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Rural Health Information Hub

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.


Effective (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, 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, a CDC Prevention Research Center
  • East Carolina University
  • Heart-Healthy Lenoir Community Advisory Committee
  • Lenoir County Alliance for a Healthy Community

Services offered

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.
  • Lifestyle changes
    A program was created to reduce heart disease risk and disparities in risk by promoting healthy eating, weight loss, and physical activity.
  • Community support
    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 influences
    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.

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.

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).

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.

Thayer, L.M., Pimentel, D.C., Smith, J.C., Garcia, B.A., Sylvester, L.L., Kelly, T., … & Keyserling, T.C. (2017). Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items. American Journal of Health Education, 48(1), 11-21.

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

Cené, C.W., Halladay, J.R., Gizlice, Z., Roedersheimer, K., Hinderliter, A., Cummings, D.M., … & DeWalt, D.A. (2016). Associations between Subjective Social Status and Physical and Mental Health Functioning among Patients with Hypertension. Journal of Health Psychology, 21(11), 2624-2635. Article Abstract

Cardiovascular disease
Wellness, health promotion, and disease prevention

States served
North Carolina

Date added
October 6, 2014

Date updated or reviewed
October 4, 2023

Suggested citation: Rural Health Information Hub, 2023. Heart Healthy Lenoir [online]. Rural Health Information Hub. Available at: [Accessed 20 February 2024]

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.