IVR-Supported Interventions for Cancer Prevention in the Deep South

每年有超过572，000名美国人死于癌症，其中约三分之一的死亡与缺乏身体活动，不良饮食和超重有关，因此可以预防。虽然确切的机制尚未确定，但体力活动（PA）可能通过促进体重控制或可能独立地通过改变与此类癌症相关的生物途径（改善能量代谢，降低性激素和胰岛素的循环浓度）来影响乳腺癌和结肠癌风险。ACS指南强调每周> 150分钟中等强度PA在降低癌症风险方面的重要性。然而，美国大部分地区都不活跃，南部的PA水平特别低。在这个主要是农村地区的低教育和收入水平，沿着关于PA的文化差异和非洲裔美国人（美国最大的少数民族群体）报告的障碍（儿童保育，成本），大多数人生活在南方，报告不活动率很高）可能限制获得PA信息和/或导致相关癌症差异。远程保健干预措施可以克服这些障碍，不需要频繁的诊所访问，昂贵的技术，或识字，因此可能是一个有前途的方法，以促进PA在南方腹地和扩大正在进行的社区卫生工作者的努力，由南方腹地网络癌症控制。大多数远程保健干预措施依赖于工作人员咨询，但这些过程可以使用交互式语音应答（IVR）系统自动化，以提高成本效益，覆盖范围和潜在的传播能力。鉴于我们的团队过去成功地使用IVR系统进行艾滋病毒风险行为的自我监测，以及PA在这一领域的研究不足，我们通过广泛的形成性研究，将现有的IVR系统形式用于PA推广和南方腹地的癌症风险降低（11个关于巴勒斯坦权力机构障碍的重点小组，来自农村和城市AL县的深南癌症控制社区健康顾问和社区成员的干预需求/偏好）现在建议在试点RCT（N=60）中测试所产生的基于家庭的IVR支持的PA（HIP）干预与等待列表对照。研究目标是记录呼叫IVR系统的意愿，审查新开发的干预模块，解决焦点小组中确定的PA障碍，并测试基于社会认知理论（SCT）的定制算法，为R 01资助的全功率RCT做准备，以测试该计划的有效性，并最终通过深南癌症控制网络传播。将在基线和3个月时评估PA（7天PAR，加速度计）、体能（6 MWT）以及体重和成分（%体脂，BIA）。主要目标包括评估 HIP干预在美国南方腹地降低癌症风险的可行性、可接受性和初步疗效。次要目的包括探索从基线至3个月的体能、体重/组成和SCT变量变化的组间差异，并评估在2个时间点（基线前7天和3个月评估）通过IVR系统报告的>中等强度PA与加速度计之间的关系。

DESCRIPTION (provided by applicant): Each year, more than 572,000 Americans die of cancer and approximately a third of these deaths are linked to physical inactivity, poor diet, and excess weight and thus can be prevented. While exact mechanisms have yet to be determined, physical activity (PA) may impact breast and colon cancer risk by promoting weight control or perhaps independently by altering biologic pathways related to such cancers (improving energy metabolism, reducing circulating concentrations of sex hormones and insulin). ACS guidelines emphasize the importance of > 150 min/week of moderate-intensity PA in reducing cancer risk. However, most of the U.S. is inactive, with particularly low PA levels found in the South. Low education and income levels in this largely rural area, along with cultural differences regarding PA and barriers (childcare, costs) reported by African Americans (largest racial minority group in U.S., most of whom live in the South and report high rates of inactivity) may limit access to PA information and/or contribute to related cancer disparities. Telehealth interventions can overcome such obstacles by not requiring frequent clinic visits, expensive technology, or literacy and thus may represent a promising approach to promoting PA in the Deep South and extending ongoing community health worker efforts by the Deep South Network for Cancer Control. Most telehealth interventions have relied on staff counseling, but such processes can be automated using an Interactive Voice Response (IVR) system to enhance cost-effectiveness, reach, and potential disseminability. Given our team's past success using IVR systems for self monitoring of HIV risk behaviors and the paucity of research in this area on PA, we adapted the existing IVR system format for PA promotion and cancer risk reduction in the Deep South through extensive formative research (11 focus groups on PA barriers, intervention needs/preferences with Deep South Cancer Control community health advisors and community members from rural and urban AL counties) and now propose to test the resulting Home-based IVR-supported PA (HIP) intervention in a pilot RCT (N=60) with a waitlist control. Study goals are to document willingness to call IVR system, vet newly developed intervention modules addressing the PA barriers identified in focus groups, and beta-test Social Cognitive Theory (SCT) based tailoring algorithms in preparation for an R01-funded fully powered RCT to test the efficacy of the program and eventual dissemination through the Deep South Network for Cancer Control. PA (7-Day PAR, accelerometers), fitness (6MWT), and body weight and composition (% body fat, BIA) will be assessed at baseline and 3 months. Primary aims include assessing the feasibility, acceptability, and preliminary efficacy of the HIP intervention for cancer risk reducton in the Deep South. Secondary aims include exploring arm differences in changes in fitness, body weight/composition, and SCT variables from baseline to 3 months and assessing the relationship between min/week of >moderate intensity PA reported via IVR system vs. accelerometers at 2 time points (7 days before baseline and 3 month assessment).