UT Southwestern School of Health Professions
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Welcome to the UT Southwestern School of Health Profession’s electronic theses and dissertations (ETD) collection. (Note: The school was previously named the UT Southwestern School of Allied Health Sciences.)
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Print theses and dissertations from 1943 to 2004 are located in the Library's Special Collections and Archives (Room E3.314) and are available by appointment. (Note: Former students may request a digitized copy of their work by email, but other users may submit an Interlibrary Loan request.) For more information, contact archives@utsouthwestern.edu.
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Browsing UT Southwestern School of Health Professions by Subject "Adolescent"
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Item ADHD and Medical Correlates of Bullying of Pediatric Neurofibromatosis Patients(2016-08-25) Patel, Sarita; Holland, Alice A.; Faith, Melissa A.; Silver, Cheryl H.Neurofibromatosis Type 1 (NF1) is an autosomal dominant disorder that involves nervous system tumor growth, and it is one of the most frequently occurring genetic disorders. NF1 is a multisystem disease with a complex phenotype. Given the range in severity of presentation in NF1, research has shown that disease severity could impact children's social-emotional functioning. Physical deformities such as tumor growth often are associated with NF1, and as a result, children and adolescents with NF1 may be at greater risk for being victims of bullying by peers. Children with NF1 also tend to have higher rates of Attention-Deficit/Hyperactivity Disorder (ADHD) as compared to children without NF1 (Barton & North, 2004; Martin et al., 2012). Common issues experienced by children with ADHD, such as social immaturity and behavioral dysregulation, may put them at higher risk for both bullying and peer victimization (Wiener & Mak, 2009; Unnever & Cornell, 2003). Overall, the current study found that parentreported ADHD symptoms predicted parent-reported but not self-reported bullying. Furthermore, the current study found that parent-reported ADHD symptoms were more predictive of being bullied than provider-rated severity of physical deformity. Since the present study was the first to examine whether physical appearance and ADHD symptoms may be associated with bullying in children with NF1, the novel information gained from the study may be used to direct future research, educate parents and teachers, and inform the development of interventions specific to the NF1 population.Item Adherence as a Mediating Variable Between Depression and Health Outcomes in Adolescents with Type 1 Diabetes(2013-12-30) Wolfe, Kristin Linette; Wiebe, Deborah J.; Kennard, Beth D.; Germann, JulieAdolescence is often a time of diabetes mismanagement and poor metabolic control in adolescents with type 1 diabetes. Symptoms of depression are related to poor metabolic control, but the mechanism that links them is under debate. Because depression tends to be associated with poorer adherence and poor adherence has been shown to be related to poor metabolic control, it is possible that adherence serves as a mediator between the two. The present study tested this mediation pathway in a sample of adolescents with type 1 diabetes. Participants (N=252) were recruited from endocrinology clinics in Utah during their routine diabetes clinic visits. Participants fell between the ages of 10 and 14, were able to read and write in either English or Spanish, had a diagnosis of type 1 diabetes for at least one year, and did not have a condition that would interfere with measurement completion. Participants were drawn from a larger longitudinal observational study. This study analyzed the first three time points of data, which were obtained six months apart. Demographic and illness information was obtained from self-report and participant medical files. Questionnaires were used to assess depression and adherence. Metabolic control was measured through HbA1c levels retrieved from medical records. Data were analyzed to test the mediation hypotheses. Higher levels of depression were correlated with poorer metabolic control in cross-sectional analyses at study entry, and in longitudinal analyses measured one year later. Adherence was found to be a partial mediator in cross-sectional analyses, but did not mediate changes in metabolic control across time.Item Body Image and Age Effects in the Pediatric Cleft Population(2015-12-03) Komachi, Candice Yuki; Heppner, Celia; Faith, Melissa A.; Seaward, JamesBACKGROUND: While orofacial clefts affect the facial appearance of many children and adolescents with this birth defect, there has not been specific research examining the impact of orofacial clefts on developing body image. Body image development in the general population follows a trend in which adolescence is characterized by more negative body image than in prepubescent children. However, as children with orofacial clefts have altered appearances from birth, their body image may differ from that of the general population. This study aims to examine the relationship between orofacial clefts and body image throughout childhood and adolescence. PARTICIPANTS: Participants included children and adolescents who were seen in the multidisciplinary craniofacial clinic at Children's Health/Children's Medical Center between March 2011 and April 2015. Patients included in the sample had a diagnosis of cleft lip and/or palate (CL/P), were between the ages of 8 and 18 years of age, and had no complex medical or genetic diagnoses. METHOD: This study utilized a retrospective chart review of patients seen in the craniofacial clinic at Children's Health from March 2011 to April 2015. Data collected from the patient charts included demographic information, medical and surgical history, and history of speech intervention and recommendations. Each patient was interviewed by a clinician and filled out self-report questionnaires. Items from the self-report questionnaires relevant to body image and self-perception were used in this study along with a body image concern item asked during the clinician interview. Participants were separated into groups based on orofacial cleft diagnosis (bilateral CL/P, unilateral CL/P, cleft lip only, and cleft palate only). RESULTS: There was no significant relationship found between body image and category of orofacial cleft diagnosis. Age also did not correlate with body image scores. Body image scores that were taken from the body image-related items were also not highly correlated. DISCUSSION: There were no significant relationships found between the variables of interest in this study. However, orofacial clefts are unique conditions that may necessitate ongoing surgical and related medical intervention throughout childhood and adolescence. For patients with CL/P, body image development may not follow a typical trend and may fluctuate rapidly depending on the success of their treatment, how well treatment outcomes meet expectations, as well as patients' adaptability to their changing appearance. As a result, there may not be a clearly identifiable correlation between age and body image scores. Other factors such as the orofacial cleft diagnostic categories used for this study, the uneven group sizes, and the body image-related items used as a measure of body image may have impacted the results. As the body image-related items were not significantly correlated, another measure that has been validated to assess body image may be more efficient and necessary in future studies so that the relationship between age, orofacial cleft condition, and body image can be more precisely examined.Item Developmental Expectations and Adolescent Type 1 Diabetes Management in Latino and Caucasian Families(2013-12-30) Sundaram, Saranya Easwar; Wiebe, Deborah J.; Wetherington, Crista E.; Gross-Toalson, JamiBACKGROUND: Transfer of responsibility for diabetes management is important across adolescence. It may contribute to poorer adherence and family conflict if unmatched to adolescent development. Research has primarily studied Caucasian samples, which may have different expectations for autonomy compared to Latino samples. This study examined developmental expectations for independence in both general and diabetes-related tasks in age- and sex-matched samples of Caucasian and Latino youth with type 1 diabetes. SUBJECTS: Participants included 118 10- to 15-year-old Caucasian and Latino adolescents with type 1 diabetes [M (SD) = 13.24 (1.69) years; 54% female] and their mothers. METHOD: Participants independently completed questionnaires measuring expectations for independence, diabetes responsibility and conflict, and adherence to diabetes management. In addition, adolescents completed an inventory measuring depressive symptoms, and HbA1c levels were obtained through medical records. RESULTS: Mothers and adolescents held different expectations for the age at which adolescents should make independent decisions about general and diabetes-related activities. In the overall sample, adolescents expected independence at younger ages for prudential activities, but at older ages for diabetes activities than did parents. These mother-adolescent differences occurred in different domains across ethnicity; Caucasians displayed mother-adolescent differences in expectations for diabetes activities, while Latinos displayed differing expectations for prudential activities. In the overall sample, expectations were associated with mother-reported conflict, but were minimally correlated with parental diabetes responsibility. Younger age expectations for prudential items were associated with poorer diabetes outcomes, but age expectations for personal and diabetes items were generally unrelated to diabetes outcomes. In contrast to expectations, associations of developmental expectations with diabetes responsibility, conflict, and outcomes were similar across Caucasian and Latino youth. DISCUSSION: Findings support that there were differing age expectations between parents and adolescents in prudential and diabetes-related activities. Different factors may influence how these expectations were associated with parental responsibility, conflict, and diabetes outcomes.Item Effects of Surgical Intervention on Parent Reported Quality of Life in Children and Adolescents with Craniofacial Conditions(2014-12-22) Perrin, Lauren Kacey; Heppner, Celia; Wetherington, Crista E.; Kane, AlexBACKGROUND: This study compared parent-reported quality of life pre- and post-surgery in children with craniofacial conditions. Many psychosocial difficulties associated with craniofacial conditions have been identified in the literature; however, research has not yet looked specifically at parent reports of patients’ quality of life and psychosocial functioning before and after surgery. OBJECTIVE: The aim of this study was to examine changes in parent-reported quality of life over time in relation to surgical intervention in children and adolescents with craniofacial conditions. DESIGN: A retrospective chart review was conducted of patients seen in a multidisciplinary craniofacial team clinic. Data were examined for two time points: initial visit and follow-up visit to team clinic. Participants included in the chart review were patients seen twice by psychology in team clinic between March 2011 and August 2014, with PedsQL™ ratings from parents at both time points. Patients ages 0 to 23 years were eligible for inclusion in the sample. Data collected from patient charts included demographic information, medical and surgical history, and scores from the PedsQL™ TM 4.0 Generic Core Scales. RESULTS: Parenting stress reported at follow-up had a significant relationship with parent reported quality of life reported at follow-up for this sample; however, surgery was not a significant predictor of outcome quality of life. DISCUSSION: Current parenting stress and initial reports of quality of life may be important variables for clinicians to consider when working with the craniofacial population. Surgery should be investigated further in terms of its impact on quality of life in relation to other psychosocial variables.Item Emotional Control and Reaction Time in Children with Internalizing Disorders and Attention-Deficit Hyperactivity Disorder(2016-12-16) Turner, Melissa Dawn; Wilkinson-Smith, Alison; Brewer-Mixon, Karen; Rose, LindseyBACKGROUND: Prior literature indicates that children with slower reaction times on neurocognitive attention measures are more likely to respond more slowly to stop signals in real world situations. Taking longer to respond may also suggest a tendency to take longer to process emotional cues in real time, thus possibly resulting in vulnerability towards emotional dyscontrol. The present study examined differences between reaction time and the parental ratings of emotional control and internalizing symptomatology in three distinct pediatric populations: those with Attention-Deficit Hyperactivity Disorder (ADHD), those with internalizing disorders such as anxiety and depression, and those with comorbid ADHD and internalizing disorders. SUBJECTS: A sample of 64 children and adolescents who were patients at the Neuropsychology Service at Children's Medical Center Dallas Texas from November 2011 through July 2014 was derived. All patients received neuropsychological evaluations and were assessed for attentional and emotional disorders. METHOD: Approval for the study was obtained from the Institutional Review Board at UT Southwestern Medical Center. Data was obtained via examination of medical records. Reaction time was measured via the Conners' Continuous Performance Test II (CPT II) Overall Hit Reaction Time (RT) variable. Parent rating forms from the Behavior Rating Inventory of Executive Function (BRIEF) Emotional Control subscale (EC) and the Behavioral Assessment Scale for Children, Second Edition (BASC-2) Internalizing Problems Composite score (IP) were used as a measure of participants' emotional control capacity. A multivariate analysis of covariance (MANCOVA) was employed to assess for significant differences between all three groups for CPT II RT, BRIEF EC, and BASC-2 IP, controlling for age, education, sex, and race. RESULTS: The MANCOVA yielded a significant overall model for group [F (6, 26) = 6.89, p < .01], controlling for age (p = .08), education (p < .01), sex (p = .13), and race (p = .02). There was a significant main effect for CPT II RT [F (2) = 8.31, p < .01] and BASC-2 IP [F (2) = 3.96, p < .04], with respectable effect sizes (η2 = .56 and .35, respectively). There was a moderately significant main effect for BRIEF EC [F (2) = 3.65, p = .051] with a moderate effect size (η2 = .33). Post hoc analyses revealed significant differences between the internalizing disorder and comorbid groups (p = .048) for CPT II RT, with slower reaction times in the internalizing disorders than comorbid groups. Significant differences were also observed between the ADHD and internalizing disorders groups (p < .01) as well as between the ADHD and comorbid groups (p = .03) for BASC-2 IP, with greatest elevation in the internalizing disorders, followed by the comorbid and ADHD groups. There were significant differences between the ADHD and the internalizing disorder groups (p = .04) as well as between the ADHD and comorbid groups (p = .01) for BRIEF EC. Of note, mean CPT II RT performance was in the normal range across the groups. All other pairwise comparisons were nonsignificant. DISCUSSION: In this study we explored associations between cognitive inefficiency and emotional dysregulation in order to further our understanding of the ways in which emotional and executive functions are related. We focused on differences between groups of three specific populations (i.e., ADHD, internalizing disorders and comorbid ADHD and internalizing disorders). The co-occurrence of ADHD and internalizing disorders may have important implications for assessment and treatment. Results such as these could be useful in determining whether treating one type of internalizing symptomatology may improve the other, and can allow providers to make more informed decisions about how to better assist children with comorbid conditions.Item Facial Asymmetry and Social Functioning in Children and Adolescents with Cleft Lip and/or Palate(2016-08-25) Salemi Milanes, Angela Patricia; Heppner, Celia; Seaward, James; Triplett, KelliBACKGROUND: While orofacial clefts may affect the facial appearance of children and adolescents with this condition, research has yet to examine the impact of facial difference on social functioning in this population. Characteristics of facial appearance, such as symmetry, are important in social interaction. Given that individuals with CL/P often present with a degree of facial asymmetry, their social experience may differ from that of the general population. This study aimed to examine the relationship between facial asymmetry and social functioning in children and adolescents with CL/P. PARTICIPANTS: Participants included children and adolescents seen in a multidisciplinary team clinic at a large plastic and craniofacial surgery center. Data was obtained from children and adolescents with a cleft lip and/or palate (CL/P) diagnosis, between the ages of 8 and 18 years of age. Participants with other complex medical or genetic diagnoses were excluded from this study. Participants were separated into groups based on cleft diagnosis (bilateral CL/P, unilateral CL/P, cleft lip only, and cleft palate only). METHOD: Data was collected via retrospective chart review and included demographic information, medical and surgical history, and responses to self-report questionnaires measuring quality of life (PedsQL). Three-dimensional images of each patient were also taken as part of routine care at each clinic visit. This study utilized measurements obtained from the three-dimensional images, as well as scores on the social functioning scale from the PedsQL. RESULTS: The current study found three-dimensional stereophotogrammetric analysis for facial asymmetry to have high interobserver reliability in the CL/P population. Overall, the current study found that there were no significant differences between diagnosis groups in regard to facial asymmetry scores and reported social functioning. Furthermore, the current study found no significant correlation between reported social functioning and facial asymmetry scores. DISCUSSION: The results suggest that three-dimensional image analysis is a useful and reliable tool for objectively evaluating facial asymmetry in youth with CL/P. The results also suggest that social functioning of youth with CL/P is not significantly associated with facial asymmetry. Future studies should focus on evaluating other factors that may determine social functioning.Item A Family Bereavement Camp: Emerging Themes Regarding Its Impact on the Lives of Bereaved Parents and Siblings(2016-08-25) Carawan, Melissa Anne; Germann, Julie; Faith, Melissa A.; Winick, NaomiBACKGROUND: Within the grief literature, family bereavement camps have yet to be researched in a combined population of bereaved parents and siblings. Camp Sol is a weekend retreat for families who have experienced the death of a child/sibling. The goal of the current study is to establish areas reported by parents and sibling campers as being impacted by their experience at camp in hopes of identifying standardized measures that can be implemented in the future evaluation process. This will provide future researchers the ability to quantitatively evaluate the overall efficacy of a family bereavement camp among bereaved parents and siblings. SUBJECTS: Camp Sol evaluations were collected post-camp over the span of five and a half years totaling 656 evaluations. Parents comprised 50.2% of the sample, where the majority of them spoke English versus Spanish (81.4% vs. 18.5%). The children comprised 49.8% of the sample and ranged from the age of 4 to 19. METHOD: Data coding and analysis followed a mixed-methods design, specifically the convergent parallel design, which utilizes both qualitative and quantitative data. The constant Comparative Method (CCM) was used to analyze and code the qualitative portion of the evaluation to arrive at core themes. A variety of quantitative analyses (independent t-test, ANOVA, MANOVA) was used to analyze potential differences between groups according to family role, language, and age. RESULTS: The prominent themes that emerged from the qualitative data were social support, communication, continuing bonds as a coping skill, increased knowledge of the grief process, adjustment, family interaction, and camp environment. Quantitative results revealed that fathers rated the Understanding Index significantly lower than unspecified parents, and siblings ' ages 8 to 11 and 12 years and older had significantly higher mean scores on communication than siblings ' ages 2 to 7. DISCUSSION: This study is the first to research both parent and sibling benefits of a family bereavement camp, which identified the importance of non-pathological constructs (e.g. social support, communication, family relationships) while providing richness of information about how a uniquely structured camp may facilitate positive adjustment and coping for entire bereaved families. The camp structure may provide cost effective and accessible grief intervention for bereaved families (English and Spanish) in a safe and supportive environment. Future research would benefit from the use of pre- and/or post- intervention measures assessing for social functioning and mental health, as well as the implementation of a control group to allow discrimination of participants' outcomes.Item Frequency, Versatility, and Duration of Nonsuicidal Self-Injury in Relation to Acquired Capability for Suicide among Adolescents(2015-08-31) Matney, Jacquelyn Deanna; Stewart, Sunita M.; Westers, Nicholas; Hughes, Jennifer L.Suicide is the 2nd leading cause of death among youth, and those who present to inpatient settings have been shown to have higher rates of suicidal behaviors (World Health Organization, 2012). Nonsuicidal self-injury (NSSI) is a leading risk factor for suicide. We propose that an increase in frequency, versatility, and/or duration of NSSI is associated with an increased risk for suicide attempt (SA) by means of the Acquired Capability for Suicide (ACS) proposed in Joiner's (2005) Interpersonal Psychological Theory of Suicide (IPTS) regardless of demographic or diagnostic factors. Preliminary results from this sample of inpatient adolescents (N = 150) were consistent with our proposed hypotheses. Yet, depressive symptoms appeared to interact with the association between these NSSI variables and ACS. These findings suggest that inpatient youth with greater NSSI versatility, frequency and duration, are at an increased risk for future SA by means of increased ACS. Consistent with the IPTS, the link between engagement in NSSI and history of SA appeared to be mediated by the ACS component. While limited by its cross-sectional design, the findings from this study have clinical implications regarding suicide risk assessment and prevention.Item ImPACT™ Performance of High School Student Athletes with ADHD(2015-08-31) Gomez, Brooke Marie; Silver, Cheryl H.; Resch, Jacob; Cullum, C. MunroBACKGROUND: To date, two studies demonstrate that adolescents with ADHD tend to perform poorer on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT; Lovell, 2013) at baseline than do adolescents without ADHD at baseline (Elbin et al., 2013; Zuckerman, Lee, Odom, Solomon, & Sills, 2013). In an effort to replicate and extend these studies, the baseline and immediate post-concussion performance of high school athletes with and without ADHD were evaluated to identify potential differences between groups on the ImPACT’s domains. SUBJECTS: Student athletes were recruited from a private high school. Baseline testing was conducted biannually to establish pre-injury/baseline levels of individual participants. Thirty-eight students with ADHD and a matched control group of thirty-eight students without ADHD were used to test the first hypothesis. Twenty-three students with ADHD and a matched control group of twenty-three students without ADHD who sustained a concussion were used to test the second and third hypotheses. Additional analyses were performed on data from four student athletes with ADHD who sustained a concussion. METHOD: Data were used from a larger study conducted by a large public metropolitan university. Variables included demographic information and the ImPACT. All data were stored on an encrypted computer or in a locked file cabinet. RESULTS: Independent samples t-tests revealed significant differences between athletes with ADHD and non-ADHD athletes at baseline on the Impulse Control (t (74) = 2.73, p < .01) and the Total Symptoms (t(74)= 2.63, p < .05) scores of the ImPACT. A multivariate analysis of variance (MANOVA) was conducted on data from two time periods. A statistically significant difference (F(6, 39) = 2.86, p = .02; Wilks’ ? = 0.694; ?2 = .31) in ImPACT performance was found between non-concussed athletes with ADHD tested at baseline and concussed athletes without ADHD tested within 72 hours of injury (M = 1.83 days). Further analysis using independent samples t-tests found that athletes with ADHD at baseline performed significantly better than concussed athletes without ADHD tested within 72 hours of injury, on the following composites: Verbal Memory (t(44)= 2.25, p < .05), Visual Motor Speed (t(44)= 2.33, p < .05), Reaction Time (t(44)= -3.42, p < .01), and Total Symptoms (t(44)= -3.52, p < .01). No significant between-group differences were found on the Visual Memory or Impulse Control composites of the ImPACT. DISCUSSION: These findings indicate that administration of the ImPACT to individuals with ADHD is appropriate. At baseline, both groups performed similarly on Verbal Memory, Visual Memory, Visual Motor Speed and Reaction Time. However, the overlap in ADHD and concussion profiles on Impulse Control and Visual Memory warrant caution in the clinical interpretation of the ImPACT profiles of individuals with ADHD. Nevertheless, these findings suggest that the overall use of normative data within an ADHD population is appropriate, and baseline testing has values for athletes with ADHD.Item Peer Victimization in the Pediatric Oncology Population: Review of Risks, Protective Factors, and Implications for Intervention(2015-08-31) Tarkenton, Tahnae R'shelle; Wetherington, Crista E.; Roop, Melissa; Heppner, Celia; Germann, JulieChildhood cancer presents patients and their families with unique short- and long-term challenges that can disrupt physical, emotional, academic, and family/social functioning. Further, many psychosocial adjustment difficulties common in the pediatric oncology population are similar to those that place healthy children at risk for peer victimization. Thus, pediatric oncology patients may be at increased risk for peer victimization. Based on current literature, this document will address the following hypotheses: (1.) children and adolescents with cancer are more at risk for peer victimization than healthy youth, (2.) children and adolescents with cancer are more susceptible to negative effects of peer victimization than healthy youth, and (3.) research examining anti-bullying interventions will indicate effective strategies that can be tailored to reduce peer victimization’s prevalence, effects, and risks in the pediatric oncology population. To address the hypotheses, potential risks, protective factors, and adverse outcomes linking peer victimization to the pediatric cancer population will be reviewed. Then, existing intervention strategies shown to be effective in preventing and reducing effects of peer victimization in healthy populations will be presented. Lastly, a manualized peer victimization intervention program tailored to the pediatric oncology population will be provided.Item Predictors of Persistent Neurobehavioral Symptoms in Adolescents with Mild Traumatic Brain Injury Using a Novel Clinical Tool(2021-07-23) Wright, Brittany Nicole; Brewer-Mixon, Karen; Cullum, C. Munro; Juengst, Shannon B.; Krumwiede, Kimberly Hoggatt; Terhorst, Lauren; Wilmoth, Kristin MichellePersistent post-concussion symptoms in adolescents are non-specific and poorly understood. A small percentage of adolescents (roughly 20%) will experience persistent symptoms following mTBI that can be disruptive in many areas of daily functioning. Including measures in assessment that are specific to adolescents but capture symptoms beyond injury may lead to more insight as to why some adolescents experience persistent symptoms. Moreover, identifying predictors of persistent symptoms could aid in management and evaluation of symptoms. The current set of studies was designed to validate a measurement tool for adolescents and identify predictors of persistent symptoms in a cohort of adolescents with mTBI. Study 1 was designed to further validate a tool (the BAST-A), which assesses persistent emotional and behavioral symptoms in adolescents. Another aim was to develop ordinal to continuous normed scores to aid in clinical interpretation. When assessing the psychometric indicators of the tool, both the Negative Affect and Fatigue and Executive and Social Function subscales performed well. However, the Risk Behaviors subscale performed poorly in this sample of adolescents with sports-related concussion. Specifically, Risk Behaviors was not able to distinguish different severity levels in the sample. Results from this study suggest further psychometric validation of the BAST-A in adolescents with mTBI. The aim of Study 2 was to utilize the ordinal to continuous normed scores in the first study to assess if a combination of predictors was associated with persistent neurobehavioral symptoms in adolescents with mTBI. A combination of pre-injury and injury predictors was significantly associated with self-reported Negative Affect and Fatigue symptoms (F (8,93) =6.09, p<.001) and Executive and Social Function symptoms (F (8,93) = 2.18, p=.036). Due to limitations within the Risk Behaviors subscale, binary (Yes/No) outcomes were used. A combination of pre-injury and injury factors was also significantly associated with self-reported Risk Behaviors [χ2(8) = 18.84, p=.016]. Across subscales, total number of recent life stressors remained a significant predictor of persistent symptoms. The results from this study indicated that a combination of injury-related and personal factors is predictive of persistent symptoms and that recent life stressors contribute to the experience of these symptoms.Item Understanding the Stressful Challenges of Adolescent Type 1 Diabetes Management in Caucasian and Latino Youth(2013-12-30) Lee, Alyssa G.; Wiebe, Deborah J.; Lee, Simon Craddock; Hamann, HeidiBACKGROUND: Type 1 diabetes management poses many challenges and is a potential source of stress among adolescents with diabetes and their families. In primarily Caucasian samples, diabetes management outcomes (e.g., metabolic control) deteriorate across adolescence. A growing literature indicates that Latino youth have poorer diabetes control than do Caucasian youth. The broad objective of the present study was to examine ethnic differences in the experience and effects of stress on type 1 diabetes management during adolescence. SUBJECTS: Participants were Caucasian and Latina mothers and adolescents with type I diabetes (N=118 dyads; 48% Latino; 54% female; 10 to 15 years old; illness duration > 1 year; 25% on insulin pump). Adolescents were between 10 and 15 years of age (M = 12.74, SD = 1.64). METHOD: Demographic information was collected through maternal report, geographic identifiers from available census data, and medical records. Adolescents completed surveys measuring the occurrence of different types of stressful events relevant to a diverse population of Latino and Caucasian youth (i.e., stress dimensions of family conflict, peer hassles, school hassles, and economic stress), treatment adherence, and depressive symptoms. Metabolic control was determined from HbA1c recorded in medical records. Socio-demographic information was collected through a combination of maternal report and census tract data. RESULTS: On average, Latino participants were of a lower socioeconomic status (SES) than Caucasian participants. However, there were not significant ethnic group differences in terms of adolescent age, adolescent gender, illness duration, or insulin pump status. There were also no ethnic differences on adolescent report of different types of stress. In the full sample, heightened levels of each type of stress were associated with indicators of poorer diabetes management and poorer psychosocial adjustment. Hierarchical regression analysis revealed that the stresses of peer hassles, school problems, and family conflict were each associated with poorer outcomes regardless of ethnicity. However, ethnicity moderated associations of economic stress with both adherence and depressive symptoms. Economic stress was associated with poorer adherence and greater depression in Caucasian youth, but was unrelated in Latino youth. DISCUSSION: Latino and Caucasian youth in the sample for this study did not show significant differences in their report of the experience of stress, but Latino youth appeared resilient against the adversity of economic stress. This interaction pattern is consistent with the Latino paradox. Understanding resiliency factors in diverse populations may assist health care professionals in providing effective and culturally sensitive interventions.