Abstract
Background. The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to increase fruit, vegetable, and fiber intake among low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland. Methods. We conducted six-month intervention programs for 1055 women at ten WIC sites; 1011 women served as controls. Intervention participants were invited to five interactive nutrition sessions and were sent written materials. Controls received usual care. Women were surveyed at baseline, two months post intervention, and one year later. All analyses conducted used an intention-to-treat paradigm. Results. Mean differences (intervention-control) in change from baseline were for percent calories from fat -1.62 ± 0.33% (P < 0.0001), for consumption of fruits and vegetables 0.40 ± 0.11 servings (P = 0.0003), and for fiber intake 1.01 ± 0.31 grams (P = 0.001). These differences in change were related in a dose-response relationship to the number of sessions women attended and remained significant one year post-intervention for the first two outcomes. Conclusions. Multiple dietary improvements can be achieved in a low-income population with an effective, multi-faceted intervention program. The changes in this trial exceeded those in previous community trials conducted in higher SES populations.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 406-416 |
| Number of pages | 11 |
| Journal | Preventive medicine |
| Volume | 37 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 2003 |
Funding
We thank the Director of the Maryland State WIC Program, Joan Salim, MHS, MLA for her invaluable assistance and support, the local health departments and WIC programs for their cooperation, the women from the WIC program for their participation in our study, Dorothy Damron, MS for her dedicated services as Project Manager for the first three years of this grant, our peer educators for their hard work, and Janine Delahante, MA, doctoral student at the University of Maryland Baltimore County, for conducting additional analyses in response to reviewer comments. This project was supported by the National Cancer Institute, grant #RO1CA59725. In 1997, funded by a competing renewal grant from the NCI, we began another randomized trial, the Maryland WIC Food for Life (FFL) Program. Our primary goals were for intervention participants to show a net decrease of 2% in the percentage of calories from fat, a net increase of 0.5 servings in fruit and vegetable consumption, and a net increase of 2 grams in fiber consumption compared to control participants. These goals are reasonable given the difficulty community programs have experienced in achieving behavior change. We placed the greatest emphasis on reducing fat. Secondary goals included positive movement in stage of change for these behaviors, as well as improved knowledge and self-efficacy. This article reviews the design and presents the final results of the FFL Program.
Keywords
- Cancer
- Fat
- Fiber
- Fruits
- Nutrition
- Randomized community trial
- Vegetables
- WIC
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Epidemiology
