This self-regulation approach has multiple benefits: A parsimonious construct for explaining both individual and interpersonal processes that contribute to risk and resilience for chronic illness self-management, the incorporation of methods used in developmental and health psychology research, including performance-based, physiological, daily, and ecological momentary assessment, and a new look to interventions that target self-regulation as a way to improve individual and interpersonal processes in chronic illness self-management.

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Background Type 1 diabetes is associated with significant mortality and economic cost. Management of type 1 diabetes involves completing multiple daily adherence behaviors, and many adolescents struggle with self-management and show poor glycemic control. Purpose The purpose was to conduct an unblinded pilot randomized controlled parallel-group study of a web-delivered multi-component intervention targeting self-monitoring of blood glucose, working memory, and parent supervision of diabetes care among adolescents with type 1 diabetes. Intervention components included high magnitude incentives for adolescents and parents, motivational and cognitive behavioral therapy and working memory training for adolescents, and training in contingency contracting for parents. Methods Adolescents (N=114) with poorly controlled type 1 diabetes were screened and N=61 were randomized using minimum likelihood allocation to usual care (usual care, N=31) or to a 25-week/15 session web-delivered intervention (WebRx, N=30). Results At the end of treatment, adolescents in WebRx had higher self-monitoring of blood glucose (d=0.58) (primary outcome), better visual spatial working memory (d=0.48) and inhibition (d=0.98), and lower HbA1c (d=0.45) than those in usual care. WebRx parents reported more frequent review of the adolescent’s glucometer (d=1.30), and reduced family conflict (d=0.56). Between-condition differences were maintained 6 months later in self-monitoring of blood glucose (d=0.42), visual spatial working memory (d=0.76), family conflict (d=0.50), and HbA1c (d=0.44). Conclusions Results showing sustained effects on self-monitoring of blood glucose and HbA1c support moving forward with a larger trial to test this innovative web-delivered and multicomponent intervention. (ClinicalTrials.gov number NCT01722643).

Abilities involved in performance on EF tests may be one resource for maintaining better glycemic control during the transition to emerging adulthood. Assessment of such EF abilities may allow for the identification of individuals who are most at risk for deterioration of glycemic control during this transition.

Objective Sexual activity often begins in early adolescence, and adolescents with mental health symptoms are at greater risk for sexual activity and other health risks. This study aimed to evaluate a developmentally targeted intervention designed to enhance early adolescents’ emotion regulation competencies as a strategy for reducing health risk behaviors, including sexual initiation. Method Adolescents 12 to 14 years old (N = 420; 53% male) with mental health symptoms participated in either an Emotion Regulation (ER) or Health Promotion (HP) intervention consisting of twelve after-school sessions. Participants completed questionnaires on laptop computers at baseline, 2-, 6-, and 12-month follow-ups. Results Time to event analyses were used to compare intervention conditions on rate of initiation to vaginal sex. Results showed that participants in the Emotion Regulation (ER) condition were less likely to transition into vaginal sexual activity by one-year follow-up than those in the Health Promotion (HP) condition (adjusted hazard ratio = 0.58, 95% CI: 0.36 to 0.94, p = .01). However, those who were sexually active did not report differences in sexual risk behaviors (e.g., condomless sex). Participants in the ER condition were significantly less likely to report violence behaviors and showed improvement on a behavioral measure of emotion identification, however they did not differ from HP participants on self-reports of emotional competence. Conclusions Emotion regulation strategies can be used to delay sexual initiation among early adolescents with mental health symptoms and may have an important role in health education.