Student J DFN 791 Dr. Demmer Grant Proposal Topic Title: Randomized, controlled

Student J

DFN 791

Dr. Demmer

Grant Proposal Topic

Title: Randomized, controlled trial of an after school, garden-based nutrition program to improve Bronx high school students’ vegetable intake.

The purpose of the study is to examine the impact of an after-school, garden-based nutrition program on vegetable intake, willingness to taste vegetables, preferences for vegetables, and nutrition knowledge of vegetables in high school students in Bronx, NY. I also want to compare the effects of garden-based nutrition education and traditional nutrition education in regards to intake, preferences, willingness and knowledge. With garden-based nutrition programs there are multiple exposures to vegetables through interactive and hands-on learning with peers, which may help to increase high school students vegetable intake. Furthermore, since students will be harvesting their own vegetables, they may develop a sense of empowerment and ownership in the project. As a result, students may be more likely to try the vegetables they grow, expand their preferences for vegetables and increase their intake. There is promising evidence from the literature indicating the efficacy of garden-based nutrition programs; however, much of the research conducted has focused on in-school gardens, elementary and middle school aged students in rural areas and states other than New York. I would like to focus then on high school students residing in Bronx, NY and conduct the study as an after-school program that utilizes the Lehman Edible Garden on Lehman College campus to see if such positive outcomes would result.

According to national data, less than half of children between the ages of 4 to 18 years consume five or more servings of fruits and vegetables daily (Robinson-O’Brien, Story & Heim, 2009). Furthermore, according to the New York City Department of Health and Mental Hygiene (2010), the Bronx has the highest rate of overweight children in New York City, as 42% of children residing in the Bronx are overweight. The Bronx continues to be the unhealthiest county in NY state, therefore, it is imperative to investigate creative, effective, and healthful eating initiatives (Office of the Bronx Borough President, 2011).

I hypothesize that the addition of gardening to a nutrition education program will produce greater improvements in vegetable intake, willingness to taste vegetables, preferences for vegetables, and nutrition knowledge of vegetables in high school students in the Bronx.

Independent variables of this study include the type of intervention: 1) Garden-based nutrition education, 2) Nutrition education alone, and 3) No intervention. Dependent variables of this study include: 1) Vegetable intake, 2) Preferences for vegetables, 3) Willingness to taste vegetables, and 4) Nutrition knowledge of vegetables.

My parents love gardening and while growing up I helped to plant tomatoes, peppers, string beans, herbs and many other delicious vegetables. Not only was I so proud to have contributed, I also had a great time seeing the vegetables grow. I found myself wanting to try the vegetables, and now notice that my preference for vegetables gradually expanded. This experience is certainly something I want to share with my children. As a registered dietitian and having a long-time boyfriend that is a chef, we are conscious of what we eat and how we prepare food. We always have talked about how we would want our children to grow up in an environment where they are able to see where food comes from, how to prepare food and understand how food affects their body by bringing them to farms and gardens and by cooking with them. Upon researching the topic of gardening, I came across studies pertaining to school gardens. Then I started thinking about the edible garden at Lehman College and how all the neighboring schools could benefit from its existence as well as contribute to its sustenance. I feel that having school gardens or community gardens that work with schools is a great way to help expand the horizon of children and adolescents when it comes to local foods, respecting our environment and improving their dietary habits. So I figured I would continue to look into gardening interventions in schools to see what has been done and what conclusions have been made in terms of children’s dietary choices.

In the United States, 25% of children are overweight while 11% are obese (Dehghan, Akhtar-Danesh, & Merchant, 2012). Childhood overweight and obesity are associated with increased risk for hyperlipidemia, hypertension, abnormal glucose tolerance, infertility, and depression (Dehghan et al., 2012). It was found that overweight children have a greater chance of not only developing cardiovascular and digestive diseases, but also dying from them when compared to lean children that were followed up to 40 and 55 years (Dehghanet al., 2012). Of obese adolescents, approximately 70% stay obese as adults (Dehghanet al., 2012). In adults, reducing excessive weight once it has been established is very challenging (Dehghanet al., 2012). Therefore, priority should be given to children and adolescents when considering intervention strategies. Despite the available evidence indicating that consuming fruits and vegetables can help prevent several chronic diseases, less than 10% of adolescents presently meet the fruit and vegetable consumption recommendations of Healthy People 2010 (Hazzard, Moreno, Beall, & Zidenberg-Cherr, 2011; Robinson-O’Brien et al., 2009). As a result, state and federal agencies have made increasing fruit and vegetable consumption by adolescents a major priority (Hazzard et al., 2011). Preference and availability have been found to be the most influential factors that affect fruit and vegetable consumption in children and adolescents (Davis, Cullen, Watson, Konarik, & Radcliffe, 2009; Heim, Stang & Ireland, 2009). Five to ten exposures of a new food are often necessary to increase acceptance and intake (Heim et al., 2009). Thus, it is necessary to allow children and adolescents to have recurring chances to taste and consume fruits and vegetables.

Since children and adolescents spend a great deal of time at school, schools have more recently been focused on as an appropriate environment for programs that seek to increase their consumption of fruits and vegetables (Hazzard et al., 2011). Furthermore, schools can provide an established infrastructure, valuable resources and connections, as well as can help ease program implementation (Hazzard et al., 2011). There is more to a garden than planting seeds and growing food. School or community gardens can be used as a tool for change that encourages children and adolescents to make healthier food choices, as they are more likely to consume what they help grow and prepare. In addition, school gardens may help develop a personal connection with food, supplement classroom studies with hands on learning, build interest in nature and our environment, foster social interaction, bonding and team work, instill patience, and raise environmental and human impact awareness. (Blair, 2009; Heim et al., 2009; Cutter-Mackenzie, 2009). In addition, gardening-based learning can also help reduce the amount of time children and adolescents spend indoors sitting in front of a television or computer screen. Garden-based nutrition programs can also enhance children and adolescent self-efficacy, which is another major predictor of fruit and vegetable intake (Heim et al., 2009). With the growing childhood obesity epidemic and its health and financial implications, I feel as health professionals it is our responsibility to seek innovative and creative ways to engage this age population. School gardens could play a role in tackling the health disparities that we see today, especially in the Bronx. It is important that we address the poor dietary and physical activity habits of children and adolescents. After all, they are the future of our nation and we want them to live long enough to be a part of that future.

Given the time frame of one year and having $5,000 at my disposal, I believe I would be able to gather all the resources needed to conduct the study. Here is a breakdown of all the resources needed and how I intend to obtain these resources:

The garden:

I would contact the chair of the health science department who manages the Lehman Edible Garden to see if I could use the garden for the study. Although the Adult Learning Center is also an active participant in the Lehman Edible Garden, the health science department is always looking for volunteers to help maintain the garden. The garden is located between the Fine Arts Building and the Goulden Avenue gate, and it includes tomatoes, cucumbers, peppers, eggplant, lettuce, beans, garlic, herbs and more. In the near future, the health science department hopes to have enough produce to hold a farmer’s market on campus. Having neighboring high school students use the garden, would certainly help support the sustenance and expansion of the garden so that the health science department can fulfill their goal of having farmer’s markets on campus.

I would also talk to the health science department about the periodic use of the food lab in Gillet Hall, when classes are not in session, to conduct food demonstrations with the produce grown from the garden.

People:

I would need a variety of people and groups committed to sustaining the garden, gathering funds for the garden, and overseeing and carrying out lessons with the students. Thankfully, the Lehman Edible Garden already has a volunteer gardening group that maintains it and has expertise in gardening. The garden also has support from the Adult Learning Center. Therefore, I can bypass many of the issues indicated by other researchers who utilized elementary and middle school gardens, which included lack of long-term volunteers, not having a garden coordinator, uncooperative administration, and burned-out teachers, as they were mainly responsible for the gardens (Hazzard et al., 2011).

I would also contact the Institute for Health Equity at Lehman, as the program was established to address the health inequities among New York City’s urban poor and ethnic populations. I helped the Institute for Health Equity conduct research on a vending machine project last year and I worked closely with Marilyn Aguirre-Molina, the Executive Director. I know they have many resources available to them such as funds; strong community connections and Institute Research Scholars that could possibly help conduct my research study.

Susan Tree, the Dietetic Internship Director at Lehman College, is another person I would contact. I would see if I could use dietetic interns to help conduct the standards-based nutrition education sessions and collect data for the study, as they have a research rotation they must fulfill.

Furthermore, I could also contact Cornell Cooperative Extension who has Master gardener volunteers that can help develop standards-based lessons and run the garden-based nutrition sessions. Master gardeners play an important role in implementing and sustaining school gardens, as they provide free technical assistance and have a wealth of knowledge and experience (Hazzard et al., 2011).

Most importantly, I would have to get the administration of schools on board, so I can conduct the after-school garden-based nutrition program with their high school students. I plan on sampling three neighboring high schools (i.e. Walton High School, High School of American Studies, The Bronx High School of Science), so I would need administrations support in recruiting students by viewing a roster of all students from the three schools, so I can randomly select participants.

Lastly, I would also need the support of parents, as they can help volunteer and reinforce what is learned during the sessions at home with the students. Given the involvement of many different people, the creation of a committee is an important step I have to take. The committee would work together; sharing the responsibility of the garden, which would reduce the possibility of failure due to burned-out staff members or volunteers.

Funding & Material:

Gardens require continuous funding and materials; however, I would have a $5,000 grant at my disposal and could seek donations from garden associations, parent teacher associations, educational funding Web sites, city and local businesses, and local farm bureaus. I could also host a garden fundraiser sponsored by a local business for additional funds. As mentioned previously, the Institute for Health Equity at Lehman may also be able to supply funds.

An important way to reduce the costs of implementing and sustaining a garden is searching for free or reduced cost materials (i.e. seeds, fencing, soil, shovels, pitchforks, gardening gloves, etc.). Forming partnerships with the grounds crew or head custodian, participating in seed swapping with local garden clubs, obtaining damaged or unwanted goods from national corporations (e.g., The Home Depot) or local garden-related businesses, and collecting donations from national seed companies, local nurseries, and parent and community volunteers are some ways to obtain free resources (Hazzard et al., 2011). Sharing is a major theme within the gardening community, so it is important to reach out and contact people in community gardens and local gardening clubs for support (Hazzard et al., 2011). Since the Lehman Edible Garden has a garden coordinator, and I intend to utilize volunteer master gardeners, I can avoid the cost of having to pay for such services, as community gardeners make on average $44,000 per year, according to national statistics (Hazzard et al., 2011).

In terms of resources for creating a standards-based curriculum, the California Department of Education provides many nutrition education guides and sample curricula that my research team can tailor and enhance as needed. I could also use curricula created by the Cooperative Extension program, as this program has already developed several garden-enhanced, standards-based nutrition education curricula (Hazzard et al., 2011).

I also want to provide the students with incentives so they participate and maintain participation in the program. It would be explained to the students that if they attend x amount of sessions (to be determined), they would receive a $5 gift card to subway restaurant, free food demonstrations and tastings, and farmer’s market vouchers (which I will try to obtain from donations).

Yes, garden-based nutrition education programs for children and adolescents are certainly relevant to health professionals. Considering the suboptimal nutritive intake by this population and the growing epidemic of child and adolescent obesity, which contributes substantially to a host of health and financial burdens, it is important that innovative interventions be implemented. Dietitians and nutrition professionals understand the importance of developing healthy eating behaviors at a young age because in doing so healthy lifestyle behaviors can be established that is maintained throughout their lifetime. Not only does healthy dietary habits contribute to overall well-being, it also is the basis for the prevention of various health conditions, which include heart disease, diabetes, high blood pressure, stroke, cancer, dental caries and asthma (Shepherd et al., 2006). It is exceptionally important for children and adolescents to develop and maintain healthy eating habits, as it helps support healthy growth and cognitive development (Shepherd et al., 2006). The adoption of healthy eating behaviors during this period, will most likely be maintained as adults (Shepherd et al., 2006). Therefore, encouraging healthy eating behaviors as early as possible is crucial. However, to engage this age population, we need to implement creative, fun and effective nutrition education strategies aimed at improving dietary intake. Garden-based nutrition education programs can connect children and adolescents with healthful foods through fun, hands-on activities that will get them excited and eager to make and maintain changes.

My study will differ from other studies in this area because unlike most of the research available on garden-based nutrition education programs, mine will be conducted with high school students as opposed to elementary or middle school students. Furthermore, my study will be implemented in an urban neighborhood instead of a rural one, and conducted as an after-school, community program instead of an in-school program. In addition, participants of my study will be randomly selected from high schools and randomly assigned to either the garden-based nutrition education group, nutrition education only group or the control group, which is a distinction from much of the research available. Most of the studies that included control and comparison groups assigned only one group per condition, so I will be assigning three groups per condition (Robinson-O’Brien et al., 2009).

According to my review of the literature, although there is a decent amount of relatively recent research on this topic, there is a need for well-designed and peer-reviewed studies to determine the effectiveness and impact of garden-based nutrition education programs. There are also many gaps in research pertaining to this topic, which is detailed in question ten, where major limitations and recommendations for future research from the current literature is reviewed. As mentioned previously, my study will fill gaps in knowledge on this topic area by:

Utilizing high school students as participants instead of elementary or middle school students.

Conducting an after-school, community, and garden-based nutrition program in an urban neighborhood instead of an in-school garden in a rural neighborhood.

Randomly selecting students from high schools and then randomly assigning students to either the garden-based nutrition education group, nutrition education only group or the control group.

Having more than one group per condition.

Conducting the study over a longer period of time (i.e. 6 months as opposed to 12-16 weeks).

My study will focus on surveying knowledge, attitudes and behavior. Not only will the garden-based nutrition education program focus on why-to knowledge, such as science-based evidence demonstrating why certain dietary patterns and why consuming certain foods are related to specific health outcomes, but also on how-to knowledge, such as understanding basic facts about food and nutrition (i.e. food groups, balanced diets, food sources of nutrients, how to prepare foods) (Contento, 2011). Incorporating both types of knowledge can help to develop skills as well as build motivation and self-efficacy (Contento, 2011). The program will also encompass experiential learning techniques and hands-on activities to help influence behavior change. Experiential learning entails the analysis of activities performed through reflection, assessment, and rebuilding of the experience as a way to draw meaning from it (Ratcliffe, Merrigan, Rogers & Goldberg, 2011). This approach has demonstrated usefulness in the teaching of leadership skills to inner-city youth because of the element of reflection (Ratcliffe et al., 2011). In terms of hands-on activities, aside from gardening, participants will have opportunities to taste the produce grown, observe food demonstrations using the produce grown, and prepare foods with the produce grown with other participants. By increasing familiarity with vegetables through preparation and consumption, we can help improve participants’ attitudes toward vegetables and self-efficacy for consuming them as well as increase their consumption of more healthful foods (Lautenschlager & Smith, 2007). A school’s curricular, physical, and social learning environments can be enhanced by neighboring community gardens in ways that influence participants’ knowledge of, attitudes, preferences for, and consumption of vegetables (Ratcliffe et al., 2011). By providing engaging and interactive education that reinforces nutrition knowledge, gardens can improve a school’s curricular learning environment (Ratcliffe et al., 2011). The school’s physical and social learning environments can be enhanced by gardens via increasing the availability and accessibility of vegetables, and by offering opportunities for adult and peer modeling of the preparation and consumption of vegetables (Ratcliffe et al., 2011). This helps to create a positive attitude toward vegetables, encourages acceptance of a variety vegetables, and fosters the development of skills and habits conducive of healthy eating patterns (Ratcliffe et al., 2011).

My initial topic of interest was gardening. I then thought about who has done gardening in the past and who is doing gardening now. That brought me to the sub-topics community and school gardens. From there, I chose to go with school gardens and questioned where, how and why they occurred. Next, I decided to narrow my topic down to garden-based nutrition programs and children’s dietary intake. I then focused on the outcomes of such an intervention and gaps in research on this topic. This caused me to narrow my topic even further to garden-based nutrition program and its impact on vegetable intake, willingness to taste vegetables, preferences for vegetables, and nutrition knowledge of vegetables. By thinking about who, what, where, when and why, and by reviewing the available literature on school gardens, I was able to tweak my topic and make it more specific. Since there was a lack of research on after-school programs, high school students, and urban neighborhoods in relation to garden-based nutrition programs, I decided to have my research focus on them. Overall, my topic has a specific focus, but is broad enough to get a manageable amount of information.

While there is a large amount of research on traditional nutrition education practices, the effect of garden-based nutrition education is a relatively new branch of research (Cotugna, Manning & DiDomenico, 2012). Research on the effects of garden-based nutrition education in the United States began to appear in the year 1995. Since then, the literature on gardening and its impact on dietary behavior change in school-aged children have been slowly expanding. Although, peer-reviewed literature has been sparse from the years 1995 to 2007, the growing movement among educators to include gardens as a teaching tool within schools and communities has triggered more peer-reviewed research pertaining to garden-based nutrition interventions (Cotugna et al., 2012). This is evident by the greater abundance of research on this topic from the year 2007 and on.

Studies on garden-based nutrition-education programs have provided evidence to show that they can be successful in improving the fruit and vegetable intake of children and adolescents. McAleese and Rankin (2007) conducted a quasi-experimental study among 122 sixth grade students participating in a 12-week garden-based nutrition education program. They found that when compared to the control group, students in the garden group experienced significant increases in their reported daily intake of fruits and vegetables as well as preference for fruits and vegetables (McAleese & Rankin, 2007). Heim, et al. (2009) utilized a one-group pretest-posttest design to evaluate the impact of a 12-week garden pilot intervention among 93 fourth to sixth grade children attending a YMCA summer camp. They assessed the effects the intervention had on children’s fruit and vegetable consumption, preferences, self-efficacy, asking behavior, and home availability of fruits and vegetables (Heim et al., 2009). At follow-up, children reported a significant increase in vegetable preferences and the number of fruits and vegetables consumed (Heim et al., 2009). Morris and Zidenberg-Cherr (2002) performed a quasi-experimental study among 200 fourth-grade students to examine the effects of a 17-week, in-school garden-based nutrition intervention. They reported that students in the garden-based nutrition-education group retained a significantly greater preference for certain vegetables at six months when compared to the nutrition education only and control groups (Morris & Zidenberg-Cherr, 2002). No differences between the groups were found on willingness to taste vegetables (Morris & Zidenberg-Cherr, 2002). Similar to Heim et al. (2009), Hermann et al. (2006) used a one-group pretest-posttest design to investigate the impact of an after-school garden-based intervention among 43 students from Kindergarten through eight grades. Participants demonstrated a significant increase in the report of daily vegetable intake (Hermann et al., 2006). Students reporting that they consumed vegetables every day increased from 22% at baseline to 44% at follow-up (Hermann et al., 2006). Ratcliffe et al. (2011) used a quasi-experimental design to assess the effects of a 13-week garden-based nutrition program on 320 sixth grade students. The students’ ability to correctly identify different vegetables increased significantly than those in the control group (Ratcliffe et al., 2011). Furthermore, students who participated in the garden-based learning significantly increased their preference for vegetables (Ratcliffe et al., 2011). Viola (2006) reported that after exposure to a 6-month garden project, fourth to ninth grade students in two indigenous school communities in Australia increased their nutrition knowledge. Somerset and Markwell (2009) evaluated the impact of a 12-month school-based food garden on attitudes and identification skills regarding vegetables and fruit. They reported that the intervention led to improved ability to identify vegetables and fruits, greater attention to origins of produce, changes to perceived consumption of vegetables and fruits, and improved confidence in preparing fruit and vegetable snacks in fourth to seventh graders (Somerset & Markwell, 2009). While several studies have reported improved preferences for fruits and vegetables, many studies have shown that garden-based nutrition programs do not have a significant affect on preference (Heim et al., 2009).

Although the use of gardening in schools and communities appear to be fairly widespread, as there are thousands of school gardens in the United States, there has been a lack of peer-reviewed studies in the past examining the effects of school gardens (Lautenschlager & Smith, 2007; McAleese & Rankin, 2007; Ozer, 2007; Ratcliffe et al., 2011; Robinson-O’Brien et al., 2009; Somerset & Bossard, 2009). This has resulted in serious gaps between research and evidence-based practice (Lautenschlager & Smith, 2007; McAleese & Rankin, 2007; Ozer, 2007; Ratcliffe et al., 2011; Robinson-O’Brien et al., 2009; Somerset & Bossard, 2009). However, a recent review of garden-based nutrition interventions in the United States suggests that such programs have the potential to improve students’ vegetable intake, willingness to taste vegetables, and preferences for them, but it also reveals that the literature needs to be expanded on (Ratcliffe et al., 2011). While there is a growing span of recent peer-reviewed literature, the literature suffers from many limitations and gaps (Lautenschlager & Smith, 2007; McAleese & Rankin, 2007; Ozer, 2007; Ratcliffe et al., 2011; Robinson-O’Brien et al., 2009; Somerset & Bossard, 2009). Some of the most common limitations observed in the available research were the use of convenience samples, quasi-experimental designs, no control groups, small sample sizes and short intervention durations (Lautenschlager & Smith, 2007; McAleese & Rankin, 2007; Ozer, 2007; Ratcliffe et al., 2011; Robinson-O’Brien et al., 2009; Somerset & Bossard, 2009). In terms of gaps in research, most of the recent literature focuses on in-school garden-based nutrition programs that target elementary and middle school aged children, and examine intake, knowledge, and preferences (Lautenschlager & Smith, 2007; McAleese & Rankin, 2007; Ozer, 2007; Ratcliffe et al., 2011; Robinson-O’Brien et al., 2009; Somerset & Bossard, 2009). Evaluation of long-term impacts, links between gardens and school meal programs, impact on high school students, barriers and sustainability of gardens, and home and community impact of gardens are lacking in the literature and require further investigation. Nonetheless, the available evidence suggests that garden-based nutrition programs may have positive impacts on the intake of, preferences for and willingness to try fruits and vegetables; however, better-designed studies are needed.

Some trends in the literature in terms of further research needed includes:

Blair (2009) reports in her review that much more rigor is required in terms of the methodology used to evaluate school-gardening programs. She went on to discuss many limitations of studies conducted on school gardening. She also identified gaps in research and provided suggestions for future research:

Short-term, quasi-experimental designs have been commonly performed to investigate how school garden affect students, but they are not considered valid or reliable.

Many of the quantitative studies reviewed did not utilize rigorous sampling procedures or random assignment of participants to control and experimental groups.

It is rare to see school gardening studies conducted with high school students, as third-to-sixth-grade students are the usual participants.

More studies are needed on how to avoid or address common barriers associated with implementing and maintaining school gardens.

More qualitative studies on school gardens are necessary.

There is a need for studies focusing on the reasons for garden failure that detail innovative ways to maintain gardens over time.

Use well-designed longitudinal studies that use both qualitative and quantitative components.

Use an appropriate sample design.

Sample sizes must be large enough so that researchers can compare subgroups.

Use validated instruments, as several of the studies reviewed used testing instruments without proven validity.

Rowe, Stewart, and Somerset (2010) reported:

There is limited evidence available pertaining to the contributions school-based food gardens make to the school food supply.

Cotugna et al. (2012) reported:

There was issues with the construct validity of the classroom observations used in this study, as only the selection of salad in the lunch line were documented and no data was collected in terms of whether or not students actually consumed the salads.

Participants’ answers on the questionnaires and the choices they made in the lunch line may have been influenced by the presence of observers in the lunch line. This may have resulted in an internal threat to validity.

The novelty effect may have come into play in this study, as more participants may have chosen garden produce salads on the grounds that they wanted to try it because it was new.

The use of a convenience sample posed a threat to the external validity of this study.

The effects that school gardens have on high school students requires further research.

Future research should assess the long-term effects of school garden programs by following-up with participants a year or two after participation.

Lautenschlager and Smith (2007) discussed several limitations of their study and offered suggestions for future research:

The study did not include a control group.

The small sample size made it difficult to split the group.

Further investigation is necessary to assess the long-term maintenance of behavioral changes resulting from garden-based nutrition programs.

Gender and age difference in regards to learning styles warrant further evaluation.

Ransley et al. (2010) reported:

The importance of using various approaches to enhance knowledge about fruit and vegetables, such as behavior change techniques that include modeling, repeated exposure and practical experience with fruit and vegetables.

Since the study was a cross-sectional study, it can only suggest associations between variables and cannot provide evidence of causation.

Limited research has been conducted to evaluate the impact of educational interventions on children’s intake of fruit and vegetables.

Somerset and Markwell (2008) reported:

Incorporating biography and geography of food may help improve the consumption of such foods.

In terms of foods that are often difficult to change behavior towards, evidence suggests that closer involvement in the production and preparation of food can be a positive influence.

The study only sampled one school and had a small number of students participate, which limits the ability to generalize the results.

The researchers used a historical control, as it enabled the researchers to avoid issues associated with the quality of participation of a control school.

Robinson-O’Brien et al. (2009) conducted a great review of the literature pertaining to garden-based nutrition education programs. Upon their review, they found that it was difficult to make conclusions based on the limited number of well-designed, methodologically peer-reviewed research studies available. In this review, they presented limitations of various studies and provided suggestions for future research:

Many studies were limited by small sample sizes, lack of long-term follow-up data, and lack of process survey data.

Some studies lacked adequate details about intervention design and information regarding the successes and challenges of study implementation.

It is important that future studies include systematic process evaluation reports.

Convenience samples were often used by investigators, which could bias the results and limit their ability to generalize their results.

Some studies did not have a control group. Of the studies that included control groups, they only assigned one group per condition.

A variety of stakeholders should be included in the intervention planning process.

Having a workgroup to determine research design and evaluation recommendations would be useful.

Use previously validated tools, or pilot test and validate assessment tools prior to use.

Use control groups, as there is a need for group-randomized trials.

Use a minimum of six groups per condition.

Longitudinal research is needed to determine if changes in intake and attitudes alter over time.

Evaluate the facilitators and barriers to long-term sustainability of programming.

Hazzard et al. (2011) discuss the best practice models for implementing and maintaining an instructional school garden:

Standards-based garden curricula are needed to keep school gardens functional.

The first and most important step in implementing a school garden is to create a committee dedicated to the school garden (school administrators, teachers, parent/community volunteers, and the garden coordinator).

The use of a garden coordinator that collaborates with teachers to create and implement standards-based garden lessons has been noted in successful school garden programs, as this helps to overcome common barriers (i.e. time, lack of curricular materials linked to academic standards, and lack of teachers’ interest, knowledge, experience, and training in relation to gardening).

Graham and Zidenberg-Cherr (2005) reported:

There is a need for various resources to facilitate school garden programs, such as curriculum linked to instruction, teacher training for gardening, and lessons on teaching nutrition.

More research is needed to examine the link between school meal programs, school gardens, and healthful eating habits.

Research has shown that foodservice staff lacks involvement with school gardens. So perhaps it would be beneficial for teachers to build relationships with the foodservice staff, so that responsibilities for school gardens could be shared.

Viola (2006) implemented a gardening project conducted in two remote Indigenous school communities. She reported several limitations:

The fact that the researcher was both the facilitator and the evaluator of the project is a limitation to the study, as it can impart a biased assessment.

Other limitations include teaching staff turnover, high degree of absenteeism in school children, and both schools being in remote rural areas.

Although the project was effective in the short-term, further work is needed with respect to sustainability.

Wright and Rowell (2010) reported:

Although the quantity of vegetables selected from the salad bar increased during the intervention, there is a lack of sufficient data to determine if the increase was due to a change in the number of students using the salad bar, the students selecting larger portions, or both.

Since this project relied on quantitative data collection, the addition of qualitative data would strengthen the research.

Heim et al. (2009) discussed several limitations of their study and made suggestions for future research:

An inadequate number of taste tests, high preference at baseline, small sample size, program length, and actual gardening time may have influenced fruit and vegetable preference results.

The use of a convenience sample with no control group was a limitation of the study.

Social desirability may have influenced the results, as self-reported data was used.

Future research is needed to examine how a garden-based nutrition program affects the family and home food environment of a child.

McAleese, and Rankin (2007) reported:

They could not make implications about prolonged behavior change because of the short duration of the intervention (i.e. 12 weeks).

Future research should examine prolonged behavior change in regards to increased consumption of fruits and vegetables with garden-based interventions.

Results are specific only to the study population, as a nonrandomized trial was conducted.

Due to self-reported data as well as other influences on the students (e.g. eating at home, parental influences, and additional classroom activities), the results should be approached cautiously.

Morris and Zidenberg-Cherr (2002) discussed limitations of their study:

Since a quasi-experimental design was used, the schools may have differed in ways that were not measurable.

The fact that the schools (not the students) were assigned to treatment groups is another limitation.

Morgan et. al. (2010) reported:

There is a lack of peer-reviewed studies with control groups that examine intake and preference data together.

The trial was not a randomized controlled trial.

The trial was conducted in one area of the Hunter region, so the results may not be generalized to other populations.

The short duration and follow-up may have influenced the outcomes.

Future research should examine the long-term sustainability of school gardens.

Somerset and Bossard (2009) conducted a study to examine the prevalence and usage of food gardens in schools. Several limitations of their study were discussed:

The study had a small sample size.

The study was cross-sectional and retrospective in nature, so one should be cautious when applying the findings in a prospective context.

The use of survey instruments grounded in theories (e.g. self determination theory) would help to create a better understanding of the underlying motivations for initiation and continuation of school-based food gardens.

Graham, Beall, Lussier, McLaughlin, and Zidenberg-Cherr (2005) assessed current school garden practices, attitudes associated with the use of gardens in schools, and barriers to having and using a school garden in academic instruction. They reported:

There was a lack of pretesting for reliability of the survey items and scales used.

There was a low response rate.

Future research should examine the link between schools gardens and the school meal program.

In order to relieve teachers from time spent focusing on garden responsibilities, strategies need to more effectively use volunteers and community members. AmeriCore volunteers, master gardeners and Cooperative Extension staff are other options.

There is a need for curriculum materials and teacher training for gardening and nutrition.

Lautenschlager and Smith (2008) discussed several limitations and suggestions:

The sample used participants that already gardened with their families, so it is possible that this group exerted a bias on the sample.

The study did not have a control group.

The results show that multiple factors, including intention, attitude, and subjective norm influence gardening and dietary behavior in youth. Keeping these factors in mind and incorporating a combination of them in the development and implementation of future gardening programs may be effective.

Ozer (2007) presents a review that summarizes the literature regarding the impact of school gardens. She suggests that there has been little rigorous research on the effects of school gardens or on the factors that promote the sustainability of these programs. She also reported:

More research using rigorous evaluation designs is needed.

Research with adequately large samples is needed.

Future research is necessary to assess the relative effectiveness of garden programs with family and community contexts.

Gathering data using multiple approaches (i.e. surveys, interviews, observations) should be used to strengthen the validity of evidence for garden programs’ effects on students.

Future research should address levels of participation in gardening and if it imparts stronger effects, and who benefits most from school garden programs.

Ratcliffe et al. (2011) discussed limitations and provided suggestions for furture research:

A limitation of this study is that the actual amount of vegetables consumed was not measured. Only the number of different vegetable varieties consumed was measured.

Home and community components should be included in garden programs.

Future research should explore the long-term effects of garden-based nutrition interventions.

In order to determine the most effective components of garden-based education, comparison studies of different kinds of school garden interventions are necessary.

Parmer, Salisbury-Glennon, Shannon and Struempler (2009) reported:

The school had an unusually low number of females in the second-grade class.

A randomized, controlled trial with a larger sample size that incorporates a follow-up assessment to determine long-term results would be an ideal research design.

The study had participants that were mainly white, second-grade students, so generalizing the results to other populations would not be appropriate.

Yes, I was able to find and review at least twenty peer-reviewed research articles pertaining to my research topic that were published within the past five years. I also found eight peer-reviewed research articles that were a bit older than five years.

Blair, D. (2009). The child in the garden: An evaluative review of the benefits of school gardening. Journal Of Environmental Education, 40(2), 15-38.

Briefel, R. R., Crepinsek, M. K., Cabili, C., Wilson, A., & Gleason, P. M. (2009). School food environments and practices affect dietary behaviors of US public school children. Journal of the Academy of Nutrition and Dietetics, 109(2), S91.

Cotugna, N, Manning, C., & DiDomenico, J. (2012). Impact of the use of produce grown in an elementary school garden on consumption of vegetables at school lunch. Journal Of Hunger & Environmental Nutrition, 7(1), 11.

Cutter-Mackenzie, A. (2009). Multicultural school gardens: Creating engaging garden spaces in learning about language, culture, and environment. Canadian Journal of Environmental Education, 14(1), 122-135.

Davis, E. M., Cullen, K., Watson, K. B., Konarik, M., & Radcliffe, J. (2009). A fresh fruit and vegetable program improves high school students’ consumption of fresh produce. Journal Of The American Dietetic Association, 109(7), 1227-1231.

Dehghan, M., Akhtar-Danesh, N., & Merchant, A. T. (2012). Childhood obesity, prevalence and prevention. African Journal Of Food, Agriculture, Nutrition & Development, 12(2), 1-16.

Graham, H., Beall, D., Lussier, M., McLaughlin, P., & Zidenberg-Cherr, S. (2005). Use of school gardens in academic instruction. Journal Of Nutrition Education & Behavior, 37(3), 147-151.

Graham, H., & Zidenberg-Cherr, S. (2005). California teachers perceive school gardens as an effective nutritional tool to promote healthful eating habits. Journal Of The American Dietetic Association, 105(11), 1797-1800.

Hazzard, E. L., Moreno, E., Beall, D. L., & Zidenberg-Cherr, S. (2011). Best practices models for implementing, sustaining, and using instructional school gardens in california. Journal Of Nutrition Education & Behavior, 43(5), 409-413.

Heim, S., Stang, J., & Ireland, M. (2009). A garden pilot project enhances fruit and vegetable consumption among children. Journal Of The American Dietetic Association, 109(7), 1220-1226.

Hermann, J. R., Parker, S. P., Brown, B. J., Siewe, Y. K., Denney, B. A., & Walker, S. J. (2006). After-school gardening improves children’s reported vegetable intake and physical activity. Journal Of Nutrition Education & Behavior, 38(3), 201-202.

Knai, C., Pomerleau, J., Lock, K., & McKee, M. (2006). Getting children to eat more fruit and vegetables: A systematic review. Preventive Medicine, 42(2), 85-95.

Lautenschlager, L., & Smith, C. (2007). An evaluation of inner-city youth garden program. American Association for Agricultural Education, 49(4), 11-24.

Lautenschlager, L., & Smith, C. (2007). Understanding gardening and dietary habits among youth garden program participants using the Theory of Planned Behavior. Appetite, 49(1), 122-130.

McAleese, J. D., & Rankin, L. L. (2007). Garden-based nutrition education affects fruit and vegetable consumption in sixth-grade adolescents. Journal Of The American Dietetic Association, 107(4), 662-665.

Morgan, P. J., Warren, J. M., Lubans, D. R., Saunders, K. L., Quick, G. I., & Collins, C. E. (2010). The impact of nutrition education with and without a school garden on knowledge, vegetable intake and preferences and quality of school life among primary-school students. Public Health Nutrition, 13(11), 1931-40.

Morris, J. L., & Zidenberg-Cherr, S. (2002). Garden-enhanced nutrition curriculum improves fourth-grade school children’s knowledge of nutrition and preferences for some vegetables. (Research and Professional Briefs). Journal of the American Dietetic Association, 102(1), 91-93.

Ozer, E. J. (2007). The effects of school gardens on students and schools: Conceptualization and considerations for maximizing healthy development. Health Education and Behavior, 34(6), 846.

Parmer, S. M., Salisbury-Glennon, J., Shannon, D., & Struempler, B. (2009). School gardens: An experiential learning approach for a nutrition education program to increase fruit and vegetable knowledge, preference, and consumption among second-grade students. Journal Of Nutrition Education & Behavior, 41(3), 212-217.

Pérez-Rodrigo, C., Klepp, K., Yngve, A., Sjöström, M., Stockley, L., & Aranceta, J. (2001). The school setting: An opportunity for the implementation of dietary guidelines. Public Health Nutrition, 4(2), 717-24.

Ransley, J., Taylor, E., Radwan, Y., Kitchen, M., Greenwood, D., & Cade, J. (2010). Does nutrition education in primary schools make a difference to children’s fruit and vegetable consumption?. Public Health Nutrition, 13(11), 1898-1904.

Ratcliffe, M. M., Merrigan, K. A., Rogers, B. L., & Goldberg, J. P. (2011). The effects of school garden experiences on middle school-aged students’ knowledge, attitudes, and behaviors associated with vegetable consumption. Health Promotion Practice, 12(1), 36-43.

Robinson-O’Brien, R., Story, M., & Heim, S. (2009). Impact of garden-based youth nutrition intervention programs: A review. Journal Of The American Dietetic Association, 109(2), 273-280.

Rowe, F., Stewart, D., & Somerset, S. (2010). Nutrition education: Towards a whole-school approach. Health Education, 110(3), 197-208.

Shepherd, J., Harden, A., Rees, R., Brunton, G., Garcia, J., Oliver, S., & Oakley, A. (2006). Young people and healthy eating: A systematic review of research on barriers and facilitators. Health Education Research, 21(2), 239-57.

Somerset, S., & Bossard, A. (2009). Variations in prevalence and conduct of school food gardens in tropical and subtropical regions of north-eastern australia. Public Health Nutrition, 12(9), 1485-93.

Somerset, S., & Markwell, K. (2009). Impact of a school-based food garden on attitudes and identification skills regarding vegetables and fruit: A 12-month intervention trial. Public Health Nutrition, 12(2), 214-21.

Viola, A. (2006). Evaluation of the outreach school garden project: Building the capacity of two indigenous remote school communities to integrate nutrition into the core school curriculum. Health Promotion Journal of Australia, 17(3), 233-9.

Wright, W., & Rowell L. (2010). Examining the effect of gardening on vegetable consumption among youth in kindergarten through fifth grade. Wisconsin Medical Journal, 109(3),125-9.

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