Technology Innovations for Supporting Health in Alaska Native People

支持阿拉斯加原住民健康的技术创新

• 批准号: 8662548
• 负责人: NEAL L BENOWITZ
• 金额: $ 77.78万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-15 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8662548
• 关键词: Abstinence; Adopted; Adoption; Alaska; Alaska Native; American Heart Association; Anthropology; Behavioral; Behavioral Sciences; Biological Markers; Cardiovascular system; Client; Clinical Trials Design; Commit; Communication; Communities; Cotinine; Counseling; Diet; Disease; Eligibility Determination; Ethnography; Face; Feedback; Future; Goals; Health; Home environment; Hypertension; Indigenous; Individual; Intention; Intervention; Intervention Trial; Leadership; Location; Lung; Maintenance; Measures; Mediating; Mediator of activation protein; Medical; Medical Technology; Medical center; Medicine; Metabolism; Modeling; Native Americans; Native-Born; Nicotine; Nutritional; Overweight; Participant; Patients; Persons; Pharmacology; Physical activity; Population; Preventive Intervention; Professional counselor; Quality-Adjusted Life Years; Randomized; Recruitment Activity; Relapse; Research; Research Design; Risk; Risk Behaviors; Risk Factors; Rural; Shapes; Smoker; System; Technology; Telemedicine; Theoretical model; Time; Tobacco; Tobacco use; Treatment outcome; Tribes; Vascular Diseases; Visual; Withholding Treatment; Woman; Work; active control; active method; addiction; behavior change; behavioral health; cancer prevention; cardiovascular disorder risk; cardiovascular risk factor; cigarette smoking; community based participatory research; computerized; cost; cost effective; cost effectiveness; disorder prevention; effective intervention; empowered; follow-up; group intervention; health disparity; health economics; hydroxycotinine; hypercholesterolemia; hypertension control; indexing; innovation; medication compliance; meetings; member; men; minimal risk; novel; primary outcome; programs; public health relevance; response; smoking cessation; tobacco abstinence; tribal organization

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.

描述（由申请人提供）拟议的研究将评估两种根据文化定制的技术介导的疾病预防干预措施的功效，以支持阿拉斯加原住民（AN）农村男性和女性改变多种风险行为。直接根据研究团队过去 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的信息，干预措施将根据 AN 健康需求和价值观进行定制，以实现美国心脏协会 7 个战略影响目标中的 5 个目标2020 年。在随机对照 2 组设计中，该试验将比较两种主动治疗条件：第 1 组针对烟草和体力活动；第 1 组针对烟草和体力活动；第 1 组针对烟草和体力活动。第 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)。这两种情况都利用了跨理论模型定制的计算机化干预措施，由安克雷奇的原住民辅导员通过远程医疗向农村家乡的原住民提供服务。计算机化干预接触在基线、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；促进社区内个人层面的随机化，因为所有参与者都会收到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/体力活动）干预措施。参与者 (N=300) 是每日吸烟者，且至少患有一种额外的心血管疾病危险因素（例如，缺乏活动、超重、高血压、HCL）或已确诊的血管疾病。该试验旨在覆盖 AN 人群，无论其居住地点或改变意愿如何。 主要假设是，经过 18 个月的随访，第 1 组经生化证实的戒烟率将显着高于第 2 组，其次将显着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 组将比第 1 组实现更好的 HTN 和 HCL 控制。第三个目标将： (a) 比较对总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模型； (c) 检查治疗结果的调节因素/调节因素，包括反式 3'-羟基可替宁与可替宁的比率，这是尼古丁代谢率的非侵入性测量。该提案结合了技术、药理学、行为科学和健康经济学，以促进 AN 人群的健康，这些人群面临着巨大的健康差异，且由于地理位置偏僻，获得干预措施的机会有限。