Strong Hearts_Healthy Communities_A Rural Community CVD Prevention Program

说明(由申请者提供)：项目概述生活在农村地区的人们，尤其是医疗服务不足的农村地区，在心血管疾病(CVD)方面存在着显著的差距。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。蒙大拿州是农村人口最多的州之一，其998,199人中有76%生活在农村或边境地区(每平方英尺6人 英里)区域。蒙大拿州的心血管疾病发病率与美国相似，但仍是主要的死亡原因，而肥胖、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。强心健康社区(SHHC)的目标是通过公民参与和在蒙大拿州10个服务不足的城镇实施基于社区的干预来减少农村心血管疾病的差距。SHHC建立在与国家粮食和农业研究所推广教育工作者长期合作的基础上，后者将实施该项目。对于具体目标1，我们将通过社区审计、定性研究和与10个城镇的居民、健康教育工作者、地方领导和其他利益相关者组成的社区咨询委员会(CAB)，向干预发展提供信息。我们将收集有关经济、社会/文化、建筑环境、食物获取、医疗保健和相关主题的知识。对于AIM 1.1，我们将结合审计、焦点小组和主要告密者的调查结果以及政策局的意见，为SHHC课程提供信息，促进社区参与，并建设能力。对于目标2，超重和肥胖的中老年女性将参加一项为期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、营养和心血管疾病预防教育和技能。每个小组还将选择与所在城镇相关的与心血管疾病相关的社区健康问题，并帮助促进社区活动和活动，例如健康食品、体育活动机会和健康服务。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天加速度法)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“社会网络”成员的态度和行为变化。目的2干预对象将被要求确定他们最亲密的朋友和/或家人中的1-5人，他们将被邀请完成基线和后续调查问卷。社区规划和公民参与的新整合有可能在参与者、家庭和社区中产生有临床意义的改善；这种方法将通过将行为变化和社区因素联系起来，帮助维持降低的心血管疾病发病率。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，并降低心血管疾病风险。此外，我们将召集SHHC国家顾问委员会，在整个项目中提供专家指导，并就未来的大规模有效性试验进行合作。

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.