Total and differential white blood cell counts in late life predict 8-year incident stroke: the Honolulu Heart Program

OBJECTIVES

To study the association between total and differential white blood cell (WBC) count and incident stroke in an older Asian population.

DESIGN

Prospective population-based study with 8 years of follow-up.

SETTING

The Honolulu Heart Program, Oahu, Hawaii.

PARTICIPANTS

Japanese-American men aged 71 to 93 who were free of stroke and had baseline WBC counts measured in 1991-93 (N=3,342).

MEASUREMENTS

Participants were divided into quartiles of total and differential WBC count for analysis and were followed for incident stroke (thromboembolic and hemorrhagic (hemorrhagic)) for 8 years using data from a comprehensive hospital surveillance system.

RESULTS

Age-adjusted incident stroke rates increased significantly with increasing WBC quartile (Q1, 7.68; Q2, 9.04; Q3, 9.26; Q4, 14.10 per 1,000 person-years of follow-up, P=.001). Hazard ratios (HRs) for stroke for each quartile of total and differential WBC count were obtained using Cox regression analysis, with the lowest quartile as the reference group. After full adjustment, including age; cardiovascular risk factors; fibrinogen; prevalent coronary heart disease, cancer, or chronic obstructive pulmonary disease, and nonsteroidal anti-inflammatory drug use, HRs were 1.62 (95% confidence interval (CI)=1.04-2.52, P=.03) in the highest quartile of total WBC and 2.19 (95% CI=1.41-3.39, P<.001) in the highest quartile of neutrophil counts. Significant associations were also seen for thromboembolic but not for hemorrhagic strokes. No significant associations were found between lymphocyte or monocyte counts and incident stroke or subtypes.

CONCLUSION

In elderly Japanese-American men, higher total WBC and neutrophil counts were independent predictors of overall stroke, as well as thromboembolic stroke.

Computer Instruction in Handwriting, Spelling, and Composing for Students with Specific Learning Disabilities in Grades 4 to 9

Effectiveness of iPad computerized writing instruction was evaluated for 4th to 9th graders (n=35) with diagnosed specific learning disabilities (SLDs) affecting writing: dysgraphia (impaired handwriting), dyslexia (impaired spelling), and oral and written language learning disability (OWL LD) (impaired syntax composing). Each of the 18 two-hour lessons had multiple learning activities aimed at improving subword- (handwriting), word- (spelling), and syntax- (sentence composing) level language skills by engaging all four language systems (listening, speaking, reading, and writing) to create a functional writing system. To evaluate treatment effectiveness, normed measures of handwriting, spelling, and composing were used with the exception of one non-normed alphabet writing task. Results showed that the sample as a whole improved significantly from pretest to posttest in three handwriting measures, four spelling measures, and both written and oral syntax construction measures. All but oral syntax was evaluated with pen and paper tasks, showing that the computer writing instruction transferred to better writing with pen and paper. Performance on learning activities during instruction correlated with writing outcomes; and individual students tended to improve in the impaired skill associated with their diagnosis. Thus, although computers are often used in upper elementary school and middle school in the United States (US) for accommodations (alternatives to pen and paper) for students with persisting SLDs affecting writing, this study shows computers can also be used for Tier 3 instruction to improve the writing skills of students in grades 4 to 9 with history of persisting writing disabilities.

Levels of Phonology Related to Reading and Writing in Middle Childhood

The relationships of different levels of phonological processing (sounds in heard and spoken words for whole words, syllables, phonemes, and rimes) to multi-leveled functional reading or writing systems were studied. Participants in this cross-sectional study were students in fourth- grade (n=119, mean age 116.5 months) and sixth- grade (n=105, mean age 139.7 months). Multiple Indicators and Multiple Causes (MIMIC) modeling was used to analyze whether different levels of sound processing in heard and spoken words were correlated with each other and with multi-leveled reading or writing systems, and if so, which phonological skills explained unique variance in the reading or writing system. The models fit well at both grade levels for both reading and writing. All four phonological skills studied correlated significantly with each other and the latent factor for reading or writing. For reading, phonology for whole words and phonemes explained unique variance in fourth and sixth graders. For writing, at the fourth grade, only phonemes explained unique variance, but at the sixth grade level, syllables, phonemes, and rimes explained unique variance. Thus, the relationships between levels of phonology and reading were stable across grades 4 and 6, but developmental differences were observed in the relationships between levels of phonology and the leveled writing construct.

Modes of Alphabet Letter Production during Middle Childhood and Adolescence: Interrelationships with Each Other and Other Writing Skills

Although handwriting is typically taught during early childhood and keyboarding may not be taught explicitly, both may be relevant to writing development in the later grades. Thus, Study 1 investigated automatic production of the ordered alphabet from memory for manuscript (unjoined), cursive (joined), and keyboard letter modes (alphabet 15 sec) and their relationships with each other and spelling and composing in typically developing writers in grades 4 to 7 (N = 113). Study 2 compared students with dysgraphia (impaired handwriting, n=27), dyslexia (impaired word spelling, n=40), or oral and written language learning disability (OWL LD) (impaired syntax composing, n=11) or controls without specific writing disabilities (n=10) in grades 4 to 9 (N=88) on the same alphabet 15 modes, manner of copying (best or fast), spelling, and sentence composing. In Study 1, sequential multilevel model regressions of predictor alphabet 15 letter production/selection modes on spelling and composition outcomes, measured annually from grade 4 to grade 7 (ages 9 to 13 years), showed that only the cursive mode uniquely, positively, and consistently predicted both spelling and composing in each grade. For composing, in grade 4 manuscript mode was positively predictive and in grades 5-7 keyboard selection was. In Study 2 all letter production modes correlated with each other and one's best and fast sentence copying, spelling, and timed sentence composing. The groups with specific writing disabilities differed from control group on alphabet 15 manuscript mode, copy fast, and timed sentence composing. The dysgraphia and dyslexia groups differed on copying sentences in one's best handwriting, with the dysgraphia group scoring lower. The educational and theoretical significance of the findings are discussed for multiple modes and manners of letter production/selection of the alphabet that support spelling and composing beyond the early grades in students with and without specific writing disabilities.

High-density lipoprotein particle concentration and subclinical atherosclerosis of the carotid arteries in Japanese men

OBJECTIVE

The association of high-density lipoprotein particle (HDL-P) with atherosclerosis may be stronger than that of HDL-cholesterol (HDL-C) and independent of conventional cardiovascular risk factors. Whether associations persist in populations at low risk of coronary heart disease (CHD) remains unclear. This study examines the associations of HDL-P and HDL-C with carotid intima-media thickness (cIMT) and plaque counts among Japanese men, who characteristically have higher HDL-C levels and a lower CHD burden than those in men of Western populations.

METHODS

We cross-sectionally examined a community-based sample of 870 Japanese men aged 40-79 years, free of known clinical cardiovascular disease (CVD) and not on lipid-lowering medication. Participants were randomly selected among Japanese living in Kusatsu City in Shiga, Japan.

RESULTS

Both HDL-P and HDL-C were inversely and independently associated with cIMT in models adjusted for conventional CHD risk factors, including low-density lipoprotein cholesterol (LDL-C) and diabetes. HDL-P maintained an association with cIMT after further adjustment for HDL-C (P < 0.01), whereas the association of HDL-C with cIMT was noticeably absent after inclusion of HDL-P in the model. In plaque counts of the carotid arteries, HDL-P was significantly associated with a reduction in plaque count, whereas HDL-C was not.

CONCLUSION

HDL-P, in comparison to HDL-C, is more strongly associated with measures of carotid atherosclerosis in a cross-sectional study of Japanese men. Findings demonstrate that, HDL-P is a strong correlate of subclinical atherosclerosis even in a population at low risk for CHD.

Low dietary vitamin D in mid-life predicts total mortality in men with hypertension: the Honolulu heart program

BACKGROUND

Vitamin D deficiency was associated with total mortality in previous epidemiological studies. Little is known about the effects of dietary vitamin D intake on mortality. We examined the association between mid-life dietary vitamin D intake and 45-year total mortality.

METHODS

The Honolulu Heart Program is a longitudinal cohort study of 8006 Japanese American men in Hawaii aged 45 to 68 at baseline (1965-1968). Mid-life dietary vitamin D intake was calculated from 24-hour dietary recall using Nutritionist IV v3 software. We divided subjects into quartiles of dietary vitamin D. Total mortality data were available over 45 years through 2010.

RESULTS

Age-adjusted total mortality rates were higher in the lower quartiles of dietary vitamin D intake compared to the highest (p for trend = 0.011). Using Cox regression, low dietary vitamin D was significantly associated with total mortality; quartile (Q) 1 hazard ratio (HR) = 1.14, 95% confidence interval (95% CI) = 1.07-1.22, p < 0.001; Q2 HR = 1.11, 95% CI = 1.04-1.18, p = 0.002; and Q3 HR = 1.08, 95% CI = 1.01-1.15, p = 0.027; Q4 = reference. After adjusting for age, kilocalories, cardiovascular risk factors, and prevalent chronic diseases, only Q2 remained significant (HR = 1.08, 95% CI = 1.00-1.15, p = 0.037). Among hypertensive subjects only, those in the lower 2 quartiles had higher total mortality; Q1 HR = 1.12, 95% CI = 1.01-1.25, p = 0.039, and Q2 HR = 1.13, 95% CI = 1.02-1.26, p = 0.025, compared to Q4. There was no significant relationship in subjects without hypertension.

CONCLUSIONS

Low dietary vitamin D intake in mid-life was a weak predictor of total mortality over 45 years of follow-up. We found a significant association between low dietary vitamin D intake and higher total mortality only among hypertensive subjects. Vitamin D may have cardioprotective effects.

The onset of STI diagnosis through age 30: results from the Seattle Social Development Project Intervention

The objectives of this study were to examine (1) whether the onset of sexually transmitted infections (STI) through age 30 differed for youths who received a social developmental intervention during elementary grades compared to those in the control condition; (2) potential social-developmental mediators of this intervention; and (3) the extent to which these results differed by ethnicity. A nonrandomized controlled trial followed participants to age 30, 18 years after the intervention ended. Three intervention conditions were compared: a full-intervention group, assigned to intervention in grades 1 through 6; a late intervention group, assigned to intervention in grades 5 and 6 only; and a no-treatment control group. Eighteen public elementary schools serving diverse neighborhoods including high-crime neighborhoods of Seattle are the setting of the study. Six hundred eight participants in three intervention conditions were interviewed from age 10 through 30. Interventions include teacher training in classroom instruction and management, child social and emotional skill development, and parent workshops. Outcome is the cumulative onset of participant report of STI diagnosis. Adolescent family environment, bonding to school, antisocial peer affiliation, early sex initiation, alcohol use, cigarette use, and marijuana use were tested as potential intervention mechanisms. Complementary log-log survival analysis found significantly lower odds of STI onset for the full-intervention compared to the control condition. The lowering of STI onset risk was significantly greater for African Americans and Asian Americans compared to European Americans. Family environment, school bonding, and delayed initiation of sexual behavior mediated the relationship between treatment and STI hazard. A universal intervention for urban elementary school children, focused on classroom management and instruction, children's social competence, and parenting practices may reduce the onset of STI through age 30, especially for African Americans.

Predicting Levels of Reading and Writing Achievement in Typically Developing, English-Speaking 2nd and 5th Graders

Human traits tend to fall along normal distributions. The aim of this research was to evaluate an evidence-based conceptual framework for predicting expected individual differences in reading and writing achievement outcomes for typically developing readers and writers in early and middle childhood from Verbal Reasoning with or without Working Memory Components (phonological, orthographic, and morphological word storage and processing units, phonological and orthographic loops, and rapid switching attention for cross-code integration). Verbal Reasoning (reconceptualized as Bidirectional Cognitive-Linguistic Translation) plus the Working Memory Components (reconceptualized as a language learning system) accounted for more variance than Verbal Reasoning alone, except for handwriting for which Working Memory Components alone were better predictors. Which predictors explained unique variance varied within and across reading (oral real word and pseudoword accuracy and rate, reading comprehension) and writing (handwriting, spelling, composing) skills and grade levels (second and fifth) in this longitudinal study. Educational applications are illustrated and theoretical and practical significance discussed.

Proteinuria in midlife and 39-year total mortality: the Honolulu Heart Program

BACKGROUND

Previous population-based studies have shown that proteinuria is an independent predictor of total mortality. However, no studies have examined multiple proteinuria measurements or had a follow-up period longer than two decades.

METHODS

Proteinuria was measured by urine dipstick on 6,815 Japanese-American men on two occasions, 6 years apart. Participants were classified into the "no proteinuria" group if both examinations were negative, "transient proteinuria" if either was positive, and "persistent proteinuria" if both were positive and followed for total mortality over 39 years.

RESULTS

Prevalence of transient and persistent proteinuria was 6.4% and 1.3%, respectively. Age-adjusted total mortality rates were 41.9, 55.0, and 71.9 per 1000 person-years follow-up for no, transient, and persistent proteinuria groups, respectively (p for trend <.0001). Multivariate Cox proportional hazards models showed increased total mortality risk in a dose-response manner: HR, 1.40; P < .001 and HR, 2.26; P < .001 for transient and persistent proteinuria groups, respectively (using no proteinuria as reference). Stratified analyses showed stronger associations between proteinuria and mortality among those with prevalent cardiovascular diseases compared with those without.

CONCLUSIONS

Proteinuria was independently associated with higher total mortality risk over 39 years. This risk was stronger among high-risk populations but also remained significant in low-risk populations. Simple urine dipstick can be a good risk assessment tool in the general population.

Youth problem behaviors 8 years after implementing the communities that care prevention system: a community-randomized trial

IMPORTANCE

Community-based efforts to prevent adolescent problem behaviors are essential to promote public health and achieve collective impact community wide. OBJECTIVE To test whether the Communities That Care (CTC) prevention system reduced levels of risk and adolescent problem behaviors community wide 8 years after implementation of CTC.

DESIGN, SETTING, AND PARTICIPANTS

A community-randomized trial was performed in 24 small towns in 7 states, matched within state, assigned randomly to a control or intervention group in 2003. All fifth-grade students attending public schools in study communities in 2003-2004 who received consent from their parents to participate (76.4% of the eligible population) were included. A panel of 4407 fifth graders was surveyed through 12th grade, with 92.5% of the sample participating at the last follow-up.

INTERVENTIONS

A coalition of community stakeholders received training and technical assistance to install CTC, used epidemiologic data to identify elevated risk factors and depressed protective factors for adolescent problem behaviors in the community, and implemented tested and effective programs for youths aged 10 to 14 years as well as their families and schools to address their community's elevated risks. MAIN OUTCOMES AND MEASURES Levels of targeted risk; sustained abstinence, and cumulative incidence by grade 12; and current prevalence of tobacco, alcohol, and other drug use, delinquency, and violence in 12th grade.

RESULTS

By spring of 12th grade, students in CTC communities were more likely than students in control communities to have abstained from any drug use (adjusted risk ratio [ARR] = 1.32; 95% CI, 1.06-1.63), drinking alcohol (ARR = 1.31; 95% CI, 1.09-1.58), smoking cigarettes (ARR = 1.13; 95% CI, 1.01-1.27), and engaging in delinquency (ARR = 1.18; 95% CI, 1.03-1.36). They were also less likely to ever have committed a violent act (ARR = 0.86; 95% CI, 0.76-0.98). There were no significant differences by intervention group in targeted risks, the prevalence of past-month or past-year substance use, or past-year delinquency or violence.

CONCLUSIONS AND RELEVANCE

Using the CTC system continued to prevent the initiation of adolescent problem behaviors through 12th grade, 8 years after implementation of CTC and 3 years after study-provided resources ended, but did not produce reductions in current levels of risk or current prevalence of problem behavior in 12th grade. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01088542.

C-reactive protein, cardiovascular disease and stroke: new roles for an old biomarker

Stroke is a leading cause of death and disability worldwide. A new and exciting development in cardiovascular disease is the recognition of the role of inflammation in atherosclerosis. C-reactive protein, an acute phase reactant, appears to be a promising biomarker for cardiovascular disease, possibly more predictive than cholesterol and also may play an etiological role. C-reactive protein also appears to be predictive of stroke risk, although less so in the elderly. Although the number of studies on stroke (apart from cardiovascular disease) is limited, there is a significant graded increase in stroke risk within the low-to-high normal range of C-reactive protein. C-reactive protein is readily amenable to treatment with anti-inflammatory drugs, such as aspirin and statins. New and increasingly available high-sensitivity assays may make C-reactive protein a standard screening tool for cardiovascular disease.

Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese: a 24-year follow-up of NIPPON DATA80

BACKGROUND

Dietary intake of long-chain n-3 PUFA (LCn3FA) among Japanese is generally higher than that in Western populations. However, little is known whether an inverse association of LCn3FA with cardiovascular disease (CVD) risk exists in a population with higher LCn3FA intake.

OBJECTIVE

To investigate the association between LCn3FA intake and the long-term risk of CVDs in a Japanese general population.

METHODS

We followed-up a total of 9190 individuals (56.2% women, mean age 50.0 years) randomly selected from 300 areas across Japan and free from CVDs at baseline. Dietary LCn3FA intake was estimated using household weighed food records. Cox models were used to calculate multivariate-adjusted hazard ratios (HR) and confidence intervals (CI) according to sex specific quartiles of LCn3FA intake.

RESULTS

During 24-year follow-up (192,897 person-years), 879 cardiovascular deaths were observed. The median daily intake of LCn3FA was 0.37% kcal (0.86 g/day). Adjusted HR for CVD mortality was lower in the highest quartile of LCn3FA intake (HR 0.80; 95% CI 0.66-0.96) compared with the lowest quartile, and the trend was statistically significant (P = 0.038). The similar but statistically non-significant trends were observed for coronary heart disease death and stroke death. In analyses by age groups, the inverse associations of LCn3FA intake with the risk of total CVD death and stroke death were significant in younger individuals (30-59 years at baseline).

CONCLUSION

LCn3FA intake was inversely and independently associated the long-term risk of total CVD mortality in a representative sample of Japanese with high LCn3FA intake.

Measuring Dimensions of Coalition Functioning for Effective and Participatory Community Practice

Social Work has a long history of community practice, but community practice models have been understudied. An important first step in conducting such studies is the establishment of psychometrically sound measures relevant for evaluations of community practice. In this paper, data are used from a community-randomized trial of Communities That Care (CTC), a coalition-based model of community practice shown to be effective at transforming communities and changing rates of youth problem behavior. Coalition functioning is reported by coalition members in 12 communities across intervention implementation phases. A four-dimensional model of coalition functioning (goal-directedness, efficiency, opportunities for participation, and cohesion) was confirmed using factor analysis and the dimensions were found to be invariant across time. One test of validity of these dimensions is conducted by correlating coalition members' ratings of coalition functioning with those of external observers.

Epidemiology of cardiovascular risk factors in Asian countries

The distribution and burden of 5 conventional risk factors (elevated blood pressure, high total cholesterol, diabetes, obesity/overweight and smoking) for cardiovascular diseases (CVD) were reviewed in 10 selected Asian countries, in addition to the United Kingdom and the United States. Over the past 3 decades, age-standardized systolic blood pressure was on the decline in high-income countries but on the rise in low- to middle-income countries. Similar patterns were observed for total cholesterol levels, although the absolute levels remained higher in high-income countries. A pronounced increase in the prevalence of diabetes mellitus was seen in most of the Asian countries, corresponding to an increase in the levels of body mass index. The number of smokers declined markedly with time, particularly in men, in some selected Asian countries (Japan, Singapore, China, Vietnam). However, the prevalence of current smokers for all countries in 2011 remained excessive. The population-attributable risks for stroke and ischemic heart were highest for high blood pressure, followed by total cholesterol, obesity, and smoking. Evidence suggests that in both Asia and the West, no country is in sufficient control of any of these factors and that intervention programs to alter their effect on CVD are of equal importance.

Research on the premotor symptoms of Parkinson's disease: clinical and etiological implications

BACKGROUND

The etiology and natural history of Parkinson's disease (PD) are not well understood. Some non-motor symptoms such as hyposmia, rapid eye movement sleep behavior disorder, and constipation may develop during the prodromal stage of PD and precede PD diagnosis by years.

OBJECTIVES

We examined the promise and pitfalls of research on premotor symptoms of PD and developed priorities and strategies to understand their clinical and etiological implications.

METHODS

This review was based on a workshop, Parkinson's Disease Premotor Symptom Symposium, held 7-8 June 2012 at the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina.

DISCUSSION

Research on premotor symptoms of PD may offer an excellent opportunity to characterize high-risk populations and to better understand PD etiology. Such research may lead to evaluation of novel etiological hypotheses such as the possibility that environmental toxicants or viruses may initiate PD pathogenesis in the gastrointestinal tract or olfactory bulb. At present, our understanding of premotor symptoms of PD is in its infancy and faces many obstacles. These symptoms are often not specific to PD and have low positive predictive value for early PD diagnosis. Further, the pathological bases and biological mechanisms of these premotor symptoms and their relevance to PD pathogenesis are poorly understood.

CONCLUSION

This is an emerging research area with important data gaps to be filled. Future research is needed to understand the prevalence of multiple premotor symptoms and their etiological relevance to PD. Animal experiments and mechanistic studies will further understanding of the biology of these premotor symptoms and test novel etiological hypothesis.

Use of Web and Phone Survey Modes to Gather Data From Adults About Their Young Adult Children: An Evaluation Based on a Randomized Design

Mode effects on responses to survey items may introduce bias to data collected using multiple modes of administration. The present study examines data from 704 surveys conducted as part of a longitudinal study in which parents and their children had been surveyed at multiple prior time points. Parents of 22-year-old study participants were randomly assigned to one of two mixed-mode conditions: (a) Web mode first followed by the offer of an interviewer-administered telephone mode; or (b) telephone mode first followed by the offer of the Web mode. Comparison of responses by assigned condition on 12 measures showed one statistically significant difference. Analyses that modeled differences by completed mode and the interaction between assigned condition and completed mode found significant differences on six measures related to completed mode. None of the differences indicated that more socially desirable responses were given in interviewer-administered surveys.

Differences between Children with Dyslexia Who Are and Are Not Gifted in Verbal Reasoning

New findings are presented for children in grades 1 to 9 who qualified their families for a multi-generational family genetics study of dyslexia (impaired word decoding/spelling) who had either superior verbal reasoning (n=33 at or above 1 2/3 standard deviation, superior or better range; 19% of these children) or average verbal reasoning (n=31 below population mean, but above - 2/3 standard deviation, average range; 18% of these children). Evidence-based rationale and results supporting the tested hypotheses are provided: (a) twice exceptional students with superior verbal reasoning and dyslexia significantly outperformed those with average verbal reasoning and dyslexia on reading, spelling, morphological, and syntactic skills, (b) but not on verbal working-memory behavioral markers of genetically based dyslexia related to impaired phonological and orthographic word-form storage and processing, naming orthographic symbols (phonological loop), writing orthographic symbols (orthographic loop), and supervisory attention (focus, switch, sustain, or monitor attention). Superior verbal reasoning may mask dyslexia if only very low achievement is used to identify this disorder of oral word reading and written spelling. Instruction for twice exceptional students who have dyslexia, but are also verbally gifted, should focus not only on oral word reading and written spelling but also the impaired working memory components within intellectually engaging lesson sets. These findings for gifted students with dyslexia are situated within the broader context of the many kinds of twice exceptionalities related to specific learning disabilities that exist in school-age children and youth.

LOX-1 ligands containing apolipoprotein B and carotid intima-media thickness in middle-aged community-dwelling US Caucasian and Japanese men

OBJECTIVE

The serum level of LOX-1 ligand containing ApoB (LAB) may reflect atherogenicity better than LDL cholesterol (LDLC), total LDL particles and usual measurement of oxidized LDL. The association between LAB and intima-media thickness (IMT) of carotid artery was investigated by ultrasound in US and Japan men.

METHODS

Participants were 297 US Caucasian and 310 Japanese men, aged 40-49 years without past history of cardiovascular disease. Serum LAB levels were measured by ELISAs with recombinant LOX-1 and monoclonal anti-apolipoprotein B antibody.

RESULTS

Serum LAB levels [median (interquartile range), μg/L] were 1321 (936, 1730) in US Caucasians and 940 (688, 1259) in Japanese. For Caucasian men, average IMT was higher in higher LAB quartile, which was 0.653, 0.667, 0.688, and 0.702 mm, respectively (p for trend = 0.02). Linear regression analysis showed serum LAB was significantly associated with IMT after adjustment for LDLC or total LDL particles in addition to other traditional or novel risk factors for atherosclerosis such as C-reactive protein. However, there was no significant relationship between LAB and IMT in Japanese men.

CONCLUSION

Serum LAB, a new candidate biomarker for residual risk, was associated with an increased carotid IMT in US Caucasian men independently of various risk factors; however, ethnic difference should be clarified in the future.

How has the economic downturn affected communities and implementation of science-based prevention in the randomized trial of communities that care?

This study examined implications of the economic downturn that began in December 2007 for the Community Youth Development Study (CYDS), a longitudinal randomized controlled trial of the Communities That Care (CTC) prevention system. The downturn had the potential to affect the internal validity of the CYDS research design and implementation of science-based prevention in study communities. We used archival economic indicators and community key leader reports of economic conditions to assess the extent of the economic downturn in CYDS communities and potential internal validity threats. We also examined whether stronger economic downturn effects were associated with a decline in science-based prevention implementation. Economic indicators suggested the downturn affected CYDS communities to different degrees. We found no evidence of systematic differences in downturn effects in CTC compared to control communities that would threaten internal validity of the randomized trial. The Community Economic Problems scale was a reliable measure of community economic conditions, and it showed criterion validity in relation to several objective economic indicators. CTC coalitions continued to implement science-based prevention to a significantly greater degree than control coalitions 2 years after the downturn began. However, CTC implementation levels declined to some extent as unemployment, the percentage of students qualifying for free lunch, and community economic problems worsened. Control coalition implementation levels were not related to economic conditions before or after the downturn, but mean implementation levels of science-based prevention were also relatively low in both periods.

Teaching children with dyslexia to spell in a reading-writers' workshop

To identify effective treatment for both the spelling and word decoding problems in dyslexia, 24 students with dyslexia in grades 4 to 9 were randomly assigned to treatments A (n=12) or B (n=12) in an after-school reading-writers' workshop at the university (thirty 1-h sessions twice a week over 5 months). First, both groups received step 1 treatment of grapheme-phoneme correspondences (gpc) for oral reading. At step 2, treatment A received gpc training for both oral reading and spelling, and treatment B received gpc training for oral reading and phonological awareness. At step 3, treatment A received orthographic spelling strategy and rapid accelerated reading program (RAP) training, and treatment B continued step 2 training. At step 4, treatment A received morphological strategies and RAP training, and treatment B received orthographic spelling strategy training. Each treatment also had the same integrated reading-writing activities, which many school assignments require. Both groups improved significantly in automatic letter writing, spelling real words, compositional fluency, and oral reading (decoding) rate. Treatment A significantly outperformed treatment B in decoding rate after step 3 orthographic training, which in turn uniquely predicted spelling real words. Letter processing rate increased during step 3 RAP training and correlated significantly with two silent reading fluency measures. Adding orthographic strategies with "working memory in mind" to phonics helps students with dyslexia spell and read English words.

The application of meta-analysis within a matched-pair randomized control trial: an illustration testing the effects of communities that care on delinquent behavior

Use of meta-analytic strategies to test intervention effects is an important complement to traditional design-based analyses of intervention effects in randomized control trials. In the present paper, we suggest that meta-analyses within the context of matched-pair designs can provide useful insight into intervention effects. We illustrate the advantages to this analytic strategy by examining the effectiveness of the Communities That Care (CTC) prevention system on 8th-grade delinquent behavior in a randomized matched-pair trial. We estimate the intervention effect within each of the matched-pair communities, aggregate the effect sizes across matched pairs to derive an overall intervention effect, and test for heterogeneity in the effect of CTC on delinquency across matched pairs of communities. The meta-analysis finds that CTC reduces delinquent behavior and that the effect of CTC on delinquent behavior varies significantly across communities. The use of meta-analysis in randomized matched-pair studies can provide a useful accompaniment to other analytic approaches because it opens the possibility of identifying factors associated with differential effects across units or matched pairs in the context of a randomized control trial.

Brain organochlorines and Lewy pathology: the Honolulu-Asia Aging Study

Although organochlorines have been reported more frequently in Parkinson's disease (PD) brains than in controls, the association with brain Lewy pathology is unknown. Honolulu-Asia Aging Study (HAAS) participants, exposed to organochlorines from a variety of sources during midlife, represent a population well suited to determining the relationship of brain organochlorines with Lewy pathology in decedents from the longitudinal HAAS. The study design included the measurement of 21 organochlorine levels in frozen occipital lobe samples from HAAS decedents. Alpha-synuclein immunostaining performed on 225 brains was used to identify Lewy bodies and Lewy neurites. With the potential for spurious associations to appear between Lewy pathology and 17 organochlorine compounds found in at least 1 brain, initial assessments identified heptachlor epoxide isomer b, methoxychlor, and benzene hexachloride b as being most important. The prevalence of Lewy pathology was 75% (6 of 8) among brains with any 2 of the 3 compounds, 48.8% (79 of 162) among those with 1, and 32.7% (18 of 55) for those with neither (P = .007 test for trend). Although findings persisted after removing cases with PD and dementia with Lewy bodies and after adjustment for age at death, body mass index, pack-years of cigarette smoking, and coffee intake (P = .013), the results were insignificant when correcting for multiple testing. Although consistent with earlier accounts of an association between organochlorines and clinical PD, associations with Lewy pathology warrant further study.

Educational Paths and Substance Use from Adolescence into Early Adulthood

This study examined how substance use trajectories from ages 15 to 23 in a community sample (N=921) were related to educational pathways. Rates of heavy drinking converged across different paths, but starting college at a 2-year college before transferring to a 4-year college was related to later increase in drinking after high school. Higher future educational attainment was negatively associated with high school marijuana use, but marijuana use increased after high school for individuals who went to 4-year colleges compared to those who did not. Noncollege youth had the highest rates of daily cigarette smoking throughout adolescence and early adulthood, while college dropouts had higher rates of smoking than college students who did not drop out. The findings support the need for universal prevention for early adult heavy drinking, addressing increases in drinking and marijuana use in 4-year colleges, and targeting marijuana use and cigarette smoking interventions at noncollege youth and college dropouts.

Low dietary vitamin D predicts 34-year incident stroke: the Honolulu Heart Program

BACKGROUND AND PURPOSE

Vitamin D deficiency has been reported to contribute to the risk of cardiovascular disease, especially stroke. We examined the relationship between dietary vitamin D intake and 34-year incident stroke.

METHODS

The Honolulu Heart Program is a prospective population-based cohort study of 8006 Japanese-American men in Hawaii who were 45 to 68 years old at the baseline examination in 1965 to 1968. Dietary vitamin D intake was calculated using the Nutritionist IV Version 3 software from a 24-hour dietary recall. Subjects with prevalent stroke were excluded, leaving 7385 men followed through 1999 for incident stroke. Subjects were divided into quartiles of dietary vitamin D for analyses.

RESULTS

During 34 years of follow-up, 960 subjects developed stroke. Age-adjusted rates of incident stroke were significantly higher in the lowest dietary vitamin D quartile compared with the highest (all stroke: 6.38 versus 5.14 per 1000 person-years follow-up, P=0.030; thromboembolic stroke: 4.36 versus 3.30, P=0.033). Using Cox regression, adjusting for age, total kilocalories, body mass index, hypertension, diabetes mellitus, pack-years smoking, physical activity index, serum cholesterol, and alcohol intake, those in the lowest quartile had a significantly increased risk of incident stroke (all stroke hazard ratio, 1.22; 95% CI, 1.01-1.47; P=0.038; thromboembolic stroke hazard ratio, 1.27; 95% CI, 1.01-1.59; P=0.044) with the highest as the reference. We found no significant associations between dietary vitamin D and hemorrhagic stroke.

CONCLUSIONS

Low dietary vitamin D intake was an independent risk factor for 34-year incidence of all stroke and thromboembolic stroke in Japanese-American men. Additional research is needed on vitamin D supplementation to prevent stroke.

Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial

OBJECTIVE

To test whether the Communities That Care (CTC) prevention system reduced levels of risk and adolescent problem behaviors community-wide 6 years after installation of CTC and 1 year after study-provided resources ended.

DESIGN

A community randomized trial.

SETTING

Twenty-four small towns in 7 states, matched within state, randomly assigned to control or intervention condition in 2003.

PARTICIPANTS

A panel of 4407 fifth-grade students was surveyed annually through 10th grade from 2004 to 2009.

INTERVENTION

A coalition of community stakeholders received training and technical assistance to install CTC, used epidemiologic data to identify elevated risk factors and depressed protective factors in the community, and implemented programs to address their community's elevated risks from a menu of tested and effective programs for youths aged 10 to 14 years, their families, and schools.

OUTCOME MEASURES

Levels of risk and incidence and prevalence of tobacco, alcohol, and other drug use; delinquency; and violent behavior by grade 10.

RESULTS

Mean levels of targeted risks increased less rapidly between grades 5 and 10 in CTC than in control communities and were significantly lower in CTC than control communities in grade 10. The incidence of delinquent behavior, alcohol use, and cigarette use and the prevalence of current cigarette use and past-year delinquent and violent behavior were significantly lower in CTC than in control communities in grade 10.

CONCLUSIONS

Using the CTC system can produce enduring reductions in community-wide levels of risk factors and problem behaviors among adolescents beyond the years of supported implementation, potentially contributing to long-term public health benefits.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01088542.

A prospective follow-up study of the association of radiation exposure with fatal and non-fatal stroke among atomic bomb survivors in Hiroshima and Nagasaki (1980-2003)

OBJECTIVE

Use of medical radiotherapy has increased markedly in recent decades. Whether the consequence includes an increased risk of cardiovascular disease remains to be determined. The purpose of this study was to examine the association between radiation exposure and the incidence of stroke among Japanese atomic bomb survivors.

DESIGN

A prospective follow-up study.

SETTING AND PARTICIPANTS

Radiation exposure from the atomic bombing was assessed in 9515 subjects (34.8% men) with 24-year follow-up from 1980. Subjects were free of prevalent stroke when follow-up began.

OUTCOME MEASURES

Stroke events and the underlying cause of death were reviewed to confirm the first-ever stroke. Subtypes (ischaemic and haemorrhagic events) were categorised based on established criteria according to the definitions of typical/atypical stroke symptoms.

RESULTS

Overall mean radiation dose (±SD) in units of gray (Gy) was 0.38±0.58 (range: 0-3.5). During the study period, 235 haemorrhagic and 607 ischaemic events were identified. For men, after adjusting for age and concomitant risk factors, the risk of haemorrhagic stroke rose consistently from 11.6 to 29.1 per 10 000 person-years as doses increased from <0.05 to ≥2 Gy (p=0.009). Incidence also rose within the dose range <1 Gy (p=0.004) with no dose threshold. In women, the risk of haemorrhagic stroke rose with increasing radiation exposure but not until doses reached a threshold of 1.3 Gy (95% CI 0.5 to 2.3). Among women, for doses <1.3 Gy, differences in stroke risk were modest (13.5 per 10 000 person-years), while it increased to 20.3 per 10 000 person-years for doses that ranged from 1.3 to <2.2 Gy and to 48.6 per 10 000 person-years for doses that were higher (p=0.002). In both sexes, dose was unrelated to ischaemic stroke.

CONCLUSION

While the risk of haemorrhagic stroke increases with rising radiation exposure for both sexes, effects in women are less apparent until doses exceed a threshold at 1.3 Gy.

Lifestyle and the risk of dementia in Japanese-american men

OBJECTIVES

To determine whether adhering to a healthy lifestyle in midlife may reduce the risk of dementia.

DESIGN

Case-control study nested in a prospective cohort.

SETTING

The Honolulu-Asia Aging Study, Oahu, Hawaii.

PARTICIPANTS

Three thousand four hundred sixty-eight Japanese-American men (mean age 52 in 1965-1968) examined for dementia 25 years later.

MEASUREMENTS

Men at low risk were defined as those with the following midlife characteristics: nonsmoking, body mass index (BMI) less than 25.0 kg/m(2) , physically active, and having a healthy diet (based on alcohol, dairy, meat, fish, fruits, vegetables, cereals, and ratio of monounsaturated to saturated fat). Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for developing overall dementia, Alzheimer's disease (AD), and vascular dementia (VaD), adjusting for potential confounders.

RESULTS

Dementia was diagnosed in 6.4% of men (52.5% with AD, 35.0% with VaD). Examining the risk factors individually, BMI was most strongly associated with greater risk of overall dementia (OR = 1.87, 95% CI = 1.26-2.77; BMI > 25.0 vs <22.6 kg/m(2) ). All of the individual risk factors except diet score were significantly associated with VaD, whereas none were significantly associated with AD alone. Men with all four low-risk characteristics (7.2% of the cohort) had the lowest OR for overall dementia (OR = 0.36, 95% CI = 0.15-0.84). There were no significant associations between the combined low-risk characteristics and the risk of AD alone.

CONCLUSION

Among Japanese-American men, having a healthy lifestyle in midlife is associated with a lower risk of dementia in late life.

An examination of the validity of retrospective measures of suicide attempts in youth

PURPOSE

This study used prospective data to investigate the validity of a retrospective measure of suicide attempts from four different perspectives.

METHODS

Data were retrieved from 883 participants in the Raising Healthy Children project, a longitudinal study of youth recruited from a Pacific Northwest school district. The retrospective measure was collected when participants were 18-19 years of age and results were compared with measures of depressive symptoms collected prospectively.

RESULTS

Results showed strong corroboration between retrospective reports of first suicide attempt and prospective measures of depression, with attempters experiencing significantly more depression than their nonattempting peers, t (df = 853) = 10.26, p < .001. In addition, within the attempter group, depression scores during the year of their reported first attempt were significantly higher than the average depression score across previous years, t (df = 67) = 3.01, p < .01.

CONCLUSIONS

Results from this study suggest that the reports of older adolescents regarding their suicide attempts are corroborated by their prospective reports of depression in childhood and earlier adolescence. Thus, there is support that retrospective measures of suicidal behavior, namely suicide attempts, may be a valid method of assessment.

Differential association of docosahexaenoic and eicosapentaenoic acids with carotid intima-media thickness

BACKGROUND AND PURPOSE

Recent studies reported the differential effect of docosahexaenoic (DHA) and eicosapentaenoic acids (EPA). We examined the differential association of DHA and EPA with carotid intima-media thickness (IMT) in Japanese individuals in Japan and in U.S. white individuals and explored whether DHA or EPA contributes to the difference in IMT between the two groups.

METHODS

A population-based cross-sectional study in 608 Japanese and U.S. white men aged 40 to 49 was conducted to assess IMT, serum DHA, EPA, and other cardiovascular risk factors.

RESULTS

Japanese compared to U.S. whites had significantly lower IMT (mean±SD, 618±81 and 672±94 μm for Japanese and whites, respectively; P<0.001) and had >2-fold higher levels of DHA and EPA. DHA, but not EPA, had an inverse association with IMT in both Japanese and U.S. whites. The inverse association remained only in Japanese men after adjusting for risk and other factors. The significant difference in multivariable-adjusted IMT became nonsignificant after further adjusting for DHA (mean difference, 17 μm; 95% CI, -8 to 43; P=0.177) but not EPA. In this multivariable-adjusted model, DHA but not EPA was a significant predictor of IMT (P=-0.032 versus 0.863, respectively).

CONCLUSIONS

These data suggest that DHA may have a more potent antiatherogenic effect than EPA, especially in levels observed in the Japanese, independent of risk factors.

Impairments in activities of daily living in older Japanese men in hawaii and Japan

Introduction. Hypertension and cigarette smoking are dominant risk factors for cardiovascular disease in Japan while in westernized countries, broader effects encompass obesity, diabetes, and hypercholesterolemia. This paper examines whether different associations also appear important in the manifestation of activities of daily living (ADL) in older Japanese men in Hawaii and Japan. Methods. Measures of ADL (feeding, toileting, dressing, bathing, and walking around the house) were assessed from 1995 to 1999 in 1,893 men in Hawaii and 543 men in Japan. Concomitant risk factors were measured from 1990 to 1993. Results. In Hawaii, diabetes increased the odds of ≥1 ADL impairment nearly 1.5-fold (P = .020). A similar association was absent in Japan. In contrast, the odds of an ADL impairment in Japan was increased more than 5-fold in the presence of stroke (P < .001). The association in Hawaii was significantly weaker (P = .007). In both cohorts, past alcohol use was associated with a greater likelihood of ADL impairment. Conclusion. In this comparison of genetically similar samples, findings suggest that different strengths in risk factor associations with cardiovascular disease in Japan and westernized countries may also include different strengths in associations with impaired ADL.

White matter lesions on brain magnetic resonance imaging scan and 5-year cognitive decline: the Honolulu-Asia aging study

OBJECTIVES

To study white matter lesions (WMLs) and 5-year cognitive decline in elderly Japanese-American men.

DESIGN

Longitudinal cohort study.

SETTING

Population-based study in Honolulu, Hawaii.

PARTICIPANTS

Japanese-American men aged 74 to 95 from the Honolulu-Asia Aging Study (HAAS) who were free of prevalent dementia, underwent a protocol brain MRI scan at the fifth HAAS examination (1994-1996), and returned for cognitive testing 5 years later (N=267).

MEASUREMENTS

WMLs were dichotomized as present (grade 3-9, 38.2%) or absent (grade 1-2, 61.8%). Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI), and 5-year cognitive decline was defined as a drop in CASI score of 12 points or more (1 standard deviation).

RESULTS

Men with WMLs on MRI at baseline were significantly more likely to experience cognitive decline at 5 years than those without (22.4% vs 34.4%, P=.03). Using multiple logistic regression, adjusting for age, education, apolipoprotein (Apo)E4 allele, large or small infarcts on MRI, baseline CASI score, and hypertension, those with WMLs were significantly more likely to develop 5-year cognitive decline (odds ratio=2.00, 95% confidence interval=1.10-3.65, P=.02). This association was stronger in men who were cognitively intact and free of the ApoE4 genotype and clinical stroke at baseline.

CONCLUSION

Presence of WMLs on MRI was significantly associated with higher odds of 5-year cognitive decline in older Japanese-American men. Presence of WMLs may help identify people at risk for developing dementia, who may benefit from early intervention.

Bullying at elementary school and problem behaviour in young adulthood: a study of bullying, violence and substance use from age 11 to age 21

AIM

The main aim of this paper is to investigate to what extent self-reported bullying at Grade 5 predicts later violence, heavy drinking and marijuana use at age 21.

METHOD

Univariate and multivariate associations between bullying and later outcomes were examined based on a longitudinal community sample of 957 young people from the Raising Healthy Children project.

RESULTS

Childhood bullying was significantly associated with violence, heavy drinking and marijuana use at age 21. These associations held up after controlling for prior risk factors.

CONCLUSIONS

Childhood bullying had unique associations with risk of later violence and substance use among young adults. Early intervention to prevent childhood bullying may also reduce other adverse outcomes later in life.

Circulating levels of 8 cytokines and marine n-3 fatty acids and indices of obesity in Japanese, white, and Japanese American middle-aged men

This study examines the differences in circulating levels of cytokines among Japanese in Japan (JJ), Japanese Americans (JA), and whites and their associations with obesity and marine n-3 fatty acids (FA) in a cross-sectional population-based study of 297 men aged 40-49 (100 JJ, 99 whites, and 98 JA). Experimental studies show that cytokines are associated with obesity positively and marine n-3 FA inversely. Serum interleukin-1alpha (IL-1alpha), IL-1 receptor agonist (IL-1ra), IL-4, IL-8, IL-10, inducible protein-10 (IP-10), tumor necrosis factor-alpha (TNF-alpha), monocyte chemoattractant protein-1 (MCP-1), and marine n-3 FA were determined. Body mass index (BMI), waist circumference, and computed tomography-measured visceral and subcutaneous adipose tissues were determined. The JJ had significantly lower levels of IL-1alpha, IL-4, IL-8, MCP-1, and TNF-alpha than whites and JA. Whites and JA had similar levels of IL-1alpha, IL-4, and IL-8 whereas whites had significantly higher levels of MCP-1 and TNF-alpha than JA. The JJ were least obese (BMI (kg/m(2)), mean +/- standard deviation) 23.6 +/- 2.8, 27.9 +/- 4.6, and 27.9 +/- 4.5 for JJ, whites, and JA, respectively. The JJ had marine n-3 FA about 100% higher than whites and JA (serum marine n-3 FA (%), median (interquartile range) 8.79 (7.41, 11.16), 3.47 (2.63, 4.83), and 4.44 (3.33, 6.01) for JJ, whites, and JA, respectively). Generally cytokines had weak and nonsignificant associations with indices of obesity and nonsignificant associations with marine n-3 FA. BMI had significant inverse associations with IL-1alpha, IL-4, and IL-8 in JA (P < 0.05). Marine n-3 FA had marginally significant inverse associations with IL-8 in JJ (P = 0.055) and TNF-alpha in whites (P = 0.076). The JJ had lower levels of many cytokines than whites and JA. Generally cytokines had weak and nonsignificant associations with indices of obesity and marine n-3 FA. Further investigation is needed to determine why JJ had lower circulating levels of cytokines.

Late-life hemoglobin and the incidence of Parkinson's disease

Brain iron promotes neurodegeneration in Parkinson's disease (PD). While hemoglobin (Hb) is the most abundant source of peripheral iron in humans, its relationship with PD is uncertain. This report examines the association between Hb in late life and PD incidence. From 1991 to 1993, Hb was measured in 3507 men in the Honolulu-Asia Aging Study. Men were aged 71-93 years and without PD. Participants were followed until 2001 for incident PD. Hb levels declined markedly with age. For men aged 71-75 years, 14.8% had levels < 14 g/dL versus 53.6% in those aged 86 and older (p < 0.001). During follow-up, 47 men developed PD (19.8/10,000 person-years). After age adjustment, PD incidence rose significantly from 10.3 to 34.9/10,000 person-years as Hb increased from < 14 to ≥ 16 g/dL (p = 0.024; relative hazard 3.2; 95% confidence interval, 1.2-8.9). Associations persisted after accounting for early mortality and adjustments for concomitant risk factors. While Hb declines with advancing age, evidence suggests that Hb that remains high in elderly men is associated with an increased risk of PD.

Effect of walking distance on 8-year incident depressive symptoms in elderly men with and without chronic disease: the Honolulu-Asia Aging Study

OBJECTIVES

To determine the effect of walking on incident depressive symptoms in elderly Japanese-American men with and without chronic disease.

DESIGN

Prospective cohort study.

SETTING

The Honolulu-Asia Aging Study.

PARTICIPANTS

Japanese-American men aged 71 to 93 at baseline.

MEASUREMENTS

Physical activity was assessed according to self-reported distance walked per day. Depressive symptoms were measured using an 11-question version of the Centers for Epidemiologic Studies Depression Scale (CES-D 11) at the fourth examination (n=3,196) and at the seventh examination 8 years later (1999/00, n=1,417). Presence of incident depressive symptoms was defined as a CES-D 11 score of 9 or greater or taking antidepressants at Examination 7. Subjects with prevalent depressive symptoms at baseline were excluded.

RESULTS

Age-adjusted 8-year incident depressive symptoms were 13.6%, 7.6%, and 8.5% for low (<0.25 miles/day), intermediate (0.25-1.5 miles/day), and high (>1.5 miles/day) walking groups at baseline (P=0.008). Multiple logistic regression analyses, adjusted for age, education, marital status, cardiovascular risk factors, prevalent diseases, and functional impairment, showed that those in the intermediate and highest walking groups had significantly lower odds of developing 8-year incident depressive symptoms (odds ratio (OR)=0.52, 95% confidence interval (CI)=0.32-0.83, P=.006 and OR=0.61, 95% CI= 0.39-0.97, P=.04, respectively). Analysis found that this association was significant only in participants without chronic diseases (coronary heart disease, cerebrovascular accident, cancer, Parkinson's disease, dementia, or cognitive impairment) at baseline.

CONCLUSION

Daily physical activity (≥0.25 mile/day) is significantly associated with lower risk of 8-year incident depressive symptoms in elderly Japanese-American men without chronic disease at baseline.

Person-environment interaction in the prediction of alcohol abuse and alcohol dependence in adulthood

BACKGROUND

Behavioral disinhibition (externalizing/impulsivity) and behavioral inhibition (internalizing/anxiety) may contribute to the development of alcohol abuse and dependence. But tests of person-by-environment interactions in predicting alcohol use disorders are needed. This study examined the extent to which interactions between behavioral disinhibition, behavioral inhibition and family management during adolescence predict alcohol abuse and alcohol dependence at age 27.

METHODS

This study used longitudinal data from a community sample of 808 men and women interviewed from ages 10 to 27 in the Seattle Social Development Project. Zero-order correlations followed by a series of nested regressions examined the relationships between individual characteristics (behavioral disinhibition and behavioral inhibition/anxiety) and environment (good vs. poor family management practices during adolescence) in predicting alcohol abuse and dependence criterion counts at age 27.

RESULTS

Behavioral disinhibition and poor family management predicted increased likelihood of both alcohol abuse and alcohol dependence at age 27. Behavioral inhibition/anxiety was unrelated to both outcomes. Youths high in behavioral disinhibition were at increased risk for later alcohol abuse and dependence only in consistently poorly managed family environments. In consistently well-managed families, high levels of behavioral disinhibition did not increase risk for later alcohol abuse or dependence.

CONCLUSIONS

Behavioral disinhibition increases risk for alcohol abuse and dependence in early adulthood only for individuals who experience poor family management during adolescence. Interventions seeking to reduce environmental risks by strengthening consistent positive family management practices may prevent later alcohol abuse and dependence among individuals at risk due to behavioral disinhibition.

Identifying trajectories of adolescents' depressive phenomena: an examination of early risk factors

Few studies have examined risk factors of childhood and early adolescent depressive symptomatology trajectories. This study examined self-report depressive symptomatology across a 6-year time period from 2nd to 8th grade to identify latent groups of individuals with similar patterns of depressive phenomena in a sample of 951 children (440 girls, 511 boys). Analyses, using semiparametric group modeling (SGM), identified 5 trajectory groups for girls and boys: low depressed stables, low depressed risers, mildly depressed stables, moderately depressed changers, and moderately depressed risers. Individual risk factors, with the exception of shy/withdrawn behavior, were significantly different across trajectory group membership for boys and girls, as was low-income status for boys. Boys in the low depressed and mildly depressed stable trajectory groups had significantly higher levels of antisocial behavior, attention problems, and lower social competency compared to girls in similar groups. These results suggest that universal prevention programs implemented in early elementary school that target selected risk factors may be helpful in reducing future adolescent mental health problems, specifically depressive symptomatology.

Serum n-6 fatty acids and lipoprotein subclasses in middle-aged men: the population-based cross-sectional ERA-JUMP study

BACKGROUND

The associations of serum omega-6 (n-6) fatty acids with lipoprotein subclasses at the population level are uncertain.

OBJECTIVE

We aimed to examine associations between major n-6 fatty acids [ie, linoleic acid (LA, 18:2n-6) and arachidonic acid (AA, 20:4n-6)] and the lipoprotein subclasses VLDL, LDL, and HDL.

DESIGN

We conducted a cross-sectional study in 1098 participants using population-based data from US white, Japanese American, Japanese, and Korean men aged 40-49 y. Serum fatty acids were analyzed by capillary gas-liquid chromatography. Lipoprotein subclasses were measured by nuclear magnetic resonance spectroscopy. Multiple linear regression models as a function of each fatty acid were used after adjustment for age, population, body mass index, pack-years of smoking, alcohol consumption, diabetes, hypertension, and omega-3 (n-3) and trans fatty acids.

RESULTS

Serum LA was inversely associated with large VLDL (beta = -0.62, P < 0.001), total LDL (beta = -22.08, P < 0.001), and small LDL (beta = -31.89, P < 0.001) particle concentrations and VLDL size (beta = -0.72, P < 0.001). Serum LA was positively associated with large HDL particle concentration (beta = 0.21, P < 0.001) and HDL size (beta = 0.03, P < 0.001). The patterns of association of AA with large VLDL and large HDL particle concentrations were comparable with those of LA.

CONCLUSIONS

At the population level, higher serum concentrations of LA were significantly associated with lower concentrations of total LDL particles. Higher serum concentrations of LA and AA were significantly associated with a lower concentration of large VLDL particles and a higher concentration of large HDL particles. These associations were consistent across the population groups. This trial was registered at clinicaltrials.gov as NCT00069797.

Growth in phonological, orthographic, and morphological awareness in grades 1 to 6

Growth curve analyses showed that (a) word-level phonological and orthographic awareness show greatest growth during the primary grades but some additional growth thereafter, and (b) three kinds of morphological awareness show greatest growth in the first three or four grades but one-derivation-continues to show substantial growth after fourth grade. Implications of the findings for the role of three kinds of linguistic awareness-phonological, orthographic, and morphological-in learning to read and spell words are discussed. A case is made that phonological awareness, while necessary, is not sufficient for learning to read English-all three kinds of linguistic awareness that are growing during the primary grades need to be coordinated and applied to literacy learning. This finding and a review of the research on linguistic awareness support the conclusion that the recommendations of the National Reading Panel need to be amended so that the research evidence supporting the importance of both orthographic and morphological awareness, and not only phonological awareness, is acknowledged. Moreover, evidence-based strategies for teaching each of these kinds of linguistic awareness and their interrelationships need to be disseminated to educational practitioners.

Relationships between level and change in family, school, and peer factors during two periods of adolescence and problem behavior at age 19

While prior research has examined family, school, and peer factors as potential predictors of problem behavior, less attention has been given to studying when these factors are most predictive of problems and if and when changes in these factors signal risk. Using annual data on a community sample of 1,040 individuals (47% female; 81% White), this study models growth in risk and protective factors during two developmental periods (Grades 5-8 and Grades 9-12) in order to predict substance misuse and crime at age 19. For protective factors of positive relationships with family and positive bonds to school, both the levels of these factors at Grade 5 and change between Grade 5 and Grade 8 predicted substance misuse and crime in early adulthood. Higher likelihoods of both forms of problem behavior also were predicted by increases in the risk factor of exposure to negative peers between 5th and 8th grade. In the late adolescent period, levels at 9th grade of all risk and protective factors examined predicted both substance misuse and crime. Also, increases in exposure to negative peers in late adolescence predicted greater likelihoods of both forms of problem behavior, while greater risk of substance misuse was predicted by decreases in school bonding and academic achievement, and greater risk of crime was predicted by worsening relationships with family. The results add to prior research by indicating that in addition to the level, change in risk and protective factors during these two stages of development can be signals of risk and are promising targets for intervention.

Implementation of the Communities That Care Prevention System by Coalitions in the Community Youth Development Study

While advances in prevention science over the past 2 decades have produced a growing list of tested and effective programs and policies for preventing adolescent delinquency and drug use, widespread dissemination and high-quality implementation of effective programs and policies in communities has not been achieved. The Community Youth Development Study (CYDS) is a randomized, community-level trial of the Communities That Care (CTC) system for promoting science-based prevention in communities. This paper compares 12 community prevention coalitions implementing the CTC system in 12 intervention communities as part of the CYDS to prevention coalitions located in the 12 control communities. As hypothesized, the CYDS coalitions implemented significantly more of the CTC core intervention elements, and also implemented significantly greater numbers of tested, effective prevention programs than the prevention coalitions in the control communities. Implications of the findings for efforts to achieve widespread dissemination of effective prevention programs, policies, and practices are discussed.

Applying the Multiple Dimensions of Reading Fluency to Assessment and Instruction

In Study 1 we evaluated whether each of three kinds of reading fluency (oral, silent—sentences, silent—passages) contributed uniquely to reading comprehension when children were in second grade (when oral reading is emphasized) and again when they were in fourth grade (when silent reading is emphasized). In Study 2 we evaluated the relationship of comprehension and other reading (automatic real word and pseudoword reading) and oral language (vocabulary) skills to each of the three kinds of fluency (oral passage, silent passage rate, and silent timed sentence comprehension) at the same grade levels. Results of both studies showed that contributions vary with the three kinds of fluency, as predictors or outcomes, and grade level, consistent with the view that fluency is a multidimensional construct that has bidirectional relationships with other language skills. Implications of multidimensional fluency for assessment and instruction are discussed.