Explore the vast range of titles available.

ObjectiveDevelop and study a culturally tailored genomics education tool to better inform future consent processes for genomics research participation among a medically underserved population with diabetes.DesignA single-arm, cohort pre/postsurvey study to assess an educational intervention developed using a community engaged approach.SettingFederally Qualified Health Centers in San Diego.ParticipantsAdults (18 years or older) self-identifying as Latino or Hispanic with type 2 diabetes or a history of gestational diabetes were invited to participate. A total of 111 enrolled and completed the preintervention survey; 60 completed the education session and postsurvey. Lay healthcare promotoras previously trained to offer bilingual diabetes education and support were also invited; 34 enrolled and completed the study.InterventionUsing community-engaged research approaches, we developed a genomics education programme to include required elements of informed consent for future diabetes genomics research. The 1-hour, face-to-face genomics education programme was delivered 14 times with a variety of day versus evening and weekday versus weekend options, across a 9-month period. Participants completed a 21-item survey, which included 12 items measuring genomics knowledge and 9 items assessing attitudes towards genomics in healthcare.Primary and secondary outcome measuresPrimary outcome was the difference between pre and posteducation mean total genomics knowledge scores among the patients who completed the education session and postsurvey. Secondary outcomes included comparison of baseline survey scores between patient and promotora subgroups, difference between patient pre and posteducation mean total attitude scores, and prescore to postscore changes within each knowledge and attitude survey item. An exploratory analysis of associations between preintervention scores and sociodemographic characteristics was also completed.ResultsAmong 60 patients, mean genomics knowledge scores significantly increased from 7.3 (SD=1.9) preintervention to 9.4 (SD=1.5) postintervention (p<0.0001). Preintervention, promotoras (mean 8.1, SD=2.0) had significantly higher knowledge scores than patients (mean 6.9, SD 2.3) (p=0.01). Similarly, promotoras (mean 6.8, SD1.3) demonstrated a more positive attitude than patients (mean 6.0, SD=1.4) (p=0.0008). Patient attitudes towards genomic testing did not change significantly from preintervention to postintervention (6.2 (SD=1.4) vs 6.3 (SD=1.4), p=0.51).ConclusionsA community-informed education intervention improved genomics knowledge in an under-represented population, providing a model to foster more adequately informed consent for advanced technology research participation.

OBJECTIVE: To evaluate the effect of a culturally sensitive diabetes self-management education program that uses a low-cost, peer-educator format (Project Dulce) on glucose control and metabolic parameters in low-income Mexican Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 207 Mexican-American patients recruited from federally funded community health centers in San Diego County with HbA1c >8% were randomly assigned to the Project Dulce peer intervention or continuation of standard diabetes care. The primary outcome of interest was HbA1c. RESULTS: The majority of subjects were born in Mexico, were female, were middle-aged, had less than an eighth-grade education, and had high baseline HbA1c levels. Significant time-by-group interaction effects for HbA1c (P = 0.02) and diastolic blood pressure (P = 0.04) indicated that the Project Dulce group exhibited greater improvement (i.e., decreases) across time. Within-group analyses showed that the intervention group exhibited significant improvements from baseline to month 4 in absolute levels of HbA1c (–1.7%, P = 0.001) and HDL cholesterol (+1.4 mg/dL, P = 0.01) and from baseline to month 10 in absolute levels of HbA1c (–1.5%, P = 0.01), total cholesterol (–7.2 mg/dL, P = 0.04), HDL cholesterol (+1.6 mg/dL, P = 0.01), and LDL cholesterol (–8.1 mg/dL, P = 0.02). No significant changes were noted in the control group. CONCLUSIONS: This randomized trial, using the Project Dulce model of culturally sensitive, peer-led education, demonstrates improvement in glucose and metabolic control and suggests that this low-cost approach to self-management education for high-risk diabetic populations is effective.

One potential explanation for the predictive utility of ambulatory blood pressure (BP) monitoring is that it captures BP in the context of social experiences that are relevant to cardiovascular health. The interpersonal circumplex (IPC) is a central component of interpersonal theory that categorizes social experiences along two perpendicular axes: affiliation (friendliness vs. hostility) and control (dominance vs. submissiveness). The present study investigated associations of social interactions and interaction quality with acute ambulatory BP reactivity, mean daytime and nighttime BP, and nocturnal BP dipping in healthy, middle-aged Mexican-American women. Participants (N=260) completed a 36-hour ambulatory BP monitoring assessment; momentary psychosocial experiences were captured via electronic diary. Findings revealed that momentary SBP and DBP were an average of 1.55 and 1.52 mmHg higher (respectively, ps < .001) in the context of a current/recent social interaction relative to observations that did not involve a social interaction. For every additional ∼13 social interactions (of any kind), SBP and DBP dipping increased by 0.8% and 1.1%, respectively (ps < .05). For interaction quality, momentary SBP and DBP were an average of 1.31 and 1.00 mmHg higher (respectively, ps < .001) during supportive (i.e., high affiliation) compared to other types of interactions; however, this association was only statistically significant when family member and/or friend was the interaction partner. A cumulative increase of ∼9 supportive interactions was associated with a 2.03 mmHg decrease in mean daytime SBP, and 2.20 and 1.28 mmHg decreases in mean nighttime SBP and DBP, respectively (ps < .05). A decrease of ∼3 disagreements (i.e., low affiliation) was associated with 1.48 and 1.14 mmHg reductions in mean nighttime SBP and DBP, respectively (ps < .05). Trends were also observed for support and disagreements and greater/lesser nocturnal (DBP) dipping, respectively (ps <.10). No statistically significant associations were observed for ambulatory BP and social experiences characterized by high/low control. This study highlights aspects of the social environment as factors that may shape resilience (via greater interaction frequency, higher levels of support) and risk (via lower interaction frequency, higher levels of conflict), and thus represent potentially modifiable targets for CVD prevention and management efforts in Latinos.