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

 描述(由申请人提供)：与美国所有其他种族和民族的同龄人相比，美国印第安人(AI)男性经历了严重的健康差距。例如，在美国男性中，人工智能男性经年龄调整后的2型糖尿病患病率最高(约18%)，而非西班牙裔白人男性最低(约7%)。近几十年来，与所有其他人群相比，人工智能患者糖尿病相关并发症和死亡率的增加不成比例，以至于人工智能男性的年龄调整后糖尿病死亡率现在几乎是白人男性的两倍。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可以预防或推迟2型糖尿病，但几乎没有关于人工智能男性预防糖尿病的干预措施的经验数据。在以临床为基础的美国糖尿病预防计划(DPP)中，3234名参与者中只有55名是人工智能男性。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。对于所有种族的男性在生活方式干预中的低参与率，人们提出了许多解释。在中国招募人工智能男性 以临床为基础的项目很困难，因为她们寻求临床护理的频率往往低于女性。人工智能男性对规范的健康行为和性别角色的看法也可能会阻碍参与，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独特的价值观和习惯制定糖尿病风险降低计划，特别关注招聘和留住。我们正在与明尼苏达州奥吉布的Mille Lacs Band，明尼苏达州明尼阿波利斯的印第安人健康委员会，以及雅卡马民族和传统大学美国原住民健康与文化中心(华盛顿)合作，制定壮士，强大社区(SMSC)计划。对于人工智能男性来说，这是一种文化上合适的方法，目标是可改变的糖尿病风险因素。它使用了适用于其他高危少数群体的成功的非临床方案的方法，并纳入了DPP和SDPI-DP的要素。我们的具体目标是：1)根据我们3个合作伙伴社区的焦点小组的反馈，完善SMSC干预。2)比较SMSC干预组和等待名单对照组中糖尿病风险评分(主要结果)和可修改的糖尿病风险因素(次要结果)的变化。3)评估SMSC保留80%的能力 240名人工智能男性参与者，年龄21-65岁，以前没有糖尿病诊断。这项拟议的研究填补了在增加招募和参与降低人工智能男性糖尿病风险的生活方式计划方面的一个显着空白。这项拟议的研究将对持续流行的人工智能肥胖和糖尿病产生广泛影响。考虑到增加人工智能男性参与生活方式干预的必要性，我们的发现可能会对美国各地的部落社区产生重大的公共健康影响。

 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.