Dietary cancer risk of low-income women and change with intervention.

The most prevalent cancer among American women is breast cancer; however, the prevalence of lung cancer is increasing (1). Black women have a higher cancer mortality than white women (457 and 380 per 100,000, respectively). Poverty is a risk, with cancer incidence increasing and survival rate decreasing as income goes down (2-4). Cancers are associated with numerous risks, including smoking, alcohol, diet, and environmental factors (5). Significant correlations have been reported between carcinogenesis (6) and excess fat and energy, obesity (7-10), alcohol (11,12), nitrites and mutagens (13,14), and meal, intake (10,15). Factors that may protect a person from cancer are fruits and vegetables (16,17); dietary fiber (18,19); carotenoids (17,20,21); vitamins A, C, and E (14,20-23); folate (24,25); calcium and milk (26,27).

This study was conducted by researchers with the Massey Cancer Center, Richmond, Va, and the Virginia Expanded Food and Nutrition Education Program (EFNEP) to determine whether the EFNEP could be an avenue for reducing cancer risks of low-income women. The EFNEP, a nutrition education program of the Cooperative Extension Service, has a successful history of improving the diets of low-income families (28,29).

METHODS

The study was conducted from 1992 through 1993 in three counties and one city and involved two intervention groups and a control group. Subjects included 339 women (68 whites and 271 blacks), aged 20 to 45 years, with low education [TABULAR DATA FOR TABLE 1 OMITTED] levels and poverty incomes (30), which are typical of EFNEP clients in Virginia.

Three random-repeat. 24-hour recalls were collected before and after intervention, in face-to-face interviews by trained paraprofessionals. Results were analyzed using the Nutritionist III software (version 7.0, 1991, N-Squared Computing, Salem, Ore). The 24-hour recall offers advantages with low-literacy people (31); random-repeat 24-hour recalls increase the representiveness of data (32) Daily intakes of energy; total fat (% of energy); fiber; calcium; folate; and vitamins A, C, and E were calculated. The software did not assess carotenoids, nitrites, and mutagens, which were included in the intervention. The Statistical Analysis System (1988, release 6.03, SAS Institute, Cary, NC) was used to perform [[Chi].sup.2] and analysis of variance tests (33). The .05 level was used for testing of significance.

We designed the 6-month intervention to determine whether adding cancer-prevention lessons to the standard EFNEP curriculum (34) would achieve greater dietary change than …