e e.e .. eee**samh : A nw rs uueOM Me 5 A Day for Bettr Health: A new research iive STEPHENHA VAS, MD, MPH, MS; JERIANNE HEIMENDINGER, ScD, MPH, RD; KIM REYNOLDS, PhD); TOMBARANOWSKI, PhD; THERESA A. NICKLAS, DrPH; DONALD BISHOP, PhD; DAVID BULLER, PhD; GLORIAN SORENSEN, PhD, MPH; SHIRLEYA. A. BERESFORD, PhD; ARNETTE COWAN, MS, RD; DOROTHYDAMRON, MS n 1993, an estimated 1,170,000 new cases of cancer were diagnosed and 526,000 people died of cancer in the United States (1). Cancer accounts for 23% of all deaths in the United States, 35% or more of which may be attributable to unhealthful dietary patterns (2,3). Diets that are high in fat, low in fiber, and/ or low in fruits and vegetables have been associated with in- creased incidence and mortality from various cancers (4-6). The scientific rationale for increasing consumption of fruits and vegetables is compelling. Two recent reviews of up to 200 studies on this subject found that the majority have shown an increased intake of fruits and vegetables to be associated with a reduced risk of various cancers (7-9). Such cancers include those of the pharynx, esophagus, oral cavity, stomach, pancreas, colon, rec- tum, larynx, lung, bladder, endometrium, cervix, and ovary. S. Havas (corresponding author) is an associate professor of epidemiology and preventive medicine with the Univer- sity of Maryland School of Medicine, Baltimore, MD 21201. J Heimendinger is the program director of 5 A Dayfor Better Health at the National CancerInstitute, Rockville, MD 20892. K Reynolds is an assistant professor of health behaviorwith the University of Alabama at Birmingham School of Public Health, Birmingham, AL 35294. T Baranowski is a professor of health behavior School of Public Health, Emory University, Atlanta, GA 30329. T. Nicklas is an associate professor of nutrition in the School of Public Health and Tropical Medicine, Tulane Unrziversity Medical Center, New Orleans, LA 70112. D. Bishop is chief of the Health Behavioral Development Education Section off the Minnesota Department of Health, Minneapolis, MN 55440. D. Buller is an associate professor of communica- tion with the University of Arizona School of Medicine. G. Sorensen is an associateprofessor of health and social behavior with the Harvard School of Public Health, Cambridge, MA 02115. S. A. A. Beresford is an associate professor of Epidemiology, University of Washington, Seattle, WA 98195. A. Cowan is the nutrition branchhead of the Division of Adult Health Promotion, North Carolina Department of Environmental Health and Natural Re- sources, Raleigh, NCs 27611. D. Damron is the project director of the Maryland WIC 5 A Day Prormotion Program. These studies have been performed in diffrent countries using a variety of dietary assessment methods. They include case-con- trol, cohort, and within-country and between-country correlation studies. On the basis of the strength and consistency of this association, in 1991 the National Cancer Institute (NCI) instituted the national 5 A Day for Better Health Program to encourage Americans to eat 5 or more servings of fruits and vegetables every day, which is one of the nation's health promotion and disease prevention objec- tives (10). The program is a public-private partnership between the NCI and the Produce for Better Health Foundation (PBH), a nonprofit foundation representing the fruit and vegetable indus- try. Industry participants include supermarkets, independent grocery stores, merchandisers, suppliers, conulodity groups, marketers, and foodservice operations. The 5 A Day Program represents a model for public-private partnerships and conmmu- nity nutrition education. Surveys indicate that Americans fall far short of the five or more servings recommended in the UIS Dietary, Guidelines (11), the Food Guide Pyramid (12), and the Diet and Health report (13). In 1991, at the beginning of the 5 A Day Program, only 23% of the population were consuming the recommended level of fruits and vegetables (14). The 5 A Day Program includes retail, media, corrinunity, and research components. Supermarkets and foodservice retailers advertise the program in local media and provide consumers with brochures, recipes, and interactive events such as food demon- strations. The NCI and PBH are working together to develop a comprehensive media campaign to obtain consistent coverage of the 5 A Day Program. The community component of the program attempts to reach consumers at the local level through the cooperative efforts of health, educational, agricultural, and volun- tary agencies and the private sector. Participating state health agencies coordinate 5 A Day activities for their states through a variety of mechanisms, including the development of coalitions. The research component is an extension of the community component. After the review of a large number of proposals submitted in response to a request for applications, the NCI funded nine studies in the spring of 1993. The studies, which will be conducted at worksites, schools, churches, and food assistance programs, will be completed in the spring of 1 997. The purpose of the research is to develop, implement, and evab at e interventions 32 / JANUARY 1994 VOLUME 94 NUMBER 1