Peer crowd affiliation, adherence, perceived support, and metabolic control in T1DM youth.

Youth with type 1 diabetes (T1DM) can face many challenges when adhering to their complex regimen in the context of their peer crowd. The aim of this study was to determine if peer crowd affiliation was associated with adolescents' adherence behaviors, perceived peer support, and metabolic control. A sample of 128 adolescents with T1DM completed the Peer Crowd Questionnaire, Diabetes Social Support Questionnaire-Friends Version, and Self-Care Inventory-Revised, and HbA1c readings were collected during their clinic visit. Results from this study suggest that adherence behaviors mediated the relationship between Jock peer crowd affiliation and metabolic control. Results also suggested that perceived peer support did not mediate the relationship between peer crowd affiliation and metabolic control through adherence behaviors. When examining the path coefficients for the purposed models, results showed a positive relationship between adherence and metabolic control, and more perceived peer support was related to worse metabolic control. Adolescents who identified mostly with the Jock peer crowd may hold lifestyle values that are consistent with the diabetes regimen which may make their diabetes management easier. In general, adolescents with T1DM may have a more multifaceted aspect of one's identity and therefore, their peer crowd affiliation is not as salient.

Validity, Reliability, and Measurement Invariance of the Diabetes Stress Questionnaire-Short Form.

OBJECTIVE: The purpose of this study was to develop a short form of the Diabetes Stress Questionnaire (DSQ) with adequate psychometric properties (i.e., internal consistency, convergent, criterion, discriminant validity, construct validity, and measurement invariance). METHODS: In total, 181 youth with type 1 diabetes (T1D) completed the 65-item DSQ, and archival data were obtained from 142 youth with T1D to serve as an independent cross-validation sample. Twenty-four items were chosen to retain the original eight scales of the DSQ and to maximize internal consistency and correlations to full subscales. Confirmatory factor analyses were used to evaluate the proposed factor structure of the Diabetes Stress Questionnaire-Short Form (DSQ-SF) and to assess invariance of the DSQ-SF across sex, race, grade level, glycemic control, illness duration, and annual income categories. RESULTS: The 24-item DSQ-SF was found to have good internal consistency, factor structure and fit, correlated highly to the full scale (r = .98), and was invariant across sex, race, grade level (<9th grade or >9th grade), glycemic control, illness duration, and annual income. CONCLUSIONS: The DSQ-SF appears to be a psychometrically robust measure of diabetes-specific stress in youth with T1D. Present findings suggest that the DSQ-SF has the potential to be a useful, quick, cost-effective, and comprehensive screening tool for identifying youth with T1D who may benefit from T1D-specific stress reduction interventions as a way to improve health behaviors, psychosocial well-being, and glycemic control.

Efficacy of mindfulness-based stress reduction in emerging adults with poorly controlled, type 1 diabetes: A pilot randomized controlled trial.

BACKGROUND/OBJECTIVE: The negative effects of stress on persons with type 1 diabetes (T1D) are well-established, but effective interventions to reduce stress among emerging adults with T1D are limited. The study objective was to conduct a pilot randomized controlled trial (RCT) to obtain preliminary data on the efficacy of mindfulness-based stress reduction (MBSR) to reduce stress and improve diabetes health outcomes in a population of high-risk, urban emerging adults with poorly controlled diabetes. METHODS: Forty-eight participants aged 16 to 20 years of age with T1D (mean duration = 8 years) were randomly assigned to one of three conditions: MSBR, cognitive-behavioral stress management (CBSM), or a diabetes support group. Data were collected at baseline, end of treatment, and 3 months after treatment completion. Measures of self-reported stress and depressive symptoms, diabetes management, and glycemic control were obtained. RESULTS: MBSR was found to reduce self-reported stress at end of treatment (P = 0.03, d = -0.49) and 3-month follow-up (P = 0.01, d = -0.67), but no effects on diabetes management or glycemic control were found. Diabetes support group participants had improved glycemic control at the end of treatment (P = 0.01, d = -0.62) as well as reduced depressive symptoms at 3-month follow-up (P = 0.01, d = -0.71). CONCLUSIONS: Results provide preliminary support for the efficacy of MBSR to improve psychosocial adjustment in emerging adults with poorly controlled T1D but require replication in adequately powered studies. Findings also support the value of peer support in improving health outcomes in this age group.

Differentiating peer and friend social information-processing effects on stress and glycemic control among youth with type 1 diabetes.

OBJECTIVE: Many adolescents with Type 1 diabetes (T1D) find adherence difficult in social situations because they fear negative evaluations by others. These negative reaction attributions are associated with anticipated adherence difficulties, stress, and glycemic control. It is unclear whether peer versus friend attributions are distinct constructs, or whether there is a differential impact on glycemic control moderated by youth characteristics. METHOD: Youth with T1D (n = 142; 58% female; 84% Caucasian, mean = 13.79 years, standard deviation = 2.10) completed the Peer Attribution and Diabetes Stress Questionnaires. HbA1cs were obtained from medical records. RESULTS: Negative peer versus friend attributions appear distinct and were differentially related to anticipated adherence difficulties, stress, and glycemic control, with peer attributions having the strongest effect. Grade, age, and sex were not moderators for these relationships. CONCLUSION: Peer-related attributions may be a particularly salient target for interventions to improve adherence and distress among youth with T1D.

Assessing measurement invariance of the diabetes stress questionnaire in youth with type 1 diabetes.

OBJECTIVE: To evaluate the factor structure and measurement invariance of the Diabetes Stress Questionnaire (DSQ), a measure of diabetes-specific stress, across sex, age (<9th grade vs. ≥9th grade), and glycemic control (optimal vs. suboptimal). METHODS: Data from 318 adolescent participants were pooled from four archival data sets and the ongoing Predicting Resiliency in Youth with Type 1 Diabetes study in which the DSQ was completed. Confirmatory factor and measurement invariance analyses were conducted to confirm the proposed factor structure and measurement invariance across sex, age, and glycemic control. RESULTS: The DSQ factor structure was found to have an acceptable fit, which was invariant across sex, age, and glycemic control. CONCLUSIONS: When using the DSQ, differences in diabetes-related stress with respect to sex, age, or glycemic control can be considered meaningful. This study supports the DSQ as an evidence-based and well-established assessment of perceived diabetes stress in youth with type 1 diabetes.

Adolescents and type 2 diabetes mellitus: a qualitative analysis of the experience of social support.

OBJECTIVE: Research on how adolescents with type 2 diabetes mellitus (T2DM) understand and use social support is limited. Therefore, we explored how adolescents with T2DM experience and perceive social support. METHODS: Adolescents with T2DM were interviewed, and data were qualitatively analyzed using Consensual Qualitative Research methodology. RESULTS: Four themes emerged: support for nondiabetes and diabetes-specific behaviors, feelings of belonging, and disclosure. All participants expressed emotional and self-care-specific support. For some, disclosure and a sense of belonging with others who had diabetes often led to support elicitation. Participants also expressed a fear of disclosing their diabetes to others. DISCUSSION: Adolescents with T2DM value tangible and emotional support for behaviors both related and not related to diabetes. Fear of disclosure was a typical experience with disclosure often limited to close friends and family. Recommendations for health professionals to assist adolescents in promoting appropriate disclosure and means of requesting support are discussed.

Empirically derived patterns of perceived stress among youth with type 1 diabetes and relationships to metabolic control.

OBJECTIVE: Given the inconsistent relationship between stress and metabolic control, the purpose of this study was to empirically derive patterns of perceived diabetes-related stress among youth with type 1 diabetes mellitus (T1DM) and determine if these patterns relate to overall diabetes-related stress levels and metabolic control. METHOD: A sample of 204 youth with T1DM completed the diabetes stress questionnaire, and their hemoglobin A(1c) (a long-term measure of metabolic control) was obtained from their medical record. RESULTS: Latent profile analyses revealed three perceived-stress profiles: "low stress" (LS), "interpersonal/peer" (IP), and "family stress" (FS). The FS and IP groups reported more overall stress than the LS group; however, only the FS group's HbA(1c) values were significantly higher than either the LS or IP groups. CONCLUSIONS: A global measure of stress may not accurately account for the association between perceived stress and metabolic control. FS, rather than IP stress seems to be a key stress domain linked to suboptimal metabolic control.

Experiencing type 2 diabetes mellitus: qualitative analysis of adolescents' concept of illness, adjustment, and motivation to engage in self-care behaviors.

PURPOSE: The purpose of this study was to explore the perspectives of adolescents diagnosed with type 2 diabetes mellitus (T2DM) in terms of how youths conceptualized the effect of T2DM on daily life, adjustment to the illness, and motivation related to diabetes self-care management. The aims of the study were to gather essential information in order to develop appropriate intervention techniques and inform future studies intended to understand the psychosocial experiences of youths with T2DM. METHODS: Eight adolescents diagnosed with T2DM were recruited from an outpatient pediatric diabetes clinic at a Midwestern children's hospital. A qualitative interview was developed, which was scheduled to last about 30 to 45 minutes. Data were analyzed using the consensual qualitative research methodology, wherein qualitative coders developed core ideas and themes related to the adolescent experience of T2DM. RESULTS: Three main themes were identified, including how the youths conceptualized the impact of T2DM, adjustment to self-care, and motivation to perform self-care behaviors. Knowledge related to the cause of T2DM and adjustment to completing self-care behaviors was varied among youths. Few adolescents spoke about motivation sources, although when mentioned, it typically involved witnessing negative health consequences in family members or friends with T2DM. CONCLUSIONS: The data represent essential initial information related to youths with T2DM, which will help guide in developing future studies designed to understand the psychosocial experiences of youths with T2DM and appropriate intervention techniques. Future research that aims to increase internal and external motivation may be able to subsequently impact adherence to self-care behaviors.

Practitioner perceptions of peer relationships in adolescents with chronic pain.

Nine practitioners who specialize in the treatment of adolescents with chronic pain were interviewed on their perceptions of the adolescents' peer functioning. A qualitative analysis based on Consensual Qualitative Research (CQR) was used. Practitioners generally reported a decline in the adolescents' peer functioning. However, if adolescents had good peer relationships prior to pain onset, they tended to maintain adequate functioning in the social arena while experiencing chronic pain. Practitioners noted that avoidance of peers was a strategy used by adolescents, due more to the pain than social competence issues. They also suggested that adolescents who felt comfortable disclosing pain status, likely to be consistent with good social skills, benefited from peer support. Implications for practice and research are discussed.

Improving adherence in social situations for adolescents with type 1 diabetes mellitus (T1DM): a pilot study.

AIMS: Management of type 1 diabetes mellitus (T1DM) involves adherence to complex daily behaviors. Some adolescents have difficulty maintaining these regimens within social contexts due to peer pressure and apprehension about being singled out (Wysocki et al., 2003 [1]). Previous research suggests that negative social attributions have a role in adherence difficulties (Hains et al., 2006 [6]). This pilot study examined a cognitive-behavioral intervention geared towards challenging and restructuring negative thinking patterns. METHODS: Ten adolescents with T1DM and HbA1c readings greater then 7.0% were recruited from a large, Midwestern Children's Hospital. The intervention consisted of a 1-h session followed by three weekly phone calls, which focused on cognitive restructuring and problem-solving training. Measures of diabetes-related stress and concerns surrounding self-care in social situations were completed by the adolescents pre- and post-intervention and at one-month follow-up. RESULTS: A series of repeated measure ANOVAS did not reveal significant differences between pre-intervention and follow-up scores across measures. CONCLUSIONS: While there were no significant differences between pre-intervention and follow-up scores, the results highlight some important trends. Specifically, preliminary results suggest that the trends in individual scores indicate that problem-solving may be helpful for improving adherence in social situations.

Attributions of teacher reactions to diabetes self-care behaviors.

OBJECTIVE: This study had two objectives: examine relationships among negative attributions of teacher reactions, anticipated adherence difficulties, teacher support, diabetes stress, and metabolic control; and develop questionnaires to test these relationships. METHODS: One hundred and two youths with type 1 insulin-dependent diabetes completed instruments measuring attribution of teacher reactions, anticipated adherence, teacher support, and diabetes stress. Metabolic control was measured by percentage of hemoglobin A(1c). RESULTS: Structural equation modeling demonstrated that negative attributions had direct effects on anticipated adherence difficulties and diabetes stress. Diabetes stress had a direct effect on metabolic control. Negative attributions had a significant indirect effect on metabolic control through associations with diabetes stress. Teacher support moderated the path between negative attributions and anticipated adherence difficulties. CONCLUSIONS: Youths making negative attributions about teacher's reactions are likely to find adherence difficult in school situations and have increased stress. Results are discussed in terms of a social information processing model of adjustment and practical applications.

Teacher support of adherence for adolescents with type 1 diabetes: preferred teacher support behaviors and youths' perceptions of support.

PURPOSE: The purpose of this study is to examine the preferences of adolescents with type 1 diabetes regarding the role of teacher support and perceptions associated with the most supportive and least supportive teachers, as well as to examine the effects of child age and gender on these relationships. Method This cross-sectional questionnaire-based study included 102 adolescents with type 1 diabetes recruited through the outpatient treatment clinic at a Midwestern children's hospital. Adolescents completed demographic questionnaires and questionnaires assessing the role of teacher support. Outcome measures included the newly developed Ideal Teacher Questionnaire, which measured adolescents' preferences for teacher support, and the Diabetes Teacher Support Questionnaire, which evaluated adolescents' perceived frequency of teacher support behaviors and feelings about this support. RESULTS: Youth rated their most supportive teacher as engaging more frequently in support behaviors than their least supportive teacher. Students who expressed a preference for an actively involved teacher had more positive feelings about the support they received from teachers and perceived a higher level of support from their most supportive teacher. Girls perceived a greater frequency of support behaviors than boys and felt more positive about these behaviors. Younger adolescents reported a higher frequency of teacher support behaviors and felt that these behaviors were more supportive. CONCLUSIONS: There are consistent interpersonal differences in adolescents' desires for teacher support of diabetes self-care. It may be important to consider adolescents' preferences for diabetes-related teacher support.

Attributions of adolescents with type 1 diabetes related to performing diabetes care around friends and peers: the moderating role of friend support.

OBJECTIVE: To examine the relationships among negative attributions of friend and peer reactions to diabetes management in social situations, anticipated adherence difficulties, friend support, diabetes stress, and metabolic control. METHODS: A sample of 102 adolescents with Type 1 diabetes completed instruments measuring attribution of friend and peer reactions, anticipated adherence, friend support, and diabetes stress. Metabolic control was measured by the percentage of hemoglobin A1c. RESULTS: Structural equation modeling demonstrated an excellent fit of two models depicting the mediating role of anticipated adherence difficulties and diabetes stress on the relationship between negative attributions of friend (first model) and peer (second model) reactions and metabolic control. Friend support was found to moderate the path between diabetes stress and metabolic control in an unexpected manner. That is, as friend support increased, so did the relationship between stress and metabolic control. CONCLUSIONS: Adolescents who make negative attributions about reactions of friends and/or non friend peers are likely to find adherence difficult in social situations and have increased stress, with the latter associated with metabolic control. Results are discussed in terms of a social information processing model of adjustment.

Attributions of adolescents with type 1 diabetes in social situations: relationship with expected adherence, diabetes stress, and metabolic control.

OBJECTIVE: To examine the relationships among negative attributions of friend reactions (NAFRs) within a social context, anticipated adherence difficulties, diabetes stress, and metabolic control. RESEARCH DESIGN AND METHODS: A sample of 104 adolescents with type 1 diabetes completed instruments measuring demographics, attribution of friend reactions, anticipated adherence, and diabetes stress. Metabolic control was measured by HbA(1c) obtained during the clinic visit. RESULTS: Path analysis demonstrated an excellent fit of a model depicting an indirect relationship between NAFRs and metabolic control through the mechanisms of expected adherence difficulties and diabetes stress. CONCLUSIONS: Adolescents who make NAFRs are likely to find adherence difficult in social situations and have increased feelings of stress, with the latter associated with poorer metabolic control. Intervention efforts to address negative attributions may impact adherence behavior and feelings of stress, especially if specific contexts of self-care behavior are taken into account.

Cystic fibrosis disclosure may minimize risk of negative peer evaluations.

BACKGROUND: Given the relatively lower body weight associated with cystic fibrosis (CF) and the visible regimen associated with eating, there is a risk that individuals with CF may be mistakenly perceived to have an eating disorder or otherwise be negatively evaluated. Based upon a theoretical model, this study explored whether disclosing CF would curtail negative peer perceptions. METHODS: Young adult respondents (N = 391) read vignettes that varied in a 2 (male vs. female character) x 2 (preventative disclosure of disorder vs. nondisclosure) design and answered 28 questions, which resulted in three subscales that were validated using confirmatory factor analysis: Abnormal Behavior, Hiding an Eating Disorder, and Worry. Vignettes depicted a lunchtime interaction including concerns about gaining weight and taking enzymes before eating. RESULTS: Disclosure of CF significantly reduced perceptions of abnormal behavior, ameliorated perceptions of an eating disorder, and alleviated respondents' worries. Manipulations of vignette character gender did not result in any significant differences; however, female respondents reported significantly more worry for the character than males. CONCLUSIONS: Individuals who disclose their CF may potentially curtail negative peer perceptions. Those who choose not to disclose may risk having their thinness and appropriate self-care misperceived as signs of an eating disorder.

Brief report: parent perceptions of hypoglycemic symptoms of youth with diabetes; disease disclosure minimizes risk of negative evaluations.

OBJECTIVE: Based on a theoretical model, this study explored the effects that the disclosure of diabetes has on parental perceptions of a hypothetical child experiencing hypoglycemia. METHODS: Parents (N = 610) first read vignettes that varied in a 2 x 2 design (Male vs. Female Character x Preventative Disclosure of Illness vs. Nondisclosure) and then answered several questions regarding the hypothetical child, resulting in four subscales that were validated using confirmatory factor analysis. RESULTS: Disclosure of diabetes significantly increased perceptions of a medical problem, decreased suspicions of drug use, and presented a lower risk of parental restrictions on future contact with their child. CONCLUSIONS: Individuals who disclose their diabetes may prevent negative social consequences and restrictions on social contact. Those who choose not to disclose may risk having a hypoglycemic event perceived as a drug or alcohol problem, which may ultimately interfere with appropriate medical intervention in a hypoglycemic event.

The impact of cognitive distortions, stress, and adherence on metabolic control in youths with type 1 diabetes.

PURPOSE: To investigate the role of cognitive distortions in the relationship between adherence behavior, diabetes-specific stress, general stress, and metabolic control. METHODS: Obtained questionnaire data, glucometer readings, and glycosylated hemoglobin (HbgA(1c)) assays from 143 youths (11-18 years old) with type 1 diabetes. Examined path model of relationships between cognitive distortions, stress, adherence behavior, and metabolic control. Data were analyzed using path analysis. RESULTS: Higher levels of negative cognitive distortions were associated with more stress (both diabetes-specific and general). Higher levels of general stress then led to less adherent behavior and subsequently poorer metabolic control (higher HbgA(1c)). More diabetes-specific stress also led to poorer metabolic control, as well as general stress. CONCLUSIONS: The findings indicate an indirect role of negative cognitive distortions in metabolic control. The current findings suggest that instead of the proposed direct link between cognitive distortions and adherence behavior, an indirect relationship may exist through stress.

Impact of diabetes disclosure on perceptions of eating and self-care behaviors.

PURPOSE: This study investigated whether disclosure of diabetes and gender influenced perceptions of eating and self-care behaviors. METHODS: A vignette was developed in which a hypothetical friend engaged in diabetes self-care behaviors during a meal. Respondents (231 young adults) read vignettes that varied according to a 2 x 2 design (male vs female, preventative disclosure vs nondisclosure of diabetes). Participants answered 12 questions, which resulted in 2 factors: concern for friend and encourage professional help. RESULTS: Significantly higher scores resulted on the concern for friend and encourage professional help factors when diabetes was not disclosed. Female characters also received significantly higher scores on the concern for friend factor. CONCLUSIONS: Individuals with diabetes who choose to disclose their illness may prevent negative or incorrect perceptions related to self-care and eating behaviors, and may have a decreased likelihood that a true eating disorder would be identified by others.