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: 7941994
• 负责人: JANETTE Louise BEALS
• 金额: $ 52.5万
• 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 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941994
• 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，美洲印第安人和阿拉斯加原住民 (AI/AN) 患 2 型糖尿病的风险更高，而且这一差距还在继续扩大。心血管疾病 (CVD) 已成为 AI/AN 的第一大死因，目前在 AI/AN 中比美国普通人群中的其他疾病更为常见，并且不仅患病率在增加，相关死亡率也在增加。 AI/AN 中 CVD 的最大危险因素是糖尿病。心血管疾病和糖尿病都有共同的危险因素，例如体重和血脂水平，而这些因素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缩小 AI/AN 面临的糖尿病和心血管疾病差异。我们建议利用 NCMHD 健康问题社会决定因素倡议（作为 RFA-OD-09-004 的一部分）提供的独特机会来评估一项干预措施的可行性和可持续性，该干预措施可提供 2 种电子工具：1) 一种用于增加锻炼2) 一个用于跟踪居住在 2 个城市地区的超重/肥胖 AI/AN 的饮食和锻炼情况。这项工作有 3 个目标： 1) 确定引入 2 种电子设备是否会降低超重/肥胖 AI/AN 患糖尿病和 CVD 的风险； 2) 使用社会行为理论评估糖尿病和心血管疾病风险变化的社会决定因素； 3) 通过探索影响范围、采用和实施等方面，将有效性调查（目标 1 和 2）置于更大的转化框架中，以了解本干预措施和类似干预措施的可行性和可持续性问题。这项研究将在两个印第安人健康服务资助的城市印第安人诊所人群（丹佛和阿尔伯克基）中进行，并由科罗拉多大学科罗拉多公共卫生学院美洲印第安人和阿拉斯加原住民健康中心的跨学科团队完成丹佛。将这项工作置于更大的理论框架内，并重点关注糖尿病和心血管疾病（这些疾病在许多美国人中变得越来越常见）；使这项工作具有广泛的公共卫生意义。我们正在经历全国范围内超重和肥胖的流行，同时糖尿病、心血管疾病和其他疾病的发病率也随之增加。健康差异人群，包括美洲印第安人和阿拉斯加原住民；尤其是那些失业、就业不足或面临经济压力的人，更不可能保持健康的锻炼和饮食习惯。当我们考虑当前经济衰退对健康的影响时，强调了制定干预方法的重要性，以解决由于财务压力增加而导致全国范围内运动和健康饮食可能减少的问题。为了抓住这个机会，以一种能够扩展我们对行为改变的理论理解的方式做到这一点是非同寻常的。