Systems Science Informed Multilevel Theoretical Model of Cardiovascular Health in Native Hawaiians

项目摘要 此K 01应用程序的目的是支持克莱尔汤森博士的研究和职业发展 在建立自己作为一个独立的调查参与社区和使用系统科学 理论和方法来检查和解决心血管疾病的多层次决定因素。原生 夏威夷人承受着高血压和心血管疾病的不成比例的负担。文化定制 由心理社会理论指导的干预措施能有效地改变个人行为， 健康成果，但需要多层次的干预措施来扩大和维持这些改善。多级 干预措施与高血压预防特别相关，因为血压受风险的影响， 个人、家庭、社区、社会和环境层面的保护因素。然而研究 研究这些因素复杂的相互作用和过程是夏威夷土著人所缺乏的。此类信息 是至关重要的发展夏威夷原住民心血管健康的多层次理论模型，以指导 为这一未充分研究的群体设计文化相关的多层次干预措施。英博士会在她的基础上 在以社区为基础的参与和转化研究的经验，以实现四个短期职业生涯 目标;提高她的知识和技能，1）多层次的科学严格的检查 心血管健康的决定因素，2）系统科学的理论和方法，包括基于群体的模型 建筑和社区为基础的系统动力学，3）高血压和心血管疾病的预防，和4）本地 夏威夷社区参与。拟议的研究将建立在与美国农业部资助的 研究（儿童健康生活卓越中心），包括6个夏威夷土著社区。其2019 重新评估将包括社会人口、心理、行为、家庭和社区因素。 通过利用这一伙伴关系，Ing博士将招募240名成年人进行额外的血液数据收集 压力、身高、体重以及行为和心理社会因素（例如，饮食、体力活动、歧视）。 利用这些数据，她将研究个人、家庭和社区因素之间的关系 还有血压此外，她还将邀请社区领导人参加6个焦点小组研讨会（n=48）， 创建多层次因素和HTN之间的感知联系的因果结构。然后她会合成 定性数据和因果结构来创建因果循环图。这个因果循环图将作为一个 夏威夷原住民心血管健康的新理论模型。具体目标是：1）估计 行为（体力活动，饮食，饮酒，吸烟），生物（BMI）， 社会心理（文化适应、歧视）、家庭（规模、组成、食物稀缺、食物使用 援助）和社区（步行能力，食物环境）因素和血压在240名成年土著 夏威夷人，以及2）通过焦点小组研讨会与社区领导人接触，以创建因果循环图 描绘了夏威夷土著社区心血管健康的多层次决定因素。

PROJECT SUMMARY The purpose of this K01 application is to support the research and career development of Dr. Claire Townsend Ing in establishing herself as an independent investigator engaging community and using system science theory and methods to examine and address multilevel determinants of cardiovascular disease. Native Hawaiians bear a disproportionate burden of hypertension and cardiovascular disease. Culturally tailored interventions guided by psychosocial theories are effective at producing individual behavior change to improve health outcomes, but multilevel interventions are needed to expand and sustain these improvements. Multilevel interventions are particularly relevant for hypertension prevention as blood pressure is influenced by risk and protective factors at individual, family, community, societal, and environmental levels. However, research examining these factors' complex interactions and processes is lacking in Native Hawaiians. Such information is critical to developing a multilevel theoretical model of Native Hawaiian cardiovascular health to guide the design of culturally relevant, multi-level interventions for this understudied group. Dr. Ing will build on her experience in community-based participatory and translational research to achieve four short-term career objectives; to improve her knowledge and skill in 1) the scientifically rigorous examination of multilevel determinants of cardiovascular health, 2) systems science theory and methods to include group-based model building and community-based system dynamics, 3) hypertension and CVD prevention, and 4) Native Hawaiian community engagement. The proposed research will build on a partnership with a USDA-funded study (Children's Healthy Living Center of Excellence) that includes 6 Native Hawaiian communities. Its 2019 reassessment will include sociodemographic, psychosocial, behavioral, household, and community factors. Through leveraging this partnership, Dr. Ing will recruit 240 adults for additional data collection on blood pressure, height, weight, and behavioral and psychosocial factors (e.g., diet, physical activity, discrimination). Using these data, she will examine the relationships between individual, household, and community factors and blood pressure. Additionally, she will engage community leaders in 6 focus group workshops (n=48) to create causal structures of perceived links between multilevel factors and HTN. She will then synthesize the qualitative data and causal structures to create a causal loop diagram. This causal loop diagram will serve as a novel theoretical model of cardiovascular health in Native Hawaiians. The specific aims are: 1) to estimate the associations between behavioral (physical activity, diet, alcohol consumption, tobacco use), biological (BMI), psychosocial (acculturation, discrimination), household (size, composition, food scarcity, use of food assistance), and community (walkability, food environment) factors and blood pressure in 240 adult Native Hawaiians, and 2) engage community leaders via focus group workshops to create a causal loop diagram depicting multilevel determinants of cardiovascular health in Native Hawaiian communities.