Dorothy Damron

Final results of the Maryland WIC 5-A-day promotion program

OBJECTIVES This National Cancer Institute-funded study sought to increase fruit and vegetable consumption among women served by the WIC program in Maryland. METHODS Over a 2-year period, a multifaceted intervention program using a randomized crossover design sought to increase fruit and vegetable consumption at 16 WIC program sites in Baltimore City and 6 Maryland counties. Participants were surveyed at baseline, 2 months postintervention, and 1 year later. RESULTS Two months postintervention, mean daily consumption had increased by 0.56 +/- 0.11 servings in intervention participants and 0.13 +/- 0.07 servings in control participants (P = .002). Intervention participants also showed greater changes in stages of change, knowledge, attitudes, and self-efficacy. Changes in consumption were closely related to number of nutrition sessions attended, baseline stage of change, race, and education. One year later, mean consumption had increased by an additional 0.27 servings in both intervention and control participants. CONCLUSIONS Dietary changes to prevent cancer can be achieved and sustained in this hard-to-reach, low-income population. However, many obstacles must be overcome to achieve such changes.

Attitudes and behaviors related to fruits and vegetables among low-income women in the WIC program:

Abstract This article describes formative research conducted as part of a study aimed at increasing fruit and vegetable consumption among low-income women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Focus group discussions and central location intercept interviews were conducted with WIC participants to answer questions such as (1) What are their food shopping, preparation, and eating habits? (2) What perceptions do they have about fruits and vegetables? (3) What barriers do they face to increased consumption of fruits and vegetables? and (4) What motivations and messages might be effective in promoting increased consumption? Results indicated that these women, while generally responsible for food shopping and preparation, did not cook extensively.They reported many positive perceptions of fruits and vegetables, but also identified barriers to increasing consumption, including lack of availability, time and effort to prepare, and preference for other foods. Several implications for nutrition interventions were suggested. First, a key motivation for these women was being a good role model for their children, suggesting a persuasive appeal to use in interventions. Second, review of the womens current eating behaviors led to an identification of five specific behaviors that had the most potential for increasing overall consumption. Finally, the findings suggested ways in which nutrition interventions could address each of the barriers identified.

Psychosocial factors and intervention-associated changes in those factors as correlates of change in fruit and vegetable consumption in the Maryland WIC 5 a day promotion program

This study sought to examine: (a) the relative effects of baseline demographic and psychosocial factors and an intensive nutritional intervention on changes in fruit and vegetable consumption in low-income, ethnically diverse women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in Maryland; (b) whether this intervention, designed to modify psychosocial factors associated with fruit and vegetable consumption, was successful in changing these factors; and (c) whether changes in these factors were associated with increased consumption. The same women from 15 WIC program sites were surveyed at baseline and postintervention 8 months later. Women randomized to the intervention group showed significantly greater mean change in self-efficacy, attitudes, social support, and knowledge of national consumption recommendations than control group women. Changes in all psychosocial factors were significantly associated with nutrition session attendance and increased consumption. In a hierarchical model, changes in these factors accounted for most of the intervention effect on increased consumption.

Commonly Used Methods of Estimating Creatinine Clearance Are Inadequate for Elderly Debilitated Nursing Home Patients

We evaluated the Jelliffe and the Cockcroft and Gault methods of estimating creatinine clearance in elderly nursing home patients (65 years) with chronic indwelling urethral catheters. Although these relationships have been prospectively validated in hospitalized and ambulatory populations previously, we found that they produced poor estimates of creatinine clearance in this patient group. For the Jelliffe method, 11 of 19 estimates were 20% or greater from the measured value; 10 of 11 poor estimates were high. The Cockcroft‐Gault method had 10 of 19 estimates 20% or greater from the measured value with 8 of 10 of the poor estimates being high. An altered relationship between body weight, muscle mass, and daily creatinine production is the most likely explanation for the bias in these creatinine‐clearance estimations. New estimates of the relationships between age, weight, serum creatinine, and creatinine clearance need to be developed for this population.

The Effect of the Maryland WIC 5-a-Day Promotion Program on Participants’ Stages of Change for Fruit and Vegetable Consumption

The Maryland Women, Infants and Children (WIC) 5-A-Day Promotion Program examined the effect of a multifaceted nutrition intervention on changing the fruit and vegetable consumption of low-income women in the WIC program in Maryland. The sample consisted of 3,122 participants (1,443 intervention and 1,679 control) with a mean age of 27.2. Fifty-six percent were Black/African American. This article focuses on the effect of the intervention on the stages of change of the participants. Intervention participants showed significantly greater positive movement through the stages than control participants. Stages of change were measured for two specific target behaviors: eating five servings of fruits and vegetables a day and eating more servings of fruit and vegetables a day. Results demonstrated significant differences in the stage status of intervention and control women and in movement through the stages. The effectiveness of the intervention across groups depended on which staging measure was used.

Factors associated with attendance in a voluntary nutrition education program

Purpose. This paper examines factors associated with attendance in a National Cancer Institute-funded randomized trial of nutrition education to increase fruit and vegetable consumption among women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Setting. The study took place at 16 WIC sites in Maryland. Subjects. The participants were 1528 women who were enrolled in WIC or who had children enrolled in WIC, were ≥18 years of age, and planned to continue enrollment at that WIC site for at least 6 months (68% of eligible women approached agreed to participate). Intervention. Women received personal invitations, letters, and telephone reminders from peer educators encouraging their attendance at three bimonthly nutrition sessions. Measures. Demographic data were collected in a baseline survey. Attendance data and telephone and address changes were also collected. The postintervention survey included a question regarding reasons for nonattendance. Focus groups were also held to ascertain reasons for attendance or nonattendance. Chi-square tests of trend and multiple logistic regression, adjusted for within-site correlation, were used in statistical analyses. Results. Fifty-four percent of enrollees attended at least one session. Multiple logistic regression analysis showed increased odds of attending with higher age, breast-feeding, and/or knowledge of the recommendation to eat five or more servings of fruits and vegetables daily. There were decreased odds of attending for pregnant women who already had children. There were nonsignificant trends toward decreased attendance among unmarried women compared with married women and among blacks compared with nonblacks. Reasons given for nonattendance included withdrawal from WIC, moving, conflicting activities, negative feelings about nutrition education, and lack of transportation or child care. Conclusions. The results suggest that numerous barriers hinder participation in nutrition programs aimed at low-income women. These barriers should be considered by health care professionals when planning intervention programs. Overcoming these barriers presents a major challenge.

Uses of Process Evaluation in the Maryland WIC 5-a-Day Promotion Program

Using a crossover design, the authors conducted a 6-month intervention program aimed at increasing fruit and vegetable consumption among women served by the Women, Infants, and Children program in Baltimore City and six Maryland counties. The theoretical framework for the interventions was the Transtheoretical Model of Change. At 2 months postintervention, mean daily consumption had increased significantly more in intervention participants than in control participants. Extensive process evaluation data were collected to assess the quantity and quality of program services delivered. These included participant nutrition session evaluation forms and attendance logs, focus groups of attenders and nonattenders of sessions, information about peer educators, and postintervention surveys. Many lessons were learned about program delivery, factors affecting attendance, and the obstacles to dietary change. Strategies to increase participants’consumption of fruits and vegetables were modified based on these lessons and the process evaluations.

Using Peer Educators in Nutrition Intervention Research: Lessons Learned from the Maryland WIC 5 A Day Promotion Program

Abstract Peer educators have been used for many years in nutrition education interventions.With the increasing importance of documented impacts, the role of peers is expanding to include research activities. Twenty-seven peer educators were hired to deliver the Maryland WIC 5 A Day Promotion Program in three pilot and 16 full-scale study WIC sites in Maryland. Their roles included recruiting and enrolling program participants, collecting pre- and postsurvey data and process evaluation forms, conducting a series of three 45-minute nutrition education sessions, providing social support, maintaining contact with participants through telephone and mail, and tracking participants through the course of the program. Peer educators can make valuable contributions to program design, deliver interventions effectively, and provide social support both to participants and to each other. However, peer educators need intensive training, support, and monitoring for complete and accurate data collection, complete and consistent program delivery, and telephone contacts with participants. Because peer educators face life crises similar to those of their target audiences, special attention is often required for them to remain effective. This paper presents strategies developed as part of the Maryland WIC 5 A Day Program for building the competencies of peer educators working in research.