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GOOD AFTERNOON, APPROXIMATE

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WELCOME.

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I WILL TART WITH JUST A FEW

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HOUSEKEEPING ITEMS.

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THE CME CODE FOR THIS

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PRESENTATION, THIS WEDNESDAY

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AFTERNOON LECTURE SERIES, IS

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50121.

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AND IF YOU'RE WATCHING  ON

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VIDEOCAST AND WANT TO SUBMIT A

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QUESTION FOR THE SPEAKER, PLEASE

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USE THE SEND LIVE FEEDBACK

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BUTTON ON THE VIDEOCAST AND THAT

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WILL SEND YOUR QUESTION.

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IT IS MY GREAT HONOR TO

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INTRODUCE DR. DEBORAH MOSER,

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DR. MOSER IS THE ENDOWED CHAIR

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OF NURSING AS WELL AS ASSISTANT

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DEAN OF THE Ph.D. PROGRAM AND

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SCHOLARLY AFFAIRS AT THE

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UNIVERSITY OF KENTUCKY.

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DR. MOSER IS THE WITH THE

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IMPOSSIBLE TO BUILD RAVASCULAR

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CARDIOVASCULAR PROGRAM OR RICH

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PROGRAM AND HER RESEARCH FOCUSED

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ON INDIVIDUALS WITH VULNERABLE

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CARDIOVASCULAR CONDITIONS, AS

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WELL AS THOSE IN THOSE RURAL

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POPULATIONS, AND THEIR

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CAREGIVERS, IN ORDER TO IMPROVE

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HEALTH AND TO ADVANCE HEALTH

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EQUITY.

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DR. MOSER HOLDS A MASTERS IN

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NURSING AND A DOCTORATE OF

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NURSING SCIENCE FROM THE

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UNIVERSITY OF CALIFORNIA AT

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LOS ANGELES, SHE HAS EARNED MANY

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HONORS AND,A WARDS IF I GAVE

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THEM ALL TO TO YOU WE WOULD BE

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LISTENING TO THAT FOR THIS WHOLE

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PER, I WILL POINT OUT JUST A

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COUPLE OF THEM.

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ONE, SHE HAS BEEN THE AMERICAN

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HEART ASSOCIATION KATHLEEN JACOB

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MENTORSHIP LECTURER, AND SHE IS

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IN THE BRAGZAL NURSING

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RESEARCHER HALL OF FAME WHICH IS

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SPONSORED BY [INDISCERNIBLE]

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WHICH IS THE INTERNATIONAL

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NURSING RESEARCH SOCIETY.

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ONE MORE REMINDER, THE CME CODE

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IS 50121, AND IF YOU WANT TO

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SEND A QUESTION, PLEASE USE THE

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SEND LIVE FEEDBACK BUTTON.

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AND WITH THAT, I'M DELIGHTED TO

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INTRODUCE DR. MOSER.

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[ APPLAUSE ]

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>> THANKS, VERY MUCH
KAREN.

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I APPRECIATE THE INTRODUCTION,

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I'VE HAD A GREAT VISIT AND SEE

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ALL KINDS OF PEOPLE AND SEE THE

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CLINICAL CENTER.

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I'VE NEVER SEEN IT BEFORE, IT'S

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ALWAYS BEEN THIS MYSTERIOUS

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PLACE THAT A LOT OF NURSES THINK

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ABOUT, MAYBE COMING TO AND MAYBE

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WORK THERE, EVERYBODY HAS BEEN

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SO WONDERFUL TO ME.

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I WILL TALK ABOUT MY FAVORITE

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TOPIC, CARDIOVASCULAR HEALTH

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DISEASE

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DISPARITIES--CARDIOVASCULAR

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DISEASE DISPARITIES IN RURAL

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AMERICA.

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AND I TITLED IT, CAN THIS HOUSE

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OF CARDS BE SAVED AND HOPEFULLY

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YOU WILL SEE WHY, I HAVE THAT

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VIEW POINT.

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MY E-MAIL ADDRESS IS ON HERE,

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PLEASE FEEL FREE TO E-MAIL ME

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WITH ANY QUESTIONS AND I AM

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HAPPY TO SHARE MY SLIDES WITH

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ANYBODY, I NEED TO ALWAYS TART

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WITH ACKNOWLEDGMENTS, FIRST OFF

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THE COMMUNITY MEMBERS WHO ARE

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REALLY IMPORTANT OBVIOUSLY TO

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THIS RESEARCH, AND WHO HAVE BEEN

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SO ENGAGED AND HAVE MADE IT SO

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SUCCESSFUL.

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THERE'S A CENTER FOR EXCELLENCE

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OF RURAL HEALTH IN HAZARD

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KENTUCKY IN APPALACHIA THAT WE

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WORK WITH REALLY CLOSELY, GREAT

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FUNDING FROM THE NATIONAL

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INSTITUTES OF HEALTH, ALSO GREAT

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FUND FREE RADICALS GENERATED

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PATIENT CENTERED OUTCOMES

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RESEARCH INSTITUTE AND HRSA, AND

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FIEPALLY THE RICH HEART TEAM IS

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THE TEAM I DIRECT IN WHO DOES

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ALL THIS RESEARCH AND WE

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DEVELOPED THIS AMAZING TEAM WITH

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COMPLIMENTARY EXPERTISES AND

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HAVE REALLY DONE SOME AMAZING

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RESEARCH AND I COULDN'T DO

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ANYTHING I DO WITHOUT THEM.

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SINCE I'M TALKING ABOUT

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RURALITY, I'LL START BY DEFINING

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IT AND I THOUGHT, OKAY, I WILL

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LOOK THIS UP AND I WILL SEE HOW

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EASY IT IS, WELL, IT'S NOT THAT

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EASY BECAUSE THERE ARE SO MANY

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DEFINITIONS OF RURALITY, I LOVE

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THE CDC, DEFINED URBAN AND

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EVERYTHING ELSE IS RURAL.

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SOW WE FOUND THE RURAL CONTINUUM

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CODES TO BE THE MOST HELPFUL FOR

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US, YOU CAN EASILY LOOK UP

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SOMEBODY'S ADDRESS, IF THEY HAVE

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1, TIMES REAL PEOPLE, HAVE

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UNUSUAL ADDRESSES, BUT YOU CAN,

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IF THAT'S THE CASE, YOU CAN

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USUALLY FIGURE OUT THAT THEY'RE

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RURAL AND IT'S DIFFERENTIALLY

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BASED ON COUNTIES BASED ON

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POPULATION SIZE AND ADJACENCY TO

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METROAREAS AND THERE ARE 9 CODES

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AND WE USE ANYTHING GREATER THAN

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OR EQUAL TO 4 AS RURAL.

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IT'S IMPORTANT TO KNOW THAT IN

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THE UNITED STATES ABOUT

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60 MILLION PEOPLE LIVE IN RURAL

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AREAS, THAT'S 20% OF THE U.S.

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POPULATION, AND WE DEFINED RURAL

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AS A TOWN OF LESS THAN 2500, A

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METROPOLITAN CENTER OF LESS THAN

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50,000 OR AN OPEN COUNTRY AND A

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LOT OF PEOPLE THAT WE WORK WITH

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IN APPALACHIA, LIVE IN OPEN

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COUNTRY AND I JUST LISTED, A FEW

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NAMES HERE, I LOVE SOME OF THE

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NAMES THAT RURAL CITIES ARE

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GIVEN, BUG TUSSLE IS IN MONROE

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COUNTY, KENTUCKY AND IT HAS THAT

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NAME, IT HAS 376 PEOPLE, THERE'S

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ONLY 11,000 PEOPLE IN THE COUNTY

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AND IT HAS THAT NAME BECAUSE

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IT'S NOTERIOUS FOR THESE FLYING

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BUGS THAT ARE SO PROLIFIC AND

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ARE AROUND AT CERTAIN TIMES OF

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THE YEAR, LATE SPRING, SUMMER

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TEEM THAT THEY'RE JUST SMASHING

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INTO EVERYBODY AND SMASHING INTO

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EVERYTHING, SO THEY NAMED THE

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TOWN BUG TUSSLE, THE INDIVIDUAL

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MEDIAN INCOME IS ABOUT $25,000 A

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YEAR, MANCHESTER IS ANOTHER

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COUNTY, ANOTHER CITY IN CLAY

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COUNTY, KENTUCKY, IT HAS 1255

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PEOPLE, MEDIAN INDIVIDUAL INCOME

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IS LESS THAN $15,000 A YEAR.

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AND AT ANY GIVEN TIME, IT'S

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RECEIVED THIS NAME OR THIS

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DISTINCTION OF BEING THE POOREST

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COUNTY IN THE ENTIRE UNITED

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STATES.

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OTHER COUNTIES WILL FIGHT WITH

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YOU OVER THIS, THEY WANT TO BE

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THE POOREST COUNTY ABOUT YOU IT

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HAS BEEN IN AND OUT OF THAT

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CATEGORY FOR A LONG TIME. 

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FORTY-TWO% OF THE PEOPLE IN THAT

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TOWN LIVE IN POVERTY.

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IT'S ALSO BEEN NAMED THE FATTEST

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COUNTY IN AMERICA AND MANCHESTER

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THE FATTEST TOWN, SO PEOPLE FROM

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THAT TOWN ARE SORT OF TIRED

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BEING THE FATTEST, POOREST AND

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THE MOST WITH DIABETES AND I

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WILL TALK ABOUT SOME OF THE

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REACTIONS PEOPLE HAVE TO THESE

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NAMES THAT THEY GET.

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HAZARD IS A TOWN IN   PERRY

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COUNTY, IT'S ABOUT 5000 PEOPLE,

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IT HAS A LOW INDIVIDUAL MEDIAN

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INCOME AND IT'S REALLY

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DISTINCTIVE, IN THAT THAT

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COUNTY, THAT SINGLE COUNTY HAS

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THE WORST LIFE EXPECTANCY OF ANY

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COUNTY IN THE UNITED STATES AND

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IT'S MAINTAINED THAT DISTINCTION

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FOR A WHILE.

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SO YOU CAN BEIMIN TO SEE THAT WE

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HAVE SOME SERIOUS DISPARITY ANDS

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A LOT OF THESE ARE RELATED AS

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YOU WILL SEE TOO CARDIOVASCULAR

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HEALTH AND JUST SO YOU GET SOME

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REFERENCE POINT, THE MEETING,

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INDIVIDUAL INCOME IN 2021 WAS

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60,000, IN THE UNITED STATES IN

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GENERAL ASK IT HAS A POVERTY

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LEVEL THAT'S ABOVE 35%, THE

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HIGHEST IS I THINK ABOUT 47%.

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I GIVE YOU THIS GREAT PICTURE OF

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DWAEVER, KENTUCKY, ALL THESE

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PEOPLE THAT ARE REALLY PROUD OF

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THEIR AREAS BUT THEY NEED HELP

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AND THEY RECOGNIZE THE NEED FOR

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HELP TO ADDRESS SOME OF THE

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SERIOUS DISPARITIES THAT EXIST

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THERE.

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THAT'S--I KNOW YOU ALL KNOW THE

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MORTALITY FROM CARDIOVASCULAR

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DISEASE IS NOT HOMOGENIUS ACROSS

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THE UNITED STATES, AND YOU CAN

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SEE THE AREA IN THE RED CIRCLE

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IS THE AREA THAT I WILL

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CONCENTRATE ON, THE DISPARITIES

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COMPARED TO RURAL COMPARED TO

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URBAN SO MY REGION THAT I AM

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SPECIALIZING IN IS IN COUNTIES

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IN KEN EXPN I HAVE WORKED IN

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RURAL COUNT NEUROECTODERMAL

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CALIFORNIA, NO 1 I THINKS

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THERE'S A REAL RURAL AREA IN

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CALIFORNIA BUT IN FACT, THERE

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ARE FARMING AND RANCH

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COMMUNITIES THAT REMAIN VERY

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RURAL AND ALSO IN NEVADA AND YOU

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CAN SEE FROM THIS SLIDE, THE

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VERY HIGH RATES IN THE RED ARE

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THE HIGHEST RATES OF DEATHS AND

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YOU CAN SEE THESE FEW YEARS THAT

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ARE REALLY CHARACTERIZED BY

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APPALACHIA BUT ALSO THE HEART

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AND STROKE BELT.

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ANOTHER THING TO NOTE ABOUT THIS

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AREA OR THAT THERE ARE CHANGES

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IN LIFE EXPECTANCY, THERE ARE 13

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U.S. COUNTIES THAT HAVE

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EXPERIENCES DECLINES IN LIFE

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EXPECTANCY SINCE 1980 ALL OF

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THEM ARE RURAL, 8 OF THOSE

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COUNTIES ARE IN APPALACHIA AND

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KENTUCKY, SO YOU CAN SEE A REAL

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CONCENTRATION OF SEVERE

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DISPARITIES IN APPALACHIA, AND

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YOU CAN SEE THESE DARK COLORS

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ISSUES THE CHANGE IN LIFE

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EXPECTANCY TO THE LEFT IS A

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DECREASE, AND EVERY PLACE ELSE

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THAT IT'S NOT ACTUALLY RED AND

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ORANGE IS AN INCREASE OR A

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MAIPTINENCE.

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THIS IS A PICTURE OF APPALACHIA,

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YOU CAN SEE AND THERE ARE

257
00:09:39,358 --> 00:09:41,193
80--LET'S SEE, I WANTED TO POINT

258
00:09:41,193 --> 00:09:43,395
OUT THIS AREA IN LIGHT IS

259
00:09:43,395 --> 00:09:46,232
CENTRAL, IS CONSIDERED SEBTERAL

260
00:09:46,232 --> 00:09:47,533
APPALACHIA, IT IS CONSIDERED THE

261
00:09:47,533 --> 00:09:50,870
LEAST HEALTHY OF ALL THE

262
00:09:50,870 --> 00:09:52,838
APPALACHIAN AREAS, IT'S IN THE

263
00:09:52,838 --> 00:09:54,607
TOP 1% OF CARDIOVASCULAR

264
00:09:54,607 --> 00:09:55,541
DISEASE, MORBIDITY AND

265
00:09:55,541 --> 00:09:57,543
MORTALITY, IT HAS THE HIGHEST

266
00:09:57,543 --> 00:09:59,278
RATES OF MULTIPLE CARDIOVASCULAR

267
00:09:59,278 --> 00:10:01,847
DISEASE RISK FACTORS INCLUDING

268
00:10:01,847 --> 00:10:04,483
OBESITY, DIABETES, PHYSICAL

269
00:10:04,483 --> 00:10:07,653
DISABILITY, PHYSICAL INACTIVITY,

270
00:10:07,653 --> 00:10:08,821
SMOKING, MULTIPLE CVD RISK

271
00:10:08,821 --> 00:10:10,222
FACTORS ARE PRESENT IN THE

272
00:10:10,222 --> 00:10:14,059
HIGHEST RATES IN A FEW COUNTIES

273
00:10:14,059 --> 00:10:15,561
IN APPALACHIA, KENTUCKY, THE

274
00:10:15,561 --> 00:10:16,395
CENTRAL APPLICATIONS RACHIA AREA

275
00:10:16,395 --> 00:10:20,132
AND ARE HIGHER THAN ANY OTHER

276
00:10:20,132 --> 00:10:21,033
PLACE IN THE UNITED STATES.

277
00:10:21,033 --> 00:10:23,035
THE HEART DISEASE MORTALITY RATE

278
00:10:23,035 --> 00:10:25,638
IS ABOUT 42% HIGHER THAN THE

279
00:10:25,638 --> 00:10:28,908
NATIONAL RATE AND 80 OF THE

280
00:10:28,908 --> 00:10:32,244
SUBREGION OF 82 COUNTIES IN

281
00:10:32,244 --> 00:10:33,512
CENTRAL APPALACHIA HAVE HEART

282
00:10:33,512 --> 00:10:34,713
DISEASE MORTALITY RATES THAT ARE

283
00:10:34,713 --> 00:10:36,215
HIGHER THAN THE NATIONAL RATES,

284
00:10:36,215 --> 00:10:39,285
ALMOST EVERYBODY IN THIS AREA.

285
00:10:39,285 --> 00:10:41,287
WE BEGENERATED TO SEE SOME OF

286
00:10:41,287 --> 00:10:42,054
THE SOURCE OF--BEGENERATED TO

287
00:10:42,054 --> 00:10:43,389
SEE THE SOURCE OF SOME OF THESE

288
00:10:43,389 --> 00:10:45,357
PROBLEMS WHEN WE SEE THAT HEART

289
00:10:45,357 --> 00:10:47,793
DISEASE, MORTALITY RATES IN

290
00:10:47,793 --> 00:10:49,061
DISTRESS COUNTYS IS 29% HIGHER

291
00:10:49,061 --> 00:10:51,831
FOR THE RATE FOR NONDISTRESSED

292
00:10:51,831 --> 00:10:54,099
AND NONDISTRESSED IS A

293
00:10:54,099 --> 00:10:56,202
DISTINCTION GIVEN TO APPALACHIA

294
00:10:56,202 --> 00:10:59,572
COUNTIES THAT ARE DISTRESSED

295
00:10:59,572 --> 00:11:02,074
SOCIOECONOMICALLY WITH REGARD TO

296
00:11:02,074 --> 00:11:04,810
YOBS, INCOME, RATES OF

297
00:11:04,810 --> 00:11:06,979
DISABILITY, BUT LARGELY INCOME,

298
00:11:06,979 --> 00:11:10,282
AND SO A COUNTY TO BE

299
00:11:10,282 --> 00:11:11,650
DISTRESSED, NOT DISTRESSED,

300
00:11:11,650 --> 00:11:13,652
MARGINAL DISTRESS, MOVING BACK

301
00:11:13,652 --> 00:11:15,621
FROM DISTRESSED, MOVING INTO

302
00:11:15,621 --> 00:11:17,556
DISTRESS, THEY SPEND A LOT OF

303
00:11:17,556 --> 00:11:19,625
TIME MAKING THESE DISTINCTIONS

304
00:11:19,625 --> 00:11:21,961
BUT THE MORE STRESSED THE WORSE

305
00:11:21,961 --> 00:11:22,828
THE CARDIOVASCULAR DISEASE

306
00:11:22,828 --> 00:11:23,028
RATES.

307
00:11:23,028 --> 00:11:30,169
THIS IS A DPRAIT SLIDE THAT

308
00:11:30,169 --> 00:11:32,371
DEMONSTRATES THE DIVERGENCE OF

309
00:11:32,371 --> 00:11:38,978
LIFE EXPECTANCY EMPLOY YOU -

310
00:11:38,978 --> 00:11:39,311
-EXPECTANCY.

311
00:11:39,311 --> 00:11:41,847
I WILL DO IT THIS WAY, THERE IT

312
00:11:41,847 --> 00:11:42,114
IS.

313
00:11:42,114 --> 00:11:46,285
YOU CAN SEE WHEN IT STARTED

314
00:11:46,285 --> 00:11:49,488
URBAN AND RURAL MORTALITY WAS

315
00:11:49,488 --> 00:11:53,525
VERY SIMILAR, BUT AROUND IN THE

316
00:11:53,525 --> 00:11:54,894
1980S, LATE 1980S, 1990S THERE

317
00:11:54,894 --> 00:11:58,230
WAS QUITE A DIVERGENCE AND YOU

318
00:11:58,230 --> 00:11:59,999
CAN SEE THE--THE GREATEST

319
00:11:59,999 --> 00:12:02,101
MORTALITY IS IN RURAL COUNTIES

320
00:12:02,101 --> 00:12:03,402
AND THAT'S CONTROLLING FOR A LOT

321
00:12:03,402 --> 00:12:06,038
OF FACTORS LIKE RACE, INCOME,

322
00:12:06,038 --> 00:12:12,211
EDUCATION, ACTUAL POVERTY LEVELS

323
00:12:12,211 --> 00:12:13,045
AND RURAL RESIDENTS SO

324
00:12:13,045 --> 00:12:16,115
CONTROLLING FOR THOSE THINGS AND

325
00:12:16,115 --> 00:12:18,217
THEN RURAL RESIDENT WAS ON THE

326
00:12:18,217 --> 00:12:20,119
AGE ADJUSTED MORTALITY AND THIS

327
00:12:20,119 --> 00:12:21,420
DISTINCTION IS CARRIED OUT, THIS

328
00:12:21,420 --> 00:12:24,256
SLIDE ONLY GOES TO 2016 BUT IN

329
00:12:24,256 --> 00:12:29,728
FACT, IT'S A DIVERGING PROBLEM.

330
00:12:29,728 --> 00:12:31,664
SO UNFORTUNATELY THESE RURAL

331
00:12:31,664 --> 00:12:32,965
URBAN HEALTH DISPARITY VS

332
00:12:32,965 --> 00:12:34,366
INCREASED OVER TIME, THOSE IN

333
00:12:34,366 --> 00:12:37,069
RURAL AREAS HAVE POORER HEALTH,

334
00:12:37,069 --> 00:12:38,203
MORE PSYCHOLOGICAL DISTRESS,

335
00:12:38,203 --> 00:12:40,172
MORE DISABILITY, AND LESS

336
00:12:40,172 --> 00:12:41,774
PHYSICAL ACTIVITY, COMPARED TO

337
00:12:41,774 --> 00:12:43,742
THEIR URBAN COUNTERPARTS AND

338
00:12:43,742 --> 00:12:45,244
THAT'S A GENERAL SPHAIMENT FOR

339
00:12:45,244 --> 00:12:46,545
ALL RURAL AREAS IN THE UNITED

340
00:12:46,545 --> 00:12:50,049
STATES, THERE'S A RURAL

341
00:12:50,049 --> 00:12:51,583
MORTALITY PENALTY, PEOPLE CALL

342
00:12:51,583 --> 00:12:52,418
IT THE MORTALITY PENALTY FOR

343
00:12:52,418 --> 00:13:02,928
LIVING IN A RURAL AREA AND THE

344
00:13:03,295 --> 00:13:06,865
PENALTY IS A RESULT OF HEART

345
00:13:06,865 --> 00:13:09,935
INJURIES, COPD, LUNG INJURIES,

346
00:13:09,935 --> 00:13:12,438
LUNG CANCER IN KENTUCKY AND IN

347
00:13:12,438 --> 00:13:17,843
MANY RURAL AREAS, STROKE,

348
00:13:17,843 --> 00:13:18,877
SUICIDE ASK DIABETES.

349
00:13:18,877 --> 00:13:20,279
THE GAP IS ACTUALLY INCREASING,

350
00:13:20,279 --> 00:13:27,186
CAN YOU SEE IT WAS ONLY .4 YEARS

351
00:13:27,186 --> 00:13:28,854
IN 1969 TO 1971, AND IT WAS UP

352
00:13:28,854 --> 00:13:32,458
TO 2 YEARS IN 2005 AND 2009, SO

353
00:13:32,458 --> 00:13:33,792
IT ACTUALLY INCREASED, IT'S NOT

354
00:13:33,792 --> 00:13:34,727
THAT THESE DISPARITIES ARE

355
00:13:34,727 --> 00:13:37,696
REALLY RELATED TO US, THE AH

356
00:13:37,696 --> 00:13:39,398
STEER ENVIRONMENT, THE

357
00:13:39,398 --> 00:13:39,999
SOCIOECONOMICALLY AH STEER

358
00:13:39,999 --> 00:13:42,167
ENVIRONMENT AND THE IMPACT OF

359
00:13:42,167 --> 00:13:43,335
SOCIAL DETERMINANTS OF HEALTH.

360
00:13:43,335 --> 00:13:47,272
SO WE, PEOPLE IN THIS, IN RURAL

361
00:13:47,272 --> 00:13:49,875
AREAS, DEAL WITH SOCIOECONOMIC

362
00:13:49,875 --> 00:13:56,582
DEPRIVATION, A NATIONAL LIBRARY

363
00:13:56,582 --> 00:13:56,882
--PHENOMENON

364
00:13:56,882 --> 00:13:58,083
CALLED POVERTY, IT EXISTS WHERE

365
00:13:58,083 --> 00:13:59,852
IT'S IN THE COUNTY OR IN THE

366
00:13:59,852 --> 00:14:02,254
REGION FOR LONGER THAN 5 YEARS

367
00:14:02,254 --> 00:14:04,023
UNCHANGED AND IT IS A MUCH

368
00:14:04,023 --> 00:14:07,259
HIGHER PREDICTER, THE PRESENCE

369
00:14:07,259 --> 00:14:09,094
OF PERSISTENT POVERTY IS A HIGHY

370
00:14:09,094 --> 00:14:11,663
PREDICTER OF ALL OF THESE

371
00:14:11,663 --> 00:14:12,297
NEGATIVE CARDIOVASCULAR DISEASE

372
00:14:12,297 --> 00:14:19,838
DISPARITIES THAT WE SEE.

373
00:14:19,838 --> 00:14:23,242
THERE'S A NUMBER OF UNEQUAL

374
00:14:23,242 --> 00:14:24,610
EXPWRIEWKS OF SERVICES THAT

375
00:14:24,610 --> 00:14:25,611
CONTRIBUTE TO THESE DISPARITIES.

376
00:14:25,611 --> 00:14:27,112
THIS IS A PICTURE THAT LOOKS AT

377
00:14:27,112 --> 00:14:29,681
OR A FIGURE THAT DEMONSTRATES

378
00:14:29,681 --> 00:14:31,183
THE SOCIAL IMPACT OF SOCIAL

379
00:14:31,183 --> 00:14:32,317
DETERMINANTS OF HEALTH EMPLOY SO

380
00:14:32,317 --> 00:14:35,954
WE HAVE BLACK RACE IN THE RED,

381
00:14:35,954 --> 00:14:38,457
PERCENT WITHOUT COLLEGE IN THE

382
00:14:38,457 --> 00:14:40,092
PURPLE DOTS, PER CAPITA INCOME

383
00:14:40,092 --> 00:14:43,829
IN THE YELLOW LINES, PERCENT

384
00:14:43,829 --> 00:14:45,330
POVERTY IN THE GREEN LINE AND

385
00:14:45,330 --> 00:14:46,598
REALITY IN THE PERCENT RURAL

386
00:14:46,598 --> 00:14:47,966
AREAS IN THE ORANGE LINE AND CAN

387
00:14:47,966 --> 00:14:54,106
YOU SEE THE TOP 3 AREAS WHERE

388
00:14:54,106 --> 00:14:57,509
THE HIGHEST MORTALITY IS, IS THE

389
00:14:57,509 --> 00:14:59,178
CONVERGENCE OF BLACK RACE, LOW

390
00:14:59,178 --> 00:14:59,812
EDUCATION AND REALITY.

391
00:14:59,812 --> 00:15:01,413
YOU GET A BETTER PICTURE OF

392
00:15:01,413 --> 00:15:05,150
WHAT'S REALLY GOING ON IN THESE

393
00:15:05,150 --> 00:15:08,554
AREAS WHEN YOU LOOK AT A

394
00:15:08,554 --> 00:15:09,488
SITUATION WHERE THESE

395
00:15:09,488 --> 00:15:12,925
INVESTIGATORS IBT--INTEGRATE

396
00:15:12,925 --> 00:15:19,198
CLUEDED THE INTERACTION OF

397
00:15:19,198 --> 00:15:21,166
RURALITY AS IN POVERTY, YOU CAN

398
00:15:21,166 --> 00:15:25,938
SEE THAT HERE, HUGE INCREASES IN

399
00:15:25,938 --> 00:15:28,140
DEATHS, FROM OR RELATED TO THE

400
00:15:28,140 --> 00:15:29,208
INTERACTION OF RURALITY AND

401
00:15:29,208 --> 00:15:30,609
POVERTY, YOU CAN SEE THAT BLACK

402
00:15:30,609 --> 00:15:33,412
RACE IS STILL A BIG PREDICTER AS

403
00:15:33,412 --> 00:15:37,783
IS LOW EDUCATION, SO HUGE

404
00:15:37,783 --> 00:15:38,951
PROBLEM TO CONSIDER WITH

405
00:15:38,951 --> 00:15:41,987
RELATION TO THE RISK OF

406
00:15:41,987 --> 00:15:43,489
MORTALITY AND

407
00:15:43,489 --> 00:15:44,490
CERTAINLY--CERTAINLY ISSUE

408
00:15:44,490 --> 00:15:45,357
SPECIALLY CARDIOVASCULAR DISEASE

409
00:15:45,357 --> 00:15:45,624
MORTALITY.

410
00:15:45,624 --> 00:15:49,228
AND I REALLY JUST WANT TO POINT

411
00:15:49,228 --> 00:15:51,430
OUT THE IMPACT OF BLACK RACE, SO

412
00:15:51,430 --> 00:15:59,071
WHEN I SAID THAT REALITY A

413
00:15:59,071 --> 00:16:01,473
MORTALITY PENALTY, THERE'S AN

414
00:16:01,473 --> 00:16:02,508
EVEN GREATER MORTALITY PENALTY

415
00:16:02,508 --> 00:16:06,278
FOR BEING BLACK IN A RURAL AREA.

416
00:16:06,278 --> 00:16:10,482
IF YOU LOOK AT THE RISK OF

417
00:16:10,482 --> 00:16:11,617
CARDIOVASCULAR DEATH, IN A

418
00:16:11,617 --> 00:16:15,354
PLAQUE PERSON LIVING IN

419
00:16:15,354 --> 00:16:17,055
THE--BLACK PERSON LIVING IN THE

420
00:16:17,055 --> 00:16:19,291
AREA WITH THE LEAST POVERTY, THE

421
00:16:19,291 --> 00:16:22,694
HIGHER RATES OF EDUCATION, THEY

422
00:16:22,694 --> 00:16:24,530
STILL HAVE WORSE OUTCOMES THAN A

423
00:16:24,530 --> 00:16:26,598
WHITE PERSON LIVING IN THE WORST

424
00:16:26,598 --> 00:16:28,000
RURAL AREA IN ANY COUNTY.

425
00:16:28,000 --> 00:16:31,570
SO NOT ONLY IS THERE A RURAL

426
00:16:31,570 --> 00:16:33,272
MORTALITY PENALTY, THERE'S AN

427
00:16:33,272 --> 00:16:35,374
ESPECIALLY STRONG BLACK RURAL

428
00:16:35,374 --> 00:16:41,113
MORTALITY PENALTY THAT REALLY

429
00:16:41,113 --> 00:16:41,813
HASN'T BEEN ADDRESSED.

430
00:16:41,813 --> 00:16:42,748
I WANT SHORTENED SHOW THE

431
00:16:42,748 --> 00:16:44,616
REASONS WHY WE SEE HAD SOME OF

432
00:16:44,616 --> 00:16:45,684
THESE, DISPARITIES AND THIS IS A

433
00:16:45,684 --> 00:16:49,221
GREAT SLIDE THAT SHOWS WHAT

434
00:16:49,221 --> 00:16:51,590
HAPPENS, LONGITUDINALLY, WHEN

435
00:16:51,590 --> 00:16:53,125
INCOME CHANGES, AND ITS

436
00:16:53,125 --> 00:16:53,792
RELATIONSHIP WITH CARDIOVASCULAR

437
00:16:53,792 --> 00:16:56,662
DISEASE AND THIS IS FROM THE ERA

438
00:16:56,662 --> 00:17:02,067
STUDIES AND YOU CAN SEE UP ON

439
00:17:02,067 --> 00:17:06,271
THE LEFT THOSE DOTTED LINES ARE

440
00:17:06,271 --> 00:17:07,272
THE CONFIDENCE INTERVALS, THAT

441
00:17:07,272 --> 00:17:08,740
GREEN STRAIGHT LINE IS THE RISK

442
00:17:08,740 --> 00:17:09,975
OR HAZARD FOR MORTALITY EMPLOY

443
00:17:09,975 --> 00:17:14,112
YOU CAN SEE IT TARTS UP HIGH,

444
00:17:14,112 --> 00:17:18,250
AND THE LOWER INCOME AS INCOME

445
00:17:18,250 --> 00:17:20,586
CHANGES MORE AND IT IMPROVES AS

446
00:17:20,586 --> 00:17:31,029
INCOME IMPROVES, THIS IS A

447
00:17:33,031 --> 00:17:35,467
REALLY NICE COMPARISON BETWEEN

448
00:17:35,467 --> 00:17:36,768
CARDIOVASCULAR RISK AND DISEASE

449
00:17:36,768 --> 00:17:37,035
MORTALITY.

450
00:17:37,035 --> 00:17:39,538
WHEN I WAS LOOKING AT SLIDES

451
00:17:39,538 --> 00:17:41,873
ABOUT APPALACHIA, AND THE

452
00:17:41,873 --> 00:17:44,543
PROBLEMS WITH APPALACHIA, I CAME

453
00:17:44,543 --> 00:17:47,045
ACROSS THIS SITE THAT CALLED THE

454
00:17:47,045 --> 00:17:52,084
APPALACHIA LEARNING INITIATIVE

455
00:17:52,084 --> 00:17:54,720
AND THEY HAVE A LITTLE SIGN LIKE

456
00:17:54,720 --> 00:17:56,121
THIS, IN RURAL KENTUCKY AND THEY

457
00:17:56,121 --> 00:18:04,963
TALK ABOUT THE POPULATION AND

458
00:18:04,963 --> 00:18:07,366
PEOPLE, UNDERINSURED, 37% IN

459
00:18:07,366 --> 00:18:11,270
THIS COUNTY HAVEN'T GRADUATED,

460
00:18:11,270 --> 00:18:13,705
HIGH COOL 52% LIVE BELOW THE

461
00:18:13,705 --> 00:18:15,674
POVERTY LEVEL, 81% OF THE ADULTS

462
00:18:15,674 --> 00:18:17,175
READ AT OR BELOW AN EIGHTH GRADE

463
00:18:17,175 --> 00:18:18,610
LEVEL ON THIS AREA, AND YOU CAN

464
00:18:18,610 --> 00:18:20,479
SEE ON THE RIGHT MANY OTHER

465
00:18:20,479 --> 00:18:22,948
PROBLEMS AND THEY ARE--OR OTHER

466
00:18:22,948 --> 00:18:25,150
PROBLEMS AND THAT I HAVE

467
00:18:25,150 --> 00:18:28,453
HIGHLIGHTED THIS PROBLEM OF

468
00:18:28,453 --> 00:18:38,930
LITERACY ADULT LITERACY AND

469
00:18:55,314 --> 00:18:55,914
APPALACHIAN COUNTIES.

470
00:18:55,914 --> 00:18:57,416
AND I THOUGHT, OKAY, THIS PLACE

471
00:18:57,416 --> 00:19:07,926
WILL KNOW WHAT TO DO ABOUT ALL

472
00:19:14,533 --> 00:19:17,669
THIS,--BUT THEY TALK ABOUT IT AS

473
00:19:17,669 --> 00:19:20,305
A WORK IN PROGRESS THEY HAVEN'T

474
00:19:20,305 --> 00:19:22,307
REALLY IDENTIFIED THE BEST

475
00:19:22,307 --> 00:19:22,774
EVIDENCE YET.

476
00:19:22,774 --> 00:19:25,344
SO WHEN WE LOOK AT SOURCES OF

477
00:19:25,344 --> 00:19:27,646
RURAL DISPARITIES COMPARED TO

478
00:19:27,646 --> 00:19:28,146
URBAN POPULATIONS, IT'S

479
00:19:28,146 --> 00:19:29,881
IMPORTANT TO NOTE THAT RURAL

480
00:19:29,881 --> 00:19:31,450
POPULATIONS HAVE HIGHER POVERTY

481
00:19:31,450 --> 00:19:33,985
LEVELS, HIGHER RATES OF

482
00:19:33,985 --> 00:19:35,687
PERSISTENT POVERTY, FEWER

483
00:19:35,687 --> 00:19:37,222
WORKFORCE OPTIONS, HIGHER

484
00:19:37,222 --> 00:19:39,691
UNEMPLOYMENT RATES, LOWER PAYING

485
00:19:39,691 --> 00:19:40,959
YOBS, LOWER LITERACY, POOR

486
00:19:40,959 --> 00:19:43,595
ACCESS TO HEALTHY FOOD ANDS MORE

487
00:19:43,595 --> 00:19:44,663
FOOD DESERTS, PEOPLE OFTEN LOOK

488
00:19:44,663 --> 00:19:46,398
AT ME LIKE, WHAT THEY CAN JUST

489
00:19:46,398 --> 00:19:49,201
GO TO THE STORE, WELL, IF YOUR

490
00:19:49,201 --> 00:19:50,602
STORE IS 20-MILES AWAY AND YOU

491
00:19:50,602 --> 00:19:52,337
DON'T HAVE A CAR, YOU CAN'T JUST

492
00:19:52,337 --> 00:19:53,171
GO TO THE STORE.

493
00:19:53,171 --> 00:19:54,940
IF YOU LIVE AT THE TOP OF A

494
00:19:54,940 --> 00:19:59,010
MOUNTAIN AND THE ROAD'S SNOWED

495
00:19:59,010 --> 00:20:00,078
IN, 30, 40% OF THE YEAR, YOU

496
00:20:00,078 --> 00:20:01,380
CAN'T JUST GO TO THE STORE AND

497
00:20:01,380 --> 00:20:02,814
WHEN YOU GO TO THE STORE, YOU

498
00:20:02,814 --> 00:20:04,216
MIGHT BE SURPRISED WHAT YOU SEE

499
00:20:04,216 --> 00:20:06,084
SO THIS PROBLEM OF FOOD DESSERS

500
00:20:06,084 --> 00:20:14,326
AND ACCESS TO HEALTHY FOOD

501
00:20:14,326 --> 00:20:15,961
SYSTEM REALLY SEVERE THERE ARE A

502
00:20:15,961 --> 00:20:17,229
LOT OF BARRIERS FOR

503
00:20:17,229 --> 00:20:19,097
OPPORTUNITIES, AND I WAS TALKING

504
00:20:19,097 --> 00:20:21,166
TO FOLKS EARLIER ABOUT YOU KNOW

505
00:20:21,166 --> 00:20:23,034
PEOPLE OFTEN SAY WITH THAT 1,

506
00:20:23,034 --> 00:20:24,469
TOO, JUST GO HAVE A WALK, WHAT'S

507
00:20:24,469 --> 00:20:26,204
THE PROBLEM WITH THAT, BUT IF

508
00:20:26,204 --> 00:20:27,639
YOU GO TO APPALACHIA AND YOU GO

509
00:20:27,639 --> 00:20:30,208
TO MANY OF THESE AREAS, THERE

510
00:20:30,208 --> 00:20:30,909
AREN'T SIDEWALKS, THERE'S NOT

511
00:20:30,909 --> 00:20:34,012
AREAS THAT ARE FLAT, WHERE YOU

512
00:20:34,012 --> 00:20:35,614
CAN WALK, THEY'RE ACTUALLY NOT

513
00:20:35,614 --> 00:20:37,783
EVEN SAFE, IT'S NOT LIKE YOU'RE

514
00:20:37,783 --> 00:20:39,985
HAPLY WALKING THROUGH THE WOODS,

515
00:20:39,985 --> 00:20:42,254
THERE'S STREAMS AND CREEKS AND

516
00:20:42,254 --> 00:20:44,790
ROCKS AND DIVOTS AND WE COME UP

517
00:20:44,790 --> 00:20:46,491
ON THIS PHENOMENON WHERE PEOPLE

518
00:20:46,491 --> 00:20:47,459
HAVE THEIR MOBILE HOMES RIGHT

519
00:20:47,459 --> 00:20:50,295
NEXT TO THE WATER, SORT OF DOWN

520
00:20:50,295 --> 00:20:53,432
IN A DIP, AND THEY--THERE'S NO

521
00:20:53,432 --> 00:20:57,536
PLACE TO WALK AROUND THERE, SO

522
00:20:57,536 --> 00:21:00,472
KIDS PUT UP BASKETBALL HOOPS

523
00:21:00,472 --> 00:21:01,406
BECAUSE KENTUCKY, REALLY

524
00:21:01,406 --> 00:21:02,474
UNIVERSITY FOR KENTUCKY IS

525
00:21:02,474 --> 00:21:03,875
FAMOUS FOR BASKETBALL AND

526
00:21:03,875 --> 00:21:06,044
EVERYBODY LOVES IT, SO THEY PUT

527
00:21:06,044 --> 00:21:07,112
UP BASKETBALL HOOPS IN THE ROAD

528
00:21:07,112 --> 00:21:09,047
AND YOU HAVE TO BE CAREFUL WHEN

529
00:21:09,047 --> 00:21:12,317
YOU'RE DRIVING THERE BECAUSE

530
00:21:12,317 --> 00:21:14,119
KIDS HAVE TO TO PAY ATTENTION

531
00:21:14,119 --> 00:21:15,754
THERE, THAT YOU'RE NOT GOING TO

532
00:21:15,754 --> 00:21:17,255
RUN KIDS OVER PLAYING BASKETBALL

533
00:21:17,255 --> 00:21:18,623
AND IT IS VERY COMMON BECAUSE

534
00:21:18,623 --> 00:21:20,692
THERE IS NO SAFE PLACE TO SAFELY

535
00:21:20,692 --> 00:21:21,426
PLAY OR WALK.

536
00:21:21,426 --> 00:21:23,829
SO IT'S A VERY COMMON PROBLEM,

537
00:21:23,829 --> 00:21:26,631
THERE ARE MUCHA POORER HOUSING

538
00:21:26,631 --> 00:21:28,166
OPGS, LOWER RATES OF INSURANCE,

539
00:21:28,166 --> 00:21:29,434
EVEN THOUGH WE THINK WE'RE ALL

540
00:21:29,434 --> 00:21:30,869
SUPPOSED TO HAVE INSURANCE NOW,

541
00:21:30,869 --> 00:21:33,538
AND VERY HIGH RATES OF

542
00:21:33,538 --> 00:21:35,273
UNDERINSURED FOLKS, POOR ACCESS

543
00:21:35,273 --> 00:21:36,575
TO HEALTHCARE, ALL OF OF THESE

544
00:21:36,575 --> 00:21:38,910
TYPES OF HEALTHCARE AND LONGER

545
00:21:38,910 --> 00:21:40,545
TRANSPORTATION TIMES, IT TAKES 2

546
00:21:40,545 --> 00:21:42,647
OR 3 OR 4 HOURS, TIMES TO GET TO

547
00:21:42,647 --> 00:21:44,716
A PLACE THAT CAN JUST PROVIDE

548
00:21:44,716 --> 00:21:48,687
BASIC CARE, LET ALONE OTHER

549
00:21:48,687 --> 00:21:49,120
SORTS OF CARE.

550
00:21:49,120 --> 00:21:50,555
SO WHEN I THINK ABOUT THE

551
00:21:50,555 --> 00:21:52,190
SOLUTIONS I TALKED ABOUT THE

552
00:21:52,190 --> 00:21:54,459
SOLUTIONS, WORKED WITH PEOPLE

553
00:21:54,459 --> 00:21:56,595
ABOUT SOLUTIONS, THE THING THAT

554
00:21:56,595 --> 00:21:57,896
BECOMES VERY IMPORTANT IS THE

555
00:21:57,896 --> 00:21:59,731
NOTION OF COMMUNITY ENGAGED

556
00:21:59,731 --> 00:22:03,101
RESEARCH, YOU REALLY CAN'T EVER

557
00:22:03,101 --> 00:22:07,572
ADDRESS A PROBLEM THAT AFFECTS A

558
00:22:07,572 --> 00:22:09,541
COMMUNITY TO SUCH DEPTH IN THIS

559
00:22:09,541 --> 00:22:11,443
PROBLEM, IN URBAN AREAS, IN

560
00:22:11,443 --> 00:22:14,479
RURAL AREAS, IN ANYWHERE WHERE

561
00:22:14,479 --> 00:22:16,381
IT'S REALLY ENDEMIC PROBLEMS,

562
00:22:16,381 --> 00:22:20,986
EPIDEMIC PROBLEMS WITHOUT

563
00:22:20,986 --> 00:22:21,520
ENGAGING THE COMMUNITY.

564
00:22:21,520 --> 00:22:23,989
SO WHERE YOU ENGAGE ALL THE

565
00:22:23,989 --> 00:22:25,757
STAKEHOLDERS, SO THAT INCLUDES

566
00:22:25,757 --> 00:22:26,925
THE PATIENTS, THE NONPATIENTS,

567
00:22:26,925 --> 00:22:29,227
BUT THE PEOPLE LIVING IN THE

568
00:22:29,227 --> 00:22:31,463
AREA WHO ARE SUSCEPTIBLE TO POOR

569
00:22:31,463 --> 00:22:32,631
HEALTH, THE HEALTHCARE

570
00:22:32,631 --> 00:22:35,033
PROVIDERS, THE BUSINESS PEOPLE,

571
00:22:35,033 --> 00:22:36,635
THE CHURCH LEADERS, THE PEOPLE

572
00:22:36,635 --> 00:22:38,637
WHO OWN GROCERY TORES, SO WE

573
00:22:38,637 --> 00:22:40,939
REALLY HAVE WORKED ON DEVELOPING

574
00:22:40,939 --> 00:22:42,541
A COMMUNITY ADVISORY BOARD THAT

575
00:22:42,541 --> 00:22:43,942
INCLUDES ALL OF THOSE PEOPLE.

576
00:22:43,942 --> 00:22:46,511
WE MEDE TO FECUS ON PROBLEMS AND

577
00:22:46,511 --> 00:22:48,246
SOLUTIONS IDENTIFIED BY TAKE

578
00:22:48,246 --> 00:22:51,182
HOLDERS, WE NEED TO DO WITH OUR

579
00:22:51,182 --> 00:22:53,852
COMMUNITY ENGAGED RESEARCH

580
00:22:53,852 --> 00:22:54,319
CULTURALLY APPROPRIATE

581
00:22:54,319 --> 00:22:55,987
RECRUITMENT, FOLLOW UP AND

582
00:22:55,987 --> 00:22:56,721
INTERVENTION OR EVERYTHING YOU

583
00:22:56,721 --> 00:23:00,492
THINK YOU WANT TO DO IS GOING TO

584
00:23:00,492 --> 00:23:01,493
FAIL THERE.

585
00:23:01,493 --> 00:23:02,394
PEOPLE ARE VERY SUSPICIOUS OF

586
00:23:02,394 --> 00:23:04,496
THIS AREA OF RESEARCHERS WHO

587
00:23:04,496 --> 00:23:05,897
COME FROM UNIVERSITIES, DO SOME

588
00:23:05,897 --> 00:23:08,833
RESEARCH AND THEN LEAVE AND

589
00:23:08,833 --> 00:23:10,569
NEVER, YOU KNOW GIVE BACK IN ANY

590
00:23:10,569 --> 00:23:12,237
WAY, SO YOU REALLY HAVE TO AVOID

591
00:23:12,237 --> 00:23:17,375
THAT PROBLEM AS WE ALL SHOULD.

592
00:23:17,375 --> 00:23:19,578
WE EMPLOY LOCAL STAFF AND

593
00:23:19,578 --> 00:23:21,446
RESOURCES TO REALLY PROVIDE

594
00:23:21,446 --> 00:23:21,646
JOBS.

595
00:23:21,646 --> 00:23:23,582
IT'S 1 WAY OF PROVIDING JOBS,

596
00:23:23,582 --> 00:23:24,616
BUT ALSO MAKING SURE HAVE YOU

597
00:23:24,616 --> 00:23:28,687
THE RIGHT PEOPLE TO RECRUIT

598
00:23:28,687 --> 00:23:30,155
FOLKS, AND TO DO EFFECTIVE

599
00:23:30,155 --> 00:23:32,057
INTERVENTIONS AND YOU HAVE

600
00:23:32,057 --> 00:23:34,593
TO--YOU NEED SUSTAINABILITY

601
00:23:34,593 --> 00:23:36,695
PLANS, BECAUSE JUST COMING IN,

602
00:23:36,695 --> 00:23:40,298
DOING A PROJECT, SHOWING IT WORK

603
00:23:40,298 --> 00:23:41,800
ANDS LEAVING, EVEN IF--IT'S

604
00:23:41,800 --> 00:23:43,568
STILL A DISASTER IF YOU DON'T

605
00:23:43,568 --> 00:23:45,403
LEAVE PEOPLE WITH SOME OF THE

606
00:23:45,403 --> 00:23:46,805
SOLUTIONS THAT THEY CAN ENGAGE

607
00:23:46,805 --> 00:23:48,673
WITH TO SOLVE THE PROBLEM THAT

608
00:23:48,673 --> 00:23:50,375
YOU IDENTIFIED AND YOU ARE LIKE

609
00:23:50,375 --> 00:23:53,178
MAKING A BIG DEAL OUT OF, IF YOU

610
00:23:53,178 --> 00:23:54,879
JUST LEAVE, REALLY

611
00:23:54,879 --> 00:23:55,213
INAPPROPRIATE.

612
00:23:55,213 --> 00:23:57,849
I SHOW THIS HOUSE HERE, I

613
00:23:57,849 --> 00:23:59,618
COMMONLY PUT IT IN TALKS BECAUSE

614
00:23:59,618 --> 00:24:00,885
IT SHOWS SOME OF THE PROBLEMS

615
00:24:00,885 --> 00:24:02,587
THAT PEOPLE FACE IN THIS AREA.

616
00:24:02,587 --> 00:24:06,524
SO AS YOU CAN IMAGINE, THIS

617
00:24:06,524 --> 00:24:08,860
HOUSE, IT HAS LIKE A PLASTIC

618
00:24:08,860 --> 00:24:11,062
WINDOW, IT'S, YOU KNOW NOT--IT'S

619
00:24:11,062 --> 00:24:13,665
NOT LOOKING SO GOOD, AND IT HAS

620
00:24:13,665 --> 00:24:15,400
A LIGHT ON THE OUTSIDE BUT THERE

621
00:24:15,400 --> 00:24:17,302
IS NO LIGHT INSIDE, THERE'S NO

622
00:24:17,302 --> 00:24:19,070
ELECTRICITY IN THIS HOUSE, AND

623
00:24:19,070 --> 00:24:20,338
THERE'S A LITTLE TRAILER TO THE

624
00:24:20,338 --> 00:24:26,211
SIDE, TO THE RIGHT HAND SIDE, SO

625
00:24:26,211 --> 00:24:28,179
AN OLDER GENTLEMAN WITH HEART

626
00:24:28,179 --> 00:24:29,614
FAILURE LIVES THERE AND HIS SON

627
00:24:29,614 --> 00:24:31,449
TAKES CARE OF HIM THERE AND

628
00:24:31,449 --> 00:24:33,618
LIVES IN THAT LITTLE TRAILER

629
00:24:33,618 --> 00:24:35,687
THING BUT HE HAS MANY PROBLEMS

630
00:24:35,687 --> 00:24:37,422
HIMSELF SO THESE ARE SOME OF THE

631
00:24:37,422 --> 00:24:38,490
LIVING ENVIRONMENT AND PERSONAL

632
00:24:38,490 --> 00:24:40,325
PROBLEMS YOU ARE FACED WHEN YOU

633
00:24:40,325 --> 00:24:41,426
HAVE CAREGIVERS WHO ARE SICK AS

634
00:24:41,426 --> 00:24:43,795
YOU ARE, YOU ARE IN THIS

635
00:24:43,795 --> 00:24:45,830
SITUATION BEING REALLY ILL

636
00:24:45,830 --> 00:24:47,932
ULTIMATELY AND HAVING VERY FEW

637
00:24:47,932 --> 00:24:49,901
RESOURCES, SO COMMUNITY ENGAGED

638
00:24:49,901 --> 00:24:54,406
RESEARCH CAN REALLY HELP THIS

639
00:24:54,406 --> 00:24:54,873
ISSUE.

640
00:24:54,873 --> 00:24:57,976
ALSO STAKEHOLDER ENGAGEMENT IS

641
00:24:57,976 --> 00:25:00,545
ESSENTIAL AND YOU SAW I WAS

642
00:25:00,545 --> 00:25:03,314
FUNDED BY PC ORI, AND A LOT OF

643
00:25:03,314 --> 00:25:04,949
FOLKS KNOW HOW I GOT THE

644
00:25:04,949 --> 00:25:06,418
STAKEHOLDERS A LOT OF PEOPLE

645
00:25:06,418 --> 00:25:09,087
DON'T LIKE THE WORD STAKEHOLDER,

646
00:25:09,087 --> 00:25:11,022
BUT IT INVOLVES THE ENGAGEMENT

647
00:25:11,022 --> 00:25:15,560
OF PEOPLE WHO FOR WHOM THE

648
00:25:15,560 --> 00:25:16,828
PROBLEM IS REALLY RELEVANT.

649
00:25:16,828 --> 00:25:19,064
WE HAVE DONE FOCUS GROUPS WITH

650
00:25:19,064 --> 00:25:20,365
PATIENTS, CARE PROVIDERS AND

651
00:25:20,365 --> 00:25:21,566
COMMUNITY LEADERS, WE HAVE

652
00:25:21,566 --> 00:25:23,201
COMMUNITY ADVISORY BOARDS THAT

653
00:25:23,201 --> 00:25:24,903
ARE CONVENED BEFORE THE STUDIES

654
00:25:24,903 --> 00:25:26,538
ARE BEGUN AND HELD THROUGHOUT

655
00:25:26,538 --> 00:25:28,473
THE ENTIRE TIME, EVERY MONTH,

656
00:25:28,473 --> 00:25:31,776
MANY OF THE COMMUNITY ADVISORY

657
00:25:31,776 --> 00:25:35,046
BOARD ARE CO INVESTIGATORS, PAID

658
00:25:35,046 --> 00:25:36,214
CO INVESTIGATORS, EVERYBODY WHO

659
00:25:36,214 --> 00:25:37,716
ATTENDS A MEETING IS PAID, ALL

660
00:25:37,716 --> 00:25:40,919
OF THE STAFF ARE HIRED FROM THE

661
00:25:40,919 --> 00:25:42,187
COMMUNITY OF FOCUS, COMMUNITY

662
00:25:42,187 --> 00:25:43,421
HEALTH WORKERS ARE ENGAGED TO DO

663
00:25:43,421 --> 00:25:45,523
A LOT OF THE INTERVENTIONS, WE

664
00:25:45,523 --> 00:25:48,126
INVOLVE PATIENTS IN THE

665
00:25:48,126 --> 00:25:49,861
DISSEMINATION WHICH IS REALLY A

666
00:25:49,861 --> 00:25:51,262
POWERFUL, POWERFUL WAY TO GET

667
00:25:51,262 --> 00:25:53,698
THE RESULTS OUT AND GET

668
00:25:53,698 --> 00:25:57,435
COMMUNITIES ENGAGED IN FOLLOWING

669
00:25:57,435 --> 00:26:01,139
THE INTERVENTIONS OR SUGGIESTING

670
00:26:01,139 --> 00:26:02,273
THE UPTAKE OF INTERVENTIONS THAT

671
00:26:02,273 --> 00:26:02,574
YOU TEST.

672
00:26:02,574 --> 00:26:04,309
I TALK ABOUT THE FIRST PATIENT

673
00:26:04,309 --> 00:26:06,511
THAT I TOOK FOLLOWING 1 OF THE

674
00:26:06,511 --> 00:26:08,913
STUDIES THAT I WILL TALK ABOUT

675
00:26:08,913 --> 00:26:12,150
WHICH WAS VERY SUCCESSFUL IN

676
00:26:12,150 --> 00:26:12,951
REDUCING CARDIOVASCULAR DEC

677
00:26:12,951 --> 00:26:15,987
RISK, I TOOK HIM TO PC ORI WITH

678
00:26:15,987 --> 00:26:17,756
ME AND I WAS PRESENTING AND HE

679
00:26:17,756 --> 00:26:19,357
WAS PRESENTING AND HE HAD NEVER

680
00:26:19,357 --> 00:26:21,926
BEEN OUT ON A PLANE AND HE HAD

681
00:26:21,926 --> 00:26:24,129
VERY, VERY RARELY EVEN BEEN OUT

682
00:26:24,129 --> 00:26:28,099
OF HIS COUNTY BUT HE WAS

683
00:26:28,099 --> 00:26:30,168
WONDERFULLY ARTICULATE AND

684
00:26:30,168 --> 00:26:30,869
REALLY EXCITED ABOUT THE

685
00:26:30,869 --> 00:26:34,272
OPPORTUNITY AND WAS SO ENGAGING.

686
00:26:34,272 --> 00:26:35,774
SO I SPOKE FIRST, AND YOU KNOW

687
00:26:35,774 --> 00:26:39,344
PEOPLE WERE SORT OF, YOU KNOW,

688
00:26:39,344 --> 00:26:40,912
MULTITASKING, LOOKING AT THEIR

689
00:26:40,912 --> 00:26:42,313
COMPUTERS, DOING ALL THIS, AND

690
00:26:42,313 --> 00:26:44,482
THEN HE GETS UP AND HE STARTS

691
00:26:44,482 --> 00:26:46,551
TALKING AND EVERYBODY JUST PUTS

692
00:26:46,551 --> 00:26:49,187
THEIR TOUGH DOWN, JUST STARES AT

693
00:26:49,187 --> 00:26:50,722
HIM BECAUSE HE WAS SO ENGAGING

694
00:26:50,722 --> 00:26:52,690
AND IT'S THE STORY OF HOW YOU

695
00:26:52,690 --> 00:26:54,092
INTERVENE AND HOW YOU'RE

696
00:26:54,092 --> 00:26:56,194
EFFECTIVE AND HOW TO KEEP IT UP.

697
00:26:56,194 --> 00:26:58,062
SO, THIS IS REALLY A POWERFUL

698
00:26:58,062 --> 00:27:01,232
WAY, AND HE ALSO DID SOME

699
00:27:01,232 --> 00:27:03,034
DISSEMINATION IN THE AREAS THAT

700
00:27:03,034 --> 00:27:06,371
WERE AFFECTED, HE ACTUALLY WAS A

701
00:27:06,371 --> 00:27:09,174
GREAT GUY AND HE DID--HE PUT THE

702
00:27:09,174 --> 00:27:10,708
GROUP TOGETHER THAT HE WAS IN

703
00:27:10,708 --> 00:27:11,976
WITH THE INTERVENTION, GOT THEM

704
00:27:11,976 --> 00:27:14,379
TO, YOU KNOW DO A LITTLE CLUB

705
00:27:14,379 --> 00:27:15,580
WHERE, AFTER THE INTERVENTIONS,

706
00:27:15,580 --> 00:27:17,649
WHEN THEY MET DURING THE WEEK,

707
00:27:17,649 --> 00:27:20,485
THEY WOULD WALK UP THE HILL TO

708
00:27:20,485 --> 00:27:22,554
THE SUPER OLD CHURCH, NO, THERE

709
00:27:22,554 --> 00:27:24,189
WAS THE TEA HALL WHICH IS A

710
00:27:24,189 --> 00:27:25,623
REALLY OLD BUILDING AND A BIGOLE

711
00:27:25,623 --> 00:27:26,891
DEAL, ABOUT YOU HE WOULD GET

712
00:27:26,891 --> 00:27:29,527
THEM TO YOU KNOW WALK UP THERE

713
00:27:29,527 --> 00:27:32,263
AND START TO DO THE THINGS THAT

714
00:27:32,263 --> 00:27:33,598
WE TALKED ABOUT WERE IMPORTANT

715
00:27:33,598 --> 00:27:33,998
TO DO.

716
00:27:33,998 --> 00:27:35,633
AND THEY WERE ALL REALLY

717
00:27:35,633 --> 00:27:37,135
INTERESTED IN DOING THESE THINGS

718
00:27:37,135 --> 00:27:38,870
BECAUSE THEY WERE FROM

719
00:27:38,870 --> 00:27:41,172
MANCHESTER AND PLAY COUNTY, THE

720
00:27:41,172 --> 00:27:43,675
POOREST, FATTEST COUNTY IN THE

721
00:27:43,675 --> 00:27:44,642
AREA, THIS THE UNITED STATES AND

722
00:27:44,642 --> 00:27:48,079
THEY DID NOT LIKE THAT AND THEY

723
00:27:48,079 --> 00:27:49,214
REALLY UPON--AS MANY PEOPLE IN

724
00:27:49,214 --> 00:27:50,748
THAT AREA FELT LIKE THEY DIDN'T

725
00:27:50,748 --> 00:27:52,283
HAVE THE RESOURCES OR THE SKILLS

726
00:27:52,283 --> 00:27:54,853
OR THE EXPERTISE TO ENGAGE IN

727
00:27:54,853 --> 00:27:56,020
SIMPLE CARDIOVASCULAR RISK

728
00:27:56,020 --> 00:27:57,755
REDUCTION, AND SO, THEY WERE

729
00:27:57,755 --> 00:27:58,723
DELIGHTED TO GET THIS

730
00:27:58,723 --> 00:28:01,793
INTERVENTION AND THEY WERE

731
00:28:01,793 --> 00:28:03,661
REALLY AMAZINGLY COMPLIANT WITH

732
00:28:03,661 --> 00:28:04,028
IT.

733
00:28:04,028 --> 00:28:07,332
FINALLY, YOU NEED TO UNDERSTAND

734
00:28:07,332 --> 00:28:08,900
THE ENVIRONMENT AND THESE ARE

735
00:28:08,900 --> 00:28:10,134
PICTURES THAT SHOWS THE--YOU

736
00:28:10,134 --> 00:28:13,137
KNOW YOU CAN SEE THE NUMBER IN

737
00:28:13,137 --> 00:28:14,806
THE DARK BROWN OF HOUSEHOLDS,

738
00:28:14,806 --> 00:28:15,974
PERCENTAGE OF HOUSE HOLES WITH

739
00:28:15,974 --> 00:28:17,375
NO CAR, WHO ARE GREATER THAN A

740
00:28:17,375 --> 00:28:19,377
MILE TO THE STORE, AND THERE'S A

741
00:28:19,377 --> 00:28:21,579
HUGE PILE OF THEM IN THAT

742
00:28:21,579 --> 00:28:24,549
EASTERN KENTUCKY AREA, AND WEST

743
00:28:24,549 --> 00:28:24,816
VIRGINIA.

744
00:28:24,816 --> 00:28:33,057
THERE'S YOU KNOW A--THERE'S A

745
00:28:33,057 --> 00:28:34,459
MOBILE HOME WITH THIS IS THE

746
00:28:34,459 --> 00:28:35,760
PICTURE WITH THE STREETS, SEE

747
00:28:35,760 --> 00:28:37,362
THE SIGN THERE THAT SAYS, THE

748
00:28:37,362 --> 00:28:38,796
RIDGE IS THE NAME OF THAT STREET

749
00:28:38,796 --> 00:28:44,202
AND THAT IS THE STREET SO DO YOU

750
00:28:44,202 --> 00:28:45,837
SEE THE STREET, I DON'T SEE THE

751
00:28:45,837 --> 00:28:46,804
STREET, BUT YOU DRIVE DOWN THERE

752
00:28:46,804 --> 00:28:48,239
AND YOU GET SORT OF INSTRUCTIONS

753
00:28:48,239 --> 00:28:50,541
LOAMACYIC THAT WHEN WE WOULD GO

754
00:28:50,541 --> 00:28:56,481
TO PEOPLE'S HOMES, YOU GET

755
00:28:56,481 --> 00:28:58,416
INSTRUCTIONS TO GO DOWN THE ROAD

756
00:28:58,416 --> 00:29:00,318
OR GO UP RIVER ROAD AND WHAT

757
00:29:00,318 --> 00:29:01,786
THAT MEANT WAS GET ON THE ROAD

758
00:29:01,786 --> 00:29:03,521
IN THE RIVER AND DRIVE UP THE

759
00:29:03,521 --> 00:29:03,721
RIVER.

760
00:29:03,721 --> 00:29:05,056
THAT TOOK A WHILE TO FIND

761
00:29:05,056 --> 00:29:06,991
BECAUSE THAT WAS NOT CLEAR WHICH

762
00:29:06,991 --> 00:29:08,059
KEPT CALLING AND CALLING AND

763
00:29:08,059 --> 00:29:15,900
THEY SAID GET ON RIVER ROAD.

764
00:29:15,900 --> 00:29:21,005
AND DO YOU KNOW WHERE THE RIVER

765
00:29:21,005 --> 00:29:24,008
IS? 

766
00:29:24,008 --> 00:29:25,610
THAT WAS GOOD.

767
00:29:25,610 --> 00:29:26,978
NOT ON GOOGLE.

768
00:29:26,978 --> 00:29:27,378
[LAUGHTER]

769
00:29:27,378 --> 00:29:29,614
WHEN I TALK ABOUT SOLUTIONS

770
00:29:29,614 --> 00:29:36,187
UNDERSTANDING COMMUNITY

771
00:29:36,187 --> 00:29:40,158
STRENGTHS IS ESSENTIAL AND AS I

772
00:29:40,158 --> 00:29:41,826
SAID WE DID A LOT OF FOCUS

773
00:29:41,826 --> 00:29:44,295
GROUPS AND PEOPLE ON THIS AREA

774
00:29:44,295 --> 00:29:46,898
HAVE A STRONG COMMUNITY OF

775
00:29:46,898 --> 00:29:47,966
AWARENESS OF LOCAL PROBLEM

776
00:29:47,966 --> 00:29:50,168
OCCURS, PEOPLE WE RECRUITED MORE

777
00:29:50,168 --> 00:29:51,536
THAN 1100 PEOPLE TO THE STUDY

778
00:29:51,536 --> 00:29:52,737
THAT--1 OF THE STUDIES I'M GOING

779
00:29:52,737 --> 00:30:00,445
TO TALK ABOUT IN LESS THAN A

780
00:30:00,445 --> 00:30:00,712
YEAR.

781
00:30:00,712 --> 00:30:01,879
THEY ALL ARE TOO HARD TO REACH

782
00:30:01,879 --> 00:30:03,514
AND IF I DO IT RIGHT AND I WILL

783
00:30:03,514 --> 00:30:11,823
TELL WHAT YOU RIGHT IS OR HOW WE

784
00:30:11,823 --> 00:30:14,592
DO IT RIGHT, THERE'S A POTENTIAL

785
00:30:14,592 --> 00:30:15,626
FOR HOME GROWN CHANGE, PEOPLE

786
00:30:15,626 --> 00:30:17,462
ARE REALLY OPEN TO BEING PART OF

787
00:30:17,462 --> 00:30:21,232
THE SOLUTION AND BEING PART OF

788
00:30:21,232 --> 00:30:22,834
PUSHING NOVEL INTERVENTIONS OUT

789
00:30:22,834 --> 00:30:23,835
THERE.

790
00:30:23,835 --> 00:30:25,837
PEOPLE ARE VERY NEIGHBORLY,

791
00:30:25,837 --> 00:30:27,805
THERE'S CONCERN FOR NEIGHBORS

792
00:30:27,805 --> 00:30:29,374
FRIENDS FAMILY AND COMMUNITY

793
00:30:29,374 --> 00:30:30,375
THERE, 'S GENUINE CONCERN FOR

794
00:30:30,375 --> 00:30:31,976
THE HEALTH OF THE COMMUNITY AND

795
00:30:31,976 --> 00:30:33,111
WILLINGNESS TO PROMOTE CHANGE TO

796
00:30:33,111 --> 00:30:33,544
IMPROVE IT.

797
00:30:33,544 --> 00:30:35,046
THERE WAS A HUGE DESIRE TO

798
00:30:35,046 --> 00:30:38,850
IMPROVE HEALTH AND AN INTEREST

799
00:30:38,850 --> 00:30:40,385
IN SELF-CARE WHICH IS OUR OWN

800
00:30:40,385 --> 00:30:41,486
SELF-MANAGEMENT ON A DAILY BASIS

801
00:30:41,486 --> 00:30:43,621
WHICH YOU WILL SEE IN A MINUTE

802
00:30:43,621 --> 00:30:45,790
IS 1 OF THE GOOD THINGS I THINK

803
00:30:45,790 --> 00:30:46,824
IS FUNDAMENTAL TO INTERVENING

804
00:30:46,824 --> 00:30:48,393
AND THEY HAVE A RECOGNITION THEY

805
00:30:48,393 --> 00:30:49,193
DON'T HAVE THE KNOWLEDGE AND

806
00:30:49,193 --> 00:30:50,728
SKILLS THAT ARE NEEDED TO MAKE A

807
00:30:50,728 --> 00:30:51,829
LOT OF THESE CHANGES.

808
00:30:51,829 --> 00:30:56,234
SO PEOPLE ARE VERY, VERY OPEN TO

809
00:30:56,234 --> 00:30:57,268
THIS INTERVENTION, ON THE LAST

810
00:30:57,268 --> 00:31:00,938
DAY THAT WE WERE CLOSING OUT OUR

811
00:31:00,938 --> 00:31:02,874
STUDY, THERE WERE PEOPLE IN

812
00:31:02,874 --> 00:31:04,442
LINES, LIKE 20 PEOPLE IN LINES

813
00:31:04,442 --> 00:31:06,210
WHO WANTED TO BE IN THIS STUDY,

814
00:31:06,210 --> 00:31:08,413
SO WE LET THEM BUT WE DIDN'T

815
00:31:08,413 --> 00:31:10,148
CLOSE IT OUT THEN BUT IT'S NOT

816
00:31:10,148 --> 00:31:15,653
THE SITUATION WHERE WHEN I IRPT

817
00:31:15,653 --> 00:31:18,056
VIEWED A LOT OF HEALTHCARE

818
00:31:18,056 --> 00:31:19,257
PROVIDERS PEOPLE WHO WERE

819
00:31:19,257 --> 00:31:20,291
TEMPORARILY WORKING THERE WHO

820
00:31:20,291 --> 00:31:22,026
SAID THINGS LIKE THESE PEOPLE

821
00:31:22,026 --> 00:31:23,528
DON'T REALLY WANT TO CHANGE,

822
00:31:23,528 --> 00:31:24,962
THEY DON'T CARE, I'M NOT EVEN

823
00:31:24,962 --> 00:31:27,265
TALKING TO THEM ABOUT IT, WHY

824
00:31:27,265 --> 00:31:27,832
ARE YOU?

825
00:31:27,832 --> 00:31:30,168
AND JUST A HUGE MISUNDERSTANDING

826
00:31:30,168 --> 00:31:32,437
ABOUT WHAT PEOPLE NEED AND WANT

827
00:31:32,437 --> 00:31:36,841
IN THESE AREAS, BASED ON

828
00:31:36,841 --> 00:31:40,011
PERCEPTIONS THAT ARE REALLY

829
00:31:40,011 --> 00:31:40,378
MISPERCEPTIONS.

830
00:31:40,378 --> 00:31:42,480
ANOTHER IMPORTANT SOLUTION IS TO

831
00:31:42,480 --> 00:31:43,614
ENGAGE IN SELF-CARE, TEACH

832
00:31:43,614 --> 00:31:46,084
PEOPLE TO ENGAGE IN SELF-CARE,

833
00:31:46,084 --> 00:31:48,352
WE OFTEN ENGAGE IN SELF-CARE,

834
00:31:48,352 --> 00:31:49,520
99.9% OF OUR TIME IS WITH

835
00:31:49,520 --> 00:31:50,655
OURSELVES AND NOT WITH DOCTORS

836
00:31:50,655 --> 00:31:52,290
AND IN A HOSPITAL BUT BY

837
00:31:52,290 --> 00:31:55,693
OURSELVES, TAKING CARE OF

838
00:31:55,693 --> 00:31:57,428
OURSELVES, SO WE NEED TO

839
00:31:57,428 --> 00:31:58,162
UNDERSTAND HOW CARDIOVASCULAR

840
00:31:58,162 --> 00:31:59,530
DEC RISK AT AN INDIVIDUAL LEVEL

841
00:31:59,530 --> 00:32:00,698
AND A FAMILY LEVEL AND THE

842
00:32:00,698 --> 00:32:01,399
COMMUNITY LEVEL.

843
00:32:01,399 --> 00:32:02,934
SO WE TEACH PEOPLE TO KNOW ALL

844
00:32:02,934 --> 00:32:04,469
THEIR NUMBERS, TO KNOW WHAT THEY

845
00:32:04,469 --> 00:32:06,971
MEAN, TO YOU KNOW FIND OUT,

846
00:32:06,971 --> 00:32:08,639
BEINIZEY IS FIND OUT EVERYBODY

847
00:32:08,639 --> 00:32:09,674
ELSE'S UNDERSTAND GOALS THAT ARE

848
00:32:09,674 --> 00:32:13,744
RELEVANT TO THE PROBLEMS YOU

849
00:32:13,744 --> 00:32:14,679
FACE AND SET THOSE AND

850
00:32:14,679 --> 00:32:16,848
UNDERSTAND HOW TO ACHIEVE THEM,

851
00:32:16,848 --> 00:32:19,951
LEARN THE SKILLS TO ACHIEVE

852
00:32:19,951 --> 00:32:21,352
GOALS, DEVELOP PARTNERSHIPS WITH

853
00:32:21,352 --> 00:32:23,121
OTHER PEOPLE WITH HEALTHCARE

854
00:32:23,121 --> 00:32:24,789
PROVIDERS WITH BUSINESSES, AND

855
00:32:24,789 --> 00:32:25,623
BUILTOT SELF-RELIANCE THAT'S

856
00:32:25,623 --> 00:32:27,525
VERY WELL KNOWN AND VERY

857
00:32:27,525 --> 00:32:30,461
CHAISHTISTIC OF MANY RURAL

858
00:32:30,461 --> 00:32:31,395
PEOPLE AND SELF-CARE IN THIS

859
00:32:31,395 --> 00:32:35,967
AREA INVOLVES A LOT OF PROBLEM

860
00:32:35,967 --> 00:32:37,001
SOLVING TEACHING.

861
00:32:37,001 --> 00:32:38,436
WHEN I SAY UNDERSTAND THE

862
00:32:38,436 --> 00:32:39,203
ENVIRONMENT IN WHICH PEOPLE

863
00:32:39,203 --> 00:32:40,738
LIVE, THIS COMES FROM THIS WHOLE

864
00:32:40,738 --> 00:32:50,815
NOTION OF WHAT'S CALLED LEWIN'S

865
00:32:50,815 --> 00:32:52,216
EQUATION, SO THEY ADAPT TO AN

866
00:32:52,216 --> 00:32:54,218
ENVIRONMENT THEY LIVE IN, SO ANY

867
00:32:54,218 --> 00:32:55,453
ASSESSMENT OF AN ENVIRONMENT IS

868
00:32:55,453 --> 00:32:56,954
ESSENTIAL WHEN YOU ARE DEALING

869
00:32:56,954 --> 00:32:58,289
WITH PEOPLE AND COMMUNITY WHO

870
00:32:58,289 --> 00:33:00,091
ARE RURAL AND REMOTE, I HAVE

871
00:33:00,091 --> 00:33:01,392
SOME, I WANT TO POINT OUT THE

872
00:33:01,392 --> 00:33:02,326
IMPORTANCE OF THIS, WE TELL

873
00:33:02,326 --> 00:33:04,795
PEOPLE ALL THE TIME, JUST EAT

874
00:33:04,795 --> 00:33:07,265
MORE FRUITS AND VEGETABLES, I

875
00:33:07,265 --> 00:33:08,466
MEAN, WHAT'S HARD ABOUT THAT,

876
00:33:08,466 --> 00:33:10,101
WELL, HERE'S THE GROCERY STORE

877
00:33:10,101 --> 00:33:13,204
IN THIS AREA, AND IT LOOKS LIKE

878
00:33:13,204 --> 00:33:14,772
THAT, IT'S NOT JUST THAT PEOPLE

879
00:33:14,772 --> 00:33:16,507
HAVE SHOPPED IT OUT, IT'S THAT

880
00:33:16,507 --> 00:33:18,309
IT NEVER FILLS UP, THAT'S WHAT

881
00:33:18,309 --> 00:33:20,178
IT LOOKS LIKE, IT MIGHT HAVE A

882
00:33:20,178 --> 00:33:22,647
FEW MORE FRUITS AND VEGETABLES

883
00:33:22,647 --> 00:33:28,286
OR THEY'RE SHOPPING AT THE LOCAL

884
00:33:28,286 --> 00:33:30,154
GROCERY OR GAS MART, THERE'S NO

885
00:33:30,154 --> 00:33:31,489
FRUITS AND VEGETABLES IN THERE,

886
00:33:31,489 --> 00:33:31,756
TRUST ME.

887
00:33:31,756 --> 00:33:32,690
SO YOU HAVE TO THINK ABOUT WHAT

888
00:33:32,690 --> 00:33:36,127
YOU SAY WHEN YOU TELL PEOPLE TO

889
00:33:36,127 --> 00:33:40,631
EAT MORE FRUSTAND VEGETABLES, SO

890
00:33:40,631 --> 00:33:42,400
AND HOW YOU FACILITATE THAT,

891
00:33:42,400 --> 00:33:43,668
THIS FELLOW DOESN'T HAVE

892
00:33:43,668 --> 00:33:45,102
ELECTRICITY, OR FRIGE OR

893
00:33:45,102 --> 00:33:47,505
FREEZER, HOOT NOT GOING TO BUY

894
00:33:47,505 --> 00:33:48,806
FROZEN FRUITS AND VEGETABLES.

895
00:33:48,806 --> 00:33:50,208
THIS STORE, THIS WAS A PRETTY

896
00:33:50,208 --> 00:33:52,276
ASHES MAZING TORE WHERE WE

897
00:33:52,276 --> 00:33:53,978
WALKED IN, WE OFTEN TELL PEOPLE

898
00:33:53,978 --> 00:33:57,114
TO BUY LOW SOD I DIDN'T MEAN,

899
00:33:57,114 --> 00:33:57,815
CANNED VEGETABLES, THEY REALLY

900
00:33:57,815 --> 00:34:01,852
ARE NOT AVAILABLE IN A LOT OF

901
00:34:01,852 --> 00:34:04,222
THESE AREAS, THERE'S--THERE'S NO

902
00:34:04,222 --> 00:34:05,990
LOW SALT CANNED VEGETABLES OR

903
00:34:05,990 --> 00:34:07,825
JUICES, THERE WERE A FEW FRUITS

904
00:34:07,825 --> 00:34:11,195
WITH HEAVY IN SYRUP, NO FROZEN

905
00:34:11,195 --> 00:34:15,933
FRUITS, NO LOW FAT OR LOW SODIUM

906
00:34:15,933 --> 00:34:18,336
CHEESS, AND THIS IS THE STORE

907
00:34:18,336 --> 00:34:22,073
WHEN IT STOPPED, THERE'S THE

908
00:34:22,073 --> 00:34:23,374
STUFF THAT YOU CAN BUY AND WE

909
00:34:23,374 --> 00:34:24,809
WENT INTO THIS STORE WHEN WE

910
00:34:24,809 --> 00:34:27,778
WERE ASSESSING IT AND WE TALKED

911
00:34:27,778 --> 00:34:29,547
IN AND WHEN YOU WALK IN, THE

912
00:34:29,547 --> 00:34:34,051
ONLY THING THAT'S FULL, ARE

913
00:34:34,051 --> 00:34:37,355
RACKS AND RACKS OF SODA POP, SO,

914
00:34:37,355 --> 00:34:44,128
NOT WATER BUT SODA POP AND THEN

915
00:34:44,128 --> 00:34:45,896
THESE REALLY SPARSELY FILLED

916
00:34:45,896 --> 00:34:48,199
RACKS OF CANNED GOODS AND 1 LIKE

917
00:34:48,199 --> 00:34:50,034
A FREEZER TYPE, A REGULAR FEASOR

918
00:34:50,034 --> 00:34:53,971
TYPE FROZE EXPEN THIS IS AND

919
00:34:53,971 --> 00:34:55,273
THIS IS WHAT PEOPLE HAVE TO

920
00:34:55,273 --> 00:34:56,674
CHOOSE FROM SO ANOTHER THING WE

921
00:34:56,674 --> 00:34:57,975
SAY, LET'S TALK ABOUT EATING

922
00:34:57,975 --> 00:34:58,209
OUT.

923
00:34:58,209 --> 00:35:00,344
IT'S EASY WHEN YOU EAT TOUT

924
00:35:00,344 --> 00:35:01,245
CHOOSE MORE VEGGIES, WELL,

925
00:35:01,245 --> 00:35:04,982
HERE'S AN EXAMPLE OF A

926
00:35:04,982 --> 00:35:06,150
RESTAURANT SO LET ME TELL THAT

927
00:35:06,150 --> 00:35:08,452
YOU FAST FOOD IS POPULAR IN NEEZ

928
00:35:08,452 --> 00:35:10,855
AREAS BECAUSE PEOPLE LIVING IN

929
00:35:10,855 --> 00:35:12,957
RURAL APPALACHIA, THEY WANT TO

930
00:35:12,957 --> 00:35:14,959
NORMALIZE, THEY ARE TIRED TO BE

931
00:35:14,959 --> 00:35:16,394
THE POOR, FAT, DOWN IN THE

932
00:35:16,394 --> 00:35:18,696
HOLLERS, ALL THOSE THINGS WE SAY

933
00:35:18,696 --> 00:35:19,530
ABOUT APPALACHIANS AND THEY WANT

934
00:35:19,530 --> 00:35:23,100
TO GO TO THE FAST FOOD PLACE, SO

935
00:35:23,100 --> 00:35:24,535
FAST FOOD PLACES ARE ACTUALLY

936
00:35:24,535 --> 00:35:26,304
REALLY,A BUNKED ANT IN A LOT OF

937
00:35:26,304 --> 00:35:30,241
THESE TOWNS, BUT THIS IS WHAT

938
00:35:30,241 --> 00:35:33,577
YOU KNOW TRY TO GET FRUITS AND

939
00:35:33,577 --> 00:35:34,512
VEGETABLES AT MCDONALDS, GOOD

940
00:35:34,512 --> 00:35:34,779
LUCK.

941
00:35:34,779 --> 00:35:36,280
THIS WAS A COMMON EATING PLACE

942
00:35:36,280 --> 00:35:38,516
WE WENT TO, IT'S THE 1 THAT I

943
00:35:38,516 --> 00:35:41,686
JUST--THIS 1 ON THE LEFT, IT'S A

944
00:35:41,686 --> 00:35:44,121
RESTAURANT THERE, AND THEIR

945
00:35:44,121 --> 00:35:46,657
SPECIAL IS A MEET AND 2 VEG, SO

946
00:35:46,657 --> 00:35:48,726
LOOK OW CHEAP IT IS SO PEOPLE DO

947
00:35:48,726 --> 00:35:50,728
GO OUT AND EAT BUT DO YOU KNOW

948
00:35:50,728 --> 00:35:53,397
WHAT THE VEGS ARE SO WE WENT

949
00:35:53,397 --> 00:35:55,966
ANDATE, THERE WERE 3 OF US AND

950
00:35:55,966 --> 00:35:57,635
HERE'S THE FOOD, FRIED SHRIMP IS

951
00:35:57,635 --> 00:36:00,171
1 OF THE MEETS AND YOU KNOW

952
00:36:00,171 --> 00:36:02,273
THERE'S FRENCH FRIES AND COAL

953
00:36:02,273 --> 00:36:05,643
SLAW, THAT'S THE VEG.

954
00:36:05,643 --> 00:36:07,278
THERE'S HAMBURGER WITH MORE

955
00:36:07,278 --> 00:36:09,380
FRENCH FRIES AND A--THAT MIGHT

956
00:36:09,380 --> 00:36:10,314
BE POTATO SALIVA--SALIVA AID BUT

957
00:36:10,314 --> 00:36:15,086
THE WHOLE IDEA OF A VEG BEING A

958
00:36:15,086 --> 00:36:22,026
VEG, A DISCREET VEGETABLE IS NOT

959
00:36:22,026 --> 00:36:24,695
IN THE THINKING OF THIS 1 AND 2

960
00:36:24,695 --> 00:36:25,029
VEG.

961
00:36:25,029 --> 00:36:26,664
ONE AND AND 3 IN THE SOUTH.

962
00:36:26,664 --> 00:36:27,732
WE NEED TO THINK ABOUT

963
00:36:27,732 --> 00:36:28,532
UNDERSTANDING THE PEOPLE IN

964
00:36:28,532 --> 00:36:29,467
THEIR ENVIRONMENT AND HOW THEY

965
00:36:29,467 --> 00:36:30,735
REACT TO THE ENVIRONMENT, AND

966
00:36:30,735 --> 00:36:32,503
THIS LADY LOVES TO HAVE US TAKE

967
00:36:32,503 --> 00:36:33,704
HER PICTURE AND SHE SAID, YOU

968
00:36:33,704 --> 00:36:36,307
CAN TALK ABOUT ME ALL YOU WANT,

969
00:36:36,307 --> 00:36:38,843
BUT SHE SPENT HER FIRST SEVERAL

970
00:36:38,843 --> 00:36:40,911
MINUTES TALKING WITH THE LADIES

971
00:36:40,911 --> 00:36:43,247
WHO WERE THE MUCH ASSISTANTS WHO

972
00:36:43,247 --> 00:36:45,316
WERE ENROLLING HER IN A STUDY,

973
00:36:45,316 --> 00:36:47,351
TELLING THEM, YOU KNOW YOU GIRLS

974
00:36:47,351 --> 00:36:48,986
ARE STUPID, STUPID, STUPID.

975
00:36:48,986 --> 00:36:51,822
IT WAS LIKE OH MY GOD THESE POOR

976
00:36:51,822 --> 00:36:52,490
RESEARCH ASSISTANTS, THEY'RE 20

977
00:36:52,490 --> 00:36:53,791
YEARS OLD, THEY'RE WANTING TO

978
00:36:53,791 --> 00:36:55,893
BACK OUT OF THE TRAILER, BUT SHE

979
00:36:55,893 --> 00:36:57,661
WAS TRYING TO SAY THAT, YOU KNOW

980
00:36:57,661 --> 00:37:00,464
YOU'RE ASKING ME TO DO STUFF

981
00:37:00,464 --> 00:37:01,132
THAT'S LITERALLY IMPOSSIBLE, SO

982
00:37:01,132 --> 00:37:09,373
SHE DOESN'T HAVE A CAR, SHE

983
00:37:09,373 --> 00:37:11,275
DOESN'T--SHE LIVERS BY HERSELF

984
00:37:11,275 --> 00:37:12,977
SHE HAS FRIENDS AND FAMILY THAT

985
00:37:12,977 --> 00:37:15,846
COME ONCE A MONTH AND SHE SNOWED

986
00:37:15,846 --> 00:37:17,014
IN THIS THE WINTER AND

987
00:37:17,014 --> 00:37:19,784
EVERYTHING WE WERE TELLING HER

988
00:37:19,784 --> 00:37:23,788
WAS RIDICULOUS UNLESS WE ADAPT

989
00:37:23,788 --> 00:37:24,088
IT.

990
00:37:24,088 --> 00:37:25,556
OUR HEART HEGHT WAS THE NAME OF

991
00:37:25,556 --> 00:37:26,490
OUR INTERVENTION AND THESE

992
00:37:26,490 --> 00:37:29,293
PEOPLE TOOK TO IT AND THIS WAS A

993
00:37:29,293 --> 00:37:30,327
GROUP OF SENIOR SIDES WHERE WE

994
00:37:30,327 --> 00:37:31,762
LET THEM TELL US WHAT WAS WRONG

995
00:37:31,762 --> 00:37:36,934
WITH THEIR ABILITY TO ENGAGE IN

996
00:37:36,934 --> 00:37:38,803
ANY CARDIOVASCULAR DISEASE AND

997
00:37:38,803 --> 00:37:40,805
HOW WE COULD FIX IT AND THAT

998
00:37:40,805 --> 00:37:41,739
INTERACTION RESULTED IN THE

999
00:37:41,739 --> 00:37:48,279
INTERVENTIONS WE DO AND THE

1000
00:37:48,279 --> 00:37:48,546
OUTCOMES.

1001
00:37:48,546 --> 00:37:50,414
SO 1 OF THESE STUDIES WE DID, WE

1002
00:37:50,414 --> 00:37:52,383
TRIED TO DETERMINE IF WE ADDRESS

1003
00:37:52,383 --> 00:37:54,118
ALL THESE ADVERSE SOCIAL

1004
00:37:54,118 --> 00:38:03,627
DETERMINANTS OF HEALTH, COULD

1005
00:38:03,627 --> 00:38:05,429
THEY BE OVERCOME?

1006
00:38:05,429 --> 00:38:07,398
THESE REDUCTIONS WERE DESIGNED

1007
00:38:07,398 --> 00:38:08,566
SPECIFICALLY FOR RURAL

1008
00:38:08,566 --> 00:38:09,099
DISTRESSED ENVIRONMENTS.

1009
00:38:09,099 --> 00:38:11,802
WE KNOW THAT LIFESTYLE

1010
00:38:11,802 --> 00:38:12,970
INTERVENTIONS CAN REDUCE CBD

1011
00:38:12,970 --> 00:38:16,073
RISK BY AT LEAST 40, 50%,

1012
00:38:16,073 --> 00:38:17,241
LIFESTYLE IS MOST EFFECTIVE WHEN

1013
00:38:17,241 --> 00:38:18,676
PATIENTS ARE GIIVE THE TOOLS TO

1014
00:38:18,676 --> 00:38:26,684
ENGAGE IN SELF-CARE AND WE

1015
00:38:26,684 --> 00:38:27,885
THOUGHT THAT THAT THESE

1016
00:38:27,885 --> 00:38:29,286
INTERVENTIONS NEED TO FOCUS ON

1017
00:38:29,286 --> 00:38:30,588
LIFESTYLE CHANGE BUT IT HAS TO

1018
00:38:30,588 --> 00:38:31,689
INCREASE THE ABILITIES OF THE

1019
00:38:31,689 --> 00:38:33,090
INDIVIDUALS WHO ENGAGE IN

1020
00:38:33,090 --> 00:38:35,359
SELF-CARE, AND THEY HAD TO BE

1021
00:38:35,359 --> 00:38:36,293
CULTURALLY APPROPRIATE, AND THEY

1022
00:38:36,293 --> 00:38:38,529
HAVE TO HAVE COMPONENTS THAT

1023
00:38:38,529 --> 00:38:39,830
OVERCOME SOCIAL DETERMINANTS OF

1024
00:38:39,830 --> 00:38:46,003
HELT BARRIERS, AND THAT WAS THE

1025
00:38:46,003 --> 00:38:47,037
HEART HEALTH INTERVENTION AND

1026
00:38:47,037 --> 00:38:48,772
SOMETIMES WHEN I DRIEB THIS

1027
00:38:48,772 --> 00:38:50,741
INTERVENTION, I AM LIKE OH GOD

1028
00:38:50,741 --> 00:38:52,376
THAT'S MY LIFESTYLE INTERVENTION

1029
00:38:52,376 --> 00:39:01,085
AND BUT THIS INTERVENTION IS

1030
00:39:01,085 --> 00:39:02,987
VERY DIFFERENT COME TO DEAL WITH

1031
00:39:02,987 --> 00:39:03,687
COMMUNITY BARRIERS AND OVERCOME

1032
00:39:03,687 --> 00:39:08,225
A LOT OF THE PROBLEMS OF THESE

1033
00:39:08,225 --> 00:39:11,829
ADVERSE SOCIAL DETERMINE NABTS

1034
00:39:11,829 --> 00:39:13,764
OF HEALTH THAT WILL IF

1035
00:39:13,764 --> 00:39:15,499
UNADDRESSED WILL NEVER LET YOU

1036
00:39:15,499 --> 00:39:16,100
BE SUCCESSFUL.

1037
00:39:16,100 --> 00:39:17,167
OUR SPECIFIC AIMS WERE TO

1038
00:39:17,167 --> 00:39:19,703
COMPARE THE IMPACT OF THE HEART

1039
00:39:19,703 --> 00:39:20,604
HEALTH INTERVENTION VERSUS USUAL

1040
00:39:20,604 --> 00:39:23,741
CARE ON 4 MONTH AND 1 YEAR CBD

1041
00:39:23,741 --> 00:39:24,808
RISK FACTOR OUTCOMES AND THIS

1042
00:39:24,808 --> 00:39:27,011
WAS SELECTED BY PATIENTS, YOU

1043
00:39:27,011 --> 00:39:29,346
KNOW A GOAL, GOOD EVIDENT BASED,

1044
00:39:29,346 --> 00:39:30,614
MATERIALS, SHOWING THAT WHEN YOU

1045
00:39:30,614 --> 00:39:32,383
PECULIAR A GOAL, YOU HAVE A

1046
00:39:32,383 --> 00:39:34,451
BETTER CHANCE OF ACHIEVING IT

1047
00:39:34,451 --> 00:39:35,986
AND THEN WE ALL WANTED TO TAKE

1048
00:39:35,986 --> 00:39:39,723
THE SAME RISK FACTORS AND

1049
00:39:39,723 --> 00:39:41,158
COMPARE 1 MONTH IMPACT IN THOSE

1050
00:39:41,158 --> 00:39:44,295
2 GROUPS ON ALL THE CVD RISK

1051
00:39:44,295 --> 00:39:45,763
FACTORS WE MEASURED SO RATHER

1052
00:39:45,763 --> 00:39:46,964
PEOPLE HAD HIGH BLOOD PRESSURE

1053
00:39:46,964 --> 00:39:49,733
OR NOT, WHETHER THEY HAD HIGH

1054
00:39:49,733 --> 00:39:52,202
LIPID PROFILES, I WILL TELL YOU

1055
00:39:52,202 --> 00:39:53,404
ABOUT THAT, BECAUSE WE--THE

1056
00:39:53,404 --> 00:39:56,240
ISSUE IS IN THIS AREA, IS THAT

1057
00:39:56,240 --> 00:39:58,342
THEY ARE JUST RAMPANT WITH

1058
00:39:58,342 --> 00:40:05,249
CARDIOVASCULAR DISEASE RISK

1059
00:40:05,249 --> 00:40:05,482
FACTORS.

1060
00:40:05,482 --> 00:40:09,086
SO I WILL GET TO TAKEN--THEY

1061
00:40:09,086 --> 00:40:11,755
POINT IN A SEC, HERE, THEY WERE

1062
00:40:11,755 --> 00:40:13,290
AT RISK, IT'S 2 GROUP RANDOMIZED

1063
00:40:13,290 --> 00:40:15,492
CONTROL TRIAL AND THIS DESIGN

1064
00:40:15,492 --> 00:40:16,927
SHOWS WHEN WE MEASURED AND I

1065
00:40:16,927 --> 00:40:19,296
TALKED ABOUT THAT, BASE LINE, 3

1066
00:40:19,296 --> 00:40:20,931
MONTHS OF INTERVENTION AND AT 4

1067
00:40:20,931 --> 00:40:25,803
MONTHS AND 12 MONTHS.

1068
00:40:25,803 --> 00:40:27,338
I INCLUDE THIS INCLUSION

1069
00:40:27,338 --> 00:40:28,939
CRITERIA HERE TO SHOW THAT YOU

1070
00:40:28,939 --> 00:40:30,774
YOU HAD TO FIRST OFF THEY DID

1071
00:40:30,774 --> 00:40:33,210
NOT, IF THEY DID NOT--TO BE

1072
00:40:33,210 --> 00:40:34,878
INCLUDED THEY COULD NOT HAVE A

1073
00:40:34,878 --> 00:40:36,347
PRIMARY CARE PROVIDER OR THEY

1074
00:40:36,347 --> 00:40:37,581
HADN'T SEEN 1 FOR MORE THAN A

1075
00:40:37,581 --> 00:40:38,849
YEAR, THAT WAS NOT DIFFICULT IN

1076
00:40:38,849 --> 00:40:43,153
THIS AREA AT ALL AND SECOND THEY

1077
00:40:43,153 --> 00:40:45,789
HAD TO BE AT RISK FOR

1078
00:40:45,789 --> 00:40:47,591
CARDIOVASCULAR DEC BY HAVING 2

1079
00:40:47,591 --> 00:40:48,058
OR MORE RISK FACTORS.

1080
00:40:48,058 --> 00:40:49,360
AND YOU SEE ALL THESE RISK

1081
00:40:49,360 --> 00:40:51,128
FACTORS HERE THAT WE ENROLLED

1082
00:40:51,128 --> 00:40:53,230
1100 PEOPLE IN A YEAR, THIS

1083
00:40:53,230 --> 00:40:59,169
THERE WAS NOT 1 SINGLE PERSON

1084
00:40:59,169 --> 00:41:00,904
THERE IS NOT 1 SINGLE PERSON WHO

1085
00:41:00,904 --> 00:41:05,376
HAD 2 OR MORE RISK FACTORS, NO 1

1086
00:41:05,376 --> 00:41:07,111
FAILED THIS EXCLUSION CRITERIA

1087
00:41:07,111 --> 00:41:09,613
WHICH IS REALLY ASTONISHING AND

1088
00:41:09,613 --> 00:41:10,514
VERYY WORRISOME.

1089
00:41:10,514 --> 00:41:12,349
OUR INTERVENTIONS WERE STANDARD

1090
00:41:12,349 --> 00:41:14,451
OF CARE, BUT WE AMPED IT UP A

1091
00:41:14,451 --> 00:41:16,086
BIT WHERE WE GOT AN APPOINTMENT

1092
00:41:16,086 --> 00:41:17,421
WITH THE PEOPLE IN THIS GROUP,

1093
00:41:17,421 --> 00:41:22,092
WITH THE PRIMARY CARE PROVIDER

1094
00:41:22,092 --> 00:41:25,863
THEY RECEIVED FREE REFERRAL TO

1095
00:41:25,863 --> 00:41:27,264
THAT PROVIDER AND THE FACTORS

1096
00:41:27,264 --> 00:41:30,934
THAT WE  IDENTIFIED IN THE

1097
00:41:30,934 --> 00:41:33,303
SCREENING AND THEY WERE GIVEN

1098
00:41:33,303 --> 00:41:34,505
PREOR LOW CAST THIS APPOINTMENT

1099
00:41:34,505 --> 00:41:35,939
ABOUT YOU WE DIDN'T OTHERWISE

1100
00:41:35,939 --> 00:41:37,107
INFLUENCE THE DELIVERY OF CARE,

1101
00:41:37,107 --> 00:41:39,109
WE SENT A LOTTER THAT SAID WE'RE

1102
00:41:39,109 --> 00:41:46,550
REFERRING THAT PATIENT TO YOU,

1103
00:41:46,550 --> 00:41:48,419
WE I DEBTIFIED THESE RISK

1104
00:41:48,419 --> 00:41:49,486
FACTORS, BUT WE DEPARTMENT

1105
00:41:49,486 --> 00:41:50,788
INFLUENCE THE DELIVERY OF CARE

1106
00:41:50,788 --> 00:41:52,489
TO BE REFLECTIVE OF THE REALITY

1107
00:41:52,489 --> 00:41:54,224
OF USUAL CARE.

1108
00:41:54,224 --> 00:41:55,959
THIS HEART HEALTH ISHT VENTION

1109
00:41:55,959 --> 00:41:57,895
AND MANY MODIFICATIONS SINCE WE

1110
00:41:57,895 --> 00:42:01,432
STOPPED OR SINCE WE MODIFIED IT

1111
00:42:01,432 --> 00:42:03,901
FOR OTHER STUDIES IT INCLUDES

1112
00:42:03,901 --> 00:42:05,069
MULTIPLE INTERACTIVE MODULES AND

1113
00:42:05,069 --> 00:42:06,603
ISHT ACTIVE, WE ALWAYS PUT THAT,

1114
00:42:06,603 --> 00:42:08,672
WE ENGAGE PEOPLE EVERY MOMENT OF

1115
00:42:08,672 --> 00:42:10,541
OUR TIME, DOING THESE MODULES,

1116
00:42:10,541 --> 00:42:17,414
WE DON'T JUST  STAND UP THERE TG

1117
00:42:17,414 --> 00:42:18,816
HEADS, WE ENGAGE THEM WITH

1118
00:42:18,816 --> 00:42:19,650
INTERESTING QUESTIONS, WE PAY

1119
00:42:19,650 --> 00:42:21,285
ATTENTION TO WHAT THEY SAY, WHAT

1120
00:42:21,285 --> 00:42:22,586
THEY'VE DONE BEFORE, WHAT THEIR

1121
00:42:22,586 --> 00:42:24,288
PROBLEMS ARE, AND SO AND THESE

1122
00:42:24,288 --> 00:42:26,256
MAJOR AREAS, RIGHT HERE, IT'S

1123
00:42:26,256 --> 00:42:28,726
DELIVERED OVER 12 WEEKS AND WE

1124
00:42:28,726 --> 00:42:31,161
DID GROUPS OF 10 OR LESS, AND WE

1125
00:42:31,161 --> 00:42:33,997
ALWAYS ENCLUED SPECIFIC BEHAVIOR

1126
00:42:33,997 --> 00:42:34,965
CHANGE PRINCIPLES IN AND A LOT

1127
00:42:34,965 --> 00:42:36,600
OF THESE ARE ADDRESSED DOWN

1128
00:42:36,600 --> 00:42:38,535
HERE, WE DEALT WITH THE

1129
00:42:38,535 --> 00:42:42,139
ENVIRONMENT, WE ADDRESSED LOW

1130
00:42:42,139 --> 00:42:43,674
LITERACY, AND ALL OF OUR

1131
00:42:43,674 --> 00:42:47,144
INTERVENTIONS, THEY WERE SKILLED

1132
00:42:47,144 --> 00:42:50,481
BASED PROMOTION OF SELF-CARE OF

1133
00:42:50,481 --> 00:42:52,116
CARDIOVASCULAR DISEASE RISK

1134
00:42:52,116 --> 00:42:53,584
FACTORS WHICH WORKS REALLY WELL

1135
00:42:53,584 --> 00:42:54,852
IN AN AREA YOU DON'T HAVE

1136
00:42:54,852 --> 00:42:56,186
ANYBODY TO GO TO EVEN IF YOU

1137
00:42:56,186 --> 00:42:57,154
WANTED TO FOR THIS SORT OF THING

1138
00:42:57,154 --> 00:42:59,590
AND IF YOU DID, THEY HAVE A

1139
00:42:59,590 --> 00:43:00,691
TENDENCY TO NOT CONCENTRATE ON

1140
00:43:00,691 --> 00:43:02,025
THESE AREAS, WE USE SUBJECTIVE

1141
00:43:02,025 --> 00:43:07,364
AND OBLIGATIONS YECTIVE MEASURES

1142
00:43:07,364 --> 00:43:09,366
FOR ALL OF THESE RISK FACTORS

1143
00:43:09,366 --> 00:43:10,768
FOR SPECIFIC GAMES IN 1 AND 2,

1144
00:43:10,768 --> 00:43:13,003
SO WE HAD A NICE MIX OF

1145
00:43:13,003 --> 00:43:15,172
SUBJECTIVE AND OBJECTIVE

1146
00:43:15,172 --> 00:43:15,506
MEASURES.

1147
00:43:15,506 --> 00:43:19,676
WE USE INTENTION TO TREAT

1148
00:43:19,676 --> 00:43:21,211
CONVENTION, WE LOOKED AT, TO SUM

1149
00:43:21,211 --> 00:43:23,347
THIS ALL UP, WE USED MIXED

1150
00:43:23,347 --> 00:43:25,682
MODELS FOR REPEATED MEASURES,

1151
00:43:25,682 --> 00:43:27,951
AND I AM NOT GOING TO SHOW YOU

1152
00:43:27,951 --> 00:43:28,786
ANYTHING ABOUT THIS, EXCEPT THIS

1153
00:43:28,786 --> 00:43:30,521
IS THE FLOW OF THE CONCERT

1154
00:43:30,521 --> 00:43:32,122
DIAGRAM, DOWN AT THE BOTTOM.

1155
00:43:32,122 --> 00:43:34,525
YOU WILL SEE AN 82% RETENTION

1156
00:43:34,525 --> 00:43:36,393
RATE WHICH IS PRETTY GOOD GIVEN

1157
00:43:36,393 --> 00:43:41,131
ANY SORT OF LONG-TERM LIFESTYLE

1158
00:43:41,131 --> 00:43:49,339
INTERVENTION AND ESPECIALLY A

1159
00:43:49,339 --> 00:43:50,440
RURAL 1.

1160
00:43:50,440 --> 00:43:51,275
WE HAD SIMILARITIES ACROSS ALL

1161
00:43:51,275 --> 00:43:52,976
OF OUR GROUPS IN THE BASE LINE

1162
00:43:52,976 --> 00:43:54,578
CHARACTER OF THETICS, THESE ARE

1163
00:43:54,578 --> 00:43:55,746
BASE LINE CHARACTERISTICS IN ALL

1164
00:43:55,746 --> 00:43:58,949
OF THESE THINGS THAT WOULD

1165
00:43:58,949 --> 00:43:59,917
CONFLUENCE OR AFFECT OUTCOMES

1166
00:43:59,917 --> 00:44:01,785
THAT WERE SIMILAR AT BASE LINE.

1167
00:44:01,785 --> 00:44:03,420
WE WERE STUNNINGLY SUCCESSFUL IN

1168
00:44:03,420 --> 00:44:05,823
GETTING PEOPLE TO MEET THEIR CVD

1169
00:44:05,823 --> 00:44:07,558
RISK REDUCTION GOALS SO IF ANY

1170
00:44:07,558 --> 00:44:09,393
GOAL WAS MET IT'S AT LEAST 50%

1171
00:44:09,393 --> 00:44:13,163
OF THE PEOPLE AND 16% IN THE

1172
00:44:13,163 --> 00:44:14,832
CONTROL GROUP, BECAUSE THEY HAD

1173
00:44:14,832 --> 00:44:16,633
A GOAL, TOO.

1174
00:44:16,633 --> 00:44:17,668
BODY WEIGHT 36%, BODY WEIGHT

1175
00:44:17,668 --> 00:44:19,436
GOAL WHICH IS TO LOSE 10% OR

1176
00:44:19,436 --> 00:44:25,676
MORE OF THEIR BODY WEIGHT, 65%

1177
00:44:25,676 --> 00:44:27,978
INCREASED PHYSICAL ACTIVITY, 88%

1178
00:44:27,978 --> 00:44:30,514
LOWERED THEIR BLOOD PRESSURE,

1179
00:44:30,514 --> 00:44:32,716
LOWERED LIPIDS ANOTHER 83% AND

1180
00:44:32,716 --> 00:44:34,284
HEMODPLOABIN IEE, AUDIENCE 1 C,

1181
00:44:34,284 --> 00:44:36,820
NOTICE LIKE AN ACTIVITY LIKE

1182
00:44:36,820 --> 00:44:38,222
SMOKING AND DEPRESSION ARE NOT

1183
00:44:38,222 --> 00:44:39,623
ON HERE THAT'S BECAUSE NO 1

1184
00:44:39,623 --> 00:44:40,924
PICKED THOSE AS GOALS.

1185
00:44:40,924 --> 00:44:43,360
NO 1 IN THIS REALLY HIGH SMOKING

1186
00:44:43,360 --> 00:44:46,697
AREA, PICKED SMOKING OR

1187
00:44:46,697 --> 00:44:48,832
DEPRESSION MANAGEMENT BECAUSE

1188
00:44:48,832 --> 00:44:50,300
THERE'S A HUGE STIGMA ASSOCIATE

1189
00:44:50,300 --> 00:44:51,602
WIDE DEPRESSION IN THIS AREA,

1190
00:44:51,602 --> 00:44:53,103
AND PEOPLE BELIEVE YOU SHOULD

1191
00:44:53,103 --> 00:44:54,838
JUST GET OVER IT BY YOURSELF AND

1192
00:44:54,838 --> 00:44:55,906
SO THEY DIDN'T PICK THAT BUT YOU

1193
00:44:55,906 --> 00:44:58,575
WILL SEE IN A SECOND, THAT

1194
00:44:58,575 --> 00:45:00,344
NONETHELESS, THERE WERE SOME

1195
00:45:00,344 --> 00:45:00,577
IMPACTS.

1196
00:45:00,577 --> 00:45:03,814
WE ACTUALLY HAD AN IMPACT ON

1197
00:45:03,814 --> 00:45:07,851
DECREASING SMOKING DEHAD A FEW,

1198
00:45:07,851 --> 00:45:09,253
BASED ON [INDISCERNIBLE] LEVEL,

1199
00:45:09,253 --> 00:45:10,888
AND WE THINK THIS IS A NICE

1200
00:45:10,888 --> 00:45:11,822
GUESTURE, WE BELIEVE THIS

1201
00:45:11,822 --> 00:45:13,023
HAPPENED BECAUSE THE TYPE OF

1202
00:45:13,023 --> 00:45:14,992
INTERVENTION WE DID WAS A WHOLE

1203
00:45:14,992 --> 00:45:16,927
HEALTH INTERVENTION, SO IT

1204
00:45:16,927 --> 00:45:19,429
INVOLVED GOOD DIET, PHYSICAL

1205
00:45:19,429 --> 00:45:20,030
ACTIVITY, MANAGING

1206
00:45:20,030 --> 00:45:20,731
CO-MORBIDITIES, UNDERSTANDING

1207
00:45:20,731 --> 00:45:23,133
THE CONDITION, SO, YOU COULD DO

1208
00:45:23,133 --> 00:45:24,401
THIS INTERVENTION TO TREAT ANY

1209
00:45:24,401 --> 00:45:26,904
OF THESE RISK FACTORS.

1210
00:45:26,904 --> 00:45:29,072
WE ALSO HAVE A DEPRESSION

1211
00:45:29,072 --> 00:45:32,142
MANAGEMENT AND STRESS REDUCTION

1212
00:45:32,142 --> 00:45:35,379
INTERVENTION AND WE THINK THAT

1213
00:45:35,379 --> 00:45:36,680
PEOPLE WHEN THEY SAW OH MY GOD,

1214
00:45:36,680 --> 00:45:39,116
I CAN DO THIS, I CAN EAT BETTER,

1215
00:45:39,116 --> 00:45:41,418
I CAN BE MORE PHYSICALLY ACTIVE,

1216
00:45:41,418 --> 00:45:43,120
I CAN CHANGE MY BLOOD PRESSURE,

1217
00:45:43,120 --> 00:45:44,288
THEY DECIDED, SOME PEOPLE

1218
00:45:44,288 --> 00:45:45,722
DECIDED TO GIVE IT A GO WITH THE

1219
00:45:45,722 --> 00:45:47,958
SMOKING AND YOU CAN SEE, THEY

1220
00:45:47,958 --> 00:45:48,892
GOT POSITIVE FEEDBACK FROM THE

1221
00:45:48,892 --> 00:45:50,193
PEOPLE IN THEIR GROUP AND FROM

1222
00:45:50,193 --> 00:45:53,330
US, SO THERE'S A REALLY AMAZING

1223
00:45:53,330 --> 00:45:57,034
LONG-TERM DECREASE IN SMOKING

1224
00:45:57,034 --> 00:45:57,301
BEHAVIOR.

1225
00:45:57,301 --> 00:45:59,870
BETTER, LOWER BODY MASS INDEX IN

1226
00:45:59,870 --> 00:46:02,139
THE INTERVENTION GROUP, THE

1227
00:46:02,139 --> 00:46:04,041
FRAMINGHAM 10 YEAR RISK SCORE

1228
00:46:04,041 --> 00:46:05,776
DECREASED, THERE WERE CHANGES IN

1229
00:46:05,776 --> 00:46:08,045
SIS TOLL-LIKE RECEPTORIC AND

1230
00:46:08,045 --> 00:46:08,912
DIAST OLDER PEOPLIC PRESSURE,

1231
00:46:08,912 --> 00:46:10,514
THE NUMBER OF STEPS THAT I

1232
00:46:10,514 --> 00:46:12,950
CANNEN PER DAY, INCREASED TOTAL

1233
00:46:12,950 --> 00:46:13,884
CHOLESTEROL INCREASED, WE DIDN'T

1234
00:46:13,884 --> 00:46:16,219
SEE A CHANGE IN DENSITY FOR

1235
00:46:16,219 --> 00:46:18,622
LIPOPROTEIN BUT DID SEE 1 IN

1236
00:46:18,622 --> 00:46:19,990
HIGH DENSITY AND IMPORTANTLY

1237
00:46:19,990 --> 00:46:21,992
DEPRESSION SO SO I DO A LOT OF

1238
00:46:21,992 --> 00:46:23,193
RESEARCH ABOUT DEPRESSION AND

1239
00:46:23,193 --> 00:46:25,996
MANAGING DEPRESSION AS A RISK

1240
00:46:25,996 --> 00:46:27,497
FACTOR FOR CARDIOVASCULAR DEC

1241
00:46:27,497 --> 00:46:28,932
AND THIS HAS ALWAYS BEEN IN OUR

1242
00:46:28,932 --> 00:46:32,302
STUDY SYSTEM MANAGEMENT OF

1243
00:46:32,302 --> 00:46:33,236
DEPRESSION TO DECREASE

1244
00:46:33,236 --> 00:46:38,976
CARDIOVASCULAR DEC RISK AND THIS

1245
00:46:38,976 --> 00:46:40,877
AREA, HAS HUGE PREPONDERANCE OR

1246
00:46:40,877 --> 00:46:42,145
DISPARITIES RELATED TO

1247
00:46:42,145 --> 00:46:43,947
DEPRESSION, SO IT'S IMPORTANT TO

1248
00:46:43,947 --> 00:46:45,716
MANAGE, SO WE THINK THAT THOSE

1249
00:46:45,716 --> 00:46:47,150
INTERVENTIONS LIKE THAT, THAT

1250
00:46:47,150 --> 00:46:48,652
FOCUS ON SELF-CARE, OR RISK

1251
00:46:48,652 --> 00:46:50,087
FACTORS AND NEGATIVE SOCIAL

1252
00:46:50,087 --> 00:46:51,588
DETERMINANTS OF HEALTH THAT ARE

1253
00:46:51,588 --> 00:46:52,556
DERIVED FROM COLLABORATION WITH

1254
00:46:52,556 --> 00:46:54,291
THE COMMUNITY CAN BE REALLY

1255
00:46:54,291 --> 00:46:56,126
EFFECTIVE, IT WAS EASY TO

1256
00:46:56,126 --> 00:46:58,295
RECRUIT, THERE WAS HIGH

1257
00:46:58,295 --> 00:47:00,764
RETENTION, IT WAS VERY

1258
00:47:00,764 --> 00:47:03,033
SUCCESSFUL, AND THAT THESE

1259
00:47:03,033 --> 00:47:04,334
INTERVENTIONS MIGHT BE WELL

1260
00:47:04,334 --> 00:47:08,105
DEVELOPED OR ADAPTED FOR OTHER

1261
00:47:08,105 --> 00:47:11,274
RURAL OR MEDICALLY UNDERSERVED

1262
00:47:11,274 --> 00:47:11,908
SOCIOECONOMICALLY DISTRESSED

1263
00:47:11,908 --> 00:47:12,109
AREAS.

1264
00:47:12,109 --> 00:47:13,577
LET ME TALK ABOUT

1265
00:47:13,577 --> 00:47:14,411
SUSTAINABILITY, WHICH IS REALLY

1266
00:47:14,411 --> 00:47:16,279
AN IMPORTANT ISSUE IN THE

1267
00:47:16,279 --> 00:47:17,647
LONG-TERM, THIS INTERVENTION,

1268
00:47:17,647 --> 00:47:19,416
ITS SUCCESS, IT WAS IMPLEMENTED

1269
00:47:19,416 --> 00:47:26,723
THEN AND TILL ONGOING AT A PLACE

1270
00:47:26,723 --> 00:47:28,592
CALLED HOME PLACE, WHICH

1271
00:47:28,592 --> 00:47:30,327
FIREFIGHTERS ADOPTED IT IN

1272
00:47:30,327 --> 00:47:33,363
SEVERAL AREAS AS THEIR

1273
00:47:33,363 --> 00:47:36,266
YEARLY--THEY WENT THROUGH THIS

1274
00:47:36,266 --> 00:47:39,136
TRAINING EVERY YEAR AS PART

1275
00:47:39,136 --> 00:47:40,070
OF--YEARLY HEALTH TRAINING THEY

1276
00:47:40,070 --> 00:47:42,706
HAVE TO DO, SEVERAL BUSINESSES

1277
00:47:42,706 --> 00:47:45,475
INCLUDED IT AND DECREASED THE

1278
00:47:45,475 --> 00:47:47,677
INSURANCE RATE FOR FOR THEIR

1279
00:47:47,677 --> 00:47:51,114
EMPLOYEES, IF THEY JOINED IN IT,

1280
00:47:51,114 --> 00:47:52,416
IT WAS ADOPTED IN HEGHT CARE

1281
00:47:52,416 --> 00:47:53,583
SYSTEM IN EASTERN AND WESTERN

1282
00:47:53,583 --> 00:47:56,453
KENTUCKY AS PART OF THE EMPLOYEE

1283
00:47:56,453 --> 00:47:57,821
HEALTH PROGRAM, PEOPLE GOT LOCAL

1284
00:47:57,821 --> 00:48:00,924
GRANDS AND LOCAL CLUBS BECAME

1285
00:48:00,924 --> 00:48:02,325
INVOLVED AND THE ADVANTAGE OF

1286
00:48:02,325 --> 00:48:04,294
LIKE, WE HAD THE HEAD OF THE

1287
00:48:04,294 --> 00:48:13,970
BETTER BUSINESS BUREAU IN RURAL

1288
00:48:13,970 --> 00:48:16,473
HAZARD, SHE GOT OUT AND

1289
00:48:16,473 --> 00:48:18,308
DEVELOPED THE SAFE WALKING

1290
00:48:18,308 --> 00:48:19,810
AREAS.

1291
00:48:19,810 --> 00:48:22,546
SOME OF QUESTIONS WE HAVE, YOU

1292
00:48:22,546 --> 00:48:23,880
KNOW, CAN WE CHAIRVELG POLICY

1293
00:48:23,880 --> 00:48:25,248
THAT IS REALLY FUNDAMENTAL TO

1294
00:48:25,248 --> 00:48:26,283
THE PROBLEMS WE CAN EXIST IN THE

1295
00:48:26,283 --> 00:48:27,517
FIRST PLACE.

1296
00:48:27,517 --> 00:48:30,420
WE CAN OVERRIDE A LOT OF THESE

1297
00:48:30,420 --> 00:48:32,322
PROBLEMS BUT FUNDMENTALLY THIS

1298
00:48:32,322 --> 00:48:34,257
PLACE WILL HAVE PERSISTENT

1299
00:48:34,257 --> 00:48:35,692
POVERTY FOREVER IF WE DON'T DO

1300
00:48:35,692 --> 00:48:37,160
ANYTHING ABOUT IT, THE LONG-TERM

1301
00:48:37,160 --> 00:48:39,496
IMPACT IS SOMETHING THAT WILL

1302
00:48:39,496 --> 00:48:40,831
HAPPEN LONGER THAN A YEAR AND WE

1303
00:48:40,831 --> 00:48:42,199
HOPE TO STUDY AND PROBABLY

1304
00:48:42,199 --> 00:48:43,600
DOESN'T ADDRESS USHED LYING

1305
00:48:43,600 --> 00:48:45,368
PROBLEMS IN THE LONG-TERM, IT

1306
00:48:45,368 --> 00:48:46,736
ADDRESSES PEOPLE'S ABILITY TO

1307
00:48:46,736 --> 00:48:48,105
DEAL WITH THOSE UNDERLYING

1308
00:48:48,105 --> 00:48:52,175
PROBLEMS BUT, YOU KNOW WE NEED

1309
00:48:52,175 --> 00:48:54,010
TO WORK ON THOSE UNDERLYING

1310
00:48:54,010 --> 00:48:56,613
PROBLEMS AS A COMMUNITY.

1311
00:48:56,613 --> 00:49:00,851
ACTUALLY AS A STATE, AS A PEOPLE

1312
00:49:00,851 --> 00:49:02,152
THESE ARE LONG-TERM PROBLEMS

1313
00:49:02,152 --> 00:49:08,091
THAT HAVE JUST EXISTED FOREVER. 

1314
00:49:08,091 --> 00:49:10,127
WE DID A SIMILAR INTERVENTION, I

1315
00:49:10,127 --> 00:49:11,895
WILL GO FAST BECAUSE I WANT TO

1316
00:49:11,895 --> 00:49:12,863
ENTERTAIN QUESTIONS BUT

1317
00:49:12,863 --> 00:49:16,733
CAREGIVERS, THE NUMBER OF PEOPLE

1318
00:49:16,733 --> 00:49:18,235
PROVIDING INFORMAL CARE TO A

1319
00:49:18,235 --> 00:49:19,903
FAMILY MEMBER IS INCREASING AND

1320
00:49:19,903 --> 00:49:21,738
CARDIOVASCULAR DISEASE IS A BIG

1321
00:49:21,738 --> 00:49:23,573
RISK FACTOR IN INFORMAL

1322
00:49:23,573 --> 00:49:24,374
CAREGIVERS, CARDIOVASCULAR DEC

1323
00:49:24,374 --> 00:49:27,144
AS A CONSEQUENCE OR PRESENT IN

1324
00:49:27,144 --> 00:49:29,012
HIGHER RATES, IN INFORMAL

1325
00:49:29,012 --> 00:49:30,313
CAREGIVERS, COMPARED TO

1326
00:49:30,313 --> 00:49:31,982
NONCAREGIVERS, AND THOSE PEOPLE

1327
00:49:31,982 --> 00:49:33,550
ARE THEN STILL OFTEN REALLY

1328
00:49:33,550 --> 00:49:34,818
INVISIBLE TO THE HEMENT CARE

1329
00:49:34,818 --> 00:49:37,454
SYSTEM AND POLICY MAKERS, AND

1330
00:49:37,454 --> 00:49:39,556
RURAL CAREGIVERS ARE

1331
00:49:39,556 --> 00:49:40,590
PARTICULAR,LY AT RISK.

1332
00:49:40,590 --> 00:49:42,759
SO WE ADOPTED, WE DEVELOPED THE

1333
00:49:42,759 --> 00:49:44,761
RURAL INTERVENTION FOR

1334
00:49:44,761 --> 00:49:46,129
CAREGIVERS HEART HEALTH.

1335
00:49:46,129 --> 00:49:48,465
WE ARE--WE JUST FINISHED THIS

1336
00:49:48,465 --> 00:49:50,200
RANDOMIZED CONTROL TRIAL WITH

1337
00:49:50,200 --> 00:49:53,003
MULTIPLE OUTCOMES, SIMILAR TO

1338
00:49:53,003 --> 00:49:54,171
THE PREVIOUS STUDY, AND LET ME

1339
00:49:54,171 --> 00:50:01,311
SEE IF I JUST--THE  DESIGN IS TE

1340
00:50:01,311 --> 00:50:04,381
TYPICAL 2 RANDOMIZED TRIAL,

1341
00:50:04,381 --> 00:50:06,716
STRATIFIED BY MALE AND FEMALE

1342
00:50:06,716 --> 00:50:08,919
SINCE THERE WAS WAY MORE FEMALE

1343
00:50:08,919 --> 00:50:09,519
CAREGIVERS, AND THIS WAS

1344
00:50:09,519 --> 00:50:14,357
DIFFERENT IN THAT IT WAS A VIDEO

1345
00:50:14,357 --> 00:50:17,194
TIME REALTIME CONVINCE BECAUSE

1346
00:50:17,194 --> 00:50:17,928
THIS WAS HELPFUL BECAUSE COVID

1347
00:50:17,928 --> 00:50:19,095
WAS HAPPENING IN THE STUDY WHEN

1348
00:50:19,095 --> 00:50:20,964
IT STARTED AND WE PROPOSED THIS

1349
00:50:20,964 --> 00:50:23,066
IN THE FIRST PLACE BECAUSE OF

1350
00:50:23,066 --> 00:50:25,302
THE DIFFICULTIES IN GETTING

1351
00:50:25,302 --> 00:50:26,503
PEOPLE WHO ARE TAKING CARE OF

1352
00:50:26,503 --> 00:50:28,572
SOMEBODY ELSE OUT OF THE HOME

1353
00:50:28,572 --> 00:50:30,307
AND IN A PLACE WHERE THEY COULD

1354
00:50:30,307 --> 00:50:31,808
GET AN INTERVENTION, SO WE'VE

1355
00:50:31,808 --> 00:50:34,344
SINCE ACTUALLY GONE TO THIS

1356
00:50:34,344 --> 00:50:35,745
DELIVERY METHOD AND IT WORKS

1357
00:50:35,745 --> 00:50:38,548
REALLY WELL BECAUSE WE HAVE

1358
00:50:38,548 --> 00:50:40,050
WONDERFUL ENGAGING

1359
00:50:40,050 --> 00:50:41,184
INTERVENTIONISTS, VERY SIMILAR,

1360
00:50:41,184 --> 00:50:43,653
INTERVENTION TO THE 1 BEFORE WE

1361
00:50:43,653 --> 00:50:46,089
GAVE PEOPLE MANY PADS IN BOTH OF

1362
00:50:46,089 --> 00:50:47,924
THESE, USUAL CARE WAS THE SAME

1363
00:50:47,924 --> 00:50:49,192
THING, HERE'S A GIANT CONCERT

1364
00:50:49,192 --> 00:50:50,627
DIAGRAM, BUT THE THING I WANT TO

1365
00:50:50,627 --> 00:50:56,733
POINT OUT AGAIN IS 85%

1366
00:50:56,733 --> 00:50:57,400
RETENTION, REALLY AMAZING.

1367
00:50:57,400 --> 00:50:59,703
AND I ONLY HAVE SOME OUTCOMES, I

1368
00:50:59,703 --> 00:51:00,837
HAVEN'T REPORTED ERGTS SO I

1369
00:51:00,837 --> 00:51:03,173
WON'T TALK ABOUT ALL THOSE BUT

1370
00:51:03,173 --> 00:51:05,508
REGARD TO ADHERENCE, CAN YOU SEE

1371
00:51:05,508 --> 00:51:06,209
MUCH BETTER ADHERENCE ACROSS

1372
00:51:06,209 --> 00:51:07,410
TIME AND SUSTAINED IN THE

1373
00:51:07,410 --> 00:51:09,012
INTERVENTION GROUP AND MUCH

1374
00:51:09,012 --> 00:51:12,682
BETTER, THESE ARE ALL INDICES OF

1375
00:51:12,682 --> 00:51:15,085
HEALTHY EATING BETTER IN THE

1376
00:51:15,085 --> 00:51:16,319
INTERVENTION VERSUS THE CONTROL

1377
00:51:16,319 --> 00:51:19,856
GROUP BY MANY OR ANY, BY MANY

1378
00:51:19,856 --> 00:51:21,224
INDICES AND THE SAME THING WITH

1379
00:51:21,224 --> 00:51:22,659
MORE AND AN IMPORTANT POINT IS

1380
00:51:22,659 --> 00:51:24,194
NO MODERATION BY AGE, SO

1381
00:51:24,194 --> 00:51:25,962
REGARDLESS OF THE AGE, YOUNGER

1382
00:51:25,962 --> 00:51:30,166
OLDER THIS INTERVENTION WAS

1383
00:51:30,166 --> 00:51:30,433
EFFECTIVE.

1384
00:51:30,433 --> 00:51:31,868
I THINK IT'S AN EFFECTIVE WAY TO

1385
00:51:31,868 --> 00:51:33,703
IRPT VENE WITH HARD TO REACH

1386
00:51:33,703 --> 00:51:35,305
ANYBODY RURAL PEOPLE EMPLOY WE

1387
00:51:35,305 --> 00:51:37,907
HAVE ANOTHER TRIAL THAT'S

1388
00:51:37,907 --> 00:51:41,344
ONGOING, THE COMBAT DS TRIAL IS

1389
00:51:41,344 --> 00:51:43,647
A COMPARATIVE EFFECTIVE STUDY TO

1390
00:51:43,647 --> 00:51:44,914
MANAGE DEPRESSIVE SYMPTOMS IN

1391
00:51:44,914 --> 00:51:47,117
RURAL PEOPLE WHO DON'T SEEK

1392
00:51:47,117 --> 00:51:49,185
CARE, COULDN'T GET CARE EVEN IF

1393
00:51:49,185 --> 00:51:50,820
THEY DID SEEK IT FOR DEPRESSION

1394
00:51:50,820 --> 00:51:54,257
BECAUSE OF ITS IMPACT ON

1395
00:51:54,257 --> 00:51:55,225
CARDIOVASCULAR DISEASE EMPLOY SO

1396
00:51:55,225 --> 00:51:56,760
WE'RE STUDYING PEOPLE WITH

1397
00:51:56,760 --> 00:51:58,194
DEPRESSION AND USING 2 DIFFERENT

1398
00:51:58,194 --> 00:52:02,132
VIDEO CONFERENCE WITH A LIVE

1399
00:52:02,132 --> 00:52:02,799
INTERVENTIONIST, CBT

1400
00:52:02,799 --> 00:52:12,108
INTERVENTION AND THEN, A

1401
00:52:12,108 --> 00:52:13,610
SELF-RUN CBT AND YOU GO ONLINE

1402
00:52:13,610 --> 00:52:15,578
AND TALK TO THE PERSON.

1403
00:52:15,578 --> 00:52:17,747
WE ARE LOOKING AT OUTCOMES HERE

1404
00:52:17,747 --> 00:52:19,482
BY SOCIAL DETERMINANTS OF HEALTH

1405
00:52:19,482 --> 00:52:20,383
AND COGNITIVE FURCHES, WE'RE

1406
00:52:20,383 --> 00:52:21,785
WORKING ON ANOTHER TRIAL OF

1407
00:52:21,785 --> 00:52:23,653
MANAGING DEPRESSION BEFORE YOU

1408
00:52:23,653 --> 00:52:24,387
MANAGE CARDIOVASCULAR DISEASE

1409
00:52:24,387 --> 00:52:25,855
RISK FACTORS AND WE'RE TRYING TO

1410
00:52:25,855 --> 00:52:28,992
TURN PARTS OF THIS INTERVENTION

1411
00:52:28,992 --> 00:52:30,493
INTO AN AT-BASED APPROACH, THE

1412
00:52:30,493 --> 00:52:33,396
INTERESTING PART HERE IS THAT

1413
00:52:33,396 --> 00:52:34,197
IT'S--DONE WITH MOTIVATIONAL

1414
00:52:34,197 --> 00:52:35,832
IRPT VIEWING AND STAGES BASED ON

1415
00:52:35,832 --> 00:52:37,067
TAIJING OF CHANGE AND YOU WONDER

1416
00:52:37,067 --> 00:52:40,403
WHO THE HECK IS GOING TO BE THE

1417
00:52:40,403 --> 00:52:41,604
COACH, WELL, THERE'S SOME

1418
00:52:41,604 --> 00:52:43,673
AMAZING AI GOING ON AND

1419
00:52:43,673 --> 00:52:44,541
THIS--THE COACHING OR THE PEOPLE

1420
00:52:44,541 --> 00:52:46,242
WHO ARE WORKING WITH US TO

1421
00:52:46,242 --> 00:52:49,012
DEVELOP THIS AI COACHING ARE

1422
00:52:49,012 --> 00:52:51,614
ACTUALLY BETTER, THE AI COACH IS

1423
00:52:51,614 --> 00:52:52,315
BETTER AT MOTIVATIONALLY

1424
00:52:52,315 --> 00:52:53,249
INTERVIEWING THAN I AM.

1425
00:52:53,249 --> 00:52:54,684
SO IT'S NOT LIKE THOSE STUPID

1426
00:52:54,684 --> 00:52:55,852
BOTS THAT YOU GET ON THAT WANT

1427
00:52:55,852 --> 00:52:57,487
TO CHAT WITH YOU AND YOU WANT TO

1428
00:52:57,487 --> 00:53:00,256
KILL THEM AND YOUR COMPUTER

1429
00:53:00,256 --> 00:53:01,191
AFTER 2 MINUTES.

1430
00:53:01,191 --> 00:53:04,527
IT'S LIKE, THIS AMAZINGLY

1431
00:53:04,527 --> 00:53:06,496
INTUITIVE AI THAT I WAS SO

1432
00:53:06,496 --> 00:53:11,935
AGAINST AI, BECAUSE OF ALL THESE

1433
00:53:11,935 --> 00:53:13,136
EXPERIENCES AND CHAT GPT,

1434
00:53:13,136 --> 00:53:14,104
WHATEVER, BUT IT'S JUST

1435
00:53:14,104 --> 00:53:16,272
PROGRESSING AT SUCH A RATE THAT

1436
00:53:16,272 --> 00:53:19,476
THIS AI COACHING MIGHT TURN OUT

1437
00:53:19,476 --> 00:53:20,410
TO BE WELL.

1438
00:53:20,410 --> 00:53:21,611
I WILL HAVE 2 MORE SLIDES.

1439
00:53:21,611 --> 00:53:26,449
I WANT TO TALK ABOUT RESILIENCE,

1440
00:53:26,449 --> 00:53:28,651
AND THIS IS A SLIDE THAT ISSUE

1441
00:53:28,651 --> 00:53:30,253
ANYBODY CAN FIND ANYWHERE,

1442
00:53:30,253 --> 00:53:34,057
PEOPLE ARE STUDYING THIS AND IT

1443
00:53:34,057 --> 00:53:36,126
HAS TO DO WITH THE COUNTIES IN

1444
00:53:36,126 --> 00:53:39,162
THE FAITION OF DAOF THER, SO,

1445
00:53:39,162 --> 00:53:40,797
TERRORIST ATTACK, ON VIERMAL

1446
00:53:40,797 --> 00:53:44,868
DISASTERS, AND IN THIS CASE,

1447
00:53:44,868 --> 00:53:48,505
WHAT WE'RE TALKING ABOUT AND YOU

1448
00:53:48,505 --> 00:53:58,715
CAN SEE THIS PART OF THE MAP

1449
00:53:58,715 --> 00:54:04,053
WHERE PEOPLE HAVE A GREAT DEAL

1450
00:54:04,053 --> 00:54:04,821
OF RESILIENCE ACTIVITY.

1451
00:54:04,821 --> 00:54:06,956
SO ABOUT 2 YEARS AGO, THERE WAS

1452
00:54:06,956 --> 00:54:09,058
THE WORST FLOOD IN EASTERN

1453
00:54:09,058 --> 00:54:10,226
KENTUCKY, WHICH IS WHERE WE DO

1454
00:54:10,226 --> 00:54:12,562
OUR WORK IN HISTORY, IT KILLED

1455
00:54:12,562 --> 00:54:13,596
50 SOMETHING PEOPLE, IT

1456
00:54:13,596 --> 00:54:14,697
DESTROYED HUNDREDS AND HUNDREDS

1457
00:54:14,697 --> 00:54:18,001
OF HOMES AND COMPLETELY

1458
00:54:18,001 --> 00:54:19,502
DESTROYED THE INFRASTRUCTURE, IN

1459
00:54:19,502 --> 00:54:20,804
HAZARD, THE PLACE I'VE BEEN

1460
00:54:20,804 --> 00:54:22,105
TALKING ABOUT, THERE'S NO

1461
00:54:22,105 --> 00:54:25,108
INTERNET, THERE'S NO, THERE WAS

1462
00:54:25,108 --> 00:54:26,709
NO PHARMACIES, THERE'S NOTHING,

1463
00:54:26,709 --> 00:54:28,878
NOTHING THAT YOU KNOW THE

1464
00:54:28,878 --> 00:54:31,014
GROCERY TORES ARE RUINED, THE

1465
00:54:31,014 --> 00:54:33,516
BES ARE RUINED AND IT IS A

1466
00:54:33,516 --> 00:54:41,024
CONSEQUENCE OF PROBABLY GLOBAL

1467
00:54:41,024 --> 00:54:42,792
WARMING AND POOR MANAGEMENT AND

1468
00:54:42,792 --> 00:54:43,693
NATURAL RESOURCES AROUND THE

1469
00:54:43,693 --> 00:54:47,764
AREA BUT I WONDER ABOUT THE--ANY

1470
00:54:47,764 --> 00:54:49,499
IMPACT THAT WE'LL EVER HAVE WHEN

1471
00:54:49,499 --> 00:54:51,868
WE'RE FACED WITH THESE SORTS OF

1472
00:54:51,868 --> 00:54:54,537
DISATTERS IN INCREASING NUMBERS,

1473
00:54:54,537 --> 00:54:55,905
KENTUCKY AS OTHERITATES IS FACE

1474
00:54:55,905 --> 00:54:57,640
WIDE ENDLESS DAOF THERES THAT

1475
00:54:57,640 --> 00:55:00,777
DESTROY THESE SUPER MARGINAL

1476
00:55:00,777 --> 00:55:01,744
AREAS ANYWAY BUT PEOPLE TILL

1477
00:55:01,744 --> 00:55:03,279
WANT TO LIVE THERE, SO WHAT ARE

1478
00:55:03,279 --> 00:55:05,915
WE GOING TO DO, YOU KNOW AS A

1479
00:55:05,915 --> 00:55:08,485
COMMUNITY, AS A HEALTHCARE

1480
00:55:08,485 --> 00:55:10,153
COMMUNITY, AS YOU KNOW A NATION

1481
00:55:10,153 --> 00:55:14,257
TO RESOLVE SOME OF THESE ISSUES,

1482
00:55:14,257 --> 00:55:16,025
SO THAT ALTHOUGH THIS WASN'T A

1483
00:55:16,025 --> 00:55:17,827
SIMPLE FLOOD, IT WAS A FLOOD

1484
00:55:17,827 --> 00:55:19,729
THAT MANY PEOPLE WANT TO RECOVER

1485
00:55:19,729 --> 00:55:23,566
FROM, AND DO RECOVER FROM.

1486
00:55:23,566 --> 00:55:25,668
BUT IN THOSE AREAS WITH THE LOW

1487
00:55:25,668 --> 00:55:26,836
RESILIENCE, THAT WILL HAPPEN,

1488
00:55:26,836 --> 00:55:30,006
THEY WILL GO BACK AND LIVE HERE

1489
00:55:30,006 --> 00:55:31,808
BUT IN EVEN WORSE CIRCUMSTANCES,

1490
00:55:31,808 --> 00:55:35,879
SO LET ME FINISH WITH QUESTIONS

1491
00:55:35,879 --> 00:55:40,717
IF YOU KNOW KUDZU, COVERING UP

1492
00:55:40,717 --> 00:55:42,819
ALL THE PROBLEMS BUT WREAKING

1493
00:55:42,819 --> 00:55:43,720
HAVOC ANYWHERE.

1494
00:55:43,720 --> 00:55:44,320
>> OKAY, THANK YOU.

1495
00:55:44,320 --> 00:55:45,355
>> THANK YOU.

1496
00:55:45,355 --> 00:55:49,859
KD--SALLY ARK PLAWZ. [ APPLAUSE]

1497
00:55:49,859 --> 00:55:55,031
>> LET ME REPEAT THE CME
CODE,

1498
00:55:55,031 --> 00:55:55,498
50121.

1499
00:55:55,498 --> 00:55:55,698
50121.

1500
00:55:55,698 --> 00:55:58,001
CERTAINLY WELCOME QUESTIONS FROM

1501
00:55:58,001 --> 00:55:59,068
THE AUDIENCE HERE, AND LET ME

1502
00:55:59,068 --> 00:56:03,940
JUST START OFF WITH FACTUAL

1503
00:56:03,940 --> 00:56:07,210
CHECK, WHAT HAPPENED BETWEEN

1504
00:56:07,210 --> 00:56:09,178
1992 AND 19 THAT WAS SUCH A

1505
00:56:09,178 --> 00:56:10,780
LARGE JUMP IN THE DEATH RATE?

1506
00:56:10,780 --> 00:56:13,283
IS THERE A NEW DEFINITION OF

1507
00:56:13,283 --> 00:56:14,117
SOME SORT?

1508
00:56:14,117 --> 00:56:16,653
>> NO IT PROBABLY WAS, I
SHOULD

1509
00:56:16,653 --> 00:56:17,787
MENTIONED IT, BECAUSE I NOTICE

1510
00:56:17,787 --> 00:56:19,556
IT TOO, A NOTICE IT, ALL THE

1511
00:56:19,556 --> 00:56:21,624
TIME BUT PEOPLE THINK IT HAD TO

1512
00:56:21,624 --> 00:56:23,626
DO WITH BETTER JUST CHRONICLING

1513
00:56:23,626 --> 00:56:30,133
OF DEATH RATES, AND THAT WAS

1514
00:56:30,133 --> 00:56:31,167
CARDIOVASCULAR DEC DEATH RATES

1515
00:56:31,167 --> 00:56:33,736
OR NO, IT WASN'T SO IT JUST WAS

1516
00:56:33,736 --> 00:56:35,238
PROBABLY BETTER RECORD KEEPING,

1517
00:56:35,238 --> 00:56:38,474
THAT'S WHAT PEOPLE THINK.

1518
00:56:38,474 --> 00:56:39,642
>> OKAY, DR. OWENS?

1519
00:56:39,642 --> 00:56:44,247
>> HI, I ENJOYED YOUR
TALK.

1520
00:56:44,247 --> 00:56:47,717
HAVE YOU TESTED ANY FINANCIAL

1521
00:56:47,717 --> 00:56:48,618
LITERACY INTERVENTIONS?

1522
00:56:48,618 --> 00:56:51,087
BECAUSE 1 THING I NOTICED IS

1523
00:56:51,087 --> 00:56:52,121
THAT HEALTHIER LIFESTYLE HELPS

1524
00:56:52,121 --> 00:56:54,157
WITH THE MONEY AND SEEING THE

1525
00:56:54,157 --> 00:56:55,558
MONEY ACCUMULATE IN THE PIGGY

1526
00:56:55,558 --> 00:56:57,760
BANK CAN BE AN INCENTIVE.

1527
00:56:57,760 --> 00:56:59,729
>> YEAH, SO WE USE THAT
MEASURE

1528
00:56:59,729 --> 00:57:01,698
OF ELT LITERACY AND BASE OUR

1529
00:57:01,698 --> 00:57:02,599
INTERVENTIONS ON HEALTH LIT RASE

1530
00:57:02,599 --> 00:57:05,368
MODEL EXPE A LOT OF THE

1531
00:57:05,368 --> 00:57:06,536
MOTIVATIONAL INTERVIEWING WE DO

1532
00:57:06,536 --> 00:57:07,971
TALKS ABOUT ACHIEVING THOSE

1533
00:57:07,971 --> 00:57:09,138
SORTS OF GOALS, YOU KNOW IT'S

1534
00:57:09,138 --> 00:57:10,873
BASED ON WHAT PEOPLE SAY THEIR

1535
00:57:10,873 --> 00:57:12,275
GOALS ARE, THEY SAY THINGS LIKE

1536
00:57:12,275 --> 00:57:13,610
I CAN'T GET SICK ANYMORE, IT

1537
00:57:13,610 --> 00:57:20,016
COSTS ME TOO MUCH AND SO WE CO

1538
00:57:20,016 --> 00:57:21,985
INCLUDE THAT BUT IT NEEDS TO BE

1539
00:57:21,985 --> 00:57:23,086
MORE INTENTIONAL, THAT YOU'RE

1540
00:57:23,086 --> 00:57:24,020
ABSOLUTELY RIGHT THAT IT'S A

1541
00:57:24,020 --> 00:57:24,988
GOAL THAT MANY PEOPLE WANT TO

1542
00:57:24,988 --> 00:57:26,522
ACHIEVE AND IF WE WERE MORE

1543
00:57:26,522 --> 00:57:29,292
INTENTIONAL WITH TI THINK IT

1544
00:57:29,292 --> 00:57:30,526
WOULD BE EFFECTIVE.

1545
00:57:30,526 --> 00:57:35,331
NTHANK YOU NTHANK YOU.

1546
00:57:35,331 --> 00:57:35,698
N.

1547
00:57:35,698 --> 00:57:37,467
>> THANK YOU FOR A LOVELY
TALK.

1548
00:57:37,467 --> 00:57:40,837
I AM INTERESTED IN DISCOVERING,

1549
00:57:40,837 --> 00:57:45,274
DO YOU HAVE MUCH IN THE WAY OF

1550
00:57:45,274 --> 00:57:48,277
RACE DIFFERENCES OR IS IT MOSTLY

1551
00:57:48,277 --> 00:57:48,711
WHITE?

1552
00:57:48,711 --> 00:57:49,545
>> APPALACHIAN KENTUCKY IS

1553
00:57:49,545 --> 00:57:50,780
MOSTLY WHITE AND YOU MAY HAVE

1554
00:57:50,780 --> 00:57:53,683
SEEN THAT 1 SLIDE AND YOU KNOW

1555
00:57:53,683 --> 00:57:55,084
IT'S RESULTED IN OUR DRIVE IN

1556
00:57:55,084 --> 00:57:57,620
THE NEXT STUDIES THAT WE DO, YOU

1557
00:57:57,620 --> 00:57:59,455
NOTICE THE RICHEST STUDY, WE ARE

1558
00:57:59,455 --> 00:58:04,527
GOING TO STRATIFY BY RACE, SO

1559
00:58:04,527 --> 00:58:10,500
THAT WE INCLUDE AT LEAST 50/50,

1560
00:58:10,500 --> 00:58:13,102
SO WE OVERENROLL BY DIFFERENT

1561
00:58:13,102 --> 00:58:14,504
RACES OTHER THAN WHITE AND WE

1562
00:58:14,504 --> 00:58:17,306
WANT TO DO A GOOD BLACK AND

1563
00:58:17,306 --> 00:58:18,307
WHITE COMPARISON, NOT COMPARISON

1564
00:58:18,307 --> 00:58:19,308
BUT ENOUGH PEOPLE TO MAKE

1565
00:58:19,308 --> 00:58:20,376
CONCLUSIONS ABOUT THE

1566
00:58:20,376 --> 00:58:22,945
EFFECTIVENESS OF ISHT VENTIONS

1567
00:58:22,945 --> 00:58:25,114
AND IT'S AN AREA THAT'S BEEN

1568
00:58:25,114 --> 00:58:26,115
NEGLECTED BY US AND EVERYONE

1569
00:58:26,115 --> 00:58:29,152
BECAUSE THEY ALL SAY, OH,

1570
00:58:29,152 --> 00:58:30,553
THERE'S ONLY WHITE PEOPLE LIVING

1571
00:58:30,553 --> 00:58:31,621
THERE, THAT'S NOT TRUE AND THERE

1572
00:58:31,621 --> 00:58:34,023
ARE MANY OTHER AREAS OF

1573
00:58:34,023 --> 00:58:38,194
APPALACHIA THAT ARE HEAVILY

1574
00:58:38,194 --> 00:58:39,829
BLACK AND WE JUST HAVE REALLY

1575
00:58:39,829 --> 00:58:41,998
INCREASED OUR ABILITY AND

1576
00:58:41,998 --> 00:58:44,500
THOUGHTS ABOUT ON DOING THAT IN

1577
00:58:44,500 --> 00:58:46,936
ALL SEBS QUENT STUDIES HAVING

1578
00:58:46,936 --> 00:58:48,204
MUCH MORE DIVERSITY.

1579
00:58:48,204 --> 00:58:49,472
GREAT QUESTION.

1580
00:58:49,472 --> 00:58:51,174
>> THANK YOU.

1581
00:58:51,174 --> 00:58:52,475
>> HI, DR. MOSER, THANK
YOU SO

1582
00:58:52,475 --> 00:58:56,145
UPON FOR YOUR TALK, TIFFANY

1583
00:58:56,145 --> 00:58:57,780
POWELL AT NHLBI, CAN YOU TALK

1584
00:58:57,780 --> 00:59:01,718
ABOUT ANY EFFORTS THAT MAY BE

1585
00:59:01,718 --> 00:59:04,487
HAPPENING TO COMBINE OR TO BRING

1586
00:59:04,487 --> 00:59:05,421
TOGETHER, URBAN COMMUNITY

1587
00:59:05,421 --> 00:59:07,290
ADVISORY BOARDS WITH RURAL

1588
00:59:07,290 --> 00:59:08,224
COMMUNITY ADVISORY BOARDS, A LOT

1589
00:59:08,224 --> 00:59:09,792
OF THINGS YOU BROUGHT UP IN

1590
00:59:09,792 --> 00:59:11,427
TERMS OF ASSETS ARE THINGS THAT

1591
00:59:11,427 --> 00:59:15,598
WE TALK ABOUT IN OUR--NYES.

1592
00:59:15,598 --> 00:59:16,199
>> --COMMUNITY BASED WORK
I

1593
00:59:16,199 --> 00:59:18,067
WOULD LOVE TO HEAR YOUR THOUGHTS

1594
00:59:18,067 --> 00:59:18,301
ON THAT.

1595
00:59:18,301 --> 00:59:19,769
>> I THINK IT'S A FABULOUS
IDEA

1596
00:59:19,769 --> 00:59:20,737
BECAUSE YOU POINT OUT THE

1597
00:59:20,737 --> 00:59:23,406
OBVIOUS THAT IT'S, YOU KNOW FOOD

1598
00:59:23,406 --> 00:59:26,142
DESERTS EXIST IN URBAN AREA,

1599
00:59:26,142 --> 00:59:27,543
HORRIBLE FOOD DESERTS OR

1600
00:59:27,543 --> 00:59:30,646
INEQUITY IN WHAT'S IN A STORE, A

1601
00:59:30,646 --> 00:59:32,949
WAL-MART, IN A YOU KNOW A LOWER

1602
00:59:32,949 --> 00:59:34,550
INCOME AREA, DOESN'T HAVE THE

1603
00:59:34,550 --> 00:59:36,519
FRESH FRUITS AND VEGETABLES IN A

1604
00:59:36,519 --> 00:59:38,588
HIGHER INCOME AREA AND IN FACT

1605
00:59:38,588 --> 00:59:39,889
THEY'RE MORE EXPENSIVE WHERE HE

1606
00:59:39,889 --> 00:59:41,724
LIVE, IT'S JUST SORT OF SHOCKING

1607
00:59:41,724 --> 00:59:43,226
BUT, SO MANY OF THE SAME

1608
00:59:43,226 --> 00:59:45,995
PROBLEMS, NO SAFE PLACE TO

1609
00:59:45,995 --> 00:59:47,196
EXERCISE, YOU KNOW, SCARED TO GO

1610
00:59:47,196 --> 00:59:49,365
TO THE DOCTOR, THE DOCTORS ARE

1611
00:59:49,365 --> 00:59:52,401
AREN'T IN THE AREAS OR THE

1612
00:59:52,401 --> 00:59:53,302
HEALTHCARE PROVIDERS, OFTEN.

1613
00:59:53,302 --> 00:59:55,371
SO I WORK WITH

1614
00:59:55,371 --> 00:59:58,040
DR. [INDISCERNIBLE] WILLIAMS,

1615
00:59:58,040 --> 00:59:59,942
AND SHE DOES SIMILAR BUT, YOU

1616
00:59:59,942 --> 01:00:03,212
KNOW HE CONCENTRATES ON

1617
01:00:03,212 --> 01:00:04,814
PREDIABETES AND SHE STUDIES

1618
01:00:04,814 --> 01:00:05,715
PLAQUE PEOPLE WITH PREDIABETES

1619
01:00:05,715 --> 01:00:07,250
AND I'M A CO INVESTIGATOR ON HER

1620
01:00:07,250 --> 01:00:09,252
GRANT WHERE SHE HAS A FABULOUS

1621
01:00:09,252 --> 01:00:10,586
COMMUNITY ADVISORY BOARD AND SHE

1622
01:00:10,586 --> 01:00:15,558
DOES HER WORK IN CHURCHES AND

1623
01:00:15,558 --> 01:00:17,426
ITS IN TOWN ISSUES NOT RURAL AND

1624
01:00:17,426 --> 01:00:19,162
I HAVE THOUGHT ABOUT WORKING

1625
01:00:19,162 --> 01:00:21,063
WITH HER TO COMBINE THOSE

1626
01:00:21,063 --> 01:00:22,598
COMMUNITY ADVISORY BOARDS

1627
01:00:22,598 --> 01:00:25,101
BECAUSE PATIENTS ARE SUCH AN

1628
01:00:25,101 --> 01:00:27,570
INCREDIBLE SOWSHES, NOT JUST

1629
01:00:27,570 --> 01:00:29,071
PATIENTS BUT THE PEOPLE WHO LIVE

1630
01:00:29,071 --> 01:00:30,606
IN THE AREAS ARE   PERFEC, WHEN

1631
01:00:30,606 --> 01:00:32,141
I FIRST THOUGHT ABOUT HAVING A

1632
01:00:32,141 --> 01:00:33,576
COMMUNITY ADVISORY BOARD, I SAID

1633
01:00:33,576 --> 01:00:35,178
EON, GOOD LORD, WHAT ARE THEY

1634
01:00:35,178 --> 01:00:37,313
GOING TO KNOW IN WELL, IN FACT,

1635
01:00:37,313 --> 01:00:39,282
BUT I WILL BE HONEST THAT'S WHAT

1636
01:00:39,282 --> 01:00:40,817
I THOUGHT AT FIRST BUT AFTER 1

1637
01:00:40,817 --> 01:00:42,952
MEETING I REALIZE THEY ACTUALLY

1638
01:00:42,952 --> 01:00:43,853
KNOW EVERYTHING.

1639
01:00:43,853 --> 01:00:45,388
AND WE REALLY NEED TO TALK TO

1640
01:00:45,388 --> 01:00:47,790
THEM AND FIGURE IT OUT, AND

1641
01:00:47,790 --> 01:00:51,093
THEN, SO I WORKED WITH DR. MUD,

1642
01:00:51,093 --> 01:00:53,162
DR. MUD DOES WORK WITH HISPANIC

1643
01:00:53,162 --> 01:00:55,097
PEOPLE, SHE HAS A FABULOUS

1644
01:00:55,097 --> 01:00:56,365
COMMUNITY ADVISORY BOARD AND ALL

1645
01:00:56,365 --> 01:00:58,534
OF US, YOU KNOW PUT TOGETHER,

1646
01:00:58,534 --> 01:00:59,802
COULD COME UP WITH IMRAIT

1647
01:00:59,802 --> 01:01:02,338
SOLUTIONS THAT CROSS ALL THESE

1648
01:01:02,338 --> 01:01:02,572
AREAS.

1649
01:01:02,572 --> 01:01:04,907
NTHANK YOU SO MUCH NGREAT POINT.

1650
01:01:04,907 --> 01:01:05,875
THANK YOU.

1651
01:01:05,875 --> 01:01:07,510
>> ALAN FROM HEART LUNG
AND

1652
01:01:07,510 --> 01:01:09,378
BLOOD, ENJOY TODAY VERY MUCH,

1653
01:01:09,378 --> 01:01:11,113
HAVE 2 RELATED QUESTIONS.

1654
01:01:11,113 --> 01:01:13,883
IS THERE A NEED FOR PERHAPS MORE

1655
01:01:13,883 --> 01:01:15,852
INTENSE INTERVENTIONS IN AND IF

1656
01:01:15,852 --> 01:01:19,422
SO, I CAN IMAGINE IN THE GENERAL

1657
01:01:19,422 --> 01:01:20,122
POPULATION, ADHERENCE COMPLIANCE

1658
01:01:20,122 --> 01:01:21,891
FOR EXAMPLE WITH STATIN SYSTEM

1659
01:01:21,891 --> 01:01:23,125
TERRIBLE AND WHETHER THAT'S AN

1660
01:01:23,125 --> 01:01:24,861
ISSUE AS WELL THAT NEEDS TO BE

1661
01:01:24,861 --> 01:01:25,261
ADDRESS?

1662
01:01:25,261 --> 01:01:29,098
>> IT IS AND WE HAVE BEEN,
I

1663
01:01:29,098 --> 01:01:30,633
THINK I WOULD SAY WE'RE VERY

1664
01:01:30,633 --> 01:01:32,935
LUCKY BECAUSE WE WERE REALLY

1665
01:01:32,935 --> 01:01:34,237
SUCCESSFUL IN GETTING

1666
01:01:34,237 --> 01:01:35,071
INTERVENTIONISTS AND RECRUITERS

1667
01:01:35,071 --> 01:01:36,572
FROM THE COMMUNITY AND THAT WAS

1668
01:01:36,572 --> 01:01:41,444
A GREAT WAY TO GET TO KEEP

1669
01:01:41,444 --> 01:01:42,511
COMPLIANCE WITH THE INTERVENTION

1670
01:01:42,511 --> 01:01:44,146
UP AND KEEP ENIMAIJMENT IN THE

1671
01:01:44,146 --> 01:01:46,649
ISHT VENTION UP, WE HAVE A

1672
01:01:46,649 --> 01:01:48,484
STUNNING INTERVENTIONIST WHO IS

1673
01:01:48,484 --> 01:01:50,553
FROM, YOU KNOW RURAL KENTUCKY,

1674
01:01:50,553 --> 01:01:54,123
AND SHE IS A PSYCHIATRIC NURSE

1675
01:01:54,123 --> 01:01:55,958
PRACTITIONER WITH EXPERTISE IN

1676
01:01:55,958 --> 01:01:58,928
CARDIAC, SO, I HAVE KEPT HER FOR

1677
01:01:58,928 --> 01:02:00,696
20 YEARS AND I HOPE I

1678
01:02:00,696 --> 01:02:01,731
ALWAYS--SHE CAN MOVE WITH ME

1679
01:02:01,731 --> 01:02:06,168
WHEN I MOVE, SHE IS SO ENGAGING

1680
01:02:06,168 --> 01:02:09,438
AND SO PERFECT, IT WORRIES ME

1681
01:02:09,438 --> 01:02:11,707
THAT TIMES THAT SUCCESSFUL

1682
01:02:11,707 --> 01:02:13,576
INTERVENTIONS OF OURS, ARE

1683
01:02:13,576 --> 01:02:14,477
INTERVENTIONIST DEPENDENT SO WE

1684
01:02:14,477 --> 01:02:18,180
TRIED TO SORT OF BOTTLE HER AND

1685
01:02:18,180 --> 01:02:19,482
FIGURE OUT THE CHARACTERISTICS

1686
01:02:19,482 --> 01:02:21,017
OF BEING A GREAT INTERVENTIONIST

1687
01:02:21,017 --> 01:02:24,320
AND IT HAS TO BE EMPATHETIC, YOU

1688
01:02:24,320 --> 01:02:26,355
HAVE TO BE ENGAGING, YOU HAVE TO

1689
01:02:26,355 --> 01:02:27,490
BE WILLING TO CONTRARY ON

1690
01:02:27,490 --> 01:02:28,658
CONVERSATIONS THAT APPEAR TO NOT

1691
01:02:28,658 --> 01:02:32,962
BE RELATED TO WHAT WE'RE TALKING

1692
01:02:32,962 --> 01:02:33,329
ABOUT AT ALL.

1693
01:02:33,329 --> 01:02:36,432
BUT I THINK WE WILL COVER THAT

1694
01:02:36,432 --> 01:02:38,200
IN THE LONG-TERM EVEN THOUGH WE

1695
01:02:38,200 --> 01:02:39,669
HAD THESE 12 MONTH IMPACTS WE

1696
01:02:39,669 --> 01:02:43,906
ARE GOING TO HAVE THAT HAVE--OH

1697
01:02:43,906 --> 01:02:44,941
GEEZ, SORRY, MORE INTERVENTIONS

1698
01:02:44,941 --> 01:02:46,042
THAT YOU HAVE TO INTERVENE, YOU

1699
01:02:46,042 --> 01:02:48,077
HAVE TO GET IN THERE YEAR AFTER

1700
01:02:48,077 --> 01:02:50,947
YEAR, I THINK TO SEE ANY SORT OF

1701
01:02:50,947 --> 01:02:53,582
LONG-TERM SUCCESS AND ANY OF

1702
01:02:53,582 --> 01:02:55,518
THESE LESS INTENSIVE

1703
01:02:55,518 --> 01:02:56,452
INTERVENTIONS THAT WE TRY.

1704
01:02:56,452 --> 01:03:00,890
SO THIS WAS A MULTIPLE

1705
01:03:00,890 --> 01:03:01,791
CARDIOVASCULAR DISEASE RISK

1706
01:03:01,791 --> 01:03:03,559
INTERVENTIONS AND EVEN THE

1707
01:03:03,559 --> 01:03:05,628
SINGLE FOCUSED INTERVENTIONS ARE

1708
01:03:05,628 --> 01:03:07,363
NOT OFTEN SUCCESSFUL, SO, YOU

1709
01:03:07,363 --> 01:03:10,700
CAN IMAGINE TRYING TO MAINTAIN

1710
01:03:10,700 --> 01:03:14,370
MULTIPLE CARDIOVASCULAR DISEASE,

1711
01:03:14,370 --> 01:03:15,104
RISK FACTOR REDUCTION IS

1712
01:03:15,104 --> 01:03:16,872
DIFFICULT SO I DO THINK MORE

1713
01:03:16,872 --> 01:03:18,374
INTENSIVE INTERVENTION IS

1714
01:03:18,374 --> 01:03:19,141
NEEDED,.

1715
01:03:19,141 --> 01:03:22,044
>> I WAS THINKING AS
PRIME--AS A

1716
01:03:22,044 --> 01:03:23,379
SECONDARY PREVENTION BUT YOU

1717
01:03:23,379 --> 01:03:24,747
ANSWERED MY QUESTION.

1718
01:03:24,747 --> 01:03:26,682
>> PRIME--OH YES, YES,
YES.

1719
01:03:26,682 --> 01:03:27,984
  PERSPECT, YES, WE ARE DOING

1720
01:03:27,984 --> 01:03:29,685
WORK WITH GRAND PARENTS, THEY

1721
01:03:29,685 --> 01:03:32,388
WOULD BE SECONDARY USUALLY BUT

1722
01:03:32,388 --> 01:03:36,625
WE ALSO ARE TRYING TO DO WORK IN

1723
01:03:36,625 --> 01:03:37,560
SCHOOLS HARDER JUST BECAUSE OF

1724
01:03:37,560 --> 01:03:39,095
THE RULES ABOUT GETTING INTO THE

1725
01:03:39,095 --> 01:03:40,062
SCHOOLS BUT THE PERFECT PLACE TO

1726
01:03:40,062 --> 01:03:41,797
DO THIS KIND OF WORK.

1727
01:03:41,797 --> 01:03:42,865
THANK YOU FOR CLARIFYING THAT

1728
01:03:42,865 --> 01:03:44,166
EMPLOY I WILL ANSWER ANY

1729
01:03:44,166 --> 01:03:47,703
QUESTIONS EVEN IF YOU DIDN'T ASK

1730
01:03:47,703 --> 01:03:48,371
IT.

1731
01:03:48,371 --> 01:03:50,539
>> DR. MOSER, THANK YOU
VERY,

1732
01:03:50,539 --> 01:03:51,841
VERY MUCH CLEARLY THIS HAS BEEN

1733
01:03:51,841 --> 01:03:53,009
A VERY INTERESTING TOPIC THAT'S

1734
01:03:53,009 --> 01:03:55,211
LED TO A LOT OF ENGAGEMENT, FOR

1735
01:03:55,211 --> 01:03:58,214
THOSE OF YOU WHO ARE HERE AT

1736
01:03:58,214 --> 01:04:00,149
LIBRARY IPSETT, YOU ARE WELCOME

1737
01:04:00,149 --> 01:04:01,951
TO JOIN DR. MOSER AND THE REF OF

1738
01:04:01,951 --> 01:04:04,387
US, WE'RE GOING TO HAVE A LITTLE

1739
01:04:04,387 --> 01:04:05,554
RECEPTION TIME OUTSIDE, FOR

1740
01:04:05,554 --> 01:04:07,323
THOSE OF YOU WHO ARE VIDEOCAST,

1741
01:04:07,323 --> 01:04:11,327
THANK YOU FOR YOINING US AND WE

1742
01:04:11,327 --> 01:04:13,329
ARE SO GLAD TO HAVE YOU HERE.

1743
01:04:13,329 --> 01:04:13,696
THANK YOU.

1744
01:04:13,696 --> 01:04:15,231
>> APPRECIATE IT, LOVE IT.

1745
01:04:15,231 --> 01:04:16,432
IT WAS GREAT.

1746
01:04:16,432 --> 01:04:26,675
[ APPLAUSE ]