Reber_NUTRITION FOR LOW-INCOME CHILDREN

Running Head: NUTRITION FOR LOW-INCOME CHILDREN
Effectiveness of Implementing Nutrition Programs in Low-Income Schools
By
Dayna E. Reber
March 8, 2016
A Capstone Report Submitted in Partial Fulfillment
of the Requirements for the Degree of
Master of Science in Educational Improvement and Transformation
at Drexel University
We accept this report as conforming to
the required standard
_____________________________________
Kristy Kelly, Ph.D.
(GIE Program, School of Education, Drexel University)
_____________________________________
Bruce Levine, J.D.
(EIT Program, School of Education, Drexel University)
_____________________________________
Samantha Mercanti-Anthony, Ed.D.
(Program Manager, School of Education, Drexel University)

Nutrition for Low-Income Children 2
Table of Contents
Abstract ........................................................................................................................................... 3
Acknowledgements......................................................................................................................... 4
Chapter 1: Introduction................................................................................................................... 5
The Research Site...................................................................................................................... 11
The Study Design....................................................................................................................... 12
Terms......................................................................................................................................... 12
Ethical Considerations.............................................................................................................. 13
Summary.................................................................................................................................... 13
Chapter 2: Literature Review........................................................................................................ 15
Nutrition Policy and Legislation............................................................................................... 15
Previous School-Based Nutrition Interventions........................................................................ 17
Food Assistance Programs for Low-Income Families.............................................................. 20
Study Overview.......................................................................................................................... 23
Chapter 3: Methodology ............................................................................................................... 25
Introduction............................................................................................................................... 25
Method....................................................................................................................................... 26
Chapter 4: Findings....................................................................................................................... 30
Results ....................................................................................................................................... 30
Chapter 5: Discussion ................................................................................................................... 39
Conclusions ............................................................................................................................... 39
Implications............................................................................................................................... 41
Limitations................................................................................................................................. 41
Recommendations...................................................................................................................... 42
Resources ...................................................................................................................................... 44
Appendix A: Sample Flyer for Participant Recruitment............................................................... 51
Appendix B: Demographic Questionnaire .................................................................................... 52
Appendix C: Sample Focus Group Questions .............................................................................. 53
Appendix D: Introductory Letter for Participants......................................................................... 54
Appendix E: IRB Approval Letter................................................................................................ 55

Abstract
The aim of this Capstone is to investigate the effectiveness of nutrition programs in schools that
are considered to be primarily low-income, specifically within the public school system of
Austin, Texas. Through personal communication with parents, information was gathered that
gauged the level of effectiveness of their child’s nutrition education based on areas of importance
from previous successful school nutrition interventions. Parents provided conflicting answers as
to how they felt the school met their child’s needs to adopt a healthy lifestyle. With the
respondents ranging in salary, education, and gender, their thoughts on the effectiveness and
transparency of the program at the school varied. While a higher income parent believed that the
school provided plenty of opportunities for healthy eating and healthy lifestyle management, the
lower income parent was unaware of opportunities for learning about healthy food choices.
Following research and investigation, there are recommendations to be considered for a program
that better suits the needs of its students, parents, and the public to ensure healthy communities.
The primary steps needed to be taken to guarantee healthier outcomes for everyone is to establish
multipronged approaches that introduce a number of resources and initiatives to all involved
members. Increasing parental outreach is a primary target for improving the effectiveness of a
program that aims to transform behaviors that are present at school and home. Due to the
occasionally difficult nature of engaging parents in school-related activities, it is suggested that
multiple outlets be available for the level in which parents are able to become involved. In
addition to parent outreach, a second recommendation is to increase visibility. More visible
reminders of healthy choices, as well as activities such as school gardens and field trips, can aim
to educate children by using multiple learning strategies.

Acknowledgements
I owe all of my thanks in the world to the strong women in my life who have supported me in all
of my endeavors. Without my mother and grandmother, I would not have had the strength to
continue and to endure everything that life has thrown at me. They have raised me to be as strong
as I possibly can be, while also remaining my constants in life and my go to person in times of
personal defeat. They take the weight off of my shoulders and lift me up to believe that I am
capable of conquering the world.
I would also like to thank Evan for being the most encouraging father-to-be. Without your
support I would not have had the momentum to tackle a thesis and my soon-to-be motherhood at
the same time. I owe you all of my love for being my partner in bringing a healthy, beautiful
baby into this world.

Chapter 1: Introduction
“Hunger is not an issue of charity. It is an issue of justice.” – Jacques Diouf, Food and
Agricultural Organization Director-General
The purpose of this paper is to examine childhood nutrition programs for low-income
students within Austin, TX. Minority children lead the statistics for malnourishment and obesity
and this injustice remains a problem to be solved. The programs studied will be both government
programs as well as non-profits, and will look within different contexts of community-based
programs versus school-based programs. In addition, the evaluations will look at these programs
within the scope of the greater context of nutrition programs and global hunger/malnourishment,
as well as from a historical point of view.
This study specifically considers the following:
1. As the United Nations recently released the Sustainable Development Goals of 2015,
how are local programs already achieving steps towards these goals? Target 2.1 states
that “By 2030, [the world will] end hunger and ensure access by all people, in
particular the poor and people in vulnerable situations, including infants, to safe,
nutritious and sufficient food all year round” (United Nations, 2015).
2. What programs, policies, and laws exist in Austin to assist schools, families and
community members to know about and reach these goals? Due to the considerable
amount of time spent in school and the amount of influence that a school can have on
a child, this study will make suggestions as to how partnerships can be strengthened
between community and school.
3. In addition, how can schools improve fostering healthy habits for a low-income
population, which tends to have higher rates of obesity and chronic illnesses as a

result of poor nutrition? Exploration of the attitudes, beliefs, and knowledge of
district parents will provide insight into current practices and needs.
With these three considerations, educators may be the best channel for improvement in
school nutrition programs and inspiring healthier lifestyles in their students. This study will
provide a complex understanding of programs created to provide students with the resources
needed to form the habits of a healthier lifestyle. In addition, it will focus on the food disparities
that are present in a city that is highly diversified in terms of income, education, race, language,
and opportunity. This study is able to contribute to the implementation of nutrition programs and
for policymakers to gain a deeper understanding of what works, as well as why programs may
fail. In addition, it will provide an explanation of underlying factors that contribute to the
inability of low-income families to gain access to nutritious food sources.
The first step towards improvement is gathering information on existing awareness and
providing additional knowledge to information seekers. Collecting data and feedback from
parents whose children attend public schools within the metropolitan area will help to gain
insight into how nutrition and healthy behaviors are actually being taught in schools, and how
this curriculum could potentially be built upon. Measuring the current effectiveness of school
nutrition programs is difficult, because of every other factor that impedes a healthy lifestyle.
Specifically seeking out and screening children with obesity and getting a deeper understanding
of their family’s eating habits could be unethical. The risk of inducing feelings of low self-
esteem may not outweigh possible benefits, considering lack of intervention in this study.
However, recruiting parents whose children are the primary recipients of the district’s nutrition
curriculum may provide important data, while also not recruiting based on defamatory
qualifications. It is this reason that parents of children attending a public school, and whose child

also receives lunch assistance, will be the primary source of information for school-based
nutrition programs and how these programs specifically meet the needs of the most vulnerable
student populations.
Historical Context of School-Based Nutrition
Historically, Harry Truman was the first president to involve the government in school
nutrition by establishing the National School Lunch Program (NSLP) in 1946 (SNA, 2015). In
1968 the need for such a program became even more evident as the Citizens’ Board of Inquiry
into Hunger and Malnutrition in the U.S. released findings that “at least 10 million persons were
suffering from hunger and malnutrition in every part of the United States” (Gunderson, 2014,
para. 8). In addition, these findings led to CBS’ release of a documentary further exploring this
issue and requesting the need for a free or more affordable lunch program for children living in
poverty. Since the conception of the NSLP, there have been additional mandates and efforts to
raise awareness for healthier meals. More recently, in 2010 President Barack Obama passed the
law for the “Healthy, Hunger-Free Kids Act,” which provides funding and set policies for
standards of child nutrition programs (USDA, 2014).
While these lunches, as well as many schools that also have existing Breakfast Programs,
must meet certain nutrition guidelines, there are many inconsistencies to be examined. Also,
what entails a nutritious meal and how are these standards created? These school lunches tend to
adhere to recommendations by the USDA, but even these suggestions still pose unhealthy threats
and choices for children to make. One example stated in the Federal Register regulating nutrition
standards includes “Schools may meet the fruit component at lunch and breakfast by offering
fruit that is fresh; canned in fruit juice, water, or light syrup” (Dept. of Agriculture, 2012, p.

4091). Offering students the choice of additional sugar present in even light syrups, and also not
being able to ensure consumption of a fruit serving, shows that there should be not only a
limitation of options, but also accountability for the types of “healthy” foods being offered to
students who may not possess the education to know the healthiest choice. Offer versus Serve
(OVS) is a provision of the NSLP that allows students to decline items offered and is aimed to
reduce food waste (Dept. of Agriculture, 2013). However, for students receiving free or reduced
lunch, they must take at least three items (one of which is a fruit or vegetable), in order for the
meal to qualify for reimbursement. The lunchroom is one place where these types of behaviors
can be influenced, and simply adding items to the menu will not battle the childhood obesity
epidemic on its own. Education, along with multiple other nutrition components, is going to be a
necessity if high-risk individuals living in low-income communities are going to be able to lead
healthier lifestyles.
Barriers to Healthy Lifestyles
Obesity rates tend to be negatively correlated with income, due to a number of factors.
Among these factors include “family schedules, lack of money to purchase healthy food, lack of
time to prepare healthy meals, the accessibility and desirability of unhealthy foods, and lack of
knowledge about the nutrient content of unhealthy fast foods” (Slusser, et. al., 2010, p. 1834).
While addressing the subject of hunger and malnourishment is important, doing so without also
addressing all of the mitigating factors will lead to an unsuccessful endeavor towards improving
nutrition habits and removing food insecurity, specifically for children in low-income
populations.
Food Insecurity and Malnourishment

While the UN addresses both hunger and malnourishment, it is the latter which can often
be the issue with low-income families in the U.S. In a National Geographic story by McMillan
(2014) titled “The New Face of Hunger,” Melissa Boteach, vice president of the Poverty and
Prosperity Program of the Center for American Progress, discusses the paradox that exists
between hunger and poverty. Typically, when most Americans picture the face of hunger, they
are generally imagining children in third world countries, the children featured on commercials
to sponsor a child in need. However, hunger is happening in the U.S., a fact, which many either
chooses to ignore, or to which they are simply unaware. The narrative by McMillan aims to
educate the general public on why and how hunger is occurring in the richest country on Earth.
The fact that one in six Americans are not sure where their next meal will come from or that
more than 48 million Americans rely on government food assistance programs is continuing to
plague children, and contribute to the growing hunger, malnourishment, food insecurity issues in
this country (McMillan, 2014). While many are aware that this is a global issue, bringing this
issue to light on a local scale is necessary to gain the help needed from uninformed individuals.
These government food assistance programs have limits and strict guidelines on what
exactly can be purchased. Many times, as an alternative to buying less food of higher quality,
families often opt to purchase greater amounts of lesser quality. As poor families buy large
quantities of inexpensive food with no nutritional value, they are essentially consuming empty
calories, which leaves them feeling full for less time. As families continue to consume food that
lacks sustenance, their bodies continue to be hungry, as it craves vital nutrients. Childhood
hunger can essentially go unnoticed as overweight children show little signs of having a lack of
food.

In addition, there is often the presence of a “feast or famine” mentality that leads to binge
eating habits in food-insecure children, suggesting these behaviors arise as a result of monthly
food allowances (Dinour, et. al., as cited in Harrison, et. al., 2015). Food allowances are part of a
supplemental government program, WIC, which “provide[s] supplemental foods designed to
meet the special nutritional needs of low-income pregnant, breastfeeding, non-breastfeeding
postpartum women, infants and children up to five years of age who are at nutritional risk”
(USDA, 2015). Food allowances permit purchase of $8.00 worth of fruits and vegetables per
month, in addition to other basic necessities such as whole wheat bread, legumes, eggs, milk,
juice, and cereal (USDA, 2015). WIC vouchers have even been expanded beyond supermarkets
and into the Farmer’s Market. However, food deserts are not addressed among questions
regarding the program, nor is lack of education regarding healthy choices.
Environmental Factors
Another contributing factor to malnourishment and obesity is the ease and affordability of
fast food, as compared to the lack of supermarkets present in low-income, urban neighborhoods.
Food deserts, described as a “location where there are few to no supermarkets or other retailers
that offer fresh fruits and vegetables (FFV) or other healthy food products” (Weatherspoon, et.
al., 2015, 960-61). In addition, Weatherspoon, et. al. (2015), discusses the issue of food retailers,
who are often hesitant to choose urban areas as a location due to high crime rates, lack of
demand for healthy foods, and zoning troubles. Residing in food deserts leads families to make
inexpensive food purchases that often lack dietary value, which further contributes to
malnutrition. Blanchard and Lyson (2006) further state that “Residents of food deserts are 23.4%
less likely to eat the recommended servings of fruits and vegetables per day than are residents
with ready access to affordable fruits and vegetables” (as cited in Weatherspoon, et. al., 2015,

961). Food deserts are just a part of a cycle that can cause low-income residents to continuously
opt for more viable choices for their families.
This epidemic of food insecurity and health issues is not only damaging the lives of
individuals who will be crucial to the future economy. These issues are also damaging to the
current economy as it effects farms, the health industry, and the individuals that are unable to be
productive members of society due to chronic health issues. With global goals in mind, a local
shift towards a community of health conscious individuals must be a top priority. Despite
implementation of government and non-government programs to address food-related issues,
issues such as childhood obesity are still on the rise. Further exploration into the laws, policies,
and programs within Austin, as well as a broader context, will begin to examine the disparities
that are contributing to the inconsistencies in nutrition for children in low-income areas. The best
ways to ensure that all children adopt healthy behaviors are becoming more apparent as more
individuals seek similar justice for students in this disparaged food crisis. Now it is only a means
of taking initiative to begin implementation.
“Hunger is not a problem. It is an obscenity. How wonderful it is that nobody need wait a
single moment before starting to improve the world.” – Anne Frank
The ResearchSite
As reported in the CDC’s 2012-2014 Behavioral Risk Factor Surveillance System, Texas
was one of the top 9 states to self-report high levels of obesity among Hispanic Adults, making
Austin an ideal city to conduct this study. In addition, Hispanics make up for 35% of Austin’s
population, which is also the population among minorities that are most likely to cluster
according to low income (City of Austin, n.d.). The primary reasoning behind Austin as an ideal
research site is the disparity between communities of different wealth and race, leaving Hispanic

disproportionately burdened by barriers effecting access to healthy, fresh foods. With almost a
quarter of the children in the county living in poverty, it is these children who are less likely to
have access to basic needs and who also “tend to be geographically concentrated in areas with
low-performing schools,” making school status an ideal method of sampling (City of Austin,
2013). While some Austin schools may have higher than average low-income populations, the
primary site for data collection is going to be an Afterschool Program specifically intended for
students qualifying for free or reduced lunch.
The Study Design
The study will collect data from parents of students in low-income households. Parents
are typically the primary decision maker for food purchases and meal planning, making them an
ideal candidate for assessing food behaviors. Focus groups will provide information of if/how
their child’s behavior has changed as a result of nutrition education at their school. In addition,
the study will assess if there are critical barriers to making healthier decisions when planning
meals.
Terms
Healthy, Hunger-Free Kids Act: Regulates and sets standards for USDA childhood nutrition
programs to improve nutrition and reduce hunger for children.
National School Lunch Program (NSLP): A federal food program that provides free or reduced-
cost lunch to public schools, non-profit private schools, and childcare institutions in which the
children are residents.
Obesity: “Weight that is higher than what is considered as a healthy weight for a given height”
(CDC).

Offer versus Serve (OVS): Allows students in reimbursable food programs to decline food
offered as a means to reduce food waste.
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): A Federally
funded program that provides services, nutrition education, and assistance with purchasing
supplemental foods to low-income women who are pregnant, breastfeeding, postpartum, and
infants and children up to the age of 5.
Sustainable Development Goals: A set of goals adopted globally to “end poverty, protect the
planet, and ensure prosperity for all” (UN, 2015). Aimed to be achieved within the next 15 years.
Ethical Considerations
The following ethical guidelines were instituted throughout the course of the study:
1. The dignity and wellbeing of participants was respected at all times.
2. The data remained confidential and the researcher obtained permission from the
Afterschool program to conduct the study on the grounds of the establishment.
3. The researcher obtained permission to use statements and data collected from the
participants to present the information under the use of pseudonyms.
Summary
The issues plaguing low-income families, specifically those in minority populations, are
growing more and more detrimental to future health outcomes. Focusing on nutrition and
nutrition education, many of these issues can become minimized and decrease obesity-related
health issues. Barriers effecting specific minority groups are considered and gaining perspective
from affected individuals can provide insight to decision makers for how to better assist under-
served populations. As childhood obesity is becoming more of an issue, educating children on

nutrition is a priority. Assessing the effectiveness of school programs may be the first step in
gathering data to illustrate whether or not legal mandates to support healthier schools are doing
what they are intended.

Chapter 2: Literature Review
Current research on nutrition policies and programs finds that they are not as strong as
they could be, but are very consistent in their recommendations for how to successfully approach
the issue of childhood obesity. It is also clear that the obesity rates and lack of nutrition
education is most evident in low-income areas. In addition, obesity rates are disproportionately
high for minority populations, “Over 40% of blacks and Hispanics were overweight or obese,
compared with 25% of whites” in a health behavior study in a low-SES school (Ranjit, et. al.,
2015, p. 56). Researchers believe that there is not one simple way to solve this problem, but
rather a multipronged approach that will be rooted in a multitude of facets. The depth of change
this issue requires is immense, and a clearer understanding of issues regarding low-income
childhood nutrition including policy changes, community programs, education and curriculum,
school lunch offerings, parental involvement, socio-economic changes (specifically in regards to
food accessibility), and public health will be necessary for successfully developing a stronger
program for reducing the risk of illnesses and problems associated with childhood obesity. Not
only is this topic important from a public health and human rights perspective, but also a
cognitive perspective considering fast food and soda consumption had a negative correlation
with grades (Snelling, et. al., 2015). Since students spend such a large amount of time in school,
this environment is ideal for implementing a program that aims to address such issues.
Nutrition Policy and Legislation
A comprehensive review regarding Texas Obesity Policies of the first decade of the
2000s had been created to discuss the challenges facing the obesity epidemic, and although
constantly changing, many discoveries still prove true. One characteristic seen as absolutely
necessary is the use of partnerships to strengthen individual programs. If approaching from a
broad perspective, Ory, et. al. (2013) believes that “statewide partnerships for leveraging

resources, fostering local policy change, and implementing varied obesity prevention and control
interventions in multiple settings” are key to reducing obesity within individual states,
specifically Texas (p. 419). In addition, Ory, et. al., (2013) further discusses the “governmental-
community-academic partnerships” that have been vital to the strategy up to this point (p. 419).
Not only do Texas politicians believe in the power of partnerships, but also similar knowledge
was presented at a recent World Meeting held in Italy, which discussed the importance of
nutrition on creating a brighter outlook for the future. On an even greater scale, the Simopoulos,
et. al., who wrote the Bellagio Report (2013) identifies the recommendation that “Working with
leaders of national governments, both executive and legislative, and international organizations
such as FAO [Food and Agriculture Organization of the United Nations], WHO [World Health
Organization] and its regional organizations, especially PAHO [Pan American Health
Organization], the World Bank and other agencies of the UN to achieve the incorporation of the
recommendations […] into their policies and programs” will better help to accomplish and create
accountability for confronting this serious health epidemic (p. 420).
Nutrition Policy in Schools
Policies for proper nutrition education are present at the national, state and local level, but
despite these policies very few teachers seem to have a clear understanding for how to teach the
material. As teachers increasingly feel pressure to perform well in educating students on the core
curriculum, very little attention is paid to separate nutrition lessons or incorporating this
information into the regular classroom. McCaughtry, et. al. (2011) states that “Without
institutional coherence and clear directives, health education teachers taught little nutrition
content, primarily due to poor training, professional development, institutional resources and
administrative accountability” (p. 69). An elementary school intervention that took place in a

large urban district found a number of implications present when implementing the pilot
program. Prelip, et. al. (2011) found that “Large school districts […] are unlikely to have the
resources to devote a labor-intensive program focusing on nutrition when there are so many
academic issues competing for resources” (p. 527). In addition, when teachers have already
received so little instruction in their own studies for how to properly integrate nutrition, how can
districts “engage teachers who are overwhelmed with other priorities focusing on the education
mission” (Prelip, et. al., 2011, p. 528). Prioritizing nutrition within the already overburdened
curriculum is a challenge that most pilot programs have faced thus far.
Previous School-Based Nutrition Interventions
One middle school intervention, aimed at increasing fruit and vegetable (F & V)
consumption, used six separate components, with varying groups of students being exposed to
none, some or all of the components. The program consisted of “(1) in-class lessons, (2) after-
school gardening program, (3) farm-to-school, (4) farmers’ visits to schools, (5) taste testing, (6)
field trips to farms” (Evans, et. al., 2012, p. 608). Also, “inadequate fruit and vegetable (F & V)
intake is a significant dietary risk behavior for the development of obesity and other chronic
diseases” both foods that are found to be consumed in lower quantities in low SES populations
(Bazzano, 2006, as cited in Evans, et. al., 2012, p. 608). This intervention not only used an
educational and hands-on approach, but it also incorporated cognitive behavioral methods to
increase motivation and self-efficacy. The primary finding was at post-test, in which the
researchers found that “Compared with students who were exposed to fewer than two
components, students who were exposed to two or more of the components scored significantly
higher on the F & V intake, self-efficacy, and knowledge […] and significantly lower on the
preference for unhealthy foods” (Evans, et. al., 2012, p. 613). Based on these results, it was

apparent that a school nutrition program would need to incorporate a number of components in
order to have a significant effect on child and adolescent behavior in regards to healthy eating
behaviors. However, with findings such as one from the National Secondary School Survey from
2010 “that U.S. middle and high school students attending low SES schools and majority
Hispanic and Black schools were less likely to have salads offered at school,” how can school
teachings coincide with what is being offered in the lunch line, especially when choices are
dictated by a federally funded program (Springer, et. al., 2015, p. 8)?
Aside from the traditional school setting, other studies have branched out to attempt to
implement nutrition programs in other settings that may benefit from such education. One
program called Cooking, Healthy Eating, Fitness and Fun (CHEFFs) began by running the
program in two afterschool programs in urban homeless shelters. The 15-week program included
curriculum intended to “ increase (1) knowledge of nutritional recommendations, (2)
understanding the effect of nutrition and physical activity on health, and (3) awareness of and
self-efficacy in making healthier choices” (Rodriguez, et. al., 2013, p. S362). Although the
participants exhibited aversive behaviors when introduced to unfamiliar foods, “facilitators
found that when children engaged in food preparation, they were more likely to try and enjoy
new foods” (Rodriguez, et. al., 2013, S364). While this study may be difficult to generalize to
other populations, many similar behaviors were found to be present in homeless children, which
could also be evident in children of low-SES. Rodriguez, et. al. (2013) observed children
discussing circumstances such as “lack of financial resources, facilities to store and cook food,
and access to fresh fruits and vegetables” are all scenarios that could potentially be evident in
homes of families also living in poverty (S364). Not only did children exhibit unhealthy eating
habits, but they also had underlying themes appear in their discussions that could be seen as

bizarre. One example of this appeared in a conversation regarding the benefits of healthy eating
and many children discussed that “being overweight would help them survive a disaster that
would leave them stranded without food for a long time” (Rodriguez, et. al., 2013, S364). This
thought process is very skewed from the typical theory of ‘survival of the fittest,’ which many
are accustomed to believing that it is the most physically fit people that will thrive in a disaster-
stricken environment.
Evaluating Nutrition Programs in Schools
If nutrition programs are inconsistent and ineffective, how can this data be evaluated and
monitored for continuous improvement? Public health officials in New York used the Wellness
School Assessment Tool (WellSAT) to assess overall “strength and comprehensiveness of
elements of LWP [Local Wellness Policies] required by the Child Nutrition and WIC
Reauthorization Act of 2004” (Brissette, 2013, p. 758). The use of this tool, they believe, will
create a standard that could “better enable them to illustrate the strengths and deficiencies of
policies within an LWP” (Brissette, 2013, p. 758). Not only are school nutrition programs poorly
monitored, but government programs that provide supplemental nutrition are also being
monitored using an algorithm that mitigates many outlying factors. The federal poverty
guidelines are using a 50 year old metric that “does not reflect: 1) greater rates of inflation of
prices for other essentials, 2) differences in the income distribution over time, or 3) price or
income differences across different locales” (Anthony, et. al., 2011, p. 2007). Furthermore,
research by Anthony, et. al. (2011) examines the inability of programs to address more than a
single domain effectively. While “small effects of the federal school lunch programs on the basic
nutritional status of the child” have been found “it is less clear […] how well the federal food
programs address food insecurity and hunger” (Anthony, et. al., 2011, p. 2003).

The Healthy Home Survey (HHS) is another tool that can be utilized which “measures
characteristics of the home environment that are hypothesized to influence healthy weight
behaviors in children, including diet and physical activity” (Chuang, et. al., 2013, p. 271). The
Nutrition Screening Form is another self-report method that measures similar data, including
specific questions such as “Does your child eat while watching TV?” (Chuang, et. al., 2013, p.
272). This behavior was found to be highest among African-American preschoolers, and also has
shown and even stronger correlation in adolescence with consumption of sugary beverages
(Chuang, et. al., 2013). Unfortunately, unhealthy behaviors may be even higher than what is
reported, as social desirability is taken into account. In addition, parents who are wanting to
introduce healthy behaviors into their home may be more likely to participate in this type of
study. While currently these tools are mostly being used to assess families that are participating
in related studies, these could be used to measure longitudinal data to help improve school
nutrition programs.
Food Assistance Programs for Low-Income Families
For families depending on government assistance to provide food, it is not only the
school lunch program that needs to be taken into account, but also programs such as the Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC). This program can be
vital for food purchases that often determine the eating behaviors that young children are going
to develop. In addition, “Studies have found a link between maternal weight status and child
obesity levels” (Chuang, et. al., 2013, p. 275). There have been many studies examining the food
environment and different food shopping outlets surrounding low-income neighborhoods, as well
as the food outlets directly surrounding the school. Low-income schools were found to have

more access to food outlets to make purchases before and after school, including many stores
that accepted WIC vouchers. However, Tester, et. al. (2010) found:
Schools near higher-income schools had significantly higher scores in the healthy
beverages/low-fat dairy and healthy snacks domains. For example, low-fat or
skimmed milk was found in 45% of the higher income stores but was not found in
any of the lower-income stores. Low-fat crackers and granola bars, each an
example of items on the healthy snacks domain, were found in 69% and 44%
respectively, of the higher-income stores but in only 31% and 21% of the lower-
income stores (p. 962).
A similar study in Baltimore City, an urban area with approximately 21% of its residents
living below the poverty line, found that “Black youth (ages 10-14) […] reported that they spent
an average of $3.96 per day at corner stores, carryouts, and fast-food outlets, typically
purchasing chips, candy, and soda” (Rossen, et. al., 2013, p. 654). Another finding that is
measured against comparisons to high-income, white residents is that “lower-income,
racial/ethnic, […] populations in the United States (US) generally have less access to healthy
foods and are faced with higher prices and poorer product quality” (Tisone, et. al., 2014, p. 726).
These data can be pertinent to shaping the food environments around schools and in low-income
areas, and further examinations of the amount of low-income children that walk to school and are
therefore more susceptible to these unhealthy food outlets.
Parental Influence on Childhood Nutrition Habits
Another strong predictor of a child’s nutritional behaviors is going to be the knowledge
and behaviors of their parents. This is a topic that has been given much thought, however,

understanding the long-term effects of implementing a parent education program can be difficult,
and can often have many limitations. With the strong effect that modeling can have on young
children, it is stated that this is “providing opportunities for children to observe their parents
eating healthy foods or engaging in physical activity, serving appropriate portion sizes for age
and setting limits for dietary intake” (Slusser, et. al., 2010, p. 1833). This specific study focusing
on parents from a district that is predominantly low-income and Hispanic/Latino, found that not
only were parents often unreceptive, due to sensitivity of their child-rearing skills, but also
“challenging because of competing time commitments and priorities, unstable schedules and lack
of transportation” (Slusser, et. al., 2010, p. 1834). A similar study by Power, et. al.(2010) (as
cited in Slusser, et. al., 2010), found that “parents blamed their children for their unhealthy
behaviour, making references to poor appetites, picky eating, preferences for junk food and fast
food, and resistance to parental attempts to encourage healthy behaviors” (p. 1834). A
contradicting finding in a study of Mexican immigrant women living in South Texas, a
population with one of the highest obesity and Diabetes rates in the country, had the common
discovery that these mothers who were very devoted to the happiness of their children often
“may not place a priority on their own health [and] do not consider their own health as essential
for ensuring their children’s health” (Johnson, et. al., 2011, p. 13). Given that obesity rates are
higher among minorities living in low-income areas, the parents of this particular group should
remain a target for educating about healthy behaviors and finding effective ways to influence
food choices.
Youth-Targeted Food Marketing
Relative to public health policy, there is one issue that is often being argued as to whether
or not it is constitutional, or if this practice should be abolished for the sake of public health and

the wellbeing of children. Advocacy groups are working effortlessly to attempt to “prevent the
publication of guidance that would limit the marketing of unhealthy foods to children by 2016”
(Roehr, 2012, p.1). This would include, but not be limited to, advertising and social media. The
disagreement lies mostly within the food industry, as this would have a great effect on the intake
of certain very profitable crops such as sugar, corn, and wheat, among many others. Others, such
as the Grocery Manufacturers Association, have stated that limiting such marketing is
““extreme,” “fundamentally flawed,” with “no basis in scientific evidence,” and “reflect an
unwarranted bias against prepared, value-added foods”” (Roehr, 2012, p. 1). While the amount
of marketing directed towards children has been steadily decreasing, it still warrants public
awareness.
In discussing the $2 billion a year industry, Margo Wootan, spokesperson for the Center
for Science in the Public Interest, states that “it shapes the whole way they expect to be fed, it
defines the whole social norm… This is a way of cultivating a way of thinking about food among
children that undermines their health, and eventually, quite frankly, will kill them” (as cited in
Roehr, 2012, p. 1). It is suggested that simply educating the public and children in schools may
not be enough to improve overall health, but also a global commitment to understanding the
“contextual influence of the built environment […] and its influence on dietary patterns”
(Morland, et. al., 2007, p. 1481). This is no longer an issue of extremism, but rather being
concerned about the outcome of the public’s health to which there is minimal longitudinal
evidence that states whether or not an entire culture of unhealthy habits can be prolonged.
Study Overview
While current research is focusing primarily on creating and adapting effective childhood
nutrition interventions, the program’s long-term effects are still unknown. Without this

information to inform policymakers, it is essential that all involved parties become further
educated on the dangers of childhood obesity and other food-related health issues, as well as the
benefits of maintaining a healthy lifestyle. Providing information to parents and teachers that are
more comprehensive in explaining who is most affected, and how these target populations can
minimize these effects. Advocacy and education are essential if nutrition programs are to become
more comprehensive and effective at lowering the risk of obesity-related health issues later in
life. Parental attitudes and understanding is an important first step in acknowledging where gaps
exist between policy and practice.

Chapter 3: Methodology
Introduction
Currently in the United States an estimated one-third of children and adolescents are
either overweight or obese (Snelling, et. al., 2014). This number is also disproportionately
distributed among minorities, specifically African Americans and Hispanic children, who suffer
about a 10% greater risk than White children, 26 %, 27.7% and 17.4% respectively (Chuang, et.
a., 2013). Taking into consideration the projected economic costs this obesity epidemic could
potentially inflict on the U.S. economy, as well as growth in chronic illnesses, more drastic
measures to change the current state of health must be taken.
In order to begin targeting the issue of child nutrition, behavioral change must be a
priority within school nutrition programs. For schools to begin adopting more comprehensive
nutrition programs, leaders need to become more aware of the most effective practices in
education and how nutrition education can be implemented into the curriculum to reverse the
obesity epidemic that has overtaken the country. While this issue is only further worsened by
food costs, marketing towards children, and food deserts in minority areas, schools can be an
environment where children can begin learning how to alleviate these other factors and attempt
to make healthier choices. With educators as the foremost leaders in these efforts, practice may
influence policy as the shift in healthy food demands begins to further effect the food market.
As is evident, this proposal is not one that can be approached from a single perspective,
but rather a complex system that involves multiple stakeholders to gain an interest in revolution
of current nutritional habits. In an effort to understand current school nutrition programs and how
they compare to policy standards, this study measures behaviors in families with children in an
urban school district in Central Texas, whose children also receive assistance through the

National School Lunch Program (NSLP). While previous studies have measured nutrition
programs in other high minority, urban areas, this study is unique in that a proportion of students
are from non-English speaking, immigrant homes, as is evident from the district’s Title I Migrant
Education Program. As of 2010, the district contained 36.5% Hispanic students, and while their
immigrant status is unable to be directly gathered from available data, it is possible that many of
the students are first generation Americans.
Parental attitudes and knowledge of nutritional practices within their child’s schools will
measure the generalization from school to home of programs that are currently being
implemented. In addition, the study will assess their current food shopping and meal preparation
habits and how they model healthy behaviors for their children. Most interventions hypothesize
that evidence of healthy food choices as well as an understanding of nutrition education are not
present and that school nutrition programs are not combining multiple approaches as a best
practice to most effectively target unhealthy behaviors. Most importantly, where do the gaps
exist between policy and practice and can a greater understanding of these gaps increase
application?
Method
Based on previous nutrition program studies, this study adopted similar techniques to
measure current behaviors surrounding nutrition in a district, focusing specifically on the
district’s Title I schools with high concentrations of minority students. Many of the measures
were created using a basis of the Healthy, Hunger-Free Kids Act of 2010 that promotes access to
nutrition for all children to allow them to grow into healthy adults.
Setting

The setting was an Afterschool Program for students currently attending a Title I school
within the Austin Independent School District (AISD). In addition, students must qualify for free
or reduced lunch. This setting allowed the researcher to identify parents who had students
attending the program.
AISD Facts and Figures (obtained from AISD- About Us)
 Enrolls approximately 84,000 students within 130 schools, primarily in urban
communities
 Graduation rate of 86.3%
 Ethnicities Represented: 59% Hispanic, 26% White, 8% African American, 7%
Other
 52% of students are Economically Disadvantaged
Participants
The study approached a small group of parents whose children attend an Afterschool
Program. The initial contact was made with administrators to gain an understanding of
expectations for nutrition within their own program, as well as to provide an introduction into the
current study. After providing details of the study to administration, permission was asked to
distribute or post a flyer, which requested parents to participate in a study regarding student
nutrition (See Appendix A). In addition, the flyer included information regarding a small gift, for
which the value did not exceed $10, which would be distributed at the end of the ~30-minute
focus group session.

Participant retention proved to be very difficult. With a total of 5 committed and 1
maybe, only three participants had shown up for the focus group. However, 1 of the participants
was unable to stay, but was able to fill out a demographic sheet. Due to lack of other information
about the participant or responses to the focus group questions, her information was not included
in the final comparative study.
The other two participants had shown up 15 minutes apart, and due to the time frame
allotted for the group, the study ended up being two separate interviews, rather than a focus
group. In addition, one of these participants ended up not fully meeting the eligibility
requirements, as her family did not receive any government food assistance. While the situation
was not as ideally intended for the study, the information gathered proved to provide a
comparison between low-income and non low-income parents and their experiences and
knowledge about the nutrition programs at their child’s school.
Measures
The focus group was centered on a core set of questions that allowed for additional
discussion. The questions, which were created for the purpose of this study, modeled many of its
questions off of the principles of the Healthy, Hunger-Free Kids Act. The Healthy Home Survey
(HHS), which contains 113 items, would have been appropriate, but access was not available. In
addition, to ensure a higher response rate, the study did not use the HHS for the concern that the
questionnaire would appear too time-consuming to participants. The focus group participants
were each provided with a 5 question demographic sheet at the beginning of the session, which
remained anonymous (See Appendix B). An additional 11 questions were asked openly by the
researcher, which assessed behaviors and knowledge surrounding nutrition knowledge, student

behaviors, personal health habits, and parental outreach for nutrition education (See Appendix
C).
Procedures
A letter was provided to all potential participants at the beginning of the session to
explain the study and provide contact information for questions, concerns, or opportunities for
additional follow-up (see Appendix D). In addition, the letter explained that the participant is
free to leave at any time or refrain from answering any questions that make them uncomfortable.
All participants had previously granted permission during the initial sign-up process. The session
itself had the researcher direct initial conversation by introducing a question, and then allowed
participants to speak freely about the topic.
Data Analysis
Focus group results will measure reported behaviors as well as attitudes and
understanding of current nutritional programs within their individual schools. Responses that
may be included in interviews will also be analyzed for frequency. Data will provide a glimpse
of the district’s overall commitment to providing low-income students with proper education to
reduce unhealthy food behaviors.

Chapter 4: Findings
The findings showed the inconsistency of knowledge in regards to programming and
nutrition information. Parents were unaware of what information was being offered to their
students, however they explained healthy habits within their own homes and within their food
purchases. In addition, parents seemed to believe that the majority of education about
maintaining a healthy lifestyle is a practice that should be primarily within the home, rather than
the school. The parents also explained that their children were aware of the consequences of
making unhealthy choices, however, the majority of these answers were not expanded upon. The
parents themselves came from different backgrounds, which also affected their experiences and
understanding of the different activities and information being offered within the school. The
following information provides a more comprehensive depiction of nutrition within schools and
how a variety of factors support, promote, and affect, both positively and negatively, the
programs’ overall effectiveness.
Results
Policies and Programs – Local and State
A program created in 2008 by the Dell Children’s Medical Center of Texas found that
“approximately 35% of the students in grades 3 to 12 are overweight or obese in Austin ISD
alone” (Dell Children’s, 2008). That statistic, along with other noticeable obesity trends, is what
led researchers to form the Texas Center for the Prevention and Treatment of Childhood Obesity.
In addition, the National School Lunch Program (NSLP) currently provides free or reduced-cost
lunches to more than 3 million children in Texas alone (NSLP, 2015), further reiterating the
importance of providing healthy options that are eligible for purchase within the NSLP.

Additional research into the political climate of the state of Texas provided a framework
for the overall commitment to nutrition within schools. The 84th legislature of Texas proved to be
mostly of a loss to the state’s advocates for healthier food choices for low-income families.
House Bill 1616, which would have incentivized food stamp recipients to shop at local farmers
markets, was left in a pending status (H.B. 1616, 2015). Among this bill was another that failed
to be passed which would have provided incentives to grocery stores for opening locations in
food deserts (H.B. 269, 2015). However, one bill had been supported for passing which allowed
schools to opt out of the National School Breakfast Program, which tends to inflate food costs,
and instead “develop and implement a locally funded program,” however in doing so the school
would also lose federal funding dollars (H.B., 1305, 2015). In addition, this new locally funded
program could lead to more flexibility in implementing appropriate nutritious meals. All of
which would likely first need to be approved by the School Health Advisory Committee
(SHAC), a board that was established in 2001 by Texas Senate Bill 19 (SB 19) mandating that
every school in the state create such a team that promotes health and nutrition initiatives within
each school (CDC, n.d., p.1).
A further look into nutrition programs at a local, state and global level showed that many
programs are available to assist in maintaining and educating families on healthy lifestyles and
nutrition choices. The detailed chart below (Figure 1) provides an overview regarding programs
and their location, their target audiences, their target audience, the organization’s primary goals
(which were taken directly from the organization’s website/about me page), and different
activities or events in which the organization is involved or sponsors. The organizations included
are all programs with a focus on poverty/hunger reduction or aiming to promote healthy
lifestyles and nutritious diets.

The organizations included in the chart below primarily focus on targeting low-income
audiences. In addition, the researcher primarily chose to include organizations whose emphasis
lies within the family structure or children. Program, such as CATCH, attempt to target the
whole system (i.e., school, family, self), whereas other programs may have more specific targets.
The organizations are all very different from one another, specifically within the activities each
group performs, as will be evident in the chart below. Of course some organizations are also
going to leverage more power than others, due to funding sources, ability to market, visibility,
manpower, and whether or not the program boasts an interest from the public.
Figure 1, while not inclusive of all programs available, were the programs in the area,
which were easily accessible without inconvenient navigation that may be more difficult for
purposes of an individual’s needs, rather than research purposes. The chart allows the reader to
understand what opportunities may be available for low-income individuals in this particular
metropolitan area. While their availability exists, whether or not its target audience knows their
existence is an area of concern.
Organization Location Target
Audience
Primary Goals (Taken
directly from org's
website)
Activities
MEND of YMCA
Austin
Austin,TX Children 7-13
and their families
Childhood Obesity
Intervention for Children
and Parents, Reduction in
Screen Time,
Improvements in Body
image and self esteem
Healthy Eating,
Regular Physical
Activity,
Behavior
Change
Austin Academy of
Nutrition and
Dietetics
Austin,TX Community
Wide
Helping the Austin
Community achieve a
healthy and nutritious
lifestyle through proper
eating habits
Events held are
primarily for
field
professionals

Global Nutrition
Empowerment
Global Underserved
areas, globally
Reducing preventable birth
defects and improving
maternal and child health
through micronutrient
supplementation and
nutrition education in
underserved areas of the
world
Build
partnerships
with local
NGOs, Develop
culturally
sensitive
educational
programs related
to nutrition and
micronutrients,
provide local
mentorship and
supplies
CATCH
(Coordinated
Approach to Child
Health)
Global, but
founded in Austin
EVERYONE,
Programs for
Pre-K, K-5, 6-8,
Afterschool, and
Training
Programs
CATCH is based on the
CDC Whole School, Whole
Community, Whole Child
model in which health
education, school
environment, and
family/community
involvement work together
to support youth in a
healthy lifestyle.
One of the ways
in which
CATCH
supports child
health is through
nutritional
coordination
with school
lunchrooms and
other food
providers.
City of Austin-
Bright Green Future
School Grants
Austin,TX Schools-
Teachers & Kids
Austin area students,
teachers and parents have
envisioned a bright green
future through a variety of
hands-on learning projects
that encompass composting
systems,rainwater
harvesting,organic
gardens,rain gardens,bike
academies, wildlife
habitats,etc.
Provide funding
for sustainable
projects and lead
schools in
hands-on
learning
projects.
KIPP: Austin (Health
& Wellness Policy)
Austin TX, other
programs
throughout US
Community
Wide
KIPP Austin Public Schools
Board recognizes that there
is a link between nutrition
education, the food served
in schools,physical
activity, and environmental
education, and that student
and staff wellness is
affected by all of these.The
Board also recognizes the
important connection
between a healthy diet and
a student’s ability to learn
effectively and achieve high
standards in school.
Survey students
twice a year
regarding food
choices in
cafeteria.

TX Dept of
Agriculture
TX State wide Provide administration and
oversight for 12 federal
nutrition programs
throughout Texas.
Encourage Texans to
consume foods produced in
Texas and to support and
understand local agriculture
and how it affects the
economy. Works with
elected officials to share
and promote best practices
to ensure a healthy state.
Farm Fresh
Fridays, Urban
Schools Ag
grant, 3E's Grant
Program, Farm
to Child
WeViva Austin,TX Community
(Low-income)
WeViva provides
affordable and accessible
fitness and nutrition
programs to people in low-
income communities
throughout Austin.
Zumba, yoga,
strength training
and nutrition
classes free
Capital Area Food
Bank of Texas
Austin,TX Community
(Low-income)
The rising cost of housing,
utilities, transportation and
healthcare leaves many of
our neighbors to make
impossible choices and
painful sacrifices. Two-
thirds of the people we
serve say they had to
choose between buying
food and paying for
housing in the past year.
Eighty percent say they had
to choose between food and
medicine.
Kids in the
Kitchen, Eat
Well Play Hard,
etc.
Sustainable Food
Center
Austin,TX Community
(Low-income)
Through SFC's The Happy
Kitchen/La Cocina
Alegre®, SFC offers
community cooking and
nutrition education classes
for the preparation of meals
that are delicious,
nutritious, seasonaland
affordable, ensuring lasting
dietary changes.
Happy Kitchen
Figure 1 – Health & Wellness Organizations (All organization websites listed in resources)
In order to understand the potential usefulness of these programs, parent interviews were
seen as necessary to gain an understanding from parents as to what their current knowledge or
programs and nutrition is currently. While none of the organizations above were mentioned
within the interviews, the parents may have had knowledge of the programs without finding their

mention noteworthy for the purpose of this study. Many of the program’s activities were briefly
mentioned within the questions asked in the interview. One example is that the Capital Area
Food Bank and the Sustainable Food Center both offer cooking demonstrations, as well as
cooking classes, both activities that parents stated were unavailable in their children’s school, to
the extent of their knowledge.
Parent Interviews
As will be evident in the comparative chart below (Figure 2), differing gender
demographics were both represented in the study, as well as income and education level
differences. Both parents interviewed in this study were Hispanic or Latino, which accounted for
60.4% of all students in the Austin Independent School District in the 2012-2013 calendar school
year (Austin ISD). The specific elementary school in which the study took place is 91.4%
Hispanic for the 2015-2016 school year, with 94.9% of students being categorized as
“economically disadvantaged” (Austin ISD). Parental age was not seen to be an important piece
of data required for this study and that information was not gathered. This research primarily
focused on effectiveness of nutrition programs for low-income schools, so household income
was the primary data piece that was most important to gain perspective within this study.
A side-by-side comparison displays insight into how each parent believes the school
performs on a variety of different nutrition-based responsibilities, as well as the information the
school provides.
Demographics/Questions Parent #1 Parent #2
Gender Female Male
Highest Level of Education Bachelor’s Degree High School Diploma
Total Household Income Above $60,000 $20,000-$40,000
Race/Ethnicity Hispanic or Latino Hispanic or Latino
# of Children in household under 1 3

age 18
Government Food Assistance None Supplemental Nutrition Assistance
Program (SNAP)/Food Stamps,
Free & Reduced Lunch
Does your child’s school promote
health and well being to all
teachers and students?
“I think so” “Um, I’m not sure”
Does your child’s school offers a
variety of healthy lunch options
for students?
“As far as I understand,yes.” “Not that I’m aware of”
Is your child aware of the effects
of making unhealthy food
choices?
“Yes” “Yes”
Does your child’s school educate
students about healthy behaviors
and how to maintain a healthy
lifestyle?
“From what I understand,yes.” “Yes”
Does your child’s school have a
clear, designated staff member
who is responsible for ensuring a
healthy environment or that you
can ask health questions?
“I really don’t know” “I would hope its Ms [name
removed], she’s the gym teacher I
believe”
Do you provide healthy food
options at home for your
children?
“mhmm” “Yes”
Are you aware of your child’s
school’s Local Wellness Policy
(LWP)?
Did not ask. Did not ask.
Does your child’s school include
families and other community
members in ensuring that our
students maintain a healthy,
nutritious lifestyle?
“I think so” “Yes”
Does your child’s school hold
events such as food
demonstrations, taste testing,
recipe contests, farm visits, school
gardens, etc?
“Not all of that but I know that they
do speakabout it, have had talks
with the parents,and there’s also
information”
“No, Boys and Girl’s club yes,they
have a garden out here, but as for
the schoolI don’t believe so”
Do you feel that schools or
parents should be primarily
responsible for a child learning
healthy behaviors?
“Home” “Yes” (Did not specify which of the
two should hold primary
responsibility)
Does your child ever discuss any
nutrition related material they
learned at school?
“Yes” “No”
Does your child help in picking
out foods for meals, and if so, are
they able to make healthy
choices?
“Yes, mixed [choices]” “Sometimes, ummm fruits and
vegetables… fruits yes, and then
the sweets come into play as well”
Figure 2 – Nutrition Program Experience Comparison

The specific school that was included in parent interviews does currently have
performance objectives listed on their website, which includes specifically to “ensure compliance
with nutrition and staff wellness guidelines” (Austin ISD). Many of the strategies listed on this
sheet were unknown to the parents interviewed. Specific strategies include nutrition classes for
adults, as well as the presence of a wellness committee, both topics that the parents interviewed
did not mention. The objectives also state that the school’s measurable targets include 100% of
students participating in nutrition lessons. Lastly, they listed include case management for
students listed within the 85th to 99th percentile for obesity to provide health and wellness
information to maintain a healthy weight. The parents were not questioned about the weight or
physical characteristics of their children, and case management services were not mentioned
during the interviews.
Analysis
Based on the answers given by the two parents, many of their answers were similar,
while many also conflicted. Both parents seem to provide healthy options in the home and
include their children in food purchases. In addition, both parents seemed to agree that most of
the influence for healthy behaviors should be the responsibility of the parents. Another area in
which both parents were in agreement was that they were unaware of a designated staff member
to provide information and resources about healthy lifestyles. The school seems to be lacking in
activities promoting healthy lifestyles, specifically in tactile learning activities such as gardening,
food demonstrations, farm visits, or education from local farmers.
As for lunch options, the parent whose child does not receive free or reduced lunch stated
that there are healthy options available at lunchtime. On the other hand, the parent whose
children receive assistance was unaware if the options included within this lunch program are

nutritious. The responses also indicate that the higher income parent is more aware of
information provided and the nutrition curriculum present in the school. Prior to the beginning of
the interview she had also briefly discussed another ongoing research project with a local
university in which the students have their weights recorded and continue to be monitored for
changes. The parent who reported a lower income had not heard previous information about any
nutrition lessons within school, nor was he aware of any initiative to promote health and wellness
within the school to all staff and students.
Despite the vast array of community programs intended to promote nutrition and
activities for health and wellness, the parents had not mentioned any of these programs, nor did
they mention programs they are designated to work directly with the school for these purposes.
The interviews had not asked about programs outside of the school, due to the school nutrition
programs being the primary focus of the research.

Chapter 5: Discussion
Conclusions
The research previously found guided the interviewing process when speaking with
parents about their understanding and knowledge of the programs currently present within their
children’s’ schools. A goal of the research was to assess the policies within both the state and
country, which should be regulating the amount of access to health and nutrition education that
students are receiving. However, due to minimal parental knowledge of nutrition programs in
their children’s school, it seems as though this topic continues to fall wayward to core subjects
such as math as reading. While these subjects are, of course, foundations for building a proper
education, without proper nutrition and a healthy lifestyle, their existence may lack relevance if
they are coming second to health issues or lack of focus due to malnourishment. With only
research from previous interventions to follow, these interviews contributed additional
perspective into the breadth of knowledge that parent have when it comes to their child’s
school’s stance on issues of nutrition.
The first research question presented in Chapter 1 focused on how local programs are
working towards achieving goals that relate to the reduction of hunger and poverty, as suggested
by the United Nations. As previously stated 94.9% of students at the specific school where
interviews took place are economically disadvantaged. The majority of the population continues
to live in poverty, to what degree was not discussed. The second research question asked what
programs, policies and laws exist in Austin to assist schools and communities? While
government programs are providing assistance for low-income individuals to purchase meals, the
quality of these meals seems inconsistent or unknown to parents. In addition, community
partnerships and organizations seem to be unknown amongst much of its target audience. Lastly,

the research asked how schools could improve fostering healthy habits for low-income
populations. Based on the responses in the parent interviews, the recommendations listed below
were formed in regards to their observations and experiences.
Overall it seemed that the parents interviewed had little understanding into the full depth
of the nutrition program being offered within the school. This specific school does have health
and wellness goals for 2016, as listed in the Parent Interviews section in chapter 4, though
neither of the parents mentioned any of the goals outlined in the school’s plan. In addition,
neither parent provided additional information that expanded on many of the questions asked in
the interviews. This led the researcher to believe that the proposed programs may not be
available, or the programs that are available do not provide adequate outreach. After further
investigation, it seemed that while there are goals outlined on the school’s website, these
activities are not necessarily being translated into programs, nor was their information that
expanded on concrete ways to achieve these goals.
It seems as though the parent with low-income was unaware of lunch food offerings, as
well as hearing children discuss nutrition information from school. Also, the parent with median
income discussed that information is provided to parents, which the low-income parent did not
mention. The demographics of the two interviews suggests that there are families coming from
different income backgrounds, and these two groups may be inconsistently aware of nutrition
education and programs being available to their children. The findings led the researcher to
believe that while the experience is not significantly different between the two parents, based on
income, the low-income parent is slightly less aware of the nutrition program taking place at his
children’s school. The two possible reasons could be means for future research. Whether
programming targets their communication at different parents is the reason for lack of awareness

within the low-income family, or whether there are differences in priority. Due to low participant
enrollment, these questions could be discussed further with a larger participant pool.
Implications
The field of Education Improvement and Transformation often focuses many of its efforts
on disadvantaged schools that lack the same opportunities and outcomes as schools that may be
in better neighborhoods, or have more funding. This research may provide further background
for future efforts in improving nutrition programs in schools and monitoring effectiveness to
seek out best practices. In addition, the field of education reform, as well as other professionals
in education, may recognize the importance of nutrition and how it can cause an umbrella effect
for student’s overall performance. Hungry children will have more difficulty concentrating on
topics such as math or reading, so nutrition should be seen as a condition for school
transformation and an area of possible improvement.
Limitations
While the research provided many details and a comprehensive look into the topic of
nutrition within AISD schools, there also remained a number of limitations that could have
boasted more results to suggest further recommendations. The primary limitations were a result
of lack of retention for study participants. The study hoped to gain 5 participants who would
answer a series of questions in a group setting and create a dialogue discussing their differences
in experiences. Due to the actual outcome of only having 2 participants present, as well as their
arrival times being inconsistent, the study became separate, individual interviews. The nature of
the questions then, did not result in the dialogue expected, and rather resulted in many closed-
ended answers.

Another limitation to the study was the inability to study directly within the schools but
rather having to go through an outlet that was an organization that worked with the schools.
AISD has a strict request for research policy, for which this research was ineligible. In addition,
response rate from organizations was very low and it was difficult for the researcher to find
willing participants to be involved in the research.
Recommendations
Due to the differences in experience of the parents, and the gender and income
differences, this specific research was focused on understanding differences based on income,
specifically. Whether these differences in experience are due to income or gender could be an
opportunity to future research. In addition, future research could expand to examine the
programs within all of the schools in AISD, rather than just one. Although the majority of
AISD’s schools are disadvantaged, there are also a few that are in median-high income
neighborhoods. Whether or not there is a difference in nutrition education and lunch food
quality/options could be a topic for future research.
Recommendations for improving the program’s effectiveness are based upon the parental
experiences as well as previous successful strategies from other interventions. First and foremost,
parental outreach needs to be a number one priority if building healthy lifestyles is going to be
successful, due to the carryover effects between home and school. Due to the differences in level
of involvement and opportunity between each parent, there needs to be a variety of ways in
which parents can become more aware and adopt simple strategies into their own home. One
option could be a resource center to provide parents with literature about programs, events,
organizations, etc. whose aim is to improve health and nutrition. This could be a physical space,

such as a school lobby, or a website. Parent surveys and newsletters could be another outlet to
gain insight into current habits and knowledge of nutrition programs, and to build lessons for
students based upon this information. There could also be weekly homework assignments that
students take home and complete with a family member. These could provide educational
passages about healthy food choices and quiz the students at the end of the reading. After
completion the student could receive a healthy prize, such as a piece of fruit.
Visibility is another area that is recommended to improve. The parents in the study
seemed unaware of any visual or tactile type of activities that provide hands-on learning
opportunities for students. Many successful interventions from other schools have included
implementing field trips to farms, having a farmer visit and educate students about agriculture,
cooking demonstrations, and healthy food taste testing so students are exposed to a variety of
fruits and vegetables that may be novelty items. Another often-successful program to implement
is a school garden. This sustainable learning experience also provides students with the tools and
knowledge they need to reproduce something similar at their own home.
This research provides a guide for researchers to replicate for future studies and to gain a
more comprehensive understanding of an effective nutrition program. With each intervention or
research that seeks to gain further comprehension, the field will hopefully grow more extensive
and understood as an area that encompasses much more than just what we eat. Rather nutrition
has expansive benefits and consequences for everyone and can make a difference in the daily
lives of individuals.

Resources
AAND. (2012). Austin Academy of Nutrition and Dietetics. Retrieved from:
http://eatrightaustin.org/
Anthony, E. K., King, B., Austin, M. J. (2011). Reducing child poverty by promoting child well-
being: Identifying best practices in a time of great need. Children and Youth Services
Review, 33, 1999-2009.
Austin Independent School District. (2015). About Us. Retrieved from:
https://www.austinisd.org/about-us
Brissette, I., Wales, K., & O’Connell, M. (2013). Evaluating the Wellness School Assessment
Tool for Use in Public Health Practice to Improve School Nutrition and Physical
Education Policies in New York. Journal of School Health, 83(11), 757-62.
Capital Area Food Bank of Texas. (n.d.). Learn More. Retrieved from:
https://www.austinfoodbank.org/learn-more
CATCH. (2016). Coordinated Approach to Child Health. Retrieved from: http://catchinfo.org/.
CDC. (2015). Prevalence of Self-Reported Obesity Among Hispanic Adults by State and
Territory, BFRSS, 20142-2014. Retrieved from: www.cdc.gov/obesity/data/table-
hispanics.html.
CDC. (n.d.). Success Story: Approach 1 Establish Nutrition Standards for Competitive Foods.

Retrieved from: www.cdc.gov/healthyschools/mih/pdf/approach1-success.pdf
Chuang, R., Sharma, S., Skala, K., & Evans, A. (2013). Ethnic Differences in the Home
Environment and Physical Activity Behaviors Among Low-Income, Minority
Preschoolers in Texas. American Journal of Health Promotion, 27(4), 270-78.
City of Austin. (n.d.). Bright Green Future School Grants. Retrieved from:
http://www.austintexas.gov/brightgreenfuture.
City of Austin. (2013). Hispanic Quality of Life Report. Retrieved from:
https://www.austintexas.gov/sites/default/files/files/City_Manager/HispanicReport-v
er_6-0901_13.pdf.
City of Austin. (n.d.). Top Ten Demographic Trends in Austin. Retrieved from:
https://www.austintexas.gov/page/top-ten-demographic-trends-austin-texas.
Dell Children’s Medical Center of Central Texas. (2015). Empowering families to live healthy,
happy lives. Retrieved from: https://www.dellchildrens.net/services_
and_programs/texas_center_for_the_prevention_and_treatment_of_childhood_obesity/d
Department of Agriculture. (2012). National Standards in the National School Lunch and School
Breakfast Programs. Federal Register, 77(17), 4087-4167.
Department of Agriculture. (2013). Offer versus Serve. Retrieved from:
www.fn.usda.gov/sites/default/files/SP45-2013a.pdf

Evans, A., Ranjit, N., Rutledge, R., Medina, J., Jennings, R., Smiley, A., Stigler, M., &
Hoelscher, D. (2012). Exposure to Multiple Components of a Garden-Based Intervention
for Middle School Students Increases Fruit and Vegetable Consumption. Health
Promotion Practice, 13(5), 608-16.
GNE. (n.d.). Global Nutrition Empowerment. Retrieved from:
http://www.globalnutritionempowerment.org/.
Gunderson, G. (2014). NSLP Public Concern, Action and Status. Retrieved from:
www.fns.usda.gov/nslp/history_7#
House Bill 1305. 84th Legislature (2015). Retrieved from: http://www.capitol.state.tx.us
Johnson, C. M., Sharkey, J. R., & Dean, W. R. (2011). It’s all about the children: a participant-
driven photo-ilicitation study of Mexican-origin mothers’ food choices. BioMed Central:
Women’s Health, 1-15.
KIPP: Austin. (2012). Health and Wellness. Retrieved from: http://www.kippaustin.org/health-
and-wellness.
McCaughtry, N., Martin, J.J., Fahlman, M. & Shen, B. (2011). Urban health educators’

perspectives and practices regarding school nutrition education policies. Health
Education Research, 27(1), 69-80.
McMillan, T. (2014). The New Face of Hunger. Retrieved from:
http://www.nationalgeographic.com/foodfeatures/hunger/
Mend Foundation. (n.d.) About MEND. Retrieved from: http://www.mendfoundation.org/home.
Morland, K. & Filomena, S. (2007). Disparities in the availability of fruits and vegetables
between racially segregated urban neighborhoods. Public Health Nutrition, 10(12), 1481-
89.
Ory, M.G., Nichols, D., Dickerson, J.B., Madsen, K. K., Dowdy, D. M., Menendez, T., Miller,
C., & Hoelscher, D. M. (2013). Creating a Tipping Point: Texas Obesity Policy Actions
in Review, 2000-1010. Progress in Community Health Partnerships, 7(4), 419-27.
Prelip, M., Slusser, W., Thai, C. L., Kinsler, J., & Erausquin, J. T. (2011). Effects of a School-
Based Nutrition Program Diffused Throughout a Large Urban Community on Attitudes,
Beliefs, and Behaviors Related to Fruit and Vegetable Consumption. Journal of School
Health, 81(9), 520-29.
Ranjit, N., Evans, A. E., Springer, A. E., Hoelscher, D. M., & Kelder, H. K. (2015). Racial and
Ethnic Differences in the Home Food Environment Explain Disparities in Dietary
Practices of Middle School Children in Texas. Journal of Nutrition Education and

Behavior, 47(1), 53-60.
Rodriguez, J., Applebaum, J., Stephenson-Hunter, C., Tinio, A., & Shapiro, A. (2013). Cooking,
Healthy Eating, Fitness and Fun (CHEFFs): Qualitative Evaluation of a Nutrition
Education Program for Children Living at Urban Family Homeless Shelters. American
Journal of Public Health, 103, S361-S367.
Roehr, B. (2012). US efforts to limit marketing of unhealthy food to children are delayed. BMJ.
doi: http://dx.doi.org/10.1136/bmj.e3340
Rossen, L. M., Curriero, F.C., Cooley-Strickland, M., & Pollack, K. M. (2013). Food availability
en route to School and Anthropometric Change in Urban Children. Journal of Urban Health,
90(4), 653-66.
School Nutrition Association. (2015). SNA History & Milestones. Retrieved from:
https://schoolnutrition.org/AboutSNA/HistoryMilestones/
SFC. (n.d.) Sustainable Food Center. Retrieved from: http://sustainablefoodcenter.org/.
Simopoulos, A. P., Bourne, P. G., Faergeman, O. (2013). Bellagio Report on Healthy
Agriculture, Healthy Nutrition, Healthy People. Nutrients, 5, 411-423.
Slusser, W., Prelip, M, Kinsler, J., Erausquin, J.T., Thai, C., & Neumann, C. (2010). Challenges
to parent nutrition education: a qualitative study of parents of urban children attending
low-income schools. Public Health Nutrition, 14(10), p.1833-1841.

Snelling, A., Belson, S. I., Beard, J., & Young, K. (2015). Associations between grades and
physical activity and food choices. Health Education, 115(2), 141-51.
Springer, A. E., Li, L., Ranjit, N., Delk, J., Mehta, K., Kelder, S. H. (2015). Schol-level
economic disadvantage and obesity in middle school children in central Texas, USA: a
cross-sectional study. International Journal of Behavioral Nutrition and Physical
Activity, 12(Suppl 1), 1-8.
Tester, J. M., Yen, I. H., Pallis, L. C., & Laraia, B. A. (2010). Healthy food availability and
participation in WIC (Special Supplemental Nutrition Program for Women, Infants, and
Children) in food stores around lower- and higher-income elementary schools. Public
Health Nutrition, 14(6), 960-964.
Texas Department of Agriculture. (2016). Home Page. Retrieved from:
https://texasagriculture.gov/Home.aspx
Texas Department of Agriculture. (2015). National School Lunch Program. Retrieved from:
http://www.squaremeals.org/Programs/NationalSchoolLunchProgram.aspx
Tisone, C. A., Guerra, S. A., Lu, W., McKyer, E. L. J., Ory, M., Dowdy, D., Wang, S., Miao, J.,
Evans, A., & Hoelscher, D. (2014). Food-shopping Environment Disparities in Texas
WIC Vendors: A Pilot Study. American Journal of Health Behaviors, 38(5), 726-36.
United Nations. (2015). Sustainable Development Knowledge Platform. Retrieved from:
https://sustainabledevelopment.un.org/

USDA. (2014). Healthy Hunger-Free Kids Act. Retrieved from: http://www.fns.usda.gov/school-
meals/healthy-hunger-free-kids-act
USDA. (2015). Final Rule: Revisions in the WIC Food Packages. Retrieved from:
http://www.fns.usda.gov/wic/final-rule-revisions-wic-food-packages
Weatherspoon, D., Oehmke, J., Dembele, A., Weatherspoon, L. (2015). Fresh vegetable demand
behaviour in an urban food desert. Urban Studies, 52(5), 960-979.
WeViva. (n.d.) About Us. Retrieved from: http://weviva.org/about-us/.

Appendix A: Sample Flyer for Participant Recruitment
Parents Needed for Research Study!
-30 Minute Focus Group-
Are you interested in participating in a 30-minute focus group about food and your child’s eating habits
with other parents? If you meet the following requirements, you are eligible to sign up to be one of the
participants in this short focus group.
 Must have child in Afterschool Program
 Must have a child eligible for free or reduced-cost lunch
 Must be a household member that makes decision about food purchases
About the Study: This study is part of a Student Research study being conducted on behalf of Drexel
University for curriculum requirements towards degree attainment. This study aims to gain information
on the effectiveness of school nutrition programs and the lifestyle habits of the students in which the
programs are reaching. Focus group will take place around 5:30 PM on a school day to later be
determined based on participant availability. In addition to your contribution, a small gift will be provided
to all participants, following the focus group, as a token of appreciation. Space is limited.
If this sounds like something you are interested in and you meet all of the above requirements or if you
have any questions, please contact Dayna by phone at 610-334-6723 or by email at der54@drexel.edu.

Appendix B: Demographic Questionnaire
Please answer the following questions to the best of your knowledge.
The answers to these questions are used only for demographic purposes.
1. What is your highest level of education?
a. Did not complete High School
b. High School Diploma
c. Bachelor’s Degree
d. Professional Degree
2. What is your total household income?
a. Below $20,000
b. $20,000-$40,000
c. $40,000-$60,000
d. Above $60,000
3. Which of the following best describes your ethnicity (or race?)
a. White
b. Hispanic or Latino
c. Black or African American
d. Native American or American Indian
e. Asian/Pacific Islander
f. Other
4. How many children under the age of 18 live in your household? ________________
5. Do you or your children currently receive assistance through any of the following
federally funded food programs? (Circle all that apply)
a. Supplemental Nutrition Assistance Program (SNAP) / Food Stamps
b. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
c. Assistance from a Food Bank, Church, other food donation program
d. Not Sure

Appendix C: Sample Focus Group Questions
1. Does your child’s school promote health and well being to all teachers and students?
2. Does your child’s school offers a variety of healthy lunch options for students?
3. Is your child aware of the effects of making unhealthy food choices?
4. Does your child’s school educate students about healthy behaviors and how to
maintain a healthy lifestyle?
5. Does your child’s school have a clear, designated staff member who is responsible for
ensuring a healthy environment or that you can ask health questions?
6. Do you provide healthy food options at home for your children?
7. Are you aware of your child’s school’s Local Wellness Policy (LWP).
8. Does your child’s school include families and other community members in ensuring
that our students maintain a healthy, nutritious lifestyle?
9. Does your child’s school hold events such as food demonstrations, taste testing,
recipe contests, farm visits, school gardens, etc?
10. Do you feel that schools or parents should be primarily responsible for a child
learning healthy behaviors?
11. Does your child ever discuss any nutrition related material they learned at school?
12. Does your child help in picking out foods for meals, and if so, are they able to make
healthy choices?

Appendix D: Introductory Letter for Participants
Dear Participant,
I thank you for taking the time out of your day to participate in this quick focus group.
Currently I am studying the effectiveness of nutrition programs in low-income school districts in
Austin as my final research towards my M.S. in Educational Improvement and Transformation.
This topic is being studied to hopefully inform stakeholders of the effectiveness or
ineffectiveness of school nutrition programs, to promote more comprehensive programs that will
aim at reducing childhood obesity. As an incentive, I will provide you with a small gift of
appreciation at the end of the session.
Please be aware that all results will be confidential and will remain anonymous, and that
you are free to leave at any time. Collecting demographic data will assist with being able to
gather more precise, generalizable data so that this study may be further replicated in the future.
Should you have any further questions or want further information about the study you
may contact my supervising professor, Dr. Kristy Kelly, PhD (email:kek72@drexel.edu) or me
at 610-334-6723.This study has been approved by Drexel University’s Institutional Research
Board. For more information, you can contact the University’s Human Research Protection
Program at 215-255-7857 or hrpp@drexel.edu.
Thank you,
Dayna Reber, M.S. Educational Improvement and Transformation, ‘16, Drexel University

Appendix E: IRB Approval Letter
Office of Research
APPROVAL OF PROTOCOL
February 11, 2016
Kristy Kelly, PhD
Drexel University
School of Education
One Drexel Plaza
3001 Market Street
Philadelphia, Pa 19104
Dear Dr. Kelly,
On February 11, 2016 the IRB reviewed the following protocol:
Type of Review: Initial
Title: Effectiveness of Implementing Nutrition Programs in Low
Income Schools
Investigator: Kristy Kelly
IRB ID: 1601004179
Funding: Internal
Grant Title: None
Grant ID: None
IND, IDE or HDE: None
Documents Reviewed: HRP-211 Initial Application Form, HRP 201 Contact Forms,
Conflict of Interest, HRP 503 Template Protocol, Written
Proposal, Permission Letter, HRP-502 Consent, Flyer,
Demographic Survey, Introductory Script to Participants,
Focus Group Questions
According to 45 CFR 46, 101(b) (2), the IRB approved the protocol on February 11, 2016. The protocol is
approved Exempt Category 2. This study will recruit 5 participants through The Boys and Girls Club,
Austin, Texas to participate in a focus group session.
In conducting this protocol you are required to follow the requirements listed in the INVESTIGATOR
MANUAL (HRP-103).
Sincerely,
Lois Carpenter
Member, Social and Behavioral IRB #3
1505 Race Street, 7th Floor Bellet Building, Philadelphia, PA 19102 | Tel: 215.762.3944
HRPP@drexel.edu|drexel.edu/research
Lois
Carpenter
Digitally signed by LoisCarpenter
DN:cn=LoisCarpenter,o=Drexel
University,ou=Human Research
Protection,
email=Lac87@drexel.edu,c=US
Date:2016.02.11 11:03:49 -05'00'

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