Full Text CA-92-17

5-A-DAY FOR BETTER HEALTH

NIH GUIDE, Volume 21, Number 12, March 27, 1992

RFA:  CA-92-17

P.T. 34

Keywords: 
  Nutrition/Dietetics 
  Cancer/Carcinogenesis 
  Behavioral/Social Studies/Service 
  Statistics 


National Cancer Institute

Letter of Intent Receipt Date:  April 24, 1992
Application Receipt Date:  June 9, 1992

PURPOSE

The Division of Cancer Prevention and Control of the National Cancer
Institute (NCI) invites applications for grants to develop, implement,
and evaluate interventions in specific community channels and/or for
specific target populations to increase the consumption of fruits and
vegetables, using the 5-A-Day message.  The 5-A-Day message is "Eat 5
servings of fruits and vegetables a day for better health."  (Products
promotable through the program and serving sizes are defined in
Appendix A, available from the NCI program contact listed under
INQUIRIES.)  Fruits and vegetables are promoted in the program in a
manner that retains their integrity as low-fat foods and as part of an
overall healthy eating pattern that is low in fat and high in fiber.

A channel is defined for this application as a specific means or route
for reaching consumers with messages and/or food for the purpose of
creating the desired dietary behavior change.  Examples are schools,
food service (may include restaurants and cafeterias) worksites, and
food assistance programs.  Within the channel, a target population must
be selected.  For example, if schools are selected as the channel, all
students may be targeted or students in specific grades may be
targeted.

Wherever it seems appropriate, applicants will be expected to utilize
the mass media as a part of the intervention.  In addition,
complementary partnerships with the fruit and vegetable industry are
encouraged.

The intent of the announcement is two-fold:  (1) to encourage research
in the development of effective community level interventions for
changing dietary patterns using a simple, positive, actionable message;
and (2) to develop the community-level component of the national 5-A-
Day program, providing the complementary and necessary interactive and
environmental elements of successful behavioral change interventions,
such as the development of skills, local media placement, social
support, and modifications of foods offered in local food systems.

These community interventions are an important component of the larger
national program, that will provide national media coverage and
industry-initiated activities.  The national program is a partnership
between the fruit and vegetable industry and the NCI, discussed in the
section below entitled "Background."

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This RFA, 5-A-
Day for Better Health, is related to the priority area of nutrition,
specifically objective 2.6.  Potential applicants may obtain a copy of
"Healthy People 2000" (Full Report:  Stock No. 017-001-00474-0) or
"Healthy People 2000" (Summary Report:  Stock No. 017-001-00473-1)
through the Superintendent of Documents, Government Printing Office,
Washington, DC 20402-9325 (telephone 202/783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic for-profit and non-profit
organizations, public and private, such as units of state and local
governments, universities, colleges, hospitals, research institutions,
consultant firms, or combinations thereof.  Universities, colleges,
research institutions, hospitals, and consultant firms must involve
either a public health agency or some other public agency with a
mandate to protect public health and the ability to access and
intervene appropriately in the channel or community chosen.  All
applications will be expected to incorporate appropriate research
design and analysis expertise, most frequently provided by
universities, colleges, research institutions, and consultants.
Interdisciplinary teams of applicants are encouraged.  Among a team of
applicants, one institution must be proposed as the lead institution.
Foreign applicants are not eligible.  Applications from minority
individuals and women are encouraged.

MECHANISM OF SUPPORT

Support of this program will be through the NIH individual grant
mechanism (R01).  Responsibility for the planning, direction, and
execution of the proposed project will be solely that of the applicant.
However, it is anticipated that a network of grantees will be formed
for the purposes of sharing design and evaluation strategies, comparing
results when possible, and distilling lessons learned from all grants
combined.  (See SPECIAL REQUIREMENTS section.)  The total project
period for applications submitted in response to the present RFA may
not exceed four years.

This RFA is a one-time solicitation.  Future unsolicited competing
continuation applications will compete with all investigator-initiated
applications and be reviewed according to the customary peer review
procedures.

FUNDS AVAILABLE

The NCI anticipates that $4,000,000 in total costs per year for four
years will be available for this RFA.  Up to 10 awards are planned.
This funding level is contingent upon receipt of a sufficient number of
applications of high scientific merit and the availability of funds.
The total project period for each award will be up to four years.
Applicants should determine what resources are required to achieve
their scientific objectives and budget accordingly.

RESEARCH OBJECTIVES

It is the goal of this research to develop, implement, and evaluate
interventions that use the 5-A-Day message in specific community
channels and/or for specific target populations to increase the
consumption of fruits and vegetables.

The primary objectives of this research are:

(1) To increase awareness in the target population of the importance of
eating at least five servings of fruits and vegetables every day for
better health.

(2) In channels chosen, where appropriate, to increase the
supportiveness of the environment for increased fruit and vegetable
consumption, either through increasing the offering of foods that meet
the criteria for the 5-A-Day program, policy changes, or other
structural or educational changes that would promote fruit and
vegetable consumption.  (Criteria are listed in Appendix A.)

(3) To increase the daily consumption of fruits and vegetables in the
target population significantly more than in the control population.

Proposals should address one of the following two design options.
Designs other than those described below are allowed but will require
justification:

(1) Interventions focused on a specific channel:

The major research question to be answered is:  Will the target groups
(e.g., schools, worksites) in a specific channel that receive a 5-A-Day
intervention, based on a selected model of dietary behavior change,
demonstrate a significantly greater increase in fruit and vegetable
consumption than the groups in the same channel not receiving the
intervention?  (A group is most likely to be the unit of randomization.
See the section on sample size considerations.)  Other research
questions of interest are:  Will the target groups in a specific
channel that receive a 5-A-Day intervention demonstrate greater changes
in dietary awareness, knowledge, attitudes and behavior than the
control groups?  Will the organizations or entities in a specific
channel that receive a 5-A-Day intervention (e.g., schools, school
cafeterias; worksites, worksite cafeterias) demonstrate greater
environmental support for increased fruit and vegetable consumption
than the organizations or entities in the same channel not receiving
the intervention?  Other innovative research questions are invited.

(2) Interventions focused on a specific hard-to-reach population:

The major research question to be answered is:  Will the groups in a
specific hard-to-reach population receiving a 5-A-Day intervention,
based on a selected model of behavior change, demonstrate a
significantly greater increase in fruit and vegetable consumption than
groups in the same target population, not receiving the intervention?
Choice of a single channel is preferable for this research question.
However, more than one channel may be used with adequate justification
of why these specific channels are more appropriate for reaching the
target population than a single channel.  Examples of appropriate
target populations might be ethnic groups, such as Blacks, Hispanics,
or Asians; low income groups; low literacy groups, and other groups at
high risk.  Other research questions of interest are the same as those
enumerated in design option (1) above, applied to the hard to reach
target population.  Other innovative research questions are invited.

Interventions should be based on a sound rationale that demonstrates an
understanding of human behavioral science, the particular channel,
geographic areas, and target populations chosen.  It is highly
recommended that geographic areas chosen be of a size that is
manageable by the resources requested and yet include adequate numbers
for attaining statistical significance.  Interventions should be based
on a model of behavioral change, reflective of current theories and
research, and should demonstrate a knowledge of how to create
awareness, motivation, support, and sustained lifestyle changes for
individuals and how to create lasting changes in food systems and
organizations that will support the requisite individual dietary
changes.  The grant application should include a rigorous evaluation,
including appropriate outcome and process measures.  Interventions
should be transferable to the same channels in other settings.

Applicants should provide a rationale for their choice of target
populations and channel of intervention.  A model of behavioral change
should be used to guide the intervention, integrating constructs from
appropriate theories such as, but not limited to, social marketing,
social cognitive theory, health belief model, stages of change, and
diffusion of innovations.  (See Glanz et al., eds., 1990.)  Strategies
for determining the appropriate system/organizational changes within a
channel should be identified, including targeting the appropriate
entities, organizations, or individuals within the channel.  Methods
for determining the appropriate messages and strategies for reaching
the target group, including understanding the consumers' wants and
needs, should be identified.  The evaluation plan should include both
process and outcome measures, with appropriate instruments for
measuring individual and organizational changes.

Appropriate measures of dietary consumption in a community setting,
especially for measuring change, is a much debated issue.  For purposes
of this RFA, appropriate instruments to use might include, but are not
limited to, the 24-hour recall, the food frequency, food records, or a
shorter instrument that has been tested for validity and reliability.
The instrument(s) chosen must be justified as an appropriate and
feasible means of measuring outcomes.

One of the implications of a broad, national 5-A-Day program for
research designs is that some contamination of control sites is likely
to occur.  Therefore, it is important to construct powerful
interventions with enough intensity and penetration to measurably
exceed the national trends and to develop creative ways of tracking
activities in control and intervention sites.  Another implication of
the national program is that various industry participants, such as
supermarkets, will be licensed to use 5-A-Day materials.  Whenever
feasible, applicants are encouraged to work cooperatively with industry
partners in the target areas chosen.  A list of current industry
participants may be found in Appendix B which may be obtained from the
NCI program contact listed under INQUIRIES.

The power to detect the desired behavioral changes will determine the
number of intervention units required.  Randomization of units to
intervention and control conditions is the preferred design, although
other well-justified designs will be considered.  Some suggested sample
size considerations are in Appendix C, which is available from the
contact listed in INQUIRIES.

Background

As a part of the capacity-building grants for state health departments,
the National Cancer Institute supported a 5-A-Day statewide initiative
in California to increase vegetable and fruit consumption among
consumers.  The "5-A-Day" message, developed by the California State
Health Department working with a board of industry representatives,
received widespread media exposure.  Between 1988 and 1991, the message
was promoted by 16 supermarket chains, representing more than 1,850
stores, at their own expense. In the three years of the campaign, over
225 media interviews occurred, resulting in about 70 million media
exposures.  The dollar value of industry and mass media contributions
was estimated at over $1.5 million.  The campaign, with its simple,
actionable message, created enthusiastic support among produce growers,
retailers, and commodity boards.  The State of California, numerous
national industry organizations, and health departments indicated
strong interest in expanding the 5-A-Day concept to the national level.

The major partners in this new national effort are the National Cancer
Institute and the Produce for Better Health Foundation (PBH). PBH is a
non-profit foundation formed in May, 1991, for the purpose of working
with NCI on this national promotion of fruit and vegetable consumption.
PBH consists of 76 companies representing producers, suppliers,
merchandisers, commodity boards, growers, shippers, supermarkets, and
manufacturers.  The PBH Foundation is licensed by the NCI to use the 5-
A-Day logo and materials, which are trademarked.  The Foundation in
turn sublicenses other partners, such as supermarkets, to participate
in the national program.  As of February, 1992, more than 80 retailers
had signed license agreements, representing more than 25,000
supermarket chain and independent grocery stores.  In addition, more
than 50 merchandisers were licensed.  (See Appendix B.)  Licensees must
abide by the guidelines for use of the materials, logo and the NCI
name, as outlined in Appendix A, available from the program contact
listed under INQUIRIES.  The program will expand over time to include
other licensees such as grantees from this RFA, health agencies, and
food service participants.

The major components of the national 5-A-Day program are the national
supermarket intervention, a national media campaign, and the community
intervention component which will be developed in response to this RFA.

The national supermarket intervention consists of printer-ready copies
of brochures, recipes, and store signage provided to supermarkets at
least two times per year by the national program.  Each participating
supermarket agrees to run at least two promotions per year, consisting
of one month duration for each promotion.  Interactive events in
supermarkets are encouraged.  Supermarkets must report process measures
to the national campaign on a periodic basis.  Any synergy with the
components of the campaign (such as the supermarket intervention) that
will contribute to the research outcomes desired by this RFA are
encouraged.  For example, it might be appropriate for grantees to
assist with interactive events in supermarkets at the local level;
alternatively supermarkets may be able to assist with interventions in
another community channel.

The national media campaign consists of a plan developed by the Office
of Cancer Communications at NCI and a complementary plan developed by
the fruit and vegetable industry.  The major components of the media
campaign are two media waves per year for print and broadcast media,
the utilization of national spokespersons, use of the Cancer
Information Service national hotline, and press conferences coordinated
with the national supermarket promotions. Grantees should work as much
as possible in tandem with the national media waves to develop
complementary local media placements, where appropriate.  Specific
timing of national media events is not yet determined for 1993.

The successful respondents to this RFA will constitute the community
level intervention component of the national program.  In addition,
national, state, or local health, education, voluntary or agricultural
agencies may request to be licensed to participate at their own expense
in the national effort.

Scientific Rationale

In a review of 12 case control and cohort studies, Willett (1990)
stated that "the inverse relationship between the intake of vegetables
and fruits and the risk of lung cancer represents one of the best
established associations in the field of nutritional epidemiology."  In
a review of 15 prospective and 11 retrospective studies, Ziegler (1991)
found the evidence for a protective effect of fruit and vegetable
consumption was most persuasive for lung cancer but was also evident
for cancers of the mouth, pharynx, larynx, esophagus, stomach, colon,
rectum, bladder, and cervix.  Of 115 studies reviewed by Block and
colleagues (submitted), 81 percent (93 studies) reported a
statistically significant protective effect of fruit and vegetable
consumption. Persons in the lowest quartile of fruit and vegetable
intake (one or fewer daily servings) experience about twice the risk of
cancer compared with those in the highest quartile (four or more
servings).

Recent dietary guidelines published by USDA/DHHS and the National
Academy of Sciences (NAS) all recommend that Americans eat at least
five or more servings of fruit and vegetables per day (USDA/DHHS, 1990;
NRC, 1989).  This is consistent with NCI recommendations that stress
increased consumption of fruits, vegetables and fiber and reduced fat
intake (NCI, 1986; Butrum et al., 1988). This is also consistent with
the national objectives enumerated in "Healthy People 2000" (USDHHS,
1990) and the NAS report on implementing dietary guidelines (IOM,
1991).  Unfortunately, most Americans fall far short of these
recommendations.  Only 9 percent of the population ate five or more
servings of fruits and vegetables on any given day as reported in
NHANES II data (Patterson et al., 1990).  Ten percent of U.S. adults
had no fruits, fruit juice or vegetables on any given day.

More recent data from USDA's Continuing Survey of Food Intakes by
Individuals (CSFII) do not indicate any improvement in these numbers
(USDA, 1987; Patterson and Block, 1991). Consumption patterns were the
poorest among low income women.  Over 4 non-consecutive days, 31
percent of the women in the lowest income bracket (less than 131
percent of the poverty level) had no fruit, whereas only 12 percent of
the high income women had no fruit.  Similar patterns were observed for
vegetables (Patterson and Block, 1991).

In a 1989 California statewide survey, 34 percent of adults ate five or
more total servings of fruits and vegetables on the previous day.  Only
23 percent of the California population was aware that they should eat
five or more servings a day for good health.  Individuals who said they
should eat five or more servings ate significantly more fruits and
vegetables than those who said they should eat fewer or did not know
how many servings they should eat.  Thirty-five percent of white
Californians and 54 percent of Hispanic Californians did not believe
that what they ate had any effect on cancer risk (California Department
of Health Services, 1992).

Various studies have shown that the media plays a vital role in
increasing consumer awareness of health issues and, in some instances,
even changing individual patterns of behavior (Levy, 1987; Davis, 1988;
Russo, 1986).  Public confidence in messages from a credible health
agency such as NCI has been shown to be a key factor in affecting
consumer buying patterns (Hammond, 1986).  The combination of credible
health messages promoted through industry via media have been shown to
be effective in influencing consumers (Levy, 1987).  Sales of
high-fiber cereals rose dramatically after a national advertising
campaign by the cereal industry which utilized government-approved
health information.  Hammond's study also found that an individual's
stated behavioral intentions seem to be affected by the perception of
the credibility of the information source.  Thus in the high fiber
cereal campaign, public confidence in NCI was a key factor in changing
consumer buying patterns.

Data suggest that while the public is concerned about diet and health,
there is a lack of the detailed knowledge needed to act effectively on
these concerns (Levy, 1988).  Although use of the media alone can
produce behavioral change, its effect is increased when its use is
supplemented by other community based educational efforts (Flay, 1987;
Farquhar et al., 1977; Puska et al., 1985).  These efforts can build on
the awareness created by the media to provide skills necessary for
people to make lifestyle changes.  Research has demonstrated the
effectiveness of community-based health education for disease risk
reduction and prevention.  The Stanford Three-Community Study was
successful in reducing the coronary risk factors of people in two
communities when compared with a control community (Farquhar et al,
1977).  It demonstrated that the health of a community could be
improved by an educational message delivered through the media and
interpersonal channels.  Favorable changes in dietary practices were
brought about by mass media campaigns after about 2.5 years (Stern et
al, 1976).  Changes were produced even more rapidly when personal
counseling and intensive instruction were
combined with mass media.

The North Karelia Project in Finland was able to demonstrate decreases
in cardiovascular mortality and morbidity as well as risk factor
reduction through a comprehensive community health promotion program
which included public education strategies (Puska et al, 1983).  The
North Karelia Project and the Stanford Three-Community Study both made
extensive use of media.  The Pawtucket Heart Health Program, which
reached blue collar consumers through successful social marketing
strategies, was able to attract low literacy populations through
simple, specific messages. Simplicity of message has been shown to be
a key factor in successful mass media campaigns (Wallack, 1981).

The Stanford Five-City Project, which tested whether or not
community-wide health education can reduce stroke and coronary heart
disease, showed significant net reductions in community risk factor
averages in the treatment cities.  The risk factor changes resulted in
important decreases in composite total mortality risk scores and
coronary heart disease risk scores. (Farquhar et al., 1990).  The
treatment cities received a 5-year, low-cost (about $4/per
person/year), comprehensive program based on community organization
principles and social marketing methods, including use of mass media.
Total exposure to educational messages of various types and duration
was calculated to be 100 messages per year, totalling 5 hours per
capita.  Yearly radio and television exposure was less than 1 hour per
adult per year.  Researchers concluded that such low-cost programs can
have an impact on risk factors in broad population groups.

Community-wide studies such as those enumerated above have demonstrated
the effectiveness of a mix of interventions, but have not tested the
independent effects of channel-specific interventions.  The development
of such tested channel and target population-specific interventions
will be a contribution to research in community nutrition interventions
and will assist in meeting the "Healthy People 2000" objectives for the
Nation.

SPECIAL REQUIREMENTS

As stated in the MECHANISM OF SUPPORT section, networking among
investigators will be expected.  Thus, applications should include in
the budget enough funds for at least two investigators to attend two
meetings per year in the Washington DC area with fellow grantees.

Investigators will be expected to supply a final report in a specific
format that summarizes both successes and failures in order to
contribute to the dissemination of community intervention research.  In
addition, grantees will be expected to participate in a joint summary
of results of all grants.  Grantees will be licensed to use the 5-A-Day
logo.

STUDY POPULATIONS

SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH
POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL
RESEARCH STUDY POPULATIONS

NIH and ADAMHA policy is that applicants for NIH/ADAMHA clinical
research grants and cooperative agreements are required to include
minorities and women in study populations so that research findings can
be of benefit to all persons at risk of the disease, disorder or
condition under study; special emphasis must be placed on the need for
inclusion of minorities and women in studies of diseases, disorders and
conditions which disproportionately affect them.  This policy is
intended to apply to males and females of all ages.  If women or
minorities are excluded or inadequately represented in clinical
research, particularly in proposed population-based studies, a clear
compelling rationale must be provided.  (See page 21 of PHS 398.)

The composition of and the rationale for the choice of the proposed
study population must be described in terms of gender and racial/ethnic
group.  In addition, gender and racial/ethnic issues must be addressed
in developing a research design and sample size appropriate for the
scientific objectives of the study.  This information must be included
in Sections 1-4 of the Research Plan in the form PHS 398 (rev. 9/91).
Applicants are urged to assess carefully the feasibility of including
the broadest possible representation of minority groups.  However, NIH
recognizes that it may not be feasible or appropriate in all research
projects to include representation of the full array of U.S.
racial/ethnic minority populations, (i.e., Native Americans, [including
American Indians or Alaskan Natives], Asian/Pacific Islanders, Blacks,
Hispanics).

The rationale for studies on single minority population groups should
be provided, and may include the requirements of the RFA, a need for
special focus on the target group in order to advance research, etc.

For the purpose of this policy, clinical research is defined as human
biomedical and behavioral studies of etiology, epidemiology, prevention
(and preventive strategies), diagnosis, or treatment of diseases,
disorders or conditions, including but not limited to clinical trials.

The usual NIH policies concerning research on human subjects also
apply.  Basic research or clinical studies in which human tissues
cannot be identified or linked to individuals are excluded.  However,
every effort should be made to include human tissues from women and
racial/ethnic minorities when it is important to apply the results of
the study broadly, and this should be addressed by applicants.

If the required information is not contained within the applications,
the application will be returned.

Peer reviewers will address specifically whether the research plan in
the application conforms to these policies.  If the representation of
women or minorities in a study design is inadequate to answer the
scientific question(s) addressed AND the justification for the selected
study population is inadequate, it will be considered a scientific
weakness or deficiency in the study design and reflected in assigning
the priority score to the application.

All applications for clinical research submitted to NIH are required to
address these policies.  NIH funding components will not award grants
or cooperative agreements that do not comply with these policies.

LETTER OF INTENT

Prospective applicants are asked to submit, by April 24, 1992, a letter
of intent that includes a descriptive title of the proposed research,
the name, address, and telephone number of the Principal Investigator,
the identities of other key personnel and participating institutions,
and the number and title of the RFA in response to which an application
may be submitted.

Although a letter of intent is not required, is not binding, and does
not enter into the review of subsequent applications, the information
that it contains is helpful in planning for the review of applications.
It allows NCI staff to estimate the potential review workload and to
avoid conflict of interest in the review.

The letter of intent is to be sent to:

Jerianne Heimendinger, Sc.D., M.P.H., R.D.
National Cancer Institute
Division of Cancer Prevention and Control
Executive Plaza North, Room 330
9000 Rockville Pike
Bethesda, MD  20892
Telephone:  (301) 496-8520
FAX:  (301) 402-0816

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 9/91) is to be used
in applying for these grants.  These forms are available at most
institutional business offices; from the Office of Grants Inquiries,
Division of Research Grants, National Institutes of Health, 5333
Westbard Avenue, Room 449, Bethesda, MD 20892, telephone 301/496-7441;
and from the NCI program administrator named below.

The RFA label available in the PHS 398 application form must be affixed
to the bottom of the face page of the application.  Failure to use this
label could result in delayed processing of the application such that
it may not reach the review committee in time for review.  In addition,
the RFA title and number must be typed on line 2a of the face page of
the application form and the YES box must be marked.

Submit a signed, typewritten original of the application, including the
Checklist, and three signed, photocopies in one package to:

DIVISION OF RESEARCH GRANTS
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892

At the time of the submission, two additional copies of the application
must also be sent to:

Jerianne Heimendinger, Sc.D., M.P.H., R.D.
National Cancer Institute
Division of Cancer Prevention and Control
Executive Plaza North, Room 330
9000 Rockville Pike
Bethesda, MD  20892
Telephone:  (301) 496-8520

Applications must be received by close of business, June 9, 1992.  If
the application is received after that date, it will be returned to the
applicant.  The Division of Research Grants (DRG) will not accept any
application in response to this announcement that is essentially the
same as one currently pending initial review, unless the applicant
withdraws the pending application.  The DRG will not accept any
application that is essentially the same as one already reviewed.  This
does not preclude the submission of substantial revisions of
applications already reviewed, but such applications must include an
introduction addressing the previous critique.

REVIEW CONSIDERATIONS

Upon receipt applications will be reviewed by NCI staff for
completeness and responsiveness.  Incomplete applications will be
returned to the applicant without further consideration.  If the
application is not responsive to the RFA, NCI staff will contact the
applicant to determine whether to return the application to the
applicant or submit it for review in competition with unsolicited
applications at the next review cycle.

Applications may be triaged by an NCI peer review group on the basis of
relative competitiveness.  The NCI will remove from further competition
those applications judged to be non-competitive for award and notify
the applicant Principal Investigator and institutional official.  Those
applications judged to be competitive will undergo further scientific
merit review.  Those applications that are complete and responsive will
be evaluated in accordance with the criteria stated below for
scientific/technical merit by an appropriate peer review group convened
by the NCI.  The second level of review will be provided by the
National Cancer Advisory Board.

Scientific/technical merit criteria specific to the objectives of this
RFA include the following:

o  Extent to which the proposed research will meet the project goal of
developing, implementing, and evaluating interventions in specific
community channels and/or specific target populations to increase the
consumption of fruits and vegetables, using the 5-A-Day message.

o  Scientific merit of the research design and methodology, including
choice of units of analysis; appropriateness of research design;
appropriateness of proposed evaluative methods, instruments and
analytic techniques; adequacy of methods for monitoring national
trends/relevant promotion activities across study sites; and adequacy
of data management and quality control procedures.

o  Merit and feasibility of the planned intervention strategies,
including justification for target channels and populations chosen,
appropriateness of the behavioral model chosen to guide the
intervention; methods for achieving both individual and
environmental/organizational (food system) behavioral change.

o  Documented support for the project from the entities in the channel
chosen as well as from other participating entities.

o  Research experience, intervention experience, and competence of the
Principal Investigator and staff and adequacy of time (effort) devoted
to the project by appropriate personnel.

o  Availability of adequate resources to conduct the proposed
interventions and evaluations, including personnel with the appropriate
skills, equipment, and data processing capacity.

o  Feasibility of approach to the work, including how tasks are to be
carried out by different partners in the project, project management,
and stated anticipated problems and proposed solutions.

o  Extent to which relationships have been or will be developed between
universities and public agencies or other sources of research expertise
and community credibility and access.

o  Appropriateness of the proposed budget and duration in relation to
the proposed research.

The review group will recommend an appropriate budget and period of
support for each application that is recommended for further
consideration.

AWARD CRITERIA

The anticipated date of the award is April 1, 1993.

Factors in addition to technical merit that may be used to make award
decisions include:  availability of resources, and geographical
distribution of awards.

INQUIRIES

Written and telephone inquiries concerning this RFA are encouraged.
The opportunity to clarify any issues or questions from potential
applicants is welcome.

Direct inquiries regarding programmatic issues to:

Jerianne Heimendinger, Sc.D., M.P.H., R.D.
National Cancer Institute
Division of Cancer Prevention and Control
Executive Plaza North, Room 330
9000 Rockville Pike
Bethesda, MD  20892
Telephone:  (301) 496-8520
FAX:  (301) 402-0816

Direct inquiries regarding fiscal matters to:

Catherine Blount
Grants Management Specialist
Grants Administration Branch
National Cancer Institute
Executive Plaza South, Room 243
9000 Rockville Pike
Bethesda, MD  20892
Telephone:  (301) 496-7800

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance
No. 93.399.  Awards are made under authorization of the Public Health
Service Act, Title IV, Part A (Public Law 78-410, as amended by Public
Law 99-158, 42 USC 241 and 285) and administered under PHS grants
policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74.  This
program is not subject to the intergovernmental review requirements of
Executive Order 12372 or Health Systems Agency review.  Except as
otherwise stated in this RFA, awards will be administered under PHS
grants policy as stated in the Public Health Service Grants Policy
Statement, DHHS Publication No. (OASH) 90-50000 (Rev. Sept. 1, 1991).

REFERENCES

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California Department of Health Services. 1992. 1989 California dietary
practices survey, focus on fruits and vegetables. Final report.
Nutrition and Cancer Prevention Program, California Department of
Health Services, California Public Health Foundation. Nutrition and
Cancer Prevention Program, Sacramento, CA.

Davis, R. 1988. Health education on the six-o'clock news. JAMA
259:1036-1038.

Donner A., Birkett N., Buck C. 1981. Randomization by cluster:
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Farquhar, J., Fortmann, S., Flora, J., Taylor, B., Haskell, W.,
Williams, P., Maccoby, N., and Wood, P. 1990. Effects of communitywide
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Farquhar, J., Maccoby, N., and Wood, P. 1977. Community education for
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Flay, B. R.  1987.  Mass media and smoking cessation: A critical
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Gail M.H., Byar D.P., Pechacek T.F., Corle D.K. (in press). Aspects of
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Glanz, K., Lewis, F.M., and Rimer, B.K., eds. 1990. Health Behavior and
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Hammond, S. 1986. Health advertising: the credibility of organizational
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Institute of Medicine. 1991. Improving America's Diet and Health, From
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Levy, A. and Stokes, R. 1987. Effects of a health promotion advertising
campaign on sales of ready-to-eat cereals. Public Health Rep
102:398-403.

Levy, A., Ostrove, N., Guthrie, T., and Heimbach, J. 1988. Recent
Trends and Beliefs about Diet/Disease Relationships: Results of the
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Health, Food and Nutrition Board, Commission on Life Sciences.
National Academy Press, Washington, D.C.

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Programs.  Panel on the Evaluation of AIDS Interventions. Commission on
the Behavioral and Social Sciences and Education. National Academy
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Patterson, B., and Block, G. In press. Fruit and vegetable consumption:
National survey data. In: Micronutrients in Health and the Prevention
of Disease, Bendich, E. and Butterworth, C., Eds. Marcel Dekker, New
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Patterson, B., Block, G., Rosenberger, W., Pee, D., and Kahle, L. 1990.
Fruit and Vegetables in the American Diet: Data from the NHANES II
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Prochaska, J. O. and DiClemente C. C.  1983. Stages and processes of
self-change of smoking: toward an integrative model of change. J
Consult Clin Psychol 51:390-395.

Puska, P., Nissinen, A., Salonen, J., and Tuomilehto, J. 1983. Ten
years of the North Karelia project: results with community-based
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Puska, P., Wiio, J., McAlister, A., Koskela, K., Smolander, A., et al.
1985.  Planned use of mass media in national health promotion: The Keys
to Health TV program in 1982 in Finland. Can J Public Health 76:336-42.
Roper Organization Inc. 1985. Public attitudes toward television and
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Russo, J., Staelin, R., Nolan, C., Russell, G., and Metcalf, B. 1986.
Nutrition information in the supermarket. J of Consumer Res 13:48-69.

Stern, M., Farquhar, J., Maccoby, N. and Russell, S. 1976. Results of
a two-year health education campaign on dietary behavior. Circulation
54:826-833.

USDA (U.S. Department of Agriculture). 1985. Human Nutrition
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USDA (U.S. Department of Agriculture). 1987. Human Nutrition
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USDA/DHHS (U.S. Department of Agriculture, U.S. Department of Health
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USDHHS (U.S. Department of Health and Human Services). 1990.  Healthy
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behavior change. Health Educ Q 8:209-260.

Willett, W. 1990. Vitamin A and Lung Cancer. Nutrition Reviews. 48;5,
May, 201-211.

Ziegler, R. G. 1991. Vegetables, fruits, and carotenoids and the risk
of cancer. Am J Clin Nutr 53: Supplement; 251S-259S.

.

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