Risky families: family social environments and the mental and physical health of offspring

Health compromising behaviors among Chinese adolescents: role of physical abuse, school experience, and social support

This study examined the influence of immediate social environment on health compromising behaviors (HCB) among 6564 high school students in China. Results showed that physical abuse by parents was a major risk factor that accounted for high rates of HCB. Perceived positive school experience and social support were protective factors associated with low rates of HCB. These two protective factors also buffered the adverse influence of abuse on the practice of individual HCB. In particular, parental abuse was associated with sexual experimentation, non-fatal self-harm, and suicide behaviors only at low levels of protective factors.

Adolescent preventive health and team-games-tournaments: five decades of evidence for an empirically based paradigm

The problematic behaviors of teenagers and the subsequent negative consequences are extensive and well documented: unwanted pregnancy, substance abuse, violent behavior, depression, and social and psychological consequences of unemployment. In this article, the authors review an approach that uses a cooperative learning, empirically based intervention that employs peers as teachers. This intervention of choice is Teams-Games-Tournaments (TGT), a paradigm backed by five decades of empirical support. The application of TGT in preventive health programs incorporates elements in common with other prevention programs that are based on a public health orientation and constitute the essential components of health education, that is, skills training and practice in applying skills. The TGT intervention supports the idea that children and adolescents from various socioeconomic classes, between the ages of 8 and 18 and in classrooms or groups ranging in size from 4 to 17 members, can work together for one another. TGT has been applied successfully in such diverse areas as adolescent development, sexuality education, psychoactive substance abuse education, anger control, coping with depression and suicide, nutrition, comprehensive employment preparation, and family intervention. This article reviews the extensive research on TGT using examples of successful projects in substance abuse, violence, and nutrition. Issues are raised that relate to the implementation of preventive health strategies for adolescents, including cognitive aspects, social and family networks, and intervention components.

Do parents and peers matter? A prospective socio-ecological examination of substance use and sexual risk among African American youth

We examined the direct contribution of parent and peer risk and promotive factors on youth condom use trajectories, in addition to the indirect influence of these factors via youth's substance use over four years in a sample of urban, African American youth (N=679; 51% female; M=14.86 years; SD=0.65). Growth curve modeling was used to estimate changes in substance use and sexual risk across adolescence and test their association with parent and peer factors. Parent and peer risk factors were strongly associated with increasing substance use as youth aged. Substance use and condom use were interrelated. Parent and peer risk factors were indirectly associated with youth condom use; parent and peer promotive factors were directly associated with condom use, after accounting for substance use. Findings suggest the value of considering multiple influences on youth risk behavior.

Incorporating children's lives into a life course perspective on stress and mental health

Emerging themes in demography, developmental medicine, and psychiatry suggest that a comprehensive understanding of mental health across the life course requires that we incorporate the lives of children into our research. If we can learn more about the ways in which the stress process unfolds for children, we will gain important insights into the factors that influence initial set points of trajectories of mental health over the life course. This will simultaneously extend the scope of the stress process paradigm and elaborate the life course perspective on mental health. Incorporating children's lives into the sociology of mental health will also extend the intellectual influence of the discipline on sociomedical and biomedical research on mental illness. I contend that sociology's greatest promise in understanding trajectories of mental health across the life course lies in a systematic analysis of the social and social-psychological conditions of children, the stressful experiences that arise out of these conditions, and the processes that mediate and moderate the stress process in childhood. In this regard, there are three major issues that sociologists could begin to address: (1) the identification of structural and institutional factors that pattern children's exposure to stress; (2) the construction of a stress universe for children; and (3) the identification of key elements of the life course perspective that may set or alter trajectories of mental health in childhood and adolescence.

Links between middle-childhood trajectories of family dysfunction and indirect aggression

Using data from three waves of a large Canadian data set, this research examined the relationship between middle-childhood trajectories of family dysfunction and indirect aggression. The authors applied family systems, developmental psychopathology, and life-course conceptualizations to meet this objective. The data analytic strategy used separate multivariate logits to examine this relationship, with and without the extent to which other possible explanations (acting as control variables) predict belonging to the highest family dysfunction trajectory. These included marital transition, socioeconomic status, family size, and depressive symptoms experienced by the adult most knowledgeable about the child (mostly mothers). The authors also explored possible interactions between indirect aggression and these explanatory variables. Supporting their hypothesis for both boys and girls, prolonged-duration high doses of family dysfunction were associated with the most extreme developmental trajectories of indirect aggression during middle childhood. Results showed gender specificity with respect to the influence of the explanatory variables on family dysfunction. For girls, the link between family dysfunction and indirect aggression persisted above and beyond such contextual influences. For boys, the relationship became unimportant once contextual factors were taken into account.

Morbidity and mortality risk among the "forgotten few": why are girls in the justice system in such poor health?

The present study assessed the physical health of a population of girls sentenced to custody in a large US State via medical examinations and clinical assessments in adolescence and young adulthood. Findings indicated that injuries, obesity, and sexually transmitted diseases were the norm, with over 50% of the population meeting criteria for each of these health problems. A dose-response relationship was documented between childhood victimization and injuries and injury risk in adolescence and self-harm, HIV risk, physical health symptoms, and hospitalizations in young adulthood. The relationship between childhood victimization and poor adult physical health was fully mediated by health-risk behaviors in adolescence. Clinical and policy implications of the high mortality and morbidity risk among female juvenile offenders are discussed.

Effects of an Early Family Intervention on Children's Memory: The Mediating Effects of Cortisol Levels

Developmental psychologists have long been concerned with the ways that early adversity influences children's long-term outcomes. In the current study, activity of the HPA axis of medically at-risk (e.g., preterm) infants was measured as a result of maternal participation in a novel cognitively-based home visitation program (versus a Healthy Start home visitation program). Maternal participation in the cognitive intervention predicted lower basal cortisol levels among infants - with reduced levels of maternal avoidance/withdrawal serving as a mediator of this relation. Lower cortisol levels in infancy, in turn, predicted higher verbal short-term memory at age 3. Short-term memory represents a cognitive ability that has importance for children's later educational outcomes. Findings provide experimental evidence concerning the pathway by which an early intervention may produce hormonal changes that can, in turn, influence children's learning outcomes.

Childhood social environment, emotional reactivity to stress, and mood and anxiety disorders across the life course

BACKGROUND

Adverse child environments are associated with the onset of mood and anxiety disorders in adulthood. The mechanisms underlying these life-course associations remain poorly understood. We investigate whether emotional reactivity to stress is a mechanism in the association between childhood environment characteristics and adult mood and anxiety disorders.

METHODS

Data are from the Study of Adult Development, a longitudinal study of men (N = 268) followed for nearly seven decades beginning in late adolescence. Childhood social environment characteristics were assessed during home visits and interviews with respondents' parents at entry into the study. Stress reactivity was assessed during respondents' sophomore year of college via physician exam. Onset of mood and anxiety disorders in adulthood was ascertained by research psychiatrists who completed chart reviews of interview, questionnaire, and physical exam data collected during repeated assessments from age 20 to 70.

RESULTS

Respondents with better overall childhood environments and a greater number of environmental strengths were at lower odds of developing a mood or anxiety disorder in adulthood than respondents with more adverse childhood environments. Higher stress reactivity was observed among respondents from families with lower socio-economic status and with childhood environments characterized by greater conflict and adversity. Elevated stress reactivity, in turn, predicted the onset of adult mood and anxiety disorders.

CONCLUSION

Heightened emotional reactivity in early adulthood is associated with both adverse childhood environments and elevated risk for developing mood and anxiety disorders in adulthood. Emotional reactivity may be one mechanism linking childhood adversity to mood and anxiety disorders in adulthood.

Animal models of early life stress: Implications for understanding resilience

In the mid-1950s, Levine and his colleagues reported that brief intermittent exposure to early life stress diminished indications of subsequent emotionality in rats. Here we review ongoing studies of a similar process in squirrel monkeys. Results from these animal models suggest that brief intermittent exposure to stress promotes the development of arousal regulation and resilience. Implications for programs designed to enhance resilience in human development are discussed.

Stress and the Development of Self-Regulation in Context

This article considers the effects of psychosocial stress on child development and describes mechanisms through which early stress in the context of poverty affects the functioning of neural networks that underlie executive functions and self-regulation. It examines the effects of early experience on glucocorticoid and catecholamine levels that influence neural activity in areas of the brain associated with executive functions, primarily as studied in animal models. Finally, it considers the strengths and limitations of this research, its relevance to understanding stress reactivity from the perspective of biological sensitivity to context, and the implications for the study of risk and resilience processes and early intervention to prevent developmental delays.

The role of brain-derived neurotrophic factor genotype, parental depression, and relationship discord in predicting early-emerging negative emotionality

The brain-derived neurotrophic factor (BDNF) gene is a plausible candidate for early-emerging negative emotionality (NE), and evidence suggests that the effects of this gene may be especially salient in the context of familial risk for child maladjustment. We therefore examined whether the single-nucleotide polymorphism producing a valine-to-methionine substitution at codon 66 (val66met) of the BDNF gene was associated with childhood NE, in the context of parental depression and relationship discord. A sample of 413 three-year-old children was assessed for NE using standardized laboratory measures. The children's parents completed clinical interviews as well as a measure of marital satisfaction. Children with at least one BDNF methionine (met) allele exhibited elevated NE when a parent had a history of depressive disorder or when relationship discord was reported by a parent. In contrast, this allele was associated with especially low NE when parental depression was absent and when the parental relationship was not discordant. Our findings suggest that the BDNF met allele confers increased child sensitivity to both positive and negative familial influences.

Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults

BACKGROUND

Childhood adversity (CA) is associated with adult mental disorders, but the mechanisms underlying this association remain inadequately understood. Stress sensitization, whereby CA increases vulnerability to mental disorders following adult stressful life events, has been proposed as a potential mechanism. We provide a test of the stress sensitization hypothesis in a national sample.

METHOD

We investigated whether the association between past-year stressful life events and the 12-month prevalence of major depression, post-traumatic stress disorder (PTSD), other anxiety disorders, and perceived stress varies according to exposure to CA. We used data from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n=34 653).

RESULTS

Past-year stressful life events were associated with an increased risk of major depression, PTSD, anxiety disorders, and perceived stress. However, the magnitude of the increased risk varied according to respondents' history of CA. For example, past-year major stressors were associated with a 27.3% increase in the 12-month risk of depression among individuals with 3 CAs and a 14.8% increased risk among individuals without CAs. Stress sensitization effects were present for depression, PTSD, and other anxiety disorders in women and men, although gender differences were found in the threshold of past-year stress needed to trigger such effects. Stress sensitization was most evident among individuals with 3 CAs.

CONCLUSIONS

CA is associated with increased vulnerability to the deleterious mental health effects of adult stressors in both men and women. High levels of CA may represent a general diathesis for multiple types of psychopathology that persists throughout the life course.

A parallel process growth mixture model of conduct problems and substance use with risky sexual behavior

Conduct problems, substance use, and risky sexual behavior have been shown to coexist among adolescents, which may lead to significant health problems. The current study was designed to examine relations among these problem behaviors in a community sample of children at high risk for conduct disorder. A latent growth model of childhood conduct problems showed a decreasing trend from grades K to 5. During adolescence, four concurrent conduct problem and substance use trajectory classes were identified (high conduct problems and high substance use, increasing conduct problems and increasing substance use, minimal conduct problems and increasing substance use, and minimal conduct problems and minimal substance use) using a parallel process growth mixture model. Across all substances (tobacco, binge drinking, and marijuana use), higher levels of childhood conduct problems during kindergarten predicted a greater probability of classification into more problematic adolescent trajectory classes relative to less problematic classes. For tobacco and binge drinking models, increases in childhood conduct problems over time also predicted a greater probability of classification into more problematic classes. For all models, individuals classified into more problematic classes showed higher proportions of early sexual intercourse, infrequent condom use, receiving money for sexual services, and ever contracting an STD. Specifically, tobacco use and binge drinking during early adolescence predicted higher levels of sexual risk taking into late adolescence. Results highlight the importance of studying the conjoint relations among conduct problems, substance use, and risky sexual behavior in a unified model.

Panic disorder and serotonergic genes (SLC6A4, HTR1A and HTR2A): Association and interaction with childhood trauma and parenting

OBJECTIVE

The aim of this study is to evaluate the association between HTR1A, HTR2A and the 5-HTTLPR in panic disorder (PD) patients and controls. In addition, this study also aims to evaluate the interaction between these genes and two environmental factors previously associated with PD: childhood trauma and parental bonding.

METHODS

This is a case-control candidate gene association study (107 PD patients and 125 controls). Genes were analyzed using a gene-based test in PLINK followed by single marker association tests and haplotype test only for genes that reached experiment-wide significance in the gene-based test in order to minimize multiple testing. Logistic regression was used to test the relationships between genotype in the additive model, trauma, optimal paternal parenting and optimal maternal parenting and their interactions.

RESULTS

Only HTR1A was associated with PD in gene-based test after correction for multiple tests (p(corrected)=0.027) and one HTR1A haplotype comprising four SNPs was associated with PD (p(corrected)=0.032). In the interaction analysis, no significant gene-environment interaction was found with the genes evaluated.

CONCLUSION

This study reinforces the association between HTR1A and PD. No major evidence of gene-environment interaction in PD with parenting or trauma was found. Further studies are necessary in order to confirm these findings.

Socioeconomic status and the brain: mechanistic insights from human and animal research

Human brain development occurs within a socioeconomic context and childhood socioeconomic status (SES) influences neural development--particularly of the systems that subserve language and executive function. Research in humans and in animal models has implicated prenatal factors, parent-child interactions and cognitive stimulation in the home environment in the effects of SES on neural development. These findings provide a unique opportunity for understanding how environmental factors can lead to individual differences in brain development, and for improving the programmes and policies that are designed to alleviate SES-related disparities in mental health and academic achievement.

A prospective cohort study of deficient maternal nurturing attitudes predicting adulthood work stress independent of adulthood hostility and depressive symptoms

Stressful childhood environments arising from deficient nurturing attitudes are hypothesized to contribute to later stress vulnerability. We examined whether deficient nurturing attitudes predict adulthood work stress. Participants were 443 women and 380 men from the prospective Cardiovascular Risk in Young Finns Study. Work stress was assessed as job strain and effort-reward imbalance in 2001 when the participants were from 24 to 39 years old. Deficient maternal nurturance (intolerance and low emotional warmth) was assessed based on mothers' reports when the participants were at the age of 3-18 years and again at the age of 6-21 years. Linear regressions showed that deficient emotional warmth in childhood predicted lower adulthood job control and higher job strain. These associations were not explained by age, gender, socioeconomic circumstances, maternal mental problems or participant hostility, and depressive symptoms. Deficient nurturing attitudes in childhood might affect sensitivity to work stress and selection into stressful work conditions in adulthood. More attention should be paid to pre-employment factors in work stress research.

Stress, sex, and neural adaptation to a changing environment: mechanisms of neuronal remodeling

The adult brain is much more resilient and adaptable than previously believed, and adaptive structural plasticity involves growth and shrinkage of dendritic trees, turnover of synapses, and limited amounts of neurogenesis in the forebrain, especially the dentate gyrus of the hippocampal formation. Stress and sex hormones help to mediate adaptive structural plasticity, which has been extensively investigated in the hippocampus and to a lesser extent in the prefrontal cortex and amygdala, all brain regions that are involved in cognitive and emotional functions. Stress and sex hormones exert their effects on brain structural remodeling through both classical genomic as well as non-genomic mechanisms, and they do so in collaboration with neurotransmitters and other intra- and extracellular mediators. This review will illustrate the actions of estrogen on synapse formation in the hippocampus and the process of stress-induced remodeling of dendrites and synapses in the hippocampus, amygdala, and prefrontal cortex. The influence of early developmental epigenetic events, such as early life stress and brain sexual differentiation, is noted along with the interactions between sex hormones and the effects of stress on the brain. Because hormones influence brain structure and function and because hormone secretion is governed by the brain, applied molecular neuroscience techniques can begin to reveal the role of hormones in brain-related disorders and the treatment of these diseases. A better understanding of hormone-brain interactions should promote more flexible approaches to the treatment of psychiatric disorders, as well as their prevention through both behavioral and pharmaceutical interventions.

Implementing trauma-focused CBT with fidelity and flexibility: a family case study

Effective approaches for the treatment of childhood posttraumatic stress disorder and traumatic grief are needed given the prevalence of trauma and its impact on children's lives. To effectively treat posttraumatic stress disorder in children, evidence-based practices should be implemented with flexibility and responsiveness to culture, developmental level, and the specific needs of the family. This case study illustrates flexibility with fidelity in the use of a manualized treatment, describing the implementation of Trauma Focused-Cognitive Behavior Therapy with three traumatized family members-a caregiver and two children. Particular attention is paid to the use of creative strategies to tailor interventions to the individual clients while maintaining fidelity to the principles and components of this evidence-based treatment.

Epigenetics and the biological definition of gene x environment interactions

Variations in phenotype reflect the influence of environmental conditions during development on cellular functions, including that of the genome. The recent integration of epigenetics into developmental psychobiology illustrates the processes by which environmental conditions in early life structurally alter DNA, providing a physical basis for the influence of the perinatal environmental signals on phenotype over the life of the individual. This review focuses on the enduring effects of naturally occurring variations in maternal care on gene expression and phenotype to provide an example of environmentally driven plasticity at the level of the DNA, revealing the interdependence of gene and environmental in the regulation of phenotype.

Social Relationships and Health Behavior Across Life Course

Sociological theory and research point to the importance of social relationships in affecting health behavior. This work tends to focus on specific stages of the life course, with a division between research on childhood/adolescent and adult populations. Yet recent advances demonstrate that early life course experiences shape health outcomes well into adulthood. We synthesize disparate bodies of research on social ties and health behavior throughout the life course, with attention to explaining how various social ties influence health behaviors at different life stages and how these processes accumulate and reverberate throughout the life course.

Family functioning and children's response to primary care treatment for overweight: a preliminary study

OBJECTIVE

The aim of this study was to assess the relation between family functioning and children's response to treatment for overweight in a primary care setting.

METHODS

Sixty predominantly African American (72%) parents of children who are overweight were recruited from a pediatric outpatient clinic to provide information about family functioning. Children's success in treatment was tracked through medical chart review.

RESULTS

Parents' baseline self-report of family adaptability was associated with child body mass index z-scores (zBMI) at 3-month follow-up, although this association was no longer significant once baseline child zBMI was taken into account.

CONCLUSIONS

Families with greater ability to adopt/implement changes may have children who do better in weight loss treatment. This preliminary study provides a model for integrating family systems ideas into pediatric overweight research and offers heuristic value as well as directions for future research in primary care settings.

Father bonding and blood pressure in young adults from intact and divorced families

OBJECTIVE

The father-child relationship may uniquely affect offspring's physical and psychological health. Divorce may change the nature of the father-child bond and the long-term health consequences of paternal parenting behaviors. The current study investigated a possible biological pathway from father-child relationship quality to physical health outcomes in young adults.

METHODS

Cardiovascular stress reactivity to a lab-based challenge task and ambulatory blood pressure (ABP) were measured in young adults (mean age=20.1 years) from divorced (n=50) and intact, married (n=49) families. Participants completed self-report measures of paternal control and caring during childhood.

RESULTS

Higher perceived father control was associated with elevated BP reactivity to the task and higher ABP among participants from divorced families. Young adults from intact families who reported lower paternal caring demonstrated higher ABP.

CONCLUSIONS

The family context may provide an important backdrop for evaluating the long-term physiological consequences of fathers' parenting behaviors.

Violence exposure in multiple interpersonal domains: cumulative and differential effects

PURPOSE

To examine dose-response effects of cumulative violence exposure including parent-to-youth aggression, marital physical aggression, and community violence, and to explore whether separate interpersonal domains of exposure differentially influence adverse outcomes.

METHODS

The present study uses parent-reports and child-reports of youth violence exposure from the first three waves of a prospective, longitudinal study of 103 community-based families. Outcomes were criterion levels (T score >or= 60) of somatic complaints, depressive symptoms, anxiety, over-arousal, aggression, delinquent behaviors, and presence versus absence of academic failure.

RESULTS

After controlling for initial symptoms, income and parents' psychopathology, adjusted relative risks showed that marital aggression contributed uniquely to anxiety, and parent-to-youth aggression contributed uniquely to somatic complaints and aggression. All three domains significantly contributed to academic failure. With each one-point increase on the cumulative violence exposure index that summed across interpersonal domains and across time, there was an increased risk of more than 50% for meeting criterion levels of depressive symptoms and anxiety, and a 10%-25% increased risk for somatic complaints, delinquent behaviors, and academic failure. Significant curvilinear effects showed high cumulative violence increased risk of comorbid symptoms; 76% of youth with higher cumulative violence met thresholds on 3+ adverse outcomes, compared to 36% and 7% for youth with moderate and low violence exposure.

CONCLUSIONS

These data highlight the importance of assessing violence exposure across multiple interpersonal domains and across time. Awareness of the contributions of violence exposure to common symptoms and particularly comorbid symptoms can inform interventions for wide-ranging adolescent problems.

Effects of stress in early life on immune functions in rats with asthma and the effects of music therapy

OBJECTIVE

Although studies have shown that psychological stress has detrimental effects on bronchial asthma, there are few objective data on whether early-life stress, as early postnatal psychosocial environment, has a long-lasting effect on adult asthma and the potential pathophysiologic mechanism. This study aims to examine the effects on immune function and hypothalamic-pituitary-adrenal (HPA) axis responses in adult asthmatic rats that experienced stress in early life and the potential ameliorative effects of music therapy on these parameters.

METHODS

Forty male Wistar rat pups were randomly assigned to the asthma group, the adulthood-stressed asthma group, the childhood-stressed asthma group, the music group, and the control group. Restraint stress and Mozart's Sonata K.448 were applied to ovalbumin (OVA)-induced asthmatic rats to establish psychological stress and music therapy models. The levels of serum corticosterone were examined in both childhood after stress and adulthood after OVA challenge. Immune indicators in blood, lung, and brain tissues were measured after the last OVA challenge.

RESULTS

Stress in both childhood and adulthood resulted in increases in leukocyte and eosinophil numbers and serum interleukin (IL)-4 levels. The adulthood-stressed group demonstrated increased corticosterone levels after challenge, whereas the childhood-stressed group showed increased corticosterone concentration in childhood but decreased level in adulthood. Central IL-1beta exhibited a similar tendency. Music group rats showed reduced serum IL-4 and corticosterone.

CONCLUSIONS

Stress in childhood and adulthood resulted in different HPA axis responsiveness in the exacerbation of markers of asthma. These data provide the first evidence of the long-term normalizing effects of music on asthmatic rats.

Health-risk behaviors in young adolescents in the child welfare system

PURPOSE

To examine rates and patterns of health-risk behavior (e.g., sexuality, depression/suicidality, substance use, delinquency) among a national probability sample of youth active to the child welfare/child protective services system. Recent federal legislation, P.L. 110-351, encourages child welfare systems, Medicaid, and pediatric experts to collaborate to ensure youth entering foster care receive comprehensive health examinations.

METHODS

Analysis of baseline caregiver, caseworker, and child interviews, and assessment data for a subsample (n = 993) of youth, aged 11-15 years, from the National Survey of Child and Adolescent Well-Being, a national probability sample of children and adolescents undergoing investigation for abuse or neglect.

RESULTS

Almost half of the sample (46.3%) endorsed at least one health-risk behavior. On Poisson multivariate regression modeling, factors related to higher rates of health-risk behaviors included older age, female gender, abuse history, deviant peers, limited caregiver monitoring, and poor school engagement.

CONCLUSION

Given the heightened vulnerability of this population, early screening for health-risk behaviors must be prioritized. Further research should explore specific subpopulations at risk for health-risk behaviors and possible interventions to change these youths' trajectories.

It's more than sex: exploring the dyadic nature of sleep and implications for health

Sleep is a critical health behavior and one that is typically shared between husbands and wives or romantic partners. However, the science of sleep has traditionally conceptualized and evaluated sleep at the level of the individual. Considering the social context of sleep represents a significant shift in sleep research and also offers a critical opportunity for investigating sleep as a novel pathway linking close relationships with health. The purpose of this review is to integrate research that focuses on how sleep affects or is affected by close relationship functioning and to provide a heuristic framework for understanding the interface between close relationships, sleep, and health. Exploring the links between close relationships and sleep may contribute to our understanding of why some relationships confer health benefits, whereas others confer health risks.

Individuals receiving addiction treatment: are medical costs of their family members reduced?

AIMS

To examine whether alcohol and other drug (AOD) treatment is related to reduced medical costs of family members.

DESIGN

Using the administrative databases of a private, integrated health plan, we matched AOD treatment patients with health plan members without AOD disorders on age, gender and utilization, identifying family members of each group.

SETTING

Kaiser Permanente Northern California.

PARTICIPANTS

Family members of abstinent and non-abstinent AOD treatment patients and control family members.

MEASUREMENTS

We measured abstinence at 1 year post-intake and examined health care costs per member-month of family members of AOD patients and of controls through 5 years. We used generalized estimating equation methods to examine differences in average medical cost per member-month for each year, between family members of abstinent and non-abstinent AOD patients and controls. We used multilevel models to examine 4-year cost trajectories, controlling for pre-intake cost, age, gender and family size.

RESULTS

AOD patients' family members had significantly higher costs and more psychiatric and medical conditions than controls in the pre-treatment year. At 2-5 years, each year family members of AOD patients abstinent at 1 year had similar average per member-month medical costs to controls (e.g. difference at year 5 = $2.63; P > 0.82), whereas costs for family members of non-abstinent patients were higher (e.g. difference at year 5 = $35.59; P = 0.06). Family members of AOD patients not abstinent at 1 year, had a trajectory of increasing medical cost (slope = $10.32; P = 0.03) relative to controls.

CONCLUSIONS

Successful AOD treatment is related to medical cost reductions for family members, which may be considered a proxy for their improved health.

Measuring the impact and costs of a universal group based parenting programme: protocol and implementation of a trial

Background

Sub-optimal parenting is a common risk factor for a wide range of negative health, social and educational outcomes. Most parenting programmes have been developed in the USA in the context of delinquency prevention for targeted or indicated groups and the main theoretical underpinning for these programmes is behaviour management. The Family Links Nurturing Programme (FLNP) focuses on family relationships as well as behaviour management and is offered on a universal basis. As a result it may be better placed to improve health and educational outcomes. Developed in the UK voluntary sector, FLNP is popular with practitioners, has impressed policy makers throughout the UK, has been found to be effective in before/after and qualitative studies, but lacks a randomised controlled trial (RCT) evidence base.

Methods/Design

A multi-centre, investigator blind, randomised controlled trial of the FLNP with a target sample of 288 south Wales families who have a child aged 2-4 yrs living in or near to Flying Start/Sure Start areas. Changes in parenting, parent child relations and parent and child wellbeing are assessed with validated measures immediately and at 6 months post intervention. Economic components include cost consequences and cost utility analyses based on parental ranking of states of quality of life. Attendance and completion rates and fidelity to the FLNP course delivery are assessed. A nested qualitative study will assess reasons for participation and non-participation and the perceived value of the programme to families. By the end of May 2010, 287 families have been recruited into the trial across four areas of south Wales. Recruitment has not met the planned timescales with barriers including professional anxiety about families entering the control arm of the trial, family concern about video and audio recording, programme facilitator concern about the recording of FLNP sessions for fidelity purposes and delays due to the new UK research governance procedures.

Discussion

Whilst there are strong theoretical arguments to support universal provision of parenting programmes, few universal programmes have been subjected to randomised controlled trials. In this paper we describe a RCT protocol with quantitative and qualitative outcome measures and an economic evaluation designed to provide clear evidence with regard to effectiveness and costs. We describe challenges implementing the protocol and how we are addressing these.

Trial Registration

Current Controlled Trials ISRCTN13919732

Biosocial Influences on the Family: A Decade Review

The past decade brought a remarkable increase in the number and quality of biosocial studies of family processes. The current review summarizes recent advances in biosocial family research by providing key exemplars of emerging research paradigms. Research in the past decade has substantiated the claim in the previous Decade Review (Booth, Carver, & Granger, 2000) that bidirectional influences between all levels of analysis are paramount. There is an emerging consensus that integrating factors at multiple biological and social levels is highly informative. Because ignoring biological factors often will underestimate mediating or moderating mechanisms, the review provides recommendations for biosocial family research. We also highlight the need for researchers who understand complex family environments to lend their expertise to biosocial studies.

Harsh family climate in early life presages the emergence of a proinflammatory phenotype in adolescence

A growing body of evidence indicates that children reared in harsh families are prone to chronic diseases and premature death later in life. To shed light on the mechanisms potentially underlying this phenomenon, we evaluated the hypothesis that harsh families engender a proinflammatory phenotype in children that is marked by exaggerated cytokine responses to bacterial stimuli and resistance to the anti-inflammatory properties of cortisol. We repeatedly measured psychological stress and inflammatory activity in 135 female adolescents on four occasions over 1.5 years. To the extent that they were reared in harsh families, participants displayed an increasingly proinflammatory phenotype during the follow-up analyses. This phenotype was marked by increasingly pronounced cytokine responses to in vitro bacterial challenge and a progressive desensitization of the glucocorticoid receptor, which hampered cortisol's ability to properly regulate inflammatory responses. If sustained, these tendencies may place children from harsh families on a developmental trajectory toward the chronic diseases of aging.

Childhood socioeconomic status and adult health

Socioeconomic status (SES) exposures during childhood are powerful predictors of adult cardiovascular morbidity, cardiovascular mortality, all-cause mortality, and mortality due to a range of specific causes. However, we still know little about when childhood SES exposures matter most, how long they need to last, what behavioral, psychological, or physiological pathways link the childhood SES experience to adult health, and which specific adult health outcomes are vulnerable to childhood SES exposures. Here, we discuss the evidence supporting the link between childhood and adolescent SES and adult health, and explore different environmental, behavioral, and physiological pathways that might explain how early SES would influence adult health. We also address the ages when SES exposures matter most for setting adult health trajectories as well as the role of exposure duration in SES influences on later health. While early childhood exposures seem to be potent predictors of a range of health outcomes, we emphasize that later childhood and adolescent exposures are risks for other health outcomes.

Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease

The brain is the key organ of stress reactivity, coping, and recovery processes. Within the brain, a distributed neural circuitry determines what is threatening and thus stressful to the individual. Instrumental brain systems of this circuitry include the hippocampus, amygdala, and areas of the prefrontal cortex. Together, these systems regulate physiological and behavioral stress processes, which can be adaptive in the short-term and maladaptive in the long-term. Importantly, such stress processes arise from bidirectional patterns of communication between the brain and the autonomic, cardiovascular, and immune systems via neural and endocrine mechanisms underpinning cognition, experience, and behavior. In one respect, these bidirectional stress mechanisms are protective in that they promote short-term adaptation (allostasis). In another respect, however, these stress mechanisms can lead to a long-term dysregulation of allostasis in that they promote maladaptive wear-and-tear on the body and brain under chronically stressful conditions (allostatic load), compromising stress resiliency and health. This review focuses specifically on the links between stress-related processes embedded within the social environment and embodied within the brain, which is viewed as the central mediator and target of allostasis and allostatic load.

The normative development of emotion regulation strategy use in children and adolescents: a 2-year follow-up study

BACKGROUND

Emotion regulation involves intrinsic and extrinsic processes responsible for managing one's emotions toward goal accomplishment. Research on emotion regulation has predominantly focused on early developmental periods and the majority of emotion regulation research examining the pre-adult years has lacked a comprehensive theoretical framework. The current study examined the use of two strategies of emotion regulation during childhood and adolescents, as conceptualised within Gross's (1998) process-oriented model.

METHODS

To determine the use, norms and development of the Expressive Suppression and Cognitive Reappraisal strategies, the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) was administered to 1,128 participants aged between 9 and 15 years. Three data collection phases, each one year apart, enabled investigation of developmental patterns in the use of the two strategies.

RESULTS

As predicted, Suppression use was found to be lower for older participants compared to their younger peers, and over time participants reported less use of this strategy. Older participants also scored lower on Reappraisal but stability over time was found. Also as expected, males reported more Suppression use compared to females.

CONCLUSIONS

By documenting the development and norms for Cognitive Reappraisal and Expressive Suppression in a community sample of children and adolescents, the current study makes a significant contribution to our understanding of these two ER strategies during these developmental periods.

Neonatal rearing conditions distinctly shape locus coeruleus neuronal activity, dendritic arborization, and sensitivity to corticotrophin-releasing factor

Early life events influence vulnerability to psychiatric illness. This has been modelled in rats and it has been demonstrated that different durations of maternal separation shape adult endocrine and behavioural stress reactivity. One system through which maternal separation may act is the locus coeruleus (LC)-norepinephrine system that regulates emotional arousal. Here we demonstrate that different durations of maternal separation have distinct effects on LC physiology and dendritic morphology. Rat pups were separated from the dam for 15 min/d (HMS-15) or 180 min/d (HMS-180) from post-natal days 2-14. Others were either undisturbed (HMS-0) or were vendor-purchased controls. LC characteristics were compared at age 22-35 d using whole-cell recordings in vitro. Cells were filled with biocytin for morphological analysis. LC neurons of HMS-180 rats were tonically activated compared to HMS-15 and control rats, with firing rates that were 2-fold higher than these groups. Corticotrophin-releasing factor (CRF) application did not further activate LC neurons of HMS-180 rats but increased LC firing rate in HMS-0 and control rats. LC neurons of HMS-15 rats were resistant to excitation by CRF. Maternal separation also affected LC dendritic morphology. LC dendrites of HMS-15 rats exhibited less branching and decreased total dendritic length, an effect that could decrease the probability of contacting limbic afferents that terminate in the pericoerulear region. This effect may provide a structural basis for an attenuated magnitude of emotional arousal. Together, these results demonstrate long-term consequences of early life events on the LC-norepinephrine system that may shape adult behaviour.

Early environment affects neuroendocrine regulation in adulthood

Animal and human research indicates that the early environment can exert effects on hypothalamic pituitary adrenal (HPA) axis functioning across the lifespan. Using data from the National Study of Midlife Development in the United States and the National Study of Daily Experience substudy, we identified curvilinear relations between adult reports of parental affection in childhood and adult diurnal cortisol rhythms. Reports of both very affectionate and very unaffectionate parental relations in childhood were associated with flatter diurnal rhythms, suggesting potential dysregulation of the HPA axis at both extremes of family environment. Participants in the bottom tertile showed more signs of HPA axis dysregulation than those in the top tertile. We discuss processes that may underlie these effects, with reference to the theory of allostatic load.

Adolescent girls' responses to warning signs of abuse in romantic relationships: implications for youth-targeted relationship violence prevention

This study explored adolescent girls' experiences of, and responses to, seven domains of partner behavior that are considered to be early warning signs of relationship abuse. Girls (N = 146) aged 14 to 18 years, attending schools in a semirural area, completed a purpose-built questionnaire, providing measures of self-reported exposure, perceived seriousness, and proposed response protectiveness in relation to each domain. Substantial proportions of girls (a) reported exposure to each of the domains, (b) lacked awareness particularly of the risks associated with jealous/possessive partner behaviors, and (c) regardless of their level of risk awareness, lacked knowledge of behavioral responses that might discourage continued warning-sign behaviors by their partners in all domains except for social restriction tactics. The implications of these findings for youth-targeted relationship abuse prevention are discussed.

Infant physiological response to the still-face paradigm: contributions of maternal sensitivity and infants' early regulatory behavior

The current study examined the independent and additive contributions of maternal sensitivity measured prior to and following a social stressor, and infant behaviors to infants' physiological response to the still-face paradigm (SFP) in a sample characterized by poverty-related environmental risk. Ninety-one mother/infant dyads participated in the SFP when their infants were 5 months old. Maternal sensitivity was coded during the play and reunion episodes. Infant behaviors were coded during the reunion episode of the SFP while measures of heart rate (HR) and Respiratory Sinus Arrhythmia (RSA) were collected from the infants at baseline and across the SFP. Maternal sensitivity during the reunion episode predicted infants' biobehavioral reactivity and regulation, over and above maternal sensitivity during the play episode. Infants' HR decreased, and RSA increased, with greater levels of maternal sensitivity during the reunion episode. Infants also exhibited greater attentional engagement and fewer resistant behaviors with greater levels of maternal sensitivity during the reunion episode. Finally, infant behaviors predicted change in HR and RSA from the still-face to the reunion episode, above and beyond that of maternal behaviors. These findings further our understanding of the dyadic basis for the development of emotion regulation in infancy.

Youth self-report of physical and sexual abuse: a latent class analysis

OBJECTIVE

To determine if meaningful groups of at-risk pre-adolescent youth could be identified based on their self-report of physical and sexual abuse histories.

METHODS

Youth participating in a consortium of ongoing longitudinal studies were interviewed using an audio-computer assisted self-interview (A-CASI) when they were approximately 12 years of age to obtain information about their perceived experiences of physical (18 items) and sexual (12 items) abuse. In addition, Child Protective Service records were reviewed and the taxonomy developed for defining maltreatment characteristics (Barnett, Manly, & Cicchetti, 1993) was applied. A total of 795 youth completed the age 12 interview and had their records reviewed during the period from birth to the time of their age 12 interview. A latent variable modeling approach, specifically latent class analysis (LCA), was used to generate profiles of youth based on their endorsements of the physical and sexual abuse items. These profiles were then compared to CPS reports of physical or sexual abuse to determine their validity.

RESULTS

The LCA identified 4 interpretable classes or groups of pre-adolescent youth. Based on the pattern of responses to specific items the classes were identified as follows: (1) no physical or sexual abuse; (2) high physical abuse/low sexual abuse; (3) no physical abuse/moderate sexual abuse; and (4) high physical and sexual abuse. Follow-up analyses indicated that the odds of a CPS report for Classes 2, 3, and 4 compared to Class 1 were significantly greater (2.21, 2.55, and 5.10, respectively).

CONCLUSION

The latent variable modeling approach allowed for the identification of meaningful groups of youth that accounted for both the occurrence of multiple types of abuse as well as differing severities associated with each type. It is suggested that this methodological approach may be most useful in future efforts to identify the antecedents and consequences of maltreatment.

PRACTICE IMPLICATIONS

The results of the present study not only have implications for future research efforts, but also suggest that in practice, youth at-risk for maltreatment may be reliable and valid reporters of their physical and sexual abuse experiences.

Factors influencing parenting in early childhood: a prospective longitudinal study focusing on change

BACKGROUND

Parenting influences child outcomes but does not occur in a vacuum. It is influenced by socio-economic resources, parental health, and child characteristics. Our aim was to investigate the relative importance of these influences by exploring the relationship between changing parental health and socio-economic circumstances and changes in parenting.

METHODS

Data collected from the Avon Longitudinal Study of Parents and Children were used to develop an eight-item parenting measure at 8 and 33 months. The measure covered warmth, support, rejection, and control and proved valid and reliable. Regression analysis examined changes in financial circumstance, housing tenure, marital status, social support, maternal health and depression, and their influence on parenting score. The final model controlled for maternal age, education, and baseline depression.

RESULTS

Most mothers reported warm, supportive parenting at both times. Maternal depression was the only variable for which both positive and negative change was associated with changes in parenting score. Less depression was associated with better parenting scores and more depression with worse parenting scores. Improvements in social support and maternal general health were both associated with improved parenting scores, but for neither of these variables was deterioration associated with deterioration in parenting scores. Worsening financial circumstances predicted deterioration in parenting score, but improvements were not predictive of improvements in parenting.

CONCLUSIONS

Programmes aiming to improve parental health and social support are likely to return greater dividends with regard to improving parenting than programmes that aim to reduce family poverty.

Shaping adult phenotypes through early life environments

A major question in the biology of stress and environmental adaptation concerns the neurobiological basis of how neuroendocrine systems governing physiological regulatory mechanisms essential for life (metabolism, immune response, organ function) become harmful. The current view is that a switch from protection to damage occurs when vulnerable phenotypes are exposed to adverse environmental conditions. In accordance with this theory, sequelae of early life social and environmental stressors, such as childhood abuse, neglect, poverty, and poor nutrition, have been associated with the emergence of mental and physical illness (i.e., anxiety, mood disorders, poor impulse control, psychosis, and drug abuse) and an increased risk of common metabolic and cardiovascular diseases later in life. Evidence from animal and human studies investigating the associations between early life experiences (including parent-infant bonding), hypothalamus-pituitary-adrenal axis activity, brain development, and health outcome provide important clues into the neurobiological mechanisms that mediate the contribution of stressful experiences to personality development and the manifestation of illness. This review summarizes our current molecular understanding of how early environment influences brain development in a manner that persists through life and highlights recent evidence from rodent studies suggesting that maternal care in the first week of postnatal life establishes diverse and stable phenotypes in the offspring through epigenetic modification of genes expressed in the brain that shape neuroendocrine and behavioral stress responsivity throughout life.