Adverse childhood experiences and co-occurring psychological distress and substance abuse among juvenile offenders: the role of protective factors.

OBJECTIVE: The purpose of this study was to estimate associations between cumulative exposure to adverse childhood experiences (ACEs), protective factors, and co-occurrence among male and female juvenile offenders. STUDY DESIGN: Cross-sectional study. METHODS: Validated measures of ACEs, internal resilience, external youth assets, psychological distress, and substance abuse were collected from 429 youths involved in the juvenile justice system in Nevada. A three-level outcome variable was created using the psychological distress and substance use measures: no problems, one problem, or co-occurring problems. Hierarchical multinomial logistic regression models were used to determine the independent, direct, and moderating impact of the protective factors on ACEs and the outcome. RESULTS: Internal resilience, family communication, school connectedness, peer role models, and non-parental adult role models were associated with lower odds of co-occurrence compared to having no problems (adjusted odds ratios [AORs] ranged from 0.11 to 0.33). When ACEs were added to the model, internal resilience and all assets except for one (non-parental adult role models) continued to offer protection against co-occurrence. Internal resilience was the only protective factor that significantly moderated the association between ACEs and co-occurrence (AOR, 0.24; 95% CI, 0.06, 0.99). CONCLUSION: Most protective factors decreased co-occurring mental health and substance abuse problems in the presence of ACE exposure and internal resilience moderated the relationship between ACEs and co-occurrence. Juvenile justice systems should use positive youth development approaches to help prevent co-occurrence among youths.

Associations between youth assets and sexual activity: does adult supervision play a role?

BACKGROUND: Youth participation in sexual risk behaviours continues to be a critically important public health topic. Additionally, as youth are frequently being left alone during the day without adult supervision, there are increased opportunities for sexual risk-taking behaviour. This study examined how the relationships of nine youth assets and sexual activity may vary according to the stratification of youth into two groups: self-care and supervised. METHODS: Data were collected through at-home, in-person interviews from a random sample of inner-city youth (mean age = 15.4 years; 51.5% female; 48.8% White; 22.4% Black; 18.5% Hispanic; 10% Native American) and their parents (n = 1079 parent/youth pairs). Nine youth assets were analysed using multiple logistic regression. Examples of assets youth may possess are: positive role models, family communication, school connectedness, constructive use of time and aspirations for the future. The item used to assess sexual intercourse was 'Have you ever had sexual intercourse ("done it", "had sex", "made love", "gone all the way")?'. Asset/risk behaviour associations that were unique to one of the two strata were the focus of the study. RESULTS: Thirty-seven per cent of youth spent two or more hours per day home alone. Youth who were supervised had a greater number of unique significant associations between assets and sexual activity than youth who were in the self-care group. CONCLUSIONS: Youth in supervised settings may be less likely to participate in sexual activity because of the presence of assets. Certain assets may also be important in deterring sexual activity for youth who are in self-care.

A matched case-control study: investigating the relationship between youth assets and sexual intercourse among 13- to 14-year-olds.

BACKGROUND: The number of teenagers engaging in sexual intercourse has consistently changed over the past several years. This can become a major challenge when trying to determine why teens continue to have sex. The purpose of this paper was to investigate the relationship between youth assets and sexual intercourse among 13- to 14-year-olds. METHODS: Cross-sectional data were collected using in-person at-home interviews from a random sample of inner-city neighbourhood 13- to 14-year-old teenagers (n = 64 matched pairs; 36% 13-year-olds, 53% female, 45% white, 28% African-American, 16% Hispanic and 11% Native American). Nine individual youth assets were analysed using conditional logistic regression (matching for several demographic variables) to assess the association between assets and abstinence in younger teens. RESULTS: Conditional logistic regression analyses showed that two assets, positive Peer Role Models [odds ratios (OR) = 4.67, 95% confidence intervals (CI) = 1.93, 11.27] and Use of Time (Religion) (OR = 2.20, 95% CI = 1.04, 4.65), were significantly related (P < 0.05) to younger teens never having engaged in sexual activity. CONCLUSION: These findings suggest, when considering abstinence behaviour, involvement in religious activities and having positive peer role models appear to be protective factors related to delaying sexual intercourse among teens aged 13-14 years.

Stability and convergent validity of the Physical Activity Scale for the Elderly (PASE).

AIM: The purpose of this study was to assess the stability and convergent validity of the Physical Activity Scale for the Elderly (PASE) among rural, community dwelling elderly persons using Computer Science and Applications, Inc. Actigraph Monitors (Actigraph) as the direct criterion measure. EXPERIMENTAL DESIGN: a correlational design was employed. SETTING: rural community in the United States. PARTICIPANTS: 56 subjects (age=75.7+/-7.9 years) who were living independently and volunteered to participate in the study. MEASURES: subjects wore an Actigraph monitor during all waking hours for 7 consecutive days. At the conclusion of the 7 days, each subject met with a trained interviewer to complete the PASE questionnaire. Three days later the subjects met with the same interviewer to complete the PASE a 2nd time recalling their physical activity for the same 7-day period. RESULTS: Actigraph data indicated that subjects averaged 168.1+/-76.3 counts x minute(-1) during the 7-day period. A high intraclass correlation coefficient (r=0.91) was calculated between the 1st interview total PASE score (115.97+/-59.91) and the 2nd interview total PASE score (115.71+/-50.97). In addition, there was a statistically significant Spearman correlation coefficient of 0.43 (p<0.01) between Actigraph mean counts x minute(-1) and 1st interview total PASE scores. CONCLUSION: In this rural elderly sample, the PASE was a stable instrument with validity indices similar to those previously reported in younger, more active, populations.

The effect of life events and exercise program format on the adoption and maintenance of exercise behavior.

This study prospectively investigated the effects of major life events on subsequent exercise adherence rates of individuals (N = 173) participating in a 2-year, randomized, controlled clinical trial of 3 different exercise conditions (higher-intensity home-based; lower-intensity home-based; and higher-intensity class-based). For 3 of 4 6-month exercise-adherence periods, an analysis of variance indicated a significant main effect (p < .05) for major life events. Compared with participants reporting 0 or 1 major life event, exercise adherence in the maintenance phase was significantly lower for those reporting 3 or 4 major life events regardless of the exercise condition. No significant life-event-exercise-adherence relationship was found in the adoption phase of exercise participation (i.e., Months 1 to 6). The deleterious effect of life events emphasizes the importance of instruction regarding how to prepare for high-risk situations that can lead to missed exercise sessions or to program attrition.

The influence of physician race, age, and gender on physician attitudes toward advance care directives and preferences for end-of-life decision-making.

OBJECTIVE: To determine whether physicians' preferences for end-of-life decision-making differ between blacks and whites in the same pattern as patient preferences, with blacks being more likely than whites to prefer life-prolonging treatments. DESIGN: A mailed survey. SETTING AND PARTICIPANTS: American Medical Association (AMA) and National Medical Association (NMA) databases. To enrich the sample of black physicians, we targeted physicians in the AMA database practicing in high minority area zip codes and graduates of the traditionally black medical schools. MAIN OUTCOME MEASURES: Self-reported physician attitudes toward end-of-life decision-making and preference of treatment for themselves in persistent vegetative state or organic brain disease compared by race, controlling for age and gender. RESULTS: The 502 physicians (28%) who returned the questionnaire included 280 white and 157 black physicians. With regard to attitudes toward patient care, 58% of white physicians agreed that tube-feeding in terminally ill patients is "heroic," but only 28 % of black physicians agreed with the statement (P < .001). White physicians were more likely than black physicians to find physician-assisted suicide an acceptable treatment alternative (36.6% vs 26.5% of black physicians) (P < .05). With regard to the physicians preferences for future treatment of themselves for the persistent vegetative state scenario, black physicians were more than six times more likely than white physicians to request aggressive treatments (cardiopulmonary resuscitation, mechanical ventilation, or artificial feeding) for themselves (15.4% vs 2.5%) (P < .001). White physicians were almost three times as likely to want physician-assisted suicide (29.3% vs 11.8%) (P < .001) in this scenario. For a state of brain damage with no terminal illness, the majority of all physicians did not want aggressive treatment, but black physicians were nearly five times more likely than white physicians (23.0% vs 5.0%) (P < .001) to request these treatments. White physicians, on the other hand, were more than twice as likely to request physician-assisted suicide (22.5% vs 9.9%), P < .001 in this scenario. CONCLUSIONS: Physicians preferences for end-of-life treatment follow the same pattern by race as patient preferences, making it unlikely that low socioeconomic status or lack of familiarity with treatments account for the difference. Self-denoted race may be a surrogate marker for other, as yet undefined, factors. The full spectrum of treatment preferences should be considered in development of guidelines for end-of-life treatment in our diverse society.

Predicting the adoption and maintenance of exercise participation using self-efficacy and previous exercise participation rates.

OBJECTIVES: To investigate the relationships among self-efficacy, changes in self-efficacy, past exercise participation, future exercise adherence, and exercise program format. METHODS: Two-year randomized trial involving subjects (n = 63) participating in an aerobic exercise program. Subjects were randomly assigned to one of three exercise conditions: higher-intensity home-based exercise, higher-intensity class-based exercise, or lower-intensity home-based exercise. RESULTS: Results indicated that baseline self-efficacy and exercise format had significant (p < .02), independent effects on adherence during the adoption and early maintenance phases of exercise behavior. In contrast, in predicting long-term exercise program maintenance, a significant (p < .05) self-efficacy x exercise format interaction indicated that self-efficacy predicted adherence only in the supervised home-based exercise conditions. Results also suggest that baseline self-efficacy, independent of the effect of past adherence, significantly (p < .03) predicted exercise adherence during the adoption phase, but not early maintenance phase, of exercise behavior. Finally, adherence change during the adoption phase of exercise behavior significantly (p < .04) predicted Year-one levels of self-efficacy even after adjusting for the effect of baseline self-efficacy. CONCLUSIONS: These results suggest that exercise program format as well as an individual's initial cognitive and behavioral experiences in an exercise program play significant roles in determining exercise adherence.

Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making.

Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence in 269 healthy, initially sedentary adults ages 50-65 years. Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year. Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later. Predictors of short-term (1-year) adherence were generally similar to predictors of 2-year adherence. Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention.

Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial.

OBJECTIVE: To determine the effects of moderate-intensity exercise training on self-rated (subjective) sleep quality among healthy, sedentary older adults reporting moderate sleep complaints. DESIGN: Randomized controlled trial of 16 weeks' duration. SETTING: General community. PARTICIPANTS: Volunteer sample of 29 women and 14 men (of 67 eligible subjects) aged 50 to 76 years who were sedentary, free of cardiovascular disease, and reported moderate sleep complaints. No participant was withdrawn for adverse effects. INTERVENTION: Randomized to 16 weeks of community-based, moderate-intensity exercise training or to a wait-listed control condition. Exercise consisted primarily of four 30- to 40-minute endurance training sessions (low-impact aerobics; brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate. MAIN OUTCOME MEASURE: Pittsburgh Sleep Quality Index (PSQI). RESULTS: Compared with controls (C), subjects in the exercise training condition (E) showed significant improvement in the PSQI global sleep score at 16 weeks (baseline and posttest values in mean [SD] for C=8.93 [3.1] and 8.8 [2.6]; baseline and posttest values for E=8.7 [3.0] and 5.4 [2.8]; mean posttest difference between conditions=3.4; P<.001; 95% confidence interval, 1.9-5.4), as well as in the sleep parameters of rated sleep quality, sleep-onset latency (baseline and posttest values for C=26.1 [20.0] and 23.8 [15.3]; for E=28.4 [20.2] and 14.6 [13.0]; net improvement=11.5 minutes), and sleep duration baseline and posttest scores for C=5.8 [1.1] and 6.0 [1.0]; for E=6.0 [1.1] and 6.8 [1.2]; net improvement=42 minutes) assessed via PSQI and sleep diaries (P=.05). CONCLUSIONS: Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program.