Influences on day-to-day self-management of type 2 diabetes among African-American women: spirituality, the multi-caregiver role, and other social context factors.

OBJECTIVE: Many African-American women are affected by diabetes and its complications, and culturally appropriate lifestyle interventions that lead to improvements in glycemic control are urgently needed. The aim of this qualitative study was to identify culturally relevant psychosocial issues and social context variables influencing lifestyle behaviors--specifically diet and physical activity--of southern African-American women with diabetes. RESEARCH DESIGN AND METHODS: We conducted 10 focus group interviews with 70 southern African-American women with type 2 diabetes. Group interviews were audiotaped and transcripts were coded using qualitative data analysis software. A panel of reviewers analyzed the coded responses for emerging themes and trends. RESULTS: The dominant and most consistent themes that emerged from these focus groups were 1) spirituality as an important factor in general health, disease adjustment, and coping; 2) general life stress and multi-caregiving responsibilities interfering with daily disease management; and 3) the impact of diabetes manifested in feelings of dietary deprivation, physical and emotional "tiredness," "worry," and fear of diabetes complications. CONCLUSIONS: Our findings suggest that influences on diabetes self-management behaviors of African-American women may be best understood from a sociocultural and family context. Interventions to improve self-management for this population should recognize the influences of spirituality, general life stress, multi-caregiving responsibilities, and the psychological impact of diabetes. These findings suggest that family-centered and church-based approaches to diabetes care interventions are appropriate.

Are the correlates of cigarette smoking initiation different for black and white adolescents?

BACKGROUND: Studies of adolescent smoking suggest that the causes of smoking initiation may differ for Blacks and Whites. METHODS: Correlates of smoking initiation were examined among 1,277 nonsmokers, ages 12-14, who completed questionnaires in their homes. The analyses examined relationships between smoking initiation and 11 explanatory variables using logistic regression with the combined sample and with Black and White samples. RESULTS: Over two years, 24 percent of Whites and 14 percent of Blacks started to smoke. Whites were more likely to start smoking at age 12 and Blacks at age 14. Having a best friend who smoked increased the odds of initiating smoking over twofold for Whites but had no effect on the odds of smoking for Blacks. CONCLUSIONS: Whites initiate smoking earlier than Blacks and are more likely to be influenced by friend behavior.

Dietary practices of persons with diabetes during insulin pump therapy.

Eating behaviors and diet composition were investigated in 15 individuals with insulin-dependent diabetes treated by continuous subcutaneous insulin infusion (CSII). Glycemic control was significantly improved and was near normal during pump treatment. Patients were interviewed with the use of a structured questionnaire composed of multiple question formats to document dietary practices and to identify changes from conventional therapy. Mealtimes were varied considerably on both conventional and pump therapy (as much as 110 +/- 19 and 126 +/- 20 minutes, respectively), but mealtime delays were reported to be manageable while the patients were using the pump. The practices of eating larger meals or additional snacks compensated for by extra insulin significantly increased during CSII therapy. Partly as a consequence of such practices, patients experienced a significant weight gain of 7.2 +/- 2 lb during pump treatment (p less than .005). Clearly, prospective studies are needed to determine the acceptable degree of dietary flexibility and the optimal management of diet during insulin pump therapy.