Neuroendocrine mechanisms in the links between early life stress, affect, and youth substance use: A conceptual model for the study of sex and gender differences.

Early life stress (ELS) is defined as an acute or chronic stressor that negatively impacts a child's development. ELS is associated with substance use and mental health problems. This narrative literature review focuses on sex and gender differences in the effects of ELS on 1) adolescent neuroendocrine development; 2) pubertal brain maturation; and 3) development of internalizing symptoms and subsequent substance use. We posit that ELS may generate larger hormonal dysregulation in females than males during puberty, increasing internalizing symptoms and substance use. Future research should consider sex and gender differences in neuroendocrine developmental processes when studying the link between ELS and negative health outcomes.

Efficacy to avoid violence and parenting: A moderated mediation of violence exposure for African American urban-dwelling boys.

We took a risk and resilience approach to investigating how witnessing physical violence influences adolescent violent behaviors overtime. We proposed efficacy to avoid violence as a major path of influence in this negative trajectory of adolescent development. We also focus on the protective roles of parenting behaviors for African American boys living in disadvantaged contexts. Most of our sample of 310 African American adolescent males (M age = 13.50, SD = .620) had experienced significant amounts of violence, but they also reported continued efficacy to avoid violence. We tested a first stage dual moderated mediation model and found that higher levels of witnessing violence lead to more violent behavior and less efficacy to avoid violence, and that efficacy was the mediator in that link. Youth who witness more violence may feel that engagement in violence is inescapable and thus may themselves end up engaging in it. These problematic long-term trajectories were moderated by parent's communication about violence and monitoring revealing possible protections for youth, and an enhancement of youths' internal strengths. Our findings propose pathways that can inform interventions that may protect African American adolescent boys against the vicious cycle of exposure to, and acts of, violence.

Physical and mental health quality of life among underserved African American and Latino older adults.

OBJECTIVES: There is an increasing amount of research on Health-Related Quality of Life (HRQoL) among older adults in the U.S. However, under-resourced and underserved African American and Latino older adults remain underrepresented in research and interventional studies, resulting in limited data on their quality of life and health promotion practices. This study examined the association between HRQoL and several layers of independent variables, including health conditions, level of pain, sleep disorders, and lifestyle factors, among African American and Latino older adults. DESIGN: Nine hundred and five African Americans and Latinos aged 55 years and older from an underserved urban community participated in this face-to-face structured study. Multiple linear regression was performed. RESULTS: This study documented that HRQoL among African American and Latino participants was substantially lower compared with their White counterparts reported by other studies. Adjusting for other relevant variables, this study documented an association between: (1) physical HRQoL and financial strain, perceived health, the severity of pain, number of major chronic conditions, smoking, and binge drinking; and (2) mental HRQoL and financial strain, perceived health status, the severity of pain, and sleep disorders. CONCLUSION: Significantly lower levels of HRQoL among underserved African American and Latino older adults, compared with their White counterparts, point to another important racial/ethnic disparity in the U.S. geriatric population. The devastating consequences of financial strain, excessive chronic conditions, undiagnosed and untreated pain, and sleep disorders are all experienced by underserved African American and Latino older adults, and these factors directly contribute to a lower quality of life among this segment of our population. Longitudinal multi-faceted, multi-disciplinary, culturally sensitive, both clinic- and community-based participatory interventions are needed to address these factors, particularly pain and sleep disorders, in order to enhance the quality of life among these underserved communities.

Black-White differences in perceived lifetime discrimination by education and income in the MIDUS Study in the U.S.

There is growing evidence on the negative effects of perceived discrimination on health outcomes and their interactions with indicators of socioeconomic status. However, less has been studied on whether income and education lead individuals of a different race to encounter different discriminatory experiences in their lifetime. Using data from the national survey of the Midlife Development in the United States-MIDUS 1 (1995-1996) and MIDUS Refresher (2011-2014)-on eight measures of perceived lifetime discrimination, this study compares discriminatory experiences of Black and White persons in two time periods. We applied generalized structural equation models and generalized linear models to test multiplicative effects of income and education by race on lifetime discrimination. In both periods, we find substantive disparities between White and Black people in all types of lifetime discrimination, with Black people reporting much higher levels of discrimination. Such disparities exacerbated in the top cohorts of society, yet these associations have changed in time, with White individuals reporting increasing levels of discrimination. Results show that, for Black people in the mid-1990s, perceived discrimination increased as education and income increased. This finding persisted for education by the early 2010s; income effects changed as now both, low- and high-income Black people, reported the highest levels of discrimination. These findings highlight a policy conundrum, given that increasing income and education represent a desirable course of action to improve overall discrimination and health outcomes. Yet, we show that they may unintendingly exacerbate racial disparities in discrimination. We also show that the U.S. is moving toward a stagnation period in health outcomes improvement, with racial disparities in discrimination shrinking at the expense of a deterioration of whites' lifetime discriminatory experiences. Our results highlight the need for a multi-systems policy approach to prevent all forms of discrimination including those due to historical, institutional, legal, and sociopolitical structures.

Social epidemiology of early adolescent problematic screen use in the United States.

OBJECTIVE: To determine sociodemographic correlates of problematic screen use (social media, video games, mobile phones) among a racially/ethnically and socioeconomically diverse population-based sample of 10-14-year-old early adolescents. STUDY DESIGN: We analyzed cross-sectional data from the Adolescent Brain Cognitive Development Study (Year 2, 2018-2020; N = 8753). Multiple linear regression analyses were used to estimate associations between sociodemographic factors (age, sex, race/ethnicity, primary language, household income, parental education) and adolescent-reported problematic video game (Video Game Addiction Questionnaire), social media (Social Media Addiction Questionnaire), and mobile phone use (Mobile Phone Involvement Questionnaire). RESULTS: Boys reported higher problematic video game use while girls reported higher problematic social media and mobile phone use. Native American, black, and Latinx adolescents reported higher scores across all problematic screen measures compared to non-Latinx white adolescents. Having unmarried/unpartnered parents was associated with higher problematic social media use. Although higher household income was generally protective against problematic video game use, these associations were weaker for black than white adolescents (p for interaction <0.05). CONCLUSIONS: Given the sociodemographic differences in problematic screen use, digital literacy education strategies can focus on at-risk populations, encourage targeted counseling by pediatricians, and adapt family media use plans for diverse backgrounds. IMPACT: While sociodemographic differences in screen time are documented, we examined sociodemographic differences in problematic screen use in a large, diverse sample of early adolescents in the US. Boys reported higher problematic video game use while girls reported higher problematic social media and mobile phone use. Native American, black, and Latinx adolescents reported higher scores across all problematic screen measures compared to non-Latinx white adolescents. Although higher household income was generally protective against problematic video game use, these associations were weaker for black than white adolescents. Beyond time spent on screens, pediatricians, parents, and educators should be aware of sociodemographic differences in problematic screen use.

Neighbourhood tobacco retail access and tobacco use susceptibility in young adolescents in urban India.

BACKGROUND: Neighbourhood tobacco retail access may influence adolescent tobacco use. In India, we examined the association between neighbourhood tobacco retail access and cognitive risks for tobacco use during early adolescence. METHODS: In 2019-2020, a population-based sample (n=1759) of adolescents aged 13-15 years was surveyed from 52 neighbourhoods in Mumbai and Kolkata. Neighbourhood tobacco retail access was measured as the frequency of visits to tobacco retailers, mapped tobacco retailer density and perceived tobacco retailer density. We estimated associations between neighbourhood tobacco retail access and cognitive risks for tobacco use (perceived ease of access to tobacco, perceived peer tobacco use and intention to use tobacco). RESULTS: There was high neighbourhood tobacco retail access. Tobacco retailer density was higher in lower income neighbourhoods (p<0.001). Adolescent frequency of tobacco retailer visits was positively associated with cognitive tobacco use risks. Mapped tobacco retailer density was associated with perceived ease of access in Kolkata but not in Mumbai, and it was not associated with perceived peer tobacco use nor intention. Perceived tobacco retailer density was associated with perceived ease of access and perceived peer use, but not with intention. In Kolkata, higher perceived retailer density and frequency of tobacco retailer visits were negatively associated with perceived ease of access. CONCLUSIONS: Efforts to reduce neighbourhood tobacco retail access in India may reduce cognitive tobacco use risk factors in young adolescents. The frequency of tobacco retailer visits and perceived tobacco retailer density increased cognitive risks, though there were some exceptions in Kolkata that further research may explain.

Racial Differences in the Association Between Alcohol Drinking and Cigarette Smoking: Preliminary Findings From an Alcohol Research Program.

AIMS: Important differences have been shown in alcohol drinking and cigarette smoking prevalence, patterns and consequences among individuals from different racial backgrounds. Alcohol and nicotine are often co-used, and the association between drinking and smoking may differ between racial groups-a question explored in the present study. METHODS: Data from the NIAAA natural history and screening protocols were utilized; non-Hispanic Black and non-Hispanic White individuals were included in the analyses [N = 1692; 65.2% male; 58.3% met criteria for current alcohol use disorder (AUD); 37.8% were current cigarette smokers]. Bivariate associations between assessments related to alcohol drinking and cigarette smoking were examined, and the strength and direction of these associations were compared between the two groups. RESULTS: The sample included 796 Black and 896 White individuals. Black participants had higher frequency (P < 0.0001) and severity (P = 0.007) of AUD, as well as higher frequency (P < 0.0001) of cigarette smoking. Bivariate analyses showed that the expected positive associations between alcohol drinking and cigarette smoking, observed among White individuals, were blunted or absent among Black individuals [age at first cigarette-AUD identification test (AUDIT) score: F(1, 292) = 7.60, P = 0.006; cigarette pack years-AUDIT score: F(1, 1111) = 10.97, P = 0.001]. CONCLUSIONS: Some decoupling in the association between alcohol drinking and cigarette smoking was found among Black compared to White individuals. The sample was drawn from a specific population enrolled in alcohol research protocols, which is a limitation of the present study. These preliminary findings highlight the importance of considering racial/ethnic background in preventive and therapeutic strategies for comorbid alcohol and nicotine use.

Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults.

PURPOSE: Although we know that racial and ethnic minorities are more likely to have mistrust in the health care system, very limited knowledge exists on correlates of such medical mistrust among this population. In this study, we explored correlates of medical mistrust in a representative sample of adults. METHODS: We analyzed cross-sectional study data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We ascertained race/ethnicity, health status, perceived discrimination, demographics, socioeconomic factors, and medical mistrust. For data analysis, we used multinomial logistic regression models. RESULTS: Analyses were based on 704 non-Hispanic Black adults, 711 Hispanic adults, and 913 non-Hispanic White adults. Racial/ethnic background was significantly associated with the level of medical mistrust. Adjusting for all covariates, odds of reporting medical mistrust were 73% higher (adjusted odds ratio [aOR] = 1.73; 95% CI, 1.15-2.61, P <.01) and 49% higher (aOR = 1.49; 95% CI, 1.02-2.17, P <.05) for non-Hispanic Black and Hispanic adults when compared with non-Hispanic White adults, respectively. Perceived discrimination was also associated with higher odds of medical mistrust. Indicating perceived discrimination due to income and insurance was associated with 98% higher odds of medical mistrust (aOR = 1.98; 95% CI, 1.71-2.29, P <.001). Similarly, the experience of discrimination due to racial/ethnic background and language was associated with a 25% increase in the odds of medical mistrust (aOR = 1.25; 95% CI, 1.10-1.43; P <.001). CONCLUSIONS: Perceived discrimination is correlated with medical mistrust. If this association is causal, that is, if perceived discrimination causes medical mistrust, then decreasing such discrimination may improve trust in medical clinicians and reduce disparities in health outcomes. Addressing discrimination in health care settings is appropriate for many reasons related to social justice. More longitudinal research is needed to understand how complex societal, economic, psychological, and historical factors contribute to medical mistrust. This type of research may in turn inform the design of multilevel community- and theory-based training models to increase the structural competency of health care clinicians so as to reduce medical mistrust.

Pathways from racial discrimination to cortisol/DHEA imbalance: protective role of religious involvement.

Objective: Racial discrimination (RD) is hypothesized to dysregulate the production of stress reactive hormones among African Americans. Psychological processes that may mediate the association between RD and such dysregulation (e.g. cortisol/DHEA ratio) are not well articulated. Organizational religious involvement (ORI) has been discussed as a psychological protective factor within the context of RD, but our understanding of ORI as a physiological protective factor remains limited. We evaluated whether RD was directly and indirectly (through depressive symptoms) associated with an imbalance of cortisol and DHEA hormones, and whether ORI buffered these direct and/or indirect pathways.Design: Data were drawn from the Flint Adolescent Study, an ongoing interview study of youth that began in 1994. Participants were 188 African American emerging adults (47.3% Female, ages 20-22). We used mediation and moderated-mediation analyses, as outlined by Hayes [2012. PROCESS SPSS Macro. [Computer Software and Manual]. http://www.afhayes.com/public/process.pdf], to evaluate the study aims.Results: We found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio. We also found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio for individuals reporting low and moderate levels of ORI, but not at high levels.Conclusions: Our findings support the socio-psychobiological model of racism and health [Chae et al. 2011. "Conceptualizing Racial Disparities in Health: Advancement of a Socio-Psychobiological Approach." Du Bois Review: Social Science Research on Race 8 (1): 63-77. doi:10.1017/S1742058X11000166] and suggest that the psychological toll of RD can confer physiological consequences. Moreover, ORI may disrupt pathways from RD to cortisol/DHEA ratio by buffering the psychological toll of RD.

Physical Activity and Insomnia Symptoms Over 10 Years in a U.S. National Sample of Late-Middle-Age and Older Adults: Age Matters.

Research suggests that physical activity may influence sleep, yet more research is needed before it can be considered a frontline treatment for insomnia. Less is known about how this relationship is moderated by age. Using multilevel modeling, we examined self-reported physical activity and insomnia symptoms in 18,078 respondents from the U.S. nationally representative Health and Retirement Study (2004-2014). The mean baseline age was 64.7 years, with 53.9% female. Individuals who reported more physical activity (B = -0.005, p < .001) had fewer insomnia symptoms. Over 10 years, the respondents reported fewer insomnia symptoms at times when they reported more physical activity than was average for them (B = -0.003, p < .001). Age moderated this relationship (B = 0.0002, p < .01). Although modest, these findings concur with the literature, suggesting moderate benefits of physical activity for sleep in older adults. Future research should aim to further elucidate this relationship among adults at advanced ages.

The effect of behavioral parent training on sleep problems of school-age children with ADHD: A parallel randomized controlled trial.

OBJECTIVE: The aim of this study was to examine the effect of behavioral parental training (BPT) on sleep problems in children diagnosed with ADHD. METHODS: This parallel randomized controlled trial was conducted in a psychiatric clinic in an urban area of Iran. Participants of this study were 58 school-age children who were diagnosed with ADHD, were receiving methylphenidate and had at least one problem in sleeping. They were randomly assigned into BPT or control groups. Participants' parents in the BPT group underwent a 5-week behavioral intervention program. Data were collected at baseline, immediately after the intervention, and two months after the intervention. Data were analyzed using Chi-square, Fisher's exact test, independent sample t-test, and repeated measure ANOVA test via the SPSS software. RESULTS: Children in the intervention group experienced a significant improvement in total sleep scores two months after the intervention compared to the control group (p = 0.03). Also, the findings showed a significant decline in total sleep problems in the intervention group compared to the control group over time (p = 0.01). CONCLUSION: The results suggest that BPT could be an effective method in improving sleep problems of school-age children diagnosed with ADHD undergoing methylphenidate treatment.

Violence Victimization Predicts Body Mass Index One Decade Later among an Urban Sample of African American Young Adults: Sex as a Moderator and Dehydroepiandrosterone as a Mediator.

Psychological stressors such as violence victimization are known contributors to obesity. However, moderators and mediators of this association have not been studied, although they might offer pathways for intervention or prevention. Using a sample of African American young adults, this study tested: (1) the moderating effect of sex on the effect of violence victimization on trajectories of body mass index (BMI), and (2) the mediating effect of dehydroepiandrosterone (DHEA) on this association. This 13-year longitudinal study followed 73 male and 80 female African American young adults who lived in an urban area from 1999 to 2012 when the youth were 20-32 years old. The independent variable was violence victimization measured in 1999 and 2000. The dependent variable was BMI measured in 2002 and 2012. The mediator was DHEA measured in 2001 and 2002. Multilevel path analysis was used to test if males and females differed in violence victimization predicting change in BMI (Model I) and the mediating effect of DHEA change on the above association (Model II). The results of Model I suggested that the change in violence victimization from 1999 to 2000 predicted change in BMI from 2002 to 2012 for females, but not males. Based on Model II, the DHEA change from 2000 to 2001 for females fully mediated the association between violence victimization from 1999 to 2000 and increases in BMI from 2002 to 2012. Our findings suggest that violence victimization in urban areas contributes to the development of obesity among African American female young adults and change in DHEA mediates this link. Violence prevention may have important implications for obesity prevention of African American young women who live in unsafe urban areas. This study also suggests that DHEA may be involved in the violence victimization-obesity link for African American women.

Racial disparities in bipolar disorder treatment and research: a call to action.

OBJECTIVES: Health disparities between individuals of African and European ancestry are well documented. The disparities in bipolar disorder may be driven by racial bias superimposed on established factors contributing to misdiagnosis, including: evolving empirically based diagnostic criteria (International Classification of Diseases [ICD], Research Diagnostic Criteria [RDC] and Diagnostic and Statistical Manual [DSM]), multiple symptom domains (i.e. mania, depression and psychosis), and multimodal medical and additional psychiatric comorbidity. METHODS: For this paper, we reviewed the phenomenological differences between bipolar individuals of African and European ancestry in the context of diagnostic criteria and clinical factors that may contribute to a potential racial bias. RESULTS: Published data show that bipolar persons of African ancestry, compared with bipolar persons of non-African ancestry, are more often misdiagnosed with a disease other than bipolar disorder (i.e. schizophrenia). Additionally, studies show that there are disparities in recruiting patients of African ancestry to participate in important genomic studies. This gap in biological research in this underrepresented minority may represent a missed opportunity to address potential racial differences in the risk and course of bipolar illness. CONCLUSION: A concerted effort by the research community to increase inclusion of diverse persons in studies of bipolar disorder through community engagement may facilitate fully addressing these diagnostic and treatment disparities in bipolar individuals of African ancestry.

Blacks' Diminished Health Return of Family Structure and Socioeconomic Status; 15 Years of Follow-up of a National Urban Sample of Youth.

The protective effect of family structure and socioeconomic status (SES) on physical and mental health is well established. There are reports, however, documenting a smaller return of SES among Blacks compared to Whites, also known as Blacks' diminished return. Using a national sample, this study investigated race by gender differences in the effects of family structure and family SES on subsequent body mass index (BMI) over a 15-year period. This 15-year longitudinal study used data from the Fragile Families and Child Wellbeing Study (FFCWS), in-home survey. This study followed 1781 youth from birth to age 15. The sample was composed of White males (n = 241, 13.5%), White females (n = 224, 12.6%), Black males (n = 667, 37.5%), and Black females (n = 649, 36.4%). Family structure and family SES (maternal education and income to need ratio) at birth were the independent variables. BMI at age 15 was the outcome. Race and gender were the moderators. Linear regression models were run in the pooled sample, in addition to race by gender groups. In the pooled sample, married parents, more maternal education, and income to need ratio were all protective against high BMI of youth at 15 years of age. Race interacted with family structure, maternal education, and income to need ratio on BMI, indicating smaller effects for Blacks compared to Whites. Gender did not interact with SES indicators on BMI. Race by gender stratified regressions showed the most consistent associations between family SES and future BMI for White females followed by White males. Family structure, maternal education, and income to need ratio were not associated with lower BMI in Black males or females. The health gain received from family economic resources over time is smaller for male and female Black youth than for male and female White youth. Equalizing access to economic resources may not be enough to eliminate health disparities in obesity. Policies should address qualitative differences in the lives of Whites and Blacks which result in diminished health returns with similar SES resources. Policies should address structural and societal barriers that hold Blacks against translation of their SES resources to health outcomes.

Psychological pathways from racial discrimination to cortisol in African American males and females.

The association between racial discrimination (discrimination) and stress-related alterations in the neuroendocrine response-namely, cortisol secretion-is well documented in African Americans (AAs). Dysregulation in production of cortisol has been implicated as a contributor to racial health disparities. Guided by Clark et al. (Am Psychol 54(10):805-816, 1999. doi: 10.1037/0003-066X.54.10.805 ) biopsychosocial model of racism and health, the present study examined the psychological pathways that link discrimination to total cortisol concentrations in AA males and females. In a sample of 312 AA emerging adults (45.5% males; ages 21-23), symptoms of anxiety, but not depression, mediated the relation between discrimination and total concentrations of cortisol. In addition, the results did not reveal sex differences in the direct and indirect pathways. These findings advance our understanding of racial health disparities by suggesting that the psychological consequences of discrimination can uniquely promote physiologic dysregulation in AAs.

"I think that's all a lie I think It's genocide": Applying a Critical Race Praxis to Youth Perceptions of Flint Water Contamination.

Background: In April 2014, the emergency manager of Flint, Michigan switched the city's water supplier from Detroit's water department to the Flint River. The change in water source resulted in the Flint Water Crisis (FWC) in which lead (Pb) from the city's network of old pipes leached into residents' tap water. Residents of Flint reported concerns about the water to officials; however, the concerns were ignored for more than a year. Objective: This study sought to understand how Black youth in Flint conceptualize, interpret, and respond to racism they perceive as part of the normal bureaucracy contributing to the FWC. Methods: In 2016, we conducted four community forums with Flint youth aged 13 to 17 years. Sixty-eight youth participated with 93% self-identifying as Black. Participants completed a brief survey. We audio-recorded the forums and transcribed them verbatim. Critical Race Theory (CRT) guided the development of the interview protocol and Public Health Critical Race Praxis (PHCRP) served as an interpretive framework during qualitative data analysis. Content analyses were completed using software. Results: Many youth viewed the FWC through a racially conscious frame. They described Flint as a Black city where historical and contemporary forms of racial stratification persist. Some described the contamination of the city's water as a form of genocide targeting Blacks. Conclusions: The findings from this exploratory study suggest some Black youth in Flint have difficulty coping with the FWC. Those who perceive it through a racial frame attribute the crisis to racism. They feel distressed about this and other traumas (eg, failure to address high rates of crime) they perceived as racism-related. Future research should examine the implications for specific mental health outcomes among youth.

Justice for all? Beliefs about justice for self and others and telomere length in African Americans.

OBJECTIVE: Believing in justice can protect health. Among marginalized racial minorities however, both endorsing and rejecting beliefs about justice might be critical. The current research examined links between African Americans' beliefs about justice for self and for others and telomere length (TL)-an indicator of biological aging that is increasingly implicated in racial health disparities, with shorter telomeres indicating poorer health. METHOD: Healthy African Americans (N = 118; 30% male; M age = 31.63 years) completed individual differences measures of justice beliefs for self and others and then provided dried blood spot samples that were assayed for TL. RESULTS: We expected that a belief in justice for self would be positively associated with TL, whereas a belief in justice for others would be negatively associated. A significant 3-way interaction with chronological age confirmed this hypothesis-among older African Americans, TL was positively associated with believing in justice for self, but only when this belief was accompanied by a weak endorsement of the belief in justice for others. CONCLUSION: Findings underscore that for racial minorities, health might be best protected when justice beliefs are both endorsed and rebuffed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Demographic, Social, and Behavioral Determinants of Lung Cancer Perceived Risk and Worries in a National Sample of American Adults; Does Lung Cancer Risk Matter?

Background: Perceived risk and worries of developing cancer are important constructs for cancer prevention. Many studies have investigated the relationship between health behaviors and subjective risk perception. However, factors correlated with lung cancer risk perception and worries in individuals more susceptible to lung cancer have rarely been investigated. Objective: To determine demographic, social, and behavioral determinants of cancer perceived risk and worries and to explore heterogeneities in these associations by the level of lung cancer risk in a nationally representative sample of American adults. Methods: For this cross-sectional study, data came from the Health Information National Trends Survey (HINTS) 2017, which included a 2277 representative sample of American adults. Smoking status, cancer perceived risk, cancer worries, age, gender, race, education, income, and insurance status were measured. We ran structural equation models (SEMs) for data analysis. Results: "Ever smoker" status was associated with higher cancer perceived risk (b = 0.25; 95% CI = 0.05⁻0.44, p = 0.013) and worries (b = 0.34, 95% CI = 0.18⁻0.50, p < 0.001), suggesting that "ever smokers" experience higher levels of cancer perceived risk and worries regarding cancer, compared to "never smokers". Other factors that correlate with cancer perceived risk and worries were race, age, income, and insurance status. Blacks demonstrated less cancer perceived risk and worry (b = -0.98, 95% CI = -1.37⁻0.60, p < 0.001) in both low and high risk lung cancer groups. However, the effects of social determinants (income and insurance status) and age were observed in low but not high risk group. Conclusions: Determinants of cancer perceived risk and worries vary in individuals depending on the level of lung cancer risk. These differences should be considered in clinical practice and policy makings with the goal of improving participation rates in lung cancer screening programs.

Equivalent linear change in cognition between individuals with bipolar disorder and healthy controls over 5 years.

OBJECTIVES: Cognitive dysfunction is a key feature of bipolar disorder (BD). However, not much is known about its temporal stability, as some studies have demonstrated a neurodegenerative model in BD while others have shown no change in cognitive functioning over time. Building upon our prior work, which examined the natural course of executive functioning, the current study aimed to investigate the natural course of memory, emotion processing, and fine motor dexterity over a 5-year period in BD and healthy control (HC) samples. METHODS: Using a 5-year longitudinal cohort, 90 individuals with BD and 17 HCs were administered a battery of neuropsychological tests at study baseline and at 1 and 5 years after study entry that captured four areas of cognitive performance: visual memory, auditory memory, emotion processing, and fine motor dexterity. RESULTS: Latent growth curve modeling showed no group differences in the slopes of any of the cognitive factors between the BD and HC groups. Age at baseline was negatively associated with visual memory, emotion processing, and fine motor dexterity. Education level was positively associated with auditory and visual memory and fine motor. Female gender was negatively associated with emotion processing. CONCLUSIONS: Extending our prior work on longitudinal evaluation of executive functioning, individuals with BD show similar linear change in other areas of cognitive functioning including memory, emotion processing, and fine motor dexterity as compared to unaffected HCs. Age, education, and gender may have some differential effects on cognitive changes.