An Intergenerational CBPR Intervention to Reduce Appalachian Health Disparities

描述（由申请人提供）：阿巴拉契亚社区不成比例地受到发病率和死亡率主要原因的影响。具体来说，癌症和糖尿病死亡率分别比全国死亡率高出17%和33%。阿巴拉契亚地区的心血管死亡率也是全国最高的，每10万人口中有328.9至405.9人死亡。所有这些健康差异的一个主要风险因素是有问题的能量平衡; BRFSS数据显示，只有22%的阿巴拉契亚州人接受水果和蔬菜摄入的RDI，62- 76%的人超重或肥胖，45- 62%的人报告久坐不动。在全国范围内，肯塔基州在不满足水果和蔬菜摄入量方面排名第三，超重排名第三，肥胖排名第九，久坐行为排名第三。特别令人担忧的是，自1990年以来，肥胖率翻了一番，肯塔基州青年在超重方面排名第一，在水果/蔬菜摄入量和体育活动方面明显低于全国同行。尽管这些风险因素和疾病负担普遍存在，但阿巴拉契亚文化包含许多特征和结构，提供基于当地的解决方案，包括强大的代际关系，基于信仰的行动主义和健康的传统活动。根据流行病学证据，并通过我们目前成功的基于信仰的、训练有素的非专业健康顾问提供信息，（R 01 CA 108696），我们建议管理和评估代际，文化上适当的CBPR能量平衡干预，通过增加水果和蔬菜摄入，降低BMI，增加身体活动。与肯塔基州阿巴拉契亚的70个宗教机构合作，拟议的项目分为三个阶段：第一阶段（发展阶段）将使用人种学方法（社会生态调查、关键知情人访谈、参与者观察）评估健康饮食、体重和体育活动的障碍和促进因素;制定文化上适当的工具;并修改现有的干预措施（健康的身体/健康的精神和我们可以！）对当地文化做出回应。在第二阶段，我们将根据健康的身体/健康的精神和NHLBI的我们可以！从理论上讲，通过SCT、TTM和健康的社会生态决定因素，干预措施将包括文化上适当的讲习班（与当地相关的活动，如广场舞、社区园艺、讲故事和烹饪班）、量身定制的非专业健康顾问访问和动机访谈。在整个项目中，RE-AIM模型将为我们的评估提供信息。在第三阶段，我们将进行定性过程评估访谈，并评估与CBPR原则的一致性。公共卫生相关性：农村阿巴拉契亚社区遭受一些最常见的死亡原因的最高比率;癌症，心脏病和糖尿病。这些情况与超重、饮食不达标和身体活动不足密切相关，这些风险因素在阿巴拉契亚地区普遍存在。拟议的项目与阿巴拉契亚肯塔基州的70个信仰机构合作，开发，管理和评估代际干预措施，使用文化上适当的活动和研讨会，以减少超重，增加体育活动和水果蔬菜摄入量。

DESCRIPTION (provided by applicant): Appalachian communities are disproportionately affected by the leading causes of morbidity and mortality. Specifically, cancer and diabetes mortality rates are 17 percent and 33 percent above national rates. The Appalachian region also has the nation's highest cardiovascular death rates with 328.9 to 405.9 deaths per 100,000 population. A leading risk factor implicated in all of these health disparities is problematic energy balance; BRFSS data indicate that only 22 percent of Appalachian Kentuckians receive the RDI for fruit and vegetable intake, between 62-76 percent are overweight or obese, and between 45-62 percent report sedentary lives. Nationally, Kentucky ranks third in not meeting fruit and vegetable intake, #3 in overweight, #9 in obesity, and #3 for sedentary behavior. Of particularly elevated concern, the obesity rate has doubled since 1990 and Kentucky youth rank #1 in overweight and significantly lower than their national counterparts in fruit/vegetable intake and physical activity. Despite the pervasiveness of these risk factors and disease burdens, Appalachian culture contains many characteristics and structures that offer locally based solutions, including strong intergenerational ties, faith-based activism, and healthy traditional activities. Drawing on epidemiologic evidence and informed by our current successful faith-based, trained lay health advisor tailored intervention (R01CA108696), we propose to administer and evaluate an intergenerational, culturally appropriate CBPR energy balance intervention that has the potential of greatly preventing and reducing cancer, CVD, and diabetes morbidity and mortality by increasing fruit and vegetable intake, lowering BMI, and increasing physical activity. Working in partnership with 70 faith-based institutions in Appalachian Kentucky, the proposed project has three phases: Phase I (Developmental phase) will use ethnographic methods (socio-ecological inventories, key informant interviews, participant observation) to assess the barriers to and facilitators of healthy diet, weight, and physical activity; develop culturally appropriate instruments; and modify existing interventions (Healthy Body/ Healthy Spirit and We Can!) to be responsive to local culture. During Phase II, we will administer the group randomized, staggered CBPR intervention based on Healthy Body/ Healthy Spirit and NHLBI's We Can! Theoretically informed by the SCT, TTM, and socio-ecological determinants of health, the intervention will include culturally appropriate workshops (with locally relevant activities, like square dance, community gardening, story telling, and cooking classes), tailored lay health adviser visits, and motivational interviewing. Throughout the project, the RE-AIM model will inform our evaluation. During Phase III, we will undertake qualitative process evaluation interviews and evaluate consistency with CBPR principles. PUBLIC HEALTH RELEVANCE: Rural Appalachian communities suffer some of the highest rates of the most common causes of death; cancer, heart disease, and diabetes. These conditions are strongly associated with being overweight and having a substandard diet and inadequate physical activity, risk factors that are pervasive in Appalachia. The proposed project works in partnership with 70 faith-based institutions in Appalachian Kentucky to develop, administer, and evaluate an intergenerational intervention that uses culturally appropriate activities and workshops to reduce overweight and increase physical activity and fruit and vegetable intake.