Introduction: Early life adversity (ELA) can result in negative behavioral outcomes, including internalizing and externalizing problems. Evidence suggests that adolescence is a critical developmental period for processing ELA. Identity formation, which is crucial to this developmental period, may moderate the effect between ELA and these problems. One potential moderating variable associated with identity formation is the latent construct Prospective Self, comprised of future-oriented attitudes and behaviors. Methods: Participants are from the first wave of an ongoing longitudinal study designed to characterize behavioral and cognitive correlates of risk behavior trajectories. A community sample of 10th and 12th grade adolescents (N = 2017, 55% female) were recruited from nine public school districts across eight Southeastern Michigan counties in the United States. Data were collected in schools during school hours or after school via self-report, computer-administered surveys. Structural equation modeling was utilized to assess Prospective Self as a latent construct and to evaluate the relationship between ELA, internalizing and externalizing problems, and Prospective Self. Results: Preliminary findings indicated a satisfactory fit for the construct Prospective Self. The predicted negative associations between Prospective Self and internalizing and externalizing problems were found and evidence of moderation was observed for externalizing problems, such that the effects of ELA (i.e., childhood maltreatment) on externalizing problems were lower for individuals with higher levels of Prospective Self. Conclusions: These results indicate that Prospective Self may play a role in supporting resilience against externalizing problems associated with ELA among adolescents.
Young adults with diabetes assume increasing responsibility for communicating with their health care providers, and engaging in high-quality health communication is an integral component of overall diabetes self-management. This article provides an overview of the main features of health communication, factors that may influence communication quality, interventions to promote communication skills, and practical strategies for clinicians working with young adults with diabetes. The review concludes with a comprehensive summary of future directions for health communication research.
Background: Adolescents and young adults (AYAs) are at higher risk for diabetes self-care challenges and elevated A1c. Understanding AYA/health care provider (HCP) communication may provide insight to better support T1D management. The current study examined content and quality of AYA/HCP communication during routine T1D care. Methods: Thirty-two AYAs (M age=20.5 ± 9.1 yrs; 53.1% male; 43.8% non-Hispanic Black; M A1c=8.± 1.4%) and 9 HCPs (100% female) participating in an RCT promoting AYA health communication had a routine T1D visit audio-recorded and transcribed. A coding framework was developed to assess communication content and quality, including: AYA initiation, self-disclosure, preparation, and future planning; HCP goal setting, supportive language, problem-solving, education/information sharing, and warnings/threats. Coders double and triple-coded transcripts until 90% agreement was reached. Chi square analyses evaluated associations among codes. Results: Routine T1D visits were primarily attended by AYAs alone (78.1%), ranging from 8-45 min (M=30.3 ±9.3). AYAs and HCPs spoke 27.0% and 69.1% of the visit, respectively. T1D adherence, lifestyle adherence, and developmental issues were discussed in all visits (100%); insurance, mental health, and T1D support systems were each discussed in 53.1% of visits. AYA preparation (e.g., bringing glucose values, regimen knowledge) was positively associated with HCP supportive language (X2(1,N=32)=5.7, p=.02) and HCP education (X2(1,N=32)=8.3, p<.01). HCP warnings/threats were identified in 25% of visits; 75% of AYAs in these visits had A1c levels ≥7.0%. Conclusion: Results highlight reciprocal AYA-HCP communication. Improving AYA preparation for T1D care visits may facilitate more efficient and informative AYA-HCP interactions, potentially leading to improved T1D outcomes. Future studies will evaluate associations among communication and T1D outcomes over time, including A1c and transition to adult care. Disclosure M. E. Zinn: None. C. H. Wang: None. B. Bryant: None. M. Monaghan: None. Funding American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.)
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