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: 8729896
• 负责人: JAMES SIDNEY JACKSON
• 金额: --
• 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 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8729896
• 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，与生活方式相关的可改变的行为包括吸烟、饮酒、饮食和体育锻炼