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.
