This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The percentage of African American and Latino women of childbearing age who are obese or have type 2 diabetes is rising, with severe consequences for individuals, families and communities. Diet and exercise behaviors, excessive pregnancy weight gain and postpartum weight retention may lead to long-term obesity that contributes to this trend. Pregnancy and the period after childbirth offer unique opportunities to reduce these risks. Nonetheless, few healthy lifestyle interventions have focused on reducing the risk of obesity during this period, or among women of childbearing age, particularly in low income and minority communities. The overall project aim is to demonstrate the effectiveness of a healthy lifestyle intervention tailored to the needs of pregnant and postpartum African American and Latino women in Eastside and Southwest Detroit, and designed to reduce risk factors for obesity and diabetes. The primary objectives are to increase women regular physical activity and healthy eating practices. Secondary objectives are to achieve appropriate weight gain during pregnancy and decreased weight retention after pregnancy, and to improve other measures of anthropometric and metabolic status. Additional objectives include assessment of whether changes in attitudes, beliefs, intentions and social support change from baseline, and whether these changes influence behavioral outcomes. A process evaluation objective aims to identify and assess aspects of project planning and implementation that contribute to achievement of project objectives. It was expected that we would have 50 participants consent to be in the study each cohort; however we currently average 56 participants.
We aim ed to have 28 participants each cohort complete all phases of the intervention and data collection; to date we have averaged this number. At our current pace we will exceed our project total for complete matriculation by 7 participants. It was determined, however, that our goal to recruit equal numbers of African American and Latino participants will not be achieved. Our revised goal is to recruit a sample that is 60% Latino (N = 240) and 40% African American (N = 160). Although recruitment figures have improved, investigating the barriers to recruitment and retention has been incorporated into the process evaluation plan. Participants will include Latino and African American women living in eastside or southwest Detroit and will be recruited from community and prenatal care settings in each community before their 5th month of pregnancy. After a qualifying period that includes baseline data collection, approximately 320 women will be randomly assigned to participate in either the healthy lifestyle intervention or healthy pregnancy education (control) intervention group. The healthy lifestyle intervention includes a 14-session curriculum led by trained community resident Womens Health Advocates (WHA) that empowers women to develop knowledge and skills related to healthy eating, exercise, stress management and provide education regarding pregnancy, childbirth and the postpartum period. This includes 2 home visits and 9 group meetings conducted weekly with women who are between 14 and 33 weeks of pregnancy; and 2 home visits and 1 group meeting conducted between 2 and 6 weeks postpartum. Optional group healthy eating and exercise activities, such as walking groups, aerobic dancing, recipe, shopping and cooking demonstrations provide additional social support for women in the healthy lifestyle intervention group during and after the periods of their curriculum sessions. The healthy pregnancy education (control) intervention group will receive a 4-session curriculum that includes pregnancy, childbirth and postpartum education, delivered by trained staff from Detroit community organizations, and written healthy lifestyles materials. Information about personal, social and neighborhood characteristics; health, social support; physical activity and dietarybeliefs and behaviors; physical measurements and a blood sample will be at baseline, and after each phase (pregnancy, postpartum) of the intervention. Partners include Community Health and Social Services (CHASS), the Detroit Health Department, Friends of Parkside, Harper-Gratiot Neighborhood Services Organziation, Latino Family Services, St. John Health System, Southwest Counseling and Development, the Detroit Community-Academic Urban Research Center and the University of Michigan (Schools of Social Work, Public Health, Nursing and Medicine). Funding and related support is provided by the National Institute of Health Grant # 5 R18 DK062344-01.
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