Objectives-Our community-academic partnership employed community-based participatory research to develop and pilot a simple, peer-led intervention to promote weight loss, which can prevent diabetes and eliminate racial/ethnic disparities in incident diabetes among overweight adults with prediabetes.Methods-We recruited overweight adults at community sites, performed oral glucose tolerance testing to identify persons with blood glucose levels in the prediabetes range, and randomized eligible people to a peer-led lifestyle intervention group or delayed intervention in 1 year. Outcomes, including weight, blood pressure, and health behaviors, were measured at baseline and 3, 6, and 12 months.Results-More than half of those tested (56%, or 99 of 178) had prediabetes and enrolled in the study. Participants were predominantly Spanish-speaking, low-income, undereducated women. The intervention group lost significantly more weight than the control group and maintained weight loss at 12 months (7.2 versus 2.4 pounds; P < .01). One fourth (24 of 99) of participants progressed to diabetes.Correspondence should be sent to Carol R. Horowitz, Dept of Health Evidence and Policy, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1077, New York, New York 10029 (carol.horowitz@ mountsinai.org). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. . Contributors P. Parikh managed data collection and analysis, and led the writing. E. P. Simon codirected study implementation and reviewed and interpreted focus group transcripts. K. Fei and H. Looker performed data analysis and led interpretation of results. C. Goytia assisted with recruitment and data collection and reviewed and interpreted focus group transcripts. C. R. Horowitz directed the research design and oversaw all aspects of study implementation and analysis. All authors helped to conceptualize ideas, interpret findings, and write and review drafts of the article. Human Participant ProtectionThis study was approved by the Mount Sinai School of Medicine's institutional review board. NIH Public Access Author ManuscriptAm J Public Health. Author manuscript; available in PMC 2011 March 16. NIH-PA Author ManuscriptConclusions-In underserved minority communities, prediabetes prevalence may be higher than previously reported. Low-cost, community-based interventions can succeed in encouraging weight loss to prevent diabetes.Despite compelling evidence that diabetes is escalating in the United States and that promoting weight loss can mitigate its rise, implementation of effective, sustainable diabetes prevention interventions has been slow and sporadic. [1][2][3][4] More than 1 in 8 American adults have diabetes. 5 Blacks and Hispanics are hit hardest by this epidemic: diabetes mortality for these groups is nearly double that of Whites. [6][7][8] Half of Hispanic and nearly half of Black children born in the first decade of this century will develop diabetes if adequate preventive measures are not taken. 9 To date, the most ef...

Background and Purpose-Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical events such as strokes and transient ischemic attacks (TIAs). Little is known regarding how PTSD triggered by medical events affects patients' adherence to medications. Methods-We surveyed 535 participants, age Ն40 years old, who had at least 1 stroke or TIA in the previous 5 years.PTSD was assessed using the PTSD Checklist-Specific for stroke; a score Ն50 on this scale is highly specific for PTSD diagnosis. Medication adherence was measured using the 8-item Morisky scale. Logistic regression was used to test whether PTSD after stroke/TIA was associated with increased risk of medication nonadherence. Covariates for adjusted analyses included sociodemographics, Charlson comorbidity index, modified Rankin Scale score, years since last stroke/TIA, and depression. Results-Eighteen percent of participants had likely PTSD (PTSD Checklist-Specific for stroke Ն50), and 41% were nonadherent to medications according to the Morisky scale. A greater proportion of participants with likely PTSD were nonadherent to medications than other participants (67% versus 35%, PϽ0.001). In the adjusted model, participants with likely PTSD were nearly 3 times more likely (relative risk, 2.7; 95% CI, 1.7-4.2) to be nonadherent compared with participants without PTSD (PTSD Checklist-Specific for stroke Ͻ25) even after controlling for depression, and there was a graded association between PTSD severity and medication nonadherence.

Patient knowledge and beliefs about treatment and medical mistrust are mutable factors associated with underuse of effective adjuvant therapies. Physicians may improve cancer care by ensuring that discussions about adjuvant therapy include a clear presentation of the benefits, not just the risks of treatment, and by addressing patient trust in and concerns about the medical system.