Theoretical mediators of diabetes risk and quality of life following a diabetes prevention program for Latino youth with obesity

Authors: SOLTERO, ERICA - Children'S Nutrition Research Center (CNRC); AYERS, STEPHANIE - Arizona State University; AVALOS, MARVYN - Arizona State University; PEÑA, ARMANDO - Arizona State University; WILLIAMS, ALLISON - Arizona State University; OLSON, MICHAH - Arizona State University; KONOPKEN, YOLANDA - The Society Of St Vincent De Paul; CASTRO, FELIPE - Arizona State University; ARCOLEO, KIMBERLY - University Of Rochester; KELLER, COLLEEN - Arizona State University; PATRICK, DONALD - University Of Washington; JAGER, JUSTIN - Arizona State University; SHAIBI, GABRIEL - Arizona State University

Submitted to: American Journal of Health Promotion
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/29/2021
Publication Date: 5/5/2021
Citation: Soltero, E.G., Ayers, S.L., Avalos, M., Pena, A., Williams, A.N., Olson, M.L., Konopken, Y.P., Castro, F.G., Arcoleo, K.J., Keller, C.S., Patrick, D.L., Jager, J., Shaibi, G.Q. 2021. Theoretical mediators of diabetes risk and quality of life following a diabetes prevention program for Latino youth with obesity. American Journal of Health Promotion. https://doi.org/10.1177/08901171211012951.
DOI: https://doi.org/10.1177/08901171211012951

Interpretive Summary: There is an urgent need for the development of prevention strategies and interventions among Hispanic youth, who have the highest rates of obesity and subsequent insulin resistance in the U.S. These strategies and interventions should be theory based and should include a theoretical framework to guide the design and development of the intervention. While many current interventions do include a strong theory, few researchers examine whether changes within the theory's theoretical constructs impact program effectiveness. This limits our ability to understand how or why an intervention is successful. In a previous study, we developed a 12-week diabetes prevention program based on the Social Cognitive Theory and tested this program among 160 Hispanic adolescents. We found that the program led to short-term improvements in insulin sensitivity, and short- and long-term improvements in quality of life. In the current study, we examined whether theoretical constructs from the Social Cognitive Theory, including social support and self-efficacy were mediators or underlying mechanisms by which the intervention was effective. Social support and self-efficacy were assessed before the intervention and immediately following the 12-week intervention. We found that youth who participated in the intervention significantly improved their social support for health behaviors immediately following the intervention. However, the intervention did not lead to improvements in self-efficacy. For youth with improved social support, particularly social support for health behaviors received by family members, they experienced increases in self-efficacy. This suggests that receiving more social support for health behaviors can also increase one's self-efficacy for those behaviors. Overall, neither social support nor self-efficacy mediated the improvements in insulin sensitivity or quality of life that were observed in this intervention. Our findings support previous studies that have demonstrated the importance of family social support for health behaviors. However, more research is needed to understand the theoretical constructs or underlying mechanisms that contributed to the effectiveness of this intervention.

Technical Abstract: This study tested self-efficacy and social support for activity and dietary changes as mediators of changes in type 2 diabetes related outcomes following a lifestyle intervention among Latino youth. Latino adolescents (14-16 years) with obesity (BMI% = 98.1 +/- 1.4) were randomized to a 3-month intervention (n=67) that fostered self-efficacy and social support through weekly, family-centered sessions or a comparison condition (n=69). Primary outcomes included insulin sensitivity and weight specific quality of life. Mediators included self-efficacy, friend, and family social support for health behaviors. Data was collected at baseline, 3-months, 6-months, and 12-months. Sequential path analysis was used to examine mediators as mechanisms by which the intervention influenced primary outcomes. The intervention had a direct effect on family (Beta=0.33, P<.01) and friend social support (Beta=0.22, P<.001) immediately following the intervention (3-months). Increased family social support mediated the intervention's effect on self-efficacy at 6-months (Beta=0.09, P<.01). However, social support and self-efficacy did not mediate long-term changes in primary outcomes (P>.05) at 12-months. Family social support may improve self-efficacy for health behaviors in high-risk Latino youth, highlighting the important role of family diabetes prevention. Fostering family social support is a critical intervention target and more research is needed to understand family-level factors that have the potential to lead to long-term metabolic and psychosocial outcome in vulnerable youth.