The effect of diabetes self-management education with frequent follow-up on the health outcomes of African American men.

PURPOSE: This study was conducted to determine whether objective clinical, patient performance, quality-of-life, and subjective outcomes are significantly different among African American men with type 2 diabetes who received follow-up at either monthly or 3-month intervals after participating in a structured diabetes self-management education program. METHODS: Prior to the diabetes self-management education program, 30 African American men with type 2 diabetes were randomly assigned to 2 groups to receive telephone follow-up at either monthly or 3-month intervals over a 6-month period. Information obtained at follow-up contact included HbA1c level, perception of general health, and present diabetes knowledge. In addition, daily foot care, dietary, exercise, and medication compliance measures were assessed postprogram. RESULTS: There were no significant differences between the participants who received follow-up at monthly and 3-month intervals on any measures of the selected clinical, patient performance, quality-of-life, and subjective outcomes. CONCLUSIONS: This cross-sectional study showed that telephone follow-up at 3-month intervals following a structured program of diabetes self-management education may be just as effective in contributing to favorable diabetes health outcomes as monthly follow-up.

The Diabetes Day Treatment experiment: a preliminary report on what we learned.

PURPOSE: This paper presents data on the efficacy of a diabetes day treatment program to modify the healthcare behavior of elderly African Americans with diabetes. METHODS: African American patients with Type 1 or Type 2 diabetes who were referred by their certified diabetes educator were eligible to participate in the day treatment program. The program was designed to serve eight patients for 4 hours 1 day a week over 9 months. Participants engaged in informal discussions, low-impact armchair exercises, and discussions of various diabetes issues. A flow sheet was initiated and maintained by the investigators to record information pertaining to each participant's blood pressure, blood sugar, and weight at each session. Attendance and reasons for not attending sessions were recorded. To obtain more in-depth information, the group leaders used a technique known as participant observation. RESULTS: Having CDEs administer a blood sugar test, take blood pressure, and weigh each patient at each clinic visit promotes patient adherence to the diabetes treatment regimen. Memory loss was observed to be especially prevalent among the subjects. CONCLUSIONS: The Diabetes Day Treatment Program may be used as a model for working with elderly persons with diabetes from different ethnic groups.

Making a case for the CDE's role in outsourcing diabetes services to a freestanding outpatient diabetes disease state management center.

Outsourcing of diabetes disease state management services by MCOs is a good thing for enrollees with diabetes. It is a good mechanism for MCOs that are striving to cut the costs of diabetes care, and it is a trend that the authors expect to see continue in an accelerated way, given the new diagnostic guidelines released by the American Diabetes Association and the epidemic of diabetes among older persons. Through a partnership with a quality, freestanding, outpatient diabetes disease state management center staffed by CDEs, MCOs with a vision can expect to profit now and pay less later for devastating, expensive diabetes complications that lead to increased hospitalizations.

Greatest fears of type 1 and type 2 patients about having diabetes: implications for diabetes educators.

This exploratory study was undertaken to describe the differences in the greatest fears about having diabetes between type 1 and type 2 patients. Frequency distributions, measures of central tendency, and nonparametric statistics were employed to examine the traits of the sample and to make comparisons between type 1 and type 2 patients. Content analysis was used to describe and analyze the subjects' responses to the question, What is your greatest fear about having diabetes? Subjects' answers to this question were categorized and scored as representing fear of either a long-term or acute complication based on the clinical judgment of the authors. Results revealed that both type 1 and type 2 patients were likely to have given responses that were suggestive of fear of long-term complications. The major fears concerned amputation, cardiovascular disease, nephropathy, neuropathy, retinopathy, and stroke. The findings of the present investigation suggest that diabetes educators may need to address patients' fears of long-term complications directly and effectively. Several areas of research that grew out of this exploratory study were recommended for future consideration.

Outreach with teenage fathers: a preliminary report on three ethnic groups.

This article presents preliminary data on suggestions for reaching Anglo, black, and Hispanic unmarried adolescent fathers. Results reveal that reaching out to these young fathers may be complicated because their needs vary within and across their culture. The data suggest that these fathers need diverse information, practical help, and counseling.

Religiosity and unmarried black adolescent fatherhood.

This paper examines the relationship between religiosity and unmarried adolescent fatherhood in a select population of unwed black adolescent fathers and their counterparts. The results indicated that the fathers did not differ so much from the nonfathers in the degree that they are religiously oriented but in the manner that they give expression to their religious involvement. The fathers were more likely to be responsive to nongroup modes of institutionalized religion, i.e., media forms; whereas the nonfathers religious involvement was likely to be within institutionalized groups.

The NIMH Diagnostic Interview Schedule: a test of its validity in a population of black adults.

This article examines the validity of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) relative to three of its measures: alcoholism, depression, and schizophrenia when compared with the clinical interview. Preliminary results indicate that greater diagnostic agreement was observed for alcoholism and depression than for schizophrenia. Much of the disagreement between the DIS interview and the clinician's ratings regarding schizophrenia seems to have occurred in cases with a mixture of schizophrenic and depressive symptoms.

Locus of control and the use of contraception among unmarried black adolescent fathers and their controls: a preliminary report.

This article presents preliminary data that examines the relationship between external locus of control and contraceptive use in a limited population of unmarried black adolescent fathers and their controls. Results reveal that black adolescent fathers are more likely to have an external locus of control, to not be church goers, and to not believe in the use of birth control. Policy implications of this research indicate that unmarried black adolescent fathers should be given birth control counseling; if other forms of counseling are warranted, attention should be paid to issues of locus of control.

Suggestions for reaching unmarried black adolescent fathers.

PIP: This paper discusses ways to involve young fathers in social agency programs. Conclusions are based on results of studies conducted in 3 United States cities: Tulsa, Oklahoma, Chicago, Illinois, and Columbus, Ohio, concerning the characteristics and needs of unmarried black adolescent fathers. Data is drawn from personal interviews with adolescent fathers who were paid a fee for their particiaption in the study. Common characteristics emerge: 49% had their 1st coital experiences with a girl by the age of 12; 54% were 17 years or younger when they became a father; 65% came from families with 5 or more children; 60% had fathers present in the home; most felt closer to their mothers when growing up; 47% had sisters and 33% had brothers who were unwed parents; to 78%, nothing was wrong with having a child out of wedlock; 68% were not active church members; 50% had completed less than 12 years of school or were unemployed or out of school; 53% first received sex education from a friend and 46% shared knowledge of their sexual activity with a friend, usually at a recreational center. Problems of the fathers include difficulties with family of origin, restricted freedom, duty of providing for the child, limited visitation, problems with the mother's family, and lack of employment and education opportunities. Social agencies are the last source they would turn to with these problems; families their 1st choice. 98% expressed an interest in their children and 60% professed love for the mother. Suggestions to help these fathers include starting in small ways and offering practical help in employment and education before tackling emotional problems, using peer counselors and meeting in the father's own environment, involving the father's parents, and remembering the deep interest of these fathers for the young mothers and their children.^ieng

A limited population of unmarried adolescent fathers: a preliminary report of their views on fatherhood and the relationship with the mothers of their children.

Although much has been documented regarding adolescent childbearing (Juhasz, 1974; Furstenburg, 1976; Card & Wise, 1978; Russ-eft, 1979; Chilman, 1980; Earl & Siegel, 1980), little is known about the attitudes of unmarried adolescent fathers toward fatherhood and their relationship with the mothers of their children. Most of what is known about this relationship has been learned from the young mothers (Sauber, 1966; Bernstein, 1971; Pope, 1971; bemis, 1976; Lorenzi, 1977; Clapp & Raab, 1978). With the exception of a few investigators (Pannor et al., 1968; Pannor, 1971, Hendricks, 1981), virtually no accounts can be found in the literature documenting unmarried adolescent fathers' perceptions of fatherhood and their relationship with the mothers of their children. This paper attempts to bridge this gap in the literature by reporting on how two select populations of black unmarried adolescent fathers view fatherhood and their relationship with the mothers of their children.

PIP: Reports on how 2 select populations of black, unmarried, adolescent fathers view fatherhood and their relationship with the mothers of their children. Data is drawn from 2 cross sectional studies of 47 recent, 1st time, unwed black adolescent fathers in Tulsa, Oklahoma (N=20) and Chicago, Illinois (N=27). Respondents to the survey were selected in a non probability manner and do not constitute a representative sample of unmarried black adolescent fathers. Tulsa and Chicago were found to be more similar sociodemographically than they were different. However, important differences were found between fathers in the 2 cities. For example, Tulsa fathers were more likely to be older at the birth of their child, more likely to be employed, and more likely to have completed 12 or more years of school than fathers in Chicago. Young fathers in Chicago were more likely to come from families with a median income of $10,000 or more. The authors compare the fathers' perceptions of their readiness for parenthood both before and after the birth or conception of their 1st child. Also compared are the adolescent fathers' perceptions of their relationship with the mothers of thier 1st children, both before and after the mothers became pregnant. Although some differences are found between the fathers in these 2 cities, the overall major findings are similar. Both populations are likely to be accepting of young fatherhood. Findings also indicate strongly that the young fathers perceive their relationship with the young mothers as one of love. The authors caution that their findings cannot be generalized because the attitudes of fathers who participated in the study may differ from those who chose not to.

Unmarried black adolescent fathers' attitudes toward abortion, contraception, and sexuality: a preliminary report.

The attitudes of a limited population of unmarried black adolescent fathers toward abortion, contraception, and sexuality were assessed using standardized data collected in Tulsa, Oklahoma, Chicago, Illinois, and in Columbus, Ohio. A majority of the surveyed fathers in each city surveyed, were opposed to abortion. Two-thirds indicated a willingness to share contraceptive responsibility with the female. These data suggest that if family planning agencies offered sex education programs for adolescent fathers, particularly in relation to contraceptive responsibility, the incidence of repeat unwed adolescent fatherhood might be reduced.

PIP: The attitudes toward abortion, contraception, and sexuality of 95 recent first-time unmarried black adolescent fathers in Tulsa, Oklahoma; Chicago, Illinois; and Columbus, Ohio, were assessed in interviews conducted by an adult black male. The paid subjects were selected in a nonprobability manner by social service workers in teenage parenting agencies and no not constitute a representative sample of black adolescent fathers. The respondents were more similar than different on the sociodemographic variables studied, but some important differences were found, including the higher age and educational level of fathers in Tulsa and the lower level of employment of fathers in Chicago. No statistically significant differences were observed in the fathers' responses. A majority of the fathers in each city were opposed to abortion, a majority in Columbus but not Tulsa or Chicago agreed that "birth control is for girls only," and at least 2/3 in each city approved of the use of birth control. 90% or more in each city disagreed with the statement that "getting a girl pregnant proves that you are a man," and at least 80% disagreed that sex education is a waste of time. The data suggest that the incidence of repeat unwed adolescent fatherhood might be reduced if family planning services offered sex education programs for teenage fathers.

Black unwed adolescent fathers: a comparative study of their problems and help-seeking behavior.

THIS RESEARCH EXAMINES THE KINDS OF PROBLEMS THESE YOUNG FATHERS ARE LIKELY TO SEEK HELP FOR AND ADDRESSES ITSELF TO THE QUESTION: Is there a difference in the help-seeking behavior of unwed adolescent fathers who reside in different cities? Despite the complexity and diversity of their difficulties, it was clear from the analyses that the young fathers were likely to have emotional as well as concrete needs. Additionally, it was found that the unmarried adolescent fathers in this research were more similar than they were different in their help-seeking behavior.

Help-seeking behavior among select populations of black unmarried adolescent fathers: implications for human service agencies.

This study was undertaken to provide additional information on what are appropriate roles for agencies in relation to unmarried adolescent fathers. The findings indicate that such appropriate roles for agencies would include the provision of psychosocial counseling, vocational guidance, and parenting education. It was concluded that agency personnel would have to reach out assertively to unmarried adolescent fathers in order to serve them more effectively. (Am J Public Health 1981;71:733-735.)