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），低体力活动（PA）和高久坐休闲屏幕时间（Sed）同时发生，增加了心血管疾病和癌症的风险。第一个更好的选择（MBC 1）实验对比了四种策略，以促进这四种风险行为的健康变化。每种干预措施同时针对两种行为（一种饮食，一种活动），并增加健康或减少不健康的反应。以增加FV和减少Sed为目标的干预措施最有效，在四种风险行为中的三种（FV，Sed，Fat）中产生了意外的持续改善。拟议的MBC 2试验测试MBC干预在6个月和12个月时促进饮食和活动的持续，健康变化的功效，与注意力控制治疗（压力管理）相比。MBC 2还（a）测试了关于在不破坏FV、Sed和Fat维持的情况下添加PA的最佳方式的竞争性假设;以及（B）检查了健康生活方式改变的介质和生物标志物。将饮食不佳和生活方式不活跃的社区居住成年人（N=250）随机分配至：1）序贯MBC（FV+ Sed-，随后为PA+），2）同时MBC（FV+ Sed-PA+）或3）对照（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来自我监控和传输数据，并将通过电话进行指导。掌握假说，基于自我调节的强度和习惯的理论，预测优越的上级健康变化的顺序干预，介导的更大的习惯强度健康饮食和活动。协同假说，基于目标系统理论，预测最好的结果，从同时干预，介导的建立一个上级健康的生活方式目标。MBC 2试验的结果将揭示普遍危险行为健康变化的机制。如果成功，该试验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.