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1.  The Role of Cognitive Attributions for Smoking in Subsequent Smoking Progression and Regression among Adolescents in China 
Addictive behaviors  2012;38(1):1493-1498.
Previous studies have documented that cognitive attributions are correlated with adolescent smoking. The present study further explored whether cognitive attributions for smoking influenced adolescents’ future smoking behaviors, especially transitions to more advanced stages of smoking.
Participants were 12,382 middle and high school students (48.5% males and 51.5% females) in seven large cities in China. They completed two waves of surveys one year apart. Cognitive attributions for smoking and three smoking behavior outcomes (lifetime smoking, past 30-day smoking, and daily smoking) were assessed. Changes in smoking, including progression from lower stages to higher stages and regression from higher stages to lower stages, over a one-year period, were defined longitudinally. Polychotomous logistic regression was used to examine associations between cognitive attributions for smoking and changes in smoking status over one year, adjusting for demographic characteristics and other plausible confounders.
Seven out of eight cognitive attributions for smoking were associated with subsequent smoking behaviors (p<0.05). Curiosity, autonomy, social image, social belonging, and coping influenced earlier stages of smoking, whereas mental enhancement and engagement influenced later stages of smoking. Curiosity, autonomy, social image, and mental enhancement preceded smoking progression; social belonging prevented smoking regression; and coping and engagement both preceded smoking progression and prevented smoking regression.
This study demonstrates that different cognitive attributions influence smoking at different stages in different ways. These findings could inform smoking prevention and cessation programs targeting Chinese adolescents.
PMCID: PMC3493682  PMID: 23017586
Attributions; Smoking; Attribution Theory; Adolescents; China
3.  Psychometric Properties of Reverse-Scored Items on the CES-D in a Sample of Ethnically Diverse Older Adults 
Psychological assessment  2011;23(2):558-562.
Reverse-scored items on assessment scales increase cognitive processing demands, and may therefore lead to measurement problems for older adult respondents.
To examine possible psychometric inadequacies of reverse-scored items on the Center for Epidemiologic Studies Depression Scale (CES-D) when used to assess ethnically diverse older adults.
Using baseline data from a gerontologic clinical trial (n=460), we tested the hypotheses that the reversed items on the CES-D: (a) are less reliable than non-reversed items, (b) disproportionately lead to intra-individually atypical responses that are psychometrically problematic, and (c) evidence improved measurement properties when an imputation procedure based on the scale mean is used to replace atypical responses.
In general, the results supported the hypotheses. Relative to non-reversed CES-D items, the four reversed items were less internally consistent, were associated with lower item-scale correlations, and were more often answered atypically at an intra-individual level. Further, the atypical responses were negatively correlated with responses to psychometrically sound non-reversed items that had similar content. The use of imputation to replace atypical responses enhanced the predictive validity of the set of reverse-scored items.
Among older adult respondents reverse-scored items are associated with measurement difficulties. It is recommended that appropriate correction procedures such as item re-administration or statistical imputation be applied to reduce the difficulties.
PMCID: PMC3115428  PMID: 21319906
CES-D; depression; reversed item format; older adults
4.  Cigarette Smoking is Associated with Unhealthy Patterns of Food Consumption, Physical Activity, Sleep Impairment, and Alcohol Drinking in Chinese Male Adults 
According to a recent national survey, tobacco use is a critical public health issue in China, with more than two thirds of Chinese males smoking. Findings in Western populations suggest that smoking may cluster with other health-risk behaviors. To explore these relationships in Chinese male adults, we utilized baseline data from the China Seven Cities Study (CSCS).
Male adults (N=12,122) were included. Smoking status was defined as never smokers, ex-smokers, current smokers, and current heavy smokers. Logistic regression was employed to investigate the association of cigarette smoking and patterns of food consumption, physical activity, and alcohol drinking.
After controlling for age, socioeconomic status, and city residence, heavy smokers consumed significantly less vegetables, fruits, milk and other dairy products, spent significantly more time watching television, slept and exercised less, and got drunk or engaged in binge drinking more frequently compared to never, ex, or current smokers (p<0.05).
Findings suggest significant associations of heavy cigarette smoking with other health-risk behaviors in Chinese male adults, underscoring the need for tobacco control interventions for Chinese males.
PMCID: PMC4651744  PMID: 26321106
Cigarette Smoking; Lifestyles; Chinese Male Adults; Tobacco
5.  Psychosocial Factors Associated With Adolescent Electronic Cigarette and Cigarette Use 
Pediatrics  2015;136(2):308-317.
Use of electronic cigarettes (e-cigarettes) among adolescents has increased since their introduction into the US market in 2007. Little is known about the role of e-cigarette psychosocial factors on risk of e-cigarette or cigarette use in adolescence.
Information on e-cigarette and cigarette psychosocial factors (use and attitudes about use in the home and among friends) was collected from 11th- and 12th-grade participants in the Southern California Children’s Health Study during the spring of 2014.
Of 2084 participants, 499 (24.0%) had used an e-cigarette, including 200 (9.6%) current users (past 30 days); 390 participants (18.7%) had smoked a combustible cigarette, and 119 (5.7%) were current cigarette smokers. Cigarette and e-cigarette use were correlated. Nevertheless, 40.5% (n = 81) of current e-cigarette users had never smoked a cigarette. Psychosocial factors (home use of each product, friends’ use of and positive attitudes toward e-cigarettes and cigarettes) and participant perception of the harm of e-cigarettes were strongly positively associated both with e-cigarette and cigarette use. Most youth who reported e-cigarette use had friends who used e-cigarettes, and almost half of current users reported that they did not believe there were health risks associated with e-cigarette use.
Longitudinal studies of adolescents are needed to determine whether the strong association of e-cigarette psychosocial factors with both e-cigarette and cigarette use will lead to increased cigarette use or dual use of cigarettes and e-cigarettes, or whether e-cigarettes will serve as a gateway to cigarette use.
PMCID: PMC4516947  PMID: 26216326
6.  Parent, Peer, and Executive Function Relationships to Early Adolescent E-Cigarette Use: A Substance Use Pathway? 
Addictive behaviors  2014;42:73-78.
Little is known about influences on e-cigarette use among early adolescents. This study examined influences that have been previously found to be associated with gateway drug use in adolescents: demographic (age, gender, ethnicity, free lunch), social contextual influences of parents and peers, and executive function deficits (EF).
A cross-sectional survey was administered to 410 7th grade students from two diverse school districts in Southern California (M age=12.4 years, 48.3% female, 34.9% on free lunch (low socioeconomic status), 45.1% White, 25.4% Hispanic/Latino, 14.9% Mixed/bi-racial.) Logistic regression analyses examined influences of demographic, parent e-cigarette ownership and peer use, and EF on lifetime e-cigarette, and gateway drug use (cigarette and/or alcohol use).
Lifetime use prevalence was 11.0% for e-cigarettes, 6.8% for cigarettes, and 38.1% for alcohol. Free lunch and age were marginally related to e-cigarette use (p<.10). Parent e-cigarette ownership was associated with use of all substances, while peer use was associated with gateway drug use (p’s<.05-.001). EF deficits were associated with use of all substances five times more likely than others to use e-cigarettes and over twice as likely to use gateway drugs.
E-cigarette and gateway drug use may have common underlying risk factors in early adolescence, including parent and peer modeling of substance use, as well as EF deficits. Future research is needed to examine longitudinal relationships of demographics, parent and peer modeling, and EF deficits to e-cigarette use in larger samples, trajectories of e-cigarette use compared to use of other substances, and the potential of EF skills training programs to prevent e-cigarette use.
PMCID: PMC4292878  PMID: 25462657
E-cigarette; adolescent; substance use; executive function; peer; parent
7.  A Longitudinal Analysis of the Effects of Socioeconomic Factors, Foreign Media, and Attitude toward Appearance on General and Central Adiposity in Chinese Adolescents 
Preventive medicine reports  2015;2:608-214.
This paper explores the longitudinal effects of socioeconomic factors (i.e., parent education and family income level), foreign media, and attitude toward appearance on general and central adiposity among Chinese adolescents.
A longitudinal analysis was performed using data from the China Seven Cities Study, a health promotion and smoking prevention study conducted in seven cities across Mainland China between 2002 and 2005. Participants included 5,020 middle and high school students and their parents. Explanatory variables included foreign media exposure, attitude toward appearance, parent education, and family income. Three-level, random-effect models were used to predict general adiposity (i.e., body mass index) and central adiposity (i.e., waist circumference). The Generalized Estimating Equation approach was utilized to determine the effect of explanatory variables on overweight status.
Among girls, foreign media exposure was significantly negatively associated with general adiposity over time (β=−0.06, p=0.01 for middle school girls; β=−0.06, p=0.03 for high school girls). Attitude toward appearance was associated with lesser odds of being overweight, particularly among high school girls (OR=0.86, p<0.01). Among boys, parental education was significantly positively associated with general adiposity (β=0.62, p<0.01 for middle school boys; β=0.37, p=0.02 for high school boys) and associated with greater odds of being overweight (OR=1.55, p<0.01 for middle school boys; OR=1.26, p=0.04 for high school boys). Across all gender and grade levels, family income was significantly negatively associated with central adiposity over time.
Interventions addressing Chinese adolescent overweight/obesity should consider these factors as potential focus areas.
PMCID: PMC4535427  PMID: 26279973
adolescent; obesity; longitudinal studies; social class; communications media; attitude
8.  Identifying Shared Latent Dimensions of Psychological Symptoms: Implications for the Psychological Correlates of Smoking 
Shared latent dimensions may account for the co-occurrence of multiple forms of psychological dysfunction. However, this conceptualization has rarely been integrated into the smoking literature, despite high levels of psychological symptoms in smokers. In this study, we used confirmatory factor analysis to compare three models (1-factor, 2-factor [internalizing-externalizing], and 3-factor [low positive affect-negative affect-disinhibition]) of relations among nine measures of affective and behavioral symptoms implicated in smoking spanning depression, anxiety, happiness, anhedonia, ADHD, aggression, and alcohol use disorder symptoms. We then examined associations of scores from each of the manifest scales and the latent factors from the best-fitting model to several smoking characteristics (i.e., experimentation, lifetime established smoking [≥100 cigarettes lifetime], age of smoking onset, cigarettes/day, nicotine dependence, and past nicotine withdrawal). We used two samples: (1) College Students (N =288; mean age =20; 75 % female) and (2) Adult Daily Smokers (N=338; mean age=44; 32 % female). In both samples, the 3-factor model separating latent dimensions of deficient positive affect, negative affect, and disinhibition fit best. In the college students, the disinhibition factor and its respective indicators significantly associated with lifetime smoking. In the daily smokers, low positive and high negative affect factors and their respective indicators positively associated with cigarettes/day and nicotine withdrawal symptom severity. These findings suggest that shared features of psychological symptoms may be parsimonious explanations of how multiple manifestations of psychological dysfunction play a role in smoking. Implications for research and treatment of co-occurring psychological symptoms and smoking are discussed.
PMCID: PMC4606875  PMID: 26478654
Negative affect; Positive affect; Disinhibition; Smoking
9.  A longitudinal analysis of the effects of socioeconomic factors, foreign media, and attitude toward appearance on general and central adiposity in Chinese adolescents 
Preventive Medicine Reports  2015;2:608-614.
This paper explores the longitudinal effects of socioeconomic factors (i.e., parent education and family income level), foreign media, and attitude toward appearance on general and central adiposity among Chinese adolescents.
A longitudinal analysis was performed using data from the China Seven Cities Study, a health promotion and smoking prevention study conducted in seven cities across Mainland China between 2002 and 2005. Participants included 5,020 middle and high school students and their parents. Explanatory variables included foreign media exposure, attitude toward appearance, parent education, and family income. Three-level, random-effect models were used to predict general adiposity (i.e., body mass index) and central adiposity (i.e., waist circumference). The Generalized Estimating Equation approach was utilized to determine the effect of explanatory variables on overweight status.
Among girls, foreign media exposure was significantly negatively associated with general adiposity over time (β = − 0.06, p = 0.01 for middle school girls; β = − 0.06, p = 0.03 for high school girls). Attitude toward appearance was associated with lesser odds of being overweight, particularly among high school girls (OR = 0.86, p < 0.01). Among boys, parental education was significantly positively associated with general adiposity (β = 0.62, p < 0.01 for middle school boys; β = 0.37, p = 0.02 for high school boys) and associated with greater odds of being overweight (OR = 1.55, p < 0.01 for middle school boys; OR = 1.26, p = 0.04 for high school boys). Across all gender and grade levels, family income was significantly negatively associated with central adiposity over time.
Interventions addressing Chinese adolescent overweight/obesity should consider these factors as potential focus areas.
•Foreign media exposure decreases BMI over time among girls.•Girls placing importance on appearance have lesser odds of being overweight.•Boys have greater odds of being overweight with high parent education.•High family income was negatively associated with central adiposity.
PMCID: PMC4535427  PMID: 26279973
Adolescent; Obesity; Longitudinal studies; Social class; Communications media; Attitude
10.  The Interaction of Social Networks and Child Obesity Prevention Program Effects: The Pathways Trial 
Obesity (Silver Spring, Md.)  2014;22(6):1520-1526.
Social network analysis was used to examine whether peer influence from one’s social networks moderates obesity prevention program effects on obesity related behaviors: healthful behaviors and unhealthful ones.
Design and Methods
Participants included 557 children residing in Southern California. Survey assessed health promoting behaviors (i.e., physical activity at school, physical activity outside of school, and fruit and vegetable intake), as well as unhealthful ones (high calorie low nutrient intake and sedentary activity), and peer exposure calculated from social network nominations as indicators of peer influence. Multilevel models were conducted separately on outcomes predicted by program participation, peer exposure, and program participation by peer exposure.
Results indicated that peer exposure was positively associated with one’s own behavior for both healthful and unhealthful behaviors. Program participation effects were moderated by peer influence, but only when unhealthful peer influence was present. Results suggest that peer influence can diminish or amplify prevention programs
Future interventions should consider peer-led components to promote healthful influence of peers on healthful and unhealthful behaviors, and programs should be mindful that their effects are moderated by social networks.
PMCID: PMC4037361  PMID: 24616241
Social Network; Peer Influence; Obesity Prevention; Childhood Obesity; Program Effects
11.  Shared versus specific features of psychological symptoms and cigarettes per day: structural relations and mediation by negative- and positive-reinforcement smoking 
Journal of behavioral medicine  2014;38(2):224-236.
This study examined the extent to which shared versus specific features across multiple manifestations of psychological symptoms (depression, anxiety, ADHD, aggression, alcohol misuse) associated with cigarettes per day. Subsequently, we investigated whether negative- (i.e., withdrawal relief) and positive- (i.e., pleasure enhancement) reinforcement smoking motivations mediated relations. Adult daily smokers (N = 338) completed self-report measures and structural equation modeling was used to construct a 3-factor (low positive affect-negative affect-disinhibition) model of affective and behavioral symptoms and to test relations of each latent factor (shared features) and indicator residual (specific features) to smoking level. Shared dimensions of low positive affect, negative affect, and disinhibition associated with smoking rate. Negative-reinforcement smoking mediated the link between latent negative affect and heavier daily smoking. Specific features of psychological symptoms unique from latent factors were generally not associated with cigarettes per day. Features shared across several forms of psychological symptoms appear to underpin relations between psychological symptoms and smoking rate.
PMCID: PMC4407566  PMID: 25231408
Positive affect; Negative affect; Disinhibition; Negative reinforcement; Positive reinforcement; Cigarettes per day
12.  Short-term effects of a rights-based sexuality education curriculum for high-school students: a cluster-randomized trial 
BMC Public Health  2015;15:293.
An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior.
A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students’ sexual behaviors.
Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms.
Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students’ sexual behaviors will be tested in subsequent analyses.
Trial registration NCT02009046 [].
PMCID: PMC4407845  PMID: 25886554
Adolescent; Sexuality education; Comprehensive sexuality education; Sexual behavior; Sexual rights; Gender norms; Intervention; Evaluation
13.  Integrating spatial technology into studying the generational differences of migrants’ health protection status in urban China 
The objectives of this study were to investigate differences on health protection status between two generations (born pre- vs. post- 1980) of rural-to-urban migrants in China, and whether the differences are associated with spatial contexts.
Respondent-Driven Sampling (RDS) approach was used to recruit migrants in Chengdu city from September 2008 to July 2009. All migrants’ residences were geo-coded on the map. Hepatitis B Vaccination serves as a surrogate for the Health protection status. Logistic regression was used to explore the association between independent variables and the Hepatitis B vaccination status. Spatial scan statistics were used to explore the spatial pattern of the Hepatitis B vaccination status.
Among the 1045 rural-to-urban migrants, higher education, better employment condition and post-80 generation are positively associated with the Hepatitis B vaccination status, while marriage status, the insurance status and the income are not. The spatial scan statistics identified three spatial clusters of low vaccination rate. Two of them were in urban villages and the other was a declining workers’ community.
The migrant population is heterogeneous, and the post-80 generation migrants get more health protection. Spatial analytical techniques illustrated clusters of low vaccination rate are highly linked with pre-1980 generation migrants and other socioeconomic factors, especially the employment condition. Such information might shed light on the differences and needs across migrant subgroups and may be useful for developing more targeted health policies for Chinese migrants.
PMCID: PMC4357190  PMID: 25889727
14.  Temporal Relationship Between Insulin Sensitivity and the Pubertal Decline in Physical Activity in Peripubertal Hispanic and African American Females 
Diabetes Care  2013;36(11):3739-3745.
Little attention has been paid to possible intrinsic biological mechanisms for the decline in physical activity that occurs during puberty. This longitudinal observational study examined the association between baseline insulin sensitivity (SI) and declines in physical activity and increases in sedentary behavior in peripubertal minority females over a year.
Participants were Hispanic and African American girls (n = 55; 76% Hispanic; mean age 9.4 years; 36% obese). SI and other insulin indices were measured at baseline using the frequently sampled intravenous glucose tolerance test. Physical activity was measured on a quarterly basis by accelerometry and self-report.
Physical activity declined by 25% and time spent in sedentary behaviors increased by ∼13% over 1 year. Lower baseline SI predicted the decline in physical activity measured by accelerometry, whereas higher baseline acute insulin response to glucose predicted the decline in physical activity measured by self-report. Time spent in sedentary behavior increased by ~13% over 1 year, and this was predicted by lower baseline SI. All models controlled for adiposity, age, pubertal stage, and ethnicity.
When evaluated using a longitudinal design with strong outcome measures, this study suggests that lower baseline SI predicts a greater decline in physical activity in peripubertal minority females.
PMCID: PMC3816891  PMID: 23846812
15.  Acculturation and Substance Use: Social Influence as a Mediator among Hispanic Alternative High School Youth* 
Research suggests that acculturation increases the risk of substance use among Hispanic youth. However, this process is not well understood. This study examined associations between acculturation and several substance use indicators among a sample of 714 Hispanic youth attending alternative high schools in southern California. Peer social influence was assessed as a potential mediator Acculturation, measured by language use, was associated with increased risk of lifetime alcohol, marijuana, and current alcohol, cigarettes, marijuana, and hard drug use, controlling for age, socioeconomic status, and gender Results of mediation analyses indicate that peer social influence mediated the relationship between acculturation and lifetime alcohol, and current alcohol, cigarettes, and hard drug use. Evidence for partial mediation was observed with lifetime and current marijuana use. These results provide evidence that peer social influence is an important mediating variable that should be considered when examining the relationship between acculturation and substance use.
PMCID: PMC4181567  PMID: 19537458
16.  Bullying Victimization as a Mediator of Associations between Cultural/familial Variables, Substance use and Depressive symptoms among Hispanic Youth 
Ethnicity & health  2013;18(4):415-432.
This article examines the antecedents and consequences of bullying victimization among a sample of Hispanic high school students. Although cultural and familial variables have been examined as potential risk or protective factors for substance use and depression, previous studies have not examined the role of peer victimization in these processes. We evaluated a conceptual model in which cultural and familial factors influenced the risk of victimization, which in turn influenced the risk of substance use and depression.
Data were collected as part of a longitudinal survey study of 9th and 10th grade Hispanic/Latino students in Southern California (n=1167). The student bodies were at least 70% Hispanic/Latino with a range of socioeconomic characteristics represented. We used linear and logistic regression models to test hypothesized relationships between cultural and familial factors and depression and substance and a meditational model to assess whether bullying victimization mediated these associations.
Acculturative stress and family cohesion were significantly associated with bullying victimization. Family cohesion was associated with depression and substance use. Social support was associated with alcohol use. Acculturative stress was associated with higher depression. The associations between acculturative stress and depression, family cohesion and depression, and family cohesion and cigarette use were mediated by bullying victimization.
These findings provide valuable information to the growing, but still limited, literature about the cultural barriers and strengths that are intrinsic to the transition from adolescence to emerging adulthood among Hispanic youth. Our findings are consistent with a mediational model in which cultural/familial factors influence the risk of peer victimization, which in turn influences depressive symptoms and smoking, suggesting the potential positive benefits of school based programs that facilitate the development of coping skills for students experiencing cultural and familial stressors.
PMCID: PMC3723765  PMID: 23297708
Hispanic; acculturation; family cohesion; bullying victimization; depression; substance use
17.  Changes in Friends’ and Parental Influences on Cigarette Smoking from Early through Late Adolescence 
This study examined the changes in friends’ and parental influences on cigarette smoking across two developmentally distinct social environments for adolescents: junior high school and high school.
Longitudinal data consisting of seven repeated measures following 1,001 adolescents from 7th to 12th grade was obtained from the Midwestern Prevention Project. A two-piece Growth Curve Model (GCM) was used to assess the growth trajectory of current cigarette use: one piece for the junior high school period, and the other for the high school period. Perceived friends’ and parental cigarette use were each used as a time-varying covariate in separate GCMs.
Effects of friends’ and parental cigarette use remained significant on adolescent cigarette smoking across the two developmental periods. The magnitude of friends’ effect was in general higher during junior high school than high school. The magnitude of the parental effect remained relatively stable between the two periods. However, decreasing trends in both effects were observed from 10th to 12th grade. Gender differences also emerged. Friends’ and parental effects were greater for girls in their early high school years, whereas friends’ effect decreased in magnitude among girls and increased among boys during high school.
The transition from junior high school to high school represents an opportunity for interventions to counteract peer influence since such influence appeared to be much weaker during this period. However, interventions should continue to target parents as their behavior remains influential through the end of high school.
PMCID: PMC3691293  PMID: 23583505
Adolescence; Smoking; Developmental stages; Peer influences; Parental influences; Longitudinal studies; Growth curve models
18.  Psychometrics of the Eating in Emotional Situations Questionnaire (EESQ) among low-income Latino elementary-school children 
Eating behaviors  2011;12(2):156-159.
The current study examines the psychometric properties of the Eating in Emotional Situations Questionnaire (EESQ) and the frequency of eating in emotional situations among 159 low-income Latino fourth graders. The EESQ assesses eating in emotional situations that are emotion-driven (“I eat when I am lonely”) and context-driven (“I eat when I get a really bad grade”). Internal consistencies for the EESQ subscales and total scale ranged from .70 to .86. Criterion validity of the EESQ was established by statistically significant correlations between the EESQ subscales and total scale, and uncontrollable eating, external eating, and junk food intake. Eating in emotional situations was common in the sample; almost one-half reported eating in at least 3 of the 11 types of emotional situations (e.g. when stressed, sad, bored) and 28% reported eating in at least 6 types. Overall, these findings provide support for the internal consistency and validity of the EESQ in low-income Latino children, and suggest that eating in emotional situations is moderately present in this demographic. Future studies are needed to validate the EESQ in other ethnic groups and examine the longitudinal tracking of eating in emotional situations among Latino youth.
PMCID: PMC3947794  PMID: 21385647
Eating in Emotional Situations Questionnaire (EESQ); emotional eating; children; Latino; Hispanic
19.  Leptin predicts a decline in moderate to vigorous physical activity in minority female children at risk for obesity 
Pediatric obesity  2012;8(1):70-77.
Leptin may influence moderate to vigorous physical activity (MVPA) at the start of puberty. The direction and magnitude of this association is unclear.
To determine the effect of baseline leptin on MVPA over one year in minority girls at high-risk for obesity.
Data came from TRANSITIONS, a longitudinal observational study on the age-related MVPA decline. Fifty peri-pubertal girls aged 8–11 years at baseline participated. Baseline leptin (ng/mL) was collected via a duplicated assay using a double antibody Radio Immune Assay. MVPA (min/day) was measured using accelerometers for at least four 10-hr days on a quarterly basis for up to one year.
Continuous leptin was negatively related to MVPA (p=0.001) independent of central adiposity at baseline and predicted the MVPA decline over one year (p=0.002). For descriptive purposes, baseline leptin was dichotomized at the sample median into ‘high leptin’ and ‘low leptin’ categories to determine whether MVPA trajectories differed between these groups. Girls with ‘low leptin’ at baseline had significantly higher levels of MPVA at baseline, visit 1, and visit 2 compared to girls with ‘high leptin’.
High leptin levels predicted nearly a 12.6% decline in MVPA over one year. These findings provide support for the biological basis of declining MVPA as girls enter puberty.
PMCID: PMC3527645  PMID: 22991241
leptin; accelerometer; biological basis; physical activity; adolescent
20.  Joint Physical Activity and Sedentary Behavior in Parent-Child Pairs 
Research examined joint physical activity and sedentary behavior among 291 parent-child pairs who both wore an accelerometer and global positioning systems (GPS) device over the same 7-day period.
Children were 52.2% female, 8-14 years, and 43.0% Hispanic. Parents were 87.6% female. An Actigraph GT2M accelerometer and GlobalSat BT-335 GPS device collected activity and global positioning data, respectively. Linear distance between the parent and child for each 30-sec. epoch was calculated using geographic coordinates from the GPS. Joint behavior was defined as a separation distance less than 50m between parents and children.
On average during non-school waking hours, parents and children spent 2.4 min. (SD = 4.1) per day performing moderate-to-vigorous physical activity (MVPA) together and 92.9 min. (SD = 40.1) per day in sedentary behavior together. Children engaged in an average of 10 min. per day of MVPA during non-school waking hours when their parent was nearby but not engaging in MVPA. During this same period, parents engaged in 4.6 min. per day of MVPA when their child was nearby but not engaging in MVPA. Household income level and the child’s age were negatively associated with joint MVPA. Girls engaged in a greater percentage of their total MVPA together with their parent than boys. Girls and older children engaged in more sedentary behavior together with their parent than boys and younger children. Older parents engaged in a greater percentage of their sedentary behavior together with their children than younger parents.
Replacing the time that parents and children spend together in sedentary pursuits with joint physical activity could have health benefits, especially for girls, older children, older parents, and higher income families.
PMCID: PMC3399090  PMID: 22367744
moderate-to-vigorous physical activity; accelerometer; global positioning systems; age; sex
21.  Depressive Symptom Deterioration among Predominantly Hispanic Diabetes Patients in Safety Net Care 
Psychosomatics  2012;53(4):347-355.
This study examines clinical predictors of symptom deterioration (relapse/recurrence) at the completion of a clinical intervention trial of depressed, low-income, predominantly Hispanic diabetes patients who were randomized to socio-culturally adapted collaborative depression treatment or usual care and no longer met clinically significant depression criteria at 12 months post-trial baseline.
A sub-cohort of 193 diabetes patients with major depression symptoms at baseline, that were randomized to a 12-month collaborative care intervention (INT) (Problem Solving Therapy and/or pharmacotherapy, telephone symptom monitoring/relapse prevention, behavioral activation and patient navigation support) or enhanced usual care (EUC), and who did not meet major depression criteria at 12 months were subsequently observed over 18 to 24 months.
Post-trial depression symptom deterioration was similar between INT (35.2%) and EUC (35.3%) groups. Among the combined groups, significant predictors of symptom deterioration were baseline history of previous depression and/or dysthymia (odds ratio [OR] =2.66), 12-month PHQ-9 score (OR=1.22), antidepressant treatment receipt during the initial 12-months (OR=2.38), 12-month diabetes symptoms (OR=2.27) and new ICD-9 medical diagnoses in the initial 12 months (OR=1.11) (R2=27%; Max-rescaled R2=37%; Likelihood ratio test, chi-sq=59.79, df=5, p<.0001).
Among predominantly Hispanic diabetes patients in community safety net primary care clinics whose depression had improved over 1 year, more than one third experienced symptom deterioration over the following year. A primary care management depression care protocol that includes ongoing depression symptom monitoring, antidepressant adherence, and diabetes and co-morbid illness monitoring plus depression medication adjustment and behavioral activation may reduce and/or effectively treat depression symptom deterioration.
PMCID: PMC3389136  PMID: 22458987
Depression Recurrence and Relapse; Depression Care Disparities; Depression Symptom Monitoring; Depression and Diabetes; Depression in Hispanics
22.  One Year Post Collaborative Depression Care Trial Outcomes among Predominantly Hispanic Diabetes Safety Net Patients 
General hospital psychiatry  2011;33(5):436-442.
To determine sustained effectiveness in reducing depression symptoms and improving depression care one year following intervention completion.
Of 387 low-income, predominantly Hispanic diabetes patients with major depression symptoms randomized to 12-month socio-culturally adapted collaborative care (psychotherapy and/or antidepressants, telephone symptom monitoring/relapse prevention) or enhanced usual care, 264 patients completed two-year follow-up. Depression symptoms (SCL-20, PHQ-9), treatment receipt, diabetes symptoms, and quality of life were assessed 24 months post-enrollment using intent-to-treat analyses.
At 24 months, more intervention patients received ongoing antidepressant treatment (38% v 25%, chi-square=5.11, df=1, P=0.02); sustained depression symptom improvement (SCL-20<0.5 (adjusted OR=2.06, 95%CI=1.09–3.90, P=0.03), SCL-20 score (adjusted mean difference −0.22, P=0.001), and PHQ-9 ≥50% reduction (adjusted OR=1.87, 95%CI=1.05–3.32, P=0.03). Over 2 years, improved effects were found in significant study group by time interaction for SF-12 mental health, SDS functional impairment, diabetes symptoms, anxiety, and socioeconomic stressors (P=0.02 for SDS, P<0.0001 for all others); however, group differences narrowed over time and were no longer significant at 24 months.
Socio-culturally tailored collaborative care that included maintenance antidepressant medication, ongoing symptom monitoring and behavioral activation relapse prevention was associated with depression improvement over 24 months for predominantly Hispanic patients in primary safety net care.
PMCID: PMC3175272  PMID: 21774987
Depression; Diabetes; Collaborative Care; Safety Net; Hispanic
23.  The influence of the perceived consequences of refusing to share injection equipment among injection drug users: Balancing competing risks 
Addictive behaviors  2011;36(8):835-842.
Injection drug users (IDUs) are at risk for HIV and other bloodborne pathogens through receptive syringe sharing (RSS) and receptive paraphernalia sharing (RPS). Research into the influence of the perceived risk of HIV infection on injection risk behavior has yielded mixed findings. One explanation may be that consequences other than HIV infection are considered when IDUs are faced with decisions about whether or not to share equipment. We investigated the perceived consequences of refusing to share injection equipment among 187 IDUs recruited from a large syringe exchange program in Los Angeles, California, assessed their influence on RSS and RPS, and evaluated gender differences. Two sub-scales of perceived consequences were identified: structural/external consequences and social/internal consequences. In multiple linear regression, the perceived social/internal consequences of refusing to share were associated with both RSS and RPS, after controlling for other psychosocial constructs and demographic variables. Few statistically significant gender differences emerged. Assessing the consequences of refusing to share injection equipment may help explain persistent injection risk behavior, and may provide promising targets for comprehensive intervention efforts designed to address both individual and structural risk factors.
PMCID: PMC3098341  PMID: 21498004
Injection drug use; HIV; gender; perceived consequences; syringe sharing
24.  Association of the Calcyon Neuron-Specific Vesicular Protein Gene (CALY) With Adolescent Smoking Initiation in China and California 
American Journal of Epidemiology  2011;173(9):1039-1048.
Although previous investigations have indicated a role for genetic factors in smoking initiation, the underlying genetic mechanisms are still unknown. In 2,339 adolescents from a Chinese Han population in the Wuhan Smoking Prevention Trial (Wuhan, China, 1998–1999), the authors explored the association of 57 genes in the dopamine pathway with smoking initiation. Using a conservative approach for declaring significance, positive findings were further examined in an independent sample of 603 Caucasian adolescents followed for up to 10 years as part of the Children's Health Study (Southern California, 1993–2009). The authors identified 1 single nucleotide polymorphism (rs2298122) in the calcyon neuron-specific vesicular protein gene (CALY) that was positively associated with smoking initiation in females (odds ratio = 2.21, 95% confidence interval: 1.49, 3.27; P = 8.4 × 10−5) in the Wuhan Smoking Prevention Trial cohort, and they replicated the association in females from the Children's Health Study cohort (hazard rate ratio = 2.05, 95% confidence interval: 1.27, 3.31; P = 0.003). These results suggest that the CALY gene may influence smoking initiation in adolescents, although the potential roles of underlying psychological characteristics that may be components of the smoking-initiation phenotype, such as impulsivity or novelty-seeking, remain to be explored.
PMCID: PMC3121219  PMID: 21415033
adolescent; dopamine; genetic association studies; smoking
25.  Randomized Controlled Trial to Improve Adiposity, Inflammation, and Insulin Resistance in Obese African-American and Latino Youth 
Obesity (Silver Spring, Md.)  2011;20(4):811-818.
The purpose of this study was to examine ethnic differences in the metabolic responses to a 16-week intervention designed to improve insulin sensitivity (SI), adiposity, and inflammation in obese African-American and Latino adolescents. A total of 100 participants (African Americans: n = 48, Latino: n = 52; age: 15.4 ± 1.1 years, BMI percentile: 97.3 ± 3.3) were randomly assigned to interventions: control (C; n = 30), nutrition (N; n = 39, 1×/week focused on decreasing sugar and increasing fiber intake), or nutrition + strength training (N+ST; n = 31, 2×/week). The following were measured at pre- and postintervention: strength, dietary intake, body composition (dual-energy X-ray absorptiometry/magnetic resonance imaging) and glucose/insulin indexes (oral glucose tolerance test (OGTT)/intravenous glucose tolerance test (IVGTT)) and inflammatory markers. Overall, N compared to C and N+ST reported significant improvements in SI (+16.5% vs. −32.3% vs. −6.9% respectively, P < 0.01) and disposition index (DI: +15.5% vs. −14.2% vs. −13.7% respectively, P < 0.01). N+ST compared to C and N reported significant reductions in hepatic fat fraction (HFF: −27.3% vs. −4.3% vs. 0% respectively, P < 0.01). Compared to N, N+ST reported reductions in plasminogen activator inhibitor-1 (PAI-1) (−38.3% vs. +1.0%, P < 0.01) and resistin (−18.7% vs. +11.3%, P = 0.02). There were no intervention effects for all other measures of adiposity or inflammation. Significant intervention by ethnicity interactions were found for African Americans in the N group who reported increases in total fat mass, 2-h glucose and glucose incremental areas under the curve (IAUC) compared to Latinos (P’s < 0.05). These interventions yielded differential effects with N reporting favorable improvements in SI and DI and N+ST reporting marked reductions in HFF and inflammation. Both ethnic groups had significant improvements in metabolic health; however some improvements were not seen in African Americans.
PMCID: PMC3106142  PMID: 21293446

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