The KaHOLO Project: Preventing Cardiovascular Disease in Native Hawaiians

描述(申请人提供)：夏威夷原住民(NH)的慢性病发病率较高，如心血管疾病(CVD)、糖尿病和癌症。高血压(HTN)是心血管疾病的一个重要的可改变的危险因素，夏威夷土著(NH)的高血压(HTN)比白人高70%。事实上，NH患心血管疾病(如中风和冠心病)的可能性是普通人的3-4倍，而且年龄更小。除了处方药物外，HTN的改善还可以通过增加体力活动(PA)和自我管理教育(例如，压力管理、减少钠摄入量、减肥和戒烟)来实现。然而，许多常用的PA，如慢跑和使用跑步机，对于NH来说很难启动和维持，因为社会经济障碍，以及缺乏与NH首选的生活方式和文化价值观(即家庭相互依赖、基于群体的PA、文化PA)的一致性。这项研究建议使用草裙舞，NH的传统舞蹈形式和NH文化的标志，作为针对HTN管理的具有文化相关性和可持续的心血管疾病预防计划的PA基础。草裙舞培训不仅在夏威夷很受欢迎，而且在全美大多数州都有784小时的草裙舞学校。利用基于社区的参与性研究(CBPR)框架，基于草裙舞的心血管疾病健康干预措施得到了库木草裙舞专家(草裙舞专家和草裙舞传统的守护者)、NH个人和社区的强烈支持。此外，草裙舞训练被确定为中等强度和剧烈强度的PA产生相当于能量消耗的代谢。来自我们的试点CBPR随机对照试验(RCT)研究的数据发现，每周两次、持续12周的60分钟草裙草裙训练使收缩压(BP)比对照组多降低7.5毫米汞柱(SD=16.5)，但长期影响喜忧参半，该研究没有评估心血管疾病的风险。有趣的是，试点干预还改善了社会功能，减少了身体疼痛，并感受到了种族歧视，这表明干预可能通过一种心理社会和社会文化机制影响BP。在此应用程序中，我们提供了CBPR指导的RCT，250 NH，医生在夏威夷和华盛顿州诊断HTN。我们将比较为期6个月的干预措施在降低收缩血压和心血管风险评分方面的效果，该干预措施结合了草裙舞训练和由同伴教育者和库木草裙舞教授的简短的文化定制HTN自我管理教育，并与等待名单对照组进行了比较。我们还将确定健康行为(例如吸烟)、自我调节、心理社会(例如社会支持)和社会文化因素(例如感知到的种族主义)对降低血压的中介作用。我们的目标是建立在hLau hula和nh组织现有的广泛基础设施的基础上，以提供可持续的、文化优先的心血管疾病预防计划。

DESCRIPTION (provided by applicant): Native Hawaiians (NH) has higher rates of chronic diseases, such as cardiovascular disease (CVD), diabetes, and cancer. Hypertension (HTN), an important modifiable risk factor for CVD, is 70% higher in Native Hawaiians (NH) than in Whites. In fact, NH is 3-4 times more likely to develop CVD conditions, such as stroke and coronary heart disease, and at a younger age. In addition to prescribed medication, improvements in HTN can be achieved through increased physical activity (PA) and self-management education (e.g. stress management, reduces sodium intake, weight-loss, and smoking cessation). Yet, many commonly prescribed PA, such as jogging and use of treadmills, are difficult for NH to initiate and maintain because of socioeconomic barriers and lack of alignment with NH preferred modes of living and cultural values (i.e. familial interdependence, group-based PA, cultural PA). This proposed research uses hula, the traditional dance form of NH and hallmark of NH culture, as the PA basis for a culturally relevant and sustainable CVD prevention program targeting HTN management. Hula training is popular, not only Hawai'i, but across the U.S. through the 784 h lau hula (hula schools) found in most States. Using a community-based participatory research (CBPR) framework, a hula-based CVD health intervention was strongly endorsed by Kumu hula (hula experts and guardians of hula traditions), NH individuals, and communities. Further, hula training was determined to yield metabolic equivalent of energy expenditure as a moderate and vigorous intensity PA. Data from our pilot CBPR randomized control trial (RCT) study found that 60 minutes of hula training twice a week for 12 weeks reduced systolic blood pressure (BP) by 7.5 mmHg (SD=16.5) more than the control group, but the long-term effects were mixed and the study did not assess CVD risk. Interestingly, the pilot intervention also improved social functioning, reduced physical pain, and perceived racial discrimination, suggesting a possible psychosocial and socio-cultural mechanism by which the intervention affects BP. In this application we offer a CBPR guided RCT of 250 NH with physician-diagnosed HTN in Hawai'i and Washington State. We will compare the effects of a 6-month intervention that combines hula training and brief culturally-tailored HTN self- management education delivered by peer educators and Kumu hula to a wait-list control group in reducing systolic BP and CVD risk scores. We will also determine the mediating effects of health behaviors (e.g., smoking), self-regulation, psychosocial (e.g., social support), and socio-cultural factors (e.g., perceived racism) on blood pressure reduction. Our goal is to build on the existing widespread infrastructure of h lau hula and NH organizations to deliver a sustainable, culturally-preferred CVD prevention program.