Presenter Name Meeting Date This presentation was prepared with assistance from Docs For Tots, docsfortots.

1.  Presenter Name Meeting Date This presentation was prepared with assistance from Docs For Tots, www.docsfortots.org.

2. WHAT IS GOOD NUTRITION? Good nutrition means consuming enough of the essential nutrients that bodies require for growth.1 For children ages 2 to 6, this means1: 6 servings from the grain group 3 servings from the vegetable group 2 servings from the fruit group 2 servings from the meat & bean group It also means eating a variety of foods daily & choosing foods that are low in saturated fat and cholesterol.1 Children need adequate calories not only for basic growth, but also for more “discretionary activity”---exploring the world around them.2 Source: 1USDA Dietary Guidelines for Americans 2000, 5th Edition, http://www.usda.gov/cnpp/Pubs/DG2000/ 2Cook, J.T. & Frank, D.F. (2004). P-I Focus: Hunger filled with dire consequences. http://seattlepi.nwsource.com/opinion/164900_hungerfocus21.html? Good nutrition means consuming enough of the essential nutrients that bodies require for growth. For children ages 2 to 6, this means: 6 servings from the grain group 3 servings from the vegetable group 2 servings from the fruit group 2 servings from the meat & bean group It also means eating a variety of foods daily & choosing foods that are low in saturated fat and cholesterol. Children need adequate calories not only for basic growth, but also for more “discretionary activity”---exploring the world around them. Good nutrition means consuming enough of the essential nutrients that bodies require for growth. For children ages 2 to 6, this means: 6 servings from the grain group 3 servings from the vegetable group 2 servings from the fruit group 2 servings from the meat & bean group It also means eating a variety of foods daily & choosing foods that are low in saturated fat and cholesterol. Children need adequate calories not only for basic growth, but also for more “discretionary activity”---exploring the world around them.

3. USDA’s FOOD GUIDE PYRAMID While not all experts agree on the appropriateness of the food pyramid, it is the current set of recommendations from the USDA. From the USDA: http://www.health.gov/dietaryguidelines/dga2000/document/build.htm#pyramidWhile not all experts agree on the appropriateness of the food pyramid, it is the current set of recommendations from the USDA. From the USDA: http://www.health.gov/dietaryguidelines/dga2000/document/build.htm#pyramid

4. INDICATORS OF POOR NUTRITION Growth stunting Defined as height for age below the fifth percentile. Results from prolonged or repeated episodes of nutritional deficiency. Anemia---an iron deficiency Deficiencies in vital nutrients (aside from iron), such as folate, magnesium, thiamin, vitamin A, vitamin B6, vitamin C, vitamin E, and zinc Speaker’s Notes: There are certain indicators of poor child nutrition, including growth stunting, anemia and vitamin deficiencies. When food is inadequate, a child’s body first limits social activity and cognitive development and then growth is affected, leading to growth stunting-defined as height for age below the 5th percentile. This is a final result from prolonged or repeated episodes of nutritional deficiency. Anemia seen as a result of poor nutrition is most often due to a deficiency of iron. In addition, specific deficiencies of other vital nutrients, such as folate, magnesium, thiamin, vitamin A, vitamin B6, vitamin C, vitamin E, and zinc can be found. Other, less commonly found deficiencies, include calcium and vitamin D, both of which can be associated with the development of rickets, a childhood disorder involving softening and weakening of the bones. Other bone diseases, including osteoporosis, may also have their roots in childhood nutrition and inadequate intake of calcium. Additional Resources and Background (not for use during presentation): For more information on growth stunting, see: Lewit, E.M., & Kerrebrock, N. (1997). Population-based growth stunting. The Future of Children, 7, 149-156. For a parent-friendly guide to anemia, see: http://www.keepkidshealthy.com/welcome/commonproblems/anemia.html For more information on nutrient deficiencies, see: America’s Second Harvest, http://www.secondharvest.org/site_content.asp?s=58 Speaker’s Notes: There are certain indicators of poor child nutrition, including growth stunting, anemia and vitamin deficiencies. When food is inadequate, a child’s body first limits social activity and cognitive development and then growth is affected, leading to growth stunting-defined as height for age below the 5th percentile. This is a final result from prolonged or repeated episodes of nutritional deficiency. Anemia seen as a result of poor nutrition is most often due to a deficiency of iron. In addition, specific deficiencies of other vital nutrients, such as folate, magnesium, thiamin, vitamin A, vitamin B6, vitamin C, vitamin E, and zinc can be found. Other, less commonly found deficiencies, include calcium and vitamin D, both of which can be associated with the development of rickets, a childhood disorder involving softening and weakening of the bones. Other bone diseases, including osteoporosis, may also have their roots in childhood nutrition and inadequate intake of calcium. Additional Resources and Background (not for use during presentation): For more information on growth stunting, see: Lewit, E.M., & Kerrebrock, N. (1997). Population-based growth stunting. The Future of Children, 7, 149-156. For a parent-friendly guide to anemia, see: http://www.keepkidshealthy.com/welcome/commonproblems/anemia.html For more information on nutrient deficiencies, see: America’s Second Harvest, http://www.secondharvest.org/site_content.asp?s=58

5. POOR NUTRITION & POVERTY Children living in poverty are considerably more likely to suffer from inadequate nutrition. Over 40% of low-income children live in households that are hungry or at risk of hunger. Source: Center on Hunger and Poverty. (nd). Fast facts about hunger. Retrieved March 2, 2004 from http://www.centeronhunger.org/facts.html Speaker’s notes: Research demonstrates that children living in poverty are considerably more likely to suffer from inadequate nutrition than children not living in poverty. According to the Center on Hunger and Poverty, over 40% of low-income children live in households that are hungry or at risk of hunger. According to the Food Research and Action Center, hunger in America refers to the “recurrent and involuntary lack of access to sufficient food due to poverty or constrained resources, which can lead to malnutrition over time.” While starvation seldom occurs in this country, children and adults do go hungry and chronic mild undernutrition does occur when financial resources are low. The mental and physical changes that accompany inadequate food intakes can have harmful effects on learning, development, productivity, physical and psychological health, and family life. Additional and background resources (not for use during presentation): America’s Second Harvest, http://www.secondharvest.org/default.asp Food Research and Action Center, Hunger and Food Insecurity in the United States, http://www.frac.org/html/hunger_in_the_us/hunger_index.htmlSpeaker’s notes: Research demonstrates that children living in poverty are considerably more likely to suffer from inadequate nutrition than children not living in poverty. According to the Center on Hunger and Poverty, over 40% of low-income children live in households that are hungry or at risk of hunger. According to the Food Research and Action Center, hunger in America refers to the “recurrent and involuntary lack of access to sufficient food due to poverty or constrained resources, which can lead to malnutrition over time.” While starvation seldom occurs in this country, children and adults do go hungry and chronic mild undernutrition does occur when financial resources are low. The mental and physical changes that accompany inadequate food intakes can have harmful effects on learning, development, productivity, physical and psychological health, and family life. Additional and background resources (not for use during presentation): America’s Second Harvest, http://www.secondharvest.org/default.asp Food Research and Action Center, Hunger and Food Insecurity in the United States, http://www.frac.org/html/hunger_in_the_us/hunger_index.html

6. POOR NUTRITION INFLUENCES CHILD DEVELOPMENT Poor nutrition and under-nutrition affect children’s development. Malnutrition has been associated with lower scores on tests of cognitive development. One specific example: Anemia has been shown to influence attention span and memory, limiting a child’s ability to learn. Source: Center on Hunger and Poverty. (1998). Statement on the link between nutrition and cognitive development in children. http://www.centeronhunger.org/cognitive.html Speaker’s Notes: Poor nutrition and under-nutrition has been identified as one of the potential pathways through which poverty effects children’s development. When children do not receive adequate nutrition, energy is not available for social and cognitive development. Research demonstrates that indicators of poor nutrition and malnutrition have been associated with lower scores on tests of cognitive development. For example, anemia specifically has been shown to influence attention span and memory, limiting a child’s ability to learn. Additional and Background Resources (not for use during presentation): For a more thorough review of the role of nutrition as a mechanism via which poverty affects children, see: Askew, A., & Wise, P. (1999). The Neighborhood: Poverty, Affluence, Geographic Mobility and Violence. In M. Levine et al (Eds.) Developmental-Behavioral Pediatrics 3rd Edition. Philadelphia: W.B. Saunders. Brooks-Gunn, J., & Duncan, G.J. (1997). The effects of poverty on children. The Future of Children, 7, 55-71. Speaker’s Notes: Poor nutrition and under-nutrition has been identified as one of the potential pathways through which poverty effects children’s development. When children do not receive adequate nutrition, energy is not available for social and cognitive development. Research demonstrates that indicators of poor nutrition and malnutrition have been associated with lower scores on tests of cognitive development. For example, anemia specifically has been shown to influence attention span and memory, limiting a child’s ability to learn. Additional and Background Resources (not for use during presentation): For a more thorough review of the role of nutrition as a mechanism via which poverty affects children, see: Askew, A., & Wise, P. (1999). The Neighborhood: Poverty, Affluence, Geographic Mobility and Violence. In M. Levine et al (Eds.) Developmental-Behavioral Pediatrics 3rd Edition. Philadelphia: W.B. Saunders. Brooks-Gunn, J., & Duncan, G.J. (1997). The effects of poverty on children. The Future of Children, 7, 55-71.

7. NUTRITION AND POVERTY PROGRAMS CAN IMPROVE CHILD OUTCOMES Programs which work to alleviate poverty in general, as well as policies and programs specifically geared towards nutrition, can improve children’s cognitive, behavioral and social outcomes as well as health-related outcomes. Speaker’s Notes: When family resources in general are limited, hunger is likely to develop. Families may be forced to choose between nutritious food and some other necessity. Therefore, policies and programs that work to alleviate poverty in general, as well as policies and programs specifically geared towards nutrition can improve a family’s nutrition status and overall well-being. This can result in improved cognitive, behavioral and social outcomes as well as health-related outcomes for children. For example, the researchers at the Children’s Sentinel Nutrition Assessment Program (C-SNAP, see Slide 16 for additional information) examined the effect of a family’s participation in the Low Income Home Energy Assistance Program (LIHEAP) on household food security. They found that receipt of LIHEAP was associated with lower levels of under-nutrition among children. Source: Frank, D.A., Skalicky, A., Cook, J., Levenson, S., Meyers, A., Cutts, D., Casey, P., Black, M., Zaldivar, N., Berkowitz, C., & C-SNAP Study Group. (2003). Heat or eat: Low Income Home Energy Assistance Program and nutritional risk among children < 3. Retrieved March 4, 2004 from http://dcc2.bumc.bu.edu/csnappublic/liheap.htmSpeaker’s Notes: When family resources in general are limited, hunger is likely to develop. Families may be forced to choose between nutritious food and some other necessity. Therefore, policies and programs that work to alleviate poverty in general, as well as policies and programs specifically geared towards nutrition can improve a family’s nutrition status and overall well-being. This can result in improved cognitive, behavioral and social outcomes as well as health-related outcomes for children. For example, the researchers at the Children’s Sentinel Nutrition Assessment Program (C-SNAP, see Slide 16 for additional information) examined the effect of a family’s participation in the Low Income Home Energy Assistance Program (LIHEAP) on household food security. They found that receipt of LIHEAP was associated with lower levels of under-nutrition among children. Source: Frank, D.A., Skalicky, A., Cook, J., Levenson, S., Meyers, A., Cutts, D., Casey, P., Black, M., Zaldivar, N., Berkowitz, C., & C-SNAP Study Group. (2003). Heat or eat: Low Income Home Energy Assistance Program and nutritional risk among children < 3. Retrieved March 4, 2004 from http://dcc2.bumc.bu.edu/csnappublic/liheap.htm

8. NUTRITION AND POVERTY PROGRAMS Programs that specifically address nutrition: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Stamps National School Lunch Program (NSLP) Programs that address poverty more generally: Temporary Assistance to Needy Families (TANF) Additional, smaller programs: School Breakfast Program Special Milk Program Summer Food Service Program Child and Adult Care Food Program Speaker’s Notes: Programs that specifically address nutrition: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Stamps National School Lunch Program (NSLP) In 2000, USDA spent $32.5 billion on food assistance programs---over 90% of that on these three programs (WIC, FS, NSLP). Programs that address poverty more generally: Temporary Assistance to Needy Families (TANF) Additional, smaller programs: School Breakfast Program Special Milk Program Summer Food Service Program Child and Adult Care Food Program Additional and Background Information: Brief descriptions of each smaller program follow: The School Breakfast Program was founded in 1966 as part of the Child Nutrition Act. It is a federally-assisted program that provides low-cost or free breakfasts to children in both public and private schools. The Special Milk Program was also created by the Child Nutrition Act in 1966. It provides free or reduced cost milk to children in schools and child care institutions that don’t participate in other nutrition meal service programs. The Summer Food Service Program is the primary federal resource available for local programs that want to combine a summary activity program with a feeding program. The following types of groups may be eligible to participate: public or private nonprofit schools; private nonprofit organizations; public or private nonprofit camps; public or private nonprofit universities or colleges; and units of local, municipal, count, tribal, or State government. The Child and Adult Care Food Program is administered through grants to the states. Independent centers and sponsoring organizations enter into agreements with their State agencies to provide nutritious meals and snacks to eligible children and adults. Participating organizations include child care centers, day care homes, adult day care centers, homeless shelters,  and after- school care programs. For an excellent overview of the 4 programs that are highlighted in this presentation (WIC, FS, NSLP, TANF), including descriptions of the programs themselves and information on usage rates and patterns of “bundling” of programs, see Winicki, J. (2001). Low-income families participating in fewer assistance programs. FoodReview, 24, 38-45. For further information on the smaller programs, see the American School Food Service Association: www.asfsa.org/childnutrition/history/Speaker’s Notes: Programs that specifically address nutrition: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Stamps National School Lunch Program (NSLP) In 2000, USDA spent $32.5 billion on food assistance programs---over 90% of that on these three programs (WIC, FS, NSLP). Programs that address poverty more generally: Temporary Assistance to Needy Families (TANF) Additional, smaller programs: School Breakfast Program Special Milk Program Summer Food Service Program Child and Adult Care Food Program Additional and Background Information: Brief descriptions of each smaller program follow: The School Breakfast Program was founded in 1966 as part of the Child Nutrition Act. It is a federally-assisted program that provides low-cost or free breakfasts to children in both public and private schools. The Special Milk Program was also created by the Child Nutrition Act in 1966. It provides free or reduced cost milk to children in schools and child care institutions that don’t participate in other nutrition meal service programs. The Summer Food Service Program is the primary federal resource available for local programs that want to combine a summary activity program with a feeding program. The following types of groups may be eligible to participate: public or private nonprofit schools; private nonprofit organizations; public or private nonprofit camps; public or private nonprofit universities or colleges; and units of local, municipal, count, tribal, or State government. The Child and Adult Care Food Program is administered through grants to the states. Independent centers and sponsoring organizations enter into agreements with their State agencies to provide nutritious meals and snacks to eligible children and adults. Participating organizations include child care centers, day care homes, adult day care centers, homeless shelters,  and after- school care programs. For an excellent overview of the 4 programs that are highlighted in this presentation (WIC, FS, NSLP, TANF), including descriptions of the programs themselves and information on usage rates and patterns of “bundling” of programs, see Winicki, J. (2001). Low-income families participating in fewer assistance programs. FoodReview, 24, 38-45. For further information on the smaller programs, see the American School Food Service Association: www.asfsa.org/childnutrition/history/

9. WIC---BASIC FACTS Provides vouchers for nutritionally dense foods to pregnant or breastfeeding women, infants & children up to 5 years old Nutrition education and health referrals Eligibility: doctor, nurse, or nutritionist determines nutritional risk income below 185% of federal poverty line* Food stamp, TANF (welfare) or CHIP receipt=automatic eligibility Average monthly benefit in 2003 was $35.23 in vouchers.1 *In 2004, the federal poverty line for a family of four is $18,850. 185% of FPL = $34,873. Source: 1 USDA Food & Nutrition Service, 2004, http://www.fns.usda.gov/pd/wisummary.htm Speaker’s Notes: WIC provides vouchers for nutritionally dense foods to pregnant or breastfeeding women, infants & children up to 5 years old. WIC provides foods high in five target nutrients: protein, calcium, iron, and vitamins A & C. In addition to providing nutritious foods to supplement diets, WIC provides nutrition education and referrals to health care and social services to participants at no charge. In 1999, WIC served 7.3 million per month, and half of those were children (Oliveira & Gundersen, 2001). The Food and Nutrition Service administers the WIC Program at the Federal level; state agencies are responsible for determining participant eligibility and providing benefits and services. Applicants must be seen by a health professional such as a medical doctor, nurse, or nutritionist who must determine whether the individual is at nutrition risk.  They must also meet income criteria of income less than 185% of the federal poverty line. In many cases, this is done in the WIC clinic at no cost to the applicant.  However, this information can be obtained from another health professional such as the applicant's physician. In addition to income requirements, certain applicants can be determined income-eligible for WIC based on their participation in certain programs including Food Stamps, Medicaid, for Temporary Assistance for Needy Families (TANF). The average monthly benefit in 2003 was $35.23 in vouchers. Additional and Background Resources (not for use during presentation): More information: http://www.fns.usda.gov/wic/ Oliveira, V., & Gundersen, C. (2001). WIC increases the nutrient intake of children. FoodReview, 24, 27-30. Data on benefit rates comes from the USDA Food & Nutrition Service: http://www.fns.usda.gov/pd/wisummary.htm Speaker’s Notes: WIC provides vouchers for nutritionally dense foods to pregnant or breastfeeding women, infants & children up to 5 years old. WIC provides foods high in five target nutrients: protein, calcium, iron, and vitamins A & C. In addition to providing nutritious foods to supplement diets, WIC provides nutrition education and referrals to health care and social services to participants at no charge. In 1999, WIC served 7.3 million per month, and half of those were children (Oliveira & Gundersen, 2001). The Food and Nutrition Service administers the WIC Program at the Federal level; state agencies are responsible for determining participant eligibility and providing benefits and services. Applicants must be seen by a health professional such as a medical doctor, nurse, or nutritionist who must determine whether the individual is at nutrition risk.  They must also meet income criteria of income less than 185% of the federal poverty line. In many cases, this is done in the WIC clinic at no cost to the applicant.  However, this information can be obtained from another health professional such as the applicant's physician. In addition to income requirements, certain applicants can be determined income-eligible for WIC based on their participation in certain programs including Food Stamps, Medicaid, for Temporary Assistance for Needy Families (TANF). The average monthly benefit in 2003 was $35.23 in vouchers. Additional and Background Resources (not for use during presentation): More information: http://www.fns.usda.gov/wic/ Oliveira, V., & Gundersen, C. (2001). WIC increases the nutrient intake of children. FoodReview, 24, 27-30. Data on benefit rates comes from the USDA Food & Nutrition Service: http://www.fns.usda.gov/pd/wisummary.htm

10. WIC---EFFECTS ON NUTRITION Research indicates that WIC has positive effects on participants’ nutrition and health including: increased nutrient intake including iron, B6 and folate (by 21%, 23% and 91% of RDA, respectively).1 positive effects on birth weight & infant temperament.2 decreased odds of being diagnosed with a nutrition deficiency by 74 percent.3 Sources 1Oliveira, V. & Gundersen, C. (2001). WIC increases the nutrient intake of children. FoodReview, 24, 27-30. 2Kowaleski-Jones, L. & Duncan, G. (2001). The effects of WIC on children’s health and development. Poverty Research News, 5 (2), 6-7. 3Lee, B.J., Mackey-Bilaver, L., & Goerge, R.M. (2000). The patterns of Food Stamp and WIC participation and their effects on health of low-income children. JCPR Working Paper 129. Speaker’s Notes: Research of the WIC program shows that it has positive effects on participants’ nutrition and health including increasing nutrient intake of iron, B6 and folate (by 21%, 23% and 91% of RDA, respectively). It also had positive effects on birth weight and infant temperament and decreased the odds of being diagnosed with a nutrition deficiency by 74 percent. Additional and Background Information (not for use during presentation): The USDA ERS study (first study listed) compared nutrient intake of children receiving WIC with nutrient intake of children who were eligible but did not receive WIC. They used data from the 1994-96 Continuing Survey of Food Intake by Individuals (CSFII) and included children 1-4 years of age who had 2 days of data. Oliveira, V. & Gundersen, C. (2001). WIC increases the nutrient intake of children. FoodReview, 24, 27-30. Kowaleski-Jones & Duncan used data from the National Longitudinal Survey of Youth, comparing siblings whose mother used WIC with one but not the other. The sample size was 71 sibling pairs. Kowaleski-Jones, L. & Duncan, G. (2001). The effects of WIC on children’s health and development. Poverty Research News, 5 (2), 6-7. Lee, Mackey-Bilaver & Goerge used administrative data from Illinois that examined patterns of Food Stamp, WIC, and Medicaid use. Lee, B.J., Mackey-Bilaver, L., & Goerge, R.M. (2000). The patterns of Food Stamp and WIC participation and their effects on health of low-income children. JCPR Working Paper 129. While this information presented focuses primarily on effects on infants and young children, WIC’s effects prenatally have also been well-established. For example, as cited by Oliveira and Gundersen, a 5-state study in 1990 found that every $1 WIC spent on women while they were pregnant translated to up to a $3.13 saving in Medicaid costs over the first 60 days of the child’s life. Use of WIC prenatally was also associated with higher birthweight, lower chance of preterm birth, and a longer gestational period. More information: WIC Works Resource System: http://www.nal.usda.gov/wicworks/ Speaker’s Notes: Research of the WIC program shows that it has positive effects on participants’ nutrition and health including increasing nutrient intake of iron, B6 and folate (by 21%, 23% and 91% of RDA, respectively). It also had positive effects on birth weight and infant temperament and decreased the odds of being diagnosed with a nutrition deficiency by 74 percent. Additional and Background Information (not for use during presentation): The USDA ERS study (first study listed) compared nutrient intake of children receiving WIC with nutrient intake of children who were eligible but did not receive WIC. They used data from the 1994-96 Continuing Survey of Food Intake by Individuals (CSFII) and included children 1-4 years of age who had 2 days of data. Oliveira, V. & Gundersen, C. (2001). WIC increases the nutrient intake of children. FoodReview, 24, 27-30. Kowaleski-Jones & Duncan used data from the National Longitudinal Survey of Youth, comparing siblings whose mother used WIC with one but not the other. The sample size was 71 sibling pairs. Kowaleski-Jones, L. & Duncan, G. (2001). The effects of WIC on children’s health and development. Poverty Research News, 5 (2), 6-7. Lee, Mackey-Bilaver & Goerge used administrative data from Illinois that examined patterns of Food Stamp, WIC, and Medicaid use. Lee, B.J., Mackey-Bilaver, L., & Goerge, R.M. (2000). The patterns of Food Stamp and WIC participation and their effects on health of low-income children. JCPR Working Paper 129. While this information presented focuses primarily on effects on infants and young children, WIC’s effects prenatally have also been well-established. For example, as cited by Oliveira and Gundersen, a 5-state study in 1990 found that every $1 WIC spent on women while they were pregnant translated to up to a $3.13 saving in Medicaid costs over the first 60 days of the child’s life. Use of WIC prenatally was also associated with higher birthweight, lower chance of preterm birth, and a longer gestational period. More information: WIC Works Resource System: http://www.nal.usda.gov/wicworks/

11. FOOD STAMPS---BASIC FACTS The Food Stamp program provides low-income households with coupons or electronic benefits they can use like cash at most grocery stores to ensure that they have access to a healthy diet. Eligibility: gross household income at or below 130% of federal poverty line Average monthly benefit in 2003 was $83.91 per person.1 Source: 1Food & Nutrition Service, 2004, http://www.fns.usda.gov/pd/fssummar.htm Speaker’s Notes: The Food Stamp program provides low-income households with coupons or electronic benefits they can use like cash at most grocery stores to ensure that they have access to a healthy diet. As with WIC, the Food and Nutrition Service administers Food Stamps at the federal level. Individuals apply for Food Stamps through local welfare offices, and that is where eligibility is determined. In order to be eligible, a household must have a gross household income at or below 130% of federal poverty line. States switched to an electronic benefits transfer system (EBT) starting in 2002, which means that individuals now receive what is essentially a debit card to use to purchase food. Food Stamps can be used to purchase food for the household to eat or seeds and plants which produce food. Food Stamps cannot be used to purchase alcohol or tobacco or non-food items, such as pet food, paper products, cleaning supplies, etc. The average monthly benefit in 2003 was $83.91 per person. Following welfare reform, there was a marked trend in families who were leaving welfare also stopping receipt of other government benefits, such as Food Stamps. This may have been because Food Stamps was often provided in conjunction with Temporary Assistance to Needy Families (TANF), welfare, and so families assumed they were no longer eligible for Food Stamps. Another possibility for the decline in receipt, aside from confusion over eligibility, was difficulty in meeting the ongoing administrative requirements. Recent research shows that this trend may be reversing and that Food Stamp receipt is higher among recent welfare leavers than among early welfare leavers. This increased use of Food Stamps and other benefit programs may be helping families to stay off welfare. Additional and Background Resources (not for use during presentation): For more information see: Loprest, P.J. (2003). Use of government benefits increases among families leaving welfare. Washington, D.C.: Urban Institute. Data on benefit rates comes from the USDA Food & Nutrition Service: http://www.fns.usda.gov/pd/fssummar.htm More information: http://www.fns.usda.gov/fsp/ http://www.frac.org/html/federal_food_programs/programs/fsp.html Speaker’s Notes: The Food Stamp program provides low-income households with coupons or electronic benefits they can use like cash at most grocery stores to ensure that they have access to a healthy diet. As with WIC, the Food and Nutrition Service administers Food Stamps at the federal level. Individuals apply for Food Stamps through local welfare offices, and that is where eligibility is determined. In order to be eligible, a household must have a gross household income at or below 130% of federal poverty line. States switched to an electronic benefits transfer system (EBT) starting in 2002, which means that individuals now receive what is essentially a debit card to use to purchase food. Food Stamps can be used to purchase food for the household to eat or seeds and plants which produce food. Food Stamps cannot be used to purchase alcohol or tobacco or non-food items, such as pet food, paper products, cleaning supplies, etc. The average monthly benefit in 2003 was $83.91 per person. Following welfare reform, there was a marked trend in families who were leaving welfare also stopping receipt of other government benefits, such as Food Stamps. This may have been because Food Stamps was often provided in conjunction with Temporary Assistance to Needy Families (TANF), welfare, and so families assumed they were no longer eligible for Food Stamps. Another possibility for the decline in receipt, aside from confusion over eligibility, was difficulty in meeting the ongoing administrative requirements. Recent research shows that this trend may be reversing and that Food Stamp receipt is higher among recent welfare leavers than among early welfare leavers. This increased use of Food Stamps and other benefit programs may be helping families to stay off welfare. Additional and Background Resources (not for use during presentation): For more information see: Loprest, P.J. (2003). Use of government benefits increases among families leaving welfare. Washington, D.C.: Urban Institute. Data on benefit rates comes from the USDA Food & Nutrition Service: http://www.fns.usda.gov/pd/fssummar.htm More information: http://www.fns.usda.gov/fsp/ http://www.frac.org/html/federal_food_programs/programs/fsp.html

12. FOOD STAMPS---EFFECTS ON NUTRITION Food Stamp participation is associated with: above-median intake for vitamin B6, folate & iron1 increased intake of iron, zinc, vitamin A, thiamin & niacin2 Duration of Food Stamps (e.g. if it lasted for 3 weeks or 4 weeks of the month) was found to be a predictor of food security.1 Sources: 1Perez-Escamilla, R., Ferris, A.M., Drake, L., Haldeman, L., Peranick, J., Campbell, M., Peng, Y.K., Burke, G., & Bernstein, B. (2000). Food stamps are associated with food security and dietary intake of inner-city preschoolers from Hartford, CT. The Journal of Nutrition, 130, 2711-2717. 2Rose, D., Habicht, J., & Devaney, B. (1998). Household participation in the Food Stamp and WIC programs increases the nutrient intakes of preschool children. The Journal of Nutrition, 128, 548-555. Speaker’s Notes: Studies of the Food Stamp program found that participation is associated with above-median intake and increased intake of certain nutrients, including vitamin B6, folate, iron, zinc, vitamin A, thiamin, and niacin. In addition, duration of food stamps, if it lasted for 3 or 4 weeks of the month, was a predictor of food security. Additional and Background Information and findings from the studies in this slide (not for use during presentation): Perez-Escamilla & colleagues compared food & nutrient intake of preschoolers in Hartford, CT whose families received food stamps with those who didn’t (all received WIC). Their sample included preschoolers in Hartford CT (n=59 enrolled in Food Stamps, 40 not enrolled). Some additional findings from their study: duration of Food Stamps (e.g. if it lasted for 3 weeks or 4 weeks of the month) was found to be a predictor of food security Kids not receiving FS were more likely to consume <8mg of iron/d Kids receiving FS tended to consume higher levels of “soda & artificially flavored beverages” Perez-Escamilla, R., Ferris, A.M., Drake, L., Haldeman, L., Peranick, J., Campbell, M., Peng, Y.K., Burke, G., & Bernstein, B. (2000). Food stamps are associated with food security and dietary intake of inner-city preschoolers from Hartford, CT. The Journal of Nutrition, 130, 2711-2717. Rose et al., examined effects of WIC and FS participation on nutrient intake of preschoolers. They used data from the 1989-1991 Continuing Survey of Food Intake by Individuals (CSFII). Their sample was 499 prescoolers between the ages of 1 & 5. Some additional findings from their study: $1 of FS per person in the household was associated with an increased iron intake of .22 RDA percentage points & an increased zinc intake of .16 RDA percentage points for preschoolers No effects of FS participation on percentage of energy from fat, saturated fat, or cholesterol Rose, D., Habicht, J., & Devaney, B. (1998). Household participation in the Food Stamp and WIC programs increases the nutrient intakes of preschool children. The Journal of Nutrition, 128, 548-555. Speaker’s Notes: Studies of the Food Stamp program found that participation is associated with above-median intake and increased intake of certain nutrients, including vitamin B6, folate, iron, zinc, vitamin A, thiamin, and niacin. In addition, duration of food stamps, if it lasted for 3 or 4 weeks of the month, was a predictor of food security. Additional and Background Information and findings from the studies in this slide (not for use during presentation): Perez-Escamilla & colleagues compared food & nutrient intake of preschoolers in Hartford, CT whose families received food stamps with those who didn’t (all received WIC). Their sample included preschoolers in Hartford CT (n=59 enrolled in Food Stamps, 40 not enrolled). Some additional findings from their study: duration of Food Stamps (e.g. if it lasted for 3 weeks or 4 weeks of the month) was found to be a predictor of food security Kids not receiving FS were more likely to consume <8mg of iron/d Kids receiving FS tended to consume higher levels of “soda & artificially flavored beverages” Perez-Escamilla, R., Ferris, A.M., Drake, L., Haldeman, L., Peranick, J., Campbell, M., Peng, Y.K., Burke, G., & Bernstein, B. (2000). Food stamps are associated with food security and dietary intake of inner-city preschoolers from Hartford, CT. The Journal of Nutrition, 130, 2711-2717. Rose et al., examined effects of WIC and FS participation on nutrient intake of preschoolers. They used data from the 1989-1991 Continuing Survey of Food Intake by Individuals (CSFII). Their sample was 499 prescoolers between the ages of 1 & 5. Some additional findings from their study: $1 of FS per person in the household was associated with an increased iron intake of .22 RDA percentage points & an increased zinc intake of .16 RDA percentage points for preschoolers No effects of FS participation on percentage of energy from fat, saturated fat, or cholesterol Rose, D., Habicht, J., & Devaney, B. (1998). Household participation in the Food Stamp and WIC programs increases the nutrient intakes of preschool children. The Journal of Nutrition, 128, 548-555.

13. NATIONAL SCHOOL LUNCH PROGRAM---BASIC FACTS Subsidized lunches for children in participating schools (public & private) Eligibility: Food Stamp or TANF receipt=automatic eligibility 130-185% of federal poverty level In 2002, 13.3 million children received free lunches.1 Lunches contain: one-third or more of the Recommended Dietary Allowance (RDA) for key nutrients no more than 30 percent of calories from fat and less than 10 percent from saturated fat Source: 1 USDA Food and Nutrition Service, 2004. http://www.fns.usda.gov/pd/slsummar.htm Speaker’s Notes: The National School Lunch Program provides subsidized lunches for children in participating schools, both public & private. As with WIC and Food Stamps, the Food and Nutrition Service administers the program at the Federal level. The NSLP is usually then administered by state education agencies at the state level, who operate through agreements with local school officials. All schools (public & private) may participate by applying to the state education agency. Families can typically qualify in two ways, both of which usually require the family to fill out an application and return it to the school. The first way is if a family receives Food Stamps, TANF, or participates in the Food Distribution Program on Indian Reservations (FDPIR), then the children are eligible for free lunch. The second way is if the family’s income is below 130% of the poverty line, then the children qualify for free lunch. Students from families with incomes between 130% and 185% of the poverty level can receive reduced-price meals, for which they can be charged no more than 40 cents. Some school districts will also use a process called “direct certification” in which they work Food Stamp, TANF and FDPIR agencies to identify and qualify students for free lunch. In 2002, 13.3 million children received free lunches. The lunches are required to contain: one-third or more of the Recommended Dietary Allowance (RDA) for key nutrients, no more than 30 percent of calories from fat and less than 10 percent from saturated fat. Additional Resources (not for use during the presentation): Data on participation rates comes from the USDA Food & Nutrition Service: http://www.fns.usda.gov/pd/slsummar.htm More information: http://www.fns.usda.gov/cnd/Lunch/AboutLunch/NSLPFactSheet.htm http://www.frac.org/html/federal_food_programs/programs/nslp.html Speaker’s Notes: The National School Lunch Program provides subsidized lunches for children in participating schools, both public & private. As with WIC and Food Stamps, the Food and Nutrition Service administers the program at the Federal level. The NSLP is usually then administered by state education agencies at the state level, who operate through agreements with local school officials. All schools (public & private) may participate by applying to the state education agency. Families can typically qualify in two ways, both of which usually require the family to fill out an application and return it to the school. The first way is if a family receives Food Stamps, TANF, or participates in the Food Distribution Program on Indian Reservations (FDPIR), then the children are eligible for free lunch. The second way is if the family’s income is below 130% of the poverty line, then the children qualify for free lunch. Students from families with incomes between 130% and 185% of the poverty level can receive reduced-price meals, for which they can be charged no more than 40 cents. Some school districts will also use a process called “direct certification” in which they work Food Stamp, TANF and FDPIR agencies to identify and qualify students for free lunch. In 2002, 13.3 million children received free lunches. The lunches are required to contain: one-third or more of the Recommended Dietary Allowance (RDA) for key nutrients, no more than 30 percent of calories from fat and less than 10 percent from saturated fat. Additional Resources (not for use during the presentation): Data on participation rates comes from the USDA Food & Nutrition Service: http://www.fns.usda.gov/pd/slsummar.htm More information: http://www.fns.usda.gov/cnd/Lunch/AboutLunch/NSLPFactSheet.htm http://www.frac.org/html/federal_food_programs/programs/nslp.html

14. NATIONAL SCHOOL LUNCH PROGRAM---EFFECTS ON NUTRITION One study of NSLP participation found no clear-cut benefit or detriment resulting from NSLP participation. Source: Dunifon, R. & Kowaleski-Jones, L. (2003). Associations between participation in the National School Lunch Program, food insecurity, and child well-being. Social Service Review, 77, 72-92. Speaker’s Notes: Results from one study of the National School Lunch Program found no clear benefit or detriment resulting from NLSP participation Additional information about the study in this slide (not for use during presentation): Dunifon & Kowaleski-Jones used data from the 1997 CDS-PSID, focusing on children 6-12. In the full sample, , NSLP participation was associated with increase externalizing behavior, increase in health limitations & lower math scores. They hypothesize that this is due to omitted variables. To test this, they used a sibling comparison model (siblings in the same family, one in NSLP & one not). In this model, NSLP does not significantly predict any of the child outcomes. They suggest that the lack of findings may be due to: additional nutrients from NSLP do not lead to overall improvements, because the kids are already receiving adequate nutrition; families may use NSLP to replace food kids would have eaten anyway; NSLP doesn’t change children’s intake of vitamins & minerals. Dunifon, R. & Kowaleski-Jones, L. (2003). Associations between participation in the National School Lunch Program, food insecurity, and child well-being. Social Service Review, 77, 72-92. As an additional note, while the School Breakfast Program is less widely used than the NSLP, research suggests that, for low-income children, participation in the School Breakfast Program is associated with improvement in standardized test scores, as well as lower levels of tardiness and absenteeism. For further information, see: Food Research and Action Center. (2003). Hunger in the U.S.: Health consequences of hunger. http://www.frac.org/html/hunger_in_the_us/health.html Speaker’s Notes: Results from one study of the National School Lunch Program found no clear benefit or detriment resulting from NLSP participation Additional information about the study in this slide (not for use during presentation): Dunifon & Kowaleski-Jones used data from the 1997 CDS-PSID, focusing on children 6-12. In the full sample, , NSLP participation was associated with increase externalizing behavior, increase in health limitations & lower math scores. They hypothesize that this is due to omitted variables. To test this, they used a sibling comparison model (siblings in the same family, one in NSLP & one not). In this model, NSLP does not significantly predict any of the child outcomes. They suggest that the lack of findings may be due to: additional nutrients from NSLP do not lead to overall improvements, because the kids are already receiving adequate nutrition; families may use NSLP to replace food kids would have eaten anyway; NSLP doesn’t change children’s intake of vitamins & minerals. Dunifon, R. & Kowaleski-Jones, L. (2003). Associations between participation in the National School Lunch Program, food insecurity, and child well-being. Social Service Review, 77, 72-92. As an additional note, while the School Breakfast Program is less widely used than the NSLP, research suggests that, for low-income children, participation in the School Breakfast Program is associated with improvement in standardized test scores, as well as lower levels of tardiness and absenteeism. For further information, see: Food Research and Action Center. (2003). Hunger in the U.S.: Health consequences of hunger. http://www.frac.org/html/hunger_in_the_us/health.html

15. TANF (WELFARE)---BASIC FACTS Temporary Assistance to Needy Families (TANF) provides basic cash assistance to eligible families. TANF is funded at $16.5 billion annually, serving 1.4 million women and 4.4 million children. In 2002, families received an average of $385 per month in “basic assistance.”1 Source: [1] National Center for Children in Poverty. National recipient and spending data. http://www.nccp.org/policy_detail_12.html Speaker’s Notes: With the passage of welfare reform in 1996, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA): Replaced Aid to Families with Dependent Children (AFDC), a federally administered entitlement for families, with Temporary Assistance for Needy Families (TANF), which is not an entitlement and is block-granted to the states to distribute. Work requirements and time limits were instituted, such that families cannot receive aid for longer than 5 cumulative years (or less, at each state’s option). Temporary Assistance to Needy Families (TANF) now provides basic cash assistance to eligible families. TANF is funded at $16.5 billion annually, serving 1.4 million women and 4.4 million children. In 2002, families received an average of $385 per month in “basic assistance.” Additional information about TANF and welfare reform (not for use during presentation): Additional information: http://www2.acf.hhs.gov/news/facts/tanf.html Docs for Tots, “What Docs Should Know About Welfare Policy and Young Children” National Center for Children in Poverty. (nd). National recipient and spending data. Retrieved December 23, 2003 from http://www.nccp.org/policy_detail_12.html Speaker’s Notes: With the passage of welfare reform in 1996, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA): Replaced Aid to Families with Dependent Children (AFDC), a federally administered entitlement for families, with Temporary Assistance for Needy Families (TANF), which is not an entitlement and is block-granted to the states to distribute. Work requirements and time limits were instituted, such that families cannot receive aid for longer than 5 cumulative years (or less, at each state’s option). Temporary Assistance to Needy Families (TANF) now provides basic cash assistance to eligible families. TANF is funded at $16.5 billion annually, serving 1.4 million women and 4.4 million children. In 2002, families received an average of $385 per month in “basic assistance.” Additional information about TANF and welfare reform (not for use during presentation): Additional information: http://www2.acf.hhs.gov/news/facts/tanf.html Docs for Tots, “What Docs Should Know About Welfare Policy and Young Children” National Center for Children in Poverty. (nd). National recipient and spending data. Retrieved December 23, 2003 from http://www.nccp.org/policy_detail_12.html

16. TANF---EFFECTS ON NUTRITION Decreases in welfare benefits have been linked to food insecurity: Among families receiving welfare, children in families whose benefits were terminated or reduced due to sanctions were 50% more at risk for food insecurity than children in families where benefits were not decreased. If welfare benefits were decreased due to increased earnings or decreased expenses, children still had 46% greater risk of being food insecure. Source: Cook, J.T., et. al. (2002). Welfare reform and the health of young children: A sentinel survey in six United States cities. Archives of Pediatric and Adolescent Medicine, 156, 678-684. Additional information on C-SNAP: http://dcc2.bumc.bu.edu/csnappublic/home.html Speaker’s Notes: Research has found that decreases in welfare benefits have been linked to food insecurity. For example, among families receiving welfare, children in families whose benefits were terminated or reduced due to sanctions were 50% more at risk for food insecurity than children in families where benefits were not decreased. Similarly, if welfare benefits were decreased due to increased earnings or decreased expenses, children still had 46% greater risk of being food insecure. Food Insecurity refers to the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways. Thus, TANF proves to be an important program for families’ food security. Whether families lost or had reduced benefits due to TANF sanctions or due to increased earnings, children were at a greater risk for food insecurity. Additional and Background Information on the study in this slide: C-SNAP is a six-city study surveying families and reviewing medical records for 0 to 3-year-olds. The cities involved are Baltimore, Boston, little Rock, Los Angeles, Minneapolis & Washington, D.C. C-SNAP researchers interviewed caregivers in ERs and at primary care services and asked questions about child’s health, parent’s health, household demographics, use of public assistance, and food security. Cook, J.T., Frank, D.A., Berkowitz, C., Black, M.M., Casey, P.H., Cutts, D.B., Meyers, A.F., Zaldivar, N., Skalicky, A., Levenson, S., & Heeren, T. (2002). Welfare reform and the health of young children: A sentinel survey in six United States cities. Archives of Pediatric and Adolescent Medicine, 156, 678-684. Additional information on C-SNAP: http://dcc2.bumc.bu.edu/csnappublic/home.htmlSpeaker’s Notes: Research has found that decreases in welfare benefits have been linked to food insecurity. For example, among families receiving welfare, children in families whose benefits were terminated or reduced due to sanctions were 50% more at risk for food insecurity than children in families where benefits were not decreased. Similarly, if welfare benefits were decreased due to increased earnings or decreased expenses, children still had 46% greater risk of being food insecure. Food Insecurity refers to the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways. Thus, TANF proves to be an important program for families’ food security. Whether families lost or had reduced benefits due to TANF sanctions or due to increased earnings, children were at a greater risk for food insecurity. Additional and Background Information on the study in this slide: C-SNAP is a six-city study surveying families and reviewing medical records for 0 to 3-year-olds. The cities involved are Baltimore, Boston, little Rock, Los Angeles, Minneapolis & Washington, D.C. C-SNAP researchers interviewed caregivers in ERs and at primary care services and asked questions about child’s health, parent’s health, household demographics, use of public assistance, and food security. Cook, J.T., Frank, D.A., Berkowitz, C., Black, M.M., Casey, P.H., Cutts, D.B., Meyers, A.F., Zaldivar, N., Skalicky, A., Levenson, S., & Heeren, T. (2002). Welfare reform and the health of young children: A sentinel survey in six United States cities. Archives of Pediatric and Adolescent Medicine, 156, 678-684. Additional information on C-SNAP: http://dcc2.bumc.bu.edu/csnappublic/home.html

17. SUMMARY Participation in WIC, Food Stamps & TANF is associated with improved nutritional outcomes for children. Therefore, it is important that families are enrolled in the programs for which they are eligible and that these programs are maintained, strengthened and adequately funded. Speakers Notes: Participation in WIC, FS & TANF is associated with improved nutritional outcomes for children. Therefore, it is important that families are enrolled in the programs for which they are eligible and that these programs are maintained, strengthened and adequately funded. Speakers Notes: Participation in WIC, FS & TANF is associated with improved nutritional outcomes for children. Therefore, it is important that families are enrolled in the programs for which they are eligible and that these programs are maintained, strengthened and adequately funded.

18. PROGRAMMATIC & POLICY RECOMMENDATIONS Improve access to anti-poverty and nutrition programs, ensuring that families are accessing programs for which they are eligible, including: Food Stamps WIC TANF Speaker’s Notes: There is work to be done in improving access to anti-poverty and nutrition programs, as well as ensuring that families are accessing programs for which they are eligible, such as Food Stamps, WIC, and TANF. Additional information on program access (not for use during presentation): As an example of the importance of improving access, in their qualitative study of welfare recipients who were part of the Project on Devolution and Urban Change, Clampet-Lundquist et al., (2003) discuss the differences between the Food Stamp programs in Cleveland and Philadelphia. In Philadelphia, individuals had to provide verification of their eligibility for Food Stamps on a monthly basis, while in Cleveland, this paperwork had to be completed quarterly. They found that this seemingly small difference had very real impacts on the lives of women in their study, with women in Philadelphia reporting frequent problems with the monthly reporting, stemming from both their own difficulties keeping up with the paperwork and from caseworker error. Clampet-Lundquist, S., Edin, K., London, A.S., Scott, E., & Hunter, V. (2003). “Making a way out of no way”: How mothers meet basic family needs while moving from welfare to work. Manpower Demonstration Research Corporation Work Paper Series, 14. Speaker’s Notes: There is work to be done in improving access to anti-poverty and nutrition programs, as well as ensuring that families are accessing programs for which they are eligible, such as Food Stamps, WIC, and TANF. Additional information on program access (not for use during presentation): As an example of the importance of improving access, in their qualitative study of welfare recipients who were part of the Project on Devolution and Urban Change, Clampet-Lundquist et al., (2003) discuss the differences between the Food Stamp programs in Cleveland and Philadelphia. In Philadelphia, individuals had to provide verification of their eligibility for Food Stamps on a monthly basis, while in Cleveland, this paperwork had to be completed quarterly. They found that this seemingly small difference had very real impacts on the lives of women in their study, with women in Philadelphia reporting frequent problems with the monthly reporting, stemming from both their own difficulties keeping up with the paperwork and from caseworker error. Clampet-Lundquist, S., Edin, K., London, A.S., Scott, E., & Hunter, V. (2003). “Making a way out of no way”: How mothers meet basic family needs while moving from welfare to work. Manpower Demonstration Research Corporation Work Paper Series, 14.

19. CURRENT LEGISLATIVE ISSUES President’s FY2005 Budget: No new investments dedicated to increasing access to the Child Nutrition Programs (School Lunch Program, School Breakfast Program, Summer Food Service Program & Child and Adult Care Food Program), which are authorized by the Child Nutrition Act (which was extended for 6 months in December, 2003) Organizations that are advocating for increased funding include: National Association for the Education of Young Children (NAEYC), http://www.naeyc.org/childrens_champions/federal.asp Food Research and Action Center (FRAC), http://www.frac.org/index.html Speaker’s Notes: President’s FY2005 Budget: No new investments dedicated to increasing access to the Child Nutrition Programs (School Lunch Program, School Breakfast Program, Summer Food Service Program & Child and Adult Care Food Program), which are authorized by the Child Nutrition Act (which was extended for 6 months in December, 2003) Organizations that are advocating for increased funding include: National Association for the Education of Young Children (NAEYC), http://www.naeyc.org/childrens_champions/federal.asp Food Research and Action Center (FRAC), http://www.frac.org/index.html. Speaker’s Notes: President’s FY2005 Budget: No new investments dedicated to increasing access to the Child Nutrition Programs (School Lunch Program, School Breakfast Program, Summer Food Service Program & Child and Adult Care Food Program), which are authorized by the Child Nutrition Act (which was extended for 6 months in December, 2003) Organizations that are advocating for increased funding include: National Association for the Education of Young Children (NAEYC), http://www.naeyc.org/childrens_champions/federal.asp Food Research and Action Center (FRAC), http://www.frac.org/index.html.

20. RESOURCES WIC: http://www.fns.usda.gov/wic/ http://www.nal.usda.gov/wicworks/ FOOD STAMPS: http://www.fns.usda.gov/fsp/http://www.frac.org/html/federal_food_programs/programs/fsp.html NATIONAL SCHOOL LUNCH PROGRAM: http://www.fns.usda.gov/cnd/Lunch/AboutLunch/NSLPFactSheet.htm http://www.frac.org/html/federal_food_programs/programs/nslp.html TANF: http://www2.acf.hhs.gov/news/facts/tanf.html GENERAL: Food Research and Action Center, http://www.frac.org Children’s Sentinel Nutrition Assessment Program (C-SNAP), http://dcc2.bumc.bu.edu/csnappublic/home.html

21. Acknowledgements For more information about this presentation or for additional resources, please contact Docs For Tots: Docs For Tots 1522 K Street NW, Suite 600 Washington, DC 20005 www.docsfortots.org Dft@docsfortots.org