Feasibility of an experiential community garden and nutrition programme for youth living in public housing

A process evaluation of a randomized-controlled trial of community gardening to improve health behaviors and reduce stress and anxiety

As part of the Community Activation for Prevention (CAPS) randomized controlled trial (RCT) of community gardening, we conducted a process evaluation to assess the implementation of a community gardening intervention over nine months, as measured by reach, fidelity (delivery, receipt, enactment), and acceptability. Evaluation instruments included repeated semi-structured interviews with study participants, direct observation of community garden sites, and an exit survey of participants. Primary outcomes were diet, physical activity, and anthropometry; secondary outcomes were stress and anxiety. The CAPS trial included 291 participants (19% non-white; 34% Hispanic/Latino; 35% without a college degree; 58% with income < $50,000 per year). Intervention delivery and receipt were high for environmental supports. Garden social events were offered by 73% of gardens, although only 48% of intervention participants reported attending these events. Of the 145 participants assigned to the gardening intervention, 97 (67%) reported gardening the entire season and reported visiting the community garden a median of 90 min per week (range: 0-840). Of the participants who completed the exit survey (48%), 89% were highly satisfied with the overall garden experience. The CAPS trial was favorably received and implemented with high fidelity, supporting the validity of the trial outcomes. These findings suggest that community gardens are a viable health promotion strategy that can be successfully implemented among new gardeners from diverse backgrounds. Strategies that engage new gardeners in the social aspects of the garden environment and connect gardeners with garden "mentors" or "buddies" to ensure new gardeners achieve success in their first years of gardening are recommended.Trial registration: NCT03089177. Registered 24 March 2017, https://clinicaltrials.gov/study/NCT03089177 .

African Americans' perceptions of nutrition interventions: a scoping review

Nutrition education and policy, systems and environmental (PSE) change interventions may be able to address food insecurity and obesity, conditions which are disproportionately experienced by African Americans. Work that seeks to address these disparities and advance social justice should uplift and learn from participant voices, particularly from marginalised groups. This scoping review aimed to summarise the available literature describing African Americans' perceptions of and experiences participating in nutrition interventions. We conducted an electronic literature search with the assistance of a research librarian which encompassed six databases (MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX and ProQuest Dissertations & Theses) and identified thirty-five sources meeting our inclusion criteria. The majority of studies assessing African Americans' satisfaction with interventions examined educational interventions alone, and about half of the included studies assessed satisfaction through quantitative methods alone. The only studies which found participants to be dissatisfied with interventions used qualitative methods and examined interventions providing education alone. Future work should evaluate African Americans' experience with nutrition-focused PSE changes, interventions which may be better able to address racial disparities in obesity and food insecurity. Nutrition educators working with African Americans should also consider evaluating future interventions using qualitative inquiry, to obtain an in-depth understanding of participant experiences with interventions.

Evaluation of community-based health promotion interventions in children and adolescents in high-income countries: a scoping review on strategies and methods used

BACKGROUND

In recent decades, community-based interventions have been increasingly adopted in the field of health promotion and prevention. While their evaluation is relevant for health researchers, stakeholders and practitioners, conducting these evaluations is also challenging and there are no existing standards yet. The objective of this review is to scope peer-reviewed scientific publications on evaluation approaches used for community-based health promotion interventions. A special focus lies on children and adolescents' prevention.

METHODS

A scoping review of the scientific literature was conducted by searching three bibliographic databases (Medline, EMBASE, PsycINFO). The search strategy encompassed search terms based on the PCC (Population, Concept, Context) scheme. Out of 6,402 identified hits, 44 articles were included in this review.

RESULTS

Out of the 44 articles eligible for this scoping review, the majority reported on studies conducted in the USA (n = 28), the UK (n = 6), Canada (n = 4) and Australia (n = 2). One study each was reported from Belgium, Denmark, Germany and Scotland, respectively. The included studies described interventions that mostly focused on obesity prevention, healthy nutrition promotion or well-being of children and adolescents. Nineteen articles included more than one evaluation design (e.g., process or outcome evaluation). Therefore, in total we identified 65 study designs within the scope of this review. Outcome evaluations often included randomized controlled trials (RCTs; 34.2%) or specific forms of RCTs (cluster RCTs; 9.8%) or quasi-experimental designs (26.8%). Process evaluation was mainly used in cohort (54.2%) and cross-sectional studies (33.3%). Only few articles used established evaluation frameworks or research concepts as a basis for the evaluation.

CONCLUSION

Few studies presented comprehensive evaluation study protocols or approaches with different study designs in one paper. Therefore, holistic evaluation approaches were difficult to retrieve from the classical publication formats. However, these publications would be helpful to further guide public health evaluators, contribute to methodological discussions and to inform stakeholders in research and practice to make decisions based on evaluation results.

Rental assistance improves food security and nutrition: An analysis of National Survey Data

The U.S. is experiencing a severe housing affordability crisis, resulting in households having to make difficult trade-offs between paying for a place to live and basic health necessities such as food. Rental assistance may mitigate these strains, improving food security and nutrition. However, only one in five eligible individuals receive assistance, with an average wait time of two years. Existing waitlists create a comparable control group, allowing us to examine the causal impact of improved housing access on health and well-being. This national quasi-experimental study utilizes linked NHANES-HUD data (1999-2016) to investigate the impacts of rental assistance on food security and nutrition using cross-sectional regression. Tenants with project-based assistance were less likely to experience food insecurity (B = -0.18, p = 0.02) and rent-assisted individuals consumed 0.23 more cups of daily fruits and vegetables compared the pseudo-waitlist group. These findings suggest that the current unmet need for rental assistance and resulting long waitlists have adverse health implications, including decreased food security and fruit and vegetable consumption.

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.

Nutrition Interventions Addressing Structural Racism: A Scoping Review

African Americans experience high rates of obesity and food insecurity in part due to structural racism, or overlapping discriminatory systems and practices in housing, education, employment, health care, and other settings. Nutrition education and nutrition-focused policy, systems, and environmental changes may be able to address structural racism in the food environment. This scoping review aimed to summarize the available literature regarding nutrition interventions for African Americans that address structural racism in the food environment and compare them to the "Getting to Equity in Obesity Prevention" framework of suggested interventions. An electronic literature search was conducted with the assistance of a research librarian encompassing 6 databases-MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX, and ProQuest Dissertations & Theses. A total of 30 sources were identified detailing interventions addressing structural barriers to healthy eating. The majority of nutrition interventions addressing structural racism consisted of policy, systems, and/or environmental changes in combination with nutrition education, strategies focused on proximal causes of racial health disparities. Only two articles each targeted the "reduce deterrents" and "improve social and economic resources" aspects of the framework, interventions which may be better suited to addressing structural racism in the food environment. Because African Americans experience high rates of obesity and food insecurity and encounter structural barriers to healthy eating in the food environment, researchers and public health professionals should address this gap in the literature.

Community gardens and wellbeing amongst vulnerable populations: a thematic review

The aim of the thematic review is to document the effects of community gardens on wellbeing amongst vulnerable populations. We searched for articles published between 1980 and 2017 in major databases resulting in the inclusion of 51 articles. Vulnerable populations included, amongst others, ethnic minorities and refugees, socioeconomically disadvantaged neighbourhoods or low-income or food insecure families. Our findings suggest that community garden participation may have a positive impact on physical health, such as reducing body weight and hypertension, and increasing physical activity and food knowledge. However, findings relating to community gardens and their potential to enhance food security were inconsistent. Furthermore we found that community gardens can have a positive influence both at the individual level (i.e. self-esteem, independence, personal control, etc.), particularly for refugees; the relational and social level (i.e. relationships, social connections, community and neighbourhood). Community garden participation have the potential to enhance wellbeing amongst vulnerable populations. However, two articles in our review presented potential food safety concerns related to community gardens, indicating that, particularly in urban settings, attention must be given to minimizing potential food safety concerns, e.g. by using raised garden beds. Based on this review, we recommend that further research and evaluation on non-US-based community gardens is carried out, as community gardens are practiced globally but there is little research to document the effects of community gardens on wellbeing amongst vulnerable populations outside of the USA.

Placemaking in Action: Factors That Support or Obstruct the Development of Urban Community Gardens

The paper examines factors that support or obstruct the development of urban community garden projects. It combines a systematic scholarly literature review with empirical research from case studies located in New Zealand and Germany. The findings are discussed against the backdrop of placemaking processes: urban community gardens are valuable platforms to observe space-to-place transformations. Following a social-constructionist approach, literature-informed enablers and barriers for the development of urban community gardens are analysed against perceived notions informed by local interviewees with regard to their biophysical and technical, socio-cultural and economic, and political and administrative dimensions. These dimensions are incorporated into a systematic and comprehensive category system. This approach helps observe how the essential biophysical-material base of the projects is overlaid with socio-cultural factors and shaped by governmental or administrative regulations. Perceptual differences become evident and are discussed through the lens of different actors.

Gardening for Health: Patterns of Gardening and Fruit and Vegetable Consumption Among the Navajo

American Indians, including Navajo, are disproportionately affected by obesity and diabetes, in part due to diet-related health behaviors. The purpose of this study was to assess the patterns of gardening and fruit and vegetable (FV) consumption among residents in two communities on the Navajo Nation in order to inform a community gardening intervention. We analyzed survey data collected from participants in the Yéego Gardening study conducted in two communities in the Navajo Nation (N = 169). We found that 51% of the sample gardened, and on average participants gardened 8.9 times per month. Lack of time (53%) and financial barriers, such as gas for transportation or irrigation (51 and 49%, respectively), were reported as barriers to gardening. Most participants reported low levels of self-efficacy (80%) and behavioral capability (82%) related to gardening. Those with higher levels of gardening self-efficacy and behavioral capability reported more frequent gardening. Average daily FV consumption was 2.5 servings. Most participants reported high levels of self-efficacy to eat FV daily (64%) and high behavioral capability to prepare FV (66%). There was a positive association between FV consumption and gardening, with those gardening more than 4 times per month eating about 1 more serving of FV per day than those gardening 4 or fewer times per month. Further research is needed to better understand how gardening can increase fruit and vegetable availability and consumption among residents of the Navajo Nation.

Sowing social inclusion for marginalised residents of a social housing development through a community garden

ISSUE ADDRESSED

In addition to food, physical activity, mental health and environmental benefits, community gardens (CGs) provide opportunities for social inclusion and increased social capital. These are particularly important to the socially isolated residents of social housing developments (SHDs). This scoping study explored the feasibility of a CG program for tenants of SHD in inner eastern Melbourne by assessing their interest in, and requirements for, inclusively designed CGs.

METHODS

In this phenomenological enquiry, focus group discussions, supported by photo-elicitation, were employed. Three focus groups (N = 19) were conducted with self-selected participants who consented to participate. Two focus groups were conducted with English-speaking tenants while a third focus group was conducted with Mandarin-speaking tenants.

RESULTS

There was a demand for CGs by the English-speaking participants driven by desire for networking, social connectedness and inclusion; for improved access to fresh produce, connection with nature, physical activity and mental well-being. Participants expressed interest in a garden located near their SHD with supportive physical and social environments including disability access, plot autonomy, fencing, socio-cultural events, training programs and management opportunities. However, the Mandarin-speaking tenants maintained that age, language difficulty and neighbourhood insecurity posed significant barriers to their participation.

CONCLUSION

Guided by the Ottawa Charter for Health Promotion, social inclusion and community development theories, the study recommends that to establish socially inclusive CGs, a dynamic relationship of the design principles of a CG and the socio-ecological determinants of health should be established to address any barriers and successfully facilitate engagement. In addition, CG programs need to be guided by community development principles. Future research could employ community-based participatory research models in the implementation and evaluation of a CG program for socially isolated population groups.

Kids SIP smartER: A Feasibility Study to Reduce Sugar-Sweetened Beverage Consumption Among Middle School Youth in Central Appalachia

PURPOSE

To test the feasibility of Kids SIP smartER, a school-based intervention to reduce consumption of sugar-sweetened beverages (SSBs).

DESIGN

Matched-contact randomized crossover study with mixed-methods analysis.

SETTING

One middle school in rural, Appalachian Virginia.

PARTICIPANTS

Seventy-four sixth and seventh graders (5 classrooms) received Kids SIP smartER in random order over 2 intervention periods. Feasibility outcomes were assessed among 2 teachers.

INTERVENTION

Kids SIP smartER consisted of 6 lessons grounded in the Theory of Planned Behavior, media literacy, and public health literacy and aimed to improve individual SSB behaviors and understanding of media literacy and prevalent regional disparities. The matched-contact intervention promoted physical activity.

MEASURES

Beverage Intake Questionnaire-15 (SSB consumption), validated theory questionnaires, feasibility questionnaires (student and teacher), student focus groups, teacher interviews, and process data (eg, attendance).

ANALYSIS

Repeated measures analysis of variances across 3 time points, descriptive statistics, and deductive analysis of qualitative data.

RESULTS

During the first intervention period, students receiving Kids SIP smartER (n = 43) significantly reduced SSBs by 11 ounces/day ( P = .01) and improved media ( P < .001) and public health literacy ( P < .01) understanding; however, only media literacy showed between-group differences ( P < .01). Students and teachers found Kids SIP smartER acceptable, in-demand, practical, and implementable within existing resources.

CONCLUSION

Kids SIP smartER is feasible in an underresourced, rural school setting. Results will inform further development and large-scale testing of Kids SIP smartER to reduce SSBs among rural adolescents.

Agricultural Experiences Are Positively Associated With High School Students' Fruit and Vegetable Perceptions and Consumption

OBJECTIVE

To examine the relationship between high school students' agricultural experiences and their (1) attitudes about consuming local fruits and vegetables, (2) willingness to try new fruits and vegetables, and (3) fruit and vegetable consumption.

DESIGN

Cross-sectional survey research.

SETTING

Public high schools in a lower-income, diverse, urban, northeastern community.

PARTICIPANTS

A total of 327 students from 3 public high schools.

MAIN OUTCOME MEASURE(S)

Exposures were prior experience helping on a farm or community garden (yes/no) and having a home garden (yes/no). Outcomes were perceptions about local produce consumption (α = .73), willingness to try new fruits (α = .86) and vegetables (α = .86), and adequate fruit and vegetable consumption (yes/no) as measured by a valid 2-item cup screener.

ANALYSIS

Independent t tests, 1-way ANOVA, and chi-square tests were used.

RESULTS

Half of students (52.9%) reported prior farm experience; 29.7% reported having a garden at home. Few students reported consuming at least 3 cups/d of vegetables (9.8%) or 2 cups/d of fruit (37.0%). Students with prior farm experience had more favorable scores for local produce perceptions (P = .002) and willingness to try new fruits (P = .001) and vegetables (P < .001) than were students without prior experience. Students with a home garden had more favorable scores for local produce perceptions (P = .02) and willingness to try new fruits (P = .001) and vegetables (P = .001) and more often consumed adequate vegetables (P = .007) than did students without a garden.

CONCLUSIONS AND IMPLICATIONS

Those working with high school students might consider offering agriculture experiences that could promote positive fruit and vegetable attitudes and behaviors.