COMMUNITY-BASED LIFESTYLE INTERVENTION TO REDUCE CVD RISK & DISPARITIES IN RISK

以社区为基础的生活方式干预，以降低CVD风险和风险差异 主要研究者：托马斯C. Keyserling，MD，MPH 心血管疾病（CVD）的发病率在按人种、种族、 社会经济地位和地理位置。造成这些差异的原因是多方面的， 已知的一个重要促成因素是生活方式，弱势群体的饮食质量较差，身体活动较少。因此，我们提出了一个3阶段的研究，以减少心血管疾病的风险和风险的差异，通过改善生活方式的因素，心血管疾病的风险，北卡罗来纳州，农村县的心血管疾病的发病率极高，特别是在其庞大的非洲裔美国人的人口。在第一阶段，我们将进行一个全面的形成性评估，由社会生态模型框架，以评估个人，人际，组织，社区和政策因素相关的心血管疾病的风险和风险降低在这个县。为此，我们将采用以社区为基础的参与性研究方法，主要是定性方法。在第二阶段，我们提出了一项研究，包括对所有参与者进行生活方式干预， 一项减肥干预的随机对照试验（RCT），将比较两种旨在维持减肥的计划。基本原理是，大多数参与者应该改善生活方式，肥胖者应该有机会减肥并保持体重（通常是减肥中最具挑战性的部分）。一开始，我们将招募400名参与者（也是帕特森博士研究的样本）参加一个以社区为基础的生活方式干预计划，该计划旨在改善饮食质量和促进体育活动（全部在 将鼓励入组基于临床的DeWalt研究，以改善BP控制）。在6个月随访时，那些希望减肥的人（N约200）将参加RCT，而其他人将继续接受基本的生活方式干预。RCT中的所有人都将接受持续6个月的强化减肥干预，之后他们将被随机分配到强化与标准维持减肥干预组。社区范围内的政策和环境变化干预措施将被实施，以支持这些计划，我们将评估不同的研究小组的吸收。成果，包括成本效益， 将在6、12、18和24个月时进行评估。在第三阶段，除了分析和报告 写作时，我们将准备研究的有效内容以供传播。

Community-Based Lifestyle Intervention to Reduce CVD Risk & Disparities in Risk Principal Investigator: Thomas C. Keyserling, MD, MPH Large disparities in rates of cardiovascular disease (CVD) exist among subgroups defined by race, ethnicity, socioeconomic status, and geographic location. The reasons for these disparities are multi-factorial, yet an important known contributing factor is lifestyle, with disadvantaged populations consuming diets of poorer quality and being less physically active. Thus, we propose a 3 phase study to reduce CVD risk and disparities in risk by improving lifestyle factors which underlie CVD risk in Lenoir County, NC, a rural county with extremely high rates of CVD, especially among its large African American population. In Phase I, we will conduct a comprehensive formative evaluation, framed by the Socio-Ecological model, to assess individual, interpersonal, organizational, community, and policy factors relevant to CVD risk and risk reduction in this county. To do so, we will use a community-based participatory research approach and primarily qualitative methods. In Phase II, we propose a study that includes a lifestyle intervention given to all participants and a randomized controlled trial (RCT) of a weight loss intervention that will compare two programs designed to maintain weight loss. The rationale is that most participants should improve lifestyle and those who are obese should have the opportunity to lose weight and keep it off (generally the most challenging component of weight loss). At the outset, we will enroll 400 participants (also the sample for Dr. Patterson's study) into a communitybased lifestyle intervention program designed to improve diet quality and promote physical activity (all in the clinic-based DeWalt study to improve BP control will be encouraged to enroll). At 6 month follow-up, those who desire weight loss (N approximately 200) will take part in the RCT while the others will continue to receive the basic lifestyle intervention. All in the RCT will receive an intensive, weight loss intervention lasting 6 months, after which they will be randomly assigned to an intensive vs. standard maintenance of weight loss intervention. Community-wide policy and environmental change interventions will be implemented to support these programs and we will assess uptake by the different study groups. Outcomes, including costeffectiveness, will be assessed at 6, 12, 18, and 24 months. In Phase III, in addition to analysis and report writing, we will prepare effective inten/ention components ofthe study for dissemination.