Objective To examine the association of family organization with metabolic control in adolescents with type 1 diabetes through the mechanisms of family self-efficacy for diabetes and disease management. Method Data from the baseline assessment of a longitudinal RCT were used, wherein 257 adolescent–parent dyads (adolescents aged 11–14) each completed the family organization subscale of the Family Environment Scale, the self-efficacy for Diabetes Self-Management Scale, the Diabetes Behavior Rating Scale, and 2 24-hr diabetes interviews. Results Structural equation modeling showed greater family organization was associated indirectly with better disease management behaviors via greater family self-efficacy (β = .38, p < .001). Greater self-efficacy was indirectly associated with better metabolic control via better disease management both concurrently (β = −.37, p < .001) and prospectively (β = −.26, p < .001). The full model indicates more family organization is indirectly associated with better metabolic control concurrently and prospectively through greater self-efficacy and better disease management (β = −.13, p < .001). Conclusions Understanding the mechanisms by which family organization is associated with metabolic control provides insight into possible avenues of prevention/intervention for better diabetes management.
disease management; family organization; self-efficacy; type 1 diabetes
Objective This study examined gender differences in family, peer, partner, and mental health characteristics related to sexual experience among emotionally and behaviorally disordered students in therapeutic day schools, a population at elevated risk for negative sexual health outcomes. Methods A total of 417 13- to 20-year-old adolescents reported on their family functioning, peer and partner relationship characteristics, mental health problems, and self-reported sexual behavior. Results For boys and girls, peer influence and conduct problems predicted sexual experience, and family dysfunction was related to negative peer influence. Greater rejection sensitivity was related to less sexual experience for boys and girls. The final path model revealed indirect effects of family dysfunction on boys’ but not girls’ sexual experiences. Conclusions Findings underscore the utility of an ecological approach to understand social and personal mechanisms that increase risk and mitigate negative outcomes among emotionally and behaviorally disordered boys and girls in therapeutic day schools.
adolescents; families; mental health; peers; sexual behavior
Objective Little is known about how participation in internet-based behavioral interventions influences outcomes in youth with health conditions. This study describes participation in an online behavioral pain management intervention for families of adolescents with chronic pain. Methods 26 adolescent–parent dyads were randomized to the intervention arm of a controlled trial evaluating a cognitive–behavioral pain intervention. Participation was measured by the number of logins, messages, completion of interactive fields, and behavioral assignments. Associations between content of messages from participants and treatment outcomes were evaluated. Results Most participants (92.3%) logged in and completed assignments. Over half of participants initiated messages to the online coach. A greater number of messages sent by adolescents containing rapport or treatment content predicted positive treatment outcomes. Conclusions Most families actively participated in the intervention. Interaction with an online coach may increase the benefit of this Internet behavioral pain management treatment program for adolescents.
adolescents; chronic and recurrent pain; computer applications/ehealth; randomized controlled trial
Objective This study examined whether racial identity moderates the relation between pain and quality of life (QOL) in children with sickle cell disease (SCD). Methods 100 children 8–18 years of age with SCD participated during a regularly scheduled medical visit. Children completed questionnaires assessing pain, QOL, and regard racial identity, which evaluates racial judgments. Results Analyses revealed that regard racial identity trended toward significance in moderating the pain and physical QOL relation, (β = −0.159, t(93) = −1.821, p = 0.07), where children with low pain and high regard reported greater physical QOL than children with low pain and low regard. Regard racial identity did not moderate the relation between pain and other QOL dimensions. Pain significantly predicted all dimensions of QOL and regard racial identity significantly predicted social QOL. Conclusions Racial identity may be important to consider in future research examining QOL in children with SCD.
children; pain; quality of life; racial identity; sickle cell disease
Objective This study examined whether emotional processing (understanding emotions), self-control (regulation of thoughts, emotions, and behavior), and their interaction predicted HbA1c for adolescents with type 1 diabetes over and above diabetes-specific constructs. Methods Self-report measures of self-control, emotional processing, self-efficacy for diabetes management, diabetes-specific negative affect, and adherence, and HbA1c from medical records were obtained from 137 adolescents with type 1 diabetes (M age = 13.48 years). Results Emotional processing interacted with self-control to predict HbA1c, such that when adolescents had both low emotional processing and low self-control, HbA1c was poorest. Also, both high emotional processing and self-control buffered negative effects of low capacity in the other in relation to HbA1c. The interaction of emotional processing × self-control predicted HbA1c over diabetes-specific self-efficacy, negative affect, and adherence. Conclusions These findings suggest the importance of emotional processing and self-control for health outcomes in adolescents with diabetes.
adolescence; diabetes management; emotional processing; self-control; self-regulation
Objective To examine orphan status, mental health, social support, and HIV risk among adolescents in rural Kenya. Methods Randomly selected adolescents aged 10–18 years completed surveys assessing sexual activity, sex-related beliefs and self-efficacy, mental health, social support, caregiver–child communication, time since parental death, and economic resources. Analysis of covariance and regression analyses compared orphans and nonorphans; orphan status was tested as a moderator between well-being and HIV risk. Results Orphans reported poorer mental health, less social support, and fewer material resources. They did not differ from nonorphans on HIV risk indicators. Longer time since parental death was associated with poorer outcomes. In moderator analyses, emotional problems and poorer caregiver–youth communication were more strongly associated with lower sex-related self-efficacy for orphans. Conclusions Orphans are at higher risk for psychosocial problems. These problems may affect orphans’ self-efficacy for safer sex practices more than nonorphans. Decreased HIV risk could be one benefit of psychosocial interventions for orphans.
adolescents; developmental outcomes; economic support; HIV; internalizing symptoms; Kenya; mental health; orphans; social support; traumatic stress
Objective To compare Hispanic and non-Hispanic White mothers and fathers of children with spina bifida on measures of individual adjustment, parental functioning, and perceived social support. Method Mothers (29 Hispanic, 79 non-Hispanic White) and fathers (26 Hispanic, 68 non-Hispanic White) completed questionnaires regarding psychological distress, parental functioning, and perceived social support. Results Mothers and fathers reported similar individual adjustment across groups. Hispanic mothers reported lower levels of parenting satisfaction, competence as a parent, and social support, as well as higher perceptions of child vulnerability. Hispanic fathers reported lower levels of parenting satisfaction and higher perceptions of child vulnerability. Effect sizes were reduced when socioeconomic status was included as a covariate. Conclusions Hispanic parents, particularly mothers, are at risk for lower feelings of satisfaction and competence as parents. More research is needed to understand cultural factors related to these differences.
Hispanic; parental adjustment; parenting stress; social support; spina bifida
Objectives Mild traumatic brain injury (TBI) and injury-related outcomes such as postconcussive symptoms (PCS) may influence health-related quality of life (HRQOL) in children. Methods We evaluated HRQOL in 186 8- to 15-year-old children with mild TBI and 99 children with orthopedic injuries (OI). Parents rated the frequency and severity of PCS at an initial assessment within 2-weeks postinjury and rated HRQOL at 3- and 12-months postinjury. Results The mild TBI and OI groups did not differ in psychosocial HRQOL, but the mild TBI group showed lower physical HRQOL at the 12-month follow-up. Somatic PCS were a significant predictor of physical HRQOL over time, and both cognitive and somatic PCS were significant predictors of psychosocial HRQOL over time. Children with higher PCS at the initial assessment had lower HRQOL scores at later time points. Conclusions Effective management of PCS may be associated with improvements in HRQOL following pediatric mild TBI.
brain injuries; child; postconcussive symptoms; quality of life
Objective This descriptive cross-sectional study aimed to determine how cognitive, disease, and environmental variables relate to social–emotional functioning in youth with NF1 and plexiform neurofibromas. Methods Psychological assessments were administered to 53 children (mean age 12.4 years); parents and teachers completed the Behavior Assessment System for Children—Second Edition (BASC-2). Disease severity was quantified by nurse–practitioner ratings and tumor burden, and parents completed a life events checklist to indicate environmental stressors. Results Notable proportions of children scored in the at-risk/clinically significant ranges on several parent and teacher BASC-2 subscales including Somatization, Attention Problems, Depression, and Withdrawal. Combinations of cognitive, disease, and environmental variables predicted scores on parent BASC-2 Internalizing Problems, Behavior Symptoms Index, and Adaptive Skills composites. Conclusions Cognitive, disease, and environmental variables relate to social–emotional outcomes in children with NF1. These youth may benefit from interventions targeting social skills, cognitive functioning, and adaptive ways of coping with NF1-related pain.
chronic illness; psychosocial functioning; social skills and development
Objective To determine if caregiver report of the Pediatric Quality of Life Inventory (PedsQL) is responsive to changes in health-related quality of life (HRQL) associated with pain episodes in pediatric sickle cell disease (SCD). Methods 81 caregivers of children ages 2–19 years with SCD completed the PedsQL as part of routine psychosocial screenings at 2 time points, ranging from 6 to 18 months apart. Frequency of SCD-related pain episodes between time points was assessed using medical chart review. Results The frequency of pain episodes between time points was a significant predictor of decreases in physical, psychosocial, and total HRQL, even after controlling for time interval, demographic, and medical variables. Conclusions The caregiver report of the PedsQL appears to be a useful tool for capturing changes in HRQL over time associated with pain episodes in SCD.
pain; quality of life; sickle cell disease
Objective A longitudinal comparison of adolescent girls with and without spina bifida (SB), regarding the effects of early pubertal timing on girls’ depressive symptoms, mother–daughter conflict, and emotional distancing. Methods 62 mother–daughter dyads (31 with SB and 31 without) reported on psychosocial outcomes at 5 time points (ages 8/9 to 16/17 years). Results A pubertal timing × SB status interaction predicted emotional distancing (T2), conflict (T2, T5), and depressive symptoms (T4), such that early maturing girls without SB reported the greatest increase in each outcome. Main effects of pubertal timing predicted emotional distancing (T4), conflict (T4), and depressive symptoms (T2, T3, T5). Findings were not always consistent across reporters, assessments of pubertal timing, and time-points. Conclusions Although early maturing girls in both groups may experience greater psychosocial difficulties, early maturing girls without SB may be most at-risk. The somewhat reduced impact of early pubertal timing in girls with SB is discussed.
adolescents; family functioning; longitudinal research; spina bifida
Objective We initiated a prospective study of very young children with cancer, in comparison with matched healthy children, to investigate neurodevelopmental consequences of non-CNS cancers and treatment. Methods A total of 61 children (≤42 months) with non-CNS cancers and 61 matched controls underwent an identical age-appropriate neuropsychological test battery. Results Children with cancer manifested deficits compared to healthy controls in motor, mental, and language development, but were similar to controls in cognitive representational abilities and emotional relationships in interaction with their mothers. Better physician-rated health status at diagnosis and mother-rated behavioral status 1 month prior to assessment were associated with better motor and mental performance in the cancer group. Conclusions This study identifies deficits as well as spared functions in children with non-CNS cancers; the results suggest ways parents and healthcare professionals may plan specific remediations to enhance quality of life in young cancer survivors.
childhood cancer; cognitive behavior; growth and development; pediatric psychology; social behavior
Objective Data suggest parents’ preprocedural anxiety is related to children's acute procedural anxiety and pain. This study examined the temporal relations among these constructs to determine whether children's anxiety mediates the relation between parents' anticipatory anxiety and children's procedural pain. Methods A total of 90 preschoolers receiving immunizations, their parents, and the nurses rated children's procedural anxiety and pain. Parents provided ratings of their own preprocedural anxiety. Results Bootstrapping analyses revealed that children's procedural anxiety mediated the relation between parents' preprocedural anxiety and children's procedural pain according to parents' report and nurses’ report but not children's self-report of anxiety and pain. Conclusions Analyses suggest that children's procedural anxiety mediates the relation between parents' anticipatory anxiety and children's procedural pain. Thus, targeting parents’ preprocedural anxiety might be beneficial to the parents as well as the children undergoing a distressing medical procedure.
anxiety; children; pain; parents
Objective The objective of this investigation was to examine how variation in adolescent physical activity is related to smoking and alternative tobacco use. Methods Adolescents (N = 1,384) completed a self-report survey every 6 months from ages 14- to 18-years old in a prospective study of health behaviors. The 8 waves of data were analyzed using General Growth Mixture Modeling (GGMM) Results GGMM identified five physical activity trajectories including stable higher (SHPA), decreased (DPA), stable regular (SRPA), curvilinear (CPA), and stable low (SLPA). Across 4 years, the likelihood of smoking was greater among adolescents in the DPA, SLPA and SRPA trajectories compared to adolescents belonging to the SHPA trajectory. Alternative tobacco use was greatest among adolescents in the DPA and SRPA trajectories. Conclusions Adolescents with decreasing physical activity and even adolescents averaging an hour of physical activity a day (SRPA) are important groups to target for tobacco use prevention and intervention efforts.
adolescent; alternative tobacco; physical activity; smoking
Objective To chart mothers’ trajectories of mental health from pregnancy to 36 months postpartum in order to investigate the association between infants’ congenital heart defects (CHD) and compromised maternal mental health. Methods Mothers of infants with mild, moderate, or severe CHD (n = 141) and mothers (n = 36,437) enrolled in the Norwegian Mother and Child Cohort Study were assessed at regular intervals from pregnancy up to 36 months postpartum, including measurements at 6 and 18 months, using an 8-item version of the Hopkins Symptom Checklist-25. Results Mean score trajectories of SCL-8 for mothers of infants with severe CHD deviated significantly from cohort controls 6, 18, and 36 months postpartum, indicating heightened symptoms of depression and anxiety. Conclusions Mothers of infants with severe CHD are at risk of compromised mental health from delivery to 36 months postpartum. Strain due to CHD-related interventions is identified as a possible partial mediator of the distress.
anxiety; critically ill children; depression; longitudinal research; parent stress
Objective To report the prevalence and comparison of cancer-linked health behaviors and identify risk factors associated with unhealthy behavior among adolescent siblings and cancer survivors. Methods The Child Health and Illness Profile—Adolescent Edition (CHIP—AE) was completed by 307 survivors and 97 sibling controls 14–20 years of age. Results Risky behavior ranged from 0.7% to 35.8% for survivors and 1.0% to 41.2% for siblings. Comparisons of sexual behavior, tobacco, alcohol, or illicit drug use utilizing continuous data revealed no differences between groups. Categorically, survivors were less likely to report past smokeless tobacco use or current use of beer/wine or binge drinking (p-values range from .01 to .04). Survivors with better mental health were at lower risk for poor behavioral outcomes. Conclusions Adolescent survivors engage in risky health behaviors at rates generally equivalent to their siblings. Aggressive health education efforts should be directed toward this high-risk population.
adolescents; childhood cancer; risky health behavior; survivors
Objective To examine genetic and environmental contributions to stability and change in sleep problems (SP) in early childhood. Methods The sample comprised over 300 twin pairs assessed at ages 2 and 3 years. Parents rated SP on the Sleep Problems subscale of the Child Behavior Checklist for ages 1.5–5 years. Results Longitudinal quantitative genetic analyses indicated that SP were genetically influenced at both ages. The stability of SP from ages 2 to 3 years was largely due to genetic factors common to both ages. Nonshared environmental influences displayed modest continuity across age. New genetic and nonshared environmental factors emerged at age 3 years. Conclusions Genetic factors contribute to the stability in SP, whereas change is due to both genetic and nonshared environmental influences. Early interventions on SP and individualized treatments based on children’s unique environmental experiences may be fruitful.
development; heritability; sleep problems; toddlerhood; twins
Objective To demonstrate the use of the actor–partner interdependence model (APIM) of dyadic relationships in a sample of children with cystic fibrosis (CF) and their caregivers. Methods Multilevel modeling evaluated relations between health-related quality of life (HRQOL) and anxiety in 29 child–caregiver dyads. The following effects were evaluated: actor and partner, and the respondent (i.e., child or caregiver) × HRQOL interaction. Results This study demonstrated a practical application of the APIM. Significant actor effects were found (i.e., lower child HRQOL was associated with increased child anxiety, caregiver anxiety increased as caregiver perceptions of their child's HRQOL decreased), but not partner effects. The significant interaction indicated that the effects were different for children and caregivers. Conclusions The APIM has the potential to increase pediatric researchers’ understanding of how social relationships and environments impact health outcomes. Future research should consider using dyadic data analysis when youth and caregiver data are available.
anxiety; cystic fibrosis; quality of life; statistical applications
Objective To characterize caregiver stress (CS) in parents of children with Eosinophilic Gastrointestinal Disorders (EGIDs) and understand relationships with psychological functioning and child behavior. Methods Caregivers with a child (0–17 years) with EGID completed questionnaires for demographics, EGID severity, treatments, CS, psychological distress, self-efficacy, and child behaviors. Results A total of 163 caregivers (98% mother, 94% Caucasian) participated. CS correlated with psychological distress, income, child behavioral problems, treatments, and disease severity. Children were rated higher than age-specific norms for emotional difficulties. Behavioral difficulties associated with gender, age, EGID severity, and duration. Parent psychological distress was most strongly associated with CS. Parental self-efficacy, dietary treatments, and child emotional difficulties were also related to stress. Conclusions Mothers reported stress and psychological distress from caring for a child with EGID. The relationship between these variables suggests these parents may benefit from supportive psychotherapy interventions. Evaluation of parental self-efficacy and child behavior is also warranted.
child behavior; eosinophilic gastrointestinal disorders; parental caregiver stress; psychological functioning