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Community Education Intervention Project:

Gods Love We Deliver (GLWD) at Project Open Door Senior Citizens Center

Whats in Season? Affordable Summer Fruits and Vegetables Nutrition Workshop





















Lily S. Leung
ARAMARK Distance Dietetic Internship
Gods Love We Deliver
May 11, 2014


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OVERVIEW
Gods Love We Deliver is a non-profit community organization operating in New York
City that delivers frozen meals to clients who cannot physically prepare their own meals and
have serious illnesses such as HIV/AIDS and cancer. Approximately 90% of clients live below the
poverty line. On May 5, 2014, GLWD delivered their 15-millionth meal, a great cause for
celebration.
Along with meal deliveries, GLWD Nutrition Services Department also conducts
individual nutrition counseling over the phone and provides monthly nutrition workshops at
community centers through NYC. On May 5, 2014, a nutrition workshop was completed at
Project Open Door Senior Citizens Center on Grand Street in the Manhattan Chinatown. The
workshop focused on affordable fruits and vegetables currently in season (spring and summer).
The lesson plan was designed to contribute to the success of Healthy People 2020 objectives to
reduce food insecurity (NWS-13) and increase the variety and contribution of vegetables (NWS-
15).
All participants were of Asian descent and over 65 years of age. Approximately 60
members sat through an hour nutrition workshop and some were asked to complete a simple
review quiz. After scoring, participants were able to get 90% of the questions correct on the
quiz. The presentation was conducted in Cantonese Chinese and all handouts translated in
Chinese can be found in the Appendix.



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NUTRITION ASSESSMENT
Client History - Personal Data (CH 1.1), Patient/Client/ Family Medical/Health history (CH 2),
Social History (CH 3.1)
The mission of GLWD is to provide nutrition education and services for people living
with HIV/AIDS, cancer and other serious illnesses. All the services are free of charge regardless
of income. Approximately 90% of the client population lives below the poverty line. As of July
2013, the non-profit organization delivers approximately 4,600 meals daily to over 5000 clients
annually. GLWD also provides over 5000 individual nutrition counseling sessions annually and
many community nutrition workshops throughout New York City. Approximately 70% of
contributions come from private funding with the remainder from government sources.
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As of December 2012, the ethnic demographics of GLWD clients were as followed: 36%
African-American, 30% Caucasian, 22% Hispanic and 10% Asian/Unknown/Other.
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While the
predominant demographic at GLWD is African-American clients, the following nutrition
intervention program was geared towards Chinese-Americans participating in a nutrition
workshop at a Chinese senior citizen community center. Most of these clients are new to the
United States and have limited English comprehension skills. In 2010, 76.9% of Asian-Americans
spoke a language other than English at home.
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New York City has the largest Asian population in
the country at approximately 1.1 million residents out of 8.2 million total residents (as of 2010
Census).
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In general the Asian-American population includes people from Philippines, China, Hong
Kong, Cambodia, Vietnam, Laos, Thailand, Korea, and Japan. Religious practices include
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Confucianism, Buddhism, Taoism, and Shinto (Japanese only); while a large number of native
Filipinos are Roman Catholic.
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As of 2005, cancer and cardiovascular disease are the two leading causes of death for
Asian Americans in the U.S. The leading cause of death in the U.S. for Asian American women is
cancer, due to the fact that Asian American women have the lowest cancer screenings rates
and are usually diagnosed at a later stage compared to other racial and ethnic groups. Asian
women also have a high risk of osteoporosis. The average calcium (essential nutrient for bone
health) intake among Asian women has been observed to be half that of Western population
groups. As many as 90% of Asian Americans are lactose intolerant or cannot easily digest dairy
products.
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Low socioeconomic status often prevents many Asian Americans from receiving health
insurance. They often lack English language skills that would allow them to even apply to jobs
paying minimum wage. Many of them have entered the country illegally and do not have access
to basic medical needs. As such, they cannot afford private health insurance and are not eligible
for Medicaid. Many senior citizens live in substandard housing and have little or no access to
medical attention. In 2001, one in five Asian Americans between the ages of 18-64 report not
having health insurance or being uninsured at some point in the past year.
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Knowledge/Beliefs and Attitudes (4) - Beliefs and attitudes (FH 4.2)
Since many low-income Asian Americans do not speak English and are illegal immigrants,
they are often wary of government interventions. Many do not seek public assistance for fear
of deportation. Lack of government support in their native countries makes many suspicious of
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free community support programs that they are eligible for. New Asian immigrants also tend to
congregate only in Chinatowns prevalent in most major US cities. These communities are self-
sustaining microcosms that function independently and people can live their whole lives within
a few blocks of space.

Food/ Nutrition-Related Food History (1) - Food and beverage intake (FH 1.2), Food intake (FH
1.2.2)
Traditional Asian foods tend to be very nutritious and well-balanced. The elderly living in
Okinawa, Japan have among the lowest mortality rates in the world and as a result has the
largest population of Centurians in the world.
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Traditional Asian diets are low in saturated fats,
sugar, gluten and void of processed foods. They eat a mainly plant-based diet with a small
amount of meat since beef and pork are often too expensive for daily meals. Seafood is also
very popular among Asians communities living along coastal region. Portion size is also
significantly less than Americanized meals with the emphasis on aesthetically-pleasing small
plates and bowls of different sizes and use of chopsticks that slows down the rate of
consumption.
Desserts are also not very popular however most Asian desserts are fruit based. Most
Asians are also lactose intolerant and avoid all dairy products. Peanut, corn and vegetable oils
are traditionally used instead of butter. Rice is the traditional accompaniment to every meal,
including breakfast when it is turned into congee, a rice-based porridge similar to grits. Asians
also tend to consume soups and broths with each meal. Drinking tea with each meal is also
popular and Asians believe tea has digestive properties.
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Factors affecting access to food and food nutrition-related supplies (6) Safe food/meal
availability (FH 6.2)
Asians like to purchase the freshest ingredients possible and often grocery shop every
day for meals. While GLWD meals are all prepared fresh then flash frozen, there is a
misconception that the meals may not be as fresh as produce bought at markets which relates
back to food preferences. Food safety concerns are also important because the meals require
refrigeration to avoid food-borne illnesses. However, some Asian American clients leave meals
to defrost on kitchen counters instead of in the refrigerator. Education on food safety is
important and nutritionists at GLWD always emphasis this when counseling clients.

NUTRITION DIAGNOSIS
PES Statement
Poor Nutrition Quality of Life (NQOL) (NB 2.5) related to food insecurity as evidence by need for
free GLWD meal deliveries and nutrition workshop on affordable produce purchases.

NUTRITION INTERVENTION
Nutrition Education (E 1.1) Purpose of the nutrition education
Nutrition Education (E1.5) Recommended modifications
The purpose of the nutrition workshop is to offer affordable produce options at peak
nutrient content for a Chinese speaking geriatric population. The recommended modification
would be to purchase produce at the peak of season for the best prices and to optimize
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nutrition content. These goals are in line with many Healthy People 2020 objectives including
the following:
Objective NWS-13: Reduce household food insecurity and in doing so reduce hunger
Objective NWS-15:Increase the variety and contribution of vegetables to the diets of the
population aged 2 years and older
NWS-15.1: Increase the contribution of total vegetables to the diets of the population
aged 2 years and older
NWS-15.2: Increase the contribution of dark green vegetables, orange vegetables, and
legumes to the diets of the population aged 2 years and older
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The first objective (NWS-13) was selected because it helps promote optimal PO intake
for the targeted senior citizen population. Approximately 90% of GLWD client population lives
below the poverty line where food insecurity is a daily concern. Approximately 14.6% of all US
households were food insecure in 2008; the goal is to reduce this figure to 6% by 2020.
The second objective (NWS-15) addresses optimizing nutrient density in food choices.
The two-part objective seeks to increase total vegetable consumption as well as specifically
increased consumption of dark leafy green vegetables, orange vegetables and legumes.
Currently Americans consume 0.8 cups of vegetables per 1000 calories between 2001-2004; the
goal is to increase consumption to 1.1 cups of vegetables per 1000 calories by 2020. For dark
green vegetables, orange vegetables and legumes, Americans consume approximately 0.1 cups
per 1000 calories between 2001-2004; the goal is to increase consumption to 0.3 cups per 1000
calories by 2020.
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Both objectives utilize SMART criteria because they are specific, measureable, attainable,
realistic and timely, which is useful during monitoring and evaluation. An emerging trends in
dietetics related to this nutrition workshop is addressing opportunities and challenges arising
from a growing aging population.
Lesson Plan
Whats in Season? Affordable Summer Fruits and Vegetables Nutrition Workshop

GLWD conducts nutrition workshops at Project Open Door Senior Citizen Center about
5-6 times annually. The presentations focus on nutrition information pertinent to Asian-
American senior citizens. The focus of this months workshop is the benefits of eating fruits and
vegetables that are currently in season. See Appendix A for lesson plan details.
Marketing
GLWD nutrition workshops are conducted throughout the city. Registered Dietitians
who work here conduct about one presentation per month at various community centers. This
service is paid for by the community centers and GLWD receives roughly $50 per session. The
presentations are free and available to members of the community centers. Prior to our arrival,
the community centers will post their own announcement flyers to attract participants at no
cost to GLWD.
Resources
Resources included nutrition handouts written in both English and Chinese highlighting
seasonal fruits and vegetables for spring and summer. Handouts contained many photos given
that our target audience may have trouble reading small text. Plastic food models of
appropriate portion sizes for fruits and vegetables were also displayed so participants can use
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visual aids to understand the presentation. Financial costs were nominal since all printing and
office supplies (pens and paper) were provided by GLWD existing supplies. Handouts used
during the session can be found in Appendix B. All Chinese translations were completed by
current GLWD volunteer: YuQing Yang (yangyuqing1218@gmail.com).

NUTRITION MONITORING AND EVALUATION
Evaluation of the nutrition workshop was based on attendance, participation through a
Q&A session and a brief review quiz for senior citizens. Our nutrition workshop was presented
on May 5, 2014 at Project Open Door before lunch in front of approximately 60 senior citizens
in Cantonese Chinese. Pauline Cheung, MS, RD observed the presentation. Chinese handouts
were distributed to the group at the beginning of the presentation. Participants were asked to
pay attention because there was a review at the end. After the lesson, participants were
encouraged to ask questions. Some interesting comments included preparation methods.
Traditional Asian cuisines typically do not include raw vegetables so participants were
concerned about ingesting raw vegetables such as salads and how that may cause arthritis. First
and foremost, we stressed the importance of food safety and proper sanitation for all produce.
We then reasoned that there is no significant evidence linking high raw food consumption to
arthritis risk, a myth centered in traditional Chinese belief of balancing food groups with energy
(Qi Gong).
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To avoid confusion, we encouraged the senior citizens to consume vegetables in
the form they are most comfortable with however to include a multitude of different variations.
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A Chinese nutrition workshop review quiz was distributed after Q&A for willing
participants (see Appendix C). The quiz was purposefully kept simple and short in light of the
client demographics. Ten quizzes were submitted with the following results:

The senior citizens were all able to understand the health benefits of increased fruit and
vegetable consumption. Two quizzes handed back had missing answers so in general the
participants were able to answer 90% of the questions correctly. The results help contribute to
the targeted Healthy People 2020 goals of reducing food insecurity and increase fruit and
vegetable consumption for at-risk populations.
GLWD will be continuing nutrition workshops at Project Open Door as well as other
Asian-American community centers in NYC. Each lesson is based on a different nutrition
concern and tailored to meet the needs of the intended audience. Most participants attend all
the sessions because they spend a lot of time at the community centers. The members know
the regular RD (Pauline Cheung) that gives lessons there every other month so they know she
will address any nutrition concerns that may arise. Future nutrition workshops will also focus on
affordable ways to incorporate more food groups into their diets.

Nutrition Workshop Review Quiz (for 10
participants) Correct Incorrect
Total %
Correct
Question 1
Increased fruit and vegetable consumption
helps reduce risk for chronic diseases such
as hypertension and coronary heart
disease. 10 0 100%
Question 2
Eating more fruits and vegetables adds
fiber to your diet. 10 0 100%
Question 3 Name one vegetable in season right now. 8 2 80%
Question 4 Name one fruit in season right now. 8 2 80%

Average Score on
Review Quiz: 90%
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Appendix A: Lesson Plan Template

Gods Love We Deliver (GLWD) at Project Open Door Senior Citizens Center -
Whats in Season? Affordable Summer Fruits and Vegetables Nutrition Workshop

Target Audience: Asian-American senior citizens living in Chinatown (60 participants)

Duration: 1 hour 35 minute presentation, 15 minutes Q&A, 5 minutes presentation review
quiz for willing participants

Goal: Participants are able to recognize the benefits of eating fresh fruits and vegetables and
know what produce are currently in season

Specific Objectives:
1. By the end of the presentation through the review quiz, participants are able to identify the
benefits of increased fruit and vegetable consumption.
S: Specific to participants attending the nutrition presentation.
M: Results measurable through participants responses on review quiz.
A: Objective to be attained within specified time frame.
R: Understanding some benefits of fresh fruit and vegetable consumption are realistic.
T: Achieving the objective by the end of the presentation is timely.
2. By the end of the presentation through the review quiz, participants are able to name one
fruit and one vegetable currently in season
S: Specific to participants attending the nutrition presentation.
M: Results measurable through participants responses on review quiz.
A: Objective to be attained within specified time frame.
R: Naming examples of seasonal fruits and vegetables is realistic.
T: Achieving the objective by the end of the presentation is timely.

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Appendix B: Nutrition Handouts All Handouts created by Lily Leung for GLWD, Chinese
Translations Provided by YuQing Yang (yangyuqing1218@gmail.com)

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Appendix C: Presentation Review Quiz


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REFERENCES

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About Us: By the Numbers. Gods Love We Deliver Website. Available at:
https://www.glwd.org/about/numbers.jsp. Accessed April 16, 2014.
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2012 Annual Report. Gods Love We Deliver Website. Available at:
https://www.glwd.org/serve.do/content/finance/annuals/2012.pdf?property=Publication&aid=14934.
Accessed April 16, 2014.
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Asian-American/Pacific Islander Profile. The Office of Minority Health Website. Available at:
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=3&lvlid=29#sthash.vTh6IUya.dpuf. Accessed April
16, 2014.
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The Asian Population: 2010. United States Census Bureau Website. Available at:
http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf. Accessed April 16, 2014.
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Cultural Diversity: Eating in America Asian. The Ohio State University Extension. Available at:
http://ohioline.osu.edu/hyg-fact/5000/pdf/5253.pdf. Accessed April 24, 2014.
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Asian American Health Initiative Website. Available at: http://www.aahiinfo.org/english/asianAmericans.php.
Accessed April 16, 2014.
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Socioeconomic Status / Insurance Status. Asian American Health Initiative Website. Available at:
http://www.aahiinfo.org/english/asianAmericans.php. Accessed April 23, 2014.
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Investigating the worlds longest lived people. Okinawa Centurian Study Website. Available at:
http://www.okicent.org/. Accessed April 23, 2014.
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10 Things You Need to Know About the Asian Diet. Huffington Post Website. Available at:
http://www.huffingtonpost.com/cathy-margolin-lac-dipl-om/asian-diet_b_4015133.html. Accessed April 24,
2014.
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Nutrition and Weight Status Topics and Objectives. Healthy People 2020 Website. Available at:
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=29. Accessed April 24,
2014.
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Food Therapy. Traditional Chinese Medicine Education Center of Canada Website. Available at:
http://www.tcmecc.org/foodtherapy.htm. Accessed May 8, 2014.