• Nearly 60 million Americans living in rural communities face additional barriers to receiving effective prevention and treatment services.
• Rural residents often enter care later in the course of their illness than their urban peers, enter care with more serious symptoms, and require more intensive and expensive treatment.
• The rural communities in the US are closely connected and can be leveraged to disseminate heart, lung, blood, and sleep relevant preventive and/or treatment options within those communities.
• Enhance understanding of community resilience factors, cultural, and individual factors that may enhance the provision and utilization of prevention and treatment services in these communities.
• Generate knowledge to improve the organization, efficiency, effectiveness, quality, and services for rural and frontier populations.
• Support movement of evidence-based effective health care and prevention and the public health knowledge base in rural communities in the US.
• Stimulate implementation science in rural and frontier communities
• High return on investment.

• NHLBI investigators could initiate controlled trials that would maximize the opportunities available in rural communities.
• Documented sustainable interventions and scientific research could serve to reduce morbidity and mortality in high-risk rural populations.

Population based and epidemiological studies have identified segments of population that are resistant or susceptible to obesity and cardiovascular risks. Continued research is needed to identify additional such populations and their differences. Moreover, the next phase of research could be to understand the basis for this relative resistance or vulnerabilities, and exploit the information to improve obesity and cardiovascular disease risk at a community level.

Moving forward, strategies are needed that don’t yield only incremental benefits, but instead emphasize ‘high risk, high impact’ research to some extent. Given the enormous public health crisis obesity represents we urge continued support of basic, clinical, population, and translational obesity research.

Accessing the EHR systems of the large care systems would provide a wealth of knowledge/data for the research community.

The stored data will only expand in the EHR systems and it would certainly be of value and interest to any number of research projects.

Global impact on cardiovascular health.

There are smaller scale community interventions but none in the literature that focuses on larger-scale multi-level trials as proposed here. This CQ would target vulnerable and diverse populations to reduce health disparities.
NHLBI supported the stroke belt initiative, and the exemplars in community CV health research: (e.g., the Stanford 5 City Project, The Minnesota Heart Health Program, The Pawtucket Heart Health). The next generation of community CVH research should harness the lessons from these studies, findings for the 8 Americas (Chris Murray), and numerous results from NHLBI cohort studies to implement large-scale community trials for cardiovascular health enhancement.
Resources for a large scale study could be a challenge. Ability to motivate a whole community, to prevent contamination, and to sustain interventions would be a challenge.

A robust global T4 translation research community that will implement proven-effective interventions across populations resulting in a significant positive health impact

The NHLBI Global Health and Health Inequities Think Tanks identified T4 translation research as an important area that needs development in the very near future.