Walking Distance Redefined - Diabetes Prevention in a Low Income Neighbourhood

2004 ◽  
Author(s):  
Andrea Thain Liptak ◽  
Donna Thompson ◽  
Jennifer Sundberg ◽  
Judy Stauffer
Keyword(s):  
Low Income ◽  
Diabetes Prevention ◽  
Walking Distance

scholarly journals A Community-Based Intervention Reduces Diabetes Risk in a Low-Income Community

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 155-155
Author(s):  
Jeneen Ali ◽  
Shavonnea Brown ◽  
Arlene Guindon ◽  
Sarah Mills ◽  
Alyssa Beavers ◽  
...  
Keyword(s):  
Weight Loss ◽  
Low Income ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Program Completion ◽  
Diabetes Risk ◽  
National Kidney Foundation ◽  
Food Bank ◽  
Community Based ◽  
Paired T Test

Abstract Objectives Promote diabetes prevention in low-income communities by offering Cooking MattersTM (CM) in coordination with the Diabetes Prevention Program (DPP). Reducing food insecurity is necessary for reducing chronic disease rates. DPP is a validated and effective intervention for reducing progression to Type II diabetes, but significant outcome disparities occur in low-income communities. Our research aims to address these outcome disparities. This study is a partnership between Gleaners Community Food Bank (GCFB), National Kidney Foundation of Michigan (NKFM), and Wayne State University. DPP, administered by NKFM, is a community-based intervention that significantly reduces diabetes risk. CM, locally administered through GCFB, is also an effective community program that teaches food skills, and provides food provisions. We hypothesize that combining DPP and CM in a low-income setting will improve program completion, and effectively reduce risk for progressing to Type 2 diabetes. Methods Over 12 months, low-income individuals participated in the combined DPP/CM study. Demographics were collected at the onset of the study. Survey information was collected for diet and physical activity at four time-points throughout the study. Body weight was collected at every session, and HbA1C was collected at the onset and conclusion of the program. Results Combining DPP and CM resulted in a 79% program completion rate. Mean HbA1C dropped 10.6% (paired t-test, P < 0.01), and each participant demonstrated lower post-test HbA1C values. Participants experienced a mean weight loss of 7.6% (paired t-test, P < 0.01), and >75% of participants exceeded the 5% DPP weight loss outcome objective at 12 months. Conclusions Cooking Matters TM coupled with the Diabetes Prevention Program is an effective strategy to improve outcomes and reduce diabetes risk in low-income communities. Food bank resources can be coupled with existing chronic illness prevention programs to improve both disease risk and food security. Funding Sources Gleaners Community Food Bank and National Kidney Foundation of Michigan provided funding for this study.

scholarly journals An Assessment of Urban Park Access Using House-Level Data in Urban China: Through the Lens of Social Equity

2020 ◽  
Vol 17 (7) ◽  
pp. 2349 ◽  
Author(s):  
Siqi Yu ◽  
Xigang Zhu ◽  
Qian He
Keyword(s):  
Low Income ◽  
Local Governments ◽  
Green Space ◽  
Housing Prices ◽  
Social Equity ◽  
Urban Parks ◽  
Urban China ◽  
Walking Distance ◽  
Urban Park ◽  
Level Data

The various benefits of urban green space are gaining increasing attention nowadays. Hence, the distribution of green space has become a scrutinized concern for spatial equity among local governments and the planning scholars. This study is the first quantitative evaluation of urban park accessibility using house-level data in urban China, from the perspective of social equity. We chose Nanjing as the empirical case and examined 2709 real estate units and 79 parks within the city. Accessibility is measured by the 10-min walking distance from homes to the adjacent urban parks. Using the Street Network Analysis model in ArcGIS and the statistical methods in SPSS, the result shows that 60.5% of the real estates in Nanjing are located within a 10-min walk to access urban parks. However, this accessibility is positively correlated with housing prices, and negatively correlated with the age of the buildings, holding all other factors constant. While affluent homeowners capture a high-quality green amenity, newly-built low-income communities, where most residents are classified as a vulnerable population, have the lowest percentage of accessible green space. This study reveals the existing spatial disparities of urban park accessibility among different socio-economic groups in Nanjing, China. Additionally, we found that urban redevelopment projects with greening and the large-scale affordable housing construction are pricing out the urban poor and rural immigrants from the inner city to the urban peripheral areas. This will reduce the accessibility to urban parks and other public service facilities among the lower income families, and exacerbate the inequality among the rich and the poor in terms of their quality of life. Main findings of this study can inform policy decisions regarding equitable park provision in the construction of the green city and the sustainable development in urban China and other developing countries.

scholarly journals Adaptation and Feasibility Study of a Digital Health Program to Prevent Diabetes among Low-Income Patients: Results from a Partnership between a Digital Health Company and an Academic Research Team

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Valy Fontil ◽  
Kelly McDermott ◽  
Lina Tieu ◽  
Christina Rios ◽  
Eliza Gibson ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Low Income ◽  
Prevention Program ◽  
Technology Implementation ◽  
Diabetes Prevention ◽  
Digital Health ◽  
Academic Research ◽  
Diabetes Prevention Program ◽  
Safety Net ◽  
Reading Level

Background. The feasibility of digital health programs to prevent and manage diabetes in low-income patients has not been adequately explored. Methods. Researchers collaborated with a digital health company to adapt a diabetes prevention program for low-income prediabetes patients at a large safety net clinic. We conducted focus groups to assess patient perspectives, revised lessons for improved readability and cultural relevance to low-income and Hispanic patients, conducted a feasibility study of the adapted program in English and Spanish speaking cohorts, and implemented real-time adaptations to the program for commercial use and for a larger trial of in multiple safety net clinics. Results. The majority of focus group participants were receptive to the program. We modified the curriculum to a 5th-grade reading level and adapted content based on patient feedback. In the feasibility study, 54% of eligible contacted patients expressed interest in enrolling (n=23). Although some participants’ computer access and literacy made registration challenging, they were highly satisfied and engaged (80% logged in at least once/week). Conclusions. Underserved prediabetic patients displayed high engagement and satisfaction with a digital diabetes prevention program despite lower digital literacy skills. The collaboration between researchers and a digital health company enabled iterative improvements in technology implementation to address challenges in low-income populations.

scholarly journals Enhanced Enrollment in the National Diabetes Prevention Program to Increase Engagement and Weight Loss for the Underserved: Protocol for a Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Natalie D Ritchie ◽  
Jodi Summers Holtrop ◽  
R Mark Gritz ◽  
Katherine Ann Sauder ◽  
Michael Josh Durfee ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Randomized Controlled Trial ◽  
Low Income ◽  
Diabetes Prevention ◽  
Controlled Trial ◽  
Diabetes Prevention Program ◽  
Evidence Based ◽  
Randomized Controlled

BACKGROUND Type 2 diabetes affects 9.4% of US adults with higher rates among racial and ethnic minorities and individuals of low socioeconomic status. The National Diabetes Prevention Program (NDPP) is an evidence-based and widely disseminated behavioral intervention to reduce diabetes incidence through modest weight loss. However, retention in the yearlong NDPP is problematic and leads to suboptimal weight loss, especially among diverse, underserved populations. Strategies to improve NDPP engagement and weight loss are needed urgently. Pilot results of the pre-NDPP, a novel enhancement to enrollment in the NDPP based on the Health Belief Model, were highly successful in a nonrandomized cohort study among 1140 racially diverse, predominately low-income participants. A total of 75 presession participants had doubled attendance and weight loss as compared with earlier participants who did not receive presessions. On the basis of these promising results, we are conducting a randomized controlled trial (RCT) to determine whether pre-NDPP reliably improves NDPP outcomes, as reported on ClinicalTrials.gov. OBJECTIVE This study aims to (1) conduct an RCT comparing NDPP attendance and weight loss outcomes between participants who receive pre-NDPP versus direct enrollment into the NDPP (usual care), (2) examine potential effect mediators (perceived risk for developing diabetes and self-efficacy and readiness for weight control) and moderators (race and ethnicity; income level), and (3) evaluate implementation factors, including cost and projected return on investment. METHODS This two-arm RCT will compare outcomes among diverse, predominately low-income participants who receive pre-NDPP versus direct enrollment into the NDPP (usual care). This is a type 1 hybrid effectiveness-implementation design to determine clinical effectiveness through an RCT, while assessing factors that may impact future pre-NDPP dissemination and implementation, including cost. Our primary research question is whether pre-NDPP improves NDPP attendance and weight loss compared with standard NDPP delivery. RESULTS This project was funded in April 2019. Recruitment is underway as of July 2019. Initial participants began the intervention in October 2019. Data analysis and results reporting are expected to be completed in 2024. CONCLUSIONS This RCT of pre-NDPP may lead to future dissemination of a scalable, evidence-based strategy to improve success of the NDPP, reduce disparities in NDPP effectiveness, and help prevent type 2 diabetes across the country. CLINICALTRIAL ClinicalTrials.gov NCT04022499; https://clinicaltrials.gov/ct2/show/NCT04022499. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/15499

scholarly journals Nurse-led continuum of care for people with diabetes and pre-diabetes in Nepal (NUCOD): study protocol for a cluster randomized controlled trial

2020 ◽  
Author(s):  
Dong (Roman) Xu ◽  
Rubee Dev ◽  
Abha Shrestha ◽  
Lingling Zhang ◽  
Archana Shrestha ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Low Income ◽  
Diabetes Prevention ◽  
Controlled Trial ◽  
Intervention Group ◽  
Continuum Of Care ◽  
Cluster Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Implementation Outcomes ◽  
Cluster Randomized

Abstract Background: The purpose of this study will be to improve diabetes prevention, access to care and advocacy through a novel cost-effective nurse-led continuum of care approach that incorporates diabetes prevention, awareness, screening and management for low-income settings, and furthermore utilizes the endeavor to advocate for establishing standard diabetes program in Nepal. Methods: We will conduct a two-arm, open-masked stratified cluster randomized controlled trial of a NU rse-led CO ntinuum of care for people with D iabetes (N1=200) and pre-diabetes (N2=1036) (NUCOD) , with primary care centers (9 Outreach Centers and 17 Government Health Posts) as a unit of randomization. NUCOD will be delivered through the trained diabetes nurses in the community to the intervention group and the outcomes will be compared to the enhanced usual-treatment group at 6 and 12 months of the intervention. The primary outcome will be change in glycated hemoglobin (HbA1c) level among diabetes and progression to type 2 diabetes among prediabetes, and implementation outcomes measured using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Outcomes will be analyzed on an intention to treat basis. Discussion: The results of this trial will provide information about the effectiveness of the NUCOD program in improving clinical outcomes for diabetes and prediabetes individuals, and implementation outcomes for the organization. Trial registration: This study was registered in a clinical trials registry via ClinicalTrials.gov (NCT04131257) on 18 October 2019. https://bit.ly/34qwIAd

Marginalizing Poverty with Car-Dependent Design: The Story of Two Expulsions

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Tristan Cleveland
Keyword(s):  
Historically Black ◽  
Urban Design ◽  
Low Income ◽  
Economic Transformation ◽  
First Nation ◽  
Walking Distance ◽  
Black Communities ◽  
Design Elements ◽  
The City

In the twentieth century in Nova Scotia, at least two racialized communities were forcibly expelled from their land: Black Africville residents in Halifax and the Membertou Mi’kmaw First Nation in Sydney. Differences in the long-term outcomes of the two expulsions, however, reveal critical factors in how urban design can support or frustrate poverty alleviation. While the Membertou First Nation was relocated as a whole to a centralized context where they were geographically positioned to stage an economic transformation, Africville residents were more widely dispersed, many to areas with less access to jobs and other economic opportunities.This article analyzes the urban design elements in Halifax that create barriers to prosperity for the city’s historically Black communities and low-income residents. These factors include housing displacement, the suburbanization of poverty, and a lack of access to transit and other destinations within walking distance of homes. This article proposes three policy options to address these barriers and ensure that the city offers opportunity to all residents.

scholarly journals Outcomes of a Weight Loss Intervention to Prevent Diabetes Among Low-Income Residents of East Harlem, New York

2019 ◽  
Vol 46 (6) ◽  
pp. 1073-1082 ◽  
Author(s):  
Victoria L. Mayer ◽  
Nita Vangeepuram ◽  
Kezhen Fei ◽  
Emily A. Hanlen-Rosado ◽  
Guedy Arniella ◽  
...  
Keyword(s):  
New York ◽  
Weight Loss ◽  
Low Income ◽  
Diabetes Prevention ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Oral Glucose ◽  
East Harlem ◽  
The Impact

There is a need for diabetes prevention efforts targeting vulnerable populations. Our community–academic partnership, the East Harlem Partnership for Diabetes Prevention, conducted a randomized controlled trial to study the impact of peer led diabetes prevention workshops on weight and diabetes risk among an economically and racially diverse population in East Harlem, New York. We recruited overweight/obese adults from more than 50 community sites and conducted oral glucose tolerance testing and completed other clinical assessments and a health and lifestyle survey. We randomized prediabetic participants to intervention or delayed intervention groups. Intervention participants attended eight 90-minute peer-led workshop sessions at community sites. Participants in both groups returned for follow-up assessments 6 months after randomization. The main outcomes were the proportion of participants who achieved 5% weight loss, percentage weight loss, and change in the probability of developing diabetes over the next 7.5 years according to the San Antonio Diabetes Prediction Model. We enrolled 402 participants who were mainly female (85%), Latino (73%) or Black (23%), foreign born (64%), and non-English speaking (58%). At 6 months, the intervention group lost a greater percentage of their baseline weight, had significantly lower rise in HbA1c (glycated hemoglobin), decreased risk of diabetes, larger decreases in fat and fiber intake, improved confidence in nutrition label reading, and decrease in sedentary behavior as compared with the control group. Thus, in partnership with community stakeholders, we created an effective low-resource program that was less intensive than previously studied programs by incorporating strategies to engage and affect our priority population.

scholarly journals A Qualitative Study on the Perspectives of Latinas Enrolled in a Diabetes Prevention Program: Is the Cost of Prevention Too High?

2020 ◽  
Vol 11 ◽  
pp. 215013272094542
Author(s):  
Maud Joachim-Célestin ◽  
Thelma Gamboa-Maldonado ◽  
Hildemar Dos Santos ◽  
Susanne B. Montgomery
Keyword(s):  
Qualitative Study ◽  
Low Income ◽  
Behavior Modification ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Prevention Programs ◽  
Theory Approach ◽  
Preventive Behaviors ◽  
Culturally Adapted

Introduction: Latinas are among the groups most affected by diabetes health disparities, yet they often benefit less from diabetes interventions even when these are culturally adapted. The purpose of this qualitative study was to explore readiness of Latinas enrolled in a diabetes prevention program to adopt recommended preventive behaviors, and to identify factors associated with the adoption and maintenance of these recommended lifestyle changes. Insights gained will be used to inform future efforts at reducing diabetes disparities and the burden of chronic diseases among Latinas. Methods: Nine focus group discussions (FGDs) and 3 key informant interviews (KIIs) were conducted after the completion of a culturally adapted diabetes prevention program led by Latino community health workers. A grounded theory approach by Charmaz informed by the transtheoretical model guided the questions. Discussions and interviews were audio-taped with participants’ permission, transcribed, coded, and themed. Results: Forty low-income Latinas contributed to FGDs and KIIs. Baseline readiness to engage in new behaviors varied. Negative personal and family health events and physician referral impacted most readiness to enroll and to adopt preventive behaviors. Built environment, financial constraints, and threat of social alienation constituted major barriers to behavior adoption and maintenance, while physician involvement, awareness of diabetes complications, and social support partially mitigated these impediments. Conclusions: Our results suggest that timing of enrollment, physician-patient dynamics, and the emotional personal/family cost of behavior modification should all be considered when planning diabetes prevention programs for low-income Latinas. Besides appropriately timing referrals to accessible culturally informed prevention programs, health educators and health care providers should be aware of the potentially negative impact of behavior modification on family dynamics and be prepared to address resulting repercussions. Future research on Latinas should also include and report data on physician involvement, family context, and social determinants of health for more consistent program comparisons.

scholarly journals Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs

2016 ◽  
Vol 2016 ◽  
pp. 1-16 ◽  
Author(s):  
Priyanka Athavale ◽  
Melanie Thomas ◽  
Adriana T. Delgadillo-Duenas ◽  
Karen Leong ◽  
Adriana Najmabadi ◽  
...  
Keyword(s):  
Case Studies ◽  
San Francisco ◽  
Low Income ◽  
Diabetes Prevention ◽  
Health Coaching ◽  
Diabetes Risk ◽  
Postpartum Women ◽  
Community Based Interventions ◽  
Community Based ◽  
Increased Risk

Background. Low-income minority women with prior gestational diabetes mellitus (pGDM) or high BMIs have increased risk for chronic illnesses postpartum. Although the Diabetes Prevention Program (DPP) provides an evidence-based model for reducing diabetes risk, few community-based interventions have adapted this program for pGDM women. Methods. STAR MAMA is an ongoing randomized control trial (RCT) evaluating a hybrid HIT/Health Coaching DPP-based 20-week postpartum program for diabetes prevention compared with education from written materials at baseline. Eligibility includes women 18–39 years old, ≥32 weeks pregnant, and GDM or BMI > 25. Clinic- and community-based recruitment in San Francisco and Sonoma Counties targets 180 women. Sociodemographic and health coaching data from a preliminary sample are presented. Results. Most of the 86 women included to date (88%) have GDM, 80% were identified as Hispanic/Latina, 78% have migrant status, and most are Spanish-speaking. Women receiving the intervention indicate high engagement, with 86% answering 1+ calls. Health coaching callbacks last an average of 9 minutes with range of topics discussed. Case studies presented convey a range of emotional, instrumental, and health literacy-related supports offered by health coaches. Discussion. The DPP-adapted HIT/health coaching model highlights the possibility and challenge of delivering DPP content to postpartum women in community settings. This trial is registered with ClinicalTrials.gov NCT02240420.

scholarly journals Translation of the National Diabetes Prevention Program to Engage Men in Disadvantaged Neighborhoods in New York City: A Description of Power Up for Health

2018 ◽  
Vol 12 (4) ◽  
pp. 998-1006 ◽  
Author(s):  
Tiffany L. Gary-Webb ◽  
Elizabeth A. Walker ◽  
Lindsey Realmuto ◽  
Alexandra Kamler ◽  
Jennifer Lukin ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Low Income ◽  
York City ◽  
Prevention Program ◽  
Group Intervention ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Advisory Panel ◽  
Disadvantaged Neighborhoods

The Diabetes Prevention Program (DPP) landmark randomized trial demonstrated that participants with prediabetes could reduce their risk for type 2 diabetes by 58% if they achieved 5%–7% weight loss through healthy eating and increasing physical activity. The National DPP (NDPP) is a group intervention based on the DPP and has been widely disseminated by the Centers for Disease Control and Prevention (CDC) and many healthcare institutions. While data show that the program is effective in diverse populations, enrollment among men from low-income and minority communities is low. Thus, the study piloted a novel adaptation focused on men living in disadvantaged neighborhoods. The study approach to adaptation and implementation used characteristics of participatory research, including input from an expert panel of African American and Latino leaders, ongoing consultation with an Advisory Panel, and focus groups with members of the target population. Discussions with these groups focused on male perspectives regarding health promotion and barriers and facilitators to participation in health programming for men. There was general agreement when reviewing ongoing pilot program implementation that the adapted program should have male-only groups with male coaches, as the Advisory Panel had originally suggested. The pilot programs were implemented at five New York City Department of Parks and Recreation sites in Harlem, the Bronx, and Brooklyn in 2015–2016.

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