Chickasaw Healthy Eating Environments in Retail Stores (CHEERS)

项目1 摘要 心血管疾病（CVD）风险与不良的食品环境有关，其特点是有限的 获得负担得起的健康食品。这样的环境在美洲印第安人社区中极为常见， 然而，很少有研究涉及土著社区的粮食环境或粮食政策。零售食品 可以扩大获得健康食品的机会并刺激社区对更健康选择的需求的干预措施 在解决美国印第安人的心血管疾病风险方面显示出了希望。Chickasaw Nation的成员， 俄克拉荷马州部落是美国第13大部落，经历了不成比例的心血管疾病风险负担，沿着 健康饮食的巨大障碍。2014年，在契卡索部落健康中心的近20，000名成年患者中， 系统有高血压前期或高血压，而84%超重或肥胖，13%患有糖尿病。在 与Chickasaw Nation合作，我们设计了Chickasaw零售业健康饮食环境 商店（CHEERS）研究。这一多层次干预将在24个月内与联合国儿童基金会合作进行， 第一家提供全方位服务的奇卡索超市，将于2017年开业。CHEERS包括几个相互 加强策略，以改善高血压患者的血压控制。我们将实施CHEERS 在俄克拉荷马州的阿达的奇克索镇，同时指定另外两个奇克索镇-硫磺和蒂绍明戈， 俄克拉荷马州-作为控制点，因为两者都缺乏一个部落经营的超市。我们将招募700名成年人（350人）， 在基线、12个月和24个月时收集调查和临床数据， 评估CHEERS对血压控制和次要结局（食物购买、饮食和 体重指数）。患有不受控制的高血压的部落成员将获得具有心脏健康的食谱 食谱量身定制的传统奇克索饮食和文化，沿着邀请参加健康烹饪 示威在干预期间，部落媒体团队将收集材料以制作一部纪录片， 它对公众健康和当地经济的影响。该纪录片将分发给部落领袖， 我们随后将调查和采访这些人，以评估他们是否准备更广泛地实施CHEERS。 CHEERS将在多媒体演示中达到高潮，该演示详细介绍了基于超市的干预措施， 高血压社区成员的个人成功故事。我们的具体目标是：1）在环境 水平，收集有关可用性，价格和货架空间的数据，专门用于健康和不太健康的选择， 基线（干预前）以及12个月和24个月时的现有当地零售店; 2） 个体水平，以测量高血压患者的血压变化和次要结局 在基线以及12个月和24个月时再次评估社区成员;以及3）在政策层面， 纪录片对部落领袖准备在奇克索国家和其他地方实施欢呼的影响 部落社区。这项研究建立在初步数据、最佳做法、已建立的伙伴关系和现有的 部落资源来最大化成功的可能性。研究结果和多媒体材料将提供很多- 需要的证据，部落运行的食品干预，并将协助部落国家减少心血管疾病相关的 通过改善健康食品的获取来实现差异。

PROJECT 1 Abstract Cardiovascular disease (CVD) risk is associated with poor food environments, which are characterized by limited access to affordable healthy foods. Such environments are extremely common in American Indian communities, yet, few studies have addressed food environments or food policies in Native communities. Retail food interventions that can expand access to healthy foods and stimulate community demand for healthier choices have shown promise in addressing CVD risk among American Indians. Citizens of the Chickasaw Nation, an Oklahoma tribe that is the 13th largest in the US, experience a disproportionate burden of CVD risk, along with substantial barriers to healthy eating. In 2014, 80% of almost 20,000 adult patients in the Chickasaw tribal health system had pre-hypertension or hypertension, while 84% were overweight or obese and 13% had diabetes. In collaboration with the Chickasaw Nation, we designed the Chickasaw Healthy Eating Environments in Retail Stores (CHEERS) study. This multilevel intervention will be conducted over 24 months in partnership with the first full-service, Chickasaw-owned supermarket, which will open in 2017. CHEERS comprises several mutually reinforcing strategies to improve blood pressure control in people with hypertension. We will implement CHEERS in the Chickasaw town of Ada, Oklahoma, while designating 2 other Chickasaw towns – Sulphur and Tishomingo, Oklahoma – as the control sites, since both lack a tribally-run supermarket. We will recruit 700 adults (350 per arm) with diagnosed hypertension and collect survey and clinical data at baseline, 12 months, and 24 months to assess the effects of CHEERS on blood pressure control and secondary outcomes (food purchasing, diet, and body mass index). Tribal members with uncontrolled hypertension will receive cookbooks featuring heart-healthy recipes tailored to traditional Chickasaw diets and culture, along with invitations to attend the healthy cooking demonstrations. During the intervention, a tribal media team will collect material to create a documentary film on its implications for public health and the local economy. The documentary will be disseminated to tribal leaders, who we will subsequently survey and interview to assess their readiness to implement CHEERS more widely. CHEERS will culminate in a multimedia presentation detailing the supermarket-based intervention and featuring personal success stories by hypertensive community members. Our Specific Aims are: 1) at the environmental level, to collect data on the availability, price, and shelf space devoted to healthy and less healthy options in existing local retail outlets at baseline (before the intervention) and again at 12 and 24 months; 2) at the individual level, to measure change in blood pressure and secondary outcomes among hypertensive community members at baseline and again at 12 and 24 months; and 3) at the policy level, to evaluate the documentary’s effect on tribal leaders’ readiness to implement CHEERS across the Chickasaw Nation and other tribal communities. This study builds on preliminary data, best practices, established partnerships, and existing tribal resources to maximize the likelihood of success. Study findings and multimedia materials will provide much- needed evidence for tribally-run food interventions and will assist tribal nations in reducing CVD-related disparities by improving healthy food access.