A Daily Diary Study of the Relation between Stress and Nonsuicidal Self-Injury and the Moderating Role of Emotion Dysregulation in Emerging Adulthood

Research on exposure to stressors and nonsuicidal self-injury (NSSI) in daily life has been lacking, particularly among emerging adults (aged 18-25 years). The aim of this study was to determine whether daily stressors predicted same-day and next-day NSSI thoughts and engagement, and whether emotion dysregulation moderated this relation. Participants included 160 emerging adults (83% female, Mage = 19.75, SD = 1.8, 44% White, 22% East Asian, 11% South Asian, and 23% other) who completed a baseline assessment and 14 days of daily diary entries which resulted in 1982 daily assessments (median compliance = 86%; IQR = 12-14). It was found that daily stressors significantly predicted same-day, but not next-day, NSSI thoughts and engagement and this relation was more pronounced for individuals with greater emotion dysregulation. The present study provides new insight into when individuals may be most at risk for NSSI, as well as which individuals may be most vulnerable.

Youth cannabis use in Canada post-legalization: service providers' perceptions, practices, and recommendations

BACKGROUND

In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16-24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use.

METHODS

This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16-24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis.

RESULTS

The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services.

CONCLUSION

Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.

Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers

BACKGROUND

Canadian youth (aged 16-24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers.

METHODS

This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data.

RESULTS

The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) "The biggest barrier in accessing mental health support is where to look," (2) "There's always going to be a waitlist," (3) "I have to have money to be healthy," (4) "They weren't really listening to my issues," (5) "Having more of a welcoming and inclusive system," and (6) "Health laws aren't doing what they need to do."

CONCLUSION

Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.

Optimists and Realists: A Latent Class Analysis of Students Graduating from High School during COVID-19 and Impacts on Affect and Well-Being

The Novel Coronavirus Disease (COVID-19) pandemic has had profound effects on physical and mental health worldwide. Students transitioning out of high school were uniquely impacted at the onset of the pandemic, having missed the opportunity to properly mark the end of their final year in the K-12 school system. The adverse effects of this loss on this population are still unknown. The purpose of the current study was to examine stress, wellbeing, and affect in a sample of 168 students (N = 168; Mage = 17.0, SD = 0.46; 60% female; 40% male) who were completing their final year of high school during the early stages of the pandemic when emergency stay-at-home orders were in place. Participants completed an online survey assessing the impact of COVID-19 on their life satisfaction (pre-COVID19, during COVID-19, and anticipated five years from now), stress, positive affect, and negative affect. Latent class analysis (LCA) was used to create classes of participants based on their responses to the pandemic. A two-subgroup solution provided the best model for the life satisfaction outcome variable. Subgroup 1, optimists, comprised 24% (N = 40) of the sample and reported high life satisfaction ratings one year prior to COVID-19 and a slight decrease in life satisfaction during COVID-19, and they anticipated an increase in life satisfaction 5 years from now. This group was characterized by low stress, low negative affect, and high positive affect during the pandemic. Subgroup 2, realists, comprised 76% of the population (N = 128) and experienced similarly high retrospective ratings of pre-COVID life satisfaction but a larger decrease in life satisfaction during the pandemic and a smaller increase in five years. The realist group was characterized by low positive affect, high stress, and high negative affect during the pandemic. The findings suggest that during the pandemic, certain subsamples of adolescents had greater difficulty in managing this transitional period and experienced changes in mood and well-being (i.e., affect, stress) as compared to other adolescents (i.e., optimists). Future research should investigate the characteristics and coping mechanisms that are instrumental for increasing life satisfaction and positive affect while lowering stress in this population.

Dynamics of daily positive and negative affect and relations to anxiety and depression symptoms in a transdiagnostic clinical sample

BACKGROUND

Despite interest in transdiagnostic dimensional approaches to psychopathology, little is known about the dynamic interplay of affecting and internalizing symptoms that cut across diverse mental health disorders. We examined within-person reciprocal effects of negative and positive affect (NA, PA) and symptoms (depression and anxiety), and their between-person associations with affective dynamics (i.e., affect inertia).

METHODS

Individuals currently receiving treatment for psychological disorders (N = 776) completed daily assessments of affect and symptoms across 14 treatment days (average). We used dynamic structural equation modeling to examine daily affect-symptom dynamics.

RESULTS

Within-person results indicated NA-symptom reciprocal effects; PA only predicted subsequent depression symptoms. After accounting for changes in mean symptoms and affect over time, NA-anxiety and PA-depression relations remained particularly robust. Between-person correlations indicated NA inertia was positively associated with NA-symptom effects; PA inertia was negatively associated with PA-symptoms effects.

CONCLUSIONS

Results suggest that transdiagnostic affective treatment approaches may be more useful for reducing internalizing symptoms by decreasing NA compared to increasing PA. Individual differences in resistance to shifting out of affective states (i.e., high NA vs. PA inertia) may be a useful marker for developing tailored interventions.

Dynamics of parental criticism and emerging adult emotional functioning: Associations with depression

Perceived parental criticism is an important measure of the family emotional environment, linked to a variety of psychological difficulties in emerging adults (EAs) and traditionally assessed at a single timepoint. Our study is the first to examine perceived parental criticism as a dynamic construct that fluctuates and interacts with emerging adult (EA) affect across daily life. EAs (N = 141; ages 18-22; M_age = 19.94, 84.5% women) completed a measure of baseline depression symptoms and daily assessments of perceived parental criticism, anger, anxiety, shame, sadness, and happiness across 30 days. Within-person results revealed that previous day perceived parental criticism predicted subsequent day EA anger (but not vice versa). This cross-lagged association only emerged for anger and not other emotions. Additionally, depression moderated this association, with higher depression symptoms increasing the strength of the association. Between-person results revealed that parental criticism was positively associated with mean/trait anger, anxiety, shame, sadness, but not happiness, as well as affect reactivity (innovation variance) for anger. Associations with affect inertia were not significant. Together, these findings suggest parental criticism is more strongly related to negative than positive emotions, is proximally associated with anger in particular, especially among EAs with increased depression, and may be related to aspects of emotion dysregulation. Family interventions aiming to target negative emotionality in EAs should focus on mitigating criticism or educating parents on the importance of considering psychological health such as depression symptomology when providing critical feedback to minimize heightened negative affect or decrease the likelihood of emotional dysfunction in EAs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Qualitative Investigation of the Positive and Negative Impacts of the COVID-19 Pandemic on Post-Secondary Students' Mental Health and Well-Being

Evidence suggests that post-secondary students without pre-existing mental health concerns may have experienced worsening mental health during the COVID-19 pandemic, relative to students with pre-existing mental health concerns. To clarify the psychological impacts of the pandemic, and elucidate why differences may exist among students, 20 interviews were conducted with emerging adults enrolled in university. Using directed content analysis, eight themes were identified: three more common among students with pre-existing mental health concerns, three more common among students without pre-existing mental health concerns, and two shared. Although all students experienced novel stressors during the pandemic, students without pre-existing mental health concerns reported greater increases in social and academic isolation, relative to students with pre-existing mental health concerns. Students with pre-existing mental health concerns also leveraged existing coping repertoires, which further supported their ability to manage pandemic-related challenges. Findings highlight how postsecondary institutions can bolster student well-being.

eTEP inferior access with tailored retromuscular dissection for small to mid-sized umbilical hernia repair with or without inguinal hernia: early experience

INTRODUCTION

The minimally invasive surgical repair of combined inguinal and ventral hernias often requires shifting from one approach or plane to another. The traditional enhanced-view totally extraperitoneal Rives-Stoppa repair consists of a large retro muscular dissection that is unjustified for small ventral hernias. Here we describe a modification to the minimally invasive Rives-Stoppa repair using a limited retro muscular dissection based on the ventral defect size for small/medium-sized hernias, with or without combined inguinal hernias.

METHODS

From a single surgical team, a retrospective study was performed over a 1-year period. Demographics, hernia characteristics, surgical techniques, intraoperative/postoperative complications, and outcomes were all analyzed and reported. We also included detailed surgical steps, landmarks, pitfalls, and personal tips for this technique.

RESULTS

Twenty-four patients underwent a laparoscopic limited retromuscular dissection ventral hernia repair utilizing the eTEP access technique. Eighteen were primary umbilical hernias and six postoperative incisional hernias, and nine were combined ventral and inguinal hernia repairs. Eight of the primary umbilical hernias were EHS classified as medium size, 11 small, and for the incisional hernias, three were classified as M3W1 and two as M3W2. One procedure was converted to TAPP. There were no intraoperative complications. The mean length of stay was 1.25 days (range 1-3). There was one postoperative retromuscular hematoma and no recurrence during the follow-up period.

CONCLUSION

eTEP with limited dissection offers a good and safe solution for small to medium size hernias; it provides an efficient solution when an inguinal hernia is to be addressed as well.

Navigating inequities in the delivery of youth mental health care during the COVID-19 pandemic: perspectives of youth, families, and service providers

OBJECTIVES

There have been concerns about the adverse effects of the COVID-19 pandemic on Canadian youth (aged 16-24) as they have the highest rates of mental health concerns. The objectives of the present study were to explore the experiences of youth with mental health and/or addiction concerns and their families during the pandemic, and to examine how adequate and equitable mental health services have been for youth and families from the perspectives of youth, parents, and service providers.

METHODS

Using a descriptive qualitative research design and a university-community partnership, we conducted individual interviews with youth, parents, and service providers. The study involved a total of 25 participants (n=15 service users, n=10 service providers). Among the service users, 11 participants were parents and four were youth. We used thematic analysis to analyze interview data.

RESULTS

The thematic analysis identified three themes in the data: (1) youth mental health concerns have increased, whereas supports have decreased, (2) families end up being the treatment team with increased burden, little support, and lack of recognition, and (3) inadequate and inequitable mental health services for youth and families are amplified during the pandemic.

CONCLUSION

At a time when mental health needs were higher, the mental health care system offered less support to youth and their families. For a more equitable response to the pandemic, we need an accessible and integrated mental health care system that shows a commitment to addressing social determinants and reducing health disparities and inequities in access to mental health services.

Stressful Experiences in University Predict Non-suicidal Self-Injury Through Emotional Reactivity

Theoretical perspectives on non-suicidal self-injury (NSSI; direct and deliberate self-injury without lethal intent such as self-cutting or hitting) have long underscored the affective regulating properties of NSSI. Less attention has been given to the processes through which individuals choose to engage in NSSI, specifically, to regulate their distress. In the present study, we tested one theoretical model in which recent stressful experiences facilitates NSSI through emotional reactivity. Further, we tested whether the indirect link between stressful experiences and NSSI was moderated by several NSSI specific risk factors (e.g., having friends who engage in NSSI). Given the widespread prevalence of NSSI among community-based samples of adolescents and emerging adults, we surveyed 1,125 emerging adults in first-year university at a large academic institution (72% female, Mage = 17.96, 25% with a recent history of NSSI at Time 1). Participants completed an online survey three times (assessments were 4 months apart), reporting on their recent stressful experiences in university, emotional reactivity, NSSI, as well as three NSSI specific risk factors (i.e., close friend engagement in NSSI, high self-disgust, and low fear of pain). As expected, path analysis revealed that there was a significant indirect effect of recent stressful experiences on NSSI engagement, through emotional reactivity. However, this effect was maintained across moderator analyses. These novel findings underscore the salient role of proximally occurring stressors in the prediction of NSSI among emerging adults in university, and can inform developing theoretical perspectives on NSSI.

Exploring the Relationship Between ADHD Symptoms and Daily Cannabis Consequences in Emerging Adulthood: The Role of Cannabis Motives

OBJECTIVE

Research has documented the relationship between attention-deficit/hyperactivity disorder (ADHD) and increased cannabis use, but the studies largely rely on cross-sectional or longitudinal designs. Few studies have examined the impact of recent (i.e., past 6 months) ADHD symptoms on more proximal cannabis-related factors. The purpose of the current study was to examine the relationship between cannabis use motives (coping, boredom, and sleep) and consequences and the impact of ADHD symptoms on these relationships.

METHOD

Participants were 62 emerging adults (ages 19-25 years; M = 22.12, SD = 2.07; 60% male) who used cannabis regularly (two or more times in the past 2 weeks) and completed a screener assessing past-6-months ADHD symptoms at baseline followed by 14 daily reports on cannabis use, consequences, and motives.

RESULTS

Across the 14 days, cannabis consequences were higher for participants with greater past-6-months symptoms of ADHD. In addition, on days when participants used cannabis for boredom and on days when they used cannabis for sleep, cannabis consequences were higher. Although greater past-6-months ADHD symptoms were associated with more consequences on days when sleep motives were endorsed, contrary to hypotheses, the strength of this relationship was greater on days when sleep motives were not endorsed. Overall, greater daily consequences for those with higher ADHD symptoms may reflect exacerbation of these symptoms, and follow-up analyses revealed that the cannabis consequences associated with higher ADHD scores were indeed ones that overlap with ADHD symptoms.

CONCLUSIONS

The results suggest that ADHD symptoms, along with sleep and boredom motives, contribute to increased daily cannabis consequences and should be considered in developing interventions for emerging adults.

Retrospective and prospective assessments of gambling-related behaviors across the female menstrual cycle

BACKGROUND AND AIMS

Despite increases in female gambling, little research investigates female-specific factors affecting gambling behavior (GB). Although research suggests that some addictive behaviors may fluctuate across menstrual cycle phase (MCP), gambling requires further investigation. In two studies, we examined associations between MCP and three risky GBs: time spent gambling, money spent gambling, and the probability of consuming alcohol while gambling. Associations between MCP and negative affect were also examined in Study 2. We predicted that, consistent with self-medication theory, increases in negative affect (Study 2) and risky GBs (Studies 1 and 2) would occur premenstrually/menstrually relative to other phases.

METHODS

Data were obtained from 33 female gamblers using a retrospective timeline followback procedure (Study 1) and from 20 female gamblers using a prospective 32-day, daily diary method (Study 2). In Study 2, salivary progesterone levels verified self-reported MCP validity.

RESULTS

Findings revealed significant, but somewhat inconsistent, MCP effects on GBs across studies. The self-medication hypothesis was partially supported. Increases relative to another MCP(s) were found for alcohol consumption while gambling premenstrually, time spent gambling menstrually/premenstrually, money spent gambling menstrually, and negative affect premenstrually. Unexpectedly, findings more consistently indicated that GBs increased during ovulation, suggestive of enhanced reward sensitivity. Progesterone assays validated self-reported MCP (Study 2).

DISCUSSION AND CONCLUSIONS

The results suggest a role of ovarian hormones on negative affect and GBs in females. This research could lead to the identification of female-specific factors affecting gambling and the development of more effective interventions for females with, or at risk for, problematic gambling.

Solitary gambling mediates the risk pathway from anxiety sensitivity to excessive gambling: Evidence from a longitudinal ecological momentary assessment study

Anxiety and gambling problems co-occur at high rates. Social learning theory (SLT) suggests that people high in anxiety engage in excessive gambling to reduce negative affect. Because anxiety sensitivity (AS) is a vulnerability factor associated with addictive behaviors, it is important to identify mediators in this high-risk pathway. Emerging research shows that social context mediates associations between anxiety vulnerability and addictive behaviors. This literature shows that anxiety-prone people are at increased risk for substance problems because they engage in frequent solitary substance use. Theory would predict a similar pathway to gambling problems, but this remains to be tested. Accordingly, this study aimed to examine solitary gambling as an explanatory variable in the anxiety pathway to gambling problems. We used a longitudinal ecological momentary assessment (EMA) design. After completing baseline measures, young adults (N = 108) were asked to report daily on their gambling behavior over a 30-day period. Bias corrected bootstrapped confidence intervals (CI) supported 1 hypothesized indirect effect from baseline AS (Time 1) to EMA time spent gambling (Time 2) via EMA solitary gambling (Time 2; B = 0.019, 95% CI [0.002, 0.045]). This suggests that emerging adults with high levels of AS at baseline engaged in frequent solitary gambling over the 30-day EMA sampling period, which in turn predicted more time spent gambling over this same time period. Our results show that solitary gambling mediates the relation between anxiety vulnerability and excessive gambling. Understanding how social context relates to excessive gambling can help create interventions to reduce solitary gambling among anxiety-prone individuals. (PsycINFO Database Record

ACTUALITIES IN ENDOCRINOLOGY- PARATHYROID IMAGING

Parathyroid imaging modalities have been used to guide clinicians and surgeons in finding the source of hyperparathyroidism for over 40 years. Primary hyperparathyroidism (PHPT) is generally caused by a parathyroid gland(s) autonomous production of parathyroid hormone (PTH), associated by enlargement of one or more glands. Noninvasive imaging procedures that are used in the management of hyperparathyroidism are anatomical (ultrasound, computer tomography, magnetic resonance imaging) and/or functional (nuclear medicine techniques: planar scintigraphy, single photon emission tomography, positron emission imaging) and/or hybrid imaging.

Intimate partner violence-related hospitalizations in Appalachia and the non-Appalachian United States

The highly rural region of Appalachia faces considerable socioeconomic disadvantage and health disparities that are recognized risk factors for intimate partner violence (IPV). The objective of this study was to estimate the rate of IPV-related hospitalizations in Appalachia and the non-Appalachian United States for 2007–2011 and compare hospitalizations in each region by clinical and sociodemographic factors. Data on IPV-related hospitalizations were extracted from the State Inpatient Databases, which are part of the Healthcare Cost and Utilization Project. Hospitalization day, year, in-hospital mortality, length of stay, average and total hospital charges, sex, age, payer, urban-rural location, income, diagnoses and procedures were compared between Appalachian and non-Appalachian counties. Poisson regression models were constructed to test differences in the rate of IPV-related hospitalizations between both regions. From 2007–2011, there were 7,385 hospitalizations related to IPV, with one-third (2,645) occurring in Appalachia. After adjusting for age and rurality, Appalachian counties had a 22% higher hospitalization rate than non-Appalachian counties (ARR = 1.22, 95% CI: 1.14–1.31). Appalachian residents may be at increased risk for IPV and associated conditions. Exploring disparities in healthcare utilization and costs associated with IPV in Appalachia is critical for the development of programs to effectively target the needs of this population.

Childhood sexual abuse, sexual motives, and adolescent sexual risk-taking among males and females receiving child welfare services

Childhood sexual abuse (CSA) is associated with multiple negative outcomes, including increased risky sexual behavior. To date, the majority of research on the relationship between CSA and risky sex in adolescence has been limited, with a lack of focus on males and youth receiving child welfare services. Participants in the current study were 297 youth (mean age=15.98; SD=1.01, 57.6% female) from the child welfare system who reported being sexually active at the time of the survey. CSA was associated with severity of other types of maltreatment for both genders, and exposure to intimate partner violence for females only. In general, males engaged in more sexual risk behaviors than females. Males with CSA had stronger motives to have sex for: (1) coping, (2) peer approval and (3) partner approval, as compared to non-CSA males; as well as (4) greater motives for partner and peer approval compared to females with CSA. Males with no CSA had stronger sexual motives for enhancement (e.g., feeling pleasure) compared to females with no CSA. Mediation analyses revealed a significant indirect effect for coping motives for males: CSA was associated with increased motives to use sex for coping which was associated with increased sexual risk-taking. These findings provide important information regarding the relationship between CSA and sexual risk-taking for child welfare sample and highlight coping with negative affect as a potential mechanism that underlies the CSA-risky sex relationship. It also encourages further consideration of motives for risk and resilience behaviors among youth.

Mood, motives, and money: An examination of factors that differentiate online and non-online young adult gamblers

Background and aims To date, there is a lack of research on psychological factors associated with young adult online gambling. The current study examined differences between young adult online and non-online gamblers, using information gathered at baseline and over 30 days during which participants reported on their moods, gambling behaviors, and reasons for initiating and discontinuing gambling. Methods Participants were 108 young adult regular gamblers (i.e., gambling four or more times in the past month) who participated in a 30-day daily diary study. Results Male gender, baseline coping motives for gambling and negative affect averaged across the 30 days emerged as significant correlates of online gambling, over and above other background variables. Online gamblers also scored higher on a baseline measure of pathological gambling. Over the 30 days of self-monitoring, online gamblers spent more time gambling, and won more money gambling, whereas non-online gamblers consumed more alcohol while gambling. Online gambling was more often initiated to make money, because of boredom and to demonstrate skills, whereas non-online gambling was more often initiated for social reasons and for excitement. Online gambling was more often discontinued because of boredom, fatigue or distress, whereas non-online gambling was discontinued because friends stopped gambling or mood was improved. Discussion and conclusions This study provides preliminary evidence that coping strategies may be particularly important to reduce risks for online gamblers, whereas strategies for non-online gamblers should focus on the social aspects of gambling.

Pathways from childhood maltreatment to emerging adulthood: investigating trauma-mediated substance use and dating violence outcomes among child protective services-involved youth

Longitudinal survey data were used to examine the relationship between two types of childhood maltreatment, abuse/neglect and exposure to intimate partner violence (IPV), and two outcomes, substance use and dating violence, within the past year. Participants were youth (N = 158, aged 16-19 at Time 3) involved with child protective services (CPS). A parallel multiple mediator model was used to test the hypothesis that trauma symptoms would mediate the relationship between both types of maltreatment and dating violence, marijuana, and alcohol use outcomes. Although both types of maltreatment were not directly associated with dating violence and substance use outcomes, the indirect effects of anxiety, anger, and dissociation on the relationship between maltreatment and substance use/dating violence were significant. Direct effects of both types of maltreatment on past year use of dating violence + alcohol use and dating violence + marijuana use were not significant, but results demonstrated a significant indirect effect for anger on the relationship between exposure to IPV and past year dating violence + marijuana use. No other indirect effects were significant. Findings highlight the negative effects of exposure to IPV and have implications for the development of prevention programming for youth transitioning out of CPS.

Child maltreatment and marijuana problems in young adults: examining the role of motives and emotion dysregulation

It is well established that childhood maltreatment is an important predictor of marijuana use, but few studies have examined the mechanisms underlying this relationship. The current study examines marijuana motives as mediators of the relationship between childhood maltreatment and marijuana use in a sample of young adults. In addition, pathways from childhood maltreatment to emotion dysregulation, coping motives, and marijuana use were explored. Participants were 125 young adults (ages 19-25, 66.9% female) recruited through online community advertising. All participants completed questionnaires assessing childhood maltreatment, emotion dysregulation, marijuana motives, past year and past three-month marijuana use, and marijuana problems. Correlational analyses revealed bivariate relationships between childhood maltreatment, emotion dysregulation, marijuana motives and marijuana problems (rs=.24-.50). Mediation analyses revealed that coping motives mediated the relationship between childhood maltreatment and marijuana problems, and emotion dysregulation was associated with marijuana problems both directly and indirectly via coping motives. The present findings highlight emotion dysregulation and coping motives as important underlying mechanisms in the relationship between childhood maltreatment and marijuana problems.

Childhood maltreatment, alcohol use disorders, and treatment utilization in a national sample of emerging adults

OBJECTIVE

The purpose of this study was to examine the relationship between childhood maltreatment and alcohol use disorders (AUDs), treatment utilization, and barriers to treatment in a national sample of emerging adults. Multiple types of maltreatment were examined, including childhood emotional abuse and neglect.

METHOD

The analyses are based on data from 18- to 25-year-olds (N = 4,468) who participated in the National Epidemiologic Survey on Alcohol and Related Conditions.

RESULTS

Adjusted for sociodemographic characteristics, we found that childhood maltreatment was associated with a greater likelihood of an AUD and a greater likelihood of accessing treatment, although these relationships were no longer significant once psychiatric comorbidities and other substance use disorders were included as control variables. We also found significant interaction effects for age; differences in the prevalence of AUDs among those who experienced physical abuse and multiple types of maltreatment were larger for the older age group. Finally, among those with AUDs, maltreatment was associated with specific perceived barriers to treatment.

CONCLUSIONS

The current findings highlight childhood maltreatment, including emotional abuse and neglect, as important correlates of AUDs among emerging adults but indicate that these relationships may be accounted for by other psychiatric comorbidities. Barriers to treatment among individuals with AUDs may reflect maltreatment experiences and should be addressed in both policy and practice.

Mood, motives, and gambling in young adults: an examination of within- and between-person variations using experience sampling

It is well established that young adults are a population at risk for problem gambling and that young adults gamble for various reasons, including positive mood enhancement and negative mood reduction. Although these motives have been identified as important proximal predictors of gambling, the research to date has focused on between-subjects relationships. What is missing is a process-level understanding of the specific within-subjects relations between mood-regulation motives for gambling, mood states, and gambling behaviors. The current study used experience sampling to assess the specific link between gambling motives, mood states, and gambling behavior. Participants were 108 young adults (ages 19-24 years), who completed baseline measures of gambling motives and gambling problems and then reported on their mood states and gambling behavior three times a day for 30 days. Multilevel modeling analyses revealed a significant positive moderating effect for enhancement motives on the relationship between positive mood and amount of time spent gambling and number of drinks consumed while gambling. In addition, problem gambling status was associated with consuming fewer drinks while gambling at higher levels of positive mood, and spending more money than intended at higher levels of negative mood. Unexpectedly, there was only one moderating effect for coping motives on the mood-gambling relationship; low coping motivated gamblers consumed more alcohol while gambling at higher levels of positive mood, whereas high coping motivated gamblers did not change their drinking in response to positive mood. The current findings highlight enhancement motives as risky motives for young adult gambling, particularly in the context of positive mood, and suggest that gambling interventions should include strategies to address positive mood management.

The relationship among internal resilience, smoking, alcohol use, and depression symptoms in emerging adults transitioning out of child welfare

OBJECTIVE

It is well established that child maltreatment reflects a context of risk for multiple negative outcomes. Identifying factors that protect against negative outcomes is important for the development of strengths-based approaches that emphasize resilience, particularly for youth transitioning out of the child welfare system. The current study examined the relationship between an internal resilience measure, the Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003), and several external measures of resilience and behavioral outcomes (tobacco use and dependence, alcohol use and problems, and depression symptoms). In addition, two models of resilience were examined in the context of child maltreatment: a compensatory model and a risk-protection model.

METHODS

Ninety-three emerging adults (ages 18-25) who were making the transition out of child welfare completed self-report measures of child maltreatment, internal resilience (CD-RISC), external resilience (academic achievement, religious and community involvement, monitoring by caregivers, and presence of an adult mentor), alcohol and tobacco use, and depression symptoms.

RESULTS

Internal resilience was significantly associated with involvement in religion and community, and monitoring by caregivers. In addition, internal resilience was negatively associated with past year smoking and nicotine dependence, and with symptoms of depression. Hierarchical regression analyses were conducted to examine the direct and interaction effects of resilience on depression symptoms in the context of child maltreatment. When internal resilience was added to the model, it made a significant contribution to depression scores over and above child maltreatment (physical, sexual, and emotional abuse; emotional neglect). In addition, there was a significant Sexual Abuse×Resilience interaction, wherein high resilience was associated with a reduction in depression scores at higher levels of sexual abuse.

CONCLUSIONS

These findings support internal resilience as both a compensatory and protective factor for depression symptoms in the context of sexual abuse among emerging adults transitioning out of child welfare. Prevention and early intervention within child welfare should include strengthening internal resilience, with continued monitoring of competencies through the transition from adolescence to emerging adulthood.

Cryptogenic stroke in hanging. A case report

This paper reports the unique neuroimaging findings of a 37-year-old woman who attempted suicide by hanging. To our knowledge, this is the first reported case describing neuroimaging findings of unilateral lesions instead of the well-documented bilateral lesions after a hanging event. Computed tomography demonstrated a low density area in the right thalamus and no hemorrhage. 3.0 T Magnetic resonance revealed a hyperintense area on both T2-weighted and FLAIR images on the right thalamus. Diffusion weighted images demonstrated no area of diffusivity restriction. Another smaller lesion with the same signal characteristics was found in the left cerebellum. A second relevant point of this report is the observation that the most probable cause of the documented unilateral lesions was an ischemic-arterial event.

Rates and correlates of violent behaviors among adolescents treated in an urban emergency department

PURPOSE

Violence is a leading cause of death for adolescents in inner-city settings. This article describes violent behaviors in relation to other risk behaviors (e.g., substance use) among adolescents screened in an urban emergency department (ED).

METHODS

Patients aged 14-18 years were approached to self-administer a computerized survey assessing violent behaviors (i.e., physical aggression), substance use (cigarettes, alcohol, marijuana), and weapon carriage.

RESULTS

A total of 1128 adolescents (83.8% participation rate; 45.9% male; 58.0% African-American) were surveyed. In the past year, 75.3% of adolescents reported peer violence, 27.6% reported dating violence, and 23.5% reported carrying a weapon. In the past year, 28.0% drank alcohol, 14.4% binge drank, 5.7% reported alcohol-related fighting, and 36.9% smoked marijuana. Logistic regression analyses predicting violent behaviors were significant. Teens reporting peer violence were more likely to be younger, African-American, on public assistance, carry a weapon, binge drink, and smoke marijuana. Teens reporting dating violence were more likely to be female, African-American, carry a weapon, binge drink, screen positive for alcohol problems, and smoke marijuana. Teens reporting alcohol-related fighting were more likely to carry a weapon, binge drink, screen positive for alcohol problems, and smoke marijuana.

CONCLUSIONS

Adolescents presenting to an urban ED have elevated rates of violent behaviors. Substance use (i.e., binge drinking and smoking marijuana) is an important risk factor for violent behaviors among urban adolescents. Universal screening and intervention protocols to address multiple risk behaviors, including violent behaviors and substance use, may be useful to prevent injury among adolescents presenting to the urban ED.

Correlates of gambling among youth in an inner-city emergency department

Correlates of past year gambling were examined in a diverse sample of 1128 youth ages 14 to 18 (54.1% female, 58.0% African American) presenting to an inner-city emergency department (ED). Overall, 22.5% of the sample reported past-year gambling. Male youth were more likely to gamble than female youth, and African American youth reported higher rates of past-year gambling than non-African American youth. Significant bivariate correlates of gambling included lower academic achievement, being out of school, working more than 20 hours per week, alcohol, cigarette, and marijuana use, alcohol problems, severe dating violence, moderate and severe general violence, and carrying a weapon. When examined simultaneously, being male, African American, out of school, working for pay, alcohol and marijuana use, severe general violence, and carrying a weapon all emerged as significant correlates of past-year gambling, largest amount of money gambled, and gambling frequency. In addition, involvement in severe dating violence was associated with frequency and largest amount gambled. The results suggest that gambling is common among youth in the inner city and is associated with several risk behaviors. The inner-city ED may provide a context for screening and intervention to address multiple risk behaviors. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Personality, alcohol use, and drinking motives: a comparison of independent and combined internal drinking motives groups

It is well-established that coping and enhancement drinking motives predict college student drinking and that personality traits predict drinking motives. Little is known, however, about personality and drinking patterns among individuals who drink for both enhancement and coping reasons. University students in the current study completed questionnaires assessing personality, alcohol use, and drinking motives. Past year drinkers (N=138) were categorized into one of four groups: coping, enhancement, coping + enhancement, and noninternally motivated drinkers. Drinking was lower among noninternally motivated drinkers and higher among coping motivated drinkers; coping + enhancement motivated drinkers reported drinking at levels most consistent with the coping group. Coping motivated drinkers reported higher levels of neuroticism, negative affect, and anxiety sensitivity, and lower levels of positive affect; coping + enhancement motivated drinkers were not significantly different from the other groups on personality traits. Although coping + enhancement motivated drinkers may be at risk for problem drinking, they may be difficult to identify via personality measures.

Brief alcohol intervention in the emergency department: moderators of effectiveness

OBJECTIVE

Prior research supports the effectiveness of brief interventions for reducing alcohol misuse among patients in the emergency department (ED). However, limited information is available regarding the mechanisms of change, which could assist clinicians in streamlining or amplifying these interventions. This article examines moderators of outcomes among ED patients, ages 19 and older, who participated in a randomized controlled trial of a brief intervention for alcohol misuse.

METHOD

Injured patients (N= 4,476) completed a computerized survey; 575 at-risk drinkers were randomly assigned to one of four brief intervention conditions, and 85% were interviewed again at 3-month and 12-month follow-ups.

RESULTS

Regression models using the generalized estimating equations approach examined interaction effects between intervention condition (advice/no advice) and hypothesized moderator variables (stage of change, self-efficacy, acute alcohol use, attribution of injury to alcohol) on alcohol outcomes over time. Overall, participants who reported higher levels of self-efficacy had lower weekly consumption and consequences, whereas those with higher readiness to change had greater weekly consumption and consequences. Furthermore, individuals who attributed their injury to alcohol and received advice had significantly lower levels of average weekly alcohol consumption and less frequent heavy drinking from baseline to 12-month follow-up compared with those who attributed their injury to alcohol but did not receive advice.

CONCLUSIONS

This study provides novel data regarding attribution for alcohol-related injury as an important moderator of change and suggests that highlighting the alcohol/injury connection in brief, ED-based alcohol interventions can augment their effectiveness.

Drinking in conjunction with sexual experiences among at-risk college student drinkers

OBJECTIVE

The primary aim of this article was to examine event-level associations between alcohol use and sexual risk taking across first and repeat oral and vaginal sex encounters among at-risk college student drinkers.

METHOD

Participants (n = 221; 51.1% women) provided information on alcohol consumption, sexual activity, and event-level data on their most recent (repeat and first) experiences with oral and vaginal sex.

RESULTS

Of the total sample, 80.5% reported ever engaging in oral or vaginal sex. Alcohol use was more likely in new, compared with, repeat sexual partnerships. In addition, for recent vaginal sex experiences with a repeat partner, alcohol use was more likely among those who were less committed to the relationship. For new sexual partnerships, regardless of the type of sex experience, knowing the partner for less time was associated with an increased likelihood of drinking. Alcohol use was also associated with fewer discussions of topics pertinent to safe sexual practices. Finally, there was a tendency for drinking in conjunction with a new vaginal sex experience to be associated with a lower likelihood of contraceptive use.

CONCLUSIONS

These findings highlight the need for integrated interventions targeting alcohol use and risky sexual practices among high-risk college students, with a particular focus on alcohol use during new sexual partnerships and the often-overlooked connection between drinking and oral sex experiences.

Gender moderates the relationship between substance-free activity enjoyment and alcohol use

Laboratory research suggests that there is an inverse relationship between substance use and substance-free reinforcement, but the relevance of this relationship to the prevention of human substance abuse remains somewhat unclear. The present study evaluated the relationship between alcohol use and enjoyment from substance-free activities in a sample of college students who had previously completed an alcohol intervention (N = 107; 55% women; 45% men). The authors used a modified 30-day timeline follow-back interview to collect data on enjoyment from specific substance-free activities that occurred in the evening. Regression analyses revealed that there was a negative association between alcohol consumption and substance-free activity enjoyment for women but not for men. Women who reported greater enjoyment on abstinent evenings reported lower past-month alcohol consumption. Greater average enjoyment from substance-free activities was associated with greater motivation to change drinking among men and women. Although further research is required to determine procedures for increasing participation in substance-free activities and to explicate possible gender differences, these results suggest that increasing enjoyable substance-free activities may be an important prevention component.

Violence and substance use as risk factors for depressive symptoms among adolescents in an urban emergency department

Violence and substance use were examined as multiple risk factors for depressive symptoms among 115 adolescents presenting to an urban emergency department. Using a hierarchical multivariate model, significant risk factors for increasing depression symptoms included female gender, increased involvement in substance use and greater exposure to community violence.

"I'll never drink like that again": characteristics of alcohol-related incidents and predictors of motivation to change in college students

OBJECTIVE

Alcohol use and its associated behaviors are among the most common reasons for medical treatment and disciplinary infractions among college students. The purpose of this study was to describe the characteristics of students who had recent serious alcohol-related incidents and to identify predictors of motivation to change alcohol use and heavy drinking in particular, with specific attention to gender.

METHOD

Students (N = 227; 52% female) who had been mandated to attend a session of alcohol education following alcohol-related medical treatment and/or a disciplinary infraction were assessed on their alcohol use, alcohol problems, characteristics of their alcohol-related incident, reactions to the incident, attributions about the incident, and motivation to change drinking and heavy drinking. Path and regression analyses were used to identify the individual and incident-related characteristics that were related to motivation to change.

RESULTS

Perceived aversiveness of the incident was directly and positively related to motivation to change drinking and heavy drinking. Alcohol consumption in the month before the incident and past-year alcohol problems were negatively related to motivation to change heavy drinking, and women were more motivated to change heavy drinking than men. The more students consumed in the incident, the more likely they were to feel responsible for it, and the more responsible they felt about the incident, the greater its aversiveness.

CONCLUSIONS

Individual and incident-related characteristics are both directly and indirectly associated with motivation to change following an alcohol-related incident, and therefore have implications for interventions with college drinkers who have experienced an alcohol-related incident.

Thymosin beta4 promotes angiogenesis, wound healing, and hair follicle development

New blood vessel formation is important in many physiological process, including development, wound repair, and tumor growth. In aged animals, angiogenesis is reduced resulting in poor wound healing. We have identified a novel small molecule, thymosin beta(4), that promotes angiogenesis and wound repair in both normal and aged rodents. It also promotes hair growth in normal and aged rodents. It acts by increasing angiogenesis and cell migration and is currently in clinical trials for wound repair.

Accessibility of alcohol expectancies from memory: impact of mood and motives in college student drinkers

OBJECTIVE

It has been hypothesized that alcohol outcome expectancies (AOEs) exist within an associative memory network and that their accessibility is facilitated in the presence of alcohol-related cues. The purpose of the present study was to examine whether the accessibility of specific AOEs varies as a function of mood state and gender and to determine whether this relationship is moderated by affect-related drinking motives.

METHOD

Undergraduate students (N = 302) were randomly assigned to one of three conditions (i.e., positive, negative and neutral mood). Mood states were achieved using musical mood-induction procedures. Postmood-induction AOEs, obtained using self-generation, were classified into five expectancy categories: social/ situational enhancement (SSE), positive emotional functioning (PEF), relaxation/tension reduction (RTR), physical/pharmacological effects (PPE) and miscellaneous (MISC).

RESULTS

Logistic regression analyses revealed that SSE and RTR expectancies were differentially accessible across mood conditions. SSE expectancies were most highly accessible to participants in a positive mood, and RTR expectancies were most highly accessible to participants in a relatively neutral mood. Although drinking motives did not moderate the AOE-mood relationship, they emerged as significant predictors of SSE and RTR expectancies. The accessibility of specific AOEs differed among men and women.

CONCLUSIONS

The findings suggest that mood serves as an implicit prime for the accessibility of specific AOEs. The implications of these findings for research concerning memory-based, cognitive-affective expectancy networks are discussed.

Rapamycin and less immunosuppressive analogs are toxic to Candida albicans and Cryptococcus neoformans via FKBP12-dependent inhibition of TOR

Candida albicans and Cryptococcus neoformans cause both superficial and disseminated infections in humans. Current antifungal therapies for deep-seated infections are limited to amphotericin B, flucytosine, and azoles. A limitation is that commonly used azoles are fungistatic in vitro and in vivo. Our studies address the mechanisms of antifungal activity of the immunosuppressive drug rapamycin (sirolimus) and its analogs with decreased immunosuppressive activity. C. albicans rbp1/rbp1 mutant strains lacking a homolog of the FK506-rapamycin target protein FKBP12 were found to be viable and resistant to rapamycin and its analogs. Rapamycin and analogs promoted FKBP12 binding to the wild-type Tor1 kinase but not to a rapamycin-resistant Tor1 mutant kinase (S1972R). FKBP12 and TOR mutations conferred resistance to rapamycin and its analogs in C. albicans, C. neoformans, and Saccharomyces cerevisiae. Our findings demonstrate the antifungal activity of rapamycin and rapamycin analogs is mediated via conserved complexes with FKBP12 and Tor kinase homologs in divergent yeasts. Taken together with our observations that rapamycin and its analogs are fungicidal and that spontaneous drug resistance occurs at a low rate, these mechanistic findings support continued investigation of rapamycin analogs as novel antifungal agents.

Development of Saccharomyces cerevisiae as a model pathogen. A system for the genetic identification of gene products required for survival in the mammalian host environment

Saccharomyces cerevisiae, a close relative of the pathogenic Candida species, is an emerging opportunistic pathogen. An isogenic series of S. cerevisiae strains, derived from a human clinical isolate, were used to examine the role of evolutionarily conserved pathways in fungal survival in a mouse host. As is the case for the corresponding Candida albicans and Cryptococcus neoformans mutants, S. cerevisiae purine and pyrimidine auxotrophs were severely deficient in survival, consistent with there being evolutionary conservation of survival traits. Resistance to the antifungal drug 5-fluorocytosine was not deleterious and appeared to be slightly advantageous in vivo. Of mutants in three amino acid biosynthetic pathways, only leu2 mutants were severely deficient in vivo. Unlike the glyoxylate cycle, respiration was very important for survival; however, the mitochondrial genome made a respiration-independent contribution to survival. Mutants deficient in pseudohyphal formation were tested in vivo; flo11Delta mutants were phenotypically neutral while flo8Delta, tec1Delta, and flo8Delta tec1Delta mutants were slightly deficient. Because of its ease of genetic manipulation and the immense S. cerevisiae database, which includes the best annotated eukaryotic genome sequence, S. cerevisiae is a superb model system for the identification of gene products important for fungal survival in the mammalian host environment.