Strengthening equity in gardening initiatives for children and youth: a rapid review

Abstract

Background

Gardening initiatives may help address modifiable risk factors for cancer and chronic disease among children and youth by fostering more supportive and equitable environments for health. However, the extent to which these initiatives have been intentionally designed to address the social determinants of health and promote health equity remains unclear. The purpose of this review is to identify whether equity-related factors have been considered in gardening initiatives for children and youth, and to explore any reported equity-related effects.

Methods

A rapid review was conducted in March 2024 across multiple electronic databases. Peer-reviewed studies from the past ten years focusing on gardening initiatives in schools, daycares, or community settings within high-income countries were included. Articles underwent dual screening, and one reviewer independently conducted quality appraisal. Equity-related data were extracted using the PROGRESS-Plus framework and synthesized narratively.

Results

Studies most frequently incorporated social capital, age/grade level, and socioeconomic status in gardening initiatives. Social capital was commonly associated with improved social connections and relationships among children and their parents, peers, and teachers. It was also linked to the transfer of food-related knowledge and skills to the home environment and contributed to the perceived success and sustainability of initiatives. These outcomes are relevant to reducing modifiable risk factors for cancer and chronic disease. However, barriers such as transportation and time constraints limited parent involvement. Few studies systematically evaluated outcomes or impacts in relation to equity-related factors.

Conclusions

Gardening initiatives that foster social capital – through engagement with parents, peers, and family members, and school-community partnerships – may support positive health-related outcomes for children and youth, including those relevant to cancer and chronic disease prevention. However, to enhance their potential to reduce inequities in health outcomes, these initiatives should be developed, implemented, and evaluated with explicit attention to equity-related factors. Rigorous, equity-focused evaluation is needed to assess the extent and nature of equity-related effects and to strengthen the evidence base for gardening as a strategy to reduce disparities in cancer and chronic disease risk among children and youth.

Trial registration

N/A.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-25392-3.

Background

Cancer and other non-communicable chronic diseases – such as cardiovascular disease and diabetes – continue to be the leading causes of death and disease burden worldwide [1, 2]. Within and between countries, the distribution of cancer cases is shaped by social inequities, with disparities evident across sociodemographic factors including age, sex and gender identity, race and ethnicity, Indigenous identity, education, geographic location, and income [3–5]. While the causes of cancer and chronic disease are complex, many cases are preventable through improvements to the broader social, economic, and environmental conditions that influence how people live, work, play, and age [6, 7]. Addressing the social determinants of health (SDH) is essential to reducing disparities in preventable risk factors for cancer and chronic disease and achieving equitable health outcomes [5, 7–9].

Gardening initiatives – defined as organized efforts in public spaces that use gardening activities to promote and support health and well-being – offer a promising opportunity to improve the unequal distribution of modifiable risk factors (MRFs) for cancer and chronic disease across the life course [10–12]. Evidence suggests that these initiatives can positively impact children and youth by promoting healthier eating habits, increasing physical activity, and supporting emotional and psychosocial well-being [10, 11]. However, in the absence of action on the SDH, gardening initiatives alone may be insufficient to produce sustained behavior change among children and youth and reduce risk of cancer and chronic disease.

While gardening initiatives are a promising means to improve social and physical environments, their availability and accessibility are unevenly distributed across populations [12]. If not designed with equity in mind, these initiatives risk creating, reinforcing, or exacerbating health inequities [12, 13]. Factors that can inhibit fair access to and distribution of gardening initiatives include unequal access to land, funding, and resources; climate and environmental conditions; limited social and community support; active and public transportation options; lack of gardening knowledge; cultural practices and preferences; and exclusion of equity-denied populations from collective decision-making [14, 15]. These challenges not only hinder the inclusiveness of gardening initiatives but also threaten their long- sustainability and impact.

Previous reviews of gardening initiatives for children and youth in school and community settings have primarily focused on academic and health and wellbeing outcomes [10, 16–24]. However, no reviews to date have applied an explicit equity lens in recognition that not all community members have equal access to the supports, resources, and opportunities necessary to participate in gardening activities. Consequently, it remains unclear whether, and to what extent, gardening initiatives have been intentionally designed to be inclusive, accessible, and responsive to the needs of diverse communities, including those disproportionately affected by cancer and chronic disease due to the SDH. The purpose of this review is to identify whether equity-related factors have been considered in gardening initiatives for children and youth, and to explore any reported equity-related effects. By doing so, it seeks to inform the development of more inclusive and impactful gardening initiatives that contribute to equitable cancer and chronic disease prevention.

Methods

A rapid review of peer-reviewed literature was conducted in March 2024, following the guidance of the National Collaborating Centre for Methods and Tools [25]. Rapid review methodology was chosen due to limited human resources and the need for timely evidence to support project development. The rapid review sought to determine the effect(s) of gardening initiatives on MRFs for cancer and chronic disease among school-aged children and youth [26].

Primary rapid review

The primary rapid review sought to answer: What is the effect of gardening initiatives on MRFs for cancer among school-aged children and youth? Included studies were published in English in the last ten years (2014-24) and reported on gardening initiatives – defined as any initiative that includes planning, preparing, planting, growing, and/or harvesting any kind of edible plants – for school-aged children and youth (0–18 years of age) in countries with high-income economies. The included studies reported health outcomes related to key MRFs for cancer and chronic disease, including nutrition-related behaviors; body weight and abdominal adiposity; physical activity; sedentary behavior; psychosocial factors; and ultraviolet radiation behaviors. Studies were included if the gardening initiative took place in an educational or community setting, at any time.

The rapid review was conducted by a specialized librarian in March 2024 across seven databases (MEDLINE (Ovid); PsycINFO; PubMed; CINAHL; MEDLINE (EBSCO); Cochrane Library) as well as AHS Insite, OAISter, ClinicalTrials.gov, ASCO and ESMO. Healthevidence.org and Google Scholar. Both reviewers then followed a multi-step dual screening and selection process. Reviewers independently screened all titles and abstracts followed by full text for inclusion eligibility. Cohen’s Kappa for initial and full screening was 0.58 and 0.60 respectively (81% and 85% proportion agreement). One reviewer conducted critical appraisal of included studies using the Mixed Methods Appraisal Tool (MMAT) [27]. A second reviewer checked a 20% random sample for accuracy verification. No studies were omitted based on quality scores.

Secondary analysis

Following the primary rapid review, the authors conducted a secondary analysis. This was undertaken in recognition that it is inadequate to view MRFs as being under the control of individuals without considering the SDH that lead to differences in opportunities to engage in healthy behaviors. Only individual studies in the primary rapid review were included and individual studies that described the same intervention were grouped.

The PROGRESS-Plus framework was used to apply an equity lens to the review by providing a structured way to identify and analyze equity-related factors and effects [28, 29]. Categories that were applicable in the context of this review included place of residence, race/ethnicity/culture/language, gender/sex, religion, social capital, socioeconomic status (SES), food security, and age/grade (Table 1). Other PROGRESS-plus categories (e.g., occupation and education) were not considered relevant for the population of interest and were therefore excluded.

Table 1.

PROGRESS-Plus categories included in study extraction

PROGRESS
Place of residence	Rural/urban, area deprivation, housing characteristics
Race/ethnicity/culture/language	Racial, ethnic, and cultural background
Gender/sex	Male, female, or other
Religion	Religious background
Social capital	Family/peer/community support, networks, and cohesion
Socioeconomic status (SES)	Family, school, or community-level combined measure of economic and social position
Plus
Food security	Household-level
Age/Grade	Age and/or grade level

Social capital was framed as the benefits that children and youth gain from social relationships and recognized as a positive SDH that promotes equitable health outcomes across the life course [30]. Three key constructs of social capital were examined: social support (direct or perceived assistance from social relationships), social networks (the people one interacts with and the nature of those relationships), and social cohesion (the perceived strength of groups to which one belongs) [30]. SES was classified by whether the concept had been measured at the family, school, or community level [31]. Food security was included as a relevant factor, recognizing the role of gardening initiatives in enhancing both household and community-level food access [32]. Lastly, age and/or grade level was considered, acknowledging that interventions may require tailoring to align with developmental differences among children and youth.

To synthesize the evidence, two reviewers independently extracted relevant data from each study using an a priori data extraction form. One section captured equity-related factors –the characteristics that stratify health outcomes across populations – which were considered in the design and reporting of gardening initiatives. Another section captured equity-related effects referring to the outcomes and impacts of gardening initiatives on reducing or exacerbating health inequities among different population groups, including analyses of both intervention effects and differential effects. Both equity-related factors and effects were systemically operationalized using the PROGRESS-Plus framework. Although a protocol for this rapid review was developed, it was neither registered nor published (available upon request). Search results are reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and checklist [33].

Results

The search process resulted in 37 individual studies (representing 31 unique initiatives) (Fig. 1) [34–70]. Most studies were assessed to be high quality (n = 21) with eight moderate quality and two weak quality (Table 2). The corpus of literature comprises 14 observational studies, 12 descriptive studies, and 11 experimental studies. The gardening initiatives were predominantly implemented in a school setting (n = 24), with 6 initiatives conducted in daycare or childcare centers, and 4 in community settings. Two studies took place across multiple settings.

Fig. 1.

PRISMA flow diagram

Table 2.

Quality assessment for individual studies included in rapid review

Author (Year)	Critical Appraisal Score
	Low	Moderate	Strong
Ambusaidi et al. (2018) [34]	✓
Carlsson et al. (2016) [35]			✓
Chaufan et al. (2015) [46]	✓
Christian et al. (2014) [57], Hutchinson et al. (2015) [38]			✓
Cosco et al. (2022) [65]	✓
Davis et al. (2021) [66]; Landry et al. (2021) [66]; Jeans et al. (2023) [71]			✓
Duncan et al. (2015) [67]			✓
Eckermann et al. (2014) [68]			✓
Gatto et al. (2017) [69]; Landry et al. (2019) [48]		✓
Grier et al. (2015) [70]		✓
Hanbazaza et al. (2015) [36]; Triador et al. (2015) [36]			✓
Holloway et al. (2023) [37]			✓
Huys et al. (2019) [39]			✓
Johnson-Jennings et al. (2020) [41]	✓
Kararo et al. (2016) [42]			✓
Kelly & Brännlund (2024) [43]			✓
Kim & Park (2020) [44]			✓
Knapp et al. (2019) [45]			✓
Lam et al. (2019) [47]			✓
Lee et al. (2017) [50]; Soltero et al. (2021) [58]			✓
Lohr et al. (2020) [52]		✓
Lohr et al. (2023) [51]			✓
Nury et al. (2017) [53]			✓
Rees-Punia et al. (2017) [54]			✓
Richardson et al. (2023) [55]			✓
Schultz & Rosen (2022) [56]			✓
Spears-Lanoix et al. (2015) [59]		✓
Vinueza et al. (2016) [61]			✓
Wansink et al. (2015) [62]			✓
Wells et al. (2014) [64]		✓
Wells et al. (2023) [63]		✓

Social capital emerged as the most frequently considered equity-related factor across the studies, appearing in sample characteristics, methodological approaches, and intervention design (n = 36, 97%). This was followed closely by age and/or grade level of participants (n = 35, 95%) and socioeconomic status (n = 31, 84%). Most studies also reported on sex and/or gender (n = 27, 73%), as well as race, ethnicity, culture, and/or language, which were incorporated in an equal number of studies (n = 27, 73%). In contrast, fewer studies accounted for place of residence (n = 15, 41%), and food security was the least frequently reported equity-related factor (n = 10, 27%). A summary of all equity-related factors and intervention effects is provided below, with full extracted data available in an additional file [see Additional file 1. Equity-related factors and effects of included studies].

Social capital

All but one study included at least one construct of social capital in the design or implementation of their gardening initiative [34–52, 54–70]. Engagement strategies included newsletters, meetings, and events involving parents and community members. Teachers, older youth, and community members were trained to deliver or facilitate programming, which was extended to families and broader community networks. These initiatives often created opportunities for shared activities such as gardening and communal meals among children, peers, parents, and community members. Children were encouraged to discuss their experiences and knowledge related to gardening and healthy eating. Several studies also described the involvement of volunteers and the formation of leadership committees and collaborations with partners (e.g., teachers, school staff, students, parents, community members) to support garden development and maintenance.

Although studies reported positive associations with social capital constructs, none conducted differential analyses. The following sections summarize equity-related outcomes across various social networks.

Parent-child

Parent–child social capital refers to the interpersonal and psychological relationship between a child and at least one parent or primary caregiver. Several studies found that gardening initiatives supported stronger parent–child relationships through shared activities and enhanced bonding time [34, 43, 46, 53]. Some evidence indicated that parent involvement was linked to improved communication around food and nutrition [34, 43, 46, 50, 53, 58]. Children reportedly shared gardening and nutrition knowledge at home and participated in meal preparation, potentially influencing household food choices and purchasing behaviors [43, 45, 46, 50, 53, 58, 59].

However, not all studies observed improvements. For example, a school-based gardening, cooking, and nutrition education intervention reported low parental participation in monthly cooking sessions, with only 7% of consented parents attending at least one event despite incentives such as free meals, childcare, and produce giveaways [40, 49, 66]. Common barriers included transportation and time constraints.

Family

Family social capital encompasses relationships between children and their kin, including siblings and grandparents. Some studies indicated that gardening initiatives facilitated increased family engagement in food-related activities and discussions [41]. These experiences were associated with enhanced feelings of connection and strengthened family bonds, particularly when children supported relatives in home gardening [53]. Involvement of family members also appeared to reinforce values, skills, and behaviors introduced through the initiatives, contributing to continuity between school and home environments [35, 38, 45, 57].

Child-peers

Child–peer social capital involves relationships among individuals at similar developmental stages. In school settings, gardening activities and communal meals provided opportunities for children to develop social skills [34]. One study encouraged students to prepare recipes using garden-grown produce and eat them together with other students [48, 69], while another integrated “family-style” meals to promote decision-making and social interaction [46]. Finally, a pre-school community garden increased interaction among peers, with parents reporting improvements in their children’s ability to communicate with other children and take turns [43].

Some studies described enhanced peer relationships and a sense of relatedness (i.e., connection and belonging in a social environment) through shared gardening experiences. One study found participating in school gardening fostered a strong sense of relatedness among children, as they regularly collaborated and supported one another with gardening tasks [53]. Another study also found that students reported feeling more connected to classmates, although no correlation was found between garden exposure duration and peer connectedness—possibly due to pre-existing social dynamics [51].

School community

School community social capital includes relationships among staff, students, and families within a school. Gardening initiatives were frequently described as strengthening these connections. Teachers often acted as role models for healthy eating and behaviors during communal meals and snack times [46]. One study found that teacher-led activities were more effective than those led by external facilitators in promoting positive attitudes toward healthy eating and increasing fruit consumption [38, 57].

Across studies, teacher involvement was consistently highlighted as a key factor in initiative success. Training and formal integration of gardening curricula enabled teachers to support students both in classrooms and garden settings, contributing to outcomes related to nutrition knowledge, healthy behaviors, and social development [37, 50, 58]. Teachers also reported that gardening allowed for more individualized attention and social support [45]. Furthermore, some studies noted improvements in academic skills, such as vocabulary development, alongside enhanced nutritional knowledge [50, 58].

Parent/Community and neighborhood community

Parent/community social capital refers to relationships between parents (or caregivers) and the broader community, while neighborhood community encompasses connections among individuals in a shared geographic area. These constructs often overlapped in gardening initiatives that engaged multiple partners. For example, one study described a parent body that facilitated engagement across families and the wider community [37]. Community support through donations, sponsorships, and grants was cited as essential for sustaining initiatives [37].

Collaborations with local neighborhood organizations also played a role in the overall success of gardening initiatives. One program partnered with a food bank to supplement garden produce, improving access to healthy food for children and families [46]. Another initiative donated harvested produce to farm stands and food banks, contributing to efforts to address food insecurity [56]. Volunteer contributions – amounting to thousands of hours – were noted as strengthening community ties and extending the impact of gardening programs beyond the school setting [45, 47, 51, 56].

Grade level/age

Participants ranged in grade level from pre-school to grade 12, with a mean of 4.91 and a median of grade 4. Ages spanned from 1 to 17 years, with a mean age of 8.29 and a median of 9 years. While no overarching equity-related effects tied to age or grade were reported across studies, three studies conducted subgroup analyses based on these variables [44, 51, 63]. One study examining a childcare gardening intervention [63] explored associations between participant age and levels of moderate to vigorous physical activity as well as sedentary time. Statistically significant interactions were observed, with the strongest effects among the youngest children (mean age = 3.3 years). These associations appeared weaker among middle-aged children and were least pronounced in the oldest tertile (mean age = 4.5 years), suggesting that age may influence how children engage physically during gardening activities.

Another study involving a school-based program [44] reported statistically significant improvements (p < 0.05) in gardening and nutrition knowledge, outcome expectancies for vegetable consumption, self-efficacy, and vegetable preferences among both 3rd and 6th grade students. Notably, reductions in food neophobia were observed among 3rd graders but not among 6th graders, indicating potential grade-level differences in responsiveness to the intervention. Finally, a third study [51] found that 5th grade students had higher self-reported learning scores than their 3rd and 4th grade peers. However, this finding may have been a result of unmeasured variables like maturity level.

Socioeconomic status (SES)

Most of the included studies considered SES at the family, school, or community level [21, 36–40, 42, 45, 46, 48, 50–65, 67–70]. Many addressed SES by recruiting participants or reporting the proportion eligible for free or subsidized lunch programs [38, 40, 48, 51, 57, 66, 69]. These efforts often had a meaningful impact on low-SES households, as students applied newly acquired skills to influence family food practices [37, 45, 61]. Nonetheless, engaging parents from low-SES backgrounds remained a challenge, even when initiatives offered incentives such as free childcare or flexible scheduling [40, 49, 66].

Three studies reported SES-related differences in outcomes [38, 57, 68]. One found a significant positive association between parental education and children’s dietary habits and social behavior (p = 0.017) [68]. Another initiative involving low-SES children [38, 57] observed no distinct advantage for targeted programming compared to broader approaches. However, during implementation, participants from higher-SES backgrounds showed slightly greater increases in mean fruit and vegetable intake than their lower-SES counterparts [38, 57].

Sex/gender

Sex and/or gender was considered in the sample characteristics of 25 studies [34, 36, 38–40, 44, 45, 47–51, 53, 55, 57, 58, 60, 61, 63–67, 69, 70] and incorporated into the methodology of two studies [35, 51]. Most studies reported no baseline differences between sexes/genders [38, 40, 48, 49, 57, 61, 65–67, 69]. Several studies observed positive outcomes for both females and males following participation in gardening initiatives as well as differential effects based on sex/gender [34, 51, 54, 63, 68]. For instance, one study found that females scored significantly higher in self-reported learning (95% CI = 0.31, 3.53) compared to males [51], while another reported higher food choice domain scores among female students (p < 0.001) [68].

In terms of activity patterns, one study [54] noted that female students were more engaged in harvesting, gardening, and squatting, whereas males tended to participate in non-gardening-related light to vigorous physical activities and spent more time standing. Another study [63] identified a statistically significant moderating effect of child sex on daily moderate to vigorous physical activity (p = 0.021), with a greater increase observed in males (28%) than females (13%). Although not statistically significant, males also showed a larger reduction in sedentary time. Finally, a study conducted in single-sex schools [34] revealed distinct thematic differences in participant interviews, which the authors attributed to varying teaching approaches.

Race, ethnicity, culture, and/or language

Twenty-seven studies addressed race or ethnicity within participant demographics or initiative design [36, 38, 40–42, 45, 46, 48–60, 62–66, 69, 70]. Of these, 70% primarily involved ethnic minority and/or non-White participants [36, 40, 41, 45, 48–52, 56, 58–60, 63–66, 69, 70]. Eight studies considered language-related factors [38, 40, 46, 49, 50, 57, 58, 66]. For example, one initiative provided bilingual recipe materials in Spanish and English [46], while others engaged bilingual educators [40, 49, 66].

Cultural relevance was a recurring theme in initiative design. Several studies incorporated culturally tailored recipes, content, and activities, including the use of specific ingredients such as tomatoes, squash, and cilantro [40, 41, 49, 66, 70]. Others aligned with cultural practices by integrating elements like line dancing and weekly tribal teachings and ceremonies [41, 70]. One initiative was situated in a historically significant neighborhood and featured local plants and a cultural shrine [51]. Another emphasized food literacy through storytelling, intergenerational learning, and social connection [47].

Gardening initiatives further fostered family engagement by embedding cultural components. In an Indigenous program, communal meals encouraged conversations about heritage and identity [41]. Families explored cultural traditions through gardening and cooking, promoting intergenerational dialogue, cultural revitalization, and cultural continuity [41]. These efforts also positively influenced food-related attitudes and behaviors among Indigenous and African American children [41, 45].

Six studies, representing three distinct initiatives, reported differential outcomes based on race, ethnicity, culture, or language [40, 48, 49, 51, 66, 69]. One found that participants were less likely to speak English at home compared to controls [48, 69]. Another observed stronger teacher and peer connectedness among Latina/o participants, who also reported higher learning scores than their non-Hispanic peers [51].

A school-based initiative, examined across three studies, revealed a significant interaction between intervention group and ethnicity/race in vegetable consumption (p = 0.033) [40, 49, 66]. Non-Hispanic participants showed a notable increase in total vegetable intake compared to controls, whereas the change was not significant for Hispanic participants. However, Hispanic children demonstrated improved dietary quality, with increased consumption of unprocessed or minimally processed foods—such as milk, plain yogurt, and whole wheat pasta—and reduced intake of ultra-processed items like reconstituted meats and fish.

Place of residence

Fifteen studies considered participants’ place of residence [36, 37, 41, 43, 45, 50, 52, 54, 56, 58, 60, 61, 64, 68, 70]. Most provided demographic context by identifying study settings as rural, urban, or metropolitan. One study reported that students from provincial schools scored significantly higher in food choice measures compared to their metropolitan counterparts (p < 0.001) [68]. However, no additional analyses were conducted to explore differential effects based on place of residence.

Food security

Food security emerged as the least addressed health equity factor across the reviewed studies [35, 37, 40, 41, 45, 46, 49, 52, 56, 66], with no differential effect analyses conducted. Several initiatives sought to leverage gardening as a tool to promote equitable access to nutritious foods, reduce community-level food insecurity, or support broader systemic efforts toward long-term food security [35, 49, 52, 56, 71, 72]. Some studies assessed baseline participant demographics or included measures of food security [37, 40, 41, 45, 46, 49, 66]. These assessments included frequency of food pantry use [46], recruitment from areas with high reported food insecurity [37, 45, 52], and survey items addressing household food access [40, 41, 49, 66].

Gardening initiatives demonstrated potential to enhance food security at individual, familial, and community levels. Reported outcomes included increased food-related knowledge, skills, and values [35, 45]; improved food literacy and self-efficacy [37, 45]; greater endorsement of food security [41]; and strengthened gardening competencies and attitudes [37]. One study [35] highlighted a school garden program that cultivated advanced comprehension among children, instilled sustainability skills in food cultivation and preparation, and promoted a heightened sense of social and environmental responsibility. These outcomes were identified as key contributors to advancing community food security.

Discussion

The purpose of this review was to identify whether equity-related factors have been considered in gardening initiatives for children and youth, and to explore any reported equity-related effects. The findings offer compelling insight into how gardening initiatives can be leveraged to advance equitable cancer and chronic disease prevention. Consistent with existing literature, gardening initiatives were found to foster interpersonal skills and build social connections, contributing to enhanced supportive environments for health [73–75]. These environments are critical for reducing risk factors associated with cancer and chronic disease, particularly among populations experiencing health inequities. Indeed, gardening initiatives cultivate social capital by encouraging community participation, providing opportunities for social interactions, and nurturing a sense of belonging [75]. In turn, social capital promotes health equity by expanding social networks and improving access to health-promoting spaces, resources, and opportunities [73, 75]. These mechanisms are particularly relevant for cancer and chronic disease prevention, as they help mitigate the effects of the SDH that disproportionately impact equity-denied populations.

However, to avoid reinforcing existing inequities and support sustainability, it is essential to proactively address barriers that limit parent, family, and community involvement [76]. Effective strategies to support engagement may include offering flexible scheduling to accommodate diverse routines, utilizing digital platforms for communication, and offering incentives such as complimentary transportation and meals [10, 77]. Moreover, early and sustained community engagement is vital to ensure that gardening initiatives are perceived as relevant, beneficial, and culturally meaningful to equity-denied populations – and that they remain viable within the context of local capacity and resources [78]. These efforts are essential for ensuring that gardening initiatives contribute meaningfully to cancer and chronic disease prevention across diverse populations and settings.

Although many studies included in this review incorporated participant SES by collecting sociodemographic data or implementing gardening initiatives in low-income communities, few explicitly considered SES or place of residence when evaluating outcomes. This oversight is notable given that gardening has demonstrated particular health benefits for equity-denied populations – yet these same groups face limited access to health-promoting activities, resources, and supports [12, 13]. To promote health equity and reduce disparities in cancer and chronic disease outcomes, it is essential to address the social and structural challenges that communities may encounter when developing gardening initiatives. These vary within and across settings but may include transportation limitations, population and housing density, and restricted access to land and water [15, 75, 79]. Recommendations to mitigate common barriers include prioritizing funding and outreach in neighborhoods with lower educational attainment and income; employing garden facilitators to assist with development and maintenance; and fostering intentional partnerships between individuals and community organizations to collaboratively organize and share resources [13].

School-based gardening initiatives have historically faced criticism for disproportionately focusing on White and affluent populations [74]. However, the majority of community- and school-based studies included in this review centered on initiatives for ethnic minority and racialized children and youth. This shift reflects growing efforts to acknowledge and address racial and ethnic inequities in access to health-promoting resources and opportunities. Such initiatives hold promise for advancing health equity and reducing disparities in cancer and chronic disease risk, as garden access has been shown to influence health and well-being differently across populations [12, 80]. For example, one study that explored home and community garden access among urban high school students (ages 13–19) found notable disparities by race and ethnicity. Students with garden access reported better self-rated health and higher vegetable consumption compared to those without access [80] – both of which are protective factors against chronic disease and certain cancers.

Consistent with prior research, findings suggest that gardening initiatives tailored to sociocultural contexts—and designed to respectfully incorporate traditions, customs, and language—are effective in fostering sustainable and equitable health outcomes [18, 21]. Initiatives that included culturally relevant elements, such as traditional foods and culturally appropriate practices, were shown to support cultural revitalization and strengthen intergenerational connections. These experiences enabled youth to engage with their heritage while simultaneously learning about healthy behaviors that reduce cancer and chronic disease risk. In multicultural settings, inclusive gardening initiatives can also serve as a platform for collaboration and resource-sharing among diverse groups. Such efforts may enhance cultural awareness, reduce social isolation, and help address structural determinants of health, including racism, discrimination, and marginalization [81–83].

Designing and implementing equity-focused gardening initiatives for children and youth requires a deliberate and inclusive approach that considers equity-related factors and expands access to health-promoting resources. Initiatives should prioritize meaningful participation from community members – particularly those most impacted by health inequities – in planning and decision-making processes. To guide equitable design, community members and researchers can apply equity frameworks like PROGRESS-Plus [29], which help identify characteristics that contribute to health inequities and ensure a comprehensive consideration of the SDH. Integrating gardening programs with broader community health efforts – such as housing, healthcare, and education initiatives – can further strengthen their impact and contribute to a more holistic strategy for reducing health inequities and preventing cancer and chronic disease [12, 13, 21].

This review underscores a critical gap in understanding how gardening initiatives influence health equity among children and youth, their families, and communities. While some studies included in this review employed experimental designs, the majority relied on observational or descriptive methods, which limit the ability to draw causal conclusions. Although these approaches are valuable for exploring equity-related effects, claims regarding long-term health benefits or reductions in health inequities should be made with caution. To advance equity-focused evaluation, future research should integrate individual health and well-being indicators (e.g., fruit and vegetable intake, physical activity levels) with broader social outcomes (e.g., community engagement, access to resources) and assess impacts across diverse subgroups.

Strengthening causal inference in community-based settings will require quasi-experimental designs with matched comparison groups or rigorous statistical adjustments for key confounders [14]. Evaluations should also be guided by theory-driven frameworks – such as realist evaluation and other explanatory models – to reveal not only whether an initiative works, but how, for whom, and under what conditions it fosters equitable outcomes in cancer and chronic disease prevention [45, 75, 84, 85]. Finally, adhering to established health equity reporting guidelines will improve the transparency, clarity, and completeness of equity-related data [86].

Strengths and limitations

This rapid review followed a rigorous rapid review methodology involving two independent reviewers to identify over thirty unique gardening initiatives for children and youth. The application of the PROGRESS-Plus framework provided a consistent equity lens, allowing for the assessment of whether studies reported equity-relevant data. However, due to time constraints, full quality appraisal was conducted by only one reviewer, which may have introduced bias or reduced reliability. As a secondary analysis, this review may have also excluded equity-focused studies not captured in the original rapid review. The inclusion criteria required studies to report health outcomes related to MRFs, but not necessarily equity-specific outcomes. Consequently, the conclusions drawn may not fully represent the broader evidence base on the design, implementation, and evaluation of equity-focused gardening initiatives. Further research is needed to explore whether studies outside the scope of this review have demonstrated measurable impacts on health equity.

Conclusions

Gardening initiatives offer considerable potential to enhance both social and physical environments, while also fostering knowledge and behaviors linked to MRFs for cancer and chronic disease. To ensure these benefits are equitably realized, initiatives must be co-designed with communities most impacted by health inequities and intentionally tailored to address the SDH that shape cancer and chronic disease outcomes. Strengthening the evidence base requires that future studies incorporate health equity into both evaluation and knowledge mobilization efforts, including particular attention to disparities in cancer and chronic disease risk. Embedding an equity lens into the design, implementation, and assessment of gardening initiatives will maximize their potential to effectively reduce health risks and promote the well-being of all children and youth.

Abbreviations

SDH

Social Determinants of Health

MRF

Modifiable Risk Factor

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

SES

Socioeconomic Status

Authors’ contributions

CG was responsible for conceptualization, methodology, investigation, formal analysis, writing - original draft, and writing – review & editing. CB was responsible for investigation, formal analysis, writing – review & editing.

Funding

Funding provided, in whole or in part, by Alberta Health. Strategic direction and applied research support provided by the Primary Care Alberta (PCA) Cancer Prevention and Screening Innovation (CPSI) team. Provision of funding by Alberta Health does not signify that this represents the policies or views of Alberta Health. The content and conclusions in this manuscript are those of the authors and do not necessarily reflect the official position of PCA.

Data availability

The study protocol, full search strategies, and raw data extraction and quality appraisal forms can be retrieved by contacting the corresponding author up to five years after publication.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.