Trends in U.S. Depression Prevalence From 2015 to 2020: The Widening Treatment Gap

INTRODUCTION

Major depression is a common and potentially lethal condition. Early data suggest that the population-level burden of depression has been exacerbated by the COVID-19 pandemic. Prepandemic estimates of depression prevalence are required to quantify and comprehensively address the pandemic's impact on mental health in the U.S.

METHODS

Data were drawn from the 2015-2020 National Survey on Drug Use and Health, a nationally representative study of U.S. individuals aged ≥12 years. The prevalence of past-year depression and help seeking for depression were estimated from 2015 to 2019, and time trends were tested with Poisson regression with robust SEs. Point estimates were calculated for 2020 and not included in statistical trend analyses because of differences in data collection procedures.

RESULTS

In 2020, 9.2% (SE=0.31) of Americans aged ≥12 years experienced a past-year major depressive episode. Depression was more common among young adults aged 18-25 years (17.2%, SE=0.78), followed closely by adolescents aged 12-17 years (16.9%, SE=0.84). Depression increased most rapidly among adolescents and young adults and increased among nearly all sex, racial/ethnic, income, and education groups. Depression prevalence did not change among adults aged ≥35 years, and the prevalence of help seeking remained consistently low across the study period.

CONCLUSIONS

From 2015 to 2019, there were widespread increases in depression without commensurate increases in treatment, and in 2020, past 12‒month depression was prevalent among nearly 1 in 10 Americans and almost 1 in 5 adolescents and young adults. Decisive action involving a multipronged public health campaign that includes evidence-based prevention and intervention to address this ongoing mental health crisis is urgently needed.

Alcohol Use Disorder Symptoms Rather than Alcohol Exposure Predict Experiences of Cannabis Use Disorder Symptoms among Adolescents and Young Adults

Background: Alcohol and cannabis use are highly comorbid. Objective: We evaluate if alcohol use and/or alcohol use disorder symptoms predict experiences of cannabis use disorder symptoms among adolescents and young adults and whether the relationships differ based on frequency of cannabis use, recency of cannabis initiation and age. Method: Data were drawn from five annual surveys of the National Survey on Drug Use and Health (2014-2018) to include adolescents and young adults (age 12 to 21 years) who reported using cannabis and alcohol at least once in the past 30 days. Results: Number of alcohol use disorder symptoms, over and above alcohol quantity or frequency, was positively associated with each of the cannabis use disorder symptoms as well as the total number of cannabis use disorder symptoms endorsed. The association between alcohol and cannabis use disorder symptoms was stronger among those who were younger and those who initiated cannabis use within the past 2 years. Conclusions: Treatment should consider these and other cross-over effects of substance disorder symptoms when addressing risk for chronic and dependent use.

Behavioral symptoms of eating disorders among adopted adolescents and young adults in the United States: Findings from the Add Health survey

OBJECTIVE

More adopted individuals report experiencing general psychopathology, poor parental attachment, and early childhood eating difficulties than nonadopted individuals, yet little is known about disordered eating in this population. This study sought to describe the relationship between adoption status and behavioral eating-disorder (ED) symptoms, and to examine potential correlates of ED symptoms that are unique to adopted individuals.

METHOD

We examined data from adolescents and young adults from Waves 1 (n adopted = 561, nonadopted = 20,184), 2 (n adopted = 211, nonadopted = 14,525), and 3 (n adopted = 416, nonadopted = 14,754) of the National Longitudinal Study of Adolescent to Adult Health. ED symptom items included dieting, breakfast skipping, binge eating, extreme weight loss behaviors (EWLBs; i.e., self-induced vomiting, laxative use, diet pill use) and lifetime ED diagnosis.

RESULTS

Compared to nonadopted individuals, adopted individuals were more likely to report EWLBs at Wave 2 and binge eating and lifetime ED diagnosis at Wave 3 (ps < .05). Among adopted individuals, contact with a biological parent was associated with higher rates of binge eating and lifetime ED diagnosis at Wave 3 (ps < .05), whereas age at adoption and having ever been in foster care were not associated with rates of ED symptoms.

DISCUSSION

This study provides preliminary evidence that being adopted may be a risk factor for certain behavioral symptoms of EDs. Given the benefits of early detection and treatment of ED symptoms, mental health professionals working with adopted individuals should assess for disordered eating.

Integrative Data Analysis of Gender and Ethnic Measurement Invariance in Nicotine Dependence Symptoms

Little research has evaluated whether conflicting evidence for gender and racial/ethnic differences in nicotine dependence (ND) may be attributed to differences in psychometric properties of ND symptoms, particularly for young Hispanic smokers. Inadequate racial/ethnic diversity and limited smoking exposure variability has hampered research in young smokers. We used integrative data analysis (IDA) to pool DSM-IV ND symptom data for current smokers aged 12-25 (N = 20,328) from three nationally representative surveys (1999, 2000 National Surveys on Drug Use and Health (NSDUH) and Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Moderated nonlinear factor analysis (MNLFA) tested symptom measurement invariance in the pooled sample containing greater ethnic and smoking exposure variability. There was study noninvariance for most symptoms. NESARC participants were more likely to report tolerance, using larger amounts or for longer periods, inability to cut down/quit, and more time spent smoking at higher levels of ND severity, but reported emotional/physical health problems at lower ND severity. Four symptoms showed gender or race/ethnicity noninvariance, but observed differences were small. An ND severity factor score adjusting for symptom noninvariance related to study membership, gender, and race/ethnicity did not differ substantively from traditional DSM-IV diagnosis and number of endorsed symptoms in estimated gender and race/ethnicity differences in ND. Results were consistent with studies finding minimal gender and racial/ethnic differences in ND, and suggest that symptom noninvariance is not a major contributor to observed differences. Results support IDA as a potentially promising approach for testing novel ND hypotheses not possible in independent studies.

Developmental and Individual Differences in Children's Ability to Distinguish Reality from Fantasy

The present study focuses on children's developing ability to categorize real and pretend events, their understanding regarding the permanence of the state of pretense, and the potential effects that emotional tones have on these abilities. Children's involvement in imagination was also assessed as a possible factor contributing to individual differences in reality/fantasy understanding. Sixty male and female children selected from university preschool and kindergarten classes judged happy, neutral, and frightening pictures selected from children's books according to whether they believed that the event could happen in real life. Findings show that kindergartners perform significantly better than preschoolers in distinguishing real from pretend events. Overall, children made significantly fewer correct distinctions between reality and fantasy for the frightening pictures than for both the happy and neutral pictures. Individual difference analyses between children judged to be differentially involved in fantasy did not reveal any differences in their ability to distinguish between real and pretend events. Theoretical and practical implications of these findings are discussed.

Progression of nicotine dependence, mood level, and mood variability in adolescent smokers

Mood processes are theorized to play a role in the initiation and progression of smoking behavior. Available work using real-time assessments in samples of young smokers, including several reports from the Social and Emotional Contexts of Adolescent Smoking Patterns (SECASP) study, has indicated that smoking events acutely improve mood and that escalating smoking frequency may stabilize mood. However, prior analyses have not specifically evaluated within-person change in nicotine dependence, which is conceptually distinguishable from frequent smoking and may be associated with unique mood consequences. The current investigation addressed this question using data from 329 adolescent SECASP participants (9th or 10th grade at recruitment) who contributed mood reports via ecological momentary assessment in up to four 1-week bursts over the course of 24 months. Mixed-effects location scale analyses revealed that within-person increases in scores on the Nicotine Dependence Syndrome Scale were associated with elevations in negative mood level and increased variability of both positive and negative moods. These effects remained when within-person changes in smoking frequency were covaried and were not fully attributable to a subgroup of youth who rapidly escalated their smoking frequency over time. The findings indicate that adolescents tend to show increasing levels of positive mood states, decreasing levels of negative mood, and diminishing mood variability between ages 16 to 18, but progression of nicotine dependence may counteract some of these developmental gains. Emergence of withdrawal symptoms is a likely explanation for the adverse mood effects associated with dependence progression. (PsycINFO Database Record

Exploring alternate processes contributing to the association between maternal smoking and the smoking behavior among young adult offspring

INTRODUCTION

Maternal smoking during pregnancy (MSP) is a known risk factor for regular smoking in young adulthood and may pose a risk independently of mother's lifetime smoking. The processes through which MSP exerts this influence are unknown but may occur through greater smoking quantity and frequency following initiation early in adolescence or increased sensitivity to nicotine dependence (ND) at low levels of smoking.

METHODS

This study used path analysis to investigate adolescent smoking quantity, smoking frequency, and ND as potential simultaneous mediating pathways through which MSP and mother's lifetime smoking (whether she has ever smoked) increase the risk of smoking in young adulthood among experimenters (at baseline, <100 cigarettes/lifetime) and current smokers (>100 cigarettes/lifetime).

RESULTS

For experimenters, MSP was directly associated with more frequent young adult smoking and was not mediated by adolescent smoking behavior or ND. Independently of MSP, the effect of mother's lifetime smoking was fully mediated through frequent smoking and was heightened ND during adolescence. Controlling for MSP eliminated a previously observed direct association between mother's lifetime smoking and future smoking among experimenters. For current smokers, only prior smoking behavior was associated with future smoking frequency.

CONCLUSIONS

These results seem to rule out sensitivity to ND and increased smoking behavior as contributing pathways of MSP. Further, the impact of MSP on young adult smoking extends beyond that of having an ever-smoking mother. Future work should test other possible mediators; for example, MSP-related epigenetic changes or gene variants influencing the brain's nicotine response.

An integrated data analysis approach to investigating measurement equivalence of DSM nicotine dependence symptoms

INTRODUCTION

Research identifying nicotine dependence (ND) symptoms most appropriate for measurement of adolescent ND and invariant across the range of smoking exposure is hampered by limited sample size and variability of smoking behavior within independent studies. Integrative data analysis, the process of pooling and analyzing data from multiple studies, produces larger and more heterogeneous samples with which to evaluate measurement equivalence across the full continuum of smoking quantity and frequency.

METHODS

Data from two studies were pooled to obtain a large sample of adolescent and young adult smokers with considerable variability in smoking. We used moderated nonlinear factor analysis, which produces study equivalent ND scores, to simultaneously evaluate whether 14 DSM ND symptoms had equivalent psychometric properties (1) at different levels of smoking frequency and (2) across a continuous range of smoking quantity, after accounting for study differences.

RESULTS

Nine of 14 symptoms were equivalent across levels of smoking frequency and quantity in probability of endorsement at different levels of ND and in ability to discriminate between levels of ND severity. A more precise ND factor score accounted for study and smoking related differences in symptom psychometric properties.

CONCLUSIONS

DSM-IV symptoms may be used to reliably assess ND in young populations across a wide range of smoking quantity and frequency and within both nationally representative and geographically restricted samples with different study designs. Symptoms shared across studies produced an equivalently scaled ND factor score, demonstrating that integrating data for the purpose of studying ND in young smokers is viable.

Time-varying effects of smoking quantity and nicotine dependence on adolescent smoking regularity

BACKGROUND

Little is known about time-varying effects of smoking quantity and nicotine dependence on the regularity of adolescent smoking behavior.

METHODS

The sample was drawn from the Social and Emotional Contexts of Adolescent Smoking Patterns Study which followed adolescent smokers over 5 assessment waves spanning 48 months. Participants included former experimenters (smoked <100 cigarettes/lifetime but did not smoke in past 90 days), recent experimenters (smoked <100 cigarettes/lifetime and smoked in past 90 days), and current smokers (smoked >100 cigarettes/lifetime and smoked in past 30 days). Mixed-effects regression models were run to examine the time-varying effects of smoking quantity and nicotine dependence on regularity of smoking behavior, as measured by number of days smoked.

RESULTS

Smoking quantity and nicotine dependence were each found to be significantly associated with regularity of adolescent smoking and the size of each effect exhibited significant variation over time. The effect of smoking quantity decreased across time for each smoking group, while the effect of nicotine dependence increased across time for former and recent experimenters. By the 48-month follow-up, the effects of smoking quantity and nicotine dependence had each stabilized across groups.

CONCLUSIONS

This study reveals that smoking quantity and nicotine dependence are not static risk factors for the development of more regular smoking patterns. At low levels of smoking when nicotine dependence symptoms are less common, smoking quantity is a stronger predictor of increased regularity of smoking, while for more experienced smokers, nicotine dependence predicts further increases in regularity.

Adolescent nicotine dependence symptom profiles and risk for future daily smoking

Recent research on adolescent smokers suggests that there are important differences in the types of nicotine dependence (ND) symptoms that emerge and different patterns of ND symptoms. The purpose of this study was to use data from the longitudinal Social and Emotional Contexts of Adolescent Smoking Patterns Study to identify latent subgroups of adolescent experimental and nondaily smokers varying in number and types of endorsed ND symptoms. Profiles were identified using baseline level of smoking, individual patterns of ND symptoms and other ND risk factors. Discrete time survival analysis was used to examine profile differences in probability of becoming daily smokers 48 months later. Four distinct subgroups of smokers with different patterns of smoking behavior, ND symptoms, and alcohol and other substance use emerged. Heavier smoking adolescents with high symptom endorsement, particularly the need to smoke in the morning, were most likely to become daily smokers 48 months later. A subgroup of social smokers had high smoking exposure and symptom endorsement (except need to smoke in the morning), and high levels of other substance use. Despite lower rates of smoking frequency and quantity compared to the heavier smoking class, 36% of these adolescents smoked daily by 48 months, with a steeper decline in survival rates compared to other lighter smoking classes. Morning smoking symptoms and symptoms prioritizing smoking (i.e., choosing to spend money on cigarettes instead of lunch or smoking when ill or where smoking is forbidden) might quickly identify adolescent non-daily smokers with more severe dependence and higher risk for daily smoking. A focus on skills for avoiding social situations involving use of alcohol and other drugs and reducing peer smoking influences may be an important focus for reducing smoking and other substance use among social smokers.

A Practical Guide to Calculating Cohen's f(2), a Measure of Local Effect Size, from PROC MIXED

Reporting effect sizes in scientific articles is increasingly widespread and encouraged by journals; however, choosing an effect size for analyses such as mixed-effects regression modeling and hierarchical linear modeling can be difficult. One relatively uncommon, but very informative, standardized measure of effect size is Cohen's f(2), which allows an evaluation of local effect size, i.e., one variable's effect size within the context of a multivariate regression model. Unfortunately, this measure is often not readily accessible from commonly used software for repeated-measures or hierarchical data analysis. In this guide, we illustrate how to extract Cohen's f(2) for two variables within a mixed-effects regression model using PROC MIXED in SAS(®) software. Two examples of calculating Cohen's f(2) for different research questions are shown, using data from a longitudinal cohort study of smoking development in adolescents. This tutorial is designed to facilitate the calculation and reporting of effect sizes for single variables within mixed-effects multiple regression models, and is relevant for analyses of repeated-measures or hierarchical/multilevel data that are common in experimental psychology, observational research, and clinical or intervention studies.

The natural course of nicotine dependence symptoms among adolescent smokers

INTRODUCTION

Few studies have investigated the natural course of nicotine dependence prospectively from the earliest experiences with smoking.

METHODS

Drawing on a cohort of 9th- and 10th-grade adolescents followed over 48 months, survival analyses were conducted to evaluate the cumulative probability, following smoking initiation, for the development of nicotine dependence symptoms.

RESULTS

Although each nicotine dependence symptom was significantly more prevalent among adolescents who had smoked more than 100 cigarettes by the end of the follow-up assessment, 20% of adolescents smoking fewer than 100 cigarettes reported experiencing "smoking to relieve restlessness and irritability" and "smoking a lot more now to be satisfied compared to when first smoked." Nicotine dependence symptoms were also reported before reaching 100 cigarettes for a substantial number of adolescents (between 9.4% and 58.8% for individual symptoms). Endorsement of nicotine dependence symptoms prospectively predicted past-week smoking (odds ratios [ORs] between 3.18 and 14.62 for significant symptoms) and past-month daily smoking (significant symptoms' ORs between 3.52 and 10.68) at the 48-month assessment even when controlling for amount of previous smoking.

CONCLUSIONS

The present study adds to the growing body of literature on the natural course of nicotine dependence from earliest experiences with smoking by showing that symptoms of nicotine dependence may develop soon after initiation and/or at low levels of smoking. Our findings suggest that novice adolescent smokers should not be neglected in smoking cessation intervention and that screening and effective intervention for early emerging symptoms among adolescent smokers may be an important target in preventing chronic smoking.

A Practical Guide to Calculating Cohen's f(2), a Measure of Local Effect Size, from PROC MIXED

Reporting effect sizes in scientific articles is increasingly widespread and encouraged by journals; however, choosing an effect size for analyses such as mixed-effects regression modeling and hierarchical linear modeling can be difficult. One relatively uncommon, but very informative, standardized measure of effect size is Cohen's f(2), which allows an evaluation of local effect size, i.e., one variable's effect size within the context of a multivariate regression model. Unfortunately, this measure is often not readily accessible from commonly used software for repeated-measures or hierarchical data analysis. In this guide, we illustrate how to extract Cohen's f(2) for two variables within a mixed-effects regression model using PROC MIXED in SAS(®) software. Two examples of calculating Cohen's f(2) for different research questions are shown, using data from a longitudinal cohort study of smoking development in adolescents. This tutorial is designed to facilitate the calculation and reporting of effect sizes for single variables within mixed-effects multiple regression models, and is relevant for analyses of repeated-measures or hierarchical/multilevel data that are common in experimental psychology, observational research, and clinical or intervention studies.

Alcohol use as a signal for sensitivity to nicotine dependence among recent onset smokers

OBJECTIVE

This study evaluated the association between alcohol use, abuse and dependence and cigarette smoking to determine whether alcohol may signal greater sensitivity to nicotine dependence at very low levels of smoking.

METHOD

Data were drawn from five annual National Surveys on Drug Use and Health and included individuals age 12 to 21 who reported first exposure to smoking within the past two years and smoking at least once in the past month.

RESULTS

Both alcohol abuse and alcohol dependence were associated with increased likelihood of symptoms that seem to tap tolerance for nicotine. These included items such as "the amount you smoke has increased"; "needing to smoke a lot more now in order to be satisfied"; and "smoking much more before starting to feel anything". Alcohol dependence, but not abuse was associated with the remaining symptoms, "after not smoking for a while, needing to smoke to feel less restless and irritable"; "craving cigarettes after not smoking for a while"; and "worrying about running out of cigarettes". All associations were not better accounted for by either alcohol use or amount smoked.

CONCLUSION

If causally associated, treatment of alcohol-use disorders may prevent or reduce the early emergence of nicotine dependence symptoms among new smokers, very early in the smoking uptake process. If instead alcohol disorders are a signal of sensitivity for nicotine dependence best accounted for by a third variable, then adolescents with alcohol dependence and/or abuse during early exposures to smoking represents an important subgroup that may benefit from interventions directly targeting this association.

An item response theory analysis of nicotine dependence symptoms in recent onset adolescent smokers

INTRODUCTION

Given absence of a "gold standard" for measuring self-reported nicotine dependence, particularly among less experienced smokers, there is a need to evaluate existing measures to determine how well symptoms measure the underlying nicotine dependence construct and whether symptoms function differently for less experienced smokers. Study aims were to determine (1) likelihood of endorsement of individual symptoms at different levels of a nicotine dependence construct and the ability of symptoms to discriminate between different levels of this construct and (2) whether these symptom properties varied between nondaily and daily smokers.

METHODS

We used multiple group item response theory analysis to evaluate nicotine dependence symptoms from the nicotine dependence syndrome scale based on a nationally representative sample of 8081 recent onset adolescent smokers from the national surveys on drug use and health.

RESULTS

After controlling for age, gender, smoking quantity and length of smoking exposure, symptoms assessing tolerance were invariant across nondaily and daily smokers, and discriminated well between levels of the nicotine dependence construct. However, the majority of symptoms functioned differently for nondaily and daily smokers. These symptoms did not discriminate as well between levels of the nicotine dependence construct and were more likely to be endorsed at lower levels of this construct for daily smokers.

DISCUSSION

A measure that encompasses a range of symptoms tapping different aspects of smoking may be ideally suited for nondaily adolescent smokers, while an ideal measure of nicotine dependence for daily smokers might also include more core diagnostic features of nicotine dependence such as withdrawal and tolerance.

DSM-IV nicotine dependence symptom characteristics for recent-onset smokers

INTRODUCTION

This study evaluated how well DSM-IV nicotine dependence symptoms measure an underlying dependence construct for recent-onset daily and nondaily smokers.

METHODS

Based on a nationally representative sample of 2,758 recent-onset adolescent smokers from the National Surveys on Drug Use and Health, we used multiple group item response theory analysis to assess 7 symptoms representing DSM-IV diagnostic features of nicotine dependence.

RESULTS

After controlling for age, gender, current smoking quantity, and length of smoking exposure, all 7 DSM-IV symptoms were invariant across nondaily and daily smokers and discriminated well among levels of the nicotine dependence construct. Symptoms most likely to be endorsed at lower levels of the dependence construct included spending more time getting, using, or getting over the effects of smoking and wanting or trying to stop or cut down. Symptoms most likely to be endorsed only at higher levels of the construct included giving up important activities and emotional/psychological and health problems related to smoking. DSM-IV symptoms were most precise for moderately high levels of the dependence construct and less precise for lower levels for both nondaily and daily smokers.

DISCUSSION

DSM-IV nicotine dependence symptoms appear to have desirable psychometric properties for measuring a nicotine dependence construct among recent-onset adolescent smokers at both daily and nondaily levels, providing justification for the use of these symptoms in a measure that aims to evaluate the full continuum of nicotine dependence severity in this population.

Nicotine dependence symptoms among recent onset adolescent smokers

The present study examined the prevalence of individual nicotine dependence symptoms among recent onset smokers across the continuum of nondaily and daily cigarette smoking behavior in a nationally representative sample of recent onset smokers from the National Surveys on Drug Use and Health (NSDUH). Rates of endorsement for 17 symptoms drawn primarily from the Nicotine Dependence Symptom Scale (Shiffman et al., 2004) were calculated for four levels of nondaily (smoked 1-3, 4-10, 11-20, or 21-29 days in the past 30 days) and daily (smoked 1, 2-5, 6-15, or >15 cigarettes per day in the past 30 days) smoking. Logistic and linear regression analyses with polynomial contrasts controlling for age, gender, length of exposure, and smoking quantity tested trends in symptom endorsement across levels of smoking. Significant linear and quadratic trends indicated that increasing rates of endorsement differed most between the lowest levels of nondaily and daily smoking. Results suggest that, for some, infrequent smoking may not represent benign experimentation. Recognizing early symptoms of nicotine dependence may assist in early identification and intervention of those at risk for heavier smoking in the future. Adolescents can be taught to recognize the early symptoms of nicotine dependence to increase awareness of the rapidity at which these symptoms may appear.

Smoking trajectories, health, and mortality across the adult lifespan

This study extends research on the association between smoking behavior and chronic disease by following a cohort from the time of initiation of regular smoking patterns into old age and by examining the association of lifetime smoking trajectories with chronic disease and mortality. Participants consisted of 232 males selected from the Harvard classes of 1942-1944 and followed biennially through 2003. Five distinct smoking trajectories were identified based on the age at which participants quit daily smoking. Participants following smoking trajectories with later cessation had a higher likelihood of developing lung disease and lived shorter lives than those who quit smoking at an earlier age. This study confirms that the earlier a smoker quits, the greater the health benefits, and that these benefits are observed even decades after smoking cessation. Additionally, by showing different survival rates between trajectory groups 25 and 40 years after quitting, the results run counter to previous work that has found no difference in mortality between smokers and non-smokers 15 years after cessation.

Predicting child maltreatment among Puerto Rican children from migrant and non-migrant families

OBJECTIVES

The objectives of the present study were to (1) describe the prevalence of child maltreatment among migrant and non-migrant Puerto Rican families and (2) identify socio-demographic and cultural (i.e., acculturation pattern, familismo) predictors of maltreatment within these two samples.

METHOD

Representative community samples of Puerto Rican children (ages 5-13 at baseline) and their adult caretakers were interviewed at two sites: the South Bronx in New York City (n=631 families) and the Standard Metropolitan Areas of San Juan and Caguas in Puerto Rico (n=859 families). Participants were re-interviewed 1 and 2 years following the baseline assessment.

RESULTS

While prevalence rates of maltreatment (physical abuse, 10%; sexual abuse 1%; neglect, 10%; and multi-type, 6%) did not differ between the two sites at baseline assessment, site differences emerged over time. Rates of physical abuse at follow-up were significantly higher in the Bronx compared to Puerto Rico. Further, for families living in the Bronx, living in poverty predicted chronic maltreatment, whereas living above the poverty line predicted new cases of maltreatment at follow-up. For families living in Puerto Rico, those who experienced physical abuse or multi-type maltreatment at baseline were more likely to report chronic maltreatment at follow-up regardless of poverty level. Cultural factors were not related to baseline or follow-up maltreatment at either site.

CONCLUSION

Findings suggest that while rates of child maltreatment may be similar in migrant and non-migrant Puerto Rican families and when compared to prevalence rates in the US, predictors of maltreatment may differ.

PRACTICE IMPLICATIONS

Since predictors of maltreatment may vary across population subgroups, studying homogenous samples will lead to more effective and targeted interventions.

Delay discounting and smoking: association with the Fagerström Test for Nicotine Dependence but not cigarettes smoked per day

Delay discounting (DD) has been shown to be related to smoking status and-less consistently-frequency of cigarette use, but its independent relationship with dependence has not been examined. In this study, we evaluated the relationship between smoking and DD as a function of both smoking quantity and level of dependence controlling for use. A sample of 710 adults completed a DD task using hypothetical monetary rewards, and participants were classified according to smoking status. Current smokers were further characterized as light, moderate, or heavy smokers on the basis of number of cigarettes smoked per day (CPD). Dependence was assessed using the Fagerström Test of Nicotine Dependence (FTND), with the CPD item removed. Current smokers discounted delayed rewards more than never, occasional, or ex-smokers; the latter three groups did not differ. DD was not related to CPD, analyzed continuously or categorically. FTND scores independently predicted DD, controlling for CPD. Analysis of individual FTND items revealed a relationship between DD and morning smoking. When analyzed categorically based on a median split, individuals high in dependence discounted delayed rewards more steeply than low dependence, never, tried-it, and ex-smokers, while these groups did not differ from each other. These results suggest that DD among smokers is not simply the result of nicotine exposure, but may be an important marker for dependence, especially urgency to smoke in the morning.

Trajectories of smoking from adolescence to early adulthood and their psychosocial risk factors

OBJECTIVE

To explore patterns of persistence and change in smoking behavior as well as risk factors associated with the developmental course of smoking from age 13 to 25.

DESIGN

Data from the public use sample of the National Longitudinal Study of Adolescent Health (N = 5,789) were analyzed using semiparametric group-based modeling.

MAIN OUTCOME MEASURES

Smoking quantity-frequency in the past 30 days.

RESULTS

Six distinct smoking trajectories were identified: nonsmokers, experimenters, stable light smokers, quitters, late escalators, and stable high smokers. Baseline risk factors that were associated with greater likelihood of membership in all of the smoking trajectory groups compared with nonsmokers included alcohol use, deviance, peer smoking, and (with the exception of the late escalators) drug use. Deviance, peer smoking, and alcohol and drug use also distinguished the likelihood of membership among several of the 5 smoking trajectory groups.

CONCLUSION

The results add to basic etiologic research on developmental pathways of smoking in adolescence and young adulthood by providing evidence of heterogeneity in smoking behavior and prospectively linking different patterns of risk factors with the probability of trajectory group membership.

Disordered eating and substance use in high-school students: results from the Youth Risk Behavior Surveillance System

OBJECTIVE

To examine the association between disordered eating (fasting, diet product use, and vomiting or laxative use) and use of 10 substances (cigarettes, alcohol, marijuana, cocaine, inhalants, heroin, methamphetamines, ecstasy, steroids, and hallucinogens) in a nationally representative adolescent sample.

METHOD

Participants were 13,917 U.S. high-school students participating in the 2005 Youth Risk Behavior Surveillance System.

RESULTS

Disordered eating was significantly associated with the use of each substance. Using effect size estimates that take base rates into consideration, for female students, associations between substance use and disordered eating were weak for all but three forms of substance use: current smoking, binge drinking, and inhalants. Among male students, strong (marijuana, steroids, and inhalants) or moderate effects (all other substances) were observed.

CONCLUSION

Future research needs to focus on inhalant use and methamphetamine use in males. Increased medical attention should be directed toward adolescents who practice disordered eating behaviors because they are also at elevated risk for using cigarettes, alcohol, inhalants, methamphetamines, and steroids.

Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R)

The present study sought to extend prior research by using data from the National Comorbidity Survey-Replication (NCS-R) to examine the relationship between number of lifetime traumas, posttraumatic stress disorder (PTSD) and 15 self-reported chronic medical conditions. The goal was to determine whether the commonly found relationship between PTSD symptomatology and physical health were better explained by the number of lifetime traumas experienced. The NCS-R is a representative US household survey that assessed lifetime experience of a variety of traumas, lifetime diagnosis of PTSD and 15 chronic medical conditions (e.g. pain conditions, cardiovascular disorders, etc.). Two major findings emerged: (1) there was a graded relationship between trauma exposure, PTSD, and the majority of chronic medical conditions where individuals with PTSD had the highest likelihood of chronic medical condition and non-traumatized individuals had the lowest risk and; (2) with the exception of headaches, the relationship between PTSD and chronic medical conditions was explained by the number of lifetime traumas experienced when analyses were subset to traumatized individuals. The present study supports prior research suggesting that multiple traumas have a cumulative effect on physical health. The impact of trauma on health may be independent of PTSD symptomatology.

Risk and protective factors associated with trajectories of depressed mood from adolescence to early adulthood

This study used semi-parametric group-based modeling to explore unconditional and conditional trajectories of self-reported depressed mood from ages 12 to 25 years. Drawing on data from the National Longitudinal Study of Adolescent Health (N = 11,559), 4 distinct trajectories were identified: no depressed mood, stable low depressed mood, early high declining depressed mood, and late escalating depressed mood. Baseline risk factors associated with greater likelihood of membership in depressed mood trajectory groups compared with the no depressed mood group included being female, Black or African American, Hispanic or Latino American, or Pacific Islander or Asian American; having lower socioeconomic status; using alcohol, tobacco, or other drugs on a weekly basis; and engaging in delinquent behavior. Baseline protective factors associated with greater likelihood of membership in the no depressed mood group compared with the depressed mood trajectory groups included 2-parent family structure; feeling connected to parents, peers, or school; and self-esteem. With the exception of delinquent behavior, risk and protective factors also distinguished the likelihood of membership among several of the 3 depressed mood groups. The results add to basic etiologic research regarding developmental pathways of depressed mood in adolescence and young adulthood.

Ethnic differences in weight control practices among U.S. adolescents from 1995 to 2005

OBJECTIVE

To examine trends in weight control practices from 1995 to 2005.

METHOD

The Youth Risk Behavior Surveillance System biennially assesses five weight control behaviors among nationally representative samples of United States high school students.

RESULTS

Across time, more females than males dieted (53.8% vs. 23.8%), used diet products (10% vs. 4.3%), purged (7.5% vs. 2.7%), exercised (66.5% vs. 46.9%), or vigorously exercised (42.8% vs. 36.8%). All weight control behaviors among males increased during the decade. Black females were less likely than Hispanic females, who were less likely than White females, to practice weight control. White males were less likely than Black males, who were less likely than Hispanic males, to practice weight control. The ethnic difference in weight control practices is consistent across time.

CONCLUSION

All male adolescents are at increasing risk for developing eating disorder symptomatology, and Black females appear to continue to resist pressure to pursue thinness.

The absence of DSM-IV nicotine dependence in moderate-to-heavy daily smokers

BACKGROUND

Current theoretical models of nicotine dependence assume a close relationship between use and dependence; however, previous data suggest that many daily smokers fail to develop nicotine dependence.

OBJECTIVES

To determine what percentage of daily smokers fail to meet DSM-IV criteria for nicotine dependence within their lifetime, how non-dependence relates to duration and quantity of cigarette use, and whether other tobacco use and/or specific dependence criteria differentiate never-dependent and dependent smokers.

METHODS

Cross-sectional data collected via personal interview from a nationally representative sample of 8213 past year daily smokers were analyzed.

RESULTS

Approximately 39.4% of daily smokers never reached nicotine dependence. While the probability of remaining non-dependent decreased with smoking quantity and duration since the onset of daily smoking, a substantial portion of individuals (37.7%) who reported smoking >or=10 cigarettes per day and began smoking daily >or=10 years prior, remained never nicotine dependent.

CONCLUSIONS

The absence of nicotine dependence in heavy daily smokers may result from limitations in the measurement of dependence and/or nicotine exposure. Alternatively, some individuals may be relatively resistant to becoming nicotine dependent despite extensive use. The latter explanation would have important implications for understanding the nature of nicotine dependence.

Association between psychiatric disorders and smoking stages within a representative clinic sample of Puerto Rican adolescents

OBJECTIVE

We examined the prevalence of smoking behaviors and their association with specific psychiatric disorders in a representative sample of youth from behavioral health clinics in Puerto Rico.

METHOD

A complex sampling design was used to select the sample, and analyses were conducted to account for the unequal selection probability, stratification, and clustering. All analyses were weighted back to the clinical population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0.

RESULTS

More than one third of the sample reported experience with cigarette smoking, and approximately one quarter reported smoking at least once per week (23.4%). As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages. These were the only disorders that remained significantly associated with nicotine dependence after controlling for comorbidity.

CONCLUSIONS

Our findings confirm the need for screening of smoking behavior and nicotine dependence in treatment settings and the integration of psychiatric/substance use treatments with smoking cessation.

Testing the dual pathway hypothesis to substance use in adolescence and young adulthood

BACKGROUND

We tested the dual pathway hypothesis to substance use which posits that substance use can develop via internalizing symptoms or deviant behaviors.

METHOD

Using data from the Add Health study, we used latent class analysis to define subgroups based on patterns of substance use, and logistic regression procedures to evaluate the prospective association between symptoms of depression, deviance, and the individual substance use patterns.

RESULTS

Groups representing similar patterns of substance use were identified in both adolescence and young adulthood. Some support for the dual pathway hypothesis was demonstrated. Deviance was prospectively associated with substance group assignment in both adolescence and young adulthood, while depression uniquely predicted assignment to the smoking group in young adulthood among females.

CONCLUSIONS

Further testing of the dual pathway hypothesis should be built on diverse pattern-centered approaches able to explore the presence of population subgroups.

Predictive validity of four nicotine dependence measures in a college sample

BACKGROUND

The present study compared the predictive and incremental validity of four commonly used dependence measures (Diagnostic and Statistical Manual-IV [DSM-IV] nicotine dependence criteria, Fagerstrom Test for Nicotine Dependence [FTND], Hooked On Nicotine Checklist [HONC], Nicotine Dependence Syndrome Scale [NDSS]) in a first year college sample reporting light smoking patterns.

METHODS

Nicotine dependence measures were administered at the end of the first semester and follow-up smoking behavior (i.e. continued smoking, quantity, frequency, and length of abstinence) was assessed at the end of the first and second academic years.

RESULTS

Higher levels of dependence as measured by the HONC and DSM-IV predicted smoking behavior at both follow-up assessments. While higher scores on some of the NDSS factors predicted heavier smoking behavior during follow-up assessments, higher scores on other NDSS factors predicted lighter smoking behavior. The DSM-IV, NDSS-priority, and HONC measures provided some evidence for incremental validity. Higher dependence scores on all four measures were related to shorter lengths of smoking abstinence.

CONCLUSIONS

The four dependence measures were differentially related to smoking behavior outcomes in a light smoking sample. These findings suggest that nicotine dependence can predict a variety of smoking behaviors in light smokers.

The association between cigarette smoking and DSM-IV nicotine dependence among first year college students

AIMS

This study was undertaken to evaluate the association between cigarette smoking behavior and DSM-IV nicotine dependence.

DESIGN

Drawing on a sample of first year college students selected for representation across a continuum of smoking behavior, current DSM-IV nicotine dependence criteria were assessed among participants reporting any smoking in the preceding week on a web-based survey protocol. Logistic regression and receiver operator characteristic analyses were used to estimate the overall concordance between smoking and DSM-IV nicotine dependence.

FINDINGS

Relationships were supported between both quantity and frequency of smoking in the past week and DSM-IV nicotine dependence showing higher prevalence of dependence at higher levels of use (p<0.05). While the highest prevalence of nicotine dependence was seen among those reporting the most frequent and heavy smoking, a substantial number of participants reporting daily and/or heavy smoking did not meet criteria for nicotine dependence. Conversely, nicotine dependence was seen among a subgroup of participants reporting relatively low levels of non-daily smoking. Diagnostic concordance was found to be moderate for both quantity and frequency and was not improved by combining information from these two indices.

CONCLUSIONS

Aside from confirming DSM-IV nicotine dependence at relatively low levels of smoking, these results may be used to inform research aimed at identifying samples of nicotine dependent youth across the range of smoking levels.

Association between parental and individual psychiatric/substance use disorders and smoking stages among Puerto Rican adolescents

OBJECTIVE

To examine the associations between parental and individual psychiatric disorders and smoking stages among Puerto Rican youth from migrant and non-migrant families.

METHOD

Analyses were conducted drawing on data collected as part of a migrant family study examining youth at high and low risk for substance use disorders based on the presence or absence of a parental history of substance abuse or dependence. Parents and their offspring were recruited in San Juan, Puerto Rico (n=450) and New Haven, CT, USA (n=350).

RESULTS

Experimental smoking among adolescent offspring was associated with parent proband disorders. In contrast, regular smoking behavior, defined as at least weekly smoking for a month or more, and DSM-IV nicotine dependence were more strongly associated with the adolescents' own psychiatric disorders. With the exception of anxiety disorders, significant bivariate associations were shown between each psychiatric/substance use disorder and nicotine dependence. Once comorbidity was statistically controlled, only attention deficit hyperactivity disorder (ADHD), and alcohol and drug use disorders were significantly associated with nicotine dependence. After controlling for adolescents' psychiatric comorbidity, there was an association between parental disorders and both experimental and regular smoking in their adolescent offspring.

CONCLUSIONS

By combining family and migrant research strategies within a single study, the present investigation was able to simultaneously examine familial, individual and sociocultural factors that may play a role in development and/or persistence of smoking behavior among Puerto Rican adolescents.

Association between psychiatric disorders and smoking stages among Latino adolescents

OBJECTIVE

We examined the prevalence of smoking behaviors and their association with psychiatric disorders within a representative sample of youth from Puerto Rico.

METHOD

A complex sampling design was used and analyses were conducted to account for the unequal selection probability, stratification and clustering. All analyses were weighted back to the population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0 (DISC-IV).

RESULTS

After controlling for other comorbidity, major depression and oppositional defiant disorder were significantly associated with nicotine dependence, rather than with lower levels of use. In contrast, conduct disorder was generally associated with lower levels of use rather than with nicotine dependence. As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages.

CONCLUSIONS

By examining psychiatric correlates of smoking stages within an island-wide sample of adolescents, the present study highlights those disorders that may play a role in the development and/or persistence of smoking behavior in Puerto Rico and further clarifies the appropriate targets for smoking intervention conducted in community settings.

Defining subgroups of adolescents at risk for experimental and regular smoking

If multiple etiologies of substance use are truly at work in the population, then further strides in the accurate prediction of smoking and the use of other substances will likely be built on diverse pattern-centered approaches that explore the presence of multiple population subgroups across various substance use stages. The present study aimed to identify population subgroups defined by individual risk factors or risk factor constellations that prospectively predict specific smoking stages. Using data from the National Longitudinal Study of Adolescent Health (Add Health), analyses were conducted on the sample that took part in the baseline and 1 year follow-up assessment between 1994 and 1996. Classification and regression tree procedures were used to investigate the structure of individual risk factors, or constellations of risk, that define population subgroups with high rates of both experimental and established smoking. For each level of smoking, a relatively simple model including two subgroups predicted over half of the smoking cases. Findings also indicated that the two group models identified higher rates of regular smokers compared to experimental smokers. Deviant behaviors and alcohol use without permission independently predicted movement to experimentation at follow-up. Progression to regular smoking from both a nonsmoking and experimental smoking status at baseline were each predicted by smoking friends. Additionally, baseline levels of experimental use predicted movement from experimental to regular smoking, while a relatively low grade point average predicted rapid progression from baseline nonuse to regular use at follow-up. By identifying first approximations of patterns, these analyses may lead to clues regarding the major multiple mechanisms at work for the progression of smoking among adolescents.

Anxiety sensitivity in adolescents at risk for psychopathology

Examined the associations of adolescents' self-reported anxiety sensitivity with semi-structured, interview-based anxiety and depressive symptoms and anxiety disorders. The sample included 121 adolescents and their parents who participated in a larger epidemiological, high-risk family study of substance abuse and anxiety disorders (Merikangas, Dierker, & Szatmari, 1998). A series of hierarchical multiple regressions revealed the incremental validity of anxiety sensitivity, beyond the contribution of self-rated anxiety, to anxiety symptoms and comorbid anxiety disorders. Furthermore, familial risk for anxiety moderated the association between anxiety sensitivity and number of anxiety symptoms as well as number of comorbid anxiety disorders. Analyses of high- and low-risk groups demonstrated that the association between anxiety sensitivity and anxiety symptoms and disorders was evident in high-risk adolescents only. Although self-reported anxiety was associated with depressive symptoms, anxiety sensitivity was not. Results from this investigation further support the utility of assessing anxiety sensitivity in an adolescent population and suggest it as a trait marker of anxiety among at-risk individuals.

Smoking and depression: an examination of mechanisms of comorbidity

OBJECTIVE

Although the association between depression and smoking has been consistently established, little evidence regarding the mechanisms that influence this association is currently available. The present study evaluates alternate familial mechanisms of comorbidity between depression and smoking.

METHOD

Probands from a case-control family study were selected from outpatient specialty clinics or through a random-digit dialing procedure. A total of 133 probands and 273 directly interviewed, first-degree relatives of the probands were included in the present analyses.

RESULTS

The pattern of cross-aggregation of heavy smoking and depression differed according to the subtype of depressive disorder. There was evidence of a shared etiology between dysthymia and heavy smoking, whereas major and double depression did not demonstrate a shared vulnerability with heavy smoking.

CONCLUSIONS

This report contributes to the present sparse evidence regarding the mechanisms involved in the etiology of smoking and depressive disorders and highlights the need for greater attention to this issue through genetic epidemiological study methods.

Association between psychiatric disorders and the progression of tobacco use behaviors

OBJECTIVE

To examine the progression of tobacco use and the patterns of comorbidity of tobacco use and psychiatric disorders.

METHOD

The authors conducted analyses of prospective and retrospective reports, collected from 1988 to 1998, of a sample of high- and low-risk youths identified on the basis of the presence or absence of a parental history of substance abuse or dependence.

RESULTS

A parental history of substance use disorders was associated with regular tobacco use and nicotine dependence, but not with experimentation for all youths. Individual and composite psychiatric diagnoses were strongly associated with nicotine dependence, but not with regular use or experimentation. While the presence of an affective disorder and drug abuse/dependence generally increased the risk for co-occurring nicotine dependence, analyses based on the temporal onset of disorders showed that it was the initiation of alcohol or drug use that predicted the progression to nicotine dependence. For low-risk youths, oppositional defiant disorder was the single psychiatric risk factor that predicted the transition to nicotine dependence.

CONCLUSIONS

This study adds to the accumulating evidence that has implicated comorbid psychiatric disorders in the etiology and subsequent course of nicotine dependence. In addition, family history may represent an important indicator of an increased risk for nicotine dependence.

Familial psychiatric illness and posttraumatic stress disorder: findings from a family study of substance abuse and anxiety disorders

BACKGROUND

Aside from the possibility of a direct relationship between individual and familial posttraumatic stress disorder (PTSD), there is accumulating evidence that implicates a family history of psychiatric and substance use disorders as an important risk factor in the development of PTSD and associated symptoms.

METHOD

The familial risk of DSM-III-R PTSD was examined within a family study of clinical- and community-ascertained probands (N = 263) and their 1206 adult first-degree relatives.

RESULTS

Although PTSD among probands was not found to significantly elevate the risk of PTSD among first-degree relatives, an elevated rate of PTSD was found among the relatives of drug abusing probands compared with the relatives of probands with alcoholism, other anxiety disorders, and normal controls. Additionally, affective disorders were significantly associated with PTSD in relatives (p < .01). When these familial and individual associations were examined according to gender, drug disorders in probands were significantly associated with PTSD only among male relatives (p < .01), while the association between PTSD and comorbid affective disorders was seen primarily among female relatives (p < .01).

CONCLUSION

Although probands in the present family study were not selected specifically for PTSD, the data afforded a unique opportunity to examine the profile of familial psychopathology as a part of the complex picture of susceptibility for PTSD. Future family study research will be able to determine the generalizability of the present findings through more complete measurement of diverse forms of trauma.

Screening for anxiety and depression in early adolescence

OBJECTIVE

To examine the level of diagnostic and discriminative accuracy of three dimensional rating scales for detecting anxiety and depressive disorders in a school-based survey of 9th grade youths.

METHOD

Classroom screening instruments, the Center for Epidemiologic Studies-Depression Scale (CES-D), the Revised Children's Manifest Anxiety Scale (RCMAS), and the Multidimensional Anxiety Scale for Children (MASC) were administered to 632 youths from three sites in 1998. On the basis of rating scale results, samples of high-scoring and non-high-scoring youths were invited to participate in a diagnostic interview conducted within 2 months of the screening sessions.

RESULTS

MASC scores were most strongly associated with individual anxiety disorders, particularly among females, whereas the CES-D composite score was associated with a diagnosis of major depression, after controlling for comorbid disorders. The RCMAS was least successful in discriminating anxiety and depression. When receiver operator characteristic curves were examined, diagnostic accuracy was moderate.

CONCLUSIONS

The ability of the MASC and CES-D to discriminate within and between categorically defined diagnostic groups has important implications for the accurate identification of youths in need of services.

Influence of parental concordance for psychiatric disorders on psychopathology in offspring

OBJECTIVE

To examine the influence of parental mating types for substance abuse and anxiety/affective disorders on the risk of psychopathology among child and adolescent offspring.

METHOD

Emotional and behavioral disorders were assessed in offspring, aged 7 to 17 years, of male and female parents who served as probands from a family study of comorbidity of substance abuse and anxiety disorders.

RESULTS

The findings indicated that (1) patterns of psychopathology among offspring were similar for mothers and fathers; (2) spouse concordance for psychopathology was greater among parents with substance abuse than among those with anxiety, particularly among female substance abusers; (3) there was a direct relationship between the number of affected parents and the magnitude of psychopathology in children, particularly with respect to the anxiety disorders; and (4) by contrast, rates of conduct disorder were elevated only among offspring of dually affected parents, irrespective of the specific parental disorders.

CONCLUSIONS

These findings underscore the importance of the contribution of both mothers and fathers, particularly those with concordance for psychiatric disorders, to the development of psychopathology in offspring.

Psychopathology among offspring of parents with substance abuse and/or anxiety disorders: a high-risk study

This paper reports the results of a high-risk study of children under age 18 of parents who served as probands in a family study of comorbidity of substance abuse and anxiety disorders. There was a strong degree of specificity of familial aggregation of both the anxiety disorders and substance disorders. Rates of conduct disorder and depression were elevated among offspring of all affected parents. Inclusion of co-parent disorders in the evaluation of familial transmission in the present study strengthened the findings regarding the specificity of transmission of the anxiety disorders and the links between both parental substance abuse and antisocial personality with child conduct disorder.