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文化定制的技术介导的疾病预防干预措施，以支持阿拉斯加农村地区（AN）男性和女性多种风险行为的变化。在过去6年中，研究团队在阿拉斯加农村的现场工作直接告知，与部落的持续社区合作以及民族志研究，干预措施将针对健康需求和价值定制，以针对美国心脏协会的7个战略影响2020年的战略影响目标。第2组通过药物依从性和营养变化来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的计算机干预措施，这些干预措施是由远程医疗通过远程医疗提供的。计算机干预接触发生在基线，3，6个月和12个月时，最终评估为18个月。研究设计提供了同等的接触时间和技术比较；随着所有参与者获得高度个性化的咨询和干预材料，可以促进社区内的个体随机分组；并可以比较传统风险因素（HTN-HCL）与风险行为（烟草/身体活动）干预措施。参与者（n = 300）将是每天吸烟者，至少有一个心血管疾病危险因素（例如，不活动，超重，HTN，HCL）或已建立的血管疾病。该审判旨在与人民联系，而不论住宅地点或打算改变的意图。 主要的假设是，第1组将获得比第2组至18个月的随访，生化确认的烟草的节制明显更大，其次将显着提高其体育锻炼。次要假设是，与（i）药物合规性和（ii）饮食变化相比，第2组对HTN和HCL的控制将明显更大。第三级目标将：（a）比较整体行为变化的干预措施； （b）每种干预措施的模型成本效益和预算影响； （c）检查治疗结果的主持人/介体，包括糖尿病的反式3'-羟基霉素与可替氨酸的比例，这是尼古丁代谢率的无创测量。该提案结合了技术，药理学，行为科学和健康经济学，以促进面临重大健康差异的人们的健康，并且鉴于其孤立的地理位置，因此对干预措施的使用有限。