Rural Lifestyle Eating and Activity Program (Rural LEAP)

描述(由申请人提供)：肥胖率和久坐行为是农村地区心血管疾病(CVD)发病率和死亡率高于城市地区的重要因素。然而，很少有研究关注如何改变这些对心脏病城乡差异的重要影响。生活方式干预可产生足以改善健康的减重效果，但现有研究仅限于两个关键因素：(A)治疗效果的长期维持和(B)对服务不足人群的翻译和传播。在一系列有效性试验中，我们的农村肥胖研究项目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项目的可行性和有效性，该服务在全国拥有2900多个办事处，其使命包括改善营养和健康。我们还证明，我们可以通过由面对面治疗或个别电话咨询组成的长期护理计划来改善治疗的长期效果。然而，这两种选择都需要相对较高的成本，这阻碍了它们在农村社区的采用。在最近发表的一项初步研究中，我们展示了以群体为基础的电话干预对来自农村地区的肥胖成年人的有效性。这种高度创新的方法解决了访问障碍，在保密环境中提供群体支持，似乎与个人电话治疗一样有效。对于农村居民来说，群体支持可能尤其重要，他们往往被孤立，对隐私的担忧加剧，并报告生活质量水平较低。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，以评估这种潜在的更有效的模式的长期效果，这种模式为农村社区的肥胖管理提供长期护理。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延长护理计划与健康教育控制(CTRL)条件相比对长期(22个月)体重变化的影响。我们的主要假设是，个人和群体干预在22个月时比CTRL条件下产生更大的体重减轻。我们将评估在每种情况下的参与者在长期随访中表现出临床显著体重减轻(初始体重的5%)的比例。我们还将检查治疗对心血管疾病危险因素的影响，并评估干预措施的成本和成本效益。

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.