Objective: The purpose of this paper is to elucidate factors impacting the health, development and management of chronic illnesses, particularly type 2 diabetes of rural grandparent-headed households (GHH).

Research Design and Methods: Prospective data were collected from rural-dwelling members of GHHs living in Appalachia Kentucky with no known diagnosis of T2D. Data collected on family characteristics, T2D clinical risk factors, and social support were assessed using the Medical Outcomes Survey (MOS) Social Support and the Child and Adolescent Social Support Scale (CASSS).

Results: Sixty-six grandparents and 72 grandchildren participated in the study. The average age and HbA1Cs were 59.4 years and 6.2% ± 1.4 for grandparents and 11.8 years and 4.9% ± 0.6 for grandchildren. The majority of grandparents were found to have prediabetes (31%) or undiagnosed diabetes (28%). The number of people living in GHHs were associated with grandparents’ triglycerides, HDL, and BMI whereas custody status was associated with BMI. Average social support scores among grandparents suggested moderately high perceived social support (79 ± 3.4). For grandchildren, social support provided by grandparents had no association with T2D risk factors, whereas support from teachers, classmates, and close friends was associated with HbA1C, BMI, and blood pressure in grandchildren.

Conclusion: This study shows that rural-dwelling grandparent caregivers are at an increased risk for T2D. In addition, increased responsibility may provide a determinant of health due to the potential stress of caregiving for grandchildren. Social support between grandparents and grandchildren has no effect on T2D risk factors. However, social support provided by peers, teachers, and close friends were associated with T2D risk factors in grandchildren. These findings support the use of peer support and school settings as mechanisms for interventions to reduce T2D in adolescents, particularly those of GHHs.


B.L. Smalls: None. K.N. Palmer: None. O.A. Contreras: None. J. Hatcher: None.


National Institute for Diabetes and Digestive and Kidney Diseases (R03DK101705 to J.H.)

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