Preventing Diabetes in Latino Families

摘要： 2型糖尿病(T2D)对拉丁裔儿童、家庭和社区的影响不成比例。T2D差异 是复杂的相互作用的结果，涉及生物易感性和各种相互依赖的社会 代表疾病根本原因的决定因素。糖尿病预防计划(DPP)确立了 T2D可以通过强化的生活方式干预在高危成年人中预防。虽然民进党一直以来 翻译成各种成人人口和环境，少数民族的参与度和有效性会降低 目前还没有针对拉丁裔的以家庭为重点的糖尿病预防试验。十多年来，我们的团队 在拉美裔青年中合作解决糖尿病的社会和文化决定因素 在获得保健方面的现存差距，低健康素养，以及可能增加糖尿病的某些文化规范 风险。我们以文化为基础的方法是由生态发展模式指导的，该模式考虑了社区， 随着时间的推移，影响健康行为和健康结果的家庭、同伴和个人因素。穿过 一系列日益严格的研究证实，生活方式干预可以显著降低T2D 拉美裔肥胖青少年中的危险因素和提高生活质量(QOL)。我们现在提议建立 凭借我们与当地拉丁裔社区合作的丰富经验，严格测试 以家庭为重点的糖尿病预防干预降低T2D风险和提高高危人群的生活质量 拉丁裔家庭。我们将使用综合混合方法来理解家庭结构和过程 影响干预结果。我们将在12个月后检查干预的可持续性，并探索 长期变革的调解人和调解人。最后，我们承认，目前的翻译差距 必须关闭科学发现和现实世界影响之间的关系，以便以证据为基础的干预措施 迅速扩大规模，以促进弱势和未得到充分服务的人口的健康公平。因此， 我们将使用探索、准备、实施、可持续(EPIS)框架指导以下领域 适应和融入以社区为基础的关键组织，这些组织可能处于有利地位，可以采用和 实施以家庭为重点的糖尿病预防计划。我们的长期目标是建立证据、网络、 以及跨服务系统扩展多层次、以家庭为重点的糖尿病预防计划的能力 弱势群体和弱势群体。作为迈向这一目标的下一步，我们提出以下建议 主要目的：测试为期4个月、以家庭为重点的糖尿病预防干预措施的有效性，并与 家庭控制状况，用于改善高危拉丁裔家庭的糖耐量和生活质量。 次要目标：了解家庭结构和家庭过程如何影响范围、扩散和 干预对家庭制度的影响。探索目标：检查12名调解人和主持人- 糖耐量和生活质量的月变化。实施目标：创建全州范围的利益相关者- 明智的计划，通过以下方式扩大家庭糖尿病预防：1)通过以下方式创建快速学习社区 为亚利桑那州的拉丁裔家庭提供服务的组织，2)探索以下方面的需求、准备情况、成本和能力 在这些组织中实施，以及3)规划适应和活动，以提高适合性和 这些组织内部干预的功能。

ABSTRACT: Type 2 diabetes (T2D) disproportionately impacts Latino children, families and communities. T2D disparities are the result of complex interactions that involve biological susceptibility and various interdependent social determinants that represent the root causes of disease. The Diabetes Prevention Program (DPP) established that T2D can be prevented in high-risk adults through intensive lifestyle intervention. Although the DPP has been translated to a variety of adult populations and settings, engagement and effectiveness is diminished in minority communities and there are no family-focused diabetes prevention trials for Latinos. For over a decade, our team has collaborated to address the social and cultural determinants of diabetes among Latino youth, in the midst of extant disparities in access to care, low health literacy, and certain cultural norms that may increase diabetes risk. Our culturally-grounded approach is guided by an Ecodevelopmental model that considers community, family, peer, and individual-level factors that influence health behaviors and health outcomes over time. Through a series of increasingly rigorous studies we established that a lifestyle intervention can significantly reduce T2D risk factors and increase Quality of Life (QoL) among Latino adolescents with obesity. We now propose to build upon our extensive experience working with the local Latino community to rigorously test the efficacy of a family-focused diabetes prevention intervention for reducing T2D risk and increasing QoL among high-risk Latino families. We will use Integrative Mixed Methods to understand how family structures and processes influence intervention outcomes. We will examine the sustainability of the intervention at 12-months and explore mediators and moderators of long-term changes. Lastly, we acknowledge that the current translational gap between scientific discovery and real-world impact must be closed so that evidence-based interventions are expeditiously scaled to advance towards health equity for vulnerable and underserved populations. Therefore, we will use the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide areas for adaptation and integration within key community-based organizations that may be well-positioned to adopt and implement family-focused diabetes prevention programs. Our long-term goal is to build the evidence, network, and capacity to scale multi-level, family-focused diabetes prevention programs across systems that serve vulnerable and disadvantaged communities. As the next step towards this goal, we propose the following Primary Aim: Test the efficacy of a 4-month, family-focused diabetes prevention intervention, compared to a family control condition, for improving glucose tolerance and increasing QoL among high-risk Latino families. Secondary Aim: Understand how family structure and family processes influence the reach, diffusion, and impact of the intervention on the family system. Exploratory Aim: Examine mediators and moderators of 12- month changes in glucose tolerance and QoL. Implementation Aim: Create a statewide, stakeholder- informed plan to take family diabetes prevention to scale by 1) generating a rapid learning community with organizations that serve Latino families in Arizona, 2) exploring the need, readiness, costs of, and capacity for implementation across these organizations, and 3) planning adaptations and activities to enhance fit and function of the intervention within these organizations.