mhne 650 thesis - nutrition & garden education

Thesis: Nutrition & Garden Education Program 1

A Nutrition and Garden Education Program to Increase Fresh Fruit and Vegetable

Consumption in Middle School Students

Jill Marie Parsh

Hawthorn University

A Master’s Thesis Presented to the

Master’s Program at Hawthorn University

in Partial Fulfillment of the Requirements

for the Degree of Master of Science in

Health & Nutrition Education

2012


Table of Contents

Abstract ........................................................................................................................................... 3

Introduction ..................................................................................................................................... 4

The Problem of Obesity .......................................................................................................................... 4

Associated Risks of Obesity ................................................................................................................... 6

Poor Nutrition and Fast Food: the Culture of Obesity ............................................................................. 6

Literature Review ......................................................................................................................... 10

Evaluation of Research Studies ............................................................................................................. 11

Methodology & Results ................................................................................................................ 21

Results of Previous Studies ................................................................................................................... 21

Methodology for Building a Successful Nutrition Curriculum ............................................................. 22

Conclusion .................................................................................................................................... 25

Biography ...................................................................................................................................... 27

References ..................................................................................................................................... 28


Abstract

This study is a contribution to the study of childhood obesity in America, and seeks to provide

solutions for improving overall education and health of America’s youth through the design of a

nutrition and gardening program. The paper discusses associated concerns related to obesity,

including physical and psychological health problems, the financial burden upon the healthcare

system, and the nationwide trend of poor eating habits. A literature review of studies on the

impact of nutrition and garden curricula in general education is presented as a possible solution

to the problem of obesity. The main objective of the thesis is to determine the essential aspects of

an effective nutrition and garden education program that would promote the increased

consumption of fresh fruit and vegetables in middle school students. The paper concludes that

for a program to be successful, it must include both weekly nutrition education and experiential

gardening components over a period of at least one year and incorporate parental involvement.

As such, this thesis demonstrates that the creation of a nutrition and gardening program can be

utilized as an effective antidote to the rampant problem of obesity in the United States.


Chapter One

Introduction

The impetus for this thesis is the problem of poor eating habits in children, which leads to

multiple health concerns, including obesity, diabetes, and other psycho-social impediments. As

such, the main focus is the need for nutrition and garden education in schools in order to improve

childhood eating habits. After explaining the significant consequences of poor eating habits, this

thesis explores various studies of educational nutrition and garden programs in schools and their

corresponding efficacy for transforming children’s attitudes and behaviors towards eating a

healthier diet consisting of more fresh fruits and vegetables. The central assertion, therefore, is

that the implementation of a dynamic nutrition curriculum in schools, including a hands-on

garden component, has a positive impact on children’s eating habits.

The Problem of Obesity

In order to understand the importance of nutrition education and healthy eating in

general, it is instructive to describe the problems resulting from an overall poor and unhealthy

American diet. This is evidenced, foremost, by the severe and escalating problem of obesity.

Obesity rates among children in the United States more than tripled between 1976 and 2008.

According to the White House Task Force on Childhood Obesity (2010), we are facing a national

health crisis. The report states that one in three children (31.7%) age 2-19 are either overweight

or obese. Additionally, one third of all children born in the year 2000 are expected to develop

diabetes during their lifetime, and, for the first time in history, the current generation may have a

shorter lifespan than their parents. The 2010 rate of obesity is cause for alarm as it indicates that

obesity has nearly doubled since 2007-2008, at which time the National Health and Nutrition


Examination Survey (NHANES) results demonstrated that an estimated 16.9% of children and

adolescents age 2–19 years were obese.

Between 1976–1980 and 2007–2008, the obesity rate of preschool children age 2–5

doubled, from 5 percent to 10.4 percent, and in children age 6-11 obesity tripled, from 6.5

percent to 19.6 percent (Ogden & Carroll, 2010). During this same period, the rate of obesity in

adolescents age 12–19 more than tripled, from 5 percent to 18.1 percent. According to the age

group breakdown, obesity rates in the United States are increasing at higher rates as children get

older. Further, socioeconomic factors also impact childhood obesity rates, which are higher

among minority and low-income children as compared to national averages, and are highest for

African-American children (Anderson & Butcher, 2006).

The White House Task Force (2010) is not using hyperbole when it claims that we are

facing a national health crisis. It outlines several ramifications for childhood obesity, such as a

higher risk of heart disease, high blood pressure, elevated cholesterol levels, and insulin

resistance. In a study to determine the risk of heart disease in obese children, Freedman (2007)

concluded that approximately 70 percent of obese children had high levels of at least one key

factor for heart disease, and approximately 30 percent had high levels of at least two factors.

Another major health concern for obese children is type-two diabetes, once called adult onset

diabetes. Recent data indicate that type-two diabetes is now affecting children far earlier than

historical averages, and, in some populations, type-two diabetes is now the dominant form of

diabetes in children and adolescents (Deckelbaum & Williams, 2001). Further, the American

Journal of Epidemiology published a study indicating that asthma is another health issue that

obese children deal with more than non-obese children (Gilliland, 2003).


Associated Risks of Obesity

In addition to threatening physical health conditions, obese children, especially girls, also

face debilitating psychological problems such as low self-esteem and troublesome behavioral

problems (Reilly, 2003). Sadly, it is documented that an obese child is more likely than a normal

weight child to become an obese adult (Anderson & Butcher, 2006). Children should not have to

deal with these health issues at such a young age, or ever in their lives. The diseases mentioned

above are lifestyle diseases and are preventable through lifestyle changes.

Beyond both physical and psychological health problems, there are additional associated

societal concerns regarding those who suffer from obesity. In 2008, it was estimated that the

annual medical burden related to obesity in the United States came to $147 billion per year

(Finkelstein, 2009). Obesity-related medical costs occur not only in adult populations, but in

children as well. The annual direct costs of childhood obesity in the U.S. are estimated at about

$14.3 billion (Hammond & Levine, 2010). However, obesity in adults often begins in childhood;

therefore, addressing obesity early on in a child’s life is a preventative action that behooves the

government and taxpayers alike. Another associated area that is effected by childhood obesity is

our military. According to the White House Task Force on Childhood Obesity (2010), more than

a quarter of all Americans ages 17-24 are unqualified for military service because they are too

heavy.

Poor Nutrition and Fast Food: the Culture of Obesity

Nutrition guidelines state that eating a minimum of five fruits and vegetables per day

contributes to a healthier diet and may help prevent cancer and heart disease (American Cancer

Society, 2004; American Heart Association, 2004; USDA, 2004; Poston, Shoemaker, &


Dzewaltowski, 2005). Unfortunately, Americans are not eating the minimum USDA

recommendations for fruit and vegetables. Between 1989 and 1991, the fruit and vegetable

intake for children ages 2-19 was just 1.3 to 2.6 servings/day, respectively; during any given

consecutive three day period, only 26 percent of children and adolescents met the food guide

pyramid recommendations for fruits and roughly 36 percent met the recommendations for

vegetables (U.S. Department of Agriculture, 1989-1991). In a similar study, Krebs-Smith, Cook,

Subar, Cleveland, Friday and Kahle (1996) reported that the total daily fruit and vegetable intake

for children age 6-11 is an average of 3.4 servings for boys and 3.5 servings for girls. Also, only

one in five children consumed five or more servings of fruits and vegetables per day, and nearly

one fourth of all vegetables consumed were reported as french fries (Krebs-Smith et al., 1996;

Poston et al., 2005).

Today children are consuming more processed food, fast food, junk food, and soda than

ever before. From 1965 to 1996, a considerable shift in the adolescent diet occurred, in which,

suprisingly, both the total energy (calorie) intake and the proportion of energy from total fat and

protein decreased (Cavadinia, Siega-Riz, & Popkin, 2000). Concurrent increases occurred in the

consumption of carbohydrates, including higher fat potatoes and mixed dishes such as pizza and

macaroni and cheese. This decrease in total energy was accompanied by an increase in

consumption of soft drinks and non-citrus juices, and a decrease in raw fruit consumption. An

increase in high-fat vegetable consumption, such as potatoes, led to a decrease in consumption of

dark green and orange vegetables. Overall, the total number of servings for fruits and vegetables

is still below the USDA recommended five per day (Cavadinia et al. 2000).


As a certified health coach, my first recommendation to my clients is to eat more

vegetables because they are packed with vitamins, minerals, antioxidants, and fiber, low in

calories, easy to prepare, and affordable. In fact, consuming the recommended daily servings of

fruits and vegetables may help prevent obesity (Minnesota Department of Health, 2008). In an

effort to halt the rising rate of obesity among children, and eventually reverse it, the intent of this

research project is to increase children’s knowledge of healthy eating habits and, most

importantly, to increase the amount of fruits and vegetables school children consume.

The causes of childhood obesity are multi-faceted; therefore, the solution will need to

include many dimensions. The causes of childhood obesity and obesity in general are woven into

the fabric of today’s culture, wherein eating at McDonald’s or other fast food restaurants is

commonplace. According to Steven Gortmaker, in an article in Harvard Magazine,(2004) 30

percent of American children aged 4 to 19 eat fast food and older and wealthier children eat even

more. Overall, 7 percent of the U.S. population visits McDonald’s every day, and 20 to 25

percent eat at a fast-food restaurant (Lambert, 2004). This is a cultural norm that will need to

change in order to effectively address childhood obesity.

Today, kids don’t walk to school or even play much outside; instead, they spend hours on

computers doing homework, communicating with friends, and playing games. To complicate

matters, due to new testing standards and budget cuts, many schools have reduced or eliminated

gym time, creating a scenario that is much different from 30 years ago, when kids walked to

school, participated in daily physical education, rode bikes and skate boards, and regularly

enjoyed other outdoor activities. The general physical malaise of our modern culture – when

added to our bad eating habits – only compounds the problem of childhood obesity.


The Institute of Medicine of the National Academies (2005) describes the significance of

childhood obesity in the book Preventing Childhood Obesity, Health in the Balance:

Childhood obesity is complex because it has biological, behavioral, social,

economic, environmental, and cultural causes, which collectively have created

over decades an adverse environment for maintaining a healthy weight. The result

is that obesity from unhealthy eating and inactivity has rapidly become the social

norm in many communities across America.

It will take many years, and involve many levels of participation from the government, food

industry, healthcare industry, communities, schools, homes, and individuals, to effectively

address and reverse the trend of childhood obesity. The research focus of this thesis is on one of

many different possible changes in the school environment: implementing school gardens in

conjunction with nutrition education in an effort to increase the consumption of fresh vegetables

and fruits in school children.


Chapter Two

Literature Review

The first step in this thesis project was to review the effectiveness of similar programs

that were previously implemented. Therefore, the literature review comprises a survey of articles

regarding research studies in schools with gardens and a nutrition education component. Further,

most of these studies involved research exploring the efficacy of such programs to increase fresh

fruit and vegetable consumption for the students involved. All of the studies included were

performed in the United States.

The first study was conducted by Lineberger and Zajicek at Texas A&M University

(Lineberger & Zajicek, 2000), and two of the studies were published in 2009 (Ratcliffe, 2009;

Parmer, Salisbury-Glennon, Shannon & Struempler, 2009). Three of the studies were performed

in Northern California (Morris, Neustadter, & Zidenberg-Cherr, 2001; Morris & Zidenberg-

Cherr, 2002; Ratcliffe, 2011), two in Kansas (O'Brien & Shoemaker, 2006; Poston et al., 2005),

and one in each of the following states: Texas (Lineberger, 2000), Oklahoma (Hermann, 2006),

Idaho (McAleese & Rankin, 2007) and Minnesota (Heim, Stang, & Ireland, 2009). One study

specified the location as South-east United States (Parmer et al., 2009). Three of the studies were

performed in after-school programs (Poston et al., 2005; O'Brien & Shoemaker, 2006; Hermann,

2006), one was performed during a Summer Camp at the Boys & Girls Club (Heim et al., 2009),

and the remaining six studies took place in schools during the school day. The grade level of the

students involved in the studies ranged from kindergarten through eighth grade. A summary of

each study follows. Table 1 is included as a quick guide to each study.


Evaluation of Research Studies

Poston et al. (2005), performed their study in an after-school Boys & Girls club. The

participants recruited were all in grades 3-5. Although the lessons and tests involved in the study

were tailored for the fourth grade level, there were not enough fourth grade participants, making

it necessary to recruit both third and fifth graders. The study was conducted in two semesters:

summer and fall. In the summer semester there were 18 total particpants, and in the fall semester

there were 11 participants. The researchers measured nutrition knowledge, fruit and vegetable

preference, and gardening self-efficacy. Both baseline and end-program testing were performed.

This study did not test for an increase in consumption of fruits and vegetables, but was enacted to

determine behavior change using social cognitive theory.

According to Poston et al. (2005), social cognitive theory postulates that behavior change

is mediated by childrens’ expectations of confidence to perform the behavior, and childrens’

expectations for the outcomes they will receive from that behavior. In other words, if children

have better nutrition and garden knowledge, and self-confidence, it is more likely that they will

change their nutrition behavior and eventually consume more fruits and vegetables. Although the

study reported no significant changes in the participant’s results between the baseline and end-

program tests in any of the measures, there was an increase in nutrition knowledge and gardening

self-efficacy in both the Professor Popcorn (PP) and Junior Master Gardener (JMG) summer

groups, as well as an increase in vegetable preference in the summer JMG participants (Poston et

al., 2005). Due to the fact that the study’s short timeline, limited number of participants ,

potential bias from recruiting students as opposed to random selection,, and high beginning

baseline scores, an increase is positive and should warrant further research.


Morris et al. (2001) performed an in-school study of first graders at two schools: an

intervention school and a control school. Three classrooms at each school, which included a total

of forty-eight and forty-nine students, respectively, participated in the study. The schools were

chosen based on their student population’s similarity in ethnicity and geographical location. The

intervention group participated in lessons from the Team Nutrition Program, which were

integrated into the normal curriculum by the classroom teacher. The lessons started after the pre-

test and were taught throughout the school year. During this time, the participants also planted

and maintained a fall and spring vegetable garden.

The control site had no formal nutrition or garden lessons. Both pre-tests and post-tests

were administered to assess the participant’s knowledge of and preference for fruits and

vegetables. The tests were conducted by a researcher and included one-to-one interviews with

each participant. The first part of the test evaluated the student’s ability to visually identify the

food groups. The second part of the test evaluated the willingness of the student to taste six

vegetables. At the intervention site, both the ability to visually identify the food groups and the

willingness to taste them improved. At the control site, no significant improvements in either

area was made.

Because the control group had a higher pre-test score on the first part of the test,

indicating a greater ability to identify vegetables visually, the researchers stated that the

statistical significance of improvements made by the intervention group in this area were

nullified (Morris et al., 2001). However, it appears that the intervention made the intended

impact in both main areas of student testing in the intervention group, with no changes occurring

in the control group. This indicates a causal relationship between the intervention and the


outcome and, hence, supports the theory that education increases children’s knowledge of

healthy eating habits. According to the researchers (Morris et al., 2001), increases in knowledge

lead to an increase in behaviors. In this case, the theory is that the more children know about

healthy foods such as fruits and vegetables, and the more they are exposed to opportunities to

consume them, the greater the chance that they will adopt the habit of eating them.

O’Brien and Shoemaker (2004) conducted a study at after-school gardening clubs in two

elementary schools in which there were 17 fourth grade participants at the intervention school

and 21 fourth grade participants at the control school. In the process of recruiting participants

into the study, demographic information was evaluated and it was determined that the two

groups were demographically similar. The intervention group participated in 10 weekly lessons

from March to May, 2004. These lessons included a healthy snack, a nutrition lesson, and garden

time. Both a pre-test and a post-test were conducted. The lessons utilized social cognitive theory

and were taught by the researcher with assistance from master gardeners and university students.

The study tested nutrition knowledge using multiple choice and true/false questions, and fruit

and vegetable preference using four fruits and eight commonly considered vegetables. The

participants were asked to rate the foods either as ―like,‖ ―like a little,‖ ―dislike,‖ or ―don’t

know.‖ Fruit and vegetable consumption self-efficacy and gardening self-efficacy were tested

using task specific, self-evaluation questions, with possible responses being: ―sure they could do

the task,‖ ―somewhat sure they could do the task,‖ or ―not sure they could do the task.‖

No significant increase in knowledge, preference, or self-efficacy was found in this study

(O’Brien & Shoemaker, 2004). The researchers postulated that the reason for the lack of

significant increases could be due to two factors that distinguished this study from previous


studies: the relatively low number of participants and the relatively short period of time of the

study. In evaluating the results of this study it is also important to note that the pre-tests and post-

tests were only six weeks apart, and the beginning baseline scores were high. A higher

population of participants would create a greater ability to notice changes made by the

intervention, and a longer period of time for the intervention would increase the potential to learn

new knowledge and eating habits. The authors of this research admitted that not harvesting the

vegetables planted in the garden potentially detrimentally impacted the student’s appreciation for

them, leading to lower test scores.

The study by Morris and Zidenberger-Cherr (2002) included a total of 213 fourth grade

students at three elementary schools. Sixty-one students at the control group school received no

formal nutrition or garden education, seventy-one students at the nutrition lesson only (NL)

school received classroom based nutrition and garden lessons, and eighty-one students at the

nutrition and garden (NG) school received both nutrition and garden lessons in the classroom, as

well as hands-on garden experience. The one-year nutrition education program included a total

of nine lessons taught by the researcher, one lesson every two weeks for seventeen weeks. The

study was designed to assess nutrition knowledge and vegetable preferences. Pre-test and post-

test evaluations, as well as a six-month follow-up using the same tests, were completed.

Nutrition knowledge was assessed using a 30 question multiple choice questionnaire, and

vegetable preference was assessed by presenting each child with a tray of six different

vegetables. During the vegetable preference assessment, each child was invited to taste all of the

vegetables and, for the ones they sampled, asked to rate the vegetables on a dislike-like scale of

1-5, whereby 1 represented the extreme of dislike and 5 represented the extreme of like.


The nutrition knowledge scores at both the six month follow-up and the post-test were

significantly greater than the control group. There were significant increases in the vegetable

preferences for carrots and broccoli between the NL and NG group compared to the control

group. The NG group had a significant increase in preference over the NL and control group for

snow peas and zucchini. At the six month follow-up, the NL group maintained its high

preference for carrots and the NG group for broccoli, snow peas, and zucchini. There was no

significant difference in the willingness to taste vegetables in any of the groups at pre, post, or

follow-up tests. Several factors may have impacted the positive results in this study: the rather

high number of participants, 213 in total, and a parental component that included a newsletter

sent to the home every other week that recapped the children’s lessons and aimed at spurring

family discussions about nutrition.

The study by Hermann et al. (2006) included 43 after school students in kindergarten

through eighth grade at a rural school in Oklahoma. Seventy-two percent of the participants were

Native American, 25 percent white/non-Hispanic, and 3 percent Hispanic. The students

participated in a group instruction one day per week that consisted of gardening, nutrition

education, and food preparation. The students were evaluated with a pre-test and post-test

questionnaire containing two prompts: ―I eat vegetables every day‖ and ―I am physically active

every day.‖ Possible answers were ―yes,‖ ―sometimes,‖ and ―no.‖ At post-test there was an

increase from twenty-one percent to forty-four percent in the ―yes‖ response to the prompt ―I eat

vegetables every day,‖ and an increase from fifty-one to seventy-nine percent to the prompt ―I

am physically active every day.‖ The positive results in this study show that including nutrition


education, gardening, and food preparation activities can have a positive impact on the vegetable

consumption of the participating students.

The study performed by Ratcliffe et al. (2009) included 320 sixth grade students at two

intervention schools and one control school. The demographics of the schools were low-income

with a diverse ethnic population: more than 90 percent of the students were non-white, 35

percent overweight, 64 percent low-income, and 35 percent were English language learners. At

the two intervention schools, the participants received 13 one hour sessions over a four month

period. Each session included 20 minutes of learning and 40 minutes of hands-on experience in

the garden. At the intervention sites, parent and community events were also included. Pre-tests

and post-tests were administered using the Garden Vegetable Frequency Questionaire (GVFQ)

and a taste test. Vegetable consumption was used as a measure and evaluated using a 24-hour

recall.

Students in the intervention group showed a significant increase in vegetable knowledge

and preference, as well as an increased preference in a variety of vegetables, not just those grown

in the garden. The garden group inceased the average number of vegetable varieties they

consumed more than once per month; however, consumption of vegetables at home did not

change. Although this study included a parent and community involvement component, which

may have had an impact on the positive results in this study, the researchers need to look at how

to change parental involvement so that an increase in consumption of vegetables at home will

increase. Because the demographics of the population for this study were mainly students of a

low-income and minority socioeconomic status, researchers may need to increase parental

involvement in the classroom so that changes in students can be effective in the context of the


family. In a situation where the school and home environments are disparate, educators may need

to take the extra step to impact parents so that changes occur on a systematic, and thus

sustainable, level.

Lineberger and Zajicek (1999) conducted a study to determine how nutrition education,

along with school garden activities, would impact fruit and vegetable preferences and

consumption in participating students. One hundred and eleven third through fifth grade students

participated in the study. Five elementary school teachers from different schools incorporated

nutrition and horticulture lessons into their curriculum over a one year period. The students took

a pre-test and post-test questionnaire and completed a 24-hr recall journal. Post-test results in

vegetable preference improved, fruit preference remained the same, and there was no change in

fruit and vegetable consumption. Although the consumption of vegetables did not increase

according to the test results, both vegetable and healthy snack preference increased, in particular

for the participants that had the lowest pre-test scores.

McAleese and Rankin (2007) conducted a study with 122 sixth grade students at three

elementary schools, including a control group and two treatment groups. Each treatment group

participated in a twelve-week nutrition education program, and the second treatment group also

participated in garden-based activities. The results showed that adolescents who participated in

the garden-based nutrition intervention group increased their daily intake servings of fruits and

vegetables more than the students in the two other groups. In fact, the number of servings of

fruits and vegetables more than doubled for the garden-based intervention group, from 1.93 to

4.5 servings per day. Food recall workbooks were used before and after to gather data.


The study showed an increase in vegetable consumption in the students that participated

in the nutrition and hands-on garden activities. This finding supports the theory that involving

children in garden and nurtition curricula in the school can have a positive impact. Further, the

fact that the garden-based intervention group increased consumption of vegetables more than the

classroom nutrition education intervention group indicates that experiential, hands-on learning is

highly valuable in the area of nutrition. Because so much of school education takes place inside a

classroom, connecting nutrition with its source—the earth—via a garden may be an invaluable

aspect of effectively teaching this subject. Therefore, this research is highly instructive on the

kind of nutrition education that is most significant.

Parmer et al. (2009) studied six second grade classes, divided into three treatment groups,

totalling 115 students. Two classes received both nutrition education and gardening, two classes

received only nutrition education, and two classes served as the control group. Treatment was

assigned based on the stated interest of the individual classroom teachers; however, this is a

condition that could easily cause bias in the study. For instance, teachers who were most

interested in nutrition education or gardening would naturally have a pre-determined interest in

ensuring that their students learned the material. Likewise, teachers who had no interest, or

possibly thought the research was not worthy, might be more apt to downplay the importance of

the learning, therefore dissuading students from scoring well on the research tests.

Children in the gardening group received nutrition lessons and gardening lessons in an

alternating biweekly schedule. Children in the nutrition education group received nutrition

education lessons every other week. Children in the control group only participated in the pre-

test and post-test assessments. The study results showed two major changes. First, the control


group ate fewer vegetables at post-test compared to pre-test. Second, the nutrition education and

garden groups ate more vegetables at post-test than at pre-test. Therefore, the experiment

supported the researcher’s hypothesis that increasing knowledge of nutrition and gardening can

positively impact student’s eating habits.

The fact that the teachers were assigned to curricula based on their preferences may also

be instructive for future research. In other words, a teacher’s effectiveness in teaching nutrition

and gardening may be dependent on their interest levels in the subject matter. Therefore, perhaps

nutrition and gardening programs in schools are most likely to succeed when instructors are both

knowledgable and interested in the subject area themselves. Increasing children’s consumption

of fruits and vegetables is critical to developing good nutritional habits. Results of the Parmer et

al. study (2009) elucidate the positive effects of school gardening experiences on the dietary

behaviour of young children. Although nutrition education alone improves fruit and vegetable

knowledge and preference in children, adding the hands-on gardening component strengthens the

likelihood that children will increase vegetable intake.

After reviewing twenty–one studies on the impact of garden and nutrition education to

determine the effect on fruit and vegetable consumption in children, Heim et al. (2009) found

that the studies had disparate results and felt some important markers were not being included. In

order to address these inadequacies, Heim et al. decided to conducted a more comprehensive

study at an after-school YMCA program. The twelve week, one hour per week study included 93

participants. There was a strong parental component that included a weekly newsletter with

recipes, information, and home activities related to garden and nutrition education. The new


study tested five areas: fruit and vegetable exposure, preference and self-efficacy, asking

behaviour, and home availability.

Unlike previous research, the study by Heim et al. (2009) prompted students to indicate

whether or not they enjoyed participating in the program. At the conclusion of the program, 97.8

percent of the students indicated that they enjoyed taste-testing different fruits and vegetable;

93.4 percent enjoyed preparing healthy snacks; 95.6 percent enjoyed gardening; and, 91.3

percent enjoyed learning about nutrition. This positive response to the garden and nutrition

program translated to an increase in the number of vegetables consumed, as well as an increase

in vegetable preference. Self-efficacy did not improve, but asking behaviour did. The quantity of

vegetables available at home was high at baseline and did not improve at post-test. In social

cognitive theory, it is important to have a positive preference before an actual change is made.

The postive response to the program seemed to have a direct result in more vegetables eaten.


Chapter Three

Methodology & Results

Results of Previous Studies

An initial review of these ten studies suggests that including nutrition education, with a

hands-on garden component, at schools increased vegetable consumption by the participants in

some cases, but not all. However, a closer review of the studies reveals that eight studies

evidenced an increase in at least one of the three areas: knowledge, preference, and consumption.

The two studies that did not show positive results in any area were those conducted by Poston et

al. (2005) and O’Brien and Shoemaker (2004). However, these two studies featured the least

number of participants, the shortest total lesson time, and the shortest length of program. The

study performed by Poston et al. (2005) included only 29 participants, and each participant only

had either seven and a half hours or twelve hours of lessons over a time period of five to eight

weeks. The study conducted by O’Brien and Shoemaker (2004) had only 38 participants and

included lessons for a total of eleven hours over six weeks.

According to Heim et al. (2009), it can take between five and ten tastes before liking a

new food, and in a study by Wardle, Cooke, Gibson, Sapochnik, Sheiham, and Lawson (2003),

after exposing a child to a food everyday for fourteen days, the child’s liking and willingness to

eat that food increases. In light of these assertions, it is obvious that only seven to twelve hours

over a period of five to eight weeks is a rather insufficient alottment of instruction time to change

either preference or consumption behavior of fruits and vegetables. Therefore, the failure of

these two studies to effect a noticable change in participant’s behavior may, in fact, be due to

inherent flaws in their design.


Overall, the findings of the studies tend to support the thesis that the inclusion of a

nutrition education program, including a hands-on garden component, into the middle school

environment will increase student’s consumption of fruits and vegetables. Studies with control

groups generally showed that the experimental groups manifested a positive change towards

greater consumption. The negative changes that were illustrated within these studies were

attributed to issues such as lesser periods of time, small number of participants, and lack of

parental involvement, as well as poor selection or lack of random selection of participants.

Perhaps adjusting the methodology of the studies with negative results would have yielded

positive findings. These adjustments would have included the lengthening of the time of the

study, the increasing of the number of participants, and the increasing of demographic variables

of the study.

Methodology for Building a Successful Nutrition Curriculum

The purpose of this research paper is to determine if the inclusion of a nutrition education

program with a hands-on gardening component in schools will increase student’s consumption of

vegetables. It is evident from research that an increase of vegetables can have a positive effect on

a person’s overall health. With the increasing rates of obesity and obesity related disease in

America among both adults and children, it is important that every effort be made to teach

children about proper nutrition and the benefits of eating fruits and vegetables daily. Most of the

studies included in the literature review implemented social cognitive theory, which promotes

behavior change using three approaches: personal knowledge, behavior/skill, and visual

connection with the environment (Contento, 2007). The reviewer looked at several criteria in

each study and determined that the following variables effected the results: the length of time the


participants were involved in the program, the number of participants, placement and timing of

the program (in/out and during/after school), if a control group was used, the ethnicity and

socioeconomic status of the participants, and parental involvement or component in the program.

After analyzing research results presented in the literature review, several things became

clear about what to include in a nutrition education program. The first and most obvious of

which is a hands-on garden component, which is an experiential way to effectively increase

valuable knowledge and skills, as well as to demonstrate a positive relationship with the

environment in respect to healthy eating. In order to effect positive results, in which an effective

nutrition and garden curriculum increased vegetable consumption in the participants, it was also

determined that the education program should be at least a year in length and include both

weekly nutrition lessons and weekly hands-on garden activities. Additionally, the program

should include taste testing of the foods grown in the garden, a cooking component to increase

the self-efficacy of healthy eating, and a parental component to reinforce and support both

learning and behavior changes in participants. A successful program necessitates that participants

learn about nutrition, gain the skills necessary to make healthy food choices, and, finally,

synthesize skill, preference, and knowledge to effect behavior change.

Due to the many external and environmental factors at play (which tend to negatively

impact a child’s likelihood of increasing consumption of fruits and vegetables), it is important

that schools develop comprehensive nutrition curricula supporting the positive trend of healthy

eating habits. Generally, a good curriculum will include multiple modes of instruction, so that

the eventual element of success is dependent on the nature of positive forces that are brought to

bear on the aspect of curriculum change. Past studies have shown that schools that adopt well-


developed curricula on nutrition are less likely to experience cases of obesity within the student

population.

In summary, the following list of criteria details the essential aspects of an effective

nutrition and garden education program:

weekly nutrition lessons

weekly experiential, hands-on gardening lessons

taste testing of fruits and vegetables (from the garden if possible)

hands-on cooking with whole, fresh food

duration of program must be at least one year

parental involvement via newsletters, recipes, and taste testing food prepared by

students while in the program

standard-based lessons

participants from low-income minority communities


Conclusion

Obesity is a major issue of concern in childhood, with multiple negative consequences for

physical and psychological health, academic performance, and the overall economy. Adding to

the problem of obesity is the established trend of poor eating habits. Additionally, obesity in

childhood is a poor indicator of health in adulthood. The findings of this thesis suggest that the

inclusion of a nutrition and garden curriculum in middle schools is likely to increase the

consumption of fruits and vegetables and, thus, decrease the incidence of obesity. A major

benefit of establishing a nutrition and gardening curriculum in general education is not only the

prevention of obesity, but the instilling of values that can transform the poor eating habits of a

generation of students, thus leading to a greater potential for better health in adulthood. An added

benefit of a nutrition and gardening curriculum is the experiential nature of the learning process,

which enables students to make direct correlations from the classroom to their everyday lives.

Lastly, family involvement is implied, which connects school learning to home life as well.

This thesis is based on the idea that the most effective curricula are those that are

modeled along the social cognitive theory (Contento, 2007; Edelstein, 2011). This theory will

make it possible for students to adjust their attitudes, beliefs, and behaviors after a prolonged

period of exposure to positive forces that they encounter in a school-based nutrition and

education learning program. The adoption of positive nutritional behavior among students is

regarded as one of the most fundamental aspects of positive lifestyle change (Hark & Morrison,

2009). Often the process of change includes the gradual transformation of the external forces that

affect the manner in which the student thinks. The nutrition and gardening education curriculum

outlined in this thesis meets these requirements for behavior change through incorporating


parental involvement, environmental factors, cultural factors, and behavioral factors (Marks,

Sisirak, & Heller, 2010).

By means of analyzing previous research on implementing nutrition and gardening curricula in

general education, this thesis has affirmed the hypothesis that such programs, when they meet the

identified criteria described in the results section, can increase student intake of vegetables and

fruits. The path forward to creating new curricula based on research must involve an intelligent

analysis of the data already gathered, as well as the inclusion of new and improved research. It is

the hope of this researcher to develop new a curriculum in the area of nutrition and gardening

that furthers the understanding of the efficacy of such a program. Ultimately, the research and

the curriculum are aimed at lowering childhood obesity through improving diet, which in turn

will improve the overall health of students and, on a societal level, the economic state of the

health care system. Indeed, many benefits can arise through making students more aware of the

foods they eat. In the end, the motto ―you are what you eat‖ may just turn out to be true.


Biography

Jill Parsh developed a passion for healthy, whole foods at an early age through her

family’s vegetable garden. As an adult, that passion ripened from growing a garden into cooking,

eating, and studying the health benefits of whole foods.

Jill worked her way through college, earning a degree in business administration and a

job in corporate America. Eventually, long workdays, stressful deadlines, and a lack of real

meaning in her job began to affect her health, and Jill began to suffer from fatigue, digestive

issues, and chronic neck and shoulder pain. Realizing how essential it was to follow her passion

for whole, healthy foods, she took a sabbatical from the corporate lifestyle and began her journey

to fulfillment. While traveling through Central America, Jill discovered the Nosara Yoga

Institute in Costa Rica, where she earned a 200-hour Yoga Teacher Certification. Upon her

return to the United States., she earned a certificate in Holistic Health Coaching at the Institute of

Integrative Nutrition in New York City.

With a Certificate as a Holistic Health Coach, and in the process of earning a Master’s

degree in Health and Nutrition Education, Jill took her passion for healthy eating and health

living into the local school garden as a volunteer. Though this experience, the issue of childhood

obesity became apparent, and Jill’s mission to empower children through nutrition knowledge,

hands-on gardening, and food activities became her main focus.


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