title: A Home-Visiting Diabetes Prevention and Management Program for American Indian Youth: The Together on Diabetes Trial.
abstract: The purpose of this study was to test the feasibility of a family-based, home-visiting diabetes prevention/management intervention for American Indian (AI) youth with or at risk for type 2 diabetes.
  
  
  
  The Together on Diabetes program, developed through community-based participatory research, enrolled 255 AI youth (aged 10-19 years) with or at risk for type 2 diabetes and 223 support persons. Delivered by local AI paraprofessionals in 4 rural AI communities, the program included home-based lifestyle education and psychosocial support, facilitated referrals, and community-based healthy living activities. Changes in AI youth participants' knowledge, behavior, psychosocial status, and physiological measurements were assessed over 12 months.
  
  
  
  Over one-half (56.1%) of youth were boys. The median age was 13.2 years. At baseline, 68.0% of youth reported no physical activity in the past 3 days; median percentages of kilocalories from fat (36.18%) and sweets (13.67%) were higher than US Department of Agriculture recommendations. Nearly 40% of participants reported food insecurity in the past month; 17.1% screened positive for depression. Support persons were predominantly family members, few reported having home Internet access (38.6%), and the majority reported being long distances (>30 minutes) from food stores. Whereas support persons were primarily responsible (≥69%) for obtaining medical care for the youth, the youth had a greater role in behavioral outcomes, indicating joint diabetes prevention/management responsibility.
  
  
  
  Baseline results confirmed the need for family-based youth diabetes prevention interventions in rural AI communities and indicated that enrolling at-risk youth and family members is feasible and acceptable.
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Chambers, Dr Rosenstock, Ms Kenney, Dr Barlow)
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Chambers
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Chambers, Dr Rosenstock, Ms Kenney, Dr Barlow)
authors.forename: Summer
authors.initials: S
authors.lastname: Rosenstock
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Albuquerque, New Mexico (Ms Neault)
authors.forename: Nicole
authors.initials: N
authors.lastname: Neault
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Chambers, Dr Rosenstock, Ms Kenney, Dr Barlow)
authors.forename: Anne
authors.initials: A
authors.lastname: Kenney
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Tuba City, Arizona (Ms Richards)
authors.forename: Jennifer
authors.initials: J
authors.lastname: Richards
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Chinle, Arizona (Ms Begay)
authors.forename: Kendrea
authors.initials: K
authors.lastname: Begay
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Shiprock, New Mexico (Ms Blackwater, Dr Reid)
authors.forename: Thomasina
authors.initials: T
authors.lastname: Blackwater
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Whiteriver, Arizona (Mr Laluk)
authors.forename: Owen
authors.initials: O
authors.lastname: Laluk
authors.affiliation: Boston Children's Hospital, Division of Gastroenterology, Hepatology and Nutrition, Center for Nutrition, Boston, Massachusetts (Dr Duggan)
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Shiprock, New Mexico (Ms Blackwater, Dr Reid)
authors.forename: Raymond
authors.initials: R
authors.lastname: Reid
authors.affiliation: Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Chambers, Dr Rosenstock, Ms Kenney, Dr Barlow)
authors.forename: Allison
authors.initials: A
authors.lastname: Barlow
mesh_terms: D000293:Adolescent; D002648:Child; D055812:Community-Based Participatory Research; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000523:psychology; D005190:Family / Q000523:psychology*; D005240:Feasibility Studies; D005260:Female; D005523:Food Supply; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008019:Life Style; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D012424:Rural Population; D012648:Self Care / Q000523:psychology; D012944:Social Support; D014481:United States; D055815:Young Adult