A Mixed Methods Approach for Developing Culturally and Ecologically Appropriate Interventions for Improving Sleep Health in a Community-Based Sample of African Americans

项目摘要（摘要） 高血压和不受控制的血压（BP）是一个重大的公共卫生负担;因此， 重要的是改善可改变的风险因素，如睡眠健康，以减少社会 负担，特别是在健康状况不同的人群中。本K 01的目标是利用混合方法 设计一项试点研究的方法，旨在改善环境压力背景下的睡眠， 长期目标是改善长期患有糖尿病的非裔美国人（AAs）的BP控制和整体健康状况。 睡眠不好，高血压（HTN）和HTN相关的合并症和死亡率的高风险。我 建议：1）测试环境（家庭内部和 社区）和社会压力（即歧视）与城市AA人群的睡眠模式; 2） 进行定性研究，为制定量身定制的干预措施提供信息，以改善相互关联的 AAs中的健康睡眠和BP控制问题，特别是为了加强对几个主题的理解 包括改善睡眠的障碍和机会以及相关的心血管风险因素;以及3）使用 混合方法研究的数据，以在社区环境中开发和试点为期12周的可行性试验 主要目的是改善睡眠，作为改善血压控制和其他健康的策略。 结果。为了实现这些研究目标，我将利用NIH和EPA资助的基础设施， 研究中心的环境和社会压力在住房的整个生命过程（CRESSH）共同- 由本提案的主要导师指导。CRESSH有两个项目将被利用：1）主页- 在马萨诸塞州波士顿市对多种族混合收入人群进行的基于观察和监测的暴露研究; （2）环境健康差异的空间格局制图研究。我将利用现有的数据， CRESSH（7天的真实的时间监测环境应激源（噪音、温度、NO2、PM2.5、超细 颗粒，通风）和社会压力），并前瞻性地收集从 CRESSH和相同的社区作为CRESSH参与者。我建议进行：a）7天腕关节活动记录 表征睡眠/觉醒时间、睡眠时间和睡眠质量; B）深入焦点小组以识别障碍 以及改善睡眠的机会;以及c）完成家庭环境审计，以描述 和社会环境。这个职业发展奖的总体目标是发展一个独立的 研究计划旨在了解睡眠健康差异的根本原因及其对健康的影响。 心血管结局，包括HTN，以及设计文化和环境适当的 干预措施。通过混合方法的研究和新培训， 干预措施和环境和心血管流行病学，这个奖项将促进我过渡到一个 睡眠流行病学和心血管健康差异领域的独立调查员， 我的研究将成为公共卫生干预和政策的杠杆。

Project Summary (Abstract) High and uncontrolled blood pressure (BP) is a significant public health burden; therefore it is important to improve modifiable risk factors such as sleep health in efforts to reduce the societal burden, particularly among health disparate populations. The goal of this K01 is to utilize a mixed methods approach to design a pilot study aimed at improving sleep in the context of environmental stressors, with a long term aim of improving BP control and overall health of African Americans (AAs) who chronically suffer from poor sleep and are at high risk for hypertension (HTN) and HTN-associated comorbidities and mortality. I propose to: 1) Test independent and interactive associations between environmental (within the home and neighborhood) and social stressors (i.e. discrimination) with sleep patterns in an urban AA population; 2) Conduct qualitative research to inform the development of tailored interventions for improving the inter-related problems of healthy sleep and BP control in AAs, particularly to enhance understanding of several topics including the barriers and opportunities to improve sleep and related cardiovascular risk factors; and 3) Use data from the mixed methods research to develop and pilot a 12-week feasibility trial in a community setting with the primary objective to improve sleep as a strategy to improve BP control as well as other health outcomes. To address these research aims, I will leverage the infrastructure of the NIH and EPA funded Center for Research on Environmental and Social Stressors in Housing across the Life Course (CRESSH) co- directed by the primary mentor of this proposal. CRESSH has two projects that will be leveraged: 1) Home- based Observation and Monitoring Exposure study of a multiethnic mixed income population in Boston, MA; and 2) the Mapping Spatial Patterns in Environmental Health Disparities study. I will utilize existing data from CRESSH (7 days of real time monitored environmental stressors (noise, temperature, NO2, PM2.5, ultrafine particles, ventilation) and social stressors) as well as prospectively collect new data among AAs sampled from CRESSH and the same communities as CRESSH participants. I propose to conduct: a) 7-day wrist actigraphy to characterize sleep/wake times, sleep timing and quality of sleep; b) in-depth focus groups to identify barriers and opportunities for improving sleep; and c) complete a home environmental audit to characterize the physical and social environment. The overall goal of this career development award is to develop an independent research program aimed at understanding the root causes of sleep health disparities and their impact on cardiovascular outcomes including HTN, and designing culturally and environmentally appropriate interventions. Through research and new training in mixed methods, community-based/behavioral interventions and environmental and cardiovascular epidemiology, this award will facilitate my transition to an independent investigator in the field of sleep epidemiology and cardiovascular health disparities and will allow my research to serve as a lever for public health interventions and policy.