Moderating Effect of Depression on Glycemic Control in an eHealth Intervention Among Black Youth With Type 1 Diabetes: Findings From a Multicenter Randomized Controlled Trial.

BACKGROUND: Black adolescents with type 1 diabetes (T1D) are at increased risk for suboptimal diabetes health outcomes; however, evidence-based interventions for this population are lacking. Depression affects a high percentage of youth with T1D and increases the likelihood of health problems associated with diabetes. OBJECTIVE: Our aim was to test whether baseline levels of depression moderate the effects of a brief eHealth parenting intervention delivered to caregivers of young Black adolescents with T1D on youths' glycemic control. METHODS: We conducted a multicenter randomized controlled trial at 7 pediatric diabetes clinics located in 2 large US cities. Participants (N=149) were allocated to either the intervention group or a standard medical care control group. Up to 3 intervention sessions were delivered on a tablet computer during diabetes clinic visits over a 12-month period. RESULTS: In a linear mixed effects regression model, planned contrasts did not show significant reductions in hemoglobin A1c (HbA1c) for intervention adolescents compared to controls. However, adolescents with higher baseline levels of depressive symptoms who received the intervention had significantly greater improvements in HbA1c levels at 6-month follow-up (0.94%; P=.01) and 18-month follow-up (1.42%; P=.002) than those with lower levels of depression. Within the intervention group, adolescents had a statistically significant reduction in HbA1c levels from baseline at 6-month and 18-month follow-up. CONCLUSIONS: A brief, culturally tailored eHealth parenting intervention improved health outcomes among Black adolescents with T1D and depressive symptoms. TRIAL REGISTRATION: ClinicalTrials.gov NCT03168867; https://clinicaltrials.gov/study/NCT03168867.

Use of a Novel Theory-Based Pragmatic Tool to Evaluate the Quality of Instructor-Led Exercise Videos to Promote Youth Physical Activity at Home: Preliminary Findings.

BACKGROUND: Exercise videos that work to minimize cognitive load (the amount of information that working memory can hold at one time) are hypothesized to be more engaging, leading to increased PA participation. PURPOSE: To use a theory-based pragmatic tool to evaluate the cognitive load of instructor-led exercise videos associated with the Interrupting Prolonged Sitting with ACTivity (InPACT) program. METHODS: Exercise videos were created by physical education teachers and fitness professionals. An evaluation rubric was created to identify elements each video must contain to reduce cognitive load, which included three domains with four components each [technical (visual quality, audio quality, matching modality, signaling), content (instructional objective, met objective, call-to-action, bias), and instructional (learner engagement, content organization, segmenting, weeding)]. Each category was scored on a 3-point scale from 0 (absent) to 2 (proficient). A video scoring 20-24 points induced low cognitive load, 13-19 points induced moderate cognitive load, and less than 13 points induced high cognitive load. Three reviewers independently evaluated the videos and then agreed on scores and feedback. RESULTS: All 132 videos were evaluated. Mean video total score was 20.1 ± 0.7 points out of 24. Eighty-five percent of videos were rated low cognitive load, 15% were rated moderate cognitive load, and 0% were rated high cognitive load. The following components scored the highest: audio quality and matching modality. The following components scored the lowest: signaling and call-to-action. CONCLUSIONS: Understanding the use of a pragmatic tool is a first step in the evaluation of InPACT at Home exercise videos. Our preliminary findings suggest that the InPACT at Home videos had low cognitive load. If future research confirms our findings, using a more rigorous study design, then developing a collection of instructor-led exercise videos that induce low cognitive load may help to enhance youth physical activity participation in the home environment.

Psychometric Properties of the Piper Fatigue Scale-12.

Background and Purpose: The Piper Fatigue Scale (PFS)-12 is a recently shortened version of the original PFS that has 40 items. Psychometric evidence for PFS-12 from a small sample of individuals on hemodialysis is presented. Methods: The psychometric analysis with pilot data was done using a detailed item analysis, including Bland-Altman plots, exploratory factor analysis of pre- and post-item scores, and item change scores. Additional measures were used to investigate the validity including the Patient-Reported Outcomes Measurement Information System-Fatigue Scale and the 6-minute walk test. Results: The sample consisted of 86 hemodialysis individuals. The internal consistency reliability of the PFS-12 total scale was 0.91 (pre), 0.95 (post), and subscale alphas were 0.79-0.94. Convergent, concurrent, and predictive validity of PFS-12 were supported. Construct validity of PFS-12 was confirmed predialysis and partially supported in the change score analysis. Conclusion: The brief 12-item PFS is a good alternative to the longer version of this scale to reduce the respondent burden and measure the overall fatigue; further validation in test-retest situations and subscale validity is needed.

Development of an online discrete choice experiment to elicit preferences for tobacco treatment among college students.

OBJECTIVE: To develop an online discrete choice experiment (DCE) to elicit preferences for the format and content of tobacco treatment and determine the feasibility of the survey in face-to-face online interviews among college students. PARTICIPANTS: A convenience sample of 28 college students. METHODS: A pilot online DCE survey with sixteen choice sets was developed. The feasibility was assessed by: 1) ease of reading the survey descriptions, 2) ease of completing the DCE survey, and 3) appropriateness of the number of choice sets. Think-aloud data were analyzed to understand decision-making processes. RESULTS: All participants completed the DCE survey and reported that it was very easy to read and complete and that the number of sixteen choice sets was appropriate. Such results support the feasibility of our online DCE survey. Five decision-making strategies were identified. CONCLUSIONS: An online DCE survey administered during online interviews may replace in-person interviews for college students.

The Psychometric Properties of the Brief COPE Among Young Adults.

Background and Process: Although the Brief COPE is a widely used instrument to measure coping, its factor structure is understudied in young adults. The purpose of this article was to determine the psychometric properties of the dispositional version of the Brief COPE among young adults. Methods: Two hundred young adults completed the dispositional version of the Brief COPE. Measures of depression, anxiety, and stress tested predictive validity. Confirmatory factor analyses and exploratory structural equation modeling were conducted. Results: The final model achieved good fit (minimum discrepancy/degrees of freedom [CMIN/df] = 1.59; comparative fit index [CFI] = .93; standardized root mean square residual [SRMR] = .07). Three second-order factors were identified: adaptive (α = .81), support (α = 78), and disengaged coping (α = 71). Adaptive and disengaged coping were differentially associated with mental health outcomes. Conclusions: The results are consistent with a growing body of evidence to support the construct validity of the Brief COPE.

Perceived adversity and psychological distress in refugee married couples resettling in the United States.

BACKGROUND: Syrian and Iraqi refugees are a growing segment of the U.S. population, and although exposure to war and violence has been linked to psychological distress in individual refugees, few studies have examined the distress in married couples. METHODS: Using a cross-sectional design, a convenience sample of 101 Syrian and Iraqi refugee couples was recruited from a community agency. The purpose of this study was to (1) examine the relationships between perceived adversity and psychological distress (PTSD, anxiety, and depressive symptoms) among individual study participants; and (2) determine whether these relationships were correlated to their spouses' perceived adversity and psychological distress. RESULTS: The bivariate correlation analysis showed strong positive correlations between PTSD and depression/anxiety for wives (r = .79; p < .001) and for husbands (r = .74; p < .001). There were also low- to mid-range positive cross-associations between husbands' and wives' PTSD (r = .34; p = .001) and depression/anxiety (r = .43; p < .001). Finally, we found a significant positive association between husbands' and wives' perception of adversity (r = .44; p < .001). Interestingly, the husbands' perception of adversity was positively associated with their PTSD (r = .30; p = .02) and depression/ anxiety scores (r = .26; p = .04) as well as with their wives' depression/ anxiety scores (r = .23; p = .08). In contrast, the wives' perception of adversity was not associated with either their own or their spouses' psychological distress. CONCLUSION: Our findings suggest that war, trauma, and stress of migration impact the couple as a unit, possibly due to shared experiences, and the impact of one partner's stress on the other. Addressing these perceptions and personal interpretations of the adverse experiences via cognitive therapy approaches could help reduce not only stress in the individual but also that of their partner.

Aligning Organizational Priorities and System Policies to Support Implementation Scale-Up of a Tailored Classroom-Based Physical Activity Intervention in Low-Resource Schools.

BACKGROUND: A mismatch between organizational priorities and system-level policies can negatively impact implementation and sustainment of classroom-based physical activity (PA) interventions. The purpose of this study was twofold: (1) present methods to systematically identify organization- and system-level implementation barriers, and (2) align organizational priorities and system policies by designing multi-level implementation strategies. This alignment will support implementation scale-up of a tailored PA intervention in one low-resource intermediate school district (ISD; 16 districts, 32 schools) in central Michigan. METHODS: Multi-level assessments of organizational readiness were conducted using the Hexagon Discussion and Analysis Tool to assess intervention-context fit, the Wellness School Assessment Tool 3.0 to evaluate district PA policy strength and comprehensiveness, and semi-structured interviews were conducted to assess administrative support and priorities related to PA programming. RESULTS: Our assessments revealed three implementation barriers: limited structural capacity to sustain teacher training, limited resources across districts and school buildings to support teachers, and misalignment of ISD and district PA policies and priorities. CONCLUSIONS: Greater attention to organizational capacity and existing infrastructure should be considered a priori to support effective implementation and sustainment of PA interventions in low-resource schools.

Does Coping Mediate the Relationship Between Adverse Childhood Experiences and Health Outcomes in Young Adults?

Adverse childhood experiences (ACEs) affect 22-75% of American young adults. ACEs are associated with adverse health outcomes that begin in young adulthood. Yet, scant research has examined if coping can mediate the relationship between ACEs and adverse outcomes. The current study determined if coping mediates the relationship between ACEs and body mass index (BMI), substance use, and mental health outcomes in young adults. A community sample of 100 White and 100 Black young adults 18-34 years of age participated in a cross-sectional study conducted via Zoom conferencing. Participants provided demographic data, height/weight, and completed measures of ACEs, coping, substance use, and mental health outcomes. Coping was measured using an established three-factor model consisting of adaptive, support, and disengaged coping. Structural equation modeling (SEM) examined the relationships of ACEs to outcomes as mediated by coping. Participants were predominantly female (n = 117; 58.5%) and mid-young adult (M = 25.5 years; SD = 4.1). SEM results indicated good model fit: (CMIN/df = 1.52, CFI = 0.94, RMSEA = 0.05 [90% CI = 0.03-0.07], SRMR = 0.06). Only disengaged coping mediated the ACE and substance use (ß = 0.36, p = .008), smoking (ß = 0.13, p = .004), and mental health (ß=-0.26, p = .008) relationships. Disengaged coping styles may be a critical mechanism in developing adverse mental health and substance use outcomes among ACE-exposed individuals. Future ACE and health outcomes research should examine the role of coping. Interventions focusing on adaptive coping may improve the health of individuals exposed to ACEs.

Information, Motivation, Behavioral Skills Model in Youth Newly Starting Antiretroviral Treatment.

An understanding of adherence among youth newly starting antiretroviral therapy (ART) is critical but understudied. The information-motivation-behavioral skills (IMB) model is often used to understand health behaviors, but has rarely been studied in youth with HIV. In a multi-site sample of 153 youth newly starting ART, structural equation modeling was utilized to test this model. The model was generally supported with information and behavioral skills directly related to the decision to adhere, while motivation was indirectly related through behavioral skills. Results suggest that interventions focusing on improving IMB constructs for medication adherence are important for preventing non-adherence in youth newly starting ART.

RESUMEN: El entendimiento de la adherencia en jóvenes que recién comienzan ART es fundamental, pero se ha estudiado poco. El modelo de información-motivación-habilidades conductuales (IMB, por sus siglas en inglés) se usa a menudo para comprender los comportamientos de salud, pero rara vez se ha estudiado en jóvenes que viven con el VIH. En una muestra de múltiples sitios de 153 jóvenes que recién comenzaban ART, se utilizó el análisis de ecuaciones estructurales para probar este modelo. En general, el modelo fue apoyado con información y habilidades conductuales directamente relacionadas con la decisión de adherirse, mientras que la motivación se relacionó indirectamente a través de las habilidades conductuales. Los resultados sugieren que las intervenciones que se enfocan en mejorar los aspectos del modelo IMB para la adherencia al medicamento son importantes para prevenir la falta de adherencia en los jóvenes que recién comienzan ART.

A Novel Policy Alignment and Enhancement Process to Improve Sustainment of School-Based Physical Activity Programming.

The purpose of the current study was twofold: (1) to evaluate the strength and comprehensiveness of district wellness policies in one central Michigan intermediate school district (ISD; 16 districts), and (2) to pilot a novel policy alignment and enhancement process in one district within the ISD to improve sustainment of district-wide physical activity (PA) programming. Policy evaluation and alignment were determined using WellSAT 3.0. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework was used to guide a seven-step policy alignment and enhancement process. Initial evaluation of the PA policy for the ISD revealed a strength score of 19/100 (i.e., included weak and non-specific language) and 31/100 for comprehensiveness (i.e., mentioned few components of the Comprehensive School Physical Activity Program). For the pilot school district, initial strength scores were 19/100 and 38/100 for comprehensiveness (exploration). An alignment of the tailored PA policy with current practices resulted in a 100% increase in strength (score of 38/100), and 132% increase in comprehensiveness (score of 88/100; preparation). However, district administrators encountered barriers to adopting the tailored policy and subsequently integrated the PA requirements into their curriculum guide and school improvement plan (implementation and sustainment). Future research should examine the effectiveness of our EPIS-informed policy evaluation, alignment, and enhancement process to promote widespread increases in student PA.

Perceived Hearing Impairment in a Rural Community.

CoSAGE Community Advisory and Ethics Committee; Age-related hearing impairment yields many negative outcomes, including alterations in mental health, functional impairments, and decreased social engagement. The purpose of the current study was to examine perceived hearing impairment and its relationship with person-centered outcomes among adults in a rural community setting. A cross-sectional, descriptive correlational design was used. Survey packets of validated instruments were distributed following all weekend services at a rural community church; 72 completed surveys were returned (26% response rate). Descriptive and inferential statistics, including Spearman's rank correlations (rs), were used to address the study aims. Mean age of participants was 54 years (SD = 17 years), 58% were female, and 97% attended church regularly. Thirty-one percent of respondents reported moderate to severe hearing impairment. Perceived hearing impairment was associated with more depressive symptoms (rs = 0.24, p = 0.052), poorer attentional function (rs = -0.29, p = 0.016), and decreased quality of life in the mental health domain (rs = -0.21, p = 0.081). Findings expand evidence supporting the relationship between hearing and person-centered outcomes, including a functional measure of cognition. These results serve as a foundation for the design of a community-driven, church-based hearing health intervention. [Research in Gerontological Nursing, 16(1), 21-32.].

Psychosocial Factors and Telomere Length Among Parents and Infants of Immigrant Arab American Families.

Background: Immigrant Arab American families face multiple stressors related to migration and resettlement. Telomere length (TL) is an established biomarker of aging and psychosocial stress. No published studies have concurrently examined the association between maternal and paternal psychosocial factors and infants' TL. The purpose of this study was to: (1) compare mother, father, and infant TLs; (2) explore the association of maternal and paternal psychosocial factors (acculturative stress and depressive symptoms) with maternal and paternal TL; and (3) explore the association of maternal and paternal psychosocial factors with infants' TL among Arab American immigrants. Method: Using a cross-sectional exploratory design, a sample of 52 immigrant Arab American mother-father-infant triads were recruited from community centers. Data were collected in a single home visit when the infant was 6-24 months old. Each parent completed the study questionnaires addressing their psychosocial factors (acculturative stress, and depressive symptoms), then parents and infants provided buccal cell for TL measurement. Results: Maternal TL was positively correlated to infants' TL (r = .31, p = .04) and significantly shorter (p < .001). Paternal TL was not correlated with infant TL but was significantly shorter than infant's TL (p < .001). Maternal depression was significantly correlated with mothers' TL (r = .4, p = .007). Higher levels of maternal depressive symptoms were significantly associated with shorter infant TL when controlling for background characteristics. Conclusions: Our pilot study is the first study to examine maternal and paternal psychosocial factors related to migration and infants' TL. More research is needed to advance our understanding of the effects of immigration on the intergenerational transfer of stress and trauma.

The Relationship of Adverse Childhood Experiences and Emotional Distress in Young Adults.

BACKGROUND: Emerging evidence notes increased depression, anxiety, and stress among the general population during the COVID-19 pandemic. However, little is known about populations at increased risk for emotional distress as the pandemic continues. Persons with adverse childhood experiences (ACE) are one group that may be at higher risk for emotional distress. AIM: The aim of this study is to examine whether young adults, particularly Black young adults, with histories of ACEs report more emotional distress during the pandemic than those with no ACE exposure. METHOD: Using a cross-sectional, quota sampling approach, 100 Black and 100 White young adults were recruited using online sources (e.g., University website, Facebook). Due to the pandemic, participants were screened via Zoom and, if eligible, completed a demographic questionnaire, emotional distress measures (i.e., anxiety, depression, stress), and the ACE Questionnaire online via a Qualtrics survey. Structural equation modeling (SEM) analysis examined the ACE and emotional distress relationship, and multigroup SEM assessed racial differences. RESULTS: High levels of both emotional distress and ACEs were observed. Black young adults reported significantly more ACEs than Whites. ACEs were significantly associated with each measure of emotional distress regardless of race or other covariates. CONCLUSIONS: Findings reveal that during the pandemic, persons exposed to ACEs reported greater emotional distress than those with no ACE exposure. Nurses must screen patients for both emotional distress and ACE to target those at higher risk for early intervention and initiate treatment as needed to mitigate long-term mental health consequences.

Association of maternal and paternal psychosocial stress and infant hair cortisol among Arab American immigrants: A pilot study.

Acculturative stress is unique among immigrants and refers to the stress associated with maintaining cultural values and traditions in the host country. Immigrant parents confront psychosocial variables such as acculturative stress, anxiety, and depression that might result in intergenerational negative consequences on their infants. Measurement of hair cortisol concentration (HCC), an outcome of neuroendocrine dysregulation, is one relatively noninvasive approach to gauge stress in infants. No published studies have evaluated associations among parents' psychosocial variables and infants' HCC among immigrant families. Therefore, the purpose of this study was to: (1) examine the relationship between maternal and paternal psychosocial stress variables; and (2) examine the association between psychosocial variables of both parents (acculturative stress, anxiety, and depression) and infants' HCC among immigrant Arab American families. A sample of 31 immigrant Arab American triads (mother-father-infant) was recruited. During one home visit, each parent completed the study questionnaires separately when the baby was 6-24 months old and a hair sample was collected from the infant for HCC. Parents reported significant symptoms of anxiety (33% mothers; 45% fathers) and depression (33% mothers; 35.5% fathers). Paternal acculturative stress, anxiety, and depressive symptoms were significantly correlated to infants' HCC. Acculturative stress, anxiety, and depressive symptoms were significantly correlated between mother-father dyads. Future research should continue to focus on immigrant families and include both parents to better understand and improve infant health.

Current and Cumulative Stress Experiences: A Model for Arab American Young Adults.

BACKGROUND: The effect of multiple stressors on immigrant young adults' endocrine functioning and health outcomes has not been comprehensively investigated. AIMS: This study tested a theoretical model of cumulative and current stressor effects on the hypothalamic-pituitary-adrenocortical (HPA) axis functioning and health-related quality of life (HRQL) among Arab American young adults. METHODS: Using a cross-sectional design, we recruited 160 participants, ages 18 to 24 years, from an urban university in the Midwest. Cumulative stress was assessed by self-report measures of childhood adversity, bullying victimization, and perceived ethnic discrimination. Current perceived stress was measured using the Perceived Stress Scale (PSS) while cortisol levels were measured in participants' hair. Structural equation modeling tested the effects of cumulative and current stress on cortisol and HRQL. RESULTS: Cumulative stress was negatively associated with HRQL (standardized path coefficient = -.51, p < .05). Interestingly, however, cumulative stress was inversely associated with hair cortisol level (standardized path coefficient = -.51, p < .05). Current stress was positively associated with cortisol level (standardized path coefficient = .43, p < .05) and negatively associated with the mental HRQL (standardized path coefficient < -.37, p < .05). CONCLUSION: Cumulative stress exhibited a different effect on HPA functioning from current perceived stress. Mental health was significantly impaired by both cumulative and current perceived stress. Implications for mental health nursing practice and research among Arab Americans are discussed.

Acculturative Stress and Postpartum Depressive Symptoms among Immigrant Arab American Couples.

PURPOSE: The purpose of this study was to examine the relationships between acculturative stress, perceived stress, social support, and postpartum depression (PPD) symptoms among immigrant Arab American couples. METHODS: Using a cross-sectional design, 30 Arab American immigrant couples were enrolled. During home visits, couples completed the demographic information, the Multi-Dimensional Acculturative Stress Inventory, Perceived Stress, the Multidimensional Scale of Perceived Social Support among Arab Women, and the Edinburgh Postnatal Depression Scale. Data were analyzed using bivariate linear regression and Pearson correlation. RESULTS: In bivariate regressions, paternal and maternal acculturative stress was moderately associated with maternal PPD symptoms (r = .39, and .46, respectively; p < .05). Maternal perceived stress (r = .70, P < .01) was strongly associated with PPD and maternal perceived social support was moderately associated with PPD (r = -.42, p < .05). Maternal and paternal acculturative stress was strongly correlated (r = .61, p < .001). CONCLUSION: Couple's acculturative stress and mother's perceived stress were positively associated with mother's PPD symptoms. Our findings suggest the need to develop a culturally appropriate procedure to assess couple's stress that may affect immigrant women at high risk for PPD.

Evaluating Subjective and Objective Fatigue Immediately Before and After Hemodialysis: A Within-Subjects' Design.

Change in fatigue within a hemodialysis (HD) session has not been established previously. A total of 55 cognitively intact adults on HD were included; individuals with mobility/hemodynamic issues were excluded. Measures included the Piper Fatigue Scale-12 (PFS-12), 6-Minute Walk Test (6MWT), demographic and clinical. Descriptive statistics, ANOVA, and stepwise regression were used. Mean age was 57 years. Mean change in PFS-12 was -4.56 ± 27.85. Mean change in walk distance was -16.26 ± 43.87 meters (p = 0.03). The change in the PFS-12 accounted for 47% quadratic trend in the change in 6MWD (p < 0.001). Both fatigue measures (PFS-12 and 6MWT) can be useful for examining changes in fatigue levels within an HD session. Our findings speak to the convergent validity of these two measures of fatigue.

Psychometric Analysis of the Arabic Translation of the Multidimensional Scale of Perceived Social Support.

BACKGROUND: Social support has been related to postpartum depression (PPD) among immigrant women. The Multidimensional Scale of Perceived Social Support (MSPSS) has been translated to Arabic (MSPSS-AW) but not validated among postpartum women. PURPOSE: To further replicate and refine the already existing MSPSS-AW to determine: (a) reliability and construct validity of the MSPSS-AW in immigrant Arab American postpartum women, and (b) relationship of dimensions of social support and PPD. METHODS: Using a cross-sectional design, 115 Arab American immigrant postpartum women completed demographic questionnaire, MSPSS-AW, and the Edinburgh Postnatal Depression Scale. RESULTS: Confirmatory factor analysis replicated three- factor model for social support (Family, Friends, and Husband). Internal consistency reliability coefficients for the three subscales ranged from .65 to .79. The MSPSS-AW subscales were related to PPD symptoms controlling for years of education, anxiety, and depression during pregnancy. CONCLUSION: The MSPSS-AW is reliable and valid for use with immigrant Arab American postpartum women.