This application is for a second competing continuation of a longitudinal study of youth with and without diabetes. In 2002, we enrolled 132 children with diabetes and 131 children without diabetes who were in the 6th, 7th, or 8th grade and on average 12 years old into a longitudinal study. The focus of that study was on the psychosocial factors that predicted a successful transition through adolescence for both groups and that predicted diabetes-related difficulties for youth with diabetes. In 2007, we received a 5-year competing continuation to examine the transition out of high school into the onset of emerging adulthood. In that study (in progress), we are examining youth in their senior year of high school and 1 and 2 years later. In the proposed application, we focus on the stage of emerging adulthood (EA) in those with and without diabetes. We propose a three-wave longitudinal study of these EAs spanning the ages of 22-24. The ages 22 through 24 are critical for the examination of health behaviors and psychological well-being. For those with diabetes, these years are critical in terms of the transfer out of the pediatric health care system into the adult health care system. Having had diabetes for an average of 15 years, we also may observe and be able to predict the onset of diabetes-related complications. We have four primary aims: (1) To determine if there are differences between persons with and without diabetes in psychosocial functioning, health behaviors, and emerging adulthood outcomes related to education, employment, relationships, and finances;(2) Among those with diabetes, to capture the transfer out of the pediatric health care system into the adult health care system, to examine health care choices made, and to evaluate the implications of these choices for diabetes health;(3) Among those with diabetes, to examine early indicators of diabetes-related complications and compare the rate of complications to a comparable cohort (in terms of age and length of diabetes) from the Epidemiology of Diabetes Complications Trial;and (4) To utilize a """"""""Risk and Resistance Framework"""""""" to predict psychological, behavioral, and physical health among EAs with and without diabetes. We will visit EAs once a year for three consecutive years to have them complete a psychosocial survey via a laptop computer, to obtain a series of general health measures for both diabetes and healthy participants (e.g., BMI), and to obtain a detailed assessment of diabetes-related complications (e.g., neuropathy, nephropathy) administered by a trained nurse (only years 1 and 3). The results of this study will be used to identify EAs at risk for mental and physical health difficulties.
The transition from adolescence to emerging adulthood is a high risk period in terms of mental health problems and risky health behaviors. However, little research focuses on this stage of development. The presence of type 1 diabetes-one of the most common childhood chronic illnesses-makes negotiating these challenges more difficult. For those with diabetes, these challenges take on increasing importance because risk behaviors, such as alcohol use, have more severe consequences;depressive symptoms affect both self-care behavior and metabolic control;and the transition from the pediatric health care system is associated with a decline in clinic attendance and a deterioration in metabolic control. We have observed a decline in self-care behavior and deterioration in metabolic control from early adolescence through the onset of emerging adulthood. The present study will help to identify those who at risk for mental or physical health difficulties and provide the foundation for interventions and public health programs aimed at adolescents with and without diabetes. A population of healthy emerging adults will benefit society and public health initiatives in a number of ways (e.g., they will be productive, able to care for others, able to mentor younger generations of people, and have a positive impact on the health care system). A population of healthy adults with type 1 diabetes will help to prevent the diabetes-related complications that affect quality and quantity of life. The information obtained from the proposed investigation will be made publicly available (through news outlets, publications, course instruction, conference presentations, websites) so that adolescents and their families can become aware of the risk and resilience factors that affect health and well-being.
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