Mindful attention is inversely associated with pain via mediation by psychological distress in orthopedic patients.

BACKGROUND: Orthopedic patients report pain as their main symptom complaint. Subjective pain experience is correlated with self-reported psychological state, such as distress. PURPOSE: This study tests whether scores from a measure of mindful attention are associated with subjective pain levels and whether psychological distress scores function as a mediation path. METHODS: During routine visits to a single orthopedic clinic in East Los Angeles, California, 525 patients were recruited to participate in the study. Participants reported on measures of pain (Universal Pain Assessment Tool [UPAT]), mindful attention (Five-Facet Mindfulness Questionnaire [FFMQ]), and psychological distress (Depression, Anxiety, Stress Scale [DASS]). We used Pearson correlations to examine relationships between FFMQ and UPAT scores and mediation analyses to test indirect effects of DASS scores as a mediation path. RESULTS: The average age of the sample was 54 years (range 18-98 years), 61% were male, and 64% were non-Hispanic White individuals. The locations of injury were the shoulder (72%), elbow (21%), and clavicle or wrist (7%). Ninety-one percent reported mild or greater pain in the prior 2 weeks (mean = 4.2 ± 2.5, range 0-10), and 49% reported mild or more severe distress symptoms (DASS: 13.0 ± 11.5). FFMQ scores inversely predicted UPAT scores (ß = -0.22, P < .01), mediated through DASS scores. DASS subscale scores for depression (ß = -0.10, P = .02) and stress (ß = -0.08, P = .04) but not anxiety (ß = -0.03, P = .33) produced significant indirect effects. FFMQ acting-with-awareness and non-judging subscales had the largest effect on depression and stress DASS subscale scores. CONCLUSIONS: We find statistical support to suggest that distress-particularly depressed mood and stress-mediates the association between mindful attention and pain intensity among orthopedic patients. A disposition of mindful attention might counter distress ailments that exacerbate subjective pain, and this has possible implications for mindfulness training interventions offered to orthopedic patients.

The Acute Relationship between Affective States and Stress Biomarkers in Ethnic Minority Youths.

Background: Whether affective states acutely predict the hypothalamic-pituitary-adrenal (HPA) axis activities and whether energy balance-related behaviors moderate the affect-HPA axis relationship in obese youths are not well-understood. Methods: 87 mostly obese (94.3% obese) minority adolescents (mean: 16.3 ± 1.2 years old; 56.8% Latino and 43.2% African American) participated in a randomized crossover trial in an observation laboratory, where they received either high-sugar/low-fiber (HSLF) or low-sugar/high-fiber (LSHF) meals first and then crossed over in the next visit 2-4 weeks later. During each visit, they rated five affective states and provided a saliva sample every 30 min for the first 5 h and wore a waist-worn accelerometer. The association between the affect ratings and cortisol levels in the subsequent 30 min and the moderation effect of energy balance-related behavior were examined using multilevel models. Results: Within-person negative affect (ß = 0.02, p = 0.0343) and feeling of panic (ß = 0.007, p = 0.004) were acutely related to the subsequent cortisol level only during the HSLF condition. The time spent in moderate-to-vigorous physical activity did not moderate the acute relationship between affect and the subsequent cortisol level. Conclusions: Negative affect could be acutely related to heightened HPA axis activities in youths, but only when they were exposed to meals with high sugar and low fiber content. These results suggest that the meals' sugar and fiber content may modulate HPA axis reactivity to negative affect in youths.

Effect of Telephone Call and Text Message Reminders on Patient Return to Acupuncture Follow-Up Treatment: A Pilot Randomized Controlled Trial.

Background: Telephone calls and text messages function as cues to elicit patient behavior. Objective: We tested the effect of telephone call and text message reminders on patient return to acupuncture follow-up treatment. Design: This is a randomized controlled trial. Setting and Subjects: We recruited adults visiting an acupuncture clinic for a new treatment consultation. Our sample contained 120 participants with 40 per study group. Interventions: Consenting patients were randomized to 1 of 3 study exposures: single voice call, single text message, or treatment as usual (TAU/no reminder). Exposures were sent 3 days after patient's initial treatment. Outcome Measures: Data from clinic charts were abstracted to quantify the absence/presence of a follow-up treatment return in the 30 days after initial treatment. Participants provided self-report of pain symptoms 10 and 30 days after initial treatment on the pain disability index (PDI) to measure change in PDI by return to follow-up treatment as a secondary outcome. Results: Telephone call (56%, P = 0.98) and text message (57%, P = 0.99) groups showed similar proportion of follow-up treatment returns compared with TAU group (57%). Presence of a follow-up appointment scheduled at the initial treatment predicted patient treatment return (odds ratio: 5.87, P < 0.01). Follow-up treatment return predicted reduced PDI scores at day 30 (ß = -3.09, P = 0.02). Conclusions: Adding a 1-time telephone call or text message reminder to standard clinic practice did not improve patient return to acupuncture follow-up treatment within 30 days of initial treatment. Scheduling a future appointment date at initial treatment visit may improve treatment return, and return attendance appears protective of pain disability in the short term.

Initial Efficacy of a Community-Derived Mindfulness-Based Intervention for Latinx Parents and their Children.

Mindfulness-based interventions (MBIs) may offer a means for Latinx families to ameliorate stress, enhance emotion regulation, and foster social support. We assessed pilot data from Latinx parents in Eastside Los Angeles (n = 27) matched with their children aged 10-16 (n = 32) to determine whether participation in a community-derived MBI was associated with greater improvements in dispositional mindfulness, perceived stress, emotion regulation, and family social support compared to a control condition. Compared to the control group, parents in the MBI group showed greater reductions in perceived stress scale (PSS) scores (B = - 2.94, 95% CI [- 5.58, - 0.39], p = 0.029), while their children reported greater increases in perceived social support from family (B = 2.32, 95% CI [0.26, 4.38], p = 0.027). Findings show a community-derived MBI may improve stress in Latinx parents and social support for their children.

Longitudinal Assessment of the Relationships Between Geriatric Conditions and Loneliness.

OBJECTIVES: In response to the lack of longitudinal evidence, this study aims to disentangle time sequence and directionality between the severity of geriatric conditions (GCs) and loneliness. DESIGN: Longitudinal panel study. SETTING AND PARTICIPANTS: The working sample had 4680 participants of 2006, 2010, and 2014 waves of the Health and Retirement Study (HRS). All participants were at least 65 years old at baseline. Proxy responded cases and individuals who suffered from moderate to severe cognitive impairment were excluded from the analysis. METHODS: Loneliness was measured with the 3-item UCLA loneliness scale. Five GCs were included: falls, incontinence, vision impairment, hearing impairment, and pain. Severity indicators were the number of times fallen in the past 2 years, number of days experiencing loss of bladder control in the past month, self-rated eyesight, self-rated hearing, and participants' perceived level of pain. RESULTS: Random-intercept cross-lagged panel models were run to analyze the relationship between the severity of each individual GC and loneliness. All models were controlled for baseline demographics, social isolation, self-rated health, physical function, comorbidities, and hospitalization. The longitudinal association between loneliness and fall was bidirectional: a higher loneliness score predicted an increased number of falls and vice versa. Incontinence, vision impairment, hearing impairment, and pain were not significantly associated with loneliness longitudinally. The association between the random intercept of loneliness and some GCs (vision and pain) were significant, indicating the severity of these GCs were related to loneliness at the between-person level at baseline. CONCLUSION AND IMPLICATIONS: Findings of the longitudinal analysis suggest a reciprocal relationship between fall and loneliness. Fall prevention programs could be integrated with social service for addressing loneliness, and alleviating loneliness might be beneficial for preventing falls. Results of this study highlight the importance of integrating clinical management of falls with social services addressing loneliness in long term care.

A positive deviance-based qualitative study of stress, coping, and feeding practices among low-income, Hispanic mothers whose children do versus do not meet guidelines for fruit and vegetable intake.

Less than 1% of children in the United States concurrently meet guidelines for fruit/vegetable intake, physical activity, screen time, and sugar-sweetened beverages. Prior evidence suggests that parents of this 1% potentially cope with stress differently. This qualitative study used a positive deviance-based approach to locate mothers whose children avoided negative feeding outcomes despite being 'high-risk' for obesity. Semi-structured interviews were conducted in Spanish for two groups: low-income, Hispanic mothers whose children were normal weight and met recommendations for fruits/vegetables and physical activity (n = 5); and a comparison group whose children had obesity and did not meet guidelines (n = 8). Topics included weight-related parenting practices, attitudes toward health, and stress management. Interviews were transcribed, translated, and coded using NVivo for theoretically driven thematic analysis. Results suggested that mothers viewed stress differently. Mothers of healthy weight children believed stress could be prevented, such as by paying children more attention or directing one's attention away from stressors; comparison group mothers tended to report stress about managing their child's eating and about financial worries. Future research is needed to understand the underlying sources of these differences (e.g. personality traits, coping practices) and test whether stress prevention interventions can promote healthy parental feeding practices.

Measurement of sustainment of prevention programs and initiatives: the sustainment measurement system scale.

BACKGROUND: Enhancing the sustainability of evidence-based prevention programs for mental and behavioral health requires tools for measuring both sustainability determinants and sustainment outcomes. The aim of this study was to develop the Sustainment Measurement System Scale (SMSS) and to assess its reliability and construct validity for measuring both determinants and outcomes of efforts to sustain prevention programs and initiatives. METHODS: A 42-item scale comprised of items identified from qualitative data collected from 45 representatives of 10 programs and 8 SAMHSA program officers was administered to 186 representatives of 145 programs funded by 7 SAMHSA prevention grant initiatives. Cronbach's alphas were used to determine inter-item reliability. Convergent validity was assessed by comparisons of a global measure of sustainment with current SAMHSA-funding status and continued operation in the same form. Discriminant validity was assessed by comparisons of sustainability determinants with whether or not the program had undergone adaptations. RESULTS: Confirmatory factor analysis provided support for a 35-item model fit to the data. Cronbach's alpha was .84 for the sustainment outcome construct and ranged from .70 to .93 for the sustainability determinant constructs. All of the determinant constructs were significantly associated with sustainment outcome individual and global measures for the entire sample (p < 0.01 to 0.001) and for community-based programs and programs with a substance abuse focus (p < 0.05 to 0.001). Convergent validity was supported by significant associations between the global sustainment measure and current SAMHSA funding status and continued operation in the same form (p < 0.001). Four of the sustainability determinant constructs (responsive to community needs; coalitions, partnerships, and networks; organizational staff capability; and evaluation, feedback, and program outcomes) were also significantly associated with current SAMHSA funding status (p < 0.5 to 0.01). With the exception of organizational staff capability, all sustainability determinants were unrelated to program adaptation as predicted. CONCLUSIONS: The SMSS demonstrated good reliability and convergent and discriminant validity in assessing likelihood of sustainment of SAMHSA funded prevention programs and initiatives. The measure demonstrates potential in identifying predictors of program sustainment and as a tool for enhancing the likelihood of successful sustainment through ongoing evaluation and feedback.

The Association of Trail Features With Self-Report Trail Use by Neighborhood Residents.

BACKGROUND: Urban trails are a useful resource to promote physical activity. This study identified features of urban trails that correlated with trail use. METHODS: Multiuse urban trails were selected in Chicago, Dallas, and Los Angeles. An audit of each trail was completed using the Systematic Pedestrian and Cyclist Environmental Scan for Trails instrument, identifying built environmental features. A self-report of trail use was obtained from trailside residents (N = 331) living within 1 mile of each trail. Univariate and multivariate Poisson regressions controlled for trail time from home and motivation for physical activity. RESULTS: Positive associations with the past month's hours on the trail were observed for the presence of distance signs, vegetation height, vegetation maintenance, and trail crowding, and a negative association was observed for the presence of crossings on the trail. Positive associations with dichotomous trail use were observed for the presence of distance signs, vegetation height, and vegetation maintenance, and a negative association was observed for the presence of crossings on the trail. CONCLUSIONS: These correlates should be confirmed in other studies and, if supported, should be considered in the promotion and design of urban trails.

Anhedonia, screen time, and substance use in early adolescents: A longitudinal mediation analysis.

INTRODUCTION: Screen time is associated with substance use risk among adolescents; however, less is known about the underlying factors that explain this association. METHODS: This research examined anhedonia, a facet of depression noted by the reduced capacity to experience pleasure, as a mediating factor in the relationship between screen time (hours spent watching television, using internet, and/or playing video games outside of school) and substance use (alcohol and/or cigarettes). We used a longitudinal survey design among a sample of students aged 9-11 years in the 4th to 6th grades in Southern California, United States of America [N = 709 (354 males)]. RESULTS: Structural equation modeling (SEM) findings revealed longitudinal mediation effects of anhedonia on the association between screen time and substance use, while controlling for baseline screen time, baseline individual and peer substance use, race/ethnicity, and gender. Moderation analysis based on a multiple-group approach revealed that gender was not a significant moderator of this mediation pathway. CONCLUSIONS: Adolescents may become desensitized and exhibit a blunted response to hedonic effects from increased screen time. This may result in increased anhedonia and greater risk for substance use through the need to compensate for the reduced experience of rewards. These findings have implications for future school-based substance use prevention and intervention programs.

Risk factors associated with subsequent initiation of cigarettes and e-cigarettes in adolescence: A structural equation modeling approach.

BACKGROUND: Previous youth tobacco research has identified multiple correlated risk factors for initiation of cigarette and e-cigarette use; whether these factors are independently associated with initiation is not known, due to challenges with disentangling the independent effects of these correlated risk factors. METHODS: Students in 11th/12th grade enrolled in the Southern California Children's Health Study were surveyed in 2014 (baseline) and again in 2015 (N = 1553). Structural equation models (SEM) were developed to investigate associations of susceptibility, marketing, and the social environment (as latent factors), and other tobacco use at baseline with cigarette or e-cigarette initiation between baseline and follow-up. Analyses were restricted to baseline never cigarette users (N = 1293) for models evaluating cigarette initiation, and to never e-cigarette users (N = 1197) for models evaluating e-cigarette initiation. RESULTS: In fully-adjusted prospective SEM models, latent factors for cigarette susceptibility, marketing, and the social environment, along with ever e-cigarette use and ever hookah use at baseline were independently associated with cigarette initiation between baseline and follow-up (P < 0.05). Similarly, latent factors for e-cigarette susceptibility, marketing, and the social environment, along with ever hookah use at baseline were associated with e-cigarette initiation between baseline and follow-up (P < 0.05); however, cigarette use at baseline was not associated with e-cigarette initiation in SEM models (P = 0.16). CONCLUSIONS: We identified independent effects of multiple risk factors in SEM models on initiation of cigarettes and e-cigarettes. E-cigarette use was associated with cigarette initiation, but cigarette use was not associated with e-cigarette initiation in fully adjusted models. Research to identify underlying causal mechanisms is warranted.

Factors in the perceived stress scale differentially associate with mindfulness disposition and executive function among early adolescents.

OBJECTIVES: The first aim was to test the factor structure and item-loadings of the 10-item Perceived Stress Scale (PSS) when administered to early adolescents. The second aim was to examine associations between PSS factors, mindfulness disposition, and executive function. METHODS: We analyzed data collected from 331 students in grade seven (M age=12.4, 48.9% female, 47.1% White, 26.0% Hispanic, 37.8% received free-lunch) classrooms from two ethnically/racially and socio-economically diverse schools. Participants completed paper and pencil self-report measures of stress (PSS), mindfulness disposition (Mindful Awareness Attention Scale, MAAS), and executive function (Behavior Rating Inventory of Executive Function, BRIEF). We tested the statistical association between two factors of the PSS: perceived coping and perceived distress with MAAS and BRIEF. RESULTS: A two-factor model of the PSS, inclusive of perceived coping and perceived distress, fit the data better than a one-dimensional model. MAAS and BRIEF scores were inversely associated with PSS distress scores (ß = -.62, p <.0001 and ß = -.66, p <.0001, respectively), but not PSS coping scores (ß = -.04, p = .21 and ß = -.02, p = .57, respectively) in a model adjusted for sex, race, and socio-economic status. CONCLUSIONS: Two factors in the PSS emerged among early adolescents and differentially associated with mindfulness disposition and executive function to similar magnitudes. Findings encourage future assessment of perceived stress in a more refined manner across developmental stages in order to examine trajectories of perceived distress versus perceived coping in relation to mindfulness disposition and executive function.

Relationship between social media engagement and e-cigarette policy support.

INTRODUCTION: Given increasing efforts to regulate e-cigarettes, it is important to understand factors associated with support for tobacco regulatory policies. We investigate such factors found in social media and hypothesize that greater online engagement with tobacco content would be associated with less support for e-cigarette regulatory policies. METHODS: We constructed social networks of Twitter users who tweet about tobacco and categorized them using a combination of social network and Twitter metrics. Twitter users were identified as representing leaders, followers or general users in online discussions of tobacco products, and invited to complete an online survey. Participants responded to questions about their engagement with tobacco-related content online, degree of support for e-cigarette regulations, exposure to tobacco marketing, e-cigarette use and other demographic information. We examined links between their reported engagement with tobacco-related content and support for e-cigarette regulatory policies using structural equation modelling. RESULTS: The analytic sample consisted of 470 participants. The conceptualized structural equation model had a good fit (χ2 (32) = 24.85, p = 0.09, CFI = 0.99, RMSEA = 0.03). Findings support our hypothesis: engagement with online tobacco content was negatively associated with support for e-cigarette policies, while controlling for e-cigarette use, tobacco marketing exposure, social media use frequency and demographic factors. CONCLUSIONS: Findings suggest that our hypothesis was supported. Twitter users engaging with tobacco-related content and harboring negative attitudes toward e-cigarette regulatory policies could be an important audience segment to reach with tailored e-cigarette policy education messages.

Disparities in retail marketing for little cigars and cigarillos in Los Angeles, California.

INTRODUCTION: Evidence of a concentration of cigarette advertising in predominantly low-income, non-White neighborhoods underscores the need to examine retail marketing and promotions for novel tobacco products like little cigars and cigarillos (LCCs). We sought to investigate neighborhood racial/ethnic disparities in LCC marketing at retail, including availability, advertising, price promotions, and product placement in Los Angeles, California. METHODS: Between January 2016 and April 2017, community health workers (n = 19) conducted in-person observational audits from tobacco retail stores (n = 679) located in zip codes with a high percentage of non-Hispanic White (n = 196), Black (n = 194), Hispanic/Latino (n = 189), or Korean American (n = 100) residents. To account for clustering effect of zip codes, multilevel modeling approach for a dichotomized outcome was conducted to evaluate the association between racial/ethnic neighborhood sample and dependent variables. RESULTS: Stores located in zip codes with a high percentage of non-Hispanic Blacks had more than eight times higher odds of selling LCCs (OR = 8.10; 95% CI = 3.10-21.11 vs. non-Hispanic White), more than five times higher odds of selling flavored LCCs (OR = 5.20; 95% CI = 2.33-11.61 vs. non-Hispanic White), and more than six times higher odds of displaying storefront exterior LCC signage (OR = 6.03; 95% CI = 2.93-12.40 vs. non-Hispanic White). Stores in Hispanic/Latino and Korean American communities had about three times higher odds of selling LCCs (OR = 3.02; 95% CI = 1.15-7.93 vs. non-Hispanic White; OR = 2.99; 95% CI = 1.33-6.71 vs. non-Hispanic White). CONCLUSIONS: LCCs are heavily marketed in retail establishments in Los Angeles, with disproportionate targeting of predominantly non-White neighborhoods, especially stores in neighborhoods with a higher proportion of African Americans. Local, state, and federal flavor restrictions, minimum pack size standards, preventive messages, and campaigns could counter the influence of LCC marketing in retail establishments.

Do fluctuations in positive affective and physical feeling states predict physical activity and sedentary time?

OBJECTIVES: Higher levels of positive affect and feelings of energy and vitality are associated with greater physical activity (PA) and lower sedentary time (ST). However, whether fluctuations in these feelings contribute to the regulation of these behaviors is unclear. This study examined the extent to which within-person variability in positive affect and feeling energetic predicted participants' overall levels of PA and ST. DESIGN: This analysis combined data from four ecological momentary assessment (EMA) studies (agerange: 8-73 years) with ambulatory monitoring via waist-worn accelerometry (N=661). METHODS: Positive affect and energy were assessed through EMA several times per day across 4-7 days. Accelerometer data was used to create the following behavioral outcomes: (1) meeting MVPA guidelines (children: 60 minutes/day, adults: 30 minutes/day) and (2) minutes of ST per hour of accelerometer wear. A two-stage analytic approach was used to test the study aim. In the first stage, Mixed-Effects Location Scale Modeling decomposed mean levels and variability in positive affect and energy. In the second stage, a linear or logistic regression (depending on whether the outcome was continuous or dichotomous, respectively) was tested to investigate associations between subject-level mean and variability in EMA ratings and the behavioral outcome. RESULTS: Greater subject-level variability but not subject-level mean of feeling energetic was associated with lower odds of meeting MVPA guidelines (ß=-0.43, p<0.05). CONCLUSIONS: Fluctuations in physical feeling states may deplete self-regulatory resources involved in planning and implementing PA behavior. Alternatively, being more physically active may stabilize one's perceived energy levels.

Demographic and Clinical Factors Associated with Patient Adherence to Acupuncture Treatment.

Objectives: Acupuncture uses needle stimulation upon the body's meridian points to alleviate physical and psychologic symptoms. In clinical practice, acupuncturists often recommend patients to attend follow-up treatment to achieve cumulative benefit over time. Adherence to acupuncture treatment was studied, and demographic and clinical factors were tested that may predict adherence. Design and subjects: A retrospective chart review at an acupuncture teaching clinic was conducted using data from 2014, where patients routinely received recommendations to return for follow-up visits to continue their management of the same health condition. A total of 131 patients were included with an initial consultation in this analysis (mean age = 43 ± 15, 40% male). Outcome measures: Rates of adherence to acupuncture follow-up treatment were determined by tracking whether patients had any subsequent follow-up visits in 30 days after their initial consultation. Demographic and clinical characteristics that differed between adherers (≥1 follow-up visit) and nonadherers (no follow-up visit) were then tested. Among the adherer sample, the authors tested whether these characteristics were associated with a higher number of follow-up visits was tested. Results: Half (50%) of the patient sample adhered to ≥1 follow-up visits in 30 days after their initial consultation. Patients reporting multiple chief complaints were more likely to have a follow-up visit than those with a single complaint (63% vs. 42%, p = 0.02). Receipt of a treatment plan (incidence rate ratio [IRR]: 1.37, p = 0.02) and first follow-up visit within 7 days of initial treatment (IRR: 1.42, p = 0.01) were associated with a higher number of follow-up visits among adherers, after adjusting for covariates. The predicted number of follow-up visits for patients with a treatment plan was 2.5 (standard error [SE] = 0.3) and that for those without a treatment plan was 1.8 (SE = 0.2) among adherers. Conclusion: The rate of return to an acupuncture clinic for follow-up treatment was low (50%). Patient adherence to acupuncture follow-up treatments may be improved by clinical administrative protocols that formalize treatment plans and appointment scheduling.

Adolescent Substance Use and Sensation-Seeking on Sexual Behaviors Among Young Adults from Continuation High Schools.

BACKGROUND: Youth from continuation high schools report greater substance use and sensation-seeking than youth from regular high schools, yet their long-term consequences on age at sexual onset and the number of sexual partners are unknown. OBJECTIVE: To examine substance use, sensation-seeking and sexual behaviors by gender and race/ethnicity and the effects of substance use and sensation-seeking in adolescence on age at sexual initiation and numbers of sexual partners by young adulthood. METHODS: Baseline and 4-year follow-up data on youth from 14 continuation high schools in Southern California who participated in a drug abuse prevention intervention were analyzed. Structural equation modeling assessed whether or not substance use or sensation-seeking in adolescence predicted age at sexual onset and numbers of sexual partners by young adulthood. RESULTS: Latinos had lower sensation-seeking and frequency of substance use and a later age at sexual onset than non-Latinos. Males were more likely than females to have multiple lifetime and recent sexual partners. The effects of adolescent substance use on the number of sexual partners by young adulthood were mediated fully by their age at sexual initiation. Sensation-seeking had no direct or indirect effects on sexual behaviors. Conclusions/Importance: Factors leading to and actual sexual risk behaviors among youth from continuation high schools vary by race/ethnicity and gender. Targeting these antecedent factors by race/ethnicity and gender may improve prevention efforts.

Tobacco Marketing and Subsequent Use of Cigarettes, E-Cigarettes, and Hookah in Adolescents.

INTRODUCTION: Tobacco marketing has expanded from cigarettes to other tobacco products through many promotional channels. Marketing exposure is associated with use of that tobacco product. However, it is unclear if marketing for one product leads to subsequent use of other tobacco products. METHODS: This prospective cohort study assessed self-reported marketing exposure for six tobacco products across five marketing channels in 11th and 12th grade students in 2014. Approximately 16 months later, a follow-up survey was conducted online (N = 1553) to assess initiation of cigarettes, electronic cigarettes (e-cigarettes), and hookah. RESULTS: Adolescent never-smokers with frequent exposure to cigarette marketing on the Internet and in stores are more than two times as likely to begin smoking as young adults (Internet OR = 2.98 [95% CI = 1.56 to 5.66]; stores OR = 2.83 [95% CI = 1.23 to 6.50]). Never users of e-cigarettes were significantly more likely to initiate use, if exposed to Internet, store, and outdoor e-cigarette marketing. Never users of hookah were more likely to use hookah after seeing it marketed in stores. Youth exposed to marketing of e-cigarettes, hookah, cigars, smokeless tobacco, and pipe tobacco in stores were two to three times more likely to begin smoking cigarettes even though the marketed products were not cigarettes. CONCLUSIONS: Adolescent exposure to marketing of tobacco products is associated with initiation of those products as young adults. Exposure to marketing for non-cigarette tobacco products is associated with subsequent cigarette smoking, even when the promoted products are not cigarettes. Future research and interventions should consider the influence of marketing from multiple tobacco products on adolescent tobacco use. IMPLICATIONS: Adolescents grow up in a rich media environment with exposure to tobacco marketing in both their homes (eg, through the Internet and television) and their communities (eg, stores and billboards). This prospective study provides evidence that adolescents exposed to tobacco marketing for multiple tobacco products are more likely to subsequently begin using those products and to begin smoking cigarettes even when the marketing they recall is for different tobacco products. Adolescent exposure to tobacco marketing can increase likelihood of cigarette smoking, e-cigarette, and hookah use with potential lifelong health effects.

Retailers' Perceptions of FDA Tobacco Regulation Authority.

OBJECTIVES: Research is limited on tobacco retailers' perceptions of the Food and Drug Administration's (FDA) tobacco regulatory authority overall, and less exists related to retailers in predominantly African-American or other racial/ethnic neighborhoods. We assessed differences in perceptions of the FDA's tobacco regulatory authority and barriers to compliance among retailers in African-American and non-African-American neighborhoods in Los Angeles, California. METHODS: Overall, 700 tobacco retailer interviews assessed demographic characteristics and perceptions of the FDA. RESULTS: Retailers in African-American neighborhoods self-identified as Hispanic/Latino (43.9% vs 39.6% non-African-American), African-American (21.2% vs 2.6% non-African-American) or Asian (19.7% vs 19.5% non-African-American). Retailers in African-American neighborhoods were significantly less likely to perceive the FDA as a trustworthy source (p = .03; vs non-African-American), but more likely to report that they do not know the federal rules (p = .002), do not understand the federal rules (p = .004), and that tobacco companies encourage them not to follow the federal rules (p = .04). CONCLUSIONS: Tobacco control agencies can use this information about retailer perceptions to design education/training materials in order to increase trust, mitigate barriers, and enhance compliance.

Linkage between teen mother's childhood adversity and externalizing behaviors in their children at age 11: Three aspects of parenting.

BACKGROUND: Experiences of childhood adversity are consistently associated with compromised behavioral health later in life. Less clear is the intergenerational influence of maternal childhood adversity on developmental outcome in children. Completely unknown are the mechanisms linking teen mother's childhood adversity to child developmental outcomes. OBJECTIVE: The present study tested whether aspects of parenting (parenting stress, physical discipline, and disagreement with grandparents) served as the pathways between teen mother's childhood adversity and the externalizing behaviors of their offspring at age 11, by gender. PARTICIPANTS AND SETTING: Data were from a longitudinal panel study of teen mothers and their children, the Young Women and Child Development Study (N = 495; 57% male). METHODS: The pathways from teen mother's childhood adversity to their offspring's externalizing behavior were tested by two subscales: rule-breaking behavior and aggressive behavior. In addition, multiple-group analysis was examined for potential gender differences. RESULTS: Teen mother's childhood adversity was positively associated with greater use of parenting stress (ß = 0.16, p < .01) and physical discipline (ß=0.11, p < .05). In addition, parenting stress, physical discipline, and disagreement with grandparent were all associated with increased rule-breaking and aggressive behaviors in children. Multiple group analysis revealed that the path between physical discipline and externalizing behavior differed by gender, with the path only significant for girls. CONCLUSIONS: These findings have implications for early intervention efforts that emphasize the need to intervene with children and parents, particularly helping teen mothers gain knowledge and skills to offset the impact of their experiences of childhood adversity on their parenting behaviors.

Mean level of positive affect moderates associations between volatility in positive affect, mental health, and alcohol consumption among mothers.

Affective volatility (i.e., variability) is typically conceptualized as a marker of poor mental and behavioral health. The current research challenges this notion. Among individuals who typically experience low positive affect (PA), vacillation between bouts of joy and marked anhedonia may be associated with better behavioral health relative to a restricted range of PA experience. We therefore tested the hypothesis that mean levels of PA captured via an 8-day intensive repeated Ecological Momentary Assessment (EMA) would moderate the association of EMA-measured PA variability with behavioral health measured at intake among working mothers (N = 202) with young children-a population at risk for experiencing repeated stress- and reward-induced PA changes. Mixed-effects location scale modeling parsed variance in PA mean and variability, which were used in subject-level regression models of associations with depressive symptoms, anxiety, and alcohol use. PA mean moderated the associations of PA variability with depressive symptoms (Interaction: ß = .20, p = .02) and alcohol consumption frequency (Interaction: ß = .22, p = .02). PA variability and depressive symptom and alcohol consumption levels were positively associated at higher PA mean levels, whereas PA variability was inversely associated with depressive symptom and alcohol consumption at low mean PA. PA Mean × Variability Interactions were not significant for anxiety and binge drinking. We conclude that (a) intensive longitudinal modeling of Affect Mean × Variability Interaction effects may provide incremental information in psychopathology research; (b) PA volatility does not unilaterally indicate poor behavioral health; and (c) a nuanced perspective on the role of PA volatility may benefit clinical services for working mothers. (PsycINFO Database Record (c) 2018 APA, all rights reserved).