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

摘要 美国农村人口的心血管疾病（CVD）患病率高得不成比例， 2型糖尿病（T2D）与城市人群相比。许多农村社区也有更大的风险因素 负担，包括不健康的饮食，更高的身体不活动率，肥胖， 吸烟，高血压、高胆固醇血症和高血糖症的患病率较高。配混 这就是社会经济条件差和卫生资源有限。西班牙裔农村居民 由于发病率较高，可能比非西班牙裔居民经历更严重的CVD和T2D疾病和风险负担 贫困、教育程度较低以及获得资源的障碍更大。美国西班牙裔 在所有种族或族裔群体中，T2D的发病率最高。适应文化的生活方式改变 需要采取干预措施，以降低西班牙裔和非西班牙裔农村人口的T2D和CVD风险。 修改策略通常针对个人，虽然这些策略可能会立即导致行为改变， 干预后，很少能实现健康行为的持续参与。家庭参与 生活方式干预可以支持持续参与健康行为，特别是在农村和西班牙裔 这些人口往往更多地依赖家庭成员提供社会支持。我们将进行 一项随机对照试验，比较了二元干预，家庭之心， 控制干预。我们将比较3个月（短期）和12个月（长期）的心脏的影响， 对T2D和CVD的生物和行为危险因素进行家庭干预，并评估种族 调节干预效果。我们还将研究每个积极干预的二元体成员的 参与健康的生活方式行为和支持他们的伴侣参与健康的生活方式行为的水平 生活方式行为会影响他们自己和他们伴侣的结果。以家庭为中心的干预可能会更好 支持长期参与健康的生活方式行为，以降低高危农村人群的T2D和CVD风险 西班牙裔和非西班牙裔。此外，这种以社区为基础的干预措施具有广泛的潜力， 实施，以成功地解决T2D和心血管疾病的健康差距在美国西班牙裔社区。

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.