Technology Innovations for Supporting Health in Alaska Native People

描述（由申请人提供）拟议的研究将评估两种文化量身定制的技术介导的疾病预防干预措施的有效性，以支持阿拉斯加原住民（AN）农村男性和女性多种风险行为的改变。根据研究小组过去6年在阿拉斯加农村的实地工作、与部落的持续社区合作以及人种学研究的直接信息，这些干预措施将根据美国心脏协会2020年7个战略影响目标中的5个健康需求和价值观进行定制。在一个随机对照的两组设计中，试验将比较两种积极的治疗条件：第一组针对烟草和体育活动；2组的目标是通过药物依从性和营养改变来控制高血压和高胆固醇血症（HTN-HCL）。这两种情况都采用了跨理论模型定制的计算机化干预措施，由安克雷奇的以土著为重点的咨询师通过远程医疗向居住在农村的安人提供服务。计算机化干预接触发生在基线、3个月、6个月和12个月，最终评估发生在18个月。研究设计提供了等效接触时间和技术比较；促进社区内个人层面的随机化，因为所有参与者都接受高度个性化的咨询和干预材料；并允许比较传统风险因素（HTN-HCL）与风险行为（烟草/身体活动）干预措施。参与者（N=300）将是每日吸烟者，至少有一个额外的心血管疾病危险因素（例如，缺乏运动、超重、HTN、HCL）或已建立的血管疾病。该试验的目标是覆盖AN人群，无论其居住地点或打算改变。主要假设是，通过18个月的随访，第一组将比第二组实现更大的生化证实的烟草戒断，其次，他们的身体活动将显著增加。次要假设是，通过(i)药物依从性和（ii）饮食改变，2组将比1组实现更大的HTN和HCL控制。第三个目标将：(a)比较对整体行为改变的干预措施；(b)每项干预措施的成本效益和预算影响示范；(c)检查治疗结果的调节因子/介质，包括反式-3′-羟基可替宁与可替宁比率，这是尼古丁代谢率的一种无创测量方法。该提案结合了技术、药理学、行为科学和卫生经济学，以促进面临严重健康差距的非洲人的健康，这些人由于地理位置偏远，获得干预措施的机会有限。

DESCRIPTION (provided by applicant) the proposed research will evaluate the efficacy of two culturally-tailored technology- mediated disease prevention interventions for supporting change in multiple risk behaviors in rural Alaska Native (AN) men and women. Directly informed by the research team's fieldwork over the past 6 years in rural Alaska, continued community partnership with the tribes, and ethnographic research, the interventions will be tailored to AN health needs and values to target 5 of the American Heart Association's 7 Strategic Impact Goals for 2020. In a randomized controlled 2-group design, the trial will compare two active treatment conditions: Group 1 targets tobacco and physical activity; Group 2 targets control of hypertension and hypercholesterolemia (HTN-HCL) through medication adherence and nutritional changes. Both conditions utilize trans theoretical model-tailored, computerized interventions, delivered via telemedicine by Indigenous-focused counselors located in Anchorage reaching AN people in their rural home villages. Computerized intervention contacts occur at baseline, 3-, 6- and 12-months with final assessment at 18-months. Study design provides an equivalent contact time and technology comparison; facilitates individual-level randomization within communities, as all participants receive highly individualized counseling and intervention materials; and allows for comparison of traditional risk factor (HTN-HCL) versus risk behavior (tobacco/ physical activity) interventions. Participants (N=300) will be daily smokers with at least one additional cardiovascular disease risk factor (e.g., inactivity, overweight, HTN, HCL) or established vascular disease. The trial aims to reach AN people regardless of residential location or intention to change. The primary hypothesis is that Group 1 will achieve significantly greater biochemically- confirmed tobacco abstinence than Group 2 through 18-months follow-up and secondarily will significantly increase their physical activity. Secondary hypotheses are that Group 2 will achieve significantly greater control of HTN and HCL than Group 1 through (i) medication compliance and (ii) dietary change. Tertiary aims will: (a) compare the interventions on overall behavior change; (b) model cost-effectiveness and budgetary impact of each intervention; and (c) examine moderators/mediators of treatment outcome, including the trans-3'-hydroxycotinine to cotinine ratio, a noninvasive measure of nicotine metabolism rate. The proposal combines technology, pharmacology, behavioral science, and health economics for advancing the health of AN people who face significant health disparities with limited access to interventions given their isolated geographics.