Ecological momentary assessment of urban adolescents' technology use and cravings for unhealthy snacks and drinks: differences by ethnicity and sex.

BACKGROUND: Adolescents' technology use is generally associated with food cravings, but it is not clear whether specific types of technology elicit particular types of cravings or whether personal characteristics play a role in these associations. OBJECTIVE: We examined whether momentary associations between four technology types (ie, television, video games, computer messaging, and phone messaging) and cravings for unhealthy snack foods and sweetened drinks were moderated by youths' sex, ethnicity, body mass index, and age. METHODS: Urban adolescents (N=158) aged 14 to 17 years provided momentary information about their technology use and food cravings during the course of 1 week and completed survey reports of their personal characteristics. We used multilevel modeling to determine momentary associations and interactions. RESULTS: Non-Hispanic adolescents showed stronger associations between television exposure and cravings for sweet snacks, salty snacks, and sweetened drinks. Being Hispanic was associated with stronger associations between phone messaging and cravings for sweet snacks, salty snacks, and sweetened drinks. Males showed stronger associations between video game use and salty snack cravings. CONCLUSIONS: As the public health field continues to monitor the effects of technology use on adolescents' eating and overall health, it will be important to determine the extent to which these groups are differentially affected by different forms of technology.

Application of item response theory to tests of substance-related associative memory.

A substance-related word-association test (WAT) is one of the commonly used indirect tests of substance-related implicit associative memory and has been shown to predict substance use. This study applied an item response theory (IRT) modeling approach to evaluate psychometric properties of the alcohol- and marijuana-related WATs and their items among 775 ethnically diverse at-risk adolescents. After examining the IRT assumptions, item fit, and differential item functioning (DIF) across gender and age groups, the original 18 WAT items were reduced to 14 and 15 items in the alcohol- and marijuana-related WAT, respectively. Thereafter, unidimensional one- and two-parameter logistic models (1PL and 2PL models) were fitted to the revised WAT items. The results demonstrated that both alcohol- and marijuana-related WATs have good psychometric properties. These results were discussed in light of the framework of a unified concept of construct validity (Messick, 1975, 1989, 1995).

Neural correlates of a Go/NoGo task with alcohol stimuli in light and heavy young drinkers.

Inhibitory processes are highly relevant to behavioral control affecting decisions made daily. The Go/NoGo task is a common task used to tap basic inhibitory processes important in higher order executive functioning. The present study assessed neural correlates of response inhibition during performance of a Go/NoGo task in which NoGo signals or tests of inhibitory control consisted of images of beer bottles. Group comparisons were conducted between 21 heavy and 20 light drinkers, ranging in age from 18 to 22. Behaviorally, overall performance assessed with d-prime was significantly better among the lighter drinkers. On a neural level, the heavy drinkers showed significantly greater activity in the right dorsolateral prefrontal cortex, medial frontal cortex and cingulate relative to the light drinkers during the NoGo trials. These regions are implicated in reflective or control processing of information. Further, heavy drinkers showed significantly greater activity in the insula relative to light drinkers during NoGo trials, a neural region implicated in habit circuitry and tied to cue induced urges and emotional memories of physical effects of drugs. These results suggest that the heavier drinkers may have experienced increased working memory demand and control efforts to withhold a response due to poorer inhibitory control from enhanced salience of alcohol cues on the beer NoGo trials, which also engaged insula mediated effects.

Inhibitory control effects in adolescent binge eating and consumption of sugar-sweetened beverages and snacks.

Inhibitory control and sensitivity to reward are relevant to the food choices individuals make frequently. An imbalance of these systems can lead to deficits in decision-making that are relevant to food ingestion. This study evaluated the relationship between dietary behaviors - binge eating and consumption of sweetened beverages and snacks - and behavioral control processes among 198 adolescents, ages 14 to 17. Neurocognitive control processes were assessed with the Iowa Gambling Task (IGT), a generic Go/No-Go task, and a food-specific Go/No-Go task. The food-specific version directly ties the task to food cues that trigger responses, addressing an integral link between cue-habit processes. Diet was assessed with self-administered food frequency and binge eating questionnaires. Latent variable models revealed marked gender differences. Inhibitory problems on the food-specific and generic Go/No-Go tasks were significantly correlated with binge eating only in females, whereas inhibitory problems measured with these tasks were the strongest correlates of sweet snack consumption in males. Higher BMI percentile and sedentary behavior also predicted binge eating in females and sweet snack consumption in males. Inhibitory problems on the generic Go/No-Go, poorer affective decision-making on the IGT, and sedentary behavior were associated with sweetened beverage consumption in males, but not females. The food-specific Go/No-Go was not predictive in models evaluating sweetened beverage consumption, providing some initial discriminant validity for the task, which consisted of sweet/fatty snacks as no-go signals and no sugar-sweetened beverage signals. This work extends research findings, revealing gender differences in inhibitory function relevant to behavioral control. Further, the findings contribute to research implicating the relevance of cues in habitual behaviors and their relationship to snack food consumption in an understudied population of diverse adolescents not receiving treatment for eating disorders.

Response inhibition moderates the association between drug use and risky sexual behavior.

BACKGROUND: HIV infection is problematic among all drug users, not only injection drug users. Drug users are at risk for contracting HIV by engaging in risky sexual behaviors. OBJECTIVE: The present study sought to determine whether inhibitory processes moderate the relationship between problematic drug use and HIV-risk behaviors (unprotected sex and multiple sex partners). METHODS: One hundred ninety-six drug offenders enrolled in drug education programs were administered a battery of computer-based assessments. Measures included a cued go/no-go assessment of inhibitory processes, the Drug Abuse Screening Test (DAST) assessment of problematic drug use, and self-report assessment of condom use and multiple sex partners. RESULTS: Findings revealed that response inhibition assessed by the proportion of false alarms on the cued go/no-go moderated the relationship between problematic drug use and an important measure of HIV risk (condom nonuse) among drug offenders. However, response inhibition did not moderate the relationship between problematic drug use and another measure of HIV risk: multiple sex partners. CONCLUSIONS: Among this sample of drug offenders, we have found a relationship between problematic drug use and condom nonuse, which is exacerbated by poor control of inhibition. These findings have implications for the development of HIV intervention components among high-risk populations.

Functional imaging of an alcohol-Implicit Association Test (IAT).

This research assessed activation in neural substrates involved in implicit associative processes through functional magnetic resonance imaging of an alcohol-Implicit Association Test (IAT) focused on positive outcomes of alcohol use. Comparisons involved 17 heavy and 19 light drinkers, ranging in age from 18 to 22, during compatible and incompatible association task trials. Behaviorally, a significant IAT effect was found with heavy drinkers showing stronger positive implicit associations toward alcohol use than light drinkers. Imaging data revealed heavy drinkers showed greater activity during compatible trials relative to incompatible trials in the left putamen and insula while no significant difference in activity between conditions was found in the light drinkers. Light drinkers showed significantly more activity in the left orbital frontal cortex during both compatible and incompatible trials than heavy drinkers, and the dorsolateral prefrontal cortex was engaged more in both light and heavy drinkers during incompatible trials relative to compatible trials. Further, within-group analyses showed significant amygdala activity along with the putamen and insula among heavy drinkers during compatible trials relative to incompatible trials. These results are consistent with a dual process framework of appetitive behaviors proposing that (1) implicit associations underlying habit are mediated through neural circuitry dependent on the striatum, and (2) controlled behaviors are mediated through neural circuitry more dependent on the prefrontal cortex. This is the first study to evaluate the neural mechanisms elicited by an alcohol-IAT, providing an additional step toward increasing understanding of associative habit processes and their regulatory influence over addictive behaviors.

Functional imaging of implicit marijuana associations during performance on an Implicit Association Test (IAT).

This research evaluated the neural correlates of implicit associative memory processes (habit-based processes) through the imaging (fMRI) of a marijuana Implicit Association Test. Drug-related associative memory effects have been shown to consistently predict level of drug use. To observe differences in neural activity of associative memory effects, this study compared 13 heavy marijuana users and 15 non-using controls, ranging in age from 18 to 25, during performance of a marijuana Implicit Association Test (IAT). Group by condition interactions in the putamen, caudate, and right inferior frontal gyrus were observed. Relative to non-users, marijuana users showed greater bilateral activity in the dorsal striatum (caudate and putamen) during compatible trials focused on perceived positive outcomes of use. Alternatively, relative to the marijuana-using group, the non-users showed greater activity in the right inferior frontal gyrus during incompatible trials, which require more effortful processing of information. Further, relative to fixation, heavy users showed bilateral activity in the caudate and putamen, hippocampus and some frontal regions during compatible trials and no significant activity during incompatible trials. The non-using group showed greater activity in frontal regions during incompatible trials relative to fixation and no significant activity during compatible trials. These findings are consistent with a dual process framework of appetitive behaviors proposing that (1) implicit associations underlying habit are mediated through neural circuitry dependent on the striatum, and (2) deliberative/controlled behaviors are mediated through circuitry more dependent on the prefrontal cortex.

Sweetened drink and snacking cues in adolescents: a study using ecological momentary assessment.

The objective of this study was to identify physical, social, and intrapersonal cues that were associated with the consumption of sweetened beverages and sweet and salty snacks among adolescents from lower SES neighborhoods. Students were recruited from high schools with a minimum level of 25% free or reduced cost lunches. Using ecological momentary assessment, participants (N=158) were trained to answer brief questionnaires on handheld PDA devices: (a) each time they ate or drank, (b) when prompted randomly, and (c) once each evening. Data were collected over 7days for each participant. Participants reported their location (e.g., school grounds, home), mood, social environment, activities (e.g., watching TV, texting), cravings, food cues (e.g., saw a snack), and food choices. Results showed that having unhealthy snacks or sweet drinks among adolescents was associated with being at school, being with friends, feeling lonely or bored, craving a drink or snack, and being exposed to food cues. Surprisingly, sweet drink consumption was associated with exercising. Watching TV was associated with consuming sweet snacks but not with salty snacks or sweet drinks. These findings identify important environmental and intrapersonal cues to poor snacking choices that may be applied to interventions designed to disrupt these food-related, cue-behavior linked habits.

Exposure to alcohol advertisements and teenage alcohol-related problems.

OBJECTIVE: This study used prospective data to test the hypothesis that exposure to alcohol advertising contributes to an increase in underage drinking and that an increase in underage drinking then leads to problems associated with drinking alcohol. METHODS: A total of 3890 students were surveyed once per year across 4 years from the 7th through the 10th grades. Assessments included several measures of exposure to alcohol advertising, alcohol use, problems related to alcohol use, and a range of covariates, such as age, drinking by peers, drinking by close adults, playing sports, general TV watching, acculturation, parents' jobs, and parents' education. RESULTS: Structural equation modeling of alcohol consumption showed that exposure to alcohol ads and/or liking of those ads in seventh grade were predictive of the latent growth factors for alcohol use (past 30 days and past 6 months) after controlling for covariates. In addition, there was a significant total effect for boys and a significant mediated effect for girls of exposure to alcohol ads and liking of those ads in 7th grade through latent growth factors for alcohol use on alcohol-related problems in 10th grade. CONCLUSIONS: Younger adolescents appear to be susceptible to the persuasive messages contained in alcohol commercials broadcast on TV, which sometimes results in a positive affective reaction to the ads. Alcohol ad exposure and the affective reaction to those ads influence some youth to drink more and experience drinking-related problems later in adolescence.

Dual process interaction model of HIV-risk behaviors among drug offenders.

This study evaluated dual process interaction models of HIV-risk behavior among drug offenders. A dual process approach suggests that decisions to engage in appetitive behaviors result from a dynamic interplay between a relatively automatic associative system and an executive control system. One synergistic type of interplay suggests that executive functions may dampen or block effects of spontaneously activated associations. Consistent with this model, latent variable interaction analyses revealed that drug offenders scoring higher in affective decision making were relatively protected from predictive effects of spontaneous sex associations promoting risky sex. Among drug offenders with lower levels of affective decision making ability, spontaneous sexually-related associations more strongly predicted risky sex (lack of condom use and greater number of sex partners). These findings help elucidate associative and control process effects on appetitive behaviors and are important for explaining why some individuals engage in risky sex, while others are relatively protected.

Deliberative and spontaneous cognitive processes associated with HIV risk behavior.

Dual process models of decision-making suggest that behavior is mediated by a spontaneous behavior selection process or by a more deliberative evaluation of behavioral options. We examined whether the deliberative system moderates the influence of spontaneous cognition on HIV-risk behaviors. A measure of spontaneous sex-related associations (word association), a measure of deliberative working memory capacity (operation span), and two measures of sexual behavior (condom use and multiple partners) were assessed in a cross-sectional study among 490 adult drug offenders. Significant effects were observed among men but not among women in two latent interaction models. In a novel finding, the accessibility of spontaneous safe sex-related associations was significantly more predictive of condom use among men with higher working memory capacity than among men with lower capacity. These results have implications for the design of interventions to promote safe sex practices.

Analyzing latent state-trait and multiple-indicator latent growth curve models as multilevel structural equation models.

Latent state-trait (LST) and latent growth curve (LGC) models are frequently used in the analysis of longitudinal data. Although it is well-known that standard single-indicator LGC models can be analyzed within either the structural equation modeling (SEM) or multilevel (ML; hierarchical linear modeling) frameworks, few researchers realize that LST and multivariate LGC models, which use multiple indicators at each time point, can also be specified as ML models. In the present paper, we demonstrate that using the ML-SEM rather than the SL-SEM framework to estimate the parameters of these models can be practical when the study involves (1) a large number of time points, (2) individually-varying times of observation, (3) unequally spaced time intervals, and/or (4) incomplete data. Despite the practical advantages of the ML-SEM approach under these circumstances, there are also some limitations that researchers should consider. We present an application to an ecological momentary assessment study (N = 158 youths with an average of 23.49 observations of positive mood per person) using the software Mplus (Muthén and Muthén, 1998-2012) and discuss advantages and disadvantages of using the ML-SEM approach to estimate the parameters of LST and multiple-indicator LGC models.

Prevention education effects on fundamental memory processes.

This study evaluated effects of a key session from a nationally recognized drug abuse prevention program on basic memory processes in 211 high-risk youth in Southern California. In a randomized, between-subject design, the authors manipulated assignment to a Myth and Denial program session and the time of assessment (immediate vs. 1-week delay). The authors examined program decay effects on memory accessibility and judgment errors. Those participants exposed to the program session generated more myths and facts from the program than those in the control group, suggesting that even a single program session influenced students' memory for program information and this was retained at least 1 week and detectable with indirect tests of memory accessibility. However, consistent with basic research perspectives, participants in the program-delayed assessment group erroneously generated more fact-related information from the session to the prompt "It is a myth that_____" than the participants in the program immediate assessment group; that is, they retained more facts as myths. These types of program effects, anticipated by basic memory theory, were not detected with a traditional judgment task in the present sample. The results suggest that basic science approaches offer a novel way of conceptually recasting prevention effects to more completely understand how these effects may operate. Implications for program evaluation and conceptualization are discussed.

Long-term effects of self-control on alcohol use and sexual behavior among urban minority young women.

High risk alcohol use and sexual behaviors peak in young adulthood and often occur in the same individuals. Alcohol use has been found to impair decision-making and contribute to high risk sexual activity. However, the association between alcohol use and risky sexual behavior may also reflect enduring individual differences in risk taking, sociability, self-control, and related variables. Both behaviors can serve similar functions related to recreation, interpersonal connection, and the pursuit of excitement or pleasure. The present study examined the extent to which high risk drinking and sexual behavior clustered together in a sample of urban minority young adult women, a demographic group at elevated risk for negative outcomes related to sexual health. We tested whether psychosocial functioning measured at the beginning of high school predicted classes of risk behaviors when girls were tracked longitudinally into young adulthood. Latent class analysis indicated three distinct profiles based on high risk drinking and sexual behavior (i.e., multiple sex partners) in young adulthood. The largest class (73% of the sample) reported low levels of risky drinking and sexual behavior. The next largest class (19%) reported high risk drinking and low risk sexual behavior, and the smallest class (8%) reported high levels of both behaviors. Compared to women from other racial/ethnic groups, black women were more likely to be categorized in the high risk drinking/low risk sex class. Multinomial logistic regression indicated that self-control in adolescence had a broad and enduring protective effect on risk behaviors eight years later and was associated with a greater probability of being in the low risk drinking/low risk sex class. Findings are discussed in terms of understanding the phenotypic expressions of risk behavior as they relate to early psychosocial development and the long-term protective function of self-control in reducing high risk drinking and sexual behaviors.

Component Processes of Executive Function-Mindfulness, Self-control, and Working Memory-and Their Relationships with Mental and Behavioral Health.

We examined the interrelationships between higher-order cognitive functions-mindfulness, self-control, and working memory-that appear to be component processes that underlie executive function (EF) and their association with indicators of mental and behavioral health. Data were collected from first-year medical students attending a large private university in California (N=31) via a computer-based questionnaire which was administered via email hyperlink. Results indicate that self-control schedule (SCS) scores were significantly correlated with the negative dimension of positive and negative affect schedule scores (r=-0.59, p<0.05), psychological well-being scale scores (r=0.46, p<0.05), and mindful attention awareness scale (MAAS) scores (r=0.35, p≤0.10). The planful behavior dimension of the SCS was correlated with MAAS scores (r=0.38, p<0.10), automated operation span task scores (r=0.51, p<0.05), and total SCS scores (r=0.72, p<0.01). Large and significant inverse correlations were found between current meditation practice and alcohol use (r=-0.56, p<0.05) and AUDIT scores (r=-0.48, p<0.05). Findings from this pilot study suggest that an overlap exists between some component processes of EF; however, the majority of variance in the components is not shared. Moreover, these higher-order cognitive processes appear to have protective relationships with substance use and are positively associated with self-reported meditation practice.

Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis.

OBJECTIVE: To conduct a meta-analysis of the association between depression and medication adherence among patients with chronic diseases. Poor medication adherence may result in worse outcomes and higher costs than if patients fully adhere to their medication regimens. DATA SOURCES: We searched the PubMed and PsycINFO databases, conducted forward searches for articles that cited major review articles, and examined the reference lists of relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: We included studies on adults in the United States that reported bivariate relationships between depression and medication adherence. We excluded studies on special populations (e.g., substance abusers) that were not representative of the general adult population with chronic diseases, studies on certain diseases (e.g., HIV) that required special adherence protocols, and studies on interventions for medication adherence. STUDY APPRAISAL AND SYNTHESIS METHODS: Data abstracted included the study population, the protocol, measures of depression and adherence, and the quantitative association between depression and medication adherence. Synthesis of the data followed established statistical procedures for meta-analysis. RESULTS: The estimated odds of a depressed patient being non-adherent are 1.76 times the odds of a non-depressed patient, across 31 studies and 18,245 participants. The association was similar across disease types but was not as strong among studies that used pharmacy records compared to self-report and electronic cap measures. LIMITATIONS: The meta-analysis results are correlations limiting causal inferences, and there is some heterogeneity among the studies in participant characteristics, diseases studied, and methods used. CONCLUSIONS: This analysis provides evidence that depression is associated with poor adherence to medication across a range of chronic diseases, and we find a new potential effect of adherence measurement type on this relationship. Although this study cannot assess causality, it supports the importance that must be placed on depression in studies that assess adherence and attempt to improve it.

A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity.

BACKGROUND: Medication nonadherence is a common problem among the elderly. OBJECTIVE: To conduct a systematic review of the published literature describing potential nonfinancial barriers to medication adherence among the elderly. METHODS: The PubMed and PsychINFO databases were searched for articles published in English between January 1998 and January 2010 that (1) described "predictors," "facilitators," or "determinants" of medication adherence or that (2) examined the "relationship" between a specific barrier and adherence for elderly patients (ie, ≥65 years of age) in the United States. A manual search of the reference lists of identified articles and the authors' files and recent review articles was conducted. The search included articles that (1) reviewed specific barriers to medication adherence and did not solely describe nonmodifiable predictors of adherence (eg, demographics, marital status), (2) were not interventions designed to address adherence, (3) defined adherence or compliance and specified its method of measurement, and (4) involved US participants only. Nonsystematic reviews were excluded, as were studies that focused specifically on people who were homeless or substance abusers, or patients with psychotic disorders, tuberculosis, or HIV infection, because of the unique circumstances that surround medication adherence for each of these populations. RESULTS: Nine studies met inclusion criteria for this review. Four studies used pharmacy records or claims data to assess adherence, 2 studies used pill count or electronic monitoring, and 3 studies used other methods to assess adherence. Substantial heterogeneity existed among the populations studied as well as among the measures of adherence, barriers addressed, and significant findings. Some potential barriers (ie, factors associated with nonadherence) were identified from the studies, including patient-related factors such as disease-related knowledge, health literacy, and cognitive function; drug-related factors such as adverse effects and polypharmacy; and other factors including the patient-provider relationship and various logistical barriers to obtaining medications. None of the reviewed studies examined primary nonadherence or nonpersistence. CONCLUSION: Medication nonadherence in the elderly is not well described in the literature, despite being a major cause of morbidity, and thus it is difficult to draw a systematic conclusion on potential barriers based on the current literature. Future research should focus on standardizing medication adherence measurements among the elderly to gain a better understanding of this important issue.

An empirical assessment of the Above the Influence advertising campaign.

This study evaluated the efficacy of Above the Influence (ATI), a national media-based health persuasion campaign to deter youth drug use. The campaign uses public service anti-drug prevention messages and targets youth between the ages of 14 and 16, a period of heightened susceptibility to peer influences. The evaluation utilized mall intercepts from geographically dispersed regions of the country. Theoretical impetus for the campaign combines elements of the theory of reasoned action (TRA), persuasion theory, and the health belief model. A series of structural equation models were tested with four randomly drawn cross-validation samples (N = 3,000). Findings suggest that awareness of ATI is associated with greater anti-drug beliefs, fewer drug use intentions, and less marijuana use. Congruent with the TRA, changes in beliefs and intentions are intermediate steps linking campaign awareness with behavior. This study provides further evidence of positive campaign effects and may strengthen reliance on mass media health persuasion campaigns as a useful adjunct to other programs targeting youth.

Seniors' perceptions of prescription drug advertisements: a pilot study of the potential impact on informed decision making.

OBJECTIVE: To conduct a pilot study exploring seniors' perceptions of direct-to-consumer advertising (DTCA) of prescription drugs and how the advertisements might prepare them for making informed decisions with their physicians. METHODS: We interviewed 15 seniors (ages 63-82) individually after they each watched nine prescription drug advertisements recorded from broadcast television. Grounded Theory methods were used to identify core themes related to the research questions. RESULTS: Four themes emerged from the interviews about DTCA: (1) awareness of medications was increased, (2) information was missing or misleading and drugs were often perceived as more effective than clinical evidence would suggest, (3) most seniors were more strongly influenced by personal or vicarious experience with a drug - and by their physician - than by DTCA, and (4) most seniors were circumspect about the information in commercial DTCA. CONCLUSIONS: DTCA may have some limited benefit for informed decision making by seniors, but the advertisements do not provide enough detailed information and some information is misinterpreted. PRACTICAL IMPLICATIONS: Physicians should be aware that many patients may misunderstand DTCA, and that a certain amount of time may be required during consultations to correct these misconceptions until better advertising methods are employed by the pharmaceutical industry.

The influence of school-based natural mentoring relationships on school attachment and subsequent adolescent risk behaviors.

A relatively new area of research suggests that naturally occurring mentoring relationships may influence the development of adolescents by protecting against risk behaviors. Few studies have explored how these relationships function to reduce risk behavior among youth, especially in the school context. Based on previous research and theory, we proposed and tested a mediation model, which hypothesized that school attachment mediated the longitudinal association between school-based natural mentoring relationships and risk behaviors, including eight indicators of substance use and violence. Students (N = 3320) from 65 high schools across eight states completed a self-report questionnaire at baseline and 1-year follow-up. The sample was comprised of youth with an average age of 14.8 years and an almost equal percentage of females (53%) and males from various ethnic backgrounds. Tests for mediation were conducted in Mplus using path analysis with full information maximum likelihood procedures and models adjusted for demographic covariates and baseline level of the dependent variable. Results suggested that natural mentoring relationships had a protective indirect influence on all eight risk behaviors through its positive association on the school attachment mediator. Implications are discussed for strengthening the association between school-based natural mentoring and school attachment to prevent risk behaviors among youth.