Involvement of Racially and Ethnically Minoritized Youths in Behavioral Type 1 Diabetes Interventions: A Systematic Review.

OBJECTIVE: Psychosocial interventions targeting glycemic health in youth with type 1 diabetes (T1D) have been promising. Nonetheless, disparities in T1D treatment and outcomes are pervasive among racially/ethnically minoritized (REM) youth and a systematic review examining the inclusion of REM youth in psychosocial interventions is lacking. Therefore, the present systematic review examined the literature to determine the inclusion of REM youth with T1D in psychosocial interventions. METHODS: A systematic literature review was conducted per PRISMA guidelines for psychosocial intervention studies of youth (<19 years) with T1D between 2011 and 2022 using PubMed, PsycINFO, CINAHL, and MedLine. Tables of contents for JPP, CPPP, and Diabetes Care were also reviewed. The date last searched was April 26, 2022. Studies were examined for risk of bias using the QualSyst rating system. RESULTS: Twenty-four studies met inclusion criteria with a total of 3,117 participants. Studies utilized various psychological interventions (e.g., CBT, MI, behavioral modalities). Seventeen studies reported participants' race/ethnicity and eleven studies included >20% REM youth. CONCLUSIONS: One study examined the impact of interventions on REM youth or whether the intervention reduces existing racial/ethnic disparities. Implications for future research and practice are discussed.

Psychosocial Impact of the COVID-19 Pandemic in Racially/Ethnically Diverse Youth With Diabetes.

OBJECTIVE: This study examined caregiver perceived impact of the Coronavirus Disease 2019 (COVID-19) pandemic on a diverse sample of U.S. youth with diabetes and their families. METHODS: Caregivers of youth with diabetes completed an electronic survey in English or Spanish at two sites. Participants provided demographic and disease characteristics and completed the COVID-19 Exposure and Family Impact Scales (CEFIS). Glycemic health was assessed via Hemoglobin A1c (HbA1c) from medical chart review. Analysis of variance and analyses of covariance were utilized to examine racial/ethnic differences in glycemic health and in COVID-19 Exposure, Impact, and Distress scales. Hierarchical linear regression was conducted to predict HbA1c. Thematic analysis was conducted on open-ended responses regarding the effects of COVID-19 on youth and families' overall and diabetes-related well-being. RESULTS: Caregivers (n = 114) of youth with diabetes (M = 12.6 ± 3.5 years) completed study measures. Mean HbA1c for Non-Hispanic White youth was lowest and significantly different from Hispanic and Non-Hispanic Black youth. Exposure to COVID-19 stressors differed by race/ethnicity (p < .05) with Hispanic caregivers reporting greatest exposure. CEFIS scales did not predict HbA1c after controlling for demographic/disease variables. Caregivers described child/family changes during COVID (e.g., more time together, health-related hypervigilance), as well as differences in diabetes management during COVID-19. CONCLUSIONS: Findings indicate differences in COVID-19 exposure but did not demonstrate other racial/ethnic disparities in COVID-19 impact or distress. Household income was the most important predictor of glycemic health. Addressing structural inequalities experienced by youth with diabetes and their families is critical. Recommendations to support families with diabetes are made.

A snapshot of sediment dynamics on an inshore coral reef.

Sediments are ubiquitous on coral reefs. However, studies of reef sediments have largely focused on isolated reservoirs, or processes, and rarely consider hydrodynamic drivers. We therefore provide a quantitative snapshot of sediment dynamics on a coral reef. Across a depth profile, we simultaneously examined: suspended sediments, sediment deposition and accumulation, and hydrodynamic and biological movement processes. We reveal the marked potential for the water column to deliver sediments. Currents carried 12.6 t of sediment over the 2,314 m2 study area in 6 days. Sediment traps suggested that a surprisingly high percentage of this sediment was potentially deposited (5.2%). Furthermore, wave-driven resuspension and reworking by parrotfishes separated a highly dynamic sediment regime on the shallow reef flat (3 m), from a more stagnant reef slope (4.5 m-12 m). This study provides a comprehensive model of how hydrodynamic forces and on-reef processes may shape sediment dynamics on a coral reef.

Working With Older Adults in Integrated Health Care: Social Workers' Perspective.

Objective: Older adults are a rapidly growing segment of the global population; a paucity of research exists on social workers supporting this vulnerable group in integrated health care that focuses on both physical and behavioral health. To fill the gap, this study explored social workers' perspectives of working with older adults in integrated healthcare settings. Methods: Using qualitative methods, a constant comparison data analysis approach was conducted to identify themes. Results: Themes included: (1) working with and highlighting the unique needs of older adults in integrated health, (2) identifying skills needed for working as a social worker within integrated healthcare settings, (3) supporting patient families, and (4) needing to make decisions on behalf of patients. Discussion: Study findings demonstrate social workers as key members of interdisciplinary team as well as highlight the unique needs, skills, and challenges for working with older adults in integrated healthcare settings.

Parents' Perceptions of and Responses to School-Based Body Mass Index Screening Programs-A Systematic Review.

BACKGROUND: Evidence for the effectiveness of state-mandated body mass index (BMI) screening programs in the United States has been inconclusive, and potential unintended consequences of the programs have been debated. The present review aims to understand parents' perceptions of and responses to school-based BMI screening, and to highlight racial/ethnic differences. METHODS: We systematically identified studies published January 2003-May 2019 examining parent and/or youth perceptions of and/or responses to US school-based BMI screening. RESULTS: A total of 16 studies were included in the review. Studies suggested that while parents largely found BMI screening helpful, they held concerns regarding stigma, lack of privacy, and unhealthy behaviors and attitudes resulting from school-based screening. Furthermore, parents did not frequently follow-up with health care providers, although they reported some healthy behavior changes. CONCLUSIONS: Our review highlights existing parent perceptions of school-based BMI screening including the potential for healthy behavior change and important concerns regarding weight-stigma and disturbed eating attitudes/behaviors. Additionally, racial/ethnic differences in screening preferences and experiences were found. Limitations of existing literature included a need to understand youths' experiences and a lack of standardized, reliable outcomes research. Implications for future research and the role of parents, schools, and providers are discussed.

Assessing disparities in barriers to attending pediatric diabetes camp.

OBJECTIVES: While the benefits of diabetes camp programs are well established, minority youth are underrepresented in camp attendance. No research to date has explored barriers to camp attendance or potential disparities in those barriers. Further, little is known about sources families prioritize in seeking diabetes information and support. METHODS: This was a prospective survey of families of children with type 1 diabetes (T1D) using convenience sampling during normally-scheduled clinic visits. Thirty-nine children and their caregivers completed the survey. Results were analyzed for prevalence and mean number of reported barriers, benefits, and diabetes information networks. RESULTS: Age range was 5-15 years and mean duration of diabetes was 2.9 years (0.4-9y). The most prevalent barriers were location, cost, and concern about sending children to overnight camp. Caregivers had high level of knowledge of camp benefits. Participants reported engaging with the diabetes community through interactions with their diabetes team, Facebook groups, and the JDRF. CONCLUSION: Increasing awareness, transportation assistance, and scholarship funding all may increase accessibility of diabetes camps. Diabetes clinic and online or social media groups are both acceptable means of disseminating information about diabetes camp. Further research is indicated to verify if these results are applicable to the larger diabetes community.

Commentary: Reflections on the COVID-19 Pandemic and Health Disparities in Pediatric Psychology.

The COVID-19 (2019 novel coronavirus) pandemic has had a significant economic, social, emotional, and public health impact in the United States. A disturbing trend is that Black, Indigenous, and/or People of Color (BIPOC) are disproportionately contracting coronavirus, as well as dying from COVID-19. Objective/Methods The pandemic has the potential to entrench and magnify existing health disparities and families marginalized across multiple demographic intersections such as race/ethnicity, class, immigration status, are especially vulnerable. These inequities have been further underscored by the recent murders of Black Americans by police and a resulting spotlight on racial injustice in the United States. Results Efforts to lessen the spread of the virus, have resulted in changes in pediatric primary and subspecialty service delivery which may affect access for BIPOC communities. BIPOC trainees including those with debt or caregiving responsibilities may be faced with new barriers resulting in delays in completion of their training. Further, clinical, community-based, and translational research has been disrupted by heightened safety precautions and social distancing which may affect BIPOC representation in research downstream. Conclusion In our roles as clinicians, supervisors, trainees, and researchers in primary and subspecialty care as well as in academia, pediatric psychologists have an ethical responsibility to address the disproportionate burden of this pandemic on vulnerable communities and to allocate our time and resources to ensuring health equity now and in the aftermath of COVID-19.

Society of Pediatric Psychology Workforce Survey: Updated Factors Related to Compensation.

OBJECTIVE: The 2017 Society of Pediatric Psychology (SPP) Workforce Survey provides self-reported compensation by pediatric psychologists, identifies predictors of compensation, and establishes a better understanding of compensation within the context of gender and race/ethnicity minority status. METHODS: SPP members who attended the SPP Annual Conference (SPPAC; April 2017) were invited to complete the survey at the conference through electronic tablets provided on-site by the Workforce Survey Committee. The survey was subsequently distributed online to SPP members who did not complete the survey at SPPAC. The statistical analyses used for this salary data employed flexible semi-parametric models, cross-validation, and prediction models for both the overall sample and academic rank subgroups. RESULTS: Of 27 potential demographic and employment-related predictors from the 2017 SPP Workforce Survey, significant predictors of salary emerged within this sample: academic rank, time since obtaining doctoral degree, managing internal and external funds (of at least $50,000), years in primary employment position, obtaining Fellowship status in the American Psychological Association (APA), and managing other employees (at least 10 people). Given low response rates for males and individuals who identify as belonging to racial and ethnic minority subgroups, only limited, exploratory results are reported for these subgroups. CONCLUSIONS: These findings suggest that not only is longevity in one's career important but managing funds/personnel and obtaining professional designations are also predictors of higher salaries for pediatric psychologists, in general. Specific implications of salary according to the psychologist's academic rank, gender, and racial/ethnicity group status are also explored.

Racial Ethnic Disparities in Youth With Type 1 Diabetes Participating in Diabetes Summer Camps.

OBJECTIVE: Diabetes camps are beneficial for campers and include benefits such as increases in diabetes knowledge, glycemic control, and psychological functioning. Racial/ethnic minority youth are likely to have poorer disease management and glycemic control. We hypothesized that minority youth with type 1 diabetes have reduced participation in diabetes summer camps. RESEARCH DESIGN AND METHODS: We analyzed deidentified data from 5,256 campers with type 1 diabetes who participated in a network of 48 American Diabetes Association-affiliated summer camps in 2018, and we compared participation rates by racial/ethnic category to the most recent SEARCH for Diabetes in Youth study prevalence rates. RESULTS: Camper demographics were significantly different than in the general population of children with type 1 diabetes (P < 0.001). Minority youth were more likely to attend day camp, be first-time campers, and request financial aid, and they were less likely to be on insulin pump therapy or use continuous glucose monitors. CONCLUSIONS: Racial/ethnic minority youth with diabetes are underrepresented in diabetes camps nationwide.

Featured Article: Comparison of Diabetes Management Trajectories in Hispanic versus White Non-Hispanic Youth with Type 1 Diabetes across Early Adolescence.

OBJECTIVE: Ethnic minority youth with type 1 diabetes (T1D) often have poorer glycemic control and lower rates of adherence compared to White Non-Hispanic (WNH) youth. Variables such as family conflict, autonomy support, and youth regimen responsibility have been shown to change over adolescence and impact diabetes management. However, these factors have been investigated in predominantly White samples. Few studies have examined potential differences in these variables and their trajectories for Hispanic youth over early adolescence. METHODS: Youth with T1D (178 WNH and 33 Hispanic youth participants), as well as their maternal caregivers (174 WNH and 32 Hispanic maternal caregivers), completed measures of diabetes-specific autonomy support, diabetes-related family conflict, regimen responsibility, and blood glucose monitoring frequency at 4 timepoints over a 3-year period. RESULTS: At baseline, Hispanic youth had significantly poorer glycemic control, more family conflict, and fewer blood glucose checks on average compared to WNH youth. Similar to WNH youth, Hispanic youth have increasing independence for regimen tasks and decreasing parent autonomy support during this developmental period. However, while Hispanic youth had worsening diabetes management during early adolescence (as did WNH youth), Hispanic parents reported a more gradual change in youth's diabetes management over early adolescence. CONCLUSIONS: This study presents an important contribution to the existing literature on youth with T1D. Findings suggest potential strengths and targets for Hispanic youth navigating diabetes management during the adolescent period. It is important to continue to investigate the trajectories of ethnic minority youth with diabetes.

School Professionals' Knowledge and Beliefs About Youth With Chronic Illness.

BACKGROUND: Existing research demonstrates that youth with chronic illness often experience challenges including poor academic performance, attendance, and social success. However, past research demonstrates a lack of support for teachers to best educate students with chronic illness. In this study, we aim to describe the needs of local educators when working with students with chronic illness. METHODS: A questionnaire was completed by 383 middle or high school professionals. Responses were analyzed using descriptive statistics. ANOVA was used to examine differences between school professional groups and chronic illness types. RESULTS: Participants tended to disagree that students with chronic illness faced challenges in school and agreed that they had enough support to meet students' needs. They tended to agree that more collaboration between the health care team, schools, and families was needed. Participants reported feeling least prepared in working with students who had cystic fibrosis, epilepsy, or sickle cell disease. School nurses were more likely to recognize the challenges, supports, and collaboration needed. CONCLUSIONS: More training and support is needed for school professionals in their work with students with chronic illness. Assessments may be useful at a local level to help schools develop better policies and plans for educating youth with chronic illness.

Diabetes Camp Counselors: An Exploration of Counselor Characteristics and Quality of Life Outcomes.

Purpose The purpose of this study is to investigate the effect of volunteering at a diabetes camp on emerging adults with and without type 1 diabetes mellitus (T1DM). Methods Thirty counselors with and 22 without T1DM (19.07 ± 2.71 years old) volunteered at a 1-week T1DM camp in the northeastern United States. Counselors with T1DM had a range of self-reported A1C scores (5.8% or 39.9 mmol/mol to 14.0% or 129.5 mmol/mol). Self-report measures of quality of life, hope, and well-being were completed pre- and postcamp at 4 time points: 1 month before camp, arrival at camp, final day of camp, and 2 months postcamp. Open-ended questions regarding counselor experiences were analyzed to understand camp effect. Results There were significant differences between counselors' levels of trait hope in comparison to published norms. There were few clear differences in psychosocial outcomes pre- and postcamp; however, some increases in well-being were revealed in anticipation of camp. Major reasons for volunteering included assisting others and reciprocating or continuing a perceived positive experience as a camper. Conclusion No changes in psychosocial outcomes pre- to postcamp were observed. However, measures used in this study may be poorly defined for a counselor population. Further research on the characteristics of emerging adults who choose to be camp counselors is needed. By understanding the demographics of this population, health professionals can help target individuals to become camp counselors as well as enhance the camp experience to fit their developmental needs.

Pediatric Psychologists' Career Satisfaction: 2015 Society of Pediatric Psychology Workforce Survey Results.

Little is known about the career satisfaction of pediatric psychologists, who specialize in psychological research, teaching, and clinical service in the context of pediatric healthcare. As part of the larger Society of Pediatric Psychology Workforce Survey and in collaboration with the American Psychological Association Center for Workforce Studies, this study aimed to: (1) describe the career domains which pediatric psychologists perceive to be important and their satisfaction in each domain, and (2) compare satisfaction of pediatric psychologists across work settings, number of positions, appointment duration, professional roles, career stage, academic rank, and gender. Responses from 336 pediatric psychologists demonstrated high career satisfaction. Domains of career satisfaction that received mean scores indicating high importance include balance of work and personal lives, peer/collegial support, and flexibility and choice in the workplace, but on average respondents reported being only somewhat satisfied in these domains. Total satisfaction scores were significantly higher among pediatric psychologists in 9-10 month appointments, primarily research careers, and at higher academic ranks, but scores were similar across employment settings and genders. To enhance career satisfaction and retention, pediatric psychologists may seek additional mentorship or explore new employment roles, and administrators and managers may consider adopting workplace policies or making environmental changes that could address specific areas of need. PUBLIC SIGNIFICANCE STATEMENT: This study suggests that overall, pediatric psychologists are highly satisfied with their employment. However, there may be some important aspects of their work that could be more satisfying. The findings have implications for identifying professional development strategies that can maintain or enhance satisfaction.

An acute, non-therapeutic dose of methylphenidate disrupts partner preference in female rats.

The present study was designed to test the effects of an acute, high dose of methylphenidate (MPH; trademarked as Ritalin) on sexual behavior in female Long-Evans rats. In Experiment 1, naturally cycling subjects in estrus were tested for partner preference 20min after receiving an i.p. injection of MPH 10mg/kg (n=8) or saline (n=7). During the partner-preference test, female subjects were given the choice to interact with a sexually active male stimulus or a sexually receptive female stimulus. Physical contact was limited by placing the stimulus animals behind a wire mesh during the no-contact phase of the test, whereas physical contact was not limited during the contact phase. Female subjects that received MPH spent significantly less time with the male stimulus than the saline-treated subjects during both phases (no-contact and contact) of the partner-preference test. This acute dose of MPH did not affect visits to the female stimulus; however, MPH-treated subjects made fewer visits to the male stimulus than the saline-treated subjects during the contact phase of the partner-preference test. Consistent with previous findings, MPH increased line crossings when subjects were tested in an open field immediately after the partner-preference test. In Experiment 2, female subjects were ovariectomized (OVX), primed with estradiol benzoate and progesterone, and tested for partner preference 20min after receiving an injection of MPH 10mg/kg (n=8) or saline (n=8). Similar to the results of Experiment 1, OVX hormone-primed subjects that received MPH spent significantly less time with the male stimulus than the saline-treated subjects during both phases of the partner-preference test. Although MPH-treated subjects were sexually receptive, they displayed fewer proceptive behaviors (i.e., hops and darts) than saline-treated subjects. Two-weeks later, the subjects from Experiment 2 were tested in an open field 20min after receiving an injection of MPH 10mg/kg or saline (counterbalancing previous MPH exposure). Once again MPH increased locomotor activity. In conclusion, the effects of MPH were equally as robust in naturally cycling subjects as in the more commonly used OVX-hormone primed subjects. The results of the present study suggest that an acute, non-therapeutic dose of MPH disrupts approach and interest in a male stimulus during a test of partner preference. This avoidance of the male stimulus may be the result of a decrease in the incentive value of a sexual partner.

Satisfaction with the Health Care Provider and Regimen Adherence in Minority Youth with Type 1 Diabetes.

To assess whether satisfaction with the health-care provider is related to regimen adherence among primarily minority youth with type 1 diabetes. Youth with type 1 diabetes (n = 169; M age = 13.88; 52 % female; 70 % Hispanic) and their parents completed questionnaires that assessed their own satisfaction with the health-care provider and youths' adherence to diabetes self-care behaviors. Higher youth and parent patient-provider relationship satisfaction was associated with higher regimen adherence. Gender affected the relationship between satisfaction and regimen adherence, such that for girls, greater satisfaction was associated with better adherence; this was not the case for boys. Patient satisfaction with the health care provider is important for regimen adherence among primarily minority youth with type 1 diabetes, particularly for girls. Future research might focus on improving youths' relationships with their health care providers as a potential pathway to improve regimen adherence.

Applicability of the SMART Model of Transition Readiness for Sickle-Cell Disease.

OBJECTIVES: This study aimed to examine the applicability of the Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) model for adolescents and young adults (AYA) with sickle-cell disease (SCD). METHODS: 14 AYA with SCD (14-24 years old) and 10 clinical experts (6-20 years of experience) completed semi-structured interviews. AYA completed brief questionnaires. Interviews were coded for themes, which were reviewed to determine their fit within the SMART model. RESULTS: Overall, most themes were consistent with the model (e.g., sociodemographics/culture, neurocognition/IQ, etc.). Factors related to race/culture, pain management, health-care navigation skills, societal stigma, and lack of awareness about SCD were salient for AYA with SCD. CONCLUSIONS: Findings suggest the SMART model may be appropriate in SCD with the consideration of disease-related stigma. This study is a step toward developing a disease-specific model of transition readiness for SCD. Future directions include the development of a measure of transition readiness for this population.

Exposure to methylphenidate during peri-adolescence affects endocrine functioning and sexual behavior in female Long-Evans rats.

The present study was designed to test the effects of methylphenidate (MPH) exposure on the maturation of endocrine functioning and sexual behavior. Female rat pups received either MPH (2.0mg/kg, i.p.) or saline twice daily between postnatal days 20-35. This period of exposure represents the time just prior to puberty as well as puberty onset. Approximately five weeks after the last injection of MPH or saline, female subjects were hormone-primed and tested during their first sexual experience. Subjects were given the choice to interact with a sexually active male or a sexually receptive female rat (i.e., the partner-preference test). The partner-preference paradigm allows us to assess multiple aspects of female sexual behavior. MPH exposure during peri-adolescence delayed puberty and, when mated for the first time, affected sexual behavior (e.g., increased time spent with the male stimulus and decreased the likelihood of leaving after mounts) during the test of partner preference. When monitoring estrous cyclicity, female subjects treated with MPH during peri-adolescence frequently experienced irregular estrous cycles. The results of the present study suggest that chronic exposure to a therapeutic dose of MPH around the onset of puberty alters long-term endocrine functioning, but with hormone priming, increases sensitivity to sexual stimuli.

Topical Review: Provider-Patient Interactions: An Important Consideration for Racial/Ethnic Health Disparities in Youth.

OBJECTIVE: To summarize literature on the role of provider-patient interactions (PPI) in racial/ethnic health disparities and consider the relevance of PPI for understanding health disparities in pediatric psychology. METHODS: Topical review of literature focusing on health disparities and PPI in adult and pediatric populations. RESULTS: For adults, evidence is clear that racial/ethnic minorities experience poorer quality PPI, which may be associated with poorer health outcomes. In pediatric populations, the emerging literature indicates similar associations, and potential promising targets for intervention including information exchange, shared decision-making and patient-centered communication. PPI research in pediatric populations poses a number of methodological challenges including culturally and developmentally sensitive measurement of triadic (caregiver, patient, provider) interactions. CONCLUSIONS: Health disparities in PPI exist for racial/ethnic minority youth and may contribute to poorer health outcomes. Pediatric psychologists can make valuable contributions, given their expertise and role within medical settings. Research, clinical, and policy recommendations are discussed.