Prevalence and correlates of vaccine attitudes and behaviors in a cohort of low-income mothers.

The US is facing a rise in vaccine hesitancy, delay, and refusal, though little is known about these outcomes in socio-economically disadvantaged populations. This study examines the prevalence and correlates of vaccine attitudes and behaviors in a diverse cohort of low-income mothers receiving home visiting services. Survey data were collected from 813 recipients of evidence-based home visiting services in Wisconsin from 2013 to 2018. Analyses were performed to describe outcome measures of vaccine attitudes and self-reported completion, and multivariate regressions were used to test associations between vaccine-related outcomes and hypothesized correlates. Most women (94%) reported their children were up to date on vaccines; 14.3% reported having ever delayed vaccination. A small minority disagreed that vaccines are important (5.0%), effective (5.4%), and safe (6.2%), though a larger proportion responded ambivalently (10.9%-21.9%). Participants with greater trust in health care providers reported more positive overall vaccine attitudes (B = 0.24; 95% CI = 0.17, 0.31), a lower likelihood of vaccine delay (OR = 0.57; 95% CI = 0.46, 0.73), and a greater likelihood of being up to date on vaccines (OR = 1.79, 95% CI = 1.30, 2.44). Women with greater trust in a home visitor also rated vaccines more positively (B = 0.09; 95% CI = 0.02, 0.15), and women who reported better mental health were more likely to report their children were up to date (OR = 1.05; 95% CI = 1.02, 1.09). Compared to non-Hispanic whites, American Indians and non-Hispanic blacks had poorer vaccine-related outcomes. More research on vaccine attitudes and behaviors among higher-risk populations is needed to develop tailored strategies aimed at addressing vaccine hesitancy and underimmunization.

Translating and Implementing Evidence-Based Mental Health Services in Child Welfare.

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent-child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children's mental health research, services, and policy are discussed.

Client and Provider Discomfort With an Adverse Childhood Experiences Survey.

INTRODUCTION: Many service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients' discomfort when they are asked similar questions by direct care providers, such as home visitors. METHODS: This study used data collected between 2013 and 2018 from 1,678 clients and 161 providers in a network of home visiting programs in Wisconsin. Clients and home visitors completed an adverse childhood experience questionnaire that concludes by asking about discomfort with the questions. Analyses conducted in 2018 examined overall client discomfort and associations between discomfort and the endorsement of 10 distinct adverse childhood experiences. Multilevel regressions were performed to test whether client and provider factors were associated with client discomfort. RESULTS: More than 80% of clients were not at all or slightly uncomfortable with the adverse childhood experience questionnaire, and 3% reported extreme discomfort. Bivariate results showed that each adverse childhood experience, except parental divorce, was associated with greater discomfort; sexual abuse was the only adverse childhood experience associated with discomfort in a multivariate analysis. Multiple client variables were linked to increased discomfort, including higher adverse childhood experience scores (b=0.06, 95% CI=0.04, 0.08) and depression scores (b=0.01, 95% CI=0.00, 0.02). Home visitor discomfort was positively associated with client discomfort (b=0.16, 95% CI=0.01, 0.31). CONCLUSIONS: Results indicated that most clients in home visiting programs tolerated an adverse childhood experience questionnaire well. The findings point to clients who may be more likely to report discomfort and highlight an important association between client and provider discomfort.

Childhood ADHD Symptoms and Future Illicit Drug Use: The Role of Adolescent Cigarette Use.

Objectives: The aim of this study is to understand how early cigarette use might predict subsequent illicit drug use, especially among individuals with attention-deficit hyperactivity disorder (ADHD) symptoms during childhood. Methods: Data were drawn from the National Longitudinal Study of Adolescent Health (Waves I-IV). The analysis sample involves participants who had not used illicit drugs at Wave I, with no missing responses for studied predictors (N = 7,332). Results: Smoking status at Wave I (ever regular vs. never regular) and childhood ADHD symptoms predicted subsequent illicit drug use at Waves II to IV. No interaction effect of smoking status at Wave I and childhood ADHD symptoms was found. However, an indirect effect from childhood ADHD symptoms on illicit drug use was identified, through smoking status at Wave I. Similar results were observed for predicting illicit drug dependence. Conclusions: The findings support the notion that smoking status during early adolescence may mediate the association between childhood ADHD symptoms and risk of later adult drug use. Interventions to prevent smoking among adolescents may be particularly effective at decreasing subsequent drug use, especially among children with ADHD symptoms.

DNA Methylation of Regulatory Regions of Imprinted Genes at Birth and Its Relation to Infant Temperament.

BACKGROUND: DNA methylation of the differentially methylated regions (DMRs) of imprinted genes is relevant to neurodevelopment. METHODS: DNA methylation status of the DMRs of nine imprinted genes in umbilical cord blood leukocytes was analyzed in relation to infant behaviors and temperament (n = 158). RESULTS: MEG3 DMR levels were positively associated with internalizing (ß = 0.15, P = 0.044) and surgency (ß = 0.19, P = 0.018) behaviors, after adjusting for birth weight, gender, gestational age at birth, maternal age at delivery, race/ethnicity, education level, smoking status, parity, and a history of anxiety or depression. Higher methylation levels at the intergenic MEG3-IG methylation regions were associated with surgency (ß = 0.28, P = 0.0003) and PEG3 was positively related to externalizing (ß = 0.20, P = 0.01) and negative affectivity (ß = 0.18, P = 0.02). CONCLUSION: While the small sample size limits inference, these pilot data support gene-specific associations between epigenetic differences in regulatory regions of imprinted domains at birth and later infant temperament.

Racial Differences in Obesity-Related Risk Factors Between 2-Year-Old Children Born of Overweight Mothers.

OBJECTIVE: Investigate racial differences in a range of obesity-related socio-behavioral risk factors in children born of obese mothers. METHODS: 142 Black and 151 White 2-year-old children and their parents were surveyed on their physical activity environment, food environment, parental role modeling, eating behaviors, feeding practices, child physical activity, dietary intake, and eating behaviors; body mass index (BMI) for parents and children (BMI z-score) were calculated. RESULTS: In bivariate analyses, Black families reported significantly more risk factors for early-childhood obesity than White families, including greater availability of soda, more television viewing, and poorer dietary intake. In multivariate analyses adjusting for maternal and socioeconomic factors, the differences between Black and White families on factors including television watching and dietary intake remained significant. CONCLUSION: These data show a greater number of risk factors for obesity among Black children and their families compared with White children even after adjustment for maternal BMI and socioeconomic status.

Attention Deficit Hyperactivity Disorder symptoms and smoking trajectories: race and gender differences.

PURPOSE: This study examined the influence of Attention Deficit Hyperactivity Disorder (ADHD) symptoms severity and directionality (hyperactive-impulsive symptoms relative to inattentive symptoms) on trajectories of the probability of current (past month) smoking and the number of cigarettes smoked from age 13 to 32. Racial and gender differences in the relationship of ADHD symptoms and smoking trajectories were also assessed. METHODS: A subsample of 9719 youth (54.5% female) was drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Cohort sequential design and zero-inflated Poisson (ZIP) latent growth modeling were used to estimate the relationship between ADHD directionality and severity on smoking development. RESULTS: ADHD severity's effect on the likelihood of ever smoking cigarettes at the intercept (age 13) had a greater impact on White males than other groups. ADHD severity also had a stronger influence on the initial number of cigarettes smoked at age 13 among Hispanic participants. The relationships between ADHD directionality (hyperactive-impulsive symptoms relative to inattentive symptoms) and a higher number of cigarettes smoked at the intercept were stronger among Hispanic males than others. Gender differences manifested only among Whites. CONCLUSION: ADHD severity and directionality had unique effects on smoking trajectories. Our results also highlight that the risk of ADHD symptoms may differ by race and gender.

Trajectories of depressive symptoms over 2 years postpartum among overweight or obese women.

BACKGROUND: Although depressive symptoms are common postpartum, few studies have followed women beyond 12 months postpartum to investigate changes in the number and severity of these symptoms over time, especially in overweight and obese women. Using two complementary analytical methods, this study aims to identify trajectories of depressive symptoms over 2 years postpartum among overweight or obese mothers, and assess the demographic, socioeconomic, and health covariates for these trajectories. METHODS: Using longitudinal data from two behavioral intervention studies (Kids and Adults Now!-Defeat Obesity [KAN-DO] and Active Mothers Postpartum (AMP); n = 844), we used latent growth modeling to identify the overall trajectory of depressive symptoms and how it was related to key covariates. Next, we used latent class growth analysis to assess the heterogeneity in the depressive symptom trajectories over time, and thereby, identify subgroups of women with distinct trajectories. FINDINGS: The overall trajectory of depressive symptoms over 2 years postpartum was relatively stable in our sample. However, the presence of three distinct latent class trajectories (stable-low [82.5%], decreasing symptoms [7.3%], and increasing symptoms [10.2%]), identified based on trajectory shape and mean depressive symptom score, supported heterogeneity in depressive symptom trajectories over time. Lower maternal education was related to a higher symptom score, and poorer subjective health status at baseline predicted inclusion in the increasing symptoms trajectory. CONCLUSIONS: In some overweight or obese mothers, postpartum depressive symptoms do not resolve quickly. Practitioners should be aware of this phenomenon and continue to screen for depression for longer periods of time postpartum.

Nicotinic receptor gene variants interact with attention deficient hyperactive disorder symptoms to predict smoking trajectories from early adolescence to adulthood.

OBJECTIVE: To examine the association of single nucleotide polymorphisms (SNPs) of the CHRNB3 (rs13280604) and CHRNA6 (rs892413) nicotinic acetylcholine receptor (nAChR) genes and symptoms of attention deficit hyperactivity disorder (ADHD) in predicting smoking patterns from early adolescence to adulthood. METHOD: A longitudinal cohort of 1137 unrelated youths from the National Longitudinal Study of Adolescent Health provided responses to four surveys from Waves I to IV, and a genetic sample in Wave III. Growth mixture modeling was used to identify smoking patterns and to assess the effects of the two SNPs and ADHD symptoms on cigarette use over time. RESULTS: There were significant main effects of ADHD symptoms and CHRNA6 variants in predicting the number of cigarettes smoked and the pattern of use over time, respectively. There were no main effects of the CHRNB3 variants. However, a significant CHRNB3 variant×ADHD symptom interaction was observed, such that individuals with elevated ADHD symptoms and a particular CHRNB3 variant were at increased risk of cigarette use over time. CONCLUSIONS: These findings demonstrate that a SNP in a nicotinic receptor gene may interact with ADHD symptoms to link with increased cigarette use across adolescence and young adulthood. Unique associations between specific variants and patterns of ADHD symptoms were identified which may be useful for targeting prevention efforts to individuals at greatest risk for cigarette smoking.

Childhood economic strains in predicting substance use in emerging adulthood: mediation effects of youth self-control and parenting practices.

OBJECTIVE: To examine the influence of childhood economic strains on substance use in young adulthood and to assess the mediating roles of self-control as well as positive parenting during adolescence in a nationally representative longitudinal cohort. METHODS: The study included data from participants (n = 1,285) in the Panel Study of Income Dynamics, Child Development Supplement, and Transition to Adult. Structural equation modeling was used to evaluate the associations among risk factors during childhood and adolescence that predicted substance use in early adulthood. RESULTS: Conditions of economic strains, especially poverty, during childhood were associated with an increased likelihood of regular smoking in adulthood, which was partially mediated by poorer self-control during adolescence. CONCLUSIONS: Self-control is negatively affected by economic strains and serves as a mediator between poverty and risk of regular smoking. Additional research is needed to better understand how economic strains effect the development of self-control.

Individual- and community-level correlates of cigarette-smoking trajectories from age 13 to 32 in a U.S. population-based sample.

BACKGROUND: Characterizing smoking behavior is important for informing etiologic models and targeting prevention efforts. This study explored the effects of both individual- and community-level variables in predicting cigarette use vs. non-use and level of use among adolescents as they transition into adulthood. METHODS: Data on 14,779 youths (53% female) were drawn from the National Longitudinal Study of Adolescent Health (Add Health); a nationally representative longitudinal cohort. A cohort sequential design allowed for examining trajectories of smoking typologies from age 13 to 32 years. Smoking trajectories were evaluated by using a zero-inflated Poisson (ZIP) latent growth analysis and latent class growth analysis modeling approach. RESULTS: Significant relationships emerged between both individual- and community-level variables and smoking outcomes. Maternal and peer smoking predicted increases in smoking over development and were associated with a greater likelihood of belonging to any of the four identified smoking groups versus Non-Users. Conduct problems and depressive symptoms during adolescence were related to cigarette use versus non-use. State-level prevalence of adolescent smoking was related to greater cigarette use during adolescence. CONCLUSIONS: Individual- and community-level variables that distinguish smoking patterns within the population aid in understanding cigarette use versus non-use and the quantity of cigarette use into adulthood. Our findings suggest that efforts to prevent cigarette use would benefit from attention to both parental and peer smoking and individual well-being. Future work is needed to better understand the role of variables in the context of multiple levels (individual and community-level) on smoking trajectories.

Adolescent nicotine dependence symptom profiles and risk for future daily smoking.

Recent research on adolescent smokers suggests that there are important differences in the types of nicotine dependence (ND) symptoms that emerge and different patterns of ND symptoms. The purpose of this study was to use data from the longitudinal Social and Emotional Contexts of Adolescent Smoking Patterns Study to identify latent subgroups of adolescent experimental and nondaily smokers varying in number and types of endorsed ND symptoms. Profiles were identified using baseline level of smoking, individual patterns of ND symptoms and other ND risk factors. Discrete time survival analysis was used to examine profile differences in probability of becoming daily smokers 48 months later. Four distinct subgroups of smokers with different patterns of smoking behavior, ND symptoms, and alcohol and other substance use emerged. Heavier smoking adolescents with high symptom endorsement, particularly the need to smoke in the morning, were most likely to become daily smokers 48 months later. A subgroup of social smokers had high smoking exposure and symptom endorsement (except need to smoke in the morning), and high levels of other substance use. Despite lower rates of smoking frequency and quantity compared to the heavier smoking class, 36% of these adolescents smoked daily by 48 months, with a steeper decline in survival rates compared to other lighter smoking classes. Morning smoking symptoms and symptoms prioritizing smoking (i.e., choosing to spend money on cigarettes instead of lunch or smoking when ill or where smoking is forbidden) might quickly identify adolescent non-daily smokers with more severe dependence and higher risk for daily smoking. A focus on skills for avoiding social situations involving use of alcohol and other drugs and reducing peer smoking influences may be an important focus for reducing smoking and other substance use among social smokers.

DSM-IV alcohol abuse and dependence criteria characteristics for recent onset adolescent drinkers.

BACKGROUND: Little is known about the psychometric properties of alcohol abuse and dependence criteria among recent-onset adolescent drinkers, particularly for those who consume alcohol infrequently. This study evaluated how well DSM-IV alcohol dependence criteria measure an alcohol use disorder (AUD) construct for recent onset adolescent drinkers at different levels of drinking frequency. METHOD: Data were drawn from the National Survey on Drug Use and Health, a nationally representative sample of 9356 recent-onset adolescent drinkers, aged 12-21, who began drinking within the past year. Multiple group item response theory analysis was conducted to assess the 11 DSM-IV alcohol abuse and dependence criteria. RESULTS: Criteria most likely to be endorsed at lower AUD severity included "withdrawal," "problems at home, school or work" and "tolerance." The criteria "drinking larger amounts/longer period of time," "unsuccessful efforts to cut down" and "continuing to drink despite related health problems" were more likely to be endorsed at higher AUD severity. Two criteria, "tolerance" and "time spent getting, using or recovering from alcohol" showed differential item functioning between drinking frequency groups (<7 vs. ≥ 7 days in past month), with lower discrimination and severity for more frequent drinkers. DSM-IV criteria were most precise for intermediate levels of AUD severity. CONCLUSIONS: All but two DSM-IV criteria had consistent psychometric properties across drinking frequency groups. Symptoms were most precise for a narrow, intermediate range of AUD severity. Those assessing AUD in recent onset adolescent drinkers might consider additional symptoms to capture the full AUD continuum.

Taiwanese adolescent cognitive autonomy and identity development: the relationship of situational and agential factors.

Taiwanese professionals have adopted information about adolescent psychosocial development from Western societies. However, scholars know little about whether they have properly applied the models to both rural and urban youth. The purpose of this study was to examine the development of cognitive autonomy and ego identity in Taiwanese adolescents from Taipei City and surrounding rural counties. We controlled for gender and examined both situational (residential location, family income, and school type) and agential factors (culture value affiliation, attachment, and resiliency) to determine the extent to which each predicted psychosocial developmental outcomes. Among all the factors in this study, resiliency had the most distinctive relationship with adolescent psychosocial development. Each factor successfully predicted specific aspects of psychosocial development for these youth. We conclude with a discussion of the utility of using Western models of development.

Latent class-derived subgroups of depressive symptoms in a community sample of older adults: the Cache County Study.

OBJECTIVE: We sought to identify possible subgroups of elders that varied in depressive symptomatology and to examine symptom patterns and health status differences between subgroups. METHODS: The Cache County memory study is a population-based epidemiological study of dementia with 5092 participants. Depressive symptoms were measured with a modified version of the diagnostic interview schedule-depression. There were 400 nondemented participants who endorsed currently (i.e., in the past 2 weeks) experiencing at least one of the three "gateway" depressive symptoms and then completed a full depression interview. Responses to all nine current depressive symptoms were modeled using the latent class analysis. RESULTS: Three depression subgroups were identified: a significantly depressed subgroup (62%), with the remainder split evenly between a subgroup with low probability of all symptoms (21%), and a subgroup with primarily psychomotor changes, sleep symptoms, and fatigue (17%). Latent class analysis derived subgroups of depressive symptoms and Diagnostic and statistical manual of mental disorders, fourth edition depression diagnostic group were nonredundant. Age, gender, education, marital status, early or late onset, number of episodes, current episode duration, and functional status were not significant predictors of depression subgroup. The first subgroup was more likely to be recently bereaved and had less physical health problems, whereas the third subgroup were less likely to be using antidepressants compared with the second subgroup. CONCLUSIONS: There are distinct subgroups of depressed elders, which are not redundant with the Diagnostic and statistical manual of mental disorders, fourth edition classification scheme, offering an alternative diagnostic approach to clinicians and researchers. Future work will examine whether these depressive symptom profiles are predictive of incident dementia and earlier mortality.

Alcohol dependence symptoms among recent onset adolescent drinkers.

This study examined prevalence of alcohol dependence symptoms and diagnosis among a nationally representative sample of recent onset adolescent drinkers aged 12-21 years (mean 17 years) across different levels of drinking drawn from National Survey of Drug Use and Health (N=9490). We assessed whether the relationship between level of alcohol use and alcohol dependence was similar for individuals from different socio-demographic groups (i.e., gender, age group, ethnic group, family income, and substance use in the past year). The most prevalent DSM-IV alcohol dependence criteria at low levels of alcohol use were "unsuccessful efforts to cut down", "tolerance", and "time spent" in activities necessary to obtain alcohol or recover from its effect. Logistic regression with polynomial contrasts indicated increasing rates of each criterion and an overall dependence diagnosis with increasing alcohol exposure that differed most between the lowest levels of recent drinking frequency. After controlling for drinking quantity, younger adolescents, females, Native American/Alaskans and Asian/Pacific Islanders were most likely to experience alcohol dependence symptoms and a diagnosis of dependence, suggesting that these demographic subgroups may experience dependence symptoms or develop dependence more quickly after beginning to drink. Recognizing early symptoms of alcohol dependence may assist in early identification and intervention of those at risk for heavier drinker in the future.

The relationship between individualistic, collectivistic, and transitional cultural value orientations and adolescents' autonomy and identity status.

In an effort to validate the use of a Western model of adolescent development with Asian youth, 781 urban and rural Taiwanese high school students (56% female) completed questionnaires about their development. Adolescents were first divided into cultural value orientations (i.e. collectivistic, individualistic, or transitional) and compared geographically. There were statistically significant differences in cultural value orientations only for rural youth. Identity statuses and levels of cognitive autonomy were then compared according to cultural value orientations and gender. Adolescents who self-identified as collectivistic were significantly more likely to self-identify as achieved rather than diffused compared to transitional adolescents. Gender, more than cultural value identifications, significantly differentiated these youth in regard to issues of cognitive autonomy measured in this study (i.e. evaluative thinking, voicing opinions, making decisions, self-assessing, and comparative validation). Taken in whole, these findings support the use of a Western model of adolescent development for Taiwanese youth.