Longitudinal health endangering behavior risk among resilient and nonresilient early adolescents.

PURPOSE: To explore the relative likelihood of engaging in new health-endangering behaviors among a group of resilient early adolescents compared to a sample of nonresilient peers and a sample of normal, low-risk peers in a nonclinical, school-based setting. METHODS: Resilient adolescents and their peer groups were identified by way of a multiple linear regression equation in which age, family structure (single or step-parent family), gender, self-injurious behaviors, and emotional risk were used to predict propensity to initiate risky health behaviors. The resilient sample consisted of those adolescents who were predicted to be above the standardized mean, yet actually scored below it. The nonresilient population included those who were predicted to and actually scored above the standardized mean. The normal, low-risk population consists of adolescents who were predicted to and scored below the standardized mean. The mean age for all populations was 13.78 years. All students completed a Health Behavior Questionnaire and the Rosenberg Self-Esteem Inventory. RESULTS: Odds ratios with 95% confidence intervals revealed that in the year following identification as resilient, nonresilient, or normal, the resilient adolescents were less likely than the nonresilient adolescents to initiate a variety of risky behaviors. At the same time, the resilient adolescents were more likely than their normal, not at-risk peers to have initiated those same risky behaviors. The resilient adolescents have modestly higher mean self-esteem than the nonresilient peers (t = 2.47, p < 0.05) but lower self-esteem than their normal, not at-risk peers (t = 3.66, p < 0.01). CONCLUSIONS: Determination of resilience status by way of multiple linear regression yielded identifiable groups which conformed to expected elevated risk of initiating new risky behaviors relative to normal, not at-risk peers but lowered risk relative to nonresilient peers. Differences were most notable with reference to new reports of substance use. The lower rate of initiating new risky behaviors among resilient relative to nonresilient peers is seen as a reflection of behavioral competence in an adverse context. However, the elevated rate of initiating new risky behaviors among resilient relative to normal, not at-risk peers is seen as a reflection of the continuing, negative impact of that adverse context.

The contribution of level of cognitive complexity and pubertal timing to behavioral risk in young adolescents.

PURPOSE: To determine the unique contributions of cognitive complexity and pubertal timing to participation in behavioral risk (substance use, sexual activity, school and legal problems) among young adolescents. DESIGN: Cross-sectional with cohort replication. METHODS: Two cohorts of middle school students in grades eight and nine in a midwestern school district completed a self-report questionnaire in 1987 and 1989. Measures of behavioral and emotional risk, cognitive complexity and pubertal timing relative to peers were included. RESULTS: Complete data were available for 817 and 796 students in each cohort year. Gender, race, level of cognitive complexity and pubertal timing each contributed significantly to the variance in behavioral risk independent of chronological age (P < .0001). Boys, whites, those at lower levels of cognitive complexity and those who began pubertal maturation earlier than peers, were at significantly greater risk. Adolescents who demonstrated higher levels of cognitive complexity and those who began puberty later compared to peers participated in a smaller array of risk behaviors, independent of chronological age. IMPLICATIONS: Pediatricians should consider adolescents at lower levels of cognitive complexity (concrete thinking) and those who begin puberty earlier at greater risk for participation in health risk behaviors. Preventive health counseling tailored to the needs of this group may be most beneficial.

Parents of children with diabetes: what are they worried about?

Parental worries, specific to having a child with diabetes, have been associated with poor diabetes control. This study addressed three questions relating to this issue: Does parental worry affect the metabolic control of the child with IDDM? What specific aspects of diabetes are the most worrisome to parents? Do these concerns change with the child's age and disease duration? Parents of 93 children with IDDM were given a modified version of the Diabetes Quality of Life measure to evaluate diabetes-specific worries. No correlation was found between parental worry and the child's metabolic control. Parents of younger children expressed the largest amount of worry, yet the kinds of things that parents were most concerned about were the same, regardless of age or duration of the child's disease.

A modified quality-of-life measure for youths: psychometric properties.

In the Diabetes Control and Complication Trial (DCCT), a Diabetes Quality of Life (DQOL) measure was developed to assess the psychosocial impact of intensified regimens. Its applicability for use with children and adolescents was limited by the exclusion criteria of the DCCT. In this study, the DQOL was modified for specific use in young diabetes populations. The result is an instrument composed of three intercorrelated scales--a Diabetes Life Satisfaction scale, a Disease Impact scale, and a Disease-Related Worries scale--with satisfactory levels of reliability. While the scale variances were independent of glycosylated hemoglobin values, they were related to adolescents' perception of their general health status. Self-perceived quality of life related to diabetes management is an important alternative outcome for diabetes education programs.

Behavioral risk, emotional risk, and child abuse among adolescents in a nonclinical setting.

In this replication study of adolescents in a nonclinical setting, the prevalence of reported problem behaviors, emotions, and abuse is evaluated, and the impact of abuse on multivariate emotional and behavioral risk is assessed. A total of 3998 students (69%) in a rural midwestern community in grades 7 to 12 participated in the study. Almost 20% of the students reported some form of physical and/or sexual abuse, with more girls than boys reporting sexual abuse (chi 2 = 48.5, P less than .001). Some problem behaviors (alcohol use) and emotions (trouble sleeping, difficulty with anger) were common among all adolescents and some were strongly associated with a history of abuse (especially, considering or attempting suicide, running away, laxative use, and vomiting to lose weight). Higher emotional and behavioral risk scores among abused students were confirmed. The effects of physical and sexual abuse on risk scores were independent and additive; no interaction was observed. An interaction of gender and sexual abuse on problem behavior was observed, with problem behavior being significantly greater among sexually abused boys. The results confirm increased risk of problem behaviors and negative feelings among abused adolescents when compared with nonabused peers, and better define influences of gender and abuse type on emotional and behavioral risks.

Pediatrics residents' attitudes about insulin-dependent diabetes mellitus and children with diabetes.

Nationwide, pediatricians provide a substantial portion of the health care of children with diabetes. Their beliefs and attitudes about diabetes and children with the illness have an important influence on their treatment decisions. The attitudes and beliefs of a 1988 sample of pediatrics residents were compared with data from a 1987 national survey of practicing pediatricians' beliefs and attitudes about children with insulin-dependent diabetes mellitus and about the disease itself. Pediatrics residents in their second and third years of training were considerably more negative about diabetes and diabetic children than were either the members of the national sample of practicing pediatricians or the residents' first-year colleagues.

Management of diabetes in pediatric resident continuity clinics.

General pediatricians provide comprehensive care for many children with insulin-dependent diabetes mellitus. To assess and improve our ambulatory training program, we first evaluated diabetes-specific care behaviors by residents in their continuity clinics and then introduced a structured visit encounter form. Based on established guidelines provided to the residents, a chart audit indicated appropriate measurement of glycosylated hemoglobin 40% of the time, cholesterol 90% of the time, urine protein 50% of the time, and thyroxine 66.7% of the time. Height was plotted 23% of the time, blood pressure was noted 66% of the time, and ophthalmologic referrals were documented 60% of the time. Requests for assistance from nonphysician members of a multidisciplinary diabetes team were minimal. After introduction of the structured visit encounter form, care behaviors did not improve. New training approaches to prepare general pediatric residents to provide excellent diabetes care are needed.

Pediatric endocrinologic recommendations, pediatric practice, and current pediatric training regarding care of children with diabetes.

Many pediatric diabetes patients are cared for by community-based pediatricians. Training for pediatricians in optimal diabetes care should be based on both the recommendations of pediatric endocrinologists regarding optimal care and the practices of general pediatricians. Pediatric endocrinologists, general pediatricians, and pediatric residency coordinators were surveyed to assess the consonance of current recommendations, practices, and training in pediatric diabetes care. Not surprisingly, pediatric endocrinologists recommended more subspecialty care than pediatricians reported practicing. A major difference between endocrinologists and pediatricians emerged in the area of psychosocial support. A total of 85% of endocrinologists answered that there should be a mental health diabetes team member, but only 37% of pediatricians reported often or sometimes working with one to develop care plans. Pediatricians who provide complete diabetes care for most of their patients measure frequent glycosylated hemoglobin levels, obtain yearly lipid measurements marginally less often, and use urinary glucose measurements more often than recommended by pediatric endocrinologists. According to the descriptions of most pediatric residency training programs, multidisciplinary teams include a pediatrician, an endocrinologist, and a dietician. However, 25% do not include a social worker or nurse and 70% do not include a psychologist. Although most training programs operate on the assumption that their trainees will ultimately share responsibility with a subspecialist for diabetes care, in 26% of programs residents saw no diabetics in their continuity clinics. Most residents do not participate in providing diabetes education.(ABSTRACT TRUNCATED AT 250 WORDS)

Longitudinal relationship of asymptomatic hypoglycemia to cognitive function in IDDM.

Early-onset insulin-dependent diabetes mellitus (IDDM) is linked to subsequent learning deficits. To investigate the relationship of learning deficits to metabolic control, 23 children with IDDM (age at testing 71 +/- 21 mo, age at diagnosis 35 +/- 15 mo) diagnosed before 5 yr of age were followed for periods of 6-78 mo. Mean glycosylated hemoglobin (HbA1), episodes of severe hypoglycemia, and frequency of self-monitoring blood glucose (SMBG) measurements less than 2.8 mM (50 mg/dl, asymptomatic hypoglycemia) were recorded every 3 mo. Six subjects entered the study 12.3 +/- 6.7 mo after diagnosis, and only severe hypoglycemia was present before entry. For the remaining 17 subjects, HbA1 and severe and asymptomatic hypoglycemia were present from the time of diagnosis of diabetes. Mean HbA1 level was 10.1 +/- 1.0%, and mean severe hypoglycemic episodes per patient was 2.9, but the frequency was highly skewed; one patient had 37 episodes, and 14 had none. The mean percentage of SMBG readings less than 2.8 mM was 2.4 +/- 2.1. On the revised Stanford-Binet Intelligence Scale there was no correlation between any subscale and severe hypoglycemia. However, the relative frequency of asymptomatic hypoglycemia correlated with scores on the abstract/visual reasoning scale (r = -.39, P = .037). This relationship was primarily accounted for by the relationship of asymptomatic hypoglycemia to performance on the copying subscale (r = -.42, P = .022). Children with frequent asymptomatic hypoglycemic episodes had lower mean copying scores and abstract reasoning scores than those with infrequent episodes.(ABSTRACT TRUNCATED AT 250 WORDS)

Reported sexual behaviors and self-esteem among young adolescents.

Six hundred seventy-seven adolescents in grades 7 through 9 of a blue-collar, midwestern junior high school responded to a survey of sexual behavior and self-esteem. The focus of this study was on the relationship between sexual experience and self-esteem. Fifty-five percent of the students reported having had at least one coital experience; 7% reported having intercourse about once a week. The proportion of sexually experienced adolescents increased with age; 28% of 12-year-olds, 52.7% of 13-year-olds, 60.1% of 14-year-olds, 73.6% of 15-year-olds, and 90% of 16-year-olds reported having intercourse on at least one occasion. More boys of all ages were sexually active than girls. Six percent of students had had, or were suspicious of having had, a sexually transmitted disease; 7.8% were involved in a pregnancy. The average of the self-esteem scores for girls was significantly lower than the average for boys. There was an interaction effect between gender and coital history for self-esteem. Girls who reported having had intercourse had lower self-esteem scores than those who did not. On the other hand, self-esteem of sexually experienced and inexperienced boys did not differ, nor did self-esteem of virginal boys and girls. Boys and girls with a history of sexually transmitted diseases had lower self-esteem than all others. Pregnancy, on the other hand, did not seem to affect self-esteem of the sexually experienced adolescents. This cross-sectional study does not permit determination of whether the lower average self-esteem among certain girls was antecedent to or a consequence of sexual experience.

Effects of marital conflict and family structure on the self-concepts of pre- and early adolescents.

This study explored the effects of marital conflict and family structure on the self-concepts of youth aged 8-12. Subjects were 16 mother-youth pairs from intact parent families (IP) and 17 mother-youth pairs from separated parent families (SP). Results revealed youth in families with low marital hostility and high marital affection had significantly more positive self-concepts. Analyses suggested differences between IP and SP groups may best be explained by differences in marital hostility. The authors discuss the effects of marital discord on parenting within an ecosystems perspective.

Cognitive maturity and self-management among adolescents with insulin-dependent diabetes mellitus.

The ability of adolescents with insulin-dependent diabetes mellitus (IDDM) to assume responsibility for self-management is complicated by normal psychosocial developmental tasks, including establishing independence from authority. We evaluated self-managerial behavior and its relation to cognitive maturity. Forty-one adolescents with IDDM (age range 12 to 21 years) and their parents, who were trained to self-adjust insulin on compensatory and anticipatory bases, participated. The data indicated that parents withdrew from the insulin adjustment process as their adolescents grew older. Parental participation had virtually ceased by the time the child reached age 15 years. Parental withdrawal, however, was not always balanced by the adolescent's assumption of responsibility for insulin adjustments. Older adolescents were statistically no more likely than younger adolescents to self-adjust insulin doses. Both self-adjustment and metabolic control (HbA1 values) among adolescents were, however, related to cognitive maturity. More cognitively mature adolescents were also more likely to perceive themselves as being in control of their illness. Thus, older adolescents who are less cognitively mature than their peers are sometimes given responsibility for self-managerial behaviors that they are unable to assume.

Management of diabetes mellitus in children younger than 5 years of age.

Optimal treatment for children younger than 5 years of age with insulin-dependent diabetes mellitus is not well defined. Nineteen young children with this disease were treated with a program in which frequent home blood-glucose monitoring was used as the basis for an educational program emphasizing parental adjustment of insulin in response to current glucose levels and anticipated diet and exercise. Eleven children were treated from diagnosis (group I) and another eight (group D) were referred after less intensive treatment. The mean duration of observation of group I children was 13.6 months (range, six to 24 months). For group D, the mean time between diagnosis and referral was 14.9 months (range, seven to 24 months) and 14.6 months (range, six to 24 months) after referral. Before referral, there were 11 hospitalizations in group D. During the intensified program there were two hospitalizations in group D and one in group I. There were 3.3 episodes of severe hypoglycemia per child per 18 months in group D before referral, 1.7 episodes after referral, and 0.4 episodes in group I. Ten of 14 severe hypoglycemic episodes during intensified treatment occurred when there was no or infrequent home blood-glucose monitoring. Only four episodes seemed to have been unpredictable and unpreventable. Mean glycosylated hemoglobin levels were higher in group D patients when compared with both the duration of insulin-dependent diabetes mellitus and the time of initiation of intensified treatment. Mean daily insulin doses increased progressively in group I patients following diagnosis, and were comparable with those in group D patients at 15 and 18 months' duration of illness. Thus, frequency of hospitalization and severe hypoglycemia can be decreased in young children. Frequent home blood-glucose monitoring is required and extensive educational and psychosocial support is necessary for families to implement this intensive approach. The long-term effects on psychoneurological development need evaluation.