The Study on Type-2 Diabetes and the Rural Experience regarding Stress and Self-management behaviors (STRESS) Project

项目摘要/摘要 农村地区2型糖尿病(T2D)的患病率比城市地区高17%。此外，T2D是 根据2020年农村健康人群，被列为第三重要的农村公共卫生优先事项 报告情况。农村人口不成比例地受到可预防的慢性疾病的影响，这种疾病因 社会背景因素，如贫困、地理隔绝和日常生活中持续暴露于压力源 活着。总而言之，这些因素可能会对T2D自我管理(T2D-SM)行为产生负面影响。 农村非裔美国人(RAAS)自我管理行为的行为解释，几乎没有 社会因素的作用一直受到研究的关注。压力是一个特别引人注目的研究领域 鉴于强有力的证据表明它与慢性病和高血压等疾病有关 还有肥胖症。该建议的目标是确定哪些压力源(即，一般压力源与特定领域压力源)是 是T2D-SM行为的重要危险因素。该项目将使环境公平模型适用于 探索生物社会和环境背景因素之间的中介、调节和相互作用 塑造T2D-SM行为。这项研究建立在社区参与研究的强大基础之上 在布拉索斯河谷地区，探讨将应激生物测定法(如唾液皮质醇)纳入 RAAS与T2D。指导这项研究建议的两个具体目标是：1)确定 哪些心理社会压力可以解释有心理压力的自闭症患者在T2D自我管理行为上的差异；以及 2)确定心理社会应激与生理应激标志物(如皮质醇)之间的关系 来自RAAS的T2D。这项研究将招募200名被诊断为T2D的RAA来确定 哪些压力源是影响自我管理行为的重要危险因素。对于目标1，这项研究将收集 并分析压力、健康状况、心理社会因素和糖尿病自我管理的主观测量 行为。对于目标2，这项研究将检查唾液皮质醇、自我报告的压力源、 和T2D-SM行为。申请者认为，提出的研究是创新的，因为它解决了 RAA中的一个重要公共卫生问题(即压力和歧视)，在很大程度上 被忽视，在农村社区和疾病自我管理的背景下。拟议的研究是 有重要意义，因为它有望提供心理社会压力和生理压力的有力证据 T2D-SM行为的测量。这一研究项目的成果可以为 公共卫生领域，因为它有可能让人们对非洲裔美国农村人的健康有新的了解。

PROJECT SUMMARY/ABSTRACT The prevalence of type 2 diabetes (T2D) 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. Behavioral explanations for rural African Americans’ (RAAs) self-management behaviors, with virtually no research attention has been paid to the role of social factors. Stress is a particularly compelling area of study in light of strong evidence demonstrating its linkages to chronic diseases and conditions such as hypertension and obesity. The goal of this proposal is to determine which stressors (i.e., general versus domain-specific) are an important risk factor for T2D-SM behaviors. This project will adapt the Environmental Affordances Model to explore the mediating, moderating, and interactions among biosocial and environmental contextual factors shaping T2D-SM behaviors. The study builds upon a robust infrastructure from community-engaged research in the Brazos Valley region 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) to determine the extent to which psychosocial stress explain differences in T2D self-management behaviors among RAAs with T2D; and 2) to determine the relationship between psychosocial stress and physiological stress markers (e.g., cortisol) from RAAs with T2D. The study will recruit 200 RAAs, who have been diagnosed with T2D, to determine which stressors are an important risk factors for self-management behaviors. For Aim 1, The study will collect and analyze subjective measures of stress, health status, psychosocial factors, and diabetes self-management behaviors. For Aim 2, The study will examine the association between salivary cortisol, self-reported stressors, and T2D-SM behaviors. The research proposed is innovative, in the applicants’ opinion, because it addresses an important public health problem (i.e., stress and discrimination) among RAAs, which has largely been ignored, within the context of rural communities and disease self-management. The proposed research is significant because it is expected to provide strong evidence of psychosocial stress and physiological stress measures 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.