Evaluation of a Disease-Specific Self-Efficacy Instrument in Adolescents with Sickle Cell Disease and its Relationship to Adjustment

The psychometric properties of a disease-specific instrument used to assess self-efficacy in adolescents with sickle cell disease, the Sickle Cell Self-Efficacy Scale, were evaluated in a sample of 131 adolescents ranging from 11 to 19 years of age. This nine-item instrument was associated with a one-item, general self-efficacy question and an item of self-control. After controlling for age, gender, highest grade of education completed, and the number of individuals in the household, high levels of self-efficacy were related to fewer physical, psychological, and total symptoms. Using the stress process framework to examine the relationship between self-efficacy and self-reported symptoms in adolescents may lead to the initiation of effective intervention programs capable of increasing levels of self-efficacy in adolescents. These interventions could lead to better outcomes for adolescents with sickle cell disease. Additional longitudinal investigations are needed to evaluate the ability of self-efficacy to predict adolescent adjustment over time.     

Reliability and validity of a self-efficacy instrument specific to sickle cell disease

The psychometric properties of a new, 9-item scale measuring disease-specific perceptions of self-efficacy were investigated in a community-based sample of adults (N = 83) with sickle cell disease (SCD). The Sickle Cell Self-Efficacy Scale (SCSES) was comprised of nine questions relating to participants' perceptions of their ability to function on a day-to-day basis and to manage SCD symptomatology (e.g. episodes of pain). The SCSES demonstrated good internal consistency, discriminant validity, and convergent and predictive validity, both with previously validated measures of related constructs as well as with reported SCD symptomatology. Overall, the instrument appears to be reliable and valid for assessing clients' self-efficacy for engaging successfully in day-to-day activities despite having SCD. Future investigators may wish to examine temporal and causal links between alterations in self-efficacy and changes in adjustment to sickle cell disease; the SCSES provides a psychometrically sound tool with which to investigate these phenomena.     

Caregiver Knowledge and Adherence in Children With Sickle Cell Disease: Knowing is Not Doing

Though the impact of disease knowledge on adherence to medical recommendations has long been the focus of research, little of this research has focussed on sickle cell compliance in the child and adolescent population. The present study examined the relationship of caregiver knowledge of sickle cell disease (SCD) and children's adherence to prescribed behaviors. Though caregivers with high levels of knowledge of SCD were more likely to report higher levels of adherence, knowledge test score did not predict adherence for the majority of participants (72%). The effect of caregiver knowledge on reported adherence was greater among preadolescents (age ≤ 11) than adolescents (age ≥12). The relationship between knowledge and adherence may not be as strong or direct as is assumed in many theories of health behavior change.     

Predictors of Social Anxiety in Children and Adolescents with Sickle Cell Disease

The aim of this study was to examine the potential moderating effect of age on the child-reported pain–social anxiety relationship in children and adolescents with sickle cell disease (SCD). Participants were children and adolescents (ages 8–17; 33 girls, 25 boys) diagnosed with SCD who completed measures of social anxiety and severity of usual pain. Caregivers provided demographic information, and mean hemoglobin levels were computed as a measure of objective disease severity. Ratings of more severe pain were associated with greater social anxiety, including fear of negative evaluation, for older children and adolescents only, revealing a moderating effect of age. Increased relevancy of peer relationships in adolescence, limited social contacts due to SCD complications, and misreading of social cues (e.g., maladaptive coping response to pain) may explain why older children and adolescents reported greater social anxiety in the presence of a stressor such as pain.     

Perfectionism,Type A Behavior,and Self-Efficacy in Depression and Health Symptoms among Adolescents

The current study examined the associations among dimensions of perfectionism, Type A behavior, self-efficacy, distress, and health symptoms in high school students. A sample of 73 high school students (34 boys, 39 girls) completed measures of self-oriented perfectionism, socially prescribed perfectionism, Type A behavior, self-efficacy, depressive symptoms, and psychosomatic symptoms. Correlational analyses found that self-oriented perfectionism was marginally related to Type A behavior. Students with elevated levels of depressive symptoms were also characterized by self-oriented perfectionism, Type A behavior, low self-efficacy, and health symptoms. In addition, health symptoms were linked with low self-efficacy. Simultaneous entry of several variables into a regression analysis found that significant unique predictors of depression were low self-efficacy and elevated self-oriented perfectionism. Similarly, a regression analysis found that low self-efficacy and high self-oriented perfectionism were unique predictors of health symptoms. The findings highlight the distinctions between the perfectionism and the Type A constructs, and support self-regulation models of depression and physical symptoms that include an emphasis on excessive perfectionistic standards and low self-efficacy. We discuss the need for preventive interventions designed for perfectionistic adolescents with low self-efficacy.     

Intra- and interpersonal factors and adolescent wellbeing during COVID-19 in three countries

COVID-19 has altered adolescents' opportunities for developing and strengthening interpersonal skills and proficiencies. Using data from adolescents in Italy, the United States, and the United Kingdom, we examined the relation between internalizing symptoms assessed pre-pandemic or when pandemic-related restrictions were lifted (Time 1) and associated internalizing symptoms during a subsequent restrictive pandemic period (Time 2). Across all 3 countries, we found significant and consistent effect sizes in the relation between Time 1 and Time 2 internalizing symptoms. We further examined the direct and moderating impact of self-efficacy and contextual supports for adolescents' internalizing symptoms. Higher self-efficacy was associated with lower levels of internalizing symptoms at Time 2 in all 3 countries. Additionally, the relation between Time 1 and 2 internalizing symptoms was buffered by regulatory self-efficacy and peer support in Italy, but in the U.S., higher levels of general self-efficacy instead had an exacerbating effect on the relation between Times 1 and 2 internalizing symptoms. Results are discussed in the context of utilizing cross-national datasets to examine similarities in adolescent well-being over time and in the face of varying government responses to the pandemic.     

Health-Related Quality of Life and Adaptive Behaviors of Adolescents with Sickle Cell Disease: Stress Processing Moderators

The objective of this study was to examine resilience among adolescents with sickle cell disease (SCD), focusing on the interaction of health-related quality of life with stress processing to explain adaptive behavior. Forty-four adolescents with SCD completed paper-and-pencil measures of health-related quality of life, appraisals (hope), pain coping strategies (e.g. adherence), and adaptive behavior. Self-reported health-related quality of life was significantly associated with adaptive behavior, as was adherence. Findings for moderation were mixed. Pain coping strategies moderated the association of health-related quality of life with adaptive behavior such that at lower levels of Coping Strategies Questionnaire (CSQ) Adherence, better quality of life was associated with higher adaptive behavior. Similarly, at higher levels of hope, better quality of life was associated with higher adaptive behavior, and poorer quality of life was associated with lower adaptive behavior. Adolescents with SCD showed resilience, particularly in terms of personal adjustment, that may be explained by their appraisals and stress processing strategies. Interventions to support an optimistic or hopeful outlook and improve adherence to recommendations for medical management of sickle cell pain may result in improved resilience/adaptive behavior.     

Dispositional Mindfulness,Posttraumatic Stress Disorder Symptoms and Academic Burnout in Chinese Adolescents Following a Tornado: The Role of Mediation through Regulatory Emotional Self-Efficacy

Limited research has been conducted on dispositional mindfulness, posttraumatic stress disorder (PTSD) symptoms and academic burnout in Chinese adolescents following a tornado. The present study investigated the ways in which dispositional mindfulness is related to PTSD symptoms and academic burnout in Chinese adolescents following a tornado by considering the role of regulatory emotional self-efficacy. A total of 431 Chinese adolescents (mean age: 14.75 years) who had experienced a severe tornado 9 months prior to this study were recruited for this study. The results indicated that our model fit the data well [χ²/df = 2.774, CFI = 0.952, TLI = 0.934, RMSEA (90% CI) = 0.064 (0.051–0.077)], and revealed that regulatory emotional self-efficacy partially mediates the relationships between dispositional mindfulness and PTSD symptoms and academic burnout, respectively. The clinical implications and limitations of our research, and recommendations for future research, are discussed in this paper.     

Protective and vulnerability factors of depression in normal adolescents

The present study investigated the role of various protective and vulnerability factors in the development of depressive symptoms. A sample of normal adolescents (N=373) completed the Children's Depression Inventory and measures of a negative attributional style, parental rearing behaviour, coping styles, and perceived self-efficacy. In addition to computing the correlations between depression and these protective and vulnerability factors, the present data were also subjected to structural equations modelling to examine the correlational structure of the data. Depression was accompanied by high levels of parental rejection, negative attributions, and passive coping, and by low levels of active coping and self-efficacy. Furthermore, a model in which negative parental rearing behaviour and a negative attributional style featured as the primary sources of depression, while coping styles and self-efficacy played a mediating role in the formation of depressive symptoms, provided a reasonable fit for the data.     

Post-traumatic stress symptoms in adolescents exposed to an earthquake: Association with self-efficacy,perceived magnitude,and fear

The objective of this study was to evaluate th×e relationship between the magnitude of an earthquake, the fear experienced, the self-efficacy beliefs, and post-traumatic stress symptoms in adolescents. We expected self-efficacy beliefs to predict post-traumatic stress symptoms, and this relation to be mediated by fear. We used data from a longitudinal project on adolescent normative development that was under way at the time of the 2010 earthquake in Chile. Six months before the earthquake, 218 adolescents responded to a self-efficacy beliefs scale; three months after the earthquake they reported the perceived magnitude of the event, the fear they experienced, and their post-traumatic stress symptoms. Results showed that perceived magnitude was not associated with fear or post-traumatic stress symptoms, but self-efficacy beliefs and fear were associated with post-traumatic stress symptoms. The hypothesized role of fear as a mediator in the relation between self-efficacy beliefs and post-traumatic stress symptoms was supported by the data. The results of the study, suggest that preventive interventions aimed to increase awareness of how to face a disaster may not only contribute to save lives but may also increase adolescentś sense of personal efficacy, reducing subsequent emotional reactivity associated with the event.     

Resilience in siblings of children with sickle cell disease

This pilot study was conducted to identify factors responsible for promoting resilience in siblings of children with sickle cell disease. Twenty siblings (10–17 years of age) of children (5–13 years) with sickle cell disease were selected from the Pediatric Clinic of Howard University Center for Sickle Cell Disease. The siblings responded to questionnaires, and the data obtained was analyzed by chi-square for association. The results indicated that age, birth order, and gender had no effect on resilience in the siblings. However, family size, number of parents in the home, sibling's knowledge of the illness, degree of morbidity of the illness, socioeconomic status of the family, and parents' attitudes and childrearing practices were all found to affect resilience. These findings provide additional insight into the psychosocial aspects of, and genetic counseling for sickle cell disease, as well as for other chronic genetic disorders.     

Predictors of Health-Related Quality of Life over Time Among Adolescents and Young Adults with Sickle Cell Disease

Little is known about what factors affect the health-related quality of life (HRQoL) of adolescents and young adults (AYAs) with sickle cell disease (SCD), and how their HRQoL changes over time. This retrospective study included 87 AYAs attending a SCD Adolescent Clinic who completed a measure of HRQoL at each visit over the course of approximately 1.3 years. Results suggested that the following were associated with poorer physical HRQoL: being female, more healthcare utilization events, and presence of internalizing symptoms. Internalizing and externalizing symptoms were the only factors correlated with poorer psychosocial HRQoL. Generalized linear mixed models indicated that physical and psychosocial HRQoL improved among all participants during the assessment period, and those with externalizing behaviors reported faster improvement in physical HRQoL over time. AYAs with SCD may benefit from early mental health screening and intervention to optimize clinical care.     

Social cognitive and demographic factors related to adolescents’ intrinsic satisfaction with school

Based on social cognitive theory, the purpose of this study is to examine certain social cognitive and demographic factors involved in intrinsic satisfaction amongst secondary school students of different cultural backgrounds in a new migrant-receiving country. Given the role of schools in youth acculturation and adaptation, it is important to detect the variables related to successful academic adaptation of adolescents. The sample comprised of 938 South American, African and Spanish adolescents who settled in Spain. Correlation analyses showed that age, social self-efficacy, academic self-concept, attribution style and intrinsic satisfaction were related. ANOVAs revealed that girls displayed a greater tendency to attribute their outcomes to internal factors than boys. Furthermore, older and Spanish adolescents displayed lower levels of intrinsic satisfaction than younger and immigrant adolescents. Path analyses found that social self-efficacy and academic self-concept were the best predictors of intrinsic satisfaction. Therefore, the promotion of social self-efficacy and academic self-concept should increase intrinsic satisfaction in schools. In addition, research into the role of cultural origin in self-regulation in schools may be necessary.     

Attention deficits in children with sickle cell disease

Previous research has suggested that children with sickle cell disease may exhibit cognitive deficits even in the absence of direct cerebrovascular involvement (stroke). This study was designed to assess specific attentional deficits in children with sickle cell disease. 12 children with sickle cell disease (Hb SS) with a prior history of stroke, 14 children with sickle cell disease (Hb SS) without evidence of stroke, and 13 similar aged siblings (Hb AA or Hb AS) were compared on measures of attention, intellectual functioning, achievement, and adaptive functioning. Significant differences were found between children with sickle cell disease (with or without stroke) and healthy controls on a timed test of visual scanning, the Coding subtest of the Wechsler Intelligence Scale for Children-Revised, and subtests of Reading, Arithmetic, and Spelling from the Wide Range Achievement Test-Revised. The differences between children with sickle cell disease and their healthy siblings appear to be the result of strokes rather than sickle cell disease itself as children with sickle cell disease without strokes did not significantly differ from controls. Implications for the effects of sickle cell disease and stroke on academic performance are discussed.     

Academic Self-Efficacy,School Engagement and Family Functioning,Among Postsecondary Students in the Caribbean

A neglected area of study in adolescent development is family functioning in relation to adolescents’ sense of self and academic success. This study investigates students’ perceptions of their levels of family functioning (cohesiveness and adaptability) as it relates to their academic self-efficacy and school engagement, and answers the following questions: (1) Are there any significant differences in the academic self-efficacy beliefs and school engagement of Caribbean adolescents based on levels of family cohesion and family adaptability? (2) To what extent does the combination of family cohesion and family adaptability predict the academic self-efficacy and school engagement of Caribbean adolescents? Data were collected from a sample of 523 adolescents (197 males and 326 females) aged 17–19 years, enroled in postsecondary institutions in two Anglophone Caribbean countries (Barbados and St. Lucia). Results indicated that adolescents from families with balanced cohesion held significantly higher academic self-efficacy beliefs and school engagement levels than those from families with low cohesion. Regression analyses indicated that the family functioning model significantly predicted academic self-efficacy and school engagement. Interpretation of these results are discussed.     

A Multivariate Analysis of the Self-Determination of Adolescents

Self-determination is a general psychological construct within the organizing structure of theories of human agentic behavior. People who are self-determined act volitionally to serve as the causal agent in their lives. To provide a fuller understanding of the self-determination of adolescents, this study collected data on self-determination, quality of life, self-efficacy, and assertiveness for more than 1,400 Italian adolescents. We conducted a series of Multivariate Analyses of Variance to examine the relationships among, differences between, and associations with self-determination, including any differences as a function of age and gender as well as differences in quality of life, self-efficacy, and assertiveness as a function of level of selfdetermination. We also examined which quality of life factors were associated with enhanced self-determination and self-efficacy. Findings support the importance of self-determination to quality of life and enhanced self-efficacy.     

Young Adults’ Pre-Existing Knowledge of Cystic Fibrosis and Sickle Cell Diseases: Implications for Newborn Screening

Parental distress following newborn screening is thought to result from inadequate preparation for screening results which can result in maladjustment to screening results after birth. Although prior awareness of relevant genetic disorders such as cystic fibrosis and sickle cell diseases, and preparedness for screening is suggested to enhance information uptake and reduce parental distress, little is known about how young adults’ prior knowledge prepares them for screening or affects the assimilation and retention of screening information. Thirty-four young adults, without familial genetic disease or screening experience took part in one of seven focus groups which examined knowledge of cystic fibrosis and sickle cell diseases and ability to assimilate new disease information. Thematic analysis revealed that adults had limited understanding of how cystic fibrosis and sickle cell diseases were inherited or how symptoms manifest, leaving them inadequately prepared for screening results if they do not engage with information interventions. Further, they selectively assimilated new disease information and had difficulty understanding new information in the absence of prior disease knowledge. Young adults’ prior disease knowledge should be considered within a newborn screening context and written materials should consider the inclusion of carrier statistics to improve information relevance.     

Relationships between Perceived Paternal and Maternal Sacrifice and Developmental Outcomes of Chinese Adolescents Experiencing Economic Disadvantage

Parental sacrifice is an important feature of Chinese socialization. According to Walsh’s family resilience framework, perceived parental sacrifice serves as a familial protective factor that enhances adolescent positive development in the context of adversity and economic hardship. Based on a sample of 716 Chinese adolescents experiencing economic disadvantage in Hong Kong, this study examined the main and interaction effects of perceived paternal and maternal sacrifice on adolescent developmental outcomes (indexed by self-identity, self-determination and self-efficacy) in Chinese families. We also examined the differences between paternal and maternal sacrifice perceived by adolescents. Results showed that adolescents perceived maternal sacrifice to be stronger than paternal sacrifice. Moreover, there were main and interaction effects of perceived paternal sacrifice and maternal sacrifice on adolescents’ self-identity, self-determination and self-efficacy. When paternal sacrifice was at higher levels, maternal sacrifice positively predicted adolescents’ self-identity, self-determination and self-efficacy. However, when paternal sacrifice was at lower levels, the influence of maternal sacrifice on adolescent self-identity, self-determination and self-efficacy became non-significant. The study underscored the importance of paternal and maternal sacrifice and illustrated their interaction in shaping the developmental outcomes of economically disadvantaged adolescents. The theoretical and practical implications for family intervention work were discussed.

     

Protection Motivation Theory and Adolescents' Perceptions of Exercise1

Coping strategies endorsed by adolescents in dealing with a potential threat to their health were assessed in a study which investigated components of protection motivation theory. Year 9 and 10 high school students were presented with information about cardiovascular disease risk and the role of exercise in maintaining cardiorespiratory fitness. Three components specified by the theory were manipulated: response efficacy (effectiveness of exercise in preventing cardiovascular disease), response costs (costs associated with taking up a regular program of exercise) and self-efficacy (belief in ability to carry out a program of exercise) in a 2 × 2 × 2 factorial design with two levels (high vs. low) of each variable. It was hypothesized that such information would affect participants' perceptions of response efficacy, response costs, self-efficacy, and their selection of coping strategies. Six dependent variables were investigated: two adaptive coping strategies (behavioral intention to exercise, rational problem solving) and four maladaptive strategies (avoidance, wishful thinking, hopelessness, arid fatalism). Manipulation checks found significant differences between the high and low conditions of each independent variable. Adaptive strategies were strongly endorsed, whereas endorsement of the maladaptive strategies ranged from minimal to complete disagreement. Participants in the high self-efficacy condition indicated stronger intentions to exercise. Students in the low response efficacy condition demonstrated more endorsement of hopelessness and fatalism than did students in the high response efficacy condition. When exercising status was included as a fourth independent variable, it was found that active adolescents endorsed the adaptive coping strategies more strongly than did inactive adolescents. The cognitive coping strategies adopted by adolescents when dealing with perceived threats to their health may be influenced by information on the efficacy of relevant behavior, by perceptions of their ability to perform such behavior, and by their actual involvement with the behavior of concern.     

Physiological correlates of intellectual function in children with sickle cell disease: hypoxaemia, hyperaemia and brain infarction

Lowered intelligence relative to controls is evident by mid-childhood in children with sickle cell disease. There is consensus that brain infarct contributes to this deficit, but the subtle lowering of IQ in children with normal MRI scans might be accounted for by chronic systemic complications leading to insufficient oxygen delivery to the brain. We investigated the relationship between daytime oxyhaemoglobin saturation (SpO2), cerebral blood flow velocity (CBFV) and intellectual function (IQ) using path-analysis in 30 adolescents with sickle cell disease (mean age 17.4 years, SD 4.2). Initial analyses revealed that the association between SpO2 and Full Scale IQ (FSIQ) was fully mediated by increased CBFV, whereby SpO2 was negatively correlated with CBFV and CBFV was negatively correlated with FSIQ, i.e. decreases in oxygen saturation are associated with increases in velocity, and increased velocity is associated with lowered IQ scores. The mediated relationship suggests that lowered IQ may be a function of abnormal oxygen delivery to the brain. Further analyses showed that the association between CBFV and IQ was significant for verbal but not for performance IQ. The pathophysiology characteristic of SCD can interfere with brain function and constrain intellectual development, even in the absence of an infarct. This supports the hypothesis that lowered intellectual function is partly explained by chronic hypoxia, and has wider implications for our understanding of SCD pathophysiology.