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

 描述（由申请人提供）：美国印第安人（AI）男性与美国所有其他种族和族裔群体的男性相比，存在严重的健康差异。例如，在美国男性中，AI男性的2型糖尿病年龄调整患病率最高（约18%），而非西班牙裔白色男性最低（约7%）。近几十年来，与所有其他群体相比，人工智能男性的糖尿病相关并发症和死亡率不成比例地增加，因此人工智能男性经年龄调整的糖尿病死亡率现在几乎是白色男性的两倍。在非人工智能人群中进行的几项大型随机对照试验证实，通过促进健康生活方式的干预措施可以预防或延迟2型糖尿病，但关于预防人工智能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，在土著社区的糖尿病预防计划中，人工智能男性的参与率很低，从33%到74%不等。对于所有种族的男子参与生活方式干预的比例低，提出了许多解释。招募人工智能男性， 基于诊所的方案很困难，因为她们往往比妇女更少寻求临床护理。AI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制定糖尿病风险降低计划，特别关注招募和保留。 我们正在与Ojibwe（明尼苏达州）的Mille拉克乐队，明尼阿波利斯（明尼苏达州）的印第安人健康委员会和Yakama国家和遗产大学美洲原住民健康和文化中心（华盛顿）合作，以制定强壮的男人，强大的社区（SMSC）计划。这是一种适合AI男性的文化方法，针对可改变的糖尿病风险因素。它使用的方法改编自成功的，非诊所为基础的计划，为其他高风险的少数群体，它结合了DPP和SDPI-DP的元素。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意见，完善SMSC干预措施。 2)比较SMSC干预组和等待名单对照组中糖尿病风险评分（主要结局）和可改变的糖尿病风险因素（次要结局）的变化。 3)评估SMSC保留80%的 240名AI男性参与者，年龄21-65岁，既往未诊断为糖尿病。这项拟议的研究填补了增加招募和参与生活方式计划的方法方面的一个显著空白，这些生活方式计划可以降低AI男性的糖尿病风险。这项拟议的研究将对AI肥胖和糖尿病的持续流行产生广泛的影响。鉴于需要增加人工智能男性参与生活方式干预，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。

 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.