Neighbourhood context and binge drinking from adolescence into early adulthood in a US national cohort.

BACKGROUND: Underage binge drinking is a serious health concern that is likely influenced by the neighbourhood environment. However, longitudinal evidence has been limited and few studies have examined time-varying neighbourhood factors and demographic subgroup variation. METHODS: We investigated neighbourhood influences and binge drinking in a national cohort of US 10th grade students at four times (2010-2014; n = 2745). We estimated odds ratios (OR) for past 30-day binge drinking associated with neighbourhood disadvantage, personal and property crime (quartiles), and number of liquor, beer and wine stores within 5 km, and then evaluated whether neighbourhood associations differ by age, sex and race/ethnicity. RESULTS: Neighbourhood disadvantage was associated with binge drinking before 18 [OR = 1.54; 95% confidence interval (1.14, 2.08)], but not after 18 years of age. Property crime in neighbourhoods was associated with a higher odds of binge drinking [OR = 1.54 (0.96, 2.45)], an association that was stronger in early adulthood [4th vs 1st quartile: OR = 1.77 (1.04, 3.03)] and among Whites [4th vs 1st quartile: OR = 2.46 (1.03, 5.90)]. Higher density of liquor stores predicted binge drinking among Blacks [1-10 stores vs none: OR = 4.31 (1.50, 12.36)] whereas higher density of beer/wine stores predicted binge drinking among Whites [one vs none for beer: OR = 2.21 (1.06, 4.60); for wine: OR = 2.04 (1.04, 4.03)]. CONCLUSIONS: Neighbourhood conditions, particularly those related to economic circumstances, crime and alcohol outlet density, were related to binge drinking among young adults, but associations varied across age and individual characteristics.

Neighbourhood disadvantage and depressive symptoms among adolescents followed into emerging adulthood.

BACKGROUND: Residents of disadvantaged neighbourhoods report higher levels of depressive symptoms; however, few studies have employed prospective designs during adolescence, when depression tends to emerge. We examined associations of neighbourhood social fragmentation, income inequality and median household income with depressive symptoms in a nationally representative survey of adolescents. METHODS: The NEXT Generation Health Study enrolled 10th-grade students from 81 US high schools in the 2009-2010 school year. Depressive symptoms were assessed with the Modified Depression Scale (wave 1) and the paediatric Patient-Reported Outcome Measurement Information System (waves 2-6). Neighbourhood characteristics at waves 1, 3, 4, and 5 were measured at the census tract level using geolinked data from the American Community Survey 5-year estimates. We used linear mixed models to relate neighbourhood disadvantage to depressive symptoms controlling for neighbourhood and individual sociodemographic factors. RESULTS: None of the models demonstrated evidence for associations of social fragmentation, income inequality or median household income with depressive symptoms. CONCLUSION: Despite the prospective design, repeated measures and nationally representative sample, we detected no association between neighbourhood disadvantage and depressive symptoms. This association may not exist or may be too small to detect in a geographically dispersed sample. Given the public health significance of neighbourhood effects, future research should examine the developmental timing of neighbourhood effects across a wider range of ages than in the current sample, consider both objective and subjective measures of neighbourhood conditions, and use spatially informative techniques that account for conditions of nearby neighbourhoods.

State alcohol policies, taxes, and availability as predictors of adolescent binge drinking trajectories into early adulthood.

BACKGROUND AND AIMS: A number of alcohol policies in the United States have been presumed to reduce underage youth drinking. This study characterized underage youth binge-drinking trajectories into early adulthood and tested associations with the strength of the alcohol policy environment, beer excise taxes and number of liquor stores. DESIGN: Longitudinal cohort study. SETTING: United States. PARTICIPANTS: A national cohort of 10th graders in 2010 (n = 2753), assessed annually from 2010 to 2015. MEASUREMENTS: Participants reported on their 30-day binge drinking [defined as consuming five or more+ (for boys) or four or more (for girls) drinks within 2 hours]. We scored the strength of 19 state-level policies at baseline and summarized them into an overall score and two subdomain scores. We also assessed state beer excise taxes (dollars/gallon) and linked the number of liquor stores in 1 km to the participants' geocoded address. FINDINGS: We identified five binge-drinking trajectories: low-risk (32.9%), escalating (26.1%), late-onset (13.8%), chronic (15.1%) and decreasing (12.0%). Lower overall alcohol policy strength was associated with increased risk of being in the escalating versus low-risk binge-drinking class [relative risk ratio (RRR) = 1.44 per 1 standard deviation (SD) in policy score; 95% confidence interval (CI) = 1.17, 1.77)]. Higher beer excise taxes were associated with a reduced risk of being in the escalating class (RRR = 0.22 per 1-dollar increase; 95% CI = 0.09, 0.50). The number of liquor stores was not significantly associated with any binge-drinking trajectory. CONCLUSIONS: In the United States, stronger state alcohol policies and higher beer excise taxes appear to be associated with lower risk of escalating alcohol consumption trajectories among underage youth.

Early life disadvantage and adult adiposity: tests of sensitive periods during childhood and behavioural mediation in adulthood.

BACKGROUND: Early exposure to socioeconomic disadvantage is associated with obesity. Here we investigated how early, and conducted mediation analyses to identify behavioural factors in adulthood that could explain why. METHODS: Among 931 participants in the New England Family Study, we investigated the associations of family socioeconomic disadvantage measured before birth and at age 7 years with the following measures of adiposity in mid-adulthood (mean age = 44.4 years): body mass index (BMI), waist circumference and, among 400 participants, body composition from dual-energy X-ray absorption scans. RESULTS: In linear regressions adjusting for age, sex, race and childhood BMI Z-score, participants in the highest tertile of socioeconomic disadvantage at birth had 2.6 additional BMI units in adulthood [95% confidence interval (CI) = 1.26, 3.96], 5.62 cm waist circumference (95% CI = 2.69, 8.55), 0.73 kg of android fat mass (95% CI = 0.25, 1.21), and 7.65 higher Fat Mass Index (95% CI = 2.22, 13.09). Conditional on disadvantage at birth, socioeconomic disadvantage at age 7 years was not associated with adult adiposity. In mediation analyses, 10-20% of these associations were explained by educational attainment and 5-10% were explained by depressive symptoms. CONCLUSIONS: Infancy may be a sensitive period for exposure to socioeconomic disadvantage, as exposure in the earliest years of life confers a larger risk for overall and central adiposity in mid-adulthood than exposure during childhood. Intervention on these two adult risk factors for adiposity would, if all model assumptions were satisfied, only remediate up to one-fifth of the excess adult adiposity among individuals born into socioeconomically disadvantaged households.

Adolescent Sexual Orientation and Developmental Transition in Emerging Adulthood: Disparities in School, Work, Residence, and Transportation.

PURPOSE: To examine associations between adolescent sexual minority status and developmental transitions in school, work, residence, and transportation 5 years later. METHOD: We analyzed data from Waves 2 (Mean age = 17.2) and 7 (Mean age = 22.6) of the NEXT Generation Health Study (n = 2,000). Relative risks were estimated using Poisson regressions. RESULTS: Relative to heterosexual females, sexual minority females were more likely to report not attending school (relative risk [RR] = 1.27, 95% confidence interval [CI] = 1.02, 1.59), not anticipating college completion (RR = 1.60, 95% CI = 1.27, 2.01), and not having a driver's license (RR = 2.64, 95% CI 1.38, 5.05) at Wave 7. Relative to heterosexual males, sexual minority males were more likely to report living in three or more places in the past year (RR = 2.98, 95% CI = 1.31, 6.76). CONCLUSIONS: Adolescent sexual minority status predicted worse educational outcomes among females and more unstable living environment among males.

Income inequality among American states and the conditional risk of post-traumatic stress disorder.

PURPOSE: Vulnerability to post-traumatic disorder (PTSD) following a traumatic event can be influenced by individual-level as well as contextual factors. Characteristics of the social and economic environment might increase the odds for PTSD after traumatic events occur. One example that has been identified as a potential environmental determinant is income inequality. The purpose of this study is to investigate the association between State-level income inequality and PTSD among adults who have been exposed to trauma. METHODS: We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,653). Structured diagnostic interviews were administered at baseline (2001-2002) and follow-up (2004-2005). Weighted multi-level logistic regression was used to determine if US State-level income inequality, as measured by the Gini coefficient, was associated with incident episodes of PTSD during the study's 3-year follow-up period adjusting for individual and state-level covariates. RESULTS: The mean Gini coefficient across states in the NESARC was 0.44 (SD = 0.02) and ranged from 0.39 to 0.53. Of the respondents, 27,638 reported exposure to a traumatic event. Of this sample, 6.9 and 2.3% experienced persistent or recurrent and incident PTSD, respectively. State-level inequality was not associated with increased odds for persistent or recurrent PTSD (OR = 1.02; 95% CI 0.85, 1.22), but was associated with incident PTSD (OR = 1.30, 95% CI 1.04, 1.63). CONCLUSION: The degree of income inequality in one's state of residence is associated with vulnerability to PTSD among individuals exposed to traumatic events. Additional work is needed to determine if this association is causal (or alternatively, is explained by other socio-contextual factors associated with income inequality), and if so, what anxiogenic mechanisms explain it.

Factors associated with first utilization of different types of care for alcohol problems.

OBJECTIVE: The purpose of this research was to investigate whether factors associated with first obtaining care for alcohol problems vary by source of care. METHOD: This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions to examine initiation of different types of care over a 3-year follow-up interval among individuals with baseline alcohol use disorders who had not previously obtained any care (n = 2,170). Three hierarchical, mutually exclusive types of care were compared: substance use disorder (SUD) specialty sources, general medical but no SUD specialty sources, and nonmedical sources only. RESULTS: Having injured oneself or someone else because of drinking was associated with initiating all three types of care. Additional factors associated with initiating care from SUD specialty treatment sources (vs. no care) comprised male sex, alcohol use disorder severity, major financial problems, and nondependent tobacco/drug use. Factors associated with initiating care from general medical but not SUD specialty sources (vs. no care) comprised marriage/cohabitation, college student status, number of medical conditions, and other substance dependence. Factors associated with obtaining care only from nonmedical sources (vs. no care) comprised low income and anxiety disorder. When direct comparisons were made among types of care, factors drawing individuals into general medical care for reasons not necessarily related to alcohol problems were those that primarily distinguished utilization of general medical sources from the other two types of care. CONCLUSIONS: Results support the importance of screening in general medical practice and student health services as an important means of identifying individuals in need of brief intervention or more intensive SUD treatment and reiterate the importance of nonmedical sources for individuals whose alcohol problems might never be addressed in routine medical visits.

Antisocial behavioral syndromes and past-year physical health among adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To describe associations of DSM-IV antisocial personality disorder (ASPD), DSM-IV conduct disorder without progression to ASPD (CD-only), and syndromal antisocial behavior in adulthood without conduct disorder before age 15 years (AABS, not a DSM-IV diagnosis) with past-year physical health status and hospital care utilization in the general U.S. adult population. METHOD: This report is based on the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093, response rate = 81%). Respondents were classified according to whether they met criteria for ASPD, AABS, CD-only, or no antisocial syndrome. Associations of antisocial syndromes with physical health status and care utilization were examined using normal theory and logistic regression. RESULTS: ASPD and AABS were significantly but modestly associated with total past-year medical conditions, coronary heart and gastrointestinal diseases, and numbers of inpatient hospitalizations, inpatient days, emergency department visits, and clinically significant injuries (all p < .05). ASPD was also associated with liver disease, arthritis, and lower scores on the Medical Outcomes Study 12-Item Short-Form Health Survey, version 2 (SF-12v2) physical component summary, role physical, and bodily pain scales (all p < .05). AABS was associated with noncoronary heart disease, lower scores on the SF-12v2 general health and vitality scales, and, among men, arthritis (all p < .05). CD-only was associated with single but not multiple inpatient hospitalizations, emergency department visits, and clinically significant injuries (all p < .05). CONCLUSIONS: Estimates of burden related to antisocial behavioral syndromes need to consider associated physical health problems. Prevention and treatment guidelines for injuries and common chronic diseases may need to address comorbid antisociality, and interventions targeting antisociality may need to consider general health status, including prevention and management of injuries and chronic diseases.

Subjective unmet need for mental health services in depressed children grown up.

BACKGROUND: Limited attention has been devoted to characterizing unmet need for treatment among individuals with mental disorders. A longitudinal follow-up of depressed, anxious, and psychiatrically normal children into adulthood provided an opportunity to examine factors associated with subjective unmet need. METHODS: Respondents (n = 208) comprise a subsample of a cohort ascertained between 1977 and 1985 consisting of three subgroups: one with major depressive disorder (MDD), one with anxiety disorders but no MDD, and controls with no psychiatric disorder up to ascertainment. Psychiatric status was reassessed in adulthood using the SADS-LA by interviewers blind to childhood diagnoses. Best-estimate diagnoses describing participants' lifetime clinical course were formulated by senior clinicians. Participants who completed SADS-LA interviews about themselves were invited to complete an additional interview about experiences with health care, including subjective unmet need for and barriers to mental health treatment. RESULTS: About 37% of respondents reported lifetime histories of subjective unmet need for mental health services. Unmet need was associated with female gender and lifetime mood and substance dependence disorders. The most commonly cited barriers included attitudes toward treatment, not knowing where to obtain it, and financial concerns. CONCLUSIONS: Subjective unmet need was common in this sample. Approaches to reducing it might include public health initiatives to foster more favorable attitudes toward treatment, increase knowledge of where to obtain it, and lower financial barriers.

Use of outpatient mental health services by depressed and anxious children as they grow up.

OBJECTIVE: Childhood-onset psychiatric disorders can be persistent and impairing but often go untreated. Affected individuals' treatment utilization into adulthood is not well understood. A 15-year follow-up of depressed, anxious, and never mentally ill children (control group) examined need, predisposing, and enabling factors associated with use of outpatient mental health care into early adulthood. METHODS: Between 1977 and 1985, a total of 315 children and adolescents were ascertained. Their psychiatric status and treatment utilization into adulthood were reassessed between 1991 and 1997 by clinicians blind to their childhood diagnoses. RESULTS: Respondents ascertained for depression demonstrated 13-fold, and those ascertained for anxiety demonstrated six-fold, greater odds of any treatment compared with controls. Among utilizers, childhood depression conferred 14-fold, and childhood anxiety, 23-fold, increased odds of long-term treatment. Blacks were less likely than whites to obtain treatment. Utilizers older at follow-up reported longer treatment duration. Mood disorder episodes over follow-up and poorer global functioning were associated with both increased odds of any utilization and increased treatment duration among utilizers. CONCLUSIONS: This sample demonstrated high and persistent treatment utilization. Need indicated by childhood diagnosis was the strongest predictor of treatment; however, utilization also differed by race or ethnicity. Strategies to maximize the uptake of effective, culturally relevant treatment approaches should be investigated.

Insurance coverage, usual source of care, and receipt of clinically indicated care for comorbid conditions among adults living with human immunodeficiency virus.

BACKGROUND AND OBJECTIVES: Associations of insurance coverage and source of care with use of human immunodeficiency virus (HIV)-related health, mental health, and substance abuse services are examined in a large, diverse, highly active antiretroviral therapy-era cohort. METHODS: Adults who were infected with HIV (n = 3818) were interviewed in clinics and community agencies in Los Angeles, Milwaukee, New York, and San Francisco regarding drug use behaviors, health status, and health care utilization. RESULTS: Most participants were insured by Medicaid. During the previous 3 months, 90% of privately insured, 87% of publicly insured, and 78% of uninsured participants had visited any provider. Publicly and privately insured participants were similar in receipt of antiretrovirals, prophylaxis against Pneumocystis carinii pneumonia, substance abuse services, and antidepressants. Uninsured participants were less likely to receive antiretrovirals but were more likely to use substance abuse services. Participants with no usual source of care were less likely to receive PCP prophylaxis. CONCLUSIONS: A lack of insurance is associated with barriers to care, but the advantage of private over public coverage appears smaller than in previous studies. PCP prophylaxis, substance abuse treatment, and antidepressants remain markedly underutilized. Educational initiatives about these treatments targeting providers and patients are indicated.