THE HARMONY Study - A culturally-relevant, randomized-controlled, stress management intervention to reduce cardiometabolic risk in African American women.

项目摘要/摘要 非裔美国女性(AAW)因慢性心脏代谢性疾病(CM)而死亡和致残率较高 与美国任何其他女性群体相比，包括糖尿病、心血管疾病和 卒中。80%的AAW超重或肥胖，他们是美国最大的社会人口群体， 对运动的投入不足。近50%的AAW有心血管疾病，AAW的比例更高 与白人女性相比，糖尿病的发病率是两倍多。令人信服的证据表明，AAW是最小的 与其他行业的男性和女性相比，成功实现和维持CM风险降低目标 种族/族裔群体，尽管参与了全面的生活方式干预。这些令人震惊的差距 部分原因是暴露在心理压力下的比例高得不成比例。与文化相关的压力源 AAW与感受到的压力、抑郁症状、不健康 进食、缺乏运动是AAW-CM的危险因素。对AAW进行干预的一个缺点是他们 对压力暴露的关注不足，包括性别和种族主义压力、压力生理学和压力-- 健康饮食和锻炼的相关障碍可降低CM风险。为了解决这一缺点，我们 建议进行一项随机对照试验，以测试基于正念的压力管理 干预。这一RCT旨在帮助AAW增强其优势，以促进压力管理和 通过加强积极的重新评价、自我调节和自我效能来改善CM的健康，所有这些都是 自我管理的认知-行为促进者，并受到正念训练的积极影响。在这2宗案件中- ARM CM-降低风险RCT与200AW≥18岁有CM风险，我们将被授权检测小组 运动和健康饮食行为的差异具体目标是：目标1：检验AAW的假设 参加为期8个疗程的与文化相关的正念干预，以降低CM风险：目标1A (主要)锻炼和健康饮食行为和目标1B(次要)方面的更大持续改善 CM风险生物标志物(BMI、体脂百分比、腰臀比[WHR]、血压和炎症)的更大降低 细胞因子[高敏C反应蛋白；hs-CRP])，与AAW相比 注意力控制CM减少风险干预，不需要正念。目标2(探索性：检验假设 在专注力、压力管理、积极的重新评价、自我调节和自我效能方面的改善 调节干预对运动和健康饮食的影响。我们将与社区卫生部门合作 机构和社区咨询委员会，以促进我们干预措施的实施和成功。我们 响应美国国立卫生研究院的呼吁，确定促进自我管理的干预措施，通过 针对AAW的文化定制、基于社区的正念干预，目标是面部弹性 与文化相关的压力源。如果有效，我们将扩大这种与背景相关的正念干预 基于AAW在社区环境中广泛使用的优势。

Project Summary/Abstract African American women (AAW) have higher rates of death and disability from chronic cardiometabolic (CM) illnesses compared to any other group of women in the US, including diabetes, cardiovascular disease, and stroke. 80% of AAW are overweight or obese, and they are the largest US sociodemographic group with inadequate engagement in exercise. Nearly 50% of AAW have cardiovascular disease, and AAW have more than twice the rate of diabetes compared to White women. Compelling evidence shows that AAW are least successful at achieving and sustaining CM risk-reduction goals compared to men and women of other racial/ethnic groups, despite participating in comprehensive lifestyle interventions. These alarming disparities are due in part to disproportionately high rates of exposure to psychological stress. Culturally-relevant stressors in AAW are positively and significantly associated with perceived stress, depressive symptoms, unhealthy eating, and physical inactivity in AAW – CM risk factors. A shortcoming of interventions with AAW is their inadequate focus on stress exposure, including gender and racialized stress, stress physiology and stress- related barriers to healthy eating and exercise known to reduce CM risk. To address this shortcoming, we propose a randomized controlled trial to test a culturally-tailored mindfulness-based stress management intervention. This RCT is designed to help AAW build on their strengths to promote stress management and improved CM health by enhancing positive reappraisal, self-regulation, and self-efficacy, all of which are cognitive-behavioral facilitators of self-management and positively impacted by mindfulness training. In this 2- arm CM-risk reduction RCT with 200 AAW ≥ 18 years old with CM risk, we will be powered to detect group differences in exercise and healthy eating behaviors Specific aims are: AIM 1: Test the hypothesis that AAW participating in an 8-session culturally-relevant mindfulness-based intervention to reduce CM risk have: AIM 1A (primary) greater sustained improvements in exercise and healthy eating behaviors and AIM 1B (secondary) greater reduction in CM risk biomarkers (BMI, % body fat, waist to hip ratio [WHR], BP, and inflammatory cytokines [High Sensitivity C-Reactive Protein; hs-CRP])) at 4, 8, and 12 months, compared to AAW in an attention-control CM risk reduction intervention without mindfulness. AIM 2 (exploratory: Test the hypothesis that improvements in mindfulness, stress management, positive reappraisal, self-regulation, and self-efficacy mediate the effects of the intervention on exercise and healthy eating. We will work with a community health agency and a community advisory board to facilitate the implementation and success of our intervention. We address the NIH call to identify interventions that promote self-management to reduce disparities through a culturally-tailored, community-based mindfulness-based intervention for AAW that targets resilience in the face of culturally-relevant stressors. If effective, we will scale this contextually relevant mindfulness intervention based on AAW's strengths for broad use in community settings.