ABSTRACT: Type 2 diabetes (T2D) disproportionately impacts Latino children, families and communities. T2D disparities are the result of complex interactions that involve biological susceptibility and various interdependent social determinants that represent the root causes of disease. The Diabetes Prevention Program (DPP) established that T2D can be prevented in high-risk adults through intensive lifestyle intervention. Although the DPP has been translated to a variety of adult populations and settings, engagement and effectiveness is diminished in minority communities and there are no family-focused diabetes prevention trials for Latinos. For over a decade, our team has collaborated to address the social and cultural determinants of diabetes among Latino youth, in the midst of extant disparities in access to care, low health literacy, and certain cultural norms that may increase diabetes risk. Our culturally-grounded approach is guided by an Ecodevelopmental model that considers community, family, peer, and individual-level factors that influence health behaviors and health outcomes over time. Through a series of increasingly rigorous studies we established that a lifestyle intervention can significantly reduce T2D risk factors and increase Quality of Life (QoL) among Latino adolescents with obesity. We now propose to build upon our extensive experience working with the local Latino community to rigorously test the efficacy of a family-focused diabetes prevention intervention for reducing T2D risk and increasing QoL among high-risk Latino families. We will use Integrative Mixed Methods to understand how family structures and processes influence intervention outcomes. We will examine the sustainability of the intervention at 12-months and explore mediators and moderators of long-term changes. Lastly, we acknowledge that the current translational gap between scientific discovery and real-world impact must be closed so that evidence-based interventions are expeditiously scaled to advance towards health equity for vulnerable and underserved populations. Therefore, we will use the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide areas for adaptation and integration within key community-based organizations that may be well-positioned to adopt and implement family-focused diabetes prevention programs. Our long-term goal is to build the evidence, network, and capacity to scale multi-level, family-focused diabetes prevention programs across systems that serve vulnerable and disadvantaged communities. As the next step towards this goal, we propose the following Primary Aim: Test the efficacy of a 4-month, family-focused diabetes prevention intervention, compared to a family control condition, for improving glucose tolerance and increasing QoL among high-risk Latino families. Secondary Aim: Understand how family structure and family processes influence the reach, diffusion, and impact of the intervention on the family system. Exploratory Aim: Examine mediators and moderators of 12- month changes in glucose tolerance and QoL. Implementation Aim: Create a statewide, stakeholder- informed plan to take family diabetes prevention to scale by 1) generating a rapid learning community with organizations that serve Latino families in Arizona, 2) exploring the need, readiness, costs of, and capacity for implementation across these organizations, and 3) planning adaptations and activities to enhance fit and function of the intervention within these organizations.

Project Narrative: Type 2 diabetes is a costly disease that is more prevalent in Latino families. This study will test the effects of a diabetes prevention program for Latino families who are at risk for diabetes. We will also look for ways to expand diabetes prevention programs across multiple communities through partnerships.