Objectives Non-Latino Black adults have greater risk for Alzheimer’s dementia compared to non-Latino White adults, possibly due to factors disproportionally affecting Black adults including cardiovascular disease (CVD). Chronic peripheral... more
Objectives Non-Latino Black adults have greater risk for Alzheimer’s dementia compared to non-Latino White adults, possibly due to factors disproportionally affecting Black adults including cardiovascular disease (CVD). Chronic peripheral inflammation is implicated in both Alzheimer’s dementia and CVD and is known to impact cognition and cerebral white matter, yet little work has examined these associations by race. This study examined associations between inflammation, cognition, and cerebral white matter generally, and by race. Methods Eighty-six non-demented older Black and White participants (age = 69.03; 50% female; 45% Black participants) underwent fasting venipuncture, cognitive testing, and MRI. Serum was assayed for interleukin-6 (IL-6), C-reactive protein (CRP), and interleukin 1-beta. Cognitive domains included memory, executive function, and attention/information processing. MRI measures included white matter hyperintensity volumes (WMH) and quantification of white matte...
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Background Iron is critical for fetal development. Neonates of obese women may be at risk for poor iron status at birth as a result of maternal inflammation-driven overexpression of hepcidin. Objectives The objective of this study was to... more
Background Iron is critical for fetal development. Neonates of obese women may be at risk for poor iron status at birth as a result of maternal inflammation-driven overexpression of hepcidin. Objectives The objective of this study was to determine differences in placental transfer of oral iron (57Fe) and expression of placental transferrin receptor 1 (TFR1) and ferroportin (FPN) mRNA and protein and their association with maternal and neonatal iron-related parameters, including maternal hepcidin, among women with and without prepregnancy (PP) obesity. Methods 57Fe ingested during the third trimester of pregnancy was recovered in venous umbilical cord blood among 20 PP obese [BMI (in kg/m2): 30.5–43.9] and 22 nonobese (BMI: 18.5–29.0) women aged 17–39 y. Placental TFR1 and FPN mRNA and protein expression were quantified via qPCR and Western blot. Maternal and neonatal markers of iron status and regulation, as well as inflammation, were measured. Descriptive and inferential statistica...
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Many perinatal characteristics are associated with risk for pediatric asthma. Identification of biologic processes influenced by these characteristics could facilitate risk stratification or new therapeutic targets. We hypothesized that... more
Many perinatal characteristics are associated with risk for pediatric asthma. Identification of biologic processes influenced by these characteristics could facilitate risk stratification or new therapeutic targets. We hypothesized that transcriptional changes associated with multiple epidemiologic risk factors would be mediators of pediatric asthma risk. Using publicly available transcriptomic data from cord blood mononuclear cells, transcription of genes involved in myeloid differentiation were inversely associated with pediatric asthma risk stratification based on multiple perinatal risk factors. This gene signature was validated in an independent prospective cohort and was specifically associated with genes localizing to neutrophil specific granules. Changes in these genes correlated with changes in protein abundance in serum. Umbilical cord blood serum concentration of PGLYRP-1, a specific granule protein, was inversely associated with mid-childhood current asthma and early-tee...
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Colorectal cancer (CRC) remains the third most commonly diagnosed cancer and the third leading cause of cancer-related death in the USA. CRC can be prevented through regular screening and removal of precancerous polyps. However, roughly... more
Colorectal cancer (CRC) remains the third most commonly diagnosed cancer and the third leading cause of cancer-related death in the USA. CRC can be prevented through regular screening and removal of precancerous polyps. However, roughly one third of eligible adults in the USA are not up to date with recommended CRC screening. To increase timely CRC screening uptake in the USA, in 2014, the National Colorectal Cancer Roundtable (NCCRT) launched 80% by 2018. This multilevel effort involved more than 1,500 pledged organizations targeting patients, providers, health care systems, and policymakers to increase U.S. CRC screening rates to 80% by 2018. Concurrent with this campaign, between 2012 and 2018, CRC screening rates increased nationwide by 3.6% from 65.2% to 68.8%, meaning that about 9.3 million more U.S. adults are being screened. NCCRT attributes these successes to widespread implementation of center- and system-wide evidence-based interventions to increase screening uptake, incl...
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Background Accumulating evidence suggests that higher Mediterranean diet (MedDiet) adherence is associated with higher global cognitive performance and brain structural integrity as well as decreased risk of Alzheimer disease (AD) and... more
Background Accumulating evidence suggests that higher Mediterranean diet (MedDiet) adherence is associated with higher global cognitive performance and brain structural integrity as well as decreased risk of Alzheimer disease (AD) and vascular dementia (VaD). Objectives We directly examined cross-sectional associations between the MedDiet and cognitive and neuroimaging phenotypes associated with AD and VaD (separately) in a cohort of nondemented, nondepressed older adults. Methods Community-dwelling older adults (n = 82; aged ∼68.8 y; 50% female, 50% minority) underwent dietary (Block Food Frequency Questionnaire 2005) and neuropsychological assessments and neuroimaging. MedDiet scores were quantified with the use of published criteria, and participants were divided into High and Low (median split) adherence groups. We focused our neuropsychological investigation on cognitive phenotypes primarily associated with AD [i.e., learning and memory (L&M)] and VaD (i.e., information process...
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African-American women are at increased risk for obesity, and therefore it is important to identify dietary factors that have the potential to prevent weight gain within this population. The purpose of the current study was to examine... more
African-American women are at increased risk for obesity, and therefore it is important to identify dietary factors that have the potential to prevent weight gain within this population. The purpose of the current study was to examine associations between daily fiber intake and Body Mass Index (BMI) over the course of an 18-month weight loss intervention for African-American women. Anthropometric measures and the Block Food Frequency Questionnaire were administered at baseline, 6-month, and 18-month follow-up between 2008 and 2010. A mixed-effects linear regression model with random intercept and time slope was used to model associations between fiber consumption and BMI controlling for time trend. Associations between fiber consumption and BMI were significantly different over time (β̂=-0.07,p-value=0.003). There was no association between fiber intake and BMI at baseline; however, there was a significant inverse relation between fiber consumption and BMI at 6 months, and the assoc...
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To examine iron metabolism during the second and third trimesters in African American women with high-risk pregnancies. Longitudinal pilot study. Large, university-based, urban Midwestern U.S. medical center. Convenience sample of 32... more
To examine iron metabolism during the second and third trimesters in African American women with high-risk pregnancies. Longitudinal pilot study. Large, university-based, urban Midwestern U.S. medical center. Convenience sample of 32 African American women with high-risk pregnancies seeking care at an urban maternal-fetal medicine clinic. Nonfasting venous blood was collected in the second and third trimesters to assess iron status, hepcidin, and systemic inflammation. Anthropometric and survey data were obtained via self-report. Descriptive statistics were calculated from these data, and changes in the clinical parameters between the second and third trimesters were evaluated via paired t tests. Associations among demographic, reproductive, anthropometric, inflammatory, and iron-related parameters were also assessed in each trimester. The mean age of participants was 28.3 (± 6.8) years, and mean prepregnancy body mass index was 31.9 (± 10.7) kg/m(2). In the longitudinal analysis, significant (p < .05) declines in serum iron, ferritin, transferrin saturation, and C-reactive protein were observed between the second and third trimesters. There was no statistically significant change in hepcidin between trimesters. When using a ferritin level cut-point of less than 15 ng/ml and soluble transferrin receptor level of greater than 28.1 nmol/L, 48% of the participants (14 of 29) were classified with iron deficiency in the third trimester. In this pilot study, iron deficiency was prevalent among a small cohort of African American women with high-risk pregnancies. Hepcidin concentrations were greater than previously reported in healthy, pregnant, primarily White women, which suggests decreased iron bioavailability in this high-risk group.
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Delta Healthy Sprouts was designed to test the comparative impact of 2 home visiting curricula on weight status, dietary intake, physical activity, and other health behaviors of rural, southern African-American women and their infants.... more
Delta Healthy Sprouts was designed to test the comparative impact of 2 home visiting curricula on weight status, dietary intake, physical activity, and other health behaviors of rural, southern African-American women and their infants. Results pertaining to physical activity outcomes in the gestational period are reported. Eighty-two women, early in their second trimester of pregnancy, were enrolled and randomly assigned to one of 2 treatment arms. Self-reported physical activity was measured 3 times in the gestational period (gestational months 4, 6 and 8). Generalized linear mixed models were used to test for significant treatment, time, and treatment by time effects on weekly minutes of moderate-to-vigorous physical activity (MVPA). Significantly less MVPA was performed at gestational month 8 when compared with gestational month 4 (enrollment) for both treatment arms. Statistically significant effects were not found for treatment or treatment by time interaction. Neither the Parents as Teachers (control) curriculum nor the Parents as Teachers Enhanced intervention proved effective at increasing or maintaining MVPA in this cohort of pregnant women. Lack of adequate physical activity in pregnancy remains an important public health concern, especially given its known health benefits.
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Obesity has been linked to cognitive impairment, cognitive decline and dementia. Given that 38.5% of U.S. adults 60years and older are obese and these numbers are rapidly increasing, strategies to decouple obesity from cognitive decline... more
Obesity has been linked to cognitive impairment, cognitive decline and dementia. Given that 38.5% of U.S. adults 60years and older are obese and these numbers are rapidly increasing, strategies to decouple obesity from cognitive decline are needed. Innovative lifestyle strategies that may postpone the onset of subclinical symptoms or even arrest the transition to overt dementia in at-risk individuals are critically needed. Poor diet is central to the development of obesity and diet may affect cognition. Adherence to a Mediterranean Diet (MedDiet) is associated with reduced risk of cognitive impairment and dementia. Furthermore, weight loss through caloric restriction improves cognitive function. This paper describes the Building Research in Diet and CoGnition (BRIDGE) study, a randomized trial examining the effect of the MedDiet, with and without weight loss, on cognitive functioning in obese older adults. Obese (BMI≥30 and ≤50kg/m(2)) older adults (≥55years) (n=180) will be randomi...
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Colorectal cancer (CRC) incidence is higher in African Americans (AAs) compared with non-Hispanic whites (NHWs). A diet high in animal protein and fat is an environmental risk factor for CRC development. The intestinal microbiota is... more
Colorectal cancer (CRC) incidence is higher in African Americans (AAs) compared with non-Hispanic whites (NHWs). A diet high in animal protein and fat is an environmental risk factor for CRC development. The intestinal microbiota is postulated to modulate the effects of diet in promoting or preventing CRC. Hydrogen sulfide, produced by autochthonous sulfidogenic bacteria, triggers proinflammatory pathways and hyperproliferation, and is genotoxic. We hypothesised that sulfidogenic bacterial abundance in colonic mucosa may be an environmental CRC risk factor that distinguishes AA and NHW. Colonic biopsies from uninvolved or healthy mucosa from CRC cases and tumour-free controls were collected prospectively from five medical centres in Chicago for association studies. Sulfidogenic bacterial abundance in uninvolved colonic mucosa of AA and NHW CRC cases was compared with normal mucosa of AA and NHW controls. In addition, 16S rDNA sequencing was performed in AA cases and controls. Correl...
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Although colorectal cancer (CRC) is largely preventable through identification of pre-cancerous polyps through various screening modalities, morbidity and mortality rates remain a challenge, especially in African-American, Latino,... more
Although colorectal cancer (CRC) is largely preventable through identification of pre-cancerous polyps through various screening modalities, morbidity and mortality rates remain a challenge, especially in African-American, Latino, low-income and uninsured/underinsured patients. Barriers to screening include cost, access to health care facilities, lack of recommendation to screen, and psychosocial factors such as embarrassment, fear of the test, anxiety about testing preparation and fear of a cancer diagnosis. Various intervention approaches to improve CRC screening rates have been developed. However, comparative effectiveness research (CER) to investigate the relative performance of different approaches has been understudied, especially across different real-life practice settings. Assessment of differential efficacy across diverse vulnerable populations is also lacking. The current paper describes the rationale and design for the Mile Square Colorectal Cancer Screening, Awareness a...
Research Interests: Poverty, Medicine, Humans, Minority Groups, Female, and 15 moreMale, Ethnic Groups, Colonoscopy, African Americans, Immunochemistry, Aged, Middle Aged, Feces, Comparative Effectiveness Research, Hemoglobins, Patient navigation, Colorectal Neoplasms, Early detection of cancer, healthcare disparities, and Medical and Health Sciences
To examine the direct relationship between nutrient intake and cervical remodeling. Longitudinal descriptive design. Maternal-fetal medicine clinic in a Midwestern urban city. Forty-seven pregnant African American women. Participants... more
To examine the direct relationship between nutrient intake and cervical remodeling. Longitudinal descriptive design. Maternal-fetal medicine clinic in a Midwestern urban city. Forty-seven pregnant African American women. Participants completed the Block brief food frequency questionnaire at 19 to 24 weeks and 27 to 29 weeks gestation and had quantitative ultrasonic attenuation estimates at 19 to 21 weeks, 23 to 25 weeks, 27 to 29 weeks, 31 to 33 weeks, and 35 to 37 weeks gestation. Trajectory mixture models identified two subpopulations within our sample: those at risk (n = 36) and at less risk (n = 11) for premature cervical remodeling. More participants in the less-risk group consumed the dietary reference intake for calcium, vitamin A, folate, vitamin E, zinc, and vitamin D than in the at-risk group. The percentage of participants in the less-risk group who consumed the recommended dietary reference intake for vitamin E was twice the percentage of women in the at-risk group (82% ...
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Objectives Beginning life in a healthy uterine environment is essential for future well-being, particularly as it relates to chronic disease risk. Baseline (early pregnancy) demographic, anthropometric (height and weight), psychosocial... more
Objectives Beginning life in a healthy uterine environment is essential for future well-being, particularly as it relates to chronic disease risk. Baseline (early pregnancy) demographic, anthropometric (height and weight), psychosocial (depression and perceived stress), and behavioral (diet and exercise) characteristics of rural, Southern, pregnant women enrolled in a maternal, infant, and early childhood home visiting program are described. Methods Participants included 82 women early in their second trimester of pregnancy and residing in three Lower Mississippi Delta counties in the United States. Baseline data were collected through direct measurement and surveys. Results Participants were primarily African American (96 %), young (mean age = 23 years), single (93 %), and received Medicaid (92 %). Mean gestational age was 18 weeks, 67 % of participants were overweight or obese before becoming pregnant, and 16 % tested positive for major depression. Participants were sedentary (mea...
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Background. In this pilot study, we examined school-aged children’s familiarity and willingness to try fruits and vegetables (FV) and the impact of a 6-week school-based snack feeding intervention on familiarity and consumption of FV.... more
Background. In this pilot study, we examined school-aged children’s familiarity and willingness to try fruits and vegetables (FV) and the impact of a 6-week school-based snack feeding intervention on familiarity and consumption of FV. Methods. In all, 190 fourth- to sixth-grade students from a rural Lower Mississippi Delta (LMD) school participated. Measures included surveys assessing familiarity and willingness to try FV and direct observation of FV snack consumption. Results. At baseline, the majority of students provided correct name recognition for 6 of the 11 snacks offered, whereas name recognition increased significantly for the other 5 FV postintervention. Similarly, previous eating experience increased for 7 of the 11 FV offered. On average, a higher percentage of the fruit (54% to 98%) and vegetable (49% to 50%) snacks offered were consumed by the students. Willingness to try and grade level were the strongest predictors of fruit and vegetable snack consumption. Conclusion...
We assessed the effects of a 6-month, church-based, diet and supervised physical activity intervention, conducted between 2011 and 2012, on improving diet quality and increasing physical activity of Southern, African American adults.... more
We assessed the effects of a 6-month, church-based, diet and supervised physical activity intervention, conducted between 2011 and 2012, on improving diet quality and increasing physical activity of Southern, African American adults. Using a quasi-experimental design, eight self-selected, eligible churches were assigned to intervention or control. Assessments included dietary, physical activity, anthropometric, and clinical measures. Mixed model regression analysis and McNemar's test were used to determine if within and between group differences were significant. Cohen's d effect sizes for selected outcomes also were computed and compared with an earlier, lower dose intervention. Retention rates were 84% (102/122) for control and 76% (219/287) for intervention participants. Diet quality components, including fruits, vegetables, discretionary calories, and total quality, improved significantly in the intervention group. Strength/flexibility physical activity also increased in...
Research Interests: Program Evaluation, Health Promotion, Health Behavior, Anthropometry, Health Education, and 15 moreDiet, Medicine, Humans, Cholesterol, Female, Male, Regression Analysis, African Americans, Middle Aged, Food habits, Adult, Public health systems and services research, Curriculum and Pedagogy, Nutritional Sciences, and Motor activity
Hepcidin is the main regulator of systemic iron homeostasis and is primarily produced by the liver but is also expressed, at the mRNA-level, in periphery tissues including the subcutaneous and visceral adipose tissue. Obesity is... more
Hepcidin is the main regulator of systemic iron homeostasis and is primarily produced by the liver but is also expressed, at the mRNA-level, in periphery tissues including the subcutaneous and visceral adipose tissue. Obesity is associated with elevated hepcidin concentrations and iron depletion suggesting that the exaggerated fat mass in obesity could contribute significantly to circulating hepcidin levels consequently altering iron homeostasis. The objective of this study was to determine if abdominal subcutaneous adipose tissue (AbScAT) releases hepcidinin vivoand if release is modified by obesity. Arterio-venous differences in concentrations of hepcidin were measured across AbScAT in 9 obese and 9 lean adults. Overall (n=18), mean plasma hepcidin concentrations were significantly higher in arterialized compared to AbScAT venous samples [mean difference (arterialized-AbScAT venous plasma hepcidin) =4.9±9.6 ng/mL,P=0.04]. Net regional release was not calculated because mean venous...
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Research Interests: Diet, Adolescent, Chicago, Humans, Child, and 15 moreAfrican American, Food Consumption, Chronic Disease, Female, Food Frequency Questionnaire, African Americans, Beverages, Food habits, Dietary pattern, Diet Quality, High energy, Energy Intake, Dietary fats, Dietary intake, and Healthy Eating Index
Research Interests: Education, Nutrition, Obesity, Diet, Public sector, and 15 moreAdolescent, Humans, Child, Correlation, Female, Male, Food Services, Questionnaires, Private Sector, Cross Sectional Studies, Nutrition Policy, Child preschool, food handling, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Focus Groups, Behavior, Content Analysis, Life Style, General Internal Medicine, and 15 moreMedicine, Humans, African American, General, Food Consumption, Female, Focus Group, African American Women, Exercise, Body Mass Index, African Americans, Clinical Sciences, Food habits, Adult, and Body Weight
Background Although the effects of replacing sugar-sweetened beverages (SSBs) with water on energy intake and body weight have been reported, little is known about how these replacements affect diet quality. Objective To simulate the... more
Background Although the effects of replacing sugar-sweetened beverages (SSBs) with water on energy intake and body weight have been reported, little is known about how these replacements affect diet quality. Objective To simulate the effects of replacing SSBs with ...
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Objectives The objectives of the present study were to evaluate diet quality among Lower Mississippi Delta (LMD) residents using the Healthy Eating Index-2005 (HEI-2005) and to identify the top five dietary sources contributing to... more
Objectives The objectives of the present study were to evaluate diet quality among Lower Mississippi Delta (LMD) residents using the Healthy Eating Index-2005 (HEI-2005) and to identify the top five dietary sources contributing to HEI-2005 components. Demographic ...
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Research Interests: Diet, Adolescent, Chicago, Humans, Child, and 15 moreAfrican American, Food Consumption, Chronic Disease, Female, Food Frequency Questionnaire, African Americans, Beverages, Food habits, Dietary pattern, Diet Quality, High energy, Energy Intake, Dietary fats, Dietary intake, and Healthy Eating Index
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To evaluate the utility of several participant engagement indicators for predicting health changes in a church-based lifestyle intervention shown effective for improving dietary, physical activity, and clinical outcomes. Descriptive... more
To evaluate the utility of several participant engagement indicators for predicting health changes in a church-based lifestyle intervention shown effective for improving dietary, physical activity, and clinical outcomes. Descriptive indicators were constructed using 2 participant engagement measures - education session attendance (EDA) and exercise class attendance (EXA) - separately and combined. Relationships of 6 engagement indicators to health outcomes were tested using generalized linear mixed models. EDA predicted 5 dietary and 1 clinical outcome, whereas EXA predicted one physical activity and one clinical outcome. The combined indicator predicted the same 7 outcomes. Use of single engagement indicators specific to each intervention component is advocated for predicting relevant health outcome.
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Adequate iron availability is essential to human development and overall health. Iron is a key component of oxygen-carrying proteins, has a pivotal role in cellular metabolism, and is essential to cell growth and differentiation.... more
Adequate iron availability is essential to human development and overall health. Iron is a key component of oxygen-carrying proteins, has a pivotal role in cellular metabolism, and is essential to cell growth and differentiation. Inadequate dietary iron intake, chronic and acute inflammatory conditions, and obesity are each associated with alterations in iron homeostasis. Tight regulation of iron is necessary because
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Obesity, diabetes, and hypertension have reached epidemic levels in the largely rural Lower Mississippi Delta (LMD) region. We assessed the effectiveness of a 6-month, church-based diet and physical activity intervention, conducted during... more
Obesity, diabetes, and hypertension have reached epidemic levels in the largely rural Lower Mississippi Delta (LMD) region. We assessed the effectiveness of a 6-month, church-based diet and physical activity intervention, conducted during 2010 through 2011, for improving diet quality (measured by the Healthy Eating Index-2005) and increasing physical activity of African American adults in the LMD region. We used a quasi-experimental design in which 8 self-selected eligible churches were assigned to intervention or control. Assessments included dietary, physical activity, anthropometric, and clinical measures. Statistical tests for group comparisons included χ(2), Fisher's exact, and McNemar's tests for categorical variables, and mixed-model regression analysis for continuous variables and modeling intervention effects. Retention rates were 85% (176 of 208) for control and 84% (163 of 195) for intervention churches. Diet quality components, including total fruit, total vegetables, and total quality improved significantly in both control (mean [standard deviation], 0.3 [1.8], 0.2 [1.1], and 3.4 [9.6], respectively) and intervention (0.6 [1.7], 0.3 [1.2], and 3.2 [9.7], respectively) groups, while significant increases in aerobic (22%) and strength/flexibility (24%) physical activity indicators were apparent in the intervention group only. Regression analysis indicated that intervention participation level and vehicle ownership were significant positive predictors of change for several diet quality components. This church-based diet and physical activity intervention may be effective in improving diet quality and increasing physical activity of LMD African American adults. Components key to the success of such programs are participant engagement in educational sessions and vehicle access.
Research Interests: Program Evaluation, Health Promotion, Obesity, Anthropometry, Diet, and 16 moreHumans, Smoking, Chronic Disease, Female, Male, Regression Analysis, Mississippi, Exercise, African Americans, Clergy, Aged, Middle Aged, Questionnaires, Adult, Public health systems and services research, and Socioeconomic Factors
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1. J Am Diet Assoc. 2011 Apr;111(4):528-31. Anemia in postmenopausal women: dietary inadequacy or nondietary factors? Tussing-Humphreys L, Braunschweig C. PMID: 21443984 [PubMed - in process].
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Iron deficiency is more prevalent in overweight children and adolescents but the mechanisms that underlie this condition remain unclear. The purpose of this cross-sectional study was to assess the relationship between iron status and... more
Iron deficiency is more prevalent in overweight children and adolescents but the mechanisms that underlie this condition remain unclear. The purpose of this cross-sectional study was to assess the relationship between iron status and excess adiposity, ...
Research Interests: Poverty, Obesity, Physical Activity, Inflammation, Adolescent, and 30 moreComorbidity, Logistic Regression, Iron Age, Adipose tissue, Linear Model, Overweight, Humans, United States, Female, Menarche, Iron, Body Mass Index, Risk factors, Children and Adolescents, Prevalence, C reactive protein, Body mass index (BMI), Odds ratio, Iron status, Risk Factors, Indexation, Linear Regression, Logistic Model, Cross sectional Study, Iron Deficiency Anemia, Cross Sectional Studies, Logistic Models, Predictive value of tests, Serum Iron, and The American
Research Interests: Bariatric Surgery, Obesity, Inflammation, Multidisciplinary, Prospective studies, and 18 moreHumans, Weight Loss, Female, Follow-up studies, Iron, Body Mass Index, Prevalence, Premenopausal women, C reactive protein, Antimicrobial Cationic Peptides, Adult, Iron status, Weight Reduction, Iron Deficiency Anemia, Hematocrit, Hemoglobins, Iron absorption, and Interleukin
Excessive and inadequate gestational weight gain can complicate a woman's pregnancy and put her and her child at risk for poor delivery and birth outcomes. Further, feeding and activity... more
Excessive and inadequate gestational weight gain can complicate a woman's pregnancy and put her and her child at risk for poor delivery and birth outcomes. Further, feeding and activity habits established early in life can significantly impact the development of childhood obesity. The on-going Delta Healthy Sprouts Project is a randomized, controlled, comparative trial testing the efficacy of two Maternal, Infant, and Early Childhood Home Visiting programs on weight status and health behaviors of 150 mothers and their infants residing in the rural Mississippi Delta region of the United States. Women are enrolled in their second trimester of pregnancy and randomized to one of two treatment arms. The control arm curriculum is based on Parents as Teachers, an evidence based approach to increase parental knowledge of child development and improve parenting practices. The experimental arm, labeled Parents as Teachers Enhanced, builds upon the control curriculum by including culturally tailored nutrition and physical activity components specifically designed for the gestational and postnatal periods. We hypothesize that, as compared to the control arm, the experimental arm will be more effective in preventing inappropriate gestational weight gain, reducing postnatal weight retention, and decreasing infant obesity rates. We also will evaluate mother and child dietary and physical activity outcomes, breastfeeding initiation and continuation, and child feeding practices. The Delta Healthy Sprouts Project tests a novel, combined approach to maternal weight management and childhood obesity prevention in pregnant women and their children at high risk for obesity and chronic disease.