Objective: Adolescents with type 1 diabetes (T1D) frequently experience deterioration in glycemic control. Providers have unique opportunities to address diabetes self-management, yet little is known about the most effective way to communicate with adolescents. This investigation used a motivational interviewing (MI) framework to characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined relations between adolescent patient-provider communication and (a) T1D self-management and (b) glycemic control (hemoglobin A1c [HbA1c]). Methods: Medical encounters between pediatric endocrine providers and 55 adolescents with T1D (49% female; M age = 14.8 years; M baseline HbA1c = 8.6%) were audio recorded and coded using standardized rating instruments. Patients and parents completed measures assessing T1D care behaviors and self-efficacy. Assessments were completed at routine endocrinology visits (baseline) and 1 and 3-month post-baseline; HbA1c was obtained from medical records at baseline and 3-month.Results: Hierarchical multiple regressions showed that greater provider use of MI non-adherent behaviors (eg, confronting, persuading) was associated with (a) poorer 3-month HbA1c, P < 0.001; (b) worse 1-month adolescent diabetes adherence P < 0.001, and (c) lower diabetes self-efficacy at 1-month (P < 0.001) follow-up. Lower patient self-efficacy for diabetes selfmanagement mediated the relation between provider use of MI non-adherent language and lower diabetes adherence (P = 0.020).Conclusion: Providers' use of persuasion and confrontation regarding risks of non-adherence was associated with poorer glycemic control and adherence. Communication training for providers that targets reductions in MI-inconsistent language may have the potential to improve diabetes self-care in this vulnerable population. K E Y W O R D S adolescents, communication, motivational interviewing, type 1 diabetes 1 | INTRODUCTION Type 1 diabetes (T1D) management is complex and requires adherence to numerous disease care behaviors to maintain glycemic control. There is a well-established decline in glycemic control observed during adolescence, because of a complex interplay of behavioral (eg, reduction in diabetes self-management behaviors and self-efficacy) and physiological factors (eg, puberty-related hormonal shifts). 1,2 Consequently, adolescents with T1D are at risk for acute and long-term complications. 3 Given that quarterly visits with an endocrine provider are recommended, 4 and provider communication can meaningfully impact patient behavior, 4,5 characterizing communication between adolescents with T1D and their providers during routine visits might help to identify aspects of communication associated with patient outcomes and guide future intervention efforts.

Short-term exposure to salad bars increased the number of FV students chose but decreased FV consumption. Additional strategies are needed to increase FV consumption.

This investigation provides preliminary support for use of digital imagery in estimating starting portions and plate waste from school salad bars. Results might inform methods used in empirical investigations of dietary intake in schools with self-serve salad bars.

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