The PILI 'Āina Project

PILI äina 项目

• 批准号: 10624026
• 负责人: Claire Townsend Ing
• 金额: $ 63.69万
• 依托单位: UNIVERSITY OF HAWAII AT MANOA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10624026
• 关键词: Adult; African American; American Heart Association; Behavior; Behavioral; Biological Markers; Blood Glucose; Blood Pressure; Body Weight decreased; Cardiometabolic Disease; Cardiovascular Diseases; Communities; Consumption; Control Groups; Data; Data Collection; Diabetes Mellitus; Diet; Dietary Intervention; Disease; Disparity; Dose; Dyslipidemias; Eating; Education; Educational Intervention; Effectiveness; Ensure; Ethnic Population; European; Event; Evidence based program; Exertion; Family member; Fishes; Food; Fostering; Fruit; Funding; Glycosylated hemoglobin A; Harvest; Hawaii; Hawaiian; Health; Health Food; Health behavior; Healthy Eating; High Prevalence; Home; Home environment; Household; Hyperlipidemia; Hypertension; Indigenous; Individual; Inequity; Intervention; Interview; Lead; Life Style; Lipids; Measures; Mediating; Mediation; Mediator; Mental Health; Morbidity - disease rate; Native Hawaiian; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Nutritional; Obesity; Outcome; Overweight; Participant; Personal Satisfaction; Persons; Physical activity; Pilot Projects; Population; Prevalence; Process; Psychosocial Factor; Qualifying; Quasi-experiment; Randomized; Randomized, Controlled Trials; Research; Research Methodology; Research Personnel; Risk Factors; Risk Reduction; Self Efficacy; Self Management; Stroke; Structure; System; Taste Perception; Testing; Time; Training; United States National Institutes of Health; Vegetables; access restrictions; base; behavioral outcome; blood lipid; cardiometabolism; cardiovascular health; community based participatory research; cooking; diabetes prevention program; dietary; disorder risk; efficacy testing; evidence base; experience; fruits and vegetables; good diet; impaired glucose tolerance; improved; indexing; intervention refinement; lifestyle intervention; member; mortality; multi-racial; neighborhood disadvantage; participant retention; physical conditioning; prevent; primary outcome; programs; psychosocial; racial population; randomized trial; response; secondary outcome; social cohesion

SUMMARY Native Hawaiians have the highest prevalence of cardiometabolic diseases of any population in Hawai‘i. Diet is strongly implicated as a cause of these disparities. Native Hawaiians historically consumed a diet rich in fish, fresh fruits, and vegetables, but Westernization led to profound shifts in food systems. The Hawaiian Homes Commission Act established a land base for Native Hawaiians to engage in subsistence living and practice their culture. However, today only 20% of Native Hawaiian homesteaders consume at least 1 serving of vegetables per day compared with 73% of other Native Hawaiians. Homesteaders also have twice the prevalence of diet- related diseases (obesity, diabetes, hypertension, dyslipidemia) than other Native Hawaiians. We have developed a multilevel intervention to promote healthy eating, weight loss, and cardiovascular health for overweight/obese Native Hawaiian adults entitled “PILI ‘Āina.” At the individual-level PILI ‘Āina provides 3 months of culturally tailored education based on the Diabetes Prevention Program’s Lifestyle Intervention. The education aims to improve self-management of prevalent cardiometabolic disease (type 2 diabetes, hypertension, and dyslipidemia) and to reduce risk factors for developing new diet-related illness. PILI ‘Āina also includes a 6- month household-level component that provides home garden materials and training as a means of connecting with traditional NH culture, values, and lifestyle in the home environment. A pilot study of PILI ‘Āina was well- received by participants, with 100% retention over 9 months and promising results for cardiometabolic outcomes. We will now conduct a group-randomized controlled trial of PILI ‘Āina on 7 O‘ahu homesteads. First, we will interview the past PILI ‘Āina pilot participants to refine the intervention to better support year-round home gardening and a traditional Native Hawaiian diet. Second, we will conduct a group-randomized controlled trial to test the efficacy of PILI ‘Āina compared to a control group among 180 adult homesteaders with overweight/obesity who have at least 1 other cardiometabolic disease. Data collection will occur at baseline and 3, 9, and 12 months. Primary outcomes are diet quality, adiposity, hemoglobin A1c, blood pressure, and lipids. Secondary outcomes are behavioral and psychosocial factors (e.g., physical activity, self-efficacy) that might mediate effects on primary outcomes. Third, a community-level program will feature traditional cooking and tasting events on all 7 homesteads. Our Specific Aims are to 1) Refine the PILI ‘Āina intervention to optimize its effectiveness for improving diet and managing diet-related cardiometabolic diseases on Native Hawaiian homesteads; 2) Test the efficacy of PILI ‘Āina compared to a control group for improving diet, biomarkers, and behavioral and psychosocial risk factors among homesteaders with diet-related cardiometabolic diseases; and 3) Evaluate the ability of community-wide food demonstrations to promote traditional diets and improve social cohesion on Native Hawaiian homesteads. Results will address the American Heart Association’s call for evidence-based programs to improve diet at the household level for preventing cardiovascular disease.

概括 夏威夷原住民的心脏代谢疾病的患病率最高。饮食是 强烈暗示是这些差异的原因。夏威夷原住民历来消耗富含鱼的饮食， 新鲜的水果和蔬菜，但西方化导致食品系统发生了深刻的转变。夏威夷房屋 委员会法案为夏威夷人建立了一个土地基础，以从事生活和实践 文化。但是，今天只有20％的夏威夷本地宅基地食用至少1份蔬菜 每天与其他夏威夷人的73％相比。寄宿家庭的患病率也是饮食的两倍 相关疾病（肥胖，糖尿病，高血压，血脂异常）比其他夏威夷本地人。我们有 开发了多层次干预措施，以促进健康饮食，体重减轻和心血管健康 超重/肥胖的夏威夷原住民成年人题为“pili'āina”。在个人级别的pili'āina提供3个月 基于糖尿病预防计划的生活方式干预的文化量身定制的教育。教育 旨在改善普遍心脏代谢疾病的自我管理（2型糖尿病，高血压和 血脂异常），并减少发展新饮食相关疾病的危险因素。 pili'āina还包括一个6- 提供家庭花园材料和培训作为连接的手段的家庭级别组件 在家庭环境中使用传统的NH文化，价值观和生活方式。一项对Pili'āina的试点研究很好 由参与者收到，在9个月内保留了100％的保留率，并有望获得心脏代谢结果的结果。 现在，我们将在7个o'ahu宅基地上对Pili'āina进行集体随机对照试验。首先，我们会的 采访过去的pili'āina飞行员参与者，以完善干预措施，以更好地支持全年的房屋 园艺和传统的夏威夷饮食。其次，我们将进行集体随机对照试验 与180名成人宅基地的对照组相比，要测试pili'āina的效率 超重/肥胖至少有1种心脏代谢疾病。数据收集将在基线和 3、9和12个月。主要结果是饮食质量，肥胖，血红蛋白A1C，血压和脂质。 次要结果是行为和社会心理因素（例如身体活动，自我效能感），可能 介导对主要结果的影响。第三，一个社区级的计划将以传统的烹饪和 在所有7个宅基地上品尝活动。我们的具体目的是1）完善pili'āina干预以优化 它在改善饮食和管理与饮食相关的心脏代谢疾病的有效性 宅基地； 2）与对照组相比，测试Pili'āina的效率，以改善饮食，生物标志物和 与饮食相关的心脏代谢疾病的寄宿家庭中的行为和社会心理危险因素；和 3）评估社区范围内的食物示范能够促进传统饮食并改善社会的能力 夏威夷本地宅基地的凝聚力。结果将解决美国心脏协会的呼吁 基于证据的计划，以预防心血管疾病的家庭水平改善饮食。