A HiSTORICAL STUDY OF TRENDS N THE METHODOLOGY AND CONTENT OF ADULT EDUCATION PROGRAMS IN NUTREHGN IN THE UNITED STATES Thesis for the Degree of Ph. D. MECHRGAN STATE UNIVERSETY’ Shirley T. Moore 1965 THESIS .49."! - ." .‘L -"W """ ‘c F "‘ W' LIBRAR Y 5‘ lv"li;l1ig..1x1 Sta-L; ilimor first employed a dietitian in 1906 (132). This woman went into the fxenements and attempted to aid the poverty-stricken mothers many of idionicould not properly be called homemakers, to overcome their ignorance anci apathy, learn how to handle their tiny incomes, and provide nourish- ing food for their families. Since the A. I. C. P. provided funds as 90 well as information for the destitute, the task was not a hOpeless one (131). Early in the instruction prOgram the mother was taught to keep a simple record of her spending, and to compare the articles she purchased with what she could purchase with the same amount of money. Lessons in marketing and food followed. Care was taken to keep instruc- tion within the limits of the available facilities in the home. Occasionally a client would protest that the visiting dietitian's food plan could not be carried out; when this happened, the dietitian her- self purchased the food'with the sums available to the family, prepared it with the utensils in the home, and served it, thus demonstrating beyond a doubt that it could be done (131), (132). The immigrant's language barrier provided additional problems,, and the visiting dietitian often had to resort to the simplest means of communication (136). Good food habits were, however, much easier to teach the immi- grant than other aspects of homemaking (1&8). In 1912, Winifred Gibbs, A. I. C. P. dietitian, published a In it she brought out the simple facts of a nourishing diet, one which would build up "tired muscles," calm "overwrought nerves," and overcome "all forms of bodily weakness." lNew YOrk: The New Ybrk Book Company, 1912, p. 157. 91 For convenience, she divided foods into five groups: 1. Proteins, for strength and muscular endurance -- meat, milk, and eggs. 2. Fats, for flesh and heat —- fat of meat, butter and cream, oils. 3. Sugar and starchy foods, for flesh and endurance -- sugar and molasses, breads and cereals. &. Vegetables and fruits, for good bones and pure blood. 5. water for keeping the body from wasting away and for cleansing the entire system. Equal parts of fats and strength foods were essential, and about three times as much starchy and bulky foods. "To sum up," she wrote, "a 'well fed' person is one whose food contains materials for keeping him warm, for building muscle, for making flesh, for keeping the blood right, for making the bones firm, and in short, for keeping the body in perfect condition.”1 The grouping of foods to facilitate meal planning was to become one of the effective teaching devices of the future. p. l&. C H A P T E R V I I I THE FEDERAL EXTENSION SERVICE "No other agency of adult education," wrote James Creese in 19&1, "reaches so many peOple so effectively as does agricultural extension. .... Beside this vast organization, reaching 6,000,000 to 7,000,000 peOple, all other extramural engagements of colleges and universities are overshadowed" (89: 9h). The Smith-Lever COOperative Extension Act, passed in l9l&, provides an annual grant of $10,000 to each state, plus additional funds on a matching basis. With these funds the land—grant colleges and universities conduct educational work in agriculture and home economics through the use of home and field demonstrations, publications, and other methods. Regular campus classes are excluded. Final administrative authority for the prOgram rests with the Secretary of Agriculture (328: ll&-115). Historically, the foundation for this prOgram goes back to the c00perative farm demonstration work originating in the southern states 'under the direction of Seaman A. Knapp, who has been called the school- Inaster of American agriculture. A part of this farm.demonstration work came to include boys' clubs for growing corn and girls' canning and tomato clubs. Home demonstration work for women was an outgrowth of the girls' clubs. As 92 93 the mothers became interested in their daughters' projects, alert demonstrators seized the opportunities to assist the mothers in home improvements, bread and butter making, cooking, and other activities (328: 58-68). In the l9&0's Bailey, biographer of Seaman Knapp (31), called attention to the changes in rural life with automobiles, movies, news- paper delivery, daily crOp and stockyard broadcasts, weather forecasts, and international crop estimates replacing the formerly almost complete isolation of the farmer (31: 203-20&). Bailey described the southern farmer in 190& and 1905 as ”closer in attitude and outlook to the Anglo—Saxon churls of Alfred the Great than to the mental world in which their sons live in l9&2" (31: 203-20&). Aside from the cooperative demonstration work in the South, land-grant colleges were already doing a vast amount of agricultural extension work, much of it through the farmers' institutes. According to True, the resulting drain on their resources provided the initiative for a demand for federal funds to carry on extension work. Because of the success of the southern system of cooperative Idemonstrations, the law, as it was finally approved by President Wilson :in May, l9l&, encouraged this type of activity. Thus it has been the 'basis of much of the practical education of both the farmer and the farmers ' wife. At the close of the first year of activity under the new law, the southern states were employing &00 women, including 350 home demonstration agents. In northern and western states 355 short courses 98 had been conducted by college home economists for the benefit of rural women (328: 72-127). Only a small part of the subject matter of short courses and demonstrations was directly concerned with nutrition. The report for the year ending June 30, 1915, gives an account of some activities of the first twelve months. In Georgia "the plan of the home-demonstration work contemplates the study and demonstration of the best methods of cooking, home decoration, dairy, poultry, and garden management" (335: 62). In South Carolina women and girls attending short courses of three or ten days received instruction in "cooking, sewing, gardening, poultryeraising, and dairying." Nearly 2000 women enrolled in home demonstration work. They made 8&0 fireless cookers, 216 iceless refrigerators, 72 wheel trays, and 360 fly traps. In addition, "72 kitchen cabinets and 2697 canning outfits [Were7 placed in homes and instruction given as to better arrangements of the kitchen, protection of the home against flies, and other sanitary devices" (335: 111). In Indiana &&22 women attended one day demonstration meetings. Twentyefive of these meetings were held in churches or other public buildings. The character of the work in these ... meetings has depended upon the wishes of the women.desiring the service. At one time it has been a study of foods, at other times laundering, home sanitation, feeding of children, care of sick, house- hold conveniences, etc. In many cases the demonstrator went into the homes on request (335: 203). In Kansas an average of thirtyeone women attended each of forty- eight extension schools lasting five days. "A half-day session is given 95 to the selection, preparation, and use of foods and half a day to the selection, use and construction of clothing. These schools are held in church basements, schoolrooms, vacant storerooms, and in large kitchens in residences" (335: 2l&-2l5). In Michigan twelve short courses of three days or one week were held, with an average attendance of fortyetwo. Subjects included food preparation, kitchen equipment, and other household topics (335: 233). In Missouri sessions of three to five days were held. The subjects receiving most attention were household sanita- tion, balacing the ration, the convenient house, the selec- tion of vegetables, meat substitutes, cuts of meat and their preparation, home furnishings, feeding babies, canning vegetables, and related tOpics. There was a total attendance of 25,&56 (335: 2&2). In New Yerk thirty-eight farm-home demonstration schools were conducted in twentyefive counties. Only'twentyethree of these schools used Smith-Lever extension funds. "Instruction was given mainly in food values, elementary dietetics, and methods and principles of cooking" (335: 272). In Pennsylvania lectures and demonstrations on cooking, canning, and home nursing were conducted (335: 298). In Rhode Island study clubs were formed; sixteen courses con- sisting largely of a study of foods were given to these clubs (335: 301). In South Dakota food preparation work was given through Farmers' Institutes or short courses (335: 30&). In Wyoming thirty-one demonstrations in cooking and baking were presented by the home economics specialist at separate sessions for 96 women attending Farmers' Institutes or extension schools (335: 325). In years to come much emphasis would be placed upon nutrition. These early years were a part of the transition period -- probably imperceptible to the homemaker -- from the old, established concern with protein and energy requirements and easily supplied mineral "salts" to the newer knowledge of nutrition with its rapidly expanding concept of food values. The Smith-Lever Act had not been passed a month too soon. With- in the next three years a strong organization was established in each of the forty-eight states. Then came the entrance of the United States into Wbrld war I, and the Cooperative Extension Service found its work multiplying rapidly on all fronts (328: l3&). C H A P T E R I X FOOD CONSERVATION The United States declared war on Germany in April, 1917. Among the most important food shortages already plaguing the fighting nations were meat and wheat (3&3). Fat and sugar were soon to be added to the list. At the time of the outbreak of war in Europe in l9l&, the condition of agriculture in the United States was such that, without stinting the American home, a greatly increased EurOpean demand for foodstuffs could be supplied (336: 9-10). In the spring of 1917, the situation was more serious (337). Although the Food Production and Food Control Acts did not become law until August, 1917, Herbert Hoover was authorized in June to promote the work of the Food Administration on the basis of voluntary action throughout the nation. The number of home demonstration agents working for the Federal Extension Service was increased, and an extensive publicity campaign was begun to convince the American housewife of her importance in the war effort (337). Within days of the declaration of war, Mrs. Ione Virginia Hill Cowles, president of the General Federation of WOmen's Clubs, had already a pledge for food conservation which was signed by thousands of 97 K aw 98 club members prior to the establishment of the Food Administration (360: 3h-35). Church members were urged to join the crusade, and fifteen denominations had representatives in washington (181: 35)- Classes in food conservation and production were scheduled at the Chautauqua Assembly in the summer of 1917 (61). "As far as women are concerned, food is the present emergency," Ida M. Tarbell told the Chautauqua Women's Club. "At this time England has only eight weeks' supply of wheat. we must save every loaf of bread"_(6l). A Red Cross course in dietetics was scheduled at which particu- lar attention was to be paid to "the caloric values of foods" (61). In 1918 the home economics division of the Chautauqua Summer School was largely given over to the needs caused by the war. Foods courses included demonstration lectures in cooking and use of wartime foods and a course of lectures and experiments called Food in war and Peace (62). A national and several state lecture bureaus were organized (181: 35), (328: 138), and newspapers and magazines took up the work. After a surplus of fruits and vegetables had been predicted for the 1917 harvest, 110 articles on the preservation of these products were supplied by the government and printed in the newspapers of twenty; eight states (337). At the annual Grange meeting in St. Louis in 1917, a call was made to the members to carry out the work of the Food Administration in 99 Washington (2&0). In May, 1917, the National 932289 Monthly suggested a prOgram on "Simplified Living, a National Service." The aim of the prOgram should be to send every woman member home determined to feed her family, accord- ing to the best nutritional information she could obtain, with a limited number of foods at one meal. The same rule for Grange "feasts" was recommended (2&3). Two months later a report on prOgress in meal simplification was suggested, and in November one of the tOpics was "How Can we Promote WOrld Democracy by Eating Wisely, Eating Enough and Not wasting?" (2&3). At such programs, and through the promotion of home gardens and instruction in preservation, the women of the Grange were helped to become a part of the home front (2&3). When the war ended Grange women were urged to "plan for the return of our boys with the greatest care and study the food that will be required to keep them healthy and strong as their training has made them" (2&1: 161-163). They were also urged to study child feeding to avoid a repetia tion of the poor physical condition found among youth in 1917 (2&2: 170- 172). Government Publications A simple device was needed to enable the housewife to plan nourishing meals and at the same time to conserve precious meat, fat, wheat, and sugar. In the Five Food Groups, prepared by Caroline L. Hunt and Helen W. Atwater, of the Office of Home Economics, United States Department of Agriculture, this need was supplied. The Five Groups, which had been 100 published in a Farmers' Bulletin in March, 1917, included the following: Group .I -- Fruits and vegetables. Group II -- Meats and meat substitutes, protein rich foods. Group III -- Foods high in starch: cereals and potatoes, breads, macaroni, etc. Group IV Sugar and other sweet foods: honey, molasses, and syrup. Group V - Foods high in fat: bacon, salt pork, butter, cream, oil, etc.(166). By the substitution of a plentiful food for a scarce one EEEEEE the same ghhhp, the meal planner would conserve needed foods safely. In the full light of today's knowledge of vitamins, one can see the faults in this grouping of foods. In 1917 it was the key to good nutrition and to patriotic food conservation (352). Through publications such as the Food Thrift Series, produced by the United States Department of Agriculture, and the Food Leaflets, published by the Food Administration, the Five Food Groups and other pertinent information on nutrition and conservation were made available to Americans everywhere. Beginning late in 1917, the Food Administration provided librar- 1 1This series included apt food facts for current emphasis, suggestions for books, pamphlets, State and federal publications, and current magazines to form a food conservation section in the library, recipes, suggestions for exhibits and bulletin boards, menus, lists of Food Administration press releases, and appropriate news notices. 101 Nutrition Teachihg Although the United States Army objected to extensive milk drink- ing among its soldiers (232), the use of milk, along with quantities of fruits and vegetables, was urged upon civilians. "The old idea that meat is especially strengthening has no foundation," they were told (&7: 3h). 0n the other hand, a pint of milk would give as much energy as four eggs, or one-half pound of meat, or several slices of bread. It was rich in calcium and cheaper than either meat or eggs. Not the least among its food values were the two "vitamins"l’ 2 it contained (&7: 51-53). Vegetables, too bulky and too perishable for foreign shipment, could be used at home as nutritional substitutes for scarce foods. For meat there were peas and beans; for wheat, potatoes; for sugar, sweet fruits; and for fat, fruit jams. "All will improve the health and therefore increase human energies for winning the war" (&7: 56). Persons who must buy all their foodstuff were urged to spend as much money for fruits and vegetables as for meat, fish, and eggs (72: 5). The chief human dietary requirements were starch and sugar, vegetable acids and fiber, minerals, fat, and protein, and "certain substances necessary for growth and health which have been only recent- 1y discovered and for which no simple names have been agreed upon." A 1It was feared that milk drinking would develop weaklings instead of fighting men. 2Fat soluble A and water soluble B. 102 liberal use of fresh fruits and vegetables was not incompatible with these needs (l6&). The Food Administration cautioned parents through the pages of American Cookery that a well balanced ration for the child should contain something from each of the five groups daily. Milk, eggs, and butter were among the best of the much needed body building foods, and the child must receive whole, not skim, milk. The fat in whole milk "con- tained some of that mysterious growth-promoting substance that we are just learning to know" (3&2). The Cooperative Extension Service Urban home demonstration work was authorized by Congress in August, 1917. Urban home demonstration agents were added to the Cooperative Extension Service staff on an emergency basis. They c00perated.with existing agencies in providing technical information, demonstrating food conservation methods, and helping housewives to use new foods. Much was done to help foreign born women, and for this activity special schools were organized, special committees set up, and special litera- ture provided. In addition to the regular activities of farm and home agents, these workers were called upon to assist in the mobilization of military forces, the organizationof farm and other labor on the home front, the sale of Liberty Bonds, and the work of federal and state Councils of Defense. They worked with the Food.Administration, the Red Cross, the 103 Public Health Service, and the Children's Bureau. In some communities demonstration centers were set up, where information could be sought at any time; in others, cooked food centers were established to acquaint the community with new products or new ways of using well-known products (328: 138-1&7). Housewives were taught to can, dry, salt, or store fruits, vegetables, and meats, to substitute milk, cottage cheese, and locally grown fruits and vegetables for scarce staples, to provide inexpensive substitutes for scarce and high priced foods, to assist in emergency food measures, and at the same time to safeguard the health and nutri- tion of their own families (72), (10&), (199), (222). The American National Red Cross The American Red Cross dates back to a small organization beginning in the District of Columbia in 1881, and granted a charter by Congress in 1900 (263: 12-18). Although dietetic instruction as a part of nursing education was authorized by the Red Cross in 1908 and again in 1912 (15), it was not until the beginning of the war that the prOgram was developed. At the end of 1915 only one class of thirteen members had completed the course in home dietetics (16). In 1917 a Bureau of Dietitians' Service was established within the Nursing Service branch. At this time dietitians were recruited by the Red Cross for two purposes: to serve in army hospitals and to teach Red Cross classes (8). 10& The first textbook was compiled in 1917, previous classes having used typewritten notes (16). The preparation of various types of foods was taught and addi- tional chapters discussed such topics as hygiene of food, digestion, fuel value and dietary standards, bill-of-fare making, and foods for specific groups -- children and invalids. The only reference to vitamins is in a statement that ideally a dietary standard would include "mineral requirements and requirements for vitamins [regulating substancee7 of which minute amounts at least are essential. With present knowledge it is difficult to give such data" (115: 77)- Langworthy is quoted as saying that a mixed diet including the Five Food Groups and supplying at least 3000 calories daily would almost surely supply the needs for protein, minerals, and other consti- tuents (115: 77). References for additional reading were selected from government publications. By the end of October, 1917, classes were being conducted in 1&9 teaching centers. At this time 309 classes, with nearly 3000 graduates, had completed the home dietetics course, and thirtyeseven.i more classes were in operation. This teaching activity continued throughout the war. In the face of demands for more complete information in nutrition, it was decided, following the war, to revise the course and make it a "large part of the health education prOgram of the future." The Bureau of 105 Dietitians' Service of the Department of Nursing Service became the Nutrition Service, with independent status, in 1921. In 1919 a system of COOperation with the Federal Extension Service had been provided, so that the two organizations might work together in the promotion of nutrition education (9). Later, cooperative relationships were to be developed with other national, state, and local organizations. By the end of the war the public was becoming more aware of the importance of good nutrition. Sherman believes this awareness was due in part to the nationwide problems of food supplies and food conserva- tion which the peeple of the United States had faced (295: 55). C H A P T E R X "THE NEWER KNOWLEDGE OF NUTRITION“1 In 1918, when the armistice was signed, there was an extensive body of technical literature on nutrition, resulting from the combined methods of chemical and biological research (203: vii, 1-2). A new term, "deficiency disease," had come into common usage among scientists engaged in the study of nutrition. Beriberi and scurvy were generally considered to be deficiency diseases (29&: 310), although as a result of wartime conditions some investigators considered scurvy due to a combination of infection and poor nutrition (29&: 316). Sherman declared the former custom of considering all mineral constituents of the body as one ash substance to be both "illogical and incorrect" (29&: 269-270). He called attention to calcium as the mineral seemingly most deficient in American diets (29&: 268). Milk and vege- tables should be consumed in larger quantities (29&: 38&-385). There was a new emphasis on the importance of milk (118), (317). Seventyefive grams of protein a day, rather than the high figures originally prOposed by Atwater and the European scientists, was ample and allowed an adequate margin over actual requirements (29&: 380). There was, however, a difference in the values of proteins from different 1Title of book by E. v. McCollum. 106 '— ‘ -mnyas 107 sources (29&: 22&-225), so that the protein of cereals and most legumes could no longer be considered the equivalent of the protein of meat and other animal products. The difference was known to lie in the amino acid composition of the various proteins. McCollum considered this discovery one of the "outstanding results of modern research in nutri- tion" (203: 131). It was no longer considered accurate to say that muscular work was done at the expense of protein (29&: 226-229). The adequate diet, according to Sherman, should contain suffi- cient energy foods, protein containing suitable amino acid combinations, well balanced prOportion of several ash constituents, and two recently rec0gnized factors, fat soluble A and water soluble B (29&: 335). It was considered doubtful that, with the new factors to be taken into consideration, dietary standards could ever be made to include all the qualities of a permanently adequate diet (29&: 385). In 1919 McCollum, then a member of the faculty of Johns Hopkins University School of Hygiene and Public Health, published the first edition of The Newer Knowledge e£ Nutrition. The book, written.with the informative needs of the American public in mind, was an interpretation of current literature in the field of nutrition. McCollum, who had done extensive research in nutrition, was a strong advocate of the addition of liberal quantities of milk and the green leaves of plants to the dietaries of mankind. For these two classes of foodstuffs he coined the term "protective foods" (201: 163), (203: 81). This concept of protective foods, plus the recently reCOgnized differences in protein 4 ......r " ‘ ' am“ 108 values, and the importance of the two factors, fat soluble A and water soluble B, formed the bulk of what McCollum referred to as the newer knowledge. Only through biological research with small laboratory animals, whose life spans, under controlled laboratory conditions, were observed through many successive generations, could the mysteries of the adequate diet be solved (203: 130). Soon the term "newer knowledge of nutrition" was being used to distinguish the new knowledge from earlier concepts based on protein and energy values and digestibility. Sufficient knowledge was then available, McCollum thought, to "make it possible to select such foods as will make good each other's deficiencies, and to combine them in such proportions as will insure the disappearance of all the diseases of man which are brought on by faulty diets" (203: 115). In 1922 and again in 1925 McCollum and Simmonds collaborated in preparing a non-technical book to assist the American public in the selection and combination of common foods to assure an adequate dietary (206), (207). As the country returned to peacetime conditions, new organiza- tions concerned with the health of American citizens were formed; organizations already in existence created new positions for the teach- ing of nutrition, and agencies already engaged in nutrition activities eXpanded their efforts. 109 The American National Red Cross With the organization of the Nutrition Service in 1921, the Red Cross began its pioneering program of community nutrition through schools, adult groups, and home service. Annual Red Cross nutrition conferences were held at area or national headquarters, and additional training of personnel was arranged through university prOgrams and with the help of medical groups. Services were geared to community needs, with prenatal, pre- school, and adult groups receiving attention. In most communities the school provided a point of origin, and in the typical prOgram all school children received instruction. In a given school month as many as 15,000 or more persons, men and women, school and preschool children, might receive instruction.1 In addition to work in teacher training schools and departments, nutrition classes were conducted for teachers already working. Through participation in chapter committees, many groups aided the Red Cross in its activities. These groups included school superintendents and principals, home economics teachers, home demonstra- tion agents, medical and paramedical personnel, social service workers, church and civic leaders, and parent group leaders (9). With the beginning of publication.of the 338.95232 Courier in 1922, a series of short articles entitled "The A. B. C. of A. R. C." was 1During the school year of 1925—1926, an average of 15,&l3 per- sons a month were given nutrition information. See American hee Cross Annual Re art for the year ending June 30, 1926, washington: Government ——_Printing or ice, 1926. 110 published. In the Opening article attention was called to the malnutri- tion found in many homes, not all of them poverty ridden (l). A recipe for nourishing home prepared meals called for milk in every meal; fruits, vegetables, and home cooked cereals daily; and eggs, even though they must be purchased at the expense of a part of the meat allowance (2). This article was typical of the series. A pamphlet published in 192& for use in nutrition classes shows the progress being made in nutrition teaching. The list of necessary nutrients included protein foods, mineral salts, water, bulk, and energy foods. Fats were to be chosen for their vitamin content. There were three vitamins -- fat soluble A, and water soluble B and C. Four minerals were especially important -- calcium, phosphorus, iron, and iodine (121). At this time the radio was coming into use to reach large num- bers of persons.1 ‘With the coming of the depression Red Cross nutritionists and volunteer workers put forth additional efforts to provide information on nourishing low cost dietaries. Since pellagra was a major problem in some southern areas, emphasis was placed on adequate preventive diets. In one pellagra ridden section thousands of diets were distributed to stricken families in packages of yeast. 1A radio audience of &0,000 was estimated to have heard the Director of Nutrition Service of the Southwestern Division as she gave her first radio talk. See "Radio Tells What to Eat," Red Cross Courier, June 17, 1922. _ " ' 111 Special pamphlets were prepared for the use of Red Cross nutri- tionists. Extension workers and home economics teachers of local chapters conducted demonstrations and prepared newspaper articles on low cost foods. In some mothers' classes the group first discussed local food prices and the values of the various foods. Then each woman planned menus suitable for her particular family. In homes having problems which could not be solved in a group, the nutritionist would go into the home. Better nutrition for the dollar was a watchword during this early period of the depression (9). Early in 1932 the National Red Cross budget committee recom- mended as an economy measure the dropping of the Nutrition Service on a national basis. From July 1, 1932, until l9&1, when the Nutrition Service was restored (102: 388), a consultant was maintained in the headquarters office to provide assistance to administrators, service heads and local chapters attempting to continue their nutrition activi- ties. The authorization of volunteer instructors was continued and itinerant nutritionists were shared by several chapters. Thus dozens of chapters continued to aid their communities through nutrition educa- tion. Some continued to conduct classes (9). In some communities it was possible to arrange for unemployed home economists to become Red Cross nutrition instructors paid by the local Emergency Relief Administration (32). Classes ranged from public nurses working among foreign born groups in New York City and members of the New Ybrk League for Hard of c- f *’ ail-1* __- .—_— &I—rg—u r.» 112 Hearing (32), to a group of Negro mothers in Florida who were fascinated by the white mice used in a demonstration (23). The COOperative Extension Service In the depression which followed the war many county agent posi- tions were abolished. The urban home demonstration agents who were professionally qualified women (356) had been active in other areas than canning prOgrams. At the close of the war many of these additional activities were taken over by local organizations (27&). To reduce the financial load &-H Clubs began to train local volunteer leaders, and this solution was soon adOpted by other extension specialists. In the following decades the leader training programs became an important phase of extension work in home economics (356). Nutrition Education Methods From early years the Extension Service had used a variety of methods in teaching nutrition. These methods have been classified as follows: Individual Group Mass Contacts Contacts Contacts Farm and home visits Method demonstration meetings Bulletins Office calls WOrk meetings Leaflets Telephone calls Leaders' training meetings News articles Personal letters Lecture meetings Circular letters Result demonstrations Conference and discussion Radio meetings Exhibits Meetings at result demon- Posters strations meetings Tours Schools 'v 113 With the coming of television, another means of reaching large numbers of people was added. Home Demonstration Work in Missouri, 1919 to l9&O Missouri was selected for a detailed study of programs during the period between the two wars. In 1919 the wartime canning program was still being conducted with the presentation of meats, vegetables and fruits. The "Children's Year" program was reflected in one city where bad weather hindered a successful campaign. Nevertheless, "the amount of advertising done and the literature distributed could not help having some effect in waking up the people to the need of greater "interest in child welfare." Six communities had child feeding programs. There were thirteen lectures on child feeding with.a total attendance of 2&0 persons, and three lectures on school lunches with a total of eighty persons attend- ing. One hundred persons attended one demonstration on food selection. In Vernon County the influenza epidemic hindered the program but some work was done in cooperation with the Red Cross, Parent-Teacher Association, Chamber of Commerce, schools, clubs, and churches. Classes were held in foods and nutrition, as well as cooking: food preservation activities continued; the school lunch received attention, and there were window displays on balanced meals, planned by the home demonstration agent and carried out by home economics classes. ,_ 11& In 1920 the following organizations joined with the Extension Service in a state wide prOgram for malnourished school children: U. S. Public Health Service Missouri State Board of Health Missouri Tuberculosis Association Local Red Cross Chapters, Parent-Teacher Associations, and clubs. A milk campaign was conducted in Kansas City. There were talks before school children, factory employers, department store employees, Parent-Teacher Associations, and clubs. In 1925 the major activities involved food selection, improve- ment of underweight children, correction of adult under and overweight and constipation, hot school lunches, and campaigns to get children to drink milk instead of tea and coffee. In the 1930 report the state home demonstration agent noted that the majority of women were interested in food preparation projects, and that in 95 per cent of the groups these projects led to requests for more work in nutrition. A rat feeding demonstration was used to stimulate interest. Meal planning projects logically followed work in food prepara- tion. Because the introductory meeting on meal planning was considered too difficult for a volunteer leader, a qualified agent presented this topic to the largest possible audience, after which the leaders took charge of the follow-up meetings. At the first meeting there was a discussion of the relations of food to health, followed by the weighing and measuring of all individuals 115 present. After filling out a health habit sheet, individuals suffering from abnormal conditions related to nutrition were given opportunity to cooperate in a nutritional rehabilitation prOgram. When a fruit and vegetable project was adopted by a community, club members listened to a talk on the dietary value of fruits and vegetables, were helped in the planning of garden and canning budgets and in estimating the size of the garden required to produce the needed yearly supply. Wbmen were also shown how to compute their own mineral and vitamin requirements. The third meeting of the project was a canning demonstration, and at the fourth meeting a demonstration was conducted on the uses of the canned products. In some communities specialists and home demonstration agents conducted these programs, in others they trained‘leaders to carry on much of the work. The 1935 report describes conditions resulting from the Great Depression and the drouth. Money was scarce and projects had to be carried out with as little money as possible; nevertheless, there was an increase in the number and enrollment of home demonstration clubs. Increased home problems and the desire for sociability during the period of financial stress stimulated interest in the clubs. In addition to the club members, nearly 20,000 non-members were helped. There was an increased use of tomatoes, citrus fruits, raw fruits or vegetables, whole grain products and cod liver oil among the club members' families. Garden and canning budgets were continued. 116 A radio program was conducted, and nutrition related subjects were presented, but there was little response from the public. The l9&O report mentions cooking schools, work in.food preser- vation, and hot school lunch demonstrations. Work in foods was included in the Live-at-Home prOgramsl in several counties. A prOgram for older youth was carried out, and the report includes a reference to the work of the nutrition specialist in prepar- ing prOgram outlines (86). Rack reports the extensive work with programs for older youth in the Extension Service (271: 287). ‘Work in Pellagra Areas The Extension Service assisted in the fight against pellagra, paticularly in Negro communities in the delta section of Louisiana. Pellagra is rarely found in Louisiana today (173), but from the early 1900's until the discovery of niacin, the pellagra preventive vitamin, it was one of the major health problems of many southern states. The pellagra preventive diet emphasized by the United States Department of Agriculture in the 1930's recommended the use of milk, lean muscle meat and liver, canned salmon, tomato juice, wheat germ, and yeast (312). In Louisiana 175 voluntary leaders in one district were trained to present the subject of anemia and pellagra diets at home demonstration 1Farm and home planning prOgrams enabling the farm families to obtain most of their food from the farm and sometimes to supplement their meager incomes with small sales of home produced products. fi-T—W" . 117 clubs and other meetings. Two demonstrations were outlined at this meeting, one showing the balanced daily diet, with particular emphasis on pellagra preventive foods, the other pointing out causes and symptoms of pellagra and indicating curative foods. Inexpensive dishes using macaroni, salmon, and dried milk were demonstrated at these meetings. The same subjects were presented by the state agent for the benefit of the tenant families on large Louisiana plantations. Literature on pellagra protection was also provided in some communities (8&). In Alabama the importance of raising adequate garden products for good health was stressed. The following canning budget for a family of five was recommended (78): Vegetables Tomatoes . Carrots Beets String beans . Okra . Kraut Soup mixture Corn . English peas Fruits Peaches Pears Plums Blackberries Huckleberries Fruit juices . Meat . 72 12 2h &8 12 21: 2h 2h 2h 72 2L: 2h 72 12 2b 100 quarts quarts quarts quarts quarts quarts quarts quarts quarts quarts quarts quarts quarts quarts quarts pints 118 One of the Alabama leaders prOposed to one of her tenant neigh— bors that she give a demonstration in her home. Eight were present at the first meeting, including two who had pellagra. The leader talked to the group about the necessity for milk and fresh vegetables for the . whole family. Upon her return for the second meeting she found the = number of tenant farmers' wives almost doubled. Ten of the group had already arranged for pasturage for a cow, and four already possessed the cow. Ten had planted gardens, and several had bought chickens. At least two of these persons had not been present at the previous meeting; they must have been strongly influenced by their neighbors who were present (78). The Nutritionist as a Social Werker A staff member of the Mothers' Pension Department of the Chicago Juvenile Court described some of her clients in 1918 as possessing excellent natural ability and anxious to learn everything which would make them better homemakers. Most of them could cook, sew, and clean, 'but they knew nothing of food values and were unable to choose foods ‘wisely; They would pay high prices for cleverly advertised products. Acute undernourishment was a frequent result (2&6: 27-28). The foreign born victim of New York City's poor sections was even less fortunate. Unable to read or write or to communicate in any tiut her native language, frequently in debt to the grocer or some other creditor, she needed help indeed. 119 When Miss Lucy Gillett went to work as a home economist in New York's A. I. C. P.,1 the nutrition problem was so acute that it was decided to abandon other home economics activities and concentrate on fulfilling the nutritional need. The first classes were unsuccessful, since the women understood no English and, furthermore, were unable to adapt class instruction to their individual problems. Literature was prepared and conferences were held with nurses and case workers to enable them to educate the homemakers with whom they worked. When these methods failed, the nutritionist herself stepped in to aid the family. With her help the homemaker learned how to budget expenditures, plan meals, purchase and prepare food, and carry out a physician's dietary prescription by fitting it into the family meal pattern. Sometimes, in order to help the family nutritionally, the educator had to help them extricate themselves from debt, overcome resistance to change, manage children, and fit racial eating patterns into a balanced dietary of available foods (136). As more and more women were able to speak and read English, classes were held, radio talks and newspaper articles presented, and exhibits prepared. Share charts were especially valuable visual aids. Using the information in the food share tables worked out by Rose, the nutri- tionist prepared scaled models with colored paper to indicate the shares of needed nutrients contributed by specific foods. 1Association for Improving the Condition of the Poor. 120 To stimulate interest in one area without a nutrition program, a Better Food Contest was announced. The contest was open to everyone living in the district. Contestants must submit records of one week's menus, with the market list and the cost. Three times a week newspapers contributed space to the project, carried pictures, and at the end announced the winners and some of the winning menus. A child feeding and training study group resulted from the interest aroused by this contest. With the discovery of Vitamin D as a factor in the prevention of rickets, an anti-rickets campaign was organized in one of the Association's health centers. There were talks to women's groups, classes for the mothers of small children, newspaper articles, slides at local theaters, distri- bution of educational leaflets, store window posters, and exhibits in local drug stores, portraying the benefits of cod liver oil. From time to time books, pamphlets, free leaflets, and slides for illustrated lectures were prepared. Research was an important part of the program (136). Before vitamins were known, emphasis was placed on protein, carbohydrates, fat, calcium, and iron (135), (136). The use of whole grain cereals was urged to increase the supply of iron. Later informa- tion on vitamins A, B, and C was soon added to the teaching materials (135) . 121 In a twenty-four page booklet for welfare workers prepared by the Association in 1931,1 the following food pattern was recommended for the low income family: At least two vegetables daily -- one should be potatoes and the other alternately a root and a green leafy vegetable; a raw leafy vegetable should be used two or three times a week. Citrus fruits or tomatoes three or four times a week for adults, daily for children. Fresh or dried fruit daily. Meat or fish limited to one meal a day three or four days a week. Milk daily, and one other protein food such as cheese, eggs, or legumes on meatless days. One-half egg daily, or a whole egg on alternate days for children. Sugar as a flavoring agent only; molasses would increase the iron content of the diet. Fats for fuel value; if a green leafy vegetable was used three or four times weekly, part of the butter at mealtime could be omitted and another fat substituted. Cod liver oil for children. In 1939 the Association for Improving the Condition of the Poor merged with the Charity Organization Society to become the Community Service Society of New York (125). Throughout the years several studies were made of families served by the Society and its predecessor to determine the effective— ness of their nutrition work as demonstrated by improved food habits. One such study was reported in l9&l. The eating habits of the children in ninety families receiving regular home instruction were compared with the eating habits of the children in fortyefive families receiving no lGood Nutrition eh Minimum Cost, New York: Association for Im— proving the Condition of the Poor, I951. 122 instruction. Significant improvement was shown in the homes receiving instruction (52). Food Clinics One of the first food clinics in the country began as a result of the observations of a few persons on the unfilled nutritional.needs of Boston's "sick poor." These needs were like three lines which should have formed a triangle but whose ends never met in an angle. Frances Stern relates how the early hospital dietitian fed her patient according to the physician's dietary order, but with little or no attention to the food conditions in the home to which he would soon return. The physician prescribed a nourishing diet at home for the patient who seldom understood the meaning of nourishing and who lacked the money to carry out the prescription. A relief agency provided food but not necessarily the most nutritious food. The Food Clinic of the Boston Dispensary, now the Frances Stern Food Clinic,l was organized in 1918 as a place where the lines of the triangle would merge. Patients were to receive basic nutrition informa— tion, an interpretation of the diet prescription in terms they could understand, and instruction on how to carry it out with the inexpensive foods available to them (310). In the late 1800's Boston's North End Diet Kitchen2 provided milk and other foods to the poor. In 1923 it added nutrition teaching 1See Chapter XII. 2Now the Massachusetts General Hospital Nutrition Clinic. 123 to its previous function (286). In Chicago a medical school clinic taught nutrition to classes of underweight and malnourished working boys and girls. Since most of these young peOple came to the evening classes directly from.work, a nourishing supper was served at a slight charge (37). The Infant Welfare Society of Chicago, founded in 1911 (169), employed a dietition about ten years later to teach mothers (37). Boston YOung Women's Christian Association A survey of nutrition education facilities in Boston in 1927 revealed the following organizations conducting nutrition prOgrams for adults: Settlement Houses -- mothers' classes, cooking and health classes, some home visitation. Neighborhood Kitchen -- cooking, meal planning, child care. YOung WOmen's Christian Association -- lectures on diet in its relation to health. Community Health Association -- prenatal instruction and classes for mothers' clubs, classes for staff nurses. City Health Department -- instruction in feeding the pre- school child. Federated..Jewish.Charities -- classes, consultation, staff training of case workers. Commercial restaurants and cafeteriasl -- information on caloric and sometimes other values included on the menus. The New England Dairy and.Food Council -- advertisements, lectures, films. Boston Dispensary Food Clinic -- outpatient work. Massachusetts Department of Public Health -- general activi- ties (305). 1The Georgian Cafeterias and Childs Restaurants. C. wIierg'y. f '0 +l~ men C0118: l2& YWCA Nutrition Service In 193& the Boston Young Women's Christian Association arranged with the Boston Dispensary Food Clinic to conduct a program of individ- ualized nutrition education for the young women of the Association. The nutritionists were to spend two evenings a week at YWCA headquarters. The work, carried out during the following winter, was aimed at helping the young women to acquire a basic knowledge of nutrition and the individual ability to adapt this basic knowledge to any abnormal condition which a young woman might face. Underpand overweight were common examples of such conditions. Emphasis was placed on a "protective” diet containing adequate energy foods, protein, calcium, phosphorus, iron, the five vitamins then considered essential,1 and water. The following foods were recommended to provide these nutrients: Milk -- two glasses daily. Fruit -- two servings daily. Vegetables -- two servings daily in addition to potato. Eggs -- three or four weekly. Meat or fish -- one serving daily. Butter -- one quarter pound weekly. Each woman had an initial conference with one of the nutrition- ists, and in case of need was invited to return. During the first season there were l3& initial visits and.forty-one return visits. This work was continued until l9&l (253). A, B, c, D, c. 125 The Children's Bureau 0n the first anniversary of the declaration of war by the United States, the Children's Bureau, in c00peration with the Child Conserva- tion Section of the Field Division of the Council of National Defense, began the observance of Children's Year (6&). Designed as a war measure, the activities carried on during the twelve month period awakened the country to the needs of children (279: 327-328), (367: 3). The opening drive included a campaign for weighing and measuring of babies and preschool children, many of whom were found to be malnourished. A pilot project called the "Child welfare Special" followed. A large government truck was converted into a mObile well-child clinic and used in a number of counties in the Central States area (65). ‘With the passage of the Maturity and Infancy Act, there was increased effort in health agencies to reach the expectant mother. By 192& forty states were cooperating with the Children's Bureau in work under this act (63). A survey of nine cities in the East and Midwest revealed the teaching methods in effect in most of the cities. Regularly scheduled classes were found to be only partially successful. Informal discus- Sion of problems was an effective method in some cities. Demonstrations, talks, cooking lessons, and discussion periods where regular attendance was not urged, proved more effective than series of meetings dependent upon good attendance records for success. The Children's Bureau continued its series of publications on child care, including nutrition. A booklet on care of the preschool age 126 child in 1920 included recipes with its nutrition instruction. While most other writers were insisting that the preschool child should not be given meat to eat (283: l39-1&O), (3&7: &29),Chi1dren's Bureau publications from the first recommended that older infants and pre- school children be fed beef, lamb, and chicken (168), (362). This is in line with today's practice. The Children's Bureau has continued to take an active interest in the nutritional needs of children, as evidenced by current publica- tion lists.l Homemakingin Adult Education The woman who wished to increase her effectiveness as a home- maker in the 1930's had a widening range of choices in subject matter. Two general areas were set up within the same overall program -- one for the person interested in the broad field of child development, family relationships, and mental health, the other for the woman interested in food selection, buying, and like skills. Consumer educa- tion was a newcomer in this latter group (197). Unemployment and the Public Schools Philadelphia is in the midst of a struggle against the evils that result from unemployment. Thirtyeseven thousand families of the unemployed are receiving financial relief. There is no wage earner in 59,000 families. It is probable that there are twice 50,000 families in Philadelphia which 1See the following Children's Bureau publications:"Nutrition and Healthy Growth," l96&; "Infant Care," l96&; "Your Baby's First Year," 1962: "Your Child From 1 to 3," l96&; "Your Child From 1 to 6," 1962; "Ybur Child From 6 to 12," l96&; "Feeding Mentally Retarded Children," 196&. ,. 1'4!" 7‘5. 127 must figure to the last penny if they are to be adequately fed during this winter of hard times. In this emergency (an emergency fraught with as great possibilities of damage as the world war) the foods teachers of Philadelphia have organized to aid in combating malnutri- tion and its attendant evils. It was Henrietta W. Colvin, director of the Division of Home Economics, the Board of Public Education, Philadelphia, speaking. What group she was addressing she does not say. On December 1&, 1931, she sent a copy of her talk to Emeline S. Whitcomb, senior spas cialist in homemaking education, United States Office of Education in Washington. Miss Whitcomb was making a study of "How Home Economics is Meet- ing the Emergency," to be presented at a meeting of the Department of Supervisors and teachers of home economics of the National Education Association in Minneapolis in February, 1933. Not only Philadelphia, but other cities across the nation had wide—awake home economics departments and were striving to help, directly or through their students, the impoverished families around them.1 A sampling of activities follows: In Adams, Massachusetts, mothers' classes were held in the schools. 1All material in this section is taken from the correspondence of Emeline S. Whitcomb, senior specialist in homemaking education, United States Office of Education, washington, D. C., in the files of the National Archives. 'M ”'0 w—~€e~o1“m£-ei3r& ' r H'. ‘..-"":“" ea- . the. - H: .. 128 In Detroit, Michigan, there were cooking classes and demonstra- tions for welfare clients. Much of the teaching of girls in home economics was done with the hOpe that it would reach the mothers at home. In Chicago low income mothers were invited to the schools to sample the work done by pupils on relief rations and to receive further directions. In Kansas City teachers visited the homes. In Denver, with the cooperation of Parent-Teacher groups, an instructive bulletin was prepared. The Denver Foundation made funds available for a meal planning and food preparation clinic in one of the school food laboratories. In Atlanta, Georgia, Smith-Hughes classes were organized in needy sections. In Los Angeles there were classes for homemakers and work with indigent families. Public Health Organizations In 1917 a home economist was employed by the Massachusetts Department of Public Health under the title health instructor in foods. By 1925 there were five nutritionists on the staff. These women pro- vided nutritional material for print, supplied information to school and public health nurses, prepared exhibits, lectured to club or community groups, and served as teachers and consultants (195). In 1936 only a few states were employing nutritionists. In that year federal grants for maternal and child health services under 129 the Social Security Act were made available to states. Within eighteen months the number of state health department nutritionists had tripled (155) . The Delaware State Board of Health, in COOperation with the State Board of Education and the Cooperative Extension Service, and with financial aid from the Children's Bureau, conducted a demonstration program in one of its counties during the 1936-37 school year. Adequate nutrition for the child was taught by means of group meetings of parents, school personnel, Parent-Teacher Associations, home demonstration clubs, groups, women's clubs, and men's service groups, and by news stories, posters and circular letters. Public health nurses were given special instruction to enable them to carry on the work with their clients. In New Mexico nutrition demonstrations were conducted for groups of village midwives and their patients. Without the influence of the midwives there was little interest among mothers. These people were taught the value of their traditional foods and helped to realize the need for other foods like milk (15&). Detroit was one of the cities employing nutritionists in the health prOgram at an early date. In 1930 the original nutrition pro- gram which was conducted in the schools was supplemented with nutrition teaching in the prenatal and child welfare clinics. This phase of the work began with a weekly talk in the patients' waiting rooms, and grew into a prOgram of interviews, group discussions, posters, and exhibits. Home visits were made, and occasionally a housewife was taught how to We. . ,1... 130 select food by a trip to market accompanied by a nutritionist. A weekly radio broadcast was arranged and a speakers' bureau organized (l&&). Current public health prOgrams will be described in Chapter XII. The Chautauqua For a decade following World War I the Chautauqua continued to include home economics work in its summer sessions, but with gradually declining emphasis as public schools, colleges, and universities took up the work. The regular summer program was terminated in 1928.1 Of the influence of Chautauqua, Gould says: The graduated income tax, slum clearance, juvenile courts, pure food laws, the school lunch program, free textbooks, a balanced diet, physical fitness, ... all these and many more were concepts introduced by circuit Chautauqua to communities that had heard of them, if at all, only from the occasional school teacher or minister who had had the good fortune to spend a few weeks at Chautauqua Lake (138: 81-82). Progress in Research At least six vitamins were known before 1930. The terms A, B, C, D, E, and G were in common use (208: &5). The pellagra preventive factor was still not well understood, but it was well known that the disease could be prevented by an adequate diet (208: 389-392). As early as 1922 McCollum referred to the diet of "milled cereals, tubers, molasses, syrup, and fat pork" which seemed to produce 1No mention is made of a home economics program in the 1929 Summer School Quarterly nor in succeeding editions. .l".—h_vr 131 the disease. It was known that milk would cure it and that it could be effectively prevented by a diet containing milk, meat, eggs, and leafy vegetables (20&: 273-290). In 1922 there was no accepted theory on the causal factor in rickets (20&: 301). Within a few years, however, the effectiveness of Vitamin D as both a preventive and a therapeutic agent became well known (208: 332). Iodine was generally recognized as a factor in the prevention of goiter. The State of Michigan had pioneered in the promotion of public health education on the use of iodine for endemic goiter (225), (77: 69)- During the decade of the thirties most of the vitamins were identified chemically and the necessity for several trace elements was demonstrated (205: 22-29). In 1939 McCollum predicted that within the next two decades scientists would have "an essentially complete solution of the present major nutritional problem"l (205}"29),. 1The discovery of all indispensable nutrients. C H A P T E R X I NUTRITION FOR AMERICA AND THE WORLD The National Nutrition Conference for Defense met on the morning of May 26, l9&l, in washington. The more than 900 delegates present represented the national network of government, industry, labor, medi- cine and public health, education, mass media, agriculture and consumer groups. The earnestness with which these men and'women went at their task of planning for the nutritional welfare of the nation was intensi- fied on the second day of the conference when, in answer to the international situation, President Roosevelt declared a state of unlimited national emergency (268: v-xiii). The Committee on Food and Nutrition of the National Research Council had prepared a table of recommended dietary allowances to be used as a general planning guide. It included data on protein, energy nutrients, minerals and vitamins to be used as a general planning guide. Among the final recommendations which the conference made to President Roosevelt were the following: Full use of the newer knowledge of nutrition should be made, not only for the armed forces, but for industry and the home. 'Vigorous and continuous research' should be conducted, and there should be increased efforts toward the education of professional workers in the newer knowledge of nutri- tion. 132 ...—.1 R"; 91:9. 133 The recommended allowances and other useful but technical- 1y worded information should be translated into understand- able food terms for individuals in different economic levels. Every possible instructional device should be utilized, and all national and local organizations should be mobilized to educate the American public. The ultimate goal was to permeate every community in the nation with an interest in, and a knowledge of practical nutrition (268: 230- 233). In September the Office of Defense Health and welfare Services was set up to coordinate health and welfare programs and to provide specialists to aid in carrying out these programs. The Nutrition Com- mittee, established in l9&0, was assigned to this agency.1 There was also a Nutrition Division within the Office, concerned with nutrition education. The War Food Administration was in effect from the spring of l9&3 until June, l9&5. The Home Economics Section, Vocational Education Division, United States Office of Education, worked.with the states in the develOp- ment of prOgrams, including nutrition and food conservation courses. The Bureau of Home Economics and the Division of Protein and Nutrition Research of the Bureau of Agricultural Chemistry and Engineering were consolidated in February, l9&3, to form the Bureau of Human Nutrition and Home Economics. This new agency was to carry on research in home economics and to disseminate information based on this research. 1It was transferred in l9&3 to the Department of Agriculture. -—w—_._H...a—uh—' 13h These organizations, with the Federal Extension Service, were among the leading government agencies responsible for the war program of nutrition education (111: 279—282), (593), (850), (988). State nutrition committees were organized in all the states. Their purpose was to pool information, assist in coordinating the efforts of different agencies, and recommend methods for spreading information. In about half the states, the nutrition committee was represented on the State Defense Committee by l9&2. In some states county and local committees were also functioning. A bibliography was prepared for the use of librarians in selecting nutrition materials; in some communities service clubs donated money for the purchase of nutrition books. Eighteen states provided refresher courses fOr persons with earlier training in home economics. Speakers' bureaus were organized, and some county committees provided nutrition consultant service at county fairs. "Nutrition weeks" and "nutrition months" were observed (309). The war Food Administration produced a national wartime nutri- tion guide —— the Basic Seven (2&5) —- which soon became widely known. It was reproduced in colorful poster form by some of the food proces— acre. The seVen groups of foods included green leafy and yellow vegetables, citrus fruits and tomatoes, other fruits and vegetables, milk and milk products except butter, meat, fish, and poultry, and other protein foods, breads and cereals, butter and fortified margarine. AAA/\AAA VVVVVVV 135 Nationally known food companies which had spent millions of dollars annually to advertise the appetizing qualities of their products now turned to an emphasis of their nutritional values (288). A publishing company donated advertising space over a ten month period to promote nutrition by means of copy contributed by an advertis- ing agency (309). A yardstick of good nutrition, based on the Recommended Dietary Allowances, was prepared (331), and the National Livestock and Meat Board invented a food selection guide and nutrient calculator, operating on a slide rule basis, to carry out the yardstick function (37). The Nutrition Division of the Office of Defense Health and Welfare Services prepared a handbook for the use of food demonstrators (1146) ~ "Teaching women to cook," said Helen Mitchell of the Office of Defense Health and Welfare Service, "is a part of a sound popular nutrition program" (226). There was much emphasis on the effects of inadequate nutrition. "Hidden hunger" would produce fatigue, accidents, and susceptibility to minor illness, and would lower morale (3&&). Much effort was expanded on the promotion of whole wheat bread. One minister attended a regional nutrition meeting and returned to his Congregation to preach on the virtues of whole grain flour and to grind some wheat in a small hand mill attached to his pulpit (309). A speaker at the Massachusetts Nutrition Conference described the vain efforts of one of the country's largest baking companies to 136 pOpularize whole wheat bread (275: 11). The whole wheat campaign was judged unsuccessful, and soon bakers were required by law to add vitamins to white bread. The Cooperative Extension Service Much of the extension work during World war II was of necessity concerned with food production and food conservation. A new method of food conservation was the home freezer. Rationing of scarce products was again an unwelcome fact. The Basic Seven instead of the Five Food Groups was the meal planner's guide. Sample prOgrams around the country in l9&5 included the follow- ing activities: In California the home demonstration agents planned their program around home food production and preservation; adequate protein foods; blood regeneration; basic nutrition information for farm families, racial groups, and families of returning veterans; diets for the expectant mother; the infant, and the older citizen; and food sanitation (79). The Colorado program included home food production and preser- ‘vation, meal planning, and child feeding (80). In Connecticut food rationing problems, meal planning, food Preservation, and protein sources were emphasized. Cereals, vegetables, and soy flour were stressed sources of protein. 137 Near the close of l9&5 the Connecticut Extension Service began a series of projects called "What's Cooking In Your Neighbor's Pot?" The first group to be studied was the Polish group. The history, culture, foods, and crafts of the Polish peOple received emphasis. A monthly radio prOgram.was planned for this and future groups studied. The extension nutritionist was responsible for the production of a weekly press release called Table Talk, based on food and nutrition information (81). Iowa extension personnel conducted an extensive prOgram on food production and presentation, food preparation, nutritious and appetizing foods, and the food habits of different racial and national groups (82). In Kentucky a refresher course for home economists was conducted by E. Neige Todhunter of the University of Alabama. Home gardens, food preservation, corrective diets, and time saving methods in the planning, preparation, and serving of meals were pOpular tOpics (83). Leader training meetings in Louisiana covered care and feeding_ of the sick, vegetable cookery, increasing the use of milk, making cheddar cheese, better breakfasts, and table service. Fiftyeone news releases were prepared, each featuring the nutri- tive value and cooking of an abundant, seasonal, or native food (8&). The Missouri Extension Service emphasized food preservation but Linterest began to lag when the war ended and canned foods began to come Off the ration lists. Major emphasis was given to food selection and preparation (86). 138 The American National Red Cross Nutrition Service was reactivated in 19&1 following the National Nutrition Conference for Defense in May (8), (102). Community chapter resources were taxed to meet the demand for nutrition classes. Certifi- cates for completion of the nutrition course rose from approximately 5500 in l9&O-l9&l to over 180,000 in 19&1—19&2, and over 300,000 in l9&2- l9h3 (272: 95-98)- Working with the state nutrition committees, the Red Cross provided refresher courses for the retraining of women who had had previous professional training in nutrition (10). A Standard Nutrition Course, revised in February, 19&2, was taught in ten two-hour classes (119). As the war continued, with new problems arising and old ones . becoming more acute, nutrition courses were adapted to the needs of the groups. In army camp areas where the wives, far from home and friends, attempted to keep house in inadequate quarters, classes emphasized food preparation with one gas burner and no storage space. Foreign speaking women attended classes with interpreters, demonstrations,.and selected Visual aids. Foreign born housewives who knew only their native foods were taken to markets by Red Cross workers and assisted in learning how to purchase American foods (&1). Volunteer Red Cross leaders in Norfolk, Virginia, went to the local utility company for help on preparing low cost menus, then taught r5. 139 European refugees coming into the Norfolk entry port (161). Housing project residents received information about foods which they had never used in the sections of the country from which they had come (11). WOmen who worked in defense factories all day could listen in the evening to radio talks and skits illustrating what to eat and how to prepare it (12). There were talks, demonstrations, films, and exhibits (272). Information centers were set up in department stores and markets, staffed by trained aides who gave demonstrations for the benefit of shOppers. The packed lunch for war workers was a pOpular subject (11), (193). Safeway stores sponsored a nutrition course for housewives (289) . Sales psycholOgy and promotion techniques were borrowed from industry. Pregrammers studied their audiences to determine their special interests then promoted nutrition in terms of this interest. Sales personnel in New Yerk City department stores were "sold" nutrition on the basis of its glamor; the non-selling personnel were told about its effect on their health. A nutrition film, "Hidden Hunger," was shown to a group of railroad men who, it was assumed, were concerned over fatigue and minor ailments (98). The wives of wastinghouse defense workers were impressed with the importance -- and the facts -- of nutrition by means of colorful cartoon—like pictures, interesting storyalectures, and, with these interest catchers, factual information (187). w-v. v Jr: J, I". ‘3: «.4 1&0 In Rochester, New York, a family of six, known to local news- paper readers as "the Browns," was selected for a demonstration of the practice and the benefits of good nutrition. For several months the Browns ate carefully planned meals, the foods for which were donated by Rochester merchants and milk dealers. Each day's menu was published in two Rochester papers; on Friday the following week's grocery order was publicized. On the women's page of the papers were articles by a local physician on the hypothetical health problems of the family, such as colds, and the effects of good nutrition in preventing these i11— nesses. Other articles described the values of the foods eaten by the Browns (152). In New YOrk City a "Wartime School for Housewives" was conducted for over 750 women. A radio program, "The wartime Cooking School of the Air," was featured on a city station. There were talks to churches, garden clubs, department store audiences, and groceryemen's associa- tions. Materials in seven languages were distributed (159). In Denver, Colorado, a city wide nutrition education prOgram was ' organized with a coordinator and three full time teachers from the Emily Griffith Opportunity School. By the fall of 19&2, approximately 10,000 women had been reached with information (96). The Adult Education Department of the Minneapolis Public Sdhools conducted city wide food and health forums. These forums emphasized vitamins, the adequate diet, nutrition wise "buymanship," and the effects of food, rest, recreation, and mental health on personal well- being (188). m ..r" yew . ....- 1&1 Work in training lay leaders to assist professional persons in carrying on programs was done in some areas (3&8). It was a part of the nutrition work of the Office of Defense Health and Welfare Services to serve as a clearinghouse for information. The state committees were asked to report their particular problems and most successful prOgrams to the Office of Defense and welfare Services, where the information would be pooled for the benefit of all states (251). To insure a lasting peace after the war, Americans were told, there must be adequate food and good nutrition for all the world's people (211: 267). There seems no reason to doubt on the basis of present evidence, that just as, by the use of modern medical science, we have conquered diseases that took an enormous toll of life in the past, so by the use of the modern knowledge of nutrition we can build a better and a stronger race, with greater average resistance to disease, greater average length of life, and greater average mental powers. This can be done by the conquest of hunger -- not only the obvious hunger man has always known, but the hidden hunger revealed by the modern knowledge of nutrition (268: 232). It remained to be seen how Americans would carry out this ideal of the National Nutrition Conference delegates. C H A P T E R X I I FOOD AND THE EDUCATION OF ADULTS About 1900 the knowledge of nutrition favored spending less instead of more money. This situation ceased to be true with the coming of the newer knowledge of nutrition. Economic problems took on new color. People needed to be assured of sufficient income for purchase of protective foods instead of being taught greater economy in purchase of the protein and energy foods. "The scientist," wrote a layman during the depression, "works in his laboratory with a few pink-eyed rats, and what he discovers is seen to be tied in with the deepest social and political and economic questions" (1&5: 166). Although the results of a nation wide nutrition survey indicated that the nutritional condition of Americans was generally good (229), the agencies most concerned with nutrition education.find much work to do. One of the most inspiring features of this study was the dedication to a task displayed by nutrition workers at many levels. Current Federal and Related PrOgrams A list of federal agencies concerned with food and nutrition includes services in five departments and five other agencies (120). 1&2 9..-, "1... w»‘ as. . - 1&3 Of these various units, one -- the Federal Extension Service -- is exclusively an educational organization. The Department of Agriculture Today the U. S. Department of Agriculture carries on an active nutrition prOgram including much research and both direct and indirect forms of education. Through its far-reaching programs of research and dissemination of information, it aids producers, marketers and distribu- tors, and consumers. It continues its studies of food composition and nutritive value, human nutritional requirements, food quality, prepara- tion, and preservation, meal planning and budgeting, consumption and dietary adequacy and food economy. In 1909 the U. S. Department of Agriculture began making estimates of the national per capita consump- tion of specific groupings of foods and their nutrient content, provid- ing the basis for certain types of studies in the adequacy of the nation's food supplies. Through its own agencies and in cooperation with others, the Department of Agriculture endeavors to provide accurate nutritional information in a form which will motivate the public to adopt sound food practices. Only one agency within the Department -- the Cooperative Extension Service -- conducts an education prOgram as its major function. In this agency are food and nutrition specialists on both the national and the state levels. WOrk in the twin fields of foods and nutrition is divided into two general divisions: (1) food production and preser- vation and (2) selection and preparation. In general the work of the 1&& Extension Service has benefited rural more than urban groups; however, there have been for many years a few programs for urban groups. For over a decade prOgrams in marketing and consumer education have been carried on in a few cities. Some nutrition education of an indirect nature has also been carried on by the Department through certain of its agencies (338). The Grange1 Today the Grange takes justifiable pride in its participation in community projects but does not, as a national organization, lead out in adult education programs in nutrition. The Federal Extension Service There is considerable autonomy in program planning within a state (97). After World War 11 there was a trend away from nutrition, with increased interest in food preparation. Today, with a decreased need for home food preservation, there is a definite trend away from canning. Some work is done with freezing fruits and vegetables. There is much emphasis on weight control, and a great deal of concern over food fade and fallacies. Groups receiving special attention at this time include the teen—age group and the young homemakers (30&). This concern over teen diets, young mothers, faddism, and overweight was evident in the state program reports between 19&6 and 1962 (80), (81), (32). (83), (85). 1The Grange is not a part of the Department of Agriculture, but is included here for convenience. 1&5 In recent years pilot programs for young homemakers have been conducted in approximately twentyhfive states. As a result a series of lessons has been developed in the Federal Extension Service for use by home economists in the state services. These lessons cover basic information about nutrition, child feeding, meal planning, food selection and purchase, food preparation, and food fads and facts (122). State Extension Programs State Extension Service reports during the past twenty years show a trend toward education in entertaining with food -- meals, snacks, parties, table setting (82), (83) -— and a wide interest in weight control (80), (81), (82), (85), and in the use of dairy products (80), (82), (85). Following world war II Connecticut had a yearly program called "What's Cooking In Your Neighbor's Pot" to promote I knowledge and understanding among groups with different national or racial and cultural backgrounds (81). Some states promoted infant or child feeding studies (80), (85). When numbers of welfare recipients in a state needed assistance in learning how to use donated foods, the Extension Service provided help (80), (83). There is a decided trend in the direction of help to low income families (30&). Efforts are made to avoid duplicating work performed by another agency (97). There are, however, cooperative efforts. The need to reach a wider audience than that offered by the home demonstration clubs has resulted in work with non-members (30&). Since World War II television has become a commonly used medium of communication. EM 1&6 Examples of current prOgrams are recorded in Appendix A. The Table in Appendix A shows the states whose annual reports were consulted, with the years studied. Food Marketing Information for Consumers The New York State Extension Service maintains a food marketing information service in the City of New Ybrk. Through radio and television prOgrams, pamphlets, and news sheets the service keeps the public in the metropolitan area informed on retail marketing facts. Nutrition information is included. Special audiences include welfare department personnel, housing project groups, low income groups, institutions, teachers, food editors, and the extension agents in the counties around New Ybrk City. Consumer education is a new phase of the prOgram (158). Public Health at the Federal Level The Division of Chronic Diseases of the Public Health Service includes work in cancer control, arthritis and diabetes, and heart disease. A major activity of these offices is the development of educa— tional materials. The services of nutritionists are made available in workshops and institutes for professional personnel (120), (315). Division of Indian Health This division has been a part of the public health service since 1955. The nutritional needs of Indian groups, surrounded by but 1h? separated from conditions of prosperity, adequate food supplies, and skilled health personnel, provide a real frontier for exploration and pioneering activities (&8). The Division of Indian Health includes Indian tribes on 250 reservations in twenty-four states and the Eskimos and Aleuts of Alaska (251:), (339). The nutrition activities of the Division are largely concerned with the education of professional staffs, although there are nutri- tionists on some of the reservations. Many Indians are eligible for commodity foods, and much work is being done in teaching them how to use these foods, especially dried milk. Nutrition teaching builds on a foundation of available foods which fit into the Indian or native Alaskan culture with much effort to expand the dietary into an adequate one. Native recipes, many of them never before put into writing, are supplemented with dried milk, experi— ments determining the amount which can be added.without reducing the acceptability of the product. There is very little teaching of nutrients. Barriers of language1 and understanding require simplified materials prepared with the Indian consumer in mind (25&). Fifteen of the twentyefour states with reservations have Extenr sion Service personnel for whose services the Bureau of Indian Affairs lMany'medical and some nutritional terms have no equivalent in the Indian languages. 1&8 of the Department of the Interior and the Department of Agriculture have provided an agreement. This extension work is carried on apart from, but in cooperation with, the Division of Indian Health. Home demonstration agents work with homemakers' clubs and com- munity develOpment or special interest groups. Every effort is made to give status to the basic native Indian foods (18&) and to build upon these to provide an adequate diet. Office of Economic Opportunity One of the newest programs found in this study was Project Head Start, a part of the current anti—poverty campaign. The fundamental purpose of Project Head Start is the physical, mental, emotional, and social development of the economically underprivileged child. This purpose is served by'a nation wide system of child development centers. Believing that poor nutrition in early childhood interferes.- with not only physical but also mental development, the planning committee for Project Head Start has made nutrition 8 part of the program.1 Included in the program by September, 1965, were 550,000 child- ren. The program's nutritional activities include the preparation and serving of meals to the children in the centers and teaching nutrition to the parents. Dietitians, nutritionists, and home economists are urged to participate in the local programs and to encourage the parents lProject Head Start, Nutrition -- Better EatinE.£2£.fl_ Head Start, washington: Office of Economic Opportunity, no date. ‘ ».i.. ‘M . u .. k,I_"-J' V ‘- gnaw»- ' 21.,“ " mg”: anagram-Esra- . ‘ .E-Iit-l‘v a. 5» a. P's. ~ "V' '- 11:9 at the center to take a part in planning the adult nutrition program (285). State and Local Programs The first state health department nutritionists were employed in Massachusetts and New York (251). Today most state health depart- ments have a nutrition section as a nutrition consultant. In a number of states the nutritionist is a member of the maternal and child welfare staff, although she may perform many services outside of this branch of the department. A11 state, county, and city health departments included in the study render indirect service, that is, provide up-to-date and practical nutrition information to professional staff members, especially nurses and social workers. These persons, in turn, translate this information into day to day service for their clients. Several of the agencies rendered additional direct service to some group or groups. Colorado State Department of Public Health The Colorado Department of Public Health, which serves a large Spanish speaking population, provides direct nutrition service to two groups, diabetic patients and migrant farm laborers. Wbrk with the diabetic patients is largely an individual counseling service. In recent years the migrant laborer program has provided an interesting and challenging task. During the summer of 1965 food demonstrations, using surplus commodity foods available to the group, were conducted for young single .. g. .. ._.__=‘....,,.t . j... “£4.5- nay-"..filgfi ...:i’ ' , - , .yvNirA‘igfii ' , ‘:' P. ~ - .-. If s- W'- 150 women in the camp. Although considerable interest was shown by the group, other social and religious activities interfered with individual attendance. In addition to the group demonstrations, individual counseling was available for persons with special problems such as overweight (105)- Louisiana State Board of Health The Louisiana Health Department employed eight nutritionists in September, 1965.1 No direct service is provided. Educational materials put out by the American Medical Associa— tion and the American Dietetic Association, with carefully screened commercially prepared materials, are used (173). A teaching handbook, hheh §hehh I E23 ehe hhy had gone through 7 five editions in 1955. The book provided charts based on the National Research Council's Recommended Dietary Allowances, and simple directions to help the user plan an adequate diet for himself (288). Confidehtially Speaking, a monthly publication for in—service education, is occasionally given to special groups such as teachers. The Massachusetts Department of PubliclHealth The seven nutritionists of the Massachusetts Department carry on a great deal of professional education, with some direct service activi- ties. In addition to in—service education of staff members, workshops 1Two more staff members were to be added in November, 1965. 151 are conducted for professional personnel in hospitals or other organiza- tions. Some educational work is done for non-professional hospital dietary personnel. Some literature is prepared, and a mimeOgraphed list of recommended and non-recommended nutrition books for lay readers1 is dis- tributed by the Nutrition Section, which currently is developing a project using color slides on child feeding, to be used by parents or nursery school staff members (359). Chicago Board of Health Nutrition in the Chicago Board of Health began with the high risk patients in the prenatal clinics. Today all expectant mothers receive instruction. Nutritionists visit the children's day care centers and long term care homes in Chicago as a part of the licensing prOgram. There is some nutrition education connected with these visits. Nutritionists are available for talks to any interested group. Forty to fifty yearly requests are received from TOPS2 clubs. Other groups include professional societies, church groups, senior citizens, and retired civil service employees. Audiences range in size from fifteen to 150 persons. 1Prepared by Helen S. Mitchell, with the cooperation of the Joint Committee on Nutrition Literature of the Massachusetts Library Association and the Food.and Nutrition Section of the Massachusetts Public Health Association. 2Take Off Pounds Sensibly. 0"" - “.... 152 An in-service education prOgram is conducted for staff members of the Board of Health. Literature from the.American Medical Association, the National Dairy Council, and the Metropolitan Life Insurance Company is used, along with a nutrition leaflet put out by the State Board of Health (301). Cook County Department of Public Health The nutrition staff of the Cook County Department participates in the in-service staff education prOgram, provides a limited amount of direct service to patients in the areas of budgeting and modified diets, and makes occasional home visits with a staff nurse. The staff provides speakers for county groups in adult educa- tion, weight control, Golden Age Clubs, or other interested groups, and c00perates in providing workshops or conferences. Free nutrition literature from any reliable source is used, but the giving out of literature is limited to cases of obvious need for printed materials (217). New YOrk City Department of Health In 1937 the Health Department of New YOrk City established a nutrition prOgram following the demonstration program begun five years before by the Health Department in c00peration with the New Ybrk Chapter of the American Red Cross (8). In l9&3 a nutrition division was established (23&). 153 In 19&9 the division became a bureau of the department (212). Many individual sections of New Ybrk City had health needs equal to those of an entire community elsewhere (175). Today the Nutrition Bureau maintains in-service training for nurses and nutritionists, consultant service for social workers and for institutions. It provides specialists for conferences and consul- tant service for physicians, dentists, dental hygienists, and dental assistants, as well as to many community organizations. The Bureau has a principal, three supervisors, and twentyenine nutritionists. Direct service is provided at five nutrition clinics in the Department of Health and one in a hospital. Basic as well as therapeu- tic nutrition education is carried on in the clinics. "Listen to Nutrition," a daily radio prOgram, is in its twenty; third year on a city station. "Nutrition to YOu" is the Bureau's weekly television program (7&). Most literature provided by the Bureau is produced by its own nutritionists. Except for the subjects of the anti-coronary research project who live on "Prudent Diet," a diet relatively low in fat, literature is based on the normal American dietary pattern but with a slight reduction in those fats having a high saturated fatty acid content (7&). Thus the "Star of Good Eating," a poster type teaching device published by the Bureau in both English and Spanish, includes lean meat, skim milk and salad and cooking oils, with a slight reduction in whole meat, animal fats, and hydrOgenated margarines and shortenings. Pix ,1... ' s 15h The Department of Health maintains an obesity clinic staffed by physicians, nurses, nutritionists and other personnel. The high degree of success, as judged by weight loss, is credited to: (1) an authoritarian approach accompanied by a system of clinic discipline;1 (2) an esprit de corps which makes the patient one of the team; (3) education in a "nutritional way of life" differing drastically from the old way and developed in both individual and group sessions with the nutritionist; and (&) a long follow-up period with encouragement and professional help from the clinic staff (69). Other Public Health Activities Many health programs, including maternal and child health, cancer control, tuberculosis control, dental health, crippled children's programs, and chronic disease control are vehicles for informal nutri- tion education (55). Public health, school, and industrial nurses have Opportunities to provide adults with nutrition information (182). Realizing the need for basic nutrition training, the former director of Community Service Society's nutrition work in New YOrk City, wrote Nutrition 22 Public Health for the purpose of giving the public health nurse a background of information to use in working with her clients (13&). Today this need is largely met by in-service education of public health and other nurses. 1If 65 per cent of the planned weight loss does not occur in the ten week period allotted to each patient, the patient is drOpped from the clinic. 155 Colorado State Board for Vocational Education The Smith—Hughes Act of 1917 provided federal funds for home economics education of women and girls over fourteen years of age through the public schools. The Defense Education Act of 1963 provided for home economics education leading to a vocation such as food service worker, visiting homemaker, family dinner service specialist, or home- maker's assistant. The Colorado State Board for Vocational Education conducts an active program with funds provided in part from these acts. School lunch supervisors are currently receiving training. In the summer of 1965 a group of twenty school lunch supervisors met in a workshOp in Denver. At its close they returned to their communities to train other women as supervisors. Nutrition education takes place with training in meal planning and food preparation (71), (218). Historically, home economics education was primarily for the activities of the home. The Emily Griffith Opportunity School, a part of the public school system in Denver, conducts numerous adult classes in food and nutrition both within the school and in other areas of the city. One of the courses taught at the Opportunity School is called "meals for moderns." Another is "food preparation in the home." Both include basic nutrition knowledge among their objectives (218). 156 Community Colleges A survey of twentyefive community colleges in the United States provided information.on nutrition courses Open to adults. Five offered no such courses, three offered one course, seven offered two courses, and four offered three courses. Only four colleges provided evening classes in foods and nutri- tion or classes planned particularly with adult needs in mind. Professional Organizations Professional groups in the medical and paramedical fields are of necessity concerned with nutrition education. The American Medical Association The American Medical Association, founded in 18&7, conducts an active campaign to supply the public with nutrition information through printed materials and other communications media. Both speakers and literature are available to groups on request. With the assistance of the American Dietetic Association and the Chicago Dietetic Association, book reviews are prepared for public libraries and professional journals. The American Medical Association prepared nutrition exhibits which are shown at twentyefive or thirty conventions, many of them medical groups, yearly. The Food and Nutrition Section of the Association receives approximately'twenty-five phone calls daily with questions on foods (185) . 157 The Association distributes a "Campaign Kit to Combat Food Faddism and False Claims" to state and county medical societies and to other professional societies active in the nutritional field. A half- hour film, "The Medicine Man," depicts the methods employed by a "health lecturer" to sell his products.1 The American Dietetic Association "The profession of dietetics is dedicated to the service of humanity through application of knowledge of the science of nutrition."2 The American Dietetic Association was founded in 1917 as a response to hospital food service problems of World war I (33: v). Its nutrition education activities today consist of work for professional groups in annual convention, institutes, and COOperation with other professional and health organizations, the publication of its Journal for members and other nutrition workers, and the preparation of pamphlets and Journal reprints for distribution to members and the professional or lay public. In addition state and local associations carry on individual projects of which the most unique is the "Dial-a-Dietitian" prOgram. At specified hours daily3 any person with a problem involving information in foods or nutrition can dial the service and present his 1Available on loan from the American Medical Society. 2From "Code of Ethics of Members of the American Dietetic Associ- ation." 3The public is advised of this prOgram and the hours of service through local newspapers. 158 question. The question is assigned to one of a staff of dietitians in the city. She provides the answer and replies by mail within hours of the request. A grant from Nutrition Foundation, Inc., made the first prOgrams in 1961 to 1963 possible. In March, 1965, the prOgram was conducted in sixteen cities in the United States and one city in Canada. The American Dietetic Association estimated that more than 10,000 persons were reached through Dial-a-Dietitian activities in l96& (&). The Frances Stern Food Clinic The Boston Dispensary Food Clinic, established in Boston in 1918,1 now the Frances Stern Food Clinic, is a unit of the New England Medical Center Hospitals and Tufts University Medical School. Although a relatively small number of patients is counseled individually in a given day, the Clinic has become widely known. The teaching staff is composed of three full time and one part time nutri- tionists and six graduate dietetic students. About 700 students, most of them medical or dental students, receive training yearly. All patient education is conducted on an individual basis. No printed diet lists are used. Each diet is based on the cultural and economic background of the patient as well as his physical condition. Since at least thirty-one different nationalities are represented among the clients, this individual attention requires a considerable 1See Chapter X. NW. .'.. 159 expenditure of ti me . Basic nutritional information is developed in terms of individ- ual nutrients, rather than as easily memorized food groups. A continuous prOgram of preparing exhibits is carried out, with each Food Clinic exhibit used for about one month. Short term exhibits are also prepared for special occasions. Each exhibit is photOgraphed, diagrammed to scale, and the information retained for future use or for use by other groups. These exhibits are an important part of the adult nutrition education of the Food Clinic (123). Harvard School of Public Health The Nutrition Department of Harvard School of Public Health,‘ under the leadership of Dr. Frederick Stare, plays an active role in providing nutrition education for the public. Dr. Stare himself began a weekly newspaper column in the Middletown.2e§gygheee£e, Middletown, New YOrk, in 1959. This column, under the Los Angeles IETEE Syndicate, is now printed in.fiftyaone newspapers.l It appears twice weekly with one column devoted to a discussion of normal nutrition and the second to a question and answer service. A short weekly radio prOgram is conducted every Thursday'after- noon on a Boston station. A member of the School of Public Health staff gives a short talk, and following the talk the public has opportunity to 1This was the number in July, 1965. 160 submit questions by telephone. Members of the faculty and staff are available for lectures or other nutrition activities upon request (235). Voluntary Non—Profit Agencies and Organizations Some new organizations including nutrition education among their activities have been organized recently; some old and well established agencies have cut back on their program. The Red Cross is included in the latter group. The American Red Cross The annual nutrition report of the Red Cross for l9&8 pictured a lively interest in nutrition classes and other activities. There was an increased use of mass educational media to reach larger numbers of persons. Posters, pamphlets, newspapers, and radio and television facilities were widely used. Nutrition classes were publicized by radio and newspaper, and hundreds of women enrolled. There were nutrition movies for community groups and arrange- ments of nutrition material for libraries, stores, and fairs. Red Cross chapters arranged programs for teachers, school lunch managers, Parent—Teacher Associations, visiting housekeepers, Girl Scout leaders, student workers in a state welfare department, prenatal clinic groups, a group from the American Association of University Women, a mothers' club, a boys' club, an organization of ministers' wives,hospital patients, penitentiary inmates, and veterans in a trade school. 161 In the year l9&7-l9&8 almost 37,000 nutrition certificates were issued (13). Three years later the American National Red Cross issued its last regular annual nutrition report, which told of the activities of the national staff in the preparation of printed materials for the use of Red Cross workers (l&). Rather than duplicate the work of public health and other agencies in the nutrition field, the national office discontinued its prOgram, except for maintaining a consultant to provide service to staff members. Some nutrition instruction is included in home nursing classes. The Boston chapter carries on an interesting, if limited, program in low income neighborhoods. Here a housewife in the neighbor- hood is given training in economical meal planning and food purchasing and other household skills and then assumes the responsibility for helping her immediate neighbors with their problems. She is required to counsel a specific number of families in a week or a month and to report her activities to the chapter (100). United Planning Organization The United Planning Organization in the Greater washington area is a private, non-profit organization, established with financial aid from two foundations, to act as the community action and planning agency in the national capital area (110). The poverty areas included in the United Planning Organization in Washington have six neighborhood development centers, each with one 162 professionally trained consumer specialist, two or three consumer aides, and from eight to thirty liaison persons, neighborhood members who work between the neighborhood and the center on legal, health, housing, employment, consumer, or other problems. This is the background against which the consumer specialists of the central office serve as coordinators and consultants in consumer education. Many of their clients have third to fifth grade reading levels. Nutrition education is carried on in terms of foods with which they are familiar instead of with nutrients, which they would be unable to understand. Planning, shOpping, and money management, in connection with the food stamp program, are areas of teaching. Plans were underway for the training of neighborhood women as food demonstrators, to work with inexpensive food products. Typical of the community action emphasis in the program is the fact that the home economist in a local gas com- pany was going to carry out the demonstrator training program. Arrangements were made early in 1965 with the Giant Food Store chain of supermarkets for a practical education program. On Thursday mornings, at the beginning of the week and sales, consumer specialists will escort small groups of low income women to the stores for practical training in food buying. Consumer specialists in the headquarters office are anxious to work with any neighborhood group who can be interested. "Innovation," said one of the specialists, "is our watchword" (230). 163 The Community Service Society offNew York The Community Service Society, formerly the A. I. C. P. and the Charity Organization Society, no longer conducts a direct service program in nutrition. Much of this phase of its earlier work has been taken over by the Bureau of Nutrition of the City Department of Health. Chm- munity Service nutritionists provide consultant service to the nurse in public health and also service, upon request, to the Family Life Educa- tion Unit of the Society. The old.records of the Association for Improving the Condition of the Poor have gone into archives. They would provide material for a fascinating study of nineteenth century attempts to provide nutrition education for the poor of New YOrk (316). The Arthritis Foundation There are a number of voluntary agencies in the United States which are concerned with research and education on one specific disease. The Arthritis Foundation, founded in l9&8, is one of these. Its national headquarters are in New York City. There are fifty different kinds of arthritis, some of them having dietary implications (353). The dietary recommendations of non-professional persons, however, are usually without scientific foundation. Nutrition education materials published by the Foundation are related to promoting a normal well balanced diet and to persuading the arthritic to ignore false claims about the virtues of or the danger in specific foods. _ w“';'-3o J.,! 16& The Diabetes Society of Greater Boston This agency is a lay organization established to provide infor- mation about diabetes. It provides free leaflets and other material on request to individuals or institutions, sponsors two yearly lectures in Boston, provides educational exhibits, and promotes community diabetes detection prOgrams. In the first six months of 1965 2000 requests for literature had been received (307). Some but not all of the dietary material distributed is related less to basic nutrition facts than to the modifi- cations of the diabetic diet. 1 The Society sells 5 Cookbook fee Diabetics, which contains valuable nutrition information for the diabetic. Commercial-Industrial Organizations Much nutrition information is provided by food processing and related industries. High quality nutrition information and visual aids are produced by the same organizations. The National Dairy Council The National Dairy Council was formed in 1915 (19h). State and local councils are supported by the dairy industry -- producers and handlers -— in the area. Industry members wishing to establish a local council approach the nearest area representative who refers the request lAmerican Diabetes Association, h_Cookbook for Diabetics, New York: The American Diabetic Association, 1959. .fl‘ ._, A 7'“ ‘~V~ .- 165 to the National Dairy Council in Chicago. The National Council is responsible for the authorization of local councils. The responsibilities of local councils can be divided into two general classifications: the distribution of nutrition materials and the conduct of nutrition education programs -- talks, conferences, con- sultant services, school programs. Most material for distribution is purchased from the National Dairy Council. Local councils prepare news releases, materials of interest to food editors, and occasionally other materials. All visual aids developed by the National Dairy Council are submitted for approval to either the American Medical Association or the American Dental Association. Materials include the heihy'Council‘higeeh, a review of nutri- tion research published every two months, posters, a wide assortment of graded materials for use in schools, adult materials, recipes, and food models. Talks and other activities are provided upon request by the local councils. Professional groups, Parent-Teacher or other school groups, churches, adult education, and Golden Age groups are among those requesting prOgrams. There are also radio and television presentations. In most activities requiring the use of speakers or consultant services, priority is assigned to leader groups who can pass on the information to their respective audiences. However, when time and personnel are available, direct service is provided to any interested community group (130). 166 Nutrition education is based on the tota1.nutritional require- ments for good health rather than on the promotion of dairy products alone (l9&). The Nutrition Foundation The Nutrition Foundation, Inc., was founded by the food industry in 19&1 for the double purpose of financial assistance to nutrition research and the promotion of public education in nutrition (250). The American housewife knows that authentic facts about nutri- tion are available, and she wants to obtain them (299). To supply this need the Foundation cooperates in the production of newspaper and magazine articles and radio and television programs. An estimated thirty—five million persons were reached in 1963 to 196& with neWSpaper articles on such topics as nutrition research, food , faddism, infant nutrition, and weight control. The Foundation itself publishes a few informative pamphlets, including A Balanced hie} and £229 £23 Fehihy Fitness. Nutrition infor- mation is furnished to teaching personnel, workers in the medical and paramedical fields, and State Extension Service personnel (260). The Foundation publishes Nutrition Reviews, a monthly review of nutrition research for thezscientifically trained reader. Eastman Kodak Compahy The Eastman Kodak Company was founded by George Eastman in 1880 to produce Mr. Eastman's new invention, the dry photographic plate (103). 167 The company expanded its health service in 1920 by setting up a Medical Department, in which a nutrition service was soon organized. To— day the professional staff of Eastman Kodak's nutrition service includes a supervisor, who is also director of the Eastman Kodak dietetic intern- ship, and two nutrition advisers. Each of the eight interns spends six weeks in the service. All Eastman employees in Rochester are entitled to nutrition counseling service on request. In addition, the nutritionists maintain a monthly mailing service to all nurses employed in Eastman plants throughout the country. In—plant activities in Rochester include individual counseling on normal and therapeutic diets, development of nutrition exhibits, pamphlets, and pick-up material for waiting room racks, and articles for the weekly personnel magazine (233). Religious Organizations Church groups are often among those interested in nutrition education programs (13), (130), (301). The Church of Latter—day Saints The Church of Latter-day Saints urges moderation in the use of healthful foods and abstinence from tea and coffee, alcoholic beverages, and tobacco. "One of the most practical teachings of the Church," wrote David McKay, is the principle of the ward of Wisdom, .... Daily practice in keeping this commandment will do more in the development 168 of true moral manhood than anything else I know. It is true, it deals principally with the appetite; but you show me a man who has complete control over his appetite, who can resist all temptations to indulge in tea, coffee, tobacco, or whisky, and I will show you a man who has likewise devel- oped power to control his passions and desires. On the other hand, a man who indulges his appetites, either secretly or otherwise, has a weakened manhood that will not serve him.when he is tempted to indulge his passions (210). The Seventh—day Adventist Church The Seventh-day Adventist church trains a corps of lay nutrition instructors under the sponsorship of the Medical Department of the General Conference. Approximately 100 to 150 women receive this train- ing annually, and thereafter are authorized to conduct cooking schools which include basic nutrition information for local church groups. Authorization must be renewed yearly (31&). The Seventh—day Adventist Dietetic Association prepares leaflets 7 on nutrition subjects and has published a small book under the title Everyday Nutrition £23 3233 Fee;_y. The hexieh ehe EEEEEE’ the church's official weekly news organ, and hige ehe heelhh, a monthly health magazine, contain frequent arti— cles on nutrition written by physicians, dietitians, and the faculty of Loma Linda University, the church's medical school. hige ehe heeihh is also prepared in braille for distribution to the blind. C H A P T E R X I I I TRENDS IN THE TEACHING OF NUTRITION TO ADULTS —- SUMMARY AND CONCLUSIONS No reports dealing with the history of adult education programs in nutrition were found in the literature. A survey, based on selected samples, has covered the field, past and present, in the United States. The survey began with the entry of the United States government into the field of nutrition research in 189&. In addition, preliminary study was given to the level of nutritional knowledge and the means by which it was being spread when Congress made its first appropriation for research in human nutrition. The following hypothesis was tested: Adult nutrition education in the United States has developed through the use of methods and materials supplied by a few core organi- zations connected with, or a part of, the United States government, and a variety of activities of other organizations —- social, religious, philanthropic, or educational -- not coordinated with each other or with the core organizations. Based on the evidence provided by the study, the following conclusions are submitted: In the period since 189& nutrition has progressed from the recognition of four nutrients —- protein, carbohydrate, fat, ash —- to a 169 170 knowledge of approximately fifty nutrients essential to human nutrition. In the same period teaching attitudes have ranged from simple insistence that the public be told what it should eat to a recognition of existence of those social, psychological, and emotional factors which create so much difficulty in changing food habits. One organization -- the United States Department of Agriculture —— has worked continuously throughout the entire period to provide nutrition education to the American public. Three great networks of American organizations have shared the major responsibility for educating adults in good nutrition. These are the federal and state Cooperative Extension Services, the public health organizations at federal, state, and local levels, and the National Red Cross with its local chapters. Of these three organizations, the National Red Cross, quasi- governmental agency, no longer conducts a nation wide program, and the public health services are relatively late comers, providing less total direct than indirect services. A fourth network, composed of commercial and industrial organi- zations, has made a great impact on the nutritional concepts of the American public. It has made available a large amount of nutritional material, some of which is of high quality. In breadth and content, and in the amount of nutritional material used in the programs sampled by this study, it cannot be classed with the other three groups of organizations. 171 The major producers of nutritional materials are the United States Department of Agriculture and the public health services. Evi- dence from the study regarding the nature and relationships of the organizations concerned with nutrition teaching of adults, confirms the hypothesis. Before the period of the newer knowledge of nutrition, informa— tion was spread by newspapers and magazines, books, cooking schools, women's clubs, religious organizations, welfare organizations, and by at least one correspondence school. The major source of information was the United States Department of Agriculture. At the turn of the century writers were urging greater economy upon Americans. The food which would provide the largest amount of protein and energy at the least cost was considered the most economical, and this opinion formed the basis of much of the teaching. The cooking of food, through its effect upon digestibility, was reckoned to be of great importance to health. Some persons urged the consumption of less food, especially of less meat. No evidence was found linking decreased meat consumption to vegetarianism. Until the work of Chittenden, and to some extent thereafter, a high protein dietary was considered desirable. The newer knowledge of nutrition completely changed earlier viewpdints. By 1910 Sherman recognized that certain minerals, particu— larly iron and calcium, must be considered in daily dietaries. During werld war I there were frequent references to a growth promoting substance found in fat and required by children. 172 With the exception of Children's Bureau publications, writers during the first quarter of the twentieth century recommended a drasti- cally different method of feeding young children from that practiced today. Addition of solid foods took place at a much later age, and before the child was old enough to attend school he was not expected to chew many unmashed vegetables nor any unchopped meat. Several writers advised allowing him no meat before the age of six or seven. By the 1930's these restrictions had been removed. The successive food groupings illustrate the growth of knowledge. The first groups of five classes of foods made no distinction between nutritionally unequal products. The Basic Seven of World war II divided foods into groups according to their protein, mineral, and vitamin values. The Daily Food Guide in use today classified four groups of foods likely to be inadequate in many dietaries, and is recommended for use with nutrition teaching rather than as a substitute for it. The major nutritional issue today is related to fats. Food faddism is not a new problem. It was clearly evident in this study as far back as 1906. Americans are still being told that as a nation they consume too much food,.but today the statement is made against a background of reduced caloric expenditure. P "L ry-o— 173 Trends Trends in content and methods of nutrition programs can be divided into three groups: (1) Trends brought about through the level of scientific knowledge. (2) Trends brought about by changes in physical structures and facilities. (3) Trends produced by contemporary beliefs, values, and social conditions. Levels of Scientific Knowledge Among the reasons advanced for recommended dietetic changes in the nineteenth and early twentieth centuries were philosophical argu- ments: meat should not be used because the use of it necessitated animal suffering; meat should be used freely because it was a part of the bounties of nature, and the survival of the fittest was everywhere evident in nature. At the turn of the century much of the research affecting nutrition education was statistical in nature. Americans were urged to eat a high protein diet because well nourished groups in the United States and elsewhere lived on dietaries high in protein. When animal experiments became common the trend shifted rapidly to an experimental basis for nutritional.recommendations. During the two decades between the two were there was a trend to apply the new science to the common nutritional ailments of the day —- 17h malnourishment, anemia, pellagra, and other problems. Today the appli- cation of science to problems of weight control provides one of the most popular programs. Today's stock of knowledge appears to exceed the public's ability to apply it. The result is increased concern among nutritionists over food faddism, and a very definite trend toward making the efforts to combat it an important part of nutrition programs. Phyeical Facilities To say that there is a trend toward innovation today would be to ignore many programs in the past. The use of the supermarket asra teaching center began during World War II. It is a trend of minor proportions, but an interesting one. There is a trend toward the use of all available mass communi- / cations techniques and media —- newspapers, magazines, books, telephone, radio, television, posters and exhibits, movies and slides, and other visual aids. This trend stands out particularly in time of war, but is clearly evident today. Social Conditions, Values, and Beliefs There was a strong religious note in early writings on food. Americans had a moral and religious duty to maintain good health and to abstain from injurious substances. Today, outside of religious organizations, appeals are based on the personal benefits to be derived from nutrition -- good health, appearance, and economy. ...—whh...’ PM. "1 .. 175 The trend in 1900 to emphasize economy differed from today's out— look. Economy today is a part of consumer education and the ability to choose well what one will enjoy. In 1900, and for a decade or two longer, economy was a national virtue allied to the need to conserve valuable resources. Trends in methods include the use of trained lay leaders or visitors, encouraging participants to assist in planning programs, discussion methods, and conferring status upon foods of national or ethnic origin. There is a trend toward division of responsibility among organizations to reduce duplication of effort. There has been a long term trend toward cooperation among agencies. The fact that a method reaches the proportions of a trend does not mean that it is new. Some of the methods popular today have been used successfully for decades by the Cooperative Extension Service. There is a current trend to promote programs benefiting teenagers, young housewives, and low income groups. Nutrition Education for Adults -- A Case Study The history of nutrition education appears to provide a case study in adult education. From 189& to the present there has been a growing body of knowledge, not always free from error and not yet completely develOped. Historically, there has been vision, enthusiasm, and much personal dedication of individuals in the promotion of the work. There P-~ ,1... 176 have been emergencies -- a depression and two world wars. There are financial problems and the presence of vested inter- ests, some of which have furthered the overall prOgram while others have hindered it. 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"Vegetarianism," The Dietetic and Hygiem cGazette, XXII: 535, 536, (Sept.,—190 Vrooman, Carl, "The Family Balanced Ration, " The Journal of Home Economics, 9: th, h22 (September, 1917)— m _\ a: :5 ‘1’ .1 (353) (35h) (355) (356) (357) (358) (359) (360) (361) (362) (363) (36h) 20h Waine, Hans, M. D., Arthritis Clinic, Boston Dispensary, New England Center Hospitals, Boston, Massachusetts, Interview, July 13, 1965. Walter, Mabel, ”Majoring in Campus Menus," Red Cross Courier, 27: 7,(Nov., 19u7). Walton, Harold M. and Nelson, Kathryn Jensen, Historical Sketches of the Medical Work of Seventh-day Adventists from 1866 to I896, weshingtofiifiaview”afififfiéra1d Publishing Association, l9&8. Warren, Miss Gertrude, Home Economics Specialist (Retired) for h—H Clubs, Federal Extension Service, United States Depart- ment of Agriculture, Washington, D. C., Interview, Sept. 15, 1965. Warren, H. A., "Report of the Training and Industrial Committee," Fourteenth Annual Report pf the Boston Youn WOmen's Christian Association, Presented March I, 1580, Boston: Frank Wood, Printer, 1880, pp. 17, 18. ”wartime Food Chart," Journal of the American Dietetic Associa- tion, 18: uéo (JfiIEjTI5E277 waters, Miss Elizabeth, Nutrition Superviser, Nutrition Section, Massachusetts Department of Public Health, Boston, Massachusetts, Interview, July 13, 1965. Wells, Mildred White, Unity in Diversity, The History of the General Federation of Women's Clubs, Diamond Jubilee Edition, ‘Washington: General Federation of Women's Clubs, 1965. Wells, Oris V., "Current Food Trends," Nutrition Reviews, 17: 161-16h, (June, 1959). west, Mrs. Max, Child Care, Part I, The Preschool Age, Care of Children Series No. 3, Bureau Publication No. 30, Children's Bureau, U. S. Department of Labor, Washington: U. S. Government Printing Office, 1920. Whetstom, Mary Snoddy, M. D., "Food," The Dietetic and Hygienic Gazette, XXII: 337-3uo (June, 19d€77"“""' White, Arthur L., Secretary, Ellen G. White Publications, General Conference of Seventh-day Adventists, washington, D. C., Interview, July 19, 1965. (365) (366) (367) (368) (369) (370) (371) (372) 205 White, Ellen G., Letter 166,1903, White Publications Office, General Conference of Seventh-day Adventists, Washing— .ton, D. C. (in the files of the office). White, Ellen G., Manuscript 27, 1906, White Publications Office, General Conference of Seventh-day Adventists, WhShing- ton, D.C.(in the files of the office. White House Conference on Child Health and Protection, Nutrition Service in the Field, Report of the Subcommittee on Nutri- tion, New Yerk: The Century Company, 1932. Williamson, Maude and Lyle, Mary S., Homemaking Education for Adults, New York. Appleton-Century-Crofts, Inc.,l9h9— Winslow, Emma A., Food Values and Body_ Needs Shown Graphically, U. S. Department of Agriculture, Farmers' Bulletin 1383, 'Washington: Government Printing Office, l92h. Winslow, Emma A., Food Values: Hg! Foods Meet Bod Needs, U. S. Department of Agriculture, Bulletin No. 97, washington: Government Printing Office, 1921. Young, Charlotte M., Berresford, Kathleen, and Waldner, Betty Greer, "What the Homemaker Knows About Nutrition," I, Descrip- tion of Studies in Rochester and Syracuse, New YOrk, Journal of the American Dietetic Association, 32: 21h-217 (March, 1956) Young, Charlotte M., waldner, Betty Greer, and Berresford, Kath- leen, ”What the Homemaker Knows About Nutrition," II, Level of Nutritional Knowledge, Journal of the American Dietetic Association, 32: 218- 222 (March, 1956)? A P P E N D I X A Year Ala. .7 Calif. Colo. Conn. Iowa Ky. La. Mo. 1920 E x 1925 ‘ x 1930 x 1932 t x x 1933 ' x 193& i x 1935 x 1937 x 1939 x l9h0 } x x l9h5 3 x x x x x x l9h6 i x x x 1950 x x x l95h x x x x 1955 i x x x x 1957 x x x x 1959 g x x .x x . L- Unpublished Annual State Extension Service Reports Used in this Study 206 207 Nutrition Teaching in State Agricultural and Home Economics Extension Services, l96& The following summaries are taken from unpublished state Exten- sion Service reports for l96h. A sufficient number of examples from each state have been included to provide a broad picture of the activi- ties throughout the country. Alabama Over S0,000 persons were given nutrition information, through home demonstration clubs and twentyesix special groups in forty-two counties. Four television programs were presented on educational tele- vision channels. The Arctic Health Research Service provided data on the nutritive values of wild game and native foods, supporting the position that Alaskans living off the land could be well fed. The use of all parts of the animal was emphasized, as well as preservation and storage methods for greens, fish, moose, and caribou. Extension Service held an annual homemakers' short course and certificate courses, provided newsletters and newspaper articles, made use of radio and television facilities. Arizona Twenty home demonstration agents conducted fourteen programs on family nutrition. Four Arizona counties participated in the nation wide pilot study of food and nutrition prOgrams for young homemakers. 208 Arkansas The Extension Service conducted short courses on food management in one county, gave one or more lessons, "More for the Food Dollar," in each of twenty-nine counties, and helped families receiving surplus commodities to use them to good advantage. California Home advisers in twenty—eight counties emphasized from one to five areas in basic nutrition, including weight control, teenage nutrition,and other aspects. One two-day countthide nutrition confer- ence was held. There were eight short courses on "Food.and You” and two on "Calories Count," a short course on food buying for social workers in a welfare department, and a four-session Market-O-Rama short course attended by TOO persons interested in food buying. Colorado The Extension Service was especially interested in problems of teenagers, young mothers, low income families, and overweight persons. The state nutrition specialist held four open meetings on "The 'Nu' in Nutrition and Food." Overweight, new research on diet and heart disease, and new food packaging develOpments were considered. Home demonstration agents received a refresher course on basic nutrition and current nutrition problems. Workers held demonstrations on the use of commodity foods for the benefit of welfare recipients. 209 Delaware Preparations were made for a training meeting in 1965 on the use of donated foods. 5.1.121 PrOgrams included the use of island products, foods for improved nutrition, economy in meals, food preservation, family hospitality, and home food production. An important part of the work involved nuclear age nutrition. All but three counties received information on emergency'feeding, the problem of water shortage,and fallout contamination. Idaho Radio, television, and newspaper publicity helped spread nutri- tion facts. There was emphasis on good food "buymanship." Indiana Twenty—six counties had leader training lessons in four areas of nutrition. Thirty-six meetings on weight control were held for non— leader groups. There were food preparation classes and one class on food additives. Iowa A two-day nutrition education workshOp was held for dietitians in schools of nursing, a one-day refresher course for hospital and 1Report for 1963. mm“. y..- “ ”'— "" "Mir ill—:5. 4' 210 public health nurses, and short courses on nutrition and related subjects. Kansas Extension Service personnel conducted meetings on teenage nutri- tion, importance of breakfast, food fads and fallacies, protein foods, gracious living, food preparation and preservation, meal planning, the Daily Four Food Groups, food processing, labeling, and additives. Louisiana Areas of particular concern were diets for low income families and the problems of young homemakers. Four parishes conducted workshops for welfare personnel; aid was given in the use of donated foods. Maine Projects were carried out on the following subjects: feeding small families, understanding nutrition, table service, normal nutrition and fad diets, weight control, nutrition for low income families. Maryland The following programs were conducted: weight control, teenage diets, general nutrition, nutrition and health, and some special pro? grams. Some counties carried work on food.faddism and additives. The problems of the urban housewife were of real concern in Maryland, since one-third of the homemaker club members live in the city or the suburbs. 211 Michigan Buying was stressed. After much work to enable home economists to understand the problems and viewpoints of low income groups, a program on foods and clothing was presented to these groups. Missouri Home economists in the southeastern section attended a two-day training session on obesity, consumer information, and.recent findings in nutrition. Other home economists were invited to area training meetings on the science of nutrition and food preparation. Schools on the use of low income foods benefited about 800 families. Individual conferences were also held with representatives of about hOO families. Classes and correspondence reached about 600 older persons; fifteen to twenty'per cent of home demonstration club members were over sixtyhfive years of age. New school lunch managers attended meetings on basic nutrition facts. . Nebraska Women in 389 home demonstration clubs studied lessons on vege- tables and salads. A television series was presented to emphasize the importance of nutrition. The Daily Food Guide plan was used as a basis. Good "buyman- ship" and low calorie meals were indludedtmn other prOgrams. F~‘-y’-.- 212 Nevada The home demonstration agent assisted the welfare department by demonstrating and giving samples of properly prepared commodity foods. Demonstrations of meat preservation were done on Indian reservations. The agent conducted demonstrations on salad preparation, and ten women reported that they had added nutritious foods in their family's diets through the use of salads. Over 700 COpieS of "Food and Fallout" were distributed. New York Staffs from forty-seven counties attended an in—service education program on feeding the family on a low cost plant. North Carolina Most of the nutrition work was related to buying. Young home- makers attended a series of nutrition classes in some of the counties. North Dakota Special groups in one county attended food classes. Ohio The nutrition specialist conducted a workshop for county workers, with special emphasis on teenage nutrition. Other prOgrams emphasized beauty and health through nutrition, feeding pre-school children, low calorie meals, and food faddism. A nutrition workshOp was held for teachers in one community. 213 In one county two senior citizen groups attended meetings on health in later years and its relation to food and good nutrition. Pennsylvania There was special concern with the nutrients most likely to be low in American food,with pre-school children, problems of young home- makers, and senior citizens. In one county the home economists, cooperated with the labor union offices and the local Young Women's Christian Association in weight control projects for the garment workers. County home economists were supplied with a monthly publication called "Food and Nutrition Digests," and spot announcements were pre- pared for radio and television audiences. Rhode Island Programs on planning and wise buying, quick meals, weight control, and food fallacies were conducted. South Carolina An intensive training prOgram in nutrition was conducted for all home demonstration agents. In an effort to reach wider audiences classes were presented to special groups, and radio and.television programs presented. There were newspaper reports and newsletters. The workers cooperated with other agencies to help low income groups, and in order to combat food faddism, basic nutrition facts were presented to the public. 21h South Dakota Objectives included stressing importance of good food habits early in life, helping homemakers to plan and serve attractive, well balanced meals in a pleasant social atmosphere, and to alert the public to food ‘ fallacies, while providing facts to combat them. Timely topics were presented in the newspapers and on radio. A program on vitamin C was presented on television. Tennessee The following groups received help: families receiving donated foods, senior citizens, persons interested in weight control, and city women . Texas There were demonstrations and individual instruction at commodity food centers. Two low rent housing projects included the use of donated foods. Management of the food dollar was a general theme throughout the year. Parent education included information on child feeding. Vir 'nia Special interest meetings included young homemakers and persons interested in weight control. 'Weight control groups were organized throughout the state. washington The state participated in the nation wide pilot project on food and food nutrition programs for young homemakers. Materials were also ‘ ...,— 215 assembled for low income area meetings. In addition, meetings were held with women's clubs, homemakers, garden clubs, dairy wives, military wives, Eastern Star members, scout leaders, Grange members, a golden age club, the W001 Growers Auxiliary, and church groups. wyoming Programs included food preparation and selection, preservation, and nutrition. A series of nine lessons on weight control was prepared, and three radio prOgrams were presented. A P P E N D I X B COMMUNITY COLLEGES INCLUDED IN THE SURVEY OF NUTRITION EDUCATION PROGRAMS FOR ADULTS MariCOpa County Junior Colleges, Phoenix, Arizona. Boise Junior College, Boise, Idaho. I Clark College, Vancouver, washington. Southern Colorado State College, Pueblo, Colorado. ‘3 Belleville Junior College, Belleville, Illinois. Northeastern Junior College, Sterling, Colorado. Palm Beach Junior College, Lake Worth, Florida. St. Petersburg Junior College, St. Petersburg, Florida. Chicago City Junior College, Loop Branch, Chicago, Illinois. Chicago City Junior College, WOodrow Wilson Branch, Chicago, Illinois. Flint Community Junior College, Flint, Michigan. Hutchinson Junior College, Hutchinson, Kansas. Montgomery Junior College, Takoma Park, Maryland. Cameron State Agricultural College, Lawton, Oklahoma. Northeastern Oklahoma Agricultural and Mechanical College, Miami, Okla- homa. The Pennsylvania State University, Ogontz Campus, Abington, Pennsylvania. Amarillo College, Amarillo, Texas. San Antonio College, San Antonio, Texas. Yakima Valley College, Yakima, Washington. Modesto Junior College, Modesto, California. 216 “-&_‘ r-w ..Tu 217 Riverside City College, Riverside, California. Santa Rosa Junior College, Santa Rosa, California. Pasadena City College, Pasadena, California. Palomar College, San Marcas, California. Shasta College, Redding, California. 218 July 1, 1965 Dear Please send brochures or other materials carrying in- formation about foods and nutrition courses currently offered (l96h-65 or 1965-66), either with or without credit, which would be Open to adult students not working toward degrees. This material will be used in one area of the research for a doctoral dissertation, for Michigan State Univer- sity, on adult education programs in nutrition. It will be very greatly appreciated. Very sincerely yours, 220 September 6, 1965 Nutrition Section Louisiana State Board of Health Dear As a doctoral candidate at Michigan State University, I am doing research for a historical study of adult education programs in nutrition. This study will include both past and present activities in public health nutrition. I would like very much to include at least one state where pellagra has been a problem in the past. Since I have chosen Louisiana as a part of my study in the Federal Extension Service, I would like also to include it in the study of public health activities. I would appreciate any or all of the following types of information: Samples of nutrition materials prepared by the Nutrition Section of the Louisiana State Board of Health for use with adults. Samples, or information, as to materials prepared by other organi- zations, used by your department. Programs, past or present, of special interest. Copies of reports of special projects. Suggestions for published articles which would be available in libraries. Any other information on your prOgram. I wish it were possible for me to visit Louisiana, but since I cannot, I hope that somehow through correspondence I can obtain an accurate picture of what the Louisiana State Board of Health is doing. Thank you very much. Very sincerely yours, ”WHITMANMrflljl‘llilfllflu‘l“