Evidence on the contribution of community gardens to promote physical and mental health and well-being of non-institutionalized individuals: a systematic review

RESEARCH ARTICLE Evidence on the contribution of community gardens to promote physical and mental health and well-being of non-institutionalized individuals: A systematic review Tarsila LampertID 1 *, Joana Costa 2 , Osvaldo Santos 1,2,3 , Joana Sousa 1,4 , Teresa Ribeiro 5 , Elisabete Freire 6 1Instituto de Sau ´de Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal, 2EnviHeB Lab, Instituto de Sau ´de Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal, 3Unbreakable Idea Research, Lisboa, Portugal, 4Laborato ´rio de Nutric¸ão, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal, 5Ca ˆmara Municipal de Cascais, Lisboa, Portugal, 6Departamento das Ciências Sociais do Territo ´rio, Faculdade de Arquitectura, Universidade de Lisboa, Lisboa, Portugal *[email protected] Abstract Introduction There has been growing interest in community gardens as an effective and affordable health promotion strategy. However, most available evidence is derived from qualitative studies, whereas quantitative research on this subject is limited. Objectives To synthetize the literature about physical and mental health outcomes associated with community gardening. Two main questions were addressed: a) is there evidence, from quantitative studies, that community gardening is associated to physical and mental health and well-being of non-institutionalized individuals? b) Does community gardening provokes any discomfort in terms of physical health, i.e., bodily pain, to their beneficiaries? Methods A systematic review of the literature was carried out following PRISMA guidelines by searching relevant electronic databases (PubMed, Scopus, and Web of Science). Empirical, quantitative studies published in English with no restrictions concerning the date of publication were considered eligible. The quality of the evidence was appraised using the tool developed by the National Heart, Lung, and Blood Institute of the National Institutes of Health for Observational Cohort and Cross-Sectional Studies. Results Overall, 8 studies were considered eligible, of which seven studies were rated as having good methodological quality (one scored as fair). Community gardeners had significantly PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 1 / 19 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Lampert T, Costa J, Santos O, Sousa J, Ribeiro T, Freire E (2021) Evidence on the contribution of community gardens to promote physical and mental health and well-being of noninstitutionalized individuals: A systematic review. PLoS ONE 16(8): e0255621. https://doi.org/ 10.1371/journal.pone.0255621 Editor: Marcel Pikhart, University of Hradec Kralove: Univerzita Hradec Kralove, CZECH REPUBLIC Received: February 9, 2021 Accepted: July 20, 2021 Published: August 6, 2021 Copyright: ©2021 Lampert et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This literature review was funded by the Fundac¸ão para a Ciência e a Tecnologia and by the Empresa Municipal de Ambiente de Cascais through a doctoral grant to the first author of this paper (PDE/BDE/122672/2016). The funders had no role in study design, data collection and better health outcomes than their neighbours not engaged in gardening activities in terms of life satisfaction, happiness, general health, mental health, and social cohesion. Conclusion Community gardens are associated to health gains for their users, irrespective of age, being an affordable and efficient way of promoting physical and mental health and well-being. To encourage the design, maintenance, and prospective evaluation of supportive urban environments promoting healthy and, at the same time, sustainable lifestyles, is essential to achieve public health gains and environmental sustainability. Introduction The global burden of mental illness is considerable, and it encompasses individual, family, social and economic impacts [1]. At the individual level, people suffering from (transient or chronic) mental illness also experience impaired quality of life characterized by distress-related feelings, lack of control, low self-esteem and confidence, among others [2,3]. This condition strongly affects their everyday living [4], including their social interactions [5] and performance at the workplace [6]. Moreover, stigma and discrimination towards people with mental illness still prevails. with negative consequences for those mentally ill [7], who might refrain from seeking professional help [8]. A recently published literature review concluded that the global burden of mental illness in terms of years lived with disabilities (YLDs) has been underestimated, and placed mental illness at the top of the list accounting for 32.4% of YLDs [1]. Concerning disability-adjusted life-years (DALYs), mental illness is at the same level as cardiovascular and circulatory diseases, accounting for 13.0% of DALYs [1]. These pictures call for action against the high burden of mental illness and gain urgency in the context of the current COVID-19 pandemic. The available literature addressing the impact of COVID-19 on mental health supports psychological suffering (e.g., anxiety, depression, post-traumatic disorder, psychological distress) from lockdowns, social distancing measures, being diagnosed with COVID-19 or being a health professional working at the frontline [9–11]. Now more than ever before, mental health promotion should be the main avenue to tackle the burden of mental illness. Human contact with nature has been highly valued in health promotion over the last years. As such, there has been a growing interest on the health benefits from greenspace exposure, i.e., parks, gardens and forests, with evidence in favour of positive health outcomes (e.g. [12– 17]). Interestingly, some authors argue that the mental health benefits arising from the contact with nature should embody the list of services provided by the natural ecosystems [13], which include crop pollination and climate regulation, among others. Empirical evidence supports the beneficial influence of greenspace exposure on several health outcomes. These include physical and general health [18]; disease prevention [19–21]; restoration of the individuals’ psychological resources by providing them with an environment free from physical and social stressors [22]; and improvement of the cognitive function, including memory, attention, concentration and impulse inhibition [23]. Contact with nature in urban areas is challenging, because outdoor greenspaces are much reduced compared to non-urban, rural areas. Cox et al. (2017) investigated which natural characteristics of selected neighbourhoods in British urban areas contributed the most for mental health gains of the nearby residents. These authors concluded that vegetation cover and the PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 2 / 19 analysis, decision to publish, or preparation of the manuscript. Competing interests: We declare that the Author OS is the CEO of the company Unbreakable Idea Research, which is a for-profit organization in the areas of health services, health-related training and applied health research. This affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials. We also declare that the company does not have any direct benefit from the involvement of its CEO in this project. abundance of birds in the afternoon were the most relevant factors contributing for mental health benefits measured as decreased prevalence of depression, anxiety, and stress. Another study concluded that the prevalence of mental health conditions can be reduced if minimum values of vegetation cover are maintained [20]. Thus, green spaces can also function as a promotion strategy for mental health [24]. These findings are highly relevant to inform strategic public health interventions and support urban planning solutions that ease the interaction between city dwellers and nature [25]. In 2019, approximately 57% of the world population lived in cities [26] and spent the great majority of the time indoors (e.g., at home, school, workplace); pre-COVID-19 pandemic estimates pointed out that humans spend, on average, 85–90% of their time indoors [27]. Then, the great challenge is to integrate nature within the urban infrastructure. One avenue to tackle this issue is by promoting citizens’ participation in community gardens [28]. Community gardens are also known as urban gardens, allotment gardens, allotments, community agriculture, agricultural allotments, roof top gardens, roof top agriculture, roof top farms, all these terms referring to a greenspace located in an urban area, where community residents mainly grow vegetables for their own consumption, although border flower beds are also commonly grown, while profiting from it in the company of other members from the neighbourhood and/or their family with no imposed frequency schedule [29]. Community gardens serve various relevant functions at multiple levels. At the environmental level, they can add to climate change mitigation by sequestrating atmospheric carbon, thus contributing for reducing the amount of greenhouse gases [30]. As previously mentioned, community gardens are also considered a sustainable way to improve the quality of life of city dwellers [31,32], namely by providing citizens with the opportunity to be in close contact with nature [33,34] while supporting healthy lifestyles [35]. Horticultural therapy, i.e., the engagement of individuals in horticultural activities with live plants to improve their health and well-being [36], has produced health benefits on people with various mental health conditions in different settings (e.g., [37–39]. However, less is known about the mental health outcomes for non-clinical populations engaging in gardening activities. A study carried out in The Netherlands provided support for a positive effect of gardening activities on relief from acute stress [40]. In another study, community gardeners were induced some stress and randomly assigned to a 30-min outdoors gardening session or indoors reading. The levels of stress measured as salivary cortisol and self-reported positive mood were significantly lower in those assigned to gardening activities versus the reading group [40]. There is also some evidence that engaging in community gardening improves well-being by encouraging healthy behaviours, such as physical activity [41] and the consumption of locally grown healthy foods [42,43]. Moreover, a qualitative study conducted in the United States pointed out that gardening is considered a moderate intensity activity that can provide older adults with the health benefits of regular moderate intensity physical activity [44]. On the other hand, some body positions during gardening can be uncomfortable or even cause pain when the target audience is the elderly [44]. Despite increased attention that community gardening has received in recent years, most available evidence on health and well-being promotion comes from qualitative studies [45,46]. As such, this study aims to review quantitative evidence about physical and mental health outcomes of community gardening. More specifically, this literature review addresses two main questions. First, is there evidence, from quantitative studies, that community gardening contributes to increased physical and mental health and well-being of non-institutionalized individuals? Second, does community gardening provokes any discomfort in terms of physical health, i.e., bodily pain, to their users? To answer these questions, a systematic literature review following PRISMA guidelines [47] was conducted. PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 3 / 19 Methods Search strategy and inclusion criteria A systematic literature review was performed following PRISMA guidelines [47] through a search of studies contained in PubMed, Scopus and Web of Science electronic databases with no restrictions concerning publication date (PRISMA Checklist is provided as S1 Checklist). The search was conducted on July 2–4, 2019, and updated on November 17–19, 2020, by using a pairwise combination of two blocks of both free-text and medical subject headings (MeSH) terms. The search strategy followed for PubMed is provided as S1 File. The following keywords were used as alternatives: (“Community garden�” OR “Urban garden�” OR “Allotment garden�” OR Allotment OR “Community agriculture” OR “Agricultural allotment” OR “Roof�top garden�” OR “Roof�top agriculture” OR “Roof�top farm�”) AND (“Mental health” OR “Quality of life” OR �happiness OR “Well�being” OR “Life satisfaction” OR “Satisfaction with life” OR “Psychological well�being” OR “Subjective well�being” OR Depression OR Anxiety OR Dysthymia OR Loneliness OR “Musculoskeletal injur�” OR “Musculoskeletal condition�” OR “Osteo�articular injur�” OR “Osteo�articular disease�”). Citations retrieved were downloaded, duplicates were removed, titles and abstracts were independently screened for eligibility by two authors of this review (TL and JC). In case of disagreement, a third researcher (OS) independently assessed the article for eligibility. Articles were assessed for eligibility based on the following criteria: a) empirical cross-sectional quantitative studies; b) community-based studies; c) data on subjective or psychological well-being and/or physical well-being reported in the study; d) the gardens referred to in the studies were exclusively community gardens; and e) full texts available in English. Documents reporting data from studies conducted in home gardens, also referred to as household gardens, as well as qualitative studies, literature reviews and grey literature were excluded. Data extraction and analysis Data were independently extracted by two authors of this review (TL and JC) into a standardized table, and a third researcher (OS) checked data for consensus. Data extracted from each article were as follows: authors, year of publication, title of the paper, country of data collection, setting (rural versus urban), target population, sample size of the participants, sample size of gardens, inclusion criteria, exclusion criteria, characteristics of the gardens (e.g., area, number of plots), motivation(s) for selecting those gardens, health outcomes under study (i.e., subjective or psychological well-being and/or physical well-being), instruments of data collection, main conclusions, and direction of the association between community gardening and health outcomes. Quality assessment The quality of the evidence was appraised using the tool by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) for Observational Cohort and Cross-Sectional Studies [48]. This was done independently by two authors of the paper (TL and JC); in case of disagreement, an independent evaluation was made by a third researcher (OS). Results Fig 1 depicts the selection process of articles included in this systematic literature review. Eight articles were considered eligible from the initial list of 262 potentially relevant titles. Main methodological characteristics of the articles are summarized in Table 1. Studies included in PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 4 / 19 Fig 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) fluxogram of study selection. https://doi.org/10.1371/journal.pone.0255621.g001 Table 1. Characteristics of the community gardens described in the studies included in this systematic literature review. Reference Country of data collection Setting Target population Participants’ inclusion criteria Community Gardens Sample size Characteristics Blair et al., 1991 [54] United States of America Urban Gardeners from the Philadelphia Urban Gardening Project and nongardeners from the same geographical area. NS 64 NS van den Berg et al., 2010 [40] The Netherlands Urban Members of 12 allotment sites and their neighbours. NS 12 Average area of 7 ha. Hawkins et al., 2011 [50] United Kingdom Urban Individuals aged 50 and over, members of various indoor and outdoor activity groups. Aged 50 years and over NS NS Gerber et al., 2017 [49] United States of America Urban Bhutanese refugees. To be a Bhutanese refugee living in the USA 2 The majority of plots required some form of transportation to reach. Soga et al., 2017b [19] Japan Urban Nerima city residents. NS 24 Area of allotment sites ranged between 0.05 and 0.47 ha. Booth et al., 2018 [53] United States of America Urban Residents in a disadvantaged neighbourhood. NS 4 Total area of the community gardens of about 3.2 ha. Mourão et al., 2019 [51] Portugal Urban Gardeners from Devesa Park. To be a gardener from the urban organic allotment garden at Devesa Park 1 The allotment gardens included 192 family plots of 25m 2 /plot, 6 raised plots of 4m 2 /plot, 3 plots of 100 m2/plot and a common composting area (120 m 2 ), 6 tool houses, 40 water taps, rest and snack areas and sanitary equipment. The urban organic allotment gardens are integrated in the park green area; access only granted for gardeners. Koay & Dillon, 2020 [52] Singapore Urban Community dwellers residing and engaging in gardening or outdoor activities in Singapore NS NS NS Notes: NS = Not specified. https://doi.org/10.1371/journal.pone.0255621.t001 PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 5 / 19 this literature review were conducted in the United States of America (n = 3), United Kingdom (n = 1), the Netherlands (n = 1), Japan (n = 1), Singapore (n = 1), and Portugal (n = 1). All studies were conducted in an urban setting and had a cross-sectional design; one of them used a mixed-methods approach by combining cross-sectional quantitative data collection and qualitative semi-structured interviews [49]. Target population was composed of adult gardeners and non-gardeners residing in the cities where the studies were carried out; one study targeted Bhutanese refugees living in the United States [49]. In all studies, outcomes of interest were compared between gardeners and non-gardeners. With regard to inclusion and exclusion criteria, these were generally not provided in the articles, with three exceptions in which specific inclusion criteria for the target population were defined: a) individuals aged 50+ years [50], b) Nepali Bhutanese Refugees [49], and c) gardeners from the urban organic allotment garden at Devesa Park, Portugal [51]. Only the study carried out in Singapore referred to exclusion criteria: participants who did not complete the survey; individuals under the age of 18 and over the age of 100; and residents who engaged in physical activities outdoors, alone and not in a group, were excluded from the study [52]. The number of community gardens analyzed in the studies ranged from 1 to 64; however, not all studies reported this information. Community gardens were variable in terms of their characteristics, including size and facilities offered to gardeners. Detailed information regarding garden characteristics was generally not provided in the papers (Table 1). Characterization of the participants Characterization of the participants (gardeners and non-gardeners) and data on the association between gardening and mental and physical well-being are provided in Table 2. The sample size of community gardeners ranged from 16 [53] to 165 [19], whereas the number of participants enrolled in the studies who were not engaged in gardening activities ranged from 28 [49,52] to 167 [19]. One study considered two groups of participants, i.e., regular and occasional gardeners, based on the frequency they engaged in gardening activities [53]. Two studies also included a group of people who performed their gardening activities within their home gardens [50,52]. With regard to non-gardeners, one study addressed community gardening and other leisure activities for stress reduction, and the latter group included home gardeners, walkers and people who engaged in physical activity indoors [50]. No study targeted only men or women, though gender representation within groups (gardeners versus non-gardeners) was highly variable among studies (Table 2). Only two studies indicated the range of participants’ age: 50+ years old [50] and between 18 and 100 years old [52]. The remaining studies provided the average age of the participants, usually above 40 years old for both gardeners and non-gardeners (Table 2). Community gardens and mental and physical well-being Studies included in this literature review addressed two types of outcomes: physical and mental health and well-being. These were measured by asking participants to fill in specific questionnaires (Table 2). All studies assessed mental health and well-being, whereas physical health and well-being was covered in five out of the eight studies. Regarding physical health and wellbeing, respondents were generally asked to rate their general health status [19,40,49–51,53, 54]. In one study, they were also asked about chronic conditions [40]. No study investigated musculoskeletal or osteoarticular injuries related to community gardening. Concerning mental health and well-being, gardeners and non-gardeners where asked about life satisfaction [40, 51,53,54], perceived stress [40,50,52], anxiety symptoms [49], depression symptoms [49], perceived social support [49,50], health-related quality of life [50], and social contacts [19,40]. PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 6 / 19 Table 2. Characteristics of the participants, i.e., gardeners (G) and non-gardeners (NG), outcomes and conclusions of the studies included in this systematic review of the literature. Reference Participants Outcomes measured Instruments used for data collection Main conclusions Direction of the association Sample size Sex (%, female) Age (mean ±SD) Physical health & well-being Psychological wellbeing, Subjective Wellbeing and Psychossocial indicators Blair et al., 1991 [54] G: 144 NG: 67 G: 53.8% NG: 65.7% G: 60.3 ±15.1 NG: 45.5 ±15.3 • Self-reported health • Life satisfaction NS • Gardeners reported significantly higher life satisfaction and positive life events than non-gardeners. • Participants in gardening activities were more actively involved in community projects than their neighbours. Positive Van den Berg et al., 2010 [40] G:121 NG:63 G:47.1% NG: 58.7% G: 61.5 ±11.8 NG: 55.9 ±13.8 • Perceived general health • Acute health complaints • Physical constraints • Chronic illnesses • Healthcare use • Perceived stress, life satisfaction, loneliness, and social contacts with friends • Short Form Health Surveys36 (SF-36) • Life Satisfaction Index-8 • Self-reported levels of physical activity (SQUASH) Impacts of community gardening on health and well-being were moderated by age: older gardeners (+62 years) scored better for all measures of health and wellbeing than neighbors in the same age category, whereas no differences were found between younger gardeners and their younger neighbors. • Gardening had a significant positive effect on well-being, life satisfaction and loneliness. Positive Hawkins et al., 2011 [50] Community gardeners: 25 Home gardeners: 21 Walkers: 25 Indoor exercisers: 23 Community gardeners: F = 32.0% Home Gardeners: 90.5% Walkers: 68.0% Indoor Exercisers: 87.0% Community: Gardeners: 65.7 ±9.1 Home Gardeners: 69.5 ±7.7 Walkers: 62.4 ±6.8 Indoor Exercisers: 72.9 ±6.9 • BMI (Anthropometric assessment) • Perceived stress • Perceived social support • Healthrelated quality of life • Perceived Stress Scale (10-item) • Social Provisions Scale • International Physical Activity Questionnaire (IPAQ; short-form) • SF-36 v2 • Self-report of diagnosed illness • Self-report of current medication • Townsend Index Score • Community gardeners reported significantly less perceived stress than participants of indoor exercise classes, which might be due to their engagement with nature and psychological restoration. • No significant differences between groups were found for self-reported levels of social support and physical activity. Positive Gerber et al., 2017 [49] G:22 NG: 28 G:48.4% NG:51.6% G:46 ±14.32 NG:43.32 ±15.69 NS • Anxiety • Depression • Posttraumatic stress disorder • Somatization • Perceived social support • Refugee Health Screener-15 • Patient Health Questionnaire-15 • Medical Outcomes Study Social Support Survey-19 • Gardeners and nongardeners did not differ in levels of self-reported distress, symptoms of depression, anxiety and somatic complaints. • Gardeners reported greater social support than nongardeners. • Age was positively associated with distress and somatization, whereas it was negatively associated with perceived support. Positive only for social support. (Continued) PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 7 / 19 Table 2. (Continued) Reference Participants Outcomes measured Instruments used for data collection Main conclusions Direction of the association Sample size Sex (%, female) Age (mean ±SD) Physical health & well-being Psychological wellbeing, Subjective Wellbeing and Psychossocial indicators Soga et al., 2017b [19] G: 165 NG: 167 G: 31.9% NG: 58.2% G: 61.9 ±17.1 NG: 61 ±16.6 • Perceived general health, subjective health, and BMI (selfreported height and weight) • Social cohesion • Sociodemographic and lifestyle variables • Motivation, frequency and duration of gardening • Perceived General Health (Single item question) • Subjective health complaints were measured with a 10-item question • Mental health was assessed using the 12-item General Health Questionnaire • Social Cohesion and Trust Scale • Socio-demographic and lifestyle items • Nature Relatedness Scale • The questionnaire for gardeners included a section about their motivation, frequency and duration of allotment gardening. • Frequency and duration of gardening activities did not significantly influence selfreported health outcomes. • Community gardeners reported better general health, less somatic complaints, better mental health and greater social cohesion. Positive Booth et al., 2018 [53] Regular gardeners: 16 Occasional gardeners: 43 NG: 56 Total: 47.8% Total: 42.1% • Physical health behaviours • Mental health behaviours • Perceptions of the community • Levels of participation on community garden • Self-rated health and Health behavior (Single item question) • Individual empowerment (two-item scale) • Well-being (five-item scale) • Psychological distress (sixitem scale) • Life satisfaction (10-item scale) • Organizational and community empowerment was measured by asking respondents about their perception of neighborhood disorganization, their sense of community, and their perceived control at the organizational and community level • Ross et al.’s (2001) nineitem scale • Sense of community was measured using a 13-item scales (Peterson, Speer, & McMillan, 2008) • Community empowerment was measured using Schulz et al. (1995) four-item scale– Organizational empowerment was measured using Schulz et al. (1995) five item scale • Regular and occasional participants reported better mental health. • Occasional Participants reported more vegetable intake, whereas regular participants reported more sense of community. • Participation in vegetable gardens was associated with increased levels of well-being and lower levels of distress. • The regularity of participation in horticultural activities did not affect wellbeing, which might indicate a selection bias (individuals with higher well-being are more likely to engage in community activities). Positive (Continued) PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 8 / 19 The study conducted in Singapore also assessed connection with nature, resilience, subjective well-being, self-esteem, optimism and openness [52]. One study targeted Bhutanese refugees living in the USA and asked participants about posttraumatic stress and adjustment to the new country [49]. According to our quality assessment criteria, seven studies included in this literature review were rated as “good” and only one scored “fair” (Fig 2). Regarding the article scored as "fair", its results pointed out to a positive association between community gardens and physical and mental well-being [51]. Overall, a positive association between engaging in community gardening and physical and mental health and well-being was found in all studies included in this Table 2. (Continued) Reference Participants Outcomes measured Instruments used for data collection Main conclusions Direction of the association Sample size Sex (%, female) Age (mean ±SD) Physical health & well-being Psychological wellbeing, Subjective Wellbeing and Psychossocial indicators Mourão et al., 2019 [51] G: 65 G: 43.1% 46–65: 47.7% 25–45 years: 36.9% >65 years: 36.9% NS • Life satisfaction • Subjective happiness • Subjective wellbeing • Personal Well-Being Index —Adult (Bem-Estar Pessoal scale) • Subjective Happiness Scale • Gardeners who visited the garden more frequently considered themselves more happier • Most relevant benefits of community gardening: occupation of free time, relaxation, and healthy food production. • Additional benefits of this activity: increased environmental awareness, change in diet habits, increased physical activity, socialization and interaction with others. Positive Koay & Dillon,2020 [52] Individual/ Home Gardening: 38 Community Gardening: 45 NonGardening Control: 28 Individual/ Home Gardening: 84,2% Community Gardening: 44,4% NonGardening Control: 57,1% Individual/Home Gardening: 43.76 ±12.99 Community Gardening: 60.20 ±13.27 Non-Gardening Control: 55.54 ±11.62 NS Connection to nature, resilience, perceived stress, subjective well-being, self-esteem, optimism and openness. • Nature in Self Scale • Brief Resilience Scale • Perceived Stress Scale • Personal Wellbeing Index • Adult, Rosenberg SelfEsteem Scale • Life-Orientation TestRevisited • Openness-to-Experience (10-item scale) • After controlling for age and connection with nature, community gardeners reported significantly higher levels of subjective well-being and optimism than the control group and individual / domestic gardeners; • Resilience levels were significantly higher for the two groups of gardeners; no difference between groups was found for perceived stress, self-esteem and openness; • The connection with nature was positively correlated with resilience; resilience was positively correlated with levels of subjective well-being and negatively correlated with levels of perceived stress. Positive Notes: G, gardeners; NG, non-gardeners; F, Female; M, Male; SD, Standard deviation; BMI, Body mass index; NS, Not specified. https://doi.org/10.1371/journal.pone.0255621.t002 PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 9 / 19 33. Lin BB, Egerer MH. Global social and environmental change drives the management and delivery of ecosystem services from urban gardens: A case study from Central Coast, California. Glob Environ Chang. 2020; 60: 102006. https://doi.org/10.1016/j.gloenvcha.2019.102006 34. Baur J. Campus community gardens and student health: A case study of a campus garden and student wellbeing. J Am Coll Heal. 2020; 0: 1–8. https://doi.org/10.1080/07448481.2020.1751174 PMID: 32369715 35. Eng S, Khun T. Healthy Lifestyle Through Home Gardening: The Art of Sharing. Am J Lifestyle Med. 2019. https://doi.org/10.1177/1559827619842068 PMID: 31285714 36. Relf D, Dorn S. of Special Populations. HortTechnology 5(2) 94–103. 1995. 37. Yasukawa M. International Handbook of Occupational Therapy Interventions. Springer NY, editor. 2009. 38. Cipriani J, Benz A, Holmgren A, Kinter D, Rufino G, Cipriani J, et al. A Systematic Review of the Effects of Horticultural Therapy on Persons with Mental Health Conditions. Occup Ther Ment Heal. 2017; 0: 1–23. https://doi.org/10.1080/0164212X.2016.1231602 39. Gonzalez MT, Hartig T, Patil G, Martinsen EW. Therapeutic horticulture in clinical depression: A prospective study of active components. J Adv Nurs 66(9), 2002–2013. 2010. https://doi.org/10.1111/j. 1365-2648.2010.05383.x PMID: 20626473 40. Van Den Berg AE, Winsum-westra M Van, Vries S De, Dillen SME Van. Allotment gardening and health: a comparative survey among allotment gardeners and their neighbors without an allotment. Environ Heal 2010,. 2010; 1–12. https://doi.org/10.1186/1476-069X-9-74 PMID: 21092248 41. Park S, Shoemaker C, Haub M. Can Older Gardeners Meet the Physical Activity Recommendation through Gardening? HortTechnology, 18(4), 639–643. 2008;18. 42. Hanbazaza MA, Triador L, Ball GDC, Farmer A, Maximova K, Nationd AF, et al. The impact of school gardening on cree children’s knowledge and attitudes toward vegetables and fruit. Can J Diet Pract Res. 2015; 76: 133–139. https://doi.org/10.3148/cjdpr-2015-007 PMID: 26280793 43. Zick CD, Smith KR, Kowaleski-Jones L, Uno C, Merrill BJ. Harvesting more than vegetables: The potential weight control benefits of community gardening. Am J Public Health. 2013; 103: 1110–1115. https://doi.org/10.2105/AJPH.2012.301009 PMID: 23597347 44. Park S, Shoemaker CA. Observing Body Position of Older Adults While Gardening for Health Benefits and Risks Observing Body Position of Older Adults While. Act Adapt Aging, 3331– 38, 2009. 2009; 37–41. https://doi.org/10.1080/01924780902718582 45. Draper C, Freedman D, Draper C. Review and Analysis of the Benefits, Purposes, and Motivations Associated with Community Gardening in the United States and Motivations Associated with Community. J ofCommunity Pract 18458–492. 2010;5422. https://doi.org/10.1080/10705422.2010.519682 46. Kingsley J, Foenander E, Bailey A. “You feel like you ‘ re part of something bigger”: exploring motivations for community garden participation in Melbourne, Australia. Kingsley al BMC Public Heal 19745. 2019; 1–12. 47. Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7) e1000097. 2009;6. https://doi. org/10.1371/journal.pmed.1000097 PMID: 19621072 48. US National Heart L and BIQAT for OC and C-SSA online: https://www.nhlbi.nih.gov/health-topics/ study-quality-assessment-tool. Study Quality Assessment Tools. 2020 pp. 1–58. 49. Gerber MM, Callahan JL, Moyer DN, Connally ML, Holtz PM, Janis BM. Nepali bhutanese refugees reap support through community gardening. Int Perspect Psychol Res Pract Consult. 2017; 6: 17–31. https://doi.org/10.1037/ipp0000061 50. Hawkins JL, Thirlaway KJ, Backx K, Clayton DA. Allotment Gardening and Other Leisure Activities for Stress Reduction and Healthy Aging. HortTechnology Oct 2011 21(5). 2011;21: 577–585. 51. Mourão I, Moreira MC, Almeida TC, Brito LM. Perceived changes in well-being and happiness with gardening in urban organic allotments in Portugal. Int J Sustain Dev World Ecol. 2019; 26: 79–89. https://doi.org/10.1080/13504509.2018.1469550 52. Koay WI, Dillon D. Community Gardening: Stress, Well-Being, and Resilience Potentials. Int J Environ Res Public Heal 2020, 17, 6740; https://doi.org/103390/ijerph17186740.2020 53. Booth JM, Chapman D, Ohmer ML, Wei K. Examining the Relationship Between Level of Participation in Community Gardens and their Multiple Functions. J Community Pract. 2018; 26: 5–22. https://doi. org/10.1080/10705422.2017.1413024 54. Blair D, Giesecke CC, Sherman S. A dietary, social and economic evaluation of the Philadelphia urban gardening project. J Nutr Educ. 1991; 23: 161–167. https://doi.org/10.1016/S0022-3182(12)81191-5 PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 16 / 19 55. Alaimo Katherine & Beavers Alyssa W. & Crawford2 Caroline, EHS Litt4& JS. Amplifying Health Through Community Gardens: A Framework for Advancing Amplifying Health Through Community Gardens: A Framework for Advancing Multicomponent, Behaviorally Based Neighborhood Interventions. Curr Environ Heal Reports. 2016. https://doi.org/10.1007/s40572-016-0105-0 PMID: 27379424 56. Warburton DER, Nicol CW, Bredin SSD. Review Health benefits of physical activity: the evidence. C • March 14, 2006 • 174(6) | 801 ©2006 C Media Inc or its Licens. 2006. 57. Park S, Lee K, Son K. Determining Exercise Intensities of Gardening Tasks as a Physical Activity Using Metabolic Equivalents in Older Adults. Hortscience 46(12)1706–1710 2011. 2011; 46: 1706– 1710. 58. Park S. A., Shoemaker C. A., & Haub MD. A preliminary investigation on exercise intensities of gardening tasks in older adults. Perceptztnl andlMotor Ski 2008, 107 9i3-980. 2008. https://doi.org/10. 2466/pms.107.3.974-980 PMID: 19235426 59. Park S, Hall T, Shoemaker CA, Hall T, Haub MD. Physical and Psychological Health Conditions of Older Adults Classified as Gardeners or Nongardeners. 2009; 44: 206–210. 60. Serrano JP. Spain: Promoting the Welfare of Older Adults in the Context of Population Aging. Gerontol Cite J as Gerontol Vol 54, No 5, 733–740 2014; 54: 733–740. https://doi.org/10.1093/geront/gnu010 PMID: 24632624 61. Scott TL, Masser BM, Pachana NA. Positive aging benefits of home and community gardening activities: Older adults report enhanced self-esteem, productive endeavours, social engagement and exercise. SAGE Open Med Creat. 2020. https://doi.org/10.1177/2050312120901732 PMID: 32030127 62. Barnidge EK, Hipp PR, Estlund A, Duggan K, Barnhart KJ, Brownson RC. Association between community garden participation and fruit and vegetable consumption in rural Missouri. Int J Behav Nutr Phys Act. 2013; 10: 128. https://doi.org/10.1186/1479-5868-10-128 PMID: 24252563 63. Castro DC, Samuels M, Harman AE. Growing Healthy Kids. AMEPRE. 2013; 44: S193–S199. https:// doi.org/10.1016/j.amepre.2012.11.024 PMID: 23415183 64. Mccormack LA, Laska MN, Larson NI, Story M. Farmers ‘ Markets and Community Gardens: J amreican Diet Assoc. 2010; 110: 399–408. https://doi.org/10.1016/j.jada.2009.11.023 PMID: 20184990 65. Ilieva RT. Urban Food Systems Strategies: A Promising Tool for Implementing the SDGs in Practice †. Sustain 2017, 9, 1707; 2017. https://doi.org/10.3390/su9101707 66. Furness WW, Gallaher CM, Furness WW. Food access, food security and community gardens in Rockford, IL Food access, food security and community gardens in Rockford, IL. Local Environ. 2018; 0: 1–17. https://doi.org/10.1080/13549839.2018.1426561 67. Wang H, Qiu F, Swallow B. Can community gardens and farmers’ markets relieve food desert problems? A study of Edmonton, Canada. Appl Geogr. 2014; 55: 127–137. https://doi.org/10.1016/j. apgeog.2014.09.010 68. Ober J, Mph A, Alaimo K, Elam D, Perry E, Ober J, et al. Growing Vegetables and Values: Benefits of Neighborhood-Based Community Gardens for Youth Development and Nutrition Growing Vegetables and Values: Benefits of Neighborhood-Based Community Gardens for Youth Development and Nutrition. J Hunger Environ Nutr ISSN. 2008;0248. https://doi.org/10.1080/19320240802529169 69. Carstensen LL. Social and Emotional Patterns in Adulthood: Support for Socioemotional Selectivity Theory. Psychol Aging 1992 Vol 7, No 3, 331–33. 1992;7: 331–338. https://doi.org/10.1037//08827974.7.3.331 PMID: 1388852 70. Wang D, Macmillan T. The Benefits of Gardening for Older Adults: A Systematic Review of the Literature The Benefits of Gardening for Older Adults: Act Adapt Aging ISSN. 2013;4788. https://doi.org/10. 1080/01924788.2013.784942 71. Porter R, Mcilvaine-newsad H. Gardening in green space for environmental justice: food security, leisure and social capital. Leisure/Loisir. 2014; 37: 379–395. https://doi.org/10.1080/14927713.2014. 906172 72. Veen EJ, Bock BB, Berg W Van Den, Visser AJ, Wiskerke JSC, Bock BB, et al. Community gardening and social cohesion: different designs, different motivations. Local Environ Int J Justice Sustain ISSN. 2016;9839. https://doi.org/10.1080/13549839.2015.1101433 73. Genter C, Roberts A, Richardson J, Sheaff M. The contribution of allotment gardening to health and wellbeing: A systematic review of the literature. Br J Occup Ther 78(10). 2015. https://doi.org/10. 1177/0308022615599408 74. Dyg PM, Christensen S, Peterson CJ. Community gardens and wellbeing amongst vulnerable populations: a thematic review. Heal Promot Int 2019, 1–14 2019; 1–14. https://doi.org/10.1093/heapro/ daz067 PMID: 31369084 PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 17 / 19 75. Harris N, Minniss FR, Somerset S. Refugees connecting with a new country through community food gardening. Int J Environ Res Public Health. 2014; 11: 9202–9216. https://doi.org/10.3390/ ijerph110909202 PMID: 25198684 76. Hartwig KA, Mason M. Community Gardens for Refugee and Immigrant Communities as a Means of Health Promotion. J Community Health. 2016. https://doi.org/10.1007/s10900-016-0195-5 PMID: 27085720 77. Cummings D., Rowe F., Harris N., & Somerset S. Quality of Life and Community Gardens: African refugees and the Griffith University Community Food Garden. Proc Popul Heal Congr Brisbane, Aust (pp 6–9). 2008. 78. Samuelsson K, Barthel S, Colding J, Macassa G, Giusti M. Urban nature as a source of resilience during social distancing amidst the coronavirus pandemic. 2020. 79. Mccunn LJ. The importance of nature to city living during the COVID-19 pandemic: Considerations and goals from environmental psychology Considerations and goals from environmental psychology. Cities Heal. 2020; 00: 1–4. https://doi.org/10.1080/23748834.2020.1795385 80. Ugolini F, Massetti L, Calaza-martı ´nez P, Cari P, Dobbs C, Ostoi SK, et al. Urban Forestry & Urban Greening Effects of the COVID-19 pandemic on the use and perceptions of urban green space: An international exploratory study. Urban For Urban Green 56 126888 Contents. 2020; 56. https://doi.org/ 10.1016/j.ufug.2020.126888 PMID: 33100944 81. Ginn F. Dig for Victory! New histories of wartime gardening in Britain. J Hist Geogr. 2012; 38: 294– 305. https://doi.org/10.1016/j.jhg.2012.02.001 82. Chenarides L, Printezis I, Lusk JL. Who practices urban agriculture? An empirical analysis of participation before and during the COVID - 19 pandemic. Agribusiness 2020;1–18. 2020; 1–18. https://doi.org/ 10.1002/agr.21675 PMID: 33362336 83. Xiang H, Wang Z, Stallones L, Keefe TJ, Huang X, Fu X. Agricultural Work-Related Injuries Among Farmers in Hubei, People ‘ s Republic of China. Am J Public Heal 1269. 2000; 90: 1269–1276. 84. Solomon C. Accidental injuries in agriculture in the UK. Occup Med Vol 52, 2002. 2002; 52: 461–466. https://doi.org/10.1093/occmed/52.8.461 PMID: 12488516 85. Mccurdy SA, Carroll DJ. Agricultural Injury. Am J Ind Med 38463±480. 2000; 480: 463–480. https:// doi.org/10.1002/1097-0274(200010)38:4<463::aid-ajim13>3.0.co;2-n PMID: 10982988 86. Bhattarai D, Singh SB, Baral D, Sah RB, Budhathoki SS, Pokharel PK. Work-related injuries among farmers: a cross-sectional study from rural Nepal. J Occup Med Toxicol. 2016; 1–7. https://doi.org/10. 1186/s12995-016-0090-0 PMID: 26759602 87. Osborne A, Blake A ˜C, Fullen BM, Meredith D, Phelan J, Mcnamara J, et al. Prevalence of Musculoskeletal Disorders Among Farmers: A Systematic Review. Am J Ind Med 38463±480 55143–158. 2012; 158: 143–158. https://doi.org/10.1002/ajim.21033 PMID: 22069159 88. Das B. Agricultural work related injuries among the farmers of West Bengal, India. Int J Inj Contr Saf Promot. 2014; 21: 205–215. https://doi.org/10.1080/17457300.2013.792287 PMID: 23672621 89. Moore M, Gould P, Keary BS. Global urbanization and impact on health. Int J Hyg Environ Health. 2003; 278. https://doi.org/10.1078/1438-4639-00223 PMID: 12971682 90. Huang S, Yeh C, Chang L. The transition to an urbanizing world and the demand for natural resources. Curr Opin Environ Sustain. 2010; 2: 136–143. https://doi.org/10.1016/j.cosust.2010.06.004 91. Wolch JR, Byrne J, Newell JP. Landscape and Urban Planning Urban green space, public health, and environmental justice: The challenge of making cities ‘ just green enough.’ Landsc Urban Plan. 2014; 125: 234–244. https://doi.org/10.1016/j.landurbplan.2014.01.017 92. Bugliarello G. Urban sustainability: Dilemmas, challenges and paradigms. Technol Soc 28 19–26. 2006; 28: 19–26. https://doi.org/10.1016/j.techsoc.2005.10.018 93. Mcmichael AJ. Population health as the ‘bottom line’ of sustainability: a contemporary challenge for public health researchers. Eur J Public Heal Vol 16, No 6, 579–582. 2006;16: 579–581. https://doi. org/10.1093/eurpub/ckl102 PMID: 16857691 94. Verma P, Raghubanshi AS. Urban sustainability indicators: Challenges and opportunities. Ecol Indic 93 282–291 Contents. 2018; 93: 282–291. https://doi.org/10.1016/j.ecolind.2018.05.007 95. Hoffman AJ, Wright L. Stewardship, Volunteerism and “Green” Sustainable Programs: Core Values of Community Psychology. Glob J Community Psychol Pract. 2020; 11: 1–15. 96. Nova P, Pinto E, Chaves B, Silva M. Urban organic community gardening to promote environmental sustainability practices and increase fruit, vegetables and organic food consumption. Gac Sanit 2020;34(1)4–9 Orig. 2020; 34: 4–9. https://doi.org/10.1016/j.gaceta.2018.09.001 PMID: 30471837 97. Ottawa. A promoc¸ão da sau ´de a carta de Ottawa. World Heal Organ Ottawa Chart Heal Promot Proc First Int Conf Heal Promot Ottawa, ON, Canada, 21 Novemb 1986. 1986. PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 18 / 19 98. European Commission. A European Green Deal Striving to be the first climate-neutral continent. 2020. 99. European Commission. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the regions. A Farm to Fork Strategy for a fair, healthy and environmentally-friendly food system. 2020. 100. Middle I, Dzidic P, Buckley A, Bennett D, Tye M, Jones R. Urban Forestry & Urban Greening Integrating community gardens into public parks: An innovative approach for providing ecosystem services in urban areas. Urban For Urban Green. 2014; 13: 638–645. https://doi.org/10.1016/j.ufug.2014.09.001 101. Duz ˇı ´B, To ´th A, Bihuňova ´M SR. Challenges of Urban Agriculture: Highlights on the Czech and Slovak Republic Specific. In: Va ´vra J, Lapka M, Cudlı ´nova ´E (eds.) Current Challenges of Central Europe: Society and Environment,. 2014. 102. Lorraine Weller Clarke; G. Darrel Jenerette. Biodiversity and direct ecosystem service regulation in the community gardens of Los Angeles, CA. Landsc Ecol 30637–653. 2015; 637–653. https://doi.org/10. 1007/s10980-014-0143-7 103. Cabral I, Keim J, Engelmann R, Kraemer R, Siebert J. Urban Forestry & Urban Greening Ecosystem services of allotment and community gardens: A Leipzig, Germany case study. Urban For Urban Green. 2017; 23: 44–53. https://doi.org/10.1016/j.ufug.2017.02.008 104. Bendt P, Barthel S, Colding J. Landscape and Urban Planning Civic greening and environmental learning in public-access community gardens in Berlin. Landsc Urban Plan. 2013; 109: 18–30. https://doi. org/10.1016/j.landurbplan.2012.10.003 105. Nordh H, Wiklund KT, Koppang KE, Nordh H, Wiklund KT, Koppang KE, et al. Norwegian allotment gardens—a study of motives and benefits Norwegian allotment gardens—a study of motives and benefits. Landsc Res. 2016; 6397: 1–16. https://doi.org/10.1080/01426397.2015.1125457 106. Lee JH, Matarrita-cascante D. Urban Forestry & Urban Greening The influence of emotional and conditional motivations on gardeners ‘ participation in community (allotment) gardens. Urban For Urban Green. 2019; 42: 21–30. https://doi.org/10.1016/j.ufug.2019.05.006 PLOS ONE Contribution of community gardens to promote physical and mental health and well-being PLOS ONE | https://doi.org/10.1371/journal.pone.0255621 August 6, 2021 19 / 19