Social support during a randomized trial of a trucker weight loss intervention

描述(申请人提供)：长途卡车司机的超重和肥胖率几乎比一般人群高出20%。肥胖已经确定了死亡率和疾病后果，包括心脏病、糖尿病和睡眠呼吸暂停。司机的健康也是一个公共安全隐患，因为肥胖和睡眠呼吸暂停会增加致命车祸的风险。司机在健康方面遇到了多个障碍，包括允许长时间工作的法律，以及限制体力活动和饮食选择的孤立的工作结构。尽管健康危机日益严重，但卡车司机缺乏有效的减肥和健康促进干预措施。为了解决这一研究空白，我们开发了一种创新的干预措施，将卡车驾驶的工作结构和现代技术整合在一起。我们的方法使用移动计算技术在减肥比赛期间提供培训和反馈，并在手机上提供激励性采访。确定了干预的可行性和可接受性。在我们发表的前瞻性非对照试验(1)中，司机的行为发生了显著的变化，体重指数下降了1个单位(M=7.8磅[3.5公斤]，p=0.005，d=0.68)。这些结果比之前对卡车司机的研究中观察到的结果要好得多。这项建议的目的是将我们的干预效果与控制条件进行比较，并确定干预前的社会支持和压力是否适度的干预效果。我们的主要假设是，新的卡车司机减肥干预措施将比控制条件产生更大的变化。我们成功验证这一假设的能力得到了我们强大的初步数据、卡车运输人口经验以及参与研究的行业承诺的支持。我们的第二个假设是，干预前的社会支持和家庭和工作环境中的压力会缓和干预效果。这一假设是基于社会支持对压力水平、生活方式行为和减肥的积极影响，以及压力对体重管理的负面影响。为了验证我们的假设，我们设计了一项整群随机试验，将工作场所(终端)随机分配到干预和控制条件下。我们将在干预前(0个月)、干预后(6个月)和一年的随访(18个月)收集司机的测量数据。该项目将在五年内进行，并实现三个具体目标：(1)确定导致饮食、运动和体重变化的干预有效性；(2)确定干预前的社会支持和压力是否具有适度的干预有效性；以及(3)衡量每个干预组成部分的完整性和干预工作的模式。

DESCRIPTION (provided by applicant): Long-haul truck drivers have overweight and obesity rates almost 20% higher than the general population. Obesity has established mortality and disease consequences, including heart disease, diabetes, and sleep apnea. Driver health is also a public safety hazard because obesity and sleep apnea increase the risk of deadly crashes. Drivers experience multiple roadblocks to health, including laws permitting long work hours and an isolating job structure that restricts physical activity and dietary choices. Despite the growing health crisis, there is a lack of effective weight loss and health promotion interventions for truck drivers. To address this research gap we developed an innovative intervention that is integrated with the job structure and modern technologies of truck driving. Our approach uses mobile computing technologies to provide training and feedback during a weight loss competition, and delivers motivational interviewing on cell phones. Intervention feasibility and acceptability are established. In our published prospective uncontrolled trial (1) drivers made significant behavior changes and lost one unit of body mass index (M=7.8 lb [3.5 kg], p=.005, d=.68). These results are substantially better than those observed in prior studies of truck drivers. The goals of this proposal are to compare the efficacy of our intervention to a control condition, and to determine whether pre-intervention social support and stress moderate intervention efficacy. Our primary hypothesis is that the new weight loss intervention for truck drivers will produce greater change than a control condition. Our ability to successfully test this hypothesis is bolstered by our strong preliminary data, experience with the trucking population, and industry commitments to participate in the study. Our secondary hypothesis is that pre- intervention social support and stress in home and work environments will moderate intervention efficacy. This hypothesis is based on the positive effects of social support on stress levels, lifestyle behaviors, and weight loss, and on the negative effects of stress on body weight management. To test our hypotheses we have designed a cluster randomized trial where worksites (terminals) will be randomized to intervention and control conditions. We will collect measures from drivers at pre-intervention (month 0), post-intervention (month 6), and one-year follow-up (month 18). The project will take place over five years and accomplish three specific aims: (1) Determine intervention effectiveness for producing changes in diet, exercise, and body weight, (2) Determine whether pre-intervention social support and stress moderate intervention effectiveness, and (3) Measure the integrity of each intervention component and model how the intervention worked.