Department of Pediatrics, Duke University School of Medicine, DUMC 102376, 2301 Erwin Rd, Durham, NC, 27705, USA.
Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914, Durham, NC, 27710, USA.
BMC Public Health. 2021 Nov 5;21(1):2018. doi: 10.1186/s12889-021-12022-x.
AA living in rural areas of the southeastern U.S. experience a disproportionate burden of cardiovascular disease (CVD) morbidity and mortality. Neighborhood environmental factors contribute to this disparity and may decrease the effectiveness of lifestyle interventions aimed at preventing CVD. Furthermore, the influence of neighborhood factors on AA CVD risk behaviors (i.e. physical activity) may be obscured by the use of researcher-defined neighborhoods and researcher-defined healthy and unhealthy places. The objective of this study was to elucidate the effects of neighborhood environments on AA CVD risk behaviors among AA adults who recently completed a lifestyle intervention. We specifically sought to identify AA adults' self-perceived places of significance and their perceptions of how these places impact CVD risk behaviors including diet, physical activity and smoking.
We conducted semi-structured interviews with AA adults (N = 26) living in two rural North Carolina counties (Edgecombe and Nash, North Carolina, USA). Participants were recruited from a community-based behavioral CVD risk reduction intervention. All had at least one risk factor for CVD. Participants identified significant places including where they spent the most time, meaningful places, and healthy and unhealthy places on local maps. Using these maps as a reference, participants described the impact of each location on their CVD risk behaviors. Data were transcribed verbatim and coded using NVivo 12.
The average age of participants was 63 (SD = 10) and 92% were female. Places participants defined as meaningful and places where they spent the most time included churches and relatives' homes. Healthy places included gyms and parks. Unhealthy places included fast food restaurants and relatives' homes where unhealthy food was served. Place influenced CVD risk behaviors in multiple ways including through degree of perceived control over the environment, emotional attachment and loneliness, caretaking responsibilities, social pressures and social support.
As we seek to improve cardiovascular interventions for rural AA in the American South, it will be important to further assess the effect of significant places beyond place of residence. Strategies which leverage or modify behavioral influences within person-defined significant places may improve the reach and effectiveness of behavioral lifestyle interventions.
居住在美国东南部农村地区的非裔美国人，其心血管疾病（CVD）发病率和死亡率过高。邻里环境因素导致了这种差异，并且可能会降低旨在预防 CVD 的生活方式干预的效果。此外，邻里因素对非裔美国人 CVD 风险行为（即体力活动）的影响可能会因使用研究人员定义的邻里和研究人员定义的健康和不健康场所而变得模糊。本研究的目的是阐明邻里环境对最近完成生活方式干预的非裔美国成年人的非裔美国人 CVD 风险行为的影响。我们特别希望确定非裔美国成年人自我感知的重要场所，以及这些场所如何影响 CVD 风险行为，包括饮食、体力活动和吸烟。
我们对居住在北卡罗来纳州两个农村县（埃奇科姆和纳什，北卡罗来纳州，美国）的 26 名非裔美国成年人进行了半结构化访谈。参与者是从基于社区的行为 CVD 风险降低干预中招募的。所有人都至少有一个 CVD 风险因素。参与者在当地地图上确定了重要场所，包括他们花费最多时间的地方、有意义的地方以及健康和不健康的地方。使用这些地图作为参考，参与者描述了每个地点对其 CVD 风险行为的影响。数据逐字转录并用 NVivo 12 进行编码。
参与者的平均年龄为 63 岁（标准差=10），92%为女性。参与者定义为有意义和花费时间最多的地方包括教堂和亲戚的家。健康的地方包括健身房和公园。不健康的地方包括快餐店和亲戚的家，那里供应不健康的食物。地点通过多种方式影响 CVD 风险行为，包括对环境的感知控制程度、情感依恋和孤独感、照顾责任、社会压力和社会支持。
在我们寻求改善美国南部农村非裔美国人的心血管干预措施时，进一步评估除居住地以外的重要场所的影响将非常重要。利用或修改个人定义的重要场所内的行为影响的策略可能会提高行为生活方式干预的效果和覆盖范围。
