IVR-Supported Interventions for Cancer Prevention in the Deep South

描述（由申请人提供）：每年，超过57.2万美国人死于癌症，其中约三分之一的死亡与缺乏体育活动、不良饮食和超重有关，因此是可以预防的。虽然确切的机制尚未确定，但体育活动（PA）可能通过促进体重控制或可能通过改变与这些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的风险。ACS指南强调每周150分钟中等强度PA治疗对降低癌症风险的重要性。然而，大部分美国人都不怎么运动，尤其是在美国南部，人们发现的肾上腺素水平特别低。在这个主要是农村地区的低教育和收入水平，以及非洲裔美国人（美国最大的种族少数群体，大多数生活在南部，报告缺乏运动的比例很高）报告的关于PA和障碍（儿童保育，费用）的文化差异可能会限制获取PA信息和/或导致相关的癌症差异。远程医疗干预可以克服这些障碍，因为它不需要频繁的诊所访问、昂贵的技术或扫盲，因此可能是一种有希望的方法，可以在深南促进PA，并扩大深南癌症控制网络正在进行的社区卫生工作者的努力。大多数远程医疗干预都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，以及在这一领域对PA的研究的缺乏，我们通过广泛的形成性研究（11个针对PA障碍的焦点小组），调整了现有的IVR系统格式，以促进PA的推广和降低深南方的癌症风险。深南癌症控制社区健康顾问和来自农村和城市AL县的社区成员的干预需求/偏好)，现在建议在一项试验性随机对照试验（N=60）中测试由此产生的基于家庭ivr支持的PA （HIP）干预。研究目标是记录呼叫IVR系统的意愿，测试新开发的干预模块，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）的裁剪算法，为r01资助的全功率随机对照试验做准备，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（6MWT）、体重和成分（体脂百分比，BIA）。主要目的包括评估

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).