Eating local: Farm-to-school gaining ground as way to fight childhood obesity and otherwise improve students' nutrition

By Tara Kaprowy
Kentucky Health News

With the faint hue of green appearing in thousands of gardens and farms, the growing season has officially begun in Kentucky. While most of the resulting produce is destined for store shelves and personal pantries, there is growing demand for it to appear in kitchens that haven't seen locally-grown fruit and vegetables for decades but are keys to children's nutrition.

Schools are the newest frontier in sustainable farming, with their collective power not only capable of transforming the agricultural landscape, but also fighting childhood obesity, one of the biggest health crises facing the nation. (Kentucky Department of Agriculture photo: Montgomery County farmer Gayle Arnold picking tomatoes)

This growing trend is called "farm to school," in which school cafeterias serve food grown by local farmers. Across the state, food-service directors in 78 school districts have made their schools Kentucky Proud institutions, meaning they serve local products in their school lunches.

This map shows that nearly 50 counties had some type of farm-to-school program in place in 2010; more have started.

"It's a growing movement," said Tina Garland, coordinator for the Kentucky Department of Agriculture's Farm-to-School Program. "Producers are being added every day. We've got orchards that can turn off their freezers in the fall because the schools buy all of their apples."

John Cain, state co-chair of Kentucky Action for Healthy Kids, attributed the trend to several factors, including efforts to find viable markets for former tobacco farmers, a concern about food security and the obesity epidemic. "We're having to revisit where does our food come from and what does the source of our food have to do with our obesity problem," he said.

This year, 10 school districts will receive $5,000 grants from the Kentucky Department of Public Health's Obesity Prevention Program so they can establish farm-to-school programs. Last year, Jackson, Lee and Owsley counties established their own programs using the grants. Owsley Food Service Coordinator Charolette Thompson served locally-grown watermelons and cantaloupes in her cafeterias. "The students noticed the difference in taste and the better quality in the produce," she said. "They love it."

In Jackson County, in addition to developing ties with farmers, students grew tomatoes, left,  and canned salsa, which will be used in the school cafeteria. They also made jam, which they sold under the label "Jammin' Generals." "Not only did they learn how to grow their own food, they learned how to market it and how to preserve it," said Elaine Russell, nutrition coordinator for the Obesity Prevention Program. (Cumberland Valley District Health Department photo)

This trend is likely to continue, especially since it now has federal support. On April 26, the U.S. Department of Agriculture established a rule that will let schools give preference to local, unprocessed farm products when they buy for the National School Lunch Program and other USDA programs.

While farm to school is gaining traction, it is not a new concept. Julie Tuttle, food nutrition coordinator at Montgomery County Schools, is one of a handful of food-service directors who have been serving locally-grown produce for several years. "We started using apples in 2006," she said. "Now we're up to four producers." (Kentucky Department of Agriculture photo: Students Macy Tabor and Makayla Donathan at Montgomery County High School)

The latest is Marksbury Farms, where Tuttle is buying beef, chicken and pork. Last week, in honor of the Kentucky Derby, Montgomery County High was one of the first Kentucky schools in decades to serve local meat. The students had the option of either burgoo or hot browns, left. "I had one student who came up to me and said, 'I just wanted you to know this is the best school lunch I've had since I've been here,'" Tuttle said. "That's what it's all about, getting those comments from students." (Kentucky Department of Agriculture photo)

Julia Bauscher, director of school and community nutrition services for Jefferson County Public Schools, teamed with Sullivan University to develop recipes, and was able to buy local squash, peppers and zucchini that she and her team processed and froze for year-round use. This year, she is buying local foods from about 12 providers, three of whom have contracts to grow for the schools.

In addition to raising awareness, she's found farm to school improves the reputation of the school cafeteria in general. "This gives everyone something to feel good about and opens everyone's eyes a little more about the program," she said. "And how we really do have to work hard to make this happen."

Farm-to-school programs have been slow to start in many places because they face logistical, legal and other challenges. Many school districts want their suppliers to carry a $1 million liability insurance policy, which they may not be able to afford, and be certified through the Good Agriculture Practices Program, education they may not be able to get.

Farm to school's biggest drawback is that it takes more work. Unlike food delivered to schools by huge providers, locally-raised produce may need to be washed and processed, which takes more staff or volunteers.

"The market has evolved a very convenient system," said Mark Swanson, an assistant professor in the University of Kentucky College of Public Health. He said school food-service directors "have one or two providers they can call and they can get what they need. Farm to school gets a lot more complicated. ... It takes a really motivated person to tackle that on their own."

Swanson said that hurdle can be lowered by social connections in rural communities. He spoke of one farmer who was selling her tomatoes to a Wendy's restaurant. Though she'd had a bad harvest, the restaurant manager was willing to use the product, in part because they went to church together. "He knew that his business arrangement would be cushioned by social ties," Swanson said.

In Owsley County, ties between the school and farmers have become so strong farmers will now host a farmers market on the grounds of the high school there. "It's the social connection with farm to school that gives it the most potential," Swanson said.

Federal procurement guidelines keep schools from paying much of a premium for local products, but "Farmers are pretty uniformly willing to accept a lower price for their produce because of the volume and they can sell it all at once," rather that waiting for single buyers at a farmers' market, Swanson said. "It's a good trade," he said. "It's a whole lot easier."

That was the case for Jeremy Hinton, owner of Hinton's Orchard and Farm Market, and the schools in LaRue County and nearby Elizabethtown, which buy 1,000 of his apples a week.

"It was a cost savings to them over what they were paying at the time," Hinton said. "Even when wholesale apples are available for less, they continue to buy our apples because of the quality and supporting locally grown. . . . Probably the biggest compliment we've gotten is talking to some cafeteria managers who said they're seeing more apple cores in the trash bin instead of apples with one or two bites out of them."

While farm to school is gaining ground in Kentucky, it is more established in the upper Midwest, the Northeast and California. Kelly Crossley, food-service director at Independence School District in Iowa, started her program in 2008. Though she is interested in supporting farmers and shrinking the district's carbon footprint, Crossley's main goal is the same as most food-service directors in the program: healthier eating.

"If you can get kids to eat more fruit and vegetables, hopefully those items will replace something more fattening they would have eaten otherwise," she said. To reinforce the effort, students meet the farmers in the classroom and travel to the farms, and Crossley posts in the cafeteria signs noting where the local foods were grown. Crossley said her staff only casually monitors what students take in the lunch line, not what actually gets eaten, but "The cooks have told me ... that they can tell which kids have been exposed because they're taking more."

Swanson is doing research in Lee County to see if farm-to-school actually improves children's nutrition. He will establish a program and photograph trays of food coming off the lunch line and being returned once the students have eaten. "There's a general assumption that farm-to-school programs work and no one has really studied the effects on nutrition," he said. "The reason I don't sell it on the nutritional benefits is we really don't know."

While the empirical evidence may be short, the anecdotal evidence is strong. Crossley said she witnessed an unforgettable success late last fall in Iowa.

"Brussels sprouts were the only thing left in the garden," she said. "The kids went out and actually harvested them off the trunks. We sautéed them, put a little bit of parmesan cheese on them and we passed them out to the kids. I'm telling you, they ate it up ... That day, we heard stuff like, 'I like Brussels sprouts and I didn't even know it.'"

Bauscher looks forward to the day that happens all over Kentucky. "As more districts become more involved in this," she said, "we ought to be able to create something that's really worthwhile, not only for the students, but for the farmers."

Parents should talk to children about drugs and alcohol often, and firmly, but spend more time listening

Talking about drugs and alcohol often, and when children are at a young age, are two of the best things parents can do to prevent substance abuse by teenagers.

"As much as parents want to be the 'anti-drug,' as media campaigns encourage, the tricky part is doing it effectively, without alienating their kids or essentially lighting a joint for them," reports Alexia Elejalde-Ruiz of the Chicago Tribune.

One of the keys is to have conversations often and early on. "What you don't want is to be having this conversation after your child has already started drinking or smoking marijuana," said J. David Hawkins, founding director of the Social Development Research Group at the University of Washington.

Nationwide, 71 percent of high school graduates have consumed alcohol, half have gotten drunk at least once, almost half have tried illegal drugs, and one-fourth have tried illegal drugs other than marijuana, the 2010 Monitoring the Future survey found. The annual poll, conducted by the University of Michigan, talked to 50,000 American teens.

Kentucky teens under 18 are among the least likely to drink alcohol of teens in the nation, the 2007-08 National Survey on Drug Use and Health showed. Kentucky teens ranked 10th lowest, but were nearly on par with the national average when it came to binge drinking. (Read more)

The workshop "Guiding Good Choices" gives lessons to parents in how to deal with the issue. It advises parents to talk to their kids about drugs before adolescence, preferably when they're in the fifth or sixth grade. Parents should talk to their kids about people in their family that may have drinking or drug problems and how that affects them. They should set a family policy on drugs or alcohol and establish consequences. And they should plan to have the conversation every year.

Teens generally obey rules until they reach the eighth grade, when it becomes unclear to them whether or not drugs and alcohol are actually bad. Alison Birnbaum, a psychotherapist and social worker based in New Canaan, Conn., said talking about drugs is only 20 percent talking, and 80 percent listening, but parents should be firm. Parents should make clear they will be disappointed if the rules are broken.

Safety First, a teen drug-prevention project, advocates "Just Say Know," rather than "Just Say No." It provides kids with science-based information and asks parents to be honest, if selective, about their own history with alcohol and drugs. "Parents often worry that they're condoning drugs if they're not condemning them, but ... acknowledging the possibility that your kids might experiment sets you up to discuss what they should do if they get in trouble," Elejalde-Ruiz writes. (Read more)

E-cigarettes are untested and promote nicotine addiction, UK professors say

In the wake of the U.S. Food and Drug Administration's move to classify the electronic cigarette as tobacco rather than a more strictly regulated drug-delivery device, two University of Kentucky professors outline the dangers, and false claims, of the product in an op-ed piece in the Lexington Herald-Leader.

"E-cigs preserve the visual, sensory and behavioral aspects of smoking, which can prolong addiction, " Ellen Hahn and Carol Riker contend. The product can also be a gateway to traditional cigarettes for non-users and, because of their flavorings, attract youth, they say.

E-cigarettes are reusable tubes that contain a mixture of liquid nicotine, flavorings, propylene glycol that mimics the look of smoke, as well as other chemicals. Hahn and Riker note that the e-cigarette industry says its product can be a replacement on occasions when traditional smoking is prohibited, but at the same time claims that e-cigs help smokers break the habit.

"Recent studies report serious labeling and quality-control issues as well as design flaws, none of which are reflected in the industry's television ads, powerful Internet pitches and testimonials using Facebook and other social media," Hahn and Riker write, adding the World Health Organization has concerns about the product and the FDA has not evaluated it for safety. "Continuing to market e-cigs without rigorous research and strict regulation is an uncontrolled experiment conducted by those whose primary interest is to profit from addition." (Read more)

National Women's Health Week kicked off yesterday; today is National Checkup Day

National Women's Health Week kicked off fittingly on Mother's Day, with communities, hospitals, health centers, churches and schools participating. The observance, which runs through May 14, is coordinated by the U.S. Department of Health and Human Services' Office on Women's Health.

This year's theme is "It's Your Time." The goal of the week is to have women make their health a top priority by encouraging them to eat a nutritious diet; go to the doctor to get a regular checkup and preventative screenings; avoid risky behaviors like smoking and not wearing a seatbelt; get enough sleep and manage stress; and get at least 2 hours and 30 minutes of moderate physical activity and 1 hour and 15 of vigorous physical activity each week.

Today is National Women's Checkup Day, which is meant to promote regular checkups for early detection of heart disease, diabetes, cancer, mental health illnesses and sexually transmitted infections. (Read more) For a list of Kentucky-based events being held in honor of National Women's Health Week, click here.

Veteran journalist sees hope in residential drug recovery program

"Kentucky's struggle to help its citizens who suffer from dependency on drugs and alcohol recently reached an impressive goal when leaders of that struggle who are prominent in different political parties celebrated the official opening of a $5 million treatment center in Western Kentucky," Al Smith wrote in an op-ed piece for the Lexington Herald-Leader.

Smith, left, reports on his trip to the dedication of the Recovery Kentucky residential center in Paducah with "First Lady Jane Beshear, wife of the Democratic governor, and Don Ball, the Lexington developer and Republican fund-raiser," who "left politics behind" to mark the opening of the 10th and last in a series of centers planned at Ball's urging by Gov. Steve Beshear's Republican predecessor, Ernie Fletcher. Smith praises Beshear or "retaining Ball as task force chairman and appointing the first lady as his cochair in a commendable commitment to making the program a bipartisan effort."

Recovery Kentucky uses "a recovery model that includes peer support, daily living skills training, job responsibilities and challenges to practice sober living," writes Smith, who overcame his own alcohol addiction almost 50 years ago while editing the Russellville newspaper. "The memory is so vivid I couldn't resist sharing it with some newcomers to sobriety in Paducah," he wrote, quoting himself: "I've been where you've been. It's a program of hope, it works if you work it." (Read more)

Health care reform will be costly to hospitals, Kentucky Hospital Association chief says

Many of Kentucky's 132 hospitals will lose money and be forced to merge because of the new health care law, says the president and CEO of the Kentucky Hospital Association.

Speaking to the Madisonville-Hopkins County Chamber of Commerce, Michael Rust, left, said one in three Kentucky hospitals is already losing money. Under the new law, reimbursement rates for Medicare are set to go down by 10 percent, which will further put the pinch on health-care facilities. "The proposed 10 percent reduction will cut jobs and wages by an estimated $5.3 million, reduce sales to businesses by $19.6 million and reduce state and local revenues by $1 million," Ron Sanders reports on iSurfHopkins.com.

Rust said the expanded coverage afforded by the law, known as the Patient Protection and Affordable Care Act, will cost Kentucky $1 trillion. Half of that will be financed by new taxes. The other half will be paid for through Medicare cuts, representing a $3.4 billion loss in Kentucky hospital revenue, Sanders reports. Hospitals are, in turn, "working to reduce costs through strategic affiliations or mergers or acquisitions," Sanders reports from Rust's speech. (Read more)

Kentucky Voices for Health Executive Director Jodi Mitchell told Kentucky Health News, "We know the law is not perfect and there are areas of concern that are valid. However, status quo is not an option given that we had a broken and costly health care system. We anticipate the reforms will continue to happen and there will be corrections and amendments to the law to improve upon it." Kentucky Voices for Health is a coalition of more than 100 organizations and individuals working to build a healthier Kentucky and does not have a formal stance on the new health care law, Mitchell said. "It is the law of the land and we are trying to provide objective information in regards to the valuable consumer protection provisions that are in the law."

Free clinic helps care for poor workers in horse racing industry

People who don't have health insurance but who work at Churchill Downs and elsewhere in the horse racing industry can get free care, thanks to the Kentucky Racing Health Services Center.

"The nonprofit, nurse-managed clinic started as a joint venture between the University of Louisville and the Kentucky Racing Health and Welfare Fund, a non-profit organization that gets its money from when people wager but do not cash their tickets," The Courier-Journal's Laura Ungar reports.

The clinic opened six years ago and helps about 2,500 patients a year. Most earn very low wages; stable-help and groom positions pay between $150 and $250 a week plus housing, equine-related employment service Equimax found.

To be treated, workers must be able to show a valid racing license and be employed in the horse industry. Many of the clinic's patients are Hispanics, who have a disproportionately high number of health issues compared to the rest of the population in part because language barriers can either keep them from getting care or understanding instruction. In Jefferson County, the number of Hispanics has increased — representing 4.4. percent of Jefferson County's population in the 2010 U.S. Census versus 1.8 percent in 2000. (Read more)

Teens are misinformed about risks of tanning beds, and are not being warned at salons

With swimsuit season just around the corner, the American Academy of Dermatology has found that more than 40 percent of people who tan have never heard from tanning salon employees about the dangers of tanning beds. This comes days after the Tanning Bed Cancer Control Act was introduced by U.S. Reps. Carolyn Maloney (D-N.Y.) and Charlie Dent (R-Pa.). It calls on the Food and Drug Administration to reclassify indoor tanning beds and require warning labels on the equipment about the dangers of ultraviolet light.

"Studies have found that UV radiation from indoor tanning beds increases a person's risk of developing melanoma by 75 percent," said dermatologist Dr. Ronald L. Moy, president of the dermatology academy. "Contributing to this problem is the fact that tanning bed facilities currently are not required to verbally warn patrons of the known health risks of ultraviolet radiation and, in some cases, they may be misleading the public by falsely promoting artificial UV light as safer than natural sunlight."

The report found tanning bed users from 14 to 17 are "more than twice as likely to think tanning beds are safer than the sun than older tanners age 18 to 22 ... and more than three times as likely to think that tanning beds do not cause skin cancer," the research-reporting service Newswise reports.

"The FDA currently ranks tanning beds as a Class I medical device, which provides a minimal level of regulation and oversight similar to bandages, tongue depressors, gauze and crutches," Moy said. "That is why it's important that the FDA change the classification of indoor tanning devices to reflect the significant health risks that they pose." (Read more)

Earlier this year in the Kentucky General Assembly, state Rep. David Watkins of Henderson introduced a bill that would prevent children under 14 from using tanning booths. The bill, which was backed by the Kentucky Medical Association and the American Cancer Society, cleared the House's Health and Welfare Committee but went no further.

Schools serving somewhat healthier lunches, but short on physical activity, national survey shows

The nation's middle and high schools are feeding students somewhat healthier lunches, but are falling short in providing physical activity to students, a report from the Robert Wood Johnson Foundation's Bridging the Gap program has found. And while soft drinks and sugary snacks are available in most schools, Kentucky is an exception.

The report, which analyzed the 2007-08 school year, found schools are offering fruits and vegetables most or every day, more whole grains and fewer helpings of french fries. However, there is still considerable progress to be made, the foundation says; pizza is available most every day, too, and students could buy sugar-sweetened drinks in vending machines, à la carte lines, store or snack bars at 71 percent of middle schools and 92 percent of high schools.

Those numbers are lower in Kentucky due to a state mandate enacted in 2005. That law prohibits students from beign served anything but water, 100 percent fruit juice, low-fat milk or beverages that have fewer than 10 grams of sugar per serving during the school day. It also prohibits anything but those types of drinks from being available in school vending machines during the school day.

In the 2008 national survey, principals said 1 in 4 middle-school students ate breakfast at school and nearly 3 in 4 ate lunch there. But among high-school students, only 18 percent eating school breakfast and 60 percent school lunch. In schools with higher percentages of students eligible for free and reduced lunch, "both breakfast and lunch consumption were significantly greater, indicating that school meals were an especially important source of nutrition for students in low socioeconomic status schools," the report reads.

Physical education was required for a part of the school year for 83 percent of middle-school students, but only 35 percent of high-school students. Only 10 to 13 percent of high-school students and 21 to 24 percent of middle-school students participated in intramural sports and physical activity clubs in 2008. Only a fourth of middle-school students and 14 percent of high-school students biked or walked to school in 2008.

The study is based on surveys that were mailed back from principals, food-service managers and other staff. In 2007, 222 middle schools and 224 high schools responded. In 2008, 265 middle schools and 262 high schools participated in the survey. The response rate from schools was 76 percent in 2007, 77 percent in 2008. The conclusions come in time for the implementation of the Healthy, Hunger-Free Kids Act of 2010. (Read more)

Legislators need to help cities tackle pill abuse, mayor says

Winchester's mayor is displeased with the Kentucky attorney general's recent finding that local governments do not have the right to ban pain clinics within their borders. "The opinion carries no legal authority, but it does represent a major roadblock for local governments," Ed Burtner writes. "It highlights the fact that local officials are limited to a reactive role in addressing the problems associated with prescription drugs abuse. That's unacceptable."

The Kentucky League of Cities supported three bills this year that would have regulated "pill mills," notes Burtner, who is on the league's executive board. None made it out of committee. "City officials throughout the state are committed to working with legislators, the Kentucky Medical Association and other interested parties to develop legislation that tackles prescription drug abuse head-on," Burtner wrote.

According to the Kentucky Office of Drug Control Policy, the abuse of prescription pain relievers in Kentucky is second only to marijuana. Prescription drug-related offenses increased by more than 13 percent in 2008. (Read more)

Adair hospital board broke meetings law, attorney general finds

Adair County Hospital's board of directors was wrong to hold a closed-session discussion about the future of an interim CEO because the discussion was about his retention, not posible discipline or dismissal, the Kentucky attorney general's office found. It also concluded the hospital board did not have sufficient cause to discuss a report by Spectrum Health Partners in private.

Adair County Community Voice Publisher Sharon Barton submitted a written complaint to the board chairman March 30 alleging the violations. To remedy the matter, she asked for a copy of the PowerPoint presentation that had been viewed during the meeting as well as any minutes, notes, records and any other documents that had been reviewed.

The board replied that it was "clearly entitled to discuss this issue in executive session" because it was a personnel issue and so exempt from public discussion.

Assistant Attorney General Amye Bensenhaver disagreed, saying the personnel exemption applies only to discussions that might lead to the appointment, discipline or dismissal of an employee, member or student. "This exception shall not be interpreted to permit discussion of general personnel matters in secret," she wrote. "The board acknowledges that the closed session discussion focused on securing the continued employment of the interim CEO and not on reviewing the comparative qualifications of competing applicants for the purpose of identifying the best qualified applicant to fill a vacant position. Although the potential for reputational damage exists where several individuals apply for a position and some must be eliminated based on their lesser qualifications, such potential does not exist where the discussion relates to the continued employment of a current employee."

Bensenhaver also said the board should not have discussed the Spectrum report in closed session. The board was obligated to give notice "in regular open meeting ... of the general nature of the business to be discussed in closed session," she wrote. In correspondence, the board said that the report "contained information on specific individuals that might lead to discipline or dismissal" or might lead to litigation. "Even with this additional information, we believe the board's ... compliance fell short of the statutory requirements," Bensenhaver wrote.

Ambulance providers raising fees to deal with rising costs

Ambulance services are being forced to raise their fees in order to pay the bills, USA Today's Greg Latshaw reports. "Ambulance providers nationwide are coping with rising costs, decreased support from local government, low Medicare reimbursement rates and a jump in the number of uninsured Americans," Stephen Williamson, president of the American Ambulance Association, told Latshaw.

Medicare reimbursement rates were between 6 and 17 percent below cost, a 2007 report by the Government Accountability Office showed. Since, that gap has grown even wider. Moreover, in the past 18 to 24 months, far more people are using ambulance services who don't have health insurance. "We're having to raise the rate on everyone else because of the people who don't have insurance," said Steve Weigland, director of servicing for the International Association of EMTs and Paramedics. (Read more)