Facilitating the Virtual Exercise Games for Youth with T1D (ExerT1D) Peer Intervention: Protocol Development and Feasibility.

Background: Barriers to moderate-to-vigorous physical activity (MVPA) for adolescents with type 1 diabetes (T1D) include physiology, transition to autonomy, and diabetes-specific stigma. Opportunities for T1D peer activities with T1D role model support are limited. To address this need, our single-arm pilot study tested the Home-based Virtual Activity Program for Youth with T1D (HAP-V-T1D) for feasibility. Methods: Participants (n=15) were mean age 15.6 [SD 1.5] years, 7 non-Hispanic white, 6 female, 2 non-binary, mean A1c 8.9%±2.2%. The program included an MVPA videogame, physician-led education regarding managing T1D around MVPA, objective habitual MVPA goal-setting , and T1D management skills guided by young adult instructors living with T1D. Results: For feasibility, 13/15 participants attended 10/12 sessions. Participants' perceptions of the program, comfort, instructors, and group cohesion were rated high/very high (4.2±0.5 to 4.8±0.3 out of 5).Motivation for the videogame was also high (4.1±0.4 out of 5). Instructor-adolescent interactions related to building T1D management skills were rated as excellent for 78% of sessions. Similarly, sharing knowledge and experiences were rated as excellent for 68% of sessions. However, adolescent-adolescent interactions were poor (communication 29% excellent, peer interactions 8% excellent). The most reported barriers to participation were negative mood and oversleeping. No participants experienced diabetic ketoacidosis, severe hypoglycemia, or injuries during the study period. Compared to baseline, glycemic metrics appeared to decrease during and post intervention (d= -0.72, -1.12). Conclusion: HAP-V-T1D facilitated unprecedented T1D peer support achievements by engaging diverse youth with T1D in an MVPA program led by T1D role models. Larger studies are needed to assess if this intervention can improve glycemic measures and reduce diabetes-specific stigma.

Symptom complaints and impact on functioning in youth with hypermobile Ehlers-Danlos syndrome.

Hypermobile Ehlers-Danlos syndrome (hEDS), a genetic connective tissue disorder, involves several body systems which makes symptom management and functioning difficult. The aim of this study was to understand pediatric hEDS patients' symptoms and primary complaints. Additionally, we examined the cumulative impact of symptoms on physical and psychological functioning. Thirty-four youth with hEDS were recruited from a genetics clinic and reported the hardest thing about having hEDS, their pain, fatigue, physical symptoms, functional disability, anxiety, and depression. Physical symptoms (pain and fatigue) and limitations (keeping up with friends) were reported as the most difficult parts of having hEDS. A higher number of somatic symptoms was the strongest predictor of disability, anxiety, and depression. Physical symptoms are subjectively distressing and significantly related to impairments in physical and psychological functioning. Thus, addressing these varied symptoms in treatment may yield better functioning in youth with hEDS.

Environmental stress and socioeconomic status: Does parent and adolescent stress influence executive functioning in urban youth?

This study examined whether parental and adolescent stress act as mediators between socio-economic status (SES) and adolescent executive functioning (EF) in urban youth. Two hundred and sixty-seven 6th-11th grade students (ages 11-16, 55.4% female; 49.1% Black/African American) attending racially and socioeconomically diverse schools in Chicago, Illinois, completed self-report measures on urban stress and EF. Parents of adolescents completed measures on parental chronic stress and demographic information on the family's socioeconomic status. Results indicated that parent stress was directly related to adolescent stress, while adolescent stress was directly related to behavior components of EF (i.e., emotion control, set shifting, and inhibition). Although parental stress was related to adolescent's ability to shift from one task to another, no relationship was found with adolescent's ability to modulate mood or delay impulsive behaviors. Implications for socio-ecological mental health interventions for youth residing in urban environments are discussed.

Predicting Depressive Symptoms and Weight from Adolescence to Adulthood: Stressors and the Role of Protective Factors.

Depressive symptoms and weight gain follow similar developmental trajectories from adolescence to adulthood and stressors are a risk factor for both. However, less is known about whether they share protective factors that reduce the risk for depressive symptoms and weight gain. The goal of the current study was to examine the role of stress and four protective factors (social support, self-esteem, physical activity, and sedentary behavior) as predictors of depressive symptoms and body mass index over time. Participating in the current study were 6504 (51.6 % female; 60.7 % European American, 22.5 % African American, 11.4 % Hispanic, 3.3 % Asian American, and 2 % other ethnicities) adolescents from the National Study of Adolescent and Adult Health. Participants were followed for three waves from adolescence to young adulthood (Wave I age range = 12-18; Wave III age range = 18-26). Data were analyzed using multi-level modeling and results showed that stressors significantly predicted trajectories of depressive symptoms and body mass index over time. Social support buffered the effects of stressors on BMI over time. Self-esteem influenced trajectories of both BMI and depressive symptoms. Differential effects were found for physical activity with physical activity predicting declines in depressive symptoms and sedentary behavior predicting declines in BMI over time. The current study suggests that stress is a common risk factor for depressive symptoms and weight gain, but that there is specificity in how the protective factors influence each type of outcome.