The influence of difficult temperament on alcohol-related aggression: better accounted for by executive functioning?

The purpose of this investigation was to test the hypothesis that executive functioning (EF) would mediate the relation between difficult temperament (DT) and intoxicated aggression. Participants were 165 social drinking men and women between the ages of 21-35years old. DT was measured using the Dimension of Temperament Scale - Revised and EF was measured using seven well-established neuropsychological tests. Following consumption of an alcoholic beverage, participants were tested on a laboratory aggression measure in which electric shocks were received from and administered to a fictitious opponent under the guise of a competitive reaction time task. Aggression was operationalized as shock intensities administered to the fictitious opponent under conditions of low and high provocation. Results indicated that EF successfully mediated the relation between DT and intoxicated aggression for men but not for women. These findings are discussed with regard to how they influence current models of aggressive behavior as well as their implications for future violence prevention efforts.

Do health behaviors mediate the association between social capital and health?

INTRODUCTION

There is increasing evidence that social capital is important for people's health. However, there is still considerable disagreement about the specific pathways that links social capital to health. This study investigates the hypothesis that the association between social capital and health is mediated by people's health behaviors.

METHOD

Data from the 2002 Health Survey for England (n = 7394) were used and analyzed from a multilevel perspective. The association between social capital and self-rated health were examined before and after controlling for smoking, alcohol intake, and fruit/vegetable consumption.

RESULTS

Social capital was found to be associated with self-rated health, as well as with the different health behaviors. In addition, the health behaviors were significantly related to self-rated health. However, controlling for smoking, alcohol intake, and fruit/vegetable consumption did not substantially affect the association between social capital and self-rated health.

CONCLUSIONS

The results demonstrate that social capital and support are important determinants of self-rated health and health behaviors. But only limited support was found for the hypothesis that health behaviors mediate the association between social capital and health.

Examining equivalence of concepts and measures in diverse samples

While there is growing awareness for the need to examine the etiology of problem behaviors across cultural, racial, socioeconomic, and gender groups, much research tends to assume that constructs are equivalent and that the measures developed within one group equally assess constructs across groups. The meaning of constructs, however, may differ across groups or, if similar in meaning, measures developed for a given construct in one particular group may not be assessing the same construct or may not be assessing the construct in the same manner in other groups. The aims of this paper were to demonstrate a process of testing several forms of equivalence including conceptual, functional, item, and scalar using different methods. Data were from the Cross-Cultural Families Project, a study examining factors that promote the healthy development and adjustment of children among immigrant Cambodian and Vietnamese families. The process described in this paper can be implemented in other prevention studies interested in diverse groups. Demonstrating equivalence of constructs and measures prior to group comparisons is necessary in order to lend support of our interpretation of issues such as ethnic group differences and similarities.

An update on the role of psychotherapy in the management of bipolar disorder

Recent studies have examined the value of combining structured forms of psychotherapy with medication maintenance for patients with bipolar disorder. These studies have been influenced by the growing body of literature on stress in the elicitation of manic and depressive episodes. Randomized trials published within the past 5 years indicate positive benefits of cognitive-behavioral therapy, interpersonal and social rhythm therapy, family-focused therapy, and group psychoeducation as adjuncts to mood stabilizers in delaying recurrences, stabilizing symptoms, and improving medication adherence. Open trials of family interventions for pediatric-onset bipolar patients also have yielded promising results. Questions remain about the relative advantages of one psychosocial approach over the others, whether there are subgroups of patients who respond to each type of intervention, the impact of psychotherapy on role functioning, mediators of treatment effects, and the potential utility of early intervention as a means of delaying the onset and/or severity of the disorder.

The Adolescent Cannabis Problems Questionnaire (CPQ-A): psychometric properties

Despite the widespread use of cannabis among young people, little research attention has been given to the development of psychometrically sound measures specific to cannabis related problems in this group. The aim of this study was to explore the reliability, validity and factor structure of a multi-dimensional measure of cannabis-related problems among adolescents. The Adolescent Cannabis Problems Questionnaire (CPQ-A) was developed as an assessment tool and treatment outcome measure. A stratified sample of 100 young people (aged 14-18 years) who had used cannabis in the past 90 days were administered the CPQ-A on two occasions 1 week apart. Exploratory factor analysis revealed three factors accounting for 63% of total variance with alpha coefficients of 0.88, 0.72 and 0.73. The CPQ-A was reliable with test-retest correlation for the total CPQ-A being 0.91. CPQ-A score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria reported. The findings show promise for the CPQ-A as a reliable, valid and potentially clinically useful measure of cannabis related problems among young people.

Improving the use of research evidence in guideline development: 7. Deciding what evidence to include

BACKGROUND

The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the seventh of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.

OBJECTIVES

We reviewed the literature on what constitutes "evidence" in guidelines and recommendations.

METHODS

We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTION AND ANSWERS: We found several systematic reviews that compared the findings of observational studies with randomised trials, a systematic review of methods for evaluating bias in non-randomised trials and several descriptive studies of methods used in systematic reviews of population interventions and harmful effects. What types of evidence should be used to address different types of questions? The most important type of evidence for informing global recommendations is evidence of the effects of the options (interventions or actions) that are considered in a recommendation. This evidence is essential, but not sufficient for making recommendations about what to do. Other types of required evidence are largely context specific. The study designs to be included in a review should be dictated by the interventions and outcomes being considered. A decision about how broad a range of study designs to consider should be made in relationship to the characteristics of the interventions being considered, what evidence is available, and the time and resources available. There is uncertainty regarding what study designs to include for some specific types of questions, particularly for questions regarding population interventions, harmful effects and interventions where there is only limited human evidence. Decisions about the range of study designs to include should be made explicitly. Great caution should be taken to avoid confusing a lack of evidence with evidence of no effect, and to acknowledge uncertainty. Expert opinion is not a type of study design and should not be used as evidence. The evidence (experience or observations) that is the basis of expert opinions should be identified and appraised in a systematic and transparent way.

Posttraumatic stress disorder and treatment seeking in a nationally representative Canadian military sample

This study aimed to identify predictors of treatment seeking in military members with posttraumatic stress disorder (PTSD) using data from the 2002 Canadian Community Health Survey-Canadian Forces Supplement (Statistics Canada, 2003). To identify predictors, two complementary analyses (binary logistic regression and recursive partitioning of independent variables) were conducted in military members with PTSD (N = 509). Results indicate that trauma-related (index traumatic event type, cumulative trauma exposure), demographic (marital status), enabling (income), and need (PTSD interference) factors predict treatment seeking in military members with PTSD, and that treatment seekers and nontreatment seekers are both comprised of distinct subgroups. Interventions aimed at increasing treatment-seeking behaviors should be tailored to the specific needs of various subgroups of nontreatment seekers.

Importance of multiple purging methods in the classification of eating disorder subtypes

OBJECTIVE

To examine two assumptions implicit in the subtyping of eating disorders: (1) purging behaviors are interchangeable, and (2) a primary distinction exists between the presence vs. absence of any means of purging.

METHOD

Data from a longitudinal study of health and eating patterns were used to compare women who reported self-induced vomiting, laxative abuse, or their combination. Further comparisons were made among women who used multiple purging methods (MP), a single purging method (SP), and randomly selected controls who never purged.

RESULTS

Vomiting and laxative abuse were associated with similar levels of eating pathology whereas their combination was associated with greater eating pathology. MP women reported significantly greater eating pathology compared to SP women who reported significantly greater eating pathology compared to controls. Differences were maintained at 10-year follow-up.

CONCLUSION

Purging behaviors may be interchangeable but the use of multiple purging methods is associated with greater severity over time.

Taxometric Investigation of PTSD: data from two nationally representative samples

Current psychiatric nosology depicts posttraumatic stress disorder (PTSD) as a discrete diagnostic category. However, only one study has examined the latent structure of PTSD, and this study suggested that PTSD may be more accurately conceptualized as an extreme reaction to traumatic life events rather than a discrete clinical syndrome. To build on the existing literature base, the present research examined the latent structure of posttraumatic stress reactions by applying three taxometric procedures (MAXEIG, MAMBAC, and L-Mode) to data collected from large nationally representative samples of women (ns=2684 and 3033) and adolescents (n=3775). Results consistently provided evidence for a dimensional PTSD solution across samples and statistical procedures. These findings have important implications for the theory, assessment, and investigation of posttraumatic stress reactions.

The reliability of measuring physical characteristics of spiculated masses on mammography

The goal of this study was to assess the reliability of measurements of the physical characteristics of spiculated masses on mammography. The images used in this study were obtained from the Digital Database for Screening Mammography. Two experienced radiologists measured the properties of 21 images of spiculated masses. The length and width of all spicules and the major axis of the mass were measured. In addition, the observers counted the total number of spicules. Interobserver and intraobserver variability were evaluated using a hypothesis test for equivalence, the intraclass correlation coefficient (ICC) and Bland-Altman statistics. For an equivalence level of 30% of the mean of the senior radiologist's measurement, equivalence was achieved for the measurements of average spicule length (p<0.01), average spicule width (p = 0.03), the length of the major axis (p<0.01) and for the count of the number of spicules (p<0.01). Similarly, with the ICC analysis technique "excellent" inter-rater agreement was observed for the measurements of average spicule length (ICC = 0.770), the length of the major axis (ICC = 0.801) and for the count of the number of spicules (ICC = 0.780). "Fair to good" agreement was observed for the average spicule width (ICC = 0.561). Equivalence was also demonstrated for intraobserver measurements. Physical properties of spiculated masses can be measured reliably on mammography. The interobserver and intraobserver variability for this task is comparable with that reported for other measurements made on medical images.

Posttraumatic stress after a motor vehicle accident: a six-month follow-up study utilizing latent growth modeling

Features of posttraumatic stress disorder (PTSD) for 596 survivors of motor vehicle accidents were examined by self-report measures at 1 week, 1 month, 3 months, and 6 months after the motor vehicle accident (MVA). Latent growth modeling was utilized to study the trend and predictors of the level of distress. Results indicated that 5-20% of the participants reported to have a significant level of posttraumatic stress in one, two, or three of the PTSD symptom clusters within the period studied. Survivors with significant acute stress 1 week after the MVA had a higher risk for developing chronic posttraumatic stress. Although the severity of intrusive and hyperarousal symptoms decreased over time, the severity of avoidance symptoms remained unchanged. Factors predicting the course of PTSD after an MVA are identified.

Marker or mediator? The effects of adolescent substance use on young adult educational attainment

AIMS

We tested the effects of adolescent substance use on college attendance and completion by young adulthood in the context of the behavioral and familial risk factors that influence substance use.

DESIGN, SETTING AND PARTICIPANTS

Longitudinal data were collected from a community sample of children of alcoholics (248) and matched controls (206) at three adolescent assessments (micro(age) = 13-15) and a long-term follow-up in young adulthood (micro(age) = 25).

MEASUREMENTS

College attendance and degree completion by age 25 were self-reported in young adulthood. During adolescence, self-reports of alcohol and drug use were assessed with log-transformed quantity/frequency measures; substance use risk factors [e.g. parental monitoring, externalizing and internalizing symptoms and Diagnostic and Statistical Manual version III (DSM-III) diagnosis of parental alcoholism] were assessed by both self- and parent-report, and adolescent reading achievement was assessed using a standardized assessment of reading achievement (Wide Range Achievement Test).

FINDINGS

Using growth curve modeling, we found that mean levels and growth in adolescent substance use mark, or identify, those adolescents who are at risk for reduced odds of attending and completing college. Moreover, adolescent substance use was not merely a marker of risk, in that growth in drug use (but not alcohol use) significantly mediated the effects of parental alcoholism and early externalizing behavior on later college completion, partially explaining the effects of these risk factors on college completion.

CONCLUSIONS

The current study provides evidence for both the marker and the mediator hypotheses, and identifies multiple pathways to higher educational attainment. The findings point to the importance of studying the effects of adolescent substance use in a broader developmental context of its correlated risk factors to specify more effectively the key pathways to later developmental outcomes.

Pathways of Adaptation from Adolescence to Young Adulthood: Antecedents and Correlates

This study examines longitudinal change using a person-centered approach to differentiate patterns of adaptive functioning from adolescence to adulthood. Data are drawn from a 20-year longitudinal study of competence and resilience in the lives of 205 school children (29% minority). Results indicate five distinct pathways of adaptation: (1) low-declining, (2) low-improving, (3) middle-improving, (4) middle-declining, and (5) consistently high. The study also compares the five groups on childhood risks and resources, and on longitudinal assessment of competence and adversity. Interestingly, the most dramatic changes in pathways of adaptation occur during the period of emerging adulthood.

Childhood abuse and intake severity in alcohol disorder patients

In a sample of 336 patients with an alcohol use disorder, this study examined, whether patients with histories of childhood sexual abuse (CSA) and childhood physical abuse (CPA) compared to those without such histories have a greater severity of alcohol and other clinical difficulties. Whether lifetime posttraumatic stress disorder (PTSD) mediates the relationship between childhood abuse and clinical outcomes was explored. Results were that CSA was associated with earlier age of onset for alcohol disorder, greater Axis I comorbidity as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), more social and psychiatric problems, but lower drinking frequency. Childhood physical abuse was related to greater drinking consequences, social and psychiatric dysfunction, and Axis I comorbidity, but also lower drinking frequency. Posttraumatic stress disorder partially mediated the effect of both CSA and CPA on severity of psychiatric problems.

Relations between dietary restraint, depressive symptoms, and binge eating: A longitudinal study

OBJECTIVE

Temporal relations between dietary restraint, depressive symptoms, and binge eating were tested by means of three competing models positing that (1) dietary restraint and depressive symptoms predict future increases in binge eating, (2) binge eating predicts future increases in dietary restraint and depressive symptoms, and (3) binge eating is reciprocally related to these two factors.

METHOD

Longitudinal data from a community sample of Dutch females (N = 143; M age = 19.6) was used to test these relations while controlling for initial levels of these factors.

RESULTS

Dietary restraint did not predict future increases in binge eating, nor did binge eating predict future increases in dietary restraint. Depressive symptoms predicted future increases in binge eating, but binge eating did not predict future increases in depressive symptoms.

CONCLUSION

Although this study had limited statistical power, the pattern of relations and effect sizes suggest that depressive symptoms, but not dietary restraint, increase risk of binge eating for late adolescent females.

Distinguishing Between Latent Classes and Continuous Factors: Resolution by Maximum Likelihood?

Latent variable models exist with continuous, categorical, or both types of latent variables. The role of latent variables is to account for systematic patterns in the observed responses. This article has two goals: (a) to establish whether, based on observed responses, it can be decided that an underlying latent variable is continuous or categorical, and (b) to quantify the effect of sample size and class proportions on making this distinction. Latent variable models with categorical, continuous, or both types of latent variables are fitted to simulated data generated under different types of latent variable models. If an analysis is restricted to fitting continuous latent variable models assuming a homogeneous population and data stem from a heterogeneous population, overextraction of factors may occur. Similarly, if an analysis is restricted to fitting latent class models, overextraction of classes may occur if covariation between observed variables is due to continuous factors. For the data-generating models used in this study, comparing the fit of different exploratory factor mixture models usually allows one to distinguish correctly between categorical and/or continuous latent variables. Correct model choice depends on class separation and within-class sample size.

Association of industry sponsorship to published outcomes in gastrointestinal clinical research

BACKGROUND & AIMS

Recent years have seen an increase in industry sponsorship of clinical trials throughout medicine. We conducted a study to evaluate the association of industry sponsorship to published outcomes in gastrointestinal (GI) clinical research. Our aims were (1) to evaluate the trends in the source of funding for GI clinical research during the period from 1992 to 2002-2003, (2) to determine whether the source of study funding predicted the likelihood that a study would publish results that favor the drug or device being tested, and (3) to determine whether differences exist in the methodologic quality of the investigational study methods used in studies funded by private industry versus other sources.

METHODS

We selected all clinical studies evaluating a drug or device from 4 prominent GI journals (Gastroenterology, The American Journal of Gastroenterology, Hepatology, and Gastrointestinal Endoscopy). All studies were abstracted by using a standardized data abstraction form. We evaluated the trends in funding source for studies published during the years 1992, 2002, and 2003. All selected studies were scored for methodologic quality by using a previously validated scoring system. The percentage of studies that reported outcomes that favored the device or drug being tested against the standard therapy or placebo was determined for each funding source. A funnel plot was constructed to assess for the presence of negative publication bias.

RESULTS

A total of 6326 studies were reviewed. For the 1992 trend data, 1860 studies were reviewed, and 135 were selected for inclusion in the study. Ninety-five studies were studies involving the investigation of drugs, and 40 studies involved the testing of a device. For the 2002-2003 data 4466 studies were reviewed, and 315 were selected for inclusion in the study. Two hundred twenty-two studies were clinical trials involving the investigation of drugs, and 93 were clinical trials involving devices. In comparing 1992 to 2002, the percentage of studies funded by industry sources more than doubled from 10% to greater than 28% of the total studies assessed. There was an associated decline in the proportion of studies with funding from non-industry sources during this period (62% to less than 48%). The percentage of studies that did not disclose a funding source fell modestly from 28% to 24%. We found that 86% of studies funded by private industry reported a result favorable to the study drug or device, and 83% of studies funded by academic sources reported a result favorable to the study drug or device (P=.572). On average, studies funded by private industry had a higher methodology score than studies funded by traditional academic sources (75 of 100 vs 65 of 100; P=.005). Analysis of the funnel plot did not reveal evidence of bias against the publication of small studies with insignificant results.

CONCLUSIONS

The proportion of research funded by industry has more than doubled during the last decade and currently comprises almost half of the funding for GI clinical research. Industry-sponsored studies are, on average, of superior methodologic quality to studies funded by other sources. Industry-sponsored studies in leading GI journals were no more likely than other studies to publish results that favored the study sponsor, although an extremely high percentage of all studies in these journals reported positive results. There has been only a modest decline in studies not acknowledging a funding source.

The dynamic prediction of antisocial behavior among forensic psychiatric patients: a prospective field study

Staff ratings of 595 supervised forensic psychiatric patients on the Proximal Risk Factor Scale and the Problem Identification Checklist were completed monthly for an average of 33 months. During the follow-up, there were 265 incidents, 86 of which were violent. The average ratings, excluding those from the index month, differentiated patients who had incidents from those who did not. As well, the average ratings distinguished between individuals with and without incidents of a violent or sexual nature. There were significant increases in staff ratings in the months preceding the index incident month. Within-patient analyses showed that changes in dynamic risk scales comprising the best items for predicting incidents of any kind and violent or sexual incidents were strongly related to their respective outcomes and were significantly related to outcome in an independent sample. Changes in monthly staff ratings predict the imminent occurrence of antisocial and violent behaviors.

Patterns of responses on health-related quality of life questionnaires among patients with HIV/AIDS

BACKGROUND

Health-related quality of life (HRQoL) has become an important facet of HIV/AIDS research. Typically, the unit of analysis is either the total instrument score or subscale score. Developing a typology of responses across various HRQoL measures, however, may advance understating of patients' perspectives.

METHODS

In a multicenter study, we categorized 443 patients' responses on utility measures (time-tradeoff, standard gamble, and rating scale) and the HIV/AIDS-Targeted Quality of Life (HAT-QoL) scale by using latent profile analysis to empirically derive classes of respondents. We then used linear regressions to identify whether class membership is associated with clinical measures (viral load, CD4, time since diagnosis, highly active antiretroviral therapy [HAART]) and psychosocial function (depressed mood, alcohol use, religious coping).

RESULTS

Six classes were identified. Responses across the HAT-QoL subscales tended to fall into 3 groupings--high functioning (Class 1), moderate functioning (Classes 2 and 3), and low functioning (Classes 4 to 6); utility measures further distinguished individuals among classes. Regression analyses comparing those in Class 1 with those in the other 5 found significantly more symptoms of depression, negative religious coping strategies, and lower CD4 counts among subjects in Class 1. Those in Class 5 had been diagnosed with HIV longer, and members of Class 6 reported significantly less alcohol consumption, had higher viral loads, and were more likely to receive HAART.

CONCLUSION

Patients with HIV respond differentially to various types of HRQoL measures. Health status and utility measures are thus complementary approaches to measuring HRQoL in patients with HIV.

The efficacy of videotape feedback for enhancing the effects of exposure-based treatment for social anxiety disorder: A controlled investigation

Correcting patients' faulty beliefs concerning social evaluative threats is the hallmark of cognitive-behavioral treatment of social anxiety disorder. The current study examined the efficacy of two videotape feedback procedures as adjuncts to exposure-based treatment. Participants suffering from social phobia (N=77) were randomly assigned to one of four conditions: (a) credible placebo treatment (PLA); (b) exposure + no feedback (EXP); (c) exposure + videotape feedback of performance (PER); or (d) exposure + videotape feedback of audience responses (AUD). Contrary to prediction, the videotape feedback procedures did not enhance the effects of exposure-based treatment. Clinical and theoretical implications are discussed.

Pre-attack stress-load, appraisals, and coping in children's responses to the 9/11 terrorist attacks

BACKGROUND

Appraisal and coping following a disaster are important factors in children's post-traumatic stress (PTS) symptoms. However, little is known about predictors of disaster coping responses. This study examined stress-load, appraisals and coping styles measured prior to the September 11 terrorist attacks as predictors of 9/11-specific appraisals, coping and PTS.

METHODS

A community sample of children and parents (N = 143) participating in an ongoing study were interviewed by phone approximately 1 month following 9/11.

RESULTS

Pre-attack stress-load, appraisal and coping styles predicted children's 9/11-specific appraisals, coping, and PTS. 9/11-specific threat appraisals and avoidant coping predicted higher PTS and mediated the effects of pre-attack stress-load and threat appraisal.

CONCLUSIONS

Pre-disaster stress-load, appraisal and coping styles predict disaster-specific appraisal and coping, which in turn, contribute to PTS. Coping interventions might mitigate PTS symptoms following a disaster.

Probability as certainty: Dichotomous thinking and the misuse ofp values

Significance testing is widely used and often criticized. The Task Force on Statistical Inference of the American Psychological Association (TFSI, APA; Wilkinson & TFSI, 1999) addressed the use of significance testing and made recommendations that were incorporated in the fifth edition of the APA Publication Manual (APA, 2001). They emphasized the interpretation of significance testing and the importance of reporting confidence intervals and effect sizes. We examined whether 286 Psychonomic Bulletin & Review articles submitted before and after the publication of the TFSI recommendations by APA complied with these recommendations. Interpretation errors when using significance testing were still made frequently, and the new prescriptions were not yet followed on a large scale. Changing the practice of reporting statistics seems doomed to be a slow process.

Developmental assessment of competence from early childhood to middle adolescence

This study represents a developmentally informed, empirically validated examination of competence across multiple domains (Social, Cognitive, Emotional well-being), gender and age (early childhood, middle childhood, early adolescence, middle adolescence). Competence indicators were created and the structure of these domains was tested using multi-method, multi-informant data collected on 191 participants drawn from a prospective study of at-risk children. The results indicated that inter-individual differences in Cognitive and Social competence were stable across time, whereas inter-individual differences in Emotional well-being were stable only between early and middle adolescence. While the strength of stability of Cognitive competence was similar across different time points, the stability of Social competence declined after middle childhood, suggesting more inter-individual variability with regard to change. The findings also indicated that both the structure and the stability of competence are similar for boys and girls.

Sexual communication and contraceptive use in adolescent dating couples

PURPOSE

This study had two aims: first, to examine the relationship between general sexual communication and contraceptive use in sexually active adolescent romantic couples, and second, to explore predictors of open communication from characteristics of adolescent couples and individual adolescents.

METHODS

Data were drawn from 209 couples dating a minimum of four weeks who participated in the Study of Tennessee Adolescent Romantic Relationships. Seventy-three adolescent dating couples (ages 14-21 years) that engaged in sexual intercourse and completed a sexual communication questionnaire were included in current analyses.

RESULTS

Nearly 30% of couples failed to use contraception at first intercourse and almost half of couples did not use contraception every time they had sex. More open communication about sex from both male and female partners was associated with increased contraceptive use. Additionally, adolescents who were more satisfied in their relationships reported more open communication about sex, and adolescent females who self-silenced reported less open communication about sex. Finally, mediation analyses revealed that boys' and girls' relationship satisfaction and girls' self-silencing indirectly predicted contraceptive use through their effects on general sexual communication.

CONCLUSIONS

This is the first known study to address individual and dyadic components of sexual communication using reports from both members of established adolescent dating couples. Findings suggest that open sexual communication between intimate partners is important to sexual decision-making. The clinical implications of these findings are discussed.

Symptoms of internalizing and externalizing problems: modeling recovery curves after the death of a parent

BACKGROUND

The death of a parent is a major family disruption that can place children at risk for later depression and other mental health problems.

DESIGN

Theoretically based randomized controlled trial for parentally bereaved children.

SETTING/PARTICIPANTS

Two-hundred and forty-four children and adolescents and their caregivers from 156 families were randomly assigned to the Family Bereavement Program (FBP) intervention condition (90 families; 135 children) or to a control condition (66 families; 109 children). Data collection occurred from 1996 to 1998.

INTERVENTION

Children and caregivers in the intervention condition met separately for 12 two-hour weekly sessions. Skills targeted by the program for children included positive coping, stress appraisals, control beliefs, and self-esteem. The caregiver program targeted caregiver mental health, life stressors, and improved discipline in the home. Both child and caregiver programs focused on improved quality of the caregiver-child relationship.

MAIN OUTCOME MEASURES

Child and caregiver reports of internalizing and externalizing symptoms.

RESULTS

Longitudinal growth curve modeling was performed to model symptoms over time from the point of parental death. The rate of recovery for girls in the program condition was significantly different from that of girls in the control condition across all outcomes. Boys in both conditions showed reduced symptoms over time.

CONCLUSIONS

The methodology offers a conceptually unique way of assessing recovery in terms of reduced mental health problems over time after an event and has contributed to further understanding of FBP intervention effects. The intervention program facilitated recovery among girls, who did not show reduction in behavior problems without the program, while boys demonstrated decreased symptoms even without intervention.

Comparison of longitudinal phenotypes based on number and timing of assessments: a systematic comparison of trajectory approaches II

The popularity of trajectory-based research to characterize developmental courses of alcohol (and other drug) involvement is growing rapidly. Given the increasing use of these methods, there is a need to identify methodological factors that affect course shape and prevalence. Using growth mixture models, the authors characterized the developmental course of 2 indices of alcohol involvement, alcohol use disorder and frequency of heavy drinking, with a prospective sample of 489 young adults (Year 1 age = 18.52; 55% female; 51% with family history of alcoholism) assessed 6 times over 11 years. Then, the authors explored the extent to which trajectory models that eliminated an assessment (at the beginning, middle, or end of the study interval) were similar to the full 6-wave model. Although classifications showed relatively high concordance, trajectory shape and predicted prevalences varied. Misclassification was associated with methodological factors such as probability of class membership and missing data. Findings suggest that researchers thoughtfully consider the nature of the phenomena being studied and the developmental period of interest when designing prospective studies.

Outcomes and costs of matching the intensity of dual-diagnosis treatment to patients' symptom severity

This study evaluated a patient-treatment matching strategy intended to improve the effectiveness and cost-effectiveness of acute treatment for dual-diagnosis patients. Matching variables were the severity of the patient's disorders and the program's service intensity. Patients (N = 230) with dual substance use and psychiatric disorders received low or high service-intensity acute care in 1 of 14 residential programs and were followed up for 1 year (80%) using the Addiction Severity Index. Patients' health care utilization was assessed from charts, Department of Veterans Affairs (VA) databases, and health care diaries; costs were assigned using methods established by the VA Health Economics Resource Center. High-severity patients treated in high-intensity programs had better alcohol, drug, and psychiatric outcomes at follow-up, as well as higher health care utilization and costs during the year between intake and follow-up than did those in low-intensity programs. For moderate-severity patients, high service intensity improved the effectiveness of treatment in only a single domain (drug abuse) and increased costs of the index stay but did not increase health care costs accumulated over the study year. Moderate-severity patients generally had similar outcomes and health care costs whether they were matched to low-intensity treatment or not. For high-severity patients, matching to higher service intensity improved the effectiveness of treatment as well as increased health care costs. Research is needed to establish standards by which to judge whether the added benefits of high-intensity acute care justify the extra costs.

The development of physical aggression from toddlerhood to pre-adolescence: a nation wide longitudinal study of Canadian children

The objectives of the study were to model the developmental trajectories of physical aggression (PA) from toddlerhood to pre-adolescence and to identify risk factors that distinguish typical (normative) from atypical developmental patterns. Ten cohorts of approximately 1,000 children (n = 10,658) drawn form a nationally representative (Canadian) sample were followed over 6 years. Using a group based trajectory approach, we identified three groups of children with distinct developmental trajectories between 2 and 11 years of age. One third of the children (31.1%) followed a low desisting trajectory, reflected in infrequent use of PA in toddlerhood and virtually no PA by pre-adolescence. The majority of children (52.2%) followed a moderate desisting trajectory, reflected in occasional use of PA in toddlerhood and infrequent use by pre-adolescence. One sixth of the children (16.6%) followed a high stable trajectory of PA. Multivariate logistic regression indicated that children in the high PA trajectory group were more likely to be boys (OR: 1.67; CI: 1.5-1.87), from low income families (OR: 1.4; CI; 1.27-1.67), from families where the mother had not completed high school (OR: 1.20; CI: 1.05-1.38) and who reported using hostile/ineffective parenting strategies (OR: 1.16; CI: 1.14-1.18). In sum, the results indicate that the typical developmental pattern of PA was one of occasional and declining use over time. However, about one sixth of children, mostly boys from disadvantaged families, exhibited an atypical developmental pattern reflected in more frequent and stable use of PA. The results suggest that most children learned relatively well to inhibit PA by the end of childhood and that a minority failed to do so. Family risks traditionally found to be associated with antisocial behaviors during adolescence appear to interfere with the socialization of PA during early and middle childhood.

The effect of white-noise mask level on sinewave contrast detection thresholds and the critical-band-masking model

It is known that visual noise added to sinusoidal gratings changes the typical U-shaped threshold curve which becomes flat in log-log scale for frequencies below 10c/deg when gratings are masked with white noise of high power spectral density level. These results have been explained using the critical-band-masking (CBM) model by supposing a visual filter-bank of constant relative bandwidth. However, some psychophysical and biological data support the idea of variable octave bandwidth. The CBM model has been used here to explain the progressive change of threshold curves with the noise mask level and to estimate the bandwidth of visual filters. Bayesian staircases were used in a 2IFC paradigm to measure contrast thresholds of horizontal sinusoidal gratings (0.25-8 c/deg) within a fixed Gaussian window and masked with one-dimensional, static, broadband white noise with each of five power density levels. Raw data showed that the contrast threshold curve progressively shifts upward and flattens out as the mask noise level increases. Theoretical thresholds from the CBM model were fitted simultaneously to the data at all five noise levels using visual filters with log-Gaussian gain functions. If we assume a fixed-channel detection model, the best fit was obtained when the octave bandwidth of visual filters decreases as a function of peak spatial frequency.

Dissociation reduction in body therapy during sexual abuse recovery

The study purpose was to examine dissociation in body therapy for women receiving psychotherapy for childhood sexual abuse. An initial intervention study provided an opportunity to examine dissociation; the sample of 24 women received eight, 1-h body therapy sessions. The Dissociative Experiences Scale served as the predictor variable, and the outcome measures reflected psychological and physical health, and body connection. Repeated measures analysis of variance was used to examine dissociation reduction across time. Pearson correlations were used to describe associations between the relative change in dissociation and outcomes. The results demonstrated that the greatest change was the reduction of dissociation; there was an incremental effect across time and a strong association between change in dissociation and health outcomes. High dissociation at baseline (moderate levels) predicted positive outcomes. The results demonstrated the importance of moderate dissociation as an indicator of distress, and the central role of dissociation reduction in health and healing.

Investigating indicators and determinants of asthma in young adults

BACKGROUND

In epidemiological studies on asthma determinants an extreme variability in results exists, probably due to different criteria utilised for defining of an asthma 'case' and for measuring determinants. We aimed to assess multiple indicators and multiple determinants of asthma in young adults by applying latent variable mixture models (LVMMs), a novel statistical modelling with hidden (or latent) variables.

METHODS

We consider the pooled data of 1103 subjects (aged 20-44 years) from the three Italian centres of the European Community Respiratory Health Survey (ECRHS 1), a standardised database. Underlying multiple asthma indicators (clinicians' diagnosis, self-report symptoms, respiratory trials) both a latent two-class of asthma syndrome, and three continuous latent variables (severity of diagnosed asthma, severity of asthma symptoms, and severity of respiratory function) were investigated.

RESULTS

Family history was the more relevant predictor of the two-class of asthma syndrome with a risk increase of about 60% per 1 relative with early life events (OR = 1.60, 95% CI: 1.30-1.97). Smoking, active and passive, are predictive for the indicators of severity of asthma symptoms. On average the risk increase of about 10% (OR = 1.10, 95%CI: 1.01-1.20) either per 1 source point of environmental tobacco smoke (ETS) or per 1 packet a day per 10 years. While, the risk of the indicators of both severity of asthma symptoms (OR = 1.59, 95%CI: 1.23-2.06) and severity of respiratory function (OR = 1.37, 95%CI: 1.03-1.82) increase in women compared to men, the risk of the indicators of severity of diagnosed asthma (OR = 0.57, 95%CI: 0.35-0.91) decreases.

CONCLUSIONS

Considering latent modelling perspective for formulating plausible hypotheses in asthma research, this study highlighted that the host (genetic) component measured as number of relatives with life-events of asthma and/or allergies seems to be the primary determinants of overall observed asthma indicators summarised by hidden two-class of asthma syndrome. Furthermore, a secondary (or trigger) role of smoking on the continuous latent variable of severity of asthma symptoms, and a gender reversal effect were suggested.

Computation of individual latent variable scores from data with multiple missingness patterns

Latent variable models are used in biological and social sciences to investigate characteristics that are not directly measurable. The generation of individual scores of latent variables can simplify subsequent analyses. However, missing measurements in real data complicate the calculation of scores. Missing observations also result in different latent variable scores having different degrees of accuracy which should be taken into account in subsequent analyses. This manuscript presents a publicly available software tool that addresses both these problems, using as an example a dataset consisting of multiple ratings for ADHD symptomatology in children. The program computes latent variable scores with accompanying accuracy indices, under a 'user-specified' structural equation model, in data with missing data patterns. Since structural equation models encompass factor models, it can also be used for calculating factor scores. The program, documentation and a tutorial, containing worked examples and specimen input and output files, is available at http://statgen.iop.kcl.ac.uk/lsc .

Mediation of the effects of the family bereavement program on mental health problems of bereaved children and adolescents

This study presents an analysis of mediation of the effects of the Family Bereavement Program (FBP) to improve mental health outcomes of girls at 11 months following program participation. The FBP was designed based on a theory that program-induced change in multiple child and family level mediators would lead to reductions in children's mental health problems. Mediational models were tested using a three wave and a two wave longitudinal design. Using a three wave longitudinal design, FBP effects on three variables at T2 (increased positive parenting, decreased negative events, and decreased inhibition of emotional expression) were found to mediate the effects of the FBP on mental health problems at 11-month follow-up. Using a two-wave longitudinal design, support was found for FBP effects on three additional variables at 11-month follow-up (increased positive coping, decreased negative thoughts about stressors, and decreased unknown control beliefs) to mediate program effects to reduce mental health problems at 11-month follow-up. The discussion focuses on theoretical explanations for the mediational effects and on implications for identifying "core components" of the FBP that are responsible for its effects to reduce mental health problems of girls.

Examining the association between parenting and childhood anxiety: a meta-analysis

Theoretical models emphasize the role of parenting in the development and maintenance of child anxiety, but reviews of the empirical literature have provided mixed support for existing theories. To help clarify the role parenting plays in childhood anxiety, we conducted a meta-analysis of 47 studies testing the association between parenting and child anxiety. Across these studies, parenting accounted for only 4% of the variance in child anxiety. Moderator tests indicated that methodological factors (i.e., how child anxiety and parenting were conceptualized and assessed) may be a source of inconsistent findings within the literature. In addition, our analyses revealed that parental control was more strongly associated with child anxiety than was parental rejection. Specific subdimensions within parental rejection and control differed in their association with child anxiety (e.g., autonomy-granting accounted for 18% of the variance, but warmth <1%), indicating that efforts to disaggregate parenting dimensions may inform theory development and future research. Overall, however, the modest association between parenting and child anxiety suggests that understanding the origins of children's anxiety will require identifying factors other than parenting that account for the bulk of the variance.