Evaluation of a Civic Engagement Approach to Catalyze Built Environment Changeand Promote Healthy Eating and Physical Activity Among Rural Residents

项目总结 近70%的美国成年人超重或肥胖，其后果可能包括增加患心脏病的风险 几种类型的癌症、糖尿病和心血管疾病。与城市同行相比，农村 居民往往有更高的癌症、肥胖率、缺乏体育锻炼和不良饮食。农村居民也 贫困率较高，医疗保险率较低，并面临独特的挑战 健康食品和/或体育活动机会，这是造成这些农村健康差距的原因。公民 建筑环境变化参与度(CEBEC)将居民主导的社区评估与 旨在改善人口健康的环境变化倡议。在几个试点研究中，参与和 增强居民能力以确定改善社区健康的解决方案已证明是成功的 实施。使用CEBEC显示行为和健康结果发生积极变化的证据 方法在范围和严谨性方面有限，但显示出显著和令人鼓舞的结果(例如，增加了体力 活动)。这项研究建议评估CEBEC的干预，多层次变化俱乐部(CC)项目， 该方案将在八个农村地区实施。社区合作委员会的目标是减少农村的风险因素 通过CEBEC体育活动和健康饮食项目，预防肥胖、癌症和其他慢性疾病。这个 CC提供了有效干预的菜单；循序渐进的计划战略；行为改变战略和 目标设定；评估和参与工具；以及通过电话会议、网络研讨会和 面向农村居民社区卫生服务的讨论板，通常包括大约12-16名居民。对于目标1，我们将 评估八个农村城镇的个人水平健康和行为结果。我们将在CC中衡量结果 会员、CC会员的本地社交网络会员(SNM)和招募的城镇居民样本 通过群发邮件和社区活动。主要结果是简单的7个复合心血管风险 得分，包括血压、血糖和胆固醇、体重指数、饮食、吸烟和体力活动； 其他结果是与健康饮食和锻炼有关的知识、态度、信念和自我效能， 包括利用社区资源进行健康饮食、体育活动和保健；以及环境 各种因素。客观指标，包括体重指数、生化指标、加速度法、真皮类胡萝卜素和 血压，将与CC成员以及SNM和城镇居民的样本一起收集。AIM 2包括一个 检查意外后果的混合方法过程评估；实施障碍和 促进者，包括成本；以及社区/建筑环境/政策、社会/集体以及 个体水平因素对干预特定结果的影响。我们将比较各个站点的成本，并探索成本- CC干预的有效性相对于简单7分的变化。这个项目是一个创新的机会 评价以慢性病危险因素行为为重点的多层次农村CEBEC干预措施。结果 过程数据将为未来传播提供对CEBEC干预措施可行性的关键洞察。

PROJECT SUMMARY Nearly 70% of US adults are overweight or obese, and the consequences can include increased risk for several types of cancer, diabetes, and cardiovascular disease. Compared to their urban counterparts, rural residents tend to have higher rates of cancer, obesity, physical inactivity, and poor diet. Rural residents also have higher rates of poverty and lower rates of health insurance, and face unique challenges accessing healthy foods, and/or physical activity opportunities, which contribute to these rural health disparities. Civic engagement for built environment change (CEBEC) integrates resident-led community assessments with environmental change initiatives aiming at improving population health. In several pilot studies, engaging and empowering residents to identify solutions to improve community health have demonstrated successful implementation. Evidence demonstrating positive change in behaviors and health outcomes using the CEBEC approach are limited in scope and rigor but show notable and encouraging outcomes (e.g. increased physical activity). This study proposes to evaluate a CEBEC intervention, the multilevel Change Club (CC) project, which would be implemented in eight rural locations. The objective of the CC is to reduce rural risk factors for obesity, cancer, and other chronic diseases through CEBEC physical activity and healthy eating projects. The CC provides a menu of effective interventions; step-wise planning strategy; behavior change strategies and goal setting; assessment and engagement tools; and ongoing support via conference calls, webinars, and discussion boards to rural resident CCs, which typically include about 12-16 residents. For Aim 1, we will evaluate individual-level health and behavioral outcomes in eight rural towns. We will measure outcomes in CC members, local social network members (SNM) of CC members, and a sample of town residents recruited through mass mailings and community events. The primary outcome is Simple 7 composite cardiovascular risk score, which includes blood pressure, glucose and cholesterol, BMI, diet, smoking, and physical activity; additional outcomes are knowledge, attitudes, beliefs, and self-efficacy related to healthy eating and exercise, including use of community resources for healthy eating, physical activity, and health care; and environmental factors. Objective measures, including BMI, biochemical measures, accelerometry, dermal carotenoids, and blood pressure, will be collected with CC members and a sample of SNM and town residents. Aim 2 includes a mixed methods process evaluation examining unintended consequences; implementation barriers and facilitators, including costs; and the effect of community/built environment/policy, social/collective, and individual-level factors on intervention-specific outcomes. We will compare costs across sites and explore cost- effectiveness of CC interventions relative to change in Simple 7 score. This project is an innovative opportunity to evaluate multilevel rural CEBEC interventions focused on chronic disease risk factor behaviors. Outcome and process data will provide critical insight into the viability of CEBEC interventions for future dissemination.