Psychological Sciences, Health Sciences Research Institute, University of California, Merced, USA.
Psychological Sciences, Health Sciences Research Institute, University of California, Merced, USA.
Soc Sci Med. 2020 Jun;255:113010. doi: 10.1016/j.socscimed.2020.113010. Epub 2020 Apr 25.
We examined whether neighborhood disadvantage predicted subsequent levels, and longitudinal trajectories, of type 1 diabetes (T1D) outcomes among late adolescents transitioning into early emerging adulthood. We also examined whether such associations occur indirectly through parent-adolescent relationship quality.
RESEARCH DESIGN & METHODS: Seniors in high school with T1D (N = 236; mean age 17.76 ± 0.39 years; 61% female; 73.7% non-Latino White) completed selfreport measures of relationship quality with mothers and fathers, and adherence to their diabetes regimen; glycemic control was measured using HbA1c assay kits. Both T1D outcomes (i.e. adherence, HbA1c) were assessed annually across three time points (two years). Census tract indicators of neighborhood disadvantage (e.g., % unemployed) were culled from participant addresses at baseline linked to American Community Survey data. Structural Equation Modeling was used to estimate direct and indirect links between neighborhood disadvantage, relationship quality, and both subsequent levels (i.e., intercepts centered at Time 2), and trajectories of T1D outcomes (i.e., slopes across three time points).
All models showed excellent fit to the data. Greater neighborhood disadvantage associated with lower relationship quality with both parents. Lower relationship quality with fathers (but not with mothers) measured at Time 1 predicted poorer levels of adherence and HbA1c at Time 2, and formed an indirect path linking neighborhood disadvantage to each Time 2 outcome. Neighborhood disadvantage and parent-adolescent relationship quality during high school did not predict longitudinal trajectories of T1D outcomes across all three time points.
Parent-adolescent relationship quality (especially with fathers) remains important for T1D outcomes among late adolescents on the cusp of emerging adulthood, but may be at risk among those living within a socioeconomically-disadvantaged neighborhood.
我们研究了邻里劣势是否预测了青少年晚期过渡到成年早期的青少年时期 1 型糖尿病（T1D）结局的后续水平和纵向轨迹。我们还研究了这些关联是否通过父母与青少年的关系质量间接发生。
高中患有 T1D 的高年级学生（N=236；平均年龄 17.76±0.39 岁；61%为女性；73.7%为非拉丁裔白人）完成了与母亲和父亲关系质量以及对其糖尿病治疗方案的依从性的自我报告测量；血糖控制使用 HbA1c 检测试剂盒进行测量。T1D 结局（即依从性、HbA1c）在三个时间点（两年）进行年度评估。基线时从参与者地址中提取邻里劣势的人口普查区指标（例如，失业百分比），并与美国社区调查数据相关联。结构方程模型用于估计邻里劣势、关系质量与 T1D 结局的后续水平（即时间 2 中心化的截距）以及 T1D 结局的轨迹（即三个时间点的斜率）之间的直接和间接联系。
所有模型都与数据拟合良好。邻里劣势越大，与父母双方的关系质量越低。1 期时与父亲（而非母亲）的关系质量较低，预示着 2 期时的依从性和 HbA1c 水平较差，并且形成了一条从邻里劣势到每个 2 期结局的间接途径。高中时期的邻里劣势和父母与青少年的关系质量并不能预测 T1D 结局在所有三个时间点的纵向轨迹。
在即将成年的青少年晚期，父母与青少年的关系质量（尤其是与父亲的关系质量）仍然对 T1D 结局很重要，但在那些生活在社会经济劣势社区的人中，这种关系可能处于危险之中。
