Understanding Health Disparities in the Progression of Type 2 Diabetes

了解 2 型糖尿病进展过程中的健康差异

• 批准号: 8074719
• 负责人: JAMES SIDNEY JACKSON
• 金额: $ 38.63万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8074719
• 关键词: Accounting; Address; Adherence; Adrenal Glands; Alcohol consumption; Alcohols; Animals; Behavior; Behavior Therapy; Behavioral; Blood Glucose; Carbohydrates; Cardiovascular Diseases; Cardiovascular system; Caring; Categories; Characteristics; Chronic; Chronic stress; Clinic; Clinical Research; Contracts; Developing Countries; Development; Diabetes Mellitus; Diagnosis; Diet; Disadvantaged; Disease; Endocrine system; Epidemic; Equation; Ethnic group; Exercise; Exposure to; Fatty acid glycerol esters; Functional disorder; Future; Health Policy; Health behavior; Hypertension; Hypothalamic structure; Incidence; Individual; International; Intervention; Intervention Studies; Lead; Life; Life Cycle Stages; Life Style; Link; Literature; Major Depressive Disorder; Measures; Mental Depression; Mental Health; Mental disorders; Metabolic; Metabolic Diseases; Modeling; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Pathway interactions; Patients; Pattern; Physical activity; Physiological; Pituitary Gland; Population; Poverty; Prevalence; Prevention strategy; Preventive Intervention; Public Health; Race; Recommendation; Relative (related person); Research; Respondent; Risk; Risk Factors; Sampling; Smoke; Smoking; Social Environment; Source; Staging; Stress; Stress and Coping; Stressful Event; Structure; Survival Analysis; Techniques; Tobacco smoking; base; biological adaptation to stress; coping; cost; design; early onset; effective intervention; experience; health disparity; hypertensive heart disease; hypothalamic-pituitary-adrenal axis; improved; longitudinal design; physical conditioning; population based; programs; psychological distress; racial and ethnic; racial difference; response; stress related disorder

DESCRIPTION (provided by applicant): It is well-established that modifiable, lifestyle-related behaviors including smoking, alcohol, diet, and physical activity greatly contribute to the risk of most common physical health conditions. The recent, almost epidemic increase in the prevalence of diseases associated with these health behaviors, especially hypertension, type 2 diabetes, cardiovascular disease (CVD), and growing disparities in the burden of these conditions across racial and ethnic groups, highlights the urgency of developing effective prevention strategies - however, few intervention studies have produced long-term changes in lifestyle and behaviors. Addressing an omission in existing behavioral intervention models, we propose that what is needed is an examination of behavioral change in the context of the interrelationships among health behaviors, sources of and coping responses to chronic stress, and their influence on physical and mental health. This proposal is motivated by a robust literature that indicates blacks in the US are more likely to engage in poor health behaviors (i.e., tobacco smoking, diets high in fat and carbohydrates, excessive alcohol use) and, expectedly, experience disproportionate burdens of common physical health conditions associated with these behaviors, including CVD and diabetes, relative to non-Hispanic whites - paradoxically, however, population-based and clinic studies have consistently found that blacks, in comparison to whites, have the same or lower rates of most mental disorders, even while experiencing higher rates of psychological distress. We theorize that a defined set of health-related stress-coping strategies (i.e., tobacco smoking, diets high in fat and carbohydrates, excessive alcohol use, etc) have a two-pronged effect that helps to account for this counterintuitive patterning. First, we suggest that these behaviors act on the hypothalamic-pituitary-adrenal (HPA) axis and related stress- hormonal systems which influences the subjective experience and development of stress-associated psychiatric disorder. Second, we believe that the effects of these poor behaviors on pathophysiology, combined with direct effects of stressful living conditions over the life-course, contribute to disproportionate burden of chronic physical health problems among blacks. Succinctly, we propose that blacks and other individuals from highly stressed populations "buy" their relative, comparatively positive rates of mental disorders at the expense of their deteriorating physical health. Therefore, this framework suggests that adherence to traditional preventative care, specifically involving changes in behavioral lifestyle, can lead to a perverse result: improvements in physical health but worsening of mental health. We will extend this line of research and assess the effect of traditional preventative care among three categories of type 2 diabetes patients: 1) pre- or borderline; 2) early onset; and, 3) poorly-controlled. In the proposed accelerated longitudinal design we will examine the inter-relationships among stress, health behaviors, and physical and mental health at three distinct points of diabetes progression. PUBLIC HEALTH RELEVANCE: Type 2 diabetes and its associated risk factors such as hypertension and heart disease continue to top the domestic and international public health agendas. The diagnoses of these conditions are invariably followed by recommendations for extensive behavioral modifications. In all cases rates of long-term adherence to recommended healthy behavioral changes are spotty at best, both intra-and inter-individually. We believe that physical and mental health disparities are linked to the lack of behavioral change adherence. The findings of this study will help anticipate, understand, and identify informal and formal programs and public health policies needed to address the physical and mental health challenges facing the growing epidemic of related cardiovascular and metabolic disorders in the U.S. and other developed and developing countries.

描述（由申请人提供）：众所周知，可改变的生活方式相关行为，包括吸烟、饮酒、饮食和体力活动，极大地增加了大多数常见身体健康状况的风险。最近，与这些健康行为相关的疾病的患病率几乎呈流行性增加，特别是高血压，2型糖尿病，心血管疾病（CVD），以及这些疾病在种族和民族群体中的负担日益增加的差异，突出了制定有效预防策略的紧迫性-然而，很少有干预研究产生了长期的生活方式和行为改变。针对现有的行为干预模型的遗漏，我们建议，需要的是检查行为变化的背景下，健康行为，慢性压力的来源和应对反应之间的相互关系，以及它们对身心健康的影响。这一提议的动机是一个强大的文献，表明黑人在美国更有可能从事不良健康行为（即，吸烟，高脂肪和碳水化合物饮食，过量饮酒），而且，与非西班牙裔白人相比，经历与这些行为相关的常见身体健康状况的不成比例的负担，包括心血管疾病和糖尿病-矛盾的是，然而，基于人口和临床的研究一直发现，与白人相比，黑人具有相同或更低的大多数精神疾病的发病率，即使在经历更高的心理痛苦的时候。我们的理论是，一套定义的健康相关的压力应对策略（即，吸烟、高脂肪和碳水化合物饮食、过量饮酒等）具有双管齐下的效果，有助于解释这种违反直觉的模式。首先，我们认为这些行为作用于下丘脑-垂体-肾上腺（HPA）轴和相关的应激激素系统，影响主观体验和应激相关精神障碍的发展。其次，我们认为，这些不良行为对病理生理学的影响，加上生活压力的直接影响，导致黑人慢性身体健康问题的负担不成比例。简而言之，我们建议黑人和其他来自高度压力人群的个体以牺牲他们不断恶化的身体健康为代价，“购买”他们相对的、相对积极的精神障碍率。因此，这一框架表明，坚持传统的预防保健，特别是涉及行为生活方式的改变，可能会导致一个反常的结果：身体健康的改善，但心理健康的恶化。我们将扩展这一研究路线，并评估传统预防护理在三类2型糖尿病患者中的效果：1）前期或临界; 2）早期发病; 3）控制不良。在建议的加速纵向设计中，我们将在糖尿病进展的三个不同点上研究压力、健康行为和身心健康之间的相互关系。 公共卫生关系：2型糖尿病及其相关的风险因素，如高血压和心脏病，仍然是国内和国际公共卫生议程的首要问题。这些条件的诊断总是遵循广泛的行为修改的建议。在所有情况下，无论是个体内部还是个体之间，长期坚持建议的健康行为改变的比率充其量都是参差不齐的。我们认为，身体和心理健康的差异与缺乏行为改变依从性有关。这项研究的结果将有助于预测，理解和确定非正式和正式的计划和公共卫生政策，以解决美国和其他发达国家和发展中国家日益增长的心血管和代谢疾病流行所面临的身心健康挑战。