Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Robin Whittemore

Second Advisor

Rafael Perez-Escamilla


Low income has been established as a risk factor for poorer outcomes in

youth with type 1 diabetes; however, the effect of moderate income has not

been studied. The purpose of this secondary analysis of baseline data from a multi-site study was to compare glycemic control, self-management, and

psychosocial outcomes [depression, stress, and quality of life (QOL)] at

different income levels in adolescents with type 1 diabetes. Youth (n=320,

mean age=12.3+1.1, 55% female, 64% white, mean A1C=8.3±1.4)

completed established self-management and psychosocial measures. A1C

levels were collected from medical records. Caregivers reported annual family income, categorized as high (>$80K), moderate ($40-80K), or low (<$40K). Youth from high-income families had significantly lower A1C

(mean=7.9±1.2) than those from the moderate-income group (8.6±1.7,

p<0.001) or the low-income group (mean A1C=8.6±1.5, p=0.003). Youth

from the high-income group reported significantly better diabetes problem

solving and more self-management goals than those from the moderate- or

low-income groups (both p<0.01). Youth from the high-income group also

reported significantly fewer symptoms of depression, lower levels of perceived stress, and better QOL than those in the moderate or low-income groups (all p<0.05). Multivariate linear regression models were used to test

psychological and behavioral predictors of A1C and QOL. Parents' education

status (p<0.05) and self-management activities (p<0.01) were significant

predictors of hemoglobin A1c, while income (p<0.01) and self-management

activities (p<0.05) were significant predictors of QOL.


This is an Open Access Thesis.