Hypertension (HTN), a major health problem in the US, is the most prevalent modifiable risk factor for cardio- vascular disease (CVD), the leading killer of women. The incidence of HTN in women increases markedly after menopause, equaling or exceeding that in men. The prehypertension category of blood pressure (BP)? systolic BP of 120-139 mm Hg or diastolic BP of 80-89 mm Hg - designates individuals at high risk of developing HTN. Prehypertensive women are not candidates for drug therapy, but for lifestyle modifications to prevent progression to HTN and CVD. Recommended lifestyle modifications include adoption of the Dietary Approaches to Stop Hypertension (DASH) diet that is high in fruits, vegetables and low fat dairy products;dietary sodium reduction;regular endurance physical activity supplemented by resistance exercise;and weight reduction by those who are overweight or obese. A few studies of face-to-face individual and/or group interventions have demonstrated that these lifestyle modifications could lower BP over 6 months in pre-hypertensive individuals. There remains a need to develop distance delivery methods to target rural women with similar behavioral interventions to lower BP. This competitive renewal application will build upon our current work in which we demonstrated that computer-generated print (mailed) newsletters tailored to constructs in the Health Promotion Model (HPM) resulted in significant and clinically important changes in behavioral and biomarkers of healthy eating and physical activity in a general population of rural midlife/older women. The proposed randomized controlled trial will evaluate Internet versus mailed print delivery methods for delivering theory-based tailored newsletters to encourage lifestyle change for BP reduction. A sample of 275 prehypertensive rural women aged 50-69 will be randomly assigned 2:2:1 to receive a) tailored messages delivered via the Internet and brief telephone counseling, b) tailored print newsletters delivered via mail and brief telephone counseling, ore) initial standard advice only. The project's primary outcomes will be change in and criterion level achievement for healthy eating, physical activity and blood pressure at 6 &12 months during the intervention and at 18 &24 months during follow-up. Change in behavior-specific cognitive/ perceptual influences from the HPM also will be examined to validate the theory base for the newsletters. Results of this study may lead to expanded access to lifestyle guidance via the Internet by other populations.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing Science: Adults and Older Adults Study Section (NSAA)
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Huss, Karen
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University of Nebraska Medical Center
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Boeckner, L S; Young, T D; Pullen, C H et al. (2015) Dietary mineral intakes of rural midlife to older adult women with prehypertension in Midwestern United States. J Nutr Health Aging 19:13-9
Hageman, Patricia A; Pullen, Carol H; Hertzog, Melody et al. (2014) Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the Wellness for Women: DASHing towards Health clinical trial. Int J Behav Nutr Phys Act 11:148
Hageman, Patricia A; Pullen, Carol H; Dizona, Paul et al. (2013) Obesity and Physical Function in Rural Women who enroll in a Lifestyle Modification Intervention for Reducing Blood Pressure. Cardiopulm Phys Ther J 24:4-11
Hageman, Patricia A; Pullen, Carol H; Hertzog, Melody et al. (2012) Associations of cardiorespiratory fitness and fatness with metabolic syndrome in rural women with prehypertension. J Obes 2012:618728
Yates, Bernice C; Pullen, Carol H; Santo, Jonathan Bruce et al. (2012) The influence of cognitive-perceptual variables on patterns of change over time in rural midlife and older women's healthy eating. Soc Sci Med 75:659-67
Walker, Susan Noble; Pullen, Carol H; Hageman, Patricia A et al. (2010) Maintenance of activity and eating change after a clinical trial of tailored newsletters with older rural women. Nurs Res 59:311-21
Walker, Susan Noble; Pullen, Carol H; Boeckner, Linda et al. (2009) Clinical trial of tailored activity and eating newsletters with older rural women. Nurs Res 58:74-85
Boeckner, Linda S; Pullen, Carol H; Walker, Susan Noble et al. (2007) Eating behaviors and health history of rural midlife to older women in the midwestern United States. J Am Diet Assoc 107:306-10
Walker, Susan Noble; Pullen, Carol H; Hertzog, Melody et al. (2006) Determinants of older rural women's activity and eating. West J Nurs Res 28:449-68; discussion 469-74
Hageman, Patricia A; Walker, Susan Noble; Pullen, Carol H et al. (2005) Physical activity and fitness among midlife and older rural women. J Aging Phys Act 13:327-42

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