The NIfETy method for environmental assessment of neighborhood-level indicators of violence, alcohol, and other drug exposure.

There are limited validated quantitative assessment methods to measure features of the built and social environment that might form the basis for environmental preventive interventions. This study describes a model approach for epidemiologic assessment of suspected environmental determinants of violence, alcohol and other drug (VAOD) exposure and fills this gap in current research. The investigation sought to test the feasibility of a systematic and longitudinal assessment of residential block characteristics related to physical and social disorder and indicators of VAOD exposure. Planometric data were used to establish a stratified random sample of street segments within defined neighborhoods of an urban metropolitan area. Field rater assessments of these neighborhood street segments were conducted using the Neighborhood Inventory for Environmental Typology (NIfETy). This report provides a detailed description of the NIfETy Method, including metric properties of the NIfETy Instrument and outcomes of training procedures and quality control measures. Also presented are block-level characteristics and estimates of observable signs of VAOD activity. This work is a first step toward developing future community-level environmental preventive interventions geared to reduce community VAOD exposure among youthful urban populations and may prove to be useful to other public health research groups as well.

A further look at the prognostic power of young children's reports of depressed mood and feelings.

A primary objective of the present study was to determine the validity of first graders' self-reports of depressed mood and feelings. To that end, the prognostic power of first grade self-reports of depressed mood and feelings was examined with respect to later psychopathology and adaptive functioning in a population of urban school children (N = 946). First grade self-reports of depressed mood predicted later child academic functioning, the need for and use of mental health services, suicidal ideation, and a diagnosis of major depressive disorder by age 14. The prognostic power of these early self-reports suggests that children as young as 5 or 6 years of age are capable of providing valid reports of depressed mood and feelings.

Proximal impact of two first-grade preventive interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior.

We assessed the immediate effects of two universal, first-grade preventive interventions on the proximal targets of poor achievement, concentration problems, aggression, and shy behaviors, known early risk behaviors for later substance use/abuse, affective disorder, and conduct disorder. The classroom-centered (CC) intervention was designed to reduce these early risk behaviors by enhancing teachers' behavior management and instructional skills, whereas the family-school partnership (FSP) intervention was aimed at improving parent-teacher communication and parental teaching and child behavior management strategies. Over the course of first and second grades, the CC intervention yielded the greatest degree of impact on its proximal targets, whereas the FSP's impact was somewhat less. The effects were influenced by gender and by preintervention levels of risk. Analyses of implementation measures demonstrated that greater fidelity to the intervention protocols was associated with greater impact on behavior ratings and on achievement scores, thus providing some evidence of specificity in the effect of the interventions.

Grandmother involvement in child caregiving in an urban community.

In a community-defined, epidemiologic sample in East Baltimore, we examined grandmothers' rates of co-residence and their involvement in four parenting activities. Co-residence rates exceeded the national average. Six types of family households with grandmothers were identified, and their frequency varied by race. Neither grandmother age nor employment was associated with grandmothers' parenting involvement, although family structure was. Grandmothers who were the sole parent (21%) or co-parent with a grandfather (6.5%) were most involved in child care and had the fewest number of helpers. Grandmothers living with single mothers (41%) were the next most involved, while grandmothers in mother/father households (9%) were least involved.

Household family structure and children's aggressive behavior: a longitudinal study of urban elementary school children.

The relationship between contemporary household family structures at fourth-grade and sixth-grade parent- and teacher-rated aggression was examined in an epidemiologically defined population of urban school children. The relationship between family structure and aggression varied by child gender and by parent and teacher ratings in the home and school, respectively. After taking into account family income, urban area, and fourth-grade aggressive behavior, boys in both mother-father and mother-male partner families were significantly less likely than boys in mother-alone families to be rated as aggressive by teachers. No significant relations between family structure and teacher- or parent-rated aggression were found for girls.

Family structure and aggressive behavior in a population of urban elementary school children.

OBJECTIVE: This report examined associations between family structure and 393 fourth-grade children's aggressive behavior. METHOD: In an epidemiologically defined urban community population, both teacher and parent ratings of child aggressive behavior were examined among family structures that reflected current demographics. Relative risks for teacher- and parent-rated child aggressive behavior in mother-alone households were compared with those in the next most prevalent family structures (mother-father, mother-grandmother, and mother-male partner families). RESULTS: With all income groups combined, teachers rated boys and girls in mother-alone families as more aggressive relative to mother-father families. Among low-income families, the protective effects for mother-father families were not apparent, and mother-male partner families were associated with an increased risk for teacher-rated aggression for boys. CONCLUSION: Absence of and type of second adult present, child gender, home and school context, and income were important factors that moderated the associations between family structure and child aggressive behavior in this urban setting.

The effects of a multimodal intervention with attention-deficit hyperactivity disorder children: a 9-month follow-up.

Using a double-blind, placebo design, we evaluated 96 attention-deficit hyperactivity disordered children for the effects of methylphenidate alone and in combination with behavioral parent training plus child self-control instruction. Seventy one of the children completed the treatment protocol. As reported previously, main effects were found for medication at posttest; however, there was no evidence of additive effects. Nine months after the termination of the behavioral interventions and the withdrawal of the stimulant medication, we found limited support for the hypothesis that the combined conditions would produce greater maintenance of treatment gains than would medication alone.

Additive effects of psychostimulants, parent training, and self-control therapy with ADHD children.

Utilizing a double-blind, placebo design, the effects of a high (0.8 mg/kg) and a low (0.4 mg/kg) dose of methylphenidate alone and in combination with behavioral parent training plus child self-control instruction were evaluated with 96 attention deficit hyperactivity disorder children. No evidence of the superiority of the combined conditions relative to medication alone was found. Some limited support was found for the hypothesis that the effects of a high dose of psychostimulant medication could be achieved by combining the low dose with a behavioral intervention. The importance of the latter finding is highlighted by the fact that both the benefits and untoward effects of the psychostimulants appear to increase with the dose.

Methods of analyzing physician practice patterns in hypertension.

A principal method of studying physician practice patterns has been to examine physicians' responses to brief written cases. We have compared this method with practice patterns of the same physicians derived from chart audit. Subjects were 98 family practice residents for whom data were available in actual patient encounters for the workup of asymptomatic hypertension. Short, carefully structured case reports using four cues were designed and a checklist similar to the one used for test ordering in practice was employed. Chart reviews and billing encounter forms were used for comparison. Results indicated residents ordered fewer tests in clinical practice, due, in part, to practice constraints not represented in the written cases. Physicians tend to make the diagnosis of hypertension incrementally in practice, with no one visit adequately representing the point of diagnosis. Studies based on data bases using a patient encounter as the unit of analysis in chronic disease such as hypertension may spuriously underestimate the actual number of tests ordered for the workup. Judgment cases may better reflect the patterns of use of information in a well-defined problem. Prediction of number of tests ordered in the clinical setting has not been established in this case.

The reliability and validity of the maternal social support index.

The Maternal Social Support Index (MSSI) is a 21-item questionnaire designed to quickly assess qualitative and quantitative aspects of a mother's social support. Previous studies have found an association between scores on the MSSI and home stimulation of preschool children, child maltreatment, and low birthweight. This report examines the test-retest reliability, internal consistency and concurrent and predictive validity of the MSSI in three samples of mothers (N = 488) from a prenatal clinic, pediatric clinic, and psychology clinic. The MSSI was found to have a test-retest correlation of .72 (P less than 0.001) over six to eight weeks. Coefficient alphas ranged from .60 to .63 across the three samples, denoting moderate internal consistency. In the psychology clinic sample, the MSSI was found to be positively correlated with the Dyadic Adjustment Scale (r = .393, P less than 0.001) and inversely correlated with the Center for Epidemiologic Studies Depression Scale (r = .296, P less than 0.001). The MSSI is a brief, reliable instrument with acceptable internal consistency and concurrent and predictive validity. It may be employed in the primary care arenas of clinical research and patient care to provide an organized assessment of maternal social support.