SANOS (SAlud y Nutricion para todOS)

项目摘要 SANOS（SAlud y Nutrición帕拉todOS）（人人享有健康和营养）解决肥胖危机， 拉美裔是美国最大、增长最快的少数族裔和移民群体，有5300万人，占美国总人口的17%。 人口墨西哥人是美国最大的西班牙裔人口;近三分之二的西班牙裔来自墨西哥。 墨西哥肥胖症及其相关的健康后果对少数群体人口的影响尤为严重; 西班牙裔，特别是墨西哥裔美国人，是最高风险群体之一。78.3%美国人 81.9%的美国女性和墨西哥男性超重或肥胖，而非西班牙裔白色人的这一比例为60.9%。 女性和73.2%的非西班牙裔白色男性。肥胖是心血管疾病（和 危险因素）和癌症。虽然有很多证据表明，在某些情况下， 非少数群体（例如糖尿病预防计划和糖尿病健康行动（展望未来））， 这些方案被认为过于昂贵和繁琐，无法广泛传播。非常少 关于如何为西班牙裔移民等难以接触的社区优化这种方法的数据。最 减肥干预措施在包括西班牙裔在内的少数民族中不太成功。有一个 迫切需要为少数群体设计优化的生活方式干预措施，特别是在可获得的 社区环境，减少参与者的负担和成本，但保留必要的干预成分， 有意义的减肥SANOS是第一个使用多阶段优化策略（MOST）的研究， 创新的方法框架，以弥补这一差距。Ventanillas de Salud（VDS; Health Windows）是一个 墨西哥政府和400多个非营利和私营机构之间的双边合作计划 各机构致力于增加低收入人群获得医疗保健的机会并促进他们选择健康的生活方式 美国拉丁裔。2016年，VDS购买了一辆移动的货车，为车辆配备了空间，以提供领事服务。 服务，并进行健康筛查（“VDS移动的”）在纽约市社区与大型墨西哥 人口。SANOS组件是根据纽约VDS的一个试点项目开发的;在此应用中， 建议在VDS移动的测试这些组件，以覆盖最边缘化的人群。的总体目标 SANOS将首次使用MOST设计一个可扩展的、文化上和 针对美国墨西哥人的语言定制饮食和生活方式干预。在这项研究中，我们将确定 4种肥胖干预成分中，哪一种对体重从基线降低5%贡献最大（主要 结果）在摄入后6个月的超重或肥胖个体中。（一）初始阶段： 个人饮食和锻炼咨询; ii）每周三次饮食和锻炼短信; iii）每周 电话支持;以及㈣自我监测工具。次要结局包括BMI、腰围、 周长、糖化血红蛋白、胆固醇、血压、饮食和运动行为。我们还将估计 成本和增量成本效益的干预组成部分。

Project Summary SANOS (SAlud y Nutrición para todOS) (Health and Nutrition for All) addresses the obesity crisis among Hispanics, the largest, fastest growing U.S. minority and immigrant group at 53 million, 17% of the total U.S. population. Mexicans are the largest U.S. Hispanic population; nearly two-thirds of Hispanics originate from Mexico. Obesity and its associated health consequences disproportionately affect minority populations; Hispanics, and particularly Mexican Americans, are among the highest risk groups. 78.3% of U.S. Mexican women and 81.9% of U.S. Mexican men are overweight or obese, compared to 60.9% of non-Hispanic White women and 73.2% of non-Hispanic White men. Obesity is a shared risk for both cardiovascular disease (and its risk factors) and cancer. While there is much evidence on effective multicomponent lifestyle interventions in non-minority populations (e.g. Diabetes Prevention Program and Action for Health in Diabetes (Look AHEAD)), these programs are considered too expensive and burdensome to be widely disseminated. There is a paucity of data on how to optimize such approaches for hard-to-reach communities such as Hispanic immigrants. Most weight-loss interventions have been less successful with ethnic minorities, including Hispanics. There is a pressing need to design optimized lifestyle interventions for minority populations, particularly in accessible community settings, that reduce participant burden and costs but retain essential intervention components for meaningful weight loss. SANOS is the first study to use the Multiphase Optimization Strategy (MOST), an innovative methodological framework, to address this gap. Ventanillas de Salud (VDS; Health Windows) is a bi-national collaborative program between the Mexican government and over 400 non-profit and private agencies, working to increase access to health care and promote healthy lifestyle choices among low-income U.S. Latinos. In 2016, the VDS purchased a mobile van, outfitting the vehicle with space to provide consular services and to conduct health screenings (“VDS Mobile”) in NYC neighborhoods with large Mexican populations. SANOS components were developed from a pilot program at the NY VDS; in this application we propose testing these components at VDS Mobile to reach the most marginalized. The overall objective of SANOS is to use MOST to design, for the first time, an optimized version of a scalable, culturally and linguistically tailored diet and lifestyle intervention for U.S. Mexicans. In the proposed research we will identify which of 4 obesity intervention components contribute most to decreasing weight by 5% from baseline (primary outcome) among overweight or obese individuals at 6 months post-intake. Components include: i) Initial in- person individual diet and exercise counseling; ii) Thrice weekly diet and exercise text messages; iii) Weekly telephone support; and iv) Self-monitoring tools. Secondary outcomes include improvements in BMI, waist circumference, HgbA1c, cholesterol, blood pressure, and diet and exercise behavior. We will also estimate the cost and incremental cost-effectiveness of the intervention components.