Parents As Teachers (PAT) High 5 Low Fat Program

Significant disparities in cancer incidence, prevalence, and mortality exist for African Americans relative to other racial and ethnic groups.  In particular, African American women have the highest incidence of colorectal and lung cancer and the highest death rates from breast cancer; African American men have the highest incidence and death rates from prostate and colorectal cancer.  Poor dietary patterns are believed to contribute to these disparities.  In addition, a large percentage of African American families live in poverty, a factor also associated with poor dietary intake.  Poverty results in families focusing on immediate priorities such as money and safety issues rather than on long-term priorities such as lowering fat intake to reduce cancer risk.  Dietary interventions that embrace the strengths and values of the African American culture and are institutionalized within well-respected organizations are needed.

The High 5, Low Fat Program (H5LF) is a culturally tailored dietary intervention for African American parents.  The program was developed in partnership with Parents as Teachers, a national parent education program free to parents of children from birth to age 3 years.  H5LF aims to reduce parents' caloric intake from fat and increase their fruit and vegetable consumption.  During five home visits, trained parent educators teach nutrition related skills and promote parental modeling of dietary behaviors consistent with nutrition guidelines.  Trained parent educators also conduct group meetings to demonstrate appropriate food selection, preparation, and taste testing.  Five newsletters and 12 monthly calendars are mailed to parents, emphasizing positive parenting skills and providing nutritional tips, respectively.

The intervention is delivered over 6 months.  The home visits are 60 - 90 minutes in length and group meetings are approximately 60 minutes in length.  The newsletter component is self-administered.

Participants who tested this program were African American parents, ages 19 to 39 years in St. Louis, MO; 98% were women; 55% were single; 57% had at least some college; 24% earned less than $10,000 and 20% earned more than $50,000.

The intervention is suitable for implementation in the home.

The H5LF Nutrition Curriculum CD-ROM is required.  The curriculum includes access to on-line training necessary to conduct the five home visits and group meetings, and individuals are also mailed five newsletters and 12 monthly calendars.  Costs associated with the program are not provided.

Twelve school districts, already offering Parents As Teachers (PAT) in the St. Louis area were paired, and then within each pair, randomly assigned to the High 5, Low Fat group or a control group.  PAT parent educators specifically recruited high-needs families because such designation entitles these families to receive home visits.  In addition to scheduling regular PAT home visits, parent educators conducted five home session visits for the express purpose of delivering H5LF intervention materials.  These sessions included the following topics: 1) assessing current intake, 2) reading and interpreting nutrition labels, 3) providing shopping tips to purchase the most nutrition for the least cost, 4) learning tips for choosing lower fat foods at fast food restaurants, and 5) modifying recipes to lower fat and increase fruit and vegetable intake.  Additionally, H5LF parents received bimonthly newsletters and monthly calendars to modify unhealthy nutrition patterns.  Participants were surveyed before and after the intervention.

Results indicated:

• H5LF participants increased their fruit and vegetable consumption to 4.8 servings compared with a reduction to 4.5 servings in the control group, a net difference of 0.53 servings.  
   
• Relative to control participants, more H5LF participants reported increasing the frequency with which they performed low-fat and fruit and vegetable eating behaviors.