Reducing Cardiovascular Disease Risk Factors in Rural Communities in North Carolina

Cardiovascular disease (CVD), the leading cause of death in the United States (US),
disproportionately burdens rural communities. CVD prevalence rates for residents of rural
areas (13.1%) is higher compared to those in urban areas (11.2%) of the US.Geographic
differences in heart disease mortality led Cosby et al. to describe the rural "mortality
penalty" in the US. The proposed settings for this research report similar trends in CVD
prevalence, where CVD and stroke are among the top three leading causes of death. In
community health assessments conducted in the last three years CVD risk factors such as
obesity and hypertension were among the top 10 health priorities in our target counties.
Compared to residents of metropolitan areas, rural residents have higher rates of cigarette
smoking, obesity, mortality from ischemic heart disease, and are physically inactive. These
disparities are likely to widen; at the current rate, its estimated 50% of individuals in the
US will have CVD by 2030.

Using a community-based participatory research (CBPR) approach, our specific aims for the
study are to:

1. Expand and sustain a coalition of community and academic stakeholders to develop
successful CVD risk prevention strategies in rural communities;

2. Conduct a mixed-method community needs and assets assessment based on: a) assemble,
review and assess existing sources of CVD data; b) identification of community strengths
and resources using a web-based survey of community, faith based, social service and
healthcare organizations; c) determine the acceptability of components of CVD risk
reduction EBIs and community members' perceptions of possible targets for intervention
using focus group interviews; d) determine specific family influences (barriers and
facilitators) on acceptability of EBI acceptability;

3. Adapt PREMIER, a multi-component EBI using intervention mapping;

4. Conduct a small-scale randomized control trial to assess a) efficacy; and, b)
feasibility and adaption of implementing adapted PREMIER in rural settings.

Inclusion Criteria:

- African American

- Aged 21 and older

- Has at least one of the following cardiovascular disease (CVD) risk factors:
pre-diabetes, hypertension, obesity, family history of early CVD, prior CVD

- Reside in Nash or Edgecombe counties of North Carolina

Exclusion Criteria:

- Evidence of active or unstable CVD

- Cognitive impairment that limits informed consent