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

项目总结 此K01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 ING将自己确立为独立的调查员，参与社区并使用系统科学 检查和解决心血管疾病的多水平决定因素的理论和方法。原生的 夏威夷人承受着不成比例的高血压和心血管疾病的负担。为文化量身定制 在心理社会理论指导下的干预有效地促使个人行为改变以改善 卫生结果，但需要多层次的干预措施，以扩大和维持这些改善。多层次 干预措施对高血压预防特别相关，因为血压受风险和 个人、家庭、社区、社会和环境层面的保护因素。然而，研究表明， 夏威夷原住民缺乏对这些因素复杂的相互作用和过程的研究。这样的信息 对于开发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与文化相关的多层次干预措施。丁博士将在她的基础上继续发展 以社区为基础的参与性和转化性研究经验，实现四个短期职业 目标：提高她在1)科学严格的多层次考试中的知识和技能 心血管健康的决定因素，2)系统科学理论和方法，包括基于群体的模型 建筑和基于社区的系统动力学，3)高血压和心血管疾病预防，4)本地 夏威夷社区参与度。拟议的研究将建立在与美国农业部资助的合作伙伴关系的基础上 研究(儿童健康生活卓越中心)，包括6个夏威夷土著社区。2019年ITS 重新评估将包括社会人口、心理社会、行为、家庭和社区因素。 通过利用这一合作关系，丁博士将招募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，她将邀请社区领导人参加6个焦点小组讲习班(n=48)，以 创建多水平因素和HTN之间可感知的联系的因果结构。然后她会合成出 定性数据和因果结构，以创建因果环图。这个因果环图将作为一个 夏威夷土著人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、构成、食物匮乏、食物使用 240名成年原住民的社区(可步行、食物环境)因素和血压 夏威夷人，以及2)通过焦点小组研讨会接触社区领导人，以创建因果环图 描述夏威夷土著社区心血管健康的多水平决定因素。

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.