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.

糖尿病影响了13%的美国成年人，非裔美国人（AAs）的糖尿病患病率更高