Reducing Hypertension among African American Men: A Mobile Stress Management Intervention to Address Health Disparities

项目总结/摘要 非洲裔美国人是美国高血压（HTN）发病率最高的人群。一旦确诊， 他们也不太可能实现血压（BP）控制。这种健康差异是至关重要的，因为血压升高是 心血管疾病的主要可改变的危险因素。HTN差异的一个原因是：压力。非洲 美国人比他们的白色同龄人报告更多的压力，最明显的是来自种族歧视， 管理这些压力源的资源。这种压力会产生严重的生理后果。相比 白人、非裔美国人显示出高的非稳态负荷，这是一种生物学指标， 慢性应激与HTN的病因有关。压力也会通过不健康的应对方式加剧HTN (e.g.,暴饮暴食、饮酒）和抗高血压药物依从性较差。 研究表明，压力管理（SM）干预可以改善HTN。尽管如此，SM培训并不是 通常是因为医疗机构缺乏提供BP的资源。一个成本- 有效的、易于扩展的解决方案是移动的电话（即，mHealth）。重要的是，98%的非洲裔美国人拥有 移动的电话。大多数是智能手机（83%）。短信干预已经被证明可以改善 各种HTN管理生活方式的改变（例如，减少吸烟，增强体力活动）。 目前市场上没有移动的认知行为SM干预（m-CBSMi）， 帮助非裔美国人管理种族和非种族压力来源，以减少HTN 差距。拟议的干预措施将填补这一空白。使用经过验证的CBSMi技术，黑人将学习 如何通过短信和综合视频管理压力和降低血压。教育文本将 增加知识，发展技能，减少适应性应对的障碍。支持性文本将促进 性别和民族自豪感。互动视频库将允许用户选择量身定制的培训和内容 基于他的个人需要和经历（例如，利用自己的冒险风格）。所有视频将 可以通过嵌入在文本消息中的链接访问，从而轻松查看它们。 在第一阶段，开发了原型m-CBSMI。这一发展是由形成性研究提供信息的 与20名非裔美国人进行了对比。第一阶段的结果有力地支持了可行性， 这表明，干预措施的潜在有效性远远超过了第一阶段建议中确定的基准。 在第二阶段，非裔美国人的m-CBSMi将得到充分开发。然后，与 家庭和医疗咨询服务，m-CBSMi降低高血压患者血压的有效性 非裔美国人将接受检查。参与者将被随机分配到干预措施中， 条件或匹配的对照条件。次要措施将评估主观压力，使用 抗高血压药物，应对，幸福感，性别种族认同和知识。

PROJECT SUMMARY/ABSTRACT African American men have the highest rate of hypertension (HTN) in the United States. Once diagnosed, they are also less likely to achieve blood pressure (BP) control. This health disparity is critical, as elevated BP is the primary modifiable risk factor for cardiovascular disease. One reason for this HTN disparity: stress. African Americans report more stress than their White peers, most notably from racial discrimination, and have fewer resources to manage these stressors. And this stress has significant physiological consequences. Compared to Whites, African Americans show heightened allostatic load, a biologic measure of the cumulative burden of chronic stress that is implicated in the etiology of HTN. Stress also exacerbates HTN through unhealthy coping (e.g., overeating, alcohol use) and poorer adherence to antihypertensive medications. Research shows that stress management (SM) interventions improve HTN. Despite this, SM training is not regularly deployed to manage BP, often because health care settings lack the resources to deliver it. One cost- effective, easily scalable solution is mobile phones (i.e., mHealth). Importantly, 98% of African Americans own a mobile phone. Most are smartphones (83%). And text messaging interventions have been shown to improve a variety of HTN management lifestyle changes (e.g., smoking reduction, physical activity enhancement). There is no mobile cognitive behavioral SM intervention (m-CBSMi) on the market today that is designed to help African American men manage racial and nonracial sources of stress in an effort to reduce HTN disparities. The proposed intervention will fill this void. Using proven CBSMi techniques, Black men will learn how to manage stress and reduce BP through text messages and integrated videos. Educational texts will increase knowledge, develop skills, and reduce barriers to adaptive coping. Supportive texts will promote gender and ethnic pride. A library of interactive videos will allow a user to choose tailored training and content based on his personal needs and experiences (e.g., utilizing a choose-your-own-adventure style). All videos will be accessible through links embedded within text messages, making it effortless to view them. In Phase I, a prototype m-CBSMI was developed. This development was informed by formative research with 20 African American men across the lifespan. The results of Phase I strongly support the feasibility and potential effectiveness of the intervention, far exceeding the benchmarks established in the Phase I proposal. During Phase II, the m-CBSMi for African American men will be fully developed. Then, in partnership with Family and Medical Counseling Service, the effectiveness of the m-CBSMi to reduce BP among hypertensive African American men will be examined. Participants will be randomly assigned to either the intervention condition or to a matched control condition. Secondary measures will assess subjective stress, use of antihypertensive medications, coping, well-being, gendered racial identity, and knowledge.