Diabetes Care and Mental Health During the COVID-19 Pandemic: Perspectives of Adolescents with Diabetes, Parents, and Providers.

This study explored ways in which the COVID-19 pandemic impacted adolescents' diabetes management and psychosocial functioning, and how adolescents, parents, and providers viewed telemedicine. We present data from three studies: (1) a comparison of psychosocial functioning and glycemic levels before and after pandemic onset (n = 120 adolescents; 89% with type 1 diabetes), (2) an online survey of parents about pandemic-related stressors (n = 141), and (3) qualitative interviews with adolescents, parents, and medical providers about the pandemic's impacts on adolescents' diabetes care and mental health (n = 13 parent-adolescent dyads; 7 medical providers). Results suggested some adverse effects, including disrupting routines related to health behaviors and psychosocial functioning and impairing adolescents' quality of life. Despite these challenges, most participants did not endorse significant impacts. Some even noted benefits, such as increased parental supervision of diabetes management that can be leveraged beyond the pandemic. Furthermore, telemedicine offers benefits to continuity of diabetes care but presents challenges to care quality. These findings underscore the varied and unique impacts of the COVID-19 pandemic on adolescents with diabetes.

The relationship between health worry, work distress, and affective symptoms during the COVID-19 pandemic: The mediating role of hopelessness and helplessness.

OBJECTIVES: The COVID-19 pandemic presented both serious health threats and economic hardships, which were reflected in increased rates of mood and anxiety symptoms. We examined two separate distress domains, health worries and work distress, as predictors of mood and anxiety symptoms. Additionally, we considered whether these two domains might be uniquely associated with the development of dysfunctional beliefs, as a proposed mechanism to account for increased symptoms during the pandemic. Two separate models were considered to examine if associations remained stable through the first year of the pandemic. METHODS: Participants (N = 2152) were a representative sample of Florida adults. They completed online surveys at three waves: Wave 1 (April-May 2020), Wave 2 (May-June 2020), and Wave 3 (December-February 2021). Participants completed measures of COVID-19 health worry and work distress, anxiety, and depression. They also reported their level of hopelessness and helplessness (indices of dysfunctional beliefs). RESULTS: In an early pandemic model (Wave 1-Wave 2), health worry directly and indirectly predicted anxiety and depression via dysfunctional beliefs. In contrast, work distress only indirectly predicted both outcomes. In a longer-term model (Wave 2-Wave 3), health worry had direct and indirect effects on downstream anxiety but not depression. Pandemic work distress had no effect on depression or dysfunctional beliefs; however, it was associated with less anxiety. CONCLUSIONS: Although health worry and work distress predicted later symptoms of anxiety and depression, they appeared to operate through different pathways. These findings provide guidance for the development of more effective interventions to reduce the impact of pandemics.

Patient and Provider Views on Psychosocial Screening in a Comprehensive Diabetes Center.

Guidelines recommend routinely screening adults with diabetes for psychological concerns, but few diabetes clinics have adopted screening procedures. This study assessed patient and provider perspectives regarding the role of mental health in diabetes care, psychosocial screening procedures, and patients' support needs. Patients with diabetes (n = 15; 73.3% type 2) and their medical providers (n = 11) participated in qualitative interviews. Thematic content analysis was used to categorize results. Participants believed that mental health was important to address within comprehensive diabetes care. Patients expressed positive or neutral opinions about psychosocial screening. Providers had mixed reactions; many thought that screening would be too time-consuming. Both groups emphasized that screening must include referral procedures to direct patients to mental health services. Patients and providers interviewed in this study viewed psychosocial screening as compatible with diabetes care. Including a mental health professional on the treatment team could reduce potential burden on other team members.

Psychosocial screening in a pediatric diabetes clinic: Adolescents' and mothers' perspectives.

OBJECTIVE: Adolescents with type 1 diabetes (T1D) frequently experience psychosocial concerns, and mental health screening is becoming increasingly common in routine diabetes care. However, little is known about what adolescents or their caregivers think about the role of mental health screening and intervention within the context of comprehensive diabetes care, or how their diabetes care providers should be involved in navigating mental health concerns. This study used qualitative methods to obtain the perspectives of adolescents with T1D and their caregivers regarding these issues. METHODS: Participants were 13 adolescents with T1D (ages 12-19 years; M = 15.1 years; 53.8% female; 61.5% Hispanic/Latinx White) and 13 mothers, recruited from an outpatient pediatric endocrinology clinic in South Florida, who participated in semi-structured interviews via video teleconference. Thematic content analysis was used to evaluate participants' responses. RESULTS: Adolescents and their mothers reported positive experiences with the clinic's psychosocial screening procedures and appreciated meeting with the psychology team during visits. They wanted the clinic to offer more opportunities for peer support. Mothers highlighted barriers to seeking mental health care outside of the clinic and the importance of mental health professionals understanding diabetes. Mothers also wanted the clinic to offer more on-site therapeutic services. DISCUSSION: Study participants valued psychosocial screening and supported addressing mental health as a routine part of diabetes comprehensive care.

Formative Development of a Technology-Based Physical Activity Intervention for Grandparents and Grandchildren.

Physical inactivity is a major public health issue among older adults and children. This study presents preliminary results that will inform the development of a technology-based physical activity intervention for grandparents and grandchildren (ages 6-12 years old). The authors used an iterative user-centered design framework to gather quantitative data from grandparents (n = 35) and subsequently invited a subset of 12 of them to engage in qualitative interviews. Participants were 63.1 ± 9.8 years old, 80% female, 64% U.S.-born, 43% Hispanic, 66% single, and 40% <$15K income. The majority of grandparents reported mobile device proficiency, very close relationships with their grandchildren, and interest in participating in an intergenerational intervention. Four key themes related to family closeness, dynamics, routines, and technology informed intervention development. Next steps involved a pilot trial using Fitbits and a fully functioning technology-based prototype. Grandparents are uniquely positioned within their families to serve as agents of change in health-promoting interventions.

Lessons from a longitudinal community-based investigation of adherence to guidelines and intent to vaccinate during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic is a major public health challenge. The US Centers for Disease Control published guidelines early in the pandemic emphasizing practicing good hygiene and staying at home, which were later modified. PURPOSE: Using a community sample of 2152 participants in the state of Florida who responded to a series of online surveys, we tested a prediction model of adherence to guidelines and intent to vaccinate during the COVID-19 pandemic. METHODS: Participants were assessed in May 2020, June 2020, and January 2021. Predictors included sociodemographic and psychological variables. RESULTS: A slight decrease in adherence was reported over time. In multivariate models, older age, female sex, having health insurance, greater knowledge about COVID-19, more worry, less loneliness, and greater confidence and trust in COVID-19 information were all significantly and consistently associated with greater adherence to guidelines. Significant predictors of intent to vaccinate were male sex, greater knowledge, higher socioeconomic status, identifying as White, and greater guideline adherence (p's < 0.05). CONCLUSIONS: Our findings highlight a number of significant predictors, including knowledge, loneliness, and confidence/trust. Critically these variables are modifiable and could therefore serve as targets in public health interventions to improve adherence to pandemic guidelines in the general population, as well as certain demographic characteristics that may influence intent to vaccinate. COVID-19 knowledge appears to play a central role in both adherence to guidelines and intent to vaccinate suggesting that having accurate information is critical for appropriate behavior.

Psychosocial and health stressors during the COVID-19 pandemic and their association with sleep quality.

OBJECTIVE: We investigated how psychosocial and health stressors and related cognitive-affective factors were differentially associated with sleep quality during the early months of the COVID-19 pandemic. METHODS AND MEASURES: Adults living in Florida (n = 2,152) completed a Qualtrics survey in April-May 2020 (Wave 1). Participants (n = 831) were reassessed one month later (Wave 2; May-June 2020). At Wave 1, participants reported their level of physical contact with someone they care about, presence of a pre-existing chronic disease, employment status, loneliness, health worry, and financial distress. At Wave 2, participants rated their quality of sleep and insomnia symptoms. RESULTS: Loneliness, but not health worry or financial distress, directly predicted worse sleep quality. Lack of physical contact was indirectly associated with worse sleep quality via greater levels of loneliness. Further, results showed the presence of a pre-existing chronic disease was associated with both greater health worry and worse sleep quality. CONCLUSION: Loneliness was the sole cognitive-affective predictor of worse sleep quality when controlling for other psychosocial factors. As expected, adults living with a chronic disease reported impaired sleep quality. Understanding the processes influencing sleep quality during a significant time of stress is important for identifying risk factors, informing treatment, and improving sleep health beyond the pandemic.

The Effects of Parent-Adolescent Acculturation Gaps on Adolescent Lifestyle Behaviors: Moderating Role of Family Communication.

Objectives: This study examined 1) associations between parent-adolescent acculturation gaps in Americanism and Hispanicism and adolescents' lifestyle behaviors (fruit and vegetable intake and physical activity), and 2) the moderating roles of adolescent- and parent-reported family communication on these associations. Methods: Hispanic adolescents who have overweight or obesity (n=280; 52% female, 13.0±0.8 years old) and their parents (88% female, 44.9±6.5 years old) completed baseline measures on acculturation, family communication, weekly physical activity, and daily fruit and vegetable intake as part of their participation in a family-based health promotion efficacy trial. Acculturation gaps were calculated by taking the product of adolescent and parent scores for each subscale (Americanism and Hispanicism). We conducted multiple linear regression analyses with three-way interaction terms (e.g., parent Americanism x adolescent Americanism x family communication) to assess for moderation. Results: Family communication significantly moderated the association between parent-adolescent acculturation gaps in Americanism and adolescent fruit and vegetable intake. For families with low adolescent-reported family communication, parent-adolescent discrepancies in Americanism were associated with lower adolescent fruit and vegetable intake whereas there were no significant associations for families with high family communication. There were no effects on weekly minutes of physical activity. Acculturation gaps in Hispanicism were not significantly associated with either outcome. Conclusions: Findings highlight the importance of parent-adolescent acculturation gaps and family communication on fruit and vegetable intake for Hispanic adolescents. Targeting parent-adolescent acculturation gaps for families with low levels of communication may be important to improve dietary behaviors in Hispanic adolescents, who are already disproportionately affected by obesity.

Objetivos: El siguiente estudio tiene como objetivo examinar 1) las asociaciones de las brechas de aculturación padre-adolescente en americanismo e hispanismo sobre comportamiento en el estilo de vida de los adolescentes (ingesta de frutas y verduras, y actividad física), 2) y el efecto moderador de la comunicación familiar reportada por padres y adolescentes sobre estas asociaciones. Métodos: Como parte de su participación para un estudio de eficacia de una intervención familiar para la promoción a la salud, adolescentes hispanos con sobrepeso u obesidad (n=280; 52% mujeres, 13,0 ± 0,8 años), y sus padres (88% mujeres, 44,9 ± 6,5 años) completaron cuestionarios de aculturación, comunicación familiar, actividad física semanal e ingesta diaria de frutas y verduras como parte de medidas de base.Las brechas de aculturación se calcularon tomando el producto de las puntuaciones de los adolescentes y los padres para cada sub-escala (americanismo e hispanismo). Para evaluar el efecto moderador, se realizaron análisis de regresión lineal múltiple con términos de interacción de tres vías (p. ej., americanismo de los padres x americanismo del adolescente x comunicación familiar). Resultados: La comunicación familiar moderó significativamente la asociación entre las brechas de aculturación entre padres e hijos adolescentes en el americanismo, y el consumo de frutas y verduras por parte de los adolescentes. Para las familias con baja comunicación familiar reportada por los adolescentes, las discrepancias entre padres y adolescentes en el americanismo se asociaron con una menor ingesta de frutas y verduras en los adolescentes, mientras que no hubo asociaciones significativas para las familias con alta comunicación familiar; tampoco se encontró asociación en los efectos sobre los minutos semanales de actividad física. Las brechas de aculturación en el hispanismo no se asociaron significativamente con ninguno de los resultados. Conclusiones: Los hallazgos hacen énfasis a la importancia de las brechas de aculturación entre padres y adolescentes al igual que a la importancia de la comunicación familiar, sobre el consumo de frutas y verduras en los adolescentes hispanos. Impactar en las brechas de aculturación entre padres y adolescentes en familias con bajo nivele de comunicación puede ser importante para mejorar los comportamientos alimentarios en los adolescentes hispanos, que ya, estos, se ven afectados de manera desproporcionada por la obesidad.

The Effects of Parental Stress on Physical Activity Among Overweight and Obese Hispanic Adolescents: Moderating Role of Family Communication and Gender.

BACKGROUND: Previous literature has shown a negative relationship between parental stress and youth moderate to vigorous physical activity (MVPA). This study examined (1) the relationship between parental stress and adolescent MVPA, (2) the moderating role of family communication on this relationship, and (3) gender differences in these effects among overweight and obese Hispanic adolescents. METHODS: Hispanic adolescents (N = 280, 52% female, 13.0 [0.8] y old, 44% obese, 12% severely obese) and their parents (88% female, 44.9 [6.5] y old) completed baseline measures for an efficacy trial. Adolescents self-reported MVPA in minutes per week for work, transportation, and recreation using a validated measure. Multiple regression analyses with interaction terms and multigroup methods were conducted. RESULTS: There was a negative effect of parental stress on adolescent MVPA (ß = -0.15, t = -2.018, P ≤ .05). This effect was moderated by family communication (ß = 0.20, t = 2.471, P = .01), such that the association between parental stress and youth MVPA was stronger for adolescents with low levels of family communication. Furthermore, a multiple group model showed that the interaction was significant for boys (ß = 0.27, t = 2.185, P = .03), but not for girls. CONCLUSIONS: Findings provide support that addressing parental stress and family communication may help facilitate MVPA among Hispanic boys, the most at-risk group for pediatric obesity.