PROJECT SUMMARY/ABSTRACT: Improving multiple domains of cardiometabolic health (CMH) through contextual behavioral interventions has the potential to substantially reduce persistent chronic disease disparities. Sleep is critical for preserving CMH and is amenable to intervention in real-world settings. Although sleep health, in conjunction with other lifestyle behaviors, can improve CMH through complementary or synergistic pathways, most existing lifestyle change programs focus solely on diet and physical activity. We will conduct a community-based cluster randomized trial to evaluate the impact of incorporating a multidimensional sleep health intervention into the BWELL4LIFE program, an ongoing 4-week program for promoting CMH through healthy diet and physical activity, delivered by peer health educators at faith-based organizations and community centers in underserved NYC neighborhoods (Aim 1). The enhanced 6-week intervention, SLEEP2BWELL, will include the following additional components: 1) two sleep health education and group coaching sessions, 2) self-monitoring and motivational enhancement using a Fitbit, and 3) addressing prevalent environmental barriers to healthy sleep in urban settings such as noise, light, heatwaves, with a novel and timely extension to address indoor air pollution based on input from our community partners. We will randomize 14 community sites into the intervention (SLEEP2BWELL) or usual care (BWELL4LIFE) group, enrolling an average of 15 participants per site for an expected sample of 210. We will collect objective measures of sleep and physical activity throughout the study, and assess diet and CMH outcomes at baseline, 10 weeks (primary endpoint), and 24 weeks (long-term follow-up to assess sustainability of the intervention’s effect). We hypothesize that SLEEP2BWELL will enhance the effectiveness of BWELL4LIFE leading to greater improvements in CMH, including reduced blood pressure (primary outcome) improved health behaviors (sleep, diet, physical activity) and adiposity markers (secondary outcomes), as well as better glycemic control and inflammatory and allostatic load indicators (exploratory outcomes). To ensure the successful completion and future expansion of this work, we will use mixed methods to understand implementation determinants and outcomes, guided by implementation science frameworks (Aim 2). This first-of-its-kind effectiveness-implementation study, addressing individual level behaviors and factors and upstream influences and leveraging key behavior change and community engagement strategies, will investigate the integration of sleep health into a multi-behavior lifestyle change intervention aimed at addressing CMH disparities in community settings. Our innovative multilevel intervention will inform scalable sustainable community health approaches and public health policy, consistent with NIH’s priorities to improve sleep health and CMH disparities through advancement in novel multilevel bundled behavioral interventions.

NARRATIVE: The goal of this project is to reduce the burden of multiple chronic conditions by improving cardiometabolic health in economically disadvantaged New York City neighborhoods of predominantly Black, Hispanic, and immigrant communities with a high prevalence of hypertension, obesity, and type 2 diabetes and an increasing co- occurrence of multiple morbidities. The SLEEP2BWELL cluster randomized trial will employ a blended effectiveness-implementation design to evaluate the impact and implementation of a multicomponent and multilevel lifestyle intervention, targeting sleep health in addition to healthy diet and physical activity and addressing upstream barriers, on cardiometabolic health. Findings can offer broad implications for reshaping ongoing lifestyle programs and public health policy and informing scalable and sustainable community and system-level changes for addressing persistent cardiometabolic health inequities.