Heart of the Family: A Cardiovascular Disease and Type 2 Diabetes Risk Reduction Intervention in High-Risk Rural Families

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ABSTRACT Rural populations in the U.S. have disproportionately higher prevalence of cardiovascular disease (CVD) and type 2 diabetes (T2D) compared to urban populations. Many rural communities also have greater risk factor burden than urban communities including unhealthier diet, higher rates of physical inactivity, obesity, and smoking, and higher prevalence of hypertension, hypercholesterolemia, and hyperglycemia. Compounding these are poor socioeconomic conditions and limited health resources. Hispanic residents of rural communities may experience worse CVD and T2D disease and risk burden than non-Hispanic residents due to higher rates of poverty, lower educational attainment, and greater barriers accessing resources. U.S. Hispanics have among the highest rates of T2D of any racial or ethnic group. Culturally responsive lifestyle modification interventions are needed to reduce T2D and CVD risk in rural Hispanic and non-Hispanic populations. Modification strategies commonly target individuals and, while these may result in behavior change immediate post-intervention, sustained engagement in healthy behaviors is seldom achieved. Family engagement in lifestyle interventions may support sustained engagement in healthy behaviors especially in rural and Hispanic populations that often have greater reliance on family members for social support. We will conduct a randomized controlled trial to compare the effects of a dyadic intervention, Heart of the Family, to an active control intervention. We will compare 3-month (short-term) and 12-month (long-term) impact of the Heart of the Family intervention on biological and behavioral T2D and CVD risk factors and evaluate whether ethnicity moderates intervention effects. We will also examine how each active intervention dyad member’s engagement in healthy lifestyle behaviors and level of support for their partner’s engagement in healthy lifestyle behaviors affects their own and their partner’s outcomes. A family focused intervention may better support long-term engagement in healthy lifestyle behaviors to reduce T2D and CVD risk among at-risk rural Hispanics and non-Hispanics. Further, this community-based intervention has significant potential for broad implementation to successfully address T2D and CVD health disparities across U.S. Hispanic communities.