Developing a multi-component intervention to address cardiometabolic disease (CMD) risk in Samoan children

建议书摘要 建议的K99/R00奖项的目标是支持Courtney Choy博士发展成为独立的 社区参与的实施科学家，专注于流行病学并利用量化和 太平洋岛民儿童中非传染性心脏代谢性疾病(CMD)风险的定性数据。 尽管他们是CMD风险最大的人群之一，但几乎没有有效的干预措施或创新来解决CMD 已经到达太平洋岛民社区。这项提议的目标是制定和实施一项背景-- 针对萨摩亚儿童CMD风险的特殊、多成分干预。中等收入的萨摩亚 波利尼西亚国家拥有大量的全球侨民，经历了世界上CMD发病率最高的国家之一。 Ola Tuputupua‘e(成长)队列研究的现有数据表明，这项提案将利用这些数据 这种风险在生命的早期就出现了。一半的注册儿童受到肥胖、血液升高的影响 血压和/或高糖化血红蛋白(HbA1c)到9岁。在K99训练阶段，蔡博士 将(1)扩展她的流行病学培训，并使用生长混合模型向干预目标和 选择时机和(2)在定性方法和实施科学方面获得新技能，以选择和适应背景 在萨摩亚使用的干预措施。积极的实施框架和循证的最佳做法 太平洋岛民社区将指导干预措施的制定和实施，这将在#年进行。 R00阶段。其结果将是针对该年龄段的萨摩亚儿童的多成分干预 其中CMD风险的标记物(体重指数、血压和HbA1c)对可修改最敏感 行为和环境风险因素。此外，多组分干预将包括至少两个 基于证据的生活方式/行为改变战略，以应对CMD风险因素，利用现有基础设施 和当地能力(有一个实施团队)，并与社区确定的优先事项保持一致。初步 在儿童中开展干预措施的可行性、可接受性和有效性的证据 萨摩亚将制定一个可扩展的方案，有可能在其他太平洋岛民和 可比的低资源环境。实现职业发展目标并确保成功过渡到 独立，蔡博士建立了卓越的培训环境，发展了体验式学习 应用从教学课程中学到的新技能的活动，并组织了一个多学科指导 拥有公共卫生、实施科学、临床试验、人类生物学、流行病学和 太平洋岛民健康。辅导、研究培训、领导力和职业发展活动 建议将确保在此奖项结束时，蔡博士将处于有利地位，可以推广这些方法 发展到美国的太平洋岛民，他们是增长最快的种族和少数民族群体之一 而且--因为他们患慢性萎缩性心脏病的风险很高--是早期干预以减少健康差距的理想受益者。

PROPOSAL SUMMARY The goal of the proposed K99/R00 award is to support Dr. Courtney Choy’s development into an independent community-engaged implementation scientist, with a focus on epidemiology and leveraging quantitative and qualitative data to address noncommunicable, cardiometabolic disease (CMD) risk in Pacific Islander children. Although they are among the most at risk of CMD, few efficacious interventions or innovations to address CMDs have reached Pacific Islander communities. The objective of this proposal is to develop and implement a context- specific, multi-component intervention to address CMD risk in Samoan children. Samoa, a middle-income Polynesian country with a large global diaspora, experiences among the highest CMD prevalence in the world. Existing data from the Ola Tuputupua’e (‘Growing Up’) cohort study, which this proposal will leverage, suggests that risk emerges early in life. Half of the enrolled children were affected by either obesity, elevated blood pressure, and/or high glycated hemoglobin (HbA1c) by the age of 9. During the K99 training phase, Dr. Choy will (1) extend her epidemiological training and use growth mixture modeling to inform intervention targets and timing and (2) gain new skills in qualitative methods, and implementation science to select and contextually adapt an intervention for use in Samoa. The Active Implementation Frameworks and evidence-based best practices in Pacific Islander communities will guide intervention development and implementation, which will take place in the R00 phase. The result will be a multi-component intervention for Samoan children that targets the age period in which markers of CMD risk (body mass index, blood pressure, and HbA1c) are most sensitive to modifiable behavioral and environmental risk factors. Further, the multi-component intervention will incorporate at least two evidence-based lifestyle/behavioral change strategies to address CMD risk factors, utilize existing infrastructure and local capacity (with an implementation team) and align with community-identified priorities. Preliminary evidence of the feasibility, acceptability, and effectiveness of the developed intervention among children in Samoa will produce a scalable program with the potential for replication in other Pacific Islander populations and comparable low-resource settings. To achieve career development goals and ensure a successful transition to independence, Dr. Choy has established an exceptional training environment, developed experiential learning activities to apply newly gained skills from didactic coursework, and assembled a multidisciplinary mentorship team with expertise in public health, implementation science, clinical trials, human biology, epidemiology, and Pacific Islander health. The mentorship, research training, leadership and career development activities proposed will ensure that at the conclusion of this award, Dr. Choy will be well-positioned to extend the methods developed to Pacific Islanders in the US, who are among the fastest-growing racial and ethnic minority groups and –because of their high CMD risk– are the ideal beneficiaries of early intervention to reduce health disparities.