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 highest standard.
The specific objectives of the Core:
- Provide coordination to the two research projects, including protocol development, staff training, participant recruitment, data management, and data analysis.
- 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.