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Food Center participants' nutrition knowledge and self-perceived quality of diet
Nutrition Research, Vol. 18. No. 3. pp. 457-463.1998 Copyright 0 1998 Elsevia Science Inc. Printed in the USA. All rights reserved m71-5317/98 $19.00 + .oo ELSEVIER
PIISO271-5317(98)00034-7
FOOD CENTER PARTICIPANTS’
NUTRITION KNOWLEDGE QUALITY OF DIET
AND SELF-PERCEIVED
Laura Calderon; Dr. P.H., RD; and Lilli Gorence, MS, RD. Laura Calderon is an Assistant Professor and Director of the Coordinated Dietetics Program at California State University, Los Angeles. Lilli Gorence is the Nutrition Coordinator of the Head Start Program, Community Housing Services, Pasadena, California.
ABSTRACT Those with low incomes face various difficulties in maintaining a nutritionally adequate diet. During the past two decades, the number of people living below the Federal poverty levels has increased substantially. The purpose of this study was to determine the PasadenalAltadena (Los Angeles County) Food Center recipients’ perception of the quality of their own and their family’s diet, and to assess nutrition knowledge. This information was deemed necessary in order to intervene with an appropriate nutrition education program. Participants in this study were 207 food recipients of two Food Centers of the Community Housing Services (CHS) in the Pasadena/Altadena community of Los Angeles County of Southern California. The Food Center participants were queried as to self-perceived quality of their, and their family’s, diet. In addition, a short nutrition knowledge questionnaire was administered. Approximately 113 of the respondents rated their diet as good or excellent while the rest (67.6%) rated the quality of their diet as fair, poor or very poor. The Food Center recipients’ nutrition knowledge was deemed very poor, with 70% of the respondents answering only three, or fewer than three, of the eight questions correctly.This information will be utilized to set up a nutrition education intervention for the Food Center participants. @1998 FlscvluScience Inc. KEY WORDS
Food Bank, Nutrition, Diet, Hunger, Food Programs, Low Income
INTRODUCTION
During the past two decades, the number of people living below the Federal poverty levels has increased substantially. In addition, the homeless population continues to grow, nationwide. Specifically, it is estimated that nearly l/4 of the children in California live in poverty. Since food is the most flexible item in the budget of a poor household, it is reasonable that more and more Americans are going hungry (1). Those with low incomes face various difficulties in maintaining a nutritionally adequate diet. Many live in areas where supermarkets are scarce and do not carry as many perishable items. Some also have inadequate cooking or refrigeration facilities. In these cases, it is not possible to prepare the more economical foods or store foods safely. Others lack the nutritional
457
L. CALDERON and L. GORENCE
awareness and food buying resources to purchase enough of the whole grain cereals and green leafy vegetables they need (2). Low income families who rely on food and meal programs have been shown to have intakes of various nutrients below the RDAs, which puts them at a greater health risk. Children in particular were found to be at risk (3). The physical and intellectual growth of more people is being compromised as the number of people suffering from hunger continues to increase (4). Undernutrition results in resistance to infection, which may lead to a loss of appetite, increased energy requirements, nutrient losses, and reduced immune response (5). The most serious effects are seen in vulnerable groups, such as pregnant women, infants, children, and the elderly. Young children are particularly vulnerable to the effects of Undernutrition. One out of five children in a study by Smith & Hoerr had skipped meals because there was not enough food in the house, and many ate less because of the shortage of food (6). In a study by Taylor & Koblinsky (7) homeless preschoolers consumed less than the USDA recommended number of servings of fruits, vegetables, dairy products, and grain products. One-third of these mothers responded that several times each month their child did not have enough food to eat. Poor nutritional status may have detrimental effects on immediate health, but also may interfere with learning and school performance. In one study, poor children had lower scores on cognitive tests and socioemotional development was less mature (8). Children that are hungry can not learn, and this affects their ability to become productive members of society (9). In children, reduction in activity is oflen the first response to undernutrition, which allows the preservation of energy for growth and other vital functions. Other signs are a decreased rate of weight gain, growth in height, irritability, lack of concentration, difficulty learning, and lower test scores (5). The purpose of this study was to determine the PasadenalAltadena (Los Angeles County) Food Center recipients’ perception of the quality of their own and their family’s diet, and to assess nutrition knowledge. This information was deemed necessary in order to intervene with appropriate nutrition education programs.
MATERIAL3 AND METHODS Participants in this study were food recipients of two Food Centers of the Community Housing Services (CHS) in the Pasadena/Altadena community of Los Angeles County of Southern California. One of the Food Centers is the Jackie Robinson Center (IRC) and the other food center is Villa Park (VP). The data was collected in February of 1996. Participants of the Food Centers must meet eligibility requirements of CHS. These eligibility requirements are: ?? at or below poverty level ?? one household member per month may participate ?? residence in Los Angeles (LA) County Eligibility status is checked upon arrival at the Food Center; therefore, all participants are at or below poverty level, and only one member of any household was asked to fill out a questionnaire. All participants reside in LA County. There were no exclusion requirements for participation in this survey. All Food Center participants were deemed eligible.
NUTRITION KNOWLEDGE OF FOOD BANK
459
Survey Instrument The survey instrument was based on a questionnaire developed at UC Berkeley as part of an EFNEP (Expanded Food and Nutrition Program) project (1). This instrument was used to survey participants of various Los Angeles County Food Bank programs. In addition to this questionnaire a short nutrition knowledge questionnaire was included. Since it was expected that many ofthe Food Center recipients would be Spanish speaking, the questionnaire was translated into Spanish. Either English or Spanish versions of the questionnaire were available, whichever the respondent preferred.
Data Collection All participating food recipients at the two Food Centers were approached to complete a questionnaire. Few declined as an incentive extra food bag was distributed to those who completed the questionnaire. Therefore, it is believed that a very representative subgroup of the population was reached; in fact, the subgroup approaches the real population for the month of February 1996. It is estimated that at least 90% of the total population for this date completed the questionnaire. Volunteers assisted the PI in collecting the data from the study participants. Volunteers included Dietetics students at California State University, Los Angeles (CSLA), and regular volunteer workers from CHS. All volunteers were trained on interviewing techniques. Questionnaires were administered in a quasi-interview method. This was deemed necessary as many of the recipients were illiterate or simply could not answer the questions without assistance. Questionnaires were checked for completeness when handed in to the volunteer to receive a “ticket” for an extra food bag. Several bi-lingual (Spanish) volunteers were available to assist as necessary. In all cases, clients were informed that the interview was anonymous, and that it would not have any effect on any services or benefits they might receive. They were also told that answering the questionnaire was strictly voluntary. A total of 2 16 questionnaires were completed, 109 from JRC and 107 from VP. Of those, 9 were discarded due to incompleteness. A total of 207 questionnaires were used for data analysis, 105 from IRC and 102 from VP. In addition, it should be noted that not all questions were answered in their entirety by the 207 respondents. Data Analvsis Data was analyzed using SAS for the PC. Simple frequencies and percentages as well as &square statistics were used to describe the population. Chi-square statistics were used to compare proportions while the F statistic was used to compare means. Missing categories were not used in computing the &i-square or F statistic and corresponding p value.
RESULTS Characteristics of the Participants A total of 207 usable questionnaires were analyzed. This data was collected during February of 1996 at two Food Centers, Jackie Robinson Center (IRC) and Villa Park (VP)
L. CALDERON and L. GORENCE
460
64% of those completing the questionnaire were female, while 36% were male. The mean age was 44.6 years with a range of 18-95 years. It is interesting to note that over l/4 of this population was over 55 years of age.
The majority of the Food Center recipients were minority; 35% were Black, 48% were Hispanic, 1% was Asian, 9% were White, 1% was American Indian, and 6% described themselves as “other”. Of interest is that the majority of the Food Center recipients had been residents of the community for an extended period of time, thus negating the concept of transients as Food Center recipients, at least for this community. The mean length of time of residence was 16 years with over 213 of the population residing in the community more than 10 years; only 1% had resided in the community less than one year. Although only 4.4% of the respondents considered themselves to be “homeless”, an additional 9% lived in a car or van, 12.1% rented a hotel or motel room, and 2% rented a room. Therefore, those in the above mentioned categories constitute 27.5% of this population. Self-Perceived Oualitv of Diet The respondents were asked how they would rate the quality of their family’s diet. Table 1 shows the responses to this question. Approximately l/3 of the respondents rated their diet as good or excellent while the rest (67.6%) rated the quality of their diet as fair, poor or very poor.
TABLE 1 “How Would You Rate the Quality of Your Family’s Diet?’ N=207
Nutrition Knowledge A short eight item nutrition knowledge questionnaire was administered. Answers were categorized as either “correct “, “inwrrect” or “no response”. When there was a possibility of more than one answer being correct, either answer (or both answers) was counted as a “correct” response. Of the eight questions, a mean of 2.79 (*1.93) correct answers was achieved. That is, on the average respondents missed approximately five of the eight questions. None of the Respondents received a perfect score, that is, none selected eight correct responses. Table 2
NUTRITION KNOWLEDGE OF FOOD BANK
461
shows the number of correct or incorrect responses selected by the respondents. 70% of the respondents answered only three, or fewer than three, of the questions correctly.
TABLE 2 Number of Correct Responses to the Nutrition Knowledge Questionnaire N=174* Number of Correct Responses: 8 7 6 5 4 3 2
Percent Correct
Frequency Correct
I
0 2 6
I
0 1.2 14
19 25 50
10.9 14.4 28.7
46
26.4
*33 respondents did not answer this section.
Table 3 shows the percent correct and incorrect for each of the eight questions.
TABLE 3 Responses to the Nutrition Knowledge Questionnaire N=177*
3. Which of the following is not a good
I
L. CALDERON and L. GORENCE
462 *30 respondents
did not complete this section. **Questions 1,2,3,7 and 8 were answered correctly by fewer than 50% of the of the study population. Close to 314 of this population did not know the correct response to 3 of the 8 questions. DISCUSSION Nationwide, the problem of poverty continues to grow. In addition, the homeless population ranges from 350,000 to 3 million and is growing. The typical family is a low-income, single mother with two young children (10). Diets of the homeless are usually lacking in many nutrients and tend to lead to medical problems such as coronary heart disease, hypertension, anemia, gastric ulcers, diabetes mellitus, malnutrition, and poor health in adults and delayed immunizations, elevated blood lead levels and increased hospital admissions in children. Homeless adult diets are usually low in fruits, vegetables and dairy products. Homeless women’s diets are low in calcium, zinc, energy, vitamin B-6, iron, magnesium and folic acid. Diets of homeless children are lacking in dairy products, fruits and vegetables, and breads and cereals (2,3). The nutritional status of those seeking emergency food must be improved. Research on the nutritional status of homeless families is lacking, however, the present study suggests that a lack of nutrition knowledge is a definite problem. Nutrition education could serve to mitigate this dilemma. Those on a limited income need to discern what foods are most cost effective in providing the necessary nutrients for health and well-being. In particular, the children in these households need adequate nutrition in order to achieve in school, and thereby break the cycle of poverty.
ACKNOWLEDGMENTS This research was made possible by a grant from the U.S. Department of Health and Human Services. Special thanks to Kerri Rosenblum, MS(IP), Kristen Curry, MS@), and Jackie Richmond for their help with this project. In addition, the Nutritional Science students at California State University, Los Angeles (CSLA) and the volunteers with CHS (Community Housing Services) were an invaluable resource.
REFERENCES 1. Turner B. Hunger in Los Angeles: a study of emergency food clients. University of California Cooperative Extension EFNEP, December 1992. 2. Emmons L. Food procurement and the nutritional adequacy of diets of diets in low-income families. Journal of the American Dietetic Association 1986; 86: 1684- 1693. 3. Rose JA, Cohen NL, Laliberte-Carey
L. The role of a food bank in serving the nutrition education needs of food assistance programs. Journal of the American Dietetic Associaiton 1990; 90: 988-989.
NUTRITION KNOWLEDGE OF FOOD BANK
463
4. Auld GW, Fulton CD. Value of theoretically based cooking classes for increasing use of
commodity foods. Joumal of the American Dietetic Association
1995; 95: 85-87.
5. American Dietetic Association. Position papr of the American Dietetic Association: domestic hunger and inadequate access to food. Journal of the American Dietetic Association 1990; 90: 1437-1441. 6. Smith PK, Hoerr SL. A comparison of current food bank users, non-users and past users in a population of low income single mothers. Journal of Nutrition Education 1992; 24: 59S-65s. 7. Taylor ML, Koblinsky SA. Food consumption and eating behavior of homeless preschool children. Journal of Nutrition Education 1994; 26: 20-25. 8. Miller JE, Korenman S. Poverty and children’s nutritional status in the United States. American Journal of Epidemiology 1994; 140: 233-243. 9. Nazario S. Hunger, high food costs founds in inner-city area. Los Angeles Times 1993; pp Al,A22. 10. Joy AB, Juhii ML, Garcia L, Lamp C, Sutherlin J, Willianson E. Hunger in California: what interventions are neded? Journal of the American Dietetic Association 1994; 94: 749-752. Accepted
for
publication
October
24,
1997.
PIISO271-5317(98)00034-7
FOOD CENTER PARTICIPANTS’
NUTRITION KNOWLEDGE QUALITY OF DIET
AND SELF-PERCEIVED
Laura Calderon; Dr. P.H., RD; and Lilli Gorence, MS, RD. Laura Calderon is an Assistant Professor and Director of the Coordinated Dietetics Program at California State University, Los Angeles. Lilli Gorence is the Nutrition Coordinator of the Head Start Program, Community Housing Services, Pasadena, California.
ABSTRACT Those with low incomes face various difficulties in maintaining a nutritionally adequate diet. During the past two decades, the number of people living below the Federal poverty levels has increased substantially. The purpose of this study was to determine the PasadenalAltadena (Los Angeles County) Food Center recipients’ perception of the quality of their own and their family’s diet, and to assess nutrition knowledge. This information was deemed necessary in order to intervene with an appropriate nutrition education program. Participants in this study were 207 food recipients of two Food Centers of the Community Housing Services (CHS) in the Pasadena/Altadena community of Los Angeles County of Southern California. The Food Center participants were queried as to self-perceived quality of their, and their family’s, diet. In addition, a short nutrition knowledge questionnaire was administered. Approximately 113 of the respondents rated their diet as good or excellent while the rest (67.6%) rated the quality of their diet as fair, poor or very poor. The Food Center recipients’ nutrition knowledge was deemed very poor, with 70% of the respondents answering only three, or fewer than three, of the eight questions correctly.This information will be utilized to set up a nutrition education intervention for the Food Center participants. @1998 FlscvluScience Inc. KEY WORDS
Food Bank, Nutrition, Diet, Hunger, Food Programs, Low Income
INTRODUCTION
During the past two decades, the number of people living below the Federal poverty levels has increased substantially. In addition, the homeless population continues to grow, nationwide. Specifically, it is estimated that nearly l/4 of the children in California live in poverty. Since food is the most flexible item in the budget of a poor household, it is reasonable that more and more Americans are going hungry (1). Those with low incomes face various difficulties in maintaining a nutritionally adequate diet. Many live in areas where supermarkets are scarce and do not carry as many perishable items. Some also have inadequate cooking or refrigeration facilities. In these cases, it is not possible to prepare the more economical foods or store foods safely. Others lack the nutritional
457
L. CALDERON and L. GORENCE
awareness and food buying resources to purchase enough of the whole grain cereals and green leafy vegetables they need (2). Low income families who rely on food and meal programs have been shown to have intakes of various nutrients below the RDAs, which puts them at a greater health risk. Children in particular were found to be at risk (3). The physical and intellectual growth of more people is being compromised as the number of people suffering from hunger continues to increase (4). Undernutrition results in resistance to infection, which may lead to a loss of appetite, increased energy requirements, nutrient losses, and reduced immune response (5). The most serious effects are seen in vulnerable groups, such as pregnant women, infants, children, and the elderly. Young children are particularly vulnerable to the effects of Undernutrition. One out of five children in a study by Smith & Hoerr had skipped meals because there was not enough food in the house, and many ate less because of the shortage of food (6). In a study by Taylor & Koblinsky (7) homeless preschoolers consumed less than the USDA recommended number of servings of fruits, vegetables, dairy products, and grain products. One-third of these mothers responded that several times each month their child did not have enough food to eat. Poor nutritional status may have detrimental effects on immediate health, but also may interfere with learning and school performance. In one study, poor children had lower scores on cognitive tests and socioemotional development was less mature (8). Children that are hungry can not learn, and this affects their ability to become productive members of society (9). In children, reduction in activity is oflen the first response to undernutrition, which allows the preservation of energy for growth and other vital functions. Other signs are a decreased rate of weight gain, growth in height, irritability, lack of concentration, difficulty learning, and lower test scores (5). The purpose of this study was to determine the PasadenalAltadena (Los Angeles County) Food Center recipients’ perception of the quality of their own and their family’s diet, and to assess nutrition knowledge. This information was deemed necessary in order to intervene with appropriate nutrition education programs.
MATERIAL3 AND METHODS Participants in this study were food recipients of two Food Centers of the Community Housing Services (CHS) in the Pasadena/Altadena community of Los Angeles County of Southern California. One of the Food Centers is the Jackie Robinson Center (IRC) and the other food center is Villa Park (VP). The data was collected in February of 1996. Participants of the Food Centers must meet eligibility requirements of CHS. These eligibility requirements are: ?? at or below poverty level ?? one household member per month may participate ?? residence in Los Angeles (LA) County Eligibility status is checked upon arrival at the Food Center; therefore, all participants are at or below poverty level, and only one member of any household was asked to fill out a questionnaire. All participants reside in LA County. There were no exclusion requirements for participation in this survey. All Food Center participants were deemed eligible.
NUTRITION KNOWLEDGE OF FOOD BANK
459
Survey Instrument The survey instrument was based on a questionnaire developed at UC Berkeley as part of an EFNEP (Expanded Food and Nutrition Program) project (1). This instrument was used to survey participants of various Los Angeles County Food Bank programs. In addition to this questionnaire a short nutrition knowledge questionnaire was included. Since it was expected that many ofthe Food Center recipients would be Spanish speaking, the questionnaire was translated into Spanish. Either English or Spanish versions of the questionnaire were available, whichever the respondent preferred.
Data Collection All participating food recipients at the two Food Centers were approached to complete a questionnaire. Few declined as an incentive extra food bag was distributed to those who completed the questionnaire. Therefore, it is believed that a very representative subgroup of the population was reached; in fact, the subgroup approaches the real population for the month of February 1996. It is estimated that at least 90% of the total population for this date completed the questionnaire. Volunteers assisted the PI in collecting the data from the study participants. Volunteers included Dietetics students at California State University, Los Angeles (CSLA), and regular volunteer workers from CHS. All volunteers were trained on interviewing techniques. Questionnaires were administered in a quasi-interview method. This was deemed necessary as many of the recipients were illiterate or simply could not answer the questions without assistance. Questionnaires were checked for completeness when handed in to the volunteer to receive a “ticket” for an extra food bag. Several bi-lingual (Spanish) volunteers were available to assist as necessary. In all cases, clients were informed that the interview was anonymous, and that it would not have any effect on any services or benefits they might receive. They were also told that answering the questionnaire was strictly voluntary. A total of 2 16 questionnaires were completed, 109 from JRC and 107 from VP. Of those, 9 were discarded due to incompleteness. A total of 207 questionnaires were used for data analysis, 105 from IRC and 102 from VP. In addition, it should be noted that not all questions were answered in their entirety by the 207 respondents. Data Analvsis Data was analyzed using SAS for the PC. Simple frequencies and percentages as well as &square statistics were used to describe the population. Chi-square statistics were used to compare proportions while the F statistic was used to compare means. Missing categories were not used in computing the &i-square or F statistic and corresponding p value.
RESULTS Characteristics of the Participants A total of 207 usable questionnaires were analyzed. This data was collected during February of 1996 at two Food Centers, Jackie Robinson Center (IRC) and Villa Park (VP)
L. CALDERON and L. GORENCE
460
64% of those completing the questionnaire were female, while 36% were male. The mean age was 44.6 years with a range of 18-95 years. It is interesting to note that over l/4 of this population was over 55 years of age.
The majority of the Food Center recipients were minority; 35% were Black, 48% were Hispanic, 1% was Asian, 9% were White, 1% was American Indian, and 6% described themselves as “other”. Of interest is that the majority of the Food Center recipients had been residents of the community for an extended period of time, thus negating the concept of transients as Food Center recipients, at least for this community. The mean length of time of residence was 16 years with over 213 of the population residing in the community more than 10 years; only 1% had resided in the community less than one year. Although only 4.4% of the respondents considered themselves to be “homeless”, an additional 9% lived in a car or van, 12.1% rented a hotel or motel room, and 2% rented a room. Therefore, those in the above mentioned categories constitute 27.5% of this population. Self-Perceived Oualitv of Diet The respondents were asked how they would rate the quality of their family’s diet. Table 1 shows the responses to this question. Approximately l/3 of the respondents rated their diet as good or excellent while the rest (67.6%) rated the quality of their diet as fair, poor or very poor.
TABLE 1 “How Would You Rate the Quality of Your Family’s Diet?’ N=207
Nutrition Knowledge A short eight item nutrition knowledge questionnaire was administered. Answers were categorized as either “correct “, “inwrrect” or “no response”. When there was a possibility of more than one answer being correct, either answer (or both answers) was counted as a “correct” response. Of the eight questions, a mean of 2.79 (*1.93) correct answers was achieved. That is, on the average respondents missed approximately five of the eight questions. None of the Respondents received a perfect score, that is, none selected eight correct responses. Table 2
NUTRITION KNOWLEDGE OF FOOD BANK
461
shows the number of correct or incorrect responses selected by the respondents. 70% of the respondents answered only three, or fewer than three, of the questions correctly.
TABLE 2 Number of Correct Responses to the Nutrition Knowledge Questionnaire N=174* Number of Correct Responses: 8 7 6 5 4 3 2
Percent Correct
Frequency Correct
I
0 2 6
I
0 1.2 14
19 25 50
10.9 14.4 28.7
46
26.4
*33 respondents did not answer this section.
Table 3 shows the percent correct and incorrect for each of the eight questions.
TABLE 3 Responses to the Nutrition Knowledge Questionnaire N=177*
3. Which of the following is not a good
I
L. CALDERON and L. GORENCE
462 *30 respondents
did not complete this section. **Questions 1,2,3,7 and 8 were answered correctly by fewer than 50% of the of the study population. Close to 314 of this population did not know the correct response to 3 of the 8 questions. DISCUSSION Nationwide, the problem of poverty continues to grow. In addition, the homeless population ranges from 350,000 to 3 million and is growing. The typical family is a low-income, single mother with two young children (10). Diets of the homeless are usually lacking in many nutrients and tend to lead to medical problems such as coronary heart disease, hypertension, anemia, gastric ulcers, diabetes mellitus, malnutrition, and poor health in adults and delayed immunizations, elevated blood lead levels and increased hospital admissions in children. Homeless adult diets are usually low in fruits, vegetables and dairy products. Homeless women’s diets are low in calcium, zinc, energy, vitamin B-6, iron, magnesium and folic acid. Diets of homeless children are lacking in dairy products, fruits and vegetables, and breads and cereals (2,3). The nutritional status of those seeking emergency food must be improved. Research on the nutritional status of homeless families is lacking, however, the present study suggests that a lack of nutrition knowledge is a definite problem. Nutrition education could serve to mitigate this dilemma. Those on a limited income need to discern what foods are most cost effective in providing the necessary nutrients for health and well-being. In particular, the children in these households need adequate nutrition in order to achieve in school, and thereby break the cycle of poverty.
ACKNOWLEDGMENTS This research was made possible by a grant from the U.S. Department of Health and Human Services. Special thanks to Kerri Rosenblum, MS(IP), Kristen Curry, MS@), and Jackie Richmond for their help with this project. In addition, the Nutritional Science students at California State University, Los Angeles (CSLA) and the volunteers with CHS (Community Housing Services) were an invaluable resource.
REFERENCES 1. Turner B. Hunger in Los Angeles: a study of emergency food clients. University of California Cooperative Extension EFNEP, December 1992. 2. Emmons L. Food procurement and the nutritional adequacy of diets of diets in low-income families. Journal of the American Dietetic Association 1986; 86: 1684- 1693. 3. Rose JA, Cohen NL, Laliberte-Carey
L. The role of a food bank in serving the nutrition education needs of food assistance programs. Journal of the American Dietetic Associaiton 1990; 90: 988-989.
NUTRITION KNOWLEDGE OF FOOD BANK
463
4. Auld GW, Fulton CD. Value of theoretically based cooking classes for increasing use of
commodity foods. Joumal of the American Dietetic Association
1995; 95: 85-87.
5. American Dietetic Association. Position papr of the American Dietetic Association: domestic hunger and inadequate access to food. Journal of the American Dietetic Association 1990; 90: 1437-1441. 6. Smith PK, Hoerr SL. A comparison of current food bank users, non-users and past users in a population of low income single mothers. Journal of Nutrition Education 1992; 24: 59S-65s. 7. Taylor ML, Koblinsky SA. Food consumption and eating behavior of homeless preschool children. Journal of Nutrition Education 1994; 26: 20-25. 8. Miller JE, Korenman S. Poverty and children’s nutritional status in the United States. American Journal of Epidemiology 1994; 140: 233-243. 9. Nazario S. Hunger, high food costs founds in inner-city area. Los Angeles Times 1993; pp Al,A22. 10. Joy AB, Juhii ML, Garcia L, Lamp C, Sutherlin J, Willianson E. Hunger in California: what interventions are neded? Journal of the American Dietetic Association 1994; 94: 749-752. Accepted
for
publication
October
24,
1997.