Research Profile

African American (AA) men are twice as likely to have type 2 diabetes (T2D) compared to non-Hispanic White men and are more likely to die from T2D-related complications. Because AA men have worsened T2D management compared to non-Hispanic White men, their risk for T2D complications is higher. Further, patients with T2D are twice as likely to have depression than those without T2D. Depressive symptoms are associated with high blood sugar levels and T2D health-complications. Research studies show the critical role of gender in the management of T2D and depression and shows that male gender norms may conflict with help-seeking and healthy behaviors. Program ACTIVE (Adults Coming Together to Increase Vital Exercise) is a program that involves cognitive behavioral therapy (CBT) and community-based exercise. The goal of Program ACTIVE is to improve T2D and depression outcomes. Considering the research pointing to the success of Program ACTIVE, such programs can be changed to meet the needs of AA men with T2D and depression to effectively reach, retain, and improve health in this population. The proposed project, Program AACTIVE (African Americans Coming Together to Increase Vital Exercise) seeks to: 1) Adapt the evidence-based Program ACTIVE program to work for AA men with T2D and depression in a community-based clinic and 2) conduct a research study to determine the impact of the new program on blood glucose levels and depression. Data from the program will help refine recruitment strategies, training materials, and how best to run a larger version of the program.

Type 2 diabetes (T2D) is highly prevalent in African American (AA) men and they are more likely to be diagnosed with T2D compared to non-Hispanic White men. Extant research in health disparities shows how poverty and race can influence the health and wellbeing trajectories of AA men. For instance, T2D has its most damaging affects within urban low-income communities of color, and yet they continue to lack access to quality health care. While men have similar rates of T2D compared to women, when poverty status and race considered, low-income AA men are disproportionately impacted with respect to severity and mortality. Discourses on gender equity in health often focus on a binary between men and women, which often ignore the structural and systemic issues that sub-groups of men and women are required to navigate. This limited framing of gender equity does not acknowledge the complex health and social inequities faced by marginalized groups of men, particularly those relating to race, age, socioeconomic status, geography and disability. Therefore, a more concerted and nuanced focus on health equity in the field of men's health is needed. In the context of our proposed project, we seek to create T2D programming that addresses the intersection of gender and markers of marginalization (e.g. race/ethnicity; income). It is our expectation to provide evidence for the effectiveness of a social behavioral therapy intervention for AA men with T2D. The findings will facilitate understanding of barriers and facilitators to implementing a community-based approach and the impact of the initiative.

My initial interest in pursuing diabetes research began in high school when I noticed the disparate impact diabetes had on my family. Since then, I have watched different family members struggle with the disease—insulin injections, lost limbs, doctor’s visits and blood tests—all magnified by inadequate medical benefits and education. Some of my earliest memories were of long lines, ridiculous fees for health care, and inaccurate diagnoses. However, these experiences only helped to ignite my commitment to study health disparities among Latino/as and African Americans, two communities I also belong to. As a result, I am committed to a career as a researcher and have been working steadily towards establishing my independence as a scientist. My long-term career goals are to: 1) establish a career as a productive, independent researcher with a focus on diabetes self-management and prevention and treatment of psychosocial issues in diabetes with a specific focus on Black men and 2) have a fully funded program of research adapting and evaluating self-management interventions with an emphasis on addressing the unique needs of Black men with diabetes. In the context of the COVID-19 and social justice crises in the U.S., an opportunity exists to tailor interventions to meet the needs of Black men using virtual delivery modalities to improve health disparities and overcome barriers for this important population. Our intervention will advance health equity by facilitating health care access for low-income Black men, a high-risk population typically left behind in diabetes research and health care programming. Success of this study sets the stage for larger implementation trials and adoption of evidence-based interventions to address foundations of health disparities in diabetes for Black men.

My long-term career goals are to: 1) further develop and adapt type 2 diabetes interventions for African American men; and 2) identify effective implementation and dissemination strategies for evidence-based type 2 diabetes interventions that address the unique needs of African American men. I have a great deal of support here at the U-M that spans across both disciplines and departments and across the country from leaders in social/behavioral diabetes research. Ultimately, my will lead to sustainable lifestyle interventions that facilitate diabetes self-management and treat psychosocial issues to reduce disparities in diabetes for African American men.