Center to Improve Chronic disease Outcomes through Multi-level and Multi-generational approaches Unifying Novel Interventions and Training for health EquitY (The COMMUNITY Center)

项目摘要/摘要： 通过情境行为干预改善心脏代谢健康的多个领域 有可能大幅减少长期存在的慢性病差距。睡眠是保持CMH的关键 而且在现实世界的环境中是可以接受干预的。虽然睡眠健康，与其他生活方式相结合 行为，可以通过互补或协同途径改善CMH，大多数现有的生活方式改变 这些计划只关注饮食和体力活动。我们将进行以社区为基础的整群随机试验 评估将多维睡眠健康干预纳入BWELL4LIFE的影响 计划，这是一个通过健康饮食和体力活动促进CMH的持续4周计划，已交付 在服务不足的纽约市，由信仰组织和社区中心的同行健康教育者 社区(目标1)。为期6周的强化干预措施SLEEP2BWELL将包括以下额外内容 内容：1)两次睡眠健康教育和小组辅导；2)自我监控和激励 使用Fitbit增强功能，以及3)解决城市环境中普遍存在的健康睡眠环境障碍 例如噪音、光线、热浪，并根据输入及时扩展以解决室内空气污染问题 来自我们的社区合作伙伴。我们将随机将14个社区站点纳入干预(SLEEP2BWELL)或 日常护理(BWELL4LIFE)组，每个地点平均招募15名参与者，预期样本为210人。 我们将在整个研究过程中收集客观的睡眠和体力活动指标，并评估饮食和CMH 基线、10周(主要终点)和24周(长期随访以评估可持续性)的结果 干预的效果)。我们假设SLEEP2BWELL将增强BWELL4LIFE的有效性 导致CMH的更大改善，包括降低血压(主要结果)改善健康 行为(睡眠、饮食、体力活动)和肥胖标记物(次要结果)以及更好的血糖 控制、炎症和不平衡负荷指标(探索性结果)。以确保成功 这项工作的完成和未来的扩展，我们将用混合的方法来理解实施 决定因素和结果，以执行科学框架为指导(目标2)。这是史无前例的 有效性-实施研究，解决个人层面的行为和因素以及上游影响 并利用关键的行为变化和社区参与战略，将调查 将睡眠健康纳入多行为生活方式改变干预措施，旨在解决 社区设置。我们创新的多层次干预将为可扩展的可持续社区健康提供信息 方法和公共卫生政策，与NIH改善睡眠健康和CMH差异的优先事项一致 通过在新的多层次捆绑行为干预方面的进步。

PROJECT SUMMARY/ABSTRACT: Improving multiple domains of cardiometabolic health (CMH) through contextual behavioral interventions has the potential to substantially reduce persistent chronic disease disparities. Sleep is critical for preserving CMH and is amenable to intervention in real-world settings. Although sleep health, in conjunction with other lifestyle behaviors, can improve CMH through complementary or synergistic pathways, most existing lifestyle change programs focus solely on diet and physical activity. We will conduct a community-based cluster randomized trial to evaluate the impact of incorporating a multidimensional sleep health intervention into the BWELL4LIFE program, an ongoing 4-week program for promoting CMH through healthy diet and physical activity, delivered by peer health educators at faith-based organizations and community centers in underserved NYC neighborhoods (Aim 1). The enhanced 6-week intervention, SLEEP2BWELL, will include the following additional components: 1) two sleep health education and group coaching sessions, 2) self-monitoring and motivational enhancement using a Fitbit, and 3) addressing prevalent environmental barriers to healthy sleep in urban settings such as noise, light, heatwaves, with a novel and timely extension to address indoor air pollution based on input from our community partners. We will randomize 14 community sites into the intervention (SLEEP2BWELL) or usual care (BWELL4LIFE) group, enrolling an average of 15 participants per site for an expected sample of 210. We will collect objective measures of sleep and physical activity throughout the study, and assess diet and CMH outcomes at baseline, 10 weeks (primary endpoint), and 24 weeks (long-term follow-up to assess sustainability of the intervention’s effect). We hypothesize that SLEEP2BWELL will enhance the effectiveness of BWELL4LIFE leading to greater improvements in CMH, including reduced blood pressure (primary outcome) improved health behaviors (sleep, diet, physical activity) and adiposity markers (secondary outcomes), as well as better glycemic control and inflammatory and allostatic load indicators (exploratory outcomes). To ensure the successful completion and future expansion of this work, we will use mixed methods to understand implementation determinants and outcomes, guided by implementation science frameworks (Aim 2). This first-of-its-kind effectiveness-implementation study, addressing individual level behaviors and factors and upstream influences and leveraging key behavior change and community engagement strategies, will investigate the integration of sleep health into a multi-behavior lifestyle change intervention aimed at addressing CMH disparities in community settings. Our innovative multilevel intervention will inform scalable sustainable community health approaches and public health policy, consistent with NIH’s priorities to improve sleep health and CMH disparities through advancement in novel multilevel bundled behavioral interventions.