Does competitive winning increase subsequent cheating?

In this preregistered study, we attempted to replicate and substantially extend a frequently cited experiment by Schurr and Ritov, published in 2016, suggesting that winners of pairwise competitions are more likely than others to steal money in subsequent games of chance against different opponents, possibly because of an enhanced sense of entitlement among competition winners. A replication seemed desirable because of the relevance of the effect to dishonesty in everyday life, the apparent counterintuitivity of the effect, possible problems and anomalies in the original study, and above all the fact that the researchers investigated only one potential explanation for the effect. Our results failed to replicate Schurr and Ritov's basic finding: we found no evidence to support the hypotheses that either winning or losing is associated with subsequent cheating. A second online study also failed to replicate Schurr and Ritov's basic finding. We used structural equation modelling to test four possible explanations for cheating-sense of entitlement, self-confidence, feeling lucky and inequality aversion. Only inequality aversion turned out to be significantly associated with cheating.

Sources of Care for Alcohol and Other Drug Problems: The Role of the African American Church

African Americans experience significant disparities in treatment access, retention, and quality of care for alcohol and drug use (AOD) problems. Religious congregations, often the first point of contact for help with AOD problems, can play an integral role in improving access to treatment. However, little is known about the role of African American churches in addressing AOD problems. We administered a survey to a faith-based collaborative of 169 African American churches in Los Angeles to examine how AOD problems are identified in congregations, the types of support provided, barriers to providing treatment referrals, and factors associated with the provision of treatment referrals. Seventy-one percent of churches reported caring often for individuals with AOD problems. AOD problems came to the attention of congregations most commonly via a concerned family member (55%) and less frequently through individuals with AOD problems directly approaching clergy (30%). In addition to providing spiritual support, a substantial proportion of churches reported linking individuals to AOD services through referrals (62%) and consultation with providers (48%). Barriers to providing treatment referrals included lack of affordable programs (50%), stigma (50%), lack of effective treatments (45%), and insufficient resources or staff (45%). The likelihood of providing treatment referrals was greater among mid-sized versus smaller-size congregations (OR 3.43; p < .05) and among congregations with clergy that had attended seminary (OR 3.93; p < .05). Knowing how to effectively coordinate informal sources of care provided by African American churches with the formal service sector could make a significant impact on AOD treatment disparities.

Predictors of Retention in an Alcohol and Risky Sex Prevention Program for Homeless Young Adults

Homeless young adults are at risk for alcohol and other drug (AOD) use and risky sexual behavior. Interventions are needed to help these young people reduce their risky behavior, but this population is often difficult to engage and retain in services. We offered a four-session AOD and risky sex reduction program to 100 participants and examined if retention in the program was predicted by a number of factors: demographics, homelessness severity, other service use, AOD behaviors, mental health symptoms, sexual risk behaviors, and readiness to change AOD and condom use. Nearly half (48%) of participants completed all sessions. In bivariate analyses, participants were significantly less likely to be retained in the program if they had slept outdoors in the past month, engaged in more alcohol and marijuana use, experienced more alcohol-related consequences, and received the program in an urban drop-in center (as opposed to a drop-in center near the beach). When controlling for all significant bivariate relationships, only sleeping outdoors and receipt of the program in the urban setting predicted fewer sessions completed. The most endorsed reasons for program non-completion were being too busy to attend and inconvenient day/time of the program. Findings can help outreach staff and researchers better prepare methods to engage higher risk homeless youth and retain them in services. Finding unique ways to help youth overcome barriers related to location of services appears especially necessary, perhaps by bringing services to youth where they temporarily reside or offering meaningful incentives for program attendance.

AHRQ series on complex intervention systematic reviews-paper 4: selecting analytic approaches

BACKGROUND

Systematic reviews of complex interventions can vary widely in purpose, data availability and heterogeneity, and stakeholder expectations.

RATIONALE

This article addresses the uncertainty that systematic reviewers face in selecting methods for reviews of complex interventions. Specifically, it lays out parameters for systematic reviewers to consider when selecting analytic approaches that best answer the questions at hand and suggests analytic techniques that may be appropriate in different circumstances.

DISCUSSION

Systematic reviews of complex interventions comprising multiple questions may use multiple analytic approaches. Parameters to consider when choosing analytic methods for complex interventions include nature and timing of the decision (clinical practice guideline, policy, or other); purpose of the review; extent of existing evidence; logistic factors such as the timeline, process, and resources for deciding the scope of the review; and value of information to be obtained from choosing specific systematic review methods. Reviewers may elect to revise their analytic approach based on new or changing considerations during the course of the review but should guard against bias through transparency of reporting.

The Hispanic Paradox: Race/Ethnicity and Nativity, Immigrant Enclave Residence and Cognitive Impairment Among Older US Adults

Hispanics, and particularly foreign-born Mexican Americans, have been shown to fare better across a range of health outcomes than might be expected given the generally higher levels of socioeconomic disadvantage in this population, a phenomena termed the "Hispanic Paradox". Previous research on social disparities in cognitive aging, however, has been unable to address both race/ethnicity and nativity (REN) in a nationally-representative sample of US adults leaving unanswered questions about potentially "paradoxical" advantages of Mexican ethnic-origins and the role of nativity, socioeconomic status (SES), and enclave residence. We employ biennial assessments of cognitive functioning to study prevalent and incident cognitive impairment (CI) within the three largest US REN groups: US-born non-Hispanic whites (US-NHW), US-born non-Hispanic blacks (US-NHB), US-born Mexican Americans (US-MA), and foreign-born Mexican Americans (FB-MA). Data come from a nationally-representative sample of community-dwelling older adults in the Health and Retirement Study linked with the 2000 Census and followed over 10 years (N = 8,433). Large disadvantages in prevalent and incident CI were observed for all REN minorities respective to US-born non-Hispanic whites. Individual and neighborhood SES accounted substantially for these disadvantages and revealed an immigrant advantage: FB-MA odds of prevalent CI were about half those of US-NHW and hazards of incident CI were about half those of US-MA. Residence in an immigrant enclave was protective of prevalent CI among FB-MA. The findings illuminate important directions for research into the sources of cognitive risk and resilience and provide guidance about CI screening within the increasingly diverse aging US population.

Neighborhood, Family and Peer-Level Predictors of Obesity-Related Health Behaviors Among Young Adolescents

Objective

This longitudinal study examines peer social functioning (PSF), familism, and neighborhood socioeconomic status (NSES) on adolescents' obesity risk.

Methods

Participants ( N  = 2,144) were originally sampled from 16 middle schools in Southern California (45% male; 45% Hispanic) as part of an alcohol and other drug use prevention program (CHOICE). Multilevel regression modeling tested main effects and interaction terms of PSF, familism, and NSES assessed at Wave 5 ( M age = 14.15) on body mass index and risk of obesity-related behaviors at Wave 6.

Results

Higher PSF predicted healthier eating habits, less screen time, and more physical activity. Higher familism also predicted more physical activity. The positive effect of PSF on healthy eating was stronger among youth who reported higher familism. PSF also moderated the associations of NSES with healthy eating and physical activity.

Conclusion

Findings emphasize the importance of targeting both peer and family factors, which may be more amenable to change than NSES.

A group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among homeless young adults

Homeless young adults ages 18-25 exhibit high rates of alcohol and other drug (AOD) use, and sexual risk behaviors such as unprotected sex. Yet few programs exist for this population that are both effective and can be easily incorporated into settings serving this population. This pilot cluster cross-over randomized controlled trial evaluates AWARE, a voluntary four session group-based motivational interviewing (MI) intervention to reduce AOD use and sexual risk behavior. We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County (mean age=21.8years; 73% male; 79% heterosexual; 31% non-Hispanic White, 25% African American, 24% Hispanic, 21% multiracial/other). Surveys were completed at baseline and three months after program completion. Retention in the AWARE program was excellent (79% attended multiple sessions) and participants reported high levels of satisfaction with the program. AWARE participants self-reported positive change in their past 3month and past 30day alcohol use (ps≤0.05), motivation to change drug use (ps<0.05), and condom use self-efficacy (p=0.05) compared to the control group. Among those with multiple sex partners, AWARE participants showed a decrease in unprotected sexual events (p<0.05), whereas the control group did not. Results from this pilot evaluation are promising, suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use. Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes.

A systematic review of modifiable risk factors in the progression of multiple sclerosis

BACKGROUND

The presenting symptoms and rate of progression of multiple sclerosis (MS) are very heterogeneous. The diverse clinical manifestations and the clinical course of the disease may vary with modifiable risk factors.

OBJECTIVE

To systematically review modifiable risk factors and exposures associated with MS progression.

METHODS

We searched six databases till March 2015, reference-mined reviews, and consulted with experts (PROSPERO 2015:CRD42015016461). Two reviewers screened and extracted data. We used random meta-analysis models and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the quality of evidence.

RESULTS

In total, 59 studies met inclusion criteria. Lower vitamin D levels were associated with higher Expanded Disability Status Scale (EDSS) scores ( r = -0.22; confidence interval (CI) = -0.32, -0.12; 11 studies; I² = 66%), smokers had an increased risk of MS progression (hazard ratio (HR) = 1.55; CI = 1.10, 2.19; I² = 72%; seven studies), and there was no association of MS progression with the use of epidural analgesics during childbirth delivery (three studies). There was insufficient evidence to draw conclusions for 11 risk factors due to conflicting results or use of different predictor and outcome measures.

CONCLUSION

MS progression was consistently associated with low vitamin D levels, and smoking was associated with a more rapid decline in MS disability. Studies used a variety of methods, predictors, and outcomes making it difficult to draw conclusions. Future studies should focus on prospective assessments.

A systematic review of the effects of modifiable risk factor interventions on the progression of multiple sclerosis

Background:

Several risk factors are associated with multiple sclerosis (MS) progression and may be amenable to intervention.

Objective:

To systematically review the evidence for interventions targeting risk factors for MS progression.

Methods:

We searched six databases and existing reviews till March 2015 and consulted with experts to identify randomized controlled trials (RCTs) of interventions targeting MS risk factors (PROSPERO 2015:CRD42015016461).

Results:

In total, 37 RCTs met inclusion criteria. Expanded Disability Status Scale (EDSS) scores after exercise interventions did not differ compared with untreated controls (standardized mean differences (SMDs): 0.02; confidence interval (CI): −0.40, 0.44; I2: 0%; seven RCTs; very low quality of evidence (QoE)). Dietary interventions did not show a statistically significant effect on the relative risk (RR) of progression (RR: 0.86; CI: 0.67, 1.05; I2: 0%; four RCTs; moderate QoE) compared to placebo. EDSS scores after vitamin D supplementation were not significantly different from placebo (SMD: −0.15; CI: −0.33, 0.02; I2: 0%; five RCTs; very low QoE).

Conclusion:

We did not identify any risk factor interventions with significant effects on MS progression, but the overall QoE was limited. More adequately powered trials are needed on vitamin D supplementation, long-term exercise, and smoking cessation.

The Air Force Deployment Transition Center: Assessment of Program Structure, Process, and Outcomes

It is often accepted as common knowledge that military personnel benefit from decompression time between a war zone and the home station. To capitalize on the potential benefits of a decompression period paired with support services, the U.S. Air Force established the Deployment Transition Center (DTC) at Ramstein Air Base in Germany in July 2010. The DTC provides airmen returning from combat missions with an opportunity to decompress and share lessons learned before returning to their home stations. The authors of this study evaluate the structure, processes, and outcomes of the DTC program. They find that, although a majority of participants found the DTC program worthwhile, a comparison of DTC participants and similar airmen who did not participate the program shows no evidence that the program helps reduce posttraumatic stress disorder symptoms, depressive symptoms, binge drinking, or social conflicts with family and coworkers. In addition, one of the DTC program elements appears to be similar to posttraumatic debriefing interventions, which several studies have found to be either ineffective or harmful. For these reasons, if the main goals of the DTC program are to improve behavioral health and social conflict outcomes, the authors recommend that the DTC program be discontinued or redesigned and Air Force resources invested in alternative programs. However, if the DTC program has other goals, such as providing rest and relaxation to airmen after a difficult deployment or capturing after-action information, then the authors recommend that these goals be documented and the DTC program be more specifically tailored to them.

How group factors affect adolescent change talk and substance use outcomes: implications for motivational interviewing training

Clients who verbalize statements arguing for change (change talk [CT]) in psychotherapy are more likely to decrease alcohol and other drug use (AOD) compared with clients who voice statements in opposition of change (sustain talk [ST]). Little is known about how CT and ST are expressed in groups in which adolescents may vary in their AOD use severity and readiness to change. First, we examined how session content was associated with CT/ST, and then we looked at whether different subtypes of CT/ST were associated with subsequent AOD outcomes 3 months later. Audio recordings (N = 129 sessions) of a 6-session group motivational interviewing (MI) intervention, Free Talk, were coded. Session content was not associated with CT; however, some session content was associated with higher percentages of ST (e.g., normative feedback). Subtypes of CT (Commitment and Reason) were associated with improved AOD outcomes, whereas Ability subtype remarks were related to increased marijuana use, intentions, and consequences. Findings offer helpful guidance for clinical training and narrow in on the type of CT to try to elicit in Group MI sessions. Regardless of session content, adolescents can benefit from hearing CT during the group.

A systematic review of St. John's wort for major depressive disorder

BACKGROUND

This systematic review evaluated St. John's wort (SJW) for the treatment of Major Depressive Disorder (MDD). The objectives of this review are to (1) evaluate the efficacy and safety of SJW in adults with MDD compared to placebo and active comparator and (2) evaluate whether the effects vary by severity of MDD.

METHODS

We searched PubMed, CINAHL, PsycINFO, CENTRAL, Embase, AMED, MANTIS, Web of Science, and ICTRP and existing reviews to November 2014. Two independent reviewers screened the citations, abstracted the data, and assessed the risk of bias. We included randomized controlled trials (RCTs) examining the effect of at least a 4-week administration of SJW on depression outcomes against placebo or active comparator in adults with MDD. Risk of bias was assessed using the Cochrane Risk of Bias tool and USPSTF criteria. Quality of evidence (QoE) was assessed using the GRADE approach.

RESULTS

Thirty-five studies examining 6993 patients met inclusion criteria; eight studies evaluated a hypericum extract that combined 0.3 % hypericin and 1-4 % hyperforin. The herb SJW was associated with more treatment responders than placebo (relative risk [RR] 1.53; 95 % confidence interval [CI] 1.19, 1.97; I(2) 79 %; 18 RCTs; N = 2922, moderate QoE; standardized mean differences [SMD] 0.49; CI 0.23, 0.74; 16 RCTs; I(2) 89 %, N = 2888, moderate QoE). Compared to antidepressants, SJW participants were less likely to experience adverse events (OR 0.67; CI 0.56, 0.81; 11 RCTs; moderate QoE) with no difference in treatment effectiveness (RR 1.01; CI 0.90, 1.14; 17 RCTs, I(2) 52 %, moderate QoE; SMD -0.03; CI -0.21, 0.15; 14 RCTs; I(2) 74 %; N = 2248, moderate QoE) in mild and moderate depression.

CONCLUSIONS

SJW monotherapy for mild and moderate depression is superior to placebo in improving depression symptoms and not significantly different from antidepressant medication. However, evidence of heterogeneity and a lack of research on severe depression reduce the quality of the evidence. Adverse events reported in RCTs were comparable to placebo and fewer compared with antidepressants. However, assessments were limited due to poor reporting of adverse events and studies were not designed to assess rare events. Consequently, the findings should be interpreted with caution.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015016406 .

Carpal Tunnel Syndrome in Association with Hand–Arm Vibration Syndrome: A Review of Claimants Seeking Compensation in the Mining Industry

Twenty six thousand eight hundred and forty-two miners seeking compensation were clinically assessed for vascular and neurosensory impairment arising from exposure to occupational hand–arm vibration (Hand–Arm Vibration Syndrome). They were also assessed clinically for Carpal Tunnel Syndrome which, if present, would result in additional compensation.

Fifteen per cent were assessed as having both HAVS and CTS. Thirty-eight per cent of claimants had nocturnal wakening, 1.3% wasting of abductor pollicis brevis, 15% had a positive Tinel’s test and 20% had a positive Phalen’s test. The 15% prevalence reported is lower than the rates cited previously in several small population studies of workers exposed to vibration.

This paper reports the results of the assessment process and discusses the difficulty of discriminating Carpal Tunnel Syndrome from diffuse neurosensory impairment arising from HAVS.

St. John's Wort for Major Depressive Disorder: A Systematic Review

RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of St. John's wort (SJW)-used adjunctively or as monotherapy-to provide estimates of its efficacy and safety in treating adults with major depressive disorder. Outcomes of interest included changes in depressive symptomatology, quality of life, and adverse effects. Efficacy meta-analyses used the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. In total, 35 studies met inclusion criteria. There is moderate evidence, due to unexplained heterogeneity between studies, that depression improvement based on the number of treatment responders and depression scale scores favors SJW over placebo, and results are comparable to antidepressants. The existing evidence is based on studies testing SJW as monotherapy; there is a lack of evidence for SJW given as adjunct therapy to standard antidepressant therapy. We found no systematic difference between SJW extracts, but head-to-head trials are missing; LI 160 (0.3% hypericin, 1-4% hyperforin) was the extract with the greatest number of studies. Only two trials assessed quality of life. SJW adverse events reported in included trials were comparable to placebo, and were fewer compared with antidepressant medication; however, adverse event assessments were limited, and thus we have limited confidence in this conclusion.

Illness Beliefs Predict Mortality in Patients with Diabetic Foot Ulcers

Background

Patients’ illness beliefs have been associated with glycaemic control in diabetes and survival in other conditions.

Objective

We examined whether illness beliefs independently predicted survival in patients with diabetes and foot ulceration.

Methods

Patients (n = 169) were recruited between 2002 and 2007. Data on illness beliefs were collected at baseline. Data on survival were extracted on 1^st November 2011. Number of days survived reflected the number of days from date of recruitment to 1^st November 2011.

Results

Cox regressions examined the predictors of time to death and identified ischemia and identity beliefs (beliefs regarding symptoms associated with foot ulceration) as significant predictors of time to death.

Conclusions

Our data indicate that illness beliefs have a significant independent effect on survival in patients with diabetes and foot ulceration. These findings suggest that illness beliefs could improve our understanding of mortality risk in this patient group and could also be the basis for future therapeutic interventions to improve survival.

Study design to evaluate cognitive behavioral therapy among a diverse sample of adults with a first-time DUI offense

BACKGROUND

Driving under the influence (DUI) of alcohol is a major public health concern, and many individuals continue to drink and drive even after being convicted of a DUI offense. Latinos, in particular, are disproportionately likely to be arrested for a DUI, have higher rates of recidivism, and are more likely to die in alcohol-related accidents than non-Latino Whites. Latinos also experience significant disparities in accessing alcohol-related treatment.

METHODS/DESIGN

This study protocol paper describes a randomized trial of cognitive behavioral therapy (CBT) compared to usual care in DUI programs for individuals with a first-time offense and at-risk drinking. We will utilize a two-group randomized design where individuals enrolled in a DUI program with a first-time conviction will be randomized to CBT (n = 150) or usual care (n = 150). Participants will be assessed at baseline, immediately post-treatment, and 6-months post-treatment. Recidivism data will be collected using administrative data within 2 years post-treatment.

DISCUSSION

This project has the potential to benefit a large population of vulnerable individuals who are at risk of DUI recidivism. It also develops a new model of care by providing treatment in DUI programs to reduce disparities associated with poor treatment access. Trial registration NCT02588703.

Predictors and consequences of prescription drug misuse during middle school

OBJECTIVES

Non-medical prescription drug use (NMPDU) is a growing public health problem among adolescents. This is the first study to examine the correlates of early NMPDU initiation during middle school, and how early initiation is associated with four domains of functioning in high school (mental health, social, academic, and delinquency).

METHODS

Students initially in 6th-8th grades from 16 middle schools completed in-school surveys between 2008 and 2011 (Waves 1-5), and a web-based survey in 2013-2014 (Wave 6). We used discrete time survival analysis to assess predictors of initiation from Waves 1 to 5 based on students who provided NMPDU information at any of these waves (n=12,904), and regression analysis to examine high school outcomes associated with initiation based on a sample that was followed into high school, Wave 6 (n=2539).

RESULTS

Low resistance self-efficacy, family substance use, low parental respect, and offers of other substances from peers were consistently associated with NMPDU initiation throughout middle school. Further, perceiving that more of one's peers engaged in other substance use was associated with initiation at Wave 1 only. By high school, those students who initiated NMPDU during middle school reported lower social functioning, and more suspensions and fighting, compared to students who did not initiate NMPDU during middle school.

CONCLUSION

NMPDU initiation during middle school is associated with poorer social functioning and greater delinquency in high school. It is important for middle school prevention programs to address NMPDU. Such programs should focus on both family and peer influences, as well as strengthening resistance self-efficacy.

Moderated mediation analysis: An illustration using the association of gender with delinquency and mental health

PURPOSE

When researchers find an association between two variables, it is useful to evaluate the role of other constructs in this association. While assessing these mediation effects, it is important to determine if results are equal for different groups. It is possible that the strength of a mediation effect may differ for males and females, for example - such an effect is known as moderated mediation.

DESIGN

Participants were 2532 adolescents from diverse ethnic/racial backgrounds and equally distributed across gender. The goal of this study was to investigate parental respect as a potential mediator of the relationship between gender and delinquency and mental health, and to determine whether observed mediation is moderated by gender.

FINDINGS

Parental respect mediated the association between gender and both delinquency and mental health. Specifically, parental respect was a protective factor against delinquency and mental health problems for both females and males.

PRACTICAL IMPLICATIONS

Demonstrated the process of estimating models in Lavaan, using two approaches (i.e. single group regression and multiple group regression model), and including covariates in both models.

Associations between neighborhood alcohol availability and young adolescent alcohol use

We investigated the association between alcohol outlet density and adolescent alcohol use, including whether this association differed by sociodemographic characteristics. We geocoded and mapped active license data from the year 2011 to calculate the number of outlets within multiple circular buffers of varying sizes (density), centered at households of adolescents ages 10-16 (n = 2,724). We examined 2 indicators of alcohol use: any lifetime use, but not in past month, and any past month heavy use. Cross-sectional hierarchal multivariate regression analyses were used to examine associations between alcohol outlet density and alcohol use, including the potential moderating effect of age, gender, race/ethnicity, and socioeconomic status. Analyses controlled for neighborhood-level socioeconomic status and accounted for census tract-level clustering. A higher number of on- and off-premise outlets within 0.10, 0.25, and 0.50 miles around the respondents' homes was associated with higher odds of being a heavy drinker. In addition, the number of on-premise outlets within the 0.25-mile radius was associated with greater odds of lifetime drinking. For on-premise outlets where minors were not allowed (clubs/bars), we observed a positive and significant association between clubs/bars within the 0.25-mile buffer zone and higher odds of both lifetime and heavy drinking. Findings suggest that youth who are exposed to higher densities of on-premise alcohol outlets are at risk for both lifetime use and recent heavy use. It is critical to advocate for stricter laws limiting the number of alcohol outlets in neighborhoods, including clubs/bars where minors are restricted, and putting into place more stringent enforcement of age identification requirements to limit distribution of alcohol to minors.

Prevalence and correlates of depression among new U.S. immigrants

Although immigrants comprise one of the fastest growing segments of society, information on their adjustment to life in the US remains limited. The present study examined the prevalence of depression and associated correlates among a national sample of immigrants newly admitted to legal permanent residence to the US. Data were derived from the baseline adult cohort of the New Immigrant Survey, a national representative sample of immigrants who had obtained legal permanent residence between May and November 2003. Approximately 3% of respondents met criteria for probable depression in the past 12 months. Respondents who were female, younger in age, in the US for a longer period of time, and exposed to political violence in their country of origin were more likely to meet criteria for probable depression. Both pre-immigration and resettlement related factors were associated with probable depression. Further research is needed to better understand how processes in the country of origin and in the resettlement country influence the adjustment of immigrants.

Gateway to curiosity: Medical marijuana ads and intention and use during middle school

Over the past several years, medical marijuana has received increased attention in the media, and marijuana use has increased across the United States. Studies suggest that as marijuana has become more accessible and adults have become more tolerant regarding marijuana use, adolescents perceive marijuana as more beneficial and are more likely to use if they are living in an environment that is more tolerant of marijuana use. One factor that may influence adolescents' perceptions about marijuana and marijuana use is their exposure to advertising of this product. We surveyed sixth- to eighth-grade youth in 2010 and 2011 in 16 middle schools in Southern California (n = 8,214; 50% male; 52% Hispanic; mean age = 13 years) and assessed exposure to advertising for medical marijuana, marijuana intentions, and marijuana use. Cross-lagged regressions showed a reciprocal association of advertising exposure with marijuana use and intentions during middle school. Greater initial medical marijuana advertising exposure was significantly associated with a higher probability of marijuana use and stronger intentions to use 1 year later, and initial marijuana use and stronger intentions to use were associated with greater medical marijuana advertising exposure 1 year later. Prevention programs need to better explain medical marijuana to youth, providing information on the context for proper medical use of this drug and the potential harms from use during this developmental period. Furthermore, as this is a new frontier, it is important to consider regulating medical marijuana advertisements, as is currently done for alcohol and tobacco products.

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events

IMPORTANCE

Serious, preventable surgical events, termed never events, continue to occur despite considerable patient safety efforts.

OBJECTIVE

To examine the incidence and root causes of and interventions to prevent wrong-site surgery, retained surgical items, and surgical fires in the era after the implementation of the Universal Protocol in 2004.

DATA SOURCES

We searched 9 electronic databases for entries from 2004 through June 30, 2014, screened references, and consulted experts.

STUDY SELECTION

Two independent reviewers identified relevant publications in June 2014.

DATA EXTRACTION AND SYNTHESIS

One reviewer used a standardized form to extract data and a second reviewer checked the data. Strength of evidence was established by the review team. Data extraction was completed in January 2015.

MAIN OUTCOMES AND MEASURES

Incidence of wrong-site surgery, retained surgical items, and surgical fires.

RESULTS

We found 138 empirical studies that met our inclusion criteria. Incidence estimates for wrong-site surgery in US settings varied by data source and procedure (median estimate, 0.09 events per 10,000 surgical procedures). The median estimate for retained surgical items was 1.32 events per 10,000 procedures, but estimates varied by item and procedure. The per-procedure surgical fire incidence is unknown. A frequently reported root cause was inadequate communication. Methodologic challenges associated with investigating changes in rare events limit the conclusions of 78 intervention evaluations. Limited evidence supported the Universal Protocol (5 studies), education (4 studies), and team training (4 studies) interventions to prevent wrong-site surgery. Limited evidence exists to prevent retained surgical items by using data-matrix-coded sponge-counting systems (5 pertinent studies). Evidence for preventing surgical fires was insufficient, and intervention effects were not estimable.

CONCLUSIONS AND RELEVANCE

Current estimates for wrong-site surgery and retained surgical items are 1 event per 100,000 and 1 event per 10,000 procedures, respectively, but the precision is uncertain, and the per-procedure prevalence of surgical fires is not known. Root-cause analyses suggest the need for improved communication. Despite promising approaches and global Universal Protocol evaluations, empirical evidence for interventions is limited.

The longitudinal relationship between employment and substance use among at-risk adolescents

This paper explores the longitudinal association between employment and alcohol/other drug (AOD) use and consequences among an at-risk youth sample with a first-time AOD offense. This study extends previous research by examining the effects of more stable employment over time. Participants were adolescents referred to a diversion program (N=193) for a first-time AOD offense. Mean age was 16.6 (SD=1.1), 67% of the sample was male; and 45% Hispanic or Latino/a, 45% white; 10% other. We examined work intensity at program intake with AOD use, AOD-related consequences and risky social environment 180 days after the first survey. Greater work intensity was associated with greater peak drinks per occasion 180 days later and time spent around teens who use alcohol and marijuana; when controlling for age, gender, and race/ethnicity, work intensity was only associated with increased contact with teens who use marijuana. Work stability was not found to be associated with AOD-related use, outcomes, or reports of a risky social environment. Understanding how employment uniquely affects at-risk youth can help us determine policies and practices that may be needed to monitor the amount of time teens work.

Differences in Substance Use and Substance Use Risk Factors by Asian Subgroups

The present study examined differences in lifetime use and initiation of substance use and associated risk factors for alcohol, cigarettes, and marijuana among seven subgroups of Asian American (AA) adolescents: Chinese, Filipino, Indian, Japanese, Korean, Vietnamese, and Mixed heritage Asian. Sixth and 7th grade AA adolescents in Southern California were surveyed five times over three academic years. We examined subgroup differences in (1) lifetime alcohol, cigarette, and marijuana use assessed at baseline, (2) initiation of each substance over three years, and (3) baseline individual (positive and negative expectancies about substances, resistance self-efficacy, and intentions to use), family (closest adult and older sibling substance use), and school factors (perceived peer use). Although there was considerable heterogeneity in lifetime substance use and initiation rates, subgroup differences were not statistically significant (ps > .20). Significant subgroup differences existed for negative expectancies about use, perceived peer use, and close adult alcohol and cigarette use (ps < .05). Specifically, Vietnamese and Japanese adolescents had the lowest negative expectancies about cigarettes and marijuana, respectively. Vietnamese adolescents reported the highest levels of perceived peer cigarette use. Mixed-heritage adolescents reported the highest frequency of alcohol and cigarette use by their closest adult. Although no differences in substance use rates were observed, these findings are an important first step in understanding heterogeneity in AA adolescents' risk for substance use and initiation.

Longitudinal family effects on substance use among an at-risk adolescent sample

OBJECTIVE

Adult and peer factors may influence whether adolescents use alcohol and other drugs (AOD). This longitudinal study examined the direct effects of adult monitoring, perceived adult AOD use, and cultural values on adolescent AOD use.

METHODS

Participants were 193 at-risk adolescents referred to a California diversion program called Teen Court for a first-time AOD offense. We assessed youth reports of past 30day AOD use (any alcohol use, heavy drinking, marijuana use), demographics, changes in parental monitoring and family values (from baseline to follow-up 180days later), as well as family structure and perceived adult substance use at follow-up.

RESULTS

Adolescents who reported that a significant adult in their life used marijuana were more likely to have increased days of drinking, heavy drinking, and marijuana use at follow-up. Higher levels of familism (importance the teen places on their family's needs over their own needs) and being in a nuclear family served as protective factors for future alcohol use. Additionally, poor family management was associated with increased alcohol use and heavy drinking.

CONCLUSION

Findings highlight how family management and perceptions of adult marijuana use influence subsequent adolescent AOD use, and how an increase in familism over time is associated with a decrease in adolescent drinking. Tailoring interventions, by including the teen's family and/or providing support to adults who use AOD may be crucial for improving interventions for adolescent AOD use.

The effects of mental health symptoms and marijuana expectancies on marijuana use and consequences among at-risk adolescents

Based on expectancy theory, adolescents at risk for mental health symptoms, such as those involved in the juvenile court system, may use marijuana due to the belief that use will attenuate anxiety and depressive symptoms. In a diverse sample of youth involved in the Santa Barbara Teen Court system (N = 193), we examined the association between mental health symptoms and marijuana expectancies on marijuana use and consequences. In general, stronger positive expectancies and weaker negative expectancies were both associated with increased marijuana use. Youth that reported more symptoms of both anxiety and depression and stronger positive expectancies for marijuana also reported more consequences. We found that youth experiencing the greatest level of consequences from marijuana were those that reported more depressive symptoms and stronger positive expectancies for marijuana. Findings suggest that these symptoms, combined with strong positive expectancies about marijuana's effects, have implications for consequences among at-risk youth.

Alcohol and marijuana use in middle school: comparing solitary and social-only users

PURPOSE

Middle school students with a history of solitary substance use are at elevated risk for substance problems by young adulthood. Understanding how these students differ from social-only users on substance use behaviors and consequences, normative beliefs, social influences, and attitudes can inform efforts to reduce solitary use and its related negative consequences.

METHODS

Sixth- to seventh-grade students completed an in-school survey. We compared those with a history of solitary versus social-only alcohol use (n = 202 and n = 616, respectively) and marijuana use (n = 92 and n = 208, respectively) on a range of substance use-related characteristics.

RESULTS

Any solitary use was reported by 25% of lifetime alcohol users and 31% of lifetime marijuana users. Those with a history of solitary use of either substance were more likely to hold positive expectancies about their use but also reported more negative consequences during the past year. Solitary users tended to have greater exposure to substance-using peers and more difficulty resisting offers to use. Compared with social-only drinkers, those with a history of solitary drinking perceived that more of their peers were alcohol users. Significant group differences were not found on negative outcome expectancies or attempts to cut down on substance use.

CONCLUSIONS

Solitary use is an important, yet, overlooked problem among middle school students who have just begun drinking or using marijuana. Results suggest that positive expectancies, peer influences, resistance self-efficacy, and normative beliefs may be important areas to target in reducing solitary use and the risk it poses for problematic use in young adulthood.

Illness beliefs predict self-care behaviours in patients with diabetic foot ulcers: a prospective study

AIMS

Patients' illness beliefs are known to be influential determinants of self-care behaviours in many chronic conditions. In a prospective observational study we examined their role in predicting foot self-care behaviours in patients with diabetic foot ulcers.

METHODS

Patients (n=169) were recruited from outpatient podiatry clinics. Clinical and demographic factors, illness beliefs and foot self-care behaviours were assessed as baseline (week 0). Foot self-care behaviours were assessed again 6, 12 and 24 weeks later. Linear regressions examined the contribution of beliefs at baseline to subsequent foot self-care behaviours, controlling for past behaviour (i.e., foot self-care at baseline) and clinical and demographic factors that may affect foot self-care (i.e., age and ulcer size).

RESULTS

Our models accounted for between 42 and 58% of the variance in foot self-care behaviours. Even after controlling for past foot-care behaviours, age and ulcer size; patients' beliefs regarding the symptoms associated with ulceration, their understanding of ulceration and their perceived personal control over ulceration emerged as independent determinants of foot self-care.

CONCLUSIONS

Patients' beliefs are important determinants of foot-care practices. They may, therefore, also be influential in determining ulcer outcomes. Interventions aimed at modifying illness beliefs may offer a means for promoting self-care and improving ulcer outcomes.

The effects of purchasing alcohol and marijuana among adolescents at-risk for future substance use

BACKGROUND

Among high-risk youth, those who may be at increased risk for adverse alcohol and other drug (AOD) use outcomes may benefit from targeted prevention efforts; how youth acquire AOD may provide an objective means of identifying youth at elevated risk.

METHODS

We assessed how youth acquired alcohol and marijuana (purchasing vs. other means), demographics, AOD behaviors/consequences, and environment among adolescents referred to a diversion program called Teen Court (N = 180) at two time points (prior to the program and 180 days from baseline). Participants were predominantly White and Hispanic/Latino(a).

RESULTS

In cross-sectional analyses among alcohol and marijuana users, purchasing marijuana was associated with more frequent marijuana use and consequences, time spent around teens who use marijuana, higher likelihood of substance use disorders, and lower resistance self-efficacy compared to non-purchasers. Teens who purchased both alcohol and marijuana experienced similar outcomes to those who purchased only marijuana, and also reported more frequent and higher quantity of drinking, greater alcohol-related consequences, time spent around teens who use other drugs, and prescription drug misuse. Longitudinally, purchasing alcohol and marijuana at baseline was associated with more frequent and higher quantity of drinking compared to non-purchasers at follow-up. Marijuana only purchasers had a greater likelihood of substance use disorders at follow-up compared to non-purchasers.

CONCLUSIONS

In an era where drinking is commonplace and attitudes towards marijuana use are becoming more tolerant, it is essential to evaluate how accessibility to AOD and subsequent purchasing behaviors affect youth consumption and intervene accordingly to prevent future consequences.

Risk for inhalant initiation among middle school students: understanding individual, family, and peer risk and protective factors

OBJECTIVE

Because initiation of inhalants at an early age is associated with a range of health and behavioral problems, including an increased likelihood of inhalant dependence (based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), we conducted discrete time survival analyses to determine the role of time-invariant and time-variant (over five waves) risk and protective factors as well as grade in inhalant initiation among middle school students.

METHOD

The current study uses data from 3,215 students who were initially surveyed as sixth graders in 2008-2009 and were resurveyed in seventh and eighth grades. Students were part of a larger substance use prevention trial conducted in greater Los Angeles. The sample is racially/ethnically diverse (54% Hispanic/Latino, 16% Asian, 14% White, 3% African American) and 51% male.

RESULTS

Seventeen percent of youths initiated inhalants during middle school. Higher drug refusal self-efficacy, familism (i.e., values related to family), and parental respect were associated with decreased odds of inhalant initiation. Having a significant adult or older sibling who used substances was associated with increased risk of initiation, but adult influence declined linearly and by the end of seventh grade was no longer a risk factor. Self-rated popularity was associated with inhalant initiation in seventh grade only, and perceived substance use by peers was associated with inhalant initiation in sixth grade only.

CONCLUSIONS

The influence of adults, siblings, and peers on inhalant use may be strongest in sixth and seventh grade. Interventions to prevent inhalant initiation should target sixth and seventh graders, address influence by family and peers, and provide skills training to improve drug refusal self-efficacy.

Temporal associations between substance use and delinquency among youth with a first time offense

OBJECTIVE

Substance use and delinquency among adolescents have been shown to be positively associated; however, the temporal relationship is not well understood. Examining the association between delinquency and substance use is especially relevant among adolescents with a first-time substance use related offense as they are at-risk for future problems.

METHOD

Data from 193 adolescents at time of diversion program entry and six months later was examined using cross-lagged path analysis to determine whether substance use and related consequences were associated with other types of delinquency across time.

RESULTS

Results demonstrated that delinquency at program entry was related to subsequent reports of heavy drinking and alcohol consequences, but not marijuana use or its consequences. In contrast, alcohol and marijuana use at program entry were not related to future reports of delinquency.

CONCLUSIONS

Findings emphasize the need to build in comprehensive assessments and interventions for youth with a first time offense in order to prevent further escalation of substance use and criminal behaviors.

Does diversity matter? The need for longitudinal research on adolescent alcohol and drug use trajectories

The existing research aimed at understanding alcohol and drug (AOD) use patterns from early to late adolescence typically does not examine samples with substantial racial and ethnic diversity. This is a critical research gap because studies have suggested that non-white adolescents often have worse health outcomes compared to white adolescents, even with less AOD use. In this paper, we discuss the need for future research on this topic, given demographic shifts in the racial and ethnic composition of the USA. We also outline how this research can provide information on what periods might be most relevant for each racial/ethnic group, and suggest measures that epidemiological studies on early substance use should assess to capture the underlying cultural, acculturation, psychosocial, and contextual factors that explain racial/ethnic differences in AOD trajectories.

Covariance among multiple health risk behaviors in adolescents

PURPOSE

In a diverse group of early adolescents, this study explores the co-occurrence of a broad range of health risk behaviors: alcohol, cigarette, and marijuana use; physical inactivity; sedentary computing/gaming; and the consumption of low-nutrient energy-dense food. We tested differences in the associations of unhealthy behaviors over time, and by gender, race/ethnicity, and socioeconomic status.

METHODS

Participants were 8360 students from 16 middle schools in California (50% female; 52% Hispanic, 17% Asian, 16% White, and 15% Black/multiethnic/other). Behaviors were measured with surveys in Spring 2010 and Spring 2011. Confirmatory factor analysis was used to assess if an underlying factor accounted for the covariance of multiple behaviors, and composite reliability methods were used to determine the degree to which behaviors were related.

RESULTS

The measured behaviors were explained by two moderately correlated factors: a 'substance use risk factor' and an 'unhealthy eating and sedentary factor'. Physical inactivity did not reflect the latent factors as expected. There were few differences in the associations among these behaviors over time or by demographic characteristics.

CONCLUSIONS

Two distinct, yet related groups of health compromising behaviors were identified that could be jointly targeted in multiple health behavior change interventions among early adolescents of diverse backgrounds.

Perceived norms moderate the association between mental health symptoms and drinking outcomes among at-risk adolescents

OBJECTIVE

There has been limited research examining the association between mental health symptoms, perceived peer alcohol norms, and alcohol use and consequences among samples of adolescents. The current study used a sample of 193 at-risk youths with a first-time alcohol and/or other drug offense in the California Teen Court system to explore the moderating role of perceived peer alcohol norms on the association between mental health symptoms and drinking outcomes.

METHOD

Measures of drinking, consequences, mental health symptoms, and perceived peer alcohol norms were taken at baseline, with measures of drinking and consequences assessed again 6 months later. Regression analyses examined the association of perceived norms and mental health symptoms with concurrent and future drinking and consequences.

RESULTS

We found that higher perceived drinking peer norms were associated with heavy drinking behavior at baseline and with negative alcohol consequences both at baseline and 6 months later. Also, perceived drinking norms moderated the association between mental health symptoms and alcohol-related consequences such that better mental health was related to increased risk for alcohol-related consequences both concurrently and 6 months later among those with higher baseline perceptions of peer drinking norms.

CONCLUSIONS

Findings demonstrate the value of norms-based interventions, especially among adolescents with few mental health problems who are at risk for heavy drinking.

A longitudinal examination of alcohol, marijuana, and cigarette perceived norms among middle school adolescents

BACKGROUND

Adolescents tend to overestimate the prevalence of substance use among their peers and these perceived norms are associated with their current and future use. However, little is known about how perceived norms change over time during middle school, a developmental period when adolescents are at-risk for initiating substance use.

METHOD

We examined changes in perceived norms of alcohol, marijuana, and cigarettes over a two-year period among a large and diverse sample of 6th and 7th grade youth (N=6097; 50.1% female; 54% Hispanic). Participants completed a baseline survey and two subsequent annual surveys. Participants estimated the percentage of their peers they believed used each substance, as well as indicated levels of personal use, offers to use from peers, and exposure to peers who were using each substance.

RESULTS

Perceived norms of all three substances increased over time. Increases were somewhat attenuated when controlling for demographic factors, personal use, and peer factors, but remained significant. Female adolescents and those reporting non-Hispanic White ethnicity experienced the greatest increase in perceived norms over time.

CONCLUSION

Normative perceptions of substance use increase greatly during the middle school years, an effect which cannot be fully explained by demographics, personal use, or peer factors. Given that perceived norms are often associated with personal use, early interventions with middle school youth are warranted to prevent the growth of these influential factors during this developmental period.

A randomized controlled trial of a group motivational interviewing intervention for adolescents with a first time alcohol or drug offense

Group motivational interviewing (MI) interventions that target youth at-risk for alcohol and other drug (AOD) use may prevent future negative consequences. Youth in a teen court setting [n=193; 67% male, 45% Hispanic; mean age 16.6 (SD=1.05)] were randomized to receive either a group MI intervention, Free Talk, or usual care (UC). We examined client acceptance, and intervention feasibility and conducted a preliminary outcome evaluation. Free Talk teens reported higher quality and satisfaction ratings, and MI integrity scores were higher for Free Talk groups. AOD use and delinquency decreased for both groups at 3 months, and 12-month recidivism rates were lower but not significantly different for the Free Talk group compared to UC. Results contribute to emerging literature on MI in a group setting. A longer term follow-up is warranted.

Cross-lagged associations between substance use-related media exposure and alcohol use during middle school

PURPOSE

This study examines the reciprocal longitudinal associations between alcohol or other drug (AOD)-related media exposure and alcohol use among middle school students, and explores whether these associations differ by ethnicity or gender.

METHODS

The analytic sample is 7th grade students who were recruited from 16 California middle schools and surveyed in the spring semester of two academic years. Students reported on their background characteristics, exposure to seven types of AOD-related media content (Internet videos, social networking sites, movies, television, magazine advertisements, songs, and video games) in the past 3 months, and alcohol use in the past 30 days. Structural equation modeling was used to examine cross-lagged associations between media exposure and alcohol use.

RESULTS

Greater AOD-related media exposure in 7th grade was significantly associated with a higher probability of alcohol use in 8th grade (p = .02), and alcohol use in 7th grade was marginally associated with greater AOD-related media exposure in 8th grade (p = .07). These cross-lagged associations did not statistically differ by ethnicity (Hispanic vs. non-Hispanic white) or gender. Further, there was no evidence that certain types of media exposure were more strongly associated with alcohol use than others.

CONCLUSIONS

Results from this study suggest that AOD-related media effects and media selectively form a reciprocal, mutually influencing process that may escalate adolescent alcohol use over time. Addressing adolescents' exposure to AOD-related media content and its effects on behavior, such as through media literacy education, may hold promise for improving the efficacy of alcohol prevention efforts for middle school students.

Mental health treatment experiences of U.S. service members previously deployed to Iraq and Afghanistan

OBJECTIVE

This study examined the mental health treatment experiences of active-duty U.S. service members who received treatment from primary care or specialty mental health providers.

METHODS

A national sample of active-duty service members (N=1,659) was surveyed about mental health treatment experiences.

RESULTS

About 17% of respondents reported receipt of mental health care in the prior 12 months. Three times as many service members had seen a specialty mental health provider (14%) as had seen a primary care provider (5%). Of those who had seen a specialty provider, 79% thought treatment helped "a lot or some" and none stated that treatment was "not at all" helpful. Of those who had seen a primary care provider, only 51% thought treatment had helped a lot or some and 15% viewed treatment as not helping at all.

CONCLUSIONS

Patterns of utilization and perceptions of treatment should be considered when addressing the unmet mental health needs of service members.

Exploring the Association Between Military Base Neighborhood Characteristics and Soldiers' and Airmen's Outcomes

Current extended military engagements in foreign nations have taken their toll on U.S. service members and their families. As a result, the services have made renewed commitments to support the needs of these families of military personnel. Quality-of-life and family programs across the services continue to grow. But no service has applied neighborhood theory and methods to better understand these military issues. Installations, and the communities where they are located, vary in terms of the quality of life they provide inhabitants. Similarly, the families who live in these communities and who are assigned to these installations vary in terms of their needs. A one-size-fits-all approach to base resource allocation and the provision of services may not be the most effective in fostering health and well-being among service members and their families. Thus, the services may want to use this approach as part of their efforts to identify gaps in support to service members and families so that they can make the necessary adjustments and better compensate where communities are lacking. This article explores the applicability of neighborhood theory and social indicators research to understanding the quality of life in and around military bases. It also highlights gaps in neighborhood study methodology that need to be addressed in future research. Finally, it outlines how a more in-depth neighborhood analysis of military installations could be conducted.

The effects of employment among adolescents at-risk for future substance use

OBJECTIVE

This paper explores the association between work intensity, alcohol and/or other drug (AOD) use, and related risk factors and consequences among an at-risk youth sample that has received a first-time AOD offense. This study extends previous research focused primarily on school-based samples.

METHOD

We examined the association between work intensity, AOD use, AOD-related consequences, and social environment among adolescents referred to a diversion program called Teen Court (N=193). Participants were surveyed prior to the start of the Teen Court program. Mean age was 17 (SD=1.1), 67% of the sample was male; 45% Hispanic or Latino/a; 45.1% White; 10% Other.

RESULTS

Greater work intensity among these youth was related to greater alcohol-related negative consequences and greater contact with co-workers who engaged in risky behaviors, but it was not significantly associated with past month AOD use.

CONCLUSIONS

Understanding the relationship between work intensity and AOD use among youth who are at-risk is critical to informing clinicians and public officials about the potential effects of employment in this population. Findings suggest that work intensity may be associated with negative consequences from alcohol use and increased contact with risky co-workers, all of which could contribute to the development of problems in the future.

A multi-sample confirmatory factor analysis of PTSD symptoms: what exactly is wrong with the DSM-IV structure?

Within the DSM-IV, PTSD symptoms are rationally classified as assessing one of three symptom domains: reexperiencing, avoidance/numbing, or hyperarousal. However, two alternative four-factor models have been advocated as superior to the DSM-IV framework, based on confirmatory factor analysis. In the Numbing model, symptoms of emotional numbing are differentiated from avoidance. In the Dysphoria model, several symptoms of numbing and hyperarousal are combined to form a factor purported to assess general psychological distress. Examination of these models, within 29 separate data sets, supports two conclusions. First, contrary to its conceptual underpinnings, the Dysphoria model differs empirically from the Numbing model solely in the correlation predicted between two hyperarousal symptoms; all other predicted correlations made by the two models are substantively identical. Second, when the factor analytic presumption of simple structure is relaxed to allow for potential presentation order effects, other plausible symptom structures emerge. In particular, the fit of the DSM-IV model improved dramatically and was a better fit to the data than either four-factor model. The ostensible inferiority of the DSM-IV model may be due to a methodological artifact stemming from the order in which symptoms are typically assessed. The provisional decision to revise the structure of PTSD symptoms in the DSM-5 in light of confirmatory factor analytic results may be misguided.

Temporal associations of popularity and alcohol use among middle school students

PURPOSE

The goal of this study is to better understand the longitudinal cross-lagged associations between popularity, assessed through self-rating and peer nominations, and alcohol use among middle school students.

METHODS

The analytical sample comprises 1,835 sixth- to eighth-grade students who were initially recruited from three California middle schools and surveyed in the fall and spring semesters of 2 academic years. Students reported on their background characteristics, past-month alcohol use, and perceived popularity. Additionally, students provided school-based friendship nominations, which were used to calculate peer-nominated popularity. A cross-lagged regression approach within a structural equation modeling framework was used to examine the longitudinal relationship between popularity (self-rated and peer-nominated) and alcohol use.

RESULTS

There was a statistically significant (p = .024) association between peer-nominated popularity and the probability of alcohol consumption at the subsequent survey, but not vice versa. Our results suggest that in a scenario where 8% of students are past-month drinkers, each increase of five friendship nominations is associated with a 30% greater risk of being a current drinker at the next wave. We found no evidence of longitudinal associations between past-month alcohol consumption and self-rated popularity.

CONCLUSIONS

Popularity is a risk factor for drinking during the middle school years, with peer-nominated popularity being more predictive of use than self-perceptions of popularity. To inform alcohol prevention efforts for middle school students, additional research is needed to better understand why adolescents with a larger number of school-based friendship ties are more inclined to drink.

Preventing alcohol use with a voluntary after-school program for middle school students: results from a cluster randomized controlled trial of CHOICE

There are many mandated school-based programs to prevent adolescent alcohol and drug (AOD) use, but few are voluntary and take place outside of class time. This cluster randomized controlled trial evaluates CHOICE, a voluntary after-school program for younger adolescents, which reduced both individual- and school-level alcohol use in a previous pilot study. We evaluated CHOICE with 9,528 students from 16 middle schools. The sample was 51% female; 54% Hispanic, 17% Asian, 15% white, 9% multiethnic and 3% African American. Fifteen percent of students attended CHOICE. All students completed surveys on alcohol beliefs and use at baseline and 6-7 months later. We conducted intention-to-treat (ITT) school-level analyses and propensity-matched attender analyses. Lifetime alcohol use in the ITT analysis (i.e., school level) achieved statistical significance, with an odds ratio (OR) of 0.70 and a NNT of 14.8. The NNT suggests that in a school where CHOICE was offered, 1 adolescent out of 15 was prevented from initiating alcohol use during this time period. Although not statistically significant (p = .20), results indicate that past month alcohol use was also lower in CHOICE schools (OR = 0.81; NNT = 45). Comparisons of attenders versus matched controls yielded results for lifetime use similar to school-wide effects (OR = 0.74 and NNT = 17.6). Initial results are promising and suggest that a voluntary after-school program that focuses specifically on AOD may be effective in deterring alcohol use among early adolescents; however, further research is needed as program effects were modest.

Is the intergenerational transmission of smoking from mother to child mediated by children's behavior problems?

INTRODUCTION

A previous paper used latent class analysis to assign individuals to 1 of 4 adolescent/young adult smoking trajectory classes and then established an association between maternal smoking before, during, and after pregnancy and these classes. In this paper, we examine one possible pathway for this relationship: that maternal smoking during pregnancy may set off a behavioral trajectory which increases the likelihood of problem behaviors generally, of which smoking is one manifestation.

METHODS

We used the Behavior Problems Index measure from age 8 through age 12 as a potential mediator. We used a path analysis modeling approach within a multinomial logistic regression (using Mplus) to estimate direct and indirect effects (via behavioral problems) between maternal smoking pattern and child trajectory class.

RESULTS

We found small but statistically significant indirect effects via behavioral problems from maternal smoking to child smoking trajectory for membership in all 3 smoking classes, relative to the nonsmoking trajectory, indicating partial mediation. Mediated effects were associated with maternal smoking after pregnancy, no statistically significant mediated effects were found for smoking before or during pregnancy.

CONCLUSIONS

The results provided no evidence that the effects of maternal smoking during pregnancy on child smoking trajectory are mediated by problem behavior. Effects from smoking after birth to child smoking trajectory appear to be partially mediated by problem behavior, supporting a behavioral rather than physiological effect of smoking during pregnancy but not ruling out more complex physiological pathways.

Voluntary After-School Alcohol and Drug Programs for Middle School Youth : If You Build It Right, They Will Come

Few after-school programs target alcohol and other drug (AOD) use because it is difficult to encourage a diverse group of youth to voluntarily attend. The current study describes attendance at a voluntary after-school program called CHOICE, which targeted AOD use among middle school students. Over 4,000 students across eight schools completed surveys and 15% participated in CHOICE. Analyses indicated that there were some differences between CHOICE participants and non-participants. For example, African American and multiethnic students were more likely to attend. Past month alcohol users were more likely to initially attend, and marijuana users were more likely to continue attendance. Thus, CHOICE reached students of different racial/ethnic groups and attracted higher risk youth who may not typically obtain prevention services.

Racial/ethnic differences in the influence of cultural values, alcohol resistance self-efficacy, and alcohol expectancies on risk for alcohol initiation

Prior research has reported racial/ethnic differences in the early initiation of alcohol use, suggesting that cultural values that are central to specific racial/ethnic groups may be influencing these differences. This 1-year longitudinal study examines associations between two types of cultural values, parental respect (honor for one's parents) and familism (connectedness with family), both measured at baseline, and subsequent alcohol initiation in a sample of 6,054 (approximately 49% male, 57% Hispanic, 22% Asian, 18% non-Hispanic White, and 4% non-Hispanic Black) middle school students in Southern California. We tested whether the associations of cultural values with alcohol initiation could be explained by baseline measures of alcohol resistance self-efficacy (RSE) and alcohol expectancies. We also explored whether these pathways differed by race/ethnicity. In the full sample, adolescents with higher parental respect were less likely to initiate alcohol use, an association that was partially explained by higher RSE and fewer positive alcohol expectancies. Familism was not significantly related to alcohol initiation. Comparing racial/ethnic groups, higher parental respect was protective against alcohol initiation for Whites and Asians, but not Blacks or Hispanics. There were no racial/ethnic differences in the association between familism and alcohol initiation. Results suggest that cultural values are important factors in the decision to use alcohol and these values appear to operate in part, by influencing alcohol positive expectancies and RSE. Interventions that focus on maintaining strong cultural values and building strong bonds between adolescents and their families may help reduce the risk of alcohol initiation.

Assessing motivational interviewing integrity for group interventions with adolescents

The group format is commonly used in alcohol and other drug (AOD) adolescent treatment settings, but little research exists on the use of motivational interviewing (MI) in groups. Further, little work has assessed the integrity of MI delivered in group settings. This study describes an approach to evaluate MI integrity using data from a group MI intervention for at-risk youth. Using the Motivational Interviewing Treatment Integrity (MITI) scale, version 3.1, we coded 140 group sessions led by 3 different facilitators. Four trained coders assessed the group sessions. Agreement between raters was evaluated using a method based on limits of agreement, and key decisions used to monitor and calculate group MI integrity are discussed. Results indicated that there was adequate agreement between raters; we also found differences on use of MI between the MI-intervention group and a usual-care group on MI global ratings and behavioral counts. This study demonstrates that it is possible to determine whether group MI is implemented with integrity in the group setting and that MI in this setting is different from what takes place in usual care.

Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis

CONTEXT

Probiotics are live microorganisms intended to confer a health benefit when consumed. One condition for which probiotics have been advocated is the diarrhea that is a common adverse effect of antibiotic use.

OBJECTIVE

To evaluate the evidence for probiotic use in the prevention and treatment of antibiotic-associated diarrhea (AAD).

DATA SOURCES

Twelve electronic databases were searched (DARE, Cochrane Library of Systematic Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE, NTIS, and AGRICOLA) and references of included studies and reviews were screened from database inception to February 2012, without language restriction.

STUDY SELECTION

Two independent reviewers identified parallel randomized controlled trials (RCTs) of probiotics (Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus) for the prevention or treatment of AAD.

DATA EXTRACTION

Two independent reviewers extracted the data and assessed trial quality.

RESULTS

A total of 82 RCTs met inclusion criteria. The majority used Lactobacillus-based interventions alone or in combination with other genera; strains were poorly documented. The pooled relative risk in a DerSimonian-Laird random-effects meta-analysis of 63 RCTs, which included 11 811 participants, indicated a statistically significant association of probiotic administration with reduction in AAD (relative risk, 0.58; 95% CI, 0.50 to 0.68; P < .001; I(2), 54%; [risk difference, -0.07; 95% CI, -0.10 to -0.05], [number needed to treat, 13; 95% CI, 10.3 to 19.1]) in trials reporting on the number of patients with AAD. This result was relatively insensitive to numerous subgroup analyses. However, there exists significant heterogeneity in pooled results and the evidence is insufficient to determine whether this association varies systematically by population, antibiotic characteristic, or probiotic preparation.

CONCLUSIONS

The pooled evidence suggests that probiotics are associated with a reduction in AAD. More research is needed to determine which probiotics are associated with the greatest efficacy and for which patients receiving which specific antibiotics.

Assessing measurement invariance of familism and parental respect across race/ethnicity in adolescents

Background

Familism and parental respect are culturally derived constructs rooted in Hispanic and Asian cultures, respectively. Measures of these constructs have been utilized in research and found to predict delays in substance use initiation and reduced levels of use. However, given that these measures are explicitly designed to tap constructs that are considered important by different racial/ethnic groups, there is a risk that the measurement properties may not be equivalent across groups.

Methods

This study evaluated the measurement equivalence of measures of familism and parental respect in a large and diverse sample of middle school students in Southern California (n = 5646) using a multiple group confirmatory factor analysis approach.

Results

Results showed little evidence of measurement variance across four racial/ethnic groups (African American, Hispanic, Asian, and non-Hispanic White), supporting the continued use of these measures in diverse populations. Some differences between latent variable means were identified – specifically that the Hispanic group and the white group differed on familism.

Conclusions

No evidence of invariance was found. However, the item distributions were highly positively skewed, indicating a tendency for youth to endorse the most positive response, which may reduce the reliability of the measures and suggests that refinement is possible.