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Pilot & Feasibility Projects

Center for American Indian and Alaska Native Diabetes Translation Research


Project Title: Clinical and Social Determinants of Health for Obesity: A Lifespan investigation of overweight/obesity among American Indians and Alaska Natives


American Indians and Alaska Natives (AI/ANs) have a prevalence of diabetes that is 2 to 3 times that of the general U.S. population. Obesity, a key risk factor for type 2 diabetes, is common in AI/AN populations and often begins in early childhood.  The prevalence of obesity is significantly higher among Native preschoolers, school-aged children, youth, and adults than in the comparable subgroups of the general U.S. population.

Social determinants of health (SDOH), or the conditions in which people are born, grow, live, and work (e.g., socioeconomic conditions, access to healthcare, and food access and security), are known to influence racial disparities in health outcomes. Although some research suggests that SDOH may play an important role in the high rates of obesity, diabetes, and cardiovascular disease among Native people, the literature does not provide clear conclusions regarding the association of SDOH with diabetes-related outcomes in Native populations.

The objective of this pilot project is to investigate the relationship between SDOH and diabetes outcomes in AI/ANs, using a life course perspective.  The specific aims of the project are the following:

Aim 1.Examine the association of SDOH with diabetes-related outcomes among AI/AN mothers (obesity, gestational diabetes) and birthweight of Native newborns. SDOH of interest include measures of community deprivation (poverty, educational attainment) and rurality.

Aim 2a.Examine the association of SDOH with diabetes-related outcomes of Native children (Body Mass Index, pre-diabetes, diabetes). SDOH of interest include measures of community deprivation (poverty, educational attainment), rurality, distance to closest clinic, access to health education services, and health insurance.

Aim 2b.Examine the association of SDOH with overweight and obesity among Native adolescents. SDOH of interest include measures of community deprivation (poverty), rurality, and distance to closest clinic.

Aim 2c.Examine the association of SDOH with overweight and obesity among Native young adults. SDOH of interest include measures of community deprivation (poverty, educational attainment), rurality, distance to closest clinic, access to health education services, health insurance, and food access and security.

Aim 3.  Examine the association of food access and security with diabetes-related outcomes among Native elders.

Five Early-Stage Investigators from our collaborating Satellite Centers are addressing these specific aims through analysis of longitudinal data available from the Indian Health Service’s (IHS) Improving Health Care Delivery Data Project (IHCDDP). The IHCDDP data set is uniquely suited to address the aims of this project as it includes clinical and SDOH data for AI/AN people across the lifespan, is inclusive of a geographically diverse sample of AIANs, and includes over 600,000 AIANs receiving IHS healthcare during fiscal years 2007-2013. SDOH data included in the data set In addition to clinical data, the data set incorporates measures of community deprivation (poverty, educational attainment), rurality, distance to closest clinic, access to health education services, and health insurance.  Measures related to food access and security will be incorporated into the IHCDDP data set from the publically available USDA Food Atlas data set.
 ​​Previously Funded Pilot Projects

​American Indian and TOPS Collaboration for Health (AITCH)

Nia Mitchell, MD
 
American Indians are at increased risk for Type 2 diabetes compared to other Americans. A primary risk factor for diabetes is being overweight or obese, and American Indians are more likely to be overweight or obese than other Americans.  Therefore, effective interventions focused on weight management hold promise for diminishing the diabetes-related disparities American Indians face.  Take Off Pounds Sensibly (TOPS) is a nonprofit, low-cost, peer-led, nationally available weight loss program, and a recent study showed that TOPS helped people lose 5% of their initial weight and maintain the weight loss for up to 3 years.  Each TOPS chapter decides the types of programs it would like to include; therefore each chapter can be tailored to fit the needs of its members. The objective of this project is to explore and address barriers to the diffusion of TOPS in the American Indian community in the Denver metropolitan area by offering the program to 50 American Indian participants through a local community organization that serves the American Indian community.  Both qualitative and quantitative assessments will be utilized. Surveys will be used to evaluate the eating and physical activity patterns, self efficacy, and stages of change pre- and post-intervention.  Focus groups will be used to determine the feasibility and acceptability of the program and to get feedback on ways to tailor the program to the American Indian community.  We will also assess the weight change of participants over a 12 week intervention.
 

Numeracy Intervention to Improve Diabetes Self-care (NIIDS) 

Angela Brega, PhD
  
Growing evidence suggests that the ability to understand and use numbers (“numeracy”) may have important implications for diabetes self-care.  Compared to patients with stronger numerical skills, those with limited numeracy check their blood sugar levels less frequently, are less likely to adjust their insulin doses based on carbohydrate intake and blood sugar levels, have less confidence that they can manage their diabetes (i.e., self-efficacy), and have worse glycemic control. The objective of this project is to develop a computerized intervention to teach American Indian patients a subset of the numeracy skills needed to manage diabetes.  The intervention will focus on three sets of self-care skills (understanding blood glucose values, monitoring carbohydrate intake, managing cardiovascular risk) and will be culturally tailored for the American Indian tribe that is participating in the project.  The computerized intervention will incorporate audio- and video-based education and will comply with recommendations for clear communication of health information.  Pilot testing of the intervention will be conducted with 50 American Indian patients with diabetes from a large Indian Health Service clinic serving our partner tribe.  Using a pre-post design, we will examine change over time in diabetes numeracy, self-efficacy, stage of change, and self-care behavior.
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Colorado School of Public Health

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