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.
Nicotine dependence criteria; Developmental trajectories; Growth mixture modeling; Adolescence
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.
Item response theory; Substance abuse; Substance dependence; Craving; DSM-IV; DSM-5
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.
Dieting; binge-eating; negative affect; self-esteem; teasing; adolescent
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.
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.
Adolescents; Young adults; Overweight; Weight control
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.
Alcohol Dependence; Anxiety Disorders; Depressive Disorders; Comorbidity
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.
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.
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.
Dieting; disordered eating; eating behaviors; weight status; weight
Marijuana is the most frequently used illicit substance in the United States. Little is known of the role that macro-level factors, including community norms and laws related to substance use, play in determining marijuana use, abuse and dependence. We tested the relationship between state-level legalization of medical marijuana and marijuana use, abuse, and dependence.
We used the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national survey of adults aged 18+ (n=34,653). Selected analyses were replicated using the National Survey on Drug Use and Health (NSDUH), a yearly survey of ~68,000 individuals aged 12+. We measured past-year cannabis use and DSM-IV abuse/dependence.
In NESARC, residents of states with medical marijuana laws had higher odds of marijuana use (OR: 1.92; 95% CI: 1.49-2.47) and marijuana abuse/dependence (OR: 1.81; 95% CI: 1.22-2.67) than residents of states without such laws. Marijuana abuse/dependence was not more prevalent among marijuana users in these states (OR: 1.03; 95% CI: 0.67-1.60), suggesting that the higher risk for marijuana abuse/dependence in these states was accounted for by higher rates of use. In NSDUH, states that legalized medical marijuana also had higher rates of marijuana use.
States that legalized medical marijuana had higher rates of marijuana use. Future research needs to examine whether the association is causal, or is due to an underlying common cause, such as community norms supportive of the legalization of medical marijuana and of marijuana use.
marijuana; community norms; medical marijuana laws; substance use disorders; legalization
To examine secular trends from 1999 to 2010 in weight status and weight-related attitudes and behaviors among adolescents.
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 age14.6±1.8) and 2,793 adolescents in 2010 (mean age14.4±2.0). Trends in weight-related variables were examined using inverse probability weighting to control for changes in sociodemographics over time.
The prevalence of obesity among boys increased by 7.8% from 1999 to 2010, with large ethnic/racial disparities. In black boys the prevalence of obesity increased from 14.4% to 21.5% and among Hispanic boys, obesity prevalence increased from 19.7% to 33.6% Trends were more positive among girls: weight status did not significantly increase, perceptions of overweight status were more accurate, the use of healthy weight control behaviors remained high, dieting decreased by 6.7%, unhealthy weight control behaviors decreased by 8.2% and extreme weight control behaviors decreased by 4.5%.
Trends indicate a need to intensify efforts to prevent obesity and other weight-related problems, particularly for boys from ethnic/racial minorities. The decreases in unhealthy weight control behaviors among girls are encouraging.
Obesity; Adolescents; Dieting; Weight control; Secular trends; Racial disparities
We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice.
We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience.
Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidence-based practice engagement and service integration were moderately correlated.
Age and race of providers, transdisciplinary collaboration, and familiarity with the community are significant variables that should inform design and implementation of provider training. Promising practices that facilitate service integration in Brazil may be used in other countries.
We examined the association between sleep duration and body mass index in young adults, and, specifically, in possible gender differences. The population-based sample included 955 young men and 1,051 young women (mean age=25.3 years, SD=1.7) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults). In 2008–2009, study participants completed a survey, on which they reported their weight, height, and typical bed and awakening times. Gender-specific regression models estimated cross-sectional associations between sleep duration and weight status, adjusting for age, race, SES, family structure, depressive symptoms, physical activity, and sedentary and dietary behaviors. In multivariable-adjusted linear regression models, an hour increase in sleep was associated with a −0.38 (−0.70, −0.048) BMI in men. Men who slept <7 hours had a 1.4 unit higher mean BMI (27.9; 95% CI: 26.9, 28.9) than men who slept 7–9 hours/day (26.5; 95% CI: 26.1, 27.0). Prevalence estimates of overweight (BMI≥25) and obesity (BMI≥30) were also inversely associated with sleep duration among men. Sleep duration was not associated with BMI, overweight, or obesity in women. Among women, but not men, there was a statistically significant positive association between trouble falling or staying asleep and mean BMI. Sleep may be an important modifiable risk factor for obesity, particularly in young adult men.
Adults; gender; obesity; population studies; risk factors
There is a paucity of research regarding the contextual factors that influence health behaviors to inform the development of programs and services for youth during the transition from adolescence to young adulthood. Researchers are thus in need of efficient strategies for surveying diverse populations of young adults. This study among a population-based sample of young adults aimed to 1) examine response to a mixed-mode survey design (web and mailed surveys) and 2) identify demographic correlates of response mode. Young adults who participated in previous study waves were invited to participate in the third wave of a 10-year longitudinal study (Project EAT-III: 2008-2009) examining factors associated with weight-related behaviors. Participants were mailed invitation letters providing the web address and a unique password for completing the survey. Nonresponders were mailed three reminder invitations; the third mailing included the paper form, and all other mailings included a postage-paid card for requesting the paper form. Most completed surveys (82.1% of n=2,287) were returned by respondents within the first four months of fielding prior to the mailing which included the paper form. Nearly all of these early responders (92.6% of n=1,878) and 86.5% of the full respondent sample (n=1,979 of 2,287) completed the web form. Response to the web versus mailed paper form of the survey was associated with age >25 years, higher socioeconomic status, current employment, student status, and having no children. The combination of web and mailed survey modes is an effective strategy for conducting data collection in demographically diverse, young adult populations.
mixed-mode survey; young adults; health behavior
Few risk factors have been established for childhood germ cell tumors (GCT). Parental infertility and infertility treatment may be associated with GCT development but these risk factors have not been fully investigated.
A case-control study of childhood GCT was conducted through the Children’s Oncology Group (COG). Cases, under the age of 15 years at diagnosis, were recruited through COG institutions from January 1993 to December 2002. Controls were obtained through random digit dialing. Information about infertility and infertility treatment along with demographic factors was collection through maternal interviews. Subgroups created by gender, age at diagnosis, and tumor location were examined separately. Statistical analysis was performed using multivariate logistic regression models.
Overall, no association between GCT and infertility or its treatment was found. In subgroup analysis, females whose mothers had two or more fetal losses were found to be at increased risk for non-gonadal tumors (Odds ratio (OR) = 3.32, 95% Confidence interval (CI) = 1.12–9.88). Younger maternal age was associated with a lower risk of gonadal GCT in females (OR = 0.52, 95% CI = 0.28–0.96). There was an increased risk of all GCT and gonadal GCT in males born to older mothers (OR = 2.88, 95% CI = 1.13–7.37 and OR = 3.70, 95% CI = 1.12–12.24).
While no association between parental infertility or its treatment and childhood GCT was found overall, possible associations with maternal age and history of recurrent fetal loss were found in subgroups defined by gender.
Germ cell tumor; infertility; pediatrics; epidemiology
Evidence-based changes planned for DSM-5 substance use disorders (SUDs) include combining dependence and three of the abuse criteria into one disorder and adding a criterion indicating craving. Because DSM-IV did not include a category for nicotine abuse, little empirical support is available for aligning the nicotine use disorder criteria with the DSM-5 criteria for other SUDs.
Latent variable analyses, likelihood ratio tests (LRT) and bootstrap tests were used to explore the unidimensionality, psychometric properties and information of the nicotine criteria.
A sample of household residents selected from the Israeli population register yielded 727 lifetime cigarette smokers.
DSM-IV nicotine dependence criteria and proposed abuse and craving criteria, assessed with a structured interview.
Three abuse criteria (hazardous use, social/interpersonal problems, and neglect roles) were prevalent among smokers, formed a unidimensional latent trait with nicotine dependence criteria, were intermixed with dependence criteria across the severity spectrum, and significantly increased the diagnostic information over the dependence-only model. LRT results also supported including the abuse criteria (Χ23=259.63, p<0.0001). A craving criterion was shown to fit well with the other criteria.
Similar to findings from research on other substances, nicotine dependence, abuse, and craving criteria formed a single factor. The results support alignment of nicotine criteria with those for alcohol and drug use disorders in DSM-5.
Item Response Theory; nicotine use disorders; nicotine dependence; DSM-IV; DSM-5; Israel
Since 1996, 16 states have legalized marijuana use for medical purposes. The current study provides a scientific assessment of the association of medical marijuana laws (MML) and adolescent marijuana use using national data.
State representative survey data on approximately 23,000 12–17 year olds was collected by the National Survey on Drug Use and Health annually from 2002–2008. Yearly state-specific estimates of prevalence of past-month marijuana use and perception of its riskiness were statistically tested for differences between states with and without MML by year and across years.
States with MML had higher average adolescent marijuana use, 8.68% (95% CI: 7.95–9.42) and lower perception of riskiness, during the period 2002–2008 compared to states without MML, 6.94% (95% CI: 6.60–7.28%). In the eight states that passed MML since 2004, in the years prior to MML passage, there was already a higher prevalence of use and lower perceptions of risk in those states compared to states that have not passed MML.
While the most likely of several possible explanations for higher adolescent marijuana use and lower perceptions of risk in MML states cannot be determined from the current study, results clearly suggest the need for more empirically-based research on this topic.
Obesity researchers increasingly use geographic information systems to measure exposure and access in neighborhood food and physical activity environments. This paper proposes a network buffering approach, the “sausage” buffer. This method can be consistently and easily replicated across software versions and platforms, avoiding problems with proprietary systems that use different approaches in creating such buffers.
In this paper, we describe how the sausage buffering approach was developed to be repeatable across platforms and places. We also examine how the sausage buffer compares with existing alternatives in terms of buffer size and shape, measurements of the food and physical activity environments, and associations between environmental features and health-related behaviors. We test the proposed buffering approach using data from EAT 2010 (Eating and Activity in Teens), a study examining multi-level factors associated with eating, physical activity, and weight status in adolescents (n = 2,724) in the Minneapolis/St. Paul metropolitan area of Minnesota.
Results show that the sausage buffer is comparable in area to the classic ArcView 3.3 network buffer particularly for larger buffer sizes. It obtains similar results to other buffering techniques when measuring variables associated with the food and physical activity environments and when measuring the correlations between such variables and outcomes such as physical activity and food purchases.
Findings from various tests in the current study show that researchers can obtain results using sausage buffers that are similar to results they would obtain by using other buffering techniques. However, unlike proprietary buffering techniques, the sausage buffer approach can be replicated across software programs and versions, allowing more independence of research from specific software.
Buffer; Network; Obesity; Physical activity environments; Food environments; GIS; Reliability; Validity; Utility
Disordered eating behaviors are prevalent in adolescence and can have harmful consequences. An important question is whether use of these behaviors in adolescence sets the pattern for continued use into young adulthood.
To examine the prevalence and tracking of dieting, unhealthy and extreme weight control behaviors, and binge eating from adolescence to young adulthood.
Population-based, 10-year longitudinal study (Project EAT-III: Eating Among Teens and Young Adults, 1999–2010).
The study population includes 2,287 young adults (55% female, 52% non-white). The sample includes a younger group (mean age = 12.8±0.7 years at baseline and 23.2±1.0 years at follow-up) and an older group (mean age = 15.9±0.8 at baseline and 26.2±0.9 years at follow-up).
Statistical analyses performed
Longitudinal trends in prevalence of behaviors were tested using generalized estimating equations. Tracking of behaviors were estimated using the relative risk of behaviors at follow-up given presence at baseline.
In general, the prevalence of dieting and disordered eating was high and remained constant, or increased, from adolescence to young adulthood. Furthermore, behaviors tended to track within individuals and, in general, participants who engaged in dieting and disordered eating behaviors during adolescence were at increased risk for these behaviors ten years later. Tracking was particularly consistent for the older females and males transitioning from middle adolescence to middle young adulthood.
Study findings indicate that disordered eating behaviors are not just an adolescent problem, but continue to be prevalent among young adults. The tracking of dieting and disordered eating within individuals suggests that early use is likely to set the stage for ongoing use. Findings suggest a need for both early prevention efforts prior to the onset of harmful behavioral patterns, as well as ongoing prevention and treatment interventions to address the high prevalence of disordered eating throughout adolescence and young adulthood.
Adolescence; young adulthood; longitudinal; dieting; disordered eating
The current study examines how body satisfaction of pregnant women compares to that of nonpregnant women. The sample included 68 pregnant and 927 nonpregnant young women who participated in a population-based longitudinal study examining eating and weight concerns in young adults. Body satisfaction was assessed using a 10-item modified version of the Body Shape Satisfaction Scale. The longitudinal design allowed for the assessment of body satisfaction among women both prior to and during their pregnancy. Mean body satisfaction was higher in pregnant women (32.6, 95% CI: 30.7–34.5) than nonpregnant women (29.6, 95% CI: 29.1–30.1) with moderate effect size 0.32, after adjusting for body satisfaction and body mass index prior to pregnancy, indicating that pregnant women experienced a significant increase in body satisfaction from the time prior to their pregnancy (p = .003) despite weight gain. These findings have important implications for clinicians delivering weight-related messages to women during pregnancy.
body satisfaction; pregnancy; young adult
To examine associations between participating in mind-body activities (yoga/Pilates) and body dissatisfaction and disordered eating (unhealthy and extreme weight control practices and binge eating) in a population-based sample of young adults.
The sample included 1030 young men and 1257 young women (mean age: 25.3 years, SD=1.7) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults).
Among women, disordered eating was prevalent in yoga/Pilates participants and non-participants, with no differences between the groups. Men participating in yoga/Pilates were more likely to use extreme weight control behaviors (18.6% vs. 6.8%, p=.006) and binge eating (11.6% vs. 4.2%, p=.023), and marginally more likely to use unhealthy weight control behaviors (49.1% vs. 34.5%; p=.053), than non-participants after adjusting for sociodemographics, weight status, and overall physical activity.
Findings suggest the importance of helping yoga/Pilates instructors recognize that their students may be at risk for disordered eating.
To investigate the potential of Mindfulness-Based Stress Reduction (MBSR) as a treatment for chronic primary insomnia.
Randomized controlled trial.
University health center.
30 adults with primary chronic insomnia based on DSM-IV-TR criteria were randomized 2:1 to MBSR or pharmacotherapy (PCT).
MBSR, a program of mindfulness meditation training consisting of 8 weekly 2.5 hour classes and a day-long retreat, with ongoing home meditation practice expectations during 3 month follow-up; PCT, consisting of 3 mg of eszopiclone (LUNESTA™) nightly for 8 weeks, followed by 3 months of use as needed. A 10-minute sleep hygiene presentation was included in both interventions.
The Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep diaries and wrist actigraphy collected pre-treatment, post-treatment (8 weeks), and at 5 months (self-reports only).
Between baseline and 8-weeks, sleep onset latency measured by actigraphy decreased 8.9 minutes in the MBSR arm (P<.05). Large, significant improvements were found on the ISI, PSQI, and diary-measured total sleep time, sleep onset latency and sleep efficiency (Ps<.01, all) from baseline to 5 month follow-up in the MBSR arm. Changes of comparable magnitude were found in the PCT arm. 27 out of 30 patients completed their assigned treatment. This study provides initial evidence for the efficacy of MBSR as a viable treatment for chronic insomnia as measured by: sleep diary, actigraphy, well-validated sleep scales and measures of remission and clinical recovery.
Chronic primary insomnia; mindfulness; meditation; sleep latency
Complicated grief, which is often under-recognized and under-treated, can lead to substantial impairment in functioning. The Brief Grief Questionnaire (BGQ) is a 5-item self-report or interview instrument for screening complicated grief. Although investigations with help-seeking samples suggest that the BGQ is valid and reliable, it has not been validated in a broader population.
A questionnaire was mailed to a randomly selected sample (n = 5000) residing in one of 4 areas of Japan. The BCQ was examined for responders who were bereaved more than 6 months and less than 10 years (n = 915). Non-specific psychological distress was assessed with the K6 screening scale. Multiple group confirmatory factor analysis supported a uni-dimensional factor structure and the invariance of parameters across gender and age. Cronbach's alpha was sufficiently high (alpha = .75) to confirm internal consistency. Average Variance Extracted (0.39) was higher than the shared covariance (0.14) between BGQ and K6, suggesting discriminant validity.
The results of this study support the reliability and validity of the BGQ in the Japanese population. Future studies should examine predictive validity by using structured interviews or more detailed scales for complicated grief.