Pamela Martyn-Nemeth

The Relationships Among Self-Esteem, Stress, Coping, Eating Behavior, and Depressive Mood in Adolescents

The prevalence of adolescent overweight is significant, almost 25% in some minorities, and often is associated with depressive symptoms. Psychological and psychosocial factors as well as poor coping skills have been correlated with unhealthy eating and obesity. The purpose of this study was to examine relationships among self-esteem, stress, social support, and coping; and to test a model of their effects on eating behavior and depressive mood in a sample of 102 high school students (87% minority). Results indicate that (a) stress and low self-esteem were related to avoidant coping and depressive mood, and that (b) low self-esteem and avoidant coping were related to unhealthy eating behavior. Results suggest that teaching adolescents skills to reduce stress, build self-esteem, and use more positive approaches to coping may prevent unhealthy eating and subsequent obesity, and lower risk of depressive symptoms.

Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus A Scientific Statement From the American Heart Association

The rates of both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) are increasing in youth.1 In the past 10 years, guidelines for the identification and management of cardiovascular disease (CVD) risk factors in youth with diabetes mellitus have been published by multiple professional organizations, including the American Diabetes Association (ADA),2,3 the American Heart Association (AHA),4,5 the American Academy of Pediatrics,6 the International Society of Pediatric and Adolescent Diabetes (ISPAD),7 and the Pediatric Cardiovascular Risk Reduction Initiative.8 This scientific statement summarizes and interprets these guidelines and new developments in the field in the past decade and outlines future research and clinical needs to improve cardiovascular health and risk factor management in youth with diabetes mellitus. Additional goals for this statement are to increase awareness of CVD risk factors and their identification, prevention, and treatment and to improve cardiovascular health in youth with diabetes mellitus by encouraging advancement in research and clinical care, including understanding and implementing current CVD guidelines. Improving cardiovascular health in youth with diabetes mellitus has important public health implications; therefore, this statement aims to reach healthcare providers in diabetes mellitus, cardiology, and related fields. (Note: The sections within this scientific statement are organized by diabetes mellitus type, when possible, with brief summary statements concluding each section. Multiple definitions for CVD are used in the cited articles. Readers of this statement should include risk factors, surrogate markers, and end-organ damage under this umbrella term of CVD.) ### Type 1 Diabetes Mellitus Multiple studies document an increase of 2% to 5% annually in the incidence of T1DM worldwide.9 The SEARCH for Diabetes in Youth (SEARCH) study estimated that there were 166 018 to 179 388 youth with T1DM in the United States in 2010.1 Worldwide, rates of T1DM differ …

Fear of hypoglycemia in adults with type 1 diabetes: impact of therapeutic advances and strategies for prevention - a review.

PURPOSE This review summarizes the current state of the science related to fear of hypoglycemia (FOH) in adults with type 1 diabetes. Fear of hypoglycemia is a critical deterrent to diabetes self-management, psychological well-being, and quality of life. We examine the influence of contemporary treatment regimens, technology, and interventions to identify gaps in knowledge and opportunities for research and practice. BASIC PROCEDURES A literature search was conducted of MEDLINE, PsycINFO, and EMBASE. Fifty-three studies that examined fear of hypoglycemia were included. MAIN FINDINGS Fear of hypoglycemia influences diabetes management and quality of life. Gender and age differences exist in experiences and responses. Responses vary from increased vigilance to potentially immobilizing distress. Fear of hypoglycemia is greater at night and may contribute to poor sleep quality. Strategies to reduce fear of hypoglycemia have had varying success. Newer technologies hold promise but require further examination. CONCLUSIONS Fear of hypoglycemia remains a problem, despite advances in technology, insulin analogs, and evidence-based diabetes management. Clinical care should consistently include assessment for its influence on diabetes self-management and psychological health. Further research is needed regarding the influence of newer technologies and individualized strategies to reduce fear of hypoglycemia while maintaining optimal glucose control.

Fear of hypoglycemia: Influence on glycemic variability and self-management behavior in young adults with type 1 diabetes

PURPOSE The purpose of this study was to examine how fear of hypoglycemia (FOH) is associated with glycemic variability (GV) and self-management behavior in young adults (aged 18-35) with type 1 diabetes (T1DM). PROCEDURES Using a prospective repeated-measures design, in 35 young adults, within- and between-person and temporal associations of FOH, specific self-management behaviors, and GV were measured. The data were collected using questionnaires and real-time measures using daily diaries, insulin pump downloads, actigraphy, and continuous glucose monitoring. FINDINGS FOH was associated with greater glycemic variability. Significant temporal associations emerged. Concurrent day (glucose SD, p=.011) and previous-evening fear levels were associated with GV (glucose SD, p=.007). FOH was also associated with greater calorie intake (r=.492, p=.003) and less physical activity (light activity, r=-.341, p=.045). CONCLUSIONS The significant associations of FOH with GV, dietary patterns, and physical activity provide evidence for FOH as an important psychological factor associated with diabetes care.

Psychological Vulnerability Among Overweight/Obese Minority Adolescents

Depression is associated with obesity among adolescents, with racial/ethnic variability noted. Psychological correlates that may influence this relationship have not been adequately explored. The primary objective of this secondary analysis was to compare levels of stress, self-esteem, coping, social support, and depressive mood between normal weight and overweight/obese minority adolescents (as defined using Centers for Disease Control and Prevention standards). Adolescents (n = 101) aged 14–18 years who were largely minority (87%) were recruited from two Midwestern-area high schools. Using a descriptive comparative design, individuals were grouped into normal weight (>5th to <85th percentile) and overweight/obese (≥85th percentile) for comparison on measures. Self-reported levels of stress, coping, self-esteem, social support, depressive mood, and body mass index were obtained. Obese/overweight adolescents reported significantly lower self-esteem than did those with normal weight (p < .05). Although stress was a significant predictor of depressive mood in both groups (p < .001), low self-esteem was also a significant predictor of depressive mood in the overweight/obese group (p = .001). Strategies to manage stress and improve self-esteem may help alleviate depressive mood in high school adolescents.

Dietary Profiles of First-Generation South Asian Indian Adolescents in the United States

This study aimed to describe the dietary profile and health characteristics of first-generation South Asian Indian (SAI) adolescents in the United States because SAIs have a high prevalence of cardiovascular disease and diabetes, and dietary risk factors for those diseases begin in youth. A descriptive cross-sectional design was used to examine age, gender, usual dietary intake, body composition, blood pressure, blood glucose, and length of residency among 56 first-generation, urban SAI adolescents. Intake of saturated fat exceeded recommendations for all participants, and potassium, magnesium, calcium, vitamin D, and fiber intakes were insufficient in nearly all. Sodium intake exceeded recommendations for most males. Cholesterol intake and sweets consumption was lower among those who lived in the U.S. longer. There were no associations of dietary patterns with health characteristics. Dietary patterns that may increase future disease risk included high saturated fats and low potassium, magnesium, calcium, vitamin D, and fiber.

Contextual correlates of energy-dense snack food and sweetened beverage intake across the day in African American women: An application of ecological momentary assessment

This study examined relationships between contextual factors and within-person variations in snack food and sweetened beverage intake in African American women (n = 79), aged 25-65 years living in metropolitan Chicago. For seven days, participants wore a global positioning system (GPS) logger and were signaled five times per day to complete an ecological momentary assessment (EMA) survey assessing behaviors and environmental, social, and other contextual factors via smartphones. Within-person associations between snack food and beverage intake and contextual factors were analyzed using three-level logistic regressions. Participants reported consuming a snack food at 38.4% of signals and a sweetened beverage at 17.9% of signals. Fast food restaurant and convenience store density within the daily activity space was not associated with either snack food or sweetened beverage intake. However, perceptions of close proximity to fast food restaurants and convenience stores making it easier to eat/drink, while accounting for ones usual proximity, were associated with increased odds of snack intake (O.R. 2.1; 95% C.I. 1.4, 3.0) but not sweetened beverage. We also found engaging in activities such as watching television (O.R. 1.8; 95% C.I. 1.2, 2.7) and talking (O.R. 1.7; 95% C.I. 1.1, 2.6) while eating were associated with higher snack intake. These factors were not related to sweetened beverage intake. Public health interventions addressing fast food restaurant and convenience store accessibility and food offerings and marketing within these outlets may help reduce snack food intake. Additionally, to reduce concurrent activities while eating, real-time interventions using smart technology could be used to enhance attentive eating in this population.

Challenges Imposed By Hypoglycemia in Adults With Type 1 Diabetes

Little is known regarding how hypoglycemia and associated fears influence day-to-day life among adults with type 1 diabetes (T1DM) who use contemporary diabetes management strategies. To address this gap, we performed an exploratory qualitative study with five focus groups of 30 people aged 20 to 57 years with T1DM. Sessions were audiotaped and transcribed, and then analyzed. Eight themes emerged: (a) hypoglycemic worry, (b) unpredictability and loss of control, (c) contending with life stress, (d) exercise benefits and challenges, (e) a changed relationship with food, (f) sleep fears, (g) a love/hate relationship with technology, and (h) coping strategies to make it better. Fear of hypoglycemia, diabetes management, and work demands confer a high degree of stress. Challenges surround food, exercise, and sleep. Technology is important but does not relieve fear of hypoglycemia. Developing strong coping skills and creating a safety net of support are necessary.

Pathways of the relationships among eating behavior, stress, and coping in adults with type 2 diabetes: A cross-sectional study

Stress is related to eating behavior, and eating behavior is important in diabetes treatment. The aim of this study was to examine the relationships among perceived stress, diabetes-related stress, coping strategies, and eating behaviors in adults living with type 2 diabetes (T2DM). Adults with type 2 diabetes (n = 183) were recruited from a large metropolitan area in the Midwest United States. Stress factors and coping strategies associated with eating behaviors were measured using validated questionnaires. Structural equation modeling was used to investigate the relationships among perceived stress, diabetes-related stress, coping strategies, and eating behaviors. The final model showed that emotion-oriented coping partially mediated the effect of stress on eating behaviors. Specifically, emotion-oriented coping partially mediated the effect of diabetes-related stress on restrained eating behavior (r = 0.318, p < .001) and emotional eating behavior (r = 0.399, p < .001); emotion-oriented coping partially mediated the effect of perceived stress on external eating behavior (r = 0.276, p < .001). Emotion-oriented coping was found to be a partial mediator in the path model between stress and eating behaviors in people with type 2 diabetes. Knowledge of the association of stress with eating behaviors may prove important for health care providers in treatment and care of people with type 2 diabetes.