Open Access. Powered by Scholars. Published by Universities.®

Digital Commons Network

Open Access. Powered by Scholars. Published by Universities.®

PDF

Theses/Dissertations

Adolescence

2014

Discipline
Institution
Publication

Articles 1 - 30 of 37

Full-Text Articles in Entire DC Network

Parenting And Youth Sexual Risk In South Africa: The Role Of Contextual Factors, Nada M. Goodrum Dec 2014

Parenting And Youth Sexual Risk In South Africa: The Role Of Contextual Factors, Nada M. Goodrum

Psychology Theses

Black South African youth are disproportionately affected by the HIV epidemic, and risky sexual behaviors increase youths’ vulnerability to HIV infection. U.S.-based research has highlighted several contextual factors that impact sexual risk, but these processes have not been examined in a South African context. In a sample of Black South African parent-youth dyads, this study examined relations among parenting, neighborhood quality, maternal social support, coparenting, and youth sexual risk. Hypotheses were evaluated using structural equation modeling. Results revealed that better neighborhood quality predicted less youth sexual risk via higher levels of positive parenting. Social support was positively related to parenting …


Impacts Of Adolescents' Emotional And Behavioral Concerns And Social Skills On Parenting Stress, Marissa Miller Dec 2014

Impacts Of Adolescents' Emotional And Behavioral Concerns And Social Skills On Parenting Stress, Marissa Miller

Theses and Dissertations

Minimal literature has examined predictors of parenting stress for parents of adolescents and what may contribute to the impact of these predictors, particularly those regarding adolescent behavior. The current study sought to evaluate whether adolescents’ internalizing and externalizing behaviors significantly predicted parenting stress and whether adolescent social skills moderated the relationship. Covariates of gender, age, ethnicity, and socioeconomic status were entered first into a multiple regression moderation model and followed by internalizing and externalizing behaviors, social skills, and interaction terms, respectively. The overall model explained 19 percent of the variance in parenting stress. While internalizing behaviors significantly predicted parenting stress, …


Science Fairs Before Sputnik: Adolescent Scientific Culture In Contemporary America, Sarah Michel Scripps Dec 2014

Science Fairs Before Sputnik: Adolescent Scientific Culture In Contemporary America, Sarah Michel Scripps

Theses and Dissertations

"Science Fairs before Sputnik: Adolescent Scientific Culture in Contemporary America" traces the formation and evolution of science fairs in America, focusing on the ways in which adolescents established communities of practice by engaging in these competitions. Over the course of the twentieth century, generations of American children conducted their first experiments by crafting science fair projects. The dissertation evaluates this understudied phenomenon against the backdrop of American fascinations and fears of science and evolving notions of adolescence. It argues that science fairs were central to shaping an adolescent scientific culture in the United States during the early to mid twentieth …


Cost Effectiveness Of Treating Generalized Anxiety Disorder In Adolescence: A Comparison By Provider Type And Therapy Modality, Kathryn Evelyn Reynolds Dec 2014

Cost Effectiveness Of Treating Generalized Anxiety Disorder In Adolescence: A Comparison By Provider Type And Therapy Modality, Kathryn Evelyn Reynolds

Theses and Dissertations

Generalized anxiety disorder (GAD) is frequently found in primary care settings and is highly prevalent among adolescents. The purpose of this study was to examine the cost effectiveness by provider type and therapy modality in treating adolescents (ages 13-17) with a GAD diagnosis (DSM-IV 300.02). A national insurance company in the United States provided outpatient and unidentifiable data for adolescent GAD cases (n = 2,932). These cases were used to analyze the cost effectiveness, total cost, treatment length, dropout, and readmission rates for the treatment of adolescents with GAD. Descriptive statistics signify that the mean cost of treatment for GAD …


Individuation As An Adolescent Developmental Task: Associations With Adoptee Adjustment, Danila Musante Nov 2014

Individuation As An Adolescent Developmental Task: Associations With Adoptee Adjustment, Danila Musante

Doctoral Dissertations

This study evaluated the associations between adolescent individuation and concurrent and long term adjustment in adoptive families. Individuation was assessed using an observational measure examining behaviors and communications demonstrative of individuality and connectedness between each parent and the adolescent. Findings did not support the hypothesized connection between adolescent individuation and concurrent and long term adjustment in adoptive families. However, further analyses revealed particular importance of connectedness between adolescent and parent for adolescent adjustment, which was found to vary by adolescent gender. Specifically, analyses revealed that gender interacts with both adolescent-father connectedness and mother-adolescent connectedness in predicting adolescent internalizing symptoms; for …


Emotion In Adoption Narratives: Links To Close Relationships In Emerging Adulthood, Holly A. Grant-Marsney Nov 2014

Emotion In Adoption Narratives: Links To Close Relationships In Emerging Adulthood, Holly A. Grant-Marsney

Doctoral Dissertations

An adopted person develops a narrative or story to help make sense of his or her adoption. This narrative provides a window into how the adoptee understands the role of adoption in his or her life and articulates feelings and thoughts about it. Adolescent and emerging adult adoptees’ data from the Minnesota-Texas Adoption Research Project (MTARP) were examined. MTARP longitudinally followed 190 adoptive kinship networks, with varying levels of openness in the adoption, from childhood to emerging adulthood. The current study sought to understand how emotion (affective valence and specific emotions), as identified in the adoption narratives during adolescence and …


The Effects Of Physical Activity On Suicidal Ideation In Adolescents, Sydney Shepperd Smith Aug 2014

The Effects Of Physical Activity On Suicidal Ideation In Adolescents, Sydney Shepperd Smith

College of Science and Health Theses and Dissertations

This thesis examines how physical activity influences suicidal ideation longitudinally in a population-based sample of adolescents in grades 7 through 12, as well as investigates potential mediating and moderating factors of this association. Physical activity has been found to be protective against depression and suicidal behaviors in various populations. Few studies have explored the relationship between physical activity and suicidal ideation in a representative sample of adolescents, and even fewer have examined this relationship prospectively. This study included measures of physical activity, self-esteem, social support, and suicidal ideation from Wave I and Wave 2 of the National Longitudinal Study of …


Affective And Cognitive Empathy Deficits Distinguish Primary And Secondary Variants Of Callous-Unemotional Youth, Rachel E. Kahn Aug 2014

Affective And Cognitive Empathy Deficits Distinguish Primary And Secondary Variants Of Callous-Unemotional Youth, Rachel E. Kahn

University of New Orleans Theses and Dissertations

The current study examined whether a sample of detained male adolescents (n = 107; Mean age = 15.50; SD = 1.30) could be disaggregated into two distinct groups, consistent with past research on primary and secondary variants of callous-unemotional (CU) traits in adolescents. This study also sought to determine a possible explanation for the CU traits among youth in the secondary variant by examining whether they differ from primary variants on measures of cognitive and affective empathy. Using Latent Profile Analyses, two groups of adolescents high on CU traits were identified, a large group (n = 30) high …


The Effects Of Social Support On At-Risk Youth, Christi Lanet Culpepper Aug 2014

The Effects Of Social Support On At-Risk Youth, Christi Lanet Culpepper

Doctoral Dissertations

Social support is conceptualized as a protective factor that buffers against distress and dysfunction. Social support can be beneficial to all individuals and is usually available through a support system consisting of family and friends. Unfortunately, there are populations that lack effective support systems and consequently do not receive social support. One such population is at-risk youth. In this project, I examined the effects of social support, within the context of participation in youth programs, on the academic, emotional, and behavioral functioning of at-risk youth. Twenty-three adolescents participating in three youth programs were assessed at three time points: the beginning …


Developmental Trajectories Of Adhd Symptoms To Adolescent Substance Use: What Influence Do Peer, Family And Neighborhood Factors Have?, Michael Lawrence Vitulano Aug 2014

Developmental Trajectories Of Adhd Symptoms To Adolescent Substance Use: What Influence Do Peer, Family And Neighborhood Factors Have?, Michael Lawrence Vitulano

Doctoral Dissertations

Attention-Deficit/Hyperactivity Disorder (ADHD) has been consistently linked to risk for early substance use. However, the potential mediating mechanisms and moderators of this association remain unclear. The current study examined peer rejection, school bonding and internalizing problems as potential mediators of the association between childhood ADHD symptoms and adolescent substance use in a longitudinal study following children from fourth to ninth grade. Results suggest that ADHD symptoms follow a path to early initiation of tobacco use through the combined effects of peer rejection and internalizing problems as well as through internalizing problems alone. ADHD symptoms did not follow developmental pathways to …


The Effects Of Endocannabinoid Agonist Win 55, 22-212 And Antagonist Am251 On Binge-Pattern Drinking In Adolescent C57bl/6j And Dba/2j Mice, Timothy Glenn Freels Jun 2014

The Effects Of Endocannabinoid Agonist Win 55, 22-212 And Antagonist Am251 On Binge-Pattern Drinking In Adolescent C57bl/6j And Dba/2j Mice, Timothy Glenn Freels

Electronic Theses and Dissertations

We hypothesized that the endocannabinoid antagonist AM251 would significantly reduce ethanol self-administration in a paradigm that facilitates binge-pattern drinking behaviors using C57BL/6J and DBA/2J mice. We used an EOD (every other day) design in which mice have 24 hour access to an ethanol solution every other day for two weeks. Our results show that B6 mice receiving injections of AM251 drank significantly less ethanol than control B6 mice, but not less than those in the vehicle only and WIN groups. This suggests that AM251 may reduce ethanol consumption in B6 mice. The results also show that ethanol consumption can vary …


Latino Cultural Implications For Art Therapy: The Influence Of Cultural Risk Factors And Academic Performance In High School, Piera Lynn Carfagno Jun 2014

Latino Cultural Implications For Art Therapy: The Influence Of Cultural Risk Factors And Academic Performance In High School, Piera Lynn Carfagno

LMU/LLS Theses and Dissertations

Through art therapy, this research examines the influence of the main components of Latino culture as risk and/or protective factors for internalizing and externalizing behaviors and disorders in Latino adolescents. The goal of this research is to also identify how these factors impact academic performance for Latino high school students. First, a literature review examines preexisting research evaluating the presence and influence of particular cultural factors like family expectations and roles, gender, religion, language, and parental involvement in education. Non-cultural factors include peer influence and socioeconomic influences. The literature further examines the impact these factors have been found to influence …


Relationships Between Life Satisfaction, Symptoms Of Inattention And Hyperactivity/Impulsivity, And Depressive Symptoms In High School Students, Lisa Paige Bateman Jun 2014

Relationships Between Life Satisfaction, Symptoms Of Inattention And Hyperactivity/Impulsivity, And Depressive Symptoms In High School Students, Lisa Paige Bateman

USF Tampa Graduate Theses and Dissertations

Given increased evidence related to the importance of fostering life satisfaction in the overall population (Diener & Diener, 1996), as well as recent suggestions regarding the importance of increasing positive academic and social outcomes for children with ADHD (DuPaul, 2007), it is important to gain a clearer understanding of how life satisfaction may be related to symptoms of inattention and hyperactivity/impulsivity. Research on the relationship between life satisfaction and symptoms of inattention, hyperactivity, and impulsivity is currently limited to two studies (Gudjonsson et al., 2009; Ogg et al., 2014). The current study investigated the relationship between symptoms of inattention and …


Middle School Transition: Faculty And Parent Perceptions Of The Academic, Procedural, And Social Changes That Occur Between Elementary And Middle School, Barbara Mckeon May 2014

Middle School Transition: Faculty And Parent Perceptions Of The Academic, Procedural, And Social Changes That Occur Between Elementary And Middle School, Barbara Mckeon

Seton Hall University Dissertations and Theses (ETDs)

This purpose of this study was to investigate the perceptions of parents and faculty regarding the transition from a private special education school to the middle school environment. Research was conducted using a mixed methods design to investigate the attitudes and perceptions of those directly involved with the transition process. Seventeen participants, nine parents and eight faculty participated in both the interviews and questionnaire processes. Social competence, academic competence, procedural challenges, maturational readiness and program planning were dominant themes in this study. The study examined the academic, procedural and social changes that occur in middle school from the stage-environment fit …


Testing Components Of A Self-Management Theory In Adolescents With Type 1 Diabetes Mellitus, Gwen Marie Verchota May 2014

Testing Components Of A Self-Management Theory In Adolescents With Type 1 Diabetes Mellitus, Gwen Marie Verchota

Theses and Dissertations

Advances in treatment technology and the importance of obtaining normoglycemia in order to prevent or delay complications associated with Type 1 Diabetes Mellitus (T1DM) has shifted much of the emphasis of diabetes self-management (SM) onto the adolescent and his or her family. The primary responsibility for managing T1DM in childhood is with the parent whereas during adolescence, increasing levels of responsibility for SM are transferred to the adolescent. This study examined the relationships of key context and process variables on proximal (self-management behaviors [SMB]) and distal outcomes (metabolic control and diabetes-specific health-related quality of life [DQOL]) from the Individual and …


An Investigation Into The Shift In Lie Acceptability In Children From Grades 3-12, Marc S. Goosie May 2014

An Investigation Into The Shift In Lie Acceptability In Children From Grades 3-12, Marc S. Goosie

Electronic Theses and Dissertations

In this study the goal was to determine if there was a shift in the extent to which children’s attitudes toward deception change as they age. Participants (N=278) enrolled in grades 3-12 completed a survey assessing their lie acceptability and other factors as potential variables associated with a prodeception attitude. Results indicated that greater lie acceptability was correlated with male children who had self-reported acts of bad behavior. Results also suggest that nontraditional family environments may increase one’s perception of the acceptability of lying. These findings provide potential predictors of the acceptability of lying in children and adolescents that offer …


Adolescent Religion And Parenthood Outcomes In Young Adulthood, Kelli K. Smith May 2014

Adolescent Religion And Parenthood Outcomes In Young Adulthood, Kelli K. Smith

Electronic Theses and Dissertations

A multitude of research exists examining the relationship between religion and early marriage, yet little research has focused on the relationship between religion and early childbearing. Even less has examined the influence of adolescent religion on early parenthood. Using data from the National Study of Youth and Religion, I examined the relationship between religion in adolescence and parenthood outcomes in early adulthood. I focus on how religiosity in adolescence shapes whether an individual is more or less likely to be sexually active, become pregnant, and/or have and keep a child. Results suggest that those who are religious in adolescence are …


Negative Experiences In Physical Education Class And Avoidance Of Exercise, Daphne Brown May 2014

Negative Experiences In Physical Education Class And Avoidance Of Exercise, Daphne Brown

Master's Theses

One of our nation’s growing concerns is obesity and the effect it has on one’s health and overall quality of life. Determining the underlying causes for an individual’s avoidance of exercise is crucial in battling the obesity crisis. The impact negative feelings involving Physical Education classes taken in adolescence may have on one’s current exercise routines and barriers to current participation in exercise were examined in the current study. Measures of barriers to exercise, self-esteem, current exercise routines and negative experiences involving Physical Education classes were examined. A total of 101 participants completed the measures of barriers to exercise, self-esteem, …


What Is The Phenomenology Of Complicated Grief In Parentally Bereaved Children And Adolescents?, Jeanne M. Abicht May 2014

What Is The Phenomenology Of Complicated Grief In Parentally Bereaved Children And Adolescents?, Jeanne M. Abicht

Master of Social Work Clinical Research Papers

The experience of parental loss in childhood and adolescence is often a trauma unparalleled as the most stressful period during the first decades of life. The literature cites contributory factors in the etiology of parentally bereaved children’s grief experience as relationship to the deceased parent, circumstances of parental death, and adjustment of the surviving parent. The research explored the contextual variables that are protective or increase the risk of vulnerability of complicated grief. Eight adults who experienced the death of a parent or custodial grandparent during childhood or adolescence were interviewed. Primary themes related to complicated grief include the surviving …


Impact Of Faah Genotype And Marijuana Use On Brain Structure And Neuropsychological Performance In Emerging Adults, Skyler Gabriel Shollenbarger May 2014

Impact Of Faah Genotype And Marijuana Use On Brain Structure And Neuropsychological Performance In Emerging Adults, Skyler Gabriel Shollenbarger

Theses and Dissertations

Introduction: Chronic MJ use may be associated with higher cognitive ability impairments (see Lisdahl et al., 2013). Regions undergoing later maturation (Gogtay 2004), may be at increased risk for MJ-induced alterations. Endogenous cannabinoid signaling (ECS) is modulated by the function the enzyme Fatty Acid Amide Hydrolase (see Ho & Hilard, 2005), thus the gene encoding for this enzyme (FAAH) impacts ECS (Sipe et al., 2002). Here, we examine the impact of MJ use and FAAH genotype on PFC complexity and underlying frontal white matter (WM) integrity in young adults. Methods: Participants included 37 MJ users and 37 non-using young adults …


Singer Identity In Adolescence, Trinny Lou Schumann May 2014

Singer Identity In Adolescence, Trinny Lou Schumann

Theses and Dissertations

There is a prevalent and growing trend of adults labeling themselves as non-singers. This crisis of singer identity becomes a factor as music education programs strive to promote singing, especially community singing. This qualitative research study addressed the self-perceptions of singing identity, ability, and attitudes in adolescents. The purpose of this study was to investigate how adolescent students view their own singing abilities in order to gain insight and understanding about what factors play an important role in the shaping of views about their own singing identity. Previous studies shaped the framework for this investigation. Studies reviewed included: (1) the …


Posttraumatic Stress, Family Functioning, And Adjustment In Urban African American Youth Exposed To Violence: A Moderated Mediation Model, Kyle Deane Jan 2014

Posttraumatic Stress, Family Functioning, And Adjustment In Urban African American Youth Exposed To Violence: A Moderated Mediation Model, Kyle Deane

Master's Theses

Exposure to community violence is a pressing public health issue that disproportionately impacts poor, urban, and ethnic minority youth. It has been associated with a multitude of negative externalizing and internalizing symptoms, most frequently with posttraumatic stress. This study investigates the role that posttraumatic stress has in mediating the relation between exposure to community violence and other adjustment difficulties. Moreover, because not all adolescents experience these difficulties in the face of significant violence exposure, the study examines the moderating role of family cohesion and support in buffering the effect of violence and posttraumatic stress on later adjustment. A sample of …


Empathy As A Moderator Of Adolescent Bullying Behavior And Moral Disengagement After Controlling For Social Desirability, Amy Zelidman Jan 2014

Empathy As A Moderator Of Adolescent Bullying Behavior And Moral Disengagement After Controlling For Social Desirability, Amy Zelidman

Wayne State University Dissertations

The purpose of this study was to assess the moderating influence empathy has on the associations between adolescent bullying behavior and moral disengagement after controlling for social desirability (e.g., response bias). 676 students in 7th and 8th grade from a suburban middle school in Southeast Michigan participated in this study in the fall of 2012.

Results showed male respondents were more likely than female respondents to (a) report engaging in all forms of traditional bullying behavior overall, including physical, verbal, and social bullying and (b) report higher rates of physical victimization and moral disengagement. Female respondents were more likely to …


An Examination Of Impulsivity In Adolescence: Relations With Emotion Regulation, Ellie Taylor Jan 2014

An Examination Of Impulsivity In Adolescence: Relations With Emotion Regulation, Ellie Taylor

University of Wollongong Thesis Collection 1954-2016

Previous studies have examined impulsivity using self-report measures, physiological measures, and behavioural tasks, primarily in adult populations. Few past studies have examined adolescents’ impulsivity across such measures concurrently. Further, past research has rarely examined the link between impulsivity and emotion regulation across various measures in a non-clinical sample. This study assessed the relationship between impulsivity, effortful control and emotion regulation. One hundred and seventy typically-functioning adolescents had heart rate, heart rate variability, and alpha EEG power recorded while undertaking two 3-minute resting tasks (eyes open and eyes closed), a visual inhibitory control task, and a visual selective attention task. Prior …


The Lived Experiences Of Adolescents With Autism Spectrum Disorder: A Personal Constructivist And Family Systems Approach, Elizabeth Kate Cridland Jan 2014

The Lived Experiences Of Adolescents With Autism Spectrum Disorder: A Personal Constructivist And Family Systems Approach, Elizabeth Kate Cridland

University of Wollongong Thesis Collection 1954-2016

Individuals with Autism Spectrum Disorder (ASD) experience persistent and significant social communicative impairments, as well as restricted and repetitive behaviours and/or interests. There is currently a dearth of literature investigating the experiences of adolescents with ASD, despite research findings indicating adolescence is a particularly challenging period for these individuals. In addition to the significant influence of ASD on the individual, having a family member with the condition can have chronic and pervasive effects on individual family members and the family unit as a whole. However, research investigating the experiences of families who have an adolescent member with ASD is scarce. …


Longitudinal Relations Between Peer Victimization And Delinquency: The Mediating Roles Of Sadness, Fear, And Anger, Lisa J. Ulmer Jan 2014

Longitudinal Relations Between Peer Victimization And Delinquency: The Mediating Roles Of Sadness, Fear, And Anger, Lisa J. Ulmer

Theses and Dissertations

Peer victimization is a common occurrence among youth, and it has been linked to a number of negative outcomes, including delinquent behaviors (e.g., physical aggression, theft/property damage, and substance use). Several studies examined relations between peer victimization and delinquency, though few have done so longitudinally or examined whether negative emotions are underlying processes that explain associations between these constructs. The current study’s purpose is to examine whether several negative emotions (i.e., anger, fear, and sadness) mediate relations between several types of peer victimization and delinquency among middle and high school youths. The study’s sample of 318 youths was predominately African …


The Contribution Of Parent Psychosocial Functioning To Parental Monitoring, Youth Adherence, And Glycemic Control During Adolescence, Elizabeth M. Robinson Jan 2014

The Contribution Of Parent Psychosocial Functioning To Parental Monitoring, Youth Adherence, And Glycemic Control During Adolescence, Elizabeth M. Robinson

Theses and Dissertations

Objective: Type 1 diabetes is one of the most common pediatric chronic illnesses. Adolescents are at risk for poorer adherence and in turn, poorer glycemic control; however, youth whose parents remain involved in diabetes care are in better control. A parent’s level of involvement is dependent in part upon his or her own social and emotional functioning. Much is known about the link between separate aspects of parent psychosocial functioning (e.g., depressive symptoms, parental stress) and parent involvement in diabetes care, adherence, and glycemic control. However, no study to our knowledge has examined these constructs simultaneously as they interrelate …


Values And Valued Action: Relationships With Perceived Parenting Styles And Well-Being At The Transition From High School To Early Adulthood, Kathryn Elizabeth Williams Jan 2014

Values And Valued Action: Relationships With Perceived Parenting Styles And Well-Being At The Transition From High School To Early Adulthood, Kathryn Elizabeth Williams

University of Wollongong Thesis Collection 1954-2016

Psychological interventions such as Acceptance and Commitment Therapy (ACT) seek to help clients identify and clarify values and to activate behaviour in valued directions. Values inspire people to commit to and maintain personally meaningful behaviours, and to overcome barriers that may arise, such as difficult feelings and situations. It is therefore important to understand what people of different ages value, what factors might promote or inhibit valued action, and the relationship between valuing and well-being.

This thesis explored values development and well-being in a group of young Australians from their final year of high school to the end of their …


How Gay, Lesbian, And Bisexual Youth Develop Positive Identities During Adolescence And Young Adulthood, Lauren E. Millerd Jan 2014

How Gay, Lesbian, And Bisexual Youth Develop Positive Identities During Adolescence And Young Adulthood, Lauren E. Millerd

Theses, Dissertations, and Projects

This qualitative study was designed to examine the ways in which gay, lesbian, and bisexual adolescents form positive identities, specifically in strength-based ways looking at factors of resilience. Twelve individuals, aged 22-28, were interviewed to give retrospective information about their adolescent development. By utilizing a semi-structured interview model for this study, the researcher was able to analyze the subjective findings utilizing thematic analysis. Significant findings include the influential nature of one's first disclosure of sexual orientation in the development of one's identity, and the positive impact that role models have for gay, lesbian, and bisexual youth during adolescence.


The Effect Of Youth Diabetes Self-Efficacy On The Relation Among Family Conflict, Disease Care And Glycemic Control, Kathryn Maher Jan 2014

The Effect Of Youth Diabetes Self-Efficacy On The Relation Among Family Conflict, Disease Care And Glycemic Control, Kathryn Maher

Theses and Dissertations

The aim of the current study was to examine the associations among youth diabetes self-efficacy, family conflict, disease care and glycemic control via a comprehensive path model. Data were from a baseline assessment of a longitudinal RCT of 257 adolescent/parent dyads (adolescents aged 11–14). Each member of the dyad separately completed the Self-efficacy for Diabetes Self-Management Scale, Family Environment Conflict subscale, Diabetes Family Conflict Scale, Diabetes Behavior Rating Scale, and 24-hr Diabetes Interview Blood Glucose Frequency subscale. Additionally, a biological marker of glycemic control, or HbA1c, and relevant demographic variables were collected. A mediation model found higher youth diabetes self-efficacy …