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Item Outreach and Public Education -- The Committee commends the NCI's dedication to the National 5-A-Day Campaign. This campaign is an important facet of NIH's overall commitment to the prevention of nutrition-related disease. The practical value of research is dependent on the translation of that research into practice by the public. The Committee recognizes that a diet including a minimum of five servings of fresh fruits and vegetables is a critical factor in reducing cancer risk. The Committee encourages NCI to substantially increase its communications and communications research for the 5-A-Day Program from its previous levels and increase its research in fruit and vegetable nutrition. (p. 116) Action taken or to be taken The NCI supports behavior change and communications research to determine effective strategies for increasing fruit and vegetable consumption. In light of this objective, the NCI and its award-winning 5-A-Day Program have conducted extensive consumer research to better understand motivators and barriers to eating more fruits and vegetables. In addition, NCI-supported communications research has provided valuable information on how best to reach target audiences. For example, NCI has been able to pinpoint areas of opportunity to reach the public when they are most likely to be receptive to health messages and to making a change in their eating behavior. Communications research also has been used to build and expand media outreach in an effort to increase the public’s knowledge and awareness of the importance of eating at least 5 servings of fruits and vegetables for cancer control. This research has shed light on a range of issues, including health benefits, accessibility, and cost, and has shaped a variety of program components, from messages reinforced in brochures, campaign theme lines, and media materials to consumer tips and suggestions found in grocery stores. For example, understanding consumer attitudes has provided a solid foundation for information and tips that are found on a World Wide Web site that NCI created in partnership with the Centers for Disease Control and Prevention in 1998. This website (http://www.5aday.gov) is designed to encourage fruit and vegetable consumption and physical activity. It enables individuals to enter their daily consumption and activity, then analyzes the results and provides tailored information. It has been heavily promoted in several media campaigns and has drawn considerable public response. Efforts are currently underway to update the 5-A-Day website and make it more user-friendly and informative to the public. Since 1991, NCI has conducted yearly surveys to track awareness of the 5-A-Day message. Results show that consumer awareness of the need to eat five or more daily servings of fruits and vegetables has more than quadrupled since the beginning of the program, from 8 percent in 1991 to 40 percent in 1999. However, further research is needed on nutrition-based community interventions and behavioral modification for underserved, minority population groups, as well as on long-term maintenance of dietary behavioral change relevant to cancer control. CD-ROM, the Internet, television, and focused, tailored messages specific to the needs of the individual are currently being explored as means to address these issues. Studies of community interventions to increase fruit and vegetable consumption also have been very promising. Research to develop and test strategies for increasing fruit and vegetable consumption demonstrated a significant increase in fruit and vegetable intake among specific populations, including work sites, schools, and churches, as well as among participants in supplemental food programs. This research and other research in nutrition and behavior change begin to address critical nutrition-related questions for cancer control. Current and Future Plans To stimulate further research, the Health Promotion Research Branch in NCI’s Behavioral Research Program hosted the first Nutrition and Behavior Research Grantees’ Meeting on September 27-28, 1999 at the Dulles Hyatt Hotel, Herndon, VA. The purposes of this conference were to bring together active researchers and NCI program staff, review current research findings, share lessons learned, and discuss the state of the science and new directions. In 1999, the NCI formed the 5-A-Day Program Evaluation Group to provide a comprehensive review and assessment of the 5-A-Day Program and its efforts to date. This will be an interdisciplinary group, which will make recommendations to NCI’s Board of Scientific Advisors. A formal report is expected by Fall, 2000. In tandem with this effort, the 5-A-Day Program is also undergoing a thorough review and evaluation of data collected since 1991 by NCI on the 5-A-Day Program. Additionally, in 1998, the NCI appointed an internal working group to review the literature and determine gaps in knowledge in nutrition and physical activity research. The recommendations of this group will guide research initiatives in the future. A report is due in Spring, 2000. Research priorities that have been identified include: I. Determinants of dietary behavior and change process
NCI is committed to supporting the spectrum of research addressing fruit
and vegetable consumption for cancer control. The following table
provides dollars spent in fiscal year 1998 (actual) and fiscal year 1999
(estimated operating level) on research, communications, and evaluation
for the 5-A-Day Program.
* Investigator-initiated R01s
Although the original set-aside Request for Application (RFA) mechanism for the 5-A-Day program ended in 1996, NCI continues to fund research in this area. Investigators incorporate the 5-A-Day message and strategies to increase fruit and vegetable consumption in their study designs, and NCI funds these studies via the research project grant (R01) competitive award mechanism. An excellent example of the diffusion and dissemination of the 5-A-Day research focus has been seen in the recent NIH Office of Behavioral and Social Sciences RFA on “Innovative Approaches to Disease Prevention Through Behavior Change,” developed in partnership with the NCI and other NIH institutes. Two of the 15 grants funded in fiscal year 1999 contain a nutrition/behavior component modeled after the 5-A-Day Program (see descriptions below). These grantees had previously received NCI research funding through R01 or State Health Agency 5-A-Day research awards. Youth Environments Promoting Nutrition and Activity Social cognitive theory is utilized to predict that 7th and 8th grade educational curriculum interventions promoting fruit and vegetable consumption as well as increased physical activity will change the behavior of these students as they enter the 9th grade. This study is of particular interest in that it addresses issues of nutrition and increased physical activity for young teenagers. Health Promotion through Black Churches A randomized controlled trial conducted in cooperation with African-American churches in the Atlanta, GA area will test the effectiveness of a culturally sensitive self-help nutrition and physical activity intervention, implemented with and without ongoing brief motivational interviewing contacts by telephone to encourage maintenance of target health behaviors. The target health behaviors -- increasing physical activity and increasing dietary intake of fruits and vegetables -- are relevant to a number of health conditions (e.g., dental caries, cardiovascular diseases, cancer). Recruitment and assessments will occur during health fairs sponsored by these churches for their respective congregations. This intervention holds special promise for developing intervention approaches which can be incorporated into ongoing social structures, and which may be maintained in some form even after outside research funding ceases. Communications efforts in partnership with the NCI’s Office of Cancer Communications and the Produce for Better Health Foundation are a significant part of the 5-A-Day Program. The following are the major 5-A-Day communications activities for fiscal year 1999. Plans are in place to continue or expand these activities in fiscal year 2000. Radio Programming For the past several years, NCI has developed and distributed radio programs through a partnership with chef Graham Kerr. The radio segments enable behavior change by providing practical tips to eat more fruits and vegetables. To date, there are more than 465 confirmed stations airing the segments, including nationally syndicated health shows. In addition, segments are fed to more than 2,400 stations through radio networks such as CBS Radio and AP Radio. NCI will continue with the development and distribution of new radio spots this year. Television Programming NCI has developed broadcast news segments with chef Graham Kerr, a personality who has been shown to appeal to the 5-A-Day target audience. The content of the 90-second TV segments are similar to the radio spots described above. The TV segments are designed for stations to run twice a week throughout the year. Currently, the segments are broadcast by 15 television markets nationwide. Efforts to broaden market reach continue with cities like Los Angeles; San Diego; Denver; Chicago; Toledo, OH; Pensacola, FL; Tallahassee, FL; Panama City, FL; and Soldiers’ TV, a network of the Armed Forces. National 5-A-Day Week National 5-A-Day Week, held on September 12-18, 1999, is a high-profile
promotion for the
Seasonal Print Media Outreach for Summer and Winter One of the most effective means to maintain the continued presence of
the 5-A-Day message in the media has been the extremely successful seasonal
outreach packages for print media. This year’s seasonal media outreach
will include summertime and winter holiday story ideas. Components
will include research, graphics, recipes, and tips.
In fiscal year 1998, NCI and CDC joined to create a 5-A-Day/physical activity Web site. The Web site includes tailored messages that consumers receive upon completing a tracking chart. NCI plans to further develop the Web site to include more tailored messages based on the stages-of-change theory. Since its development, it continues to draw positive audience response. When highlighted in a September 12, 1999 Parade Magazine Article, hits to this web site jumped from 3000+ per week to over 60,000+ per week in the two weeks following the publication of the article. Three-Market Media Test With the recent launch of the TV segments, awareness of the 5-A-Day message is likely to increase in the markets in which it is shown. NCI plans to conduct a media test to measure awareness levels in markets using the TV segments versus markets not using the segments. 5-A-Day Communications Research To continue to mark the progress of the 5-A-Day media campaign, NCI will track awareness and attitudes among the target audience through several research methods, including focus groups and omnibus surveys. Research and Communications Training for State Health Agencies In July 1999, NCI provided training to the 5-A-Day community coordinators (including 55 state and territorial coordinators, and U.S. Military Health Promotion Professionals) at the Society for Nutrition Education Annual Meeting. This meeting included dissemination of promising research findings from NCI-funded behavioral change research and new strategies in 5-A-Day communications and media for use in the community. The key nutrition professionals present from each state and branch of the military served as the conduit to diffuse cutting edge research from the NCI. In keeping with the public/private partnership intervention model, extensive possibilities for nutrition program partnering at the community level were discussed with the Centers for Disease Control, American Cancer Society, American Heart Association, National Heart Lung and Blood Institute, Produce for Better Health Foundation, and the U.S. Department of Agriculture. |