The National Cancer Institute's 5 A Day for Better Health Program
NCI's 5 A Day for Better Health Program (the Program) is a national program that approaches Americans with a simple, positive message: Eat 5 or more servings of vegetables and fruit daily for better health. The Program, a partnership between the vegetable and fruit industry and the NCI, has four major components: mass media, point of purchase, community coalitions, and research. Over the past 10 years, it has emerged as the most prominent population-based initiative focused on cancer prevention through dietary change.
Charge to the Evaluation Group
Because the 5 A Day for Better Health Program was initiated in 1991 as a 5-year effort that included a formal evaluation, the NCI believes that any new commitments to the Program should be informed by an objective, thorough review. Consequently, in September 1999, the Director of the NCI established the 5 A Day Program Evaluation Group (the Evaluation Group) to review and evaluate the Program. Specifically, the Evaluation Group was asked to review (1) the science underlying the Program, (2) the implementation and accomplishments of the Program, and (3) the degree to which the Program has achieved its goals and objectives. The Evaluation Group also was charged with making recommendations to the NCI about the future conduct of the Program and to articulate NCI's role in large, coordinated efforts to promote healthy eating.
Process of the Evaluation Group
In completing its charge, the Evaluation Group met face-to-face three times during 2000—in January, April, and September—and by conference call on several other occasions.
The Evaluation Group interpreted its charge as follows:
- To review briefly the science underlying the possible protective role of vegetables and fruit against cancer;
- To describe and analyze the origins of the Program, including the policy background;
- To describe and analyze the media and health-message environment in which the Program operated; and
- To evaluate the Program based on: (a) implementation, (b) process measures (communication of the 5 A Day message), (c) dietary change and factors that mediate dietary change, and (d) controlled trials that were part of the Program.
The Evaluation Group planned at the outset to provide specific conclusions as well as recommendations. To do so, the Evaluation Group needed specific data from NCI scientists and asked for specific analyses to be undertaken. These analyses are, in part, presented in this report. Additional data, particularly regarding media activity, were analyzed by members of the Evaluation Group and also are, in part, presented in this report.
The Evaluation Group's first meeting, held in Arlington, Virginia, on January 12-13, 2000, focused on presentations from staff at the NCI and the 5 A Day Program partners (CDC, the PBH Foundation, state health agencies, the vegetable and fruit industry, the American Cancer Society [ACS], and other Federal agencies). The meeting also included testimony from 15 representatives of professional societies and associations, schools of public health, state health departments, industry, and advocacy groups. All of the testimony showed enthusiastic support for the Program.
During its second meeting, held in Seattle, Washington, on April 27-28, 2000, the Evaluation Group received and discussed additional background information and reviewed new analyses of data provided by the NCI and the PBH. These data focused on dietary behavior change and knowledge of the 5 A Day message. The Evaluation Group also reviewed findings from controlled trials of 5 A Day interventions and discussed and revised an outline for a final report.
During the following 4 months, members of the Evaluation Group drafted sections of the report and critiqued and edited them via e-mail and teleconferences. The Evaluation Group dedicated its final face-to-face meeting, held in Minneapolis, Minnesota on September 18-19, 2000, to sharpening conclusions and reaching a consensus regarding its recommendations.
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