Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults.

BACKGROUND: Childhood adversity (CA) is associated with adult mental disorders, but the mechanisms underlying this association remain inadequately understood. Stress sensitization, whereby CA increases vulnerability to mental disorders following adult stressful life events, has been proposed as a potential mechanism. We provide a test of the stress sensitization hypothesis in a national sample. METHOD: We investigated whether the association between past-year stressful life events and the 12-month prevalence of major depression, post-traumatic stress disorder (PTSD), other anxiety disorders, and perceived stress varies according to exposure to CA. We used data from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n=34 653). RESULTS: Past-year stressful life events were associated with an increased risk of major depression, PTSD, anxiety disorders, and perceived stress. However, the magnitude of the increased risk varied according to respondents' history of CA. For example, past-year major stressors were associated with a 27.3% increase in the 12-month risk of depression among individuals with 3 CAs and a 14.8% increased risk among individuals without CAs. Stress sensitization effects were present for depression, PTSD, and other anxiety disorders in women and men, although gender differences were found in the threshold of past-year stress needed to trigger such effects. Stress sensitization was most evident among individuals with 3 CAs. CONCLUSIONS: CA is associated with increased vulnerability to the deleterious mental health effects of adult stressors in both men and women. High levels of CA may represent a general diathesis for multiple types of psychopathology that persists throughout the life course.

Education and race-ethnicity differences in the lifetime risk of alcohol dependence.

OBJECTIVES: While lower socioeconomic status (SES) is related to higher risk for alcohol dependence, minority race-ethnicity is often associated with lower risk. This study attempts to clarify the nature and extent of social inequalities in alcohol dependence by investigating the effects of SES and race-ethnicity on the development of alcohol dependence following first alcohol use. DESIGN: Cross-sectional analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). Survival analysis was used to model alcohol dependence onset according to education, race-ethnicity and their interaction. SETTING: United States, 2001-2. RESULTS: Compared with non-Hispanic white people, age-adjusted and sex-adjusted risks of alcohol dependence were lower among black people (odds ratio (OR) = 0.70, 95% confidence interval (CI) = 0.63 to 0.78), Asians (OR = 0.65, CI = 0.49 to 0.86) and Hispanics (OR = 0.68, CI = 0.58 to 0.79) and higher among American Indians (OR = 1.37, CI = 1.09 to 1.73). Individuals without a college degree had higher risks of alcohol dependence than individuals with a college degree or more; however, the magnitude of risk varied significantly by race-ethnicity (chi(2) for the interaction between education and race-ethnicity = 19.7, df = 10, p = 0.03); odds ratios for less than a college degree were 1.12, 1.46, 2.24, 2.35 and 10.99 among Hispanics, white people, black people, Asians, and American Indians, respectively. There was no association between education and alcohol dependence among Hispanics. CONCLUSIONS: Race-ethnicity differences in the magnitude of the association between education and alcohol dependence suggest that aspects of racial-ethnic group membership mitigate or exacerbate the effects of social adversity.

Is a general women's health promotion program as effective as an HIV-intensive prevention program in reducing HIV risk among Hispanic women?

OBJECTIVE: This study aimed to assess whether participants in an HIV-intensive prevention program and participants in a general women's health promotion program reported greater HIV risk-reduction than participants in a wait-list control group immediately following program participation and at three-month follow-up. METHODS: The authors studied 162 Hispanic women ages 18 to 35 years, most of them immigrants. Three-fourths of the sample (74%) reported earning less than $800 a month, 29% did not have a high school degree, and 90% had children. Data were gathered through surveys at baseline, at intervention completion, and at three-month follow-up. Information was collected on sociodemographics, HIV risk factors, and risk behaviors. Crude and adjusted (for demographics and dose) logistic regression analyses were used to assess program effects on participants' risk reduction. RESULTS: Crude logistic regression analyses reveal that both programs resulted in increased condom use at post-test and follow-up. Only participants in the HIV-intensive prevention program reported increased safer sex negotiation at post-test and follow-up, however, and only participants in the women's health promotion program reported increased HIV testing at post-test. CONCLUSION: Both interventions increased condom use. The HIV-intensive prevention program appeared to be more effective in promoting safer sex negotiation, and the women's health promotion program appeared more effective in promoting HIV testing. The findings suggest that both approaches may be viable ways to package HIV prevention for short-term behavior change in this population.