ARRA: Biobehavioral Cardiovascular Health Promotion Intervention in a State Prison System

The long-term objective of our program of research is to improve the cardiovascular (CV) heaTh of inmates by implementation of a state-wide CV risk factor reduction program in prisons. The purpose of the proposed study in male inmates is to test the effects of a behavioral CV risk reduction (BCVRR) intervention on health outcomes (i.e., Cooper Clinic Mortality Risk Index [a composite index that includes heart rate, blood pressure, diabetes, smoking status, body mass index, age, and cardio-respiratory fitnessi, lipid profile, and modifiable lifestyle behaviors) in 4 Kentucky Department of Corrections (KyDOC) state-run prisons. This study will be conducted in 4 state operated prisons. A multiple baselines, repeated measures design will be used in which all participants receive the intervention, and all have a 3 month run-in period in which to establish their own baseline without intervention. This type of design is ideal in the prison environment where it is not possible to randomly assign inmates to a control group. We will enroll 560 inmates to reach our goal of 400 who finish the program, as a drop-out rate of 30% is expected based on existing literature and our prior work. At each prison, data will be gathered from inmates at four time points (run-in baseline, pre-intervention baseline, immediately post-intervention and 3 months post-intervention). The BCVRR intervention is a 12-week CV health education/behavior change, and aerobic physical training program, consisting of: 1) health education with behavior change strategies session delivered by certified health educators and other trained professionals from the community; and 2) an aerobic exercise program led by CV risk reduction trainers. Short and long-term effects will be measured immediately after the 12-week intervention and 3 months after the intervention ends. Specific Aim 1: To determine the impact of the BCVRR intervention on CV risk factor reduction (i.e., the total Cooper Clinic Mortality Risk Index [CCMRfl, individual modifiable components of the CCMRI, HgA1 c in diabetics, and lipid profile) Hypothesis 1: There will be a significant decline in total CCMRI and improvement in the individual modifiable components of the CCMRI and an improved HgA1 c for diabetics, and improved lipid profile over time following the intervention, compared with the run-in and pre-intervention baseline for each outcome. Specific Aim 2: To determine the impact of the intervention on the self-report of modifiable lifestyle behaviors (i.e., Inmate Health Risk Assessment). Hypothesis 2: There will be a significant improvement in self-reported modifiable lifestyle behaviors compared with the run-in and pre-intervention baseline for each outcome. Specific Aim 3: To generate data from the proposed study for a proposal for state-wide testing and implementation of the intervention at all of the 13 KyDOC state-run prisons in order to sustain the program.