American Indians and Alaska Natives (AI/ANs) are at increased risk for Type 2 diabetes when compared to other Americans, a gap that continues to widen. Cardiovascular disease (CVD) has become the number one cause of death among AI/ANs, is now more common among AI/ANs than others in the U.S. general population, and is increasing not only in prevalence but also in associated mortality. The greatest risk factor for CVD in AI/ANs is diabetes. Both CVD and diabetes share common risk factors, such as weight and lipid levels, which in turn are strongly related to diet and exercise behaviors. Effective preventive interventions focused on these behaviors hold promise for diminishing the diabetes and CVD disparities AI/ANs face. We propose to use the unique opportunity provided by the NCMHD's Social Determinants of Health Initiative (as part of RFA-OD-09-004) to assess the viability and sustainability of an intervention that makes accessible 2 electronic tools: 1) one for increasing exercise and 2) one for tracking diet and exercise among overweight/obese AI/ANs living in 2 urban areas. This work has 3 aims: 1) To determine whether introduction of 2 electronic devices leads to decreased risk for diabetes and CVD among overweight/obese AI/ANs;2) To assess the social determinants of resultant changes in diabetes and CVD risk using sociobehavioral theories;and 3) To place the investigations of effectiveness (aims 1 and 2) in a larger translational framework by exploring aspects of reach, adoption, and implementation in order to understand issues of viability and sustainability of this and comparable interventions. This study will take place with 2 Indian Health Service-funded urban Indian clinic populations (Denver and Albuquerque) and be completed by a transdisciplinary team from the Centers for American Indian and Alaska Native Health within the Colorado School of Public Health at the University of Colorado Denver. The placement of this work within larger theoretical frameworks, as well as the focus on diabetes and CVD (diseases becoming more common among many Americans);renders this work for broad public health significance. We are experiencing a nationwide epidemic of overweight and obesity, with concomitant increases in diabetes, CVD, and other conditions. Health disparity populations, including American Indians and Alaska Natives;especially those who are unemployed, underemployed, or otherwise facing financial stress are even less likely to maintain healthy exercise and dietary habits. As we consider the health implications of the current recession, the importance of developing intervention methods which address possible decreases in exercise and healthy diet nationally due to increased financial stress is accentuated. To seize the opportunity do so in a way that allows the expansion of our theoretical understandings of behavior change is extraordinary.

RC2MD004738

2009-09-28

2012-05-31