The Change Club intervention: 2-year impacts from a cluster-randomized trial in rural communities in New York and Texas.

Introduction: Obesity and related chronic diseases in the U.S., particularly within rural communities and/or medically underserved areas, are a major societal and cost burden. Built environments with health-promoting attributes, which can be influenced through civic engagement, are a potential pathway to help address this substantial problem. Methods: We conducted a community-randomized delayed intervention trial in medically underserved rural communities ( Results: Using an intent-to-treat framework, no net effects were observed when comparing year-2 individual and collective outcomes for the intervention arm relative to the control arm, adjusting for baseline outcome values. Exploratory analyses compared attendees (61%) to non-attendees (39%) in the intervention group and found attendees had higher year-2 values than non-attendees (with baseline adjustment) on the primary outcome and two other individual measures: Life's Simple 7 composite cardiovascular risk score (+0.93, Discussion: This is among the first studies to evaluate how a civic engagement curriculum targeting built environment change may impact the health of residents who actively attend the Change Club meetings. While net impacts on the whole sample were not observed, exploratory analysis indicated that the approach holds promise when participants attend. Clinical trial registration: http://www.clinicaltrials.gov, identifier (NCT05002660).