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

项目概要/摘要 非裔美国妇女（AAW）因慢性心血管代谢（CM） 疾病相比，任何其他群体的妇女在美国，包括糖尿病，心血管疾病， 中风80%的AAW超重或肥胖，他们是美国最大的社会人口群体， 锻炼不够。近50%的AAW有心血管疾病，AAW有更多的心血管疾病。 糖尿病发病率是白色女性的两倍多。令人信服的证据表明，AAW是最少的 成功实现和维持CM风险降低目标相比，男性和女性的其他 种族/族裔群体，尽管参与了全面的生活方式干预。这些令人震惊的差异 部分原因是他们承受心理压力的比例过高。文化相关压力源 在AAW的积极和显着相关的感知压力，抑郁症状，不健康 进食和缺乏运动是AAW-CM的危险因素。AAW干预措施的一个缺点是， 对压力暴露，包括性别和种族压力、压力生理学和压力- 健康饮食和锻炼的相关障碍，已知可降低CM风险。为了解决这个问题，我们 提出一项随机对照试验，以测试基于文化定制的正念压力管理 干预这项随机对照试验旨在帮助AAW利用其优势，促进压力管理， 通过增强积极的重新评价，自我调节和自我效能来改善CM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- 200名年龄≥ 18岁的AAW患者的CM风险降低RCT组，我们将有把握度检测组 运动和健康饮食行为的差异具体目标是：目的1：检验AAW 参与8个会议的文化相关的正念为基础的干预，以减少CM风险有：目的1A （主要）运动和健康饮食行为的持续改善以及AIM 1B（次要） CM风险生物标志物（BMI、%体脂、腰臀比[WHR]、BP和炎性 细胞因子[高敏C反应蛋白; hs-CRP]）），与AAW相比， 注意力控制CM风险降低干预没有正念。目的2（探索性：检验假设 正念、压力管理、积极的重新评价、自我调节和自我效能的改善 调节干预对运动和健康饮食的影响。我们将与一个社区卫生组织合作， 我们还成立了一个社区咨询委员会，以促进我们干预措施的实施和成功。我们 响应NIH的呼吁，确定促进自我管理的干预措施，以通过 针对AAW的文化定制，基于社区的正念干预，以面部复原力为目标 文化相关的压力源如果有效，我们将扩大这种与情境相关的正念干预， 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.