Making Healthy Habits Stick: Extended Contact Interventions to Promote Long Term Physical Activity in African American Cancer Survivors

癌症存活率的差异是持久和普遍的。肥胖、内科合并症、二次主症 癌症、糟糕的生活质量和身体功能受损对非裔美国人的影响不成比例 (Aa)癌症幸存者。有强有力的证据表明，体力活动(PA)有可能消除这些 差距。然而，PA不足在AA癌症幸存者中更为普遍，76%的患者不符合PA 指导方针。增加癌症幸存者的PA的长期治疗的努力已经取得了一定的成功。现存的 文献和我们自己在癌症幸存者中的初步数据表明，PA的采用通常伴随着 PA随时间的衰减。这些发现导致了最近思维的转变，特别是社会 认知理论结构(例如，自我效能感)对PA的采用很重要，但在PA中的作用较小 维修。额外的理论结构(即习惯和身份)可能是 长期的行为改变。可以想象，在促进PA维护方面缺乏成功也可能是由于 很少有研究考察健康行为改变干预措施在更广泛的社会背景下如何发挥作用。为 例如，对于AAA来说，歧视是健康的一个强有力的社会决定因素。普遍存在歧视(报告 82%的AA乳腺癌幸存者)，不成比例(AA更有可能报告与歧视有关 与其他种族和民族群体相比，压力)和压力(压力，通常阻碍PA)。尽管如此 有证据表明，歧视对PA干预结果的影响尚不清楚。因此，要推进PA 维护科学的重点是弱势群体，我们建议测试两个潜在的可翻译 260人中的PA维护促进干预(短信服务和同伴教练) 不活跃的AA癌症幸存者采用严格的随机2×2析因实验设计。 幸存者将完成为期3个月的PA采用阶段(即基于理论的有效PA行为改变 计划)，然后随机接受PA维护促进干预或常规护理。我们为期6个月的短信 同行教练PA维护促进干预将由多过程行动控制指导 (M-PAC)框架，包括在癌症幸存者中尚未得到充分研究的结构，但假设 对PA的维护很重要(例如，习惯、身份)。评估将在基线上进行(PA采用前)，3 9个月、15个月(PA采用后；随机化之前)。我们的具体目标 包括：1)确定两种PA维护干预措施(短信、同伴教练)与常规护理的效果 PA维护(即主要影响，如果一种干预效果因另一种干预效果不同而不同)；2) 确定PA维持的基于理论的调解人；以及3)确定歧视是否缓和干预 对PA维护的影响。该项目将产生关于PA基础机制的新知识 维护并洞察歧视对干预效果的影响，从而导致更多 有效的行为干预措施，将改善健康结果，缩小健康差距。

Disparities in cancer survivorship are persistent and pervasive. Obesity, medical comorbidities, second primary cancers, poor quality of life and compromised physical functioning, disproportionately affect African American (AA) cancer survivors. There is strong evidence that physical activity (PA) has the potential to eliminate these disparities. Yet, insufficient PA is more prevalent among AA cancer survivors and 76% do not meet PA guidelines. Efforts to increase PA longer term in cancer survivors have been modestly successful. The extant literature and our own preliminary data in cancer survivors shows that PA adoption is often followed by an attenuation of PA over time. These findings have led to a recent shift in thinking, specifically that the social cognitive theory constructs (e.g., self-efficacy), important for PA adoption play less of a role in PA maintenance. Additional theoretical constructs (i.e., habit and identity) may be the key constructs necessary for long term behavior change. Conceivably, lack of success in promoting PA maintenance may also be due to few studies examining how well health behavior change interventions work in the broader societal context. For example, for AAs, discrimination is a potent social determinant of health. Discrimination is prevalent (reported by 82% of AA breast cancer survivors), disproportionate (AAs are more likely to report discrimination-related stress compared to other racial and ethnic groups), and stressful (stress, in general, impedes PA). Despite this evidence, the effect of discrimination on PA intervention outcomes is unknown. Thus, to advance PA maintenance science with a focus on a vulnerable population, we propose testing two potentially translatable PA maintenance promotion interventions (Short Message Service [SMS] and peer coach) in 260 physically inactive AA women cancer survivors using a rigorous, randomized 2 x 2 factorial experimental design. Survivors will complete a 3-month PA adoption phase (i.e., efficacious theory-based PA behavior change program) prior to randomization to a PA maintenance promotion intervention or usual care. Our 6-month SMS and peer coach PA maintenance promotion interventions will be guided by the Multi-Process Action Control (M-PAC) framework which includes constructs which are understudied in cancer survivors yet hypothesized to be important for PA maintenance (e.g., habit, identity). Assessments will occur at baseline (pre-PA adoption), 3 months (post-PA adoption; immediately prior to randomization), 9 months, and 15 months. Our specific aims are: 1) Determine effects of both PA maintenance interventions (SMS, peer coach) compared to usual care on PA maintenance (i.e., main effects and if either intervention effects differ in the presence of the other); 2) Identify theory-based mediators of PA maintenance; and 3) Determine if discrimination moderates intervention effects on PA maintenance. The project will generate new knowledge about the mechanisms underlying PA maintenance and provide insight about the impact of discrimination on intervention effects thus leading to more effective behavioral interventions that will improve health outcomes and reduce health disparities.