INTERVENTION

Participants were randomly assigned to a wait-list control or a 1-year home-based gardening intervention and individually mentored by extension-certified master gardeners to cultivate spring, summer, and fall vegetable gardens.

MAIN OUTCOME MEASURES

Although the RCT's primary end point was a composite measure of vegetable and fruit consumption, physical activity, and physical functioning, this article focuses on recruitment and modifications made to the intervention and assessments during COVID-19.

STATISTICAL ANALYSES PERFORMED

χ2 and t tests (α < .05) were used to compare enrolled vs unenrolled populations.

RESULTS

Older cancer survivors (n = 9,708) were contacted via mail and telephone; 1,460 indicated interest (15% response rate), 473 were screened eligible and consented, and 381 completed baseline assessments and were randomized. Enrollees did not differ from nonrespondents/refusals by race and ethnicity, or rural-urban status, but comprised significantly higher numbers of comparatively younger survivors, those who were female, and survivors of breast cancer (P < .001). Although COVID-19 delayed trial completion, protocol modifications overcame this barrier and study completion is anticipated by June 2022.

CONCLUSIONS

This RCT will provide evidence on the effects of a mentored vegetable gardening program among older cancer survivors. If efficacious, Harvest for Health represents a novel, multifaceted approach to improve lifestyle behaviors and health outcomes among cancer survivors-one with capacity for sustainability and widespread dissemination.

Evaluating the impacts of school garden-based programmes on diet and nutrition-related knowledge, attitudes and practices among the school children: a systematic review

BACKGROUND

Previous evidence suggests that school garden-based programmes (SGBP) may be a promising yet cost-effective intervention to improve children's knowledge, attitudes and practices (KAP) on healthy eating. This review aimed to summarise and evaluate the evidence available on the impacts of SGBP in addressing diet and nutrition-related KAP among school-aged children.

METHODS

Five databases including PubMed, Embase, Cochrane, Web of Science and Scopus were searched until February 2021. Randomised, non-randomised controlled and pre-post intervention studies investigating the impacts of SGBP on at least one of the outcomes of interest including diet and nutrition-related knowledge, attitudes towards fruits and vegetables (F&V), food diversity and dietary practice among school-aged children were included. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Quality appraisal for studies included was assessed using American Dietetic Association Quality Criteria Checklist.

RESULTS

A total of 10,836 records were identified, and 35 studies that met the inclusion and exclusion criteria were included. This includes 25,726 students from 341 schools and 8 nurseries from 12 countries. Intervention duration ranged from 6 weeks to 4 years with 18 studies involving a varied degree of parental participation. SGBP, which majorly includes school gardening activities, cooking lessons and nutrition education, demonstrated beneficial effects on children's nutritional knowledge, their attitudes and acceptability towards fruits and vegetables and children's dietary practices including the actual F&V consumption and dietary diversity. However, the impacts of SGBP on such outcomes were highly influenced by various social and environmental factors including the activities/components and duration of the intervention, parental involvement, sample size, and the age of children when interventions were first introduced.

CONCLUSION

These findings suggest that SGBP may be effective in promoting children's nutritional knowledge, attitudes and acceptability towards vegetables, however, the impacts may vary by the type, the extent, and the length of the programmes, and other factors such as parent involvement. Future SGBP is suggested to implement using a combined multidisciplinary approach targeting the children, parents, and community to effectively promote healthy eating among the children and prevent childhood obesity.

Children's Afterschool Culinary Education Improves Eating Behaviors

Objective(s)

Culinary education may be one way to improve children's eating behaviors. We formatively evaluated the effect of a hands-on afterschool 12-module, registered dietitian-led culinary education program on healthy eating behaviors in a predominately Hispanic/Latino, low-socioeconomic community.

Methods

Of 234 children participating in the program, 77% completed both pre- and post-assessment surveys (n = 180; mean age 9.8 years; 63.3% female; 74.3% Hispanic/Latino, 88.4% receiving free/reduced lunch). In addition to program satisfaction, we assessed changes in children's self-reported fruit, vegetable, and whole-grain consumption, knowledge, and culinary skills using binary and continuous mixed effects models. We report false discovery rate adjusted p-values and effect sizes.

Results

95.5% of participants reported liking the program. Improved whole grain consumption had a medium effect size, while effect sizes for whole grain servings and vegetable consumption were small, but significant (all p < 0.05). Culinary skills increased between 15.1 to 43.4 percent points (all p < 0.01), with medium to large effect sizes.

Conclusion(s)

The program was well-received by participants. Participants reported improved eating behaviors and culinary skills after program completion. Therefore, this hands-on afterschool culinary education program can help improve healthy eating in a predominantly Hispanic/Latino, low-socioeconomic community.

Cooking Matters for Kids Improves Attitudes and Self-Efficacy Related to Healthy Eating and Cooking

OBJECTIVE

To assess changes in self-efficacy and attitudes related to healthy eating and cooking in Cooking Matters for Kids participants.

DESIGN

Prepost study design.

SETTING

Cooking Matters for Kids programs offered by 35 organizations.

PARTICIPANTS

Predominantly third- to fifth-grade children participating in Cooking Matters for Kids lessons during fiscal years 2012-17 with matched presurvey and postsurveys (n = 18,113).

INTERVENTION(S)

Cooking Matters for Kids consists of six 2-hour experiential nutrition and cooking education lessons.

MAIN OUTCOME MEASURE(S)

Self-efficacy related to healthy eating and cooking and attitudes toward healthy foods assessed through the Cooking Matters for Kids Participant Survey.

ANALYSIS

Changes from the presurvey to postsurvey were assessed using mixed models and repeated measures ordered logistic regression accounting for clustering by course. Effect sizes were calculated using Cohen d for repeated measures. A Bonferroni adjustment was used to correct for multiple comparisons (α = 0.025).

RESULTS

Both overall and individual self-efficacy and attitude scores improved from presurvey to postsurvey (P < 0.0001). The effect sizes were 0.35 for overall self-efficacy score and 0.17 for overall attitude score.

CONCLUSIONS AND IMPLICATIONS

Participation in Cooking Matters for Kids was associated with improvements in self-efficacy and attitudes related to healthy eating and cooking.

Facilitating a high-quality dietary pattern induces shared microbial responses linking diet quality, blood pressure, and microbial sterol metabolism in caregiver-child dyads

Low-resource individuals are at increased risk of obesity and cardiovascular disease (CVD), partially attributable to poor dietary patterns and dysfunctional microbiota. Dietary patterns in childhood play critical roles in physiological development and are shaped by caregivers, making caregiver-child dyads attractive targets for dietary interventions to reduce metabolic disease risk. Herein, we targeted low-resource caregiver-child dyads for a 10-week, randomized, controlled, multifaceted lifestyle intervention including: nutrition and physical activity education, produce harvesting, cooking demonstrations, nutrition counseling, and kinetic activites; to evaluate its effects on dietary patterns, CVD risk factors, and microbiome composition. Subjects in the lifestyle intervention group improved total diet quality, increased whole grain intake, decreased energy intake, and enhanced fecal elimination of the microbe-derived metabolite lithocholic acid (LCA) in contrast to control subjects. Microbiomes were highly personalized, similar within dyads, and altered by lifestyle intervention. Differential modeling of microbiome composition identified taxa associated with total diet quality, whole grain intake, and LCA elimination including recognized fiber-degrading bacteria such as Subdoligranulum, and bile acid metabolizing organisms like Bifidobacterium. Inclusion of taxa identified in diet and metabolite modeling within blood pressure models improved prediction accuracy of microbiome-blood pressure associations. Importantly, microbiota-blood pressure relationships were shared between dyads, implying shared host-microbiota responses to lifestyle intervention. Overall, these outcomes provide insight into mechanisms by which dietary interventions impact the gut-cardiovascular axis to reduce future CVD risk. Registered at clinicaltrials.gov: NCT05367674.

Engaging School and Family in Navajo Gardening for Health: Development of the Yéego Intervention to Promote Healthy Eating among Navajo Children

Objective

Navajo children are at increased risk for obesity, in part due to limited access to healthy foods. School garden interventions have been shown to increase access to fresh fruit and vegetables and consumption of healthy foods. Our study describes the development and pilot testing of a school garden intervention for Navajo elementary school children.

Methods

We reviewed existing school garden interventions and conducted formative research with students, caregivers, and school staff to inform the intervention. The intervention consisted of a garden built at the school and a yearlong curriculum on gardening and healthy eating. We pilot tested the intervention in an elementary school on the Navajo Nation.

Results

Formative research revealed the importance of incorporating Diné culture, including traditional growing practices and the preparation of traditional foods into the curriculum. School staff also stressed the value of tying the curriculum to state and Diné educational standards. Students enjoyed opportunities for hands-on activities and snack preparation.

Conclusions

Schools have a meaningful role to play in addressing childhood obesity disparities among Navajo children. School-based interventions that draw on cultural strengths and include healthy traditional practices can be a promising strategy for increasing fruit and vegetable consumption.

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).

Is School Gardening Combined with Physical Activity Intervention Effective for Improving Childhood Obesity? A Systematic Review and Meta-Analysis

School gardening activities (SGA) combined with physical activities (PA) may improve childhood dietary intake and prevent overweight and obesity. This study aims to evaluate the effect of SGA combined with PA on children’s dietary intake and anthropometric outcomes. We searched studies containing randomized controlled trials up to January 2021 in Web of Science, PubMed, Cochrane Library, and the EBSCO database on this topic for children aged 7 to 12 years. Fourteen studies met the requirements for meta-analysis (n = 9187). We found that SGA has no obvious effect on improving children’s BMI (WMD = −0.49; p = 0.085; I² = 86.3%), BMI z-score (WMD = −0.12; p = 0.235; I² = 63.0%), and WC (WMD = −0.98; p = 0.05; I² = 72.9%). SGA can effectively improve children’s FVs (WMD = 0.59, p = 0.003, I² = 95.3%). SGA combined with PA can significantly increase children’s FVs but cannot greatly improve weight status. Although more studies on this topic are needed to prove the effectiveness of this method, the results of our review show that both SGA and SGA combined with PA has a modest but positive impact of reducing BMI and WC outcomes but can significantly increase children’s FVs.

Involvement of children in hands-on meal preparation and the associated nutrition outcomes: A scoping review

BACKGROUND

Emerging research has explored hands-on meal preparation as a strategy to improve children's nutrition-related outcomes. This scoping review was conducted to describe the extent of studies on children's involvement in hands-on meal preparation and the related psychosocial outcomes, actual nutrition behaviour/food consumption and weight status.

METHODS

Scoping review methodology was used to select relevant studies, as well as extract and collate the data. Four databases (PubMed, Google Scholar, Science Direct and Cochrane Database of Systematic Reviews) were searched from the earliest available time up to December 2020. Observational studies, experimental studies and reviews that were conducted among children aged 5-12 years old and published from 2010 to 2020 were retrieved. Studies extracted involved children in hands-on healthy meal preparation activities and explored the associated nutrition outcomes.

RESULTS

In total, 28 studies (5 observational studies, 21 experimental studies, 2 reviews) were included in the final review. Studies conducted demonstrated improvement in children's psychosocial outcomes and actual nutrition behaviour/food consumption after participating in hands-on meal preparation activities, despite differences in methodology, programme content and settings (countries/cultural origins). Limited studies assessed children's nutrients intake and weight status.

CONCLUSIONS

The current review suggests that hands-on meal preparation comprises approach for instilling positive perceptions towards nutrition/healthy foods, potentially improving children's diet. Future studies should include the assessment of nutrient intake and weight status. The long-term sustainability of these nutrition outcomes should be explored.

Play with Your Food and Cook It! Tactile Play with Fish as a Way of Promoting Acceptance of Fish in 11- to 13-Year-Old Children in a School Setting-A Qualitative Study

Despite a tradition of consuming fish in Denmark and despite the health benefits of eating fish, Danish children consume only one-third of the officially recommended amount of fish. The objective of this study was to explore an experiential and sensory-based exercise in a school setting with focus on tactile play and cooking as a way of promoting 11- to 13-year-old children’s acceptance of fish. The design was a qualitative exploratory multiple-case design using participant observation in a school setting. Six classes were recruited from the Eastern part of Denmark (n = 132). Based on an exercise with cooking fish and gyotaku (fish print), four meta-themes were identified by applying applied thematic analysis: rejection, acceptance, craftsmanship, and interaction. Rejection and acceptance appeared along a rejection–acceptance continuum related to how the fish was categorised (animal, non-animal, food) in different phases of the experiment. Rejection was promoted by mucus, smell, animalness, and texture, whereas helping each other, tactile play, and craftsmanship promoted acceptance. In conclusion, this study found that tactile play combined with cooking could be a way of promoting acceptance of fish. The findings also support a school setting as a potential gateway in promoting healthy food behaviour.

Characteristics of successful primary school-based experiential nutrition programmes: a systematic literature review

OBJECTIVE

Diet and nutrition in childhood has been associated with the risk of chronic disease later in life. The aim of this review was to identify key characteristics of successful experiential nutrition interventions aimed to change nutrition-related cognitive and behavioural outcomes in primary schoolchildren.

DESIGN

A systematic literature review was undertaken using search terms ('food security', 'school', 'nutrition' and 'program') applied to five scientific databases (CINAHL, Scopus, Web of Science, Medline and Academic Search complete), with outcomes defined as nutrition-related knowledge, attitudes and/or dietary behaviours.

PARTICIPANTS

Primary school-aged children exposed to interventions conducted, at least partially, on school grounds.

RESULTS

A total of 3800 articles were identified from the initial search and manual searching, of which sixty-seven articles were eligible for inclusion. Forty-two articles met the criteria of being successful, defined as achieving significant differences in outcomes of interest, accompanied by a demonstrated reach. Interventions included school gardens (n 9), food provision (n 5), taste testing (n 8), cooking classes (n 10) and multicomponent programmes (n 10). Nutrition education (when combined with taste testing), cooking-related activities and gardening interventions increased children's willingness to taste unfamiliar foods including new fruits and vegetables, improved their cooking and food preparation skills and increased nutritional knowledge.

CONCLUSIONS

This review provides evidence that nutrition education programmes in primary schoolchildren that are experiential in nature are most likely to be successful if they include multiple strategies, have parental involvement and focus specifically on vegetable intake.

Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years

IMPORTANCE

Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth.

OBJECTIVE

This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5-21 yr at home, at school, and in the community.

METHOD

The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5-21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research.

RESULTS

One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners.

CONCLUSIONS AND RECOMMENDATIONS

On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence.

WHAT THIS ARTICLE ADDS

When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5-21 yr.

Feasibility of collection and analysis of microbiome data in a longitudinal randomized trial of community gardening

Aim: We explored the feasibility of collecting and analyzing human microbiome data in a longitudinal randomized controlled trial of community gardening. Methods & materials: Participants were randomly assigned to gardening (N = 8) or control (N = 8). Participants provided stool, mouth, hand and forehead microbiome samples at six timepoints. Analyses combined mixed models with Qiita output. Results: Participant satisfaction was high, with 75% of participants completing evaluations. While no microbial effects were statistically significant due to small sample size, the analysis pipeline utility was tested. Conclusion: Longitudinal collection and analysis of microbiome data in a community gardening randomized controlled trial is feasible. The analysis pipeline will be useful in larger studies for assessment of the pathway between microbiota, gardening and health outcomes.

Culinary Education Programs for Children in Low-Income Households: A Scoping Review

Child obesity in the United States is at an all-time high, particularly among underserved populations. Home-cooked meals are associated with lower rates of obesity. Helping children develop culinary skills has been associated with improved nutrition. The purpose of this study is to report results from a scoping review of culinary education interventions with children from low-income families. Three databases and hand searches of relevant articles were examined. Retained articles met inclusionary criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, as appropriate. A data extraction template was developed. Data were independently extracted and verified. Only nine out of 370 articles met the inclusionary criteria and were included in the review. Most interventions were school-based, used a quasi-experimental design, and recruited minority children. Children-only was the primary intervention focus. Primary outcomes were mostly psychosocial from child self-report. Most interventions focused on children only and were guided by Social Cognitive Theory. Most reported stakeholder involvement; however, type and degree varied. All had an in-person component; only one used technology. Few reported training program leaders. Culinary education programs for children from low-income families could benefit from a broader theoretical grounding, program leader training, and greater parental involvement.

The Association Between Child Cooking Involvement in Food Preparation and Fruit and Vegetable Intake in a Hispanic Youth Population

BACKGROUND

Cooking interventions have been linked to reductions in obesity and improvements in dietary intake in children.

OBJECTIVE

To assess whether child cooking involvement (CCI) was associated with fruit intake (FI), vegetable intake (VI), vegetable preference (VP), and vegetable exposure (VE) in children participating in the Texas, Grow! Eat! Go! (TGEG) randomized controlled trial.

METHODS

Baseline data from TGEG included 1231 3rd grade students and their parents. Conducted in 28 low-income, primarily Hispanic schools across Texas, TGEG schools were assigned to: 1) Coordinated School Health (CSH) only (control group), 2) CSH plus gardening and nutrition intervention (Learn, Grow, Eat & Go! or LGEG group), 3) CSH plus physical activity intervention (Walk Across Texas or WAT group), and 4) CSH plus LGEG plus WAT (combined group). Height, weight, dietary intake, VE, VP, and CCI were collected at baseline and postintervention. Linear regressions were used to assess the relation between baseline CCI and fruit and vegetable (FV) intake, VE, and VP. A priori covariates included age, sex, race/ethnicity, and TGEG treatment group.

RESULTS

Children who were always involved in family cooking had higher VP and VE when compared with children who were never involved in family cooking (β = 3.26; 95% CI: 1.67, 4.86; P < 0.01 and β = 2.26; 95% CI: 0.67, 3.85; P < 0.01, respectively). Both VI and FI were higher for children who were always involved in family cooking compared with children who never cooked with their family (β = 2.45; 95% CI: 1.47, 3.44; P < 0.01 and β = 0.93; 95% CI: 0.48, 1.39; P < 0.01, respectively). VI and fruit consumption were higher for children who reported being sometimes involved in family cooking compared with children who were never involved in family cooking, (β = 1.47; 95% CI: 0.51, 2.42; P < 0.01, and β = 0.64; 95% CI: 0.20, 1.08; P < 0.01, respectively).

CONCLUSIONS

Results show a positive relation between family cooking and FV intake and preference in high-risk, minority children.

Occupation- and Activity-Based Interventions to Improve Performance of Instrumental Activities of Daily Living and Rest and Sleep for Children and Youth Ages 5-21: A Systematic Review

IMPORTANCE

Practitioners seek evidence from intervention effectiveness studies to provide best-practice services for children.

OBJECTIVE

To examine the effectiveness of occupation- and activity-based interventions to improve instrumental activities of daily living (IADLs) and sleep outcomes for children and youth ages 5-21 yr.

DATA SOURCES

MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane Database of Systematic Reviews.

STUDY SELECTION AND DATA COLLECTION

The American Occupational Therapy Association research methodologist conducted the first review of literature published from 2000 to 2017. The results were exported, and we completed the subsequent stages of review. Only peer-reviewed Level I, II, and III evidence was reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane risk-of-bias guidelines were used to compile evidence and risk-of-bias tables.

FINDINGS

We reviewed 96 articles; 28 studies met the inclusion criteria for IADL and rest-sleep outcomes. Analysis resulted in several themes: rest-sleep, health management (nutrition-dietary, physical activity-fitness, wellness), and the IADLs of driving, communication management, and safety. Strong evidence exists for interventions embedded in school programming to improve physical activity and fitness and for sleep preparation activities to maximize quality of rest and sleep. Moderate-strength evidence exists for interactive education and skills training interventions to improve health routines, dietary behaviors, and IADL participation and performance.

CONCLUSIONS AND RELEVANCE

Use of skills-focused training in activity- and occupation-based interventions was supported. Service provision in the context of natural environments, including school settings and with parental or caregiver participation, is recommended for children and youth ages 5-21 yr with varied abilities and diagnoses.

WHAT THIS ARTICLE ADDS

Occupational therapy practitioners can confidently examine their current practices and choose activity- and occupation-based interventions and methods of service delivery that are supported by evidence.

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.

Best Practices Among Food-Based Community Organizations: A Qualitative Analysis

Food-based community organizations (FBCO) have positive impacts on community health, yet little is known about best practices that facilitate organization sustainability. To identify strategies among FBCOs used to facilitate member engagement/retention, reach future members/participants, and support organizational growth, key informants from four FBCOs in Texas participated in in-depth interviews. Semi-structured interviews were informed by grounded theory, voice recorded, and transcribed. Results from eight interviews, representing four organizations, indicated five themes for organization sustainability: commitment to a mission, supportive leadership, physical meeting space, clear communication, and community partnerships. Implementation of these strategies may benefit other FBCOs by helping them create sustainable organizations.

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.

Scoping review of the impacts of urban agriculture on the determinants of health

Background

There has been an increasing interest in urban agriculture (UA) practice and research in recent years. Scholars have already reported numerous beneficial and potential adverse impacts of UA on health-related outcomes. This scoping review aims to explore these impacts and identify knowledge gaps for future UA studies.

Methods

A systematic search was conducted in seven electronic bibliographic databases to identify relevant peer-reviewed studies. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize, collate, appraise the quality and make a narrative account of the findings.

Results

A total of 101 articles (51 quantitative, 29 qualitative, and 21 mixed methods studies) were included in our final analysis. Among these articles, 38 and 37% reported findings from North America and Sub-Saharan Africa respectively. Quantitative studies revealed evidence of positive impacts of UA on food security, nutrition outcomes, physical and mental health outcomes, and social capital. The qualitative studies reported a wide range of perceived benefits and motivations of UA. The most frequently reported benefits include contributions to social capital, food security, health and/or wellbeing. However, the evidence must be interpreted with caution since the quality of most of the studies was assessed as weak to moderate. While no definitive conclusions can be drawn about the adverse impacts of UA on health, paying particular attention to contamination of UA soil is recommended.

Conclusion

More peer-reviewed studies are needed in areas where UA is practiced such as Latin America and Caribbean. The inconsistency and the lack of strong quality in the methodology of the included studies are proof that more rigorous studies are also needed in future research. Nevertheless, the substantial existing evidence from this review corroborate that UA can influence different determinants of health such as food security, social capital, health and well-being in a variety of contexts.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6885-z) contains supplementary material, which is available to authorized users.

School gardening increases knowledge of primary school children on edible plants and preference for vegetables

At least 10% of children worldwide are diagnosed with overweight. Part of this problem is attributed to low vegetable intake, for which preference at a younger age is an indicator. Few studies examined long-term effects of school garden interventions on the knowledge about and preference for vegetables. Therefore, in this study, an intervention period of 7 months (17 lessons) was organized for primary school students (n = 150) of age 10-12 years in the Municipality of Nijmegen (the Netherlands). Surveys were conducted before and after the intervention period to test the ability of students to identify vegetables, to measure their self-reported preference for vegetables, and to analyze students' attitudes toward statements about gardening, cooking, and outdoor activity. The long-term effects were measured by repeating the survey 1 year after the intervention (n = 52). Results were compared with a control group of students (n = 65) with similar background and tested for significance with α = 0.05. School gardening significantly increases the knowledge of primary schoolchildren on 10 vegetables as well as their ability to self-report preference for the vegetables. The short-term (n = 106) and long-term (n = 52) preference for vegetables increased (p < 0.05) in comparison with the control group. The latter did not show a significant learning effect (p > 0.05). This implies that the exposure to vegetables generated by school gardening programs may increase willingness to taste and daily intake of vegetables on the long term. Students' attitudes toward gardening, cooking, and outdoor activity were unaffected by the intervention.

Impact of food security on glycemic control among low-income primarily Hispanic/Latino children in Los Angeles, California: A cross-sectional study

Studies examining the impact of food insecurity on metabolic markers are limited, specifically in Hispanic youth. This study was a cross-sectional analysis of 218 3^rd-5^th grade students (83% Hispanic and 49% male). Anthropometrics, blood glucose, insulin, and lipids via fasting blood draw, dietary intake via Block screener, and a 5-item food security scale were collected. HOMA-Insulin Resistance was calculated. Multivariate analyses of covariance were used to examine differences in glucose and insulin indices, adiposity, metabolic and dietary intake variables between categories of food security. Food secure children had greater glycemic control and decreased insulin resistance compared to food insecure children.

Virtual Sprouts: A Virtual Gardening Pilot Intervention Increases Self-Efficacy to Cook and Eat Fruits and Vegetables in Minority Youth

OBJECTIVE

To examine the effect of the Virtual Sprouts intervention, an interactive multiplatform mobile gardening game, on dietary intake and psychosocial determinants of dietary behavior in minority youth.

MATERIALS AND METHODS

In this quasi-experimental pilot intervention, 180 third-, fourth-, and fifth-grade students in Los Angeles Unified School District participated in a 3-week program that included three Virtual Sprouts gaming sessions, three in-school lessons, and three in-home activities, using a nutrition- and gardening-focused curriculum. Pre- and postintervention questionnaires were used to assess psychosocial determinants of dietary behavior, including knowledge about and self-efficacy to eat fruits and vegetables (FV). Data were collected on FV, whole grains, fiber, total sugar, added sugar, and energy from sugary beverages through the Block Kids Food Screener ("last week" version) for Ages 2-17. Repeated measures analysis of covariance models was used for continuous outcomes, controlling for age, sex, ethnicity, school, and free school lunch.

RESULTS

After the intervention, the intervention group (n = 116) compared with the control group (n = 64) had a significantly improved self-efficacy to eat FV score (+1.6% vs. -10.3%, P = 0.01), and an improved self-efficacy to cook FV score (+2.9% vs. -5.0%, P = 0.05). There were no significant differences in dietary intake or self-efficacy to garden scores between intervention and control groups.

CONCLUSION

The results from this 3-week pilot study suggest that an interactive mobile game with a nutrition- and gardening-focused curriculum can improve psychosocial determinants of dietary behavior in minority youth.

Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease

BACKGROUND

A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions.

OBJECTIVES

The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children.

SEARCH METHODS

All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research.

SELECTION CRITERIA

'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy.

DATA COLLECTION AND ANALYSIS

Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated).

MAIN RESULTS

We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review.

AUTHORS' CONCLUSIONS

Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.

Fruit and Vegetable Preferences and Identification by Kindergarteners through 2nd-Graders With or Without the US Department of Agriculture Fresh Fruit and Vegetable Program

OBJECTIVE

The US Department of Agriculture Fresh Fruit and Vegetable Program (FFVP) allows schools to increase fruit and vegetable (FV) exposure by distributing FV as snacks. The objective of this study was to compare kindergarten through second (K-2nd)-graders who were exposed or not to FFVP for preferences and identification.

DESIGN, SETTING, PARTICIPANTS

The FV Preference Survey for K-2nd-graders contained 12 fruits and 12 vegetables, a 3-Likert scale (liked it, okay, don't like it), and an I don't know option. Data were collected from K-2nd-graders at 2 elementary schools near Chicago, IL (n = 435, FFVP school, n = 235 with 12 teachers; non-FFVP school, n = 200 with 10 teachers).

MAIN OUTCOME MEASURE(S)

Mean preference scores.

ANALYSIS

Chi-square, Mann-Whitney U, and multiple linear regression analyses compared school data (P < .05).

RESULTS

There were significant differences in mean preference scores, with higher fruit scores at the FFVP school (1.8 ± 0.6) than at the non-FFVP school (1.7 ± 0.6). In contrast, there was a higher vegetable score for the non-FFVP school (1.3 ± 0.9) than for the FFVP school (1.2 ± 0.9). The school variable had weak impact on fruit ranking (multivariate coefficient = 0.01; P < .05). For fruits and vegetables and combined, there were fewer I don't know responses in the FFVP (χ² = 149.080; P < .01).

CONCLUSIONS AND IMPLICATIONS

At the FFVP school, fewer I don't know responses suggested better FV identification. Non-FFVP students had higher vegetable preferences than did FFVP students. Tasting a variety of FV may help with identifying FV, but more research is needed to determine the impact on preferences.

Changing children's eating behaviour - A review of experimental research

The interest in children's eating behaviours and how to change them has been growing in recent years. This review examines the following questions: What strategies have been used to change children's eating behaviours? Have their effects been experimentally demonstrated? And, are the effects transient or enduring? Medline and Cab abstract (Ovid) and Web of Science (Thomson Reuters) were used to identify the experimental studies. A total of 120 experimental studies were identified and they are presented grouped within these 11 topics; parental control, reward, social facilitation, cooking programs, school gardens, sensory education, availability and accessibility, choice architecture and nudging, branding and food packaging, preparation and serving style, and offering a choice. In conclusion, controlling strategies for changing children's eating behaviour in a positive direction appear to be counterproductive. Hands-on approaches such as gardening and cooking programs may encourage greater vegetable consumption and may have a larger effect compared to nutrition education. Providing children with free, accessible fruits and vegetables have been experimentally shown to positively affect long-term eating behaviour. The authors recommend future research to examine how taste and palatability can positively affect children's attitudes and eating behaviour.

Increasing Fruit and Vegetable Intake among Children and Youth through Gardening-Based Interventions: A Systematic Review

Although there are numerous health benefits associated with eating fruit and vegetables (F/V), few children are consuming recommended amounts. Gardening interventions have been implemented in various settings in an effort to increase children's F/V consumption by expanding knowledge, exposure, and preferences for a variety of F/V. The purpose of this review was to identify the effectiveness of gardening interventions that have been implemented to increase F/V consumption among children. A systematic review was conducted using four electronic databases: Web of Science, PubMed, Scopus, and the Cumulative Index to Nursing and Allied Health Literature. English language studies conducted in developed countries between January 2005 and October 2015 were included in this review. Included studies measured F/V consumption among children aged 2 to 15 years before and after implementation of a gardening intervention in a school, community, or afterschool setting. All study designs were included in this review. A total of 891 articles were identified through database searching and cross-referencing. After removing duplicates, 650 articles remained and were screened using inclusion and exclusion criteria. Twenty-seven full-text articles were analyzed and 14 articles were included in this review. Of the 14 articles reviewed, 10 articles found statistically significant increases in fruit or vegetable consumption among participants after implementation of a gardening intervention. However, many studies were limited by the use of convenience samples, small sample sizes, and self-reported measurements of F/V consumption. Although the evidence is mixed and fraught with limitations, most studies suggest a small but positive influence of gardening interventions on children's F/V intake. Future studies that include control groups, randomized designs, and assessments of F/V consumption over at least 1 year are needed to advance the literature on this topic.

Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective

The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.

An Experiential Cooking and Nutrition Education Program Increases Cooking Self-Efficacy and Vegetable Consumption in Children in Grades 3-8

OBJECTIVE

Evaluate the effect of a community-based, experiential cooking and nutrition education program on consumption of fruits and vegetables and associated intermediate outcomes in students from low-income families.

DESIGN

Quasi-experimental program evaluation by pre-post survey of participating students and their parents.

SETTING

Underserved elementary and middle schools in Chicago.

PARTICIPANTS

Students (n = 271; 65% girls, 44% Hispanic, 32% African American; 94% eligible for free/reduced price lunch) in grades 3-8 selected by school staff to participate by variable inclusion criteria. 59% of students who applied returned both pre- and post-surveys.

INTERVENTION(S)

Ten-week (2 h/wk) chef-instructor-led program held in cafeteria kitchens after school.

MAIN OUTCOME MEASURE(S)

Changes in student nutrition knowledge, cooking self-efficacy, fruit and vegetable liking and consumption, and communication to family about healthy eating.

ANALYSIS

Changes from beginning to end of program were analyzed with paired t test. Results were considered significant at P < .05.

RESULTS

Increased nutrition knowledge score from 0.6 to 0.8, cooking self-efficacy score from 3.2 to 3.6, and vegetable consumption score from 2.2 to 2.4 (all P < .05). Increased score for communication about healthy eating (4.1 to 4.4; P < .05) 6 months after the end of the course.

CONCLUSIONS AND IMPLICATIONS

Experiential cooking and nutrition education programs led by chef-instructors may be effective ways to improve nutrition in low-income communities.