APP-ME: Addressing Place & People MicroEnvironments in weight loss disparities

APP-ME：地址地点

• 批准号: 9268777
• 负责人: DANIEL O CLARK
• 金额: $ 64.18万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-02 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9268777
• 关键词: Accelerometer; Address; Affect; African American; Age; Awareness; Back; Behavior; Bite; Body Size; Body Weight Changes; Body Weight decreased; Calories; Cause of Death; Cellular Phone; Charge; Conscious; Cues; Data; Data Collection; Decision Making; Eating; Eating Behavior; Ecological momentary assessment; Emotions; Energy Metabolism; Environment; Exposure to; Fatty acid glycerol esters; Federally Qualified Health Center; Food; Goals; Health; Health system; Healthy People 2010; Home environment; Human; Hybrids; Hypertension; Image; Individual; Intention; Interruption; Intervention; Intervention Trial; Lead; Life; Life Style; Literature; Location; Measures; Methods; Mind; Modeling; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Outcome; Participant; Persons; Prevalence; Provider; Randomized; Reporting; Research; Risk; Risk Reduction; Role; Scientist; Site; Smell Perception; Social Environment; Social Interaction; Social Network; Social support; Sodium; Source; Stimulus; Stroke; Testing; Time; Translating; Weight; Weight Gain; Weight maintenance regimen; Woman; Work; arm; design; disparities in morbidity; experience; experimental study; fast food; health disparity; improved; lifestyle intervention; member; middle age; next generation; novel; novel strategies; obesogenic; programs; public health relevance; racial disparity; randomized trial; reconstruction; response; safety net; sedentary activity; sedentary lifestyle; smoking cessation; social; sugar; tailored messaging; tool; treatment as usual; weight loss intervention

 DESCRIPTION (provided by applicant): Multi-site RCTs have shown that every 2lbs of weight loss is associated with a 20% reduction in the 3yr risk of hypertension and a 32% reduction in the 3yr risk of type 2 diabetes. This is equivalent to the stroke risk reduction associated with smoking cessation. Unfortunately, in intervention trials dating back to 1990, black women have experienced 50% less weight loss than white women. Thus, lifestyle weight loss interventions may actually increase racial disparities in morbidity; all 5 leading causes of death among black women are obesity-related. Obesity prevalence among the urban poor is very high and obesity research in the urban poor is an IOM and DHHS priority. Starting in 2006, we worked with the 3rd largest safety-net health system in the U.S. to implement a lifestyle weight loss intervention that operates in its 8 Federally Qualified Health Centers. This program too has resulted in 50% less weight loss in black relative to white women. We also have an ongoing weight loss RCT testing the impact of delivering the intervention into the homes of the urban poor. No outcomes are available yet but it too is a person-centric lifestyle intervention. With a goal of improving weight loss outcomes, we successfully piloted a novel approach to assessing micro- environments that coincide with weight-related behaviors including momentary social interactions and emotions. Literature places a very strong emphasis on the role of social micro-environments in obesity and weight loss disparities. Individuals are often unaware of the influence of micro-environments on their behavior. For example, experiments have shown that we consume up to 70% more calories when eating with others and that we are largely unaware we have done so. Previous research suggests social networks of black women are less supportive of weight loss than are those of white women. Such social networks may lead to more exposures to obesity, food, eating, sedentary activities, and acceptance of these. In fact, a recent year-long study that captured objective assessments of social interactions among first year dormitory residents found the number of interactions with weight gaining others accounted for 1/3rd of the variance in one-year weight gain. We seek in the proposed study to assess, compare, and test the influence of social and physical micro- environments and emotions on inactivity and eating in 300 urban poor black and white women. Our Aim 1 involves novel data collection via GPS, Bite Counters, and accelerometers to obtain location and behavior data and a hybrid of ecological momentary assessment and the day reconstruction method to obtain social interaction and emotion data. In our Aim 2 randomized trial, these data are used to test hypotheses about micro-environments and weight change. Each individual's Aim 1 data are used to test whether messages in the form of health-related words and images at the time and location each woman's data indicate she is vulnerable to eating or sedentary activity affect weight change. This work will inform next-generation weight loss programs and advance our understanding of automatic behaviors in health and health disparities.

 描述（由申请人提供）：多中心随机对照试验表明，体重每减轻 2 磅，患高血压的 3 年风险就会降低 20%，患 2 型糖尿病的 3 年风险就会降低 32%。这相当于与戒烟相关的中风风险降低。不幸的是，在 1990 年的干预试验中，黑人女性的体重减轻比白人女性少 50%。因此，生活方式减肥干预实际上可能会增加发病率的种族差异；黑人女性死亡的 5 个主要原因都与肥胖有关。城市贫民的肥胖患病率非常高，城市贫民的肥胖研究是 IOM 和 DHHS 的优先事项。从 2006 年开始，我们与美国第三大安全网医疗系统合作，在其 8 个联邦合格健康中心实施生活方式减肥干预措施。与白人女性相比，该计划也使黑人的体重减轻了 50%。我们还有一项正在进行的减肥随机对照试验，测试向城市贫民家庭提供干预措施的影响。目前还没有结果，但这也是一种以人为本的生活方式干预措施。为了改善减肥效果，我们成功地尝试了一种新颖的方法来评估与体重相关行为（包括瞬时社交互动和情绪）相一致的微环境。文献非常强调社会微环境在肥胖和减肥差异中的作用。人们往往意识不到微环境对其行为的影响。例如，实验表明，与他人一起吃饭时，我们会多消耗 70% 的卡路里，而我们基本上没有意识到自己已经这样做了。先前的研究表明，黑人女性的社交网络对减肥的支持程度低于白人女性。这样的社交网络可能会导致更多地接触肥胖、食物、饮食、久坐活动，并接受这些。事实上，最近一项为期一年的研究对第一年宿舍居民的社交互动进行了客观评估，发现与体重增加的其他人的互动次数占一年体重增加方差的 1/3。我们在拟议的研究中寻求评估、比较和测试社会和身体微环境以及情绪对 300 名城市贫困黑人和白人女性不活动和饮食的影响。我们的目标 1 涉及通过 GPS、咬合计数器和加速计进行新颖的数据收集，以获得位置和行为数据，并结合生态瞬时评估和日重建方法来获取社交互动和情感数据。在我们的 Aim 2 随机试验中，这些数据用于检验有关微环境和体重变化的假设。每个人的目标 1 数据用于测试每个女性的数据表明她容易受到饮食或久坐活动影响体重变化的时间和地点的健康相关文字和图像形式的信息是否影响体重变化。这项工作将为下一代减肥计划提供信息，并增进我们对健康和健康差异中自动行为的理解。