Community-Based Strategies to Reduce Cardiometabolic Disease in the Deep South

1个项目摘要/摘要 2美国近四分之三的成年人超重或肥胖(体重指数为≥25 3公斤/平方米)，黑人、农村居民和较低社会经济群体的发病率最高。肥胖是 4与心脏代谢疾病有关，如糖尿病、心脏病和中风，以及多种癌症。完毕 5在过去的十年中，男性的肥胖趋势总体上是稳定的，但女性的肥胖趋势显著增加。 在黑人女性中尤其如此，她们的肥胖率为56.9%，而美国的肥胖率为39.8% 7名白人女性。与同种族/性别相比，生活在农村的黑人女性肥胖率更高 8个城市环境中的同龄人。循证干预(EBI)促进减肥、更健康的饮食和 9体力活动能有效减缓糖尿病前期(Pre-DM)和高血压(HTN)的转化 糖尿病和心力衰竭分别为10%。然而，这些干预措施往往没有得到人们的充分利用 11个风险最高的人，包括生活在南方腹地农村的黑人妇女。深南中心的使命是 12减少慢性病差距就是要促进健康公平，减轻心脏代谢负担 13种疾病横跨整个南方腹地。与该中心的主题一致(应用精确的公共卫生 14跨医疗连续统一体的方法以实现健康公平)，这项研究利用了我们团队领导的两个EBI 15个以前在文化上适应了目标人群并实现了与临床相关的减肥 16和其他临床结果(基于群体的减肥干预)以及饮食和身体状况的改善 17活动(个人园艺干预)。组合这些EBI可解决多个域(行为、 18个人环境、社会文化)和水平(个人、人际、社区)对风险因素的影响 19为肥胖和其他心脏新陈代谢疾病，流行于南方腹地。这些干预措施由 20名当地非专业工作人员和非学术伙伴，具有很高的可持续性潜力；然而，有必要 21进一步评价外部有效性和与执行有关的障碍和促进者，以最大限度地扩大影响； 22.通过和实施。我们将采用务实、多层次、集群随机、类型1的混合 23.有效性--执行试验。共有264名黑人女性(年龄30岁)超重或肥胖， 来自12个农村县(阿拉巴马州6个，密西西比州6个)的24名糖尿病前期或HTN患者将获得合并的组权重 25损失干预(更好的健康之旅；JTBH)加上个人园艺干预(收获健康； 26 H4H)或仅JTBH。具体目标是比较以下方面的干预措施：(1)与以下方面有关的主要结果 27实施成效(达到、采用、维持健康行为)，(2)次要成果 28临床疗效；(3)成本效益。调查结果将为与联盟合作伙伴的讨论提供信息 29实现我们广泛传播和持续的多层次干预措施的长期目标，以减少 30南方腹地的慢性疾病负担和健康差距。

1 PROJECT SUMMARY/ABSTRACT 2 Nearly 3 out of 4 adults in the United States (US) live with overweight or obesity (body mass index (BMI) of ≥ 25 3 kg/m2), with the highest rates among Blacks, rural residents, and lower socioeconomic groups. Obesity is 4 associated with cardiometabolic diseases like diabetes, heart disease and stroke, well as multiple cancers. Over 5 the past decade, trends in obesity have been generally stable for men, but increased significantly among women. 6 This is particularly true among Black women who have an obesity prevalence of 56.9% compared to 39.8% in 7 White women. Black women living in rural settings have higher rates of obesity compared to their same race/sex 8 peers in urban settings. Evidence-based interventions (EBIs) that promote weight loss, healthier diet and 9 physical activity are effective at slowing the conversion of pre-diabetes mellitus (pre-DM) and hypertension (HTN) 10 to diabetes and heart failure, respectively. However, these interventions are often underutilized by populations 11 at highest risk, including Black women living in the rural Deep South. The mission of the Deep South Center to 12 Reduce Disparities in Chronic Diseases is to promote health equity and reduce the burden of cardiometabolic 13 diseases across the Deep South. Consistent with the Center’s theme (applying a precision public health 14 approach across the care continuum to achieve health equity), this study leverages two EBIs led by our team 15 that have been previously culturally-adapted for the target population and achieved clinically-relevant weight loss 16 and other clinical outcomes (group-based weight loss intervention) along with improvements in diet and physical 17 activity (individual gardening intervention). Combining these EBIs addresses multiple domains (behavioral, 18 personal environment, sociocultural) and levels (individual, interpersonal, community) of influence on risk factors 19 for obesity and other cardiometabolic diseases prevalent in the Deep South. These interventions, delivered by 20 local lay staff and non-academic partners, have a high potential for sustainability; however, there is a need to 21 further evaluate the external validity and implementation-related barriers and facilitators to maximize reach, 22 adoption and implementation. We will employ a pragmatic, multilevel, cluster-randomized, type 1 hybrid 23 effectiveness-implementation trial. A total of 264 Black women (age >30 years) with overweight or obesity and 24 Pre-DM or HTN from 12 rural counties (6 Alabama, 6 Mississippi) will receive either the combined group weight 25 loss intervention (Journey to Better Health; JTBH) plus individual gardening intervention (Harvest for Health; 26 H4H) or the JTBH alone. The specific aims are to compare interventions on: (1) primary outcomes related to 27 implementation effectiveness (reach, adoption, maintenance of health behaviors), (2) secondary outcomes on 28 clinical effectiveness, and (3) cost effectiveness. Findings will inform discussions with coalition partners to 29 achieve our long-term goal of widely disseminating and sustaining multi-level interventions to reduce the multiple 30 chronic disease burden and health disparities in the Deep South.