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.
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