REDUCING DISEASE RISK IN LOW INCOME POSTPARTUM WOMEN

产后时期是一个机会之窗，可以通过干预措施促进减少慢性疾病风险和有利于生殖健康的行为，解决低收入妇女在社会环境中的多重影响。本研究将测试由扩大食品和营养计划（EFNEP）的社区辅助专业人员提供的教育模式的有效性。这项教育计划旨在改善低收入、多民族妇女产后12个月期间的饮食和活动模式，随后是6个月的维持期。妇女将通过妇女、婴儿和儿童特别补充食品计划（WIC）招募，并随机分配到：1)常规WIC护理，包括在产后第一次和随访时提供适当的营养风险和母乳喂养教育信息；2)增强EFNEP，包括常规WIC护理加上三部分干预，包括4次家访和4次由EFNEP辅助专业人员提供的小组烹饪和活动课程，以及项目人员每月进行的激励电话。在为期6个月的维修期间，工作人员将每两个月打电话一次。在4个时间点（产后2-6周和产后6、12、18个月）评估的主要研究结果包括：a)水果和蔬菜摄入量；B)饱和脂肪摄入；C)体力活动；次要结果是身体质量指数和脂肪质量和分布指标。统计分析将包括调解和修改因素的探索，包括社会支持和规范，感知健康状况，吸烟，看电视，食品不安全，食品/活动获取，以及联邦计划和医疗保健的利用。利用现有的针对低收入家庭的联邦方案作为渠道，干预成分专门针对多种族产后妇女采用健康饮食和活动行为的中介影响。如果有效，这个项目可以很容易地通过现有的社区组织进行推广。

The postpartum period is a window of opportunity to promote behaviors to reduce risk of chronic disease and benefit reproductive health, through interventions that address multiple levels of influence in the social context of low-income women. This study will test the efficacy of an education model delivered by community-based paraprofessionals from the Expanded Food and Nutrition Program (EFNEP). This educational program aims to improve dietary and activity patterns among low income, multi- ethnic women over a 12-mo postpartum period, followed by a 6-mo maintenance period. Women will be recruited through the Special Supplemental Food Program for Women, Infants, and Children (WIC) and randomized to: l) Usual WIC Care, consisting of nutrition-risk appropriate and breastfeeding educational messages at the first postpartum and follow-up visits; 2) Enhanced EFNEP, consisting of Usual WIC Care plus a three-component intervention including 4 home visits and 4 group cooking and activity classes delivered by EFNEP paraprofessionals, and monthly motivational telephone calls made by project staff. During a 6-mo maintenance period, staff will make calls bi-monthly. Primary study Outcomes assessed at 4 time points (2-6 wk and 6, 12, 18 mo postpartum) include: a) fruit and vegetable intake; b) saturated fat intake; c) physical activity; secondary outcomes are Body Mass Index and indicators of fat mass and distribution. Statistical analysis will include explorations of mediating and modifying factors including social support and norms, perceived health status, smoking, television viewing, food insecurity, food/activity access, and utilization of federal programs and health care. Using existing federal programs for low income families as channels, intervention components specifically address influences that mediate adoption of healthy diet and activity behaviors among multi-ethnic, postpartum women. If efficacious, this program can be readily disseminated through the existing community organizations in which it is being tested.