Castro Felipe González, Shaibi Gabriel Q, Boehm-Smith Edna
Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, USA.
J Behav Med. 2009 Feb;32(1):89-105. doi: 10.1007/s10865-008-9194-z. Epub 2008 Dec 20.
Diabetes is the sixth leading cause of death in the United States and it is now cited along with obesity as a global epidemic. Significant racial/ethnic disparities exist in the prevalence of diabetes within the US, with racial and ethnic minorities disproportionately affected by type 2 diabetes and its complications. Racial/ethnic and socioeconomic factors influence the development and course of diabetes at multiple levels, including genetic, individual, familial, community and national. From an ecodevelopmental perspective, cultural variables assessed at one level (e.g., family level dietary practices) may interact with other types of variables examined at other levels (e.g., the availability of healthy foods within a low-income neighborhood), thus prompting the need for a clear analysis of these systemic relationships as they may increase risks for disease. Therefore, the need exists for models that aid in "mapping out" these relationships. A more explicit conceptualization of such multi-level relationships would aid in the design of culturally relevant interventions that aim to maximize effectiveness when applied with Latinos and other racial/ethnic minority groups. This paper presents an expanded ecodevelopmental model intended to serve as a tool to aid in the design of multi-level diabetes prevention interventions for application with racial/ethnic minority populations. This discussion focuses primarily on risk factors and prevention intervention in Latino populations, although with implications for other racial/ethnic minority populations that are also at high risk for type 2 diabetes.
糖尿病是美国第六大死因,目前它与肥胖症一同被视为全球流行病。在美国,糖尿病患病率存在显著的种族/族裔差异,少数种族和族裔群体受2型糖尿病及其并发症的影响尤为严重。种族/族裔和社会经济因素在多个层面影响糖尿病的发生和发展过程,包括基因、个体、家庭、社区及国家层面。从生态发展的角度来看,在一个层面评估的文化变量(如家庭层面的饮食习惯)可能会与在其他层面考察的其他类型变量(如低收入社区内健康食品的可及性)相互作用,因此需要清晰分析这些系统关系,因为它们可能会增加患病风险。所以,需要有助于“梳理”这些关系的模型。对这种多层次关系进行更明确的概念化,将有助于设计出与文化相关的干预措施,这些措施旨在应用于拉丁裔和其他少数种族/族裔群体时能最大限度地提高有效性。本文提出了一个扩展的生态发展模型,旨在作为一种工具,帮助设计针对少数种族/族裔人群的多层次糖尿病预防干预措施。尽管该讨论主要聚焦于拉丁裔人群的风险因素和预防干预措施,但对同样面临2型糖尿病高风险的其他少数种族/族裔群体也有借鉴意义。