Wendy Auslander

Family Characteristics of Diabetic Adolescents: Relationship to Metabolic Control

This research compares the family environments of diabetic adolescents in good (HbA1c < 10), fair (10 ≥ HbA1c ≤ 14), and poor (HbA1c > 14) control. Fifty-eight adolescents diagnosed with type I diabetes and their parents (mothers) were independently assessed with structured interviews, the Moos Family Environment Scale, and adolescents also completed the Piers-Harris Childrens Self-Concept Scale. As compared with adolescents in poor control, those in good control reported fewer diabetes-related symptoms and had less anxiety and a more positive self-concept. Well-controlled youths also reported more cohesion and less conflict among family members. More parents of well-controlled youths stated that family members were encouraged to behave independently. In addition, more parents of poorly controlled adolescents believed that diabetes had negatively affected the childs personality, physical well-being, schooling, and participation in activities away from home. These findings suggest a complex interplay between the diabetic adolescents psychological and physical functioning, metabolic control, and the family environment.

Disparity in Glycemic Control and Adherence Between African-American and Caucasian Youths With Diabetes: Family and community contexts

OBJECTIVE To describe sociodemographic, family, and community factors that contribute to the glycemic control of African-American and Caucasian youths with diabetes, we investigated two questions: 1) Is there a disparity in glycemic control between African-American and Caucasian youths with diabetes, and if so, what sociodemographic, family, and community factors explain the disparity? and 2) Is there a difference in the adherence to treatment between African-American and Caucasian youths with diabetes, and if so, what sociodemographic, family, and community factors explain the difference? RESEARCH DESIGN AND METHODS This cross-sectional study included 146 youths with diabetes (95 Caucasians and 51 African-Americans) and their mothers. The youths were invited to participate if they had been diagnosed with diabetes at least 1 year before the study, did not have another chronic illness, and were < 18 years of age. RESULTS The findings indicate that African-American youths with diabetes are in significantly poorer metabolic control than their Caucasian counterparts (1.5% difference in HbA1c levels). Single-parent household status and lower levels of adherence partially account for the poorer glycemic control. Examination of the adherence subscales indicates that African-Americans report significantly lower adherence to diet and glucose testing than Caucasian youths. CONCLUSIONS This study suggests that African-American youths with diabetes may be at greater risk for poor glycemic control due to the higher prevalence of single parenting and lower levels of adherence found in this population.

Research on Diabetes Management and the Family: A Critique

Research on diabetes management and the family has been traditionally viewed within a linear model, in which parental attitudes toward diabetes are seen as the principal influence on the childs adjustment and metabolic control. Recently the focus of research has shifted to the broader family milieu, with an emphasis on patterns of cooperation and conflict among all family members in implementing the treatment regimen. As investigators have begun to study the entire family, the linear model of parental influences has been overshadowed by a systems model of family interaction, based on the concept of mutual influences among all individuals in the family. Several methodological problems have characterized research in this area, such as inadequate assessments of family functioning, unreliable indices of metabolic control, and insensitivity to differences in age and disease variables. Future studies of diabetes management will have much to gain from consideration of the role of the father and siblings in treatment, attention to the diabetic childs impact on family functioning, and recognition of sources of support and stress outside the family that affect adaptation to diabetes.

Mental Health Problems and Sexual Abuse Among Adolescents in Foster Care: Relationship to HIV Risk Behaviors and Intentions

Adolescents in foster care present with multiple psychosocial and mental health problems that individually are associated with increased risk for HIV infection. However, few studies have examined empirically the interrelationships among these problems and HIV risk behaviors in this population. This study examined the sexual abuse histories and mental health problems among 343 youths in foster care to determine their association with HIV-risk behaviors and behavioral intentions. Results indicated that 25% reported internalizing behaviors (withdrawn, somatic complaints, depressed) and 28.3% reported externalizing behaviors (delinquent and aggressive behaviors). Of the sample, 37% reported some form of prior sexual abuse. Multivariate analyses using simultaneous entry of variables indicated that controlling for demographic variables and behavioral intentions, externalizing behaviors showed the strongest relationship with HIV-risk behaviors. Likewise, in the multivariate model, it was most strongly associated with behavioral intentions. Moreover, there was a significant race-by-gender interaction, with White females engaging in more risky behaviors than their male counterparts and youths of color.

Neighbors for a smoke free north side: evaluation of a community organization approach to promoting smoking cessation among African Americans.

OBJECTIVES This study evaluated a community organization approach that emphasized involvement of audiences in program planning and implementation in promoting nonsmoking among African American residents of low-income neighborhoods. METHODS The quasi-experimental design involved a 24-month intervention in 3 low-income, predominantly African American neighborhoods in St. Louis. Intervention neighborhoods were compared with comparable, untreated neighborhoods in Kansas City. RESULTS The program was successful in engaging audience members in its governance and in instigating numerous and diverse neighborhood activities to promote nonsmoking. The prevalence of smoking declined from 34% to 27% in program neighborhoods but only from 34% to 33% in comparison neighborhoods. This difference was apparent within all demographically defined subsamples, indicating that observed changes were consistent and not attributable to confounding by demographic characteristics. CONCLUSIONS A community organization approach emphasizing local authority for program decisions and involvement of informal networks may have an appreciable impact on smoking among residents of low-income, African American neighborhoods.

Signs of Resilience in Sexually Abused Adolescent Girls in the Foster Care System

ABSTRACT In a sample of 99 sexually abused adolescent girls in the foster care system (64% in congregate living situations and 36% in family/foster care homes), nearly half were psychologically functioning well despite having experienced moderate-to-severe emotional, physical, and sexual abuse. It was hypothesized that these girls with resilient trajectories would differ from the currently symptomatic girls on several protective factors: education, future orientation, family support, peer influence, and religion. The results revealed that the girls with resilient trajectories were significantly more certain of their educational plans and optimistic about their future and had more positive peer influences.

Knowledge, attitudes and behaviors related to AIDS among youth in residential centers: results from an exploratory study.

This study assesses the level of knowledge about and attitudes toward AIDS among youth residing in residential centers. It also assesses the degree to which they engage in high risk behaviors related to AIDS. The study evaluates the impact of a short educational intervention on the youths knowledge, attitudes, and behaviors related to AIDS. Findings suggest that the respondents are relatively knowledgeable about the disease and how to prevent it. However, a substantial proportion of them do not hold positive attitudes toward prevention and are actually engaging in unsafe behavior. The results also show that a short intervention that provides information about AIDS is ineffective in reducing engagement in high risk activities.

Improving dietary behavior in African Americans: the Parents As Teachers High 5, Low Fat Program

BACKGROUND The High 5, Low Fat Program (H5LF) for African American parents was developed in partnership with the Parents As Teachers program, and was designed to test a dietary intervention appropriate for national adoption. METHODS H5LF used a group randomized, nested cohort design with 738 parents. Consistent with organizational goals and methods, parent educators delivered a dietary change program via personal visits, newsletters, and group meetings. Primary outcomes were reducing percentage calories from fat and increasing fruit and vegetable consumption among participating parents; intermediate aims included improving in nutrition-related skills and parental modeling of dietary behaviors. RESULTS H5LF parents achieved a 0.53 increase in fruit and vegetable consumption (P = 0.03), and a higher proportion of H5LF parents reduced their intake to less than 30% calories from fat (chi(2) = 4.8, P < 0.03; -1.7% calories from fat, p = 0.07) and improved performance of dietary behaviors (F = 14.2, P = 0.004). Improvements in parental modeling were not statistically significant. CONCLUSIONS H5LF is an effective intervention that is appropriate for national adoption by over 2000 Parents As Teachers sites with the potential to impact dietary intake of African American parents nationwide.

Cultural Relevancy of a Diabetes Prevention Nutrition Program for African American Women

Diabetes among African American women is a pressing health concern, yet there are few evaluated culturally relevant prevention programs for this population. This article describes a case study of the Eat Well Live Well Nutrition Program, a community-based, culturally specific diabetes prevention nutrition program for African American women. The stages of change theory and principles from community organization guided the development of the program. Health education strategies, including participatory development and program delivery by peer educators, were applied to promote cultural relevance. Results indicated that overall participants (90%) believed the program to be culturally relevant and were very satisfied with the program (82%). Cultural relevancy was significantly associated with greater program satisfaction and changes in dietary patterns when controlling for the number of sessions attended. Conclusions suggest that participatory strategies can be effective in designing culturally specific prevention programs for African American women.

African American Family Structure: Are There Differences in Social, Psychological, and Economic Well-Being?

This study addresses the following research questions: (a) What are the various types of family structures that exist in urban African American households? and (b) to what extent do differences in family structure influence social, psychological, and economic well-being as reported by urban African American women? The authors present findings from 301 African American women who participated in a community-based nutrition prevention program in a large Midwestern urban center. This studys results indicate that family structure has more influence on African American womens economic well-being than do social and psycho-logical factors. Implications of these findings for intervention are presented.