Heart of the Family: A Cardiovascular Disease and Type 2 Diabetes Risk Reduction Intervention in High-Risk Rural Families

摘要 美国农村人口心血管疾病(CVD)的患病率高得不成比例 2型糖尿病(T2D)与城市人口的比较。许多农村社区也有更大的风险因素 比城市社区更沉重的负担，包括不健康的饮食，更高的运动率，肥胖率，以及 吸烟，以及高血压、高胆固醇血症和高血糖的较高患病率。复利 这些都是糟糕的社会经济条件和有限的卫生资源。农村社区的拉美裔居民 由于发病率较高，可能会比非西班牙裔居民经历更严重的心血管疾病和T2D疾病和风险负担 贫穷、较低的教育程度以及获取资源的更大障碍。美国拉美裔美国人 在任何种族或民族中，T2D的比率都是最高的。适应文化的生活方式改变 需要采取干预措施，以降低农村拉美裔和非拉美裔人口中的T2D和CVD风险。 修改策略通常以个人为目标，虽然这些策略可能会立即导致行为改变 干预后，健康行为的持续参与很少实现。家庭参与度在 生活方式干预可能会支持持续的健康行为，特别是在农村和西班牙裔 通常更多地依赖家庭成员获得社会支持的人群。我们将进行一项 比较家庭之心与主动干预效果的随机对照试验 控制干预。我们将比较3个月(短期)和12个月(长期)对心脏的影响 家庭干预对生物和行为T2D和CVD危险因素的影响并评估种族 缓和干预效果。我们还将研究每个积极干预的二元成员是如何 对健康生活方式行为的参与度和对伴侣参与健康生活方式的支持程度 生活方式行为会影响他们自己和伴侣的结果。以家庭为中心的干预可能会更好 支持长期参与健康的生活方式行为，以降低高危农村人群的T2D和CVD风险 拉美裔和非拉美裔美国人。此外，这种以社区为基础的干预措施具有广泛的潜力。 实施成功地解决了美国拉美裔社区的T2D和CVD健康差距。

ABSTRACT Rural populations in the U.S. have disproportionately higher prevalence of cardiovascular disease (CVD) and type 2 diabetes (T2D) compared to urban populations. Many rural communities also have greater risk factor burden than urban communities including unhealthier diet, higher rates of physical inactivity, obesity, and smoking, and higher prevalence of hypertension, hypercholesterolemia, and hyperglycemia. Compounding these are poor socioeconomic conditions and limited health resources. Hispanic residents of rural communities may experience worse CVD and T2D disease and risk burden than non-Hispanic residents due to higher rates of poverty, lower educational attainment, and greater barriers accessing resources. U.S. Hispanics have among the highest rates of T2D of any racial or ethnic group. Culturally responsive lifestyle modification interventions are needed to reduce T2D and CVD risk in rural Hispanic and non-Hispanic populations. Modification strategies commonly target individuals and, while these may result in behavior change immediate post-intervention, sustained engagement in healthy behaviors is seldom achieved. Family engagement in lifestyle interventions may support sustained engagement in healthy behaviors especially in rural and Hispanic populations that often have greater reliance on family members for social support. We will conduct a randomized controlled trial to compare the effects of a dyadic intervention, Heart of the Family, to an active control intervention. We will compare 3-month (short-term) and 12-month (long-term) impact of the Heart of the Family intervention on biological and behavioral T2D and CVD risk factors and evaluate whether ethnicity moderates intervention effects. We will also examine how each active intervention dyad member’s engagement in healthy lifestyle behaviors and level of support for their partner’s engagement in healthy lifestyle behaviors affects their own and their partner’s outcomes. A family focused intervention may better support long-term engagement in healthy lifestyle behaviors to reduce T2D and CVD risk among at-risk rural Hispanics and non-Hispanics. Further, this community-based intervention has significant potential for broad implementation to successfully address T2D and CVD health disparities across U.S. Hispanic communities.