Vertaisjohtajan ohjaaman dyadisen intervention toteuttaminen

Twenty marital dyads from the site randomly assigned as the intervention site(s) will receive the 12- week peer leader-facilitated dyadic intervention. Topics over the 12 week intervention will address stress management, family history and genetic risk, dietary habits, physical activity and social support/community engagement.

In the CHAI (Cardiovascular Health among Asian Indian immigrants) Dyad study, we plan to Implement and pilot test a peer leader-facilitated 12-week dyadic intervention to decrease CVD risk among first generation AI immigrants;

• CHAI for 2

Twenty dyads from the site randomly assigned as the "usual care" control group site will receive a basic cardiovascular lifestyle modification program. This program will be similar to a classic cardiac rehabilitation program and will consist of diet, physical activity and medical management.

In the CHAI (Cardiovascular Health among Asian Indian immigrants) Dyad study, we plan to Implement and pilot test a peer leader-facilitated 12-week dyadic intervention to decrease CVD risk among first generation AI immigrants;

• CHAI for 2

Measured by the QRISK3- The score estimates the likelihood (percentage) of a person developing CVD over the next 10 years. The higher the percentage, the greater the likelihood that they will suffer a heart attack or stroke in the next ten years. A 10-year risk <10% is considered low, 10-20% moderate, and >20% high. Collected data are entered into the QRISK3 calculator online Factors involved in the calculation include age, gender, ethnicity, smoking status, history of T2DM, history of hypertension, systolic BP, cholesterol/HDL. ratio, and BMI. Data are entered into Citation- Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study, BMJ 2017;357:j2099

Measured by the Riverside Acculturation Stress Inventory (RASI). The RASI is a 15 item scale that measures 5 domains of acculturative stress, including intercultural relations, language skills, discrimination, work challenges, and cultural/ethnic makeup of the community. Each item is rated on a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). In the RASI, higher scores reflect higher levels of acculturative stress, ranging from 15 to 75 points. Citation: Benet-Martinez V. The Riverside Acculturation Stress Inventory (RASI). Development and Psychometric Properties. Department of Psychology, University of California at Riverside; Riverside, CA, USA: 2003. Technical Report.

Measured by the Perceived Stress Scale (PSS-10). The PSS is a 10-item, 5 point Likert scale questionnaire that was designed to measure the degree to which situations in one's life are appraised as stressful. A total PSS-10 score from 0 to 40 is presented, with higher scores representing higher levels of self-reported stress. There are two sub-scales on the PSS-10: Perceived helplessness (items 1, 2, 3, 6, 9, 10) and Lack of self-efficacy (items 4, 5, 7, 8). Citations: Cohen, S., Kamarch, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385; Lee, E.-H. (2012). Review of the psychometric evidence of the perceived stress scale. Asian Nursing Research, 6(4), 121-127. https://doi.org/10.1016/j.anr.2012.08.004.

BMI (weight and height will be combined to report BMI in Kg/m^2). Desirable BMI for Asian Indians is below 23 kg/m^2; overweight falls from 23 - 27.4 Kg/m^2 (25 - 30Kg/m^2 for other ethnicities) and 27.5 Kg/m^2and up is considered obese (30Kg/m^2 for other ethnicities).

Waist circumference as a measure of body composition. Desirable waist circumference measures in Asian Indian women are < 31 in. and for Asian Indian men, < 35 inches.

Measure of glucose control- in the Asian Indian community, an A1C value of ≥6.0% is optimal for diagnosing diabetes with a very high level of accuracy

Cholesterol/HDL ratio- A cholesterol/HDL ratio of below 3.5 is optimal and indicates a very low risk for heart disease.

Ratios above 5 to 1 are considered high and may mean an elevated risk for heart disease

C-reactive protein is a generalized measure of inflammation; Levels of CRP less than 1 mg/L are desirable and reflect a low overall cardiovascular risk. Levels of CRP between 1 and 3 mg/L are indicative of moderate risk, while levels of CRP in excess of 3 mg/L suggest quite elevated vascular risk.

Lipoprotein a is a genetic risk for CVD. Approximately 25-50% of South Asians have elevated levels (>50mg/dL), contributing to a higher prevalence of and premature coronary disease, with higher levels often found in Indian individuals compared to other ethnicities. We drew lipoprotein a samples on June 27 and 28 and are awaiting the results.

Perceived community support questionnaire (PCSQ) is a 14-item 5 point Likert scale that includes three scales assessing three dimensions of community support. These dimensions are social integration in the community, participation in the community, and use of community organizations. Scores range from 14 (high community support) to 70 (low community support). Citation: Herrero, J. & Gracia, E. (2007). Measuring perceived community support: Factorial structure, longitudinal invariance, and predictive validity of the PCSQ (Perceived Community Support Questionnaire). Journal of Community Psychology, 35(2), 197 - 217

Chronic psychological stress has been linked to elevated salivary cortisol levels and flattening of the circadian pattern. In this study, participants collect three specimens in a 24 hour period (upon rising, one-half hour later and at bedtime)

The NASA/Johnson Space Center (JSC) Physical Activity Rating (PA-R) scale is an 8-point scale (0-7) used to estimate measure self-reported habitual physical activity over the previous 6 months. It categorizes individuals from sedentary (0) to highly active (7), with higher scores indicating higher levels of regular, intense exercise. Citation: Jackson et al., (1990). Prediction of functional aerobic capacity without exercise testing. Medicine and Science in Sports and Exercise, 22(6), 863-870.

3 day dietary diary- We encountered issues with data collection and are still analyzing this data.