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'31:? i! l llllll ll 5 ll NIH/l MICHIGAN STATE UN 8 TY RARIE LIBRARY Michigan State University This is to certify that the thesis entitled A Cost and Nutrient Analysis lfilWill/ml ~' ” 1 3 1293 01038 5700 I". of Lansing Area Community Kitchens presented by Janet Ann Bielawski has been accepted towards fulfillment of the requirements for M.S. degreein Institution Administration ajor professor Date November 3, 1993 MS U is an Affirmative Action/Equal Opportunity Institution PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date duo. DATE DUE DATE DUE DATE DUE MSU Io An Affirmative Action/Equal Opportunity Instituion mm: A COST AND NUTRIENT ANALYSIS OF LANSING AREA COMMUNITY KITCHENS By Janet Ann Bielawski A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN INSTITUTION ADMINISTRATION Department of Food Science and Human Nutrition 1993 ABSTRACT A COST AND NUTRIENT ANALYSIS OF LANSING AREA COMMUNITY KITCHENS By Janet Ann Bielawski The objective of this study was to obtain baseline cost and nutrient information from Lansing, Michigan community kitchen meals. This study is important because little information is available on community kitchens. Data were collected on population demographics of guests (n=428), portions sizes of menu items, corresponding recipes or menus, and actual and equivalent market values of labor and food costs. Meals were analyzed to determine the percent of 1/3 of the US Recommended Daily Allowance (USRDA) supplied to the highest need USRDA age-sex group. Actual labor costs ranged from 39 to 57 percent of the total costs for that meal. All kitchens provided adequate protein for the highest need USRDA age-sex group. Calcium, iron, magnesium, folic acid, vitamin B-6, vitamin A, and vitamin C, were inadequate in some meals. This data supports the need for further development of comparable methodology to identify the costs and nutrition of community kitchen meals. This paper is dedicated to the homeless man sleeping in the back of the all night computer center as I print this paper. To all Americans struggling to make their way in the world, may the wheels of progress tread lightly and injure few. ACKNOWLEDGMENTS I would like to thank Dr. Carol Sawyer for her longstanding support, compassion, encouragement and guidance throughout this process. I would also like to thank my committee members Dr. Sharon Hoerr, Dr. Judy Anderson, and Dr. Frank Fear for their input, assistance and varied perspectives. iv TABLE OF CONTENTS Introduction 1 Chapter 1: Literature Review 1.1 Introduction 1.2 Hunger and Food Security 1.2.1 Hunger in the U.S. 1.2.2 Example of Disparity Among Researchers Involving the Issue of Hunger in America 1.2.3 Food Security Proposed to Measure Hunger 1.2.3.1 Food Security in Underdeveloped Nations 1.2.3.2 Food Security in the US. and Developed Nations 1.2.3.3 The Food Security Continuum 1.2.3.4 Methods Needed to Assess Food Security 1.3 Community Kitchens: History and Function 1.3.1 Communities Respond to Food Insecurity 10 10 10 10 ll 12 l3 13 14 15 15 16 1.4 1.3.2 The First Community Kitchens in the U.S. 1.3.3 Community Kitchen Definitions Populations Served in Community Kitchens 1.4.1 The Poverty Threshold and the Poor 1.4.1.1 The Thrifty Food Plan 1.4.1.2 Faulty Assumptions of the Poverty Threshold 1.4.1.3 The Working Poor 1.4.2 Socioeconomic Status and Health 1.4.2.1 Undemutrition, Hunger and Learning in Children 1.4.2.2 "Hunger in America: Perspective of the American Dietetic Association" 1.4.3 Dietary Information Related to Low Income Families 1.4.3.1 National Nutrition Surveys 1.4.3.2 "Audit and Evaluation of Food Program use in New York State: Food Price Survey" 1.4.3.3 Multiple Program Participation: Comparison of Nutrition and Food Assistance Program Benefits with Food Costs in Boston, Massachusetts 1.4.3.4 "Food Costs in Persistently Poor Rural America" vi 16 l7 17 18 18 19 22 22 23 24 24 26 26 27 1.4.4 U.S. Food Assistance Programs 1.4.4. 1 1.4.4.2 1 .4.4.3 1.4.4.4 Comparison of the U.S. to the Eurpoean Community and Swedish Food Assistance Programs Nonparticipation in Welfare Programs by Eligible Households: The Case of the Food Stamp Program Relationship of Participation in Food Assistance Programs to the Nutritional Quality of Diets Food Procurement and the Nutritional Adequacy of Diets in Low-Income Families 1.4.5 The Homeless Population 1.4.5.1 1.4.5.2 1.4.5.3 1.4.5.4 1.4.5.5 1.4.5.6 1.4.5.7 The Definition of Homeless Studying Homelessness: The Difficulty of Tracking a Transient Population Characteristics of Sheltered Homeless Families Hunger Among the Homeless: A Survey of 140 Shelters, Food Stamp Participation and Recommendations A Status Report on Hunger and Homelessness in America’s Cities: 1988 Homeless Persons and Health Care Health Problems of Homeless Children in New York City vii 28 29 30 31 31 32 32 33 35 36 37 37 1.4.6 Information Available About the 38 Population Receiving Meals at Community Kitchens 1.4.6.1 Audit and Evaluation of Food 39 Program Use in New York State; Report on Phase One and Phase Two 1.4.6.2 Demographic Profile and 40 Nutrient Intake Assessment of Individuals Using Emergency Food Programs 1.4.6.3 "1988 Census of Emergency Food 41 Relief in New York State" 1.4.6.4 "Within Month Variability in 42 Use of Soup Kitchens in New York State" 1.4.6.5 Dependency on Soup Kitchens 43 in Urban Areas of New York State 1.4.6.6 Food Sources and Intake of 43 Homeless Persons 1.5 Community Kitchens: Financial Resources 44 1.6 Community Kitchens: Quality of Meals Served 45 1.6.1 Nutritional Status of Men 46 Attending a Soup Kitchen: A Pilot Study 1.6.2 A Report on the Quality of Meals 46 Served in Soup Kitchens in New York State 1.6.3 Soup Kitchen Meals: An 47 Observation and Nutrient Analysis 2 Materials and Methods 49 2.1 Sample 49 viii 2.2 Materials 2.3 Procedures 2.3.1 Community Kitchen Demographic Data Collection 2.3.2 Questionnaire Distribution 2.3.3 Cost Data Collection 2.3.4 Nutrient Content Data Collection 2.4 Design 2.5 Analyses 2.5.1 Actual Market Value (AMV) of Labor Cost/Plate 2.5.2 Equivalent Market Value (EMV) of Labor Cost/Plate 2.5.3 AMV of Food Cost/Plate 2.5.4 EMV of Food Cost/Plate 2.5.5 Nutrient Analyses of Meals Served 2.5.6 Statistical Analyses Results and Discussion 3.1 3.2 Demographics of Community Kitchen Operations from Cooks and Administrators Interviewed 3.1.1 Food Procurement 3.1.2 Difficulties with Meal Services Reported by Community Kitchen Cooks 3.1.3 Meal Service Periods(MSP) and Quanitity of Guest Served per MSP Labor 50 51 52 52 53 53 53 E 55 56 57 58 59 8 63 65 66 3.3 3.2.1 Paid Labor 3.2.2 Volunteer Labor 3.2.3 Total Labor Time Demographics of Guests Eating at Community Kitchens 3.3.1 Questionnaire Respondent Totals 3.3.2 Repeat Questionnaire Respondents 3.3.3 Community Kitchen Non-repeat Questionnaire Responses 3.3.4 Title III Non-repeat Questionnaire Responses 3.3.5 Gender of Community Kitchen Respondents 3.3.6 Marital Status of Community Kitchen Respondents 3.3.7 Employment Status of Community Kitchen Respondents 3.3.8 General Assistance Participation of Community Kitchen Respondents 3.3.9 Aid to Families with Dependent Children Program Particiaption of Community Kitchen Respondents 3.3.10 Social Security Participation of Community Kitchen Respondents 3.3.10.1 Social Security Participation of Title III Respondents 3.3.11 Food Stamp Participation of Community Kitchen Respondents 3.3.12 Non-participation in Social Assistance Programs of Community Kitchen Respondents 69 70 71 72 73 73 74 75 76 77 78 79 80 82 83 84 3.3.13 Respondent Age/Sex Data 3.4 Survey Questions and Responses 3.4.1 Frequency of Eating at Community Kitchens 3.4.2 Usual Number of Meals Eaten per Day 3.4.3 Perceived Sensory Quality of Community Kitchen Meals 3.5 Labor and Food Cost Analyses 3.5.1 Actual Market Value (AMV) of Labor Costs/Plate 3.5.2 Equivalent Market Value of Labor Costs/Plate 3.5.3 Actual Market Value of Food Costs/Plate 3.5.4 Equivalent Market Value of Food Costs/Plate 3.5.5 The Equivalent Market Value of Donations 3.6 Nutrient Content of Meals 3.6.1 Nutrient Standards for Community Kitchens and one Title 111 site: One Third of the USRDA for Each Nutrient 3.6.2 Percent of One Third of the USRDA Supplied by Community Kitchen Meals 4 Summary, Conclusions and Recommendations 4.1 Evaluation and Suggested Modifications of Methods for Collecting Community Kitchen Demographic Data 4.2 Evaluation and Suggested Modifications of Methods for Collecting Community Kitchen Guest Demographic Data Methods 85 87 88 91 92 92 93 95 96 98 99 103 104 109 110 111 4.3 Evaluation and Suggested Modifications of Methods 112 for Collecting Community Kitchen AMV and EMV Costs of Labor and Food 4.4 Evaluation and Suggested Modifications of Methods 113 to Determine Nutrient Content and the Evaluation of Community Kitchen Meals 4.5 Conclusions and Reconunendations for Lansing 115 Community Kitchens 4.5.1 Recommendations Regarding Meal Planning 116 and Preparation 4.6 Recommendations for Agencies 116 4.7 Conclusion 1 17 Glossary 1 19 Appendix A: Data Collection Questionnaire for Community Kitchen 123 Operations Appendix B: Community Kitchen Questionnaire, Letter of Introduction 124 and Consent Form to Kitchen Managers Appendix C: Community Kitchen Questionnaire, Letter of Introduction 125 and Consent Form to Community Kitchen Guests Appendix D: Questionnaire 126 Appendix E: Section Two: To be Completed by Cooks and/or 127 Administrators During Each Visit Appendix F: Community Kitchen Managers’ Strategies for Menu 128- 129 Flaming ' Appendix G: Meal One from Community Kitchens and One Title 130- 131 111 Site in Lansing, MI Appendix H: Meal Two from Community Kitchens and One Title 132- 133 III Site in Lansing, MI Appendix 1: Meal Three from Community Kitchens and One Title 134-135 111 Site in Lansing, MI xii List of References 136 xiii LIST OF TABLES Table 1: Demographic factors from community kitchens and one Title 111 site in Lansing, MI. Table 2: Demographic information from six community kitchens and one Title III site in Lansing, MI. Table 3: Demographics of guests of five community kitchens and one Title III site in Lansing. MI. Table 4: Mean age/sex distribution from non-repeat respondents from five community kitchens and one Title 111 site in Lansing, MI. Table 5: Client meal data and sensory information from non-repeat respondents eating in five Lansing community kitchens and one Title 111 site. Table 6: Mean actual market value (AMV) and mean equivalent market value (EMV) of labor cost and food cost from six Lansing, MI community kitchens and one Title III site. Table 7: Selected nutrients in meals from Lansing, MI community kitchens and one Title 111 site. Table 8: Mean percent of 1/3 of the USRDA from three meals in six Lansing, MI community kitchens and one Title 111 site. xiv 61-62 67 81 86 89 94 100- 101 105 INTRODUCTION Hunger and food insecurity is a growing problem facing American society today. Throughout the 1980’s, the problem of hunger has been controversial because no definition or measurement of hunger or food security was widely accepted by public health professionals and governmental agencies. However, many state governments sponsored hunger and food security reports during this time (DI-IRS, 1986; IDHS, 1984; SMGT‘FFN, 1985; MDPH, 1984; NJCH, 1986; OSHTF, 1984; ISCHNSC, 1986; SICHN, 1984). The economic conditions during the 1980’s help to explain some causes for the increased concern regarding hunger and food security among Americans. For example, in its 1981 and 1982 attempt to manage an unbalanced budget and control deficit spending, the federal government cut social assistance program benefits along with the Food Stamp and other food assistance programs, Medicare and Medicaid (ADA, 1987). Also, between 1981 and 1986, federal support for low income housing dropped from $28 billion to $9 billion making adequate housing more scarce for low wage earners (USCM, 1987). At the same time, the U.S. work force experienced many changes. In the period from 1979 to 1987, an estimated two million jobs were lost from major industries such as steel and textiles, partially as a result of technological advancement and increasing machine efficiency (Heinz, 1987). The higher paying jobs lost from 2 the manufacturing industry were largely replaced with lower paying and minimum wage jobs in the service industry (I-Iightower, 1987). Also, the Federal minimum wage remained at $3.35 per hour from 1981 until 1990, the longest period in its history without an increase (USDC, 1990). By 1988, the 20% of the U.S. population at the bottom of the economic strata received only 4.6% of the national income (Leland, 1988). The end of the 1980’s marked a time when half of all poor renters paid at least 70% of their income for rent and utilities (Mayer, 1990). After meeting housing costs, a poor household had little income remaining for food and other expenses. Moreover, it is unlikely that all of what income was left would be spent on food, or that this would be adequate to meet the nutritional needs of poor households (Cohen, 1990). Therefore, hunger and food security must be viewed in terms of the consequences of the larger socio-political problem of poverty (Wardlow, 1990; Cohen, 1990). Some researchers have concluded that the hunger and food security problem in the U.S. are so pervasive that only intervention at the federal level can successftu eliminate the problem (W ardlaw, 1990). It has been estimated that four to five billion dollars annually would be required to feed the hungry in the U.S. (Brown and Allen, 1988). Moreover, it has been demonstrated that when adequate nutrition was not acheived during periods of rapid growth such as infancy, childhood, adolescence, and pregnancy, additional housing and medical costs have become necessary (Mayer, 1990). In Massachusetts, the lifetime cost of maintaining a mentally retarded person was $2.5 million dollars (Mayer, 1990). With the annual federal budget of over $1.2 trillion dollars, the problems of hunger and food insecurity in America has become a 3 question of federal government priorities (Cohen, 1990). Historically, state and federal governments have provided the poor with various economic and food assistance programs. Such programs however, did not maintain mechanisms for monitoring their own impact. Additionally, of the national nutrition surveys regularly conducted by the Department of Heath and Human Services and the Department of Agriculture, none purposefully had investigated the problem of hunger in America prior to 1991 (Nestle, 1990). The Third National Health and Nutrition Examination Survey (NHANES III) sponsored by the federal Department of Health and Human Services does include food sufficiency questions in the questionnaires for families and individuals (Briefel and Woteki, 1992). However, this survey is limited because it does not sample people who are homeless, migrant families, or other population groups likely to have limited access to food (Nestle, 1990). A 1989 report from the House Select Committee on Hunger suggested that households in every region of the United States rely on food provided by food pantries and community kitchens (HSCH, 1989). These organizations are typically funded by donations of food, labor, and space from the community. Food pantries provide people with canned and dry groceries, free of charge, and community kitchens provide hot meals on a daily and weekly basis free of charge to anyone who comes to the operation during its hours of service. Increases in the number of community kitchens and food pantries, and increases in the number of people receiving emergency food and shelter assistance have been reported throughout the 1980’s (USCM, 1987, 1989, 1990). Additionally, these private emergency food systems have reportedly not met the demand for food (Brown and Allen, 1988; USCM, 1987; USCM, 1989; PT'FHA, 1986). Despite the clear need manifested in the increasing number of people seeking emergency food, the problem of hunger and food security remained controversial throughout the 1980’s. Regarding food security; "federal policy decision makers are reluctant to rely on locally generated data because no uniform or comparable methodology exists for collecting data" (HSCH, 1989). Yet many researchers and health professionals agree that for relevant public policy decisions regarding government assistance benefits and methods of intervention to be made, the nutritional status and food security of poor Americans needs further investigation on a local level (CNI, 1989). It becomes evident then that comparable methods are needed to assess hunger and food security in communities at a local level throughout the U.S. (HSCH, 1989; RPTFFA, 1984). The link between the measurement of hunger or food security among communities and the operations of community kitchens should be explored for a number of reasons. First, the number of community kitchens in the U.S. has grown significantly throughout the 1980’s, and guests of community kitchens were likely to be suffering from hunger or food insecurity. Next, community kitchens, unlike any other community or governmental food assistance program, provide prepared meals to poor families on a daily or weekly basis. Little quantitative information exists in the scientific literature regarding the operations of community kitchens, or the nutritional quality of their meals. In one study, half of the community kitchens surveyed did not provide even one third of the RDA for some nutrients (McGrath-Morris, 1988). Therefore, a single, braodly 5 acceptable method is needed to identify and investigate the operations of community kitchens and their guests throughout the U.S. This method would provide information regarding community kitchen operations and their guests and to assist the development and measurement of the concept of hunger or food security. Information about community kitchen operations would be useful to the local, state, and federal government, because the scope of the food security problem would be more objectively defined. For example, nationally representative data showing the number of meals served per kitchen per week or the number of people served at community kitchens per week would help identify the scope of the food security problem. A better definition of the scope of the food security problem would assist policy decisions at all levels, aimed at intervention or social welfare reformation. Information about community kitchen operations would also be useful to state and local health departments, city or county agencies, local non-profit agencies, and the business sector. This information would assist in the planning of projects aimed at intervention, research, and financial or technical assistance. Information about community kitchen operations would be useful for comparisons of need among communities or regions of the nation. Demographic information about community kitchen services would be useful to more readily identify and compare communities or kitchens with greater need. Other useful demographic information would include the type, amount, and nature of community kitchen services. Demographic information about community kitchen guests would also be useful. Specifically, information about the age, sex, marital status, employment, and participation in social assistance programs of guests would be useful to better define 6 the scope of the food security problem. Also, information regarding the relative dependency guests have on community kitchen meals for their daily nutrition would be useful. For example, a question regarding the number of meals per week guests eat at community kitchens could be used to develop a measure of the relative level of food security guests were experiencing. Information regarding the labor and food costs of community kitchen operations would be useful for purposes of intervention or assistance. The amount of resources required for meal service operations including the percent and value of donated resources could be evaluated. This would provide information about the amount of resources needed to subsidize community kitchens operations. This financial information would also help to further define the scope of the food security problem. Also, the cost effectiveness of a community kitchen relative to the nutritional quality of the meals it serves could be evaluated, and be useful in planning strategies for intervention and training. Information on the nutrient content of meals served in community kitchens is important for two reasons. First, information on the nutrient content of meals served could be used to develop a measure of the nutritional quality of meals served. No measure of the nutritional quality of meals was available in nutrition research literature at the time of this writing. A qualitative measure of the nutrient content of meals could be used to determine, if intervention or planning of asistance with community kitchen meal services would be warranted. Second, the nutrient content of meals served in community kitchens could provide information regarding the diets and nutritional status of the Americans likely 7 to be suffering from hunger or food insecurity. Also, an evaluation of the food quality based on a measure of nutrients supplied and not soley by the number of calories supplied would be important to investigate because a diet providing adequate calories without concern for protein and vitamins could only be considered as a temporary means of nutrition. Information about diets including amounts of protein and vitamins would help to establish the nutritonal status and possible health risk factors of the individual experiencing food insecurity. The federal government acknowledges quality nutrition as a priority through its school lunch program, and other agencies such as the National Institutes on Health promotes quality nutrition as a health prevention measure. Since hunger is a long term problem (CNI, 1989), it is plausable to conjecture that community kitchen guests may be likely to use community kitchens as a food source for extended periods of time, and it would be reasonable to evaluate the quality of community kitchen meals based on a measure of nutrients supplied. Information about the quality of community kitchen meals would help to define the food insecurity problem by addressing specific nutritional aspects, and possible patterns of nutrient inadequacies in the diets of low income populations. The controversy involved in the identification of the hunger problem is rooted in the fact that governmental and health officials do not have enough information regarding food insecurity or hunger because little verifiable information is available on a local level. National health studies have provided a basic indication of the hunger problem, but more specific, local information is needed in order to help federal agencies prioritize the allocation of funding for social programs (HSCH, 1989; CNT, 1989). Additionally, a methodology needs to be developed which could be used to 8 make comparisons related to the degree of food insecurity among cities or other regions (CNI, 1989). Therefore, this study will be a demonstration study to obtain baseline information regarding: community kitchens, their guests, and their services in a specific region, Lansing, MI. Specifically, research objectives included developing and analyzing research methods, and obtaining baseline information regarding: demographic information about community kitchens and their guests; the costs of operations including the actual and equivalent market value of services and donations; and the nutrient content of the meals served in Lansing area community kitchens. Demographic information of kitchens included: sources of funding; the number of meal service periods (MSP) per week; the number of guests per MSP; and the quantity of labor used per MSP. A MSP was defined as the period of operation when a community kitchen served meals to guests. Demographic information of guests was defined as: age; sex; marital status; employment; and participation in social assistance programs. Operational costs were determined in two ways: 1) as an actual market value in dollars and 2) as an equivalent market value in dollars when costs were adjusted for donations. All labor and food resources used for meal preparation, service, and clean- up during each meal service period were included as operational costs. An analysis of the nutrient content of meals included seven nutrients; vitamin A, vitamin C, folate, vitamin 36, iron, magnesium, calcium, and calories, carbohydrate, fat, protein, and sodium. These nutrients were chosen for the following reasons; 1) the diets of low income families have been shown to be inadequate in 9 vitamin A, vitamin C, vitamin B-6, folate, iron, magnesium, and calcium (USDA, 1982; USDI-IEW, 1974; USDI-IHS, 1983, Lenhart and Read, 1989), and 2) some community kitchen meals have been shown to be inadequate in various subsets of these nutrients (McGrath-Morris, 1988; Carrillo et al., 1990; Laven and Brown, 1985). CHAPTER 1 LITERATURE REVIEW 1.1 Introduction The general focus of this literature review is hunger or food security in the U.S., and more specifically, community ("soup") kitchens which offer to feed the hungry. The relation of hunger to food security is described below, followed by a brief history of community kitchens as well as information about the poor and homeless populations served at community kitchens. This chapter ends with a review of published information about the financial resources of community kitchens and the quality of meals served. 1.2 Hunger and Food Security Section 1.2.1 below reviews information regarding the concepts of hunger and food security in the U.S. Problems reported in the literature related to the definition and measurement of hunger and food security in the U.S. have also been included. 1.2.1 Hunger in the U.S. Throughout the 1980’s, there has been disagreement among researchers and policy makers over the issue of hunger in America. The major thrust of the disagreement was over the definition of hunger. Many definitions of hunger have been reported in the 10 ll literature. (ADA, 1986; Campbell et al., 1988; HSCH, 1987; PTFHA, 1987; RPTFFA, 1984) As late as 1991, no single conceptual, or clinical definition of hunger has been generally accepted among researchers, policy makers, or other vested groups. Additionally, very little information and objective data has been available from U.S. communities about hunger (HSCH, 1989; PTFFA, 1984; Ranney, 1986;). Thus, in 1991, disparity among researchers continued to exist over the definition, existence and scope of the hunger problem in the U.S. An example of the controversial nature of the hunger issue during the 1980’s follows. 1.2.2 Example of Disparig Among Researchers Involving the Issue of Hunger in m In 1984, President Reagan’s executive office requested that the President’s Task Force on Food Assistance document the extent of hunger in America. The task force defined hunger in two ways. Their "clinical" definition of hunger was; "a weakened, disordered condition brought about by prolonged lack of food" (RPTFFA, 1984). Based on their clinical definition of hunger, the President’s Task Force concluded that "there is no evidence that widespread undernutrition is a major health problem in the United States" (RPTFFA, 1984). A second, "common usage" definition of hunger was also included: a situation where some people even occasionally--cannot obtain an adequate amount of food, even if the shortage is not prolonged enough to cause health problems. It is the experience of not getting enough to eat (RPTFFA, 1984). 12 The President’s Task Force acknowledged that there was evidence of hunger based on the common usage definition, but reported an "inability to document the degree of hunger caused by income limitations" (RPTFFA, 1984). The Physician Task Force on Hunger in America was a group of medical doctors and health experts from various regions throughout the country. Since 1984, the primary goal of the Physician Task Force has been to document the nature and scope of hunger in America by collecting information from clinical settings around the U.S. The task force defined hunger as "the chronic underconsumption of food and nutrients" (PTFHA, 1985). In contrast to the President’s Task Force on Food Assistance, the Physician Task Force was able to document the existence of hunger and estimated that 20 million Americans suffered from hunger at some time, each month (PTFHA, 1985). Publications of the Physician Task Force on Hunger in America however, have been met with much skepticism and controversy. Frederick Stare, Emeritus Professor of Nutrition at the Harvard School of Public Health, exemplified the opposition to the Physician Task Force and their estimates on hunger in America in a Wall Street Journal editorial (1988). Stare described the task force as a complete hoax, and asserted that "a lot of what activists are calling hunger is absolute rubbish". Stare contended that the major public health nutrition problem in the U.S. today is obesity, not hunger. 1.2.3 Food Securig Progosed to Measure Hunger In 1989, the House Select Committee addressed the disparity over the definition of hunger, by introducing the concept of food security as a way to measure hunger among 13 communities in the United States (HSCH, 1989). The Committee asserted that the concept of food security was a better, more measurable indicator of the circumstances around which individuals might not acquire enough food (HSCH, 1989). 1.2.3.1 Food Security in Underdevelofl Nations Food security has been defined as "access by all people at all times to enough food for an active, healthy live" (Reutlinger and Holst, 1986). The term has been generally accepted as a reference to the access and availability of food to people in underdeveloped nations. The level of food security experienced by people in third world nations has been thought to be primarily influenced by environmental conditions such as droughts, floods and warfare (HSCH, 1989). 1.2.3.2 Food Securig in the U.S. and Develom Nations The definition of food security for developed nations is the same as that for underdeveloped nations. Additionally, the level of food security experienced by people in developed nations, has been thought to be primarily influenced by money, time, information, and health (HSCH, 1989). Campbell et al. (1988) outlined six components of food security for developed countries: 1) The availability of a variety of foods at a reasonable cost; 2) Ready access to quality grocery stores, food service operations, or alternate food sources; 3) Sufficient personal income to purchase adequate foods for each household member each day; 4) The freedom to choose personally acceptable foods; 5) Legitimate confidence in the quality of the foods available; and 6) Easy access to understandable accurate information about food and nutrition. 14 According to Margen (CNI, 1989), from the University of California at Berkeley, hunger is defined as food insecurity, or the lack of access to nutritionally adequate food through normal food channels. Normal food channels identified by Margen were food stores, gardens, restaurants, fast food chains, and other outlets. 1.2.3.3 The Food Securig Continuum Food security can be conceptualized as a continuurrr, in two dimensions. One dimension describes a level of difficulty in acquir- ing enough food. The easier the acquisition of food, the more food security, the more dif- ficult the acquisition of food, the less food security (CNI, 1989). The second dimension of food security involves the unit to whom the term is applied, individuals, families, communities, or larger groups. Information collected from a representative sample of individuals can be collated and applied to larger groups like families, communities, or population groups (CNI, 1989). For example, consider the two dimensions of the term food security in the following situation. A child from a low income family goes away to camp for two weeks (a community organization sponsors the child so that there is no charge to the family). The child experiences an increase in relative level of food security because the camp provides three meals a day plus snacks, more than normally received at home. This increase in level of food security demonstrates the first dimension of the term. The second dimension of food security is demonstrated by the family unit which remains at home. The family both as a single unit, and as each of the other individuals in the family also experience an increase in their relative level of food security, because of reduced strain on the fixed amount of food resources available. When the child returns 15 home, the family unit and each of the individuals within the family experienced a decrease in their relative level of food security (FRAC, 1984). 1.2.3.4 Methods Needed to Assess Food Securig The House Select Committee on Hunger (HSCH;1989) recognized that a nationally relevant, operational definition of food security would require the development of comparable methods to collect information from U.S. commi'inities. Primary data needed to assess food security are food costs in the community, the available household resources to obtain food, and the experience of individuals or household in obtaining adequate food (CNI, 1989). The Committee also realized however, that this requirement may prove to be burdensome in terms of the resources necessary to collect and analyze such information (HSCH, 1989). Despite the continuing debate over the definition, existence and scope of hunger in America, enough information exists in the literature to warrant further research into the problem. Many reports from across the country have cited an increase in the demand for emergency food in communities, and an increase in the number of food pantries and community kitchens in operation (FRAC, 1984; HSCH, 1987; PT'FHA, 1985; USCM, 1986; USCM, 1987; USCM, 1989). 1.3 Community Kitchens: History and Function Section 1.3 is a historical review of community kitchens. The function and a brief I history of community kitchens in the U.S. will be discussed followed by examples of 16 current community kitchen definitions found in the literature. 1.3.1 Communities Respond to Food Insecurity U.S. communities have responded to the needs of people experiencing food insecurity by providing alternative food sources such as community kitchens. Since the 1890’s community kitchens have been established in the United States to provide meals to the hungry, as the need for emergency food in communities arose. When the economic downturn subsided, such kitchens typically closed their doors (McGrath Morris, 1987). 1.3.2 The First Communig Kitchens in the U.S. The first community kitchen in the U.S. opened its doors in Boston in the early 1890’s (Levenstein, 1988). Although the kitchen was patterned after the western European kitchens of that era, the aim was quite different. The European kitchens were organized to serve the poor. The intention of the New England Kitchen was not just charity, but to provide practical food and nutrition education as well as to "enhance the value of the workingman’s dollar" (New York Times, 1917). Over time, these initial goals of the kitchen became unattainable. The idea caught on, however, and kitchens opened across the country with the charitable intention to feed the poor and hungry (Levenstein, 1988). In 1986, there were more community kitchens in existence than at any time since the 1930’s (Davis and Senauer, 1986). 17 1.3.3 Community Kitchen Definitions Some variations of the definition of a community kitchen exist in the literature. Two examples of current definitions follow. The U.S. government defined a soup kitchen in 1988 as: ...public and charitable institutions that maintain an established feeding operation to provide food to needy homeless persons on a regular basis as an integral part of their normal activities (PL 100-435, 1988). A more detailed description was published by the Physician Task Force on Hunger in America in 1985: Soup kitchens are places where a meal, usually lunch or dinner, is served on a regular basis (daily or weekly). Kitchens are typically located in churches, shelters for the homeless, or community centers. They are staffed by volunteers who plan, prepare, and serve a full meal at little or no cost to as many as several hundred people. Meals range from soup or a sandwich and beverage to a full course hot dinner (PT'FHA, 1985). 1.4 Populations Served in Community Kitchens Little demographic information is available on the populations served at community kitchens. Many reports have cited increases in the number of families with children being served (HSCH, 1987; PTFHA, 1985; USCM, 1989). People of all ages and most likely to be living at or below the poverty level eat at community kitchens. People who are homeless also eat at community kitchens. A review of the available published information on the two major population groups eating at community kitchens, the poor and the homeless, follows. Information about the definition and number of poor in America will be followed by a review of health and diet related information about the poor. Next, the definition and number of people homeless in America will be reported; this will be followed by a review of health 18 and diet related information about people who were homeless. Finally, information from studies specific to the papulation eating at community kitchens will be reviewed. 1.4.1 The Povem Threshold and the Poor In 1987 there were 32.5 million Americans who’s income fell below the poverty threshold (USDCa, 1989). Forty percent (40%) of those living in poverty were children (USDCa, 1989). In 1990, the federal poverty income guideline for an individual was $6,280, and for a family of four, $12,700 (SSB, 1990). The Social Security Administration defined poverty income guidelines in relation to the least costly Economy or Thrifty Food Plan (TFP) designed by the U.S. Department of Agriculture (USDA, 1962). A 1955 USDA Survey of Food Consumption had determined that families of three or more persons spent one third of their income on food. The poverty level then, was set at three times the cost of the Thrifty Food Plan (U SDCb, 1989). 1.4.1.1 The Thrifty Food Plan The idea of food plans to assist individuals in obtaining adequate nutrition, dates back to the 1890’s (USDA, 1950). The USDA first published food plans in 1950. These plans, including the Economy Food Plan, were modified and again published in 1962 (USDA, 1962). The Economy or T'FP has been the most important of the plans, because it was made the basis for poverty threshold determinations as well as for Food Stamp Program benefit allotments. The last modification to the TFP was made in 1983 (USDA, 1983). The USDA’s TFP specified the least costly foods and amounts flrat could be purchased 19 from 31 food groups for a four person family, for one week (USDA, 1983). The groups were thought to contain foods similar in nutrient content and cost. The T'FP was designed, however, as a nutritionally adequate diet for use when the cost of food must be lower than the average food expenditures of low-income families. The plan was essentially designed for emergency or short term usage, because it relied heavily on dry peas and beans, potatoes and grains for kilocalories and protein (USDA, 1962). The TFP was developed to provide 100% of the Recommended Dietary Allowances (RDA; NAS/NRC, 1980) for protein, vitamin A, vitamin B12, thiarnin, riboflavin, niacin, vitamin C, calcium, phosphorous, and magnesium. The T'FP was developed to provide a minimum of 80% of the RDA for vitamin E, zinc, and folacin, as well as calorie levels at the midpoint of the RDA for energy (USDA, 1983). In 1988, the cost of the TFP for a family of four ranged from $72.60 to $63.30 per week. The T'FP cost for an adult male and female were $18.80 and $20.80 respectively, per week (USDA, 1989). Adjustments to the cost of the TFP are made annually and are based on the Consumer Price Index (CPI; USDCb, 1989). The CPI is a market basket of U.S. goods and services including some foods, thought to be purchased by a typical American family. 1.4.1.2 Faulty Assgmptions of the Povm Threshold The determination of the poverty threshold was based on a number of faulty assumptions (O’Hare, 1988). These assumptions have clouded the meaning of poverty level living, and have interfered with accurate census information about the number of people who are poor in the U.S. Because of the methods used to determine the poverty threshold, the number of people 20 who are poor has been both over counted and under counted. The poverty threshold is the same in every part of the U.S., even though living costs have varied dramatically across the country. For example, the poverty threshold for the individual living in suburban Detroit is the same as the threshold for the person living in New York City. Therefore, the individual living just above the poverty threshold in New York City most likely has less purchasing power than the individual living at the poverty threshold in suburban Detroit, yet the individual from New York City would not be counted among the poor. Because of the assumed equality in the cost of living throughout various areas of the country, the poverty threshold leaves the numbm of poor in America under counted (O’Hare, 1988). The poverty threshold is determined from income before taxes, because the government assumes that people with low-incomes do not pay taxes. Census Bureau data showed, however that about two-thirds of low-income households pay some tax in addition to sales tax. On average, taxes absorb about eight percent (8%) of the income of low-income households (O’Hare, 1988). Therefore, some low-income families have income levels after taxes below the poverty threshold, yet these families are not included in poverty statistics. In this way, the number of "poor" in America are under estimated. Annual estimates of the number of people poor in America are based on the Census Bureau’s Current Population Survey. People who are homeless or who are living in jails, nursing homes, or other institutions are not included in the poverty statistics because the Census Bureau’s survey was household based. Thus, by not counting people in institutions, poverty statistics have under estimated the actual number of people poor in America. 21 The Social Security Administration assumed that current income alone was an adequate measure to determine. whether or not an individual or family fell below the poverty threshold. The assets or accumulated savings of individuals are not factored into this measure. Therefore, individuals who had little recorded income such as the interest from investments, but who have significant assets, such as houses, cars, boats, or thousands of dollars stuffed into a mattress, were counted among the poor. The number of poor in this instance were over counted (O’Hare, 1988). Another assumption made regarding the poverty threshold is that people living in poverty would spend money on the goods and services included in the Consumer Price Index (CPI). The CPI gauges the changes in a market basket of goods and services for a typical American family. Rises in the CPI fueled by increased costs of things that poor people seldom buy, can cause the poverty threshold to become too high. For example, in the late 1970’s the CPI rose reflecting the increasing cost of a new house. Since this was a cost seldom borne by those in poverty, the poverty threshold became in effect, too high, causing the number of poor in America to be over estimated (O’Hare, 1988). The federal government’s poverty threshold measures only a household’s current cash income in its determination. Non-cash benefits such as food stamps, and medical care are not considered income. These benefits, however, do increase the purchasing power of low-income households. In this sense, the number of poor can be over estimated (O’Hare, 1988). 22 1.4.1.3 The Working Poor In the 1980’s, individuals working all year round but whose income fell below the poverty level were referred to as the working poor (Orr, 1988). In the period from 1979 to 1987, an estimated 2 million jobs per year were lost from dying industries such as steel and textiles (Heinz, 1987). These traditionally well paying jobs were replaced with low paying, minimum wage jobs (I-Iightower, 1987). The federal minimum wage remained at $3.35 per hour from 1981 until April of 1990, the longest period in history without an increase (Orr, 1988). Consequently, by 1988 the 20% of the U.S. population at the bottom of the economic strata received only 4.6% of the national income (Leland, 1988). In 1986, the total number of people earning minimum wages was roughly 58 million (USGAO, 1990). 1.4.2. Socioeconomic Status and Health. Much information is available in the literature on the subject of socioeconomic status and health (Syme and Berkrnan, 1976; Kitagawa and Hauser, 1973). The following section will review general information regarding the issues of health and hunger among low-income populations. Closing the Gap: The Burden of Unnecess_a11 Illness (Kaplan, et al.,1987) was written by the California State Dept. of Health, the University of California at Berkeley, and the California Public Health Foundation. The publication reviewed available literature regarding socioeconomic position and the prevalence of health problems. Health problems more frequently experienced by people in lower socioeconomic levels are: total mortality, heart disease, arthritis, diabetes, hypertension, epilepsy, respiratory infections, anerrria, lung cancer, tuberculosis, unintentional injury, low birth weight, infant and child 23 mortality, and rheumatic fever (Kaplan etal., 1987). The authors argue that consistent evidence exists to claim socioeconomic position as a generic risk factor (Kaplan et al., 1987). Additionally, the authors also indicate, "those at low socioeconomic levels face greater environmental demands, both physical and social, and have fewer resources to deal with these demands" (Kaplan et al., 1987). 1.4.2.1 Undernutrition, Hunger and Learning in Children A 1989 National Dairy Council publication outlined current information available regarding undernutrition and children (Meyers, 1989). Undernutrition was defined as "malnutrition that results from an inadequate intake, absorption, or utilization of nutrients or calories needed to provide for optimal growth, development, and function." Problems associated with undernutrition in the U.S. included stunted growth, iron deficiency, and effects on learning and intellectual function. The publication by the National Dairy Council also pointed out the limitations of the current knowledge of the relationship between hunger and learning. The council suggested that "a direct causal relationship between the chronic mild undernutrition that results in stunting and reduced cognitive abilities remains to be establish " (Meyers, 1989). The council reported that there is limited objective support for links between some rnicronutrients and intellectual function. Iron deficiency, however has been linked to reduced physical activity and capacity for work (Meyers, 1989). 24 1.4.2.2 "Hunger in America: Per§pe_ctive of the American Dietetic Association" This publication approved by the Board of Directors of the American Dietetics Association in 1987, outlined a number of issues related to "hunger" in America (Foerster and Hinton, 1987). If hunger is not attended, the resulting social costs are high, including infant prematurity and mental retardation, inadequate growth and development, poor school performance, decreased work output, and excess chronic disease morbidity. Additionally, the Association stated; that the federal government must be charged with primary responsibility for leadership and resource allocation in solving this problem that has again grown to national proportions (Foerster and Hinton, 1987). 1.4.3 Diem Information Related to Low Income Families. This section of the Review of Literature covers dietary information available about low income families. National nutrition surveys and information from research involving the Thrifty Food Plan will be discussed first. The last portion of this section will review the federal food assistance programs, in particular the Food Stamp Program. Food assistance policy in the U.S. will be compared with policy of two European countries. Finally, the relationships between food assistance participation and low income families’ diets will be reviewed. 1.4.3.1 National Nutrition Surveys The United States Department of Agrculture (USDA) and the U.S. Department of Health and Human Service (USDHHS) have conducted national nutrition surveys regularly since the 1950’s to represent the U.S. population. The two major nutrition surveys conducted by these departments were the 25 Nationwide Food Consumption Survey (NFCS) conducted by the USDA and the National Health and Examination Survey (NHANES) conducted by the USDHHS (USDA, 1981, USDHEW, 1974). One of the main purposes of the NCF S surveys was to obtain data to monitor the food and nutrient content of U.S. diets, and to assess dietary adequacy and factors affecting dietary status. The NFCS is a decennial survey which has focused on food intake at home and away from home by individual household members, including the kinds, amounts, and costs of foods used during a 7-day period. A second survey conducted by the USDA, the Continuing Survey of Food Intakes by Individuals (CSFII) is an ongoing collection of data from selected sample population groups. Data generated from the two USDA surveys has been used to form the basis of the T'FP and food assistance program policy (USDA, 1983). The USDHHS has completed two NHANES studies and a third one began in 1988. Each of the two first NHANES studies lasted four years and assessed the nutritional status of individuals. Data was collected from health histories and medical examinations including; anthropometric measurements, biochemical analyses, 24-hour dietary recalls, and food frequency recalls (U SDI-IHS, 1981). The data collected from these nationwide nutrition surveys are not representative of communities, and do not focus on the question of relative food security. Therefore, their use in assessing or monitoring the "hunger" of Americans is not considered appropriate (HSCH, 1989). The NHANES surveys however, have shown that low income diets are inadequate in calories, vitamin B-6, iron, magnesium, and calcium (USDA, 1981; USDA, 1982, USDA, 1988; USDHEW, 1974, USDHI-IS, 1983). 26 1.4.3.2 "Audit and Evaluation of Food Prom use in New York State: Food Price Survey" Crockett, et a1. (1989) conducted a study to determine whether the cost of the T'FP as computed by USDA (1983), accurately reflected the cost of a market basket of foods in the 31 food groups of the TFP, in stores likely to be used by poor people in several areas of New York State. The 83 items included in the market basket were chosen based on the food consumption patterns of low income households reported by the 1977-78 Nationwide Food Consumption Survey (USDA, 1982). Approximately 30 supermarkets and small stores were surveyed in each of two counties and the borough of Brooklyn (Crockett et a1, 1989). About 1/3 of the super- markets and stores were located in a low income area where 20% or more of the population lived below the poverty level. The remaining supermarkets and stores were chosen from surrounding suburban areas where poverty rates were lower. Results of the study by Crockett et a1. (1989) indicated that costs for T'FP foods were higher than those estimated by USDA in all areas surveyed except for those in supermarkets in one county. Market basket costs were higher in small stores than they were in supermarkets, though a statistical difference did not exist for the cost difference in the borough of Brooklyn. There was no significant difference in mean costs at small stores by demographic area (Crockett et al., 1989). 1.4.3.3 "Multiple Progpar_n Participation: Comparison of Nutrition and Food Assistance Prom Benefits with Food Costs in BostonI Massachusetts." Weicha, et a1. (1989) conducted a study in the Boston area to determine if the value of social and food assistance benefits could exceed T'FP costs, as suggested by a Government Accounting 27 Office report (USGAO, 1978). Households included in the study were those whose sole source of income was Aid to Families with Dependent Children (AFDC), and who had housing in the private sector. Investigators in the Boston study challenged key assumptions underlying the methods used for the GAO report. An alternate method which did not allow for 30% of AFDC benefits to be available for food purchases was applied, to determine if program benefits could exceed TFP costs. Results indicated that the food costs in the Boston area exceeded the combined value of food assistance benefits that AFDC households can receive (Weicha and Palombo, 1989). Multiple program participation was shown to be more beneficial in achieving TFP goals than was receipt of benefits from a single food assistance program. The authors conclude that, " ...food stamps and AFDC benefits indexed to actual costs of living are needed to meet food needs of low-income families in Boston" (Weicha and Palombo, 1989). 1.4.3.4 "Food Costs in Persistently Poor Rural America." Haas, et al. (1990) studied actual food costs of a T'FP market basket in persistently poor rural America. For this study, persistently poor rural America was defined as, " all non-metropolitan counties in the 48 contiguous states that had poverty rates of 25% or more in 1980 and 35% or more in 1970" (Haas et al., 1990). There were a total of 269 counties identified as persistently poor, of which 33 were randomly selected for inclusion in the study. Store types were identified as supermarkets or small to medium stores. The researchers visited a total of 133 food stores, including 51 supermarkets and 82 small to medium food stores. The survey found that the price of a T'FP market basket 28 exceeded the USDA’s defined TFP costs. TFP food costs averaged 8% higher than the USDA defined costs in the supermarkets and 17% higher in the small to medium stores. The authors conclude that "...food stamp benefit allotments are not adequate to purchase the foods necessary for the minimally adequate diet, the Thrifty Food Plan, for persons living in persistently poor rural America" (Haas et al., 1990). 1.4.4 U.S. Food Assistance Progmps In 1988, federally funded food assistance programs cost the federal government over 20 billion dollars (U SGAOa, 1988). A majority of those costs, over 12.5 billion dollars, funded the Food Stamp Program (U SGAO, 1990). The Food Stamp Program has been shown to have a positive impact on food expenditures (Basiotis et al., 1983). Morgan et a1. (1985) showed that Food Stamp participants allocated significantly lower proportions of total food dollars to fruits and bread than did eligible nonparticipants. They also showed that households participating in the Food Stamp Program had a significantly higher level of calcium per food dollar than did eligible nonparticipants (Morgan et al., 1985). Much controversy has existed among politicians, researchers, and economists over the kind and amount of federal food assistance nwded in this country. The major arguments have revolved around the Food Stamp Program. Some think that switching to a cash out program would have out much of the administrative costs associated with food starrrps and would have little impact on recipient food spending (Davis and Senauer, 1986; Whitfield, 1982). These groups continue to lobby for program reformation, which would be vital to ending recipient program dependence and the perpetuation of poverty (Davis 29 and Senauer, 1986; Senauer, 1982). Social and food assistance reform at the federal level during the 1980’s however, did not appear to be a priority (Davis and Senauer, 1986; Senauer, 1982). 1.4.4.1 Comparison of the US to the European Communig and Swedish Food Assistance Proga_m_s In 1988, the Senate Committee on Agriculture, Nutrition and Forestry requested a review of selected European food assistance programs. Unlike the United States government, the European Council of Ministers expect a portion of the cash benefits received from their social assistance programs to be spent on food, but a particular percentage of the benefits for food is not denoted. The European Community, an economic union of 12 European countries including France, Great Britain, West Germany and Ireland, operated six food assistance programs in 1987, costing about $227 million annually. In reference to surplus commodity distribution, the Council responded, " such programs encourage dependency and therefore are not an effective means for disposing of European Community surpluses" (U SGAOa, 1988). According to a 1988 report of the food assistance practices in Sweden, the central government of Sweden, considered food assistance programs dehumanizing and no longer used them (USGAOb, 1988). The central government believed financial assistance was the best way to support its needy population because there was less shame attached to this form of assistance. Additionally, to enhance national nutrition and health, participation in locally funded food assistance programs was open to all citizens, irrespective of income. The locally funded programs were school lunch, child care food, summer camp food, elderly food assistance, and consumer and institutional subsidies (U SGAOb, 1988). 30 1.4.4.2 Nonparticipation in Welfare Proggams by Eligible Households: The Case of the Food Stamp Prom Coe (1983) asked individuals participating in the 1979 Michigan Panel Study of Income Dynamics, a set of questions regarding the reasons why they did not participate in the Food Stamp (FS) program. Five categories of reasons were identified prior to the start of the study. The categories were: 1) informational problems; 2) problems with program parameters; 3) physical access problems; 4) administrative problems; and 5) attitudinal factors. Demographic information and participation in other social assistance programs was also collected to determine relationships to nonparticipa- tion. The results of the study showed that the primary barrier to F S program participation among those eligible was lack of information concerning eligibility standards (Coe, 1983). More than 40% of the eligible nonparticipants did not think they were entitled to benefits. Twenty percent (20%) of the nonparticipants reported attitudinal reasons for nonparticipation, while 8% cited administrative barriers to participation. Physical access problems were identified by 5.7% of the nonparticipants. Additionally, nonparticipation was positively related to the age of the eligible person and negatively related to the benefit level to which the person was entitled. Nonparticipation was higher for unmarried men and unmarried elderly, and more prevalent in rural areas. People who were currently receiving other forrrrs of assistance were more likely to participate in the F S program. These individuals were less likely to believe they were ineligible for the FS program for nonfinancial reasons, and likely had better access to information regarding program participation eligibility standards (Coe, 1983). 31 1.4.4.3 Relationship of Participation in Food Assistance Prom to the Nutritional maligy of Diets Emmons (1987) described the relationship between participa- tion in six food assistance programs and the diets of low-income families, over a one month period (1987). The food assistance programs included in the study were the Food Stamp (FS) Program, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Headstart, School Breakfast, School Lunch, and the Temporary Emergency Food Assistance Program (TEFAP). All families participated in the FS Program. Diets were analyzed to determine if the nutritional goals of the Thrifty Food Plan (T'FP) were met. Twenty-four hour dietary recalls were taken for each member of the family over age six, one day a week for one month (Emmons, 1987). Larger families participated in more food assistance programs than did smaller farrrilies. The nutrients consumed in the diets of larger families did not differ from those of the smaller families. Seventy-one percent of the families participated in more than just the FS pro gram, however many did not consume the nutrients supposedly available from the FS program alone (Emmons, 1987). 1.4.4.4 Food Procuremen; and the Nutritional Adguag of Diets in Low-income Families Emmons (1986) also conducted a one month survey of 76 black and white families in the inner city of Cleveland to determine how much was spent on food using FS, W1C, and cash, and how much additional food they obtained from other sources. All families had at least one child under the age of 3 years. After the families had received their public assistance and F S allotment, a twenty-four dietary recall was obtained each 32 week from each family member over the age of six. Nutrient intakes were compared to the RDA. Families bought most of their food during the first two weeks of the month, though their food intake remained relatively constant through the last week of the month (Emmons, 1986). Diets were found to be adequate in protein, ascorbic acid, tlriarrrin, niacin, riboflavin, vitamin B-12, vitamin A, and phosphorus. Diets were inadequately supplied in vitamin B-6, Vitamin D, Vitamin E, iron, calcium, magnesium, pantothenic acid and zinc. (Emmons, 1986) 1.4.5 The Homeless Population The following section will review information about the homeless, the second major population segment receiving meals at community kitchens. The difliculties encountered in the definition and the study of the homeless population will be reviewed. Demographic and other psycho- social characteristics of homeless people will also be summarized. The section will conclude with a review of information regarding the health status of homeless persons. 1.4.5.1 The Definition of Homeless. The definition of homelessness is controversial and disputed among researchers, governmental agencies, and advocacy groups. Many of the definitions of homelessness that exist in the literature appear to be complementary, however, researchers have expressed much difl’iculty defining homelessness operationally (Brickner, 1986; Ensign-Bowdler, 1989; Coughlin, 1988). One definition of homelessness authored by the National Governor’s Association was; 33 "an undomiciled person who is unable to secure permanent and stable housing without Special assistance" (Cuomo, 1983). Another definition of homelessness authored by the U.S. Government Accounting Office (1985) was; "those persons who lack resources and community ties necessary to provide for their own adequate shelter." The Michigan Department of Mental Health Task Force on the Homeless developed a more detailed "working" definition of homelessness; Homeless individuals are those who lack a permanent residence (a place of one’s own where one can both sleep and receive mail) because of inadequate resources, inadequate access to resources, inadequate management of resources, or because they are unable or unwilling to accept a traditional residential setting for other reasons (MDMH, 1986) Without an agreed upon operational definition of homelessness, the number of people homeless is often disputed. The US Department of Housing and Urban Development (HUD) reported that the number of homeless in 1983 ranged from 250,000 to 350,000 (1984). Other private sector groups have estimated the number of homeless to be between two and three million on any given day or night (Bombs and Snyder, 1983). The U.S. Census Bureau Projected Methods for 1990 Census Information included counting all people who are outside on certain streets between 2-4 am on a given date (Coughlin, 1988). 1.4.5.2 Studm' g Homelessness: The Difficulg of Tracking a Transient Population Coughlin (1988) defined problems of investigators who count people who are homeless. Various stages of "homelessness" were recognized to exist. Additionally, researchers found census information about the population without homes very difficult to determine. Random probability samples were not possible for the population of people 34 homeless because there was no way to list the entire population prior to an investigation, because people who are homeless have no adress or other way of being identified. Controversial methods used by researchers to gather census information about people who were homeless were reported in the Coughlin article (1988). In a Baltimore study completed in 1985 and 1986, the "capture-recapture" method was used to count people homeless. This method was originally developed for counting wildlife, and involves taking successive samples of a target population within a defined area (Coughlin, 1988). 1.4.5.3 Characteristics of Sheltered Homeless Families. To describe the characteristics of sheltered homeless families, Bassuk, et al., (1986) interviewed 80 mothers who were homeless and 151 children in 14 family shelters in the state of Massachusetts. A family was defined as at least one parent with one child, or a pregnant mother. Semi-structured clinical interviews were conducted by psychiatrists with adult participants. Questions in the interview focused on; demographics, developmental background, family disruptions and violence, housing, income and work histories, nature of relationships, health status and perceptions of service delivery. A child psychologist administered various standardized tests to children participants. Results indicated many social, psychological and behavioral problems for both the mothers and children (Bassuk, et al., 1986). Ninety-four percent (94%) of the families were headed by women, and ninety-one percent received AFDC benefits. Sixty percent (60%) of the mothers had completed high school although only one- third had worked for longer than one month. One-third of the mothers reported some form of abuse during 35 their childhood, and two-thirds had experienced a major family disruption. Two thirds of the mothers reported a lack or minimal supportive relationships and one forth named their child as the major support. Seventy-one percent (71%) of the mothers had personality disorders, and about 50% of the children were found to have developmental lags, anxiety, depression, and learning difficulties. About half of the children required further psychiatric evaluation. Two thirds of the mothers described housing and social welfare agencies as not helpful. The authors conclude; given the many serious problems of mothers and the difficulties already manifested by their children, comprehensive psychosocial and economic intervention must be made to interrupt a cycle of extreme instability and family breakdown (Bassuk et al., 1986). 1.4.5.4 "Hunger Among the Homeless: A Survey of 140 Shelters, Food Stamp Participation and Recommendations." This report was published by the House Select Committee on Hunger in 1987 (HSCH, 1987). Questions were asked of shelter providers in areas throughout the country. The report did not attempt to describe a representative sample of all homeless shelters, but was intended to be used to confirm findings from local and state studies. The demand for shelter and foodservice was reported to be increasing because the homeless population was increasing (HSCH, 1987). More families with children were becoming homeless. Resources available to shelter and feed people were stressed and often inadequate. In 1987, 45% of the people homeless and identified as eligible did not receive food stamps, primarily because of administrative barriers to participation. Shelter providers identified food sources for people who were homeless as soup kitchens, 36 dumpsters and other free food sites (HSCH, 1987). Health problems of people homeless were confirmed by previous reports from federal, state and local agencies (HSCH, 1987). High blood pressure, susceptibility to respiratory and other infections, mental health problems, and chronic diseases such as diabetes and high blood pressure were widely reported. Children were reported to have high incidences of anemia, growth failure, and respiratory and ear infections (HSCH, 1987). 1.4.5.5 A Status Report on Hunger and Homelessness in America’s Cities: 1988 The U.S. Conference of Mayors (U SCM) have surveyed cities throughout the country every year since 1982, to assess the status of homelessness and hunger in urban America (FRAC, 1990). These reports document an increase in the demand for emergency food and shelter as compared to the demand documented in reports of previous years. In 1988, the USCM completed a survey of 27 cities throughout the country. Information was collected about shelter and food resources available to people who were homeless, and demographic information about those experiencing these problems. The demand for emergency food and shelter assistance was reported to have increased since the last report in 1987. Food assistance demands increased by an average of 19%, while shelter demands increased by an average of 13%. In a majority of cities, an average of 15% of the need for emergency food assistance went unmet. Eighty-five percent (85%) of the surveyed cities expected the demand for emergency food assistance to increase in the year following (USCM, 1989). There is a reported increase in the number of families among the population that 37 are homeless (USCM, 1989). In 1988 the number of families with children requesting assistance increased by an average of 17%, in 84% of the cities. Every city cited the lack of affordable housing as the main cause of homelessness. Other causes of homelessness and hunger cited by the survey included: unemployment; low benefit levels and other limitations of public assistance programs; and poverty or lack of income (U SCM, 1989). 1.4.5.6 Homeless Persons and Health Care Brickner, et a1. reviewed available literature on the health care of homeless persons (1986). They reported that health care was generally unavailable for the homeless. They identified the homeless population as a heterogeneous group of men and women, including long-term street dwellers, residents of shelters, the chronically mentally ill, the economically debased, and alienated youth. Health problems common among the homeless were trauma, pulmonary tuberculosis, infestations and peripheral vascular disease. These problems were reported to be intensified by unsuitable living conditions, stress and sociopathic behavior. Incomplete and fragmentary health care exacerbated chronic health disorders (Brickner et al., 1986). 1.4.5.7 Health Problems of Homeless Children in New York Cipy Alperstein, et al. (198 8), reviewed the outpatient medical records of 265 homeless children less than five years of age and compared them with children of similar socioeconomic status attending the same pediatric clinic. Homeless children included in the sample were those living in "welfare hotels" in the midtown area of Manhattan, New York City. Welfare hotels were those hotels whose owners agree to accept payment for rent through the city welfare agency. The children in the comparison group were not matched for age and sex. 38 The authors reported that the frequency of some health problems among the children homeless exceeded those for the comparison group (Alperstein et al., 1988). The proportion of children homeless with a blood lead level greater than 30 mcg/ml, and the rates of reported child abuse and neglect were higher than those in the comparison groups. The rate of admission to hospitals and delayed immunizations were also higher for the children who were homeless than for the comparison group. There was little difference between the two groups in the percentage of children with a height below the fifth percentile (7.5% and 7.7%, respectively), or weight below the fifth percentile (8.7% and 6.4%, respectively). Similarly, there was little difference between the groups in the percentage of iron deficiency (14.7% children homeless, 14.1% children domiciled). No child had frank kwashiorkor or marasmus. The authors conclude that, ...some of the health problems of homeless children may be remediable by good preventive health care, whereas others would require broader political, social, and economic changes (Alperstein et al., 1988). 1.4.6 Information Available About the Population Receiving Meals at Communig Kitchens. Little information was available related specifically to the population receiving meals at community kitchens. Some studies have shown that some community kitchen guests do not regularly eat three meals a day (Campbell, 1985; Lasdon, 1987; Laven and Brown, 1985). One report indicated that many community kitchen guests had poor dentition (Broughton, 1987). 39 1.4.6.1 Audit and Evaluation of Food Progpam Use in New York State; Report on Phase One and Phase Two Clancy and Bowering (1989 a,b) studied the interaction between emergency feeding systems (EFS) and other public benefit programs such as food stamps and AFDC in New York State. Emergency feeding systems were considered to be food pantries and community kitchens. The study was conducted in two phases. Phase one consisted of a short interview with clients from a random sample of EFS clients in Upstate New York food pantries, and New York City soup kitchen and food pantry users. Phase two consisted of an in-depth study of EFS users from four areas of the state representing rural, urban, and suburban communities. Questions asked in both phases focused on demographic information, the use of EF S, and participation in the food stamp and other social assistance programs. Results of the first phase indicated that EFS users were both substituting for and supplementing their food stamp benefits (Clancy and Bowering, 1989a). A number of the EFS respondents had been using EFS for a year or more; 21% of the NYC soup kitchen respondents, 26% of the NYC food pantry respondents, and 39% of the Upstate food pantry respondents. Twenty-one percent (21%) of the soup kitchen respondents reported being homeless, and 30% reported having no income. Only 33% of the soup kitchen respondents reported participation in the Food Stamp Program, while 40% reported using a soup kitchen at least once a day. Only 1-2% of the food pantry respondents reported being homeless, and all reported some income. Fifty-seven percent (57%) of the upstate and 51% of the NYC food pantry respondents reported participation in the Food Stamp Program. Two thirds of the food pantry respondents in both Upstate and NYC reported using food pantries at least once a month. 40 Nearly 90% of the respondents from all three groups claim that in the past, they had run out of food stamps before the end of the month (Clancy and Bowering, 1989a). Results of the second phase indicated many of the federally funded food assistance programs were relatively well used, and that many respondents used the EFS to save money and stretch their food budget (Clancy and Bowering, 1989b). Food stamp participation rates ranged from 50% for the suburban and rural sample, to 69% in the urban sample. Seventy-eight to 99% of the food starrrp users claimed they ran out of food stamps before the end of the month. A higher proportion of the total income (25-36%) of food stamp participants was spent on food than of those not participating in the program. Of those not currently receiving food stamps, 50-74% had received food stamps in the past; 12-l6% had never applied for the program. Of eligible households, participation rates for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), ranged from 44% (NYC) to 73% (rural). Participation rates in the School Lunch Program ranged from 68% in the urban sample to 93% in the suburban sample. 1.4.6.2 Demogr_aphic Prpfile and Nutrient Intake Assessment of Individuals Using Emergency Food Prom Lenhart and Read (1989) conducted a study to determine the demographic profile and dietary assessment of food pantry and soup kitchen users in Reno, Nevada. Face to face interviews were completed with 191 individuals while in line to receive food assistance. Interviews collected demographic information, FS participation information, and 24 hour dietary recall data. 41 Researchers found that no demographic information was significantly related to nutrient intake (Lenhart and Read, 1989). Sixty-eight percent (68%) of the sample demonstrated some degree of inadequate nutrient intake. Nutrients that were most often inadequate were calcium (76% of the sample), vitamin C (74% of the sample), and thiarnin (74% of the sample). Inadequate nutrient intake was significantly associated with the lack of cooking facilities, lower monthly incomes, and lesser amounts of money spent on food (Lenhart and Read, 1989). 1.4.6.3 "1988 Census of Emergency Food Relief in New York State" Since 1984, the New York State Department of Health, Bureau of Nutrition, Nutrition Surveillance Program has monitored the use of emergency food relief programs across the state through a series of surveys (NYSDH, 1989). The purpose of the 1988 survey was to identify and enumerate all food pantries and soup kitchens in the state, to quantify the amount of service provided, and to identify areas of the state where emergency foodservices were inadequate. Questionnaires were distributed to all known food pantries and soup kitchen staff by mail in February of 1988. Sites that did not respond to the mailing were contacted by telephone. Food pantry stafi‘ were asked to count the total number of people served including everyone in a household receiving food, each time they received it, during 1987. Soup kitchen staff were asked to report the total number of meals served during 1987. Results indicated that the demand and amount of emergency food services provided in New York State was enormous (NYSDH, 1989). In 1987, there were a total of 1,884 soup kitchen and food pantries in operation in the state. In 1987, food pantries 42 served 5,305,385 people, and community kitchens served 6,418,124 meals, throughout the state. Problems with public assistance such as sanctioning and inadequate or late benefits was the most frequent reason cited by respondents for clients’ use of food pantries and soup kitchens. Lack of funds was reported most often as the most severe problem jeopardizing continued operations of the food pantries and soup kitchens. Lack of volunteers was the second most frequently cited problem reported by soup kitchen staff, and lack of food was the second most frequently cited problem reported by food pantry staff. Areas of unmet need were reported in parts of NYC, Long Island and other areas scattered throughout the state (NY SDH, 1989). 1.4.6.4 "Within Month Variame in Use of Soup Kitchens in New York State" Thompson, et al (1988) described the variation in use of soup kitchens throughout the month using data from the New York State Nutritional Surveillance Program. Soup kitchens selected for inclusion in the sample were randomly selected and stratified by the six New York State public health regions. The months of November, December and May were excluded, because the holiday meals served during those months created a different pattern of use. Results showed an overall increase in use of soup kitchens throughout the month for both Upstate New York (UNY) and New York City (NYC; Thompson et al., 1988). The increase in use corresponded to the tinting of the distribution of public assistance benefits. However there was a difference in the timing of benefit distribution. In UNY, most benefits were distributed at the beginning of each month. In NYC, social assistance benefits were staggered throughout the month. (Thompson et al., 1988) 43 1.4.6.5 Dep_endency on Soup Kitchens in Urban Areas of New York State Rauschenbach, et al (1990) conducted a study to determine demographic information from meal recipients and their dependency on soup kitchens. Study data was collected from 28 urban soup kitchens in New York State. Since the total number of meals served at the soup kitchens was available, meals were sampled and the recipients of those meals were interviewed. A total of 501 meal recipients were interviewed. Seventy percent(7 0%) of the meals selected were during the last half of the month. Ninety three percent (93%) of the recipients had incomes below the poverty threshold. Twenty percent (20%) of the recipients were working, and 48% received food stamps. Sixty two percent (62%) of those interviewed lived in apartments or homes, while 20% were homeless. Forty percent (40%) of those interviewed were women, and 17% of the recipients had a child in their household. Fifty one percent (51%) of the recipients had eaten five or more meals at soup kitchens during the last week, and 59% had started eating at soup kitchens more than a year prior to the study (Rauschenbach et al., 1990). 1.4.6.6 Food Sources and Intake of Homeless Persons Cohen et al., (1992) investigated the frequency of meal services and the nutrient content of soup kitchen and homeless shelter meals, as well as the food consumption patterns and the frequency of consumption of food groups from 24 hour food lists of homeless people. Twenty cities with populations of 100,000 or more were included in the nationally representative sample. Over half of the shelters (54%) served three or more meals per day. Only 3% of 44 the soup kitchens served three meals per day, while 72% served one meal per day. Consequently, more than twice as many meals per day were served to the homeless in shelters rather than at soup kitchens. It was estimated that the average meal served at either soup kitchens or shelters provided more than 50% of the RDA for both men and women for protein, vitamin C, thiamin, riboflavin, niacin, vitamin A and phosphorus. Fifty percent (50%) or less of the RDA was provided to both men and women for calcium, vitamin B-6, and magnesium. Iron was available at 70% of the RDA for men, but at only 39% of the RDA for women. Homeless people were also found to generally eat only two meals per day. Data from the food lists showed that the diets of homeless people were low in fruits, vegetables, grains, and dairy products. The results of this study showed that for many homeless persons, hunger and food insecurity was a problem. 1.5 Community Kitchens: Financial Resources The private sector has been identified as the major funding source for shelters and foodservice for people who were homeless (HSCH, 1987; NRA, 1987). Many community kitchen nrangers and shelter providers have stressed, however, that the demand for emergency food and shelter is so great that it threatens to overwhelm the system (HSCH, 1987; Morgan, 1986; NRA, 1987; NYSDH, 1989; USCM, 1988). Robert Anderson, a founder of the privately supported Rainbow Soup Kitchen in Homestead, Pennsylvania describes the difficulty in maintaining their community kitchen, "I’m afiaid we’re becoming the substitute for a long-term solution. We aren’t the answer, but we can’t get out from under it " (Ansberry, 1988). Father Tom Lumpkin who helped manage the 45 Manna Meals soup kitchen in Detroit, Michigan reports on the increased demands at their community kitchen, "We used to be able to sit around with people. Now it’s an assembly-line operation. We’re in the fast food business" (Hoover, 1987). Many restaurants have become involved in supporting local food banks and community kitchens (Zuckerman, 1988). Some states have included tax laws which allow for restaurateurs to write-off up to 50% of the unrealized profits from donated foods (Zuckerman, 1988). The National Restaurant Association fully supports in kind, supportive, financial and other donations to community kitchens and food banks (NRA, 1987). The association has made a guide available to foodservice operators which outlines ways to incorporate donations of leftover foods to emergency food systems into their operations, and to anticipate potential problems (NRA, 1987). The Hunger Prevention Act of 1988 included an allotment of additional commodity foods to be distributed to each State for redistribution to community kitchens and food banks. The share of commodities, as measured by their value, to be provided to each State shall be based 60 percent on the number of persons in households within the State having incomes below the poverty level and 40 percent on the number of unemployed persons within the State (PL 100-435, 1988). 1.6 Community Kitchens: Quality of Meals Served The following section will review food and nutrition related problems that have been identified from studies completed with community kitchens. Some reports indicated that community kitchen menus typically were difficult to plan and to make palatable, because donated items often dictated the menu (Ansberry, 1988; Hales, 1988). 45 1.6.1 Nutritional Status of Men Attending a Soup Kitchen: A Pilot Study Laven and Brown (1985) studied the socioeconomic characteristics and the nutritional status of 49 men receiving meals at a Birmingham, Alabama soup kitchen. Face to face interviews were conducted with meal recipients, and anthmpometric data and laboratory assays were collected. The authors also estimated the nutrient composition of three typical meals served at the kitchen. The mean age of the men participating in the study was 33 years with a standard deviation of 10.8 years. Eighty six (86%) percent of the men were living below the poverty level, and 85% were black. Fifty-three percent (53%) of the participants received food stamps, and all of the men had a local address. A nutrient deficiency determined from blood analysis was detected in 94% of the men. Deficiencies present included; ascorbate (63%), folate (35%), and thianrin (29%). The typical soup kitchen meal served at the Birmingham, Alabama kitchen was inadequate in vitamin C, thiamin, and folate, when compared to 1/3 of the National Research Council’s RDA for these nutrients (Laven and Brown, 1985). 1.6.2 A Rgport on the mality of Meals Served in Soup Kitchens in New York State McGrath-Morris (1987) studied fifty randomly selected soup kitchens in New York State to determine the nutritional quality of meals served. The investigator visited 24 kitchens in New York City and 26 in Upstate New York one time during a three month period. A food log was administered to collect information about meals. The investigator recorded the food served and estirrrated serving sizes during the on-site visit. The kitchen manager was then asked to recall all meals served during the previous week. Meals were 47 recalled starting from the most recent. The investigator standardized serving sizes for recalled meals by equating them with the on-site serving size estimates. Meals were analyzed both for their nutrient content and for the kinds of food that were included in the meals (McGrath-Morris, 1987). Twelve nutrients, including protein, calcium, iron, vitamin A, thiamine, riboflavin, niacin, vitamin C, vitamin B-6, vitamin B- 12, folic acid, and vitamin D were analyzed to determine if 1/3 of the 1980 Recommended Dietary Allowances was provided. The Basic Four Food Groups and a Food Diversity Score was used to determine the kinds and variety of food served in the meals. The majority of the 50 soup kitchens studied did not provide nutritionally adequate, well balanced meals (McGrath-Morris, 1987). None of the kitchens provided 1/3 of the RDA for vitamin B-6, and folate in the average meal. Only 4% of the kitchens provided 1/3 of the RDA for vitamin D and for vitamin B-12. Over half of the kitchens failed to provide 1/3 of the RDAs for calcium, riboflavin, iron and calories. Most kitchens served at least one vegetable and fruit with their meals. Less than one-third of the soup kitchens served one food from the dairy group. Ninety-eight percent (98%) of the soup kitchens served one food from the meat or meat alternative food group, and 92% of the soup kitchens served at least one serving from the bread and cereal food group (McGrath-Morris, 1987). 1.6.3 Soup Kitchen Meals: An Observation and Nutrient Analysis Canillo and Gilbride (1990) studied the quality of meals served in five community kitchens in New York City. A questionnaire was used to determine demographic 48 information and the history of the community kitchens, menu planning and foodservice procedures, and specific menu information for one community kitchen meal. Nutrients in the meals analyzed were, carbohydrate, protein, fat, vitamin C, folacin and thiamin. Nutrient content was compared to 1/3 of the 1989 RDA for 25-50 year old men, because that group represented the typical recipient of community kitchen meals. Results indicated that all five of the community kitchens opened in response to the emergency need in the community (Carrillo and Gilbride, 1990). Daily operation of the kitchens depended heavily on volunteers. The number of meals served per day ranged from 300 to 1,000. All of the community kitchen meals analyzed provided adequate calories and protein. One kitchen meal did not provide 1/3 of the RDA for vitamin C, while 3 of the kitchens did not provide 1/3 of the RDA for folacin. None of the kitchens provided 1/3 of the RDA for thiamin. The authors indicated; ...a need for nutritionists and dietitians to become involved not only in soup kitchens and other emergency food programs but in the overall hunger and food security issues (Carrillo and Gilbride, 1990). CHAPTER 2 MATERIALS AND METHODS Throughout the 1980’s poverty and food security have increasingly become a concern for a growing number of Americans (ADA, 1986; HSCH, 1987; PTFHA, 1987). The scope of the food security problem has been controversial because little quantitative information about food security has been available. However, increases in the number of community kitchens serving meals to the poor, and in the number of people attending community kitchens throughout the United States has been documented (HSCH, 1987; USCM, 1987). 2.1 Sample For this study, two sampling frames were chosen. The first sampling frame was all community kitchens in Lansing, MI. For the purposes of this study, a community kitchen was defined (glossary) as any foodservice organization which served meals on a regular basis without charge to any individual, male or female, and was funded to some extent by donations from service organizations or individuals. Area shelters which served meals only to overnight shelter guests were excluded from the study because they did not meet the definition of a community kitchen. A second sampling frame included all guests of the Lansing community kitchens. 49 50 Guests of community kitchens were defined as anyone who received a meal fi'om the community kitchen during the regularly scheduled meal service period. Guests may have included community kitchen staff or other building staff, and volunteers. Six community kitchens in Lansing, M1 were identified from an area directory of service organizations (MDPH, 1985) and asked to participate in the study (N=6). A Lansing congregate nutrition site funded through Title IIIC of the Comprehensive Older Americans Act (PL 95-478:92,197 8), was included in the study for comparison purposes. The Title III site was included because such sites are mandated to meet one third of the US Recommended Daily Allowances (USRDA;NAS/NRC, 1968), and because their foodservice managers regularly consult with registered dietitians (PL 95-478z92, 1978). 2.2 Materials A community kitchen demographic data collection form was developed to record kitchen demographic information one time per kitchen (n=7;Appendix A). This form included questions regarding; operational funding sources, the number of meal service periods (MSP) hosted per week, menu planning abilities, and other problems encountered with meal services. Two different consent forms, one for kitchen administrators (Appendix B) and one for guests (Appendix C) plus a guest questionnaire (Appendix D) were developed and approved by Michigan State University’s "University Committee on Research Involving Human Subjects" (UCRIHS). The consent form for administrators was used to obtain permission to distribute questionnaires. The guest consent form was used to obtain permission to use the information provided by guests as part of the results of the study. 51 Instructions were included for adults regarding questionnaire participation from children. Parents or adult supervisors were asked to obtain verbal consent from the child, sign the consent form themselves and then assist the child, if necessary, in filling out the questionnaire. The guest questionnaire contained demographic factors including sex, age, marital status, employment, and social assistance. Also, three additional questions were included pertaining to; the number of meals eaten at community kitchens per week, the usual number of full meals eaten per day, and the perceived sensory quality of community kitchen meals. To identify repeat respondents, guests were required to mark a space on the bottom of the questionnaire if they had previously completed a questionnaire at any community kitchen. A cost data collection form was developed (Appendix E) to record labor and food cost information during each data collection visit (n=18). This form included questions regarding; the number of paid workers, the number of hours they worked and their pay rate, the number of volunteer workers and the number of hours they worked, the quantity (weight) of individual food items used for recipes, the quantity (weight) of the food item purchased, and the cost of the each food item purchased for the meal served. 2.3 Procedures Community kitchen and Title III site administrators (n=7) were contacted by phone and a brief, informal description of the purpose and methods of the study was provided. Data collection visits were described over the phone and included; obtaining kitchen demographics from interviews with kitchen administrators or cooks (n=1), administering 52 a written questionnaire to guests at noon MSPs (n=3), weighing three pre-plated portions of each food item (n=3), collecting labor and food cost information (n=3), and obtaining recipe information (n=3). The administrators were then asked to allow the community kitchen to participate in the study. 2.3.1 Communigy Kitchen Demographic Data Collection During the first of the three data collection visits at each community kitchen (n=6), cooks or administrators were interviewed to obtain community kitchen demographic information using the form in Appendix A. 2.3.2 Qpestionnaire Distribution During the first data collection visit (n=6), kitchen administrators were provided with a copy of both consent forms (Appendices B and C) and a sample questionnaire (Appendix D) for review. They were then asked to sign their consent form if they chose to allow questionnaires to be distributed to guests as previously described. The consent form and questionnaires were distributed to guests at each data collection visit (n=18). before the MSP began. A brief verbal explanation of the purpose and directions for the questionnaire were given to all guests. Also, to improve results, guests were offered assistance in completing the questionnaire. The researchers and other volunteers trained on site were available to read the consent form to any guest. Some guests were expected to need this assistance because of reading, language, or vision difficulties. 53 2.3.3 Cost Data Collection The number of volunteer and paid workers, the pay rates if applicable, and the number of hours worked were recorded during each MSP observed (n=18) using the cost data collection form (Appendix E). The costs and weights of all foods purchased for all MSPs observed (n=18) were also obtained from kitchen administrators and cooks. In addition, recipes for each menu item served at each MSP observed were obtained from kitchen administrators and cooks. 2.3.4 Nutrient Content Data Collection To determine the nutrient content of meals served in community kitchens and the Title 111 site, information was needed on the portioned weight of menu items, as served. The weights of all portioned menu items were obtained in grams (Model SR-1000, Edlund 1000g portion scale, 159-T Industrial Parkway, Burlington, VT 05401) fi'om three plated meals per data collection visit (n=54), at the beginning of each MSP (n=18). The weights were documented on the data collection form (APPENDIX E). 2.4 Design One kitchen or site per day for one month (March, 1989) was randomly selected for a visit at the noon MSP (n=18 visits). March was considered an appropriate month to obtain nutrient data because that month may be less likely to be influenced by charitable or seasonal changes in the amount or kind of foods available. Three visits per kitchen or site were considered appropriate for the statistical analyses performed and the time constraints involved. The six community kitchens included in the study represented 54 the total population of community kitchens located in Lansing, MI. The Title 111 site was one of 32 Title III sites in the Greater Lansing area. Community kitchens were labeled with numbers one through six to maintain anonymity. 2.5 Analyses Analyses of the labor and food cost were based on actual and equivalent market values of food, and are given per plate. The cost given per plate reflects the cost for all food items on the plate as it was served. The Actual Market Values (AMV) depicted the costs which the community kitchen actually incurred for the labor and food per plate served. The equivalent market value (EVM) was the total cost of labor and food when volunteer labor and donated foods were assessed at current market costs and added to the AMV of labor or food cost. To complete the analyses, the following definitions and formulas were developed (See also glossary). 2.5.1 Actual Market Value (my) of Labor Cosgljlate The AMV of labor cost per plate was defined as the direct costs paid by the community kitchen for the labor time used for the production, service, and clean-up of each observed MSP, divided by the total number of plates used in the same MSP. Operationally, the AMV of labor cost/plate was determined by multiplying the reported number of labor hours during the MSP for each paid worker by their reported hourly wage, summing the gross pay for all workers involved in that MSP, and dividing this by the number of plates used for that same MSP. 55 Formula One: AMV of Labor Cost/Plate AMV of Labor Cost = 1 (number of paid labor hours)(pourly wage)) 1 plate total number of plates used This definition of labor cost did not include administrative labor time. Typically, kitchen administrators had many responsibilities such as securing donations, organizing volunteer schedules, or procuring food and were not often directly involved in meal service operations. 2.5.2 Eguivalent Market Value (2M2) of Labor Cosfllate The EMV of labor cost/plate was defined as the 1989 federal minimum wage ($3.35/hr) multiplied by the quantity of volunteer labor hours involved in the production, service, or clean-up of a MSP, divided by the number plates used in that MSP, plus the AMV of labor cost/plate for that same MSP. Operationally, the EMV of labor cost/plate was defined as the total number of reported volunteer labor hours involved in the production, service, and clean up of a MSP, multiplied by $3.35/hour, then divided by the number of plates used for that MSP, plus the AMV of labor cost/plate for that same MSP. Minimum wage was used to determine the EMV of volunteer labor time because volunteers were usually not trained in food handling practices and would normally enter the foodservice labor market at that level of compensation. 56 Formula Two: EMV of Labor Cost/Plate EMV of labor cost = (total volunteer labor hrs)(§3.35 1+ AMV of labor cost plate total number of plates used plate a=As determined by Formula One Additionally, a useful interpretation of labor was the quantity of labor minutes per plate used per MSP. This was useful because the efficiency of the kitchen operation could be evaluated. Total labor minutes per plate was derived by multiplying total labor hours (volunteer plus paid) by 60 rrrinutes and then dividing by the total number of plates used per MSP. Formula Three: Total Labor Minutes/Plate Total Labor Minutes = 60(volunteer labor hours + paid labor hours) plate total number of plates used per MSP 2.5.3 AMV of Food Costlljlate The AMV of food cost/plate was defined as the direct costs paid by the kitchen for the food used in each observed MSP, divided by the total number of plates used in that MSP. Operationally, the AMV of food cost/plate was defined as the sum of the percent by weight of each whole food item used in a recipe multiplied by the actual cost of that whole food item, divided by the total number of plates used in that MSP. 57 Formula Four: AMV of Food Cost/Plate AMV of Food Cost= (cost of whole item(% of whole item ufllrpg’mn plate total number of plates used in the MSP Leftover or waste food items were not quantitatively assessed and were not deducted from AMV food cost determinations. Also, the food cost determinations did not consider pre-preparation waste. 2.5.4 EMV of Food Cosgzlate The EMV food cost per plate was defined as current local, wholesale (institutional) cost of all food items used for a MSP, divided by the total number of plates used for that MSP. Operationally, the EMV of food cost/plate was defined as the sum of the fraction by weight of each food item used in a recipe multiplied by the wholesale cost of that whole food item, divided by the total number of plates used in that MSP. Formula Five: EMV of Food Cost/Plate EMV Food Cost= (wholesale § whole item(% of item uspgagcimn plate total number of plates used in the MSP Wholesale or institutional costs were used to determine the EMV of food costs because large scale foodservice operations (n=50 people/service period) typically purchase food supplies from a wholesale distributor. All food items were initially priced at a Lansing area wholesale distributor (Gordon’s Cash and Carry, Pennsylvania Ave., Lansing, MI) during the week of April 17, 1988. Items not available from the wholesale 58 distributor, were priced from a Michigan State University Food Stores’ (Service Rd, East Lansing, MI) price list from the same week. 2.5.5 Nuuient Analyses of Meals Served A nutrient analysis of 21 meals served at community kitchens and the Title 111 site was completed using Diet Analyzer Ver.3.02b (The CBORD Group, Inc., Ithaca, NY) with the ESSHA II nutrient database (ESSHA Research, Salem, OR 97302). Nutrient databases may not be complete in some nutrients because some nutrients are difficult to isolate from food sources in the irnmunoassays used in the development of nutrient databases (Morgan, 1992). Therefore, some nutrients in particular, magnesium, folate, and vitamin B-6 may be reported as deficient because of the incompleteness of the nutrient database and not necessarily because the nutrient was lacking in the food analyzed. Meals were analyzed according to their portioned weight as served not as consumed. The analysis included seven nutrients: vitamin A, vitamin C, folate, vitamin B-6, iron, magnesium, calciunr, and calories, carbohydrate, fat, protein, and sodium. These nutrients were chosen for the following reasons: 1) the diets of low income families have been shown to be inadequate in vitamin A, vitamin C, vitamin B-6, folate, iron, magnesium, and calcium (USDA, 1982; USDHEW, 1974; USDI-IHS, 1983, Lenhart and Read, 1989), and 2) some community kitchen meals have been shown to be inadequate in various subsets of the nutrients included in the analysis (McGrath-Morris, 1988; Carrillo et al., 1990; Laven and Brown, 1985). One third of the US Recommended Daily Allowance (U SRDA;NAS/NRC, 1968) 59 for each nutrient was considered the standard for comparisons because this is also the standard used for menu deve10pment in the federal congregate nutrition program (PL 95- 478:92). Each nutrient was evaluated against its standard to determine whether the community kitchen guests from the were supplied with at least 1/3 of the USRDA. Though this study used the 1/3 of the USRDA as the nutrient standards for the evaluation of community kitchen meals, the USRDA was intended for use with healthy populations (NAS/NRC, 1968). From the literature available regarding low income populations (Kaplan et al., 1987), it was evident that the population eating at community kitchens cannot be assumed to be healthy. Low income populations have been shown to have higher incidences of health problems, and it is likely that the majority of the population eating at community kitchens has lower incomes. 2.5.6 Statistical Analyses A one way analysis of variance was completed on the labor and food cost data and the nutrient data collected, using the MSTAT microcomputer statistical program Ver.4.0, (Dept. of Plant and Soil Sciences, MSU, East Lansing, MI) on a Xerox personal computer (Model # 6065, Stamford, CT, 06904-1600). The analysis was completed to determine if there were significant differences among community kitchens for each of the following variables; the AMV of labor cost per plate, the EMV of labor cost per plate, the AMV of food cost per plate, the EMV of food cost per plate, and the nutrient content of meals. All data will be reported to one decimal place, with rounding up from the second decimal place when appropriate. CHAPTER 3: RESULTS AND DISCUSSION Five corrrrnunity kitchens out of six agreed to fully participate in the current study; the administrator of Kitchen One agreed to participate in all aspects of the study except the distribution of the guest survey and the weighing of food portions. The policy of Kitchen One’s administration provided that guests would not be questioned, and that portion sizes of menu items served would not be regulated or measured. Data from Kitchen One, where available, were used in the analyses and discussion below. 3.1 Demographics of Community Kitchen Operations from Cooks and Administrators Interviewed Community kitchens in this study were located in community centers and churches of Lansing, MI (Ingham County, Table 1). Kitchens One, Two, Four, and Six were located in the downtown area, while kitchen Three was located in a west neighborhood, and kitchen Five was located in a north neighborhood. Kitchens One, Two, Four, Five and Six were equipped to prepare large quantities of food for on-site service. Kitchens Three and Four did not prepare meals on site, but had hot meals brought fi'om high school and home kitchens, respectively. Only kitchens Four and Five provided an opportunity for social activities. 60 l 6 Snag 3:58:50 o: 8» o: o: 88:83 woe c2805 8» c: we» 8» 83:83 .58 23.20:? 8» o: 8% 8» 33:83 noon. Exam 0: o: 8» o: 2:20 boooem 384 o: o: 8» we» x53 teem o: o: a»; 2. 5:58:80 83:83 .58 8538.5 8» o: 8» we» woe Lo Eons—SQ 0:5 Boom .>.~. £250 25 Z 25 Z 252 8:385 38m 2286— 025$ 60:8 :33 26 :0 2mm :0 528305 coo.“ a8 .8383 caesium 08:52:ng so? :BoanD :BoEBoD means 553» .8283 55:0 53:0 .528 b_==EEoU 55:0 08% 95.53 m N L 86am oEneonoQ .:z .9555 E 26 E 25. 28 new 82.32 5:58:56 :5: £208 oEQEmoEoQ ”Am Lo _ omae L 2an 62 o: 8% 8» 8% 8» 8» 8% 88: LaLoom 2% :0 80:83:28: 8.52 888 988800 2% 5 2:8 0: o: o: o: o: o: 8» 8:2 26 :0 :388500 888 3828800 o: 8» 8% 8» 8» 8» 8% 88: 30% 26:0 88:89:28: 5.82 888 38.880 88:83 88 838E 88:95: 88 2822.? 88:83 88 LLSom 8:80 boooew L83 2:2 coon bLLeo88o0 88:08: L58 828585 L58 Lo 82:80Q 8288 38m :28;qu :08 Lo 8883 83:5 85:5 :23qu 8an 885: o n :unoLLvL $838800 82% LE 8883 :L 2% LLL 22L. 8:: .8: 82622 585888 8:: 8908 28:88an Am Lo N omav .8888 L 28¢. 63 3.1.1 Food Procurement Based on information obtained from interviews with community kitchen administrators and cooks, community kitchens in this study procured food in one of four ways (Table 1). Food items were procured by (in order of estimated frequency); I) donated foods, 2) discounted purchases, 3) retail purchases, 4) wholesale purchases and 5)prepared meals. All community kitchens participating in this study except Kitchen Three procured some food by donation (Table 1). Donated foods first most frequently came from church or community groups, second from individuals, and least often from independent store owners. Most kitchens had similar policies regarding donations. The donor needed to complete and sign a short form before the donation would be accepted. Typically, the form included the items donated, a contact person and phone number. Only three community kitchens (One, Two and Five) reported regularly procuring food through discounted purchases (Table 1). Most often, these kitchens purchased discounted foods from the Ingham County Food Bank (affiliated with the United Way Foundation and the American Red Cross). Less frequently, these kitchens purchased federal commodity foods at discounted prices. These kitchens obtained some types of federal government commodity foods for $0.08 -0.12 per pound plus the cost of shipping. The least used method of procuring discounted foods for kitchens One, Two and Five was from local retail grocery chains. Each of the administrators or cooks from these community kitchens had independently negotiated discount purchase plans for some types of food with one or more local grocery stores. Four community kitchens (One, Two, Four, and Five) reported retail purchases as a regular method of food procurement (Table 1). Retail purchases were made from local 64 grocery stores. Foods most often purchased at regular retail price included staples such as milk, coffee, meats, paper supplies, fresh fruits and vegetables. Kitchens One, Two, Four and Five reported occasionally using wholesale food outlets as a method to procure food (Fable 1). No community kitchens reported regularly purchasing foods from wholesale food outlets as a method to procure food. When possible, community kitchens should purchase foods from wholesale food outlets instead of making non-discounted retail purchases, to cut expenses. Kitchen Three was the only kitchen that purchased prepared meals from a satellite school lunch program. The Title III congregate nutrition site used all four methods to procure food (Table 1). Most often the site procured food through regular retail purchases. The site also reported procuring foods through donations, discounted purchases, and wholesale food outlets with equal regularity. Interviews with community kitchen personnel also indicated that most community kitchens and the Title 111 site did not regularly participate in gleaning projects. Gleaning is a method of food procurement whereby surplus, leftover and discarded foods are obtained, usually free of charge from manufacturers, storage warehouses, grocery stores, and restaurateurs (Glossary). Usually, gleaning was not done by community kitchens because of the time constraints involved. Typically, community kitchen cooks and administrators were very busy and had little extra time to participate in gleaning projects. Also, community kitchen personnel reported that while many volunteers may be available to undertake gleaning projects, most did not have any means of transportation. 65 3.1.2 Difficulties with Meal Services Rpported by Community Kitchen Cooks Cormnunity kitchen cooks had developed strategies for menu planning which compensated for the uncertainties involved with their jobs (Appendix F). No community kitchen cooks reported a great deal of difficulty procuring enough food to serve meals to all of their guests. However, shortages of prepared food did occur. These shortages usually were due to an unexpectedly high number of guests attending a particular meal service period (MSP). The cooks reported that they usually had on hand some type of back-up menu items (e. g. canned chili) which could be heated quickly to accommodate unexpected guests. Another difficulty reported by community kitchen cooks was knowing how to use and/or combine the food items they had on hand at the time, to prepare good tasting, well balanced meals. This occurred because often the food items on hand had not been purchased but had been donated and may have needed to be used quickly. Often, these food items may have been donated just prior to a meal service period. 3.1.3 Meal Service Periods (MSP) and Quantity of Guests m MSP A MSP was defined as the period of operation when a community kitchen served meals to guests (Glossary). The author observed that most community kitchens were very strict about the time frame involved with MSPs. Guests were usually requested to line up single file outside the dining room before a MSP began. Generally, MSPs began on time, and at the end of the MSP the community kitchen staff would close the doors to the dining room Guests who would come to the dining room after the doors were closed would most likely not be served. 66 The community kitchens in this study did not vary greatly in the number of MSPs per week (Table 2). Kitchen One served meals only once per week, while Kitchens Two, Three and Five served meals twice per week. Kitchen Six had the greatest number of MSPs per week (n=2l). The Title III site had 4 MSPs per week. McGrath-Morris (1988) found that 34% of the 50 soup kitchens included in her study in New York State were open for one MSP per week. Twenty percent (20%) of the kitchens were open for two to four MSPs per week. Thirty four percent (34%) of the New York soup kitchens were open for five MSPs per week, and 12% were open for six or more MSP’s per week (McGrath-Morris, 1988). Cohen et al., (1992) reported that 3% of the nationally representative sample of community kitchens in their study were open for three MSPs per day, while 72% were Open for one MSP per day. No other similar information was available in the literature regarding MSPs of community kitchens. The mean number of guests served per MSP also varied greatly among Lansing community kitchens in the present study (T able 2). Kitchen Two served the greatest mean number of guests per MSP (n=147.7), while Kitchen Six served the smallest mean number of guests per MSP (n=18.7). The mean number of guests served per MSP was 63.7 1 10.9 for all community kitchens in the study. No other information was found in the literature regarding the number of guests served per MSP in community kitchens. The mean number of guests per MSP for the Title III site was 27.0 _-t_- 4.1. 3.2 Labor Labor for the preparation and service of meals in Kitchens Two, Four and Six was provided by paid employees and volunteers (Table 2). Labor for the remaining three 7 6 8:2 .8 :8, 8:88:88 2:: 8: 88: m 32:88:88: 8368 f; 838 8: 85 8:: totem 0338 L3: .12.. 88:32 88888 a 8 888:2. 85 E 8: 2: 3L: 2: 8:88: .8: 888:8 8:: muz ..v 98% 8:2 8:22: L. odfimém 888.3 8.302 :LHQNL 342.2 mdfldm L..~Hm.om :dedm 88 2298888 8:2 L88 ow88>< o.m.4n~.m~ méflodm 35% @353 odfiodw 30:me 8.8.23 @853 8288: 8:2 L89 8883.. Wmfimd 3893 Wind mdfindm v.35; :6“me finflodm N888: “5238:: 82:29» 8:83. Emdfimi 930: Nd“: o mLHmL. o m.m.+.~.3 o $2588: . 8:2 2:: 8883. 3.8.8 85.8 38:: 8.828 83.; 88.9. 23.2: 238.8 2:538:28?» 8 138:: ow88>< a. m a N m m m L 2:533 :83 a: ...:.an2 8 8:8:2 :88 c n v m m L 828 ......28 8:82 38.8800 525. .L2 8883 8 2L: LLL 25. :8 L8: 828:2 b89888 8m 88.. 88888 288885 ”a 2:3. 68 kitchens was provided solely by volunteers. All six community kitchens reported instances of labor shortages. These shortages were similar to the findings reported by the New York State Department of Health in 1988 (NY SDH, 1989). A lack of volunteers was found to be the second most frequently reported problem which may jeopardize community kitchen services in the state of New York. Community kitchen cooks and administrators reported the need for a flexible work schedule to compensate for the unpredictable nature of available labor to prepare community kitchen meals (Appendix F). From interviews with community kitchen cooks, labor for community kitchen meal services could be unpredictable for two reasons. First and most often, labor shortages were due to the irregularity of the volunteer work schedules. Reportedly, there were days when enough volunteers simply did not come to work. Second, the labor requirements of a given meal service period often increased due to an unexpected increase in the number of guests attending a MSP. The labor force may not have been able to effectively or efficiently serve all guests. All six community kitchen cooks reported that the quantity of meals served increased at the end of the month. This increase was thought to be due to guests running out of Foodstamps and other government assistance benefits near the end of the month. This information concurred with a study completed by Thompson et al. in New York State (1988). They reported a pattern of an increase in the number of meals served per week toward the end of the month at community kitchens in Upstate New York, and to a lesser degree in New York City. Conversely, in a Hillsborough County, Florida study, Taren, et al. (1990) found that the number of food servings per week in randomly selected low income families decreased the during last week of the month. 69 Knowledge of such patterns allowed community kitchen cooks to do some informal forecasting. Community kitchen cooks reported, however, that there were many times that they could not accurately predict the number of guests that would be attending a given MSP. This may have caused the cooks and staff to prepare more food "at the last minute". All community kitchens cooks reported an ability to "get by" when questioned about the difficulty in dealing with the unpredictable nature of meal services. 3.2.1 Paid Labor Community Kitchens Two, Four, and Six used paid labor for meal preparation and service (Table 2). Kitchen Two had the greatest mean amount (n=3 MSPs) of paid labor hrs per MSP (14.2 1; 3.2 hours), while Kitchen Six had the lowest mean number of paid labor hrs per MSP (1.7 1- 0.2 hours). Information available in the literature regarding paid labor for other community kitchen meal services was not available at the time of this writing. The Title 111 site used more paid labor hours per MSP (14.8 3; 0.2 hours, n=3 MSPs) than any community kitchen. This was most likely due to the fact that the site employed a bus driver to transport guests to and from the site for meal services. The labor hours of the bus driver were included as part of the paid labor hours involved in the site’s meal preparation, service and clean-up because those labor hours were integral to the site’s meal services. As with the community kitchens, the labor hours of the administrator of the Title 111 site were not included in the determination of labor hours involved in the preparation, service and clean-up of the Title III site’s meals. 7 0 3.2.2 Volunteer Labor All community kitchens used some amount of volunteer labor for their meal services (Table 2). Volunteer labor only was used in Kitchens One, Three, and Five. Kitchen Six operated with the least number of volunteer hours (3.5 i 0.5 hrs). Kitchen One had the greatest number of volunteer labor hours (44.5 i 8.2 hrs) per MSP. This may be explained in part by the fact that the 10 to 15 founding senior citizen volunteers participated in all aspects of meal preparation and clean up during every MSP. The author observed that these volunteers thoroughly enjoyed the social benefits of getting together and serving meals. During data collection, the researcher observed the volunteers singing, joking and celebrating birthdays. Consequently, this socializing may have added to the time needed to prepare meals in Kitchen One as compared to other kitchens. Similar information available in the literature regarding the use of volunteer labor for community kitchen MSPs was not available at the time of this writing. Volunteer labor played a vital role in community kitchen operations. All kitchen administrators and staff from all kitchens expressed gratitude and appreciation for volunteer labor. The author observed that most volunteers enjoyed participating in the social and community activities associated with preparing and serving hot meals to others in their community. Additionally, some volunteers were working at community kitchens to obtain hours of community service as part of the "diversion" program. These volunteers worked to compensate for some type of illegal infraction. The author observed that there were some problems associated with the use of volunteer labor. Some volunteers were less likely to work diligently at tasks when compared to paid workers. Per observation, among volunteers there was generally a lack 71 of training in food preparation and handling, as well as meal service techniques. Consequently, more labor hours may have been expended by volunteers than was actually necessary. 3.2.3 Total Labor Time Total labor hours per MSP varied substantially among all six community kitchens (Table 2). Kitchen Two had the greatest mean number of total labor hours per meal service period (50.2 3; 9.9 hrs). Kitchen Six had the lowest mean number of total labor hours per meal service period (5.2 1- 0.6 hrs). The labor minutes per plate used was a good indicator of the efficiency of a community kitchen. The mean total labor minutes (volunteer plus paid) involved in the production, service, and clean-up of each guest meal ranged from 12.3 i 1.6 minutes per plate (Kitchen Five) to 39.3 1 9.6 minutes per plate (Kitchen One; Table 2). Kitchen One then, was the least efficient kitchen, due to the reasons discussed previously. Labor minutes per plate of community kitchens were generally higher that those reported for other types of institutions with similar menus. The average labor minutes per meal in hospital cafeterias was 10.9 minutes (Sneed, 1989). In school foodservice, the average labor minutes per meal was only 4.3 minutes (Snwd, 1989). These numbers indicated that the community kitchens in Lansing, M1 were not as efficient as these two types of institutional foodservice operations. This was likely due to the use of volunteers. Some elderly and other community kitchen volunteers may have worked at a slower pace. Also, volunteers may have worked more inefficiently because of the minimal training they received. 72 Workers at the Title 111 site used more labor minutes per plate than any of the community kitchens. The mean labor minutes per plate for the Title 111 site was 54.2 i 2.0 (Table 2). Again, this was most likely due to (l) the labor time required to transport the majority of guests to and from the site for meal services as well as (2) the slower physical ability of older workers and volunteers. 3.3 Demographics of Guests Eating at Community Kitchens Demographic data from community kitchen guests who had completed questionnaires are in Table 3. Demographic information for Kitchen One was not available since the administrators at that kitchen did not permit questionnaires to be distributed to guests. 3.3.1 estionnaire Re ondent Totals The total number of respondents and questionnaire response rates are in Table 3. The average response rate among five kitchens ranged from 27.2% _-_+_- 5.5% (Kitchen Five) to 40.9% 1 3.2% (Kitchen 2). These rates were expected to be low because low income populations may feel uneasy about disclosing personal information because of feelings of resentment towards "outsiders" who gather information (CNI, 1989). However, in another Lansing based study including low income populations, female food stamp and concurrent AFDC program participants were reportedly less likely to feel stigmatized by their assistance program participation than past users were(Smith, 1992). The questionnaire response rates may also have been negatively affected for the following reasons. Some guests may not have wanted to disclose vision, reading, or 73 language difficulties by requesting assistance to complete questionnaires. Also, the response rate may have been affected by the strict time frame involved with MSPs, as previously mentioned in Section 3.2.1. Guests generally were not allowed in the dining room before MSPs began and generally were not encouraged to loiter after they had finished eating and the MSP was over. Consequently, there was a limited amount of time for guests to eat, and to sit or socialize. Guests may not have wanted to jeopardize the time allowed for eating by taking time to complete a questionnaire. 3.3.2 R t estionnaire Res ondents The author observed that many guests regularly visited more than one community kitchen in Lansing. These guests accounted for most of the repeat respondents. In talking with guests, the researcher was told that many "make the rounds" to community kitchen MSPs within walking distance. Also, the author observed that some guests enjoyed the attention obtained from repeatedly completing a questionnaire. Some guests would greet the researchers and immediately ask for a questionnaire. Additionally, volunteer and staff members of community kitchens and the Title III site were among the repeat respondents. Volunteers and staff were given a questionnaire during each data collection visit if they ate a meal during the MSP. 3.3.3 Communig Kitchen Non-refit Qgestionnaire Responses Demographic information for all community kitchens and the Title 111 site was determined solely from non-repeat questionnaire responses. N on-repeat questionnaire responses included those questionnaires which had not been marked by guests as repeats. 74 The total number of non-repeat respondents and the non-repeat response rate is given in Table 3. Average non-repeat response rates for questionnaires ranged from 18.3% i 2.7% (Kitchen Three) to 36.3% ;+_- 5.5% (Kitchen Two) among community kitchens (n=5; Table 3). 3.3.4 Title III N on-rgflt mestionnaire Responses The Title III kitchen’s non-repeat response rate was greater than the non-repeat response rate of any of the community kitchens. Forty-three per cent (43.1% i 6.6%) of the Title III guests completed a questionnaire. This may be due in part to the period of time both before and after the MSP when guests were allowed to sit together in the dining room. This period became an opportunity for the Title III guests to socialize. During the data collection visits, this period was an excellent opportunity for the researcher to distribute questionnaires and to assist guests with the completion of questionnaires. At the first data collection visit to the Title III site, the researcher observed that language difficulties impeded questionnaire completion. Most of the regular guests of the site primarily spoke and read Spanish. Consequently, to enhance the accuracy and completion of questionnaires, the researcher had the questionnaire translated orally into Spanish by a Title III site volunteer who spoke Spanish and English fluently. Other Spanish speaking volunteers were informally trained on site to assist guests with questionnaire completion. 7 5 3.3.5 Gender of Communig Kitchen Respondents Mean data of all community kitchens included in this study showed that 51.7% of the respondents were female (Table 3). The percent of female respondents ranged from 20.1% (Kitchen Six) to 73.7% (Kitchen Two). These results were not similar to the results of other studies. Ninety-two percent (92%) of the 174 respondents in a Reno, NV study among community kitchen and food pantry guests were male (Lenhart and Read, 1989). Rauschenbach et al., (1990) reported that 60% of the community kitchen guests they interviewed were male. The respondents of Community Kitchens Two, Three, and Four were 50% or more female (Table 3). However, this data does not support observations made by the researcher during data collection visits. Generally, the researcher observed that males and females were equally represented at community kitchen meal service periods. There are a few possible explanations for this higher response from females. It may be that low income females were more likely to complete questionnaires than low income males. Also, the fact that the researcher was female may have influenced more females to complete questionnaires, or more males not to complete questionnaires. The Title Three site respondents were predominately female (74.8%, Table 3). This response more accurately reflected the observations of the researcher. The researcher observed that there appeared to be more female guests than male guests at the site during data collection visits. However, the possible explanations given above for a greater percentage of female respondents at community kitchens may also apply to the Title 111 site guests. Also, since the Title III site is specifically for senior citizens, and the average life expectancy for females is roughly seven years longer than the life expectancy of 76 males, it is plausible that the number of female guests at the site was greater than the number of male guests (Hoffman, 1989). 3. .6 Marital S s of Comm ' Kitchen Res ondents Mean data for all community kitchens showed that less than one quarter of the respondents were married (23.3%, n=15 MSPs; Table 3). Laven and Brown (1985) reported that only 6% of the 50 male Birmingham, AL community kitchen guests they interviewed were married. Kitchen Four had the greatest mean percentage of married respondents (39%, n=3 MSPs; Table 3). This may have been related to the availability of family oriented activities at the site. There were many more opportunities at Kitchen Four for social and physical activity for all members of the family. For example, there was a gymnasium which was open for use by children and adults after MSPs. There also was a play area for children which was well stocked with toys and books. To allow parents more freedom to socialize, guests were allowed to use the facility’s nursery during MSPs. The nursery was equipped with volunteer staffing, and ten cribs and small cots. Respondents of Kitchen Six were least often married (14.3%) among the five kitchens surveyed (Table 3). Interviews with the administrators of Kitchen Six indicated that the guests of Kitchen Six were more likely to have insecure housing or shelter than guests attending any other community kitchen in Lansing. This was due in part to the fact that Kitchen Six was located in an area of Lansing where a known population of people who were homeless lived and received shelter, food and rrwdical care. The fact that a lesser percent of Kitchen Six’s respondents reported being married than any other community 77 kitchen was not incongruous with what was reported by Bassuk et al. (1986) who reported on the characteristics of sheltered homeless families. There appeared to have been an increase in the number of families that were homeless across the country throughout the 1980’s (Bassuk et al., 1986). Families in this context, more often refer to women and children, and less often to a married couple (Weicha, 1989; Bassuk et al., 1986). The stress of homelessness has been reported to have been so great that even a brief period of homelessness may cause individuals to suffer anxiety, low self worth, depression, and personality disorders (Bassuk et al., 1986). The stress of homelessness, or of the events leading to homelessness may also have influenced the stability of a marriage or the likelihood that it would survive (Bassuk et al., 1986). In contrast, 53% of the Title 111 guests reported currently being married (Table 3). This was of a greater percent than any of the five community kitchens. This may be due in part to the cultural and generational differences of the Title [[1 guests as compared to the community kitchen guests. More guests may have been married at the Title 111 site because guests of the site were of a generation where divorce and separation were likely to be more uncommon. Also, it may be that the hispanic culture values marriage more than a non-hispanic culture, so that divorce and separation were less likely to occur. 3.3.7 Emplomrpnt Status of Communigy Kitchen Respondents Mean data from all community kitchens participating in the guest questionnaire indicated that 15.0% of the respondents reported that they were currently employed (Table 3). Lenhart and Read (1989) found that 43% of the 191 respondents in their study among 78 community kitchen and food pantry guests reported casual, part, or full time employment. In another study at a Birmingham, AL community kitchen, 29% of the 50 men participating in the study reported some type of employment. The results of Rauschenbach et al. (1990) were more similar to the results of the present study. Only 20% of the meal recipients in the study by Rauschenbach et al. reported some type of employment. Kitchen Six had the highest rate of employment (28.8%), and Kitchen Five had the lowest rate (7.8%; Table 3). The researcher noted from conversations with a few guests of Kitchen Six that they were less likely to have conventional jobs, and more likely to engage in flee-lance or self employment activities. For example, one guest described himself as a "Jack of all trades", picking up odd jobs such as painting, mowing lawns, and fixing things, wherever he could. Although 25.2% of the Title III guests reported being employed, it is not likely that this number of senior citizen guests were actually employed (Table 3). From observations, approximately 25% of the non-repeat questionnaire respondents at the site were staff or volunteers. Consequently, these respondents probably accounted for the majority of those who reported employment. 3.3.8 General A sistance Pr Partici ation of Communi Kitchen Res on ents Mean data from all community kitchens showed a mean of 25.9% of the respondents reported receiving General Assistance (GA) benefits (Table 3). In a similar study Lenhart and Read (1989) reported that less than 1% of the respondents surveyed in Reno, NV reported receiving GA benefits. Other studies of community kitchens have 79 not reported information on guest GA program participation. This may be because Michigan was one of the few states that funds this type of assistance program (Note: GA was eliminated in Michigan in 1991). General Assistance participation was highest in Kitchen Six (36.4%) where only 20.1% of the respondents were female, and lowest in Kitchen Four (19.2%) where 61.3% of the respondents were female (T able 3). These data support the idea that male guests of community kitchens were more likely to receive GA benefits than females. It was more likely that females would be receiving AFDC benefits instead of GA benefits, because females were more likely to have dependent children. 3.3.9 Aid to Families with Demndent Children Progam Participation of Community Kitchen Resppndents Less than one third (31.2%) of the respondents in the present study reported receiving Aid to Families with Dependent Children (AFDC; Table 3). Lenhart and Read (1989) reported that only 1% of their respondents in Reno, NV received AFDC benefits. Rauschenbach et al., (1990) reported that 9% of the community kitchen guests in New York State in their study received AFDC benefits. In Kitchens Two and Three where a higher percent of the respondents were women, a higher percentage of the respondents reported receiving AFDC benefits (Table 3). For example, 49.7% of the respondents in Kitchen Two were female. Additionally, 41.3% of the respondents from Kitchen Two reported receiving AFDC benefits, while only 27.3% reported receiving GA benefits. In Kitchen Six, where only 20.1% of the respondents were female, 26.9% reported receiving AFDC benefits, but 36.4% reported 80 receiving GA benefits. This data supports the conclusion fi'om Rauschenbach et al., (1990) that female respondents in their study were more likely to receive AFDC benefits. No Title 111 respondents reported receiving GA benefits, and only 15.1% reported receiving AFDC benefits (Table 3). Those guests reporting receiving AFDC benefits were most likely volunteers and staff members who completed questionnaires. Because volunteers and staff were allowed to eat at the Title III site they were given a questionnaire to complete. Thése data on GA and AFDC participation were expected because the majority of the Title III guests (80%) were over the age of 60 (Table 4). 3.3.10 Social Securig Benefits of Community Kitchen Respondents The age of eligibility for Social Security benefits is 62 years (Hoffman, 1989). Mean age data for all community kitchens showed (Table 4) that only 7.3% (males and females over 60 years) of the respondents would be likely to be eligible for SS benefits. Still, 23.2% of all community kitchen respondents reported receiving SS benefits (Table 3). This may be explained by the lack of a separate category for Social Security Supplemental Income (SS1), or Social Security Disability Income (SSDI) benefits. Respondents who were receiving either 881 or SSDI benefits may have checked the space indicating they received SS benefits. The SSI and SSDI benefit programs were administered by the Social Security Administration, however they did not have age dependent eligibility requirements similar to SS benefits. The Mean of all community kitchen respondents reported receiving Social Security (SS) benefits was 23.2% (Table 3). Data from the present study could not be compared :. 8:82 2: 288 8:. 2:88: :88 8 c2588 82 I... 88 88:8: H :88 .2 88:8 882.2888 2 8:: 88:88 81 8:2: 58:88:: 2:88:88 :_ 2:828: 8: :8 8:0 8:26. 8 28:0 ...... S: 8:82. 2: E 8: :8 2: 2: 2:88: :8 <98: 2: 8 m: 88 2;. .888, 8828: 58 nnz ... men Wmm 3m 8w. v.8 W: 2.2 :82 m.m~ :8 od :9 NS 92 2.2 2.2: 88822 288:2 .w.2 880 :8. 4.8 3: 2m 8:. 4.2 :8 2:388: :2. :2 8m 3: N8 :2 a: 8 .58 :8 .8: 88m 88m fin _ Sm :.:~ 9.3 :m 3% m2: 09282280 8282253, 858E 2 E< 3.: :.mm v.2“ m. _ N NE m.wm 08 8888.2 8880 8:: 8:28:82 82.2-8: a: 88228: 3:828: 38m 3.: :2 :8 M: :2 m2 :8 8 822:8 Wm: m.m~ mi 98 $8 28 v.2 8:: 882 82 8 :2 Ni. 3: SR :9. :8 882 odfifimv VSHNKN wéfldm mdfiodm vfifldm fimfimgz ndfimdm 3 be o: co 3. mm :2 wdfimdv vdfifimm 2185mm deNSN wdfimdm méfimdm Ndflmdv 8:: 3:28:82 28:28:: .8 22 88:82 2:28:82 832-8: 9: 8:8:2 8.2 22 8882 28:8:8:O 22> 8828: mm 8:: w: on 8 mm «3 :8: 825 :8 2:28:82 a: 8:88 88.: :88 o n v m m 88:": ...28 :8822 b8:88:0 m: 23H. ..=2 8:883 8 28 E 22,—. :8 :8 82.28 58:88:: :2: :o 28:» 8 8892882: ”m 2:3. 8 2 to similar data from Rauschenbach et al. (1990). They reported that 22% of the community kitchen guests they interviewed received SS benefits, while 21% received Social Security Supplemental Income (S 81). Since the present study did not delineate between 88 and 881 benefits, the data could not be compared to that of Rauschenbach et al.(l990). Social Security benefit data from the present study were unlike those reported by Lenhart and Read (1989). In the Reno, NV study among community kitchen and food pantry guests, only 9% reported receiving either SS or 881 benefits. Data from Rauschenbach et al.(l990). Lenhart and Read (1989), and the present study indicated that there was a wide variation in the percent of people who received SS or 881 benefits and attended community kitchens. 3.3. 10.1 Social Securig Benefits of Title III Respondents Forty-six per cent (46%) of the respondents at the Title 111 site reported receiving SS benefits (Table 3). While this participation rate was higher than any of the SS participation rates reported in the community kitchens, it was lower than expected due to the age distribution of the Title 111 guests (Table 4). Eighty percent(80%) of the Title III guests reported ages in the over 60 category (Table 4). Since individuals were eligible for SS benefits at the age of 62 years, it was expected that 80 percent or more of the guests would have reported receiving these benefits. There were many possible explanations for this low reported rate of receiving Social Security benefits. Guests may not have understood the question, or they may not 83 have felt comfortable disclosing personal income information. Also, the guests may not have been eligible for benefits due to recent immigration, or because they may not have worked at jobs that contributed to Social Security. 3.3.11 Food Stamp Program Participation of Communig Kitchen Respondents Mean data from all community kitchens show an average of 38.4% of all non- repeat respondents in the present study reported receiving Food Stamps (FS; Table 3). This lower than expected participation rate in the federal FS program found among presumably eligible individuals is similar to the findings of other researchers (Rauschenbach et al., 1990; Allen et. a1, 1986; Coe, 1983; Lenhart and Read, 1989; Laven and Brown, 1985). Kitchen Three had the highest FS participation rate (52.4%), while Kitchen Six reported the lowest participation rate (18.5%;Tab1e 3). As stated previously, the guests of Kitchen Six were also more likely to be homeless. According to the USDA’s Food and Nutrition Services, only 18% of homeless people take advantage of the FS program because of a lack of facilities to prepare meals from raw food (Romero, 1990). The fact that all community kitchen respondents had lower than expected participation rates reflects a number of documented problems with FS participation. First, in similar studies, the majority of individuals not receiving F S benefits had received F8 in the past (Rauschenbach et al., 1990; Clancy and Bowering, 1989). This would indicate that F S program participants may not feel the benefits of participation outweigh the detriments. Some detriments of participation included the negative social implications of using the F S coupons to purchase food, and the bureaucratic difficulties involved with 84 actually obtaining them (Coe, 1983). Second, it has been reported that many individuals and families who are eligible for PS benefits did not know they qualified (Coe, 1983; Cohen, 1990). Third, transportation was a problem for some individuals. They were not able to pick up food stamps or to drop off the appropriate monthly forms (Coe, 1983). Forth, the required monthly forms may be too complicated to complete (Coe, 1983). 3.3.12 Non-participation in Social Assistance Proggar_ns of Communig Kitchen Respondents The mean data reported in Table 3 show that non-participation rates among presumably eligible recipients was significant. An average of 22.5% of the respondents reported nonparticipation in any type of government assistance programs (Table 3). Non- participation was highest in Kitchen Six (35.1%). Information on non-participation was not reported by researchers of similar studies. The employment information from Table 3 (% employed) indicates that nearly all guests may be eligible for program benefits of some kind. Reported non-participation may have occurred for a number of reasons. These may be similar to the four reasons reported by Coe (1983) in reference to non-participation in the Food Stamp Program First, respondents may not have been participating because they may not know that they are eligible, or how to apply for benefits. Second, they may have felt intimidated by the application and subsequent forms required to receive benefits. The comprehension, reading level, or number of forms may have been overwhelming for some guests. Third, they also may have felt uncomfortable participating because of the social implications of 85 receiving government assistance benefits. Forth, they may actually be participating in an assistance program. but not feel comfortable disclosing income information on the questionnaire. 3.3.13 Respondent Age/Sex Data Age and sex data for all community kitchens and the Title III site are given in Table 4. The mean age (n=3) of respondents roughly followed a normal distribution for most community kitchens participating in the questionnaire distribution. These data on age distribution were similar to the findings reported by Lenhart and Read (1989). Their report of community kitchen age distributions showed a majority of guests in the 20 to 60 age range. Only 10% of the respondents in their study reported ages in the over 60 category, while the present study found only 7.3% of the respondents reported ages in the same category. Mean data for all community kitchens showed that persons aged 18 or under were well represented among respondents (Table 4). This finding is similar to findings of other studies which indicate that increasingly, families with children were receiving various forms of emergency food assistance (PTFHA, 1985; USCM, 1989). Lenhart and Read (1989), however, found only 2% of the population attending community kitchens in the Reno, NV study to be under 20 year of age, while the present study found 17.7% of the respondents to be 18 years of age and under. Lansing population age-sex data for the same year is also given in Table 4. Males and females questionnaire respondents from community kitchens aged 11-18 years were under-represented (2.2% and 2.5%, respectively), compared with the population data for .8628 ozaszEca 2 26 5:2:an 86 95a enigma 58 E 2895ng 32.2-5: .0 89:5: :22 u z t. 2852.83 E Sascha 8: Eu 25 5:25. .8 38:0 1.... .555— »:5888 a do 822:8 2: E 5: Eu 2% 05 3283 9a <9. 3% 5:238 mafia.— mwfl ...... .55 Em: 82: S 3.53. as 288 .55 3:88 :88 E 8530:. 52 ...... 3;; 238:8 sup n u z . ode Se o o 0.3 we ma m6 GS oEEom odm Wm c o Nd o m.m we as 222 cc .5>O o.m_ we #6 me Om 0.2 m.m md 28 oBEom o as v. _ N ms 62 o ed Qm $8 222 8-3 G 5.: 2. me 02 NE 0.: v.2 A59 oEEom cs 3: 5mm 0.3 ad. ad mg 3: 88 28.4 3.3 o mg _.n a: 5.2 0.2 3: 9.x 20 2an& o oi 03 0.2 cw v.2 02 ex A3; 222 3-2 C ON 0 Se o o Wm as @ oEEom o 3 c E 3 2. I an E 222 ”T: O Na o me 9m 32 We Z. 63 2an& c So 2. 5s e; We m6 m6 Am: 222 o: A as iv $an 955 gm $53.30}. SEE c n v m m Signor: oEquoEoD 236 :83 5 out. ...:onozm bEaEERV wag—3 .32 means 5 26 E 25. use 28 28:23 5:58:50 3c :5: 33288.. 382-5: Eat cosmetic “Bahama :82 ”v 933. 87 the same age-sex groups (5.3% and 7.0%, respectively). Also, a higher percentage of males and females in the 19-24 year old range (13.9% males, 16.1% females), and the 51- 60 year old range (7.9% males, 6.6% females) responded to questionnaires at community kitchens than was in the general Lansing population (8.4% males, 8.9% females; and 3.9% males, 4.3% females, respectively; USDCb, 1989). As was expected, the Title III site served more individuals over the age of 60 than any community kitchen (Table 4). The 7% of Title III respondents reporting ages in the 25-50 yr age category reflected the fact that volunteers and other stafi ate meals at the site and completed questionnaires. As expected, a much higher percent of males and females in the over 60 age group (20.0% males and 60.0% females) in the Title 111 site completed questionnaires than was represented in Lansing population data (4.2% males, 6.3% females; Table 4). 3.4 Survey Questions and Responses The questionnaire distributed to community kitchen and Title 111 guests asked three questions related to meals (Appendix D). The first question was: "How many meals do you eat per week at this or another community kitchen?". Possible responses included; (<1), (1-3), (4»6), or (7 or more). A second question asked: "How many full meals do you usually eat per day?" Possible responses included; 0, 1, 2, or 3 or more. The third question was: "The food here usually tastes...", with the possible response options: very bad, bad, fair, good or very good. 88 3.4.1 quency of Eating at Communig Kitchens Mean community kitchen data showed that 14.2% of the respondents ate meals at community kitchens less than once time per week (Table 5). The majority of respondents, (59.5%) reported eating at community kitchens one to three times per week, while 19.8% reported eating at community kitchens four to six times per week. In a similar study, the majority (51%) of community kitchen guests in urban New York reported eating five or more community kitchen meals during the previous week (Rauschenbach et al., 1990). Of the respondents from the present study, only 26.3% (19.8 + 6.5%) reported eating at community kitchens four or more times per week. This may indicate that the respondents from Lansing community kitchens may be less dependent on community kitchen meals than the guests of the urban New York community kitchens studied. Kitchen Six had the highest percent (17.7%) of respondents that reported eating at community kitchens seven or more times per week (Table 5). Based on what was previously discussed regarding the stability of housing or shelter for guests of Kitchen Six, this result was expected. This idea is supported by the findings of Cohen et al., (1992) who reported that about one quarter of the homeless respondents in their study ate at soup kitchens on a daily basis. Most Title [[1 respondents (47.8%) reported eating four to six meals per week at that site, or at similar sites (Table 5). While these data may indicate that the dependency on the site for meals was significant, this also may indicate a dependency the guests had on the site for social interaction and stimulation. The researcher observed that the senior citizens enjoyed the brief period before and after meals to socialize with peers. 89 .55.: £55.88 a ..o 5:35: 2: E 5: E: 2; 2: 8:83 :5 <5 2: :o m: .85 o. 8:38 2: 288 :2: 3 3:83 :88 E 8:22: 82 ...... 36:0: o>:e.m_=_E:a 2 on: 5:332: 0:28:83 5 336:3: 5: E: 25 55520 33:0 .. 3m :8 e: 08 SN ZN 4.8 8% be, we. oi. 3m 3m 3m 0R n.5, 8% :2 3m 4.9m 3% o o SN .3 o 3 o e 3 o o as o 3 o o.m 3 o 1 can .9; Ag :8 SM n? :2 :2. E m: 205 a m ”.8 me. E. 4.3. as. :8 0% N we 3: w: 3% mm 3. fl: : a mm on 3. 3 o S o 6.0.3333 c no 5: 02 :8 o 06 82: B n we. :2 mm a: in o 0.2 3. 3m 0% 2H HS 38 3o 3“ E a: S: Sm 2: ed 3 0.2 v and? A s V @33an =85 o m a. m N seam :26 5 02C. EBBQ £58500 .26 E 0:; 25 new 20:85: 9:28:50 min—.3 2,: 5 mafia £53833. 332-5: :5: :EEELEE .085» :5 Ba: 32: 30:0 ”n 2:5. 90 2.4.2 Usual Number of Full Meals Eaten E Day Mean community kitchen data showed that a majority of the respondents (45.3%) ate two full meals a day (Table 5). Only 33.5% of the respondents usually ate three or more full meals per day, and 18.9% usually ate only one full meal per day. This information was in agreement with the findings of other researchers which indicated that a majority of community kitchen meal recipients normally ate less than three meals a day (Campbell, 1985; Cohen et al., 1992; Lasdon, 1987). Laven and Brown (1985) however, reported that 53% of the men at a Birmingham, AL community kitchen usually ate three meals a day. None of the studies, including the present one, inquired about the role of snacking in the diets of community kitchen guests. Snacking may play an important role in the community kitchen guests diets and respondents most likely did not report snacking as a meal. A majority, 66.7% of the Title 111 respondents reported usually eating three meals a day (Table 5). Only 20.8% reported usually eating only two full meals per day, while 12.5% reported usually eating only one full meal per day. More Title III (66.7%) than community kitchen (33.5%) respondents usually ate three meals a day. Tine a many plausible explanations for these difl‘erences. Title 111 guest may have more resources available to purchase and prepare meals. They may also have more time in their day to prepare and enjoy meals. They may also have more knowledge or sldlls regarding economical meal preparation and menu planning. 9 1 3.4.3 Perceived Sensog Quality of Communig Kitchen Meals Mean community kitchen data showed that a majority (71.1%) of all community kitchen non-repeat respondents reported that the food tasted good (44.0%) or very good (27.1%; Table 5). Fewer of the respondents (26.6%), reported that the food tasted fair. Very few non-repeat respondents reported meals at any of the kitchens as tasting had (0.9%) or very bad (1.4%). From interviews with cooks, the researcher determined that Lansing community kitchens made special efforts to provide soft foods because they recognized that their guests may have poor dentition or difficulty chewing (Appendix F). The cooks also made special efforts to prepare foods they thought would be well liked. Similar information is not available in the literature regarding how well community kitchen guests liked community kitchen meals. Of the Title 111 respondents who answered the same question, no one indicated that the food tasted bad or very bad (Table 5). Only 20.8% reported that the food tasted fair, and the majority (45.8%) of the respondents reported that the food tasted good. This was similar to the mean of all community kitchens, which also showed a majority (44.0%) of guests reported that the food tasted good. In general, most community kitchen and Title 111 guests thought the food tasted good. Since the food was generally well liked, it can be assumed that most of the meals served were likely to be eaten and not left on the plates. 92 3.5 Labor and Food Cost Analyses An analysis of variance was conducted on all labor and food cost information from all community kitchens except Kitchen Three, to determine if significant differences existed among community kitchens. Kitchen Three was unusual in that they purchased meals from a satellite meal program operated from a local high school. Therefore, the methods to obtain labor and food cost information described in Chapter 2 could not be used with Kitchen Three. The Title 111 Site was also excluded from the analyses because it was used as a standard of comparison and because it did not fit the definition of a community kitchen. The analysis of variance identified which community kitchens in Lansing vary the most from other community kitchens regarding particular variables. This information may be used to compare the cost of services among community kitchens. Also, this information may be used to identify community kitchens that may have budgetary problems. The variables used in these analyses describe a cost per plate used, as was indicated in the Methods portion (Sections 2.5.1, 2.5.2, 2.5.3, and 2.5.4) of this paper. The fact that some guests may have had second helpings at community kitchens is not reflected in these analyses. Data was collected on the number of plates used, not on the number of meals or people served. .5.l Actual Market Value of Labor Cos late The AMV of labor costs per guest served indicated the amount of dollars actually being spent on labor at the time the data was collected. Kitchens One, Three and Five 93 operated with volunteer labor only and had no AMV of labor cost (Table 6). Mean AMV of labor costs ranged from $0.00 (Kitchens One, Three and Five) to $0.51 1- $0.11 (Kitchen Two) per plate used among community kitchens included in the analysis (T able 6). The AMV of labor costs of Kitchens One and Five (no paid labor) were significantly different from Kitchens Two and Four (paid labor), as expected. The labor costs of Kitchen Six were low enough ($0.23 1; $0.08) that they did not vary significantly from Kitchens One and Five. There were no significant differences among the three community kitchens (Kitchens Two, Four and Five) that had paid labor. N 0 similar information was available from other research completed with community kitchens. As was expected, the AMV of the Title 111 site was higher than any community kitchen. This was most likely due to the inclusion of the bus driver’s hours in the analysis. Bus driver hours were included because they were thought to be integral to the functioning of the site, and because they were within the limits of the AMV of labor cost definition (Section 2.5.1, Methods). 3.5.2 uivalent Market Value E of Labor Cos late The EMV of labor cost per plate used indicated what total labor costs would have been involved in community kitchen meal services if volunteer labor had been compensated at $3.35 per hour. However, the EMV labor costs may overestimate the amount of resources necessary to serve community kitchen meals because of the nature of volunteer labor. As previously described, and from observations made by the researcher during data collection visits, paid labor was better trained and more diligent 30.: :5 :82 .«o 28:28: .8 58 >35 253.802 +2. 58.... 35:55 H 502 : A3255 323%.: 52:20: ”nodwe 822:: 35:25:: 05 2:335 828:: 8:5 38 8883: 05: 2: 8 838:2 :. 35:98: 053 2:28 355:: 853: 2955 88.: 3:298 53 8:5. 5:20: ...... .5522 E5888 5 .5 5:83: 2: E :o: E: 2:: 2: 3.53: :5 <9: 2: .5 m: :02: o: 3:58 05 :38 :2: 853: 508 8 3:22: 82 ...... 22w. :2: «22> 530:8 8:: muz .. 94 8.: 5.38.: 8.3.3.: 2.32:} 2.3.8.: 8.: 8.3.3.: 8.3.8.: 28.: 22: :2: 25:50: :0 25> 22m 8.: 8.38.: 8.3.8.: 2.3.3: 2.3.8.: 8.: 8.3.8.: 8.3.8.: 82.228.880.25: 8.: 2.33.: .8: 8.3.2.: 2.3.8.: 8.: 83.8.: 83.3: 8322:2888>2< :3 2.32.: 2.3.8: 8.3.8.: 8.3.8.: 2.: 8.3.8.: 8.3.2.: 8... 22882355 8.: 8.35.: 8.3.8.: 28.: 2.3.8.: 8.: 82.3.3: 38.: .8... 228828.35 A 8.8 x, 5.5 m. n a. ...: N 2 .98.: 38 .. . 5 2 3.5880 8 28. g 2 . o (2:: E 22H 25 :5 822:. $5888 :2 88:54 8:. 80: 88 :08 :5 :8: :32 :o A>2mvosa> .858 82:25... 508 :5 92$ 25> .858 :25: 502 u: 25.: 95 in completing tasks than volunteer labor. Compensating volunteer labor at $3.35 per hour may actually over inflate the costs necessary to serve community kitchen meals, when all workers were trained equally. The EMV of labor costs ranged from $0.69 :1: $0.09 to $2.25 1 $0.56 per plate (Table 6). There were no significant differences in the BMV of labor costs per plate among community kitchens. Kitchen One’s EMV of labor costs ($2.25 1- $0.56) were the highest. This result was expected because, as was described earlier, Kitchen One was run by a large group of senior citizen volunteers. Similar information was not available from other research completed involving community kitchens. The EMV of labor costs per plate used at the Title 111 site was more than twice as much as the Mean EMV of labor costs for community kitchens. This again was most likely due to the high AMV of labor costs per plate used, and the labor hours of the bus driver. The researcher observed that the Title 111 site did not have more volunteers than the community kitchens included in the study. 3.5.3 Actual Market Value of Food Costlglate AMV of food cost ranged from $0.00 (Kitchen Six) to $0.55 :1: $0.13 (Kitchen Three) per plate used (Table 6). Kitchen Six was the only kitchen that received all food as donations. The low AMV of food costs for all of the community kitchens reflects the wide use of donated food, and discounted or wholesale purchases. Similar information was not available from other studies completed with community kitchens. Some community kitchens varied significantly in the AMV of food cost per plate. The AMV of food costs for Kitchens One and Four ($0.31 1 $0.11, and $0.55 1 $0.13, 96 respectively) were significantly higher than Kitchens Two, Five and Six ($0.08 i$0.03, $0.10 1 $0.02, and $0.00, respectively). It is likely then, that Kitchens One and Four purchased more foods at retail prices, or received fewer donated and discounted foods than did the other kitchens. The mean AMV of food cost per plate for the Title III site ($1.04) was much higher than the mean AMV of food cost for all community kitchens ($0.44 :1; $0.14; Table 6). This finding reflects the fact that relatively few donated foods were used by the Title 111 site, and that the majority of food items were purchased from retail grocery stores. In a similar study, Welch and Bush (1986) reported that the mean actual food cost per meal served for the fourteen Title III sites in their southern Illinois study was $1.03. 3.5.4 gguivalent Market Value of Food Cosyljlate As expected, all community kitchens except Kitchen Three had an EMV of food cost per plate higher than the actual cost of food (Table 6). This was expected because the use of donated and discounted foods reduces the AMV cost per plate below its wholesale cost. Kitchen Three’s EMV food costs were less than their AMV food costs because they purchased prepared meals, as previously indicated. The purchase price of these prepared meals likely included some allowance for the overhead and delivery involved with the meals as well as a profit margin. The EMV of food costs ranged from $0.59 (Kitchen 2) to $0.97 (Kitchen 6; Table 6). There were no significant differences in the EMV of food costs among community kitchens. This result indicated that the Mean EMV of food cost for all community kitchen ($0.70 :|: $0.05) likely reflected the cost of food necessary to prepare any 9 7 community kitchen meal in Lansing if all food items were purchased from local wholesale outlets. Similar information was not available from other studies completed with community kitchens. Kitchen Six had the highest EMV of food costs per plate ($0.97; Table 6). This result was interesting because all of the food for meals served by Kitchen Six were donated. A few different scenarios may explain why this kitchen had a higher EMV of food costs per plate. A higher EMV of food costs could have indicated that the donated foods of Kitchen Six cost more than the foods used in other kitchens, when all foods were purchased wholesale. This could have meant that the foods donated to Kitchen Six were more expensive types of foods. For example, Kitchen Six had more meats, cheeses, and dairy products in their meals (Appendices G, H and I). It was more likely however, that Kitchen Six prepared more food per plate used than did the other kitchens. More food per plate used would have indicated that the serving sizes of meals served at Kitchen Six were larger than those of other kitchens. Also, more food per plate used could have indicated that it was more likely that second and possibly third helpings were available at Kitchen Six. More food per plate used may also indicate that Kitchen Six had difficulty estimating the number of guests they were going to serve during a meal service period. Consequently, Kitchen Six could have ended up with more leftovers or wasted food than the other kitchens. The EMV of food cost per plate for the Title III site ($1.00) was much higher than the mean EMV of food costs for all kitchens ($0.70; Table 6). The Title 111 site may have been serving larger quantities of food per plate. Also, the EMV of food cost for the Title 111 site was just slightly lower than the AMV for the site, $1.04 (Table 6). This 98 verified the strong reliance the site had on retail food purchases. Therefore, it appeared that the Title III site would be able to lower their AMV food costs by purchasing foods from wholesale outlets more often. 3.5.5 The Eguivalent Market Value of Donations The EMV of donations per plate showed the difference between the EMV of labor and food, and the AMV of labor and food. This difference showed the value in dollars of donated or discounted labor and donated or discounted food per plate used. This information is interesting because it shows the relative value of donated labor and food. This information would be useful to agencies that may be interested in assisting community kitchens in improving meal services. Also this would be useful to agencies interested in beginning community kitchen operations to plan and manage budgets. The EMV of donations ranged from $0.52 1 $0.12 (Kitchen Four) to $2.56 1' $0.50 (Kitchen One) per plate (Table 6). The mean EMV of donations for all community kitchens was $1.24 1; $0.21 per plate. Similar information was not available from other published studies of community kitchens. The EMV of donations per guest served did vary significantly among two kitchens (Table 6). The EMV of donations for Kitchen One ($2.56 ,4; $0.50) was significantly higher than that of Kitchen Four ($0.52 -_I-_ $0.12). Kitchen One’s EMV of donations was higher than the other kitchens’ because of the heavy use of volunteers as previously discussed in Section 3.2.2. Kitchen Four had a lower EMV of donations largely because their AMV of food costs ($0.55 1 $0.13) was very close to their EMV of food costs ($0.60 :1;$0.15). There were no other significant differences in the EMV of donations per 99 plate used among community kitchens. The Title III site’s EMV of donations ($1.05) was lower than the Mean EMV of donations among community kitchens ($1.24 :1: $0.21; Table 6). This was expected because the AMV costs of labor and food for the Title 111 site were closer to their EMV costs of labor and food. This occurred because the Title 111 site purchased foods at retail cost and had more paid laborers than most of the community kitchens. 3.6 Nutrient Content of Meals Menus of community kitchens during MSPs of data collection are in Appendices G, H and I. The content of selected nutrients in community kitchen and Title III meals is in Table 7. Community kitchens did not vary significantly in the amount of kilocalories, protein, Vitamin A, Vitamin C, and Sodium in the meals analyzed (n=18, p<.05). There were significant differences among community kitchens in fat, saturated fat. carbohydrate, calcium, iron, magnesium, vitamin B6, and folic acid content of meals (p<.05). The meals of Kitchen Three was significantly higher in fat than Kitchens Two, and Four (38.8gm 1 4.0gm, 15.5gm :1: 4.5gm and 16.4gm t 6.9gm, respectively). Likewise, the meals from Kitchen Three were significantly higher in the percent of calories from saturated fat than the meals from Kitchens Two and Four (16.2% i: 2.2%, 11.5% 3; 3.0%, and 10.0% _-I; 2.5%, respectively). There were no other significant differences in the fat content of community kitchen meals. Kitchen Three was significantly higher in fat and saturated fat content of their meals because they used ground beef three times and offered whole milk at each meal 100 Ste Emccfim ...u. :88 ...... .Gomecm ©6663 2223— ficdmé E20§c 3.852% 2m 39833 85:: 5:5 38 355.5; 083. 05 E 83:52 ... new“ .28 33 «.582 22..” .33 23. H .032 RE 5325 aeuuoam new“? 3de wafiwwm as: 22 0:8 3&3 in; .o Sauna _.fi.~.o 3.53 5.533 Noismsm odfiaflwm vdfiEdv m.mH.o.~m $583832 his? 0323 53.33 we“ an” 95 8: 083$ $3333 3323: «5323:. 3.5 5326 5.1.9.8 defies odfiKS $3.2 3.5 u 553 336:. iaflnms o.%_u...m.§ «623.5 55 < 5953 23.3% 3 33.3 333.? guano: 2.30:0 3 H ...a? 3“ .NE 3 H ..v: 2 u ..Su 5 5:8”; .3 e 9.36.2 ofiwxm manna 2.“ swam 3.3 5 ”3.2.3 amend». Sad: aflgfi E3 528m Nd 3.3:. 3%ng manncfi m :3???” 325385. a. m N a 8552 552M bEsEEoU .26 E 25. one can 2.2.23 §==EEoo =2 .wEmcs :5: £85 5 3:352: 882% Am mo _ omen: 2an coho eaves..." H :88 H .8332.“ c.n.v.m.~._ 226:2 ”modwav 2.89:6 2:8:ng 2m antenna 220:6 .23 3o. BEBE: 2:3 05 5 £3.52 ...... .555. $5558 a do 555% as E 8: E: 2: 95 8:33 23 <3 2: ..o m: 32: o. 3.53. as $86 55 8:83 :85 E 33.2: .oz ... 101 E: H was. 38H 32: 33 H .532 mg H .03 3.5 528m QSHHHM H.239. w.~mH.m.~§ 59ng 33 22 23... SHE 3H2 ~.oH.m.o ..ono 3.55 see; ”.meon HEHS .2 HEHKHS Sana. aéeaacwaz 2qu 3th _._H.e.w SHEEN 95 5: HSHZQ. VQHEMM ~.w~H.m.mmm 93%? a 95 5226 ””deme weHmdm 33.: SNHdsn 3.5 o 5:55 EmHnoS $va 3 3.32 5205.85 9: < 559$ nflHwS 3ng Safe 53.30 €305 M: H 2: 2 H q: 2 H ..gi 3H awe an .333 e EHS: 3H2 .2 o.~H..c.oM oeHacé 2.3 an canine 33:“ Nandm «$63 2.3 592m 0me2; 23.2w HSHNHQ eQHwemm ..8E_So§ came 0 n 3:0552 ...26 E 225. :unozx 3:58:50 .28 E 25. 25 was 20:82 5:55:50 :2 .wEmSfi Soc 28:. E 35:5: Baum—om ”AN .8 m omaqv 825.80 b 033. 102 service period visited(Appendices G, H and I). Kitchen Two was significantly lower in fat than Kitchen Three because they served ground beef only one time, chicken two times and offered no milk during any of the three meal service periods visited. Kitchen Four was significantly lower in fat than Kitchen Three because they served tuna two times, chicken one time, and offered 2% milk at every meal service period visited. The meals of Kitchens One, Three and Six offered significantly more calcium (p<.05; 418.7mg i 19.4mg, 473.0mg 3; 23.2mg, and 553.3mg : 28.2mg, respectively) than the meals of Kitchens Two, Four, or Five (178.0mg 1- 48.5mg, 84.7mg t 20.3mg, and 311.0mg t 79.6mg, respectively; Table 7). The calcium in meals from Kitchen One (418.7mg j: 19.4mg) and Kitchen Three (473.0mg i 23.2mg) was significantly higher than the calcium in meals from Kitchens Two (178.0mg i 48.5mg) and Four (84.7mg 2t 20.3mg). The calcium in meals from Kitchen Six (553.3mg i 28.2mg) was significantly higher than the calcium in meals from Kitchens Two (178.0 mg 1 48.5mg), Four (84.7mg j; 20.3mg) and Five (311.0mg j: 79.6mg). This may be attributable to cheese being included in Kitchen Six’s menus for two of the three meals observed(Appendices G. H and I). There were no other significant differences in the calcium content of meals. The meals of Kitchens One and Six offered significantly more iron than Kitchens Two and Four (p<.05; 4.4mg 1- 0.7mg and 3.8mg i 0.7mg, respectively; Table 7). The iron in meals from Kitchen One (7.5mg 1: 0.8mg) was significantly higher than the iron in meals from Kitchen Five (3.6mg 3; 0.7). The iron in meals from Kitchen Six (8.6mg 3; 1.1mg) was significantly higher than the iron in meals from Kitchens Two (4.4mg i 0.7mg), Four (3.8mg 1: 0.7mg) and Five (3.6mg 1- 0.7mg). There does not appear to be any obvious explanation for the significant differences in the amount of iron in the meals 103 from Kitchens One and Six, other than their portion sizes of their protein sources appear to be larger than other community kitchen meals (Appendices G, H, and I). There were no other significant differences in the iron content of meals. The meals of Kitchen Six were significantly higher (p<.05) in magnesium, vitamin B6, and folic acid content than all other community kitchens (30.9mg, 27.0mg and 61.3 g respectively; Table 7). The difference noted in the meals served by Kitchen Six are likely due to the fact that they served magnesium, vitamin B-6, and folic acid rich legumes in two of the three MSPs observed (Appendices G, H and I). Kitchens One through Five did not vary significantly in the content of these nutrients in the meals served. 3.6.1 Nutrient Standards for Community Kitchens and the Title 111 Site: One Third of the USRDA for Each Nutrient The standard chosen to evaluate the nutrient content of community kitchen meals corresponded to the standard used in menu preparation for the federal congregate nutrition sites. However, the majority of guests in the present study reported eating only two meals a day. If a community kitchen’s meals meet 1/3 of the USRDAs, they may still fall short of meeting the more specific needs of their guests. It may be valuable for future studies to evaluate the nutrient content of community kitchen meals based on 1/2 of the USRDA. For the purposes and scope of this paper however, community kitchen meals were evaluated based on what would similarly be expected from meals served from the federal congregate nutrition program. The Trtle III site did not fit the definition of a community kitchen because guests 104 (other than volunteers and staff) were required to be 55 years of age or older, and because their meals are mandated by the federal government to meet 1/3 of the USRDA(PL 95- 47892). The Title III site was included in the present study for comparison purposes only. 3.6.2 Percent of One Third of the USRDA Supplied by Communig Kitchen Meals Meals in all kitchens provided more than 100% of 1/3 of the USRDA nutrient standard for protein (ngm; Table 8). This finding was similar to those of McGrath- Morris (1989). All of the 50 community kitchens included in the New York State study provided 1/3 of the RDA for protein in their meals. Laven and Brown (1985), also reported similar findings in the Birmingham, AL study of one community kitchen. All three community kitchen meals in their study were estimated to provide 1/3 of the RDA for the adult males. Cohen et al., (1992) found that community kitchen meals provided 50% of the RDA for protein for both males and females. Like community kitchen meals from the present study, meals from the Title 111 site met 100 % of 1/3 of the RDA for protein (Table 8). Only Kitchen Six fell below 100% of 1/3 of the highest RDA nutrient standard for vitamin A (Table 8). The average nutrient content of the three meals sampled at Kitchen Six contained only 67.6% of 1/3 of the USRDA for vitamin A(333RE). No community kitchens in the McGrath-Morris (1988) study fell below 1/3 of the RDA for vitamin A. Cohen et al., (1992) found that community kitchen meals provided 50% of the RDA for vitamin A for both males and females. Similar information regarding the vitamin A content of community kitchen meals was not available from other studies 105 .5an masses .o 5235 mics—88 852 63m 33m 888. Ewmm 33m 830... Ewnm 282 282 uESomo> 95m oBSowo> Emmfl Comm 9580 95m gauge—cam 822 5280 «EC. 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