Publications by authors named "Lisa M Ingerski"

23 Publications

  • Page 1 of 1

Use of Wise Device Technology to Measure Adherence to Hydroxyurea Therapy in Youth With Sickle Cell Disease.

J Pediatr Hematol Oncol 2021 01;43(1):e19-e25

Hematology, St. Jude Children's Research Hospital, Memphis, TN.

Despite broad support for hydroxyurea (HU) therapy, suboptimal adherence is reported for youth with sickle cell disease. Valid adherence measurement is crucial to understanding the relationship between medication behavior, disease response, and patient-centered health outcomes. The current pilot study examined the feasibility of the Wise electronic device for longitudinal HU adherence measurement in a sample of 36 youths prescribed HU. The study also explored the association between HU adherence, as measured by the Wise device, with other adherence measures (ie, family report, lab values, pill count, and medication possession ratio). A measure of family-reported acceptability was also completed. Overall, results supported the feasibility of the Wise device (rate of consent=82%, device use=75%, device failure=3%) for HU adherence measurement and most families rated their experience using their device positively (favorable responses ranged from 67% to 100%). Associations between HU adherence, as measured by the Wise device, and other adherence measures were not significant. Overall, the feasibility was supported. The Wise device allows longitudinal measurement of adherence with HU from initiation as a young child (ie, with liquid formulations) through adolescence and provides a novel means of adherence measurement for both clinical and research use.
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http://dx.doi.org/10.1097/MPH.0000000000001997DOI Listing
January 2021

Clinic Attendance of Youth With Sickle Cell Disease on Hydroxyurea Treatment.

J Pediatr Hematol Oncol 2017 07;39(5):345-349

Departments of *Psychology †Hematology, St. Jude Children's Research Hospital, Memphis, TN.

Objective: The objective of this study is to describe rates of clinic attendance of youth with sickle cell disease prescribed hydroxyurea and examine potential demographic and medical factors related to consistent clinic attendance.

Methods: Participants included 148 youth diagnosed with sickle cell disease and prescribed hydroxyurea during a single calendar year. Clinic attendance and potential demographic and medical factors related to attendance were extracted via systematic retrospective medical chart review.

Results: Youth attended 90.3% of scheduled appointments and 85.1% of youth attended at least 80% of scheduled clinic appointments during the study window. Adjusting for other factors, multivariate analysis revealed families with fewer children in the household, families with private insurance, youth experiencing fever, and youth not experiencing pain during the calendar year were more likely to consistently attend clinic visits.

Conclusions: Adherence to clinic appointments is critical to optimizing health outcomes for youth with sickle cell disease and integral for adequate monitoring of youth prescribed hydroxyurea, in particular. Findings may aid providers in appropriately identifying possible barriers to clinic attendance to develop attendance promotion interventions.
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http://dx.doi.org/10.1097/MPH.0000000000000859DOI Listing
July 2017

Use of Placebo Pills Before Treatment Initiation in Youth with HIV: Are They Ready?

J Int Assoc Provid AIDS Care 2017 Jul/Aug;16(4):412-417. Epub 2017 Apr 10.

3 Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA.

Highly active antiretroviral therapy (HAART) nonadherence is related to negative health outcomes and is well-documented in adolescents and young adults (AYAs) with behaviorally acquired HIV. Few studies describe methods to improve adherence in this population. This retrospective study describes placebo pill trial use (ie, pills with inert substance prescribed to practice taking HAART) in AYAs initiating HAART and its relation to disease outcomes. Sixty-two AYAs initiated HAART during the review period. Disease outcomes during the first year of standard clinical care were abstracted from medical records. In all, 72.6% of participants received ≥1 pill trial and 27.4% received ≥2 trials. Placebo trial use was not independently related to adherence post-HAART initiation. "Prescription" of a second trial was related to less optimal disease status over the first 6 months of treatment. Placebo trials have the potential to inform clinical care, aid in identifying AYAs at risk for nonadherence, and may provide a novel intervention strategy before/after HAART initiation.
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http://dx.doi.org/10.1177/2325957417702483DOI Listing
April 2018

Telehealth behavioral treatment for medication nonadherence: a pilot and feasibility study.

Eur J Gastroenterol Hepatol 2013 Apr;25(4):469-73

Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, MLC 7039, Cincinnati, OH 45229-3039, USA.

Objective: To evaluate an individually tailored multicomponent nonadherence treatment protocol using a telehealth delivery approach in adolescents with inflammatory bowel disease.

Methods: Nine participants, age 13.71±1.35 years, completed a brief treatment online through Skype. Medication nonadherence, severity of disease, and feasibility/acceptability data were obtained.

Results: Adherence increased markedly from 62% at baseline to 91% for mesalamine (δ=0.63), but decreased slightly from 61% at baseline to 53% for 6-mercaptopurine /azathioprine. The telehealth delivery approach resulted in cost savings of $100 in mileage and 4 h of travel time/patient. Treatment session attendance was 100%, and the intervention was rated as acceptable, particularly in terms of treatment convenience.

Conclusion: Individually tailored treatment of nonadherence through telehealth delivery is feasible and acceptable. This treatment shows promise for clinical efficacy to improve medication adherence and reduce costs. Large-scale testing is necessary to determine the impact of this intervention on adherence and health outcomes.
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http://dx.doi.org/10.1097/MEG.0b013e32835c2a1bDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703848PMC
April 2013

White coat adherence over the first year of therapy in pediatric epilepsy.

J Pediatr 2012 Oct 18;161(4):695-9.e1. Epub 2012 May 18.

Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

Objective: To examine white coat adherence over time in children with epilepsy.

Study Design: 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: 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.

Conclusions: 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.
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http://dx.doi.org/10.1016/j.jpeds.2012.03.059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426618PMC
October 2012

Distress at the Dinner Table? Observed Mealtime Interactions among Treatment-Seeking Families of Obese Children.

Child Obes 2011 Oct;7(5):385-391

Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

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 challenges and a less positive meal environment than non-obese comparisons. There were no significant group differences in observed family mealtime interactions. CONCLUSION: Interestingly, although group means on the observational measure of mealtime family functioning were not significantly different, caregivers of obese children reported greater mealtime stress. Accordingly, it is important in the context of treatment to address caregiver perceptions of mealtime challenges and to examine the extent to which these self-reported challenges affect implementation of treatment recommendations and treatment outcomes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531982PMC
http://dx.doi.org/10.1089/chi.2011.0066DOI Listing
October 2011

Evaluation of a group-based behavioral intervention to promote adherence in adolescents with inflammatory bowel disease.

Eur J Gastroenterol Hepatol 2012 Jan;24(1):64-9

Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.

Objective: To pilot test the feasibility and acceptability of a family-based group behavioral intervention and to improve medication adherence in adolescents diagnosed with inflammatory bowel disease.

Methods: Participants were 40 adolescents aged 11-18 years diagnosed with inflammatory bowel disease and their primary caregivers, who were randomized to either a four-session Family-Based Group Behavioral Treatment or Usual Care over a 6-week period. Adherence was measured using a multi-method, multi-informant assessment involving caregiver-report and patient-report, pill count data, and electronic monitoring.

Results: Adherence rates ranged from 66 to 89% for 6-mercaptopurine/azathioprine and 51 to 93% for mesalamine across assessment methods. The intervention was feasible, as evidenced by the 99% treatment session attendance rate, and acceptable based on patient and caregiver report. Repeated measures analysis of variance tests revealed nonsignificant differences between the conditions from baseline to post-treatment assessments for pill count, electronic monitor, and primary caregiver-reported adherence (P's>0.05). There was a statistically significant improvement in patient-reported mesalamine adherence represented by a significant main effect for Condition (F=22.24, P<0.01; δ=0.79) and Condition×Time interaction (F=13.32, P<0.05; δ=0.69).

Conclusion: Findings suggest potential for use of behavioral intervention to improve medication adherence in this population. This intervention may be more effective with more complex regimens (e.g. multiple doses per day) such as those prescribed with mesalamine. Further research is needed to examine this type of intervention in more diverse samples with more active disease. Use of alternative adherence measurement approaches, including electronic pill boxes and/or real-time self-report (e.g. by text messaging, electronic diaries, etc.) is also recommended.
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http://dx.doi.org/10.1097/MEG.0b013e32834d09f1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233635PMC
January 2012

Electronic measurement of medication adherence in pediatric chronic illness: a review of measures.

J Pediatr 2011 Oct 1;159(4):528-34. Epub 2011 Jul 1.

Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio 45229, USA.

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http://dx.doi.org/10.1016/j.jpeds.2011.05.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176987PMC
October 2011

Individually tailored treatment of medication nonadherence.

J Pediatr Gastroenterol Nutr 2011 Oct;53(4):435-9

Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.

Objective: Nonadherence is a significant health care issue in pediatric inflammatory bowel disease (IBD) that requires intervention to improve outcomes. This pilot randomized controlled trial was designed to evaluate the feasibility, acceptability, and preliminary efficacy of an individually tailored behavioral treatment for nonadherence in adolescents with IBD.

Patients And Methods: Fourteen adolescents ages 14.89 ± 2.01 years were randomly assigned to immediate care or wait list control conditions and received a manualized individually tailored behavioral intervention for nonadherence. Medication adherence, measured by pill count, served as the primary endpoint. Parents provided demographic data and ratings of intervention acceptability and patients provided disease-severity data.

Results: Feasibility of the treatment was demonstrated by 100% treatment session attendance for all of the patients enrolled in the trial. Both parent and patient acceptability ratings were favorable. Comparison of baseline with posttreatment percent adherence across both conditions demonstrated that treatment resulted in a 4% gain in 6-mercaptopurine/azathioprine adherence (52% at baseline; 56% at posttreatment; δ = 0.07) and a 25% gain in mesalamine adherence (43% at baseline; 68% at posttreatment; δ = 0.57).

Conclusions: Individually tailored treatment of nonadherence in adolescents with IBD is feasible and may result in substantial improvement in medication adherence. Differential effect of the intervention on medications requires further investigation, but it may reflect differences in regimen complexity, concerns about medication adverse effects, and/or patient/parent preference to target more complex regimens. Large-scale testing of this intervention is needed to demonstrate effect on clinical outcomes.
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http://dx.doi.org/10.1097/MPG.0b013e3182203a91DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674887PMC
October 2011

Treatment factors affecting longitudinal quality of life in new onset pediatric epilepsy.

J Pediatr Psychol 2011 May 29;36(4):466-75. Epub 2011 Jan 29.

Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self Management, MLC-7039, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.

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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http://dx.doi.org/10.1093/jpepsy/jsq114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079128PMC
May 2011

Explaining the family conflict-glycemic control link through psychological variables in adolescents with type 1 diabetes.

J Behav Med 2011 Aug 8;34(4):268-74. Epub 2011 Jan 8.

Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.

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.
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http://dx.doi.org/10.1007/s10865-010-9307-3DOI Listing
August 2011

Preparing for transition? The allocation of oral medication regimen tasks in adolescents with renal transplants.

Pediatr Transplant 2011 Feb 30;15(1):9-16. Epub 2010 Sep 30.

Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.

A mixed-methods design was utilized to examine strategies that families use to manage the post-transplant oral medication regimen of adolescents with renal transplants. Seventeen adolescents and their caregivers were administered structured interviews assessing the tasks that families identified as comprising the oral medication regimen, how tasks were allocated across family members and how the dyad decided on the allocation of tasks. Adherence was assessed via electronic pill bottles and calculated by dividing the number of doses taken by those prescribed. Patients and their caregivers identified the following tasks as part of the oral medication regimen: filling the pillbox (71%), calling for refills (65%) and verifying that the pillbox is filled correctly (47%). Adult caregivers were primarily responsible for managing the medication regimen for the majority of adolescents (70%). Secondary analyses revealed that the number of oral medication regimen tasks identified by the dyad was significantly associated with patient adherence. Our findings highlight the need to bolster efforts to develop methods to quantitatively assess and promote self-management skills among adolescents with renal transplants.
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http://dx.doi.org/10.1111/j.1399-3046.2010.01369.xDOI Listing
February 2011

A pilot study comparing traumatic stress symptoms by child and parent report across pediatric chronic illness groups.

J Dev Behav Pediatr 2010 Nov-Dec;31(9):713-9

Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.

Objective: Researchers have recently used a framework of traumatic stress to describe the psychological functioning of children experiencing a chronic illness and their families; however, few studies are available directly comparing symptoms across disease groups. This study compared traumatic stress symptoms of youth being considered for solid organ and bone marrow transplantation, youth diagnosed with human immunodeficiency virus, youth diagnosed with sickle cell disease and their parents. Correlates of traumatic stress across these populations were also examined.

Method: Participants included 64 youth and caregiver dyads with previously scheduled appointments at 1 of 3 specialty clinics. Parents completed measures of family demographics, traumatic stress symptoms, and child functional status. Youth (n = 45) and parents each completed self-report and parent-proxy measures of youth traumatic stress symptoms.

Results: Ten percent of youth by self-report, 18% of youth by parent-proxy report, and 13% of caregivers described symptoms suggestive of posttraumatic stress disorder. Parents of pediatric transplant self-reported greater symptoms than caregivers of youth with human immunodeficiency virus and sickle cell disease (p < .05). Although child functional impairment did not predict child symptoms, a trend was found where parents experiencing more traumatic stress symptoms themselves reported their children experienced greater symptoms by parent-proxy report (p =.07).

Conclusion: Findings suggest that although most children and parents across disease groups report subclinical levels of traumatic stress symptoms, traumatic stress symptoms may be especially salient for families of pediatric transplant candidates. Although interventions are currently available to treat posttraumatic stress disorder symptoms, they will likely need to be individualized to meet the needs of specific disease groups.
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http://dx.doi.org/10.1097/DBP.0b013e3181f17c52DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975762PMC
March 2011

Blood glucose monitoring and glycemic control in adolescence: contribution of diabetes-specific responsibility and family conflict.

J Adolesc Health 2010 Aug 7;47(2):191-7. Epub 2010 Apr 7.

Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.

Purpose: To examine age and time trends in responsibility for diabetes management tasks and diabetes-specific family conflict and their relationship to blood glucose monitoring (BGM) frequency and blood glucose control (HbA1c).

Methods: A sample of 147 adolescents (mean = 15.5 +/- 1.4 years) with type 1 diabetes and their caregivers completed measures of diabetes-specific responsibility and family conflict at baseline and 6 months. BGM frequency and HbA1c were measured during outpatient clinic appointments.

Results: Responsibility for diabetes management tasks shifted from caregivers to adolescents with increasing age by adolescent and caregiver report. Diabetes-specific conflict was stable. Similar trends in responsibility and conflict were seen over the 6-month follow-up period. Less frequent BGM and higher HbA1c were also observed with increasing adolescent age. Multivariate analyses demonstrated adolescents taking greater responsibility for management tasks and experiencing greater family conflict at baseline reported lower BGM at 6 months. Family, demographic, psychosocial, and disease-specific variables accounted for 26% of the variance in BGM frequency by both adolescent and caregiver report. Adolescents reporting greater diabetes-specific family conflict at baseline experienced higher HbA1c values at 6 months. Variables accounted for 23% and 28% of the variance in HBA1c by adolescent and caregiver report respectively.

Conclusions: Diabetes-specific responsibility and conflict have important implications for improving disease outcomes. Interventions targeting responsibility and conflict (i.e., reducing conflict while keeping caregivers involved in diabetes management) may help prevent the deterioration in BGM and HbA1c frequently seen during adolescence.
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http://dx.doi.org/10.1016/j.jadohealth.2010.01.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907244PMC
August 2010

Responsibility sharing between adolescents with type 1 diabetes and their caregivers: importance of adolescent perceptions on diabetes management and control.

J Pediatr Psychol 2010 Nov 5;35(10):1168-77. Epub 2010 May 5.

Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

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.
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http://dx.doi.org/10.1093/jpepsy/jsq038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955833PMC
November 2010

Correlates of glycemic control and quality of life outcomes in adolescents with type 1 diabetes.

Pediatr Diabetes 2010 Dec;11(8):563-71

Center for Treatment Adherence, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.

Background: A major focus of pediatric multidisciplinary diabetes care is promoting glycemic control (A1c) while ensuring high quality of life (QOL). The current study investigated factors associated with A1c and QOL using a methodology that considered these variables as simultaneous outcomes.

Method: A total of 261 adolescents (aged 13-18) with type 1 diabetes completed measures of blood glucose monitoring (BGM) frequency, diabetes-specific QOL, negative affect, and depression. Caregivers completed measures of demographic and disease characteristics, depression, and family conflict.

Results: A1c was negatively correlated with QOL (r = -0.18 to -0.29, p < 0.01) across all subscales. Based on clinical A1c goals and median QOL scores, adolescents fell into four glycemic control-QOL groups. Multinomial logistic regression determined correlates of group membership utilizing adolescents with suboptimal glycemic control-low QOL as the referent group. Adolescents with optimal glycemic control-high QOL reported increased BGM frequency (OR = 1.87), less negative affect (OR = 1.32), and were more likely to use CSII (OR = 5.41). Adolescents with optimal A1c-low QOL reported greater BGM frequency (OR = 1.91) and shorter disease duration (OR = 1.09). Adolescents with suboptimal glycemic control-high QOL reported greater BGM frequency (OR = 1.41), fewer depressive symptoms (OR = 1.13), and less negative affect (OR = 1.31).

Conclusions: Results reveal disease, management, and psychosocial characteristics that differentiate glycemic control-QOL outcome groups and identify risk factors related to this relationship. Further appreciation of these characteristics may increase clinicians' understanding and attention to these important clinical outcomes and help tailor the most appropriate interventions (e.g., individual psychotherapy vs. family problem-solving interventions) to help adolescents achieve glycemic control without sacrificing QOL.
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http://dx.doi.org/10.1111/j.1399-5448.2010.00645.xDOI Listing
December 2010

Health-related quality of life across pediatric chronic conditions.

J Pediatr 2010 Apr 1;156(4):639-44. Epub 2010 Feb 1.

Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.

Objective: To compare health-related quality of life (HRQOL) across 8 pediatric chronic conditions, including 5 understudied populations, and examine convergence between youth self-report and parent-proxy report.

Study Design: Secondary data from 589 patients and their caregivers were collected across the following conditions: obesity, eosinophilic gastrointestinal disorder, inflammatory bowel disease, epilepsy, type 1 diabetes, sickle cell disease, post-renal transplantation, and cystic fibrosis. Youth and caregivers completed age-appropriate self-report and/or parent-proxy report generic HRQOL measures.

Results: Youth diagnosed with eosinophilic gastrointestinal disorder and obesity had lower HRQOL than other pediatric conditions by parent report. Caregivers reported lower HRQOL by proxy report than youth self-reported across most subscales.

Conclusions: Use of brief, easily administered, and reliable assessments of psychosocial functioning, such as HRQOL, may provide clinicians additional opportunities for intervention or services targeting improved HRQOL relative to the needs of each population.
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http://dx.doi.org/10.1016/j.jpeds.2009.11.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115583PMC
April 2010

Factors contributing to weight misperception in obese children presenting for intervention.

Clin Pediatr (Phila) 2010 Apr 13;49(4):330-6. Epub 2010 Jan 13.

Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH, USA.

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 hospital-based multidisciplinary weight management program.

Methods: Participants (N = 97; mean age = 8.56 +/- 1.66 years) used a figural rating scale to assess weight stigma and their current and ideal body type, and Sizing Me Up, a measure of obesity-specific health-related quality of life (HRQOL).

Results: The majority endorsed negative/stereotypical attributes toward an obese body type, chose an average or underweight figure as their ideal, and 39% misperceived their weight status. Older child age and greater HRQOL impairment were significant predictors (P < .01) of correct self-perception.

Conclusion: Pediatricians may find that talking with the elementary school-aged patient and family about whether weight/size affects their day-to-day life will prove to be a salient and neutral opening to discussing the child's obesity and need for intervention.
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http://dx.doi.org/10.1177/0009922809346571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485675PMC
April 2010

Barriers to oral medication adherence for adolescents with inflammatory bowel disease.

J Pediatr Psychol 2010 Jul 23;35(6):683-91. Epub 2009 Sep 23.

Center for the Promotion of Treatment Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 7039, Cincinnati, OH 45229-3039, USA.

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.
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http://dx.doi.org/10.1093/jpepsy/jsp085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902844PMC
July 2010

The impact of peer victimization, parent distress and child depression on barrier formation and physical activity in overweight youth.

J Dev Behav Pediatr 2008 Feb;29(1):26-33

Department of Clinical and Health Psychology, University of Florida, Gainesville 32610-0165, Florida, USA.

Objective: With the prevalence of childhood overweight reaching epidemic proportions, there is an increased need to identify factors which may aid in the development of successful weight intervention programs. Given that lower levels of physical activity are inversely correlated with weight status in children, research has focused on identifying and addressing reported barriers to physically activity. A relationship exists between the number of reported barriers and weight status such that children who are overweight report more barriers to being physically active. However, important demographic and psychosocial correlates of barriers have not been examined.

Methods: This study investigates the relationship among parent distress, peer victimization, childhood depression, barriers to physical activity, and physical activity among a sample of 95 clinically overweight children and adolescents. Higher levels of parent distress, peer victimization, and childhood depression are predictive of a variety of barriers to physical activity, with peer victimization emerging as the strongest predictor of barriers. Barriers to physical activity mediate the relationships between peer victimization, parent distress, child depression and physical activity.

Results: These findings have significant implications for the development/design of weight intervention programs. Interventions targeting increases in physical activity should not only focus on the barriers children report, but should also include a psycho-emotional component to address factors such as parent distress, peer victimization and child mood that may contribute to barrier formation/maintenance.

Conclusion: Future interventions may benefit from the identification of additional factors that impact barrier formation and physical activity levels among children.
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http://dx.doi.org/10.1097/DBP.0b013e31815dda74DOI Listing
February 2008

Social support, coping, and psychological distress in mothers and fathers of pediatric transplant candidates: a pilot study.

Pediatr Transplant 2007 Nov;11(7):781-7

Pain Treatment Service, Children's Hospital of Boston, Boston, MA 02115, USA.

Both parents and children report significant psychological difficulties and family disruption prior to transplantation; however, there have been fewer studies examining predictors of distress in both mothers and fathers and across multiple transplant groups. Thirty-four mothers and 22 fathers participated in this pilot study. Parents completed measures during a routine tertiary pretransplant psychological evaluation. Paired sample t-test results indicated that mothers and fathers differed significantly on specific coping strategies employed, with fathers less likely to use engagement strategies than mothers. Correlation analyses demonstrated strong associations between engagement coping strategies and less psychological distress and the reverse with disengagement coping strategies for both mothers and fathers. Social support was associated with less psychological distress for mothers, but was unrelated to distress for fathers. Using regression analyses, for mothers, lack of social support, and disengagement coping predicted poor psychological outcomes. Taken together, these results suggest that assessing specific coping strategies employed by both mothers and fathers is an essential component of the pretransplant evaluation process. This study delineates areas for intervention that impact adjustment in parents of pediatric transplant candidates.
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http://dx.doi.org/10.1111/j.1399-3046.2007.00726.xDOI Listing
November 2007

Impact of psychosocial factors on quality of life in overweight youth.

Obesity (Silver Spring) 2007 Jul;15(7):1799-807

Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610-0165, USA.

Objective: The psychosocial functioning of overweight youth is a growing concern. Research has shown that overweight children report lower quality of life (QOL) than their non-overweight peers. This study sought to extend the literature by examining the association between peer victimization, child depressive symptoms, parent distress, and health-related QOL in overweight youth. Mediator models are used to assess the effect of child depressive symptoms on the relationship between psychosocial variables and QOL.

Research Methods And Procedures: The sample consisted of 96 overweight and at-risk-for-overweight children (mean age=12.8 years) and their parents who were recruited from a Pediatric Endocrinology Obesity Clinic. Parents completed a demographic questionnaire, the Pediatric Quality of Life Inventory-parent-proxy version, and the Brief Symptom Inventory. Children completed the Children's Depression Inventory-Short Form, the Schwartz Peer Victimization Scale, and the Pediatric Quality of Life Inventory.

Results: Increased parent distress, child depressive symptoms, and peer victimization were associated with lower QOL by both parent-proxy and self-report. Child depressive symptoms mediated the relationship between psychosocial variables (parent distress and peer victimization) for self-reported QOL but not for parent-proxy-reported QOL.

Discussion: This study documented the important impact of peer victimization and parental distress on the QOL of overweight children. Expanding our understanding of how overweight children experience and interact with their environment is critical. Further research is needed to examine the mechanisms by which parent distress and peer victimization impact the development of depressive symptoms in overweight children, including coping and support strategies that may buffer these children against the development of depressive symptoms and ultimately lower QOL.
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http://dx.doi.org/10.1038/oby.2007.214DOI Listing
July 2007

Brief report: quality of life in overweight youth-the role of multiple informants and perceived social support.

J Pediatr Psychol 2007 Aug 8;32(7):869-74. Epub 2007 May 8.

Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610-0165, USA.

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. Paired-samples 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.
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http://dx.doi.org/10.1093/jpepsy/jsm026DOI Listing
August 2007