Diabetes is a significant health problem for Native Hawaiians (NHs) living in the State of Hawaii. Ironically in a state with the reported healthiest population in the Nation, the indigenous peoples, the NHs, have the highest age-adjusted mortality from diabetes (DM) compared to other Hawaii residents and a rate that is 3-fold higher than the US population. Despite these findings, little is actually known about the prevalence or incidence of DM among NHs and there is essentially no research on diabetes interventions among NHS. While the basis for any diabetes program is diet and exercise, promoting long-term behavioral changes are often difficult to achieve. Conventional approaches to DM education holds little relevance to the diet, social context and environmental influences experienced by most NHs. However, building on cultural strengths, such as reverence for the family unit (or 'ohana), preferences for traditional Hawaiian foods a-respect for Hawaiian culture, will likely improve the success of an intervention program designed for NHs. The purpose of this project is to determine whether a cultural-based, healthy lifestyles program administered through the 'ohana (Hawaiian family unit) will have a positive long term effect on diabetic and at-risk Native Hawaiians. Outcome measures will be nutrition and exercise habits, social and family functioning, health care and medication use and measurements of the insulin resistance syndrome (i.e. hyperinsulinemia, hypertension, obesity, and dyslipidemia). The initial phase of the study will survey the entire NH population identified and will invite all eligible subjects to participate in the intervention. Thereby minimizing any biases inherent to volunteer subjects and also providing mph needed data on DM and at-risk individuals in the NH population. The main focus of the study will be a culturally-sensitive, family-based community intervention targeting families at high risk for developing DM and will involve two treatment arms: l) healthy lifestyles program, delivered through the 'ohana and 2) the same information delivered through community meetings. The healthy lifestyles program will emphasize cultural aspects of diet, exercise and behavior modification to achieve enduring health practices. Since the overall goal of the program is to promote long-term changes in health behaviors, the active intervention will continue for l year and participants followed for another year after completing the program.
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