Although nonadherence is well documented and strategies for adherence have been shown to be criti... more Although nonadherence is well documented and strategies for adherence have been shown to be critical to overcoming barriers and improving overall adherence rates, it is unknown how family strategy use is related to adherence in the pediatric renal transplant population. The aims of this study were to assess (a) the strategies used by adolescents with kidney transplants and their caregivers to adhere to the posttransplant oral medication regimen and (b) the relationship of these strategies to objective adherence rates. Semistructured interviews to assess self-management were administered to 17 adolescents (14-18 years) and 17 caregivers. Adherence to oral immunosuppressant medication, measured via electronic monitors, was determined also for a subset of 13 dyads. Common strategies endorsed by families included the following: making it part of the routine (88.2%), verbal reminders by caregiver (82.4%), caregiver verifying medication was taken (76.5%), placing medication in a convenient location (76.5%), and using a pillbox (70.6%). A greater number of family-endorsed strategies were correlated with higher levels of adherence. Of those strategies spontaneously endorsed, only caregiver reminders to take medication and caregiver verification that medications were taken were related significantly to higher adherence rates. The findings highlight the importance of identification and use of specific strategies to improve adherence rates of pediatric renal transplant recipients and emphasize the need for continued caregiver involvement in the promotion of adherence to the treatment regimen.
Objective To examine the impact of overweight status on pediatric quality of life (QOL). Method T... more Objective To examine the impact of overweight status on pediatric quality of life (QOL). Method This correlational study examined the relationship between weight, social support, race, informant, and QOL in a sample of 107 clinically overweight youth, ages 12 to 17 years. Results Regression analysis did not support the relation between QOL and weight. Social support was a significant predictor of youth reports of overall QOL. Males reported better physical QOL than females by both parent and youth report. Pairedsamples t-tests supported a discrepancy between child and parent-proxy reports of QOL; parents reported significantly worse QOL than their children across many dimensions. Analysis of variance found no significant difference between Caucasian and African American youth's QOL. Conclusions These results highlighted the importance of considering informant, gender, and the impact of social support when measuring QOL in clinically overweight pediatric populations.
Objective-To assess weight stigma, self-perception of weight status, and factors contributing to ... more Objective-To assess weight stigma, self-perception of weight status, and factors contributing to accurate self-perception of weight status in obese youth presenting for treatment at a hospitalbased multidisciplinary weight management program.
To examine whether individual psychological variables mediate the family conflict-glycemic contro... more To examine whether individual psychological variables mediate the family conflict-glycemic control relationship. During three study visits spanning 9 months, 147 adolescents with type 1 diabetes completed questionnaires measuring anxiety and depressive symptoms, and diabetes-specific worry. Caregivers similarly completed a measure of diabetes-specific family conflict. Blood glucose monitoring frequency and glycemic control were also obtained during study visits. Separate mediation analyses revealed that anxiety was the only individual psychological variable that mediated the caregiver-reported family conflict-glycemic control link. Anxiety accounted for 20% of the family conflict-glycemic control link, compared to 8.5% for depression and 6% for diabetes-specific worry. Results suggest that anxiety symptoms may be promoted in a family environment characterized by conflict and these symptoms have detrimental effects on glycemic control. Continued monitoring of family functioning and adolescents' anxiety symptoms, as well as refinement of interventions, is needed to promote positive health outcomes.
BACKGROUND: Although family-based, behavioral interventions for pediatric obesity require caregiv... more BACKGROUND: Although family-based, behavioral interventions for pediatric obesity require caregivers to make major changes to dietary intake and the family meal, few studies have examined family functioning, and specifically, mealtime behaviors among families of treatment-seeking obese children. The current study compared mealtime family functioning of treatment-seeking obese children and nonobese demographically matched comparisons using a multimethod design. METHODS: Participants included the families of 27 obese children (BMI ≥95(th) percentile; M body mass index (BMI) z-score values [M zBMI] = 2.55) at the time of treatment initiation and 27 families of nonobese children (M zBMI = 0.17). Each family's evening meal was videotaped and coded for observed family functioning using the Mealtime Interaction Coding System (MICS). Caregivers completed a demographics form and a measure of family mealtime climate. RESULTS: Caregivers of obese children self-reported greater mealtime cha...
JANICKE, DAVID M., KRISTEN K. MARCIEL, LISA M. INGERSKI, WENDY NOVOA, KELLY W. LOWRY, BETHANY J. ... more JANICKE, DAVID M., KRISTEN K. MARCIEL, LISA M. INGERSKI, WENDY NOVOA, KELLY W. LOWRY, BETHANY J. SALLINEN, AND JANET H. SILVERSTEIN. Impact of psychosocial factors on quality of life in overweight youth. Obesity. 2007;15:1799 -1807.
To examine white coat adherence over time in children with epilepsy. This was a longitudinal pros... more To examine white coat adherence over time in children with epilepsy. This was a longitudinal prospective study to examine medication adherence prior to and following consecutive clinic visits over a 13-month period in 120 children with newly diagnosed epilepsy (M(age) = 7.2 ± 2.9 years; 38% female) and their caregivers. Electronic monitors were used to assess adherence and ordinal logistic regression models were employed. Results demonstrated white coat adherence, with adherence increasing during the 3 days preceding clinic visits. Data also revealed a significant interaction, whereby adherence increased following initial clinic visits, but decreased following the last clinic visit. White coat adherence occurs for children with newly diagnosed epilepsy. Increased awareness of white coat adherence has important implications for clinical decision-making and should be examined in other pediatric populations. Increased monitoring of medication patterns can help clinicians avoid unnecessary changes to the treatment regimen. Interventions targeting improved communication around adherence behaviors are necessary to maximize therapy benefits.
OBJECTIVE-Despite the growing use of patient-reported outcomes, few studies directly compare heal... more OBJECTIVE-Despite the growing use of patient-reported outcomes, few studies directly compare health-related quality of life (HRQOL) across different pediatric chronic illnesses. Understanding the differential impact of specific illnesses on youth psychosocial functioning has treatment implications, especially for primary care providers. This study compared HRQOL across eight pediatric chronic conditions, including five understudied populations, and examined convergence between youth self-report and parent-proxy report.
Objective To identify family-reported, adherence-related barriers for adolescents with inflammato... more Objective To identify family-reported, adherence-related barriers for adolescents with inflammatory bowel disease (IBD) and examine their relationship to 6-MP/azathioprine and 5-ASA medication adherence. Methods Participants included 74 adolescents, aged 13-17 years, diagnosed with IBD and their caregivers. Adolescents and caregivers jointly completed a measure of barriers to medication adherence. Adherence to medication was measured by family-report, pill-count, and serum assay. Results Families endorsed one to seven total barriers to medication adherence. The most commonly reported barriers included forgetting, being away from home, and interference with an activity. Neither demographic nor disease severity variables were related to the total number of reported barriers. Fewer total reported barriers was related to better adherence by adolescent and maternal report. Conclusion Most families experience at least one barrier to treatment adherence. Effective problem-solving around these barriers and its integration into future treatment protocols may help improve medication adherence in the pediatric IBD population.
Objective To analyze associations between factor scores for caregiver responsibility for direct a... more Objective To analyze associations between factor scores for caregiver responsibility for direct and indirect diabetes management tasks with glycemic control and blood glucose monitoring (BGM) frequency. Methods Two hundred and sixty one adolescents with type 1 diabetes and their caregivers completed the Diabetes Family Responsibility Questionnaire (DFRQ). Data on diabetes management (e.g., BGM frequency) and glycemic control (e.g., A1c values) were obtained. Results Confirmatory factor analysis of the DFRQ revealed two factors-direct and indirect management tasks. Multivariate analyses demonstrated that adolescent perception of greater responsibility sharing with caregivers on direct management tasks was significantly associated with higher BGM frequency. Conclusions Adolescents who perceive greater caregiver responsibility, particularly around direct management tasks, engage in better diabetes management. Implications of these findings include designing interventions that encourage and sustain caregiver responsibility through adolescence and make explicit the contribution of caregivers.
Objectives Recognizing the importance of patient-reported outcomes, this longitudinal, prospectiv... more Objectives Recognizing the importance of patient-reported outcomes, this longitudinal, prospective study examined: Changes in health-related quality of life (HRQOL) over seven months following antiepileptic drug (AED) initiation and the relationship of seizures, AED side-effects, and AED type to HRQOL. Method Parents of 124 children with newly diagnosed epilepsy completed measures of HRQOL and side-effects at each clinic visit. Treatment information was also collected. Results HRQOL remained stable over time; however, seizures and AED side-effects significantly affected multiple HRQOL domains. Higher seizure activity was associated with decreased Physical HRQOL. Side-effects were negatively associated with all HRQOL domains. Children taking carbamazepine who experienced higher side-effects early in therapy demonstrated declining emotional functioning compared to children experiencing no/some side-effects. Conclusions AED side-effects, AED type, and seizure frequency were associated with longitudinal HRQOL in children with newly-diagnosed epilepsy. Routine assessment of AED side-effects and HRQOL may be useful for clinical decision making.
Although nonadherence is well documented and strategies for adherence have been shown to be criti... more Although nonadherence is well documented and strategies for adherence have been shown to be critical to overcoming barriers and improving overall adherence rates, it is unknown how family strategy use is related to adherence in the pediatric renal transplant population. The aims of this study were to assess (a) the strategies used by adolescents with kidney transplants and their caregivers to adhere to the posttransplant oral medication regimen and (b) the relationship of these strategies to objective adherence rates. Semistructured interviews to assess self-management were administered to 17 adolescents (14-18 years) and 17 caregivers. Adherence to oral immunosuppressant medication, measured via electronic monitors, was determined also for a subset of 13 dyads. Common strategies endorsed by families included the following: making it part of the routine (88.2%), verbal reminders by caregiver (82.4%), caregiver verifying medication was taken (76.5%), placing medication in a convenient location (76.5%), and using a pillbox (70.6%). A greater number of family-endorsed strategies were correlated with higher levels of adherence. Of those strategies spontaneously endorsed, only caregiver reminders to take medication and caregiver verification that medications were taken were related significantly to higher adherence rates. The findings highlight the importance of identification and use of specific strategies to improve adherence rates of pediatric renal transplant recipients and emphasize the need for continued caregiver involvement in the promotion of adherence to the treatment regimen.
Objective To examine the impact of overweight status on pediatric quality of life (QOL). Method T... more Objective To examine the impact of overweight status on pediatric quality of life (QOL). Method This correlational study examined the relationship between weight, social support, race, informant, and QOL in a sample of 107 clinically overweight youth, ages 12 to 17 years. Results Regression analysis did not support the relation between QOL and weight. Social support was a significant predictor of youth reports of overall QOL. Males reported better physical QOL than females by both parent and youth report. Pairedsamples t-tests supported a discrepancy between child and parent-proxy reports of QOL; parents reported significantly worse QOL than their children across many dimensions. Analysis of variance found no significant difference between Caucasian and African American youth's QOL. Conclusions These results highlighted the importance of considering informant, gender, and the impact of social support when measuring QOL in clinically overweight pediatric populations.
Objective-To assess weight stigma, self-perception of weight status, and factors contributing to ... more Objective-To assess weight stigma, self-perception of weight status, and factors contributing to accurate self-perception of weight status in obese youth presenting for treatment at a hospitalbased multidisciplinary weight management program.
To examine whether individual psychological variables mediate the family conflict-glycemic contro... more To examine whether individual psychological variables mediate the family conflict-glycemic control relationship. During three study visits spanning 9 months, 147 adolescents with type 1 diabetes completed questionnaires measuring anxiety and depressive symptoms, and diabetes-specific worry. Caregivers similarly completed a measure of diabetes-specific family conflict. Blood glucose monitoring frequency and glycemic control were also obtained during study visits. Separate mediation analyses revealed that anxiety was the only individual psychological variable that mediated the caregiver-reported family conflict-glycemic control link. Anxiety accounted for 20% of the family conflict-glycemic control link, compared to 8.5% for depression and 6% for diabetes-specific worry. Results suggest that anxiety symptoms may be promoted in a family environment characterized by conflict and these symptoms have detrimental effects on glycemic control. Continued monitoring of family functioning and adolescents' anxiety symptoms, as well as refinement of interventions, is needed to promote positive health outcomes.
BACKGROUND: Although family-based, behavioral interventions for pediatric obesity require caregiv... more BACKGROUND: Although family-based, behavioral interventions for pediatric obesity require caregivers to make major changes to dietary intake and the family meal, few studies have examined family functioning, and specifically, mealtime behaviors among families of treatment-seeking obese children. The current study compared mealtime family functioning of treatment-seeking obese children and nonobese demographically matched comparisons using a multimethod design. METHODS: Participants included the families of 27 obese children (BMI ≥95(th) percentile; M body mass index (BMI) z-score values [M zBMI] = 2.55) at the time of treatment initiation and 27 families of nonobese children (M zBMI = 0.17). Each family's evening meal was videotaped and coded for observed family functioning using the Mealtime Interaction Coding System (MICS). Caregivers completed a demographics form and a measure of family mealtime climate. RESULTS: Caregivers of obese children self-reported greater mealtime cha...
JANICKE, DAVID M., KRISTEN K. MARCIEL, LISA M. INGERSKI, WENDY NOVOA, KELLY W. LOWRY, BETHANY J. ... more JANICKE, DAVID M., KRISTEN K. MARCIEL, LISA M. INGERSKI, WENDY NOVOA, KELLY W. LOWRY, BETHANY J. SALLINEN, AND JANET H. SILVERSTEIN. Impact of psychosocial factors on quality of life in overweight youth. Obesity. 2007;15:1799 -1807.
To examine white coat adherence over time in children with epilepsy. This was a longitudinal pros... more To examine white coat adherence over time in children with epilepsy. This was a longitudinal prospective study to examine medication adherence prior to and following consecutive clinic visits over a 13-month period in 120 children with newly diagnosed epilepsy (M(age) = 7.2 ± 2.9 years; 38% female) and their caregivers. Electronic monitors were used to assess adherence and ordinal logistic regression models were employed. Results demonstrated white coat adherence, with adherence increasing during the 3 days preceding clinic visits. Data also revealed a significant interaction, whereby adherence increased following initial clinic visits, but decreased following the last clinic visit. White coat adherence occurs for children with newly diagnosed epilepsy. Increased awareness of white coat adherence has important implications for clinical decision-making and should be examined in other pediatric populations. Increased monitoring of medication patterns can help clinicians avoid unnecessary changes to the treatment regimen. Interventions targeting improved communication around adherence behaviors are necessary to maximize therapy benefits.
OBJECTIVE-Despite the growing use of patient-reported outcomes, few studies directly compare heal... more OBJECTIVE-Despite the growing use of patient-reported outcomes, few studies directly compare health-related quality of life (HRQOL) across different pediatric chronic illnesses. Understanding the differential impact of specific illnesses on youth psychosocial functioning has treatment implications, especially for primary care providers. This study compared HRQOL across eight pediatric chronic conditions, including five understudied populations, and examined convergence between youth self-report and parent-proxy report.
Objective To identify family-reported, adherence-related barriers for adolescents with inflammato... more Objective To identify family-reported, adherence-related barriers for adolescents with inflammatory bowel disease (IBD) and examine their relationship to 6-MP/azathioprine and 5-ASA medication adherence. Methods Participants included 74 adolescents, aged 13-17 years, diagnosed with IBD and their caregivers. Adolescents and caregivers jointly completed a measure of barriers to medication adherence. Adherence to medication was measured by family-report, pill-count, and serum assay. Results Families endorsed one to seven total barriers to medication adherence. The most commonly reported barriers included forgetting, being away from home, and interference with an activity. Neither demographic nor disease severity variables were related to the total number of reported barriers. Fewer total reported barriers was related to better adherence by adolescent and maternal report. Conclusion Most families experience at least one barrier to treatment adherence. Effective problem-solving around these barriers and its integration into future treatment protocols may help improve medication adherence in the pediatric IBD population.
Objective To analyze associations between factor scores for caregiver responsibility for direct a... more Objective To analyze associations between factor scores for caregiver responsibility for direct and indirect diabetes management tasks with glycemic control and blood glucose monitoring (BGM) frequency. Methods Two hundred and sixty one adolescents with type 1 diabetes and their caregivers completed the Diabetes Family Responsibility Questionnaire (DFRQ). Data on diabetes management (e.g., BGM frequency) and glycemic control (e.g., A1c values) were obtained. Results Confirmatory factor analysis of the DFRQ revealed two factors-direct and indirect management tasks. Multivariate analyses demonstrated that adolescent perception of greater responsibility sharing with caregivers on direct management tasks was significantly associated with higher BGM frequency. Conclusions Adolescents who perceive greater caregiver responsibility, particularly around direct management tasks, engage in better diabetes management. Implications of these findings include designing interventions that encourage and sustain caregiver responsibility through adolescence and make explicit the contribution of caregivers.
Objectives Recognizing the importance of patient-reported outcomes, this longitudinal, prospectiv... more Objectives Recognizing the importance of patient-reported outcomes, this longitudinal, prospective study examined: Changes in health-related quality of life (HRQOL) over seven months following antiepileptic drug (AED) initiation and the relationship of seizures, AED side-effects, and AED type to HRQOL. Method Parents of 124 children with newly diagnosed epilepsy completed measures of HRQOL and side-effects at each clinic visit. Treatment information was also collected. Results HRQOL remained stable over time; however, seizures and AED side-effects significantly affected multiple HRQOL domains. Higher seizure activity was associated with decreased Physical HRQOL. Side-effects were negatively associated with all HRQOL domains. Children taking carbamazepine who experienced higher side-effects early in therapy demonstrated declining emotional functioning compared to children experiencing no/some side-effects. Conclusions AED side-effects, AED type, and seizure frequency were associated with longitudinal HRQOL in children with newly-diagnosed epilepsy. Routine assessment of AED side-effects and HRQOL may be useful for clinical decision making.
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