Extension News: Health Archives

3rd annual Grazing Conference March 8

The daylong event will feature two nationally known grazing experts: Jim Gerrish, author of Management-intensive Grazing and columnist for the Stockman-Grass Farmer, and Sarah Flack, a grazing specialist and organic farmer from Vermont.

Gerrish will deliver the keynote address on the topic of Yeah, but that will never work on my place! also lead two workshops: Stock Density-the Most Powerful Tool in the Grazier's Toolbox and Extending the Grazing Season for More Money in Your Pocket. Flack will conduct a two-part workshop on Getting Started with Managed Intensive Grazing.

The afternoon sessions will focus on marketing grass-fed products. Featured speakers include grass farmers Ridge Shinn, Matt & Beth LeClair, Jim & Adele Hayes, and Ed Jackson.

Conference sponsors: Granite State Graziers, Natural Resources Conservation Service and UNH Cooperative Extension.

Download a brochure containing full conference schedule and speaker bios.

Register for the conference online

Obesity-prevention Web site offers wide variety of information resources to Granite Staters

UNH Cooperative Extension (UNHCE) announces the launch of Lighten Up New Hampshire!, a health-promotion Web site designed to help Granite Staters working to address overweight and obesity.

Supporting the efforts of New Hampshire individuals, families, communities, schools, and health care professionals, the site features subsections containing the latest research-based information on food and nutrition, fitness, motivation, creating healthier communities, and resources for professionals. The site will also host interactive blogs and discussion forums.

"More than half the people in New Hampshire are obese or overweight, including about 20 percent of the state's children," says Charlene Baxter, who heads UNHCE's Family and Consumer Resources program. "Nationally, the annual direct and indirect costs associated with obesity add up to more than $231 billion."

"UNH Cooperative Extension has been reaching out to individuals, families and communities with health-promotion messages and programs for 91 years," Baxter continues. "This project expands the health education work we already do.

"We know the Web can serve as a powerful tool for organizing information and connecting people, yet no statewide Web site was collecting and integrating obesity-prevention resources specific to New Hampshire. We decided to create one."

A $215,000 grant from the HNH Foundation funded the Lighten Up New Hampshire! initiative. In addition to the Web site, the grant also funds the formation of a statewide Lighten Up NH! Alliance, a collaboration of agencies, organizations, and concerned individuals who will collectively continue to develop and expand the Lighten Up NH! Web site.

A sample of what site visitors can find at Lighten Up New Hampshire!

Community leaders might visit the Healthier Communities pages to download a worksheet on how to start a local wellness team.

Health professionals might want to check out the nation's top obesity research centers for information on the latest in obesity prevention and management.

And just about anyone might be interested in learning more about 10 healthy holiday foods, things to do and places to go in New Hampshire, or helpful resources for starting or maintaining an exercise program tailored to their stage of readiness or involvement.

Lost your oomph for exercise and healthful eating? Don't despair. Here's help.

Posted December 3, 2007 | TrackBack

Changing the Scene launches Web page

Since 2003, Changing the Scene, UNH Cooperative Extension's school wellness initiative, has worked with school personnel in 403 New Hampshire schools and five Head Start programs, to help the schools improve their overall nutrition and fitness environment.

Based on a U.S. Department of Agriculture program, Changing the Scene works by enlisting school nurses, school lunch personnel, teachers and administrators to survey and improve the entire school environment, from school cafeteria meals to snacks served at classroom birthday celebrations, from expanding exercise opportunities for students and staff to reaching out with health and fitness messages to parents and the general public.

Three-quarters of participating schools have already taken significant steps that include buying fitness equipment, starting before-school walking programs, adding nutrition education to the curriculum, and developing newsletters to send home to parents.

Parents, educators, healthcare professionals and others who want to learn more about this health promotion effort, please stop by our Changing the Scene Web pages, where you'll find success stories from participating schools, sample newsletters, curriculum materials, tips on improving children's nutrition and increasing physical activity, and more

New Hampshire Partners in Education, a nonprofit promoting the efforts of volunteers and outside organizations that work with schools, has honored UNH Cooperative Extension's Awilda Muniz with a 2007 Gold Circle Award

Muniz, Hillsborough County program associate with the Nutrition Connections program, was recognized for her nutrition education work with third graders at the Ledge Street School in Nashua. Pilar Peigh, assistant principal from the Ledge Street School nominated Muniz for the award.

Ledge School teacher Bonnie Blaisdell said of the nutrition series, "Awilda's classes were always so motivating to the students. She used hands-on and fun materials. The students enjoyed all the healthy snacks she made with them. She stressed the importance of eating healthy food, and I've noticed this starting to make a difference in their choice of snacks. All of Awilda's lessons really involved the students. She made learning about nutrition and taking care of our bodies fun. We are looking forward to working with her again."

Congratulations, Awilda!

2 humans ill; horse dies of mosquito-borne viral illness

Two people in New Hampshire (Newton and Newfields) have fallen ill with Eastern Equine Encephalitis (EEE) and a horse has died of the disease. EEE is a mosquito-spread, viral disease of birds that sometimes gets transmitted (via mosquito bite) to horses and people.

Only a handful of the 47 species of mosquitoes in New Hampshire can transmit EEE. Although the chances of getting it are very low, the consequences can be serious. Symptoms in people range from mild flu-like illness to inflammation of the brain, coma, and death. The human death rate is 35 percent, and about 35 percent of people who survive have lasting neurological effects of some type.

Infected humans can't pass the disease to others by coughing, sneezing or other means.

People most at risk for contracting EEE: those younger than 15 or older than 50.

The EEE season runs from late August until the arrival of hard frost, typically late September to mid-October. Southeast Rockingham County is at highest risk for EEE, although southern Merrimack, southern Strafford, and possibly eastern Hillsborough have a slightly elevated risk.

Protect yourself: Reduce your risk of getting bitten:

• Use insect repellent containing either DEET or picaridin when you are outdoors.
• Wear clothing that doesn't expose lots of skin. Consider wearing net-like clothing that is stiff enough to stay away from your skin, such as Bug Baffler.
• Try to limit time spent outdoors within an hour or so of dusk or dawn, especially in areas with lots of mosquitoes.
• Mosquitoes that transmit EEE aren't very active in mid-day. An exception is if you walk through thick brush or woods. You disturb the vegetation on which they rest, so they will then fly to you and bite.
• Be sure that sleeping quarters have tight-fitting screens on doors and windows. This includes tents and other camping quarters.
• Limit your activity in areas near freshwater marshes with permanent vegetation, especially cattails.

For more on the subject, read our 13-page fact sheet, which contains links to much more information.

You may also want to check the latest information from the N.H. Department of Health and Human Services.

By Dr. Alan T. Eaton, UNH Cooperative Extension entomology specialist

Protect yourself and your family

Reported cases of Lyme Disease in New Hampshire jumped from 271 in 2005 to 617 last year, according to the N.H. Division of Public Health Services.

Caused by a bite from an infected blacklegged tick (formerly known as the "deer tick"), the bacterial illness disease is treatable in its early stages, but can lead to serious complications if left untreated. UNH Cooperative Extension entomologist Alan Eaton says the worst time for bites is from May through mid -July, when young ticks, called nymphs, are biting.

"New Hampshire is home to many other species of ticks, but the others don't spread Lyme Disease," said Eaton. "The blacklegged tick itself becomes infected with Lyme Disease-causing bacteria by feeding on an infected reservoir host, an organism that carries high levels of the bacteria in its bloodstream. In New Hampshire, the primary reservoir host for Lyme disease is the white-footed mouse."

Blacklegged tick must feed a day or longer to infect
The ticks encounter hosts, including humans, by climbing on tall grass, shrubs or weeds, where they wait for something to come along, holding several legs outstretched. When they are touched by fur, hair, your skin or clothing, they grab on and climb aboard. Then they crawl around in search of an appropriate location on which to attach and feed. The attachment bite is usually painless and goes unnoticed. A blood meal takes several days to complete.

"Because it takes 30 or more hours for an adult blacklegged tick to infect you after it attaches to your body, doing a tick check every night before you go to bed will greatly reduce your chances of getting Lyme disease," said Eaton. "An adult blacklegged tick that's just begun to feed will appear about the size of a sesame seed, but it can reach the size of a small grape as it becomes engorged with your blood."

More infected ticks than expected
A study done in spring 2004 by Eaton and Eleanor Lacombe of the Maine Medical Center Research Institute, found the percentage of infected blacklegged ticks in N.H. was much higher than expected. Eaton said more than half the approximately 50 adult ticks sampled in Lee and Durham and more than 70 percent in Concord were infected with the bacteria that causes Lyme Disease.

"Although reported cases of Lyme Disease have been concentrated around the Seacoast and in the southeastern part of the state, from eastern Hillsborough County through Rockingham and Strafford counties, there are many areas in the state where ticks have not been tested, and much about ticks is still unknown," Eaton says, urging all New Hampshire residents to take simple precautions to protect themselves.

Keep yourself safe
To reduce your chances of getting Lyme Disease, Eaton suggests the following:

• Tuck pant legs into socks before a trip into woods or fields.


• Check your entire body thoroughly for ticks after a day outdoors (common sites of attachment include the underarms, the groin, behind the knee, and the nape of the neck).


• Use insect repellent on socks and pant legs (most effective repellants contain either Deet, called n,n-dimethyl-m-toluamide, or picaridin).


• Wear light-colored clothing (to help locate ticks easily).


• Stay close to the center of trails (avoid brushing against vegetation).


• Keep grass mowed.


• Remove brush piles (brush provides animal nesting sites).

Since tick bites are painless, ticks are often discovered after they have begun to feed. To remove a tick, grasp it with tweezers only (bent "needle nose" tweezers work the best), around its head and close to the skin. Pull the tick out slowly and firmly. Disinfect the bite afterward with antiseptic.

If possible save the tick for identification. For proper identification place the tick in a stoppered vial and send or bring to:

UNH Cooperative Extension Arthropod Identification Laboratory
G28 Spaulding Hall
38 College Road
University of New Hampshire
Durham, NH 03824-3544

The lab charges $5.00 per specimen.

Symptoms of infection
Lyme Disease often, but not always, starts with a large, reddish, circular rash around or near a tick bite. The rash slowly expands and fades. Other symptoms include chills, fever, headache, fatigue, stiff neck, swollen glands, and muscle and/or joint pain.

If you have further questions about ticks in New Hampshire call the New Hampshire Department of Health and Human Services, Bureau of Communicable Disease Control, @ 603-271-4496 or 800-852-3345 x4496, or refer to Biology and Control of Ticks in New Hampshire

UNH Cooperative Extension has received a $215,000, three-year grant from the Healthy New Hampshire Foundation (HNHfoundation) to fund our Lighten Up New Hampshire! project, an initiative aimed at helping New Hampshire residents reach and maintain a healthy weight.

The grant will fund a comprehensive Web site of New Hampshire-specific resources and formation of a statewide Lighten Up NH! alliance of organizations and health professionals interested in reducing obesity in the Granite State.

“UNH Cooperative Extension has been reaching out to individuals, families and communities with health promotion messages and programs for 91 years,” says Charlene Baxter, who heads Extension’s Family and Consumer Resources program.

“The grant will allow us both to expand the health education work we already do that helps prevent obesity, and to connect people and programs statewide that aim at helping citizens reach and maintain a healthy weight.”


Obesity: a complex phenomenon
Obesity may soon challenge smoking as the nation's No.1 public health concern, says Colette Janson-Sand, a UNH associate professor and Extension nutrition specialist. “More than 65 percent of American adults classify themselves as overweight or obese, and the percentage of overweight children has doubled in the past 20 years - to 58 percent. The direct and indirect costs associated with obesity add up to more than $231 billion.”

“More than half the people in New Hampshire are obese or overweight, including 63 percent of food stamp recipients and about 20 percent of the state’s children,” says Janson-Sand.

“But below these alarming statistics, obesity emerges as an extremely complex problem that goes well beyond individual choices about food and exercise,” says Janson-Sand. “It involves dramatic changes in patterns of work and family life in recent decades, changes in land use and community design, competition for leisure time, jobs that require increasingly less manual labor, increasingly longer work hours. Today’s families spend half their food dollars eating out, where healthy food choices may be limited, and many Americans say their long work and commuting hours and their children’s schedules leave them no time for exercise. Many people live in neighborhoods without safe places to exercise, or in areas where they have limited access to healthful foods.”

The need: connecting New Hampshire people and programs
“We’ve had an interdisciplinary team looking at the many dimensions of the obesity issue for more than three years to find ways to expand our outreach, Baxter says. “Each of our team members knew of many first-rate local and statewide initiatives aimed at some aspect of the problem, but we realized the state lacked a program to make them visible to one another, and to connect all these people and programs in some meaningful way.

“We know the Web can serve as a powerful tool for organizing information and connecting people in interactive online communities of practice and interest, but no Web site currently collects and integrates all obesity resources specific to New Hampshire.” says Baxter.

She continues, “The site we envision will organize and integrate the best online resources in ways that individuals, parents, teachers, health professionals, and community leaders will find useful. So, community leaders might visit there to learn about approaches other communities have tried, health professionals to connect their patients with local programs, and individuals to find information and peer support. The alliance will help concerned professionals, organizations, and individuals connect with each other to share ideas, collaborate on programs, and maximize scarce resources.

“Extension works in communities throughout New Hampshire in nearly every dimension of human life. We’ve had a long history of establishing successful coalitions that bring together a wide array of people and organizations working toward a common goal,” says Baxter. “So forming the alliance seemed like a natural role for us to play in our statewide effort to tackle obesity.”

By Peg Boyles, Extension writer/editor

Current UNH Cooperative Extension health promotion outreach programs

• Changing the Scene A statewide program that recruits school nurses and school faculty to change the nutrition and fitness environment in their schools schools.
• Liveable, Walkable Communities
  Explore the vital role community design and development play in citizen health and well-being, including obesity prevention.
• Fact sheets, worksheets, newsletters and lessons A large and growing collection of useful information about improving your diet and becoming more physically active.
• 4-H Get up and Go Part of a larger statewide initiative, Walk New Hampshire (Walk NH) , 4-H Get Up and Go encourages parents and other adults to lace up their walking shoes and join their kids in a walk across New Hampshire.
• Nutrition Connections Nutrition and fitness education and support for income-eligible residents. Focuses on dietary quality, food resource management, shopping behavior, food safety, food security, and importance of physical activity.
• Matt’s story The story of how one family found help for a health problem from an Extension Nutrition Connections educator to solve individual helped nutrition outreach.
• Physical activity equipment, school breakfast programs, and school nutrition programs needs assessment Report to the HNH foundation of a statewide survey intended to help the foundation better direct grant money to elementary schools most in need.

During the holidays we traditionally think about providing food to those who can’t afford to provide for themselves. While the holidays are difficult for families with limited incomes, many families must search year-round for food from emergency sources, such as food pantries and soup kitchens.

The New Hampshire Food Bank, the only food bank in New Hampshire, knows the challenges of hunger all too well. Serving more than 350 soup kitchens, shelters, and food pantries throughout New Hampshire, the Food Bank distributed 3.9 million pounds of food last year—up from just over two million in 2004, according to Melanie Gosselin, the Food Bank’s executive director. By supporting the New Hampshire Food Bank, you are supporting an organization that “feeds the programs that feed the hungry.”

New Hampshire’s emergency food system: straining from the need
More than 95,000 people in New Hampshire live below the federal poverty guideline, $20,000 annual income for a family of four. An additional 120,000 people live in households with incomes below 200 percent of the poverty level.

The majority of New Hampshire’s poor adults hold jobs, but earn low wages. From 2000 to 2005 New Hampshire experienced a loss of manufacturing jobs and an increase in low-wage retail jobs. We see this shift reflected in the rise in use of federal food assistance programs and food pantries.

Last year 56,338 people received food stamp benefits in New Hampshire, yet only 54 percent of the households eligible to receive the benefits choose to participate in the program. This lack of full participation in the federal nutrition assistance programs strains the already-burdened emergency food system. Even when families participate in the food stamp program, they must still rely to some extent on the emergency food system, since average monthly food assistance benefit per person is $80.56.
 
Studies reveal the extent of hunger and need in New Hampshire
America’s Second Harvest, the organization that provides networks for more than 800 food banks around the country conducted a national survey in 2005 to determine the extent of need in each state. Food pantries, shelters, and soup kitchens reported increases in requests for their services and survey respondents verified their need to visit one or more food pantries a month in order to meet their family’s nutritional needs. Here in New Hampshire:

• 45 percent of respondents said they had to choose to pay medical bills before food
• 42 percent choose to pay for utilities before food
• 27 percent reported paying for rent before food

The recently released New Hampshire’s Basic Needs and Livable Wage Study indicates that a family of four (two parents, two children, both parents working) must have an income of $48,625 to meet their basic needs—is two to two-and-a-half times more than the average low-wage employee earns annually. The study defines the basic needs as food, shelter, heating fuel, transportation, taxes, basic telephone service, childcare, healthcare, and some clothing allowances. It assumes the family prepares all of their food from home and doesn’t count cable television or internet services—living conditions most of us would consider stark at best.

These aren’t temporary statistics occurring only during the holidays. These figures persist throughout the year and are on the rise. Census and federal nutrition assistance program data show a steady increase in individuals and families looking for sources of food to meet their basic needs.

In October the United States Department of Agriculture released their 2005 Household Food Security Study, which indicates the percentage of people who have difficulty buying enough food for their families because they don’t have enough money. The USDA survey reports:

• Nearly 7 percent of New Hampshire households experience food insecurity because they don’t have money to buy enough food to meet their family’s nutritional needs.
  
  
• More than 2 percent report going without food for a number of days at some point during the year because they didn’t have enough money to buy food.

Need for emergency food supplies will continue
Unless these root causes of hunger and food insecurity change, many families in New Hampshire will continue to require emergency food assistance to meet minimum nutrition needs. You can support the New Hampshire Food Bank with donations of money, food, or time. The virtual food drive is a welcome effort to combat hunger in New Hampshire. Every dollar donated to the food bank has the buying power of four meals. Donations of food with high nutritional value and volunteering are all welcome sources of support.

By Helen E. Costello, MS, RD, LD, UNH Cooperative Extension Nutrition Connections Program Food Security Consultant

Costello chairs the Hunger and Environmental Nutrition Dietetic Practice Group of the America Dietetic Association and sits on the advisory councils for both the UNH Center for a Food Secure Future and the New Hampshire Food Bank.

For more information about hunger and food security in New Hampshire:

• Extension’s hunger and food security pages
• UNH Center for a Food-Secure Future
• New Hampshire Food Bank

Robin Abodeely, the school nurse for the 425-student Dr. Crisp Elementary School in Nashua, strolls into a first-grade classroom on “snack patrol.”

“Anybody have a healthy snack to show me today?” she asks. The hands shoot up.

“I brought grapes today!”

“I have a banana!”

“I have an apple!”

Since signing up for Changing the Scene, a USDA school nutrition program, offered to N.H. schools in an enhanced format through UNH Cooperative Extension, Abodeely evaluated her school’s nutrition and fitness habits and spearheaded formation of  a school wellness team, which has since instituted an impressive variety of changes, including:

• Setting up a “Super Snackers” bulletin board with photos of students “caught” eating nutritious food
• Offering nutrition information in the school’s monthly newsletter
• Sending a healthy snacks suggestion list home to parents
• Hosting a full-scale farmers’ market of locally grown foods during a school open house
• Holding a PTO Family Fun Night, complete with jumping rope, salsa dancing, obstacle courses and healthy snacks
• Developing a 20-minute before-school walking program for students, faculty, and parents

Nation/statewide obesity epidemic affects children
“Obesity has reached epidemic levels in the nation and in New Hampshire, rivaling smoking as the number one public health threat,” says UNH Extension nutrition specialist, Valerie Long. “Studies have documented dramatic increases in childhood obesity in recent decades, raising concerns that today’s overweight kids will develop serious chronic illnesses such as diabetes, heart disease and some cancers at an early age, burdening a health care system already stressed to the breaking point.”

Long cites these statistics:

• The latest Kids Count survey estimates 27 percent of New Hampshire children are overweight or obese.
• Public health authorities estimate that 36 percent of children born in the U.S. in 2000 will develop diabetes in their lifetime.
• Sixty percent of overweight five- to 10 year-olds already have at least one risk factor for heart disease and 25 percent have two or more risk factors.
• Annual health costs directly associated with overweight and obesity among U.S. children more than tripled in the past two decades.

UNH Cooperative Extension steps in
“Getting to the root of a problem is what UNH Cooperative Extension does best, and when Extension nutrition educators wanted to begin improving the health of children in the state of New Hampshire, that’s just what we did,” says Extension nutrition specialist, Valerie Long.
“USDA had already developed a terrific program called Changing the Scene: Improving the School Nutrition Environment, with a toolkit of resources for local action. Since most children spend a large portion of their day at school, schools are a natural setting within which to influence the health and well-being of children and their families.

“We decided to target school nurses, because parents and community leaders respect nurses as child health advocates.” Says Long, “Collectively, they have the ability to reach large numbers of children. Nurses have knowledge in the areas of nutrition and exercise. They know a lot about the kids and the families of the kids in their schools.”

In early 2003 Long hired Martha Judson, a recently retired school nurse and past president of the NH School Nurses Association, to coordinate the program.

“I posted a note to the N.H. School Nurses’ Association listserv that we’d work with any school—at no cost to them,” says Judson. “I contacted a few schools I thought would have an interest, and then I hit the road, talking up the program one school at a time. Our timing was right. The data on the extent of childhood obesity had just begun making front page headlines.

“Most people call me to their schools because they know they have to do something,” Judson says. “Beginning in the 2006-2007 school year, the federal Child Nutrition and WIC Reauthorization Act will require all schools to form wellness teams and develop policy guidelines that promote student health through nutrition education, physical activity, and other school-based wellness activities.

“Our UNH Extension version of Changing the Scene gives schools the help they need to jumpstart the process.”

Changing the Scene: benefits to schools
“The program delivers a lot of value,” says Judson. “In exchange for a commitment of a minimum of 30 hours a year working on the project, Changing the Scene offers participants:

• a tool for assessing their own nutrition and exercise programs
• guidelines for identifying, contacting, and working with all of the groups who need to be actively involved with the school wellness team
• a rich assortment of resources and teaching materials
• ongoing support they need to develop and implement plans for change tailored to their schools’ specific needs and constraints.
• training conferences throughout the year
• one-on-one mentoring and individual meetings with school nurses and wellness teams to keep them up-to-date on the latest nutrition and physical activity information
• tips for attracting media attention and working effectively with the media
• one-on-one mentoring and coaching
• an email listserv
• access to a dedicated Web site for group discussion and sharing resources
• newsletters schools can send home to parents, with a blank page the schools can use to promote their own programs

 
Schools large and small, north and south
To date, Judson says, more then 350 school personnel from 118 schools the length and breadth of New Hampshire have signed on with the Changing the Scene program since its inception in 2003. “About three-quarters of the schools involved have made some changes, and many have made significant change to improve their school nutrition and fitness environments,” she says.

For her part, Abodeely says, “I used the Changing the Scene assessment tool, which revealed that our school was actually pushing junk food. With the best of intent—parents and teachers just want kids to be happy—we had birthday parties with cupcakes and sodas, pizza parties with cakes for dessert, a 100th-Day-of-School party, which featured a mix of  a hundred different pieces of candy.”

“In April, 2004, we had our first wellness committee meeting: The team decided to be proactive, to educate rather than punish, and to promote wellbeing, good nutrition and exercise.

“We kicked off our 2004 school year open house with a farmers’ market in the school cafeteria, organized by Awilda Muniz of UNH Cooperative Extension’s Nutrition Connections program. Local farmers sold corn and apples under a big tent. It was a huge hit.”

“We’ve put up posters everywhere, and filled our classrooms with nutrition and fitness books and supplies.”

Abodeely says having support at the top really helped ensure the program got off on solid footing. “Our school principal at the time, Jennifer Seusing, whose office was decorated with M&M dispensers, said, ‘If we’re going to be a healthy school, then I have to set a healthy example.’ She hired a personal trainer, joined Weight Watchers, and lost 85 pounds.”

Warren Elementary
In some New Hampshire schools, the administrators themselves sign on with the program. Rose Darrow, principal at the 82-pupil, K-6 Warren Elementary School, enrolled her school in 2004.
 
“We do a lot of research-based activities at this school. We’re always doing research,” she says. “When Martha [Judson] contacted us two years ago offering a researched-based program, we jumped at the chance. We already realized child obesity was an up-and-coming problem.”

Darrow says a lot has changed at Warren Elementary in two years. “We serve only fruit for dessert most days now, and we’ve switched to mostly [whole] wheat bread. We’ve become peanut-free. Our cooks have interested in nutrition. They’ve done taste tests of different cheeses and vegetables and taken periodic surveys to see what the children like and don’t like.

“We learned the children wanted more salads in their lunches, so we’ve begun serving more salads,” says Darrow. “They also wanted to go back to white bread; we didn’t go along with that.
We still have soda in the vending machines, but I’m happy to say that water is our biggest seller. It’s a fine balance: We really want change, but we want the change to feel positive.”

Darrow says, “Our fourth-, fifth-, and sixth-graders are ‘walking across New Hampshire,’ out in the school yard. The school bought pedometers for every child in the program—they love their gadgets! The little ones aren’t officially enrolled in the program, but they follow along anyway.”

“Another change we’ve made: Teachers eat their own lunches in the cafeteria, modeling good eating behavior. The children see them taking their time eating and enjoying their food.

Darrow summarizes her school’s experience with the Changing the Scene program this way: “Overall, we’re more thoughtful than we used to be. That’s what it’s all about.”

Other UNH Cooperative Extension health promotion outreach programs

Liveable, Walkable Communities Explore the vital role community design and development play in citizen health and well-being, including obesity prevention.

4-H Get up and Go Part of a larger statewide initiative, Walk New Hampshire (Walk NH), 4-H Get Up and Go encourages parents and other adults to lace up their walking shoes and join their kids in a walk across New Hampshire.


Nutrition Connections Nutrition and fitness education and support for income-eligible residents. Focuses on dietary quality, food resource management, shopping behavior, food safety, food security, and importance of physical activity.


Matt’s story The story of how one family found help for a health problem from an Extension Nutrition Connections educator to solve individual helped nutrition outreach

Physical activity equipment, school breakfast programs, and school nutrition programs needs assessment Report to the HNH foundation of a statewide survey intended to help the foundation better direct grant money to elementary schools most in need.

by Peg Boyles, UNH Cooperative Extension writer/editor; map by Shirley Clark, MerrimackCounty Family & Consumer Resources/ Nutrition Connections administrative assistant.

For more information:

• To learn more about UNH Cooperative Extension’s Changing the Scene program, email Martha Judson.
  
• USDA Team Nutrition’s Changing the Scene Program (national program)
• Making It Happen! School Nutrition Success Stories

A series of booking photos (scroll to bottom of page) taken over a 10-year span shows an attractive, 28-year-old blonde who changes into a gaunt, sickly woman looking much older than her 37 years.

The woman’s health and appearance was drastically altered by her body’s addiction to methamphetamine, which Newsweek magazine, in its August, 2005, cover story, called “America’s most dangerous drug.”

New Hampshire has yet to see the large numbers of methamphetamine addicts that Western and Midwestern states have experienced. But law enforcement officials say New Hampshire’s large expanses of wilderness are attracting those who manufacture the drug. In fact, 12 of the 18 methamphetamine labs discovered in New England in 2004 and 2005 were located in New Hampshire, many of them in rural Grafton County.

The effects of meth
Methamphetamine, also known as meth, crystal, ice, fire, croak, crank, glass, crypto, and white cross, is a powerful stimulant that affects the central nervous system. It makes people feel euphoric; its high can last for six to eight hours or more. Unlike some drugs that can take years to form an addiction, meth can cause addiction from a single use.

But though they keep trying, many users find it impossible to replicate that first feeling of euphoria experienced after initial use. People addicted to meth may suffer irreparable brain damage, as well as other health problems, financial ruin, loss of family, and death.

When on an extended meth high (called “tweaking”) people lose interest in eating and sleeping. Their only goal is to keep the high going for as long as they can, sometimes for days. Paranoia, hallucinations, violent behavior, and psychosis are common. Meth addicts’ typical neglect of personal hygiene is compounded by the smell of meth in their perspiration, a smell described as “putrid.”

Dentists across the country are discovering “meth mouth” caused by long-term methamphetamine use. Symptoms include tooth decay and receding gums. While on meth, some users begin picking at their skin to rid their bodies of imaginary bugs. Perhaps the worst effect is permanent brain damage, as meth destroys the part of the brain that registers pleasure. Long-term meth users can no longer feel pleasure, no matter how much of the drug they use.

Effects on children
Addicted parents may abuse or neglect their children when under the influence of the meth. Some children become “cooking assistants” to parents manufacturing the drug. Others get injured when the “cooking” process erupts into fires or explosions.
Children growing up or around a meth lab may carry the remnants of the drug dust on their clothing and skin. When children are removed from their home, all their possessions must be destroyed because they too are contaminated.

The walls, floors, furniture, draperies and other furnishings in a home, apartment, or garage where methamphetamine is produced and where wastes are disposed typically require assessment and cleanup. The average cost of a cleanup is about $5,000, but can reach $150,000. Who should pay the bill for this cleanup? The building’s owner? The renter? The town? A federal agency? What happens when those resources are exhausted?

Environmental hazards
In addition to the human toll, methamphetamine also poses a hazard for the environment. Meth paraphernalia left on the open ground can contaminate the soil and water runoff can pollute surface waters, wetlands, and groundwater. In some areas of the country, runoff from meth manufacturing facilities has killed livestock and destroyed large areas of trees and vegetation.

Experts estimate that the manufacture of each pound of meth produces five to six pounds of hazardous wastes that often get disposed of illegally in the environment. To make matters more challenging, many of these sites are in residential settings. This means children and other occupants of the property, as well as nearby neighbors, may be exposed to hazardous chemicals and harmful gases during and after the cooking process.

Cheap and easy to manufacture
Meth is cheaply and easily manufactured from readily available ingredients such as decongestant tablets (pseudoephedrine), iodine, Drano, rubbing alcohol, salt, common matches, and commercial fertilizer. “Lab” equipment includes such common items as plastic tubing, Mason jars, coffee filters, soda bottles, blenders, camera batteries, propane cylinders, and hot plates, electric frying pans or camp stoves.

New Hampshire’s Attorney General and county attorneys, as well as local, state and federal law enforcement officials, have begun working together to keep the methamphetamine problem from escalating in New Hampshire. Despite relatively low numbers of meth users, the social and economic costs of meth addiction are high.

Farm and forest factories
Methamphetamine’s relative ease of manufacture has long range implications for communities and landowners. People who make methamphetamines may use secluded farm or forest land to hide their illegal activities. Landowners who frequently walk their land are less likely to become victims of unauthorized use of their land.

Here are a few tips to help landowners protect themselves and their property:

• Don’t accept cash for the use of your property.
• Know what happens on your property.
• Don’t bury, move, or examine any trash found on your property.
• If you discover the trappings of meth manufacturing: red-stained coffee filters, plastic bottles with attached tubing, empty cold-tablet packaging, don’t touch or move anything. You could be putting your health at risk. Don’t confront anyone involved in suspicious activity on your property. If your town has an anonymous reporting system, call that number. Report any suspicious activity on your land to local law enforcement officials, but leave the dangerous part to those who are specially trained for cleanup.

Inform yourself and take action
A recently formed New Hampshire Government Leaders Methamphetamine Task Force has developed a statewide strategy to keep meth use from growing in New Hampshire.

Local, state and federal officials are committed to getting and keeping methamphetamine issues in the open for citizens to learn more. As a community member, learn all you can about this drug and its devastating impacts. You can mobilize your fellow community members to become more aware of the dangers of methamphetamine, co-sponsor open forums and protect yourself and your family.

To learn more:

• How meth destroys the body
• Meth pharmacology (how it works in the body)
• Meth Q & A
• National Institute on Drug Abuse Infofacts: Methamphetamine
• New Hampshire Government Leaders Methamphetamine Task Force
• Photo gallery: Faces of meth

My daughter just came back from a five-week program UNH offers in Ascoli Piceno, Italy. The program offers two courses: one in Italian history and the other on the Mediterranean Diet, which examines Italy’s gastronomic culture.
 
Numerous research studies have shown the Mediterranean Diet to provide many health benefits. One study, published in the New England Journal of Medicine in 2003, involved some 22,000 people living in Greece. During this four-year study, researchers found that those people following a “Mediterranean Diet” were less likely to die from either heart disease or cancer.
 
So just what are the components of this healthful diet? First, an abundance of nutrient rich foods, especially fruits, vegetables, whole grains, beans, nuts and seeds These foods are rich in fiber and antioxidants. In addition to cancer and heart disease prevention, a diet rich in fruits and vegetables can help keep obesity at bay, help reduce the incidence of stroke, prevent birth defects, and decrease one’s chances of developing cataracts and age-related macular degeneration.

Your local farmer’s market is a good place to find fruits and vegetables harvested at the peak of ripeness and flavor. The diet is moderate in fat with olive oil as the major source. Some fat also is derived from nuts and seeds. Olive oil and nuts are excellent sources of monounsaturated fat, which can help lower total cholesterol and LDL cholesterol while increasing HDL cholesterol. They are also good sources of antioxidants including vitamin E.

Today, our grocery stores carry a variety of olive oils to suit every type of cooking.

Moderate amounts of fish, especially “oily fish” such as salmon, mackerel and tuna, is consumed, providing significant amounts of Omega 3 fatty acids, a type of polyunsaturated fat, which can also lower cholesterol.

The consumption of red meat is minimal, reducing intake of saturated fat that elevates cholesterol levels and LDL cholesterol. In addition, only low to moderate amounts of dairy products are eaten with cheese the primary choice. Cheese is usually an accompaniment or used as a condiment on foods. Using just a little of the hard cheeses, like a good parmesan, romano or asiago, can go a long way in adding flavor to a dish.

Consumption of eggs is also quite moderate with an average intake of four a week.
Italians drink a glass or two of wine a day with meals. Red wine is a rich source of flavonoids called phenolics - antioxidants that protect against heart disease by increasing HDL cholesterol and preventing blood clots from forming.

What is most impressive of this Mediterranean culture is the whole lifestyle that surrounds it. My daughter noticed how everything is so unhurried. Meals aren’t wolfed down but savored. Everything closes down for several hours in the afternoon. People walk a lot or ride bicycles. There are fewer work-saving amenities. This increase in physical activity and the decrease in stress do play an important part in the whole health picture along with the diet.

Summertime is a perfect time to consider trying the Mediterranean lifestyle. The abundance of fresh produce and the opportunity to relax a bit and include more physical activity in your day is one way to make it happen. There are some good books to get you started. These may be available at your local library. Try the Mediterranean Diet by Marissa Cloutier and try making some mouth-watering recipes from Mediterranean Diet cookbooks by Jeanette Seaver and Nancy Jenkins.

By Colette Janson-Sand Ph.D., RD, LD, Nutrition Specialist UNH Cooperative Extension

July, 2006

The disastrous floods of May have receded and most New Hampshire residents have cleaned up and returned to their flood-damaged homes.

But more than 300 New Hampshire families are waiting for help cleaning and sanitizing their homes to make them safe enough to live in. Some displaced families are living in cars and shelters.
 
“With the arrival of summer heat and humidity, we need to move fast to get ahead of the growth of mildew and other molds that can cause health problems for residents,” says Carole Totzkay-Sitar, a health educator with the Bureau of Emergency Management. “State health and safety officials need 200 volunteers to take the training and team up with experienced mold-mitigation teams already on the job.”

Molds threaten human health
“Families in Rockingham, Strafford, Merrimack, Hillsborough, Belknap, and Carroll Counties need immediate help,” Totzkay-Sitar says. “Failure to remove contaminated materials and to reduce moisture and humidity can present serious long-term health risks to the people who live there. Microorganisms that thrive in areas that are wet, damp, or retain water can cause disease, trigger allergic reactions and continue to damage household materials long after the floodwaters recede.”

“Mud Out” volunteer training
To boost volunteer recruitment, state health and emergency management officials, working through Volunteer NH!, have joined forces with southern New Hampshire church groups who’ve had experience organizing volunteers to go into homes to remove damaged contents, clean, and sanitize flooded premises. They plan to offer at least one “Mud Out” volunteer training in July, which will cover proper clothing, tools, safety, and health issues related to molds. All Mud Out volunteers will be teamed with an experienced “mudder.”

Volunteers must be at least 18 years old and healthy. They will need to sign a liability waiver, and provide their own protective equipment. For more information about becoming a Mud Out volunteer, call 1-800-780-8058.

Flood-damaged home? Take action now!
State officials encourage any resident whose home was flooded not to wait for FEMA funds, insurance payouts, or volunteer helpers before taking action to assess health and safety threats in their homes. If you have concerns about the health risks of molds, contact your family health care provider. For information about conducting a mold assessment or about mold removal, call Rhonda Martin at the Department of Environmental Services at 271-3911.

Links to written information about mold in homes:

• Mold in Your Home? (NH Department of Environmental Services flyer)
  
• NH Air Resources fact sheet
  
• A Brief Guide to Mold, Moisture, and Your Home (US Environmental Protection Agency)
  

UNH Cooperative Extension has an array of information to help New Hampshire residents recover from multiple problems caused by this weekend’s floods.

Storm damage can leave behind debris-strewn areas, contaminated water, spoiled food, displaced wildlife and conditions, if not treated properly, may lead to health problems.

With rain totals reaching as high as 11 inches in some areas, and more on the way, residents must assume that all water sources are contaminated until proven safe. Food contaminated by flood waters should be handled carefully and a determination made on what to keep or discard.

Topics include staying safe, recovering from a power outage, restoring storm-damaged buildings, helping children cope with disaster, salvaging water-damaged belongings, financial recovery and more.

To those in the flood areas, the Federal Emergency Management Agency (FEMA) urges residents to do the following immediately:

• If your home, apartment or business has suffered damage, call the insurance company or agent who handles your insurance right away to file a claim.
• Before entering a building, check for structural damage.
• Do not use matches, cigarette lighters or any other open flames once you’ve entered a damaged building, since gas may be trapped inside. Use a flashlight.
• Keep electricity off until an electrician has inspected your system for safety.
• Flood waters pick up sewage and chemicals from road, farms and businesses. If your home has been flooded, start cleaning up as soon as possible. Throw out foods and medicines that may have come in contact with flood waters.
• Boil water for drinking and food preparation vigorously for five minutes before using.

If you have additional questions, please contact your local Extension office. Please click on all our links for further advice.

Current Conditions in New Hampshire:

• Road conditions and travel alerts
• WMUR-TV Weather
  
• National Weather Service – Interactive Weather Information Service for NH
• NOAA - WaterWatch – current NH water resources conditions
• Real-time NH - NH Department of Environmental Services (NHDES)
  water level monitoring site

General:

• American Red Cross (ARC)
  • Disaster Services
• Center for Disease Control and Prevention (CDC) – Floods
• Federal Emergency Management Agency (FEMA)
  • FEMA En Espanol
  • Guide to Disaster Assistance

Recovery:

• Food & Drinking Water Safety:
  • Food and Water in an Emergency (FEMA)
  • Food Security and Emergency Preparedness - Food Safety
    Inspection Service, USDA
  • Keeping Food Safe During an Emergency - fact sheet
  • N.H. Drinking Water Testing
    • Fact sheet on private well water testing
    • Request water sample containers
    • Understanding your water test results
    • For other drinking water questions, call Bernie Lucey at (603) 271-2952
• Shelter-In-Place (American Red Cross) What it means, what to do (PDF version)
• Cleaning Flood Damaged Homes
• Cleaning Household Utensils and Metals & Salvaging Papers
• Disaster Recovery: A Guide to Financial Issues - (American Institute of Certified Public Accountants (AICPA), AICPA Foundation, the American Red Cross, and the National Endowment for Financial Education® - NEFE®)
• Helping Children Cope With a Disaster
• How To Repair a Flooded Home (ARC)
  • English (PDF)
  • En Español (PDF)
• Recovering From and Coping With Flood Damaged Property (FEMA)
  • After a Flood: The First Steps (PDF)
  • Returning Home
• Removing Odors from Refrigerators & Freezers
• Restoring Emotional Balance After a Disaster
• Saving Family Treasures Guidelines

Safety:

• Are you Ready for a Flood or a Flash Flood?:
  
  • English
  • En Español
    
    
  • Blackouts
    
    • English
    • En Español
      
      
  • Flood Safety (National Weather Service)
  • Fact Sheet En Español
    
  • Turn Around Don’t Drown (National Weather Service)
  • Your Family Disaster Plan

   

  Posted May 15, 2006 | TrackBack

Many communities across our state are considering programs to monitor and/or control mosquito populations in response to last year’s outbreak of Eastern Equine Encephalitis, a viral disease spread by mosquitoes.

If your community is among those considering a mosquito-monitoring or mosquito-control program, or if you simply want detailed information about this complicated illness, check out this new 13-page information bulletin, Eastern Equine Encephalitis Could Return to New Hampshire this Summer,  by UNH Cooperative Extension entomologist Alan Eaton.

From Thanksgiving through Valentine’s Day, we Americans spike our long winter darkness with holidays, bowl games and other special events marked by feasting, food exchanges and a general celebration of abundance.

Yet, according to a report released November 19 by the U.S. Department of Agriculture, last year 36.3 million Americans either went hungry or reported uncertainty about getting enough to eat at some point during the year. This figure includes 13 million children.

By national standards, New Hampshire , with the fourth-highest median household income in the nation, has a relatively low rate of hunger. Yet our state’s affluence masks the harsh truth that tens of thousands of Granite State residents can’t stretch their incomes to meet the basic food requirements for healthy living.

Hunger and food insecurity in New Hampshire

Although we don’t have hard data on hunger and food insecurity in New Hampshire , we can gauge its incidence through related indicators like these:

• A U.S. Census Bureau report issued last August estimated that 96,000 New Hampshire people lived below the federal poverty guidelines ($18, 850 for a family of four) at some point during 2003, up from 79, 200 in 2002 and 63,300 in 2000. Most of these people rely on a combination of government food assistance programs and emergency food providers to get enough to eat.
  
  
• The 2003 USDA Household Food security survey revealed that 45 percent of households reporting hunger or food insecurity have incomes above 130 percent of official poverty levels, meaning they probably don’t quality for federal food assistance programs.
  
  “We have real concerns for the thousands of people who earn just enough that they don’t qualify for food stamps and other government assistance programs,” says Val Long, Nutrition Coordinator for UNH Cooperative Extension’s Food Stamp Nutrition Education Program.
  
  “Steep increases in the costs of housing, fuel, transportation and healthcare, as well as food, haven’t been matched by increases in wages. A lot of working families have begun depending on emergency food pantries to feed their families. The emergency food system was intended to be just that: help for temporary emergencies. But people have begun relying on it chronically. That shouldn’t happen in the United States . It’s not an acceptable way to ensure that people are getting a nutritionally adequate diet that keeps them active and healthy.”
  
  
• In 2000, 36,266 New Hampshire residents received food stamps. By 2004, that number had risen to 48,449.
  
  
• Survey results released in December by the National Low Income Housing Coalition indicate that to afford the average two-bedroom apartment (including utilities) in New Hampshire , a worker must earn $16.75 per hour, more than three times the federal minimum wage.
  
  
• By the end of 2004, the New Hampshire Food Bank will have distributed about four million pounds of food to nonprofit and emergency food providers throughout New Hampshire —a million more pounds than last year, according to executive director Melanie Gosselin. “In one year, we expanded membership from 240 agencies to 342,” she says.

New Hampshire ’s emergency food providers

The federal government’s nutrition safety net, which includes the Food Stamp Program, the Women, Infants and Children Nutrition Program (WIC) and the School Meals Program, has traditionally built nutritious food and nutrition education into their programs.

In recent years, the net has frayed. Many low- and moderate-income people with incomes too high to qualify for food stamps and other government assistance programs can’t keep up with the escalating costs of housing, home heating fuel, and transportation. Responding to an increase in need, the state’s charitable emergency food system has grown dramatically in recent years.

Founded in 1984 as a program of Catholic Charities, the New Hampshire Food Bank serves as a centralized warehouse and distribution center for a network of nonprofit daycare centers, senior feeding sites, emergency food pantries, soup kitchens and homeless shelters.

The New Hampshire Food Bank maintains an affiliation with a nationwide network of more than 200 food banks and perishable food “rescue operations” called America ’s Second Harvest . The nationwide organization takes advantage of its collective buying and bargaining power, and today serves local agencies that feed needy people in every county in the U.S.

The New Hampshire Food Bank receives food from grocery stores, wholesalers, farmers and individuals, as well as cash donations from individuals, organizations and a variety of fundraising activities. The Food Bank requires its members to acquire nonprofit status, have refrigeration if they plan to store perishable foods, and undergo periodic inspections that ensure safe food handling practices. Agencies preparing food onsite must have state-certified commercial kitchens.

Some emergency food facilities offer classes that promote nutrition and cooking skills to the agencies and their clients. For example, a nationwide program called Operation Frontline, pairs nutritionists with chefs from local restaurants to teach cooking skills and nutrition to clients of emergency food pantries. UNH Cooperative Extension Nutrition Connections staff in Hillsborough and Rockingham counties have collaborated with Operation Frontline to teach classes which deliver nutrition education to Food Stamp clients.

In addition, some food pantries provide other services that range from cash assistance to meet emergency needs for housing, fuel, clothing, and medicine, to job training and health screenings and clinics.

Observations from the field

Persis Gow, the bookkeeper for St. Paul ’s Church Food Pantry in Concord , has noticed an increase in demand on the pantry in recent years and months. “In January 2004, we served people from 25 surrounding towns. In November, we had people from 30 towns,” she says. “In 2001 we added 363 new families—people we’d never seen before. Already this year we’ve had 400 new families, with December figures not in yet. In 2001 we served 3688 children under 18; in 2004, to date, we’ve had 4228.

Gow says people who visit the pantry include elders, single parents, and people with disabilities. “But lately, I’ve noted an increase in the number of traditional, stable, working families—mother, father and children, all with the same last name,” she says. “That’s new.”

Dot Hunt has served as treasurer of St. John’s St. Vincent de Paul Food Pantry in Concord for the past 22 years. “There are at least 27 food pantries here in Merrimack County , and we’re all busy. Our numbers are up, with 400 new families this year. As many as 1200 individuals pass through each month,” she says. “We’re seeing more elderly, more working families and—what’s new for us—more single young people. Sometimes three or four single people will be living together and one will come in to get food for them all.”

Hunt says the pantry also provides emergency help with rent, medicine, fuel and clothing. “Usually I get about 12-14 requests a month for help with fuel and rent. But one month not too long ago, I had 60 calls. We’re seeing a lot of people facing eviction.”

2005 hunger study

In 2005, the N.H. Food Bank will participate in the Hunger in America Survey that America ’s Second Harvest conducts every four years. “This will be the first time New Hampshire has joined the survey,” says Erin Chamberlain, the N.H. Food Bank’s program services director. The two-part study will collect demographic data from face-to-face interviews with clients of emergency food pantries and soup kitchens, as well as from a survey of provider agencies themselves. “It will give us hard data about who is hungry in New Hampshire and how they deal with it,” says Chamberlain. “The study will also help us learn about what our member agencies are doing for the people in need and what more we could do for [the agencies].”

If you or someone you know needs food

If you face a family food emergency, or know someone who does, find the most available source of food. Call the Nutrition Connections staff person in your county or call your town hall and ask how and where to apply for local welfare. If you have children in school, go to the school nurse for help finding out whether your children qualify for free or reduced lunches. The New Hampshire Assistance Handbook offers sections on eligibility and how to sign up for food stamps WIC, and other government assistance programs.

If you want to help

Besides educating yourself about the extent of hunger and food insecurity in your own community, you can also participate in a local food drive, contribute cash to the Food Bank, or volunteer your time at a food pantry or soup kitchen.

Donating directly to the N.H. Food Bank instead of purchasing food products yourself increases the buying power of your donations. “A $10 donation to the N.H. Food Bank will buy 40 meals for hungry people,” says Gosselin. “Our buying power allows us to sell food to local pantries at only 18 cents a pound.”

Since most local pantries or soup kitchens run on volunteer labor, citizens can also consider donating time. Call to find out if an emergency food provider near you (link to list of emergency food providers) needs help.

Resources 

Nutrition Connections
This list connects you with UNH Cooperative Extension county staff who provide nutrition education to low-income individuals and families in New Hampshire. Staff can help connect you with emergency food resources.

New Hampshire Food Bank
New Hampshire ’s only food bank; warehouses and distributes food to a statewide network of 342 member agencies.

America ’s Second Harvest - America’s Food Bank Network
A nationwide network of more than 200 food banks and “food rescue” operations.

Serve New England
An “alternative to food shopping” that offers families of any income level deep discounts on major brand name foods in exchange for at least two hours of volunteer service each month. New Hampshire has 35 pick-up locations. You can buy a package of frozen meats, fresh fruits and vegetables at about half the grocery store price. No limit on how much food you can buy. Call 1-800-603-4855 for nearest location.

New Hampshire Assistance Handbook

Published in 2003, but updated for 2004, the handbook contains a listing of critical resources for people in need, including food assistance, shelters for the homeless and for battered women, nutrition education, legal assistance, fuel assistance, social services, and much more.

Kids Café
A service of the Salvation Army. Serves dinner to needy Manchester children, followed by an hour of crafts or games, four nights a week

The Paradox of Hunger and Obesity in America
Obese, but hungry and malnourished? This paper, issued jointly by Brandeis University ’s Center on Hunger and Poverty and the Food Research & Action Center , helps explain the apparent paradox of how dual threats of hunger and obesity can co-exist in individuals and families.

By Peg Boyles, UNH Cooperative Extension writer/editor, and Helen Costello, Food Security Coordinator

See also: "It can happen to anybody."

Parents of the 14,000 babies born each year in New Hampshire have many choices about how and where their babies will enter the world, and who will attend the birth.

These decisions affect the whole family. The birth attendant and setting can make all the difference in a birth experience that is satisfying to mom, dad, siblings, and the family’s newest member. The goal is to find the combination of birth method, birth setting and attendant that help laboring mothers and their partners feel most comfortable.

Who will attend your birth?

New Hampshire families have several options:

• A medical doctor—either a family doctor or obstetrician Obstetricians (OBs) are trained to handle high-risk pregnancies, and can perform surgery and other high-tech interventions when necessary. A few obstetricians perform elective, or on-demand caesareans for women who choose to have a surgical delivery for reasons other than medical necessity. Elective cesarean is a controversial choice and is something that parents should research carefully before making a decision.

• A Certified Nurse Midwife (CNM) A special category of Advanced Registered Nurse Practitioners, CNMs have taken advanced training in childbirth. Certified through the N.H. State Board of Nursing, CNMs usually work in group practices with obstetricians and attend births that take place in hospitals. CNMs support natural childbirth and tend to spend more time with women in labor than doctors do.

• A New Hampshire Certified Midwife (NHCM) An NHCM has specialized training in low-risk pregnancies, childbirth, and lactation and newborn care. NHCMs are certified by the state, and their training requirements and scope of practice are regulated by state statute. NHCMs accept only women with low-risk pregnancies. The same NHCM you see for prenatal care typically also attends your labor and birth.

• Unassisted childbirth Some women choose to give birth without a trained attendant, although they may ask close friends and family to help them during labor and delivery. Although pregnancy and childbirth are natural processes that rarely become medical conditions, those who choose to give birth without professional help take on a great responsibility. Like elective cesarean, unassisted birth is a controversial choice you should research carefully before making a decision.

Your choice of birth attendant will affect where you have your baby .

Family doctors, OBs, and CNMs work almost exclusively in hospitals, whereas NHCMs attend births in homes and free-standing birth centers licensed by the state but not affiliated with a hospital.

Research has shown that all settings can be equally safe, provided mothers have received adequate prenatal care, parents are well prepared, and birth attendants are well trained.

• You might choose a hospital if you are among the small number of women with a high-risk pregnancy, if you feel more comfortable knowing that emergency interventions are available on site, or if you know think you may want pain medication during labor.

• Homebirth is an option for women who feel more comfortable at home, knowing they won’t have to interrupt labor to drive to another place, follow a hospital’s routine, or interrupt their bonding with their newborn by leaving to go home. Homebirth works best when mothers feel confident in their ability and safe in their surroundings. Homebirth also requires different preparation from hospital birth.

• Birth centers are an option for only a few New Hampshire families, as two centers have closed recently. If you aren’t likely to need the high-tech interventions offered in hospitals, you might still prefer the security that comes from knowing the center is completely set up for birth and any emergencies that might arise. If you can afford a birth center birth, and you live within an hour of one, this could be an option for you.

How can you decide?

Talk to other families, especially those who share your values. Talk to families who have had their babies in hospitals, birth centers, and homes, with different types of attendants. Ask midwives for references if you don’t already know women who have given birth outside of a hospital. Ask what preparation each family made for the birth and what they wish they’d known ahead of time. You are looking for a good fit for you and your family.

Tour the hospital or free-standing birth center. Ask a lot of questions. You are looking both for good answers and a good attitude about parents who are involved in their own birth experience. In a hospital, the maternity nurses—not your OB or CNM—may provide most of your care.

Consider finances. Most insurance carriers cover hospital births attended by medical doctors or CNMs, though you should check your terms of coverage before you become pregnant. Although N.H. Medicaid and some smaller carriers cover births attended by NHCMs at home or in a birth center, the major health insurance carriers in New Hampshire don’t.

A bill (SB 175) introduced during this legislative session would have required all insurance companies to cover midwife-attended out-of-hospital births, a service N.H. Medicaid and some smaller insurance companies already cover.

Although the bill passed the full Senate, and the House Commerce Committee voted 14-7 to recommend passage, the House sent it back to committee for further study and revision. Supporters expect to reintroduce a revised version of the bill in January, 2006.

Homebirths cost around $2000, birth-center births a little more. Hospital births may cost four or five times as much, but if you are not on Medicaid or covered by one of the small health insurance companies offering out-of-hospital coverage, you probably will have to pay for an out-of-hospital birth out of pocket.

You can change your mind. Birth attendants need enough time to assess your well-being and preparation for birth before your baby is due. You’ll want to have your birth attendant and setting arranged by early in your third trimester if possible. But you need time to assess your own decisions about where to have your baby and who will attend your birth.

Keep learning and talking to other parents and birth providers. You may you may discover available alternatives you didn’t know about, and change your mind about how and where you want to have your baby, and who will attend the birth.

Links: