Paths to reading comprehension in at-risk second-grade readers

Two studies of second graders at risk for reading disability, which were guided by levels of language and functional reading system theory, focused on reading comprehension in this population. In Study 1 (n = 96), confirmatory factor analysis of five comprehension measures loaded on one factor in both fall and spring of second grade. Phonological decoding predicted accuracy of real-word reading; automatic letter naming predicted rate of real-word reading; accuracy and rate of both real-word reading (more so than decoding of pseudowords) and text reading predicted reading comprehension; and Verbal IQ also predicted reading comprehension. In Study 2 (n = 98), the treatment group (before/after school clubs receiving an integrated instructional approach that was supplementary to the general reading program) improved significantly more in phonological decoding and state standards for reading fluency than the control group (general reading program that had some code instruction but emphasized comprehension). The rate of phonological decoding explained 60.3% of real-word reading. Both treatment and control children improved significantly in reading comprehension, but controlling for pretreatment individual differences in oral vocabulary or in phonological decoding eliminated this effect. Taken together, the results of the two studies support two paths to reading comprehension: one from vocabulary and verbal reasoning, and one from written language that has multiple links between subskills: (a) alphabetic principle --> phonological decoding, (b) automatic phonological decoding --> accurate real-word reading, (c) automatic letter coding ---> automatic word reading, and (d) automatic word reading --> fluent text reading. Instructional implications of both paths and the links within the written language are discussed.

Effects of prior attention training on child dyslexics' response to composition instruction

Twenty children (Grades 4 to 6) who met research criteria for dyslexia were randomly assigned to a treatment (attention training) or contact control (reading fluency training) group during their regular language arts block at a school that had emphasized multisensory, structured language treatment for reading disability. A university team provided either individual attention training (sustained, selective, alternating, and divided attention) or reading fluency training during the first 10 sessions and group composition instruction during the next 10 sessions. Analysis of variance evaluated the significance of Treatment x Session interactions from pretest to midtest (before composition instruction began) and midtest to posttest (when compositon instruction ends). Treatment x Time interactions were not significant between pretest and midtest, but the Treatment x Time interactions were significant from midtest to posttest for Wechsler Individual Achievement Test, Second Edition Written Composition and Delis-Kaplan Executive Function System Verbal Fluency (attention treatment group improved more over time). Individual children showed the same pattern as group results. For child dyslexics in upper elementary school, attention training did not transfer directly to improved composition but prior attention training led to faster improvement in composing and oral verbal fluency once composition instruction was introduced. Effective instruction for dyslexia may depend on the sequencing as well as the nature of instructional components and require specialized instruction for writing as well as reading.

Executive functions in becoming writing readers and reading writers: note taking and report writing in third and fifth graders

Results are reported for a study of 2 separate processes of report writing-taking notes while reading source material and composing a report from those notes-and related individual differences in executive functions involved in integrating reading and writing during these writing activities. Third graders (n = 122) and 5th graders (n = 106; overall, 127 girls and 114 boys) completed two reading-writing tasks-read paragraph (mock science text)-write notes and use notes to generate written report, a reading comprehension test, a written expression test, four tests of executive functions (inhibition, verbal fluency, planning, switching attention), and a working memory test. For the read-take notes task, the same combination of variables was best (explained the most variance and each variable added unique variance) for 3rd graders and 5th graders: Wechsler Individual Achievement Test-Second Edition (WIAT-II) Reading Comprehension, Process Assessment of the Learner Test for Reading and Writing (PAL) Copy Task B, WIAT-II Written Expression, and Delis-Kaplan Executive Function System (D-KEFS) Inhibition. For the use notes to write report task, the best combinations of variables depended on grade level: For 3rd graders, WIAT-II Reading Comprehension, WIAT-II Written Expression, D-KEFS Verbal Fluency, and Tower of Hanoi; for 5th graders, WIAT-II Reading Comprehension, D-KEFS Verbal Fluency, WIAT-II Written Expression, and PAL Alphabet Task. These results add to prior research findings that executive functions contribute to the writing development of elementary-grade students and additionally support the hypothesis that executive functions play a role in developing reading-writing connections.

Relation of habitual snoring with components of metabolic syndrome in Korean adults

AIMS

To examine the association between habitual snoring and components of the metabolic syndrome in Korean adults. Whether these associations are independent of obesity was also explored.

METHODS

Four thousand five hundred and six men and 5041 women aged 40-69 years from the Korean Health and Genome Study were examined. Information of snoring frequency was obtained by a questionnaire and components of the metabolic syndrome were measured.

RESULTS

There was a clear dose-response relationship between the increasing frequency of snoring and the higher prevalence of each component of the metabolic syndrome (P<0.001). After adjustment for age, abdominal obesity, and the other metabolic components, hypertension was significantly associated with a 1.2-fold excess of habitual snoring in both men (P<0.05) and women (P<0.05). The association of habitual snoring with hypertension was unaltered by obesity. Regardless of the presence or absence of abdominal obesity, there was an increase in the prevalence of habitual snoring as the number of metabolic abnormalities increased.

CONCLUSIONS

Habitual snoring is associated with hypertension independent of obesity. While the relationship between habitual snoring and obesity is well recognized, characterization of the role of the other components of the metabolic syndrome as a cause or result of habitual snoring warrants a further study.

Early Development of Language by Hand: Composing, Reading, Listening, and Speaking Connections; Three Letter-Writing Modes; and Fast Mapping in Spelling

The first findings from a 5-year, overlapping-cohorts longitudinal study of typical language development are reported for (a) the interrelationships among Language by Ear (listening), Mouth (speaking), Eye (reading), and Hand (writing) in Cohort 1 in 1st and 3rd grade and Cohort 2 in 3rd and 5th grade; (b) the interrelationships among three modes of Language by Hand (writing manuscript letters with pen and keyboard and cursive letters with pen) in each cohort in the same grade levels as (a); and (c) the ability of the 1st graders in Cohort 1 and the 3rd graders in Cohort 2 to apply fast mapping in learning to spell pseudowords. Results showed that individual differences in Listening Comprehension, Oral Expression, Reading Comprehension, and Written Expression are stable developmentally, but each functional language system is only moderately correlated with the others. Likewise, manuscript writing, cursive writing, and keyboarding are only moderately correlated, and each has a different set of unique neuropsychological predictors depending on outcome measure and grade level. Results support the use of the following neuropsychological measures in assessing handwriting modes: orthographic coding, rapid automatic naming, finger succession (grapho-motor planning for sequential finger movements), inhibition, inhibition/switching, and phonemes skills (which may facilitate transfer of abstract letter identities across letter formats and modes of production). Both 1st and 3rd graders showed evidence of fast mapping of novel spoken word forms onto written word forms over 3 brief sessions (2 of which involved teaching) embedded in the assessment battery; and this fast mapping explained unique variance in their spelling achievement over and beyond their orthographic and phonological coding abilities and correlated significantly with current and next-year spelling achievement.

Relationships between respiratory symptoms and FEV1 in men and women with normal lung function: The Korean Health and Genome Study

Although the prevalence of chronic obstructive pulmonary disease (COPD) and its relationship with respiratory symptoms are well documented, few studies have focused on individuals with normal lung function, particularly in developed regions of Asia. The purpose of this report is to examine the relationship between respiratory symptoms and FEV1 in a population-based sample of Korean men and women with normal lung function. Subjects comprised 7518 individuals aged 40-69 years without airflow obstruction based on spirometric testing and in the absence of a medical history of pulmonary disease. Respiratory symptoms included chronic cough, chronic phlegm, wheezing, and shortness of breath. In men, the age-adjusted mean FEV1 was lower by 165 ml in smokers and 133 ml in nonsmokers in the presence versus the absence of wheezing (p < 0.05). While walking at a usual pace, FEV1 in smoking men was 210 ml lower in the presence versus the absence of shortness of breath (p < 0.05). Among nonsmoking men, overall shortness of breath and shortness of breath while walking uphill were associated with a lower FEV1 by 56 and 80 ml, respectively) versus those who reported having no shortness of breath (p < 0.05). Respiratory symptoms were unrelated to FEV1 in women smokers, although only 3.5% smoked cigarettes. In nonsmoking women, FEV1 was lower by an average of 89 ml in the presence versus the absence of wheezing (p < 0.001). Nonsmoking women also had a lower FEV1 in the presence of shortness of breath (overall, while at rest, and while walking uphill or at a usual pace, p < 0.001). Our findings suggest that respiratory symptoms are associated with a lower FEV1 in men and nonsmoking women with normal lung function. Whether respiratory symptoms can be used to identify individuals at risk for developing COPD needs further study.

Adolescent substance use outcomes in the Raising Healthy Children project: a two-part latent growth curve analysis

Raising Healthy Children (RHC) is a preventive intervention designed to promote positive youth development by targeting developmentally appropriate risk and protective factors. In this study, the authors tested the efficacy of the RHC intervention on reducing adolescent alcohol, marijuana, and cigarette use. Ten public schools, which comprised 959 1st- and 2nd-grade students (54% male students, 18% minority, 28% low socioeconomic status), were matched and assigned randomly to either intervention or control conditions. A 2-part latent growth modeling strategy was used to examine change in both use-versus-nonuse and frequency-of-use outcomes while students were in Grades 6-10. Results indicated significant (p < .05) intervention effects in growth trajectories for frequency of alcohol and marijuana use but not for use versus nonuse. These findings provide support for preventive interventions that take a social development perspective in targeting empirically supported risk and protective factors and demonstrate the use of 2-part models in adolescent substance use research.

Recent clinical-pathologic research on the causes of dementia in late life: update from the Honolulu-Asia Aging Study

In this study, we compare neuropathological findings at autopsy with clinical dementia diagnoses, such as Alzheimer's disease and vascular dementia. Participants consisted of 363 aged Japanese-American men from the Honolulu-Asia Aging Study. Results indicated that the correspondence between clinical and neuropathologic diagnosis was not great, with 56% of patients diagnosed with probable or possible Alzheimer's disease during life but with only 19% having neuritic plaques and/or neurofibrillary tangles as the sole or dominant dementia-related lesions in the brain at autopsy. Although 16% of cases were attributed to mixed causes during life, almost 40% were found to have significant mixtures of dementia-related lesions at autopsy. Finally, both Alzheimer's disease and non-Alzheimer's disease neuropathologic lesions contributed independently to the explanation of variance on a test of overall cognitive performance. The results suggest that clinical diagnosis of dementia made during life may fail to reflect the pathogenic complexity of this condition in very elderly persons.

Excessive daytime sleepiness and subsequent development of Parkinson disease

OBJECTIVE

To determine if excessive daytime sleepiness (EDS) can predate future Parkinson disease (PD).

METHODS

EDS was assessed in 3,078 men aged 71 to 93 years in the Honolulu-Asia Aging Study from 1991 to 1993. All were free of prevalent PD and dementia. Follow-up for incident PD was based on three repeat neurologic assessments from 1994 to 2001.

RESULTS

During the course of follow-up, 43 men developed PD (19.9/10,000 person-years). After age adjustment, there was more than a threefold excess in the risk of PD in men with EDS vs men without EDS (55.3 vs 17.0/10,000 person-years; odds ratio [OR] = 3.3; 95% CI = 1.4 to 7.0; p = 0.004). Additional adjustment for insomnia, cognitive function, depressed mood, midlife cigarette smoking and coffee drinking, and other factors failed to alter the association between EDS and PD (OR = 2.8; 95% CI = 1.1 to 6.4; p = 0.014). Other sleep related features such as insomnia, daytime napping, early morning grogginess, and frequent nocturnal awakening showed little relation with the risk of PD.

CONCLUSIONS

Excessive daytime sleepiness may be associated with an increased risk of developing Parkinson disease.

Family influences on the risk of daily smoking initiation

PURPOSE

To examine developmental patterns and family influences on the risk of daily smoking initiation from adolescence to young adulthood.

METHOD

A gender-balanced, ethnically diverse urban sample of 808 children aged 10-11 years was surveyed in 1985 and followed prospectively to age 21 in 1996. Discrete-time survival analysis was used to assess the hazard of initiation of daily smoking during this time period, as well as the effects of family factors on the risk of daily smoking initiation.

RESULTS

Less parental smoking, more strict family monitoring and rules, and stronger family bonding predicted a significantly lower risk of daily smoking initiation controlling for socio-demographic background. The decline in the impact of family bonding over time was marginally significant; however, none of the interactions between family factors and time were significant, indicating generally consistent family influences on daily smoking from age 10 to 21.

CONCLUSIONS

The present findings indicate that parent smoking contributes to the onset of daily smoking in their teenagers even if parents practice good family management, hold norms against teen tobacco use, and do not involve their children in their own tobacco use. Smoking prevention programs should include components focused on parents of adolescents. To reduce risks for daily smoking among adolescents, it is important to encourage parents to stop or reduce their own smoking. In addition, these data indicate that parents can reduce their children's risk of daily smoking initiation by reducing family conflict, by maintaining strong bonds with their children, by setting clear rules, and by closely monitoring their children's behaviors.

Measures of positive adult behavior and their relationship to crime and substance use

Drawing on diverse approaches to the study of youth development and adult functioning, as well as social capital and citizenship, this investigation identifies measures of positive adult behavior. Although prevention researchers study protective factors, as well as risk factors, for problem behaviors and other negative outcomes, less attention is given to positive behavior outcomes and there is little understanding of the relationships between positive and negative outcomes. Analyses included 765 participants from the Seattle Social Development Project interviewed at age 21. Seven measures of positive adult behavior were identified: volunteerism, group involvement, neighborliness, interpersonal connection, constructive engagement, financial responsibility, and honesty. Measures related to distal social relationships (group involvement and neighborliness) had relatively weak associations with crime and substance use. In contrast, the measures of constructive engagement, financial responsibility, and honesty had significant negative associations with multiple measures of crime and substance use. Results indicate that the seven measures provide relatively independent variables useful for assessing positive adult behavior. These measures can be used to assess positive outcomes in adulthood of intervention studies, or to assess the prevalence of positive adult behavior in different populations or groups.

Consumption of milk and calcium in midlife and the future risk of Parkinson disease

OBJECTIVE

To examine the relation between milk and calcium intake in midlife and the risk of Parkinson disease (PD).

METHODS

Findings are based on dietary intake observed from 1965 to 1968 in 7,504 men ages 45 to 68 in the Honolulu Heart Program. Men were followed for 30 years for incident PD.

RESULTS

In the course of follow-up, 128 developed PD (7.1/10,000 person-years). Age-adjusted incidence of PD increased with milk intake from 6.9/10,000 person-years in men who consumed no milk to 14.9/10,000 person-years in men who consumed >16 oz/day (p = 0.017). After further adjustment for dietary and other factors, there was a 2.3-fold excess of PD (95% CI 1.3 to 4.1) in the highest intake group (>16 oz/day) vs those who consumed no milk. The effect of milk consumption on PD was also independent of the intake of calcium. Calcium from dairy and nondairy sources had no apparent relation with the risk of PD.

CONCLUSIONS

Findings suggest that milk intake is associated with an increased risk of Parkinson disease. Whether observed effects are mediated through nutrients other than calcium or through neurotoxic contaminants warrants further study.

Prevalence and correlates of orthostatic hypotension in middle-aged men and women in Korea: the Korean Health and Genome Study

To examine the prevalence and correlates of orthostatic hypotension (OH) in middle-aged adults enrolled in the Korean Health and Genome Study. Participants were 8908 individuals aged 40-69 years. Supine blood pressure (BP) was measured three times at 30-s intervals after at least 5 min of rest in the supine position and single standing BP was measured at 0 and 2 min after standing, respectively. OH was defined as a reduction in systolic BP or diastolic BP > or = 20 and 10 mmHg, respectively. The prevalence of OH at 0 and 2 min after standing was 12.3 and 2.9%, respectively. At 0 min of standing, OH frequency increased significantly with age from 6.4% in those aged 40-44 years to 23.1% in those aged 65-69 (P < 0.001). After adjustment for age and other characteristics, hypertension was associated with a 1.7-fold excess in the odds of OH in men and a 1.6-fold excess in women (P < 0.001). In contrast, an increase in body mass index (BMI) on the order of 5 kg/m2 was associated with a 20-30% reduction in the odds of OH (P < 0.001). Diabetes in women was also associated with a 1.4-fold excess in the odds of OH (P < 0.05). An increase in triglyceride by 136 mg/dl in men was associated with an increase in the odds of OH (P < 0.05). In conclusion, the prevalence and correlates of OH other than diabetes and triglycerides were notably similar in men and women. While the association between hypertension and OH has been observed elsewhere, low BMI in Korean adults with OH may be an important marker for subclinical morbidity or coexisting risk factors that need to be identified.

Promoting positive adult functioning through social development intervention in childhood: long-term effects from the Seattle Social Development Project

OBJECTIVE

To examine the long-term effects of the Seattle Social Development Project intervention in promoting positive adult functioning and preventing mental health problems, crime, and substance use (including tobacco, alcohol, and other drugs) at 21 years of age.

DESIGN

This nonrandomized controlled trial followed up participants to 21 years of age, 9 years after the intervention ended. We compared the following 3 intervention conditions: a full 6-year intervention (grades 1 through 6); a late 2-year intervention (grades 5 and 6 only); and a no-treatment control condition.

SETTING

Eighteen public elementary schools serving diverse neighborhoods, including high-crime neighborhoods, of Seattle, Wash.

PARTICIPANTS

A sex-balanced, multiethnic sample of 605 participants across the 3 conditions who completed interviews at 21 years of age (94% of the original sample in these conditions).

INTERVENTIONS

Teacher training in classroom instruction and management, child social and emotional skill development, and parent training.

MAIN OUTCOME MEASURES

Self-reports of functioning in school and work, emotional and mental health, and crime and substance use at 21 years of age and official court records.

RESULTS

Broad significant effects on functioning in school and work and on emotional and mental health were found. Fewer significant effects on crime and substance use were found at 21 years of age. Most outcomes had a consistent dose effect, with the strongest effects in subjects in the full-intervention group and effects in the late-intervention group between those in the full-intervention and control groups.

CONCLUSIONS

A theory-guided preventive intervention that strengthened teaching and parenting practices and taught children interpersonal skills during the elementary grades had wide-ranging beneficial effects on functioning in early adulthood.

Mediator effects in the social development model: an examination of constituent theories

BACKGROUND

The social development model (SDM) provides an explanatory framework for the progression of antisocial behaviour in children and adolescents. Although previous research has assessed the predictive validity of the model, alternative associations based on the SDM's constituent theories have not been examined.

METHOD

Using structural equation modelling, a series of direct paths was examined for mediation by SDM constructs. Data for the study consisted of teacher-, parent- and self-report of 1016 fourth- and fifth-grade students from the Raising Healthy Children project, a longitudinal etiological study with an embedded preventive intervention.

RESULTS

Four of the seven paths examined were partially or totally mediated by SDM constructs. Specifically, the relationship between prosocial bonding and adolescent antisocial behaviour, as hypothesized by social control theory, was fully mediated by prosocial beliefs. As hypothesized by social learning theory, students' socioemotional and cognitive skills significantly predicted antisocial behaviour, independent of partial mediation through rewards, bonding and beliefs. As hypothesized by differential association theory, involvement with both prosocial and antisocial persons was directly associated with respective prosocial and antisocial beliefs, independent of partial mediation through rewards and bonding.

CONCLUSIONS

These findings suggest additional associations that are not currently specified in the SDM and underscore the importance of re-examining hypotheses from constituent theories when integrating developmental models of antisocial behaviour.

Respiratory symptoms and undiagnosed airflow obstruction in middle-aged adults: the Korean Health and Genome Study

BACKGROUND

The prevalence of undiagnosed airflow obstruction is difficult to measure since it requires screening in population-based samples to identify individuals free of clinical symptoms. The purpose of this report is to examine the prevalence of undiagnosed airflow obstruction and its relation with respiratory symptoms in middle-age adults in the Korean Health and Genome (KHG) Study.

METHODS

The KHG study is an ongoing population-based study of Korean adults aged 40 to 69 years. The current report includes 8,140 men and women without a pulmonary disorder or obstructive lung disease. In this sample, undiagnosed airflow obstruction was defined on the basis of spirometric testing and in the absence of a medical history or a recognized pulmonary disorder. Respiratory symptoms included chronic cough, chronic phlegm, wheezing, and shortness of breath.

RESULTS

Undiagnosed airflow obstruction was observed in 12.4% of the men (470 of 3,806 subjects) and in 3.5% of the women (152 of 4,334 subjects). In men, the age-adjusted prevalence of undiagnosed airflow obstruction increased consistently with increasing number of respiratory symptoms. In those who smoked, there was a 2.3-fold excess in its prevalence when three or more symptoms were present, as compared to when they were absent (27.4% vs 12.0%, p < 0.001). A 2.4-fold excess (20.6% vs 8.5%, p = 0.004) was observed in nonsmoking men, in whom respiratory symptoms were consistently less common than in those who smoked. Respiratory symptoms were unrelated to undiagnosed airflow obstruction in women smokers, although only 3.9% smoked cigarettes. In women who were nonsmokers, the prevalence of undiagnosed airflow obstruction increased from 2.3% in those without a respiratory symptom to 6.0% when three or more symptoms were present (p = 0.003).

CONCLUSIONS

Findings suggest that undiagnosed airflow obstruction is common in Korea with several respiratory symptoms. Whether respiratory symptoms with associations with undiagnosed airflow obstruction can be used to design early intervention strategies that prevent or delay the onset of COPD and its disabling consequences warrants further study.

Parkinsonian signs and substantia nigra neuron density in decendents elders without PD

Substantia nigra (SN) neurons were counted on single, transverse caudal midbrain sections from 217 male participants in the Honolulu-Asia Aging Study, aged 74-97 years at death. Quadrants areas within the SN were determined with a planimeter and neuronal density was expressed as neurons/mm(2) for 10 Parkinson's disease (PD) cases, 29 incidental Lewy body cases, and 178 controls with neither condition. Mean densities in all quadrants were significantly lower in the PD group compared with the other groups (p = 0.006). This relationship was strongest in the ventrolateral quadrant. In a subgroup of 50 controls who were examined with the Unified Parkinson's Disease Rating Scale an average of 2.1 years prior to death, there was an association of stooped posture (p = 0.009), postural instability (p = 0.013), body bradykinesia (p = 0.048), and gait disturbance (p = 0.05) with neuron density in the dorsolateral quadrant; and impaired speech (p = 0.014), abnormal facial expression (p = 0.022), and difficulty rising from a chair (p = 0.032) with neuron density in the dorsomedial quadrant. There was a significant association of increasing number of signs present with decreasing neuron density in both quadrants (p = 0.001 for trend). Low SN neuron density may be the basis for parkinsonian signs in the elderly without PD.

Prospective Association Between Low and High Total and Low-Density Lipoprotein Cholesterol and Coronary Heart Disease in Elderly Men

OBJECTIVES

To examine the relationship between total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and the incidence of coronary heart disease (CHD) in elderly men.

DESIGN

Prospective.

SETTING

Population based.

PARTICIPANTS

A sample of 2,424, Japanese-American men aged 71 to 93 was used.

MEASUREMENTS

Six years of data on incident fatal plus nonfatal CHD were examined.

RESULTS

Analysis revealed a significant U-shaped relationship between age-adjusted CHD rates and both TC and LDL-C. The ranges of TC and LDL-C with the lowest risk of CHD were 200 to 219 mg/dL and 120 to 139 mg/dL, respectively. As cholesterol concentrations declined and increased beyond these ranges, the risk of CHD increased. These U-shaped relationships remained significant after adjusting for age and other risk factors.

CONCLUSION

The U-shaped associations between TC and LDL-C and CHD imply a complex relationship between lipids and CHD in late life. The results indicate that elevated lipid levels should continue to be treated in healthy elderly individuals, as they are in those who are younger, although pharmacologically lowering lipids to excessively low levels in the elderly may warrant further study, as does the contribution of subclinical frailty to the relationship of lipids to CHD risk.

Walking and dementia in physically capable elderly men

CONTEXT

Evidence suggests that physical activity may be related to the clinical expression of dementia. Whether the association includes low-intensity activity such as walking is not known.

OBJECTIVE

To examine the association between walking and future risk of dementia in older men.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

Distance walked per day was assessed from 1991 to 1993 in 2257 physically capable men aged 71 to 93 years in the Honolulu-Asia Aging Study. Follow-up for incident dementia was based on neurological assessment at 2 repeat examinations (1994-1996 and 1997-1999).

MAIN OUTCOME MEASURES

Overall dementia, Alzheimer disease, and vascular dementia.

RESULTS

During the course of follow-up, 158 cases of dementia were identified (15.6/1000 person-years). After adjusting for age, men who walked the least (<0.25 mile/d) experienced a 1.8-fold excess risk of dementia compared with those who walked more than 2 mile/d (17.8 vs 10.3/1000 person-years; relative hazard [RH], 1.77; 95% confidence interval [CI], 1.04-3.01). Compared with men who walked the most (>2 mile/d), an excess risk of dementia was also observed in those who walked 0.25 to 1 mile/d (17.6 vs 10.3/1000 person-years; RH, 1.71; 95% CI, 1.02-2.86). These associations persisted after accounting for other factors, including the possibility that limited amounts of walking could be the result of a decline in physical function due to preclinical dementia.

CONCLUSIONS

Findings suggest that walking is associated with a reduced risk of dementia. Promoting active lifestyles in physically capable men could help late-life cognitive function.

High density lipoprotein cholesterol and the risk of stroke in elderly men: the Honolulu heart program

High density lipoprotein (HDL) cholesterol has been inversely associated with coronary heart disease. Associations with stroke are less clear, particularly among the elderly. In this study, the authors examined the relation between HDL cholesterol levels and the risk of stroke in elderly men. Levels of HDL cholesterol were measured in 2,444 Honolulu Heart Program men aged 71-93 years at the 1991-1993 examinations. The participants, who were free of prevalent stroke, coronary heart disease, and cancer at baseline, were followed to the end of 1998 for thromboembolic and hemorrhagic stroke. While HDL cholesterol was unrelated to hemorrhagic events, incidence of thromboembolic stroke declined consistently with increasing HDL cholesterol level (p = 0.003). There was a nearly threefold excess of thromboembolic stroke in men with low HDL cholesterol levels (<1.0 mmol/liter (<40 mg/dl)) compared with men with high levels (> or =1.6 mmol/liter (> or =60 mg/dl)) (10.6/1,000 person-years vs. 3.6/1,000 person-years; p = 0.001). Adjustment for other risk factors had little effect on these findings, although associations appeared strongest in elderly men with "desirable" total cholesterol levels, hypertension, or diabetes mellitus. These findings suggest that HDL cholesterol level is inversely related to the risk of thromboembolic stroke in elderly men. Whether HDL cholesterol alters the effect of other factors on stroke risk in elderly men warrants further study.

Pathways from physical childhood abuse to partner violence in young adulthood

Analyses investigated several competing hypotheses about developmental pathways from childhood physical abuse and early aggression to intimate partner violence (IPV) for young adult males and females at age 24. Potential intervening variables included: adolescent violence (age 15 to 18), negative emotionality at age 21, and quality of one's relationship with an intimate partner at age 24. At the bivariate level, nearly all variables were associated in the expected directions. However, tests of possible intervening variables revealed only a few significant results. For males, a strong direct effect of abuse on later partner violence was maintained in each model. For females, the quality of one's relationship with an intimate partner did appear to mediate the effect of childhood abuse on later violence to a partner, raising the possibility of gender differences in developmental pathways linking abuse to IPV. Implications with regard to prevention are discussed.

A prospective study of HDL-C and cholesteryl ester transfer protein gene mutations and the risk of coronary heart disease in the elderly

High density lipoprotein cholesterol (HDL-C) levels are inversely associated with the incidence of coronary heart disease (CHD) in middle-aged individuals; in the elderly, the association is less clear. Genetic factors, including variations in the cholesteryl ester transfer protein (CETP) gene, play a role in determining HDL-C levels. Controversy remains about whether CETP deficiency and the resultant rise in HDL-C are antiatherogenic, or whether CETP has the opposite effect due to its role in reverse cholesterol transport. In a seven-year follow-up of 2340 men aged 71-93 in the Honolulu Heart Program, the age-adjusted CHD incidence rates were significantly lower in men with high versus low HDL-C levels. After adjustment for age, hypertension, smoking, and total cholesterol, the relative risk of CHD for those with HDL-C levels >or=60 mg/dl, compared with those with HDL-C levels <40 mg/dl, was 0.6. Men with a CETP mutation had the lowest rates of CHD, although this was not statistically significant. These data indicate that HDL-C remains an important risk factor for CHD in the elderly. Whether a CETP mutation offers additional protection against CHD warrants further investigation.

Environmental, life-style, and physical precursors of clinical Parkinson's disease: recent findings from the Honolulu-Asia Aging Study

BACKGROUND

Increased westernization with Japanese migration to the U. S. in the early 20(th) century is thought to have altered the risk of cardiovascular disease. Whether similar effects include changes in the risk of Parkinson's disease (PD) is not clear. This report describes the relations between environmental, life-style, and physical attributes and the incidence of PD that have been observed in the Honolulu-Asia Aging Study.

METHODS

Beginning in 1965, environmental, life-style, and physical attributes were recorded at selected examinations in a cohort of 8,006 Japanese-American men. Subjects were followed for clinical PD.

FINDINGS

During 30 years of follow- up, PD was observed in 137 men. Overall incidence (7.1/10,000 person-years) was generally higher than in Asia and similar to rates observed in Europe and the U. S. Precursors of PD included constipation, adiposity, years worked on a sugar or pineapple plantation, years of exposure to pesticides, and exposure to sugar cane processing. Factors showing an inverse association with PD included coffee intake and cigarette smoking. Among dietary factors, carbohydrates increased the risk of PD while the intake of polyunsaturated fats appeared protective. Total caloric intake, saturated and monounsaturated fats, protein, niacin, riboflavin, beta-carotene, vitamins A, B, and C, dietary cholesterol, cobalamin, alpha-tocopherol, and pantothenic acid showed no clear relation with clinical PD.

INTERPRETATION

Findings suggest that several environmental, life-style, and physical attributes appear to be precursors of PD. Whether patterns of precursors can be used to identify individuals at high risk of future PD or can broaden the scope of early interventions or recruitment into neuroprotective trials warrants further study.

AD lesions and infarcts in demented and non-demented Japanese-American men

Neocortical neuritic plaques and neurofibrillary tangles are hallmark neuropathological lesions of dementia. Concomitant cerebrovascular lesions increase dementia severity in patients meeting neuropathological criteria for Alzheimer's disease and contribute to cognitive impairment in persons with mild entorhinal Alzheimer lesions. This study investigates whether individuals with sparse neocortical neuritic plaques experience increased odds of crossing the threshold to clinical dementia when they have coexistent cerebrovascular lesions. Dementia examinations were given to 3,734 men during the 1991-1993 Honolulu-Asia Aging Study examination and to 2,603 men during the 1994-1996 examination. Lesion quantification was done without clinical data. Among 333 autopsied men, 120 had dementia, 115 had marginal results, and 98 had normal cognition. In men with neurofibrillary tangles, dementia frequency increased with increasing neuritic plaque density, and increased further in the presence of cerebrovascular lesions. The association was strongest in men with sparse neuritic plaques (1-3/mm(2)) where dementia frequency more than doubled with coexistent cerebrovascular lesions (45 vs 20%). Among all dementia cases, 24% were linked to cerebrovascular lesions. Findings suggest cerebrovascular lesions are associated with a marked excess of dementia in cases with low neuritic plaque frequency. Prevention of cerebrovascular lesions may be critically important in preserving late-life cognitive function.

Dietary magnesium intake and the future risk of coronary heart disease (the Honolulu Heart Program)

Magnesium (Mg) deficiency is believed to have adverse cardiovascular consequences that are broad and complex, although an association between dietary Mg intake and the risk of coronary heart disease (CHD) has not been clearly identified. The purpose of this study is to examine the relation between dietary Mg intake and future risk of CHD. Reported findings are based on dietary Mg intake in 7,172 men in the Honolulu Heart Program. Intake of Mg was recorded at baseline examinations that took place from 1965 to 1968 when the men were aged 45 to 68 years. In 30 years of follow-up, 1,431 incident cases of CHD were identified. Within 15 years after dietary assessment, the age-adjusted incidence decreased significantly from 7.3 to 4.0 per 1,000 person-years in the lowest (50.3 to 186 mg/day) versus highest (340 to 1,183 mg/day) quintiles of Mg intake (p <0.001). When adjustments were made for age and other nutrients (singly or combined), there was a 1.7- to 2.1-fold excess in the risk of CHD in the lowest versus highest quintiles (p <0.001). The excess risk ranged from 1.5- to 1.8-fold after further adjustment for other cardiovascular risk factors (p <0.05). Associations between dietary Mg and coronary events occurring after 15 years of follow-up were modest. We conclude that the intake of dietary Mg is associated with a reduced risk of CHD. Whether increases in dietary Mg intake can alter the future risk of disease warrants further study.

Quantification of regional glial fibrillary acidic protein levels in Alzheimer's disease

OBJECTIVES

Our objectives were to quantify glial fibrillary acidic protein (GFAP) in brains of Alzheimer's disease (AD) cases, and non-AD controls to determine the regions with the most severe gliosis in AD.

MATERIAL AND METHODS

In a case control design, we used an enzyme-linked immunosorbent assay (ELISA) to quantify GFAP in frozen brain from four areas of neocortex in 10 AD cases, 10 age-matched controls, and 10 younger controls from the Honolulu-Asia Aging Study autopsy archive.

RESULTS

Median age at death was 83.5 years for cases and age-matched controls, and 77 years for younger controls. For the AD cases compared with the age-matched controls, levels of GFAP in occipital (P=0.01), parietal (P=0.028), and temporal lobes (P=0.004) (but not frontal) were significantly higher in the cases. The median GFAP excess in AD cases compared with age matched controls was highest in the temporal lobe.

CONCLUSIONS

Regional quantification of GFAP reveals that the glial response is most prominent in the temporal lobe in AD.

C-reactive protein and the future risk of thromboembolic stroke in healthy men

BACKGROUND

Evidence suggests that C-reactive protein (CRP) is related to thromboembolic (TE) stroke. Whether associations are altered in the presence of other risk factors is unclear. The purpose of this study was to additionally assess the relation between CRP and TE stroke.

METHODS AND RESULTS

On the basis of 20 years of follow-up after CRP measurement, 259 cases of TE stroke were identified and compared with 1348 controls. Subjects were aged 48 to 70 years when CRP was measured. Levels of CRP were positively associated with TE stroke throughout the 20 years of follow-up. Although associations were modest within 5 years of CRP measurement, the odds of stroke in the top versus bottom CRP quartile increased over time to a 3.8-fold excess by 10 to 15 years into follow-up (P<0.001). For men without hypertension or diabetes, the overall corresponding odds were 1.6 to 1.7 (P<0.05). In men <or=55 years of age, the odds increased to a 3-fold excess (P=0.006), and in nonsmokers, there was a 5.8-fold excess (P<0.001). Associations in past and current smokers, in men >55 years of age, and in those with hypertension or diabetes were not significant.

CONCLUSIONS

Findings suggest that elevated CRP in middle adulthood and in men with healthier risk factor profiles may be important as a risk factor for TE stroke. Use of CRP levels as a clinical screen to identify an increased risk of cardiovascular disease in otherwise healthy men warrants consideration.

Comparison of Three Approaches to Supplementary Reading Instruction for Low-Achieving Second-Grade Readers

Purpose: This research evaluated the relative effectiveness of three instructional approaches to supplementing the regular reading program for second graders with low word reading and/or pseudoword reading skills.

Method: In the instructional experiment, 96 second graders with low reading achievement were randomly assigned to one of four conditions: (a) explicit and reflective word recognition, (b) explicit and reflective reading comprehension, (c) combined explicit word recognition and explicit reading comprehension, or (d) treated control that only practiced reading skills without any instruction. In the extension study, these conditions were compared to an untreated control group of 29 second graders.

Results: In the instructional experiment, combined word recognition and reading comprehension treatment increased phonological decoding (pronouncing pseudowords) significantly more than the treated control or word recognition only treatment and had the highest effect size. The comprehension only treatment was not significantly different from the treated control. In the extension study, (a) the treated children receiving supplemental instruction improved significantly more in phonological decoding and reading real words than did those in the regular program, and (b) the combined word recognition and reading comprehension treatment, which was explicit, had the highest effect sizes for both pseudoword and real-word reading.

Clinical Implications: The most effective supplemental instruction for increasing phonological decoding was combining explicit word recognition and explicit reading comprehension training.

Predicting response to early reading intervention from verbal IQ, reading-related language abilities, attention ratings, and verbal IQ-word reading discrepancy: failure to validate discrepancy method

Additional analyses of a previously published study addressed three questions about growth in word reading during early reading intervention: (1) How well do Verbal IQ, reading-related language abilities (phonological, rapid naming, and orthographic), and attention ratings predict reading growth? (2) How well do language deficits predict reading growth? and (3) How well does Verbal IQ-word reading discrepancy predict reading growth? Univariate analyses showed that Verbal IQ, phonological skills, orthographic skills, rapid automatized naming (RAN), and attention ratings predicted the response to early intervention, but multivariate analyses based on a combination of predictors for real-word reading and pseudoword reading showed that Verbal IQ was not the best unique predictor. Students with double or triple deficits in language skills (RAN, phonological, and orthographic processing) responded more slowly to early intervention than students without language deficits. Verbal IQ-word reading discrepancy did not predict the response to early intervention in reading. Overall results supported the use of reading-related language and attention measures rather than IQ-achievement discrepancy in identifying candidates for early reading intervention.

A randomized, double-blind, placebo-controlled trial of porcine versus synthetic secretin for reducing symptoms of autism

OBJECTIVE

To compare the effects of a single dose of biologic and synthetic porcine secretin to placebo on a variety of autism symptoms.

METHOD

Eighty-five children with autism without other medical conditions and not taking other psychotropic medications participated (ages between 3 and 12 years, mean IQ = 55). Children were grouped into trios matched by age and communication level and then randomly assigned to one of three treatment groups: biologic secretin (2 CU/kg), synthetic secretin (0.4 microg/kg), and placebo. Measures collected 1 week before and 4 weeks after infusion included autism symptoms, language skills, and problem behaviors, gathered from parents, teachers, and investigators, who were all blind to treatment. Two-factor, repeated-measures analyses of variance (3 treatment levels by 2 repeated measures, pre- and postinfusion) were used to examine efficacy.

RESULTS

Direct observation measures did not show change over time related to secretin. Parent reports showed an overall reduction of symptom severity for all treatment groups, including the placebo group. One teacher-report measure showed decreases in autism symptoms in the placebo and synthetic secretin groups.

CONCLUSIONS

No evidence that either biologic or synthetic secretin provided amelioration of symptoms beyond placebo was observed. This held true when children with and without gastrointestinal problems were examined separately.

Reproducibility of proton MR spectroscopic imaging (PEPSI): comparison of dyslexic and normal-reading children and effects of treatment on brain lactate levels during language tasks

BACKGROUND AND PURPOSE

We repeated a proton echo-planar spectroscopic imaging (PEPSI) study to test the hypothesis that children with dyslexia and good readers differ in brain lactate activation during a phonologic judgment task before but not after instructional treatment.

METHODS

We measured PEPSI brain lactate activation (TR/TE, 4000/144; 1.5 T) at two points 1-2 months apart during two language tasks (phonologic and lexical) and a control task (passive listening). Dyslexic participants (n = 10) and control participants (n = 8) (boys and girls aged 9-12 years) were matched in age, verbal intelligence quotients, and valid PEPSI voxels. In contrast to patients in past studies who received combined treatment, our patients were randomly assigned to either phonologic or morphologic (meaning-based) intervention between the scanning sessions.

RESULTS

Before treatment, the patients showed significantly greater lactate elevation in the left frontal regions (including the inferior frontal gyrus) during the phonologic task. Both patients and control subjects differed significantly in the right parietal and occipital regions during both tasks. After treatment, the two groups did not significantly differ in any brain region during either task, but individuals given morphologic treatment were significantly more likely to have reduced left frontal lactate activation during the phonologic task.

CONCLUSION

The previous finding of greater left frontal lactate elevation in children with dyslexia during a phonologic judgment task was replicated, and brain activation changed as a result of treatment. However, the treatment effect was due to the morphologic component rather than the phonologic component.

Plantation work and risk of Parkinson disease in a population-based longitudinal study

CONTEXT

Parkinson disease (PD) has an unknown cause; however, convincing evidence is emerging that indicates pesticides can selectively injure the dopaminergic system in laboratory animals. Retrospective studies in humans demonstrate a link between exposure to agricultural lifestyle factors and PD.

OBJECTIVE

To determine whether working on a plantation in Hawaii and exposure to pesticides are associated with an increased risk of PD decades later.

DESIGN AND SETTING

Prospective cohort study based on the island of Oahu, Hawaii, with 30 years of follow-up. Years of work on a plantation were assessed by questionnaire at study enrollment in 1965. Self-reported information on pesticide exposure was collected at a separate examination 6 years later.

PARTICIPANTS

Participants were 7986 Japanese American men born between 1900 and 1919 who were enrolled in the longitudinal Honolulu Heart Program.

MAIN OUTCOME MEASURES

Incident PD was determined by medical record review or by an examination conducted by a study neurologist at a later date.

RESULTS

During follow-up, 116 men developed PD. Age-adjusted incidence increased significantly among men who worked more than 10 years on a plantation. The relative risk of PD was 1.0 (95% confidence interval, 0.6-1.6), 1.7 (95% confidence interval, 0.8-3.7), and 1.9 (95% confidence interval, 1.0-3.5) for men who worked on a plantation 1 to 10 years, 11 to 20 years, and more than 20 years compared with men who never did plantation work (P =.006, test for trend). Age-adjusted incidence of PD was higher in men exposed to pesticides than in men not exposed to pesticides although this was not statistically significant (P =.10, test for trend).

CONCLUSION

These longitudinal observations regarding plantation work in Hawaii support case-control studies suggesting that exposure to pesticides increases the risk of PD.

Midlife adiposity and the future risk of Parkinson's disease

BACKGROUND

Evidence suggests that nigrostriatal system disorders are associated with PD and adiposity. Whether patterns of adiposity coexist or predate clinical PD is unknown. This report examines the relation between midlife adiposity and the risk of PD.

METHODS

Measurement of adiposity occurred from 1965 to 1968 in 7,990 men in the Honolulu Heart Program (aged 45 to 68 years and without PD). Adiposity measures included body mass index (BMI), subscapular skinfold thickness (SSF), and triceps skinfold thickness (TSF). Follow-up for incident PD occurred over a 30-year period.

RESULTS

During the course of follow-up, PD was observed in 137 men. Among the measures of adiposity, age-adjusted incidence of PD increased threefold from 3.7/10,000 person-years in the bottom quartile of TSF (1 to 5 mm) to 11.1/10,000 person-years in the top quartile (11 to 32 mm, p < 0.001). Effects of TSF on PD were independent of cigarette smoking, coffee consumption, physical activity, daily caloric and fat intake, and the other measures of adiposity (p < 0.001). Whereas rates of PD were lowest in the bottom quartile of BMI and SSF vs higher quartiles, associations with PD were weaker than they were for TSF. The effect of TSF on clinical onset before age 65 years was similar to the effect that was observed in later life.

CONCLUSIONS

Increased triceps skinfold thickness measured in midlife is associated with an elevated risk of future PD. Whether patterns of adiposity reflect a unique metabolic pathology in individuals at a high risk of PD warrants further study.

Developmental relationships between adolescent substance use and risky sexual behavior in young adulthood

To examine the developmental relationship between adolescent substance use and risky sexual behavior in young adulthood. A gender-balanced, ethnically diverse urban sample of 808 children in Seattle was surveyed at age 10 years in 1985 and followed prospectively to age 21 years in 1996. Semiparametric group-based modeling was used to determine trajectory groups of binge-drinking, cigarette smoking, marijuana use, and the use of other illicit drugs. Negative binomial regressions and logistic regressions were used to examine whether these trajectory groups predicted the number of sex partners and condom use at age 21 years. Specific forms of adolescent substance use significantly predicted risky sexual behavior at age 21 years, after other substance use and early measures of sexual behavior were controlled. Early binge-drinkers had significantly more sex partners than nonbinge-drinkers. Late onset binge-drinkers and marijuana users had significantly more sex partners and were less likely to use condoms consistently than those who did not binge drink or use marijuana. Experimenters in cigarette smoking, who did not escalate smoking, were more likely to use condoms consistently than nonsmokers. In contrast, the use of other illicit drugs in adolescence did not predict risky sexual behavior at age 21 years. The effects of adolescent substance use on risky sexual behavior at age 21 years differed for youths with developmentally different substance use trajectories in this urban sample disproportionately drawn from high crime neighborhoods. To prevent risky sexual behavior among young adults, attention should be paid to binge-drinking and marijuana use during adolescence.

A developmental analysis of sociodemographic, family, and peer effects on adolescent illicit drug initiation

OBJECTIVE

To examine the effects of sociodemographic, family, and peer predictors on the developmental patterns of illicit drug initiation from ages 12 to 21 years.

METHOD

A gender-balanced, ethnically diverse urban sample of 808 children in Seattle was surveyed at age 10 in 1985 and followed prospectively to age 21 in 1996. Discrete-time survival analysis was used to assess the effects of sociodemographic, family, and peer factors on the risk of initiation.

RESULTS

The risk for initiating illicit drug use increased steadily from ages 12 to 21. High family conflict, low family bonding, and high peers' antisocial activities predicted higher risk of initiation across this developmental period. The effect of family bonding began to decline after age 18, while the effect of peers' antisocial activities began to increase after age 15. Few gender and ethnic differences were found.

CONCLUSIONS

Prevention programs need to include family and peer factors as important targets. Parents should create a warm and supportive family environment with appropriate supervision and control throughout adolescence. Association with antisocial peers should be reduced, especially in high school. Interventions addressing these family and peer factors should have beneficial effects across gender and ethnic groups.

The American Diabetes Association and World Health Organization classifications for diabetes: their impact on diabetes prevalence and total and cardiovascular disease mortality in elderly Japanese-American men

OBJECTIVE

To compare the prevalence of diabetes according to the American Diabetes Association (ADA) and World Health Organization (WHO) classifications in a sample of elderly Japanese-American men; to examine the association with total and cardiovascular mortality by diabetes status using both classifications; and to determine whether the fasting or 2-h glucose measurement is a stronger predictor of adverse outcomes.

RESEARCH DESIGN AND METHODS

Examinations given from 1991 to 1993 in the Honolulu Heart Program were used as baseline for these analyses. Subjects were 71-93 years of age at that time and were followed for total and cardiovascular disease mortality for up to 7 years.

RESULTS

A total of approximately 66% of individuals who had diabetes by WHO criteria were missed when the ADA definition was used. The relative risks of total and cardiovascular mortality for those with versus those without diabetes were similar for both definitions; however, when fasting and postload glucose measures were analyzed as continuous variables, the 2-h measurement was a superior predictor and was independent of fasting glucose. In contrast, fasting glucose was not an independent predictor of these outcomes in the presence of the 2-h measurement.

CONCLUSIONS

The prevalence of glucose metabolism abnormalities was very high among elderly Japanese-American men. The WHO classification was superior to the ADA classification in identification of subjects at high risk for adverse outcomes. Therefore, we conclude that the 2-h glucose measurement is valuable and should be retained in epidemiologic studies.

C-reactive protein and myocardial infarction

C-reactive protein (CRP) has been shown to predict cardiovascular disease. Whether predictions differ across risk factor strata and for short and long-term follow-up has not been clearly examined. The purpose of this report is to assess the relation between CRP and the development of myocardial infarction (MI) over a 20-year period in men in the Honolulu Heart Program. Subjects were aged 48 to 70 years and free of prevalent disease at the time when CRP levels were measured and follow-up began. Using a case-control design, 369 cases of MI were compared with 1,348 control subjects. After risk factor adjustment, the odds of an MI rose with increasing levels of CRP as early as 5 years into follow-up (P = 0.009). Associations appeared to persist beyond this time, but after 15 years, effects became modest. Adverse effects of an elevated CRP level were observed in middle-aged men (< or =55 years), in men without hypertension or diabetes, and in those who were nonsmokers (P < 0.05). Although positive effects were also observed in those who were hypertensive and smoking at the time of CRP measurement, findings suggest that in clinically healthy men, atherosclerosis could have origins more closely linked with inflammation than with other processes.

Effects of the Seattle social development project on sexual behavior, pregnancy, birth, and sexually transmitted disease outcomes by age 21 years

OBJECTIVE

To examine the long-term effects of the full Seattle Social Development Project intervention on sexual behavior and associated outcomes assessed at age 21 years.

DESIGN

Nonrandomized controlled trial with long-term follow-up.

SETTING

Public elementary schools serving children from high-crime areas in Seattle, Wash.

PARTICIPANTS

Ninety-three percent of the fifth-grade students enrolled in either the full-intervention or control group were successfully interviewed at age 21 years (n = 144 [full intervention] and n = 205 [control]).

INTERVENTIONS

In-service teacher training, parenting classes, and social competence training for children.

MAIN OUTCOME MEASURES

Self-report measures of all outcomes.

RESULTS

The full-intervention group reported significantly fewer sexual partners and experienced a marginally reduced risk for initiating intercourse by age 21 years as compared with the control group. Among females, treatment group status was associated with a significantly reduced likelihood of both becoming pregnant and experiencing a birth by age 21 years. Among single individuals, a significantly increased probability of condom use during last intercourse was predicted by full-intervention group membership; a significant ethnic group x intervention group interaction indicated that after controlling for socioeconomic status, single African Americans were especially responsive to the intervention in terms of this outcome. Finally, a significant treatment x ethnic group interaction indicated that among African Americans, being in the full-intervention group predicted a reduced probability of contracting a sexually transmitted disease by age 21 years.

CONCLUSION

A theory-based social development program that promotes academic success, social competence, and bonding to school during the elementary grades can prevent risky sexual practices and adverse health consequences in early adulthood.

Age-related changes in risk factor effects on the incidence of coronary heart disease

PURPOSE

The purpose of this report is to examine the potential for risk factor effects on the incidence of CHD to change over a broad range of ages from middle adulthood to late-life.

METHODS

Findings are based on repeated risk factor measurements at four examinations over a 26-year period in men enrolled in the Honolulu Heart Program. After each examination, six years of follow-up were available to assess risk factor effects as the cohort aged from 45 to 93 years.

RESULTS

Based on 18,456 person intervals of follow-up, 677 men developed CHD (3.7%). After risk factor adjustment, a positive relation between hypertension and CHD declined significantly with age (p = 0.013), primarily due to a large increase in the risk of CHD in elderly men (75 to 93) without hypertension. Effects of total cholesterol on CHD also seemed to decline with advancing age, although changes were not statistically significant. In contrast, men with diabetes had a consistent 2-fold excess risk of CHD across all age groups, while a positive association with body mass index in younger men (45 to 54) became negative in those who were the oldest (75 to 93). Due to infrequent smoking in the elderly, associations between smoking and CHD weakened with age. In the oldest men (75 to 93), alcohol intake was unrelated to CHD, while effects of sedentary life-styles on promoting CHD appeared stronger than in those who were younger.

CONCLUSION

Findings suggest that changes in risk factor effects on the incidence of CHD with advancing age may require updated strategies for CHD prevention as aging occurs.

Beginning literacy: links among teacher knowledge, teacher practice, and student learning

Although the importance of phonological awareness has been discussed widely in the research literature, the concept is not well understood by many classroom teachers. In the study described here, we worked with groups of kindergarten and first-grade teachers (the experimental group) during a 2-week summer institute and throughout the school year. We shared with them research about learning disabilities and effective instruction, stressing the importance of explicit instruction in phonological and orthographic awareness. We followed the experimental group and a control group into their classrooms for a year, assessing teachers' classroom practices and their students' (n = 779) learning. The study yielded three major findings: We can deepen teachers' own knowledge of the role of phonological and orthographic information in literacy instruction; teachers can use that knowledge to change classroom practice; and changes in teacher knowledge and classroom practice can improve student learning.

Writing and reading: connections between language by hand and language by eye

Four approaches to the investigation of connections between language by hand and language by eye are described and illustrated with studies from a decade-long research program. In the first approach, multigroup structural equation modeling is applied to reading and writing measures given to typically developing writers to examine unidirectional and bidirectional relationships between specific components of the reading and writing systems. In the second approach, structural equation modeling is applied to a multivariate set of language measures given to children and adults with reading and writing disabilities to examine how the same set of language processes is orchestrated differently to accomplish specific reading or writing goals, and correlations between factors are evaluated to examine the level at which the language-by-hand system and the language-by-eye system communicate most easily. In the third approach, mode of instruction and mode of response are systematically varied in evaluating effectiveness of treating reading disability with and without a writing component. In the fourth approach, functional brain imaging is used to investigate residual spelling problems in students whose problems with word decoding have been remediated. The four approaches support a model in which language by hand and language by eye are separate systems that interact in predictable ways.

Risk of hospitalized stroke in men enrolled in the Honolulu Heart Program and the Framingham Study: A comparison of incidence and risk factor effects

BACKGROUND AND PURPOSE

Risk of death due to stroke in Japan is more than double the risk in the United States. It remains unknown why some ethnic groups are more prone to stroke than others. Our purpose was to compare the 20-year incidence of hospitalized stroke between Japanese-American men in the Honolulu Heart Program and white men in the Framingham Study.

METHODS

This was a 20-year follow-up study beginning around 1965, a population-based study on the island of Oahu, Hawaii, and in Framingham, Mass. Participants were 7589 men in Honolulu and 1216 men in Framingham without prevalent coronary heart disease and stroke. Subjects were 45 to 68 years old when follow-up began. Main outcome measures were incident thromboembolic and hemorrhagic stroke.

RESULTS

Framingham men had a 40% excess of thromboembolic stroke compared with Honolulu men after adjustment for age and other risk factors (62/1000 versus 45/1000, respectively, P<0.001), whereas incidence of hemorrhagic stroke was nearly identical (14.8/1000). In both cohorts, each stroke type was consistently elevated in the presence of hypertension and cigarette smoking. Diabetes and body mass index increased the risk of thromboembolic stroke in both samples, and diabetes increased the risk of hemorrhagic events in Framingham. Alcohol intake and low total cholesterol were associated with hemorrhagic events in Honolulu but not in Framingham. Despite occasional differences in risk factor effects, none were significantly different between cohorts.

CONCLUSIONS

The incidence of thromboembolic stroke requiring hospitalization is markedly less in Honolulu than in Framingham. The difference in stroke incidence rates observed cannot be explained by the traditional risk factors. Further studies are needed to identify factors that protect Japanese-American men in Honolulu from stroke.

Assessing the effects of a school-based intervention on unscheduled school transfers during elementary school

Raising Healthy Children is a cluster-randomized study of a school-based intervention aimed at preventing problem behaviors among children recruited into the project in the first or second grade of elementary school. Multilevel analysis was used to compare students in intervention and control schools with respect to whether they transferred out of their original schools. Students in intervention schools were less likely to transfer within the first 5 years of the project. A multilevel discrete-time survival model that included both time-varying and contextual variables revealed that the difference in hazard of transfer was greatest in the earlier years of the project.

Preadolescent predictors of substance initiation: a test of both the direct and mediated effect of family social control factors on deviant peer associations and substance initiation

A review of the literature suggests that early substance initiation is related to a variety of negative outcomes, including substance misuse or abuse in adolescence and adulthood. This study examines potentially modifiable predictors of early substance initiation, including both family and peer factors known to influence early initiation. A theoretically derived model of substance initiation was tested using structural equation modeling. Results indicate that both family and peer factors have an impact on early substance initiation when children in this sample were 11 and 12 years old. The model explained 60% of the variance in substance initiation. Prosocial family processes (rules, monitoring, and attachment) had a significant impact on child peer association, decreasing involvement with antisocial peers. These prosocial family processes had a significant negative effect on substance initiation even while modeling the influence of antisocial peers. Implications for drug use prevention practice are discussed.