Celebrating Food is Elementary at Enfield Elementary School in NY

Mitigating Lead Poisoning with Healthy Snacks

By Antonia Demas, Ph.D.

Background

The Enfield, New York Food is Elementary© program took place over the spring semester, 2016. Enfield is part of the Ithaca City School District and serves a population with a higher rate of poverty than other schools in the Ithaca area, with 74% of students receiving free or reduced school meals at the time of this study. Lead had recently been detected in the school’s water supply and school leadership was concerned about the effects of lead poisoning in the school community, which was approximately 230 students from pre-K to 5th grade at the time.

Dr. Antonia Demas from the Food Studies Institute was invited to meet with the principal and parent liaison to discuss implementing a food education program to help mitigate any damage from lead poisoning and to enhance an existing healthy snack program. The school had been in the news a number of times because of an issue of high levels of lead in the water. Dr. Demas was very interested in working with students to promote consumption of foods that build the immune system and hinder any effect that might have occurred from lead exposure. These foods have high levels of vitamin C, calcium, and iron. Furthermore, the foods that the Food is Elementary© curriculum emphasizes help prevent the development of many of the chronic diseases that are now afflicting children, such as type-2 diabetes, heart disease, many cancers, Multiple Scleroses, arthritis, and auto-immune diseases.

Principal Rieger asked Dr. Demas to put together options of what she might be able to do concerning food education. Principal Rieger presented this to teachers and several of them were interested in participating. Dr. Demas then met with these teachers individually to determine what would be the best approach for their classrooms. Since a goal was to get students to consume healthy snacks as well as improve their diets, Dr. Demas met with students and teachers to interview them and get a sense of what would be most appropriate in terms of an intervention.

Healthy Snack Program

The Enfield school was participating in a healthy snack program offered by the school food service three days a week. The district snack program was supplemented by a snack program provided by a local nonprofit called Woods Earth two days a week, so students had access to healthy snacks five days a week. However, there was little education around the healthy snacks, many of which the students were unfamiliar with, so students were not eating much of the food that was provided.

To learn more about the snack program, Dr. Demas arranged to meet with the personnel from the school district’s central kitchen where it is produced. Ms. Jamie Zervos administered the program under the direction of Ms. Denise Agati, food service director for the Ithaca City School District. Ms. Agati met with Dr. Demas and made arrangements for her to tour the central kitchen and meet with Ms. Zervos. Ms. Zervos was very gracious in taking time to show Dr. Demas not only the snack program but the entire operation of the central kitchen. Ms. Agati felt that the snack program “is a great way to introduce fruits and vegetables” and that “feedback about this program is very valuable” to her staff.

Ms. Zervos provided Dr. Demas with a list of the foods she prepared for the snack program. Her goal was to have zero waste in the kitchen so she utilized whatever foods there was a surplus of and created some unusual recipes such as fruit cocktail crisp. Ms. Zervos was interested in getting feedback about the snack program and agreed that classroom education was an effective way to expose students to a variety of foods that they might not be familiar with.

Snacks prepared and developed by the School District’s Central Kitchen

Apple salad
Apple slices
Applesauce
Applesauce cups
Black beans & rice
Broccoli salad
Carrots & hummus
Chickpea salad
Coleslaw
Corn & black bean salsa
Croquettes
Cucumber salad
Cuke, pepper salad
Dried apples
Fruit cocktail cake
Fruit cocktail crisp
Fruit slaw
Grapefruit
Grapes
Green salad
Kale
Kiwi
Nutmeg carrots
Peaches & cream
Pear bread pudding
Pear/apple salad
Pepper salad
Raisins
Roasted butternut squash, raisins
Roasted carrots
Roasted chickpeas
Roasted pears
Roasted potatoes
Spiced apple & pear salad
Squash coins/zucchini
Squash soup
Strawberry cups
Swiss chard chips
Tossed salad
Veggie salad

Teacher and Students Interviews

Participating teachers were able to provide useful information during their interviews. Results of the teacher interviews about the snack program and what they would like Food Studies Institute to offer are as follows:

Grade 2 Teacher
All but 3 kids (out of 14) on free or reduced lunch
Kids won’t eat the potatoes or squash from the snack program. Served cold w/out seasonings
Interest in fresh herb introductions – pairing foods with herbs – start with potatoes and squash
Interest in working with Dr. Demas to write grant for herb/garden development
Label reading to counter interest in sugar cereals
Will collect confidential info on amount of sugar cereals consumed/day prior to label reading
April begin study of birds – possible work with millet as warm cereal and grain primarily fed to birds in U.S.

Grade 2 and Grade 3 Teachers (interviewed together)
Fun facts about food instead of morning announcements about nutrition facts (can test out both approaches and student retention of information)
Kids don’t eat radishes, bitter lettuce, chard. Units on these items
Will administer Favorite Snack Survey (attached)
Label reading to see if sugar cereals will be affected and will collect baseline data

Grade 1 Teacher
Kids unwilling to try most foods in snack program – not familiar with them
Snacks sent by parents often unhealthy – list of healthy options that are not expensive needed
Will collect baseline data on acceptance of snacks
Wed am from 8 – 8:40 open to do snack curriculum
Only 2 kids open to trying foods
Bean salad not accepted

Pre-K Teacher
Whole story of food – from planting seed, harvest, cooking, nutrition
Big kids teaching younger kids
Kale unappetizing – develop in class recipes for kale chips
Veggies as colors – vitamin lesson
Manners – eat family style

Kindergarten Teacher
Kids unfamiliar with most of the foods – need for positive education
Cauliflower plain – rejected by kids (likes idea of purple and orange cauliflower for comparisons)
Use colors – vitamin lesson
Ideas for simple meals
Focus on spices and herbs
Sensory education – especially with smell

Music Teacher
Kids live in rural community and eat mainly processed items, not farm fresh
Very interested in working with garden
Enfield borderline food desert community – Dandy gas station for food
Will work on music and songs to go with curriculum
Dr. Demas to get food bibliography to share

Interviews with Students

Dr. Demas met with each classroom to get a sense of student response to the current snack program and general food knowledge. The following information was gleaned from interviews with students specific to the snack program:

  • Students love fresh fruit – should be offered more often – all classrooms said this
  • There needs to be more variety
  • It would be great to learn about the plants that produce food
  • There is no dressing on salads- would like to have options
  • There are no dips – would love options
  • Offer celery more often
  • Many don’t like the plain broccoli or cauliflower
  • If serving things like potato wedges, they need to be served warm
  • Many dislike things such as beans & pineapple, beans mixed with red peppers, the green salad which does not have dressing and is sometimes brown (from a bag), spicy cabbage.

Design of Study and Methods

After meeting with the teachers and getting their input, interviewing students, and getting a sense of the current snack program, it became clear that the best strategy for Food Studies Institute was to familiarize the students with the Food is Elementary© curriculum and give them dietary exposure to a variety of healthful foods they may not be familiar with that could be served as snacks. Another goal was to teach students basic nutrition concepts such as why we need vitamins and how we get them from whole foods.

Food is Elementary© at Enfield Elementary School

Dr. Demas taught the weekly classes for ½ hour every Tuesday. Students learned the “no yuck” rule, hand washing, basic food safety issues, and about vitamins A, B, C, D, and E. They learned how to distinguish the difference between a whole food and a processed food and that whole foods from plants are the most healthful. The foods they sampled and evaluated include the following:

Foods Sampled – 36 Total

Apples
Black beans
Blue grapes
Blueberries
Broccoli
Brussel sprouts
Carrots
Chickpeas
Chive flowers
Chives
Corn
Dandelion greens
Green grapes
Green peppers
Kale
Kumquat
Mint
Orange bell peppers
Peas
Purple cabbage
Purple cauliflower
Purple grapes
Walnuts
Raisins
Red grapes
Red leaf lettuce
Red peppers
Romaine lettuce
Seaweed

Pre and Post-Surveys

Prior to the classroom education, students were given a survey by their teachers asking them to name their three favorite foods and predicting if these would remain the same at the end of the semester. The same survey was given to students after the Food is Elementary© program had ended. The pre and post surveys were evaluated to determine if there were changes in favorite foods, if they were healthier or less healthy at the end of the semester, and if any of the Food is Elementary© foods were named.

Pre-K Post Survey

Sunflower Seeds, Seaweed, Dandelion Leaves

Parent Education

Principal Reiger and parent liaison Ms. Cropf wanted to reach parents as well as students. They discussed offering three parent workshops with Dr. Demas, it was decided that the first would be an overview of the Food is Elementary© curriculum at the PTA meeting. Because of the lead issue, which was already on the PTA agenda, Dr. Demas discussed nutrition as it relates to lead as part of her presentation.

The second workshop was a hands-on event that was also open to children. Parents and kids made a delicious fruit tart that contained all of the vitamins (except vitamin D) with no added sugar. The following article about this event was published in the Ithaca Journal.

The third event was about processed foods and processed soil compared to whole foods and healthy soil without chemicals. This event was part of a “mindfulness evening” event that the school offered to parents and students which included “make your own salad” organized by Woods Earth, along with various wellness activities. Dr. Demas and one of her former students who had participated in Food is Elementary© lessons facilitated the interactive activities at the event.

Results

Enfield Data

Students were given a pre-survey and post-survey asking them to name their three favorite snacks. On the pre-survey they were asked to predict if these foods would remain the same at the end of the semester. All but two students said “yes” they would remain the same. The name of the teacher, date, and name of the student were filled out. Student names were necessary so that individual students could be evaluated to determine if there was any change within the individual. Student names were not included in this report.

Only complete data sets were used in this analysis with the exception of the pre-K classroom that did only the post-survey. There had to be three foods mentioned in both the pre and post surveys and not all students named three foods each time. Some of the students were absent from school or not available in the classroom during either the pre or post survey so their data could not be used. The evaluation gave a point for each healthy food mentioned so the top score could be 3 and the lowest score could be 0.

Number of students listing 0, 1, 2, or 3 healthy foods as their favorite

The graph above shows that the number of healthy foods listed three times dramatically increased on the post test.

Every time a food that was introduced in the Food is Elementary© program was mentioned in the post-survey it was written down and a tally was kept of these foods in each classroom. One of the classrooms did not take either the pre or post survey so there is no data for them. Another class, the pre-K took only the post-survey but their response was so remarkable that this data is mentioned in the report. In this pre-K classroom, only FIE foods were mentioned as favorite foods with the exception of one student naming applesauce. All pre and post-surveys were administered by teachers with instructions that this was not a test and to be honest.

New Favorite Foods at Enfield Food is Elementary (FIE) Program

A total of 62 students were evaluated. The number of times each Food is Elementary© food was mentioned in the post-survey is summarized below and shown in the graph above.

2 – raisins
2 – apples
2 – mint
2 – strawberries
3 – chives
3 – chive flowers
4 – peas
5 – Brussels sprouts
5 – tofu
5 – kumquats
6 – purple cauliflower
6 – carrots
9 – craisins
10 – corn
15 – blueberries
16 – seaweed
21 – grapes
22 – sunflower seeds

Pre-survey Average = 0.86,
Post-survey Average = 2.64 (out of 3)

Healthy foods were mentioned on the post-survey a total of 132 times for the 50 students who took both the pre and post-survey. Below are the summaries of the data for the classrooms evaluated.

Classroom Data

The students with complete data sets are listed in the first column of the tables below along with the initial of their first name. The last column indicates what the difference is between the pre and pos-survey.

Grade 3 Teacher: Desen
Student (initial of first name) Pre-surveyPost-surveyDifference
K033
L033
S133
Z033
S033
B132
H033
M231
M033
A033

New Favorite Foods Named

1 – Cauliflower
1 – Chives
1 – Healthy Rainbow
1 – Mint
1 – Peas
2 – Blueberries
2 – Carrots
2 – Craisins
2 – Seaweed
2 – Strawberries
2 – Tofu
2- Kumquats
3 – Corn
4- Sunflower seeds
5 – Grapes
Dear Ms. A – Thank you for everything (written by a student)

Grade K, Teacher Rekczis
Student (initial of first name) Pre-surveyPost-surveyDifference
K231
F231
L033
A132
J132
C033
M033
K033
J033
K132
J132
I033
R033
D033

New Favorite Foods Named

3 – Peas
9 – Sunflower Seeds
3 – Corn
5 – Blueberries
6 – Grapes
4 – Carrots
2 – Craisins
1 – Tofu
4 – Seaweed
4 – Cauliflower
1 – Brussel Sprouts

Grade 2, Teacher Bakos
Student (initial of first name) Pre-surveyPost-surveyDifference
P231
P231
C231
L231
C231
A132
E231
M231
V231
D033
J033
S033

New Favorite Foods

1– Corn
2 – Tofu
4 – Brussel Sprouts
2 – Chives & chive flowers
3- Grapes
3- Kumquats
4 – Seaweed
3 – Sunflower Seeds
1 – Cauliflower
2 – Blueberries
Thank you for vitamins! (written by a student)

Grade 1, Teacher Larkin
Student (initial of first name) Pre-surveyPost-surveyDifference
C220
I330
H231
D000
S132
C022
A10-1
H231
Q330
M011
D000
C000
A022
R022

New Favorite Foods

1 – Sunflower Seeds
2 Craisins
2 Grapes
1 Blueberries

Grade: Pre-K – Teacher: Halton

12 Students – only post test
All named only Food is Elementary© foods except one named applesauce

1 – Dandelion greens
3 – Corn
5 – Blueberries
3 – Craisins
6 – Seaweed
5 – Sunflower seeds
5 – Grapes
2 – Raisins
2 – Apples
1 – Mint

Statistical Significance

A paired-samples t-test indicates a significant increase in the number of healthy foods listed as favorites from the pre-test to the post-test (t(49)  = -11.137, p <.0005).

The above analysis shows that the probability of the results being a random occurrence is less than 0005. It is clear that the classroom exposure to the Food is Elementary© healthy foods made a significant difference in the favorite foods of participating children.

Recommendations

The Food is Elementary© program at the Enfield Elementary School was very successful in terms of student response, teacher and administration support and getting students to consume healthier foods. Parent liaison Ms. Cropf was extremely helpful with scheduling and logistics. It was important to have a “go-to” person in the school in addition to the principal. There were no glitches, and the program ran very smoothly.

Coordination with the snack program was difficult because there was little or no advance notice of what the snack would be each week. On some days the principal did not have this information for the morning announcements and a number of teachers mentioned this as an issue.

Children are often hungry during the school day so the snack program provides a valuable service if the students eat the snacks. There needed to be better coordination of the snack menu with the Food is Elementary© program. The Food Studies Institute’s research over the course of many years has clearly demonstrated that sensory-based classroom education is essential if new healthy foods are to be accepted in the diet. The Food is Elementary© curriculum leads to positive behavior change around food and eating. The data in this report clearly shows positive results in getting students to enjoy eating new foods.

Recommendations are as follows:

  • Snack menus should be developed for the month if possible (minimum – 2 weeks in advance)
  • Seasonal themes for snacks would be a good way to organize the snack menu
  • Food is Elementary© should continue and expand at Enfield and include a control group in addition to the intervention group at the school
  • The Woods Earth nonprofit should consider providing snacks at Enfield which will include their offering of fresh produce along with the Central Kitchen snacks
  • There should be communication between the Food Studies Institute, Woods Earth, and the School’s Central Kitchen periodically to determine how best to support each other and promote the healthy foods
  • Students should be followed each year to document changes in individual students (this would be done with confidentiality) to document if their taste preferences change over time
  • Expand the parent education component of the program
  • Coordinate new foods with the lead issue and if possible, target students with high lead levels for education and additional evaluation
  • Focus snacks on foods that mitigate lead poisoning
  • Expand the current school garden, test soil for lead, and integrate the garden with the Food is Elementary© curriculum and snack program

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