A randomized controlled trial to reduce post-cessation weight gain.

BACKGROUND/OBJECTIVES: Weight gain is a barrier to smoking cessation. Previous interventions targeting weight gain while quitting smoking have largely been unsuccessful. The current study aimed to assess the efficacy of weight stability and weight loss interventions compared to a low-intensity, self-guided bibliotherapy weight management group. SUBJECTS/METHODS: A randomized controlled trial with 12-month follow-up from 2018 to 2022 was conducted with participants (N = 305) who reported smoking at least five cigarettes per day for the last year and interest in quitting initially recruited from the Memphis, TN, USA area. Recruitment was expanded nationally with the onset of the COVID-19 pandemic. Subsequently, 276 completed 12-month follow-up. INTERVENTIONS/METHODS: The Bibliotherapy group was provided a weight management book. Both the Stability and Loss groups met via telephone for eight weeks to learn strategies for maintaining/losing weight, respectively. All three groups then received the same six-week smoking cessation intervention, with six months of varenicline provided. RESULTS: Individuals in the Loss group lost more weight (-2.01 kg, SE = 1.58) than individuals in the Bibliotherapy group (+1.08 kg, SE = 1.49, p = 0.0004), while the Stability group (-0.30 kg, SE = 1.56) was not significantly different from the Bibliotherapy group (p = 0.17). Those in the Stability group did not gain a significant amount of weight. Participants in the Loss group did not gain back all weight lost after smoking cessation and ended the study approximately 2.01 kg lower than baseline. The Bibliotherapy group did not gain the amount of weight expected after cessation. There were no significant differences between groups related to self-reported smoking cessation at each time point except at eight-month follow-up (p = 0.005). CONCLUSIONS AND RELEVANCE: Results indicated the Stability and the Loss interventions were effective for preventing post-smoking cessation weight gain, with the Loss group having the benefit of sustained weight loss. These interventions may be helpful to implement to combat weight gain and potentially facilitate smoking cessation. TRIAL REGISTRATION: The trial is registered on clinicaltrials.gov (NCT03156660).

Recruitment strategies for a post cessation weight management trial: A comparison of strategy cost-effectiveness and sample diversity.

Background: Effective recruitment of representative and diverse samples in research trials is important to the generalizability of findings and in describing access to behavioral interventions. The current study evaluated the effectiveness of local and national recruitment strategies for a smoking cessation and weight management-focused randomized controlled trial (Fit & Quit). The overall cost-effectiveness of recruitment strategies was also evaluated. Methods: The study initially recruited participants locally in the Memphis, TN area and later transitioned to national recruitment, necessitated by the transition to remote assessment strategies due to the COVID-19 pandemic. The study evaluated effective recruitment strategies for randomized participants (n = 305) across gender, race, rurality, and recruitment method, as well as the cost-effectiveness of methods used during the recruitment period of this study. Results: The most effective recruitment strategies were local postcards, local radio advertisements, word-of-mouth referrals, and national internet advertisements, which resulted in a combined 71.8% (n = 219) of the total randomized sample (n = 305). Radio advertisements were the best method for recruiting Black participants. Electronic recruitment strategies were the most effective method for non-urban participants. Additionally, gender, recruitment method, race, and rurality predicted randomization. Overall, electronic media methods were more cost-effective ($430.97 per participant) compared to traditional media methods ($931.43 per participant); however, traditional media methods resulted in a greater number of recruited and randomized participants. Conclusion: Results provide information on effective and cost-effective local and national recruitment methods for recruiting underrepresented groups of participants in behavioral clinical intervention studies.

Association of Friday School Report Card Release With Saturday Incidence Rates of Agency-Verified Physical Child Abuse.

Importance: Corporal punishment is a leading risk factor for physical abuse. Strong anecdotal evidence from physicians and other professionals working in child protection suggest that punishment-initiated physical abuse for school-aged children increases after release of report cards. However, no empirical examination of this association has occurred. Objective: To examine the temporal association between school report card release and incidence rates (IRs) of physical abuse. Design, Setting, and Participants: This retrospective study reviewed calls to a state child abuse hotline and school report card release dates across a single academic year in Florida. Data were collected in a 265-day window from September 8, 2015, to May 30, 2016, in the 64 of 67 Florida counties with report card release dates available (16 960 days). Participants included all children aged 5 to 11 years for whom calls were made. A total of 1943 verified cases of physical abuse were reported in the study period in the 64 counties. Data were analyzed from October 2017 through May 2018. Exposures: School report cards release across a single academic year, measured daily by county. Main Outcomes and Measures: Daily counts of calls to a child abuse hotline that later resulted in agency-verified incidents of child physical abuse across a single academic year by county. Results: During the academic year, 167 906 calls came in to the child abuse hotline for children aged 5 to 11 years; 17.8% (n = 29 887) of these calls were suspected incidents of physical abuse, and 2017 (6.7%) of these suspected incidents were later verified as cases of physical abuse before excluding the 3 counties with no release dates available. Among the 1943 cases included in the analysis (58.9% males [n = 1145]; mean [SD] age, 7.69 [1.92] years), calls resulting in verified reports of child physical abuse occurred at a higher rate on Saturdays after a Friday report card release compared with Saturdays that do not follow a Friday report card release (IR ratio, 3.75; 95% CI, 1.21-11.63; P = .02). No significant association of report card release with IRs was found for any other days of the week. Conclusion and Relevance: This association of school report card release and physical abuse appears to illustrate a unique systems-based opportunity for prevention.

Impact of Knowledge, Self-Efficacy, and Perceived Importance on Steps Taken Toward Cancer Prevention Among College Men and Women.

The incidence of skin, most HPV-related, liver, and lung cancers can be reduced through primary prevention. Morbidity from breast and testicular cancers can be reduced through secondary prevention. Thus, it is important to understand the mechanisms that predict engagement in primary and secondary prevention behaviors for these cancers. We investigated the roles of knowledge of cancer prevention, perceived importance of cancer prevention, and self-efficacy to engage in prevention steps in order to predict college students' actual engagement in cancer prevention behaviors (CPB). Participants were 315 undergraduates who completed an online survey to assess these constructs. Hierarchical linear regression analyses were used to model knowledge, self-efficacy, and perceived importance as predictors of CPB for a range of cancers. Self-efficacy predicted CPB similarly across all cancers such that having a higher level of self-efficacy to prevent the cancer predicted having engaged in more CPB. Increase in knowledge predicted an increase in the frequency of CPB for skin and HPV-related cancers. Perceived importance of prevention predicted skin cancer CPB. These findings can be used to tailor cancer prevention programs for undergraduates to achieve greatest impact.

Perspective Taking Explains Gender Differences in Late Adolescents' Attitudes Toward Disadvantaged Groups.

Adolescents' attitudes toward disadvantaged groups are surprisingly understudied. What we know from these few studies is that adolescents' attitudes tend to become more favorable over time and that adolescent girls display more favorable attitudes than do adolescent boys. However, researchers have not offered explanations for why these effects occur. We proposed that changes in social-cognitive abilities that accompany adolescent development increase perspective taking and that the increased perspective taking facilitates more favorable attitudes toward disadvantaged groups. Because girls develop social-cognitive abilities earlier than boys, girls should show greater perspective taking and thus more positive attitudes toward disadvantaged groups than should boys. Importantly, we propose that these more positive attitudes are explained better by perspective taking than by gender. Participants were late adolescents (n = 803, 53.3 % female, ages 15-19) from high schools in north-central Florida (United States) participating in an ongoing, multi-wave study. Participants completed a measure of perspective-taking and reported their attitudes toward three disadvantaged groups (Black, gay, and poor people) during their third year of high school and, again, 6 months later during their fourth year of high school. Our findings provided strong support for our theorizing. Girls generally reported warmer attitudes than did boys toward disadvantaged groups, with the gender differences in warmth tending to diminish across time. Similarly, girls were higher than boys in perspective-taking abilities at both time points, although boys increased over time whereas girls did not. Crucially, perspective taking mediated observed gender differences in attitudes, suggesting that perspective taking is a mechanism for improving attitudes toward disadvantaged groups during late adolescence.

A life history theory of father absence and menarche: a meta-analysis.

Is the absence of biological fathers related to their daughters' earlier age at menarche? Drawing on evolutionary psychology and life history theory, prior research has suggested such a relationship (Belsky, Steinberg, and Draper, 1991; Draper and Harpending, 1982; Ellis, 2004). Although qualitative reviews have shown narrative support for this relationship (Allison and Hyde, 2013; Ellis, 2004; Kim, Smith, and Palermiti, 1997; Susman and Dorn, 2009), no quantitative review exists to provide empirical support for this relationship or to explain mixed results. Thus, we conducted a random-effects meta-analysis of correlations (Card, 2012) on father absence and daughter menarcheal age (k=33; N=70,403). The weighted mean correlation was .14, 95% CI [.09, .19], suggesting that father absence was significantly related to earlier menarche; effect sizes were heterogeneous. Egger's regression (Egger, Smith, Schneider, and Minder, 1997) showed no evidence of publication bias (file-drawer effect; r=.34, p=.052). Outcome measure differences (menarcheal age vs. menarcheal age embedded in a multi-item pubertal timing scale) did not moderate effect sizes. Study year effects (Schooler, 2011) were also non-significant. Our findings support one aspect of the life history model and provide groundwork for subsequent examination of other pathways in the model.

Pubertal timing and the development of psychopathology in adolescence and beyond.

This article is part of a Special Issue "Puberty and Adolescence". This paper examines consistency of effects of pubertal timing (going through puberty earlier, later or at the same time one's cohort of peers) on the development of psychopathology during adolescence as well as the persistence of effects into adulthood. It is argued that early maturing girls are at unique risk for psychopathology not only in terms of elevated internalizing and externalizing symptoms and disorders during adolescence but also persistence of elevated risk for depressive disorders and other symptomatology in adulthood. Emerging evidence supports bio-psychosocial pathways for these effects. In addition, recent evidence indicates that late maturation in males may also be a pathway for psychopathology typified by elevated symptoms of psychopathology during early and mid-adolescence and the emergence of disorder in the late adolescent period. While less well established, potential pathways for this association are also discussed.

Methodological considerations in use of the cortisol/DHEA(S) ratio in adolescent populations.

OBJECTIVE: The cortisol/DHEA(S) ratio has demonstrated utility in studies of HPA activity and psychopathology. However, use of the cortisol/DHEA(S) ratio in adolescent populations requires additional consideration of differential changes in DHEA(S) and cortisol during the course of puberty. This study examines the relationship between pubertal status and individual cortisol and DHEAS levels as well as with the cortisol/DHEAS ratio. METHOD: Morning salivary cortisol and urinary DHEAS levels were obtained for 267 young adolescents at three time points, each approximately one year apart. Growth curve modeling and repeated measures ANOVA were used to assess the effect of adrenal development on individual hormone levels and on the total ratio. RESULTS: Pubic hair development was a significant predictor of change over time in DHEAS but not cortisol. Development was also a significant predictor of the cortisol/DHEAS ratio when raw cortisol and DHEAS values were used. CONCLUSIONS: Our findings indicate that, when DHEAS levels were adjusted to control for pubertal status, the ratio demonstrated stability over time. This finding is in line with the hypothesis that the ratio may tap stable individual differences in HPA functioning.

Neuroendocrine predictors of emotional and behavioral adjustment in boys: longitudinal follow-up of a community sample.

BACKGROUND: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been observed in adults and children with mood and anxiety disorders and is thought to be involved in the pathogenesis of these disorders. We recently studied a diverse community sample of boys and found associations of behavioral problems, including symptoms of depression and anxiety, with basal and stress-induced cortisol concentrations. Here we examine cortisol-emotional/behavioral associations at a two-year follow-up and test whether initial cortisol is predictive of worsening emotional/behavioral problems two years later. METHOD: Seventy-eight 10-14-year-old boys and their mothers completed a battery of psychosocial assessments, provided morning and afternoon saliva samples, and participated in a home visit involving mildly stressful tasks and saliva collection for cortisol assay during a two-year follow-up assessment. RESULTS: Consistent with the findings from our time 1 assessment, greater declines in cortisol across the home-visit challenge task were significantly associated with internalizing and externalizing behaviors as well as attention problems and social problems at the two-year follow-up. In addition, morning and afternoon cortisol concentrations at the initial assessment were significant positive predictors of the later development of child depressive symptoms at follow-up after controlling for initial depressive symptoms. CONCLUSION: These findings demonstrate that children in the community with internalizing and externalizing behavior problems have altered patterns of HPA axis stress reactivity. In addition, our prospective findings suggest that elevated cortisol concentrations may influence the later development of emotional/behavioral problems in boys.

Adult-Directed and Peer-Directed Respect for Authority: Relationships With Aggressive and Manipulative Behavior.

This study investigated whether respect for adult and peer authority are separate attitudes which have distinct relationships with aggressive and manipulative behavior. Items assessing admiration for and obedience toward parents, teachers, popular students, and friend group leaders were administered to 286 middle school students (M age = 12.6 yrs). Factor analysis revealed two primary factors which corresponded to adult-directed and peer-directed respect orientations. Results suggested that adult-directed respect was associated with lower levels of aggression and social manipulation, whereas peer-directed respect was associated with higher levels of these behaviors. The role of peer-directed respect as a risk factor for negative social behavior in adolescence is discussed.

Peer relationships and depressive symptomatology in boys at puberty.

The physical changes of puberty coincide with an increase in the salience of peer relationships and a growing risk for depression and other forms of psychopathology. Previously, we reported that pubertal tempo, defined as a child's rate of intraindividual change in pubertal status (measured using parent-reported Tanner stages; Marshall & Tanner, 1970), was associated with changes in boys'--but not girls'--depressive symptoms over and above effects explained by pubertal timing (Mendle, Harden, Brooks-Gunn, & Graber, 2010). The present study extends this previous research by examining changes in the quality of peer relationships in the association between individual differences in pubertal development and change in boys' depressive symptoms. Boys (N = 128, M = 9.61 years, SD = 0.70, at Time 1) were recruited from public schools and assessed annually for 4 years. Results from latent growth curve models indicated that earlier pubertal timing and more rapid pubertal tempo were associated with greater decrements in the quality of boys' peer relationships. After accounting for the association between change in peer relationships and depressive symptoms, the direct effects of pubertal timing and tempo on depressive symptoms were no longer significant. These results highlight a multifaceted approach to studying puberty and emphasize how social mechanisms may intersect with biological risk to produce psychological distress.

Trajectories of aggression, delinquency, and substance use across middle school among urban, minority adolescents.

This study evaluated bidirectional associations between substance use, aggression, and delinquency across sixth, seventh, and eighth grades using data available from a large study of urban minority youth (n = 2,931). Group-based trajectory analysis revealed trajectories of aggression, delinquency, and substance use which support the existence of both adolescent-limited and life-course persistent offenders. In addition, a pattern of decreasing aggression was observed during middle school. Clear temporal associations were observed between developmental changes in aggression, delinquency, and substance use. Notably, the decreasing aggression trajectory was as likely to be associated with high trajectories of substance initiation as was the high aggression trajectory. Furthermore, trajectories of delinquency were differentially associated with future substance use; however, substance use trajectories did not predict trajectories of delinquency. There were few gender differences in the developmental progression of these problem behaviors during middle school with only two exceptions, males were more likely to follow a trajectory of decreasing aggression and a trajectory of high stable delinquency. Evaluations of ethnic/racial differences in the trajectory group membership also revealed few differences. The results of this study provide important information regarding interconnections between developmental changes in problem behavior that occur during the middle school years, highlighting groups that may be missed via traditional analytic approaches that predict mean changes.

Is sensation seeking a stable trait or does it change over time?

The theory of sensation seeking has conceptualized this construct as a stable personality trait associated with a variety of problem behaviors. Reckless behavior theory posits that increases in reckless behavior during adolescence can be attributed, in part, to increases in sensation seeking. This study evaluated patterns of stability and change in sensation seeking among 868 urban, minority youth (53% female), followed longitudinally across middle school (6th-8th grades). Group-based trajectory analysis identified a stable low group (20%), a moderate increasing group (60%), and a stable high group (20%) each of which demonstrated unique associations with changes in problem behaviors. Stable low sensation seekers reported consistently low levels of aggression, delinquency, and substance use across middle school. Moderate increasing sensation seekers reported significant increases in these risk behaviors over time from levels near zero in the 6th grade. Stable high sensation seekers reported high, stable levels of aggression and delinquency upon entry into middle school as well as significant increases in substance use across middle school. These results lend support to both theories and highlight a need for caution when categorizing adolescents as high or low sensation seekers.

The role of peer stress and pubertal timing on symptoms of psychopathology during early adolescence.

Stress is known to amplify the link between pubertal timing and psychopathology. However, few studies have examined the role of peer stress as a context for this link. The present study examined the interaction between perceived pubertal timing and peer stress on symptoms of psychopathology in early adolescence. The sample consisted of 264 students (63% female; M (age) = 12.40, SD = 1.00; 55% Caucasian, 23% African American, 7% Latino, 11% biracial and 4% other). Higher peer stress was associated with symptoms of anxiety/depression; this effect did not vary by timing or gender. However, early-maturing girls with high peer stress demonstrated higher rates of relational and overt aggression compared to other girls. Findings also suggested that late-maturing boys with high stress are at risk for aggression problems; however, due to the small number of boys, analyses were exploratory. Overall, results suggest that developmentally salient contexts as indicated by stressful peer experiences may pose unique threats to early maturing girls and possibly late-maturing boys.

Traditional and cyber aggressors and victims: a comparison of psychosocial characteristics.

To date, relatively little is known about differences between perpetrators and victims of cyber and traditional forms of aggression. Hence, this study investigated differences among traditional and cyber aggressors and victims on psychosocial characteristics typically examined in research on traditional aggression and victimization, specifically effortful control, manipulativeness, remorselessness, proactive and reactive aggression, and anxious/depressive symptoms. Participants (N = 300; 63.2% female; M age = 12.89, SD = .95; 52% Caucasian, 27% African American, 11% Latino, and 10% other) were categorized based on aggressor type (non/low aggressor, traditional-only, cyber-only, and combined traditional and cyber) and victim type (non-victim, traditional-only, cyber-only, and combined traditional and cyber). Cyber aggressors reported lower levels of reactive aggression compared to traditional-only and combined aggressors. Combined aggressors demonstrated the poorest psychosocial profile compared to all other aggressor groups. For victimization, cyber-only and combined victims reported higher levels of reactive aggression and were more likely to be cyber aggressors themselves compared to traditional-only victims and non-victims. Findings suggest that there may be unique aspects about cyber aggression and victimization that warrant further investigation.

Development's tortoise and hare: pubertal timing, pubertal tempo, and depressive symptoms in boys and girls.

Although the sequence of pubertal maturation remains consistent across most individuals, the timing and tempo of development fluctuate widely. While past research has largely focused on the sequelae of pubertal timing, a faster tempo of maturation might also present special challenges to children for acclimating to new biological and social milestones. Using latent growth curve modeling, the present study investigated how pubertal tempo and pubertal timing predicted depressive symptoms over a 4-year period in a sample of children recruited from New York City area public schools. Rate of intraindividual change in parent-reported Tanner stages was used as an index of pubertal tempo, and more advanced Tanner development at an earlier chronological age was used as an index of pubertal timing. For girls (N = 138, M = 8.86 years old at Time 1), pubertal timing emerged as the most salient factor, and the tempo at which girls progressed through puberty was not significant. In boys (N = 128, M = 9.61 years old at Time 1), both timing and tempo of development were significant; notably, however, the effects of pubertal tempo were stronger than those of timing. These findings highlight the need to consider multiple sources of individual variability in pubertal development and suggest different pubertal challenges for boys and girls.

Coping with perceived peer stress: gender-specific and common pathways to symptoms of psychopathology.

This study investigated gender differences in the moderating and mediating effects of responses to stress on the association between perceived peer stress and symptoms of psychopathology. A sample of 295 middle school students (63.7% female; M(age) = 12.39 years, SD = 0.99) completed self-report surveys on stress, coping, and behavioral problems. Involuntary responses to stress (e.g., physiological arousal, intrusive thoughts, impulsive action) mediated the association between perceived stress and anxiety/depression and aggression for girls and for boys. Disengagement coping (e.g., denial, avoidance) partially mediated the association between peer stress and anxiety/depression for boys and for girls. In contrast, disengagement coping mediated the association between peer stress and overt aggression for boys only. Finally, engagement coping (e.g., problem solving, emotion regulation, cognitive restructuring) buffered the indirect effect of peer stress on symptoms of psychopathology for girls only. Implications for prevention and intervention efforts are discussed.

Do trajectories of household risk in childhood moderate pubertal timing effects on substance initiation in middle school?

Previous research on pubertal timing has either evaluated contextual predictors of early puberty or negative adjustment outcomes associated with off-time development, especially early maturation. In this study, we integrated these 2 lines of research by evaluating the moderating influence of early childhood household risk on associations between early puberty and 8th-grade substance use in a longitudinal sample of 1,070 participants. We determined trajectories of early childhood household risk using group-based trajectory analysis. Rates of early maturation were higher but not significantly so in groups with high household risk. Early timing was associated with higher rates of substance initiation only among individuals with a history of high household risk.

Refusal skill ability: an examination of adolescent perceptions of effectiveness.

This pilot study examined whether refusal assertion as defined by a proven drug prevention program was associated with adolescent perceptions of effectiveness by comparing two sets of coded responses to adolescent videotaped refusal role-plays (N = 63). The original set of codes was defined by programmatic standards of refusal assertion and the second by a group of high school interns. Consistency with programming criteria was found for interns' ratings of several indicators of verbal and non-verbal assertiveness. However, a strategy previously defined by the program as effective was perceived as ineffective by adolescents while another deemed ineffective and problematic by intervention developers was viewed as effective. Interns endorsed presenting detailed and reasonable arguments as an effective refusal strategy while short, simple statements were deemed ineffective. This study suggests the importance of including adolescent perspectives in the design, delivery, and evaluation of drug prevention strategies.