Objective

To evaluate the contribution of neighborhood characteristics to treatment adherence and glycemic control in late adolescents with Type 1 diabetes.

Research design and methods

As part of a larger study, 220 late adolescents with Type 1 diabetes (aged 17.8 ± 0.4 years, 59.6% female, diabetes duration 7.3 ± 3.9 years) were recruited from outpatient pediatric clinics during their senior year of high school. Adolescents completed self-report measures of adherence behaviors and subjective social status, and their HbA1c values were collected during a lab assessment. Their mothers reported on their own educational achievement. These data were linked with neighborhood characteristics obtained from 2010 American Community Survey data using participants' home addresses. Based on previous work (Dulin-Keita et al., 2012), a neighborhood disorder composite score was computed from Census-tract-level variables, including percent of the population achieving less than a high school education, under 18 who lived in poverty, unemployed, receiving public assistance, and percent of households that were vacant.

Results

- Adolescents with Type 1 diabetes who lived in more disordered neighborhoods were at higher risk for poorer glycemic control (p < .001), but did not report poorer adherence behaviors. The association between neighborhood disorder and HbA1c was significant after accounting for family socioeconomic status (maternal education), but not subjective social status.

Conclusions

- Results highlight the importance of neighborhood disorder for adolescents' glycemic control. The nonsignificant association between neighborhood disorder and adherence behaviors suggests physiological rather than behavioral mechanisms may be driving neighborhood SES-health outcome links.

Objective

To examine whether depressive symptoms are associated with greater perceived daily stress and moderate the link between stress severity and poorer daily adherence in late adolescents with Type 1 diabetes (T1D).

Method

175 late adolescents with T1D completed measures of depressive symptoms and glycemic control during a baseline laboratory assessment. This assessment was followed by a 14-day daily diary during which adolescents rated the severity of general (GS) and diabetes-specific (DSS) stressful events, as well as adherence to their diabetes regimen.

Results

Multilevel modeling revealed that adolescents with more depressive symptoms reported more severe daily stress and poorer daily adherence on average, and had poorer glycemic control. On days with more severe DSS, but not GS, adolescents reported poorer adherence. This association was moderated by an interaction between depressive symptoms and the mean level of DSS severity experienced across the 2-week diary. In adolescents with low levels of depressive symptoms, poorer adherence was reported on days with more severe DSS across all levels of mean DSS severity. In adolescents with average or high levels of depressive symptoms, poorer adherence was reported on days with more severe DSS only when mean DSS severity was average or high.

Conclusions

Depressive symptoms are associated with poorer daily adherence and greater stress severity, and interact with mean DSS severity to moderate the link between daily stress and adherence. The results point to the importance of depressive symptoms for understanding associations between stress and adherence during late adolescence.

OBJECTIVE: To examine how adolescents’ daily disclosure to parents about type 1 diabetes management may foster a process whereby parents gain knowledge and are viewed as helpful in ways that may aid diabetes management. METHODS: A total of 236 late adolescents (M age = 17.76) completed a 14-day diary where they reported daily disclosure to, and solicitation from, their parents, how knowledgeable and helpful parents were, and their self-regulation failures and adherence; blood glucose was gathered from meters. RESULTS: Multilevel models revealed that adolescent disclosure occurred in the context of greater parent solicitation and face-to-face contact and was positively associated with adolescents’ perceptions of parental knowledge and helpfulness. Disclosure to mothers (but not to fathers) was associated with better diabetes management (fewer self-regulation failures, better adherence). CONCLUSIONS: Adolescent disclosure may be an important way that parents remain knowledgeable about diabetes management and provide assistance that serves to support diabetes management.

Successfully managing Type 1 diabetes involves adherence to a complex daily medical regimen, requiring self-regulatory skills that rely on neurocognitive processes known as executive functioning (EF). Adolescents with poorer rated EF abilities display poorer diabetes outcomes. The purpose of this study was to examine the relationship of EF questionnaire and performance measures with adherence and glycemic control, after controlling for IQ and general questionnaire response style. Adolescents with Type 1 diabetes (M age = 17.74, SD = .38 years) and their mothers (N = 196) completed a self/mother-report questionnaire assessing adolescents' ratings of EF abilities (Behavior Rating Inventory of Executive Functioning-Self-Report). Adolescents also completed performance-based tests of EF (Delis-Kaplan Executive Function System) and intellectual functioning (Wechsler Adult Intelligence Scale, 4th ed., Vocabulary). Adherence was indexed via 2 self-report inventories and the number of daily blood glucose checks, and glycemic control via HbA1c obtained from assay kits. Self/mother-reports of EF ability were associated with self/mother-reported adherence. Both questionnaire and performance-based measures of EF were associated with glycemic control. However, once IQ was taken into consideration, performance-based EF was no longer associated with glycemic control; IQ independently shared variance with glycemic control. Our findings suggest that self-reports of EF may be useful in identifying late adolescents who need assistance in managing diabetes in daily life. The finding that performance-based EF measures were not related to glycemic control independent of underlying intellectual capacity raises questions about the specific role of EF in diabetes outcomes. (PsycINFO Database Record

OBJECTIVE : To examine how adolescents' daily disclosure to parents about type 1 diabetes management may foster a process whereby parents gain knowledge and are viewed as helpful in ways that may aid diabetes management.  METHODS:  A total of 236 late adolescents (M age = 17.76) completed a 14-day diary where they reported daily disclosure to, and solicitation from, their parents, how knowledgeable and helpful parents were, and their self-regulation failures and adherence; blood glucose was gathered from meters.  RESULTS:  Multilevel models revealed that adolescent disclosure occurred in the context of greater parent solicitation and face-to-face contact and was positively associated with adolescents' perceptions of parental knowledge and helpfulness. Disclosure to mothers (but not to fathers) was associated with better diabetes management (fewer self-regulation failures, better adherence).  CONCLUSIONS:  Adolescent disclosure may be an important way that parents remain knowledgeable about diabetes management and provide assistance that serves to support diabetes management.

Objective

To examine how adolescents’ daily disclosure to parents about type 1 diabetes management may foster a process whereby parents gain knowledge and are viewed as helpful in ways that may aid diabetes management.

Methods

A total of 236 late adolescents (M age = 17.76) completed a 14-day diary where they reported daily disclosure to, and solicitation from, their parents, how knowledgeable and helpful parents were, and their self-regulation failures and adherence; blood glucose was gathered from meters.

Results

Multilevel models revealed that adolescent disclosure occurred in the context of greater parent solicitation and face-to-face contact and was positively associated with adolescents’ perceptions of parental knowledge and helpfulness. Disclosure to mothers (but not to fathers) was associated with better diabetes management (fewer self-regulation failures, better adherence).

Conclusions

Adolescent disclosure may be an important way that parents remain knowledgeable about diabetes management and provide assistance that serves to support diabetes management.