Associations of Historical Redlining With BMI and Waist Circumference in Coronary Artery Risk Development in Young Adults.

Introduction: Historical maps of racialized evaluation of mortgage lending risk (i.e., redlined neighborhoods) have been linked to adverse health outcomes. Little research has examined whether living in historically redlined neighborhoods is associated with obesity, differentially by race or gender. Methods: This is a cross-sectional study to examine whether living in historically redlined neighborhoods is associated with BMI and waist circumference among Black and White adults in 1985-1986. Participants' addresses were linked to the 1930s Home Owners' Loan Corporation maps that evaluated mortgage lending risk across neighborhoods. The authors used multilevel linear regression models clustered on Census tract, adjusted for confounders to estimate main effects, and stratified, and interaction models by (1) race, (2) gender, and (3) race by gender with redlining differentially for Black versus White adults and men versus women. To better understand strata differences, they compared Census tract-level median household income across race and gender groups within Home Owners' Loan Corporation grade. Results: Black adults (n=2,103) were more likely than White adults (n=1,767) to live in historically rated hazardous areas and to have higher BMI and waist circumference. Redlining and race and redlining and gender interactions for BMI and waist circumference were statistically significant (p<0.10). However, in stratified analyses, the only statistically significant associations were among White participants. White participants living in historically rated hazardous areas had lower BMI (ß=-0.63 [95% CI= -1.11, -0.15]) and lower waist circumference (ß=-1.50 [95% CI= -2.62, -0.38]) than those living in declining areas. Within each Home Owners' Loan Corporation grade, residents in White participants' neighborhoods had higher incomes than those living in Black participants' neighborhoods (p<0.0001). The difference was largest within historically redlined areas. Covariate associations differed for men, women, Black, and White adults, explaining the difference between the interaction and the stratified models. Race by redlining interaction did not vary by gender. Conclusions: White adults may have benefitted from historical redlining, which may have reinforced neighborhood processes that generated racial inequality in BMI and waist circumference 50 years later.

Can the systemic inflammation score be used to predict prognosis in gastric cancer patients undergoing surgery? A systematic review and meta-analysis.

Background: Inflammatory markers are being increasingly used to predict the prognosis of cancer patients. We hereby conducted the first meta-analysis assessing the association between systemic inflammation score (SIS) and prognosis of gastric cancer patients undergoing surgical intervention. Methods: A literature search was carried out on PubMed, CENTRAL, Scopus, and Embase up to 3rd June 2022 for relevant studies. Adjusted data reported as hazard ratios (HR) was combined in a random-effects model. Results: A total of seven studies with 5,338 patients could be included. All studies were from either China or Japan and published in the last four years. Meta-analysis showed that higher SIS scores (1 or 2) were significant predictors of poor overall survival (OS) in gastric cancer patients (HR: 1.25 95% CI: 1.05, 1.49, I 2 = 11%). Similarly, the meta-analysis demonstrated that an SIS score of 2 was associated with poor OS as compared to scores of 0/1 (HR: 2.53 95% CI: 1.30, 4.89, I 2 = 45%). Data on disease-free survival (DFS) was scarce to draw conclusions. Conclusion: The SIS score can be a simple and useful tool to predict OS in gastric cancer patients undergoing surgery. Data on DFS is scarce and conflicting. Future studies should report using standard reference groups and provide data on DFS to enhance current evidence.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier: CRD42022335548.

A novel data-driven decision model based on extended belief rule base to predict China's carbon emissions.

Global warming and climate change are gaining traction in recent years. As a major cause of global warming, carbon emissions were centered to China's climate change policy initiatives. Nevertheless, the existing policy discourse has yet reached a consensus on the optimal modeling method for carbon emissions prediction that is well-informed of both policy goals and the time-series pattern of carbon emissions. This paper fills the gap by promoting a novel data-driven decision model for carbon emissions prediction that is based on the extended belief rule base (EBRB) inference model. The new decision model consists of three components: 1) an indicator integration method, which aims to generate a few group indicators from a large number of statistical indicators; 2) a new EBRB construction method, which aims to consider the management policy goals for constructing EBRB; 3) a new ER-based inference method, which aims to predict carbon emissions based on time series change of relevant factors. The effectiveness of the proposed decision model has been tested against carbon emissions management data from 30 provinces in China. Experimental results demonstrate that the model will offer powerful reference value in the policy decision-making process, which will help to meet policy requirements for carbon emissions.

Cross-substance patterns of alcohol, cigarette, and cannabis use initiation in Black and White adolescent girls.

Characterizing variations in the timing of alcohol, cigarette, and cannabis use onset both among and between Black and White youth can inform targeted prevention. The current study aimed to capture cross-substance initiation patterns in Black and White girls and characterize these patterns with respect to substance use related socioeconomic, neighborhood, family, community, and individual level factors. Data were drawn from interviews conducted at ages 8 through 17 in an urban sample of girls (n = 2172; 56.86% Black, 43.14% White). Discrete-time multiple event process survival mixture modeling was used to identify patterns (i.e., classes) representing timing of alcohol, cigarette, and cannabis use initiation, separately by race. Class characteristics were compared using multinomial logistic regression. Among both Black and White girls, four classes, including abstainer and cross-substance early onset classes, emerged. Two classes characterized by mid-adolescence onset (Black girls) and variation in onset by substance (White girls) were also observed. Class differences centered around cannabis for Black girls (e.g., preceding or following cigarette use) and alcohol for White girls (e.g., (in)consistency over time in greater likelihood of initiation relative to cigarette and cannabis use). Several factors distinguishing the classes were common across race (e.g., externalizing behaviors, friends' cannabis use); some were specific to Black girls (e.g., intentions to smoke cigarettes) or White girls (e.g., primary caregiver problem drinking). Findings underscore the need to recognize a more complex picture than a high-risk/low-risk dichotomy for substance use initiation and to attend to nuanced differences in markers of risky onset pathways between Black and White girls.

Development and validation of a patient experience of care survey for emergency departments.

OBJECTIVES: To (1) develop a survey to assess the patient experience of care in hospital-based emergency departments (ED) and (2) evaluate the reliability and validity of composite measures of patient experience using data collected through the experimental implementation of the newly developed Emergency Department Patient Experience of Care (EDPEC) Discharged to Community (DTC) Survey. DATA SOURCE: 4893 adult patients were treated in the ED of 16 hospitals across the United States in 2018. STUDY DESIGN: The study utilized a cross-sectional survey. DATA COLLECTION: Survey development activities included a literature review, focus groups, and cognitive interviews with recently discharged ED patients, technical expert panels, and multiple field experiments. Survey development resulted in a 34-item instrument; the analysis reported here focuses on 18 items on patient experience of care. Using data from the EDPEC DTC Survey in the 2018 Feasibility Test, we performed confirmatory factor analysis to group 15 evaluative survey items into composite measures. We examined internal consistency reliability, interunit reliability, and associations between each composite measure and patients' overall rating and willingness to recommend the ED. PRINCIPAL FINDINGS: Analyses of 15 evaluative items identified four composite measures: Getting Timely Care, How Well Doctors and Nurses Communicate, Communication about Medications, and Communication about Follow-up. Patient-level internal consistency reliability exceeded 0.75 for two of four composites; ED-level internal consistency reliability exceeded 0.83 for all four composites. Interunit reliability estimates indicated that 450 survey completes per ED results in at least 0.70 reliability for all composites. Higher scores on each composite were associated with higher overall ratings and willingness to recommend the ED. CONCLUSIONS: The composite measures derived from the EDPEC DTC Survey are statistically reliable and valid. These results provide guidance for EDPEC DTC Survey adopters on how to construct meaningful and psychometrically-sound composite measures for monitoring the quality of care they provide.

Reliable and Valid Survey-Based Measures to Assess Quality of Care in Home-Based Serious Illness Programs.

Background: There is a pressing need for standardized measures to assess the quality of home-based serious illness care. Currently, there are no validated quality measures that are specific to home-based serious illness programs (SIPs) and the unique needs of their patients. Objective: To develop and evaluate standardized survey-based measures of serious illness care experiences for assessing and comparing quality of home-based serious illness care programs. Methods: From October 2019 through January 2020, we administered a survey to patients who received care from 32 home-based SIPs across the United States. Using the 2263 survey responses, we assessed item performance and constructed composite measures via factor analysis, evaluated item-scale correlations, estimated reliability, and examined validity by regressing overall ratings and willingness to recommend care on each composite. Results: The overall survey response rate was 36%. Confirmatory factor analyses supported five composite quality measures: Communication, Care Coordination, Help for Symptoms, Planning for Care, and Support for Family and Friends. Cronbach's alpha estimates for the composite measures ranged from 0.69 to 0.85, indicating adequate internal consistency in assessing their underlying constructs. Interprogram reliability ranged from 0.67 to 0.80 at 100 completed surveys per measure, meeting common standards for distinguishing between programs' performance. Together, the composites explained 45% of the variance in patients' overall care ratings. Communication, Care Coordination, and Planning for Care were the strongest predictors of overall ratings. Conclusion: Our analyses provide evidence of the feasibility, reliability, and validity of proposed survey-based measures to assess the quality of home-based serious illness care from the perspective of patients and their families.

Targeting AURKA by microRNA-490-3p suppresses gastric cancer cell growth.

OBJECTIVE: To illustrate the molecular mechanism of microRNA-490-3p regulating gastric cancer (GC) cells by targeting AURKA. METHODS: Genes with significantly different expression in GC and normal tissue in TCGA-STAD dataset were analyzed by bioinformatics. Expression levels of genes and proteins in GC cells were measured by qRT-PCR and western blot. The interaction between microRNA-490-3p and AURKA was verified by dual luciferase assay. Proliferation, migration, invasion and apoptosis of GC cells were evaluated through a set of cell function assays. RESULTS: MicroRNA-490-3p was significantly less expressed in GC, while AURKA was significantly highly expressed. Dual luciferase reporter gene assay proved that microRNA-490-3p targeted AURKA. Up-regulation of microRNA-490-3p restrained proliferation, migration, invasion and stimulated apoptosis of GC cells, which was attenuated by overexpression of AURKA. CONCLUSIONS: MicroRNA-490-3p was likely to restrain the development of GC cells by inhibiting AURKA, and it may be an underlying target for GC treatment.

Drum-Assisted Recovery Therapy for Native Americans (DARTNA): Results from a feasibility randomized controlled trial.

Alcohol and other drug (AOD) use among American Indians and Alaska Natives (AI/ANs) is a significant health issue in the United States. However, few evidence-based substance use interventions that utilize AI/AN traditional practices, such as drumming, exist. The current study is a feasibility randomized controlled trial (RCT) analyzing the potential benefits of DARTNA (Drum-Assisted Recovery Therapy for Native Americans) among 63 AI/AN adults seeking substance use treatment within an urban area in southern California. We compared DARTNA participants to usual care plus, which involved an integrated multimedia health educational program and usual care from providers for AOD use. At end of treatment, DARTNA participants reported significantly lower cognitive impairment and lower counts of physical ailments. Given that this was a feasibility trial, we also used Cohen's d = 0.20 or odds ratio = 2 or 0.5 to determine clinical significance. At end of treatment, we found promising benefits for DARTNA participants related to better physical health, fewer drinks per day, and lower odds of marijuana use in the past 30 days compared to the control group. Using these criteria, at 3-month follow-up, DARTNA participants reported less adoption of 12-step principles, less cognitive impairment, and lower anxiety with relationships. However, DARTNA participants reported more drinks per day and more cigarettes compared to the control group. Overall, this study demonstrates feasibility of conducting an RCT with AI/AN people in urban settings and highlights how a substance use treatment intervention utilizing drumming may help to meet the diverse needs of AI/AN people seeking substance use treatment.

Mental Health, Physical Health, and Cultural Characteristics Among American Indians/Alaska Natives Seeking Substance Use Treatment in an Urban Setting: A Descriptive Study.

Although approximately 70% of American Indians/Alaska Natives (AI/ANs) reside in urban areas, our knowledge of risk and protective factors among AI/ANs seeking substance use treatment within urban areas is limited. We analyze substance and commercialized cigarette use, AI/AN cultural identity and involvement, physical health and cognitive functioning, and mental health symptoms among 63 AI/AN adults seeking substance use treatment within an urban area in California. Alcohol (37%), marijuana (27%), and methamphetamine (22%) were the most commonly reported substances. Sixty-two percent used commercialized tobacco use. The majority of AI/AN adults (78%) engaged in at least one traditional practice during the past month and endorsed high levels of spiritual connectedness. Those who engaged in traditional practices demonstrated significantly less depression (p = 0.007) and anxiety (p = 0.04). Medical and mental health issues were not prominent, although participants revealed high levels of cognitive impairment. Results highlight the importance of utilizing AI/AN traditional practices for AI/AN adults seeking substance use treatment within urban areas. Clinical Trials Registry Number NCT01356667.

Improvements in Neighborhood Socioeconomic Conditions May Improve Resident Diet.

Neighborhood socioeconomic conditions (NSECs) are associated with resident diet, but most research has been cross-sectional. We capitalized on a natural experiment in Pittsburgh, Pennsylvania, in which 1 neighborhood experienced substantial investments and a sociodemographically similar neighborhood that did not, to examine pathways from neighborhood investments to changed NSECs and changed dietary behavior. We examined differences between renters and homeowners. Data were from a random sample of households (n = 831) in each of these low-income Pittsburgh neighborhoods that were surveyed in 2011 and 2014. Structural equation modeling tested direct and indirect pathways from neighborhood to resident dietary quality, adjusting for individual-level sociodemographics, with multigroup testing by homeowners versus renters. Neighborhood investments were directly associated with improved dietary quality for renters (ß = 0.27, 95% confidence interval (CI): 0.05, 0.50) and homeowners (ß = 0.51, 95% CI: 0.10, 0.92). Among renters, investments also were associated with dietary quality through a positive association with commercial prices (ß = 0.34, 95% CI: 0.15, 0.54) and a negative association with residential prices (ß = -0.30, 95% CI: -0.59, -0.004). Among homeowners, we did not observe any indirect pathways from investments to dietary quality through tested mediators. Investing in neighborhoods may support resident diet through improvements in neighborhood commercial environments for renters, but mechanisms appear to differ for homeowners.

LncRNA BLACAT1/miR-519d-3p/CREB1 Axis Mediates Proliferation, Apoptosis, Migration, Invasion, and Drug-Resistance in Colorectal Cancer Progression.

BACKGROUND: Colorectal cancer (CRC) is a common severe disease around the world. The merging papers reported that long noncoding RNAs (lncRNAs) took part in the diversified pathological processes of CRC. This study aimed to uncover the role and the potential mechanism of lncRNA bladder cancer-associated transcript 1 (BLACAT1) in CRC progression. METHODS: LncRNA BLACAT1, micro-519d-3p (miR-519d-3p), and cAMP-responsive element binding protein 1 (CREB1) levels were detected by quantitative real-time polymerase chain reaction (qRT-PCR) in CRC tissues and cells. The bio-functional effects were examined by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT), flow cytometry assay, and transwell assay. The susceptibility testing was determined by oxaliplatin (OXA) administration. The potential binding sites between miR-519d-3p and BLACAT1 or CREB1 were predicted by online software starBase and confirmed by dual-luciferase reporter analysis. The relative proteins expression in CRC cells was determined by Western blot analysis. Xenograft tumor model was used to evaluate biological function of BLACAT1 in vivo. RESULTS: The expression of BLACAT1 was promoted in CRC tissues and cells, and correlated to the TNM (tumor, node, metastasis) stage, distant metastasis, and overall survival rate. Silencing of BLACAT1 limited the proliferation, migration, and invasion, facilitated the apoptosis, and re-sensitized OXA-resistance in CRC cells. MiR-519d-3p was a target of BLACAT1. Furthermore, miR-519d-3p deletion reversed the positive effects of BLACAT1 deletion on CRC cells. Moreover, our data showed that miR-519d-3p directly targeted CREB1 and BLACAT1 sponged miR-519d-3p to regulate CREB1 expression. Besides, CREB1 disrupted the bio-functional results above from BLACAT1 suppression. Additionally, BLACAT1 knockdown promoted CRC cells sensitivity to OXA in vivo. CONCLUSION: BLACAT1 mediated the progression of CRC and OXA-resistance by miR-519d-3p/CREB1 axis.

Youth Perceptions of Parental Involvement and Monitoring, Discrepancies With Parental Perceptions, and Their Associations With First Cigarette Use in Black and White Girls.

OBJECTIVE: Low parental involvement and monitoring are risk factors for adolescent cigarette use. Assessments of parental involvement and monitoring by youth and parents may capture an additional source of risk: differences in perceptions of these parenting behaviors. This study tested for unique contributions of youth-reported parental involvement and monitoring and youth-parent discrepancies in reporting to first cigarette use in girls. METHOD: Data were drawn from interviews at ages 8-17 with 1,869 girls (57.3% Black, 42.7% White) and their primary caregivers (94% mothers) in the Pittsburgh Girls Study. Cox proportional hazards regression analyses were conducted to predict first cigarette use as a function of girls' reports of parental involvement and monitoring, magnitude and direction of youth-parent reporting discrepancies, and the interaction between them, adjusting for neighborhood, socioeconomic, and individual level factors. RESULTS: High magnitude of discrepancy in parental involvement reports (hazard ratio [HR] = 1.14, 95% confidence interval [CI] [1.03, 1.26]) and lower perceived parental involvement by girls (HR = 1.14, CI [1.03, 1.27]) were associated with an elevated risk for first cigarette use. Girls' reports of low parental monitoring also predicted first cigarette use (HR = 1.14, CI [1.06, 1.21]). CONCLUSIONS: Girls whose parents have limited awareness of their whereabouts and friends (i.e., low monitoring) are at an elevated risk for trying cigarettes, but parent-daughter differences in perceived awareness do not affect risk. By contrast, girls who perceive a lower degree of parental involvement than their parents do are at increased risk. Monitoring is one component of parenting that may reduce smoking risk; shared perspectives on the parent's level of involvement are similarly important.

Classroom Quality and Adolescent Student Engagement and Performance in Mathematics: A Multi-Method and Multi-Informant Approach.

Mathematics learning, engagement, and performance are facilitated by quality interactions within the classroom environment. Researchers studying high-quality interactions in mathematics classrooms must consider adopting multiple methods of data collection so as to capture classroom quality from all perspectives. As such, this longitudinal study examined student, teacher, and observer perspectives of interaction quality in mathematics classrooms and their predictive associations with mathematics outcomes. Data were collected during the fall and spring semesters of the 2015-2016 school year from 1501 students in 150 mathematics classes (n = 499 fifth graders, 523 seventh graders, 479 ninth graders; 51% female; 51% European American, 30% African American, and 19% other ethnic background; 52% qualifying for free/reduced price lunch). Observer and aggregated student reports of interaction quality at the classroom level were moderately correlated with one another, and these reports predicted student mathematics engagement and performance. Individual student reports of interaction quality also predicted math engagement and performance; yet, teacher reports of interaction quality did not align with student or observer perspectives. Furthermore, teacher reports did not predict student mathematics outcomes. Implications for research, practice, and policy are discussed.

Relational Peer Victimization Interacts With Depression Severity to Predict the Timing of Alcohol Use Initiation in Adolescent Girls.

BACKGROUND: Peer victimization is consistently linked to adolescents' alcohol use. However, the relative influence of relational and physical peer victimization on alcohol use, and timing of drinking initiation, is not well understood. In this study, we evaluate the impact of both relational and physical peer victimization on adolescent girls' alcohol use initiation, and the extent to which depression severity moderates these associations. METHODS: Participants were 2,125 girls in the Pittsburgh Girls Study, a longitudinal community-based study. Participants reported experiences of relational and physical peer victimization, depression severity, and alcohol use each year from ages 10 to 17. Cox proportional hazards (PH) regression analyses predicting the timing of first drink were conducted in 2 stages, testing for main effects of peer victimization in Model 1 and moderation by depression severity in Model 2. RESULTS: Analyses were split at age 14 to adjust for PH violations. Model 1 results supported a main effect for relational (Hazards ratio [HR] = 1.83, CI: 1.46 to 2.28 ≤ age 13; HR = 1.23, CI: 1.05 to 1.45 ≥ age 14) but not physical victimization on timing of alcohol use onset (HR = 1.10, CI: 0.88 to 1.39). Model 2 results show that depression severity moderates the association between relational victimization and alcohol use initiation: the association between relational victimization and early alcohol use onset was stronger for lower depression severity (-1 SD HR = 2.38, CI: 1.68 to 3.39 ≤ age 13; -1 SD HR = 1.48, CI: 1.10 to 1.52 ≥ age 14). CONCLUSIONS: Results demonstrate that relational (and not physical) victimization predicts earlier drinking among adolescent girls. Relational peer victimization conferred greater risk for alcohol use initiation when depression severity was lower, whereas girls with high depression severity engaged in early alcohol use regardless of peer victimization. Results suggest that interventions focused on relational peer victimization may have spillover effects for delaying girls' alcohol use initiation, particularly in early adolescence, when this association is most robust.

Integration of Palliative Care and Infection Management at the End of Life in U.S. Nursing Homes.

CONTEXT: Infections in nursing home (NH) residents are often terminal illnesses. Integration of palliative care (PC) and infection management (IM) is a new concept that can help reduce burdensome treatments and improve quality of care for NH residents at the end of life. OBJECTIVES: To develop measures of integration, describe the integration in U.S. NHs, and examine predictors of integration. METHODS: A nationally representative sample of NHs was surveyed. An instrument to measure integration was tested using factor analyses. Descriptive analyses of each integration factor were conducted, construct validity was examined using correlations between the integration factors and validated measures of PC and IM, and multivariable linear regression models were developed to identify NH characteristics associated with integration. RESULTS: A total of 892 NH surveys were returned (49% response rate), 859 with complete data. Three integration factors were identified: patient involvement in care planning (Involvement), formalized advance care planning (Advance Care Planning), and routine practices of integration (Routine Practices). The highest level of integration in NHs was reported for Involvement (mean (µ) = 73.2, standard error [SE] = 1.57), with lower rates for Advance Care Planning and Routine Practices (respectively, µ = 34.1, SE = 1.05; µ = 31.4, SE = 1.48). Each integration measure was weakly, positively associated with the PC and IM measures (r ≤ 0.25, P ≤ 0.01). There were few associations between NH characteristics and integration. CONCLUSION: Integration is a distinct concept that is associated with, but different from, PC and IM. Results serve as a baseline assessment of integration in NHs. Continued refinement of the integration instrument is recommended, as is studying if higher integration leads to better resident outcomes.

Psychometric evaluation of the Medicare Advantage and prescription drug plan disenrollment reasons survey.

OBJECTIVES: To develop and assess the reliability and validity of composite measures of reasons for disenrollment from Medicare Advantage (MA) and prescription drug plans (PDPs). DATA SOURCE: Medicare beneficiaries who responded to the Medicare Advantage and Prescription Drug Plan Disenrollment Reasons Survey. STUDY DESIGN: Separate multilevel factor analyses of MA and PDP data suggested groupings of survey items to form composite measures, for which internal consistency and interunit reliability were estimated. The association of each composite with an overall plan rating was examined to evaluate criterion validity. PRINCIPAL FINDINGS: Five composites were identified: financial reasons for disenrollment; problems with prescription drug benefits and coverage; problems getting information and help from the plan; problems getting needed care, coverage, and cost information; and problems with coverage of doctors and hospitals. Beneficiary-level internal consistency reliability exceeded 0.70 for all but one composite (financial reasons); plan-level internal consistency reliability exceeded 0.80 for all composites; average interunit reliability for plans with ≥ 30 survey completes exceeded 0.75 for 3 of 5 composites. As expected, greater endorsement of reasons for disenrollment was associated with lower overall plan ratings. CONCLUSIONS: The Disenrollment Reasons Survey provides a reliable and valid assessment of beneficiaries' reasons for leaving their plans. Multiple reasons for disenrollment may indicate especially poor experiences.

A Comparison of Multilevel Mediation Modeling Methods: Recommendations for Applied Researchers.

Multilevel structural equation modeling (MSEM) has been proposed as a valuable tool for estimating mediation in multilevel data and has known advantages over traditional multilevel modeling, including conflated and unconflated techniques (CMM & UMM). Recent methodological research has focused on comparing the three methods for 2-1-1 designs, but in regards to 1-1-1 mediation designs, there are significant gaps in the published literature that prevent applied researchers from making educated decisions regarding which model to employ in their own specific research design. A Monte Carlo study was performed to compare MSEM, UMM, and CMM on relative bias, confidence interval coverage, Type I Error, and power in a 1-1-1 model with random slopes under varying data conditions. Recommendations for applied researchers are discussed and an empirical example provides context for the three methods.

Racial disparities in the transgenerational transmission of low birthweight risk.

Objective: To examine the association of maternal low birthweight (LBW) with infant LBW and infant LBW subgroups (i.e. moderate and very LBW), overall and among non-Hispanic (NH) white and NH black mothers. Design: We conducted a population-based cohort study in Allegheny County, Pennsylvania, using linked birth record data of NH white and NH black mother-infant pairs (N = 6,633) born in 1979-1998 and 2009-2011, respectively. The exposure of interest was maternal LBW (birthweight <2500 grams) while the outcomes were infant LBW and LBW subgroups - moderate LBW (1,500-2,499 grams) or very LBW (<1,500 grams). Logistic regression (binomial and multinomial) models were used to estimate adjusted Odds Ratios (ORs), Relative Risk Ratios (RRRs), and related 95% confidence intervals (CI). Stratified analyses were conducted to assess effect modification by mothers' race. Results: Maternal LBW was associated with 1.53 (95%CI: 1.15-2.02) and 1.75 (95%CI: 1.29-2.37) -fold increases in risk of infant LBW and MLBW, respectively, but not VLBW (RRR = 0.86; 95%CI: 0.44-1.70). In race-stratified models, maternal LBW-infant LBW associations were observed among NH blacks (OR = 1.88; 95%CI: 1.32-2.66) and not among NH whites (OR = 1.03; 95%CI: 0.62-1.73) (P for interaction = 0.07). Among NH blacks, maternal LBW was associated with a 2.18 (95%CI: 1.49, 3.20) -fold increase in risk of infant MLBW, but not VLBW (RRR = 1.12; 95%CI: 0.54, 2.35). Among NH whites, LBW subgroup analyses could not be performed due to small numbers of VLBW infants among LBW mothers. Conclusion: Mothers who were LBW at their own birth were more likely to have MLBW infants. Maternal race modified associations of maternal LBW with infant LBW, particularly infant MLBW. Further research is needed in this area to understand the potential mechanisms involved in the transgenerational transmission of LBW risk and race-specific differences in the transmission.

Longitudinal Reciprocal Associations Between Anxiety, Depression, and Alcohol Use in Adolescent Girls.

BACKGROUND: Depression, anxiety, and alcohol misuse predict adverse social, academic, and emotional outcomes, and their relations to one another increase during adolescence-particularly in girls. However, evidence on the directions of these relations is mixed. Longitudinal models of internalizing problem-alcohol use links may identify promising prevention targets. Accordingly, we examined reciprocal associations between anxiety severity and alcohol use, as well as between depression severity and alcohol use, in adolescent girls. METHODS: Data were drawn from a population-based longitudinal study of female adolescents. The current sample comprised 2,100 participants (57.1% Black, 42.9% White) assessed annually between ages 13 and 17. Girls self-reported depression severity, anxiety severity, and frequency of alcohol use (consumption of ≥1 full drink) in the past year. Primary caregivers reported on socioeconomic and neighborhood factors; these were included with race, early puberty, and conduct problems (youth-report) as covariates. Anxiety and depression severity were included within a single cross-lagged panel model, along with alcohol use, to isolate their independent and reciprocal links to drinking behavior. RESULTS: Higher depression severity modestly predicted increased likelihood of subsequent alcohol use from ages 13 to 17. However, inconsistent relations emerged for the reverse pathway: Alcohol use modestly predicted decreased depression severity at ages 14 and 16; associations were nonsignificant in other lagged associations. Anxiety severity and alcohol use were not consistently associated. CONCLUSIONS: Results highlight the key role of depression, relative to anxiety, in predicting later alcohol use. Future studies may examine whether depression prevention programs yield secondary reductions in alcohol use in adolescent girls.

Strengthening College Students' Mental Health Knowledge, Awareness, and Helping Behaviors: The Impact of Active Minds, a Peer Mental Health Organization.

OBJECTIVE: To examine the relationship between college students' familiarity with and involvement in Active Minds, a student peer organization focused on increasing mental health awareness, decreasing stigma, and affecting mental health knowledge, attitudes, and behaviors. METHOD: Students (N = 1,129) across 12 California colleges completed three waves of a web-based survey during the 2016-2017 academic year to assess familiarity with and involvement in Active Minds and mental health attitudes, behaviors, and perceived knowledge. Fixed-effects models assessed relations between changes in organization familiarity and involvement and changes in mental health-related outcomes over time overall and stratified by students' baseline engagement (ie, familiarity/involvement) with Active Minds. RESULTS: Overall, increased familiarity with Active Minds was associated with increases in perceived knowledge (0.40; p < .001) and decreases in stigma over time (-0.33; p < .001). Increased involvement was associated with increases in perceived knowledge (0.40; p < .001) and a range of helping behaviors. Associations differed by students' baseline engagement with Active Minds. For students with low engagement, increased familiarity with Active Minds was associated with decreased stigma and improved perceived knowledge. For students with moderate baseline engagement, increasing involvement with Active Minds was associated with increases in helping behaviors (eg, providing emotional support, connecting others to services) over time. CONCLUSION: Student peer organizations' activities can improve college student mental health attitudes and perceived knowledge and significantly increase helping behaviors. Such organizations can complement more traditional programs and play an important role in improving the campus climate with respect to mental health.