Culturally and Linguistically Adapted Physical Activity Intervention for Latinas

描述（由申请人提供）：在美国，拉丁美洲人报告的不活动率和相关的健康状况（例如，高血压、高脂血症、肥胖、心脏病、中风和糖尿病）的发病率高于非西班牙裔白人。此外，拉丁美洲妇女（拉丁美洲人）报告久坐行为的比率高于拉丁美洲男子。由于文化因素、社会经济环境、教育背景差异和语言障碍，拉丁美洲人，特别是拉丁美洲人，获得促进身体活动生活方式的公共卫生干预措施的机会有限。为了解决这一公共卫生危机，需要利用最先进的理论和方法进行有效的干预。我们的研究小组有20年的经验，开发和评估个性化的计算机专家系统驱动的身体活动干预（基于社会认知理论和跨理论模型）。在我们最近的试点研究（R21 NR 009864）中，我们在文化和语言上调整了我们现有的针对久坐拉丁裔的定制干预措施，并对修改后的计划进行了一项小型随机试验（N=94）。六个月（干预后）评估仍在进行中，但已收集了87名参与者的三个月数据（保留率为93%）。干预参与者的身体活动从基线时的平均每周17分钟（SD=25.8）增加到三个月时的92分钟（SD=69.8），而接触控制参与者报告说，他们的身体活动从基线时的每周12分钟（SD=21.8）增加到三个月时的64分钟（SD=84.3）。3个月时的平均值趋势初步支持了我们的干预措施的有效性和高保留率，特别是针对拉丁裔等难以接触的群体的研究，预示着其可行性和可接受性。对于目前的提案，我们将在这些令人鼓舞的结果的基础上，进行一项具有充分把握度（N=312）的随机对照试验，以测试文化和语言修改的、个性化定制的印刷干预与健康接触控制条件（例如，来自西班牙语NHLBI的心血管健康信息）。将在基线、6个月和12个月时使用完善的体力活动测量（7天PAR，Actigraphs）以及一套全面的心理社会问卷收集数据。我们假设，在治疗结束时（第六个月），干预参与者将报告每周至少中等强度体力活动的时间比健康接触控制参与者显着增加。我们还将检查12个月时治疗效果的维持情况、提供定制干预方案的成本以及干预-体力活动关系的潜在介导者和调节者。在拟议的研究中，我们寻求使用高覆盖率，低成本的策略在这一高危人群中促进体育活动，该策略具有更大规模采用的巨大潜力，因此具有减少美国现有健康差距的巨大潜力。由于拉丁裔是美国增长最快的少数民族，报告说他们的不活动率和相关的健康状况很高，我们将进行一项大规模的随机对照试验，以测试在拉丁美洲人（n=312）中进行文化和语言修改，个性化定制的身体活动干预的有效性。这项拟议中的研究旨在使用高覆盖率，低成本的策略在这一高危人群中促进体育活动，该策略具有更大规模采用的巨大潜力，因此具有减少美国现有健康差距的巨大潜力。

DESCRIPTION (provided by applicant): In the U.S., Latinos report higher rates of inactivity and related health conditions (e.g., hypertension, hypercholesteremia, obesity, heart disease, stroke, and diabetes) than non-Hispanic whites. Furthermore, Latino women (Latinas) report higher rates of sedentary behavior than Latino men. Due to cultural factors, socioeconomic circumstances, differences in educational background, and language barriers, Latinos in general, and especially Latinas, have limited access to public health interventions that promote physically active lifestyles. To address this public health crisis, effective interventions that leverage state-of-the-art theory and methods are needed. Our research group has 20 years experience developing and evaluating individually tailored computer expert system-driven physical activity interventions (based on Social Cognitive Theory and the Transtheoretical Model). In our recent pilot study (R21NR009864), we culturally and linguistically adapted our existing tailored intervention for sedentary Latinas and conducted a small randomized trial of the modified program (N=94). Six month (post-intervention) assessments are still ongoing, but three month data have been collected on 87 participants (93 percent retention). Intervention participants increased their physical activity from a mean of 17 minutes per week (SD=25.8) at baseline to 92 minutes (SD=69.8) at three months, whereas contact control participants reported increasing their physical activity from 12 minutes per week (SD=21.8) at baseline to 64 minutes (SD=84.3) at three months. The trends in the means at 3 months lend preliminary support for the efficacy of our intervention and the high retention rates, especially for a study targeting a hard-to-reach group like Latinas, bode well for its feasibility and acceptability. For the current proposal, we will build on these encouraging results by conducting an adequately powered (N=312) randomized controlled trial to test the efficacy of the culturally and linguistically modified, individually tailored print intervention compared with a wellness contact control condition (e.g., cardiovascular health information from NHLBI in Spanish). Data will be collected at baseline, 6, and 12 months using well-established physical activity measures (7-Day PAR, Actigraphs), as well as a comprehensive set of psychosocial questionnaires. We hypothesize that at the end of treatment (month six) intervention participants will report significantly more minutes of at least moderate intensity physical activity per week than the wellness contact control participants. We will also examine the maintenance of treatment effects at 12 months, costs of delivering the tailored intervention program, and potential mediators and moderators of the intervention-physical activity relationship. In the proposed study we seek to promote physical activity among this at-risk population using a high-reach, low-cost strategy, which has great potential for adoption on a larger scale and thus high potential for reducing existing health disparities in the U.S. PUBLIC HEALTH RELEVANCE: As Latinos are the fastest growing minority group in the U.S. and report high rates of inactivity and related health conditions, we will conduct a large scale randomized controlled trial to test the efficacy of a culturally and linguistically modified, individually tailored physical activity intervention among Latinas (n=312). The proposed study seeks to promote physical activity among this at-risk population using a high-reach, low-cost strategy, which has great potential for adoption on a larger scale and thus high potential for reducing existing health disparities in the U.S.