School Gardening Interventions to Improve Nutritional Intake in Children

There is sufficient evidence for the impact of school gardening interventions on social outcomes, particularly related to academic performance; and sufficient evidence for their impact on children’s health outcomes.

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Study Characteristics and Contextual Tags

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Impact Assessment

The findings below synthesize the results of the studies on school gardening interventions across three domains of measurement:

  • Healthcare Cost, Utilization & Value: There is insufficient evidence that school gardening interventions positively impact healthcare utilization and costs for children. None of the studies assessed measured outcomes related to healthcare cost, utilization, or value. Further research is needed to evaluate how school gardens may influence these outcomes.
  • Health: There is sufficient evidence that school gardening interventions positively impact children’s health outcomes, particularly in reducing body mass index (BMI) z-scores (a standardized measure of a child’s BMI relative to age and sex). 
  • Social: There is sufficient evidence that school gardening interventions positively impact nutrition behaviors, social, and academic outcomes. In one study, the positive impact on physical activity was found in both the child and their parent. Systematic reviews and randomized controlled trials indicate that these interventions can lead to significant improvements in nutrition knowledge, vegetable preference, and attitudes toward healthy eating. Evidence for fruit and vegetable intake and broader obesity-related outcomes is mixed, with some studies reporting no significant changes. Nonetheless, the consistency of improvements in vegetable intake and nutrition-related behaviors across multiple studies suggests a positive health impact. Systematic reviews and supporting studies demonstrate significant improvements in science and math achievement, science identity (someone’s self-identification as a “science person”), and STEM (science, technology, engineering, and mathematics) engagement. These interventions also foster school connectedness, particularly for minority groups, and promote opportunities to learn new skills.
Background of the Need / Need Impact on Health

Food-related needs fall into three interrelated categories: food insecurity, nutrition insecurity, and dietary quality.

Food Insecurity

Food insecurity is defined as not having access to enough food due to limited financial resources[1]. In 2021, 10.2% (13.5 million) of United States (U.S.) households reported experiencing food insecurity. Of families experiencing food insecurity, 6.4% (8.4 million) were identified as having low food security and 3.8% (5.1 million) were identified as having very low food security[2]. Food insecurity varies by race, ethnicity, household makeup, and income. Rates of food insecurity are higher than the national average (10.2%) for families that identify as Black (19.8%) or Hispanic/Latino (16.2%), for households with children (12.5%), and for households with income below 185% of the Federal Poverty Level (FPL) (26.5%)[3]. The majority of Medicaid enrollees have household incomes below 185% FPL. Additionally, food insecurity may be more common for those whose employment status, neighborhood of residence, and access to transportation further reduce their food access[4],[5],[6].

Nutrition Insecurity

Nutrition insecurity is defined as the lack of “consistent and equitable access to nutritious, safe, affordable foods essential to optimal health and wellbeing[7].” While most households that experience food insecurity also experience nutrition insecurity, households that experience food security can also experience nutrition insecurity. As most screenings focus on food security rather than nutrition security, national data on the prevalence of nutrition insecurity is not yet available. The concept of nutrition insecurity has been adopted by the United States Department of Agriculture (USDA) and the Centers for Disease Control and Prevention (CDC) as a core goal for their food-related initiatives. Nutrition security, beyond just food security, is necessary to reduce the development and exacerbation of chronic illnesses resulting from poor nutrition[8].  

Dietary Quality 

While food and nutrition insecurity are primary drivers of poor diet, other factors such as food availability (food deserts), personal preference, religious and cultural dietary practices, nutrition knowledge, and other psychosocial factors may contribute to dietary options and choices[9]. Analysis found that 45% of U.S. adults have a poor diet[10]. According to analysis of a representative sample of U.S. high school students, only “8.5% of high school students nationwide met [USDA] fruit recommendations and 2.1% met vegetable recommendations[11].” Research on adult dietary consumption has shown that income is a predictor for inadequate vegetable consumption (only 7% of adults below or close to the FPL consume an adequate amount of vegetables) but even high income groups had inadequate vegetable consumption (only 11.4% of adults in the highest income categories consume an adequate amount of vegetables)[12]. Healthy People 2030 includes a number of specific nutrition objectives including increasing calcium, potassium, fruit, and vegetable (including dark green, red and orange, beans and peas) consumption in people over age two[13],[14],[15],[16],[17],[18],[19]. 

Health Impacts of Food and Nutrition Insecurity and Poor Diet

Having an unhealthy diet and poor nutrition is associated with a range of physical and behavioral health conditions that are disproportionately experienced by people of color[20]. Poor diet is associated with both obesity and type 2 diabetes, as well as other chronic health conditions such as cardiovascular disease and cancer[21],[22],. Individuals experiencing food and nutrition insecurity have a higher risk of long-term chronic health conditions including obesity, diabetes, and hypertension[23],[24],[25],[26],[27]. Individuals experiencing food insecurity are more likely to go to the emergency room (ER), less likely to have a usual source of care, and have higher healthcare costs[28],[29],[30],[31]. 

The length of time a person experiences food insecurity is related to the severity of the health impacts[32]. A study examining food insecurity in children over four years of age found that children who experienced food insecurity for longer periods of time had worse health outcomes[33].  

According to the CDC, the prevalence of obesity among those ages two to 19 was 19.7%, or about 14.7 million children, adolescents, and young adults. Childhood obesity is also more prevalent among certain racial and ethnic groups (26.2% among Hispanic/Latino children, 24.8% among non-Hispanic Black children). Obesity-related conditions include high blood pressure, high cholesterol, type 2 diabetes, breathing problems such as asthma and sleep apnea, and joint problems[34].

The impacts of food insecurity extend beyond diet-related conditions. Children who experience food insecurity have a higher risk of iron deficiency anemia, low non-cognitive performance, asthma, depression, suicide ideation, and tooth decay[35]. Food insecurity has been shown to be a major stressor in early childhood with implications for cognitive, language, motor, and socio-emotional skills[36].

Background on the Intervention

School garden interventions typically consist of gardening activities (such as planting, growing, and harvesting vegetables), cooking lessons, and/or nutrition education[37]. According to the United States Department of Agriculture (USDA), there are over 7,000 school-based gardens across the country[38]. Since the early 1900’s, there has been strong federal support for the development and cultivation of school gardens[39]. School gardens vary in size and biodiversity as they can be successfully created with any amount of available space and in any climate. School food service directors can use produce from school gardens in cafeteria meal programs and schools start their own salad bars with vegetables grown in these on-campus gardens. They are also educational tools that provide students with the opportunity to learn about nutrition and agriculture, among other disciplines[40]. School gardens can also support the sustainability of summer meal programs for students who usually eat meals at school. Tribal communities across the country have cultivated school gardens to provide hands-on opportunities for education about cultural heritage as well as nutrition and connection to the land[41].

Prior to March 2025, federal funds were available from the USDA Farm to School Grants and National School Lunch Program Funds[42]. Federal funds could be used for supplies, equipment, and staff to support school gardens. The development of a permanent structure would require additional funds apart from federal resources. Local parent associations, non-profits, businesses, and public agencies can also provide resources to start and maintain school gardens. If a school garden produces a high yield of vegetables, financial arrangements can be created between outside food service personnel and the school to purvey produce[43]. Medicaid managed care organizations could use community reinvestment funds to invest in school gardens, if that is aligned with state requirements and policies. Additionally, some schools offer teacher garden training, distribute garden-based curriculum, develop leadership committees, and collaborate with other local organizations[44].

Evidence Review
Note: The vocabulary used in the table is the same terminology used in the study in order to preserve the integrity of the summary. 
Study
Population
Intervention Summary
Type of Study Design
Outcomes

Children from 23 schools in London, England. The mean age of participants was 8.1 years.

A school gardening program. Schools were randomized into either a Royal Horticultural Society (RHS)-led intervention or a teacher-led intervention. HRS-led schools received scheduled day visits from the RHS regional advisor, follow-up visits to aid lead teachers with planning, general ongoing advice, twilight teacher training, and free access to a wide range of teacher resources online. Teacher-led schools attended termly twilight training at their nearby RHS-led school, to help support them in developing and using their school garden. 

Randomized controlled trial to evaluate children’s fruit and vegetable intake. Ten schools were randomized into the RHS-led intervention and 13 schools were randomized into the less involved teacher-led intervention. A total of 641 children completed the trial. A 24-hour food diary (CADET) collected baseline and follow-up dietary intake 18 months apart. Questionnaires were also administered to evaluate the intervention implementation. 

Social: There was little difference in children’s mean change in fruit, vegetable, or combined fruit and vegetable intake between the two groups. The teacher-led group had slightly higher mean intake of vegetables and combined fruit and vegetables than the RHS-led group; however, there was no significant intervention effect after adjusting for confounders.

Children in fourth and fifth grades from 16 schools in Austin, Texas from 2016 to 2019. A majority of the children were Hispanic and participated in the free and reduced lunch program.

The Texas Sprouts program, a one-year school-based gardening, nutrition, and cooking intervention. The control cohort received a delayed intervention that was implemented the following academic year with the same protocol as the intervention arm.

Randomized controlled trial. 16 total schools were evenly distributed (n = 8 each) into either the intervention or control. A total of 3,114 children participated.

Social: Schools that received the intervention had a 6.5% increase in fourth grade reading, as measured by State of Texas Assessments of Academic Readiness scores, compared with control schools (p =.047). There were no significant differences in reading scores for fifth-grade students (p=.991) or math scores for fourth or fifth-grade students (p=.624; p=.995).

Children from 16 elementary schools in Texas. The average age was 9.2 years; 64% were Hispanic, 47% were male, and 69% were eligible for free and reduced lunch.

The Texas Sprouts program, a one-year school-based gardening, nutrition, and cooking intervention. The control cohort received a delayed intervention that was implemented the following academic year with the same protocol as the intervention arm.

Randomized controlled trial. A total of 3,135 children were enrolled in the study (intervention n = 1,412). 

Social: There were no effects of the intervention compared to control on fruit intake or sugar-sweetened beverages. However, the intervention resulted in significant increases in vegetable intake (p=0.02). 

Health: There was no effect on any of the obesity measures or blood pressure.

Students from third to fifth grade, in elementary schools in Los Angeles, California. The study population was ~89% Hispanic/Latino and ~90% eligible for free lunch at school. The majority (>50%) were overweight (BMI ≥85th percentile), and more than one-third were obese.

LA Sprouts, a school-based 12-week gardening, nutrition, and cooking intervention taught in school gardens. An outdoor modular kitchen was outfitted with cooking supplies. Classes were held once a week for 12 weeks. The classes consisted of a 45-minute interactive cooking/nutrition lesson and a 45-minute gardening lesson taught by an educator with a nutrition or gardening background. Gardening activities also used a “hands-on” approach, where children participated in planting, growing, and harvesting organic fruits and vegetables. Parallel classes were offered to parents bimonthly on mornings, evenings, and weekends. Students at the control schools did not receive any nutrition, cooking, or gardening information. 

Randomized controlled trial. Four elementary schools (total n = 319 students) were evenly randomized by school into the intervention (n = 172 students) or control (n = 147 students). 

Health: LA Sprouts participants had significantly greater reductions in BMI z-scores (p=0.01) and waist circumference (p<0.001). Fewer LA Sprouts participants had metabolic syndrome after the intervention than before, while the number of students from the control schools with metabolic syndrome increased. 

Social: LA Sprouts participants increased dietary fiber intake compared to controls (p=0.04). All participants decreased vegetable intake, but decreases were less in LA Sprouts participants than controls (p=0.04). Change in fruit intake did not differ between LA Sprouts participants and controls.

Students from 16 schools in Texas from 2016 to 2019.

Texas Sprouts, a school-based gardening, cooking, and nutrition program designed for  elementary school students whose family earns a lower income and has a curriculum culturally tailored to Hispanic children. 

The intervention arm received the formation and training of Garden Leadership Committees, a 0.25-acre outdoor teaching garden, 18 student lessons including gardening, nutrition, and cooking activities taught weekly in the teaching garden during school hours, and nine parent lessons taught monthly.

Randomized controlled trial. Eight schools were randomized to the Texas Sprouts intervention and eight schools to control (i.e., delayed intervention). Dietary intake data was collected using two 24-hour dietary recalls on a random subsample (n = 468). Dietary quality was calculated using the Healthy Eating Index 2015 (HEI-2015).

Social: The intervention group compared to control had a modest increase in protein intake as a percentage of total energy (p = 0.021) and in HEI-2015 total vegetable component scores (p = 0.003). When stratified by ethnicity/race, non-Hispanic/Latino children had a significant increase in HEI-2015 total vegetable scores in the intervention group compared to the control group (p = 0.026). Both the intervention and control groups increased added sugar intake; however, this was observed to a lesser extent within the intervention group (p = 0.05).

Students in Title I schools where ≥75% of students are eligible for free lunch.

A university-supported school garden program.

Observational. The authors used a cross-sectional survey design using secondary data from an evaluation of a school garden program, with a focus on Latino/a (Hispanic) identifying students.

Social: Regardless of past exposure, fifth-grade students, females, and those who identify as Hispanic/Latino felt that school garden programming improved their learning. Hispanic/Latino students who participate in school garden programming may also feel a greater sense of connection to their teachers and peers at school. 

Duration of school garden exposure did not have a significant association with self-reported learning or feelings of school connectedness. 

Qualitative results demonstrated that most students enjoyed spending time in the garden and indicated that participating in the program helped them learn new things and feel connected to their school.

Fourth-graders (ages nine to 10) from four different California schools.

A school gardening intervention (Shaping Healthy Choices Program). The program included nutrition education and promotion, which involved instructional school gardens, cooking demonstrations, and related curricula. The program also had other components including availability of food on school campuses and school wellness committees. 

Randomized controlled trial. There were 230 students in the intervention schools and 179 in the control schools.

Social: Compared with the control schools, students in the intervention schools had significantly greater improvement in nutrition knowledge and vegetable identification. There was not a significant difference between groups in reported fruit and vegetable consumption. 

Health: Anthropometric measures (BMI and mean waist-to-height ratios) improved significantly more in the intervention than in the control schools.

Students from kindergarten to 12th grades in 25 schools in Chicago’s South and West Sides.

Gardeneers provides Chicago, Illinois students with education about and equitable access to healthy food. In 2019, Gardeneers served 2,000 students from 25 schools in Chicago’s South and West Sides from kindergarten to 12th grades. Gardens implemented by Gardeneers are located on school property or within one to two blocks from each school. 

Observational study. Descriptive statistics analyze the data from a pre-post self-report survey administered in 2018 to 108 third through eighth-grade students. 

Social: Of the 108 students enrolled in third through eighth grades, nearly all (96%) indicated that they tried new and healthy foods throughout the program. A 14.5% increase in self-reported everyday consumption of fruits and vegetables took place in settings other than the Gardeneers’ program.

Students reported eating fruits and vegetables an average of 4.39 days per week before participating in the program. After participating in the program, students reported eating fruits and vegetables an average of 4.93 days per week (an increase of .54 servings of fruits and vegetables per week).

Third-grade students and their parents from 28 low-income schools in Texas. 42% of students were Hispanic/Latino, and 78% were eligible for free/reduced lunch.

Texas!Grow!Eat!Go! (TGEG), a school-based gardening and physical activity (PA) intervention.  

Randomized controlled trial. Participants included 1,326 students and parents. Schools were randomized to one of four conditions: (1) School garden intervention (Learn!Grow!Eat!Go! [LGEG]), (2) physical activity intervention (Walk Across Texas [WAT!]), (3) both garden and PA intervention (combined), or (4) neither garden nor PA intervention (control). Student and parent data were collected at the beginning and end of the school year. Two different sets of analyses measuring pre-post changes in outcomes within and across conditions were conducted. 

Social: Relative to children at schools that did not receive LGEG, children at schools that received LGEG, either individually or in combination with WAT!, showed significant increases in nutrition knowledge, vegetable preference, and vegetable taste (p < 0.001 in all cases). Within-group analyses show that compared to the control group, children in the WAT! group significantly increased the amount of time parents and children were active together (p = 0.038).

Health: Children in LGEG and WAT! schools significantly decreased BMI percentile (p = 0.042, p = 0.039, respectively), relative to children in control schools.

Students in under-resourced elementary schools in New York State. The mean age at baseline was 9.3 years; across all schools participants were 30% African Americans, 8.8% Hispanic/Latino, 9.7% Asian, and 51.5% White. 

Healthy Garden, Healthy Youth, a school garden intervention.

The intervention consisted of a garden for each classroom and a 20-lesson curriculum focused on nutrition and growing plants. In addition, educators led students in planting, weeding, and harvesting.

Randomized controlled trial. There were six intervention schools and six wait-list control schools. 255 students were included in the analysis.

Social: Children in the intervention group spent more time in moderate physical activity and moderate-to-vigorous physical activity than the control group. The authors concluded that school-based gardens show promise to promote children’s physical activity.

Students in second, fourth, and fifth grades from Arkansas, Iowa, Washington, and New York. 

A school gardening intervention. Within each region, schools were randomly assigned to receive the school gardening intervention or be placed in a wait-list control group. For the intervention, each classroom received a garden kit and an educational toolkit of gardening-related lessons. 

Randomized controlled trial. A total of 46 low-income schools (n = 2,768 total students) were included. 

Social: The garden intervention led to an overall increase in the availability of vegetables at home. 

Sixth-graders at two Title I schools (≥75% of students are eligible for free lunch) in Portland, Oregon (59% female; 25% Asian, 2% Black, 26% Latino/Hispanic, 27% White). Students were also linguistically and culturally diverse: English was not the primary home language for 51% of students, which was indicative of the high number of immigrant families at these schools. The most common home languages spoken were Spanish, Vietnamese, Russian, and Chinese; parental consent materials were translated into these languages.

The Science in the Learning Gardens (SciLG) program was designed to address the under-representation in science of students from racial and ethnic minority groups and the inadequacies of curriculum and pedagogy to address their cultural and motivational needs. 

The gardens served as an extension of the schools’ classrooms. Besides acquiring basic gardening skills, students discovered their connections to the place-based flora and fauna, studied science, learned to compost, created art, and shared cultural stories about food and gardening.

Observational study. Longitudinal data included a measure of students’ overall motivational experiences in the garden (that combined their reports of relatedness, competence, autonomy, and engagement and teacher reports of re-engagement in garden-based learning activities) to predict four science outcomes: engagement, learning, science grades, and science identity (someone’s self-identification as a “science person”).

Social: Findings suggest that garden-based activities show promise for supporting students’ engagement and learning in science classes and in fostering students’ interest in pursuing science long-term.

New Zealand secondary school students.

Presence of school gardens.

Data was collected from a national study of the health and well-being of New Zealand secondary school students (n = 8,500) conducted in 2012. The association between school gardens (school level) and student nutrition behaviors, physical activity, and measured BMI (student level) were examined.

Health: Approximately half of secondary schools had a fruit/vegetable garden for students to participate in. School gardens were associated with lower student BMI and less frequent consumption of fast food. The relationship between school gardens and BMI was strongest for students living in household poverty. There was no relationship with fruit and vegetable consumption or physical activity.

Systematic Reviews
Note: The vocabulary used in the table is the same terminology used in the study in order to preserve the integrity of the summary. 
Study
Population
Intervention Summary
Type of Study Design
Outcomes
Berezowitz et al. (2015)

Children enrolled in school gardening programs.

School gardening interventions at least one month in duration and including measures of academic performance and diet. 

Systematic review. Twelve studies met the review’s eligibility criteria. 

Social: All 12 studies reporting fruit and vegetable intake predictors (for example, knowledge and willingness to try new foods) found significant improvement after a school gardening intervention. Seven studies reported fruit and vegetable consumption results were mixed. Three studies found an increase in consumption, two showed no change, one study found an increase only in vegetable consumption, and one showed an increase in the variety of vegetables consumed. 

Four studies reported academic outcomes in schools with gardening interventions; these interventions were conducted with elementary school-aged children. Two studies found significantly higher science achievement scores in the gardening group, one study found significant improvement in math scores, and one study did not find an impact of the gardening intervention on academic achievement.

Chan et al. (2022)

Students enrolled in school garden-based programs (SGBP). Intervention duration ranged from six weeks to four years. The 18 studies involved a varying degree of parental participation.

School garden-based programs, which majorly include school gardening activities, cooking lessons, and nutrition education.

Systematic review. A total of 35 studies met the inclusion and exclusion criteria. This includes 25,726 students from 341 schools and eight nursery schools from 12 countries.

Social: SGBP without parental involvement (n=6/10), with a shorter intervention duration, and a small sample size (70-320 participants), which resulted in a more favorable outcome in children’s vegetable intake compared to those with longer intervention duration and larger sample sizes. Most programs with parental involvement did not show significant improvement in children’s vegetable intake (n = 11/16).

SGBP with a shorter duration of ~ 12 weeks and a sample size of ~ 77 to 99 participants showed better improvement in children’s fruit intake among preschool and primary school-aged children compared to other ages. The majority of the SGBP with longer intervention duration (~ one  year to four  years) and larger sample size (~ 60 to 4,300 participants) did not observe significant improvement in children’s fruit intake, regardless of parental involvement.

Most studies did not demonstrate a significant improvement in fruit (six studies) and vegetable (7 studies) (F&V) consumption (n = 5/6, n = 4/7, respectively).

Fourteen out of 20 studies reported that SGBP with or without parental involvement demonstrated significant improvement in children’s nutritional knowledge at the post-intervention, especially those shorter SGBP interventions (less than a year) integrating with classroom education and intervening at a younger age (six to 15  years old).

Two-thirds of the reported studies showed significant improvement in children’s attitudes and acceptability towards vegetables at post-intervention (n = 13/19), especially those with shorter intervention duration ranging from 12  weeks to one year, regardless of the sample size and the children’s age group (n = 7/9).

The majority of the SGBP with parental involvement reported improvement in children’s attitudes towards fruits (n = 3/5), compared to those without parental involvement (n = 3/7).

Parental involvement in SBGP seems to exert beneficial effects on improving children’s willingness to consume F&V, especially when intervened at a younger age (aged three to 12  years old) with an intervention duration ranging from eight weeks to 2.5  years (n = 4/6).

Most of the studies reported no significant improvement in dietary self-efficacy (n = 3/4).

Only one out of eight reported positive findings on home vegetable availability, with the remaining failing to demonstrate significant improvement. One U.S. study investigated the effect on school F&V availability and reported a positive finding on improving overall F&V consumption.

Rochira et al. (2020)

Children enrolled in school gardening programs. The settings of the interventions varied; most took place during school hours, but some took place after school or during the summer.

School-based gardening programs.

Systematic review. 33 studies with gardening interventions were identified. Studies were randomized controlled trials and observational studies of interventions with primary school students. 

Social: Twenty studies reported fruit and vegetable consumption; of these, five reported a positive impact of a school gardening intervention on combined fruit and vegetable intake, five studies found an increase in vegetable consumption, one study found an increase in fiber consumption, and one study found an increase in vitamin A and vitamin C consumption. 

Seventeen studies evaluated knowledge related to fruits and vegetables and 13 of these studies found a greater increase in knowledge in the intervention group compared with the control group. 

Twenty studies examined attitudes towards fruits and vegetables. Five studies reported an improved preference for healthy fruit and vegetable-based snacks and four studies reported an increase in “willingness to try” new fruits and vegetables. 

Two studies reported physical activity, which increased in both studies. 

Health: Only a few studies reported measures related to BMI. One study found a significant reduction in absolute BMI and this change occurred only in the overweight/obese subgroup. Another study found a significant BMI reduction only in the second year of follow-up. 

Two studies found a significant reduction in BMI z-score and, in one of these, the BMI z-score reduction was associated with a reduction in waist circumference.

Assessment Synthesis Criteria
Strong Evidence
There is strong evidence that the intervention will produce the intended outcomes.
  • At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect; and  
  • Consistent findings of health effects from other studies (cohort, case-control, and other designs).
Sufficient Evidence
There is sufficient evidence that the intervention will produce the intended outcomes.
  • At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect, but inconsistent findings in other studies; or
  • Consistent findings from at least three non-randomized control trial studies (cohorts, practical trials, analysis of secondary data); or
  • A single, sufficiently large well-conducted randomized controlled trial demonstrating clinically meaningful health effect and consistent evidence from other studies; or 
  • Multiple expert opinions/government agencies supporting the intervention.

More Evidence Needed or Mixed Evidence
There is insufficient evidence that the intervention will produce the intended outcomes, however the results may indicate potential impact.
There is strong evidence that the intervention will produce the intended outcomes.
There is sufficient evidence that the intervention will produce the intended outcomes.
There is insufficient evidence that the intervention will produce the intended outcomes, however the results may indicate potential impact.
  • At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect; and  
  • Consistent findings of health effects from other studies (cohort, case-control, and other designs).
  • At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect, but inconsistent findings in other studies; or
  • Consistent findings from at least three non-randomized control trial studies (cohorts, practical trials, analysis of secondary data); or
  • A single, sufficiently large well-conducted randomized controlled trial demonstrating clinically meaningful health effect and consistent evidence from other studies; or 
  • Multiple expert opinions/government agencies supporting the intervention.

Sources

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[2] Coleman-Jensen A, Rabbitt MP, Gregory CA, et al. Household Food Security in the United States in 2021. United States Department of Agriculture (USDA), Economic Research Service; 2022. Available at: https://www.ers.usda.gov/webdocs/publications/104656/err-309.pdf?v=6629.3. Accessed on April 10, 2023.

[3] Coleman-Jensen A, Rabbitt MP, Gregory CA, et al. Household Food Security in the United States in 2021. United States Department of Agriculture (USDA), Economic Research Service; 2022. Available at: https://www.ers.usda.gov/webdocs/publications/104656/err-309.pdf?v=6629.3. Accessed on April 10, 2023.

[4] Nord, M. Characteristics of Low-Income Households With Very Low Food Security: An Analysis of the USDA GPRA Food Security Indicator. U.S. Dept. of Agriculture, Econ. Res. Serv. 2007. Available at: https://www.ers.usda.gov/webdocs/publications/44171/11530_eib25_1_.pdf?v=5687.7.  Last Accessed: April 13, 2023. 

[5] United States Department of Health and Human Services (HHS) A, HealthyPeople 2030. Food Insecurity. Available at: https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/food-insecurity. Accessed on April 13, 2023. 

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[7] United States Department of Agriculture. Food and Nutrition Security. Available at: https://www.usda.gov/nutrition-security. Last Accessed: February 5, 2025 *site has since been removed*

[8] Mozaffarian, D. Measuring And Addressing Nutrition Security To Achieve Health And Health Equity Health Affairs Health Policy Brief, March 30, 2023.

[9] Eicher-Miller HA, Graves L, McGowan B, Mayfield BJ, Connolly BA, Stevens W, Abbott A. A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States. Adv Nutr. 2023 Jul;14(4):914-945. doi: 10.1016/j.advnut.2023.05.006. Epub 2023 May 13.

[10] Rehm CD, Peñalvo JL, Afshin A, Mozaffarian D. Dietary Intake Among US Adults, 1999-2012. JAMA. 2016;315(23):2542–2553. doi:10.1001/jama.2016.7491

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[12] Lee-Kwan SH, Moore LV, Blanck HM, et al. Disparities in state-specific adult fruit and vegetable consumption — United States, 2015. MMWR Morb Mortal Wkly Rep 2017;66:1241–1247.

[13] U.S. Department of Health and Human Services (HHS) A, HealthyPeople 2030. Increase fruit consumption by people aged 2 years and over – NWS-06. Retrieved from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/nutrition-and-healthy-eating/increase-fruit-consumption-people-aged-2-years-and-over-nws-06. Last Accessed: October 21, 2022.

[14] U.S. Department of Health and Human Services (HHS) B, HealthyPeople 2030. Increase vegetables consumption by people aged 2 years and over – NWS-07. Retrieved from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/nutrition-and-healthy-eating/increase-vegetable-consumption-people-aged-2-years-and-older-nws-07. Last Accessed: October 21, 2022. 

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