Rural Lifestyle Eating and Activity Program (Rural LEAP)

乡村生活方式饮食和活动计划（Rural LEAP）

• 批准号: 8472080
• 负责人: MICHAEL G PERRI
• 金额: $ 74.64万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-15 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8472080
• 关键词: Address; Adoption; Adult; Attention; Behavior; Blood Pressure; Body Weight; Body Weight Changes; Body Weight decreased; Cardiovascular Diseases; Chronic; Clinical effectiveness; Control Groups; Counseling; County; Eating; Education; Effectiveness; Effectiveness of Interventions; Electronic Mail; Health; Health education; Heart Diseases; Individual; Intake; Intervention; Knowledge; Life Style; Lipids; Long-Term Care; Long-Term Effects; Mails; Maintenance; Mediating; Medical; Mission; Modeling; Monitor; Morbidity - disease rate; Nutritional; Obesity; Outcome; Participant; Performance; Physical activity; Pilot Projects; Prevalence; Privacy; Problem Solving; Provider; Public Health; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Research; Research Infrastructure; Risk Factors; Rural; Rural Community; Series; Services; Telephone; Testing; Translations; Treatment outcome; Underserved Population; Work; base; blind; cardiovascular disorder risk; clinically significant; community setting; cost; cost effectiveness; dissemination research; effectiveness trial; follow-up; glycemic control; group intervention; group support; health related quality of life; improved; innovation; lifestyle intervention; medically underserved; mortality; nutrition; obesity management; programs; public health relevance; rural area; rural disparities; sedentary; skills; treatment effect; urban area; vigilance

DESCRIPTION (provided by applicant): Higher rates of obesity and sedentary behavior represent significant contributors to the greater prevalence of cardiovascular disease (CVD) morbidity and mortality observed in rural versus urban areas. Yet little research attention has been given to modifying these important influences on the urban/rural disparity in heart disease. Lifestyle interventions can produce weight reductions of sufficient magnitude to improve health, but the existing research is limited with respect to two critical factors: (a) the long-term maintenance of treatment effects and (b) translation and dissemination to underserved populations. In a series of effectiveness trials, our rural obesity research program has demonstrated the feasibility and effectiveness of delivering lifestyle programs through the existing infrastructure of the USDA Cooperative Extension Service (CES), which has more than 2,900 offices nationwide and whose mission includes improving nutrition and health. We have also demonstrated that we can improve the long-term effects of treatment via extended-care programs consisting of either face-to-face treatment sessions or individual telephone counseling. However, both of these options entail relatively high costs, which inhibit their adoption in rural communities. In a recently published pilot study, we demonstrated the effectiveness of a group-based telephone intervention for obese adults from rural areas. This highly innovative approach addresses barriers to access, provides group support in a confidential setting, and appears to be as effective as individual phone treatment. Group support may be especially important for rural residents who tend to be isolated, have heightened concerns about privacy, and report lower levels of quality of life. The next logical step in this lne of research is to conduct a randomized controlled trial to evaluate the long-term effects of this potentially more efficient mode of providing extended care for the management of obesity in rural communities. We propose to conduct a single-blind, randomized controlled "effectiveness" trial in obese adults (N=540) to evaluate the effects of extended-care programs delivered via INDIVIDUAL or GROUP telephone counseling, compared to a health education control (CTRL) condition, on long-term (22 month) changes in body weight. Our principal hypothesis is that both the INDIVIDUAL and GROUP interventions will produce greater weight reductions at 22 months than the CTRL condition. We will evaluate the proportion of participants in each condition who demonstrate clinically significant weight losses (> 5% of initial body weight) at long-term follow-up. We also will examine the effects of treatment on CVD risk factors, and we will evaluate the costs and cost effectiveness of the interventions.

描述（由申请人提供）：与城市相比，肥胖和久坐行为的发生率较高是导致心血管疾病（CVD）发病率和死亡率较高的重要因素。然而，很少有研究注意到修改这些重要的影响城市/农村心脏病的差距。生活方式干预措施可使体重减轻到足以改善健康的程度，但现有的研究在两个关键因素方面受到限制：（a）长期维持治疗效果和（B）向得不到充分服务的人群转化和传播。在一系列的有效性试验中，我们的农村肥胖研究计划已经证明了通过美国农业部合作推广服务（CES）的现有基础设施提供生活方式计划的可行性和有效性，该服务在全国拥有2，900多个办事处，其使命包括改善营养和健康。我们还证明，我们可以通过包括面对面治疗或个人电话咨询在内的扩展护理计划来改善治疗的长期效果。然而，这两种选择都涉及相对较高的费用，这阻碍了农村社区采用这些方法。在最近发表的一项试点研究中，我们证明了基于小组的电话干预对农村地区肥胖成年人的有效性。这一高度创新的方法消除了获取信息的障碍，在保密的环境中提供了团体支持，似乎与个人电话治疗一样有效。团体支持对于农村居民可能特别重要，因为他们往往被孤立，对隐私的关注程度较高，生活质量较低。这项研究的下一个合乎逻辑的步骤是进行一项随机对照试验，以评估这种可能更有效的模式对农村社区肥胖管理的长期影响。我们建议在肥胖成年人（N=540）中进行一项单盲、随机对照的“有效性”试验，以评估通过个人或团体电话咨询提供的扩展护理计划与健康教育对照（CTRL）条件相比对体重长期（22个月）变化的影响。我们的主要假设是，个体和群体干预在22个月时的体重减轻幅度均大于对照组。我们将评估在长期随访中表现出临床显著体重减轻（>初始体重的5%）的每种情况下的参与者比例。我们还将检查治疗对CVD危险因素的影响，并评估干预措施的成本和成本效益。