The purpose of this study is to develop a community-level 5-A-Day intervention program for low-income women in the special Supplemental Food program for Women, Infants, and Children (WIC) in Maryland. A multi-faceted intervention program will be implemented and evaluated in 16 WIC program sites in five counties and one city in Maryland by an interdisciplinary team of health professionals with expertise in clinical preventive medicine, public health, nutrition, epidemiology, health education, health communication, and biostatistics. The project will be carried out by a coalition of agencies and institutions including two campuses of the University of Maryland, the Cooperative Extension Service, the Maryland Department of Health and Mental Hygiene, the Maryland Department of Agriculture, six local health departments, and the American Cancer Society. The study population will consist of pregnant, postpartum, and breastfeeding women in intervention and control sites. Approximately 70% of participants in the study are minority women, most of whom are black. The study will use a randomized crossover design, with 16 WIC sites serving as the units of analysis. Intervention strategies will undergo rigorous pre-testing and extensive formative research will take place in the planning phase to ensure compatibility of intervention components with the target population. Proposed intervention strategies include 1) nutrition counseling/education including WIC paraprofessional counseling, Cooperative Extension Service educational sessions, and group discussions led by trained peer leaders, 2) supplemental print materials such as posters, calendars, and tip sheets, and 3) family and community-based interventions through recipe solicitations, enhanced Farmer's Market Coupon Program, and supermarket programs. Knowledge, attitudes, self-efficacy, behavioral intent, and stage of readiness to change behavior will be evaluated pre- and post- intervention, as well as the outcome measure of consumption rates. Evaluation of these parameters will be conducted at six month, one-year, and two year intervals through written as well as telephone surveys.
