Evaluation of a Multidisciplinary Disease Management Program to Achieve Asthma Control in Seven Safety Net Hospitals in Louisiana.

The objective was to evaluate a multidisciplinary guideline-driven disease management program focused on achievement of asthma control among sustained patients with confirmed asthma in Louisiana and to assess factors affecting achievement of asthma control. Data were extracted from the electronic health records of 1596 adults with confirmed asthma, sustained care for >1 year in the outpatient setting, and ≥2 recorded Asthma Control Test (ACT) scores. Multivariable logistic regression modeling was used to assess the association of demographic variables, comorbidities, and process measures with the best achieved asthma control as represented by the highest ACT score. Most subjects were female (81.1%) and African American (63.9%). Approximately half of them (48.9%) were able to achieve asthma control (ACT ≥20). The most prevalent comorbidities were hypertension (79.8%), rhinitis (55.3%), and obesity (50.5%). Most patients received pulmonary function testing (PFT) (88.6%), controller medication therapy (85.5%), or written asthma action plans (92.7%). Asthma control was positively associated with presence of PFT (OR = 1.63, 95% CI: 1.13, 2.37) and being a "never" smoker (OR = 1.49, 95% CI: 1.08, 2.04). Asthma control was less likely to be achieved by patients who were African American (OR = 0.68, 95% CI: 0.52, 0.87), had more comorbidities (OR = 0.89, 95% CI: 0.83, 0.96), or were on more medications (OR = 0.79, 95% CI: 0.72, 0.88). Asthma control was achieved in 48.9% of an adult, primarily African American population with the implementation of comprehensive guideline-driven care. Furthermore, this is the first study to observe that the presence of PFT may be associated with asthma control.

Maternal pre-pregnancy weight status modifies the influence of PUFAs and inflammatory biomarkers in breastmilk on infant growth.

BACKGROUND: Human breastmilk contains pro- and anti-inflammatory compounds and hormones that can influence infant growth. However, little is known about the specific interrelationships between these compounds and whether their effects on infant growth may be influenced by pre-pregnancy weight status. OBJECTIVE: The purpose of this novel, prospective cohort study was to assess the interrelationships between pro-inflammatory cytokines (TNF-α, IL-6), hormones (insulin, leptin) and PUFAs (n-6, n-3) in blood and breastmilk in early postpartum between women with normal BMI (Group 1, n = 18; 18.5

Health beliefs associated with poor disease self-management in smokers with asthma and/or COPD: a pilot study.

Background: Compared to nonsmokers, smokers with chronic disease are less likely to adhere to self-management recommendations for the management of their chronic conditions. Although the literature notes poor adherence trends in smokers, actual influences of adherence in these patients require further study. This study examines the health beliefs that influence self-management behaviors in smokers with chronic lung disease. Methods: This prospective, cross-sectional study surveyed patients (n = 83) seen in the pulmonary outpatient clinics of the University Medical Center of New Orleans between November 2015 and February 2016. Eligible patients included those between 40-64 years old diagnosed with asthma and/or chronic obstructive pulmonary disease (COPD). Primary measures included perceived beliefs related to the susceptibility to asthma and/or COPD becoming worse, perceived barriers to adherence, and perceived benefits to adherence. Patient characteristics under-study included smoking status, race, gender, and diagnosis. Descriptive and chi-square analyses were performed to characterize the sample. Student's t and and regression analyses were conducted to examine the relationships between perceptions, smoking status, race, gender, and diagnosis. Results: Compared to nonsmokers, smokers perceived their asthma and/or COPD becoming worse (p = 0.0023). Smokers also perceived more barriers (p < 0.0001), and fewer benefits to adherence than nonsmokers (p = 0.0021). Conclusion: The health beliefs of smokers may influence their self-management behaviors. Results of this study can inform the development of services that target smokers in order to improve adherence to self-management behaviors and health outcomes.

Farmers' Market Utilization among Supplemental Nutrition Assistance Program Recipients in New Orleans, Louisiana: Preliminary Findings.

Objective: Farmers' markets are increasingly being promoted as a means to provide fresh produce to poor and underserved communities. However, farmers' market (FM) use remains low among low-income patrons. The purpose of our study was to examine FM awareness and use, grocery shopping behaviors, and internet use among Supplemental Nutrition Assistance Program (SNAP) recipients. Design: A descriptive analysis of preliminary data was performed to evaluate quantitative baseline data among SNAP recipients between June and August 2016 in New Orleans, Louisiana (N=51). Data were collected via a 42-item online survey that included demographics, internet use, FM awareness and use, health information seeking behaviors and fruit and vegetable purchasing behaviors. Results: Less than half of the survey respondents (n=24) had ever been to a FM. Local grocery stores and Wal-Mart were most used for purchasing fruits and vegetables (88% and 84%, respectively). The most common sources of healthy eating information were Women, Infants and Children (WIC) and the internet, frequently accessed via smartphones. More than 80% of participants were not aware that local FMs accepted electronic benefit transfer payments as a form of payment. Conclusion: These results support the incorporation of promotional methodology that combines internet-based mobile technology and existing services (eg, WIC) as a viable strategy to improve farmers' market use among low-income populations. As most participants were not aware that participating FMs accept electronic benefit transfer payments, this fact should be emphasized in promotional material.

Social marketing for a farmer's market in an underserved community: A needs assessment.

The aim of the present paper is to assess local residents' awareness of utilizing Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fresh produce at local farmers' markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (La, USA). The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers' markets; 63% of low-income participants never attended a farmers' market compared to 27% of mid/high-income. Over 50% of the low-income respondents have access to the internet at least once per day. The results show the potential of raising awareness among a wide range of members in the community. This needs assessment will serve as the foundation for a social marketing intervention, which will be disseminated city-wide.

Integrative Family Medicine - Are Louisiana Patients Ready?

PURPOSE: The purpose of this preliminary study was to assess patient readiness to use a family medicine clinic that integrates complementary and alternative medicine (CAM) with conventional medicine. METHODS: A survey using the theory of planned behavior as a framework addressed patient attitudes and use of CAM. Descriptive statistics provided demographic characteristics. Additional analyses assessed differences among CAM users and responses to survey items. RESULTS: Patients who self-reported as using CAM in the past 12 months were 39.8%. The majority of patients had favorable attitudes toward CAM use and integrative medicine; 62.7% reported they are likely to use CAM if offered at the clinic. Most patients want their physician to inquire about their use of CAM (61.5%) and to be trained to treat with CAM (64%). CONCLUSIONS: Preliminary data from this study highlights patients' interest in a family medicine integrative center and may be used by providers to develop tailored messages for patients.

Applying the Social Ecological Model to Creating Asthma-Friendly Schools in Louisiana.

BACKGROUND: In 2010, the Louisiana Asthma Management and Prevention Program (LAMP) implemented the Asthma-Friendly Schools Initiative in high-risk Louisiana populations. The social ecological model (SEM) was used as a framework for an asthma program implemented in 70 state K-12 public schools over 2 years. METHODS: Activities included a needs assessment, identification of students with asthma, individualized asthma action plans (AAP), staff trainings, environmental quality improvement, and school system policy changes to address the asthma burden. RESULTS: There were 522 new or existing asthma cases recognized. Asthma knowledge/awareness was measurably improved among school personnel. School indoor air quality was improved across all locations. School-level policies were adopted that improved AAP collection, compliance to bus-idling restrictions, and asthma medication self-carry. CONCLUSIONS: The SEM framework can be used for school-based programs to address successfully and improve asthma-related issues from the individual through policy levels.

Use of asthma control indicators in measuring inhaled corticosteroid effectiveness in asthmatic smokers: a systematic review.

OBJECTIVE: The objective of this review is to explore how current research measures the effectiveness of inhaled corticosteroids (ICS) in smokers with asthma. DATA SOURCES: PubMed, CINAHL and PsycINFO databases were searched for combinations of terms relating to asthma, tobacco use and ICS effectiveness. STUDY SELECTIONS: The search was limited to articles published between 2004 and 2015, in English language. Studies met inclusion criteria if reporting the use of guideline-based asthma control indicators to measure the therapeutic effects of ICS or ICS combination therapies. This review did not exclude articles based on study design. Data were extracted and summarized to describe how indicators were measured across studies in order to characterize and describe the effects of ICS in smokers. RESULTS: Thirteen studies were included in this review. Six of these 13 studies used only one indicator to measure asthma control in smokers and ICS was found to improve asthma in only one of six of these studies. Of studies evaluating combination therapy, three of four studies reported a therapeutic benefit to smokers. In these studies of combination therapy multiple indicators of control were measured to assess drug effects. CONCLUSIONS: To assess the therapeutic benefit of ICS drugs in smokers, multiple indicators should be measured to determine if current therapy is improving asthma control. Asthma therapy should then be adjusted based on the patient's current asthma status. The development of clinical treatment guidelines for asthmatic smokers may help clinicians make best-practice, evidence-based recommendations in order to optimize care for these patients.

Applying the Social Ecological Model to evaluate a demonstration colorectal cancer screening program in Louisiana.

OBJECTIVE: Lack of health insurance is correlated with noncompliance in colorectal cancer screening. Louisiana ranks 48th among all states in residents with health insurance. This paper describes initial results of Louisiana's first statewide colorectal cancer screening program. METHODS: The program enhanced screening capacity of state hospitals by providing fecal immunochemical tests (FITs), colonoscopes, and funded patient navigators. The Social Ecological Model (SEM) was used as the framework for the program. RESULTS: Patient navigators distributed 975 FITs to adults 50 to 64 years (21% men, 78% women).The overall return rate was 66%. There was no association among return rates, race, or gender. Participants who were previously screened (10.7%) were more likely to return their FIT. DISCUSSION: The combination of patient navigation and providing patients with an easy-to-use CRC screening option proved to be an effective method that potential colorectal cancer screening programs can deploy in similar populations of un- and under-insured adults.

Development and evaluation of WillTry. An instrument for measuring children's willingness to try fruits and vegetables.

This paper describes the development and evaluation of the WillTry instrument, a psychometric tool designed to measure children's willingness to try fruits and vegetables. WillTry surveys were interviewer-administered to 284 children in an elementary school and summer day camps located in rural Mississippi and Arkansas (United States) communities. Factor analysis was used to determine construct dimensionality. Additional evaluation included internal consistency, test-retest reliability, and predictive validity. Factor analysis suggested a single dimension for the food items. The WillTry food scale had substantial reliability (intraclass correlation coefficients between 0.61 and 0.80) and sufficient internal consistency (Cronbach's alpha > or = 0.70). Results of the regression analysis for percent consumption of foods offered on WillTry response confirmed the predictive validity of the instrument. The results of these analyses provide psychometric evidence for the use of the WillTry instrument as a measure of willingness to try fruits and vegetables in rural, southern US children 5-14 years of age.

Participatory development and implementation of a community research workshop: experiences from a community-based participatory research partnership.

BACKGROUND: Although community-based participatory research (CBPR) principles stress the importance of "equitable partnerships" and an "empowering and power-sharing process that attends to social inequalities," descriptions of actual projects often focus on the challenges confronted in academic-community partnerships. These challenges occur in the context of economic and power inequities and the frequently limited diversity of researchers. Less often does this discourse attend to the link between the principles of CBPR and their empowering potential for community members who internalize and use these principles to hold outside partners accountable to these ideals. OBJECTIVES: This article documents the participatory development and implementation of a community research workshop, the community and organizational contexts, the content of the workshop, and lessons learned. Workshop objectives included increasing community knowledge of the research process, positively impacting community members' perceptions and attitudes about research, and improving researchers' understanding of community knowledge, perceptions, and experiences with research. METHODS: This project was conducted as a part of the larger United States Department of Agriculture, Agriculture Research Service (USDA ARS) Delta Nutrition Intervention Research Initiative (Delta NIRI). The workshop was developed by a joint academic-community team in partnership with a community-based workshop advisory committee (WAC) and implemented in three rural communities of the lower Mississippi Delta. Development included a dry run with the WAC, a pilot workshop, and a focus group to refine the final content and format. CONCLUSIONS: Applying participatory principles to the development of the community research workshop resulted in the creation of a mutually acceptable workshop and co-learning experience that empowered community members in their involvement in other community research projects.

Personalizing nutrigenomics research through community based participatory research and omics technologies.

Personal and public health information are often obtained from studies of large population groups. Risk factors for nutrients, toxins, genetic variation, and more recently, nutrient-gene interactions are statistical estimates of the percentage reduction in disease in the population if the risk were to be avoided or the gene variant were not present. Because individuals differ in genetic makeup, lifestyle, and dietary patterns than those individuals in the study population, these risk factors are valuable guidelines, but may not apply to individuals. Intervention studies are likewise limited by small sample sizes, short time frames to assess physiological changes, and variable experimental designs that often preclude comparative or consensus analyses. A fundamental challenge for nutrigenomics will be to develop a means to sort individuals into metabolic groups, and eventually, develop risk factors for individuals. To reach the goal of personalizing medicine and nutrition, new experimental strategies are needed for human study designs. A promising approach for more complete analyses of the interaction of genetic makeups and environment relies on community-based participatory research (CBPR) methodologies. CBPR's central focus is developing a partnership among researchers and individuals in a community that allows for more in depth lifestyle analyses but also translational research that simultaneously helps improve the health of individuals and communities. The USDA-ARS Delta Nutrition Intervention Research program exemplifies CBPR providing a foundation for expanded personalized nutrition and medicine research for communities and individuals.

A nutrition and physical activity intervention promotes weight loss and enhances diet attitudes in low-income mothers of young children.

The purpose of this study was to evaluate a nutrition and physical activity program for reducing body weight and improving nutrition attitudes in mothers of young children. A convenience sample of 114 intervention mothers and 33 comparison mothers was recruited from public health clinics and community centers. Eligibility criteria included Hispanic, African American, or white ethnicity; body mass index of at least 25 kg/m(2); low income (< 200% of the federal poverty index); and youngest child aged 1 to 4 years. For intervention participants, height, weight, percentage of body fat, waist circumference, demographics, nutrition attitudes, and dietary intake were measured at weeks 0 and 8; height, weight, percentage of body fat, and waist circumference were reassessed at 6 months. Overweight mothers in the comparison group provided anthropometric and demographic data at weeks 0 and 8. Changes in anthropometrics, attitudes, and dietary intake were evaluated in intervention mothers. Anthropometric data of intervention vs comparison group mothers were examined. Differences in anthropometrics and attitude scores between weight loss responders (> or = 2.27 kg) and nonresponders (< 2.27 kg) were assessed at week 8. Intervention participants lost weight (x = -2.7 kg; P < .001), whereas comparison mothers gained a slight amount of weight (x = 0.1 kg) by week 8. Weight loss responders had healthier eating attitudes (5.6 vs 5.2; P < .01) and fewer perceived barriers (2.4 vs 2.9; P < .05) than nonresponders postintervention. In conclusion, this dietary and physical activity curriculum is a valuable resource for weight management programs serving low-income women.

Greater nutrition knowledge is associated with lower 1-year postpartum weight retention in low-income women.

The purpose of this study was to assess nutrition knowledge during early and late postpartum in a sample of low-income and minority women, and to determine if that knowledge had any relationship to weight retention at 1-year postpartum. A questionnaire was developed and validated in a sample of 151 low-income new mothers. This instrument was then administered to a separate sample of mothers (n=140) of similar demographics to assess nutrition knowledge at 0 to 1 days and 12 months postpartum. In addition, a survey of nutrition information sources was administered at both time points. Nutrition knowledge was compared with 12-month postpartum weight retention and demographic variables. Women who retained less than 5% of weight gained during pregnancy had greater knowledge of nutrition at 0 months (53% vs 49%, P<0.05) and 12 months (55% vs 51%, P<0.05) than those who retained 5% or more of weight gained during pregnancy. Whites had higher nutrition knowledge scores than non-Hispanic blacks and Hispanics. Women who lactated 6 months or more had more knowledge than those who lactated less than 6 months. Higher knowledge test scores were observed among women who used the Internet and books/magazines as their source for information. These results indicate that assessment of nutrition knowledge in early postpartum can identify women at risk for significant weight retention.

Low-income, overweight and obese mothers as agents of change to improve food choices, fat habits, and physical activity in their 1-to-3-year-old children.

OBJECTIVE: To examine the effects of a weight loss program for mothers on the diet and activity of mothers and their 1-3 year old children. DESIGN: Overweight and obese mothers participated in an 8-week weight loss intervention encompassing diet, physical activity, and behavioral modification. Anthropometrics, demographic, dietary, and physical activity questionnaires were administered at weeks 0 and 8; anthropometrics were re-evaluated at week 24. SUBJECTS: Mothers (N=91) of a 1-3 year old child; body mass index (BMI) >or= 25 kg/m2; non-breastfeeding; age 18-45 years; income < 200% of federal poverty index; Hispanic, African American, or white; and English-speaking were recruited from Special Supplemental Program for Women Infants and Children (WIC) and public health clinics. INTERVENTION MEASURES OF OUTCOME: Weight loss in mothers and improvements in diet (reduction in calories, fat, snacks/desserts, sweetened beverages, and increases in fruit, vegetables) and activity in mothers and children. RESULTS: Weight loss in mothers was modest (-2.7 kg, p < 0.001) and sustained at week 24 (-2.8 kg, p < 0.001), and children gained in height and weight as expected for normal growth (p < 0.001). Initial energy intakes of children exceeded Estimated Energy Requirements (123%) and were reduced to acceptable levels post-intervention (102%, p < 0.001); additional beneficial changes in children's diets were decreased total (47.7 to 39.9 g/day) and saturated fat (19.2 to 16.6 g/day), high-fat snacks/desserts (1.6 to 0.9 servings/day), added fats (81.8 to 40.9% using), sweetened beverages (0.8 to 0.4 servings/day), and fast food consumption (11.6 to 6.6% of meals), and increased home-prepared meals (63.2 to 71.6% of meals) (p < 0.01 for all). Physical activity scores improved by 7% in children (p < 0.05). Comparable changes in food choices and activity also were seen in mothers. CONCLUSION: Offering weight loss classes was a successful method of enticing low-income women to participate in an educational intervention that benefited their children. Overweight and obese mothers who modified their food choices and fat habits made comparable changes for their child.

Promotion of physical activity in low-income mothers using pedometers.

OBJECTIVE: This study tested the effectiveness of a pedometer program for increasing physical activity levels and reducing body weight in overweight and obese mothers of young children. DESIGN: Participants' motivational readiness to exercise, exercise self-efficacy, pedometer steps, pedometer kilocalories, and anthropometrics were evaluated at week 0 and week 8; anthropometrics were reassessed at week 24. Healthful-weight mothers provided comparison data at baseline. SUBJECTS/SETTING: A convenience sample of 93 intervention women (body mass index [calculated as kg/m(2)] >or=25) and 31 comparison women (body mass index <25) were recruited from public health clinics, community centers, and churches. Eligibility criteria included Hispanic, African-American, or white ethnicity and low income (<200% of the federal poverty index). INTERVENTION: An 8-week physical activity and dietary program was conducted. MAIN OUTCOME MEASURES: Motivational readiness to exercise, exercise self-efficacy, pedometer steps, and weight loss. STATISTICAL ANALYSES PERFORMED: Independent sample t tests, chi(2) tests, paired t tests, Wilcoxon signed-ranks tests, repeated measures analysis of variance, and Pearson and Spearman correlations. RESULTS: Mothers enhanced their motivational readiness to exercise, exercise self-efficacy, pedometer steps, and pedometer kilocalories. Reductions in body weight, percent body fat, and waist circumference also were observed. Significant correlations were found between exercise self-efficacy and exercise readiness (r=0.28, P<0.01), pedometer steps (r=0.30, P<0.01), and pedometer kilocalories (r=0.28, P<0.05). CONCLUSIONS: This intervention successfully increased the physical activity levels and promoted weight loss in low-income mothers. Public health clinics may wish to incorporate elements of this intervention into their programs to improve the physical fitness of recipients.

Influence of nutrition attitudes and motivators for eating on postpartum weight status in low-income new mothers.

OBJECTIVE: The purpose of this study was to identify attitudes about nutrition and their influence on weight status in low-income mothers in the first year postpartum. DESIGN: Nutrition attitudes were assessed at 1.5, 6, and 12 months postpartum. Body weight was measured at each time point and height at 1.5 months to calculate body mass index. Nutrition attitudes at each time were compared with demographic variables and weight status. SUBJECTS: Subjects were 340 non-Hispanic white (31.3%), non-Hispanic black (25.1%), and Hispanic (43.7%) new mothers (mean age=22.4 years) located in central Texas. Criteria for participation included good health at delivery and low income (

Nutrition knowledge is associated with greater weight loss in obese and overweight low-income mothers.

OBJECTIVE: To examine if greater nutrition knowledge vs gains in knowledge promote more successful weight loss in low-income, overweight and obese mothers with young children. DESIGN: A convenience sample of mothers and their children were measured for height and weight; mothers completed demographic and nutrition knowledge questionnaires pre- and post-intervention. SUBJECTS/SETTING: Participants (N=141) were recruited from government and public health clinics and elementary schools. Inclusion criteria for mothers were: family income <200% federal poverty level; overweight/obese; and Hispanic, African-American, or white race/ethnicity. INTERVENTION: Eight weekly weight-loss classes emphasizing diet, physical activity, and behavior modification based on Social Cognitive Theory were administered to mothers. MAIN OUTCOME MEASURES: Improvements in maternal nutrition knowledge and weight loss. STATISTICAL ANALYSES PERFORMED: Paired-samples t tests, repeated measures analysis of variance, analysis of covariance, Pearson correlations, and chi(2) statistics. RESULTS: Nutrition knowledge of mothers increased in all areas. Participants with weight loss > or =2.27 kg (responders) had greater knowledge than those who did not; however, the actual net gain was similar for those who lost and did not lose weight. Weight gainers only improved in two areas on the test, whereas weight-loss responders increased knowledge in all six. Responders appeared more cognizant of diet, weight loss, and health information. CONCLUSIONS: Weight-management programs should include a strong component of nutrition education to alleviate knowledge inequalities and promote more effective weight control. In low-income mothers, greater initial knowledge may be more predictive of weight loss than gains in knowledge during an intervention.

Food choices of low-income women during pregnancy and postpartum.

OBJECTIVES: The purpose of this study was to examine dietary behavior during pregnancy and postpartum in a multiethnic sample of low-income women. SUBJECTS: Participants were 149 Medicaid-qualified women (30% white, 24% African American, and 46% Hispanic; median age, 22 years). DESIGN: Subjects were recruited into a longitudinal cohort design 0 to 1 days following delivery. Dietary choices during pregnancy and the first 6 months postpartum were assessed via validated food frequency questionnaires administered at 6 weeks and 6 months postpartum, respectively. STATISTICAL ANALYSES PERFORMED: Frequencies and means were used for descriptive purposes. Paired and independent sample t tests were used for continuous variables; chi 2 and McNemar tests were used for categorical variables. RESULTS: In all subjects, mean daily servings of grains (7.4 vs 6.2, P <.004), vegetables (2.5 vs 2.0, P <.002), and fruit (3.4 vs 1.7, P <.001) declined following childbirth, while the percentage of energy from fat (37.3% vs 38.4%, P <.023) and added sugar (14.4% vs 16.4%, P <.019) increased. Women who breastfed their infants at 6 months postpartum reported lower intakes of total fat (34.2% vs 37.9%, P <.005) during pregnancy and higher fruit (2.2 vs 1.6, P <.05) and vegetable (2.6 vs 1.8, P <.02) intakes in postpartum than those who bottle-fed. Also, a greater proportion of lactating than nonlactating women (66.7% vs 36.9%, P <.05) met recommendations for fruit intake during pregnancy. CONCLUSIONS: The findings suggest that the transition from pregnancy to postpartum may be associated with a negative impact on dietary behavior that could compromise nutritional status in low-income women.

Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum.

OBJECTIVES: The goals were to evaluate compliance with the Dietary Guidelines among low-income women during late postpartum and to examine the relationship between psychosocial variables and dietary compliance. SUBJECTS/SETTING: Participants were 146 triethnic, low-income women who were recruited 0 to 1 days after childbirth and who visited a clinic site at 1 year postpartum. DESIGN: At 1 year postpartum, multiple psychosocial characteristics were measured, and food choices and nutrient intakes were assessed via a validated food frequency questionnaire. Dietary guidelines index scores and measures of adherence to dietary recommendations were computed. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, analysis of variance with post-hoc Scheffe tests, chi 2 with follow-up tests of independent proportions, and Pearson correlation coefficients were utilized. RESULTS: For dietary compliance, 60% had adequate intakes of meat, but less than 30% met recommendations for grains, vegetables, fruits, dairy foods, total fat, and added sugar. Healthful weights (body mass index <25) were observed in 37% of women. Those in the highest tertile of dietary compliance had a more positive body image than those in the lowest tertile, and less neglect of self-care, weight-related distress, stress, depressive symptoms, and perceived barriers to weight loss ( P <.05). Dietary compliance and psychosocial scale scores did not vary by ethnicity. CONCLUSIONS: Adherence to dietary guidelines was limited in the low-income, postpartum women. Psychosocial variables, such as neglect of self-care, weight-related distress, negative body image, stress, and depressive symptoms were associated with less healthful diets and lifestyle in late postpartum. Programs that target diet-related behavior change in low-income women might be improved by inclusion of psychosocial assessment and counseling components.