Mujeres Interesadas en Cambios por la Salud (MI CASA)

描述（由申请人提供）：墨西哥裔美国妇女是肥胖和2型糖尿病（T2D）风险最脆弱和服务不足的人群之一。利用翻译研究范式，我们建议在德克萨斯州圣安东尼奥西区（一个高度贫困的内城社区）试点一个以社区为基础的、具有文化敏感性的T2D预防项目，该项目名为“关注改变健康生活方式的女性”。MI CASA以两个成功的随机临床试验（RCT）项目为蓝本，分别是美国糖尿病预防项目和芬兰糖尿病预防研究项目，这两个项目都是以初级保健为基础的T2D预防项目。MI CASA建立在Edgewood家庭网络（EFN）的现有基础设施之上，EFN是一个基层倡导组织，旨在改善圣安东尼奥西区居民的福祉。初级社区保健服务将由全民保健网络的推广人员（非专业社区保健工作者）提供。200名非糖尿病墨西哥裔美国女性（年龄25 - 65岁），BMI 28 - 40， T2D家族史，缺乏运动，或先前诊断为空腹糖耐量或妊娠糖尿病，将从社区医院招募，并在基线测试后随机分为干预组或对照组。提出的研究假设，在9个月的干预结束时，以促进剂为主导的生活方式干预将显著降低MI CASA参与者的体重、体脂百分比和空腹血糖，并增加心肺健康。我们还将对降低体重和空腹血糖的成本效益进行分析。将使用一个流动卫生实验室在社区方便的地点收集数据。由训练有素的卫生专业人员实施有组织的、密集的生活方式干预，成本过高，难以广泛传播。MI CASA主要针对低成本、可获得的体育活动形式，以及由推广人员提供的具有文化敏感性的健康饮食习惯；如果成功，它有可能在资源有限、服务不足的社区传播。项目的可持续性通过与社区医院的联系以及利用社区倡导组织提供的服务、低成本设备和现有的物理基础设施得到加强。很少有证据表明，在高危少数人群中，促进者主导的生活方式改变项目在扭转肥胖和降低T2D风险方面的有效性。因此，本研究符合美国国立卫生研究院医学研究路线图中减少实验室/临床研究与社区健康促进之间差距的目标。最后，拟议的研究解决了2010年健康人10个优先公共卫生问题中的3个问题（缺乏身体活动、超重/肥胖和获得卫生保健）。

DESCRIPTION (provided by applicant): Mexican American women are one of the most vulnerable and underserved populations at risk for obesity and Type 2 Diabetes (T2D). Utilizing a translation research paradigm, we propose to pilot a community-based, culturally sensitive T2D prevention program for high-risk Mexican American women, "Mujeres Interesadas en Cambios por la Salud" (MI CASA; Women Interested in Changes for a Healthy Lifestyle) in West Side San Antonio, Texas, a highly impoverished inner-city community. MI CASA is modeled after two successful programs that have been tested in randomized clinical trials (RCT), the U.S. Diabetes Prevention Program and the Finnish Diabetes Prevention Study - both primary care-based T2D prevention programs. MI CASA has been built upon the existing infrastructure of the Edgewood Family Network (EFN), a grassroots advocacy group for improving the well-being of residents in West Side San Antonio. MI CASA will be delivered by EFN's promotoras de salud (lay community health workers). Two hundred non-diabetic Mexican American females (ages 25 to 65), who have BMI 28 to 40, family history of T2D, and physical inactivity or who have previously diagnosed fasting glucose tolerance or gestational diabetes, will be recruited from a community hospital and randomized into intervention or comparison conditions after baseline testing. The proposed study hypothesizes that a promotoras-led lifestyle intervention will significantly reduce body weight, percent body fat, and fasting glucose and increase cardiorespiratory fitness in MI CASA participants at the end of the 9-mo intervention. We will also conduct an analysis of cost-effectiveness on the reduction of body weight and fasting glucose. A mobile health laboratory will be used to collect data in convenient locations in the community. Implementation of a structured, intensive lifestyle intervention by highly trained health professionals is cost-prohibitive to widespread dissemination. MI CASA primarily targets low cost, accessible forms of physical activity, and culturally sensitive healthy eating practices delivered by promotoras; if successful, it has the potential to be disseminated in underserved communities with limited resources. Program sustainability is enhanced by its connection with a community hospital and utilization of a community advocacy group for delivery, low cost equipment, and existing physical infrastructure. Little evidence exists regarding the effectiveness of promotoras-led lifestyle change programs in high-risk minority populations to reverse obesity and reduce risk for T2D. Thus, this study fits the goal of reducing the gap between bench/clinical research and health promotion at the community level in the NIH Roadmap for Medical Research. Finally, the proposed study addresses three (physical inactivity, overweight/obesity, and access to health care) of the 10 priority public health issues in Healthy People 2010. PUBLIC HEALTH RELEVANCE: The proposed study will pilot the feasibility of a promotoras-led lifestyle intervention program to lose weight and reduce risk for type 2 diabetes in high risk Mexican-American women. If successful, the low-cost intervention can be disseminated to underserved communities across country.