Developing a Research Agenda for Cardiovascular Disease Prevention in High-Risk Rural Communities
Cathy L. Melvin is with the Medical University of South Carolina, Charleston. Giselle Corbie-Smith, Thomas C. Ricketts, and Alice Ammerman are with the University of North Carolina at Chapel Hill. Shiriki K. Kumanyika is with the University of Pennsylvania, Philadelphia. Charlotte A. Pratt, Cheryl Nelson, Evelyn R. Walker, and Jane Harman are with the National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD. Guadalupe X. Ayala is with the San Diego State University, San Diego, CA. Lyle G. Best is with the Missouri Breaks Industries Research Inc., Timber Lake, SD. Andrea L. Cherrington is with the University of Alabama-Birmingham. Christina D. Economos is with the Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA. Lawrence W. Green is with the University of California-San Francisco. Steven P. Hooker is with the University of South Carolina, Columbia. David M. Murray is with Ohio State University, Columbus. Michael G. Perri is with the University of Florida, Gainesville.American Journal of Public Health (Impact Factor: 4.55). 04/2013; 110(6). DOI: 10.2105/AJPH.2012.300984
The National Institutes of Health convened a workshop to engage researchers and practitioners in dialogue on research issues viewed as either unique or of particular relevance to rural areas, key content areas needed to inform policy and practice in rural settings, and ways rural contexts may influence study design, implementation, assessment of outcomes, and dissemination. Our purpose was to develop a research agenda to address the disproportionate burden of cardiovascular disease (CVD) and related risk factors among populations living in rural areas. Complementary presentations used theoretical and methodological principles to describe research and practice examples from rural settings. Participants created a comprehensive CVD research agenda that identified themes and challenges, and provided 21 recommendations to guide research, practice, and programs in rural areas. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e11. doi:10.2105/AJPH.2012.300984).
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ABSTRACT: Objective: We examined the efficacy of a community-based, culturally relevant intervention to promote healthy eating and physical activity among African American (AA) women between the ages of 45-65 years, residing in rural Alabama. Methods: We conducted a group randomized controlled trial with counties as the unit of randomization that evaluated two interventions based on health priorities identified by the community: (1) promotion of healthy eating and physical activity; and (2) promotion of breast and cervical cancer screening. A total of 6 counties with 565 participants were enrolled in the study between November 2009 and October 2011. Results: The overall retention rate at 24-month follow-up was 54.7%. Higher retention rate was observed in the "healthy lifestyle" arm (63.1%) as compared to the "screening" arm (45.3%). Participants in the "healthy lifestyle" arm showed significant positive changes compared to the "screening" arm at 12-month follow-up with regard to decrease in fried food consumption and an increase in both fruit/vegetable intake and physical activity. At 24-month follow-up, these positive changes were maintained with healthy eating behaviors, but not engagement in physical activity. Conclusions: A culturally relevant intervention, developed in collaboration with the target audience, can improve (and maintain) healthy eating among AA women living in rural areas.Preventive Medicine 08/2014; 69. DOI:10.1016/j.ypmed.2014.08.016 · 3.09 Impact Factor
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ABSTRACT: Objective To evaluate the effects and costs of three doses of behavioral weight-loss treatment delivered via Cooperative Extension Offices in rural communities.Methods Obese adults (N = 612) were randomly assigned to low, moderate, or high doses of behavioral treatment (i.e., 16, 32, or 48 sessions over two years) or to a control condition that received nutrition education without instruction in behavior modification strategies.ResultsTwo-year mean reductions in initial body weight were 2.9% (95% Credible Interval = 1.7-4.3), 3.5% (2.0-4.8), 6.7% (5.3-7.9), and 6.8% (5.5-8.1) for the control, low-, moderate-, and high-dose conditions, respectively. The moderate-dose treatment produced weight losses similar to the high-dose condition and significantly larger than the low-dose and control conditions (posterior probability > 0.996). The percentages of participants who achieved weight reductions ≥ 5% at two years were significantly higher in the moderate-dose (58%) and high-dose (58%) conditions compared with low-dose (43%) and control (40%) conditions (posterior probability > 0.996). Cost-effectiveness analyses favored the moderate-dose treatment over all other conditions.ConclusionsA moderate dose of behavioral treatment produced two-year weight reductions comparable to high-dose treatment but at a lower cost. These findings have important policy implications for the dissemination of weight-loss interventions into communities with limited resources.Obesity 11/2014; 22(11). DOI:10.1002/oby.20832 · 3.73 Impact Factor
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ABSTRACT: Background Lifestyle modification is recommended for management of prehypertension, yet finding effective interventions to reach rural women is a public health challenge. This community-based clinical trial compared the effectiveness of standard advice to two multi-component theory-based tailored interventions, using web-based or print-mailed delivery, in reducing blood pressure among rural women, ages 40¿69, with prehypertension.Methods289 women with prehypertension enrolled in the Wellness for Women: DASHing towards Health trial, a 12-month intervention with 12-month follow-up. Women were randomly assigned to groups using a 1:2:2 ratio, comparing standard advice (30-minute counseling session) to two interventions (two 2-hour counseling sessions, 5 phone goal-setting sessions, strength-training video, and 16 tailored newsletters, web-based or print-mailed). Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure, healthy eating and activity, adjusted for age and baseline level. General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity.ResultsMean blood pressure reduction ranged from 3.8 (SD¿=¿9.8) mm Hg to 8.1 (SD¿=¿10.4) mm Hg. The 24-month estimated marginal proportions of women achieving normotensive status were 47% for web-based, and 39% for both print-mailed and standard advice groups, with no group differences (p¿=¿.11 and p¿=¿.09, respectively). Web-based and print-mailed groups improved more than standard advice group for waist circumference (p¿=¿.017 and p¿=¿.016, respectively); % daily calories from fat (p¿=¿.018 and p¿=¿.030) and saturated fat (p¿=¿.049 and p¿=¿.013); daily servings of fruit and vegetables (p¿=¿.008 and p¿<¿.005); and low fat dairy (p¿<¿.001 and p¿=¿.002). Greater improvements were observed in web-based versus standard advice groups in systolic blood pressure (p¿=¿.048) and estimated VO2max (p¿=¿.037). Dropout rates were 6% by 6-months, 11.4% by 24 months, with no differences across groups.Conclusions Rural women with prehypertension receiving distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status.Trial registrationClinicalTrials.gov NCT00580528.International Journal of Behavioral Nutrition and Physical Activity 12/2014; 11(1):148. DOI:10.1186/s12966-014-0148-2 · 4.11 Impact Factor
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