*91* October 23, 2005 Community Health Improvement Clerkship Block 3 “Mi Libro de Cocina Muy Proprio!”
BACKGROUND We are all very aware that childhood obesity is becoming a huge problem in for healthcare system’s future. The 1999-2002 National Health and Nutrition Examination Survey (NHANES) documents that 16% of children and adolescents ages 6-19 years are overweight, which represents a 45% increase from the overweight estimates of 11% obtained from The Third National Health and Nutrition Examination Survey (NHANES III, 1988-94). Ethnic disparities are prevalent throughout many aspects of healthcare. The prevalence of obesity is higher among minorities, especially African American women and Hispanic Americans (especially Mexican Americans and Puerto Ricans). In 1999-2002, 73% of Mexican-American adults were overweight and 33% were considered obese (NHANES 1999-2002). Among US children, the highest overweight and obesity prevalence is found within the Mexican American population. According to the American Obesity Association, 39.3% of Hispanic children (ages 6-11) are overweight compared with 26.2% of white children. Furthermore, 23.7% of Mexican American children are considered obese, while only 19.5% black children and 11.8% of white children are obese. These trends continue for Mexican Americans throughout childhood and into adolescence.
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These statistics are frightening when one considers the long-term medical complications of obesity. The role of obesity in predisposing individuals to diabetes, hypertension, and other aspects of CVD risk has been well established. Most importantly, overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese. This continues to put them at greater risk for heart disease, hypertension, and stroke. However, an American Obesity Association survey to parents highlighted some interesting findings. Thirty percent of parents said that they are "somewhat" or "very" concerned about their children's weight, and 12% of parents considered their child overweight. However, it ranked the lowest among six choices of what they believed to be the greatest risk to their children's long-term health and quality of life when compared to other choices such as alcohol, violence, and illegal drugs. To me, this emphasizes the importance of educating parents about these long-term effects of childhood obesity. It is my belief that parents play an important role in the development of their children's eating behaviors. However, there appears to be discrepant views on childhood obesity among parents. One study by McArthur et al, studied immigrant Hispanic families with school-aged children living in Eastern North Carolina. They found that 47% of parents believed that overweight children are unhealthy, and over 90% believed that overweight children should be taken to a nutritionist or physician for help with weight reduction (McArthur et al; 2004). However, another study by Crawford contradicted this. It showed that Hispanic American mothers had difficulty acknowledging overweight children and that health and weight were poorly associated.
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Additionally, certain cultural values were identified as barriers to adopting healthful behaviors in this study (Crawford et al; 2004). Thus, it appears that there is a wide discrepancy of beliefs and attitudes surrounding childhood obesity and healthy eating in the Hispanic American population in the United States of America that need to be addressed. Additionally, this highlights a need for bilingual community health professionals to develop culturally sensitive wellness programs targeted at immigrant Hispanic families that promote healthier food choices.
PROJECT PROCESS DESCRIPTION AND METHODS During Block 1 of CHIC, another student completed a children’s cookbook for our local community. It contains many of easy, nutritious recipes that can inspire children to develop healthy eating habits. I thought this was a terrific idea. The cookbook was written in English, and was not distributed within the community due to time restraints. Thus, I wanted to keep this project sustained by distributing the English versions to the community, but most important to me was a chance to provide a Spanish language version as well. Rochester is the home of many immigrants from different Hispanic and Latino countries. Many of these families prefer speaking and reading in their native languages. Being apart of this Spanish speaking community myself, I have been able to see first hand that many of our local Hispanic children are dealing with the physical and psychosocial issues of childhood obesity. I wanted to focus on this troubled population, and specifically reach out to them. I felt the best way to do this is to provide them with a Spanish version of the cookbook, and highlight to these families the issues that face their population.
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Partnership Identification: I first decided to utilize the resources already identified in past CHIC projects to assess the need for both the English and Spanish versions of the cookbook. I first contacted Eleanor Coleman from S.W.A.N and Jaime Saunders from Foodlink NY. They were excited about me continuing this project and directed me to Celeste Barkley at Foodlink NY. Mrs. Barkley is the head of Foodlink NY Kids Café programs of the greater Rochester area. Kids Cafe is an after-school feeding program for children eligible for free and reduced lunch as provided by the National School Lunch Program. Foodlink prepares the meals at our kitchen and distributes it to approximately 27 sites throughout the community. When I first contacted Mrs. Barkley, there were 18 sites reopening as of 10/11/05 for the new school year. All of the sites are not homogeneous. They have some enrolled programs that provide kids with tutoring and a number of additional enrichment activities as well as open sites. She mentioned that a large population of the children that participate in the programs are in fact minority children, and that there is a decent percent of them who Spanish is their preferred language. While no two programs are identical, each shares a common goal of providing a safe, respectful environment where youth can receive wholesome meals, nutrition education, academic and recreational activities. This exactly fit what I was looking for in a community sponsor.
METHODS Part 1:
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After making solid contacts within the community, I proceeded to translate the children’s cookbook into the Spanish language, both the recipes and the games within in. I additionally added a couple of culture specific recipes to it. These recipes were initially compiled from many sources during the making of the English version. The previous student used recipe ideas from “Heart Healthy Cooking” from the National Institutes of Health, Project firm, “Recipes and Tips for Healthy, Thrifty Meals” from the United States Department of Agriculture, and other various resources. All of these recipes had a common theme. Healthy recipes that could be made by children aged 613 years old either alone or under direct adult supervision. This was a key objective, as many kids need to learn for themselves how to make healthy snacks, instead of reaching for that bag of chips. Additionally, as many Hispanic children in our area come from lower socioeconomic families (i.e. single parent families, or families in which the parents work long hours to provide for their children), they may have more time home alone without adult supervision. Therefore, if we could provide them with the knowledge of healthy food preparation and instill an excitement about cooking in them, this cookbook can be a perfect and practical educational tool that is not dependent on direct parental teaching. Part 2: Once the Spanish cookbook was completed, I wanted to see if it was in fact a fun way to teach kids about healthy eating. I collected all of the ingredients for the recipes: “Salsa de garbanzos Suave” (smooth chick pea dip appetizer), “Ensalada de Dos Rodillas y de Codos” (Two-knee and Elbow salad main dish), and “Bombas de Miel” (honey bombs dessert). On Friday, October 21st, 2005 I invited over three family
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friends (a mother, her 10 year old son, and 4-year-old daughter), who also invited two of their neighbors (a mother and her six-year-old daughter). I was unsuccessful of trying to recruit the fathers of these families unfortunately. Together we all made the appetizer dish, but the main dish was already pre-prepared by myself. Then, we let the kids go to town for dessert! The three children made the dessert recipe pretty much on their own under our supervision. As a gift of my appreciation, I provided each of my participants with a bound colored copy of the Spanish version of the cookbook. Part 3: After conducting the small test run at my home, it was time to attempt to massproduce both the English and Spanish version of the cookbook. This is where I ran into the most difficulty. Unfortunately, due to recent financial budget cuts at the Department of Health, financial support for photocopying of the 28-page long cookbook fell through at the last minute. Attempting to find a financial support partnership so late in the month of my project has been fruitless. I contacted two different photocopying centers/business in our community for help, and I also spoke with Foodlink NY/Kids Café as well. Unfortunately, it seems that times are rough for many organizations and businesses and they are not able to contribute to this project. Wegman’s grocery stores help sponsor Kids Café sites, but I was unable to contact the correct person within their company to ask for assistance due to time constraints. I met with Mrs. Barkley about these troubles, and we decided to print out a bunch of copies at their facility by ourselves to get a small solid stack of cookbooks for them to distribute at their sites. Additionally, I gave her electronic files of the both English (with permission from the
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Block 1 student) and Spanish version of the project for them to utilize if funding or printing materials becomes available.
RESULTS: Feedback from children in the Rochester community: I had a terrific time with my friends during the test run of some of the recipes. As stated before, everyone participated in the preparation of the appetizer and main course dish. We first made the appetizer dish. At first the kids seemed hesitant about the chickpeas, questioning, “what are chickpeas?” and “they smell funny”. However, as the parents did the chopping of the onions and vegetables, the kids had a blast mashing up the chickpeas! Alejandro loved that “it was messy!” From my observation, the kids really enjoyed being involved with the recipes, and liked working alongside their mothers (although the 4-year-old seemed more interested in coloring in the cookbook). The kids liked the finished product, and even ate a handful of vegetables because “it is fun to dip them into the dip!” The main dish was already pre-prepared by me prior to everyone coming over. It was actually much less received both by the parents and the children. The kids tried some of the salad and said that it tasted “okay”. However, even with that initial response, two of the three children finished their bowls completely. One mother stated that “it tasted bland” but that it seemed easy to make and give her children for lunch at school. Then it was time for dessert, “Bombas del Meil” (honey bombs). They are so easy to make that we let the kids try it on their own. Besides making a small mess, they were successful and they stated that they were “delicious!” After dinner, I asked the kids what they thought about our cooking session. All three
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kids said that they had a fun time and that they would use the cookbook at home. The desserts were the unanimous favorite dish of the day, although 2 of the 3 kids had the most fun making the chickpea dip. Both mothers were very pleased with the cooking experience and deeply appreciated the cookbooks.
Feedback from partnerships: Mrs. Barkley from Foodlink NY/Kids Café went out of her way to express to me that my project would nicely compliment the vision for Kids Café. She stated that not only would she love to offer the cookbook to their youth programs through the food bank, but that she really appreciated “you thinking of us and offering us additional educational tools for our kids”. She additionally wanted to put extra copies of the cookbooks in pantry bags for the clients. Her boss stated that they were a “perfect addition to the gift bags that are being assembled for their annual Thanksgiving celebration". I also received terrific words of encouragement from various personnel in education ranging from teachers, a priest, public relations from a private school, and a nurse. Everyone emphasized the importance of community outreach for these children and agreed this was a fantastic idea to “combat obesity in minority children…or all children for that matter”.
Personal Feedback: This project was extremely meaningful to me. As stated in the background, so many children, especially among the Hispanic population, are overweight and obese.
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Hispanic children are developing adult health problems and are not correctly learning to adapt to the American eating culture. Often times, people expect immigrant children to just utilize English resources overlooking the fact that they may be more comfortable reading/speaking/writing in their native language. This blatantly ignorant idea often leaves Spanish speaking children isolated from terrific educational resources that are provided for the English speaking counterparts. Bridging the gaps of healthcare. Now that there are two versions necessary for the children in our area, a much larger percentage of our community will be impacted and paid attention to.
SUSTAINABILITY There are many ways that this project is sustainable within our community. We really need to mass-produce both versions of the cookbook for appropriate fair outreach. I initially wanted to produce copies for various local children and minority health clinics, The Gollisano Children’s Hospital at Strong Memorial Hospital, and a few Churches and restaurants/markets that cater to the Spanish speaking population here in Rochester. However, due to the recent Department of Health funding crisis, CHIC was unable to financially support the production of hard copies of the text. I unfortunately did not find this out until the middle of the 3rd week of the clerkship and I was unsuccessful in finding another partnership willing to help with photocopying costs. This would be the major focus for continuation of this project in my opinion. In the future, I would hope another student might be able to identify more than one partnership to help make a financial contribution or help organize a fundraiser at the University of Rochester for mass-production. Along the same line of outreach,
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producing an online version of the cookbook would be great for families who have access to a computer. As mentioned by a previous student, providing an educational pamphlet about the childhood obesity epidemic and tips for building healthy food choices at an early age in English and Spanish to accompany the cookbook would be very beneficial. Not only do we need to educate our children but we need to educate their parents as well. Organizing a campaign to provide formal education for local Spanish speaking parents/families with health fairs, school visits, a regular teaching spots at Kids Café sites would be extremely helpful at getting at the roots of the childhood obesity problem….the need for prevention!
IMPACT I have hopefully impacted the greater Rochester community at large considering that we are becoming a much more diverse place than some may believe. Our community already values our children’s healthcare with utmost importance, with a leading children’s hospital and many different child’s health outreach programs. My hope to reach out to an isolated subgroup of our community does not stand on its own. There are many other organizations/people that strive to educate our minority children about healthy living, whether ranging from healthy food choices to lead paint education to cessation of tobacco. We value our children here in Rochester and do not want any of them to fall between the cracks. I hope that Foodlink NY will be able to continue to provide our children with this invaluable resource for many years to come. The Kids Café program goals and my personal goal for this cookbook is to teach kids to become
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involved with cooking at an early age, become interested with healthy food choices and exercise, and to stimulate family food-quality time among our Rochester families.
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RESOURCES American Obesity Association; www.obesity.org Surgeon’s General; www.surgeongeneral.gov/topics/obesity National Institutes of Health Child Health and Human Development; www.nhi.gov McArthur LH. Anguiano R. Gross KH. Are household factors putting immigrant Hispanic children at risk of becoming overweight: a community-based study in eastern North Carolina. Journal of Community Health. 29(5):387-404, 2004 Oct. Flegal KM. Ogden CL. Carroll MD. Prevalence and trends in overweight in Mexicanamerican adults and children. Nutrition Reviews. 62(7 Pt 2):S144-8, 2004 Jul. Sherry B. McDivitt J. Birch LL. Cook FH. Sanders S. Prish JL. Francis LA. Scanlon KS. Attitudes, practices, and concerns about child feeding and child weight status among socioeconomically diverse white, Hispanic, and African-American mothers. Journal of the American Dietetic Association. 104(2):215-21, 2004 Feb. Garces C. Gutierrez-Guisado J. Benavente M. Cano B. Viturro E. Ortega H. de Oya M. Obesity in Spanish schoolchildren: relationship with lipid profile and insulin resistance. Obesity Research. 13(6):959-63, 2005 Jun. Smith SC Jr. Clark LT. Cooper RS. Daniels SR. Kumanyika SK. Ofili E. Quinones MA. Sanchez EJ. Saunders E. Tiukinhoy SD. American Heart Association Obesity, Metabolic Syndrome, and Hypertension Writing Group. Discovering the full spectrum of cardiovascular disease: Minority Health Summit 2003: report of the Obesity, Metabolic Syndrome, and Hypertension Writing Group. Circulation. 111(10):e134-9, 2005 Mar 15. Centers for Disease Control and Prevention; www.cdc.gov/nchs Third National Health and Nutrition Examination Survey (NHANES III); 1999-2000 and 2001-2002 National Health and Nutrition Examination Survey (NHANES) full reports. Crawford PB. Gosliner W. Anderson C. Strode P. Becerra-Jones Y. Samuels S. Carroll AM. Ritchie LD. Counseling Latina mothers of preschool children about weight issues: suggestions for a new framework. Journal of the American Dietetic Association. 104(3):387-94, 2004 Mar.
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APPENDIX A
Celeste Barkley Foodlink NY Kids Café Child Nutrition Manager 936 Exchange Street Rochester, NY 14608 585-328-3380 x148
Jaime Saunders Foodlink NY 936 Exchange Street Rochester, NY 14608
Jaime@foodlinkny.org
Eleanor Coleman Community Asset Manager S.W.A.N 275 Dr. Samuel McCree Way Rochester, NY 14611 585-436-8201 x1391
ecoleman@swanonline.org
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