Heart Healthy Lenoir
- Need: In rural eastern North Carolina, Lenoir County residents experience significantly higher rates of cardiovascular disease, stroke, and obesity rates compared to other parts of the state and nation.
- Intervention: A community-based research project was designed to develop and test better ways to tackle cardiovascular disease, from prevention to treatment.
- Results: The end goal includes the development of long-lasting strategies and approaches within the community to help decrease the risk and disparities in risk of cardiovascular disease.
Evidence-levelEffective (About evidence-level criteria)
Like countless other counties nationwide, the largely rural county of Lenoir in North Carolina points to heart disease as its leading cause of death among its community members. Heart Healthy Lenoir was implemented to address and combat the rise of cardiovascular problems and ultimately develop long-lasting approaches to help decrease the risk of heart disease and related health issues within the community.
This project was for Lenoir County residents, male or female, ages 18 or older. The project, which ended in April 2016, was funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH).
Additionally, this project was coordinated through:
- UNC Center for Health Promotion and Disease Prevention
- East Carolina University
- Heart-Healthy Lenoir Community Advisory Committee
- Lenoir County Alliance for a Healthy Community
The first phase of the project started in the summer of 2010, and the second phase began in the fall of 2011.
Part 1 consisted of formative research to learn about the community. The researchers talked to many community members and officials to learn the extent of the county's battle with heart disease and discover what measures were being taken to address such issues. The researchers interviewed policymakers, healthcare providers, farmers, grocery store and restaurant owners, business leaders, and community agency leaders. Based on information gained, the research team in collaboration with a Community Advisory Committee developed a comprehensive approach to address cardiovascular disease risk in the community.
Part 2 was the implementation phase, consisting of a multi-level approach to addressing cardiovascular disease:
Clinic system changes
A practice-based, enhanced-care intervention for hypertension was developed to work with both patients and health professionals.
A program was created to reduce heart disease risk and disparities in risk by promoting healthy eating, weight loss, and physical activity.
A program was designed to help create a healthier food environment. One major focus was to help restaurants better market healthy menu items so that patrons can more easily choose healthy eating options when dining out.
Genetic and hereditary influences were under study, investigating why treatments work on some patients with cardiovascular disease and not on others.
Economic opportunity and health
Business opportunities to raise health awareness and encourage healthy lifestyles were created by working alongside agencies throughout the county.
For more information, please see the 2012 Preventing Chronic Disease article, A Community-Driven Approach to Identifying "Winnable" Policies Using the Centers for Disease Control and Prevention's Common Community Measures for Obesity Prevention.
Enrollment totaled roughly 650 community members. The project is also featured in the RHIhub Rural Monitor article Providing Patients with Access to Nutritious Food.
For more detailed program results:
Cummings, D.M., Adams, A., Halladay, J., Hinderliter, A., Donahue, K.E., Cené, C.W., ... & DeWalt, D. (2019). Race-Specific Patterns of Treatment Intensification among Hypertensive Patients Using Home Blood Pressure Monitoring: Analysis Using Defined Daily Doses in the Heart Healthy Lenoir Study. Annals of Pharmacotherapy, 53(4), 333-340. Article Abstract
Halladay, J.R., Lenhart, K.C., Robasky, K., Jones, W., Homan, W.F., Cummings, D.M., ... & Schisler, J.C. (2018). Applicability of Precision Medicine Approaches to Managing Hypertension in Rural Populations. Journal of Personalized Medicine, 8(2), 16(3), 542-549.
Halladay, J.R., Donahue, K.E., Cené, C.W., Li, Q., Cummings, D.M., Hinderliter, A.L., ... & DeWalt, D. (2017). The Association of Health Literacy and Blood Pressure Reduction in a Cohort of Patients with Hypertension: The Heart Healthy Lenoir Trial. Patient Education and Counseling, 100(3), 542-549.
Embree, G.G.R., Samuel-Hodge, C.D., Johnston, L.F., Garcia, B.A., Gizlice, Z., Evenson, K.R., ... & Keyserling, T.C. (2017). Successful Long-Term Weight Loss among Participants with Diabetes Receiving an Intervention Promoting an Adapted Mediterranean-Style Dietary Pattern: the Heart Healthy Lenoir Project. BMJ Open Diabetes Research & Care, 5(1). eCollection.
Jilcott Pitts, S.B., Keyserling, T.C., Johnston, L.F., Evenson, K.R., McGuirt, J.T., Gizlice, Z., ... & Ammerman, A.S. (2017). Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults. Journal of the Academy of Nutrition and Dietetics, 117(10), 1618-1627.
Cené, C.W., Halladay, J.R., Gizlice, Z., Donahue, K.E., Cummings, D.M., Hinderliter, A., ... & DeWalt, D. (2017). A Multicomponent Quality Improvement Intervention to Improve Blood Pressure and Reduce Racial Disparities in Rural Primary Care Practices. Journal of Clinical Hypertension, 19(4), 351-360. Article Abstract
Keyserling, T.C., Samuel-Hodge, C.D., Jilcott Pitts, S., Garcia, B.A., Johnston, L.F., Gizlice, Z., ... & Ammerman, A.S. (2016). A Community-Based Lifestyle and Weight Loss Intervention Promoting a Mediterranean-Style Diet Pattern Evaluated in the Stroke Belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health, 16, 732.
Donahue, K.E., Tillman, J., Halladay, J.R., Cené, C.W., Hinderliter, A., Cummings, D.M., ... & DeWalt, D. (2016). Lessons Learned from Implementing Health Coaching in the Heart Healthy Lenoir Hypertension Study. Progress in Community Health Partnerships: Research, Education, and Action, 10(4), 559-567. Article Abstract
Skinner, H.G., Calancie, L., Vu, M.B., Garcia, B., DeMarco, M., Patterson, C., ... & Schisler, J.C. (2015). Using Community-Based Participatory Research Principles to Develop More Understandable Recruitment and Informed Consent Documents in Genomic Research. PLoS ONE, 10(5), eCollection.
Kowitt, S., Woods-Jaeger, B., Lomas, J., Taggart, T., Thayer, L., Sutton, S., & Lightfoot, A.F. (2015). Using Photovoice to Understand Barriers to and Facilitators of Cardiovascular Health among African American Adults and Adolescents, North Carolina, 2011-2012. Preventing Chronic Disease, 12, E164.
Halladay, J.R., Donahue, K.E., Hinderliter, A.L., Cummings, D.M., Cené, C.W., Miller, C.L., ... & DeWalt, D. (2013). The Heart Healthy Lenoir Project – an Intervention to Reduce Disparities in Hypertension Control: Study Protocol. BMC Health Services Research, 13, 441.
Jilcott Pitts, S.B., Smith, T.W., Thayer, L.M., Drobka, S., Miller, C., Keyserling, T.C., & Ammerman, A.S. (2013). Addressing Rural Health Disparities through Policy Change in the Stroke Belt. Journal of Public Health Management and Practice, 19(6), 503-510.
Tillman, J. (2013). Health Coaching Interventions with a Heart-Healthy Lenoir Project Client. Global Advances in Health and Medicine, 2(3), 83-86.
Contact InformationBeverly Garcia, Project Director
UNC Center for Health Promotion and Disease Prevention
Wellness, health promotion, and disease prevention
October 6, 2014
Date updated or reviewed
November 1, 2019
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.