Understanding the Stressful Challenges of Adolescent Type 1 Diabetes Management in Caucasian and Latino Youth

BACKGROUND: Type 1 diabetes management poses many challenges and is a potential source of stress among adolescents with diabetes and their families. In primarily Caucasian samples, diabetes management outcomes (e.g., metabolic control) deteriorate across adolescence. A growing literature indicates that Latino youth have poorer diabetes control than do Caucasian youth. The broad objective of the present study was to examine ethnic differences in the experience and effects of stress on type 1 diabetes management during adolescence. SUBJECTS: Participants were Caucasian and Latina mothers and adolescents with type I diabetes (N=118 dyads; 48% Latino; 54% female; 10 to 15 years old; illness duration > 1 year; 25% on insulin pump). Adolescents were between 10 and 15 years of age (M = 12.74, SD = 1.64).

METHOD: Demographic information was collected through maternal report, geographic identifiers from available census data, and medical records. Adolescents completed surveys measuring the occurrence of different types of stressful events relevant to a diverse population of Latino and Caucasian youth (i.e., stress dimensions of family conflict, peer hassles, school hassles, and economic stress), treatment adherence, and depressive symptoms. Metabolic control was determined from HbA1c recorded in medical records. Socio-demographic information was collected through a combination of maternal report and census tract data. RESULTS: On average, Latino participants were of a lower socioeconomic status (SES) than Caucasian participants. However, there were not significant ethnic group differences in terms of adolescent age, adolescent gender, illness duration, or insulin pump status. There were also no ethnic differences on adolescent report of different types of stress. In the full sample, heightened levels of each type of stress were associated with indicators of poorer diabetes management and poorer psychosocial adjustment. Hierarchical regression analysis revealed that the stresses of peer hassles, school problems, and family conflict were each associated with poorer outcomes regardless of ethnicity. However, ethnicity moderated associations of economic stress with both adherence and depressive symptoms. Economic stress was associated with poorer adherence and greater depression in Caucasian youth, but was unrelated in Latino youth.
DISCUSSION: Latino and Caucasian youth in the sample for this study did not show significant differences in their report of the experience of stress, but Latino youth appeared resilient against the adversity of economic stress. This interaction pattern is consistent with the Latino paradox. Understanding resiliency factors in diverse populations may assist health care professionals in providing effective and culturally sensitive interventions.