Vicki S. Helgeson - US grants

The purpose of the present research is to identify the correlates of successful Psychological and Physical adjustment to chronic illness, utilizing the framework of cognitive adaptation theory (CAT). According to CAT, successful adjustment to chronic illness is accomplished by maintaining an optimistic outlook, feeling a sense of control over the illness, enhancing one's self-esteem, and deriving meaning from the experience. Much of the research on CAT has been conducted with cancer patients, and the specific components of the theory are vague, leaving many questions unanswered. The first goal of the proposed research is to determine the extent to which CAT describes successful adjustment to a second major chronic illness, coronary heart disease (CHD). To this end, clarifications and refinements in the components of the theory are made. The second goal of the proposed research is to broaden the scope of CAT by asking what implications the theory has for adjustment to an illness recurrence. Adjustment to recurrence is an important issue in chronic illness. The recurrence in the present study is a treatment failure, specifically restenosis following non-emergent percutaneous transluminal coronary angioplasty. Restenosis occurs in 1/3 of angioplasty patients within 6 months following hospital discharge. All English-speaking persons ages 35 to 70 who are admitted to a hospital for a first coronary event treated successfully with angioplasty will be eligible for the proposed research. Personal interviews will be conducted with patients shortly before hospital discharge and 6 months following discharge. Phone follow-up interviews will be conducted 12 months after discharge. The components of CAT will be assessed during the two personal interviews,, and psychological distress and physical health status will be assessed during all three interviews. At 6 months and 12 months, it will be determined whether restenosis of the angioplasty has occurred (by patient and physician), so that the extent to which CAT predicts adjustment to treatment success and failure can be examined.

behavioral /social science research tag; locus of control; long term survivor

This research examines how household computing and the
Internet are changing the social and psychological well being of the
American family, and compares the influence of these new technologies
on households with that of older ones--telephones and
televisions. The research objectives are (1) to determine whether the
early results showing that use of the Internet decreases psychological
and social well being generalizes across samples, Internet services, and
time, (2) to identify mechanism for these effects, and (3) to compare
the impact of different patterns of household information technology
use. Data will come from a national three-wave, panel survey, allowing one
to examine how the amount of television, telephone, computing, and
Internet people use at one time predict later changes in their social
involvement and psychological well being at a subsequent time. The
survey will be supplemented with a quasi-experiment, in which a subsample
of respondents who have computers but no Internet access will be
randomly assigned free Internet access instead of a cash payments to
participate in the survey. Results will have implications both for
emerging policy debate about universal access to the Internet and for
the design of socially responsible Internet services.

The goal of the proposed research is to examine the impact of insulin-dependent diabetes on quality of life over the transition through adolescence. The focus is on the implications of a set of gender-related traits for psychological and physical well-being. Gender-related issues are important during the transition to adolescence because gender-role norms become salient. The gender-related factors addressed in the proposed research are important because they have been linked to psychological and physical health. These traits are: communion, unmitigated communion, agency, unmitigated agency. We hypothesize that unmitigated communion and unmitigated agency will be associated with poor psychological and physical well- being, agency will be associated with good health outcomes, and communion will be related to a supportive environment. Children (ages 10-12) with diabetes and sex, age, race, and family structure matched healthy controls will be enrolled in the study and followed for four years. The longitudinal design will enable us to determine when and if the traits have implications for health. Among the children with diabetes, these traits also will be linked to self-care behaviors and a set of diabetes-related complications (e.g., poor metabolic control, early stage retinopathy). Children with and without diabetes will be interviewed in-person on an annual basis on five occasions. At each wave, parents will complete a set of brief questionnaires. Children and parents also will respond to 24-hour recall phone interviews to assess self-care behavior and aspects of the social environment once a month for three consecutive months each year. These methods will determine whether: (a) gender-related traits change over the course of adolescence to influence health or (b) whether the relation of gender-related traits to health becomes stronger over the transition to adolescence. These methods also will help to identify the personal (e.g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being.

DESCRIPTION (provided by applicant): In 1993-1995, we enrolled 364 women with early stage breast cancer into a study, 312 of whom agreed to be randomized to a psychosocial group intervention: education, peer discussion, education + peer discussion, control. The education group had significant benefits to mental and physical functioning, some of which lasted 4 years. No benefits of peer discussion have been documented. In 1998, we began a case-control study of these women as they reached their 5-year survivorship mark. This study is notable for the rigorous control group employed (neighborhood controls) and the wide array of quality of life indices assessed. We found few differences in quality of life between cases and controls, consistent with other recent findings, with the exception of physical functioning. Survivors had worse functioning than controls. We would like to conduct one final in-person interview with these women as they reach their 10-year survivorship mark. Research on survivorship is lacking in general, and there is very little research on 10-year survivors. The goals of the study are: (1) to investigate the positive aspects of the cancer experience with a series of open-ended and close-ended questions on benefit-finding; (2) to describe how survivorship is integrated into women's self-concepts and examine the implications of the survivor self-concept for quality of life; (3) to evaluate changes in quality of life over the 10 years and to discriminate women who are adjusting well in the long-term from those who are having continued difficulties, and (4) to evaluate the research study, including the intervention. We wilt conduct in-person interviews with survivors and significant others to address the issues of benefit-finding and survivor self-concept. We will measure quality of life broadly, identify trajectories of quality of life over the 10 years, and discriminate among the different patterns of change. Finally, we will conduct focus groups with women to examine the positive and negative aspects of their experience with the research study.

DESCRIPTION (provided by applicant): The goal of this research is to use daily diary methods to link stress and social interactions to mood, self-care behaviors, and blood glucose levels among adolescents (ages 14-16) with Type 1 diabetes. Previous research has relied on retrospective reports of stress rather than on-line measures. Eighty-eight adolescents (44 male, 44 female) will carry palm pilots for two separate 48-hour periods, which will prompt them every two hours during the day to complete a 2-minute questionnaire. The questionnaire will assess mood, stress, social interactions (conflict, social barriers), and self-care behaviors. Four prompts will also request that blood glucose levels are tested and recorded. Adolescents will wear the Actical, an accelerometer that measures frequency, duration, and intensity of movement during the same days of assessment. With this methodology, we can link stress and aspects of social interactions to mood, specific self-care behaviors, and blood glucose in a moment-to-moment fashion. A second goal of the study is to examine whether individual difference variables moderate these relations. We will examine whether sex influences these relations, as interpersonal stress is associated with more negative health consequences for females than males. We also will examine whether unmitigated communion (focus on others to exclusion of self) influences these relations, as relationship stressors and social barriers to self-care behavior may be more strongly tied to negative outcomes for people high in unmitigated communion.

[unreadable] DESCRIPTION (provided by applicant): The transition from adolescence to early adulthood is a neglected area of research, despite the high prevalence of risk behaviors that emerge and the potential for these risk behaviors to set in motion a pattern of behavior that will persist throughout adulthood and put one at risk for chronic disease. This transition is even more critical for youth with diabetes as they assume primary responsibility for self-care behavior and transition out of the pediatric health care system. Yet, very little is known about how this transition occurs. The primary goal of this study is to examine the health implications of the transition to young adulthood for youth with and without diabetes and to compare the level of difficulties between the two groups. To this end, we are in the middle of a longitudinal study of adolescents with and without diabetes who were enrolled when they were in grades 5-7. Because we interview them every year, we have extensive psychosocial and medical data available. The primary goal of this competing continuation is to follow these youth as they complete high school and during the first two years after high school. We will (a) describe the life situations of those with and without diabetes, and determine if there are group differences; (b) examine the effects of group and time on psychosocial variables determined to be important in the original study: depressive symptoms, disturbed eating behavior, somatization, and peer relationships; (c) examine the effects of group and time on risk behaviors that are relevant to young adulthood and critical to health: alcohol, smoking, diet, and activity; and (d) examine the impact of time and life situations on the health care utilization patterns of youth with diabetes. A second goal is to link key aspects of the parent relationship to risk behaviors and mental health outcomes for both groups and to health care utilization and diabetes outcomes for youth with diabetes. A third goal is to link key psychosocial variables, as specified in aims 1 and 2, to the same set of outcomes. We will use the results of this study to determine if and when diabetes affects the transition in terms of important life choices made; depressive symptoms, an important comorbid condition of diabetes in adulthood; disturbed eating behavior; and risk behaviors that have important consequences for health. For youth with diabetes, we will use our wealth of demographic and psychosocial data to predict contact with the health care system and to identify youth who are at risk for leaving the health care system prematurely. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): This application is for a second competing continuation of a longitudinal study of youth with and without diabetes. In 2002, we enrolled 132 children with diabetes and 131 children without diabetes who were in the 6th, 7th, or 8th grade and on average 12 years old into a longitudinal study. The focus of that study was on the psychosocial factors that predicted a successful transition through adolescence for both groups and that predicted diabetes-related difficulties for youth with diabetes. In 2007, we received a 5-year competing continuation to examine the transition out of high school into the onset of emerging adulthood. In that study (in progress), we are examining youth in their senior year of high school and 1 and 2 years later. In the proposed application, we focus on the stage of emerging adulthood (EA) in those with and without diabetes. We propose a three-wave longitudinal study of these EAs spanning the ages of 22-24. The ages 22 through 24 are critical for the examination of health behaviors and psychological well-being. For those with diabetes, these years are critical in terms of the transfer out of the pediatric health care system into the adult health care system. Having had diabetes for an average of 15 years, we also may observe and be able to predict the onset of diabetes-related complications. We have four primary aims: (1) To determine if there are differences between persons with and without diabetes in psychosocial functioning, health behaviors, and emerging adulthood outcomes related to education, employment, relationships, and finances; (2) Among those with diabetes, to capture the transfer out of the pediatric health care system into the adult health care system, to examine health care choices made, and to evaluate the implications of these choices for diabetes health; (3) Among those with diabetes, to examine early indicators of diabetes-related complications and compare the rate of complications to a comparable cohort (in terms of age and length of diabetes) from the Epidemiology of Diabetes Complications Trial; and (4) To utilize a Risk and Resistance Framework to predict psychological, behavioral, and physical health among EAs with and without diabetes. We will visit EAs once a year for three consecutive years to have them complete a psychosocial survey via a laptop computer, to obtain a series of general health measures for both diabetes and healthy participants (e.g., BMI), and to obtain a detailed assessment of diabetes-related complications (e.g., neuropathy, nephropathy) administered by a trained nurse (only years 1 and 3). The results of this study will be used to identify EAs at risk for mental and physical health difficulties.

DESCRIPTION (provided by applicant): Type 2 diabetes is a public health problem of great significance. The key determinant of whether health complications ensue is patient self-management. However, the self-care regimen for diabetes is complex and the health care system has limited resources to assist patients. Thus, it is not a surprise that self-care is poor. The present application recognizes that patient self-care takes place in a social context and aims to explore the impact of partner behaviors on patient self-care, self-efficacy, and mental and physical health. We propose to enroll 220 persons who have been diagnosed with type 2 diabetes in the past 2 years and their partners. Half of the couples will be African-American, and half will be Caucasian. Within these two groups, half will consist of female patients and half will consist of male patients. We hypothesize that communal coping in couples will lead to better patient self-care, while maintaining high levels of patient self-efficacy and good mental health. We hypothesize that partner supportive behaviors will mediate these relations. We will explore racial and gender differences in communal coping and supportive behavior as well as whether relations of communal coping and partner behavior are differentially related to outcomes due to race and gender. We propose to use multiple methods to assess independent and dependent variables. Methods include: (1) survey instruments that assess communal coping, patient and partner behavior, patient self-care, self- efficacy, and mental health; (2) a dyadic interview measure of communal coping; (3) a laboratory observational study in which couples discuss the way patients manage their disease so that raters can code the videotaped interactions for communal coping, supportive and unsupportive behavior, and affect; (4) an extension of the laboratory study in which patients view the videotapes, recall thoughts and feelings at key points, and raters code the behavior that precipitated the reactions; (5) in person assessments of physical health parameters; and (6) a 14-day ecological momentary assessment (EMA) study that consists of patients/partners completing a brief survey about patient-partner interactions at the end of each day. During the EMA study, three 24-hour dietary recall interviews will be performed, and patients/partners will wear accelerometers to capture activity and energy expenditure. Couples will be contacted six months later to repeat the survey, physical health assessment, and 24-hour recall interviews. The results of this study can be used to design a couples' intervention aimed at maximizing behaviors that help and minimizing behaviors that hinder self-care.

Diabetes is the 7th leading cause of death in the United States and is associated with health complications that pose serious threats to quality and quantity of life. Preventing complications involves adhering to a labor- intensive self-care regimen, involving changes in diet, exercise, glucose monitoring, and taking medications to control blood glucose levels and associated conditions (e.g., blood pressure). Previous research in the area of diabetes emphasizes how person factors contribute to outcomes, but diabetes is a chronic illness that takes place in an interpersonal context that extends beyond the person with diabetes. Over the past 5 years, we adopted a communal coping framework to understand the role of the spouse/partner in patient adjustment to newly diagnosed type 2 diabetes (R01 DK095780). Communal coping represents a joint appraisal of the problem (i.e., ?our? problem instead of ?his/her? problem) and couple collaboration to manage the problem. To date, we have recruited 191 (goal 220) couples from the community in which the patient was diagnosed with type 2 diabetes in the past 3 years. Patients are diverse in terms of race (56% white, 44% black), income, and sex (56% male). We have examined communal coping with multiple methods (self-report, language, behavior) and report promising results. With this competing continuation, we have a rare opportunity to collect 5-year longitudinal data on a large sample of Whites and African Americans with type 2 diabetes to examine changes in psychological and physical health with a rich set of psychosocial predictor variables. Primary Aim 1 is to examine how communal coping changes over 5 years and determine if initial communal coping and changes in communal coping predict changes in psychological well-being, self-care behavior, and glycemic control. Primary Aim 2 is to examine sex and race as moderators of the relation of communal coping to health. A secondary exploratory aim is to recruit a comparison group of people without romantic partners to determine if communal coping and the relation of communal coping to outcomes extends to family and friends. Because African Americans are less likely than Whites to be married and are more likely than Whites to have significant non-spousal sources of support, this aim is directed at African Americans. We plan to re-recruit 220 current study couples 5 years after the initial interview and recruit 50 new non-romantic partnered African American dyads. Study methods include: (1) survey instruments to assess communal coping, patient/partner behavior, patient self-care, self-efficacy, and mental health; (2) interview measure of communal coping; (3) evaluation of videotaped couple conversations about diabetes-related problems to assess communal coping, supportive and unsupportive behavior, and affect; (4) in person assessments of physical health parameters, including HbA1c; and (5) 14-day ecological momentary assessment that consists of patients/partners completing brief surveys about their interactions and diabetes care at the end of each day. The results of this study can be used to design dyadic interventions aimed at fostering self-care behavior among persons with type 2 diabetes. 1

Abstract Type 1 diabetes is one of the most common chronic diseases among children. Managing type 1 diabetes is a complicated, labor intensive effort as one has to monitor blood glucose levels throughout the day, monitor diet, exercise, inject insulin, and adjust insulin based on these activities. The failure to engage in appropriate self- care behavior is problematic as uncontrolled blood sugars can pose both short-term and long-term threats to health. Adolescence is characterized as a developmental period in which youth with type 1 diabetes face difficulties in maintaining good glycemic control, in part due to declines in self-care behavior. Much of the research aimed at this decline has focused on the family, but peer relationships are another important and neglected aspect of youth's social environment. Thus, the present proposal focuses on the role that friends play in the psychological, behavioral, and physical health of adolescents with type 1 diabetes. We have three specific aims: (1) to examine the relations of friend integration and friend conflict to psychological well-being and diabetes outcomes (self-care behavior, glycemic control); (2) to identify potential mechanisms that explain the link of friend integration and friend conflict to these outcomes; (3) to examine the trait of unmitigated communion (i.e., overinvolvement in others to the neglect of the self) as a moderator of the relations of friend integration and friend conflict to outcomes, predicting that links will be stronger for those high in unmitigated communion. We hypothesize that friend conflict will lead to increased psychological distress, distraction from self-care, failure to discuss diabetes, and the perception that friends will respond negatively to the enactment of diabetes self-care. Because the literature on the positive aspects of friendship to diabetes outcomes is mixed, we examine mechanisms for potential positive and negative relations. To the extent that friend integration is beneficial, potential mechanisms include positive affect, disclosure to friends about diabetes, and the perception that friends will respond positively to self-care. To the extent that friend integration is detrimental, potential mechanisms include vulnerability to friend influence and distraction. Because peer relationships occur in the context of family relationships, we also will examine the synergy between the two relationships. We will enroll 160 teens with diabetes in 9th through 11th grades and conduct an ecological momentary assessment (EMA) study over a 4-day period in which interactions with friends and family are assessed as well as previously noted mechanisms. EMA is an innovative method that allows one to tap ongoing experiences as they naturally unfold and to examine within-person variability in links of friend relations to outcomes. The procedure will be repeated 6 months later at yearend. Survey measures of variables will be assessed as a 2nd approach to address the same questions. Regression, multi-level modeling, mediation, moderation, and mediated moderation will be used. The research is highly significant in focusing on friends, using multiple methods, creating an innovative measure of friend knowledge, and employing a strong focus on mechanisms. 1