Non-insulin Dependent Diabetes Mellitus NIDDM), or Type II Diabetes, has reached epidemic proportions among American Indians throughout North America. The age adjusted diabetes mellitus mortality rate for American Indians and Alaska Natives in the Indian Health Service (IHS) Areas is 21.7 per 100,000. When the three IHS Areas with problems in underreporting of Indian race on death certificates are excluded, the diabetes mellitus mortality rate rises to 41.4 per 100,000. This is 248 percent higher than the US All Races rates of 11.9 per 100,000. Obesity is a risk factor for NIDDM, as well as other chronic diseases. Levels of obesity have increased dramatically among American Indians during the last 50 years. NIDDM is believed to be preventable with a healthy lifestyle which includes proper nutrition and exercise. The goal of this project is to design, implement and evaluate a community-based health care model for American Indians which incorporates culturally appropriate approaches to NIDDM prevention and control. Our target population is American Indian adults residing in the Aberdeen IHS Service Area, which includes the states of Nebraska and South Dakota. Phase I (Year 01) of this three-phase study will consist of planning and start up activities. Staff will be hired and trained, the Advisory Board will be convened, and initial planning will take place. Focus groups will meet during the fourth and eighth months of the first year. Curriculum will be developed, data collection protocols and survey instrument development will take place. The training video will be produced during the last six months of the first year. A cookbook emphasizing local Native American foods will be developed by the Project Field Director. This cookbook will be provided as a gift to participants and will be widely disseminated to the intervention and control groups at the project s end. In Phase II (Years 02 and 03), four sites will be randomized into intervention and control groups. Adult American Indians with diabetes and those at-risk for diabetes will be identified and invited to participate. Wellness Circle (with pre- and post-tests, anthropometric measures and 24 hour dietary recalls) will be implemented in the intervention sites. Pre- and post-tests, anthropometric measures and 24 hour dietary recalls will be administered at the control sites. Phase III (Year 04) activities will focus on completion of data entry, analyses, evaluation/hypothesis testing and reporting on the findings of the intervention and project results. During this final year, control sites will be provided all educational materials and one training session per site.
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