The purpose of this competing renewal study is to expand upon the successful community-level nutrition intervention program developed for low-income women who are in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland. This study builds on extensive experience working with this population under an NCI-funded study, -the Maryland WIC 5 A Day Promotion Program - which focused on increasing consumption of fruits and vegetables. The Maryland WIC Healthy Eating for a Lifetime Program will focus on reducing nutrition-related risks for cancer by adding two new components: 1) decreasing dietary fat and 2) increasing dietary fiber. The study will extend the highly effective collaboration over the past four years among researchers at the University of Maryland and campuses at Baltimore and College Park, the Maryland Department of Health and Mental Hygiene, and local health departments in Maryland. Researchers from the University of Maryland Baltimore County and the University of California at Berkeley will also collaborate on this project. The study will consist of women enrolled in WIC and mothers of children enrolled in WIC. The investigators will also expand their current study to assess changes in children, age two to four. Approximately 60 percent of participants in the study will be minorities most of whom are black. After an initial planning phase, the investigators will conduct a pilot test in one intervention and one control site. After making any necessary revisions, the will proceed to full-scale implementation, using a randomized crossover design for 12 WIC sites located in Baltimore City, and four counties in Maryland. This multi-faceted intervention program will utilize peer educators as the cornerstone of its educational efforts. Another important modality will be direct mail with tailored messages. All of the intervention strategies have either been successfully tested with WIC participants as part of the investigators' current study or will be developed based on their experience working with this population. The interventions will provide sufficient visibility, education, environmental supports, and incentives to encourage and facilitate changes in knowledge, attitudes, self-efficacy, perceived barriers to change, stage of change, and food consumption in the participants. All interventions will be based upon extensive formative research and will be rigorously pre-tested prior to program implementation.
