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Results for “Structural equation modeling”

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PubMed1991

Differentiation of early adolescent predictors of drug use versus abuse: a developmental risk-factor model.

Many psychosocial factors are associated with adolescent drug use, though most have not been tested as true predictors of drug use in prospective studies. Studies to date have also not differentiated predictors of drug use from abuse and have not addressed differential effects for specific substances. To address these concerns, we expanded the multiple risk-factor approach using 2-year longitudinal data from a sample of seventh graders. Frequencies of use for alcohol, cigarettes, marijuana, cocaine, and hard drugs were assessed at Time 1 and Time 2 and used to reflect latent constructs of polydrug use. From a set of 29 risk factors, unique predictors of any substance were separated conceptually according to whether they most related to initiation/experimental or problem/heavy drug use and were then summed into two-unit weighted indexes at each time. Distribution-free structural equation models were used to accommodate the nonnormal distributions of the illicit drug use measures. The problem risk index was strongly correlated with polydrug use at Time 1 and increased polydrug use at Time 2. Several specific relationships between risk and drug use across time also were noted.

Adolescent↗

PubMed2003

A twin study of the genetics of fear conditioning.

BACKGROUND: Fear conditioning is a traditional model for the acquisition of fears and phobias. Studies of the genetic architecture of fear conditioning may inform gene-finding strategies for anxiety disorders. The objective of this study was to determine the genetic and environmental sources of individual differences in fear conditioning by means of a twin sample. METHODS: Classic fear conditioning data were experimentally obtained from 173 same-sex twin pairs (90 monozygotic and 83 dizygotic). Sequences of evolutionary fear-relevant (snakes and spiders) and fear-irrelevant (circles and triangles) pictorial stimuli served as conditioned stimuli paired with a mild electric shock serving as the unconditioned stimulus. The outcome measure was the electrodermal skin conductance response. We applied structural equation modeling methods to the 3 conditioning phases of habituation, acquisition, and extinction to determine the extent to which genetic and environmental factors underlie individual variation in associative and nonassociative learning. RESULTS: All components of the fear conditioning process in humans demonstrated moderate heritability, in the range of 35% to 45%. Best-fitting multivariate models suggest that 2 sets of genes may underlie the trait of fear conditioning: one that most strongly affects nonassociative processes of habituation that also is shared with acquisition and extinction, and a second that appears related to associative fear conditioning processes. In addition, these data provide tentative evidence of differences in heritability based on the fear relevance of the stimuli. CONCLUSION: Genes represent a significant source of individual variation in the habituation, acquisition, and extinction of fears, and genetic effects specific to fear conditioning are involved.

Adult↗

PubMedDate not supplied

Causal relationships of processes of change and decisional balance: stage-specific models for smoking.

This study, a secondary analysis of prospective data of smokers, tested whether the causal relationships between the processes of change and decisional balance of the transtheoretical model of change (TTM) are stage-specific. It was expected that for smokers in the contemplation stage, higher levels of experiential processing cause the cons of smoking to become more important and the pros of smoking to become less important. In other words, the level of experiential process use was expected to causally influence decisional balance (pros minus cons) for people in the contemplation stage. For ex-smokers in the action stage, when the cons outweigh the pros (cons become more important while pros become less important), they should increase their behavioral process use: decisional balance was expected to causally influence use of behavioral processes. Cross-lagged panels were analyzed using structural equation modeling. Results indicate that experiential process use has causal predominance over decisional balance for smokers in the contemplation stage. For those in the action stage, however, neither decisional balance nor behavioral process had apparent causal predominance. Mean-level invariance indicates that the contemplation and action stages are different. Further analysis investigated smokers who progressed from contemplation to either preparation or action or from preparation to action. For these smokers who had progressed toward action, decisional balance did causally influence use of behavioral processes. This evidence provides support for the use of the TTM as the basis for planning interventions that target specific stage-dependent causal mechanisms.

Adult↗

PubMed2001

Interrelations of lead levels in bone, venous blood, and umbilical cord blood with exogenous lead exposure through maternal plasma lead in peripartum women.

Recent research has raised the possibility that fetal lead exposure is not estimated adequately by measuring lead content in maternal whole blood lead because of the variable partitioning of lead in whole blood between plasma and red blood cells. Lead in maternal plasma may derive in large part from maternal bone lead stores. In this study we aimed to estimate the contribution of maternal whole blood lead, maternal bone lead levels, and environmental lead to umbilical cord blood lead levels (as a measure of fetal lead exposure). In the model, we assumed that lead from all of these sources reaches the fetus through the maternal plasma lead pathway. In 1994-1995, we recruited 615 pregnant women for a study of lead exposure and reproductive outcomes in Mexico City. We gathered maternal and umbilical cord blood samples within 12 hr of each infant's delivery and measured maternal lead levels in cortical bone and trabecular bone by a K-X-ray fluorescence (K-XRF) instrument within 1 month after delivery. We administered a questionnaire to assess use of lead-glazed ceramics (LGC) to cook food and we obtained data on regional air lead levels during the 2 months before delivery. We used structural equation models (SEMs) to estimate plasma lead as the unmeasured (latent) variable and to quantify the interrelations of plasma lead, the other lead biomarkers, and environmental lead exposure. In the SEM analysis, a model that allowed plasma lead to vary freely from whole blood lead explained the variance of cord blood lead (as reflected by a total model R(2); R(2) = 0.79) better than did a model without plasma lead (r(2) = 0.67). Cortical bone lead, trabecular bone lead, use of LGC, and mean air lead level contributed significantly to plasma lead. The exchange of lead between plasma and red blood cells was mostly in the direction of plasma to cells. According to the final model, an increase in trabecular bone lead and cortical bone lead was associated with increases in cord blood lead of 0.65 and 0.25 microg/dL, respectively. An increase of 0.1 microg/m(3) in air lead was associated with an increase in the mean level of fetal cord blood lead by 0.67 microg/dL. With one additional day of LCG use per week in the peripartum period, the mean fetal blood lead level increased by 0.27 microg/dL. Our analyses suggested that maternal plasma lead varies independently from maternal whole blood lead and that the greatest influences on maternal plasma lead are maternal bone lead stores, air lead exposures, and recent cooking with LGC. The contributions from endogenous (bone) and exogenous (environmental) sources were relatively equal. Measurement of plasma and bone lead may be important in accurately assessing fetal lead exposure and its major sources, particularly if exogenous exposures decline.

Air Pollutants↗

PubMed2002

Reporting heterogeneity in the measurement of health and health-related quality of life.

OBJECTIVE: To investigate heterogeneity (systematic and observable variation) in health or health-related quality-of-life reports across population groups, for a given level of 'true health'. DESIGN: The investigators undertook full sit-down face-to-face interviews with 1999 individuals representing Jewish Israelis aged 45 to 75 years who resided in urban Israeli communities in 1993. Three popular measures of health and health-related quality of life were used: a categorical subjective evaluation, the 36-item Short Form health survey and a visual analogue health-related quality-of-life rating scale. The empirical analysis of the various relationships was based on the use of multiple-indicator linear structural equation models with latent variables. The model was estimated by the 2-stage least squares (2SLS) method. RESULTS: In general, the results confirm the existence of substantial measure-specific heterogeneity in reporting (with differences associated with age, gender and education level) for all three measures. CONCLUSIONS: The existence of heterogeneity in reporting renders the results of quality-of-life investigations sensitive to the sample used, and considerably limits the ability to generalise from these results and make comparisons with other populations. Economic evaluations based on self-reports are thus sensitive not only to the measure used, but also to the sample used. The application of results to populations differing in their socioeconomic and demographic structures, even if similar in the distribution of 'true health', might be misleading.

Aged↗

PubMed1999

Sensation seeking and drug use by adolescents and their friends: models for marijuana and alcohol.

OBJECTIVE: To investigate the prospective influence of individual adolescents' sensation seeking tendency and the sensation seeking tendency of named peers on the use of alcohol and marijuana, controlling for a variety of interpersonal and attitudinal risk and protective factors. METHOD: Data were collected from a cohort of adolescents (N = 428; 60% female) at three points in time, starting in the eighth grade. Respondents provided information about sensation seeking, the positivity of family relations, attitudes toward alcohol and drug use, perceptions of their friends' use of alcohol and marijuana, perceptions of influence by their friends to use alcohol and marijuana, and their own use of alcohol and marijuana. In addition, they named up to three peers, whose sensation seeking and use data were integrated with respondents' data to allow for tests of hypotheses about peer clustering and substance use. RESULTS: Structural equation modeling analyses revealed direct effects of peers' sensation seeking on adolescents' own use of both marijuana and alcohol 2 years later. An unexpected finding was that the individual's own sensation seeking had indirect (not direct) effects on drug use 2 years later. CONCLUSIONS: These findings indicate the potential importance of sensation seeking as a characteristic on which adolescent peers cluster. Furthermore, the findings indicate that, beyond the influence of a variety of other risk factors, peer sensation seeking contributes to adolescents' substance use.

Adolescent↗

PubMed2007

Stress, self-efficacy and quality of life in cancer patients.

The purpose of the study was to examine the effect of different stressors on various domains of quality of life (QOL) in cancer patients. The study focused on testing a model describing interrelations between two kinds of stress antecedents, two mediating variables--perceived stress and self-efficacy--and QOL. The participants were 60 cancer patients of both genders and various diagnoses. They were administered questionnaires of background information, QOL, perceived stress and general self-efficacy. Two stress indices were defined empirically: health stress (based on advanced disease stage, long disease duration, and undergoing treatment) and social stress (based on unemployment, recent immigration, and older age). Confirmatory factor analysis enabled defining five factors of QOL. Hierarchical regression analyses showed that the index of social stress was related to more QOL scales than the index of health stress and very few interactions with the mediating variables. Structural equation modeling provided a more comprehensive and accurate view. It showed that the index of health stress affected QOL mainly through perceived stress, and that self-efficacy affected QOL by reducing perceived stress and increasing QOL. The major conclusions are that QOL is affected negatively by both health stresses and social stresses, but the former are mediated primarily by the experience of perceived stress.

Adolescent↗

PubMed2006

Students' motivational processes and their relationship to teacher ratings in school physical education: a self-determination theory approach.

In the present study, we used a model of motivation grounded in self-determination theory (Deci & Ryan, 1985, 1991; Ryan & Deci, 2000a, 2000b, 2002) to examine the relationship between physical education (PE) students' motivational processes and ratings of their effort and persistence as provided by their PE teacher. Data were obtained from 394 British secondary school students (204 boys, 189 girls, 1 gender not specified; M age = 11.97 years; SD = .89; range = 11-14 years) who responded to a multisection inventory (tapping autonomy-support, autonomy, competence, relatedness, and self-determined motivation). The students' respective PE teachers subsequently provided ratings reflecting the effort and persistence each student exhibited in their PE classes. The hypothesized relationships among the study variables were examined via structural equation modeling analysis using latent factors. Results of maximum likelihood analysis using the bootstrapping method revealed the proposed model demonstrated a good fit to the data, chi-squared (292) = 632.68, p < .001; comparative fit index = .95; incremental fit index = .95, standardized root mean square residual = .077; root mean square error of approximation (RMSEA) = .054 (90% confidence interval of RMSEA = .049 -.060). Specifically, the model showed that students who perceived an autonomy supportive environment experienced greater levels of autonomy, competence, and relatedness and had higher scores on an index of self-determination. Student-reported levels of self-determined motivation positively predicted teacher ratings of effort and persistence in PE. The findings are discussed with regard to enhancing student motivation in PE settings.

Adolescent↗

PubMed1998

Prospective family predictors of aggression toward female partners for at-risk young men.

Social learning models of the intergenerational transmission of aggression were tested for an at-risk sample of young adult men who entered a longitudinal study (Oregon Youth Study) in Grade 4 and were assessed with a female partner in young adulthood (17-20 years old). The associations of 2 family process variables--parental dyadic aggression and unskilled parenting, assessed both in late childhood and early adolescence with the son's later aggression toward a partner--were examined. Parental antisocial behavior was hypothesized to be associated with both family process variables. Unskilled parenting was hypothesized to play a key role in the son's later aggression toward an intimate partner, mediated by his development of antisocial behavior by adolescence. Fully prospective structural equation models were tested with multimethod, multiagent data, including both observed and reported aggression toward the partner. Findings indicate that the major hypothesized pathways through unskilled parenting practices and the boys' antisocial behavior were implicated in the intergenerational transmission of aggression.

Adolescent↗

PubMed2006

Study protocol: SPARCLE--a multi-centre European study of the relationship of environment to participation and quality of life in children with cerebral palsy.

BACKGROUND: SPARCLE is a nine-centre European epidemiological research study examining the relationship of participation and quality of life to impairment and environment (physical, social and attitudinal) in 8-12 year old children with cerebral palsy. Concepts are adopted from the International Classification of Functioning, Disability and Health which bridges the medical and social models of disability. METHODS/DESIGN: A cross sectional study of children with cerebral palsy sampled from total population databases in 9 European regions. Children were visited by research associates in each country who had been trained together. The main instruments used were KIDSCREEN, Life-H, Strength and Difficulties Questionnaire, Parenting Stress Index. A measure of environment was developed within the study. All instruments were translated according to international guidelines. The potential for bias due to non response and missing data will be examined. After initial analysis using multivariate regression of how the data captured by each instrument relate to impairment and socio-economic characteristics, relationships between the latent traits captured by the instruments will then be analysed using structural equation modelling. DISCUSSION: This study is original in its methods by directly engaging children themselves, ensuring those with learning or communication difficulty are not excluded, and by studying in quantitative terms the crucial outcomes of participation and quality of life. Specification and publication of this protocol prior to analysis, which is not common in epidemiology but well established for randomised controlled trials and systematic reviews, should avoid the pitfalls of data dredging and post hoc analyses.

Cerebral Palsy↗

PubMed2005

The relationship between sexual abuse during childhood and parenting outcomes: modeling direct and indirect pathways.

OBJECTIVE: This study examined the association between childhood sexual abuse (CSA) and parenting outcomes including parenting stress, feelings of competence and discipline strategies. Maternal depression and current partner violence were hypothesized to be mediators of the association between CSA and parenting. METHOD: This study is based on secondary data analysis of archived data. The participants were 263 primiparous mothers (107 with a history of CSA and 156 comparison mothers recruited from a prenatal clinic prior to the birth of their first child. Mothers were interviewed twice: once when they were between 28 and 32 weeks gestation and again when their child was between 2 and 4 years of age. During the first interview, women were asked about childhood experiences of sexual abuse. During their second interview, they were asked about current symptoms of pathology and experiences with partner violence and parenting beliefs and practices. RESULTS: Structural Equation Modeling indicated that the relationship between CSA and punitive discipline was mediated by maternal depression and current partner violence. CSA was associated with higher maternal depression and higher partner violence. CSA, maternal depression, and current partner violence were associated with more negative parental perceptions and higher punitive discipline. Once maternal depression and current partner violence were in the model, the relationship between CSA and parenting outcomes was no different from zero. CONCLUSION: These results highlight the risks associated with CSA for parenting outcomes and suggest two potential pathways for this increased risk.

Adult↗

PubMedDate not supplied

Predictors of fat intake behavior differ between normal-weight and obese WIC mothers.

PURPOSE: To determine whether predictors of fat intake behavior were the same for normal-weight and obese WIC mothers when applying the PRECEDE-PROCEED model and to identify predictors for each group. DESIGN: Proportional stratified convenience sampling. SUBJECTS: Five hundred eighty-one nonpregnant, black and white normal-weight (n = 180) or obese (n = 401) women. SETTINGS: The Special Supplemental Nutrition Program for Women, Infants and Children in six counties in southern Wisconsin. MEASURES: The independent variables were predisposing, enabling, and reinforcing factors. Predisposing factors included beliefs in diet and health, beliefs in diet and body shape, health concerns in food choice, health concerns in nutrition, and eating habits. Enabling factors were cost of food, availability of time to prepare food, and accessibility to purchase food. Reinforcing factors were weight control intentions, sensory appeal, and mood. The dependent variable was fat intake behavior. Structural equation modeling was performed. RESULTS: When controlling for covariates, certain factors affectingfat intake behavior differed between the normal-weight and the obese groups. For the normal-weight group, only reinforcing factors were positively associated with fat intake behavior For the obese group, reinforcing and enabling, but not predisposing, factors were positively associated with fat intake behavior. CONCLUSIONS: Interventions to modify low-income women's fat intake behavior might benefit from targeting behavioral predictors that differ with body size. Messages that emphasize weight control intentions, sensory appeal, and mood are likely to affect both normalweight and obese women. Information about cost of food, availability of time to prepare food, and accessibility to purchase food is likely to be more effective with obese women.

Adult↗

PubMed2005

Interactions of task and subject variables among continuous performance tests.

BACKGROUND: Contemporary models of working memory suggest that target paradigm (TP) and target density (TD) should interact as influences on error rates derived from continuous performance tests (CPTs). The present study evaluated this hypothesis empirically in a typically developing, ethnically diverse sample of children. The extent to which scores based on different combinations of these task parameters showed different patterns of relationship to age, intelligence, and gender was also assessed. METHODS: Four continuous performance tests were derived by combining two target paradigms (AX and repeated letter target stimuli) with two levels of target density (8.3% and 33%). Variations in mean omission (OE) and commission (CE) error rates were examined within and across combinations of TP and TD. In addition, a nested series of structural equation models was utilized to examine patterns of relationship among error rates, age, intelligence, and gender. RESULTS: Target paradigm and target density interacted as influences on error rates. Increasing density resulted in higher OE and CE rates for the AX paradigm. In contrast, the high density condition yielded a decline in OE rates accompanied by a small increase in CEs using the repeated letter CPT. Target paradigms were also distinguishable on the basis of age when using OEs as the performance measure, whereas combinations of age and intelligence distinguished between density levels but not target paradigms using CEs as the dependent measure. CONCLUSIONS: Different combinations of target paradigm and target density appear to yield scores that are conceptually and psychometrically distinguishable. Consequently, developmentally appropriate interpretation of error rates across tasks may require (a) careful analysis of working memory and attentional resources required for successful performance, and (b) normative data bases that are differently stratified with respect to combinations of age and intelligence.

Adolescent↗

PubMed1996

Assessing the stages of pain processing: a multivariate analytical approach.

A four-stage model of pain processing was proposed, consisting of pain sensation intensity, pain unpleasantness (stage 1 affect), suffering (stage 2 affect), and pain behavior. We studied 506 chronic pain patients (230 male and 276 female) using a multivariate statistical technique (LISREL) in order to demonstrate the structural relationship among multiple indicators of pain processing; and to characterize these stages in terms of their interactions. A strong relationship was revealed between the majority of the underlying indicators of each pain processing stage. A linear stage sequence best fitted the relationship between the four stages. Successive stages did not have recursive effects on earlier pain components. A confirmatory LISREL analysis was conducted with an additional sample of 502 chronic pain patients. In this replication analysis the structural equation model consisted of pain intensity, unpleasantness (stage 1 affect), emotional suffering (stage 2 affect), and pain behavior. This study extends the validation of these pain dimensions, as well as the validity of the measure(s) of each separate stage.

Adolescent↗

PubMed2006

Examining a conceptual framework of intimate partner violence in men and women arrested for domestic violence.

OBJECTIVE: There is a paucity of research developing and testing conceptual models of intimate partner violence, particularly for female perpetrators of aggression. Several theorists' conceptual frameworks hypothesize that distal factors-such as personality traits, drinking patterns, and marital discord-influence each other and work together to increase the likelihood of physical aggression. The purpose of the present study was to investigate these variables in a relatively large sample of men and women arrested for domestic violence and court-referred to violence intervention programs. METHOD: We recruited 409 participants (272 men and 137 women) who were arrested for domestic violence. We assessed perpetrator alcohol problems, antisociality, trait anger, relationship discord, psychological aggression, and physical abuse. We also assessed the alcohol problems, psychological aggression, and physical abuse of their relationship partners. We used structural equation modeling to examine the interrelationships among these variables in both genders independently. RESULTS: In men and women, alcohol problems in perpetrators and their partners contributed directly to physical abuse and indirectly via psychological aggression, even after perpetrator antisociality, perpetrator trait anger, perpetrator relationship discord, and perpetrator and partner psychological and physical aggression were included in the model. The only significant gender difference found was that, in male perpetrators, trait anger was significantly associated with relationship discord, but this path was not significant for women perpetrators. CONCLUSIONS: The results of the study provide further evidence that alcohol problems in both partners are important in the evolution of psychological aggression and physical violence. There were minimal differences between men and women in the relationships of most distal risk factors with physical aggression, suggesting that the conceptual framework examined may fit equally well regardless of perpetrator gender. This finding suggests that, in arrested men and women, violence intervention programs might have improved outcomes if they offered adjunct or integrated alcohol treatment.

Adolescent↗

PubMed2005

Relation of academic support from parents, teachers, and peers to Hong Kong adolescents' academic achievement: the mediating role of academic engagement.

The author tested a model hypothesizing that students' self-perceived academic support (from parents, teachers, and peers) is related to their achievement directly and indirectly through their own perceived academic engagement. The participants were 270 adolescents (M age = 15.41 years, range = 14-20 years) from 3 grade levels (Forms 3-5, equivalent to Grades 9-11 in the United States) in a Hong Kong secondary school. The school principal and teachers helped to collect data based on these adolescents' responses to a self-report questionnaire, consisting of a demographic profile and 4 scales assessing their self-perceptions of the extent of parental, teacher, and peer support, and their own academic engagement. Academic achievement was measured by self-reported grades in math, English, and Chinese. Structural equation modeling analyses revealed that adolescents' perceived parental, teacher, and peer support were all indirectly related to their academic achievement mediated by their own perceived academic engagement. The strength of the relationships, however, varied by support system, with perceived teacher support to achievement being the strongest, followed closely by perceived parental support, and then perceived peer support. In addition, both perceived parental support and perceived teacher support were directly related to academic achievement. However, perceived teacher support made the most total (direct and indirect) contribution to student achievement. Perceived peer support had the smallest, nonetheless significant, indirect relationship to academic achievement. However, the negative, direct influence of perceived peer support canceled out its positive, indirect influence on academic achievement.

Achievement↗

PubMed2004

Neural predictive error signal correlates with depressive illness severity in a game paradigm.

Considerable experimental evidence supports the existence of predictive error signals in various brain regions during associative learning in animals and humans. These regions include the prefrontal cortex, temporal lobe, cerebellum and monoamine systems. Various quantitative theories have been developed to describe behaviour during learning, including Rescorla-Wagner, Temporal Difference and Kalman filter models. These theories may also account for neural error signals. Reviews of imaging studies of depressive illness have consistently implicated the prefrontal and temporal lobes as having abnormal function, and sometimes structure, whilst the monoamine systems are directly influenced by antidepressant medication. It was hypothesised that such abnormalities may be associated with a dysfunction of associative learning that would be reflected by different predictive error signals in depressed patients when compared with healthy controls. This was tested with 30 subjects, 15 with a major depressive illness, using a gambling paradigm and fMRI. Consistent with the hypothesis, depressed patients differed from controls in having an increased error signal. Additionally, for some brain regions, the magnitude of the error signal correlated with Hamilton depression rating of illness severity. Structural equation modelling was used to investigate hypothesised change in effective connectivity between prespecified regions of interest in the limbic and paralimbic system. Again, differences were found that in some cases correlated with illness severity. These results are discussed in the context of quantitative theories of brain function, clinical features of depressive illness and treatments.

Adult↗

PubMed2002

The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control.

OBJECTIVE: The primary goals in treating patients with diabetes are maintaining blood glucose levels as close to normal as possible and making a relatively normal quality of life achievable. Both of these goals are influenced by a multitude of somatic and psychological factors that should be seen as building a complex network. We examined whether a mathematical model can be construed that can depict the relative significance of each factor for achieving these treatment goals. RESEARCH DESIGN AND METHODS: A total of 625 patients from 32 different treatment facilities were examined (224 type 1 and 401 type 2 diabetic patients) using HbA(1c) values (high-performance liquid chromatography), number of secondary illnesses, and standardized questionnaires with respect to health-related quality of life (World Health Organization Quality of Life questionnaire), coping behavior (Freiburger Illness-Coping Strategies questionnaire), diabetes-specific knowledge (Test of Diabetes-Specific Knowledge), doctor-patient relationship (Medical Interview Satisfaction Scale), and personality characteristics (Giessen Test and Assessment of Beliefs in Self-Efficacy and Optimism). The analyses were carried out by means of a structural equation model. RESULTS: The model proved to be valid (chi(2) = 88.5, df = 76, P = 0.16), showing a sound fit (adjusted goodness of fit [AGFI] = 0.94). It explained 62% of the variance of the quality of life and 5% of the HbA(1c) values. Subjects characterized by strong beliefs in their self-efficacy and an optimistic outlook on life were more likely to be satisfied with their doctor-patient relationships. They demonstrated more active coping behavior and proved to have a higher quality of life. Active coping behavior was the only psychological variable significant for the HbA(1c) values. CONCLUSIONS: It was possible to illustrate the various factors involved and their mutual dependency and significance for the treatment goals. Belief in self-efficacy and active coping behavior appear to have the greatest relevance for achieving the primary treatment goals.

Blood Glucose↗