Health-Related Social Needs and Diet Quality in Youth and Young Adults with Youth-Onset Type 1 Diabetes: Cross-Sectional Findings From the SEARCH Food Security Cohort Study

Objectives

This cross-sectional study from the SEARCH Food Security Cohort Study (2018–2020) examined the association between unmet health-related social needs (USN) and diet quality among 821 youth and young adults (YYA) with type 1 diabetes (T1D).

Methods

Daily dietary intake of calcium, dairy, fiber, and fruits and vegetables (F/V) was estimated with the National Cancer Institute dietary screener questionnaire. USN included having one or more of the following: ≥3 affirmations on the USDA Household Food Security Survey Module, not having a personal vehicle in the past year, reporting housing instability over the past 90 days, or reporting health care costs as a big problem. Quantile regression examined associations between the count of USN and diet, and associations between specific social needs and diet, controlling for the presence of the other three needs.

Results

For YYA with T1D (mean age: 22.6 ± 5), 36.9% had 1 + USN, with healthcare unaffordability most prevalent (24.6%), followed by food insecurity (17.5%). Overall diet quality was poor with estimated intakes below dietary guideline recommendations, especially for fiber. Consumption for all nutrients and F/V was lower across the intake distribution among those with 1 + USN, compared to no unmet needs. After adjustment, those with 1 + USN consumed significantly less calcium at the 10th and 25th percentiles (P < 0.05), fiber at the 25th and 50th percentiles (P < 0.05), and F/V at the 25th percentile (P = 0.02), compared to no unmet needs. For housing instability, unreliable transportation, and unaffordable healthcare, no diet quality indicator differed after further controlling for the presence of the other three needs. Independent of the other social needs, food insecurity was associated with lower fiber intake at the 10th, 25th, and 50th percentiles (P < 0.04), and F/V intake at the 50th and 75th percentiles (P < 0.01).

Conclusions

USN were associated with reduced intake of calcium, fiber, and F/V largely due to food insecurity, particularly among participants with lower intake. USN, arising from economic strain, is associated with poorer nutrition.

Funding Sources

National Institute of Diabetes and Digestive and Kidney Diseases.

Trends in Glycemic Control Among Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study

OBJECTIVE

To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes.

RESEARCH DESIGN AND METHODS

The study included 6,369 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods of 2002-2007, 2008-2013, and 2014-2019, diabetes durations of 1-4, 5-9, and ≥10 years, and age groups of 1-9, 10-14, 15-19, 20-24, and ≥25 years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen, and diabetes duration, overall and stratified for each diabetes duration and age group.

RESULTS

Adjusted mean HbA1c for the 2014-2019 cohort of YYA with type 1 diabetes was 8.8 ± 0.04%. YYA with type 1 diabetes in the 10-14-, 15-19-, and 20-24-year-old age groups from the 2014-2019 cohort had worse glycemic control than the 2002-2007 cohort. Race/ethnicity, household income, and treatment regimen predicted differences in glycemic control in participants with type 1 diabetes from the 2014-2019 cohort. Adjusted mean HbA1c was 8.6 ± 0.12% for 2014-2019 YYA with type 2 diabetes. Participants aged ≥25 years with type 2 diabetes had worse glycemic control relative to the 2008-2013 cohort. Only treatment regimen was associated with differences in glycemic control in participants with type 2 diabetes.

CONCLUSIONS

Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.

Adverse childhood experiences (ACEs) and transitions in stages of alcohol involvement among US adults: Progression and regression

BACKGROUND

Adverse childhood experiences (ACEs) are associated with a number of medical comorbidities. However, there is a paucity of data on the role ACEs play in transitions in stages of alcohol involvement.

OBJECTIVE

To examine the association between ACEs and transitions in alcohol problems progression and regression between No Problems, Moderate Problems and Severe Problems stages.

PARTICIPANTS AND SETTING

Data from 14,363 male and 19,774 female participants in Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

METHODS

We used latent transition analysis (LTA) with propensity score adjustment to estimate the odds of transitioning across stages of alcohol involvement, between waves, based on the number of types of ACEs experienced. We hypothesized that ACEs would be associated with increased risk of progression and decreased risk of regression.

RESULTS

ACEs were associated with progression to higher alcohol involvement stages, with greatest likelihood of progression from No Problems to Severe Problems for those reporting ≥3 ACEs (males: aOR = 4.78 [CI (1.84-12.44)]; females: aOR = 3.81 [CI (1.69-8.57)]). ACEs were also associated with decreased odds of regression to less problematic alcohol involvement stages, with some distinctive patterns of associations in males and in females.

CONCLUSIONS

This study suggests that ACEs impact transitions in alcohol involvement in both males and females, affecting both progression and regression. The association is magnified for those with multiple types of ACE exposures. These results highlight the need for prevention, early identification and intervention to mitigate the risks associated with childhood maltreatment.

Neighborhood Profiles and Associations with Coping Behaviors among Low-Income Youth

Extant research has typically examined neighborhood characteristics in isolation using variable-centered approaches; however, there is reason to believe that perceptions of the neighborhood environment influence each other, requiring the use of person-centered approaches to study these relationships. The present study sought to determine profiles of youth that differ in their perceptions of their neighborhoods and objective neighborhood characteristics, and whether these profiles are associated with youth coping. Participants were low-income, African American youth (N= 733; 51.0% female, M age = 18.76 years, SD = 1.71) from a metropolitan city who were originally recruited for the Youth Opportunity program in Baltimore, Maryland. A latent profile analysis was conducted which included self-reported neighborhood social cohesion, collective efficacy, disorder, violence, and disadvantage derived from census data. Coping behaviors, specifically positive cognitive restructuring, problem-focused coping, distraction strategies, and avoidant behaviors were assessed via self-reported questionnaires. Four neighborhood profiles were identified: highest disorder (20.0%); highest violence/highest disadvantage (5.2%); high violence (26.6%); and highest cohesion/lowest disorder (48.2%). Individuals in the highest violence/highest disadvantage profile reported higher positive cognitive restructuring and problem-focused coping than the other profiles. These findings warrant an investigation into the individual assets and contextual resources that may contribute to more positive coping behaviors among youth in more violent and disadvantaged neighborhoods, which has the potential to improve resilient outcomes among youth in similar at-risk settings.

Trends in point-of-sale tobacco marketing around college campuses: Opportunities for enhanced tobacco control efforts

OBJECTIVE

Colleges have implemented policies to limit tobacco use on-campus; however, the off-campus environment is often overlooked in tobacco control efforts. We assessed availability, marketing, and promotion of cigarettes, snus, and traditional smokeless tobacco (SLT) in a sample of communities surrounding 11 college campuses in North Carolina and Virginia.

PARTICIPANTS

Between January-March of 2011, 2012 and 2013, 481 tobacco-selling retailers, including convenience stores, pharmacies and supermarkets, located near campuses were assessed.

METHODS

Trained observers completed annual point-of-sale assessments.

RESULTS

The percentage of stores selling (81.4% to 58.6%; p < .0001) and advertising snus (80.1% to 53.11%; p < .0001) significantly decreased over time. Convenience stores increased promotions of cigarettes (65.4% to 72.8%; p = 0.04) and SLT (3.1% to 23.3%; p = 0.02).

CONCLUSIONS

Off-campus environments have abundant tobacco availability and marketing. Colleges should collaborate with state and local tobacco control advocates to address tobacco promotion near campuses to potentially decrease product appeal and access among young adults.

The HIV Risk Profiles of Latino Sexual Minorities and Transgender Persons Who Use Websites or Apps Designed for Social and Sexual Networking

The use of websites and GPS-based mobile applications ("apps") designed for social and sexual networking has been associated with increased HIV risk; however, little is known about Latino sexual minorities' and transgender persons' use of these websites and apps and the risk profiles of those who use them compared with those who do not. Data from 167 participants who completed the baseline survey of a community-level HIV prevention intervention, which harnesses the social networks of Latino sexual minorities and transgender persons, were analyzed. One quarter of participants (28.74%, n = 48) reported using websites or apps designed for social and sexual networking, and 119 (71.26%) reported not using websites or apps designed for social and sexual networking. Those who used websites or apps were younger and reported more male sex partners, a sexually transmitted disease diagnosis, and illicit drug use other than marijuana. HIV prevention interventions for those who use websites or apps should consider addressing these risks for HIV.

Depressive symptoms among immigrant Latino sexual minorities

OBJECTIVE

To estimate the prevalence and identify correlates of depressive symptoms among immigrant Latino sexual minorities.

METHODS

Respondent-driven sampling (RDS) was used to estimate the prevalence of depressive symptoms, and univariate and multivariable analyses were conducted to identify correlates of depressive symptoms.

RESULTS

Unweighted and RDS-weighted prevalence estimates of depressive symptoms were 69.2% and 74.8%, respectively. In the multivariable analysis, low social support, sexual compulsivity, and high self-esteem were significantly associated with increased depressive symptoms.

CONCLUSIONS

A need exists for culturally congruent mental health services for immigrant Latino sexual minorities in the southern United States.

Reading problems, psychiatric disorders, and functional impairment from mid- to late adolescence

OBJECTIVE

To examine psychiatric morbidity and functional impairment of adolescents with and without poor reading skills during mid- to late adolescence.

METHOD

The sample consisted of 188 adolescents, 94 with poor reading skills and 94 with typical reading skills, screened from a larger sample in the public schools at age 15. To assess psychiatric disorders, participants were assessed annually with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version (up to 4.5 years; maximum age, 20 years). Functional impairment was assessed with the Child and Adolescent Functional Assessment Scale.

RESULTS

Adolescents with poor reading skills evidenced higher rates of current attention-deficit/hyperactivity, affective, and anxiety disorders, particularly social phobia and generalized anxiety disorder. Anxiety disorders but not affective disorders were related to reading status after controlling for attention-deficit/hyperactivity disorder. Adolescents with poor reading evidenced more functional impairment across multiple areas than youths with typical reading skills, even after considering the presence of comorbid attention-deficit/hyperactivity disorder.

CONCLUSIONS

The increased psychiatric morbidity and functional impairment of adolescents with reading problems highlight the importance of developing interventions that help these youths address reading deficits and associated vulnerabilities during the last years of secondary school.

Cross-sectional association between markers of inflammation and serum sex steroid levels in the postmenopausal estrogen/progestin interventions trial

BACKGROUND

Standard risk factors do not adequately capture cardiovascular risk in postmenopausal women. We sought to determine the associations between levels of sex steroids and levels of inflammatory markers in postmenopausal women.

METHODS

We analyzed baseline data from a subset of postmenopausal women aged 45-64 years who had stored samples during a randomized controlled trial. We measured levels of C-reactive protein (CRP), interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP-9), soluble intercellular adhesion molecule (sICAM), and circulating sex steroids. Multiple linear regression models were created with each of the following hormone levels as the primary exposure variable: estrone, total estradiol, bioavailable estradiol, total testosterone, bioavailable testosterone, progesterone, and sex hormone-binding globulin (SHBG). Sociodemographic and lifestyle covariates were derived from standardized self-report questionnaires and direct measurement (weight, height).

RESULTS

Mean age of the 623 women was 56 years. After adjustment for age, body mass index (BMI), physical activity, alcohol consumption, and smoking, the bioavailable testosterone level (p = 0.03) was positively and the SHBG level (p < 0.001) was negatively associated with the logCRP level. The increment in CRP level between the highest and lowest quartile of bioavailable testosterone was 1.28 microg/mL. The increment in CRP level between the lowest and highest quartile of SHBG was 2.62 microg/mL. Compared with SHBG or bioavailable testosterone as predictors of logCRP in separate regression models, when both SHBG and bioavailable testosterone were included in the same multivariate linear regression model, only SHBG remained a statistically significant predictor of logCRP. Progesterone level was positively associated with the logMMP-9 level (p < 0.001); no other sex steroid level was associated with the logMMP-9 level. In multiply adjusted models, no association was found between levels of any sex steroid and IL-6 or sICAM level.

Reliability of telepsychiatry assessments: subjective versus observational ratings

Geriatric patients in underserved areas could benefit from the use of telecommunications to expand access to mental health services. It is important to determine the clinical limitations of using videoconferencing for psychiatric assessments, particularly in the elderly. The goal of this study was to test the hypothesis that videoconferencing ratings based on visual observations of behavior would be less reliable than ratings based on patients' verbal reports of symptoms. Videoconferencing assessments of 30 geriatric patients using low-bandwidth (ISDN) equipment were compared to gold standard face-to-face assessments. The Brief Psychiatric Rating Scale (BPRS) was dichotomized into subjective items based on patients' verbal reports and observational items based on visual ratings of behavior. Reliability of the BPRS subjective items was consistently higher than for the observational items. Future studies should emphasize the accuracy of telemedicine ratings that require visual observation of behavior, which is crucial to clinical assessment of psychogeriatric conditions.

Effects of mood and age on quality of life in depressed inpatients

BACKGROUND

Prior investigations have demonstrated a link between quality of life (QOL) deficits and depression. This report elaborates on prior investigations findings by implementation of formal assignment of the diagnosis of depression and a hierarchical approach to assessment of QOL.

METHODS

A masters or doctoral level mental health clinician used the SCID to confirm a diagnosis of major depression in ninety psychiatric inpatients. Function was assessed with the PSMS (a measure of ADL), the IADL scale, and the "daily living and role functioning" and the "relation to self and others" subscales of the Basis-32.

RESULTS

Patient age and severity of depression were the most consistent predictors of QOL deficits, although the direction of the age-effect on QOL depended on the specific measure of QOL. Increasing severity of depression was consistently associated with worse QOL, and remained significant after adjusting for age.

LIMITATIONS

The cross-sectional method of this study limits the inference of causality between depression severity and poor QOL.

CONCLUSIONS

QOL deficits in acutely depressed hospitalized patients occur at multiple strata in the hierarchy of behavior and are most consistently influenced by age and severity of depression. The effect of age on QOL in depressed inpatients is complex, and age is not uniformly associated with poor QOL.

Pretreatment differences in specific symptoms and quality of life among depressed inpatients who do and do not receive electroconvulsive therapy: a hypothesis regarding why the elderly are more likely to receive ECT

Electroconvulsive therapy (ECT) is among the most commonly performed medical procedures requiring general anesthesia in the United States. Nevertheless, very little is known about the characteristics of depressed patients who receive ECT and how they differ from depressed patients receiving psychotropic medication. We conducted a detailed examination of demographic, clinical, and quality-of-life (QOL) measurements in a group of 90 depressed inpatients, and we then used these measurements to contrast the 31 patients who received ECT with the 59 who received alternative therapies. The ECT group did not differ from the non-ECT group in gender composition, marital status, race, education, employment status, overall severity of depression, chronicity of depression, adequacy of prehospitalization antidepressant treatment, extent of physical illness, or extent of social support. The ECT group was older. Furthermore, the ECT group had greater weight loss, worse functioning in activities of daily living (ADLs), and worse functioning in instrumental activities of daily living (IADLs). The differences in weight loss, ADL, and IADL scores disappeared after age adjustment. However, statistical adjustment for age revealed that the ECT group reported worse capacity in their daily living and role functioning than did the non-ECT group. We conclude that the decision to pursue ECT is based in part on the perceived effect of the depression on QOL, as well as the severity of specific symptoms such as weight loss. The elderly seem particularly vulnerable to depression-related functional deficits and weight loss, and this may explain why prior studies showed a differential use of ECT in the elderly.