THREE WOMEN ARE gathered around a dining room table in Oxon Hill on a sunny summer afternoon reading food labels. Bernice Day, an aide with the Prince George's County Extension Office, is explaining how label reading can improve both diet and purchasing power.
"Read the ingredient statement," she tells Lynne Millard, 26, and her mother, Bernice Warren, 68. "Whatever is listed first, that's what you're paying for. If it says water, that's what you're paying for" since ingredients are listed in decreasing order of weight.
Day has been teaching food and nutrition for 10 years as a paraprofessional aide in the Expanded Food and Nutrition Education Program (EFNEP) in both Charles and Prince George's counties. The 15-year-old program, jointly administered by the U.S. Department of Agriculture, State Cooperative Extension Services and county extension agents, employs 5,000 aides who work in 961 counties and cities across the country. The aides, hired from the local community, teach low-income homemakers how to plan a healthy diet on a small budget. The standard teaching method is one on one, in the family's home.
EFNEP itself lives on a small budget. It reached a federal funding level of $50 million in 1972, climbing to only $60 million in 1983. For fiscal 1984, the Reagan administration proposed a 40 percent budget cut, but supporters of the program on Capitol Hill are hopeful that Congress will restore funding to 1983 levels. The ominous cloud of future budget cuts continues to hang over all government social programs, however, and officials are now looking for ways to make EFNEP reach more people with fewer dollars.
Millard, who has an 11-year-old daughter, and her mother have been in the program for five months. When they agreed to participate, they were asked to write down all the food they had eaten in the last 24 hours. In another month, they will be asked to participate in another 24-hour "food recall" and Day will examine the results to see if their diets have improved and whether she needs to re-emphasize certain nutritional points.
Day says most people's diets are heavy on the protein--they always list two servings of meat in their first food recall. "They're low in the vegetable and fruit and milk groups, but the bread and meat always stay up there," Day observes.
Millard says Day's once-a-month visits have made a big difference in the way she eats, and she wishes Day had been around when she was pregnant with her daughter. "I don't buy bags of cookies now like I used to," she says. "I've been eating more fruits and juices. It makes you more aware of what you're eating."
Day is in Temple Hills now, in an old farmhouse, visiting Jeannette Shirley, the mother of five young children, who is nearing the end of the two year EFNEP curriculum. Shirley is active in her children's elementary school programs, and Day recently appeared before the PTA to show parents how to make breakfast in a glass. The breakfast consisted of an orange juice, milk and egg shake, and the parents loved it. The idea, says Day, is to get parents to make breakfast for their children now that school is out. "All the parents have to do is mix it in a plastic pitcher and the kids can pour out some for themselves," Days explains.
The lesson of the day at the Shirley house is food safety. Day tells Shirley to be careful about purchasing dented cans, to get groceries into the refrigerator as soon as possible, and to keep hot foods hot and cold foods cold. Shirley asks about sandwiches she can safely pack for lunches. "Stay away from meat," Day warns. She suggests peanut butter and jelly as a safer alternative.
Shirley says the program has helped her children eat better. "If I make it nice looking, I don't have a problem," she says. "The way you fix things makes it more enjoyable."
In another Oxon Hill apartment complex, at another dining room table later the same morning, Day talks with a 24-year-old mother about nutritious snacks.
"Snacking isn't bad," says Day to Candelaria McGee, whose 11-month-old baby is sleeping in the next room. "But there are good snacks and bad snacks."
Baked custard, cheese, celery sticks and hard boiled eggs are healthy snacks, Day says. Then Day shows McGee photos of undesirable snacks: devil's food cake, potato chips, soft drinks.
She suggests McGee make her own pudding instead of using the instant variety. "What do we have the most of--time or money?" Day asks McGee. She explains that the instant pudding is expensive primarily because it is designed to save time, and promises on her next visit to demonstrate how to make pudding.
The EFNEP curriculum is structured around the four food group system, which prescribes two servings daily from the meat and milk groups and four servings daily from the fruit/vegetable and cereal groups. In the last few years, some nutritionists have questioned whether a diet based on this system provides an adequate supply of all nutrients, while others have expressed concern that the guide does not deal with the presence in the American diet of too much sugar, salt, fat and calories. Mardelle Amstutz, EFNEP coordinator for the state of Maryland, says until a better system is devised, "We really don't have much to replace it with. No other system is quite as simple."
Six women and two men, all recently settled refugees from Cambodia, are sitting around a cafeteria table at Chillum Elementary School in Prince George's County. Today, extension aide Pat Duran has brought in food ads from the newspaper, and asks the group to tell her how much the cabbage costs.
"Nineteen cents a pound," one of the women answers. Duran asks similar questions of the other students. Then she asks which is cheaper: the cabbage, or the broccoli at two pounds for 88 cents.
The 1 1/2-hour lesson continues in the same manner--part English lesson and part instruction in comparison shopping. Duran organized the twice-a-week class after stumbling on a local volunteer group trying to teach English to the newly settled refugees.
The teaching approach for this community, notes Duran, must differ from the established EFNEP curriculum. "If you tried to explain what vitamin A is, where would you possibly start?" she asks. Instead, her aim is "to reinforce the good things in their diet and head them off from the bad American foods."
The small-group approach in EFNEP is being encouraged by USDA as more cost-effective than the traditional one-on-one method. "The group approach can also be a better way of teaching," says Amstutz. "It becomes a more social thing, and the sharing of ideas becomes very important."
Each aide in the Maryland program is expected to maintain a caseload of 50 families. This means that the aides, who work 35 hours per week at or near minimum wage, must spend time "recruiting" new families to replace those who have dropped out or have completed the two-year curriculum. Door-to-door recruiting is a common method used by aides, but it is time-consuming and often difficult.
Privacy laws prevent state and local agencies from giving the names of families who have applied for assistance or food stamps to the county extension service unless prior permission from the family is obtained by the agency. Caseworkers, anxious to process families in need of assistance, are often reluctant to take time to explain about EFNEP, program officials comment. Amstutz says an effort is always made to establish contacts at state and local agencies. "Some counties work better than others," she says about Maryland. "In the large counties, it gets more bureaucratic."
After a homemaker has completed the EFNEP curriculum, an aide evalutes her "food behavior" with a checklist. Does the homemaker have a basic knowledge of nutrition? Does she use a shopping list, plan her menus and compare food prices? Does she serve a variety of foods, including a good source of iron, daily? Can she follow a recipe? Does she conserve nutrients in cooking?
Several EFNEP graduates interviewed were wildly enthusiastic about the program. "It's like having a nutrition counselor," says Yvonne Hawkins of Silver Spring. Hawkins, who has four children, says the program has "helped me with my budget tremendously." And, she adds, she now eats a wider variety of foods, including more vegetables, and does all of her baking from scratch.
Violet Washington of Rockville was also full of praise. "You won't see cans in my house," she says proudly, noting that she makes her own white sauce for macaroni and cheese and her own version of hamburger helper. "It's so easy instead of buying it from the store." And the program not only helped her save money, Washington continued, "I know what to give my kids. It's benefitting my grandchild--she won't have decaying teeth."
A research study conducted by Amstutz, which surveyed 129 EFNEP graduates and 194 newly enrolled homemakers, appears to bear out these testimonials. The diets of the graduated homemakers, who had been out of the program an average of 20 months, were significantly more nutritious than those of the homemakers new to the program.
Dr. Ava Rodgers, a deputy administrator of USDA's extension service, says program officials will continue to look very hard to make the best possible use of limited resources. "Efficient and effective are the words that keep coming to mind," she says. "To do it a little better."