Correlates of suicidal behaviors and genetic risk among United States veterans with schizophrenia or bipolar I disorder.

Persons diagnosed with schizophrenia (SCZ) or bipolar I disorder (BPI) are at high risk for self-injurious behavior, suicidal ideation, and suicidal behaviors (SB). Characterizing associations between diagnosed health problems, prior pharmacological treatments, and polygenic scores (PGS) has potential to inform risk stratification. We examined self-reported SB and ideation using the Columbia Suicide Severity Rating Scale (C-SSRS) among 3,942 SCZ and 5,414 BPI patients receiving care within the Veterans Health Administration (VHA). These cross-sectional data were integrated with electronic health records (EHRs), and compared across lifetime diagnoses, treatment histories, follow-up screenings, and mortality data. PGS were constructed using available genomic data for related traits. Genome-wide association studies were performed to identify and prioritize specific loci. Only 20% of the veterans who reported SB had a corroborating ICD-9/10 EHR code. Among those without prior SB, more than 20% reported new-onset SB at follow-up. SB were associated with a range of additional clinical diagnoses, and with treatment with specific classes of psychotropic medications (e.g., antidepressants, antipsychotics, etc.). PGS for externalizing behaviors, smoking initiation, suicide attempt, and major depressive disorder were associated with SB. The GWAS for SB yielded no significant loci. Among individuals with a diagnosed mental illness, self-reported SB were strongly associated with clinical variables across several EHR domains. Analyses point to sequelae of substance-related and psychiatric comorbidities as strong correlates of prior and subsequent SB. Nonetheless, past SB was frequently not documented in health records, underscoring the value of regular screening with direct, in-person assessments, especially among high-risk individuals.

Time to first report of signs of nicotine dependence among youth who use e-cigarettes and cigarettes in the United States: A nationally representative cohort study, findings from the Population Assessment of Tobacco and Health, 2013-2019.

OBJECTIVE: To determine the time to first report of signs of nicotine dependence among youth exclusive e-cigarette users and compare this time to that for exclusive cigarette users. METHODS: Secondary analysis of data (Waves 1-5; 2013-2019) from the Population Assessment of Tobacco and Health was conducted. Youth never tobacco users in the United States who reported exclusive past-30-day (P30D) e-cigarette or cigarette use (n = 2940, N = 5,391,642) in at least one wave were included in the current analysis. Survival analysis was used to estimate the time to the first report of three nicotine dependence indicators (i.e., "use within 30 minutes of waking"; "cravings" and "really needing to use") following the first report of P30D use. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR). RESULTS: There were no significant differences in the time to first report of "use within 30 minutes of waking" (aHR = 1.1, 95% CI = 0.87-1.40) and "cravings" (aHR = 1.09, 95% CI = 0.81-1.47) between exclusive P30D e-cigarette use and exclusive P30D cigarette use. However, compared to exclusive P30D e-cigarette use, the hazard of first reporting "really needing to use" tobacco was 39% (aHR 1.39; 95% CI: 1.05-1.84) times higher for those who reported exclusive P30D cigarette use after controlling for covariates. CONCLUSION: Compared to exclusive P30D cigarette use, no differences in the time to first report of signs of nicotine dependence ("use within 30 minutes" and "cravings") were observed among exclusive P30D e-cigarette users. Policymakers and regulatory agencies should consider this evidence when assessing the abuse liability of e-cigarette products.

The Association Between Tobacco and Cannabis Use and the Age of Onset of Depression and Anxiety Symptoms: Among Adolescents and Young Adults.

INTRODUCTION: No studies have prospectively explored the association between the use of tobacco or cannabis use and the age of onset of depressive or anxiety symptoms, and no studies have identified the peak ages and ranges of onset of these symptoms among tobacco and/or cannabis users. AIMS AND METHODS: This is a secondary analysis of Texas Adolescent Tobacco and Marketing Surveillance System data, waves 9-14 (2019-20121). Participants were in 10th grade, 12th grade, and 2 years post-high school (HS) at baseline (wave 9). Interval-censoring multivariable Cox proportional hazards models were fit to assess differences in the estimated age of onset of depression and anxiety by tobacco and cannabis use while adjusting for covariates. RESULTS: We found that lifetime or ever cigarette, e-cigarette, and cannabis use had an increased risk of an earlier age of onset of depressive and anxiety symptoms across the three cohorts, and the youngest cohort was the most differentially impacted by substance use. Between ages 18 to 19 years in the 10th-grade cohort, between ages 20 to 21 years in the 12th-grade cohort, and between ages 22 to 23 years in the post-HS cohort, the estimated hazard function (or cumulative incidence) for reporting depressive and anxiety symptoms almost doubled among lifetime cigarette, e-cigarette, and cannabis users. CONCLUSIONS: Tobacco and cannabis users should be screened for mental health problems at an earlier age, especially those aged 18 years and younger, and provided with age- and culturally appropriate resources to prevent or delay the onset of anxiety and/or depression symptoms. IMPLICATIONS: The study's findings indicate that tobacco and cannabis use is directly linked to the early onset of depressive and anxiety symptoms among youth. This highlights the significance of early screening and substance use interventions, particularly for youth aged 18 years and younger, as they are disproportionately affected by both substance use and mental health problems. School-based interventions that are age- and culturally appropriate hold promise as they enable youth to seek professional help early, and in a supportive environment. Intervening early in substance shows promise in reducing the likelihood of developing mental health problems at a young age.

Longitudinal Examination of ENDS Use Among Young Adult College Students: Associations with Depressive Symptoms and Sensation Seeking.

The present study examined (1) intraindividual changes in the frequency of electronic nicotine delivery systems (ENDS) use across young adulthood, 18 to 30 years old, and (2) if depressive symptoms and sensation-seeking tendencies, independently and in interaction with one another, were associated with these changes. Data were from a longitudinal study of students recruited from 24 Texas colleges and followed across six waves from fall 2015 to spring 2019. Participants (n = 1298; 36.3% non-Hispanic white, 56.3% women) were 18 to 26 years old in fall 2015 and all reported past 30-day ENDS use on at least one wave. We used growth curve modeling for an accelerated longitudinal design to examine if ENDS use frequency changed with increasing age and if depressive symptoms and sensation seeking, independently and in interaction with one another, were associated with these changes. Results showed that ENDS use frequency increased with increasing age. Depressive symptoms and sensation seeking were not independently associated with more frequent ENDS use or an accelerated increase in ENDS use frequency across increasing age. However, a significant two-way interaction indicated that young adults with elevated depressive symptoms used ENDS more frequently, but only when they had higher levels of sensation seeking. Findings indicate that young adults with depressive symptoms are a heterogeneous population and that those with high levels of sensation-seeking tendencies are at elevated risk for more frequent ENDS use. Interventions for young adults high in both sensation-seeking and depressive symptoms may help prevent and decrease ENDS use.

Symptoms of Depression and Anxiety and Subsequent Use of Nicotine and THC in Electronic Cigarettes.

BACKGROUND: This study examines whether symptoms of depression, anxiety, or comorbid depression and anxiety are associated with future use of nicotine or THC in e-cigarettes. METHODS: Data were from an online survey of youth and young adults in urban areas of Texas with complete data (n = 2,307) in spring 2019 (baseline) and spring 2020 (12-month follow-up). Multivariable logistic regression models examined associations between self-reported symptoms of depression, anxiety, or comorbid depression and anxiety at baseline and past 30-day e-cigarette use with nicotine or THC at 12-month follow-up. Analyses adjusted for baseline demographics and baseline past 30-day e-cigarette, combustible tobacco, marijuana, and alcohol use and stratified by race/ethnicity, gender, grade level, and SES. RESULTS: Participants were 16-23 years old, 58.1% female and 37.9% Hispanic. At baseline, 14.7% reported symptoms of comorbid depression and anxiety, 7.9% depression, and 4.7% anxiety. Prevalence of past 30-day e-cigarette use at 12-month follow-up was 10.4% with nicotine and 10.3% with THC. Symptoms of depression and comorbid depression and anxiety at baseline were significantly associated with both nicotine and THC use in e-cigarettes 12 months later. Symptoms of anxiety were associated with nicotine use in e-cigarettes 12 months later. CONCLUSIONS: Symptoms of anxiety and depression may be important indicators of future nicotine and THC vaping among young people. Clinicians should be aware of groups most at risk who may benefit from substance use counseling and intervention.

Prenatal Exposure to Tobacco and Childhood Cognition and Behavior: Effect Modification by Maternal Folate Intake and Breastfeeding Duration.

In this exploratory analysis, we assessed whether nutrition modified the association between prenatal exposure to tobacco and childhood cognition/behavior among 366 Colorado-based mothers and their offspring (born ≥ 37 weeks with birthweights ≥ 2500 g). Interaction by folate ( 5 months, but not for shorter durations. Our findings support the need for smoking cessation campaigns throughout pregnancy and throughout the postpartum period breastfeeding to reduce neurobehavioral risks in the offspring.

Perceived stress and E-cigarette use during emerging adulthood: A longitudinal examination of initiation, progression, and continuation.

E-cigarettes are the most commonly used tobacco product among youth and young adults in the US. Limited research has examined how stress impacts e-cigarette use among young people. We examine the longitudinal associations between perceived stress scale (PSS) score and e-cigarette use behaviors among a diverse cohort of emerging adults. We analyzed two waves of data collected in Fall 2019 (baseline) and Spring 2020 (6-month follow-up) of the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were classified into three mutually exclusive subsamples at baseline: (1) n = 1177 never e-cigarette users; (2) n = 806 ever but not current (past 30-day) e-cigarette users (i.e., ever users); and (3) n = 257 current (past 30-day) e-cigarette users. Three multivariate logistic regression models examined the relationship between PSS at baseline and: (1) initiation among never users; (2) progression to current use among ever users; and (3) continuation among current users, at 6-month follow-up. PSS scores were standardized using z-scores. Models controlled for race/ethnicity, sex, age, ever marijuana use, and ever use of other tobacco products. Mean age ranged from 18.6 to 19.4 among cohorts. Risk for e-cigarette progression among ever users (aOR: 1.30; 95%CI: 1.01-1.69) and e-cigarette continuation among current users (aOR: 1.33 (95%CI: 1.01-1.75) increased with each unit increase in PSS score at baseline. PSS at baseline was not associated with e-cigarette initiation among never users. PSS predicted greater risk of e-cigarette progression and continuation but not initiation among a diverse cohort of emerging adults. E-cigarette prevention and cessation strategies should consider perceived stress an important risk factor for e-cigarette use during emerging adulthood.

Trajectories of depressive symptoms among young adults in Texas 2014-2018: a multilevel growth curve analysis using an intersectional lens.

INTRODUCTION: Research has demonstrated disparities in depressive symptoms among people who are marginalized. However, more work should examine depressive symptoms through an intersectional lens, recognizing that multiple systems of privilege and oppression interlock to create unique struggles where multiple marginalized identities meet. Recent methodological developments have advanced quantitative intersectionality research using multilevel modeling to partition variance in depressive symptoms to person-level sociodemographic variables and intersectional-level social strata. The purpose of this study is to leverage these methods to examine trajectories of depressive symptoms among young adults in Texas through an intersectional lens. METHODS: Multilevel modeling was used to examine the longitudinal trajectories of depressive symptoms among 3575 young adults from 24 colleges in Texas assessed seven times between Fall 2014 and Spring 2018. Intersectional identities included sex, race/ethnicity, and sexual and gender minority identities. The model examined time nested within individuals and individuals nested within intersectional social strata. RESULTS: Young adults in Texas experienced an increase in depressive symptoms from 2014-2018. Those with female, Hispanic, AAPI, other race/ethnicity, or LGBTQ + identities experienced more depressive symptoms. After controlling for the main effects of the sociodemographic variables, 0.08% of variance in depressive symptoms remained attributed to the effects of intersectional identities. CONCLUSION: Evaluating disparities in depressive symptoms through an intersectional lens offers a more complete description of the epidemiology of depressive symptoms. Communities and institutions that serve marginalized people should consider the elevated burden of depressive symptoms that marginalized people may carry, and integrate culturally competent psychoeducation, assessments, and therapies where possible.

A machine learning compatible method for ordinal propensity score stratification and matching.

Although machine learning techniques that estimate propensity scores for observational studies with multivalued treatments have advanced rapidly in recent years, the development of propensity score adjustment techniques has not kept pace. While machine learning propensity models provide numerous benefits, they do not produce a single variable balancing score that can be used for propensity score stratification and matching. This issue motivates the development of a flexible ordinal propensity scoring methodology that does not require parametric assumptions for the propensity model. The proposed method fits a one-parameter power function to the cumulative distribution function (CDF) of the generalized propensity score (GPS) vector resulting from any machine learning propensity model, and is henceforth called the GPS-CDF method. The estimated parameter from the GPS-CDF method, ã , is a scalar balancing score that can be used to group similar subjects in outcome analyses. Specifically, subjects who received different levels of the treatment are stratified or matched based on their ã value to produce unbiased estimates of the average treatment effect (ATE). Simulation studies presented show remediation of covariate balance, minimal bias in ATEs, and maintain coverage probability. The proposed method is applied to the Mexican-American Tobacco use in Children (MATCh) study to determine whether an ordinal treatment of exposure to smoking imagery in movies causes cigarette experimentation in Mexican-American adolescents.

Propensity score stratification methods for continuous treatments.

Continuous treatments propensity scoring remains understudied as the majority of methods are focused on the binary treatment setting. Current propensity score methods for continuous treatments typically rely on weighting in order to produce causal estimates. It has been shown that in some continuous treatment settings, weighting methods can result in worse covariate balance than had no adjustments been made to the data. Furthermore, weighting is not always stable, and resultant estimates may be unreliable due to extreme weights. These issues motivate the current development of novel propensity score stratification techniques to be used with continuous treatments. Specifically, the generalized propensity score cumulative distribution function (GPS-CDF) and the nonparametric GPS-CDF approaches are introduced. Empirical CDFs are used to stratify subjects based on pretreatment confounders in order to produce causal estimates. A detailed simulation study shows superiority of these new stratification methods based on the empirical CDF, when compared with standard weighting techniques. The proposed methods are applied to the "Mexican-American Tobacco use in Children" study to determine the causal relationship between continuous exposure to smoking imagery in movies, and smoking behavior among Mexican-American adolescents. These promising results provide investigators with new options for implementing continuous treatment propensity scoring.

Longitudinal trajectories of E-cigarette use among adolescents: A 5-year, multiple cohort study of vaping with and without marijuana.

E-cigarette use harms adolescent health, yet it continues to escalate rapidly among teens nationwide. This longitudinal study sought to identify and differentiate between developmental trajectories of past 30-day e-cigarette use with and without marijuana (i.e., liquid THC) across adolescence (11-19 years old). Three population-based cohorts of adolescents (n = 3907; N = 461,069) living in major metropolitan areas of Texas (Houston, Dallas-Ft. Worth, San Antonio, Austin) completed up to 9 Waves of an e-cigarette use survey, from 2014 to 2019. Growth curve models (GCMs) were used to identify average trajectories of past 30-day e-cigarette use, by cohort. Growth mixture models (GMMs) were used to investigate developmental patterns in these trajectories, by cohort. Sociodemographic differences in trajectories were also investigated. Stable trajectories of e-cigarette use with and without marijuana were identified, from 11 through 19 years of age. Trajectories varied by age of onset; frequency and escalation in use; and substance used. With one exception, all trajectories of e-cigarette use escalated with age. Moreover, age of onset and progression in use were positively related. The most problematic trajectories, corresponding to more frequent use, were observed among the younger cohorts compared to the oldest. Primary prevention is critical. Interventions to prevent the onset and progression in e-cigarette use among teens must begin early (e.g., in middle school) and be sustained throughout adolescence.

ENDS Device Type and Initiation of Combustible Tobacco Products Among Adolescents.

INTRODUCTION: The aim of this study was to determine whether Electronic Nicotine Delivery Systems (ENDS) device type (disposable devices, replaceable cartridges, and refillables) at initial or first ENDS use predicts subsequent initiation of combustible tobacco products (cigarettes, hookah, cigars) among adolescents and/or differentiates between those who initiate use of both ENDS and combustible tobacco products at the same time. METHODS: The study examined data from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS), a longitudinal population-based cohort of students in major metropolitan areas of Texas (n = 3907; N = 461 069). Data were collected every 6 months, from 2014 to 2018; 33.9% (n = 1324; N = 151 784) of the sample initiated ENDS use across this period. Unadjusted and adjusted logistic regression models were used to assess the odds of initiating combustible tobacco products at a subsequent or similar wave as ENDS initiation, given initial ENDS device type. RESULTS: After adjusting for sociodemographic factors, the odds of initiating combustible tobacco use subsequent to ENDS initiation were significantly lower among those who reported using Cartridges as their initial device type compared to those who reported Refillables as their initial device type (adjusted odds ratio = 0.42 [0.18-0.98], p = .05). In addition, after controlling for sociodemographic variables, the odds of initiating combustible tobacco use in the same wave as ENDS initiation were significantly higher among those who reported using Cartridges as their initial device type, compared with those who reported Refillables as their initial device type (adjusted odds ratio = 2.31 [1.05-5.10], p = .04). No significant differences were found in adjusted models when Disposables were compared to Refillables and Cartridges to Disposables. CONCLUSION: ENDS device type differentiates between adolescents who start using combustible tobacco products at the same time as initial ENDS use, or subsequently. IMPLICATIONS: Previous research has shown ENDS use predicts subsequent combustible use among adolescents, but there is lack of research on the role of specific ENDS device types and the timing of initiation. Findings from this longitudinal study show that initiation of combustible tobacco product use varies by initial ENDS device type among adolescents. These findings can become a focal point for developing interventions for adolescents and could have regulatory implications for ENDS products.

Nicotine Inhalation and Suicide: Clinical Correlates and Behavioral Mechanisms.

BACKGROUND AND OBJECTIVES: Extensive evidence links smoking and suicide independently of psychiatric diagnoses, but there are questions about the pathophysiology and specificity of this relationship. We examined characteristics of this linkage to identify potential transdiagnostic mechanisms in suicide and its prevention. METHODS: We reviewed literature that associated suicide with smoking and e-cigarettes, including the temporal sequence of smoking and suicide risk and their shared behavioral risk factors of sensitization and impulsivity. RESULTS: Smoking is associated with increased suicide across psychiatric diagnoses and in the general population, proportionately to the number of cigarettes smoked per day. Rapid nicotine uptake into the brain through inhalation of conventional cigarettes, electronic cigarettes (e-cigarette), or even second-hand smoke can facilitate long-term sensitization and short-term impulsivity. Both impair action regulation and predispose to negative affect, continued smoking, and suicidal behavior. Intermittent hypoxia, induced by cigarettes or e-cigarettes, synergistically promotes impulsivity and sensitization, exacerbating suicidality. Two other shared behavioral risks also develop negative urgency (combined impulsivity and negative affect) and cross-sensitization to stressors or to other addictive stimuli. Finally, early smoking onset, promoted by e-cigarettes in never-smokers, increases subsequent suicide risk. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Prevention or cessation of nicotine inhalation can strategically prevent suicidality and other potentially lethal behavior regardless of psychiatric diagnoses. Medications for reducing smoking and suicidality, especially in younger smokers, should consider the neurobehavioral mechanisms for acute impulsivity and longer-term sensitization, potentially modulated more effectively through glutamate antagonism rather than nicotine substitution. (Am J Addict 2021;30:316-329).

Viewing images of alcohol use in PG-13-rated movies and alcohol initiation in Mexican-heritage youth.

Mexican American adolescents report high rates of alcohol consumption as well as media use. Viewing alcohol images in the media is associated with increased alcohol consumption; however, to date, this association has not been examined across different ethnic groups in the United States. To bridge this gap, we examined the association between viewing alcohol use images in PG-13-rated movies and alcohol initiation in Mexican-heritage adolescents. A cohort of 1,154 Mexican-heritage youth, average age 14 years, was followed for 2 years; in 2008-2009, participants reported alcohol use in the past 30 days and again in 2010-2011. Exposure to alcohol use images in PG-13-rated movies was estimated from 50 movies randomly selected from a pool of 250 of the top box office hits in the United States using previously validated methods. A series of generalized linear models, adjusting for age, gender, peer and family alcohol use, family functioning, anxiety, sensation-seeking tendency, and acculturation were completed. Multiple imputation was utilized to address missing data. Overall, N = 652 participants reported no alcohol use in 2008-2009; by 2010-2011, 33.6% (n = 219) had initiated alcohol use. Adjusted models indicated an independent association between exposure to alcohol use images in PG-13-rated movies and alcohol initiation (comparing quartiles 3 to 1: RR =1.53; 95% CI [1.11, 2.10]). The findings emphasize that the relationship between viewing alcohol use scenes in American films and alcohol initiation holds among Mexican-heritage adolescents and underscore the need to limit adolescents' exposure to such powerful images in PG-13-rated movies.

Genetic, Psychological, and Personal Network Factors Associated With Changes in Binge Drinking Over 2 Years Among Mexican Heritage Adolescents in the USA.

Background: Despite prevalent binge drinking and alcohol-dependent symptoms among Hispanics, few studies have examined how multidimensional factors influence Hispanic adolescents' binge drinking. Purpose This study examines the effects of genetic, psychological, and social network factors on binge drinking over time among Mexican heritage adolescents in the USA and whether there are correlations among genetic variants that are associated with binge drinking and psychological and network characteristics. Methods: Mexican heritage adolescents (n = 731) participated in a longitudinal study, which included genetic testing at baseline, alcohol use assessments at first and second follow-ups, and questionnaires on sensation seeking, impulsivity, and peer and family network characteristics at second follow-up. Logistic regression and Spearman correlation analyses were performed. Results: After adjusting for demographic characteristics, underlying genetic clustering, and binge drinking at first follow-up, two genetic variants on tryptophan hydroxylase 2 (TPH2; rs17110451, rs7963717), sensation seeking and impulsivity, and having a greater fraction of peers who drink or encourage drinking alcohol were associated with greater risk whereas another genetic variant on TPH2 (rs11178999) and having a greater fraction of close family relationships were associated with reduced risk for binge drinking at second follow-up. Genetic variants in TPH1 (rs591556) were associated with sensation seeking and impulsivity, while genetic variants in TPH2 (rs17110451) were associated with the fraction of drinkers in family. Conclusions: Results reveal that genetic variants in the serotonin pathway, behavioral disinhibition traits, and social networks exert joint influences on binge drinking in Mexican heritage adolescents in the USA.

Longitudinal associations of family functioning with body mass index in Mexican-origin adolescents living in the U.S.

Mexican-origin adolescents have a high prevalence of obesity. Research is needed to understand how family context may shape adolescent BMI. This study examined longitudinal associations of family functioning variables with the Centers for Disease Control and Prevention's modified BMI z-score (BMIaz) in 1175 Mexican-origin adolescents, and explored interactions with acculturation. Adolescents (50% female, aged 11-13 y in 2005-06) were identified from an ongoing cohort study of Mexican-origin adults in Houston, TX, and were assessed three times from 2005-06 to 2010-11. In multivariate linear mixed models stratified by gender, we assessed longitudinal associations of family cohesion and family conflict with adolescent BMIaz and explored interactions with language acculturation. We disaggregated the between- (mean) and within-person (individual deviation) components of family cohesion and family conflict to assess the effects on BMIaz. Approximately one-third of adolescents were obese at baseline, and BMIaz declined during the study. In girls, higher mean family cohesion and conflict were associated with steeper declines in BMIaz. Parental linguistic acculturation modified the relationship between within-person deviation in family cohesion and BMIaz in girls, such that high parental U.S. acculturation was associated with a stronger inverse association. There were no significant associations in boys. These findings highlight the potential importance of the family context to female adolescent BMI and the promise of addressing family context in obesity-related interventions.

Activating Communal Coping Related to Diabetes Risk in Mexican-Heritage Families.

We investigate how interpersonal ties influence communication about type 2 diabetes risk and encouragement to maintain or adopt a healthy lifestyle between family members of Mexican heritage, after a family history-based risk assessment intervention. Results suggest that individuals are more likely to initiate risk communication with another family member if they are close to, already seek advice from, or discuss health with him or her. Risk communication precedes encouragement, which is initiated by the older generation of the family. Understanding the role of interpersonal relationships in Mexican-heritage families can help identify who best to target in future health behavior interventions.

Bayesian variable selection for multistate Markov models with interval-censored data in an ecological momentary assessment study of smoking cessation.

The application of sophisticated analytical methods to intensive longitudinal data, collected with ecological momentary assessments (EMA), has helped researchers better understand smoking behaviors after a quit attempt. Unfortunately, the wealth of information captured with EMAs is typically underutilized in practice. Thus, novel methods are needed to extract this information in exploratory research studies. One of the main objectives of intensive longitudinal data analysis is identifying relations between risk factors and outcomes of interest. Our goal is to develop and apply expectation maximization variable selection for Bayesian multistate Markov models with interval-censored data to generate new insights into the relation between potential risk factors and transitions between smoking states. Through simulation, we demonstrate the effectiveness of our method in identifying associated risk factors and its ability to outperform the LASSO in a special case. Additionally, we use the expectation conditional-maximization algorithm to simplify estimation, a deterministic annealing variant to reduce the algorithm's dependence on starting values, and Louis's method to estimate unknown parameter uncertainty. We then apply our method to intensive longitudinal data collected with EMA to identify risk factors associated with transitions between smoking states after a quit attempt in a cohort of socioeconomically disadvantaged smokers who were interested in quitting.

Developing Shared Appraisals of Diabetes Risk Through Family Health History Feedback: The Case of Mexican-Heritage Families.

Background: Collecting complete and accurate family health history is critical to preventing type 2 diabetes. Purpose: We seek to identify the optimal risk feedback approach that facilitates risk communication between parents and their adult children and helps them develop shared appraisals of family history of type 2 diabetes. Methods: In a sample of parent-adult child dyads from 125 Mexican-heritage families residing in Houston, Texas, we examine change in parent-child dyadic (dis)agreement with respect to their shared family health history from baseline to 10 months after receipt of risk feedback generated by Family Healthware. A 2 × 2 factorial design is applied to test how the recipient (one parent or all family members) and the content (risk assessment with or without behavioral recommendations) of the feedback affect (dis)agreement through interpersonal ties, particularly dyadic risk communication. Results: Providing risk assessment without behavioral recommendations to the parent, but not the adult child, shifts the dyads toward agreement (relative risk ratio [RRR]= 1.78, 95% confidence interval [CI] [1.18-2.67]), by activating reciprocal risk communication between parents and children (RRR =2.70, 95% CI [1.81-4.03]). Dyads with close interpersonal ties are more likely to shift toward agreement (RRR = 3.09, 95% CI [1.89-5.07]). Conclusion: Programs aimed at improving family health history knowledge and accuracy of reports should tailor risk feedback strategically for better intervention effect and leverage a network approach in disease prevention among at-risk minority and/or immigrant populations. Trial Registration Number: NCT00469339.

The Time-Varying Relations Between Risk Factors and Smoking Before and After a Quit Attempt.

Introduction: Intensive longitudinal data (ILD) collected with ecological momentary assessments (EMAs) can provide a rich resource for understanding the relations between risk factors and smoking in the time surrounding a cessation attempt. Methods: Participants (N = 142) were smokers seeking treatment at a safety-net hospital smoking cessation clinic who were randomly assigned to receive standard clinic care (ie, counseling and cessation medications) or standard care plus small financial incentives for biochemically confirmed smoking abstinence. Participants completed EMAs via study provided smartphones several times per day for 14 days (1 week prequit through 1 week postquit). EMAs assessed current contextual factors including environmental (eg, easy access to cigarettes, being around others smoking), cognitive (eg, urge to smoke, stress, coping expectancies, cessation motivation, cessation self-efficacy, restlessness), behavioral (ie, recent smoking and alcohol consumption), and affective variables. Temporal relations between risk factors and smoking were assessed using a logistic time-varying effect model. Results: Participants were primarily female (57.8%) and Black (71.8%), with an annual household income of <$20000 per year (71.8%), who smoked 17.6 cigarettes per day (SD = 8.8). Individuals assigned to the financial incentives group had decreased odds of smoking compared with those assigned to usual care beginning 3 days before the quit attempt and continuing throughout the first week postquit. Environmental, cognitive, affective, and behavioral variables had complex time-varying impacts on smoking before and after the scheduled quit attempt. Conclusions: Knowledge of time-varying effects may facilitate the development of interventions that target specific psychosocial and behavioral variables at critical moments in the weeks surrounding a quit attempt. Implications: Previous research has examined time-varying relations between smoking and negative affect, urge to smoke, smoking dependence, and certain smoking cessation therapies. We extend this work using ILD of unexplored variables in a socioeconomically disadvantaged sample of smokers seeking cessation treatment. These findings could be used to inform ecological momentary interventions that deliver treatment resources (eg, video- or text-based content) to individuals based upon critical variables surrounding their attempt.