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

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.