'.1I
i
San Fernando Valley State College
A Study of the Relationship Between Diet 1
I!
Ir9n Deficiency Anemia and
Scholastic Achievement
A thesis submitted in partial satisfaction of the
requirements for the degree of Master of Science
in Health Science
by
Ruth Mae Kennedy
:il "'
)
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f
June~
1967
I.
L.
I
I
1
1,,
I
The thesis of Ruth Mae Kennedy is approved:
San Fernando Valley State College
June, 1967
ii
[,
I
I
This Thesis
is
~edicated
to the memory of
M. Louene Birch,
Consultant in Health, Ventura County Schools.
A friend, whose contribution to health
education has left a lasting imprint
on our c onununi ty and on the
lives of many.
111
TABLE OF CONTENTS
Page
LIST OF FIGURES
• • • • • • • • • • • • • • • • • •
vi
LIST OF TABLES •
• • • • • • • • • • • • • • • • • •
vii
ACKNOWLEDGMENTS
• • • • • • • • • • • • • • • • • •
viii
ABSTRACT • • • • • • • • • • •
• • • • • • • • • • •
1x
Chapter
I.
II.
INTRODUCTION • • • • • • • • • • • •
Health and School Performance • •
Culture and Diet • • • • • • • • •
Iron Deficiency Anemia • • • • • •
Statement of the Problem • • • • •
LITERATURE REVIEW
• • • •
1
• • ••
• • • •
1
....
2
3
• • • •
4
• • • • • • • • • • • • •
6
Section I: Methods of Measuring
Food Intake • • • • • • • • • • •
Section II: Methods of Measuring
Scholastic Achievement • • • • • • • • • •
Section III: Methods of Measuring
Anemia • • • • • • • • • • • • • • •
Physiology • • • • • • • • • • • • • • •
Normal Range of Values • • • • • • • • •
Methods of Measurement • • • • • • • • •
Surveys of Hemoglobin Levels in
Populations • • • • • • • • • • • • • •
Section IV: Studies of the Relationship Between Diet. Iron Deficiency
Anemia and Scholastic/Achievement • • • •
Relationship Between Food Intake,
Blood Nutrients, and Hemoglobin • • • •
....
...
iv
7
10
13
i~
15
17
19
19
TABLE OF CONTENTS (continued)
Chapter
II.
Page
LITERATURE REVIEW (continued)
Relationship Between Diet and
Scholastic Achievement • • • •
Relationship Between Diet and
Scholastic Achievement in the
Pre-School Child • • • • • • •
III.
• • • •
20
• • • • •
21
•
.Conclusions from the Literature
Review • • • • • •
• • • • • •
RESEARCH DESIGN
.•
..
• • • •
....... ......
Measurements • • •
Achievement Tests
Population Studied
Research Design •
•
•
•
•
24
24
25
26
• • • •
32
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35
• • • • • • • • • •
39
• • • • • • • • • •
51
BIBLIOGRAPHY
• • • • • • • • • • • • • • • • • • • •
54
APPENDIX ••
• • • • • • • • • • • • • • • • • • • •
58
ANALYSIS AND DISCUSSION OF FINDINGS
Survey One • • • • • •
Survey Two • • • • • •
V.
•
•
•
•
SUMMARY AND CONCLUSIONS
v
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24
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IV.
•
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22
LIST OF FIGURES
Figure
1.
2.
Page
Relationship between estimated nutrient
iron and hemoglobin in 146 students from
the fourth, fifth, and sixth grades
attending Juanita Elementary School • •
• • • •
36
Relationship between estimated nutrient
iron and hemoglobin in 46 students; 23
classified as anemic and 23 classified
as non-anemic. Non-anemic students are
matched to anemic students using the
criteria: age, grade, sex, race, and IQ • • • •
40
3. Relationship between IQ and hemoglobin
in 46 students; 23 classified as anemic
and 23 classified as non-anemic
4.
5.
6.
7.
• • • •
• • • •
43
Rela'tionship between Word Meaning and
hemoglobin in 46 students; 23 classified as anemic and 23 classified as
non-anemic • • • • • • • • • • • • • • • • • • •
44
Relationship between
and hemoglobin in 46
classified as anemic
fied as non-anemic •
45
Paragraph Meaning
students; 23
and 23 classi• • . • • • • • • • • • • •
Relationship between Arithmetic Computations and hemoglobin in 46 students;
23 classified as anemic and 23 classified as non-anemic • • • • • • • • • • • • • • •
Relationship between Arithmetic Concepts
and hemoglobin in 46 students; 23 classified as anemic and 23 classified as nonanemic • • • • • • • • • • • • • • • • • • • • •
vi
46
47
I
LIST OF TABLES
Table
l.
Page
Hemoglobin and Hematocrit Concentration
for Different Age Groups • • • • • • • • • • •
vii
14
ACKNOWLEDGMENTS
The writer wishes to express her appreciation to the
persons who have helped to make this study possible:
Dr. John M. Weiner, who has given so generously of his
time and talent to serve as chairman of my Thesis Committee;
Dr. Lennin H. Glass and Dr. Wilfred
c. Sutton for their con-
tributions as members of my committee.
The Oxnard Elementary School District; the cooperative
efforts of my school principals, and especially Mr. James
Blundell, principal of the Juanita School; the fourth,
fifth, and sixth grade students who participated in the
study; the school nurse, Mrs. Stephanie Clezie, and the
staff of' the Juanita School; and the community volunteers.
The contribution
of Edwin L. Lowe, M.D. and his office
staff' is gratefully acknowledged.
viii
ABSTRACT
A Study or the Relationship Between Diet 1
Iron Dericiency Anemia and
Scholastic Achievement
by
Ruth Mae Kennedy
Master or Science in Health Science
June~
1967
The health or the school-age child traditionally was
believed to be associated with his ability to perform school
related activities.
This relationship was investigated in
a sample of Mexican-American students attending Juanita ·
Elementary School 1 Oxnard 1 California.
Measures of
diet~
disease 1 and scholastic achievement were used.
The specific characteristic of nutrient iron estimated
from a twenty-four hour recall of foods consumed was used to
reflect diet.
Levels of blood hemoglobin were used to
classify individuals as anemic or non-anemic.
Scholastic
achievement was estimated by the scores obtained from speciric sections of the Stanford Achievement Tests.
A total of 146 1 fourth 1 fifth, and sixth grade students
were studied.
The relationship between nutrient iron and
hemoglobin was investigated and found to be non-significant.
One hundred and twenty-one of the 146 students were Mexican-
ix
Americans and 23 of those Mexican-American students were
found to be anemic using the classification less than or
equal to 11.6 grams of hemoglobin.
Twenty-three non-anemic
Mexican-American students were matched to the anemic
students using the criteria:
age~
sex, grade, and IQ.
The
relationship between nutrient iron and hemoglobin 1n these
46 students also was found to be non-significant.
The rela-
tionship between scholastic achievement (as measured by Word
Meaning, Par!Sraph Mean!n5, Arithmetic Computation, and
Arithmetic Concepts) and anemia (as measured by hemoglobin)
was found to be non-significant.
These findings suggest the need for a more sophisticated approach in studying this problem.
CHAPTER I
INTRODUCTION
Health and School Performance
It has been traditionally assumed by most experts in
the fields of education and health, that there is a direct
association between the health of the school-age child and
his total school performance.
Assessment of the association
is difficult because of the measurement problem.
The
measurement of an individual's health is subject to many
sources of error.
Similarly, measurement of performance,
whether one considers total performance or separate physical
and mental components, is subject to numerous sources of
error.
Concomitantly these measurements of the association
between health and performance are made within the framework
of a complex social system.
It is the system which intro-
duces many of the error sources.
For example, poor scholastic performance may result
from poor health or from poor communication between
and teacher.
stud~nt
Determination of those characteristics most
related to poor performance must take into account both
health and cultural factors.
Some previous studies, in at-
tempting to do this, have measured cultural differences using characteristics such as race or ethnicity.
·1
Others have
2
used food consumption practices as a measure of culture and
have attempted to relate such measures to existing or potential health problems.
Culture and Diet
In an extensive survey of a Mexican-American neighborhood6 Sal si Puedes 6 an unincorporated community on the
eastern edge of San Jose, California,
G~ark
studied the
relationship of cultural influences upon food practices and
-
habits of the first and second-generation Mexican-Americans.
She observed that many food concepts are clearly derived
from the Mexican folk beliefs.
Many disorders are traced to
the imbalanced intake of "hot" foods, such as:
white beans,
fish, pork, potatoes, rice 6 honey, brown sugar, salt; and
"cold 11 foods, such as:
green beans, carrots, peas, citrus
fruit 6 beef, lamb, milk, red beans, corn tortillas.
For
proper diet and good health "cold" foods must be balanced
with "hot" ones.
For example, skin eruptions are believed
to be a result of eating too much "cold" fruit and are often
treated with "hot" foods such as sweet red plums.
The addi-
tion of the "hot" food to the "cold" food is thought to
neutralize the imbalance and restore the individual to good
health. 1 For this reason, Mexican-American children may
1Margaret Clark, Health in the Mexican-American Culture
(Berkeley and Los Angeles:
1959), pp. 164-183.
university of california Press,
3
have beliefs about food which are very different from the
beliefs of those who are responsible for serving a "balanced"
school lunch.
These children often refuse to taste or eat
foods which are not customarily included in the home diet.
Iron Deficiency Anemia
Observations indicate that diet is related to levels of
hemoglobin.
This measurement has been used to indicate the
presence or absence of iron deficiency anemia.
Iron defi-
ciency anemia is associated with the diminished oxygencarrying potential of the blood.
Clinically, this condition
is manifested by general fatigue, lassitude, giddiness,
headache and lethargy.
Some of these signs and symptoms may
be perceived by the teacher as behavioral problems in the
classroom, when in reality they are evidence of disease.
The diagnosis of iron deficiency anemia cannot be made
on clinical grounds alone but requires confirmation by
laboratory examinations of blood hemoglobin and hematocrit.
Studies vary regarding the normal range o:f hemoglobin and
hematocrit values.
An accepted range for boys and girls
under 13 years of age is for hemoglobin, 12 to 13 grams per
lOOcc blood volume and for hematocrit, 37 to 39 percent
packed cell volume. 2
2Alfred Stefferud (ed.), Food, The Yearbook of A'rioulture (Washington, D.C.: United states Oovernmentr!nting
O??Ice, 1959), p. 211.
4
Diet and blood composition in children under 13 years
or age were studied at various United States Agriculture
Experiment Stations.
The study included individuals rrom a
number of eastern 1 mid-western and southern states.
Micro-
chemical methods were used to analyze the blood samples in
the determination of the relationship between hemoglobin
levels and the oxygen-carrying capacity of the blood.
The
hemoglobin levels were similar in the two sexes 1 approximately 13 grams.
These observations suggested a positive
correlation between intake or nutrients and levels or hemoglobin irrespective or culture.
Behavior was not studied.3
Statement of the Problem
The relationship between diet, behavior and disease has
not as yet been investigated in the school environment.
If
the lower socioeconomic segment of the population is, in
fact, nutritionally deprived, then the frequency of students
with conditions such as iron-deficiency anemia may be expected to be higher.
The presence of this condition may aid
1n explaining poor school performance as measured by decreased attendance, increased number of apparent behavioral
problems, and lowered scholastic achievement.
\ The purpose of this study was to determine the relationship between iron deficiency anemia, diet, and scholastic
3 Ibid • , p • 201 •
5
achievement in elementary school age children. l The population chosen for study lives in the Colonia area of Oxnard
and is 95 percent Mexican-American.
It is believed to be
relatively homogeneous with respect to cultural characteristics and scholastic achievement.
Children in the
el!~entary
schools serving this area are considered to be low-achievers
as contrasted with other elementary schools in oxnard, although variations are observed.
There are three elementary
schools in the Colonia area, each relatively similar to the
others.
One school, Juanita Elementary School, was chosen
for study.
A review of previous investigations of this and closely
related problems is presented in Chapter II.
contains the design of the study.
Analysis and discussion
of findings are presented in Chapter IV.
marized in Chapter
Chapter III
The study is sum-
v.
I
CHAPTER II
.,
LITERATURE REVIEW
Aspects or the relationship between nutritional status,
scholastic achievement and occurrence or disease have been
studied with a variety of techniques.
The methodologies
employed have been classified in the review that follows:
Section I:
Methods of Measur!ng Food Intake
Food intake has most frequently been used to
estimate nutritional status.
In recent years
chemical determinations of specific nutrients in
the blood also have been utilized in estimating
this parameter.
Section II;
Achievement
Methods of Measurieg Scholastic
This parameter has been estimated using a
variety or methods which test cognitive functioning.
A number of cultural factors have been demon-
strated to affect results of some of these testing
procedures.
Section III:
Methods of Measur&gs Anemia
This disease condition is thought to be related
to both poor nutritional status and poor scholastic
6
7
achievement.
A number of macro- and micro-chemical
methods for ascertaining anemia have been developed.
Section IV: Studies of the Relationship Between
Diet, Scholastic Achievement and Iron Deficiency
Anemia
The relationship between these three factors
are reviewed in this section.
Section I:
Methods of Measuring Food Intake
Meredith, et
~
{1951), studied the ability of 94 chil-
dren 9 to 12 years of age to recall the kind and quantity of
food they had eaten one and one-half to two hours after the
meal.
The children were served a meal of weighed portions
of food. Leftovers on the plate were deducted, thus facilitating accurate determination of food intake for each child.
The children then were asked to recall the kind of food and
the amount of food they had consumed.
Only six of the
94
individuals were able tf recall accurately both the kind and
quantity o:f all foods served; 35 percent {33 children) recalled all o:f the types o:f .food eaten, but estimated the
quantities inaccurately; 58 percent {55 children) were inaccurate as to the number of .foods, types of food, and
quantity served.
Comparisons of the nutrients calculated
from the actual diet consumed and those calculated from the
diet recalled by the
child~en,
indicated that the recall
8
list of nutrients agreed with the actual list. 1
--
Chalmer, et al. (1952), investigated dietary records to
determine how many days and which days would produce the
most accurate information regarding food intake practices.
In seeking the answer to "how many days," the correlations
in dietary intake between consecutive days were found to be
virtually zero in the twenty-eight Aay, fourteen-day and
seven-day dietary records.
In an analysis of 150 records it
was determined that a dietary record need consist of only
one day when characterizing the intake pattern of a group.
They suggested that in order to obtain an estimate of the
mean intake for a group with greater precision, it is more
efficient to take more subjects, not more days.
No signifi-
cant differences were found between days for any of the
nutrients or for any of the population types except one--the
college student.
The investigators recommended the use of
caution regarding a bias which may be introduced subconsciously by the subjects if they are instructed to record a
one-day diary type of diet record.
This bias results from
the subjects• subconscious desire to either consume a balanced diet or record this consumption, even though these
foods have actually not been eaten.
They suggested that as
an alternative to the one-day diary method, a twenty-four
1Alla Meredith, Anne Mathews, Mayton Zickefouse, Eleanor
Weagley, Marion Wayave, and Edna G. Brown, "How Well Do
School Children Recall What They Have Eaten?" Journal of
American Dietetic Association, Vol. 27 (Sept., 1951),
pp. 749-751.
9
hour recall of foods consumed could be used especially if the
subjects were interviewed by a trained interviewer.
They
concluded that both methods would yield essentially the same
information regarding food consumption and that the twentyfour hour recall method was an easier technique to use. 2
A review of a ten year study.to determine the food
habits of California's children was reported by Shapiro
(1961).
The subjects studied ranged from grade one through
senior high and included both boys and girls.
Approximately
thirty counties were represented throughout the
One
stat~.
aspect of this study dealt with food intake information from
2,200 elementary school aged children from urban, semiurban,
rural and semirural areas.
The technique used for collecting
the food intake data was the twenty-four hour recall.
Chil-
dren were asked to record from memory the foods they had
eaten during the previous twenty-four hours.
Foods were
classified by recommended food groups in order to estimate
the specific amounts of nutrients consumed.
Analysis indi-
cated deficiencies of intake in protein, milk products and
vegetables.
Children most frequently omitted vegetables
from their diet.
Fifty-one percent of the children reported
less than one serving of vitamin C rich foods and 42 percent,
2Faith W. Chalmers, Mary M. Clayton, Lorraine o. Gates,
Ruth E. Tucker, Anne W. Wertz, Charlotte M. Young, and Walter
D. Foster, "The Dietary Record--How Many and Which Days,"
Journal of the American Dietetic Association, Vol. 28 (Aug.,
1952), pp. 711-717.
10
less than one serving of vitamin A rich foods.
Shapiro ob-
served that the twenty-four hour recall method is subject to
errors from" ••• poor memory and
othe~
human failings."
She stated, however, that the recall method is generally considered to be satisfactory for evaluating food patterns in
groups.
She further observed a need for more nutritional
studies which would include the use of clindcal and biochemical methods coupled with dietary intake information.3
Section II: Methods of
Scholastic Achievement
Measuri~
Tireman (1951) investigated the achievement of bilingual students in three schools in Albuquerque, New Mexico.
The Gates reading tests, both Primary and
Silent~
were used in
grades one and two, and the Stanford achievement tests in
grades three through eight.
The population of the three schools was predominantly
Spanish-speaking with 95 percent of the beginners speaking
little or no English.
An additional feature in this study
was the comparison of an experimental program with the usual
curriculum.
The number of students in the experimental
school was 2,312 and in the control schools, 2,651.
Special
emphasis was given to reading and oral English in the experimental program.
After five years the experimental program
3Leona R.Shapiro, "Food Habits of California Children,"
Cali:rornia 's Health, Vol. 21, No. 2 (July 15, 1.963),
pp. 9-13.
11
was found to be associated with improved reading ability,
" ••• without much loss," in other subjects.
Fourth through
eighth graders in the control schools did not make equal
progress with those students in the experimental school.
Students in the eighth grade in the experimental school were
achieving seventh grade work as measured by the Gates Reading Teats. Eighth grade students 1n the control schools
achieved at the four and one-half grade level.
The investi-
gator suggested that the experimental program involving increased exposure to the English language may account for
some of the differences in the reading abilities between the
three schools. 4
Jensen (1961) observed that in a number of California
school districts many or the Mexican-American children were
classified as "slow-learners" or as "mentally retarded" on
the basis of currently popular standard intelligence tests.
Jensen attempted to study better ways of measuring the learning potential of the Mexican-American child.
Students were
selected from the fourth and sixth grades in five public
schools in Contra Costa County,California.
These students
were members of a semirural, lower socioeconomic laboring
class population.
Groups of Mexican-American and Anglo-
American, fourth and sixth grade school children at different IQ levels ranging from 60 to 120 or above were matched
4
L. s. Tireman, Teachi~ Spanish-Speaking Children
(Albuquerque: University o New ~exlco Press, 1951),
pp. 28-34.
12
and compared on a number of learning tasks consisting of
Immediate Recall, Serial Learnins., Paired Associates,. and
learning of Familiar and Abstract objects.
Findings as
measured by the Serial LearniPi test in this study suggest
that Anglo-American children of low IQ were slow learners
whereas the Mexican-American students of the same IQ were
not necessarily slow learners.
Mexican-Americans of above
average IQ did not differ significantly in learning ability
from Anglo-Americans of the same IQ.
High IQ's were rarely
observed in this study of a Mexican-American population.
The study further suggested that the majority of MexicanAmericans with low IQ.'s, at least as measured by the California Test of Mental Maturity, were normal in basic learning ability.
The investigator surmised that other factors
not inherent in basic learning ability might be influencing
the scholastic performance of the Mexican-American school
child.5
Caplan and Ruble (1964) studied Junior High School
students from the lower socioeconomic class in Albuquerque,
New Mexico.
Students were selected on the basis of the lan-
guage spoken in the home.
interviewed.
Families of these students were
The investigator studied the relationship be-
tween bilingualism (Spanish and English) and intelligence as
measured by the Lorge-Thorndyke Intelligence Test, both
5Arthur R. Jensen, "Learn~ Abilities in Mexican-American and Anglo-American Children, California Journal of Educational Research, Vol. 12, No. 4 (Sept., 1961), pp. 147-59.
13
verbal and non-verbal.
The relationship between bilingualism
and scholastic achievement was measured by the Iowa Test of
Educational Development.
This test includes social
studies~
correctness of expression, natural science, quantitative
thinking and reading.
The research team stated that students
from bilingual backgrounds might lack essential communicative skills.
Lack of these skills might have en adverse
effect on their achievement as measured by standardized
tests.
Monolingual (English speaking) students failed to do
any better on the Iowa Test than did the bilingual students
with the single exception of the Correctness of Ex£ression
sub-test. 6
Section III:
Methods of Measuring Anemia
Physiology.--Bauer (1965) discussed the relationship between hemoglobin and anemia.?
The physiology of this rela-
tionship is indicated in the following:
The red blood cells give blood its color. The
color comes from an iron pigment which is combined
with a protein. The chemical combination is called
hemoglobin. Hemoglobin carries the oxygen from the
lungs to the capillaries, where it is released to
the individual tissue cells. The hemoglobin also
6stanley w. Caplan and Ronald A. Ruble, "A Study of Cul ...
turally I~osed Factors on School Achievement in a Metropolitan Area," The Journal of Educational Research, Vol. 58, No.
1 (sept., 196~) .. pp. Io-21.
cago:
7w. w.
Bauer, "Hemoglobin," Todat•s Health Guide (ChiAmerican Medical Association,965), pp. ioo-101.
14
attracts carbon dioxide and carries it to the lungs.
Hemoglobin is round in the muscles and permits the
muscles to build up a reserve of oxygen for the
spurts of energy released when engaged in physical
activity. When the red cells do not contain enough
hemoglobin, the body is not able to get the proper
amount of oxygen and hence cannot get the energy it
needs. This condition is called anemia.
Normal Ranse of Values.--Abritton (1953) estimated the
mean and range of hemoglobin concentration and the mean of
hematocrit in grams per 100 cc of blood value. 8 These
values are given in Table 1.
Table 1.
Hemoglobin and Hematocrit Concentration
for Different Age Groups.
Hemo§lobin:
(g/lOOcc)
Hematocrit:
(%)
Mean
8th year
12.9
lOth year
13.0
12th year
13.4
8th year
lOth year
12th year
14th year
and over
Ra!!ie
10.3 - 15.5
10.7 - 15.5
11.0 - 16.5
38.9
39.0
39.6
47.0 Males
42.0 Females
8Errett C Abritton (ed.), Standard Values in Blood
(Philadelphia and London:
p. 38.
w.
E. sauhaers
co., 1953),
15
Wintrobe (1956) estimated the normal hemoglobin for
males to be 14.5 to 15.0 grams per 100 cc of blood and 13.5
grams to 14.0 grams for females with a hematocrit (packed
volume of red blood cells) of 40 to 50 percent for males and
37 to 47 percent for females.9
The Merck Manual (1961) stated that hemoglobin values
between six and ten grams per 100 cc of blood volume indicated iron deficiency anemia. 10
Frankel and Reitman (1963) estimated hematocrit-hemoglobin values for the male to average 47.0 percent with a
range of 50-54 and the female average to be 42.0 percent
with a range of 37-54 percent.
Values of hemoglobin below
40 percent for the male (or 13.4 grams of hemoglobin) and
below 37 percent (or 12.9 grams of hemoglobin) for females
were considered to be anem1a. 11
Methods of Measurement.--A micro-chemical method for
measuring hemoglobin was developed and tested by Loury and
Bessey (1945).
The micro-method was developed in their
laboratory for determining nutritive substances in the blood
9M. M. Wintrobe, Clinic Hematolo~ (4th ed.; Philadelphia: Lea and Febiger 1 19.56), pp.
8-109.
10charles E. Lyght (ed.), The Merck Manual (lOth ed.;
New Jersey: Merck Sharp and Dohfue Research taboratories,
1961), p. 49.
11 sam Frankel and Stanley Reitman, Clinical Laboratory
Methods and Di~osis (6th ed.~ vol. 2; St. touis: c. v.
Mosby Co., 1963 , pp. ll25-ll2b.
16
and other body fluids.
A limited field test on about 1#000
New York school children demonstrated the simplicity of obtaining and preserving specimens as well as the rate at
which determinations could be performed in the laboratory.
Seven of the essential nutrients were studied by the
micro-method.
The method was compared for reproducibility
and accuracy against the usual macro-methods and other
standards.
Seven determinations, namely; vitamin A, caro-
tene# ascorbic acid, riboflavin# serum protein# hemoglobin#
and phosphatase# were done from two to three drops (0.1 ml)
of blood.
Three groups of New York school children were
studied to determine the relationship between socioeconomic
background, ascorbic acid and hemoglobin.
bered about 75.
Each group num-
Sixty percent of the high socioeconomic
group (A) had ascorbic acid levels of 1.5-2.0 mg percent
while only five percent of those in the low socioeconomic
group (C) had ascorbic acid values 1n the same rangee
There
were no children in group A with values below 0.4 mg percent
(considered subnormal) while there were 25 percent of the
children in group C below this value.
A similar distribution was found for the hemoglobin determinations. 12
Davidson and Wells (1962) discussed the centrifuge
method for measuring hematocrit and hemoglobin values.
They
12oliver H. Lowry and Otto A. Bessey, "Microchemical
Methods for Nutritional Studies#" Federation Proceedi!l§S#
Vol. 4 {Sept., 1945), pp. 268-271.
17
suggested that this technique was simple, fast and inexpensive.
Analysis is made after centrifuging the blood at
10,000 revolutions per minute for four minutes.
The tubes
are "read" using a graphic reader on a linear chart.
Con-
centrations of hematocrit and hemoglobin are obtained from
the reader.
The average hematocrit for the "normal" male
was suggested to be 47.0 percent with a standard deviation
of seven percent.
The average for the "normal" female was
estimated to be 42.0 percent with a standard deviation of
.five percent. 13
Surveys of Hemoglobin Levels in Populations.--Abbott, .·
et al. (1945), using the micro-method studied hemoglobin conoentration of' 2,205 rural white school children in Florida.
The hemoglobin was determined by a Fisher electrohemometer.
In making comparisons of' the hemoglobin levels of' the children, three ranges were established:
13.6 grams per 100 co
of blood volume was considered to be an average hemoglobin
value for children six to eighteen years of age; hence
values of 13.6 grams and greater were called normal; values
between 11.4 and 13.6 grams were called subnormal; and values
between 3.6 and 11.4 grams were classified as anemia.
Twenty-two percent of the subjects were in the "normal"
range of hemoglobin values; 35 percent were ·in the
subnormal"
11
l3Israel Davidson and Benjamin Wells, Clinical Diagnosis
by Laborato~ Methods (13th ed.; Philadelphia: Q. n. saunders no., 1 2), pp. 92-93.
18
range; 27 percent of the subjects had hemoglobin values from
9 to 11.4 grams; 13.3 percent had values of 6.1 to 9.0 grams,
indicating a serious anemia aondition;and approximately two
percent had values of 3.6 to 6.1 grams indicating a critical
anemia condition.
No significant differences were found in
the values of boys and girls. 14
Kaucher, .!!
~
{1948), made hemoglobin determinations
on 392 children in Michigan.
Hemoglobin was determined by
the micro-alkaline method developed by Bessey and Loury.
The color intensity was measured with a Beckman spectrophotometer.
Determinations were made in both the spring and
fall for 155 of the subjects.
The values for all subjects
ranged from 10.5 to 18.0 grams per 100 aa of blood with an
average of 13.5 grams.
Thirty-two percent were below 12.5
grams, four percent were below 12.0 grams.
No significant
differences were found between the mean values for the fall
and the spring.
Averages for girls rose from 12.4 grams at
three years of age to 13.4 grams at ten years of age with no
evidence of consistent change in the older girls.
Values
for boys increased from 12.4 grams at three years of age to
13.8 grams at 14 years of age to 14.7 grams in the seventeen
year olds. l5
14o. D. Abbott, Ruth Townsend, and c. F. Ahmann, "Hemoglobin Values for 2,205 Rural School Children in Florida,"
American Journal of Di~ea111es of Children, Vol. 69 {June,
1~5), pp. 3~6-~8.
l5Mildred Kaucher, Elsie z. Moyer, Ann P. Harr,ison,
19
Section IV: Studies of the Relationship
Between Diet, Iron Deficiency Anemia
and Scholastic Achievement
Relationship Between Food Intake, Blood Nutrients, and,
Hemoglobin.--Some of the moat extensive studies in the relationship of the type and amounts of foods consumed in the
United States, especially among school children, are those
of the United States Agriculture Department Experiment
Stations.
Diet records of more than 3,000 children, four to
12 years of age, living in four regions of the country, were
studied for daily nutrient intake.
Nutrients included
calories, protein, calcium, iron, vitamin A, thiamine, riboflavin, niacin, and
asco~bio
acid.
Seven-day, three-day,
and one-day diet records were compared to the recommended
dally requirements established by the Nattonal Academy of
Sciences--National Research Council, 1958 •. The investigators observed an intake of less than two-thirds of the recommended daily requirement for the following nutrients:
cal-
cium (in Iowa and West Virginia) and ascorbic acid (in all
of the states).
Among the school children, 9 to 11 years
old in Kansas, the investigators observed an average hemoglobin value of 11 grams.
had an average of 11 grams.
Rural children in Virginia also
Other children in the study had
an average of hemoglobin value of approximately 13 grams.
Ruth Uhler Thomas, Marjorie Mary Rutledge, Wanda Lamick, and
Eliot F. Beach, "Nutritional Status of Children," Journal of
the American Dietetics Association, Vol. 24 (June, 1~8),
pp. 496-501.
20
The investigators suggested that the blood sample studies
were related to estimated nutrient intake. 16
Relationsh1E Between Diet and Scholastic Achievement.-Blanton (1919) studied the relationship of prolonged undernutrition on the mental ability of 6,500 German school children at the close of World War I.
For three and one-half
years these children had received meager diets.
Blanton
studied the mental ability of his subjects as determined by
the "usual mental tests."
subjects• pre-war records.
Findings were compared to the
The
majority of the children did
not appear to have suffered any impairment in fundamental
intelligence as determineq by the mental·tests.
Children of
good "mental inheritance," if tested for short periods of
time in the mornings rated good or superior in intelligence.
The investigator observed that the students who were tested
~
in the afternoon appeared almost "stupid."
/'
A definite lower-
ing of the mental level was observed to be more or less
permanent in those children less endowed in mental ability.
The investigator suggested that the inability to concentrate,\
slowness of comprehension, poor memory, inattention and
failure to achieve were apparently due to lack of energy,
resulting from insufficient diet.
The restlessness was at-
-
tributed to nervous instability believed to be a result of
under-nutrition.
Disturbance of the central nervous system
16Alfred Stefferud (ed.), Food, The Yearbook of Africulture (Washington, D.C.: U. S. Oovernment Printing off ce,
1959), pp. 205-210.
\
21
is not uncommon if diets are mildly inadequate in specific
dietary essentials. 17
The influence of nourishment upon school performance
was observed by Mme. Doctor Sauve.
Mme. Sauve was in charge
or medical services for both a primary school and an infirmary school in France.
Sauve by the teachers.
Students were referred to Mme.
The students were observed by the
teacher to be inattentive and listless in the classroom.
Although described as bright intelligent youngsters with
respect to their past scholastic performance, they were observed to be failing or under-achieving in their school work
at the time of referral.
Investigation of these cases in-
dicated insufficient nutrients in their diets.
The children
were observed to respond favorably to the diet, iron and
vitamin supplements. 18
Relationship Between Diet and Scholastic Achievement in
the Pre-School Ch1ld.--The effects of under-nutrition on the
central nervous system were reported by Coursin.
Newborn
children in some of the developing countries were evaluated
and shown to have normal performance on a standard scale of
100.
Many of them were capable of superior neuromuscular
l7S. Blanton, "Mental and Ne-l:'vous Changes in the Children of the Volksschulen of Trier, Germany, Caused by Undernutrition.(" Mental Hygiene, Vol. 3 (July, 1919),
pp.
343-3t}6.
18Mme. Doctor Sauve, "The Influence of Nourishment Upon
School," Macro-Medioal, April, 1965, pp. 263-264.
22
perrormance (score 140 or more) at birth and comparable to
that expected in European newborns at four to six weeks of
age.
With adequate nutrition they made excellent progress
(120 to 140 on standard psychometric testing) with gradual
regression of abilities to within usual normal range of 100
to 110 by three to four years of age.
In contrast, infants
of similar initial abilities who received a deficient diet
and lived under poor health and environmental conditions
during these early years, showed general retardation of
central nervous system capacity (score 75) by three to four
years of age. 19
Conclusions from the Literature Review
There appears to be a need to investigate further the
interrelationship among diet, scholastic achievement and
levels of hemoglobin in the elementary school age child.
Techniques involved in studying this relationship are subJect to theoretical
w_ould appec:t:r_,, that
.._,_,~·-~o---~·-•~..._~_.--~--
-·--~"' •-·-~---~~"· ...
and
:tll~S
<'
•
empirical limitations.
However, it
relationship may be studied with the
----~--~."-• --~ ·•~' ----·~·--·-·~." •···~····-•""''''''' ~-·--·--- ·-~-··---~--·•·••-•·-'''"•·--·---.,~""
-·
'•·
.,-.•'••«
"~~ -~_...--,..--·--------------~
__follQ.!_~~~~~\,lPements:--~--~-1.
The 24-hour recall.
This technique is a
customary and practical one for accurate assessment of food intake patterns in groups.
It ap-
l9navid Baird Coursin, "Effects of Undernutrition on
Central Nervous System Function," Nutrition Reviews, Vol.
23, No. 3 (March, 1965), pp. 65-68.
23
pears to be most effective when information is
obtained using trained interviewers.
2.
Micro-hemoglobin.
Hemoglobin levels 1 in a
gross way 1 seem to be related to food intake
and to the recognition of iron deficiency
anemia.
3.
Achievement tests.
Tests of comprehension and
skills may be related to scholastic achievement
when important factors 1 such as culture 1 are
held constant.
These tests may then be used to
determine the degree of relationship between
achievement 1 diet 1 and iron deficiency anemia.
CHAPTER III
RESEARCH DESIGN
The purpose of this study was to determine the relationship between diet, scholastic achievement, and iron-deficiency anemia in fourth, fifth, and sixth grade students
with a common cultural background.
Measurements
For the purpose of this study, diet was measured by
determining the reported foods consumed within a twenty-four
hour period.
This twenty-four hour recall was obtained by
interview.
Measurements of scholastic achievement were obtained
using the reading and arithmetic sections of.the Stanford
Achievement Tests
Iron-deficiency anemia was determined by measuring
micro-hemoglobin.
In order to study the relationship between diet, scho-
lastic achievement, and iron-deficiency anemia, it was
necessary to use more specific measurements derivable from
the gross measurements indicated above.
These specific
measurements are:
1.
The Amount of Nutrient Iron.
24
This nutrient was
25
calculated rrom the roods consumed (assuming
standard portions) and the concentration of
nutrient iron in each food as indicated in
the Home and Garden Bulletin No, 72. 1
2.
Achievement Test Scores.
Test scores for the
seotions 4 Word Meaning, ParagraRh Meaning,
Arithmetic Computation, and Arithmetic Concepts, were obtained for selected students.
3.
Hemoglobin Levels.
Analysis of the hemoglobin
concentration per 100 co or blood was obtained
using the Adams micro-hematocrit machine.
Population Studied
The population selected for study was the fourth,
fifth, and sixth grade elementary students living 1n the
Colonia area of Oxnard, Ventura County, California, and attending the Juanita Elementary School.
For the most part,
these children are second or third generation Mexican-Americans.
They tend to be low-achievers as compared to children
from other elementary schools in Oxnard.
They tend to de-
emphasize health practices which others consider acceptable.
They exhibit behavioral problems in the classroom.
Many are
1consumer and Food Economics Res$arch Division, "Nutritive Value of Foods," Agricultural Research Service, U. S.
Department of Agriculture, Circular Home and Garden Bulletin
No. 72 (Washington, D.C.: Government Printing Office, 1964),
p. 36.
26
bilingual (Spanish and English) and most have learned English as a result of exposure to the language in the school.
These children are a product of a community blending a
combination of aspects of "old Mexico 11 with modern urbanism.
Socioeconomic levels in this community range from lower
lower-middle class.
to
Most of the adult inhabitants are farm
workers.
Others are employed in construction or commercial
canning.
The community is considered to be debilitated
and, as such, has been designated as eligible for special
poverty funds, under Title I of the Elementary Secondary
Education Act, 1965. 2
Research Design
The research design involved two surveys:
1.
The purpose of the first survey was to determine the relationship between estimated nutrient iron and levels of hemoglobin in all of the
fourth, fifth, and sixth grade students at the
Juanita Elementary School.
2.
The purpose of the second survey was to determine the relationship between estimated nutrient
iron, levels of hemoglobin, and scholastic
achievement in students with anemia (less than
2Buckman Osborne, "A School Man's Guide to Federal Aid,"
School Ma~ement (Greenwich, Connecticut: School Management Magaz es llic., Vol. 9, No. 6 June, 1965), pp. 96-98.
\
27
or equal to 11.6 grams of hemoglobin) and
matched non-anemic students (hemoglobin greater
than 11.6 grams).
Non-anemic students were
matched to anemic students using the characteristics:
age 1 grade, sex, race 1 and IQ.
Procedures utilized in conducting these surveys are outlined
below:
Steo I.
Parental consent was necessary in order to col-
lect blood samples from school children.
The principal and
the school nurse developed a letter to accomplish this.
letter was written in both English and Spanish.
The
One hundred
and ninety letters were mailed on January 18 1 1967, to all
parents of the fourth, fifth, and sixth grade students.
By
January 20,· 1967, 140 forms had been returned to school.
One hundred and twenty-two gave signed permission.
ary 30, thirty-two follow-up letters were mailed.
On JanuA total
of 161 parents gave signed permission (see Appendix, pp. 58-59).
Step II.
A food inventory list was prepared, using the
Agricultural Yearbook as a guide. 3 The inventory was designed so that foods consumed could be quickly checked.
Space for additional foods consumed was provided (see Appendix, p. 60).
3Alfred Stefferud (ed.), Food, The Yearbook of A'rioulture (Washington, D.c.: u. s. Government Printing or lee,
1959), pp. 241-266.
28
Step III.
Training sessions for interviewers were
given one day prior to collecting the food intake data.
Three Mexican-American
mothers~
who had been volunteers in
the school health screening programs, offered their services
as interviewers.
The school nurse in the school served as
the fourth interviewer.
ducted at the school.
discussed.
The training sessions were con-,
The food inventory check-list was
The interviewers were trained to use the inter-
view schedule and to 'formulate brief and simple questions
regarding foods consumed.
An attempt was made to eliminate
ways in which the interviewer might influence the responses
of students.
The importance of voice inflection and facial
expression was discussed.
The significance of a threatening
or non-threatening voice 1 or facial expressions which could
indicate acceptance or non-acceptance 1 such as:
a frown,
raising an eyebrow, or a smile, were stressed as being possible influences 1n the response of the student.
Each in-
terviewer was given the opportunity to practice and become
acquainted with her role.
Step IV.
The students were oriented in groups of ten.
At this time 1 the twenty-four hour recall interview was explained as follows:
You will be asked to give your name 1 birthdate~
grade 1 and room number. This is a study to find
out what foods you have eaten recently. For example: Did you have breakfast this morning? If
so, what did you eat this morning before you came
to school? Please try to remember everything you
29
have had to eat or drink. All the questions will
be like the examples I have just given you. They
are not difficult (see Appendix, p. 72).
Step
v.
The twenty-four hour recall food data were
evaluated, using the recommended daily dietary allowances in
the Home and Garden Bullet~ No. z2, 4 in order to calculate
nutrient iron.
Step VI.
The blood samples were drawn by the consult-
ing doctor and four nurses.
The students walked to the
laboratory, accompanied by a certificated teacher.
lab ora tory was within one block of the school.
The
The blood
samples were taken from the finger, using a microlance
(blood lancet) and collected in hematocrit tubes.
of the hemoglobin and the hematocrit :was
Adams micro-hematocrit machine.
Analysis
done, using the
Name lists which identified
the student, his birthdate, sex, grade, room number, and
race were sent to the laboratory for recording the hemoglobin and hematocrit findings (see AppendiX, p. 73).
Step VII.
A hemoglobin of 11.6 grams and a hematocrit
of 35 percent were recommended by the consulting doctor as
minimal levels of normality.
The individuals with values be-
low these minima were classified as having anemia.
While
this classification is arbitrary, the dividing line of 11.6
grams tends to fall within the range normally used.
4u.
This
s. Department of Agriculture, Circular Home and
Garden Bulletin No. 72, p. 51.
30
range is between 11.0 and 13.0 grams.
Most studies use
"less than 12 grams" as the dividing line.5
SteR VIII.
The non-anemia student was matched to the
anemia student with respect to age, grade, sex, race, and
IQ.
St~
IX.
Matched anemic and non-anemia students were
given the reading and arithmetic sections of the Stanford
Achievement Test.
The Stanford Achievement Tests are de-
signed " ••• to test comprehension, and measure important
knowledges, skills, and understandings commonly accepted as
desirable outcomes of the major branches of the elementary
ourr1oulum. 116
Step X.
The Stanford Achievement Tests were adminis-
tered by the school principal, who is skilled in administering tests.
Both groups (anemic and non-anemia) were tested
at the same time.
SteE
X~.
The food intake and hemoglobin data for the
fourth, fifth, and sixth grade students tested (N•l46) were
-
prepared for analysis of the relationship between food intake, nutrient iron, and hemoglobin levels.
5M. M. Wintrobe, Clinic Hematoloi{ (4th ed.; Philadelphia: Lea and Feb1ger, 1956), pp. 08-109.
6
Herber~~Ru~ma~~ 1 ~K~a~t~a~~s~~d~te~!~~teG~i~Ue~ta~~d
ford Achievement Test (New York:
195~), p. 6.
!nc.,
Harcourt, Brace and World,
31
Step XII.
The food intake, hemoglobin, and scholastic
achievement data for the matched anemic and non-anemic
students were prepared for the analysis of the relationship
between food intake, nutrient iron, hemoglobin, and scholastic achievement.
CHAPTER IV
ANALYSIS AND DISCUSSION OF FINDINGS
This study attempted to investigate the relationship
between diet, behavior and disease in the school environment.
Diet was measured by determining the reported foods
consumed within a twenty-tour hour period.
Measurements ot
behavior were restricted to those attempting to assess scholastic achievement.
Specific tests used for this were the
reading and arithmetic sections of the Stanford Scholastic
Achievement instrument.
The condition, iron deficiency
anemia, was chosen as the "disease" under investigation.
In-
dividuals were classified as having iron deficiency anemia
or not, depending on the value of blood micro-hemoglobin observed.
Those individuals with a micro-hemoglobin less than
or equal to 11.6 grams were classified as anemic and those
with a value greater than 11.6 grams were classified as nonanemic.
The sample studied consisted of fourth, fifth, and
sixth grade, elementary students attending Juanita Elementary School.
The total number studied was 146.
The school
is located in the Colonia area of Oxnard, Ventura County,
California.
Eighty-two percent (l21/146)ot the students in
the sample were Mexican-American.
32
Approximately 14 percent
33
(20/146) were Negro 1 and the remaining four percent consisted of Anglo-Saxons and Orientals.
Fifty-nine percent
(86/146) were male and 41 percent were female.
The sample
of students were distributed by grade as follows:
Forty-one
percent (61/146)were fourth graders, 31 percent (46/146)
were fifth graders and 28 percent were sixth graders.
Parental consent was necessary in order to perform this
study.
A letter written in both English and Spanish was
sent to the 190 families comprising the total number of
fourth 1 fifth 1 and sixth grade students.
One hundred and
sixty-one of the parents responded affirmatively.
The
sample of 146 represent those who were available during the
period of blood collection and interviewing.
Blood samples
were drawn by the consulting doctor and his staff.
call was obtained by interview.
Food re-
Selected students were
given the reading and arithmetic sections of the Stanford
Achievement Test by the school principal.
Students were
selected for the latter test using the criteria:
not,
age~
grade 1 sex, race, and IQ.
anemic or
The non-anemic
students, using the latter five criteria 1 were selected.
The variates used in this study were:
1.
Amount of nutrient iron.
This value was calcu-
lated from foods consumed, assuming standard
portions and the concentration of nutrient iron
in each food as indicated in the Home and Garden
34
Bulletin No. 72. 1
2.
Hemoilobin levels.
Determination of the hemo-
globin concentration per 100 cc of blood was
obtained using the Adams micro-hematocrit
machine.
3. Achievement test scores.
These values were
/
determined from the responses in the sections
Word Meaning, Paragraph Meaning, Arithmetic
Computation, and Arithmetic Concepts (on the
matched anemic and non-anemic students only).
The research design employed in this study involved
two surveys:
1.
The purpose of the first survey was to determine
the relationship between estimated nutrient iron
and hemoglobin in the 146 students comprising
the total sample.
2.
The purpose of the second survey was to determine the relationship between estimated nutrient
iron, hemoglobin, and scholastic achievement in
the matched anemic and non-anemic students.
1u. s. Department of Agriculture, Circular Home and
Garden Bulletin No. 72, p. 5.
35
Survey One
The relationship between estimated nutrient iron and
hemoglobin in the 146 students is shown in Figure 1.
The
vertical axis represents the values of hemoglobin observed
which range from 9.8 grams to 14.8 grams.
The mean hemo-
globin was 12.6 grams with a standard error of .075 (standard
error equals standard deviation ~!square root of sample
size).
The horizontal axis represents the values of esti-
mated nutrient iron observed.
Values of nutrient iron range
between 1.0 milligrams and 20.7 milligrams.
The mean nutri-
ent iron was 10.6 milligrams with a standard error of .32.
As seen in Figure 1, the distribution of points is
circular.
The correlation coefficient is 0.02, which is not
significantly different from zero.
In order for this cor-
relation coefficient to be significant at the five percent
level, a sample size greater than 1,000 would be necessary. 2
The recommended daily dietary allowance of nutrient
iron for this age group is 15 milligrams.
Seventeen percent
(25/l46) met this recommendation in terms of the observed
estimated nutrient iron.
Approximately 50 percent (72/l46)
had nutrient iron values between 10 and 15 milligrams.
Thirty-three percent had nutrient iron values below 10 milligrams with approximately 30 percent having values between 5
2
W. J. Dixon, F. J. Massey, Jr., Introduction to Statisfioal AnalKsis (2nd. ed.; New York: McGraw-Rill Book co.,
957) I p. 68.
36
Relationship between estimated nutrient
iron and hemoglobin in 146 students from
the fourth. fifth, and sixth grades attending Juanita Elementary School.
Figure 1.
'"
H
0
y
2
0
,~
0
oo
2 <2•2o2... 232o
0
22 o22.oo
2
40()
33<>4543.252+
t32. o o 4 2. o.Z. o
I~
2 oooH <.6 /, 2..o
o2
o a 2.
rl.
f:: . o A.
( N.
0
~
()
II
o2o
()
fO
CJ
0
y:
x:
Y:
N-.Sh;
'
I?
/0
1..0
1.5'
X
Hemoglobin (grams per lOOcc of blood volume)
Estimated nutrient iron (milligrams)
Correlation coefficient
Correlation is not statistically significant
$.)
37
and 10 milligrams.
Thus, approximately 83 percent of the
146 students were consuming foods which did not yield iron
content sufficient to meet the dietary recommendation.
Previous studies have assessed the effectiveness of the
twenty-four hour recall technique in eliciting food intake
patterns.3
A number of studies have indicated that the
micro-hemoglobin measurement is effective in approximating
the level of nutrient iron combined with globulin in the
blood. 4 There is no indication from the literature that
hemoglobin is highly correlated with the nutrient iron available for combination with this globulin.
lack of relationship may be:
nutrient iron
Reasons for this
the degree of absorption of
from the small intestine; the production of
globulin; the storage or utilization of each in the tissues
and the balance between nutrient iron and other nutrients.5
It has been postulated that the relationship between hemoglobin and nutrient iron is more difficult to establish when
the nutrient iron is.excessive in the diet. 6
If the require-
3Meredith, lli)Ii"-~ eft§·, pp. 749-751; Chalmers, et
al., .2£.:.. cit., pp.
-717; a . Shapiro, .ER.:,. cit., pp. 9-1"3'.
4
Abritton, .2£:.. cftti" p. 38; Wintrobe, 2h cit., pp.
108-109; Frankel ana e tma9~ .2.e.:., cite\" pp.J:r25-1128; Lowry
and Bes_sey, ~.o§~·~ pp. 2~-271; an Davidson and Wells,
.2£.L cit., pp~---92- •
5Bauer, ..2llt.. cit., pp. 100-101; Lowey and Bessey, 1oc.
cit.; and Ste??erud, ~ oit., pp. 205-207, 211.
6Stefterud,
OR·
cit., p. 211.
38
ment of 15 milligrams of nutrient iron or more is taken as
the optimum range, this study appears to contradict that
postulate.
Over 80 percent of the subjects had nutrient
iron intake of less than 15 milligrams, hence a significant
relationship between hemoglobin and nutrient iron would be
expected, but was not observed.
Further, no significant
differences were observed between mean values of hemoglobin
by graQe, sex, or race.
Explanations for the lack of rela-
tionship between a nutrient iron and hemoglobin in these
children may be:
l.
The method of estimating nutrient iron from
reported food intake may be grossly inadequate.
2.
Measures of the protein pattern in the blood
may be needed in order to observe the relationship between hemoglobin and nutrient iron.
3.
Measures of absorptions of nutrients and subsequent metabolism of these nutrients may be
needed in order to assess this relationship.
4.
Combinations of the above measurements may be
needed.
5. There may be no relationship between the two.
The findings from this survey indicate the need for
comprehensive study of this relationship in a large sample
of children (1,000 or more), with careful attention to the
measurement of available nutrient iron in the foods; actual
39
consumption and absorption of nutrient iron and other nutrients; concomitant and subsequent production of proteins; and
combination of this nutrient iron with the proteins.
While
such a study would be extremely difficult to carry out, it
would appear necessary in order to clarify the desired relationship.
This is particularly so since the less sophisti-
cated ways of establishing this relationship (as performed
in this study) appear to be inadequate.
Survey Two
An attempt was made in the second survey to remove
sources of variation between individuals classified as
anemic ( =11.6 grams of hemoglobin) and those classified as
non-anemic
(~
11.6 grams of hemoglobin).
Since the majority
of students studied in the first survey were Mexican-American, this second survey was restricted to that group also.
Twenty-three (18 percent--23/121) of the Mexican-American
students were found to have hemoglobin values in the anemic
range.
These students constituted the sample of anemic in-.
dividuals considered.
Twenty-three of the non-anemic Mexi-
can-American students were matched to the anemic students using the criteria:
age, sex, grade, and IQ.
The relationship
between hemoglobin and estimated nutrient iron in these 46
students is shown in Figure 2.
The vertical axis is used
to represent the values of hemoglobin and the horizontal
axis, values of the estimated nutrient iron.
The mean
4o
Relationship between estimated nutrient iron
and hemoglobin in 46 students; 23 classified
as anemic and 23 classified as non-anemic.
Non-anemic students are matched to anemic
students using criteria: age 1 grade 1 sex 1
race~ and IQ.
Figure 2.
fit,
0
IS'
y
JJf
0
co
/.3
2.
oo2'2.ao
Z
a 2.o
0
II
o2o
0
X
~=
Hemoglobin (grams per lOOcc of blood volume)
Estimated nutrient iron (milligrams)
Correlation coefficient
N.S.:
Correlation is not statistically significant
y:
x:
41 '
nutrient iron is 11.5 with a standard error of
.so.
The
nutrient iron intake in this subsample is somewhat higher
than that observed for all 146 students.
ent iron values is from 6.2 to 18.9.
The range of nutri-
Two of the anemic
students had values of nutrient iron greater than 15 milligrams in contrast to five of the non-anemic students.
Nine
of the anemic students had nutrient iron values less than
10 milligrams as· compared with eight of the non-anemic
students.
The relationship between nutrient iron and hemo-
globin is similar to that as seen for the 146 students.
The
correlations coefficient is 0.07 which is not significantly
different from zero.
In order for this correlation coeffi-
cient to be significant a sample of at least 500 individuals
would be needed.7
It would appear from this survey that attempting to
select individuals who are observed to differ in hemoglobin
concentration does not aid in demonstrating a relationship
with nutrient iron.
It may be that the matching process is
effective in minimizing any relationships that might exist
between these two characteristics.
Scholastic achievement was measured in these indiViduals
by the Stanford Achievement Tests--Word Mean±ns 1 Paragraph
Mean1ng 1 Arithmetic Computat1on1 and Arithmetic Concept.
The characteristic of IQ was also determined in order to
1Dixon and Massey 1 .2£.:.. c 1 t. 1 p • 468 •
42
account for# if necessary, differences in the individual's
performance of the achievement tests.
The relationship be-
tween IQ and hemoglobin concentration in the 46 students is
given in Figure 3.
The vertical axis is used to represent
values of IQ and the horizontal axis, values of hemoglobin.
The average IQ in this group was 91.7 with a standard error
of 1.3.
The correlation coefficient is 0.09 which is not
significant.
It would appear from these findings that gross
differences between ind.ividuals as dt9termined by IQ cannot
be explained by the characteristic of anemia or non-anemia.
The relationship between Word Meanin5 and hemoglobin
concentration for the 46 students is shown in Figure 4.
The
correlation coefficient of 0.09 is not statistically significant.
The average Word Meaning score was 31.7 with a
standard error of 1.0.
There is no indication, however,
from these data that the hemoglobin concentration markedly
affects their ability to perform this achievement task.
The relationship between Paragraph Meaning and hemoglobin is given in Figure 5, between Arithmetic Computation
and hemoglobin in Figure 6, and Arithmetic Concepts and
hemoglobin in Figure 7.
The correlation coefficient for
each of these is not significantly different from zero.
The
mean score for Paragraph Meani05 is 32.1 with a standard
error of 1.5.
The average score for the Arithmetic Computa-
tion is 35.3 with a standard
error o.f 1.5.
The average
score for Arithmetic Concepts is 30.8 with a standard error
43
Figure 3.
Relationship between IQ and hemoglobin
in 46 students; 23 classified as
anemic and 23 classified as non-anemic.
po
()
f{C
0
0
0
0
0
0
0
IOO
0
2o
IQ
r;. o~(N.s)
0
3o
22..
qo
0
0
0
0
C)
0
0
()
go
0
0
Q
2.
I)
10
U·
~
/0
II
/J
I~
/4
IS'
Jil
X
;x:
IQ:
Y:
N .s.:
Hemoglobin (grams per lOOcc of blood volume)
Intelligence quotient
Correlation coefficient
Correlation is not statistically significant
44
Figure 4.
Relationship between Word Meaning and
hemoglobin in 46 students; 23 classified as anemic and 23 classified as
non-anemic.
0
0
0
0
1o
0
0
0
0
3~
W.M.
34..
2ll
0
()
0
... - - - - - - ' = . a 1{H.s)
0
() (I
0
~-~
--------·-o
0
2
2..
0
2L/
0
0
0
0
0
0
).0
,
l't
j;l..
X
x:
W.M.:
Y:
N.S.:
IS
'"
17
Hemoglobin {grams per lOOcc of blood volume)
Word Meaning (number of correct answers)
Correlation coefficient
Correlation is not statistically significant
45
'· ~
I
Figure 5 •. Relationship between Paragraph Meaning
and hemoglobin in 46 students; 23
classified as anemic and 23 classified
as non-anemic •
0
Sb
0
0
0
~9
0
0
0
0
0
0
/0
"
13
I'J..
l'f
IS
II:,
11
X
x: Hemoglobin (grams per lOOcc of blood volume)
P.M.;
~:
N.S.:
Paragraph Meaning (number of correct answers)
Correlation coefficient
Correlation is not statistically significant
46
Figure 6.
Relationship between Arithmetic Computations and hemoglobin in 46 students;
23 classified as anemic and 23 classified
as non-anemic.
1).
(:,<g
/,~
to
Sb
$")....
0
0
0
0
~~
0
2
~to
A.C.
0
0
Jfo
0
0
2
b
l.
0
C)
0
0
3k
0
0
0
3
cc
1: .ol ( N.s.)
,3'l.
00
D
,g
2.c
0
0
0
0
~tf
()
:;20
0
0
Jb
0
}')..(
g
I
I
9
/0
II
-
J'J...
/3
1'/-
IS"
lfo
X
~·•
A.C.:
y:
N.S.:
Hemoglobin {grams per lOOcc of blood volume)
Arithmetic Computations {number of correct answers)
Correlation coefficient
Correlation is not statistically significant
47
Figure 7.
Relationship between Arithmetic Concepts
and hemoglobin in 46 students; 23 classified as anemic and 23 classified as nonanemic.
b<it
t1
6o
()
Sb
0
Sl.
0
0
0
l.ff
1'-1
0
00
0
0
0
0
r= .otf(N.S.)
0
()
0
0
2 2.
02-
0
oo
0
0
02.
2
0
0
0
0
0
/0
Jl
p ...
/3
,,
X
x:
A.C.:
y-:
N.S.:
Hemoglobin (grams per lOOcc of blood volume)
Arithmetic Concepts (number or correct answers)
Correlation coefficient
Correlation is not statistically significant
48
or 1.6.
No significant dirferences were observed between
those individuals classiried as anemic and those individuals
classiried as non-anemic with respect to any or the measures
of scholastic achievement.
The mean value in the indi-
viduals classiried non-anemic was 12.8 grams and in those
classiried anemic was 11.3 grams or hemoglobin.
While aver-
age values in observed hemoglobin concentration were signiricantly dirrerent between the two groups these dirrerences were not rerlected in their ability to perform these
achievement tests.
T.he ability or Mexican-American students to perform
tasks related to scholastic achievement has been studied by
a number of 1nvestigators. 8 The rindings rrom these studies
have suggested that racility in using the English language
is the primary factor explaining the Mexican-American
child's inability to do as well as Anglo-American children.
This ractor was controlled in this survey by studying only
Mexican-American students subjected to a common sociocultural environment.
This restriction was designed to
racilitate comparison or the individuals on the primary
factor--anemia.
Other studies have suggested that the anemic child is
unable to perform achievement tasks as well as the non-
8
Jensen,
~cit.,
pp. 147-159; Tiremanl ~cit., pp.
~cit., pp. 16-~
28-34; and Caplan and Ruble,
49
anemic student.9
If this finding is correct, it would
appear from this survey that extreme levels of hemoglobin
should be used in defining anemia and non-anemia.
None of
the students surveyed in the subsample had hemoglobin values
less than 10 grams nor greater than 16 grams.
These data
do not present the opportunity to test the relationship between hemoglobin and scholastic achievement in extremal
cases.
The lack of relationship between scholastic achievement
and levels of hemoglobin in these children may therefore be
due to one or more of the following:
1.
These measures of scholastic achievement may
be inappropriate in assessing the subtle changes
in performance or ability associated with individuals.
2.
A larger number of students (1,000 or more) may
be needed in order to demonstrate this relationship using the present measures of scholastic
achievement within the range of hemoglobin values
studied.
3.
There may be no relationship between scholastic
achievement and this range of hemoglobin values.
9Blanton, ~cit., pp. 343-386; and Mme. Sauve, .21?.!.
cit., pp. 263-2~ ·
50
In order to clarify this relationship it would be necessary to evaluate a large number of different achievement
tasks.
These might include:
ability to learn simple and
difficult concepts; ability to perform a variety of physical
tasks; and ability to retain learned concepts.
In addition,
it would seem desirable to develop sensitive measures of
classroom, playground, and home behavior.
This suggested
study would involve many complications and difficulties in
successful execution.
However, it would appear that there
is a need for considering a more sophisticated approach,
particularly when the easier approach {as utilized in this
study) is unable to demonstrate the relationship.
CHAPTER V
SUMMARY AND CONCLUSIONS
The health of the school-age child traditionally was
believed to be associated with his ability to perform school
related activities.
This relationship was investigated in
a sample of Mexican-American students attending Juanita
Elementary School, Oxnard, California.
Measures of diet,
disease, and scholastic achievement were used.
The. specific characteristic of nutrient iron estimated
from a twenty-four hour recall of foods consumed was used to
reflect diet.
Levels of blood hemoglobin were used to
classify individuals as anemic or non-anemic.
Scholastic
achievement was estimated by the scores obtained from specific sections of the Staqtord Achievement Tests.
A total of 146, fourth, fifth, and sixth grade students
were studied.
The relationship between nutrient iron and
hemoglobin was investigated and found to be non-significant.
One hundred and twenty-one of the 146 students were MexicanAmericans and 23 of those Mexican-American students were
found to be anemic using the classification less than or
equal to 11.6 grams of hemoglobin.
Twenty-three non-anemic
Mexican-American students were matched to the anemic
students using the criteria:
51
age, sex, grade, and IQ.
The
52
relationship between nutrient iron and hemoglobin in these
46 students also was i'ound to be non-sign1i'icant.
The rela-
tionship between scholastic achievement (as measured by
Meaning, Paragraph Mean1ng 1 Arithmetic
Com~utation,
~
and
Arithmetic Concepts ) and anemia (as measured by hemoglobin)
was i'ound to be non-signii'icant.
These i'indings suggest the need i'or a more sophisticated approach in studying this problem.
BIBLIOGRAPHY
53
BIBLIOGRAPHY
Abbott,
o. D., Ruth Townsend, and c. F. Ahmann. nHemoglobin
Values for 2,205 Rural School Children in Florida."
American Journal of Diseases of Children, Vol. 69
(June, 1~5), pp. 346-348.
Abritton, Errett C. (ed.). Standard Values in Blood.
Philadelphia and London: w. B. Saunders co., 1953.
Bauer, W. W. "Hemoglobin. " Today' s Health Guide. Chicago:
American Medical AssociatiOn, 1965, pp. I00-101.
Blanton, s. "Mental and Nervous Changes in the Children of
the Volkschulen of Trier, Germany, Caused by Undernutrition." Mental Hlgiene, Vol. 3 (July, 1919) ..
pp. 343-386.
Caplan, Stanley W., and Ronald A. Ruble. "A Study of Culturally Imposed Factors on School Achievement in a
Metropolitan Area." The Journal of Educational Research, Vol. 58, No. 1 (september, 1964), pp. 16-21.
Chalmers, Faith W., Mary M. Clayton, Lorraine 0. Gates,
Ruth E. Tucker, Anne W. Wertz, Charlotte M. Young,
and Walter D. Foster. "The Dietary Record--How Many
and Which Days." Journal of the American Dietetic
Association, Vol. 28 (~ug., 1952), pp. 711-717.
Clark, Margaret. Health in the Mexican-American Culture.
Berkeley ana LOS Angeles: university or California
Press, 1959.
Consumer and Food Economics Research Division. "Nutritive
Value of Foods." Agricultural Research Service,
u. S. Department of Agriculture, Circular Home and
Garden Bulletin No. 72. Washington, n.c.: Government Printing Ofrlce, 1964.
Coursin, David Baird. "Effects 11 of Undernutrition on Central
Nervous System Funct1on.
Nutrition Reviews, Vol.
23, No. 3 (March, 1965), pp. 65-68.
Davidson, Israel, and Benjamin Wells. Clinical Diagnosis by
Laboratory Methods. 13th ed. Pfil!aaeiphia: w. It
54
55
Frankel, Sam, and Stanley Reitman. Clinical Laborato~
Methods and Diagnosis. 6th ed., Vol. 2. St.
uis:
C. V. Mosby Co., 1963, pp. 1125-1128.
Jensen, Arthur R. "Learning Abilities in Mex.ican-American
and Anglo-American Children." California Journal of
Educational Research, Vol. 12, No. 4 (September,
1961), pp. 147-159.
Kaucher, Mildred, Elsie Z. Moyer, Ann P. Harrison, Ruth
Uhler Thomas, MarJorie11 Mary Rutledge, Wanda Lamick,
and Eliot F. Beach.
Nutritional Status of Children.11 Journal of the American Dietetics Association, Vo!. 24 (June, 1948), pp. 495-501.
Kelly, Turman L., Richard Madden, Eric F. Gardner, and
Herbert c. Rudman. "Reading Tests, Intermediate II."
Stanford Achievement Test. New York: Harcourt,
Brace and World, !lie., 19'64.
Lowry, Oliver H.,·and Otto A. Bessey. "Microchemical
Methods for Nutritional Studies." Federation Proceedings, Vol. 4 (September, 1945), pp. 268-2'71.
Lyght, Charles E. (ed.). The Merck Manual. lOth ed. New
Jersey: Merck Sharp and Donme Research Laboratories,
1961.
Meredith, Alla, Anne Mathews, Mayton Zickefouse, Eleanor
Weagley, Marion Wayave, and Edna G. Brown •. "How
Well Do School Children Recall What They Have Eaten?"
Journal of American Dietetic Association, Vol. 27,
(Sep'eethbe:r, 1951), pp. 721'9-'751.
Osborne, Buckman. "A School Man's Guide to Federal Aid."
School Manafi&ment. Greenwich, Connecticut: School
~na~ement
gaz!nes Inc., Vol. 9, No. 6 (June,
1965), pp. 96-98.
Sauve, Mme. Doctor. "The Influence of Nourishment Upon
School." Macro-Medical, April, 1965, pp. 263-264.
Shapiro, Leona R. "Food Habits of California Children."
Cali,forn*a's Health, Vol. 21, No. 2 (July 15, 1963),
pp. 9-13.
Stefferud, Alfred {ed.).
Washington, D.c.:
1959.
Food, The Yearbook ot Agriculture.
U. g. GOvernment Pr!hElng orrlce,
Tireman, L. s. Teachipg Spanish-Speakipg Children. Albuquerque: University or New Mexico Press, I951.
Wintrobe, M. M. Clinic Hematology.
Lea and Feolger, I956.
4th ed.
Philadelphia:
APPENDIX
57
58
JUANITA SCHOOL
224 Juanita Avenue
Oxnard, California
Dear Parents,
A study on the incidence and effects of simple anemia
is being conducted at Juanita School. Parent consent must
be obtained prior to administering any blood tests to any
students to determine whether anemia exists.
If you approve having a blood test done to your child,
at the school's expense, please sign below and return the
form to school before January 20, 1967.
If you have any questions regarding the testing procedure please feel free to call Juanita School, 487-3918,
Ext. 74.
·
I give my permission for a blood test to be administered on my child --------------------------------------Parent Signature
Date
Estimados Padres,
Un estudio en el incidencia y efectos de simple anemia
se va conducta en la escuela Juanita. El consenti de los
padres se necesita antes de administra la examinacion de la
sangre a los estudiantes para determina a ver se tienen
anemia.
I
Si usted aproba que su nino tome esta examinacion de la
sangre, a expensas de la escuela, por favor firme abajo y
regresa esta forma antes de 20 de enero 1967s
Si usted tiene unas preguntas de esta examinacion, por
favor llame le escuela Juanita, 487-3918, Ext. 74.
Mi nino
tiene me permiso para
que le den el exam1nac16n de la sangre.
I
Su Firma
Fecha
Sinceramente,
Stephanie Clexie, School Nurse
59
JUANITA SCHOOL
224 Juanita Avenue
Oxnard, California
Dear Parents,
Last week a letter was sent advising you of a study
that will be conducted at Juanita School. This study is
concerned with the incidence and effects of anemia upon
school performance. Please indicate below whether or not
you want your child to participate in this study.
D
I give permission for my child to participate in
this study and give my permission for a blood
test to be admi~istered.
D
I do not give permission for my child to participate in this study.
Estimados Padres,
La semana pasada mandamos una carta para avisale a
ustedes de un estudio que se va conducta en la escuela
Juanita. Este estudio es para le interes con la incidencias
y effectos de anemia contra las funciones de la escuela. Por
favor indica abajo si usted quiere o no quiere que su nino
participar en este estudio.
D
D
Mi nino puede participa en este estudio y tiene
me permiso que le dan la examinacion de la sangre.
Mi nino no tiene mi permiso de participa en este
estudio.
Sinceramente,
Stephanie Clexie, School Nurse
ID
TWENTY-FOUR HOUR FOOD RECALL INVENTORY
Name
DATE
Birthdate
Hemoglobin
Grade
............. Room
Hematocrit
Achievement
SCORES:
Word Meaning ---+-Arithmetic Computation
Kinds of Food
--------------
Sex
Race
------------------
Paragraph Meaning - - - - - -
--------
Arithmetic Concepts ------------*Snacks
After
*Snacks
Evening Evening
After
IJleal
I-leal ·
School
Breakf'ast
*Snacks
MidLunch Morning
:
Apple
Asi>aragus
Asparagus soup
Avocado
Other
I
!
i
!
i
I
I
I
I
I
Bacon
I
Banana
Beans dry smalll__ ~--- ~--- ~--- ____ ,__ -------~--- ____
!
* Interviewe/r
--
---~------
-
~
-----
----
j
uses the term food or drink to illustrate snack.
0\
0
ID_ _ _ __
Breakfast
Kinds of Food
Beans dry lima
Beans chili
Beans green lima
Beans butter
Beans green string
Beans yellow
Beans refried
Beans soup
Beans other
Beef
Beef soup
Beef other
Beets
)3eer
Bologna
Bread hot
Bread cold
Brocoli
*Snacks
After
Evening Evening
Meal
Meal
I
I
I
l
*Snacks
.After
School
Lunch
*Snacks
MidMorning
I
I
'•
I
I
!
l
I
I
!
l
i
I
l
I
!j
~
'
t
;
l
\
•
!
1
~
I
T
i
I
'
!
I
I
l
i
!
!
;
t
l'
*Interviewer uses the term food or drink to illustrate snack.
0'1
~
ID
Kinds of Food
*Snacks
After
Evening Evening
Meal
Meal
Breakfast
-----------------
*Snacks
After
School
Lunch
*Snacks
MidMorning
Brussel sprouts
Butter or fat
Other
Carrots raw
Carrots cooked
Cabbage raw
Cabbaged cooked
Cake
Candy chocolate
Candy carmel
Candy fudge
Cand~ marshmallow
Cand~ hard
Catsup
Cauliflower
Cereal dry_
Cereal cooked
Celery
Cheese yellow
l
l
-
0'1
1\)
ID
Kinds o:f Food
Cheese cottage
Cheese jack
Chicken
Chicken soup
Chili con carne
Chili w/beans
Chili w/o beans
Chili sauce
Chocolate syrup
Cocoa
Cof:fee
Collards
Cookies
Cola type drink
Corn bread
Cream
Cream soup
Corn
* Interviewer
Breakfast
*Snacks
A:fter
Evening Evening
Meal
Meal
-------------------
*Snacks
A:fter
School
*Snacks
MidLunch Morning
I
'
!
I
uses the term :food or drink to illustrate snack.
""
w
ID
Kinds of Food
Breakfast
------------------
*Snacks
.Arter
School
*Snacks
MidLunch Morning
<"·
Crackers
Custard
Other
Donut
Dressing
Dressing
Dressing
Dressing
Dressing
Dressing
Other
*Snacks
After
Evening Evening
Meal
Meal
I
oil
blue cheese
french
mayonnaise
thousand island
commercial
Eggs fried
Eggs boiled
E_ggs scrambled
Eggs raw
-Other
--·----
:
I
!
j
1
~----------
·--·
---
--------
---------
* Interviewer used the term food or drink to illustrate snack.
0\
~
ID
*Snacks
After
Evening Evening
Meal
Meal
Breakfast
Kind of Food
*Snacks
After
School
Lunch
*Snacks
MidMorning
l'
Fat
Frankfurters
Fish_or sea food
Fruit fresh
Fruit dried
Fruit canned
Other
Garbanzo
Gelatin
Grapefruit
Gravy
Greens turnip
Greens mustard
Greens other
Other
------------------
.
i
I
I
i
I
I
* Interviewer used the term food or drink to illustrate snack.
0'\
IJl
ID
-------------------
Kind of' Food
*Snacks
.Af'ter
Evening Evening
Meal
Meal
Breakf'ast
Ham
Hamburger Sandwich
Heart
Honey
Hominy
Other
*Snacks
Af'ter
School
*Snacks
MidLunch Morning
,...
Ice Cream
Ice Milk
Imitation Ice Cream
Other
I
Jam
Jelly
Other
Liver
Lamb
Lunch Meat
I
I
0\
0'\
.
,
ID__________________
Kind of Food
Breakfast
*Snacks
After
Evening Evening
Meal
Meal
*Snacks
After
School
*Snacks
MidLunch Morning
Lettuce
Li9,uor
Other
Macaroni
Macaroni w/cheese
Mayormaise
Margarine
Meatloaf
Melon
Milk whole
Milk skim
Milk evaporated
Milk chocolate
Milk Malted
Milk pudding
Molasses
* Interviewer
.
I
1
f
I
lI
i
uses the term food or drink to illustrate snack.
0\
~
ID
Breakfast
Kind of Food
------------------
*Snacks
-After
Evening Evening
Meal
Meal
Mu.ff'ins
Other
*Snacks
After
School
*Snacks
MidLunch Morning
'
-
Noodles
Nuts
Other
J
l
l
Okra
Olives
Olives
Onions
Onions
Orange
Other
!
green
ripe
dry
green
1
Pancakes
Peanuts
Peanu~ butter sandwich
* Interviewer
---
------
---
--
---·--~---
~--
uses the term f'ood or drink to illustrate snack.
0\
co
ID
*Snacks
After
Breakfast
Kind of' Food
Peas green
Peas dried
Peppers sweet
Pep_pers hot
Pie
Pickles sweet
Pickles dill
Popcorn
Potatoes white
Potatoes Sweet
Potatoes french f'ried
*Snacks
Af'ter
School
Evening Evening
Meal
Meal
*Snacks
MidLunch Morning
.
--
I
Pudd!ng_
'
Other
Rabbit
Radishes
Raisins
Rice
Other
l
I
----·-
I
--
____ _l
0\
\0
ID___________________
Breakfast
Kind of Food
Sandwich Jel~
Sandwich peanut butter
Sandwich bologna
Sandwich bean
Sandwich other
Salad
Sausage
Sauerkraut
Sherbert
Snrumetti
Spaghetti w/meat sauce
S_p~nach
Soda so.ft drink
Sugar
_§g_uash
*Snacks
After
Evening Evening
Meal
Meal
*Snacks
After
School
*Snacks
MidLunch Morning
.
'
I'
I
i
!
t
!
l
I
I
~
l
Syrup
Other
-·-----
* Interviewer
uses the term food or drink to illustrate snack.
~
ID
------------------*Snacks
*Snacks
*Snacks
*Snacks
~After
Breakfast
Kind of Food
Evening Evening
Meal
Meal
*Snacks
MidLunch Morning
~A.fter
School
;
Tamale
Tomato :rresh
Tomato canned
Tomato juice
Tomato sauce
Tortilla corn
Tortilla f'lour
Tostado
Tea
Turkey
Other
I
I
I
i
j
Vitamins
White sauce
Wine
Other
* Interviewer
Pupil Personnel
~-------------
--~~~
__; -- -~ -----
__ ...:____~--~·----.
~-
-
uses the term food or drink to illustrate snack.
2/14/67
~
f-1
72
Interview Schedule
Twenty-Four Hour Recall Food Intake
1.
Did you eat breakfast today?
What did you have?
2.
Did you have an evening meal last night?
What did you
eat?
3.
Did you have any food or drink after your evening meal
and before you went to bed?
4.
What did you eat?
Did you have any food or drink after school and before
your evening meal?
What did you eat or drink?
5. Did you have lunch yesterday? Did you eat at home, at
school, or at some other place?
If at school, did you
eat in the cafeteria, or did you bring a sack lunch?
Hemoglobin-Hematocrit Findings
BirthDate
Name
Sex
Race
Grade
Room
Number
Hematocrit
Hemoglobin
I
1.
2.
3.
4.
5.
- 6.
7.
8.
9.
10.
11.
-
-
-
-
I
12.
13.
14.
15.
16.
17.
18.
I'
I
.
..-:,
w
.
,
Typist:
Ardell Boyse
8907 Etiwanda Ave.,
Northridge California
Phone: 34 -4614
4
Blackline diazo reproduction:
Mary 1\icCullum
5972 Jamieson Avee,
Encino, California
Phone: 344-8841