Promotora-based latino Family CVD risk reduction: Remaking the home environment

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We propose a UCLA-USC community-based randomized controlled trial of a home environment intervention involving families in East Los Angeles, a predominantly Mexican-American community at high risk of metabolic syndrome-related cardiovascular disease. The interveners will be trained community workers (promotoras). This multilevel intervention is designed to reduce vascular stiffness, an early-in-life biomarker of cardiovascular risk; one that is sensitive to lifestyle intervention. 240 families with a family member recently diagnosed with diabetes will be enrolled in the study. Half will be randomized to the Family Environment Cardiovascular Disease Risk Reduction program, the other half to the Family Cancer Early Detection attention-control condition. The promotoras will provide up to 16 counseling sessions to a designated adult family member without diabetes. The sessions will focus on improving the home environment by reducing TV viewing opportunities, increasing fruit and vegetable availability, decreasing access to refined carbohydrates, assuring access to a scale to monitor body weight and increasing access to exercise equipment Lifestyle change goals will be consistent with the Dietary Guidelines for Americans, especially the DASH diet and 30 minutes of daily moderate physical activity, but tailored to the family's capacity to change. Four group health education sessions include atour of a make-over comer store participating in Project #3 of this program project. Local farmers market coupons will be given as incentives for each counseling and group health education session. Self-report, diet and cardiovascular disease biomarkers will be collected at baseline, 6 months, 12 months and 24 months follow-up. Retention is expected to be 90% over 12 months and 85% over 24 months, based on the investigators' past experience with this population. The primary outcomes will be two measures of arterial stiffness. Secondary outcomes will include the consensus features of the metabolic syndrome and community-level moderators of cardiovascular risk, including walkability and density of fast food restaurants in the census tracts in which the study participants reside, which are expected to influence the sustainability of the intervention impact.