COMMUNITY-BASED LIFESTYLE INTERVENTION TO REDUCE CVD RISK & DISPARITIES IN RISK

以社区为基础的生活方式干预降低心血管疾病风险和风险差异 主要调查者：Thomas C.Keyserling，医学博士，公共卫生硕士 心血管疾病(CVD)的发病率在按种族、民族、性别和性别划分的亚组之间存在很大差异 社会经济地位和地理位置。造成这些差距的原因是多方面的，但 已知的重要促成因素是生活方式，弱势群体食用的饮食质量较差，体力活动较少。因此，我们建议进行一项三阶段研究，通过改善生活方式因素来降低心血管疾病风险和风险差异，这些因素是北卡罗来纳州勒诺伊尔县心血管疾病风险的基础，该县是一个农村县，心血管疾病发病率极高，尤其是在其庞大的非裔美国人人口中。在第一阶段，我们将在社会生态模型的框架下，进行全面的形成性评估，以评估与该县心血管疾病风险和降低风险相关的个人、人际、组织、社区和政策因素。为此，我们将使用以社区为基础的参与性研究方法，主要是定性方法。在第二阶段，我们提出了一项研究，包括对所有参与者的生活方式干预和 一项减肥干预的随机对照试验(RCT)，它将比较两种旨在保持减肥的方案。理由是，大多数参与者应该改善生活方式，肥胖的人应该有机会减肥并保持减肥(通常是减肥最具挑战性的组成部分)。首先，我们将招募400名参与者(也是帕特森博士研究的样本)参加一个旨在改善饮食质量和促进体力活动的社区生活方式干预计划(所有这些都是 将鼓励以临床为基础的DeWalt研究改善BP控制)。在6个月的随访中，那些希望减肥的人(N约200人)将参加随机对照试验，而其他人将继续接受基本的生活方式干预。所有RCT患者都将接受为期6个月的强化减肥干预，之后他们将被随机分配到强化减肥干预与标准减肥干预的对比中。将实施社区范围的政策和环境变化干预措施，以支持这些计划，我们将评估不同研究小组的接受情况。结果，包括成本效益， 将在6个月、12个月、18个月和24个月进行评估。在第三阶段，除了分析和报告 在写作时，我们将准备有效的补充研究内容以供传播。

Community-Based Lifestyle Intervention to Reduce CVD Risk & Disparities in Risk Principal Investigator: Thomas C. Keyserling, MD, MPH Large disparities in rates of cardiovascular disease (CVD) exist among subgroups defined by race, ethnicity, socioeconomic status, and geographic location. The reasons for these disparities are multi-factorial, yet an important known contributing factor is lifestyle, with disadvantaged populations consuming diets of poorer quality and being less physically active. Thus, we propose a 3 phase study to reduce CVD risk and disparities in risk by improving lifestyle factors which underlie CVD risk in Lenoir County, NC, a rural county with extremely high rates of CVD, especially among its large African American population. In Phase I, we will conduct a comprehensive formative evaluation, framed by the Socio-Ecological model, to assess individual, interpersonal, organizational, community, and policy factors relevant to CVD risk and risk reduction in this county. To do so, we will use a community-based participatory research approach and primarily qualitative methods. In Phase II, we propose a study that includes a lifestyle intervention given to all participants and a randomized controlled trial (RCT) of a weight loss intervention that will compare two programs designed to maintain weight loss. The rationale is that most participants should improve lifestyle and those who are obese should have the opportunity to lose weight and keep it off (generally the most challenging component of weight loss). At the outset, we will enroll 400 participants (also the sample for Dr. Patterson's study) into a communitybased lifestyle intervention program designed to improve diet quality and promote physical activity (all in the clinic-based DeWalt study to improve BP control will be encouraged to enroll). At 6 month follow-up, those who desire weight loss (N approximately 200) will take part in the RCT while the others will continue to receive the basic lifestyle intervention. All in the RCT will receive an intensive, weight loss intervention lasting 6 months, after which they will be randomly assigned to an intensive vs. standard maintenance of weight loss intervention. Community-wide policy and environmental change interventions will be implemented to support these programs and we will assess uptake by the different study groups. Outcomes, including costeffectiveness, will be assessed at 6, 12, 18, and 24 months. In Phase III, in addition to analysis and report writing, we will prepare effective inten/ention components ofthe study for dissemination.