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SUPPLEMENTAL COMMODITY FOOD USE BY FOCUS:

HOPE PARTICIPANTS

Thesis for the Degree of M. S.

MICHIGAN STATE UNIVERSITY

EILEEN FRANCES KASS

1977

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ABSTRACT

SUPPLEMENTAL COMMODITY FOOD USE BY FOCUS: HOPE PARTICIPANTS

By

Eileen Frances Kass

Forty-eight participants in Detroit's Focus: HOPE Food Pre-

scription Program (FPP), a federally funded program providing USDA

commodities to high risk pregnant and nursing women and young children,

were interviewed to determine their use of supplemental foods.

Eighteen who were also involved in the Expanded Nutrition and Family

Program (ENFP) did not differ significantly from those not on ENFP

in nutrition knowledge, food preparation skills, or use of commodity

foods, but did more often use Food Stamps (p 3_.Ol). Only l5 per-

cent of the total sample understood the purpose for prescription

commodity foods; most felt the program was intended as an income

supplement. All respondents reported feeding the commodities to the

entire family. Many had a concept of the relationship of food to

health, but did not demonstrate knowledge of specific nutrients.

Farina and dried eggs were reported as the most difficult commodities

to USE.

SUPPLEMENTAL COMMODITY FOOD USE BY FOCUS: HOPE PARTICIPANTS

By

Eileen Frances Kass

A THESIS

Submitted to

Michigan State University

in partial fulfillment of the requirements

for the degree of

MASTERS OF SCIENCE

Department of Food Science

and Human Nutrition

1977

TO MY MOTHER AND FATHER

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ACKNOWLEDGMENT

Any successful research has resulted from the input of many

individuals without which the project may not have been possible.

My sincere appreciation is extended to:

Dr. Kathy Kolasa, my major advisor, for her continuous

support, encouragement and endurance throughout this project and

graduate school.

Drs. Jenny Bond, Henda Chenoweth and Don Tavano for their

support and advise during the course of the project.

Thanks are extended to Mr. Charles Grenville, director of

the Focus: HOPE Food Prescription Program and the State and Wayne

County offices of The Expanded Nutrition and Family Program for

their assistance in making the whole project possible.

Partial financial support for the project from the Department

of Food Science and Human Nutrition, the Expanded Nutrition and

Family Program and the Michigan Agricultural Experiment Station

are gratefully acknowledged.

I wish to express a warm thank you to all the families who

welcomed me into their homes without which this study could never

have been conducted.

A very special thank you to Helen for accompanying me

throughout Detroit.

And last but not least a huge thank you to my friends and

Michael who helped me through to the very end.

iv

TABLE OF CONTENTS

LIST OF TABLES

LIST OF FIGURES

INTRODUCTION

OPERATIONAL DEFINITIONS

REVIEW OF LITERATURE

Nutritional Status in the United States

Food Program -- A Brief History

Focus: HOPE Food Prescription Program

Expanded Nutrition and Family Program

Nutrition Education within Food Programs

Dietary Adequacy of Preschool Diets

Gatekeeper

Nutrition Knowledge

Effectiveness of Supplemental Feeding Programs

Problems in Changing Food Habits

Evaluation of Nutrition Intervention Programs

METHODOLODY

RESULTS

Program Selection

Interview Schedule

The Sample

Pretest of Interview Schedule

Interview Process

Field Notes

Nutritional Quality of Focus: HOPE Prescription

Commodity Foods

Procedure for Analysis of Data

Sample

Family Characteristics

Usual Meal Patterns

Extent Gatekeeper Understands Purpose of

Focus: HOPE FPP

Commodities Refused to Eat

Commodities most Disliked

New Commodity Desired

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Gatekeepers' Knowledge of Importance of an

Food

Adequate Diet

Change in Food Habits while Pregnant

Foods Important for Child's Growth

Nutritional Advice During Pregnancy

Preceived Nutritional Quality of Commodities

Preparation Skills of Gatekeeper

Food Preparation and Shopping

Training

Commodity Use

Kitchen Equipment

Number of Items Prepared with Each Commodity

Commodity Use in Family Meal Patterns

Problem Solving

DISCUSSION

Family Characteristics

Usual Meal Pattern

Extent Gatekeeper Understands Purpose of Focus:

HOPE FPP

Gatekeeper's Knowledge of the Importance of an

Adequate Diet

Food Preparation Skills of Gatekeeper

Commodity Use in Family Meal Pattern

SUMMARY AND IMPLICATIONS

Summary

Implications

LIST OF REFERENCES

APPENDICES

Appendix A: Interview Materials

Appendix 8: Composition of Focus: HOPE Commodities

Appendix C: Focus: HOPE Commodities

Appendix D: Meal Pattern Recall

Appendix E: Map of Detroit and Vicinity

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LIST OF TABLES

Demographic Characteristics of all the

Respondents, those on ENFP (FPPE) and those

only on the FPP (FPPNE)

Description of Kitchen Equipment in the Home of

the Total Sample, those on ENFP (FPPE) and those

only on the FPP (FPPNE)

Percent of Families Preparing Specific Dishes

with Each Commodity for'the Total Sample, those

on ENFP (FPPE) and those only on the FPP (FPPNE)

Percent of Male and Female Family Members Eating

Breakfast, Lunch and Dinner in the Home for the

Total Group, those on ENFP (FPPE) and those only

on the FPP (FPPNE)

Percent of Children Eating Breakfast, Lunch and

Dinner in the Home for the Total Sample, those on

ENFP (FPPE) and those only on the FPP (FPPNE)

Percent of Families for the Total Group, those on

ENFP (FPPE) and those only on the FPP (FPPNE) Using

Each Commodity to Prepare Breakfast

Percent of Families for the Total Group, those on

ENFP (FPPE) and those only on the FPP (FPPNE) Using

Each Commodity to Prepare Lunch

Percent of Families for the Total Group, those on

ENFP (FPPE) and those only on the FPP (FPPNE) Using

Each Commodity to Prepare Dinner

Nutritive Value of Prescription Commodities

Calorie and Iron Content of Commodities Provided

to Each Age Group

Number of Commodities taken During October, 1976

Number of Participants Certified for the FPP

During October, 1976

Percent of Foods Reported Usually Eaten by the

Total Sample, those on ENFP (FPPE) and those only

on the FPP (FPPNE)

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LIST OF FIGURES

Figure Page

A-l Family Data Obtained from Focus: HOPE Records 68

A-2 Focus: HOPE Survey - Interview Schedule 69

A-3 Sample Dialogue 79

A-4 Probe Card 80

A-5 Consent Form Bl

E-l Detroit and Vicinity 92

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INTRODUCTION

Commodity food distribution in the United States was imple-

mented in order to utilize surplus foods and feed hungry pe0ple. The

Food Stamp program replaced the old commodity food distribution pro-

gram because the commodity program provided only a limited number of

foods, required separate food distribution sites, affected local re-

tail sales and did not assure adequate diets (l).

The results of the.Ten-State Nutrition Survey (2) were that

the Food Stamp program has had limited success in providing adequate

nutrition. The expansion of the Food Stamp program continued under

the basic assumption that individuals receiving food at a lower cost

would not have any type of nutrition problem related to income.

Evidence of nutritional inadequacies in women of child bear-

ing age, infants and young children has been cited in the literature.

Read (3) reported that malnutrition and hunger during pregnancy and

infancy can lead to serious long-term effects on learning and be-

havioral development of the child. The previously mentioned high

risk groups were considered by the state of Michigan Task Force on

Nutrition (4) to be at nutritional risk and in need of supplemental

foods.

Since the commodity distribution program was replaced by the

Food Stamp program, the U.S. Department of Agriculture needed an

outlet for the commodities (5). A program offering eleven commodities

l

on a monthly basis to supplement the diet of low-income pregnant

and nursing women, infants and children up to the age of six was

developed as an outlet. A non-profit organization, Focus: HOPE, in

Detroit became involved in the supplemental feeding program in 1971.

During the next five years Focus: HOPE became the largest prescrip-

tion comnodity food program in the nation. The Focus: HOPE Food

Prescription Program (FPP) has increased to a maximum allowed level

of 35,000 participants through the use of an extensive volunteer

transportation system, community outreach program and the commitment

of the director and staff to the program. Nutrition education how-

ever has not been a part of the program. On occasion nutrition pro-

grams are presented by dietetic and public health trainees or

interested agencies.

In Michigan, Cooperative Extension's Expanded Nutrition and

Family Program (ENFP) has been the primary provider of nutrition educa-

tion for low-income families. The primary objective of ENFP is to

teach low-income families the necessary skills and knowledge to main-

tain an adequate diet. Also in October, 1975 nutrition education

became an integral part of the Special Supplemental Food Program for

HOmen, Infants and Children (HIC).

The majority of the preschool child's meals are eaten in the

home and are the responsibility of the person who controls the food

in the family (6). The person that controls food channels of the

family has been described as the gatekeeper (7). The study of the

gatekeeper's knowledge and attitude of nutrition provides a better

understanding of food behavior within the family.

III

on

There are few studies available describing or documenting

the effect of supplemental feeding programs forhigh risk persons

("1 the nutritional status of all family members. There is a need to

evaluate the efficiency of existing nutritional intervention programs

to determine whether they are meeting the needs of the target audi-

ence and if the food is being used by the intended group.

The purpose of this research was to determine: (a) the

gatekeeper's understanding of the need for prescription commodity

foods; (b) the gatekeeper's recognition of the importance of a

nutritionally adequate diet for pregnant and nursing women, infants

and young children; (c) the gatekeeper's food preparation skills in

the utilization of Focus: HOPE prescription commodity foods; (d) the

use of prescription commodities in the entire family's food behavior

and (e) the difference between those families involved in ENFP and

those only on the FPP in knowledge and use of commodities.

OPERATIONAL DEFINITIONS

Commodities: surplus food purchased by USDA and distributed to

needy individuals through local distribution center.

Focus: HOPE commodities: canned meat (beef or chicken), canned

vegetables (green beans, peas or corn), canned fruit juice

(orange, apple or grapefruit), nonfat dried milk,

evaporated milk, corn syrup, dried egg mix, peanut butter

(every other month), farina, instant mashed potatoes and

canned plums.

Food Behavior: the way in which an individual or group of people

select, prepare, consume and dispose of food.

Food and Nutrition Attitudes: a complex system of beliefs and

values concerning food and nutrition.

Food and Nutrition Knowledge: information related to common foods

included in the basic four food groups and to the effect

of their intake upon one's health.

Prescription Foods: specially selected dietary supplements to off-

set health hazards of chronic hunger.

Gatekeeper: the person who decides what food will be purchased for

the home and controls the food placed on the table.

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REVIEW OF LITERATURE

Nutritional Status in the United States

The report entitled Hunger USA (8) released in 1968 by the

Citizens Board of Inquiry insisted that malnutrition was prevalent

in the U.S. The report by the Board described nutrition as a

national concern even though the report focused on an isolated group

in Mississippi (9).

The Ten State Nutrition Survey (2) was the first compre-

hensive assessment of nutritional status in the United States. This

survey was designed to assess the nutritional status of people living

in poverty and included Michigan in the sample. In 1970 the Depart-

ment of Health, Education and Welfare (10) continued documentation

of nutritional status in a study known as HANES (Health and Nutri-

tion Examination Survey). The findings of these reports were that

undernutrition and malnutrition are not confined to any one social,

economic, cultural or ethnic group. The groups of people described

as most "at risk" of malnutrition in these surveys were women of

child bearing age, infants, preschool children and the elderly.

Shneour (11) defined malnutrition as "the impairment or risk

of impainment to mental and physical health resulting from the

failure to meet the total nutrient requirements of an individual".

A case of severe malnutrition rarely is identified in this country.

Kallen (12) indicated that milder forms of malnutrition that do not

5

threaten life but can affect the size of an adult and intellectual

development is the form usually seen in the United States but the most

difficult to detect.

Optimum development of an infant is dependent on the nutri-

tional status of the mother as well as the quality and quantity of a

child's diet during the first years of life (13, 14). Malnutrition

and hunger during pregnancy and infancy can lead to serious long-

term effects on learning and behavioral development of the child (3).

It has been reported that nutrition can determine the path of emotional

growth and influence the role of the child in the community (15).

Biochemical evidence indicated that poverty children were

smaller than average and more "at risk" nutritionally than more

affluent children (16). Ten goals to upgrade the nutritional (17)

status of Michigan residents were outlined in the State Plan for

Nutrition. A major concern is for the nutritional well-being of

infants and children. To ensure optimal development of young chil-

dren one objective is "to maximize the availability of and partic-

ipation in supplemental feeding programs for needy infants, young

children and pregnant and nursing women". The Michigan Task Force

on Nutrition (4) described this same group at nutritional risk and

in need of special supplemental foods.

Food Program -- A Brief History

Federal food programs were initiated in the early 1900's.

The majority of food programs came into existence as a result of the

depression of the thirties. One such program, the Commodity Credit

Corporation was formed to federalize and manage the acquisition of

overproduced agricultural commodities and feed hungry people (18).

The distribution of Food Stamps was another program that began in the

late thirties but was terminated in 1943. The Food Stamp program was

reestablished under new legislation in 1964. Initially, food stamp

recipients were allowed only nutritious surplus foods but today any

food and beverage (except alcoholic) can be purchased with food

stamps (18). The Food Stamp program continues to operate under the

assumption that individuals receiving fabd stamps will not develop

nutritional problems due to limited income. A recent study conducted

by the U.S. Department of Agriculture (19) did not support this basic

assumption. In order for the Food Stamp program to be economically

efficient, the family must use the USDA Economy Food Plan, which does

not take into account people with higher nutritional requirements or

special needs (20).

With the replacement of the old commodity food distribution

program by the Food Stamp program the U.S. Department of Agriculture

sought another outlet for the commodities (5). The U.S. Department

of Agriculture made available selected commodities to be used by low-

income pregnant and nursing women, infants and children up to six

years of age. Participants of the supplemental feeding program would

be required to become certified (a prescription given) as in need by a

health professional. The supplemental food program for women, in-

fants and children developed out of a brief executive directive

that the secretary of agriculture may give needy people the surplus

foods and has never been specifically authorized by Congress (5).

Focus: HOPE Food Prescription Program (FPP)

The Salvation Army in 1971 was operating the supplemental

feeding program in Detroit, Michigan with very little success. Their

major problem was that 2,100 were certified as eligible for the pro-

gram and only 800 actually were receiving the food. Area health pro-

fessionals were concerned and approached a non-profit organization in

Detroit named Focus: HOPE (21).

Focus: HOPE is a volunteer run organization formed shortly

after the Detroit civil disturbances in 1967. The main objective of

the organization is to promote projects in the areas of education,

employment and housing, in order to bring black and white people to-

gether against racial injustice (5).

Focus: HOPE assumed the Food Prescription Program (FPP) in

1971 with the hope of reaching the malnourished and hungry in Detroit.

Since that time the program has expanded to include two warehouses,

an extensive outreach program and provides food for 25,000 partici-

pants with maximum level of 35,000 (5). Today, the Focus: HOPE FPP

is the largest of its type in the nation. Focus: HOPE does not pro-

vide nutrition education for low-income mothers. The major provider

of nutrition education in selected counties in Michigan at the pre-

sent time is the Expanded Nutrition and Family Program (22).

Expanded Nutrition and Family Prggram (ENFP)

The Federal Expanded Food and Nutrition Education Program

(EFNEP) of the USDA's Extension Service was authorized in November of

1968 to upgrade diets of low-income families through education (19).

The program is known as the Expanded Nutrition and Family Program

(ENFP) in Michigan. The main objective of the program is "to help

families living in poverty or near poverty to acquire knowledge,

skills and changes in behavior to achieve adequate diets providing

normal nutrition“ (23). More specifically, the aim is to help in-

crease family knowledge of the essentials of good nutrition. A

supportive objective is to increase participation in food assistance

programs (24).

Paraprofessional nutrition aides usually indigenous to the

comunity are employed by the program. Aides help to extend the

efforts of the professional home economist to the community while also

providing a rapport with the family that only they can develop (25).

EFNEP has had a positive effect in teaching homemakers nutri-

tion. Hang and Ephross (26) reported a substantial upgrading of nutri-

tive intake for homemakers and their families with the use of new foods

and wise buying. Prichard and Hall (27) have noted that 75 percent of

the clients improved meal planning as a result of visits by an aide.

Some other ways aides helped homemakers, according to Prichard and Hall

were in decreasing order of value to the homemaker, were providing in;

formation about how to: prepare recipes, save money while shopping, do

'better housekeeping, use free lunch and breakfast programs for child-

ren, apply for food stamps and secure help through other agencies.

Verma and Jones (28) found that the greatest dietary changes of

clients occurred after a year of program participation on ENFP with the

significant increase in intake of fruits and vegetables, followed by

milk, bread and cereal and lastly, meat. The greatest effectiveness

occurred within the first year of the program; further gains have

not been demonstrated after the second year (29).

lO

Aides also have shown to be effective in changing dietary

habits of high-risk pregnant women. Bowering and coworkers (30) found

that changes in the diet occurred in a considerably shorter period of

time when aides operated in an obstetric clinic than those doing

regular home visits. The group of pregnant women was too small to re-

port significant changes in nutrient intake. Nevertheless, aides were

seen as a valuable addition to an obstetric care program for low-

income women.

Caliendo and coworkers (31) reported that nutrition classes

in well-baby clinics were beneficial to the child's dietary quality.

Public health clinics and the Cooperative Extension Service have

potential to work together in the provision of nutrition services.

Nutrition Education withianood Programs

Aside from the Focus: HOPE FPP another program currently in

Michigan, provides nutrition assistance to this high risk group. This

is a federally financed project under the child nutrition act of 1966.

The project provides Special Supplemental Foods for Women, Infants and

Children (HIC). In addition to receiving HIC foods, many participants

also receive counseling in nutrition.

Bendick and coworkers (32) in a report on the efficiency and

effectiveness of HIC found only 12 percent of the participants receiving

nutrition education indicated that they had learned something from the

experience. However, this study was conducted before nutrition educa-

tion became a mandatory component of the HIC program. Six objectives

for successful nutrition education program within HIC were outlined

II

in the report (32). Many of the principles discussed duplicated those

utilized by the ENFP. In one HIC program which implemented the use

of nutrition aides, similar to ENFP aides, more clients were reached

with the HIC aides than previously and the nutritionist's time was

freed for more complex nutrition problems (33). Participants in

Focus: HOPE FPP are not eligible to receive HIC supplements.

Dietary Adequacy of Preschool Diets

The diets of some preschool children have been found nutri-

tionally inadequate in certain major nutrients. Guthrie (34) reported

that ascorbic acid and iron were the nutrients that most frequently

fell below the recommended amounts for children, while Dierks and

Marse (35) found only iron to be unusually low. In a recent study

Karp and coworkers (36) reported that inner-city children entering

school had low hemoglobin concentrations and tricep fat folds below

standard, indicating undernutrition.

Family income, money spent on food and educational level of

the mother also have been related to the nutritional adequacy of pre-

school children. Inano and Pringle(37) found a positive relationship

between the intake of individual nutrients and income levels. Hendel

and coworkers (38) focused on specific vitamins, finding that the

adequacy of vitamins A and C intakes in children's diets had a direct

correlation with income. Money spent on food exerted a positive in-

fluence on the dietary intake of children, especially iron and

calcium (39). Educational level of the mother has been shown an in-

fluential factor affecting the feeding practices of children. Futrell

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and coworkers (40) reported that iron was low in the diet of children

except when mothers had a college education.

The analysis of the dietary pattern of children usually has

been in relationship to specific nutrients. Yet, according to Lund and

Burk (41) in order to analyze the diet effectively such factors as

nutrition knowledge and food attitudes of the person controlling the

food in the family need to be examined.

Gatekeeper

The family serves as an environment for the developing child

and in general is responsible for the child's food intake and

nutrients (6). The foods eaten by the family are determined by the

choices made by the gatekeeper (7). The gatekeeper's nutrition know-

ledge can affect the selection, preparation and distribution of food

within the family.

Nutrition Knowledge

There are conflicting opinions concerning the level of educa-

tion and nutrition knowledge of the homemaker. Young and coworkers

(42) and Eppright and coworkers (43) demonstrated that the more educa-

tion of the mother the greater her nutrition knowledge. Schwartz (44)

however found that high school graduates did not apply their knowledge

of nutrition to their choice of food and so no correlations between

knowledge and practices were apparent.

Several studies (45, 46) describing the performance of home-

makers in feeding their family reported that their practical know-

ledge was considerably better than their theoretical nutrition know-

ledge. Emmons and Hayes (46) reported that mothers considered foods

13

important based on customs or habit rather than for a specific

nutrition reason.

Fox and coworkers (47) suggested that mothers of preschool

children rely on nutrition information from lay sources, in descending

order of importance: magazines, newspapers, books, TV, radio and

extension bulletins. Information about family food needs is sought

most often from a mother or a relative. Cosper and Wakefield (48)

noted that friends, relatives and family members were the main in-

fluence on homemaker's food choices.

The translation of nutrition knowledge to actual food con-

sumption practices also may be affected by attitude. Eppright and

coworkers (43) indicated favorable attitudes toward nutrition did seem

to influence the nutritional quality of a child's diet. Sims (49)

found that attitudes appeared to exert a consistent influence on

nutrition knowledge.

Effectiveness of Sgpplemental Feeding;Programs

Since commodity food distribution has been in operation,

little attempt to evaluate the program's effectiveness in improving

the dietary intake of recipients has been reported. In a recent study

conducted by Guthrie and coworkers (50), the comodity food program

was found ineffective in improving the overall nutritive intake of

family members participating when compared to nonparticipants. Fewer

families receiving commodities had diets below two-thirds of the rec-

ommended amount of four or more nutrients than did nonparticipating

families.

I4

A comparison of EFNEP families on food stamps, food distribu-

tion programs and those eligible for food but not participating in

any food assistance program was conducted by the U.S. Department of

Agriculture (51). The results were that food stamp families had better

diets, larger families and higher income than the families in the

other two groups. In another study, the use of donated foods by

black families made no difference in the nutritional status of the

preschool children (52).

Donated foods, when used by families, should contribute to

the adequacy of calories and protein of the meals. However, certain

conmodities weremore difficult for families of the Potawatimi Indian

community to use due to food preparation equipment, knowledge of

preparation and personal and family preference (53). Neff (54) re-

ported that dried eggs, due to their unfamiliarity, and dried milk,

due to the lack of knowledge of use other than as a beverage, were

the least often used by low income families. Pontzer and Dodds (55)

indicated that rural families seem to need help using the food. Some

observers believe the Department of Agriculture's main concern in

founding the commodity food program was to stablize farm prices and

not to distribute food to the needy (56).

Problems in ChangjngFood Habits

Parrish (57) raised serious doubt whether the use of food

programs such as food stamps and selected commodities can increase the

nutritive quality of the American diet. Giving people shopping money

or supplemental food and telling them what to eat does not guarantee

adaptation of better food habits. However a program does not fail

15

just because all families do not show success. Families will not want

to change their food pattern unless the change is meaningful to them

(58).

Food habits are seen as a standardized set of behaviors

manifested by individuals reared within a culture (59). Food habits

are interwoven with the entire way of life of a people (60). Culture

acts as a screen of values and perception through which the person

views food, his own body and the world (61). Programs designed to

change food habits have not produced significant changes in food

consumption (62). The motivational forces and goals of low-income

families need to be understood for successful nutrition intervention

(63).

Evaluation of Nutrition Intervention Programs

There is a need to evaluate the efficiency of existing food

assistance programs to determine whether they are meeting the food

needs of low-income people. According to the panel of the Senate

committee on Nutrition and Human Needs (64) evaluation should:

(1) determine whether or not the participants in the program per-

ceive the program to be helpful and designed to meet their needs,

(2) determine the quality of nutritional benefits, and (3) reach all

those in need. Because of the growing significance and size of

food distribution programs, nutrition educators are obligated to

make significant efforts at evaluation (65).

METHODOLOGY

Program Selection

Focus: HOPE Food Prescription Program (FPP) was chosen for

the following reasons: (1) no previous research on the use of

commodity food has been conducted on this FPP, (2) the large number of

low-income participants involved in the program, and (3) the inter-

viewer's familiarity with the geographic area. Expanded Nutrition

and Family Program (ENFP) involvement was sought because nutrition

education is not a part of the Focus: HOPE FPP and ENFP aides pro-

vide nutrition education to many of the participants.

Contacts were made by the researcher with appropriate pro-

fessionals of the Focus: HOPE FPP and both the state and the Wayne

County office of the ENFP. The professionals from both programs

indicated a willingness to cooperate with the study. Each program

permitted all participant records to be used by the researcher. The

availability of the records assisted the researcher in the sample

selection and provided some demographic data including: the use of

food stamps, the length of time on programs, the certification clinic,

and the number of children below six years of age in each family

(Appendix A, Figure l).

The nutrition professionals associated with the Detroit

Maternity and Infant Care - Preschool, School and Adolescent (DMIC-

PRESCAD) Project were contacted. While they were willing to pro-

I6

I7

vide some information, clinic records were being computerized and

were not available for use at this time.

Interview Schedule

An interview schedule (Appendix A, Figure 2) was developed

by the researcher for the assessment of nutrition knowledge and food

preparation skills of Focus: HOPE participants. The interview

schedule was designed focusing on the following subjects: food and

nutrition knowledge and attitudes of the gatekeeper concerning

pregnant and nursing women, infants and children under six years of

age; food preparation skills of the gatekeeper especially with the

use of commodity foods; kitchen facilities in the home and prescrip-

tion commodity food use during meals.

The interview schedule "The Use of Prescription Commodity

Foods as Affected by the Expanded Nutrition Program" was approved for

use with human subjects by University Committee on Research involving

Human Subjects.

The Sample

Focus: HOPE FPP and ENFP records were used by the researcher

to select the sample. The potential interviewees were selected from

families where at least one member was not eligible for Focus: HOPE FPP.

Families with children older than six years of age and/or husbands

living in the home were chosen. This selection process would allow

the researcher to determine if commodities are used by family members

not directly participating in the FPP.

The selection of the sample was accomplished by first obtain-

ing those families on Focus: HOPE FPP and ENFP (FPPE). The Focus:

18

HOPE families not participating in ENFP (FPPNE) were then matched

by certification clinic with those Focus: HOPE FPP families partic-

ipating in ENFP. The researcher contacted all potential interviewees

by telephone to verify the address and the number of children living

in the home. The original sample drawn totaled ninety-nine families,

fifty-one families were FPPNE and forty-eight were FPPE. The sample

was then randomly ordered by the use of a random number table.

Pretest of Interview Schedule

Prior to the actual interviewing the questionnaire was pre-

tested for clarity, ability of participants to understand questions,

length of time of the interview and appropriateness of questions.

Three Focus: HOPE FPP participants were interviewed to pretest the

interview schedule; minor changes were made. A second pretest of the

interview schedule was accomplished under actual interviewing con-

ditions; no changes were made.

Interview Process

The interviews were conducted in the participants' homes

from September through November, 1976. The researcher was advised

against interviewing in either the certification clinic or the Focus:

HOPE food warehouse due to the many distractions. It was necessary

to call each prospective interviewee a week prior to set up an

appointment and then the week of the interview to confirm the appoint-

ment. A verbal explanation was given on the phone describing the pur-

pose of the study, assuring confidentiality and introducing the

interviewer (Appendix A, Figure 3).

19

At the beginning of each interview the respondent's role was

clearly stated along with the right to terminate the interview at any

time and participation or answers would not je0pardize their certifi-

cation for the FPP. Each interview was conducted according to the

format of the interview schedule. If at any time the interviewee did

not understand a question, the question was first stated again and

then if further clarification was necessary the question was care-

fully reworded not to change the original meaning of the question

and for further clarification a probe card (Appendix A, Figure 4)

was used. Each interview lasted between 30 and 60 minutes. Due to

the high crime rate in Detroit during the fall of 1976, the re-

searcher was accompanied for added safety by a black volunteer to

each interview.

A consent form was signed at the end of each interview

(Appendix A, Figure 5). For those participants that worked during

the day, or who would not consent to a personal interview, inter-

views were conducted on the telephone. A consent was given verbally

at the end of the interview.

Field Notes

Field notes were recorded after each interview. Information

describing the home, the respondent and any children present at the

time of the interview, attitude of respondent towards the interview

and any problems related to food and nutrition that arose during the

course of the interview were recorded.

20

Nutritional Quality of Focus: HOPE Prescription Commodity Foods

Focus: HOPE FPP provides eleven commodities to participants.

The participants are divided into five groups; mothers, children zero

to three months, children four to twelve months, children thirteen to

thirty-six months and children three to six years. Specific amounts

of each commodity are given to each age group.

The nutritional quality of the Focus: HOPE comodities was

determined for calories, protein, fat (total, saturated and unsaturated),

carbohydrates, fiber, calcium, phosphorus, iron, sodium, potassium and

magnesium by calculation from the Nutritive Value of Food Distributed

under USDA Food Assistance Programs (66) and Nutritive Value of American

Foods (67) (Appendix B, Table l). Calories and iron were calculated

for the total package of commodities given to each group (Appendix B,

Table 2).

Procedure for Analysis of Data

The analysis program used for this study was the SPSS statis-

tical package developed for the 6500 model computer at Michigan State

University.

All variables including the five problem solving questions

were calculated for frequencies. Variables calculated for mean and

range were: age, number of children per family, length of time on

Focus: HOPE FPP and ENFP, kitchen equipment, and number of items made

with each commodity. The two groups, FPPE and FPPNE were compared for

differences by the use of the Chi-square statistical test. The vari-

ables used to compare the groups were: age, number of children, Food

21

Stamps use, race, person preparing and shopping for food, nutrition

training received, changes in eating habits while pregnant, advice

obtained while pregnant, reason Focus: HOPE commodities were given,

foods important for a child's growth, commodity importance to health,

concern about food eaten, advice asked while pregnant, help received

in using commodities, trouble using commodities, recipes tried on

I". :4"

packages of commodities, number of items made with each commodity,

number of family members eating commodities and length of time on

Focus: HOPE FPP and ENFP.

RESULTS

The data will be discussed as they relate to the five

principal aspects of the study: family characteristics; the gate-

keeper's understanding of the purpose of prescription commodity foods;

the gatekeeper's knowledge of the importance of an adequate diet for

pregnant and nursing women, infants and young children; the gate-

keeper's food preparation skills as they relate to prescription

commodity foods and the use of prescription commodity foods in family

meal patterns.

In each section the data will describe the total sample,

participants on both the Focus: HOPE Food Prescription Program (FPP)

and Expanded Nutrition and Family Program (ENFP) (FPPE) and those

participants only on Focus: HOPE FPP and not on ENFP (FPPNE). Any

statistical significance will be presented comparing FPPE and FPPNE.

Sample

The final sample consisted of 48 women, 48 percent of the

possible sample, 18 of whom were on both Focus: HOPE FPP and ENFP.

Failure to reach 51 prospective respondents was due to unpublished

phone number (9x), disconnected phone (15x), no such person at given

number (9x), no phone (5x), could never reach at home (9x), no longer

certified for FPP (2x) and have not received food (2x).

22

23

The number of commodities allotted, the amount actually taken

and the number of participants enrolled in the program during the month

of October are described in Appendix C, Tables 1 and 2.

Family Characteristics

The demographic characteristics of the 48 respondents are

shown in Table 1. The mean age of the sample was 29 years, with a

range of 19 to 46 years. FPPE and FPPNE did not vary significantly

from each other. The mean age of FPPE was 28 years while FPPNE was 31

years. Forty—six (86%) of the sample were black, one was Mexican-

American and one Oriental. The FPPE group was all black.

The number of children per family ranged from one to ten with

a mean of four. The age range of the children was between one week and

26 years. Three of the respondents interviewed were pregnant. There

was no significant difference between FPPE and FPPNE in the number of

children per household.

Eight clinics certified the sample interviewed. Most (62%)

were certified at the Grace Ross Clinic. The other clinics in des-

cending order of use were: Comprehensive Health Services of Detroit

(14%), Franklin (6%), Gloria Bingham, Herman Kiefer, and Childrens

Hospital (4% each), and Bruce Douglas and Gratiot (2% each). There was

no significant difference between the certification clinic used by the

two groups.

Food Stamps were used by 71 percent of the sample. There was

a significant (p g .01) difference between the two groups in the use

of Food Stamps. All of FPPE families used Food Stamps as compared to

53 percent of FPPNE families.

DEMOGRAPHIC CHARACTERISTICS OF ALL THE RESPONDENTS

THOSE ON ENFP (FPPE) AND THOSE ONLY ON THE

FPP (FPPNE)

24

Table 1

DEMOGRAPHIC TOTAL FPPE FPPNE

CHARACTERISTICS (N = 48) (N = 18) (N = 30)

AGE,(YEARS) .% E. .%

Under 25 15 15 15

26-30 45 49 40

31-35 17 10 25

36-40 17 15 17

41 and older 6 ll 3

11s. 11s. 11s.-

Range 19-46 20-42 19-46

Mean 29 28 31

RACE 2 24; 2

Black 96 100 94

Mexican-American 2 0 3

Oriental 2 O 3

NUMBER OF CHILDREN %_ .1 %_

1-2 15 28 4

3-4 50 45 53

5-6 18 17 20

7 and over 17 10 34

Mean 4 4 4

25

Table 1 (continued)

DEMOGRAPHIC TOTAL FPPE FPPNE

CHARACTERISTICS (N = 48) (N = 18) (N = 30)

AGE OF CHILDREN (YEARS) % of Total % of Total % of Total

No. Children No. Children No. Children

Over 18 19 17 20

15-17 19 22 16

12-14 25 27 23

10-11 27 27 43

8-9 50 55 47

6-7 44 27 53

5 37 27 43

4 25 27 23

3 31 11 * 43

2 21 27 16

l 15 l7 13

Less than 1 year 33 27 37

Range 1 week-26 1 week-23 1 month-26

CERTIFICATION CLINIC .E %_ %.

Grace Ross 62 56 66

Franklin 6 5 6

CNS-Detroit 14 17 13

Bruce Douglas 2 O 3

Gratiot 2 O 3

Gloria Bingham 4 5 3

Herman Kiefer 3 5 3

Childrens Hospital 4 11 O

FOOD STAMPS %_ %_ %_

Yes 71 100 ** 53

No 29 O 47

LENGTH OF TIME ON FPP (YEARS) %_ %_ %_

Less than 1 44 50 40

l k - 2 36 45 30

3 - 4g 20 5 30

Range 6-54 6-42 6-54

Mean 20 16 24

Table 1 (continued)

26

DEMOGRAPHIC TOTAL FPPE FPPNE

CHARACTERISTICS (N = 48) (N = 18)» (N = 30)

LENGTH OF TIME ON ENFP

(MONTHS)24;

7-12 33

13 and over 67

Months

Range 7-29

Mean 15

Significant at p

**

Significant at p

(A

5..05

.01

27

The average length of time on the Focus: HOPE FPP was one

year eight months, with a range of six to 54 months. The FPPNE

group averaged about a half a year longer on the program with a mean

of two years as compared to one year four months for FPPE. However,

the difference between the groups was not significant. The average

length of time on ENFP was fifteen months, with a range of six months

to two years five months.

Usual Meal Patterns

No typical pattern of foods consumed was apparent based on a

usual meal pattern recall. Foods consumed by 20 percent or more by the

total sample, FPPE and FPPNE groups are listed in Appendix 0, Table 1.

In the total sample, foods consumed for breakfast were eggs (62%),

toast (56%), bacon (48%), cereal (37%), milk (25%), sausage (23%), and

juice (21%). Other breakfast foods in descending order of use were:

grits, coffee, oatmeal, pancakes, farina, grapefruit juice, orange

juice, hot cereal, peanut butter, cocoa, ham, a sandwich, meat, rice,

potato, biscuits and applesauce. Foods consumed for lunch were:

sandwich (67%), soup and milk (23% each). Other foods in descending

order or use were: meat, fruit juice, vegetables, cookie, hamburger,

hot dog, lunch meat, salad, french fries, cake, potato, bread, drink,

tea, bacon, beef stew, peanut butter, and chicken. Foods consumed for

dinner were: meat (58%), vegetables (54%), potato (29%), salad (23%)

and rice (21%). Other foods eaten for dinner in descending order of

use were chicken, beans, mashed potatoes, corn bread, bread, milk, corn,

stew, dessert, juice, macaroni and cheese, peas, pork chops, steak,

28

jello, cabbage, rolls, sandwich, croquette, leg bones, broccoli,

sweet potato, soup, kool aid, drink, pie, turkey and dressing and

biscuits. Foods consumed for snacks were cookies (44%); others in

descending order of use were milk, fruit, cake, sandwich, ice cream,

peanut butter sandwich, potato chips, candy, apple, orange, raisins,

pie, cheese and crackers, donuts, baked goods, vegetables, popcorn,

salad, jello, plums, rice pudding, cereal and juice. There was no

significant difference between the two groups in foods eaten.

Extent Gatekeeper understands purpose of Focus: HOPE FPP

Only 56 percent of the respondents reported knowing why Focus:

HOPE commodities were given to pregnant and nursing women, infants and

children up to six years. A greater but not a significantly different

percentage of FPPNE (67%) indicated knowing the purpose of the FPP as

compared to FPPE (39%). When asked for the reason why commodities

were given, 39 percent reported to supplement budget or income. Other

reasons in descending order of frequency were providing a balanced

meal, providing nourishing food, for proper nutrition, for growing

bones, protecting children from deficiencies, for vitamins and iron,

for children to get a good start and for brain food. When asked how

the food program most helped them 44 percent of the respondents re-

ported helping increasing their food budget. Other answers were

Ihaving food, having meat, buying less, not needing to buy essentials

like milk and farina, cutting food bill, giving proper food, pro-

viding variety, providing filling food, providing more meals, pro-

viding more vegetables and liking the food.

29

Commodities refused to eat

Thirty-five percent of the children refused to eat one or more

of the commodities. A greater but not significantly different per-

centage (44%) of the FPPE children than FPPNE children (27%) refused

to eat the food. The commodities most disliked by children were dried

eggs, farina, potatoes, vegetables, milk, chicken, fruit juice and

peanut butter. The dislike was mainly due to taste or texture of the

food.

Forty-seven percent of the respondents on the program

would not eat all of the foods given. The commodities disliked most by

those women were farina, canned plums, peanut butter, vegetables, dried

milk, dried eggs, chicken, and instant potatoes. The respondents'

reasons for not liking the foods were the same as the childrens'

reasons. There was little variation between FPPE (50%) and FPPNE (47%)

in the percent of respondents refusing to eat one or more conmodities.

Commodities most disliked

Forty-eight percent of the respondents did not like one or

more of the commodities. Foods the respondents would most like to see

removed from the program were plums, fruit juice, instant potatoes,

peanut butter, dried eggs, chicken, farina, evaporated milk and dried

milk. Most respondents stated the taste or texture was the reason

they did not like the commodity.

New commodity desired

Twenty-nine percent of the respondents would like cheese

added to the list. Other foods asked for were another kind of juice,

meat, vegetable, milk or hot cereal, butter, sugar, rice, bread, pork,

bacon, cooking oil, flour, cocoa and dried beans.

30

Gatekeepers' knowledge of importance of an adequate diet

The majority (83%) of the women reported that they were con-

cerned about what they ate normally. Ninety-four percent of the FPPE

group reported concern as compared to 77 percent of the FPPNE group.

When asked why, the reasons given in deScending order of importance

were losing weight (21%), eating balanced meals (17%), eating vege-

tables (12%) and maintaining health (12%). Other reasons given by

less than ten percent were providing proper nutrition, eating foods

liked, regulating blood pressure, getting enough iron, preventing

anemia, eating proper foods, eating fewer fried foods and sweets and

eating good breakfasts. No significant difference was noted between

the two groups.

Change in food habits while pregggnt

Sixty-seven percent of the women interviewed reported chang-

ing the way they ate while pregnant. A variety of changes were re-

ported: 15 percent of the total sample indicated their diet changed

by increasing vegetables, milk, or fruit; 12 percent reported increase

in meat: ten percent changed behavior because of craving or weight.

Other changes included: increasing leafy vegetables, juice, vitamins,

or protein; decreasing salt, sweets, greasy food, highly seasoned food.

junk food or starchy food; eating a balanced meal: eating breakfast;

eating foods good for the baby.

Thirty-five percent of the total sample indicated that a

pregnant woman should eat for two. A larger but not significantly

larger percentage (44%) of the FPPE group reported eating for two

than FPPNE (30%).

31

Twenty-three percent of the total sample reported having a

craving for Argo corn starch during one of their pregnancies. More of

the FPPNE (27%) reported having a craving than FPPE (17%). The dif-

ference was not significant.

Foods important for child'sgrowth

The food group most often mentioned as being important for a

child's growth was vegetables (83%); the others were meat (81%), milk

(79%), bread (65%) and fruit (46%).

Nutritional adviceduring gregnancy

Only 27 percent of the total sample asked for advice during

pregnancy. Their major concern was weight (15%); other concerns were

food groups, blood, foods hurting baby, swelling feet. There was no

difference noted between the two groups. The majority of the re-

spondents reported receiving advice.

Less than half (45%) of the women reported obtaining advice

from a doctor. Twenty-seven percent reported obtaining advice from no

one. Other places from which information was obtained were clinic (8%),

nutritionist (6%), doctor and nutritionist, books and prenatal class

(4% each). No one reported getting advice from an ENFP aide. Advice

from these services was given on dieting (25%), food groups (19%),

lowering salt and increasing vitamins consumption (10% each). Less

than ten percent were advised on increasing iron, milk or protein;

A decreasing fried foods, hot foods, or fluids; and regulating blood

pressure.

Perceived nutritional quality of commodities

One section of the interview schedule focused on partici-

pant's ideas of the value of commodities. Specifically interviewees

32

were asked if commodities were good for pregnant and nursing women,

infants and young children. There were no significant differences be-

tween the two groups FPPE and FPPNE.

Canned meat. Canned meat was considered good by every

respondent. The reason most given fer meat being important to health

was it provides protein (42%). Other reasons were meat had vitamins

(15%), iron (12%), minerals, was just good, had calcium, energy, oil,

was free of bacteria, makes blood and fills basic need (all below 10%).

Ten percent did not provide a reason.

Canned fruithgice. Canned fruit juice also was considered

nutritionally good by the total group. The reasons most given were it

contained vitamins (40%), and vitamin C (29%). Other reasons were

fruit juice had nutrients, protein, was a basic food, was good for you,

had minerals, folic acid, was a laxative, was supposed to drink.

Seventeen percent did not know a reason.

Cannedgeggtables. Canned vegetables were reported good for

the intended group by 98 percent of the total group. The major

reasons were vegetables had vitamins (48%), iron (17%), or vitamins

and minerals (10%). Other reasons given were vegetables had protein,

nutrition, was important, was good for you, had vitamin A, had vitamin

C, built body, was supposed to have once or twice a day, was better

than fresh, had no additives and needed more.

Dried milk. Dried milk was reported good for women by 96 per-

cent. The major reasons were milk had vitamins (27%), calcium (19%),

was good for bones (19%), teeth (14%), and had vitamin 0(12%). Other

reasons stated were milk had iron, protein, vitamin A, built muscle,

33

had minerals, was fat free, was nutritious, helped eyesight, and had

vitamin C.

Dried milk was reported good for children by the total group.

The main reasons were milk was good for teeth (31%), bones (29%), had

calcium (25%) and vitamins. Other reasons given were milk had vitamin

A, protein, iron, minerals, was part of basic seven, had vitamin C,

helped in growing, was babies' first food and helped in the formative

years. Ten percent did not give a reason.

Dried eggs. Dried eggs were reported good by 96 percent.

Forty percent of the group reported dried eggs had protein as the

reason, 16 percent did not know the reason, 16 percent had stated

vitamins, 10 percent each stated had iron and similar to real eggs.

Other reasons given were eggs had calcium, cholesterol, vitamin A,

health, and similar to milk, or meat.

fggigg. Farina was reported good by 98 percent. The reasons

stated were farina was a morning food (37%), had vitamins (23%), iron

(21%), protein and starch (12% each). Other reasons given were

farina was a cereal, had minerals, was nutritious, makes one strong,

and was good for you.

Peanut butter. Peanut butter was reported good by 90 per-

cent. The reasons given were peanut butter had vitamins (21%), was

similar to meat (19%), nutritious (16%), had protein (15%), minerals

'(12%), and oil (10%). Other reasons given by less than 10% were

peanut butter had iron, was good for bones, was a laxative, provided

energy, had vitamin C, and keeps you healthy.

34

Dried potatoes. Dried potatoes were reported good by 98 per-

cent of the total sample. The main reasons given were dried potatoes

was a starch or cereal (33%), and had vitamins (19%). Other reasons

given were dried potatoes was a protein, mineral, was a part of basic

seven and provided calories. Twenty-five percent did not know a

reason.

Canned_plums. Canned plums were reported to be good for you

by 96 percent of total sample. The major reasons given were plums

was a fruit (44%), had vitamins (25%), and was a laxative (21%). Other

reasons given were plums had vitamin C, iron and minerals.

Food Preparation Skills of Gatekeeper

Food_preparation and shoppjgg.

Ninety-two percent of the respondents reported preparing their

own food. Other people who prepared the food were the grandmother (6%)

and sister (2%). Ninety-six percent of the respondents reported doing

their own shopping. Other people that would do shopping were the grand-

mother and sister (2% each). No significant difference was found be-

tween the two groups.

Training

Fifty-eight percent of the total sample received training in

Home Economics, 18 percent received no training. Others received

Atraining in either food preparation, nutrition or a combination. The

, majority of the training was received in high school (44%). Other

places were junior high school, cooking professionally, as a dietetic

aid, or a combination. Thirty-nine percent of the FPPE group stated

they had received training from an ENFP aide. Due to ENFP aide

35

training, there was a significant difference (p §_.05) between the

groups where training was received. Forty-one percent of the sample

had a year or less of training, 21 percent had between one and one-half

to two years, 21 percent had between two and one-half and six years of

training.

Approximately half (52%) of the sample learned what foods to

feed their family from their mother, 33 percent learned from school,

16 percent learned on their own at home, six percent each learned from

an ENFP aide, or clinic. Other respondents learned from: books,

pamphlets, brother, nutritionist, 4H club, Head Start or just knew.

Commodity use

Forty-eight percent had no help using commodities. For those

who did receive help, it came from an ENFP aide (19%), friend (15%),

sister, women in line at Focus: HOPE and nutritionist (4% each). Only

39 percent of the FPPE group received help from an ENFP aide.

Twenty-nine percent of the total sample reported having trouble

using the commodities. Commodities considered the most difficult to

use were farina, dried milk, dried eggs, chicken, peanut butter and

meat. These connodities were considered hard to use because of their

taste and texture. There was no significant difference between the

two groups.

Ninety percent of the total sample reported seeing recipes on

the packages of the commodities. However, only 58 percent reported try-

ing those recipes. The recipes most often tried were BBQ Beef (31%) and

peanut butter cookies (30%). Other recipes tried were regular instant

milk, chocolate milk, vanilla pudding, hot cereal, chicken salad and

buttermilk.

36

Sixty-three percent of the total sample reported receiving

recipes. Twenty-nine percent reported receiving recipes from an ENFP

aide and 20 percent from Focus: HOPE. Others received recipes from

the clinic, a friend, mother, and through the mail. There was a

significant difference (p 5_.05) between where the FPPE and FPPNE

groups received their recipes. Only 61 percent of the FPPE group re-

ported receiving recipes from an ENFP aide.

Kitchen equipment

Table 2 indicates the amount of equipment available in the

respondents' homes. The total group had refrigerators , 98 percent a

range, 96 percent a can opener, 67 percent an electric mixer, 44 per—

cent a blender, 25 percent an electric fry pan, 15 percent a toaster

oven, ten percent a freezer and eight percent a hot plate. The mean

number of pots was eight with a range from two to 35. The mean number

of fry pans was 3.6, with a range of one to eight. The mean number

of measuring cups was 2.3 with a range of zero to eight. Mean number

of measuring spoons sets was 1.2 with a range of zero to four. Fifteen

percent of the respondents had no measuring cups, 27 percent had no

measuring spoons.

Number of items_prepared with each commodity

Canned meats. The average number of items prepared from the

(canned meats (both beef and chicken) was 3.3, from beef alone 1.5 and

from chicken alone 1.8. The range of items made from both meats was

one to eight, beef alone zero to four and chicken alone zero to five.

There was no difference in the use of meats between the two groups.

Items prepared with the commodities are listed in Table 3. The

favorite items made from the beef were 880 beef (44%) and beef stew

Table 2

DESCRIPTION OF KITCHEN EQUIPMENT IN THE HOME

OF THE TOTAL SAMPLE, THOSE ON ENFP (FPPE) AND

THOSE ONLY ON THE FPP (FPPNE)

KITCHEN TOTAL FPPE FPPNE

EQUIPMENT ((N = 48) (N = 18) (N = 30)

APPLIANCES %_ _%_ 1

Refrigerator -

1 door 23 28 20

Refrigerator -

2 door 77 72 80

Freezer 10 11 10

Range 98 100 97

Hot plate 8 5 10

Electric fry pan 25 17 30

Not operating 2 5 O

Blender 44 44 43

Not operating 2 O 3

Electric mixer 67 5O 77

Not operating 4 5 3

Toaster oven 15 5 20

Not operating 4 O 7

Can opener 96 90 100

Not operating 2 5 O

POTS %_ g 5

Five or

less 28 47 37

more 62 53 63

22;. £24. 22;.

Mean 2-35 2-10 3-35

Range 8 5 9.1

FRY PANS %_ g ;%_

.1'2 19 28 13

3-4 60 61 6O

5 and more 21 ll 27

no. no. no.

Range 138' 1:6' 138'

Mean 3.6 3.3 4.0

38

Table 2 (continued)

KITCHEN TO L FPPE FPPNE

EQUIPMENT (N = 48) (N = 18) (N = 30)

MEASURING CUPS 1 Z %_

O 15 17 33

1-2 48 28 60

3 and more 37 55 27

no. no. no.

Range "078' OTB 5:6

Mean 2.3 2.8 2.0

MEASURING SPOONS

24. 24. a

0 27 17 33

l and more 73 83 67

no. no. no.

Range 6:4’ 'O:4 IO:2

Mean 1.2 1.3 .7

PERCENT OF FAMILIES PREPARING SPECIFIC DISHES

WITH EACH COMMODITY FOR THE TOTAL SAMPLE,

THOSE ON ENFP (FPPE) AND THOSE ONLY ON THE FPP (FPPNE)

39

Table 3

COMMODITY TOTAL FPPE FPPNE

g: a aCanned Meat

BBQ Beef 44 50 40

Beef Stew 4O 50 33

Chicken Salad 54 67 47

Fruit Juice

Drink 100 100 100

Vegetable

Plain 56 50 6O

Soup 30 39 13

Bean 8 Potato 25 33 20

Dried Milk

Made with water 37 33 40

Made half with

homogenized milk 37 33 40

Chocolate 34 45 13

Bread 29 39 23

In cooking 44 44 43

Dried Egg Mix

Scrambled 52 56 50

Corn Bread 58 50 63

Cakes 42 44 40

Farina '

Hot Cereal 94 89 97

Corn Bread 40 56 3O

Peanut Butter

Sandwich 96 89 100

Cookies 81 83 80

On Crackers 33 33 33

Potatoes

Mashed 100 100 100

Plums

Plain 83 83 83

*Significant at p 5_.Ol.

4O

(40%). Other items in descending order of importance were beef with

gravy, hash, sloppy joes, beef with tomato sauce, beef pie, pepper

steak, spaghetti, beef With vegetables, chili and cream chip beef.

Items made from chicken were chicken salad (54%), casserole, soup,

with dressing, pattie, with rice or noodles, with dumplings, pie, a la

king, fried, hash and loaf.

Canned fruit‘juice. Items prepared with the fruit juice

ranged from one to three with a mean of 1.3. Every respondent reported

using the juice to drink. Other uses for the juice were punch, kool

aid, jello and tea. There was no significant difference found between

the two groups and the use of the juice.

Canned vegetables. Use of the vegetables ranged from one to

six items with a mean of 2.6. The majority of the vegetables were

prepared plain (56%), in soup (30%) and with beans and potatoes (25%).

Other ways the vegetables were prepared (below 10%) in descending order

of importance were in stews, as fried corn, with white sauce, in pie,

with tuna, in a bean or pea salad, with meat or salt pork. No dif-

ference was found between the two groups and the use of vegetables.

Dried milk. Use of the dried milk ranged from one to seven

items with a mean of 3.5. The majority of the respondents used the

milk in cooking (44%). When used as a beverage: 37 percent mixed the

powder dried milk with just water, 37 percent mixed equal portions of

7 powder dried milk with homogenized fluid milk and 34 percent made

chocolate milk. Dried milk also was used in: corn bread (29%), in

cakes, cereal, pudding, ice cream, macaroni and cheese, cream potato.

cream sauce, salad dressing, milk shakes, coffee, eggs and grits.

There was a significant difference (p §_.Ol) found between the two

groups and the use of dried milk.

41

Dried egg. Use of dried eggs ranged from one to six items

with a mean of 2.8. The majority of the respondents used the dried

eggs in: corn bread (58%), scrambled eggs (52%), baking cakes (42%).

Other uses for the dried eggs were mixed in: fresh eggs, baking

breads, cooking, puddings, macaroni and cheese, pies, pancakes, custard,

meat' loaf, french toast and cookies. There was no difference found

between the two groups and the use of dried eggs.

[25151. Use of farina ranged from one to four items with a

mean of 1.7. Hot cereal (94%) and corn bread (40%) were the two most

used preparation methods. Other items made were muffins, fried cakes,

meat loaf, pizza, cake, peanut butter cookies and cupcakes. There was

a significant difference (p 5_.Ol) in the use of farina and the two

groups.

Peanut butter. Use of peanut butter ranged from one to five

items with a mean of 2.5. Almost all of the respondents used the pea-

nut butter in sandwiches (96%) or cookies (81%). Other uses were on

crackers, in cakes, plain, on fruit, on toast, on pancakes, on ice

cream, as candy, on celery and in cupcakes. No significant difference

was noted between the two groups.

Instant Potatoes. Use of potatoes ranged from one to three

items with a mean of 1.4. Everyone used the potatoes as mashed. Other

methods of preparation were in patties, as shepard pie, with cheese,

vwith beans, on salad, in rolls and in soup. No significant difference

was noted between the two groups.

Cannedplums. Use of plums ranged from zero to three items

with a mean of 1.2. Most of the respondents ate the plums plain (83%).

42

Other uses for the plums were: mixed with fruit, in cobbler, in

pudding, in cake, as a pie, with yogurt or dream whip. No significant

difference was noted.

Evaporated milk. Use of evaporated milk ranged from one to

six items with a mean of 2.6. The major use was in cooking (65%),

coffee and drinking (33% each). Other ways were mixed with dried milk,

in cereal, in cake making, in macaroni and cheese, in pudding, in

mashed potatoes, as ice cream, in breads, in corn bread, in pie, in

cocoa, in pancakes, in milk shakes and in sauces. No significant dif-

ference was noted.

Commodity Use in Family Meal Patterns

Focus: HOPE commodities are intended to be used by only those

who are eligible for the FPP. The use of commodities during meals were

studied from three different questions. All respondents indicated the

commodities were used by every family member. Tables 4 and 5 indicate

which family members eat at each meal. There is a significant (P §_.05)

difference between the number of males in FPPE and FPPNE groups eating

dinner and children under six eating breakfast.

Tables 6, 7 and 8 show the distribution of commodities with

each meal.

Problem Solving_

The data obtained from the five problem solving questions had

no definable answer. The information obtained from the questions were

used in the same manner as subjective field notes.

43

Table 4

PERCENT OF MALE AND FEMALE FAMILY MEMBERS EATING

BREAKFAST. LUNCH AND DINNER IN THE HOME FOR THE

TOTAL GROUP, THOSE ON ENFP (FPPE) AND THOSE ONLY ON THE FPP (FPPNE)

MEAL MAKE FEMALE

TOTAL FPPE FPPNE TOTAL FPPE FPPNE

(N=48) (N=18) (N=30) (N=48) (N=18) (N=3Q)

2‘: 1 2‘: 2‘: LE 24.

Breakfast 17 5 23 67 61 70

Lunch 8 O 13 77 61 87

Dinner 25 O * 4O 96 89 100

*

significant at P :_.O5

Table 5

PERCENT OF CHILDREN EATING BREAKFAST, LUNCH AND DINNER

IN THE HOME FOR THE TOTAL SAMPLE, THOSE ON

ENFP (FPP) AND THOSE ONLY ON THE FPP (FPPNE)

MEAL CHILDREN 2.6 CHILDREN < 6

TOTAL FPPE FPPNE TOTAL FPPE FPPNE

(N=48) (N‘IBIIN=3QI: (N348) (N=18) ,(N=30)

1 1 z. 2‘: a 3

Breakfast 94 89 97 96 44 * 93

' Lunch 27 28 27 83 94 87

Dinner 96 94 97 96 100 93

*significant at P _<_ .05

44

Table 6

PERCENT OF FAMILIES FOR THE TOTAL GROUP,

THOSE ON ENFP (FPPE) AND THOSE ONLY ON THE

FPP (FPPNE) USING EACH COMMODITY TO PREPARE BREAKFAST

COMMODITIES TOTAL FPPE FPPNE

(N = 48) (N = 18) (N = 30)

1 Z Z:

Canned meat 0 O O

Canned fruit juice 65 55 7O

Canned vegetables 0 O 0

Dried milk 77 67 83

Dried egg mix 62 67 6O

Farina 92 89 93

Peanut butter 2 O 3

Instant potatoes 0

Canned plums 2 5 O

Evaporated milk 52 55 50

Corn syrup 0 O O

45

Table 7

PERCENT OF FAMILIES FOR THE TOTAL GROUP,

‘THOSE ON ENFP (FPPE) AND THOSE ONLY ON THE

FPP (FPPNE) USING EACH COMMODITY TO PREPARE LUNCH

COMMODITIES TOTAL FPPE FPPNE

(NT48) (111481 (N7; 301

Canned meat 40 44 37

Canned fruit juice 25 22 27

Canned vegetables 25 22 27

Dried milk 50 33 6O

Dried egg mix 8 0 13

Farina 2 O 3

Peanut butter 52 5O 53

Instant potatoes 14 O 20

Canned plums, 19 0 3O

Evaporated milk 30 22 23

Corn syrup 0 O O

46

Table 8

PERCENT OF FAMILIES FOR THE TOTAL GROUP,

THOSE ON ENFP (FPPE) AND THOSE ONLY ON THE

FPP (FPPNE) USING EACH COMMODITY TO PREPARE DINNER

COMMODITIES TOTAL FPPE FPPNE

(N = 48) ,(N = 18) (N = 30)

E Z 25.

Canned meat 100 100 100

Canned fruit juice 23 39 13

Canned vegetables 98 95 100

Dried milk 58 61 57

Dried egg mix 14 11 17

Farina O O 0

Peanut butter 4 5 3

Instant potatoes 79 78 80

Canned plums 25 33 20

Evaporated milk 35 39 33

Corn syrup 0 O O

DISCUSSION

The following discussion will focus on the five principal

aspects of the study: family characteristics; the gatekeeper's know-

ledge of the purpose of prescription commodity foods; the gatekeeper's

knowledge of the importance of an adequate diet for pregnant and

nursing women, infants and young children; the gatekeeper's food pre-

paration skills as they relate to prescription commodity foods and

the use of prescription commodity foods in family meal patterns. The

discussion section will include a description of the total sample,

participants on both the Focus: HOPE Food Prescription Program (FPP)

and the Expanded Nutrition and Family Program (ENFP) and those

participants only on Focus: HOPE FPP and not on ENFP.

Family Characteristics

The 48 respondents in this study ranged in age from 19 to 46

years, with the mean age of 29 years. Three of the respondents were

pregnant. The method of sampling included only families with members

not eligible for the FPP. This sampling procedure excluded single

pregnant women living alone, and single mothers with only children

under 6 years. None of the families in the sample were childless.

The average age of respondents and the number of children in the family

were similar to those of homemakers surveyed in a nationwide study (19)

of the Expanded Family and Nutrition Education Program (EFNEP).

47

48

ngg, All but two of the respondents interviewed were black.

This sample had a higher percentage of black participants than re-

ported in the U.S. Department of Agriculture study (51) on the com-

parison of EFNEP families on food assistance programs. However,

respondents in this study resided within approximately a two mile

radius of the Oakman Boulevard warehouse of FPP (Appendix E, Figure l)

in a largely black section of Detroit. The sample was selected from

Focus: HOPE participants certified by eight clinics, all of which

principally served black clientele. The respondents were considered

by the researcher to be representative of the Focus: HOPE clientele.

Bendick and coworkers (32) studied efficiency and effectiveness in

the WIC Delivery system; black participants comprised only 40 percent

of their sample. However, 21 percent of the clinics surveyed by

Bendick and coworkers (32) did not serve any black clientele.

Food Stamps. All of the families on ENFP and the Focus:

HOPE FPP (FPPE) were also recipients of food stamps. This was

significantly different (p 5 .01) from those families only on the

Focus: HOPE FPP (FPPNE). Since clinics certifying for the FPP pro-

vide health care to low-income families, most families using these

clinics would be eligible for Food Stamp benefits. Therefore, there

is probably no difference in eligibility for the Fbod Stamp program

, between FPPE and FPPNE. Sixty-six percent of those participants on

ENFP were certified for FPP shortly after an ENFP aide started visit-

ing. A major objective of EFNEP nationally as stated by Frye (24)

is to increase the use of food stamps and other food assistance pro-

grams. This study provided evidence that ENFP aides do encourage

49

families to enroll in food programs and the aides have been success-

ful.

Length of Participation in Programs. The mean length of time

of all sampled families on Focus: HOPE FPP was 20 months. For the

FPPE group, the average length of time on ENFP was 15 months. Since

66 percent of the FPPE families were certified for the FPP after

starting ENFP, they have been on the program for a shorter time than

FPPNE families. Therefore, FPPE respondents may not have had as much

experience in using the commodities as FPPNE. The FPPE group's shorter

length of participation on the FPP may account for the lack of a

significant difference between the two groups in food preparation

skills and nutrition knowledge of commodities.

Usual Meal Pattern

Most respondents ate three meals a day. The foods commonly

eaten for breakfast were eggs, toast and bacon; for lunch a sandwich;

for dinner meats and vegetables and for a snack, cookies. In general

the foods eaten at meals followed a traditional pattern; few snack

foods were reported as part of meals. In describing the foods normally

eaten for meals, most of the sample mentioned the use of foods from

each of the four basic food groups.

Commodities in meals. Focus: HOPE commodities except for

milk and juice did not seem to be a main part of the meal pattern.

Milk is received by participants in two forms, evaporated and dried,

in quantities usually enough to last the entire month. A typical

family with one child under and one over three years of age would

receive approximately 75 quarts of milk a month, which is equivalent

50

to 2.5 quarts a day. This seems to make a significant addition of

milk to the diet. Juice is considered important for health by

participants and is provided by the program in moderate amounts (three

46 ounce cans per client per month). The majority of the other

commodities usually were received in smaller quantities and merely

supplemented the monthly food supply.

Nutrient contribution. Focus: HOPE commodities did appear to

provide an increased amount of available nutrients to the diet. For

example, a family of five with two children (one under and one over

three years) on the program would receive a total of 1262 mg. of iron

a month in the 11 FPP commodities. Each family member could obtain

eight mg. of iron per day from this supplemental food, if the 11

commodities were divided equally. This study has shown that the com-

modities are eaten by all family members. If so, the one to three

year old and three to six year old child would receive approximately

50 percent and 80 percent of their respective RDA's for iron from the

commodities.

Effect on food bugget. The dollar value that the commodities

contributed to the food budget was difficult to document. If com-

modities were not a part of the food budget,participants because of

the cost might not drink as much milk. The interview schedule was not

constructed to be sensitive in detecting how much the FPP commodities

added to the food budget.

Extent Gatekeeper Understands Purpose of Focus: HOPE FPP

The use of commodities in the hoUsehold may be affected by the

participants' perception of why they are receiving supplemental food.

51

Fifty six percent of the respondents in this study reported knowing

why they were given Focus: HOPE commodities. However, only 15 per-

cent could provide an accurate reason for the purpose of prescription

commodity foods.

Most of the other respondents reported income supplementation

as the reason for obtaining the food. Without understanding the primary

reason for the program, participants used the commodities to feed the

entire family. Rada stated (18) that in the past, the main purpose of

food assistance programs was to supplement the budget of low-income

people. The perception of why participants are getting the food has

not seemed to have changed even though each participant of the FPP must

be certified as eligible by a participating health clinic or a private

physician. The intent of food distribution programs is to raise the

nutritional status and ultimately to improve the health of recipients

(32). To accomplish these goals people must have a full understanding

of the purpose of the program.

A plan has been proposed to have the participants of the

Special Supplemental Food Program for Women, Infants and children '

sign an affidavit stating supplemental foods will only be given to the

intended group. Implementation of this plan would probably not affect

supplemental food distribution in the family as the purpose of the

program was not understood by Focus: HOPE participants.

Commodities disliked. A concern of the U.S. Senate panel on

Nutrition and Special groups (64) is that the food must meet the needs

of the people. Certain commodities provided by the FPP were disliked

by this sample. Some children refused to eat prepared dried eggs

52

because they disliked the taste and texture. Pontzer and Dodds (55)

also found that several commodities, including dried eggs, were dis-

liked. Reasons other commodities were disliked included the chicken

was stringy, peanut butter was dry, farina was coarse, vegetables

were tough or soft and grapefruit juice was too tart. More FPPE than

FPPNE children refused to eat the commodities, however, the difference

was not statistically significant. This difference in acceptance may

be a function of length of time exposure to commodities. The FPPE

group had been receiving commodities for a shorter time.

In this study, the women did not like the taste of farina, so

most used it as a breakfast cereal for only the children. It was un-

fortunate that the women did not eat farina as it is an excellent

source of iron. The farina contained approximately one-half of the

iron in the month's supplemental food package intended for consump-

tion by the mother.

At least 98 percent of all commodities allotted in October, 1976,

except dried eggs, were picked up from the warehouse. However, of the

egg mix allotted, only eight percent was not taken despite the fact

that for five days it was not available. Respondents did not report

sale or discard of dried eggs or other disliked commodities. Parti-

cipants whose children did not like the dried egg mix and other dis-

liked commodities used them in cooking or baking, where the taste was

’ not detected. This indicates efforts made by the respondents to use

commodities in preparations acceptable to themselves and their children.

Changes desired. When asked to pick one commodity that

participants did not wish to receive, plums were most often chosen due

53

to their unfamiliarity with and the sweetness of the product. This is

unfortunate because the fruit is a good source of vitamin A and iron.

Cheese would be preferred as a substitute commodity. The addi-

tion of cheese to the diet would provide an extra source of protein,

calcium and vitamin A. Women felt it was difficult to use all of the

milk provided, therefore the replacement of some milk with cheese would

maintain nutrients provided while adding variety to commodities

received.

Gatekegper's Knowledge of the Importance of an Adeqpate Diet

Most (83%) of the sample expressed concern about their diet be-

fore and during pregnancy. Their two main concerns focused around

weight and a desire to increase consumption of foods from the four

food groups. Fox and coworkers (47) found homemakers rely on lay

sources, mainly magazines and newspapers, for nutrition information.

Nutrition knowledge provided in magazines is usually related to diet-

ing and weight. The source of nutrition information may influence

dietary concerns. Verma and Jones (28) reported that the greatest

change in the diets of EFNEP families was the increased intake of

foods in the basic four food groups. The interest expressed by

respondents in increasing the frequency of basic four foods in the

diet may be related to both ENFP aide visits and to prenatal clinic

visits, where the basic four groups also is emphasized. The reason

offered for change in diet during pregnancy rarely was related to

the needs of the unborn infant.

Nutrition education in pregnancy. Women during pregnancy

seem to be concerned about what they eat. Bowering and coworkers

54

(30) showed that ENFP aides in a prenatal clinic were more effective

in changing behavior than aides making home visits. Nutrition educa-

tion during pregnancy may be more effective than at other times of

life.

Perceived nutritional quality of commodities. Respondents

were asked if commodities were good for the intended group and if so

why. Most (90% or more) reported that each commodity was good for

health. However when asked for a specific reason why each commodity

was good less than 40 percent could name a major nutrient in the

food. The highest number of correct answers were given for canned

meat, fruit juice, vegetables, dried eggs and milk. The widest

variety of incorrect reasons for why commodities are good were given

for dried potatoes, canned plums, farina and peanut butter. Dried

potatoes, canned plums and farina were the most unfamiliar commodities.

Few respondents could name a major nutrient in farina; most felt it

was good because it was a breakfast food. This may account for the

inability of respondents to prepare farina in other ways besides as a

hot breakfast cereal.

Respondents appeared to recognize nutrient names but in many

cases did not know foods which were good sources of each nutrient.

When the probe card was used respondents often answered with the

nutrient most familiar to them. Extra emphasis should be made to

teach participants both knowledge about and use of those commodities

which were unfamiliar.

Effectiveness of ENFP. According to Verma and Jones (28),

EFNEP is most effective in making dietary changes within the first

55

year of participation. Longer participation than this initial year

has not been demonstrated to produce significant change in dietary

habits (29). Most of the FPPE group had the optimum exposure to the

nutrition information provided by ENFP aides since they had partic-

ipated longer than one year.

There was no difference between the FPPE group and the FPPNE

group in nutrition knowledge. From the data collected it does not

appear that participation in ENFP made an impact on the respondents'

technical nutrition knowledge since there was no significant difference

between FPPE and FPPNE. However, this appraisal may not be fair since

the level of knowledge ENFP families had before participating in the

program was not tested. Additionally, although the sample is not dif-

ferent based on family characteristics the groups may differ in vari-

ables not studied such as income. The FPPE group may have had a lower

income than the FPPNE group. Other socioeconomic factors also may have

contributed to differences in nutrition knowledge before participation

in ENFP.

The FPPE group did report receiving more recipes than the

FPPNE group. The majority of recipes were received from ENFP aides,

indicating an impact by aides on homemakers' use of commodities.

Problem solvipguguestions. Answers to the five problem

questions did not provide additional information concerning nutrition

knowledge of the respondents. A more intense probing might have

solicited answers which could indicate respondents' nutrition know-

ledge. The use of problem solving questions is an interesting approach

to studying nutrition knowledge but requires further refinement in

order to provide useful data.

56

Food Preparation Skills of Gatekeeper

Most respondents reported doing their own shopping and food

preparation. They are responsible for food eaten in the home so they

are the family member for whom nutrition education is most important.

Over one-half the respondents reported that they learned what

foods to feed their families from their mother. A possible nutrition

education program directed at the grandmother with special emphasis on

children may be a means of increasing the mother's nutrition knowledge.

Only six percent mentioned an ENFP aide as a primary source of informa-

tion on feeding the family. Cosper and Wakefield (48) also found that

friends and relatives were the main influence on homemakers' food choices.

Homemakers do not recognize the importance of the ENFP aides as teachers.

To be effective the ENFP aides must be perceived as a reliable informa-

tion source.

Help Using Commodities. Fifty-two percent of respondents re-

ported receiving help in using Focus: HOPE commodities. Only 39 per-

cent of the FPPE group reported receiving help from an ENFP aide. How-

ever, a greater percentage of respondents reported receiving recipes

and approximately 60 percent of FPPE received recipes from an ENFP

aide. The FPPE group made chocolate milk from dried milk and cornbread

from farina significantly more than the FPPNE group (p 5_.Ol). These

are recipes that are available to ENFP aides for distribution.

Difficulty in Using Commodities. Respondents in this sample

stated that the most difficult commodity to use was farina. They were

unsure of how to serve it other than as a breakfast food and they dis-

liked the taste. Respondents found most commodities difficult to pre-

pare in a way that tasted good.

57

Lack of kitchen equipment did not seem to be a problem with

the majority of the sample. Most of the sample had the necessary equip-

ment to prepare foods. On the whole, commodities were reported dif-

ficult to use because they were unfamiliar products. Many women desired

more recipes for using the foods. Provision of recipes, then, may be

an effective method of promoting better use of the commodities. Age

of the respondent and number of children in the family did not seem to

affect commodity use. Women who liked to cook in general made better

use of foods.

Commodity Use in FamilyIMeal Pattern

Commodities were utilized in meals at which all family members

ate. When directly asked how many in the house ate the commodities,

all the respondents stated either "everyone" or gave the exact number

of people living in the home. Bendick and coworkers (32) reported

similar results; 81 percent of WIC families studied used the food for

the entire family.

A significantly (p :3.05) greater number of adult males ate

dinner at home in the FPPNE than in the FPPE group. The FPPNE group

reported a greater number of males living in the home. This may

account for the difference. More children under six years of age ate

breakfast at home in the FPPNE than in the FPPE group (p 5_.O5).

Participation in school breakfast programs, which was not ascertained,

may account for the difference.

Proper use of commodities depends upon both the knowledge of

why the food is given and practical skills in food preparation. More

than 90 percent of the respondents reported that commodities were

58

good for health but specific nutrients in the commodities which were

good for health were rarely known. These findings are similar to

those of Emmons and Hayes (46) which documented that mothers had better

practical use of food than theoretical knowledge. In utilizing com-

modity foods, practical knowledge of food is more important than

technical nutrition knowledge. However, the main purpose of the pro-

gram must be understood in order for the food to be distributed to

appropriate individuals in the family who are "at risk". The re-

spondents in this study had adequate practical knowledge of commodity

use but did not understand the main purpose of the program, thus

participants used the food to feed the entire family.

SUMMARY AND IMPLICATIONS

Summary

Forty-eight participants of the Focus: HOPE Food Prescription

Program (FPP), a federally funded program providing 11 USDA commodities

to high risk pregnant and nursing women, infants and young children,

were interviewed in fall, 1976. Nutrition education is not a part of

the Focus: HOPE FPP. However, the Expanded Nutrition and Family Pro-

gram (ENFP) does provide nutrition education to many Focus: HOPE FPP

participants.

The purpose of the study was to determine: the gatekeeper's

understanding of the need for prescription commodity foods; the gate-

keeper's recognition of the importance of a nutritionally adequate diet

for pregnant and nursing women, infants and young children; the gate-

keeper's food preparation skills in the utilization of prescription

commodity foods and the use of prescription commodities in the entire

family's food behavior. Total sample data were analyzed. Two subsets

of the Focus: HOPE families, one group participating in ENFP (FPPE)

and the second not enrolled in ENFP (FPPNE), were compared.

The two groups, FPPE and FPPNE,did not differ significantly

in age, number of children per family and the clinic used for certi-

fication. More of the FPPE group (p 5_.Ol) participated in the Food

Stamp program than FPPNE.

59

60

The use of commodities by participants may be affected by

their perception of why they are receiving the supplemental food.

Only 15 percent of the respondents could provide an accurate reason

for the purpose of supplemental commodity foods; most felt the pro-

gram was intended as an income supplement. The respondents in this

sample reported feeding the commodities to the entire family. Par-

ticipants' lack of understanding of the program's intent may con-

tribute to the use of commodities by all family members.

Most respondents reported a concern about their diet before

and during pregnancy. Their interest focused on weight and the desire

to increase consumption of a specific food from the basic four food

groups. Respondents' interest in increasing the frequency of the

basic four foods groups in their diet may relate to the emphasis

placed on the basic four groups by both ENFP aides and the prenatal

clinics.

FPP participants' knowledge of nutrition did not vary signif-

icantly between FPPE and FPPNE. While many respondents did not know

specific nutrients, they had a general concept of the relationship of

food to health. Dried potatoes, farina and canned plums were un-

familiar commodities to respondents and also had the widest variety

of incorrect reasons given for why commodities are good for health.

In nutrition education an extra emphasis on nutrients should be made

on these unfamiliar commodities.

Certain commodities, mainly farina and dried eggs, were re-

ported as difficult to use by participants. However, respondents

still took their allotted amounts and found ways to feed the commodity

61

to their family. The use of the commodities by the two groups was

not significantly different, except for the greater use of two recipes

by the FPPE group (p 5_.01). These recipes for chocolate milk and

farina cornbread were available to the ENFP aides.

This study indicated that commodities were eaten by all family

members. Proper use of commodities depends upon the knowledge of why

the foods were given and the practical skills in food preparation of

participant. The purpose of the program must be understood so that

the food is distributed to appropriate "high risk" individuals.

62

Implications

Limitations of the Research and Needs for Future Research

1. Only trends can be described due to the small number of

participants interviewed.

Medical information about participants to determine if

the commodities are in fact improving the health of high

risk individuals was not available.

The interview schedule was pretested with the target

population but was not tested for reliability, validity

and repeatability.

More food programs for high risk groups are being developed.

The effectiveness of these programs must be determined.

In view of the limitations of this research there exists a

need in future research to:

1. develop, test and establish a reliable instrument to

determine the effectiveness of food supplementation pro-

grams.

study the impact of such programs on food behavior within

the family.

determine the need for nutrition education programs within

such food programs and if needed an effective method of

teaching participants.

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10.

11.

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Wang, V.L. & Ephross, P.H. (1971) ENEP evaluated. J. Nutr. Ed.

2, 148-152.

Prichard, K. & Hall, M.R. (1971) Attitudes of aides and clients

in the Expanded Nutrition Program. J. Home Economics 63, 545-551.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

65

Verma , S. & Jones, J.H., Jr. (1973) Educational participation

and dietary changes of EFNEP homemakers in Louisiana. J. Home

Econ. Res. 2, 94-104.

Green, L.W., Wang, V.L. 8 Ephross, P.H. (1974) A 3-year

longitudinal study of the impact of nutrition aides on the know-

ledge, attitudes and practices of rural poor homemakers. Am. J.

Pub. Health 64, 722-724.

Bowering, J., Morrison, M.A., Lowenenberg, R.L. & Tirado, N.

(1976) Role of EFNEP aides in improving diets of pregnant women.

J. Nutr. Ed. 8, 111-117.

Caliendo, M.A., Sanjur, 0., Wright, J. & Cummings, G. (1976) Use

of path analysis as a statistical technique for the analysis of

qualitative nutrition data. Ecol. Food & Nutr. 5, 75-81.

Bendick, J., Campbell, T.H., Bawden, D.L. & Jones, M. (1976)

Toward efficiency and effectiveness in the WIC delivery system.

The Urban Inst., Washington, D.C.

Classen, L.A. (1976) Four views of WIC a unique environment for

nutrition education. J. Nutr. Ed. 8, 156-159.

Guthrie, H.A. (1963) Nutritional intake of infants. J. Am.

Dietet. A. 43, 120-124.

Dierks, E.C. & Morse, L.M. (1965) Food habits and nutrient in-

takes of preschool children. J. Am. Dietet. A. 47, 292-296.

Karp, R.J., Nuchpakdee, M., Fairoroth, J. & Groman, J.M. (1976)

Malnutrition among inner-city children. Am. J. Clin. Nutr.

29. 216-218.

Inano, M. 8 Pringle, D.J. (1975) Dietary survey of low-income,

rural families in Iowa and North Carolina: Family distribution

of dietary adequacy. J. Am. Dietet. A. 66, 361-365.

Hendel, G.M., Burk, M.C. & Lund, L.A. (1965). Socioeconomic

factors influence children's diets. J. Home Econ. 57, 205-208.

Fryer, B.A., Lamkin, G.H., Vivian, V.M. & Eppright, E.S. (1971)

Diets of preschool children in North Central Region: Calcium,

phosphorus and iron. J. Am. Dietet A. 59, 233-237.

Futrell, M.F., Kilgore, L.T. & Windham, F. (1971) Nutritional

status of Negro preschool children in Mississippi: Impact of

education and income. J. Am. Dietet. A. 59, 224-227.

Lund, L.A. & Burk, M.C. (1969) A multidisciplinary analysis of

childrens food consumption behavior. Ag. Exp. Sta., U. of Minn.,

Bull. 265. St. Paul, MN.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

66

Young, C.M., Waldner, B.G. & Berresford, K. (1956) What the

homemaker knows about nutrition: Level of nutrition knowledge.

J. Am. Dietet. A. 32, 218-222.

Eppri ht, E.S., Fox, H.M., Fryer, B.A., Lamkin, G.H. & Vivian,

V.M. 1970) The North Central Regional study of diets of pre-

school children: Nutrition knowledge and attitudes of mothers.

J. Home Econ. 62, 327-332.

Schwartz, N.E. (1975) Nutrition knowledge, attitudes and

practices of high school graduates. J. Am. Dietet. A. 66, 28-31.

Young, C.M., Berresford, K. B Waldner, B.G. (1956) What the

homemaker knows about nutrition, relation of knowledge to practice.

J. Am. Dietet. A. 32, 321-326.

Emmons, L. & Hayes, M. (1973) Nutrition knowledge of mothers and

children. J. Nutr. Ed. 5, 134-139.

Fox, H.M., Fryer, B.A., Lamkin, G.H., Vivian, V.M. & Eppright,

E.S. (1970) The North Central Regional study of diets of pre-

gchool children, family and environment. J. Home Econ. 62, 241-

45.

Cosper, B.A. & Wakefield, L.M. (1975) Personal, attitudinal and

motivational factors, food choices of women. J. Am. Dietet. A.

66, 152-155.

Sims, L. (1976) Demographic and attitudinal coorelates of nutri-

tion knowledge. J. Nutr. Ed. 8, 122-125.

Guthrie, H.A., Madden, J.P., Yoder, M.D. & Koontz, H.P. (1972)

Effects of USDA Commodity Distribution Program on nutritive in-

take. J. Am. Dietet. A. 61, 287-292.

U.S. Department of Agriculture (1973) Families in the Expanded

Food and Nutrition Education Program: Comparison of Food Stamps

and Food Distribution Program participants and nonparticipants.

Econ. Res. Serv. Rpt. 246. Washington, D.C.

Futrell, M.F., Kilgore, L.T. & Windham, F. (1975) Nutritional

status of black preschool children in Mississipi, influence of

income, mother's education and food programs. J. Am. Dietet. A.

66. 22-27.

Larkin, F.A. & Sandretto, A.M. (1970) Dietary patterns and the

use of commodity food in a Potawatimi Indian community. J. Home

Econ. 62, 384-388.

Neff, M.E. (1964) Helping low-income families use donated food.

J. Am. Dietet. A. 45, 358-361.

55.

56.

57.

58.

59.

60.

61.

62.

63.

64.

65.

66.

67.

67

Pontzer, M.E. & Dodds, M.L. (1963) Use of government-donated

food in a rural community. J. Am. Dietet. A. 42, 128-130.

Lukaczer, M. (1971) Lessons for the Federal effort against

hunger and malnutrition - from a case study. Am. J. Pub. Health

61, 259-276.

Parrish, J.B. (1971) Implications of changing food habits for

nutrition educators. J. Nutr. Ed. 2, 140-146.

Hertzler, A.A. & Owen, C. (1976) Sociologic study of food

habits - a review, diversity in diet and scalogram analysis. J.

Am. Dietet. A. 69, 377-381.

National Research Council (1943) The problem of changing food

habits. Bull. 108. Nat. Acad. of Sci. Nat. Res. Council.

Washington, D.C.

National Research Council (1945) Manual for the study of food

habits. Bull. 111. Nat. Acad. of Sci. Nat. Res. Council.

Washington, D.C.

Wellin, E. (1955) Cultural factors in nutrition. Nutr. Rev.

13, 129-131.

Zimmerman, R.R. B Munro, N. (1972) Changing Head Start mothers'

food attitudes and practices. J. Nutr. Ed. 4, 66-69.

Sanjur, D. 8 Scoma, A.D. (1971) Food habits of low-income

children in northern New York. J. Nutr. Ed. 2, 85-95.

U.S., Congress, Senate (1975) Committee on Nutrition and Human

Needs: Part 8: Administration failure of the Food Stamp Pro-

gram. Hearing before Select Committee on Nutrition and Human

Needs. 94th Cong., lst sess., Washington, D.C.

Hiemstra, S.J. (1972) Evaluation of USDA Food Programs. J.

Am. Dietet. A. 60, 193-196.

Feely, R.M. & Watt, B.K. (1970) Nutritive value of food dis-

tributed under USDA Food Assistance Programs. J. Am. Dietet.

A. 57, 528-547.

Agriculture Research Service (1975) Nutritive value of american

foods in common units. Agr. Handbk. 456. U.S. Dept. of Agr.

Washington, D.C.

APPENDIX A

INTERVIEW MATERIALS

Si as

68

Figure A-l

sunny 1]) so.

rmrmnommmmmzmnoom

(not to be used during interview)

1. lane of’Mothar

2. Address

3. Phone

A. Birthdatas of preschool children:

1.

2.

3.

It.

5.

5. Food Sta-pa: yes ____ no

6. Clinic

1. Data of original certification

8. Expiration date

9. Race

10. Col-oditias Amount allotted. Alount taken

evaporated ndlk (13 on.)

canned neat (1 lb. 13 on.)

corn syrup (1 pt.)

canned fruit Juice (1 qt. it on.)

dried .111: (II 15.)

farina (13 on.)

canned vegetables (1 lb.)

peanut butter (2 lb.)

(every other loath)

dried as; nix (6 cs.)

immune-unnagnaummn(1ih.)

canned plull (1 15. 13 on.)

§ at

69

Figure A-2

ruily ID lo.

roamnoram—mscmr

Parson being interviewed:

nothar

whether

sister

other

What is your age?

Arayonnsnallythsparsonvhopraparcsthafoodforthahonsahold?

__ its (so to question 5)

no

Ityondonotpraparathafoodvhoosnallydoas?

nothar

“bother

sister

other

IA

Aroyonnsnallythaparsuvhodocsthafoodshoppingforthahonsoholdi

:vsieotOINIflnunT)

nutrition

nonaofthaabovahotoqnastionlo)

How did you receive the training?

jmior high school

high school

specialised. class

IA

no! long did the training last?

years

nonths

sa-tar

3%!”

70

run: 19 lo.

10.

13.

p r O

15.

16.

11.

18.

Uhat are the ages of the children eating in the has?

1.

10.

Who usually eats breakfast in the hon? (record nuher)

adult males

adult females

children over 6

children mder 6

usually eats lunch in the ham (record amber)

adult nales

adult fenles

children over 6

children under 6

i

usually eats dinner in the hone? (record nunher)

adult nales

adult fenles

children over 6

children under 6IIII?

5 3 é a E a ? a 3 5 § 3 E

8:

ill

Giveneenideaofvhatyoueatvhenyouerenotpregnent.

Breakfast Lunch Dinner Snacks

Shouldapregn-tsuaneatenoughfortvo?

yes

no

Should a vuan eat differently while pregnant?

yes (so to question 18)

no (so to question 19)

not should the diet change?

IA

3;!"

71

Fuily ID lo.

19 .

20.

21.

22.

23.

2h.

25.

26.

27.

28.

MINGOUPOPMGSIBMTBW: H

mmmmmmnm,mrwmmmmnmmmmnmn

Why should a van not eat differently?

IA

Did anyone give you advice on shat to eat vhile pregnant?

_1'“ l ‘

no (go to question 23)

Who gave you the advise and what vas the advise given?

IA

Did you ask for hny advise vhile pregnant?

yes

no

(that use the advise that you asked for?

Doyouknevvlwrocus:lepefoodsareonlygivnntoprepantandpostpartu

vuenandchildrenuptoGyeas-sofage?

yes (go to question 28)

no (go to question 25)

VhyisPocus: nopefoodonlyforthisgroup?

mt ,vouldyou assune the reason is?

Hhen you vere pregnant did you have any cravings for:

other

Ilhich foods are important—{Eris youg childi growth!

fruits

vegetables

neat

lilk

breads

other

Did your kids ever eat my

dirt

paint chips

cm

other

WAYS mun PAIIIJ HILL m m FOOD.

29. Did anyone help you learn how to use the emodities?

__m__no (note question 31)

72

PhilyIDlo.

30.. he use this_ person?

IA

31. When you first received the Mties did you have any trouble using then?

yes

no (go to question 33)

32. "hat were the specific foods and their probl-s?

neat

Juice

vegetsbles

dried silk

eveporated nilk

_consyruL

farina

peanut butter

dried egg nix

instnt potatoes

plm

IA

33. Are there any recipes on the label of the Focus: nope Mties?

yes

no (go to question 36)

35. Have you used any of those recipes?

yes

:2 (go to qustion 36)

35. Have there been any of the recipes vhich you have used nore than once?

Dried Milk

regular

butter

hot cocoa

vanilla cre- pudding

vegetable in crean sauce

chocolate

833 n1:

sore-bled

egg-cheese—neat pie

Instant potatoes

nashed

Farina

hot cereal

Corn Syrup

_ peanut butter sauce

naple syrup

Peanut Butter

cookies

Meat

barbecue beef

IA

339"

p .3

Us

73

Panily ID Io.

36. Iaveyouever received awrecipes on hovtopreparethe Iocus: lope food?

yes

no (go to question 38)

37. Where did you receive these recipes?

38. Iovhaveyoufoudtobethebestveytopreparethecannedneat?

39. How did you cue up with this recipe for canned neat?

ho. What other recipes have you used with canned neat?

51. Is this calmed neat good for preput or post part. vuen and young children?

yes

no (go to questim 53)

he. misthiscannedneatgoodforpregnant orpostpartuvuenandyoungchildren?

Probecardused

IA

33. Why does focus: nope give cannedfruit Juice to pregnant or . post part1- vase

and young children?

Probe card used

Ht. Ihet ways have you found to use the Juice?

Its. What recipes have you fodd to use in preparing canned vegotables?

1:6. Are cmnedvegetables goodforpregnant orpostpartuvaenandyomg

children?

yes

_ no (go to question £8)

1:7. Wmcannedvegetablesgoodforpregnentorpostpartuvonsnandyoung

children?

probe card used

IA

he. Ihatisthebestmthatyouhavefoundtoservethedriednilktoyour

yomgchildren?

1:9. What other recipes have you used vith the dried silk?

50. Is dried nilk good for pregnant or post part1. vonen?

yes

no (go to question 52)

51. this driednilkgoodforpregnantorpostpartunvonsn?

‘ Probecardused

IA

iii!"

74

Panily ID lo.

52. II 41'1“ I113 800‘ form children?

yes

no (go to question 55)

53. m is dried nilk good for young children?

probe card used

IA

Immmmmmaanimrmui'sooammonm

IORIOV. IAHGOIIGTOGIVIYWASIMTIWOIAIAHILYAIDABKIWMWIOIS

MMTIAIILY.

Pat has It children, a l nonth old infant and her mther stuing vith her in the

has. Two of the children are preschoolers and the other 2 are attending a near by

elementary school vhich provides a school lunch. Pat is receiving food fro-

Focus: Hope for herself, the baby and the 2 preschoolers.

Sh. 119s dinner tine and Pat ran out of enough neat to serve the entire fenily.

What advise vould you give her?

55. Pat has heard that you an lose vit-ins vhen storing fruit Juice. How vould

you advise Pat to store the' Juice?

56. Pat is breast feeding her baby and she vents to go beck to her old dress size.

Pat tellsyouofherplantogoonadiet. Whatadvisevouldyougiveher?

Ln'saomcxrommossimmmcusznorsroom.

57. i'ellneaboutthevmyouusuallypreparetheeggnix?

58. Is egg nix good for pregnant or post part-mean and young children?

yes

no (go to question 60)

59. W is egg nix good for pregnant or post pert:-m and young children?

Probe card used ‘

IA

60. Ion is farina helpful to the diet of a young child?

hobo card used

61. Whatvayshaveyoufoundtoser'vethefarina?

1916

75

Fully ID Io.

62.

63.

65.

Can peanut butter help young children to grow?

yes

no (go to question 68)

W does peanut butter help young children to grov?

Probe cardused

now have you found to serve the peanut butter?

norwmrummlmmmmhcmm m.nrlmsm

WWI“.

65. Pat can't decide if she should pickth farinafraPocus: Iopebecause

herpreschoolersvouldrathereatacerealthathasslotofeugaronit.

Ihatadvisevouldyougiveher?

Pat is concernedabout them she cooks her canned vegetables. Shenants

togetthenostnutritionfrathevegetables. lovvouldyousuggesttoher

tocookthevegetables?

add vater

tins of cooking

type of preparation

murbmlsaurrnmormmasmm:mmons.

67.

68.

69.

70.

71.

Ihstveyshaveyoufoudtoservetheinstantpotatoes?

Areinstantpotatoesgoodforpregn-torpostpu-tuvusnandyougchildren?

_m

no(gotoquestion70)

Vhyareinstantpotatoesgoodforprepantorpostpctuvonenandyoung

children?

Probecardused

IA

Ihatmshaveyoufoundtoservethecannedplus?

Are cannedplus good forpregnant orpoet pat-tum andyomgchildren?

yes

__ no (go to question 73)

Vivarecannedplusgoodforpregnanterpostpartuvusnandyoungchildren?

Probecerdused

76

Fully ID lo.

73.

Th.

75.

76.

TB.

339"

Iowdoordidyeunakc infant fornula?

Where did you get this recipe for infant fornula?

Invhatvays sreyouusingthe eveporatednilk?

who is the first person to be served food at the table?

m is this person served first?

Arethereawoftherocus: Iopefoodsthatthechildrenvillrefusetoeat? mm

canned neot

canned Juice

vegetables

dried nilk

__ use In

__ farina

__ peanut butter

__ potatoes

__ Plus

__ evaporated nilk

_vill eat everything

menyou'erepregnantorpostpartu,verethereuwoftherocus: Iopefoods

youvould not est? HIV?

canned neat

calmed Juice

Monmou-

Uhichofthelocus: Hopefoodsdeyouusuallyusevhennskingbreakfaet?

canned-eat peanutbutter

canned Juice potatoes

_vegetsbles plus

__driednilk evaporated-ilk

_eggn.ix __comsyrup

__farina

77

Fenily ID I0.

81. Which Focus: lope foods do you usmlly use vhen asking lunch?

canned neat peanut butter

__ canned Juice potntm

__ vegetables 131..

__ dried nilk evaporated nilk

en nixcorn syrup

fnrina

82. Which Focus: Hope foods do you usually use when nking dinner?

canned neat __ __ peanut butter

canned Juice potatoes

vegetables pluns

dried nilk evaporated nilk

._ 988 I1! __ con syrup

farina

83. Where did you learn vhat types of food to feed your fenily?

81!. IovnanyinthehouseeatthefoodfraFocus:Hope?

85. Ivould liketofindout aboutthe followingitensyouhave inyourhueand

their cmditim.

not yes, not in yes, vorks

Do m have: present 92. cond. vell

Refrigerator (1. door)

Refrigerator (2 door)

Freeser (separate unit)

Range (vith oven)

Hot plate or range v/o oven

can opener

electric fry pan

blender

electric liner

toaster oven

“O

Bovnanyof each ofthe following has doyouhave?

pots

_ff! Pm

neasuring cups or equivalent

neasuring spoons

m people get large quantities of cans fron Focus: lope, how do you store yours?

DoyoufeelFocus:Iopefoodshavehelpedyou?

yes

no (go to question 90)

Why do you feel Focus: Iope foods have helped

31%!"

78

Fanily ID Io.

\

90. If Focus: Hope had to select 1 food not to give each south, which food would

you like to see not given?

91. Why, vould you like to see this food not given?

92. If Focus: nope was to add 1 new food, what vould you like to get?

79

Figure A-3

SAMPLE DIALOGUE

Hello, my name is Eileen Kass. I am doing a survey with

Focus: HOPE Food Prescription program to learn more about the use of

commodity foods in the home. I need to speak with the person who does

most of the meal preparation for your household. This will require

about a half an hour of your time. We would very much appreciate

you answering a few questions for us. The information you provide will

aid us in developing programs and support for the continuation of

current programs for pregnant and post partum women and young children.

80

Figure A-4

Probe Card

@vcw Msgui

@WhmmC "

@lron (HOOK . .

gCalm m (Bones)©

@E-o‘tem (Wxie‘) -—-—-—- 1“

WW

81

Figure A-S

Consent Form

Focus: Hope Prescription Commodity Food Distribution Program

I, the undersigned,

willingly consent to participate in an interview related to

the use of prescription commodity foods distributed by Focus: Hope.

I do so understanding my response will contribute to the

project which has been explained to me. The project is being

conducted by Michigan State University in cooperation with

Focus: Hope.

I understand there is no obligation to stay in the

project and all my answers will be protected in the strictest

confidence. I also may request a summary of the study.

Address (if request summary)

Participant

Interviewer

Date

APPENDIX B

COMPOSITION OF FOCUS: HOPE COMMODITIES

Table

B-l

Nutritive

Value

of

Prescription

Commodities

Food

Fatty

Acids

Commodity

Water

Energy

Protein

Fat

Sat.

Oleic

Linoleic

Apple

Juice

Beef

natural

juices

Corn

solids

and

liquid

Egg

mix

scrambled

dehydrated

Farina,

enriched

quick

cooking,

dry

Beans,

snap,

green,

canned

solids

and

liquid

Grapefruit

Juice

unsweetened

Milk,

nonfat,

dry

instand,

fortified

Orange

Juice

unsweetened

Peanut

Butter

it...

100

46

100

29

100 l

100

12

100

14

100 1

100

46

100 4

100

46

100

gm.

02.

gm.

02.

gm.

1b.

gm.

lb.

02.

gm.

lb.

% 87

87

65.4

65.4

o 0

mm

mm OD [\h mm NN CO VG" [\N

0 MM NN mm 0501 Q'Q’ [\N r-r—

F-F' 0105 mm 0000

kcal

47

67l

198

1628

66

299

562

1912

361

1433

18

82

41

582

359

6512

48

686

582

5280

92L

o.— o'o r-ooN‘D

P

Pd‘ mm 050 O‘F‘ ON OLD LDr- wfi' mfi‘ LDQ‘

MN PMP

one cow .—<:- o°r\ mm o.— m.-

”ar-Nm

N

MNP

SON <‘N 050 Pm F-d' [\N N03 to.—

P

NNN om oo 0'.— ON ON mo»

fi’d’

d’

13

117

22

202

12

112

82

Table

B-l

(continued)

Commodity

Peas,

green,

immagure

canned

solids

and

liquids

Poultry

(fowl

oryoung

turkey)

boned,

canned

Potatoes,

mashed

dehydrated,

flakes

Canned

Plums

heavy

syrup

Corn

Syrup

31L.

100

gm.

1lb.

100

gm.

29

oz.

100

gm.

llb.

1cup

30

oz.

l6

oz.

Water

% 82.6

82.6

65 5.2

5.2

77.4

77.4

24

Food

Energy

£9.61

66

299

195

1603

364

1651

214

671

1900

Protein

an.

3.5

Fat

5) o°.-: Flo- C56; 600r—O'l

00¢ L00 ‘DN moo

Sat.

Fatty

Acids

Llfiolfic

UTeiC

am;

83

Table

B-1

(continued)

CHO

Tota1

FIBER:

sun;

.smc

.

11.9

0.

69.8

1

0O

O0

71.2

Calcium

.92;

6

86

14

115 4

18

506

1721

486

1929

34

154

114

1293

23455

10

143

61

554

20

91

Phos.

EEL.

128

188

1546

48

218

736

2504

546

2167

21

95

14

199

1005

18231

18

257

395

3583

66

299

£21 oat; mm.N r—MLO

r-Q'W GIN r—LD OLD CC OLD NCD PM

F

‘00 .—m <roo 000': NU) NV Q'N $005 Q'N O:— (\N

P P

Na 14

452*

3716

236*

1070

779#

2649

244

968

236%

1070

14

526

9542

14

543:

4926

233%

107

101

1441

351

2886

97

440

785

2669

81

321

95

431

162

2299

1725

31298

199

2844

652

5915

96

435

Magnesium

Eflc. 4

57

21

171

(19)

(86)

.67

228

24

95

(14)

(64)

(12)

(170)

142

2576

12

171

173

1570

20)

91)

(ITEM)

Apple

Juice

Beef,

natural

juice

Corn

Eggs

Farina

Beans

Grapefruit

Juice

Dry

Milk

Orange

Juice

Peanut

Butter

Peas

84

Table

B-1

(continued)

CHO

Total

FIBER

Calcium

Phos.

Fe

Na

KMagnesium

(ITEM)

010

187

O82

1583

13667++

2286

156

84.0

35

(173)

89

(1600)

100

Potatoes

13

446++

278

19

Chicken

07

17

381.0

159

(785)

7.7

404

(7258)

454

23

73

69

‘00“)

CO F-l\

AA

VV

55.8

-23

26

3367

Plums

174.6

-73

81

81048

492.8

-302

105

2.

447*

26

0Corn

Syrup

*Value

based

on

product

with

1%

salt

added.

+Estimated

average

based

on

addition

of

salt

in

amount

of

0.6%

of

the

finished

product.

#Value

based

on

product

with

maximum

level

of

1%

salt

as

stated

specification.

QValue

based

on

product

with

minimum

level

of

enriched

or

fortified

stated

in

the

specification.

1Estimated

average

based

on

addition

of

salt

in

the

amount

of

0.6%

of

the

finished

product.

AValue

based

on

productwith

1.4%

salt

added.

Specifications

state

that

salt

added

to

the

finished

product

shall

not

be

<1.2%

or

>1.6%.

Consequently,

sodium

may

range

from

465

to

620

mg.

per

100

gm.

++Va1ue

based

on

product

with

1%

salt

added.

Specification

state

that

salt

added

should

not

exceed

1.25%.

The

finished

product

may

contain

amaximum

of

543

mg.

sodium/100

gm.

85

86

Table B-2

Calorie and Iron Content of Commodities

Provided to Each Age Group

“6614—1160111! GROUPS Cdlories Iron

Mothers Kcal mg.

2 13 oz. cans milk 11,180 8

1 1 lb. 13 oz. can meat (chicken) 1,630 10.7

2 1 qt. 14 oz. cans juice (orange) 2,058 17.1

1 4 1b. dry milk 6,512 10.9

1 14 oz. Farina 1,433 157.5

2 6 oz. egg mix 3,824 32.6

7 1 1b. cans vegetables (peas) 2,093 53.9

1 2 1b. can peanut butter

(every other month) __§_,_2_§_g __1_8_:_1_

Tota1 33,983 311.6

Children (0-3 months)

30 13 oz. cans milk 16,770 15

3 1 pt. bottles corn syrup 5,715 80.7

1 1 qt. 14 oz. can juice (orange) 686 5.7

3 14 oz. Farina 4,299 472.5

Total 27,470 573.9

87

Table B-2 (continued)

WY GROUPS Calories Iron

Children (4e12 months) kcal mg.

30 13 oz. cans milk 16,770 12.0

3 1 pt. bottles corn syrup 5,715 80.7

2 1 qt. 14 oz. cans juice (orange) 1,372 11.4

2 2 oz. egg mixes 3,824 32,6

3 14 oz. Farina _4_,_2_99 412:5

Tota1 31,980 609.2

Children (13-36 months)

30 13 oz. cans milk 16,770 12.0

1 1 1b. 13 oz. meat (chicken) 1,603 10.7

3 1 qt. 14 oz. cans juice (orange) 2,058 17.1

1 4 1b. dry milk 6,512 10.9

3 14 oz. Farina 4,299 472.5

4 6 oz. egg mix 7,648 65.2

4 1 1b. cans vegetables (peas) 1,196 30.8

1 2 1b. can Peanut Butter

(every other month) _§,2§Q_ _l§;1_

Total 42,726 637.3

88

Table B-2 (continued)

COMMOOTFT7fififififiI’ Calories Iron

Children (37 months - 6 yearS) kcal mg.

10 13 oz. cans milk 5,590 4.0

1 1 1b. 13 oz. can meat (chicken) 1,603 10.7

3 1 qt. 14 oz. cans juice (orange) 2,058 17.1

1 4 1b. dry mi1k 6,512 10.9

3 14 oz. Farina 4,299 472.5

4 6 oz. egg mixes 7,648 65.2

4 1 1b. cans vegetables (peas) 1,196 30.8

1 2 1b. can peanut butter

(every other month) 2,640 _l§;l

Tota1 31,546 625.3

APPENDIX C

FOCUS: HOPE COMMODITIES

89

Table C-1

Number of Commodities Taken During October, 1976

Commodity Amount Amount Not Percent-

Allotted Taken Taken age not

Taken

%_

Evaporated Milk (13 02.) 387,130 385,643 1487 0.4

Chicken (1 1b. 13 02.) 22,091 5,003

41 0.2

Beef (1 1b. 13 oz.) 17,072

Corn Syrup (1 pt.) 13,296 13,126 320 2.0

Orange Juice (1 qt.

14 02.) 72,868 61,296

Grapefruit Juice 140 0.2

(1 qt. 14 02.) 11,437

Dry Milk (4 1b.) 22,091 21,376 615 3.0

Farina (14 02.) 68,969 67,136 1633 2.0

Peas (1 lb.) 104,264 99,865 899 0.9

Egg Mix* (5 oz.) 82,090 75,373 6332 3.0

Plums (1 1b. 14 02.) 22,091 21,979 112 0.5

Potatoes

Granules (1 1b.) 22,201 13,096 78

0.6

Flakes (1 1b.) 8,976 51

*

Ran out of egg mix for 5 days explains high number not taken.

90

Table C-2

Number of Participants Certified for the

FPP during October, 1976

GROUP AGETRANGF MW

Infants 0 - 6 months 2,269

Infants 6 - 12 months 2,163

Child 13 - 24 months 3,783

Child 2 - 5 years 13,008

Mothers ._§L§QQ

Total 26,523

APPENDIX D

MEAL PATTERN RECALL

91

Table D-l

Percent of Foods Reported Usually Eaten

by the Total Sample, Those on ENFP (FPPE)

and Those Only on the FPP (FPPNE)

Meal Total FPPE FPPNE

Z. 24; 72

Breakfast

Eggs 62 78 53

Bacon 48 72 33

Toast 56 44 63

Cereal 37 44 33

Milk 25 5 37

Sausage 23 33 17

Juice 21 17 23

Lunch

Sandwich 67 61 70

Soup 23 17 27

Milk 23 17 27

Dinner

Meat 58 67 53

Vegetable 54 55 53

Potato 29 28 30

Salad 23 23 23

Rice 21 11 27

Snack

Cookie 44 44 43

*

foods reported usually eaten by 20% or more of the participants are

listed above.

APPENDIX E

MAP OF DETROIT AND VICINITY

92

Figure E-l

Detroit and Vicinityken-bale

olden->4

Isl-ole»

E265

nz<

:Ouhwn

HOPE Oakman Boulevard WarehouseFocus:

HICHIGRN STATE UNIV. LIBRRRIES

31293106353158