REDUCING DISEASE RISK IN LOW INCOME POSTPARTUM WOMEN

产后期是一个机会之窗，通过针对低收入妇女社会背景中的多层次影响的干预措施，促进降低慢性病风险和有益于生殖健康的行为。这项研究将测试由扩展食品和营养计划(EFNEP)的社区辅助专业人员提供的教育模式的有效性。这一教育计划旨在改善低收入多民族妇女在产后12个月期间的饮食和活动模式，然后是6个月的维持期。将通过妇女婴幼儿食品特别补充计划招募妇女，并随机分配到：L)常规妇幼食品补充计划，包括产后第一次适当营养和母乳喂养的教育信息和后续访问；2)加强妇幼保健品计划，包括4次家访和4次小组烹饪以及由EFNEP辅助专业人员开设的三项干预措施，包括4次家访和4次小组烹饪和活动课程，以及项目人员每月拨打的励志电话。在6个月的维护期间，工作人员将每两个月打一次电话。在4个时间点(2-6周和产后6、12、18个月)评估的主要研究结果包括：a)水果和蔬菜的摄入量；b)饱和脂肪的摄入量；c)体力活动；次要结果是体重指数和脂肪质量和分布指标。统计分析将包括探索调解和调整因素，包括社会支持和规范、感知的健康状况、吸烟、看电视、食品不安全、食品/活动机会以及对联邦计划和医疗保健的利用。以现有的针对低收入家庭的联邦计划为渠道，干预部分专门针对调解多种族产后妇女采用健康饮食和活动行为的影响。如果有效，这项计划可以很容易地通过正在进行测试的现有社区组织进行传播。

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.