Evaluation of a Civic Engagement Approach to Catalyze Built Environment Changeand Promote Healthy Eating and Physical Activity Among Rural Residents

项目摘要 近70%的美国成年人超重或肥胖，其后果可能包括： 几种癌症、糖尿病和心血管疾病。与城市相比，农村 居民的癌症、肥胖、缺乏运动和不良饮食习惯的发病率往往较高。农村居民也 贫困率更高，健康保险率更低，并面临独特的挑战 健康食品和/或体育活动机会，这些都是造成农村健康差距的原因。公民 建筑环境变化参与（CEBEC）将居民主导的社区评估与 旨在改善人口健康的环境变化举措。在一些试点研究中， 授权居民确定改善社区健康的解决方案已经证明是成功的 实施.使用CEBEC证明行为和健康结果发生积极变化的证据 方法的范围和严格性有限，但显示出显著和令人鼓舞的成果（例如， 活动）。本研究建议评估CEBEC干预，多层次的变化俱乐部（CC）项目， 将在八个农村地区实施。社区委员会的目标是减少农村地区的风险因素， 通过CEBEC的体育活动和健康饮食项目，治疗肥胖、癌症和其他慢性疾病。的 CC提供了一个有效的干预菜单;逐步规划战略;行为改变战略和 目标设定;评估和参与工具;以及通过电话会议、网络研讨会和 讨论板到农村居民CC，通常包括约12-16名居民。目标1： 评估八个乡镇的个人健康和行为结果。我们将在CC中衡量结果 成员，CC成员的本地社交网络成员（SNM），以及招募的城镇居民样本 通过大量邮件和社区活动。主要结局是简单7复合心血管风险 评分，包括血压、血糖和胆固醇、BMI、饮食、吸烟和体力活动; 其他结果是与健康饮食和锻炼相关的知识、态度、信念和自我效能， 包括利用社区资源进行健康饮食、体育活动和保健; 因素客观测量，包括BMI、生化测量、加速度计、皮肤类胡萝卜素， 血压，将收集与CC成员和SNM和城镇居民的样本。目标2包括 混合方法过程评价，审查意外后果;实施障碍， 促进因素，包括成本;以及社区/建筑环境/政策、社会/集体的影响， 个体水平因素对干预特定结果的影响。我们将比较各个地点的成本，并探讨成本- CC干预措施相对于Simple 7评分变化的有效性。这个项目是一个创新的机会 评估农村CEBEC多层次干预措施，重点是慢性病危险因素行为。结果 和过程数据将提供关键的洞察力的可行性CEBEC的干预措施，为未来的传播。

PROJECT SUMMARY Nearly 70% of US adults are overweight or obese, and the consequences can include increased risk for several types of cancer, diabetes, and cardiovascular disease. Compared to their urban counterparts, rural residents tend to have higher rates of cancer, obesity, physical inactivity, and poor diet. Rural residents also have higher rates of poverty and lower rates of health insurance, and face unique challenges accessing healthy foods, and/or physical activity opportunities, which contribute to these rural health disparities. Civic engagement for built environment change (CEBEC) integrates resident-led community assessments with environmental change initiatives aiming at improving population health. In several pilot studies, engaging and empowering residents to identify solutions to improve community health have demonstrated successful implementation. Evidence demonstrating positive change in behaviors and health outcomes using the CEBEC approach are limited in scope and rigor but show notable and encouraging outcomes (e.g. increased physical activity). This study proposes to evaluate a CEBEC intervention, the multilevel Change Club (CC) project, which would be implemented in eight rural locations. The objective of the CC is to reduce rural risk factors for obesity, cancer, and other chronic diseases through CEBEC physical activity and healthy eating projects. The CC provides a menu of effective interventions; step-wise planning strategy; behavior change strategies and goal setting; assessment and engagement tools; and ongoing support via conference calls, webinars, and discussion boards to rural resident CCs, which typically include about 12-16 residents. For Aim 1, we will evaluate individual-level health and behavioral outcomes in eight rural towns. We will measure outcomes in CC members, local social network members (SNM) of CC members, and a sample of town residents recruited through mass mailings and community events. The primary outcome is Simple 7 composite cardiovascular risk score, which includes blood pressure, glucose and cholesterol, BMI, diet, smoking, and physical activity; additional outcomes are knowledge, attitudes, beliefs, and self-efficacy related to healthy eating and exercise, including use of community resources for healthy eating, physical activity, and health care; and environmental factors. Objective measures, including BMI, biochemical measures, accelerometry, dermal carotenoids, and blood pressure, will be collected with CC members and a sample of SNM and town residents. Aim 2 includes a mixed methods process evaluation examining unintended consequences; implementation barriers and facilitators, including costs; and the effect of community/built environment/policy, social/collective, and individual-level factors on intervention-specific outcomes. We will compare costs across sites and explore cost- effectiveness of CC interventions relative to change in Simple 7 score. This project is an innovative opportunity to evaluate multilevel rural CEBEC interventions focused on chronic disease risk factor behaviors. Outcome and process data will provide critical insight into the viability of CEBEC interventions for future dissemination.