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

养成健康习惯：延长接触干预措施以促进非裔美国癌症幸存者的长期身体活动

• 批准号: 10821052
• 负责人: MICHELLE Y MARTIN
• 金额: $ 67.41万
• 依托单位: UNIVERSITY OF TENNESSEE HEALTH SCI CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-21 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10821052
• 关键词: Accelerometer; Address; Adherence; Adopted; Adoption; Affect; African American; Attention; Attenuated; Behavior; Behavior Therapy; Behavioral; Breast Cancer survivor; Cancer Survivor; Cancer Survivorship; Clinical Trials; Complex; Data; Discrimination; Disparity; Effectiveness; Emotional; Ethnic Population; Evaluation; Exercise; Experimental Designs; Guidelines; Habits; Health; Health Benefit; Health behavior; Health behavior change; Individual; Intervention; Knowledge; Literature; Maintenance; Mediating; Mediator; Medical; Modeling; Monitor; Obesity; Outcome; Participant; Phase; Physical Function; Physical activity; Physical assessment; Play; Population; Process; Public Health; Quality of life; Randomized; Reduce health disparities; Regulation; Reporting; Research; Research Design; Role; Science; Second Primary Cancers; Self Efficacy; Source; Stress; Survivors; System; Testing; Text Messaging; Thinking; Time; United States; Vulnerable Populations; Woman; Work; Writing; active lifestyle; attenuation; behavior change; biological adaptation to stress; cancer health disparity; comorbidity; comparison intervention; disability; disparity elimination; exercise intervention; exercise program; experience; experimental study; health disparity; improved; insight; intervention delivery; intervention effect; moderate-to-vigorous physical activity; novel; obesity risk; outcome disparities; peer coaching; perceived discrimination; physical inactivity; poor health outcome; primary outcome; programs; racial population; response; service intervention; social cognitive theory; social health determinants; success; theories; therapy design; treatment as usual

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.

癌症生存的差异是持久而普遍的。肥胖，医学合并症，第二个初级 癌症，生活质量差和身体机能差，对非裔美国人的影响不成比例 （AA）癌症幸存者。有强有力的证据表明，体育锻炼（PA）有可能消除这些 差异。但是，在AA癌症幸存者中，PA不足更为普遍，而76％的PA不符合PA 指南。在癌症幸存者中长期增加PA的努力取得了适度的成功。现存 文学和我们自己在癌症幸存者中的初步数据表明，PA采用通常是随后的 随着时间的流逝，PA的衰减。这些发现导致了最近的思维转变，特别是社会 认知理论的构建（例如自我效能感），对PA采用的重要性很重要 维护。其他理论结构（即习惯和身份）可能是必要的关键构造 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 很少有研究研究健康行为改变干预措施在更广泛的社会背景下的工作状况。为了 例如，对于AAS，歧视是健康的有效社会决定因素。歧视很普遍（报告 在82％的AA乳腺癌幸存者中），不成比例（AA更有可能报告与歧视有关 与其他种族和种族相比，压力和压力很大（通常压力会阻碍PA）。尽管如此 证据，歧视对PA干预结果的影响尚不清楚。因此，促进PA 维护科学以关注脆弱人群的关注，我们建议测试两个可能翻译的 PA维护促进干预措施（短消息服务[SMS]和同伴教练）在260个身体上 使用严格的，随机的2 x 2阶乘实验设计的无效AA女性癌症幸存者。 幸存者将完成3个月的PA采用阶段（即基于理论的PA行为改变 程序）在随机进行PA维护促进干预或通常的护理之前。我们6个月的短信 和同伴PA维护促进干预措施将由多进程的动作控制指导 （M-PAC）框架，其中包括在癌症幸存者中研究的结构，但假设 对于维持PA（例如，习惯，身份）很重要。评估将在基线时进行（PEA PEA采用），第3款 月（PA后采用；在随机分组之前），9个月和15个月。我们的具体目标 是：1）与通常的护理相比，确定两种PA维护干预措施（SMS，同伴教练）的影响 PA维持（即主要影响以及两者的干预效应在其他情况下的效果有所不同）； 2） 确定基于理论的PA维护的调解人； 3）确定歧视是否适中干预 对PA维护的影响。该项目将产生有关PA基础机制的新知识 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 有效的行为干预措施将改善健康结果并减少健康差异。