PedsQL 3.2 Diabetes Module for Children, Adolescents, and Young Adults: Reliability and Validity in Type 1 Diabetes.

OBJECTIVE: The objective of the study was to report on the measurement properties of the revised and updated Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module for children, adolescents, and young adults with type 1 diabetes. RESEARCH DESIGN AND METHODS: The 33-item PedsQL 3.2 Diabetes Module and PedsQL Generic Core Scales were completed in a 10-site national field test study by 656 families of patients ages 2-25 years with type 1 diabetes. RESULTS: The 15-item Diabetes Symptoms Summary Score and 18-item Diabetes Management Summary Score were derived from the factor analysis of the items. The Diabetes Symptoms and Diabetes Management Summary Scores evidenced excellent reliability (patient self-report α = 0.88-0.90; parent proxy report α = 0.89-0.90). The Diabetes Symptoms and Diabetes Management Summary Scores demonstrated construct validity through medium to large effect size correlations with the Generic Core Scales Total Scale Score (r = 0.43-0.67, P < 0.001). HbA1c was significantly correlated with the Diabetes Symptoms and Diabetes Management Summary Scores (r = -0.21 to -0.29, P < 0.001). Minimal clinically important difference scores ranged from 5.05 to 5.55. CONCLUSIONS: The PedsQL 3.2 Diabetes Module Diabetes Symptoms and Diabetes Management Summary Scores demonstrated excellent measurement properties and may be useful as standardized patient-reported outcomes of diabetes symptoms and diabetes management in clinical research, clinical trials, and practice in children, adolescents, and young adults with type 1 diabetes.

Diabetes management mediating effects between diabetes symptoms and health-related quality of life in adolescents and young adults with type 1 diabetes.

OBJECTIVES: The primary objective was to investigate the mediating effects of diabetes management in the relationship between diabetes symptoms and generic health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with type 1 diabetes. The secondary objective explored patient health communication and perceived treatment adherence barriers as mediators in a serial multiple mediator model. METHODS: The PedsQL 3.2 Diabetes Module 15-item diabetes symptoms summary score, 18-item diabetes management summary score, and PedsQL 4.0 generic core scales were completed in a 10-site national field test study by 418 AYA aged 13 to 25 years with type 1 diabetes. Diabetes symptoms and diabetes management were tested for bivariate and multivariate linear associations with overall generic HRQOL. Mediational analyses were conducted to test the hypothesized mediating effects of diabetes management as an intervening variable between diabetes symptoms and generic HRQOL. RESULTS: The predictive effects of diabetes symptoms on HRQOL were mediated in part by diabetes management. In predictive analytics models utilizing multiple regression analyses, demographic and clinical covariates, diabetes symptoms, and diabetes management significantly accounted for 53% of the variance in generic HRQOL (P < 0.001), demonstrating a large effect size. Patient health communication and perceived treatment adherence barriers were significant mediators in an exploratory serial multiple mediator model. CONCLUSIONS: Diabetes management explains in part the effects of diabetes symptoms on HRQOL in AYA with type 1 diabetes. Patient health communication to healthcare providers and perceived treatment adherence barriers further explain the mechanism in the relationship between diabetes symptoms and overall HRQOL.

Diabetes symptoms predictors of health-related quality of life in adolescents and young adults with type 1 or type 2 diabetes.

OBJECTIVES: The objective was to investigate the patient-reported diabetes symptoms predictors of generic health-related quality of life (HRQOL) in adolescents and young adults (AYA) with type 1 or type 2 diabetes. METHODS: The 15-item PedsQL™ 3.2 Diabetes Module Diabetes Symptoms Summary Score and PedsQL™ 4.0 Generic Core Scales were completed in a 10-site national field test study by 513 AYA ages 13-25 years with type 1 (n = 424) or type 2 (n = 89) diabetes. Diabetes symptoms were tested for bivariate and multivariate linear associations with generic HRQOL. RESULTS: Diabetes symptoms were associated with decreased HRQOL in bivariate analyses. In predictive analytics models utilizing hierarchical multiple regression analyses controlling for relevant demographic and clinical covariates, diabetes symptoms accounted for 38 and 39% of the variance in patient-reported generic HRQOL for type 1 and type 2 diabetes, respectively, reflecting large effect sizes. The diabetes symptoms facets hyperglycemia symptoms, hypoglycemia symptoms, and nonspecific diabetes symptoms individually accounted for a significant percentage of the variance in separate exploratory predictive analytics models after controlling for demographic and clinical covariates, with small-to-large effect sizes. CONCLUSIONS: Diabetes symptoms are potentially modifiable predictors of generic HRQOL in AYA with diabetes. Identifying specific diabetes symptoms or symptoms facets that are the most important predictors from the patient perspective facilitates a patient-centered approach in clinical research, clinical trials, and practice designed to enhance overall generic HRQOL in AYA with diabetes.

Ethnicity as a moderator of how parents' attitudes and perceived stigma influence intentions to seek child mental health services.

OBJECTIVE: Research has identified several variables that affect utilization of mental health services. However, more could be explored regarding ethnic differences among parents seeking help for their children. METHOD: In our study, 238 caregivers were recruited from the southern United States to examine ethnic differences in intentions to access child mental health services with the Parental Attitudes Toward Psychological Services Inventory (Turner, 2012) as the primary measure. RESULTS: Group comparisons indicated that African-American parents reported less positive attitudes and more stigma than European-American or Hispanic-American parents. Moderation analyses found (a) attitudes were associated with a higher level of parental help-seeking intention among European Americans, but not among African Americans or Hispanic Americans and (b) stigma was associated with a lower parent-reported likelihood of help-seeking for Hispanic Americans, but not for European Americans or African Americans. CONCLUSIONS: Ethnicity deferentially impacts attitudes and stigma associated with seeking mental health services. Public education efforts to increase service use should be tailored toward under-served groups to be more effective.

Parent and peer influence on recreational use of pain medication: are their influences similar to that of marijuana use?

Parent and peer disapproval were examined as potential predictors of recreational use of over-the-counter (OTC) and prescription pain medication. Risk perception was studied as a potential mediator of the effects of parent and peer disapproval. Four hundred and sixty-five college students (M age = 18.57, SD = 0.86) were recruited between September 2009 and September 2010. Participants completed an online survey about their recreational medication use, other substance use, and correlates of use. Path analyses showed that predictors of OTC and prescription pain medication recreational use are largely similar to predictors of marijuana use in college students such that risk perception mediated both the effect of parent and peer disapproval on dichotomous misuse, and peer disapproval had a significant direct effect on dichotomous misuse. Prevention interventions for recreational use of pain medication should target risk perception and peer disapproval.

Understanding nonprescription and prescription drug misuse in late adolescence/young adulthood.

This study explored the extent to which nonprescription and prescription drugs misuse among adolescents/young adults are related to their perception that it is safer than illicit drugs, ease of access, and lower societal stigma. Adolescents/young adults (N = 465; M age = 18.57, SD = 0.86) completed an online survey about their nonprescription and prescription drug misuse, other substance use, and correlates of use. Perceived risk, societal stigma, and access to nonprescription and prescription drugs were predictive of misuse. Results support program planners working towards targeting perceived risk and societal stigma in reducing misuse and the need to restrict and monitor access to nonprescription and prescription drugs for adolescents/young adults.

A parent-focused pilot intervention to increase parent health literacy and healthy lifestyle choices for young children and families.

Health literacy affects caregivers' ability to engage in preventive health care behaviors for themselves and their children. Studies suggest that health literacy among low-income families needs improvement, and this possibly contributes to disparities in preventive health care rates. Additionally, parents and caregivers may not be able to provide or seek preventive health care for their children because of lack of knowledge and skills to do so effectively. This study designed and piloted an intervention that delivered to parents of young children (1) health literacy information in an experiential manner and (2) practical skills to engage their families in healthy lifestyle choices. Specifically, the intervention focused on diet/nutrition, physical activity, sleep hygiene, parenting, and mental wellness. Postintervention improvements were noted for factual knowledge for diet/nutrition, physical activity, and sleep, beliefs about diet/nutrition, and the relationship between mental health and stress. Additionally, postintervention improvements were noted for general knowledge and beliefs about sleep, knowledge about the relationship between sleep and health, knowledge about common childhood sleep problems, and parents' bedtime interactions with children. The efficacy of the intervention should be evaluated on a larger, more diverse sample in the future with considerations for multiple health behavior change in the evaluation.

Impact of growing up with a chronically ill sibling on well siblings' late adolescent functioning.

The purpose of this study was to explore the continuing impact of growing up with an ill sibling on well siblings' late adolescent functioning. Forty late adolescents (M age = 18.78, SD = 0.83), who identified themselves as growing up with an ill sibling, completed a semistructured interview, demographic questionnaire, Personality Assessment Screener, and My Feelings and Concerns Sibling Questionnaire. Participants reported clinically significant problems on some PAS scales, and gender differences were found for acting out and alienation. Significant relationships were reported for communication and social withdrawal and alienation. Both positive and negative themes about the experience were elicited from the responses in the semistructured interview. This study provides evidence for some lingering negative effects of growing up with an ill sibling on well siblings' late adolescent functioning. Additionally, evidence for siblings' development of positive characteristics that may act as protective variables as they face the stressors of late adolescence was also highlighted.

Perceptions of preventive health care and healthy lifestyle choices for low income families: a qualitative study.

This paper examines Head Start parents' perceptions of preventive health and healthy lifestyle choices and Head Start administrators' perceptions of the needs of parents they serve. To address the preventive health of the population, it is necessary that we explore perceptions, risks, and protective factors of preventive health. Focus groups were conducted with parents and administrators to elicit this information and to obtain suggestions for improving preventive health and healthy lifestyle choices among this group. Overall, nutrition and physical activity emerged as themes in parents' definition of preventive health and healthy lifestyle choices. They further identified social support and education as major protective factors for engaging in preventive health and healthy lifestyle choices. Results of this study can be used to inform research and practice to develop interventions to increase preventive health and healthy lifestyle choices among low income families.

Patient-reported Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales in pediatric patients with attention-deficit/hyperactivity disorder and comorbid psychiatric disorders: feasibility, reliability, and validity.

OBJECTIVES: The primary objective of the study was to evaluate the feasibility, reliability, and validity of the Pediatric Quality of Life Inventory™ (PedsQL) 4.0 Generic Core Scales as a patient self-reported health-related quality of life measurement instrument in pediatric patients with attention-deficit/hyperactivity disorder (ADHD) and physician-diagnosed comorbid psychiatric disorders being seen in a pediatric psychiatric clinic. The secondary objective was to evaluate parent proxy-reported PedsQL in this population. METHODS: One hundred seventy-nine children with ADHD and comorbid psychiatric disorders ages 5 to 18 years and 181 parents completed the PedsQL 4.0 Generic Core Scales and parents also completed the Vanderbilt ADHD Diagnostic Rating Scales. Known-groups discriminant validity comparisons were made between the sample of pediatric patients with ADHD and comorbid psychiatric disorders and healthy, cancer, and type 1 diabetes samples. RESULTS: The PedsQL evidenced minimal missing responses for patient self-report and parent proxy-report (0.2% and 0.5%, respectively), demonstrated no significant floor or ceiling effects, and achieved excellent reliability for the Total Scale Score (α = 0.85 patient self-report, 0.92 parent proxy-report). Pediatric patients with ADHD and comorbid psychiatric disorders and their parents reported statistically significantly worse PedsQL scores than healthy children, with large effect sizes across all domains, supporting known-groups discriminant validity. Pediatric patients with ADHD and comorbid psychiatric disorders and their parents reported worse PedsQL scores compared to pediatric patients with cancer and diabetes with the exception of physical health, in which pediatric cancer patients manifested lower physical health, indicating the relative severe impact of ADHD and comorbid psychiatric disorders. More severe ADHD symptoms were generally associated with more impaired PedsQL scores, supporting construct validity. CONCLUSIONS: These data demonstrate the feasibility, reliability, and validity of patient self-reported PedsQL 4.0 Generic Core Scales in this high risk population of pediatric patients and highlight the profound negative impact of ADHD and comorbid psychiatric disorders on generic health-related quality of life, comparable to or worse than serious pediatric chronic physical diseases.

Dispositional, ecological and biological influences on adolescent tranquilizer, Ritalin, and narcotics misuse.

The primary purpose of this study was to examine the extent to which two of the three sources of risk-taking--dispositional and ecological--in adolescence and demographic variables were related to Ritalin, tranquilizer and narcotics misuse. The secondary aim of this study was to distinguish subgroups of Ritalin, tranquilizer, and narcotics misusers using dispositional, ecological and demographic variables. An archival dataset containing 1672 participants (11-18 years old) was used. Ritalin, tranquilizer, and narcotics misuse were dichotomized and hierarchical logistic regressions were computed for dispositional and ecological sources of risk-taking and demographics. To distinguish subgroups of misusers, hierarchical multinomial regressions were computed. Dispositional, ecological, and demographic variables were related to Ritalin, tranquilizer, and narcotics misuse and distinguished among non-users, experimenters/occasional misusers, and frequent misusers. Prescription drug prevention programs should incorporate demographic, dispositional, and ecological variables and should parallel the guidelines currently used for developing effective substance abuse prevention programs.

The PedsQL™ Infant Scales: feasibility, internal consistency reliability, and validity in healthy and ill infants.

OBJECTIVE: The PedsQL™ (Pediatric Quality of Life Inventory™) is a modular instrument designed to measure health-related quality of life (HRQOL) and disease-specific symptoms in children and adolescents ages 2-18. The new PedsQL™ Infant Scales were designed as a generic HRQOL instrument specifically for healthy and ill infants ages 1-24 months. The objective of this study was to report on the initial feasibility, internal consistency reliability, and validity of the PedsQL™ Infant Scales in healthy, acutely ill, and chronically ill infants. METHODS: The 36-item (ages 1-12 months) and 45-item (ages 13-24 months) PedsQL™ Infant Scales (Physical Functioning, Physical Symptoms, Emotional Functioning, Social Functioning, Cognitive Functioning) were completed by 683 parents of healthy, acutely ill, and chronically ill infants. RESULTS: The PedsQL™ Infant Scales evidenced minimal missing responses, achieved excellent internal consistency reliability for the Total Scale Scores (α = 0.92), distinguished between healthy infants and acutely and chronically ill infants, and demonstrated a confirmatory factor structure largely consistent with the a priori conceptual model. CONCLUSIONS: The results demonstrate the initial measurement properties of the PedsQL™ Infant Scales in healthy and ill infants. The findings suggest that the PedsQL™ Infant Scales may be utilized in the evaluation of generic HRQOL in infants ages 1-24 months.

Using the bioecological model to predict risk perception of marijuana use and reported marijuana use in adolescence.

PURPOSE: The purpose of the study was to investigate the ability of the Bioecological Model (BEM) to predict adolescents' risk perception (RP) of marijuana use and reported marijuana use. The secondary aim of the study was to investigate the extent to which the BEM influenced adolescents' decision-making regarding marijuana use by exploring the BEM's ability to moderate the relationship between adolescents' RP of marijuana use and reported use. METHODS: Systems in the proposed BEM included variables from the literature proven to influence adolescents' health risk behaviors. Hierarchical linear regression was used to predict RP from BEM variables. Hierarchical logistic regressions were used to predict marijuana use from BEM variables and to assess the ability of the BEM to moderate the relationship between RP and reported marijuana use. RESULTS: Three systems in the BEM, Adolescent, Microsystem, and Mesosystem, were predictive of RP and reported marijuana use. At least two variables in each system predicted RP and reported marijuana use. The Mesosystem moderated the relationship between RP and use. CONCLUSION: The combination of the BEM and the HBM provides the unique opportunity to understand adolescents' decision to engage in marijuana use. Because the BEM is viewed as part of a generative process, results here can be used to produce a more integrated HBM specific to adolescence.

Health-related quality of life and cognitive functioning from the perspective of parents of school-aged children with Asperger's Syndrome utilizing the PedsQL.

HRQOL as a multidimensional construct has not been previously investigated in children with Asperger's Syndrome. The objective of the present study was to examine the initial feasibility, reliability, and validity of the PedsQL 4.0 Generic Core Scales and PedsQL Cognitive Functioning Scale parent proxy-report versions in school-aged children with Asperger's Syndrome. The PedsQL evidenced no missing responses (0.0%), achieved excellent reliability for the Generic Core Total Scale score (alpha = 0.82) and Cognitive Functioning Scale (alpha = 0.92), distinguished between children with Asperger's Syndrome and a matched sample of healthy children, and was related to similar constructs on the Asperger Syndrome Diagnostic Scale. The results demonstrate the initial measurement properties of the PedsQL in school-aged children with Asperger's Syndrome.