Candidate. The overarching goal of this Mentored Career Development Award (K01) is to provide Dr. Sinclair with the skills and experience to establish an independent program of diabetes-related disparities research. This career development award is grounded in a multilevel population health conceptual framework that merges advanced didactic instruction with individualized one-on-one mentorship. The advanced research training will serve to catalyze Dr. Sinclair's work, which focuses on unexplored contextual factors that contribute to diabetes prevalence and incidence. This award will provide her with time and salary support to develop an educational foundation and research program that broadens her capabilities to carry out multilevel health disparities research. To build this foundation, the training program consists of three core components: 1) formal coursework in epidemiology, biostatistics, Geographic Information Systems (GIS) technology, spatial analysis, and health disparities research, 2) mentored research training in multilevel modeling and GIS, and 3) instruction in the responsible conduct of research. Dr. Sinclair brings together an interdisciplinary mentorship board that offers extensive research experience and support of her career development program. The K01 award will allow her to benefit from a rich, multidisciplinary mentorship and training environment, which includes experts in epidemiology, biostatistics, GIS, diabetes, and health disparities research. Research Project. Dr. Sinclair proposes to empirically examine the spatial patterning and distribution of diabetes risk factors, prevalence and incidence among the Multiethnic Cohort Study participants by combining individual- and area-level data. The Multiethnic Cohort Study includes a diverse population-based sample of more than 100,000 Hawaiian residents, identified in 1993-1996, who have been followed for more than 15 years. In the proposed project, Dr. Sinclair will geocode the residential addresses of study participants at the time of entry into the cohort. Neighborhood socioeconomic status will be defined from the 1990 U.S. Census. Similarly, measures of neighborhood resources for physical activity and access to healthy foods will be defined.
Research aims are to: 1) determine the cross-sectional association between neighborhood characteristics and the prevalence of diabetes and individual-level risk factors for diabetes, including obesity, poor diet, and low levels of physical activity, 2) assess the longitudinal association between neighborhood characteristics and the incidence of diabetes after adjustment for individual-level diabetes risk factors, and 3) examine if the association between neighborhood characteristics and diabetes prevalence and incidence differs by race and ethnicity. The use of a multilevel perspective can help to identify factors associated with diabetes-related disparities, and is congruent with the NIH strategic plan to move the country toward health equity. Findings from this study will illuminate the larger social and economic forces that create differences in health between neighborhoods, and identify geographical areas where traditional and novel public health interventions may best be targeted. The K01 award is critical to Dr. Sinclair's future as a diabetes researcher and will provide her with the time, mentorship, research skills, analytical training, and practical research experience to develop into an independently funded investigator in diabetes prevention and control among health disparate populations. Environment. The University of Hawaii at Manoa is a major education and research facility that serves as the center for research and advanced graduate and professional studies. The UH School of Medicine houses the largest biomedical research facility in Hawaii, and is the most culturally and ethnically diverse medical school in the U.S. Housed within the medical school is the Department of Native Hawaiian Health where Dr. Sinclair is a member of the research faculty. Laurence N. Kolonel, MD, PhD, will serve as Dr. Sinclair's primary mentor. Dr. Kolonel is a Professor at the UH Cancer Research Center and Principal Investigator of the Multiethnic Cohort Study from which Dr. Sinclair will draw her research project. The Cancer Research Center is an NCI- designated cancer center and receives funding from a Cancer Center Support Grant. The Center's mission is to reduce the burden of cancer through research, education, and service with an emphasis on the unique ethnic, cultural, and environmental characteristics of Hawaii and the Pacific. There are currently three cohort studies in the Epidemiology Program, including the Multiethnic Cohort Study. A GIS workgroup, of which Dr. Sinclair is a member, was recently formed to examine contextual factors and cancer incidence. There are several shared resources of the Cancer Center including the Hawaii Tumor registry which is a member of NCI's SEER Program;biostatistics which provides support for study design and data analysis;nutrition support which provides expertise in dietary questionnaire development and maintains extensive food and supplement composition databases;an analytical laboratory capable of analyzing biospecimens and foods for a wide array of constituents;a genomics laboratory which supports studies of genetic susceptibilities and whole-genome expression;and a bioinformatics group which supports the management and analysis of large and complex datasets. While the research activities of the faculty are varied, they are thematically related to the focus on ethnic diversity. 2

Public Health Relevance

The NIDDK Mentored Research Scientist Development Award will allow for additional training and mentorship that will position Dr. Sinclair to become an independent investigator. She will need protected time to acquire the comprehensive training in health disparities research and multilevel modeling. Dr. Sinclair's proposed research is may aid in efforts to understand and address the persistent problem of inequalities in health from a multilevel perspective. The proposed research has the potential to move our current understanding of contextual/environmental factors and diabetes forward.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Scientist Development Award - Research & Training (K01)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Hyde, James F
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University of Hawaii
Internal Medicine/Medicine
Schools of Medicine
United States
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Sinclair, Ka'imi A; Makahi, Emily K; Shea-Solatorio, Cappy et al. (2013) Outcomes from a diabetes self-management intervention for Native Hawaiians and Pacific People: Partners in Care. Ann Behav Med 45:24-32