title: Strong Hearts, healthy communities: a rural community-based cardiovascular disease prevention program.
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of death in the United States and places substantial burden on the health care system. Rural populations, especially women, have considerably higher rates of cardiovascular disease, influenced by poverty, environmental factors, access to health care, and social and cultural attitudes and norms.
  
  
  METHODS
  This community-based study will be a two-arm randomized controlled efficacy trial comparing a multi-level, community program (Strong Hearts, Healthy Communities) with a minimal intervention control program (Strong Hearts, Healthy Women). Strong Hearts, Healthy Communities was developed by integrating content from three evidence-based programs and was informed by extensive formative research (e.g. community assessments, focus groups, and key informant interviews). Classes will meet twice weekly for one hour for 24 weeks and focus on individual-level skill building and behavior change; social and civic engagement are also core programmatic elements. Strong Hearts, Healthy Women will meet monthly for hour-long sessions over the 24 weeks covering similar content in a general, condensed format. Overweight, sedentary women 40 years of age and older from rural, medically underserved communities (12 in Montana and 4 in New York) will be recruited; sites, pair-matched based on rurality, will be randomized to full or minimal intervention. Data will be collected at baseline, midpoint, intervention completion, and six-month, one-year, and eighteen months post-intervention. The primary outcome is change in body weight; secondary outcomes include physiologic, anthropometric, behavioral, and psychosocial variables. In the full intervention, engagement of participants' friends and family members in partnered activities and community events is an intervention target, hypothesizing that there will be a reciprocal influence of physical activity and diet behavior between participants and their social network. Family members and/or friends will be invited to complete baseline and follow-up questionnaires about their health behaviors and environment, height and weight, and attitudes and beliefs.
  
  
  CONCLUSIONS
  Strong Hearts, Healthy Communities aims to reduce cardiovascular disease morbidity and mortality, improve quality of life, and reduce cardiovascular disease-related health care burden in underserved rural communities. If successful, the long-term goal is for the program to be nationally disseminated, providing a feasible model to reduce cardiovascular disease in rural settings.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT02499731 Registered on July 1, 2015.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Savage Hall, Room 412, Ithaca, NY, 14853, USA. rs946@cornell.edu.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Seguin
authors.affiliation: Montana State University Extension, 235 Culbertson Hall, Bozeman, MT, 59718, USA. galen.eldridge@montana.edu.
authors.forename: Galen
authors.initials: G
authors.lastname: Eldridge
authors.affiliation: Division of Nutritional Sciences, Cornell University, Savage Hall, Room 413, Ithaca, NY, 14853, USA. mlg22@cornell.edu.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Graham
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA. sara.folta@tufts.edu.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Folta
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA. miriam.nelson@tufts.edu.
authors.forename: Miriam E
authors.initials: ME
authors.lastname: Nelson
authors.affiliation: Center for Rural Community Health, Bassett Research Institute, One Atwell Road, Cooperstown, NY, 13326, USA. david.strogatz@bassett.org.
authors.forename: David
authors.initials: D
authors.lastname: Strogatz
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D050177:Overweight; D011322:Primary Prevention / Q000458:organization & administration*; D011788:Quality of Life; D040242:Risk Reduction Behavior; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States
references.citation: Arch Intern Med. 2008 Apr 14;168(7):713-20
references.pmid: 18413553
references.citation: Appetite. 2012 Oct;59(2):541-9
references.pmid: 22796186
references.citation: J Rural Health. 2012 Fall;28(4):392-7
references.pmid: 23083085
references.citation: J Hunger Environ Nutr. 2010 Jul 1;5(3):302-315
references.pmid: 21116465
references.citation: Stat Med. 2013 Feb 20;32(4):556-77
references.pmid: 22711416
references.citation: Prev Med. 2014 Apr;61:34-41
references.pmid: 24412896
references.citation: Am J Prev Med. 2003 Oct;25(3 Suppl 2):141-9
references.pmid: 14552938
references.citation: Public Health Nutr. 2004 Dec;7(8):1081-8
references.pmid: 15548347
references.citation: BMC Geriatr. 2010 Jun 02;10:32
references.pmid: 20525208
references.citation: Int J Obes (Lond). 2015 Jul;39(7):1109-13
references.pmid: 25394308
references.citation: Arch Intern Med. 2006 May 22;166(10):1092-7
references.pmid: 16717171
references.citation: Soc Sci Med. 1999 Sep;49(6):781-9
references.pmid: 10459889
references.citation: Food Nutr Res. 2011;55:
references.pmid: 21845142
references.citation: Int J Obes (Lond). 2009 Jun;33(6):611-20
references.pmid: 19399021
references.citation: Am J Clin Nutr. 2001 Jul;74(1):80-9
references.pmid: 11451721
references.citation: Ann Intern Med. 2006 Jul 4;145(1):1-11
references.pmid: 16818923
references.citation: Am J Health Promot. 2006 Jul-Aug;20(6):411-21
references.pmid: 16871821
references.citation: J Am Diet Assoc. 2003 Jun;103(6):721-8
references.pmid: 12778044
references.citation: Prev Med. 1987 Nov;16(6):825-36
references.pmid: 3432232
references.citation: J Nutr Educ Behav. 2011 Nov-Dec;43(6):426-33
references.pmid: 21616721
references.citation: N Engl J Med. 2007 Jul 26;357(4):370-9
references.pmid: 17652652
references.citation: Am J Public Health. 1999 Feb;89(2):235-7
references.pmid: 9949755
references.citation: J Gerontol Nurs. 2006 Jul;32(7):31-9; quiz 40-1
references.pmid: 16863044
references.citation: Circulation. 2012 Jan 3;125(1):e2-e220
references.pmid: 22179539
references.citation: Clin Chem. 2009 May;55(5):888-94
references.pmid: 19395440
references.citation: Am J Public Health. 2015 Dec;105(12):2578-85
references.pmid: 26469644
references.citation: Public Health. 2012 Oct;126(10):813-20
references.pmid: 22922043
references.citation: Menopause. 2012 May;19(5):503-9
references.pmid: 22547251
references.citation: J Cardiovasc Nurs. 2007 Jul-Aug;22(4):304-12
references.pmid: 17589283
references.citation: Women Health. 2011 Jul 22;51(5):442-60
references.pmid: 21797678
references.citation: Am J Clin Nutr. 2000 Jun;71(6):1503-10
references.pmid: 10837291
references.citation: Health Promot J Austr. 2012 Aug;23(2):153-6
references.pmid: 23088479
references.citation: Prev Chronic Dis. 2008 Jan;5(1):A06
references.pmid: 18081995
references.citation: Am J Public Health. 2009 Jul;99(7):1271-7
references.pmid: 19443826
references.citation: Obes Rev. 2014 Jun;15(6):453-61
references.pmid: 24636206
references.citation: Med Sci Sports Exerc. 2003 Aug;35(8):1381-95
references.pmid: 12900694
references.citation: Prev Chronic Dis. 2011 Nov;8(6):A149
references.pmid: 22005642
references.citation: Am J Geriatr Cardiol. 2004 May-Jun;13(3):153-60
references.pmid: 15133418
references.citation: Prev Med. 2008 Dec;47(6):600-4
references.pmid: 18976684
references.citation: Aging Clin Exp Res. 2008 Oct;20(5):479-86
references.pmid: 19039291
references.citation: J Am Coll Cardiol. 2011 Apr 19;57(16):1690-6
references.pmid: 21492767
references.citation: J Gerontol A Biol Sci Med Sci. 1999 May;54(5):M242-8
references.pmid: 10362007
references.citation: Int J Behav Med. 2008;15(3):194-200
references.pmid: 18696313
references.citation: J Rural Health. 2012 Fall;28(4):398-407
references.pmid: 23083086
references.citation: Circulation. 2015 Jan 27;131(4):e29-322
references.pmid: 25520374
references.citation: Prev Chronic Dis. 2008 Jan;5(1):A25
references.pmid: 18082014
references.citation: Am J Prev Med. 2009 Apr;36(4 Suppl):S151-5
references.pmid: 19285206
references.citation: N Engl J Med. 1997 Apr 17;336(16):1117-24
references.pmid: 9099655
references.citation: Circulation. 2011 Oct 18;124(16):1795-9
references.pmid: 21914834
references.citation: Obesity (Silver Spring). 2010 Apr;18(4):725-35
references.pmid: 19696752
references.citation: Health Educ Behav. 2012 Apr;39(2):183-90
references.pmid: 22234966
references.citation: Circulation. 2010 Feb 2;121(4):586-613
references.pmid: 20089546
references.citation: J Ext. 2013 Aug;51(4):
references.pmid: 25767297
references.citation: Aging Ment Health. 2010 Aug;14(6):652-69
references.pmid: 20686977
references.citation: Span J Psychol. 2006 May;9(1):86-93
references.pmid: 16673626
references.citation: Obes Rev. 2008 Sep;9(5):409-19
references.pmid: 18179615
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914
references.citation: N Engl J Med. 2001 Jan 4;344(1):3-10
references.pmid: 11136953
references.citation: Transl Behav Med. 2015 Mar;5(1):94-102
references.pmid: 25729458
references.citation: Prev Chronic Dis. 2005 Oct;2(4):A11
references.pmid: 16164815
references.citation: Clin Rehabil. 2009 Oct;23(10):888-96
references.pmid: 19717503
references.citation: Obes Res. 2004 Nov;12(11):1814-20
references.pmid: 15601977
references.citation: Am J Public Health. 2010 Aug;100(8):1417-9
references.pmid: 20558803
references.citation: J Nutr Educ Behav. 2002 Jan-Feb;34(1):38-46
references.pmid: 11917670
references.citation: Adv Nutr. 2011 May;2(3):293-4
references.pmid: 22332062
references.citation: JAMA. 2001 May 16;285(19):2486-97
references.pmid: 11368702
references.citation: N C Med J. 2006 Jan-Feb;67(1):71-6
references.pmid: 16550995
references.citation: Int J Behav Nutr Phys Act. 2008 Dec 04;5:62
references.pmid: 19055821
references.citation: PLoS One. 2012;7(3):e34287
references.pmid: 22470551
references.citation: J Affect Disord. 2009 Apr;114(1-3):163-73
references.pmid: 18752852
references.citation: J Adv Nurs. 2006 Apr;54(1):11-9
references.pmid: 16553686
references.citation: Obes Rev. 2005 Feb;6(1):67-85
references.pmid: 15655039