Medication Development For Aud: A Systematic Review Of Clinical Trial Methodology.

Refining clinical trial methodology has become increasingly important as study design is shown to influence treatment efficacy. To maximize the efficiency of randomized clinical trials (RCTs), researchers aim to establish standardized practices. The goal of this systematic review is to describe methodological practices of clinical trials for alcohol use disorder (AUD) over the past 40 years. To achieve this goal, a PubMed search was conducted in April 2023 for RCTs on AUD medications published between July 2018 through April 2023. Resulting studies were combined with a previous search from 1985 through 2018. Inclusion criteria for the RCT studies were: (1) a randomized controlled trial, (2) double or single blinded, (3) placebo or active control condition, (4) alcohol use as the primary endpoint, (5) 4 or more weeks of treatment, and (6) 12 or more weeks of follow-up. In total, methodological data from 139 RCTs representing 19 medications and spanning the past four decades were summarized. Results indicated that the most common medications tested were naltrexone (k=42), acamprosate (k=24), and baclofen (k=11). On average, participants were 74% male and consumed 226 drinks per month pre-randomization. The median length of treatment was 12 weeks (IQR= 12-16; min=4 max=52) and the median follow-up duration was 12.5 weeks (IQR: 12-26; min=7 max= 104). There were two broad domains of outcomes (i.e., abstinence and heavy drinking), with most studies featuring outcomes from both domains (k=87; 63%). Reporting practices were summarized by decade, revealing an increased enrollment of females, better reporting of race and ethnicity data, and less studies requiring pre-trial abstinence. This review summarizes the current state of the literature on randomized clinical trials for AUD including effect sizes for individual studies and summaries of key methodological features across this representative set of clinical trials.

The role of sex in daily levels of high-risk alcohol and cannabis co-use.

Background: Co-use of alcohol and cannabis is highly prevalent and may be associated with negative outcomes. The intersection between alcohol and cannabis use remains poorly understood. The present study assessed this intersection and the moderating effects of sex on the daily levels of high-risk alcohol and cannabis co-use. Methods: A secondary analysis of an experimental pharmacology study specifically designed to recruit individuals using both alcohol and cannabis was conducted. Thirty-three non-treatment seeking subjects (19 M/14F) reporting high-risk levels of alcohol and cannabis use completed a 30-day Timeline Follow-back (TLFB) assessment for alcohol and cannabis use, resulting in a total of N = 990 observations. Logistic models tested the probability of same day cannabis use as predicted by alcohol use (any use, total drinking, and binge drinking), sex, and alcohol use by sex interactions. Results: Drinking any alcohol on a given day was associated with a significant increase in the likelihood of same-day cannabis use (b = 0.61, p = 0.001) as was amount of alcohol consumed on a given day (b = 0.083, p = 0.012). These relations were significantly moderated by sex (b = 1.58, p<0.001; b = 0.14, p = 0.044). Male-identifying individuals demonstrated an increased probability of concurrent cannabis use with any alcohol use on a given day, and this relationship increased linearly as the number of drinks consumed increased. Conclusions: The present study investigated the patterns associated with co-using alcohol and cannabis in individuals reporting high-risk levels of both alcohol and cannabis use. The sex-dependent findings suggest that males are at higher risk for co-using alcohol and cannabis compared with females.

Evaluation of delay discounting as a transdiagnostic research domain criteria indicator in 1388 general community adults.

BACKGROUND: The Research Domain Criteria (RDoC) approach proposes a novel psychiatric nosology using transdiagnostic dimensional mechanistic constructs. One candidate RDoC indicator is delay discounting (DD), a behavioral economic measure of impulsivity, based predominantly on studies examining DD and individual conditions. The current study sought to evaluate the transdiagnostic significance of DD in relation to several psychiatric conditions concurrently. METHODS: Participants were 1388 community adults (18-65) who completed an in-person assessment, including measures of DD, substance use, depression, anxiety, posttraumatic stress disorder, and attention-deficit hyperactivity disorder (ADHD). Relations between DD and psychopathology were examined with three strategies: first, examining differences by individual condition using clinical cut-offs; second, examining DD in relation to latent psychopathology variables via principal components analysis (PCA); and third, examining DD and all psychopathology simultaneously via structural equation modeling (SEM). RESULTS: Individual analyses revealed elevations in DD were present in participants screening positive for multiple substance use disorders (tobacco, cannabis, and drug use disorder), ADHD, major depressive disorder (MDD), and an anxiety disorder (ps < 0.05-0.001). The PCA produced two latent components (substance involvement v. the other mental health indicators) and DD was significantly associated with both (ps < 0.001). In the SEM, unique significant positive associations were observed between the DD latent variable and tobacco, cannabis, and MDD (ps < 0.05-0.001). CONCLUSIONS: These results provide some support for DD as a transdiagnostic indicator, but also suggest that studies of individual syndromes may include confounding via comorbidities. Further systematic investigation of DD as an RDoC indicator is warranted.

Alcohol, tobacco, and marijuana consumption is associated with increased odds of same-day substance co- and tri-use.

BACKGROUND: Little is known about event-level patterns of marijuana co- or tri-use with alcohol and tobacco. Thus, the study goal was to examine patterns of same-day alcohol, cigarette, and marijuana co- and tri-use at the individual level in non-treatment-seeking alcohol users. METHODS: Participants (N = 551) completed an in-person interview for alcohol, cigarette, and marijuana use over the previous 30 days, and the event-level substance use patterns of n = 179 participants who reported using each of these substances at least once per month were analyzed. RESULTS: The use of alcohol, marijuana, or cigarettes independently increased the probability of subsequent, simultaneous co-use of one of the two remaining substances. The co-use of alcohol with cigarettes and marijuana with cigarettes produced generally additive effects on the odds of same day tri-use of marijuana and alcohol, respectively. Conversely, the co-use of alcohol and marijuana produced sub-additive effects on likelihood of cigarette use. Sex moderated several of the observed patterns of co- and tri-use: the relationship between alcohol or cigarette use predicting marijuana co-use was stronger in men, whereas the observed additive relationships between drug co-use leading to tri-use was stronger in women. CONCLUSIONS: The presented results may aid in the understanding of how simultaneous co-use of marijuana with alcohol and/or tobacco relates to the etiology, maintenance, and treatment of comorbid and trimorbid substance use disorder. Replication and extension of the results in treatment seeking populations using more fine-grained analysis approaches, e.g. ecological momentary assessment, is needed.

Regional cerebral blood flow in humans at high altitude: gradual ascent and 2 wk at 5,050 m.

The interindividual variation in ventilatory acclimatization to high altitude is likely reflected in variability in the cerebrovascular responses to high altitude, particularly between brain regions displaying disparate hypoxic sensitivity. We assessed regional differences in cerebral blood flow (CBF) measured with Duplex ultrasound of the left internal carotid and vertebral arteries. End-tidal Pco2, oxyhemoglobin saturation (SpO2), blood pressure, and heart rate were measured during a trekking ascent to, and during the first 2 wk at, 5,050 m. Transcranial color-coded Duplex ultrasound (TCCD) was employed to measure flow and diameter of the middle cerebral artery (MCA). Measures were collected at 344 m (TCCD-baseline), 1,338 m (CBF-baseline), 3,440 m, and 4,371 m. Following arrival to 5,050 m, regional CBF was measured every 12 h during the first 3 days, once at 5-9 days, and once at 12-16 days. Total CBF was calculated as twice the sum of internal carotid and vertebral flow and increased steadily with ascent, reaching a maximum of 842 ± 110 ml/min (+53 ± 7.6% vs. 1,338 m; mean ± SE) at ∼ 60 h after arrival at 5,050 m. These changes returned to +15 ± 12% after 12-16 days at 5,050 m and were related to changes in SpO2 (R(2) = 0.36; P < 0.0001). TCCD-measured MCA flow paralleled the temporal changes in total CBF. Dilation of the MCA was sustained on days 2 (+12.6 ± 4.6%) and 8 (+12.9 ± 2.9%) after arrival at 5,050 m. We observed no significant differences in regional CBF at any time point. In conclusion, the variability in CBF during ascent and acclimatization is related to ventilatory acclimatization, as reflected in changes in SpO2.

The CRHR1 gene, trauma exposure, and alcoholism risk: a test of G × E effects.

The corticotropin-releasing hormone type I receptor (CRHR1) gene has been implicated in the liability for neuropsychiatric disorders, particularly under conditions of stress. On the basis of the hypothesized effects of CRHR1 variation on stress reactivity, measures of adulthood traumatic stress exposure were analyzed for their interaction with CRHR1 haplotypes and single-nucleotide polymorphisms (SNPs) in predicting the risk for alcoholism. Phenotypic data on 2533 non-related Caucasian individuals (1167 alcoholics and 1366 controls) were culled from the publically available Study of Addiction: Genetics and Environment genome-wide association study. Genotypes were available for 19 tag SNPs. Logistic regression models examined the interaction between CRHR1 haplotypes/SNPs and adulthood traumatic stress exposure in predicting alcoholism risk. Two haplotype blocks spanned CRHR1. Haplotype analyses identified one haplotype in the proximal block 1 (P = 0.029) and two haplotypes in the distal block 2 (P = 0.026, 0.042) that showed nominally significant (corrected P < 0.025) genotype × traumatic stress interactive effects on the likelihood of developing alcoholism. The block 1 haplotype effect was driven by SNPs rs110402 (P = 0.019) and rs242924 (P = 0.019). In block 2, rs17689966 (P = 0.018) showed significant and rs173365 (P = 0.026) showed nominally significant, gene × environment (G × E) effects on alcoholism status. This study extends the literature on the interplay between CRHR1 variation and alcoholism, in the context of exposure to traumatic stress. These findings are consistent with the hypothesized role of the extra hypothalamic corticotropin-releasing factor system dysregulation in the initiation and maintenance of alcoholism. Molecular and experimental studies are needed to more fully understand the mechanisms of risk and protection conferred by genetic variation at the identified loci.

Treatment for older men with fractures.

UNLABELLED: Less than 10% of men receive osteoporosis treatment, even after a fracture. A study of 17,683 men revealed that older men, those with spinal fractures, and those taking steroids or antidepressants are more likely to receive treatment after a fracture. Seeing a primary care physician also increases osteoporosis treatment rates. INTRODUCTION: In 2000, the FDA approved bisphosphonates for the treatment of osteoporosis in men. The purpose of this study is to estimate the frequency of bisphosphonate therapy within 12 months following a fracture and describe patient/physician factors associated with treatment. METHODS: Health insurance claims for 17,683 men ≥ 65 years of age, who had a claim for an incident fracture from 2000 to 2005, were followed for at least 6 months post-fracture for the initiation of treatment with a bisphosphonate. Patient characteristics, diagnostic procedures, therapies, co-morbidities, and provider characteristics were compared for men who received treatment with those who did not. RESULTS: Eight percent of men (n = 1,434) received bisphosphonate therapy. Overall treatment increased from 7% in 2001 to 9% in 2005 (p < 0.001). Treatment for hip fractures remained at 7% (p = 0.747). Treatment increased with age: 6% in men aged 65-69 compared to 11.6% in men aged 85-89 (p < 0.001). Factors associated with treatment included: diagnosis of osteoporosis (OR = 8.8; 95% CI, 7.7, 10.4), glucocorticoid therapy (OR = 3.2; 95% CI, 2.4, 4.3), bone mineral density measurement (OR = 3.4; 95% CI, 2.9, 4.0), and antidepressant therapy with tricyclics (OR = 2.0; 95% CI, 1.2, 3.5) or selective serotonin reuptake inhibitors (OR = 1.7; 95% CI, 1.3, 2.4). Men with vertebral fractures (OR = 2.2; 95% CI, 1.8, 2.6) and men seen by primary physicians (OR = 2.6; 95% CI, 2.3, 3.1) were more likely to receive treatment. CONCLUSIONS: Less than 10% of men received bisphosphonate therapy following a low-impact fracture. Men with a primary physician were more likely to receive bisphosphonate therapy; however, <25% of men were seen by a primary physician.

Self-reported urge urinary incontinence (UUI) among older Mexican-American men: risk factors and psycho-social consequences.

Extant literature on Urge Urinary Incontinence (UUI) focuses on women and non-Hispanic Whites and little is known about ethnic minority men. We analyzed 700 Mexican-American men aged 75 and older from the fifth Wave (2004/5) of the Hispanic Established Population for the Epidemiologic Study of the Elderly. Logistic regression analyses examined risk factors for self-reported UUI and the impact of UUI on mental health and social support. Twenty-nine percent reported having difficulty holding their urine until they could get to a toilet. Men with more co-morbid conditions and men with prostate problems were more likely to report UUI symptoms. Men with UUI were less likely to report having a confidant and had a higher risk of high depressive symptoms. This study is the first to examine risk factors for and consequences of self-reported UUI among older Mexican-American men using a large community-based survey.

Human gamma-aminobutyric acid A receptor alpha2 gene moderates the acute effects of alcohol and brain mRNA expression.

Gamma-aminobutyric acid A (GABA(A)) receptors moderate several of the behavioral effects of alcohol. In fact, recent studies have shown an association between the gene for the alpha2-subunit of the GABA(A) receptor (GABRA2) and alcoholism. In the present study, we examined the functional relevance of the GABRA2 gene in alcohol dependence by assessing brain GABRA2 mRNA and GABA(A)alpha2-subunit protein levels in post-mortem prefrontal cortical tissue collected from control and alcohol-dependent individuals. In addition, using an endophenotype approach, we tested whether the GABRA2 gene moderates sensitivity to the acute effects of alcohol in two independent samples from distinct human alcohol challenge studies. Results indicated that GABRA2 mRNA levels significantly differed by GABRA2 genotype. GABRA2 single nucleotide polymorphisms (rs573400, rs279871 and rs279858) were significantly associated with sensitivity to the acute effects of alcohol. Specifically, there was a significant main effect of GABRA2 x breath alcohol concentration on several measures of subjective responses to alcohol, including the hedonic value of alcohol. Importantly, reanalysis of a previous intravenous alcohol administration study confirmed the results of the oral alcohol challenge study. In summary, these results extend previous findings and provide new insights into the putative biobehavioral mechanisms that may moderate the association between the GABRA2 gene, sensitivity to the acute effects of alcohol and ultimately alcohol dependence.

Postmenopausal hormone replacement therapy use by older Mexican-American women.

OBJECTIVES: To determine the prevalence of current hormone replacement therapy (HRT) use and describe its correlates among community-dwelling, Mexican-American women aged 67 and older. DESIGN: A population-based survey of older Mexican-Americans conducted in 1995/1996. SETTING: Five Southwestern states: Texas, New Mexico, California, Arizona, and Colorado. PARTICIPANTS: An area probability sample of 1,424 noninstitutionalized Mexican-American women aged 67 and older (mean age = 75.1) completed the survey instrument via a 90-minute in-home interview, which included examination and recording of all medications taken. MEASUREMENTS: Current use of HRT. RESULTS: In this sample of older Mexican-American women, 4.7% were current users of HRT. Controlling for sociodemographic characteristics (age, marital status, living arrangements, years of education, income, language of interview), current HRT use is significantly related to years of education (per each year) (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.05-1.20), having had a hysterectomy (OR = 4.37; 95% CI 2.50-7.64), a diagnosis of osteoporosis (OR = 3.40, 95% CI = 1.58-7.33), age at menopause (per each year) (OR = 1.07; 95% CI = 1.03-1.12), ever having a mammogram (OR = 3.72; 95% CI = 1.66-8.37), ever having a Pap test/pelvic examination (OR = 2.11; 95% CI = 1.08-4.12), having spoken with a pharmacist within the past year regarding health conditions (OR = 1.96; 95% CI = 1.06-3.65), and having Medicare plus private insurance (OR = 2.13; 95% CI = 1.14-3.97). CONCLUSION: The prevalence of HRT use is lower than that reported in the older non-Hispanic white female population. In general, these findings indicate that access to and utilization of the traditional U.S. health care system are indicators of HRT use.

Chronic rheumatologic symptoms in a tri-ethnic sample of men and women aged 75 and older.

BACKGROUND: The high prevalence of musculoskeletal symptoms in elderly persons tends to obscure the recognition of specific medical conditions. The purpose of this study is to describe the prevalence of chronic rheumatologic symptoms and the associated measures of health status in an older population. METHODS: This is a cross-sectional study of 507 noninstitutionalized tri-ethnic men and women aged 75 and older living in Galveston County, Texas. A home interview collected data on demographics, chronic medical conditions, cognition, depression, and functional status. Site, severity, and duration of rheumatologic symptoms such as morning stiffness, body tenderness, and body aching in the past month were also collected. RESULTS: There was a high prevalence of nonspecific rheumatologic symptoms such as morning stiffness (32% in the shoulder girdle, 31% in the hip girdle), tenderness to touch (9%), and generalized body aching (11%) in the study population. Twenty-one percent of the subjects reported either bilateral shoulder or hip girdle stiffness or tenderness lasting more than 30 minutes almost every day or every day or generalized body aching most of the time during the past month. Age-, gender-, and ethnicity-adjusted multivariate analyses showed that more than three self-reported chronic medical conditions, poor or fair self-reported health, impairment in instrumental activities of daily living (IADL), and the presence of depressive or anxiety symptoms were associated with the presence of these chronic rheumatologic symptoms. CONCLUSION: Chronic rheumatologic symptoms are common in people aged 75 and older. Such symptoms are markers for underlying poor health and for anxiety and depression among older subjects.

The influence of noncognitive factors on the Mini-Mental State Examination in older Mexican-Americans: findings from the Hispanic EPESE. Established Population for the Epidemiologic Study of the Elderly.

Mini-Mental State Examination data from the Hispanic Established Population for the Epidemiologic Study of the Elderly baseline survey, a population-based study of community-dwelling Mexican Americans aged 65 and older, were used to examine the relationship between cognitive impairment, sociodemographics, and health-related characteristics. The rate of cognitive impairment found in this group of older Mexican Americans, using the conventional cut point of 23/24 on the MMSE, was 36.7%. Using a more conservative cut point of 17/18 indicated an overall rate of severe cognitive impairment of 6.7%. Rates of impairment varied significantly with age, education, literacy, marital status, language of interview, and immigrant status and were associated with high and moderate levels of depressive symptoms, and history of stroke. Importantly, although education was strongly related to poor cognitive performance, it was not a significant predictor of severe cognitive impairment. Multivariate analyses further indicated that as a screen for cognitive impairment in older Mexican Americans, the MMSE is strongly influenced by these noncognitive factors. Scores may reflect test bias, secondary to cultural differences or the level of education in this population.

The prevalence and health burden of self-reported diabetes in older Mexican Americans: findings from the Hispanic established populations for epidemiologic studies of the elderly.

OBJECTIVES: The prevalence and health burden of self-reported adult-onset diabetes mellitus were examined in older Mexican Americans. METHODS: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were used to assess the prevalence of self-reported diabetes and its association with other chronic conditions, disability, sensory impairments, health behaviors, and health service use in 3050 community-dwelling Mexican Americans 65 years and older. RESULTS: The prevalence of self-reported diabetes in this sample was 22%, and there were high rates of obesity, diabetes-related complications, and diabetic medication use. Myocardial infarction, stroke, hypertension, angina, and cancer were significantly more common in diabetics than in nondiabetics, as were high levels of depressive symptoms, low perceived health status, disability, incontinence, vision impairment, and health service use. Many of the rate differences found in this sample of older Mexican Americans were higher than those reported among other groups of older adults. CONCLUSIONS: Our findings indicate that the prevalence and health burden of diabetes are greater in older Mexican Americans than in older non-Hispanic Whites and African Americans, particularly among elderly men.

Changes in the smoking behavior of elderly Mexican Americans in the Southwest from 1982-1984 to 1993-1994.

OBJECTIVES: The aim of this work was to examine changes in the smoking behavior of elderly Mexican Americans in the southwestern United States from the early 1980s to the early 1990s. METHODS: Data from the 1993-1994 Hispanic EPESE study (n = 2,809) on persons ages 65 to 74 and 75 to 84 residing in the five southwestern states were compared with data from the 1982-1984 Hispanic HANES study (n = 753, persons ages 55 to 74), which included a Mexican American sample from the same five southwestern states. RESULTS: Rates of current smoking in 1993-1994 for persons ages 65 to 74 were approximately half the rates for persons of the same age a decade earlier. Smoking rates for persons ages 75 to 84 in 1993-1994 were significantly lower than rates for persons ages 65 to 74 a decade earlier. Finally, rates for persons ages 65 to 74 in 1993-1994 were significantly lower than those for persons ages 55 to 64 in 1982-1984. CONCLUSIONS: Although some of the declines in smoking in recent years represent aging effects (including declines due to greater mortality among smokers), the much lower rates for same-age people (65 to 74) over the 10-year period are more significant in that they represent cohort differences. It appears that the broader public health message that is causing the general population to quit smoking is reaching the elderly Mexican American population of the Southwest.

Epidemiology of self-reported past heavy drinking in Hispanic adults.

OBJECTIVES: Self-reports of past heavy drinking correlate with the current drinking practices and with risk of mortality in non-Hispanic males. The prevalence of past heavy drinking has not been reported in Hispanic populations. METHODS: Using data from the Hispanic Health and Nutrition Examination Survey (HHANES) we (1) report on the prevalence, duration and severity of past heavy drinking in three Hispanic groups, (2) compare the current alcohol consumption patterns among past heavy drinkers and those who do not report a history of past heavy drinking and (3) compare the risk factor profiles and health indicators in these two groups. RESULTS: The prevalence of past heavy drinking among Mexican American and Puerto Rican males ranged from 28-35% while the rates for Cuban American males ranged from 7-16%. The rates for Hispanic women were much lower (1-8%). The average years of past heavy drinking ranged from 2.3-14.9 years, while the alcohol consumption during the past heavy drinking period ranged from 24.4-44.0 drinks per week. Past heavy drinkers tended to consume more alcohol at present than did never heavy drinkers with the greatest differences found for Mexican American females. Comparisons of the risk factors and health indicators by drinking status revealed a higher prevalence of smoking among past heavy drinkers (50-60%) versus never heavy drinkers (34-43%). Past heavy drinking Mexican American females also reported significantly more chronic conditions and depressive symptoms than did never heavy drinkers. CONCLUSIONS: Prevalence rates of past heavy drinking among Mexican American and Puerto Rican males are approximately three times higher than rates reported for non-Hispanic male populations.

The effect of medical conditions on the functional limitations of Mexican-American elderly.

We examined the relationship of self-reported functional status to common medical conditions using a probability sample of 3050 noninstitutionalized Mexican-American men and women aged 65 or older and residing in the Southwestern United States (Arizona, California, Colorado, New Mexico, and Texas). All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their homes during late 1993 and early 1994. The questionnaire obtained information on self-reported functional status and prevalence of arthritis, cancer, diabetes, stroke, heart attack, and hip fracture. The prevalence of medical conditions ranged from 4.1% for hip fracture to 40.8% for arthritis. Prevalence of impairments in seven activities of daily living ranged from 5.4% for eating to 11.7% for bathing, while 25.1% could not walk up and down stairs, and 28.9% could not walk a half mile without help. In multiple logistic regression analyses, previous diagnoses of stroke and hip fracture were most predictive of functional limitations, though all conditions examined (arthritis, cancer, diabetes, stroke, heart attack, and hip fracture) were independently associated with increased odds of impairment in some activities of daily living. In general, the odds for functional impairment associated with specific medical conditions were higher than those previously published for non-Hispanic white populations. The fact that Mexican-American elderly who live in the community and who have medical conditions, especially stroke and hip fracture, are at high risk for functional impairment probably reflects the low rate of institutionalization in this population and has implications for the provision of community-based long-term care services for Mexican-American elderly.

Religious attendance and psychological well-being in Mexican Americans: a panel analysis of three-generations data.

This study examined the effects of religious attendance on three dimensions of psychological well-being using panel data from a three-generations study of Mexican Americans from Texas (N = 624). Well-being dimensions included life satisfaction (the 13-item LSIA), and respective seven- and four-item depressed and positive affect subscales of the CES-D. Two-wave path analyses revealed a cross-sectional association between religious attendance and life satisfaction in the two oldest generations, and a salutary longitudinal effect of religious attendance on subsequent depressed affect in the youngest generation. Findings for life satisfaction and depressed affect withstood controlling for health and five sociodemographic correlates of religious attendance and well-being.

A test of the psychosocial vulnerability and health behavior models of hostility: results from an 11-year follow-up study of Mexican Americans.

Previous research has shown that interpersonal conflict and depression are cross-sectionally associated with hostility. Our objective was to determine whether hostility is longitudinally predictive of interpersonal distress and depression and to replicate previous research that suggests that hostility is a risk factor for other health behaviors (e.g., smoking and excessive alcohol use) and psychosocial health problems. We use data from the youngest generation of a three-generation, 11-year follow-up study of Mexican Americans, that represent 251 Mexican Americans between the ages of 18 and 42 years. Our indicator of hostility was the irritability subscale from the Buss-Durkee Hostility Inventory. After statistically controlling for marital status, language acculturation, education, age, and sex, irritability was found to predict subsequent heavy drinking, somatic symptoms associated with depression, psychosomatic symptoms, infectious disease, divorce, marital separation, ending a serious nonmarital relationship, not being married at the follow-up, and more negative feelings associated with divorce, marital separation, and ending a serious relationship. Our research supports theory and research suggesting that hostility is predictive of physical symptoms, poor health habits, and interpersonal conflict.

Physicians' ratings of health in middle and old age: a cautionary note.

Physicians' global assessments traditionally have been considered to be relatively objective estimates of older people's health against which self-ratings of health and other self-reported measures are compared. Using data on middle-aged and older Mexican Americans from the Hispanic Health and Nutrition Examination Survey, it is suggested that the subjective component of physicians' assessments can create problems with validity, especially when a small number of physicians perform the assessments, as was the case in this study. It is recommended that researchers should not always assume that physicians' assessments represent an objective "gold standard" for validating self-reported measures of health.

Acculturation and hypertension in Mexican Americans.

In this analysis, we employ data from the Hispanic Health and Nutrition Examination Survey to examine the association between level of acculturation into the larger society and rates of hypertension in Mexican Americans. Analyses conducted separately by gender in three broad age groups (ages 20 to 39, 40 to 59, and 60 to 74 years) fail to indicate a linear effect of acculturation on hypertension after controlling for age, education, marital status, employment, smoking, alcohol consumption, and body mass index. A nonlinear hypothesis was subsequently examined and found partial support among middle-aged men. Other things equal, middle-aged men at the middle of the acculturation continuum have significantly higher rates of hypertension than persons at the low end of the continuum. Lower rates are also observed among men at the high end of the acculturation continuum, but these rates are not significantly lower than those among men in the middle acculturation group when other variables are controlled. These findings for middle-aged men support an "acculturative stress" model that suggests that stress is higher at the middle of the acculturation continuum. Research on the influence of acculturation on health outcomes should go beyond simply examining linear effects to investigate the viability of nonlinear effects.