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定制的技术介导的疾病预防干预措施的有效性，以支持改变阿拉斯加农村土著（AN）男性和女性的多种风险行为。通过研究团队过去6年在阿拉斯加农村的实地考察，与部落的持续社区合作以及人种学研究，这些干预措施将根据AN的健康需求和价值观进行定制，以实现美国心脏协会2020年7个战略影响目标中的5个。 在随机对照2组设计中，试验将比较两种积极治疗条件：第1组针对烟草和体力活动;第2组通过药物依从性和营养变化控制高血压和高胆固醇血症（HTN-HCL）。这两种情况都利用跨理论模型定制的计算机化干预措施，通过位于安克雷奇的以土著为重点的咨询师提供远程医疗，在他们的农村家乡接触AN人。计算机干预联系在基线、3个月、6个月和12个月时进行，最终评估在18个月时进行。研究设计提供了等效的接触时间和技术比较;促进社区内的个人水平随机化，因为所有参与者都接受高度个性化的咨询和干预材料;并允许比较传统的风险因素（HTN-HCL）与风险行为（烟草/体育活动）干预措施。受试者（N=300）将是每日吸烟者，至少有一个额外的心血管疾病风险因素（例如，不活动、超重、HTN、HCL）或已确诊的血管疾病。该试验的目的是接触安人，无论居住地点或意图改变。 主要假设是，通过18个月随访，第1组将比第2组实现更大的经生化证实的戒烟，其次将显著增加他们的体力活动。次要假设是，通过（i）药物依从性和（ii）饮食改变，第2组对HTN和HCL的控制将显著高于第1组。第三个目标是：（a）比较干预措施对总体行为改变的影响;（B）对每种干预措施的成本效益和预算影响进行建模;（c）检查治疗结果的调节剂/介导剂，包括反式-3 '-羟基可替宁与可替宁的比例，这是尼古丁代谢率的一种非侵入性测量方法。该提案结合了技术，药理学，行为科学和卫生经济学，以促进AN人群的健康，这些人面临着显著的健康差异，由于其孤立的地理位置，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.