Objective To evaluate a theory based, subject-centered, staff/subject communication program, AASAP (Anticipate, Acknowledge, Standardize, Accept, Plan), to increase recruitment and retention in RCTs. Methods AASAP was evaluated with logistical regression by comparing rates of recruitment (at telephone screening, baseline assessment, initial intervention) and intervention retention (over 16 weeks) before (−AASAP) and after (+AASAP) it was introduced to a 3-arm RCT to reduce disease distress among highly distressed subjects with type 2 diabetes. Results Included were 250 subjects in −AASAP and 338 in +AASAP. Significant improvement in recruitment occurred at each of the 3 recruitment stages: agreed at screening (OR=2.52, p<.001), attended baseline assessment (OR = 1.91, p<.001), attended initial intervention (OR = 1.46, p<.03). Higher education and shorter diabetes duration predicted better recruitment in −AASAP (OR = 2.23, p<.001), but not in +AASAP. AASAP also improved intervention retention over 16 weeks (OR = 3.46, p<.05). Conclusion AASAP is a structured program of subject/staff communication that helps improve external validity by enhancing both subject recruitment and retention. Practical Implications AASAP can be taught to non-professional staff and can be adapted to a variety of health settings. It can also be used by clinicians to engage patients in programs of ongoing care.

Type 1 diabetes (T1D) is a complex chronic disease that has many facets for successful management. The burden of this management falls largely on the individual and their family members. Self-management has a major influence on T1D health outcomes, and with successful management, children and adolescents with T1D can lead long and healthy lives. We discuss how various individual, family, and systemic/technologic factors influence T1D self-management, providing research that supports interventions targeting each of these factors. With this information, health care practitioners and researchers can better understand the role of T1D self-management and bolster this important aspect of T1D care.

The current study examined drug treatment-related reductions in alcohol and marijuana use, cigarette smoking, and non-drug offending among male adolescents who had been adjudicated of a serious (almost exclusively felony) offense. Results indicated that the "real world" drug treatments that these adolescents experienced had significant effects on substance use, which could not be explained solely by incarceration in controlled environments. However, effects on cigarette smoking and criminal offending were found only for treatments that included family involvement. Results suggest that involving families in adolescents' treatment may be useful for promoting desistence from criminal offending in this population.

PURPOSE We wanted to identify risk factors associated with the development of major depressive disorder (MDD) among patients with type 2 diabetes over time. METHODSIn a noninterventional study, 338 adult patients with type 2 diabetes and no MDD diagnosis at baseline were assessed 3 times during 18 months (9-month intervals) to ascertain predictors of MDD. We tested a model incorporating personal, behavioral, biologic, and psychosocial variables to identify predictors of MDD. Exploratory analyses tested whether current negative affect mediated the relationship between predictors and subsequent MDD. We also conducted a stratifi ed analysis of moderate vs high negative affect to explore whether level of baseline negative affect mediated the relationship between specifi c predictors and MDD.RESULTS Prior MDD and negative affect predicted future development of MDD. In subpopulations stratifi ed by moderate negative affect, negative life events, an elevated body mass index (BMI), prior MDD, and poor control of glycated hemoglobin (hemoglobin A 1c ) each predicted MDD. In subpopulations stratifi ed by elevated negative affect, negative life events and poor control of hemoglobin A 1c predicted MDD. Current negative affect partially mediated the relationship between prior MDD and subsequent MDD, as well as the relationship between negative life events and subsequent MDD. CONCLUSIONSAlthough negative affect at baseline was the primary predictor of subsequent MDD, when stratifi ed by negative affect, negative life events, BMI, and poor control of hemoglobin A 1c also predicted MDD. Thus, life stresses and patients' disease-related concerns are important when understanding what predicts subsequent MDD. Addressing depressive symptoms and broader life context issues expands the scope of a potential intervention to reduce the risk of developing MDD in persons with type 2 diabetes. 2011;9:115-120. doi:10.1370/afm.1212. Ann Fam Med INTRODUCTIOND epression is a common comorbidity among patients with type 2 diabetes. It is associated with increased health care costs, disability, functional impairment, and mortality.1,2 Patients with type 2 diabetes are 52% more likely to develop major depressive disorder (MDD) than the general population, 3 and most of these patients are managed in primary care. 4Although several studies have suggested all patients with diabetes be screened for MDD, 5,6 the ability to identify subsets of patients with type 2 diabetes who are at risk would channel scarce resources and focus attention on a vulnerable population. 7,8 We undertook this study in an effort to identify biologic, behavioral, and psychosocial characteristics at baseline that predict the onset of MDD among primary care patients with diabetes. METHODSOur study was of a 3-wave, 18-month, noninterventional, longitudinal design that included a primary care sample of 506 patients with type 2

Within the United States, diabetes is a serious public health concern and patients with diabetes are more likely to experience clinical depression, psychological distress, and depressive symptoms than those without. Negative psychosocial factors are associated with poorer diabetes management and glycemic control. Overall, both the rates of diabetes and related psychological distress are greater for persons of diverse ethnicities than for non-Latino whites, and have reached epidemic proportions in certain groups. The following article will provide an overview across ethnicities of the rates of diabetes, health outcomes, psychosocial outcomes, and unique cultural and linguistic challenges that contribute to disparities within US diabetes patients of diverse ethnicities. Using this information, our hope is that health care practitioners and researchers alike can better respond to the psychosocial needs of ethnically diverse patients.