Addressing Diabetes/CVD Health Disparities among American Indians: A Transdiscipl

描述(由申请人提供)：与其他美国人相比，美国印第安人和阿拉斯加原住民(AI/ANS)患2型糖尿病的风险更高，这一差距仍在继续扩大。心血管疾病(CVD)已成为AI/ANS中的头号死亡原因，目前在AI/ANS中比美国普通人群中的其他疾病更常见，而且不仅患病率和相关死亡率都在上升。糖尿病是AI/ANS中心血管疾病的最大危险因素。心血管疾病和糖尿病都有共同的危险因素，如体重和血脂水平，而这些因素反过来又与饮食和锻炼行为密切相关。针对这些行为的有效预防干预有望减少AI/ANS面临的糖尿病和心血管疾病差异。我们建议利用NCMHD的社会健康决定因素倡议(作为RFA-OD-09-004的一部分)提供的独特机会来评估一项干预措施的可行性和可持续性，该干预措施使两个电子工具可用：1)一个用于增加运动，2)一个用于跟踪居住在两个城市地区的超重/肥胖AI/AN的饮食和运动。这项工作有3个目标：1)确定2个电子设备的引入是否导致超重/肥胖的AI/ANS中糖尿病和心血管疾病风险的降低；2)使用社会行为理论评估糖尿病和心血管疾病风险结果变化的社会决定因素；以及3)通过探索REACH、采用和实施方面的问题，将有效性研究(目标1和2)置于更大的翻译框架中，以了解该干预措施和类似干预措施的可行性和可持续性问题。这项研究将在2名印度卫生服务资助的印度城市诊所人群(丹佛和阿尔伯克基)中进行，并由科罗拉多大学丹佛大学科罗拉多公共卫生学院内的美国印第安人和阿拉斯加原住民健康中心的跨学科小组完成。将这项工作置于更大的理论框架内，以及对糖尿病和心血管疾病(在许多美国人中变得越来越常见的疾病)的关注，使这项工作具有广泛的公共卫生意义。我们正在经历一场全国范围内的超重和肥胖流行病，随之而来的是糖尿病、心血管疾病和其他疾病的增加。健康差距人群，包括美洲印第安人和阿拉斯加原住民；特别是那些失业、未充分就业或面临经济压力的人，保持健康运动和饮食习惯的可能性更小。在我们考虑当前经济衰退对健康的影响时，制定干预方法的重要性得到了强调，这些方法可以解决由于经济压力增加而可能导致的全国锻炼和健康饮食的减少。抓住机会，以一种允许扩展我们对行为变化的理论理解的方式这样做，是非同寻常的。

DESCRIPTION (provided by applicant): American Indians and Alaska Natives (AI/ANs) are at increased risk for Type 2 diabetes when compared to other Americans, a gap that continues to widen. Cardiovascular disease (CVD) has become the number one cause of death among AI/ANs, is now more common among AI/ANs than others in the U.S. general population, and is increasing not only in prevalence but also in associated mortality. The greatest risk factor for CVD in AI/ANs is diabetes. Both CVD and diabetes share common risk factors, such as weight and lipid levels, which in turn are strongly related to diet and exercise behaviors. Effective preventive interventions focused on these behaviors hold promise for diminishing the diabetes and CVD disparities AI/ANs face. We propose to use the unique opportunity provided by the NCMHD's Social Determinants of Health Initiative (as part of RFA-OD-09-004) to assess the viability and sustainability of an intervention that makes accessible 2 electronic tools: 1) one for increasing exercise and 2) one for tracking diet and exercise among overweight/obese AI/ANs living in 2 urban areas. This work has 3 aims: 1) To determine whether introduction of 2 electronic devices leads to decreased risk for diabetes and CVD among overweight/obese AI/ANs; 2) To assess the social determinants of resultant changes in diabetes and CVD risk using sociobehavioral theories; and 3) To place the investigations of effectiveness (aims 1 and 2) in a larger translational framework by exploring aspects of reach, adoption, and implementation in order to understand issues of viability and sustainability of this and comparable interventions. This study will take place with 2 Indian Health Service-funded urban Indian clinic populations (Denver and Albuquerque) and be completed by a transdisciplinary team from the Centers for American Indian and Alaska Native Health within the Colorado School of Public Health at the University of Colorado Denver. The placement of this work within larger theoretical frameworks, as well as the focus on diabetes and CVD (diseases becoming more common among many Americans); renders this work for broad public health significance. We are experiencing a nationwide epidemic of overweight and obesity, with concomitant increases in diabetes, CVD, and other conditions. Health disparity populations, including American Indians and Alaska Natives; especially those who are unemployed, underemployed, or otherwise facing financial stress are even less likely to maintain healthy exercise and dietary habits. As we consider the health implications of the current recession, the importance of developing intervention methods which address possible decreases in exercise and healthy diet nationally due to increased financial stress is accentuated. To seize the opportunity do so in a way that allows the expansion of our theoretical understandings of behavior change is extraordinary.