Integrating Diabetes Prevention Education Among Teenagers Involved in Summer Employment: Encouraging Environments for Health in Adolescence (ENHANCE).

Type 2 diabetes (T2D) in youth is a growing healthcare and public health concern. It is costly, and youth suffer from disabling and deadly comorbid conditions at a faster pace than adult onset. However, T2D is preventable. The population of obese youth at greatest risk for T2D is of minority race/ethnicity and socioeconomically disadvantaged background, which creates barriers to health promoting lifestyles. Despite being the first line of prevention efforts for T2D, efficacious behavioral lifestyle interventions are still lacking at the community level. During the summers of 2016 and 2017, a study integrated obesity and diabetes prevention health education into TeenWorks summer employment program at Indy Urban Acres in Indianapolis, Indiana. Results were analyzed using paired sample t-tests. Participants (N = 168) had a mean age of 15.8 ± 0.7 years, 61% female, 13% Hispanic, 80% Black. By the end of the intervention, physical activity (p = 0.000) and prevention knowledge (p = 0.000) were significantly higher. Dietary intake (p = 0.204), self-efficacy (p = 0.58), food insecurity (p = 0.058) and depression screening scores (p = 0.809) were not significantly different. In light of the continuing childhood obesity epidemic and increasing prevalence of prediabetes and T2D in youth, there is a pressing need to understand and reduce barriers to obesity and diabetes prevention in high-risk populations. This study demonstrated the feasibility of integrating obesity and T2D prevention health education into a teen summer employment program.

Rationale and design of a comparative effectiveness trial to prevent type 2 diabetes in mothers and children: the ENCOURAGE healthy families study.

The number of youth with type 2 diabetes (T2D) is expected to quadruple over 4 decades. Gestational diabetes mellitus (GDM) is also increasing and is linked with development of T2D in women, and greater risk for T2D in adolescents exposed to GDM. Despite the increasing prevalence of T2D, approaches to prevent diabetes in high-risk youth and families are rare. To address this, we are conducting the Encourage Health Families Study (ENCOURAGE). This is a randomized trial evaluating the comparative effectiveness and costs of an adaptation of the Diabetes Prevention Program (DPP) directed at mothers who had GDM or prediabetes and their children. The intervention is a group-based lifestyle program which we developed and implemented in partnership with the YMCA. We are comparing the ENCOURAGE intervention targeted to 1) mothers who have had GDM or prediabetes, and 2) mothers who have had GDM or prediabetes along with their school-aged children. This manuscript provides 1) the rationale for a targeted approach to preventing T2D and the interventions, 2) description of the translation of the DPP curriculum, and 3) the study design and methodology. The primary aims are to determine if participation leads to 1) weight loss in high-risk mothers, and 2) youth having healthier weights and lifestyle habits. We will also evaluate costs associated with each approach. These data are essential to build a translation model of T2D prevention that is both realistic and feasible to address this growing problem in both youth and adults.