Biobehavioral Cardiovascular Health Promotion Intervention in a State Prison Syst

描述（由申请人提供）：我们的研究计划的长期目标是通过在监狱中实施全州范围的CV风险因素降低计划来改善囚犯的心血管（CV）健康。在男性囚犯中进行拟议研究的目的是测试行为CV风险降低（BCVRR）干预对健康结果的影响（即，库珀诊所死亡风险指数[一个综合指数，包括心率，血压，糖尿病，吸烟状况，体重指数，年龄和心肺健康]，血脂谱和可改变的生活方式行为）在4个肯塔基州惩教部（KyDOC）州立监狱。这项研究将在4所州立监狱进行。将使用多基线、重复测量设计，其中所有参与者都接受干预，并且所有参与者都有3个月的导入期，在此期间建立自己的基线而不进行干预。这种设计在监狱环境中是理想的，因为不可能将囚犯随机分配到对照组。我们将招收560名囚犯，以达到我们的目标，400人完成该计划，因为根据现有的文献和我们以前的工作，预计辍学率为30%。在每个监狱，将在四个时间点（导入基线、干预前基线、干预后立即和干预后3个月）从囚犯那里收集数据。BCVRR干预是一项为期12周的CV健康教育/行为改变和有氧体育训练计划，包括：1）由认证的健康教育工作者和社区其他受过培训的专业人员提供的健康教育和行为改变策略课程; 2）由CV风险降低培训师领导的有氧运动计划。短期和长期影响将在12周干预后立即测量，并在干预结束后3个月测量。具体目标1：确定BCVRR干预对CV风险因素降低的影响（即，总的库珀临床死亡风险指数[CCMRI]、CCMRI的个体可变组分、糖尿病患者的HgA 1c和血脂谱）假设1：在干预后，总CCMRI将显著下降，CCMRI的单个可变组分将改善，糖尿病患者的HgA 1c将改善，血脂谱将随时间推移而改善，与导入期和干预前基线相比，每个结果。具体目标2：确定干预对可改变的生活方式行为（即，囚犯健康风险评估）。假设二：与导入期和干预前基线相比，自我报告的可改变的生活方式行为将有显著改善。具体目标3：从拟议的研究中生成数据，以便在所有13个KyDOC国营监狱进行全州范围的测试和实施干预，以维持该计划。 公共卫生相关性：叙述心血管疾病是里森中死亡的主要原因，囚犯有不成比例的高心血管危险因素。我们研究计划的目标是通过在监狱实施降低心血管风险因素的计划来改善囚犯的心血管健康。有效管理心血管风险因素可以改善囚犯在监禁期间和释放后的健康状况，并减少心血管疾病的重大个人和社会负担。

DESCRIPTION (provided by applicant): The long-term objective of our program of research is to improve the cardiovascular (CV) health of inmates by implementation of a state-wide CV risk factor reduction program in prisons. The purpose of the proposed study in male inmates is to test the effects of a behavioral CV risk reduction (BCVRR) intervention on health outcomes (i.e., Cooper Clinic Mortality Risk Index [a composite index that includes heart rate, blood pressure, diabetes, smoking status, body mass index, age, and cardio-respiratory fitness], lipid profile, and modifiable lifestyle behaviors) in 4 Kentucky Department of Corrections (KyDOC) state-run prisons. This study will be conducted in 4 state operated prisons. A multiple baselines, repeated measures design will be used in which all participants receive the intervention, and all have a 3 month run-in period in which to establish their own baseline without intervention. This type of design is ideal in the prison environment where it is not possible to randomly assign inmates to a control group. We will enroll 560 inmates to reach our goal of 400 who finish the program, as a drop-out rate of 30% is expected based on existing literature and our prior work. At each prison, data will be gathered from inmates at four time points (run-in baseline, pre-intervention baseline, immediately post-intervention and 3 months post-intervention). The BCVRR intervention is a 12-week CV health education/behavior change, and aerobic physical training program, consisting of: 1) health education with behavior change strategies session delivered by certified health educators and other trained professionals from the community; and 2) an aerobic exercise program led by CV risk reduction trainers. Short and long-term effects will be measured immediately after the 12-week intervention and 3 months after the intervention ends. Specific Aim 1: To determine the impact of the BCVRR intervention on CV risk factor reduction (i.e., the total Cooper Clinic Mortality Risk Index [CCMRI], individual modifiable components of the CCMRI, HgA1c in diabetics, and lipid profile) Hypothesis 1: There will be a significant decline in total CCMRI and improvement in the individual modifiable components of the CCMRI and an improved HgA1c for diabetics, and improved lipid profile over time following the intervention, compared with the run-in and pre-intervention baseline for each outcome. Specific Aim 2: To determine the impact of the intervention on the self-report of modifiable lifestyle behaviors (i.e., Inmate Health Risk Assessment). Hypothesis 2: There will be a significant improvement in self-reported modifiable lifestyle behaviors compared with the run-in and pre-intervention baseline for each outcome. Specific Aim 3: To generate data from the proposed study for a proposal for state-wide testing and implementation of the intervention at all of the 13 KyDOC state-run prisons in order to sustain the program. PUBLIC HEALTH RELEVANCE: Narrative Cardiovascular disease is the main cause of death in rison and inmates have disproportionately higher rates of cardiovascular risk factors. The objective of our program of research is to improve the cardiovascular health of inmates by implementation of a cardiovascular risk factor reduction program in prisons. Effective management of cardiovascular risk factors could improve the health of inmates both while incarcerated and once released, and reduce the substantial personal and societal burden of cardiovascular disease.