Diabetes affects 13% of US adults and African Americans (AAs) have higher prevalence of diabetes, higher
diabetes related cost, higher risk of complications, and higher risk of early death compared to non-Hispanic
Whites. A key factor that is emerging as a significant contributor to poor health outcomes for AAs is structural
racism. A component of structural racism is historical redlining and restrictive covenants that has forced AAs to
live in less-than-optimal neighborhoods in inner cities of most urban areas. A recent community-based case
study conducted by our team in Milwaukee identified a new paradigm for addressing health disparities in inner-
city environments. The study suggests that mass incarceration, residential segregation, violence, housing
instability, food insecurity, intergenerational poverty, and the limited educational opportunities that characterize
the lived experience of inner-city AAs create a state of chronic stress, which leads to poor health and increased
disability and ultimately leads to decreased human capital (defined as the intangible, yet integral, economically
productive aspects of individuals). A promising intervention that may address the underlying poverty related
chronic stress of structural racism and living in inner city environments for AAs with type 2 diabetes (T2DM) is
Cash Transfer, which can be conditional or unconditional. Conditional cash transfers (CCTs) supplements
basic income conditional on performing certain health-related activities such as attending health education
classes or completing preventive care recommendations, whereas unconditional cash transfers (UCTs) are not
conditional on any required activities. However, CCTs and UCTs have not been tested in the United States as
a strategy to alleviate the poverty-related chronic stress that detract from effective self-care for chronic
diseases like T2DM in inner city AAs. This study will test the preliminary efficacy of diabetes-tailored CCT (DM-
CCT), which will be conditional on participating in biweekly (every two weeks), nurse-led, virtual diabetes
education/skills training and stress/coping intervention compared to UCT (with no requirement for participation)
on clinical outcomes, self-care behaviors, and psychological health in 100 inner city AAs with poorly controlled
T2DM using an RCT design. The aims of the proposed study include: AIM 1: Test the preliminary efficacy of
the DM-CCT intervention on glycemic control and quality of life for inner-city AAs with T2DM. AIM 2: Test the
preliminary efficacy of the DM-CCT intervention on self-care behaviors and psychological health for inner-city
AAs with T2DM. AIM 3: Estimate the cost of delivery of the DM-CCT and UCT interventions in preparation for
future cost effectiveness analysis.
