Understanding Health Disparities in the Progression of Type 2 Diabetes

了解 2 型糖尿病进展过程中的健康差异

• 批准号: 8074719
• 负责人: JAMES SIDNEY JACKSON
• 金额: $ 38.63万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8074719
• 关键词: Accounting; Address; Adherence; Adrenal Glands; Alcohol consumption; Alcohols; Animals; Behavior; Behavior Therapy; Behavioral; Blood Glucose; Carbohydrates; Cardiovascular Diseases; Cardiovascular system; Caring; Categories; Characteristics; Chronic; Chronic stress; Clinic; Clinical Research; Contracts; Developing Countries; Development; Diabetes Mellitus; Diagnosis; Diet; Disadvantaged; Disease; Endocrine system; Epidemic; Equation; Ethnic group; Exercise; Exposure to; Fatty acid glycerol esters; Functional disorder; Future; Health Policy; Health behavior; Hypertension; Hypothalamic structure; Incidence; Individual; International; Intervention; Intervention Studies; Lead; Life; Life Cycle Stages; Life Style; Link; Literature; Major Depressive Disorder; Measures; Mental Depression; Mental Health; Mental disorders; Metabolic; Metabolic Diseases; Modeling; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Pathway interactions; Patients; Pattern; Physical activity; Physiological; Pituitary Gland; Population; Poverty; Prevalence; Prevention strategy; Preventive Intervention; Public Health; Race; Recommendation; Relative (related person); Research; Respondent; Risk; Risk Factors; Sampling; Smoke; Smoking; Social Environment; Source; Staging; Stress; Stress and Coping; Stressful Event; Structure; Survival Analysis; Techniques; Tobacco smoking; base; biological adaptation to stress; coping; cost; design; early onset; effective intervention; experience; health disparity; hypertensive heart disease; hypothalamic-pituitary-adrenal axis; improved; longitudinal design; physical conditioning; population based; programs; psychological distress; racial and ethnic; racial difference; response; stress related disorder

DESCRIPTION (provided by applicant): It is well-established that modifiable, lifestyle-related behaviors including smoking, alcohol, diet, and physical activity greatly contribute to the risk of most common physical health conditions. The recent, almost epidemic increase in the prevalence of diseases associated with these health behaviors, especially hypertension, type 2 diabetes, cardiovascular disease (CVD), and growing disparities in the burden of these conditions across racial and ethnic groups, highlights the urgency of developing effective prevention strategies - however, few intervention studies have produced long-term changes in lifestyle and behaviors. Addressing an omission in existing behavioral intervention models, we propose that what is needed is an examination of behavioral change in the context of the interrelationships among health behaviors, sources of and coping responses to chronic stress, and their influence on physical and mental health. This proposal is motivated by a robust literature that indicates blacks in the US are more likely to engage in poor health behaviors (i.e., tobacco smoking, diets high in fat and carbohydrates, excessive alcohol use) and, expectedly, experience disproportionate burdens of common physical health conditions associated with these behaviors, including CVD and diabetes, relative to non-Hispanic whites - paradoxically, however, population-based and clinic studies have consistently found that blacks, in comparison to whites, have the same or lower rates of most mental disorders, even while experiencing higher rates of psychological distress. We theorize that a defined set of health-related stress-coping strategies (i.e., tobacco smoking, diets high in fat and carbohydrates, excessive alcohol use, etc) have a two-pronged effect that helps to account for this counterintuitive patterning. First, we suggest that these behaviors act on the hypothalamic-pituitary-adrenal (HPA) axis and related stress- hormonal systems which influences the subjective experience and development of stress-associated psychiatric disorder. Second, we believe that the effects of these poor behaviors on pathophysiology, combined with direct effects of stressful living conditions over the life-course, contribute to disproportionate burden of chronic physical health problems among blacks. Succinctly, we propose that blacks and other individuals from highly stressed populations "buy" their relative, comparatively positive rates of mental disorders at the expense of their deteriorating physical health. Therefore, this framework suggests that adherence to traditional preventative care, specifically involving changes in behavioral lifestyle, can lead to a perverse result: improvements in physical health but worsening of mental health. We will extend this line of research and assess the effect of traditional preventative care among three categories of type 2 diabetes patients: 1) pre- or borderline; 2) early onset; and, 3) poorly-controlled. In the proposed accelerated longitudinal design we will examine the inter-relationships among stress, health behaviors, and physical and mental health at three distinct points of diabetes progression. PUBLIC HEALTH RELEVANCE: Type 2 diabetes and its associated risk factors such as hypertension and heart disease continue to top the domestic and international public health agendas. The diagnoses of these conditions are invariably followed by recommendations for extensive behavioral modifications. In all cases rates of long-term adherence to recommended healthy behavioral changes are spotty at best, both intra-and inter-individually. We believe that physical and mental health disparities are linked to the lack of behavioral change adherence. The findings of this study will help anticipate, understand, and identify informal and formal programs and public health policies needed to address the physical and mental health challenges facing the growing epidemic of related cardiovascular and metabolic disorders in the U.S. and other developed and developing countries.

描述（由申请人提供）：众所周知，可改变的、与生活方式相关的行为，包括吸烟、饮酒、饮食和体力活动，会极大地增加最常见身体健康状况的风险。最近，与这些健康行为相关的疾病，特别是高血压、2 型糖尿病、心血管疾病 (CVD) 的患病率几乎呈流行性增长，而且这些疾病在不同种族和族裔群体中的负担差异日益扩大，凸显了发展以下疾病的紧迫性：有效的预防策略——然而，很少有干预研究能够对生活方式和行为产生长期的改变。针对现有行为干预模型中的遗漏，我们建议需要在健康行为、慢性压力的来源和应对反应及其对身心健康的影响之间的相互关系的背景下检查行为变化。该提案的动机是大量文献表明，美国黑人更有可能出现不良健康行为（即吸烟、高脂肪和碳水化合物饮食、过度饮酒），并且预计会承受不成比例的常见身体负担。与非西班牙裔白人相比，与这些行为相关的健康状况，包括心血管疾病和糖尿病 - 然而，矛盾的是，基于人口和临床的研究一致发现，与白人相比，黑人具有相同的健康状况或大多数精神障碍的发生率较低，即使在经历较高的心理困扰发生率时也是如此。我们认为，一套明确的与健康相关的压力应对策略（即吸烟、高脂肪和碳水化合物饮食、过量饮酒等）具有双管齐下的作用，有助于解释这种违反直觉的模式。首先，我们认为这些行为作用于下丘脑-垂体-肾上腺（HPA）轴和相关的压力荷尔蒙系统，影响与压力相关的精神障碍的主观体验和发展。其次，我们认为，这些不良行为对病理生理学的影响，加上一生中压力生活条件的直接影响，导致黑人慢性身体健康问题负担过重。简而言之，我们建议黑人和其他来自高压力人群的个体以牺牲身体健康状况恶化为代价“购买”他们相对的、相对积极的精神障碍发生率。因此，该框架表明，坚持传统的预防性护理，特别是改变行为生活方式，可能会导致反常的结果：身体健康得到改善，但心理健康却恶化。我们将扩展这一研究方向，评估传统预防性护理对三类 2 型糖尿病患者的效果：1) 前期或临界期； 2）发病早； 3）控制不力。在拟议的加速纵向设计中，我们将研究糖尿病进展的三个不同点的压力、健康行为以及身心健康之间的相互关系。 公共卫生相关性：2 型糖尿病及其相关危险因素（如高血压和心脏病）继续成为国内和国际公共卫生议程的首要议题。这些病症的诊断之后总是会提出广泛的行为改变的建议。在所有情况下，长期坚持建议的健康行为改变的比率充其量是参差不齐的，无论是个体内部还是个体之间。我们认为，身心健康差异与缺乏行为改变依从性有关。这项研究的结果将有助于预测、理解和确定非正式和正式的计划和公共卫生政策，以解决美国和其他发达国家和发展中国家日益流行的相关心血管和代谢紊乱所面临的身心健康挑战。