Engaging NHPIs and Activating Communities to Take Steps (ENACTS)

项目3 摘要 高血压是心血管疾病和中风的一个强大但可改变的危险因素。与白人相比， 夏威夷原住民和太平洋岛民（NHPIs）患这些疾病的可能性要高出3到4倍。他们 在NHPIs中也表现在较年轻的年龄，并且比所有种族的人口更有可能致命。 高血压患病率是70%以上的NHPIs比白人，近50%的NHPIs超过21岁 患有高血压。然而，NHPI在这一主题的研究中基本上缺席。许多NHPI的饮食消耗高 在钠和糖中。自我保健教育，减少钠摄入量，增加钾摄入量， 鼓励减肥、戒烟和体育活动可以改善血压（BP）。我们将 调整现有的教育干预措施，以解决NHPI中高血压的自我管理问题。多级 6-一个月的干预-“让国家卫生和公共卫生机构参与并动员社区采取措施”-将运作 使用同伴促进，自我护理BP教育每周提供8周，强调健康饮食，传统 NHPI食品，坚持服药，鼓励增加体力活动和戒烟; 发短信来提高忠诚度我们将在3个社区实施ENERGY作为随机对照试验 服务于华盛顿普吉湾地区的NHPI的站点。我们将随机分配270名NHPI成人（每个研究中心90名） 在入组时自我报告医生诊断为高血压和血压升高 一般的照顾或照顾。这两组都将收到一般健康教育小册子，加上每周30美元的信贷 网上买杂货我们将使用地理信息系统（GIS）移动的手机应用程序来跟踪 参与者主要结果是收缩压的变化。次要结果是食物购买行为 （在线订购，杂货店收据）;药物依从性;社会支持;戒烟;和GIS数据 每日能量消耗。将在基线、每周和6个月时测量结局。我们亦会研究 改变家庭食物购买模式，加强家庭对BP控制的支持，以及BP改善 在家庭成员中。将邀请一部分干预参与者和家庭成员参加 一个使用个人照片进行叙事艺术项目的项目，以促进当地健康食品的标签 零售店。我们的具体目标是：1）在个人层面上，比较BP的人内变化， 干预组和对照组之间的次要结局; 2）在家庭水平上，评估ENERGY ' 对血压和次要结局的影响，如提供主要支持的家庭成员的个人内变化， 以及不直接参与干预的其他成年家庭成员的平均变化;以及3）在 政策层面，评估干预措施影响杂货店明确识别食品政策的能力 低钠或高钾，其中一些可能不容易用现有标签识别（例如， 新鲜农产品）。ENERGY结合了现有方案的经验支持要素，从而增加了其 成功的概率。它与美国心脏协会对多层次预防的呼吁一致。

PROJECT 3 Abstract Hypertension is a strong but modifiable risk factor for cardiovascular disease and stroke. Compared to Whites, Native Hawaiians and Pacific Islanders (NHPIs) are 3 to 4 times more likely to develop these conditions. They also manifest at younger ages among NHPIs, and are more likely to be fatal than in the all-races population. Hypertension prevalence is 70% higher in NHPIs than in Whites, and nearly 50% of NHPIs over the age of 21 have hypertension. Yet, NHPIs are largely absent from research on this topic. Many NHPIs consume diets high in sodium and sugar. Education on self-care for reducing sodium intake, increasing potassium intake, and encouraging weight loss, smoking cessation, and physical activity can improve blood pressure (BP). We will adapt an existing educational intervention to address self-management of hypertension in NHPIs. The multilevel 6-month intervention – “Engaging NHPIs and Activating Communities to Take Steps” (ENACTS) – will operate use peer-facilitated, self-care BP education delivered weekly for 8 weeks emphasizing healthy diet, traditional NHPI foods, adherence to medication, and encouragement to increase physical activity and stop smoking; with text messaging to boost adherence. We will implement ENACTS as a randomized controlled trial at 3 community sites serving NHPIs in the Puget Sound area of Washington. We will randomize 270 NHPI adults (90 per site) with a self-reported physician diagnosis of hypertension and elevated BP measured at enrollment to either ENACTS or usual care. Both groups will receive general health education brochures, plus a $30 weekly credit for online grocery shopping. We will use a Geographic Information Systems (GIS) mobile phone app to track participants. The primary outcome is change in systolic BP. Secondary outcomes are food purchasing behaviors (online ordering, grocery receipts); medication adherence; social support; smoking cessation; and GIS data on daily energy expenditure. Outcomes will be measured at baseline, weekly, and at 6 months. We will also examine change in household food purchasing patterns, enhanced family support for BP control, and BP improvement among family members. A subset of intervention participants and family members will be invited to participate in a program that uses personal photographs for narrative art projects to promote labeling of healthy foods by local retail outlets. Our Specific Aims are: 1) at the individual level, to compare within-person change in BP and secondary outcomes between the intervention and control groups; 2) at the family level, to evaluate ENACTS’ effects on BP and secondary outcomes as within-person change in family members who provide primary support, and as mean change in other adult family members who are not directly engaged in the intervention; and 3) at the policy level, to evaluate the intervention’s ability to influence grocery store policy on clearly identifying foods that are low in sodium or high in potassium, some of which might not be easily identified with existing labels (e.g., fresh produce). ENACTS combines empirically supported elements of existing programs, thus increasing its probability of success. It aligns with the American Heart Association’s call for multilevel prevention.