title: Gender differences in adherence and metabolic control in urban youth with poorly controlled type 1 diabetes: the mediating role of mental health symptoms.
abstract: OBJECTIVE
  To examine gender differences in adherence and metabolic control and test the mediating role of mental health symptoms in a sample of predominantly African-American, low-income youth with chronically poor metabolic control.
  
  
  METHODS
  Baseline questionnaire data from an intervention study were collected from 119 youth and their primary caregiver.
  
  
  RESULTS
  Boys had worse adherence than girls, but there were no gender differences in hemoglobin A1C (HbA1C). Boys had more externalizing symptoms, whereas girls had more anxiety; there were no gender differences in depression. Externalizing symptoms were associated with poor adherence and metabolic control. Although anxiety was correlated with poor adherence, this relationship was not significant in the invariate analysis. Results of structural equation modeling (SEM) suggested that externalizing symptoms mediated the relationship between gender and adherence.
  
  
  CONCLUSIONS
  Results suggest that gender differences in adherence may be attributed, in part, to gender differences in externalizing symptoms in urban youth with poor metabolic control. Interventions targeting these symptoms may be necessary to improve adherence and HbA1C in both boys and girls.
authors.affiliation: Wayne State University, USA. snaarkin@med.wayne.edu
authors.forename: Sylvie
authors.initials: S
authors.lastname: Naar-King
authors.forename: April
authors.initials: A
authors.lastname: Idalski
authors.forename: Deborah
authors.initials: D
authors.lastname: Ellis
authors.forename: Maureen
authors.initials: M
authors.lastname: Frey
authors.forename: Thomas
authors.initials: T
authors.lastname: Templin
authors.forename: Phillippe B
authors.initials: PB
authors.lastname: Cunningham
authors.forename: Nedim
authors.initials: N
authors.lastname: Cakan
mesh_terms: D000293:Adolescent; D002648:Child; D003710:Demography; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data*