Interventions in Nutrition Education and Skills

描述(由申请人提供)：居住在阿巴拉契亚食物沙漠农村的个人心血管疾病(CVD)发病率在全国名列前茅。9个风险因素占所有心血管疾病风险的90%，其中8个因素(不包括吸烟)受到营养习惯的影响。饮食取决于个人和环境因素，特别是在农村食品沙漠，那里的社会经济因素导致了不良的饮食习惯。很少有研究人员开发和测试旨在改善农村食物沙漠饮食模式的策略，在过去几十年里，大多数阿巴拉契亚农村人的饮食行为没有显著改善。鉴于该区域不成比例的心血管疾病发生率和经济劣势，至关重要的是制定和测试成本效益高的干预措施，针对该区域特有的健康饮食的个人和环境障碍。通过培训计划，包括护理和营养科学家团队的指导，以及正式的课程工作、研讨会和研究研究，K23奖将培养开发和测试旨在增加阿巴拉契亚农村地区心血管疾病风险降低食品消费的新干预措施的技能。这位申请者于2011年完成了她的护理博士学位，此后进行了初步研究，表明有必要开发和测试个性化的营养干预措施，以解决阿巴拉契亚地区健康饮食的独特障碍。这项研究计划的广泛假设是，针对每个参与者的特定动机和能力而个性化的营养行为改变干预比集体提供的标准化干预更有可能产生长期的行为改变。将在阿巴拉契亚的六个食物沙漠县进行一项试点研究，其中三个县的参与者作为对照，其他三个县的参与者接受个性化干预。这项研究的具体目的是：1)测试旨在增加心血管疾病风险降低食品消费的个体化干预的结果；2)确定健康素养、经济状况和食品不安全风险是否缓和了这种影响 干预的结果。结果变量将使用食物频率问卷、食物安全调查和监测每月食品杂货购买情况来衡量。有组织的培训计划和研究项目的结合将支持申请者的长期目标，即成为一名专注于改善营养的初级心血管疾病预防的独立调查者。具体地说，申请者将获得以下原则的培训：a)在严峻的环境中进行个性化饮食干预的杂乱无章的试验，b)评估 营养状况和c)提高科学生产力(拨款和出版)。这项研究将提供申请R01赠款所需的初步数据、研究技能和专业知识，以进行个性化干预的受控试验，旨在改善生活在农村食品沙漠和其他有类似健康饮食障碍的严酷环境中的个人的饮食模式。

DESCRIPTION (provided by applicant): Individuals living in rural Appalachian food deserts have among the highest cardiovascular disease (CVD) rates in the nation. Nine risk factors account for 90% of all CVD risk and eight of those factors, excluding smoking, are influenced by nutritional habits. Diet is dependent upon individual and environmental factors, particularly in rural food deserts where socioeconomic factors contribute to poor eating habits. Few researchers have developed and tested strategies aimed at improving dietary patterns in rural food deserts and there has been no significant improvement in the dietary behaviors of most rural Appalachians over the past several decades. Given the disproportionate CVD rates and economic disadvantage in this region, it is vital to develop and test cost-effective interventions that target the individual and environmental barriers to healthy eating that are specific to this region. Through a training plan that includes mentoring by a team of nursing and nutritional scientists, and formal course work, seminars and a research study, this K23 Award will engender the skills to develop and test novel interventions aimed at increasing consumption of CVD risk- reducing foods in rural Appalachia. The applicant completed her doctorate in nursing in 2011 and has since conducted preliminary studies that inform the need to develop and test individualized nutritional interventions that address the unique barriers to healthy eating in rura Appalachia. The broad hypothesis of this program of research is that nutritional behavior change interventions individualized to each participant's specific motivation and ability are more likely to yield long-term behavior change than standardized interventions delivered en masse. A pilot study will be conducted in six Appalachian food desert counties with participants in three counties serving as controls and participants in the other three counties receiving an individualized intervention. The specific aims of the study are to: 1) test the outcome of an individualized intervention aimed at increasing consumption of CVD-risk reducing foods and 2) determine whether health literacy, financial status and risk of food insecurity moderate the effect of the intervention. Outcome variables will be measured using a food frequency questionnaire, food security survey and by monitoring monthly grocery purchases. The combination of a structured training plan and the research project will support the applicant's long-term goal of becoming an independent investigator in primary CVD prevention focused on improving nutrition. Specifically, the applicant will obtain training in the principles of a) conducting rigoous trials of individualized dietary interventions in the context of austere environments, b) assessing nutritional status and c) improving scientific productivity (grant-writing and publishing). The research study will provide the preliminary data, research skills and expertise needed to apply for R01 grant funding to conduct controlled trials of individualized interventions aimed at improving dietary patterns of individuals living in rural food deserts and other austere environments with similar barriers to healthy eating.