OBJECTIVES: This study assessed the effects of the Black Churches United for Better Health project on increasing fruit and vegetable consumption among rural African American church members in North Carolina. METHODS: Ten counties comprising 50 churches were pair matched and randomly assigned to either intervention or delayed intervention (no program until after the follow-up survey) conditions. A multicomponent intervention was conducted over approximately 20 months. A total of 2519 adults (77.3% response rate) completed both the baseline and 2-year follow-up interviews. RESULTS: The 2 study groups consumed similar amounts of fruits and vegetables at baseline. AT the 2-year follow-up, the intervention group consumed 0.85 (SE = 0.12) servings more than the delayed intervention group (P < .0001). The largest increases were observed among people 66 years or older (1 serving), those with education beyond high school (0.92 servings), those widowed or divorced (0.96 servings), and those attending church frequently (1.3 servings). The last improvement occurred among those aged 18 to 37 years and those who were single. CONCLUSIONS: The project was a successful model for achieving dietary change among rural African Americans.

The North Carolina Black Churches United for Better Health project was a 4-year intervention trial that successfully increased fruit and vegetable (F&V) consumption among rural African American adults, for cancer and chronic disease prevention. The multicomponent intervention was based on an ecological model of change. A process evaluation that included participant surveys, church reports, and qualitative interviews was conducted to assess exposure to, and relative impact of, interventions. Participants were 1,198 members of 24 intervention churches who responded to the 2-year follow-up survey. In addition, reports and interviews were obtained from 23 and 22 churches, respectively. Serving more F&V at church functions was the most frequently reported activity and had the highest perceived impact, followed by the personalized tailored bulletins, pastor sermons, and printed materials. Women, older individuals, and members of smaller churches reported higher impact of certain activities. Exposure to interventions was associated with greater F&V intake. A major limitation was reliance on church volunteers to collect process data.

Higher fruit and vegetable consumption is associated with a reduced risk of certain cancers and chronic diseases. The 5-a-Day for Better Health community studies are evaluating population-based strategies to achieving dietary behavior change using the stages-of-change model and associated theories. The authors present baseline comparisons of stages of change for fruit and vegetable consumption among adults and young adults in eight study sites representing diverse regions of the United States and diverse populations and settings. Three dominant stages, precontemplation, preparation, and maintenance, were found across sites. Women and those with college degrees were more likely to be in action/maintenance. Fruit and vegetable consumption, self-efficacy, and knowledge of the 5-a-Day recommendation were positively associated with more advanced stages of change in all study sites. The authors discuss the findings in relation to possible limitations of this and other dietary stages-of-change measures and suggest directions for future research.

Tapping into an established community-based network and linking researchers to community-identified priorities ensures that NC TraCS addresses the most pressing health needs of North Carolina's residents.

COMMENTARYn public health, the first step in assessment of a health or social problem is enumeration of the population affected and the impact of the problem. Estimated rates of child physical abuse in North Carolina range from 0.5 to 36 per 1,000 children, 1,2 a 70-fold difference. Such disparate estimates of abuse rates challenge policy makers to establish policies and systems for prevention. A child maltreatment surveillance system is needed in North Carolina that will provide for continuous and systematic data to identify the magnitude and the impact of child abuse and neglect. This will inform the allocation of resources and public health action, 3 and it will require leadership and responsibility within state government. In this commentary, we review the current approaches to child maltreatment surveillance, options for surveillance, and promising new practices.A public health-based child maltreatment surveillance system must rely on coordinated efforts and a variety of data sources from multiple sectors: social services, public health, law enforcement, and academic research. One of the challenges of developing a surveillance system lies in the definition of child maltreatment. Currently, this differs widely among agencies and care providers. The Centers for Disease Control and Prevention (CDC) Division of Violence Prevention has made establishing uniform definitions of child abuse and neglect a priority for moving forward with surveillance, research, and prevention. A position statement with uniform definitions of various types of maltreatment will be forthcoming from the CDC. 4 North Carolina's Division of Public Health needs to begin the work of designing a child maltreatment surveillance system with elements that are aligned with our child maltreatment laws, yet are consistent with national definitions and data elements. Current ApproachThe current approach to monitoring child abuse relies on reports or complaints about suspected maltreatment that are made to county departments of social services (DSSs). In 2003