A further look at the prognostic power of young children's reports of depressed mood and feelings.

A primary objective of the present study was to determine the validity of first graders' self-reports of depressed mood and feelings. To that end, the prognostic power of first grade self-reports of depressed mood and feelings was examined with respect to later psychopathology and adaptive functioning in a population of urban school children (N = 946). First grade self-reports of depressed mood predicted later child academic functioning, the need for and use of mental health services, suicidal ideation, and a diagnosis of major depressive disorder by age 14. The prognostic power of these early self-reports suggests that children as young as 5 or 6 years of age are capable of providing valid reports of depressed mood and feelings.

Use of recommended laboratory testing methods among patients with tuberculosis in California.

This study assessed the extent to which laboratory methods recommended by the Centers for Disease Control and Prevention were used in tuberculosis testing of patients in California in 1998. While recommended methods were used for most patients, there was room for improvement by hospital and independent non-health maintenance organization laboratories.

Immunization levels and risk factors for low immunization coverage among private practices.

OBJECTIVES: Previous studies have indicated that provider characteristics are an important determinant of immunization coverage. The objectives of this study were to: 1) assess immunization coverage levels among 2-year-old children receiving care in private practices in 3 California counties; and 2) evaluate practice and patient risk factors for low immunization coverage. STUDY DESIGN: Cross-sectional chart review of immunization histories and provider survey of immunization policies. SETTING: Forty-five randomly selected, private medical practices in 3 counties in California. PATIENTS: Children 12 to 35 months old, followed by the participating practices. METHODS: Providers underwent a detailed assessment of their immunization coverage and completed a questionnaire describing their immunization policies and procedures. Immunization data were abstracted from randomly selected medical charts of children 12 to 35 months old. Only patients who met the criteria for active status (>/=2 visits and >/=1 visit during the preceding 18 months) were included in analyses. Immunization coverage levels were calculated and logistic regression was used to estimate the risk of underimmunization associated with different practice and child characteristics. RESULTS: Of the 72 eligible practices that were contacted, 45 participated in the study, yielding a participation rate of 62%. The median immunization coverage of participating offices was 54% (range: 0%-91%). Multivariate analysis revealed 5 independent risk factors for underimmunization. The strongest predictors were having fewer than 50% active children in the practice and children having fewer than 8 visits to the provider. Other significant predictors were the percentage of patients in the practice on Medicaid, administering diphtheria-tetanus-pertussis 4 at a separate visit from the Haemophilus influenzae type b booster, and practice location. CONCLUSIONS: These data provide new insights into immunization practices in an important clinical setting that has been poorly characterized previously. Immunization coverage levels were found to be low and significant risk factors for underimmunization were identified. Recommendations are made for immunization policy changes and targeting of immunization improvement interventions at practices that may be at risk for low immunization coverage. immunization, vaccination, immunization programs, primary prevention, private practice, child, preschool, pediatrics, family practice.

Core elements of developmental epidemiologically based prevention research.

In the early 1990's, important progress was documented in prevention research on mental and behavioral disorders, with recommendations for a prevention research agenda. One of the earliest implementation efforts was the workshop, "A Scientific Structure for the Emerging Field of Prevention Research," sponsored by the National Institute of Mental Health and The Johns Hopkins University Prevention Research Center, and held in Baltimore, Maryland, in December of 1994. The purpose of the workshop was to merge three perspectives from the traditionally disparate areas of epidemiology, life course development, and intervention trials technology into an integrated, interdisciplinary effort that would define a scientific structure enabling rapid advancement in prevention science. As a consequence of that workshop, the papers were written that are contained in this and the next special issue on prevention of the American Journal of Community Psychology. This first paper is a description of the salient features of developmental epidemiologically-based prevention research. Beyond the above three perspectives, we discuss the role of developmental and intervention theories; measurement of implementation, mediators, and moderators, including multi-stage sampling and measurement; the central role of multilevel growth modeling; concepts of attributable risk and prevented fraction; proximal/distal modeling and effect sizes; and partnerships between researchers and communities.

Proximal impact of two first-grade preventive interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior.

We assessed the immediate effects of two universal, first-grade preventive interventions on the proximal targets of poor achievement, concentration problems, aggression, and shy behaviors, known early risk behaviors for later substance use/abuse, affective disorder, and conduct disorder. The classroom-centered (CC) intervention was designed to reduce these early risk behaviors by enhancing teachers' behavior management and instructional skills, whereas the family-school partnership (FSP) intervention was aimed at improving parent-teacher communication and parental teaching and child behavior management strategies. Over the course of first and second grades, the CC intervention yielded the greatest degree of impact on its proximal targets, whereas the FSP's impact was somewhat less. The effects were influenced by gender and by preintervention levels of risk. Analyses of implementation measures demonstrated that greater fidelity to the intervention protocols was associated with greater impact on behavior ratings and on achievement scores, thus providing some evidence of specificity in the effect of the interventions.

Targeting early antecedents to prevent tobacco smoking: findings from an epidemiologically based randomized field trial.

OBJECTIVES: This study examined whether interventions aimed at aggressive/disruptive classroom behavior and poor academic achievement would reduce the incidence of initiation of smoking. METHODS: An epidemiologically based, universal randomized preventive trial involved 2311 children in 2 classroom-based preventive interventions or controls. Each intervention was directed at 1 of the aforementioned 2 antecedents over first and second grades in 19 urban schools. RESULTS: Smoking initiation was reduced in both cohorts for boys assigned to the behavioral intervention. CONCLUSIONS: Targeting early risk antecedents such as aggressive behavior appears to be an important smoking prevention strategy.

The effect of the level of aggression in the first grade classroom on the course and malleability of aggressive behavior into middle school.

This paper is on the influences of the classroom context on the course and malleability of aggressive behavior from entrance into first grade through the transition into middle school. Nineteen public elementary schools participated in developmental epidemiologically based preventive trials in first and second grades, one of which was directed at reducing aggressive, disruptive behavior. At the start of first grade, schools and teachers were randomly assigned to intervention or control conditions. Children within each school were assigned sequentially to classrooms from alphabetized lists, followed by checking to insure balanced assignment based on kindergarten behavior. Despite these procedures, by the end of first quarter, classrooms within schools differed markedly in levels of aggressive behavior. Children were followed through sixth grade, where their aggressive behavior was rated by middle school teachers. Strong interactive effects were found on the risk of being highly aggressive in middle school between the level of aggressive behavior in the first grade classrooms and each boy's own level of aggressive, disruptive behavior in first grade. The more aggressive first grade boys who were in higher aggressive first grade classrooms were at markedly increased risk, compared both to the median first grade boys, and compared to aggressive males in lower aggressive first grade classrooms. Boys were already behaving more aggressively than girls in first grade; and no similar classroom aggression effect was found among girls, although girls' own aggressive behavior did place them at increased risk. The preventive intervention effect, already reported elsewhere to reduce aggressive behavior among the more aggressive males, appeared to do so by reducing high levels of classroom aggression. First grade males' own poverty level was associated with higher risk of being more aggressive, disruptive in first grade, and thereby increased their vulnerability to classroom level of aggression. Both boys and girls in schools in poor communities were at increased risk of being highly aggressive in middle school regardless of their levels of aggressive behavior in first grade. These results are discussed in terms of life course/social field theory as applied to the role of contextual influences on the development and etiology of severe aggressive behavior.

Grandmother involvement in child caregiving in an urban community.

In a community-defined, epidemiologic sample in East Baltimore, we examined grandmothers' rates of co-residence and their involvement in four parenting activities. Co-residence rates exceeded the national average. Six types of family households with grandmothers were identified, and their frequency varied by race. Neither grandmother age nor employment was associated with grandmothers' parenting involvement, although family structure was. Grandmothers who were the sole parent (21%) or co-parent with a grandfather (6.5%) were most involved in child care and had the fewest number of helpers. Grandmothers living with single mothers (41%) were the next most involved, while grandmothers in mother/father households (9%) were least involved.

The course of aggression in first-grade children with and without comorbid anxious symptoms.

We studied the course of aggressive behavior in an epidemiologically defined sample of first graders with and without comorbid anxious symptoms. Our primary purpose in doing so was to understand whether the stability of aggression in young children was attenuated or strengthened in the presence of comorbid anxiety. Previous studies of older children and adolescents had produced equivocal findings in this regard. Data on anxious symptoms were obtained through an interview of the children, whereas aggressive behavior was assessed through the use of a teacher interview and peer nominations. Assessments were performed in the fall and spring of first grade. In contrast to children classified as aggressive alone in the fall of first grade, boys and girls classified as aggressive and anxious in the fall of first grade were significantly more likely to be classified as aggressive in the spring in terms of teacher ratings and/or peer nominations of aggression. Thus our findings suggest that the link between early and later aggression may be strengthened in the presence of comorbid anxious symptoms, rather than attenuated. Future studies are needed to identify the mechanisms by which the course of aggression is influenced by the presence of comorbid anxiety.

Effect of concentration problems on the malleability of children's aggressive and shy behaviors.

OBJECTIVE: Previous research has demonstrated the central role of early childhood concentration problems in the development of aggression and other maladaptive behaviors. The present study investigated the moderating effect of concentration problems on the impact of a classroom-based preventive intervention directed at aggressive and shy behaviors in an epidemiologically defined sample of 1,084 urban first-grade children. METHOD: Concentration problems, aggressive behavior, and shy behavior were assessed by a structured teacher interview (the Teacher Observation of Classroom Adaptation-Revised) in the fall and spring of first grade. RESULTS: Children with high ratings on concentration problems in the fall had higher levels of teacher-rated aggressive and shy behavior in the spring than did children without such problems. The intervention reduced aggressive and shy behavior in children regardless of fall concentration level. Boys, but not girls, in the intervention condition with high concentration problems had higher levels of spring aggression than those without such problems, but they also showed the greatest reductions in aggressive behavior from fall to spring. CONCLUSIONS: These results suggest that aggressive behavior is malleable in children with concentration problems, provide further evidence on the etiological significance of concentration problems for the development of maladaptive behavior, and highlight the importance of directly targeting concentration problems to maximize preventive intervention impact.

Household family structure and children's aggressive behavior: a longitudinal study of urban elementary school children.

The relationship between contemporary household family structures at fourth-grade and sixth-grade parent- and teacher-rated aggression was examined in an epidemiologically defined population of urban school children. The relationship between family structure and aggression varied by child gender and by parent and teacher ratings in the home and school, respectively. After taking into account family income, urban area, and fourth-grade aggressive behavior, boys in both mother-father and mother-male partner families were significantly less likely than boys in mother-alone families to be rated as aggressive by teachers. No significant relations between family structure and teacher- or parent-rated aggression were found for girls.

The significance of self-reported anxious symptoms in first grade children: prediction to anxious symptoms and adaptive functioning in fifth grade.

In an earlier study of an epidemiologically defined sample of first grade children, primarily between the ages of 5 and 6, self-reported anxious symptoms proved relatively stable and were significantly related to adaptive functioning. In the present study we follow that cohort of first graders longitudinally and assess the prognostic value of self-reports of anxious symptoms in first grade with respect to anxious symptoms and adaptive functioning in the late elementary school years or at about age 10. First grade anxious symptoms were found to have significant prognostic value in terms of levels of anxious symptoms and adaptive functioning in fifth grade.

The significance of self-reported anxious symptoms in first-grade children.

It is generally believed that prior to the middle to late elementary school years children's reports of anxious symptoms represent nothing more than transient developmental phenomena. In light of the limited empirical study of this issue and its import to the allocation of mental health resources, the present study seeks to provide empirical evidence of the significance of anxious symptoms in children younger than 7. Specifically, utilizing an epidemiologically defined population of 1197 first-grade children, followed longitudinally from the fall to spring of first grade, we examine the stability, prevalence and caseness of children's self-reports of anxious symptoms. Self-reported anxious symptoms proved relatively stable over 4-month test-retest interval. In addition, they appeared to have a significant impact on academic functioning in terms of reading achievement. These findings on stability, caseness, and prevalence suggest children's self-reported anxious symptoms in the early elementary school years may have clinical significance. However, further study is necessary before firm conclusions can be drawn.

Family structure and aggressive behavior in a population of urban elementary school children.

OBJECTIVE: This report examined associations between family structure and 393 fourth-grade children's aggressive behavior. METHOD: In an epidemiologically defined urban community population, both teacher and parent ratings of child aggressive behavior were examined among family structures that reflected current demographics. Relative risks for teacher- and parent-rated child aggressive behavior in mother-alone households were compared with those in the next most prevalent family structures (mother-father, mother-grandmother, and mother-male partner families). RESULTS: With all income groups combined, teachers rated boys and girls in mother-alone families as more aggressive relative to mother-father families. Among low-income families, the protective effects for mother-father families were not apparent, and mother-male partner families were associated with an increased risk for teacher-rated aggression for boys. CONCLUSION: Absence of and type of second adult present, child gender, home and school context, and income were important factors that moderated the associations between family structure and child aggressive behavior in this urban setting.

The course and malleability of aggressive behavior from early first grade into middle school: results of a developmental epidemiologically-based preventive trial.

The course and malleability of aggressive behavior from beginning elementary school through transition into middle school was investigated. In a developmental epidemiologically defined population of 1000 urban first graders, a two year classroom-based randomized preventive trial was aimed at reducing aggressive behavior, an antecedent of delinquency, violent behavior, and heavy drug use in adolescence and adulthood. Earlier we reported impact in first grade on teacher and peer ratings and on classroom observations. We report here on the course and on sixth grade teacher ratings of aggressive behavior. Improvement was observable during transition times, in first grade and in middle school, among the males in the preventive intervention who were more aggressive in first grade.

High-throughput microtiter plate-based chromogenic assays for glycosidase inhibitors.

Rapid microtiter plate-based colorimetric assays have been developed that allow the screening of large numbers of samples for the presence of inhibitors of alpha-glucosidase, alpha-amylase, and beta-galactosidase. The assays are particularly useful for screening large numbers of microbial culture filtrates.

Epinephrine absorption from commercial gingival retraction cords in clinical patients.

Absorption of epinephrine from commercial gingival retraction cords was measured in vivo under clinical conditions. The amount of epinephrine absorbed was estimated by measurement with fluorospectrophotometry of the amount of dl-epinephrine remaining in the cords after they were removed and subtracting this value from the dl-epinephrine concentration in matching control cords. All cords lost substantial amounts of epinephrine while in the sulcus, with individual losses ranging from 64% to 94%. An average 71 micrograms of l-epinephrine was absorbed per inch of two-ply cord, and extreme variability in the dl-epinephrine concentration for individual segments of commercial cord was noted. In addition, the cords did not contain the concentration of epinephrine (500 micrograms/inch) listed on the package label but instead had a mean dl-epinephrine concentration of 225.5 micrograms/inch.

Self-reported depressive symptoms in first-grade children: developmentally transient phenomena?

The question of whether self-reported depressive symptoms in young children represent more than transient developmental phenomena was examined in an epidemiologically defined sample of 1,313 first graders. Children's reports of depressive symptoms were relatively stable over a 4-month interval. The level of stability was particularly impressive for children initially in the highest quartile of depression, of all whom remained in the highest quartile at retest, 4 months later. In addition, depressive symptoms were significantly related to the negotiation of a number of salient developmental tasks at entrance to first grade, including academic achievement, peer relations, and attention/concentration in the classroom. Moreover, the relationships between depressive symptoms and the various indices of social and academic functioning remained stable over the 4-month test-retest interval.