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

> **NIH NIH R21** · UNIVERSITY OF MISSOURI-COLUMBIA · 2022 · $177,192

## Abstract

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.

## Key facts

- **NIH application ID:** 10690211
- **Project number:** 7R21DK124732-03
- **Recipient organization:** UNIVERSITY OF MISSOURI-COLUMBIA
- **Principal Investigator:** Idethia Shevon Harvey
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $177,192
- **Award type:** 7
- **Project period:** 2020-09-14 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10690211

## Citation

> US National Institutes of Health, RePORTER application 10690211, The Study on Type-2 Diabetes and the Rural Experience regarding Stress and Self-management behaviors (STRESS) Project (7R21DK124732-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10690211. Licensed CC0.

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