A Multilevel Physical Activity Intervention for South Asian Women and Girls

项目摘要 亚裔印度和巴基斯坦(南亚)移民缺乏体育活动的比例很高， 心脏代谢危险因素。南亚(SA)妇女和女孩由于融合而面临特别高的风险 移民、文化和性别构成了南澳妇女和女孩在整个生命过程中的健康风险。 我们基于社区的参与性研究发现，SA妇女(其中85%是第一代 移民)经历：a)社会孤立和社会支持低，这减少了体力活动(PA) 动机和自我效能感；b)渴望维护与当地PA冲突的传统价值观和规范 环境(例如，男女混合运动班)；以及c)语言和环境障碍。当SA 女孩(大多数是第二代)进入青春期，她们描述：a)与文化适应有关的家庭冲突 因为锻炼被认为是一种“美国行为”；b)性别限制；c)缺乏榜样； D)他们的社区有一个共同的疾病信念，即“如果你很瘦，你就不需要锻炼。”重要的是， 社区还确定了赋予南澳妇女和女孩权力的个人、人际和家庭过程 变得更加活跃，包括PA的整体好处，对儿童健康的渴望，以及感觉 在与其他女性和家人一起锻炼时，保持联系和快乐。建立在试点研究演示的基础上 可行性和初步效果，拟议研究的目的是测试 南亚国家积极联手(SAATH)干预。为期16周的干预针对的是个人， 通过四个主要组成部分，在人际关系和家庭层面：1)为母女开设集体训练班 二人组；2)使用激励性访谈的母女PA咨询；3)同伴讨论小组， (3)家庭步行小组。干预措施还通过与公园地区合作来针对环境水平， 公共卫生部门和社区组织对当地环境进行改变，采取 考虑到社会文化(例如，性别、家庭重点)和环境(例如，同性阶层)期望 来自SA的。研究的第一个目标是确定SAATH干预的有效性，以增加中等强度 PA在SA母女二人组中采用随机等待名单对照研究设计。次要结果是： 母亲的步行和久坐时间与心脏代谢危险因素。目标2将评估 干预对个体(自我效能感、自主支持、社会支持、动机)和二元性的影响 (文化冲突、沟通、连通性)调节干预效果的假设因素 在宾夕法尼亚州。目标3是评估SAATH的执行情况和可持续性，包括环境和 跨部门合作伙伴为在南非妇女和女童中促进和维持PA而进行的系统改革。给定 SA人群的增长及其心脏代谢性疾病风险的增加，确定 在亚洲、印度和巴基斯坦移民妇女中增加PA具有重要的公共卫生意义。

Project Summary Asian Indian and Pakistani (South Asian) immigrants have a high prevalence of physical inactivity and cardiometabolic risk factors. South Asian (SA) women and girls are particularly at high risk due to a confluence of immigration, culture, and gender which shape the health risk of SA women and girls across the life course. Our community-based participatory research found that SA women (85% of whom were 1st generation immigrants) experienced: a) social isolation and low social support, which reduced physical activity (PA) motivation and self-efficacy; b) desire to maintain traditional values and norms, which conflicted with local PA environments (e.g., mixed-gender exercise classes); and c) linguistic and environmental barriers. When SA girls (majority 2nd generation) entered adolescence, they described: a) acculturation-related family conflict because exercise was perceived as an “American behavior”; b) gender constraints; c) lack of role models; and d) their community's shared illness belief that “if you are thin, you don't need to exercise.” Importantly, the community also identified individual, interpersonal, and familial processes that empowered SA women and girls to become more active, including holistic benefits of PA, aspirations for children's health, and feeling connected and happy when exercising with other women and family. Building on a pilot study demonstrating feasibility and preliminary efficacy, the proposed study aims to testing the efficacy and implementation of the South Asians Active Together (SAATH) intervention. The 16-week intervention targets individual, interpersonal, and family levels through four main components: 1) group exercise classes for mother-daughter dyads; 2) dyadic mother-daughter PA counseling using motivational interviewing; 3) peer discussion groups, and 3) family walking groups. The intervention also targets the environment level by working with park districts, a public health department, and community organizations to make changes to the local environment that take into account sociocultural (e.g., gender, family focus) and environmental (e.g., same sex classes) expectations of SA. Aim 1 of the study is to determine the efficacy of the SAATH intervention to increase moderate-vigorous PA in SA mother-daughter dyads using a randomized wait-list control study design. Secondary outcomes are: walking and sedentary time in dyads and cardiometabolic risk factors in mothers. Aim 2 will evaluate the impact of the intervention on individual (self-efficacy, autonomy support, social support, motivation) and dyadic (acculturation conflict, communication, connectedness) factors hypothesized to mediate the intervention effect on PA. Aim 3 is to evaluate implementation and sustainability of SAATH, including the environment and systems changes made by cross-sector partners to promote and sustain PA in SA women and girls. Given the growth of the SA population and their increased risk for cardiometabolic disease, identifying interventions that increase PA among Asian Indian and Pakistani immigrant women is of significant public health import.