There are substantial differences in chronic disease and health behaviors
across race/ethnic, gender, and socioeconomic groups in our society (Kanjilal et
al. 2006). These differences contribute to startling discrepancies in mortality
in the U.S., where groups defined by race/ethnicity, gender, and geography have
life expectancy differences of up to15 years. (Murray et al. 2006). Two key
factors, diet, and physical inactivity, contribute to obesity and associated
risk factors (elevated blood pressure, high glucose, dyslipidemia) which are
frequently clustered together and labeled the metabolic syndrome (Grundy et al.
2004). Obesity prevalence has been increasing, affects the entire population
from youth to the elderly (CDC 2011) and threatens to reverse
20th century gains in life expectancy. Much of the focus in
addressing health inequalities has been to identify and address racial/ethnic
differences in the quality of health care. (2003) There is some evidence of
differential counseling for obesity by race and/or gender (Bleich et al. 2011)
however overall, obesity is poorly addressed by usual medical care.(Ma et al.
2009) Rather, social and structural inequalities, such as poverty, the built
environment, health literacy, and cultural preferences may need to be addressed.
Major trials demonstrate that even modest (5-7%) weight loss and increased
physical activity is associated with reduced incidence of diabetes and
improvement in risk factor control. (Knowler et al. 2002; The Look AHEAD
Research Group 2007). Translating such research into interventions that are
effective in different populations, either defined by cultural, geographic, or
socio-economic characteristics is imperative, as is determining whether such
interventions are best delivered in community-based settings or in the clinical
arena, by professionals, community health workers ( also known as lay health
advisors), or a combination of both. The Maya Angelou Center for Health
Equity (MACHE) has chosen the theme Translating evidence based,
lifestyle strategies to eliminate health disparities in diabetes prevention and
control for this application. The Research Core will provide an
infrastructure for the conduct of research addressing this theme among
vulnerable populations on multiple levels of the social-ecological framework,
from community-level research to individual-level
interventions. Vulnerable populations are those who are
marginalized economically, socially, geographically, or medically and thus are
unable to achieve optimal health. The projects included within this application
are new R01-level projects that are consistent with the MACHE mission.
Translating Lifestyle Trials into the
Clinic and Community for Diabetes (TLCC
Diabetes) will recruit overweight and obese adults with T2DM drawn from clinics
serving lower-income patients and minorities. The trial will test a lifestyle
intervention delivered either by physician-supervised group visits, or delivered
in community venues via groups led by trained community health workers.
Latino Diabetes Prevention Trial (LDPT) translates elements of
the Diabetes Prevention Program, focusing on Latinos at high risk for developing
T2DM. It will test whether a culturally adapted, church-based lifestyle
intervention will reduce glucose and associated factors (lipids, inflammation,
blood pressure) associated with IFG. The Research Core's role in these two
projects is to provide infrastructure and resources to facilitate the respective
research teams' ability to conduct their research projects according to the
The specific objectives of the Core:
- Provide coordination to the two research projects, including protocol
development, staff training, participant recruitment, data management, and data
- Collaborate with the Community Core, the institution and externally with
local and national communities to promote participation in research and
disseminate results from these projects and other.
- Collaborate with the Research Training/Education core to foster an
environment supportive of training new investigators, disseminating research,
and capitalizing on the health equity research that MACHE affiliates at Wake
Forest School of Medicine are currently conducting.
- Collaborate with the Administrative Core, which will conduct semiannual
reviews of the research projects to ensure that all research activities
undertaken by project investigators and staff are consistent with MACHE goals
and compliant with IRB/human subjects protection regulations.