Negative Affect and Drinking among Indigenous Youth: Disaggregating Within- and Between-Person Effects.

Negative affect (depression/anxiety) and alcohol use among Indigenous youth in Canada remain a concern for many communities. Disparate rates of these struggles are understood to be a potential outcome of colonization and subsequent intergenerational trauma experienced by individuals, families, and communities. Using a longitudinal design, we examined change in alcohol use and negative affect, and reciprocal associations, among a group of Indigenous adolescents. Indigenous youth (N = 117; 50% male; Mage=12.46-16.28; grades 6-10) from a remote First Nation in northern Quebec completed annual self-reported assessments on negative affect (depression/anxiety) and alcohol use. A Latent Curve Model with Structured Residuals (LCM-SR) was used to distinguish between- and within-person associations of negative affect and alcohol use. Growth models did not support change in depression/anxiety, but reports of drinking increased linearly. At the between-person level, girls reported higher initial levels of depression/anxiety and drinking; depression/anxiety were not associated with drinking. At the within-person level, drinking prospectively predicted increases in depression/anxiety but depression/anxiety did not prospectively predict drinking. When Indigenous adolescents reported drinking more alcohol than usual at one wave of assessment, they reported higher levels of negative affect than expected (given their average levels of depression/anxiety) at the following assessment. Our findings suggest that when Indigenous youth present for treatment reporting alcohol use, they should also be screened for negative affect (depression/anxiety). Conversely, if an Indigenous adolescent presents for treatment reporting negative affect, they should also be screened for alcohol use.

Effectiveness of Sexual Assault Protective Behaviors on the Daily Level: The Roles of Intoxication and Executive Control.

Young adult women engage in a variety of behaviors aimed at reducing their risk of sexual assault (SA), termed sexual assault protective behavioral strategies (SA-PBS), yet the evidence demonstrating the effectiveness of SA-PBS in reducing SA risk has been relatively sparse and inconclusive. The current study examined the use of SA-PBS, the factor structure of a diverse array of SA-PBS, and their association with the occurrence of SA. The influence of state- and trait-level moderators on the association between SA-PBS and SA events was also examined. In a sample of community young adult women (N = 174), use of SA-PBS and the occurrence of same night SA were examined with a longitudinal burst design over 1 year that spanned 27 weekend nights when women were out in social contexts. We also examined the influence of state intoxication of alcohol use and trait effortful control (EC) on the relationship between SA-PBS factors and SA events. We found that SA-PBS cluster into two factors representing Proactive and Reactive SA-PBS. While Proactive PBS was not associated with SA, Reactive PBS were positively associated with a SA event occurring. There was no evidence in the current sample to support a moderating role of intoxication on the relationship between Proactive or Reactive PBS and SA. However, there was a marginal interaction effect found for the moderating role of EC on the relationship between Proactive PBS and SA. Our findings identify important differences in SA-PBS, and perhaps most importantly, suggest that not all strategies are created equal with respect to reducing risk.

The role of effortful control in mitigating negative consequences associated with emerging adult drinking.

BACKGROUND: Identifying factors that protect against alcohol-related negative consequences associated with emerging adult drinking is a critical public health issue. It has been proposed that high levels of self-regulation moderate risks associated with drinking, decreasing alcohol-related negative consequences. Past research testing this possibility is limited by a lack of advanced methodology for testing moderation and failure to consider facets of self-regulation. This study addressed these limitations. METHODS: Three hundred fifty-four community emerging adults (56% female; predominantly non-Hispanic Caucasian (83%) or African American (9%)) were assessed annually for 3 years. Moderational hypotheses were tested using multilevel models and the Johnson-Neyman technique was used to examine simple slopes. Data were organized such that repeated measures (level 1) were nested within participants (level 2) to test cross-sectional associations. Self-regulation was operationalized as effortful control and its facets (attentional, inhibitory, and activation control). RESULTS: We found evidence of moderation. The association between alcohol use during a heavy drinking week and consequences weakened as effortful control increased. This pattern was supported for two facets (attentional and activation control), but not for inhibitory control. Regions of significance results revealed that this protective effect was only evident at very high levels of self-regulation. CONCLUSIONS: The results provide some evidence that very high levels of attentional and activation control protect against alcohol-related negative consequences associated with drinking. Emerging adults who are very high in attentional and activation control are likely better able to control their attention and engage in goal-directed behavior, like leaving a party at a reasonable hour, or attending school and/or work when experiencing the punishing effects of a hangover. Results emphasize the importance of distinguishing facets of self-regulation when testing self-regulation models.

The Acquired Preparedness Model of Cannabis Use in Emerging Adulthood: Comparing Within-Person and Between-Person Effects.

OBJECTIVE: The acquired preparedness model (APM) posits that high sensitivity to reward biases individuals to learn and maintain positive outcome expectancies, which in turn increase substance use, and that high sensitivity to punishment biases individuals to learn and maintain negative outcome expectancies, decreasing use. Little work has applied the APM to cannabis use, particularly with longitudinal data and methods that separate within- and between-person associations. The current study addressed these gaps. METHOD: The sample comprised 314 emerging adults (age range: 19.13-21.39 years; 52% female; predominantly non-Hispanic White [76%] or African American [15%]) recruited using random-digit dialing. Data were taken from three annual assessments. Latent curve models with structure residuals were used to distinguish between- and within-person associations. We controlled for bidirectional associations and demographic covariates. RESULTS: At the between-person level, high sensitivity to reward was related to high positive expectancies and high cannabis use. High positive expectancies were associated with high cannabis use. High sensitivity to punishment was related to high negative expectancies and low cannabis use. No within-person associations were supported. CONCLUSIONS: These findings suggest a risk profile for emerging adult cannabis use involving high sensitivity to reward and positive expectancies and a protective profile involving high sensitivity to punishment and negative expectancies. However, our findings did not support the notion that the proposed learning processes unfold within individuals across annual assessments. Most notably, the findings emphasize the importance of disaggregating within- and between-person associations using a longitudinal design to better understand pathways to cannabis use in the developmental period of emerging adulthood.

Reciprocal associations between implicit attitudes and drinking in emerging adulthood.

BACKGROUND: Implicit alcohol attitudes are considered important in the etiology of drinking, and theory posits reciprocal associations between them. Research testing reciprocal associations between implicit attitudes (using the Implicit Association Task, IAT) and drinking is limited by a failure to consider multiple processes influencing performance on the IAT and to disaggregate within- and between-person effects. The current study addressed these limitations by using a diffusion model to analyze IAT data and Latent Curve Models with Structured Residuals to test reciprocal associations. METHODS: The sample included 314 emerging adults from the community (52% female; predominantly non-Hispanic Caucasian (76%) or African American (15%)) assessed annually for three years. Differences between IAT conditions in the drift rate parameter of the EZ-diffusion model (vΔ) were used as an alternative to traditional response-time-based indices from the IAT (d-scores). Differences in drift rate have been found to index implicit attitudes effectively. RESULTS: Within-person reciprocal associations were supported, but between-person associations were not. Positive implicit alcohol attitudes (vΔ) were prospectively associated with heavy drinking, which was positively associated with subsequent positive implicit alcohol attitudes. CONCLUSIONS: We found that positive implicit alcohol attitudes and heavy drinking reinforce each other in a negative cascade within individuals. The results highlight the importance of disaggregating within- and between-person prospective effects when testing dual process models and suggest that the diffusion model may be a fruitful approach to enhance the construct validity of IAT assessed implicit attitudes.

Developmental Cascade Effects of Maternal Depression on Offspring Substance Use Across Adolescence: Pathway Through Mother-Child Relationship Quality and Peer Deviancy.

There is evidence that maternal depression can disrupt adolescent social development and trigger a risk cascade to adolescent substance use that involves poor quality mother-child relationships (Lovejoy et al., 2000) and affiliation with deviant peers (Visser et al., 2012). However, relatively little work has considered maternal depression as a catalyst for this risk pathway to adolescent substance use. The current study aims to clarify whether maternal depression has cascading effects to adolescent substance use through related developmental systems. Using structural equation modeling and bootstrapping for testing indirect effects, we tested the prospective association between maternal depression and middle adolescent substance use and whether poor mother-child relationship quality and peer deviancy mediated this relationship. We controlled for a variety of important cofounding variables. The sample included N = 338 adolescents (57% female; predominantly non-Hispanic Caucasian (83.14%) or African American (8.88%)) and mothers drawn from a larger nine-year longitudinal study of adolescent substance use. Data from wave 1 through wave 6 of the longitudinal project were utilized. The average age of adolescents was 11.6, 12.6, 13.6, 14.6, 15.5, and 16.6 at W1-W6, respectively. The indirect effect from maternal depression to substance use was supported (ab = 0.03, 95% CI [0.002, 0.07]). Findings emphasize that future work should more closely examine how maternal depression operates in developmental cascade models of adolescent substance use.

Transverse Pedicle Angle Is Associated With Pelvic Incidence and Increased in Lumbar Isthmic Spondylolisthesis.

STUDY DESIGN: Retrospective radiographic review. OBJECTIVES: Investigate and quantify transverse pedicle angle (TPA), the medial-to-lateral pedicle angulation, and its potential association with pelvic incidence (PI) in patients with isthmic lumbar spondylolisthesis (ISLS) and compare to those with degenerative lumbar spondylolisthesis (DSLS) and controls. METHODS: A total of 200 patients (64 ISLS, 70 DSLS, 66 control) were included. TPA was calculated at the L3-5 vertebral levels using axial computed tomography slices. PI was measured on lateral radiographs. Two independent observers completed the measurements. As a sensitivity analysis, TPA was also measured at the most cranial and caudal aspects of the L3-5 vertebral levels of a subset of participants (29 ISLS, 31 DSLS, 35 control) and the cranial to caudal change (ΔTPA) was calculated. RESULTS: TPA values (mean ± SD) at L4 and L5 for ISLS (L4: 17.3° ± 3.7°, L5: 26.0° ± 5.2°) were significantly higher than those for the DSLS (L4: 14.3° ± 3.8°, L5: 22.2° ± 5.0°) and control (L4: 14.5° ± 3.9°, L5: 20.7° ± 3.8°) groups. TPA in the DSLS group was significantly higher than controls at L5, but not L4. High PI predicted wider TPA at L5 in both DSLS and ISLS. ΔTPA (mean ± SD) increased sequentially proceeding through the L3-5 spinal levels for the ISLS (L3: 6.8° ± 4.4°, L4: 8.7° ± 5.2°, L5: 15.6° ± 9.0°), DSLS (L3: 8.2° ± 6.0°, L4: 8.3° ± 5.9°, L5: 18.3° ± 7.2°), and control (L3: 6.8° ± 4.4°, L4: 8.2° ± 4.7°, L5: 17.7° ± 7.0°) groups. CONCLUSIONS: TPA was significantly increased in ISLS compared with DSLS and controls. High PI significantly predicted high TPA at the L5 vertebral level in ISLS and DSLS. ΔTPA increased sequentially proceeding through the lumbar spine across groups.

An examination of reciprocal associations between substance use and effortful control across adolescence using a bifactor model of externalizing symptoms.

Early adolescence is thought to represent a window of vulnerability when exposure to substances is particularly harmful, partly because the neurotoxic effects of adolescent substance use may derail self-regulation development. However, previous studies fail to account for externalizing symptoms, such as aggression and delinquency, that accompany adolescent substance use and may also derail the development of self-regulation. The current study aims to clarify whether the neurotoxic effects of adolescent substance use are associated with deficits in effortful control (EC) after accounting for externalizing symptoms and to examine reciprocal relationships between EC, externalizing symptoms, and substance use. A longitudinal sample of adolescents (N = 387) was used to estimate bifactor models of externalizing symptoms across five assessments (Mage = 11.6 to 19.9). The broad general externalizing factors were prospectively associated with declines in EC across adolescence and emerging adulthood. However, the narrow substance use specific factors were not prospectively associated with EC. Findings suggest that the broader externalizing context, but not the specific neurotoxic effects of substance use, may hamper self-regulation development. It is critical to account for the hierarchical structure of psychopathology, namely externalizing symptoms, when considering development of EC.

Alcohol-Specific Communication and Emerging Adult Offspring's Perceived Parental Approval and Drinking in the Context of Parent Alcohol Expectancies.

BACKGROUND: There are mixed findings in the literature regarding the association between parental alcohol communication and offspring alcohol use. To clarify this association, this study tested a prospective mediated moderation model in which the association between parental communication about the risks of alcohol use and emerging adult offspring drinking was mediated by offspring perceived parental approval of drinking. Parental alcohol expectancies and use were tested as moderators of the link between communication and perceived approval. METHOD: The community sample of 378 emerging adult and caregiver dyads completed 3 annual assessments (first assessment mean age = 19.13). The sample was 54% female and majority White/non-Hispanic (76%). Caregivers reported on their own alcohol expectancies and use, and emerging adult offspring reported on parental communication of alcohol risks, perceived parental approval of drinking, and their own alcohol use. Multilevel modeling was used to test hypotheses. RESULTS: Mediated moderation was largely supported. More frequent communication about the risks of drinking was prospectively associated with low levels of perceived parental approval of alcohol use, which in turn was associated with low levels of offspring drinking. This pathway depended on parental alcohol expectancies. CONCLUSIONS: Findings suggest that including mediators (e.g., perceived approval of drinking) helps to clarify the mixed literature on parental communication about alcohol and that parental attitudes about alcohol can impact the effectiveness with which parents convey the risk of alcohol to offspring.

Long-Term Effects of Early Adolescent Marijuana Use on Attentional and Inhibitory Control.

OBJECTIVE: This study sought to examine the prospective effects of early adolescent marijuana use on late adolescent attentional and inhibitory control. Alcohol use, antisocial problems, and gender were included as statistical control variables. METHOD: The community sample of 387 adolescents and a caregiver was drawn from a longitudinal study of adolescent substance use that included nine annual assessments. Adolescents were eligible if they were between ages 11 and 12 at recruitment and did not have any disabilities that would preclude them from either understanding or completing the assessment. The sample was evenly split on gender (55% female) and was predominantly non-Hispanic White (83.16%) or African American (9.07%). Attentional and inhibitory control were assessed using parent and adolescent self-reports on the Early Adolescent Temperament Questionnaire-Revised and the Adult Temperament Questionnaire. RESULTS: Hypotheses were tested using structural equation modeling. High levels of early marijuana use at ages 12-14 significantly predicted low levels of adolescent attentional control at ages 18-21 (ß = -.20, p < .05), above and beyond early attentional control, early alcohol use, and antisocial problems. CONCLUSIONS: Findings suggest that marijuana use may adversely affect cognitive development, especially during the sensitive period of early adolescence. Results emphasize the need for further prospective work to investigate relationships between early adolescent marijuana use and the development of executive functioning.

Understanding Risk Factors for Opioid Overdose in Clinical Populations to Inform Treatment and Policy.

Overdoses involving opioid analgesics represent a significant public health problem in the United States. We reviewed the literature on risk factors for overdose, with a focus on studies that examine clinical populations of patients receiving opioids for pain and potential risk factors for overdose in these populations. A structured review resulted in 15 articles published between 2007 and 2015 that examined risk factors for fatal and nonfatal overdose in patients receiving opioid analgesics. Opioid dosage was the factor most consistently analyzed and also associated with increased risk of overdose. Other risk factors include concurrent use of sedative-hypnotics, use of extended-release/long-acting opioids, and the presence of substance use and other mental health disorder comorbidities. Future research is needed to better characterize populations taking opioids for pain to help clarify discrepancies between existing studies and identify previously unexplored risk factors for overdose. Given that policy and clinical practice have shifted as a result of prior studies reviewed here, further efforts in understanding patient groups and opioid-related prescribing practices associated with overdose risk have great potential to impact policy and practice in the treatment of pain while improving the safety around opioid prescribing.

An improved method for collecting breath from 3- to 7-year-old children.

Breath sampling and analysis provide healthcare professionals with a practical, noninvasive diagnostic measurement for children with a variety of gastrointestinal (GI) disorders. New biomarkers found in human breath have been investigated and provide the opportunity to diagnose bacterial overgrowth and other underlying causes of GI dysfunction. Although several protocols have been described previously regarding breath sampling, few have demonstrated the feasibility of collection in young children. This communication introduces a simple game that allows for 3- to 7-year-old children to practice breath exhalation to give a proper breath sample in a relaxed and comfortable environment. The technique described offers clinicians a creative approach for obtaining breath samples from a child by reducing the apprehension and anxiety associated with the research and clinical environment.

Childhood overweight/obesity and pediatric asthma: the role of parental perception of child weight status.

Childhood obesity and asthma are on the rise in the U.S. Clinical and epidemiological data suggest a link between the two, in which overweight and obese children are at higher risk for asthma. Prevention of childhood obesity is preferred over treatment, however, in order to be receptive to messages, parents must perceive that their child is overweight. Many parents do not accurately assess their child's weight status. Herein, the relation between parental perceptions of child weight status, observed body mass index (BMI) percentiles, and a measure of child feeding practices were explored in the context of asthma, food allergy, or both. Out of the children with asthma or food allergy that were classified as overweight/obese by BMI percentiles, 93% were not perceived as overweight/obese by the parent. Mean scores for concern about child weight were higher in children with both asthma and food allergy than either condition alone, yet there were no significant differences among the groups in terms of pressure to eat and restrictive feeding practices. In summary, parents of children with asthma or food allergy were less likely to recognize their child's overweight/obese status and their feeding practices did not differ from those without asthma and food allergy.