Research Project #2

癌症诊断后的生活质量问题和功能缺陷对于低社会经济地位(SES)和少数癌症幸存者来说尤其严重。体力活动已被证明可以补救幸存者所经历的许多问题，并已被证明可以减少疲劳和心理痛苦，改善身体功能和生活质量。观察数据表明，身体活动较多的幸存者与癌症相关的死亡率较低。然而，大多数癌症幸存者没有达到推荐的运动量，人们对如何在持续贫困地区增加癌症幸存者的体力活动知之甚少。在持续贫困的社区中存在相当大的体育活动障碍，例如缺乏休闲体育活动的设施，人行道和公园很少/质量差，以及对社区安全的担忧。癌症后积极生活(ALAC)是一项基于证据的体力活动计划，适合少数族裔和医疗服务不足的幸存者，向参与者传授行为和认知技能，以增加体力活动。然而，它主要关注的是个人行为的改变。拟议的项目将把社区层面的干预措施纳入ALAC计划，然后在德克萨斯州休斯敦一个历史上黑人、长期贫困的社区英亩之家实施。我们建议利用Be Well Acres Home，一个以地方为基础的癌症预防倡议，利用健康促进交织来开发多层次的干预。在Be Well Acres之家开发的社区资源和计划将使参与者能够连接/导航到资源，因为参与者发展了增加体力活动的技能，并将在参与ALAC计划完成后促进可持续的社区支持。ALAC的适应将把干预措施与信息环境(通过加强沟通战略以招募潜在参与者并接触到Be Well Acres社区提供的癌症预防教育信息)、社会/文化/组织环境(在单个社区创建癌症幸存者网络，将幸存者与其他团体/项目，例如散步俱乐部、健身课程、社区花园联系起来)以及Acres社区的物理环境(将幸存者与环境支持活动联系起来，例如公园改善)交织在一起。使用等待名单对照设计，我们将评估适应的ALAC干预对癌症幸存者的身体功能和生活质量的影响。此外，使用基于RE-AIM框架的成果衡量标准，我们将评估ALAC计划的影响范围、有效性和实施情况，并调查计划有效性和参与度的贫困相关主持人，以确定持续贫困社区幸存者所需的进一步计划调整。

Quality of life problems and functional deficits after cancer diagnosis are particularly acute for low socioeconomic status (SES) and minority cancer survivors. Physical activity has been shown to remediate many problems experienced by survivors and has been shown to reduce fatigue and psychological distress and improve physical functioning and quality of life. Observational data indicate that survivors who are more physically active have lower cancer-related mortality. Yet most cancer survivors do not exercise at recommended levels, and little is known about how to increase physical activity among cancer survivors in persistent poverty areas. Considerable physical activity barriers exist in persistent poverty neighborhoods, such as lack of facilities for leisure-time physical activity, few/poor quality sidewalks and parks, and concerns about neighborhood safety. Active Living After Cancer (ALAC) is an evidence-based physical activity program, adapted for minority and medically underserved survivors, that teaches participants behavioral and cognitive skills to increase physical activity. However, it is focused primarily on individual behavior change. The proposed project will incorporate community-level interventions into the ALAC program before implementing it in Acres Homes, a historically Black, persistent poverty community in Houston, Texas. We propose to leverage Be Well Acres Homes, a place-based cancer prevention initiative, to develop a multi-level intervention using health promotion interweaving. The community resources and programs developed in Be Well Acres Homes will enable connection/navigation to resources as participants develop the skills for increasing their physical activity and will foster sustainable community supports beyond the completion of participation in the ALAC program. The adaptations in ALAC will interweave the intervention with the informational environment (through enhanced communication strategies to recruit potential participants and exposure to cancer prevention educational messages provided by Be Well Acres Homes), social/cultural/organizational environment (creating a network of cancer survivors in a single neighborhood, connecting survivors with other groups/programs, e.g., walking clubs, fitness classes, community gardens), and the physical environment (connecting survivors with environmental supports for activity, e.g., park improvements) of the Acres Homes community. Using a wait-list control design we will evaluate the effect of the adapted ALAC intervention on cancer survivors’ physical functioning, quality of life. Additionally, using outcome measures based on the RE-AIM framework we will evaluate the reach, effectiveness, and implementation of the ALAC program and investigate poverty-related moderators of program effectiveness and engagement to identify further program adaptations needed for survivors in persistent poverty communities.