Date of Graduation


Document Type


Degree Type



Eberly College of Arts and Sciences



Committee Chair

Christina Duncan

Committee Member

Nicholas Turiano

Committee Member

Claire St. Peter


Background: Adolescents with cystic fibrosis (awCF) exhibit suboptimal adherence to dietary and enzyme recommendations despite the fact that eating a high calorie diet with enzymes significantly improves lung functioning. Furthermore, during adolescence teens and their caregivers begin to negotiate treatment responsibility, shifting treatment tasks to the youth. As such, it is important to understand which aspects of the complex decision-making process (e.g., expressing an opinion, asking for information from parents/adults, making joint decisions with parents) relate to better dietary adherence in adolescents with CF and how parents can best support these healthy behaviors. Thus, this study aimed to identify how adolescent decision-making involvement (DMI) relates to both caloric and enzyme adherence in adolescents with CF and how parental social support for healthy behaviors moderates those relations. Method: As part of a larger, ongoing project, 28 adolescents and their caregivers were recruited from five sites in the United States. Adolescents and caregivers completed surveys measuring DMI. Adolescents also completed an online survey on perceived parental support for healthy behaviors, as well as two 24-hour diet recalls by phone or video conferencing. Height, weight, and forced expiratory volume (FEV1) were gathered from medical charts. Self-reported caloric and enzyme adherence were calculated as the percentage of time adolescents followed standard CF calorie or enzyme guidelines. Six moderation models examining the relation between DMI, perceived social support for healthy behaviors, and caloric or enzyme adherence were run in SPSS using PROCESS. Results: It was found that 60% of adolescents reported being 100% adherent to enzyme recommendations. Only 37% of teens met CF dietary guidelines of 120% recommended daily intake (RDI). Nearly 75% of adolescents made a dietary related decision in the past month either with a caregiver or primarily by themselves. Means of caregiver and youth reports of all three DMI subscales (Child Seek, Child Express, and Joint/Options) fell between 1.8-2.3, indicating that most youth asked questions, expressed opinions, and discussed solutions to treatment problems at least “a little bit.” AwCF reported DMI scores were significantly correlated to social support for healthy behaviors (r=.50-.63, p