title: Evaluation of the impact of a school gardening intervention on children's fruit and vegetable intake: a randomised controlled trial.
abstract: BACKGROUND
  Current academic literature suggests that school gardening programmes can provide an interactive environment with the potential to change children's fruit and vegetable intake. This is the first cluster randomised controlled trial (RCT) designed to evaluate whether a school gardening programme can have an effect on children's fruit and vegetable intake.
  
  
  METHODS
  The trial included children from 23 schools; these schools were randomised into two groups, one to receive the Royal Horticultural Society (RHS)-led intervention and the other to receive the less involved Teacher-led intervention. A 24-hour food diary (CADET) was used to collect baseline and follow-up dietary intake 18 months apart. Questionnaires were also administered to evaluate the intervention implementation.
  
  
  RESULTS
  A total of 641 children completed the trial with a mean age of 8.1 years (95% CI: 8.0, 8.4). The unadjusted results from multilevel regression analysis revealed that for combined daily fruit and vegetable intake the Teacher-led group had a higher daily mean change of 8 g (95% CI: -19, 36) compared to the RHS-led group -32 g (95% CI: -60, -3). However, after adjusting for possible confounders this difference was not significant (intervention effect: -40 g, 95% CI: -88, 1; p = 0.06). The adjusted analysis of process measures identified that if schools improved their gardening score by 3 levels (a measure of school gardening involvement - the scale has 6 levels from 0 'no garden' to 5 'community involvement'), irrespective of group allocation, children had, on average, a daily increase of 81 g of fruit and vegetable intake (95% CI: 0, 163; p = 0.05) compared to schools that had no change in gardening score.
  
  
  CONCLUSIONS
  This study is the first cluster randomised controlled trial designed to evaluate a school gardening intervention. The results have found very little evidence to support the claims that school gardening alone can improve children's daily fruit and vegetable intake. However, when a gardening intervention is implemented at a high level within the school it may improve children's daily fruit and vegetable intake by a portion. Improving children's fruit and vegetable intake remains a challenging task.
  
  
  BACKGROUND
  ISRCTN11396528.
authors.affiliation: Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK. m.s.christian@leedsmet.ac.uk.
authors.forename: Meaghan S
authors.initials: MS
authors.lastname: Christian
authors.forename: Charlotte El
authors.initials: CE
authors.lastname: Evans
authors.forename: Camilla
authors.initials: C
authors.lastname: Nykjaer
authors.forename: Neil
authors.initials: N
authors.lastname: Hancock
authors.forename: Janet E
authors.initials: JE
authors.lastname: Cade
mesh_terms: D002648:Child; D016000:Cluster Analysis; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D005638:Fruit; D051639:Gardening / Q000379:methods*; D006293:Health Promotion; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D009753:Nutritive Value; D015397:Program Evaluation; D012574:Schools; D011795:Surveys and Questionnaires; D014675:Vegetables