Make Better Choices (MBC) - Multiple Behavior Change in Diet and Activity

描述（由申请人提供）：在美国，低质量的饮食和缺乏身体活动是最普遍的、可预防的死亡原因。特别是，高饱和脂肪饮食（fat）、低水果和蔬菜摄入量（FV）、低身体活动（PA）和久坐的休闲屏幕时间（Sed）共同发生，并增加了心血管疾病和癌症的风险。第一个“做出更好的选择”（MBC1）实验对比了四种促进健康改变这四种风险行为的策略。每次干预同时针对两种行为（一种饮食，一种活动），要么增加健康反应，要么减少不健康反应。以增加FV和降低Sed为目标的干预是最有效的，在四种风险行为（FV、Sed、Fat）中的三种中产生了意想不到的持续改善。拟议的MBC2试验测试了MBC干预在6个月和12个月时促进持续、健康的饮食和活动改变的功效，并与注意控制治疗（压力管理）进行了对比。MBC2还(a)检验了关于在不破坏FV、Sed和Fat维持的情况下添加PA的最佳方法的相互竞争的假设；(b)检查健康生活方式改变的媒介和生物标志物。250名饮食和生活方式不佳的社区居民将被随机分为：1)顺序MBC （FV+Sed-，然后是PA+), 2)同时MBC (FV+Sed-PA+)，或3）控制（压力管理）。所有人都将使用带有行为决策支持工具的智能手机进行自我监控和传输数据，并将通过电话进行指导。掌握假说，基于自我调节力量和习惯的理论，预测了顺序干预的卓越健康变化，由健康饮食和活动的更大习惯力量介导。基于目标系统理论的协同假说预测了同时干预的最佳结果，通过建立一个优越的健康生活方式目标作为中介。MBC2试验的结果将揭示普遍危险行为健康改变的机制。如果试验成功，还将产生一种创新的、高度可传播的技术支持的最小咨询干预，以解决美国人的不健康饮食和久坐不动的生活方式。

DESCRIPTION (provided by applicant): Poor quality diet and physical inactivity are the most prevalent, preventable causes of death in the United States. In particular, high saturated fat diet (Fat), low fruit and vegetable intake (FV), low physical activity (PA), and high sedentary leisure screen time (Sed) co-occur and heighten the risks of cardiovascular disease and cancers. The first Make Better Choices (MBC1) experiment contrasted four strategies to promote healthful change across these four risk behaviors. Each intervention targeted two behaviors (one diet, one activity) simultaneously and either increased healthy or decreased unhealthy responding. The intervention targeting increased FV and decreased Sed was most efficacious, yielding unexpectedly sustained improvement in three out of the four risk behaviors (FV, Sed, Fat). The proposed MBC2 trial tests the efficacy of MBC intervention to promote sustained, healthful change in diet and activity at 6 and 12 months, as contrasted with an attention control treatment (stress management) . MBC2 also (a) tests competing hypotheses about the optimal way to add PA without undermining maintenance of FV, Sed, and Fat; and (b) examines mediators and biomarkers of healthy lifestyle change. Community dwelling adults (N=250) with suboptimal diet and inactive lifestyle will be randomized to: 1) Sequential MBC (FV+ Sed-, followed by PA+), 2) Simultaneous MBC (FV+Sed-PA+), or 3) Control (stress management). All will use a smart phone with behavioral decision support tools to self- monitor and transmit data and will be coached by telephone. The Mastery hypothesis, based upon theories of self-regulatory strength and habit, predicts superior healthy change for sequential intervention, mediated by greater habit strength for healthy eating and activity. The Synergy hypothesis, based upon goal systems theory, predicts best outcome from simultaneous intervention, mediated by the establishment of a superordinate healthy lifestyle goal. Results of the MBC2 trial will shed light on mechanisms that underlie healthy change in prevalent risk behaviors. If successful, the trial also will result in an innovative, highly disseminable technology-supported minimal counseling intervention to address the modal American unhealthy diet and sedentary lifestyle. PUBLIC HEALTH RELEVANCE: The average adult has a poor quality diet and sedentary lifestyle, but the best way to produce sustained healthy change remains unknown. Make Better Choices treatment uses handheld technology to help people monitor and transmit information about their eating and activity to a personal coach. The proposed trial tests whether Make Better Choices treatment improves diet and activity more than stress management does and whether it is better to add new lifestyle goals all at once or one after another.