. Type 1 diabetes (T1D) is the third most common pediatric chronic illness in the United States. Although historically more prevalent in white youth, the rate and prevalence of pediatric T1D diagnoses are increasing disproportionately among black youth. Racial disparities persist beyond incidence, such that black youth with T1D are at risk for disparities in T1D treatment, management and outcomes as compared to white and Hispanic youth. Compelling evidence demonstrates that racial health disparities exist even when income and education are similar among racial/ethnic groups. These health disparities are compounded in black youth from single parent homes, in comparison to those from two-parent homes. Despite being at high risk, the family voices of black youth from single parent homes continue to be underrepresented in pediatric T1D research, as prior research has predominantly focused on ?majority culture? families (white, two parent, middle class). Daily family and self-management of T1D is critical to reducing the risk of poor diabetes related outcomes and the social determinants of health (SDOH) that families experience can substantially influence a family's ability to manage a chronic illness. Thus, understanding how SDOH contribute to health disparities seen in this at risk population is paramount to the delivery of nursing care, the development of interventions and to future nursing science research efforts. This proposed research intensive training plan prepares the applicant to conduct a three-phase sequential exploratory mixed methods study [QUAL?quan] with a purposive sample of single parents of black youth with T1D from an urban pediatric diabetes center. Focus groups and semi-structured interviews will be conducted to identify the most influential SDOH components for these families, how they influence T1D family and self-management, and potential strengths and solutions for addressing these barriers in this at risk population. Not all families are alike, thus qualitative findings will be used to develop and disseminate a quantitative survey within a broader T1D population of black, single parent families to elucidate within group differences for resource, clinical, and structural needs and generate hypotheses for future research and intervention development. Knowledge gained will focus resources on the most in need families and guide development of clinical, community and structural interventions to improve family and self- management and reduce health disparities. This research and training plan will build the foundation for the applicant's long term goal of developing a program of research committed to improving patient and families' quality of life (QoL) and family and self-management by addressing the impacts of SDOH on family and self- management of pediatric chronic illnesses. The proposed study and applicant's research goals align with the National Institute of Nursing Research's strategic plan to address focusing chronic illness self-management and QoL, by on SDOH as drivers of T1D family and self-management in high risk patients.

Public Health Relevance

. Black youth with Type 1 diabetes experience persistent and marked racial disparities in incidence, treatment, management and outcomes, as compared to white youth. Disparities are compounded in black youth from single parent families, as compared to two parent families. Understanding how social determinants of health contribute to these disparities is paramount to nursing care and research, allowing us to target resources to those most in need and develop clinical, community and structural interventions designed to reduce health disparities.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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University of Pennsylvania
Schools of Nursing
United States
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