Strong Hearts_Healthy Communities_A Rural Community CVD Prevention Program

描述（由申请人提供）：项目总结生活在农村环境中的人之间存在显着的心血管疾病（CVD）差异，特别是医疗服务不足的农村地区。社会经济劣势、社会和文化动态、地理距离/障碍以及获得医疗保健、健康食品和/或体育活动机会有限等复杂因素促成了这一问题。蒙大拿州是最具乡村特色的州之一，其998，199人口中有76%居住在乡村或边境地区（<6人/平方米 英里）地区。蒙大拿州的心血管疾病发病率与美国相似，但它仍然是死亡的主要原因，肥胖、高胆固醇、高血压和糖尿病等心血管疾病风险因素正在增加。坚强的心，健康的社区（SHHC）的目标是减少农村心血管疾病的差距，通过公民参与和实施社区为基础的干预在10个服务不足的蒙大拿州城镇。SHHC建立在与国家粮食和农业研究所合作推广教育工作者的长期合作基础上，他们将实施该项目。对于具体目标1，我们将通过社区审计、定性研究以及与10个城镇的居民、卫生教育工作者、地方领导和其他利益相关者组成社区咨询委员会（CAB），为干预措施的制定提供信息。我们将收集有关经济，社会/文化，建筑环境，食品获取，医疗保健和相关主题的知识。就目的1.1而言，我们将纳入审计、焦点小组和主要知情人的调查结果，以及来自CAB的意见，以告知SHHC课程，促进社区参与和能力建设。对于目标2，超重和肥胖的中年和老年妇女将参加一项为期24周的社区随机研究。受试者将参加每周两次的课程，重点是运动，营养和CVD预防教育和技能。每个小组还将选择一个与他们所在城镇相关的CVD相关社区健康问题，并帮助促进社区活动和活动，例如健康食品、体育活动机会、健康服务。我们将评估人体测量（例如BMI）、生理（例如血脂、血压）、行为（例如7天加速度计）和心理社会（例如生活质量）结果。对于目标2.1，我们将评估SHHC参与者“社交网络”成员的态度和行为变化。目标2将要求干预受试者确定1-5名最亲密的朋友和/或家庭成员，并邀请他们完成基线和随访问卷。社区规划和公民参与的新整合有可能影响参与者，家庭和社区的临床有意义的改善;这种方法将有助于通过将行为改变和社区因素联系起来来维持降低的CVD率。此外，SHHC将为其他服务不足的农村社区提供一个可行的模式，以改善居民的健康和生活质量，降低心血管疾病风险。此外，我们将召集一个SHHC国家咨询委员会，在整个项目中提供专家指导，并在未来的大规模有效性试验中进行合作。

DESCRIPTION (provided by applicant): PROJECT SUMMARY There are notable cardiovascular disease (CVD) disparities among people living in rural settings, particularly medically underserved rural areas. Complex factors such as socioeconomic disadvantage, social and cultural dynamics, geographic distances/barriers, and limited access to healthcare, healthy foods, and/or physical activity opportunities contribute to the issue. Montana is one of the most rural states, with 76% of its 998,199 people living in rural or frontier (<6 people/square mile) areas. Montana's CVD rates have declined similarly to U.S. rates, but it remains the leading cause of death, and CVD risk factors such as obesity, high cholesterol, hypertension, and diabetes are increasing. The objective of Strong Hearts, Healthy Communities (SHHC) is to reduce rural CVD disparities through civic engagement and implementation of a community-based intervention in 10 underserved Montana towns. SHHC builds upon a long-standing collaboration with National Institute of Food and Agriculture cooperative extension educators, who will implement the project. For Specific Aim 1, we will inform intervention development through community audits, qualitative research, and forming Community Advisory Boards (CABs) with residents, health educators, local leadership, and other stakeholders in the 10 towns. We will gather knowledge about economic, social/cultural, built environment, food access, healthcare, and related topics. For Aim 1.1, we will incorporate audit, focus group, and key informant findings as well as input from CABs to inform the SHHC curriculum, facilitate community engagement, and build capacity. For Aim 2, overweight and obese midlife and older women will participate in a 24-week community-randomized study. Subjects will attend twice weekly classes focused on exercise, nutrition, and CVD prevention education and skills. Each group will also choose a CVD-related community health issue of relevance to their town and help facilitate community events and activities, e.g. healthy foods, physical activity opportunitie, wellness services. We will evaluate anthropometric (e.g. BMI), physiologic (e.g. lipids, blood pressure), behavioral (e.g. 7-day accelerometry), and psychosocial (e.g. quality of life) outcomes. For Aim 2.1, we will evaluate attitudinal and behavioral changes among members of the SHHC participants' "social network". Aim 2 intervention subjects will be asked to identify 1-5 of their closest friends and/or family members, who will be invited to complete baseline and follow-up questionnaires. The novel integration of community programming and civic engagement has the potential to effect clinically meaningful improvements in participants, families, and communities; this approach will help sustain reduced CVD rates by linking behavior change and community factors. Further, SHHC will provide a feasible model for other underserved rural communities to improve health and quality of life and reduce CVD risk among residents. In addition, we will convene a SHHC National Advisory Board, to provide expert guidance throughout the project, and to collaborate on a future large-scale effectiveness trial.