The distinction between beliefs legitimizing aggression and deviant processing of social cues: testing measurement validity and the hypothesis that biased processing mediates the effects of beliefs on aggression. Conduct Problems Prevention Research Group.

In 2 studies the authors examined knowledge and social information-processing mechanisms as 2 distinct sources of influence on child aggression. Data were collected from 387 boys and girls of diverse ethnicity in 3 successive years. In Study 1, confirmatory factor analyses demonstrated the discriminant validity of the knowledge construct of aggression beliefs and the processing constructs of hostile intent attributions, accessing of aggressive responses, and positive evaluation of aggressive outcomes. In Study 2, structural equation modeling analyses were used to test the mediation hypothesis that aggression beliefs would influence child aggression through the effects of deviant processing. A stronger belief that aggressive retaliation is acceptable predicted more deviant processing 1 year later and more aggression 2 years later. However, this latter effect was substantially accounted for by the intervening effects of deviant processing on aggression.

Fall history is an independent predictor of adverse health outcomes and utilization in the elderly.

OBJECTIVE: To determine whether a history of falls predicts functional decline, adverse health events, and hospitalization. STUDY DESIGN: Twelve-month prospective cohort study. PATIENTS AND METHODS: Participants were members of a Medicare managed care program. Outcomes were assessed each quarter and included functional status, healthcare utilization (hospitalization), and adverse events (hospitalizations, nursing home placement, or death). Subject healthcare utilization diaries were corroborated with health system data files. RESULTS: At baseline, 70% reported no falls (NF), 18% had 1 fall (F), and 12% reported 2 or more falls (RF). Fall status predicted functional decline; new ADL deficits were seen in 18% of NF, 28% of F, and 55% of RF (P < or = .0001). Following adjustment for baseline function, this association remained predictive (adjusted odds ratio [OR] for new ADL deficits: 3.5, P = .007; and for new ADL and IADL deficits: 12.0, P= .0001). Fall frequency was a univariate predictor of adverse events (hospitalizations, nursing home placement, or death) and of hospital utilization alone. One or more adverse event(s) occurred in 18% of NF, 22% of F, and 38% of RF (P = .049). Hospitalization occurred in 16% of NF, 22% in F, and 35% of RF (P = .03). Following adjustment for likelihood of future hospitalization (P(ra)), these associations remained predictive for RF (adjusted OR for one or more adverse event[s]: 2.4, P = .05; OR for hospitalization 2.4, P = .06). CONCLUSIONS: Fall history predicts decline in function, hospitalization, and adverse events among a Medicare managed care population and remains independently predictive of poor outcomes after controlling for baseline function and likelihood of future hospitalization.

Internal representational models of peers: implications for the development of problematic behavior.

The authors investigated the relation between children's knowledge structures for peers and externalizing behavior problems. Initial levels of aggression were evaluated in 135 boys and 124 girls (Grades 1-3; 40% African American, 60% Caucasian) in Year 1 and again in Years 6 and 9. In Year 6, 3 aspects of their social knowledge structures were assessed: quality, density, and appropriateness. Results indicate that knowledge structures are related to children's concurrent levels of externalizing behaviors and that knowledge structures are related to children's concurrent levels of externalizing behaviors and predict externalizing behaviors 3 years later even after controlling for current levels of behavior. In addition, knowledge structures in Year 6 mediate the relation between aggression in Year 1 and externalizing behaviors in Year 9. The role of knowledge structures in the maintenance and growth of children's antisocial behavior is discussed.

Management of hypertension for stroke prevention in older people.

It is no longer acceptable to attribute elevated blood pressure in elderly people to the natural processes of aging and thereby withhold treatment. Sound evidence demonstrates increased risk of cardiovascular disease with increasing levels of blood pressure and decreased incidence of cardiovascular disease with blood pressure control. Hypertension is known to be the most modifiable risk factor for stroke. Given projected demographic shifts in the population, the number of older Americans with hypertension and increased risk of morbidity and mortality from stroke will grow during the first part of the next century. Health care providers should familiarize themselves with the unique pathophysiology of hypertension in elderly people, and integrate appropriate approaches to comprehensive evaluation and management into practice.

If it's offered, will they come? Influences on parents' participation in a community-based conduct problems prevention program.

This study examined influences on the rate and quality of parent participation in the Fast Track Program, a multi-system, longitudinal preventive intervention for children who are at risk for conduct problems. A theoretical model of the relations among family coordinator characteristics, parent characteristics, the therapeutic engagement between family coordinator and parent, and rate and quality of parent participation was the basis for this study. "Family coordinators" are the Fast Track program personnel who conduct group-based parent-training sessions and home visits. Participants in this study included 12 family coordinators (42% were African American, 58% European American) and 87 parents (55% were African American, 45% European American). The level of therapeutic engagement between the parent and the family coordinator was positively associated with the rate of parent attendance at group training sessions. The extent of family coordinator-parent racial and socioeconomic similarity and the extent of the family coordinator's relevant life experiences were highly associated with the level of therapeutic engagement. The quality, but not the rate, of participation was lower for African American parents. Implications of these findings for preventive intervention with this population are discussed.

Peer rejection in childhood, involvement with antisocial peers in early adolescence, and the development of externalizing behavior problems.

A longitudinal, prospective design was used to examine the roles of peer rejection in middle childhood and antisocial peer involvement in early adolescence in the development of adolescent externalizing behavior problems. Both early starter and late starter pathways were considered. Classroom sociometric interviews from ages 6 through 9 years, adolescent reports of peers' behavior at age 13 years, and parent, teacher, and adolescent self-reports of externalizing behavior problems from age 5 through 14 years were available for 400 adolescents. Results indicate that experiencing peer rejection in elementary school and greater involvement with antisocial peers in early adolescence are correlated but that these peer relationship experiences may represent two different pathways to adolescent externalizing behavior problems. Peer rejection experiences, but not involvement with antisocial peers. predict later externalizing behavior problems when controlling for stability in externalizing behavior. Externalizing problems were most common when rejection was experienced repeatedly. Early externalizing problems did not appear to moderate the relation between peer rejection and later problem behavior. Discussion highlights multiple pathways connecting externalizing behavior problems from early childhood through adolescence with peer relationship experiences in middle childhood and early adolescence.

Antecedents and behavior-problem outcomes of parental monitoring and psychological control in early adolescence.

The early childhood antecedents and behavior-problem correlates of monitoring and psychological control were examined in this prospective, longitudinal, multi-informant study. Parenting data were collected during home visit interviews with 440 mothers and their 13-year-old children. Behavior problems (anxiety/depression and delinquent behavior) were assessed via mother, teacher, and/or adolescent reports at ages 8 through 10 years and again at ages 13 through 14. Home-interview data collected at age 5 years were used to measure antecedent parenting (harsh/reactive, positive/proactive), family background (e.g., socioeconomic status), and mother-rated child behavior problems. Consistent with expectation, monitoring was anteceded by a proactive parenting style and by advantageous family-ecological characteristics, and psychological control was anteceded by harsh parenting and by mothers' earlier reports of child externalizing problems. Consistent with prior research, monitoring was associated with fewer delinquent behavior problems. Links between psychological control and adjustment were more complex: High levels of psychological control were associated with more delinquent problems for girls and for teens who were low in preadolescent delinquent problems, and with more anxiety/depression for girls and for teens who were high in preadolescent anxiety/depression.