Culturally and Linguistically Adapted Physical Activity Intervention for Latinas

描述（由申请人提供）：在美国，与非西班牙裔白人相比，拉丁裔美国人报告的缺乏运动和相关健康状况（如高血压、高胆固醇血症、肥胖、心脏病、中风和糖尿病）的发生率更高。此外，拉丁裔女性（Latinas）报告的久坐行为比例高于拉丁裔男性。由于文化因素、社会经济环境、教育背景差异和语言障碍，拉丁美洲人，特别是拉丁美洲人，获得促进积极运动生活方式的公共卫生干预措施的机会有限。为了解决这一公共卫生危机，需要利用最先进的理论和方法进行有效干预。我们的研究小组有20年的开发和评估个人定制的计算机专家系统驱动的体育活动干预（基于社会认知理论和跨理论模型）的经验。在我们最近的试点研究（R21NR009864）中，我们在文化和语言上对我们现有的针对久坐拉丁裔的量身定制的干预措施进行了调整，并对修改后的计划进行了小型随机试验（N=94）。六个月（干预后）的评估仍在进行中，但已经收集了87名参与者的三个月数据（93%的保留率）。干预组参与者的体力活动从基线时的平均每周17分钟（SD=25.8）增加到三个月后的92分钟（SD=69.8），而接触控制组参与者的体力活动从基线时的每周12分钟（SD=21.8）增加到三个月后的64分钟（SD=84.3）。3个月的数据趋势为我们干预的有效性和高保留率提供了初步支持，特别是针对拉丁裔等难以接触到的群体的研究，预示着其可行性和可接受性。对于目前的建议，我们将在这些令人鼓舞的结果的基础上，进行一项充分有力的（N=312）随机对照试验，以测试文化和语言修改的、个性化定制的印刷干预措施与健康接触控制条件（例如，来自西班牙语NHLBI的心血管健康信息）的效果。数据将在基线、6个月和12个月收集，使用完善的身体活动测量（7天PAR、活动图）以及一套全面的社会心理问卷。我们假设，在治疗结束时（第六个月），干预参与者每周至少进行中等强度体力活动的时间明显多于健康接触控制参与者。我们还将研究12个月后治疗效果的维持，提供量身定制的干预方案的成本，以及干预-身体活动关系的潜在中介和调节因子。在拟议的研究中，我们试图通过一种高范围、低成本的策略来促进这些高危人群的体育活动，这种策略有很大的潜力被更大规模地采用，从而有很大的潜力减少美国公共卫生相关性中现有的健康差距。由于拉丁美洲人是美国增长最快的少数群体，并且报告缺乏运动和相关健康状况的比例很高，我们将进行一项大规模随机对照试验，以测试在拉丁美洲人中进行文化和语言修改的、量身定制的体育活动干预的效果（n=312）。这项拟议的研究旨在通过一种高覆盖范围、低成本的策略，在这些高危人群中促进体育活动，这种策略有很大的潜力被更大规模地采用，从而有很大的潜力缩小美国现有的健康差距

DESCRIPTION (provided by applicant): In the U.S., Latinos report higher rates of inactivity and related health conditions (e.g., hypertension, hypercholesteremia, obesity, heart disease, stroke, and diabetes) than non-Hispanic whites. Furthermore, Latino women (Latinas) report higher rates of sedentary behavior than Latino men. Due to cultural factors, socioeconomic circumstances, differences in educational background, and language barriers, Latinos in general, and especially Latinas, have limited access to public health interventions that promote physically active lifestyles. To address this public health crisis, effective interventions that leverage state-of-the-art theory and methods are needed. Our research group has 20 years experience developing and evaluating individually tailored computer expert system-driven physical activity interventions (based on Social Cognitive Theory and the Transtheoretical Model). In our recent pilot study (R21NR009864), we culturally and linguistically adapted our existing tailored intervention for sedentary Latinas and conducted a small randomized trial of the modified program (N=94). Six month (post-intervention) assessments are still ongoing, but three month data have been collected on 87 participants (93 percent retention). Intervention participants increased their physical activity from a mean of 17 minutes per week (SD=25.8) at baseline to 92 minutes (SD=69.8) at three months, whereas contact control participants reported increasing their physical activity from 12 minutes per week (SD=21.8) at baseline to 64 minutes (SD=84.3) at three months. The trends in the means at 3 months lend preliminary support for the efficacy of our intervention and the high retention rates, especially for a study targeting a hard-to-reach group like Latinas, bode well for its feasibility and acceptability. For the current proposal, we will build on these encouraging results by conducting an adequately powered (N=312) randomized controlled trial to test the efficacy of the culturally and linguistically modified, individually tailored print intervention compared with a wellness contact control condition (e.g., cardiovascular health information from NHLBI in Spanish). Data will be collected at baseline, 6, and 12 months using well-established physical activity measures (7-Day PAR, Actigraphs), as well as a comprehensive set of psychosocial questionnaires. We hypothesize that at the end of treatment (month six) intervention participants will report significantly more minutes of at least moderate intensity physical activity per week than the wellness contact control participants. We will also examine the maintenance of treatment effects at 12 months, costs of delivering the tailored intervention program, and potential mediators and moderators of the intervention-physical activity relationship. In the proposed study we seek to promote physical activity among this at-risk population using a high-reach, low-cost strategy, which has great potential for adoption on a larger scale and thus high potential for reducing existing health disparities in the U.S. PUBLIC HEALTH RELEVANCE: As Latinos are the fastest growing minority group in the U.S. and report high rates of inactivity and related health conditions, we will conduct a large scale randomized controlled trial to test the efficacy of a culturally and linguistically modified, individually tailored physical activity intervention among Latinas (n=312). The proposed study seeks to promote physical activity among this at-risk population using a high-reach, low-cost strategy, which has great potential for adoption on a larger scale and thus high potential for reducing existing health disparities in the U.S.