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

13%的美国成年人患有糖尿病，非裔美国人(AA)的糖尿病患病率更高， 与非西班牙裔相比，糖尿病相关费用、并发症风险和早期死亡风险更高 白色的。一个关键因素是结构性的，它正在成为导致AAA健康状况不佳的一个重要因素 种族主义。结构性种族主义的一个组成部分是历史上的红线和限制性契约，这些契约迫使AA 居住在大多数城市中心城区的不太理想的社区。最近一起以社区为基础的案件 我们的团队在密尔沃基进行的研究发现了一种新的范式来解决内部和外部的健康差距 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、代际贫困和有限的教育机会 市区居民的生活经历造成了一种长期的压力状态，从而导致健康状况不佳和增加 残疾并最终导致人力资本减少(定义为无形的、但不可或缺的、经济上的 个人的生产方面)。一种有希望的干预措施，可能会解决与 结构性种族主义和居住在市中心环境对患有2型糖尿病(T2 DM)的AA患者的长期压力是 现金转移，可以是有条件的，也可以是无条件的。有条件现金转移(CCT)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 课程或完成预防性护理建议，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还没有在美国进行测试，因为 缓解与贫困相关的慢性压力的战略，这些压力有损于对慢性病患者的有效自我护理 像T2 DM这样的疾病在市中心的AAS。这项研究将测试糖尿病定制CCT(DM-CCT)的初步疗效。 CCT)，这将以参加双周(每两周)、护士引导的虚拟糖尿病为条件 与UCT相比，教育/技能培训和压力/应对干预(不要求参加) 100例控制不良的城区AAS患者的临床结局、自我护理行为和心理健康状况 使用RCT设计的T2 DM。拟议研究的目标包括：目标1：测试 DM-CCT干预对市区2型糖尿病腹主动脉硬化患者血糖控制和生活质量的影响目标2：测试 DM-CCT干预对城区居民自我护理行为和心理健康的初步效果 AAS合并T2 DM。目标3：估计DM-CCT和UCT干预措施的交付成本 未来成本效益分析。

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.