Leveraging Implementation Science to Promote Behavior Change and Reduce Cancer Health Disparities among American Indian and Alaska Native Older Adults

项目概要 美洲印第安人和阿拉斯加原住民 (AIAN) 成年人比白人更容易患癌症并死于癌症 美国成年人，反映了明显且持续的癌症健康差异（CHD）。结直肠癌 (CRC) 北部平原和阿拉斯加地区的 AIAN 发病率异常高； likewise, risk CRC 的影响因素也很高，包括不可改变的因素，如年龄增长和农村地区，并且已被证明 可改变的危险因素，例如缺乏身体活动和肥胖。最近的一份共识报告表明， 有证据表明体力活动 (PA) 通过全身性活动（即新陈代谢、 炎症）和肥胖减少途径。然而，尽管有有效的行为 增加老年人 PA 的干预措施，产生的证据和行动之间存在重大差距 采取措施在 AIAN 老年人中实施此类干预措施。这一差距意味着错失了机会 在高危人群的癌症预防中实施当前的循证干预措施（EBI） 患有明显的先心病。实施科学专注于理解和加速 将此类 EBI 纳入公共卫生实践环境以改善健康，并可用于 解决这一关键的公共卫生差距，从而解决持续存在的冠心病并改善人们的整体健康 AIAN 社区。此 F99/K00 博士前到博士后研究员过渡奖申请可帮助 有前途的实习生 - Maja Pedersen，在社区行为方面拥有 15 年经验 对北部平原和阿拉斯加地区的农村 AIAN 社区进行干预——着手开展 严格的研究和培训计划，利用最佳干预实践来应对这一关键差距 与 AIAN 社区进行研究以及当前的实施科学方法。 Pedersen 的长期目标是 成为设计和实施服务不足的 PA 干预措施的独立研究者 包括 AIAN 在内的人群，以改善与癌症相关的健康结果并减少冠心病。 Her short-term 目标包括获得多层次干预方法的使用、传播和实施方面的专业知识 科学、老年人群癌症预防和控制、实验设计和强化 纵向方法。她与她的多学科博士前导师团队合作， 制定培训计划，通过课程、研讨会、科学会议、指导来启动这些目标 阅读和指导研究（F99 阶段）。当她过渡到博士后阶段时，她将 组建一支高水平、专注于癌症的导师团队，通过持续的指导培训为她提供支持 明确重点关注癌症预防和控制。她的博士后研究（K00阶段）执行了 她的研究序列中合乎逻辑的下一步是全面实施和 作为独立科学家的有效性试验。

Project Summary American Indian and Alaska Native (AIAN) adults are more likely to develop cancer and die from it than white American adults, reflecting pronounced and persistent cancer health disparities (CHDs). Colorectal cancer (CRC) rates are disproportionately high among AIANs in the Northern Plains and Alaska regions; likewise, risk factors for CRC are also high, including non-modifiable factors such as increasing age and rurality, and proven modifiable risk factors such as physical inactivity, and obesity. A recent consensus report indicates strong evidence that physical activity (PA) lowers risk for colon cancer through systemic (i.e., metabolism, inflammation) and obesity reduction pathways. However, despite availability of efficacious behavioral interventions to increase PA among older adults, a critical gap exists between evidence generated and action taken to implement such interventions among AIAN older adults. This gap represents a missed opportunity to implement current evidence-based interventions (EBIs) in cancer prevention among high-risk populations experiencing pronounced CHDs. Implementation science concentrates on understanding and accelerating integration of such EBIs into public health practice settings to improve health and can be leveraged here to address this critical public health gap, thus addressing persistent CHDs and improving overall health among AIAN communities. This F99/K00 Predoctoral to Postdoctoral Fellow Transition Award application assists a promising trainee - Maja Pedersen, who has 15 years of experience in community-based behavioral interventions among rural AIAN communities in the Northern Plains and Alaska regions - to embark on a rigorous research and training program to confront this critical gap using best practices for intervention research with AIAN communities and current implementation science methods. Pedersen’s long-term goal is to become an independent investigator in designing and implementing PA interventions among underserved populations - including AIANs - to improve cancer-related health outcomes and reduce CHDs. Her short-term goals include gaining expertise in the use of multilevel intervention methods, dissemination and implementation science, cancer prevention and control among geriatric populations, experimental design, and intensive longitudinal methods. In collaboration with her multidisciplinary team of predoctoral mentors, she has developed a training plan to initiate these goals via coursework, workshops, scientific meetings, directed readings, and mentored research (F99 Phase). As she transitions into the postdoctoral phase, she will assemble a team of high-level, cancer-focused mentors to support her through continued mentored training with an explicit focus on cancer prevention and control. Her postdoctoral research (K00 Phase) executes the logical next steps in her research sequence on a trajectory toward a full-scale implementation and effectiveness trial as an independent scientist.