The Role of Authoritative Parenting in Adolescent Type 1 Diabetes Management.

Objective: Adolescents with Type 1 diabetes are at risk for poorer adherence, lower quality of life (QOL), and poorer glycemic control (HbA1c). Authoritative parenting (AP) along with youth adherence and QOL was hypothesized to relate to better HbA1c. Methods: Parent-youth dyads (N = 257) completed baseline measures of adherence and QOL. Youth completed an AP questionnaire, and HbA1c samples were evaluated. Structural equation modeling determined relations among AP, adherence, QOL, and glycemic control. Results: AP indirectly linked to better HbA1c (ß = -.15, p = .021) through both better adherence and higher QOL. AP also was associated directly with better adherence (ß = .26, p = .001), which in turn was linked to better HbA1c (ß = -.35, p = .021). In addition, adherence was associated directly with QOL (ß = -.56, p = .001). Conclusions: Together, better youth adherence and higher QOL are two mechanisms by which more AP indirectly relates to better glycemic control during the early adolescent years.

Dysfunctional personality disorder beliefs and lifetime suicide attempts among psychiatrically hospitalized military personnel.

BACKGROUND: Personality disorders (PDs) are associated with an increased risk for suicide. However, the association between PDs and suicide risk has not been examined among military personnel. This study evaluated whether endorsement of different PD dysfunctional beliefs was associated with lifetime suicide attempt status. METHODS AND MATERIALS: Cross-sectional data were collected during the baseline phase of a randomized controlled trial, evaluating the efficacy of an inpatient cognitive behavior therapy protocol for the prevention of suicide. Participants (N = 185) were military service members admitted for inpatient psychiatric care following a suicide-related event. MANOVA and Poisson regression evaluated the association between each type of PD dysfunctional belief and the number of suicide attempts. RESULTS: Service members' PBQ subscale scores for borderline (p = 0.049) and histrionic PD dysfunctional beliefs (p = 0.034) significantly differed across those with suicide ideation only, single attempt, and multiple attempts. Upon further analysis, histrionic PD dysfunctional beliefs scores were significantly higher among those with multiple suicide attempts than those with single attempts. One point increase of dependent (Incidence Risk Ratio = 1.04, p = 0.009), narcissistic (IRR = 1.07, p < 0.001), and paranoid PD dysfunctional beliefs (IRR = 1.04, p = 0.002) was associated with a greater number of lifetime suicide attempts. CONCLUSIONS: Assessment and targeting dependent, narcissistic, paranoid, borderline, and histrionic beliefs as part of a psychosocial intervention will be useful.

Are residents of mountain-top mining counties more likely to have infants with birth defects? The West Virginia experience.

BACKGROUND: Pooled 1996 to 2003 birth certificate data for four central states in Appalachia indicated higher rates of infants with birth defects born to residents of counties with mountain-top mining (MTM) than born to residents of non-mining-counties (Ahern 2011). However, those analyses did not consider sources of uncertainty such as unbalanced distributions or quality of data. Quality issues have been a continuing problem with birth certificate analyses. We used 1990 to 2009 live birth certificate data for West Virginia to reassess this hypothesis. METHODS: Forty-four hospitals contributed 98% of the MTM-county births and 95% of the non-mining-county births, of which six had more than 1000 births from both MTM and nonmining counties. Adjusted and stratified prevalence rate ratios (PRRs) were computed both by using Poisson regression and Mantel-Haenszel analysis. RESULTS: Unbalanced distribution of hospital births was observed by mining groups. The prevalence rate of infants with reported birth defects, higher in MTM-counties (0.021) than in non-mining-counties (0.015), yielded a significant crude PRR (cPRR = 1.43; 95% confidence interval [CI] = 1.36-1.52) but a nonsignificant hospital-adjusted PRR (adjPRR = 1.08; 95% CI = 0.97-1.20; p = 0.16) for the 44 hospitals. So did the six hospital data analysis ([cPRR = 2.39; 95% CI = 2.15-2.65] and [adjPRR = 1.01; 95% CI, 0.89-1.14; p = 0.87]). CONCLUSION: No increased risk of birth defects was observed for births from MTM-counties after adjustment for, or stratification by, hospital of birth. These results have consistently demonstrated that the reported association between birth defect rates and MTM coal mining was a consequence of data heterogeneity. The data do not demonstrate evidence of a "Mountain-top Mining" effect on the prevalence of infants with reported birth defects in WV.

Family Density and SES Related to Diabetes Management and Glycemic Control in Adolescents With Type 1 Diabetes.

OBJECTIVE: Youth with Type 1 diabetes (T1D) from single-parent families have poorer glycemic control; a finding confounded with socioeconomic status (SES). Family density (FD), or youth:adult ratio, may better characterize family risk status. METHODS: Structural equation modeling assessed the relation of single-parent status, SES, and FD to parenting stress, diabetes-related conflict, parental monitoring, adherence, and glycemic control using cross-sectional parent and youth data (n = 257). RESULTS: Single-parent status exhibited similar relations as SES and was removed. Lower FD was associated with better glycemic control (ß = -.29, p = .014) via less conflict (ß = .17, p = .038) and greater adherence (ß = -.54, p < .001). CONCLUSIONS: Beyond SES, FD plays a significant role in adherence and glycemic control via diabetes-related conflict. In contrast, the effects of single-parent status were indistinguishable from those of SES. FD provides distinct information related to adolescent glycemic control.

Bladder/lung cancer mortality in Blackfoot-disease (BFD)-endemic area villages with low (<150 µg/L) well water arsenic levels--an exploration of the dose-response Poisson analysis.

OBJECTIVE: To examine the analytic role of arsenic exposure on cancer mortality among the low-dose (well water arsenic level <150 µg/L) villages in the Blackfoot-disease (BFD) endemic area of southwest Taiwan and with respect to the southwest regional data. METHOD: Poisson analyses of the bladder and lung cancer deaths with respect to arsenic exposure (µg/kg/day) for the low-dose (<150 µg/L) villages with exposure defined by the village median, mean, or maximum and with or without regional data. RESULTS: Use of the village median well water arsenic level as the exposure metric introduced misclassification bias by including villages with levels >500 µg/L, but use of the village mean or the maximum did not. Poisson analyses using mean or maximum arsenic levels showed significant negative cancer slope factors for models of bladder cancers and of bladder and lung cancers combined. Inclusion of the southwest Taiwan regional data did not change the findings when the model contained an explanatory variable for non-arsenic differences. A positive slope could only be generated by including the comparison population as a separate data point with the assumption of zero arsenic exposure from drinking water and eliminating the variable for non-arsenic risk factors. CONCLUSION: The cancer rates are higher among the low-dose (<150 µg/L) villages in the BFD area than in the southwest Taiwan region. However, among the low-dose villages in the BFD area, cancer risks suggest a negative association with well water arsenic levels. Positive differences from regional data seem attributable to non-arsenic ecological factors.

Family and youth factors associated with health beliefs and health outcomes in youth with type 1 diabetes.

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 (ß = .38, p < .001). Greater self-efficacy was indirectly associated with better metabolic control via better disease management both concurrently (ß = -.37, p < .001) and prospectively (ß = -.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 (ß = -.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.

The retention of recalled United States Navy nurse reservists.

The purpose of this study was to identify factors that contribute to the retention of United States Navy Nurse Corps reservists called to duty in 2003. Data were collected by questionnaires based on Price and Mueller's causal model of voluntary turnover and were analyzed via descriptive statistics, multiple regression analysis, exploratory factor analysis, and structural equation modeling. The data indicate that the model fits the data well, with job satisfaction having the strongest influence on one's intent to stay in the Reserve. The data analyses did not support the concern that a negative experience with a recall could make a reservist resign his/her commission. The results may prove useful to any nation that relies on a volunteer reserve force to augment its day-to-day nursing capabilities.

Maternal tobacco use: A third-trimester risk factor for small-for-gestational-age pregnancy outcome.

BACKGROUND: Small for gestational age (SGA) is a well-known consequence of maternal smoking. Here, we newly examine the magnitude of SGA risk by week of gestational age. METHODS: Singleton live births (N = 3,032,928) with recorded birth weight, gestational age (22-44 weeks), and maternal tobacco use (Y/N) were categorized as to SGA (Y/N), based on 10th percentile gender-specific weights-for-age. RESULTS: SGA prevalence among tobacco users (19.5%) and non-users (9.1%) yielded a significant SGA prevalence rate ratio of 2.15 (2.13-2.16) and a significant adjusted odds ratio of 2.36 (2.34-2.38). The tobacco non-users' rate was steadily near 9% across the week 22-44 gestational age range. The tobacco users' rate was steady until week 33 when it rose monotonically through week 37 to about 20% at week 38 and remained high. This pattern for SGA by gestational week was similar for prevalence rates and adjusted ORs. Tobacco use only through week 33 was not seen to be an SGA risk factor. The magnitude of tobacco use as an SGA risk factor for late third trimester births increased during the period of preterm birth and became fully evident with a two-fold risk for full term infants. CONCLUSION: We newly report the temporal pattern of tobacco-related SGA by week of gestational age. Tobacco-related SGA was only seen for late third trimester births - increasing during weeks 33-37 with a doubling during weeks 38-44. This pattern, informative for issues of mechanism, highlights the potential benefit of extending tobacco cessation programs through the third trimester of pregnancy.

Collaborative involvement of primary and secondary caregivers: associations with youths' diabetes outcomes.

OBJECTIVE: Collaboration between youths with type 1 diabetes (T1D) and their adult caregivers may be central to effective management of T1D. This article includes analysis of cross-sectional associations between T1D outcomes (adherence, glycemic control, quality of life, family conflict, depression, and self-efficacy) and scores on the Collaborative Parent Involvement (CPI) Scale obtained from 309 youths with T1D about their primary and secondary caregivers. METHODS: MANCOVA, controlling for age, evaluated associations of diabetes outcomes with youths' CPI scores for each caregiver. RESULTS: Diabetes outcomes were poor when both caregivers obtained CPI scores below the median. Diabetes outcomes were more strongly associated with CPI scores of primary, rather than secondary, caregivers. CPI scores at or above the median among primary caregivers were associated with more favorable status on multiple youth outcomes. When both caregivers obtained CPI scores at or above the median, children had significantly lower HbA1C and parents retained more responsibility for diabetes care. CONCLUSIONS: Higher collaborative involvement, particularly among primary caregivers, was associated with favorable status along a variety of diabetes outcomes. Longitudinal studies could confirm if youth-parent collaboration is a justifiable intervention target.

Generic and diabetes-specific parent-child behaviors and quality of life among youth with type 1 diabetes.

OBJECTIVE: To evaluate associations among parent-child behaviors and generic and diabetes-specific health-related quality of life (HRQOL) in a multi-site sample of youth with type 1 diabetes. METHOD: One hundred and twenty-one youth and their primary caregivers completed measures of parent-child behaviors, child HRQOL, and participated in an observed family interaction task. RESULTS: Diabetes-specific parent-child variables were associated significantly with both generic and diabetes-specific HRQOL above and beyond the contributions of demographic and generic parent-child variables, accounting for between 13% and 31% of the variance in HRQOL. Diabetes-specific family conflict and negative diabetes-specific family communication were associated with lower HRQOL. Collaborative parent involvement in diabetes care was associated with higher levels of HRQOL. CONCLUSIONS: Interventions that target diabetes-specific family interactions will be beneficial to the quality of life of children with type 1 diabetes.

Concurrent changes in conduct problems and depressive symptoms in early adolescents: a developmental person-centered approach.

The co-occurrence of conduct problems (CP) and depressive symptoms (DS) is an important topic in developmental psychopathology; however, research in this area is still in its early stages. Using data from a school-based longitudinal sample of 2,453 adolescents with five waves from Grade 6 to 9, we examined the prevalence, etiology, and consequences of the co-occurrence of CP and DS. A person-centered approach, general growth mixture modeling, was applied to obtain CP and DS trajectory groups. The risk factors and consequences of the co-occurrence problem were examined using the trajectory groups. As hypothesized in a nonclinical sample, a small proportion of boys (8.8%) and girls (3.7%) reported to be high in both CP and DS over time. Among the adolescents with the highest level of CP, only 6.3% of the boys and 6.0% of the girls experienced the highest level of DS. However, among those with the highest level of DS trajectories, 42.9% of the boys and 10.2% of the girls reported the highest level of CP, indicating a gender-specific risk of the co-occurrence problem for depressed boys. Psychosocial and family factors were identified as vulnerable precursors to co-occurring CP and DS, a finding in line with the multiple domain risk model for CP and the transactional model for DS. The study also found that adolescents with the co-occurrence problem were more similar to those with "pure DS" than those with "pure CP" in academic adjustment at the ninth grade.

Peer and Parent Influences on School Engagement Among Early Adolescents.

This PDF receipt will only be used as the basis for generating PubMed Central (PMC) documents. PMC documents will be made available for review after conversion (approx. 2-3 weeks time). Any corrections that need to be made will be done at that time. No materials will be released to PMC without the approval of an author. Only the PMC documents will appear on PubMed Central -- this PDF Receipt will not appear on PubMed Central.Students who are not motivated and do not try to do well are unlikely to achieve at a level consistent with their abilities. This research assessed the relationships over time between school engagement and parenting practices and peer affiliation among 6(th)-9(th) graders using latent growth models (LGM). Participants included 2,453 students recruited from 7 public middle schools who were assessed 5 times between fall of 6(th) and 9(th) grades as part of a program evaluation study. During this period school engagement and adjustment declined somewhat, while substance use, conduct problems, and problem behaving friends increased, and authoritative parenting practices declined. The significant, positive over-time associations between school engagement and parent involvement, expectations, and monitoring were fully mediated by growth in problem behaving friends. School adjustment mediated the relationship between school engagement and parent expectations. These findings suggest that authoritative parenting practices may foster school engagement directly and also indirectly by discouraging affiliation with problem behaving friends and facilitating school adjustment.

Diabetes problem solving by youths with type 1 diabetes and their caregivers: measurement, validation, and longitudinal associations with glycemic control.

OBJECTIVES: This article introduces a new measure of problem-solving skills of youths with type 1 diabetes (T1DM) and adult caregivers in correcting glycemic fluctuations. METHODS: The Diabetes Problem Solving Interview (DPSI), a structured interview, was validated during a pilot study of a behavioral intervention. DPSI data and measures of diabetes management were obtained at baseline from 114 youths (ages 9-14.5) and 109 caregivers. Glycosylated hemoglobin (HbA(1c)) was measured quarterly over 9 months. RESULTS: Results confirmed the psychometric adequacy of the DPSI. For caregivers, but not youths, low DPSI scores (indicating poor problem-solving skills) were significantly associated with worse HbA(1c) over 9 months. CONCLUSIONS: The DPSI has clinical and research utility as a measure of diabetes problem-solving skills. Identification and targeted remediation of caregivers' deficient diabetes problem-solving skills or promotion of youths' utilization of these skills could possibly enhance glycemic control in youths with T1DM.

Small-for-gestational age prevalence risk factors in central Appalachian states with mountain-top mining.

OBJECTIVES: To identify risk factors for small-for-gestational age (SGA) for counties in central Appalachian states (Kentucky (KY), Tennessee (TN), Virginia (VA), and West Virginia (WV)) with varied coal mining activities. MATERIAL AND METHODS: Live birth certificate files (1990-2002) were used for obtaining SGA prevalence rates for mothers based on the coal mining activities of their counties of residence, mountain-top mining (MTM) activities, underground mining activities but no mountain-top mining activity (non-MTM), or having no mining activities (non-mining). Co-variable information, including maternal tobacco use, was also obtained from the live birth certificate. Adjusted odds ratios were obtained using multivariable logistic regression comparing SGA prevalence rates for counties with coal mining activities to those without coal mining activities and comparing SGA prevalence rates for counties with coal mining activities for those with and without mountain-top mining activities. Comparisons were also made among those who had reported tobacco use and those who had not. RESULTS: Both tobacco use prevalence and SGA prevalence were significantly greater for mining counties than for non-mining counties and for MTM counties than for non-MTM counties. Adjustment for tobacco use alone explained 50% of the increased SGA risk for mining counties and 75% of the risk for MTM counties, including demographic pre-natal care co-variables that explained 75% of the increased SGA risk for mining counties and 100% of the risk for MTM. The increased risk of SGA was limited to the third trimester births among tobacco users and independent of the mining activities of their counties of residence. CONCLUSIONS: This study demonstrates that the increased prevalence of SGA among residents of counties with mining activity was primarily explained by the differences in maternal tobacco use prevalence, an effect that itself was gestational-age dependent. Self-reported tobacco use marked the population at the increased risk for SGA in central Appalachian states. Int J Occup Med Environ Health 2018;31(1):11-23.

Anger, hostility, and hospitalizations in patients with heart failure.

OBJECTIVE: Heart failure patients have a high hospitalization rate, and anger and hostility are associated with coronary heart disease morbidity and mortality. Using structural equation modeling, this prospective study assessed the predictive validity of anger and hostility traits for cardiovascular and all-cause rehospitalizations in patients with heart failure. METHOD: 146 heart failure patients were administered the STAXI and Cook-Medley Hostility Inventory to measure anger, hostility, and their component traits. Hospitalizations were recorded for up to 3 years following baseline. Causes of hospitalizations were categorized as heart failure, total cardiac, noncardiac, and all-cause (sum of cardiac and noncardiac). RESULTS: Measurement models were separately fit for Anger and Hostility, followed by a Confirmatory Factor Analysis to estimate the relationship between the Anger and Hostility constructs. An Anger model consisted of State Anger, Trait Anger, Anger Expression Out, and Anger Expression In, and a Hostility model included Cynicism, Hostile Affect, Aggressive Responding, and Hostile Attribution. The latent construct of Anger did not predict any of the hospitalization outcomes, but Hostility significantly predicted all-cause hospitalizations. Analyses of individual trait components of each of the 2 models indicated that Anger Expression Out predicted all-cause and noncardiac hospitalizations, and Trait Anger predicted noncardiac hospitalizations. None of the individual components of Hostility were related to rehospitalizations or death. CONCLUSION: The construct of Hostility and several components of Anger are predictive of hospitalizations that were not specific to cardiac causes. Mechanisms common to a variety of health problems, such as self-care and risky health behaviors, may be involved in these associations. (PsycINFO Database Record

Arsenic cancer risk confounder in southwest Taiwan data set.

Quantitative analysis for the risk of human cancer from the ingestion of inorganic arsenic has been based on the reported cancer mortality experience in the blackfoot disease (BFD) -endemic area of southwest Taiwan. Linear regression analysis shows that arsenic as the sole etiologic factor accounts for only 21% of the variance in the village standardized mortality ratios for bladder and lung cancer. A previous study had reported the influence of confounders (township, BFD prevalence, and artesian well dependency) qualitatively, but they have not been introduced into a quantitative assessment. In this six-township study, only three townships (2, 4, and 6) showed a significant positive dose-response relationship with arsenic exposure. The other three townships (0, 3, and 5) demonstrated significant bladder and lung cancer risks that were independent of arsenic exposure. The data for bladder and lung cancer mortality for townships 2, 4, and 6 fit an inverse linear regression model (p < 0.001) with an estimated threshold at 151 microg/L (95% confidence interval, 42 to 229 microg/L) . Such a model is consistent with epidemiologic and toxicologic literature for bladder cancer. Exploration of the southwest Taiwan cancer mortality data set has clarified the dose-response relationship with arsenic exposure by separating out township as a confounding factor. Key words: arsenic, blackfoot disease, bladder cancer, cancer risk, confounder, dose-response relationship, southwest Taiwan, threshold model.

Over time relationships between early adolescent and peer substance use.

Peer and adolescent substance use are highly correlated, but this relationship is not fully understood. In particular, the relative contributions of selection and socialization to substance use progression have not been established. Students (n=2453) in the seven middle schools in one school district were assessed at school at the beginning and end of the sixth, seventh, eighth grade and beginning of the 9th grade. Self-reported smoking and drinking and the number of substance using friends were assessed 5 times over 3 years. The relationship between peer and adolescent substance use were assessed in parallel processes as part of an autoregressive latent trajectory model. Substance use and the number of substance using friends increased in linear fashion from T1 to T5. Initial substance use predicted an increase in the number of substance using friends over time, indicating an effect of selection, and the initial number of substance using friends predicted substance use progression, providing evidence of socialization. The magnitudes of these relationships were similar. Bivariate, lagged autoregressive analyses of the successive relationships from one assessment to the next showed consistent, significant associations from peer use to adolescent substance use. The association from adolescent to peer use was significant only from 7th to 8th grade. The findings provide evidence of reciprocal influences, but socialization was a more consistent influence than selection.

A model of parental distress and factors that mediate its link with parental monitoring of youth diabetes care, adherence, and glycemic control.

OBJECTIVE: Parental monitoring of adolescents' diabetes self-care is associated with better adherence and glycemic control (A1c). A number of parent-level factors are associated with higher levels of parental monitoring, including lower levels of parental distress (depressive symptoms, stress, anxiety), as well as higher levels of parental self-efficacy for diabetes management and authoritative parenting. Often studied in isolation, these factors may be best considered simultaneously as they are interrelated and are associated with parental monitoring and youth adherence. METHOD: Structural equation modeling with a cross-sectional sample of 257 parent/youth (aged 11-14) dyads: (a) examined a broad model of parental factors (i.e., parental distress, parental diabetes self-efficacy, authoritative parenting), and (b) assessed their relation to parental monitoring, youth adherence, and A1c. Post hoc analyses of variance (ANOVAs) evaluated clinical implications of daily parental monitoring. RESULTS: Parental distress was not related directly to parental monitoring. Instead less distress related indirectly to more monitoring via higher parental self-efficacy and more authoritative parenting which, in turn, related to better adherence and A1c. Higher parental self-efficacy also related directly to better youth adherence and then to better A1c. Clinically, more parental monitoring related to more daily blood glucose checks and to better A1c (8.48% vs. 9.17%). CONCLUSIONS: A broad model of parent-level factors revealed more parental distress was linked only indirectly to less monitoring via lower parental self-efficacy and less authoritative parenting. Behaviorally, more parental monitoring related to better adherence and to clinically better A1c in adolescents. Further study of parent-level factors that relate to parental distress and monitoring of adherence appears warranted. (PsycINFO Database Record

Arsenic in Drinking Water and Lung Cancer Mortality in the United States: An Analysis Based on US Counties and 30 Years of Observation (1950-1979).

Background. To examine whether the US EPA (2010) lung cancer risk estimate derived from the high arsenic exposures (10-934 µg/L) in southwest Taiwan accurately predicts the US experience from low arsenic exposures (3-59 µg/L). Methods. Analyses have been limited to US counties solely dependent on underground sources for their drinking water supply with median arsenic levels of ≥3 µg/L. Results. Cancer risks (slopes) were found to be indistinguishable from zero for males and females. The addition of arsenic level did not significantly increase the explanatory power of the models. Stratified, or categorical, analysis yielded relative risks that hover about 1.00. The unit risk estimates were nonpositive and not significantly different from zero, and the maximum (95% UCL) unit risk estimates for lung cancer were lower than those in US EPA (2010). Conclusions. These data do not demonstrate an increased risk of lung cancer associated with median drinking water arsenic levels in the range of 3-59 µg/L. The upper-bound estimates of the risks are lower than the risks predicted from the SW Taiwan data and do not support those predictions. These results are consistent with a recent metaregression that indicated no increased lung cancer risk for arsenic exposures below 100-150 µg/L.