Armenia-US Collaboration to Address Chronic Disease via Education in Social Determinants Science (ACCESS) - Non-communicable diseases (NCDs) account for >70% of deaths each year globally and approximately 86% of deaths in the US. NCDs have a particularly profound impact in low- and middle-income countries (LMICs), where about 73% of NCD-related deaths worldwide occur. Critical to decreasing the NCD burden is reducing modifiable NCD risk factors (e.g., tobacco/alcohol use, poor nutrition), which also disproportionately impact LMICs. Importantly, addressing social determinants (SDs) of health is critical in reducing the global NCD burden. SDs – or conditions in which people are born, live, learn, work, play, and age – are important drivers of NCDs, and impact both modifiable risk factors (e.g., smoking) and disease outcomes. SDs represent various domains including: healthcare access/quality, social/community context, neighborhood/built environment, economic stability, and education access/quality. Thus, key approaches to NCD prevention and control include addressing SDs of NCD risk factors via multilevel interventions. Notably, disadvantages related to SDs are especially prominent in LMICs. The ACCESS program (i.e., the Armenia [AM]-US Collaboration to Address Chronic Disease via Education in Social Determinants Science program) will be the first program of its kind and will provide a model for studying and addressing pressing NCD-related health priorities among high-risk populations and in low-resource settings. AM is an LMIC that faces particular NCD-related challenges, as NCDs account for 93% of all deaths and the top 10 causes of death, premature death, and disability in AM. Relatedly, AM is plagued with profound NCD risk factors, as AM has the 11th highest male smoking rate globally (52%), ranks in the top 40% of countries in alcoholism rates, and has a 48% prevalence of overweight/obesity. Moreover, understanding the SDs of NCD and related risk factors in high-risk populations and in low-resource settings, like AM, may provide unique scientific insights that translate to such settings and populations in the US and globally. ACCESS is a strategic collaboration between George Washington University (GW), American University of Armenia (AUA), AM’s Ministry of Health (MOH), and its entities (e.g., NIH) – thus capitalizing on the unique scientific talent in our partnering Armenian organizations and their commitment to developing an effective, sustainable training program to enhance SDs and NCD research capacity, emphasizing high-risk populations and delivery in low-resource settings, including those in the US and more broadly. Aim 1 will establish a formal SDs and NCD prevention and control research training program and related institutional infrastructure for MPH training among doctoral-level investigators that contributes to US-based training and infrastructure. Aim 2 will advance global NCD research priorities via mentored research focused on SDs of NCD risk factors among future NCD research leaders. Aim 3 will catalyze NCD-related research dissemination and knowledge translation to inform high-impact interventions. ACCESS will establish a bidirectional exchange of data and expertise to identify and address key SDs of NCDs, informing and supporting the development, testing, and dissemination of evidence-based interventions that improve and protect health in the United States and worldwide.
