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1.  Impact of Social Status and Antidepressant Treatment on Neurogenesis in the Baboon Hippocampus 
Neuropsychopharmacology  2014;39(8):1861-1871.
Adult hippocampal neurogenesis is critically implicated in rodent models of stress and anxiety as well as behavioral effects of antidepressants. Whereas similar factors such as psychiatric disorder and antidepressant administration are correlated with hippocampal volume in humans, the relationship between these factors and adult neurogenesis is less well understood. To better bridge the gap between rodent and human physiology, we examined the numbers of proliferating neural precursors and immature cells in the hippocampal dentate gyrus (DG) as well as in vivo magnetic resonance imaging (MRI)-estimated whole hippocampal volume in eight socially dominant- or subordinate-like (SL) baboons administered the antidepressant fluoxetine or vehicle. SL baboons had lower numbers of proliferating cells and immature neurons than socially dominant-like baboons. Fluoxetine treatment was associated with a larger whole hippocampal volume but surprisingly resulted in lower numbers of immature neurons. These findings are the first to indicate that adult neurogenesis in the baboon hippocampal DG may be functionally relevant in the context of social stress and mechanisms of antidepressant action.
PMCID: PMC4059894  PMID: 24518288
adult neurogenesis; dentate gyrus; antidepressants; social stress
2.  Childhood maltreatment, stressful life events, and alcohol craving in adult drinkers 
Little is known about the relationship of stressful life events and alcohol craving in the general population, and whether a history of childhood maltreatment sensitizes individuals to crave alcohol after adult stressors.
Participants were 22,147 past-year drinkers from Wave 2 (2004-2006) of the National Epidemiologic Survey on Alcohol and Related Conditions. A structured, face-to-face interview assessed past-year stressful life events, alcohol craving, and history of childhood maltreatment. Logistic regression was used to generate adjusted odds ratios (aOR) to evaluate the relationship between stressful life events and craving, adjusting for demographic characteristics and parental history of alcoholism. Interaction between stressful life events and childhood maltreatment was also assessed.
Compared to participants with no stressful life events, those with ≥3 events had increased odds of moderate alcohol craving (aOR=3.15 [95% CI=2.30-4.33]) and severe craving (aOR=8.47 [95% CI=4.78-15.01]). Stressful life events and childhood maltreatment interacted in predicting severe craving (p=0.017); those with ≥3 events were at higher risk for craving if they had been exposed to childhood maltreatment.
A direct relationship between stressful life events and risk for alcohol craving was observed. Further, history of childhood maltreatment increased the salience of stressful life events in adulthood. Future studies should examine the role of psychiatric comorbidity in more complex models of stress sensitization and alcohol craving.
PMCID: PMC4107183  PMID: 24961735
alcohol craving; stressful life events; childhood maltreatment; stress sensitivity
3.  Changes in the prevalence of mood and anxiety disorders among male and female current smokers in the United States: 1990 to 2001 
Annals of epidemiology  2014;24(7):493-497.
The present study investigated whether the prevalence of mood and anxiety disorders has increased over time among current smokers, as well as whether these trends differ by gender and in comparison to non-smokers.
Data were drawn from the National Comorbidity Survey (NCS; 1990) and the National Comorbidity Survey-Replication (NCS-R; 2001), representative samples of the US adult population. Binomial regression analyses were used to determine differences between mood and anxiety disorders among current smokers in 1990 and 2001 and whether these differed by gender and in comparison to those who were former or never current smokers.
Any anxiety disorder, panic attacks, panic disorder, social anxiety disorder and dysthymia were all significantly more common among current smokers in 2001 compared with 1990 and these increases were significantly greater than any trend found in non-smokers. Increases in each of these disorders were more pronounced in female than in male smokers. Major depressive disorder and generalized anxiety disorder were not found to increase over time among smokers.
The prevalence of several anxiety disorders and dysthymia among current smokers appears to have increased from 1990 to 2001. Future studies are needed to determine whether these trends have continued. If so, interventions aimed at moving the prevalence lower may have limited success if mental health problems such as anxiety disorders and certain mood disorders are not considered in the development and dissemination of tobacco control programs.
PMCID: PMC4393820  PMID: 24935462
tobacco; depression; anxiety; prevalence
4.  Multicontextual Correlates of Adolescent Leisure-Time Physical Activity 
Adolescent moderate to vigorous physical activity (MVPA) is influenced by many factors. MVPA-promotion interventions would fare better if these multiple determinants were better understood.
To simultaneously assess overall and relative contributions of factors from personal, family, friend, school, and neighborhood contexts to adolescent MVPA. It was hypothesized that: (1) key correlates would emerge in each context; (2) factors from more- versus less-proximal contexts would relate more strongly to MVPA.
Students in grades 6–12 (n=2793; mean age=14.4 [SD=2.0] years; 53% girls) were recruited from 20 Minnesota public schools in 2009–2010 to participate in the Eating and Activity in Teens 2010 study. Regression analyses conducted in 2013 examined factors related to weekly MVPA. Data were collected from adolescent participants, their parents and friends, school teachers and administrators, and GIS sources.
Fifty multicontextual factors explained 25% of MVPA variance for boys and 27% for girls. Personal factors (e.g., self-efficacy) were most predictive of MVPA, followed by social factors (e.g., support for PA); environmental factors (e.g., access to PA resources) were least predictive of adolescent PA. Gender differences emerged for several predictors (e.g., in mutually adjusted analyses, MVPA among girls, but not boys, related positively to distance to trails and MVPA among female friends and fathers, and related negatively to perceived barriers).
Stronger linkages exist between adolescent MVPA and more-proximal (personal, family, and friend) factors compared to more-distal (school and neighborhood) factors, suggesting the importance of working with adolescents, their families, and friends to promote PA.
PMCID: PMC4030467  PMID: 24842737
5.  Multiple Types of Harassment: Associations with Emotional Well-being and Unhealthy Behaviors in Adolescents 
To explore relationships between harassment (i.e., race-, weight-, SES-based, sexual) and health-related outcomes, including self-esteem, depressive symptoms, body satisfaction, substance use, and self-harm behavior, among diverse adolescents.
Cross-sectional analysis using data from a population-based study with socioeconomically and racially/ethnically diverse sample (81% racial/ethnic minority; 54% low or low-middle income) of adolescents participating in Eating and Activity in Teens 2010 (EAT 2010) (n = 2,793; mean age = 14.4 years).
Harassment experiences were significantly associated with negative health behaviors and well-being. After mutually adjusting for other types of harassment, weight-based harassment was consistently associated with lower self-esteem and lower body satisfaction in both genders (standardized βs ranged in magnitude from 0.39 to 0.48); sexual harassment was significantly associated with self-harm and substance use in both genders (ORs: 1.64 to 2.92); and both weight-based and sexual harassment were significantly associated with depressive symptoms among girls (standardized βs = 0.34 and 0.37). Increases in the number of harassment types reported by adolescents were associated with elevated risk for all outcomes regarding substance use/self-harm (ORs: 1.22 to 1.42) and emotional well-being (standardized βs: 0.13 to 0.26).
Harassment—particularly weight-based and sexual harassment— is associated with a variety of negative health and well-being outcomes among adolescents, and risk for these outcomes increases with the number of harassment types an adolescent experiences. Early detection and intervention to decrease harassment experiences may be particularly important in mitigating psychological and behavioral harm among adolescents.
PMCID: PMC4107652  PMID: 24411820
adolescents; harassment; bullying; teasing; weight; socioeconomic status; race/ethnicity; gender; self-esteem; depression; self-harm; substance use; body satisfaction
6.  The course of binge eating from adolescence to young adulthood 
The course of binge eating in adolescence is variable and little is known about factors maintaining binge eating behaviors. The current study sought to characterize the course of binge eating and identify psychosocial factors associated with its maintenance.
A population-based sample reported on binge eating, depression symptoms, self-esteem, and body satisfaction at 5-year intervals spanning early/middle adolescence [Time 1 (T1)], late adolescence/early young adulthood [Time 2 (T2)] and early/middle young adulthood [Time 3 (T3)]. Logistic regression examined factors predicting maintenance or cessation of binge eating.
A total of 15.8% of participants with binge eating at T1 continued to report binge eating at T2, and 42.0% of participants with binge eating at T2 continued to report binge eating at T3. From T1 to T2, improvements in self-esteem predicted cessation of binge eating. From T2 to T3, cessation of binge eating was predicted by improved body satisfaction, greater decreases in depression symptoms, and greater improvements in self-esteem.
Binge eating is relatively stable from late adolescence/early young adulthood to early/middle young adulthood, but less so from middle/late adolescence to late adolescence/early young adulthood. Improvements in psychosocial functioning during this timeframe may improve the outcome of binge eating, although mechanisms responsible for psychosocial changes (e.g., treatment involvement) require further investigation. Self-esteem appears to be a particularly salient factor involved in binge eating cessation and should be targeted in prevention and treatment programs.
PMCID: PMC3843976  PMID: 23977873
Binge eating; longitudinal; psychosocial functioning; maintenance; adolescent
7.  The risk for persistent adult alcohol and nicotine dependence: the role of childhood maltreatment 
Addiction (Abingdon, England)  2014;109(5):842-850.
Background and aims
Alcohol and nicotine dependence are associated with considerable morbidity and mortality, especially when cases are persistent. The risk for alcohol and nicotine dependence is increased by childhood maltreatment. However, the influence of childhood maltreatment on dependence course is unknown, and is evaluated in the current study.
Physical, sexual, and emotional abuse, and physical and emotional neglect, were evaluated as predictors of persistent alcohol and nicotine dependence over three years of follow-up, with and without control for other childhood adversities.
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
NESARC participants completing baseline and follow-up who met criteria at baseline for past-year alcohol dependence (n=1,172) and nicotine dependence (n=4,017).
Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) measures of alcohol/nicotine dependence, childhood maltreatment, and other adverse childhood experiences (e.g., parental divorce).
Controlling for demographics only, physical, sexual, and emotional abuse, and physical neglect, predicted three-year persistence of alcohol dependence (adjusted odds ratios [AORs]: 1.50–2.99, 95% CIs 1.04–4.68) and nicotine dependence (AORs: 1.37–1.74, 95% CIs 1.13–2.11). With other childhood adversities also controlled, maltreatment types remained predictive for alcohol persistence (AORs: 1.53–3.02, 95% CIs 1.07–4.71) and nicotine persistence (AORs: 1.35–1.72, 95% CIs 1.11–2.09). Further, a greater number of maltreatment types incrementally influenced persistence risk (AORs: 1.19–1.36, 95% CIs 1.11–1.56).
A history of childhood maltreatment predicts persistent adult alcohol and nicotine dependence. This association, robust to control for other childhood adversities, suggests that maltreatment (rather than a generally difficult childhood) affects the course of dependence.
PMCID: PMC3984602  PMID: 24401044
8.  The Unique and Additive Associations of Family Functioning and Parenting Practices with Disordered Eating Behaviors in Diverse Adolescents 
Journal of behavioral medicine  2012;37(2):205-217.
To examine the unique and additive associations of family functioning and parenting practices with adolescent disordered eating behaviors (i.e., dieting, unhealthy weight control behaviors, binge eating).
Data from EAT (Eating and Activity in Teens) 2010, a population-based study assessing eating and activity among racially/ethnically and socio-economically diverse adolescents (n = 2,793; mean age = 14.4, SD = 2.0; age range = 11–19) was used. Logistic regression models were used to examine associations between adolescent dieting and disordered eating behaviors and family functioning and parenting variables, including interactions. All analyses controlled for demographics and body mass index.
Higher family functioning, parent connection, and parental knowledge about child’s whereabouts (e.g. who child is with, what they are doing, where they are at) were significantly associated with lower odds of engaging in dieting and disordered eating behaviors in adolescents, while parent psychological control was associated with greater odds of engaging in dieting and disordered eating behaviors. Although the majority of interactions were non-significant, parental psychological control moderated the protective relationship between family functioning and disordered eating behaviors in adolescent girls.
Clinicians and health care providers may want to discuss the importance of balancing specific parenting behaviors, such as increasing parent knowledge about child whereabouts while decreasing psychological control in order to enhance the protective relationship between family functioning and disordered eating behaviors in adolescents.
PMCID: PMC3605198  PMID: 23196919
Adolescents; Family Functioning; Parenting; Weight Control Behaviors; Binge Eating; Dieting
9.  Relationship between psychiatric disorders and sexually transmitted diseases in a nationally representative sample 
Journal of psychosomatic research  2014;76(4):322-328.
Sexually transmitted diseases (STDs) are a significant public health concern. Numerous internalizing and externalizing psychiatric disorders have been found to be related to STD risk. However, to date, no studies have examined several psychiatric disorders simultaneously to account for STD risk. Given that psychiatric disorders often co-occur and can be explained by a limited number of latent dimensions of psychopathology, it is important to examine whether the relationship between STDs and psychiatric disorders is best explained by broad dimensions of psychopathology.
The current study examined the associations between a range of Axis I and II psychiatric disorders at baseline and rates of STDs at a three-year follow up in a large, nationally representative sample of adults in the United States (n = 34,434). A confirmatory factor analysis (CFA) was conducted to fit three factors, two internalizing and one externalizing. Structural equation modeling (SEM) was used to assess the relationships between and among the factors and STD status and to test for mediation.
In bivariate analyses, most Axis I and II disorders were associated with STD diagnosis at Wave 2, whereas the results of the structural model showed that only the externalizing factor was significantly associated with STD diagnosis at Wave 2. Further, the externalizing factor mediated the relationship between one of the internalizing factors and STD diagnosis.
Findings suggest the unique contribution of externalizing psychopathology to STD risk and the importance of examining latent dimensions of disorders when understanding this relationship between psychiatric disorders and STDs.
PMCID: PMC4000753  PMID: 24630184
externalizing; internalizing; sexually transmitted disease; latent factors; structural model
10.  Examining associations between adolescent binge eating and binge eating in parents and friends 
Binge eating is prevalent among adolescents, but little is known about how parents and friends may influence such behaviors. This study examined associations between adolescent binge eating behaviors, and similar behaviors in their parents and friends.
Participants were 2,770 target adolescent boys and girls who had at least one friend and/or parent who also participated. Logistic regression, stratified by gender, examined associations between parents’ and friends’ self-reported binge eating, and similar behaviors in target adolescents.
Girls’ binge eating was associated with their male friends’ (odds ratio=2.33; p=.03) and fathers’ binge eating (odds ratio=3.38; p=.02), but not with their female friends’ or mothers’ binge eating (p>.05). For boys, binge eating was not associated with parents’ or friends’ behavior.
Adolescent girls’ binge eating is associated with similar behaviors in their other-sex parents and friends. Results should be replicated, and mechanisms explaining this relation should be further explored.
PMCID: PMC4050969  PMID: 24105696
Binge eating; loss of control; social network; interpersonal; parents
11.  Complex Drug Use Patterns and Associated HIV Transmission Risk Behaviors in an Internet Sample of U.S. Men Who Have Sex with Men 
Archives of sexual behavior  2014;44(2):421-428.
Although the relationship between drug use and HIV risk among men who have sex with men (MSM) is well described, relatively few studies have employed empirical methods to assess underlying classes of drug use that may better predict the risk of HIV or sexually transmitted infections (STIs) among MSM. The aim of this study was to determinewhether latent class analysis (LCA) would identify underlying drug classes reported prior to sex, as well as predict unprotected anal intercourse (UAI) in the last sexual encounter among MSM. From 2004 to 2005, an anonymous online survey was conducted among 8,717 sexually active MSM recruited from gay-affiliated U.S. websites. LCA clustered participants into six distinct drug use classes based on the specific types and number of drugs used: (1) low/no drug use, (2) recreational drug use, (3) poppers with prescription erectile dysfunction (ED) drug use, (4) poppers with both prescription and non-prescription ED drug use, (5) recreational, club, and ED drug use, and (6) high polydrug use. Compared with men in Class 1, men in the highest drug use class were 4.84 times more likely to report UAI in their last sexual encounter and 3.78 times more likely to report an STI in the past year (both ps<.001). Younger MSM aged 18–29 were significantly more likely to report an STI than men aged 50 and above (p<.001). There is a need to better understand the complex relationship between a diverse set of drugs used among MSM and how polydrug use impacts sexual negotiation over time.
PMCID: PMC4381804  PMID: 25104104
Men who have sex with men; Gay men; Internet; Drug use; HIV; Group sex
12.  Youth Dietary Intake and Weight Status: Healthful Neighborhood Food Environments Enhance the Protective Role of Supportive Family Home Environments 
Health & place  2013;26:69-77.
The aim of this study is to investigate individual and joint associations of the home environment and the neighborhood built environment with adolescent dietary patterns and body mass index (BMI) z-score. Racially/ethnically and socioeconomically diverse adolescents (n = 2682; 53.2% girls; mean age14. 4 years) participating in the EAT 2010 (Eating and Activity in Teens) study completed height and weight measurements and surveys in Minnesota middle and high schools. Neighborhood variables were measured using Geographic Information Systems data. Multiple regressions of BMI z-score, fruit and vegetable intake, and fast food consumption were fit including home and neighborhood environmental variables as predictors and also including their interactions to test for effect modification. Supportive family environments (i.e., higher family functioning, frequent family meals, parent modeling of healthful eating) were associated with higher adolescent fruit and vegetable intake, lower fast food consumption, and lower BMI z-score. Associations between the built environment and adolescent outcomes were fewer. Interaction results, although not all consistent, indicated that the relationship between a supportive family environment and adolescent fruit and vegetable intake and BMI was enhanced when the neighborhood was supportive of healthful behavior. Public health interventions that simultaneously improve both the home environment and the neighborhood environment of adolescents may have a greater impact on adolescent obesity prevention than interventions that address one of these environments alone.
PMCID: PMC3942084  PMID: 24378461
Family Functioning; Adolescents; Obesity; Dietary Intake; Physical Activity; Family Meals
13.  The Latent Structure and Comorbidity Patterns of Generalized Anxiety Disorder and Major Depression Disorder: A National Study 
Depression and anxiety  2013;31(3):214-222.
There is controversy on whether generalized anxiety disorder (GAD) and major depressive disorder (MDD) constitute the same or separate disorders. This study sought to examine the factor structure of the DSM-IV diagnostic criteria of GAD and MDD and the patterns of comorbidity associated with both disorders.
Data were drawn from the National Epidemiological Survey on Alcohol and Related conditions (NESARC), a representative sample of the adult general population in the United States (N=43,093). Sociodemographic and psychiatric comorbidity correlates of GAD, MDD and co-occurring GAD-MDD were obtained. Exploratory and confirmatory factor analyses of the DSM-IV diagnostic criteria for GAD and MDD were conducted, followed by a Multiple Indicators Multiple Causes (MIMIC) model to examine the invariance of the model across several sociodemographic covariates.
A bifactor model with one general factor underlying all the MDD and GAD diagnostic criteria and another factor with large loadings only for the GAD criteria best represented the latent structure. This model showed excellent fit indices (CFI=1.00, TLI=1.00, RMSEA <.02), and a high degree of invariance across sociodemographic covariates. The comorbidity patterns of individuals with MDD only (n=4,885), GAD only (n=947) and GAD-MDD (n=810) were clearly distinguishable.
The latent structure of the diagnostic criteria of MDD and GAD and their comorbidity patterns suggests that GAD and MDD are closely related but different nosological entities, with distinct latent structures, clinical manifestations and patterns of comorbidity.
PMCID: PMC3956045  PMID: 23776155
Anxiety/anxiety disorders; epidemiology; mood disorders; factor analysis; nosology
14.  Alcohol dependence and suicide-related ideation/behaviors in an Israeli household sample, with and without major depression 
Suicide-related ideation and behaviors (SRIB) are associated with both alcohol disorders and major depressive disorder (MDD). The objective of this study was to evaluate the relationship of alcohol dependence (AD) and major depression to the risk for lifetime SRIB.
Data from a community-based sample of 1,237 adult Israeli lifetime drinkers assessed with reliable diagnostic measures were analyzed using logistic regression.
Lifetime SRIB was reported in 4.7%, and was more prevalent among participants with alcohol dependence (9.0%) than among those without alcohol dependence (4.1%); p-value=0.01. Although both alcohol dependence and major depression were associated with SRIB (AD: OR 2.2, 95% CI 1.1–4.4; MDD: OR 11.4, 95% CI=6.4–20.4), joint analysis showed that AD without MDD increased risk for SRIB as compared to those without AD or MDD (OR 3.1, 95% CI 1.1–9.1), but AD did not increase risk among those with MDD (OR 1.1, 95% CI 0.4–2.7). Among those with AD, the severity of subclinical depressive symptoms was associated with increased SRIB.
These findings show that alcohol dependence increases risk for SRIB among individuals without a history of major depression. Suicidal tendencies may be undetected and underdiagnosed in this group because of the absence of major depression, and therefore left untreated. These findings should be considered when adopting suicide prevention or treatment strategies for this high-risk sub-population.
PMCID: PMC3959279  PMID: 24117756
suicide; alcohol dependence; major depressive disorder; prevention; control
15.  Teacher Burnout: A Comparison of Two Cultures Using Confirmatory Factor and Item Response Models 
The present study addresses teacher burnout and in particular cultural differences and similarities in burnout. We used the Maslach Burnout Inventory Education Survey (MBI-ES) as the starting point for developing a latent model of burnout in two cultures; Jamaica W.I. teachers (N= 150) and New York City teachers (N= 150). We confirm a latent 3 factor structure, using a subset of the items from the MBI-ES that adequately fit both samples. We tested different degrees of measurement invariance (model fit statistics, scale reliabilities, residual variances, item thresholds, and total variance) to describe and compare cultural differences. Results indicate some differences between the samples at the structure and item levels. We found that factor variances were slightly higher in the New York City teacher sample. Emotional Exhaustion (EE) was a more informative construct for differentiating among teachers at moderate levels of burnout, as opposed to extreme high or low levels of burnout, in both cultures. In contrast, Depersonalization in the Workplace (DW) was more informative at the more extreme levels of burnout among both teacher samples. By studying the influence of culture on the experience of burnout we can further our understanding of burnout and potentially discover factors that might prevent burnout among primary and secondary school teachers.
PMCID: PMC4342052  PMID: 25729572
burnout; teacher; New York City; Jamaica W.I; culture; MBI-ES
16.  The Development of the DSM-5 Cultural Formulation Interview-Fidelity Instrument (CFI-FI): A Pilot Study 
This paper reports on the development of the Cultural Formulation Interview-Fidelity Instrument (CFI-FI) which assesses clinician fidelity to the DSM-5 Cultural Formulation Interview (CFI). The CFI consists of a manualized set of standard questions that can precede every psychiatric evaluation. It is based on the DSM-IV Outline for Cultural Formulation, the cross-cultural assessment with the most evidence in psychiatric training. Using the New York sample of the DSM-5 CFI field trial, two independent raters created and finalized items for the CFI-FI based on six audio-taped and transcribed interviews. The raters then used the final CFI-FI to rate the remaining 23 interviews. Inter-rater reliability ranged from .73 to 1 for adherence items and .52 to 1 for competence items. The development of the CFI-FI can help researchers and administrators determine whether the CFI has been implemented with fidelity, permitting future intervention research.
PMCID: PMC4306341  PMID: 25130248
Cultural psychiatry; cultural formulation; fidelity; cultural competence; health disparities
17.  The latent structure and predictors of non-medical prescription drug use and prescription drug use disorders: a national study 
Drug and alcohol dependence  2013;133(2):10.1016/j.drugalcdep.2013.07.011.
Despite growing concerns about non-medical prescription drug use and prescription drug use disorders, whether vulnerability for these conditions is drug-specific or occurs through a shared liability and common risk factors is unknown.
Exploratory and confirmatory factor analysis of Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to examine the latent structure of non-medical prescription drug use and prescription drug use disorders. Multiple indicators multiple causes (MIMIC) analysis was used to examine whether the effect of sociodemographic and psychiatric covariates occurred through the latent factor, directly on each drug class or both.
A one-factor model described well the structure of both non-medical prescription drug use and prescription drug use disorders. Younger age, being White, having more intense pain or one of several psychiatric disorders increased the risk of non-medical prescription drug use through the latent factor. The same covariates, except for anxiety disorders also significantly increased the risk of prescription drug use disorders through the latent factor. Older age directly increased the risk of non-medical use of sedatives, and alcohol use disorders decreased the risk of non-medical tranquilizer use. No covariates had direct effects on the risk of any prescription drug use disorders beyond their effect through the latent factor.
The risk for non-medical prescription drug use and prescription drug use disorders occurs through a shared liability. Treatment, prevention and policy approaches directed at these drugs as a group maybe more effective than those focused on individual classes of drugs.
PMCID: PMC3818293  PMID: 23962421
Non-medical prescription drug use; Prescription Drug Use Disorders; Latent Structure; NESARC
18.  Adolescence to Young Adulthood: When Socio-economic Disparities in Substance Use Emerge 
Substance use & misuse  2013;48(14):1522-1529.
Our objective was to examine the longitudinal trends of substance use (cigarette, alcohol, and marijuana use) in a cohort of young people by participants’ eventual educational attainment. We aimed to pinpoint the life stages when the socioeconomic disparities in these behaviors emerge.
The analytic sample included 1,902 participants from Project EAT, a 10-year longitudinal study. Participants were assessed from early adolescence (middle school) through middle young adulthood (mid 20s) and categorized into groups of eventual educational attainment.
Generally, for cigarettes and marijuana, disparities were evident by early adolescence with prevalence of use highest among those who had no secondary education, followed by 2-year college and then 4-year college attendees/graduates. With alcohol, reported use tended to be similar during adolescence for all three education groups, but then diverged during young adulthood. At this stage the 4-year college group reported the most weekly alcohol use, but the no postsecondary education group reported the most daily use.
The points at which disparities in substance use behaviors first emerge and later escalate can offer guidance as to how to craft, and when to target, interventions and policies.
PMCID: PMC4060522  PMID: 23834465
smoking; alcohol; marijuana; young adulthood; adolescence; socio-economic status
The diagnosis, Posttraumatic Stress Disorder, was introduced in 1980 amidst debate about the psychiatric toll of the Vietnam War. There is controversy, however, about its central assumption that potentially traumatic stressors are more important than personal vulnerability in causing the disorder. We tested this assumption with data from a rigorously diagnosed male subsample (n = 260) from the National Vietnam Veterans Readjustment Study. Combat exposure, pre-war vulnerability, and involvement in harming civilians or prisoners were examined, with only combat exposure proving necessary for disorder onset. While none of the three factors proved sufficient, estimated onset reached 97% for veterans high on all three, with harm to civilians or prisoners showing the largest independent contribution. Severity of combat exposure proved more important than pre-war vulnerability in onset; pre-war vulnerability at least as important in long-term persistence. Implications for the primacy of the stressor assumption, further research, and policy are discussed.
PMCID: PMC4192653  PMID: 25309830
20.  Modeling the Structure of Partnership Between Researchers and Front-Line Service Providers: Strengthening Collaborative Public Health Research 
Partnerships between HIV researchers and service providers are essential for reducing the gap between research and practice. Community-Based Participatory Research principles guided this cross-sectional study, combining 40 in-depth interviews with surveys of 141 providers in 24 social service agencies in New York City. We generated the Provider-Researcher Partnership Model to account for provider- and agency-level factors’ influence on intentions to form partnerships with researchers. Providers preferred “balanced partnerships” in which researchers and providers allocated research tasks and procedures to reflect diverse knowledge/skill sets. An organizational culture that values research can help enhance providers’ intentions to partner. Providers’ intentions and priorities found in this study may encourage researchers to engage in and policy makers to fund collaborative research.
PMCID: PMC4193907  PMID: 25309155
CBPR; practitioner–researcher partnership; HIV research
21.  Predictors of Risk-based Medical Follow-up: A Report from the Childhood Cancer Survivor Study1 
To conduct an intervention study designed to assess the effectiveness of using a newsletter to increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications.
Survivors participating in the Childhood Cancer Survivor Study who were at least 25 years of age and at risk of cardiovascular disease, breast cancer, or osteoporosis related to previous cancer treatment were randomly assigned to receive a newsletter featuring brief health risk information or a newsletter including an insert providing more comprehensive health risk information. A follow-up survey distributed 24 months after the newsletter intervention assessed predictors of medical follow-up.
Overall there were no differences found among the groups in terms of access to a treatment summary, medical follow-up, discussion of childhood cancer health risks, and medical screening for the targeted health behaviors. One exception, indicating borderline significance was that women at risk for osteoporosis who received the newsletter insert were more likely to have discussed their risk with a doctor than those who only received the brief information (10.1% vs. 4.0% p=0.05). Discussion of breast cancer (OR=2.14; 95% CI=1.73–2.65), heart disease (OR=5.54; 95% CI=4.67–6.57) and osteoporosis (OR=7.87; 95% CI=6.34–9.78) risk with physician significantly predicted report of undergoing screening for targeted behavior in previous 2 years as did physician access to treatment summary.
More detailed content in a newsletter had minimal effect on recommended screening. However, survivor’s discussion of cancer-related risks with one’s doctor significantly influenced participation in health screening. These results highlight the integral role of communication in health behavior.
PMCID: PMC3737257  PMID: 23568405
pediatric cancer; survivorship; late effects; communication
22.  Exposure to the Lebanon War of 2006 and effects on alcohol use disorders: The moderating role of childhood maltreatment☆ 
Drug and alcohol dependence  2013;134:10.1016/j.drugalcdep.2013.10.014.
Civilian populations now comprise the majority of casualties in modern warfare, but effects of war exposure on alcohol disorders in the general population are largely unexplored. Accumulating literature indicates that adverse experiences early in life sensitize individuals to increased alcohol problems after adult stressful experiences. However, child and adult stressful experiences can be correlated, limiting interpretation. We examine risk for alcohol disorders among Israelis after the 2006 Lebanon War, a fateful event outside the control of civilian individuals and uncorrelated with childhood experiences. Further, we test whether those with a history of maltreatment are at greater risk for an alcohol use disorder after war exposure compared to those without such a history.
Adult household residents selected from the Israeli population register were assessed with a psychiatric structured interview; the analyzed sample included 1306 respondents. War measures included self-reported days in an exposed region.
Among those with a history of maltreatment, those in a war-exposed region for 30+ days had 5.3 times the odds of subsequent alcohol disorders compared to those exposed 0 days (95%C.I. 1.01–27.76), controlled for relevant confounders; the odds ratio for those without this history was 0.5 (95%C.I. 0.25–1.01); test for interaction: X2 = 5.28, df = 1, P = 0.02.
Experiencing a fateful stressor outside the control of study participants, civilian exposure to the 2006 Lebanon War, is associated with a heightened the risk of alcohol disorders among those with early adverse childhood experiences. Results suggest that early life experiences may sensitize individuals to adverse health responses later in life.
PMCID: PMC3884580  PMID: 24262650
Alcohol disorders; War; Stress; Childhood maltreatment; Israel; Interaction
23.  Family Functioning: Associations with Weight Status, Eating Behaviors, and Physical Activity in Adolescents 
This paper examines the relationship between family functioning (e.g. communication, closeness, problem solving, behavioral control) and adolescent weight status and relevant eating and physical activity behaviors.
Data are from EAT 2010 (Eating and Activity in Teens), a population-based study that assessed eating and activity among socioeconomically and racially/ethnically diverse youth (n = 2,793). Adolescents (46.8% boys, 53.2% girls) completed anthropometric assessments and surveys at school in 2009–2010. Multiple linear regression was used to test the relationship between family functioning and adolescent weight, dietary intake, family meal patterns, and physical activity. Additional regression models were fit to test for interactions by race/ethnicity.
For adolescent girls, higher family functioning was associated with lower body mass index z-score and percent overweight, less sedentary behavior, higher intake of fruits and vegetables, and more frequent family meals and breakfast consumption. For adolescent boys, higher family functioning was associated with more physical activity, less sedentary behavior, less fast food consumption, and more frequent family meals and breakfast consumption. There was one significant interaction by race/ethnicity for family meals; the association between higher family functioning and more frequent family meals was stronger for non-white boys compared to white boys. Overall, strengths of associations tended to be small with effect sizes ranging from - 0.07 to 0.31 for statistically significant associations.
Findings suggest that family functioning may be protective for adolescent weight and weight-related health behaviors across all race/ethnicities, although assumptions regarding family functioning in the homes of overweight children should be avoided given small effect sizes.
PMCID: PMC3580029  PMID: 23299010
Family Functioning; Adolescent Obesity; Dietary Intake; Family Meals; Physical Activity
24.  Changes in the frequency of family meals from 1999-2010 in the homes of adolescents: Trends by sociodemographic characteristics 
To examine secular trends from 1999 to 2010 in family meal frequency in a population-based sample of adolescents across sociodemographic characteristics.
A repeated cross-sectional design was used. Participants were from Minneapolis/St. Paul middle schools and high schools and included 3,072 adolescents in 1999 (mean age=14.6±1.8) and 2,793 adolescents in 2010 (mean age=14.4±2.0) from diverse ethnic/racial and socioeconomic backgrounds. Trends in family meal frequency were examined using inverse probability weighting to control for changes in sociodemographic characteristics over time.
Family meal frequency remained fairly constant from 1999 to 2010 in the overall sample, but decreases were found in population subgroups including girls, middle school students (grade 6-8), Asians, and youth from low socioeconomic backgrounds. Among youth from the lowest socioeconomic backgrounds, the mean number of family meals in the past week decreased from 4.0 in 1999 to 3.6 in 2010 (p=.003). Furthermore, the percentage of youth from low socioeconomic backgrounds eating five or more meals in the past week decreased from 46.9% in 1999 to 38.8% in 2010 (p<.001). In contrast, family meal frequency tended to increase over time among youth from higher socioeconomic backgrounds.
The widening gap in family meal frequency between youth from low and high socioeconomic backgrounds is concerning, particularly given the greater risk for poor health outcomes among low-income youth. Given findings from other studies suggesting multiple benefits of family meals, interventions to increase family meal frequency are needed that target adolescents and their families from the most vulnerable segments of the population.
PMCID: PMC3552297  PMID: 23332485
25.  The Structure and Predictive Validity of the Internalizing Disorders 
Journal of abnormal psychology  2012;122(1):86-92.
Multivariate comorbidity research indicates mood and anxiety (internalizing) disorders share one or more common liabilities, but categorical, dimensional, and hybrid accounts of these liabilities have not been directly compared. We modeled seven internalizing disorders in a nationally representative sample of 43,093 individuals via confirmatory factor, latent class, exploratory factor mixture, and exploratory structural equation modeling analyses. A two-dimensional (distress-fear) liability structure fit best and replicated across gender, assessment waves, and lifetime/12-month diagnoses. These liabilities, not disorder-specific variation, predicted future internalizing pathology, suicide attempts, angina, and ulcer.
PMCID: PMC3755742  PMID: 22905862
internalizing; dimensions; classes; psychopathology; depression; anxiety

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