Theses and Dissertations

Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


College of Psychology

First Advisor

Jessica M. Valenzuela

Second Advisor

F. Daniel Armstrong

Third Advisor

Ryan Black


academic achievement, family environment, family functioning, health care utilization, sickle cell disease


Sickle cell disease (SCD) is the most common group of genetic, chronic hematologic disorders, and is characterized by chronic pain resulting from vaso-occlusive episodes. As such, youth with SCD utilize a disproportionately high amount of health care resources. Youth with frequent health care utilization (HCU) are at increased risk for psychosocial consequences, including disruptions in family functioning and decreased academic performance. While studies have separately examined HCU, family functioning, and academic achievement in this population, there is a dearth of research examining the association between these variables. The present study aimed to: (1) examine associations between family environment and patterns of HCU, (2) examine associations between patterns of HCU and academic achievement scores in math and reading, and (3) evaluate the indirect effect of family environment on academic achievement scores in math, as explained by patterns of HCU. This study included 41 youth with HbSS or HbS beta-thalassemia. Youth were administered the Woodcock-Johnson III Achievement, and caregivers completed the Family Environment Scale. Sociodemographic characteristics were collected, and medical history information was obtained via retrospective medical chart review. Overall, participants reported a more positive family environment, demonstrated less pain-related ED visits and hospital admissions, and obtained below average scores on academic achievement in math and reading. The present study did not provide evidence of associations between family environment, HCU, and academic achievement. Unique characteristics of the study sample, as well as clinical implications and next steps for future research are discussed.

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