Type 2 diabetes prevention in community health care settings for children and mothers at risk, 7/1/2018-6/30/2020, NIH R34 planning grant mechanism, University of Arizona Department of Nutritional Sciences, College of Agriculture & Life Sciences, and the Department of Health Promotion Sciences, College of Public Health.
The goal of this project is to test the feasibility and acceptability of a family-focused lifestyle behavior change intervention delivered to mothers with prediabetes and their 8-12-year-old children by staff at a Federally Qualified Health Center (El Rio Community Health Center). The program, designed to prevent new cases of diabetes in at-risk Latino women and children, will be adapted from the investigators’ previous successful community-based type 2 diabetes prevention programs. (Hingle 2015 BMC Public Health; Ackermann 2008 Am J Prev Med) We will evaluate program acceptability, implementation, cost, integration with the FQHC infrastructure, and potential for replicability and maintenance in order to determine potential for long-term
program sustainability within this healthcare setting. Preliminary impact of the 16-week family-focused intervention on diabetes and cardiovascular risk factors (weight status, glucose control, lifestyle behaviors) will be assessed in 60 mother-child dyads participating in the 16-week group-randomized trial.
The proposed study is significant in its focus on reducing obesity and type 2 diabetes prevalence in Latino children and women using a family-focused, community-based approach that leverages parental involvement and El Rio’s wide network of facilities, professionals, and resources. We are the first to address diabetes risk of mother and child simultaneously using the concept of “primordial prevention,” in which parents are activated to modify the social and physical environment to halt risk transmission to their offspring. Our proposed study is also novel in its engagement of mothers with metabolic phenotypes associated with diabetes and known risk transmission to offspring and will leverage these strengths and resources to make family-based diabetes prevention a reality for populations disproportionately burdened by this disease.
Developing a model of diet-sensitive disease prevention for food insecure populations: formative research, 1/1/18-6/30/19, intramural seed funding from Community Food Bank of Southern Arizona (CFBSA) awarded to the CFBSA’s Health and Nutrition Team in collaboration with the UA Department of Nutritional Sciences and Arizona Cooperative Extension, CALS, and the Department of Health Promotion Sciences, COPH.
The long-term goal of this project is to develop a replicable, sustainable model of diet-sensitive disease prevention and management in food insecure populations, with an emphasis on type 2 diabetes, a highly prevalent and serious health condition affecting approximately 10% of adults, and more than 20% of food insecure adults. (Hill et al., 2013 Diabetes Care) In order to reduce negative health consequences associated with food insecurity, individuals must have the means, capability, and opportunity to access, obtain, prepare, and consume nutrient-dense foods. The care model we envision developing consists of a therapeutic food box (containing perishable and non-perishable foods adapted from the standard Emergency Food Assistance Program for clients with, or at risk of, diet-sensitive disease), delivered in combination with one or more of the following: i) food preparation aids (e.g., can openers, recipes), ii) diabetes self-management support and/or prevention education (e.g., delivered by an educator/health professional or trained paraprofessional), and/or iii) referral to appropriate extant services (e.g., SNAP, WIC, health services), all of which will be tailored to address clients’ specific health, economic, and social circumstances, and made available at their preferred point of food distribution (one of three CFBSA locations).
Development of the proposed care model will be accomplished in phases. In Phase I, we will characterize the diet quality, sources of food, and challenges related to food procurement and preparation of up to 200 adult clients of the CFBSA. Phase II is focused on developing and iteratively refining a prototype “therapeutic food box” (based on the existing 3-4-day emergency food box currently provided to clients of the CFBSA) that will be enhanced with related materials and support designed to reduce risk of diet-sensitive disease (n=20 adults). In Phase III, we will conduct a pilot study (n=25 adults with pre-diabetes or diabetes) in which the refined prototype food box + enhancements will be evaluated (feasibility, acceptability, cost)