Community-Based Lifestyle Intervention to Reduce CVD Risk &Disparities in Risk Principal Investigator: Thomas C. Keyserling, MD, MPH Large disparities in rates of cardiovascular disease (CVD) exist among subgroups defined by race, ethnicity, socioeconomic status, and geographic location. The reasons for these disparities are multi-factorial, yet an important known contributing factor is lifestyle, with disadvantaged populations consuming diets of poorer quality and being less physically active. Thus, we propose a 3 phase study to reduce CVD risk and disparities in risk by improving lifestyle factors which underlie CVD risk in Lenoir County, NC, a rural county with extremely high rates of CVD, especially among its large African American population. In Phase I, we will conduct a comprehensive formative evaluation, framed by the Socio-Ecological model, to assess individual, interpersonal, organizational, community, and policy factors relevant to CVD risk and risk reduction in this county. To do so, we will use a community-based participatory research approach and primarily qualitative methods. In Phase II, we propose a study that includes a lifestyle intervention given to all participants and a randomized controlled trial (RCT) of a weight loss intervention that will compare two programs designed to maintain weight loss. The rationale is that most participants should improve lifestyle and those who are obese should have the opportunity to lose weight and keep it off (generally the most challenging component of weight loss). At the outset, we will enroll 400 participants (also the sample for Dr. Patterson's study) into a communitybased lifestyle intervention program designed to improve diet quality and promote physical activity (all in the clinic-based DeWalt study to improve BP control will be encouraged to enroll). At 6 month follow-up, those who desire weight loss (N approximately 200) will take part in the RCT while the others will continue to receive the basic lifestyle intervention. All in the RCT will receive an intensive, weight loss intervention lasting 6 months, after which they will be randomly assigned to an intensive vs. standard maintenance of weight loss intervention. Community-wide policy and environmental change interventions will be implemented to support these programs and we will assess uptake by the different study groups. Outcomes, including costeffectiveness, will be assessed at 6, 12, 18, and 24 months. In Phase III, in addition to analysis and report writing, we will prepare effective inten/ention components ofthe study for dissemination.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Specialized Center (P50)
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Special Emphasis Panel (ZCA1-SRLB-3)
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University of North Carolina Chapel Hill
Chapel Hill
United States
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Calancie, Larissa; Keyserling, Thomas C; Taillie, Lindsey Smith et al. (2018) TAS2R38 Predisposition to Bitter Taste Associated with Differential Changes in Vegetable Intake in Response to a Community-Based Dietary Intervention. G3 (Bethesda) 8:2107-2119
Wu, Jia-Rong; Cummings, Doyle M; Li, Quefeng et al. (2018) The effect of a practice-based multicomponent intervention that includes health coaching on medication adherence and blood pressure control in rural primary care. J Clin Hypertens (Greenwich) 20:757-764
Jilcott Pitts, Stephanie B; Keyserling, Thomas C; Johnston, Larry F et al. (2017) Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults. J Acad Nutr Diet 117:1618-1627
Thayer, Linden M; Pimentel, Daniela C; Smith, Janice C et al. (2017) Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items. Am J Health Educ 48:11-21
Cené, Crystal W; Halladay, Jacqueline R; Gizlice, Ziya et al. (2017) A multicomponent quality improvement intervention to improve blood pressure and reduce racial disparities in rural primary care practices. J Clin Hypertens (Greenwich) 19:351-360
Halladay, Jacqueline R; Donahue, Katrina E; Cené, Crystal W et al. (2017) The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial. Patient Educ Couns 100:542-549
Embree, Genevieve G R; Samuel-Hodge, Carmen D; Johnston, Larry F et al. (2017) Successful long-term weight loss among participants with diabetes receiving an intervention promoting an adapted Mediterranean-style dietary pattern: the Heart Healthy Lenoir Project. BMJ Open Diabetes Res Care 5:e000339
Cené, Crystal W; Halladay, Jacqueline R; Gizlice, Ziya et al. (2016) Associations between subjective social status and physical and mental health functioning among patients with hypertension. J Health Psychol 21:2624-2635
Chatterjee, Avik; Daftary, Genevieve; Gatison, Lenward et al. (2016) Lessons Learned From a Partnership to Evaluate a School Food Program. Prog Community Health Partnersh 10:577-584
Keyserling, Thomas C; Samuel-Hodge, Carmen D; Pitts, Stephanie Jilcott et al. (2016) A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health 16:732

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