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.

糖尿病影响13％的美国成年人和非洲裔美国人（AAS）的糖尿病患病率更高，更高 与非西班牙裔相比 白人。成为AAS健康不良结果的重要因素是结构性的 种族主义。结构性种族主义的一个组成部分是历史上的红线和限制性盟约，迫使AAS 生活在大多数城市地区内城市中不太理想的社区中。最近基于社区的案件 我们的团队在密尔沃基进行的研究确定了一种新的范式，以解决内部健康差异 城市环境。该研究表明，批量监禁，住宅隔离，暴力，住房 不稳定，粮食不安全，代际贫困以及有限的教育机会 市中心AA的生活经验会产生长期压力的状态，从而导致健康状况不佳并增加 残疾，最终导致人力资本减少（定义为无形但不可或缺的，经济上不可或缺的 个人的生产力）。一种有希望的干预措施，可能针对基本贫困有关 结构性种族主义的慢性压力和生活在城市内部环境中的2型糖尿病（T2DM）的慢性压力为 现金转移，可能是有条件的或无条件的。有条件的现金转移（CCT）补品 基本收入有条件地进行某些与健康有关的活动，例如参加健康教育 上课或完成预防性护理建议，而无条件的现金转移（UCT）不是 以任何必需的活动为条件。但是，CCT和UCT尚未在美国测试 一种减轻与贫困相关的慢性压力的策略 内城AAS中的T2DM等疾病。这项研究将测试糖尿病限制的CCT的初步疗效（DM- CCT），这将有条件参加双周（每两周），由护士主导的虚拟糖尿病 与UCT相比 关于临床结果，自我保健行为和心理健康，在100内城市AA中，控制不善 使用RCT设计T2DM。拟议研究的目的包括：目标1：测试初步功效 DM-CCT干预具有T2DM的市中心AA的血糖控制和生活质量。目标2：测试 DM-CCT干预对自我保健行为和心理健康的初步疗效 带有T2DM的AA。目标3：估计DM-CCT和UCT干预措施的交付成本 未来的成本有效性分析。