Mujeres Interesadas en Cambios por la Salud (MI CASA)

描述(由申请人提供)：墨西哥裔美国妇女是最脆弱和最缺乏服务的人群之一，面临肥胖和2型糖尿病(T2D)的风险。利用翻译研究范式，我们建议在德克萨斯州圣安东尼奥西区一个高度贫困的市中心社区，为高危墨西哥裔美国妇女试行一个以社区为基础、对文化敏感的T2D预防计划--MuJeres Interesadas en Cambios Por la Salud(MI CASA；妇女对改变健康的生活方式感兴趣)。MI CASA是以两个已在随机临床试验(RCT)中测试的成功计划为模型的，即美国糖尿病预防计划和芬兰糖尿病预防研究-这两个计划都是基于初级保健的T2D预防计划。MI CASA建立在Edgewood Family Network(EFN)现有基础设施的基础上，Edgewood Family Network(EFN)是一个基层倡导组织，旨在改善圣安东尼奥西区居民的福祉。MI CASA将由EFN的推动者as de salud(非专业社区卫生工作者)提供。200名非糖尿病的墨西哥裔美国女性(年龄在25岁到65岁之间)，她们的体重指数在28到40之间，有T2D家族史，没有运动，或者之前被诊断为空腹糖耐量或妊娠期糖尿病，她们将从社区医院招募，并在基线测试后随机进入干预或比较条件。这项拟议的研究假设，在9个月的干预结束时，由推动者领导的生活方式干预将显著降低MI CASA参与者的体重、体脂百分比和空腹血糖，并提高心肺健康。我们还将对降低体重和空腹血糖的成本效益进行分析。将使用流动卫生实验室在社区内方便的地点收集数据。由训练有素的卫生专业人员实施结构化、密集的生活方式干预，成本高昂，难以广泛传播。MICASA主要针对低成本、可获得的体育活动形式，以及由促进者提供的具有文化敏感性的健康饮食做法；如果成功，它有可能在资源有限、服务不足的社区传播。通过与社区医院的联系和利用社区倡导团体提供的服务、低成本的设备和现有的有形基础设施，计划的可持续性得到了增强。几乎没有证据表明促进者领导的生活方式改变计划在高危少数人群中逆转肥胖和降低T2D风险的有效性。因此，这项研究符合NIH医学研究路线图中减少BASK/临床研究和社区层面健康促进之间差距的目标。最后，拟议的研究解决了2010年健康人10个优先公共卫生问题中的3个(缺乏运动、超重/肥胖和获得医疗保健的机会)。 公共卫生相关性：这项拟议的研究将试验由推动者领导的生活方式干预计划的可行性，以减轻体重，降低高危墨西哥裔美国女性患2型糖尿病的风险。如果成功，这种低成本的干预措施可以传播到全国各地服务不足的社区。

DESCRIPTION (provided by applicant): Mexican American women are one of the most vulnerable and underserved populations at risk for obesity and Type 2 Diabetes (T2D). Utilizing a translation research paradigm, we propose to pilot a community-based, culturally sensitive T2D prevention program for high-risk Mexican American women, "Mujeres Interesadas en Cambios por la Salud" (MI CASA; Women Interested in Changes for a Healthy Lifestyle) in West Side San Antonio, Texas, a highly impoverished inner-city community. MI CASA is modeled after two successful programs that have been tested in randomized clinical trials (RCT), the U.S. Diabetes Prevention Program and the Finnish Diabetes Prevention Study - both primary care-based T2D prevention programs. MI CASA has been built upon the existing infrastructure of the Edgewood Family Network (EFN), a grassroots advocacy group for improving the well-being of residents in West Side San Antonio. MI CASA will be delivered by EFN's promotoras de salud (lay community health workers). Two hundred non-diabetic Mexican American females (ages 25 to 65), who have BMI 28 to 40, family history of T2D, and physical inactivity or who have previously diagnosed fasting glucose tolerance or gestational diabetes, will be recruited from a community hospital and randomized into intervention or comparison conditions after baseline testing. The proposed study hypothesizes that a promotoras-led lifestyle intervention will significantly reduce body weight, percent body fat, and fasting glucose and increase cardiorespiratory fitness in MI CASA participants at the end of the 9-mo intervention. We will also conduct an analysis of cost-effectiveness on the reduction of body weight and fasting glucose. A mobile health laboratory will be used to collect data in convenient locations in the community. Implementation of a structured, intensive lifestyle intervention by highly trained health professionals is cost-prohibitive to widespread dissemination. MI CASA primarily targets low cost, accessible forms of physical activity, and culturally sensitive healthy eating practices delivered by promotoras; if successful, it has the potential to be disseminated in underserved communities with limited resources. Program sustainability is enhanced by its connection with a community hospital and utilization of a community advocacy group for delivery, low cost equipment, and existing physical infrastructure. Little evidence exists regarding the effectiveness of promotoras-led lifestyle change programs in high-risk minority populations to reverse obesity and reduce risk for T2D. Thus, this study fits the goal of reducing the gap between bench/clinical research and health promotion at the community level in the NIH Roadmap for Medical Research. Finally, the proposed study addresses three (physical inactivity, overweight/obesity, and access to health care) of the 10 priority public health issues in Healthy People 2010. PUBLIC HEALTH RELEVANCE: The proposed study will pilot the feasibility of a promotoras-led lifestyle intervention program to lose weight and reduce risk for type 2 diabetes in high risk Mexican-American women. If successful, the low-cost intervention can be disseminated to underserved communities across country.