title: Improving women's preconceptional health: findings from a randomized trial of the Strong Healthy Women intervention in the Central Pennsylvania women's health study.
abstract: OBJECTIVE
  Improving the health of women before pregnancy is an important strategy for reducing adverse pregnancy outcomes for mother and child. This paper reports the first pretest-posttest results from a randomized trial of a unique, multidimensional, small group format intervention, Strong Healthy Women, designed to improve the health behaviors and health status of preconceptional and interconceptional women.
  
  
  METHODS
  Nonpregnant pre- and interconceptional women ages 18-35 were recruited in 15 low-income rural communities in Central Pennsylvania (n = 692). Women were randomized in a ratio of 2-to-1 to intervention and control groups; participants received a baseline and follow-up health risk assessment at 14 weeks and completed questionnaires to assess behavioral variables. The analytic sample for this report consists of 362 women who completed both risk assessments. Outcomes include measures of attitudinal and health-related behavior change.
  
  
  RESULTS
  Women in the intervention group were significantly more likely than controls to report higher self-efficacy for eating healthy food and to perceive higher preconceptional control of birth outcomes; greater intent to eat healthy foods and be more physically active; and greater frequency of reading food labels, physical activity consistent with recommended levels, and daily use of a multivitamin with folic acid. Significant dose effects were found: Each additional intervention session attended was associated with higher perceived internal preconceptional control of birth outcomes, reading food labels, engaging in relaxation exercise or meditation for stress management, and daily use of a multivitamin with folic acid.
  
  
  CONCLUSIONS
  The attitudinal and behavior changes attributable to the intervention were related primarily to nutrition and physical activity. These results show that these topics can be successfully addressed with pre- and interconceptional women outside the clinical setting in community-based interventions.
authors.affiliation: Pennsylvania State University, College of Health and Human Development, University Park, Pennsylvania 16802, USA. mmh18@psu.edu
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Hillemeier
authors.forename: Danielle Symons
authors.initials: DS
authors.lastname: Downs
authors.forename: Mark E
authors.initials: ME
authors.lastname: Feinberg
authors.forename: Carol S
authors.initials: CS
authors.lastname: Weisman
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Chuang
authors.forename: Roxanne
authors.initials: R
authors.lastname: Parrott
authors.forename: Diana
authors.initials: D
authors.lastname: Velott
authors.forename: Lori A
authors.initials: LA
authors.lastname: Francis
authors.forename: Sara A
authors.initials: SA
authors.lastname: Baker
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dyer
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006304:Health Status; D006801:Humans; D008425:Maternal Behavior; D010414:Pennsylvania / Q000453:epidemiology; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D012424:Rural Population / Q000706:statistics & numerical data*; D012648:Self Care / Q000379:methods; D012649:Self Concept; D011795:Surveys and Questionnaires; D016387:Women's Health; D055815:Young Adult