Physical Activity in Underserved Populations: Using Epidemiologic Assessments to Inform Sustainable Intervention

摘要 身体活动（PA），包括定期锻炼，可防止体重增加，延迟功能性 然而，每三个美国人中就有一个不活跃。PA 在服务不足的人群中进行衡量和宣传，如低收入种族/族裔 少数民族社区尤其具有挑战性。文化适应不足导致 自我给药和连续监测之间的显著测量误差（例如， 基于设备）PA评估。确定PA的决定因素， 社会文化和地理规范，是发展可持续和成本- 有效的PA促进战略。新出现的证据表明，文化适应PA 促进战略，如那些使用社区卫生工作者，可以提供文化 衡量和干预措施的解释和调整，对社会文化的敏感性 规范，并增加治疗依从性和干预活动的社会支持。然而，在这方面， 这些干预措施难以推广。移动的健康（mHealth）技术，包括文本 信息传递，已经显示出对行为干预和疾病自我治疗的巨大希望， 管理，但共同关注的问题包括非个性化的性质，文本和不确定性 关于有效频率和内容。适应文化的健康指导和社交 社区卫生工作者提供支持，并通过短信进行频繁联系 消息传递，可能是一种有效的、可扩展的PA推广工具，但可行性不好 在服务不足的社区中得到理解。该职业发展奖将提供 我接受了健康行为理论、PA测量策略和同伴支持方面的培训， 制定和评价移动保健干预措施。我们建议对PA进行分析， 全国妇女健康纵向研究，一个不同的妇女样本， 这项研究已经进行了20年，并招募了60名墨西哥裔拉丁裔美国人作为样本， 来自联邦合格健康中心的女性，比较自我管理和基于设备的 多个人种/种族组的PA数据（目标1）。然后，我们将开发（目标2）和试点 (Aim 3）使用社区卫生工作者和移动健康工具进行PA行为干预， 增加拉丁裔参与者的社会支持和PA。本指导研究的目标 科学家发展奖（K 01）是准备博士凯利Ylitalo成为一个独立的 在整个生命周期中具有创新PA推广专业知识的调查员， 强调适应文化的衡量和干预，以支持 预防或延缓重点人群的功能限制和与衰老有关的残疾。

ABSTRACT Physical activity (PA), including regular exercise, prevents weight gain, delays functional limitations, and improves cardiovascular function, yet one in three Americans is inactive. PA measurement and promotion in underserved populations, such as low-income race/ethnic minority communities, is especially challenging. Inadequate cultural adaptation contributes to substantial measurement error between self-administered and continuously-monitored (e.g., device-based) PA assessments. Identification of the determinants of PA, within the context of sociocultural and geographic norms, is a central component of developing sustainable and cost- effective PA promotion strategies. Emerging evidence suggests that culturally-adapted PA promotion strategies, such as those that use community health workers, can provide cultural interpretation and adaptation of measurement and intervention, sensitivity to sociocultural norms, and increase treatment adherence and social support of intervention activities. However, these interventions are difficult to scale. Mobile health (mHealth) technology, including text messaging, has shown great promise for behavioral interventions and disease self- management, but common concerns include the impersonalized nature of texts and uncertainty regarding effective frequency and content. Culturally-adapted health coaching and social support provided by community health workers, combined with frequent contact via text messaging, may be an effective, scalable PA promotion tool, but the feasibility is not well understood among underserved communities. This career development award will provide me with training in health behavior theories, PA measurement strategies, and peer support and mHealth intervention development and evaluation. We propose to conduct an analysis of PA in the longitudinal Study of Women’s Health Across the Nation, a diverse sample of women that have been followed for 20 years, and recruit a sample of 60 Mexican-heritage Latina women from a federally-qualified health center to compare self-administered and device-based PA data among multiple race/ethnic groups (Aim 1). Then, we will develop (Aim 2) and pilot (Aim 3) a PA behavioral intervention using community health workers and mHealth tools to increase social support and PA among Latina participants. The goal of this Mentored Research Scientist Development Award (K01) is to prepare Dr. Kelly Ylitalo to become an independent investigator with expertise in innovative PA promotion throughout the lifecourse, with a specific emphasis on culturally-adapted measurement and intervention, to support the long-term goal of preventing or delaying functional limitations and aging-related disability in priority populations.