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

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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.