Modifiable microsystemic influences as an avenue for pediatric type II diabetes prevention
Type 2 diabetes mellitus (T2DM), a chronic disease associated with increased morbidity and mortality, historically has not been a pediatric concern. However, the prevalence of the disease in youth is rising at a startling rate, paralleling increasing rates of pediatric overweight. The heterogenic etiology of T2DM in youth calls for a comprehensive approach to prevention, beginning with an analysis of the factors that contribute to the main modifiable risk factor of obesity. Primarily individual- and family-level, or microsystemic, risk factors are associated with childhood overweight, with key risk factors for childhood overweight being considered modifiable. The current study conceptualizes the family as central to the etiology, maintenance, and treatment of overweight in youth. Key non-modifiable (age, sex, ethnicity, household income) and modifiable risk factors (parental nurturance, risk perceptions, limit setting, and parent BMI status) at the microsystemic level that contribute to childhood overweight (and thus T2DM), are considered within the context of the Biopsychosocial (BPS; Engel, 1977) Model. The overall goal of this study is to expand research evaluating modifiable parental variables, with a particular focus on parental perceptions of risk for T2DM, and the degree to which these variables are predictive of adolescent BMI within the context of T2DM prevention. Seventy caregiver-adolescent pairs participated in the study, the majority of which were African-American (90.0%). The total adolescent sample consisted of 41 females (58.6%) and 29 males (41.4%) ranging in age from 11 to 16 years (M = 12.6, SD = 1.34) with 70% of the total adolescent sample classified as overweight or obese. Anthropometric measures and self-report measures were administered, and BMI was calculated for both adolescents and caregivers. Measures administered to parents included subscales from the following well-validated instruments: the Parenting Dimensions Inventory-Short Version (PDI-S) to assess parental nurturance; the Parenting strategies for Eating and Activity Scale (PEAS) to assess parents' use of appropriate boundaries for sedentary behavior; and a modified version of the Risk Perception Survey for Developing Diabetes (mRPS-DD) to assess parental risk perceptions for T2DM. Results of a set of hierarchical linear regressions indicated the overall variance accounted by the complete model, including both non-modifiable and modifiable risk factors was .36. Key modifiable risk factors accounted for a significant proportion of the variance in adolescent BMI above and beyond what was predicted by the non-modifiable risk factors, R2 = .20. Parental nurturance, parental risk perceptions, limit-setting, and parent BMI status all significantly predicted adolescent zBMI. These findings suggest the importance of isolating change possibilities at the microsystemic level in order to inform effective intervention practices.