Culturally and Linguistically Adapted Physical Activity Intervention for Latinas

 描述(由申请者提供)：在美国，拉丁裔报告了很高的不活动率和相关疾病(肥胖症、糖尿病)。需要利用最先进的理论和方法的有效干预措施来解决这种健康差距。我们最近对拉丁裔(Seamos Saludables，R01NR011295)进行了一项文化/语言适应的、基于印刷的、邮寄的体力活动(PA)干预的随机对照试验，参与者(N=266)接受了基于跨理论模型和社会认知理论的个性化体力活动干预材料，或印刷的健康材料。从基线到6个月，干预组中到重度PA(MVPA)的变化(1.87分钟/周到73.37分钟/周)明显大于对照组(3.02分钟/周到32.98分钟/周)。这些增长维持在12个月，并通过干预目标的心理社会结构的变化来调节。建议更新R01NR011295以在墨西哥裔美国人(他们只占原始样本的5%，但大部分是美国拉丁裔人口)中复制这些发现，探索其在预防和管理慢性病方面的临床潜力，并通过纳入参与者反馈(希望增加互动性和责任感)来提高干预的有效性，进一步针对总体上不受原始干预影响但在最成功的参与者中得到改善的SCT结构(社会支持和结果预期)，并对拉丁裔人口中不断变化的趋势和技术使用做出反应(增加短信)。在这项拟议的研究中，250名墨西哥裔美国妇女将被随机分为两组：1)原始的、有经验支持的Seamos Saludables定制印刷品干预；2)技术和理论增强版本的Seamos Saludables干预。数据将在基线、6个月(治疗后)和12个月(维持)时收集，使用完善的客观(加速计)和主观(7天平均标准杆)PA测量，以及一套全面的心理社会问卷。我们假设，在治疗结束时(第六个月)，增强的定制干预参与者将比原始定制干预参与者报告更多的MVPA分钟/周。我们还将检查心血管和代谢生物标志物(空腹血糖、HbA1c、甘油三酯、低密度脂蛋白、高密度脂蛋白、超敏C反应蛋白)的变化、12个月后治疗效果的维持、实施强化干预计划与原始干预计划的成本、干预-体力活动关系的潜在调解人和调节者，还将比较最初的Seamos Saludables计划在墨西哥裔美国妇女中的疗效与原始人群(主要是多米尼加、哥伦比亚和波多黎各人)的结果。这种促进体力活动的高覆盖、低成本战略具有在更大范围内采用的巨大潜力，并可能对缩小健康差距产生重大影响。

 DESCRIPTION (provided by applicant): In the U.S., Latinas report high rates of inactivity and related conditions (obesity, diabetes). Effective interventions that leverage state-of-the-art theory and methods are needed to address such health disparities. We recently conducted a randomized controlled trial of a culturally/linguistically adapted, print-based, mail- delivered physical activity (PA) intervention for Latinas (Seamos Saludables, R01 NR011295), in which participants (N=266) received either individually tailored PA intervention materials based on the Transtheoretical Model and Social Cognitive Theory, or printed wellness materials. Changes in moderate to vigorous PA (MVPA) were significantly greater in the intervention arm from baseline to six months (1.87 min/week to 73.37 min/week) than the control arm (3.02 min/week to 32.98 min/week). These increases were maintained at 12 months and mediated by changes in psychosocial constructs targeted by the intervention. A renewal of R01NR011295 is proposed to replicate these findings in Mexican Americans (who comprised only 5% of the original sample but most of US Latino population), explore its clinical potential in preventing and managing chronic disease, and to improve the intervention's effectiveness by incorporating participant feedback (desire for increased interactivity and accountability), further targeting SCT constructs that were overall not influenced by the original intervention yet improved amongst the most successful participants (social support and outcome expectancies), and responding to changing trends and technology use in the Latino population (adding text messaging). In the proposed study, 250 Mexican American women will be randomized to either 1) the original, empirically supported Seamos Saludables tailored print intervention or 2) the technology and theory-enhanced version of the Seamos Saludables intervention. Data will be collected at baseline, 6 months (post-treatment), and 12 months (maintenance) using well-established objective (accelerometers) and subjective (7 Day PAR) PA measures, as well as a comprehensive set of psychosocial questionnaires. We hypothesize that at the end of treatment (month six) the Enhanced Tailored Intervention participants will report significantly more minutes/week of MVPA than the Original Tailored Intervention participants. We will also examine changes in cardiovascular and metabolic biomarkers (fasting blood glucose, HbA1c, triglycerides, LDL, HDL, HS-CRP), maintenance of treatment effects at 12 months, costs of delivering the enhanced vs. original intervention programs, potential mediators and moderators of the intervention- physical activity relationship, and will also compare the efficacy of the original Seamos Saludables program in Mexican American women to results in the original population (who were mostly Dominican, Colombian, and Puerto Rican). Such high-reach, low-cost strategies for promoting physical activity have great potential for adoption on a larger scale and could have a large impact on reducing health disparities.