Evaluation of the impact of a school gardening intervention on children's fruit and vegetable intake: a randomised controlled trial

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.

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.

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.

Nature-Based Interventions and Exposure among Cancer Survivors: A Scoping Review

BACKGROUND AND PURPOSE

nature-based interventions (NBI) have been shown to have positive effects on physical, psychological, social, and spiritual health. The purpose of this scoping literature review was to describe what is known regarding the cancer survivor experience in relationship to their interaction with the natural environment. Description/methods: this review was completed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The research strategy included a combination of these terms: cancer, neoplasms, nature, and forest therapy. The articles were blinded and screened by four independent researchers. A total of twelve articles were selected. Outcome/results: a total of 2786 cancer survivors participated in the twelve studies with multiple types and stages of cancer represented. The studies used multiple designs and measures. Results showed improvements in anxiety, depression, sleep, connectedness, stress, tension, confusion, fatigue, and pain. Participants reported that nature was the most important resource in coping with their cancer.

CONCLUSIONS AND IMPLICATIONS

nature is beneficial for cancer survivors while they experience cancer diagnosis and treatment. Nature opportunities can be feasibly delivered with this population and need to be explored further and safely implemented to support the overall health and well-being of cancer survivors.

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).

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.

Do school-based nutrition interventions improve the eating behavior of school-age children?

BACKGROUND/OBJECTIVES

Filipino children aged 6–10 yrs are consuming poor quantities and quality of food based on the 2013 Philippine National Nutrition Survey. During these years healthy eating habits must be formed through family influence. Within this background, a complete package of nutrition intervention—feeding and nutrition classes, was pilot tested in selected schools to determine 1) changes in nutrition attitude and behavior and 2) food intake of schoolchildren after the intervention.

SUBJECTS/METHODS

A quasi-experimental design was used in the study. School children aged 7–9 yrs enrolled in selected Philippine public elementary schools and their mothers/caregivers were the study participants. Profile and socio-demographic data were collected from each participant at baseline. The nutrition behavior and food intake of children were determined using the modified Child and Diet Evaluation Tool (CADET) and the 24-h food recall form, respectively. Data were analyzed using Stata version 15.

RESULTS

No significant differences in characteristics were found among the 339 child-mother pairs in the 4 study groups. The modified CADET recorded improved mean attitude scores of children ranging from 22 to 24 points at endline in the group receiving both lunch feeding and nutrition education classes (group 3). The perceived better behavior of children was reported by their mothers in terms of increased intake of milk and vegetables and decreased consumption of sugar. These improvements were supported by the actual food intake of children obtained from the 24-h food recall.

CONCLUSIONS

Family involvement, particularly of mothers/caregivers, appeared to be an important factor in shaping the children's eating behavior. An intervention package with lunch feeding and nutrition classes resulted in a substantial improvement in children's behavior and actual food intake with increased levels of vegetables and milk while lowering sugar consumption. The adoption of the intervention package in public elementary schools should therefore be pursued.

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

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

Experiential Learning Interventions and Healthy Eating Outcomes in Children: A Systematic Literature Review

Experiential learning is the process where learners create meaning from direct experience. This systematic review aimed to examine the effects of experiential learning activities on dietary outcomes (knowledge, attitudes, behaviors) in children. Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to 2020. Eligible studies included children 0-12 years, assessed effect of experiential learning on outcomes of interest compared to non-experiential learning and were open to any setting. The quality of studies was assessed using the revised Cochrane risk of bias tool by two independent reviewers and effect size was calculated on each outcome. Nineteen studies were conducted in primary school, six in pre-school and one in an outside-of-school setting and used nine types of experiential learning strategies. Cooking, taste-testing, games, role-playing, and gardening were effective in improving nutrition outcomes in primary school children. Sensory evaluation, games, creative arts, and storybooks were effective for preschool children. Multiple strategies involving parents, and short/intense strategies are useful for intervention success. Experiential learning is a useful strategy to improve children's knowledge, attitudes, and behaviors towards healthy eating. Fewer studies in pre-school and outside of school settings and high risk of bias may limit the generalizability and strength of the findings.

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).

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

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

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.

Characteristics and practices of school-based cluster randomised controlled trials for improving health outcomes in pupils in the United Kingdom: a methodological systematic review

Background

Cluster randomised trials (CRTs) are increasingly used to evaluate non-pharmacological interventions for improving child health. Although methodological challenges of CRTs are well documented, the characteristics of school-based CRTs with pupil health outcomes have not been systematically described. Our objective was to describe methodological characteristics of these studies in the United Kingdom (UK).

Methods

MEDLINE was systematically searched from inception to 30^th June 2020. Included studies used the CRT design in schools and measured primary outcomes on pupils. Study characteristics were described using descriptive statistics.

Results

Of 3138 articles identified, 64 were included. CRTs with pupil health outcomes have been increasingly used in the UK school setting since the earliest included paper was published in 1993; 37 (58%) studies were published after 2010. Of the 44 studies that reported information, 93% included state-funded schools. Thirty six (56%) were exclusively in primary schools and 24 (38%) exclusively in secondary schools. Schools were randomised in 56 studies, classrooms in 6 studies, and year groups in 2 studies. Eighty percent of studies used restricted randomisation to balance cluster-level characteristics between trial arms, but few provided justification for their choice of balancing factors. Interventions covered 11 different health areas; 53 (83%) included components that were necessarily administered to entire clusters. The median (interquartile range) number of clusters and pupils recruited was 31.5 (21 to 50) and 1308 (604 to 3201), respectively. In half the studies, at least one cluster dropped out. Only 26 (41%) studies reported the intra-cluster correlation coefficient (ICC) of the primary outcome from the analysis; this was often markedly different to the assumed ICC in the sample size calculation. The median (range) ICC for school clusters was 0.028 (0.0005 to 0.21).

Conclusions

The increasing pool of school-based CRTs examining pupil health outcomes provides methodological knowledge and highlights design challenges. Data from these studies should be used to identify the best school-level characteristics for balancing the randomisation. Better information on the ICC of pupil health outcomes is required to aid the planning of future CRTs. Improved reporting of the recruitment process will help to identify barriers to obtaining representative samples of schools.

Horticultural Activity Type, Psychological Well-Being, and Fruit and Vegetable Intake

The purpose of this study was to explore the effect of the frequency of participation in horticultural activity types on psychological well-being and fruit and vegetable intake. The study sought to understand the mediating effect of psychological well-being between the frequency of types of horticultural activities and the frequency of fruit and vegetable intake. Convenience sampling was used to collect 400 valid data through a self-administered questionnaire that inquired about the frequency of four horticultural activity types (indoor plant activities, outdoor plant activities, arts/crafts activities, and excursions), the measure of psychological well-being, and the frequency of fruit and vegetable intake. The results showed that a higher frequency of indoor and outdoor plant activity positively affected psychological well-being. Psychological well-being played a partial mediation role between indoor plant activity and vegetable and fruit intake and a full mediation role between outdoor plant activity and vegetable and fruit intake. The plant-related arts/crafts activities and excursions were not associated with psychological well-being or vegetable and fruit intake.

Effectiveness of healthy eating interventions among children: A quantitative systematic review

AIMS

This review aimed to evaluate the effectiveness of healthy eating interventions among normal-weight children.

DESIGN

A systematic review of randomized controlled trials.

DATA SOURCES

Seven databases were searched from the inception of each database until September 2019.

REVIEW METHODS

A systematic review of quantitative studies was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA extension for reporting a synthesis without a meta-analysis.

RESULTS

Fifteen studies were included in this review. A meta-analysis could not be conducted because of the observed heterogeneity across studies. There were mixed effects of the included interventions on healthy eating habits, ranging from effective to not effective. Only a few studies found behavioural determinants effective in enhancing healthy eating.

CONCLUSION

Because of the observed heterogeneity and varied outcome variables, a meta-analysis could not be conducted, and the overall effectiveness of the included interventions could not be verified. Interventions that were theory based, parent focused, and delivered through the multimodal interactive approach were found to be effective in enhancing healthy eating habits among children. More studies involving peers that are institution based need to be conducted.

Measuring commissioners' willingness-to-pay for community based childhood obesity prevention programmes using a discrete choice experiment

BACKGROUND

In the UK, rates of childhood obesity remain high. Community based programmes for child obesity prevention are available to be commissioned by local authorities. However, there is a lack of evidence regarding how programmes are commissioned and which attributes of programmes are valued most by commissioners. The aim of this study was to determine the factors that decision-makers prioritise when commissioning programmes that target childhood obesity prevention.

METHODS

An online discrete choice experiment (DCE) was used to survey commissioners and decision makers in the UK to assess their willingness-to-pay for childhood obesity programmes.

RESULTS

A total of 64 commissioners and other decision makers completed the DCE. The impact of programmes on behavioural outcomes was prioritised, with participants willing to pay an extra £16,600/year if average daily fruit and vegetable intake increased for each child by one additional portion. Participants also prioritised programmes that had greater number of parents fully completing them, and were willing to pay an extra £4810/year for every additional parent completing a programme. The number of parents enrolling in a programme (holding the number completing fixed) and hours of staff time required did not significantly influence choices.

CONCLUSIONS

Emphasis on high programme completion rates and success increasing children's fruit and vegetable intake has potential to increase commissioning of community based obesity prevention programmes.

Nudging children toward healthier food choices: An experiment combining school and home gardens

School gardens have become a widely used approach to influence children's food knowledge, preferences and choices in low- and high-income countries alike. However, evidence indicates that such programs are more effective at influencing food knowledge and preferences than actual food choices. Such finding may occur because school gardens insufficiently influence the food behavior of parents and because healthy food items are not always available in children's homes. We tested this hypothesis using a one-year cluster randomized controlled trial in Nepal with 15 treatment and 15 control schools and a matched sample of 779 schoolchildren (aged 8-12) and their caregivers. Data were collected before and after the intervention during the 2018-2019 school year. In addition, children's food consumption was monitored using a monthly food logbook. Average treatment effects were quantified with a double-difference estimator. For caregivers, the intervention led to a 26% increase in their food and nutrition knowledge (p < 0.001), a 5% increase in their agricultural knowledge (p = 0.022), a 10% increase in their liking for vegetables (p < 0.001), and a 15% increase in home garden productivity (p = 0.073). For children, the intervention had no discernible effect on food and nutrition knowledge (p = 0.666) but led to a 6% increase in their liking for vegetables (p = 0.070), healthy food practices (p < 0.001), and vegetable consumption (October-December +15%; p = 0.084; January-March +26%; p = 0.017; April-June +26%; p = 0.088). The results therefore indicate both schools and parents matter for nudging children toward healthier food choices.

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.

Nutritional and health status of children 15 months after integrated school garden, nutrition, and water, sanitation and hygiene interventions: a cluster-randomised controlled trial in Nepal

Background

It has been suggested that specific interventions delivered through the education sector in low- and middle-income countries might improve children’s health and wellbeing. This cluster-randomised controlled trial aimed to evaluate the effects of a school garden programme and complementary nutrition, and water, sanitation and hygiene (WASH) interventions on children’s health and nutritional status in two districts of Nepal.

Methods

The trial included 682 children aged 8–17 years from 12 schools. The schools were randomly allocated to one of three interventions: (a) school garden programme (SG; 4 schools, n = 172 children); (b) school garden programme with complementary WASH, health and nutrition interventions (SG+; 4 schools, n = 197 children); and (c) no specific intervention (control; 4 schools, n = 313 children). The same field and laboratory procedures were employed at the baseline (March 2015) and end-line (June 2016) surveys. Questionnaires were administered to evaluate WASH conditions at schools and households. Water quality was assessed using a Delagua kit. Dietary intake was determined using food frequency and 24-h recall questionnaire. Haemoglobin levels were measured using HemoCue digital device and used as a proxy for anaemia. Stool samples were subjected to a suite of copro-microscopic diagnostic methods for detection of intestinal protozoa and helminths. The changes in key indicators between the baseline and end-line surveys were analysed by mixed logistic and linear regression models.

Results

Stunting was slightly lowered in SG+ (19.9 to 18.3%; p = 0.92) and in the control (19.7 to 18.9%). Anaemia slightly decreased in SG+ (33.0 to 32.0%; p < 0.01) and markedly increased in the control (22.7 to 41.3%; p < 0.01), a minor decline was found in the control (43.9 to 42.4%). Handwashing with soap before eating strongly increased in SG+ (from 74.1 to 96.9%; p = 0.01, compared to control where only a slight increase was observed from 78.0 to 84.0%). A similar observation was made for handwashing after defecation (increase from 77.2 to 99.0% in SG+ versus 78.0 to 91.9% in control, p = 0.15).

Conclusions

An integrated intervention consisting of school garden, WASH, nutrition and health components (SG+) increased children’s fruit and vegetable consumption, decreased intestinal parasitic infections and improved hygiene behaviours.

Trial registration

ISRCTN17968589 (date assigned: 17 July 2015).

Roof-Harvested Rainwater Use in Household Agriculture: Contributions to the Sustainable Development Goals

Food and water are at the heart of sustainable development. Roof-harvested rainwater kept in rainwater storage systems (RSS) and used in household agriculture (HA) has the potential to increase yields and supplement household nutrition. Combined systems may contribute to at least eight of the United Nations’ 17 Sustainable Development Goals (SDGs). In this paper, a daily analysis tool, ERain, is used to assess what area of vegetables can be reliably irrigated by roof-harvested rainwater. A socio-economic context is built around an orphanage in the semi-humid region of Nakuru, Kenya. Comparisons are made with the semi-arid region of East Pokot. A 225 kL closed masonry tank and a 1 ML open reservoir with an additional 8 kL/day of recycled water entering are analyzed for various roof sizes. The 225 kL RSS connected to 1000 m2 of roof and irrigating 1000 m2 could increase yields from 1850 to 4200 kg/year in Nakuru. If evaporation was controlled, the 1 mL RSS and recycled water system could support 4000 m2 of land, yielding nearly 20,000 kg/year, which is enough to meet the WHO recommended vegetable dietary requirements of the orphanage. A combination of crops, some for consumption and some for sale, could be grown.

The feasibility and acceptability of a primary school-based programme targeting diet and physical activity: the PhunkyFoods Programme

Background

This study aims to evaluate the feasibility and acceptability of the PhunkyFoods Programme, a primary school-based intervention to promote healthy nutrition and physical activity knowledge and behaviours to assess outcomes to inform a phase 3 trial.

Methods

The cluster randomised feasibility trial recruited eight primary schools from the North of England. Elibility criteria included all primary schools in one town, excluding independent and special schools and schools that comprised of only key stage 2 pupils (years 3–6). Eight schools agreed to participate. Randomisation to intervention or control arms was in a 1:1 ratio. Intervention schools received PhunkyFoods over 17 months. Control schools continued with usual curriculum. Assessors were blinded to group assignment. Measures comprised of a Healthy Lifestyle Knowledge Questionnaire and Synchronised Nutrition and Activity Program to assess diet and physical activity, height, weight, and psychological wellbeing. Feasibility outcomes were recruitment, attrition rates, interviews with teaching staff, focus groups with pupils to explore the acceptability of outcome measures, implementation, intervention content, and programme fidelity.

Results

Three hundred fifty-eight pupils, aged 6–9 years from eight schools were recruited at baseline (control n = 170, intervention n = 188); 337 (94.1%) at 6 months (control n = 163, intervention n = 181); and 331 (92.5%) at 18 months (control n = 152, intervention n = 179), and 6 pupils opted out. Trends in increased knowledge of healthy lifestyle behaviours, healthier eating, and liking of fruit and vegetables were reported in the intervention compared to the control group. Year 4 intervention pupils had significantly higher healthy balanced diet knowledge scores compared to control pupils, mean difference 5.1 (95% CI 0.1 to 10.1, p=0.05). At 18 months, the mean percentage of vegetables liked was higher (intervention 53.9% vs. 43.0% control). Similarly, percentage of fruits liked was also higher (intervention 76.9% vs. 67.2% control). Qualitative data showed that delivery of the intervention was feasible and acceptable to teachers and pupils. Lessons were learned to inform the phase 3 trial around the dietary assessment measure and timing of recruitment.

Conclusions

Whilst the study was not powered to detect a definitive effect, results suggest a potential to increase knowledge of healthy lifestyle behaviours and dietary behaviours, suggesting that with minor changes, a phase 3 trial is likely to be deliverable.

Trial registration

ISRCTN, ISRCTN15641330. Registered 8 May 2015—retrospectively registered, 10.1186/ISRCTN15641330

Effects of a School Based Intervention on Children's Physical Activity and Healthy Eating: A Mixed-Methods Study

Combined diet and physical activity school-based interventions (rather than only diet or physical activity interventions) are more likely to help prevent children from becoming overweight in the long term. However, such interventions are less prevalent, and therefore, this pilot study aimed to assess the feasibility of a gardening intervention coupled with awareness about plant-based meals among 9-10 year old children in a London primary school. We recruited 60 children from two Year 5 classes, one class participated as an intervention group, and results were compared against another class who acted as the control group. Children's physical activity (PA) was measured using GENEActiv wrist-worn accelerometers. Their fruit and vegetable intake and attitudes to and preferences in eating fruits and vegetables were measured using a self-report questionnaire. Furthermore, three focus groups were held with children in the intervention group to understand the reasons behind any change as a result of the intervention. Results are inconclusive; however, they indicate some impact on reduction of sedentary behaviour, increase of moderate to vigorous PA, knowledge of nutrition and some level of acceptance in trying new vegetables. School-based interventions involving gardening show some promise to increase children's PA and improve their attitudes to eating fruits and vegetables.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Nature-Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes

Engagement with nature is an important part of many people's lives, and the health and wellbeing benefits of nature-based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature-based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature-based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Comparison of school day eating behaviours of 8-11 year old children from Adelaide, South Australia, and London, England: Child eating behaviours in South Australia and England

Objective

School food intake makes a considerable contribution to children's overall diet, especially fruit and vegetable intake. Comparing differing school food provision systems can provide novel insights for intervention and improved nutrition policy. This study compared school day food in children from Australia and England.

Design

Children completed food frequency questionnaires reporting school day food intake, breakfast intake and family evening meals. Differences in food consumed over the school day between Australian and English children were evaluated. Multinomial logistic regressions compared fruit and vegetable intake, family dinner frequency and breakfast in Australian and English children adjusting for confounders: age, sex, ethnicity and parent education.

Setting

27 Primary schools in Adelaide, Australia and 32 in London, England.

Subjects

N = 772 children aged 8–11 years from the Australian REACH study (n = 347) and UK RHS School Gardening Trial in England (n = 425).

Results

Considerably more English children reported consuming vegetables at school than Australian children (recess/lunchtime Australian children 3.4%/6.1%; English children recess/lunctime 3.6/51.1%). However, Australian children were more likely to consume vegetables daily (OR = 4.1; 1.3, 12.5), and have family evening meals everyday [OR = 4.01; 1.88, 8.55], and were less likely to consume breakfast (OR = 0.26; 0.08, 0.79) than English children.

Conclusions

Findings indicate that provision of a school lunch meal, compared to a packed lunch from home, may be more supportive of children's vegetable intake. However, without a supportive home environment that encourages vegetable intake, children will not be able to consume sufficient amounts of vegetables.

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

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

Measures of low food variety and poor dietary quality in a cross-sectional study of London school children

BACKGROUND/OBJECTIVES

The use of simple screening tools to measure nutritional adequacy in a public health context in developed countries are currently lacking. We explore the relationship between food variety and nutrient intake of London school children using a simple tool with potential use for screening for inadequate diets.

SUBJECTS/METHODS

A cross-sectional survey was carried out in 2010. The survey included 2579 children aged 7-10 years in 52 primary schools in East London in the United Kingdom. The analysis included 2392 children (93% of the original sample). Food variety was assessed as the total number of listed foods recorded over 24 h using the validated Child and Diet Assessment Tool (CADET) comprising 115 listed foods divided into 16 food categories. Dietary quality was determined by the proportion of children meeting recommended intakes of individual micronutrients, namely, calcium, iron, zinc, folate, vitamin A and vitamin C.

RESULTS

The mean number of CADET-listed foods consumed daily by children was 17.1 (95% CI: 16.8, 17.5). Children who consumed fewer than 11 foods on the collection day had particularly low nutrient intakes. Children consuming three different vegetables and two different fruits on average consumed 19-20 listed foods. It was estimated between 4 and 20% of children did not meet the recommended levels for individual micronutrients during the period of data collection.

CONCLUSIONS

A simple method using food counts to assess daily food variety may help public health nutritionists identify groups of children at risk of inadequate diets.

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.

Effects of School Gardening Lessons on Elementary School Children’s Physical Activity and Sedentary Time

Background: Recess and physical education time continue to diminish, creating a need for additional physical activity opportunities within the school environment. The use of school gardens as a teaching tool in elementary science and math classes has the potential to increase the proportion of time spent active throughout the school day. Methods: Teachers from 4 elementary schools agreed to teach 1 math or science lesson per week in the school garden. Student physical activity time was measured with ActiGraph GT3X accelerometers on 3 garden days and 3 no-garden days at each school. Direct observation was used to quantify the specific garden-related tasks during class. The proportion of time spent active and sedentary was compared on garden and no-garden days. Results: Seventy-four children wore accelerometers, and 75 were observed (86% participation). Children spent a significantly larger proportion of time active on garden days than no-garden days at 3 of the 4 schools. The proportion of time spent sedentary and active differed significantly across the 4 schools. Conclusions: Teaching lessons in the school garden may increase children’s physical activity and decrease sedentary time throughout the school day and may be a strategy to promote both health and learning.

What Should Be Taught in Secondary Schools' Nutrition and Food Systems Education? Views from Prominent Food-Related Professionals in Australia

Education can help young people to attain the knowledge and the skills that they need to make proper food choices and develop lifelong healthy eating patterns. This study explored the perspectives of prominent food-related professionals in Australia regarding essential nutrition and food systems (N&FS) education programs for adolescents during formal education. Semi-structured interviews were conducted with 21 prominent food-related professionals in Australia. Interview transcripts were analysed thematically. Four essential areas for N&FS education programs were identified. (1) Key nutrition messages to a healthy lifestyle; (2) Skill development programs to enhance health and wellbeing; (3) Ethical food-related lessons to support environmental sustainability, farm animal welfare, local producers, and food security; and, (4) Introductory lessons about foods from farm to plate to facilitate more informed food choices. Findings of this study may provide new insights for curriculum developers in Australia for further assessment of the current gaps in N&FS components of secondary school curriculum. Integration of these four areas into secondary school curricula has the potential to enhance adolescents’ knowledge of important scientific and ethical issues in a range of N&FS fields, and enable them to develop fundamental food-related life skills that are supportive of health and wellbeing.

How effective are family-based and institutional nutrition interventions in improving children's diet and health? A systematic review

BACKGROUND

Effective strategies to improve dietary intake in young children are a priority to reduce the high prevalence of chronic non-communicable diseases in adulthood. This study aimed to assess the impact of family-based and school/preschool nutrition programs on the health of children aged 12 or younger, including the sustainability of these impacts and the relevance to socio-economic inequalities.

METHODS

A systematic review of literature published from 1980 to December 2014 was undertaken. Randomised controlled trials involving families with children aged up to 12 years in high income countries were included. The primary outcomes were dietary intake and health status. Results were presented in a narrative synthesis due to the heterogeneity of the interventions and outcomes.

RESULTS

The systematic search and assessment identified 39 eligible studies. 82% of these studies were set in school/preschools. Only one school study assessed the impact of involving parents systematically. The family-based programs which provided simple positive dietary advice to parents and regular follow-up reduced fat intake significantly. School and family-based studies, if designed and implemented well, increased F&V intake, particularly fruit. Effective school-based programs have incorporated role-models including peers, teachers and heroic figures, rewards and increased access to healthy foods. School nutrition programs in disadvantaged communities were as effective as programs in other communities.

CONCLUSIONS

Family and school nutrition programs can improve dietary intake, however evidence of the long-term sustainability of these impacts is limited. The modest overall impact of even these successful programs suggest complementary nutrition interventions are needed to build a supportive environment for healthy eating generally.

School Children's Intestinal Parasite and Nutritional Status One Year after Complementary School Garden, Nutrition, Water, Sanitation, and Hygiene Interventions in Burkina Faso

The potential health benefits of combined agricultural, nutrition, water, sanitation, and hygiene (WASH) interventions are poorly understood. We aimed to determine whether complementary school garden, nutrition, and WASH interventions reduce intestinal parasites and improve school children's nutritional status in two regions of Burkina Faso. A cluster-randomized controlled trial was conducted in the Plateau Central and Center-Ouest regions of Burkina Faso. A total of 360 randomly selected children, aged 8-15 years, had complete baseline and end-line survey data. Mixed regression models were used to assess the impact of the interventions, controlling for baseline characteristics. The prevalence of intestinal parasitic infections decreased both in intervention and control schools, but the decrease was significantly higher in the intervention schools related to the control schools (odds ratio [OR] of the intervention effect = 0.2, 95% confidence interval [CI] = 0.1-0.5). Indices of undernutrition did not decrease at end-line in intervention schools. Safe handwashing practices before eating and the use of latrines at schools were significantly higher in the intervention schools than in the control schools at end-line (OR = 6.9, 95% CI = 1.4-34.4, and OR = 14.9, 95% CI = 1.4-153.9, respectively). Parameters of water quality remained unchanged. A combination of agricultural, nutritional, and WASH-related interventions embedded in the social-ecological systems and delivered through the school platform improved several child health outcomes, including intestinal parasitic infections and some WASH-related behaviors. Sustained interventions with stronger household and community-based components are, however, needed to improve school children's health in the long-term.

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.

Effect of home vegetable gardening on the household availability of fruits and vegetables

ABSTRACT Objective: Evaluate the effect of planting herb or vegetable seeds and seedlings on the household availability of fruits and vegetables through an intervention study combining various actions (educational practices, home visits, and distribution of seeds and seedlings) for the promotion of fruit and vegetable consumption in multiple settings. Methods: Data from 70 families were analyzed. Using the stratified sampling technique, the participant families were selected from a stratum within a population of 1,743 families living in three low-income communities in the city of Rio de Janeiro, Brazil. Three post-intervention groups were formed and compared: families that did not receive the seeds and seedlings during the intervention; families that received but did not plant the seeds and seedlings; families that received and planted the seeds and seedlings. Results: Among the families that did not grow their own fruits and vegetables before the intervention, those that received and planted the seeds and seedlings achieved an increase in household availability of fruits and vegetables (Δ=+5.8 percentage points) up to three times higher (p<0.05) than that achieved by the families who did not receive the seeds and seedlings (Δ=+1.8 5 percentage points) and those that received but did not plant them (Δ=+2.3 percentage points). As for the families that grew their own fruits and vegetables before the intervention, the comparison between those that did not receive the seeds and seedlings, those that received and planted them, and those that received but did not plant them showed no differences in the household availability of fruits and vegetables. Conclusion: The planting of the seeds and seedlings that they received by the families that did not grow their own fruits and vegetables before the intervention contributed to a significant increase in the household availability of fruits and vegetables.

LA sprouts randomized controlled nutrition, cooking and gardening programme reduces obesity and metabolic risk in Hispanic/Latino youth

BACKGROUND

Many programmes for children that involve gardening and nutrition components exist; however, none include experimental designs allowing more rigorous evaluation of their impact on obesity.

OBJECTIVES

The objective of this study is to explore the effects of a novel 12-week gardening, nutrition and cooking intervention {'LA Sprouts'} on dietary intake, obesity parameters and metabolic disease risk among low-income, primarily Hispanic/Latino youth in Los Angeles..

METHODS

This study used a randomized control trial involving four elementary schools [two randomized to intervention {172, 3rd-5th grade students}; two randomized to control {147, 3rd-5th grade students}]. Classes were taught in 90-min sessions once per week for 12 weeks. Data collected at pre-intervention and post-intervention included dietary intake via food frequency questionnaire, anthropometric measures {body mass index, waist circumference}, body fat, and fasting blood samples.

RESULTS

LA Sprouts participants compared with controls had significantly greater reductions in body mass index z-scores {-0.1 vs. -0.04, respectively; p = 0.01} and waist circumference {-1.2 vs. 0.1 cm; p < 0.001}. Fewer LA Sprouts participants had the metabolic syndrome after the intervention than before, while controls with metabolic syndrome increased. LA Sprouts participants compared with controls increased dietary fiber intake {+3.4% vs. -16.5%; p = 0.04}. All participants decreased vegetable intake, but decreases were less in LA Sprouts than controls {-3.7% vs. -26.1%; p = 0.04}. Change in fruit intake did not differ between LA Sprouts and controls.

CONCLUSIONS

LA Sprouts was effective in reducing obesity and metabolic risk; however, additional larger and longer-term studies are warranted.

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.

Best Strategies to Improve School-leavers' Knowledge of Nutrition and Food Systems: Views from Experts in Iran

Background:

The research to date does not present an articulated approach to ensure nutrition and food systems education is systematically implemented within schools. This paper aimed to investigate food experts’ views of the best strategies to improve school-leavers’ knowledge of nutrition and food systems.

Methods:

In this qualitative study, 28 Iranian food and nutrition experts from four major provinces (Tehran, Fars, Isfahan, and Gilan) were selected and agreed to be interviewed. Required data were collected through in-depth, semi-structured, face-to-face, or telephone interviews and were analyzed thematically using NVivo.

Results:

The experts’ suggested strategies to improve Iranian school-leavers’ knowledge of nutrition and food systems fell into three key themes: Policy, education processes, and supportive environments. Together they formed an overarching theme of a multileveled system approach for transferring knowledge.

Conclusions:

Development of a scaffolded education program could assist curriculum developers and policy makers to assess and update current nutrition and food systems education programs in schools. Insights gained about education initiatives in one country such as Iran can provide an important impetus to support nutrition and food system education more widely.

Home Gardening and the Health and Well-Being of Adolescents

BACKGROUND

The current article explores the associations between home gardening and dietary behaviors, physical activity, mental health, and social relationships among secondary school students in New Zealand.

METHOD

Data were drawn from a national youth health and well-being survey, conducted in 2012. In total, 8,500 randomly selected students from 91 randomly selected secondary schools completed the survey.

RESULTS

Two thirds of students had a vegetable garden at home and one quarter of all students participated in home gardening. Students participating in gardening were most likely to be male, of a Pacific Island ethnicity, of younger age, and living in a rural area. Gardening was positively associated with healthy dietary habits among students, such as greater fruit and vegetable consumption. Gardening was also positively associated with physical activity and improved mental health and well-being. Students who participate in gardening report slightly lower levels of depressive symptoms and enhanced emotional well-being and experience higher family connection than students who do not participate in gardening.

CONCLUSIONS

Gardening may make a difference for health and nutrition behaviors and may contribute to adolescents' health and well-being in a positive manner. Health promoters should be encouraged to include gardening in future interventions for young people.

Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: Study design and baseline data of the Texas, Grow! Eat! Go! (TGEG) cluster-randomized controlled trial

Background

Coordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data.

Methods

The study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student’s weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling.

Results

Descriptive data are presented for students (n = 1369) and parents (n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed.

Conclusions

The TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design.

Associations between physical activity patterns and dietary patterns in a representative sample of Polish girls aged 13-21 years: a cross-sectional study (GEBaHealth Project)

BACKGROUND

Similar to other countries, trends of decreasing levels of physical activity (PA) and an increasing prevalence of unhealthy dietary patterns are observed among girls in Poland. Better understanding of potentially inter-related behaviours within this population can help to design tailored interventions. The purpose of this study was to determine associations between PA patterns and dietary patterns in a representative sample of Polish girls.

METHODS

Girls aged 13-21 years (n = 1107) were randomly selected for the study. PA was assessed using International Physical Activity Questionnaire - Long (IPAQ-L). Dietary data were collected with food frequency questionnaires. PA patterns and dietary patterns were drawn separately by Principal Component Analysis (PCA). Logistic regression was used to find the associations between PA patterns and dietary patterns.

RESULTS

Four major PA patterns ('School/work activity', 'Active recreation', 'Yard activity' and 'Walking and domestic activity') and four dietary patterns ('Traditional Polish', 'Fruit & vegetables', 'Fast food & sweets' and 'Dairy & fats') were identified. Level of PA was the highest in the upper tertile of 'School/work activity' pattern (mean 1372.2 MET-minutes/week, 95 % Confidence Intervals [CI]: 1285.9-1458.5). Girls in upper tertiles of 'Yard activity', 'Active recreation' and 'School/work activity' patterns had significantly higher chances of being in the upper tertile of the 'Fruit and vegetables' dietary pattern (odds ratio [OR] 2.17, 95 % CI: 1.50-3.14, p < 0.0001; OR 2.02, 95 % CI: 1.41-2.91; p < 0.001 and OR 1.76, 95 % CI: 1.24-2.51, p < 0.01 respectively; all adjusted for confounders) in comparison to bottom tertiles. Weak, but significant inverse associations were found between upper tertiles of 'Active recreation' and 'Yard activity' patterns and unhealthy dietary patterns.

CONCLUSIONS

We found associations between PA patterns and dietary patterns in the population of Polish girls. Girls with the highest adherence to the 'School/work activity' pattern had the highest levels of PA and presented pro-healthy dietary behaviours. School should be recognised as potentially efficient and important setting to maximise girls' PA potential. The after-school time is the area that should also be targeted to increase daily PA or to at least sustain the level of PA after completing education.

A systematic review of the health and well-being impacts of school gardening: synthesis of quantitative and qualitative evidence

BACKGROUND

School gardening programmes are increasingly popular, with suggested benefits including healthier eating and increased physical activity. Our objectives were to understand the health and well-being impacts of school gardens and the factors that help or hinder their success.

METHODS

We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42014007181). We searched multiple databases and used a range of supplementary approaches. Studies about school gardens were included if they reported on physical or mental health or well-being. Quantitative studies had to include a comparison group. Studies were quality appraised using appropriate tools. Findings were narratively synthesised and the qualitative evidence used to produce a conceptual framework to illustrate how benefits might be accrued.

RESULTS

Evidence from 40 articles (21 quantitative studies; 16 qualitative studies; 3 mixed methods studies) was included. Generally the quantitative research was poor. Evidence for changes in fruit and vegetable intake was limited and based on self-report. The qualitative research was better quality and ascribed a range of health and well-being impacts to school gardens, with some idealistic expectations for their impact in the long term. Groups of pupils who do not excel in classroom activities were thought to particularly benefit. Lack of funding and over reliance on volunteers were thought to threaten success, while involvement with local communities and integration of gardening activities into the school curriculum were thought to support success.

CONCLUSION

More robust quantitative research is needed to convincingly support the qualitative evidence suggesting wide ranging benefits from school gardens.

School gardens and adolescent nutrition and BMI: Results from a national, multilevel study

OBJECTIVE

The aim of the current study was to determine the impact of school gardens on student eating behaviors, physical activity and BMI in New Zealand secondary schools. The current study also aimed to determine if school gardens could buffer the association between household poverty and adolescent BMI.

METHODS

Data were drawn from a national study of the health and wellbeing of New Zealand secondary school students (n=8500) conducted in 2012. Multilevel regression models were used to determine the association between school gardens (school-level) and student nutrition behaviors, physical activity and measured BMI (student-level).

RESULTS

Approximately half of secondary schools had a fruit/vegetable garden for students to participate in. School gardens were associated with lower student BMI (p=0.01) and lower prevalence of overweight (p<0.01).

CONCLUSIONS

School gardens appear to have a positive impact on student health. Future research may explore how school gardens are implemented to better understand their impact and to extend the benefits beyond the school community.

Effect of Educational Intervention on the Fruit and Vegetables Consumption among the Students: Applying Theory of Planned Behavior

BACKGROUND

The importance of consuming fruits and vegetables (F&V) in prevention of chronic diseases is known. Childhood play an important role in formation of healthy eating habits. The purpose of this study was to examine the effect of education, with application of the theory of planned behavior, on improvement of F&V consumption.

METHODS

In this quasi-experimental study, 184 fourth, fifth, and sixth-grade students participated were enrolled from Jan 2013 to Jun 2014. The samples were selected from 6 schools in Chalderan County, West Azerbaijan, Iran through cluster random sampling method. Two out of 6 schools were randomly selected and each was employed in either experimental or control group. The data collection instruments included a researcher-made questionnaire and a 24-h F&V recall. Data were collected after verification of the reliability and validity of the questionnaire.

RESULTS

Before the intervention, no significant difference was observed between the intervention and control group regarding attitude, subjective norms, perceived behavioral control, behavioral intention and fruits and vegetables consumption (P>0.05). However, after the educational intervention, the mean scores of attitude, subjective norms, perceived behavioral control, behavioral intention variables and fruits and vegetables were significantly higher in the intervention group when compared to the control group(P<0.05).

CONCLUSIONS

Increased behavioral intention, attitude, subjective norms, and perceived behavioral control can promote F&V consumption among the students.

Vegetable and Fruit Acceptance during Infancy: Impact of Ontogeny, Genetics, and Early Experiences

Many of the chronic illnesses that plague modern society derive in large part from poor food choices. Thus, it is not surprising that the Dietary Guidelines for Americans, aimed at the population ≥2 y of age, recommends limiting consumption of salt, fat, and simple sugars, all of which have sensory properties that we humans find particularly palatable, and increasing the variety and contribution of fruits and vegetables in the diet, to promote health and prevent disease. Similar recommendations may soon be targeted at even younger Americans: the B-24 Project, led by the US Department of Health and Human Services and the USDA, is currently evaluating evidence to include infants and children from birth to 2 y of age in the dietary guidelines. This article reviews the underinvestigated behavioral phenomena surrounding how to introduce vegetables and fruits into infants' diets, for which there is much medical lore but, to our knowledge, little evidence-based research. Because the chemical senses are the major determinants of whether young children will accept a food (e.g., they eat only what they like), these senses take on even greater importance in understanding the bases for food choices in children. We focus on early life, in contrast with many other studies that attempt to modify food habits in older children and thus may miss sensitive periods that modulate long-term acceptance. Our review also takes into consideration ontogeny and sources of individual differences in taste perception, in particular, the role of genetic variation in bitter taste perception.

School-Based Interventions to Reduce Obesity Risk in Children in High- and Middle-Income Countries

School-based interventions are relatively new and were first introduced in the United States in the 1990s. Early programs were mainly education based with many of the findings now embedded in school policy in the form of a healthy eating curriculum. More recent school programs have taken education outside the classroom and attempted to engage parents as well as teachers. Environmental changes such as improving the quality of foods available at lunchtime and at other times during the school day are now common. Reviews of evaluations of school-based programs have demonstrated that they are effective and successfully improve dietary quality such as increasing fruit and vegetable intake and decreasing sweet and savory snacks and sweetened drinks; not just in school but over the whole day and particularly in younger school children. School-based interventions are also effective at reducing obesity if components to increase physical activity and reduce sedentary behaviors are also targeted but not if only dietary behaviors are tackled. Most of the high-quality evaluation studies using randomized controlled trials have been carried out in high-income countries as they are costly to run. However, middle-income countries have benefitted from the information available from these evaluation studies and many are now starting to fund and evaluate school-based programs themselves, resulting in unique problems such as concomitant under- and overnutrition being addressed. Action for the future demands more focus on populations most at risk of poor dietary quality and obesity in order to reduce inequalities in health and on adolescents who have not benefited as much as younger children from school-based interventions. This will involve innovative solutions within schools as well as targeting the food environment outside schools such as reducing the density of fast-food outlets and marketing of sweet and savory snacks and drinks.

Lessons learned from the AFLY5 RCT process evaluation: implications for the design of physical activity and nutrition interventions in schools

Background

Systematic reviews have highlighted that school-based diet and physical activity (PA) interventions have had limited effects. This study used qualitative methods to examine how the effectiveness of future primary (elementary) school diet and PA interventions could be improved.

Methods

Data are from the Active For Life Year 5 (AFLY5) study, which was a cluster randomised trial conducted in 60 UK primary schools. Year 5 (8–9 years of age) pupils in the 30 intervention schools received a 12-month intervention. At the end of the intervention period, interviews were conducted with: 28 Year 5 teachers (including 8 teachers from control schools); 10 Headteachers (6 control); 31 parents (15 control). Focus groups were conducted with 70 year 5 pupils (34 control). Topics included how the AFLY5 intervention could have been improved and how school-based diet and PA interventions should optimally be delivered. All interviews and focus groups were transcribed and thematically analysed across participant groups.

Results

Analysis yielded four themes.

Child engagement: Data suggested that programme success is likely to be enhanced if children feel that they have a sense of autonomy over their own behaviour and if the activities are practical.

School: Finding a project champion within the school would enhance intervention effectiveness. Embedding diet and physical activity content across the curriculum and encouraging teachers to role model good diet and physical activity behaviours were seen as important.

Parents and community: Encouraging parents and community members into the school was deemed likely to enhance the connection between schools, families and communities, and “create a buzz” that was likely to enhance behaviour change.

Government/Policy: Data suggested that there was a need to adequately resource health promotion activity in schools and to increase the infrastructure to facilitate diet and physical activity knowledge and practice.

Discussion and Conclusions

Future primary school diet and PA programmes should find ways to increase child engagement in the programme content, identify programme champions, encourage teachers to work as role models, engage parents and embed diet and PA behaviour change across the curriculum. However, this will require adequate funding and cost-effectiveness will need to be established.

Trial registration

ISRCTN50133740