The KaHOLO Project: Preventing Cardiovascular Disease in Native Hawaiians

描述（由申请人提供）：夏威夷原住民（NH）有较高的慢性病发病率，如心血管疾病（CVD）、糖尿病和癌症。高血压（HTN）是心血管疾病的一个重要的可改变危险因素，夏威夷原住民（NH）比白人高70%。事实上，NH患者发生心血管疾病（如中风和冠心病）的可能性是正常人的3-4倍，而且发病年龄更小。除处方药外，可通过增加身体活动和自我管理教育（如压力管理、减少钠摄入量、减肥和戒烟）来改善HTN。然而，由于社会经济障碍和缺乏与NH偏好的生活模式和文化价值观（即家庭相互依存、基于群体的PA、文化PA）的一致性，许多常用的PA，如慢跑和跑步机的使用，对NH来说很难开始和维持。本研究将草裙舞作为NH的传统舞蹈形式和NH文化的标志，作为针对HTN管理的文化相关和可持续的心血管疾病预防计划的PA基础。草裙舞训练很受欢迎，不仅在夏威夷，而且在美国各地，在大多数州都有784所草裙舞学校。利用基于社区的参与性研究（CBPR）框架，以草裙舞为基础的心血管疾病健康干预得到了Kumu草裙舞（草裙舞专家和草裙舞传统守护者）、NH个人和社区的大力支持。此外，草裙舞训练被确定为产生代谢当量的能量消耗作为一个中等和高强度的PA。我们的CBPR随机对照试验（RCT）的先导研究数据发现，与对照组相比，每周进行两次60分钟的草裙舞训练，持续12周，使收缩压（BP）降低了7.5 mmHg (SD=16.5)，但长期效果好坏参半，该研究没有评估心血管疾病的风险。有趣的是，试点干预还改善了社会功能，减少了身体疼痛，并感知到种族歧视，这表明干预可能通过心理社会和社会文化机制影响BP。在这个应用中，我们提供了一个CBPR引导的随机对照试验，在夏威夷和华盛顿州有250 NH的医生诊断HTN。我们将比较为期6个月的干预的效果，该干预结合了草裙舞训练和由同伴教育者和Kumu草裙舞提供的简短的文化定制的HTN自我管理教育，以降低收缩压和心血管疾病风险评分。我们还将确定健康行为（如吸烟）、自我调节、社会心理（如社会支持）和社会文化因素（如感知种族主义）对血压降低的中介作用。我们的目标是建立在现有广泛的法律草裙舞和NH组织基础设施的基础上，提供一个可持续的、文化上优先的心血管疾病预防计划。

DESCRIPTION (provided by applicant): Native Hawaiians (NH) has higher rates of chronic diseases, such as cardiovascular disease (CVD), diabetes, and cancer. Hypertension (HTN), an important modifiable risk factor for CVD, is 70% higher in Native Hawaiians (NH) than in Whites. In fact, NH is 3-4 times more likely to develop CVD conditions, such as stroke and coronary heart disease, and at a younger age. In addition to prescribed medication, improvements in HTN can be achieved through increased physical activity (PA) and self-management education (e.g. stress management, reduces sodium intake, weight-loss, and smoking cessation). Yet, many commonly prescribed PA, such as jogging and use of treadmills, are difficult for NH to initiate and maintain because of socioeconomic barriers and lack of alignment with NH preferred modes of living and cultural values (i.e. familial interdependence, group-based PA, cultural PA). This proposed research uses hula, the traditional dance form of NH and hallmark of NH culture, as the PA basis for a culturally relevant and sustainable CVD prevention program targeting HTN management. Hula training is popular, not only Hawai'i, but across the U.S. through the 784 h lau hula (hula schools) found in most States. Using a community-based participatory research (CBPR) framework, a hula-based CVD health intervention was strongly endorsed by Kumu hula (hula experts and guardians of hula traditions), NH individuals, and communities. Further, hula training was determined to yield metabolic equivalent of energy expenditure as a moderate and vigorous intensity PA. Data from our pilot CBPR randomized control trial (RCT) study found that 60 minutes of hula training twice a week for 12 weeks reduced systolic blood pressure (BP) by 7.5 mmHg (SD=16.5) more than the control group, but the long-term effects were mixed and the study did not assess CVD risk. Interestingly, the pilot intervention also improved social functioning, reduced physical pain, and perceived racial discrimination, suggesting a possible psychosocial and socio-cultural mechanism by which the intervention affects BP. In this application we offer a CBPR guided RCT of 250 NH with physician-diagnosed HTN in Hawai'i and Washington State. We will compare the effects of a 6-month intervention that combines hula training and brief culturally-tailored HTN self- management education delivered by peer educators and Kumu hula to a wait-list control group in reducing systolic BP and CVD risk scores. We will also determine the mediating effects of health behaviors (e.g., smoking), self-regulation, psychosocial (e.g., social support), and socio-cultural factors (e.g., perceived racism) on blood pressure reduction. Our goal is to build on the existing widespread infrastructure of h lau hula and NH organizations to deliver a sustainable, culturally-preferred CVD prevention program.