Reducing Hypertension among African American Men: A Mobile Stress Management Intervention to Address Health Disparities

项目摘要/摘要 非裔美国男性患高血压(HTN)的比率是美国最高的。一旦确诊， 他们实现血压(BP)控制的可能性也较小。这种健康差距是至关重要的，就像血压升高一样 心血管疾病的主要可改变危险因素。HTN出现这种差异的一个原因是：压力。非洲 美国人报告的压力比他们的白人同龄人更大，最明显的是种族歧视，而他们的压力更少 管理这些压力源的资源。这种压力会产生重大的生理后果。与.相比 白人和非裔美国人表现出高度的非稳态负荷，这是对 慢性应激与HTN的病因有关。压力还会通过不健康的应对方式加剧HTN (例如，暴饮暴食、饮酒)和对降压药的依从性较差。 研究表明，压力管理(SM)干预提高了HTN。尽管如此，SM培训并不是 定期部署来管理BP，通常是因为医疗保健机构缺乏资源来提供它。一项成本-- 有效、易于扩展的解决方案是移动电话(即mHealth)。重要的是，98%的非裔美国人拥有 一部手机。大多数是智能手机(83%)。而短信干预已被证明可以改善 HTN管理生活方式的各种变化(例如，减少吸烟、加强体力活动)。 今天的市场上没有专门设计的移动认知行为SM干预(m-CBSMi 帮助非裔美国人管理种族和非种族的压力源，以努力减少HTN 差距。拟议中的干预将填补这一空白。使用经过验证的CBSMi技术，黑人将学习 如何通过短信和集成视频管理压力和降低血压。教育文本将 增加知识，发展技能，减少适应应对的障碍。支持性文本将促进 性别和民族自豪感。互动视频库将允许用户选择量身定做的培训和内容 基于他的个人需求和经验(例如，利用你自己选择的冒险风格)。所有视频都将 可以通过嵌入在文本消息中的链接进行访问，使您可以轻松查看它们。 在第一阶段，开发了m-CBSMI原型。这一发展是由形成性研究提供的。 与20名非洲裔美国人共度一生。第一阶段的结果有力地支持了这一计划的可行性和 干预措施的潜在有效性，远远超过第一阶段提案中确定的基准。 在第二阶段，非洲裔美国男性的m-CBSMi将全面发展。然后，与 家庭与医疗咨询服务：m-CBSMi对高血压患者降压效果的研究 非洲裔美国人将接受检查。参与者将被随机分配到干预措施中的任何一个 条件或匹配的对照条件。二次测量将评估主观压力，使用 抗高血压药物、应对、幸福感、性别种族认同和知识。

PROJECT SUMMARY/ABSTRACT African American men have the highest rate of hypertension (HTN) in the United States. Once diagnosed, they are also less likely to achieve blood pressure (BP) control. This health disparity is critical, as elevated BP is the primary modifiable risk factor for cardiovascular disease. One reason for this HTN disparity: stress. African Americans report more stress than their White peers, most notably from racial discrimination, and have fewer resources to manage these stressors. And this stress has significant physiological consequences. Compared to Whites, African Americans show heightened allostatic load, a biologic measure of the cumulative burden of chronic stress that is implicated in the etiology of HTN. Stress also exacerbates HTN through unhealthy coping (e.g., overeating, alcohol use) and poorer adherence to antihypertensive medications. Research shows that stress management (SM) interventions improve HTN. Despite this, SM training is not regularly deployed to manage BP, often because health care settings lack the resources to deliver it. One cost- effective, easily scalable solution is mobile phones (i.e., mHealth). Importantly, 98% of African Americans own a mobile phone. Most are smartphones (83%). And text messaging interventions have been shown to improve a variety of HTN management lifestyle changes (e.g., smoking reduction, physical activity enhancement). There is no mobile cognitive behavioral SM intervention (m-CBSMi) on the market today that is designed to help African American men manage racial and nonracial sources of stress in an effort to reduce HTN disparities. The proposed intervention will fill this void. Using proven CBSMi techniques, Black men will learn how to manage stress and reduce BP through text messages and integrated videos. Educational texts will increase knowledge, develop skills, and reduce barriers to adaptive coping. Supportive texts will promote gender and ethnic pride. A library of interactive videos will allow a user to choose tailored training and content based on his personal needs and experiences (e.g., utilizing a choose-your-own-adventure style). All videos will be accessible through links embedded within text messages, making it effortless to view them. In Phase I, a prototype m-CBSMI was developed. This development was informed by formative research with 20 African American men across the lifespan. The results of Phase I strongly support the feasibility and potential effectiveness of the intervention, far exceeding the benchmarks established in the Phase I proposal. During Phase II, the m-CBSMi for African American men will be fully developed. Then, in partnership with Family and Medical Counseling Service, the effectiveness of the m-CBSMi to reduce BP among hypertensive African American men will be examined. Participants will be randomly assigned to either the intervention condition or to a matched control condition. Secondary measures will assess subjective stress, use of antihypertensive medications, coping, well-being, gendered racial identity, and knowledge.