PROJECT SUMMARY/ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA- 24-032”. Overweight/obesity is strongly linked to mortality from multiple chronic diseases, including obesity- related cancers. For health disparity-facing populations, including racial/ethnic minority and/or low income individuals, who have both high prevalence of obesity and cancer, interventions promoting behavioral change for nutrition, physical activity, and weight are a national health priority. Social, physical, and neighborhood environments have long been implicated in the promotion of obesity-related behaviors and likely play a role in the efficacy of behavioral weight management interventions. Path to Health is a clinical trial (CA238335) to examine the efficacy of a weight management intervention among diverse residents living in urban public housing developments. We will test whether participants who receive community health worker behavioral counseling plus mobile health text messaging or mobile health text messaging only will outperform assessment only control in terms of weight loss at 12 months. For secondary outcomes, we will examine intervention effects on diet and physical activity behaviors. We will also examine moderating effects of participant characteristics and social contextual variables on the effect of the intervention. In the proposed administrative supplement connected to the scope of the parent R01 award, we will expand our moderation analysis to include a new social contextual variable, neighborhood crime rate, and examine whether it moderates the impact of the intervention on weight management, diet, and physical activity behaviors using both quantitative and qualitative methods. Specifically, we will characterize crime exposure using two data sources: crime incident data available from the Boston Police Department and service request data available from the City of Boston’s ‘311’ system and examine to what extent neighborhood crime rate moderates the effect of the intervention (Specific Aim 1); and using qualitative methods, assess how perceptions of crime experienced by Path to Health intervention trial participants impact weight management, diet, and physical activity behaviors (Specific Aim 2). Findings from this administrative supplement will enhance our understanding of variation in crime levels in communities lived in by underrepresented public housing residents and how this heterogeneity influences weight management, an important outcome linked to prevention of several obesity-related cancers.

PROJECT NARRATIVE This project will collect information about city crime levels and test whether or not crime levels have an impact on how well a weight management program works to help people lose weight. We will also conduct focus groups with residents of public housing developments who are part of a trial focused on weight management to explore how crime in their neighborhoods effects their ability to manage their weight, eat healthy, and be physically active.