Neighborhood Moderating Effects on Intervention Response in Cardiovascular Health

该奖项的目的是提供研究培训，使申请人成为心血管健康和相关风险因素领域的高效，独立的调查员。通过结合研究经验，课程和指导指导的战略培训计划，申请人将发展建立独立研究职业所需的技能和经验。该提案将研究心血管健康风险和结果的多层次性质。也就是说，个人的特征和他们生活的邻里环境的属性同时影响健康和健康相关行为。承认这种环境/个人的相互作用是特别相关的干预措施，重点是改变个人的健康行为。虽然以个人为重点的干预措施在解决与饮食调整或体育活动有关的健康行为方面是有用的，但这种干预措施通常不会考虑邻里环境对这些行为的影响。这项研究计划有两个目的：1）在参与随机对照试验（RCT）研究的个体中，检查邻里环境是否会调节干预对心血管健康因素和行为变化的影响，以及2）研究社区环境是否不同地调节干预对非裔美国人和白色人心血管健康因素和行为变化的影响参加RCT研究的受试者。来自NIH资助的和AHA资助的研究的数据将被链接以测试以下假设：1）不健康的背景环境的特征（即，不良的社会环境，缺乏体育活动的机会，以及鼓励不健康饮食习惯的食物可获得性）将显著缓和运动干预对心血管健康指标变化的影响，并将抑制1）体重，2）能量摄入，3）总胆固醇，4）血压，5）葡萄糖，6）腰围，7）低密度脂蛋白（LDL），8）甘油三酯，和9）总身体脂肪;并且将抑制10）体力活动和11）高密度脂蛋白（HDL）的增加;和2）非裔美国人参与者将表现出显着较弱的心血管健康指标的变化，以响应运动干预，由于差异不健康的邻里环境特征的调节影响。这项研究的结果将提供新的证据，可用于开发旨在改善心血管健康的更有效的干预措施。在执行本研究提案的目的时，申请人将开发1）与心血管健康多层次决定因素相关的概念和分析技能，以及2）与随机对照干预试验相关的临床研究技能。这些技能对于申请人成功启动一个独立的，富有成效的研究生涯，将专注于心血管健康至关重要。

DESCRIPTION (provided by applicant): The objective of this F32 award is to provide research training that will allow the applicant to become a productive, independent investigator in the fiel of cardiovascular health and related risk factors. With a strategic training plan that combines research experience, coursework, and guided mentorship, the applicant will develop the skills and experience necessary for establishing an independent research career. This proposal will examine the multilevel nature of cardiovascular health risks and outcomes. That is, both the characteristics of individuals and attributes of the neighborhood environments in which they live concurrently influence health and health-related behaviors. Acknowledging this environmental/individual interaction is particularly relevant to interventions that focus on modifying the health behaviors of individuals. While individually-focused interventions are useful in addressing health behaviors related to diet modification or physical activity, such intervention most often do not account for the influence of the neighborhood environment on such behaviors. This research proposal has 2 aims: 1) to examine if the neighborhood environment moderates the effect of an intervention on change in cardiovascular health factors and behaviors in individuals who participated in a randomized control trial (RCT) study and 2) to examine if the neighborhood environment differentially moderates the effect of an intervention on change in cardiovascular health factors and behaviors between African American and white participants who participated in RCT study. Data from an NIH-funded and an AHA-funded study will be linked to test the hypotheses that: 1) Features of an unhealthy contextual environment (i.e., poor social environment, lack of opportunities for physical activity, and food availability that encourages unhealthy dietary practices) will significantly moderate the effect of an exercise intervention on change in indicators of cardiovascular health and will inhibit decreases in 1) weight, 2) energy intake, 3) total cholesterol, 4) blood pressure, 5) glucose, 6) waist circumference, 7) low-density lipoprotein (LDL), 8) triglycerides, and 9) total body fat; and will inhibit increases in 10) physical activity and 11) high- density lipoprotein (HDL); and 2) African American participants will demonstrate significantly weaker change in indicators of cardiovascular health in response to an exercise intervention due to the differential moderating influence of features of an unhealthy neighborhood environment. Findings from the proposed study will provide novel evidence that can be used in the development of more efficacious interventions that aim to improve cardiovascular health. In carrying out the aims of this research proposal, the applicant will develop 1) conceptual and analytical skills related to multilevel determinants of cardiovascular health and 2) clinical-based research skills related to randomize controlled intervention trials. These skills are crucial for the applicant to successfully initiatean independent, productive research career that will focus on cardiovascular health.