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Principal Investigator: Erik D Hanson
Organization: UNIV OF NORTH CAROLINA CHAPEL HILL
Fiscal Year: 2024
Award: $513,784
Funding agency: National Heart Lung and Blood Institute
ABSTRACT
Among young adults (18-24 years), a concerning 10-20% develop advanced but asymptomatic atherosclerotic
lesions, yet cardiometabolic disease (CMD) prevention is understudied. In the U.S. two-thirds of young adults
attend college, during which they adopt poor lifestyle behaviors that contribute to CMD risk. For example,
college-based young adults (CBYA) engage in sedentary behavior (SB), defined as very low intensity
behaviors in a seated, reclined, or supine postures, for ~7 hr/day. National and international public health
agencies have recently called on the research community to better understand how to implement SB-reduction
strategies. However, while CBYA present a captive but understudied population, we have scant understanding
as to how to target this multi-dimensional behavior. Our long-term goal is the primary prevention of CMD in
CBYA. To support this goal, the overarching aim of this proposal is to develop an evidence-based,
multi-level intervention to target SB reduction. This longitudinal observational study will recruit a cohort of
500 CBYA (18-24 years) from a representative state college population. On each of the two visits (12 months
apart) we will measure traditional and novel CMD risk biomarkers and administer participant questionnaires to
collect information on lifestyle behaviors (diet, chronotype, substance use) and socio-ecological (individual,
intra-individual, inter-individual) predictors of SB. Over the next 7 days, SB quantity will be captured using a
thigh-worn inclinometer, and physical activity and sleep behaviors using accelerometry. SB context (television,
transportation, academic/occupational, leisure computer, other) will be measured using ecological momentary
analysis. Aim 1 will identify whether total SB (T-SB) or context-specific SB (CS-SB) is more strongly
associated with CMD risk. The degree to which SB confers CMD risk likely depends on the context in which it
occurs. For example, in the general adult population, television viewing is more strongly associated with CMD
than other CS-SB. The reasons are unknown but may include the greater likelihood of co-occurring unhealthy
behaviors (e.g., processed foods) while watching television. Therefore, Aim 2 will identify how much CMD risk
is explained directly by SB, versus indirectly mediated by co-occurring lifestyle behaviors. Aim 3 will then
identify multi-level intervention targets. To date, the existing longitudinal research has predominantly focused
on non-modifiable socio-demographic variables. We will use a socioecological model to identify modifiable
predictors. Last, will use the Intervention Mapping protocol to design an intervention implementation and
evaluation plan. This innovative proposal will enhance our understanding of the importance of CS-SB and co-
occurring behaviors to CMD risk. The final product will be an evidence-based CS-SB reduction intervention to
target primary CMD prevention in CBYA. The likelihood of future high impact is enhanced by: college
campuses are relatively contained are well-suited to multi-level interventions; behaviors adopted during college
track into older adulthood; and our experienced multi-disciplinary team.
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