An Exploratory Analysis of Accelerometer-Measured Physical Activity and Emotional Functioning in Patients With Chronic Pain.

BACKGROUND: Physical activity (PA) can benefit pain and emotional functioning for patients with chronic pain. However, associations between different intensities of PA (moderate-to-vigorous PA, light PA, and sedentary behavior), pain, and emotional functioning are not well understood in patients with chronic pain. OBJECTIVE: The goals of this study were to (1) describe PA patterns of adult patients with chronic pain using accelerometers and (2) explore preliminary associations between PA intensities, pain, and emotional functioning. METHODS: Thirteen patients with chronic pain completed self-report measures of pain, cognitive and emotional reactions to pain, depression and anxiety, and wore ActiGraph accelerometers for 1 week before participating in a pilot mind-body PA intervention. RESULTS: Sedentary behavior and light activity were strongly inversely correlated (r = -0.93, P < 0.01). Greater sedentary behavior was associated with lower pain during activity (r = -0.55, P = 0.05), and greater light activity was correlated with higher pain during activity (r = 0.63, P = 0.02) and pain at rest (r = 0.54, P = 0.06). However, greater moderate-to-vigorous PA was correlated with lower pain at rest (r = -0.66, P = 0.01), pain catastrophizing (r = -0.53, P = 0.06), depression (r = -0.44, P = 0.14), and anxiety (r = -0.57, P = 0.04). CONCLUSIONS: Objective accelerometer-measured PA has the potential to reveal differential associations between PA intensities, pain, and emotional functioning. Findings here suggest preliminary recommendations to focus on interconnections between moderate-to-vigorous PA, pain at rest, pain catastrophizing, anxiety, and depression for patients with chronic pain.

Assessing within- and between-family variations in an expanded measure of childhood adversity.

Previous measures of childhood adversity have enabled the identification of powerful links with later-life wellbeing. The challenge for the next generation of childhood adversity assessment is to better characterize those links through comprehensive, fine-grained measurement strategies. The expanded, retrospective measure of childhood adversity presented here leveraged analytic and theoretical advances to examine multiple domains of childhood adversity at both the microlevel of siblings and the macrolevel of families. Despite the fact that childhood adversity most often occurs in the context of families, there is a dearth of studies that have validated childhood adversity measures on multiple members of the same families. Multilevel psychometric analyses of this childhood adversity measure administered to 1,194 siblings in 500 families indicated that the additional categories of childhood adversity were widely endorsed, and increased understanding of the sources and sequalae of childhood adversity when partitioned into within- and between-family levels. For example, multilevel confirmatory factor analyses (MCFAs) indicated that financial stress, unsafe neighborhood, and parental unemployment were often experienced similarly by siblings in the same families and stemmed primarily from family wide (between-family) sources. On the other hand, being bullied and school stressors were often experienced differently by siblings and derived primarily from individual (within-family) processes. Multilevel structural equation modeling (MSEM) further illuminated differential criterion validity correlations between these categories of childhood adversity with midlife psychological, social, and physical health. Expanded, multidomain, and multilevel measures of childhood adversity appear to hold promise for identifying layered causes and consequences of adverse childhood experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Thriving in midlife: The roles of childhood nurturance and adult defense mechanisms.

The current study examined whether reliance on more adaptive defense mechanisms throughout early adulthood may help explain previously documented relationships between childhood nurturance and better midlife functioning. Utilizing a unique longitudinal study, data were from age 18 through midlife (age 63) on 135 males. Childhood nurturance was assessed upon study entry and defense mechanism usage was assessed throughout earlier adulthood. Percentage of 'engaging' (more adaptive) vs. 'avoidant' (less adaptive) defenses mediated the relationship between childhood nurturance and 3 midlife outcomes: participants' relationship quality with their children, marriage stability, and maximum earned income. Results suggest that greater childhood nurturance relates to more adaptive defensive styles in early adulthood, which is then associated with healthier midlife functioning at work and in relationships.

Special Education Financing and ADHD Medications: A Bitter Pill to Swallow.

Accurate diagnosis of attention deficit/hyperactivity disorder (ADHD) in children is difficult because the major symptoms, inattentiveness and hyperactivity, can be exhibited by any child. This study finds evidence of systematic differences in diagnosis and treatment of ADHD due to third party financial incentives. In some states, due to the financing mechanism for special education, schools face a financial incentive to facilitate the identification of children with ADHD. Using variation in special education funding policies across states, we find that children living in states with financial incentives are about 15 percent more likely to report having ADHD and are about 22 percent more likely to be taking medication for ADHD. We provide support that these findings are causal by leveraging variation from two states that implemented policy changes during the time period studied.

The effect of college education on mortality.

We exploit exogenous variation in years of completed college induced by draft-avoidance behavior during the Vietnam War to examine the impact of college on adult mortality. Our estimates imply that increasing college attainment from the level of the state at the 25th percentile of the education distribution to that of the state at the 75th percentile would decrease cumulative mortality for cohorts in our sample by 8 to 10 percent relative to the mean. Most of the reduction in mortality is from deaths due to cancer and heart disease. We also explore potential mechanisms, including differential earnings and health insurance.

A longitudinal examination of positive parenting following an acceptance-based couple intervention.

Positive parenting practices have been shown to be essential for healthy child development, and yet have also been found to be particularly challenging for parents to enact and maintain. This article explores an innovative approach for increasing positive parenting by targeting specific positive emotional processes within marital relationships. Couple emotional acceptance is a powerful mechanism that has repeatedly been found to improve romantic relationships, but whether these effects extend to the larger family environment is less well understood. The current longitudinal study examined the impact of improved relational acceptance after a couple intervention on mother's and father's positive parenting. Participants included 244 parents (122 couples) in the Marriage Checkup (MC) study, a randomized, controlled, acceptance-based, intervention study. Data indicated that both women and men experienced significantly greater felt acceptance 2 weeks after the MC intervention, treatment women demonstrated greater positive parenting 2 weeks after the intervention, and all treatment participants' positive parenting was better maintained than control couple's 6 months later. Importantly, although mothers' positive parenting was not influenced by different levels of felt acceptance, changes in father's positive parenting were positively associated with changes in felt acceptance. As men felt more accepted by their wives, their levels of positive parenting changed in kind, and this effect on positive parenting was found to be mediated by felt acceptance 2 weeks after the MC. Overall, findings supported the potential benefits of targeting couple acceptance to generate positive cascades throughout the larger family system.

The effects of retiree health insurance plan characteristics on retirees' choice and employers' costs.

To moderate the rate of growth of retiree health insurance costs, employers can modify plans and move retirees into less expensive plans. We examine policy modifications implemented by the North Carolina State Health Plan. We investigate whether incentives produce the desired plan elections and whether these changes, along with cost shifting, produce the expected reductions in cost growth. Using individual-level administrative data, along with aggregated data on expenditures for retirees, we estimate the effects of the introduction and subsequent repeal of a Comprehensive Wellness Initiative for non-Medicare eligible retirees, as well as increases in coinsurance and copayments and the introduction of a premium for all retirees. Over a third of non-Medicare retirees shifted into the least generous plan between June 2009 and December 2012. The level effects on annual costs and unfunded accrued liabilities were relatively modest, but growth rates were diminished. Increases in the retiree premiums reduced the state's projected costs.

Active and retired public employees' health insurance: potential data sources.

Employer-provided health insurance for public sector workers is a significant public policy issue. Underfunding and the growing costs of benefits may hinder the fiscal solvency of state and local governments. Findings from the private sector may not be applicable because many public sector workers are covered by union contracts or salary schedules and often benefit modifications require changes in legislation. Research has been limited by the difficulty in obtaining sufficiently large and representative data on public sector employees. This article highlights data sources researchers might utilize to investigate topics concerning health insurance for active and retired public sector employees.

The Marriage Checkup: a randomized controlled trial of annual relationship health checkups.

OBJECTIVE: This study assessed the efficacy of the Marriage Checkup (MC) for improving relationship health and intimacy. METHOD: Cohabiting married couples (N = 215, Mage women = 44.5 years, men = 47 years, 93.1% Caucasian) recruited from a northeastern U.S. metropolitan area through print and electronic media were randomly assigned to MC treatment or wait-list control. Treatment but not control couples participated in assessment and feedback visits, at the beginning of the study and again 1 year later. All couples completed 9 sets of questionnaires over 2 years. Outcome measures included the Quality of Marriage Index, the Global Distress subscale of the Marital Satisfaction Inventory-Revised, the Intimate Safety Questionnaire, and the Relational Acceptance Questionnaire. RESULTS: A latent growth curve model indicated significant between-group differences in intimacy at every measurement point after baseline (d ranged from .20 to .55, Md = .37), significant between-group differences in women's felt acceptance for every measurement point after baseline (d ranged from .17 to .47, Md = .34), significant between-group differences in men's felt acceptance through the 1-year 2-week follow-up (d across follow-up ranged from .11 to .40, Md = .25), and significant between-group differences in relationship distress through 1-year 6-month follow-up (d across follow-up ranged from .11 to .39, Md = .23). CONCLUSIONS: Longitudinal analysis of the MC supports the hypothesis that the MC significantly improves intimacy, acceptance, and satisfaction. Implications for dissemination are discussed.

Business Cycles and Divorce: Evidence from Microdata.

We use individual-level data to show that divorce is pro-cyclical on average, a finding robust to the inclusion of a wide range of controls. Pro-cyclical divorce is concentrated among women who married young and/or do not have a college degree.

The marriage checkup: increasing access to marital health care.

Despite the ongoing prevalence of marital distress, very few couples seek therapy. Researchers and clinicians have increasingly been calling for innovative interventions that can reach a larger number of untreated couples. Based on a motivational marital health model, the Marriage Checkup (MC) was designed to attract couples who are unlikely to seek traditional tertiary therapy. The objective of the MC is to promote marital health for as broad a population of couples as possible, much like regular physical health checkups. This first paper from the largest MC study to date examines whether the MC engaged previously unreached couples who might benefit from intervention. Interview and survey data suggested that the MC attracted couples across the distress continuum and was perceived by couples as more accessible than traditional therapy. Notably, the MC attracted a substantial number of couples who had not previously participated in marital interventions. The motivational health checkup model appeared to encourage a broad range of couples who might not have otherwise sought relationship services to deliberately take care of their marital health. Clinical implications are discussed.

Reliability and validity of the Time-Sensitive ADHD Symptom Scale in adults.

OBJECTIVES: The objective of this study was to examine the psychometric properties of the Time-Sensitive ADHD Symptom Scale (TASS) to evaluate change of attention-deficit/hyperactivity disorder (ADHD) symptoms over the course of a day in adults. METHODS: Eighty adults with ADHD participated in 1 or 2 visits, 1 to 9 weeks apart. At each visit, participants completed the TASS followed by raters administering the ADHD Rating Scale (ADHD-RS). Additional TASS and ADHD-RS ratings were completed 2 to 6 hours after each visit via telephone. Internal consistency of TASS items was assessed by Cronbach's α. Convergent validity of TASS and ADHD-RS total mean item scores was assessed using Pearson's correlation coefficients. κ correlations were calculated to assess item-by-item reliability between TASS and ADHD-RS items. RESULTS: Internal consistency of TASS items was high, with an overall Cronbach's α coefficient of .93. The Pearson's correlation coefficient between the TASS and ADHD-RS was significant for all visits (r = 0.70, P < .0001). There was moderate agreement between individual items on the TASS and ADHD-RS, with significant κ coefficients for almost all items (P < .05). DISCUSSION: The TASS showed high internal consistency and concurrent validity with the clinician-administered ADHD-RS and is a valid and reliable scale for measuring change in ADHD symptoms over the course of a day in adults.

The effects of maternal employment on the health of school-age children.

The effects of maternal employment on children's health are theoretically ambiguous and challenging to identify. There are trade-offs between income and time, and a mother's decision to work reflects, in part, her children's health and her underlying preferences. I utilize exogenous variation in each child's youngest sibling's eligibility for kindergarten as an instrument. Using the restricted-access National Health Interview Survey (1985-2004), I identify the effects on overnight hospitalizations, asthma episodes, and injuries/poisonings for children ages 7-17. Maternal employment increases the probability of each adverse health event by nearly 200 percent. These effects are robust and do not reflect a non-representative local effect.

Booms, Busts, and Divorce.

For almost a century, anecdotes have suggested that divorce rates decline during recessions. However, until very recently there has been surprisingly little formal empirical evidence on whether such a link exists, let alone its magnitude if it does. Moreover, the anticipated direction of the effect is ambiguous theoretically. Although previous studies have concluded that individual job loss destabilizes marriages, macroeconomic conditions may affect divorce probabilities even for those not directly experiencing a job shock. We add to the few existing contemporaneous studies of the effects of macroeconomic shocks on divorce by conducting an empirical analysis of the relationship between state-level unemployment rates and state-level divorce rates using vital statistics data on divorces in the United States from 1976-2009. We find a significant and robust negative relationship between the unemployment and divorce rates, whereby a one percentage point rise in the unemployment rate is associated with a decrease of 0.043 divorces per one thousand people, or about a one percent fall in the divorce rate. The result that divorce is pro-cyclical is robust to a host of alternative empirical specifications, to disaggregating by state characteristics and time period, to expanding the unemployment series back to 1970, and to using alternative measures of local economic conditions.

Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children.

We exploit the discontinuity in age when children start kindergarten generated by state eligibility laws to examine whether relative age is a significant determinant of ADHD diagnosis and treatment. Using a regression discontinuity model and exact dates of birth, we find that children born just after the cutoff, who are relatively old-for-grade, have a significantly lower incidence of ADHD diagnosis and treatment compared with similar children born just before the cutoff date, who are relatively young-for-grade. Since ADHD is an underlying neurological problem where incidence rates should not change dramatically from one birth date to the next, these results suggest that age relative to peers in class, and the resulting differences in behavior, directly affects a child's probability of being diagnosed with and treated for ADHD.

Pathways between marriage and parenting for wives and husbands: the role of coparenting.

As family systems research has expanded, so have investigations into how marital partners coparent together. Although coparenting research has increasingly found support for the influential role of coparenting on both marital relationships and parenting practices, coparenting has traditionally been investigated as part of an indirect system which begins with marital health, is mediated by coparenting processes, and then culminates in each partner's parenting. The field has not tested how this traditional model compares with the equally plausible alternative model, in which coparenting simultaneously predicts both marital relationships and parenting practices. Furthermore, statistical and practical limitations have typically resulted in only one parent being analyzed in these models. This study used model-fitting analyses to include both wives and husbands in a test of these two alternative models of the role of coparenting in the family system. Our data suggested that both the traditional indirect model (marital health to coparenting to parenting practices), and the alternative predictor model where coparenting alliance directly and simultaneously predicts marital health and parenting practices, fit for both spouses. This suggests that dynamic and multiple roles may be played by coparenting in the overall family system, and raises important practical implications for family clinicians.

Combination pharmacotherapy for adult ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders of adulthood. Although clinical guidelines recommend monotherapy with stimulants or atomoxetine, combination pharmacotherapy is a common practice among clinicians. There are four main situations in which combination medications may be necessary: partial response, dose-limiting side effects, associated disorders, and comorbid diagnoses. We present data from two chart reviews that support existing research on combination pharmacotherapy. Adjunct treatment of d-methylphenidate to stimulant medications extended the duration of therapeutic effect. Adjunct treatment of mirtazapine to stimulant medications reduced associated insomnia. These data support previous research that validates the use of combination pharmacotherapy for adults with ADHD.