Cardiovascular (CV) disease remains the leading cause of death in this country and the City of Boston, (ref) Ofconcern, there is compelling evidence that a disproportionate share of the burden of CV disease, andmetabolic/vascular risk factors falls on racial and ethnic minorities. [1] [3, 4] Eliminating these disparities is anational and local health priority; and adequate access to culturally appropriate, clinically effective preventivecardiovascular services is important to achieve this goal, (ref) The trend for individuals to have multiple riskfactors is increasing[5] and although weight loss and lifestyle interventions have been shown to modifymetabolic/vascular abnormalities and CVD risk factors, [3] [6-8] prevalence estimates of these conditionscontinue to increase, particularly for African Americans.[5] The barriers to effective risk factor reduction aremultifactorial, including individual biopsychosocial and environmental factors.[9, 10] The high prevalence ofAfrican Americans with known multiple risk factors for CAD, the evidence that modifying risk factors canprevent or modify these conditions and the fact that barriers to effective risk factor reduction are multifactorial,suggests that prevention and risk factor reduction efforts should focus on comprehensive risk reductionstrategies in this at-risk group. [5]Our team will test the feasibility of conducting a randomized, non-blinded,'parallel-group, study to assess theoutcome of a community based, multiple risk factor diabetes prevention program in an at-risk African Americancommunity (Roxbury). The primary aims of the study are to demonstrate the feasibility of recruiting andretaining African American adults to this randomized trial and to describe changes in weight and waistcircumference as well as behavioral, psychosocial and physiological endpbints. Recruitment in randomizedclinical trials can be difficult in the African American community because of mistrust. This trial arises fromseveral years of community partnership in the community of interest and builds on the trust established in thisclinical work. In addition, little is known about the effectiveness, in underserved communities, of communitybased,culturally appropriate, multiple risk reduction interventions. Successful implementation of a communitybased multiple risk factor reduction program in this underserved and at-risk community has implications forpractice and policy.
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