Unidas por la Vida: Testing a family-based intervention among high-risk Latinas

描述(由申请人提供)：糖尿病预防计划(DPP)已经表明，生活方式干预可以增加体力活动和适度减肥，可以延缓或预防高危人群中2型糖尿病的发生。与其他种族相比，墨西哥裔美国女性一生中患糖尿病的风险最高。与白人女性相比，她们也更有可能超重和肥胖。墨西哥裔美国妇女改变饮食和体育活动的能力可能会受到“家族主义”的影响，这是一种反映拉美文化以家庭为导向和集体主义的文化特征。母女关系是拉美文化中的重要纽带，也是促进健康的关键干预点。选购食物、为家人做饭等日常活动往往是母女共同参与的活动。在这方面，Unidas por la Vida(联合为生命)干预措施修改了DPP生活方式干预措施，并对其进行调整，使其适用于患有糖尿病的墨西哥裔美国妇女及其有糖尿病风险的超重或肥胖的成年女儿。我们的目标是测试实施这种以合作伙伴为基础的方法的可行性，这种方法利用母女关系来促进更多的体力活动和减肥。墨西哥裔美国母女二人组(母亲患有2型糖尿病；女儿超重或肥胖，有糖尿病前期)是在初级保健环境中确定的。利用糖尿病教育工作者、运动科学专家和社区非专业卫生工作者组成的团队方法，干预在社区环境下的小组会议中进行，也在参与者的家中进行。这一为期16周的项目是以民进党的频繁接触原则为蓝本的，采用小组和个人会议相结合的方式，并量身定做应对种族多样性的战略。然而，Por la Vida的特点是使用家庭成员的“伙伴”来确定共同目标和相互加强。干预还利用社区组织之间的伙伴关系中的社区资源。这种干预可能是可持续的，因为它允许个人利用当地社区和家庭成员作为“社会资本”来改变行为。这一点尤其重要，因为之前的研究表明，墨西哥裔美国女性报告说，健康饮食和锻炼的社会支持很少。此外，由于减肥和体重控制很难维持，以伴侣为基础的方法，利用对参与者生活重要且不可或缺的家庭成员，可能会增强长期的成功。来自R34规划赠款的初步数据将为R18有效性试验提供支持，该试验将在包括其他高危人群的多地点研究中测试干预措施。如果这种干预在R18研究中被发现是有效的，那么这个以伙伴为基础的计划的原则可能会被调整，以便在糖尿病高危人群中传播，这些人可以与另一个支持减肥和持续体重维持的人合作。 公共卫生相关性：这项提案是测试总体目标的关键的第一步，这一总体目标是，这种以合作伙伴为基础的干预措施可以积极促进高危拉丁裔妇女改变生活方式，从而预防和逆转肥胖症和2型糖尿病。

DESCRIPTION (provided by applicant): The Diabetes Prevention Program (DPP) has shown that lifestyle intervention resulting in increased physical activity and modest weight loss can delay or prevent the incidence of type 2 diabetes in those at risk. Mexican-American women have the highest lifetime risk of diabetes compared to any other ethnic groups. They are also more likely to be overweight and obese compared to white women. The ability of Mexican-American women to modify their diets and physical activities may be influenced by "familism," a cultural characteristic that reflects the family-oriented and collectivistic aspects of Latino culture. The mother-daughter relationship is an important bond in Latino culture, and is a critical point of intervention for health promotion. Daily activities such as shopping for food and preparing meals for the family are often shared mother-daughter activities. In this context, the Unidas por la Vida (United for Life) intervention modifies the DPP lifestyle intervention and adapts it for use among Mexican-American women with diabetes and their overweight or obese adult daughters at risk for diabetes. We aim to test the feasibility of implementing this partner-based approach that leverages the mother-daughter relationship for promoting increased physical activity and weight loss. Mexican-American mother-daughter dyads (mothers have type 2 diabetes; daughters are overweight or obese, with pre-diabetes) are identified in the primary care setting. Using a team-based approach of diabetes educators, exercise science experts, and community lay health workers, the intervention is delivered in group meetings in a community-based setting and also in participants' homes. This 16-weeks program is modeled after the DPP's principles of frequent contact using a combination of group and individual sessions and tailoring the strategies to address ethnic diversity. However, Unidas por la Vida is distinguished by the use of a family-member "partner" for shared goal-setting and mutual reinforcement. The intervention also leverages community resources in a partnership between community-based organizations. This intervention is potentially sustainable because it allows the individual to utilize the local community and family members as "social capital" for behavioral change. This is especially important because previous research has shown that Mexican-American women report little social support for healthy diet and exercise. Furthermore, because weight loss and weight control are difficult to maintain, a partner-based approach that uses family members who are important and integral to the participant's life may enhance long-term success. Preliminary data from this R34 planning grant will provide support for the R18 effectiveness trial that will test the intervention in a multi-site study that will include other high-risk groups. Should this intervention be found to be effective in the R18 study, the principles of this partner-based program may be adapted for dissemination among individuals at risk for diabetes who can partner with another supportive person for weight loss and sustained weight maintenance. PUBLIC HEALTH RELEVANCE: This proposal represents the critical first step to test the overall objective that this partner-based intervention could positively promote lifestyle change among high risk Latina women, and thus, prevent and reverse obesity and type 2 diabetes.