Improving VA Weight Management Outcomes: Role of the Residential Environment

改善 VA 体重管理成果：居住环境的作用

• 批准号: 8783196
• 负责人: Elizabeth Tarlov
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2017-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8783196
• 关键词: Accounting; Address; Adopted; Affect; African American; Area; Behavior; Beryllium; Body Weight; Body Weight decreased; Chronic; Complement; Control Groups; Counseling; Data; Decision Making; Diet; Dietary intake; Dropout; Economically Deprived Population; Effectiveness; Elements; Enrollment; Environment; Etiology; Evaluation; Exposure to; Failure; Female; Gender; Goals; Health; Health Food; Hispanics; Indium; Individual; Intervention; Investigation; Joints; Knowledge; Life; Life Style; Link; Measures; Methods; Minority Groups; Modeling; Modification; Morbidity - disease rate; Not Hispanic or Latino; Nutritionist; Obesity; Outcome; Overweight; Participant; Personal Satisfaction; Physical activity; Population; Price; Production; Quality of life; Registered nurse; Research; Resources; Retrospective Studies; Risk; Role; Rural; Rural Community; Sampling; Site; Source; Statistical Models; Subgroup; Telephone; Variant; Veterans; Weight; Weight maintenance regimen; Woman; design; ethnic minority population; evidence base; fitness; flexibility; health care service utilization; high risk; improved; innovation; male; meetings; nutrition; patient population; programs; racial and ethnic disparities; rural area; social; theories; weight maintenance

DESCRIPTION (provided by applicant): Almost 40% of Veterans using VA are obese and have associated debilitating chronic health conditions. Populations at particular risk include women, Veterans from racial or ethnic minority groups, and rural dwelling Veterans. VA developed the MOVE! weight management program to address obesity but 50% of Veterans who enroll in MOVE! attend only one session and recent evaluations suggest modest weight loss and potential gender and racial/ethnic disparities in outcomes. MOVE! was implemented with flexibility in program design, with some standard elements and other elements determined locally. For the most part, little is known about how well these local variations in specific program elements meet the needs of local MOVE! populations and assist Veterans in adopting healthier lifestyles and managing their weight. Growing evidence suggesting the importance of environmental attributes (e.g., healthy food availability and prices, walkability, access to recreational places such as parks) in obesity- related behaviors points to a promising new direction for investigation: the interplay between weight management interventions and the environment in influencing people's ability to adopt and sustain healthy lifestyles. Drawing on an innovative conceptual model that incorporates aspects of a social-ecological model and microeconomic theory of the demand for and production of health, the goal of the proposed research is to understand environmental contributions to MOVE! engagement and outcomes and how best to assist Veterans in adopting lifestyle change through MOVE! by taking into account the residential environment. In a nationwide sample of overweight and obese Veterans, specific aims are (1) Determine the extent to which local MOVE! elements are aligned with Veterans' residential environment attributes; (2) Determine the extent to which specific MOVE! elements promote engagement for Veterans living in environments with or without facilitating attributes; (3) Determine the extent t which attributes of the residential environment and specific MOVE! elements interact to help MOVE! participants lose weight at 6 months and maintain weight loss at 18 months; and (4) Determine whether African American, Hispanic, female, and rural Veterans are different from their Non-Hispanic White, male, and urban-dwelling counterparts in regard to the environment- MOVE! relationships and impacts on weight loss examined in Aims 2 and 3. To address these aims, the proposed research will use a retrospective design in which MOVE! program data on specific elements available at each facility and information on Veterans' MOVE! engagement, health including body weight and other measures, and healthcare utilization are linked to public and proprietary data characterizing Veterans' residential environments. Analyses will employ a matched control group derived through propensity score analysis and panel data statistical models that are robust to a broad class of potential sources of bias and reverse causality. Veteran populations at highest risk for obesity and associated morbidity and for exposure to environments with fewer salutary attributes--women, racial and ethnic minorities, and those living in rural areas--will be a key focus of this research.

描述(由申请人提供)： 几乎40%的退伍军人使用退伍军人是肥胖的，并有相关的衰弱的慢性健康状况。特别危险的人群包括妇女、来自种族或少数民族群体的退伍军人以及农村居住的退伍军人。维亚康姆开发了这一招！体重管理计划旨在解决肥胖问题，但50%的退伍军人参加了Move！只参加一次会议，最近的评估表明体重略有减轻，结果可能存在性别和种族/民族差异。移动!在程序设计方面实现了灵活性，一些标准元素和其他元素在当地确定。在很大程度上，我们很少知道这些特定计划元素的本地变化如何满足本地迁移的需求！帮助退伍军人采取更健康的生活方式和控制体重。越来越多的证据表明，环境属性(例如，健康食品的供应和价格、步行能力、公园等娱乐场所的通达性)在肥胖相关行为中的重要性，这表明了一个有希望的新研究方向：体重管理干预措施与环境之间的相互作用，在影响人们采用和维持健康生活方式的能力方面。利用一个创新的概念模型，该模型结合了社会生态模型和健康需求和生产的微观经济学理论的各个方面，拟议的研究的目标是了解环境对搬家的贡献！参与度和结果，以及如何最好地帮助退伍军人通过Move改变生活方式！通过考虑居住环境。在全国范围内的超重和肥胖退伍军人样本中，具体目标是(1)确定当地搬迁的程度！要素与退伍军人居住环境属性对齐；(2)确定具体搬家程度！要素促进退伍军人在具有或不具有便利属性的环境中的参与度；(3)确定居住环境的哪些属性和具体搬家！元素相互作用，帮助移动！参与者在6个月后体重减轻，并在18个月内保持体重减轻；以及(4)确定非裔美国人、西班牙裔、女性和农村退伍军人在环境方面是否与他们的非西班牙裔白人、男性和城市居民不同--行动！在目标2和目标3中研究了关系和对减肥的影响。为了解决这些目标，拟议的研究将使用回溯性设计，其中移动！关于每个设施可用的特定元素的计划数据和关于退伍军人行动的信息！参与度、健康(包括体重和其他测量)以及医疗保健利用与描述退伍军人居住环境的公共和专有数据有关。分析将采用通过倾向得分分析和面板数据统计模型得出的匹配对照组，这些模型对广泛类别的潜在偏差来源和反向因果关系具有健壮性。肥胖症和相关发病率风险最高的退伍军人群体以及暴露在有益属性较少的环境中--妇女、种族和少数民族以及生活在农村地区的人--将是这项研究的重点。