The Native Proverbs 31 Health Project

描述(由申请人提供)：近年来，美国印第安人的心血管疾病(CVD)发病率急剧上升。在大多数美洲印第安人社区中，可改变的心血管疾病风险因素，如肥胖、2型糖尿病、久坐行为和烟草使用，通常比非西班牙裔白人更高，尽管对这些人群中适当的心血管疾病初级预防策略的独特文化方面的了解有限。伦比印第安人部落是一个非保留地部落，人口约5万人，是密西西比河以东最大的美洲印第安人部落，主要集中在北卡罗来纳州东南部的罗伯逊县。这个县大部分是农村，贫困率很高，美国印第安人、非裔美国人和非西班牙裔白人几乎平分秋色。有限的现有数据表明，心血管疾病及其危险因素在北卡罗来纳州的美洲印第安人中普遍很高，特别是兰比人。伦比部落主要是基督徒，而教会是伦比文化的一个非常重要的组成部分，为在这一人群中发展基于教会的健康干预提供了机会。拟议的项目名为“土著谚语31健康项目”，是对RFA-MD-10-004(NCMHD基于信仰的健康差距研究创新方法)的回应。该项目旨在开发、实施和评估北卡罗来纳州罗伯逊县伦比印第安人妇女的心血管疾病预防计划，重点是《箴言》第31章中的圣经信息。将实现以下目标：1)基于社区先前的研究和形成工作，合作为北卡罗来纳州罗伯逊县的Lumbee印第安人妇女制定基于社区的、文化上合适的心血管疾病干预计划，重点放在《箴言》第31章圣经段落中与健康相关的信息；2)利用社区健康/世俗健康教育者模式，在北卡罗来纳州罗伯逊县的四个Lumbee印第安人教堂实施为期6个月的心血管疾病干预计划。3)使用一项双臂随机试验，采用群组设计和对照教会的延迟干预，评估基于社区的、文化上合适的CVD干预计划对Lumbee妇女的饮食、体力活动和烟草使用的影响。我们这项研究的主要结果将是健康行为(饮食、体力活动)的变化和沿着烟草使用变化的跨理论模型阶段的运动。次要结果将包括体重指数(BMI)的变化以及自我效能和自尊的变化。我们将进行过程评估，以确定制定和交付干预材料的可行性水平。这一模式可以适用于其他美洲印第安人教会以及其他种族/民族的教会。 公共卫生相关性：项目说明拟议的项目名为土著谚语31健康项目是对RFA-MD-10-004的回应。该项目旨在开发、实施和评估北卡罗来纳州罗伯逊县伦比印第安人妇女中基于教会的心血管疾病预防计划。该计划将侧重于一门基于《箴言31》中圣经信息的教育课程，该课程重点关注“贤惠女性”的行为。主要结果包括饮食、体力活动和烟草使用的变化，以及体重指数、自我效能和自尊的次要结果。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) rates have increased dramatically among American Indians in recent years. Modifiable CVD risk factors, such as obesity, type 2 diabetes, sedentary behavior, and tobacco use are generally higher in most American Indian communities compared to non-Hispanic whites, although there is limited understanding of the unique cultural aspects of appropriate CVD primary prevention strategies in these populations. The Lumbee Indian tribe, a non-reservation tribe with a population of about 50,000, is the largest American Indian tribe east of the Mississippi River, and is largely concentrated in Robeson County, in southeastern North Carolina (NC). This county is largely rural, has a high poverty rate, and is almost equally divided among American Indians, African Americans and non-Hispanic whites. Limited available data indicate that CVD and its risk factors are very high among American Indians in North Carolina in general and Lumbees in particular. The Lumbee tribe is largely Christian, and the church is a very important component of Lumbee culture, providing opportunities to develop church-based health interventions in this population. The proposed project, entitled, "The Native Proverbs 31 Health Project," is in response to RFA-MD-10-004 (NCMHD Innovative Faith-based Approaches to Health Disparities Research). This project is designed to develop, implement and evaluate a CVD prevention program among Lumbee Indian women in Robeson County, NC, focusing on the biblical messages in Proverbs 31. The following aims will be performed 1) Based on prior research and formative work in the community, collaboratively develop a community-based, culturally appropriate CVD intervention program for Lumbee Indian women in Robeson County, NC, focusing on the health-related messages in biblical passage in Proverbs 31; 2) Implement a 6-month CVD intervention program in four Lumbee Indian churches in Robeson County, NC, using a community health / lay health educator model. 3) Evaluate the community-based, culturally appropriate CVD intervention program on diet, physical activity and tobacco use among Lumbee women using a two-armed randomized trial with a cluster design and delayed intervention for control churches. Our primary outcomes for this study will be changes in health behaviors (diet, physical activity) and movement along the transtheoretical model stages of change for tobacco use. Secondary outcomes will include changes in body mass index (BMI) and changes in self-efficacy and self-esteem. We will conduct process assessments to determine the level of feasibility in the development and delivery of the intervention materials. This model could be adapted for other American Indian churches as well as churches of other racial/ethnic groups. PUBLIC HEALTH RELEVANCE: Project Narrative The proposed project entitled The Native Proverbs 31 Health Project is in response to RFA-MD-10-004. The project is designed to develop, implement and evaluate a church-based CVD prevention program among Lumbee Indian women in Robeson County, NC. The program will focus on an educational curriculum based on the biblical messages in Proverbs 31, which focuses on the behaviors of the "virtuous woman." The primary outcomes include changes in diet, physical activity and tobacco use and secondary outcomes in BMI, self-efficacy and self-esteem.