Parenting goals: predictors of parent involvement in disease management of children with type 1 diabetes

The purpose of this study was to develop a measure of diabetes-specific parenting goals for parents of children with type 1 diabetes and to examine whether parenting goals predict a change in parenting involvement in disease management. An independent sample of primary caretakers of 87 children aged 10 to 16 years with type 1 diabetes completed the measure of parenting goals (diabetes-specific and general goals); both parent and child completed measures of parent responsibility for diabetes management at baseline and 6 months. Parents ranked diabetes-specific parenting goals as more important than general parenting goals, and rankings were moderately stable over time. Parenting goals were related to parent responsibility for diabetes management. The relative ranking of diabetes-specific parenting goals predicted changes in parent involvement over 6 months, with baseline ranking of goals predicting more parental involvement at follow-up. Parenting goals may play an important role in family management of type 1 diabetes.     

Impact of diabetes control on mortality by race in a national cohort of veterans

PurposeThe association between glycated hemoglobin (HbA1c), medication use/adherence, and mortality stratified by race/ethnicity was examined in a national cohort of veterans with type 2 diabetes.MethodsA total of 892,223 veterans with diabetes in 2002 were followed through 2006. HbA1c category was the main exposure (i.e., HbA1c <7%, HbA1c 7%–8% [reference], HbA1c 8%–9%, and HbA1c >9%). Covariates included age, sex, marital status, rural/urban residence, geographic region, number of comorbidities, and diabetes medication use/adherence (i.e., adherent, medication possession ratio ≥80%; nonadherent; and nonusers). HbA1c and medication use/adherence varied over time, and Cox regression models accounting for time-varying variables were used.ResultsIn nonmedication users, HbA1c greater than 9% predicted higher mortality risk relative to HbA1c of 7%–8% in non-Hispanic whites (hazard ratio [HR], 1.55; 95% confidence interval [95% CI], 1.43–1.69), non-Hispanic blacks (NHB) (HR, 1.58; 95% CI, 1.34–1.87), and Hispanics (HR, 2.22; 95% CI, 1.75–2.82). In contrast, in nonadherent medication users, HbA1c less than 7% predicted higher mortality risk in NHB (HR, 1.12; 95% CI, 1.05–1.20), whereas HbA1c greater than 9% only predicted mortality in non-Hispanic whites (HR, 1.11; 95% CI, 1.06–1.16). In adherent medication users, HbA1c less than 7% predicted higher mortality in NHB (HR, 1.18; 95% CI, 1.07–1.31), whereas HbA1c greater than 9.0% predicted higher mortality risk across all race/ethnic groups.ConclusionWe found evidence for racial/ethnic differences in the association between glycemic control and mortality, which varied by medication use/adherence.     

The Role of Parents’ Critical Thinking About Media in Shaping Expectancies,Efficacy and Nutrition Behaviors for Families

A convenience survey completed online by 137 4-H parents in Washington state explored their orientation toward critical thinking regarding media sources and content and its implications for family dietary behaviors. Parents’ critical thinking toward media sources predicted their information efficacy about content. Critical thinking toward media content predicted information efficacy about sources, expectancies for parental mediation, and expectancies for family receptiveness to lower-fat dietary changes. Expectancies for receptiveness to dietary changes and expectancies for parental mediation predicted efficacy for implementing healthy dietary practices; this strongly predicted healthy dietary practices. Media-related critical thinking, therefore, indirectly but consistently affected self-reported family dietary behaviors through its effects on efficacy for managing media and expectancies for the family’s receptiveness to healthy dietary changes. The results suggest parents’ media literacy skills affect their family’s dietary behavior. Health campaigns that help parents interpret and manage the media environment may benefit all family members.     

Piloting Home-Based Behavioral Family Systems Therapy for Adolescents With Poorly Controlled Diabetes

This study employed a within-subjects design in which 18 adolescents with poorly controlled diabetes received 10 11/2-hr sessions of home-based Behavioral Family Systems Therapy (BFST). Adolescents and their parents completed a variety of psychosocial questionnaires at baseline and immediately following their last session of BFST. Metabolic control was assessed at each evaluation using a hemoglobin A1c assay. The initial posttreatment follow-up evaluation indicated that participants participating in 10 sessions of home-based BFST evidenced pre- to posttreatment decreases in general family conflict, diabetes-related family conflict, and behavior problems. In addition, pre- to posttreatment improvements were observed for treatment adherence of adolescents with poorly controlled diabetes. No significant differences were observed between pre- and posttreatment HbA1c values.     

Development of the Diabetes Family Adherence Measure (D–FAM)

The objective of this research was to develop and validate the Diabetes Family Adherence Measure (D–FAM), a comprehensive and up-to-date tool designed for the assessment of adherence-related parenting behaviors for youth with type 1 diabetes (T1D). Further, this article outlines an empirical approach for scale design. First, experts reviewed a battery of potential items to create a preliminary version of the D–FAM. Subsequently, 165 youth with T1D and their families completed an initial administration. A parsimonious measure resulted, consisting of 19 items with 4 additional validity items. Factor analysis identified supportive, coercive, control, and monitoring subscales. D–FAM factors were generally associated with both adherence and health status (HbA1c [glycosolated hemoglobin]), as well as with extant scales of family functioning. Strong internal consistency, test–retest reliability, and construct-convergent reliability were obtained. This initial evaluation of the D–FAM suggests utility for efficient evaluation of family functioning related to adherence and glycemic control for research and clinical purposes.     

Moderating Effects of Parental Well-Being on Parenting Efficacy Outcomes by Intervention Delivery Model of the Early Risers Conduct Problems Prevention Program

Parent-focused preventive interventions for youth conduct problems are efficacious when offered in different models of delivery (e.g., individual in-home, group center-based). However, we know little about the characteristics of parents associated with a positive response to a particular model of delivery. We randomly assigned the parents of an ethnically diverse sample of kindergarten through second grade students (n = 246) displaying elevated levels of aggression to parent-focused program delivery models emphasizing receiving services in a community center largely with groups (Center; n = 121) or receiving services via an individualized in-home strategy (Outreach; n = 125). In both delivery models, parents received parent skills training and goal setting/case management/referrals over an average of 16 months. Structural equation modeling revealed a significant interaction between parental well-being at baseline and intervention delivery model in predicting parenting efficacy at year 2, while controlling for baseline levels of parenting efficacy. Within the Outreach model, parents with lower levels of well-being as reported at baseline appeared to show greater improvements in parenting efficacy than parents with higher levels of well-being. Within the Center model, parental well-being did not predict parenting efficacy outcomes. The strong response of low well-being parents within the Outreach model suggests that this may be the preferred model for these parents. These findings provide support for further investigation into tailoring delivery model of parent-focused preventive interventions using parental well-being in order to improve parenting outcomes.     

Parental feeding practices predict authoritative, authoritarian, and permissive parenting styles

BACKGROUND: Our goal was to identify how parental feeding practices from the nutrition literature link to general parenting styles from the child development literature to understand how to target parenting practices to increase effectiveness of interventions. Stand-alone parental feeding practices could be targeted independently. However, parental feeding practices linked to parenting styles require interventions treating underlying family dynamics as a whole. OBJECTIVE: To predict parenting styles from feeding practices and to test three hypotheses: restriction and pressure to eat are positively related whereas responsibility, monitoring, modeling, and encouraging are negatively related to an authoritarian parenting style; responsibility, monitoring, modeling, and encouraging are positively related whereas restriction and pressure to eat are negatively related to an authoritative parenting style; a permissive parenting style is negatively linked with all six feeding practices. DESIGN: Baseline data of a randomized-controlled intervention study. SUBJECTS/SETTING: Two hundred thirty-nine parents (93.5% mothers) of first-grade children (134 boys, 105 girls) enrolled in rural public schools. MEASURES: Parental responses to encouraging and modeling questionnaires and the Child Feeding Questionnaire, as well as parenting styles measured by the Parenting Styles and Dimensions Questionnaire. STATISTICAL ANALYSES: Correlation and regression analyses. RESULTS: Feeding practices explained 21%, 15%, and 8% of the variance in authoritative, authoritarian, and permissive parenting, respectively. Restriction, pressure to eat, and monitoring (negative) significantly predicted an authoritarian style (Hypothesis 1); responsibility, restriction (negative), monitoring, and modeling predicted an authoritative style (Hypothesis 2); and modeling (negative) and restriction significantly predicted a permissive style (Hypothesis 3). CONCLUSIONS: Parental feeding practices with young children predict general parenting styles. Interventions that fail to address underlying parenting styles are not likely to be successful.     

Factors influencing parenting in early childhood: a prospective longitudinal study focusing on change

Background Parenting influences child outcomes but does not occur in a vacuum. It is influenced by socio‐economic resources, parental health, and child characteristics. Our aim was to investigate the relative importance of these influences by exploring the relationship between changing parental health and socio‐economic circumstances and changes in parenting. Methods Data collected from the Avon Longitudinal Study of Parents and Children were used to develop an eight‐item parenting measure at 8 and 33 months. The measure covered warmth, support, rejection, and control and proved valid and reliable. Regression analysis examined changes in financial circumstance, housing tenure, marital status, social support, maternal health and depression, and their influence on parenting score. The final model controlled for maternal age, education, and baseline depression. Results Most mothers reported warm, supportive parenting at both times. Maternal depression was the only variable for which both positive and negative change was associated with changes in parenting score. Less depression was associated with better parenting scores and more depression with worse parenting scores. Improvements in social support and maternal general health were both associated with improved parenting scores, but for neither of these variables was deterioration associated with deterioration in parenting scores. Worsening financial circumstances predicted deterioration in parenting score, but improvements were not predictive of improvements in parenting. Conclusions Programmes aiming to improve parental health and social support are likely to return greater dividends with regard to improving parenting than programmes that aim to reduce family poverty.     

Trajectories of Stress among Parents of Children with Disabilities: A Dyadic Analysis

Parents of children with developmental disabilities (DD) face greater caregiving demands than other parents, which may lead to heightened levels of stress. Characteristics of the child with DD as well as family resources may explain the extensive variability observed in parental adjustment. This study examined trajectories of parenting stress among 108 mother–father dyads parenting a child with DD, from early childhood (age 3) through adolescence (age 15). Using multilevel dyadic analyses, stress was found to increase from early to middle childhood then subsequently decrease through adolescence. Child‐related stressors (behavior problems, adaptive behavior) and family resources (social support, positive family climate) in early childhood predicted initial levels and change in stress. Mother–father differences and recommendations for intervention are discussed.     

The role of family factors and school achievement in the progression of adolescents to regular smoking

This study examines whether parental smoking and single parenting were related to adolescents' school achievement and anti-smoking parental practices as well as how these factors predicted later smoking. The sample comprised 1163 Finnish students in Grades 7 through 9. Results show that at the beginning of the seventh grade, parental smoking and single parenting were related to adolescents' lower levels of school achievement. Moreover, parental smoking had moderate association with lack of house smoking rules. At the beginning of the ninth grade, these associations were strengthened and lack of house smoking rules as well as loosened perceived parental punishment for smoking was related to both parental smoking and single parenting. The likelihood of ninth grade regular smoking was greater among adolescents whose parents smoked, who had no smoking rules in their homes and had substandard school achievement. These results suggest that smoking parents and single parents had similar anti-smoking regulations for their children at the baseline but once children became older smoking parents were not able to maintain these rules as successfully as non-smoking parents and families with two parents. Motivating parents to uphold these anti-smoking regulations offers a prospective intervention opportunity.     

Parenting stress in US families: implications for paediatric healthcare utilization

Objective According to family stress models, parental responses to stress disrupt interactions between parent and child and may lead to parental inability to seek timely medical care for their child. The objective of this study was to quantitatively assess the relationship between high parenting stress and child healthcare utilization. Methods We used the 2003–2004 National Survey of Children's Health to determine the prevalence of parenting stress in US families and associated socio‐demographic variables. We used weighted logistic regression to investigate associations between parenting stress and healthcare utilization, controlling for other parental psychosocial and socio‐demographic variables. The primary independent variables were parenting stress, parental mental health, parental coping and social support. The main dependent variables were emergency care, sick visits to primary care and preventive care in the past 12 months. Results Nationally, 13% of children lived in households with at least one parent experiencing high parenting stress. Socio‐demographic variables associated with the highest odds of parenting stress included Black race, special needs status and non‐English primary language. Parents with high parenting stress had a higher odds (adjusted odds ratio 1.24, 95% confidence interval 1.10–1.41) of seeking emergency care for their children compared with parents with low parenting stress, controlling for other parental psychosocial factors and socio‐demographic variables. Conclusions Having a parent who is experiencing high parenting stress is associated with greater utilization of paediatric emergency care. Interventions targeted at parenting stress may provide families with needed support and reduce unnecessary emergency care utilization.     

Predictors of Group Leaders’ Perceptions of Parents’ Initial and Dynamic Engagement in a Family Preventive Intervention

Attendance and participant engagement are two consistent predictors of the efficacy of preventive interventions. Although both are typically measured and analyzed as static factors, evidence indicates patterns of attendance and participant engagement change over the course of intervention. Understanding parent characteristics that predict engagement may inform strategies to maximize parents’ involvement thereby increasing intervention uptake and improving effects. This study examined whether parents’ baseline characteristics predicted their engagement in a family-based intervention. The study was conducted with 515 caregivers participating in a randomized comparative trial testing the efficacy of The Mindfulness-Enhanced Strengthening Families Program 10-14 (MSFP 10-14) and The Strengthening Families Program: For Parents and Youth 10-14 (SFP 10-14). Facilitator ratings were used to measure parent engagement. Results indicated generally high levels of initial engagement with small, but a significant linear increase across the intervention. Parental education level and involvement with their youth predicted engagement in the first session, while parents’ marital/relationship status, avoidance of conflict with their youth, involvement with their youth, and perceived parent-youth relationship quality at baseline predicted change in engagement. Results highlight engagement as a dynamic construct that changes over time and indicates potential variables that may help identify parents that may need support engaging in this intervention.     

Remembered Parental Rejection and Postpartum Declines in Marital Satisfaction: Moderated Dyadic Links

Utilizing a sample of 80 married couples, the current study employed a dyadic approach to examine links between remembered parental rejection during childhood and change in marital satisfaction across the transition to parenthood. Partner remembered parental rejection, parenting efficacy, and infant temperamental reactivity (frustration and fear reactivity) were examined as moderator variables. Spouses' own remembered parental rejection was linked with declines in marital satisfaction among spouses whose partners recalled more rejection from their parents in childhood, among spouses who felt less efficacious in the parenting role, and among spouses who reported high infant frustration. Partner remembered parental rejection was linked with declines in marital satisfaction among spouses who reported that they were less efficacious in the parenting role. Results support the perspective that family‐of‐origin experiences are best understood in conjunction with other domains of family life. Applied implications are discussed.     

From financial hardship to child difficulties: main and moderating effects of perceived social support

Background There is an unequivocal relationship between socio‐economic status and child well‐being. The Family Stress Model of economic hardship proposes that this relationship is mediated by financial hardship, parenting stress and parenting behaviours. In this study, the Family Stress Model is tested and analysis is extended to examine main and moderating effects of social support. Methods A survey incorporating well‐validated measures of financial hardship, parenting stress, parenting behaviours and child difficulties was sent to 1296 parents who had utilized universal family support services in Alberta, Canada. A total of 923 parents (71%) responded. Hierarchical linear regression was employed to investigate the mediating roles of financial hardship, parenting stress and parenting behaviours, and to investigate main and moderating influences of parental social support. Results The study findings generally support the Family Stress Model. The relationship between socio‐economic status and child difficulties was mediated by financial hardship and parenting stress. Higher levels of parental social support were associated with lower levels of parenting stress, ineffective parenting and child difficulties. Parental social support was important irrespective of parenting stress levels. Conclusions The study findings add to the now critical mass of data showing that parent–child health and well‐being is inextricably linked with parental social support. While there is a burgeoning literature on parent training, far less research attention has been given to the development and evaluation of strategies to strengthen parents' social relationships. This is an important direction for future research.     

Intergenerational influences on the parent-infant relationship in the transition to parenthood

In this study, questions were addressed concerning the intergenerational transmission of parent-child relationships in couples going through the transition to parenthood. During the 2nd trimester of their 1st pregnancy, 38 couples provided information concerning experiences of parenting in their family of origin, then were reinterviewed and observed interacting with their infants at 3 months postpartum. It was expected that when these young adults had reported prenatally better parenting by their parents on specific parenting variables, they in turn would experience early parenthood more adaptively and would show better parenting with their own infants. The analyses suggest that women's reports in interviews of their delight in their child, their investment in their child, their sensitivity to the child's needs, and their acceptance of the child--construed as a factor to represent quality of adaptation to parenting--were significantly predicted by their perception of their own mother's intrusiveness, the support they received from their fathers during adolescence, the sensitivity of their fathers, and, lastly, the subject mother's level of psychological health. Although individual psychological health added some prediction of maternal adaptation to parenting over and above that provided by the family of origin variables, neither psychological health nor marital competence seemed to mediate the relationship between family of origin variables and mother's adaptation to parenthood. For men, adaptation to parenthood was predicted powerfully by the perception of their father's intrusiveness and further predicted by the quality of their current marriage. Thus the quality of their marriage added to but did not replace the predictiveness of the family of origin variable.     

The effects of physical and emotional status on adherence to a low-fat dietary pattern in the Women's Health Initiative

OBJECTIVE: To examine whether the effects of physical and emotional status on adherance to a low-fat (20% energy) dietary pattern are mediated by participation in an intervention program (attending sessions and self-monitoring). DESIGN: The Baron and Kenny mediator model, a series of 4 regression analyses, was used to evaluate whether: a) physical and emotional status predicted program participation, b) program participation predicted dietary adherence, c) physical and emotional status factors predicted dietary adherence, and, ultimately d) the effects of physical and emotional status on dietary adherence were mediated by program participation. SUBJECTS/SETTING: Data from 13,277 postmenopausal women randomly assigned to the low-fat intervention arm of the Women's Health Initiative Dietary Modification Trial. INTERVENTION: The nutrition goals for women randomly assigned to the low-fat intervention were to reduce total fat intake to 20% or less of energy from fat and to consume 5 or more fruit/vegetable servings daily and 6 or more grain servings daily. MAIN OUTCOME MEASURES: Year 1 program participation (degree of attending group sessions and submitting fat scores) and adherence to the low-fat dietary pattern (percent energy from fat) as predicted by baseline physical and emotional status (eight SF-36 Health Survey subscales). RESULTS: Participating in the dietary intervention program reduced (mediated) the negative effect of poorer mental health on dietary adherence by 15%. Additional findings included that a 10% increase in physical functioning increased session attendance by 0.4% (P<.001) and a 10% increase in mental health predicted a decrease in percent energy from fat of 0.3% (P<.001). Program participation had a marked effect on dietary adherence: a 10% increase in session attendance predicted a 1.2% decrease in percent energy from fat (P<.001). APPLICATIONS/CONCLUSIONS: Understanding and using instruments to assess the physical and emotional status of a target population will help dietetic professionals promote healthful dietary change and maintenance.     

Comparison of Child Obesity Prevention and Control Content in Mainstream and Spanish-Language US Parenting Magazines

Mass media coverage of child obesity is rising, paralleling the child obesity epidemic's growth, and there is evidence that parents seek parenting advice from media sources. Yet little to no research has examined the coverage of child obesity in parenting magazines or Spanish-language media. The purpose of this study was to use qualitative and quantitative content analysis methods to identify, quantify, and compare strategies for child obesity prevention and control presented in mainstream and Spanish-language US parenting magazines. Child obesity?related editorial content in 68 mainstream and 20 Spanish-language magazine issues published over 32 months was gathered. Magazine content was coded with a manual developed by refining themes from the sample and from an evidence-based child obesity prevention action plan. Seventy-three articles related to child obesity prevention and control were identified. Most focused on parental behavior change rather than environmental change, and only 3 in 10 articles referred to the social context in which parental behavior change takes place. Child obesity?focused articles were not given high prominence; only one in four articles in the entire sample referred to child obesity as a growing problem or epidemic. Key differences between genres reflect culturally important Latino themes, including family focus and changing health beliefs around child weight status. Given mass media's potential influence on parenting practices and public perceptions, nutrition communication professionals and registered dietitians need to work to reframe media coverage of childhood obesity as an environmental problem that requires broad-based policy solutions. Spanish-speaking media can be an ally in helping Latina women change cultural health beliefs around child weight status.     

Caregiver Responsiveness to the Family Bereavement Program: What Predicts Responsiveness? What Does Responsiveness Predict?

The study developed a multidimensional measure to assess participant responsiveness to a preventive intervention and applied this measure to study how participant baseline characteristics predict responsiveness and how responsiveness predicts program outcomes. The study was conducted with caregivers who participated in the parenting-focused component of the Family Bereavement Program (FBP), a prevention program for families that have experienced parental death. The sample consisted of 89 caregivers assigned to the intervention condition in the efficacy trial of the FBP. Positive parenting, caregiver depression, and child externalizing problems at baseline were found to predict caregivers' use of program skills outside the group, and more child internalizing problems predicted more positive perceptions of the group environment. Higher levels of skill use during the program predicted increased positive parenting at the 11-month follow-up, whereas positive perceptions of the group environment predicted decreased caregiver depressive symptoms at follow-up. Caregiver skill use mediated the relation between baseline positive parenting and improvements in positive parenting at 11-month follow-up, and skill use and perceived group environment mediated changes in caregiver depression from baseline to 11-month follow-up.     

Authoritative parenting and drug-prevention practices: implications for antidrug ads for parents

This research employed the theory of reasoned action to investigate the role of authoritative parenting in 3 drug-prevention behaviors: (a) parental monitoring, (b) parent-child discussions, and (c) awareness of the child's environment. A phone survey of 158 parents of adolescents in 7th, 9th, and 11th grades revealed that authoritative parenting was correlated with parenting practices that reduce the likelihood of adolescent drug use, including discussing family rules about drugs, discussing strategies to avoid drugs, discussing those in trouble with drugs, parental monitoring, knowing the child's plans for the coming day, and personally knowing the child's friends well. Additionally, authoritative parenting moderated the attitude-behavioral intention relation for parental monitoring and awareness of the child's environment, with the weakest relation detected for low-authoritative parents. The utility of these findings in helping design and target antidrug messages for parents more effectively is discussed.