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

1项目概要/摘要 2在美国，近四分之三的成年人超重或肥胖（身体质量指数（BMI）≥ 25 3公斤/平方米），黑人、农村居民和社会经济地位较低的群体的比例最高。肥胖是 4与心脏代谢疾病如糖尿病、心脏病和中风以及多种癌症有关。超过 5.在过去十年中，男性的肥胖趋势基本稳定，但女性的肥胖趋势显著增加。 6这在黑人妇女中尤其如此，她们的肥胖患病率为56.9%，而黑人妇女的肥胖患病率为39.8%。 7个白色女人。生活在农村的黑人妇女与同种族/性别相比肥胖率更高 城市环境中的8个同伴。循证干预措施（EBI），促进减肥，健康饮食， 9体力活动可有效减缓糖尿病前期（pre-DM）和高血压（HTN）的转化 10糖尿病和心力衰竭，分别。然而，这些干预措施往往没有得到充分利用， 11人风险最高，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减少慢性病的差异是为了促进健康公平，减少心脏代谢的负担 13种疾病遍布南方腹地与该中心的主题一致（应用精确的公共卫生 14整个护理连续体的方法，以实现健康公平），这项研究利用了我们的团队领导的两个EBI 15个先前已适应目标人群的文化并实现了临床相关的体重减轻 16和其他临床结果（基于组的减肥干预）沿着饮食和身体状况的改善 第17集（个人园艺活动）结合这些EBI可以解决多个领域（行为， 18个人环境、社会文化）和对风险因素的影响程度（个人、人际、社区） 19为肥胖和其他心脏代谢疾病流行的深南部。这些干预措施由 20名当地非专业工作人员和非学术合作伙伴，具有很高的可持续性潜力;但是，需要 进一步评估外部有效性和与实施有关的障碍和促进因素，以最大限度地扩大覆盖面， 22、通过与实施我们将采用一个务实的，多层次的，集群随机，1型混合 23篇有效性试验。共有264名超重或肥胖的黑人妇女（年龄>30岁）， 来自12个农村县（6个亚拉巴马，6个密西西比）的24名DM前或HTN将接受合并组体重 25个损失干预（健康之旅; JTBH）加上个人园艺干预（收获健康; 26 H4 H）或单独的JTBH。具体目的是比较干预措施：（1）与以下方面有关的主要结果： 27实施有效性（健康行为的覆盖、采用、维持），（2）次要结果 28临床效果;（3）成本效益。调查结果将为与联盟伙伴的讨论提供信息， 29.实现我们的长期目标，即广泛传播和维持多层次干预措施，以减少 30慢性疾病负担和健康差距在南方腹地。

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.