Local food sources around home and school and adolescent dietary intake

 描述(由申请人提供)：这份职业发展提案将为一位有前途的早期职业研究员肖恩·C·卢肯博士提供成为一名独立调查员所需的额外知识、工具和技能。卢肯博士感兴趣的是当地的食物环境如何影响青少年的饮食以及与饮食相关的健康。卢肯博士将参加各种培训活动，并将所学知识直接应用于一个创新的以患者为中心的研究项目。该项目将把青少年患者的饮食数据与该地区的食物来源数据联系起来 他们居住和上学的周围地区。拟议的培训和研究将促进从监督研究向独立调查的过渡，最终提交R01申请，解决过渡到成年的年轻人的偶发性肥胖和糖尿病等问题。卢肯博士和一组忠心耿耿的导师和顾问设计了一个研究和培训计划，以解决现有科学文献和卢肯博士自己的技能组合中的局限性。关于现有的科学文献，研究表明，青少年家庭和学校周围的地区--尤其是在低收入和少数族裔社区--往往主要提供快餐、加工食品和其他不太健康的便利食品，几乎没有健康的替代品；这些环境通常与较差的饮食和较差的健康状况有关。然而，许多研究表明，这种联系在几个重要方面都受到了限制。因此，目前尚不清楚如何干预以改变环境，使青少年更容易选择(或根本不选择)更健康的饮食，而更难(或不是唯一的选择)不健康的饮食。拟议的项目将建立在先前工作的基础上，并在几个重要方面具有创新性。它将依靠青少年研究助理和地理信息科学(GISC)来直接评估青少年学校和家庭步行距离内的各种食物来源。这项研究将评估青少年患者食物来源和饮食摄入量之间的联系，利用一个独特的健康系统数据集：包含临床和调查数据的电子医疗记录(EMR)。具体目标是：目标1.对当地食物来源进行全面评估：青少年将评估他们在家中和学校周围接触到的各种食物来源的地点和食物供应。目的2.生成一个新的集成的多层次数据库。卢肯博士将把食物来源数据(来自目标1)与其他当地数据以及青少年个体患者数据(来自医疗系统EMR)合并目标3.评估当地食物来源与青少年饮食摄入量之间的关系。卢肯博士将使用数据库(来自Aim 2)，评估青少年家庭和学校周围的食物来源与他们报告的膳食摄入量(例如，水果、蔬菜和 含糖饮料摄入量)。这项K23工作中的分析将是横断面的，但方法、数据库和培训将直接为纵向研究奠定基础(例如，当地食物环境的变化与饮食相关健康结果的变化，如偶发肥胖、糖尿病、血脂异常和高血压--所有这些都可能通过EMR中提供的临床数据来实现)。纵向研究将为干预试验提供信息，Lucan博士可以将其作为R01申请提交，以告知政策变化和改善食品环境、饮食和健康。至于卢肯博士目前的技能，他已经确定了课程作业和指导研究(GISC)的一个主要重点领域和三个支持领域(加密数据管理、统计分析以及行为和社会科学)，他将需要这些领域进行将推动该领域和他的职业生涯向前发展的研究类型。卢肯博士将报名参加 参加GISC的正式证书课程，并参加安全数据处理、多层建模、行为和社会科学理论方面的课程。这些学习活动，以及专家导师指导下的研究，将在拟议的研究中得到实际应用：GISC定义对当地食物来源的‘暴露’，数据管理连接不同的数据集，行为和社会科学理论为多水平分析提供信息，回归建模和GISC分析关联。研究和培训活动将培养出一名自信的、以患者为导向的研究人员，他们具有进行涉及敏感、多层次、多样化的空间数据的研究的技能。培训将在一流的研究和学习环境中进行。该机构和部门在NIH的资助方面都很高，而且有特殊的资源、设施、人员、合作伙伴关系和专业知识来支持Lucan博士的项目和培训需求。在以患者为中心的研究方面有多层次GISC考虑的经验，在行为和社会科学、营养研究和涉及青少年的研究方面有丰富的专业知识。资深督导教师与NICHD有着广泛的历史和历史联系。拟议的工作将为卢肯博士提供培训和实际经验，以支持他作为一名独立调查员的职业生涯。

 DESCRIPTION (provided by applicant): This career development proposal will provide a promising early-career researcher, Dr. Sean C. Lucan, with the additional knowledge, tools, and skills needed to become an independent investigator. Dr. Lucan's interest is in how local food environments influence adolescent diet and diet-related health. Dr. Lucan will participate in a variety of training activities and apply lessons directly to an innovative patient-oriented researc project. The project will link dietary data from adolescent patients to data on food sources in the areas around which they live and attend school. The proposed training and research will facilitate transition from supervised study to independent investigation, culminating in the submission of R01 applications that address problems like incident obesity and diabetes for young people transitioning to adulthood. Dr. Lucan and a team of committed mentors and advisers designed a research-and-training plan to address limitations in both the existing scientific literature and in Dr. Lucan's own skill set. Regarding the existing scientific literatur, research suggests that areas around adolescents' homes and schools-most notably in low-income and minority communities-tend to offer predominantly fast foods, processed foods, and other less-healthy convenience items, with few healthy alternatives; such environments are generally associated with poorer diets and poorer health. However, many studies suggesting associations have been limited in several important ways. As a result, it is not clear how to intervene to change environments to make healthier eating an easier option (or an option at all) and unhealthy eating more difficult (or not the only option) for adolescents. The proposed project will build on prior work and be innovative in several important ways. It will rely on adolescent research assistants and geographic information science (GISc) to directly assess a full range of food sources within walking distance of adolescents' schools and homes. The research will assess links between food sources and dietary intake for adolescent patients, capitalizing on a unique health-system dataset: an electronic medical record (EMR) that contains both clinical and survey data. The specific aims are: Aim 1. To conduct a comprehensive assessment of local food sources: Adolescents will assess locations and food offerings for a full range of food sources to which they are exposed around their homes and schools. Aim 2. To generate a novel integrated multi-level database. Dr. Lucan will merge food-source data (from Aim 1) with other local data and with data on individual adolescent patients (from the health-system EMR) Aim 3. To assess how local food sources relate to adolescents' dietary intake. Dr. Lucan will use the database (from Aim 2), to assess how food sources around adolescents' homes and schools relate to their reported dietary intake (e.g., fruit, vegetable, and sugary-drink consumption). Analyses in this K23 work will be cross-sectional but the methods, database, and training will directly lay the foundation for longitudinal study (e.g., how changes i local food environments relate to changes in diet-related health outcomes like incident obesity, diabetes, dyslipidemia, and hypertension-all possible through the clinical data available in the EMR). Longitudinal studies will inform intervention trials that Dr. Lucan can submit as R01 applications towards informing policy changes and improving food environments, diet, and health. Regarding Dr. Lucan's own current skill set, he has identified one major areas of focus for coursework and mentored study (GISc) and three supporting areas (encrypted data management, statistical analyses, and behavioral and social science) that he will need to conduct the type of research that will move the field and his career forward. Dr. Lucan will enroll in a formal certificate program in GISc, and take courses in secure-data handling, multilevel modeling, behavioral and social-science theory. These learning activities, along with mentored study under expert mentors, will find practical application in the proposed research: GISc to define 'exposures' to local food sources, data management to link diverse datasets, behavioral and social-science theory to inform multilevel analyses, and regression modeling and GISc to analyze associations. The research and training activities will produce a confident patient-oriented researcher with the skills to conduct studies involving sensitive, multilevel, diverse, spatial data. Training will occur in a superlative research and learning environment. Both the institution and department rank highly in NIH funding and there are exceptional resources, facilities, personnel, partnerships, and expertise to support Dr. Lucan's project and training needs. There is experience with multilevel GISc considerations in patient-oriented research and tremendous expertise in behavioral and social sciences, nutrition studies, and research involving adolescents. Veteran supervising faculty has wide-ranging current and historical ties to NICHD. The proposed work will provide Dr. Lucan the training and the practical experience to support a career as an independent investigator.