Type 2 diabetes (T2D) prevalence is 17% higher in rural areas than in urban areas. Additionally, T2D is ranked as the third most important rural public health priority, according to the Rural Healthy People 2020 report. Rural populations are disproportionately affected by preventable chronic diseases exacerbated by social contextual factors such as poverty, geographic isolation, and persistent exposure to stressors in daily living. Together, these factors may have a negative impact on T2D self-management (T2D-SM) behaviors. Stress is a particularly compelling area of study in light of strong evidence demonstrating its linkages to chronic diseases and metabolic syndrome such as hypertension and obesity. The central hypothesis of this proposed study is that stress influences T2D SM behaviors. The rationale for the proposed research is that psychobiological measures provide compelling data linking poverty, chronic stress, and discrimination to poor T2D outcomes. This study will employ a data triangulation approach through which biological assays for stress will be combined with experiential stress survey data to access the intersections and interactions between stress and T2D SM behaviors among rAAs. The study builds upon a robust infrastructure from community-engaged research in the Brazos Valley region of Texas to explore the inclusion of biological assays for stress (e.g., salivary cortisol) among rAAs with T2D. The two specific aims that guide this research proposal are: 1) determine the relationship between selected psychobiological markers of stress, psychosocial stress, and T2D SM behaviors and among rAAs with T2D; and 2) to determine the extent to which different forms of psychosocial stress (i.e., general versus domain-specific) contribute to differences in T2D SM behaviors among rAAs with T2D. The study will recruit 200 rAAs, who have been diagnosed with T2D to determine which stressors are important risk factors for self-management behaviors.
For Aim 1, The study will examine the association between salivary cortisol, self-reported stressors, and T2D-SM behaviors.
For Aim 2, The study will analyze the relationship of subjective self-reported measures of stress, health status, and psychosocial factors to the level of adherence to effective T2D SM behaviors. The research proposed is innovative, in the applicants? opinion, because it addresses an important public health problem (discrimination and other chronic stressors ) in a population (i.e., AAs) largely ignored within the contexts of rurality and disease self- management. The proposed research is significant because it is expected to provide strong evidence of the effect of psychosocial and physiological stressors on T2D-SM behaviors. The results of this research project can offer considerable contributions to the public health field because it has the potential to shed new light on the health of rural African Americans.
The proposed research is relevant to public health because it represents an innovative approach for understanding the complex relationship between stress and behavioral modification (e.g., self-management) for type-2 diabetes among rural African Americans. Once the stressors have been identified, we can see the potential for significant advancement in the development of type-2 diabetes self-management programs for rural minority communities. Thus, the proposed research is relevant in part because it embodies the National Institute of Diabetes and Digestive Kidney Diseases? dual mission: to reduce health disparities and to increase diversity in health-related research.
