THE HARMONY Study - A culturally-relevant, randomized-controlled, stress management intervention to reduce cardiometabolic risk in African American women.

THE HARMONY 研究 - 一项与文化相关的、随机对照的压力管理干预措施，旨在降低非裔美国女性的心脏代谢风险。

• 批准号: 10560580
• 负责人: Susan Gaylord
• 金额: $ 60.63万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-29 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10560580
• 关键词: 18 year old; Address; Adherence; Adopted; Adult; Affect; African American; Behavioral; Biological Markers; Body fat; Body mass index; C-reactive protein; Cardiovascular Diseases; Chronic; Chronic Disease; Chronic stress; Cognitive; Communities; Community Health; Death Rate; Diabetes Mellitus; Diet; Disparity; Distress; Eating; Eating Behavior; Educational process of instructing; Emotional; Ethnic Population; Exercise; Exposure to; Gender; Goals; Health; Healthy Eating; Inflammatory; Informal Social Control; Intake; Intervention; Life; Measures; Mediating; Mediator; Mindfulness Training; Obesity; Outcome; Overweight; Participant; Patient Self-Report; Physiology; Posture; Psychological Stress; Quality of life; Questionnaires; Race; Randomized; Randomized, Controlled Trials; Research; Risk; Risk Assessment; Risk Factors; Risk Reduction; Self Care; Self Efficacy; Self Management; Stress; Stroke; Testing; United States National Institutes of Health; Waist-Hip Ratio; Weather; Woman; Women' s Group; Work; actigraphy; allostatic load; arm; attentional control; cardiometabolic risk; cardiometabolism; caregiving; community setting; cytokine; depressive symptoms; design; dietary; disability; disparity reduction; experience; feasibility research; fruits and vegetables; health disparity; healthy lifestyle; implementation facilitation; improved; intervention effect; lifestyle intervention; loved ones; men; mindfulness; mindfulness intervention; nutrition; nutrition education; perceived stress; physical inactivity; racial population; resilience; response; self reliance; social culture; sociodemographic group; stress management; stress reduction; stressor; success

Project Summary/Abstract African American women (AAW) have higher rates of death and disability from chronic cardiometabolic (CM) illnesses compared to any other group of women in the US, including diabetes, cardiovascular disease, and stroke. 80% of AAW are overweight or obese, and they are the largest US sociodemographic group with inadequate engagement in exercise. Nearly 50% of AAW have cardiovascular disease, and AAW have more than twice the rate of diabetes compared to White women. Compelling evidence shows that AAW are least successful at achieving and sustaining CM risk-reduction goals compared to men and women of other racial/ethnic groups, despite participating in comprehensive lifestyle interventions. These alarming disparities are due in part to disproportionately high rates of exposure to psychological stress. Culturally-relevant stressors in AAW are positively and significantly associated with perceived stress, depressive symptoms, unhealthy eating, and physical inactivity in AAW – CM risk factors. A shortcoming of interventions with AAW is their inadequate focus on stress exposure, including gender and racialized stress, stress physiology and stress- related barriers to healthy eating and exercise known to reduce CM risk. To address this shortcoming, we propose a randomized controlled trial to test a culturally-tailored mindfulness-based stress management intervention. This RCT is designed to help AAW build on their strengths to promote stress management and improved CM health by enhancing positive reappraisal, self-regulation, and self-efficacy, all of which are cognitive-behavioral facilitators of self-management and positively impacted by mindfulness training. In this 2- arm CM-risk reduction RCT with 200 AAW ≥ 18 years old with CM risk, we will be powered to detect group differences in exercise and healthy eating behaviors Specific aims are: AIM 1: Test the hypothesis that AAW participating in an 8-session culturally-relevant mindfulness-based intervention to reduce CM risk have: AIM 1A (primary) greater sustained improvements in exercise and healthy eating behaviors and AIM 1B (secondary) greater reduction in CM risk biomarkers (BMI, % body fat, waist to hip ratio [WHR], BP, and inflammatory cytokines [High Sensitivity C-Reactive Protein; hs-CRP])) at 4, 8, and 12 months, compared to AAW in an attention-control CM risk reduction intervention without mindfulness. AIM 2 (exploratory: Test the hypothesis that improvements in mindfulness, stress management, positive reappraisal, self-regulation, and self-efficacy mediate the effects of the intervention on exercise and healthy eating. We will work with a community health agency and a community advisory board to facilitate the implementation and success of our intervention. We address the NIH call to identify interventions that promote self-management to reduce disparities through a culturally-tailored, community-based mindfulness-based intervention for AAW that targets resilience in the face of culturally-relevant stressors. If effective, we will scale this contextually relevant mindfulness intervention based on AAW's strengths for broad use in community settings.

项目概要/摘要 非裔美国女性 (AAW) 因慢性心脏代谢 (CM) 导致的死亡率和残疾率较高 与美国任何其他女性群体相比，她们患有的疾病包括糖尿病、心血管疾病和 中风。 80% 的 AAW 超重或肥胖，他们是美国最大的社会人口群体 锻炼参与度不够。近 50% 的 AAW 患有心血管疾病，且 AAW 的患病率更高 与白人女性相比，糖尿病发病率是白人女性的两倍多。令人信服的证据表明 AAW 是最少的 与其他国家的男性和女性相比，成功实现并维持 CM 风险降低目标 种族/族裔群体，尽管参与了全面的生活方式干预措施。这些令人震惊的差距 部分原因是承受心理压力的比例过高。与文化相关的压力源 AAW 与感知压力、抑郁症状、不健康症状呈正相关且显着相关。 饮食和缺乏身体活动是 AAW – CM 的危险因素。 AAW 干预措施的一个缺点是 对压力暴露的关注不够，包括性别和种族压力、压力生理学和压力- 已知健康饮食和锻炼的相关障碍可降低 CM 风险。为了解决这个缺点，我们 提出一项随机对照试验来测试基于文化的正念压力管理 干涉。该随机对照试验旨在帮助 AAW 发挥其优势，促进压力管理和 通过增强积极的重新评价、自我调节和自我效能来改善 CM 健康，所有这些都是 自我管理的认知行为促进者，并受到正念训练的积极影响。在这个2- 手臂 CM 风险降低随机对照试验，200 AAW ≥ 18 岁有 CM 风险，我们将有能力检测组 运动和健康饮食行为的差异 具体目标是： 目标 1：检验 AAW 的假设 参加为期 8 期的文化相关的正念干预以降低 CM 风险：AIM 1A （主要）运动和健康饮食行为以及 AIM 1B 的持续改善（次要） CM 风险生物标志物（BMI、体脂百分比、腰臀比 [WHR]、血压和炎症）显着降低 细胞因子[高敏C反应蛋白； hs-CRP])) 在 4、8 和 12 个月时，与 AAW 相比 注意力控制 CM 风险降低干预，无需正念。目标 2（探索性：检验假设 正念、压力管理、积极重新评估、自我调节和自我效能的改善 调节干预对运动和健康饮食的影响。我们将与社区卫生部门合作 机构和社区咨询委员会，以促进我们干预措施的实施和成功。我们 响应 NIH 的号召，确定促进自我管理的干预措施，通过 针对 AAW 的文化量身定制、以社区为基础、以正念为基础的干预措施，目标是面部复原力 与文化相关的压力源。如果有效，我们将扩大这种与情境相关的正念干预 基于 AAW 在社区环境中广泛使用的优势。