Youth exploring the relationship between school 2 gardens , food literacy and mental well-being using 3 photovoice . 4

The goal of the project was to gain an understanding of the secondary school youth 14 experience with food literacy and school gardens on their mental well-being. Over the course of 15 five months, sixteen youth participated in a photovoice research project in which they expressed 16 their personal experiences about food and gardening through photography and writing. The 17 aspects of secondary school youths’ life experiences affected by exposure to food literacy and 18 school gardens and their impact upon their well-being were identified. These included emotions 19 and feelings, having a safe place, nutrition and relaxation. The youth explicitly connected 20 relaxation with the themes of love and connectedness, growing food, garden as a place, cooking, 21 and food choices. This was linked to nature, beauty, environment and sustainability. Youth clubs or 22 groups were also identified as a key enabler for connection. Youth shared their food literacy 23 experiences, observing that their engagement improved some aspect of their mental well-being. 24 They identified food literacy and gardens as being the most important to mental well-being 25 including: connecting, personal health and personal growth. The youth recognized that connecting 26 comes from having community, relationships and respect. Fostering opportunities for food literacy 27 such as growing and preparing food contributes to resiliency. 28


Introduction
The school context is seen as a setting for prevention strategies to reach many children and youth at key points in their development.It is assumed that children's and young people's learning influences their health behaviours and therefore what disease they develop in later life [1] however the etiology of disease is both complicated and contentious [2].What young people might have to say about their health and what they might want or prefer is an equally important perspective in creating spaces where health and well-being are optimized.
This paper reports on a study that focused on youth exploring three interrelated aspectsconsideration of mental health and food literacy while situated within a school garden context.The opportunity offered by school gardens as green spaces is due to them being widely placed and accessible for youth, particularly in the Vancouver city area.These green spaces enabled experiential, problem-based education while also allowing for interactions and social engagement amongst the "gardeners" [3].Thus, engaging with green spaces supports positive mental health in youth by building their resilience, sense of autonomy and positive outlook [4][5] as well as a sense of inclusion and belonging.The complimentary focus on food literacy was possible due to a number of the green spaces being school gardens.The youth were able to plant, cultivate, harvest and prepare foods that they had grown.Food literacy is an emerging concept that requires a holistic approach where understandings about food that are socially constructed and able to be shared [6][7][8].
Hands-on food education provides empowerment and skill building that can bolster resiliency to support the mental well-being of students [9] and support academic development [10][11].Local school and community partners, who have worked with the authors, shared observations and comments related to school connectedness, improved self-esteem, feeling safe in school gardens and mental well-being about students who were involved in school garden and food literacy activities.
However, no local research data was available, particularly from a youth perspective.
In this study, photography was chosen as way to enable participating youth to investigate their world, [12][13][14] looking for connections between school gardens and how they perceived their own mental health [15].Using an arts-based methodology for this study, specifically photovoice, was predicated on the understanding that knowledge exists between and among youth in social settings and that learning is the result of their interactions [16][17].Thus, the use of photovoice enabled the youth to become empowered through active involvement as co-researchers and engaging with the process of developing knowledge [17] about the underlying reasons for the observations between youth mental well-being and food literacy activities.

Materials and Methods
Photovoice methodology was developed by Wang and Burris [13] with the specific intent to share expertise and knowledge in participatory ways and to enable people to document community strengths and concerns [12,14].The framing of photovoice as community-based participatory research [18] privileged the voices of youth as they represented their experiences of the school garden green space.The resultant conversations and discussions were possible because of the shared experiences, respectful relationships and level of trust [18][19].
The research team funded a professional photographer, with experience in photovoice projects, to collaborate with the primary investigator to guide planning and facilitation of youth sessions around photography and writing.The photographer helped youth build skills in storytelling through photography, showing examples of other photovoice projects, providing digital camera equipment, training youth on how to operate the digital camera equipment, and collecting and organizing their digital photographs.This process of working with youth to build their photography skills and develop the technical capacity to present their views as both "competent citizens and active participants" [12] (p.152) who are engaging in transformational acts.
Ethics approval for this study was obtained from The University of British Columbia (UBC) [H15-03101].Permission to approach and engage with schools in Vancouver was obtained from the Vancouver Board of Education.School and community partners in Vancouver recommended recruiting participants from existing youth clubs and groups.Flyers were distributed in January to community partners and posted at secondary schools to help with recruitment and a Youth Photovoice Project Facebook page was created to share information and updates about the study.
Purposive sampling was used to recruit secondary school students from these sources, which provided a diverse group of youth.
Sixteen youth, nine females and seven males, in grades nine to twelve, attended seven, one to one and a half hour photography and writing sessions over a five-month period.Based on youth preferences, the sessions were held primarily on a weekday after school at their own school site or where their existing club or group was already convening.These sites included two secondary schools, a university farm site, a community center and a neighbourhood house.
The youth participated in the three stages of the participatory approach of photovoice methodology described by Wang and Burris [13].The first stage is having youth take the lead in selecting photographs.The second stage focused on contextualizing or providing stories about the meaning behind the chosen photos.The sessions with youth included having them document their reflections in personal journals and sharing some of their writing with investigators and fellow youth.The third stage involved codifying or identifying themes from the research process, which took place both individually with each of the investigators and then together, followed by identifying and checking themes with youth co-researchers.
Since different methods were used to collect information to triangulate findings and increase rigor and credibility a meta-analysis was facilitated.Each investigator used a holistic thematic approach by independently reading the transcribed interviews, focus group transcript and youth writing.One investigator utilized the NVivo 10.0 [20] computer software and the other investigator used a manual review process to develop a preliminary coding framework that emerged from the data.They met several times to iteratively develop a shared list of categories, overarching themes and sub-themes to enhance inter-rater reliability.
Based on the derived draft list of themes and categories, overarching themes were shared for participant verification at a second focus group held in September to further improve inter-rater reliability and verify findings with youth co-researchers.Five females and one male were in attendance.Two male participants joined through a video Skype call on a mobile phone.A mind mapping activity was utilized to allow youth to further refine and validate the key themes and connections between themes.

Results
The youth and investigators identified the following three broad emergent themes related to food literacy and gardens as being the most important to mental well-being; connection, personal growth and personal health.Youth clubs or groups were identified as a key enabler for connection.
They provide diversity and contribute to hope and mindfulness.For personal health, factors included emotions and feelings, having a safe place, nutrition and relaxation.Relaxation was connected with the following grouped themes of: growing food, garden as a place, cooking, love and food choices.This was linked to nature, beauty, environment and sustainability.In addition, participants indicated a group of themes that related to those things that "change all the time", such as self-discovery, life, personal growth, slower pace, future and nurture.

Images and text
As the youth were setting up and reflecting on their photographs and text, they were asked brainstorming questions as a way to help youth guide their photography and story writing.The examples of questions included: What does mental well-being mean to you? and What does food and gardening mean to you?Table 1 presents the themes, sub-themes and selections of quotes from students, which emerged from the data.Participants indicated that connecting comes from having community, relationships and respect.When you're the one who grew the food, like, it just adds that extra sort of excitement and makes you want to eat the food.
We heal ourselves using the foods we eat." "So that's part of the problem I see, is that people don't care enough about the-about themselves and their health and the environment, the planet, because that's all connected.The photographs taken by the youth and the accompanying texts could also be sorted according to the themes and sub-themes.The experience of being in the garden with others, thinking about the image, its composition, use of light and texture, shape and form all come together to convey the youth's impressions about food, gardening and mental well-being.The accompanying text highlights a particular experience that the young person wanted to convey about themselves and their relationships with others.Evident in these artifacts is a sense of agency [21] and personal growth due to the interactions both with the school garden as a green space and with other gardeners [19].

Evidence of Food Literacy
Food literacy is a sociocultural knowing where food-related activities are based on particular understandings that are context dependent and infused with power-relations [6][7].As a way to understand what this food literacy might look like, we utilize a critical food literacy model that is a multidimensional model [7].This model was used as a way to elicit the researchers' understanding about the ways the youth as participants were food literate.
In their discussions, the youth identified both the conversations and activities reflected in each dimension of food literacy -operational, cultural and critical.For example, when youth spoke about their experiences of planting, growing, harvesting and preparing food, these were aspects of the operational dimension of food literacy.Such comments included: For me [ I ] like food workshops, we make foods; I like to make pizza, or pretzels.Pretzel is fun.
It's really about the skills, something you gonna do when you grow up.
Between cooking and gardening we use cooking more in the future because we have to eat.
Youth spoke about their food experiences and how they connected to family.They drew on ways of knowing, especially around traditional and healing plants, reflecting a cultural dimension of food literacy.Their cultural food literacy included the retelling of experiences with family members, intergenerational learning and connecting to others with expertise.
A lot of the stuff [my grandfather] showed me are pretty simple things that gave me a little fed start with teaching the kids… how to plant things, like how far do they have to be, like the spacing.Making sure that if they have to dig something up, if there's a rock or something, try to find a way around it, not just dig the rock out.And leave the rock somewhere else far away from the plant.
It's easier in the garden to talk about and learn about other people.
I always go with my mom to the market, like supermarket or market place, buy vegetables and rice, so I know how to pick them.Like choosing apples or oranges as fruits, or cabbage something like that.
The critical dimension was evident when the youth discussed how they connected the growing of food with eating healthy or sustainable food.When engaging with this dimension youth were able to connect their experiences to what is occurring elsewhere.For instance, their efforts to produce food was scaled up in their imaging of what those who work on the land would need to do to feed communities.

Although it's fun and rewarding, it's a lot of work to grow something and when it dies you're kind of a little bit sad but it's part of it I guess and you kind of realize how much work it is, like to grow one plant, it took
us a lot of work and then I think about the farmers that do like that for a living and then I'm like, you kind of realize how hard they work and you appreciate it more.
Drawing on Cullen et al.'s [22] definition of food literacy, these quotes from the youth about their thinking around their food experiences demonstrated an understanding of what is involved in growing and preparing food.They also highlighted the relationship between food and the youth, as evidenced in 'real' social contexts, which supported their connectedness with others.This food literacy is concerned with the interactions and concepts about food, typified as farm to table and how it has meaning in daily life [22][23].The very processes of producing and preparing food for consumption are implicated with physical, emotional and mental health.

Discussion
This research contributes to the data that investigated the relationship between school gardens, food literacy and student mental health.All of the youth shared that their food literacy experiences improved some aspect of their mental well-being.The research provided an in-depth understanding of the intersection of mental health and food literacy from a youth's perspective.All youth shared that their food literacy experiences improved some aspect of their mental well-being that included building their confidence, resiliency and sense of self-mastery.Seventy-five percent of Vancouver public schools have food gardens, which can provide opportunities to be outside and be involved with hands-on, interactive learning.Fostering opportunities for food literacy such as growing and preparing food could help build resiliency.These strategies can build a supportive environment around mental health promotion in schools [24].The school garden can be used to promote physical activity, mental health and well-being, neighbourhood connections [3,14], as well as cross-curricular and inquiry-based learning and educational outcomes [3].The attention restoration theory explains the link between spending time in nature such as the school garden with being able to concentrate better [25].This is supported by the qualitative research by Chawla et al. [26], which involved youth in gardening programs.
The Comprehensive School Health (CSH) framework is recognized internationally and is used by public health practitioners and school stakeholders in Vancouver.The framework helps to build sustainable changes in school culture that support the health, learning and well-being of students.Coordinator; an oral presentation at a university dietetic intern research symposium; a poster presentation at a regional health authority workshop for dietitians and part of a walking tour at a national Dietitians of Canada conference.
The use of a research method with a qualitative focus and the resultant small sample size meant that the specific findings are not intended to be generalized beyond the study participants and localized context.However, the general findings may be applicable to other secondary school youth involved in food literacy, in particular school gardens and related school and community activities.
Further research on the long-term impact of this photovoice research project on school community food literacy activities is warranted.
The intention of this project was to engage with youth as co-researchers to explore the relationship between their well-being and green spaces such as school gardens.Thus, there was an exploration of engaging with green spaces that both supported mental health but also supported the development of food literacy.From this project, the following are recommendations for further research.Addressing how  Food literacy in a cultural context such as growing and preparing food can build resiliency;  School food gardens can promote both cross-curricular learning and inquiry-based learning; and  Incorporating the perspective of youth can impact their sense of connectedness and engagement with learning.
These ideas are encompassed in the following thoughts from a Grade 12 participant in the research: Photovoice is an adaptable, qualitative, community-based participatory research method that can be used by public health practitioners to gain an in-depth understanding of client experiences in order to support their health and well-being.The findings suggest further research possibilities for working with youth around mental health and food literacy.

Table 1 .
Examples of themes and comments you need to see something like that, to see it, that gardening can do this to people.Community I've seen it in gardening mostly, that people do come together of all ages.Like, you don't need a lot of experience or not a lot of knowledge to actually be able to do gardening.Like, you can just pick up and do Preprints (www.

preprints.org) | NOT PEER-REVIEWED | Posted: 22 April 2019 doi:10.20944/preprints201904.0229.v1
Peer-reviewed version available at Nutrients 2019, 11, 1354; doi:10.3390/nu11061354something in the smallest way and it can help.And you see, like, the actual growth and the actual outcome of your own efforts, so it's really rewarding.Well, I see people laughing, making jokes about small things, and just enjoying the process of gardening.It's not-it's not really actual gardening, but it's working with other people, other peers.And-yeah.RespectI think that the biggest thing is that when you're gardening, that there's kind of like a sense of, like, no judgment of what you're doing in the moment.So you can share your opinions and really get to-get to know people from, like, a different point of view, and get to see, like, what their skills that they're good at.So in terms of mental wellbeing, I would say it really makes you find that connection of what you're good at, and makes you feel good about yourself in the end.You don't always have to be around others, and especially for youth, at my age or-we kind of feel the need to fit in and always be around people, like social media and things like that.But I think what's more important is, like, finding that balance in order to solve that problem, and finding that balance might mean something like gardening or, like, doing something else you love.
Well, especially this age, it's just, it comes from peers, like, kind of that pressure to always fitting-to always fit in and, like, always be talking to other people, but sometimes we have to take that time off for ourselves, for, like, self-growth, and how we can still be bright and colourful just on our own.Well, it's again, like, taking time, doing things like gardening and like, finding that balance in our lives, just focusing on multiple things, not just one, in order to-in order for that self-growth to happen.…how gardening, it-there's, like-it can relate to everyday life, not-it's not just gardening.

Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 22 April 2019 doi:10.20944/preprints201904.0229.v1
Peer-reviewed version available at Nutrients 2019, 11, 1354; doi:10.3390/nu11061354RelaxationIt'stherapeutic in some way actually.Like, touching the soil is actually calm-not calm-like, calming, but, like, it's nice to just garden and get your hands dirty and grow stuff and seeing it grow, watching it grow.

Table 2 .
Examples of images and texts

Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 22 April 2019 doi:10.20944/preprints201904.0229.v1
Peer-reviewed version available at Nutrients 2019, 11, 1354; doi:10.3390/nu11061354 [12][13][14].[25]identifiedcore conditions for CSH implementation that include students as change agents, school-specific autonomy, demonstrated administrative leadership, dedicated champion to engage school staff, community support, evidence and professional development.The contextual conditions of time, funding and project supports, readiness and prior community connectivity influence the capability of the core conditions to be achieved.The current study addressed the core conditions of secondary school students as change agents and generated evidence from the local school district setting.This supports Wang and her colleagues'[12][13][14]recommendations for action based on findings from photovoice projects.The action part of the process for the present study is ongoing and has involved two public art gallery exhibitions; mobile displays at school board lobby, a secondary and elementary school; sharing research summaries with the funding group and fellow researchers, school board Research Committee, school board Sustainability Manager and would say give the opportunity to students to actually bring out what they think is important, and to not only teach what is part of the curriculum, but something that could help nurture what they want to do in life.