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

描述(申请人提供)：在美国，低质量的饮食和缺乏运动是最普遍的、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)和长时间久坐闲暇时间(SED)并存，并增加心血管疾病和癌症的风险。第一个做出更好的选择(MBC1)实验对比了四种策略，以促进这四种危险行为的健康改变。每个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为目标的干预最有效，在四种危险行为中有三种意外地持续改善(FV、SED、Fat)。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、健康的饮食和活动变化的有效性，并与注意力控制治疗(压力管理)进行了对比。MBC2还(A)测试关于在不破坏FV、SED和Fat保持的情况下添加PA的最佳方式的相互竞争的假设；以及(B)检查健康生活方式改变的介体和生物标记物。饮食不佳、生活方式不活跃的社区成年人(N=250)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)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。基于自我调节强度和习惯理论的掌握假说预测，在更大的健康饮食和活动习惯强度的中介下，顺序干预会产生更好的健康变化。协同假说以目标系统理论为基础，通过建立最高健康生活方式目标来预测同时干预的最佳结果。MBC2试验的结果将阐明普遍危险行为健康改变的机制。如果成功，这项试验还将产生一种创新的、高度可传播性的技术支持的最低限度的咨询干预，以解决典型的美国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.