Links Between Parent/Child Acculturation and Health for Adolescents with Type 1 Diabetes: Testing the Immigrant Paradox and Acculturation Gap Distress Models

• In Event: Physical and mental health across the lifecourse

Abstract

Diagnoses of type 1 diabetes have been increasing yearly in Latinx adolescents faster than increases seen in Non-Latinx Whites (Mayer-Davis et al., 2017). Less acculturated immigrants sometimes have better health than more acculturated immigrants, a phenomenon referred to as the immigrant paradox (Hernandez et al., 2012). The acculturation-gap distress model posits that when children acculturate more quickly than their parents, family conflict and negative child outcomes follow (Telzer, 2011). Adolescents from U.S. Latinx families who immigrated more recently have been found to have better adherence to diabetes care tasks than those who had been in the U.S. for more generations (Hsin et al., 2009). However, it remains unclear why these differences exist.

We examined relations between traditional Latinx and American cultural values and diabetes management in a Latinx sample of adolescents with type 1 diabetes and their parents (N=66, Mage=12.34 years). We hypothesized that the Latinx cultural values would be associated with better diabetes management (lower glycemic control, higher diabetes self-management, higher quality of life), while Independence/Self-Reliance would be associated with worse diabetes management. We also hypothesized that a larger gap between parent and adolescent cultural values would be related to worse diabetes management.
Adolescent and parent cultural values were measured with the Mexican American Cultural Values Scale (Knight et al., 2010). Latinx cultural values were measured using the Familism and Respect subscales and mainstream American values were measured using the Independence/Self-Reliance subscale. Diabetes management was measured in four ways: adolescent and parent reports of self-management using the Self-Care Inventory (Lewin et al., 2009), adolescent-reported health-related quality of life using the Pediatric Quality of Life Inventory (Vaarni et al., 2003), and HbA1c (glycemic control) was obtained from medical records. We used hierarchical multiple regressions to test the main effects of cultural values controlling for demographic variables (age, insulin pump usage, SES, and generation status) and included an interaction term of parent X adolescent cultural values to test for the effect of acculturation gaps.

Adolescent and parent independence were correlated with lower quality of life; adolescent familism was correlated with higher adolescent-reported self-management (see Table 1). After demographic variables were added, the relationship between adolescent familism and adolescent-reported self-management remained significant, and a relationship between parental respect and HbA1c emerged such that higher parental respect was related to higher levels of respect (see Table 2). There were no significant interactions between adolescent and parent report of cultural values predicting diabetes management.

Findings from the current study partially support the immigrant paradox. Family collaboration has been linked to better diabetes management, which may explain the relationship between familism and self-management (Helgeson et al., 2008). Independence is related to a reluctance to seek support, and families who value independence may be at risk for adolescents seeking less support for their diabetes management, which may be detrimental for health (Claire et al., 2017). We did not find support for the acculturation-gap distress model. Directions for future research exploring the role of culture in chronic illness management will be discussed.

Authors

• Abigail Bolter, University of California Merced
  Presenting Author

• Alexandra Main, University of California, Merced
  Non-Presenting Author

• Deborah Wiebe, University of California, Merced
  Non-Presenting Author

• Jennifer Raymond, Children's Hospital Los Angeles
  Non-Presenting Author

• Linda Cameron, University of California, Merced
  Non-Presenting Author