Carolyn E. Ievers-Landis

A situational analysis was conducted to evaluate challenges with the treatment regimen (a low protein diet and special supplemental formula) for children and adolescents with phenylketonuria (PKU) and their caregivers. A semistructured interview was administered to 19 caregivers and 11 children with PKU to describe formula and dietary problems and their frequency, difficulty, and affective intensity. Information was also gathered on attempted solutions to problems and their perceived effectiveness. Caregivers who rated dietary problems as less frequent, difficult, and emotionally upsetting and strategies as more effective for solving problems had children with significantly lower phenylalanine (Phe) levels, a biological indicator of adherence (i.e., better adherence; all p values <.05). Caregivers who reported using strategies coded as representing an authoritarian parenting style to solve dietary problems were significantly more likely to have lower household incomes and older children with higher Phe levels than were those who did not report such strategies (all p values <.05).

Objective To examine associations between observations of the quality of family relationships and problem-solving skills and reported adherence to medical treatments for older children and adolescents with cystic fibrosis (CF). Methods Reports of adherence were obtained from 96 youth with CF and their parents recruited from six CF centers in the Midwest and southeastern United States. Videotaped observations of family discussions of high conflict issues were used to assess quality of relationships and problem-solving skills. Results Hierarchical regression analyses indicated that observed family relationship quality (RQ) was related to parent and child reports of adherence to airway clearance and aerosolized medications after controlling for demographic variables and illness severity. Observed family problem solving was not a significant predictor after controlling for RQ. Conclusions Older children and adolescents who come from families experiencing unhappy and conflicted relationships may be at greater risk for poor adherence to treatments; thus, family relationships are appropriate targets for interventions aimed at improving adherence.

Objective To develop and test a model based on Bandura's social cognitive theory to predict healthy lifestyle behaviors for the prevention of osteoporosis. Methods Participants were 354 girls, ages 8–11 years, recruited from area Girl Scout troops. Baseline data from a randomized trial of behavioral interventions are presented. Measures of social support, knowledge, self-efficacy, dietary calcium intake, and weight-bearing physical activity (WBPA) were obtained via interviews and self-administered questionnaires. Results A structural equation model was tested and fit the data well. Family social support, perceived self-efficacy for eating a calcium-rich diet, and knowledge of WBPA significantly predicted calcium intake. Friend and family support for exercise predicted WBPA. Self-efficacy partially mediated the relationship between family support and calcium intake, as confirmed by Holmbeck's post-hoc probing strategy (2002). Conclusions Suggestions are made for primary prevention interventions such as parent and peer involvement, health education, and problem-solving training.