Biobehavioral Cardiovascular Health Promotion Intervention in a State Prison Syst

描述(由申请人提供)：我们研究计划的长期目标是通过在监狱中实施全州范围的心血管风险因素减少计划来改善囚犯的心血管(CV)健康。这项针对男性囚犯的拟议研究旨在测试行为心血管风险降低(BCVRR)干预对肯塔基州惩教署(KyDOC)4所州立监狱的健康结果(即库珀诊所死亡风险指数[包括心率、血压、糖尿病、吸烟状况、体重指数、年龄和心肺健康状况的综合指数]、血脂状况和可改变的生活方式行为)的影响。这项研究将在4所公立监狱中进行。将采用多基线、重复测量的设计，所有参与者都接受干预，并有3个月的磨合期，在此期间建立自己的基线，而不进行干预。这种类型的设计在监狱环境中非常理想，因为在监狱环境中，不可能将囚犯随机分配到控制组。我们将招募560名囚犯，以达到完成该计划的400人的目标，因为根据现有文献和我们之前的工作，预计辍学率为30%。在每个监狱，将在四个时间点(磨合基线、干预前基线、干预后立即和干预后3个月)收集囚犯的数据。BCVRR干预是一个为期12周的CV健康教育/行为改变和有氧体育训练计划，包括：1)由社区认证的健康教育人员和其他训练有素的专业人员提供的带有行为改变策略的健康教育课程；以及2)由CV风险降低培训师领导的有氧锻炼计划。短期和长期效果将在干预12周后立即和干预结束后3个月进行评估。具体目标1：确定BCVRR干预对降低心血管危险因素(即总库珀临床死亡风险指数[CCMRI]、CCMRI的单个可修改成分、糖尿病患者的HgA1c以及血脂状况)的影响假设1：与每个结果的磨合和干预前基线相比，总CCMRI将显著下降，CCMRI的个体可修改成分将显著改善，糖尿病患者的HgA1c将得到改善，并且随着时间的推移，血脂状况将得到改善。具体目标2：确定干预对可改变生活方式行为的自我报告(即囚犯健康风险评估)的影响。假设2：与磨合和干预前的每个结果的基线相比，自我报告的可改变的生活方式行为将有显著的改善。具体目标3：从拟议的研究中产生数据，以便在全州范围内测试并在所有13个KyDOC州立监狱实施干预措施，以维持该计划。 公共卫生相关性：叙述性心血管疾病是狱中死亡的主要原因，囚犯心血管危险因素的发生率高得不成比例。我们研究计划的目标是通过在监狱中实施心血管危险因素减少计划来改善囚犯的心血管健康。对心血管危险因素的有效管理可以改善囚犯在服刑期间和获释后的健康，并减轻心血管疾病造成的重大个人和社会负担。

DESCRIPTION (provided by applicant): The long-term objective of our program of research is to improve the cardiovascular (CV) health of inmates by implementation of a state-wide CV risk factor reduction program in prisons. The purpose of the proposed study in male inmates is to test the effects of a behavioral CV risk reduction (BCVRR) intervention on health outcomes (i.e., Cooper Clinic Mortality Risk Index [a composite index that includes heart rate, blood pressure, diabetes, smoking status, body mass index, age, and cardio-respiratory fitness], lipid profile, and modifiable lifestyle behaviors) in 4 Kentucky Department of Corrections (KyDOC) state-run prisons. This study will be conducted in 4 state operated prisons. A multiple baselines, repeated measures design will be used in which all participants receive the intervention, and all have a 3 month run-in period in which to establish their own baseline without intervention. This type of design is ideal in the prison environment where it is not possible to randomly assign inmates to a control group. We will enroll 560 inmates to reach our goal of 400 who finish the program, as a drop-out rate of 30% is expected based on existing literature and our prior work. At each prison, data will be gathered from inmates at four time points (run-in baseline, pre-intervention baseline, immediately post-intervention and 3 months post-intervention). The BCVRR intervention is a 12-week CV health education/behavior change, and aerobic physical training program, consisting of: 1) health education with behavior change strategies session delivered by certified health educators and other trained professionals from the community; and 2) an aerobic exercise program led by CV risk reduction trainers. Short and long-term effects will be measured immediately after the 12-week intervention and 3 months after the intervention ends. Specific Aim 1: To determine the impact of the BCVRR intervention on CV risk factor reduction (i.e., the total Cooper Clinic Mortality Risk Index [CCMRI], individual modifiable components of the CCMRI, HgA1c in diabetics, and lipid profile) Hypothesis 1: There will be a significant decline in total CCMRI and improvement in the individual modifiable components of the CCMRI and an improved HgA1c for diabetics, and improved lipid profile over time following the intervention, compared with the run-in and pre-intervention baseline for each outcome. Specific Aim 2: To determine the impact of the intervention on the self-report of modifiable lifestyle behaviors (i.e., Inmate Health Risk Assessment). Hypothesis 2: There will be a significant improvement in self-reported modifiable lifestyle behaviors compared with the run-in and pre-intervention baseline for each outcome. Specific Aim 3: To generate data from the proposed study for a proposal for state-wide testing and implementation of the intervention at all of the 13 KyDOC state-run prisons in order to sustain the program. PUBLIC HEALTH RELEVANCE: Narrative Cardiovascular disease is the main cause of death in rison and inmates have disproportionately higher rates of cardiovascular risk factors. The objective of our program of research is to improve the cardiovascular health of inmates by implementation of a cardiovascular risk factor reduction program in prisons. Effective management of cardiovascular risk factors could improve the health of inmates both while incarcerated and once released, and reduce the substantial personal and societal burden of cardiovascular disease.