Table Of ContentTHEEFFECTSOFFAMILYHISTORYONPATIENTHEALTHBEHAVIOR:AN
EXAMINATIONOFYOUTHSWITHTYPE1ANDTYPE2DIABETES
By
RWANDALaTOYAAKER
ADISSERTATIONPRESENTEDTOTHEGRADUATESCHOOL
OFTHEUNIVERSITYOFFLORIDAINPARTIALFULFILLMENT
OFTHEREQUIREMENTSFORTHEDEGREEOF
DOCTOROFPHILOSOPHY
UNIVERSITYOFFLORIDA
2003
Thisdocumentisdedicatedinlovingmemory,tomyfather,WaymondRoscoeAker,Sr.
(May24,1941-July03,1998).
ACKNOWLEDGMENTS
Iexpressthemostsinceregratitudetomymother,SandraAker,forbeingwhoshe
isandgivingmeunconditionalloveandsupport. Iamforeverindebtedtomybrother,
WaymondR.Aker,Jr.,withoutwhoseguidance,encouragement,wisdomandstrength
thiswouldnothavebeenpossible.Iwouldliketothankallofmyextendedfamilyfor
theirreassuranceandconfidenceinmyabilitytoreachthisgoal. Ithankmyfriends,
RobertNewton,Ph.D.,SherriFrizell,Ph.D.,YvetteMcGowan,andNikkiMinorwho
comfortedmethroughthehardtimesandgavethosegentlenudgeswhenneeded. Ithank
mydissertationchair,SuzanneBennettJohnson,Ph.D.,forherdirectionandpatience.I
countmyselfastrulyblessedtohavebeenfortunateenoughtohavehadherasa
dissertationchair,asaprofessionalmentor,andasafriend. MygratitudetothePediatric
EndocrinologyDepartmentatVanderbiltUniversityandDr.JohnMayattheNashville
VAMCforhelpincompletingrecruitmentforthisstudy. IthanktheCPRPstaffatthe
ClevelandClinicFoundationforhelpingmetostayfocusedandfortheirstrong
demonstrationsofsupportandlove.1wouldliketothankmylab-matesattheUniversity
ofFlorida,especiallyStacyCarmichael.Ph.D.andKimberlyKirkpatrickJustice,Ph.D.;
withouttheirlastminutehelpthiswouldnothaveoccurredthissemester.Ialsogivemy
gratitudetomychurchfamilyatMonteochaNewLifeChristianCenterfortheirprayers
iii
andspiritualstrengththroughouttheprocess. Mostofall,IthankmyLordandSavior,
JesusChrist,forthelessonslearnedduringthisexperience,thestrengthtoseeitthrough
totheend,andthetruthinHiswordPhillipians1:6,whichstates"Beingconfidentofthis
verything,thatHewhichhathbegunagoodworkinyouwillperformituntilthedayof
JesusChrist."
iv
TABLEOFCONTENTS
Page
ACKNOWLEDGMENTS iii
LISTOFTABLES vii
LISTOFFIGURES ix
ABSTRACT x
CHAPTER
1 INTRODUCTION 1
Diabetes:AnOverview 1
Type2DiabetesinYouths 2
DiabetesinEthnicMinorities 4
ComplianceProblemsinDiabetes 4
FamilyHistoryinDiabetes 5
PossibleFamilyHistoryMechanisms 6
TheImpactofParentBehavioronChildBehavior 8
FamilyHistory:AMulti-factorialVariable 15
2 PURPOSEANDHYPOTHESES 17
3 METHODS 20
Participants 20
Recruitment 20
Procedure 21
4 DESCRIPTIONOFVARIABLES 24
OutcomeVariables 24
PredictorVariables 26
V
5 DATAANALYSIS 35
6 RESULTS 39
Attrition 39
SampleCharacteristics 40
ModelsTested 49
ModelResults 53
7 DISCUSSION 92
OutcomeVariables 100
Models 103
Limitations 112
StudyStrengths 113
TreatmentImplications 118
APPENDIX /
A DEMOGRAPHICQUESTIONNAIRE 115
B STRUCTUREDFAMILYINTERVIEW 116
C DEMOGRAPHICSBYCAMPUSOFRECRUITMENT 120
LISTOFREFERENCES 121
BIOGRAPHICALSKETCH 126
vi
LISTOFTABLES
Table page
LDemographicsofStudyCompletersvs.Incompleteres 66
2.DemographicsofTotalStudySample 67
3.TotalSampleDescriptivesofFamilyMemberswithDiabetes 68
4.SampleDescriptivesbyParticipantDiseaseTypeandEthnicity 69
4(Continued).SampleDescriptivesbyParticipantDiseaseTypeandEthnicity 70
5.MedicationandBloodGlucoseTestingBehaviorbyDiseaseTypeandEthnicity 71
6. ParticipantDietandExerciseBehaviorbyDiseaseTypeandEthnicity 72
7. DegreeofIntercormectednessbyParticipantDiseaseTypeandEthnicity 73
8.GeneralHealthBeliefsbyParticipantDiseaseTypeandEthnicity 74
8(Continued).GeneralHealthBeliefsbyParticipantDiseaseType&Ethnicity 75
9. DomainSpecificHealthBeliefsbyParticipantDiseaseTypeandEthnicity 76
10.Relatives'DeathsandHospitalizationsbyParticipantDiseaseTypeandEthnicity...77
11.RelativeMicrovascularComplicationsbyParticipantDiseaseTypeandEthnicity...78
12.RelativeMacrovascularComplicationsbyParticipantDiseaseTypeandEthnicity..79
13.Relative'sMedicationTakingbyParticipantDiseaseTypeandEthnicity 82
14.Relative'sBGTestingbyParticipantTypeandEthnicity 81
15.Relative'sExerciseBehaviorbyParticipantTypeandEthnicity 82
16.Relative'sDietBehaviorbyParticipantDiseaseTypeandEthnicity 83
vii
17.DescriptiveModelforBloodGlucoseMonitoring 84
18.FinalGeneralModelforExercise 84
19.FinalDomain-SpecificModelforExercise 85
20.FinalDomain-SpecificModelforMeanCalories/dayConsumed 85
21.FinalGeneralModelforPercentofFatConsumed 86
22.FinalDomain-SpecificModelforPercentFatConsumed 86
23. FinalGeneralModelfor%ofCaloriesfromCarbohydrates 87
24. FinalGeneralModelforConcentratedSweets 87
25. FinalDomain-SpecificModelforConcentratedSweets 88
26. GeneralModelforMealFrequency 88
27.FinalDomain-SpecificModelforMealFrequency 89
28. VarianceAccountedfor(Adj.R^)byModel 90
29.SpecificModelSummarybySignificantMainEffectsandInteracfions 91
viii
LISTOFFIGURES
Figure page
1.ModelOverview 38
2.GeneralModelInteractionforExercise 54
3.Domain-SpecificInteractionAforExercise 55
4.Domain-SpecificInteractionBforExercise 56
5.Domain-SpecificInteractionforTotalCalories 57
6. GeneralModelInteractionforPercent Fat 58
7.Domain-SpecificModelInteractionforPercentFat 58
8.GeneralModelAInteractionfor PercentCarbohydrates 60
9.GeneralModelInteractionBforPercentCarbohydrates 61
10. GeneralModelInteractionforGramsofSugar 62
11Domain-SpecificInteractionforGramsofSugar 63
12. Domain-SpecificInteractionforMealFrequency 64
ix
AbstractofDissertationPresentedtotheGraduateSchool
oftheUniversityofFloridainPartialFulfillmentofthe
RequirementsfortheDegreeofDoctorofPhilosophy
THEEFFECTSOFFAMILYHISTORYONPATIENTHEALTHBEHAVIOR:AN
EXAMINATIONOFYOUTHSWITHTYPE1ANDTYPE2DIABETES
By
RwandaLaToyaAker
December2003
Chair:SuzanneBennettJohnson,Ph.D.
MajorDepartment: ClinicalandHealthPsychology
Complianceratesforchronicdiseaseregimensarepoorandareestimatedtobe
approximately50%. Itappearsthatfamilyhistoryofdiseaseisalikelyexplanatory
factorthathasbeenoverlooked,asfamilyhistoryofdiseasehasrarelybeenexaminedfor
itsinfluenceonpatienthealthbeliefsandhealthbehavior. Additionally,theemergence
ofType2diabetesinethnicminorityyouthsisarecentdevelopment. Thisstudysought
togaindescriptiveinformationaboutyouthswithType2diabetesincomparisonto
youthswithType1diabetes. Additionally,thestudyalsoinvestigatedtheroleoffamily
historyonpatienthealthbehaviorandbeliefsbytestingaGeneralandDomain-Specific
Model.
X
