Self -esteem, self-efficacy, hope, health promoting behaviors and insulin resistance in overweight Mexican American adolescents

Insulin resistance (IR) and type 2 diabetes in Mexican American adolescent s living along the United States (US)–Mexico border are linked to genetics, poverty, developm ental characteristics, and psychological attributes. Understanding relationshi ps among psychological attributes, health promoting behaviors (HPB) and IR markers addresses gap in health promotion science that test relationships between lifestyle and biological outcomes. Hendricks’ Perceptual Health Promotion Determinants Model provided theoretical underpinnings. The aims were to test the predictive ability of HPB and IR usi ng p ychological attributes (self–esteem, self–efficacy, and hope). Biological marker s for IR included body mass index (BMI), waist circumference (WC), and Homeostasis Mathematica l Assessment Model for Insulin Resistance (HOMA–IR). Forty five Mexican American adolescents (62% female; 16.4 [±1.27] mean years) participated. The majority (60%) were obese (BMI > 95 percentile) with 40% overweight (BMI > 85 percentile), 45% with WC >95 percentile, and 76% with HOMA–IR > 3.16. With self–efficacy for physical activity, 38% (R 2 = 0.3771; F = 8.27, df = 3; p < 0.002) of variance in HPB was explained by hope. With self–efficacy for nutrition fats/ sodium, 44% (R = 0.4382; F = 10.66; df = 3; p < .0001) of variance in HPB was explained by self–efficacy for nutrition fats/sodium and hope. With self–efficacy for nutrition fruits/vegetables, 49% (R = 0.4894; F = 13.10; df = 3; p <.0001) of variance in HPB was explained by self–efficacy for nutrition fruits/vegetables and hope. Additionally, with IR reflected as WC, 21% (R 2 = 0.2129; F = 2.71; df = 4; p = 0.0437) of variance was explained by self–esteem and self–efficacy for physic al activity. With IR reflected as HOMA–IR, 22% (R 2 = 0.2214; F = 2.84; df = 4; p = 0.0364) of variance was 12 explained by self–efficacy for physical activity and 23% (R 2 = 0.2254; F = 2.91; df = 4; p = 0.0333) of variance was explained by self–efficacy for nutrition fruits/vege tables. Evidence supports using hope and self–efficacy to test interventions to increase HPB and decre ase IR in adolescents residing along the US–Mexico border region. 13 CHAPTER 1: INTRODUCTION Chronic health problems such as obesity and type 2 diabetes often develop insidiously in youth requiring major lifestyle changes later in adulthood (Ogden, Car roll, McDowell, & Flegal, 2007; Ogden et al., 2006; Ogden, Yanovski, Carroll, & Flegal, 2007; Ogden, Carroll, & Flegal, 2008). The Surgeon General (2007) advocates health promotion and prevention strategies to approach the impending crisis of obesity-related disorders. Three focus area s of Healthy People 2010 (#5: Diabetes, #19: Nutrition and Overweight and #22: Physical Activity and Fitne ss) directly address this crisis. Although improvement was noted in 2005 at the time of H ealth People 2010 Midcourse Review for the objectives in these focus areas, lifestyle b haviors did not change enough to reach target with persistence of multiple disparities i n he Hispanic population (U.S. Department of Health and Human Services, 2000). Multiple factors including psychological attributes, health promoting behaviors (HPB) and biological factors influence an individual’s ability to make required life styl changes. Mitigation of the future impact of chronic disorders requires a shift in healthcar e toward HPB in young populations rather than relying on lifestyle change in adulthood. Within the c ontext of preventing type 2 diabetes, this shift requires determining relationships betwe en psychological attributes that contribute to HPB and markers of obesity related disease s uch as insulin resistance (IR). This chapter provides an overview of type 2 diabetes with background informati n related to prevention of type 2 diabetes in Mexican American adolescents living in Texas (T X) along the United States (US)–Mexico border, concluding with the significance, purpose a nd specific aims of the proposed research. 14 Background and Significance of the Problem Ethnicity, genetic background, poverty, and developmental characteristics pre di pose Mexican American adolescents living in TX along the US–Mexico border to increas ed risk for negative health outcomes, such as obesity and IR with subsequent type 2 diabetes. Becaus e th Hispanic population is the fastest growing and largest minority group (15.1%) i n the US (U. S. Census Bureau, 2008), these issues extend beyond the Mexican American individuals who l ive in TX along the US–Mexico border to the entire nation.