An Intergenerational CBPR Intervention to Reduce Appalachian Health Disparities

描述（由申请人提供）：阿巴拉契亚社区受到发病率和死亡率主要原因的不成比例的影响。具体来说，癌症和糖尿病的死亡率分别比全国平均水平高出17%和33%。阿巴拉契亚地区也是美国心血管死亡率最高的地区，每10万人中有328.9至405.9人死亡。与所有这些健康差异相关的一个主要风险因素是能量平衡问题；BRFSS数据显示，只有22%的阿巴拉契亚肯塔基人接受了水果和蔬菜摄入量的RDI， 62%至76%的人超重或肥胖，45%至62%的人报告久坐不动的生活。在全国范围内，肯塔基州在水果和蔬菜摄入量不达标方面排名第三，在超重方面排名第三，在肥胖方面排名第九，在久坐行为方面排名第三。尤其令人担忧的是，自1990年以来，肥胖率翻了一番，肯塔基州的年轻人超重排名第一，在水果/蔬菜摄入量和体育活动方面明显低于全国同龄人。尽管这些风险因素和疾病负担无处不在，但阿巴拉契亚文化包含许多特点和结构，提供了基于当地的解决方案，包括牢固的代际关系、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，并根据我们目前成功的基于信仰的、受过训练的非专业健康顾问量身定制的干预（R01CA108696），我们建议管理和评估一种代际的、文化上合适的CBPR能量平衡干预，这种干预有可能通过增加水果和蔬菜摄入量、降低BMI和增加体育活动来大大预防和减少癌症、心血管疾病和糖尿病的发病率和死亡率。拟议的项目与肯塔基州阿巴拉契亚地区的70个信仰机构合作，分三个阶段：第一阶段（发展阶段）将使用人种学方法（社会生态清单、关键线人访谈、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；发展适合文化的工具；修改现有的干预措施（健康的身体/健康的精神和我们能！），以适应当地文化。在第二阶段，我们将根据健康的身体/健康的精神和NHLBI的we Can！在SCT、TTM和健康的社会生态决定因素的理论指导下，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）、量身定制的外行健康顾问访问和动机性访谈。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：阿巴拉契亚农村社区的一些最常见死因的死亡率最高；癌症、心脏病和糖尿病。这些疾病与超重、饮食不达标和体育活动不足密切相关，这些风险因素在阿巴拉契亚地区普遍存在。拟议中的项目与肯塔基州阿巴拉契亚地区的70个宗教机构合作，开发、管理和评估一种代际干预，该干预使用符合文化的活动和讲习班来减少超重，增加体育活动和水果和蔬菜的摄入量。

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.