recognized and how many have beenrecognized but have not been reported isimpossible to say. For instance, on Sep­tember 6-9, 1979, fluoride levels in Cin­cinnati's municipal water exceeded thoseset by the Ohio state law.

In her letter (JNE 11: 163 and 167, 1979)V.L. Richmond indicated that a thoroughstudy of all details of 90 articles has con­vinced her of the desirability of fluorida­tion. No matter how intensive herresearch may have been, judging by thekind of references cited in her article (JNE11 :62-64, 1979) and those in her response(JNE 11:163 and 167, 1979), she could notpossibly have become aware of thenumerous fallacies, omissions, and errorswhich prevail through the extensiveliterature on fluoridation.

George L. Waldbott, M.D., 11670 Mar­tin Rd., Warren, MI48093.

REFERENCES

1 Waldbott, G.L. Acute fluoride intoxication(monograph), Acta Medica Scandinavica,Supplementum 174, (400), 1963.

2 Waldbott, G.L. Chronic fluorine intoxica­tion from drinking water at 1ppm concentra­tion, A case report. International Archives ofAllergy and Applied Immunology 7:70-74,1955.

3 Waldbott G.L. Fluoridation: A clinician'sexperience. Southern Medical Journal73:301-6, 1980.

4 Waldbott, G.L. Fluoride in clinical medicine(monograph), International Archives ofAllergy and Applied Immunology, 20(Suppl. I), 1962.

5 Waldbott, G.L. Preskeletal fluorisis near anOhio enamel factory, A preliminary report.Veterinary and Human Toxicology, 21:4-8,1979.

6 Waldbott, G.L., A.W. Burgstahler, and H.L.McKinney. Fluoridation, The great dilemma.Lawrence, Kans.: Coronade Press, 1978.

7 Leland, D.E., K.E. Powell, and R.S. Ander­sons, Jr. A fluoride overfeed incident at Har­bor Springs, Michigan. Journal of theAmerican Water Works Association72:238-43, 1980.

EDITOR REPLIES

Surveys and interviews are worthy toolsfor collection of preliminary informationand may, if appropriately designed andadministered to exclude bias, provide"evidence." There is no indication in thereport by Anderson et al. or in Waldbott'sletter that the interviews in questions wereso designed and administered. Waldbott'sopinion concerning his telephone andhotel interviews should therefore beregarded as an anecdotal account until afull report including methodology is peerreviewed and published. The phrase"epidemic of illness" is based on ex­trapolation of the incidence of nonspecificsymptoms among a small number of

146 JOURNAL OF NUTRITION EDUCATION

employees in a single building to the entirepopulation of a city. This extrapolationseems inappropriate, particularly when nounusual school absenteeism or use ofmedical services was reported for the area.

Overstatement of the potential dangersof fluoridation often leads to reactionaryoverstatement of the absolute safety, andvice versa. This reply to Waldbott is notmeant to condone negligence or equip­ment malfunction which allows perhaps 50times the recommended fluoride level intopublic water supplies. Nor does it provethat fluoridation is "safe" under all cir­cumstances. Rational scientists, educa­tors, and health professionals must con­tinue to question and research both theefficacy and safety of fluoridation.

Nutrition inFamily Day Care Homes

The components of a model child nu­trition program have been delineated bythe American Dietetic Association (JADA64:520-521, 1979): (a) assessing the nutri­tional needs of the child, (b) meeting theneeds of the child through foods servedand the environment in which it is served,(c) providing educational opportunitiesfor the child to learn about food and its re­lationship to life, both physically and so­cially, and (d) planning educational activi­ties about food and nutrition for parentsof the children. Since day care centers mayprovide a significant portion of meals serv­ed to children of parents who are at workor school, they would seem an appro­priate location for child nutrition pro­grams. In order to assess the need for de­velopment of such programs, we carriedout an exploratory survey of licensed fam­ily day care homes in Berkeley, California,in the summer of 1978. These were privatehomes, where only a small number of chil­dren attended. The objectives of the studywere to determine: 1) the number ofmeals, the foods served, and food-relatedactivities; and 2) the extent and nature offood and nutrition education offered byproviders.

Of the 90 licensed family day carehomes operating in the area, 45 were se­lected randomly and were invited by mailto participate. Nine were not in operationat the time of the study, 6 declined to par­ticipate, and 5 did not respond after 2 fur­ther attempts to schedule an interview.The 25 homes in the final sample providedcare for a total of 135 children, ranging inage from 2 months to 12 years. All but 1 ofthe homes provided 8 or more hours ofcare. The majority of providers were

experienced: 16 had provided day-care forat least 5 years.

Meals, foods, and food activities. Only2 homes provided an evening meal and 12provided breakfast; but 22 offered mid­morning snacks, 22 provided lunch, and23 had mid-afternoon snacks available.Individual nutrient intakes could not beassessed by the data collected in this sur­vey; but at least 2 servings from each ofthe Four Food Groups were served eachday by 20 of the 25 homes, and childrencould have second helpings in nearly allhomes. Although 18 providers claimed todo advance menu planning, only 1 pro­duced an example of a written menu.

The provider ate with the children in 9homes, but, in most, the children atealone. In over half of the homes, childrenwere involved with meal preparation andservice; clearing and setting the table andhelping to prepare or cook food were fre­quently mentioned. At 3 homes, childrenhelped wash dishes, and at 1 each theyhelped with shopping and gardening.

Food and nutrition education. Therewas little evidence of provision of food ornutrition education to the children. At­tempts were made by 14 providers to in­troduce new foods. Information about thechild's eating pattern, food preferences,and/or foods served at home was soughtby 21 providers, but only 5 believed theparents to be concerned about these as­pects. Many providers expressed resis­tance to the certification requirements ofthe USDA-sponsored Child Care FoodProgram for family day care homes. Pro­viders received food and nutrition infor­mation from a variety of nonprofessionalsources; none mentioned health profes­sionals as sources of nutrition informa­tion. Additional information on food ac­tivities, menu planning and budgeting,and food and nutrition programs or ser­vices was requested by 6-8 providers foreach topic.

Implications. In this preliminary surveywe found that a significant portion of theday's food frequently is provided at familyday care homes. This confirms the appro­priateness and the need for good food andnutrition practices in these settings. In thissample, the variety and amount of foodoffered to the children appeared adequate,but this did not appear to be due to plan­ning. Only 1 provider was able to show awritten menu, indicating a need for assis­tance in menu preparation and meal plan­ning. Only in a few homes did the childreneat together with the provider, family­style. Several homes had children involved

VOLUME 12 NUMBER 3 1980

in other food-related activities such as pre­paring the food and setting the table. Inthese limited nutrition-related activities,the potential exists for significant expan­sion of nutrition education and of rein­forcement of sound food practices.

There was some interest among pro­viders in discussing the children's foodhabits with their parents, but the parentsdid not seem that concerned. More infor­mation is needed to determine what theparents' real interest is in this area. Pro­viders utilized limited sources of nutritioninformation, and only a few expressed aninterest in nutrition consultation. Such asituation may result in little knowledge oreven misinformation on nutrition prac­tices.

Given this perspective, it would seemthat before a full-scale program of nutri­tion education is inaugurated, interest innutrition by the providers, the children,and the parents must be stimulated. Theopportunities for organized food and nu­trition education in the family day carehomes are present but are not beingutilized.

It would appear, therefore, that nutri­tion services provided in licensed familyday care homes now need the attention ofnutritionists working in health depart­ments, Cooperative Extension, commu­nity health centers, schools, and othercommunity nutrition projects, if day carehomes are to serve as a setting for pro­moting good nutritional habits for chil­dren and families.

Albert Chang, Assistant Professor, andMaryann Saffold, Nutrition Student,School of Public Health, University ofCalifornia. Berkeley, CA 94720; andKathryn Buringrud, Nutritionist, ValleyGeneral Hospital, 400 S. 43rd Street,Renton, WA 98055.

Nutrition forAlternative Education

While teaching nutrition in a nontradi­tional program, I found certain food andnutrition learning activities to be particu­larly successful. A brief description ofthese activities is offered here, since theymight be useful to other nutrition instruc­tors in similar situations.

The students are juvenile offenders andtruants referred by the court to the com­munity school because they cannot be orneed not be confined in a juvenile hall sit­uation. Many are substance abusers. Alarge percentage are from single-parent,low-income, minority (primarily Mexicanand Native American) homes. The stu-

VOLUME 12 NUMBER 3 1980

dents the school receives are the malad­justed, the problem learners, the sociallyrejected, the aggressive, the passive, andthe school phobics. They are often brightbut characteristically recalcitrant youngpeople, rigidly opposed to the impositionof structure on their lives; they commonlyhave an extremely short attention span, acondition exacerbated when they feel theyare being "taught" something.

Dietary practices are poor among thesestudents, both from the nutritional andeconomic standpoints. Breakfasts aremeager or skipped entirely; high-caloriesnacks and soda are common between­meal items; and canned, boxed, or frozenconvenience foods usually replace cookingfrom scratch at home.

The education philosophy of the pro­gram within which this nutrition educa­tion program operates encourages theteacher to serve as a resource person andto risk involvement with the students. Thecurriculum is flexible, individualized, andresponsive to student needs and sugges­tions. Participatory activities as opposedto lectures or reading assignments are thepreferred approach to the teaching andlearning.

Four food and nutrition concepts andthe activities that form the basis of the in­struction are described below. These havebeen selected for relevancy to the prob­lems and interests of this particular stu­dent population and reflect the educationphilosophy of the school.

Four Food Groups. The concept of in­cluding all of the Four Food Groups inone meal was introduced via a sandwichcontest. The students were to create anoriginal sandwich using foods from all ofthe Four Food Groups. The students firsttried the sandwiches at home, then sub­mitted recipes; the ingredients were pur­chased by the school, and each pupil madeseveral of their sandwiches - enough foreveryone to have a bite. They were alltasted by each student, and the top threepicked by vote: the students who madethese were awarded prizes.

Meat Alternates. Instruction aboutcomplementary proteins and legumes asan inexpensive protein source was com­bined with many related food and nutri­tion concepts during a Mexican luncheonproject. The students expressed an interestin preparing a complete meal by them­selves, with Mexican food voted the favor­ite. Ten different legumes were brought toclass; pinto beans were washed, soaked,and cooked for use as one of the menuitems. The students were encouraged to

smell and stir the beans. Each student wasassigned a food preparation duty for thegroup meal which included chicken enchi­ladas, bean and cheese burritos, guaca­mole dip with raw broccoli, fruit salad,and milk to drink. Nutrition information,along with assistance with the cookingtechniques, was provided by the in­structor. Photographs of the preparationand eating of the meal were taken andlater submitted with a press release to thelocal newspaper; the result was an articlein the paper's society section describingthe event. The students saw - and tasted ­the results of their efforts and were quiteproud of the article. They demonstrateduncommon enthusiasm while cooking,each person obviously proud to be incharge of an essential task.

Nutritious snacking. Alternatives to theubiquitous soda and candy bars wereshown by bringing to school examples ofnutritious snack foods; these were placedon a table, grouped according to the FourFood Groups, and offered for consump­tion. Discussion centered around the newand different tastes of the snack itemswhich included yogurt, cheese, raw vege­tables, nuts, seeds, and dried fruits.

Food economy. To help the studentsgain skills in buying food on a limitedbudget, several of them accompanied theinstructor each time food was purchased.As they walked through the store, the in­structor pointed out foods and explainedgeneric brands, unit pricing, buying inbulk, and so forth.

The focus of nutrition education at theschool has been hands-on experienceswith food, especially cooking fromscratch. Convenience foods have been de­emphasized. Through using such ingredi­ents as dry beans, rice, fresh fruits andvegetables, bread, and cheese, studentsgain an appreciation for the feel, smell,and appearance of foods in their naturalstate that is missed when highly processedconvenience foods are used. The lowercost of less processed foods, and generallyhigher nutrient content, is also of practicalbenefit to the students. It is through thesecooking experiences that students havefound a renewed interest in eating, in theirbodies, and in their overall health.

Lorin M. Hawley, Mendocino CountyCommunity School, Ukiah, CA 95482.

CORRECTION

The film, Have A Healthy Baby:Pregnancy, was incorrectly listed as HaveA Healthy Baby (JNE 12:70, 1980).

JOURNAL OF NUTRITION EDUCATION 147