Reber_NUTRITION FOR LOW-INCOME CHILDREN

Running Head: NUTRITION FOR LOW-INCOME CHILDREN

Effectiveness of Implementing Nutrition Programs in Low-Income Schools

By

Dayna E. Reber

March 8, 2016

A Capstone Report Submitted in Partial Fulfillment

of the Requirements for the Degree of

Master of Science in Educational Improvement and Transformation

at Drexel University

We accept this report as conforming to

the required standard

_____________________________________Kristy Kelly, Ph.D.(GIE Program, School of Education, Drexel University)

_____________________________________Bruce Levine, J.D.(EIT Program, School of Education, Drexel University)

_____________________________________Samantha Mercanti-Anthony, Ed.D.(Program Manager, School of Education, Drexel University)

Nutrition for Low-Income Children

Table of ContentsAbstract............................................................................................................................................3Acknowledgements..........................................................................................................................4Chapter 1: Introduction....................................................................................................................5

The Research Site.......................................................................................................................11The Study Design.......................................................................................................................12Terms..........................................................................................................................................12Ethical Considerations...............................................................................................................13Summary.....................................................................................................................................13

Chapter 2: Literature Review.........................................................................................................15Nutrition Policy and Legislation................................................................................................15Previous School-Based Nutrition Interventions.........................................................................17Food Assistance Programs for Low-Income Families...............................................................20Study Overview..........................................................................................................................23

Chapter 3: Methodology................................................................................................................25Introduction................................................................................................................................25Method.......................................................................................................................................26

Chapter 4: Findings........................................................................................................................30Results........................................................................................................................................30

Chapter 5: Discussion....................................................................................................................39Conclusions................................................................................................................................39Implications................................................................................................................................41Limitations.................................................................................................................................41Recommendations......................................................................................................................42

Resources.......................................................................................................................................44Appendix A: Sample Flyer for Participant Recruitment...............................................................51Appendix B: Demographic Questionnaire.....................................................................................52Appendix C: Sample Focus Group Questions...............................................................................53Appendix D: Introductory Letter for Participants.........................................................................54Appendix E: IRB Approval Letter.................................................................................................55

2


Abstract

The aim of this Capstone is to investigate the effectiveness of nutrition programs in schools that are considered to be primarily low-income, specifically within the public school system of Austin, Texas. Through personal communication with parents, information was gathered that gauged the level of effectiveness of their child’s nutrition education based on areas of importance from previous successful school nutrition interventions. Parents provided conflicting answers as to how they felt the school met their child’s needs to adopt a healthy lifestyle. With the respondents ranging in salary, education, and gender, their thoughts on the effectiveness and transparency of the program at the school varied. While a higher income parent believed that the school provided plenty of opportunities for healthy eating and healthy lifestyle management, the lower income parent was unaware of opportunities for learning about healthy food choices.

Following research and investigation, there are recommendations to be considered for a program that better suits the needs of its students, parents, and the public to ensure healthy communities. The primary steps needed to be taken to guarantee healthier outcomes for everyone is to establish multipronged approaches that introduce a number of resources and initiatives to all involved members. Increasing parental outreach is a primary target for improving the effectiveness of a program that aims to transform behaviors that are present at school and home. Due to the occasionally difficult nature of engaging parents in school-related activities, it is suggested that multiple outlets be available for the level in which parents are able to become involved. In addition to parent outreach, a second recommendation is to increase visibility. More visible reminders of healthy choices, as well as activities such as school gardens and field trips, can aim to educate children by using multiple learning strategies.

3


Acknowledgements

I owe all of my thanks in the world to the strong women in my life who have supported me in all of my endeavors. Without my mother and grandmother, I would not have had the strength to continue and to endure everything that life has thrown at me. They have raised me to be as strong as I possibly can be, while also remaining my constants in life and my go to person in times of personal defeat. They take the weight off of my shoulders and lift me up to believe that I am capable of conquering the world.

I would also like to thank Evan for being the most encouraging father-to-be. Without your support I would not have had the momentum to tackle a thesis and my soon-to-be motherhood at the same time. I owe you all of my love for being my partner in bringing a healthy, beautiful baby into this world.

4


Chapter 1: Introduction “Hunger is not an issue of charity. It is an issue of justice.” – Jacques Diouf, Food and

Agricultural Organization Director-General

The purpose of this paper is to examine childhood nutrition programs for low-income

students within Austin, TX. Minority children lead the statistics for malnourishment and obesity

and this injustice remains a problem to be solved. The programs studied will be both government

programs as well as non-profits, and will look within different contexts of community-based

programs versus school-based programs. In addition, the evaluations will look at these programs

within the scope of the greater context of nutrition programs and global hunger/malnourishment,

as well as from a historical point of view.

This study specifically considers the following:

1. As the United Nations recently released the Sustainable Development Goals of 2015,

how are local programs already achieving steps towards these goals? Target 2.1 states

that “By 2030, [the world will] end hunger and ensure access by all people, in

particular the poor and people in vulnerable situations, including infants, to safe,

nutritious and sufficient food all year round” (United Nations, 2015).

2. What programs, policies, and laws exist in Austin to assist schools, families and

community members to know about and reach these goals? Due to the considerable

amount of time spent in school and the amount of influence that a school can have on

a child, this study will make suggestions as to how partnerships can be strengthened

between community and school.

3. In addition, how can schools improve fostering healthy habits for a low-income

population, which tends to have higher rates of obesity and chronic illnesses as a

5


result of poor nutrition? Exploration of the attitudes, beliefs, and knowledge of

district parents will provide insight into current practices and needs.

With these three considerations, educators may be the best channel for improvement in

school nutrition programs and inspiring healthier lifestyles in their students. This study will

provide a complex understanding of programs created to provide students with the resources

needed to form the habits of a healthier lifestyle. In addition, it will focus on the food disparities

that are present in a city that is highly diversified in terms of income, education, race, language,

and opportunity. This study is able to contribute to the implementation of nutrition programs and

for policymakers to gain a deeper understanding of what works, as well as why programs may

fail. In addition, it will provide an explanation of underlying factors that contribute to the

inability of low-income families to gain access to nutritious food sources.

The first step towards improvement is gathering information on existing awareness and

providing additional knowledge to information seekers. Collecting data and feedback from

parents whose children attend public schools within the metropolitan area will help to gain

insight into how nutrition and healthy behaviors are actually being taught in schools, and how

this curriculum could potentially be built upon. Measuring the current effectiveness of school

nutrition programs is difficult, because of every other factor that impedes a healthy lifestyle.

Specifically seeking out and screening children with obesity and getting a deeper understanding

of their family’s eating habits could be unethical. The risk of inducing feelings of low self-

esteem may not outweigh possible benefits, considering lack of intervention in this study.

However, recruiting parents whose children are the primary recipients of the district’s nutrition

curriculum may provide important data, while also not recruiting based on defamatory

qualifications. It is this reason that parents of children attending a public school, and whose child

6


also receives lunch assistance, will be the primary source of information for school-based

nutrition programs and how these programs specifically meet the needs of the most vulnerable

student populations.

Historical Context of School-Based Nutrition

Historically, Harry Truman was the first president to involve the government in school

nutrition by establishing the National School Lunch Program (NSLP) in 1946 (SNA, 2015). In

1968 the need for such a program became even more evident as the Citizens’ Board of Inquiry

into Hunger and Malnutrition in the U.S. released findings that “at least 10 million persons were

suffering from hunger and malnutrition in every part of the United States” (Gunderson, 2014,

para. 8). In addition, these findings led to CBS’ release of a documentary further exploring this

issue and requesting the need for a free or more affordable lunch program for children living in

poverty. Since the conception of the NSLP, there have been additional mandates and efforts to

raise awareness for healthier meals. More recently, in 2010 President Barack Obama passed the

law for the “Healthy, Hunger-Free Kids Act,” which provides funding and set policies for

standards of child nutrition programs (USDA, 2014).

While these lunches, as well as many schools that also have existing Breakfast Programs,

must meet certain nutrition guidelines, there are many inconsistencies to be examined. Also,

what entails a nutritious meal and how are these standards created? These school lunches tend to

adhere to recommendations by the USDA, but even these suggestions still pose unhealthy threats

and choices for children to make. One example stated in the Federal Register regulating nutrition

standards includes “Schools may meet the fruit component at lunch and breakfast by offering

fruit that is fresh; canned in fruit juice, water, or light syrup” (Dept. of Agriculture, 2012, p.

7


4091). Offering students the choice of additional sugar present in even light syrups, and also not

being able to ensure consumption of a fruit serving, shows that there should be not only a

limitation of options, but also accountability for the types of “healthy” foods being offered to

students who may not possess the education to know the healthiest choice. Offer versus Serve

(OVS) is a provision of the NSLP that allows students to decline items offered and is aimed to

reduce food waste (Dept. of Agriculture, 2013). However, for students receiving free or reduced

lunch, they must take at least three items (one of which is a fruit or vegetable), in order for the

meal to qualify for reimbursement. The lunchroom is one place where these types of behaviors

can be influenced, and simply adding items to the menu will not battle the childhood obesity

epidemic on its own. Education, along with multiple other nutrition components, is going to be a

necessity if high-risk individuals living in low-income communities are going to be able to lead

healthier lifestyles.

Barriers to Healthy Lifestyles

Obesity rates tend to be negatively correlated with income, due to a number of factors.

Among these factors include “family schedules, lack of money to purchase healthy food, lack of

time to prepare healthy meals, the accessibility and desirability of unhealthy foods, and lack of

knowledge about the nutrient content of unhealthy fast foods” (Slusser, et. al., 2010, p. 1834).

While addressing the subject of hunger and malnourishment is important, doing so without also

addressing all of the mitigating factors will lead to an unsuccessful endeavor towards improving

nutrition habits and removing food insecurity, specifically for children in low-income

populations.

Food Insecurity and Malnourishment

8


While the UN addresses both hunger and malnourishment, it is the latter which can often

be the issue with low-income families in the U.S. In a National Geographic story by McMillan

(2014) titled “The New Face of Hunger,” Melissa Boteach, vice president of the Poverty and

Prosperity Program of the Center for American Progress, discusses the paradox that exists

between hunger and poverty. Typically, when most Americans picture the face of hunger, they

are generally imagining children in third world countries, the children featured on commercials

to sponsor a child in need. However, hunger is happening in the U.S., a fact, which many either

chooses to ignore, or to which they are simply unaware. The narrative by McMillan aims to

educate the general public on why and how hunger is occurring in the richest country on Earth.

The fact that one in six Americans are not sure where their next meal will come from or that

more than 48 million Americans rely on government food assistance programs is continuing to

plague children, and contribute to the growing hunger, malnourishment, food insecurity issues in

this country (McMillan, 2014). While many are aware that this is a global issue, bringing this

issue to light on a local scale is necessary to gain the help needed from uninformed individuals.

These government food assistance programs have limits and strict guidelines on what

exactly can be purchased. Many times, as an alternative to buying less food of higher quality,

families often opt to purchase greater amounts of lesser quality. As poor families buy large

quantities of inexpensive food with no nutritional value, they are essentially consuming empty

calories, which leaves them feeling full for less time. As families continue to consume food that

lacks sustenance, their bodies continue to be hungry, as it craves vital nutrients. Childhood

hunger can essentially go unnoticed as overweight children show little signs of having a lack of

food.

9


In addition, there is often the presence of a “feast or famine” mentality that leads to binge

eating habits in food-insecure children, suggesting these behaviors arise as a result of monthly

food allowances (Dinour, et. al., as cited in Harrison, et. al., 2015). Food allowances are part of a

supplemental government program, WIC, which “provide[s] supplemental foods designed to

meet the special nutritional needs of low-income pregnant, breastfeeding, non-breastfeeding

postpartum women, infants and children up to five years of age who are at nutritional risk”

(USDA, 2015). Food allowances permit purchase of $8.00 worth of fruits and vegetables per

month, in addition to other basic necessities such as whole wheat bread, legumes, eggs, milk,

juice, and cereal (USDA, 2015). WIC vouchers have even been expanded beyond supermarkets

and into the Farmer’s Market. However, food deserts are not addressed among questions

regarding the program, nor is lack of education regarding healthy choices.

Environmental Factors

Another contributing factor to malnourishment and obesity is the ease and affordability of

fast food, as compared to the lack of supermarkets present in low-income, urban neighborhoods.

Food deserts, described as a “location where there are few to no supermarkets or other retailers

that offer fresh fruits and vegetables (FFV) or other healthy food products” (Weatherspoon, et.

al., 2015, 960-61). In addition, Weatherspoon, et. al. (2015), discusses the issue of food retailers,

who are often hesitant to choose urban areas as a location due to high crime rates, lack of

demand for healthy foods, and zoning troubles. Residing in food deserts leads families to make

inexpensive food purchases that often lack dietary value, which further contributes to

malnutrition. Blanchard and Lyson (2006) further state that “Residents of food deserts are 23.4%

less likely to eat the recommended servings of fruits and vegetables per day than are residents

with ready access to affordable fruits and vegetables” (as cited in Weatherspoon, et. al., 2015,

10


961). Food deserts are just a part of a cycle that can cause low-income residents to continuously

opt for more viable choices for their families.

This epidemic of food insecurity and health issues is not only damaging the lives of

individuals who will be crucial to the future economy. These issues are also damaging to the

current economy as it effects farms, the health industry, and the individuals that are unable to be

productive members of society due to chronic health issues. With global goals in mind, a local

shift towards a community of health conscious individuals must be a top priority. Despite

implementation of government and non-government programs to address food-related issues,

issues such as childhood obesity are still on the rise. Further exploration into the laws, policies,

and programs within Austin, as well as a broader context, will begin to examine the disparities

that are contributing to the inconsistencies in nutrition for children in low-income areas. The best

ways to ensure that all children adopt healthy behaviors are becoming more apparent as more

individuals seek similar justice for students in this disparaged food crisis. Now it is only a means

of taking initiative to begin implementation.

“Hunger is not a problem. It is an obscenity. How wonderful it is that nobody need wait a

single moment before starting to improve the world.” – Anne Frank

The Research SiteAs reported in the CDC’s 2012-2014 Behavioral Risk Factor Surveillance System, Texas

was one of the top 9 states to self-report high levels of obesity among Hispanic Adults, making

Austin an ideal city to conduct this study. In addition, Hispanics make up for 35% of Austin’s

population, which is also the population among minorities that are most likely to cluster

according to low income (City of Austin, n.d.). The primary reasoning behind Austin as an ideal

research site is the disparity between communities of different wealth and race, leaving Hispanic

11


disproportionately burdened by barriers effecting access to healthy, fresh foods. With almost a

quarter of the children in the county living in poverty, it is these children who are less likely to

have access to basic needs and who also “tend to be geographically concentrated in areas with

low-performing schools,” making school status an ideal method of sampling (City of Austin,

2013). While some Austin schools may have higher than average low-income populations, the

primary site for data collection is going to be an Afterschool Program specifically intended for

students qualifying for free or reduced lunch.

The Study DesignThe study will collect data from parents of students in low-income households. Parents

are typically the primary decision maker for food purchases and meal planning, making them an

ideal candidate for assessing food behaviors. Focus groups will provide information of if/how

their child’s behavior has changed as a result of nutrition education at their school. In addition,

the study will assess if there are critical barriers to making healthier decisions when planning

meals.

TermsHealthy, Hunger-Free Kids Act: Regulates and sets standards for USDA childhood nutrition

programs to improve nutrition and reduce hunger for children.

National School Lunch Program (NSLP): A federal food program that provides free or reduced-

cost lunch to public schools, non-profit private schools, and childcare institutions in which the

children are residents.

Obesity: “Weight that is higher than what is considered as a healthy weight for a given height”

(CDC).

12


Offer versus Serve (OVS): Allows students in reimbursable food programs to decline food

offered as a means to reduce food waste.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): A Federally

funded program that provides services, nutrition education, and assistance with purchasing

supplemental foods to low-income women who are pregnant, breastfeeding, postpartum, and

infants and children up to the age of 5.

Sustainable Development Goals: A set of goals adopted globally to “end poverty, protect the

planet, and ensure prosperity for all” (UN, 2015). Aimed to be achieved within the next 15 years.

Ethical ConsiderationsThe following ethical guidelines were instituted throughout the course of the study:

1. The dignity and wellbeing of participants was respected at all times.

2. The data remained confidential and the researcher obtained permission from the

Afterschool program to conduct the study on the grounds of the establishment.

3. The researcher obtained permission to use statements and data collected from the

participants to present the information under the use of pseudonyms.

SummaryThe issues plaguing low-income families, specifically those in minority populations, are

growing more and more detrimental to future health outcomes. Focusing on nutrition and

nutrition education, many of these issues can become minimized and decrease obesity-related

health issues. Barriers effecting specific minority groups are considered and gaining perspective

from affected individuals can provide insight to decision makers for how to better assist under-

served populations. As childhood obesity is becoming more of an issue, educating children on

13


nutrition is a priority. Assessing the effectiveness of school programs may be the first step in

gathering data to illustrate whether or not legal mandates to support healthier schools are doing

what they are intended.

14


Chapter 2: Literature ReviewCurrent research on nutrition policies and programs finds that they are not as strong as

they could be, but are very consistent in their recommendations for how to successfully approach

the issue of childhood obesity. It is also clear that the obesity rates and lack of nutrition

education is most evident in low-income areas. In addition, obesity rates are disproportionately

high for minority populations, “Over 40% of blacks and Hispanics were overweight or obese,

compared with 25% of whites” in a health behavior study in a low-SES school (Ranjit, et. al.,

2015, p. 56). Researchers believe that there is not one simple way to solve this problem, but

rather a multipronged approach that will be rooted in a multitude of facets. The depth of change

this issue requires is immense, and a clearer understanding of issues regarding low-income

childhood nutrition including policy changes, community programs, education and curriculum,

school lunch offerings, parental involvement, socio-economic changes (specifically in regards to

food accessibility), and public health will be necessary for successfully developing a stronger

program for reducing the risk of illnesses and problems associated with childhood obesity. Not

only is this topic important from a public health and human rights perspective, but also a

cognitive perspective considering fast food and soda consumption had a negative correlation

with grades (Snelling, et. al., 2015). Since students spend such a large amount of time in school,

this environment is ideal for implementing a program that aims to address such issues.

Nutrition Policy and Legislation A comprehensive review regarding Texas Obesity Policies of the first decade of the

2000s had been created to discuss the challenges facing the obesity epidemic, and although

constantly changing, many discoveries still prove true. One characteristic seen as absolutely

necessary is the use of partnerships to strengthen individual programs. If approaching from a

broad perspective, Ory, et. al. (2013) believes that “statewide partnerships for leveraging

15


resources, fostering local policy change, and implementing varied obesity prevention and control

interventions in multiple settings” are key to reducing obesity within individual states,

specifically Texas (p. 419). In addition, Ory, et. al., (2013) further discusses the “governmental-

community-academic partnerships” that have been vital to the strategy up to this point (p. 419).

Not only do Texas politicians believe in the power of partnerships, but also similar knowledge

was presented at a recent World Meeting held in Italy, which discussed the importance of

nutrition on creating a brighter outlook for the future. On an even greater scale, the Simopoulos,

et. al., who wrote the Bellagio Report (2013) identifies the recommendation that “Working with

leaders of national governments, both executive and legislative, and international organizations

such as FAO [Food and Agriculture Organization of the United Nations], WHO [World Health

Organization] and its regional organizations, especially PAHO [Pan American Health

Organization], the World Bank and other agencies of the UN to achieve the incorporation of the

recommendations […] into their policies and programs” will better help to accomplish and create

accountability for confronting this serious health epidemic (p. 420).

Nutrition Policy in Schools

Policies for proper nutrition education are present at the national, state and local level, but

despite these policies very few teachers seem to have a clear understanding for how to teach the

material. As teachers increasingly feel pressure to perform well in educating students on the core

curriculum, very little attention is paid to separate nutrition lessons or incorporating this

information into the regular classroom. McCaughtry, et. al. (2011) states that “Without

institutional coherence and clear directives, health education teachers taught little nutrition

content, primarily due to poor training, professional development, institutional resources and

administrative accountability” (p. 69). An elementary school intervention that took place in a

16


large urban district found a number of implications present when implementing the pilot

program. Prelip, et. al. (2011) found that “Large school districts […] are unlikely to have the

resources to devote a labor-intensive program focusing on nutrition when there are so many

academic issues competing for resources” (p. 527). In addition, when teachers have already

received so little instruction in their own studies for how to properly integrate nutrition, how can

districts “engage teachers who are overwhelmed with other priorities focusing on the education

mission” (Prelip, et. al., 2011, p. 528). Prioritizing nutrition within the already overburdened

curriculum is a challenge that most pilot programs have faced thus far.

Previous School-Based Nutrition InterventionsOne middle school intervention, aimed at increasing fruit and vegetable (F & V)

consumption, used six separate components, with varying groups of students being exposed to

none, some or all of the components. The program consisted of “(1) in-class lessons, (2) after-

school gardening program, (3) farm-to-school, (4) farmers’ visits to schools, (5) taste testing, (6)

field trips to farms” (Evans, et. al., 2012, p. 608). Also, “inadequate fruit and vegetable (F & V)

intake is a significant dietary risk behavior for the development of obesity and other chronic

diseases” both foods that are found to be consumed in lower quantities in low SES populations

(Bazzano, 2006, as cited in Evans, et. al., 2012, p. 608). This intervention not only used an

educational and hands-on approach, but it also incorporated cognitive behavioral methods to

increase motivation and self-efficacy. The primary finding was at post-test, in which the

researchers found that “Compared with students who were exposed to fewer than two

components, students who were exposed to two or more of the components scored significantly

higher on the F & V intake, self-efficacy, and knowledge […] and significantly lower on the

preference for unhealthy foods” (Evans, et. al., 2012, p. 613). Based on these results, it was

17


apparent that a school nutrition program would need to incorporate a number of components in

order to have a significant effect on child and adolescent behavior in regards to healthy eating

behaviors. However, with findings such as one from the National Secondary School Survey from

2010 “that U.S. middle and high school students attending low SES schools and majority

Hispanic and Black schools were less likely to have salads offered at school,” how can school

teachings coincide with what is being offered in the lunch line, especially when choices are

dictated by a federally funded program (Springer, et. al., 2015, p. 8)?

Aside from the traditional school setting, other studies have branched out to attempt to

implement nutrition programs in other settings that may benefit from such education. One

program called Cooking, Healthy Eating, Fitness and Fun (CHEFFs) began by running the

program in two afterschool programs in urban homeless shelters. The 15-week program included

curriculum intended to “ increase (1) knowledge of nutritional recommendations, (2)

understanding the effect of nutrition and physical activity on health, and (3) awareness of and

self-efficacy in making healthier choices” (Rodriguez, et. al., 2013, p. S362). Although the

participants exhibited aversive behaviors when introduced to unfamiliar foods, “facilitators

found that when children engaged in food preparation, they were more likely to try and enjoy

new foods” (Rodriguez, et. al., 2013, S364). While this study may be difficult to generalize to

other populations, many similar behaviors were found to be present in homeless children, which

could also be evident in children of low-SES. Rodriguez, et. al. (2013) observed children

discussing circumstances such as “lack of financial resources, facilities to store and cook food,

and access to fresh fruits and vegetables” are all scenarios that could potentially be evident in

homes of families also living in poverty (S364). Not only did children exhibit unhealthy eating

habits, but they also had underlying themes appear in their discussions that could be seen as

18


bizarre. One example of this appeared in a conversation regarding the benefits of healthy eating

and many children discussed that “being overweight would help them survive a disaster that

would leave them stranded without food for a long time” (Rodriguez, et. al., 2013, S364). This

thought process is very skewed from the typical theory of ‘survival of the fittest,’ which many

are accustomed to believing that it is the most physically fit people that will thrive in a disaster-

stricken environment.

Evaluating Nutrition Programs in Schools

If nutrition programs are inconsistent and ineffective, how can this data be evaluated and

monitored for continuous improvement? Public health officials in New York used the Wellness

School Assessment Tool (WellSAT) to assess overall “strength and comprehensiveness of

elements of LWP [Local Wellness Policies] required by the Child Nutrition and WIC

Reauthorization Act of 2004” (Brissette, 2013, p. 758). The use of this tool, they believe, will

create a standard that could “better enable them to illustrate the strengths and deficiencies of

policies within an LWP” (Brissette, 2013, p. 758). Not only are school nutrition programs poorly

monitored, but government programs that provide supplemental nutrition are also being

monitored using an algorithm that mitigates many outlying factors. The federal poverty

guidelines are using a 50 year old metric that “does not reflect: 1) greater rates of inflation of

prices for other essentials, 2) differences in the income distribution over time, or 3) price or

income differences across different locales” (Anthony, et. al., 2011, p. 2007). Furthermore,

research by Anthony, et. al. (2011) examines the inability of programs to address more than a

single domain effectively. While “small effects of the federal school lunch programs on the basic

nutritional status of the child” have been found “it is less clear […] how well the federal food

programs address food insecurity and hunger” (Anthony, et. al., 2011, p. 2003).

19


The Healthy Home Survey (HHS) is another tool that can be utilized which “measures

characteristics of the home environment that are hypothesized to influence healthy weight

behaviors in children, including diet and physical activity” (Chuang, et. al., 2013, p. 271). The

Nutrition Screening Form is another self-report method that measures similar data, including

specific questions such as “Does your child eat while watching TV?” (Chuang, et. al., 2013, p.

272). This behavior was found to be highest among African-American preschoolers, and also has

shown and even stronger correlation in adolescence with consumption of sugary beverages

(Chuang, et. al., 2013). Unfortunately, unhealthy behaviors may be even higher than what is

reported, as social desirability is taken into account. In addition, parents who are wanting to

introduce healthy behaviors into their home may be more likely to participate in this type of

study. While currently these tools are mostly being used to assess families that are participating

in related studies, these could be used to measure longitudinal data to help improve school

nutrition programs.

Food Assistance Programs for Low-Income FamiliesFor families depending on government assistance to provide food, it is not only the

school lunch program that needs to be taken into account, but also programs such as the Special

Supplemental Nutrition Program for Women, Infants, and Children (WIC). This program can be

vital for food purchases that often determine the eating behaviors that young children are going

to develop. In addition, “Studies have found a link between maternal weight status and child

obesity levels” (Chuang, et. al., 2013, p. 275). There have been many studies examining the food

environment and different food shopping outlets surrounding low-income neighborhoods, as well

as the food outlets directly surrounding the school. Low-income schools were found to have

20


more access to food outlets to make purchases before and after school, including many stores

that accepted WIC vouchers. However, Tester, et. al. (2010) found:

Schools near higher-income schools had significantly higher scores in the healthy

beverages/low-fat dairy and healthy snacks domains. For example, low-fat or

skimmed milk was found in 45% of the higher income stores but was not found in

any of the lower-income stores. Low-fat crackers and granola bars, each an

example of items on the healthy snacks domain, were found in 69% and 44%

respectively, of the higher-income stores but in only 31% and 21% of the lower-

income stores (p. 962).

A similar study in Baltimore City, an urban area with approximately 21% of its residents

living below the poverty line, found that “Black youth (ages 10-14) […] reported that they spent

an average of $3.96 per day at corner stores, carryouts, and fast-food outlets, typically

purchasing chips, candy, and soda” (Rossen, et. al., 2013, p. 654). Another finding that is

measured against comparisons to high-income, white residents is that “lower-income,

racial/ethnic, […] populations in the United States (US) generally have less access to healthy

foods and are faced with higher prices and poorer product quality” (Tisone, et. al., 2014, p. 726).

These data can be pertinent to shaping the food environments around schools and in low-income

areas, and further examinations of the amount of low-income children that walk to school and are

therefore more susceptible to these unhealthy food outlets.

Parental Influence on Childhood Nutrition Habits

Another strong predictor of a child’s nutritional behaviors is going to be the knowledge

and behaviors of their parents. This is a topic that has been given much thought, however,

21


understanding the long-term effects of implementing a parent education program can be difficult,

and can often have many limitations. With the strong effect that modeling can have on young

children, it is stated that this is “providing opportunities for children to observe their parents

eating healthy foods or engaging in physical activity, serving appropriate portion sizes for age

and setting limits for dietary intake” (Slusser, et. al., 2010, p. 1833). This specific study focusing

on parents from a district that is predominantly low-income and Hispanic/Latino, found that not

only were parents often unreceptive, due to sensitivity of their child-rearing skills, but also

“challenging because of competing time commitments and priorities, unstable schedules and lack

of transportation” (Slusser, et. al., 2010, p. 1834). A similar study by Power, et. al.(2010) (as

cited in Slusser, et. al., 2010), found that “parents blamed their children for their unhealthy

behaviour, making references to poor appetites, picky eating, preferences for junk food and fast

food, and resistance to parental attempts to encourage healthy behaviors” (p. 1834). A

contradicting finding in a study of Mexican immigrant women living in South Texas, a

population with one of the highest obesity and Diabetes rates in the country, had the common

discovery that these mothers who were very devoted to the happiness of their children often

“may not place a priority on their own health [and] do not consider their own health as essential

for ensuring their children’s health” (Johnson, et. al., 2011, p. 13). Given that obesity rates are

higher among minorities living in low-income areas, the parents of this particular group should

remain a target for educating about healthy behaviors and finding effective ways to influence

food choices.

Youth-Targeted Food Marketing

Relative to public health policy, there is one issue that is often being argued as to whether

or not it is constitutional, or if this practice should be abolished for the sake of public health and

22


the wellbeing of children. Advocacy groups are working effortlessly to attempt to “prevent the

publication of guidance that would limit the marketing of unhealthy foods to children by 2016”

(Roehr, 2012, p.1). This would include, but not be limited to, advertising and social media. The

disagreement lies mostly within the food industry, as this would have a great effect on the intake

of certain very profitable crops such as sugar, corn, and wheat, among many others. Others, such

as the Grocery Manufacturers Association, have stated that limiting such marketing is

““extreme,” “fundamentally flawed,” with “no basis in scientific evidence,” and “reflect an

unwarranted bias against prepared, value-added foods”” (Roehr, 2012, p. 1). While the amount

of marketing directed towards children has been steadily decreasing, it still warrants public

awareness.

In discussing the $2 billion a year industry, Margo Wootan, spokesperson for the Center

for Science in the Public Interest, states that “it shapes the whole way they expect to be fed, it

defines the whole social norm… This is a way of cultivating a way of thinking about food among

children that undermines their health, and eventually, quite frankly, will kill them” (as cited in

Roehr, 2012, p. 1). It is suggested that simply educating the public and children in schools may

not be enough to improve overall health, but also a global commitment to understanding the

“contextual influence of the built environment […] and its influence on dietary patterns”

(Morland, et. al., 2007, p. 1481). This is no longer an issue of extremism, but rather being

concerned about the outcome of the public’s health to which there is minimal longitudinal

evidence that states whether or not an entire culture of unhealthy habits can be prolonged.

Study OverviewWhile current research is focusing primarily on creating and adapting effective childhood

nutrition interventions, the program’s long-term effects are still unknown. Without this

23


information to inform policymakers, it is essential that all involved parties become further

educated on the dangers of childhood obesity and other food-related health issues, as well as the

benefits of maintaining a healthy lifestyle. Providing information to parents and teachers that are

more comprehensive in explaining who is most affected, and how these target populations can

minimize these effects. Advocacy and education are essential if nutrition programs are to become

more comprehensive and effective at lowering the risk of obesity-related health issues later in

life. Parental attitudes and understanding is an important first step in acknowledging where gaps

exist between policy and practice.

24


Chapter 3: Methodology

IntroductionCurrently in the United States an estimated one-third of children and adolescents are

either overweight or obese (Snelling, et. al., 2014). This number is also disproportionately

distributed among minorities, specifically African Americans and Hispanic children, who suffer

about a 10% greater risk than White children, 26 %, 27.7% and 17.4% respectively (Chuang, et.

a., 2013). Taking into consideration the projected economic costs this obesity epidemic could

potentially inflict on the U.S. economy, as well as growth in chronic illnesses, more drastic

measures to change the current state of health must be taken.

In order to begin targeting the issue of child nutrition, behavioral change must be a

priority within school nutrition programs. For schools to begin adopting more comprehensive

nutrition programs, leaders need to become more aware of the most effective practices in

education and how nutrition education can be implemented into the curriculum to reverse the

obesity epidemic that has overtaken the country. While this issue is only further worsened by

food costs, marketing towards children, and food deserts in minority areas, schools can be an

environment where children can begin learning how to alleviate these other factors and attempt

to make healthier choices. With educators as the foremost leaders in these efforts, practice may

influence policy as the shift in healthy food demands begins to further effect the food market.

As is evident, this proposal is not one that can be approached from a single perspective,

but rather a complex system that involves multiple stakeholders to gain an interest in revolution

of current nutritional habits. In an effort to understand current school nutrition programs and how

they compare to policy standards, this study measures behaviors in families with children in an

urban school district in Central Texas, whose children also receive assistance through the

25


National School Lunch Program (NSLP). While previous studies have measured nutrition

programs in other high minority, urban areas, this study is unique in that a proportion of students

are from non-English speaking, immigrant homes, as is evident from the district’s Title I Migrant

Education Program. As of 2010, the district contained 36.5% Hispanic students, and while their

immigrant status is unable to be directly gathered from available data, it is possible that many of

the students are first generation Americans.

Parental attitudes and knowledge of nutritional practices within their child’s schools will

measure the generalization from school to home of programs that are currently being

implemented. In addition, the study will assess their current food shopping and meal preparation

habits and how they model healthy behaviors for their children. Most interventions hypothesize

that evidence of healthy food choices as well as an understanding of nutrition education are not

present and that school nutrition programs are not combining multiple approaches as a best

practice to most effectively target unhealthy behaviors. Most importantly, where do the gaps

exist between policy and practice and can a greater understanding of these gaps increase

application?

MethodBased on previous nutrition program studies, this study adopted similar techniques to

measure current behaviors surrounding nutrition in a district, focusing specifically on the

district’s Title I schools with high concentrations of minority students. Many of the measures

were created using a basis of the Healthy, Hunger-Free Kids Act of 2010 that promotes access to

nutrition for all children to allow them to grow into healthy adults.

Setting

26


The setting was an Afterschool Program for students currently attending a Title I school

within the Austin Independent School District (AISD). In addition, students must qualify for free

or reduced lunch. This setting allowed the researcher to identify parents who had students

attending the program.

AISD Facts and Figures (obtained from AISD- About Us)

Enrolls approximately 84,000 students within 130 schools, primarily in urban

communities

Graduation rate of 86.3%

Ethnicities Represented: 59% Hispanic, 26% White, 8% African American, 7%

Other

52% of students are Economically Disadvantaged

Participants

The study approached a small group of parents whose children attend an Afterschool

Program. The initial contact was made with administrators to gain an understanding of

expectations for nutrition within their own program, as well as to provide an introduction into the

current study. After providing details of the study to administration, permission was asked to

distribute or post a flyer, which requested parents to participate in a study regarding student

nutrition (See Appendix A). In addition, the flyer included information regarding a small gift, for

which the value did not exceed $10, which would be distributed at the end of the ~30-minute

focus group session.

Participant retention proved to be very difficult. With a total of 5 committed and 1

maybe, only three participants had shown up for the focus group. However, 1 of the participants

27


was unable to stay, but was able to fill out a demographic sheet. Due to lack of other information

about the participant or responses to the focus group questions, her information was not included

in the final comparative study.

The other two participants had shown up 15 minutes apart, and due to the time frame

allotted for the group, the study ended up being two separate interviews, rather than a focus

group. In addition, one of these participants ended up not fully meeting the eligibility

requirements, as her family did not receive any government food assistance. While the situation

was not as ideally intended for the study, the information gathered proved to provide a

comparison between low-income and non low-income parents and their experiences and

knowledge about the nutrition programs at their child’s school.

Measures

The focus group was centered on a core set of questions that allowed for additional

discussion. The questions, which were created for the purpose of this study, modeled many of its

questions off of the principles of the Healthy, Hunger-Free Kids Act. The Healthy Home Survey

(HHS), which contains 113 items, would have been appropriate, but access was not available. In

addition, to ensure a higher response rate, the study did not use the HHS for the concern that the

questionnaire would appear too time-consuming to participants. The focus group participants

were each provided with a 5 question demographic sheet at the beginning of the session, which

remained anonymous (See Appendix B). An additional 11 questions were asked openly by the

researcher, which assessed behaviors and knowledge surrounding nutrition knowledge, student

behaviors, personal health habits, and parental outreach for nutrition education (See Appendix

C).

28


Procedures

A letter was provided to all potential participants at the beginning of the session to

explain the study and provide contact information for questions, concerns, or opportunities for

additional follow-up (see Appendix D). In addition, the letter explained that the participant is

free to leave at any time or refrain from answering any questions that make them uncomfortable.

All participants had previously granted permission during the initial sign-up process. The session

itself had the researcher direct initial conversation by introducing a question, and then allowed

participants to speak freely about the topic.

Data Analysis

Focus group results will measure reported behaviors as well as attitudes and

understanding of current nutritional programs within their individual schools. Responses that

may be included in interviews will also be analyzed for frequency. Data will provide a glimpse

of the district’s overall commitment to providing low-income students with proper education to

reduce unhealthy food behaviors.

29


Chapter 4: Findings

The findings showed the inconsistency of knowledge in regards to programming and

nutrition information. Parents were unaware of what information was being offered to their

students, however they explained healthy habits within their own homes and within their food

purchases. In addition, parents seemed to believe that the majority of education about

maintaining a healthy lifestyle is a practice that should be primarily within the home, rather than

the school. The parents also explained that their children were aware of the consequences of

making unhealthy choices, however, the majority of these answers were not expanded upon. The

parents themselves came from different backgrounds, which also affected their experiences and

understanding of the different activities and information being offered within the school. The

following information provides a more comprehensive depiction of nutrition within schools and

how a variety of factors support, promote, and affect, both positively and negatively, the

programs’ overall effectiveness.

Results

Policies and Programs – Local and State

A program created in 2008 by the Dell Children’s Medical Center of Texas found that

“approximately 35% of the students in grades 3 to 12 are overweight or obese in Austin ISD

alone” (Dell Children’s, 2008). That statistic, along with other noticeable obesity trends, is what

led researchers to form the Texas Center for the Prevention and Treatment of Childhood Obesity.

In addition, the National School Lunch Program (NSLP) currently provides free or reduced-cost

lunches to more than 3 million children in Texas alone (NSLP, 2015), further reiterating the

importance of providing healthy options that are eligible for purchase within the NSLP.

30


Additional research into the political climate of the state of Texas provided a framework

for the overall commitment to nutrition within schools. The 84th legislature of Texas proved to be

mostly of a loss to the state’s advocates for healthier food choices for low-income families.

House Bill 1616, which would have incentivized food stamp recipients to shop at local farmers

markets, was left in a pending status (H.B. 1616, 2015). Among this bill was another that failed

to be passed which would have provided incentives to grocery stores for opening locations in

food deserts (H.B. 269, 2015). However, one bill had been supported for passing which allowed

schools to opt out of the National School Breakfast Program, which tends to inflate food costs,

and instead “develop and implement a locally funded program,” however in doing so the school

would also lose federal funding dollars (H.B., 1305, 2015). In addition, this new locally funded

program could lead to more flexibility in implementing appropriate nutritious meals. All of

which would likely first need to be approved by the School Health Advisory Committee

(SHAC), a board that was established in 2001 by Texas Senate Bill 19 (SB 19) mandating that

every school in the state create such a team that promotes health and nutrition initiatives within

each school (CDC, n.d., p.1).

A further look into nutrition programs at a local, state and global level showed that many

programs are available to assist in maintaining and educating families on healthy lifestyles and

nutrition choices. The detailed chart below (Figure 1) provides an overview regarding programs

and their location, their target audiences, their target audience, the organization’s primary goals

(which were taken directly from the organization’s website/about me page), and different

activities or events in which the organization is involved or sponsors. The organizations included

are all programs with a focus on poverty/hunger reduction or aiming to promote healthy

lifestyles and nutritious diets.

31


The organizations included in the chart below primarily focus on targeting low-income

audiences. In addition, the researcher primarily chose to include organizations whose emphasis

lies within the family structure or children. Program, such as CATCH, attempt to target the

whole system (i.e., school, family, self), whereas other programs may have more specific targets.

The organizations are all very different from one another, specifically within the activities each

group performs, as will be evident in the chart below. Of course some organizations are also

going to leverage more power than others, due to funding sources, ability to market, visibility,

manpower, and whether or not the program boasts an interest from the public.

Figure 1, while not inclusive of all programs available, were the programs in the area,

which were easily accessible without inconvenient navigation that may be more difficult for

purposes of an individual’s needs, rather than research purposes. The chart allows the reader to

understand what opportunities may be available for low-income individuals in this particular

metropolitan area. While their availability exists, whether or not its target audience knows their

existence is an area of concern.

Organization Location Target Audience

Primary Goals (Taken directly from org's website)

Activities

MEND of YMCA Austin

Austin, TX Children 7-13 and their families

Childhood Obesity Intervention for Children and Parents, Reduction in Screen Time, Improvements in Body image and self esteem

Healthy Eating, Regular Physical Activity, Behavior Change

Austin Academy of Nutrition and Dietetics

Austin, TX Community Wide

Helping the Austin Community achieve a healthy and nutritious lifestyle through proper eating habits

Events held are primarily for field professionals

Global Nutrition Empowerment

Global Underserved areas, globally

Reducing preventable birth defects and improving maternal and child health through micronutrient supplementation and

Build partnerships with local NGOs, Develop culturally

32


nutrition education in underserved areas of the world

sensitive educational programs related to nutrition and micronutrients, provide local mentorship and supplies

CATCH (Coordinated Approach to Child Health)

Global, but founded in Austin

EVERYONE, Programs for Pre-K, K-5, 6-8, Afterschool, and Training Programs

CATCH is based on the CDC Whole School, Whole Community, Whole Child model in which health education, school environment, and family/community involvement work together to support youth in a healthy lifestyle.

One of the ways in which CATCH supports child health is through nutritional coordination with school lunchrooms and other food providers.

City of Austin- Bright Green Future School Grants

Austin, TX Schools- Teachers & Kids

Austin area students, teachers and parents have envisioned a bright green future through a variety of hands-on learning projects that encompass composting systems, rainwater harvesting, organic gardens, rain gardens, bike academies, wildlife habitats, etc.

Provide funding for sustainable projects and lead schools in hands-on learning projects.

KIPP: Austin (Health & Wellness Policy)

Austin TX, other programs throughout US

Community Wide

KIPP Austin Public Schools Board recognizes that there is a link between nutrition education, the food served in schools, physical activity, and environmental education, and that student and staff wellness is affected by all of these. The Board also recognizes the important connection between a healthy diet and a student’s ability to learn effectively and achieve high standards in school.

Survey students twice a year regarding food choices in cafeteria.

TX Dept of Agriculture

TX State wide Provide administration and oversight for 12 federal nutrition programs throughout Texas. Encourage Texans to consume foods produced in Texas and to support and understand local agriculture and how it affects the economy. Works with

Farm Fresh Fridays, Urban Schools Ag grant, 3E's Grant Program, Farm to Child

33


elected officials to share and promote best practices to ensure a healthy state.

WeViva Austin, TX Community (Low-income)

WeViva provides affordable and accessible fitness and nutrition programs to people in low-income communities throughout Austin.

Zumba, yoga, strength training and nutrition classes free

Capital Area Food Bank of Texas

Austin, TX Community (Low-income)

The rising cost of housing, utilities, transportation and healthcare leaves many of our neighbors to make impossible choices and painful sacrifices. Two-thirds of the people we serve say they had to choose between buying food and paying for housing in the past year. Eighty percent say they had to choose between food and medicine.

Kids in the Kitchen, Eat Well Play Hard, etc.

Sustainable Food Center

Austin, TX Community (Low-income)

Through SFC's The Happy Kitchen/La Cocina Alegre®, SFC offers community cooking and nutrition education classes for the preparation of meals that are delicious, nutritious, seasonal and affordable, ensuring lasting dietary changes.

Happy Kitchen

Figure 1 – Health & Wellness Organizations (All organization websites listed in resources)

In order to understand the potential usefulness of these programs, parent interviews were

seen as necessary to gain an understanding from parents as to what their current knowledge or

programs and nutrition is currently. While none of the organizations above were mentioned

within the interviews, the parents may have had knowledge of the programs without finding their

mention noteworthy for the purpose of this study. Many of the program’s activities were briefly

mentioned within the questions asked in the interview. One example is that the Capital Area

Food Bank and the Sustainable Food Center both offer cooking demonstrations, as well as

34


cooking classes, both activities that parents stated were unavailable in their children’s school, to

the extent of their knowledge.

Parent Interviews

As will be evident in the comparative chart below (Figure 2), differing gender

demographics were both represented in the study, as well as income and education level

differences. Both parents interviewed in this study were Hispanic or Latino, which accounted for

60.4% of all students in the Austin Independent School District in the 2012-2013 calendar school

year (Austin ISD). The specific elementary school in which the study took place is 91.4%

Hispanic for the 2015-2016 school year, with 94.9% of students being categorized as

“economically disadvantaged” (Austin ISD). Parental age was not seen to be an important piece

of data required for this study and that information was not gathered. This research primarily

focused on effectiveness of nutrition programs for low-income schools, so household income

was the primary data piece that was most important to gain perspective within this study.

A side-by-side comparison displays insight into how each parent believes the school

performs on a variety of different nutrition-based responsibilities, as well as the information the

school provides.

Demographics/Questions Parent #1 Parent #2Gender Female MaleHighest Level of Education Bachelor’s Degree High School DiplomaTotal Household Income Above $60,000 $20,000-$40,000Race/Ethnicity Hispanic or Latino Hispanic or Latino# of Children in household under age 18

1 3

Government Food Assistance None Supplemental Nutrition Assistance Program (SNAP)/Food Stamps, Free & Reduced Lunch

Does your child’s school promote health and well being to all teachers and students?

“I think so” “Um, I’m not sure”

35


Does your child’s school offers a variety of healthy lunch options for students?

“As far as I understand, yes.” “Not that I’m aware of”

Is your child aware of the effects of making unhealthy food choices?

“Yes” “Yes”

Does your child’s school educate students about healthy behaviors and how to maintain a healthy lifestyle?

“From what I understand, yes.” “Yes”

Does your child’s school have a clear, designated staff member who is responsible for ensuring a healthy environment or that you can ask health questions?

“I really don’t know” “I would hope its Ms [name removed], she’s the gym teacher I believe”

Do you provide healthy food options at home for your children?

“mhmm” “Yes”

Are you aware of your child’s school’s Local Wellness Policy (LWP)?

Did not ask. Did not ask.

Does your child’s school include families and other community members in ensuring that our students maintain a healthy, nutritious lifestyle?

“I think so” “Yes”

Does your child’s school hold events such as food demonstrations, taste testing, recipe contests, farm visits, school gardens, etc?

“Not all of that but I know that they do speak about it, have had talks with the parents, and there’s also information”

“No, Boys and Girl’s club yes, they have a garden out here, but as for the school I don’t believe so”

Do you feel that schools or parents should be primarily responsible for a child learning healthy behaviors?

“Home” “Yes” (Did not specify which of the two should hold primary responsibility)

Does your child ever discuss any nutrition related material they learned at school?

“Yes” “No”

Does your child help in picking out foods for meals, and if so, are they able to make healthy choices?

“Yes, mixed [choices]” “Sometimes, ummm fruits and vegetables… fruits yes, and then the sweets come into play as well”

Figure 2 – Nutrition Program Experience Comparison

The specific school that was included in parent interviews does currently have

performance objectives listed on their website, which includes specifically to “ensure compliance

with nutrition and staff wellness guidelines” (Austin ISD). Many of the strategies listed on this

sheet were unknown to the parents interviewed. Specific strategies include nutrition classes for

36


adults, as well as the presence of a wellness committee, both topics that the parents interviewed

did not mention. The objectives also state that the school’s measurable targets include 100% of

students participating in nutrition lessons. Lastly, they listed include case management for

students listed within the 85th to 99th percentile for obesity to provide health and wellness

information to maintain a healthy weight. The parents were not questioned about the weight or

physical characteristics of their children, and case management services were not mentioned

during the interviews.

Analysis

Based on the answers given by the two parents, many of their answers were similar,

while many also conflicted. Both parents seem to provide healthy options in the home and

include their children in food purchases. In addition, both parents seemed to agree that most of

the influence for healthy behaviors should be the responsibility of the parents. Another area in

which both parents were in agreement was that they were unaware of a designated staff member

to provide information and resources about healthy lifestyles. The school seems to be lacking in

activities promoting healthy lifestyles, specifically in tactile learning activities such as gardening,

food demonstrations, farm visits, or education from local farmers.

As for lunch options, the parent whose child does not receive free or reduced lunch stated

that there are healthy options available at lunchtime. On the other hand, the parent whose

children receive assistance was unaware if the options included within this lunch program are

nutritious. The responses also indicate that the higher income parent is more aware of

information provided and the nutrition curriculum present in the school. Prior to the beginning of

the interview she had also briefly discussed another ongoing research project with a local

university in which the students have their weights recorded and continue to be monitored for

37


changes. The parent who reported a lower income had not heard previous information about any

nutrition lessons within school, nor was he aware of any initiative to promote health and wellness

within the school to all staff and students.

Despite the vast array of community programs intended to promote nutrition and

activities for health and wellness, the parents had not mentioned any of these programs, nor did

they mention programs they are designated to work directly with the school for these purposes.

The interviews had not asked about programs outside of the school, due to the school nutrition

programs being the primary focus of the research.

Chapter 5: Discussion

Conclusions

The research previously found guided the interviewing process when speaking with

parents about their understanding and knowledge of the programs currently present within their

38


children’s’ schools. A goal of the research was to assess the policies within both the state and

country, which should be regulating the amount of access to health and nutrition education that

students are receiving. However, due to minimal parental knowledge of nutrition programs in

their children’s school, it seems as though this topic continues to fall wayward to core subjects

such as math as reading. While these subjects are, of course, foundations for building a proper

education, without proper nutrition and a healthy lifestyle, their existence may lack relevance if

they are coming second to health issues or lack of focus due to malnourishment. With only

research from previous interventions to follow, these interviews contributed additional

perspective into the breadth of knowledge that parent have when it comes to their child’s

school’s stance on issues of nutrition.

The first research question presented in Chapter 1 focused on how local programs are

working towards achieving goals that relate to the reduction of hunger and poverty, as suggested

by the United Nations. As previously stated 94.9% of students at the specific school where

interviews took place are economically disadvantaged. The majority of the population continues

to live in poverty, to what degree was not discussed. The second research question asked what

programs, policies and laws exist in Austin to assist schools and communities? While

government programs are providing assistance for low-income individuals to purchase meals, the

quality of these meals seems inconsistent or unknown to parents. In addition, community

partnerships and organizations seem to be unknown amongst much of its target audience. Lastly,

the research asked how schools could improve fostering healthy habits for low-income

populations. Based on the responses in the parent interviews, the recommendations listed below

were formed in regards to their observations and experiences.

39


Overall it seemed that the parents interviewed had little understanding into the full depth

of the nutrition program being offered within the school. This specific school does have health

and wellness goals for 2016, as listed in the Parent Interviews section in chapter 4, though

neither of the parents mentioned any of the goals outlined in the school’s plan. In addition,

neither parent provided additional information that expanded on many of the questions asked in

the interviews. This led the researcher to believe that the proposed programs may not be

available, or the programs that are available do not provide adequate outreach. After further

investigation, it seemed that while there are goals outlined on the school’s website, these

activities are not necessarily being translated into programs, nor was their information that

expanded on concrete ways to achieve these goals.

It seems as though the parent with low-income was unaware of lunch food offerings, as

well as hearing children discuss nutrition information from school. Also, the parent with median

income discussed that information is provided to parents, which the low-income parent did not

mention. The demographics of the two interviews suggests that there are families coming from

different income backgrounds, and these two groups may be inconsistently aware of nutrition

education and programs being available to their children. The findings led the researcher to

believe that while the experience is not significantly different between the two parents, based on

income, the low-income parent is slightly less aware of the nutrition program taking place at his

children’s school. The two possible reasons could be means for future research. Whether

programming targets their communication at different parents is the reason for lack of awareness

within the low-income family, or whether there are differences in priority. Due to low participant

enrollment, these questions could be discussed further with a larger participant pool.

40


Implications

The field of Education Improvement and Transformation often focuses many of its efforts

on disadvantaged schools that lack the same opportunities and outcomes as schools that may be

in better neighborhoods, or have more funding. This research may provide further background

for future efforts in improving nutrition programs in schools and monitoring effectiveness to

seek out best practices. In addition, the field of education reform, as well as other professionals

in education, may recognize the importance of nutrition and how it can cause an umbrella effect

for student’s overall performance. Hungry children will have more difficulty concentrating on

topics such as math or reading, so nutrition should be seen as a condition for school

transformation and an area of possible improvement.

Limitations

While the research provided many details and a comprehensive look into the topic of

nutrition within AISD schools, there also remained a number of limitations that could have

boasted more results to suggest further recommendations. The primary limitations were a result

of lack of retention for study participants. The study hoped to gain 5 participants who would

answer a series of questions in a group setting and create a dialogue discussing their differences

in experiences. Due to the actual outcome of only having 2 participants present, as well as their

arrival times being inconsistent, the study became separate, individual interviews. The nature of

the questions then, did not result in the dialogue expected, and rather resulted in many closed-

ended answers.

Another limitation to the study was the inability to study directly within the schools but

rather having to go through an outlet that was an organization that worked with the schools.

AISD has a strict request for research policy, for which this research was ineligible. In addition,

41


response rate from organizations was very low and it was difficult for the researcher to find

willing participants to be involved in the research.

Recommendations

Due to the differences in experience of the parents, and the gender and income

differences, this specific research was focused on understanding differences based on income,

specifically. Whether these differences in experience are due to income or gender could be an

opportunity to future research. In addition, future research could expand to examine the

programs within all of the schools in AISD, rather than just one. Although the majority of

AISD’s schools are disadvantaged, there are also a few that are in median-high income

neighborhoods. Whether or not there is a difference in nutrition education and lunch food

quality/options could be a topic for future research.

Recommendations for improving the program’s effectiveness are based upon the parental

experiences as well as previous successful strategies from other interventions. First and foremost,

parental outreach needs to be a number one priority if building healthy lifestyles is going to be

successful, due to the carryover effects between home and school. Due to the differences in level

of involvement and opportunity between each parent, there needs to be a variety of ways in

which parents can become more aware and adopt simple strategies into their own home. One

option could be a resource center to provide parents with literature about programs, events,

organizations, etc. whose aim is to improve health and nutrition. This could be a physical space,

such as a school lobby, or a website. Parent surveys and newsletters could be another outlet to

gain insight into current habits and knowledge of nutrition programs, and to build lessons for

students based upon this information. There could also be weekly homework assignments that

42


students take home and complete with a family member. These could provide educational

passages about healthy food choices and quiz the students at the end of the reading. After

completion the student could receive a healthy prize, such as a piece of fruit.

Visibility is another area that is recommended to improve. The parents in the study

seemed unaware of any visual or tactile type of activities that provide hands-on learning

opportunities for students. Many successful interventions from other schools have included

implementing field trips to farms, having a farmer visit and educate students about agriculture,

cooking demonstrations, and healthy food taste testing so students are exposed to a variety of

fruits and vegetables that may be novelty items. Another often-successful program to implement

is a school garden. This sustainable learning experience also provides students with the tools and

knowledge they need to reproduce something similar at their own home.

This research provides a guide for researchers to replicate for future studies and to gain a

more comprehensive understanding of an effective nutrition program. With each intervention or

research that seeks to gain further comprehension, the field will hopefully grow more extensive

and understood as an area that encompasses much more than just what we eat. Rather nutrition

has expansive benefits and consequences for everyone and can make a difference in the daily

lives of individuals.

Resources

AAND. (2012). Austin Academy of Nutrition and Dietetics. Retrieved from:

43


http://eatrightaustin.org/

Anthony, E. K., King, B., Austin, M. J. (2011). Reducing child poverty by promoting child well-

being: Identifying best practices in a time of great need. Children and Youth Services

Review, 33, 1999-2009.

Austin Independent School District. (2015). About Us. Retrieved from:

https://www.austinisd.org/about-us

Brissette, I., Wales, K., & O’Connell, M. (2013). Evaluating the Wellness School Assessment

Tool for Use in Public Health Practice to Improve School Nutrition and Physical

Education Policies in New York. Journal of School Health, 83(11), 757-62.

Capital Area Food Bank of Texas. (n.d.). Learn More. Retrieved from:

https://www.austinfoodbank.org/learn-more

CATCH. (2016). Coordinated Approach to Child Health. Retrieved from: http://catchinfo.org/.

CDC. (2015). Prevalence of Self-Reported Obesity Among Hispanic Adults by State and

Territory, BFRSS, 20142-2014. Retrieved from: www.cdc.gov/obesity/data/table-

hispanics.html.

CDC. (n.d.). Success Story: Approach 1 Establish Nutrition Standards for Competitive Foods.

Retrieved from: www.cdc.gov/healthyschools/mih/pdf/approach1-success.pdf

Chuang, R., Sharma, S., Skala, K., & Evans, A. (2013). Ethnic Differences in the Home

44


Environment and Physical Activity Behaviors Among Low-Income, Minority

Preschoolers in Texas. American Journal of Health Promotion, 27(4), 270-78.

City of Austin. (n.d.). Bright Green Future School Grants. Retrieved from:

http://www.austintexas.gov/brightgreenfuture.

City of Austin. (2013). Hispanic Quality of Life Report. Retrieved from:

https://www.austintexas.gov/sites/default/files/files/City_Manager/HispanicReport-v

er_6-0901_13.pdf.

City of Austin. (n.d.). Top Ten Demographic Trends in Austin. Retrieved from:

https://www.austintexas.gov/page/top-ten-demographic-trends-austin-texas.

Dell Children’s Medical Center of Central Texas. (2015). Empowering families to live healthy,

happy lives. Retrieved from: https://www.dellchildrens.net/services_

and_programs/texas_center_for_the_prevention_and_treatment_of_childhood_obesity/d

Department of Agriculture. (2012). National Standards in the National School Lunch and School

Breakfast Programs. Federal Register, 77(17), 4087-4167.

Department of Agriculture. (2013). Offer versus Serve. Retrieved from:

www.fn.usda.gov/sites/default/files/SP45-2013a.pdf

Evans, A., Ranjit, N., Rutledge, R., Medina, J., Jennings, R., Smiley, A., Stigler, M., &

45


Hoelscher, D. (2012). Exposure to Multiple Components of a Garden-Based Intervention

for Middle School Students Increases Fruit and Vegetable Consumption. Health

Promotion Practice, 13(5), 608-16.

GNE. (n.d.). Global Nutrition Empowerment. Retrieved from:

http://www.globalnutritionempowerment.org/.

Gunderson, G. (2014). NSLP Public Concern, Action and Status. Retrieved from:

www.fns.usda.gov/nslp/history_7#

House Bill 1305. 84th Legislature (2015). Retrieved from: http://www.capitol.state.tx.us



Johnson, C. M., Sharkey, J. R., & Dean, W. R. (2011). It’s all about the children: a participant-

driven photo-ilicitation study of Mexican-origin mothers’ food choices. BioMed Central:

Women’s Health, 1-15.

KIPP: Austin. (2012). Health and Wellness. Retrieved from: http://www.kippaustin.org/health-

and-wellness.

McCaughtry, N., Martin, J.J., Fahlman, M. & Shen, B. (2011). Urban health educators’

perspectives and practices regarding school nutrition education policies. Health

Education Research, 27(1), 69-80.

46


McMillan, T. (2014). The New Face of Hunger. Retrieved from:

http://www.nationalgeographic.com/foodfeatures/hunger/

Mend Foundation. (n.d.) About MEND. Retrieved from: http://www.mendfoundation.org/home.

Morland, K. & Filomena, S. (2007). Disparities in the availability of fruits and vegetables

between racially segregated urban neighborhoods. Public Health Nutrition, 10(12), 1481-

89.

Ory, M.G., Nichols, D., Dickerson, J.B., Madsen, K. K., Dowdy, D. M., Menendez, T., Miller,

C., & Hoelscher, D. M. (2013). Creating a Tipping Point: Texas Obesity Policy Actions

in Review, 2000-1010. Progress in Community Health Partnerships, 7(4), 419-27.

Prelip, M., Slusser, W., Thai, C. L., Kinsler, J., & Erausquin, J. T. (2011). Effects of a School-

Based Nutrition Program Diffused Throughout a Large Urban Community on Attitudes,

Beliefs, and Behaviors Related to Fruit and Vegetable Consumption. Journal of School

Health, 81(9), 520-29.

Ranjit, N., Evans, A. E., Springer, A. E., Hoelscher, D. M., & Kelder, H. K. (2015). Racial and

Ethnic Differences in the Home Food Environment Explain Disparities in Dietary

Practices of Middle School Children in Texas. Journal of Nutrition Education and

Behavior, 47(1), 53-60.

Rodriguez, J., Applebaum, J., Stephenson-Hunter, C., Tinio, A., & Shapiro, A. (2013). Cooking,

47

http://www.nationalgeographic.com/foodfeatures/hunger/


Healthy Eating, Fitness and Fun (CHEFFs): Qualitative Evaluation of a Nutrition

Education Program for Children Living at Urban Family Homeless Shelters. American

Journal of Public Health, 103, S361-S367.

Roehr, B. (2012). US efforts to limit marketing of unhealthy food to children are delayed. BMJ.

doi: http://dx.doi.org/10.1136/bmj.e3340

Rossen, L. M., Curriero, F.C., Cooley-Strickland, M., & Pollack, K. M. (2013). Food availability

en route to School and Anthropometric Change in Urban Children. Journal of Urban Health,

90(4), 653-66.

School Nutrition Association. (2015). SNA History & Milestones. Retrieved from:

https://schoolnutrition.org/AboutSNA/HistoryMilestones/

SFC. (n.d.) Sustainable Food Center. Retrieved from: http://sustainablefoodcenter.org/.

Simopoulos, A. P., Bourne, P. G., Faergeman, O. (2013). Bellagio Report on Healthy

Agriculture, Healthy Nutrition, Healthy People. Nutrients, 5, 411-423.

Slusser, W., Prelip, M, Kinsler, J., Erausquin, J.T., Thai, C., & Neumann, C. (2010). Challenges

to parent nutrition education: a qualitative study of parents of urban children attending

low-income schools. Public Health Nutrition, 14(10), p.1833-1841.

Snelling, A., Belson, S. I., Beard, J., & Young, K. (2015). Associations between grades and

physical activity and food choices. Health Education, 115(2), 141-51.

48


Springer, A. E., Li, L., Ranjit, N., Delk, J., Mehta, K., Kelder, S. H. (2015). Schol-level

economic disadvantage and obesity in middle school children in central Texas, USA: a

cross-sectional study. International Journal of Behavioral Nutrition and Physical

Activity, 12(Suppl 1), 1-8.

Tester, J. M., Yen, I. H., Pallis, L. C., & Laraia, B. A. (2010). Healthy food availability and

participation in WIC (Special Supplemental Nutrition Program for Women, Infants, and

Children) in food stores around lower- and higher-income elementary schools. Public

Health Nutrition, 14(6), 960-964.

Texas Department of Agriculture. (2016). Home Page. Retrieved from:

https://texasagriculture.gov/Home.aspx

Texas Department of Agriculture. (2015). National School Lunch Program. Retrieved from:

http://www.squaremeals.org/Programs/NationalSchoolLunchProgram.aspx

Tisone, C. A., Guerra, S. A., Lu, W., McKyer, E. L. J., Ory, M., Dowdy, D., Wang, S., Miao, J.,

Evans, A., & Hoelscher, D. (2014). Food-shopping Environment Disparities in Texas

WIC Vendors: A Pilot Study. American Journal of Health Behaviors, 38(5), 726-36.

United Nations. (2015). Sustainable Development Knowledge Platform. Retrieved from:

https://sustainabledevelopment.un.org/

USDA. (2014). Healthy Hunger-Free Kids Act. Retrieved from: http://www.fns.usda.gov/school-

meals/healthy-hunger-free-kids-act

49


USDA. (2015). Final Rule: Revisions in the WIC Food Packages. Retrieved from:

http://www.fns.usda.gov/wic/final-rule-revisions-wic-food-packages

Weatherspoon, D., Oehmke, J., Dembele, A., Weatherspoon, L. (2015). Fresh vegetable demand

behaviour in an urban food desert. Urban Studies, 52(5), 960-979.

WeViva. (n.d.) About Us. Retrieved from: http://weviva.org/about-us/.

Appendix A: Sample Flyer for Participant Recruitment

Parents Needed for Research Study!

50


-30 Minute Focus Group-Are you interested in participating in a 30-minute focus group about food and your child’s eating habits with other parents? If you meet the following requirements, you are eligible to sign up to be one of the participants in this short focus group.

Must have child in Afterschool Program Must have a child eligible for free or reduced-cost lunch Must be a household member that makes decision about food purchases

About the Study: This study is part of a Student Research study being conducted on behalf of Drexel University for curriculum requirements towards degree attainment. This study aims to gain information on the effectiveness of school nutrition programs and the lifestyle habits of the students in which the programs are reaching. Focus group will take place around 5:30 PM on a school day to later be determined based on participant availability. In addition to your contribution, a small gift will be provided to all participants, following the focus group, as a token of appreciation. Space is limited.

If this sounds like something you are interested in and you meet all of the above requirements or if you have any questions, please contact Dayna by phone at 610-334-6723 or by email at [email protected].

Appendix B: Demographic QuestionnairePlease answer the following questions to the best of your knowledge.

The answers to these questions are used only for demographic purposes.

1. What is your highest level of education?

51


a. Did not complete High Schoolb. High School Diplomac. Bachelor’s Degreed. Professional Degree

2. What is your total household income?a. Below $20,000b. $20,000-$40,000c. $40,000-$60,000d. Above $60,000

3. Which of the following best describes your ethnicity (or race?) a. Whiteb. Hispanic or Latinoc. Black or African Americand. Native American or American Indiane. Asian/Pacific Islanderf. Other

4. How many children under the age of 18 live in your household? ________________

5. Do you or your children currently receive assistance through any of the following federally funded food programs? (Circle all that apply)

a. Supplemental Nutrition Assistance Program (SNAP) / Food Stampsb. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)c. Assistance from a Food Bank, Church, other food donation programd. Not Sure

Appendix C: Sample Focus Group Questions1. Does your child’s school promote health and well being to all teachers and students?

2. Does your child’s school offers a variety of healthy lunch options for students?

3. Is your child aware of the effects of making unhealthy food choices?

52


4. Does your child’s school educate students about healthy behaviors and how to

maintain a healthy lifestyle?

5. Does your child’s school have a clear, designated staff member who is responsible for

ensuring a healthy environment or that you can ask health questions?

6. Do you provide healthy food options at home for your children?

7. Are you aware of your child’s school’s Local Wellness Policy (LWP).

8. Does your child’s school include families and other community members in ensuring

that our students maintain a healthy, nutritious lifestyle?

9. Does your child’s school hold events such as food demonstrations, taste testing,

recipe contests, farm visits, school gardens, etc?

10. Do you feel that schools or parents should be primarily responsible for a child

learning healthy behaviors?

11. Does your child ever discuss any nutrition related material they learned at school?

12. Does your child help in picking out foods for meals, and if so, are they able to make

healthy choices?

Appendix D: Introductory Letter for ParticipantsDear Participant,

I thank you for taking the time out of your day to participate in this quick focus group.

Currently I am studying the effectiveness of nutrition programs in low-income school districts in

Austin as my final research towards my M.S. in Educational Improvement and Transformation.

53


This topic is being studied to hopefully inform stakeholders of the effectiveness or

ineffectiveness of school nutrition programs, to promote more comprehensive programs that will

aim at reducing childhood obesity. As an incentive, I will provide you with a small gift of

appreciation at the end of the session.

Please be aware that all results will be confidential and will remain anonymous, and that

you are free to leave at any time. Collecting demographic data will assist with being able to

gather more precise, generalizable data so that this study may be further replicated in the future.

Should you have any further questions or want further information about the study you

may contact my supervising professor, Dr. Kristy Kelly, PhD (email:[email protected]) or me

at 610-334-6723.This study has been approved by Drexel University’s Institutional Research

Board. For more information, you can contact the University’s Human Research Protection

Program at 215-255-7857 or [email protected].

Thank you,

Dayna Reber, M.S. Educational Improvement and Transformation, ‘16, Drexel University

54


Appendix E: IRB Approval Letter

55

Documents

Reber_NUTRITION FOR LOW-INCOME CHILDREN