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

> **NIH NIH R21** · TEXAS A&M UNIVERSITY · 2020 · $178,325

## Abstract

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.

## Key facts

- **NIH application ID:** 10124732
- **Project number:** 1R21DK124732-01A1
- **Recipient organization:** TEXAS A&M UNIVERSITY
- **Principal Investigator:** Idethia Shevon Harvey
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $178,325
- **Award type:** 1
- **Project period:** 2020-09-14 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10124732

## Citation

> US National Institutes of Health, RePORTER application 10124732, The Study on Type-2 Diabetes and the Rural Experience regarding Stress and Self-management behaviors (STRESS) Project (1R21DK124732-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10124732. Licensed CC0.

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