Strong Men, Strong Communities: Cultural Tradition to Improve Native Men's Health

坚强的男人，强大的社区：改善土著男性健康的文化传统

• 批准号: 9062440
• 负责人: KA'IMI ALOHILANI SINCLAIR
• 金额: $ 46.67万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9062440
• 关键词: 21 year old; Address; Affordable Care Act; Age; Age-Years; American Indians; Animals; Bison; Blood Pressure; Body Weight decreased; Climate; Clinic; Clinical; Communities; Community Participation; Complications of Diabetes Mellitus; Control Groups; Data; Death Rate; Diabetes Mellitus; Diabetes prevention; Diagnosis; Diet; Drops; Economics; Elements; Employee Strikes; Enrollment; Epidemic; Ethnic group; Evaluation; Feedback; Fishes; Focus Groups; Gender; Gender Role; Habits; Health; Health Status; Health behavior; High Prevalence; Incidence; Indian reservation; Indigenous; Individual; Intervention; Life Style; Measures; Methods; Mille Lacs Band; Minnesota; Minority; Minority Groups; Native Americans; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Obesity; Ojibwe; Outcome; Overweight; Participant; Perception; Phase; Physical activity; Population; Prevalence; Proteins; Public Health; Race; Randomized; Randomized Controlled Trials; Recruitment Activity; Resources; Risk Factors; Risk Reduction; Site; Universities; Waiting Lists; Washington; Woman; base; clinical care; community intervention; community setting; cost; cost effective; design; diabetes prevention program; diabetes risk; experience; fruits and vegetables; good diet; group intervention; health disparity; healthy lifestyle; high risk; improved; lifestyle intervention; male; male health; men; men' s group; mortality; prevent; primary outcome; programs; racial and ethnic; response; retention rate; secondary outcome; tribal community; waist circumference

 DESCRIPTION (provided by applicant): American Indian (AI) males experience profound health disparities compared to their counterparts in all other U.S. racial and ethnic groups. For example, AI men have the highest age-adjusted prevalence of type 2 diabetes (~18 percent) among U.S. men, while non-Hispanic White men have the lowest (~7 percent). In recent decades, AIs have seen a disproportionate increase in diabetes-related complications and mortality compared to all other groups, such that age-adjusted diabetes death rates in AI men are now almost twice those in White men. Several large randomized, controlled trials in non-AIs confirm that type 2 diabetes can be prevented or delayed by interventions that promote healthy lifestyles, but little empirical data exist on interventions to prevent diabetes in AI men. In the clinic-based U.S. Diabetes Prevention Program (DPP), only 55 out of 3,234 participants were AI men. Similarly, in the diabetes prevention programs in Native communities, participation by AI males is low, ranging from 33 percent to 74 percent. Many explanations have been posited for the low participation rates among men of all races in lifestyle interventions. Recruiting AI men in clinic-based programs is difficult because they tend to seek clinical care less often than women. AI men's perceptions of normative health behaviors and gender roles may also discourage participation, particularly in mixed-gender groups. Therefore, an urgent need exists for diabetes risk reduction programs tailored to the unique values and habits of AI men, with a particular focus on recruitment and retention. We are collaborating with the Mille Lacs Band of Ojibwe (Minnesota), the Indian Health Board of Minneapolis (Minnesota), and Yakama Nation and Heritage University Center for Native American Health and Culture (Washington) to develop the Strong Men, Strong Communities (SMSC) program. This is a culturally appropriate approach for AI men that targets modifiable diabetes risk factors. It uses methods adapted from successful, non-clinic based programs for other high-risk minority populations, and it incorporates elements of DPP and SDPI-DP. Our Specific Aims are to: 1) Refine the SMSC intervention with feedback from focus groups in our 3 partner communities. 2) Compare change in diabetes risk score (primary outcome) and modifiable diabetes risk factors (secondary outcomes) in the SMSC intervention and wait-list control groups. 3) Evaluate the ability of SMSC to retain 80 percent of 240 AI male participants, 21-65 years of age with no previous diagnosis of diabetes. The proposed study fills a striking gap in approaches to increase recruitment and participation in lifestyle programs that reduce diabetes risk in AI men. The proposed study will have broad implications for the ongoing epidemic of AI obesity and diabetes. Given the need to increase AI men's participation in lifestyle interventions, our findings might have substantial public health impact on tribal communities across the U.S.

 描述（由申请人提供）：与美国所有其他种族和族裔群体的男性相比，美洲印第安人 (AI) 男性的健康状况存在巨大差异。例如，在美国男性中，人工智能男性的 2 型糖尿病患病率按年龄调整最高（约 18%），而非西班牙裔白人男性的患病率最低（约 7%）。近几十年来，与所有其他群体相比，人工智能的糖尿病相关并发症和死亡率不成比例地增加，因此人工智能男性的年龄调整糖尿病死亡率现在几乎是白人男性的两倍。几项针对非 AI 的大型随机对照试验证实，可以通过促进健康生活方式的干预措施来预防或延迟 2 型糖尿病，但关于预防 AI 男性糖尿病的干预措施的经验数据很少。在以诊所为基础的美国糖尿病预防计划 (DPP) 中，3,234 名参与者中只有 55 名是 AI 男性。同样，在原住民社区的糖尿病预防项目中，AI 男性的参与率很低，从 33% 到 74% 不等。对于所有种族男性生活方式干预参与率低的原因，人们提出了多种解释。招募 AI 人员 基于临床的方案很困难，因为她们寻求临床护理的频率往往低于女性。人工智能男性对规范健康行为和性别角色的看法也可能阻碍参与，特别是在混合性别群体中。因此，迫切需要针对人工智能男性的独特价值观和习惯量身定制糖尿病风险降低计划，特别关注招募和保留。 我们正在与奥及布威族的 Mille Lacs Band（明尼苏达州）、明尼阿波利斯印第安人健康委员会（明尼苏达州）以及亚卡马民族和遗产大学美洲原住民健康与文化中心（华盛顿）合作开发强人强社区 (SMSC) 计划。对于人工智能男性来说，这是一种文化上合适的方法，针对可改变的糖尿病风险因素。它使用的方法改编自针对其他高危少数群体的成功的非临床项目，并结合了 DPP 和 SDPI-DP 的要素。我们的具体目标是： 1) 根据我们 3 个合作伙伴社区焦点小组的反馈完善 SMSC 干预措施。 2) 比较 SMSC 干预组和等待名单对照组的糖尿病风险评分（主要结果）和可改变的糖尿病风险因素（次要结果）的变化。 3) 评估 SMSC 保留 80% 的能力 240 名 AI 男性参与者，年龄在 21-65 岁之间，之前没有糖尿病诊断。这项拟议的研究填补了在增加招募和参与降低人工智能男性糖尿病风险的生活方式计划方面的显着差距。这项拟议的研究将对当前流行的人工智能肥胖和糖尿病产生广泛影响。鉴于需要增加人工智能男性对生活方式干预的参与，我们的研究结果可能会对美国各地的部落社区产生重大的公共卫生影响。