A Mixed Methods Approach for Developing Culturally and Ecologically Appropriate Interventions for Improving Sleep Health in a Community-Based Sample of African Americans

项目摘要(摘要) 高血压和失控的血压是一个重大的公共卫生负担；因此 重要的是改善可改变的风险因素，如睡眠健康，以努力减少社会 负担，特别是在健康状况不同的人群中。这款K01的目标是利用混合方法 设计一项旨在环境压力背景下改善睡眠的先导性研究的方法，需要很长时间 改善长期患有高血压的非裔美国人的血压控制和整体健康的长期目标 睡眠不佳，是高血压(HTN)和HTN相关并发症和死亡率的高风险人群。我 建议：1)测试环境(在家庭内和家庭内)之间的独立和交互关联 在城市AA人群中，睡眠模式与社会压力源(即歧视)有关；2) 开展定性研究，为制定量身定做的干预措施提供信息，以改善 AAS的健康睡眠和血压控制问题，特别是提高对几个主题的理解 包括改善睡眠的障碍和机会以及相关的心血管危险因素；以及3)使用 来自混合方法研究的数据，用于在社区环境中开发和试行为期12周的可行性试验 主要目标是改善睡眠，以此作为改善血压控制和其他健康的战略 结果。为了解决这些研究目标，我将利用美国国立卫生研究院和环境保护局资助的基础设施 住房全生命周期环境和社会压力源研究中心 由该提案的主要导师指导。CRESSH有两个将被利用的项目：1)Home- 基于观察和监测的马萨诸塞州波士顿多民族混合收入人群暴露研究 2)环境健康差异研究中的空间格局测绘。我将利用来自 CRESSH(7天实时监测环境应激源(噪音、温度、NO2、PM2.5、超细 颗粒物、通风)和社会应激源)以及前瞻性地收集从以下来源抽样的AA中的新数据 CRESSH和与CRESSH参与者相同的社区。我建议进行：a)7天手腕动作检查 确定睡眠/醒来时间、睡眠时间和睡眠质量；b)深入焦点小组，以确定障碍 和改善睡眠的机会；以及c)完成家庭环境审计，以确定 和社会环境。这个职业发展奖的总体目标是发展一名独立的 旨在了解睡眠健康差距的根本原因及其对 心血管结果，包括HTN，并设计符合文化和环境的 干预措施。通过研究和新的混合方法培训，以社区为基础/行为 干预和环境和心血管流行病学，这个奖项将促进我向 睡眠流行病学和心血管健康差异领域的独立调查员，并将允许 我的研究将作为公共卫生干预和政策的杠杆。

Project Summary (Abstract) High and uncontrolled blood pressure (BP) is a significant public health burden; therefore it is important to improve modifiable risk factors such as sleep health in efforts to reduce the societal burden, particularly among health disparate populations. The goal of this K01 is to utilize a mixed methods approach to design a pilot study aimed at improving sleep in the context of environmental stressors, with a long term aim of improving BP control and overall health of African Americans (AAs) who chronically suffer from poor sleep and are at high risk for hypertension (HTN) and HTN-associated comorbidities and mortality. I propose to: 1) Test independent and interactive associations between environmental (within the home and neighborhood) and social stressors (i.e. discrimination) with sleep patterns in an urban AA population; 2) Conduct qualitative research to inform the development of tailored interventions for improving the inter-related problems of healthy sleep and BP control in AAs, particularly to enhance understanding of several topics including the barriers and opportunities to improve sleep and related cardiovascular risk factors; and 3) Use data from the mixed methods research to develop and pilot a 12-week feasibility trial in a community setting with the primary objective to improve sleep as a strategy to improve BP control as well as other health outcomes. To address these research aims, I will leverage the infrastructure of the NIH and EPA funded Center for Research on Environmental and Social Stressors in Housing across the Life Course (CRESSH) co- directed by the primary mentor of this proposal. CRESSH has two projects that will be leveraged: 1) Home- based Observation and Monitoring Exposure study of a multiethnic mixed income population in Boston, MA; and 2) the Mapping Spatial Patterns in Environmental Health Disparities study. I will utilize existing data from CRESSH (7 days of real time monitored environmental stressors (noise, temperature, NO2, PM2.5, ultrafine particles, ventilation) and social stressors) as well as prospectively collect new data among AAs sampled from CRESSH and the same communities as CRESSH participants. I propose to conduct: a) 7-day wrist actigraphy to characterize sleep/wake times, sleep timing and quality of sleep; b) in-depth focus groups to identify barriers and opportunities for improving sleep; and c) complete a home environmental audit to characterize the physical and social environment. The overall goal of this career development award is to develop an independent research program aimed at understanding the root causes of sleep health disparities and their impact on cardiovascular outcomes including HTN, and designing culturally and environmentally appropriate interventions. Through research and new training in mixed methods, community-based/behavioral interventions and environmental and cardiovascular epidemiology, this award will facilitate my transition to an independent investigator in the field of sleep epidemiology and cardiovascular health disparities and will allow my research to serve as a lever for public health interventions and policy.