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: 8307240
• 负责人: JAMES SIDNEY JACKSON
• 金额: $ 38.49万
• 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/8307240
• 关键词: Accounting; Address; Adherence; 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; Developed Countries; 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; Health Policy; Health behavior; Hypertension; 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; Population; Poverty; Prevalence; Prevention strategy; Public Health; Race; Recommendation; Relative (related person); Research; Respondent; Risk; Risk Factors; Sampling; 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 difference; response; stress related disorder

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.

众所周知，可改变的、与生活方式有关的行为，包括吸烟、饮酒、饮食和身体健康， 活动极大地增加了大多数常见身体健康状况的风险。最近，几乎流行的 与这些健康行为有关的疾病的流行率增加，特别是2型高血压 糖尿病、心血管疾病（CVD）以及不同种族之间这些疾病负担的日益增长的差异 和族裔群体，突出了制定有效预防战略的紧迫性-然而， 干预研究已经使生活方式和行为发生了长期变化。处理《公约》 现有的行为干预模型，我们建议，需要的是检查行为 健康行为、疾病来源和应对措施之间相互关系的背景变化 慢性压力及其对身心健康的影响。这一提议的动机是一个强大的 文献表明美国黑人更有可能从事不良健康行为（即，烟草 吸烟、高脂肪和碳水化合物饮食、过量饮酒）， 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 CVD和糖尿病，相对于非西班牙裔白人-矛盾的是，然而，基于人群和临床 研究一直发现，与白人相比，黑人的大多数死亡率相同或更低， 精神障碍，即使在经历更高的心理痛苦率。我们的理论是， 一套与健康有关的压力应对策略（即，吸烟，高脂肪和碳水化合物的饮食， 过量饮酒等）具有有助于解释这种违反直觉的模式的双管齐下的效果。 首先，我们认为这些行为作用于下丘脑-垂体-肾上腺（HPA）轴和相关的压力- 荷尔蒙系统，影响主观经验和发展的压力相关 精神障碍其次，我们相信这些不良行为对病理生理学的影响， 再加上生活压力的直接影响，造成了不成比例的 黑人慢性身体健康问题的负担。简单地说，我们建议黑人和其他 来自高度压力人群的个体“购买”他们相对的、相对积极的心理健康水平。 以他们日益恶化的身体健康为代价的疾病。因此，该框架表明， 坚持传统的预防性护理，特别是涉及行为生活方式的改变，可能会导致 相反的结果：身体健康得到改善，但心理健康恶化。我们将把这条线延伸到 研究和评估传统预防护理在三种类型的2型糖尿病中的效果 患者：1）前期或临界; 2）早期发作; 3）控制不良。在加快 纵向设计，我们将研究压力，健康行为，身体和 糖尿病进展的三个不同点的心理健康。