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1.  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
2.  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
3.  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
5.  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
6.  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
7.  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
8.  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
9.  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
10.  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
11.  Physical Activity and Screen Time in Adolescents and Their Friends 
Little is known about the actual physical activity and screen time behaviors of an adolescent’s friends relative to the individual’s behavior.
To determine the associations between an adolescent’s physical activity and screen time and his/her nominated friends’ physical activity and screen time.
Data were obtained from EAT 2010 (Eating and Activity Among Teens), a large cross-sectional study (n=2126) conducted in 20 middle schools and high schools in Minneapolis/St. Paul MN during the 2009–2010 academic year and analyzed during 2011. Each participant nominated up to six friends from a school roster, and data from those friends were obtained as part of the school-based data collection procedures. Physical activity and screen time were assessed with previously used and validated questionnaires. Generalized estimating equation models, stratified by gender, were used to assess associations between adolescents’ physical activity and screen time and their friends’ physical activity and screen time.
Physical activity for female adolescents was associated with their male and female friends’ physical activity, including their male and female best friends (all p<0.05). Males’ physical activity was associated with their female friends’ physical activity (p<0.03). Females’ screen time was associated with their male and female friends’ screen time (p≤0.03), but not with that of their best friends. Males’ screen time was associated with only their female friends’ screen time (p=0.04).
The consistent association between female adolescents’ physical activity and their friends’ physical activity indicates a need to include peer effects on adolescent female physical activity in future intervention work.
PMCID: PMC3684163  PMID: 23253649
12.  Substance-Use Disorders and Poverty as Prospective Predictors of First-Time Homelessness in the United States 
American journal of public health  2013;103(0 2):10.2105/AJPH.2013.301302.
We examined whether substance-use disorders and poverty predicted first-time homelessness over 3 years.
We analyzed longitudinal data from waves 1 (2001–2002) and 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions to determine the main and interactive effects of wave 1 substance use disorders and poverty on first-time homelessness by wave 2, among those who were never homeless at wave 1 (n = 30 558). First-time homelessness was defined as having no regular place to live or having to live with others for 1 month or more as a result of having no place of one’s own since wave 1.
Alcohol-use disorders (adjusted odds ratio [AOR] = 1.34), drug-use disorders (AOR = 2.51), and poverty (AOR = 1.34) independently increased prospective risk for first-time homelessness, after adjustment for ecological variables. Substance-use disorders and poverty interacted to differentially influence risk for first-time homelessness (P < .05), before, but not after, adjustment for controls.
This study reinforces the importance of both substance-use disorders and poverty in the risk for first-time homelessness, and can serve as a benchmark for future studies. Substance abuse treatment should address financial status and risk of future homelessness.
PMCID: PMC3865876  PMID: 24148043
13.  Muscle-enhancing Behaviors Among Adolescent Girls and Boys 
Pediatrics  2012;130(6):1019-1026.
Media images of men and women have become increasingly muscular, and muscle-enhancing techniques are available to youth. Identifying populations at risk for unhealthy muscle-enhancingbehaviors is of considerable public health importance. The current study uses a large and diverse population-based sample of adolescents to examine the prevalence of muscle-enhancing behaviors and differences across demographic characteristics, weight status, and sports team involvement.
Survey data from 2793 diverse adolescents (mean age = 14.4) were collected at 20 urban middle and high schools. Use of 5 muscle-enhancing behaviors was assessed (changing eating, exercising, protein powders, steroids and other muscle-enhancing substances), and a summary score reflecting use of 3 or more behaviors was created. Logistic regression was used to test for differences in each behavior across age group, race/ethnicity, socioeconomic status, BMI category, and sports team participation.
Muscle-enhancing behaviors were common in this sample for both boys and girls. For example, 34.7% used protein powders or shakes and 5.9% reported steroid use. Most behaviors were significantly more common among boys. In models mutually adjusted for all covariates, grade level, Asian race, BMI category, and sports team participation were significantly associated with the use of muscle-enhancing behaviors. For example, overweight (odds ratio = 1.45) and obese (odds ratio = 1.90) girls had significantly greater odds of using protein powders or shakes than girls of average BMI.
The use of muscle-enhancing behaviors is substantially higher than has been previously reported and is cause for concern. Pediatricians and other health care providers should ask their adolescent patients about muscle-enhancing behaviors.
PMCID: PMC3507247  PMID: 23166333
adolescence; muscle enhancement; steroids; body image
14.  Associations between friends' disordered eating and muscle-enhancing behaviors 
Social science & medicine (1982)  2012;75(12):2242-2249.
Dieting, unhealthy weight control and muscle-enhancing behaviors are common among adolescents: friends are a probable source of influence on these behaviors. The present study uses data provided by nominated friends to examine associations between friends' disordered eating and muscle-enhancing behaviors and participants' own behaviors in a diverse sample of American youth. Male and female adolescents (mean age = 14.4) completed surveys and identified their friends from a class roster; friends' survey data were then linked to each participant. Participants (N = 2126) who had at least one nominated friend were included in the analytic sample. Independent variables were created using the same weight control and muscle-enhancing behaviors reported by nominated friends, and were used in logistic regression models to test associations between participants' and their friends' behaviors, stratified by gender. Results indicated that dieting, disordered eating and muscle-enhancing behaviors were common in this sample, and selected friends' behaviors were associated with the same behaviors in participants. For example, girls whose friends reported extreme weight control behaviors had significantly greater odds of using these behaviors than girls whose friends did not report these same behaviors (OR = 2.39). This research suggests that friends' weight- and shape-related behaviors are a feature of social relationships, and is the first report demonstrating these associations for muscle-enhancing behaviors. Capitalizing on the social element may be important to the development of increasingly effective intervention and prevention programs.
PMCID: PMC3509792  PMID: 23010337
U.S.A.; Adolescents; Disordered eating; Muscle-enhancing; Friends; Social influence
15.  Do Adolescents Who Live or Go to School Near Fast Food Restaurants Eat More Frequently From Fast Food Restaurants? 
Health & place  2012;18(6):1261-1269.
This population-based study examined whether residential or school neighborhood access to fast food restaurants is related to adolescents’ eating frequency of fast food. A classroom-based survey of racially/ethnically diverse adolescents (n=2,724) in 20 secondary schools in Minneapolis/St. Paul, Minnesota was used to assess eating frequency at five types of fast food restaurants. Black, Hispanic, and Native American adolescents lived near more fast food restaurants than white and Asian adolescents and also ate at fast food restaurants more often. After controlling for individual-level socio-demographics, adolescent males living near high numbers fast food restaurants ate more frequently from these venues compared to their peers.
PMCID: PMC3501600  PMID: 23064515
Fast food; restaurants; neighborhood; school; adolescents
16.  Trajectories of criteria of nicotine dependence from adolescence to early adulthood☆ 
Drug and alcohol dependence  2012;125(3):283-289.
To identify patterns and correlates of developmental trajectories of DSM-IV nicotine dependence criteria from adolescence to early adulthood.
The analytical sample of lifetime smokers (N = 877) is from a longitudinal cohort of 6th–10th graders drawn from an urban school system. Subjects were interviewed 5 times at 6-month intervals and once 4.5 years later. Growth mixture models were estimated to identify trajectories of DSM-IV nicotine dependence criteria over ages 12–23.
A four-class solution fitted the data best: No dependence criteria (Class 1, 32.0%); Early onset/Chronic course (Class 2, 26.1%); Early onset/Remission (Class 3, 15.4%); Late onset (Class 4, 26.5%). There appeared to be three critical periods. At ages 12–15, symptoms increased rapidly. As of age 16, the Early onset/Chronic class stabilized at high levels of symptoms, the Early onset/Remission class started its symptomatic decline, and the Late onset class experienced a sharp increase in symptoms. At age 20, there was a convergence in the prevalence of symptoms experienced at high (Classes 2 and 4) and low levels (Classes 1 and 3). Extensiveness of smoking and marijuana use were associated with higher baseline levels of nicotine dependence criteria. Anxiety disorders were associated with all three symptomatic trajectories. Parental smoking and nicotine dependence were associated specifically with the Early/Chronic class, while pleasant initial sensitivity and earlier onset ages of cigarette and marijuana use characterized the two early onset classes (2 and 3).
Trajectories of dependence criteria constitute an advantageous phenotype for research and intervention over static summaries of smoking behaviors.
PMCID: PMC3592202  PMID: 22513378
Nicotine dependence criteria; Developmental trajectories; Growth mixture modeling; Adolescence
17.  Analyses related to the development of DSM-5 criteria for substance use related disorders: 2. Proposed DSM-5 criteria for alcohol, cannabis, cocaine and heroin disorders in 663 substance abuse patients 
Drug and alcohol dependence  2011;122(0):28-37.
A number of changes have been proposed and investigated in the criteria for substance use disorders in DSM-5. However, although clinical utility of DSM-5 is a high priority, relatively little of the empirical evidence supporting the changes was obtained from samples of substance abuse patients.
Proposed changes were examined in 663 patients in treatment for substance use disorders, evaluated by experienced clinicians using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Factor and item response theory analysis was used to investigate the dimensionality and psychometric properties of alcohol, cannabis, cocaine and heroin abuse and dependence criteria, and craving.
The seven dependence criteria, three of the abuse criteria (hazardous use; social/interpersonal problems related to use; neglect of roles to use), and craving form a unidimensional latent trait for alcohol, cannabis, cocaine and heroin. Craving did not add significantly to the total information offered by the dependence criteria, but adding the three abuse criteria and craving together did significantly increase total information for the criteria sets associated with alcohol, cannabis and heroin.
Among adult patients in treatment for substance disorders, the alcohol, cannabis, cocaine and heroin criteria for dependence, abuse (with the exception of legal problems), and craving measure a single underlying dimension. Results support the proposal to combine abuse and dependence into a single diagnosis in the DSM-5, omitting legal problems. Mixed support was provided for the addition of craving as a new criterion, warranting future studies of this important construct in substance use disorders.
PMCID: PMC3755770  PMID: 21963333
Item response theory; Substance abuse; Substance dependence; Craving; DSM-IV; DSM-5
18.  Which dieters are at risk for the onset of binge-eating? A prospective study of adolescents and young adults 
Dieting is a well-established risk factor for binge-eating, yet the majority of dieters do not develop binge-eating problems. The purpose of the current study was to examine psychosocial factors involved in the relation between dieting and binge-eating over a 10-year follow-up period.
A population-based sample (n=1,827) completed surveys assessing eating habits, psychological functioning, and weight status at 5-year intervals spanning early/middle adolescence (Time 1), late adolescence/early young adulthood (Time 2) and early/middle young adulthood (Time 3). Dieting, along with depression symptoms, self-esteem, and teasing experiences at Time 1 and Time 2 were used to predict new onset binge-eating at Time 2 and Time 3, respectively. Interactions between dieting status and varying degrees of these psychosocial factors in relation to binge-eating onset were also tested.
Dieters were 2–3 times more likely than non-dieters to develop binge-eating problems over 5-year follow-ups. At most time-points, depression symptoms and self-esteem predicted binge-eating onset beyond the effects of dieting alone. Detrimental levels of these factors among dieters (relative to non-dieters) increased the likelihood of binge-eating onset only during the latter follow-up period.
Depression and self-esteem appear to be particularly salient factors involved in the relation between dieting and binge-eating onset among adolescents and young adults. Early identification of these factors should be a priority in order to prevent the development of binge-eating problems among already at-risk individuals.
PMCID: PMC3383602  PMID: 22727082
Dieting; binge-eating; negative affect; self-esteem; teasing; adolescent
19.  Patterns of Obesogenic Neighborhood Features and Adolescent Weight: A comparison of statistical approaches 
Few studies have addressed the potential influence of neighborhood characteristics on adolescent obesity risk and findings have been inconsistent.
Identify patterns among neighborhood food, physical activity, street/transportation, and socioeconomic characteristics and examine their associations with adolescent weight status using three statistical approaches.
Anthropometric measures were taken on 2,682 adolescents (53% female, mean age=14.5) from 20 Minneapolis/St. Paul, Minnesota schools in 2009–2010. Neighborhood environmental variables were measured using Geographic Information Systems data and by survey. Gender-stratified regressions related BMI z-scores and obesity to 1) separate neighborhood variables 2) composites formed using factor analysis and 3) clusters identified using spatial latent class analysis in 2012.
Regressions on separate neighborhood variables found low percentage of parks/recreation and low perceived safety were associated with higher BMI z-scores in boys and girls. Factor analysis found five factors: away-from-home food and recreation accessibility, community disadvantage, green space, retail/transit density, and supermarket accessibility. The first two factors were associated with BMI z-score in girls but not in boys. Spatial latent class analysis identified six clusters with complex combinations of both positive and negative environmental influences. In boys, the cluster with highest obesity (29.8%) included low socioeconomics, parks/recreation, and safety; high restaurant and convenience store density; and nearby access to gyms, supermarkets, and many transit stops.
The mix of neighborhood-level barriers and facilitators of weight-related health behaviors leads to difficulties disentangling their associations with adolescent obesity; however, statistical approaches including factor and latent class analysis may provide useful means for addressing this complexity.
PMCID: PMC3380614  PMID: 22516505
20.  Personal, behavioral and socio-environmental predictors of overweight incidence in young adults: 10-yr longitudinal findings 
The objective of this study was to identify 10-year longitudinal predictors of overweight incidence during the transition from adolescence to young adulthood.
Data were from Project EAT (Eating and Activity in Teens and Young Adults). A diverse, population-based cohort (N = 2,134) completed baseline surveys in 1998–1999 (mean age = 15.0±1.6, ‘adolescence’) and follow-up surveys in 2008–2009 (mean age = 25.4±1.7, ‘young adulthood’). Surveys assessed personal, behavioral and socio-environmental factors hypothesized to be of relevance to obesity, in addition to height and weight. Multivariable logistic regression was used to estimate the adjusted odds for each personal, behavioral and socio-environmental factor at baseline, and 10-year changes for these factors, among non-overweight adolescents (n = 1,643) being predictive of the incidence of overweight (BMI ≥ 25) at 10-year follow-up.
At 10-year follow-up, 51% of young adults were overweight (26% increase from baseline). Among females and males, higher levels of body dissatisfaction, weight concerns, unhealthy weight control behaviors (e.g., fasting, purging), dieting, binge eating, weight-related teasing, and parental weight-related concerns and behaviors during adolescence and/or increases in these factors over the study period predicted the incidence of overweight at 10-year follow-up. Females with higher levels of whole grain intake and breakfast and dinner consumption frequency during adolescence were protected against becoming overweight. Among males, increases in vegetable intake protected against the incidence of overweight 10 years later.
Findings suggest that obesity prevention interventions for adolescents should address weight-specific factors from within the domains of personal, behavioral, and socio-environmental factors such as promoting positive body image, decreasing unhealthy weight control behaviors, and limiting negative weight talk.
PMCID: PMC3623851  PMID: 23531253
Adolescents; Young adults; Overweight; Weight control
21.  Alcohol Dependence is Related to Overall Internalizing Psychopathology Load Rather than to Particular Internalizing Disorders: Evidence from a National Sample 
Alcohol dependence is more prevalent among those with any one of several anxiety or depressive (“internalizing”) disorders than among those in the general population. However, because internalizing disorders are highly inter-correlated, it is ambiguous whether alcohol dependence is related to internalizing psychopathology components that are: a) unique to a particular internalizing disorder (“specific”); versus b) shared across a number of internalizing disorders (“general”). To clarify this ambiguity, we employed structural equation and logistic models to decompose the specific versus general components of internalizing psychopathology and then related these components separately to alcohol dependence.
The data were based on face-to-face interviews of U.S. community residents collected in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093).
Both analytic approaches demonstrated that increases in the general internalizing psychopathology load are accompanied by increases in the prevalence of alcohol dependence. Once the general internalizing psychopathology load is accounted for, knowing whether a particular internalizing disorder is present or absent provides little additional information regarding the prevalence of alcohol dependence.
The components of internalizing psychopathology that are associated with alcohol dependence are shared and cumulative among common anxiety and depressive disorders. These findings have the potential to influence clinical and scientific conceptualizations of the association between alcohol dependence and internalizing psychopathology.
PMCID: PMC3235250  PMID: 21895708
Alcohol Dependence; Anxiety Disorders; Depressive Disorders; Comorbidity
22.  Childhood maltreatment and the structure of common psychiatric disorders† 
The British Journal of Psychiatry  2012;200(2):107-115.
Previous research suggests that various types of childhood maltreatment frequently co-occur and confer risk for multiple psychiatric diagnoses. This non-specific pattern of risk may mean that childhood maltreatment increases vulnerability to numerous specific psychiatric disorders through diverse, specific mechanisms or that childhood maltreatment engenders a generalised liability to dimensions of psychopathology. Although these competing explanations have different implications for intervention, they have never been evaluated empirically.
We used a latent variable approach to estimate the associations of childhood maltreatment with underlying dimensions of internalising and externalising psychopathology and with specific disorders after accounting for the latent dimensions. We also examined gender differences in these associations.
Data were drawn from a nationally representative survey of 34 653 US adults. Lifetime DSM-IV psychiatric disorders were assessed using the AUDADIS-IV. Physical, sexual and emotional abuse and neglect were assessed using validated measures. Analyses controlled for other childhood adversities and sociodemographics.
The effects were fully mediated through the latent liability dimensions, with an impact on underlying liability levels to internalising and externalising psychopathology rather than specific psychiatric disorders. Important gender differences emerged with physical abuse associated only with externalising liability in men, and only with internalising liability in women. Neglect was not significantly associated with latent liability levels.
The association between childhood maltreatment and common psychiatric disorders operates through latent liabilities to experience internalising and externalising psychopathology, indicating that the prevention of maltreatment may have a wide range of benefits in reducing the prevalence of many common mental disorders. Different forms of abuse have gender-specific consequences for the expression of internalising and externalising psychopathology, suggesting gender-specific aetiological pathways between maltreatment and psychopathology.
PMCID: PMC3269653  PMID: 22157798
24.  Commentary on Harper S, Strumpf EC, Kaufman JS. Do Medical Marijuana Laws Increase Marijuana Use? Replication Study and Extension 
Annals of epidemiology  2012;22(7):536-537.
Replicability is a crucial element of good science, particularly so when the subject matter is sensitive and political. Therefore, we welcome close scrutiny of our brief report in the Annals of Epidemiology in 2011, “Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear.” We were glad to see that Harper et al. (1) were able to replicate our results showing that states with medical marijuana laws (MML) showed greater rates of marijuana use among their residents during 2002 to 2008 and that states that passed MML after 2002 already had greater use among their residents before they passed the law. However, we have several concerns with the additional analyses run by Harper et al. and further concerns with the way their results were presented. We summarize our concerns in this commentary.
PMCID: PMC3547124  PMID: 22534177
25.  Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass index 
Dieting and unhealthy weight control behaviors are common among adolescents and questions exist regarding their long-term effect on weight status.
To examine 10-year longitudinal associations between dieting and unhealthy weight control behaviors and changes in body mass index (BMI) from adolescence to young adulthood.
Methods and Procedures
A diverse population-based sample of middle school and high school adolescents was followed for 10 years. Participants (N=1,902) completed surveys in 1998–99 (Project EAT-I), 2003–04 (Project EAT-II), and 2008–09 (Project EAT-III). Dieting and unhealthy weight control behaviors at Time 1 and Time 2 were used to predict 10-year changes in BMI at Time 3, adjusting for sociodemographic characteristics and Time 1 BMI.
Dieting and unhealthy weight control behaviors at both Time 1 and Time 2 predicted greater BMI increases at Time 3 in males and females, as compared to no use of these behaviors. For example, females using unhealthy weight control behaviors at both Time 1 and Time 2 increased their BMI by 4.63 units as compared to 2.29 units in females not using these behaviors (p<.001). Associations were found in both overweight and non-overweight respondents. Specific weight control behaviors at Time 1 that predicted larger BMI increases at Time 3 included skipping meals and reporting eating very little (females and males), use of food substitutes (males), and diet pill use (females).
Findings clearly indicate that dieting and unhealthy weight control behaviors, as reported by adolescents, predict significant weight gain over time.
PMCID: PMC3245517  PMID: 22188838
Dieting; disordered eating; eating behaviors; weight status; weight

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