Conditional Cash Transfer Intervention to Improve Health Outcomes among Inner-City African Americans with T2DM

有条件现金转移干预可改善患有 T2DM 的内城非裔美国人的健康状况

• 批准号: 10351648
• 负责人: Jennifer Annette Campbell
• 金额: $ 13.97万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-12 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10351648
• 关键词: Address; Adult; Affect; African American population; Attention; Behavior; Case-Control Studies; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chronic Disease; Chronic stress; Clinical; Communities; Cost Effectiveness Analysis; Developing Countries; Diabetes Mellitus; Discrimination; Environment; Fostering; Funding; Future; Glycosylated hemoglobin A; Health; Health education; High Prevalence; Imprisonment; Income; Individual; Intervention; Mental Health; Morbidity - disease rate; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Nurses; Outcome; Poverty; Preparation; Preventive care; Psyche structure; Quality of life; Randomized; Recommendation; Resources; SF-12; Self Care; Social Environment; Societies; Stress; Stress and Coping; Structural Racism; System; Testing; United States; Violence; Walkers; Work; comparison intervention; cost; cost estimate; design; diabetes education; diet and exercise; disability; experience; food insecurity; functional status; glycemic control; health disparity; high risk; housing instability; human capital; improved; inner city; intergenerational; medication compliance; mortality; physically handicapped; poverty alleviation; racial health disparity; residential segregation; skills training; urban area; virtual

Diabetes affects 13% of US adults and African Americans (AAs) have higher prevalence of diabetes, higher diabetes related cost, higher risk of complications, and higher risk of early death compared to non-Hispanic Whites. A key factor that is emerging as a significant contributor to poor health outcomes for AAs is structural racism. A component of structural racism is historical redlining and restrictive covenants that has forced AAs to live in less-than-optimal neighborhoods in inner cities of most urban areas. A recent community-based case study conducted by our team in Milwaukee identified a new paradigm for addressing health disparities in inner- city environments. The study suggests that mass incarceration, residential segregation, violence, housing instability, food insecurity, intergenerational poverty, and the limited educational opportunities that characterize the lived experience of inner-city AAs create a state of chronic stress, which leads to poor health and increased disability and ultimately leads to decreased human capital (defined as the intangible, yet integral, economically productive aspects of individuals). A promising intervention that may address the underlying poverty related chronic stress of structural racism and living in inner city environments for AAs with type 2 diabetes (T2DM) is Cash Transfer, which can be conditional or unconditional. Conditional cash transfers (CCTs) supplements basic income conditional on performing certain health-related activities such as attending health education classes or completing preventive care recommendations, whereas unconditional cash transfers (UCTs) are not conditional on any required activities. However, CCTs and UCTs have not been tested in the United States as a strategy to alleviate the poverty-related chronic stress that detract from effective self-care for chronic diseases like T2DM in inner city AAs. This study will test the preliminary efficacy of diabetes-tailored CCT (DM- CCT), which will be conditional on participating in biweekly (every two weeks), nurse-led, virtual diabetes education/skills training and stress/coping intervention compared to UCT (with no requirement for participation) on clinical outcomes, self-care behaviors, and psychological health in 100 inner city AAs with poorly controlled T2DM using an RCT design. The aims of the proposed study include: AIM 1: Test the preliminary efficacy of the DM-CCT intervention on glycemic control and quality of life for inner-city AAs with T2DM. AIM 2: Test the preliminary efficacy of the DM-CCT intervention on self-care behaviors and psychological health for inner-city AAs with T2DM. AIM 3: Estimate the cost of delivery of the DM-CCT and UCT interventions in preparation for future cost effectiveness analysis.

糖尿病影响13%的美国成年人，非洲裔美国人（AA）的糖尿病患病率较高， 与非西班牙裔相比，糖尿病相关费用、并发症风险更高、早期死亡风险更高 白人一个关键因素，正在成为一个显着的贡献者，为不良的健康结果的AA是结构性的 种族主义结构性种族主义的一个组成部分是历史性的红线和限制性公约，迫使AA 居住在大多数城市地区的市中心的不太理想的社区。最近的一个社区案例 我们的团队在密尔沃基进行的一项研究确定了一种新的范式， 城市环境。研究表明，大规模监禁，居住隔离，暴力，住房 不稳定、粮食不安全、代际贫困和教育机会有限， 市中心AA的生活经历造成了一种慢性压力状态，这导致健康状况不佳， 残疾，并最终导致人力资本减少（定义为无形的，但整体的，经济的， 个人的生产力）。一项有希望的干预措施，可解决与贫困有关的根本问题， 结构性种族主义和生活在市中心环境中的2型糖尿病（T2 DM）AA的慢性压力是 现金转移，可以是有条件的或无条件的。有条件现金转移支付补充 基本收入，条件是从事某些与健康有关的活动，如参加健康教育 课程或完成预防保健建议，而无条件现金转移（UCT）不是 以任何必要的活动为条件。然而，CCT和UCT尚未在美国进行测试， 一项战略，以减轻与贫困有关的慢性压力，减损有效的自我照顾的慢性 像T2 DM这样的疾病。这项研究将测试糖尿病定制的CCT（DM-1）的初步疗效。 CCT），这将是有条件的参加双周（每两周），护士主导，虚拟糖尿病 教育/技能培训和压力/应对干预，与UCT相比（不要求参与） 在100名控制不良的市中心AA中， 使用RCT设计的T2 DM。拟议研究的目的包括：目的1：测试 DM-CCT干预对城市AA患者2型糖尿病血糖控制和生活质量影响目标2：测试 DM-CCT干预对城市居民自理行为和心理健康的初步效果 T2 DM患者的AA。目标3：估计DM-CCT和UCT干预措施的实施成本， 未来成本效益分析。