Feasibility and Acceptability of a Novel Primary Care-Based Intervention to Promote Parent-Teen Communication About Teen Strengths.

Strength-based approaches to youth development have been tested in community settings and are related to improvements in social, health, and academic realms. However, little is known about similar approaches to enhance parent-teen communication (PTC) in pediatric primary care. The goal of this study was to test the feasibility and acceptability of an intervention to facilitate parent-teen communication about teen strengths. Intervention materials were developed based on a literature review, expert consultation, and feedback from stakeholders. The final intervention was a parent-directed booklet and a parent-teen discussion activity. At the well-adolescent visit (WAV), dyads received an orientation to the materials and were instructed to complete the discussion activity within 2 weeks of the WAV. Health Care Providers verbally endorsed the materials and instructed parents to read the booklet and complete the discussion activity with their teens. Acceptability was assessed at 2-week and 2-month follow-ups. Parent-adolescent dyads from an urban, pediatric primary care practice were enrolled with half assigned to the treatment group. Those in the treatment group (60 dyads) are the focus of this paper. Youth were 13-15 years old, 55% female, and 66% Black. Most participating parents (97%) were female. Fidelity was ≥ 88% for delivery of each of the intervention components. Fifty-four of the 60 parents in the intervention group completed the 2-week call. Of those 54 parents, 96% read the booklet and 62% found the booklet either extremely or very helpful. The majority of parents (67%) and teens (72%) reported that the discussion activity was excellent or very good. Analysis of qualitative data also provided rich insight into the participants' experiences with the intervention materials. Overall results suggest that an intervention to promote PTC about teen strengths is feasible and acceptable to parents and teens within primary care.

Efficacy of a Primary Care-Based Intervention to Promote Parent-Teen Communication and Well-Being: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the impact of a primary care-based, parent-directed intervention on changes in parent-teen communication, parental beliefs about adolescents, parent and adolescent well-being, adolescent distress, and adolescent positive affect from baseline to 2-month follow-up. STUDY DESIGN: In this randomized controlled trial, 120 adolescents (13-15 years of age) scheduled for well visits and their parents were randomized to the strength intervention or control group. The intervention included a booklet highlighting 3 key messages about adolescence, instructions to have a discussion with their teen about each other's strengths, and clinician endorsement. Outcomes were assessed before the well visit and 2 months later. RESULTS: Adolescents were 61% female and 65% black. Parents were primarily female (97%); 72% had a 4-year degree or higher. The intervention had a positive impact on adolescent-reported open communication among adolescents with baseline low open communication scores (B = 3.55; P = .005; 95% CI, 1.07-6.03). Adolescents in the intervention group reported a decrease in distress (-1.54 vs 3.78; P = .05; partial eta squared [η2] = 0.038) and increase in positive affect (1.30 vs -3.64; P = .05; η2 = 0.04) compared with control group adolescents. The intervention did not affect parent-reported communication, parental beliefs, or adolescent well-being. Control parents demonstrated a marginal increase in well-being, whereas intervention parents did not (0.82 vs -0.18; P = .07; η2 = 0.029). CONCLUSIONS: This study highlights the potential impact of primary care-based, universal, low-intensity interventions targeting parents of adolescents on parent-teen communication and important adolescent health outcomes. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03496155.

Does Self-Efficacy Mediate the Link Between Impulse Control and Diabetes Adherence?

OBJECTIVE: The goal of this study was to test the hypothesis that diabetes self-efficacy mediates the relationship between impulse control and type 1 diabetes (T1D) management from ages 8 to 18 years, using multilevel modeling. METHODS: Participants included 117 youth with T1D and their parents. Youth (aged 8-16 years at baseline) and parents were assessed 5 times over 2 years. Using a cohort sequential design, we first estimated the growth trajectory of adherence from age 8 to 18 years, then specified a multilevel mediation model using impulse control as the main predictor, diabetes self-efficacy as the mediator, and changes in adherence (both within- and between-individuals) as the outcome. RESULTS: According to youth-reported adherence only, self-efficacy partially mediated the within-person effect of impulse control on adherence. On occasions when youth reported increases in impulse control, they tended to report higher adherence, and this was, in part, due to increases in youths' perceived self-efficacy. Self-efficacy accounted for approximately 21% of the within-person relationship between impulse control and youth-reported adherence. There was no association between impulse control and adherence between-individuals. Impulse control and self-efficacy were not related to parent-reported adherence. CONCLUSION: Environments that enrich youth with confidence in their own diabetes-related abilities may benefit self-care behaviors in youth with T1D, but such increases in youths' perceived competence do not fully account for, or override, the behavioral benefits of impulse control. Efforts to improve adherence in youth with T1D will benefit from consideration of both impulse control and self-efficacy.

Daily Parent-Teen Conflict and Parent and Adolescent Well-Being: The Moderating Role of Daily and Person-Level Warmth.

In early-mid adolescence, parent-teen conflicts become more intense and parents' displays of warmth tend to decline temporarily. Daily increases of parent-teen conflict have been linked to concurrent increases in adolescent emotional distress, yet greater average levels of parental warmth are known to buffer adolescents' response to daily stressors such as interpersonal conflict. It is unclear whether daily increases in parental warmth may also function as a protective buffer that attenuates the daily association between parent-teen conflict and individuals' well-being. The present study aimed to fill an important gap in the literature by examining daily (within-person) fluctuations, and average between-person differences, in parental warmth as potential moderators of the daily association between parent-teen conflict intensity (defined here by the degree of negative emotions in parent-teen interactions) and well-being (distress, positive affect, and self-esteem) of both parents and adolescents. Data are based on daily reports from 120 parents-adolescents dyads recruited from a primary care practice in the Northeastern U.S. Almost all parents were mothers (Mage = 44.55, SD = 6.36), 61% of adolescents were female (Mage = 14.36, SD = 0.88), and 66% of dyads were African American. Multilevel modeling was used to assess the daily association between parent-teen conflict and well-being and examine daily and person-level (across-days) warmth as moderators of that association. Examining daily parental warmth as a moderator addressed whether the daily association between conflict and well-being varied as a function of when parental warmth increased or decreased within individuals (relative to individuals' own daily average). In contrast, examining person-level mean warmth as a moderator addressed whether the daily association between conflict and well-being varied as a function of who, on average, reported higher vs. lower levels of parental warmth. As expected, both parents and adolescents reported significantly lower well-being on days they experienced more conflict than usual. Daily fluctuations in parental warmth did not moderate the daily associations between conflict and well-being in parents or adolescents, indicating that the daily association did not change when parents were warmer than usual. In adolescents, the daily associations between conflict and distress, as well as conflict and positive affect, were moderated by person-mean levels of parental warmth, such that daily increases in conflict were associated with higher distress and lower positive affect (on the same day) primarily among adolescents with average or below average levels of parental warmth. Daily conflict was not associated with lower well-being among adolescents with higher-than-average levels of parental warmth. In parents, neither daily nor person-level warmth moderated the daily association between conflict and well-being, suggesting that the negative, daily association between conflict and well-being did not change as a function of parents' daily or average perceptions of warmth. These findings suggest that isolated, day-specific increases in warmth may be less protective than high, stable levels of parental warmth in mitigating the daily association between parent-teen conflict and adolescent well-being.

Joint Effects of Peer Presence and Fatigue on Risk and Reward Processing in Late Adolescence.

Peers are thought to increase adolescents' risk-taking behavior, at least in part, by heightening their sensitivity to rewards. In this study, we investigate whether the effect of peers on late adolescent males is exacerbated when youth are cognitively fatigued, a state characterized by weakened cognitive control and heightened orientation toward rewards, and well established as a factor that compromises decision making. We hypothesized that fatigued adolescents' top-down regulation of reward-related impulses may be compromised, thereby potentially amplifying the effect of peers on reward- and risk-seeking behavior. Late adolescent males between 18 and 22 years old (mean age = 19.64, SD = 1.22; 61% Caucasian) completed a decision-making battery either alone or in the presence of 3 same-sex peers, and were either cognitively fatigued or non-fatigued. We compared behavior between four experimental groups-fatigued adolescents in a peer group, non-fatigued adolescents in a peer group, fatigued adolescents by themselves, and non-fatigued adolescents by themselves. The findings showed that cognitive fatigue and peer presence evinced independent effects on risk taking and sensitivity to rewards, but that these factors do not influence adolescent decision-making in an additive or synergistic fashion. To our surprise, being fatigued reduces (but does not eliminate) the effect of peers of risk taking. Moreover, the impact of peers on adolescent males' ability to learn from negative consequences is not compromised when adolescents are in a state of mental fatigue. Our results suggest that mental fatigue increases late adolescent males' reward sensitivity to the same extent as peer presence, but does not amplify the peer effect on risk-taking behavior. In this regard, grouping adolescents when they are fatigued may be less dangerous than when they are rested. Similarly, the added presence of peers does not further exacerbate the effect of fatigue on adolescent's reward- and risk-seeking inclinations. In fact, given peers' unique effect on adolescents' ability to learn from costly decisions, our findings suggest that seeking the presence of peers-which is often a rewarding experience in and of itself-may be an adaptive response to mitigate the impact of fatigue on decision making.

Adolescents in Peer Groups Make More Prudent Decisions When a Slightly Older Adult Is Present.

Adolescents make more reckless decisions when with peers than when alone, which poses a challenge for organizations that place adolescents in situations in which risky and myopic decision making is problematic. We asked whether the effect of peers on adolescents' decision making is mitigated by the presence of a slightly older adult. We examined whether target subjects' risk taking was greater when they were in groups of 4 late-adolescent males (ages 18-22) than when they were in groups that mixed 3 late-adolescent males with 1 slightly older adult (age 25-30); risk taking in both of these conditions was compared with that of adolescents tested alone. We found that adolescents took more risks and expressed stronger preference for immediate rewards when they were grouped with 3 same-age peers than when they were alone. When 1 adolescent was replaced by someone slightly older, however, adolescents' decision making and reward processing resembled that seen when adolescents were tested alone. Adding a young adult to a work team of adolescents may improve group decision making.

Peers Increase Late Adolescents' Exploratory Behavior and Sensitivity to Positive and Negative Feedback.

Adolescents take more risks with peers than when alone. It is not clear how peer presence affects adolescents' risky decision making, however. We used the Iowa Gambling Task (IGT)-a game used to assess decision making involving risk and reward-to examine how peers affect late adolescents' exploration of relevant environmental cues, ability to learn from the outcomes (positive and negative) of that exploration, and ability to integrate feedback to adjust behavior toward optimal long-term outcomes. One hundred and one 18- to 22-year old males (M = 19.8 years) were randomly assigned to play the IGT either alone or observed by peers. Late adolescents tested with observers engaged in more exploratory behavior, learned faster from both positive and negative outcomes, and evinced better task performance than those tested alone.

Prescription Drug Misuse and Sexual Risk Behaviors Among Young Men Who have Sex with Men (YMSM) in Philadelphia.

This study examined the relationship between prescription drug misuse and sexual risk behaviors (i.e. unprotected sex, increased number of sex partners) in a sample of young men who have sex with men (YMSM) in Philadelphia. Data come from a cross-sectional study of 18-29 year old YMSM (N = 191) who misused prescription drugs in the past 6 months. Associations were investigated in two regression models: logistic models for unprotected anal intercourse (UAI) and zero-truncated Poisson regression model for number of sex partners. Of 177 participants engaging in anal intercourse in the past 6 months, 57.6 % engaged in UAI. After adjusting for socio-demographic variables and illicit drug use, misuse of prescription pain pills and muscle relaxants remained significantly associated with engaging in receptive UAI. No prescription drug class was associated with a high number of sex partners. This study provides additional evidence that some prescription drugs are associated with sexual risk behaviors among YMSM.

Associations between prescription opioid injection and Hepatitis C virus among young injection drug users.

OBJECTIVE: Hepatitis C virus (HCV) incidence has been increasing among young injection drug users (IDUs). This analysis examined whether the emerging practice of prescription opioid (PO) injection is associated with self-reported HCV among young IDUs. METHODS: Young IDUs (n = 162) aged 18-25-years-old who indicated recent misuse of prescription drugs were sampled in New York and Los Angeles during 2009-2011. Participants reported lifetime PO injection history and results from their most recent HCV test as well as demographic characteristics and lifetime drug use. Bivariate analyses examined relationships between covariates and both lifetime PO injection and HCV positivity. Poisson regression examined the associations between lifetime PO injection, HCV positivity, and significant covariates. RESULTS: A majority reported lifetime PO injection (72.2%) and 30.9% self-reported being HCV positive. Lifetime PO injectors were nearly three times more likely to report being HCV positive than non-PO injectors (adjusted incidence rate ratio (AIRR): 2.69, p<0.05) after controlling for socio-demographic and other drug use variable. Additionally, substituting POs for heroin (AIRR: 2.27, p<0.05), growing up in a lower social class (AIRR: 1.67, p<0.05), age (AIRR: 1.12, p<0.05), age of injection initiation (AIRR: 0.87, p<0.001), and history of being prescribed stimulants (AIRR: 0.64, p<0.05) were independently associated with HCV positivity. CONCLUSIONS: Findings suggest that PO injection should be given further consideration as a contributing factor to rising HCV infection among young adults in the US.

Injection drug users trained by overdose prevention programs: responses to witnessed overdoses.

In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPPs), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when responding to a drug overdose. IDUs (n = 30) trained by two OPPs in Los Angeles were interviewed in 2010-2011 about responses to their most recently witnessed drug overdose using an instrument containing both open and closed-ended questions. Among the 30 witnessed overdose events, the victim recovered in 29 cases while the outcome was unknown in one case. Participants responded to overdoses using a variety of techniques taught by OPPs. Injecting the victim with naloxone was the most commonly recommended response while other recommended responses included stimulating the victim with knuckles, calling 911, and giving rescue breathing. Barriers preventing participants from employing recommended response techniques in certain circumstances included prior successes using folk remedies to revive a victim, concerns over attracting police to the scene, and issues surrounding access to or use of naloxone. Practical solutions, such as developing booster sessions to augment OPPs, are encouraged to increase the likelihood that trained participants respond to a drug overdose with the full range of recommended techniques.

Prescription drug misuse and risk behaviors among young injection drug users.

Prescription drug misuse among young adults, especially opioids, is a substantial public health problem in the United States. Although risks associated with injection of illicit drugs are well established, injection and sexual risks associated with misuse of prescription drugs are under-studied. Forty young injection drug users aged 16 to 25 who reported injection of a prescription drug were recruited in 2008-09 in Los Angeles and New York City. Descriptive quantitative and qualitative data were analyzed to illustrate risky injection and sexual behaviors reported in this sample. Over half of participants engaged in risky injection behavior, three-quarters engaged in risky sexual behavior, nearly half reported both risky behaviors, and five did not report either risk behavior while misusing a prescription drug. Prescription opioids, tranquilizers, and stimulants were misused in the context of risky sexual behaviors while only opioids were misused in the context of injection risk behaviors. Access to clean syringes, attitudes and beliefs regarding hepatitis C, and risk reduction through partner selection were identified as key themes that contextualized risk behaviors. Although these findings help identify areas to target educational campaigns, such as prevention of sexually transmitted infections, risk behaviors specifically associated with prescription drug misuse warrant further study.

Perceived Drug Use Functions and Risk Reduction Practices Among High-Risk Nonmedical Users of Prescription Drugs.

Nonmedical use of prescription drugs has become the fastest growing drug problem in the United States, particularly among young adults. This study examines the reasons young polydrug users misuse prescription drugs, and explores how young users employ risk reduction strategies to minimize adverse consequences. The sample was recruited during 2008 and 2009 in Los Angeles and New York, and comprised 45 nonmedical users of prescription drugs, aged 16 to 25. Data from a semistructured interview were analyzed quantitatively and qualitatively. Participants reported nonmedical use of prescription drugs to change mood, to facilitate activity, and to monitor the intake of other substances. Commonly employed risk reduction strategies included calculating pill timing, dosage, and access, and monitoring frequency of use, particularly when combining different substances. Most study participants often planned drug use to occur within socially acceptable parameters, such that prescription drug misuse was a normalized feature of their everyday lives.

Effect of Systemic and Auricular Acupuncture with a 2/100 Hz Frequency and Nogier Frequency in Fibromyalgia: a Randomized Clinical Trial, Pilot Study.

Background: Fibromyalgia is a syndrome of chronic, generalized muscular pain, accompanied by sleep disturbances, fatigue and cardic autonomic dysfunction that will affect the quality of life. There is currently no gold standard treatment. There are limitations of studies with electroacupuncture in auricular acupuncture. Objectives: We evaluate the effects of systemic electroacupuncture (EA) with frequencies of 2/100 Hz associated of auricular acupuncture with a Nogier frequency (2.28, 4.56 and 9.12 Hz) for pain intensity, heart rate variability (HRV), and quality of life in fibromyalgia. Methods: Randomized clinical trial, a pilot study. Eighteen volunteers were randomized into a control group (CG, n = 9) and an experimental group (EG, n = 9). Six systemic EA sessions systemic and auricular were applied in the EG for 20 min, twice a week, for six weeks consecutive. The Numerical Pain Assessment Scale (NPRS), 2010 diagnostic criteria of the American College of Rheumatology (FDC 2010), Fibromyalgia Impact Questionnaire (FIQ) and analysis of HRV were the instruments used. The independent t-test compared to the groups was applied. Results: There was no statistically significant difference for the primary outcome for NPRS (p > 0.05). In the secondary outcome there was a significant difference in the total score and in some FIQ domains (p = 0.008) and some variables such as pain (p = 0.02) and anxiety (p = 0.006). There was no significant difference for the FDC 2010 and HRV variables (p > 0.05). Conclusion: 2/100 Hz systemic EA associated with the Nogier frequency positively influenced some quality of life variables; however, pain intensity, diagnostic criteria, and HRV variables did not change.

Patterns of prescription drug misuse among young injection drug users.

Misuse of prescription drugs and injection drug use has increased among young adults in the USA. Despite these upward trends, few studies have examined prescription drug misuse among young injection drug users (IDUs). A qualitative study was undertaken to describe current patterns of prescription drug misuse among young IDUs. Young IDUs aged 16-25 years who had misused a prescription drug, e.g., opioids, tranquilizers, or stimulants, at least three times in the past 3 months were recruited in 2008 and 2009 in Los Angeles (n = 25) and New York (n = 25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analyzed both quantitatively and qualitatively. Most IDUs sampled were both homeless and transient. Heroin, prescription opioids, and prescription tranquilizers were frequently misused in the past 30 days. Qualitative results indicated that young IDUs used prescription opioids and tranquilizers: as substitutes for heroin when it was unavailable; to boost a heroin high; to self-medicate for health conditions, including untreated pain and heroin withdrawal; to curb heroin use; and to reduce risks associated with injecting heroin. Polydrug use involving heroin and prescription drugs resulted in an overdose in multiple cases. Findings point to contrasting availability of heroin in North American cities while indicating broad availability of prescription opioids among street-based drug users. The results highlight a variety of unmet service needs among this sample of young IDUs, such as overdose prevention, drug treatment programs, primary care clinics, and mental health services.

Denial of prescription opioids among young adults with histories of opioid misuse.

OBJECTIVES: An exploratory study was undertaken to examine how being denied prescription opioids to treat pain impacted the drug-using careers of young adults with a history of misuse of prescription drugs. DESIGN: Ethno-epidemiological methodology utilizing a cross-sectional design, semi-structured interviews, and qualitative/quantitative data analysis. Settings. Non-clinical participants were recruited from natural settings, such as streets, parks, beaches, and college campuses, in New York City and Los Angeles during 2008 and 2009. PARTICIPANTS: One hundred fifty participants aged 16 to 25 who had misused a prescription opioid, tranquilizer, or stimulant in the past 90 days. Outcome Measures. Analyses focused on denial of opioids and associated consequences, including self-medication with prescription opioids and heroin. RESULTS: Thirty-four participants (22.7%) described being denied prescription opioids for the treatment of a painful condition. Current opioid misuse and current pain problems were higher in this group compared to those who had never been denied prescription opioids. Reasons for denial included being identified as a drug user by a physician, lack of health insurance, and having medication withheld by a parent or authority figure. Approximately half reported self-medicating pain with either illegally obtained prescription opioids or heroin. Self-medication often coincided with initiation of new risk behaviors and more intensive drug use. CONCLUSION: Being denied prescription opioids was an important moment in the drug using careers of many study participants. Results suggest that effective pain management techniques are needed to prevent high-risk young adults with pain problems from engaging in escalated opioid misuse and risk behaviors.

Parenting and the Development of Impulse Control in Youth with Type 1 Diabetes: The Mediating Role of Negative Affect.

Parents are important for the development and maintenance of regulatory control. The current longitudinal study examined associations between parental coercion and autonomy support and impulse control in 117 youth (ages 8-16; Mage= 12.87, SD=2.53; 44% male) with Type 1 diabetes and explored whether youth negative affect mediated these associations. Parental coercion (but not autonomy support) was concurrently associated with lower impulse control and higher negative affect within individuals. Increases in youth negative affect partially mediated the within-person association between parental coercion and impulse control. These findings suggest that parent-directed interventions to reduce parental coercion may be most beneficial for impulse control if combined with youth-directed interventions to help them regulate negative affect. Replication of the current findings in a larger sample of youth with and without a chronic illness is needed to address the theoretical and empirical importance of negative affect as a potential mechanism through which parental coercion impacts youth impulsivity.

Pulsed Laser Acupuncture in the Treatment of Pain and Heart Rate Variability in Fibromyalgia Patients: A Pilot Randomized Clinical Trial.

Introduction: Laser acupuncture (LA) is a medically approved treatment for chronic pain, especially fibromyalgia. It is widely known that all pain is related to autonomic modulation, which may influence heart rate variability (HRV). There are robust studies in the literature on the effect of LA with continuous frequency on musculoskeletal pain and autonomic modulation. However, little is known about the effect of pulsed frequency on fibromyalgia. Therefore, this study aimed to evaluate whether an individualized intervention protocol applying pulsed LA would provide benefits related to pain symptoms and cardiac autonomic modulation in patients with fibromyalgia. Methods: In this pilot randomized clinical controlled trial, the sample consisted of women with fibromyalgia between the ages of 40 and 80, randomized into two groups: a control group (CG; n=10) and an experimental group (EG; n=10). EG received the intervention twice per week for 3 weeks. Statistical analysis was conducted by delta (difference between post-intervention and pre-intervention) and the Shapiro-Wilk test (normality). For comparison between the groups, the Mann-Whitney test was used. Results: The results showed a significant reduction in pain intensity as reported via the pain numerical scale (PNS; P=0.00), generalized pain index (GPI; P=0.00), and symptom severity scale (SSS; P=0.00). There was no significant difference in any HRV variable (P>0.05). Conclusion: Pulsed LA, when applied in an individualized protocol, can reduce pain intensity, as reported on the PNS, GPI, and SSS. However, no therapeutic effect was observed for HRV.

Determining the Polymorphism Information Content of a molecular marker.

This review was carried out with the purpose of contributing to the discussion on the equations used in calculating the Polymorphism Information Content (PIC) of molecular markers. PIC measures the ability of a marker to detect polymorphisms, and therefore has enormous importance in selecting markers for genetic studies. We perform a summary analysis of PIC and its difference in relation to heterozygosity, another parameter used to evaluate the quality of a marker, presenting and discussing the several equations registered in the literature for both dominant and codominant markers. Finally, we present a brief direction on estimating PIC for dominant markers.

The Role of Cognitive and Psychosocial Maturity in Type 1 Diabetes Management.

PURPOSE: The purpose of the article was to explore the longitudinal relationship between treatment responsibility and type 1 diabetes management (i.e., adherence and glycemic control) in adolescence and to examine whether indicators of cognitive and psychosocial maturity moderate the link between youth responsibility and diabetes outcomes. METHODS: Participants included 117 youth with type 1 diabetes and their parents. Youth (aged 8-16 years) and parents were assessed five times over 2 years. Using a cohort sequential design, we estimated the growth trajectory of adherence and glycemic control (i.e., hemoglobin A1c [HbA1c]) from age 8 to 18 years. Treatment responsibility, verbal ability, and impulse control were used as predictors of within-person variability and between-person differences in the growth parameters (i.e., intercept and slope). RESULTS: Adherence and HbA1c declined linearly from ages 8 to 18 years. Significant within-person interactions between impulse control and responsibility revealed that on occasions when youth experienced increases in both responsibility and impulse control, adherence and HbA1c were higher than would be predicted by the age-related trajectory. For adherence only, when youth acquired more responsibility, without experiencing contemporaneous gains in impulse control, adherence worsened. For glycemic control only, a significant within-person interaction indicated that time-specific increases in both youth responsibility and verbal capacity were associated with a concurrent decline in HbA1c. CONCLUSIONS: The present findings underscore that the associations between treatment responsibility and diabetes management depend on youths' maturational context. Intervention efforts to enhance impulse control skills in youth with diabetes may prevent the decline in diabetes management that tends to occur as youth acquire more responsibility for diabetes-related tasks.

The dual systems model: Review, reappraisal, and reaffirmation.

According to the dual systems perspective, risk taking peaks during adolescence because activation of an early-maturing socioemotional-incentive processing system amplifies adolescents' affinity for exciting, pleasurable, and novel activities at a time when a still immature cognitive control system is not yet strong enough to consistently restrain potentially hazardous impulses. We review evidence from both the psychological and neuroimaging literatures that has emerged since 2008, when this perspective was originally articulated. Although there are occasional exceptions to the general trends, studies show that, as predicted, psychological and neural manifestations of reward sensitivity increase between childhood and adolescence, peak sometime during the late teen years, and decline thereafter, whereas psychological and neural reflections of better cognitive control increase gradually and linearly throughout adolescence and into the early 20s. While some forms of real-world risky behavior peak at a later age than predicted, this likely reflects differential opportunities for risk-taking in late adolescence and young adulthood, rather than neurobiological differences that make this age group more reckless. Although it is admittedly an oversimplification, as a heuristic device, the dual systems model provides a far more accurate account of adolescent risk taking than prior models that have attributed adolescent recklessness to cognitive deficiencies.