Longitudinal Model Building Using Latent Transition Analysis: An Example Using School Bullying Data

Latent transition analysis on post-traumatic stress and post-traumatic growth among firefighters

Background: Firefighters, in the course of their professional responsibilities, confront an array of stressors contingent upon the distinctive characteristics of their duties.Objective: This study investigated the longitudinal impact of trauma incidents during duty on firefighters using latent transition analysis.Method: Data from 346 firefighters in South Korea who had experienced trauma events while on duty were utilized. Initially, latent groups were identified based on the relationship between post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG). Groups were labelled based on the analysis of differences in PTSD, mental health, and growth-related factors among classified groups. Subsequently, transition probabilities and patterns from Time 1 to Time 2 were examined, followed by an investigation into variances based on demographic factors (gender, age) and occupational factors (work experience, shift pattern) using variance analysis and multinomial logistic regression analysis.Results: First, at Time 2, a five-group model was classified into 'Growth,' 'Resilience or Numbness,' 'Struggle,' 'Partial Struggle,' and 'PTSD' groups. Second, upon examining the transition patterns between latent groups, four patterns emerged: 'continued distress,' 'growth,' 'adaptation,' and 'escalated distress.' Third, the 'Struggle' group showed a 0% probability of transitioning to the 'Growth' group, whereas it displayed the highest probability among the groups transitioning to the 'PTSD' group. Fourth, latent transition analysis results showed a strong tendency for the 'Growth' group and 'Resilience or Numbness' group to remain in the same category. Fifth, age was found to be a significant factor affecting the transition of latent groups.Conclusion: This research represents the inaugural attempt to longitudinally investigate the interplay between PTSD and PTG among firefighters.

Cooperative coparenting and the associations with adolescent behavioral problems and delinquency in unmarried families

INTRODUCTION

Coparenting in unmarried families is a protective factor for positive adolescent adjustment. Although the relations between coparenting and adolescent outcomes have been investigated, it remains unclear whether the specific patterns of maternal and paternal coparenting are associated with adolescent behavioral outcomes.

METHODS

The present study includs a longitudinal cohort of 1143 triads of unmarried parents and their adolescents to examine the associations between different patterns of coparenting and adolescent behavioral problems and delinquency. The data were drawn from the Future of Families and Child Wellbeing Study in the United States. Our study used six waves of publicly available data at children's birth, ages 1, 3, 5, 9, and 15.

RESULTS

The latent profile analyses identified four coparenting profiles of maternal and paternal coparenting perceived by the other unmarried parent. Comparing average levels of coparenting between mothers and fathers, the profiles were entitled Low Mom-Low Dad, High Mom-Medium Dad, Low Mom-Medium Dad, and High Mom-High Dad. Parents characteristics, such as cohabitation and marital status, predicted the likelihood of being in cooperative coparenting profiles. Furthermore, all the identified coparenting profiles predicted adolescent externalizing behavioral problems; only the high mom cooperative coparenting profiles predicted adolescent internalizing behavioral problems; none of the coparenting profiles predicted adolescent delinquency.

CONCLUSIONS

Our study adds empirical evidence for coparenting research by revealing that coparenting patterns vary in unmarried families and that cooperative coparenting benefits child behavioral outcomes. The findings encourage introducing different coparenting training programs targeting unmarried parents' diverse needs, thus promoting positive adolescent adjustment.

Stability in health behavior patterns in middle adulthood: a 19-year follow-up study

Objective: This study investigated subgroups of adults with particular health behavior patterns, their stability over 19 years, and the role of sociodemographic and personality characteristics in these.

Methods and Measures: Data on smoking, alcohol consumption, and physical activity were collected at ages 42, 50, and 61 in the Jyväskylä Longitudinal Study of Personality and Social Development (n = 205-302). Latent class, latent transition, and logistic regression analyses were used.

Results: Four similar classes of health behaviors were identified at each age. A class named low alcohol consumption (AC)-high physical activity (PA) included individuals with the lowest levels of alcohol consumption and the highest levels of physical activity, and a class named high AC-low PA vice versa. Classes between these extremes of alcohol consumption and physical activity levels were nonsmokers with the lowest proportion of smokers, and smokers vice versa. Although transitions emerged, class memberships were relatively stable. Women, those who were married, held a degree, had higher occupational status, and certain personality traits at age 42 were more likely to belong continuously to healthier classes compared to a stable membership in high AC-low PA.

Conclusion: Health behaviors exist in patterns, are relatively stable across adulthood, and associated with sociodemographic and personality characteristics.

Understanding Household Dynamics From the Ground Up: A Longitudinal Study From a Rural South African Setting

Investigations into household structure in low- and middle-income countries (LMICs) provide important insight into how families manage domestic life in response to resource allocation and caregiving needs during periods of rapid sociopolitical and health-related challenges. Recent evidence on household structure in many LMICs contrasts with long-standing viewpoints of worldwide convergence to a Western nuclearized household model. Here, we adopt a household-centered theoretical and methodological framework to investigate longitudinal patterns and dynamics of household structure in a rural South African setting during a period of high AIDS-related mortality and socioeconomic change. Data come from the Agincourt Health and Socio-Demographic Surveillance System (2003-2015). Using latent transition models, we derived six distinct household types by examining conditional interdependency between household heads' characteristics, members' age composition, and migration status. More than half of households were characterized by their complex and multigenerational profiles, with considerable within-typology variation in household size and dependency structure. Transition analyses showed stability of household types under female headship, while higher proportions of nuclearized household types dissolved over time. Household dissolution was closely linked to prior mortality experiences-particularly, following death of a male head. Our findings highlight the need to better conceptualize and contextualize household changes across populations and over time.

Environment profiles, social participation patterns, depressive symptoms and quality of life of disabled older adults: a longitudinal investigation

OBJECTIVES

This study used the World Health Organization's healthy ageing framework to explore longitudinal influences of environment profiles and social participation (SP) patterns on depressive symptoms (DSs) and on quality of life (QOL).

METHODS

Data were collected from a sample of community-dwelling older adults in Taiwan in 2018 (T1; N = 1,314) and a follow-up survey in 2020 (T2; N = 831). Latent class analysis was conducted to obtain environment and SP profiles. Multilevel modeling was carried out to explicate the hypothesized associations.

RESULTS

Three unique environment profiles, labeled as Highly- (Highly-FE), Moderately- (Moderately-FE) and Weakly-Facilitative Environment (Weakly-FE), were identified from T1 data. The three SP classes that were obtained from T1 and T2 data denoted High-, Moderate- and Low-SP. Participants in the 'Highly-FE' class were more likely to belong to the 'High-SP' and 'Moderate-SP' subgroups and exhibited significantly fewer DSs and better QOL. The associations were confirmed both cross-sectionally and longitudinally.

CONCLUSION

Interventions should be developed to promote or maintain preferred SP to maximize the current and future mental health and subjective well-being of disabled older adults.

Longitudinal profile of post-traumatic symptoms in HealthCare Workers during COVID-19 pandemic: A latent transition model

INTRODUCTION

Pandemics have the potential to be considered traumatic event, increasing the risk of developing post-traumatic stress symptoms (PTSS) in HealthCare Workers (HCW). However, few longitudinal studies have evaluated the impact of prolonged exposure to the risk imposed by COVID-19. Our aim was to identify subgroups of HCW with profiles of PTSS, how this profile changed during the pandemic and which variables were related to these changes.

METHODS

We evaluated the levels of PTSS and psychological distress in a Brazilian HealthCare Workers' sample (n = 1398) in three waves of assessment: from May to June 2020 (Wave 1), December 2020 to February 2021 (Wave 2) and May to August 2021 (Wave 3), using Latent Profile Analysis (LPA) to identify subgroups with different profiles of symptms, and then, Latent Transition Analysis (LTA) was applied to examine changes in symptom profiles over time, including gender, psychiatric diagnosis history, and pandemic-related fears as covariates.

RESULTS

two profiles were identified: high-PTSS profile (Wave 1-23%; Wave 2-64% and Wave 3-73%) and a low-PTSS (Wave 1-77%; Wave 2-36% and Wave 3-27%). Being female, fear of contamination, and fearing financial problems were strong predictors of changes in the profile. In addition, the participants had a high probability of being in the high-PTSS in the long run.

CONCLUSION

These results suggests that targeted interventions can mitigate the impact of pandemic. Providing financial support, and psychological support can be beneficial for those with psychiatric diagnoses and experiencing bereavement.

Longitudinal patterns of lifestyle risk behaviours among UK adults with established cardiovascular disease: a latent transition analysis

Background

People with cardiovascular disease (CVD) need to engage in healthy lifestyle behaviours. However, there is a gap in identifying longitudinal patterns of change in lifestyle behaviours among people with CVD. This study aimed to identify clustering of lifestyle risk behaviours and their 4 ± year changes among UK adults with CVD, and to determine the associated factors.

Methods

We used the UK Biobank data collected at two time points (2006-2010/baseline data = T0 and 2014+/third visit data = T4). Six key lifestyle risk behaviours were assessed: smoking, high alcohol intake, poor fruit and vegetable consumption, physical inactivity, poor sleep balance (<7 or >8 h/night) and prolonged sitting. A random intercept latent transition analysis was performed to identify patterns of lifestyle risk behaviours at T0 and their changes from T0 to T4.

Results

We included 5,304 participants with CVD whose data on lifestyle risk behaviours were collected at two-time points. Alcohol intake and current smoking were 75.7% and 5.4% at baseline, respectively, and 67.4% and 3.0% at follow-up. Three latent classes emerged: Latent class (LC) 1-"high alcohol intake, poor sleep balance and poor fruit and vegetable intake", LC2-"high alcohol intake and poor fruit and vegetable intake", and LC3-"high alcohol intake". Most adults remained in the same LC over the 4 + years (range: 83.9%-100.0%). After 4 + years, 3.5% from LC3 and 10.4% from LC2 at baseline moved into LC1. The odds of transitioning to LC2 relative to staying in LC1 and LC3 were 2.22 and 4.13 times higher for males than for females, respectively. A single-year increase in participants' age was associated with a 1.16 times increase in the odds of moving to LC1 relative to staying in LC2.

Conclusion

People with CVD did not show improvement in lifestyle risk behaviours, and interventions targeting multiple lifestyle risk behaviours are needed to improve CVD.

Identifying hostile versus paternalistic classism profiles: a person-based approach to the study of ambivalent classism

Research on ambivalent classism suggests that individuals can manifest classism not only in a hostile and explicit manner but also in a condescending and paternalistic form. However, researchers have not determined the existence of individual profiles or population subgroups that show this ambivalence pattern. Therefore, to assess the existence of different profiles based on their manifestation of ambivalent classism, we carry out a latent profile analysis with a national representative sample (N = 1536). We identify different classist profiles among the population, including a minority of individuals who score low on both dimensions of classism (low generalized classists, 8.65%) and another minority who score high on both hostile and paternalism classism (high generalized classists, 8.13%). Further, we discovered that most of the population adhered to a moderated classism profile, endorsing both dimensions of classism (moderately generalized classist, 40.95%) or to an ambivalent profile, scoring low in hostile classism and high in paternalistic attitudes (paternalistic classists, 42.25%). The likelihood of adhering to the different profiles seems to be related to the individual’s level of education and system justification beliefs. Those individuals who score higher on system justification and with lower educational attainment are more willing to be highly generalized classists rather than be part of other profiles. Profiles also differ to an extent regarding concerns about economic inequality and social attitudes, with moderate and highly generalized classists being less concerned about economic inequality and less willing to support poor groups. We discuss the implications for developing targeted interventions aimed to confront classism patterns for each profile.

Contraceptive Behavior Dynamics and Unintended Pregnancy: A Latent Transition Analysis

The average U.S. woman wants to have two children; to do so, she will spend about three years pregnant, postpartum, or trying to become pregnant, and three decades trying to avoid pregnancy. However, few studies have examined individual patterns of contraceptive use over time. These trajectories are important to understand given the high rate of unintended pregnancy and how little we know about the complex relationship between contraceptive use, pregnancy intention, and patterns of reproductive behavior. We use data from the 2015-2017 National Survey of Family Growth to examine reproductive behavior and pregnancies across three years of calendar data. We identify seven behavior typologies, their prevalence, how women transition between them, and how pregnancies affect transitions. At any given time, half of women are reliably using contraception. A small proportion belong to a high pregnancy risk profile of transient contraceptive users, but some transition to using condoms or other methods consistently. An unintended pregnancy may initiate a transition into stable contraceptive use for some women, although that is primarily condom use. These findings have important implications for the ways contraception fits into women's lives and how that behavior interacts with relationships, sex, and life stage trajectories.

Latent Transitions of Learning Interests among Kindergarteners in Hakka Bilingual Teaching Programs

The profiles of kindergarteners' learning interests in Hakka bilingual teaching programs are unclear and the effects of these programs on the transition of such interests over the long term are under investigation. This study analyzed the learning interest profiles of 112 kindergarteners (data gathered by kindergarten teachers) enrolled in immersion/non-immersion Hakka bilingual programs in Taiwan. Latent transitions in these profiles were analyzed based on pre- and post-implementation data. The results showed that two different subgroups were identified based on the kindergarteners' learning interest profiles before and after the implementation of the Hakka bilingual program. The pre-implementation subgroups contained the "moderate situational and low-to-moderate individual interest" and the "high situational and moderate-to-high individual interest" profiles. Post-implementation subgroups consisting of "moderate-to-high situational and moderate individual interest" and "high situational and individual interest" profiles were identified. Moreover, four patterns of transition in the kindergarteners' learning interest profiles were uncovered: (1) a slight increase in both learning interests, (2) a significant increase in both learning interests, (3) a slight regression in both, and (4) a maintenance of situational interest coupled with a slight increase in individual interest. Lastly, the non-immersion Hakka program showed significant and more positive effects on the "moderate situational and low-to-moderate individual interest" profile subgroup compared to the equivalent group from the Hakka immersion program. These results provide new evidence complementing previous findings reached via different analytical approaches and contribute to the overall conclusion that bilingual programs improve learning outcomes.

Longitudinal Assessment of Multimorbidity Medication Patterns among Smokers in the COPDGene Cohort

Background and objectives: Chronic obstructive pulmonary disease (COPD) is usually comorbid with other chronic diseases. We aimed to assess the multimorbidity medication patterns and explore if the patterns are similar for phase 1 (P1) and 5-year follow-up phase 2 (P2) in the COPDGene cohort. Materials and Methods: A total of 5564 out of 10,198 smokers from the COPDGene cohort who completed 2 visits, P1 and P2 visits, with complete medication use history were included in the study. We conducted latent class analysis (LCA) among the 27 categories of chronic disease medications, excluding COPD treatments and cancer medications at P1 and P2 separately. The best number of LCA classes was determined through both statistical fit and interpretation of the patterns. Results: We found four classes of medication patterns at both phases. LCA showed that both phases shared similar characteristics in their medication patterns: LC0: low medication; LC1: hypertension (HTN) or cardiovascular disease (CVD)+high cholesterol (Hychol) medication predominant; LC2: HTN/CVD+type 2 diabetes (T2D) +Hychol medication predominant; LC3: Hychol medication predominant. Conclusions: We found similar multimorbidity medication patterns among smokers at P1 and P2 in the COPDGene cohort, which provides an understanding of how multimorbidity medication clustered and how different chronic diseases combine in smokers.

Variable patterns of daily activity participation across settings in autistic youth: A latent profile transition analysis

LAY ABSTRACT

What people do or engage in in their daily lives, or daily life participation, is often linked to their state of being happy and healthy, as well as potential for living independently. To date, little research has been conducted on daily activity participation by autistic youth at home, at school or in the community. Learning more about individual differences in participation levels and what might influence them can help to create custom supports for autistic youth and their families. In this study, 158 caregivers of autistic youth were asked how often their children took part in 25 common activities at two assessments, about one year apart. The analysis showed three profiles for each of the home and school settings and two profiles for the community setting. These profiles reflected distinct patterns in how often autistic youth took part in various daily activities, particularly in doing homework, school club activities and community gatherings. Most autistic youth were in profiles marked by often taking part at home but less often at school and in the community, and about three-fourths of them tended to stay in the same profile over time. Autistic youth with limited participation profiles were more likely to have lower scores on measures of cognitive ability and daily life skills and more challenging behaviour, and faced more barriers in their environment. These findings show how important it is to think about each autistic person's strengths and weaknesses, and changing needs, to better support their daily life participation.

Stability and Change in Men's Intimate Partner Violence and Substance Use in Early Adulthood

Despite substantial evidence of the role of substance use in intimate partner violence (IPV), little is known about the impact of substance use on stability and change in the experience of IPV as both a perpetrator and a victim. Using an ethnically diverse sample of 232 men in early adulthood (mean age = 29.1, SD = 0.91), this study defined typologies of IPV based on men's reports of both perpetration and victimization; examined the potential impact of substance use, including alcohol and marijuana use, on IPV typologies over two measurement occasions; and quantified stability and change in these typologies over time. Patterns of IPV were characterized by three classes at each time point: no IPV, psychological aggression, and physical aggression. Men's regular marijuana use was associated with physical aggression contemporaneously and prospectively. Partner's problem alcohol use was associated with psychological aggression contemporaneously, suggesting that women's problem alcohol use could be a risk factor for their own and their partner's IPV perpetration. IPV appeared to remain somewhat stable over time with 67% of men remaining in the same IPV class. Among those who did transition from one typology to another, it was most often to a less severe IPV typology. Regular marijuana users were more likely to be in the physical aggression typology rather than the no IPV typology, with a higher probability of transitioning to a more severe IPV typology than nonusers. The present study has implications for prevention and intervention efforts by its ability to identify men who are at greatest risk for continued or increased violence and underscores that men's marijuana use may exacerbate IPV.

Continuity versus change in latent profiles of emotion regulation and working memory during adolescence

Significant structural and functional brain development occurs during early adolescence. These changes underlie developments in central neurocognitive processes such as working memory (WM) and emotion regulation (ER). The preponderance of studies modeling trajectories of adolescent brain development use variable-centered approaches, omitting attention to individual differences that may undergird neurobiological embedding of early life stress and attendant psychopathology. This preregistered, data-driven study used latent transition analysis (LTA) to identify (1) latent profiles of neural function during a WM and implicit ER task, (2) transitions in profiles across 24 months, and 3) associations between transitions, parental support, and subsequent psychopathology. Using two waves of data from the ABCD Study (Mage T1 = 10; Mage T2 = 12), we found three unique profiles of neural function at both T1 and T2. The Typical, Emotion Hypo-response, and Emotion-Hyper response profiles were characterized by, respectively: moderate amygdala activation and fusiform deactivation; high ACC, fusiform, and insula deactivation; and high amygdala, ACC, and insula response to ER. While 69.5 % remained in the Typical profile from T1 to T2, 27.8 % of the sample moved from one profile at T1 to another at T2. However, neither latent profiles nor transitions exhibited associations between parental support or psychopathology symptoms.

Latent transition analysis in organizational psychology: A simplified “how to” guide by using an applied example

Demands for more robust designs in organizational research have led to a steady increase in the number of longitudinal studies in organizational psychology (OP) journals. Similarly, the number and ways to analyze longitudinal data have also increased. In this paper, we adopt a relatively new and promising approach to help researchers analyze their longitudinal data in OP, namely latent transition analysis (LTA). We present a simplified guideline on LTA and discuss its role for OP researchers. Moreover, we demonstrate how organizational scholars can use this method with a practical example. In this example, we investigate (a) if there are qualitatively distinct subgroups of employees based on particular patterns of psychological capital (PsyCap) dimensions (i.e., efficacy, hope, resilience, and optimism), (b) if employees stay in these subgroups or transition to other groups over time, and finally, (c) if leader-member exchange (LMX) is associated with this transition. We use LTA to examine these steps in a German sample (N = 180).

Stability and Changes in Traditional and Cyberbullying Perpetration and Victimization in Childhood: The Predictive Role of Depressive Symptoms

Childhood bullying is a public health concern. The stability and changes in children's bullying profiles should provide useful information about specific risk groups and their developmental patterns. The current longitudinal study examined the stability and changes in bullying involvement in children along with the predictive roles of depressive symptoms in bullying subgroup memberships and transitions. A total of 4,321 Chinese children (55.1% male, M_age = 9.93) participated in self-report assessments at three time points with six-month intervals. Bullying subgroups were identified based on physical, relational, and cyberbullying using latent profile analysis. The transitions patterns were modeled using latent transition analysis. Depressive symptoms were added as a covariate in bullying subgroup memberships and transitions. Five bullying subgroups were found at Time 1 and Time 2: traditional bully-victims, traditional victims, (cyber) bully-victims, (cyber) victims, and noninvolved children, whereas four bullying subgroups were found at Time 3: traditional bully-victims, traditional victims, (cyber) bully-victims, and noninvolved children. Findings suggested that (a) childhood bullying involvement showed varying levels of stability, with noninvolved children displaying the most stability and cyberbullying-involved children displaying the least stability; (b) children reporting more severe depressive symptoms manifested a higher risk of bullying involvement; (c) initially noninvolved children showing depressive symptoms were at a higher risk for becoming traditional victims; and (d) children reporting depressive symptoms found it more difficult to escape from bullying than children without depressive symptoms. The findings offer support for both the cumulative continuity and interactional models of development. The findings also highlight the important the role of depressive symptoms in preventing and ameliorating children's bullying.

Gendered difference in motivational profiles, achievement, and STEM aspiration of elementary school students

To better understand the gender gap in science, technology, engineering and math (STEM) aspiration, the article examines the critical role of domain-specific motivation (i.e., expectancy and task values). Using longitudinal data from 5th and 6th grade (∼11–12-year-old) students (n = 360, 55% girls), person-oriented analyses was applied to understand the gendered motivational profiles and their longitudinal influence on achievement and STEM aspiration. Specifically, we aimed to (1) derive motivational belief profiles regarding science, mathematics, and language (Finnish), (2) analyze the stability and change in the profiles between the 5th and 6th grade, (3) assess the relationship between motivational profiles and achievement and STEM aspiration, and (4) test for gender differences. We derived four motivational profiles for both years: high motivation in all subjects (∼21%), high mathematics motivation (∼46%), low mathematics motivation (∼11%), and low motivation in all subjects (∼8%). Latent transition analysis revealed that most students remained in the same profile throughout the 2 years. We found evidence of gendered differences in the motivational profiles and the chance of transitioning between profiles. More girls are characterized by low math motivation, while boys are more likely to transition to higher math motivation in 6th grade. The motivational difference is reflected in their achievement, although not strongly coupled with their STEM aspiration. The findings suggest that at this developmental stage, Finnish students have not developed a strong association between (gendered) STEM aspiration and their domain-specific motivation, although their motivation may have influenced their achievement. Interpretation and practical implications are discussed.

Longitudinal Patterns of Material Hardship among US Families

Material hardship has emerged as a direct measure of deprivation in the United States and an important complement to income poverty, providing different evidence about the ways in which deprivation may affect wellbeing. This study addresses gaps in our knowledge about deprivation as the first to examine patterns of material hardship over time. Using data from the Fragile Families and Child Well-Being Study, this study examined five material hardship types (food, housing, medical, utility, and bill-paying) experienced at five timepoints over 15 years. Employing latent class analysis and latent transition analysis, this study identified six longitudinal patterns of material hardship experience, characterized by trajectories of stability or movement and relative severity of material hardship experience over time. These findings improve our conceptual understanding of deprivation and move us towards understanding the impacts of material hardship on wellbeing and identifying policy approaches to prevent deprivation or mitigate negative consequences.

Hypertension and Diabetes Status by Patterns of Stress in Older Adults From the US Health and Retirement Study: A Latent Class Analysis

Background

Hypertension and diabetes disproportionately affect older non‐Hispanic Black and Hispanic adults in the United States. Chronic stress may partially explain these disparities. This study identified underlying stress profiles of older US adults, analyzed stress profiles in relation to hypertension and diabetes, examined the distribution of stress profiles by race and ethnicity, and assessed patterns of change in latent classes of stress over time.

Methods and Results

Latent class analysis was conducted with a nationally representative sample of older US adults who completed 3 waves of the HRS (Health and Retirement Study) (ie, 2010 [n=6863], 2014 [n=4995], and 2018 [n=3089]). Latent classes of stress in 2010 (ie, stress profiles) were identified using 15 indicators of unmet needs within 5 categories (ie, physiological, safety/security, belonging, esteem, and self‐fulfillment). Hypertension and diabetes status were examined as outcomes of latent class membership at 3 time points, and race and ethnicity were examined in association with class membership, adjusting for sociodemographic covariates. Finally, a latent transition analysis examined the stability of latent class membership and racial and ethnic differences in the patterns of stress profiles experienced from 2010 to 2018. Five classes were identified: Generally Unmet Needs (13% of sample), Generally Met Needs (42% of sample), Unmet Self‐Efficacy/Goal Needs (12% of sample), Unmet Financial Needs (20% of sample), and Unmet Social Belonging Needs (13% of sample). Compared with the Generally Met Needs class, the Generally Unmet Needs class had higher odds of hypertension (odds ratio [OR], 1.80; [95% CI, 1.35–2.39]) and diabetes (OR, 1.94; [95% CI, 1.45–2.59]), and the Unmet Financial Needs class had higher odds of diabetes (OR, 1.50; [95% CI, 1.10–2.05]). Non‐Hispanic Black participants compared with non‐Hispanic White participants had higher odds of being members of the Generally Unmet Needs, Unmet Self‐Efficacy/Goal Needs, and Unmet Financial Needs classes (OR, 2.70; [95% CI, 1.59–4.58]; OR, 1.99; [95% CI, 1.15–3.43]; and OR, 4.74; [95% CI, 3.32–6.76], respectively). Class membership remained relatively stable over time, with 93% of participants remaining in Generally Met Needs and 78% of participants remaining in Generally Unmet Needs across time points. Compared with non‐Hispanic White participants, non‐Hispanic Black participants had lower odds of Generally Met Needs class membership at any time point (OR, 0.60; [95% CI, 0.42–0.84]) and had lower odds of moving into the Generally Met Needs class and higher odds of moving into the Unmet Financial Needs class from 2010 to 2014 (OR, 0.33; [95% CI, 0.13–0.86]; and OR, 3.02; [95% CI, 1.16–7.87], respectively).

Conclusions

Underlying classes of stress based on unmet needs were associated with hypertension and diabetes status. Racial and ethnic differences were observed for both latent class membership and transitions between classes over time. Latent classes of stress associated with unmet needs, hypertension, and diabetes and the ability to transition between classes may explain the perpetuation of racial and ethnic disparities in cardiovascular health. Interventions targeting unmet needs may be used to confront these disparities.

Change in suicidal ideation and associated factors among young adults in Hong Kong from 2018 to 2019: a latent transition analysis

PURPOSE

Suicide in young adulthood is a vital public health concern. There have been few systematic studies that examined the prevalence and transition of suicidal ideation classes in young adults and the factors associated with the transition.

METHODS

This two-wave survey recruited 1269 young adults (Mean age = 24.0 years, 70.1% males) in Hong Kong. The participants completed the Suicidal Ideation Attributes Scale, Chinese Health Questionnaire, and help-seeking behaviors in 2018 and 2019. Latent profile analysis was used to classify the participants into latent classes of suicidal ideation with substantive checking under the 3-step approach. Latent transition analysis with measurement invariance examined the transition among the latent classes from 2018 to 2019 and the associations with help-seeking behaviors and change in psychological distress.

RESULTS

Three latent classes of suicidal ideation were identified and over two-thirds of the participants belonged to the Low-risk class with minimal suicidal ideation. The prevalence of the High-risk class dropped from 10.2 to 7.2%, while that of the Moderate-risk class remained stable from 2018 to 2019. Increases in psychological distress predicted higher probabilities to remain at or transit into more risky classes. Engagement in help-seeking behaviors showed differential transitions in suicidal ideation across time.

CONCLUSION

The findings suggest three latent classes of suicidal ideation with distinct profiles among the young adults. Deterioration in psychological distress showed a temporal effect on worsening of suicidal ideation over a 1-year period. Future studies should elucidate the comparative effectiveness of help-seeking behaviors via online and offline channels.

A Latent Transition Analysis of Youth Bullying Victimization Patterns over Time and Their Relations to Delinquency

Peer victimization patterns from elementary school transitioning into late middle school have not been assessed in detail. Even less work has considered how these patterns differ across family context and then are linked to delinquency in adolescence. This study used longitudinal data (n = 2,892) from the Fragile Families and Child Wellbeing Study to examine peer victimization classification and change over six years while distinguishing across sex and family contexts. Latent transition analysis (LTA) shows that youth can be classified into minor victimization, mainly verbal victimization, and all-type victimization subgroups over time with some sex differences, regardless of whether they were in two-parent families. The majority of the youth were in either the mainly verbal victimization (53% for boys; 42% for girls) or all-type victimization (12% for boys; 21% for girls) statuses when they were about 9 years old, but substantial transition positioned most boys (84%) and girls (82%) in the minor victimization status instead when they were about 15 years old. Youth who were Hispanic, in two-parent families, and more open to parents had a reduced risk of peer victimization, but youth who were in a poor family had an increased risk of peer victimization. Peer victimization statuses were significantly associated with youth delinquency, and there were sex and time differences in the association. In year 9, 45% to 94% of boys and 24% to 75% of girls were involved in delinquency based on their victimization statuses, but the difference was 48% to 67% for boys and 39% to 59% for girls in year 15. The findings suggest developing and implementing peer victimization prevention starting from early elementary school, concurrently addressing peer victimization and delinquency, and paying close attention to sex and family context differences.

Polysubstance use and re-incarceration in the 12-months after release from jail: a latent transition analysis of rural Appalachian women

BACKGROUND

Rural areas have high rates of opioid and stimulant involved polysubstance use which are known to contribute to overdose. Justice-involved women are likely to have multiple substance use disorders and are particularly vulnerable in rural areas where treatment is limited.

OBJECTIVES

The research had three aims to (1) identify the patterns of polysubstance use of rural Appalachian justice-involved women, (2) examine how women's engagement in polysubstance use changed in the 12-months following initial release from jail, and (3) determine if women's changes in substance use patterns were associated with re-incarceration during the 12-months of post-release follow-up.

METHODS

A total of 339 women with recent substance use histories were randomly recruited from three rural jails. Latent transition analysis of women's substance use from baseline (in jail) to 6 and 12-months was examined, including the effect of re-incarceration on transitions (changes in substance use patterns).

RESULTS

Three latent classes were found: High Polysubstance/injection drug use (IDU) (36.3% baseline), Opioid/Benzo (Benzodiazepine) Involved Polysubstance Use (57.3% baseline), and Low Use (6.4% baseline). Polysubstance use classes were characterized by use of opioids and benzodiazepines; the High Polysubstance/IDU class was distinct in co-use and injection use of methamphetamine. Post-release, women transitioned to latent classes of reduced substance use and/or reduced injection drug use, particularly in the first six months. Women who were re-incarcerated during follow-up were likely to remain engaged in, or transition to, the High Polysubstance/IDU class (ORs: 3.14-46.56).

CONCLUSION

Justice-involved women in Appalachia reported risky polysubstance use. The first six-months post-release were a critical period for changes in substance use.

Transitions in Social Network Types over Time among Older Adults

OBJECTIVE

Network typology studies have identified heterogeneous types of older adults' social networks. However, little is known about stability and change in social network types over time. We investigate transitions in social network types among older adults, aged 60 years and older, and factors associated with such transitions.

METHODS

We used data on 1,305 older adults, participating in 2 waves of a national, longitudinal survey, conducted in 2016-2017 and 2019, in Singapore. Latent transition analysis identified the distinct types of social networks and their transition patterns between the waves. Multinomial logistic regression examined the association of baseline and change in physical, functional, and mental health and baseline sociodemographic characteristics with network transitions into more diverse or less diverse types.

RESULTS

We found 5 social network types at both waves, representing the most to the least diverse types - diverse, unmarried and diverse, extended family, immediate family, and restricted. Between waves, about 57% of respondents retained their social network type, whereas 24% transitioned into more diverse types and 19% into less diverse types. Those who were older and less educated and those with worsening functional and mental health were more likely to transition into less diverse types versus remaining in the same type.

DISCUSSION

The findings capture the dynamics in social network composition among older adults in the contemporary aging society. We highlight sociodemographic and health disparities contributing to later life social network diversity.

Conceptualizing and Measuring Appetite Self-Regulation Phenotypes and Trajectories in Childhood: A Review of Person-Centered Strategies

This review uses person-centered research and data analysis strategies to discuss the conceptualization and measurement of appetite self-regulation (ASR) phenotypes and trajectories in childhood (from infancy to about ages 6 or 7 years). Research that is person-centered provides strategies that increase the possibilities for investigating ASR phenotypes. We first examine the utility of examining underlying phenotypes using latent profile/class analysis drawing on cross-sectional data. The use of trajectory analysis to investigate developmental change is then discussed, with attention to phenotypes using trajectories of individual behaviors as well as phenotypes based on multi-trajectory modeling. Data analysis strategies and measurement approaches from recent examples of these person-centered approaches to the conceptualization and investigation of appetite self-regulation and its development in childhood are examined. Where relevant, examples from older children as well as developmental, clinical and educational psychology are drawn on to discuss when and how person-centered approaches can be used. We argue that there is scope to incorporate recent advances in biological and psychoneurological knowledge about appetite self-regulation as well as fundamental processes in the development of general self-regulation to enhance the examination of phenotypes and their trajectories across childhood (and beyond). The discussion and conclusion suggest directions for future research and highlight the potential of person-centered approaches to progress knowledge about the development of appetite self-regulation in childhood.

The experience of physiological and psychosocial alcohol-related harms across adolescence and its association with alcohol use disorder in early adulthood: A prospective cohort study

BACKGROUND

Different forms of alcohol-related harm (e.g., hangovers, fighting) may confer differential risk of clinically relevant alcohol problems. We examine: (i) patterns of transition in experiencing alcohol-related harms across adolescence; (ii) whether factors in early adolescence predict transition patterns; and (iii) whether transition patterns predict later alcohol use disorder (AUD) symptoms.

METHODS

We used a longitudinal Australian cohort (n = 1828) to model latent class transition patterns of alcohol-related harms across three timepoints (M_age  = 13.9, 16.8, 18.8 years). Regression models assessed whether child, peer, and parent factors in early adolescence (M_age  = 12.9) predicted harms transition patterns and whether these patterns predicted AUD symptoms in early adulthood (M_age  = 19.8).

RESULTS

Five transition patterns characterized most of the cohort (n ≈ 1609, 88.0%): (i) minimal harms (n ≈ 381, 20.8%); (ii) late physiological harms (n ≈ 702, 38.4%); (iii) early physiological harms (n ≈ 226, 12.4%); (iv) late all harms (n ≈ 131, 7.2%); and (v) gradual all harms (n ≈ 169, 9.2%). With late physiological harms as the reference, females had increased risk of experiencing early physiological harms (relative risk [RR]: 2.15; 99.5% CI: 1.19, 3.90). Late all harms (RR: 1.71; CI: 1.19, 2.47) and gradual all harms (RR: 1.84; CI: 1.37, 2.47) were each associated with increased odds of meeting criteria for AUD, even when patterns of alcohol consumption are considered.

CONCLUSIONS

Adolescents display heterogeneous transition patterns across physiological and psychosocial alcohol-related harms. Females are at greater risk of experiencing early physiological harms. Experience of both physiological and psychosocial harms in late adolescence is an important and potentially modifiable precursor to clinically relevant alcohol problems in early adulthood.

Transitions between social network profiles and their relation with all-cause mortality among older adults

BACKGROUND

The importance of social network in mortality among older adults has been acknowledged. However, existing studies typically overlook the interplay among social network indicators, and seldom consider the change in social network over time. We take a person-centered approach to identify transitions between social network profiles, and examine the linkage of such transitions with subsequent mortality risk.

METHODS

Data came from 2738 older Singaporeans enrolled in a longitudinal study. Latent transition analysis examined nine social network indicators assessed at two time points, two years apart to reveal the corresponding transitions between social network profiles. Adjusted Cox regression then associated the identified transitions with all-cause mortality risk in the subsequent four years.

RESULTS

We observed three diverse social network profiles (that featured diversified social interaction and involved both household and non-household members) and three relatively restricted social network profiles (that focused on household or non-household members). Compared to sustained diverse profiles over time, sustained restricted profiles or a transition from diverse to restricted profiles entailed increased mortality risk. The mortality risk following a restricted-to-diverse profile transition could be as low as that associated with sustained diverse profiles.

CONCLUSIONS

Dynamics of social network profiles have implications for mortality risk in later life. To promote longevity, initiatives are needed to help older people to maintain or shift to diverse social network profiles.

Changes in depressive symptoms and cognitive impairment in older long-stay nursing home residents in the USA: a latent transition analysis

OBJECTIVES

To longitudinally examine the latent statuses of depressive symptoms and their association with cognitive impairment in older U.S. nursing home (NH) residents.

METHOD

Using Minimum Data Set 3.0, newly-admitted, long-stay, older NH residents with depression in 2014 were identified (n = 88,532). Depressive symptoms (Patient Health Questionnaire-9) and cognitive impairment (Brief Interview of Mental Status) were measured at admission and 90 days. Latent transition analysis was used to examine the prevalence of and the transition between latent statuses of depressive symptoms from admission to 90 days, and the association of cognitive impairment with the statuses at admission.

RESULTS

Four latent statuses of depressive symptoms were identified: 'Multiple Symptoms' (prevalence at admission: 17.3%; 90 days: 13.6%), 'Depressed mood' (20.0%; 19.5%), 'Fatigue' (27.4%; 25.7%), and 'Minimal Symptoms' (35.3%; 41.2%). Most residents remained in the same status from admission to 90 days. Compared to residents who were cognitively intact, those with moderate impairment were more likely to be in 'Multiple Symptoms' and 'Fatigue' statuses; those with severe impairment had lower odds of belonging to 'Multiple Symptoms', 'Depressed Mood', and 'Fatigue' statuses.

CONCLUSION

By addressing the longitudinal changes in the heterogeneous depressive symptoms and the role of cognitive impairment, findings have implications for depression management in older NH residents.

Infection-exposure in infancy is associated with reduced allergy-related disease in later childhood in a Ugandan cohort

Background

Lack of early infection-exposure has been associated with increased allergy-related disease (ARD) susceptibility. In tropical Africa, little is known about which infections contribute to development of ARDs, and at which time.

Methods

We used latent class analysis to characterise the early infection-exposure of participants in a Ugandan birth cohort and assessed ARDs in later childhood.

Results

Of 2345 live births, 2115 children (90%) had data on infections within the first year of life while 1179 (50%) had outcome data at 9 years. We identified two latent classes of children based on first-year infection-exposure. Class 1 (32% membership), characterised by higher probabilities for malaria (80%), diarrhoea (76%), and lower respiratory tract infections (LRTI) (22%), was associated with lower prevalence of wheeze, eczema, rhinitis, and Dermatophagoides skin prick test (SPT) positivity at 9 years. Based on 5-year cumulative infection experience, class 1 (31% membership), characterised by higher probabilities for helminths (92%), malaria (79%), and LRTI (45%), was associated with lower probabilities of SPT positivity at 9 years.

Conclusions

In this Ugandan birth cohort, early childhood infection-exposure, notably to malaria, helminths, LRTI, and diarrhoea, is associated with lower prevalence of atopy and ARDs in later childhood.

Funding

This work was supported by several funding sources. The Entebbe Mother and Baby Study (EMaBS) was supported by the Wellcome Trust, UK, senior fellowships for AME (grant numbers 064693, 079110, 95778) with additional support from the UK Medical Research Council. LL is supported by a PhD fellowship through the DELTAS Africa Initiative SSACAB (grant number 107754). ELW received funding from MRC Grant Reference MR/K012126/1. SAL was supported by the PANDORA-ID-NET Consortium (EDCTP Reg/Grant RIA2016E-1609). HM was supported by the Wellcome's Institutional Strategic Support Fund (grant number 204928/Z/16/Z).

Longitudinal analysis of symptom-based clustering in patients with primary Sjogren's syndrome: a prospective cohort study with a 5-year follow-up period

BACKGROUND

Sjogren's syndrome (SS) is a heterogenous disease with various phenotypes. We aimed to provide a relevant subclassification based on symptom-based clustering for patients with primary (p) SS.

METHODS

Data from patients in a prospective pSS cohort in Korea were analysed. Latent class analysis (LCA) was performed using patient reported outcomes, including pain, fatigue, dryness, and anxiety/depression. Clinical and laboratory differences between the classes were analysed. Latent transition analysis (LTA) was applied to the longitudinal data (annually for up to 5 years) to assess temporal stability of the classifications.

RESULTS

LCA identified three classes among 341 patients with pSS (i.e., 'high symptom burden', 'dryness dominant', 'low symptom burden'). Each group had distinct laboratory and clinical phenotypes. LTA revealed that class membership remained stable over time. Baseline class predicted future salivary gland function and damage accrual represented by a Sjogren's syndrome disease damage index.

CONCLUSION

Symptom-based clustering of heterogenous patients with primary Sjogren's syndrome provided a relevant classification supported by temporal stability over time and distinct phenotypes between the classes. This clustering strategy may provide more homogenous groups of pSS patients for novel treatment development and predict future phenotypic evolvement.

Heterogeneity in Longitudinal Healthcare Utilisation by Older Adults: A Latent Transition Analysis of the Irish Longitudinal Study on Ageing

Background

Older adults likely exhibit considerable differences in healthcare need and usage. Identifying differences in healthcare utilisation both between and within individuals over time may support future service development.

Objectives

To characterise temporal changes in healthcare utilisation among a nationally representative sample of community-dwelling older adults.

Methods

A latent transition analysis of the first three waves of The Irish Longitudinal Study on Ageing (TILDA) (N = 6128) was conducted.

Results

Three latent classes of healthcare utilisation were identified, ‘primary care only’; ‘primary care and outpatient visits’ and ‘multiple utilisation’. The classes were invariant across all three waves. Transition probabilities indicated dynamic changes over time, particularly for the ‘primary care and outpatient visits’ and ‘multiple utilisation’ statuses.

Discussion

Older adults exhibit temporal changes in healthcare utilisation which may reflect changes in healthcare need and disease progression. Further research is required to identify the factors which influence movement between healthcare utilisation patterns.

Can Policy Promote Adoption or Outcomes of Evidence-based Prevention Programming?: a Case Illustration of Positive Behavioral Interventions and Supports

This study examined the impact of a state policy requiring that any school with a habitual truancy rate of 8% or higher to be trained in Tier 1 school-wide Positive Behavioral Interventions and Supports (SW-PBIS). A regression discontinuity (RD) design was used to examine how the schools' mandate status related to SW-PBIS training as well as student suspensions, truancy, and achievement in 410 public middle and high schools, of which 261 were affected by the mandate. We further examined the growth trajectories (i.e., improvement) of implementation fidelity over time using growth mixture modeling (GMM). Contrary to the intent of the policy to improve student outcomes, the RD results suggested that the mandate did not significantly impact reading and math achievement, truancy rates, or SW-PBIS training in 2010-2011 through 2013-2014. Mandated schools had higher suspension rates in 2010-2011 through 2013-2014 than the non-mandated schools; however, these differences in the suspension rates appear to have persisted from years prior to the mandate. Descriptive analyses suggested that mandated schools had statistically significantly higher rates of training, and the GMM analyses on the fidelity data indicated that mandated schools were significantly more likely to be in an improving implementation growth trajectory over time. Taken together, results suggested that the policy showed some promise for improving SW-PBIS training and fidelity over time, but it had little to no impact on student outcomes.

Multimorbidity patterns and their related characteristics in European older adults: A longitudinal perspective

BACKGROUND

The concurrence of several chronic conditions is a rising concern that poses a serious burden on ageing populations. Analysing how these conditions appear together and how they change through time may provide useful information to design successful multimorbidity-management programs.

OBJECTIVE

To identify multimorbidity patterns and their related characteristics from a longitudinal perspective.

SUBJECTS

25,931 older adults aged 50+ drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE), a population-based longitudinal European study.

METHODS

A sex-stratified Latent Transition Analysis was conducted to fit latent classes based on 15 self-reported chronic conditions across three time points. Health-related and socioeconomic variables were assessed as covariates of those patterns.

RESULTS

We identified 4 time-constant latent classes for each sex. A "severely impaired" class (with a weighted prevalence percentage of 7.24% for females and 3.30% for males at the first time point), a "metabolic" class (26.15% and 23.82%) and a "healthy" class (50.92% and 54.32%). The fourth class was named "osteoarticular" for females (15.70%) and "articular-COPD-ulcer" for males (18.56%). Age, smoke, material deprivation and a high body mass index were associated with worse health patterns, whereas education, being employed and physical activity were related to less multimorbid classes. Few class changes were detected when modelling transitions.

CONCLUSIONS

We reported information of multimorbidity classes and their characteristics that may help to develop targeted health strategies. Within a time window of four years, the identified latent classes were consistent between time points.

Deconstructing bullying roles: A longitudinal latent profile analysis of bullying participant behaviors for students in grades 4 through 12

Bullying behavior is understood as a complex social phenomenon that includes many, and sometimes overlapping, bullying participant behaviors. The current study utilized latent profile analysis (LPA) at two time points approximately one year apart and examined what bullying participant behavior groups emerged based on students' reported levels of bullying, assisting, victimization, defending, and outsider behavior. Additionally, longitudinal latent profile analyses (LLPA) were utilized to examine potential changes in groups over time. Results suggested four groups found at two timepoints: (a) Uninvolved-Occasional Defending, with defending at a monthly rate and infrequent engagement in other behaviors; (b) Frequent Defending-Occasional Victimization, with monthly victimization and weekly defending behaviors; (c) Frequent Victimization-Occasional Broad Involvement, with weekly levels of victimization and monthly bullying, defending, and outsider behaviors; and (d) Frequent Broad Involvement, with weekly engagement in all of the bully participant behaviors (i.e., bullying, assisting, victimization, defending, and outsider behavior). The largest proportion of students (more than half) were in the Uninvolved-Occasional Defending group, which was also the most stable group over time. The smallest group (7%) was Frequent Broad Involvement, which was the least stable group over time, with students in this group typically moving to groups with at least occasional broad involvement of bullying participant behaviors. More male students than female students were in both broad involvement groups (i.e., Frequent Victimization-Occasional Broad Involvement; Frequent Broad Involvement) and more female students than male students, as well as more elementary students than secondary students, were in the Frequent Defending-Occasional Victimization group. The current study suggests that researchers should use caution when categorizing or conceptualizing simple bullying participant roles such as bully or victim, or even "bully-victim," especially if the other bullying participant behaviors are not assessed. Practitioners should develop interventions that capitalize on the high proportions of students engaging in some level of defending and account for the complex social ecology that suggests that students are engaging in complex overlapping patterns of bullying participant behaviors.

Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals

BACKGROUND

The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include "implementing appropriate infection prevention and control" and "appropriate use of antimicrobials," which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship.

METHODS

We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses.

RESULTS

The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses.

CONCLUSIONS

Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.

Appetite self-regulation declines across childhood while general self-regulation improves: A narrative review of the origins and development of appetite self-regulation

This narrative review discusses the origins and development of appetite self-regulation (ASR) in childhood (from infancy to age 6 or 7 years). The origins, or foundations, are the biological infrastructure associated with appetite regulation and appetite self-regulation. Homeostatic regulation in infancy is examined and then evidence about developmental change in components of ASR. The main ASR-related components covered are: delay-of-gratification, caloric compensation, eating in the absence of hunger, food responsiveness/hedonics and fussy eating. The research included behavioral measures, parent-reports of appetitive traits and fMRI studies. There were two main trends in the evidence: a decline across childhood in the components of ASR associated with food approach (and therefore an increase in disinhibited eating), and wide individual differences. The decline in ASR contrasts with general self-regulation (GSR) where the evidence is of an improvement across childhood. For many children, bottom-up automatic reactive processes via food reward/hedonics or food avoidance as in fussy eating, appear not to be matched by improvements in top-down regulatory capacities. The prominence of bottom-up processes in ASR could be the main factor in possible differences in developmental paths for GSR and ASR. GSR research is situated in developmental science with its focus on developmental processes, theory and methodology. In contrast, the development of ASR at present does not have a strong developmental tradition to access and there is no unifying model of ASR and its development. We concluded (1) outside of mean-level or normative changes in the components of ASR, individual differences are prominent, and (2) there is a need to formulate models of developmental change in ASR together with appropriate measurement, research designs and data analysis strategies.

Patterns of substance use before and after hospitalization among patients seen by an inpatient addiction consult service: A latent transition analysis

BACKGROUND AND AIMS

Polysubstance use is common and contributes to morbidity and mortality of hospitalized patients, and yet little is known about patterns of substance use among hospitalized patients, or how an addiction consult service (ACS) might impact polysubstance use after discharge. The objective of this study was to identify patterns of substance use at admission and after discharge among hospitalized patients with substance use disorders who saw an ACS.

DESIGN

Prospective cohort study. We used latent transition analysis of substance use scores at the time of hospital admission and 30 to 90 days posthospitalization.

SETTING

Single, academic health center with an ACS in Portland, Oregon, from 2015 to 2018.

PARTICIPANTS/CASES

Patients were eligible if they received a consult to the inpatient ACS.

MEASUREMENTS

We used Addiction Severity Index-Lite scores to capture self-reported substance use at baseline and follow-up for heroin, other opioid, alcohol, amphetamine, and cocaine.

FINDINGS

From 2015 to 2018, 486 individuals consented to participate. More than half of patients used more than one substance at baseline. Of those reporting any baseline opioid use, nearly three-quarters (n=187, 69.5%) had polysubstance use in the previous 30 days, including alcohol (n=80, 29.7%), cocaine (n=25, 9.3%), or amphetamine use (n=142, 52.8%). We identified three patterns of substance use at baseline: 1) alcohol use dominant, 2) polysubstance use dominant, and 3) heroin and other opioid use dominant. Patients transitioned along five trajectories to three different follow-up profiles that showed lower endorsement of all substances used. Slightly more than 40% (40.1%) of patients newly endorsed abstinence of at least one substance at follow-up.

CONCLUSIONS

Polysubstance use is common in hospitalized patients with substance use disorders and identifying patterns of polysubstance use can guide clinical management. Hospital providers should prepare to manage polysubstance use during hospitalization and hospitals should broaden care beyond interventions for opioid use disorder.

Trajectory Modelling Techniques Useful to Epidemiological Research: A Comparative Narrative Review of Approaches

Trajectory modelling techniques have been developed to determine subgroups within a given population and are increasingly used to better understand intra- and inter-individual variability in health outcome patterns over time. The objectives of this narrative review are to explore various trajectory modelling approaches useful to epidemiological research and give an overview of their applications and differences. Guidance for reporting on the results of trajectory modelling is also covered. Trajectory modelling techniques reviewed include latent class modelling approaches, ie, growth mixture modelling (GMM), group-based trajectory modelling (GBTM), latent class analysis (LCA), and latent transition analysis (LTA). A parallel is drawn to other individual-centered statistical approaches such as cluster analysis (CA) and sequence analysis (SA). Depending on the research question and type of data, a number of approaches can be used for trajectory modelling of health outcomes measured in longitudinal studies. However, the various terms to designate latent class modelling approaches (GMM, GBTM, LTA, LCA) are used inconsistently and often interchangeably in the available scientific literature. Improved consistency in the terminology and reporting guidelines have the potential to increase researchers' efficiency when it comes to choosing the most appropriate technique that best suits their research questions.

Continuity and change in anger and aggressiveness from infancy to childhood: The protective effects of positive parenting

Early signs of anger and aggression can be identified in infancy. Our aim was to use person-centered methods to identify which infants were most at risk for clinically significant behavioral problems by age 3 and diagnoses of ODD/CD by 7 years, while considering the role of family risk factors and positive parenting. A representative British community sample of 304 infants was assessed by multiple informants at mean ages of 6, 21, and 36 months of age. Latent Transition Analysis (LTA) identified three ordered subgroups at each age, with one subgroup (18%) displaying high levels of physical force as well as anger. These angry aggressive infants were at elevated risk for behavioral problems in early childhood and diagnoses of conduct disorder (CD) and/or oppositional defiant disorder (ODD) at 7 years of age. After other risk factors were taken into account, parents' beliefs in warm parenting and their observed positive affect while interacting with their infants were protective factors. These findings indicate the significance of very early manifestations of angry aggressiveness and have relevance for developmental theories of aggression and prevention strategies.

Predictors and Changes in Paternal Perinatal Depression Profiles-Insights From the DREAM Study

In contrast to the large body of research on maternal perinatal depression, paternal perinatal mental health has received little attention; and longitudinal studies on paternal perinatal depression, following (expectant) fathers over time, are exceedingly rare. This population-based study aimed to (1) estimate prevalence rates of perinatal depression symptoms among German (expectant) fathers, (2) identify differential profiles of perinatal depression in (expectant) fathers, (3) determine modifiable predictors of latent depression profiles, and (4) estimate how membership in subgroups changes during the perinatal period. Data were derived from the longitudinal cohort study DREAM (Dresden Study on Parenting, Work, and Mental Health), including 1,027 (expectant) fathers responding to the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy and 8 weeks postpartum. Unobserved profiles of paternal perinatal depression and movement between profiles were investigated using latent transition analysis. A number of potential predictors with regard to lifestyle and current life situation were included as covariates. We found that rates of paternal depression symptoms decreased with 9% during pregnancy to 5% at 8 weeks postpartum. Further, four latent depression profiles emerged: most (expectant) fathers did not exhibit any depression symptoms (not depressed), whereas some reported mainly the absence of joy (anhedonic) and some experienced mainly self-blame and worries (anxious-worried). The depressive profile was characterized by endorsement to most symptoms of perinatal depression. Perceived social support and relationship satisfaction appeared to be protective against paternal depression symptoms. Differential transitioning or stability patterns in profile membership during the perinatal period were found, whereas the depressive profile showed to be the least stable. This prospective population-based cohort study is the first study to identify paternal perinatal depression profiles together with their predictors and changes during the perinatal period. Future research is warranted to examine whether the identified paternal depression profiles have differential outcomes, particularly in the context of person-centered prevention and intervention strategies. Further, longitudinal trajectories of paternal depression ought to be studied, taking into account additional measurement points as well as modifiable risk factors.