Addressing cancer among rural, African American, and low-income Americans is a high priority for cancer prevention in the U.S. Cancer mortality rates among these groups are often disproportionately high compared to urban, Caucasian, and high-income populations. Some of the high cancer mortality rates in these groups can be slowed by changing the foods Americans eat. Specifically, government agencies, including the National Cancer Institute, recommend that Americans consume at least 20 grams of fiber per day and no more than 30 percent of their daily calories from fat. We are far from reaching these goals, and rural, low-income individuals are especially disadvantaged when it comes to dietary programs and knowledge. These groups are often less ready to change their diets, and in need of both reading level appropriate material and extra motivation to make changes. Yet, our educational materials and techniques for changing diet in the underserved are clearly inadequate. The investigators propose testing a theoretically guided intervention package designed to decrease fat and increase fiber consumption in rural, low-income, low-literacy level individuals in southern Virginia. This intervention will adapt an effective dietary change booklet entitled """"""""Help yourself: A Guide to Healthful Eating"""""""" to this population. Personalized dietary feedback and recommendations, and personal physician letters will be provided for additional motivation for dietary modification. One thousand and fifty individuals recruited through rural primary care practices in southern Virginia will participate in this five year study. Subjects will be randomly assigned to intervention and control conditions. The revised self-help booklets and motivational materials will be delivered in the mail to the home of patients. All intervention information will be provided with the personal rural primary care physician's endorsement. Study participants will be followed up by telephone at one, six, and twelve month intervals. Primary outcomes of dietary fat and fiber behavior will be measured using the Fat and Fiber Behavior Questionnaire (FFB). A sub-study in the intervention participants will test three different strategies for presenting personalized dietary feedback based on prior research. This project will provide new information on motivating this underserved population toward dietary change. The combined strategies will form a self-help intervention package that is maximally effective while retaining the long term, desirable qualities of low intensity and cost.
| McClish, Donna; Carcaise-Edinboro, Patrica; Esinhart, Hali et al. (2014) Differences in response to a dietary intervention between the general population and first-degree relatives of colorectal cancer patients. J Nutr Educ Behav 46:376-83 |
| Fries, Elizabeth; Edinboro, Patricia; McClish, Donna et al. (2005) Randomized trial of a low-intensity dietary intervention in rural residents: the Rural Physician Cancer Prevention Project. Am J Prev Med 28:162-8 |
