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: 10549846
• 负责人: Jennifer Annette Campbell
• 金额: $ 13.82万
• 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/10549846
• 关键词: Address; Adult; Affect; African American population; Attention; Behavior; Case/Control Studies; Cessation of life; Chronic Disease; Chronic stress; Clinical; Communities; Cost Effectiveness Analysis; Developing Countries; Diabetes Mellitus; Diet; Discrimination; Education; Environment; Exercise; Fostering; Funding; Future; Glycosylated hemoglobin A; Health; Health education; High Prevalence; Imprisonment; Income; Individual; Inequity; Intervention; Mental Health; Morbidity - disease rate; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Nurses; Outcome; Poverty; Preparation; Preventive care; Productivity; 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; Work; comparison intervention; coping; cost; cost estimate; design; diabetes education; 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; poor health outcome; 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.

13% 的美国成年人患有糖尿病，非洲裔美国人 (AA) 的糖尿病患病率更高， 与非西班牙裔人相比，糖尿病相关费用、并发症风险更高以及过早死亡的风险更高 白人。结构性因素是导致 AA 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红线和限制性契约，迫使AA 居住在大多数城市地区内城的不太理想的社区。最近的一个社区案例 我们在密尔沃基的团队进行的研究确定了解决内部健康差异的新范例 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、代际贫困以及教育机会有限 市中心 AA 的生活经历造成了一种慢性压力状态，从而导致健康状况不佳并增加了 残疾，并最终导致人力资本（定义为无形的、但完整的、经济上的）减少。 个人的生产力方面）。一项有希望的干预措施，可以解决与贫困相关的根本问题 对于患有 2 型糖尿病 (T2DM) 的 AA 来说，结构性种族主义和生活在市中心环境中的慢性压力是 现金转移，可以是有条件的或无条件的。有条件现金转移（CCT）补充 基本收入以进行某些与健康相关的活动为条件，例如参加健康教育 课程或完成预防性护理建议，而无条件现金转移（UCT）则不是 以任何必需的活动为条件。然而，CCT 和 UCT 尚未在美国进行测试，因为 减轻与贫困有关的长期压力的战略，这种压力有损于慢性病患者的有效自我护理 AA 内城区的 T2DM 等疾病。这项研究将测试糖尿病定制 CCT（DM- CCT），其条件是参加每两周一次、护士主导的虚拟糖尿病 与 UCT 相比，教育/技能培训和压力/应对干预（无需参与） 100 个控制不良的内城区 AA 的临床结果、自我保健行为和心理健康 使用 RCT 设计的 T2DM。拟议研究的目的包括： AIM 1：测试初步功效 DM-CCT 干预对患有 T2DM 的市中心 AA 的血糖控制和生活质量。目标 2：测试 DM-CCT 干预对内城区自我护理行为和心理健康的初步效果 AA 与 T2DM。目标 3：估算 DM-CCT 和 UCT 干预措施的实施成本，为 未来成本效益分析。