Vicki Helgeson

Summary

Affiliation: Carnegie Mellon University
Country: USA

Publications

  1. ncbi The implications of unmitigated agency and unmitigated communion for domains of problem behavior
    V S Helgeson
    Psychology Department, Carnegie Mellon University, Pittsburgh, PA, USA
    J Pers 68:1031-57. 2000
  2. ncbi Illness centrality and well-being among male and female early adolescents with diabetes
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh 15213, USA
    J Pediatr Psychol 32:260-72. 2007
  3. ncbi A meta-analytic review of benefit finding and growth
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Consult Clin Psychol 74:797-816. 2006
  4. ncbi Cognitive adaptation theory and breast cancer recurrence: Are there limits?
    Patricia L Tomich
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Consult Clin Psychol 74:980-7. 2006
  5. ncbi The role of friendship in the lives of male and female adolescents: does diabetes make a difference?
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
    J Adolesc Health 40:36-43. 2007
  6. pmc Early adolescent relationship predictors of emerging adult outcomes: youth with and without type 1 diabetes
    Vicki S Helgeson
    Carnegie Mellon University, Pittsburgh, PA, 15213, USA
    Ann Behav Med 47:270-9. 2014
  7. pmc Characterizing the transition from paediatric to adult care among emerging adults with Type 1 diabetes
    V S Helgeson
    Psychology Department, Carnegie Mellon University, Pittsburgh, PA, USA
    Diabet Med 30:610-5. 2013
  8. pmc Agentic and communal traits and health: adolescents with and without diabetes
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Pers Soc Psychol Bull 38:415-28. 2012
  9. pmc Families with children with diabetes: implications of parent stress for parent and child health
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Pediatr Psychol 37:467-78. 2012
  10. ncbi Unmitigated communion and health among adolescents with and without diabetes: the mediating role of eating disturbances
    Vicki S Helgeson
    Psychology Department, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
    Pers Soc Psychol Bull 33:519-36. 2007

Research Grants

  1. ADJUSTMENT TO BREAST CANCER
    Vicki Helgeson; Fiscal Year: 1993
  2. ADJUSTMENT TO BREAST CANCER
    Vicki Helgeson; Fiscal Year: 2001
  3. Effects of Stress on Behavior and Glucose in Type 1 DM
    Vicki Helgeson; Fiscal Year: 2005
  4. Breast Cancer Survivorship: 10 Years Later
    Vicki Helgeson; Fiscal Year: 2005
  5. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2006
  6. Adolescents with and without Diabetes: Transition to Emerging Adulthood
    Vicki Helgeson; Fiscal Year: 2007
  7. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2004
  8. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2004
  9. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2002
  10. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2003

Detail Information

Publications42

  1. ncbi The implications of unmitigated agency and unmitigated communion for domains of problem behavior
    V S Helgeson
    Psychology Department, Carnegie Mellon University, Pittsburgh, PA, USA
    J Pers 68:1031-57. 2000
    ..The links to problem behavior for unmitigated agency individuals stem from their unwillingness to attend to relationships and their negative view of others...
  2. ncbi Illness centrality and well-being among male and female early adolescents with diabetes
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh 15213, USA
    J Pediatr Psychol 32:260-72. 2007
    ..We examined the implications of illness centrality for psychological and physical health among male and female early adolescents with type 1 diabetes...
  3. ncbi A meta-analytic review of benefit finding and growth
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Consult Clin Psychol 74:797-816. 2006
    ..Moderator analyses showed that relations of benefit finding to outcomes were affected by the amount of time that had passed since stressor onset, the benefit finding measured used, and the racial composition of the sample...
  4. ncbi Cognitive adaptation theory and breast cancer recurrence: Are there limits?
    Patricia L Tomich
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Consult Clin Psychol 74:980-7. 2006
    ..These findings highlight the notion that there may be boundary conditions on the adaptiveness of perceived control...
  5. ncbi The role of friendship in the lives of male and female adolescents: does diabetes make a difference?
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
    J Adolesc Health 40:36-43. 2007
    ..We examined differences in the nature of friendship between adolescents with diabetes and healthy adolescents. We also examined whether friend support and negative relations with friends were related to health for both groups...
  6. pmc Early adolescent relationship predictors of emerging adult outcomes: youth with and without type 1 diabetes
    Vicki S Helgeson
    Carnegie Mellon University, Pittsburgh, PA, 15213, USA
    Ann Behav Med 47:270-9. 2014
    ..Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes...
  7. pmc Characterizing the transition from paediatric to adult care among emerging adults with Type 1 diabetes
    V S Helgeson
    Psychology Department, Carnegie Mellon University, Pittsburgh, PA, USA
    Diabet Med 30:610-5. 2013
    ....
  8. pmc Agentic and communal traits and health: adolescents with and without diabetes
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Pers Soc Psychol Bull 38:415-28. 2012
    ..These results underscore the need to focus on unmitigated agency and unmitigated communion when studying the implications of personality for health during adolescence...
  9. pmc Families with children with diabetes: implications of parent stress for parent and child health
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Pediatr Psychol 37:467-78. 2012
    ..To examine the relation of parent stress to parent mental health and child mental and physical health...
  10. ncbi Unmitigated communion and health among adolescents with and without diabetes: the mediating role of eating disturbances
    Vicki S Helgeson
    Psychology Department, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
    Pers Soc Psychol Bull 33:519-36. 2007
    ....
  11. ncbi Comparison of adolescents with and without diabetes on indices of psychosocial functioning for three years
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Pediatr Psychol 32:794-806. 2007
    ..To determine whether diabetes is associated with psychosocial difficulties over the transition to adolescence...
  12. pmc Parent and adolescent distribution of responsibility for diabetes self-care: links to health outcomes
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Pediatr Psychol 33:497-508. 2008
    ..To examine the relation of adolescent and parent responsibility distribution for diabetes self-care to psychological and physical health...
  13. pmc Predictors of metabolic control among adolescents with diabetes: a 4-year longitudinal study
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Pediatr Psychol 34:254-70. 2009
    ..To employ a risk and resistance framework to examine changes in metabolic control over early to middle adolescence...
  14. pmc Brief report: Nature and implications of personal projects among adolescents with and without diabetes
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Pediatr Psychol 34:1019-24. 2009
    ..We examined the relation of adolescent goals to psychological well-being and diabetes health...
  15. pmc Peer relationships and diabetes: retrospective and ecological momentary assessment approaches
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Health Psychol 28:273-82. 2009
    ..To examine the association of positive and negative aspects of friendship to psychological well-being, self-care behavior, and blood glucose control and to determine whether these relations were moderated by gender...
  16. pmc Brief report: trajectories of glycemic control over early to middle adolescence
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Pediatr Psychol 35:1161-7. 2010
    ..To identify distinct patterns of glycemic control over early to middle adolescence, and to determine whether psychosocial variables predicted those patterns...
  17. pmc Relation of stressful life events to metabolic control among adolescents with diabetes: 5-year longitudinal study
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Health Psychol 29:153-9. 2010
    ..To determine the relation of stressful life events to metabolic control...
  18. pmc A focus on blood glucose monitoring: relation to glycemic control and determinants of frequency
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Pediatr Diabetes 12:25-30. 2011
    ....
  19. pmc Survivor centrality among breast cancer survivors: implications for well-being
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Psychooncology 20:517-24. 2011
    ..e. survivor centrality), identify predictors of survivor centrality, and determine the relation of survivor centrality to well-being...
  20. pmc Moderators of the benefits of psychoeducational interventions for men with prostate cancer
    Vicki S Helgeson
    Psychology Department, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Health Psychol 25:348-54. 2006
    ..Of these 3 moderator variables, the most consistent results emerged for self-esteem. That is, the benefits of the intervention were strongest for men with low self-esteem...
  21. ncbi Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer
    V S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
    Health Psychol 20:387-92. 2001
    ..The authors continued to find no benefits of the peer discussion intervention, either alone or in combination with education...
  22. ncbi Cognitive adaptation, psychological adjustment, and disease progression among angioplasty patients: 4 years later
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
    Health Psychol 22:30-8. 2003
    ..In addition, the CATI predicted a reduced likelihood of sustaining a subsequent cardiac event over 4 years. This association was more robust for men...
  23. ncbi Brief report: adjustment to juvenile rheumatoid arthritis: a family systems perspective
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
    J Pediatr Psychol 28:347-53. 2003
    ..To examine the relations of the family environment to adjustment to juvenile rheumatoid arthritis (JRA), and to examine how those relations are influenced by child sex and age...
  24. ncbi Psychological and physical adjustment to breast cancer over 4 years: identifying distinct trajectories of change
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Health Psychol 23:3-15. 2004
    ..Indices of personal resources (i.e., self-image, optimism, perceived control) and social resources (i.e., social support) successfully distinguished different courses of mental and physical functioning...
  25. ncbi Is finding something good in the bad always good? Benefit finding among women with breast cancer
    Patricia L Tomich
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Health Psychol 23:16-23. 2004
    ..Findings suggest there are qualifiers as to whether "finding something good in the bad" is good or bad...
  26. ncbi Surviving cancer: a comparison of 5-year disease-free breast cancer survivors with healthy women
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA 15213, USA
    Psychooncology 14:307-17. 2005
    ..Women who sustain a recurrence suffer an impaired QOL in some, but not all, domains...
  27. ncbi Recent advances in psychosocial oncology
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Consult Clin Psychol 73:268-71. 2005
    ..Helgeson concludes by identifying several challenges that researchers in this area face and by highlighting future avenues for research...
  28. ncbi Diet of adolescents with and without diabetes: Trading candy for potato chips?
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Diabetes Care 29:982-7. 2006
    ..To compare the dietary intake of adolescents with type 1 diabetes with that of adolescents without diabetes matched on age, sex, and year in school and to compare the diets of both groups with recommendations...
  29. ncbi Brief report: friendships of adolescents with and without diabetes
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, Pennsylvania 15213, USA
    J Pediatr Psychol 31:194-9. 2006
    ..Friendships of adolescents with chronic illness have been rarely studied...
  30. ncbi Five years later: a cross-sectional comparison of breast cancer survivors with healthy women
    Patriciav L Tomich
    Psychology Department, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Psychooncology 11:154-69. 2002
    ..In both groups, a continued search for meaning in life had a negative impact on quality of life. The strongest and most consistent correlate of quality of life for both survivors and healthy women was having a sense of purpose in life...
  31. ncbi Perceived growth and decline following breast cancer: a comparison to age-matched controls 5-years later
    Patricia L Tomich
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA ptomoich andrew cmu edu
    Psychooncology 14:1018-29. 2005
    ..These findings suggest that some growth is unique to breast cancer, but much of the decline associated with breast cancer is similar to the decline associated with other types of health problems...
  32. ncbi Social interactions and cardiovascular reactivity during problem disclosure among friends
    Heidi L Fritz
    Department of Psychology, Clarkson University, Potsdam, NY 13699 5825, USA
    Pers Soc Psychol Bull 29:713-25. 2003
    ..Negative interactions predicted slower diastolic blood pressure (DBP) recovery, whereas advice predicted slower heart rate (HR) recovery. Sex composition of dyad moderated some of these effects...
  33. ncbi Social support and quality of life
    Vicki S Helgeson
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    Qual Life Res 12:25-31. 2003
    ..Also addressed is how to translate the correlational research on social support and quality of life into the field of support interventions, taking into account individual and situational differences...
  34. ncbi Moderators of interventions designed to enhance physical and psychological functioning among younger women with early-stage breast cancer
    Michael F Scheier
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
    J Clin Oncol 25:5710-4. 2007
    ..To identify factors that condition or moderate the impact of a previously described set of interventions on psychological and physical adjustment after diagnosis and treatment for early-stage breast cancer...
  35. ncbi Interventions to enhance physical and psychological functioning among younger women who are ending nonhormonal adjuvant treatment for early-stage breast cancer
    Michael F Scheier
    Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, 15213, USA
    J Clin Oncol 23:4298-311. 2005
    ..To conduct a clinical trial to determine if an educational intervention and a nutritional intervention could enhance physical and psychological functioning among younger women completing treatment for early-stage breast cancer...
  36. ncbi Introduction to the special section: growth following highly stressful life events--current status and future directions
    Crystal L Park
    Department of Psychology, University of Connecticut, Storrs, CT 06269, USA
    J Consult Clin Psychol 74:791-6. 2006
    ..The authors end with suggestions for future research...
  37. pmc Randomized controlled trial of a collaborative care intervention to manage cancer-related symptoms: lessons learned
    Jennifer Steel
    Department of Surgery and Psychiatry, University of Pittsburgh School of Medicine, PA, USA
    Clin Trials 8:298-310. 2011
    ..However, few studies have expanded the collaborative care model to other settings and targeted comorbid physical symptoms of depression...
  38. ncbi Is it beneficial to involve a family member? A meta-analysis of psychosocial interventions for chronic illness
    Lynn M Martire
    University of Pittsburgh, Department of Psychiatry and University Center for Social and Urban Research, Pittsburgh, PA 15260, USA
    Health Psychol 23:599-611. 2004
    ..Although statistically significant aggregate effects were found, they were generally small in magnitude. These findings provide guidance in developing future interventions in this area...
  39. pmc Improving quality of life in men with prostate cancer: a randomized controlled trial of group education interventions
    Stephen J Lepore
    Columbia University, Teachers College, Department of Health and Behavior Studies, New York, NY 10027, USA
    Health Psychol 22:443-52. 2003
    ..Among college graduates, controls were comparable with the GE and GED groups in physical functioning and positive health behaviors...
  40. pmc Psychological distress in spouses of men treated for early-stage prostate carcinoma
    David T Eton
    Center on Outcomes, Research, and Education, Evanston Northwestern Healthcare and Northwestern University Feinberg School of Medicine, Evanston, Illinois 60201, USA
    Cancer 103:2412-8. 2005
    ..The authors examined levels and predictors of psychological distress in the wives of men treated for early-stage prostate carcinoma (PCa)...
  41. ncbi Really, disease doesn't matter? A commentary on correlates of depressive symptoms in women treated for early-stage breast cancer
    Michael F Scheier
    J Clin Oncol 24:2407-8. 2006
  42. doi The positives of negative emotions: willingness to express negative emotions promotes relationships
    Steven M Graham
    Family Institute, Florida State University, Tallahassee 32306, USA
    Pers Soc Psychol Bull 34:394-406. 2008
    ....

Research Grants31

  1. ADJUSTMENT TO BREAST CANCER
    Vicki Helgeson; Fiscal Year: 1993
    ..Adherence to treatment and long-term follow-up will be assessed over the same period of time...
  2. ADJUSTMENT TO BREAST CANCER
    Vicki Helgeson; Fiscal Year: 2001
    ..Women will be sent questionnaires on an annual basis, up to 5 years post-intervention. Medical records will be evaluated to gather information on recurrence. ..
  3. Effects of Stress on Behavior and Glucose in Type 1 DM
    Vicki Helgeson; Fiscal Year: 2005
    ..abstract_text> ..
  4. Breast Cancer Survivorship: 10 Years Later
    Vicki Helgeson; Fiscal Year: 2005
    ..Finally, we will conduct focus groups with women to examine the positive and negative aspects of their experience with the research study. ..
  5. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2006
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  6. Adolescents with and without Diabetes: Transition to Emerging Adulthood
    Vicki Helgeson; Fiscal Year: 2007
    ..For youth with diabetes, we will use our wealth of demographic and psychosocial data to predict contact with the health care system and to identify youth who are at risk for leaving the health care system prematurely. ..
  7. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2004
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  8. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2004
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  9. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2002
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  10. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2003
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  11. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2003
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  12. Adolescents with and without Diabetes: Transition to Emerging Adulthood
    Vicki S Helgeson; Fiscal Year: 2010
    ..For youth with diabetes, we will use our wealth of demographic and psychosocial data to predict contact with the health care system and to identify youth who are at risk for leaving the health care system prematurely. ..
  13. Adolescents with and without Diabetes: Transition to Emerging Adulthood
    Vicki S Helgeson; Fiscal Year: 2010
    ..For youth with diabetes, we will use our wealth of demographic and psychosocial data to predict contact with the health care system and to identify youth who are at risk for leaving the health care system prematurely. ..
  14. ADJUSTMENT TO BREAST CANCER
    Vicki Helgeson; Fiscal Year: 2000
    ..Women will be sent questionnaires on an annual basis, up to 5 years post-intervention. Medical records will be evaluated to gather information on recurrence. ..
  15. Adolescents with and without Diabetes: Transition to Emerging Adulthood
    Vicki Helgeson; Fiscal Year: 2009
    ..For youth with diabetes, we will use our wealth of demographic and psychosocial data to predict contact with the health care system and to identify youth who are at risk for leaving the health care system prematurely. ..
  16. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2003
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  17. ADJUSTMENT TO BREAST CANCER
    Vicki Helgeson; Fiscal Year: 1999
    ..Women will be sent questionnaires on an annual basis, up to 5 years post-intervention. Medical records will be evaluated to gather information on recurrence. ..
  18. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2002
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  19. ADJUSTMENT TO BREAST CANCER
    Vicki Helgeson; Fiscal Year: 1999
    ..Women will be sent questionnaires on an annual basis, up to 5 years post-intervention. Medical records will be evaluated to gather information on recurrence. ..
  20. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2005
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  21. Psycholsocial Factors in Adolescent Adjustment to IDDM
    Vicki Helgeson; Fiscal Year: 2004
    ..g., self-efficacy), interpersonal (e.g., social support), and behavioral processes (self-care behavior) that link gender-related traits to psychological and physical well-being. ..
  22. Adolescents with and without Diabetes: Transition to Emerging Adulthood
    Vicki Helgeson; Fiscal Year: 2008
    ..For youth with diabetes, we will use our wealth of demographic and psychosocial data to predict contact with the health care system and to identify youth who are at risk for leaving the health care system prematurely. ..