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Helgeson Carnegie Mellon University July 10, 2006 ;- STUDY GOALS<(1) To link stress and aspects of social interactions to mood, self-care behaviors, and blood glucose among adolescents with type 1 diabetes. (2) To determine whether two individual difference variables (sex, unmitigated communion [i.e., focus on others to exclusion of self]) influence or moderate these relations.d?Rationale for EMA Approach-Blood glucose levels can change rapidly. Little research has examined momentary changes in blood glucose levels. Fluctuation in blood glucose levels is an important topic among adolescents with diabetes because metabolic control fluctuates greatly and self-care behavior declines during adolescence...Eligibility Requirementsx type 1 diabetes diagnosed for at least one year age 13-16 no other health problems live within 1 hour from Pittsburgh 0vySample{n=76 (38 male, 38 female) 89.5% Caucasian mean age 14.54 51.3% on insulin pump diagnosed 1.0 to 14.0 years ago (M=6.34)>|PsTime-based Sampling Strategy=carried palm pilots for four days: 2 weekend days and 2 weekdays 2 sessions separated by 1 month completed palm pilot entries every two hours during the day mood stress social interactions self-care behavior (diet, wear ID, test) tested and recorded blood glucose* wore activity monitor continuously *every 4 hoursZl " Z " Z#ZZO% Data Hierarchy Mood QuestionsHow are you feeling? happy not at all& & .very sad not at all& & .very mad not at all& & .very annoyed not at all& & .very relaxed not at all& & .very nervous not at all& & .very items adapted from previous research .Z% Stress QuestionsIn the past 2 hours, did something bad happen to you? no yes IF yes, which category (mark one): school, friends, family, personal, health, other In the past 2 hours, did someone hassle you? no yes Think about your most recent interaction in the past 2 hours: Was there a problem or disagreement? no yes no interaction items adapted from previous research .Pw% Social Interaction QuestionsThink about your most RECENT interaction in the past 2 hours. Whom did you interact with? (mark all that apply) parent same-sex friends other family other-sex friends someone else no interaction 4Ua Think about your most recent interaction in the past 2 hours: Did you enjoy it? not at all& & & .very Did it upset you? not at all& & & ..very Did you feel that someone understood your diabetes? no yes Did someone help you with your diabetes? no yes Did someone remind you to do something to take care of your diabetes? no yes Did someone eat something in front of you that you shouldn t eat? no yes Did someone say something negative about the way you take care of your diabetes? no yes $ZZ Diet QuestionsIn past 2 hours, did you have any of these FOODS? Chinese - avg + grilled cheese - avg + hamburger - avg + hot dog - avg + mac & cheese - avg + pizza - avg + ravioli - avg + taco/burrito - avg +ZB 2In past 2 hours, did you have any of these SNACKS?33(cake/pastry - avg + candy - avg + chips - avg + cookies - avg + crackers - avg + popcorn - avg + pretzels - avg + soda (non-diet) - avg + 3In past 2 hours, did you have any of these BREADS? 44(bagel - avg + bread - avg + cereal - avg + noodles - avg + pancake - avg + rice - avg + stuffing - avg + other bread - avg +  7In past 2 hours, did you have any of these FRUITS/VEGS?88(creamy soup - avg + french fries - avg + fresh fruit - avg + fruit cup - avg + juice - avg + potato - avg + vegetable - avg + beans - avg + 4In past 2 hours, did you have any of these PROTEINS?55(bacon/sausage - avg + baked chicken/fish - avg + beef/pork - avg + egg - avg + fried chicken/fish - avg + lunchmeat - avg + nuts - avg + peanut butter - avg + 1In past 2 hours, did you have any of these DAIRY?22(butter - avg + cheese - avg + ice cream - avg + pudding - avg + skim or 1% milk - avg + whole or 2% milk - avg + yogurt - avg + other dairy - avg +Trade-Offs with Childrentested every 4 hours rather than every 2 hours no reminder beep only 4 days of data, not consecutive no training days maximized flexibility at expense of complete data (but mean number of entries per day was 6.67) importance of a young interviewer to establish rapport z2082,8    Lessons LearnedAdolescents are smarter than us. Could get out of questionnaire without completing it Reset button on the back Adolescents lie. BG reading did not correspond to meter No meter available to verify reading Compliance with completing PP every 2 hours.!ZNZZZLZZ-Z!NL  -Solutions Implemented61. changes to palm pilot 2. gave them a meter and set the clock 3. changed payment plan 4. clear feedback after session 1 5. added  back button to PP.P6What Have We Learned About Using EMA with Adolescents?77$principals are 100% supportive teachers thought it was  cool adolescents CAN do this adolescents CAN do this at school (in future, direct to RN office) could have increased frequency of BG tests need better way of keeping PP with adolescent|z#YJZ&What We Plan to Learn About the Method''$Gvalidity of food diaries validity of Actical validity of BG recordingHH&%How Did Adolescents Respond to Study?&& OHow difficult was it to answer the questions? 1=not at all; 5= very session a: M= 1.5 93% said 1 or 2 session b: M= 1.5 88% said 1 or 2 How often did you find that what you ate was not on the PP? 1= never, 2= once or twice, 3= a few times, 4= often session a: M= 2.03 76% said 1 or 2 session b: M= 1.82 86% said 1 or 2 How often did completing the PP interfere with what you were doing? 1= not at all; 5= a lot session a: M= 1.87 83% said 1 or 2 session b: M= 2.11 68% said 1 or 2  NPPP !+/<I0E-1" eFeelings while completing PP: 1= not at all; 5= a lot annoyed session a: M= 1.70 session b: M= 1.83 having fun session a: M= 2.68 session b: M= 2.82 bored session a: M= 1.78 session b: M= 1.88 interrupted session a: M= 1.75 session b: M= 1.97 interested session a: M= 3.00 session b: M= 3.07 H7ZZ>Z<ZZZ4 "$!,J'How Did Adolescents Respond to Actical?(( Did it bother you? no a little bit a lot session a: 54% 42% 4% session b: 67% 30% 3% Did you notice that you were wearing it  were you self-conscious about it? no a little bit a lot session a: 72% 26% 1% session b: 59% 38% 3% Did knowing that you had the activity monitor have any kind of an effect on your behavior? 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+T3f3f___PPT10.ך@|e+D' = @B D' = @BA?%,( < +O%,( < +DR' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*p%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*pD' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*pDR' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*pB%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*pBD' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*pBDR' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*pC[%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*pC[D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*pC[DR' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*p\~%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*p\~D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*p\~DR' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*p%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*pD' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*p+P! > 0L0 `XP(  Xr X S $ֽP    X S ( <$D  0  H X 0޽h ? +T3f3f ___PPT10.+D' = @B D' = @BA?%,( < +O%,( < +DR' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*XD' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*XDR' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X>%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*X>D' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*X>DR' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X>W%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*X>WD' =+4 8?RCBBCB#ppt_hB*Y3>B ppt_h<*X>WD' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*XWz%(D' =+4 8?RCBBCB#ppt_wB*Y3>B ppt_w<*XWzD'