Making Healthy Habits Stick: Extended Contact Interventions to Promote Long Term Physical Activity in African American Cancer Survivors

癌症生存率的差异是持久和普遍的。肥胖，医学合并症，第二主要 癌症，生活质量差和身体功能受损，不成比例地影响非洲裔美国人 (AA)癌症幸存者有强有力的证据表明，体力活动（PA）有可能消除这些 差距。然而，PA不足在AA癌症幸存者中更为普遍，76%的人不符合PA 指南在癌症幸存者中长期增加PA的努力取得了一定的成功。现存 文献和我们自己在癌症幸存者中的初步数据表明，PA的采用通常伴随着 PA随时间的衰减。这些发现导致了最近的思想转变，特别是社会 认知理论构造（例如，自我效能），重要的PA采用发挥较小的作用，PA 上维护其他理论结构（即，习惯和身份）可能是必要的关键结构， 长期行为改变。可以想象，在促进PA维护方面缺乏成功也可能是由于 很少有研究考察健康行为改变干预措施在更广泛的社会背景下的效果。为 例如，对AA来说，歧视是健康的一个强有力的社会决定因素。歧视现象普遍存在（据报告 82%的AA乳腺癌幸存者），不成比例（AA更有可能报告与歧视有关的 压力（与其他种族和民族相比）和压力（压力，一般来说，阻碍PA）。尽管如此 根据证据，歧视对PA干预结果的影响尚不清楚。因此，为了提高PA 维护科学的重点是弱势群体，我们建议测试两个潜在的翻译 在260名身体健康的人中进行PA维护促进干预（短信服务[SMS]和同伴教练） 非活动性AA女性癌症幸存者使用严格的，随机2 × 2析因实验设计。 幸存者将完成为期3个月的PA采用阶段（即，基于有效理论的PA行为改变 在随机化至PA维持促进干预或常规护理之前，我们的6个月短信 和同伴教练PA维护促进干预措施将由多过程行动控制指导 （M-PAC）框架，包括在癌症幸存者中研究不足但假设 对PA维护很重要（例如，习惯，身份）。评估将在基线时进行（PA采用前），3 个月（PA采用后;随机化前即刻）、9个月和15个月。我们的具体目标 是：1）确定与常规护理相比，两种PA维持干预（SMS，同伴教练）对 PA维护（即，主要效应，并且如果其中一种干预效应在另一种干预效应存在的情况下不同）; 2） 确定基于理论的PA维持介质; 3）确定歧视是否会调节干预 对PA维护的影响。该项目将产生关于保护区机制的新知识 维护，并提供有关歧视对干预效果的影响的见解，从而导致更多的 有效的行为干预，将改善健康结果，减少健康差距。

Disparities in cancer survivorship are persistent and pervasive. Obesity, medical comorbidities, second primary cancers, poor quality of life and compromised physical functioning, disproportionately affect African American (AA) cancer survivors. There is strong evidence that physical activity (PA) has the potential to eliminate these disparities. Yet, insufficient PA is more prevalent among AA cancer survivors and 76% do not meet PA guidelines. Efforts to increase PA longer term in cancer survivors have been modestly successful. The extant literature and our own preliminary data in cancer survivors shows that PA adoption is often followed by an attenuation of PA over time. These findings have led to a recent shift in thinking, specifically that the social cognitive theory constructs (e.g., self-efficacy), important for PA adoption play less of a role in PA maintenance. Additional theoretical constructs (i.e., habit and identity) may be the key constructs necessary for long term behavior change. Conceivably, lack of success in promoting PA maintenance may also be due to few studies examining how well health behavior change interventions work in the broader societal context. For example, for AAs, discrimination is a potent social determinant of health. Discrimination is prevalent (reported by 82% of AA breast cancer survivors), disproportionate (AAs are more likely to report discrimination-related stress compared to other racial and ethnic groups), and stressful (stress, in general, impedes PA). Despite this evidence, the effect of discrimination on PA intervention outcomes is unknown. Thus, to advance PA maintenance science with a focus on a vulnerable population, we propose testing two potentially translatable PA maintenance promotion interventions (Short Message Service [SMS] and peer coach) in 260 physically inactive AA women cancer survivors using a rigorous, randomized 2 x 2 factorial experimental design. Survivors will complete a 3-month PA adoption phase (i.e., efficacious theory-based PA behavior change program) prior to randomization to a PA maintenance promotion intervention or usual care. Our 6-month SMS and peer coach PA maintenance promotion interventions will be guided by the Multi-Process Action Control (M-PAC) framework which includes constructs which are understudied in cancer survivors yet hypothesized to be important for PA maintenance (e.g., habit, identity). Assessments will occur at baseline (pre-PA adoption), 3 months (post-PA adoption; immediately prior to randomization), 9 months, and 15 months. Our specific aims are: 1) Determine effects of both PA maintenance interventions (SMS, peer coach) compared to usual care on PA maintenance (i.e., main effects and if either intervention effects differ in the presence of the other); 2) Identify theory-based mediators of PA maintenance; and 3) Determine if discrimination moderates intervention effects on PA maintenance. The project will generate new knowledge about the mechanisms underlying PA maintenance and provide insight about the impact of discrimination on intervention effects thus leading to more effective behavioral interventions that will improve health outcomes and reduce health disparities.