Urban Nutrition Initiative Congressional Testimony

UNI Testimony to Congress on May 29, 2003.

The Urban Nutrition Initiative

Founded in 1992, the Center for Community Partnerships (CCP) is Penn's primary vehicle for enlisting the broad range of knowledge of the research university and the engagement of students, faculty, and neighbors in implementing communal efforts to address the complex, comprehensive, and interconnected problems of the American city. Much of the CCP's work has focused on the public school as the educational and neighborhood institution that can, if effectively transformed, serve as the concrete vehicle of community change and innovation.

Through service-learning courses in the department of Anthropology and Environmental Studies, the CCP established the Urban Nutrition Initiative (UNI), a program with a ten-year track record of implementing innovative nutrition education in public schools. First developed from a partnership between Turner middle school and an undergraduate seminar at the University of Pennsylvania taught by Professor Francis Johnston in 1990, UNI has evolved into a multifaceted program that connects Penn undergraduate courses with courses in an elementary, middle, and high school in West Philadelphia, creating a pre-K through 16+ curriculum focused on improving community health. Operating daily in five public schools and involving 1,000 students in grades K-12, UNI's goals are to:

• Create and sustain an interdisciplinary pre-K through 16+ curriculum that focuses on improving community health and simultaneously results in increased educational skills and abilities.

• Work with university faculty, public school teachers and community residents to effectively engage students as agents of school and community change resulting in students' increased sense of control over their lives and their futures, and in mobilization of substantial and effective resources (youth) to improve community health.

• Improve the nutritional and health status of public school students, their families' and the local community.

UNI activities to improve nutritional and health status fall into three general categories:

• Improving health and nutrition knowledge.

• Improving the supply of healthy foods.

• Encouraging and supporting active lifestyles.

UNI is focused on researching and developing integrated approaches that will create substantial and broad community participation. Accordingly, changing the curriculum is at the core of UNI’s school-based school and community improvement approach. UNI has developed and implemented a curriculum that teaches core subjects (math, social studies, language arts) through the following activities:

• After school fruit and vegetable stands.

• Farmers' market open on weekends; winter buying club in the off season.

• School gardens.

• Community Fitness program that is free for parents and community members.

• Urban agriculture and microbusiness development.

UNI promotes effective citizenry among youth by engaging high school students, along with college students, in a complete spectrum of problem-solving activities, including opportunities for advocacy work, focused on addressing the nutritional crisis in urban America. By linking community-problem solving activities to the curriculum of public schools and the University of Pennsylvania, UNI integrates civic participation into the core mission of educational institutions. This strategy is effective because the engagement of K-16+ learners in hands-on approaches to improving nutritional status and community health in West Philadelphia improves the quality of the educational experience. In active learning situations students apply knowledge and understand the relevance of theories as they are put into practice. This approach has improved levels of student achievement in many ways. At the elementary and high school level, students involved with UNI programs have won awards for science fair projects, improved their test scores and attendance levels.

The research accomplished to date by UNI has proceeded as follows:

1. Description of the problem.

2. Development of a strategy for intervention.

3. Evaluation of the results.

Percentage of 396 West Philadelphia females that are obese, by age group.

Description of the problem

The first stage in our efforts was to describe the problem, viz., the nutritional status of the school children served by UNI. To that end surveys have been conducted to determine the extent of overweight and obesity and to quantify the dietary intake of nutrients. Table I shows the percentage of obesity in 396 females from two schools. Not only are the levels high among elementary girls (11.9%) they increase through the middle school years. These percentages are among the highest found in the USA. Furthermore, rates of overweight and obesity have increased dramatically in West Philadelphia school children in the past few decades. Figure I, shows how these rates have increased from the 1970's to the 1990's in teenagers from West Philadelphia. Not only is obesity among males and females of the 1990's approximately twice that seen in the 1970, but the 1990 values are notably higher than national values, as determined by the US Health and Nutrition Examination Survey (NHANESIII).

Overweight and obesity increased significantly from the 1970s to the 1990s among lower SES Philadelphia adolescents.

The nutritional problems of the school children served by UNI are not limited to excessive levels of overweight and obesity. Surveys that we have conducted reveal that the dietary intakes fail to conform to published guidelines for a number of nutrients. Specifically, middle school boys and girls are characterized by diets that are high in calories and fat (especially saturated fat), and low in calcium and iron, nutrients that are associated with disease during the adult years, e.g. cardiovascular disease and osteoporosis. Fruit and vegetable consumption is also low. Our surveys reveal that 6-8 year old boys and girls average 1.7 servings per day, significantly this lower than the recommended five servings per day.

Development of a strategy for intervention

One of the basic theories underlying the Urban Nutrition Initiative is that dietary change is more likely to be accomplished when all stakeholders, including the children themselves, are involved in the planning, implementation, and operation of the program. This was demonstrated in the initial development of the school store, which was planned and set up by three 6~ grade classes of 60 children. When the store opened, the number of visits of these children to the store over the next few weeks was determined and compared to other 6~ grade classes that had not participated. (All children in the school, grades 6-8 were exposed to posters and announcements advertising the store.)

Mean number of visits to school store by involvement in its planning.

Figure 2 shows the number of visits to the school store by 6^th graders by their involvement in planning. Some 60% of the non-planners did not visit, while only approximately 15 of the planners failed to do so. And, repeat visits were clearly higher among the planners. These early data validate the theory that participation and ownership and essential components of successful programs designed to effect change. This approach has guided all subsequent efforts of UNI.

Evaluation of the results

Reducing obesity in the USA has proven to be a nearly-unsolvable problem. Despite public awareness of the problem, and in the face of the billions of dollars spent by public and private agencies and groups, overweight and obesity continue to increase, leading to the recognition of an "obesity epidemic" among all age, sex, and demographic groups .Given the dimensions of the problem and the complexity of the interactions among the various causal agents, we have concentrated our assessment of UN Ion dietary change. Surveys of diets among elementary age children from UNI schools reveal what is described for children (and adults as well) across the country. Snacks play an important of our diet, and the snacks that are consumed most often are usually not healthy ones. Over 50% of 2"d to 4fh grade children report regular afterschool snacking, and 30% eat snacks on a daily basis. Candy, chips, juice, fruit, and sodas - in that order- are the items reported most frequently. It is worth noting that "juice" refers usually to drinks that are mostly water and sweetened by the addition of sugar. This pattern of snacking is typical of children across the country, and is usually pictured as one that is especially difficult to change. "Who is going to substitute a piece of fruit for a bag of potato chips?" is a comment commonly heard. Table 2 demonstrates that the Urban Nutrition Initiative can, in fact, result in the consumption of healthier after school snack. The table shows the percentage of children reporting eating chips, fruits, and vegetables. For the UNI school, percentages are given for the day following the school store and for other days. For the control school, where there without a school store, only one set of data is presented. Consumption of potato chips (and similar foods) is lower in the UNI than the control school overall, most likely reflecting UNI activities. However, on the day following the school store, chips dropped by 25% while fruit and vegetables increased by70% and almost 200% respectively. This suggests not only that UNI has increased the consumption of fruits and vegetables, but has done so at the expense of non-nutritive snacks. It is also encouraging that students stay involved in UNI programs even after graduating from high school and university. Each summer, graduates of University City High School have returned from college to help lead younger students in summer nutrition education camps and job-training programs. Graduates of the University of Pennsylvania who have been highly involved in running UNI frequently choose careers in public health or community medicine and maintain their involvement with the program and related work in other cities.

Percentage of children reporting after school snacking, UNI and control schools, grades 2-4.

Through this K-16+ partnership, learners are engaged in solving real-world problems and practicing effective civic participation. It is important to note that the UNI programs developed jointly by these students have demonstrated positive results in terms of improving afterschool snacking patterns among public schools students and raising levels of community participation in fitness activities. These successes are a valuable measure of the effective citizenship skills that youth develop through UNI.

Another indicator of the success of the UNI model is the continued evolution of the program. The combination of academics and community problem solving fosters a dynamic structure in which student achievement invites innovation and new program development. As students create new knowledge the program evolves to incorporate new findings. In this way, service-learning courses at the University of Pennsylvania change each year along with K-12 classes and programs.

© 2005 by the Urban Nutrition Initiative. University of Pennsylvania - Franklin Building Annex 3451 Walnut Street, P-117.
Philadelphia PA 19104 Phone: (215) 898-1600 - Fax: (215) 573 - 1134