This competing continuation application seeks support for a significant extension of our current studies of the effects of a behavioral intervention, coping skills training (CST), for children and adolescents with type 1 diabetes (T1D) on intensive insulin therapy. In previous studies, we have demonstrated significant improvements in metabolic control and adaptation over 12 months in adolescents. Rapid advances in technology and access to the internet have made it a viable mode for the delivery of psycho-educational interventions. Psycho-educational interventions delivered via the internet have demonstrated efficacy in a variety of ages and illness experiences. The internet, therefore, represents a delivery system for our CST intervention that has the potential to be appealing, effective, and time-efficient for adolescents with type 1 diabetes. In addition, this study will allow us to move beyond in-person sessions to a virtual community to deliver our intervention to a broad audience in a cost-effective manner. Thus, the aims for this application are: 1. Principal Aims: A. Using a clinical trial design, we will determine the effect of TEENCOPE(tm) (an internet-based CST intervention) on primary endpoints of physiologic (Hemoglobin A1c (HbA1c), psychosocial (quality of life), and family (conflict) adaptation compared to an internet education intervention for adolescents with T1D. B. To determine the effect of TEENCOPE on secondary endpoints of stress, coping, self-efficacy, social competence, and family support compared to an internet education intervention for adolescents with T1D. 2. Secondary Aims: A. To evaluate the mediating effects of stress, coping, self-efficacy, social competence, and family support on relations between participation in TEENCOPE and the primary outcomes of physiologic (HbA1c), psychosocial (quality of life) and family (conflict) adaptation. B. To evaluate the usage, satisfaction, and cost of TEENCOPE compared to an internet education intervention. 3. Exploratory Aim: To explore the stressors and coping strategies of adolescents with T1D during participation in TEENCOPE. The results of this study will provide new data on an innovative internet method to deliver CST that may improve diabetes management, metabolic control, and quality of life in adolescents with T1 D.
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