Food & Nutrition [Volume 13, Number 4]

              October 1983 Volume 13 Number 4
School Lunch
Wins Customers ...
And Praise
Income Verification
Helps Target Benefits
to Children in Need
Careful Buying
Keeps Prices Low
l For Br1ik'ing u----~ - - --.-.. , l sa.... 0 nI Y
The school lunch program received
excellent marks in a national evalua­tion
completed earlier this year.
Thanks to creative food service
managers, participation in the pro­gram
remains high. Page 2
Starting this fall, schools across the
country will be verifying income
information on a sample of applica­tions
for free and reduced-price
meals. Several school districts tried
verification last year, with some
interesting results. Page 5
Borrowing some planning tech­niques
from private industry, school
lunch managers in Mississippi are
learning to get more food for less
money. The difference is showing
up in lower meal costs. Page 7
Video Teleconference
Focuses on Nutrition
For Mothers and
Babies
Food and Education
Go Hand in Hand
-In Oklahoma
PROP~RTY OF THE
IIRRllPV
OCT 2 6 1983
A video teleconference held this
spring brought together thousands
of health and nutrition profession­als.
Tapes of the conference are
now available. Page 10
The Oklahoma Department of
Human Services reaches people of
all ages with its nutrition education
program. Communal dining centers
offer monthly classes for the elderly.
Page17
School Lunch
Wins Customers ... And Praise
Across the country, the school
lunch program-a part of American
life since the end of World War 11-is
back in vogue. School cafeterias are
sprouting salad bars and offering
new choices to keep up with student
tastes in a generation where Apple
brings to mind a computer as much
as it does a healthful snack.
About half the student enrollment
currently takes part in the National
School Lunch Program, according
to a recent survey by the National
School Board Association. And,
USDA figures show, lunch partic­ipation
has been on the rise.
For the first 5 months of the 1982-
83 school year, total average daily
participation increased by 177,000
lunches, compared to the same
period the previous year. Approxi­mately
23.3 million students now
participate each school day.
Last year's participation increases
are even more striking because they
occurred at the same time national
enrollments were declining by about
three-quarters of a million students.
Particularly noteworthy is that the
number of children served free
meals-children who are most in
need of food help-has jumped from
9.9 million to 10.2 million.
2
Local food service directors say
participation remains high because
parents believe that school meals
are a good buy and are nutritionally
better for their children than other
meals.
Creative managers
are getting results
School food service people are
paying more attention to merchan­dising
these days. They're finding
new ways to make lunches more
attractive to kids, and they're letting
parents know that alternatives to
school lunch, such as a good brown
bag lunch from home, can be more
expensive and offer less variety.
In New York, Richard Reed, chief
of the state's bureau of school food
management, reports participation
increases in a number of his dis­tricts.
He attributes this to stable
prices and creative work on the part
of school lunch managers.
For example, in Corning, New
York, lunch manager William
LaRock boosted his participation by
600 meals a day or roughly 10 per­cent
by introducing a peanut butter
sandwich bar in his elementary
schools. It's similar to a salad bar, but
children can put their own fruit and
nut toppings on peanut butter
sandwiches as part of the meal.
In the Horseheads Central Dis­trict,
manager Peter Forcier offers a
lunch that looks like a Ia carte,
which children love. Actually the
meal is a reimbursable lunch offer­ing
the five necessary components.
Forcier has had such success with
this and other initiatives that he's
been able to reduce his prices.
Ann Toman, food service director
in the rural district of Granville, spe­cializes
in getting students involved.
She keeps participation high by
going into the classroom and letting
the children plan menus. Last
Christmas she gave a raffle ticket to
each child who bought a lunch, and
held a drawing for a gingerbread
house scene made by the cafeteria
staff.
Creative, fun ideas like these
attract children to a lunch program,
Reed says. He encourages local
managers to build their participation
by "bringing business promotion
right into the schools and not being
bashful about it."
Marketing wins
new customers
All over the country food service
people have tried new ideas with
great success in the past year.
They've kept the lunch program via­ble
by tightening up their manage­ment
and taxing their ingenuity. Fol­lowing
are a few examples:
-At Griegos Elementary School
in New Mexico, students sit down at
tables and serve each other family
style instead of going through a
cafeteria line. Teachers eat with the
children, and everyone helps clear
the tables. Principal William Chavez
says the program has led to a more
serene and popular lunchtime and
less wasted food.
-The Kansas School Food
Service Association has printed
pamphlets for schools to use in
marketing school lunch. The pam­phlets
help parents see that the
meal's a deal, and nourishing, too.
- In Clinton, North Carolina,
food service director Billie DeVane
works hard to make lunches fun for
children. The school offers "gra­cious
dining" where students occa­sionally
can eat lunch in a fancy set-
Food and Nutrition
ting with tablecloths and lots of
silverware. She also holds a party
every month, where every child who
has a birthday that month gets
punch and cupcakes. These activi­ties,
along with expanded choices,
have boosted participation.
- Theme days are good partici­pation
boosters, too. In Knoxville,
Tennessee, participation is extra
good on Grandparents' Day, Thanks­giving
turkey dinner days, and dur­ing
National School Lunch Week,
when many parents come and eat
lunch at school with their children.
John Carter, director of the city's
school food service, says participa­tion
has remained a constant 58
percent of total enrollment. He
attributes this to student involve­ment
in menu planning and absence
of price hikes.
-In Quincy, Florida, food serv­ice
manager and American School
Food Service Association President
Clarice Higgens increased her lunch
participation by 200 children a day
by setting up taste-testing commit­tees
and installing three new salad
bars in the high school.
-Some California school lunch
managers have found price de­creases
can get dramatic results.
Managers in Fairfield, California,
rolled back lunch prices, and partic­ipation
increased by 37 percent in
the secondary schools, making the
change a cost-effective measure.
There was also a 10-percent in­crease
in participation in the ele-mentary
school lunch program,
mainly as a result of the favorable
response to an offer-versus-serve
plan that now gives children more
choice in the foods they get for
lunch.
-In Jefferson County, Colo­rado,
school food service manager
Linda Schumacher uses a computer
to track the most popular meals. She
tends to the tastes of her students as
well as to their nutritional needs.
Included on her menus are sand­wiches
and chef or taco salads,
which meet the same standards but
provide a popular alternative to the
traditional hot lunch.
Evaluation shows
program is working
School lunch is a big part of a
child's day, both nutritionally and
socially. During the past few years,
food service managers have coupled
good management techniques with
efforts to make the lunch period
more enjoyable for students. They
have also reached out to the com­munity
to involve parents.
The result has been a very pos­itive
outlook in the school food
service industry, an outlook that is
enhanced by the excellent review
the lunch program received in a
recent evaluation of the program's
nutritional impact. The evaluation,
released by USDA in April, is the
first nationally representative public
health and nutrition survey of the
school nutrition programs.
The study, which was requested
by Congress, took nearly 4 years to
complete and looked at both the
national school lunch and school
breakfast programs. While the
school lunch program received
extremely high marks in the final
report, the school breakfast program
has further to go in reaching nutri­tional
goals, the study concluded.
The breakfast program generally
does not provide meals that are
nutritionally superior when com­pared
to alternative breakfasts.
About 7,000 families throughout
the country took part in the study,
which provides an extensive body
of current information on many
aspects of the school nutrition pro­grams,
including the impact of fed­eral
school meal subsidies on family
food expenditures.
Here are more details:
Nutritional impact of lunch
The study shows that the lunch
program improves the nutritional
intake of children from all income
levels. The program is available in
virtually all-about 98 percent-of
public school districts in the U.S.
While participation rates are higher
among lower income students than
among students from other income
..... _. groups, substantial numbers of stu­dents
from all income and ethnic
• groups participate.
3
The study shows:
Students who participate in the
National School Lunch Program
have higher intakes of energy and
eight important nutrients than stu­dents
who do not. Participating
children get higher daily percent­ages
of protein, vitamin A, riboflavin,
vitamin 86, calcium, phosphorus,
magnesium, and niacin.
The lunch program is superior not
only when participants' nutrient
intake from the noon meal is com­pared
to that of nonparticipants, but
also when nonparticipants' 24-hour
nutrient intake is compared to that
of nonparticipants. This means that
program meals make a significant
nutrient contribution compared to
alternative lunches-a contribution
which is not generally compensated
for by other meals eaten during the
day by non-participants.
Four of the nutrients for which
lunch program participants show
superior intakes-vitamins A and
86, calcium, and magnesium-are
ones that typically are deficient in
the diet of the school-age popula­tion,
and therefore are especially
important for children.
The study attributes the superior
nutritional quality of school lunches
to the well-balanced variety of foods
that must be served under federal
meal pattern standards.
Breakfast results
In contrast to the wide availability
of the lunch program in the U.S., the
breakfast program is offered in just
39 percent of school districts. These
districts tend most often to be in
low-income areas. Most school
breakfasts-four out of five-are
served to children qualifying for free
school meals.
The availability of the breakfast
program increases the likelihood
that children will eat breakfast.
Based on the study data, USDA
estimates that if most schools chose
to serve breakfast, up to 6aa,aaa
students nationwide who currently
skip breakfast would eat a morning
meal.
School breakfast participants nat­urally
get better nourishment than
students who eat no breakfast. How-
4
ever, the breakfast program is super­ior
to alternative breakfasts for only
three of the 11 measured nutrients:
calcium, phosphorous and ribo­flavin.
All are nutrients which, in
most cases, are obtained by con­suming
milk or other dairy products.
Impact of family food expenditures
The study indicates that families
whose children participate in school
nutrition programs do not reduce
their food expenditures at home
when their children receive subsi­dized
meals at school. This means
they use the school meal subsidy as
a supplement to, rather than a sub­stitute
for, family food spending.
The lunch program, therefore, is
achieving one of its legislated goals:
promoting the consumption of agri­cultural
products by increasing the
amount or quality of food obtained
by participating families.
It also means the school lunch
program is an efficient way of
increasing the value of food availa­ble
to participating families. For
most families, each dollar of federal
subsidy received through the pro­gram
represents an average in­crease
of $1.aa in the weekly value
of food obtained by the family. In
contrast, it would require an in­crease
of direct family income of
about $1 a.aa to have the same effec­tive
increase on food expenditures.
Participation
The biggest single determinant of
school lunch program participation
is meal price. Holding other factors
constant, students who pay higher
prices participate less frequently.
Also, the higher the price, the more
participation drops off with price
increases.
For example, at a lunch price of
4a cents, a 1 a-percent increase in
price is associated with a 5-percent
decrease in participation. At a price
of 6a cents, a 1 a-percent increase in
price is associated with a 7.5-percent
decrease in participation.
Students whose parents report
that the school lunch is less expen­sive,
more convenient, and of higher
nutritional value than lunch at home
are more likely to take part in the
program. This suggests that parent
attitudes as well as economic fac­tors
affect participation levels.
In addition, more frequent partici­pants
in the lunch program are stu­dents
who: are younger (under age
13); have parents who make the
decision where to eat lunch; are
male; cannot eat lunch at home; live
in rural areas; and go to schools
where the faculty and staff eat in the
same dining area as students.
Income verification
The extensive data base provided
by the study backs up the need for
income verification in the school
meal application process. The study
data generally correlate with the
findings of a report done by USDA's
Office of the Inspector General
(OIG) in February 1981 .
The similar finding in both the
National Evaluation of School Nutri­tion
Programs and the OIG report is
that a significant percentage of
children receive free or reduced­price
meal benefits for which they
are not eligible. The national evalua­tion
showed that about 21.8 percent
of meal applicants were receiving
excess benefits at the time the study
was done.
Impact of 1981 legislation
Study results have allowed USDA
to look more closely at how legisla­tive
changes have affected the meal
benefits provided to students of var­ious
income levels. Among the
Food and Nutrition
changes made by the 1981 Omnibus
Reconciliation Act were: increases
in the maximum amount schools
can charge for reduced-price meals;
more stringent accountability on
eligibility for free and reduced-price
meals; decreases in subsidies for
meals served to non-needy chil­dren;
and increases in subsidies for
meals served free to the neediest
students.
Using the data from the national
evaluation, USDA has compared the
income characteristics of children
receiving free and reduced-price
meals before and after the 1981 leg­islation
took effect. The data show
that, across income groups, the
poorest families were not affected
by the eligibility changes.
The impact was greater for less
needy families-that is, those with
annual incomes of $12,000 to
$20,000 for a five-person family with
school-age children. The findings
show that efforts to better target
reduced-price meal benefits to lower
middle-income children are working.
All students, regardless of family
income, get a subsidized lunch
under the program. While schools
earn higher rates of reimbursement
for meals served to needy children,
even lunches served to children
from higher income levels earn fed­eral
reimbursements in cash and
USDA commodities currently worth
about 30 cents a meal. That subsidy
helps schools offer lunches at low
cost even to students paying full
price. The national evaluation show­ed
that after the Omnibus Recon­ciliation
Act took effect, average
cost of a full price school lunch was
81 cents.
School lunch is
still a bargain
The study proves what many peo­ple
have believed for a long time:
school lunch is indeed a very good
deal. As local school lunch manag­ers
creatively accommodate new
tastes and trends, they are continu­ing
to make an old formula work
well by providing balanced, whole­some
food in a friendly, pleasant
environment. The result is healthier
children.
article by Jane Mattern Vachon
October 1983
Income Verification Helps Target
Benefits to Children in Need
One of the conclusions drawn
from the recent National Evaluation
of School Nutrition Programs and
earlier studies was a need for closer
scrutiny of applications for free and
reduced price meals.
Since 1981, schools have had the
option of voluntarily checking the
information parents submitted on
applications. Starting this year,
however, schools will be required to
verify eligibility on a small sample
of approved applications within
5 months of the beginning of school.
"We've tried to strike a balance
between the need for verification
and the difficulty of imposing a new
requirement on already hard­working
school officials," says
George Braley, deputy administrator
for special nutrition programs in
USDA's Food and Nutrition Service.
Designed to help
target benefits
Under the new requirement,
school districts must verify 3 per­cent
or 3,000, whichever is less, of
the approved applications on file as
of October 31 each year.
"We're requiring quite a small
sample," Braley says. "Even in a
large urban high school with a thou­sand
applications for free and
reduced-price meals, you're really
talking about verifying only about
30 of the applications.
"While the new requirement will
add some additional duties for
school officials," he says, "the
benefits in terms of improving the
image of the program and directing
spending to those genuinely in need
are worth the investment in time."
Local districts will have broad flex­ibility
in the methods they decide to
use in confirming eligi_bility. Some
schools might choose to require
parents to present documentation,
such as proof of current participa­tion
in the Food Stamp Program, or
a check stub from an employer.
Others may check with state employ­ment
offices or other agencies that
would have information on a family's
income.
5
The new requirement does not
change the application approval
process. The verification takes place
after the applicati-ons are approved,
and school administrators have up
to 5 months after the beginning of
school to complete the needed
sample.
The National Evaluation of School
Nutrition Programs was not the first
study to highlight the need for better
accountability. A 1981 report by
USDA's Office of the Inspector
General showed that a significant
percentage of children's applica­tions
understated family income.
"This came as a surprise to many
of us," Braley says. "I think it's
important that we've taken some
steps since then-calling for social
security numbers on applications,
for example-to begin to deal with
the problem.
"Now we're following through with
a system to reduce underreporting
of income. I think this is the best
way for all of us in the school food
service field to protect the good
name of the school lunch program."
Prior to the 1981-82 school year,
school districts could verify income
information only if they had reason
to suspect it was not correct.
Has been tried
in some areas
During the 2 years that routine
income verification has been
allowed, many school administrators
who have tried it on a voluntary
basis have been pleased with the
results. "They've found it does help
target benefits to children who are
legitimately entitled to them,"
Braley says.
Patricia Barker in Beaumont,
Texas, is one of several school food
service directors around the country
who tried voluntary verification this
past year as part of a USDA pilot
study. She's found that verification
has made her lunch program strong­er
and more accountable.
"As a taxpayer, I think it's a good
thing," says Barker, whose district
has 11,000 students in the lunch
program, about a quarter of whom
get free or reduced-price meals. "I
honestly feel the verification this
year did deter fraud."
Barker has found that asking for
6
documentation works best. "We ask
parents to bring in employment
check stubs, food stamp papers,
whatever they have," she says. Tele­phone
checks can be more difficult,
she adds, because working parents
are hard to catch at home. "But,"
she says, "once we reached them by
phone it was not hard to get the
information." Barker has also used
computer checks through the state
welfare agency to verify information.
Lucille Lee, food service director
in Las Lunes, New Mexico, has
found that community knowledge of
verification activity is a helpful
deterrent to· abuse. "When you begin
to call parents in a small community
like ours, it gets around-people talk
to each other. So I feel it will have
an added impact this year because
people know we were checking on
the information last year. I think
they'll be a little more cautious when
they apply again," she says.
Verification has not been without
its problems for Lee. "About 1,800
applications for free and reduced
price meals come in to one central
office, and you process them all
yourself," she says. "When you send
letters out to the parents, you can't
get them to respond."
But she feels that verification,
however it is done, is important in
countering some people in the com­munity
who do falsify their applica­tions.
"I've seen for many years that
we need to have some kind of con­trol.
We needed to let people know
that we have the authority to check
the information," she says.
"I know that many people will say,
'Verification can't be done. We don't
have time to do it.' But I feel if it will
help cut out the fraud or abuse in
the program, we ought to be willing
to try."
Educating parents
is important
In North Carolina, Pitt County
food service director Donna Ware
has discovered the verification pro­cess
has opened new lines of com­munication
with parents. Educating
them as to why the school was
verifying was an important
part of the process.
"It's been a real surprise
for us, but we have found
that the majority of parents have
not minded submitting the informa­tion
once they understood what was
needed. Many of them contacted
the school to get some help from
the principals, because this was the
first time," Ware says.
A new measure
of accountability
Income verification will bring a
new measure of accountability to
the lunch program, which provides
essential nourishment to nearly
12 million low-income and 11 million
higher-income children every school
day. According to USDA, the new
requirement strikes a balance be­tween
the need for program integrity
and a minimal administrative burden
for school officials.
"I think school food service peo­ple
are as interested as we are in a
strong school lunch program," says
George Braley. "We want to work
together to do whatever it takes to
maintain the program's fine image."
article by Jane Mattern Vachon
Careful Buying
Keeps Prices Low
Many schools are finding they can
save on meal costs-and keep lunch
prices low-by using more USDA­donated
foods. But what about sav­ings
on food they buy themselves?
Mississippi is taking the lead in help­ing
school districts look at their buy­ing
practices in a new way, using
something called "critical path
analysis."
For years, the concept of critical
path has been important in indus­tries
that depend on getting the right
materials to the right place at the
right time. In simple terms, critical
path is a management technique
that charts a flow of activities with
checkpoints at critical spots. The
goal is to make sure that the total
project or system is kept on course.
Together with his staff, John
Walker, assistant director of finance
for the Mississippi Department of
Education, has developed a system
schools are using to "smooth out"
the critical path in procuring food
for their lunch and breakfast
programs.
According to Marlene Gunn, who
supervises school programs for
Walker, schools using this system
examine every step in food procure­ment-
from the time menus are
planned to when the bills (invoices)
are paid. They look at how menus
are planned, how order forms are
developed, how orders are placed
with distributors, how foods are
received and stored, and how dis­tributors
are paid. Local food man­agers
can smooth out their critical
path-and achieve greater effi­ciency-
if they can identify and
eliminate any bottlenecks in the
system.
Survey showed
need for changes
Walker credits Marlene Gunn with
the state's recent accomplishments
in procurement. "When Marlene
came with us," he says, "she did a
survey that showed the differences
in food prices being paid by adjoin­ing
school districts. The wide differ­ences
in costs, in some cases for the
same product, indicated that some­thing
needed to be done."
More than 85 percent of Missis­sippi
schools participated in the sur-
October 1983
vey. A number of school districts
were already using good bid proce­dures
for food, but many were
simply buying from distributors
without using bids at all.
For example, in October 1981,
canned goods and staple food items
were being bid in only 22 percent of
the schools. Meats were being bid in
only 20 percent, and fresh produce
was bid in only 18 percent. Districts
using bids were tending to get lower
prices than those that were not.
In some instances, Gunn found,
vendors were charging a variety of
prices for the same item. One dis­tributor's
price for sliced peaches
ranged from $12.97 to $21.38 for the
same quality product. The size of
the school district, the amount
ordered, and the size of the food
package did not always have an
impact on cost.
The state department of education
staff felt the survey demonstrated
that better procurement could help
schools get more for their money.
They decided to offer a series of
workshops for all school districts in
the state, then select several dis­tricts
for pilot projects that would
test two different buying systems.
An important part of the plan was
working closely with distributors so
they would understand what the
state was trying to accomplish.
Meeting with distributors was the
first step. In early spring of 1982,
representatives from every distribu­tor
selling to schools were invited to
a state meeting.
"We pointed out that we were not
trying to make rules to eliminate
anybody," Gunn explains, "but were
trying to develop an open and free
competition in school buying. This
way the distributors understood that
they were going to have to change
their sales approach to schools and
to some e'Xtent change the bid
procedures with them."
The state staff shared survey
results with the distributors and let
them draw their own conclusions
about the wide discrepancy in prices
charged to schools. Looking at all
factors, Gunn says, it was clear that
food service people were not always
using the best buying practices, or
the differences in prices would not
have happened.
Workshops reach
local managers
During the 1981-82 school year,
the state held 22 regional workshops
for local school food service per­sonnel.
The sessions focused on
federal procurement guidelines, tra­ditional
line item bidding, and price
quote procedures.
During the 1982-83 school year,
the state held additional workshops
to familiarize local food service
directors with the critical path con­cept.
Participants learned about
developing specifications, ordering,
and estimating quantities. At these
workshops, food service administra­tors
could analyze the critical path
in their districts to see if there were
steps creating too much paperwork
or causing problems, such as not
having a needed food at the right
time.
Workshop participants also
learned to examine inventory and
organize storerooms. To save steps,
food managers were taught to
organize storerooms in the same
manner as the order sheets are
organized. They were encouraged to
identify what are called "par stock"
items-certain foods that are used
every week-and keep a specific
amount on hand for better inventory
control.
Throughout, the workshops
emphasized bidding procedures and
the importance of listing quantities
on all bids. "In the past, some of our
bids did not specify quantities, so
distributors were having to bid with­out
knowing whether they would be
selling one case or 300 cases. There
was no way to get the best price by
bidding in that fashion," says Gunn.
To project proper quantities, the
critical path and menu planning
have to be worked out. School food
supervisors learned they need to
have a standardized set of cycle
menus just as they have a standard­ized
set of recipes.
In each workshop, the supervisors
were asked to bring every menu
they had used during the preceding
4 months. They then placed them in
stacks by entree to see how many
entrees each school typically uses.
Generally, the exercise showed, the
number of entrees varied from 25 to
7
35, so the state staff recommended
that the typical school district prob­lably
needs a standardized menu
cycle with 30 menus. Gunn feels
that fewer than 30 menus does not
provide enough variety.
Another recommendation was that
each school list the menus on file
cards with space for participation
data. This makes it easy for food
supervisors to evaluate the popular­ity
of the menus. An order guide on
the back of the menu card helps
managers develop food orders.
"If the school food manager
places standardized menus on
cards, she can use the cards at ran­dom
to avoid having hamburgers
every Tuesday. When a month's
menus are planned, the manager
can put the entree on Tuesday one
week and somewhere else later in
the month. In this way, the manag­ers
have the flexibility they need and
can put in some special menus they
may use only once a year," says
Gunn.
This card system benefits stu­dents
as well, since managers can
simply pull any menus that are not
well received and replace them with
other cards.
To assure consistency in bidding,
schools must have food specifica­tions.
But who should write the
specifications? Many workshop par­ticipants
and distributors suggested
this should be done by the state
office. Gunn doesn't agree. She
feels that the person who is going to
take the bids and analyze them in
terms of quality and price should
come up with the specifications.
"The same person who receives
the food must write the specifica­tions
to understand what the words
mean," she says. "As a state agency,
we do not think it is our role to tell a
district to use a certain specification
because food tastes vary too much.
Decisions about food quality should
not be removed very far from the
point at which the child is being fed."
Projects begin
in four areas
As local school food managers
were putting to use what they
learned in the workshops, four dis­tricts
began working more closely
with the state staff on pilot projects.
8
The projects, which are continuing
this school year, test one of two
variations of a basic food purchas­ing
model. In both variations, items
are bid on a bottom line basis. The
difference is the pricing method.
With one method, schools pay a
fixed fee for service plus the distrib­utors'
actual cost for the product.
Items are normally bid for a year,
and distributors can pass along any
increases or decreases in the price
of food. However, the fixed fee for
service cannot change for the life of
the contract.
With the other method, all items
have a set price which cannot
change until the contract runs out.
Foods under this type of arrange­ment
will normally be rebid every
60 or 90 days.
Debbie Turman, food service
supervisor for the West Point Sepa­rate
School District, is testing the
first method. She now puts out
yearly bids for the food she buys
and currently uses three distribu­tors.
One of these distributors also
delivers USDA-donated foods.
Turman says she likes the new
system and the flexibility of writing
her own food specifications. After
writing the specifications, she talks
with every distributor about the dif­ferent
products they will be offering
in their bids. By doing this, the issue
of food quality is cleared up before
the bidding process begins.
As it has turned out, distributors
have had to add very few, if any,
items to their existing product lines
to meet Turman's quality standards.
In order to bid on a product other
than that specified, Turman requires
distributors to show her that the
quality is comparable. "I expect the
distributors to do their job and show
me what products they think will
please me," she says.
School cafeteria managers in
West Point have accepted the new
system well. Procurement now
involves only 2 days a week for
them. On Monday, they send in
weekly food orders to Turman's
office. On Friday, they receive the
foods and check them in. According
to Turman, the time saved each
week is well worth the small extra
effort it takes to put out yearly bids.
A special arrangement with one of
her commercial distributors is mak­ing
ordering even faster. Turman
uses a hand-held computer to order
some of her foods from Purnell's
Pride, a full line distributor in
Tupelo. The mini-computer works
through a telephone hook-up and
can recall the last order that was
placed. It can also provide summa­ries
of past food orders. Turman
phones in orders for her schools on
Mondays but can change them as
late as Thursday for delivery on
Friday.
Turman recalls her anxiety when
she began using the equipment. "I
called the computer operator at the
distributor after placing my first
order to see if it was received," she
says. "I could tell immediately that it
came through fine because of the
cheering I heard at the other end."
Distributors see
positive changes
Murle Kitchen, food service man­ager
at Purnell's Pride, says he's
seen Debbie Turman and other
school food administrators become
more sophisticated as a result of the
new food procurement system. He
believes school food managers are
now getting more competitive prices
and are more attentive to food
quality.
Efficiency has also increased at
his distributorship, he adds, because
bids are done only once a year and
any updates on food prices can be
done through his computer system.
And, he says, if school purchases
are handled strictly from a bid
standpoint, prices should be just as
good or better than for any other
commercial buyer.
As part of the critical path, distib­utors'
records are routinely exam­ined
to ensure correct prices have
been charged. Kitchen says he does
not mind the audits and understands
the necessity of checking his vouch­ers.
He feels good communication
between the distributor and the pur­chaser
is essential .
If school officials do not plan and
communicate well with distributors
to let them know what products they
need, they may miss out on oppor­tunities
to lower their food costs. If a
distributor can meet schools' needs
with his existing product lines, he
Food and Nutrition
1
can usually offer lower prices
because he's selling foods he buys
in volume. Individual special orders
are more expensive for distributors
and, therefore, for schools.
John Walker and Marlene Gunn
believe the new procurement activi­ties
have been successful because
they have had good cooperation
from local school officials and
commercial food distributors. In
some areas without pilot procure­ment
projects, school superintend­ents
have begun working together to
upgrade food service operations.
In 12 districts where only the
school principals had been in
charge of food service, school food
service operations are now central­ized.
The districts have hired a quali­fied
food service supervisor to work
with the school principals. In meet­ing
their need for better food pro­curement,
the districts took steps
that upgraded the overall quality of
food service management.
Changes also made
in commodity system
Mississippi's efforts to "look at the
whole" of food procurement have
included dramatic improvements in
the way the state distributes foods
donated by USDA. Prior to 1982,
USDA commodities were distributed
at 12 carstop points throughout the
state. When the commodities
arrived, each school district would
be called upon to pick up their share
of the foods for delivery to schools
or warehouses.
Now commodities go directly to
commercial distributors that are
selected through the bid process.
This system is more advantageous
to local school districts in several
ways. First, they can take foods out
of the commercial facilities as they
need them. Also, since none of the
districts have refrig·erated trucks,
any frozen or refrigerated items are
now handled better. Another big
advantage is savings-commercial
food delivery costs can often be
decreased by consolidating deliver­ies
of commodities with deliveries of
purchased items.
Schools have 60 days to withdraw
the commodities from the time they
are received by the commercial dis­tributor.
Schools can store foods
October 1983
Debbie Turman, food service supervisor for the
West Point Separate District, orders food using a
special mini-computer with a telephone hook-up.
more than 60 days but incur an addi­tional
cost. "Our distributors have
cooperated well with us on storage
of commodities and have not yet
charged us a penalty for keeping
some commodities past the 60
days," Walker says.
Commercial distributors deliver
donated foods to schools every
2 weeks. If a distributor is also sup­plying
a district with commercially
purchased foods, the district can
receive their donated foods weekly
along with deliveries of purchased
food.
With distributors storing donated
foods, many school districts have
been able to reduce the amount of
freezer space they use or, in some
cases, shut off freezers completely.
This has significantly reduced utility
costs. The savings in staff time are
significant, too.
"With the new system, you have
better control over when you get the
commodities," says Walker. "Under
the old system, you may have had
commodities at several different
locations, and all had to be picked
up the same day." Sometimes pick­ups
had to be made on non-work
days-many times, for example, fro­zen
turkeys arrived on holidays.
"Now," Walker adds, "the foods are
delivered when you need them and
you work the system instead of the
system working you."
The improved storage and ship­ment
system for commodities has
cut down on contamination and
theft, and has resulted in significant
Turman is one of several food service managers
participating in pilot buying projects in Mississippi.
savings for the state. According to
Walker, the direct savings for the
1982-83 school year alone totaled
almost $450,000.
Recent improvements
add up for schools
How much are schools saving as a
result of the combined management
improvements? While it's hard to
pinpoint exact savings in each area,
the total picture shows that food
costs for schools are indeed down.
For the 1982-83 school year, the
state's cost accounting system
shows food costs were 7 cents per
meal less than the previous year.
This year, the state has added five
new pilot procurement programs to
the four continuing from last year.
The results in these districts will
help others select the best buying
methods for them.
Critical path analysis has played a
key role in the improvements made
during the past few years. But, says
John Walker, it couldn't have been
effective without the cooperation,
professionalism, and dedication dis­played
by school food service peo­ple
throughout the state.
For more information on food
procurement or commodity distribu­tion
in Mississippi, write:
John Walker
State Department of Education
P.O. Box 771
Jackson, Mississippi 39205
Telephone: (601) 352-8480
article by Kent Taylor
9
Video Teleconference Focuses on
Nutrition For Mothers and Babies
The Georgia Mental Health Institute in Atlanta
was one of 125 teleconference viewing sites. On
the day of the conference, this satellite receiver
On a blizzardy day in April, 85
dietitians, nurses, and county home
economists from all over New Mex­ico
wound their way into Albuquer­que.
Some had traveled 250 miles
through the storm to be there. They
were coming to see and participate
in the largest federally produced
video teleconference in history,
broadcast live via satellite from
Washington, D.C.
Joining them in Albuquerque­and
in hotels, hospitals, and televi­sion
stations in cities throughout the
country-were WIG nutritionists,
Extension specialists, pediatricians,
teachers, hunger advocates, profes­sionals
from school food service,
and members of organizations like
the March of Dimes and Red Cross.
Bound by a common interest in
protecting and enhancing the nutri­tional
status of our nation's mothers
and children, approximately 10,000
health and nutrition professionals
convened at nearly 125 viewing sites
for the simultaneous broadcast.
10
picked up the signal broadcast live from Washing­ton,
D. C. Approximately 150 people from through­out
Georgia came to Atlanta to participate.
The teleconference-titled "Im­proving
Nutrition for Mothers and
Babies: A Research Update"­featured
11 well-known experts from
the American scientific community.
Panelists presented key research
findings in maternal and fetal
nutrition, and, thanks to special tel­ephone
hook-ups at all the broad­cast
sites, spoke directly on the air
to participants calling in questions
from across the country.
A joint effort
of several groups
The 3-hour video teleconference
took the better part of a year to plan
and was the result of a collaborative
effort between the U.S. Department
of Agriculture (USDA), the U.S.
Department of Health and Human
Services (DHHS), and coordinating
committees in each state. The Pub­lic
Service Satellite Consortium, a
private nonprofit organization,
handled the production and other
technical aspects of the program.
PSSC has had extensive experience
producing video teleconferences for
educational and other purposes.
The teleconference had two cen­tral
aims. One was to provide nutri­tion
and health professionals with
up-to-date research information and
encourage them to apply the find­ings
in their work. The other was to
strengthen state-level networks in
the area of maternal and infant nutri­tion
and health.
According to Dr. Luise Light and
Dr. Lenora Moragne, who headed
the teleconference planning team
from USDA and DHHS, the telecon­ference
was designed to serve as a
catalyst for furthering the team
approach in working on maternal
and infant nutrition and health. Par­ticularly
significant, they feel, is that
the teleconference gave public
health nutritionists and Extension
food and nutrition specialists from
land-grant universities an opportun­ity
to work together on a project.
USDA's Anne Brown, who coordi­nated
the teleconference, says nutri­tion
and health professionals are
natural constituencies of the two
Departments. "They are the ones
who need and use this kind of
information," she says, "and they
can disseminate it further through
lots of different channels."
The planners felt it was important
to have a diverse group of profes­sionals
participate. "We wanted to
foster communications among peo­ple
who may view issues from differ­ing
perspectives and experiences,"
Brown says, "and also to have the
various nutrition and health com­munities
hear the same messages
about maternal and infant nutrition."
Teleconferences offer
several advantages
The use of this form of satellite
communication had already proved
itself to be beautifully suited to the
transmission of technical and con­tinuing
education kinds of informa­tion.
USDA first tried video telecon­ferencing
as a tool for communi­cating
nutrition research in 1981 and
found it an effective way of dissemi­nating
complex material to a large
professional audience.
"There are a number of advan­tages
to video teleconferencing,"
Food and Nutrition
J
l
i
l
says Anne Brown, who coordinated
both of the teleconferences. "A
video teleconference can provide
nearly the same degree of face-to­face
interaction as a traditional con­ference,
but it can involve an almost
unlimited number of people. And,
participants don't have to spend
days away from the office or dollars
on travel and lodging.
"Teleconferences are also an ex­pedient
way of delivering informa­tion,"
she adds. "The graphic and
visual techniques employed often
increase the impact of the informa­tion
conveyed and make it easier to
remember. Since the viewer has
direct access to the source of infor­mation,
there's less error, and
transferring critical or difficult
information is more efficient."
The April1983 conference cost
each Department $45,000 in produc­tion
expenses, not counting the time
and salaries of federal and state
employees who contributed many
hours to planning and coordinating
the event. At the federal level, seven
representatives from various USDA
and DHHS agencies worked on the
planning team. In each state, USDA­and
DHHS solicited the help of a
Cooperative State Extension Service
food and nutrition specialist and a
state department of health nutrition­ist,
who set up and co-chaired coor­dinating
committees.
The state coordinating commit­tees
accomplished many important
tasks, including identifying potential
topics, publicizing the event, making
arrangements for viewing at the
local sites, disseminating packets of
background materials, and assisting
the federal task force in evaluating
the teleconference. State coordinat­ing
committees invited many differ­ent
groups of professionals working
in maternal and infant health. They
were free to tailor arrangements to
respond to the needs and interests
of professionals in their states.
Two main areas of
interest selected
The federal task force gave states
the lead in determining the topics
for the teleconference and discov­ered
widespread interest in two sub­jects:
substance abuse and its effect
during pregnancy, and lactation and
October 1983
breastfeeding.
After narrowing substance abuse
to those issues most directly linked
to nutrition and nutritional status­namely,
the effects of tobacco,
alcohol, and caffeine-federal coor­dinators
began their search for key
scientists with significant research
experience in these areas.
Central to the goals of the tele­conference
was the task of commun­icating
to conferees ways to apply
research findings at the community
level. Health and nutrition profes­sionals
are a vital link to helping
women achieve good nutrition dur-
Research on the special properties of breast milk
underscores the importance of encouraging
mothers to breastfeed. "Mothering the mother"
ing pregnancy. They not only pro­vide
pregnant women and new
mothers with the best available die­tary
information, but also play an
important role in helping expectant
mothers adjust to the special nutri­tional
demands of pregnancy.
The 11 panelists selected for the
teleconference were asked to pre­sent
relevant research as well as sug­gestions
on how health and nutrition
practitioners might help mothers
make informed choices. They were
free to select and discuss data from
any source, government or other­wise,
and the views they expressed
can make the difference in ensuring a successful
breastfeeding experience, panelists told telecon­ference
participants.
11
reflected their own unique perspec­tives
and areas of expertise.
The panelists hailed from diverse
backgrounds-:with specialties in
everything from anthropology and
psychiatry to dietetics and obstet­rics-
and all were excited by the
prospect of participating in the tele­conference
and reaching such a
wide audience.
"The teleconference provided us
with the opportunity to bring the
subject of human lactation into
sharp focus for medical practition­ers,"
says Dr. Ruth Lawrence, an
expert in human lactation with spe­cial
experience in working with nurs­ing
mothers.
Lawrence, an associate professor
of pediatrics and obstetrics and
gynecology at the University of
Rochester School of Medicine, says
there's been a lack of adequate
information about breastfeeding
among health practitioners. Over the
years, this has presented difficulties
as more and more people have been
seeking this information. "This was
our first big chance to reach the
practitioners," she says.
For Dr. Henry Rosett, the telecon­ference
provided an opportunity to
reach a group of health profession­als
he'd never before had access
to-nutritionists. Dr. Rosset is a
clinical professor of psychiatry at
Boston University's School of Medi­cine
and director of its Fetal Alcohol
Education Program.
"Participating in the teleconfer-
12
Highlights of
Research Findings
On Substance Abuse
and Breastfeeding
For centuries, mankind has been
concerned about the diet of preg­nant
women. In times of war and
famine, expectant mothers have
received special consideration. This
practice has proved to be well
founded.
Today, health professionals know
that nearly everything a pregnant
woman consumes reaches her un­born
child, in one form or another. A
nutritious diet during pregnancy
makes a significant difference in
protecting and enhancing the well­being
of mother and baby alike.
Unfortunately, many of the mech­anisms
that help transport nutrients
across the placenta to the fetus also
allow the transmittal of harmful sub­stances.
Changes in the diets of
pregnant women in the last half cen­tury
have included some new con­sumption
patterns-ones that health
professionals have been studying
for possible harmful effects during
pregnancy.
In particular, experts have been
watching three substances-alcohol,
tobacco, and caffeine-and testing
their safety. The widespread availa­bility
of these substances today, and
their extensive use among women of
childbearing years may have serious
health implications.
Today's health community is ask­ing:
How many women are using
these substances during pregnancy?
Are these substances having harm­ful
effects on fetal development?
When is the fetus in danger of being
harmed by these substances? And,
if there are potential harmful conse­quences,
what can health profes­sionals
to do help mothers avoid or
minimize them?
Panelists participating in the
video-teleconference provided the
following insights:
Alcohol
Although adverse effects of alco­hol
on fetal development have been
suspected for more than 250 years,
the discovery of a specific pattern of
abnormalities known as Fetal Alco­hol
Syndrome (FAS) has served to
focus increased scientific attention
on the problems of drinking during
pregnancy.
FAS is characterized by prenatal
and/or postnatal growth retardation,
damage to the central nervous sys­tem,
and distinctive differences in
facial features. Children demonstrat­ing
signs of FAS may also have
external malformations affecting
their eyes, ears, nose, and throat, in
addition to internal abnormalities.
The occurrence of FAS is judged
to be between 1 in 300 to 1 in 2,000
live births. Mothers of FAS babies
are chronic alcoholics who drank
heavily throughout pregnancy.
Heavy-drinking mothers-to-be can
also give birth to infants who show
signs of being affected by maternal
drinking without having the syn­drome.
These infants are diagnosed
as having Fetal Alcohol Effects
(FAE).
To understand how maternal drink­ing
affects the unborn child, scien­tists
have studied how ethyl alcohol
"acts" in the body, once it's
ingested. It is now known that:
-Alcohol can alter the structure
of cell membranes, and can disturb
the organization of embryonic tissue
during the first 3 months of preg­nancy.
-Throughout pregnancy, alco­hol
can act on the metabolism of
carbohydrates, fats, proteins, and
the synthesis of RNA and DNA­retarding
cell growth and division.
-Large quantities of alcohol
during pregnancy can cause fetal
malnutrition even when the mother's
diet is adequate, because the alco­hol
interferes with the transport of
essential nutrients across the
placenta.
-The biochemical effects of
alcohol are related to its concentra­tion.
An episode of heavy drinking at
a critical phase of prenatal devel­opment
can harm the fetus.
-High blood concentration of
alcohol during the last 3 months of
pregnancy can be detrimental to the
growth of the fetus' central nervous
system and future intellectual and
behavioral development.
Experts do not yet know exactly
when or how much drinking harms
the fetus. There does not appear to
be any "safe" time to drink during
pregnancy. Light drinking (less than
one ounce of absolute alcohol daily)
has not been demonstrated to be
dangerous, but cautious mothers-to-
Food and Nutrition
be may decide to abstain altogether.
Tobacco
Twenty years ago, not much was
known about the adverse effects of
smoking during pregnancy. The Sur­geon
General's 1964 report on smok­ing
and health covered the subject
in just one paragraph and a few ref­erences.
But by 1979, evidence link­ing
cigarette smoking to complica­tions
for the pregnant woman and
her child had grown dramatically.
The report that year included nearly
100 pages and several hundred ref­erences
documenting this research.
Today, cigarette smoking is rec­ognized
to be the single most impor­tant
identifiable contributor to
perinatal mortality-that is •. death
occurring during the period from 8
weeks prior to birth to 4 weeks fol­lowing
birth. Yet, in spite of the
risks, presently about one-third of
all women and two-thirds of all teen-l
. agers who smoke contmue to smoke
during pregnancy.
Research findings show that:
-Women who smoke run a
higher risk of certain complications,
such as vaginal bleeding during the
third trimester of pregnancy. The
occurrence of complications seems
to increase with the number of
cigarettes smoked.
-Infants born to smoking
mothers weigh, on the average,
200 grams less than babies born to
comparable women who do not
smoke. Birthweight is inversely
related to the number of cigarettes
smoked.
-The risk of spontaneous
abortion is 30 to 70 percent higher
among pregnant smokers than
among non-smokers-and increases
with the number of cigarettes
smoked.
-The rate of premature deliver­ies
increases significantly with the
amount the mother smokes. About
13 percent of all preterm births can
be attributed to smoking.
-.For women who smoke more
than one pack of cigarettes. a day,
there is an increase in perinatal mor­tality
of about 37 percent. Smoking
less than one pack of cigarettes a
day is associated with a 24 percent
increase in perinatal mortality.
Research. also suggests that the
adverse effects of smoking extend
beyond the prenatal period:
October 1983
-Smokers' children have more
hospitalizations, more visits to the
doctor, and are more likely to be vic­tims
of Sudden Infant Death Syn­drome.
- Several studies suggest that
in older children, maternal smoking
can hinder physical growth, intellec­tual
ability, emotional development,
and behavior.
Short of quitting or cutting down
on the number of cigarettes smoked,
is there anything mothers can do to
otfsetthe adverse effects of smok­ing?
The experts say switching to
low tar, low nicotine cigarettes will
have no effect. On the other hand, it
appears that improved nutrition can
partially offset the effects of
smoking.
Caffeine
In the last few years, there has
been a great deal of attention
focused on the safety of caffeine
consumption. One area of special
concern has been its use during
pregnancy.
In the fall of 1980, the Food and
Drug Administration reported a
study in which pregnant rats were
fed caffeine at various levels. The
study found evidence of growth
retardation in the offspring of rats
consuming the human equivalent of
two cups of coffee a day. A 1982
Boston study of 12,000 pregnant
women, however, showed no rela~
tion between coffee.consumption
and low birthweight, early births, or
malformations.
Although caffeine is known to
cross the placenta, there is little evi­dence
that caffeine has a harmful
effect on the human fetus. It appears
that moderate caffeine consumption
may not be harmfuL However,
experts advise pregnant women to
avoid heavy consumption.
Breastfeeding
Today's health and nutrition
experts agree-human milk is the
ideal source of nutrients for most
infants. In the 1980's, mothers are
being encouraged to breastfeed by
many national and international pro­fessional
groups including the Amer~
ican Academy of Pediatrics, the
American Dietetic Association, and
the American Medical Association.
In recent years, new methodolo­gies
and sophisticated equipment
have allowed scientists to gain new
knowledge about the composition
human milk and how nursing con~
tributes to the health of infants and
their mothers. As breast milk's spe­cial
properties are increasingly doc­umented
by research, it is clear that
it is uniquely suited to the needs of
the developing infant in ways that
formula cannot match.
Experts have found breast milk
provides the building blocks needed
for energy and growth, and also has
a wide variety of functional capabili­ties
that match and complement the
physiological needs of the infant.
For instance, breast milk:
• provides protection against
human viruses and infectious dis­eases;
• increases baby's absorption of
needed nutrients;
• protects against excess growth of
harmful bacteria in baby's intestinal
tract;
• doesn't overload baby's system
with hard-to-process substances;
and
• changes in composition over time
to better meet the baby's changing
needs.
Mothers benefit too from breast­feeding.
Nursing helps mothers
return to their pre-pregnant shape
more quickly by its action on the
uterus and its use of fat stored dur­ing
pregnancy. Breastfeeding is also
less taxing physically for mothers,
since feeding time is less hectic and
more restful than formula feedings.
Since the early 1970's there has
been a steady increase in the pro­portion
of breastfed babies in the
United States. However, the in­crease
has been primarily among
babies born to mothers with college
degrees. In 1981, only 35 percent of
infants were. breastfed for 3 or more
months.
Before the 1970's, women's
employment status appeared to be
unrelated to whether or not they
chose to breastfeed their first-born.
Today, although more working
mothers are breastfeeding than in
previous decades, researchers are
finding that mothers who are
emptoyed full-time have difficulty
continuing to breastfeed once they
return to work. This finding poses a
great challenge for health practi­tioners
who hop_e to help working
mothers continue to breastfeed.
13
ence was very worthwhile," he says.
"I'm primarily a medical educator­most
of my educating has been
toward medical audiences. I'd never
considered nutritionists as a poten­tial
counseling group before." Nutri­tionists,
Dr. Rosett feels, can play an
important part in identifying moth­ers
with drinking problems and in
providing them with information that
can motivate them to change their
behavior.
Conference divided
into two parts
The teleconference was divided
into two 90-minute segments.
Experts on substance abuse made
presentations during the first half,
and experts in lactation and breast­feeding
spoke during the second
half. Each 90-minute segment includ­ed
time for viewers to call in ques­tions
and speak with panelists.
"We had some misgivings about
the teleconference at first," says
Paulette Ybarra, an Extension spe­cialist
who helped organize the
screening in Georgia. Research pre­sentations
can be dry and academic,
Ybarra observes, and she hoped the
teleconference wouldn't leave partic­ipants
feeling bored or "trapped for
3 hours." Her concerns evaporated
the day of the conference. "Every
speaker was so exciting and person­able,"
she says.
Ybarra's reaction was echoed by
Alma Saddam, one of Ohio's co­leaders.
"It was a super conference
and very well organized," she says.
"They chose the best speakers, the
best resource people."
The two half-hour call-in sessions
gave audience members the oppor­tunity
to adapt the teleconference to
their individual interests. One view­er,
for example, asked about the
latest research on the effects of caf­feine
contained in over-the-counter
drugs. Another wanted to know
when it's safe for a breastfeeding
woman to drink.
Many members of the audience
took the call-in opportunity to ask
the panelists "how to" information­such
as ways to persuade expectant
mothers to stop smoking or what to
tell mothers of premature infants
about breastfeeding. Of special
interest to the teleconference
audience was information experts
presented on working with mothers­to-
be to help them cut down on
their drinking and to encourage new
mothers to breastfeed.
Working with
problem drinkers
Dr. Henry Rosett has had exten­sive
experience working with preg­nant
women with drinking problems.
During his presentation, he shared
findings from his clinical experience
at Boston City Hospital and results
from a study he and his colleagues
performed involving 1,700 women
registered for prenatal care.
In his study of this group, Dr.
Rosett found that 40 percent of the
women drank moderately and 50
percent hardly drank at all. Ten per­cent
had serious drinking problems.
Although no "safe" level of drinking
has been established, Rosett said,
research has not linked "occasional"
drinks to harm to the fetus. But
women who drink upwards of five to
six drinks on some occasions or 45
drinks a month are putting their
babies in real danger, he said.
Dr. Rosett defined a "drink" as
one-half ounce of absolute alcohol,
the equivalent of a 12-ounce beer, a
4-ounce glass of wine, or a cocktail
containing a one-ounce shot of 100-
proof liquor. At the Boston City
Hospital clinic, Dr. Rosett's team
discovered that approximately one
in 10 women coming to the prenatal
clinic were drinking heavily-and
averaging nine drinks a day.
Combining alcohol screening with
routine prenatal care, the medical
team used a diet history question­naire
to learn about each patient's
eating and drinking habits. In the
course of a 10-question survey,
clinic personnel asked each patient
about food and beverage consump­tion,
including questions about non­alcoholic
beverages and individual
questions about beer, wine, and
hard liquor.
The survey helped medical pro­fessionals
take a systematic drinking
history. "It gives you an idea of the
estimated risk involved and also
heightens women's awareness of
their own practices," Dr. Rosett said.
Teaching tools· like this March of Dimes chart help
mothers visualize how their babies grow. Re­searchers
in Boston found that many mothers with
drinking problems were motivated to change their
behavior once they understood how it could affect
their babies' development.
Food and Nutrition
He discovered most pregnant
patients responded readily to the
clinician's information about drink­ing
and its effects on unborn chil­dren.
Two-thirds of heavy drinkers
stopped drinking heavily within
2 weeks after learning of the poten­tial
harm drinking could do to their
babies.
A helpful, nonjudgmental attitude
by health professionals is essential,
Dr. Rosett told teleconference par­ticipants.
Health care providers need
to get across the idea: "We want to
help you have a healthy baby."
"We found that heavy drinkers,
when pregnant, were motivated
to stop drinking because of their
concern for their unborn child,"
said Dr. Rosett.
But even with encouragement and
information, a few pregnant women
in the study were unable to alter
their heavy drinking. In cases like
these Dr. Rosett advised, health pro­fessionals
need to refer the women
to alcohol treatment programs
right away.
It's crucial to get help for alco­holic
mothers as early in their preg­nancies
as possible. Dr. Rosett
found that infants born to mothers
who had quit drinking heavily before
the third trimester showed signifi­cantly
fewer harmful effects than
babies born to mothers who con­tinued
to drink heavily throughout
their pregnancies.
Helping mothers
to breastfeed
Several panelists at the telecon­ference
expanded upon the research
discussions to share advice on how
to work with expectant and new
mothers to encourage and assist
them in breastfeeding their infants.
"In our culture, women rarely have
witnessed breastfeeding when they
have their own first baby," Dr. Law­rence
told viewers. "For them, it is
a learned behavior." As a conse­quence,
a great many of the difficul­ties
mothers have with breastfeeding
are related to inadequate knowledge.
According to Lawrence, mothers­to-
be make up their minds early
whether or not they will breastfeed.
Health professionals, she said,
should take advantage of a woman's
early prenatal visits to discuss
October 1983
breastfeeding with her and provide
her with information.
Practitioners can use the prenatal
breast exam as an opportunity to
reassure the patient that nature pre­pares
the breast for nursing during
pregnancy, and to explain the proc­ess
of lactation. Women may be
aware of the advantages of breast­feeding
but be fearful that they will
have problems supplying their
babies with enough milk. They may
worry that nursing will tie them
down, make it hard to lose weight,
or spoil the appearance of their
breasts. Informed health practition­ers
can lay these fears to rest.
Expectant mothers who choose
to breastfeed should be encouraged
to discuss their plans with their
spouse, panelists said. Breastfeed­ing
involves the whole family, ex­plained
Dr. Audrey Naylor, who
teaches community and family med­icine
and pediatrics at the University
of California's San Diego School of
Medicine.
New mothers need instruction,
encouragement, and privacy right
after the baby arrives to get nursing
off to a good start. Breastfeeding is
a "biological partnership" between
mother and baby, the experts
stressed.
Frequent nursing helps stimulate
a good supply of milk, so mothers
should be encouraged to put the
baby to the breast within the hour of
birth and then every few hours for
the first several weeks. Nursing
mothers also need a good diet and
time to rest and relax. A lactating
woman needs to get an extra 500
calories daily and plenty of calcium
and vitamin C.
"A good nutritionist can tell moth­ers
how to select foods that will fit
within their budgets as well as what
foods to eat," Dr. Naylor told the
teleconference audience.
It's important to
"mother the mother"
As for helping new moms relax,
Dr. Lawrence encouraged health
professionals to give n!Jrsing women
plenty of encouragement and tender
loving care. "Mothering the mother,"
she said, "may make the critical dif­ference"
in ensuring a successful
breastfeeding experience for
women.
The teleconference included a
videotape of Dr. Naylor's San Diego
Lactation Clinic, which has been
helping families in that community
learn to breastfeed their children
since it was founded 5 years ago.
15
There, trained professionals teach
breastfeeding techniques and pro­vide
information and support to fam­ilies
in both the prenatal and post­natal
periods.
Dr. Naylor's staff makes sure to
have new mothers bring in their
babies within a week of their birth to
make sure mother and baby are
doing well. If problems exist, they
help families work them out before
they become discouraged. The
clinic has a 24-hour hotline where
families can call for advice and
encouragement. Families do not
have to be coming to the clinic to
use the hotline.
As Dr. Naylor's experience at the
clinic has shown, when health prac­titioners
get involved in teaching
practical information and helping
families use it, everybody benefits.
"Conferences like this one contrib­ute
to helping professionals and
mothers learn," Dr. Naylor says.
Opportunities for
training continue
Both before and after the telecon­ference,
state coordinators tailored
the arrangements to respond to the
needs and interests of professionals
in their states.
For instance, in Atlanta, state
coordinators planned and presented
a 30-minute program on infant mor­tality
to precede the broadcast. The
presentation featured an expert on
infant mortality in Georgia from the
state department of health and
human services. A member of the
Georgia Extension Service prepared
fact sheets on "Drugs Excreted in
Human Milk" and "Fetal Alcohol
Syndrome" to supplement the
broadcast.
Many participants have expressed
interest in using tapes of the tele­conference
in coming months for
training groups that did not attend
the broadcast. For example, the
Extension Service in Ohio and
Georgia will be showing copies of
the broadcast at their annual con­ferences
this year.
Mae Martha Johnson, who organ­ized
New Mexico's viewing, feels the
teleconference is an excellent train­ing
tool. "You can go through a
whole year of journals before you'd
get that much information on one
particular topic," she says.
USDA and DHHS have the tapes
of the teleconference available for
loan or purchase. The presentations
on substance abuse and human lac­tation
and breastfeeding are availa­ble
separately, with each edited
down to less than an hour in length.
The American Dietetic Associa­tion,
the American Nurses Associa­tion,
and the American Academy of
Family Physicians all offered con­tinuing
education credits at the time
of the original airing of the confer­ence.
Members of these associa­tions
may wish to inquire about
obtaining credit for later viewing of
the tapes.
For more information on the video
teleconference, or for information
on obtaining copies of the video
tapes, contact:
Dr. Lenora Moragne
Nutrition Coordinating Office
U.S. Department of Health and
Human Services
Washington, D.C. 20201
Telephone: (202) 472-5308
or
Dr. Luise Light
Human Nutrition Information Service
U.S. Department of Agriculture
Hyattsville, Maryland 20782
Telephone: (301) 436-5194
article by Carol M. Stansfield
Food and Education
Go Hand in Hand In Oklahoma
J:~t iCr;v~ I!~C!J/1 .
¥tlti FdJII
·REGATE MEAL
CALif. 235· i$06
Volunteers from Community Action arrive at the
Will Rogers Court Community Center in Oklahoma
City with the day's meals. All the meals for the
A van stops at a small frame home
outside of Oklahoma City and an
elderly woman, with assistance from
the driver, climbs aboard.
She is en route to the Will Rogers
Court Community Center, where
she will meet friends for a game of
dominoes, compare crochet tech­niques
with other women about her
age, or just sit and visit with people
in the center. Around noon, she will
join the others in a simple, yet well­balanced
meal designed to meet the
special needs of someone her age.
The center may be the one social
contactofherday,andthefoodthe
one balanced meal.
Similar scenes take place each
day at thousands of community cen­ters
throughout the country. What's
interesting about Will Rogers-and
188 other community centers in
October 1983
elderly are prepared in a central kitchen, which
provides food to several other community
centers in Oklahoma City.
Oklahoma-is the way state and
local food program managers are
combining nutrition education with
meals and companionship.
Each month, the center offers
classes on nutrition tailored to the
particular needs and interests of
older people. The classes are con­ducted
by the staff dietitian, student
nurses, a representative of the Okla­homa
State University Extension
Service, or a home economist from
the Oklahoma Department of
Human Resources.
The Department of Human Re­source's
Food and Nutrition Unit
administers both the Food Stamp
and Food Distribution Programs for
the state. The nutrition education
classes offered to the elderly are
part of a statewide effort to help
food stamp participants of all ages
learn more about diet and health.
According to Marilyn Henderson,
coordinator of Oklahoma's nutrition
education program, the communal
dining centers are a particularly
good way to reach elderly food
stamp participants since many of
them come to the centers. At the
Will Rogers center, for example,
most meal participants also receive
food stamps.
Activities are
lively and fun
Working with the elderly presents
special challenges for nutrition edu­cators.
"You're talking with people
who have been doing things a cer­tain
way for a long time," says
Henderson. "Their eating habits are
set, and it's hard to get them to
make changes.
"We've found," she adds, "you get
better results if you can show them
what you're saying by using visuals.
For example, to show them how
much fat is in potato chips, we actu­ally
burn some potato chips and
watch the grease burn off. We make
a bottle of orange soda pop to show
them how much sugar is in it."
Many elderly people need to limit
their salt intake. Included in the les­sons
is advice on how to look for
unexpected sources of salt. "We
show them how to read labels to see
how much salt is in a particular prod­uct,"
Henderson says. "They're
amazed to see how much salt you
get from sources other than table
salt. We also talk about food and
drug interaction."
A few years ago, l)tate food pro­gram
managers got some clues on
participants' needs from a study of
food stamp households in two Okla­homa
counties. The study showed
that more than half-56 percent-of
all food stamp participants there
were 60 years of age or older.
Most people responding to the
survey questionnaire reported eat­ing
foods from three of the four
major food groups on a regular
basis. Seventy-one percent had milk
and cheese every day. Seventy-nine
percent ate some meat, poultry, fish,
beans, or eggs daily. Ninety percent
included breads and cereals in their
daily diet. But only 25 percent ate
fruits and vegetables every day.
17
Encouraging people to make
changes in their diets-like eating
more fruits and vegetables-is not
easy. Marilyn Henderson, her staff,
and local food program managers
make nutrition education activities
lively, interesting, and fun. Each
center has some kind of nutrition
activity at least once every 4 weeks.
State home economists visit each
center on the average of once every
6 months.
"Elderly people enjoy the activities
tremendously," says Henderson.
"It's hard to get their attention some­times
because we're competing with
Marilyn Henderson, coordinator of Oklahoma's
nutrition education program, shows a group of
elderly people how much sugar is in a bottle of
18
all sorts of social activities." But, she
says, they are usually eager to take
part. To supplement activities at the
centers, the state staff has put
together a special cookbook for the
elderly. They've also reprinted the
USDA pamphlet, Cooking for One
or Two.
Nutrition lessons
for families, too
In addition to their work with the
elderly, Oklahoma nutrition special­ists
also work with families in a va­riety
of group settings. They go
where the people are-churches,
orange soda. People learn more, she says, with
hands-on demonstrations and activities that are
lively and fun.
Head Start centers, PTA meetings­armed
with film strips, posters,
puppets and hands-on projects to
help demonstrate what's a nutri­tional
bargain and what isn't.
Among their students are home
care providers, trained by the
Department of Human Services
through the state's Non-Technical
Medical Care Program, whose work
with elderly clients includes plan­ning
meals and preparing special
diets.
The nutrition specialists also do
one-to-one nutrition counseling with
families at health fairs throughout
the state. Between July 1982 and
June 1983, they estimate they
reached nearly 15,300 people
through all their various nutrition
activities.
Last spring, USDA Secretary
John R. Block visited Oklahoma to
see firsthand the state's one-of-a­kind
nutrition education program.
"The program is unique," he told a
senior citizen's group at the Will
Rogers Court Community Center.
"Oklahoma is the only state in the
nation that has a nutrition education
program staff going across the state
to tell people how they can get the
best nutrition for their money."
Secretary Block wound up his
visit with a pop quiz for the senior
citizens on Marilyn Henderson's
"Supermarket Survival" curriculum:
"Are you going to these classes?"
Block asked.
"Yes," they chorused. "We had
one yesterday."
"Are they any good?" Heads
nodded.
"Are you learning anything?"
"We're learning how to read those
labels," a white-haired woman
responded. "If you're a diabetic like
me, those first three ingredients can
tell you what you need to stay away
from."
Participation averages around 85
per day at the Will Rogers Center.
Some people come only for the meal
and then leave, but most of the
elderly participate in the center's
activities.
Meals include
food from USDA
The meals include foods donated
by USDA through the Food Distribu-
Food and Nutrition
tion Program. According to John
Hooper, who heads Oklahoma's
Food and Nutrition Unit, about half
the foods used in the meals pro­grams
for the elderly are USDA­donated
foods. While states have the
option of receiving cash instead of
donated foods for meals served to
the elderly, Hooper sees definite
advantages to the donated foods
option.
"The volume and quantity of food
we get with our entitlement is much
greater than what we would get if we
were to cash out and purchase
locally," he says. "Even if all the
sites bought together, they couldn't
buy in volume the way USDA can."
When the elderly meals program
began several years ago, the sites
received only staples, like flour, oil,
cheese, and butter. Today, they
receive a full range of foods, includ­ing
meats and canned fruits and
vegetables. The state staff assists
the local sites by testing the foods,
providing recipes, and reviewing
menus. The sites order directly from
October 1983
Companionship is as important as meals at
community centers like Will Rogers. Many of the
volunteers, like this woman (right), are elderly
people who have fun helping serve lunch to their
friends and neighbors.
the state office and receive ship­ments
about every 6 weeks.
In Oklahoma City, the meals pro­gram
is sponsored by Communty
Action, a nonprofit community serv­ices
agency. The meals are prepared
at a central kitchen and delivered in
bulk to local sites. In addition to the
people served at the centers, meals
are also delivered to those who are
temporarily housebound. The Meals
on Wheels Program serves those
who are confined to their homes on
a long-term basis.
Elderly benefit
in many ways
Mary Lewis, assistant project
director who helped open the meals
program in 1974, says volunteers
play an important role at the cen­ters.
"Only one paid employee is
used to serve the food," she says.
"The rest are volunteers."
Help is not limited to meals,
though. The whole Oklahoma City
community steps in to assist the
elderly, Lewis points out. Depart-ment
stores and other businesses
provide clothing and other gifts at
Christmas. One local philanthropist
provides a monthly bingo party for
the seniors. In addition to prizes, he
also gives them a free meal at a local
cafeteria.
Do the meals and activities make a
difference in the lives of the elderly?
"Even their appearance improves
after they come to the center," says
Jackie Edwards, community serv­ices
district director. "They are more
concerned about their looks-and
they are obviously happier."
Like the meals served to children
through the National School Lunch
Program, the meals served through
the nutrition program for the elderly
are contributing to good health.
For more information on Oklaho­ma's
nutrition education or meals
programs, write:
Marilyn Henderson
Department of Human Services
P.O. Box 25352
Oklahoma City, Oklahoma 73125
article by Ronald J. Rhodes
19
UNITED STATES GOVERNMENT PRINTING OFFICE
Division of Public Documents. Washington. D.C 20402
Official Business
Penalty for Private Use. $300
Published four times a year by
the Food and Nutrition Service,
U.S. Department of Agriculture,
Washington, D.C. 20250.
John R. Block
Secretary of Agriculture
Mary C. Jarratt
Assistant Secretary
Robert E. Leard
Administrator
Food and Nutrition Service
Jan Kern, Editor
Jan Proctor, Art Director
(o)foOd
~Nutrition
Yearly subscription: $7.50 domestic,
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this periodical is necessary in the
transaction of the public business
required by law of this Department.
The use of funds for printing this
publication was approved by the
Director of the Office of Manage­ment
and Budget May 2, 1982.
Food and Nutrition is a magazine of
the U.S. Department of Agriculture.
In it you'll find articles on the family
food assistance and child nutrition
programs administered by USDA's
Food and Nutrition Service in coop­eration
with state governments and
local agencies.
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