The Urban Nutrition Initiative: Bringing Academically-Based Community

Service to the University of Pennsylvania’s Department of Anthropology

Francis E. Johnston

Ira Harkavy

Frances Barg

Danny Gerber

Jennifer Rulf

Department of Anthropology and the Center for Community Partnerships

University of Pennsylvania, Philadelphia, PA

Senior author’s address:

Department of Anthropology

University of Pennsylvania

Philadelphia PA 19103-6398

Phone:  215 898-6834

Fax:      215 898-7462

Email:   fjohnsto-at-sas.upenn.edu

Introduction

Academically based community service (ABCS) is an extension of traditional service learning that is directed more strategically at the structurally-based inequalities that afflict societies. While retaining the basic components of service learning – self-discovery, reflection, and values clarification – ABCS integrates them with academics and research into a problem-solving initiative that enriches the curriculum and contributes to the transformations of neighborhoods and communities. Students learn course content and disciplinary perspectives by bringing appropriate theory and methods to bear on specific problems, by working to develop real-world solutions to them, and by learning more generally how to solve problems in a collaborative way through the mutual engagement of all stakeholders.

Academically based community service meshes well with the tripartite mission of colleges and universities:

•          Teaching; through the curriculum ABCS engages students deeply with the local community. Students are drawn outward into the world, becoming active learners through an educational process that is democratic in its ideals and participatory in its manifestation.

•          Research; students become producers of knowledge. This is especially important for undergraduates who all-too-often are consciously separated from research, more often and not by the curriculum itself.

•          Service; the engagement of students with the local community through service provides a context for problem-solving learning that cannot be matched in any other setting

Finally, ABCS plays an important role in the intellectual and scholarly development of academic disciplines. While professional schools and associations – those whose prime purpose is to render a public service – have a tradition of community engagement and service, undergraduate and postgraduate departments in the arts and sciences have no similar corporate history, at least for the past 100 years. Individual scholars or departments may utilize service learning as a pedagogical method, but by and large, it is typically uncommon and unrelated to core training in the discipline.

Anthropology is typical of these disciplines. While the American Anthropological Association and the societies representing the major subdivisions of the field (archaeology, biological, cultural) recognize their public roles, and while some departments offer courses or training programs that are aimed at applying anthropological principles to practical problems, there are relatively few that employ service learning or ABCS to achieve their ends.

The application of academically based community service to discipline-oriented education is based on the principle that such experiences improve the quality of learning within the conceptual framework of a discipline. Put simple, a student will be a better anthropologist when ABCS is an integral part of his or her training. The emphasis on a problem-solving approach in which the problems are real ones, on programs that are multidisciplinary and eclectic, on the understanding that they are best approached through university/community partnerships among the stakeholders, and the incorporation of anthropological theory and methods appropriate to the problems provide a powerful curriculum that results in anthropologists who are effective as citizens and as practitioners of the discipline, and communities that are enriched and self-directed through mutually-beneficial partnerships with neighboring colleges and universities.

This paper describes and discusses the Urban Nutrition Initiative (UNI), an ABCS program that is a joint initiative of the University of Pennsylvania’s Center for Community Partnerships and Department of Anthropology, and that is partnered with university-assisted community schools in the area, known as West Philadelphia, of which Penn is a part.

1.       A description of the Urban Nutrition Initiative as an ABCS program aimed at promoting healthy behaviors and enriching educational experiences.

2.       An analysis of the impacts of UNI on the nutritional well-being of West Philadelphia students and on (primarily) undergraduate education at Penn.

3.       A discussion of UNI as a general model for community and educational change.

A Needs Assessment of Nutrition and Health in West Philadelphia

Without question, the obesity epidemic is one of the major public health problems facing virtually all countries of the world. In the USA, the prevalence of overweight and obesity in children and youth has more than doubled since the 1970’s (e.g., Ogden et al, 2002), with the greatest increases among minority groups. And while we tend to associate such increases with developed nations there are parallel trends in the lesser developed economies (Peña and Bacallao, 2002).

In the USA obesity and overweight tend to be most prevalent in the poorer neighborhoods of cities, especially those that surround the large, metropolitan universities. This is certainly the case at the University of Pennsylvania. Penn is located in West Philadelphia, an area of the city that is characterized by economic disadvantage, high rates of crime, and urban blight. In the neighborhoods served by the university, over 39% of families fell below the federal poverty threshold in the 2000 census.

As expected, the prevalence of obesity in West Philadelphia is high. Table 1 presents the percentage of obesity among school students measured by Penn participants in the Urban Nutrition Initiative. These figures are considerably higher than those found by the US National Health and Nutrition Examination Survey (NHANES-III), carried out in the early 1990’s, indicating the greater risk associated with low SES and highlighting one aspect of the nutrition-related problems of the community.

As noted above for the nation as a whole, rates of obesity have tripled in the past three decades in West Philadelphia. Figure 1 shows the increase in obesity from the 1970’s to the 1990’s in teenage youth from this area. Over this 20-year period, the prevalence in males has increased from 6 to 17% and in females from 9 to 18%. The figure also shows the percentage nationally for males and females as determined by NHANES-III. The rates of obesity are significantly higher among the West Philadelphia males and females than was found nationally.

Without question, overweight and obesity are major public health problems in the USA but even more in the disadvantaged community around the University of Pennsylvania. They are visible conditions that are associated with a broad spectrum of diseases the majority of which are nutrition-related. And obesity and overweight among the young are precursors of chronic disease in the adult years, such as diabetes, hypertension, cardiovascular disease, and arthritis.

It is known that, among individuals some are at greater risk for obesity because of their genes. However, at the level of the population, differences among populations are the result of environmental factors, diet, and exercise. And in particular, the basis of the obesity epidemic is found in the increase in caloric intake (and the reduction in energy expenditure) and the composition of the calories that are ingested. To understand the dynamics of weight gain requires an understanding of the diet.

The US Food and Drug Administration, charged with the development of dietary guidelines, recommends that no more than 30% of one’s daily intake of calories be derived from fat. Our surveys of West Philadelphia schoolchildren indicate that the figures are 35 and 38% for males and females respectively with higher than recommended intake of saturated fats, known to be a risk factor for cardiovascular disease. This excess in energy derived from fat is as a result important in and of itself, but it is also important in that the high amounts of dietary fat replace other foods that contain essential nutrients, vitamins and minerals. Thus a needs analysis of the community requires looking at other nutrients that may be consumed at lower-than-recommended levels.

Table 2 shows the percentage of dietary records of 11-14 females with intakes of selected nutrients that were less than two-thirds of the FDA Recommended Dietary Allowance (RDA). Since the RDA for these nutrients is an allowance for the population it is likely to be an overestimate for most individuals. As a consequence 67% of the RDA is usually utilized as the cut-off point for population surveys. One further point is that these data are based on one 24-hour recall per individual and, due to day-to-day variability in our diets, do not necessarily represent any one person. However, when they are aggregated they provide a valid estimate of dietary adequacy for the group as a whole.

The table indicates that over half of the females meet the RDA for iron and zinc. While this may sound good, this means that some 40% are deficient in zinc and almost one-third in iron. The importance of adequate iron intake in females due to its loss during menstruation, and the association between zinc intake and pregnancy outcome suggest significant levels of deficiency.

Of greater concern are the proportion of females whose records indicate deficiency in calcium and vitamin-D (55% and 88% respectively). Adequate calcification of the skeleton during the growing years is necessary to prevent osteoporosis in older women and requires both calcium and vitamin-D. The data suggest that, as a group, West Philadelphia youth manifest significant deficiency in these nutrients.

Overall, the diets of the schoolchildren described here show excessive intakes of fat and deficiencies in particular nutrients. The high fat intake is likely to come from foods to which fat is added during preparation (French fries, potato chips); 91% of 2^nd, 3^rd, and 4^th grade children report that they snack after school either sometimes or always, and our observations are in agreement with the data that indicate these snacks are likely to high in fat content. And they are, almost without exception, lacking in nutrients such as those discussed above. The consumption of soda and sugar-laden drinks is high, replacing milk and yogurt – sources of calcium. Finally, as shown in Table 3, intakes of fruits and vegetables fall significantly below the 5-a-day guidelines.

In summary, our assessment of the nutritional needs of the children of the West Philadelphia community reveals the same problems that have been identified in similar communities throughout the USA: diets that are high in calories relative to need, and that are deficient in many nutrients known to be necessary for the maintenance of health and well-being. The most obvious consequence is the striking increase in obesity and overweight, not just in adults, but reaching down into the early years of elementary school. A set of related consequences involves specific nutrient deficiencies that place the children and youth of the community at risk of chronic disease during the adult years. The remainder of this paper focuses on the Urban Nutrition Initiative, a comprehensive school-based ABCS initiative designed to change the behaviors that are responsible and enhance the nutrition and health status of the community.

The Urban Nutrition Initiative

History

The Urban Nutrition Initiative (UNI) is an ABCS partnership between the University of Pennsylvania and schools in the West Philadelphia area, where Penn is located. It developed from an undergraduate service learning course (Anthropology 310) in the Anthropology department offered first in 1990. The original title was Anthropology and Biomedical Science, changed subsequently to Nutrition, Health, and Community Schools. From its inception until 1994 university students taking the course worked on nutrition-related issues at the John B. Turner Middle School: 1), developing and teaching in a nutrition and health curriculum in collaboration with regular teachers, 2), carrying out needs and formative research on nutrient intake, diet quality, and the prevalence of overweight and obesity, and 3), participating in a variety of afterschool formal and nonformal projects. The research findings generated have been reported in peer-reviewed journals, books, and, to date, in one PhD dissertation. All activities carried out by students during this period, and extending to the present day, have been characterized by the following attributes:

•          Collaboration among all participants through the auspices of university-assisted community schools that function as centers of education, services, engagement, and activity for the public school students, their families, and community members

•          Academically based community service as the organizing principle

•          A problem-solving focus on improving community nutritional and health status

•          The integration of in- and out-of-class activities

•          An emphasis on the creation of knowledge by school and university students with participatory action research as the core methodology

In the Spring of 1995,  Penn undergraduates enrolled in Anthropology 310 and Turner Middle School students designed and implemented Fruits ‘R Us (and Vegetables, Too), a fruit and vegetable stand operated by students aimed at improving diets through increasing knowledge and the consumption of healthy foods. The “fruit stand” was operated after school and on weekends for students, staff, parents, and members of the community and represented a major step in the development of UNI. While retaining the classroom as the hub of its operation, the Urban Nutrition Initiative began the process of linking the class to external activities in an integrated curriculum of health promotion designed to change behavior and improve community nutrition and health status. As the undergraduates became engaged in service opportunities, readings and lectures addressed the epidemiology of obesity, theory and methods related to community based participatory action research, theories of health behavior change, nutrition assessment, anthropometrics, and environmental effects on nutrition. Coupling this course content with real world exposure to the problems that contribute to and exacerbate obesity in West Philadelphia provided a powerful learning experience for these undergraduates.

Over the next two years UNI expanded to the Charles Drew School (K-8) and University City High School (UCHS, grades 9-12). In the last few years it has grown further, extending its activities into additional schools. In particular, UNI has become a core component of the Penn- Sayre Partnership, a Health Promotion/Disease Prevention Program at the Sayre Middle School, initiated in 2003, that brings the resources of the Schools of Medicine, Nursing, Dentistry, Social Work, and Arts and Sciences and the Center for Community Partnerships into a collaborative and mutually-beneficial relationship with the Sayre Middle School centered around ABCS and participatory action research. UNI now operates seven days/week and 12 months/year in public schools and the University of Pennsylvania involving over 1,000 school and university students, K to 16+.

Structure

Over the years, the Urban Nutrition Initiative has evolved into a multifaceted program that connects the university with elementary, middle, and high school curricula in West Philadelphia through service learning and participatory action research creating a pre-K through 16+ curriculum. However its purpose has remained the same:

•          To create and sustain a curriculum that focuses on improving community health and increasing educational skills and abilities

•          To work with university faculty, public school teachers and community residents to engage students as agents of school and community change

•          To increase students' sense of control over their lives and their futures through a focus on  healthy life styles

•          To improve the nutritional and health status of school students, their families and the local community

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:

•          School gardens maintained by students as part of their studies

•          Afterschool fruit and vegetable stands that sell to school students, staff, parents, and other community members

•          Urban agriculture and microbusiness development for high school students

•          Farmers' market open on weekends with a winter buying club in the off season

•          Community fitness program that is free for parents and community members

•          A range of summer programs linking students to wider nutritional concerns and to the University of Pennsylvania

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.

Penn students – largely undergraduates – participate in UNI through their ABCS courses in a range of departments and programs, e.g., Anthropology, Health and Society, Nursing, Urban Studies, and Political Science. The courses employ a problem-solving format dealing e.g. with community health, food security, obesity, and the politics of food. Many students continue their interests by taking other ABCS courses leading to an ABCS minor, currently being developed in a number of departments. Students also continue their involvement with UNI through volunteering, as part-time employees, and in independent study and senior and Master’s theses. Finally, through the generosity of private donors, a minimum of eight undergraduates are appointed annually as Fellows who assist UNI in a variety of ways. These include being paired with elementary and high school teachers to develop lesson plans employing nutrition and gardening as themes, working with students and their families as life guards, aerobics and yoga instructors at Community Fitness Night, and coordinating courses for adults in nutrition-related topics, e.g., cooking.

Research and Evaluation

The Urban Nutrition Initiative is a community-based, ABCS intervention that seeks to enhance the nutrition and health status of the West Philadelphia community (including the University of Pennsylvania). It also seeks to enhance learning by impacting the teaching programs of the university and the university-assisted community schools with which it works. Finally, UNI seeks to develop a model that can be extrapolated, with appropriate modifications, to other settings nationally and internationally. As a consequence, a basic component of its activities is involved with research and evaluation.

The research model utilized by UNI is that of participatory action research (PAR), a process for generating knowledge about a specific problem that brings together all stakeholders into a joint process aimed at meeting both research and intervention objectives (Israel, Schurman, and Hugentobler, 1992; Benson, Harkavy, and Puckett, 1996)).  Like any research PAR is rigorous in conceptualization and methodology, and seeks not only to solve a particular problem, but to develop models that can be generalized and applied to other situations (Harkavy, Johnston, and Puckett, 1996). In addition to being problem-driven, participatory action research is characterized as being cyclical (rather than linear), engaged (rather than detached), and reflective (rather than objective). With respect to UNI, the result is not a set of traditional research projects but an ongoing partnership in which questions arise out of the mutual engagement of all parties and are answered through the collection and analysis of pertinent data.

The needs analysis summarized above is based on data collected by Penn and community school students as part of their ABCS course-related activities (see, e.g., Johnston and Pollock, 1994; Johnston and Gordon-Larsen, 1999; Gordon-Larsen, Zemel, and Johnston, 1997; Gordon-Larsen, 1997) and was the basis for the continued development of UNI. Other unpublished papers and reports have added to the available information describing the nutritional status of the West Philadelphia community.

The problem of overweight and obesity is especially complex and rooted deeply within the behavioral, social, political economic and cultural ecosystems of our cities. As such, it meets the criteria of “ill-defined problems” (Gallagher, 1997):

•          More information than is initially available is needed to understand the problem and decide what actions are required for resolution

•          No single formula exists for conducting an investigation to resolve the problem

•          As new information is obtained, the problem changes

•          One can never be sure that the “right” decision has been made

No better evidence is to be found than the fact that, despite the awareness of the medical and public health sectors of the significant health risks associated with obesity, and the tens of millions  dollars(at least) spent by federal agencies to alleviate the problem, the prevalence of obesity has tripled over the last three decades. The Urban Nutrition Initiative has approached the problem of obesity in West Philadelphia as one component of a spectrum of nutrition-related conditions and diseases, with UNI designed within the framework of health promotion and disease prevention. Rather than using a disease outcome, we have focused on prevention, changing the behaviors responsible for overweight, obesity, and other nutrition-related diseases.

Impacts on school children

Central to the design of UNI is the principle that interventions are more likely to succeed over the long run if they are designed and implemented by all participants working collectively. This stands in contrast to interventions that are developed by “experts” – often in a different setting – and brought into the setting. The fruit and vegetable stand was developed collaboratively by three 6^th grade classes of the Turner Middle School working with two senior Anthropology majors. They planned the store, helped build it, and publicized it throughout the school. Figure 2 shows the number of visits made to the store by those students involved in the process in the month after its opening. For comparison the graph also shows the visits made by children who, while attending the same school were not involved in planning or implementation. The results are clear: those who were part of the process visited the store significantly more (χ²<.001) than those who, while likely to know about it, nonetheless were not involved.

The impact of the Urban Nutrition Initiative on schoolchildren has been examined through projects carried out by Penn students. Griffin (2000) compared attitudes of 8^th grade students toward gardening from two elementary schools, a UNI school and a control school in the same neighborhood. He found that the students involved in gardening as part of UNI exhibited greater beliefs in themselves to “make a difference,” most often expressed as improving the neighborhood. They also exhibited more positive attitudes toward gardening than control school children.

Table 4 shows the changes in afterschool snacking in a UNI elementary school attributed to the fruit and vegetable stand. A control school (non-UNI) is included for comparison. When compared to other days in the school week, on the day following the school store the consumption of fruits almost doubled (39 to 68%) while vegetables almost tripled (13 to 38%). But regardless of when recorded, the snacks of children of the UNI school were healthier than those of the control school. This suggests a positive effect of the fruit and vegetable stand on the diets of children, not just the day after it was open, but throughout the school week as well.

One study has examined the impact of the Urban Nutrition Initiative on parents of the schoolchildren. Schwartz (2000) surveyed 93 parents regarding knowledge about and attitudes toward the afterschool fruit stand. In conjunction with the students, she also hosted a table during report card conferences where parents were given literature, invited to taste healthy snacks, and asked further questions. The aims of the study were to:

1.       gauge the extent of parental participation in the fruit stand

2.       examine its effects on the school community

3.       make recommendations for changes

When compared to children who were not involved in UNI activities, Schwartz found that children who were involved were significantly more likely to make at least one purchase from the stand and their parents were more likely to know about the fruit stand itself. She also demonstrated the importance of child-to-parent communication as the primary pathway for learning about the stand. For the involved children, 76% of the parents learned about the stand from their children, while 66% had seen the stand when they came to the school. For parents of non-involved children the figures were lower – 33 and 35% respectively.

Impacts on university students

One of the goals of academically-based community service is to enhance the educational experiences of University of Pennsylvania students. We currently have no data on the impact of the Urban Nutrition Initiative itself on Penn students participating through their course-related activities; however, there have been assessments of ABCS in general. As part of an ABCS course on evaluation, Jenks and McClain examined the impact of ABCS on students by means of questionnaires filled out by 55 students, 22 who had taken no ABCS courses and 32 who had (Johnston and Weinrab, 2002; Jenks and McClain 1999). No differences were found between the two groups in their ranking of the relative importance of the following activities: academic requirements: getting good grades, socializing with friends, volunteering, being a leader, belonging to organizations, working for pay, and knowing current events. In terms of specific items, the two groups differed significantly only on the importance of volunteering, with 45% of ABCS and only 15% of non-ABCS students indicating it very or extremely important.

The questionnaires also included questions dealing with the degree of concern of students for a set of social problems. Students who had taken one or more ABCS courses were more concerned about issues that reflect social structural disparities – quality of public education, urban poverty, income disparity, teen pregnancy, universal health care, quality of public health, homelessness – while students who had no ABCS courses were more concerned about issues relating to personal safety – race relations, crime/violence, drug use, uncontrollable diseases. While the design of their research precluded Jenks and McClain from attributing the differences to the impact of ABCS courses, it is of note that the two groups did not differ in the rankings of activities, but did differ in their social concerns.

Johnston and Weinrab (2002) and Eng (2001) utilized qualitative methods in attempting to understand the ways in which ABCS affects the learning of Penn students. Interviews and focus groups suggest that a significant factor lies in the context within which learning takes place in an ABCS course. The participation of school and university students in problem solving leads to a bonding that is beneficial to both. As one undergraduate remarked: “A positive thing about the project is the individual connections formed with the kids and breaking down barriers between Penn and the community.”

A high school teacher, in speaking of this experience, notes that “…this has changed the lives of Penn students,” while a professor in the School of Arts and Sciences expressed it this way:

“the students in this class have been writing brilliant things; they are going through a transformational experience. They will continue to be involved in community service. White kids from Scarsdale say for the first time, ‘I can see myself in these kids.’ It’s stunning!”

In her study of Penn students taking ABCS classes, Eng (2001) suggests that ABCS reinforces levels of civic responsibility developed from “family life, community life, and schooling.” Service learning through community engagement is not seen as service, “but as a way of life.”

This research discussed here cannot separate completely the transformative aspects of ABCS – and by extension the Urban Nutrition Initiative – from its selective aspects. And it is the case that none can do so even employing awkward and convoluted designs that attempt to reproduce controlled laboratory conditions in the real world. Students are moved to engage in UNI because of who they are, as is the case throughout higher education. They are not assigned randomly to courses. But the available evidence suggests clearly that, as a group, those that do engage in UNI, some through their commitment, others through their curiosity, are affected by their experiences.

Discussion

This paper has described the Urban Nutrition Initiative, a project that employs the principles of academically-based community service to achieve its goals. As such, UNI contributes both to the enhancement of the nutritional status of the West Philadelphia population and of the educational experiences of school and university students, achieving these goals by the integration of teaching, research, and service. It is the integration of these components – unfortunately all too often isolated from each other – that gives ABCS its power as a learning tool and its promise as a method of intervention.

The nutritional problems confronted by UNI are, as noted above, difficult to solve, to say the least. The steady growth of obesity, tripling in prevalence in just 30 years and characterized as an epidemic, has occurred despite the billions of dollars spent attempting to reverse it. This must rank as one of the great public health failures in history, reflecting the complexity of the problem and the ways in which it is embedded within contemporary culture and social structure (Johnston and Foster, 2001). The Urban Nutrition Initiative represents an innovative approach to the problem, emphasizing partnership, engagement, participation, and community-based problem solving as the pathways to promoting healthy behaviors. The integration of endogenous and exogenous knowledge, the utilization of a range of methods, and above all a focus on improving the lives of individuals are its hallmark.

UNI also seeks to improve the educational process through a focus on problem solving, active learning, and student engagement in those real world issues that constrain the realization of human potential. Its focus on a specific problem cuts across the various fields of knowledge and breaks down the fortress mentality that tends to characterize training today in the various disciplines. And the research done by undergraduates as part of their classes cannot be underestimated as a major contributor to their learning.

The impacts of UNI on nutritional well-being and on student learning have been described above. Contrary to conventional wisdom, school students who are full participants in UNI activities will eat healthy snacks instead of unhealthy ones. This model – engagement, participation, problem-solving, and service oriented – can be applied to a range of other issues that confront our society.

Finally, the Urban Nutrition Initiative is an example of how ABCS can be brought into the core curriculum of anthropology (as well as other disciplines and areas of study). The history of anthropology has been one of engagement with local peoples and involvement in their problems. The position of anthropology in the social sciences can be attributed in large part to its success in understanding the collective without losing sight of the individual, and in illustrating how seemingly exotic behaviors inform significantly our interpretation of our own. In recent years anthropologists have all-too-often lost sight of the worlds in which they work and the peoples with whom they are involved. Academically-based community service, as illustrated here in the Urban Nutrition Initiative, provides an avenue for renewal of training – and learning – as it becomes a basic component of the student experience.

Acknowledgements

The Urban Nutrition Initiative is supported in part, by: National Institutes of Health, W. K. Kellogg Foundation, Ford Foundation, U. S. Department of Agriculture, U.S. Centers for Disease Control, Department of Housing and Urban Development, Pennsylvania Nutrition Education Project, Edward and Barbara Netter, Jill Gilbert, the estate of Fred and Barbara Roll, and the University of Pennsylvania School of Arts and Sciences and Center For Community Partnerships

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