An examination of influential factors in diabetes prevention efforts

D.P.H. University of Hawaii at Manoa 2013.Includes bibliographical references.Type 2 Diabetes Mellitus (hereafter referred to as "diabetes") is a growing public health concern in the United States (U.S.), making prevention a priority. An estimated 79 million U.S. adults (35% of adults) have pre-diabetes, a health condition that denotes a high risk for diabetes, surpassing the number of adults who have diabetes. Clinical trials have shown that diabetes can be prevented in individuals with pre-diabetes through lifestyle health behaviors including weight loss, physical activity, and diet/nutrition. Understanding the factors that influence diabetes prevention is important in efforts to improve the health of at-risk individuals. This three-part dissertation aimed to better understand the influential factors in diabetes prevention efforts and the implications for chronic disease prevention. Through a secondary data analysis of the National Health and Nutrition Examination Survey (NHANES), the first study quantitatively examined the impact of risk awareness on physical activity and diet in pre-diabetic individuals. The second study used survival/time-to-event analysis and data from the epidemiological Kohala Health Study to investigate the predictive ability of the metabolic syndrome in Native Hawaiians at risk for diabetes. The third study used qualitative methods to identify the salient factors that influence the perceptions of potential adopters on lifestyle interventions, and how the identified issues affect the implementation of lifestyle interventions. Together, these three studies suggest that in order to decrease diabetes incidence, prevention efforts will need to extend beyond the education and awareness efforts at the individual-interpersonal level (i.e. prevention programs), and address the broader environmental context (i.e. public policies, community norms, organizational values). Individual-level prevention programs will need to be complemented by population-based strategies that seek to minimize the underlying causes of diabetes