Interventions in Nutrition Education and Skills

描述（由申请人提供）：生活在阿巴拉契亚食物沙漠农村的个人是全国心血管疾病（CVD）发病率最高的人群之一。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）受营养习惯的影响。饮食取决于个人和环境因素，特别是在社会经济因素导致不良饮食习惯的农村食物沙漠地区。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，在过去的几十年里，大多数阿巴拉契亚农村人的饮食行为没有显著改善。鉴于该区域心血管疾病发病率不成比例和经济劣势，必须制定和试验具有成本效益的干预措施，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，以及正式课程、研讨会和研究，K23奖将培养技能，以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。申请人于2011年完成了她的护理博士学位，此后进行了初步研究，告知有必要开发和测试个性化营养干预措施，以解决阿巴拉契亚农村健康饮食的独特障碍。这个研究项目的广泛假设是，根据每个参与者的具体动机和能力进行个性化的营养行为改变干预，比大规模实施标准化干预更有可能产生长期的行为改变。一项试点研究将在六个阿巴拉契亚食品沙漠县进行，其中三个县的参与者作为对照，另外三个县的参与者接受个性化干预。该研究的具体目的是：1)测试旨在增加心血管疾病风险降低食品消费的个性化干预的结果；2)确定健康素养、财务状况和食品不安全风险是否会调节效果

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.