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St Fleur RG, Tanofsky-Kraff M, Yanovski JA, Horton NJ, Hirschhorn JN, Field AE. Phenotyping children and adolescents with obesity using behavioral, psychological, and familial data. Obesity (Silver Spring) 2023; 31:3016-3024. [PMID: 37987184 DOI: 10.1002/oby.23893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE This prospective cohort study aimed to empirically derive phenotypes of children and adolescents with overweight and obesity. METHODS Latent class analyses using Mplus were carried out in the Growing Up Today Study. Information on participants' weight status, disordered eating behaviors, body image and weight concerns, depressive symptoms, and pubertal timing, as well as and maternal weight status, were included in the latent class analyses, which were stratified by sex. Mixed-effects regression was used to examine associations of the obesity phenotypes with adult weight gain, between age 20 and 35 years, independent of weight at beginning of follow-up and duration of follow-up. RESULTS Among the girls, four obesity phenotypes were identified: 1) "early puberty"; 2) "mothers with obesity"; 3) "high weight concerns"; and 4) "mixed." Only three phenotypes were identified among the boys: 1) "high weight concerns"; 2) "mothers with obesity"; and 3) "mixed." Participants who had overweight or obesity in childhood or adolescence gained more weight in young adulthood than their leaner peers, but the patterns of weight gain in young adulthood varied by phenotype of obesity in childhood and adolescence. CONCLUSIONS These results support examining risk factors for and treatment outcomes by obesity phenotypes.
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Affiliation(s)
- Ruth G St Fleur
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of The Health Sciences, Bethesda, Maryland, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, Massachusetts, USA
| | - Joel N Hirschhorn
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alison E Field
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
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2
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Sun J, Horton NJ, Voss SE. Absorbance Measurements From Normal-hearing Ears in the National Health and Nutrition Examination Survey, 2015-2016 and 2017-2020. Ear Hear 2023; 44:1282-1288. [PMID: 36991532 PMCID: PMC10440228 DOI: 10.1097/aud.0000000000001358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To summarize absorbance and impedance angles from normal-hearing ears within the 2015-2016 and 2017-2020 US National Health and Nutrition Examination Surveys (NHANES). DESIGN Two publicly available NHANES datasets were analyzed. Ears meeting criteria for normal hearing and valid absorbance and impedance angle measurements were identified. Measurements were summarized via descriptive statistics within categories of age cohort, race/ethnicity cohort, sex (male, female), and ear (left, right). RESULTS A total of 7029 ears from 4150 subjects, ages 6 to 80 years, met inclusion criteria. Differences between subgroups within all categories (age, race/ethnicity, sex, and ear) were fractions of the sample SDs. The largest differences occurred between age cohorts younger than 20 years. CONCLUSIONS The NHANES absorbance and impedance angle measurements are consistent with published literature. These results demonstrate that trained professionals, using the Titan instrument in a community setting inclusive of all demographics, produce comparable measurements to those in laboratory settings.
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Affiliation(s)
- Jiayi Sun
- Picker Engineering Program, Smith College, Northampton, 01063, MA, USA
| | - Nicholas J. Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, 01002, MA, USA
| | - Susan E. Voss
- Picker Engineering Program, Smith College, Northampton, 01063, MA, USA
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3
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Balouch AP, Bekhazi K, Durkee HE, Farrar RM, Sok M, Keefe DH, Remenschneider AK, Horton NJ, Voss SE. Measurements of ear-canal geometry from high-resolution CT scans of human adult ears. Hear Res 2023; 434:108782. [PMID: 37201272 DOI: 10.1016/j.heares.2023.108782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
Description of the ear canal's geometry is essential for describing peripheral sound flow, yet physical measurements of the canal's geometry are lacking and recent measurements suggest that older-adult-canal areas are systematically larger than previously assumed. Methods to measure ear-canal geometry from multi-planar reconstructions of high-resolution CT images were developed and applied to 66 ears from 47 subjects, ages 18-90 years. The canal's termination, central axis, entrance, and first bend were identified based on objective definitions, and the canal's cross-sectional area was measured along its canal's central axis in 1-2 mm increments. In general, left and right ears from a given subject were far more similar than measurements across subjects, where areas varied by factors of 2-3 at many locations. The canal areas varied systematically with age cohort at the first-bend location, where canal-based measurement probes likely sit; young adults (18-30 years) had an average area of 44mm2 whereas older adults (61-90 years) had a significantly larger average area of 69mm2. Across all subjects ages 18-90, measured means ± standard deviations included: canals termination area at the tympanic annulus 56±8mm2; area at the canal's first bend 53±18mm2; area at the canal's entrance 97±24mm2; and canal length 31.4±3.1mm2.
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Affiliation(s)
- Auden P Balouch
- Picker Engineering Program, Smith College, Northampton, 01063, MA, USA
| | - Karen Bekhazi
- Picker Engineering Program, Smith College, Northampton, 01063, MA, USA
| | - Hannah E Durkee
- Picker Engineering Program, Smith College, Northampton, 01063, MA, USA
| | - Rebecca M Farrar
- Picker Engineering Program, Smith College, Northampton, 01063, MA, USA
| | - Mealaktey Sok
- Picker Engineering Program, Smith College, Northampton, 01063, MA, USA
| | | | | | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, 01002, MA, USA
| | - Susan E Voss
- Picker Engineering Program, Smith College, Northampton, 01063, MA, USA.
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Bather JR, Horton NJ, Coull BA, Williams PL. The impact of correlated exposures and missing data on multiple informant models used to identify critical exposure windows. Stat Med 2023; 42:1171-1187. [PMID: 36647625 PMCID: PMC10023485 DOI: 10.1002/sim.9664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/15/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
There has been heightened interest in identifying critical windows of exposure for adverse health outcomes; that is, time points during which exposures have the greatest impact on a person's health. Multiple informant models implemented using generalized estimating equations (MIM GEEs) have been applied to address this research question because they enable statistical comparisons of differences in associations across exposure windows. As interest rises in using MIMs, the feasibility and appropriateness of their application under settings of correlated exposures and partially missing exposure measurements requires further examination. We evaluated the impact of correlation between exposure measurements and missing exposure data on the power and differences in association estimated by the MIM GEE and an inverse probability weighted extension to account for informatively missing exposures. We assessed these operating characteristics under a variety of correlation structures, sample sizes, and missing data mechanisms considering various exposure-outcome scenarios. We showed that applying MIM GEEs maintains higher power when there is a single critical window of exposure and exposure measures are not highly correlated, but may result in low power and bias under other settings. We applied these methods to a study of pregnant women living with HIV to explore differences in association between trimester-specific viral load and infant neurodevelopment.
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Affiliation(s)
- Jemar R Bather
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, Massachusetts, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Ziobrowski HN, Buka SL, Austin SB, Duncan AE, Sullivan AJ, Horton NJ, Field AE. Child and Adolescent Abuse Patterns and Incident Obesity Risk in Young Adulthood. Am J Prev Med 2022; 63:809-817. [PMID: 35941047 DOI: 10.1016/j.amepre.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Child abuse is associated with adult obesity. Yet, it is unknown how the developmental timing and combination of abuse types affect this risk. This report examined how distinct child and adolescent abuse patterns were associated with incident obesity in young adulthood. METHODS Data came from 7,273 participants in the Growing Up Today Study, a prospective cohort study in the U.S. with 14 waves from 1996 to 2016 (data were analyzed during 2020-2021). An abuse group variable was empirically derived using latent class analysis with indicators for child (before age 11 years) and adolescent (ages 11-17 years) physical, sexual, and emotional abuse. Risk ratios for obesity developing during ages 18-30 years were estimated using modified Poisson models. Associations of abuse groups with BMI across ages 18-30 years were then examined using mixed-effects models. All models were stratified by sex. RESULTS Among women, groups characterized by abuse had higher BMIs entering young adulthood and greater changes in BMI per year across young adulthood. Groups characterized by multiple abuse types and abuse sustained across childhood and adolescence had approximately twice the risk of obesity as that of women in a no/low abuse group. Associations were substantially weaker among men, and only a group characterized by physical and emotional abuse in childhood and adolescence had an elevated obesity risk (risk ratio=1.38; 95% CI=1.04, 1.83). CONCLUSIONS Obesity risk in young adulthood varied by distinct abuse groups for women and less strongly for men. Women who experience complex abuse patterns have the greatest risk of developing obesity in young adulthood.
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Affiliation(s)
- Hannah N Ziobrowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
| | - Stephen L Buka
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexis E Duncan
- Brown School, Washington University in St. Louis, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Nicholas J Horton
- Department of Mathematics & Statistics, Amherst College, Amherst, Massachusetts
| | - Alison E Field
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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6
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Horton NJ. Foundations of Statistics for Data Scientists: With R and Python. J Am Stat Assoc 2022. [DOI: 10.1080/01621459.2022.2104726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Ziobrowski HN, Buka SL, Austin SB, Duncan AE, Simone M, Sullivan AJ, Horton NJ, Field AE. Child and adolescent maltreatment patterns and risk of eating disorder behaviors developing in young adulthood. Child Abuse Negl 2021; 120:105225. [PMID: 34352683 PMCID: PMC8493560 DOI: 10.1016/j.chiabu.2021.105225] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/01/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Child maltreatment may be an important risk factor for eating disorder (ED) behaviors. However, most previous research has been limited to clinical, female, and cross-sectional samples, and has not adequately accounted for complex abuse patterns. OBJECTIVE To determine whether women and men with distinct patterns of child and adolescent maltreatment have higher risks of developing ED behaviors in young adulthood than individuals with a low probability of maltreatment. PARTICIPANTS AND SETTING Data came from 7010 U.S. women and men (95% White) in the Growing Up Today Study, a prospective, community-based cohort study (14 waves between 1996 and 2016). METHODS We used a previously created maltreatment variable that was empirically derived using latent class analysis. Maltreatment groups were characterized as: "no/low abuse," "child physical abuse," "adolescent emotional abuse," "child and adolescent physical and emotional abuse," and "child and adolescent sexual abuse." We estimated risk ratios for ED behaviors developing in young adulthood using the modified Poisson approach with generalized estimating equations. We stratified models by sex. RESULTS Groups characterized by maltreatment had elevated risks of incident ED behaviors compared with the "no/low abuse" group among both women and men. For women, risks tended to be strongest among the "child and adolescent sexual abuse" group. For men, risks tended to be strongest among the "child and adolescent physical and emotional abuse" group. Risks were particularly strong for purging behaviors. CONCLUSION Risk of incident ED behaviors in young adulthood varied by distinct maltreatment groups. Detecting maltreatment early may help prevent EDs and subsequent maltreatment.
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Affiliation(s)
| | - Stephen L Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexis E Duncan
- Brown School at Washington University in St. Louis, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa Simone
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | | | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, MA, USA
| | - Alison E Field
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
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8
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Glazer KB, Ziobrowski HN, Horton NJ, Calzo JP, Field AE. The Course of Weight/Shape Concerns and Disordered Eating Symptoms Among Adolescent and Young Adult Males. J Adolesc Health 2021; 69:615-621. [PMID: 34074590 PMCID: PMC8429109 DOI: 10.1016/j.jadohealth.2021.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE Male weight concerns tend to focus on shape and muscularity as opposed to a desire for thinness and remain underdetected by conventional eating disorder assessments. We aimed to describe the longitudinal course of weight concerns and disordered eating behaviors among males across adolescence and young adulthood. METHODS We used prospective assessments of 4,489 U S. males, aged 11 to 18 years at baseline of analyses, in the Growing Up Today Study. We assigned mutually exclusive classifications of behaviors consistent with bulimia nervosa (BN), binge eating disorder (BED), purging disorder (PD); high levels of concern with thinness and/or muscularity; and use of muscle-enhancing products. We estimated the probability of maintenance, resolution, or transition to different weight concerns and/or disordered eating behaviors across consecutive survey waves. RESULTS Less than 1% of participants met full or partial criteria for BN, PD, or BED at baseline. One-quarter (25.4%, n = 1,137) of males reported high weight concerns during follow-up; nearly all these cases (93.7%, n = 1,065) had high muscularity concerns. The most common transition in concerns or behaviors involved the addition of muscularity concerns to a preoccupation with thinness. Eleven percent of participants used muscle-building products during follow-up. Multi-year product use (23.0% [standard deviation 1.0%] of males who used products) was more common than maintenance of bulimic behaviors (3.0% [.7%] of BN/PD, 10.5% [1.2%] of BED cases). CONCLUSIONS Integrating muscularity concerns and product use into health promotion and screening tools may improve prevention and early detection of harmful body image and weight control among adolescent and young adult males.
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Affiliation(s)
- Kimberly B. Glazer
- Department of Population Health Science & Policy and the Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, New York, USA
| | - Hannah N. Ziobrowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, USA
| | - Nicholas J. Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, Massachusetts, USA
| | - Jerel P. Calzo
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts,Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, California, USA
| | - Alison E. Field
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S121, Floor 2, Providence, Rhode Island, USA,Department of Pediatrics, Warren Alpert Medical School, Providence, Rhode Island, USA
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9
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Voss SE, Horton NJ, Fairbank KE, Xia L, Tinglin LRK, Girardin KD. Measurements of ear-canal cross-sectional areas from live human ears with implications for wideband acoustic immittance measurements. J Acoust Soc Am 2020; 148:3042. [PMID: 33261382 PMCID: PMC7791892 DOI: 10.1121/10.0002358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 05/29/2023]
Abstract
Wideband acoustic immittance (WAI) measures are noninvasive diagnostic measurements that require an estimate of the ear canal's area at the measurement location. Yet, physical measurements of the area at WAI probe locations are lacking. Methods to measure ear-canal areas from silicone molds were developed and applied to 169 subjects, ages 18-75 years. The average areas at the canal's first bend and at 12 mm insertion depth, which are likely WAI probe locations, were 63.4 ± 13.5 and 61.6 ± 13.5 mm2, respectively. These areas are substantially larger than those assumed by current FDA-approved WAI measurement devices as well as areas estimated with acoustical methods or measured on cadaver ears. Left and right ears from the same subject had similar areas. Sex, height, and weight were not significant factors in predicting area. Age cohort was a significant predictor of area, with area increasing with decade of life. A subset of areas from the youngest female subjects did not show an effect of race on area (White or Chinese). Areas were also measured as a function of insertion depth of 4.8-13.2 mm from the canal entrance; area was largest closest to the canal entrance and systematically decreased with insertion depth.
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Affiliation(s)
- Susan E Voss
- Picker Engineering Program, Smith College, Northampton, Massachusetts 01063, USA
| | - Nicholas J Horton
- Department of Mathematics & Statistics, Amherst College, Amherst, Massachusetts 01002, USA
| | - Katherine E Fairbank
- Picker Engineering Program, Smith College, Northampton, Massachusetts 01063, USA
| | - Lu Xia
- Picker Engineering Program, Smith College, Northampton, Massachusetts 01063, USA
| | - Lauren R K Tinglin
- Picker Engineering Program, Smith College, Northampton, Massachusetts 01063, USA
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Ziobrowski HN, Buka SL, Austin SB, Sullivan AJ, Horton NJ, Simone M, Field AE. Using latent class analysis to empirically classify maltreatment according to the developmental timing, duration, and co-occurrence of abuse types. Child Abuse Negl 2020; 107:104574. [PMID: 32531618 PMCID: PMC7494521 DOI: 10.1016/j.chiabu.2020.104574] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/18/2020] [Accepted: 05/29/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Individuals can have vastly different maltreatment experiences depending on the types, developmental timing, and duration of abuse. Women and men may be differentially affected by distinct abuse patterns. OBJECTIVE To examine whether maltreatment subgroups could be identified based on the types, developmental timing, and duration of abuse, and to determine their prevalence among a large, community-based sample. We also examined sex differences in associations of maltreatment subgroups with adverse health outcomes. PARTICIPANTS AND SETTING Data came from 9310 women and men (95 % White) in the United States who responded to the Growing Up Today Study questionnaire in 2007 (aged 19-27 years). METHODS Participants reported on physical, sexual, and emotional abuse occurring in childhood (before age 11 years) and adolescence (ages 11-17 years). We conducted latent class (LC) analyses using indicators for child and adolescent abuse. We examined associations of LCs with health outcomes using sex-stratified log-binomial models with generalized estimated equations. RESULTS We identified five LCs characterized by: 1) no/low abuse (59 %), 2) child physical abuse (16 %), 3) adolescent emotional abuse (9%), 4) child and adolescent physical and emotional abuse (16 %), and 5) child and adolescent sexual abuse (1%). LCs were uniquely associated adult health outcomes among both women and men. Associations of LCs with eating disorder behaviors appeared stronger for men than women. CONCLUSIONS Individuals experience distinct patterns of maltreatment based on the types, developmental timing, and duration of abuse. These patterns are uniquely associated with adverse health outcomes in adulthood, and can be identified using LCA.
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Affiliation(s)
- Hannah N Ziobrowski
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Stephen L Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam J Sullivan
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, MA, USA
| | - Melissa Simone
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Alison E Field
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Channing Division of Network Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
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11
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Ziobrowski HN, Sonneville KR, Eddy KT, Crosby RD, Micali N, Horton NJ, Field AE. Maternal Eating Disorders and Eating Disorder Treatment Among Girls in the Growing Up Today Study. J Adolesc Health 2019; 65:469-475. [PMID: 31277989 PMCID: PMC6755056 DOI: 10.1016/j.jadohealth.2019.04.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of the study was to assess whether girls with mothers who have had an eating disorder (ED) have greater odds of developing ED symptoms and whether girls with ED symptoms have greater odds of receiving ED treatment if their mothers have an ED history. METHODS Data came from 3,649 females in the Growing Up Today Study. Data were collected via questionnaires that were mailed every 12-24 months from 1996 to 2013. Girls who reported on ED treatment in 2013 and whose mothers completed a questionnaire in 2004 about maternal and child EDs were included in main analyses. Generalized estimating equations were used. RESULTS Among complete cases, 28.3% of girls reported symptoms meeting criteria for an ED in at least 1 year and, of these, 12.4% reported receiving treatment. Girls with mothers with ED histories had nearly twice the odds of reporting symptoms of any ED (adjusted odds ratio: 1.89; 95% confidence interval: 1.38-2.60). Girls who reported symptoms meeting criteria for any ED had more than twice the odds of reporting treatment if their mother had an ED history (adjusted odds ratio: 2.23; 95% confidence interval: 1.25-3.99). CONCLUSIONS Girls with mothers with an ED history had greater odds of both reporting ED symptoms and receiving ED treatment. Screening both girls and their mothers for current or previous disordered eating may be important for the prevention and detection of ED symptoms. More research is needed to examine reasons for the association between maternal ED history and ED treatment in girls.
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Affiliation(s)
- Hannah N Ziobrowski
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland; Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, Massachusetts
| | - Alison E Field
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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12
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Glazer KB, Sonneville KR, Micali N, Swanson SA, Crosby R, Horton NJ, Eddy KT, Field AE. The Course of Eating Disorders Involving Bingeing and Purging Among Adolescent Girls: Prevalence, Stability, and Transitions. J Adolesc Health 2019; 64:165-171. [PMID: 30509766 PMCID: PMC10535941 DOI: 10.1016/j.jadohealth.2018.09.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To quantify eating disorder (ED) stability and diagnostic transition among a community-based sample of adolescents and young adult females in the United States. METHODS Using 11 prospective assessments from 9,031 U.S. females ages 9-15 years at baseline of the Growing Up Today Study, we classified cases of the following EDs involving bingeing and purging: bulimia nervosa (BN), binge ED, purging disorder (PD), and subthreshold variants defined by less frequent (monthly vs. weekly) bingeing and purging behaviors. We measured number of years symptomatic and probability of maintaining symptoms, crossing to another diagnosis, or resolving symptoms across consecutive surveys. RESULTS Study lifetime disorder prevalence was 2.1% for BN and roughly 6% each for binge ED and PD. Most cases reported symptoms during only one survey year. Twenty-six percent of cases crossed between diagnoses during follow-up. Among participants meeting full threshold diagnostic criteria, transition from BN was most prevalent, crossing most frequently from BN to PD (12.9% of BN cases). Within each disorder phenotype, 20%-40% of cases moved between subthreshold and full threshold criteria across consecutive surveys. CONCLUSIONS Diagnostic crossover is not rare among adolescent and young adult females with an ED. Transition patterns from BN to PD add support for considering these classifications in the same diagnostic category of disorders that involve purging. The prevalence of crossover between monthly and weekly symptom frequency suggests that a continuum or staging approach may increase utility of ED classification for prognostic and therapeutic intervention.
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Affiliation(s)
- Kimberly B Glazer
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
| | | | - Nadia Micali
- Child and Adolescent Psychiatry Division, University of Geneva, DEA, HUG, Geneva, Switzerland; Institute of Child Health, University College London, London, United Kingdom
| | - Sonja A Swanson
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ross Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, Massachusetts
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alison E Field
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; Department of Pediatrics, Warren Alpert Medical School, Providence, Rhode Island
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Wang X, Reich NG, Horton NJ. Enriching Students’ Conceptual Understanding of Confidence Intervals: An Interactive Trivia-Based Classroom Activity. AM STAT 2019. [DOI: 10.1080/00031305.2017.1305294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Xiaofei Wang
- Department of Statistics and Data Science, Yale University, New Haven, CT
| | - Nicholas G. Reich
- Department of Biostatistics and Epidemiology, University of Massachusetts at Amherst, Amherst, MA
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Walton K, Horton NJ, Rifas-Shiman SL, Field AE, Austin SB, Haycraft E, Breen A, Haines J. Exploring the Role of Family Functioning in the Association Between Frequency of Family Dinners and Dietary Intake Among Adolescents and Young Adults. JAMA Netw Open 2018; 1:e185217. [PMID: 30646382 PMCID: PMC6324390 DOI: 10.1001/jamanetworkopen.2018.5217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Eating meals, particularly dinner, with family members has been associated with improved dietary intake among youths. However, existing studies have not examined how family functioning may moderate or confound this association. OBJECTIVE To examine whether level of family functioning is associated cross-sectionally with frequency of family dinners and dietary intake among a US national sample of adolescents and young adults. DESIGN, SETTING, AND PARTICIPANTS Data from the 2011 questionnaire in the Growing Up Today Study 2 were used for this cross-sectional study. Linear regression models examined the extent to which family dinner frequency was associated with self-reported intake of fruits and vegetables, sugar-sweetened beverages, fast food, and takeout food among 2728 adolescents and young adults (age, 14-24 years). To explore effect modification by family functioning, an interaction term for family functioning and family dinner frequency was included for each dietary outcome. To explore confounding, models adjusted for family functioning were run. All models were stratified by sex and included participant age, educational attainment of mother's spouse or partner, and family structure as covariates. Statistical analysis was conducted between January 1, 2017, and August 31, 2018. MAIN OUTCOMES AND MEASURES Dietary intake measured by consumption of fruits and vegetables, sugar-sweetened beverages, takeout food, and fast food; family dinner frequency per week; and family functioning. RESULTS Among the 2728 participants, there were 1559 female and 1169 male participants who were 14 to 24 years of age (mean [SD] age, 19.4 [1.9] years) and were living with their parents in 2011. Most participants (2453 of 2649 [92.6%]) identified as white. More frequent family dinners were associated with higher-quality dietary intake regardless of level of family functioning; interactions between family functioning and family dinner frequency were not significant. Associations between family meal frequency and dietary intake outcomes did not change substantively when adjusting for family functioning. In adjusted models, more frequent family dinners were associated with higher intakes of fruits (female participants: β, 0.09 servings/d; 95% CI, 0.04-0.15 servings/d; male participants: β, 0.07 servings/d; 95% CI, 0.01-0.12 servings/d) and vegetables (female participants: β, 0.21 servings/d; 95% CI, 0.12-0.30 servings/d; male participants: β, 0.19 servings/d; 95% CI, 0.09-0.30 servings/d), and lower intakes of fast food (female participants: β, -0.04 times/wk; 95% CI, -0.07 to 0.00 times/wk; male participants: β, -0.10 times/wk; 95% CI, -0.15 to -0.04 times/wk) and takeout foods (female participants: β, -0.04 times/wk; 95% CI, -0.07 to -0.01 times/wk; male participants: β, -0.06 times/wk; 95% CI, -0.10 to -0.02 times/wk). More frequent family dinners were associated with lower intake of sugar-sweetened beverages for male participants only (β, -0.07 servings/d; 95% CI, -0.13 to -0.02 servings/d). CONCLUSIONS AND RELEVANCE More frequent family dinners are associated with healthful dietary intakes among youths, regardless of level of family functioning. Family dinners may be an appropriate intervention target for improving dietary intake among youths.
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Affiliation(s)
- Kathryn Walton
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Nicholas J. Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Harvard Pilgrim Health Care Institute, Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Alison E. Field
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - S. Bryn Austin
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Andrea Breen
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
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15
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Colman I, Kingsbury M, Sucha E, Horton NJ, Murphy JM, Gilman SE. Depressive and anxious symptoms and 20-year mortality: Evidence from the Stirling County study. Depress Anxiety 2018; 35:638-647. [PMID: 29719088 PMCID: PMC6035782 DOI: 10.1002/da.22750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/10/2018] [Accepted: 02/17/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Depression and anxiety disorders are highly comorbid, and share significant symptom overlap. Whereas depression has been consistently associated with excess mortality, the association between anxiety and mortality is less clear. Our aim was to identify constellations of anxious and depressive symptoms and examine their associations with mortality. METHOD This study considers respondents from the 1970 (n = 1203) and 1992 (n = 1402) cohorts of the Stirling County study. Symptoms of depression and anxiety were assessed using structured at-home interviews. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. RESULTS Exploratory factor analysis yielded three correlated factors in each cohort. Items loading on each factor varied slightly between cohorts, but roughly corresponded to (1) depressive symptoms, (2) anxious symptoms, and (3) somatic symptoms. The depressive factor was associated with increased risk of mortality in both the 1970 (HR: 1.35, 95% CI: 1.12, 1.62) and 1992 (HR: 1.25, 95% CI: 1.05, 1.48) cohorts. Anxious symptoms were associated with a reduced risk of mortality in the 1992 sample (HR: 0.72; 95% CI: 0.53, 0.90). Somatic symptoms were associated with a reduced risk of mortality in the 1970 sample (HR: 0.83, 95% CI: 0.69, 0.99), but an elevated risk of mortality in the 1992 sample (HR: 1.29; 95% CI: 1.11, 1.51). CONCLUSIONS This study provides evidence that symptoms of depression and anxiety may have differential associations with early mortality. Somatic symptoms such as upset stomach and loss of appetite may be protective against mortality, perhaps through increased use of health care services. Conversely, symptoms such as weakness and cold sweats may be indicative of failing health.
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Affiliation(s)
- Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ewa Sucha
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Jane M. Murphy
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA; Department of Psychiatry, Dalhousie University Faculty of Medicine, Halifax, NS, Canada
| | - Stephen E. Gilman
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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16
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Bell ML, Horton NJ, Dhillon HM, Bray VJ, Vardy J. Using generalized estimating equations and extensions in randomized trials with missing longitudinal patient reported outcome data. Psychooncology 2018; 27:2125-2131. [DOI: 10.1002/pon.4777] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/16/2018] [Accepted: 05/18/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Melanie L. Bell
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health; University of Arizona; Tucson AZ USA
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology; University of Sydney; Sydney New South Wales Australia
| | - Nicholas J. Horton
- Department of Mathematics and Statistics, Amherst College; Amherst MA USA
| | - Haryana M. Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology; University of Sydney; Sydney New South Wales Australia
- Department of Medical Oncology, Liverpool Hospital; Sydney New South Wales Australia
| | - Victoria J. Bray
- Department of Medical Oncology, Liverpool Hospital; Sydney New South Wales Australia
- University of Sydney; Sydney New South Wales Australia
| | - Janette Vardy
- University of Sydney; Sydney New South Wales Australia
- Concord Cancer Centre; Sydney New South Wales Australia
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Abstract
BACKGROUND Power reflectance measurements are an active area of research related to the development of noninvasive middle-ear assessment methods. There are limited data related to test-retest measures of power reflectance. PURPOSE This study investigates test-retest features of power reflectance, including comparisons of intrasubject versus intersubject variability and how ear-canal measurement location affects measurements. RESEARCH DESIGN Repeated measurements of power reflectance were made at about weekly intervals. The subjects returned for four to eight sessions. Measurements were made at three ear-canal locations: a deep insertion depth (with a foam plug flush at the entrance to the ear canal) and both 3 and 6 mm more lateral to this deep insertion. STUDY SAMPLE Repeated measurements on seven subjects are reported. All subjects were female, between 19 and 22 yr old, and enrolled at an undergraduate women's college. DATA COLLECTION AND ANALYSIS Measurements on both the right and left ears were made at three ear-canal locations during each of four to eight measurement sessions. Random-effects regression models were used for the analysis to account for repeated measures within subjects. The mean power reflectance for each position over all sessions was calculated for each subject. RESULTS The comparison of power reflectance from the left and right ears of an individual subject varied greatly over the seven subjects; the difference between the power reflectance measured on the left and that measured on the right was compared at 248 frequencies, and depending on the subject, the percentage of tested frequencies for which the left and right ears differed significantly ranged from 10% to 93% (some with left values greater than right values and others with the opposite pattern). Although the individual subjects showed left-right differences, the overall population generally did not show significant differences between the left and right ears. The mean power reflectance for each measurement position over all sessions depended on the location of the probe in the ear for frequencies of less than 1000 Hz. The standard deviation between subjects' mean power reflectance after controlling for ear (left or right) was found to be greater than the standard deviation within the individual subject's mean power reflectance. The intrasubject standard deviation in power reflectance was smallest at the deepest insertion depths. CONCLUSIONS All subjects had differences in power reflectance between their left and right ears at some frequencies; the percentage of frequencies at which differences occurred varied greatly across subjects. The intrasubject standard deviations were smallest for the deepest probe insertion depths, suggesting clinical measurements should be made with as deep an insertion as practically possible to minimize variability. This deep insertion will reduce both acoustic leaks and the effect of low-frequency ear-canal losses. The within-subject standard deviations were about half the magnitude of the overall standard deviations, quantifying the extent of intrasubject versus intersubject variability.
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Affiliation(s)
- Defne Abur
- Picker Engineering Program, Ford Hall, Smith College, Northampton, MA
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, MA
| | - Susan E Voss
- Picker Engineering Program, Ford Hall, Smith College, Northampton, MA
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McNamara A, Horton NJ. Wrangling Categorical Data in R. AM STAT 2018. [DOI: 10.1080/00031305.2017.1356375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amelia McNamara
- Program in Statistical and Data Sciences, Smith College, Northampton, MA
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19
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White IR, Carpenter J, Horton NJ. A mean score method for sensitivity analysis to departures from the missing at random assumption in randomised trials. Stat Sin 2018; 28:1985-2003. [PMID: 30283213 DOI: 10.5705/ss.202016.0308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Most analyses of randomised trials with incomplete outcomes make untestable assumptions and should therefore be subjected to sensitivity analyses. However, methods for sensitivity analyses are not widely used. We propose a mean score approach for exploring global sensitivity to departures from missing at random or other assumptions about incomplete outcome data in a randomised trial. We assume a single outcome analysed under a generalised linear model. One or more sensitivity parameters, specified by the user, measure the degree of departure from missing at random in a pattern mixture model. Advantages of our method are that its sensitivity parameters are relatively easy to interpret and so can be elicited from subject matter experts; it is fast and non-stochastic; and its point estimate, standard error and confidence interval agree perfectly with standard methods when particular values of the sensitivity parameters make those standard methods appropriate. We illustrate the method using data from a mental health trial.
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Affiliation(s)
- Ian R White
- MRC Biostatistics Unit, Cambridge, UK.,MRC Clinical Trials Unit at UCL, London, UK
| | - James Carpenter
- MRC Clinical Trials Unit at UCL, London, UK.,London School of Hygiene and Tropical Medicine, UK
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21
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Gilman SE, Sucha E, Kingsbury M, Horton NJ, Murphy JM, Colman I. Depression and mortality in a longitudinal study: 1952-2011. CMAJ 2017; 189:E1304-E1310. [PMID: 29061855 DOI: 10.1503/cmaj.170125] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Many studies have shown that depression increases mortality risk. We aimed to investigate the duration of time over which depression is associated with increased risk of mortality, secular trends in the association between depression and mortality, and sex differences in the association between depression and mortality. METHODS We conducted a cohort study of 3410 adults enrolled in 3 representative samples of a county in Atlantic Canada in 1952 (n = 1003), 1970 (n = 1203) or 1992 (n = 1402) (the Stirling County Study). Depression was measured using a diagnostic algorithm based on the presence of depressed mood and associated symptoms, duration of more than 1 month, and substantial impairment. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. RESULTS Depression was associated with a heightened risk of mortality among men during the 3 time periods of the study, with hazard ratios (HRs) of 2.90 (95% confidence interval [CI] 1.69-4.98) between 1952 and 1967, 1.97 (CI 1.34-2.89) between 1968 and 1990, and 1.52 (CI 1.09-2.13) between 1991 and 2011. Elevated risk of mortality was noted among women only between 1990 and 2011 (HR = 1.51; CI = 1.11-2.05). INTERPRETATION The association between depression and mortality persists over long periods of time and has emerged among women in recent decades, despite contemporaneous improvements in the treatment of depression and reduction of stigma associated with depression. Further research is needed to better understand the mechanisms involved.
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Affiliation(s)
- Stephen E Gilman
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont.
| | - Ewa Sucha
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
| | - Mila Kingsbury
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
| | - Nicholas J Horton
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
| | - Jane M Murphy
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
| | - Ian Colman
- Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont
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Katz LA, Aloisio KM, Horton NJ, Ly M, Pruss S, Queeney K, Rowen C, DiBartolo PM. A Program Aimed toward Inclusive Excellence for Underrepresented Undergraduate Women in the Sciences. CBE Life Sci Educ 2017; 16:16/1/ar11. [PMID: 28213581 PMCID: PMC5332037 DOI: 10.1187/cbe.16-01-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 05/11/2023]
Abstract
Created to foster inclusive excellence, Smith College's Achieving Excellence in Mathematics, Engineering, and Science (AEMES) Scholars program provides early faculty-mentored research opportunities and other programming as a way to foster success in academic outcomes for underrepresented women in science. Using academic record data, we compared Scholars' outcomes over time with those of underrepresented students before program launch and to relevant peer comparison groups. Since its launch, AEMES Scholars have achieved significantly higher gateway life sciences course grade point averages (GPAs), rates of persistence in life and natural sciences, and participation in natural sciences advanced research relative to baseline. Gains for Scholars in gateway course GPA eliminated the significant gap that previously existed between science, technology, engineering, and mathematics (STEM)-underrepresented and other students, whereas gains in natural sciences persistence now has Scholars continuing in STEM at significantly higher rates than all other students. Many of the gains for AEMES Scholars were echoed in findings of improved outcomes for our STEM students overall since AEMES' launch. Underrepresented students who were not part of the Scholars program also evidenced increased gateway course GPA over this same period. We discuss potential explanations for these outcomes and ongoing work aimed at achieving further inclusive excellence for women in the sciences.
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Affiliation(s)
- Laura A Katz
- Department of Biological Sciences, Smith College, Northampton, MA 01063
| | | | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, MA 01002
| | - Minh Ly
- Institutional Research, Smith College, Northampton, MA 01063
| | - Sara Pruss
- Department of Geosciences, Smith College, Northampton, MA 01063
| | - Kate Queeney
- Department of Chemistry, Smith College, Northampton, MA 01063
| | - Cate Rowen
- Institutional Research, Smith College, Northampton, MA 01063
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Williams MA, Malm J, Eklund A, Horton NJ, Voss SE. Distortion Product Otoacoustic Emissions and Intracranial Pressure During CSF Infusion Testing. Aerosp Med Hum Perform 2016; 87:844-851. [PMID: 27662346 DOI: 10.3357/amhp.4572.2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND A noninvasive method to monitor changes in intracranial pressure (ICP) is required for astronauts on long-duration spaceflight who are at risk of developing the Visual Impairment/Intracranial Pressure syndrome that has some, but not all of the features of idiopathic intracranial hypertension. We assessed the validity of distortion product otoacoustic emissions (DPOAEs) to detect changes in ICP. METHODS Subjects were eight patients undergoing medically necessary diagnostic cerebrospinal fluid (CSF) infusion testing for hydrocephalus. DPOAE measurements were obtained with an FDA-approved system at baseline and six controlled ICP levels in ∼3 mmHg increments in random order, with a range from 10.8 ± 2.9 mmHg (SD) at baseline to 32.3 ± 4.1 mmHg (SD) at level 6. RESULTS For f2 frequencies between 800 and 1700 Hz, when ICP was ≥ 12 mmHg above baseline ICP, DPOAE angles increased significantly and DPOAE magnitudes decreased significantly, but less robustly. DISCUSSION Significant changes in DPOAE angle and magnitude are seen when ICP is ≥ 12 mmHg above a subject's supine baseline ICP during CSF infusion testing. These results suggest that the changes in DPOAE angle and magnitude seen with change in ICP are physiologically based, and suggest that it should be possible to detect pathological ICP elevation using DPOAE measurements. To use DPOAE for noninvasive estimation of ICP during spaceflight will require baseline measurements in the head-up, supine, and head-down positions to obtain baseline DPOAE values at different ICP ranges. Williams MA, Malm J, Eklund A, Horton NJ, Voss SE. Distortion product otoacoustic emissions and intracranial pressure during CSF infusion testing. Aerosp Med Hum Perform. 2016; 87(10):844-851.
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Affiliation(s)
- Michael A Williams
- Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
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Calzo JP, Horton NJ, Sonneville KR, Swanson S, Crosby RD, Micali N, Eddy KT, Field AE. Male Eating Disorder Symptom Patterns and Health Correlates From 13 to 26 Years of Age. J Am Acad Child Adolesc Psychiatry 2016; 55:693-700.e2. [PMID: 27453083 PMCID: PMC4964795 DOI: 10.1016/j.jaac.2016.05.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/04/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Research on the manifestations and health correlates of eating disorder symptoms among males is lacking. This study identified patterns of appearance concerns and eating disorder behaviors from adolescence through young adulthood and their health correlates. METHOD Participants were 7,067 males from the prospective Growing Up Today Study. Surveys from 1999 to 2007 (spanning ages 13-26 years) provided repeated measures data on muscularity and leanness concerns, eating disorder behaviors (purging, overeating, binge eating, use of muscle-building products), and health correlates (obesity, non-marijuana drug use, binge drinking, and depressive symptoms). RESULTS Latent class analyses of observations at ages 13 to 15, 16 to 18, 19 to 22, and 23 to 26 years identified 1 large Asymptomatic class and 4 symptomatic patterns: Body Image Disturbance (high appearance concerns, low eating disorder behaviors; 1.0%-6.0% per age period); Binge Eating/Purging (binge eating and purging, use of muscle-building products, low appearance concerns; 0.1%-2.5%); Mostly Asymptomatic (low levels of muscularity concern, product use, and overeating; 3.5%-5.0%); and Muscularity Concerns (high muscularity concerns and use of products; 0.6%-1.0%). The Body Image Disturbance class was associated with high estimated prevalence of depressive symptoms. Males in the Binge Eating/Purging and Muscularity Concerns classes had high prevalence of binge drinking and drug use. Despite exhibiting modestly greater appearance concerns and eating disorder behaviors than the Asymptomatic class, being in the Mostly Asymptomatic class was prospectively associated with adverse health outcomes. CONCLUSION Results underscore the importance of measuring concerns about leanness, muscularity, and use of muscle-building products when assessing eating disorder presentations among males in research and clinical settings.
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Haines J, Rifas-Shiman SL, Horton NJ, Kleinman K, Bauer KW, Davison KK, Walton K, Austin SB, Field AE, Gillman MW. Family functioning and quality of parent-adolescent relationship: cross-sectional associations with adolescent weight-related behaviors and weight status. Int J Behav Nutr Phys Act 2016; 13:68. [PMID: 27301414 PMCID: PMC4908682 DOI: 10.1186/s12966-016-0393-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about how factors within the general family environment are associated with weight and related behaviors among adolescents/young adults. METHODS We studied 3768 females and 2614 males, 14-24 years old in 2011, participating in the Growing Up Today Study 2. We used generalized mixed models to examine cross-sectional associations of family functioning and quality of mother- and father-adolescent relationship with adolescent/young adult weight status, disordered eating, intake of fast food and sugar-sweetened beverages, screen time, physical activity, and sleep duration. In all models, we included participant's age and family structure. RESULTS Eighty percent of participants reported high family functioning and 60% and 50% of participants reported high-quality mother and father relationship, respectively. Among both males and females, high family functioning was associated with lower odds of disordered eating (adjusted odds ratio [AOR] females = 0.53; 95% Confidence Interval [CI] = 0.45-0.63; AOR males = 0.48; CI = 0.39-0.60), insufficient physical activity, i.e., less than 1 h/day, (AOR females = 0.74; CI = 0.61-0.89; AOR males = 0.73; CI = 0.58-0.92), and insufficient sleep, i.e., less than 7 h/day, (AOR females = 0.56; CI = 0.45-0.68; AOR males = 0.65; CI 0.5-0.85). High family functioning was also associated with lower odds of being overweight/obese (AOR = 0.73; CI = 0.60-0.88) and eating fast food one or more times/week (AOR = 0.74; CI = 0.61-0.89) among females only. Among females, high-quality mother and father relationship were both associated with lower odds of being overweight/obese and disordered eating, eating fast food, and insufficient sleep and the magnitude of associations were similar for mother and father relationship quality (AOR range 0.61-0.84). Among males, high-quality mother and father relationship were both associated with lower odds of disordered eating, insufficient physical activity and insufficient sleep, but only father relationship quality was associated with lower odds of overweight/obesity. CONCLUSIONS Adolescents/young adults reporting high family functioning and more positive relationships with their parents reported better weight-related behaviors. For weight status, females appear to be affected equally by the quality of their relationship with both parents, whereas males may be more affected by their relationship with fathers.
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Affiliation(s)
- Jess Haines
- Department of Family Relations and Applied Nutrition, Room 226, Macdonald Stewart Hall, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2 W1, Canada.
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, USA
| | - Ken Kleinman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, USA
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, USA
| | - Kirsten K Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Kathryn Walton
- Department of Family Relations and Applied Nutrition, Room 226, Macdonald Stewart Hall, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2 W1, Canada
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Alison E Field
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
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Walton K, Kleinman KP, Rifas-Shiman SL, Horton NJ, Gillman MW, Field AE, Austin SB, Neumark-Sztainer D, Haines J. Secular trends in family dinner frequency among adolescents. BMC Res Notes 2016; 9:35. [PMID: 26795723 PMCID: PMC4722777 DOI: 10.1186/s13104-016-1856-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/12/2016] [Indexed: 11/24/2022] Open
Abstract
Background Eating meals, particularly dinner, with family members has been found to be associated with improved dietary intake, lower prevalence of disordered eating behaviors, lower levels of substance abuse, and improved academic outcomes among adolescents. Limited research has examined how the frequency of family meals has changed over time. The objective of this study was to examine secular trends in family dinner frequency over a 12-year period using a large, nation-wide sample of adolescents. Methods Using data from two cohorts of the Growing up Today study (GUTS; n = 18,075 observations for 14,79,714 and 15 year olds), we compared family dinner frequency among 14–15-year-olds in 1996 (GUTS1) through 2008 (GUTS2) and rate of change in family dinner frequency from 1996 to 1998 (GUTS1) and 2004–2008 (GUTS2). We fit logistic models using generalized estimating equations with independence working correlation and empirical variance to account for correlation within individual and between siblings. Results From 1996 to 2008, the number of family dinners per week among males decreased from 5.3 to 4.6 (p = 0.04) and among females from 5.0 to 4.4 (p = 0.03). We found that the rate of decline in frequency of family meals was consistent in GUTS1 (1996–1998) and GUTS2 (2004–2008) among both males and females. Conclusions From 1996 to 2008, frequency of family dinners decreased among adolescents. Future research should explore reasons for this decline as well as strategies to increase family meals among adolescents.
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Affiliation(s)
- Kathryn Walton
- Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
| | - Ken P Kleinman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA.
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA.
| | - Nicholas J Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, USA.
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA. .,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Alison E Field
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, USA. .,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, USA. .,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA.
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
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Horton NJ, Hardin JS. Teaching the Next Generation of Statistics Students to “Think With Data”: Special Issue on Statistics and the Undergraduate Curriculum. AM STAT 2015. [DOI: 10.1080/00031305.2015.1094283] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hardin J, Hoerl R, Horton NJ, Nolan D, Baumer B, Hall-Holt O, Murrell P, Peng R, Roback P, Temple Lang D, Ward MD. Data Science in Statistics Curricula: Preparing Students to “Think with Data”. AM STAT 2015. [DOI: 10.1080/00031305.2015.1077729] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bershad EM, Urfy MZ, Pechacek A, McGrath M, Calvillo E, Horton NJ, Voss SE. Intracranial pressure modulates distortion product otoacoustic emissions: a proof-of-principle study. Neurosurgery 2015; 75:445-54; discussion 454-5. [PMID: 24871147 DOI: 10.1227/neu.0000000000000449] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is an important need to develop a noninvasive method for assessing intracranial pressure (ICP). We report a novel approach for monitoring ICP using cochlear-derived distortion product otoacoustic emissions (DPOAEs), which are affected by ICP. OBJECTIVE We hypothesized that changes in ICP may be reflected by altered DPOAE responses via an associated change in perilymphatic pressure. METHODS We measured the ICP and DPOAEs (magnitude and phase angle) during opening and closing in 20 patients undergoing lumbar puncture. RESULTS We collected data on 18 patients and grouped them based on small (<4 mm Hg), medium (5-11 mm Hg), or large (≥15 mm Hg) ICP changes. A permutation test was applied in each group to determine whether changes in DPOAEs differed from zero when ICP changed. We report significant changes in the DPOAE magnitudes and angles, respectively, for the group with the largest ICP changes and no changes for the group with the smallest changes; the group with medium changes had variable DPOAE changes. CONCLUSION We report, for the first time, systematic changes in DPOAE magnitudes and phase in response to acute ICP changes. Future studies are warranted to further develop this new approach. ABBREVIATIONS DPOAE, distortion product otoacoustic emissionICP, intracranial pressureIIH, idiopathic intracranial hypertensionLP, lumbar punctureTBI, traumatic brain injury.
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Affiliation(s)
- Eric M Bershad
- *Baylor College of Medicine, Department of Neurology, Houston, Texas; ‡Smith College, Department of Engineering, Northampton, Massachusetts; §Amherst College, Department of Mathematics and Statistics, Amherst, Massachusetts
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Micali N, Solmi F, Horton NJ, Crosby RD, Eddy KT, Calzo JP, Sonneville KR, Swanson SA, Field AE. Adolescent Eating Disorders Predict Psychiatric, High-Risk Behaviors and Weight Outcomes in Young Adulthood. J Am Acad Child Adolesc Psychiatry 2015; 54. [PMID: 26210334 PMCID: PMC4515576 DOI: 10.1016/j.jaac.2015.05.009] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate whether anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorders (OSFED), including purging disorder (PD), subthreshold BN, and BED at ages 14 and 16 years, are prospectively associated with later depression, anxiety disorders, alcohol and substance use, and self-harm. METHOD Eating disorders were ascertained at ages 14 and 16 years in 6,140 youth at age 14 (58% of those eligible) and 5,069 at age 16 (52% of those eligible) as part of the prospective Avon Longitudinal Study of Parents and Children (ALSPAC). Outcomes (depression, anxiety disorders, binge drinking, drug use, deliberate self-harm, weight status) were measured using interviews and questionnaires about 2 years after predictors. Generalized estimating equation models adjusting for gender, socio-demographic variables, and prior outcome were used to examine prospective associations between eating disorders and each outcome. RESULTS All eating disorders were predictive of later anxiety disorders. AN, BN, BED, PD, and OSFED were prospectively associated with depression (respectively AN: odds ratio [OR] = 1.39, 95% CI = 1.00-1.94; BN: OR = 3.39, 95% CI = 1.25-9.20; BED: OR = 2.00, 95% CI = 1.06-3.75; and PD: OR = 2.56, 95% CI = 1.38-4.74). All eating disorders but AN predicted drug use and deliberate self-harm (BN: OR = 5.72, 95% CI = 2.22-14.72; PD: OR = 4.88, 95% CI = 2.78-8.57; subthreshold BN: OR = 3.97, 95% CI = 1.44-10.98; and subthreshold BED: OR = 2.32, 95% CI = 1.43-3.75). Although BED and BN predicted obesity (respectively OR = 3.58, 95% CI = 1.06-12.14 and OR = 6.42, 95% CI = 1.69-24.30), AN was prospectively associated with underweight. CONCLUSIONS Adolescent eating disorders, including subthreshold presentations, predict negative outcomes, including mental health disorders, substance use, deliberate self-harm, and weight outcomes. This study highlights the high public health and clinical burden of eating disorders among adolescents.
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Affiliation(s)
- Nadia Micali
- Institute of Child Health, Child and Adolescent Mental Health Palliative Care and Pediatrics Section, University College London, and Icahn School of Medicine at Mount Sinai, New York.
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Williams MA, Voss SE, Horton NJ, Malm J, Eklund A. Comparison of invasive ICP measurements to Distortion Product Otoacoustic Emissions (DPOAE) in adults during infusion testing for INPH. Fluids Barriers CNS 2015. [PMCID: PMC4582894 DOI: 10.1186/2045-8118-12-s1-o60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sonneville KR, Calzo JP, Horton NJ, Field AE, Crosby RD, Solmi F, Micali N. Childhood hyperactivity/inattention and eating disturbances predict binge eating in adolescence. Psychol Med 2015; 45:2511-2520. [PMID: 26098685 PMCID: PMC4655585 DOI: 10.1017/s0033291715000148] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identifying childhood predictors of binge eating and understanding risk mechanisms could help improve prevention and detection efforts. The aim of this study was to examine whether features of attention-deficit/hyperactivity disorder (ADHD), as well as childhood eating disturbances, predicted binge eating later in adolescence. METHOD We studied specific risk factors for the development of binge eating during mid-adolescence among 7120 males and females from the Avon Longitudinal Study of Parents and Children (ALSPAC), a cohort study of children in the UK, using data from multiple informants to develop structural equation models. Repeated assessment of eating disturbances during childhood (mid-childhood overeating, late-childhood overeating and early-adolescent strong desire for food), as well as teacher- and parent-reported hyperactivity/inattention during mid- and late childhood, were considered as possible predictors of mid-adolescent binge eating. RESULTS Prevalence of binge eating during mid-adolescence in our sample was 11.6%. The final model of predictors of binge eating during mid-adolescence included direct effects of late-childhood overeating [standardized estimate 0.145, 95% confidence interval (CI) 0.038–0.259, p = 0.009] and early-adolescent strong desire for food (standardized estimate 0.088, 95% CI −0.002 to 0.169, p = 0.05). Hyperactivity/inattention during late childhood indirectly predicted binge eating during mid-adolescence (standardized estimate 0.085, 95% CI 0.007–0.128, p = 0.03) via late-childhood overeating and early-adolescent strong desire for food. CONCLUSIONS Our findings indicate that early ADHD symptoms, in addition to an overeating phenotype, contribute to risk for adolescent binge eating. These findings lend support to the potential role of hyperactivity/inattention in the development of overeating and binge eating.
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Solmi F, Sonneville KR, Easter A, Horton NJ, Crosby RD, Treasure J, Rodriguez A, Jarvelin MR, Field AE, Micali N. Prevalence of purging at age 16 and associations with negative outcomes among girls in three community-based cohorts. J Child Psychol Psychiatry 2015; 56:87-96. [PMID: 24975817 PMCID: PMC4303957 DOI: 10.1111/jcpp.12283] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The comorbidity of purging behaviours, such as vomiting, inappropriate use of laxatives, diuretics or slimming medications, has been examined in literature. However, most studies do not include adolescents, individuals who purge in the absence of binge eating, or those purging at subclinical frequency. This study examines the prevalence of purging among 16-year-old girls across three countries and their association with substance use and psychological comorbidity. METHODS Data were obtained by questionnaire in 3 population-based cohorts (Avon Longitudinal Study of Parents and Children (ALSPAC), United Kingdom, n = 1,608; Growing Up Today Study (GUTS), USA, n = 3,504; North Finland Birth Cohort (NFBC85/86), Finland, n = 2,306). Multivariate logistic regressions were employed to estimate associations between purging and outcomes. Four models were fit adjusting for binge eating and potential confounders of these associations. RESULTS In ALSPAC, 9.7% of girls reported purging in the 12-months prior to assessment, 7.3% in GUTS, and 3.5% in NFBC. In all 3 cohorts, purging was associated with adverse outcomes such as binge drinking (ALSPAC: odds ratio (OR) = 2.0, 95% confidence interval (CI) = 1.4-2.9; GUTS: OR = 2.5, 95% CI = 1.5-4.0; NFBC: OR = 1.7, 95% CI = 1.0-2.8), drug use (ALSPAC: OR = 2.9, 95% CI = 1.8-4.7; GUTS: OR = 4.5, 95% CI = 2.8-7.3; NFBC: OR = 4.1, 95% CI = 2.6-6.6), depressive symptoms in ALSPAC (OR = 2.2, 95% CI = 1.5-3.1) and GUTS(OR = 3.7, 95% CI = 2.2-6.3), and several psychopathology measures including clinical anxiety/depression in NFBC (OR = 11.2, 95% CI = 3.9, 31.7). CONCLUSIONS Results show a higher prevalence of purging behaviours among girls in the United Kingdom compared to those in the United States and Finland. Our findings support evidence highlighting that purging in adolescence is associated with negative outcomes, independent of its frequency and binge eating.
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Affiliation(s)
- Francesca Solmi
- Behavioural & Brain Sciences Unit, Institute of Child Health, University College LondonLondon, UK
| | - Kendrin R Sonneville
- Division of Adolescence Medicine, Boston's Children Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Abigail Easter
- Behavioural & Brain Sciences Unit, Institute of Child Health, University College LondonLondon, UK
| | - Nicholas J Horton
- Department of Mathematics & Statistics, Amherst CollegeAmherst, MA, USA
| | - Ross D Crosby
- Department of Neuroscience, Neuropsychiatric Research Institute, University of North DakotaFargo, ND, USA
| | - Janet Treasure
- Eating Disorder Unit, Institute of Psychiatry, King's College LondonLondon, UK
| | - Alina Rodriguez
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College LondonLondon, UK,Mid Sweden University, Department of Psychology, Campus ÖstersundÖstersund, Sweden
| | - Marjo-Riitta Jarvelin
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College LondonLondon, UK,Institute of Health Sciences, University of OuluOulu, Finland,Biocenter Oulu, University of OuluOulu, Finland,Unit of Primary Care, Oulu University Hospital, OYSOulu, Finland,Department of Children and Young People and Families, National Institute for Health and WelfareOulu, Finland
| | - Alison E Field
- Division of Adolescence Medicine, Boston's Children Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Nadia Micali
- Behavioural & Brain Sciences Unit, Institute of Child Health, University College LondonLondon, UK
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Bell ML, Fiero M, Horton NJ, Hsu CH. Handling missing data in RCTs; a review of the top medical journals. BMC Med Res Methodol 2014; 14:118. [PMID: 25407057 PMCID: PMC4247714 DOI: 10.1186/1471-2288-14-118] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/30/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Missing outcome data is a threat to the validity of treatment effect estimates in randomized controlled trials. We aimed to evaluate the extent, handling, and sensitivity analysis of missing data and intention-to-treat (ITT) analysis of randomized controlled trials (RCTs) in top tier medical journals, and compare our findings with previous reviews related to missing data and ITT in RCTs. METHODS Review of RCTs published between July and December 2013 in the BMJ, JAMA, Lancet, and New England Journal of Medicine, excluding cluster randomized trials and trials whose primary outcome was survival. RESULTS Of the 77 identified eligible articles, 73 (95%) reported some missing outcome data. The median percentage of participants with a missing outcome was 9% (range 0 - 70%). The most commonly used method to handle missing data in the primary analysis was complete case analysis (33, 45%), while 20 (27%) performed simple imputation, 15 (19%) used model based methods, and 6 (8%) used multiple imputation. 27 (35%) trials with missing data reported a sensitivity analysis. However, most did not alter the assumptions of missing data from the primary analysis. Reports of ITT or modified ITT were found in 52 (85%) trials, with 21 (40%) of them including all randomized participants. A comparison to a review of trials reported in 2001 showed that missing data rates and approaches are similar, but the use of the term ITT has increased, as has the report of sensitivity analysis. CONCLUSIONS Missing outcome data continues to be a common problem in RCTs. Definitions of the ITT approach remain inconsistent across trials. A large gap is apparent between statistical methods research related to missing data and use of these methods in application settings, including RCTs in top medical journals.
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Affiliation(s)
- Melanie L Bell
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA.
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Swanson SA, Horton NJ, Crosby RD, Micali N, Sonneville KR, Eddy K, Field AE. A latent class analysis to empirically describe eating disorders through developmental stages. Int J Eat Disord 2014; 47:762-72. [PMID: 24909947 PMCID: PMC4211958 DOI: 10.1002/eat.22308] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/18/2014] [Accepted: 05/20/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The current standards for classifying eating disorders were primarily informed by adult, clinical study populations, while it is unknown whether an empirically based classification system can be supported across preadolescence through young adulthood. Using latent class analyses, we sought to empirically classify disordered eating in females from preadolescence to young adulthood, and assess the association between classes and adverse outcomes. METHOD Latent class models were fit using observations from the 9,039 girls participating in the growing up today study, an on-going cohort following participants annually or biennially since 1996 when they were ages 9-14 years. Associations between classes and drug use, binge drinking, and depressive symptoms were assessed using generalized estimating equations. RESULTS Across age groups, there was evidence of six classes: a large asymptomatic class, a class characterized by shape/weight concerns, a class characterized by overeating without loss of control, and three resembling full and subthreshold binge eating disorder, purging disorder, and bulimia nervosa. Relative prevalences of classes varied across developmental stages, with symptomatic classes increasing in prevalence with increasing age. Symptomatic classes were associated with concurrent and incident drug use, binge drinking, and high depressive symptoms. DISCUSSION A classification system resembling broader definitions of DSM-5 diagnoses along with two further subclinical symptomatic classes may be a useful framework for studying disordered eating among adolescent and young adult females.
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Affiliation(s)
- Sonja A. Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston MA
| | | | - Ross D. Crosby
- Neuropsychiatric Research Institute and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK
| | - Kendrin R. Sonneville
- Division of Adolescent Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Kamryn Eddy
- Harris Center for Education and Advocacy in Eating Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Alison E. Field
- Department of Epidemiology, Harvard School of Public Health, Boston MA,Division of Adolescent Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Aloisio KM, Swanson SA, Micali N, Field A, Horton NJ. Analysis of partially observed clustered data using generalized estimating equations and multiple imputation. Stata J 2014; 14:863-883. [PMID: 25642154 PMCID: PMC4306281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Clustered data arise in many settings, particularly within the social and biomedical sciences. As an example, multiple-source reports are commonly collected in child and adolescent psychiatric epidemiologic studies where researchers use various informants (e.g. parent and adolescent) to provide a holistic view of a subject's symptomatology. Fitzmaurice et al. (1995) have described estimation of multiple source models using a standard generalized estimating equation (GEE) framework. However, these studies often have missing data due to additional stages of consent and assent required. The usual GEE is unbiased when missingness is Missing Completely at Random (MCAR) in the sense of Little and Rubin (2002). This is a strong assumption that may not be tenable. Other options such as weighted generalized estimating equations (WEEs) are computationally challenging when missingness is non-monotone. Multiple imputation is an attractive method to fit incomplete data models while only requiring the less restrictive Missing at Random (MAR) assumption. Previously estimation of partially observed clustered data was computationally challenging however recent developments in Stata have facilitated their use in practice. We demonstrate how to utilize multiple imputation in conjunction with a GEE to investigate the prevalence of disordered eating symptoms in adolescents reported by parents and adolescents as well as factors associated with concordance and prevalence. The methods are motivated by the Avon Longitudinal Study of Parents and their Children (ALSPAC), a cohort study that enrolled more than 14,000 pregnant mothers in 1991-92 and has followed the health and development of their children at regular intervals. While point estimates were fairly similar to the GEE under MCAR, the MAR model had smaller standard errors, while requiring less stringent assumptions regarding missingness.
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Swanson SA, Aloisio KM, Horton NJ, Sonneville KR, Crosby RD, Eddy KT, Field AE, Micali N. Assessing eating disorder symptoms in adolescence: is there a role for multiple informants? Int J Eat Disord 2014; 47:475-82. [PMID: 24436213 PMCID: PMC4183354 DOI: 10.1002/eat.22250] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/19/2013] [Accepted: 12/29/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Studies of adolescent psychiatric disorders often collect information from adolescents and parents, yet most eating disorder epidemiologic studies only rely on adolescent report. METHOD We studied the eating disorder symptom reports, from questionnaires sent at participants' ages 14 and 16 years, provided by 7,968 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), and their parents. Adolescents and parents were asked questions about the adolescent's eating disorder symptoms (binge eating, vomiting, laxative use, fasting, and thinness). We assessed cross-sectional concordance and prevalence using kappa coefficients and generalized estimating equations. Generalized estimating equations were used to assess prospective associations between symptom reports and adolescent weight outcomes measured at a face-to-face assessment at 17.5 years. RESULTS Parents and adolescents were largely discordant on symptom reports cross-sectionally (kappas < 0.3), with the parent generally less likely to report bulimic symptoms than the adolescent but more likely to report thinness. Female adolescents were more likely to report bulimic symptoms than males (e.g., two to four times more likely to report binge eating), while prevalence estimates according to parent reports of female vs. male adolescents were similar. Both informants' symptom reports were predictive of body mass and composition measures at 17.5 years; compared to adolescent report, parentally reported binge eating was more strongly predictive of body mass index. DISCUSSION Parent report of eating disorder symptoms seemed to measure different, but potentially important, aspects of these symptoms during adolescence. Epidemiologic eating disorder studies should consider the potential value added from incorporating parental reports, particularly in studies of males.
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Affiliation(s)
- SA Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston MA
| | - KM Aloisio
- Division of Adolescent Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - NJ Horton
- Department of Mathematics, Amherst College, Amherst, MA
| | - KR Sonneville
- Division of Adolescent Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - RD Crosby
- Neuropsychiatric Research Institute and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - KT Eddy
- Harris Center for Education and Advocacy in Eating Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - AE Field
- Department of Epidemiology, Harvard School of Public Health, Boston MA,Division of Adolescent Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - N Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK
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Horton NJ, Toth D, Phipps P. Adjusting models of ordered multinomial outcomes for nonignorable nonresponse in the occupational employment statistics survey. Ann Appl Stat 2014. [DOI: 10.1214/14-aoas714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kypri K, Vater T, Bowe SJ, Saunders JB, Cunningham JA, Horton NJ, McCambridge J. Web-based alcohol screening and brief intervention for university students: a randomized trial. JAMA 2014; 311:1218-24. [PMID: 24668103 PMCID: PMC4413370 DOI: 10.1001/jama.2014.2138] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Unhealthy alcohol use is a leading contributor to the global burden of disease, particularly among young people. Systematic reviews suggest efficacy of web-based alcohol screening and brief intervention and call for effectiveness trials in settings where it could be sustainably delivered. OBJECTIVE To evaluate a national web-based alcohol screening and brief intervention program. DESIGN, SETTING, AND PARTICIPANTS A multisite, double-blind, parallel-group, individually randomized trial was conducted at 7 New Zealand universities. In April and May of 2010, invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening test were e-mailed to 14,991 students aged 17 to 24 years. INTERVENTIONS Participants who screened positive (AUDIT-C score ≥4) were randomized to undergo screening alone or to 10 minutes of assessment and feedback (including comparisons with medical guidelines and peer norms) on alcohol expenditure, peak blood alcohol concentration, alcohol dependence, and access to help and information. MAIN OUTCOMES AND MEASURES A fully automated 5-month follow-up assessment was conducted that measured 6 primary outcomes: consumption per typical occasion, drinking frequency, volume of alcohol consumed, an academic problems score, and whether participants exceeded medical guidelines for acute harm (binge drinking) and chronic harm (heavy drinking). A Bonferroni-corrected significance threshold of .0083 was used to account for the 6 comparisons and a sensitivity analysis was used to assess possible attrition bias. RESULTS Of 5135 students screened, 3422 scored 4 or greater and were randomized, and 83% were followed up. There was a significant effect on 1 of the 6 prespecified outcomes. Relative to control participants, those who received intervention consumed less alcohol per typical drinking occasion (median 4 drinks [interquartile range {IQR}, 2-8] vs 5 drinks [IQR 2-8]; rate ratio [RR], 0.93 [99.17% CI, 0.86-1.00]; P = .005) but not less often (RR, 0.95 [99.17% CI, 0.88-1.03]; P = .08) or less overall (RR, 0.95 [99.17% CI, 0.81-1.10]; P = .33). Academic problem scores were not lower (RR, 0.91 [99.17% CI, 0.76-1.08]; P = .14) and effects on the risks of binge drinking (odds ratio [OR], 0.84 [99.17% CI, 0.67-1.05]; P = .04) and heavy drinking (OR, 0.77 [99.17% CI, 0.56-1.05]; P = .03) were not significantly significant. In a sensitivity analysis accounting for attrition, the effect on alcohol per typical drinking occasion was no longer statistically significant. CONCLUSIONS AND RELEVANCE A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems. There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12610000279022.
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Affiliation(s)
- Kypros Kypri
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia2Injury Prevention Research Unit, University of Otago, Dunedin, New Zealand
| | - Tina Vater
- Injury Prevention Research Unit, University of Otago, Dunedin, New Zealand
| | - Steven J Bowe
- Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - John B Saunders
- Disciplines of Psychiatry and Addiction Medicine, University of Sydney, Sydney, NSW, Australia
| | - John A Cunningham
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia6Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Jim McCambridge
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Field AE, Sonneville KR, Crosby RD, Swanson SA, Eddy KT, Camargo CA, Horton NJ, Micali N. Prospective associations of concerns about physique and the development of obesity, binge drinking, and drug use among adolescent boys and young adult men. JAMA Pediatr 2014; 168:34-9. [PMID: 24190655 PMCID: PMC3947325 DOI: 10.1001/jamapediatrics.2013.2915] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Relatively little is known about the prevalence of concerns with physique and eating disorders among males and their relation to subsequent adverse outcomes. A broader range of eating disorders needs to be defined to diagnose these illnesses appropriately in males. OBJECTIVE To investigate whether males with psychiatric symptoms related to disordered eating and concern about physique are more likely to become obese, to start using drugs, to consume alcohol frequently (binge drinking), or to develop high levels of depressive symptoms. DESIGN, SETTING, AND PARTICIPANTS The data come from questionnaires sent every 12 to 36 months from 1999 through 2010 to youth in a prospective cohort study, the Growing Up Today Study. The analysis included 5527 males aged 12 to 18 years in 1999 from across the United States who responded to the Growing Up Today Study questionnaires. MAIN OUTCOMES AND MEASURES Development of obesity and high levels of depressive symptoms and initiation of drug use and binge drinking at least monthly. RESULTS From 1999 through 2011 in at least 1 study year, 9.2% of respondents reported high concerns with muscularity but no bulimic behaviors; 2.4%, high concerns with muscularity and use of supplements, growth hormone derivatives, or anabolic steroids to achieve their desired physique; 2.5%, high concerns with thinness but no bulimic behaviors; and 6.3%, high concerns with thinness and muscularity. For eating disorders, 0.8% had partial- or full-criteria bulimia nervosa or purging disorder and 2.9% had partial or full-criteria binge eating disorder but no association with the outcomes of interest. Infrequent binge eating or purging or overeating without a loss of control were reported by 31.0%. However, independent of age and body mass index, males with high concerns about thinness but not muscularity were more likely to develop high depressive symptoms (odds ratio, 2.72; 95% CI, 1.36-5.44). Males with high concerns about muscularity and thinness were more likely than their peers to use drugs (odds ratio, 2.13; 95% CI, 1.31-3.46), and males with high concerns about muscularity who used supplements and other products to enhance physique were more likely to start binge drinking frequently (2.06; 1.58-2.69) and using drugs (2.16; 1.49-3.11). CONCLUSIONS AND RELEVANCE High concerns with muscularity are relatively common among adolescent boys and young men. Males with these concerns who use potentially unhealthy products to improve their physique are at increased risk of adverse outcomes but may not be recognized by their health care providers as having a weight-related disorder because of the sex-specific presentation.
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Affiliation(s)
- Alison E. Field
- Division of Adolescent Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Kendrin R. Sonneville
- Division of Adolescent Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Sonja A. Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Kamryn T. Eddy
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Carlos A. Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Nicholas J. Horton
- Department of Mathematics and Statistics, Smith College, Northampton, MA
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, UK
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Eisenberg BW, Waldrop JE, Allen SE, Brisson JO, Aloisio KM, Horton NJ. Evaluation of risk factors associated with recurrent obstruction in cats treated medically for urethral obstruction. J Am Vet Med Assoc 2013; 243:1140-6. [DOI: 10.2460/javma.243.8.1140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Borsari B, Zamboanga BL, Correia C, Olthuis JV, Van Tyne K, Zadworny Z, Grossbard JR, Horton NJ. Characterizing high school students who play drinking games using latent class analysis. Addict Behav 2013; 38:2532-40. [PMID: 23778317 DOI: 10.1016/j.addbeh.2013.04.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/15/2013] [Accepted: 04/30/2013] [Indexed: 12/01/2022]
Abstract
Heavy alcohol use and its associated negative consequences continue to be an important health issue among adolescents. Of particular concern are risky drinking practices such as playing drinking games. Although retrospective accounts indicate that drinking game participation is common among high school students, it has yet to be assessed in current high school students. Utilizing data from high school students who reported current drinking game participation (n=178), we used latent class analysis to investigate the negative consequences resulting from gaming and examined underlying demographic and alcohol-related behavioral characteristics of students as a function of the resultant classes. Three classes of "gamers" emerged: (1) a "lower-risk" group who had a lower probability of endorsing negative consequences compared to the other groups, (2) a "higher-risk" group who reported that they experienced hangovers and difficulties limiting their drinking, got physically sick, and became rude, obnoxious, or insulting, and (3) a "sexual regret" group who reported that they experienced poor recall and unplanned sexual activity that they later regretted. Although the frequency of participating in drinking games did not differ between these three groups, results indicated that the "lower-risk" group consumed fewer drinks in a typical gaming session compared to the other two groups. The present findings suggest that drinking games are common among high school students, but that mere participation and frequency of play are not necessarily the best indicators of risk. Instead, examination of other constructs such as game-related alcohol consumption, consequences, or psychosocial variables such as impulsivity may be more useful.
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Affiliation(s)
- Brian Borsari
- Center for Alcohol and Addiction Studies,Warren Alpert Medical School of Brown University, Providence, RI 02912-9001, United States.
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Elwy AR, Horton NJ, Saitz R. Physicians' attitudes toward unhealthy alcohol use and self-efficacy for screening and counseling as predictors of their counseling and primary care patients' drinking outcomes. Subst Abuse Treat Prev Policy 2013; 8:17. [PMID: 23718191 PMCID: PMC3680085 DOI: 10.1186/1747-597x-8-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/18/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Patients' unhealthy alcohol use is often undetected in primary care. Our objective was to examine whether physicians' attitudes and their perceived self-efficacy for screening and counseling patients is associated with physicians' counseling of patients with unhealthy alcohol use, and patients' subsequent drinking. METHODS This study is a prospective cohort study (nested within a randomized trial) involving 41 primary care physicians and 301 of their patients, all of whom had unhealthy alcohol use. Independent variables were physicians' attitudes toward unhealthy substance use and self-efficacy for screening and counseling. Outcomes were patients' reports of physicians' counseling about unhealthy alcohol use immediately after a physician visit, and patients' drinking six months later. RESULTS Neither physicians' attitudes nor self-efficacy had any impact on physicians' counseling, but greater perceived self-efficacy in screening, assessing and intervening with patients was associated with more drinking by patients six months later. CONCLUSIONS Future research needs to further explore the relationship between physicians' attitudes towards unhealthy alcohol use, their self-efficacy for screening and counseling and patients' drinking outcomes, given our unexpected findings.
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Affiliation(s)
- A Rani Elwy
- Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Department of Veterans Affairs, 200 Springs Road (152), Bedford, MA 01730, USA
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot 3W, Boston, MA 02118, USA
| | - Nicholas J Horton
- Department of Mathematics, Amherst College, Box 2239, PO 5000, Amherst, MA 01002, USA
| | - Richard Saitz
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
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Sonneville KR, Horton NJ, Micali N, Crosby RD, Swanson SA, Solmi F, Field AE. Longitudinal associations between binge eating and overeating and adverse outcomes among adolescents and young adults: does loss of control matter? JAMA Pediatr 2013; 167:149-55. [PMID: 23229786 PMCID: PMC3654655 DOI: 10.1001/2013.jamapediatrics.12] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the association between overeating (without loss of control) and binge eating (overeating with loss of control) and adverse outcomes. DESIGN Prospective cohort study. SETTING Adolescents and young adults living throughout the United States. PARTICIPANTS Sixteen thousand eight hundred eighty-two males and females participating in the Growing Up Today Study who were 9 to 15 years old at enrollment in 1996. MAIN EXPOSURE Overeating and binge eating assessed via questionnaire every 12 to 24 months between 1996 and 2005. MAIN OUTCOME MEASURES Risk of becoming overweight or obese, starting to binge drink frequently, starting to use marijuana, starting to use other drugs, and developing high levels of depressive symptoms. Generalized estimating equations were used to estimate associations. All models controlled for age and sex; additional covariates varied by outcome. RESULTS Among this large cohort of adolescents and young adults, binge eating was more common among females than males. In fully adjusted models, binge eating, but not overeating, was associated with incident overweight/obesity (odds ratio, 1.73; 95% CI, 1.11-2.69) and the onset of high depressive symptoms (odds ratio, 2.19; 95% CI, 1.40-3.45). Neither overeating nor binge eating was associated with starting to binge drink frequently, while both overeating and binge eating predicted starting to use marijuana and other drugs. CONCLUSIONS Although any overeating, with or without loss of control, predicted the onset of marijuana and other drug use, we found that binge eating is uniquely predictive of incident overweight/obesity and the onset of high depressive symptoms. These findings suggest that loss of control is an important indicator of severity of overeating episodes.
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Affiliation(s)
- Kendrin R. Sonneville
- Division of Adolescent Medicine, Department of Medicine, Children’s Hospital Boston and Harvard Medical School, Boston, MA,Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nicholas J. Horton
- Department of Mathematics and Statistics, Smith College, Northampton, MA
| | - Nadia Micali
- University College London, Institute of Child Health, Behavioural and Brain Sciences Unit, London, UK
| | - Ross D. Crosby
- Neuropsychiatric Research Institute and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Sonja A. Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Francesca Solmi
- University College London, Institute of Child Health, Behavioural and Brain Sciences Unit, London, UK
| | - Alison E. Field
- Division of Adolescent Medicine, Department of Medicine, Children’s Hospital Boston and Harvard Medical School, Boston, MA,Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard School of Public Health, Boston, MA
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Kypri K, McCambridge J, Vater T, Bowe SJ, Saunders JB, Cunningham JA, Horton NJ. Web-based alcohol intervention for Māori university students: double-blind, multi-site randomized controlled trial. Addiction 2013; 108:331-8. [PMID: 22925046 PMCID: PMC3588153 DOI: 10.1111/j.1360-0443.2012.04067.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/02/2012] [Accepted: 08/21/2012] [Indexed: 11/29/2022]
Abstract
AIMS Like many indigenous peoples, New Zealand Māori bear a heavy burden of alcohol-related harm relative to their non-indigenous compatriots, and disparities are greatest among young adults. We tested the effectiveness of web-based alcohol screening and brief intervention (e-SBI) for reducing hazardous drinking among Māori university students. DESIGN Parallel, double-blind, multi-site, randomized controlled trial. SETTING Seven of New Zealand's eight universities. PARTICIPANTS In April 2010, we sent e-mail invitations to all 6697 17-24-year-old Māori students to complete a brief web questionnaire including the Alcohol Use Disorders Identification Test (AUDIT)-C, a screening tool for hazardous and harmful drinking. Those screening positive were computer randomized to: <10 minutes of web-based alcohol assessment and personalized feedback (intervention) or screening alone (control). MEASUREMENTS We conducted a fully automated 5-month follow-up assessment with observers and participants blinded to study hypotheses, design and intervention delivery. Pre-determined primary outcomes were: (i) frequency of drinking, (ii) amount consumed per typical drinking occasion, (iii) overall volume of alcohol consumed and (iv) academic problems. FINDINGS Of the participants, 1789 were hazardous or harmful drinkers (AUDIT-C ≥ 4) and were randomized: 850 to control, 939 to intervention. Follow-up assessments were completed by 682 controls (80%) and 733 intervention group members (78%). Relative to controls, participants receiving intervention drank less often [RR = 0.89; 95% confidence interval (CI): 0.82-0.97], less per drinking occasion (RR = 0.92; 95% CI: 0.84-1.00), less overall (RR = 0.78; 95% CI: 0.69-0.89) and had fewer academic problems (RR = 0.81; 95% CI: 0.69-0.95). CONCLUSIONS Web-based screening and brief intervention reduced hazardous and harmful drinking among non-help-seeking Māori students in a large-scale pragmatic trial. The study has wider implications for behavioural intervention in the important but neglected area of indigenous health.
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Affiliation(s)
- Kypros Kypri
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Jim McCambridge
- Faculty of Public Health & Policy, London School of Hygiene & Tropical MedicineLondon, UK
| | - Tina Vater
- Injury Prevention Research Unit, University of OtagoDunedin, New Zealand
| | - Steven J Bowe
- Centre for Behavioural Research in Cancer, Cancer Council VictoriaMelbourne, Vic., Australia
| | - John B Saunders
- Disciplines of Psychiatry and Addiction Medicine, University of SydneySydney, NSW, Australia
| | | | - Nicholas J Horton
- Department of Mathematics and Statistics, Smith CollegeNorthampton, MA, USA
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Affiliation(s)
- Melanie L Bell
- Psycho-Oncology Co-operative Research Group, University of Sydney, Sydney, Australia.
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Rosenberg L, Palmer JR, Wise LA, Horton NJ, Kumanyika SK, Adams-Campbell LL. A Prospective Study of the Effect of Childbearing on Weight Gain in African-American Women. ACTA ACUST UNITED AC 2012; 11:1526-35. [PMID: 14694218 DOI: 10.1038/oby.2003.204] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To prospectively assess the influence of bearing a first, second, or later child on weight gain among African-American women in the context of other risk factors. RESEARCH METHODS AND PROCEDURES Data were obtained in a prospective follow-up study of African-American women from across the U.S. who are participants in the Black Women's Health Study. Postal questionnaires were used to collect baseline data in 1995 and follow-up data in 1997 and 1999. Parous and nulliparous women (11,196) (21 to 39 years old at baseline), of whom 1230 had a singleton birth during follow-up, are the subjects of the present analyses. We assessed change in BMI (kilograms per meter squared) in relation to childbearing during 4 years of follow-up, with use of multivariable linear regression to control for important risk factors. RESULTS During 4 years of follow-up, the BMI of participants increased by an average of 1.6 kg/m2, equivalent to a weight gain of approximately 4.4 kg. Women who had a child during follow-up gained more weight than women who remained nulliparous, and those who had a first child gained more than those who had a second or later child. The weight gain associated with childbearing increased with increasing baseline BMI and was appreciable among heavier women. For example, among women with a baseline index of 36, the increase in BMI for women who bore a first child was 1.1 kg/m2 more than that of nulliparous women, equivalent to a difference in weight gain of approximately 3.0 kg. DISCUSSION Childbearing is an important contributor to weight gain among African-American women.
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Affiliation(s)
- Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, Massachusetts 02215, USA. lrosenberg@
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