ALIVE: A community-research partnership to reduce diet-related chronic disease in African American congregations

项目摘要/摘要 低收入非裔美国人患心血管疾病和死亡的风险增加，原因是 心血管(CVD)危险因素，如高血压、糖尿病和肥胖。改善非洲人的饮食质量 美国人可以减少黑人和白人的健康差距，但饮食干预在 非洲裔美国人比其他群体更多。Alive是一种根据文化定制的、基于教会的饮食干预措施，由 由研究人员、非裔美国牧师和会众组成的伙伴关系使用基于社区的 参与式研究方法。干预的主要内容包括增加对圣经的研究 吃得更健康的内在动机，配以小组会议，专注于通过 营养教育、烹饪指导和行为改变技术。所有干预组件均为 由教会成员在超过9个月的24次会议中宣讲。Alive先导研究导致临床和 蔬菜消费的统计显著改善，以及饮食质量和 减轻体重和血压。这项拟议的研究的目标是进行为期21个月的行为 Clusterrandomizedcontrolledtrialinwhichchurchesarerandomizedtooneoftwoarms:theinterventionarm， 在第一年接受Alive干预，在第二年接受金融教育干预Money Smart，或 比较臂，它以相反的顺序接收干预。本研究设计的广告服饰 社区合作伙伴的需求，同时控制一些可能的混杂因素，如注意力。这个 这项研究的主要目的是通过比较登记的会众来评估活体干预的效果。 来自干预和比较教会关于饮食质量的变化，以替代健康 饮食指数(AHEI)。二次研究的目的是评价活体干预对血浆的影响 类胡萝卜素和评估饮食质量变化的潜在中介因素，包括自我效能，内在的 健康饮食的动机、态度和主观社会规范。这项研究的探索性目的是 EvaluatesustainabilityofchangeinAHEIscoreat12monthspost-interventionintheinterventionarm，评估 活体干预对血压、血脂和肥胖症变化的影响 活动干预的实施和参与者机会成本。这项拟议的研究是第二项 旨在降低非裔美国成年人心血管疾病死亡率的综合研究计划的阶段。 第一阶段显示，活的干预导致临床和统计上显著的增加。 蔬菜消费。第二阶段，也就是拟议的研究，将测试我们是否可以将这种影响扩展到整体饮食 当与对照组相比时，更多的教会之间的质量。第三阶段将进行 一项更大规模的试验，以测试这种干预在降低血压方面的效果。

Project Summary/Abstract Low-income African Americans suffer increased risk of cardiovascular disease and death due to high levels of cardiovascular (CVD) risk factors, such as hypertension, diabetes and obesity. Improving diet quality in African Americans could reduce black-white health disparities but dietary interventions have been less successful in African Americans than other groups. ALIVE is a culturally-tailored, church-based diet intervention designed by a partnership of researchers, African American pastors and congregants using a community-based participatory research methodology. The main components of the intervention include a Bible study to increase intrinsic motivation to eat healthier, paired with small group sessions focused on bui lding self-efficacy through nutrition education, cooking instruction and behavior change techniques. All intervention components are delivered by church members in 24 sessions over 9 months. The ALIVE Pilot study resulted in clinically and statistically significant improvements in vegetable consumption, as well as increased diet quality and reductions in weight and blood pressure. The goal of the proposed study is to conduct a 21 -month behavioral clusterrandomizedcontrolledtrialinwhichchurchesarerandomizedtooneoftwoarms:theinterventionarm, which receives ALIVE intervention in year 1 and Money Smart, a financial education intervention, in year 2, or the comparison arm, which receives the interventions in the reverse order. This study design ad dresses the needs of community partners while controlling for a number of possible confounders such as attention. The primary aim of the study is to assess the efficacy of the ALIVE intervention by comparing enrolled congregants from intervention and comparison churches on change in diet quality as measured by the Alternative Healthy Eating Index (AHEI). Secondary study aims are to evaluate the effect of the ALIVE intervention on plasma carotenoids and evaluate potential mediators of change in diet quality, including self-efficacy, intrinsic motivation, attitudes and subjective social norms for eating healthy. Exploratory aims of the study are to evaluatesustainabilityofchangeinAHEIscoreat12monthspost-interventionintheinterventionarm,evaluate the effect of the ALIVE intervention on changes in blood pressure, lipids, and adiposity, and assess the implementation and participant opportunity costs of the ALIVE intervention. The proposed study is the second phase of an integrated program of research aimed at reducing CVD mortality in African American adults. Phase one showed that the ALIVE intervention resulted in a clinically and statistically significant increase in vegetable consumption. Phase 2, the proposed study, will test whether we can expand this effect to overall diet quality among a larger number of churches and when compared to a control group. Phase 3 will be to conduct a larger trial to test the efficacy of this intervention in reducing blood pressure.