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All in the Family

PIXLEY -- The sound of chirping mockingbirds muffled the constant roar of cars and trucks whizzing along Highway 99. Teresa García relaxed on a wooden picnic bench in the dusty yard outside her old, two-story home on the outskirts of this unincorporated Tulare County community of about 2,500.

García had spent time that afternoon sewing an elastic band on her 8-year-old daughters' sunflower-yellow folkloric dance skirt, in preparation for the group's upcoming performance at an elementary school in nearby Earlimart, and cooking her four children their main meal of the day -- Mexican rice topped with pre-shredded cheese, fried potatoes with the grease patted off them, and fresh cucumbers and strawberries.

Later in the evening, she and her daughter, Morelia, would put on their sneakers, stuff peanuts into the pockets of their hooded sweatshirts, and take a night-time stroll through the fallow raisin grape vineyards that surround her home on three sides, and the walnut and pistachio trees beyond them, shedding peanut shells as they walked.

But for now, as she waited for her husband, Gilberto, to return from the nearby dairy where he works, she took advantage of the peaceful Wednesday evening -- the one night during the week when her 8-year-old daughter does not have folkloric dance rehearsal, her two middle-school-aged sons do not have soccer practice, and she did not have English or leadership classes.

She watched as the family's small dogs -- Mickey, Minnie, and their puppy, Spike -- trotted through the overgrown vineyards.

"Es una familia saludable" (they are a healthy family), she said of the mutts.

She laughed at her light comment. She had spent much of the afternoon talking about the barriers that make it difficult for Pixley families to live healthy lives -- the lack of access to fresh fruits and vegetables, and the dearth of safe places for children to play and be active, and what she is doing to make the community a healthier place -- so it was amusing to see the canine family exercising together.

Improving the health of her family and her community -- which is 68.2 percent Latino, according to the 2000 census -- has become a mission for García, who emigrated from Morelia, Michoacán, México, with her husband about 15 years ago.

Through her dedication to cooking healthier food for her children, her directing of a folkloric dance group for the young girls, and her husband's organization of local soccer teams, García and her husband have become leaders in a community movement to make Pixley a healthier place for children and their families.









On a Thursday afternoon in May, García sat at her kitchen table and fed her daughter's folkloric dance skirt through a sewing machine.

When the sewing machine wasn't humming, the only noise interrupting the quiet afternoon was the constant song of the mockingbirds, which wafted into the kitchen with the light breeze. The mutts slept in the sun, just outside the kitchen.

García stood up from the table to check on the pot of chicken, which simmered on the gas stove. It was part of her children's mid-day meal, which she always has ready when they return from school around 3:30 p.m.

García is aware of the childhood obesity rate in Valley communities, and said she does her best to teach her four children to eat healthy. And so far, she has succeeded: Morelia, and Ediberto, 16, Leo, 13, and Ronaldo, 10, are all long and lean like their father, and physically active.

In the San Joaquín Valley, 14.4 percent of children are overweight for their age, according to the 2007 California Health Interview Survey.

"It is the mother's responsibility to shape how a child grows, and what a child eats," said García, who is also slim, but more solidly built. "Since they were little, I've tried to show them how to eat healthy."

On many days, García places bowls of fresh apples, bananas, pears, and grapes, and sliced strawberries and cucumbers on the table, and encourages her children and house guests to eat them.

She stocks her refrigerator with pitchers of horchata (a sweet, rice-based drink) and bottles of water (she said the tap water in Pixley is not safe to drink) but never soda.

She doesn't cook with manteca like her own mother did in México, and doesn't serve much red meat either. She reduced the amount of red meat her family consumes after learning about the health problems associated with it in a nutrition class about five years ago.

But in a community dotted with burger joints, taco trucks, and corner stores, the way the García family eats is not the easy way.

To offer a variety of fruits and vegetables to her family, García drives about 17 miles north to the city of Tulare, or about 14 miles south to Delano. She then spends between $150 and $200 on a week's worth of groceries for the family of six.

She has no other option but to travel to purchase groceries. Though Tulare County is the country's second-most agriculturally productive county -- specializing in milk, Valencia and navel oranges, cattle and calves, and grapes -- the food options in Pixley reflect little of this abundance.

The 3.1-square-mile town of Pixley, located along Highway 99 between Fresno and Bakersfield, could be called a "food desert" -- an area with little or no access to healthy foods or mainstream grocery stores.

The Pixley Food Mart -- located toward the southern end of the community's dilapidated Main Street, along with a second-hand store, a carnicería (meat shop), and a post office -- is the only local grocery store. It has an overpowering aroma when a customer first enters, but the store does have a small selection of fresh -- yet sometimes expensive -- fruits and vegetables.

The Food Mart's prices for fruits and vegetables are beyond the budget of many Pixley residents, said Susan Elizabeth, who works closely with the community through the Central California Regional Obesity Prevention Program (CCROPP.)

For example, the store recently offered heads of cabbage for 69 cents per pound, and apples for 89 cents per pound. In comparison, Fiesta Foods in Fresno recently sold three heads of green cabbage for $1, and apples for 99 cents.

"The range and the quality and the attractiveness of the fruits and vegetables (at the Food Mart) is a huge improvement over where it was three or fours years ago -- except for the affordability issue," Elizabeth said. "The poverty in that neighborhood simply makes a whole lot of food products inaccessible to the people that live there, because they can't afford to buy them."

Around 3:30 p.m., Morelia arrived home from school, and García prepared for her daughter a bowl of chicken, with zucchini and cabbage. Morelia squeezed lime juice over her meal.

As she ate her meal, García asked her daughter what the school had served for lunch that day. In the Pixley-Union School District, 96.5 percent of the students are eligible for free and reduced lunch.

A tostada with meat, cheese, and lettuce, and some milk, Morelia responded in her small voice.

"Estaba bueno (It was good)," she said.









When García speaks about the small home she and her husband rent, she appears embarrassed.

"Es viejo (It's old)," she says of the home, which is located off the access road that parallels Highway 99.

What she likes about the home, though, is its yard.

It is safe and secluded, and large enough to host a pole with a tetherball, some trees with low branches that are ideal for climbing, and space for the boys to kick their soccer ball against the house (as long as they don't shatter the windows with their ball, as they have done before.)

Until recently, that was practically all there was to do in Pixley.

The community has few sidewalks, lacks streetlights, and has stray dogs, all of which prevent people from feeling comfortable walking or biking along the streets.

Besides the fields and tracks at the elementary and middle schools, Pixley Park is the only public park where children and their families can play. The park is not in good condition though, residents say.

A lack of resources prevents Pixley residents from generally pursuing a healthy lifestyle.

In Pixley, where the median family income in 1999 was about $23,750, and about 43.2 percent of families lived below the poverty line, most of the adults work in agriculture, and many of the men work at dairies. Pixley's unemployment rate was 20.5 percent in April, according to the State Department of Labor.

The poverty, the scarcity of accessible, healthy food, and the lack of safe places to play, have combined to make Pixley residents -- like many residents of rural communities across the San Joaquín Valley -- vulnerable to obesity and other chronic diseases.

It's not easy to determine the obesity rate in the small community of Pixley, but in Tulare County, 77.6 percent of Latino adults are overweight or obese, according to the 2007 California Health Interview Survey. (According to the survey, 39.5 percent of Latino adults in the Valley are overweight, and 38 percent are obese.)

"Pixley is a classic example of a community that lacked safe places to play, and still does to some extent, and they lack access to affordable, fresh fruits and vegetables," Elizabeth of CCROPP said.

"I think it's a challenge to be healthy in Pixley. No matter what, you're going to have to drive somewhere to engage in physical activity, if you're an adult, and to buy affordable fruits and vegetables. And if you're a kid -- oh well."

The factors that make Pixley a difficult place to lead a healthy lifestyle are not unique. Small, rural communities across the Valley -- like Kettleman City in Kings County, Fairmead in Madera County, or Earlimart in Tulare County -- face similar health barriers.

These unincorporated communities don't have local governments to advocate for changes and policies that could benefit residents' health, and many residents lack the ability to speak up for their health on their own, Elizabeth said.

"What has tended to happen over the years is that they have been kind of overlooked, and therefore underserved, and I think that that state of affairs has continued to exist because there has been no push-back from the community," Elizabeth said.

"The people most affected by the neglect in their communities, and those environmental and policy issues that are perpetuating the inequities that affect health -- they need to be taught how to advocate."

But things are beginning to change in Pixley.

Thanks to courses in nutrition, parenting, leadership, and advocacy, residents are beginning to find their voices, and make changes in their communities.

They have developed a community garden at Pixley Middle School, and a farm stand opened on the school grounds about two years ago. Both efforts aim to address the lack of affordable produce in Pixley.

To increase the recreation opportunities in the community, García, along with a few other Pixley mothers, started a Mexican folkloric dance group for the younger girls, which is now part of the school's after-school program, and García's husband helps coach Los Indios de Pixley, local soccer teams that compete in the Tulare Liga Infantil Soccer League.

"What's in place right now doesn't promote health, but I do think there are some great things that are happening," said Jane Alvarado, who works with the community through Project LEAN, a joint program of the California Department of Public Health and the Public Health Institute.

"I think the exciting thing is, we've really seen the community take leadership and take ownership of the work. I think Pixley has the potential to become a community that we can all look at."

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