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

项目摘要/摘要 农村地区的2型糖尿病(T2D)患病率比城市地区高17%。此外，T2D还进行了排名 根据《2020年农村健康人口报告》，这是第三重要的农村公共卫生优先事项。农村 人口不成比例地受到可预防的慢性疾病的影响，而社会背景加剧了这种疾病 贫穷、地理上与世隔绝，以及日常生活中持续暴露在压力源中等因素。一起， 这些因素可能对T2D自我管理(T2D-SM)行为产生负面影响。压力是一种 特别引人注目的研究领域，因为有强有力的证据表明其与慢性病的联系 以及代谢综合征，如高血压和肥胖。这项拟议研究的中心假设是 这种压力会影响T2D SM行为。这项拟议研究的基本原理是心理生物学 这些措施提供了令人信服的数据，将贫困、长期压力和歧视与糟糕的T2D结果联系起来。 这项研究将使用一种数据三角方法，通过这种方法，生物压力测试将 结合经验压力调查数据，了解压力和压力之间的交集和相互作用 RAA中的T2D SM行为。这项研究建立在社区参与的强大基础设施之上 在德克萨斯州的布拉索斯山谷地区进行了一项研究，以探索纳入压力的生物测试(例如， T2D组RAAS患者的唾液皮质醇)。指导这项研究建议的两个具体目标是：1) 确定压力的选定心理生物学标记物、心理社会压力和 T2D SM行为以及RAA与T2D之间的关系；以及2)确定不同形式的 心理社会压力(即一般与特定领域的心理压力)导致了T2D SM行为的差异 在具有T2D的RAAS中。这项研究将招募200名被诊断为T2D的RAA，以确定哪些 压力源是影响自我管理行为的重要危险因素。对于目标1，这项研究将审查 唾液皮质醇、自我报告的应激源和T2D-SM行为之间的关系。对于目标2，研究将 分析主观压力自评量表与健康状况、心理社会因素的关系 到遵守有效的T2D SM行为的程度。提出的研究具有创新性，主要体现在 申请人的意见，因为它涉及一个重要的公共卫生问题(歧视和其他慢性 应激源)在人群(即，AA)中在乡村和疾病自身的背景下基本上被忽视 管理层。这项拟议的研究意义重大，因为它有望提供强有力的证据，证明 心理社会和生理应激源对T2D-SM行为的影响这项研究项目的成果 可以为公共卫生领域做出相当大的贡献，因为它有可能为 农村非裔美国人的健康。

PROJECT SUMMARY/ABSTRACT 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.