Eat Your Way to Better Health: Outcomes of a Garden-Based Education Program in Indiana Schools

1. Eat Your Way to Better Health: Outcomes of a Garden-Based Education Program in Indiana Schools Courtney Sanor1, Matthew Kararo1, Dr. Kathryn Orvis1, & Dr. Neil Knobloch1 1Youth Development and Agriculture Education, Purdue University, West Lafayette, IN INTRODUCTION EVALUATION METHODS DISCUSSION & CONCLUSIONS The Institutional Review Board approved the study and protocol. In the fall of 2009, pretests and post-tests were administered to 3rd grade students in 40 Indiana counties before and after participating in the Eat Your Way to Better Health program. Students completed the questionnaires in the classroom. Pretests and post-tests were paired for each student to conduct paired sample t-test analyses. To determine the outcome of the EYWTBH program, all survey data were analyzed for descriptive statistics and comparative statistics (t-tests) by the Statistical Package for Social Sciences (SPSS). Descriptive statistics were reported. Statistical significant probability level for analysis was established at P ≤0.05. For Cohen’s d, medium effect sizes (d = 0.50) were interpreted as practically significant. Childhood obesity is a nationwide problem, with rates more than tripling in the past 30 years.1,2 Major contributing factors to this epidemic are improper nutrition and lack of physical activity.3,4,5 According to the 2007 Indiana Youth Risk Behavior Survey, almost 14% of Indiana teens in 9th through 12th grade were considered overweight, with 82% of students reporting they did not eat the recommended amount of fruits and vegetables per day and more than 56% of students reporting they didn’t engage in the recommended amount of physical activity per day.6 Childhood obesity, in turn, not only increases a child’s chances of being overweight or obese as an adult, but also increases their risk for developing certain diet-related chronic diseases both in childhood and into adulthood.1-5,7 Thus, primary prevention strategies for encouraging healthy eating practices and physical activity among children are imperative to combating this obesity epidemic. Garden-based education programs are a promising strategy for improving the nutrition status of the nation’s children. Studies have shown that when students plant and harvest their own fruits and vegetables, they are more likely to eat them. In turn, children eating more fruits and vegetables builds a foundation for lifelong healthy eating habits and reduces their risk of several chronic diseases.8,9 Moreover, since children spend a great deal of time in school, implementing these programs in schools can enhance the outcomes by providing more opportunities to engage students in hands-on gardening and nutrition activities and, thus, reinforce the program’s message of staying healthy by eating healthy.3,4,7 • Students reported higher outcomes upon completion of the Eat Your Way To Better Health program: • Increasein 3rd grade students’ self-reported fruit and vegetable consumption. • The program may have the potential to increase students’ fruit and • vegetable consumption by one fruit and one vegetable per day. • Increase in 3rd grade students’ self-reported interest in eating fruits and junk • food as a snack at home. • A stronger design is needed to determine if the program influenced students’ • interest in eating fruits and junk food. • Increasing students’ interest in eating junk food is an unexpected and • undesired outcome that will need to be addressed in future studies. • Increase in 3rd grade students’ self-reported healthy snack choice self-efficacy. • Students reported they felt more confident in their abilities to choose healthier • snacks, yet a quasi-experimental design is needed to determine this effect. • Increase in 3rd grade students’ self-reported intentions to talk to friends • about the benefits of eating fruits and vegetables. • Students agreed they planned to talk to friends about the health benefits of • eating fruits and vegetables, and mixed methods could help verify if students • acted on this intention. Student data should be corroborated with parent data. • Limitations: Although these findings support previous studies3,4,7-9, this pre-experimental design does not establish cause-effect relationships of the outcomes. Furthermore, although most of the outcomes were statistically significant, observations need to be conducted to determine the effect size criteria for practical significance. • Recommendations: This simple assessment suggests that future adjustments to the Eat Your Way To Better Health program should focus on (1) improving the practical significance of the program, (2) decreasing students’ interest in eating junk food, (3) emphasizing vegetables more in an effort to increase students’ interest in eating them, (4) controlling for confounding variables, and (4) determining the program’s effect on obesity in Indiana children. RESULTS TABLE 1. Behavior, Interest, Self-Efficacy, and Social Intention Outcomes PROGRAM DESCRIPTION & OBJECTIVES REFERENCES • The Eat Your Way to Better Health (EYWTBH) program is a comprehensive state program carried out by Purdue Extension – Consumer and Family Sciences and the Purdue Extension 4-H program, in conjunction with the Indiana State Department of Health. The program utilizes school garden-based nutrition education and school salad bars to teach 3rd grade students, their families, and school personnel about the connection between fruit and vegetable consumption, overall health, and, ultimately, to enhance their appreciation for fruits and vegetables. • The main objectives of this study were to assess if 3rd grade students reported an increase on the following variables upon completion of EYWTBH: • Fruit and vegetable consumption • Interest in healthy snack choices • Self-efficacy to choose healthy snacks • Intentions to talk to friends about the benefits of eating fruits and • vegetables American Heart Association. (2010). Heart Disease and Stroke Statistics 2010 Update: A Report From the American Heart Association. Circulation,121, e46-e215. doi:10.1161/CIRCULATIONAHA.109.192667 Goldberg, M. E., & Gunasti, K. (2007). Creating and Environment in Which Youths Are Encouraged to Eat a Healthier Diet. Journal of Public Policy & Marketing, 26(2), 162-181. doi:10.1509/jppm.26.2.162 O’Brien, L. M., Polacsek, M., MacDonald, P. M., Ellis, J., Berry, S., & Martin, M. (2010). Impact of a School Health Coordinator Intervention on Health-Related School Policies and Student Behavior. Journal of School Health, 80(4), 176-185. doi:10.1111/j.1746-1561.2009.00484.x Gross, S. M., & Cinelli, B. (2004). Coordinated School Health Program and Dietetics Professionals: Partners in Promoting Healthful Eating. Journal of the American Dietetic Association, 104(5), 793-798. doi:10.1016/j.jada.2004.02.024 United States Department of Health and Human Services. (2001). The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Retrieved from http://www.surgeongeneral.gov/topics/obesity/ Indiana State Department of Health. (2007). The 2007 Indiana Youth Risk Behavior Survey. Retrieved from http://www.in.gov/isdh/24887.htm Story, M. (1999). School-based approaches for preventing and treating obesity. International Journal of Obesity, 23(Suppl 2), S43-S51. Retrieved from http://www.nature.com/ijo/journal/v23/n2s/abs/0800859a.html  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. doi:10.1016/j.jada.2009.04.009 Robinson-O’Brien, R., Story, M., & Hem, S. (2009). Impact of Garden-Based Youth Nutrition Intervention Programs: A Review. Journal of the American Dietetic Association, 109(2), 273-280. doi: 10.1016/j.jada.2008.10.051 * Medium effect sizes (d = 0.50) were interpreted as practically significant **The probability level of P ≤0.05 was interpreted as statistically significant ACKNOWLEDGMENTS • Department of Youth Development and Agriculture Education, Purdue University, West Lafayette, IN • Discovery Undergraduate Research Internship Program, Purdue University, West Lafayette, IN • Purdue Extension – Consumer and Family Sciences, Purdue University, West Lafayette, IN • Purdue Extension 4-H Youth Program, Purdue University, West Lafayette, IN • Indiana State Department of Health • Indiana 3rd grade students, their parents, and their teachers