Perception and awareness of diabetes risk and reported risk-reducing behaviors in adolescents

IMPORTANCE: Lifestyle change is central to diabetes risk reduction in youth with overweight or obesity. Feeling susceptible to a health threat can be motivational in adults. OBJECTIVE: To evaluate associations between diabetes risk perception and/or awareness and health behaviors in youth. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2011 to 2018. Participants included youths aged 12 to 17 years with body mass index (BMI) in the 85th percentile or higher without known diabetes. Analyses were conducted from February 2022 to February 2023. MAIN OUTCOMES AND MEASURES: Outcomes included physical activity, screen time, and attempted weight loss. Confounders included age, sex, race and ethnicity, and objective diabetes risk (BMI, hemoglobin A1c [HbA1c]). EXPOSURES: Independent variables included diabetes risk perception (feeling at risk) and awareness (told by clinician), as well as potential barriers (eg, food insecurity, household size, insurance). RESULTS: The sample included 1341 individuals representing 8 716 794 US youths aged 12 to 17 years with BMI in the 85th percentile or higher for age and sex. The mean age was 15.0 years (95% CI, 14.9-15.2 years) and mean BMI z score was 1.76 (95% CI 1.73-1.79). Elevated HbA1c was present in 8.6% (HbA1c 5.7%-6.4%: 8.3% [95% CI, 6.5%-10.5%]; HbA1c ≥6.5%: 0.3% [95% CI, 0.1%-0.7%]). Nearly one-third of youth with elevated HbA1c reported risk perception (30.1% [95% CI, 23.1%-38.1%), while one-quarter (26.5% [95% CI, 20.0%-34.2%]) had risk awareness. Risk perception was associated with increased TV watching (β = 0.3 hours per day [95% CI, 0.2-0.5 hours per day]) and approximately 1 less day per week with at least 60 minutes of physical activity (β = -1.2 [95% CI, -2.0 to -0.4) but not with nutrition or weight loss attempts. Awareness was not associated with health behaviors. Potential barriers had mixed associations: larger households (≥5 members vs 1-2) reported lower consumption of non-home-prepared meals (OR 0.4 [95% CI, 0.2-0.7]) and lower screen time (β = -1.1 hours per day [95% CI, -2.0 to -0.3 hours per day), while public insurance (vs private) was associated with approximately 20 fewer minutes per day of physical activity (β = -20.7 minutes per day [95% CI, 35.5 to -5.8 minutes per day]). CONCLUSIONS AND RELEVANCE: In this cross-sectional study including a US-representative sample of adolescents with overweight or obesity, diabetes risk perception and awareness were not associated with greater engagement in risk-reducing behaviors in youth. These findings suggest the need to address barriers to engagement in lifestyle change, including economic disadvantage

Benefit finding in renal transplantation and its association with psychological and clinical correlates:A prospective study

OBJECTIVES: The identification of positive psychological changes, including benefit finding (BF), in chronic illness has gained substantial interest. However, less is known about BF in the context of a positive medical intervention. End-stage renal disease (ESRD) can be regarded as a burdensome condition, but transplantation is expected to restore physical and psychological functioning to a large extent after a period of illness. The aim of this study was to examine (1) changes in BF from pre- to 12 months post-transplantation, (2) the concurrent association of disease-related characteristics and optimism to BF, and (3) the potential causal relations between BF and distress. METHODS: In this longitudinal study, 319 patients completed questionnaires before, 3 months, 6 months, and/or 12 months post-transplantation. Multilevel models were used for the analyses. Measures included the Illness Cognitions Questionnaire to measure BF, the Life Orientation Test to measure optimism, and the General Health Questionnaire to measure distress. RESULTS: Benefit finding increased from pre- to post-transplantation. Fewer symptoms and comorbidities, and more optimism, were related to more BF over all time-points. The direction of the relation between BF and distress changed over time. Before transplantation, distress predicted an increase in BF, whereas post-transplantation, distress predicted a decrease in BF. The causal relation between BF and distress post-transplantation appeared to be reciprocal. CONCLUSIONS: A positive medical intervention such as renal transplantation might facilitate the development of BF. This study indicates the need for longitudinal research on the relation between BF and psychological health in the face of positive events. Statement of contribution What is already known on this subject? Benefit finding refers to the identification of positive psychological changes following a negative life event. Individuals can experience benefit finding following chronic illness. The positive event of kidney transplantation is associated with improvements in patients' physical and psychological functioning. What does this study add? Benefit finding increases from pre- to post-kidney transplantation. Fewer symptoms and comorbidities, and higher optimism are related to more benefit finding. Before transplantation, distress predicts an increase in benefit finding. After transplantation, there appears to be a reciprocal relation between distress and benefit finding such that distress predicts a decrease in benefit finding and benefit finding predicts a decrease in distress

Undoing gender through performing the other

Following the perspective of gender as a socially constructed performance, consumer research has given light to how individuals take on, negotiate, and express a variety of gender roles. Yet the focus of research has remained on gender roles themselves, largely overlooking the underlying process of gender performativity and consumers’ engagement with it in the context of their everyday lives. Set within a performance methodology and the context of crossplay in live action role-playing games, this paper explores how individuals undo gender on a subjective level, thus becoming conscious and reflexive of gender performativity. The study suggests that individuals become active in undoing gender through engaging in direct, bodily performance of the gender other. Such performance does not challenge or ridicule norms, but pushes individuals to actively figure out for themselves how gender is performed. As a result, individuals become aware of gender performativity and become capable of actively recombining everyday performance

DATA file

These are the data file

Social support and quality of life

Social support is a broad term, which includes the supportive ways that different people behave in the social environment. Structural measures of the environment deal with the mere existence of social relationships. Functional measures refer to the resources that people within an individual's social network provide. Structural support shows a linear relation to quality of life; the functional aspects of support demonstrate the stress-buffering hypothesis. One of the main focuses of this article is to help researchers determine what aspects of social relationships or what types of support need to be measured and to consider the mechanisms by which support might influence quality of life. Also addressed is how to translate the correlational research on social support and quality of life into the field of support interventions, taking into account individual and situational differences.</p

Gender-Related Traits and Health

Sex differences in cognitive domains, such as mathematical ability, and social domains, such as moral development, continue to be hotly debated, but there is widespread agreement that there are sex differences in health and that the size of these differences are substantive. To start with, women live longer than men (Hoyert et al., 1999). In fact, men are more likely than women to die of each of the ten leading causes of death, which include heart disease, cancer, accidents, and stroke (Hoyert et al., 1999). However, while living, women’s health appears to be worse than that of men. Women suffer from more acute illnesses and more nonfatal chronic illnesses compared to men (Verbrugge, 1989). Thus, at any given point in time, women are more likely than men to be ill and to be living with a chronic disease. Women report more disability than men – more days spent in bed due to illness and more days in which they restrict their activities due to illness compared to men (Cleary et al., 1982; Kandrack et al., 1991; Verbrugge, 1989). Women also suffer from more painful disorders compared to men (Berkley, 1997; Macintyre et al., 1996; Unruh, 1996), and women perceive their health to be worse than men (Arber and Ginn, 1993; Cleary et al., 1982; Denton and Walters, 1999). Women suffer twice the rate of depression as men (Culbertson, 1997; Nolen- Hoeksema, 1987), yet men are roughly four times as likely as women to commit suicide (US Department of Justice, 1998)

Survivor centrality among breast cancer survivors: implications for well-being.

OBJECTIVE: The goal of this research was to examine the extent to which 10-year breast cancer survivors integrated cancer into their self-concept (i.e. survivor centrality), identify predictors of survivor centrality, and determine the relation of survivor centrality to well-being. METHODS: Breast cancer survivors (n=240) were interviewed 10 years following the initial diagnosis. They completed measures of survivor centrality, illness valence (i.e. positive or negative views of illness), and well-being (positive and negative affect, mental and physical functioning, psychological distress, benefit finding). RESULTS: There were few predictors of the kinds of women who were more likely to integrate breast cancer into their self-concepts, but survivor centrality was related to engaging in behaviors that suggested survivorship was relevant to women's daily lives, such as becoming involved in breast cancer activities. Survivor centrality was related to three markers of negative psychological well-being: more negative affect, poorer mental functioning, and greater psychological distress. However, in the case of negative affect and psychological distress, this relation was moderated by illness valence, such that survivor centrality was only related to negative psychological well-being when the illness was viewed in less positive terms. CONCLUSIONS: Women vary in the extent to which they define themselves in terms of the breast cancer experience. Survivor centrality in and of itself is not always indicative of adjustment to disease. When women have a more negative view of being a breast cancer survivor, survivor centrality is more likely to signify potential problems.</p