An Intergenerational CBPR Intervention to Reduce Appalachian Health Disparities

减少阿巴拉契亚健康差异的代际 CBPR 干预措施

• 批准号: 8034944
• 负责人: Nancy E. Schoenberg
• 金额: $ 9.96万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-10 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8034944
• 关键词: Affect; Appalachian Region; Behavior; Behavioral Risk Factor Surveillance System; Body Weight decreased; Cardiovascular system; Cause of Death; Cessation of life; Characteristics; Chronic Disease; Communities; Dancing; Data; Death Rate; Development; Diabetes Mellitus; Diet; Dietary intake; Educational workshop; Effectiveness of Interventions; Ensure; Epidemiology; Equipment and supply inventories; Evaluation; Exercise; Goals; Health; Health care facility; Heart Diseases; Institution; Intake; Intervention; Interview; Kentucky; Life; Linguistics; Malignant Neoplasms; Modeling; Morbidity - disease rate; Nutritionist; Obesity; Overweight; Participant; Phase; Physical activity; Population; Process; Protocols documentation; Psychologist; Questionnaires; Randomized; Regimen; Reporting; Research; Research Personnel; Research Project Grants; Risk Factors; Rural; Solutions; Structure; Testing; Training; Translational Research; Visit; Weight; Work; Youth; base; burden of illness; community based participatory research; cooking; design; energy balance; ethnographic method; fruits and vegetables; good diet; health disparity; improved; informant; innovation; instrument; intergenerational; meetings; member; mortality; motivational enhancement therapy; prevent; public health relevance; sedentary

DESCRIPTION (provided by applicant): Appalachian communities are disproportionately affected by the leading causes of morbidity and mortality. Specifically, cancer and diabetes mortality rates are 17 percent and 33 percent above national rates. The Appalachian region also has the nation's highest cardiovascular death rates with 328.9 to 405.9 deaths per 100,000 population. A leading risk factor implicated in all of these health disparities is problematic energy balance; BRFSS data indicate that only 22 percent of Appalachian Kentuckians receive the RDI for fruit and vegetable intake, between 62-76 percent are overweight or obese, and between 45-62 percent report sedentary lives. Nationally, Kentucky ranks third in not meeting fruit and vegetable intake, #3 in overweight, #9 in obesity, and #3 for sedentary behavior. Of particularly elevated concern, the obesity rate has doubled since 1990 and Kentucky youth rank #1 in overweight and significantly lower than their national counterparts in fruit/vegetable intake and physical activity. Despite the pervasiveness of these risk factors and disease burdens, Appalachian culture contains many characteristics and structures that offer locally based solutions, including strong intergenerational ties, faith-based activism, and healthy traditional activities. Drawing on epidemiologic evidence and informed by our current successful faith-based, trained lay health advisor tailored intervention (R01CA108696), we propose to administer and evaluate an intergenerational, culturally appropriate CBPR energy balance intervention that has the potential of greatly preventing and reducing cancer, CVD, and diabetes morbidity and mortality by increasing fruit and vegetable intake, lowering BMI, and increasing physical activity. Working in partnership with 70 faith-based institutions in Appalachian Kentucky, the proposed project has three phases: Phase I (Developmental phase) will use ethnographic methods (socio-ecological inventories, key informant interviews, participant observation) to assess the barriers to and facilitators of healthy diet, weight, and physical activity; develop culturally appropriate instruments; and modify existing interventions (Healthy Body/ Healthy Spirit and We Can!) to be responsive to local culture. During Phase II, we will administer the group randomized, staggered CBPR intervention based on Healthy Body/ Healthy Spirit and NHLBI's We Can! Theoretically informed by the SCT, TTM, and socio-ecological determinants of health, the intervention will include culturally appropriate workshops (with locally relevant activities, like square dance, community gardening, story telling, and cooking classes), tailored lay health adviser visits, and motivational interviewing. Throughout the project, the RE-AIM model will inform our evaluation. During Phase III, we will undertake qualitative process evaluation interviews and evaluate consistency with CBPR principles. PUBLIC HEALTH RELEVANCE: Rural Appalachian communities suffer some of the highest rates of the most common causes of death; cancer, heart disease, and diabetes. These conditions are strongly associated with being overweight and having a substandard diet and inadequate physical activity, risk factors that are pervasive in Appalachia. The proposed project works in partnership with 70 faith-based institutions in Appalachian Kentucky to develop, administer, and evaluate an intergenerational intervention that uses culturally appropriate activities and workshops to reduce overweight and increase physical activity and fruit and vegetable intake.

描述（由申请人提供）：阿巴拉契亚社区受发病和死亡的主要原因的影响不成比例。具体而言，癌症和糖尿病的死亡率比国家率高17％和33％。阿巴拉契亚地区的心血管死亡率最高，每100,000人口为328.9至405.9死亡。与所有这些健康差异有关的主要风险因素是能源平衡问题。 BRFSS数据表明，只有22％的阿巴拉契亚肯塔基人接受了RDI的水果和蔬菜摄入量，在62-76％之间超重或肥胖，在45-62％之间，报告了久坐的生活。在全国范围内，肯塔基州在不遇到水果和蔬菜摄入量的情况下排名第三，超重的第三名，肥胖症的第9名，久坐行为的＃3排名第三。自1990年以来，肥胖率尤为高，肥胖率增加了一倍，而肯塔基州青年在超重中排名第一，并且在水果/蔬菜摄入量和体育锻炼方面的全国同行大大低于其国家。尽管这些危险因素和疾病负担都普遍存在，但阿巴拉契亚文化包含许多特征和结构，这些特征和结构提供了本地解决方案，包括强烈的代际关系，基于信仰的行动主义和健康的传统活动。 Drawing on epidemiologic evidence and informed by our current successful faith-based, trained lay health advisor tailored intervention (R01CA108696), we propose to administer and evaluate an intergenerational, culturally appropriate CBPR energy balance intervention that has the potential of greatly preventing and reducing cancer, CVD, and diabetes morbidity and mortality by increasing fruit and vegetable intake, lowering BMI, and increasing physical 活动。该拟议项目与阿巴拉契亚肯塔基州的70个基于信仰的机构合作，有三个阶段：第一阶段（发展阶段）将使用民族志方法（社会生态学库存，关键的线人访谈，参与者观察）来评估健康饮食，体重，体重和身体活动的障碍和促进者；开发文化适当的工具；并修改现有的干预措施（健康的身体/健康精神，我们可以！）对当地文化做出反应。在第二阶段，我们将根据健康的身体/健康精神和NHLBI的随机，交错的CBPR干预进行管理！理论上由SCT，TTM和社会生态生态决定因素告知，该干预措施将包括文化上适当的研讨会（包括当地相关的活动，例如方形舞蹈，社区园艺，讲故事和烹饪课），量身定制的外行健康顾问访问和动机面试。在整个项目中，RE-AIM模型将为我们的评估提供信息。在第三阶段，我们将进行定性过程评估访谈，并评估与CBPR原则的一致性。公共卫生相关性：阿巴拉契亚农村社区遭受最常见的死亡原因率最高；癌症，心脏病和糖尿病。这些疾病与超重，饮食不合标准和体育锻炼不足，阿巴拉契亚无处不在的危险因素密切相关。拟议的项目与阿巴拉契亚肯塔基州的70个基于信仰的机构合作，开发，管理和评估一种代际干预措施，该干预使用文化上适当的活动和讲习班来减少超重并增加体育锻炼，并增加了体育锻炼以及果实和蔬菜摄入量。