Peer relationships and diabetes: retrospective and ecological momentary assessment approaches

Applications of the experience sampling method (ESM) in paediatric healthcare: a systematic review

BACKGROUND

With the Experience Sampling Method (ESM) participants are asked to provide self-reports of their symptoms, feelings, thoughts and behaviours in daily life. This preregistered systematic review assessed how ESM is being used to monitor emotional well-being, somatic health, fatigue and pain in children and adolescents with a chronic somatic illness.

METHODS

Databases were searched from inception. Studies were selected if they included children or adolescents aged 0-25 years with a chronic somatic illness and used ESM focussing on mental health or psychosocial wellbeing, biopsychosocial factors and/or somatic health. Two reviewers extracted data of the final 47 papers, describing 48 studies.

RESULTS

Most studies evaluated what factors influence medical or psychological symptoms and how symptoms influence each other. Another common purpose was to study the feasibility of ESM or ESM as part of an app or intervention. Study methods were heterogeneous and most studies lack adequate reporting of ESM applications and results.

CONCLUSIONS

While ESM holds great potential for providing results and feedback to patients and caregivers, little use is being made of this option. Future studies should consider what they report in their studies, conduct a priori power analyses and how ESM can be embedded in clinical practice.

IMPACT

While ESM has many clinical applications, it is currently mostly used for research purposes. Current studies using ESM are heterogeneous and lack consistent, high-quality reporting. There is great potential in ESM for providing patients and parents with personalised feedback.

Thinking Style Moderates the Impact of the Classroom Environment on Language Creativity

The classroom environment significantly affects the development of creativity. This study examined the impact of the classroom environment on students' creativity and the moderating role of thinking styles in this relationship. For this study, we recruited 451 students from six secondary schools. Data were collected using the Chinese Language Creativity Test, Classroom Environment Inventory, and Thinking Styles Inventory. Hierarchical regression analysis examined the moderating effect of thinking styles on the relationship between the classroom environment and creativity. The results showed that peer relationships in the classroom environment negatively influence students' fluency and originality in creativity. At the same time, teachers' evaluation and teaching methods positively affect the fluency of creativity. Thinking styles moderated the impact of the classroom environment on language creativity. This study identified four different moderating effects: the thinking styles matching the classroom environment can enhance language creativity, whereas the mismatched ones hinder it. However, matching would limit language creativity for individuals with creative thinking styles (e.g., legislative and anarchic thinking styles), while a mismatch can boost creative performance. The findings help educators understand students' creativity with different thinking styles in various classroom environments and provide individualized and effective strategies for optimizing educational environments and enhancing language creativity.

Support and Conflict Among Youth With Type 1 Diabetes: A Focus on Friends

OBJECTIVE

The goal of the study was to examine the relations of general and diabetes-specific friend support and conflict to psychological and diabetes health among youth with type 1 diabetes. We examined gender as a moderator of these relations, and friend responsiveness and information-sharing as potential mediators.

METHODS

Youth with type 1 diabetes (n = 167; M age 15.83 [SD = 0.78]; 50% female) were interviewed once in the Fall and once in the following Spring of the school year. Using multiple regression analysis, general friend support, general friend conflict, diabetes-specific support, and diabetes-specific conflict were investigated as simultaneous predictors of psychological and diabetes outcomes cross-sectionally and longitudinally over four months.

RESULTS

Cross-sectionally friend conflict, including both general and diabetes-specific, was more predictive of outcomes than friend support. In cross-sectional and longitudinal analyses, gender was a significant moderator, such that several relations of general friend conflict to outcomes were significant for females but not nonfemales. Friend support revealed mixed relations to outcomes across cross-sectional and longitudinal analyses. Although we found links of friend relationship variables to mediators (perceived responsiveness; information sharing), we found little evidence of mediation.

CONCLUSIONS

These findings show stronger evidence that conflictual friend relationships than supportive friend relationships are linked to health. Findings suggest that problematic friend relationships may have a stronger impact on the health of females than nonfemales. These results underscore the need to better understand the conditions under which friend support is helpful versus harmful and the reasons underlying these links.

Longitudinal associations between allostatic load, pet ownership, and socioeconomic position among U.S. adults aged 50

It is hypothesized that pets provide benefits to human health by buffering the deleterious effects of stress, but varying exposure to chronic stress via social position is rarely considered in these conceptual and empirical models. Allostatic load is an index of biological and physical measures that represents cumulative wear and tear on the body via chronic stress exposure. In this study, we use the 2006-2016 waves of the Health and Retirement Study, a nationally representative, longitudinal panel survey of adults aged 50+ in the United States, to test whether and to what extent pet ownership has an impact on allostatic load, and whether pet ownership moderates the effects of socioeconomic position on allostatic load. Linear mixed effects regression models revealed that pet owners had significantly lower allostatic load scores than those who do not own pets; however, after adjusting for socioeconomic position (i.e., wealth, education, race, ethnicity, gender, marital status), the effect of pet ownership was no longer significant. We estimated a series of models stratified by sociodemographic groups to test moderation effects. Among those who had a high school education, pet owners had lower allostatic load scores, whereas among those who had attended some college, pet owners had higher scores. Among those who were aged 80+, pet owners had higher scores than those who did not own pets. These findings suggest that the magnitude of the effect of pet ownership on allostatic load may not be sufficient to counteract experiences of high chronic stress as experienced by lower-status groups. Supporting the human-animal bond may contribute to improving older adult population health if paired with efforts to address the underlying causes of population health disparities.

The role and need for psychological support in the treatment of adolescents and young people suffering from type 1 diabetes

Psychological support might be perceived as one of the most important factors in the treatment of people suffering from type 1 diabetes, particularly among vulnerable groups such as adolescents and young people. Problems arising from extreme pressure put on young patients, high expectations, and specific limitations associated with diabetes often reflect in negative wellbeing and affect patients' behavior, resulting in lower self-esteem, mood swings, depression, or even eating disorders. Therefore, the need for a more holistic approach to the treatment of diabetes and caring about psychological support can be observed, which may contribute to better functioning and management of the disease. Differentiation of certain approach methods such as the positive approach (PA) discussed in the text may help young patients in motivation and coping with their disease as well as accepting limitations caused by type 1 diabetes. This would decrease the risk of potential revolt against medical recommendations, common for patients at the mentioned age, and help raise awareness of the problem. Maintaining life balance through undertaking regular physical activities and being open to new strategies such as telenursing can also result in the improvement of glycemic control. The studies presented have proven the great effectiveness of personalized care adjusted to the patient with psychological support, as well as the invaluable role of education in diabetes, which includes not only standard procedures such as calculating an appropriate insulin dose but also the invention of effective coping mechanisms, which influence patients' performance and wellbeing.

Division of Type 1 Diabetes Responsibility in Latinx and Non-Latinx White Mother-Adolescent Dyads

Incidence rates of type 1 diabetes are increasing faster in Latinx youth than other ethnic groups, yet this population remains understudied. The current study (1) tested differences in division of diabetes-related responsibility (adolescent alone, mother alone, and shared) across Latinx and non-Latinx White families (N = 118 mother-adolescent dyads, 56 = Latinx dyads, M_age=13.24 years), and (2) examined associations between diabetes responsibility and adolescent health (HbA1c, diabetes self-management behaviors, and depressive symptoms). Latina mothers reported more shared and less adolescent responsibility than non-Latinx White mothers, but there were no ethnic differences in adolescent reports of responsibility. Independent of demographic and illness-related characteristics, mother- and adolescent-reports of shared responsibility were associated with higher self-management behaviors, while individual responsibility (adolescent or mother alone) was generally associated with lower self-management behaviors. Shared responsibility associations with higher mother-reported self-management behaviors occurred among Latinx families, but not non-Latinx White families. Shared and individual responsibility were not associated with HbA1c or depressive symptoms. The findings suggest the importance of shared responsibility for diabetes management in adolescence, particularly in Latinx families.

Development of Peer Relationships From Adolescence into Emerging Adulthood: Comparing Males and Females With and Without Type 1 Diabetes

OBJECTIVE

Friendships and romantic relationships are important sources of support that contribute to well-being for youth across adolescence and emerging adulthood and may be especially important for those with a chronic illness. We examined gender differences in trajectories of peer relationships among those with type 1 diabetes (T1D) and how they differ from those without.

METHODS

Individuals with T1D (N = 132) and controls (N = 131) completed questionnaires across 11 years (M age = 12 years at baseline). Trajectories of friend support, conflict, and companionship were estimated from ages 11 to 23. Romantic support and conflict trajectories were estimated from ages 17 to 23.

RESULTS

Females experienced more friend support than males, especially in comparison to males with T1D. Control females experienced highest levels of romantic support and lowest levels of romantic conflict. In comparison to control males, males with T1D experienced less friend support in early adolescence and less companionship in late adolescence and emerging adulthood. In comparison to control females, females with T1D experienced less friend support in late adolescence and more romantic conflict in emerging adulthood.

CONCLUSIONS

Findings that males with T1D report less friend support and companionship compared to control males, and females with T1D report less friend support and more romantic conflict than control females are of concern as these results suggest those with T1D may be missing out on important aspects of peer relationships. Understanding the broader social network of peer relationships may be useful to clinicians as they assist individuals in garnering support in general and for their diabetes.

Ecological Momentary Assessment: A Systematic Review of Validity Research

Ecological momentary assessment (EMA) is a self-report method that involves intensive longitudinal assessment of behavior and environmental conditions during everyday activities. EMA has been used extensively in health and clinical psychology to investigate a variety of health behaviors, including substance use, eating, medication adherence, sleep, and physical activity. However, it has not been widely implemented in behavior analytic research. This is likely an example of the empirically based skepticism with which behavioral scientists view self-report measures. We reviewed studies comparing electronic, mobile EMA (mEMA) to more objective measures of health behavior to explore the validity of mEMA as a measurement tool, and to identify procedures and factors that may promote the accuracy of mEMA. We identified 32 studies that compared mEMA to more objective measures of health behavior or environmental events (e.g., biochemical measures or automated devices such as accelerometers). Results showed that the correspondence rates varied considerably across individuals, behavior, and studies (agreement rates ranged from 1.8%-100%), and no unifying variables could be identified across the studies that found high correspondence. The findings suggest that mEMA can be an accurate measurement tool, but further research should be conducted to identify procedures and variables that promote accurate responding.

The Experience Sampling Method in Monitoring Social Interactions Among Children and Adolescents in School: A Systematic Literature Review

Background

The experience sampling method (ESM) is an increasingly popular data collection method to assess interpersonal dynamics in everyday life and emotions contextualized in real-world settings. As primary advantages of ESM sampling strategies include minimization of memory biases, maximization of ecological validity, and hypothesis testing at the between- and within-person levels, ESM is suggested to be appropriate for studying the daily lives of educational actors. However, ESM appears to be underutilized in education research. We, thus, aimed to systematically evaluate the methodological characteristics and quality of published ESM studies of social interactions among children and adolescents in school settings, as well as to explore how much variance in social interaction variables could be attributed to the within-person level.

Method

Using Academic Search Complete, APA PsycINFO, APA PsycArticles, ProQuest, Web of Science, Wiley Online Library, and SAGE Journals, and in accordance with PRISMA guidelines and pre-defined eligibility criteria, we conducted a systematic literature search of experience sampling studies up to November 2020. To assess methodological quality, we used a modified checklist for reporting of ESM studies.

Results

Of the originally 2 413 identified studies, a final 52 experience sampling studies were included in the present review. Findings on sample and study design characteristics generally revealed wide variability. Even if high-quality studies were associated with higher scores on the training of participants in using the ESM procedure, and use of incentives, these design strategies did not reveal a statistically significant impact on compliance. The intraclass correlation coefficient was reported in nine studies and on average 58% of the variance in social interaction variables could be attributed to within-person fluctuation between timepoints.

Conclusion

The current study is the first to systematically review ESM-based studies on social interactions among children and adolescents in the school context. These observations suggest that ESM is a potentially favorable technique for extracting complex social phenomena in real-world settings. We hope that this review will contribute to improving the quality assessment of ESM studies as well as to inform and guide future experience sampling studies, particularly regarding social phenomena with children and adolescents in educational settings.

Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies

Type 1 diabetes (T1D) is one of the most common chronic childhood diseases, and its prevalence is rapidly increasing. The management of glucose in T1D is challenging, as youth must consider a myriad of factors when making diabetes care decisions. This task often leads to significant hyperglycemia, hypoglycemia, and glucose variability throughout the day, which have been associated with short- and long-term medical complications. At present, most of what is known about each of these complications and the health behaviors that may lead to them have been uncovered in the clinical setting or in laboratory-based research. However, the tools often used in these settings are limited in their ability to capture the dynamic behaviors, feelings, and physiological changes associated with T1D that fluctuate from moment to moment throughout the day. A better understanding of T1D in daily life could potentially aid in the development of interventions to improve diabetes care and mitigate the negative medical consequences associated with it. Therefore, there is a need to measure repeated, real-time, and real-world features of this disease in youth. This approach is known as ecological momentary assessment (EMA), and it has considerable advantages to in-lab research. Thus, this viewpoint aims to describe EMA tools that have been used to collect data in the daily lives of youth with T1D and discuss studies that explored the nuances of T1D in daily life using these methods. This viewpoint focuses on the following EMA methods: continuous glucose monitoring, actigraphy, ambulatory blood pressure monitoring, personal digital assistants, smartphones, and phone-based systems. The viewpoint also discusses the benefits of using EMA methods to collect important data that might not otherwise be collected in the laboratory and the limitations of each tool, future directions of the field, and possible clinical implications for their use.

Qualitative analysis of helpful and unhelpful aspects of social relationships among young adults with type 1 diabetes

AIMS

Young adulthood is a high-risk time for type 1 diabetes management when individuals are managing diabetes within changing social contexts and new social relationships. This qualitative study examined helpful and unhelpful aspects of social relationships in the daily lives of young adults with type 1 diabetes.

METHODS

Semi-structured qualitative interviews with 29 young adults with type 1 diabetes (ages 22-24, mean = 23 years; 55% female) explored: (a) who in the past week was present when diabetes management occurred; (b) what others did that was helpful or unhelpful for diabetes management; (c) what made helpful and unhelpful aspects of social relationships more or less likely; and (d) what young adults disclosed to others about diabetes.

RESULTS

Romantic partners and parents were commonly present and helpful in giving reminders and offering instrumental support, but the presence of trusted individuals was also helpful to management. Co-workers and friends were present during episodes of diabetes management but were often unhelpful, especially when lacking knowledge about participants' diabetes or its management. Participants also discussed conflicting and spontaneous changes in schedules were unhelpful to management. Disclosing diabetes to others and planning for social context barriers were described as strategies to facilitate helpful and reduce unhelpful aspects of social relationships.

CONCLUSIONS

Young adults face social barriers to management if they are unable to utilize their relationships effectively. Interventions to promote disclosure to trusted others and planning to avoid social context-related barriers to diabetes management may facilitate more effective self-management at this high-risk time of development.

[Using new media in pediatric psychosomatic medicine]

Neue Medien wie Smartphone-Apps oder virtuelle Realitäten (VR) finden zunehmend Anwendung in der pädiatrischen Psychosomatik. In der Diagnostik liegen die Vorteile in der Erfassung von Daten im Alltag sowie in der realitätsnahen und zugleich standardisierten Erfassung mithilfe der VR. In der Behandlung lassen sich selbstadministrierte und hybride Technologien von computerassistierten und computerspielbasierten Interventionen unterscheiden, die allesamt zunehmend in der pädiatrischen Psychosomatik zum Einsatz kommen, so z. B. bei Schmerzerkrankungen, Enkopresis, chronischen Erkrankungen oder auch begleitenden Depressionen und Ängsten. Durch das Auslösen alltagsnaher Reaktionen bei gleichzeitiger maximaler Kontrolle bieten VR auch in der Forschung große Vorteile. Nichtsdestotrotz sind Kontraindikationen wie Psychosen, Epilepsie und Migräne zu beachten. Eine umfassende Schulung des Fachpersonals ist daher für die Nutzung neuer Medien in der Diagnostik, Behandlung und Forschung essenziell.

Ecological momentary assessment for health behaviors and contextual factors in persons with diabetes: A systematic review

AIM

The objective of this systematic review was to summarize the ecological momentary assessment (EMA) methodology and associations between EMA-measured psychosocial, contextual factors and diabetes self-management.

METHODS

The inclusion criteria were: research of EMA and diabetes self-management behaviors such as glucose checks, administration of insulin and eating-and dietary intake behaviors among persons with diabetes. A comprehensive search of several databases was conducted across all dates until July 2020.

RESULTS

A modified Checklist for Reporting EMA Studies was used to assess the quality of studies. Among the ten included studies, participants were predominantly White adolescents with type 1 diabetes (T1D) and type 2 diabetes was studied in two studies. Time-varying, psychosocial contexts such as negative affect or negative social interaction were associated with missed insulin injection and poor adherence to glucose check. More preceding psychological stress was associated with more calorie intake from snacks or binge eating behaviors. Mornings were the most challenging time of day for adherence to diabetes self-management among adolescents with T1D. Intentional insulin withholding was more common in the afternoon in adults with T1D.

CONCLUSIONS

EMA has potential clinical utility in the assessment of diabetes self-management and in the development of timely and individualized diabetes interventions.

Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes

OBJECTIVE

Following the Journal of Pediatric Psychology's special edition on health disparities, calling for Phase 2 research exploring mechanisms of racial groups in health disparities, this study aims to explore social information processing predictors of longitudinal hemoglobin A1c (HbA1c) trajectories in a racially diverse group of adolescents. The social information processing model of glycemic control in type 1 diabetes (T1D) posits that adolescents who make negative attributions about reactions of friends are likely to find adherence difficult in social situations, have increased stress, and have suboptimal glycemic control.

METHODS

One hundred eighty-four youth with T1D completed self-report measures and HbA1c at three time points within 1 year was extracted from medical records. Growth mixture modeling empirically derived classes of HbA1c trajectories and explored predictive relationships of social information processing variables, demographics, and diabetes characteristics.

RESULTS

Three classes emerged: High Decelerating, Mid-High Accelerating, and Near-Optimal Accelerating. Black/African American participants were highly likely to be in the High and Mid-High groups. Higher anticipated adherence difficulties in social situations predicted increased odds of being in the Mid-High versus Near-Optimal HbA1c group. Increased diabetes stress predicted increased odds of being in the High versus Near-Optimal and Mid-High groups.

CONCLUSIONS

Continuing research on mechanisms behind this health disparity is necessary with more representation from varied racial and ethnic groups. Equal access to diabetes technology and psychosocial treatments are recommended and implications for clinical intervention development are discussed.

Social Support and Peer Group Integration of Adolescents with Diabetes

The aim of this study was to examine, through the roles of peers with regards to diabetes, the relationship between the support perceived by adolescents with diabetes and their peer-group affiliation. This is a descriptive, phenomenological and retrospective study based on a qualitative methodology. In-depth interviews with 15 people aged 18-35 with type 1 diabetes mellitus diagnosed in their childhood or adolescence were carried out. Data was analyzed through the interpretation of general discourses. Peers have considerable influence on adolescents and provide them social support from different roles. The protective role basically offers emotional support and sends reminders of different aspects of the treatment, while the indifferent role does not meddle in any aspect related to the diabetes. Both roles can foster social integration of adolescents with diabetes into the peer group. The offender role creates social conflicts through discrimination and stigma of adolescents with diabetes. These roles appear during the process of socialization of adolescents with diabetes, where commensality and situations of self-monitoring or administering insulin, key aspect of diabetes treatment, are crucial. Peer groups, depending on the role adopted, may offer support or bring a specific conflict regarding diabetes to their adolescent peer. The combination of roles that friends and peer group play with regards to diabetes will determine the degree of socialization and integration of adolescents with diabetes.

Daily text message assessments of 6-mercaptopurine adherence and its proximal contexts in adolescents and young adults with leukemia: A pilot study

BACKGROUND

This pilot study explored the feasibility and acceptability of implementing text-based assessments of oral chemotherapy adherence in adolescents and young adults (AYA) with leukemia.

METHODS

AYA prescribed maintenance 6-mercaptopurine (6MP) received daily text message surveys and utilized an electronic pill bottle for 28 days. Text surveys assessed 6MP adherence and contextual associates (eg, mood). Feasibility was defined by recruitment/retention rates, survey completion rates, cost, and technical issues. After the 28-day period, AYA completed an acceptability survey. Secondary analyses compared text survey and electronic pill bottle adherence rates, and explored the daily associations between contextual factors and 6MP nonadherence.

RESULTS

Eighteen AYA enrolled (M age = 18, range 15-22) and completed study procedures (100% recruitment and retention rates). Adherence survey completion rates were high (M = 88.9%), the technology cost was $204.00, and there were few technical issues. AYA reported high satisfaction with the surveys and perceived them as a helpful medication reminder. While not significantly correlated, survey and electronic pill bottle adherence data converged on the majority of days (>90%). Exploratory analyses showed that AYA were more likely to miss a dose of 6MP on weekends (OR = 2.33, P = .048) and on days when their adherence motivation (OR = 0.28, P = .047) and negative affect (OR = 3.92, P = .02) worsened from their own typical functioning.

CONCLUSIONS

For AYA with leukemia, daily text-based surveys are a feasible and acceptable method for delivering medication adherence assessments, and may operate as a short-term intervention. To develop personalized mobile health interventions, findings also highlighted the need to study time-varying predictors of 6MP nonadherence.

Factors Influencing Adherence Among Youth with Type-1-Diabetes Mellitus - The Hungarian Case

Background and Introduction: Due to the increasing prevalence of type-1-diabetes, an increasing number of studies have drawn attention to its psychological effects and long-term consequences. As Type 1 Diabetes Mellitus is a chronic, non-curable, yet maintainable condition, with the affected children and their families facing a lifelong challenge, our research focuses on the factors influencing adherence.

METHODS

The adherence of youth was examined in a sample involving 114 patients treated in the Medical and Health Science Centre at the University of Debrecen by employing a new adherence questionnaire (DAQ abbreviated version, Munkácsi et al. 2019) (DAF 2017; N=114). The influence of socio- demographic variables and those related to the disease (age at the time of diagnosis, the time elapsed since diagnosis, method of treatment, the time elapsed since the use of the pump) was measured by linear regression. Furthermore, the between-group comparisons were made by independent sample t-tests and variance analysis. The investigation was carried out between September 2017 and May 2018.

RESULTS

The effect of using insulin pump as therapy turned out to be significant and positive (0.36. p=0.045). It was observed that the adherence of the patients using insulin pump was higher while the effect of the age at the diagnosis had a significantly negative effect (-.247, p=0.035). Thus, earlier detection of the disease may lead to a higher level of adherence. The effects of the socio-demographic variables (gender, family structure, educational level, type of the settlement, owning sibling and birth order) were not significant (p>0.05). Regarding the between-group comparisons, a significant difference could be pointed out concerning the siblings and birth-order as the adherence of those with siblings was higher (p=0.044). Moreover, concerning insulin pump therapy, the adherence of patients using pump was significantly better (p=0.048). Also, regarding the age of the diagnosis, the adherence of those diagnosed before 12 was seemingly higher (p=0.039). Concerning the other socio-demographical and disease-related variables, no significant differences could be detected.

CONCLUSION

The results suggest that the treatment has an outstanding role in the adherence of the disease. Moreover, the role of the appropriate treatment, living conditions as well as the early diagnosis is relevant.

How Peer Conflict Profiles and Socio-Demographic Factors Influence Type 1 Diabetes Adaptation

OBJECTIVE

This study aimed to (a) validate the factor structure for a measure of peer conflict in youth with type 1 diabetes (T1D); (b) determine empirical patterns of peer conflict in terms of context (friend vs. nonfriend) and content (diabetes-specific vs. general) within a broader context of socio-demographic factors; and (c) examine how these patterns and socio-demographic factors relate to adolescents' T1D adherence, quality of life, and glycemic control (HbA1c).

METHODS

Youth with T1D (N = 178), ages 12-18, reported demographic variables, illness duration, adherence, quality of life, and peer conflict. HbA1c was extracted from medical records. Confirmatory factor analysis validated a factor structure for the Diabetes Peer Conflict Scale (DPCS) and latent profile analysis (LPA) determined profiles of peer conflict.

RESULTS

A four-factor structure emerged for the DPCS: general friend conflict, general nonfriend conflict, T1D friend conflict, and T1D nonfriend conflict. Using these factors as indicators in LPA, four profiles were confirmed: (a) Low Overall Conflict (LOC) and (b) Moderate Overall Conflict (MOC), (c) a Nonfriend Conflict (NFC), and (d) a Friend Conflict (FC) profile. Differences were not identified between diabetes specific versus general conflict. Socio-demographic variables did not predict class membership. The LOC profile reported the highest quality of life and best glycemic control, whereas the FC profile reported the lowest adherence behaviors. Conclusions: Peer conflict uniquely contributes to diabetes adaptation above and beyond socio-demographic and illness factors.

Social Support and Common Dyadic Coping in Couples' Dyadic Management of Type II Diabetes: Protocol for an Ambulatory Assessment Application

Background

Type II diabetes mellitus (T2DM) is a common chronic disease. To manage blood glucose levels, patients need to follow medical recommendations for healthy eating, physical activity, and medication adherence in their everyday life. Illness management is mainly shared with partners and involves social support and common dyadic coping (CDC). Social support and CDC have been identified as having implications for people’s health behavior and well-being. Visible support, however, may also be negatively related to people’s well-being. Thus, the concept of invisible support was introduced. It is unknown which of these concepts (ie, visible support, invisible support, and CDC) displays the most beneficial associations with health behavior and well-being when considered together in the context of illness management in couple’s everyday life. Therefore, a novel ambulatory assessment application for the open-source behavioral intervention platform MobileCoach (AAMC) was developed. It uses objective sensor data in combination with self-reports in couple’s everyday life.

Objective

The aim of this paper is to describe the design of the Dyadic Management of Diabetes (DyMand) study, funded by the Swiss National Science Foundation (CR12I1_166348/1). The study was approved by the cantonal ethics committee of the Canton of Zurich, Switzerland (Req-2017_00430).

Methods

This study follows an intensive longitudinal design with 2 phases of data collection. The first phase is a naturalistic observation phase of couples’ conversations in combination with experience sampling in their daily lives, with plans to follow 180 T2DM patients and their partners using sensor data from smartwatches, mobile phones, and accelerometers for 7 consecutive days. The second phase is an observational study in the laboratory, where couples discuss topics related to their diabetes management. The second phase complements the first phase by focusing on the assessment of a full discussion about diabetes-related concerns. Participants are heterosexual couples with 1 partner having a diagnosis of T2DM.

Results

The AAMC was designed and built until the end of 2018 and internally tested in March 2019. In May 2019, the enrollment of the pilot phase began. The data collection of the DyMand study will begin in September 2019, and analysis and presentation of results will be available in 2021.

Conclusions

For further research and practice, it is crucial to identify the impact of social support and CDC on couples’ dyadic management of T2DM and their well-being in daily life. Using AAMC will make a key contribution with regard to objective operationalizations of visible and invisible support, CDC, physical activity, and well-being. Findings will provide a sound basis for theory- and evidence-based development of dyadic interventions to change health behavior in the context of couple’s dyadic illness management. Challenges to this multimodal sensor approach and its feasibility aspects are discussed.

International Registered Report Identifier (IRRID)

PRR1-10.2196/13685

High social strain and physical health: Examining the roles of anxious arousal, body mass index, and inflammation

Social relationships have powerful effects on physical health. Indeed, high social strain (i.e., frequent negative interactions with friends, family, or one's partner) increases risk of morbidity and mortality. Frequent social strain leads to anxious arousal and an increased body mass index (BMI), both of which may be underlying mechanisms for the association between social strain and health given that persistent anxious arousal promotes damaging biological and behavioral conditions contributing to increased inflammation. When chronic, heightened inflammation results in the deterioration of overall health. The purpose of the current study was to investigate anxious arousal, BMI, and inflammation as underlying mechanisms of the association between social strain and health. A sample of 763 middle aged adults participating in the Midlife in the United States (MIDUS 2) study completed self-report measures of social strain, anxious arousal, and physical health. Blood collection and a physical examination were completed to measure BMI and inflammation. Using 5000 bootstrap samples, results indicated that greater social strain was associated with poorer self-reported health (SRH) due to the serial pathway from high anxious arousal to BMI and inflammation.

Role of Social Factors in Glycemic Control Among African American Children and Adolescents with Type 1 Diabetes

OBJECTIVE

With the rising incidence of Type 1 diabetes (T1DM), it is important to recognize deficiencies in care and areas of improvement to provide better access to resources and education for T1DM patients. The objective of this study was to recognize social factors and compliance barriers affecting glycated hemoglobin (A1c) level in T1D patients among the minority population.

METHODS

A total of 84 T1DM patients, ages 3 to 21 years, 49% males, 87% African American participated in the study. Study questionnaires assessing patient knowledge and other variables were distributed and patient charts were reviewed retrospectively to obtain relevant clinical data. T-tests, one-way ANOVA and spearman correlation were used for analysis.

RESULTS

Mean A1c in our study was 10.5% and mean knowledge score was 10.1 out of 14. There was no significant correlation (r = 0.12, p = 0.26) between A1c and patients' knowledge scores. Patients with more frequent blood sugar (BS) monitoring (3-4 times/day) had 2 points lower A1c (9.6 vs 11.6 %, 95% CI 0.2-3.7, p = 0.03) than those with 2 or less times/day. No significant difference in A1c between 3-4 checks/day vs >4 checks/day BS checks. Most patients reported 'forgetfulness' (19%) followed by 'too time consuming' (17.9%) as barriers to daily BS monitoring. There was no significant difference in A1c between pen or pump users (10.5 vs 10.2 %, p = 0.55). Surprisingly, those with home supervision had higher A1c than those without (10.7 vs 9.6 %, p = 0.04) while there was no significant difference between those with or without nurse supervision at school (10.6 vs 9.8 %, p = 0.33). Those reporting happy mood interestingly had higher A1c than those with sad/depressed mood (10.7 vs 9.4 %, p = 0.04). On multiple linear regression analysis, frequency of BS checks, home supervision and mood were the most significant predictors of A1c and altogether explained 20% of the variability in A1c.

CONCLUSION

Frequent BS monitoring is associated with lower A1c. Supervision at home and school did not improve A1c, but it was self-reported information. Mood did not affect A1c contrary to that reported in other studies.

A Practical Guide to Analyzing Time-Varying Associations between Physical Activity and Affect Using Multilevel Modeling

There is growing interest in within-person associations of objectively measured physical and physiological variables with psychological states in daily life. Here we provide a practical guide with SAS code of multilevel modeling for analyzing physical activity data obtained by accelerometer and self-report data from intensive and repeated measures using ecological momentary assessments (EMA). We review previous applications of EMA in research and clinical settings and the analytical tools that are useful for EMA research. We exemplify the analyses of EMA data with cases on physical activity data and affect and discuss the future challenges in the field.

Ecological momentary assessment of contextual variables, satisfaction, and emotional and behavioral states of adolescents by level of victimization

The harmful effects of victimization on mental health have been demonstrated in several age groups, cultures, and populations, but there is wide variability in the resulting psychopathology. Ecological momentary assessment (EMA) allows the expression of an emotional state to be recorded at any given time and linked to a situation or context. This study aimed to analyze the contextual variables (where, with whom, and what), momentary satisfaction, and perception of momentary emotional and behavioral symptoms in a cohort of adolescents by the level of victimization, using EMA. We explored the everyday symptom profiles and the contexts in which events took place among 100 adolescents over a one-week period. Sociodemographic data were collected and assessment was done using the EMA (as a smartphone application) and the Juvenile Victimization Questionnaire (to assess childhood and adolescent victimization). In this study, regarding contextual variables, the group with the highest level of victimization (top 10%) showed a significant relationship with being away from home and being with friends other than classmates, and not being with parents or relatives. There was also an unexpectedly higher frequency of sporting engagement in this group. A relationship existed between emotional and behavioral problems and higher levels of victimization. In conclusion, the different groups of victimized subjects present a relatively high level of satisfaction in relation to the daily contexts and show low levels of emotional and behavioral symptomatology.

Communal Coping and Adjustment to Chronic Illness: Theory Update and Evidence

We present a theory of communal coping that describes an optimal pathway to patient adjustment among couples in which one person faces a chronic illness. Communal coping consists of a shared illness appraisal (i.e., person perceives illness as a joint rather than individual problem) and collaboration with a partner to manage the illness. We present a model of the communal coping process that links patient and partner shared illness appraisals to collaboration and a set of supportive interactions that might be reframed as collaboration in the presence of shared illness appraisals. We then outline a model that identifies potential antecedents of communal coping and mechanisms that link communal coping to patient illness adjustment (i.e., enhanced psychological well-being, improved health behaviors, better physical health) and partner psychological well-being. We review the empirical evidence for this model and conclude by identifying several moderator variables, noting potential limitations, and outlining future research directions.

Compliance With Mobile Ecological Momentary Assessment Protocols in Children and Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Mobile device-based ecological momentary assessment (mobile-EMA) is increasingly used to collect participants' data in real-time and in context. Although EMA offers methodological advantages, these advantages can be diminished by participant noncompliance. However, evidence on how well participants comply with mobile-EMA protocols and how study design factors associated with participant compliance is limited, especially in the youth literature.

OBJECTIVE

To systematically and meta-analytically examine youth's compliance to mobile-EMA protocols and moderators of participant compliance in clinical and nonclinical settings.

METHODS

Studies using mobile devices to collect EMA data among youth (age ≤18 years old) were identified. A systematic review was conducted to describe the characteristics of mobile-EMA protocols and author-reported factors associated with compliance. Random effects meta-analyses were conducted to estimate the overall compliance across studies and to explore factors associated with differences in youths' compliance.

RESULTS

This review included 42 unique studies that assessed behaviors, subjective experiences, and contextual information. Mobile phones were used as the primary mode of EMA data collection in 48% (20/42) of the reviewed studies. In total, 12% (5/42) of the studies used wearable devices in addition to the EMA data collection platforms. About half of the studies (62%, 24/42) recruited youth from nonclinical settings. Most (98%, 41/42) studies used a time-based sampling protocol. Among these studies, most (95%, 39/41) prompted youth 2-9 times daily, for a study length ranging from 2-42 days. Sampling frequency and study length did not differ between studies with participants from clinical versus nonclinical settings. Most (88%, 36/41) studies with a time-based sampling protocol defined compliance as the proportion of prompts to which participants responded. In these studies, the weighted average compliance rate was 78.3%. The average compliance rates were not different between studies with clinical (76.9%) and nonclinical (79.2%; P=.29) and studies that used only a mobile-EMA platform (77.4%) and mobile platform plus additional wearable devices (73.0%, P=.36). Among clinical studies, the mean compliance rate was significantly lower in studies that prompted participants 2-3 times (73.5%) or 4-5 times (66.9%) compared with studies with a higher sampling frequency (6+ times: 89.3%). Among nonclinical studies, a higher average compliance rate was observed in studies that prompted participants 2-3 times daily (91.7%) compared with those that prompted participants more frequently (4-5 times: 77.4%; 6+ times: 75.0%). The reported compliance rates did not differ by duration of EMA period among studies from either clinical or nonclinical settings.

CONCLUSIONS

The compliance rate among mobile-EMA studies in youth is moderate but suboptimal. Study design may affect protocol compliance differently between clinical and nonclinical participants; including additional wearable devices did not affect participant compliance. A more consistent compliance-related result reporting practices can facilitate understanding and improvement of participant compliance with EMA data collection among youth.

Feasibility and adherence paradigm to ecological momentary assessments in urban minority youth

All adolescents in general, including ethnic and racial minorities, report high levels of cell phone use, making mobile technology a useful tool for assessment and intervention. Known health and education disparities based on minority status motivated us to conduct an in-depth investigation regarding feasibility of and adherence to the ecological momentary assessment (EMA) research protocol, studying daily life of urban minority youth. In addition, this paper presents a methodological approach to conceptualizing and reporting adherence in EMA studies. The sample was comprised of 126 youth (41.3% boys; 40.5% 7th and 59.5% 8th graders; 75.4% African American, and 20.6% Hispanic) who carried a mobile phone for 10 days, including 2 weekends and reported on activities, moods, and attitudes. Mean level of adherence was 81% for momentary and 93.8% for daily assessments; it decreased over time and was higher during the week compared to weekends. Adherence was lower on days when participants reported high levels of negative affect and on days when they were engaged in physical activities. Our findings underscore the importance of differentiating between human and technology-related factors when computing adherence rates and portray adherence as a complex and dynamic construct that can vary across individuals. Specific study recommendations and methodological discussion provide guidelines for designing future studies. (PsycINFO Database Record

The social context of managing diabetes across the life span

Diabetes self-management is crucial to maintaining quality of life and preventing long-term complications, and it occurs daily in the context of close interpersonal relationships. This article examines how social relationships are central to meeting the complex demands of managing Type I and Type 2 diabetes across the life span. The social context of diabetes management includes multiple resources, including family (parents, spouses), peers, romantic partners, and health care providers. We discuss how these social resources change across the life span, focusing on childhood and adolescence, emerging adulthood, and adulthood and aging. We review how diabetes both affects and is affected by key social relationships at each developmental period. Despite high variability in how the social context is conceptualized and measured across studies, findings converge on the characteristics of social relationships that facilitate or undermine diabetes management across the life span. These characteristics are consistent with both Interpersonal Theory and Self-Determination Theory, 2 organizing frameworks that we utilize to explore social behaviors that are related to diabetes management. Involvement and support from one's social partners, particularly family members, is consistently associated with good diabetes outcomes when characterized by warmth, collaboration, and acceptance. Underinvolvement and interactions characterized by conflict and criticism are consistently associated with poor diabetes outcomes. Intrusive involvement that contains elements of social control may undermine diabetes management, particularly when it impinges on self-efficacy. Implications for future research directions and for interventions that promote the effective use of the social context to improve diabetes self-management are discussed. (PsycINFO Database Record

An analysis of the relationships between peer support and diabetes outcomes in adolescents with type 1 diabetes

This study explores the relationships between the various subtypes of global and diabetes-specific peer support and health outcomes in adolescents with type 1 diabetes. Global peer support significantly predicted self-care and glycated haemoglobin, although no associations were identified for diabetes-specific support overall, nor its factors. When comparing participants with above or below average glycaemic control, significantly greater diabetes-specific support was reported in those with poorer control. It is suggested that this may be related to feelings of nagging, in which diabetes-specific support is perceived as harassment.

Depressive symptoms, daily stress, and adherence in late adolescents with type 1 diabetes

OBJECTIVE

To examine whether depressive symptoms are associated with greater perceived daily stress and moderate the link between stress severity and poorer daily adherence in late adolescents with Type 1 diabetes (T1D).

METHOD

175 late adolescents with T1D completed measures of depressive symptoms and glycemic control during a baseline laboratory assessment. This assessment was followed by a 14-day daily diary during which adolescents rated the severity of general (GS) and diabetes-specific (DSS) stressful events, as well as adherence to their diabetes regimen.

RESULTS

Multilevel modeling revealed that adolescents with more depressive symptoms reported more severe daily stress and poorer daily adherence on average, and had poorer glycemic control. On days with more severe DSS, but not GS, adolescents reported poorer adherence. This association was moderated by an interaction between depressive symptoms and the mean level of DSS severity experienced across the 2-week diary. In adolescents with low levels of depressive symptoms, poorer adherence was reported on days with more severe DSS across all levels of mean DSS severity. In adolescents with average or high levels of depressive symptoms, poorer adherence was reported on days with more severe DSS only when mean DSS severity was average or high.

CONCLUSIONS

Depressive symptoms are associated with poorer daily adherence and greater stress severity, and interact with mean DSS severity to moderate the link between daily stress and adherence. The results point to the importance of depressive symptoms for understanding associations between stress and adherence during late adolescence.

Health-related quality of life and social support in adolescents with type 1 diabetes

This study investigated the correlations between health-related quality of life and social support in adolescents with type 1 diabetes (T1DM). Participants were 102 adolescents between 12 and 17 years old, who were patients of a healthcare program in the city of Porto Alegre, south of Brazil. Two questionnaires, the KIDSCREEN-52 and the Brazilian version of Social Support Appraisals, were used to evaluate health-related quality of life and social support. Results showed good quality of life and social support levels. Strong correlations were verified between social support and three of the KIDSCREEN-52 dimensions: psychological well-being (r = .63; p < .01); peers and social support (r = .67; p < .01) and school environment (r = .64; p < .01). Analysis of linear regression showed that gender, age and social support are variables associated with health-related quality of life, explaining 52.6% of variance. Results revealed the impact of the disease to young people, and can help to find strategies to improve care in these cases.

Social relationships and allostatic load in the MIDUS study

OBJECTIVE

This study examines how the social environment is related to allostatic load (AL), a multisystem index of biological risk.

METHOD

A national sample of adults (N = 949) aged 34-84 rated their relationships with spouse, family, and friends at 2 time points 10 years apart. At the second time point, participants completed a biological protocol in which indices of autonomic, hypothalamic-pituitary-adrenal axis, cardiovascular, inflammatory, and metabolic function were obtained and used to create an AL summary score. Generalized estimating equations were used to examine the associations among 3 aspects of social relationships-social support, social negativity, and frequency of social contact-and AL.

RESULTS

Higher levels of spouse negativity, family negativity, friend contact, and network level contact were each associated with higher AL, and higher levels of spouse support were associated with lower AL, independent of age, sociodemographic factors, and health covariates. Tests for age interactions suggested that friend support and network support were each associated with higher AL among older adults, but at younger ages there appeared to be no association between friend support and AL and a negative association between network support and AL. For network negativity, there was a marginal interaction such that network negativity was associated with higher AL among younger adults but there was no association among older adults.

CONCLUSIONS

These findings demonstrate that structural and functional aspects of the social environment are associated with AL, and extend previous work by demonstrating that these associations vary based on the type of relationship assessed and by age.

Momentary assessment of social context and glucose monitoring adherence in adolescents with type 1 diabetes

PURPOSE

To investigate the associations between momentary social context and glucose monitoring adherence in adolescents with type 1diabetes (T1D).

METHODS

For 14 days, patients (14-18 years old, T1D duration >1 year) of a pediatric diabetes clinic carried handheld computers that prompted them to report their location, companionship, and attitudes toward companions at the times they usually checked their glucose, and again 30 minutes later to report whether they checked their glucose and, if not, why. Associations between social context factors and checking glucose (adherence) were analyzed using logistic generalized estimating equations and adjusted for age, sex, duration of T1D, and pump use.

RESULTS

Thirty-six participants (mean age 16.6 ± 1.5 years, mean duration of T1D 8.7 ± 4.4 years) completed 971 context and 1,210 adherence reports, resulting in 805 paired reports. Median signal response rate was 63%. The odds of checking glucose was higher when participants expressed very strong desire to blend in (adjusted odds ratio [AOR] = 2.30, 95% confidence interval 1.07-4.94, p = .03). Strong desire to impress others was associated with decreased likelihood of checking glucose (AOR = .52, 95% confidence interval .28-.97, p = .04.) Location, solitude, type of companion, and attitudes toward companions were not significantly associated with checking glucose.

CONCLUSIONS

Desire to blend in may support glucose monitoring adherence and desire to impress others may impede this behavior in adolescents with T1D. Other dimensions of social context were not linked to checking glucose in this study.

Autonomy, positive relationships, and IL-6: evidence for gender-specific effects

OBJECTIVES

A body of evidence indicates that women value relationship-centred aspects of well-being more than men do, while men value autonomy-centred aspects of well-being more than women do. The current study examined whether gender moderates relations between autonomy and positive relationships and interleukin-6 (IL-6), a cytokine associated with inflammatory processes. Aspects of well-being consistent with gender-linked values were expected to be most health protective such that positive relationships would predict lower IL-6 only or more strongly in women, and autonomy would predict lower IL-6 only or more strongly in men.

METHODS

In the first study, a sample of 119 older adults (55% female) living in Kentucky were visited in their homes for interviews and blood draws. In the second study, a sample of 1,028 adults (45% female) living across the United States underwent a telephone interview followed by a visit to a research centre for blood draws.

RESULTS

In the Kentucky sample, autonomy was quadratically related to IL-6 such that moderate autonomy predicted higher IL-6; this effect was stronger in men. In the US national sample, more positive relationships were associated with lower IL-6 in women only. When the national sample was restricted to match the Kentucky sample, moderate autonomy was again associated with higher IL-6 in men only.

CONCLUSIONS

Results provide preliminary evidence for gender-specific effects of positive relationships and autonomy on IL-6. Further work is needed to establish the generalizability of these effects to different ages, cultures, and health statuses.

STATEMENT OF CONTRIBUTION

What is already known on this subject? A host of previous work indicates that women value relationship-centred aspects of well-being more than men, while men value autonomy-centred aspects of well-being more than women. Further, there is some evidence suggesting that well-being consistent with gender-linked values is more health protective, such that relationships are more protective for women than for men, while autonomy is more protective for men than for women. What does this study add We provide preliminary support for the hypothesis that gender moderates the associations of autonomy and positive relationships with IL-6. Specifically, higher levels of positive relationships may be associated with lower IL-6 in women only, whereas moderate levels of autonomy may be associated with higher IL-6 in males only, particularly among older adults.

Friends or foes? A review of peer influence on self-care and glycemic control in adolescents with type 1 diabetes

OBJECTIVE

We reviewed studies published from 1990 to 2010 examining the relation of peer influence to diabetes outcomes for adolescents with type 1 diabetes.

METHODS

We searched PsychInfo and MedLine databases and personal archives for studies meeting our criteria. 24 articles were included in the final review.

RESULTS

Qualitative studies revealed that teens believe peers have an impact on diabetes behaviors, but quantitative findings are inconclusive. We found more evidence that social conflict was harmful than social support was helpful. Associations were more likely in studies that measured specific support and specific self-care variables. Studies addressing how individual differences interact with social context had promising findings.

CONCLUSIONS

The literature linking peer relations to diabetes outcomes is mixed. Future research should consider moderator variables, expand the conceptualization of peer relationships, and consider interactions between person and social context.

Using mobile phones to measure adolescent diabetes adherence

OBJECTIVES

1) describe and determine the feasibility of using cell-phone-based ecological momentary assessment (EMA) to measure blood glucose monitoring and insulin administration in adolescent Type 1 diabetes, 2) relate EMA to traditional self-report and glycemic control, and 3) identify patterns of adherence by time of day and over time using EMA.

METHOD

Adolescents with Type 1 diabetes (n = 96) completed baseline measures of cell phone use and adherence. Glycemic control (measured by levels of HbA1c) was obtained from medical records. A subgroup of adolescents (n = 50) completed 10 days of EMA to assess blood glucose monitoring frequency, timing of glucose monitoring, insulin administration, and insulin dosing. One third of adolescents were not allowed to use their cell phones for diabetes at school. Parental restrictions on cell phone use at home were not prevalent.

RESULTS

The EMA response rate (59%) remained stable over the 10-day calling period. Morning time was associated with worse monitoring and insulin administration, accounting for 59-74% of missed self-care tasks. EMA-reported missed glucose checks and missed insulin doses were correlated to traditional self-report data, but not to HbA1c levels. Trajectory analyses identified two subgroups: one with consistently adequate adherence, and one with more variable, and worse, adherence. The latter adherence style showed worse glycemic control.

CONCLUSION

Mobile phones provide a feasible method to measure glucose monitoring and insulin administration in adolescents, given a limited assessment duration. The method provided novel insights regarding patterns of adherence and should be explored in clinical settings for targeting or tailoring interventions.

Social support for diabetes illness management: supporting adolescents and caregivers

OBJECTIVE

The aim of this research study was to examine the relationship between 4 sources of social support (support for the adolescent from family, support for the adolescent from friends, support for the caregiver from another adult, and support to the family from the health care provider) and adolescents' diabetes outcomes (illness management behavior and health status) using a diverse sample of urban adolescents.

METHOD

One hundred forty-one adolescents with insulin-managed diabetes and their primary caregivers completed questionnaires assessing social support and illness management behavior. Glucose meters were downloaded and hemoglobin A1c assays were obtained. Structural equation modeling was used to test a model social support informed by social ecological theory.

RESULTS

The results of the structural equation modeling indicated that support for the caregiver from another adult was directly and positively related to support for the adolescent from family and indirectly related to better illness management. Support for the adolescent from family was directly related to better diabetes management and, through better management, to better diabetes health. Support to the family from the health care provider was not related to support for the adolescent and support to the adolescent from friends was not related to illness management, as hypothesized.

CONCLUSION

This study identifies a novel target for social support intervention to improve adolescents' illness management behavior-the caregivers of adolescents with diabetes. By enhancing the social support caregivers receive from other adults in their lives, caregivers' ability to support their adolescent children with diabetes might also be improved which, in turn, improves adolescents' illness outcomes.

Is There a Connection Between Diabetes and Psychological Dysfunction?

This review discusses evidence-based perspectives on the relationship between diabetes and psychological distress. Future directions for inquiry and clinical management also are addressed.

Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention

PURPOSE OF REVIEW

Despite the availability of effective therapies, adolescents with type 1 diabetes demonstrate poorer adherence to treatment regimens compared with other pediatric age groups. Nonadherence is tightly linked to suboptimal glycemic control, increasing morbidity, and risk for premature mortality. This article will review barriers to adherence and discuss interventions that have shown promise in improving outcomes for this population.

RECENT FINDINGS

Adolescents face numerous obstacles to adherence, including developmental behaviors, flux in family dynamics, and perceived social pressures, which compound the relative insulin resistance brought on by pubertal physiology. Some successful interventions have relied on encouraging nonjudgmental family support in the daily tasks of blood glucose monitoring and insulin administration. Other interventions overcome these barriers through the use of motivational interviewing and problem-solving techniques, flexibility in dietary recommendations, and extending provider outreach and support with technology.

SUMMARY

Effective interventions build on teens' internal and external supports (family, technology, and internal motivation) in order to simplify their management of diabetes and provide opportunities for the teens to share the burdens of care. Although such strategies help to minimize the demands placed upon teens with diabetes, suboptimal glycemic control will likely persist for the majority of adolescents until technological breakthroughs allow for automated insulin delivery in closed loop systems.

Relation of stressful life events to metabolic control among adolescents with diabetes: 5-year longitudinal study

OBJECTIVE

To determine the relation of stressful life events to metabolic control.

DESIGN

We interviewed adolescents with Type 1 diabetes (n = 132; average age at enrollment = 12 years) annually for 5 years.

MEASURES

Each year we administered measures of stressful life events, psychological distress, and self-care behavior. We downloaded data from blood glucose meters, and obtained measures of metabolic control (hemoglobin A1c) from medical records.

RESULTS

Using longitudinal growth curve modeling, stressful life events predicted greater psychological distress, poorer self-care behavior, and worse metabolic control in both cross-sectional and longitudinal (lagged) analyses. Cross-sectionally, many of these relations were stronger among older than younger adolescents. Self-care behavior partly mediated this association.

CONCLUSION

Stressful life events are related to poor metabolic control-especially for older adolescents. A primary mechanism appears to be a lack of good self care. (PsycINFO Database Record (c) 2010 APA, all rights reserved).