SUMMARY Physical activity (PA) is a cornerstone for enhancing overall health, reducing the risk of chronic diseases, and improving the quality of life for individuals of all ages. Despite the health benefits of PA, only 23% of adults in the United States meet the recommended guidelines for both aerobic and muscle-strengthening activities. Recommended PA levels are not equally distributed across Americans; there are disparities in PA levels among different racial and ethnic groups. Socioeconomic barriers, environmental factors, and systemic racism contribute to lower levels of PA in minoritized communities. Dr. Brennan Rhodes-Bratton aims to become an independent health equity researcher with expertise in chronic disease prevention through rigorous mixed- methods. She seeks to investigate the interplay of structural, environmental, and behavioral determinants of chronic disease using a theory-driven approach to learn how to best support PA improvement by incorporating gentrification and health habitus as central to discovering solutions to the PA health disparities. Aligning with the purpose of PA-21-071, this diversity supplement extends the research from the parent award, Community Walks Clinical Trial, to specifically explore the sustainability of a multi-level PA intervention among residents of public housing developments. The diversity supplement aims to estimate the confounding and potential moderating effects of gentrification and health habitus on moderate-intensity physical activity among participants across all four arms of the Community Walks intervention trial. This supplement will evaluate publicly available neighborhood-level gentrification indicators, individual-level psychosocial factors, and health behaviors that act as a proxy for gentrification and health habitus from the Community Walks baseline, 12- month, and 24-month follow-up surveys. Countless studies have sought to improve physical activity in sedentary populations by focusing on individual factors like motivation, attitudes, and self-efficacy. However, the improvements in activity levels achieved by these interventions often do not persist beyond the initial intervention period. One potential reason for this lack of sustainability is the need for more consideration of environmental factors that promote physical activity. Consequently, there is a growing emphasis on the complex interplay of environmental and social factors that influence physical activity to develop multi-level strategies to better tailor interventions. Both the parent grant and this diversity supplement emphasize the importance of the interplay between structural, environmental, and behavioral determinants of health by developing a multi-level intervention (parent grant) and centering the social process of gentrification and the theoretical construct of health habitus in the study design (supplement). Our analysis will determine whether gentrification and health habitus have moderation effects on the four intervention arms of the Community Walks clinical trial. This supplement will set up the candidate for success as an independent health equity researcher with expertise in mixed-method study design and chronic disease prevention.

PROJECT NARRATIVE The proposed “Research Supplement to Promote Diversity in Health-Related Research” builds on the parent grant (R01-MD015165: Multilevel Physical Activity Intervention for Low Income Public Housing Residents) to test a multi-level intervention aimed at increasing physical activity among public housing residents. This supplement will support the career goals of Dr. Brennan Rhodes-Bratton, a social epidemiologist focused on chronic disease prevention in minoritized communities. Using data from the Community Walks clinical trial, Dr. Rhodes-Bratton aims to examine the impact of gentrification and health habitus on moderate-intensity physical activity among public housing residents in Boston, Massachusetts, employing an explanatory sequential design with semi-structured interviews to interpret quantitative data findings; results will be used to determine strategies for improving chronic disease prevention interventions among minoritized groups.