Addressing Diabetes/CVD Health Disparities among American Indians: A Transdiscipl

解决美国印第安人的糖尿病/心血管疾病健康差异：跨学科

• 批准号: 7848779
• 负责人: JANETTE Louise BEALS
• 金额: $ 81万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-28 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7848779
• 关键词: Address; Administrator; Adoption; Age; American; American Indian and Alaska Native; American Indians; Behavior; Biometry; Blood Glucose; Body Weight decreased; Cardiovascular Diseases; Case Management; Cause of Death; Centers for Disease Control and Prevention (U.S.); Clinic; Clinical Sciences; Colorado; Communities; Community Psychology; Complement; Congresses; Coupled; Devices; Diabetes Mellitus; Diet; Diet Habits; Discipline of Nursing; Disease; Doctor of Medicine; Doctor of Philosophy; Educational Curriculum; Educational Technology; Effectiveness; Electronics; Epidemic; Evaluation; Exercise; Face; Faculty; Funding; General Population; Gifts; Healed; Health; Heart; Human Resources; Intervention; Investigation; Knowledge; Life; Lipids; Measurement; Methods; Moderate Exercise; Native Americans; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Overweight; Population; Prevalence; Prevention; Preventive Intervention; Public Health; Public Health Schools; Recovery; Research; Research Infrastructure; Research Personnel; Research Project Grants; Research Training; Risk; Risk Factors; Role; Social Behavior; Stress; Time; Tribes; Underemployment; Unemployment; United States Indian Health Service; United States National Institutes of Health; Universities; Weight; Work; Writing; behavior change; cardiovascular disorder risk; diabetes risk; diabetic; diet and exercise; experience; good diet; healing; health disparity; health economics; implementation research; member; mortality; prevent; primary outcome; programs; secondary outcome; social; social health determinants; theories; tool; urban area

DESCRIPTION (provided by applicant): American Indians and Alaska Natives (AI/ANs) are at increased risk for Type 2 diabetes when compared to other Americans, a gap that continues to widen. Cardiovascular disease (CVD) has become the number one cause of death among AI/ANs, is now more common among AI/ANs than others in the U.S. general population, and is increasing not only in prevalence but also in associated mortality. The greatest risk factor for CVD in AI/ANs is diabetes. Both CVD and diabetes share common risk factors, such as weight and lipid levels, which in turn are strongly related to diet and exercise behaviors. Effective preventive interventions focused on these behaviors hold promise for diminishing the diabetes and CVD disparities AI/ANs face. We propose to use the unique opportunity provided by the NCMHD's Social Determinants of Health Initiative (as part of RFA-OD-09-004) to assess the viability and sustainability of an intervention that makes accessible 2 electronic tools: 1) one for increasing exercise and 2) one for tracking diet and exercise among overweight/obese AI/ANs living in 2 urban areas. This work has 3 aims: 1) To determine whether introduction of 2 electronic devices leads to decreased risk for diabetes and CVD among overweight/obese AI/ANs; 2) To assess the social determinants of resultant changes in diabetes and CVD risk using sociobehavioral theories; and 3) To place the investigations of effectiveness (aims 1 and 2) in a larger translational framework by exploring aspects of reach, adoption, and implementation in order to understand issues of viability and sustainability of this and comparable interventions. This study will take place with 2 Indian Health Service-funded urban Indian clinic populations (Denver and Albuquerque) and be completed by a transdisciplinary team from the Centers for American Indian and Alaska Native Health within the Colorado School of Public Health at the University of Colorado Denver. The placement of this work within larger theoretical frameworks, as well as the focus on diabetes and CVD (diseases becoming more common among many Americans); renders this work for broad public health significance. We are experiencing a nationwide epidemic of overweight and obesity, with concomitant increases in diabetes, CVD, and other conditions. Health disparity populations, including American Indians and Alaska Natives; especially those who are unemployed, underemployed, or otherwise facing financial stress are even less likely to maintain healthy exercise and dietary habits. As we consider the health implications of the current recession, the importance of developing intervention methods which address possible decreases in exercise and healthy diet nationally due to increased financial stress is accentuated. To seize the opportunity do so in a way that allows the expansion of our theoretical understandings of behavior change is extraordinary.

描述（由申请人提供）：与其他美国人相比，美国印第安人和阿拉斯加原住民（AI/ANS）患2型糖尿病的风险增加，这一差距继续扩大。心血管疾病（CVD）已成为AI/ANS中死亡的第一大原因，现在在AI/ANS中比美国普通人群中的其他人更为普遍，并且不仅在患病率上，而且在相关的死亡率方面都在增加。 AI/ANS中CVD的最大风险因素是糖尿病。 CVD和糖尿病都有共同的危险因素，例如体重和脂质水平，而体重和脂质水平又与饮食和运动行为密切相关。针对这些行为的有效预防干预措施有望减少糖尿病和CVD差异AI/ANS面部。我们建议利用NCMHD的健康计划的社会决定因素（作为RFA-OD-09-004的一部分）提供的独特机会，以评估使可访问的2电子工具的干预措施的可行性和可持续性：1）一种用于增加运动的锻炼和2）一种用于追踪和运动的饮食和运动，以在超级ai/obese/obese/obese ai/obese/obese ai/obese ai/obese ai/obese ai/obe ai/ain Ans中居住。这项工作具有3个目的：1）确定引入2种电子设备是否导致超重/肥胖AI/ANS中糖尿病和CVD的风险降低； 2）评估使用社会行为理论的糖尿病和CVD风险变化的社会决定因素； 3）通过探索覆盖范围，采用和实施方面，将有效性的调查（目标1和2）放在更大的翻译框架中，以了解这种和可比的干预措施的可行性和可持续性问题。这项研究将与印度卫生服务资助的印度临床人口（丹佛和阿尔伯克基）一起进行，并由科罗拉多大学丹佛大学科罗拉多州公共卫生中的美洲印第安人和阿拉斯加本地健康中心的跨学科团队完成。这项工作的放置在较大的理论框架中，以及对糖尿病和CVD的关注（疾病在许多美国人中变得越来越普遍）；使这项工作具有广泛的公共卫生意义。我们正在经历超重和肥胖症的全国流行病，糖尿病，CVD和其他疾病的增加。健康差异人群，包括美洲印第安人和阿拉斯加人；特别是那些失业，就业不足或面临财务压力的人甚至不太可能保持健康的运动和饮食习惯。当我们考虑当前经济衰退的健康影响时，开发干预方法的重要性，该方法解决了由于财务压力增加而在全国范围内可能减少的锻炼和健康饮食的重要性。抓住机会的方式可以使我们对行为改变的理论理解的发展是非凡的。