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Based on the review and analysis, the
Evaluation Group makes the following recommendations.
Overall Recommendations
- That the NCI continue the 5 A Day
Program as a multifaceted program to support
research and applied public health programs to
promote increased vegetable and fruit consumption.
- That the NCI continue to lead the 5 A Day
Program and, to accomplish this task, ensure that it has
a strong senior leader and
specific scientific expertise in evaluation,
intervention methods development, media, and
community-based interventions, as well as nutrition and epidemiology.
- That the NCI partner more closely with
the USDA to better focus dietary guidelines and to promote research in agricultural and
economic policies that encourage vegetable and fruit
consumption.
- That the NCI partner with other NIH
institutes to (1) promote research into the role of
specific vegetables and fruit and their components
in lowering disease risk more generally, (2) promote
methodologic and applied
behavioral research, (3) expand awareness of the scope of
chronic and deficiency diseases
that may benefit from increased consumption of
vegetables and fruit, and (4) develop a comprehensive
and rigorous surveillance plan to
monitor vegetable and fruit consumption
and the psychosocial and economic factors related to it. This
last effort should include the
CDC and, possibly, the FDA.
- That the NCI partner with the CDC to
develop and manage state-level 5 A Day programs.
Implementation
The Media and Message Delivery
- That the 5 A Day Program, as part of its
continuing public relations efforts, seek to
prevent the further growth of "dietary helplessness,"
to help the public differentiate between good and poor
information, to provide a larger
context for personal dietary decisions, and to help
clarify the confusion engendered in the message
environment. In the dense, fragmented, and competitive
message environment
surrounding diet and behavior, there is a need for
reliable and credible sources of information.
Resources
- That direct expenditures and leveraged
resources furthering delivery of the 5 A Day message
be increased.
Message Design
- That the NCI reconsider the design and
emphasis of the 5 A Day message. Specifically,
media process-evaluation data suggest the need to
"reinvent" the 5 A Day message on a
regular basis to prevent "wear-out" and to enhance
its continuing attractiveness to the mass media.
In addition, the current strategy seems less
successful in reaching minorities and low-income groups, which suggests that any change in
message emphasis should take these groups
into consideration.
Media Strategies
- That the 5 A Day Program devote
additional resources to a variety of media strategies,
including a systematic media relations effort to educate
reporters, editors, and producers
about diet and nutrition issues. As part of this
approach, program planners should consider
pursuing partnerships with the media to
develop a long-term community emphasis
on the 5 A Day message. The goal is to
influence both the quantity and quality of news
coverage of the 5 A Day Program in particular and
of diet and nutrition issues in general.
- That the 5 A Day Program rethink its
channel-use strategy, with a particular focus on
new media, tailored communications, and how
media channels may be used as part of a
collective approach to reaching lower socio-
economic groups and the disadvantaged.
Evaluation of Communication Efforts
- That the NCI and the 5 A Day Program
partners pay close attention to developing a package of media evaluation approaches that
are consistent, simple, complete, and affordable.
Industry
- That NCI's collaboration with the PBH be
continued and expanded.
- That the NCI use its relationships with
industry specifically to ensure that vegetables
and fruit become more available to high-risk and underserved communities.
States
- That the NCI increase the resources,
staffing, and expertise made available to the states
for the dissemination, monitoring, and evaluation of the 5 A Day Program.
Minorities and the Underserved
- That the NCI, in partnership with relevant
organizations, develop operational strategies aimed at understanding and reducing
disparities among ethnic groups and across
educational and socioeconomic differences.
- That the NCI continue to take the lead in
evaluating the effectiveness of the 5 A Day Program.
This evaluation must include the extensive involvement of the states.
Evaluation
- That the NCI continue to take the lead in
evaluating the effectiveness of the 5 A Day
Program. This evaluation must include the
extensive involvement of the states.
- That the NCI undertake a comprehensive
evaluation of each of the 5 A Day Program
components: media; research; and industry, private
nonprofit, state, and Federal
partnerships.
Research
- That the NCI maintain and support
intramural and extramural research in the following
areas, noting particularly the need to modify,
where appropriate, available funding and
specific peer-review expertise:
- Research into dissemination
methods—
how to translate small-scale research
findings into large-scale, long-term, sustainable community
programs—with particular
emphasis on programs of demonstrated
efficacy and for underserved populations;
- Research into behavior change—how to translate
established data on changes
that will plausibly reduce risk into choices
individuals and communities can make. In
particular,
(a) Research into the development of
more effective dietary intervention programs, determining
which components of
such programs contribute most to program effectiveness;
(b) Studies of children and adolescents as the development of food
preferences begins;
(c) Studies on ways to develop
supportive environments and increase the avail- ability of
vegetables and fruit; and
(d) Randomized controlled trials of
school-based interventions targeting middle and high school students.
- Policy
research—particularly on ways to establish an optimal environment for
making healthy food choices in a
capitalist economy;
- Research into environmental influences
on dietary behavior and behavior change,
including agricultural production, food
distribution and availability, food
labeling, pricing structures, taxation and price
supports, purchase habits, advertising, cultural and social norms, and so on;
- Research into the mechanisms by
which vegetables and fruit reduce cancer risk,
particularly in humans;
- Research into influences on food
choice, particularly genetic and environmental
influences on taste preferences; early life experiences
involving exposure to food;
and education about food, food choice, and food preparation;
- Research into methods of measuring
dietary behavior, particularly the further development of
short- and long-term
biological markers. In these research
endeavors, access to relevant data collected by
industry partners seeking to understand
human preferences, behavior, and biology could prove a
significant resource.
- That research focused on vegetable and
fruit consumption measure and report vegetables
and fruit separately, rather than combining the
two into a single measure.
Surveillance
- That the NCI in partnership with other
relevant Federal agencies—including the U.S.
Public Health Service, the CDC, and the USDA—
coordinate, facilitate, and strengthen surveillance
and monitoring of (1) national
vegetable and fruit consumption; (2) psychosocial
mediators of dietary behavior change such as self-
efficacy, knowledge, and taste
preferences; and (3) if future research establishes their
importance, possible environmental mediators of dietary
behavior and behavior change,
including food availability, price structures,
taxation policy, and so on.
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