Improving VA Weight Management Outcomes: Role of the Residential Environment

描述（由申请人提供）： 几乎40%的退伍军人使用VA是肥胖和相关的衰弱慢性健康状况。特别危险的人群包括妇女、少数种族或族裔群体的退伍军人和农村居住的退伍军人。开发了MOVE！体重管理计划，以解决肥胖，但50%的退伍军人谁参加移动！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。动起来！在程序设计上具有灵活性，一些标准元素和其他元素在本地确定。在大多数情况下，很少有人知道这些特定程序元素的本地变化如何满足本地MOVE的需求！帮助退伍军人采取更健康的生活方式和管理他们的体重。越来越多的证据表明环境属性的重要性（例如，健康食品的可获得性和价格，步行性，进入公园等娱乐场所）在肥胖相关行为中的作用，指出了一个有希望的新研究方向：体重管理干预和环境之间的相互作用，影响人们采取和维持健康生活方式的能力。借鉴一个创新的概念模型，结合社会生态模型和微观经济理论的需求和生产的健康方面，拟议的研究的目标是了解环境的贡献移动！参与和成果，以及如何最好地帮助退伍军人通过MOVE改变生活方式！考虑到居住环境。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）确定当地移动的程度！元素与退伍军人的居住环境属性对齐;（2）确定在何种程度上特定的移动！元素促进退伍军人在有或没有促进属性的环境中生活的参与;（3）确定居住环境和特定MOVE！元素交互帮助移动！参与者在6个月时体重减轻，并在18个月时保持体重减轻;（4）确定非洲裔美国人、西班牙裔、女性和农村退伍军人在环境方面是否与非西班牙裔白色、男性和城市居民不同--移动！目标2和目标3中研究了与减肥的关系和影响。为了实现这些目标，拟议的研究将使用回顾性设计，其中移动！每个设施提供的特定元素的程序数据和退伍军人移动的信息！参与度、健康（包括体重和其他测量）以及医疗保健利用率与表征退伍军人居住环境的公共和专有数据相关联。分析将采用通过倾向评分分析和面板数据统计模型得出的匹配对照组，这些模型对广泛的潜在偏倚和反向因果关系来源具有稳健性。肥胖和相关发病率风险最高的退伍军人群体以及暴露于健康属性较少的环境中的退伍军人群体-妇女，种族和少数民族以及生活在农村地区的退伍军人-将成为这项研究的重点。

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.