Factors contributing to U.S. parents' decisions to administer melatonin to children

OBJECTIVE

Pediatric melatonin use is increasingly prevalent in the U.S. despite limited research on its efficacy and long-term safety. The current study investigated factors contributing to parents' decisions whether to give children melatonin.

METHODS

Parents of children 1.0-13.9 years completed an online questionnaire on children's health, sleep, and melatonin use. Parents who reported giving melatonin to their child were asked open-ended follow-up questions on why their child takes melatonin and why they stopped (if applicable). Responses were assigned to categories through thematic coding.

RESULTS

Data were analyzed on 212 children who either consumed melatonin in the past 30 days (n = 131) or took melatonin previously (n = 81). Among children who recently took melatonin, 51.1 % exhibited bedtime resistance and 46.2 % had trouble falling asleep. Parents most commonly gave children melatonin to: help them fall asleep (49.3 %), wind down before bedtime (22.7 %), facilitate changes in their sleep routine (17.5 %), and/or change their circadian rhythm (11.4 %). Parents stopped giving melatonin because their child did not need it anymore (32.0 %), experienced negative side effects (9.3 %), and/or concerns about health and safety (13.3 %). Finally, parents initiated melatonin use on their own (50.0 %), were encouraged by a friend or family member (27.4 %), and/or followed the recommendation of a health provider (48.1 %).

CONCLUSIONS

Parents administered melatonin to children for a number of reasons and discontinued melatonin based on their own observations of a variety of effects. Parents frequently initiated use without the recommendation of a medical professional. Further research on indications and efficacy of melatonin and wider dissemination of guidelines are needed to help parents make informed decisions regarding children's sleep health.

The Sleep Environment, Napping, and Sleep Outcomes among Urban Children With and Without Asthma

OBJECTIVES

Children with asthma living in U.S. urban neighborhoods experience increased risk for asthma morbidity and poor sleep outcomes. In addition to asthma, environmental factors (e.g. noise, uncomfortable temperature, light exposure) related to urban poverty may disturb children's sleep. This study examined the association between environmental factors and sleep outcomes among urban children with and without asthma, and whether napping underlies the environment-sleep link. Additionally, the study tested whether these associations differed by health status (i.e. asthma) or race/ethnicity.

METHOD

Participants included urban children aged 7-9 years with (N = 251) and without (N = 130) asthma from Latino, Black, or non-Latino White (NLW) background. Caregivers reported sleep environmental factors and naps. Sleep duration, efficiency, and nightly awakenings were assessed via actigraphy.

RESULTS

Regardless of health status, frequent exposure to noise and light was associated with poorer sleep outcomes only among Latino children. In the full sample with and without asthma, noise exposure during nighttime sleep was related to more frequent daytime naps, which were linked to shorter nighttime sleep duration.

CONCLUSIONS

Exposure to noise and light may play a particularly influential role in shaping urban children's sleep outcomes. Racial/ethnic differences and the potential mediating role of napping in this environment-sleep association may inform tailored interventions.

Characteristics of Melatonin Use Among US Children and Adolescents

This survey study describes parent-reported sleep practices, such as prevalence, frequency, and timing of melatonin use, among young people aged 1 to 13 years.

A Pilot Randomized Control Trial Demonstrating the Efficacy of the SIESTA Sleep Hygiene Intervention

Shorter sleep duration can negatively impact children's daytime functioning and health. Latino children living near urban areas in the Mainland U.S. and Island Puerto Rico (PR) can be exposed to urban poverty and sociocultural stressors that challenge optimal sleep outcomes. Interventions to improve urban Latino children's sleep health should consider families' cultural background and environmental context to enhance acceptability and feasibility. This work describes our stepwise, multimethod approach to adapting a culturally and contextually tailored "School Intervention to Enhance Latino Students' Time Asleep (SIESTA)" for sixth- to eighth-grade Latino children residing in Greater Providence and San Juan and findings from a pilot randomized control trial (RCT) demonstrating SIESTA's efficacy. Results indicated high acceptability and greater improvement of sleep duration and behaviors in SIESTA versus control participants. The SIESTA shows potential to improve sleep outcomes in urban Latino middle schoolers. Results will inform a large-scale RCT to evaluate SIESTA's effectiveness and barriers to implementation.

Physical Activity Among Urban Children with Asthma: Does Sleep Matter?

The present study examined associations between sleep and physical activity among a diverse sample of 97 urban children (ages 7-9) with persistent asthma. Differences in associations were evaluated by race/ethnicity and weight status. The extent to which sleep moderated the association between lung function and physical activity was also evaluated. Generalized linear models were utilized to examine associations. Findings indicated that, among the aggregate sample, more frequent nighttime awakenings were associated with less time spent engaging in moderate-to-vigorous physical activity (MVPA). Important differences in these associations were identified by both race/ethnicity and weight status. Better lung function was associated with, (a) higher levels of MVPA for children with better sleep efficiency and fewer nighttime awakenings, and (b) lower levels of MVPA for children with poorer sleep efficiency and more frequent nighttime awakenings. In short, sleep mattered with respect to children's physical activity levels in this sample.

Internalizing symptoms and sleep outcomes in urban children with and without asthma

STUDY OBJECTIVES

This study examines associations between internalizing symptoms and sleep in a sample of urban children with and without asthma, whether asthma status moderates these associations, and whether associations differ by ethnic group.

METHODS

Participants were Latino, African American (AA), and non-Latino white (NLW) urban 7- to 9-year-olds with (n = 259) and without (n = 122) persistent asthma. Teacher-reported internalizing symptoms (anxiety, depressive, and somatic) were assessed using the Behavioral Assessment System for Children-2. Sleep duration, variability in sleep duration, and sleep onset latency were assessed with actigraphy.

RESULTS

Depressive symptoms were associated with variability in sleep duration and shorter sleep onset latency; somatic symptoms were associated with variability in sleep duration. In Latino children, depressive symptoms were associated with shorter sleep onset latency. In AA children, anxiety, depressive, and somatic symptoms were associated with variability in sleep duration; somatic symptoms were related to variability in sleep duration in NLW children. The association between internalizing symptoms and sleep outcomes did not differ by asthma status. However, asthma status was a significant moderator when examining these associations by ethnic group: among AA children, depressive symptoms were significantly related to variability in sleep duration only in children with asthma, whereas in NLW children, somatic symptoms were related to variability in sleep duration only in children without asthma.

CONCLUSIONS

Targeting specific internalizing symptoms and sleep outcomes may be beneficial in the development of interventions tailored for urban children with and without asthma from specific ethnic groups.

Racial and ethnic disparities in sleep outcomes among urban children with and without asthma

BACKGROUND

Suboptimal sleep has been documented in at-risk groups such as urban minority children, particularly those with asthma. It is therefore critical to examine differences in sleep outcomes across specific racial and ethnic groups and to identify factors that contribute to such variations in sleep outcomes to inform tailored interventions to improve sleep health.

OBJECTIVES

The objectives were to examine racial/ethnic differences in sleep outcomes among urban children with and without asthma and to evaluate the extent to which asthma status and aspects of sleep hygiene and the sleep environment contribute to racial/ethnic differences in sleep outcomes in this sample.

METHODS

Two hundred and sixteen African American, Latino, or non-Latino white (NLW) urban children, ages 7-9 years, with (n = 216) and without asthma (n = 130) and their primary caregivers were included. Objective sleep duration and efficiency were assessed via actigraphy. Asthma status was assessed by a study clinician. Caregiver-reported sleep hygiene and exposure to noise were assessed using a questionnaire.

RESULTS

Minority children in the sample had, on average, shorter sleep duration compared to NLW children during the monitoring period (mean difference Latino vs NLW = -22.10, SE = 5.02; mean difference AA vs NLW = -18.69, SE = 5.28) Additionally, several racial/ethnic group differences in sleep outcomes emerged and were dependent on whether or not children had asthma. Specifically, Latinos had lower mean number of awakenings compared to NLWs but only among control participants with no asthma. Furthermore, specific aspects of sleep hygiene and exposure to nighttime noise in the home and neighborhood contributed to racial/ethnic differences in sleep outcomes.

CONCLUSION

Considering urban stressors and asthma status when treating pediatric populations is important, as factors related to urban stress and asthma management may influence sleep hygiene practices and sleep outcomes.

Featured Article: Multiple Comorbid Conditions, Sleep Quality and Duration, and Academic Performance in Urban Children With Asthma

Objective

Common comorbid medical conditions including allergic rhinitis (AR), obesity, and sleep disordered breathing (SDB) have been linked with asthma exacerbations; however, these conditions also impact sleep and academic functioning. The current study sought to examine unique and combined associations of these common comorbidities on sleep and academic performance among urban minority children with persistent asthma. We expected additional comorbid diagnoses would be associated with poorer sleep and academic functioning.

Method

Urban children 7-9 years old (n = 249) with persistent asthma from African American, Latino, and non-Latino White backgrounds participated in this cross-sectional study. Asthma and AR were assessed using guidelines-based approaches. Overweight/obesity was assessed using body mass index and parents reported on SDB risk. Sleep quality (sleep efficiency) and sleep duration were assessed via 4 weeks of actigraphy. A cumulative risk index (CRI) score of asthma-related comorbidities (i.e., number of comorbidities for which each child met criteria) was calculated.

Results

Comorbid conditions were prevalent (AR, 85%; overweight/obese, 39%; SDB risk, 44%). Lower SDB risk and better AR control were both associated with fewer school absences. A higher CRI score was associated with shorter sleep duration and more absences. For children with 1 comorbid condition, better lung function was associated with better sleep efficiency.

Conclusion

Findings suggest increased risk of shorter sleep and more frequent school absences among urban minority children with asthma and more comorbid conditions. Assessment and treatment of this high-risk group must consider how comorbid conditions exacerbate children's asthma and may affect sleep and daytime functioning.

Sleep Hygiene and Sleep Outcomes in a Sample of Urban Children With and Without Asthma

Objective

To assess sleep hygiene and the sleep environment of urban children with and without asthma, and examine the associations among urban stressors, sleep hygiene, and sleep outcomes.

Methods

Urban children, 7-9 years old, with (N = 216) and without (N = 130) asthma from African American, Latino, or non-Latino White backgrounds were included. Level of neighborhood risk was used to describe urban stress. Parent-reported sleep hygiene and daytime sleepiness data were collected using questionnaires. Sleep duration and efficiency were assessed via actigraphy.

Results

Higher neighborhood risk, not asthma status, was associated with poorer sleep hygiene. Controlling for neighborhood risk, sleep hygiene was related to daytime sleepiness. Asthma status, not sleep hygiene, was related to sleep efficiency. In children with asthma, poorer sleep hygiene was associated with shorter sleep duration.

Conclusion

Considering urban stressors when treating pediatric populations is important, as factors related to urban stress may influence sleep hygiene practices and sleep outcomes.

Asthma-related lung function, sleep quality, and sleep duration in urban children

OBJECTIVES

Examine (1) the extent to which changes in objectively measured asthma-related lung function (forced expiratory volume in 1 second) within a sleep period are associated with sleep quality and sleep duration during that sleep period in a group of urban children with persistent asthma, (2) associations between morning and evening asthma-related lung function and sleep quality and duration on the adjacent night, and (3) whether these associations differ by ethnic group.

DESIGN

Cross-sectional, multimethod approach. Children completed a clinic assessment of asthma and allergy status and used home-based objective measurements of asthma-related lung function and sleep.

SETTING

Children and their caregivers participated in a clinic assessment at an asthma and allergy clinic and completed additional assessments at home.

PARTICIPANTS

Two hundred and sixteen African American, Latino, and non-Latino white urban children, ages 7-9 years, and their primary caregivers.

MEASUREMENTS

Participants took part in a clinic assessment of asthma and allergy status, completed interview-based questionnaires including a diary to track asthma symptoms and sleep patterns, and used actigraphy and home-based spirometry daily across a 4-week period to assess sleep and lung function.

RESULTS AND CONCLUSIONS

Results from analyses using structural equation modeling revealed an association between worsening asthma-related lung function and poor sleep quality in the full sample, as well as better asthma-related lung function at night and more optimal sleep efficiency that night. Ethnic group differences emerged in the association with morning or nighttime lung function measurements and sleep quality. Urban minority children with asthma may be at heightened risk for poorer quality sleep. Timing of lung function worsening may be important when considering when and how to improve both asthma health outcomes and sleep quality within specific groups.

Good Sleep Health in Urban Children With Asthma: A Risk and Resilience Approach

OBJECTIVES

To identify children demonstrating "good" sleep health in a sample of urban children with persistent asthma; to compare sociocontextual, asthma clinical characteristics, and sleep behaviors in children with "good" versus "poor" sleep health; and to examine protective effects of family-based health behaviors on sleep health.

METHODS

Participants were 249 Black (33%), Latino (51%) and non-Latino White (16%) children with asthma, ages 7-9 years, and their primary caregivers. 

RESULTS

32 percent of children had "good" sleep health. Well-controlled asthma and better lung function were more likely in this group. In the context of urban risks, sleep hygiene appeared to be a protective factor associated with better sleep quality. The protective effect of asthma management functioned differently by ethnic group.

CONCLUSIONS

This study identifies protective processes that may guard against urban risks to optimize sleep health in children with asthma. Intervention programs can be tailored to consider specific supports that enhance sleep health in this high-risk group.

Asthma, allergic rhinitis, and sleep problems in urban children

OBJECTIVES

In this study, we examine the association of asthma (asthma symptoms, asthma control, lung function) and sleep problems in a group of urban children. The role of allergic rhinitis (AR), a comorbid condition of asthma, on children's sleep problems is also examined. Finally, we investigate whether sleep hygiene moderates the association between asthma and sleep problems, and whether there are differences in these associations based on ethnic background.

METHODS

Non-Latino White, Latino, and African American urban children with asthma (n = 195) ages 7-9 (47% female) and their primary caregivers participated in a baseline visit involving interview-based questionnaires on demographics, asthma and rhinitis control, and caregiver report of children's sleep problems and sleep hygiene. Children and their caregivers participated in a clinical evaluation of asthma and AR, followed by a month monitoring period of children's asthma using objective and subjective methods.

RESULTS

Total sleep problem scores were higher in children of the sample who were from African American and Latino backgrounds, compared to non-Latino white children. Poor asthma control was predictive of higher levels of sleep problems in the entire sample. Poorer AR control also was related to more sleep problems, over and above children's asthma in the sample. This association was more robust in non-Latino white children. Poor sleep hygiene heightened the association between poor asthma control and sleep problems in the entire sample and in African American children.

CONCLUSIONS

Multidisciplinary interventions integrating the co-management of asthma, AR, and the effects of both illnesses on children's sleep, need to be developed and tailored to children and their families' ethnic background.

Stability of Emotional and Behavioral Functioning in Youth with Inflammatory Bowel Disease

This study prospectively examined stability of psychological and behavioral functioning in two matched cohorts of youth with inflammatory bowel disease (IBD): (1) newly-diagnosed and (2) previously-diagnosed patients. Youth and their parents completed measures of emotional and behavioral functioning at Time 1 and 6-months later. Mean-level analyses indicated that scores at Time 1 and Time 2 were within the nonclinical range. A significant decrease occurred in Internalizing symptoms for previously-diagnosed patients. Both groups demonstrated high levels of profile stability, with no significant differences across groups. Results suggest that emotional and behavioral functioning is generally stable without targeted intervention.

A transdisciplinary approach to protocol development for tobacco control research: a case study

The increasing complexity of scientific problems related to lifestyle risk factors has prompted substantial investments in transdisciplinary or team science initiatives at the biological, psychosocial, and population levels of analysis. To date, the actual process of conducting team science from the perspectives of investigators engaged in it has not been well documented. We describe the experience of developing and implementing data collection protocols using the principles of transdisciplinary science. The New England Family Study Transdisciplinary Tobacco Use Research Center was a 10-year collaboration involving more than 85 investigators and consultants from more than 20 disciplines as well as more than 50 research staff. We used a two-phase process in which all the study personnel participated in the developing and testing of 160 instruments. These instruments were used in 4,378 assessments with 3,501 participants. With substantial effort, it is possible to build a team of scientists from diverse backgrounds that can develop a set of instruments using a shared conceptual approach, despite limited or no experience working together previously.

Parental Interest in a Bereavement Support Visit When a Child Dies from Cancer

Parents who have experienced the death of a child from cancer have unique bereavement needs. This study evaluated the possibility of instituting a home-based bereavement visit from the oncology team following a child's death. Parents completed a brief anonymous questionnaire measuring preferences regarding visit logistics and content. The majority (84%) of the 31 participants agreed that a home-based bereavement program is desirable. Qualitative analysis of parental comments revealed common themes including processing grief, practical suggestions for visit, recognition of individual differences, perceived risks and benefits of visit, connections with medical staff, and unmet needs for support. In conclusion, a home visit program may satisfy needs for additional support while alleviating barriers to other types of bereavement care.

Missed sleep and asthma morbidity in urban children

BACKGROUND

Children living in urban environments have many risk factors for disrupted sleep, including environmental disturbances, stressors related to ethnic minority status, and higher rates of stress and anxiety. Asthma can further disrupt sleep in children, but little research has examined the effects of missed sleep on asthma morbidity.

OBJECTIVE

To examine the associations among missed sleep, asthma-related quality of life (QoL), and indicators of asthma morbidity in urban children with asthma from Latino, African American, and non-Latino white backgrounds. Given the importance of anxiety as a trigger for asthma symptoms and the link between anxiety and disrupted sleep, the associations among anxiety, asthma morbidity indicators, and missed sleep were also tested.

METHODS

Parents of 147 children ages 6 to 13 years completed measures of asthma morbidity and missed sleep, parental QoL, and child behavior.

RESULTS

Higher reports of missed sleep were related to more frequent school absences, more activity limitations, and lower QoL across the sample. The associations between missed sleep and asthma morbidity were stronger for Latino children compared with non-Latino white and African American children. For children with higher anxiety, the associations between missed sleep and asthma morbidity were stronger than for children with lower anxiety.

CONCLUSION

Results offer preliminary support for missed sleep as a contributor to daily functioning of children with asthma in urban neighborhoods. Missed sleep may be more relevant to Latino families. Furthermore, anxiety may serve as a link between sleep and asthma morbidity because higher anxiety may exacerbate the effects of disrupted sleep on asthma.

Development and reliability of the lifetime interview on smoking trajectories

INTRODUCTION

Assessments of lifetime smoking history are useful in many types of research including surveillance, epidemiology, prevention, intervention, and studies of genetic phenotypes and heritability. Because prospective assessment is impractical for most research, our objective was to develop a reliable retrospective measure of lifetime smoking history. This paper presents descriptive and test-retest reliability data on smoking history variables assessed using the Lifetime Interview on Smoking Trajectories (LIST).

METHODS

Data were collected on a birth cohort sample of 1,625 men and women (ages 34-44) from the Collaborative Perinatal Project. A subsample of 344 was invited to participate in a retest interview 4-8 weeks later and 220 participated. Indices of test-retest reliability were evaluated for smoking history variables, including: (a) early smoking experiences; (b) age at various smoking milestones, such as first puff, and progression to weekly and daily smoking; (c) smoking rate and time to first cigarette within initial, current, most recent, and heaviest phases; and (d) prolonged nonsmoking phases.

RESULTS

Responses to whether each of 5 major smoking milestones occurred were all highly reliable (κ = .78-.92), and of the 20 phase-specific variables assessed, more than half were reported at the highest level of reliability. None of the variables demonstrated low reliability.

CONCLUSIONS

Although retrospective reports have unavoidable limitations, our findings indicate that the LIST is a reliable instrument for assessing detailed retrospective smoking history data and can be used to add to the knowledge base of how patterns of use relate to a variety of outcomes of interest.

Sleep and culture in children with medical conditions

OBJECTIVES

To provide an integrative review of the existing literature on the interrelationships among sleep, culture, and medical conditions in children.

METHODS

A comprehensive literature search was conducted using PubMed, Medline, and PsychINFO computerized databases and bibliographies of relevant articles.

RESULTS

Children with chronic illnesses experience more sleep problems than healthy children. Cultural beliefs and practices are likely to impact the sleep of children with chronic illnesses. Few studies have examined cultural factors affecting the relationship between sleep and illness, but existing evidence suggests the relationship between sleep and illness is exacerbated for diverse groups.

CONCLUSIONS

Sleep is of critical importance to children with chronic illnesses. Cultural factors can predispose children both to sleep problems and to certain medical conditions. Additional research is needed to address the limitations of the existing literature, and to develop culturally sensitive interventions to treat sleep problems in children with chronic illnesses.

Relationships of personality and psychiatric disorders to multiple domains of smoking motives and dependence in middle-aged adults

INTRODUCTION

Individual differences in psychopathology and personality may associate with dependence on smoking for specific motivational reasons. However, the associations among psychopathology, personality, and smoking dependence and motives have not been examined simultaneously in studies to date, leaving it unclear whether specific patterns of affective and behavioral functioning are associated with specific aspects of smoking dependence.

METHODS

The present study examined these associations in 296 current smokers aged 35-43 years. Smoking dependence and motives were assessed with structured interview, the Fagerström Test for Nicotine Dependence, and the Wisconsin Inventory of Smoking Dependence Motives.

RESULTS

Regardless of the measure of smoking dependence tested, a lifetime history of major depression and high levels of trait stress reaction were consistently related to greater current smoking dependence severity. Substance dependence showed significant associations with some measures of smoking dependence but had relatively few effects when entered in models along with depression history and trait stress reaction. In multivariate models, alcohol dependence and conduct disorder history did not show unique significant associations with smoking dependence nor did trait aggression, alienation, control, or harm avoidance.

DISCUSSION

Results indicate little specificity in the associations of particular psychiatric diagnoses or personality traits with specific self-reported facets of smoking dependence. It appears that a general vulnerability to depression and negative emotions is the most robust indicator of vulnerability to high levels of self-reported smoking dependence, regardless of which dimensions of smoking dependence are analyzed.

Personality, psychiatric disorders, and smoking in middle-aged adults

INTRODUCTION

A number of personality traits have been associated with cigarette smoking. Current smokers generally show higher levels of negative emotionality and lower levels of behavioral constraint than former smokers and those who never smoked. However, prior investigations have not examined thoroughly whether these smoking-personality associations are unique to smoking status or simply reflect the fact that these personality traits tend to be elevated across numerous forms of psychopathology. Likewise, prior studies have not addressed whether personality shows differential associations with smoking based on the presence or absence of lifetime psychiatric disorders.

METHODS

The present study examined these questions using data from 472 current, 311 former, and 324 never-smokers aged 34-44 years.

RESULTS

Current smokers reported being more reactive to stress, more aggressive, more alienated, and less harm avoidant than both former smokers and never-smokers, whereas former smokers and never-smokers showed similar personality profiles overall. Psychiatric disorder history did not interact with smoking status in predicting personality. Controlling for differences in four major lifetime psychiatric disorders (major depression, alcohol dependence, drug dependence, and conduct disorder) reduced the differences in personality traits associated with smoking status. However, smoking status continued to relate uniquely and significantly to higher levels of negative emotionality and behavioral under control with the most robust effect observed for trait alienation.

DISCUSSION

These results provide the most comprehensive depiction to date of interrelations among personality, psychopathology, and smoking and suggest an important role of personality in smoking that is not redundant with or conditional upon lifetime psychopathology.

Parental smoking and adolescent smoking initiation: an intergenerational perspective on tobacco control

OBJECTIVE

Adolescence is an important period of risk for the development of lifelong smoking behaviors. Compelling, although inconsistent, evidence suggests a relationship between parental smoking and the risk of smoking initiation during adolescence. This study investigates unresolved issues concerning the strength and nature of the association between parent smoking and offspring smoking initiation.

METHODS

We enrolled 564 adolescents aged 12 to 17, along with 1 of their parents, into the New England Family Study between 2001 and 2004. Lifetime smoking histories were obtained from parents and their adolescent offspring. Discrete-time survival analysis was used to investigate the influence of parental smoking histories on the risk of adolescent smoking initiation.

RESULTS

Parental smoking was associated with a significantly higher risk of smoking initiation in adolescent offspring. In addition, the likelihood of offspring smoking initiation increased with the number of smoking parents and the duration of exposure to parental smoking, suggesting a dose-response relationship between parental smoking and offspring smoking. Offspring of parents who had quit smoking were no more likely to smoke than offspring of parents who had never smoked. The effects of parental smoking on offspring initiation differed by sex (with a stronger effect of fathers' smoking on boys than girls), developmental period (with a stronger effect of parental smoking before the adolescent was age 13 than afterward), and residence of parents (with effects of fathers' smoking being dependent on living in the same household as the adolescent). Parental smoking was also associated with stronger negative reactions to adolescents' first cigarette, a potential marker of the risk of progression to higher levels of use.

CONCLUSIONS

Parental smoking is an important source of vulnerability to smoking initiation among adolescents, and parental smoking cessation might attenuate this vulnerability.

Child sleep disorders: associations with parental sleep duration and daytime sleepiness

This study examined the associations between childhood sleep disorders and mothers' and fathers' sleep duration and daytime sleepiness. One hundred seven families of children (ages 2-12 years) presenting to a pediatric sleep disorders clinic completed questionnaires assessing the sleep symptoms of the mother, father, and child. Parents of children with more than 1 type of sleep disorder experienced more daytime sleepiness than parents of children with a single sleep disorder. The pattern of results suggested more associations between maternal and child sleep than between paternal and child sleep. Within families, mothers reported significantly more daytime sleepiness than fathers, although there were no parental differences in sleep duration. Results provide preliminary evidence for an association between child sleep problems and parental daytime sleepiness, which may, in turn, extend previous research linking young children's sleep problems and parental functioning. Implications for treatment of both children and adults with sleep problems are discussed.

Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts

The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior.

Risk-taking behavior and adolescent suicide attempts

This study examined the overall rates of common risk-taking behaviors in a sample of 109 adolescents, aged 13 to 18 years, who made a suicide attempt, compared to a matched control sample of 218 adolescents in the community. No differences in either the total number of risk-taking behavior or the frequency of individual risk-taking behaviors were found. These findings suggest that suicide attempts in adolescents are not a function of risk-taking behavior.

Predictors of continued suicidal behavior in adolescents following a suicide attempt

Describes adolescents who attempt suicide and their risk for ongoing suicidal behavior. Fifty-eight adolescents (53 female) who attempted suicide received a baseline evaluation that was analyzed to identify factors that were associated with continued suicidal ideation and reattempt. At a 3-month follow-up assessment, 45% reported continued suicidal ideation and 12% reported a repeat attempt. Baseline measures of family functioning, feelings of hopelessness, and abilities to regulate affect were associated with suicidal ideation at follow-up but not as strongly as depressed mood. After controlling for depressive symptoms, the association between family functioning and continued suicidal behavior was no longer significant. Depressed mood at baseline was most strongly associated with both continued suicidal ideation and reattempt.

Survey of physician attitudes and practices related to pediatric obesity

The purpose of this study was to survey physicians regarding their attitudes and practices related to the treatment of pediatric obesity in a primary care setting. Surveys were sent to physicians who were members of the American Academy of Pediatrics and the American Academy of Family Physicians practicing in the Southern New England area (Connecticut, Massachusetts, and Rhode Island). The 14-item survey consisted of three main areas of focus: attitudes toward obesity, treatment and referral approaches, and barriers to addressing weight concerns in children and adolescents. Physicians estimated that 27.7% of their adolescent and 23% of their child patients are overweight. The frequency with which physicians address weight issues with both child and adolescent patients appears to increase incrementally with the patient's level of overweight. When addressing obesity, one fourth of physicians think that they are not at all or only slightly competent, while 20% report feeling not at all or only slightly comfortable. These findings suggest that physicians would benefit from additional training and education regarding safe and efficacious intervention strategies for pediatric obesity, to effectively integrate the discussion of weight issues into the primary care setting.

Neighborhood predictors of hopelessness among adolescent suicide attempters: preliminary investigation

The role of neighborhood factors in predicting hopelessness among adolescent suicide attempters was examined in this study. Forty-eight adolescents who attempted suicide were administered measures of hopelessness and depression. Family socioeconomic status (SES) was calculated based on family demographics and characteristics of neighborhood context were examined using a geocoding software package. Adolescents who lived in neighborhoods with weak social networks reported higher levels of hopelessness, even after controlling for SES and depression. These preliminary findings suggest that environmental context may play a role in the emotional status of adolescents who attempt suicide.

Adolescent obesity, overt and relational peer victimization, and romantic relationships

OBJECTIVE

To examine associations between obesity and peer relations in adolescents, specifically testing the hypotheses that obese adolescents are more frequent victims of peer aggression and are less likely to develop romantic relationships.

RESEARCH METHODS AND PROCEDURES

Measures of overt and relational victimization, as well as dating status and satisfaction, were collected for a group of 416 ninth- through twelfth-grade students (51.7% girls). Body mass index was computed for each teen based on self-reported height and weight data.

RESULTS

Results revealed that obese boys reported more overt victimization and obese girls reported more relational victimization compared with their average-weight peers. Obese girls were also less likely to date than their peers. However, both obese boys and girls reported being more dissatisfied with their dating status compared with average-weight peers.

DISCUSSION

The results suggest that obese adolescents are at greater risk for mistreatment by peers and may have fewer opportunities to develop intimate romantic relationships; this may contribute to the psychological and health difficulties frequently associated with obesity.

An intervention trial to improve adherence to community treatment by adolescents after a suicide attempt

OBJECTIVE

To determine whether a problem-solving intervention would increase adherence to outpatient treatment for adolescents after a suicide attempt.

METHOD

Sixty-three adolescents who had attempted suicide and were evaluated in an emergency department between 1997 and 2000 were randomly assigned to undergo standard disposition planning or a compliance enhancement intervention using a problem-solving format. At 3 months after the intervention, all evaluable adolescents, guardians, and outpatient therapists were contacted to determine adherence to outpatient treatment.

RESULTS

At 3-month follow-up, the compliance enhancement group attended an average of 7.7 sessions compared with 6.4 sessions for the standard disposition group, but this difference was not statistically significant. However, after covarying barriers to receiving services in the community (such as being placed on a waiting list and insurance coverage difficulties), the compliance enhancement group attended significantly more treatment sessions than the standard disposition-planning group (mean = 8.4 versus 5.8 sessions).

CONCLUSION

Interventions designed to improve treatment attendance must address not only individual and family factors but also service barriers encountered in the community that can impede access to services.

Treatment-as-usual for adolescent suicide attempters: implications for the choice of comparison groups in psychotherapy research

Studied Treatment-as-Usual (TAU) in a sample of 63 adolescent suicide attempters. Randomized clinical trials (RCT's) with high-risk populations, such as suicidal patients, are difficult to conduct due to clinical and ethical concerns about control groups. Therefore, TAU comparison groups have been proposed as ethically defensible alternatives to control groups. However, TAU is rarely characterized in treatment trials. Following a suicide attempt, the adolescents in our sample reported attending 0 to 22 outpatient psychotherapy sessions, with an average of 7.0 sessions. Fifty-two percent of the adolescents reported attending six or fewer sessions. Supportive psychotherapy techniques were reported by three fourths of the sample, psychodynamic and cognitive techniques by one half of the sample, and behavioral techniques by one third of the sample. Results suggest that TAU with this population of adolescents is highly variable, both in terms of the number of sessions attended and type of treatment received. This variability makes interpretation of treatment results in clinical trials with TAU comparison groups tenuous. Given the attention paid to treatment attendance and fidelity in most RCTs, even less potent control groups in such trials may be both ethically and clinically as justifiable as TAU designs for high-risk populations.

Overt and relational aggression in adolescents: social-psychological adjustment of aggressors and victims

Examined the relative and combined associations among relational and overt forms of aggression and victimization and adolescents' concurrent depression symptoms, loneliness, self-esteem, and externalizing behavior. An ethnically diverse sample of 566 adolescents (55% girls) in Grades 9 to 12 participated. Results replicated prior work on relational aggression and victimization as distinct forms of peer behavior that are uniquely associated with concurrent social-psychological adjustment. Victimization was associated most closely with internalizing symptoms, and peer aggression was related to symptoms of disruptive behavior disorder. Findings also supported the hypothesis that victims of multiple forms of aggression are at greater risk for adjustment difficulties than victims of one or no form of aggression. Social support from close friends appeared to buffer the effects of victimization on adjustment.

Self-mutilative behavior in adolescents who attempt suicide by overdose

OBJECTIVE

To examine the cognitive/affective and behavioral symptoms of adolescent suicide attempters with self-mutilative behavior (SMB).

METHOD

Adolescents evaluated after a suicide attempt that occurred between 1996 and 2000 were divided into two groups: suicide attempters with a history of SMB (n = 52) and suicide attempters without SMB (n = 43). The groups were then compared on psychiatric diagnosis, suicide intent, depression, hopelessness, loneliness, anger, reckless behavior, substance use, and family functioning.

RESULTS

Carving on the skin and picking at a wound were the most commonly reported SMBs, occurring in about one third of the sample. The SMB group was significantly more likely to be diagnosed with oppositional defiant disorder, major depression, and dysthymia and had higher scores on measures of hopelessness, loneliness, anger, risk taking, reckless behavior, and alcohol use than did the non-SMB group. Loneliness increased the odds of SMB almost 6-fold.

CONCLUSIONS

Adolescent suicide attempts with SMB are associated with greater cognitive/affective and behavioral symptoms. Adolescent suicide attempters should be routinely screened for SMB.

Adolescents' and their friends' health-risk behavior: factors that alter or add to peer influence

OBJECTIVE

To examine models of risk for adolescent health-risk behavior, including family dysfunction, social acceptance, and depression as factors that may compound or mitigate the associations between adolescents' and peers' risk behavior.

METHODS

Participants were 527 adolescents in grades 9-12. Adolescents reported on their substance use (cigarette and marijuana use, heavy episodic drinking), violent behavior (weapon carrying, physical fighting), suicidality (suicidal ideation and attempts), and the health-risk behavior of their friends.

RESULTS

Adolescents' substance use, violence, and suicidal behavior were related to their friends' substance use, deviance, and suicidal behaviors, respectively. Friends' prosocial behavior was negatively associated with adolescent violence and substance use. Family dysfunction, social acceptance, and depression altered the magnitude of association between peers' and adolescents' risk behavior. In cumulative risk factor models, rates of adolescent health-risk behavior increased twofold with each added risk factor.

CONCLUSIONS

Results supported both additive and multiplicative models of risk. Implications for intervention and primary prevention are discussed.

Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients' suicidal ideation severity

Examined models of suicidal ideation severity that include two psychosocial risk factors (i.e., peer and family functioning) and four domains of psychological symptoms (i.e., generalized anxiety, depression, conduct problems, and substance abuse/dependence). Participants were 96 psychiatric inpatients (32 boys, 64 girls), ages 12 to 17, who were hospitalized because of concerns of suicidality. Adolescents completed a structured diagnostic interview, measures of suicidal ideation, and several dimensions of family and peer functioning. Results supported a model in which greater levels of perceived peer rejection and lower levels of close friendship support were associated directly with more severe suicidal ideation. In addition, indirect pathways included deviant peer affiliation and global family dysfunction related to suicidal ideation via substance use and depression symptoms. The results are among the first to demonstrate relations between suicidal ideation and several areas of adolescent peer functioning, as well as divergent processes for peer and family predictors of suicidal ideation.

Reasons for adolescent suicide attempts: associations with psychological functioning

OBJECTIVE

To determine reasons for suicide attempts in adolescents and to examine the relationship between these reasons and psychological functioning.

METHOD

Self-reported reasons for suicide attempts and psychological functioning were examined in 120 adolescent suicide attempters who presented to a pediatric general hospital.

RESULTS

Consistent with prior research, the most frequently endorsed motives for self-harm were to die, to escape, and to obtain relief. More manipulative reasons for overdose (such as making people sorry) were endorsed less frequently. Adolescents who cited death as a reason for their suicide attempt reported more hopelessness, socially prescribed perfectionism, depression, and anger expression. Discriminant function analyses indicated that high levels of depression and anger expression predicted a self-reported wish to die, and high levels of depression and socially prescribed perfectionism predicted death as the primary reason reported for the suicide attempt.

CONCLUSIONS

Systematic assessment of the reasons for a suicide attempt is a useful tool for clinicians in determining recommendations for follow-up treatment.

Dysphoric interpersonal schemata and preadolescents' sensitization to negative events

Addresses the hypothesis that interpersonal schemata sensitize dysphoric youngsters to negative social information and contribute to the amplification of depressive symptoms. Sensitization was conceptualized as involving multiple components, including heightened anticipation, selective focus, and rapid information processing. Four studies with separate samples of preadolescents and early adolescents were conducted. Results from 3 laboratory-based studies indicated that depressed and dysphoric youngsters evince relatively negative interpersonal schemata, and that these schemata are related to the 3 components of sensitization. A short-term prospective study examined the hypothesis that dysphoric interpersonal schemata moderate the emotional impact of a normative social stressor, the transition to high school. Results indicated that youngsters who entered the transition with relatively negative schema experienced the transition as more stressful than youngsters with relatively positive schema, and that negative interpersonal schema amplified the effects of stress on depressive symptoms.