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

Gardening initiatives as an approach to cancer prevention for children and youth

OBJECTIVES

Gardening initiatives may be used to address modifiable risk factors for cancer from an early age. This review synthesizes evidence on the effects of gardening initiatives on modifiable cancer risk factors among school-aged children and youth.

STUDY DESIGN

Rapid review.

METHODS

A rapid review was conducted in March 2024 using databases (e.g., MEDLINE, PubMed), registers (e.g., ClinicalTrials.gov), and other sources (e.g., Healthevidence.org, Google Scholar). Two reviewers independently screened and selected articles for inclusion, and one completed quality appraisal. Peer-reviewed studies from the past ten years on gardening initiatives in schools, daycares, or community settings in high-income countries were included. Studies had to report health outcomes for children and youth (aged 0-18 years) related to modifiable cancer risk factors including: nutrition behaviors, body weight, physical activity (PA), sedentary behavior, psychosocial factors, and ultraviolet ray (UVR) behaviors.

RESULTS

This resulted in forty-eight included studies. Most measured outcomes related to nutrition behaviors, psychosocial factors, body weight, and PA. Fewer studies measured sedentary behavior, and none included UVR behaviors. Gardening initiatives generally led to positive nutrition behaviors (e.g., improved knowledge, dietary diversity), increased PA, decreased sedentary behavior, and improved psychosocial factors (e.g., depression, social cohesion). Effects on body weight and abdominal adiposity were inconclusive.

CONCLUSIONS

Gardening initiatives in educational and community settings could help prevent cancer by improving diet, PA, and psychosocial health in children and youth. However, more rigorous, longitudinal studies are needed to better understand their effectiveness, mechanisms, and long-term impact on cancer prevention into adulthood.

The impact of a school garden program on children's food literacy, climate change literacy, school motivation, and physical activity: A study protocol

OBJECTIVE

FoodACT aims to investigate how school gardens affect children's food literacy (FL), climate change literacy (CCL), school motivation (SM), and physical activity (PA).

DESIGN

It comprises a multimethod, quasi-experimental inquiry into an existing Danish school garden program, Gardens to Bellies (GtB). Data will be collected using surveys, accelerometry, semi-structured and focus-group interviews. The study is preregistered with ClinicalTrials.gov (#NCT05839080).

SETTING

Six GtB school garden locations across Region Zealand and Region of Southern Denmark.

PARTICIPANTS

Fourth grade pupils attending GtB (approx. 1600) are recruited to the intervention group. Fourth grade pupils from schools not attending GtB (approx. 1600) are recruited to the control group.

INTERVENTION

Pupils grow, prepare and cook foods for meals in the school garden during eight garden sessions.

MAIN OUTCOME MEASURES

FL, CCL and SM are measured using pre- and post-intervention surveys in both groups. Pupils participating in GtB have their PA assessed using accelerometery, and acute SM by text-message-surveys. Semi-structured and focus-groups interviews are held with garden facilitators and pupils focusing on the implementation of GtB and mechanisms related to developing FL and CCL.

ANALYSIS

The effect on FL, CCL and SM is assessed using linear mixed models. PA and acute SM are assessed by comparing data on days with and without GtB in a subsample of 900 pupils. Qualitative data will be analysed using thematic analysis.

Interventions on Fruit and Vegetable Intake in Low-, Middle-, and High-Income Countries: A Scoping Review of Evidence and Knowledge Gaps

BACKGROUND

Adequate fruit and vegetable (F&V) intake is important for health, yet populations globally are failing to meet recommendations.

OBJECTIVE

A scoping review to summarize available evidence of evaluations of interventions to increase F&V intake globally, focusing on target populations, intervention strategies, research methods, and summarizing their evaluated impacts.

METHODS

We searched PubMed and Web of Science in February 2023 for intervention studies in which dietary intake of fruit and/or vegetables were documented. Eligible studies included all age groups, excluding those targeting populations with specific disease-related conditions, such as cancer patients/survivors. Only articles published in English since 2012 were included in the review.

RESULTS

We identified 6338 articles, with 226 meeting inclusion criteria, comprising 223 unique studies and 284 intervention comparisons. Most comparisons occurred in high-income countries (n = 192) compared to low- and middle-income countries (n = 92). Randomized controlled trials (RCTs; 37.3%) and cluster RCTs (52.5%) were predominant. Interventions primarily targeted adults (31.7%), school-aged children (18.0%), children under-five (14.4%), and adolescents (13.7%), lasting an average of 24 weeks (range: 2 weeks to 20 years). Food-frequency questionnaires (59.2%) and 24-h recalls (26.8%) were the most used dietary assessment method. Health and nutrition education (75.9%) was the most common intervention, utilizing interpersonal communication, mass media, and information-communication technology, often in combinations. Positive impacts on fruit (43.9%), vegetable (40.2%), and combined F&V intake (53.0%) were observed in nearly half the intervention comparisons.

CONCLUSIONS

These findings highlight the predominance of health and nutrition education interventions, predominantly in high-income countries, showing mixed success in improving F&V intake, emphasizing the need for context-specific strategies and standardized methodologies to design sustainable, cost-effective interventions for better diet quality and health outcomes.

PLAIN LANGUAGE TITLE

A literature review assessing what we know and do not know about efforts to improve fruit and vegetable intake across the world.

Perceived influences of fruit and vegetable consumption among Indian adolescents - A qualitative inquiry

BACKGROUND

Fruits and vegetables are primary sources of vitamins and minerals that may alleviate the risk of chronic illnesses. However, Indian adolescents consume inadequate amounts of fruits and vegetables, with less than 10% meeting recommendations. Micronutrient deficiencies are a major public health problem in India. For example, the prevalence of iron-deficiency anemia and Vitamin A deficiency in adolescents is 28.5% and 14.4%, respectively. To promote fruit and vegetable consumption among Indian adolescents, we need to identify the factors which may influence the consumption. The aim of this qualitative inquiry was to explore perceived influences of fruit and vegetable consumption among Indian adolescents.

METHODS

Using purposive sampling, adolescents aged 10-19 years were recruited from two public and two private (independent) schools in Varanasi, India. Face-to-face interviews along with the 'draw and tell' technique were used for data collection. Interviews were conducted in English as well as in Hindi depending on the preferences of the adolescents. The conversations were digitally recorded and transcribed verbatim. The transcribed data were subjected to thematic analysis. Data were coded inductively, and themes were extracted using NVivo software program.

RESULTS

A total of 58 adolescents (53% female; 74% urban) with mean age 13.6 years completed the interviews. Nine major themes and associated sub-themes emerged, including: (i) Sensory properties (i.e., taste, color, flavor, texture); (ii) Health and immunity; (iii) Allergy; (iv) Home food environment (i.e., influence of mothers, availability and accessibility of fruits and vegetables); (v) Cost; (vi) Food preparation; (vii) Influence of peers; (viii) School food environment; (ix) Proclivity for energy-dense, nutrient-poor foods and beverages.

CONCLUSIONS

The emerging themes and sub-themes show that multiple factors are likely to affect fruit and vegetable consumption in adolescents, aligning with literature on adolescent fruit and vegetable consumption in international settings. Behavioral interventions should be designed to create enabling environments to encourage fruit and vegetable consumption in Indian adolescents by removing barriers at the individual, household, and community levels, thereby reducing the enduring prevalence of micronutrient deficiencies.

Hands-On Gardening in Childcare Centers to Advance Preschool-Age Children's Fruit and Vegetable Liking in Semi-Arid Climate Zone

Hands-on gardening is linked with healthy eating behaviors, increased outdoor activities, and overall well-being, all contributing factors to preventing obesity. Although these positive associations are widely established for adults and school-aged children, little evidence can be found on how such relationships may extend to early childhood, especially in the preschool years (3-5 years). One recent study conducted in North Carolina (NC) showed that participating in hands-on gardening significantly increased preschoolers' accurate identification of fruits and vegetables (FV) and FV consumption compared to children who did not participate in hands-on gardening, but no association was found between participation in hands-on gardening and the children's liking (eating preferences) of FV. FV identification and liking during the early years may lead to lifelong healthy eating behaviors and preferences, making hands-on gardening a critical health intervention in early childhood environments, especially in childcare centers where a majority of the 13 million children in the United States between the ages of 0 and 5 spend most of their waking hours. This research aimed to investigate how hands-on gardening in childcare centers may impact preschoolers' (3-5 years old) FV knowledge (identification) and liking in a semi-arid climate zone with a high concentration of Hispanic families by conducting experimental research with eight childcare centers and one hundred forty-nine children (n = 149) in Lubbock County, located in West Texas. The findings showed changes in average liking scores are generally positive in the experimental group of children who participated in hands-on gardening (compared to the control non-gardening group), implying an improved liking. The findings indicate that the benefits of hands-on gardening in childcare centers for enhancing healthy eating preferences are evident even in a semi-arid climate zone, where high temperatures and limited rainfall present significant gardening challenges. This research underscores the importance of integrating hands-on gardening into childcare programs, highlighting its potential as an effective obesity prevention strategy not only within the US but also in other regions with similar environmental constraints.

External Factors Influencing the Implementation of Policy, System, and Environmental Change Strategies Within Cooperative Extension

Introduction. Multilevel approaches are important to promote the adoption of healthier practices at the individual and community levels. Cooperative Extension pairs policy, systems, and environmental (PSE) change approaches with direct education programs focused on individual and community health. This study sought to understand Family and Consumer Sciences (FCS) Extension agents' perceptions of PSE change supports, benefits for their communities, and resources and partnerships important for implementation. Method. The Consolidated Framework for Implementation Research was used to develop a survey to assess outer setting domains related to PSE work. In addition to close-ended questions, the survey included several open-ended, qualitative questions exploring the benefits, resources, and relationships required to implement PSE changes. The surveys were collected online from FCS agents in two states. Descriptive statistics were calculated, open responses were coded, and key themes were established. Results. FCS agents (n=116) indicated high levels of agreement about having necessary support from state-level specialists (71%) and the overall Extension organization (64%). The largest gaps in support were reported as grant or external funding sources, time, and county programming funds. Half of the sample agreed that PSE training was adequate, but only 38.5% reported previously participating in PSE-specific training. Open-ended question responses revealed diverse relationships and numerous benefits of PSE work, including more sustainable health behavior changes and greater local Extension visibility. Discussion. Our findings corroborate previous work and identify potential gaps that future interventions can address to better support Extension and public health professionals when implementing PSE work at the community level.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

BACKGROUND

Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions designed to increase children's consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment, is required to assess the potential to reduce this disease burden.

OBJECTIVES

To assess the benefits and harms of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 March 2023. We searched Proquest Dissertations and Theses in December 2022. We reviewed reference lists of included trials and contacted authors of the included trials to identify further potentially relevant trials.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster-randomised controlled trials (C-RCTs) and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both amongst children aged five years and under compared to no-intervention control, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. We used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the certainty of evidence (GRADE approach) using Cochrane procedures.

MAIN RESULTS

We included 53 trials with 120 trial arms and 12,350 participants. Sixteen trials examined the impact of child-feeding practice interventions only (e.g. repeated food exposure) in increasing child vegetable intake. Twenty trials examined the impact of multicomponent interventions primarily conducted in the childcare setting (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Seventeen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children only in increasing child fruit and vegetable intake and one each examined a child-focused mindfulness intervention or providing families with fruit and vegetable interventions. We judged nine of the 53 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is moderate-certainty evidence that child-feeding practice interventions versus no-intervention control probably have a small positive effect on child vegetable consumption, equivalent to an increase of 15.5 grams as-desired consumption of vegetables (SMD 0.44, 95% confidence interval (CI) 0.24 to 0.65; 15 trials, 1976 participants; mean post-intervention follow-up = 12.3 weeks). No trials in this comparison reported information about intervention costs. One trial reported no harms or serious unintended adverse consequences (low-certainty evidence). Multicomponent interventions versus no-intervention control probably have a small effect on child consumption of fruit and vegetables (SMD 0.27, 95% CI 0.11 to 0.43; 14 trials, 4318 participants; moderate-certainty evidence; mean post-intervention follow-up = 4.0 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. One trial, which tested a multicomponent garden-based intervention, reported the installation of the garden as part of the intervention to be USD 1500 per childcare centre (low-certainty evidence). No trials in this comparison reported information about unintended adverse consequences of interventions. Parent nutrition education interventions may have little to no short-term impact on child consumption of fruit and vegetables versus no-intervention control (SMD 0.10, 95% CI -0.02 to 0.22; 14 trials, 4122 participants; low-certainty evidence; mean post-intervention follow-up = 6.4 weeks). One trial reported the total estimated cost of delivering a parent nutrition education intervention for infant feeding, physical activity and sedentary behaviours delivered by a dietitian as approximately AUD 500 per family (low-certainty evidence). One trial reported no unintended adverse consequences on family food expenditure following implementation of an intervention delivered over the telephone to improve parental knowledge and skills about the home food environment (low-certainty evidence). Trials reported receiving governmental or charitable funds, except for one trial reporting industry funding.

AUTHORS' CONCLUSIONS

There was moderate-certainty evidence that child-feeding practice interventions and multicomponent interventions probably lead to only small increases in fruit and vegetable consumption in children aged five years and under. Parent nutrition education interventions may have little or no effect on increasing fruit and vegetable consumption in children aged five years and under. Future research should be prioritised on assessment and reporting of both intervention cost and adverse effects, and development and evaluation of interventions in research gaps, including in a broader range of settings and in low- and middle-income countries. This review continues to be maintained as a living systematic review with monthly searches for new evidence and incorporation of relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

Development and validation of the gratitude for food scale for Japanese adults

Gratitude for food is a concept associated with various aspects of healthy and sustainable diet and originates from Buddhism and Shintoism in Japan. Against this background, a scale specifically targeting adults is essential for boosting studies concerning gratitude for food. This study aimed to adapt the Gratitude for Food Scale (GFS), originally developed for Japanese children, to Japanese adults and to examine the reliability and validity of GFS for adults (GFS-A). This cross-sectional study used baseline and one-week follow-up data from a longitudinal survey. The analysis included 1800 Japanese adults at baseline and 1380 at the one-week follow-up based on completion of self-administered questionnaires in February 2023. Construct validity was confirmed using exploratory and confirmatory factor analyses. Further, Spearman's and intraclass correlation coefficients and Cronbach's alpha were calculated to confirm criterion validity and reliability (test-retest and internal consistency). Participants' mean (SD) age was 40.2 (11.2) years (women: n = 900, 50.0%) at baseline. The analysis revealed a one-factor structure comprising five items with good model fit. Criterion validity was confirmed by the correlation coefficients between the total GFS score and the gratitude questionnaire and the sub-score of awareness and appreciation for food, which represents a subscale of the expanded mindful eating scale. Moreover, test-retest reliability and internal consistency were confirmed. From this study's results, we can see that the developed GFS-A is an appropriate scale with good reliability and validity for measuring Japanese adults' gratitude for food.

Effect of a family-based lifestyle intervention on weight reduction among Jordanian children with obesity aged 6-9 years

This study aimed to evaluate the effect of a family-based lifestyle intervention on reducing body weight among Jordanian children with obesity aged 6-9 years old. The pretest-posttest control group design was conducted among 162 children (75 in the intervention group and 87 in the control group) with obesity aged 6-9 years old at four primary schools in Jordan during the period from March 2021 to July 2021. The results found that, after the intervention, there was a statistically significant change in the F scores in the control group vs. in the intervention group (M = 37.07, SD = 2.77; M = 33.48, SD = 2.73; t (160) = 8.29, P < 0.001), where the mean BMI percentile was reduced by 2.05 in the intervention group. A significant difference was demonstrated in the median BMI percentile in the intervention and control groups post-intervention (P < 0.001). A significant difference was also noticed between the average weekly reported dietary habits and the physical activities of both the control group and the intervention group post-intervention. The findings support the effect of family-based lifestyle interventions. Healthcare providers should adopt such interventions for children living with obesity. Future study is required to evaluate the long-term effectiveness of this intervention on weight reduction.

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

OBJECTIVE

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

DESIGN

Focus groups with current participants and program alumni.

SETTING

Washington, DC.

PARTICIPANTS

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

PHENOMENON OF INTEREST

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

ANALYSIS

Inductive thematic analysis.

RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

School-based intervention impacts availability of vegetables and beverages in participants' homes

As rates of metabolic syndrome rise, children consume too few vegetables and too much added sugar. Because children tend to eat what is available at home, the home environment plays a key role in shaping dietary habits. This secondary analysis evaluated the effects of a school-based gardening, cooking, and nutrition education intervention (TX Sprouts) compared to control on the availability of vegetables, fruit juice, and sugar-sweetened beverages (SSBs) at home. In the TX Sprouts cluster-randomized trial, 16 schools were randomized to TX Sprouts (n = 8 schools) or control (n = 8 schools) for one academic year. All schools served predominately Hispanic families with low incomes. TX Sprouts built school gardens and taught 18 lessons to all 3rd-5th grade students at intervention schools. TX Sprouts also offered monthly caregiver lessons before and/or after school. Caregivers completed questionnaires pre and post, providing demographics and information about home availability of vegetables, fruit juice, and SSBs. Summary statistics were used to describe the sociodemographic characteristics of participants. Linear regression assessed the change in scores (pre to post) for the food/ beverage availability question. The model was adjusted for the caregiver's education, employment status, child's grade, and free or reduced-price lunch eligibility. The analytic sample included 895 participants. Compared to control, the intervention positively changed the home availability of targeted foods and beverages, largely by improving the availability of vegetables and vegetable juice. This study showed that a school gardening, nutrition, and cooking program delivered to elementary children may positively influence the home food environment.

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

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

Child characteristic correlates of food rejection in preschool children: A narrative review

Dietary habits formed in early childhood are key for establishing a healthy diet later in life. Picky eating and food neophobia - the two main forms of food rejection in young children - form an important barricade to establishing such healthy habits. Understanding these types of food rejection is thus essential for promoting healthy eating behaviour in both children and adults. To this end, the present narrative review aims to provide an overview of food rejection research in preschool-aged children, focusing on recent advances in the cognitive literature. Specifically, we evaluate the link between children's cognitive development, chemosensory perception and affective evaluation of food, food knowledge, decision-making strategies, anxiety and disgust sensitivity, and food rejection behaviour. Longitudinal and experimental studies are necessary to establish how the relationships between food rejection and cognitive processes develop over time and to determine their causal directions.

Enhancing Food Literacy and Food Security through School Gardening in Rural and Regional Communities

A qualitative case study approach with in-depth, semi-structured interviews of key school staff, and student feedback was used to assess a school kitchen and garden program in the regional area of North-West Tasmania, Australia. A detailed program description was produced to conduct a realist evaluation with a Context-Mechanism-Outcome configuration, followed by a program theory evaluation through the construction of a retrospective program logic model. Dedicated kitchen and garden spaces, knowledgeable teachers committed to the program, provision of sufficient materials and consumables, and support from the school and community were found to be the basic requirements to establish a program. Additionally, it is essential to integrate both the kitchen and garden teaching components into the school curriculum. The positive outcomes (e.g., engagement, participation, knowledge, skills, behavioral change) of the program were dependent on the underlying factors, including dedicated support of school leadership, teaching staff, and the parent body for effective student engagement in the teaching spaces and for wider engagement from families and the community. The students' feedback provided supporting evidence of increased food literacy with improvements in their understanding, abilities, and attitudes towards gardening, producing healthy food, and preparing food. This may further lead to enhanced food security for students' families and the broader community.

A Whole School, Whole Community, Whole Child Approach to Support Student Physical Activity and Nutrition: Introduction/Methods

BACKGROUND

We introduce the Whole School, Whole Community, Whole Child approach to supporting student and school staff physical activity and nutrition and describe the methods used to generate the evidence synthesized across the special issue articles.

METHODS

A 2-phase literature review search included a search of systematic reviews (2010-2018) for individual qualifying articles (Phase 1) and a search for individual articles on topics not addressed by a review (2010-2020) or that needed an update because they were in a review that was older (2010-2016) or showed insufficient evidence (Phase 2). Research librarians developed search strategies. In each phase, pairs of subject matter experts applied criteria to review abstracts and full-text articles and extracted data using standardized forms. We included 314 articles, describing 293 studies.

FINDINGS

Most of the included studies looked at elementary or secondary school level interventions; 51% were rated poor quality, and few took place in a rural setting.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Most of the identified studies engaged majority minority or racially/ethnically diverse schools, suggesting that these interventions are feasible in a variety of settings.

CONCLUSIONS

This collection of 10 articles identifies evidence-based interventions, gaps in research, and implications for health equity.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS/SETTING

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

INTERVENTION

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

MAIN OUTCOME MEASURES

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

STATISTICAL ANALYSES PERFORMED

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

RESULTS

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

CONCLUSIONS

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

Extended reality as a health education strategy of adolescents at school: protocol for systematic review and meta-analysis

INTRODUCTION

Extended reality (XR) is the ensemble of interactive experiences based on a computer-simulated environment that encompasses virtual reality and augmented reality and has been proven to be potentially innovative in the field of health education with adolescents. The objective of this study is to present a systematic review and meta-analysis protocol that seeks to evaluate the main effects of interventions that use XR on health parameters (food intake, sound quality and physical activity) of adolescent students.

METHODS AND ANALYSIS

The literature search will be performed in the following databases: MEDLINE, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, APA and ADOLEC. Intervention studies (clinical trials-randomised or non-randomised) and quasi-experimental studies will be included. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomised controlled trials (RCTs), non-RCTs and quasi-experimental trials. Two independent researchers will conduct all the assessments, and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be performed using RevMan V.5.4.1 software. The study will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guideline.

ETHICS AND DISSEMINATION

Ethical approval and human consent were not required, as this is a protocol for a systematic review and only secondary data will be used. The findings will be published in a journal and presented at conferences. In case of any changes to this protocol, it will be updated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses website, and the modifications will be explained in the final report of this review.

PROSPERO REGISTRATION NUMBER

CRD42022373876.

Effects of a School-Based Gardening, Cooking, and Nutrition Cluster Randomized Controlled Trial on Unprocessed and Ultra-Processed Food Consumption

BACKGROUND

School-based gardening and nutrition education interventions report improvements in dietary intake, notably through fruit and vegetables. However, gardening, cooking, and nutrition randomized controlled trials are limited in evaluating dietary quality, and none have examined processed food consumption to date.

OBJECTIVES

The study examined the effects of Texas Sprouts (TX Sprouts), a gardening, cooking, and nutrition education intervention, compared with control on unprocessed and ultra-processed food (UPF) consumption in predominately low-income Hispanic children.

METHODS

TX Sprouts was a school-based cluster randomized controlled trial that consisted of 16 elementary schools randomly assigned to either the TX Sprouts intervention (n = 8 schools) or control (delayed intervention; n = 8 schools) over 3 y (2016-2019). TX Sprouts schools received an outdoor teaching garden and 18 1-h lessons taught by trained educators throughout the school year. Dietary intake data via 2 24-h dietary recalls were collected on a random subsample (n = 468) at baseline and postintervention. All foods and beverages were categorized using the NOVA food classification system (e.g., unprocessed, processed, ultra-processed). Generalized linear mixed effects modeling tested changes in percent calories and grams of NOVA groups between the intervention and control estimates with schools as random clusters.

RESULTS

Of the sample, 63% participated in the free and reduced-price lunch program, and 57% were Hispanic, followed by non-Hispanic White (21%) and non-Hispanic Black (12%). The intervention, compared to the control, resulted in an increase in consumption of unprocessed foods (2.3% compared with -1.8% g; P < 0.01) and a decrease in UPF (-2.4% compared with 1.4% g; P = 0.04). In addition, Hispanic children in the intervention group had an increase in unprocessed food consumption and a decrease in UPF consumption compared to non-Hispanic children (-3.4% compared with 1.5% g; P < 0.05).

CONCLUSIONS

Study results suggest that school-based gardening, cooking, and nutrition education interventions can improve dietary intake, specifically increasing unprocessed food consumption and decreasing UPF consumption. This trial was registered at clinicaltrials.gov as NCT02668744.

Perceptions of food environments in the school and at home during Covid-19: An online cross-sectional study of parents, teachers and experts from Latin America

BACKGROUND

The high prevalence of overweight and obesity in children from Latin America (LA) have been related to obesogenic food environments. Besides, the negative effects of the Covid-19 pandemic should also be considered. The objective of this research was to describe and compare the perceptions of parents, teachers, and experts in LA of food environments at home and school that favor healthy habits in schoolchildren in pre Covid-19 stage and during the pandemic.

METHODS

This study used a survey self-reporting regarding conditions at home and the school favoring healthy habits, for three profiles: parents, primary school teachers, and experts. A fisher exact test was used to establish the difference between the response categories between countries and profiles. Logistic regression models were used to determine the probability of response in the levels of importance adjusted for sex and nationality.

RESULTS

Information from 954 questionnaires was reported: 48.4% experts, 32.0% teachers, and 19.6% parents. There were differences in the perception of food environments at school between profiles (p<0.001). In multivariate logistic regression models, experts and teachers were 20% more likely to give greater importance to elements of the food environment at school compared to parents (p<0.001).

CONCLUSIONS

Our findings showed that parents were less likely to perceive important elements of the school food environment compared to experts and teachers. Interventions are required to improve healthy eating environments that consider children's interpersonal mediators.

Students' consumption of high and low nutrition foods and reduced plate waste by schools' wellness-related policies and garden program participation

BACKGROUND

Participation in school-based programs that may support children's nutritious dietary behaviours varies across schools. We examined school participation in wellness-related policies, school-based garden programs and students' dietary behaviours.

METHODS

Among matching schools who did and did not participate in school-based garden programs, we analysed the lunches of 80 Pittsburgh Public Schools (PPS) students in 1st, 2nd, 6th and 7th grades during Autumn 2019 using digital food photography. We also acquired school wellness policy data. Using cross-sectional linear regression, we estimated the association between school-based garden programming, wellness-related policies and dietary outcomes, adjusting for grade.

RESULTS

School's implementation of nutrition services policies was negatively associated with energy wasted from lunch (β = - 44.7 , p = 0.01 ${\rm{\beta }}=-44.7,{p}=0.01$ ). The number of semesters the students' school had participated in the garden program was positively associated with students' whole grain consumption (β = 0.07 , p < 0.001 ${\rm{\beta }}=0.07,{p}\lt 0.001$ ).

CONCLUSIONS

Cross-sectional associations suggest that schools that are more engaged in wellness policies and garden programs may provide environments that are more supportive of students' nutrition than in other schools.

Insights into parents' and teachers' support for policies promoting increased plant-based eating in schools

Global environmental and public health challenges related to current food systems call for large-scale shifts towards increasingly plant-based diets, especially in Western meat-centric societies. School meal systems can play a role in these changes due to their widespread prevalence and multi-sectoral impact. However, there is a lack of evidence about how adults involved in the school meals system perceive school-based pro-environmental food policies, which limits the ability to align those policies with the needs and expectations of the school community. This study aimed to address this knowledge gap by exploring parents' (n = 104) and teachers' (n = 252) support for policies to promote increased plant-based eating in public schools in a highly meat-centric EU country (Portugal). Overall, teachers seemed to be slightly more supportive of such policies and displayed more favorable (injunctive and dynamic) norms toward plant-based eating, more negative appraisals of meals with meat (i.e., perceived healthiness, naturalness, and sustainability), and lower attachment to meat consumption. Furthermore, injunctive norms in favor of plant-based meals were linked with higher support for measures promoting plant-based meals in schools, in both samples (parents, teachers). Lower meat attachment and favorable perceived meal attributes (e.g., perceptions about plant-based and fish meals) were associated with teachers' support for measures promoting plant-based meals in schools. These findings suggest that future efforts and research with parents and teachers to enable less meat-centric and more flexitarian food practices in schools should consider social and motivation variables relevant to plant-forward transitions.

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.

Acceptability and Feasibility of Community Gardening Interventions for the Prevention of Non-Communicable Diseases among Indigenous Populations: A Scoping Review

Compared with non-Indigenous populations, Indigenous populations experience worse health across many outcomes, including non-communicable diseases, and they are three times more likely to live in extreme poverty. The objectives were to identify (1) the content, implementation, and duration of the intervention; (2) the evaluation designs used; (3) the outcomes reported; and (4) the enablers and the challenges. Using the PRISMA-ScR guidelines, a search of research databases and grey literature was conducted. Seven studies met the inclusion criteria. Papers reported on acceptability, nutrition knowledge, fruit and vegetable intake, self-efficacy, motivation, and preference concerning fruit and vegetable, diet, and gardening. No study measured all outcomes. All papers reported on acceptability, whether implicitly or explicitly. The evaluation used mostly pre- and post-intervention assessments. The effect of gardening on nutrition and gardening knowledge and fruit and vegetable intake was inconclusive, and was related to a general lack of robust evaluations. Applying the He Pikinga Waiora Framework, however, revealed strong evidence for community engagement, cultural centeredness, integrated knowledge translation and systems thinking in increasing the acceptability and feasibility of gardening in Indigenous communities. Despite environmental challenges, the evidence signaled that gardening was an acceptable intervention for the Indigenous communities.

China Requires a Sustainable Transition of Vegetable Supply from Area-Dependent to Yield-Dependent and Decreased Vegetable Loss and Waste

China, the largest country in vegetable supply, faces a transition to sustainable vegetable production to counteract resource waste and environmental pollution. However, there are knowledge gaps on the main constraints and how to achieve sustainable vegetable supply. Herein, we integrated the vegetable production and supply data in China, compared its current status with five horticulture-developed countries US, the Netherlands, Greece, Japan and South Korea, using data from the Food and Agriculture Organization (FAO) and National Bureau of Statistics of China, and predicted the vegetable supply in 2030 and 2050 by a model prediction. The vegetable supply in China increased from 592 g capita-1 d-1 in 1995 to 1262 g capita-1 d-1 in 2018 and will keep constant in 2030 and 2050. Compared to the five countries, the greater vegetable supply is primarily achieved by higher harvested areas rather than higher yield. However, it is predicted that the harvested areas will decrease by 13.6% and 24.7% in 2030 and 2050. Instead, steady increases in vegetable yield by 11.8% and 28.3% are predicted for this period. The high vegetable supply and greater vegetable preference indicated by the high vegetable-to-meat production ratio cannot guarantee recommended vegetable intake, potentially due to the high rate of vegetable loss and waste. Under the scenarios of decreased vegetable loss and waste, the harvested area will decrease by 37.3-67.2% in 2030 and 2050. This study points out that the sustainable transition of Chinese vegetable supply can be realized by enhancing yield and limiting vegetable loss and waste instead of expanding the harvested area.

Familiarity and Use of MyPlate: An Online Focus Group Exploration Among Midwestern K-12 Teachers

OBJECTIVE

To examine teachers' familiarity and use of MyPlate, including barriers to using it.

METHODS

Twenty kindergarten through grade 12 teachers were recruited from 1 urban and suburban school district in the Midwest to participate in virtual focus groups regarding familiarity, use, and barriers to MyPlate. A basic descriptive qualitative approach with thematic analysis was guided by systems thinking. Common categories were coded and agreed on by the authors.

RESULTS

Findings included main categories of individual awareness, use in curriculum, and appropriate facilitators of MyPlate. Awareness and use of MyPlate were mixed. Teachers integrated MyPlate in math, history, and other subjects. Barriers included packed curriculum and cultural issues. The facilitators of MyPlate mentioned were health or physical education teachers.

CONCLUSIONS AND IMPLICATIONS

Online focus groups successfully collected formative data on teachers' perspectives toward MyPlate. The technology could be used in future similar research. Enhanced teacher training may improve the integration of MyPlate into schools. School teachers identified major barriers to MyPlate in the classroom, including lack of time and resources. There was mixed feedback on how MyPlate and nutrition may be used in school curricula. Enhanced teacher training may improve the integration of MyPlate into schools.

Group Randomized Trial of Healthy Eating and Gardening Intervention in Navajo Elementary Schools (Yéego!)

Introduction

Few healthy eating, school-based interventions have been rigorously evaluated in American Indian communities. Gardening and healthy eating are priorities in the Navajo Nation. Collaborations between researchers and local partners supported the design and implementation of this project.

Design

The Yéego! Healthy Eating and Gardening Study was a group-randomized controlled trial to evaluate a school-based healthy eating and gardening intervention in 6 schools in the Navajo Nation. Schools were randomized 1:2 to intervention or comparison.

Setting/participants

The Shiprock and Tsaile/Chinle areas in the Navajo Nation were selected. Elementary schools were screened for eligibility. All students in third and fourth grades were invited to participate in the assessments.

Intervention

Delivered during 1 school year in the intervention schools, the intervention included a culturally relevant nutrition and gardening curriculum and a school garden.

Main outcome measures

Student self-efficacy for eating fruits and vegetables, student self-efficacy for gardening, and student healthy foods score from a modified Alternative Healthy Eating Index were assessed in third and fourth graders at the beginning and end of a school year affected by the COVID-19 pandemic. Primary analyses used repeated measures linear mixed models accounting for students nested within schools to estimate the intervention effect and 95% CIs.

Results

Students in the intervention schools had self-efficacy scores for eating fruits and vegetables that were 0.22 points greater (95% CI=0.04, 0.41) than those in the comparison schools, although the student healthy foods score increased in the intervention schools by 2.0 (95% CI=0.4, 3.6); the differential change was modest at 1.7 (95% CI=-0.3, 3.7). The self-efficacy to grow fruits and vegetables in the school garden increased among those in the intervention schools (OR=1.92; 95% CI=1.02, 3.63) but not significantly more than it increased in the comparison schools (OR=1.29; 95% CI=0.60, 2.81).

Conclusions

The intervention was efficacious in improving self-efficacy for eating fruits and vegetables among third- and fourth-grade students over a school year. The findings warrant further evaluation of the intervention in larger-group randomized trials with schools in Navajo communities.

Trial registration

This study is registered at clinicaltrials.gov NCT03778021.

Hands-on childcare garden intervention: A randomized controlled trial to assess effects on fruit and vegetable identification, liking, and consumption among children aged 3–5 years in North Carolina

Gardening at childcare centers may have a potent influence on young children’s learning about fruits and vegetables and their development of healthy dietary behaviors. This randomized controlled trial examined the effect of a garden intervention on fruit and vegetable (FV) identification, FV liking, and FV consumption among 3–5-year-old children enrolled in childcare centers in Wake County, North Carolina, USA. Eligible childcare centers (serving primarily low-income families) were randomly selected and then randomly assigned to one of three groups: (1) intervention; (2) waitlist-control that served as a control in year 1 and received the intervention in year 2; or (3) no-intervention control. From the 15 participating childcare centers, 285 children aged 3–5  years were consented by their parents or guardians to participate. The intervention comprised six standardized, raised, mulched garden beds, planted with warm-season annual vegetables and fruits, and perennial fruits. A Gardening Activity Guide describing 12 age-appropriate, sequential gardening activities was distributed for teachers to lead hands-on gardening activities during the growing season. Data were gathered between Spring 2018 and Fall 2019. FV identification and liking were measured using an age-appropriate tablet-enabled protocol. FV consumption was measured by weighing each child’s fruit and vegetable snack tray before and after tasting sessions. Compared to children receiving no-intervention, children who received the garden intervention showed a greater increase in accurate identification of both fruits and vegetables as well as consumption of both fruit and vegetables during the tasting sessions. Consistent with prior research, the effects on fruit consumption were greater than on vegetable consumption. There was no significant effect of the garden intervention on children’s FV liking. Garden interventions implemented early in life foster learning about FV and promote healthy eating. Early exposure to gardening may yield a return on investment throughout the lifecourse, impacting healthy diet and associated health outcomes, which are particularly important within disadvantaged communities where children’s health is challenged by a host of risk factors. Clinical Trials Registration #NCT04864574 (clinicaltrials.gov).

Fresh Produce Delivery to Middle School Youth: Outcomes of a Case Study in Providing Fresh Fruit and Vegetables to Underserved Youth

Purpose

The purpose of this study was to evaluate a weekly school-based fruit and vegetable delivery via a mobile market on urban middle schoolers’ nutrition behaviors.

Design

One-group, pretest-posttest design, quasi-experimental intervention in middle schoolers (6th-8th graders, N = 158) in Kansas City, MO

Intervention

Weekly delivery of free produce via a mobile market over 12 weeks.

Measures

A self-administered survey to assess self-report consumption of fruits, vegetables, soda, and sports drinks.

Analysis

Univariate and bivariate analyses were used. Proportions were compared and chi-square tests were conducted to compare youth at baseline and 12 weeks.

Results

More youth reported consuming fresh fruit (73.8% to 83.3%; χ2 = 7.76, P = .005) and vegetables (66.4% to 71.3%; χ2 = 13.55, P = <.001) from baseline to follow-up. Less youth reported soda (49.0% to 52.8%; χ2= 6.33, P = .012) and sports drinks (41.8% to 38.2%; χ2= 12.32, P < .001) from baseline to follow-up.

Conclusions

A mobile produce delivery intervention, like the Healthy Harvest Mobile Market, may be an effective strategy to increase fruit and vegetable consumption for adolescents.

Increasing Fruit and Vegetable Intake of Primary School Children in a Quasi-Randomized Trial: Evaluation of the Three-Year School-Based Multicomponent Intervention

Insufficient consumption of fruit and vegetables was found in primary school children. To address this problem, a three-year school-based multicomponent intervention was conducted in 14 primary schools in the City of Zagreb. The aim of the study was therefore to evaluate one of the primary goals of the intervention—the increase in fruit and vegetable intake among primary school children. A total of 681 children were allocated to the intervention (n = 300 in the control group and n = 381 in the intervention group). The intervention included 23 interactive classroom workshops, 10 cross-curricular activities, 13 homework challenges, visual exposure with educational posters in classrooms, parent education via the website, and the implementation of new dishes into the school food system. Fruit and vegetable intake was assessed using a semi-quantitative food frequency questionnaire at baseline and after the intervention. Data were analyzed by per-protocol analysis. The study involved 259 children (50.2% girls; age 7.7 ± 0.4 years; n = 116 in the control group and n = 143 in the intervention group) who completed a food intake frequency questionnaire at both time points. Children in the intervention group showed a significant increase (p < 0.001) in total daily fruit and vegetable intake (before: 332.1 ± 164.9 g; after: 430.1 ± 186.7 g) compared to the control group (before: 350.2 ± 187.5; after: 382.6 ± 196.8) after the intervention. The increase in fruit and vegetable intake was achieved in 89% of children, while 25% more children reached the daily recommendation of 400 g. The use of the multicomponent intervention showed potential to increase fruit and vegetable intake in primary school children.

The Association Between Home or Community Garden Access and Adolescent Health

Little is known about the influence of home or community garden (HCG) access on adolescent health. The objective of this study was to determine the association between adolescent self-rated health, nutrition knowledge, attitudes, and intake with HCG access. Urban high school students (n = 401) completed a questionnaire prior to a nutrition education intervention. Point biserial correlations and one-way analyses of variance evaluated garden access and health variables. Garden access differed by race ( P < .001), and students with HCG access consumed more vegetables than students who did not ( P = .003) and rated themselves as healthier ( P = .034). Findings suggest that garden access is associated with higher adolescent vegetable consumption and higher self-rated health. Future research should investigate adolescent levels of engagement in HCGs.

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

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

Development of a conceptual framework of food and nutrition literacy in children

BACKGROUND

This study aimed to develop a conceptual framework to better understand food and nutrition literacy and its dimensions and components among Iranian children.

METHODS

The study included three sub-studies. First, two qualitative studies were conducted to explore experts' and students' perspectives and experiences regarding the topic. A comprehensive qualitative literature review was then conducted to identify food/nutrition literacy definitions and its components in the relevant literature. The data of the above three sub-studies were compiled as text data and were analyzed utilizing MAXQDA₂₀₁₀ software.

RESULTS

Two main domains, including cognitive and skill domains, emerged from the data analysis. The cognitive domain consisted of food- and nutrition-related knowledge included four subcategories "nutrition knowledge", "lifestyle knowledge", "food safety knowledge", and "knowledge of food and its preparation") as well as "food and nutrition understanding". The skill domain consisted of three dimensions: "functional", "interactive", and "critical" food and nutrition literacy.

CONCLUSIONS

The developed framework highlights the importance of integrated application of all dimensions of food and nutrition literacy among this population group. It can assist policymakers and curriculum developers in assessing education curricula and developing effective strategies for teaching and learning to increase students' food and nutrition literacy.

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

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

Impact of a Farm-to-School Nutrition and Gardening Intervention for Native American Families from the FRESH Study: A Randomized Wait-List Controlled Trial

Establishing healthy eating habits during childhood is critical to prevent chronic diseases that develop in adulthood. Tribally owned Early Childhood and Education (ECE) programs signify fundamental influence in childhood obesity disparities. A strategy to improve diet is the use of school gardens; however, few studies have used rigorous methods to assess diet and health outcomes. The purpose of this manuscript is to describe results from the six-month Food Resource Equity for Sustainable Health (FRESH) study among Native American families. We aimed to recruit 176 families of children attending Osage Nation ECE programs in four communities. Two communities received the intervention and two served as wait-list controls. Outcomes included change in dietary intake, body mass index, health status, systolic blood pressure (adults only), and food insecurity in children and parents. There were 193 children (n = 106 intervention; n = 87 control) and 170 adults (n = 93 intervention; n = 77 control) enrolled. Vegetable intake significantly increased in intervention children compared to controls for squash (p = 0.0007) and beans (p = 0.0002). Willingness to try scores increased for beans in intervention children (p = 0.049) and tomatoes in both groups (p = 0.01). FRESH is the first study to implement a farm-to-school intervention in rural, tribally owned ECEs. Future interventions that target healthy dietary intake among children should incorporate a comprehensive parent component in order to support healthy eating for all household members.

Exploring health and wellness with First Nations communities at the "knowing your health symposium"

Indigenous older adults living in rural communities require accessibility to and readiness for new technologies to support the monitoring of health data and health status, as well as dementia education. Morning Star Lodge partnered with the File Hills Qu'Appelle Tribal Council, a Community Research Advisory Committee and All Nations Hope Network to bring a diverse group of First Nations community members to the “Knowing Your Health Symposium” to learn about traditional health and First Nations’ wellness. Indigenous research methods and community-based involvement informed and guided the research. An environmental scan was conducted relating to co-researchers’ nutrition, exercise, and self-management of health and health issues through an anonymous survey distributed at the symposium. The purpose of the symposium was to provide communities with information about healthy lifestyles as it relates to dementia and equip community members with the ability to make constructive decisions regarding their health.

Food Environment and Youth Intake May Influence Uptake of Gluten-Free Food Guide Recommendations in Celiac Disease

A gluten-free (GF) food guide for children and youth (4-18 years) living with celiac disease (CD) has been developed and extensively evaluated by stakeholders, including registered dietitians. A case study analysis was conducted on data from 16 households of youth with CD to examine how factors related to parental food literacy, the home food environment, and food purchasing patterns may influence food guide uptake by Canadian youth with CD and their families. Households were of higher socioeconomic status, parents had good food literacy, and the home food availability of fruits, vegetables and GF grains was diverse. However, households also had a diverse supply of convenience foods and snack options. Youth reported consuming a larger proportion of these foods (>35% dietary intake) and had suboptimal diet quality. Dietary intake of fruits and vegetables were below GF plate model recommendations by over 30%. Despite limited economical barriers, good parental food literacy, and diverse food availability, meeting fruit and vegetable recommendations based on the pediatric GF food guide remains a major challenge. Findings inform that effective strategies and healthy public policies to support the uptake of GF food guide recommendations are needed to improve the health outcomes of youth with CD.

Sustainability via Active Garden Education: The Sustainability Action Plan Model and Process

Sustainability of intervention programming is challenging to achieve under real world conditions, since few models exist and many studies do not plan far beyond the funding period. Programming content in early care and education centers (ECECs) is often driven by guidelines. However, implementation is very sensitive to contextual factors, such as the setting and implementer (teacher) characteristics. This paper presents the model, definitions, and methodology used for the sustainability action plan capitalizing on a community-based participatory research (CBPR) approach, developed for a multi-site, multi-level garden-based childhood obesity prevention study, Sustainability via Active Garden Education (SAGE). The Ecologic Model of Obesity is applied to develop a sustainability action plan (SAP) and accompanying measures to link early care and education (ECE) environment, the community, policies, and classroom practices to an early childhood obesity prevention program. The SAGE SAP provides an example of how to iteratively evaluate and refine sustainability processes for an obesity prevention intervention utilizing CBPR approaches and will be applied to assess the sustainability of SAGE in a cluster randomized controlled trial. This SAP model can also help inform intervention delivery and scalability within ECECs.

School Gardens' Impact on Students' Health Outcomes in Low-Income Midwest Schools

Childhood obesity in Chicago, particularly in underrepresented communities of color, exceeds that of national rates. Access to healthy foods in these communities is also often limited. A garden-based education program was implemented in Chicago's South and West Side elementary, middle and high schools. Findings from this work augment the literature and illustrate that implementing gardens in elementary, middle, and high schools has a positive impact on availability, access, and consumption of fresh fruits and vegetables, as well as students' social emotional well-being. School nurses are in prime positions to advocate for students' health and well-being by collaborating with community programs, and championing policy development. Rigorous studies are needed to better understand the long-term health and social benefits of having school gardens on the prevention of obesity, positive mental health outcomes, and economic benefits, while controlling for socio-economic status.

What Works to Improve Nutrition and Food Sustainability across the First 2000 Days of Life: A Rapid Review

Informed by the Innocenti framework, this rapid review of systematic reviews (n = 60) and sentinel grey literature (n = 27) synthesises the evidence of what works to improve nutrition and food sustainability across the first 2000 days. Most systematic reviews focused on interventions targeting the behaviour of parents and caregivers (n = 49), with fewer reviews focusing on the personal (n = 7) and external (n = 4) food environments. No reviews focused on food supply-chain activities. Most reviews were rated as critically low (n = 28, 47%) or low (n = 21, 35%) quality using AMSTAR 2. Evidence supports the effectiveness of multi-component breastfeeding interventions, interventions delivered in home and child-care settings, particularly when involving parents, interactive skill building and repeated exposure to vegetables. Food vouchers and access to local farmers markets and community gardens have potential for improving access and availability to healthier foods, while evidence supports interventions improving the external food environment, including fiscal strategies such as the SSB tax, restrictions on marketing and advertising of discretionary products and improved food labelling. Overall, this review highlights the importance of action across a range of settings and sectors at the international, national and local levels to improve young children's diets.

School Garden Benefits: Health Promotion and Environmental Conservation

Garden-based learning promotes environmental awareness, health, and wellness across the school community and beyond. In this article, we review the literature on the benefits of school gardening and describe firsthand experiences for garden success. By sharing lessons learned, our aim is to inspire school nurses to join forces with like-minded teachers and staff or take the lead to build capacity in their school for gardening and a green culture dedicated to the conservation of natural resources.

Current Systems-Level Evidence on Nutrition Interventions to Prevent and Treat Cardiometabolic Risk in the Pediatric Population: An Evidence Analysis Center Scoping Review

Improving and maintaining cardiometabolic health remains a major focus of health efforts for the pediatric population. Recent research contributes understanding of the systems-level nutrition factors influencing cardiometabolic health in pediatric individuals. This scoping review examines current evidence on interventions and exposures influencing pediatric cardiometabolic health to inform registered dietitian nutritionists working at each systems level, ranging from individual counseling to public policy. A literature search of MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, and other databases was conducted to identify evidence-based practice guidelines, systematic reviews, and position statements published in English from January 2017 until April 2020. Included studies addressed nutrition interventions or longitudinal exposures for participants 2 to 17 years of age who were healthy or had cardiometabolic risk factors. Studies were categorized according level of the social-ecological framework addressed. The databases and hand searches identified 2614 individual articles, and 169 articles were included in this scoping review, including 6 evidence-based practice guidelines, 141 systematic reviews, and 22 organization position statements. The highest density of systematic reviews focused on the effects of dietary intake (n = 58) and interventions with an individual child or family through counseling or education (n = 54). The least frequently examined levels of interventions or exposures were at the policy level (n = 12). Registered dietitian nutritionists can leverage this considerable body of recent systematic reviews to inform a systems-level, collaborative approach to prevention and treatment of pediatric cardiometabolic risk factors.

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

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

VeggieSense: A non-taste multisensory exposure technique for increasing vegetable acceptance in young children

Vegetable consumption falls well below recommended levels for children in the UK. Previous research has found that repeated non-taste sensory exposure over the course of several days increases young children's willingness to touch and taste vegetables. The current study examined the impact of a one-off multisensory non-taste exposure intervention that took place on a single day on children's willingness to taste and intake of the exposed vegetables. Children (N = 110) aged 3- to 4-years-old were assigned to one of three intervention groups or to a control group. Children in all groups participated individually in a single activity session delivered in their nursery. Children in the intervention conditions took part in fun activities that provided either (a) visual exposure, (b) smell and visual exposure, or (c) smell, touch and visual exposure to six raw and prepared vegetables. Children in the control group engaged in a visual exposure activity with non-food items. After the exposure activities, all children were offered the prepared vegetables to eat; their willingness to taste and intake of the vegetables were measured. Results confirmed previous findings of sensory exposure activities increasing children's willingness to taste and intake of vegetables and revealed linear trends in both measures of acceptance with the number of senses engaged; children who took part in smell, touch and visual activities showed the highest level of acceptance. Findings suggest that multisensory exposures are effective in increasing consumption of vegetables in young children and that the effect of sensory exposure to healthy foods may be cumulative, with the more senses engaged prior to offering a food, the better.

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).

Establishing a campus garden and food pantry to address food insecurity: lessons learned

This case study describes the simultaneous establishment of a campus garden and food pantry at an urban, Hispanic-serving institution. Lessons learned and implications for practice are discussed. Participants: Students, staff, and faculty established a campus garden (February 2016) and food pantry (March 2017). Methods: University administration approved funds to establish both a campus garden and food pantry after adequate student and academic support was provided. Results: Both the campus garden and food pantry aligned with campus initiatives for student success and sustainability. The food pantry had adequate staffing and local partnerships that aided in its success, while the student-led garden struggled with student-turn over, limited financial support, and lack of regulatory guidance that has slowed progress to address food security. Conclusions: Institutions considering these strategies to address food insecurity would benefit from university financial support based on student-relevant data, dedicated staff, students, and faculty, and collaboration with local organizations.

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.

Home food procurement impacts food security and diet quality during COVID-19

Background

Home food procurement (HFP) (i.e. gardening, fishing, foraging, hunting, backyard livestock and canning) have historically been important ways that people obtain food. Recently, some HFP activities have grown (e.g. gardening), while other activities (e.g. hunting) have become less common in the United States. Anecdotally, COVID-19 has sparked an increase in HFP evidenced by increased hunting licenses and shortages in seeds and canning supplies. HFP may have positive benefits for food security and diet quality, though research beyond gardening is especially limited in high-income countries.

Methods

We examine HFP activities since the COVID-19 pandemic began, and their relationship to food security and dietary quality using multivariable logit models and matching analysis with a statewide representative survey (n = 600) of residents of Vermont, United States.

Results

We find 29% of respondent households classified as food insecure since COVID-19, and higher prevalence of food insecurity among those experiencing a negative job change since COVID-19, households earning less than $50,000 annually, Hispanic and multi-race respondents. Nearly 35% of respondents engaged in HFP activities since the COVID-19 pandemic began; the majority of those gardened, and more than half pursued HFP activities more intensely than before the pandemic or for the first time. Food insecure households were more likely to pursue HFP more intensely, including more gardening, fishing, foraging, and hunting. Respondents who were food insecure, Black, Indigenous, People of Color, those with a negative job disruption, and larger households all had greater odds of increased intensity of HFP during the COVID-19 pandemic. HFP was significantly associated with eating greater amounts of fruits and vegetables; however, this effect was only significant for food secure households.

Conclusion

Overall, these results suggest that HFP activities have increased since the start of the COVID-19 pandemic, and may be an important safety net for food insecure households. However, HFP for food insecure households does not translate into the same higher fruit and vegetable intake as found among food secure HFP households, suggesting this population may be trying to maintain intake, or that they may have potential important resource or technical assistance needs. Long-term, HFP activities may have important food security and diet quality impacts, as well as conservation implications, which should be more thoroughly explored. Regardless, the increased interest and intensity of HFP demonstrates opportunities for educational and outreach efforts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10960-0.