Amy E. Hughes

Emotional Processing and Self-Control in Adolescents With Type 1 Diabetes

OBJECTIVE This study examined whether emotional processing (understanding emotions), self-control (regulation of thoughts, emotions, and behavior), and their interaction predicted HbA1c for adolescents with type 1 diabetes over and above diabetes-specific constructs. METHODS Self-report measures of self-control, emotional processing, self-efficacy for diabetes management, diabetes-specific negative affect, and adherence, and HbA1c from medical records were obtained from 137 adolescents with type 1 diabetes (M age = 13.48 years). RESULTS Emotional processing interacted with self-control to predict HbA1c, such that when adolescents had both low emotional processing and low self-control, HbA1c was poorest. Also, both high emotional processing and self-control buffered negative effects of low capacity in the other in relation to HbA1c. The interaction of emotional processing × self-control predicted HbA1c over diabetes-specific self-efficacy, negative affect, and adherence. CONCLUSIONS These findings suggest the importance of emotional processing and self-control for health outcomes in adolescents with diabetes.

Financial Incentives for Promoting Colorectal Cancer Screening: A Randomized, Comparative Effectiveness Trial.

OBJECTIVES:Offering financial incentives to promote or “nudge” participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population.METHODS:We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50–64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a

Neighborhood effects in a behavioral randomized controlled trial

5 incentive (n=1,000), or outreach plus a

Overlapping geographic clusters of food security and health: Where do social determinants and health outcomes converge in the U.S?

10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis.RESULTS:FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the

Estimating the Health and Economic Impacts of Changes in Local Air Quality

10 incentive (34.6%, P=0.32 vs. no incentive) or

Using address histories in health research: challenges and recommendations for research

5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups.CONCLUSIONS:Financial incentives, in the amount of

Individual Differences and Day-to-Day Fluctuations in Perceived Self-Regulation Associated With Daily Adherence in Late Adolescents With Type 1 Diabetes

5 or

What Mom and Dad Don’t Know CAN Hurt You: Adolescent Disclosure to and Secrecy From Parents About Type 1 Diabetes

10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.

The utility of EMR address histories for assessing neighborhood exposures

Randomized controlled trials (RCTs) of interventions intended to modify health behaviors may be influenced by neighborhood effects which can impede unbiased estimation of intervention effects. Examining a RCT designed to increase colorectal cancer (CRC) screening (N=5628), we found statistically significant neighborhood effects: average CRC test use among neighboring study participants was significantly and positively associated with individual patients CRC test use. This potentially important spatially-varying covariate has not previously been considered in a RCT. Our results suggest that future RCTs of health behavior interventions should assess potential social interactions between participants, which may cause intervention arm contamination and may bias effect size estimation.

Social disadvantage, healthcare utilization, and colorectal cancer screening: Leveraging longitudinal patient address and electronic health records data

We identified overlapping geographic clusters of food insecurity and health across U.S. counties to identify potential shared mechanisms for geographic disparities in health and food insecurity. By analyzing health variables compiled as part of the 2014 Robert Wood Johnson Foundation County Health Rankings, we constructed four health indices and compared their spatial patterns to spatial patterns found in food insecurity data obtained from 2014 Feeding Americas County Map the Meal Gap data. Clusters of low and high food security that overlapped with clusters of good or poor health were identified using Local Morans I statistics. Next, multinomial logistic regressions were estimated to identify sociodemographic, urban/rural, and economic correlates of counties lying within overlapping clusters. In general, poor health and high food insecurity clusters, “unfavorable cluster overlaps”, were present in the Mississippi Delta, Black Belt, Appalachia, and Alaska. Overlapping good health and low food insecurity clusters, “favorable cluster overlaps”, were less common and located in the Corn Belt and New England. Counties with higher black populations and higher poverty were associated with an increased likelihood of lying within overlapping clusters of poor health and high food insecurity. Generally consistent patterns in spatial overlaps between food security and health indicate potential for shared causal mechanisms. Identified regions and county-level characteristics associated with being located inside of overlapping clusters may be used in future place-based intervention and policy.