Preventing Diabetes in Latino Families - Diversity Supplement

摘要： 2型糖尿病（T2 D）不成比例地影响拉丁美洲儿童，家庭和社区。T2 D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 这些决定因素是疾病的根本原因。糖尿病预防计划（DPP）规定， T2 D可以通过强化的生活方式干预来预防高危成人。虽然民进党一直在 翻译到各种成年人口和环境，参与和有效性减少，在少数民族 社区，没有针对拉丁美洲人的以家庭为中心的糖尿病预防试验。十多年来，我们的团队 合作解决拉丁美洲青年糖尿病的社会和文化决定因素， 在获得护理方面存在的差距，低健康素养，以及某些可能增加糖尿病的文化规范 风险我们以文化为基础的方法是由一个生态发展模式，考虑社区， 家庭，同伴和个人层面的因素，随着时间的推移影响健康行为和健康结果。通过 一系列日益严格的研究表明，生活方式干预可以显著降低T2 D 风险因素和增加生活质量（QoL）在拉丁美洲青少年肥胖。我们现在建议建立 根据我们与当地拉丁裔社区合作的丰富经验，严格测试 以家庭为中心的糖尿病预防干预，以降低T2 D风险并提高高风险人群的QoL 拉丁裔家庭。我们将使用综合混合方法来了解家庭结构和过程 影响干预结果。我们将在12个月时检查干预的可持续性，并探讨 长期变化的调节者和调节者。最后，我们承认，目前的翻译差距 科学发现和现实世界的影响之间的联系必须被关闭，以便基于证据的干预措施 迅速扩大规模，推动弱势和得不到充分服务的人口实现保健公平。因此，我们认为， 我们将使用“探索、准备、实施和维持”（EPIS）框架，指导以下领域： 适应和融入主要的社区组织，这些组织可能处于有利地位， 实施以家庭为重点的糖尿病预防方案。我们的长期目标是建立证据网络 和能力，以扩大多层次，以家庭为重点的糖尿病预防计划，在系统， 弱势群体和弱势群体。作为实现这一目标的下一步，我们提出以下建议 主要目的：测试为期4个月的以家庭为中心的糖尿病预防干预措施的有效性， 家庭控制条件，用于改善葡萄糖耐量和增加高风险拉丁美洲家庭的生活质量。 第二个目标：了解家庭结构和家庭过程如何影响影响范围，扩散， 干预对家庭系统的影响。探索性目的：检查12- 葡萄糖耐量和QoL的月变化。实施目标：创建一个全州范围的利益相关者- 通过以下方式实现家庭糖尿病预防的知情计划：1）建立一个快速学习社区， 为亚利桑那州的拉丁裔家庭服务的组织，2）探索的需要，准备，成本，和能力， 在这些组织中实施，以及3）规划适应性和活动，以提高适应性和 在这些组织中的作用。

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.