Diversity Supplement for McWhorter: Kentucky Center for Clinical and Translational Science

Project Summary/Abstract: The University of Kentucky (UK) Center for Clinical and Translational Science (CCTS) has created an integrated home for clinical and translational research which promotes scientific progress and discoveries at every phase of the translational continuum. The CCTS has partnered with communities in Central Appalachia to address multiple generations of recalcitrant health inequities related in part to the economic distress of rural communities. The CCTS has fundamentally transformed UK and Central Appalachia through the development of strong academic-community research networks and collaborations within the CTSA consortium. Appalachian health disparities are further magnified by the opioid and substance abuse epidemic, which has greatly impacted eastern Kentucky and West Virginia. The strong UK research portfolio puts the UK CCTS in an optimal position to lead local, regional and national research efforts focused on rural health inequities. The aligned missions of UK, UK HealthCare and the CCTS focus on achieving health equity by engaging in highly innovative, collaborative and dynamic translational research to address rural health needs. The CCTS will continue to educate the translational workforce of the future, engage rural communities in translational and bi-directional team science and work with the national network to advance transdisciplinary research and clinical trials through the following Specific Aims: 1) develop, innovate and transform our research environment to promote impactful science and discovery within our integrated health care system to meet the unique health needs of Central Appalachian residents; 2) lead institutional innovation in the delivery of impactful clinical and translational research that covers the lifespan, fully engages the community and embraces team science; 3) catalyze an efficient, university-wide clinical trials organization which adds value to the CTSA consortium by engaging participants from rural Central Appalachia; and 4) foster and enhance a workforce characterized by diversity and inclusivity across all translational science disciplines and populations. The UK CTSA hub is uniquely positioned in the National CTSA Consortium to foster novel technologies, team science, clinical trial start-up and cutting-edge translational research across the lifespan with a focus on rural communities. We have a particular focus on the Central Appalachian community, a rural area with many of the highest levels of health disparities in the nation. This focus will ultimately elevate the health and quality of life of rural communities throughout the United States. The diversity supplement titled, “Impact of co-exposures on pediatric obesity and sleep in Appalachian Children,” further supports the mission of the CCTS as secondhand tobacco smoke exposure (SHS) is a common early-life exposure that may contribute to future risk for obesity. Co-exposure to air pollution (e.g., metal mixtures) and SHS may also influence early-life pediatric obesity, but few studies have attempted to extricate their joint effects. This association may be stronger in children with poor sleep behaviors. Biomarkers of exposure to metals and SHS have been linked to self-reported sleep disturbances, such as insufficient sleep, nocturnal leg cramps (an indicator of poor sleep health), delayed sleep onset, frequent night awakenings, and a diagnosis of obstructive sleep apnea; however, this co-exposure has not been examined in children in relationship to obesity. Moreover, residents of Appalachia have the nation’s highest rates of insufficient sleep, but the reasons for this are unclear. The central hypothesis is co-exposure to SHS and metals will result in a statistically significant increased prevalence of childhood obesity. We also hypothesize that poor sleep behaviors will moderate this relationship. To accomplish this, the study will accomplish the following specific aims: Aim 1. Examine the relationship between SHS exposure and BMI in a rural Appalachian pediatric cohort. Aim 2. Explore the relationship between co-exposure to SHS and metal mixtures on BMI. A strong mentorship team and training plan has been developed to achieve these aims. By elucidating the role of sleep, an upstream, modifiable health behavior, in the complex relationship between co-exposures to multiple environmental factors and pediatric obesity, this proposal can contribute to innovative, tailored interventions that target multiple health risk factors including poor diet, sedentary behavior, and tobacco use in children and families, all of which are needed to prevent adverse health outcomes related to tobacco use and obesity in a vulnerable, understudied population.