Empowering Cardiovascular Health in Custodial Grandparents (ECG)

PROJECT SUMMARY There has been a steady increase in grandparent caregiving in the US. This acceleration is due to recent trends in domestic violence, parents’ incarceration, parents’ death due to the COVID-19 pandemic, and opioid overuse that increase familial instability and leave more grandchildren to be cared for by custodial grandparents. These grandparent caregivers face ongoing stressors as they navigate legal custody arrangements, cope with loss of their own child(ren), or face social isolation. A higher prevalence in an array of social determinants of health often put them at higher risk for cardiovascular disease (CVD): belonging to a racial/ethnic minority, living below the poverty line, living in single-caregiver households, and having lower levels of educational attainment. Additionally, custodial grandparents appear to have higher rates of adverse childhood experiences, another known risk for CVD. This unique mixture of stressors manifests in custodial grandparents’ health, where they are at higher risk for CVD compared to their non-caregiving peers. However, there is a dearth of intervention addressing custodial grandparents’ CVD risk. To address this gap and optimize healthy aging and cardiovascular health among this growing at-risk population, we will implement a virtually delivered, evidence-based CVD risk reduction intervention - The Rural Caregiver Heart Health Education [RICHH] Intervention. The RICHH intervention was originally targeted for adult caregivers of adult family members with a chronic illness, and has not been tested in the context of custodial grandparents’ CVD risk. We propose a 3-year planning project to determine the feasibility, acceptability, and initial effect of the RICHH intervention conducted with custodial grandparents. We will employ a mixed method design and conduct a 2-arm randomized controlled trial with 70 custodial grandparents in Oregon. The specific aims are: 1) modify the RICHH intervention to target custodial grandparents from a variety of backgrounds; 2) employ the re-designed intervention and assess its feasibility and acceptability; and 3) evaluate and refine the RICHH protocol among our team members and explore the initial effect of the intervention based on measures of CVD risk, self- management behaviors, and depressive symptoms at 4-months and at 6-months, compared to baseline. Expected outcomes are to complete the sufficient and scientifically necessary groundwork to support a future clinical trial that will test the effectiveness of the RICHH intervention with a longer follow-up and increased inclusivity of participants from marginalized populations, with the objectives of: a) preventing CVD-related morbidity and mortality and overall physical decline, b) improving psychological well-being in these grandparents, and c) fostering a more heart-healthy environment in grandfamilies.