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STUDY OF THE USE GE THE FRIJEN:!DSHIP NUTRII~IO2; EDUCATION * EARL LOMON KOOS THE PURPOSE OF THE STUDY PA T TERN TN Gne of the urgent needs in health education, and especially nutrition edu- cation, is for channels through which information can be diffused into the population. This need is especially urgent in the low income urbar1 areas where many factors militate against active participation by large :aumbers of tl~e population. Not only do sheer numbers of people and the great need for information add to the problem, but certain contributing factors are present. The most obvious of these is the physical condition of living to which the low income urban dweller is subjected. However, the tenement is not only a particular kind of building it is also "a way of living, a whole series of limits, attitudes and sentiments." From this way of living a narcotization results which renders the less able portion of the population insensitive to social stimuli. A second factor is the lack of education which enables the individual to cope with the problems of a complex urban environment. The cultural heritage of the foreign-born and of the native-born-of-foreign-par- ents provides a further handicap since Marty of our foreign-born come from those areas which brave had the least contact with modern ways of living. The fact that the transplanted cultural heritage rarely has a chance to be wholly old- or new-world has a bearing here. The difficulty for the low income family of living in a money-centered culture adds to o'er general problem. The sense of security which comes fry 'making a living rather than earning it" is lacking and the family supers accordingly. Attempts to set up channels to these groups ua-ve ~ Bully treks ens ,-~ ad_ other of three approaches: first, a spatial approach, such as the block plarl; second, an orgar.izatiGn approach which sets up a super-organization to dic- tate policies and procedures to existing organizations; third, by artificialyv ~r~sLrue'Led groups through which information is distributed. The first of Sac seemed undesirable since it has been determined empirically that asso- ciation tends to form without regard for area limits. The second appeared weak ire that it depends upon the strength of individual personalities arid their ability to finesse vested interests against each other. The third often failed when initial enthusiasms had waned and left a residue of discouraged par- ticipants. *An experiment undertaken by the Department of Public Health and Preventative Medicine of Cornell University Medical School in the Kipps-Bay Yorkville Area of New York City, with a grant from the Committee on Food Habits, National Research Council. 74

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Friendship Pattern: ill ~\rutritio?r Education 75 A study of urban life shows that the old feel is, of belonging to or being identified with a pa~ticutar ne~,3~borhood has waned. It is known however, that associations between individuals, and families, continue and that these assxiat~ons can be recognized as structures .~ the social pattern. The possible utilization o; these `'1riendship patterr~s" as a channel for diffusing knowled~,e, and as a possible channel through which the low income group can express its needs, was the primary purpose of this research project. A second purpose was to ascertain, in the brief time allotted ro the project, something about the social patterns of tile nationality groups arid the place of nutrition ii-. these patterns. ~ HE TECENIQUES EMPLOYFO Potential leaders were nest picked from among the women known to settie- ments and other agencies as leaders in community life. This was done because of the brief time elerner~t. These women were asked to invite five or six friends to a "nutrition luncheon" as guests of the leader. The luncheon was carefully planned to include as much nutrition information as could be put into the preparation and demonstration of one meal. Lyle purpose of this luncheon was twofold: it was obviously bait to attract women into the group but it had ~ folkway similarity in that it appealed to the "breaking bread witl: friends" idea current among this group. Its second purpose was to interest the women in nutrition and to make them a continuing unit in that interest. This first contact vvas to be followed by conferences of the group, closely following the outline of nutrition courses then being, offered in the area. Also, the nutritionist was to continue as consultant to these women through the course.o the project. As their contribution the women were asked to bring in menus and keep accurate shopping lists for the period of participation. Case studies of the participating, families at the beginning and the end of the project were to be made by the sociologist. An evaluation of the changes taking place between the beginning and the end of the project and a study of the patterns of friendship in relation to the natural areas and nationality distributions would enable us to learn the degree of effectiveness of this type of teaching. The ability to widen the effectiveness of such a program depends upon the fact that Mrs. A around whom the first group was built, invited Mrs. B. C D, E and :F to participate. Each of these women, in turn, had a set of friends not identical with those of Mrs. A; therefore each was potentially the center of another teaching unit. This widening of the circle of effectiveness would make it possible to reach a cross-section of the families ire any one natural area of the city. For experimental purposes, however, groups from several areas were to be chosen to show more clearly the results of such procedures and so that the coverage of several nationalities might be facilitated. THE OPERATION OF THE PROJECT In all, ~77 housewives were contacted in the course of the project and only ~2, or 6.770, refused any cooperation whatever. One hundred and forty

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76 The Problem of Changing Food Habits four, 8~.5 TO, of the total number refused to cooperate to the extent of having a luncheon, but discussed one or more phases of the nutritional pat- tern with the staff. Fourteen, or 7.8go, gave the luncheons and 7 others, or 470, agreed to do so but later failed to carry out their agreement. Of the ~44 housewives who refused to give a luncheon, 5~, or 3670, ex- pressed an interest in doing so but were sure their friends were not suf- ficiently interested in nutrition to participate. It- was our impression that this interest was in large measure a spurious one, since only 4 of these women had previously availed themselves of nutrition courses. Twenty-nine, or Promo, stated that they were unable to participate in the project because of either part time or full time employment. An additional ~6, or Who, re- garded their home duties as too strenuous to allow such participation. It was our impression that this reason originated more from the concept of the role of the woman in the low income home than from actual pressure of house- work. This was substantiated in part by the fact that these women appeared to experience little difficulty in shelving home duties when more interesting activities were available. Only 9, or 6.370, admitted that they were not in- terested in learning about nutrition. The remaining reasons assigned for refusing to cooperate were for the most part genuine and account for only hobo of the cases. Only 3 luncheon units were carried through the complete schedule. Two units, both Italian, were composed of relatives of the hostess, and these, to- gether with 8 others, did not return for follow-up conferences. The remain- ing luncheon (Hungarian) failed to attract any of the guests who had ac- cepted. This failure to cooperate seems to have its genesis in certain factors in the urban culture which have been mentioned in the Introduction. The follow-up study of the failures indicated that neither the structure of the project nor the methods employed by the nutritionist were at fault, since both were acceptable to the participants. THE FRIENDSHIP PATTERNS The configurations of the friendship patterns showed in only one instance a block pattern. They tend for the most part to confine themselves to the natural areas of the city and any of the friendships which cross these boun- daries appear to be the results of earlier associations. Figure I shows graphically the spatial distribution of the members of an Irish friendship pattern. It should be noted that none of these luncheons drew guests from within any one census or social block; they were confined, however, to the same natural area in the city. The sole exception was one guest at the third luncheon, a childhood friend of the hostess, who lived some fifteen blocks away. The second factor in determining the configurations of the friendship pat- terns was that of adherence to a local organization. The friendship pattern of the Irish group illustrated in Figure I Is shown in Figure II as it relates to the Mothers' Club in a local Catholic church. It will be seen that with the exception of persons Nos. 6 and id, all of the

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Friendship Pattern in Nutrition Education - ~r :~[10111~0 1@~53~: b nnnnnnnnn r 1; S;~F art| FIRST LUNCHEON GROUP Inn nnnnnnr oSE~D'u~-G~P O THIRD ~ RECHEW CROUP FIGURE I.-Spatial distribution of an Irish Friendship Pattern. -INDICATES PARTICIPANTS INCLUDE') IN ~OTHERS' CLI)8 (NOB. 6 AND 14 ONLY GUESTS NOT WITHIN THE ORGANIZA1~10N) FIGURE II. Relationship of Irish Friendship Pattern to established organization in the community. 77

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_Q The Problems of Gig Food Habits luncheon participants were found inside the shaded area which represents the aura of the ~Mothers' Club. The tendency of native-born-of-fo~ei~-~-parents to mix nationalities in their friendship patterns is seen in this project. The foreign-born hostesses invited only guests of their own nationality (and significantly from Within Heir own or:,anizations), whereas the r~ative-born hostesses failed to exercise such choice. In the case of the Irish pattern illustrated in Figures I and lit the fit st luncheon entertained ~ Irish and ~ Hungarian guests, the second, 4 Irish and ~ Czechoslovakian, and the third (a FInngarian hostess), ~ Irish and 3 Czechoslovakian guests. This pattern of isolating or Nixing nationalities In the friendship patterns has its chief significance in the idiomatic food pat- terns, which are discussed in a later section. IDIOM ATIC FOOD PATTERNS AMONG NATIONALITIES The nationalities comprising the population of Lois section of New York City are intermingled. Few tenements have residents of only one nationality and this intermingling apparently has done much to break down the idiocratic food patterns. While the foreign food patterns persist, there is apparently a modification of the native diet. (The stores supplying foods for particular rationalities have less of the special foods associated with particular groups than is the case in some other parts of the city. A special shopping study with volunteer workers was undertaken to ascertain this point.) Examples of this modification are found in Italian families where the housewives indi- cate an increased use of potatoes and ~ice, with a slightly decreased use of spaghetti. Of all the established diet patterns which are brou~-l~t to this country from foreign cultures, the pork-potato-cabbage-tea pattern of the Irish appears to continue with greater tenacity than does any other diet pattern. Several Irish families which are two generations removed from $oreign-born stock continue in this pattern, and it is a matter of some pride in the family. This accompanies an identification with "the ould sod" which seems to persist longer in the Irish families than in other nationalities. There are, however, remnants of this pride in a nationality diet in most of the other groups. The heavy diet of the meat-potato-vegetable variety which is enjoyed in the central European countries continues here. The Czechoslovakian, Hungarian' and German families studied all report adherence to this pattern. They do, however, admit to a greater choice and variety of food than was utilized in Europe. Regardless of the caloric requirements of the individual, these groups consume quantities of heavy food, even when in straitened economic circumstances. In this group, as with the Italians, food is mentioned re- peatedly as being eaten for enjoyment. A further demonstration of the high esteem in which these groups regard food is evidenced by the fact that it is rarely used as a psychological weapon for forcing obedience or for the punishment of children. Likewise, the families studied in these nationalities exerted less pressure upon the children to eat particular foods than do the Irish.

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Friendship Pattern its lV;ttrition Education, 79 Certain of the ideas and patterns idiomatic to these nationalities appear to have sloughed off or are in the process of disintegration. Faced with new patterns of food distribution and food preparation, many housewives have found it expedient to forego established practices in food preparations. The Italians' increased use of canned and other prepared foods is an example of this. Nutritionists have told us that except for tomatoes and tomato paste, the Italian woman regards tinned food as an abomination. In a majority of the Italian homes, however, we found tinned food of other varieties, and prepared cereals were in general use. The influence of the school lunch, of the factory cafeteria meal, etc., is felt among these families. Many reported some event or circumstance outside the home which caused a new food to be adopted, or an old one to be dropped from use. This was especially true where late adolescents were in the family and certain foods had a high value for their status giving qualities. FACTORS INFLUENCING THE FAMILY S NUTRITION PATTERN The nutrition patterns of the families studied appear to be influenced by two sets of factors those inherited from the past and those operative in the environment. The relative weights of the two vary from family to family and from nationality to nationality but a few are found consistently. The first of these is the status giving quality of certain foods. A major portion of the low income families we have studied came from European peasant stock, and therefore had been confined to less varied and more~simple foods than are available here. Foods which in our culture have only utility value carry in European cultures a connotation of wealth and position. The ability to buy meat at all times, and even on limited budgets, is status giving and is not likely to be relinquished without adverse effects. The same atti- tude seems to hold for white bread. Only a few families admitted the use of whole wheat breads, and less than loft used enriched white bread. The identification of whole wheat bread with the dark breads of low income European diets militates against its acceptance. This attitude was so usual about meat (especially beef) and bread, that it offers a clue as to reasons for rejecting contemporary nutritional teachings. A summation of this idea is represented in the statement of a Polish woman (not in the present group) who was asked her reasons for not enrolling in a nutrition course: "Why should I take a course those teachers just want you to do things a certain way. In Poland we had to eat a certain way it was all we had to eat. Here we can have what we want to eat-why should I let her (the nutritionist) tell me what to eat and how to eat it?" This desire for freedom of choice, and especially to choose those foods which are symbols of status, appears to be so universal among the low income groups as to warrant consideration by nutritionists when planning low income courses. The outstanding example of this lack of consideration is the resent- ment our respondents expressed at being told to eat the cheaper cuts of meat. Our nutritionist was careful to avoid this mistake, but resentment on this point was generated by current advertising and by the publicity of agencies and industry

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80 The Problem of Changing Food Habits In addition to the symbolic values of certain foods, the unregimented use of foods appears to have a "release" value. Whether or not the respondent buys wisely or prepares the food well is not important here the important thing seems to be that choice and the ability to "splurge" on food provides a psychological release from the problems of urban living. The buying patterns of these families vary greatly as to place and time, but they are confined largely to day-by-day buying. Most of the women rec- ognized the value of quantity purchases and of planned purchasing, but the physical environment prohibits storage of perishable and bulky foods. Meal- by-meal buying has a psychological value, too, for many of these women, since it provides an excuse for getting out of the tenement. Here again a conflict exists between the low income consumer of nutrition information and the nutritionist whose orientation, in the main, is not toward the low income group. The fact that the number of prepared foods has increased greatly in recent years, coupled with the physical limitations of the low income homes, seems to have an effect upon the nutrition patterns of these families. Overcrowding is so universal, and housing conditions in general are so poor, that the utilization of things which make the task of food preparation less complicated is understandable. Here again it seems to us to be necessary for the nu- tritionist interested ire implementing a program to consider the nutrition pat- terns as single facets in the whole problem. The cultures out of which our respondents have come, either directly or one generation removed, have stressed the sanctity of the home and have emphasized its place as a training center for living. From this has come the practical attitude that "what we did at home, what we were taught, is right," even when forced adjustments to the present environment are made. Eighty- nine respondents mentioned the strength of this influence when discussing reasons why they were not affected by nutritional teaching. However, this resentment seemed to arise only when the food pattern as a whole was at- tacked. When pressure was exerted on isolated items in the diet, a more favorable response resulted. The educational campaign for increased use of milk, for example, has occasioned less resentment than the "You Must Eat These Five Foods Every Day for Health" campaign recently instituted. The former is additive, and therefore not necessarily destructive of values inherited from the past. SUMMARY Our original premise included an indictment of the "block plan" and of the "organizations" plan, with the assumption that the natural friendship pattern would be more effective for diffusing information on nutrition. This as- sumption seems unwarranted in view of the fact that the destruction of the peer-nature of the friendship pattern, or the introduction of an ulterior motive, tends to render ineffective this pattern. The fact that friendship patterns operate for the most part within the confines of existing organizations suggests that strong local organizations

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Friendsl~;p Pattern in Nutrition Educatio;r 81 can be utilized as channels for the diffusion of information. The fact that th urban culture is crowded with organizations which overlap spatially seems to indicate a possible coverage that would be adequate. The wide variety of foods available to the low income family, the inter- digitation of nationalities, and the pressure of American institutions on the family through the children and through industrial and social contacts, have all tended to weaken the idiomatic food patterns. The psychological value gained frown the use of certain foods and in par- ticular ways is greater than are the benefits from the usual nutrition course. Unless the nutritionist is willing to recognize these factors, the effectiveness of her work with the low income group is doubtful. 6