Document Type : Research Article (s)

Authors

1 University of Miami Miller School of Medicine, MD/MPH Program, Miami, Florida 33136

2 Joseph P. Cory Foundation, West Palm Beach, Florida

Abstract

Background: School gardens are exemplary learning environments for providing hands-on nutrition and health education, promoting time outdoors, and developing collaborative skills. However, randomized controlled trials of school gardening programming to provide evidence of the robust benefits to child health can be time consuming and costly. We therefore sought to develop an inter-professional framework for continuous quality improvement (QI) of school gardening programming to improve health outcomes while limiting program implementation and evaluation costs.
Methods: This QI cohort study took place in two elementary schools and served 75 students in Palm Beach County, Florida during the 2019-2020 academic year. Students participating in a non-profit sponsored after-school gardening club completed investigator-designed pre- and post-assessments from which unique lessons pertaining to health and food literacy were developed to target knowledge deficits. We present a lesson pertaining to harvesting, preparing, and sampling foods as an exemplar for this framework. Paired and independent samples t-tests and chi-squared tests were used to compare student learning outcomes.
Results: Twenty-seven students (36%) participated in the harvest lesson, which led to marginal improvement in overall food literacy compared to non-participants (X2=3.6, P=0.057).Considering cumulative garden club activities, club participation improved students’ likelihood to individually prepare fresh fruits and vegetables (P=0.002).
Conclusion: This project provides an important framework for inter-professional collaboration to engage in QI of small-scale school gardening programs. Future work should focus on the creation and implementation of further lessons to develop a full, individualized, health-oriented curriculum that optimizes learning outcomes, and thereby health, for elementary-aged children.

Keywords

1. Delele M, Janakiraman B, Bekele Abebe A, Tafese A, van de Water ATM. Musculoskeletal pain and associated factors among Ethiopian elementary school children. BMC Musculoskelet Disord. 2018;19(1):276. doi: 10.1186/s12891-018-2192-6. PubMed PMID: 30064400; PubMed Central PMCID: PMC6069959. ## 2. Dabaghi-Tabriz F, Bahramian A, Rahbar M, Esmailzadeh M, Alami H. Ergonomic Evaluation of Senior Undergraduate Students and Effect of Instruction Regarding Ergonomic Principles on It. Maedica. 2020;15(1):81-6. doi: 10.26574/maedica.2020.15.1.81. PubMed PMID: 32419865; PubMed Central PMCID: PMC7221274. ## 3. Bettany-Saltikov J, McSherry R, van Schaik P, Kandasamy G, Hogg J, Whittaker V, et al. School-based education programmes for improving knowledge of back health, ergonomics and postural behaviour of school children aged 4–18: A systematic review. Campbell Systematic Reviews. 2019;15(1-2):e1014. doi: 10.1002/cl2.1014. ## 4. Eckhoff C, Straume B, Kvernmo S. Multisite musculoskeletal pain in adolescence as a predictor of medical and social welfare benefits in young adulthood: The Norwegian Arctic Adolescent Health Cohort Study. Eur J Pain. 2017;21(10):1697-1706. doi: 10.1002/ejp.1078. PubMed PMID: 28685909. ## 5. Lee JCN, Li SSW, Chow DHK. School backpack design: A systematic review and a summary of design items. International Journal of Industrial Ergonomics. 2021;84:103166. doi: 10.1016/j.ergon.2021.103166. ## 6. Lederman E. Neuromuscular Rehabilitation in Manual and Physical Therapies: Principles to Practice. Churchill Livingstone/Elsevier; 2010. ## 7. Birrell SA, Haslam RA. The effect of load distribution within military load carriage systems on the kinetics of human gait. Appl Ergon. 2010;41(4):585-90. doi: 10.1016/j.apergo.2009.12.004. PubMed PMID: 20060096. ## 8. Orantes-Gonzalez E, Heredia-Jimenez J, Beneck GJ. Children require less gait kinematic adaptations to pull a trolley than to carry a backpack. Gait Posture. 2017;52:189-193. doi: 10.1016/j.gaitpost.2016.11.041. PubMed PMID: 27915223. ## 9. Orantes-Gonzalez E, Heredia-Jimenez J, Robinson MA. A kinematic comparison of gait with a backpack versus a trolley for load carriage in children. Appl Ergon. 2019;80:28-34. doi: 10.1016/j.apergo.2019.05.003. PubMed PMID: 31280807. ## 10. Orr RM, Johnston V, Coyle J, Pope R. Reported load carriage injuries of the Australian army soldier. J Occup Rehabil. 2015;25(2):316-22. doi: 10.1007/s10926-014-9540-7. PubMed PMID: 25178432. 11. Li SSW, Chow DHK. Effects of backpack load on critical changes of trunk muscle activation and lumbar spine loading during walking. Ergonomics. 2018;61(4):553-565. doi: 10.1080/00140139.2017.1365950. PubMed PMID: 28791922. ## 12. Ozgul B, Akalan NE, Kuchimov Sh, Uygur F, Temelli Y, Polat MG. Effects of unilateral backpack carriage on biomechanics of gait in adolescents: a kinematic analysis. Acta Orthop Traumatol Turc. 2012;46(4):269-74. doi: 10.3944/aott.2012.2678. PubMed PMID: 22951758. ## 13. Chen Y-L, Nguyen H-T, Chen Y. Influence of school bag loads and carrying methods on body strain among young male students. International Journal of Industrial Ergonomics. 2021;82:103095. doi: 10.1016/j.ergon.2021.103095. ## 14. Lucas-Cuevas A, Perez-Soriano P, Bush M, Crossman A, Belloch S, Cortell-Tormo J, et al. Effects of Different Backpack Loads in Acceleration Transmission during Recreational Distance Walking. J Hum Kinet. 2013;37:81-9. doi: 10.2478/hukin-2013-0028. PubMed PMID: 24146708; PubMed Central PMCID: PMC3796846. ## 15. Vera-Garcia FJ, Moreside JM, McGill SM. MVC techniques to normalize trunk muscle EMG in healthy women. J Electromyogr Kinesiol. 2010;20(1):10-6. doi: 10.1016/j.jelekin.2009.03.010. PubMed PMID: 19394867. ## 16. Jafari Roodbandi AS, Hajizadeh L, Daneshvar S, Asghari M, Feyzi V, Jalali M. Weight of School Bags and its Relationship with Musculoskeletal Disorders in Elementary School Students of Kerman, Iran in 2014. Int J School Health. 2018;5(3):1-6. doi: 10.5812/intjsh.14890. ## 17. Delele M, Janakiraman B, Bekele Abebe A, Tafese A, van de Water ATM. Musculoskeletal pain and associated factors among Ethiopian elementary school children. BMC Musculoskelet Disord. 2018;19(1):276. doi: 10.1186/s12891-018-2192-6. PubMed PMID: 30064400; PubMed Central PMCID: PMC6069959. ## 18. Rezapur-Shahkolai F, Gheysvandi E, Karimi-Shahanjarini A, Tapak L, Heidarimoghadam R, Dianat I. Identification of factors related to behaviors associated with musculoskeletal pain among elementary students. BMC Musculoskelet Disord. 2021;22(1):527. doi: 10.1186/s12891-021-04413-3. PubMed PMID: 34103028; PubMed Central PMCID: PMC8188695. ## 19. Jadidian AA, Shirzad E. The Effect of the Height of Placement of Two Types of Backpacks on Gait Kinetic and Kinematic Parameters in Schoolchildren Aged between 8 and 11. Journal of Exercise Science and Medicine. 2018;10(1):91-110. doi: 10.22059/jsmed.2019.264749.915. Persian. ## 20. Namazizadeh M, Ebrahim K, Sarreshteh M, Salehi H. The kinematics effects of carrying the school backpack on the parameters of gait cycle and posture of youngsters aged. Movement. 2003;16(16):5-23. Persian. ## 21. Rezaie J, Babakhani F, Balouchi R, Saied R. The effect of backpack load on the rural students posture and gait pattern in two modes of carrying. Journal of Applied Exercise Physiology. 2015;12(23):141-152. doi: 10.22080/jaep.2016.1315. Persian. ## 22. Ahmadi-Goodini F, Khaleghi-Tazji M, Letafatkar A. The Effect of Backpack Carriage in Different Weights and Gradients on Ground Reaction Force Parameters of 10-12 Year Old Schoolchildren’s Gait in Tehran, Iran. Journal of Research in Rehabilitation Sciences. 2020;16:17-23. doi: 10.22122/jrrs.v16i0.3487. ## 23. Rezaei J, Babakhani F. The effects of unilateral backpack carrying on postural changes and gait pattern in rural children during treadmill walking. mrj. 2016;9(s1):161-70. Persian. ## 24. Ghamari Hoveyda SS, Babakhani F, Hajilou B, Anbarian M. The effect of backpack carriage with different loads on kinematics variables during walking in elementary school students in Hamedan city. Journal of practical studies of Biosciences in Sport. 2017;5(10):87-97. doi: 10.22077/jpsbs.2018.758. Persian. ## 25. Ebrahimpour M, Naderi S. Evaluation of Spatio-Temporal Gait Symmetry during Unilateral and Bilateral Backpack Carrying with Different Weights Using VBT Algorithm. Scientific Journal of Rehabilitation Medicine. 2020;9(3):154-161. doi: 10.22037/jrm.2020.112868.2278. Persian. ## 26. Hoseini SH, Khuri A, Siavashi M, Amirian S, Abdolmohammadi A. Effect of Carrying Backpacks With Different Weights on Electromyography Activity of Rectus abdominis and Lumbar Erector Spine Muscles in Eementary Schools students. Olympic. 2012;20(3):73-83. Persian. ## 27. Hoseini SH, Dastmanesh H, Daneshmanidi H. The examination of EMG Changes of Student's Trunk Muscles When Carrying Traditional Schoolbags. Journal of Exercise Science and Medicine. 2019;1(2):5-25. Persian. ## 28. Ebrahimi Atri A, Khoshraftar Yazdi N, Hoseini H, Mahdavi Moghadam S. The effect of common school bags on elementary school girls’ trunk muscles electrical activity. Journal of Research and Health. 2014;4(4):863-870. Persian. ## 29. Alessa F, Ning X. Changes of lumbar posture and tissue loading during static trunk bending. Hum Mov Sci. 2018;57:59-68. doi: 10.1016/j.humov.2017.11.006. PubMed PMID: 29161614; PubMed Central PMCID: PMC5929132. ## 30. Madadi-Shad M, Jafarnezhadgero A, Zago M, Granacher U. Effects of varus knee alignment on gait biomechanics and lower limb muscle activity in boys: A cross sectional study. Gait Posture. 2019;72:69-75. doi: 10.1016/j.gaitpost.2019.05.030. PubMed PMID: 31173948. ## 31. Hardie R, Haskew R, Harris J, Hughes G. The effects of bag style on muscle activity of the trapezius, erector spinae and latissimus dorsi during walking in female university students. J Hum Kinet. 2015;45:39-47. doi: 10.1515/hukin-2015-0005. PubMed PMID: 25964808; PubMed Central PMCID: PMC4415842. ## 32. Yoon JG. Correlations between Muscle Activities and Strap Length and Types of School Bag during Walking. J Phys Ther Sci. 2014;26(12):1937-9. doi: 10.1589/jpts.26.1937. PubMed PMID: 25540502; PubMed Central PMCID: PMC4273062. ## 33. Ben Ayed H, Yaich S, Trigui M, Ben Hmida M, Ben Jemaa M, Ammar A, et al. Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci. 2019;19(1):e00440. PubMed PMID: 31133629; PubMed Central PMCID: PMC6941626. ##