The Maryland Women Infants and Children (WIC) 5-A-Day Promotion Program, funded by the National Cancer Institute, aimed to increase fruit and vegetable consumption by women served by the Maryland WIC program in order to reduce the risk of cancer.

The Maryland WIC 5-A-Day program consisted of three components. The first was a series of nutrition sessions about increasing consumption of fruits and vegetables conducted by a peer educator. The three small group discussions took place immediately before the WIC voucher distribution days, and child care was provided by another peer educator during the sessions. The first session focused on self assessment and setting personal goals for eating more fruits and vegetables, the second on identifying and overcoming barriers, and the third on maintenance strategies. Sessions also included food demonstrations, explaining how to cook healthy food and allowing participants to try new foods. The second component of the program included a set of printed and visual materials, a photonovella in which participants wrote down their goals and ideas. The third and final component of the program was intervention through direct mail. Because peer educators had limited opportunities for direct contact with all WIC participants, participants were sent four letters accompanied by tip sheets and other tools over a period of six months. Letters were tailored to participants by factors such as pregnancy status, attendance at nutrition sessions, and individual goals.

To increase daily fruits and vegetables servings by half in women served by WIC participants with the long term goal of reducing risk of cancer.

The Maryland WIC 5-A-Day Program shows that while multi-faceted community based interventions can effectively promote and sustain dietary change among low-income populations in order to reduce the risk of cancer, many obstacles remain in implementing such programs.

The Maryland WIC program was evaluated using a randomized controlled trial in 16 WIC sites located in Baltimore City and 6 Maryland counties; eight sites were randomized to intervention status and eight to control status. After the completion of phase I, control sites became intervention sites and vice versa. Since participants of phase I were ineligible to participate in phase II, this crossover design was applicable. In each phase, participants completed a self-administered survey at enrollment and after the last nutrition session. A follow-up survey was done one year post-intervention.

At the end of the program, the mean increase in daily servings of fruits and vegetables among intervention participants was higher among intervention participants than the control group (p-value = 0.002). A strong association between attendance at the nutrition sessions and changes in consumption was found. Women who attended more sessions had an larger increase in fruit and vegetable consumption (p-value = 0.02). One year after the completion of phase I, the follow-up data showed that consumption increased by an additional 0.27 (0.18-0.36) servings among intervention participants. The study demonstrated statistically significant changes in reported nutritional intake. Even such small increases in servings at an individual level can lead to a significant decrease in risk of cancer at the population level.