restaurants more frequently (Kirby

The Effects of Nutrition Education and et al., 1995). Research has reported
Gardening on Attitudes, Preferences, and many low-income families suffer from
food insecurity, which is associated
Knowledge of Minority Second to Fifth with a reduced variety and availabil-
ity of fruit and vegetables at home
Graders in the Rio Grande Valley Toward (Dave et al., 2010; Kaiser et al., 2003;
Matheson et al., 2002).
Fruit and Vegetables Additionally, research has sug-
gested demographics influence risk
Geralyn A. Nolan1, Amy L. McFarland2, Jayne M. Zajicek3, levels for obesity and Type II diabe-
tes. In the United States, the prev-
and Tina M. Waliczek4,5 alence of overweight people and
obesity is greatest among the low-
income groups (Morton and Guthrie,
ADDITIONAL INDEX WORDS. social issues, obesity, Type II diabetes, horticulture,
health, fruit and vegetable questionnaire
1999; Wang, 2001). Cullen et al.
(2002) found Hispanic children on
SUMMARY. Child obesity has become a national concern. Obesity in children ages average consumed fewer fruit and
6–17 years has more than doubled in the past 30 years. Only 20% of children today vegetables per day compared with
consume the recommended daily servings of fruit and vegetables. This trend is non-Hispanic white children. Male
even more pronounced in minority populations. Past studies have reported Hispanics and the youngest and old-
a horticulture-based curriculum, including gardening, can improve children’s
attitudes toward eating fruit and vegetables. To investigate whether children of
est age groups among Hispanics have
a minority population can benefit from gardening combined with a curriculum on reported the lowest intakes of fruit
nutrition, research was conducted with elementary schools in a primarily Hispanic and vegetable servings per week (Subar
region of Texas. Elementary school teachers participating in this research agreed to et al., 1995). Furthermore, Hispanics
have school gardens and complete all activities in a curriculum on nutrition are more likely to have a high body mass
provided to them through the Texas Agrilife Extension Service. One hundred and index compared with non-Hispanic
forty-one children in the participating schools completed a pre- and posttest whites (American Heart Association,
evaluating their nutritional knowledge, preference for fruit and vegetables, and 2011; Wang, 2001). Hispanic parents
snack choices before and after a gardening program supplemented with nutrition also report significantly fewer ‘‘meal
education. Differences were detected between pre- and posttest scores for all three planning practices’’ (such as making
variables. After comparing pre- and posttest scores, it was concluded that gardening
and nutritional instruction had a positive effect on students’ nutritional knowledge,
a menu before shopping) than non-
fruit and vegetable preference (FVP), and snack choices. Hispanic white parents (Cullen et al.,
2002).
Early childhood is a critical pe-

O
ver the years, children in et al., 2002; Djousse et al., 2004; riod for developing obesity (Law,
America have consistently Domel et al., 1993b; Kirby et al., 2001). The number of overweight
consumed fewer than the re- 1995; Liu et al., 2000; Ness and children aged 6 to 17 has increased
commended servings of fruit and veg- Powles, 1997). Fruit and vegetable by almost 200% in the last 30 years
etables [Centers for Disease Control consumption decreases the risk for and those numbers continue to rise
(CDC), 1996a; Cullen et al., 2001; numerous diseases and health prob- in America (Blumenthal et al., 2002;
Domel et al., 1993b; Krebs-Smith et al., lems (Bazzano et al., 2002; Djousse CDC, 1996b; Jolliffe, 2004; Law,
1996; Subar et al., 1995]. Instead, they et al., 2004; Liu et al., 2000). Including 2001; St.-Onge et al., 2003; Wang,
are consuming high fat, caloric-dense, fruit and vegetables consistently in a 2001; Weisberg, 2002). About 30%
nutrient-poor foods. As a result, the diet can also assist with weight control of children aged 6 to 19 years old are
number of overweight children has in- (Lin and Morrison, 2002). This may overweight (St.-Onge et al., 2003;
creased to record numbers (Blumenthal be a result of fruit and vegetables Wang, 2001). According to the 2005–
et al., 2002; CDC, 1996a). The preva- being nutrient-dense and generally 2008 National Health and Nutrition
lence of Type II diabetes in children is low in calories. Examination Survey, only 31% of adult
also on the rise (St.-Onge et al., 2003). Low-income populations tend to Americans are at a healthy weight, in-
The consumption of fruit and consume even fewer fruit and vegeta- dicating many children are at risk for
vegetables is vital to the health of bles and are at greater risk of being becoming overweight as adults [Na-
children (Bazzano et al., 2002; Cullen overweight and obese (Morton and tional Center for Health Statistics
Guthrie, 1999; Treiman et al., 1996; (NCHS), 2011]. Overweight individ-
1
Graduate Assistant, Department of Horticultural Wang, 2001). Often, fruit and vege- uals and the incidence of obesity has
Sciences, Texas A&M University, College Station, tables are not available in the homes increased so rapidly both worldwide
TX 77843
2
of low-income families because of and within the United States that phy-
Haupt Fellow, Smithsonian Gardens, Smithsonian
Institution, Washington, DC 20013 areas of food deserts (areas without a sicians are now calling it an epidemic
3
Professor, Department of Horticultural Sciences,
proper grocery store) combined with and believe that it will soon pass
Texas A&M University, College Station, TX 77843 the expense and perishable nature of smoking as the leading cause of pre-
4
Professor, Department of Agriculture, Texas State fresh foods (Goodman, 2009; Treiman ventable death within the United
University-San Marcos, San Marcos, TX 78666 et al., 1996; Wang, 2001). Low-income States (Blumenthal et al., 2002; Hesketh
5
Corresponding author. E-mail: [email protected]. families also report eating at fast food and Campbell, 2010; Weisberg, 2002).
• June 2012 22(3) 299
RESEARCH REPORTS

Diseases that result from being over- and a posttest was administered in (Domel et al., 1993a) and reported
weight or obese are believed to be March of the following year. Schools internal consistency reliabilities of a =
responsible for 300,000 deaths per were recruited to participate through 0.70 for the vegetable portion of the
year in the United States and have the Junior Master Gardener (JMG) questionnaire, a = 0.73 for the fruit
been estimated to cost in excess of program (Seagraves et al., 2005). The portion of the questionnaire and a =
$200 billion annually for medical ex- teachers who volunteered their classes 0.74 for the snack portion of the ques-
penses and lost productivity (CDC, to participate in this study attended tionnaire (Domel et al., 1993b). In
1996b; NCHS, 2011; Weisberg, a 6-d workshop presented by extension a study of second through fifth-grade
2002). agents during the summer months. students, this scale was again reported
Food preferences and dietary hab- At the workshop, teachers observed to be reliable and valid with an internal
its are established during childhood demonstrations, participated in mini consistency reliabilities of a = 0.85 for
(Carter, 2002; Kirby et al., 1995). workshops, attended seminars, and the fruit portion of the questionnaire,
Therefore, interventions need to be went on a field trip to an orchard. In a = 0.81 for the vegetable portion of
targeted toward young children while addition, teachers were given the cur- the questionnaire, and a = 0.79 for the
they are forming their lifelong habits. riculum to take back to their school to snack portion of the questionnaire
Preference for and positive attitudes teach in their classrooms. (Lineberger and Zajicek, 2000). A
about fruit and vegetables have been A total of 141 second-grade county extension agent administered
major predictors of fruit and vegeta- through fifth-grade students partici- the pre- and posttests.
ble consumption (Cullen et al., 2002; pated in this study. Complete data The FVP questionnaire was com-
Domel et al., 1993b; Reniscow et al., sets were collected from nine differ- prised of two distinct parts. The first
1997). Since many chronic diseases ent classrooms in four different public consisted of a list of 10 fruit and
begin in childhood and carry over schools in the Rio Grande Valley. The vegetables. The students were asked
into adulthood and dietary prefer- grade level of students in the study to circle an answer for how they felt
ences are learned while children are varied per school depending on the about a specific fruit or vegetable.
young, strategies should be aimed at teachers who volunteered to partici- Instead of numbers for choice ratings,
younger children to improve their pate. Most teachers reported that students rated their preference with
preferences and attitudes toward fruit they taught all the concepts and com- a face symbol. ‘‘I like this a lot’’ was a
and vegetables (Baranowski et al., pleted most of the activities in the smiley face; ‘‘I like this a little’’ was
1997). Strategies aimed at younger JMG program curriculum. A county a neutral face, and ‘‘I do not like this’’
children tend to have better long-term extension agent ensured teachers’ was a frowning face. The second part
results than strategies focused on ad- questions were addressed and that consisted of 10 snack preference op-
olescents (Carter, 2002). gardens were being used consistently tions. The students were asked to
There are many ways teachers over the study period. choose which they preferred most be-
can teach nutrition. School-based nu- According to the 2000 U.S. Cen- tween fruit or vegetable snack and
trition education increases nutritional sus Bureau (USCB), there were 12,439 non-fruit or vegetable snack.
knowledge and can influence positive children aged 5 to 9 years in this re- To analyze data, each answer re-
attitude change toward healthy eating gion (USCB, 2000). The median house- ceived a score. The response ‘‘I like
in most grade levels (Contento et al., hold income was $23,799 and 33% of this a lot’’ was given a score of 2
1992). School gardens are a way to the households earned $14,999 or less points. The response ‘‘I like this a lit-
teach students using hands-on activ- in 1999. Of families with related chil- tle’’ was given a score of 1 point. The
ities that are fun and teach skills at the dren under 18 years of age, 42.2% had response ‘‘I do not like this’’ was given
same time. Gardening provides hands- household incomes below the poverty 0 points. The points were summed so
on activities through the actual grow- line. Of those sampled by the USCB, each participant received a preference
ing, harvesting, and preparation of 88.4% were Hispanic or Latino (USCB, score that ranged from 0 to 20 points.
vegetables. Gardening and related 2000). In this study, of those sampled, For the snack questionnaire, a student
activities improve attitudes about, pre- 84.4% (119 of 141) reported to be was given 1 point for choosing the
ferences for, and willingness to taste Hispanic. fruit or vegetable snack and 0 points
new fruit and vegetables (Lineberger INSTRUMENT AND DATA COLLEC- for choosing the non-fruit or vege-
and Zajicek, 2000; Morris et al., 2001). TION. The instrument used for this table snack item. The points were
The objective of the current study study consisted of three sections. The summed so each participant received
was to evaluate the impact of a health first section was a modified version of a snack score that ranged from 0 to
education through gardening pro- the FVP questionnaire, which mea- 10 points. The higher the score the
gram on children’s knowledge about sured fourth and fifth graders’ prefer- better the FVP/attitude and snack
nutrition and the attitudes they have ence for fruit and vegetables (Domel preference/attitude.
toward fruit and vegetables. et al., 1993b). The questionnaire was The second section of the in-
created and used to identify FVPs of strument used in this study contained
Materials and methods fourth- and fifth-grade students par- 13 multiple-choice questions testing
SAMPLE. The sample for this re- ticipating in a health program target- the knowledge that each student
search study included participants ing fruit and vegetable consumption should have gained from the curricu-
from elementary schools in the Rio (Domel et al., 1993b). This instrument lum and gardening project. It asked
Grande Valley of Texas, a primarily His- was considered to be a ‘‘reliable, valid, questions regarding food groups, vi-
panic region. A pretest was conducted in and easy-to-administer tool for assess- tamin sources, serving amounts, and
August at the start of the school year, ing fruit and vegetable preferences’’ other nutrition-related questions. To
300 • June 2012 22(3)
analyze these questions, each correct with their scores at the start of the Howison et al., 1988; Lawatsch, 1990;
answer received 1 point. An incorrect program. Previous research has also Morris et al., 2002).
answer received 0 points. The scores shown an increase in knowledge after There was no interaction by gen-
were summed so each participant re- an intervention (Domel et al., 1993a; der which indicated that both males
ceived a score ranging from 0 to 13
points. The higher the score, the more
knowledge each student should have Table 1. Demographic breakdown of sample in the study of the effects
of nutrition education and gardening on attitudes, preferences, and knowledge
about fruit, vegetables, and nutrition.
of second-to-fifth graders in the Rio Grande Valley of Texas toward fruit and
Each questionnaire included a vegetables.
third section to collect demographic
information including the student’s Survey section Pretest Posttest
gender, ethnicity, and grade level. demographic N mean score Pretest SD mean score Posttest SD
These questions were modeled after Nutrition knowledge (0–13 scale)z
previously published, similar studies Gender
(Koch et al., 2006). After the tests were Male 64 7.05 2.04 8.81 2.77
returned, each test was coded with a Female 77 6.71 1.85 8.19 2.49
number for each participant so the pre- Ethnicity
test and posttest could be matched. Hispanic 119 6.81 1.95 8.34 2.69
DATA ANALYSIS. Only students Black 5 7.00 2.12 8.60 0.89
who completed all the testing were White 13 7.38 1.90 9.85 2.27
included in the data analysis. Data Other 4 6.75 2.06 8.00 2.45
were entered into an electronic spread- Grade level
sheet and analyzed using SPSS (ver- Second 31 6.65 1.64 8.90 ay 3.30
sion 12.0; IBM Corp., Armonk, NY). Third 52 7.02 2.02 8.92 a 2.76
Paired t tests were conducted to com- Fourth 22 6.09 2.00 8.09 a 2.11
pare the pretest to posttest scores for Fifth 36 7.31 1.94 7.69 b 1.80
each section of the instrument. Addi-
tional comparisons using two-factor Fruit and vegetable preference (0–20 scale)x
analysis of variance (ANOVA) with Gender
repeated measures were performed Male 64 11.31 3.87 12.38 4.61
to determine exactly where the dif- Female 77 12.49 3.33 12.92 3.66
ferences occurred. Ethnicity
Hispanic 119 11.97 3.62 12.73 4.24
Results and discussion African-American 5 13.00 4.64 11.40 3.78
RELIABILITY OF INSTRUMENT. A Caucasian 13 12.23 3.06 13.54 3.10
Cronbach’s reliability test for the Other 4 9.50 4.45 9.75 2.50
knowledge portion of the instrument Grade level
in this study resulted in a reliability Second 31 13.48 3.24 14.90 cdw 3.93
coefficient of a = 0.67, a reliability Third 52 12.52 3.58 12.98 cd 3.80
coefficient of a = 0.72 for the FVP Fourth 22 10.73 3.47 11.50 d 3.56
section, and a reliability coefficient of Fifth 36 10.58 3.48 11.03 e 4.19
a = 0.83 for the fruit and vegetable
snack choice section, showing this Snack choice (0–10 scale)v
instrument to be a reliable measure Gender
(Gall et al., 2006). Male 64 3.89 2.42 5.96 3.21
DEMOGRAPHICS. This sample in- Female 77 4.78 2.57 6.78 2.91
cluded an almost equal split of male Ethnicity
(64) and female participants (77). The Hispanic 119 4.51 2.6 6.35 3.09
majority of the sample was Hispanic Black 5 3.40 3.36 6.40 3.78
(as targeted) (119), with a handful White 13 4.23 1.09 7.54 2.63
of African-American (5), Caucasian Other 4 2.00 0.82 4.25 1.71
(13), and members of other ethnic Grade level
groups (4). The sample was composed Second 31 4.55 2.98 7.03 fgu 2.99
of second (31), third (52), fourth (22) Third 52 4.63 2.41 7.13 g 2.74
and fifth (36) graders (as targeted) Fourth 22 3.18 1.87 6.18 f 3.17
(Table 1). Fifth 36 4.58 2.55 4.94 f 3.08
NUTRITIONAL KNOWLEDGE SEC- z
Scores ranged from 0 to 13 with higher scores indicating more nutritional knowledge.
TION . A repeated measures ANOVA
y
Difference in nutritional knowledge posttest score means followed by the same letters within the column are not
different according to least significant difference (LSD) test at the P = 0.05 level.
revealed a main effect difference in the x
Scores ranged from 0 to 20 with higher scores indicating more preference for fruit and vegetables.
pretest to the posttest scores (Table 2). w
Difference in fruit and vegetable preference pre- to posttest means followed by the same letters within the column
This indicated students scored higher are not different according to LSD test at the P = 0.05 level.
v
Scores ranged from 0 to 10 with higher scores indicating a healthier snack selected more frequently.
on the nutritional knowledge test after u
Difference in snack choice pre- to posttest means followed by the same letters within the column are not different
completing the program compared according to LSD test at the P = 0.05 level.

• June 2012 22(3) 301

Table 2. Repeated measures analysis of variance for the nutritional knowledge Limitations of the study
scores in the study of the effects of nutrition education and gardening on
attitudes, preferences, and knowledge of second-to-fifth graders in the Rio
An in-depth training session for
Grande Valley of Texas toward fruit and vegetables. this curriculum was provided and re-
quired for all teachers that volunteered
Mean score their classes for research. However,
Source of variationz (0–13 scale)y SD df F P there was no follow-up to ensure they
Pretest 6.87 1.94 1 42.74 0.001* implemented the curriculum correctly.
Posttest 8.48 2.62 Therefore, future researchers need
Pretest to posttest change · gender 1 0.340 0.563 to develop a process to evaluate the
Pretest to posttest change · grade levelx 3 3.09 0.029* implementation of the curriculum to
z
N = 141 for both pre- and posttests. ensure it is standardized.
y
x
Scores ranged from 0 to 13 with higher scores indicating more nutritional knowledge. This research concentrated on
Grade levels in this study included second, third, fourth, and fifth.
*Significant at the P = 0.05 level.
assessing the participants’ nutritional
knowledge, and attitudes and prefer-
ences for fruit and vegetables. It did
not measure nutritional behavior. Rep-
and females increased their knowl- posttest by grade level, which in- etition of this study using different
edge scores from pretest to posttest, dicated all grade levels benefitted evaluation tools that include behavior
and there was no difference between similarly with regards to their indica- should be conducted. Examples of
the rate of change in scores of male tion of their FVPs. possible ways to measure changes in
and female students on the knowl- However, there were main ef- behavior might include having the stu-
edge section of the survey. Male and fects between the grade levels only dent actually choose a snack (rather
female scores improved similarly from on the posttest preference scores. A than having them hypothetically select
pretest to posttest. least significant difference (LSD) post one on paper), telling the student they
However, a grade level interac- hoc test was administered to investi- have $1 and ask them what they would
tion did exist where fifth graders had gate which grade levels were different buy with that $1, or a 24-h recall diary
the highest pretest score but the low- at the end of the testing period repeated several times throughout the
est posttest score. The change from (Table 1). Differences in the posttest study.
pretest to posttest knowledge scores scores were found between grades In addition, repetition of this study
for fifth-grade students was less than second and fourth (P = 0.001), sec- should be conducted using students of
the change for all other grade levels ond and fifth (P = 0.001), and third different ages and populations. This may
(Table 1). Since the curriculum com- and fifth (P = 0.007). Second-graders include younger children—kindergarten
bined with gardening had a greater scored higher compared with fourth- and first-grade students, or older
effect on the younger students, the and fifth-graders, and third-graders children with a revised curriculum—
activities may be better geared toward scored higher compared with fifth- reevaluating fourth and fifth graders,
younger students. These findings sup- graders on the posttest. and including junior-high and/or high-
port the research conducted by Carter SNACK CHOICE. A repeated mea- school aged students. Future research
(2002) and Baranowski et al. (1997) sures ANOVA revealed an increase from could also look at different socioeco-
who found nutrition programming pretest to posttest snack choice scores nomic status populations to determine
was best geared toward younger chil- (Table 4). The results indicated a posi- how a gardening curriculum would
dren and not adolescents. tive change in preferences for fruit and affect their nutritional knowledge, at-
FRUIT AND VEGETABLE PREFER- vegetables after participating in the titudes, and behavior.
ENCE SECTION . An ANOVA revealed gardening and nutrition curriculum.
an increase from pretest to posttest There was no interaction by
scores on the FVP scores (Table 3). gender indicating males and females Conclusion
The results indicated a positive change benefitted similarly from the program Elementary students who were
in preference for fruit and vegetables with regards to their snack choices. taught a nutrition curriculum while
after participating in the gardening and However, a grade level interaction was actively participating in gardening sig-
nutrition curriculum (Genzer et al., found with regards to snack choices. nificantly improved their nutritional
2001). An improved attitude toward An LSD post hoc test indicated differ- knowledge, preference for fruit and
fruit and vegetables after an interven- ences between the posttest snack choice vegetables and chose a fruit or vegeta-
tion has been found by previous re- scores for third- and fourth-grades ble snack over a non-healthy snack more
search (Byrd-Bredbenner et al., 1993; (P = 0.033) and third- and fifth- frequently after the program. The sig-
Koch et al., 2006; Lawatsch, 1990; grades (P = 0.020) (Table 1). Third- nificant improvement in nutritional
Lineberger and Zajicek, 2000). graders scored higher on the posttest knowledge scores, FVP scores, and
There was no interaction by gen- snack scores compared with fourth- and snack choice scores indicated the hands-
der on the FVP scores of male and fe- fifth-graders, while third- and second- on nutrition curriculum combined with
male students on the preference section graders scored similarly to each other. active participation in gardening can be
of the survey. Male and female scores These findings reinforce supporting nu- used to influence elementary children’s
improved similarly from pretest to trition programming for younger children attitudes and preferences regarding
posttest and benefitted similarly from as suggested by the research conducted fruit and vegetables and improve their
the program. There was also no inter- by Carter (2002) and Baranowski et al. knowledge about nutrition. However,
action on the change from pretest to (1997). it did not have the same effect on all
302 • June 2012 22(3)
Table 3. Repeated measures analysis of variance for the fruit and vegetable Correlates of availability and accessibility
preference scores in the study of the effects of nutrition education and gardening of fruits and vegetables in homes of low-
on attitudes, preferences, and knowledge of second-to-fifth graders in the Rio income Hispanic families. Health Educ.
Grande Valley of Texas toward fruit and vegetables. Res. 25:97–108.
Mean score Djousse, L., D. Arnett, H. Coon, M.
Source of variationz (0–20 scale)y SD df F P Province, L. Moore, and C. Ellison.
Pretest 11.96 3.62 1 6.72 0.011* 2004. Fruit and vegetable consumption
and LDL cholesterol: The National
Posttest 12.67 4.11
Heart, Lung, and Blood Institute Fam-
Pretest to posttest change · gender 1 1.22 0.272 ily Heart Study. Amer. J. Clin. Nutr. 79:
Pretest to posttest change · grade levelx 3 0.612 0.608 213–217.
z
N = 141 for both pre- and posttests.
y
Scores ranged from 0 to 20 with higher scores indicating more preference for fruit and vegetables. Domel, S.B., T. Baranowski, H. Davis, S.
x
Grade levels in this study included second, third, fourth, and fifth. Leonard, P. Riley, and J. Baranowski.
*Significant at the P = 0.05 level.
1993a. Measuring fruit and vegetable
preferences among fourth- and fifth-grade
Table 4. Repeated measures analysis of variance for the snack choice scores in the students. Prev. Med. 22:866–879.
study of the effects of nutrition education and gardening on attitudes,
Domel, S.B., T. Baranowski, H. Davis,
preferences, and knowledge of second-to-fifth graders in the Rio Grande Valley
W. Thompson, S. Leonard, P. Riley, J.
of Texas toward fruit and vegetables.
Baranowski, B. Dudovitz, and M. Smyth.
Mean score 1993b. Development and evaluation of a
Source of variationz (0–10 scale)y SD df F P school intervention to increase fruit and
vegetable consumption among fourth
Pretest 4.38 2.54 1 49.20 0.001*
and fifth grade students. J. Nutr. Educ. 25:
Posttest 6.40 3.06 345–349.
Pretest to posttest change · gender 1 0.012 0.914
Pretest to posttest change · grade levelx 3 4.25 0.007* Gall, M.D., W.R. Borg, and J.P. Gall.
z
N = 141 for both pre- and posttests.
2006. Educational research: An introduc-
y
Scores ranged from 0 to 10 with higher scores indicating a healthier snack selected more frequently. tion. 8th ed. Allyn and Bacon, White Plains,
x
Grade levels in this study included second, third, fourth, and fifth. NY.
*Significant at the P = 0.05 level.
Genzer, S., R. Seagraves, L. Whittlesey,
C.W. Robinson, and S. Koch. 2001.
ages. The younger students, in second Byrd-Bredbenner, C., M.L. Marecic, and Junior Master Gardener Level 1 Golden
and third grades, had more positive J. Bernstein. 1993. Development of a nu- Ray: Health and nutrition from the gar-
outcomes compared with the fourth- trition education curriculum for head start den. Newman Publishing, Bryan, TX.
and, especially, fifth-grade participants. children. J. Nutr. Educ. 25:134–139.
Goodman, D. 2009. Place and Space in
This may be an indication the curricu- Carter, R.C. 2002. The impact of public Alternative Food Networks: Connecting
lum was not targeting the older chil- schools on childhood obesity. J. Amer. Production and Consumption. 12 Mar.
dren and may need to be adapted for Medical Assn. 288:2180. 2012. <http://www.kcl.ac.uk/content/
older age groups. Centers for Disease Control. 1996a. Sum- 1/c6/03/95/42/GoodmanWP21.pdf>.
mary of CDC’s guidelines for school Hesketh, K.D. and K.J. Campbell. 2010.
health programs to promote lifelong
Literature cited healthy eating. J. Nutr. Educ. 29:45–46.
Interventions to prevent obesity in 0-5
year olds: An updated systematic review of
American Heart Association. 2011. Over-
Centers for Disease Control. 1996b. the literature. Obesity (Silver Spring)
weight in Children. 12 Mar. 2012. <http:
Guidelines for school health programs to 18:S27–S35.
//www.heart.org/HEARTORG/Get
tingHealthy/Overweight-in-Children_ promote lifelong healthy eating. Centers Howison, D., F. Niedermyer, and R.
UCM_304054_Article.jsp>. Disease Control Prevention 45:1–41. Shortridge. 1988. Field testing a fifth-
Contento, I.R., A. Manning, and B. grade nutrition education program
Baranowski, T., M. Smith, M. Hearn, L.
Shannon. 1992. Research perspective on designed to change food-selection behav-
Lin, J. Baranowski, C. Doyle, K. Reniscow,
school based nutrition education. J. Nutr. ior. J. Nutr. Educ. 20:82–86.
and D. Wang. 1997. Patterns in children’s
fruit and vegetable consumption by meal Educ. 24:247–260. Jolliffe, D. 2004. Extent of overweight
and day of the week. J. Amer. Coll. Nutr. Cullen, K.W., T. Baranowski, E. Owens, among US children and adolescents from
16:216–223. C. de Moor, L. Rittenberry, N. Olvera, 1971 to 2000. Intl. J. Obes. 28:4–9.
Bazzano, L., J. He, L. Ogden, C. Loria, S. and K. Resnicow. 2002. Ethnic differ-
Kaiser, L.L., H. Melgar-Quinonez, M.S.
Vupputuri, L. Myers, and P. Whelton. ences in social correlates of diet. Health
Townsend, Y. Nicholson, M.L. Fujii, A.C.
Educ. Res. 17:7–18.
2002. Fruit and vegetable intake and risk Martin, and C.L. Lamp. 2003. Food in-
of cardiovascular disease in US adults: The Cullen, K.W., T. Baranowski, L. Rittenberry, security and food supplies in Latino
first national health and nutrition exami- C. Cosart, D. Herbert, and C. de Moor. households with young children. J. Nutr.
nation survey epidemiologic follow-up 2001. Child-reported family and peer in- Educ. Behav. 35:148–153.
study. Amer. J. Clin. Nutr. 76:93–99. fluences on fruit, juice and vegetable con-
Kirby, S.D., T. Baranowski, K.D. Reynolds,
sumption: Reliability and validity measures.
Blumenthal, S.J., J. Hendi, and L. Marsillo. G. Taylor, and D. Brinkley. 1995. Children’s
Health Educ. Res. 16:187–200.
2002. A public health approach to decreas- fruit and vegetable intake: Socioeconomic,
ing obesity. J. Amer. Medical Assn. 228: Dave, J.M., A.E. Evans, K.A. Pfeiffer, adult-child, regional, and urban-rural influ-
2176–2181. K.W. Watkins, and R.P. Saunders. 2010. ences. J. Nutr. Educ. 27:261–271.
• June 2012 22(3) 303
RESEARCH REPORTS

Koch, S., T.M. Waliczek, and J.M. Zajicek. Matheson, D.M., J. Varady, A. Varady, Lewis, and S. Grahmann. 2005. Junior
2006. The effect of a summer gardening and J.D. Killen. 2002. Household food Master Gardener: Level 1 teacher/leader
program on the nutritional knowledge, insecurity and nutritional status of His- guide. Texas A&M Agr. Commun., Col-
attitudes, and behaviors of children. Hort- panic children in the fifth grade. Amer. J. lege Station, TX.
Technology 16:620–625. Clin. Nutr. 76:210–217.
St.-Onge, M., K.L. Keller, and S.B.
Krebs-Smith, S.M., D.A. Cook, A.F. Morris, J.L., A. Neustadter, and S. Heymsfield. 2003. Changes in childhood
Subar, L. Cleveland, J. Friday, and L.L. Zidenberg-Cherr. 2001. First-grade gar- food consumption patterns: A cause for
Kahle. 1996. Fruit and vegetable intakes deners more likely to taste vegetables. Calif. concern in light of increasing body weights.
of children and adolescents in the United Agr. 55:43–46. Amer. J. Clin. Nutr. 78:1068–1073.
States. Arch. Pediatr. Adolesc. Med.
150:81–86. Morris, J.L., A. Neustadter, and S. Subar, A., J. Heimendinger, B. Patterson, S.
Zidenberg-Cherr. 2002. Garden-enhanced Krebs-Smith, E. Pivonka, and R. Kessler.
Law, C. 2001. Adult obesity and growth nutrition curriculum improves fourth-grade 1995. Fruit and vegetable intake in the
in childhood: Children who grow rapidly school children’s knowledge of nutri- United States: The baseline survey of the
during childhood are more likely to be tion and preferences for some vegetables. five a day for better health program. Amer.
obese as adults. BMJ 323:1320–1321. J. Amer. Dietetic Assn. 102:91–93. J. Health Promot. 9:352–360.
Lawatsch, D.E. 1990. A comparison of two Morton, J.F. and J.F. Guthrie. 1999. Diet Treiman, K., V. Freimuth, D. Damron, A.
teaching strategies on nutrition knowledge, related knowledge, attitudes, and practices Lasswell, J. Anliker, S. Havas, P. Langenberg,
attitudes and food behavior of preschool of low income households with children. and R. Feldman. 1996. Attitudes and behav-
children. J. Nutr. Educ. 22:117–123. J. Early Educ. Family Rev. 6:26–33. iors related to fruits and vegetables among
low-income women in the WIC program.
Lin, B. and R.M. Morrison. 2002. Higher National Center for Health Statistics. J. Nutr. Educ. 28:149–156.
fruit consumption linked with lower body 2011. Healthy People 2010: Final Review.
mass index. FoodReview 25:28–32. 9 Feb. 2012. <http://www.cdc.gov/ U.S. Census Bureau. 2000. U.S. Census
nchs/data/hpdata2010/hp2010_final_ Bureau. 12 Mar. 2012. <http://www.
Lineberger, S. and J.M. Zajicek. 2000. review.pdf>. census.gov/>.
School gardens: Can a hands-on teaching
tool affect students’ attitudes and behav- Ness, A. and J. Powles. 1997. Fruit and Wang, Y. 2001. Cross national compari-
iors regarding fruit and vegetables? Hort- vegetables, and cardiovascular disease: A son of childhood obesity: The epidemic
Technology 10:23–27. review. Intl. J. Epidemiol. 26:1–13. and the relationship between obesity and
socioeconomic status. Intl. J. Epidemiol.
Liu, S., J. Manson, I. Lee, S. Cole, C. Reniscow, K., T. Baranowski, and M. 30:1129–1136.
Hennekens, W. Willett, and J. Buring. Hearn. 1997. Social cognitive predictors
2000. Fruit and vegetable intake and risk of fruit and vegetable intake in children. Weisberg, S.P. 2002. Societal change to
of cardiovascular disease: The Woman’s Health Psychol. 16:272–276. prevent obesity. J. Amer. Medical Assn.
Health Study. Amer. J. Clin. Nutr. 288:2176–2181.
72:922–928. Seagraves, R.L., L. Whittlesey, C. Klemmer,
C.W. Robinson, G. Hall, S.S. Genzer, C.

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