PROMOTING HEALTHY LIFESTYLES--ALTERNATIVE MODELS EFFECT

描述(摘自研究人员摘要)：有证据表明，有规律的体育锻炼和健康的饮食可以预防/治疗疾病和延长寿命，但大多数美国人都没有做到这一点。实现并保持行为改变仍然是一项重大挑战。具有不同理论取向和专业知识的研究人员设计了这一应用程序，以测试两种基于模型的干预措施，解决不健康的营养做法和久坐不动的生活方式。这些模型基于社会学习理论(模型1)和跨理论模型(模型2)。模式一S干预是以社会单位为基础，所有成员共同参与。它利用不同的经历、共同的行为规范和同伴影响。跨理论模型介入个体。它认识到变化过程中的动态性质和个体差异，并定义变化的阶段，相应地定制每个交互。激励理论的使用促进了从确定的阶段开始的进步。消防员将是这项研究的参与者。他们集中了困扰美国民众的有害行为和健康风险，他们独特的工作时间表使他们成为这两种干预措施的理想人选。调查人员认为，他们与消防员建立的关系应该会促进招募和参与，同时减少自然减员。S研究的主要结果是增加了体力活动和有氧健身，降低了脂肪卡路里的百分比，增加了水果和蔬菜的摄入量，并使体脂百分比正常化。第一年将对干预措施和研究过程进行试点研究。全部结果试验将在两到四年内进行。在全面试验中，来自36个站点的消防员(每个站点20-2名受试者)将被随机分配到3种情况中的一种：模式1、模式2或常规控制。模式1将是11次45分钟的同伴促进小组会议，并在下一年举行5次45分钟的助推会。同伴辅导员将接受培训，并使用脚本化的教案。模式2将使用初始医生访问、6次健康教育人员会议和18次、每两周一次的后续电话。下一年还将举行5次45分钟的额外健康教育人员会议。模型的接触时间是相同的，评估的指标对于所有三种情况都是相同的。评估将在干预前和每年进行，每季度确定每个目标行为的变化阶段。年度指标包括最大摄氧量；饮食调查；体脂百分比和分布；力量、柔韧性、脊柱健康和自我报告的体力活动指数；以及评估理论结构和中介变量的问卷。在第四年，不会发生干预，尽管受试者将继续接受评估。将使用直接观察和录音来监测这两个模型的计划实施和保真度。结果将评估分层线性模型，包括潜在增长模型和附加增长模型，这些模型适用于嵌套受试者和重复措施设计。调查人员将确定调解人之间的关系、干预和结果衡量标准。这项研究将对这两种健康促进模式进行比较，并提供对行为改变如何发生以及在什么条件下可以发生和维持的理解。

DESCRIPTION (adapted from investigator's abstract): Evidence that regular physical activity and a healthy diet prevent/treat illness and prolong life is overwhelming, yet the majority of Americans do neither. Achieving and maintaining behavior change remains a major challenge. Investigators with different theoretical orientations and expertise have designed this application to test two model- derived interventions, addressing unhealthy nutrition practices and sedentary lifestyles. The models are based on Social Learning Theory (Model 1) and the Transtheoretical Model (Model 2). Model 1 s intervention is social unit based, with all members participating together. It capitalizes on vicarious experiences, shared behavioral norms and peer influences. The Transtheoretical Model intervenes with the individual. It recognizes the dynamic nature and individual differences in the change process and defines stage of change, tailoring each interaction accordingly. Progress from the defined stage is enhanced by use of motivational theory. Fire fighters will be the participants in the study. They have a concentration of the harmful behaviors and health risks afflicting the US population, and their unique work schedules makes them ideal for both interventions. The investigators believe that the established relationship they have with firefighters should facilitate recruitment and participation, while reducing attrition. The study s primary outcomes are increased physical activity and aerobic fitness, reduced percent calories as fat, increased servings of fruit ad vegetables and normalized percent body fat. A pilot study of interventions and research process will be conducted in year one. The full outcome trial will be conducted in years two-to-four. In the full trial, firefighters from 36 stations (20-2 subjects per station) will be randomly assigned by station to 1 of 3 conditions: Model 1, Model 2, or usual practice control. Model 1 will be 11, 45-minute peer facilitated group meetings, with 5, 45-minute booster meetings the following year. Peer facilitators will be trained and use scripted lesson plans. Model 2 will use an initial physician visit, 6 health educator meetings and 18, bi-weekly follow-up phone calls. Five, 45-minute additional health educator meetings will occur the following year. The Models contact times are the same, and indices assessed are the same for all three conditions. Evaluation will occur pre- intervention and annually, with quarterly determination of the stage of change for each targeted behavior. Annual measures include maximum oxygen uptake; dietary surveys; body fat percent and distribution; indices of strength, flexibility, spine health and self-reported physical activity; and a questionnaire assessing theoretical constructs and mediating variables. During year 4, no interventions will occur, although subjects will continue to be assessed. Program implementation and fidelity will be monitored for both models, using direct observation and audio taping. Outcomes will be assessed hierarchical linear modeling, including latent and added growth models, which are appropriate for the nested subjects and repeated measures design. Investigators will identify relationships among mediators, the intervention and outcome measures. The study will compare the two health promotion paradigms and provide an understanding of how, and under what conditions behavior change can occur and be maintained.