Alcohol use and cognitive aging in middle-aged men: The Vietnam Era Twin Study of Aging.

OBJECTIVE: To determine associations of alcohol use with cognitive aging among middle-aged men. METHOD: 1,608 male twins (mean 57 years at baseline) participated in up to three visits over 12 years, from 2003-2007 to 2016-2019. Participants were classified into six groups based on current and past self-reported alcohol use: lifetime abstainers, former drinkers, very light (1-4 drinks in past 14 days), light (5-14 drinks), moderate (15-28 drinks), and at-risk drinkers (>28 drinks in past 14 days). Linear mixed-effects regressions modeled cognitive trajectories by alcohol group, with time-based models evaluating rate of decline as a function of baseline alcohol use, and age-based models evaluating age-related differences in performance by current alcohol use. Analyses used standardized cognitive domain factor scores and adjusted for sociodemographic and health-related factors. RESULTS: Performance decreased over time in all domains. Relative to very light drinkers, former drinkers showed worse verbal fluency performance, by -0.21 SD (95% CI -0.35, -0.07), and at-risk drinkers showed faster working memory decline, by 0.14 SD (95% CI 0.02, -0.20) per decade. There was no evidence of protective associations of light/moderate drinking on rate of decline. In age-based models, light drinkers displayed better memory performance at advanced ages than very light drinkers (+0.14 SD; 95% CI 0.02, 0.20 per 10-years older age); likely attributable to residual confounding or reverse association. CONCLUSIONS: Alcohol consumption showed minimal associations with cognitive aging among middle-aged men. Stronger associations of alcohol with cognitive aging may become apparent at older ages, when cognitive abilities decline more rapidly.

Heart Rate Responses of High School Students Participating in Surfing Physical Education.

Despite the nation's rising epidemic of childhood obesity and diabetes, schools struggle to promote physical activities that help reduce risks for cardiovascular disease. Emerging data suggest that adopting novel activities into physical education (PE) curriculum may serve as an effective strategy for increasing physical activity in children. The purpose of this investigation was to characterize activity in the water and heart rates (HRs) of high school students participating in surf PE courses. Twenty-four male (n = 20) and female (n = 4) high school students (mean age = 16.7 ± 1.0 years) who were enrolled in surf PE courses at 2 high schools participated in this investigation. Daily measurements of surfing durations, average HR, and maximum HR were made on the students with HR monitors (PolarFT1) over an 8-week period. In addition, HR and activity in the water was evaluated during a single session in a subset of students (n = 11) using a HR monitor (PolarRCX5) and a video camera (Canon HD). Activity and HR were synchronized and evaluated in 5-second intervals during data analyses. The average duration that PE students participated in surfing during class was 61.7 ± 1.0 minutes. Stationary, paddling, wave riding, and miscellaneous activities comprised 42.7 ± 9.5, 36.7 ± 7.9, 2.9 ± 1.4, and 17.8 ± 11.4 percent of the surf session, respectively. The average and maximum HRs during these activities were 131.1 ± 0.9 and 177.2 ± 1.0 b·min, respectively. These data suggest that high school students participating in surf PE attained HRs and durations that are consistent with recommendations with cardiovascular fitness and health. In the future, PE programs should consider incorporating other action sports into their curriculum to enhance cardiovascular health.

Social Anxiety and Onset of Drinking in Early Adolescence.

The present study examines several types of social anxiety that may be associated with the onset of alcohol use in middle school students, and whether the relationship differs by sex and grade. Students in the seventh and eighth grades (N = 2621) completed the Social Anxiety Scale for Adolescents and a measure of lifetime drinking via school-wide surveys. Distinct aspects of social anxiety were associated with higher and lower rates of onset of alcohol use. A high level of fear of negative evaluation was associated with drinking initiation in boys and girls, while girls who reported no social anxiety or distress in new situations were more likely than other groups to have started drinking by early adolescence. Youth with either very low or very high levels of generalized anxiety had higher rates of drinking than youth with scores in between. These findings suggest that the relationship between social anxiety and initiation of alcohol use is complex and varies by type of anxiety symptomatology.

Explanations for the Cloudy Evidence That Theory Benefits Health Promotion.

Persuasive arguments for using theory have been influential in health behavior and health promotion research. The use of theory is expected to improve intervention outcomes and facilitate scientific advancement. However, current empirical evaluations of the benefits of theory have not consistently demonstrated strong effects. A lack of resolution on this matter can be attributed to several features of the current body of evidence. First, the use of theory may be confounded with other features that impact health-related outcomes. Second, measurement of theory use has not been reliable. Third, the field conflates models and theories. Lastly, the evidentiary status and applicability of theories are not considered. Addressing these challenges during the execution of meta-analyses and designing original research specifically to estimate the benefits of theory could improve research and practice.

Specification curve analysis shows that social media use is linked to poor mental health, especially among girls.

An important 2019 paper applied a novel analytic technique called Specification Curve Analysis (SCA) to data from three large-scale community samples to investigate the association between adolescent technology use and mental health/well-being. The paper concluded that an association exists but is tiny, with median betas between -0.01 and -0.04. This association was reported to be smaller than links between mental health and various innocuous variables in the datasets such as eating potatoes, and therefore to be of no practical significance. The current paper re-ran SCA on the same datasets while applying alternative analytic constraints on the model specification space, including: 1) examining specific digital media activities (e.g., social media) separately rather than lumping all "screen time" including TV together; 2) examining boys and girls separately, rather than examining them together; 3) excluding potential mediators from the list of controls; and 4) treating scales equally (rather than allowing one scale with many subscales to dominate all others). We were able to reproduce the original results with the original configurations. When we used the revised constraints, we found several much larger relationships than previously reported. In particular: among girls, there is a consistent and substantial association between mental health and social media use (median betas from -0.11 to -0.24). These associations were stronger than links between mental health and binge drinking, sexual assault, obesity, and hard drug use, suggesting that these associations may have substantial practical significance as many countries are experiencing rising rates of depression, anxiety, and suicide among teenagers and young adults.

Comparison of factor analysis models applied to the NCANDA neuropsychological test battery.

The factor structure of neuropsychological functioning among a large sample (N = 831) of American youth (ages 12-21 at baseline) was investigated in order to identify an optimal model. Candidate models were selected based on their potential to provide service to the study of adolescent development and the effects of heavy episodic alcohol consumption. Data on neuropsychological functioning were obtained from the NCANDA study. This is a longitudinal community study of the effects of alcohol exposure on neurodevelopment. Three conceptually motivated and one empirically motivated factor analysis model of neuropsychological domains were compared based on penalized-likelihood selection criteria and model fit statistics. Two conceptually-motivated models were found to have adequate fit and pattern invariance to function as a measurement model for the Penn Computerized Neurocognitive Battery (Penn CNB) anchored neuropsychological battery in NCANDA. Corroboration of previous factor analysis models was obtained, in addition to the identification of an alternative factor model that has higher discriminant capacity for neuropsychological domains hypothesized to be most sensitive to alcohol exposure in human adolescents. The findings support the use of a factor model developed originally for the Penn CNB and a model developed specifically for the NCANDA project. The NCANDA 8-Factor Model has conceptual and empirical advantages that were identified in the current and prior studies. These advantages are particularly valuable when applied in alcohol research settings.

Moderate Alcohol Use Is Associated with Reduced Cardiovascular Risk in Middle-Aged Men Independent of Health, Behavior, Psychosocial, and Earlier Life Factors.

We examined whether the often-reported protective association of alcohol with cardiovascular disease (CVD) risk could arise from confounding. Our sample comprised 908 men (56−67 years), free of prevalent CVD. Participants were categorized into 6 groups: never drinkers, former drinkers, and very light (1−4 drinks in past 14 days), light (5−14 drinks), moderate (15−28 drinks), and at-risk (>28 drinks) drinkers. Generalized linear mixed effect models examined the associations of alcohol use with three established CVD risk scores: The Framingham Risk Score (FRS); the atherosclerotic CVD (ASCVD) risk score; and the Metabolic Syndrome (MetS) Severity score, adjusting for group differences in demographics, body size, and health-related behaviors. In separate models we additionally adjusted for several groups of potentially explanatory factors including socioeconomic status, social support, physical and mental health status, childhood factors, and prior history of alcohol misuse. Results showed lower CVD risk among light and moderate alcohol drinkers, relative to very light drinkers, for all CVD risk scores, independent of demographics, body size, and health-related behaviors. Alcohol-CVD risk associations were robust to further adjustment for several groups of potential explanatory factors. Study limitations include the all-male sample with limited racial and ethnic diversity, and the inability to adjust for sugar consumption and for patterns of alcohol consumption. Although this observational study does not address causation, results show that middle-aged men who consume alcohol in moderation have lower CVD risk and better cardiometabolic health than men who consume little or no alcohol, independent of a variety of health, behavioral, psychosocial, and earlier life factors.

Neuropsychological functioning and outcomes of treatment for co-occurring depression and substance use disorders.

BACKGROUND: We previously published findings from our clinical trial comparing treatment outcomes for substance-dependent veterans with co-occurring depression who received Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation (TSF) Therapy. OBJECTIVES: This study is a secondary analysis that examined whether neuropsychological functioning at baseline moderated substance use and depression outcomes in ICBT relative to TSF. METHODS: This study was a randomized clinical trial in which 164 veterans with major depressive disorder and comorbid alcohol, cannabinol, and/or stimulant dependence were randomly assigned to either ICBT or TSF group therapy. A comprehensive neuropsychological test battery was administered at baseline. RESULTS: Contrary to our hypothesis, participants with poor neuropsychological functioning had better substance use outcome in ICBT than in TSF, whereas participants with good neuropsychological functioning had comparable substance use outcomes in TSF and ICBT by 18-month follow-up. Depression outcomes, in contrast, were not moderated by neuropsychological functioning by 18-month follow-up. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The substance use outcomes may suggest that substance-dependent depressed adults with poorer neuropsychological functioning should be offered ICBT over TSF. These individuals may be less able to develop and use novel coping skills for managing substance use and depressive symptoms on their own without formal structured training in cognitive and behavioral skills provided in ICBT.

Acceptability, Validity, and Engagement With a Mobile App for Frequent, Continuous Multiyear Assessment of Youth Health Behaviors (mNCANDA): Mixed Methods Study.

BACKGROUND: Longitudinal studies of many health behaviors often rely on infrequent self-report assessments. The measurement of psychoactive substance use among youth is expected to improve with more frequent mobile assessments, which can reduce recall bias. Researchers have used mobile devices for longitudinal research, but studies that last years and assess youth continuously at a fine-grained, temporal level (eg, weekly) are rare. A tailored mobile app (mNCANDA [mobile National Consortium on Alcohol and Neurodevelopment in Adolescence]) and a brief assessment protocol were designed specifically to provide a feasible platform to elicit responses to health behavior assessments in longitudinal studies, including NCANDA (National Consortium on Alcohol and Neurodevelopment in Adolescence). OBJECTIVE: This study aimed to determine whether an acceptable mobile app system could provide repeatable and valid assessment of youth's health behaviors in different developmental stages over extended follow-up. METHODS: Participants were recruited (n=534; aged 17-28 years) from a larger longitudinal study of neurodevelopment. Participants used mNCANDA to register reports of their behaviors for up to 18 months. Response rates as a function of time measured using mNCANDA and participant age were modeled using generalized estimating equations to evaluate response rate stability and age effects. Substance use reports captured using mNCANDA were compared with responses from standardized interviews to assess concurrent validity. Reactivity was assessed by evaluating patterns of change in substance use after participants initiated weekly reports via mNCANDA. Quantitative feedback about the app was obtained from the participants. Qualitative interviews were conducted with a subset of participants who used the app for at least one month to obtain feedback on user experience, user-derived explanations of some quantitative results, and suggestions for system improvements. RESULTS: The mNCANDA protocol adherence was high (mean response rate 82%, SD 27%) and stable over time across all age groups. The median time to complete each assessment was 51 s (mean response time 1.14, SD 1.03 min). Comparisons between mNCANDA and interview self-reports on recent (previous 30 days) alcohol and cannabis use days demonstrate close agreement (eg, within 1 day of reported use) for most observations. Models used to identify reactivity failed to detect changes in substance use patterns subsequent to enrolling in mNCANDA app assessments (P>.39). Most participants (64/76, 84%) across the age range reported finding the mNCANDA system acceptable. Participants provided recommendations for improving the system (eg, tailoring signaling times). CONCLUSIONS: mNCANDA provides a feasible, multi-year, continuous, fine-grained (eg, weekly) assessment of health behaviors designed to minimize respondent burden and provides acceptable regimes for long-term self-reporting of health behaviors. Fine-grained characterization of variability in behaviors over relatively long periods (eg, up to 18 months) may, through the use of mNCANDA, improve our understanding of the relationship between substance use exposure and neurocognitive development.

Farewell to Bright-Line: A Guide to Reporting Quantitative Results Without the S-Word.

Recent calls to end the practice of categorizing findings based on statistical significance have focused on what not to do. Practitioners who subscribe to the conceptual basis behind these calls may be unaccustomed to presenting results in the nuanced and integrative manner that has been recommended as an alternative. This alternative is often presented as a vague proposal. Here, we provide practical guidance and examples for adopting a research evaluation posture and communication style that operates without bright-line significance testing. Characteristics of the structure of results communications that are based on conventional significance testing are presented. Guidelines for writing results without the use of bright-line significance testing are then provided. Examples of conventional styles for communicating results are presented. These examples are then modified to conform to recent recommendations. These examples demonstrate that basic modifications to written scientific communications can increase the information content of scientific reports without a loss of rigor. The adoption of alternative approaches to results presentations can help researchers comply with multiple recommendations and standards for the communication and reporting of statistics in the psychological sciences.

Alcohol Expectancies Moderate the Association Between School Connectedness and Alcohol Consumption.

BACKGROUND: In this study, we investigate the moderated association of school connectedness and alcohol expectancies with adolescent drinking. METHODS: Two large community samples were obtained with 2 repeated attempted censuses of all students attending a large suburban school district. Participants completed a self-administered questionnaire that assessed substance use, alcohol expectancies, and school connectedness. We used logistic regression analyses on the training sample and confirmed with Bayesian test intervals with the test sample. RESULTS: Party related alcohol expectancies and school connectedness interacted in their explanatory association with recent drinking and binging, such that school connectedness had a protective association only for youth with lower positive expectancies. These findings were the result of pre-planned exploratory analysis, which were confirmed with out-of-sample test data. CONCLUSIONS: The potential benefits for student health behaviors resulting from improved school connectedness may be dependent on at least one dimension of alcohol expectancies, at the individual level.

Sex-specific association of fetuin-A with type 2 diabetes in older community-dwelling adults: the Rancho Bernardo study.

OBJECTIVE: This study evaluated the sex-specific association of plasma fetuin-A levels with prevalent and incident type 2 diabetes in community-dwelling older adults. RESEARCH DESIGN AND METHODS: Participants were 684 men and 1,058 women (median age, 71 years) whose fetuin-A levels, diabetes prevalence, and diabetes risk factors were evaluated in 1992-1996. The participants were followed for incident diabetes through 2010 (median follow-up, 9 years). RESULTS: Women with impaired glucose tolerance had elevated fetuin-A levels compared with women with normal glucose tolerance (P = 0.019), but fetuin-A levels were not elevated in women with impaired fasting glucose. Fetuin-A did not vary by glucose tolerance status in men. There were significant interactions of fetuin-A by sex for prevalent (P = 0.007) and incident (P = 0.020) diabetes. For women, each SD (0.10 g/L) higher fetuin-A level was associated with a higher odds of prevalent diabetes (odds ratio [OR] 1.79, 95% CI 1.47-2.17) and greater risk of incident diabetes (hazard ratio [HR] 1.66, 95% CI 1.18-2.34), adjusting for age and estrogen therapy. These associations were not materially altered by adjustment for diabetes risk factors but were attenuated by adjusting for postchallenge glucose levels. Among men, although positive associations with prevalent (OR 1.15 [0.94-1.41]) and incident (HR 1.24 [0.93-1.65]) diabetes were suggested in age-adjusted models, risk estimates attenuated to one after multivariable adjustment. CONCLUSIONS: Higher fetuin-A concentrations were independently associated with an increased risk of developing type 2 diabetes in older women but were not related to diabetes risk in older men. Fetuin-A may provide novel insights into mechanisms underlying sex differences in glucose homeostasis and diabetes risk in old age.

Kidney function and progression of coronary artery calcium in community-dwelling older adults (from the Rancho Bernardo Study).

Longitudinal studies of the association of estimated glomerular filtration rate (eGFR) and albuminuria with coronary artery calcium (CAC), a measure of cardiovascular disease burden, are few and contradictory. In this study, 421 community-dwelling men and women (mean age 67 years) without known heart disease had eGFRs assessed using the Modification of Diet in Renal Disease (MDRD) equation and albuminuria assessed by urine albumin/creatinine ratio (ACR) from 1997 to 1999. The mean eGFR was 78 ml/min/1.73 m(2), and the median ACR was 10 mg/g. CAC was measured using electron-beam computed tomography from 2000 to 2001, when the median total Agatston CAC score was 77; 4.5 years later, 338 participants still without heart disease underwent repeat scans (median CAC score 112); 46% of participants showed CAC progression, defined as an increase ≥2.5 mm(3) in square root-transformed CAC volume score. Cross-sectional and longitudinal logistic regression analyses showed no separate or joint association between eGFR or ACR and CAC severity or progression. In conclusion, this study does not support the use of eGFR or ACR to identify asymptomatic older adults who should be screened for subclinical cardiovascular disease with initial or sequential scanning for CAC. In the elderly, kidney function and CAC may not progress together.

The association of fetuin-A with cardiovascular disease mortality in older community-dwelling adults: the Rancho Bernardo study.

OBJECTIVES: The goal of this study was to evaluate the prospective association of fetuin-A levels with cardiovascular disease (CVD) mortality. BACKGROUND: Fetuin-A is a circulating inhibitor of calcium deposition in the vasculature and of insulin action in muscle and fat, and may be involved in the pathogenesis of CVD. METHODS: This is a population-based prospective study of 633 men and 1,025 women (median age = 73 years) who had fetuin-A levels and CVD risk factors evaluated in 1992 to 1996 and were followed for vital status through 2010. RESULTS: Plasma fetuin-A (g/l ± SD) was highest in women using oral estrogens (0.55 ± 0.12), intermediate for women not using oral estrogens (0.51 ± 0.10), and lowest for men (0.50 ± 0.10), p < 0.001. Lower fetuin-A levels were associated with older age, but with lower levels of other CVD risk factors including adiposity, blood pressure, lipids, triglycerides, and insulin resistance (all p < 0.01). During the median 12-year follow-up, 273 deaths were attributed to CVD. The association of fetuin-A with CVD mortality differed by diabetes status (p for interaction = 0.003). Adjusting for age, sex, oral estrogens, and lifestyle, the hazard ratio for CVD mortality comparing the lowest fetuin-A quartile with all higher values was 1.76 (95% confidence interval [CI]: 1.34 to 2.31; p < 0.001) for participants without diabetes and 0.43 (95% CI: 0.19 to 0.98; p = 0.046) for participants with diabetes. CONCLUSIONS: Low fetuin-A levels predicted greater risk for CVD mortality in older adults without diabetes, but were associated with reduced risk of CVD death in those with diabetes. Fetuin-A may provide novel insight into mechanisms leading to CVD death in those with versus without diabetes.

Alcohol and drug involvement after adolescent treatment and functioning during emerging adulthood.

This study identified patterns of alcohol and other drug (AOD) involvement during the decade following adolescent AOD treatment and developmental outcomes in emerging adulthood. AOD and psychosocial variables were assessed at eight time points from adolescence into adulthood (n=153; 41.2% women) in an inpatient treatment sample of alcohol and other drug dependent teens. Latent class growth analysis identified six trajectories based on alcohol and substance use frequency which were consistent with developmental transitions and validated by measures of dependency symptoms. While few differences were evident at intake, the educational, occupational and interpersonal attainments were differentially associated with the alcohol/drug trajectories as youth transitioned into adulthood. High rates of high school graduation (71.1%), professional occupations (45.2%), marriage/cohabitation (48.5%), and financial responsibility for children (F[5,27]=2.75, p=.02) were evident for those with the least alcohol and drug involvement. More severe drug use trajectories were associated with higher rates of dependence, incarceration and more treatment at the final period of assessment. Outcomes of the trajectory of frequent alcohol involvement were distinct from combined alcohol and drug use. These findings highlight the long-term diversity of substance use outcomes following adolescent treatment and suggest that identification of these patterns of use following treatment can help clarify the developmental impact of youth alcohol and drug use on outcomes in young adulthood.

Clinical outcomes of an integrated treatment for depression and substance use disorders.

The authors compared longitudinal treatment outcomes for depressed substance-dependent veterans (N = 206) assigned to integrated cognitive-behavioral therapy plus standard pharmacotherapy (ICBT + P) or 12-step facilitation therapy plus standard pharmacotherapy (TSF + P). Drug and alcohol involvement and depressive symptomology were measured at intake and at 3-month intervals during treatment and up to 1 year posttreatment. Participants in both treatment conditions showed decreased depression and substance use from intake. ICBT + P participants maintained improvements in substance involvement over time, whereas TSF + P participants had more rapid increases in use in the months following treatment. Decreases in depressive symptoms were more pronounced for TSF + P than ICBT + P in the 6 months posttreatment. Within both treatment groups, higher attendance was associated with improved substance use and depression outcomes over time. Initial levels of depressive symptomology had a complex predictive relationship with long-term depression outcomes. Early treatment response predicted long-term substance use outcomes for a portion of the sample. Although both treatments were associated with improvements in substance use and depression, ICBT + P may lead to more stable substance use reductions compared with TSF + P.