Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program.

OBJECTIVE: We sought to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic. STUDY DESIGN: Data of dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N = 2,983) were used to compare birth outcomes before and during the pandemic (n = 2,355), and a partially overlapping sample (n = 1,490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes. RESULTS: Symptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B = - 0.33 weeks, p = 0.025), and depression was significantly associated with shortened gestation (B = - 0.02 weeks, p = 0.015) after adjustment. Birth weights were similar (B = - 28.14 g, p = 0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B = 0.15 z-score units, p = 0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of the impact of COVID-19 on their life. CONCLUSION: In this national cohort, we detected no effect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth, as well as distress about changes in prenatal care early in the pandemic. KEY POINTS: · COVID-19 was associated with shortened gestations.. · Depression was associated with shortened gestations.. · However, stress during the pandemic remained unchanged.. · Most women reported negative impacts of the pandemic..

Equitable Policies Need Equitable Practices: Alcohol- and Substance-Exposed Pregnancy as a Case Study.

There is clear need for more effective public health policies. Coupled with calls for more effective policies, increasing demand to address public health disparities experienced by systemically marginalized and historically oppressed groups emphasizes the long-standing need for policies that improve public health equity. Such need is highlighted when examining public health issues such as alcohol- and substance-exposed pregnancy (ASEP): Current policies are ineffective at reducing ASEP, and marginalized groups experience disproportionately lower benefits and higher negative consequences as a result of such policies. Powerful strategies to develop more effective policies that can account for the complexity of such issues, such as systems science methods (SSMs), are becoming popular. However, current best practices for such methods often do not emphasize the additional efforts that will be required to develop equitable, not just effective policies. Using ASEP as an example of a crucial complex issue requiring new policy, we suggest additional steps to include in SSM projects for developing more effective policies that will also help stakeholders determine high-equity policies to reduce health disparities. These steps include modeling structural differences experienced by marginalized groups via systemic racism and oppression, incorporating existing cultural and community sources of strength and resilience as key areas for policy development, and evaluating the sustainability of policies as a dimension of efficacy. We also discuss using community-based participatory approaches as a framework for all SSM processes to ensure that policy development itself is grounded in equitable shared decision-making for marginalized individuals.

Where there's a will, there's a way? Strategies to reduce or abstain from alcohol use developed by Northern Plains American Indian women participating in a brief, alcohol-exposed pregnancy preconceptual intervention.

BACKGROUND: Alcohol-exposed pregnancy (AEP) is an ongoing concern, especially within low-resource, high-risk areas such as rural American Indian/Alaska Native (AIAN) communities. Brief, preconceptual AEP-reduction interventions are popular in such areas but have a small impact on alcohol use. Developing a strategic alcohol change plan is a key program component; however, there is little research on strategy selection, especially within contexts that positively or negatively impact selection (e.g., cultural strengths, trauma, collective efficacy within AIAN communities). This study qualitatively analyzed strategies chosen to reduce alcohol use by AIAN women participating in a culturally tailored, brief, preconceptual AEP-reduction intervention. METHODS: One hundred-sixty Northern Plains AIAN women who were participating in a brief AEP-reduction program developed a plan to accomplish an alcohol reduction/abstention goal at the first and last program sessions. The plan included choosing 1 or more strategies to (1) achieve the goal, (2) mitigate barriers, and (3) use cultural strengths. Qualitative analysis of the data involved thematic open and structured coding of all 3 strategies separately. We also examined how many different themes (different individual strategies) participants reported for each strategy component. RESULTS: Most participants reported only 1 strategy (theme) for each of the 3 components. Common goal-achieving and barrier-mitigation strategies included positive social supports and avoiding negative or alcohol-involved social environments. Other strategies involved circular logic (e.g., the strategy to reduce drinking was to drink less). Both traditional and western cultural strengths were reported as important resources, although many participants had no cultural resource strategy. CONCLUSION: Programs aimed at reducing AEPs may need to provide participants more support to develop strong strategies to reduce alcohol use when implemented within areas with high levels of trauma and contextual barriers that can impact strategy selection. Such support could include ways to improve health on both interpersonal and community levels.

Punch-Drunk or Drunken Boxing? The Etiology of Alcohol-Related Physical Violence through Adolescence and Young Adulthood.

BACKGROUND: Alcohol-related physical violence (ARPV) can be a causal consequence of alcohol consumption, but only for specific individuals (e.g., those predisposed to violence). Studies have not accounted for the shared etiology explaining comorbidity between alcohol use and violent behavior as a potential third-variable explanation of ARPV. The current study examined genetically-informed associations between ARPV, heavy alcohol use (HAU) and overall physical violence (OPV) in adolescence and young adulthood, by testing two proposed theories of ARPV processes (HAU causes ARPV, causal relationships depend upon OPV) and how overarching shared covariance may account for these associations. METHODS: Using the twin and sibling subsample from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a series of biometric models tested hypotheses individually in adolescence and young adulthood. This included estimating bivariate Cholesky and direction-of-causality models, and trivariate Cholesky, independent pathway, and common pathway models. RESULTS: HAU had a causal effect on ARPV in adolescence and young adulthood. This effect was not moderated by OPV at either developmental stage. A shared etiology or common latent factor did not explain associations between ARPV, OPV, and HAU, even though ARPV strongly covaried independently with HAU and with OPV. Finally, OPV also had a causal effect on ARPV in adolescence, and in young adulthood for adolescent-onset drinkers. CONCLUSIONS: Causal theories of ARPV still hold when accounting for shared genetic and environmental variance. Further research on the exact role of violence (predispositions, environmental contexts) is required, as both phenotypes substantially (and separately) explain influences driving ARPV.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1887244.

Neighborhood alcohol outlet density and genetic influences on alcohol use: evidence for gene-environment interaction.

BACKGROUND: Genetic influences on alcohol involvement are likely to vary as a function of the 'alcohol environment,' given that exposure to alcohol is a necessary precondition for genetic risk to be expressed. However, few gene-environment interaction studies of alcohol involvement have focused on characteristics of the community-level alcohol environment. The goal of this study was to examine whether living in a community with more alcohol outlets would facilitate the expression of the genetic propensity to drink in a genetically-informed national survey of United States young adults. METHODS: The participants were 2434 18-26-year-old twin, full-, and half-sibling pairs from Wave III of the National Longitudinal Study of Adolescent to Adult Health. Participants completed in-home interviews in which alcohol use was assessed. Alcohol outlet densities were extracted from state-level liquor license databases aggregated at the census tract level to derive the density of outlets. RESULTS: There was evidence that the estimates of genetic and environmental influences on alcohol use varied as a function of the density of alcohol outlets in the community. For example, the heritability of the frequency of alcohol use for those residing in a neighborhood with ten or more outlets was 74% (95% confidence limits = 55-94%), compared with 16% (95% confidence limits = 0-34%) for those in a neighborhood with zero outlets. This moderating effect of alcohol outlet density was not explained by the state of residence, population density, or neighborhood sociodemographic characteristics. CONCLUSIONS: The results suggest that living in a neighborhood with many alcohol outlets may be especially high-risk for those individuals who are genetically predisposed to frequently drink.

The Importance of Intimate Partner Violence in Within-Relationship and Between-Person Risk for Alcohol-Exposed Pregnancy.

BACKGROUND: Preconceptual prevention programs geared toward reducing alcohol-exposed pregnancy (AEP) typically emphasize behavioral change of alcohol use and birth control exclusively, but rarely consider other important AEP predictors that may affect behavioral change. Intimate partner violence (IPV) substantially relates to AEP and to AEP predictors; however, few studies have tested if IPV is a unique indicator of prospective AEP risk, as both a main effect and a contextual influence on alcohol use or birth control. METHODS: Using Waves II and III of the National Longitudinal Study of Adolescent to Adult Health, multilevel logistic regression models were estimated, in which IPV and birth control (both within-person and between-person) and adolescent alcohol use (between-person only) were examined as unique predictors of AEP compared to both nonpregnancy and non-AEP (nAEP) outcomes over up to 5 sexual relationships. Interactions between within-person and between-person IPV, and birth control or alcohol use were also tested. RESULTS: Within-person and between-person IPV significantly related to higher odds of AEP compared to nonpregnancy and nAEP. Adolescent alcohol use had similarly increased odds for AEP when compared to nonpregnancy or nAEP outcomes. Only between-person birth control use related to higher odds for AEP compared to nonpregnancy and nAEP. Between-person IPV also moderated adolescent alcohol use on odds of AEP, such that infrequent adolescent drinkers had higher odds of AEP compared to nonpregnancy or nAEP if they experienced IPV over their relationships. CONCLUSIONS: IPV is a substantial predictor for AEP as both a direct influence within relationships (within-person) and between individuals (between-person). Intervention and prevention programs focused on reducing AEP may benefit from including IPV-specific curricula.

Selection and Socialization Influences on Adolescent Alcohol Use: The Individual and Joint Contexts of Neighborhood Disadvantage and Population Density.

Background: Neighborhood disadvantage (ND) and population density (PD) are two community characteristics contextualizing friends' influence on adolescent alcohol use. However, these community characteristics are rarely examined for potential joint contributions, although it is possible that the way friends are selected or influence alcohol use are shaped by both ND and PD. In addition, prior studies examining ND or PD contexts on friend influence rarely discern between socialization and selection. Objectives: The current study examined how selection and socialization influences on adolescent alcohol use are shaped by unique and joint contexts of ND and PD. Methods: Adolescents from Waves I and II of the National Longitudinal Study of Adolescent and Adult Health (Add Health) were included in three models assessing friends' socialization of alcohol us initiation and binge drinking, and selection of drinking friends. ND and PD were tested for mediation and moderation individually and jointly. Results: Results indicated that socialization of drinking initiation was stronger in high ND contexts, and that continued binge drinking was stronger in low ND contexts. PD indirectly influenced socialization of initiation and binge drinking maintenance via a negative association with number of drinking friends. PD and ND jointly influenced the association between initial binge drinking and next-year selection of drinking friends, such that selection was stronger within areas related to lower levels of drinking friends. Conclusions/Importance: Current results indicate that PD and ND shape friends' influence on alcohol use in unique ways. These must be accounted for to better understand bidirectional effects of friend influence.

Developmental Change in Adolescent Delinquency: Modeling Time-Varying Effects of a Preventative Intervention and GABRA2 Halpotype Linked to Alcohol Use.

Better integrating human developmental factors in genomic research is part of a set of next steps for testing gene-by-environment interaction hypotheses. This study adds to this work by extending prior research using time-varying effect modeling (TVEM) to evaluate the longitudinal associations between the PROSPER preventive intervention delivery system, a GABRA2 haplotype linked to alcohol use, and their interaction on adolescent delinquency. Logistic and Poisson analyses on eight waves of data spanning ages 11 to 19 (60% female, 90% Caucasian) showed the intervention reduced delinquency from ages 13 to 16. Moreover, interaction analysis revealed that the effect of the multicomponent intervention was significantly greater for T-allele carriers of the GABRA2 SNP rs279845, but only during the 13 to 16 age period. The results are discussed in terms of adolescent delinquency normativeness, implications for preventive intervention research, and the utility of incorporating development in GxE research.

Developmental Etiologies of Alcohol Use and Their Relations to Parent and Peer Influences Over Adolescence and Young Adulthood: A Genetically Informed Approach.

BACKGROUND: Distinct changes in alcohol use etiologies occur during adolescence and young adulthood. Additionally, measured environments known to influence alcohol use such as peers and parenting practice can interact or be associated with this genetic influence. However, change in genetic and environmental influences over age, as well as how associations with measured environments change over age, is understudied. METHODS: The National Longitudinal Study of Adolescent Health (Add Health) sibling subsample was used to examine data-driven biometric models of alcohol use over ages 13 to 27. Associations between friends' drinking, parental autonomy granting, and maternal closeness were also examined. RESULTS: The best-fitting model included a 5-factor model consisting of early (ages 13 to 20) and overall (ages 13 to 27) additive genetic and unique environmental factors, as well as 1 overall common environment factor. The overall additive genetic factor and the early unique environment factor explained the preponderance of mean differences in the alcohol use over this portion of the life span. The most important factors explaining variance attributed to alcohol use changed over age. Additionally, friend use had the strongest associations with genetic and environmental factors at all ages, while parenting practices had almost no associations at any age. CONCLUSIONS: These results supplement previous studies indicating changes in genetic and environmental influences in alcohol use over adolescence and adulthood. However, prior research suggesting that constraining exogenous predictors of genetic and environmental factors to have effects of the same magnitude across age overlooks the differential role of factors associated with alcohol use during adolescence. Consonant with previous research, friend use appears to have a more pervasive influence on alcohol use than parental influence during this age. Interventions and prevention programs geared toward reducing alcohol use in younger populations may benefit from focus on peer influence.

From alcohol initiation to tolerance to problems: Discordant twin modeling of a developmental process.

The current study examined a stage-based alcohol use trajectory model to test for potential causal effects of earlier drinking milestones on later drinking milestones in a combined sample of two cohorts of Australian monozygotic and same-sex dizygotic twins (N = 7,398, age M = 30.46, SD = 2.61, 61% male, 56% monozygotic twins). Ages of drinking, drunkenness, regular drinking, tolerance, first nontolerance alcohol use disorder symptom, and alcohol use disorder symptom onsets were assessed retrospectively. Ages of milestone attainment (i.e., age-of-onset) and time between milestones (i.e., time-to-event) were examined via frailty models within a multilevel discordant twin design. For age-of-onset models, earlier ages of onset of antecedent drinking milestones increased hazards for earlier ages of onset for more proximal subsequent drinking milestones. For the time-to-event models, however, earlier ages of onset for the "starting" milestone decreased risk for a shorter time period between the starting and the "ending" milestone. Earlier age of onset of intermediate milestones between starting and ending drinking milestones had the opposite effect, increasing risk for a shorter time period between the starting and ending milestones. These results are consistent with a causal effect of an earlier age of drinking milestone onset on temporally proximal subsequent drinking milestones.

Neighborhood Contextual Factors, Alcohol Use, and Alcohol Problems in the United States: Evidence From a Nationally Representative Study of Young Adults.

BACKGROUND: There is considerable variation in alcohol use and problems across the United States, suggesting that systematic regional differences might contribute to alcohol involvement. Several neighborhood contextual factors may be important aspects of this "alcohol environment." METHODS: Participants were 15,197 young adults (age 18 to 26) from Wave III of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative U.S. survey. Measures of past-year alcohol use and problems were obtained via structured in-home interviews. Tract-level neighborhood contextual factors (density of on- and off-premises alcohol outlets, neighborhood disadvantage, rural vs. urban residence) were derived from census indicators and geocoded state-level alcohol outlet licenses. Multivariate logistic regression, ordered logistic regression, or negative binomial regression models, including age, sex, race, and household income as covariates, were fit to examine the relation of the neighborhood contextual factors with alcohol use and problems. RESULTS: The most consistent finding across 4 of the 5 measures of alcohol involvement was their association with neighborhood advantage; the active ingredient underlying this effect was primarily the proportion of educated residents in the neighborhood. The densities of alcohol outlets were associated with any alcohol use-they were not associated with binge drinking or alcohol problems, nor could they explain any of the neighborhood advantage effects. The influence of alcohol outlet densities on alcohol involvement did not differ for those above or below the legal age to purchase alcohol. Living in a rural versus an urban neighborhood was associated with a different alcohol use pattern characterized by a lower likelihood of any drinking, but among those who drank, consuming more alcohol per occasion. CONCLUSIONS: Living in a more advantaged and educated urban neighborhood with greater densities of bars and restaurants is associated with greater alcohol involvement among 18- to 26-year-olds in the United States.

A longitudinal examination of parenting processes and Latino youth's risky sexual behaviors.

Latino adolescents engage in riskier sexual behaviors compared to their peers, shown by their higher rates of sexually transmitted infections and lower rates of condom usage; therefore, examining the precursors and correlates of these risky sexual behaviors is important for prevention-intervention program development. Based on cultural-ecological, symbolic interaction, and gender socialization perspectives, we examined associations among mothers' and fathers' parenting and Latino youth's sexual risk over a 5 year period. Further, we investigated the direct and moderating roles of acculturation (e.g., language spoken in the home), nativity (e.g., citizenship status), and adolescents' gender. Using data from the National Longitudinal Study of Youth (N = 1,899 Latino youth; 49 % female), we conducted a multi-level path model controlling for adolescents' age and prior sexual experience. Our findings revealed that more strictness by mothers and less strictness by fathers at Time 1 were related to lower sexual risk for adolescents at Time 2. Additionally, more monitoring by fathers at Time 2 was associated with lower sexual risk for adolescents at Time 3. Significant gender differences were found such that there were stronger associations among parenting processes and sexual risk for girls than for boys. Finally, we found support for the immigrant paradox (foreign-born youth reported lower sexual risk than US-born youth) and greater gender differences (boys had riskier sexual behaviors than girls) for immigrant compared to US-born youth. The findings reveal the complex associations among parenting processes, nativity status, gender, and sexual risk for Latino adolescents.

The role of gender and friends' gender on peer socialization of adolescent drinking: a prospective multilevel social network analysis.

Although socializing effects of friends' drinking on adolescent drinking behavior have been firmly established in previous literature, study results on the importance of gender, as well as the specific role that gender may play in peer socialization, are very mixed. Given the increasing importance of gender in friendships (particularly opposite-sex friendships) during adolescence, it is necessary to better understand the nuanced roles that gender can play in peer socialization effects on alcohol use. In addition, previous studies focusing on the interplay between individual gender and friends' gender have been largely dyadic; less is known about potential gendered effects of broader social networks. The current study sought to further investigate potential effects of gender on friends' influence on adolescent drinking behavior with particular emphasis on the number of same-sex and opposite-sex friends within one's friendship network, as well as closeness to these friends. Using Waves I and II of the saturated sample of the National Longitudinal Study of Adolescent Health (Add Health), adolescent friendship networks were used to calculate the mean drinking behaviors of adolescent friends. Multi-level models estimated the effects of individual drinking behaviors, friend drinking behaviors, and school-level drinking behaviors on adolescent drinking 1 year later, as well as moderating effects of gender composition of friendship groups and male and female friend closeness on the relationship between friends' drinking behaviors and adolescent drinking behavior. Results documented that gender composition of friendship groups did not influence the effect of friends' drinking on individual drinking 1 year later. However, closeness to friends did influence this relationship. As closeness to male friends decreased, the influence of their drinking behavior increased, for both boys and girls. A similar effect was found for female friends, but only for boys. Female friend closeness did not affect the relationship between peer alcohol socialization and girls' alcohol use. The findings indicate that the role of gender on alcohol socialization may be more complex than previously thought, particularly when examining the potential role that alcohol use may play as a mechanism for social bonding within opposite-sex friendships and same-sex male friendships.

Grounding alcohol simulation models in empirical and theoretical alcohol research: a model for a Northern Plains population in the United States.

The growing number of systems science simulation models for alcohol use (AU) are often disconnected from AU models within empirical and theoretical alcohol research. As AU prevention/intervention efforts are typically grounded in alcohol research, this disconnect may reduce policy testing results, impact, and implementation. We developed a simulation model guided by AU research (accounting for the multiple AU stages defined by AU behavior and risk for harm and diverse transitions between stages). Simulated projections were compared to historical data to evaluate model accuracy and potential policy leverage points for prevention and intervention at risky drinking (RD) and alcohol use disorder (AUD) stages. Results indicated prevention provided the greatest RD and AUD reduction; however, focusing exclusively on AUD prevention may not be effective for long-term change, given the continued increase in RD. This study makes a case for the strength and importance of aligning subject-based research with systems science simulation models.

How Funding Policy Maintains Structural Inequity Within Indigenous Community-Based Organizations.

Despite efforts to increase investment in Indigenous health and well-being in the United States, disparities remain. The way in which health-promoting organizations are funded is one key mechanism driving the systemic, long-term health disparities experienced by Indigenous people in the US. Using Indigenous-led community-based organizations (ICBOs) that provide psychosocial care as a case study, we highlight multiple ways in which policies that regulate the external funding that ICBOs depend on must change to promote equity and allow the organizations to flourish and address unmet psychosocial needs for Indigenous community members. We use a system dynamics approach to discuss how "capability traps" arise from a misfit between external funding regulations and organizations' needs for sustainability and effective care provision. We provide suggestions for reforming funding policies that focus on improving ICBO sustainability.

Rates and Correlates of Intimate Partner Abuse Among Indigenous Women Caregivers.

Intimate partner abuse (IPA) is a public health crisis that disproportionately impacts indigenous women. We know little about rates and correlates of IPA victimization (IPAV) and abuse directed at one's partner (ADP) among indigenous women caregivers (people who take care of children). The purpose of the current study was to address this critical gap in the literature. Participants were 44 indigenous women caregivers in the United States in a current relationship who completed a survey. Most women reported IPAV and ADP experiences in the past 6 months, and IPAV and ADP abuse directed at partner were positively associated. Further, IPAV was positively associated with adverse childhood experiences (ACEs), participants' engagement in harsh parenting, and depressive symptoms. IPAV was negatively associated with age, income, indigenous cultural identity, and social support. ADP was positively associated with ACEs, harsh parenting, and depressive symptoms. ADP was negatively associated with age and income. ADP was not associated with indigenous cultural identity and social support. These data suggest the urgency with which efforts are needed to prevent and respond to IPA among indigenous women caregivers, especially those who are younger and of lower income, and that culturally grounded initiatives that seek to build social support may be especially impactful.

Parent and peer pathways to adolescent delinquency: variations by ethnicity and neighborhood context.

Effects of ethnicity and neighborhood quality often are confounded in research on adolescent delinquent behavior. This study examined the pathways to delinquency among 2,277 African American and 5,973 European American youth residing in high-risk and low-risk neighborhoods. Using data from a national study of youth, a meditational model was tested in which parenting practices (parental control and maternal support) were hypothesized to influence adolescents' participation in delinquent behavior through their affiliation with deviant peers. The relationships of family and neighborhood risk to parenting practices and deviant peer affiliation were also examined. Results of multi-group structural equation models provided support for the core meditational model in both ethnic groups, as well as evidence of a direct effect of maternal support on delinquency. When a similar model was tested within each ethnic group to compare youths residing in high-risk and low-risk neighborhoods, few neighborhood differences were found. The results indicate that, for both African American and European American youth, low parental control influences delinquency indirectly through its effect on deviant peer affiliation, whereas maternal support has both direct and indirect effects. However, the contextual factors influencing parenting practices and deviant peer affiliation appear to vary somewhat across ethnic groups. Overall the present study highlights the need to look at the joint influence of neighborhood context and ethnicity on adolescent problem behavior.

Community-based system dynamics modelling of stigmatized public health issues: Increasing diverse representation of individuals with personal experiences.

Utility of community-based system dynamics (CBSD) models on stigmatized public health issues and health disparities depends upon how representative the model is to real-world experience within the community. "Personal experience" participants (PEP), especially from marginalized groups, are essential model contributors, but are often underrepresented in modeling groups due to multiple barriers. This study details a method to increase PEP representation for models on stigmatized issues. We use a case study from a CBSD project on health disparities within the association between alcohol misuse (AM) and intimate partner violence (IPV) for Northern Plains Indigenous women. Short group model building sessions were held at three community organizations providing relevant resources. Each model contributed unique system components, and there were few similarities between models. A consolidated model provided a rich picture of the complex system. Adding brief PEP-based group modeling sessions can enhance PEP representation in model development for stigmatized public health issues.

Effect of individual or comorbid antenatal depression and anxiety on birth outcomes and moderation by maternal traumatic experiences and resilience.

Background: Although antenatal depression and anxiety (e.g., negative antenatal mental health; NAMH) are individually associated with preterm birth (PTB) and infant neurological impairment, few studies account for comorbidity. Understanding how NAMH impacts PTB and infant neurological functioning by either singular (depression or anxiety) or comorbid status, as well as the way in which these effects can be moderated by additional risk or protective factors (traumatic experiences and trait resiliency) can contribute further understanding of NAMH effects on birth outcomes. Methods: The sample included 3042 mother-infant dyads from U.S. and South Africa cohorts of the Safe Passage Study (N = 3042). A four-category NAMH variable was created to categorize depression-only, anxiety-only, comorbid, or no NAMH statuses. Results: There were no NAMH main effects on PTB, however, anxiety-only and comorbid NAMH increased odds of PTB for mothers with higher rates of traumatic life experiences. Anxiety-only and comorbid NAMH were associated with increased odds of newborn neurological impairment, and the effect of comorbid NAMH was stronger for mothers with higher rates of traumatic experiences. Resiliency decreased odds of neurological impairment for mothers who reported depression-only or anxiety-only NAMH. Limitations: Limitations included potential artefacts of two cohorts that differed in rates of almost all variables, a single time point for measuring NAMH, and lack of pregnancy-specific NAMH measures. Conclusions: Especially when compared to mothers with no NAMH, comorbidity or singular-condition NAMH statuses associate with negative birth outcomes in nuanced ways, especially when considering additional contexts that may foster or protect against NAMH.

Dynamic change in the association of a cigarettes-per-day polygenic risk score across the numeric range of its corresponding phenotype over adolescence and young adulthood.

The association between cigarettes per day (CPD) and CPD-calibrated polygenic risk scores (CPD-PGS) is positive, however, the shape of the association is unknown. CPD measurement is inconsistent across studies and different measurement can lead to different results. The pattern shape may also patterns may change over time, given differences in genetic influence on smoking. This study examines the dynamic pattern between number of cigarettes smoked and PGS-CPD over adolescence and young adulthood. A time-varying effects model in which CPD was the continuous dynamic variable, was estimated for ever-smokers in a nationally representative study tracking partiicpants over adolescence and young adulthood. Participants were genotyped and a CPD-PGS score was created using results from a large genome-wide study meta-analysis. Results indicated that the association between CPD and CPD-PGS changed over CPD. Low CPD-PGS related to higher odds of not smoking or smoking very low CPD. A flat positive association at 5-12 CPD suggeted a "low risk" group. The association peaked around 20 CPD, indicating that a high-risk score applied best to those smoking approximately 1 pack of cigarettes per day. Age also moderated the effect of CPD-PGS at specific CPD rates, such that CPD-PGS was stronger at later ages and higher CPD. The association between CPD and CPD-PGS should not be assumed to be linear or static over age; there seem to be CPD-PGS thresholds corresponding to significant CPD risk, although the effect of CPD-PGS also varies over age. More care and attention to measurement can improve behavior genetic addiction science.