title: Ecological Factors Predict Transition Readiness/Self-Management in Youth With Chronic Conditions.
abstract: OBJECTIVE
  Health care transition readiness or self-management among adolescents and young adults (AYA) with chronic conditions may be influenced by factors related to their surrounding environment.
  
  
  METHODS
  Study participants were AYA diagnosed with a chronic condition and evaluated at pediatric- and adult-focused subspecialty clinics at the University of North Carolina Hospital Systems. All participants were administered a provider-administered self-management/transition-readiness tool, the UNC TRxANSITION Scale. Geographic area and associated characteristics (ecological factors) were identified for each participant's ZIP code using the published U.S. Census data. The Level 1 model of the hierarchical linear regression used individual-level predictors of transition readiness/self-management. The Level 2 model incorporated the ecological factors.
  
  
  RESULTS
  We enrolled 511 AYA with different chronic conditions aged 12-31 years with the following characteristics: mean age of 20± 4 years, 45% white, 42% black, and 54% female. Participants represented 214 ZIP codes in or around North Carolina, USA. The Level 1 model showed that age, gender, and race were significant predictors of transition readiness/self-management. On adding the ecological factors in the Level 2 model, race was no longer significant. Participants from a geographic area with a greater percentage of females (β = .114, p = .005) and a higher median income (β = .126, p = .002) had greater overall transition readiness. Ecological factors also predicted subdomains of transition readiness/self-management.
  
  
  CONCLUSIONS
  In this cohort of adolescents and young adults with different chronic conditions, ecological disparities such as sex composition, median income, and language predict self-management/transition readiness. It is important to take ecological risk factors into consideration when preparing patients for health self-management or transition.
authors.affiliation: School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Karina
authors.initials: K
authors.lastname: Javalkar
authors.affiliation: School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Meredith
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Department of Medicine, Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Abhijit V
authors.initials: AV
authors.lastname: Kshirsagar
authors.affiliation: College of Arts and Sciences, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ocegueda
authors.affiliation: Department of Medicine, Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Randal K
authors.initials: RK
authors.lastname: Detwiler
authors.affiliation: Department of Medicine, Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, North Carolina. Electronic address: maria_ferris@med.unc.edu.
authors.forename: Maria
authors.initials: M
authors.lastname: Ferris
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000367:Age Factors; D002648:Child; D002908:Chronic Disease / Q000628:therapy*; D019468:Disease Management; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009657:North Carolina; D012648:Self Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care; D055815:Young Adult
keywords: Chronic illness; Disparities; Ecological factors; Health care transition