Research Project

N4节：研究核心--干预研究 项目总结 这项拟议的研究将评估在社区参与性研究(CBPR)框架内实施的以理论和经验为基础、文化上量身定做的动机和问题解决(MAP)的有效性(1-3)，以降低与吸烟、不良饮食和缺乏体育活动有关的癌症风险。整个研究设计和干预方法建立在调查人员对拉丁裔进行的大量CBPR、外联和其他研究的基础上，所有这些都导致了拟议项目的发展(有关大部分工作的更详细讨论，请参阅初步研究、行政核心和外联核心)。将从MA队列研究(19,000名参与者)中招募高风险MA个人(即，吸烟者也有超重/肥胖；N=400)，并将进行为期18个月的跟踪调查，并将 随机分配到两组中的一组：健康教育(HE)或MAP。参与者不需要被激励来改变他们的行为。评估在基线以及基线后6、12和18个月进行。所有评估都在参与者的家中进行。潜在参与者将通过MA队列研究中已经收集的数据来确定。将通过电话联系潜在参与者并对其资格进行筛选。基线访问将安排在至少两周内。在完成基线评估后，参与者将被随机分配到HE或MAP。主要结果是吸烟状况，水果和蔬菜的摄入量，总卡路里，脂肪产生的卡路里百分比，以及自我报告和客观的体力活动(PA)指标。他的模型类似于与非专业卫生工作者的短暂相遇，包括针对三种危险行为的简短咨询和自助材料、可用资源的转介以及家庭运动工具包(例如，计步器、健身球、力量训练电缆)。 当参与者准备戒烟时，将提供6周的免费尼古丁贴片。他将总共出现3次(基线、6个月和12个月)。MAP将包括18个月期间的HE外加9次积极的电话咨询会议。在MAP中，9次咨询的时间是灵活的，由参与者和咨询师共同决定。MAP是一种基于动机访谈(ML)(4，5)和社会认知理论相结合的整体、动态的促进行为改变的方法。(6-8)此外，MAP还纳入了来自经验证的方法的关键策略，如慢性护理模型和患者导航，这些方法已被证明对许多疾病和情况有效。(9-12)MAP是为所有个人设计的，无论他们是否愿意改变，并特别针对动机、代理/自我效能和其他关键因素 与未得到充分服务的人群特别相关(例如，压力源、家庭问题、财政资源)。由于MAP围绕着一项“健康计划”展开，该计划解决了服务不足人群中普遍存在的许多障碍和担忧，因此特别适合于治疗高危MA患者。激励和社会认知方法已被广泛应用于吸烟、饮食和PA的治疗。然而，据我们所知，MAPS是首批将这些方法结合到一个全面的整体干预模式中的治疗方法之一，该模式围绕动机的动态性质建立，针对多种癌症风险行为，并专注于高风险、讲西班牙语的MA患者。

SECTION N4: RESEARCH CORE - INTERVENTION STUDY PROJECT SUMMARY The proposed study will evaluate the efficacy of a theoretically- and empirically-based, culturally-tailored Motivation And Problem Solving (MAPS) inten/ention, conducted within a community-based participatory research (CBPR) framework(1-3) for reducing cancer risk related to smoking, poor diet, and physical inactivity. The entire study design and intervention approach builds on a large body of CBPR, outreach, and other research among Latinos by the investigators, all of which has led to the development of the proposed project (see the Preliminary Studies, Administrative Core, and Outreach Core for more detailed discussion of much of this work). High-risk MA individuals (i.e., smokers who are also ovenweight/obese; N = 400) will be recruited from the MA Cohort Study (>19,000 participants), will be followed for a period of 18 months, and will be randomly assigned to one of two groups: Health Education (HE) or MAPS. Participants do not need to be motivated to change their behavior. Assessments occur at Baseline and at 6,12, and 18 months after Baseline. All assessments occur in the participants' homes. Potential participants will be identified via data already collected in the MA Cohort Study. Potential participants will be contacted and screened for eligibility over the phone. A Baseline visit will be scheduled within at least two weeks. At the completion of the Baseline assessment, participants will be randomly assigned to HE or MAPS. Primary outcomes are smoking status, servings of fruits and vegetables, total calories, percent of calories from fat, and both self-reported and objective measures of physical activity (PA). HE is modeled to resemble a brief encounter with a lay health worker and includes brief counseling and self-help materials addressing the three risk behaviors, referrals to available resources, and a home-based exercise kit (e.g., pedometer, exercise ball, strength training cables). When and if a participant is ready to make a smoking cessation attempt, a 6-week supply of free nicotine patches will be provided. HE will occur a total of 3 times (Baseline, 6 months, and 12 months). MAPS will include HE plus 9 proactive, telephone counseling sessions over the 18 month period. The timing of the 9 counseling sessions in MAPS is flexible and determined jointly by the participant and the counselor. MAPS is a holistic, dynamic approach to facilitating behavior change based on a combination of motivational interviewing (Ml) (4,5) and social cognitive theory.(6-8) Moreover, MAPS incorporates key strategies from empirically-validated approaches such as the chronic care model and patient navigation that have been demonstrated to be effective across numerous diseases and conditions. (9-12) MAPS is designed for all individuals regardless of their readiness to change, and specifically targets motivation, agency/self-efficacy, and other key factors of particular relevance to underserved populations (e.g., stressors, family issues, financial resources). Because MAPS revolves around a "wellness program" that addresses numerous barriers and concerns that are prevalent among underserved populations, it is particularly appropriate for treating high-risk MA individuals. Motivational and social cognitive approaches have been used extensively in the treatment of smoking, diet, and PA. However, to the best of our knowledge, MAPS is among the first treatments to combine these approaches into a comprehensive, holistic intervention model built around the dynamic nature of motivation, target multiple cancer risk behaviors, and focus on high-risk, Spanish-speaking MA individuals.