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几乎所有的心血管疾病和大多数肺部疾病本质上都是慢性的，需要复杂和有效的治疗

Virtually all cardiovascular and most pulmonary diseases are chronic in nature, and require complex and life-long self-management. Current statistics elaborating the impact of chronic cardiovascular and pulmonary conditions ' illustrate the importance of targeting self-management research specifically to cardiovascular and pulmonary diseases. Chronic cardiac or pulmonary diseases comprise 3 of the top 4 causes of death (i.e., heart disease, cancers, stroke, and chronic lower respiratory diseases). Worldwide, cardiovascular disease (CVD) is the most common cause of death and morbidity, and in most developed countries is the single largest healthcare expenditure.2'3 At least one in three Americans lives with chronic CVD; this percentage increases with age, and ultimately, one in two dies of CVD, usually after living years with the challenge of engaging in self-management of the chronic condition.2'3 The World Health Organization (WHO) estimates that chronic lower respiratory diseases share 4th and 5th places with HIV/AIDS as causes of death worldwide. There were more than 3 million deaths worldwide from chronic obstructive pulmonary disease in 2005, which corresponds to 5% of all deaths globally. As with CVD, most patients with chronic lower respiratory diseases live years with the associated self-management challenges. As people accumulate CVD and pulmonary risk factors, develop chronic CVD and pulmonary illnesses or grow older, the process of selfmanagement becomes exponentially more complex, demanding and time-consuming. In fact, it is precisely when people could benefit most from self-management, that self-management efforts fail, are abandoned, or are not even attempted.4"15 thus, research aimed at improving self-management skills and efforts should have a measurable impact on the public and personal burden from cardiac and pulmonary conditions.16" In order to address this significant problem, we propose to establish an exploratory research center, the Center for Biobehavioral Research on Self-Management of Cardiopulmonary Disease, at the University of Kentucky, College of Nursing (UKCON). The short-term goal of the Center is to provide both new and experienced investigators with the support and resources necessary to conduct pilot/feasibility work using biobehavioral measures to investigate self-management related to cardiopulmonary conditions. The long-term goal of the Center is to facilitate faculty use of data from these studies to develop sustained interdisciplinary programs of self-management research and to support more established investigators in the continuation, expansion or redirection of current research programs. The Center will be composed of an Administrative Core that oversees the Center and the two additional Cores: 1) Self-Management Pilot/Feasibility and Biobehavioral Outcomes Core; and 2) Research Program Development, Data Analysis and Dissemination Core. The specific aims for the Center are listed below. Strategies for achieving these aims and associated evaluation criteria are outlined in the Evaluation section. 1. Develop the research infrastructure at the UKCON to promote and support research on processes, interventions, and outcomes of self-management of cardiovascular and pulmonary diseases by establishing an exploratory research Center for Biobehavioral Research on Self-Management of Cardiopulmonary Disease. 2. Expand the quality and quantity of self-management research projects using biobehavioral methods by centralizing methodological resources. 3. Expand the number of nurse investigators doing interdisciplinary self-management research by supporting interdisciplinary exchange and linkages. 4. Contribute to the scientific foundation for self-management by promotion and dissemination of systematic investigations of self-management processes, interventions, and outcomes. 5. Plan for and develop sustainability of interdisciplinary self-management research programs by building active and growing partnerships inside and outside of the University of Kentucky. Given existing research strengths in the UKCON, our initial pilot/feasibility studies will focus on improving self-management in patients with heart failure. However, the focus will expand to improvement of selfmanagement of other cardiopulmonary conditions. We will publish calls, once the Center is funded, for pilot/feasibility studies in all areas of CVD and pulmonary disease self-management. The initial focus on heart failure self-management interventions will be innovative in that each study proposes a different self-management skill target and focuses on a different process or processes. The project proposed by Dr. Chung will target a full range of heart failure self-management skills, and will focus on the role of family members as partners in the self-management process who can either help or hinder the process. Dr. Peden's proposal focuses on depression, a major co-morbidity in heart failure that markedly impairs heart failure self-management,20'21 using a cognitive restructuring intervention to manage depression and enhance patient's self-management skills. Dr. Welsh's project will include a test of a theory-based intervention aimed at improving one particularly intractable behavior among patients with heart failure, following a low-sodium diet. Because fluid overload related to sodium diet nonadherence is thought to be one of the major proximate causes of rehospitalization in patients with heart failure, improvement of self-management in this one area could have a substantial impact on rehospitalization outcomes.22'23 Research Base for Self-Management. There are 5 separate, ongoing R01's at the UKCON directly related to self-management. Dr. Debra Moseris PI on one NIH NINRR01, and site PI on two other NIH NINRROIs. Dr. Terry Lennie is PI on one NIH NINR R01; and Dr. Ellen Hahn is PI on a NIH NHLBI R01 (see biosketches for details of these 5 grants). The R01 s encompass the range of self-management from the individual (Drs. Moser and Lennie's 4 grants that address self-management in patients with heart failure or CVD) to the community (Dr. Hahn's R01 that addresses the impact of state-wide smoke-free policy development on smoking cessation) levels as defined by the WHO (see Evaluation section for definition).