The Diabetes Prevention Program (DPP) has shown that lifestyle intervention resulting in increased physical activity and modest weight loss can delay or prevent the incidence of type 2 diabetes in those at risk. Mexican-American women have the highest lifetime risk of diabetes compared to any other ethnic groups. They are also more likely to be overweight and obese compared to white women. The ability of Mexican-American women to modify their diets and physical activities may be influenced by """"""""familism,"""""""" a cultural characteristic that reflects the family-oriented and collectivistic aspects of Latino culture. The mother-daughter relationship is an important bond in Latino culture, and is a critical point of intervention for health promotion. Daily activities such as shopping for food and preparing meals for the family are often shared mother-daughter activities. In this context, the Unidas por la Vida (United for Life) intervention modifies the DPP lifestyle intervention and adapts it for use among Mexican-American women with diabetes and their overweight or obese adult daughters at risk for diabetes.
We aim to test the feasibility of implementing this partner-based approach that leverages the mother-daughter relationship for promoting increased physical activity and weight loss. Mexican-American mother-daughter dyads (mothers have type 2 diabetes;daughters are overweight or obese, with pre-diabetes) are identified in the primary care setting. Using a team-based approach of diabetes educators, exercise science experts, and community lay health workers, the intervention is delivered in group meetings in a community-based setting and also in participants'homes. This 16-weeks program is modeled after the DPP's principles of frequent contact using a combination of group and individual sessions and tailoring the strategies to address ethnic diversity. However, Unidas por la Vida is distinguished by the use of a family-member """"""""partner"""""""" for shared goal-setting and mutual reinforcement. The intervention also leverages community resources in a partnership between community-based organizations. This intervention is potentially sustainable because it allows the individual to utilize the local community and family members as """"""""social capital"""""""" for behavioral change. This is especially important because previous research has shown that Mexican-American women report little social support for healthy diet and exercise. Furthermore, because weight loss and weight control are difficult to maintain, a partner-based approach that uses family members who are important and integral to the participant's life may enhance long-term success. Preliminary data from this R34 planning grant will provide support for the R18 effectiveness trial that will test the intervention in a multi-site study that will include other high-risk groups. Should this intervention be found to be effective in the R18 study, the principles of this partner-based program may be adapted for dissemination among individuals at risk for diabetes who can partner with another supportive person for weight loss and sustained weight maintenance.

Public Health Relevance

This proposal represents the critical first step to test the overall objective that this partner-based intervention could positively promote lifestyle change among high risk Latina women, and thus, prevent and reverse obesity and type 2 diabetes.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Planning Grant (R34)
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Special Emphasis Panel (ZDK1-GRB-1 (O1))
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Hunter, Christine
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University of California Irvine
Internal Medicine/Medicine
Schools of Medicine
United States
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