As students descended on the cafeteria at Kelly Miller Middle School in Washington, D.C.’s Ward 7 last year, they were met with a shocking sight.
Gone were the burgers and pizza, replaced by whole grain pasta and farm-fresh fruits and vegetables. The lighter, healthier menu—prepared from scratch at the D.C. Central Kitchen—was the result of the Healthy Schools Act of 2010, legislation that aims to fight hunger, obesity, and disease among Washington’s youth.
The intention was good — but the reviews were not.
“One student told me, ‘they’re trying to poison us,’” says Anastasia Snelling, a professor in AU’s School of Education, Teaching and Health (SETH), who’s been working at Kelly Miller since 2009 as part of Community Voices for Health. “Here’s this delicious, healthy food, and kids won’t even touch it.”
The “nutrition lady,” as Snelling’s affectionately known at Kelly Miller, had her work cut out for her.
Navigating Nutritional Wastelands
Located in Lincoln Heights, just east of the Anacostia in northeast Washington, Kelly Miller is just blocks shy of what social scientists, policy makers, and health advocates have dubbed a “food desert.”
According to the United States Department of Agriculture (USDA), a food desert is a low-income census tract where at least 33 percent of residents live more than a mile from the nearest supermarket. Case in point: Ward 7, the second poorest ward in Washington, has just two Safeway stores. Located on either end of the ward, neither is within walking distance for many of the 70,000 people who live in the neighborhood.
What they lack in big box retail, however, communities like Ward 7 make up for with corner stores: mom and pop operations that offer high-calorie snack food, cigarettes, alcohol, canned goods, and a limited selection of fresh produce. (A 2008 report by the Food Research and Action Center found that, of 21 corner stores in Wards 7 and 8, only one offered apples.) And while fresh food is scarce, fast food is abundant: Ward 7 has one farmers’ market and 13 fast food outlets.
According to the USDA, 10 percent of the 65,000 census tracts in the United States are food deserts. Of the 13.5 million people in these areas, the majority — 82 percent — live in urban areas like northeast Washington. (Locally, the problem is even more pronounced in Maryland’s Prince George’s County.)
Typically, food insecurity — the lack of or inability to purchase nutritious food — is just one on a long list of social ills that mar poor neighborhoods. Unemployment is high and median household income is low, as is educational achievement. At Kelly Miller, only 19 percent of students read at grade level and 18 percent pass math proficiency.
Obesity, paradoxically linked with hunger, is also on the rise in these communities, as are diabetes, hypertension, and other chronic diseases. According to a 2010 report by the D.C. Department of Health, 40 percent of adults in Ward 7 are obese, compared to 22 percent, citywide. Nearly 42 percent of adults in Ward 7 suffer from high blood pressure and almost 14 percent are diabetic.
The link between diet, exercise, and health is well documented. And there’s no question that in food deserts like Ward 7 — which ranks last in fruit and vegetable consumption in Washington — access to fresh produce, whole grains, low-fat dairy products, and other staples of a well-balanced diet is limited.
But, as Kelly Miller students’ preference for grease over greens indicates, access, alone, doesn’t guarantee people will make healthful choices.
“Researchers study, in very sophisticated terms, a single variable: access. But the solution here is multifaceted,” says Snelling. “Just because we build a supermarket doesn’t mean we’ve addressed how people in lower socioeconomic areas view the importance of nutrition.
“We have to increase access to healthy foods in places like Ward 7. But, more importantly, we have to educate and empower people to make the healthy choices, the right choices,” she continues. “The best solutions bubble up — they don’t parachute down.”
An Appetite for Learning
The District has been creative in tackling the food desert dilemma. Although only two of the city’s 26 farmers’ markets are located east of the Anacostia, 15 now accept food stamps. And this summer, Washington’s first mobile market—a school bus powered by a blend of diesel and vegetable oil—will hit the streets, offering fresh, locally-grown produce from the Arcadia Center for Sustainable Food and Agriculture. Urban farms and community gardens are also sprouting up across the city.
But, when the mobile market rolls through Lincoln Heights, peddling peaches and peppers, will residents bite?
Snelling’s scholarship around food deserts — what she calls “community-based participatory research” — is unusual, in that it looks beyond access, asking: can carrots and corn compete with Cheetos?
“It comes down to behavior modification,” she explains. “We have to work within the family, the school, and the community to change the culture of food.”
Now in her third year at Kelly Miller, where she pioneered the Community Voices for Health project, Snelling is doing just that.
“Education and health care are the two big social issues of our time and we’ve done little to work on them, simultaneously,” she says. “Healthier students are better learners so, for us, the school was the obvious place to start.”
Community Voices in Health began with the five-week Kids Take Action project, during which sixth graders learned about public policy, nutrition, and fitness. Students wrote letters to President Obama and other legislators, sharing their ideas for improving access to healthy foods and safe play spaces in their neighborhoods. They also created songs, skits, poems, and posters promoting exercise and healthy eating and designed a community garden for the school, planting strawberries, beans, and basil in six raised beds.
“It’s an empowerment tool,” says Snelling of the green space. “I can show the kids the food pyramid or we can go down to their garden and grow some strawberries.”
Next, Snelling and her team of grad students turned their attention to Kelly Miller’s 40 teachers and staff, helping them integrate health and nutrition lessons into the learning standards for math, language arts, science, and social studies. In math class, for instance, kids calculate the volume of a box of Cheerios; in social studies, they learn about the gardens maintained by slaves on southern plantations.
Snelling also encouraged the teachers — some of whom, like the students, expressed a preference for cafeteria pizza — to act as healthy role models. “We told them the same thing we told the kids: ‘just try it,’” says Snelling of the healthier lunchroom offerings.
Now, armed with a $95,000 grant from Kaiser Permanente, Snelling is focusing on the Kelly Miller parents: a critically important but difficult-to-capture group.
Teachers and staff can monitor what kids eat at school, but when the afternoon bell rings, all bets are off. Snelling says parents need to model healthy behavior for their children, in order to change the culture of food in neighborhoods where SpaghettiOs are more plentiful than spinach.
Although the real work will get underway when school starts in the fall, parents — about one-quarter of whom met with Snelling during parent-teacher conferences in May — have expressed an interest in cooking and stress management classes, a walking club, and a job fair. Thanks to the money from Kaiser, Snelling will also offer a variety of health screenings.
“We have to look at the whole person,” she says. “What do they want and need to live a healthier life?”
Harnessing the Supermarket’s Power
Consumers base their food choices on four criteria: taste, cost, convenience, and nutrition. When a working mom goes to the McDonald’s drive-thru for dinner, she’s put convenience at the top of the list; when a shopper opts for conventional strawberries over the organic version, he’s likely based his decision on cost. Not surprisingly, nutrition is often an afterthought.
And while it’s easier to put nutrition atop the list when cost is less of a concern — call it the Whole Foods effect — Snelling is adamant that it’s possible to eat healthy on a budget. “It’s not easy. You have to learn the skill of cooking and the skill of shopping, but it’s possible,” she says.
Navigating the grocery store, with shelves stocked with products promising low-fat, high fiber, and gluten-free, might be the trickier skill to master. That’s why Snelling, along with AU marketing professor Anusree Mitra and public administration and policy professor Taryn Morrissey, is undertaking a study of front-of-the-package marketing at Safeway in Ward 7.
The research, funded by an AU grant, is significant for two reasons. First, most studies of food packaging have been conducted in high-income areas; second, research on food deserts focuses almost exclusively on corner stores — likely because independent grocers are more autonomous and more prevalent than large chains.
“But the fact is, I can reach more people at Safeway than at the corner store,” says Snelling. “Large supermarkets should be the leaders in educating consumers about point-of-purchase food choices.”
Last month, Snelling and her team began surveying consumers about their shopping habits, food preferences, and the ways in which marketing claims influence their purchases. They’ll use the data to craft “interventions” aimed at helping shoppers make healthier choices. If, for example, someone buys a gallon of whole milk, the register will spit out a coupon for a free gallon of skim.
Snelling also plans to organize cooking demonstrations at Safeway, preparing a healthy dinner using six sale items. “If I have 30 minutes, I’d rather teach people to cook on a budget, engaging them in skill building around food preparation, than drill them down about their blood pressure,” she says.
Nudging Kids Toward the Salad Bar
Word of Snelling’s work is spreading.
In June, she was approached by the USDA’s Economic Research Service to use behavioral economics-based strategies—a new trend in nutrition and health promotion—to coax students at Kelly Miller to make better food choices. The $20,000 to $30,000 grant, currently pending approval by the Office of Management and Budget, will allow Snelling to tweak the cafeteria layout, experimenting with things like plate size and food placement. The goal: to nudge kids to make smarter selections by changing the way their options are presented.
Previous research conducted by the Center for Behavioral Economics in Child Nutrition Programs at Cornell University revealed that, giving foods more descriptive names — “creamy corn,” for example — increased sales by 27 percent. Also, when researchers put apples and oranges in a fruit bowl rather than a stainless steel pan, fruit sales more than doubled.
Although USDA has funded similar research at 15 colleges and universities, Snelling’s grant is the first in Washington.
“It’s exciting that USDA wants to roll up its sleeves in its own backyard, and I’m glad AU can be a part of that,” says Snelling, who will collect pilot data at Kelly Miller and other D.C. schools in the fall, and hopes to implement similar strategies in lunchrooms across Washington next year.
“Access is one thing, but when you get kids engaged, that’s when change happens,” she continues. “This is where the rubber meets the road.”