The primary goal of this project is to extend a promising lifestyle change program to an underserved population at high risk for coronary heart disease (CHD). Hispanic Americans, the fastest growing ethnic population in the US, and in particular postmenopausal Hispanic women (Latinas), have an increased prevalence of type 2 diabetes, and a greater incidence of diabetes complications than non-Hispanic Whites. The proposed study, the Latina Lifestyle Program (LLP), will comprehensively evaluate a multiple-risk-factor intervention (diet, physical activity, stress management, social support, and smoking cessation) in a randomized effectiveness trial and will be offered in English and in Spanish. Our research team has shown that this theory-based comprehensive lifestyle change program is effective in improving behavioral, psychosocial, quality of life, and biologic outcomes among heterogeneous postmenopausal Anglo women with type 2 diabetes. Though the results to date are promising, four important research issues must be addressed before such a program is ready for translation to practice. This proposal focuses on these questions'. (1) How should the structure and content of the program be modified to address the cultural characteristics of Latinas? (2) Will the program succeed if offered in a large health plan serving minority populations (i.e., Kaiser Permanente in Denver, CO)? (3) What are the economic implications of the LLP? (4) How generalizable are the program effects across participants, intervention staff, settings and time? The RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) will be used to assess the impact of this program, when conducted by regular health plan staff, on dimensions important for translation to practice. Primary outcomes will include change on behavioral measures of healthful eating and physical activity;secondary outcomes will include impacts on quality of life, physiologic measures, member satisfaction, and cost-effectiveness. We also will study the relations between cultural variables in Latinas (e.g., family and social support;acculturation) and program participation and outcomes. Substantial public health impacts of this study include (1) intervening with a high-risk, underserved population, (2) the focus on multiple, critically important lifestyle behaviors known to reduce risk for CHD, (3) a test of maintenance of behavioral changes, (4) the methodology employed to estimate the program's readiness for translation, and (5) measuring the robustness, reach, and cost-effectiveness of the program. The program results, materials, and lessons learned will be disseminated via multiple avenues.
