Supporting healthy sleep: a qualitative assessment of adolescents with type 1 diabetes and their parents.

OBJECTIVE: Poor sleep health is common in adolescence due to a combination of physiological, psychosocial, and environmental factors. Adolescents with type 1 diabetes (T1D) may be at increased risk for poor sleep health due to physiological and behavioral aspects of diabetes and its management. This article describes a qualitative analysis of interviews with adolescents with T1D and their parents about facilitators and barriers to sleep health and family strategies to balance teens' sleep with competing demands. METHODS: Separate interviews were conducted with 20 adolescents with T1D and 20 parents. Interviews were recorded and transcribed verbatim and analyzed thematically. Participants were on average 15.8 ± 1.2 years old, 45% female, and 85% non-Hispanic White. RESULTS: Overnight diabetes management was the most frequently reported barrier to sleep. Families reported different strategies for taking responsibility of overnight diabetes management, which differentially impacted sleep. Families worked to balance diabetes management and sleep with other aspects of adolescent life, including school demands, social activities, and electronics use. Facilitators to healthy sleep identified by families included diabetes assistive technology and maintaining a consistent sleep/wake schedule. Both adolescents and parents voiced beliefs that their diabetes care team is not able to help with sleep health. CONCLUSIONS: Pediatric psychologists should be aware of the specific sleep barriers experienced by adolescents with T1D and their parents. A focus on overnight diabetes management strategies may facilitate psychologists' support of families in the adolescent's transition to independent diabetes management. Research is needed on the impact of optimizing sleep health in adolescents with T1D.

A Universal Program to Improve Mental Health among Youth from Low-Income Predominantly Minority Communities: Implementation of Advocates 4 ALL Youth (ALLY).

Disparities in mental health care and access to care disproportionately affect youth from minoritized and low-income communities. School-based prevention programs have the potential to offer a non-stigmatized approach to mental health care as well as the ability to reach many students simultaneously. Advocates 4 All Youth (ALLY) is a program developed for 5-6th grade students aimed at improving self-efficacy and resilience via individualized sessions with a trusted adult (ALLYs). The feasibility of delivering ALLY in a racially and minoritized low-income community is discussed and modifications required to implement the program documented. Students completed questionnaires and sessions with an ALLY. Aspects of program delivery deemed feasible included training ALLYs to delivery program, stakeholder buy-in regarding missing class time, and students attending the sessions. Further modifications included adjustments to materials due to lower reading level and health literacy related-educational needs. Programs designed in one demographic setting may not work in a different setting.

A call to create evidence-based mental health promotion interventions for youth that are equitable across ethnic/racial subgroups: Advocates 4-ALL Youth.

Background: Adolescents from historically racial and ethnic minoritized and low-income communities have higher rates of early-life and chronic difficulties with anxiety and depression compared to non-Hispanic White youth. With mental health distress exacerbated during and in the wake of the COVID-19 pandemic, there is a need for accessible, equitable evidence-based programs that promote psychological well-being, strengthen one's ability to adapt to adversity, and build self-efficacy prior to adolescence. Methods: An evidenced-based resiliency-focused health coaching intervention was adapted using a health equity implementation framework to meet the needs of a Title I elementary school in rural Alabama (AL) that serves over 80% Black and Hispanic students. To ensure that the program met local community needs while maintaining core program educational activities, all adaptations were documented utilizing a standard coding system. Results: Leveraging an existing academic-community partnership with Auburn University and a local AL school district, a new program, Advocates 4-All Youth (ALLY), was created. Three major adaptations were required: (1) the use of local community volunteers (ALLYs) to deliver the program versus health coaches, (2) the modification of program materials to meet the challenge of varying levels of general and health-related literacy, and (3) the integration of the Empower Action Model to target protective factors in a culturally-tailored delivery to ensure key program outcomes are found equitable for all students. Conclusion: With continued increases in youth mental health distress, there is a need for the development of universal primary prevention interventions to promote mental well-being and to strengthen protective factors among youth from historically disadvantaged backgrounds. ALLY was created to meet these needs and may be an effective strategy if deemed efficacious in improving program outcomes.

Universal, School-Based Mental Health Program Implemented Among Racially and Ethnically Diverse Youth Yields Equitable Outcomes: Building Resilience for Healthy Kids.

Although suicide is a leading cause of mortality among racial and ethnic minority youth, limited data exists regarding the impact of school-based mental health interventions on these populations, specifically. A single-arm pragmatic trial design was utilized to evaluate the equity of outcomes of the universal, school-based mental health coaching intervention, Building Resilience for Healthy Kids. All sixth-grade students at an urban middle school were invited to participate. Students attended six weekly sessions with a health coach discussing goal setting and other resilience strategies. 285 students (86%) participated with 252 (88%) completing both pre- and post-intervention surveys. Students were a mean age of 11.4 years with 55% identifying as girls, 69% as White, 13% as a racial minority, and 18% as Hispanic. Racial minority students exhibited greater improvements in personal and total resilience compared to White students, controlling for baseline scores.

The influence of stress and coping on diabetes self-care activities among college students.

OBJECTIVE: The purpose of this pilot study was to examine relationships between perceived stress, coping, and diabetes self-care activities among college students with type 1 diabetes. PARTICIPANTS: College students, self-reported as diagnosed with type 1 diabetes. METHODS: Students responded to an online self-report questionnaire (Perceived Stress Scale, Brief COPE, Summary of Diabetes Self-Care Activities). RESULTS: ANOVA analysis showed significant differences between levels of perceived stress for healthy diet and foot care. Simple linear regression analysis showed significant relationships between healthy diet and active coping, positive reframing, and planning; between exercise and humor; between blood glucose testing and active coping, planning, and acceptance; and between foot care and active coping and positive reframing. CONCLUSIONS: Our results indicate that effective stress management and coping skills will positively impact diabetes self-care. Educational programs for college students with type 1 diabetes should address self-care activities as well as psychosocial factors that affect health.

The Impact of a Universal Mental Health Intervention on Youth with Elevated Negative Affectivity: Building Resilience for Healthy Kids.

Objective: In response to the rise in mental health needs among youth, a school-based resilience intervention was implemented for sixth graders at an urban middle school. The goal of this analysis is to examine improvements in key mental health parameters among students who endorsed negative affectivity at baseline. Method: A total of 285 11-12-year-olds (72% white, 18% Hispanic, 55% female) participated in a single-arm, non-randomized 6-week 1:1 school-based coaching intervention, Healthy Kids. Youth completed validated surveys at baseline and 6-week follow-up assessing depression/anxiety symptoms, bullying, self-efficacy, academic pressure, grit, and resilience. Participants were determined to have elevated negative affectivity if they reported mild-to-severe symptoms for both depression and anxiety symptoms. General linear models examined differences between groups for each mental health parameter, as well as change in outcomes from baseline to follow-up. Results: A third of participants (38%) at baseline endorsed negative affectivity. Youth who endorsed negative affectivity were more often female (71% vs 29%; p < 0.001) and identified as victims of cyberbullying (25% vs 8%; p < 0.001). Youth with baseline negative affectivity scored lower for self-efficacy (total 70.5 vs 86.8; p < 0.0001). Baseline negative affectivity was a significant moderator for change in mental health parameters. Post-intervention, those who endorsed baseline negative affectivity, medium effect sizes were observed for self-efficacy (g = 0.6; 95%CI 0.3, 0.9; p < 0.001) and anxiety symptoms (g = - 0.70; 95%CI - 1.0, - 0.4; p < 0.001). Among all youth, there were significant medium intervention effects in resilience (g = 0.5; 95%CI 0.3, 0.7; p < 0.001) and self-efficacy (g = 0.7; 95%CI 0.4, 0.9; p < 0.001). Conclusions: A universal resiliency program may improve self-efficacy and symptoms of anxiety among youth experiencing negative affectivity, while improving resilience and self-efficacy among all youth. Our findings suggest a universal school-based coaching program benefits all youth, while also specifically targeting the needs of youth with negative affectivity who are most at risk for mental health concerns.

Longitudinal assessment of anxiety and depression symptoms in U.S. adolescents across six months of the coronavirus pandemic.

BACKGROUND: The present study aimed to describe anxiety and depression symptoms at two timepoints during the coronavirus pandemic and evaluate demographic predictors. METHODS: U.S. high school students 13-19 years old completed a self-report online survey in May 2020 and November 2020-January 2021. The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Depression and Anxiety short forms queried depression and anxiety symptoms. RESULTS: The final sample consisted of 694 participants (87% White, 67% female, 16.2 ± 1.1 years). Nearly 40% of participants reported a pre-pandemic depression diagnosis and 49% reported a pre-pandemic anxiety diagnosis. Negative affect, defined as both moderate to severe depression and anxiety PROMIS scores, was found in ~ 45% of participants at both timepoints. Female and other gender identities and higher community distress score were associated with more depression and anxiety symptoms. Depression symptoms T-score decreased slightly (- 1.3, p-value ≤ 0.001). CONCLUSION: Adolescent mental health screening and treatment should be a priority as the pandemic continues to impact the lives of youth.

A Naturalistic Actigraphic Assessment of Changes in Adolescent Sleep, Light Exposure, and Activity Before and During COVID-19.

The majority of high school-aged adolescents obtain less than the recommended amount of sleep per night, in part because of imposed early school start times. Utilizing a naturalistic design, the present study evaluated changes in objective measurements of sleep, light, and physical activity before (baseline) and during the first wave of the COVID-19 pandemic (during COVID-19) in a group of US adolescents. Sixteen adolescents (aged 15.9 ± 1.2 years, 68.8% female) wore an actigraphy monitor for 7 consecutive days during an in-person week of school before the pandemic (October 2018-February 2020) and again during the pandemic when instruction was performed virtually (May 2020). Delayed weekday sleep onset times of 1.66 ± 1.33 h (p < 0.001) and increased sleep duration of 1 ± 0.87 h (p < 0.001) were observed during COVID-19 compared with baseline. Average lux was significantly higher during COVID-19 compared with baseline (p < 0.001). Weekday physical activity parameters were not altered during COVID-19 compared with baseline, except for a delay in the midpoint of the least active 5 h (p value = 0.044). This analysis provides insight into how introducing flexibility into the traditional school schedule might influence sleep in adolescents.

Sleep Moderates Improvements in Mental Health Outcomes in Youth: Building Resilience for Healthy Kids.

PURPOSE: To examine the role of sleep in a school-based resiliency intervention. DESIGN: Single group feasibility study. SETTING: Urban middle school. SUBJECTS: Sixth grade students. INTERVENTION: A total of 285, 11-12-year-old students (70% White, 18% Hispanic, 55% female) participated in the six-week 1:1 Healthy Kids intervention. Youth (n = 248) completed electronic surveys at pre-post the 6-week study assessing mental health parameters and self-reported bed and wake time. MEASURES: Students were categorized as having insufficient sleep opportunity if they reported time in bed of <9 hours per night. ANALYSIS: General linear models examined differences between groups for each mental health parameters pre-post-study. RESULTS: A third of participants (28%) were classified as having insufficient sleep opportunity. Youth with insufficient sleep were more often Hispanic (27% vs 16%; P < .001) and were more often classified with both mild to severe depression and anxiety symptoms (55% vs 35%; P = .004). The health coaching intervention was found to have a significant improvement on overall resilience and self-efficacy only among students who reported sufficient sleep, while no significant intervention effect was found for those students who reported insufficient sleep. CONCLUSIONS: Our findings suggest that youth with poor sleep health may not benefit from school-based resiliency interventions.

Short sleep, insomnia symptoms, and evening chronotype are correlated with poorer mood and quality of life in adolescent transgender males.

OBJECTIVE: Poor sleep is common among adolescents and associated with impaired mood and health-related quality of life (HRQOL). Transgender individuals are at increased risk of mood problems hypothesized to be due to minority stress; however, no research has investigated associations between sleep and mood in this population. We aimed to examine sleep, mood, and HRQOL in transgender adolescent males. DESIGN & SETTING: Transgender males age 13-16 were recruited from a U.S. gender diversity clinic. MEASUREMENTS: Participants completed one week of home actigraphy monitoring. Questionnaires assessed insomnia symptoms, chronotype, mood, and HRQOL. Pearson correlations between sleep, mood, and HRQOL were examined. RESULTS: A total of 10 participants completed study measures during the school year. Participants obtained less than the recommended 8-10 hours of sleep per night, and half of participants endorsed insomnia symptoms. Greater insomnia symptoms were correlated with higher anxiety (P = .04) and depression (P = .04) symptoms, and poorer Psychosocial HRQOL (P = .03). Earlier weekday and weekend bed and wake times and earlier weekday sleep midpoint were associated with better Wellbeing HRQOL. No other significant correlations between sleep and mood or HRQOL variables were found. CONCLUSIONS: Anxiety and depression symptoms were associated with self-reported insomnia symptoms, while HRQOL was associated with both insomnia symptoms and objective sleep timing in this sample of adolescent transgender males. Clinicians should assess both sleep and mood symptoms in this population and future research should evaluate the impact of improved sleep and gender-affirming care on mood and HRQOL for transgender adolescents.

Project SMART: Preliminary Results From a Test of the Efficacy of a Swedish Internet-Based HIV Risk-Reduction Intervention for Men Who Have Sex With Men.

In Sweden, 57 % of HIV transmission occurs among MSM, and other sexually transmitted infections are increasing, supporting the need for innovative interventions. The Internet is a potentially useful HIV-prevention platform, but there is a lack of such programs in Sweden. The purpose of this exploratory study was to test the efficacy of the Internet-based SMART intervention to decrease HIV sexual risks in Swedish MSM. The intervention was adapted from the Wyoming Rural AIDS Prevention Project to the Swedish context, which was guided by the Information-Motivation-Behavioral (IMB) skills model and consisted of six sessions. A total of 112 men responded to a pretest questionnaire and were randomly assigned to the SMART intervention or to a waitlist group. Fifty-four men dropped out, leaving a final sample of 58 participants. Twenty-five were assigned to the SMART intervention and 33 to a waitlist group. One month post intervention, the number of casual anal sex partners significantly decreased (t = 2.19, p = .04). Compared with the waitlist group, men in the intervention group increased their HIV knowledge (ß = 0.70, p = .01), their belief of condom use as an act of responsibility (ß = 1.19, p = .04), their willingness to use a condom with every new partner all the time (ß = 1.39, p = .03), and their confidence in using condoms in challenging situations (ß = 1.65, p = .02). Condom use was not analyzed due to the small sample size. Despite the small sample, high drop-out, and short follow-up, the study provides support for the efficacy of the Internet interventions, the SMART intervention specifically, for reducing the proportion of casual anal sex partners and improving the three cognitive components of the IMB model for Swedish MSM.

The Emotional and Functional Impact of the Type of Tinnitus Sensation.

One to three percent of individuals with tinnitus experience significant reduction in quality of life. Factors that contribute to distress include personality variables, intolerance to loud noises, external locus of control, and pre-existing anxiety. Characteristics of tinnitus itself, such as perceived loudness, can also cause functional impairment. It is unknown whether different tinnitus sensations have various effects on either emotional or functional impairment, which can reduce quality of life. While audiological tests can determine pitch and loudness of tinnitus, questionnaires also can be easily used to assess subjective characteristics of tinnitus. In this study, 370 participants, recruited via email from a national tinnitus organization, completed online surveys that assessed tinnitus-related distress and provided qualitative descriptions of their tinnitus sensation. Self-reports of tinnitus sensation were rated by five independent coders, with excellent agreement. Individuals who reported a combination of tinnitus sensations were found to experience significantly more functional impairment and avoidant behavior. Future research should utilize more sophisticated approaches to categorize individuals' tinnitus sensation and to examine associated emotional and functional differences. Providers should appropriately refer patients for tinnitus management and empirically-supported therapies aimed at reducing tinnitus related distress and functional impairment.

Acceptance Mediates the Relationship Between Tinnitus-Related Cognitions and Anxiety Sensitivity.

PURPOSE: Negative cognitions related to tinnitus sensation have been previously shown to affect the level of emotional distress. Anxiety sensitivity is another psychological factor that influences individuals to more closely monitor their own bodily sensations, resulting in increased negative cognitions and negative emotional responses among tinnitus patients. However, increasing acceptance of tinnitus sensation may attenuate emotional distress. The goal of this research was to investigate the relationship between negative tinnitus-related cognitions, acceptance, and anxiety sensitivity. METHOD: Two hundred sixty-seven participants completed online measures of the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996), Acceptance and Action Questionnaire (Hayes, Follette, & Linehan, 2004), and the Anxiety Sensitivity Index-3 (Taylor et al., 2007). RESULTS: Hierarchical regression analyses indicated that acceptance fully mediated the relationship between negative tinnitus-related cognitions and anxiety sensitivity. CONCLUSIONS: On the basis of these results, it is suggested that practitioners improve acceptance of tinnitus sensation, duration, and intensity. More research is warranted on the clinical techniques to improve acceptance.

Use of the implicit association test for the measurement of tinnitus-related distress.

PURPOSE: A priming stimulus activates and increases an association with the target stimulus. The goal of this research was to investigate whether current tinnitus measures are susceptible to increased error due to priming and, if so, to examine the feasibility of using the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) for an alternative measurement of tinnitus-related distress. METHOD: Participants completed 2 tinnitus-related questionnaires and the IAT online. RESULTS: Although participants with tinnitus did not view sound-related words as significantly more negative and IAT scores did not predict scores on the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996), priming did affect negative implicit attitudes toward sound-related words. CONCLUSIONS: On the basis of these results, it is suggested that current tinnitus measures may be susceptible to priming error and that future studies should continue to pursue how the IAT can be utilized in the measure of tinnitus-related distress. Moreover, researchers should develop overt-behavioral measurements that can assess the validity of a tinnitus IAT.

Build a better mouse: directly-observed issues in computer use for adults with SMI.

Integrating information technology into healthcare has the potential to bring treatment to hard-to-reach people. Individuals with serious mental illness (SMI), however, may derive limited benefit from these advances in care because of lack of computer ownership and experience. To date, conclusions about the computer skills and attitudes of adults with SMI have been based primarily on self-report. In the current study, 28 psychiatric outpatients with co-occurring cocaine use were interviewed about their computer use and opinions, and 25 were then directly observed using task analysis and think aloud methods as they navigated a multi-component health informational website. Participants reported low rates of computer ownership and use, and negative attitudes towards computers. Self-reported computer skills were higher than demonstrated in the task analysis. However, some participants spontaneously expressed more positive attitudes and greater computer self-efficacy after navigating the website. Implications for increasing access to computer-based health information are discussed.

Sexual and geographic organisation of men who have sex with men in a large East African city: opportunities for outreach.

OBJECTIVES: To describe geographical and dispersion patterns of men who have sex with men (MSM)-related venues in a large East African city and their associations with times, participants and venue type. METHODS: Mapping of MSM sites in Dar es Salaam was carried out by community research workers who catalogued, observed and reported data on venue sites, formality, times of operation, type of participant, police or vigilante activity, length of operation and the degree to which it is known both in and outside the MSM and gay communities. RESULTS: There is a large and widely disseminated MSM/gay satellite cultures of at least 98 sites, which has some formal sites, but is largely informal and operates within mixed entertainment environments and at particular times (including some weekend-only locales) across the city. There is a mix of places for sexual contact, largely social venues and sex on location sites. Cruising appears to be limited to open spaces and parks, with no vehicular component and almost no internet component. They are widely disseminated across all suburbs and there is no central location for MSM activities. MSM sex workers (SWs) operate at a third of these sites. CONCLUSIONS: There is a large number of 'local' MSM contact, social and sex sites and any work with MSM will have to include these less-formal and less-known sites. The widely disseminated nature of the MSM sites, however, also suggests that sexual networks may not be closely linked between sites. The climate of stigma, abuse and potential violence appear to be limiting the development of more formal sites. This pattern is probably typical of other large urban areas in East Africa and perhaps across sub-Saharan Africa (SSA).

An investigation of bioecological influences associated with first use of methamphetamine in a rural state.

PURPOSE: Methamphetamine (MA) addiction is a significant problem in rural areas of the United States. Yet, little theoretically driven formative research has been conducted on the interactions of factors influencing initiation. The study was guided by Bronfenbrenner's bioecological model. METHODS: Eighty-three MA users participated in an interview. Quantitative data included sociodemographic characteristics, drug use history, and psychosocial functioning. Semistructured interviews examined MA use histories with a focus on initiation. Transcripts of the interviews were coded for 5 themes related to Bronfenbrenner's influences including individual motivation, family, peers, work or school, or community as factors influencing initiation of MA use. Five dummy variables representing the presence or absence of a mention of Bronfenbrenner's 5 influences were created from the qualitative codes and entered into a hierarchical cluster analysis. FINDINGS: The analyses revealed 4 distinct clusters: (1) predominantly female, influenced by peers and individual curiosity, (2) predominantly female, youngest age of first use, influenced by a family culture of drug use, (3) predominantly male, older age at first use, influenced by work settings and family co-workers, and (4) predominantly male, older age at first use, in the school context with a desire to increase intimacy. CONCLUSIONS: Bronfenbrenner's bioecological model was useful for classifying initiating influences and grouping individuals based on different combinations of influences. Identifying combinations of initiating factors such as work and community may facilitate tailoring of prevention programs, which may maximize efficacy and cost-effectiveness.

An assessment of brief group interventions to increase condom use by heterosexual crack smokers living with HIV infection.

The purpose of this study was to assess the efficacy of brief group interventions, the positive choices intervention (PCI) and a standard intervention (SI), to increase condom use and intention to use condoms and to change condom use attitudes and beliefs. The design of the study was a randomized comparative trial. Participants were 347 heterosexual African American crack cocaine users living with HIV infection. Data were collected at intake and at three and nine months after intake. Behavioral and sociocognitive data were collected. Although both brief interventions achieved positive results, there were significant differences in outcomes between the interventions groups. The mean number of sex partners was significantly lower in the PCI group at three months. The proportion of those assigned to the PCI reporting sex with a paid partner significantly decreased, while the proportion disclosing their serostatus to their partners increased. There were no significant differences on these measures in the SI group. Significant time effects were found on measures of condom use, condom use attitudes, and self-efficacy beliefs. These measures significantly increased from intake to one month for both groups. One significant time-by-group effect was found. The measure of situational self-efficacy significantly increased in the PCI group, but not the SI group. Results also showed significant time-by-time effects. Mean condom use, intention to use condoms, attitudes, and condom use self-efficacy beliefs showed significant difference between three and nine months. However, there was no clear pattern of change. Findings suggest that brief group interventions designed to reduce HIV can help heterosexual drug users living with HIV infection increase condom use and intention to use condoms and change condom use attitudes and beliefs. A significant time-by-group effect was observed only for situational self-efficacy, suggesting limited additional efficacy of the PCI intervention. Given similar positive findings between groups, more research is needed to determine which components of brief interventions produce changes in motivations and risk behaviors.

Sexual decision making for the "better than average" college student.

OBJECTIVES: to examine the impact of downward social comparison and the "known partner is a safe partner" heuristic on college students' sexual decisions. PARTICIPANTS: One hundred-eighty heterosexual or bisexual undergraduate college students. METHODS: participants read dating vignettes that varied on perspective and familiarity and then rated the likelihood the couple would engage in sexual intercourse and use a condom. RESULTS: there were no differences in rated likelihood based on familiarity, suggesting that the students did not view the 2 partner types as significantly different. Students rated the likelihood of sexual intercourse lower and condom use higher when the vignette was presented from the second person perspective. CONCLUSIONS: the students' use of downward social comparison is consistent with the "better than average effect," suggesting that the students perceive their own behavior as safe. The implication is that safer sex messages might be most effective if they focus on what students will gain by practicing safer sex behaviors, not just avoidance of a risk behavior.