The role of phonological structure and experience in bilingual children's nonword repetition performance.

The current study examined the influence of phonological structure and language experience on the nonword repetition performance of bilingual children. Twenty-six Spanish-dominant and 26 English-dominant Spanish-English bilingual five-year-old children were matched on current exposure to the dominant language and year of first exposure to English. Participants repeated non-wordlike nonwords in English and Spanish. The Spanish-dominant group performed better than the English-dominant group for both Spanish and English nonwords. In addition, there was a main effect for test language, where Spanish nonwords were produced more accurately than English nonwords overall. The Spanish-dominant group advantage for nonwords is interpreted as emerging from the extra practice the dominant Spanish speakers had producing multisyllabic words.

Story retelling by bilingual children with language impairments and typically developing controls.

BACKGROUND: To date there is limited information documenting growth patterns in the narratives of bilingual children with and without primary language impairment (PLI). AIMS: This study was designed to determine whether bilingual children with and without PLI present similar gains from kindergarten to first grade in the macro- and microstructure of stories told in Spanish and English. METHODS & PROCEDURES: In this longitudinal study, 21 bilingual children identified with PLI were each matched to a bilingual typically developing (TD) peer on age, sex, non-verbal IQ and language exposure. During their kindergarten and first-grade years, children retold stories from wordless picture books in Spanish (L1) and English (L2). OUTCOMES & RESULTS: Overall, TD children outperformed those with PLI on measures of macro- and microstructure at both time points. For the macrostructure measure, the TD group made significantly larger improvements in both languages from kindergarten to first grade than the PLI group. For microstructure, the TD children made more gains on their Spanish retells than their English retells. However, the PLI children's microstructure scores did not differ from kindergarten to first grade in either language. We found that macrostructure scores in Spanish at kindergarten predicted macrostructure scores in English at first grade when English experience was held constant. However, this same relationship across languages was not evident in microstructure. CONCLUSIONS & IMPLICATIONS: TD and PLI children differed in the development of narrative macro- and microstructure between kindergarten and first grade. The TD bilinguals transferred conceptually dependent narrative skills easily, but then had to learn independently the nuances of each language to be successful using literate language. Because most children with PLI need more exposure to establish strong connections between their L1 and L2, they had more difficulty transferring their knowledge of literate language forms from one language to another.

Identification of specific language impairment in bilingual children: I. Assessment in English.

PURPOSE: This study was designed to derive cut scores for English testing for use in identifying specific language impairment (SLI) in bilingual children who were learning English as a second language. METHOD: In a 1-gate design, 167 children received comprehensive language assessments in English and Spanish during their first-grade year. The reference standard was identification by a team of expert bilingual speech-language pathologists. Receiver operating curve (ROC) analyses were used to identify the optimal prediction model for SLI. RESULTS: The original, English EpiSLI criteria (Tomblin, Records, & Zhang, 1996) yielded a sensitivity of .95 and a specificity of .45 (LR+ = 1.73, LR- = 0.11, and AUC = .79) for our bilinguals. Revised cutoff scores yielded a sensitivity of .86 and a specificity of .68 (LR+ = 2.67, LR- = 0.21, and AUC = .77). An optimal prediction model yielded a sensitivity of .81 and a specificity of .81 (LR+ = 4.37, LR- = 0.23 and AUC = .85). CONCLUSION: The results of English testing could be used to make a reasonably accurate diagnostic decision for bilingual children who had attended public school for at least 1 year and were using English at least 30% of the time.

Use of antidepressants and the risk of type 2 diabetes mellitus: a nested case-control study.

BACKGROUND: Recent evidence from case reports, observational studies, and randomized trials suggests that long-term use of antidepressants increases the risk of developing diabetes. However, the nature of the relationship between antidepressants and diabetes remains unclear. OBJECTIVE: To determine whether there is an association between antidepressant use and the risk of developing type 2 diabetes mellitus. METHODS: A nested case-control study using the Texas Medicaid prescription claims database was conducted. Data were extracted for new users of either antidepressant agents (exposed) or benzodiazepines (unexposed) from January 1, 2002 through December 31, 2009. Patients aged 18-64 years without a history of diabetes were included in the cohort. The adjusted odds ratio (OR) and 95% confidence interval (CI) for the risk of diabetes associated with antidepressant exposure was computed using conditional logistic regression, controlling for demographic and clinical covariates. MAIN OUTCOME MEASURE: Development of type 2 diabetes mellitus. RESULTS: Among the total sample (N = 44,715), the majority were in the exposed (N = 35,552) vs. the unexposed (N = 9,163) group. A total of 2,943 cases of type 2 diabetes mellitus and 11,748 matched controls (1:4) were identified using risk-set sampling. Cases and controls were matched using age and gender. Antidepressant use was associated with an increase in the risk of (type-2) diabetes when compared to benzodiazepine use [Adjusted Odds Ratio (OR) = 1.512; 95% CI 1.345-1.700]. The association was observed with serotonin-norepinephrine reuptake inhibitors (OR = 1.742; 95% CI 1.472-2.060), tricyclic antidepressants (OR = 1.533; 95% CI 1.295-1.814), selective serotonin reuptake inhibitors (OR = 1.457; 95% CI 1.279-1.659), "Other" antidepressants (OR = 1.318; 95% CI 1.129-1.540). CONCLUSIONS: Antidepressant use was associated with an increased risk of (type-2) diabetes. This association was observed for tricyclic antidepressants, serotonin-reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and other antidepressants.

Evaluating patient adherence to antidepressant therapy among uninsured working adults diagnosed with major depression: results of the Texas Demonstration to Maintain Independence and Employment study.

This study examined antidepressant adherence and persistence among uninsured working adults diagnosed with major depression enrolled in the Texas Demonstration to Maintain Independence and Employment (DMIE) program. Antidepressant adherence was measured between intervention and control cohorts using proportion of days covered (PDC) during a 365-day observation period. Persistence examined duration of time from drug initiation to discontinuation based on a ≥35-day refill supply gap. Older, non-minority patients with higher education were more adherent or persistent to antidepressant therapy. Adjusting for covariates, results showed no significant difference in PDC at the end of 12-months between intervention and control participants (b = .07, P = .054, semi-partial η (2) = .02). Exploratory analysis found subgroup differences in PDC among the study recruitment cohorts. No significant difference between intervention and control groups was found in persistence between the groups. Follow-up investigation is planned to assess the longer term impact of the DMIE program on antidepressant adherence and persistence.

The measure matters: Language dominance profiles across measures in Spanish-English bilingual children.

The purpose of this study was to determine if different language measures resulted in the same classifications of language dominance and proficiency for a group of bilingual pre-kindergarteners and kindergarteners. Data were analyzed for 1029 Spanish-English bilingual pre-kindergarteners who spanned the full range of bilingual language proficiency. Parent questionnaires were used to quantify age of first exposure and current language use. Scores from a short test of semantic and morphosyntactic development in Spanish and English were used to quantify children's performance. Some children who were in the functionally monolingual range based on interview data demonstrated minimal knowledge of their other languages when tested. Current use accounted for more of the variance in language dominance than did age of first exposure. Results indicate that at different levels of language exposure children differed in their performance on semantic and morphosyntax tasks. These patterns suggest that it may be difficult to compare the results of studies that employ different measures of language dominance and proficiency. Current use is likely to be a useful metric of bilingual development that can be used to build a comprehensive picture of child bilingualism.

Risk for poor performance on a language screening measure for bilingual preschoolers and kindergarteners.

PURPOSE: This study documents the risk for language impairment in Latino children who had different levels of exposure to English and Spanish. METHOD: A total of 1,029 preschool- and kindergarten-age children were screened in the domains of semantics and morphosyntax in both Spanish and English. Parent report was used to document current exposure to and use of Spanish and English, as well as year of first exposure to English. Risk for language impairment was compared for language group, year of first English exposure, age, and mother's education. RESULTS: While bilingual children's scores on each subtest were significantly lower compared to their functional monolingual peers, they were no more likely to fall in the at-risk range based on a combination of all 4 subtests. Maternal education and year of first English exposure were weakly associated with risk for language impairment but not with language group (via 5 levels of first and second language exposure). CONCLUSIONS: Prevalence of risk for language impairment when both languages are tested is not related to language group.

Use of complementary and alternative medicine for treatment among African-Americans: a multivariate analysis.

BACKGROUND: The use of complementary and alternative medicine (CAM) is substantial among African-Americans; however, research on characteristics of African-Americans who use CAM to treat specific conditions is scarce. OBJECTIVE: To determine what predisposing, enabling, need, and disease-state factors are related to CAM use for treatment among a nationally representative sample of African-Americans. METHODS: A cross-sectional study design was employed using the 2002 National Health Interview Survey (NHIS). A nationwide representative sample of adult (> or =18 years) African-Americans who used CAM in the past 12 months (n=16,113,651 weighted; n=2,952 unweighted) was included. The Andersen Health Care Utilization Model served as the framework with CAM use for treatment as the main outcome measure. Independent variables included the following: predisposing (eg, age, gender, and education); enabling (eg, income, employment, and access to care); need (eg, health status, physician visits, and prescription medication use); and disease state (ie, most prevalent conditions among African-Americans) factors. Multivariate logistic regression was used to address the study objective. RESULTS: Approximately 1 in 5 (20.2%) who used CAM in the past 12 months used CAM to treat a specific condition. Ten of the 15 CAM modalities were used primarily for treatment by African-Americans. CAM for treatment was significantly (P<.05) associated with the following factors: graduate education, smaller family size, higher income, region (northeast, midwest, west more likely than south), depression/anxiety, more physician visits, less likely to engage in preventive care, more frequent exercise behavior, more activities of daily living (ADL) limitations, and neck pain. CONCLUSIONS: Twenty percent of African-Americans who used CAM in the past year were treating a specific condition. Alternative medical systems, manipulative and body-based therapies, and folk medicine, prayer, biofeedback, and energy/Reiki were used most often. Health care professionals should routinely ask patients about the use of CAM, but when encountering African-Americans, there may be a number of factors that may serve as cues for further inquiry.

Bilingual performance on nonword repetition in Spanish and English.

BACKGROUND: Nonword repetition (NWR) involves the ability to perceive, store, recall and reproduce phonological sequences. These same abilities play a role in word and morpheme learning. Cross-linguistic studies of performance on NWR tasks, word learning, and morpheme learning yield patterns of increased performance on all three tasks as a function of age and language experience. These results are consistent with the idea that there may be universal information-processing mechanisms supporting language learning. Because bilingual children's language experience is divided across two languages, studying performance in two languages on NWR could inform one's understanding of the relationship between information processing and language learning. AIMS: The primary aims of this study were to compare bilingual language learners' recall of Spanish-like and English-like items on NWR tasks and to assess the relationships between performance on NWR, semantics, and morphology tasks. METHODS & PROCEDURES: Sixty-two Hispanic children exposed to English and Spanish were recruited from schools in central Texas, USA. Their parents reported on the children's input and output in both languages. The children completed NWR tasks and short tests of semantics and morphosyntax in both languages. Mixed-model analysis of variance was used to explore direct effects and interactions between the variables of nonword length, language experience, language outcome measures, and cumulative exposure on NWR performance. OUTCOMES & RESULTS: Children produced the Spanish-like nonwords more accurately than the English-like nonwords. NWR performance was significantly correlated to cumulative language experience in both English and Spanish. There were also significant correlations between NWR and morphosyntax but not semantics. CONCLUSIONS & IMPLICATIONS: Language knowledge appears to play a role in the task of NWR. The relationship between performance on morphosyntax and NWR tasks indicates children rely on similar language-learning mechanisms to mediate these tasks. More exposure to Spanish may increase abilities to repeat longer nonwords. This knowledge may shift across levels of bilingualism. Further research is needed to understand this relationship, as it is likely to have implications for language teaching or intervention for children with language impairments.

What You Hear and What You Say: Language Performance in Spanish English Bilinguals.

PURPOSE: This study assesses the factors that contribute to Spanish and English language development in bilingual children. METHOD: 757 Hispanic Pre-kindergarten and kindergarten age children completed screening tests of semantic and morphosyntactic development in Spanish and English. Parents provided information about their occupation and education as well as their children's English and Spanish exposure. Data were analyzed using zero-inflated regression models (comprising a logistic regression component and a negative binomial or Poisson component) to explore factors that contributed to children initiating L1 and L2 performance and factors that contributed to building children's knowledge. RESULTS: Factors that were positively associated with initiating L1 and L2 performance were language input/output, free and reduced lunch, and age. Factors associated with building knowledge included age, parent education, input/output, free and reduced lunch and school district. CONCLUSION: Amount of language input is important as children begin to use a language, and amount of language output is important for adding knowledge to their language. Semantic development seemed to be driven more by input while morphosyntax development relied on both input and output. Clinicians who assess bilingual children should examine children's language output in their second language to better understand their levels of performance.

A nutrition and physical activity intervention promotes weight loss and enhances diet attitudes in low-income mothers of young children.

The purpose of this study was to evaluate a nutrition and physical activity program for reducing body weight and improving nutrition attitudes in mothers of young children. A convenience sample of 114 intervention mothers and 33 comparison mothers was recruited from public health clinics and community centers. Eligibility criteria included Hispanic, African American, or white ethnicity; body mass index of at least 25 kg/m(2); low income (< 200% of the federal poverty index); and youngest child aged 1 to 4 years. For intervention participants, height, weight, percentage of body fat, waist circumference, demographics, nutrition attitudes, and dietary intake were measured at weeks 0 and 8; height, weight, percentage of body fat, and waist circumference were reassessed at 6 months. Overweight mothers in the comparison group provided anthropometric and demographic data at weeks 0 and 8. Changes in anthropometrics, attitudes, and dietary intake were evaluated in intervention mothers. Anthropometric data of intervention vs comparison group mothers were examined. Differences in anthropometrics and attitude scores between weight loss responders (> or = 2.27 kg) and nonresponders (< 2.27 kg) were assessed at week 8. Intervention participants lost weight (x = -2.7 kg; P < .001), whereas comparison mothers gained a slight amount of weight (x = 0.1 kg) by week 8. Weight loss responders had healthier eating attitudes (5.6 vs 5.2; P < .01) and fewer perceived barriers (2.4 vs 2.9; P < .05) than nonresponders postintervention. In conclusion, this dietary and physical activity curriculum is a valuable resource for weight management programs serving low-income women.

Assessing health care organizations' ability to implement screening, brief intervention, and referral to treatment.

OBJECTIVES: : To determine if a new measure of organizational readiness for change reflects site and staff role differences when implementing a screening, brief intervention, and referral to treatment (SBIRT) program for alcohol and drug misuse in a healthcare organization. SAMPLE: : One hundred forty-one Community Health Program (CHP) and 45 Emergency Center (EC) respondents completed the survey. METHODS: : Medical and ancillary staff from a Level 1 trauma hospital EC and 3 CHP clinics within a large, urban, publicly funded health-care system were asked to complete the 45-item Medical Organizational Readiness for Change (MORC) survey 5 to 7 months after the start of implementation planning. One-way ANOVAs compared the 4 sites' responses and independent t tests compared the clinical versus administrative staff responses on 8 MORC scales. RESULTS: : There were statistically significant differences between the EC and CHP sites on Need for External Guidance, Pressure to Change, Organizational Readiness to Change, Workgroup Functioning, Work Environment, and Autonomy Support. Clinical and administrative staff differed significantly on Need for External Guidance, Pressure to Change, and Organizational Readiness to Change. When change agents used the MORC data to inform their implementation process, the results were positive. CONCLUSIONS: : Among CHP sites, there were differences in organizational functioning, which were consistent with CHP implementation outcomes. The MORC scales can help planners and change agents understand their organization's current readiness to integrate screening, brief intervention, and referral to treatment services into their medical setting.

Patterns of complementary and alternative medicine use in African Americans.

OBJECTIVES: This study sought to determine (1) characteristics of complementary and alternative medicine (CAM) users in the African-American (AA) population; (2) the prevalence of CAM use; and (3) CAM use for treatment and prevention of disease. DESIGN: The authors analyzed data from the 2002 National Health Interview Survey (NHIS), which included 4256 AA adults representing 23,828,268 AA adults nationwide. Chi-squared tests based on weighted data were used to examine differences in CAM users and nonusers. OUTCOME MEASURES: CAM use was categorized as CAM Ever, CAM Past 12 Months, and CAM for Treatment. RESULTS: A total of 23,828,268 (weighted) AAs were identified in the NHIS dataset. Of those, 67.6% used CAM in the past 12 months, when prayer for health was included. Users were more likely older (43.3 +/- 0.4 versus 39.5 +/- 0.5 years; p < 0.0001); female (60.9% versus 44.0%; p < 0.0001), college educated (17.4% versus 9.8%; p < 0.0001); and insured (91.0% versus 88.1%; p < 0.0001) compared to nonusers. Prayer was the most common CAM used by more than 60% of respondents, followed by herbals (14.2%) and relaxation (13.6%). A majority utilized CAM to treat illness. The use of CAM was significantly (p < 0.0001) higher across all the disease states common in AAs compared to nonuse. CONCLUSIONS: A substantial number of AAs use CAM, with use varying across sociodemographic characteristics. Prayer was the most commonly used therapy. Overall, CAM was most often used for the treatment of specific conditions as opposed to prevention, and its use was common among AAs with prevalent disease states. The extent to which CAM served as a complement or an alternative to conventional medical treatment among AAs is unknown and should be investigated.

Predictors of weight loss in low-income mothers of young children.

OBJECTIVE: To identify predictors of weight loss in a tri-ethnic population of low-income mothers. DESIGN: An 8-week dietary and physical activity program was tested. Demographic data were collected at baseline; anthropometric, dietary, physical activity, and psychosocial data were measured at baseline and week 8. SUBJECTS/SETTING: A convenience sample of 114 Hispanic, African-American, and white, low-income mothers with a body mass index > or = 25 (calculated as kg/m2) participated in the intervention. INTERVENTION: Weight-loss classes that incorporated nutrition, physical activity, and behavior modification were administered for 8 weeks. MAIN OUTCOME MEASURES: Anthropometry (body weight, weight loss). STATISTICAL ANALYSES PERFORMED: Analysis of variance, chi2 tests, and Spearman and Pearson correlations were used to test for associations between baseline and change data and total weight loss. Hierarchical regression was employed to assess the marginal importance of factors beyond socioeconomic influences. RESULTS: Correlates of weight loss included less satisfaction with appearance (r=0.24), greater percentage of energy from protein (r=-0.22), enhanced nutrition knowledge (r=-0.23), and higher scores for benefits of weight loss (r =-0.20) at baseline; and the change in healthful eating attitudes (r=-0.28) and social support (r=-0.21) at 8 weeks. The predictive models of baseline and change variables represented 11.4% and 13.8% of the variance, respectively. CONCLUSIONS: Weight-management programs serving low-income mothers should provide techniques to enhance social support, attitudes toward healthful eating, benefits of weight loss, and nutrition knowledge.

Low-income, overweight and obese mothers as agents of change to improve food choices, fat habits, and physical activity in their 1-to-3-year-old children.

OBJECTIVE: To examine the effects of a weight loss program for mothers on the diet and activity of mothers and their 1-3 year old children. DESIGN: Overweight and obese mothers participated in an 8-week weight loss intervention encompassing diet, physical activity, and behavioral modification. Anthropometrics, demographic, dietary, and physical activity questionnaires were administered at weeks 0 and 8; anthropometrics were re-evaluated at week 24. SUBJECTS: Mothers (N=91) of a 1-3 year old child; body mass index (BMI) >or= 25 kg/m2; non-breastfeeding; age 18-45 years; income < 200% of federal poverty index; Hispanic, African American, or white; and English-speaking were recruited from Special Supplemental Program for Women Infants and Children (WIC) and public health clinics. INTERVENTION MEASURES OF OUTCOME: Weight loss in mothers and improvements in diet (reduction in calories, fat, snacks/desserts, sweetened beverages, and increases in fruit, vegetables) and activity in mothers and children. RESULTS: Weight loss in mothers was modest (-2.7 kg, p < 0.001) and sustained at week 24 (-2.8 kg, p < 0.001), and children gained in height and weight as expected for normal growth (p < 0.001). Initial energy intakes of children exceeded Estimated Energy Requirements (123%) and were reduced to acceptable levels post-intervention (102%, p < 0.001); additional beneficial changes in children's diets were decreased total (47.7 to 39.9 g/day) and saturated fat (19.2 to 16.6 g/day), high-fat snacks/desserts (1.6 to 0.9 servings/day), added fats (81.8 to 40.9% using), sweetened beverages (0.8 to 0.4 servings/day), and fast food consumption (11.6 to 6.6% of meals), and increased home-prepared meals (63.2 to 71.6% of meals) (p < 0.01 for all). Physical activity scores improved by 7% in children (p < 0.05). Comparable changes in food choices and activity also were seen in mothers. CONCLUSION: Offering weight loss classes was a successful method of enticing low-income women to participate in an educational intervention that benefited their children. Overweight and obese mothers who modified their food choices and fat habits made comparable changes for their child.

Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute?

This study examined the unique effects of four variable groups on changes in older adults' depressive symptoms for a 2-year period: (1) baseline health and disability status, (2) changes in health and disability since baseline, (3) stability and changes in marital and caregiving status and in work and volunteering, and (4) stability and changes in health-related behaviors. With data from the 1998 and 2000 interview waves of the Health and Retirement Study, the authors used gender-separate multistep (hierarchical) residualized regression analyses in which the Center for Epidemiological Studies Depression scale (CES-D) score at follow-up is modeled as a function of the effect of each group of independent variables. As hypothesized, changes in health, disability, marital, and caregiving status explained a larger amount of variance than the existing and stable conditions, although each group of variables explained a relatively small amount (0.3-3.4%) of variance in the follow-up CES-D score.

Differences in characteristics of heroin inhalers and heroin injectors at admission to treatment: a preliminary study using a large database of client records.

AIMS: To compare the characteristics of heroin injectors vs. inhalers at their first admission to publicly funded treatment in Texas. METHODS: The sample consisted of 9732 unique clients who entered publicly funded treatment programs in Texas between 1997 and 2001 and who had a primary problem with either injected or inhaled heroin, which they had used in the past 30 days. The records were analyzed using a generalized linear model of logistic regression with the outcomes modeled as binomial and multinomial distribution and a hierarchical linear model for continuous outcomes to compare heroin inhalers and injectors. FINDINGS: There were large statistically significant differences between injectors and inhalers. Inhalers were more likely to be older at first use of heroin, to have entered treatment sooner, to have minor children at home, to have higher annual incomes, to be first admissions to treatment, and to have a secondary drug problem with crack cocaine. They were also more likely to be Hispanic [odds ratio (OR) = 1.74] or African-American (OR = 12.32). CONCLUSIONS: Even though the race/ethnic differences in the Texas population and the type of heroin available for use in Texas differs from that studied elsewhere, many of the characteristics of heroin users are similar. Inhalers have more strengths in many areas, and these findings raise the possibility that there are factors, particularly among African-American participants in Texas, that lessen the risk of injecting heroin. Efforts should be directed to providing therapeutic interventions to discourage the transition to injecting and to encourage inhalers to enter treatment earlier rather than progressing on to injecting. This analysis is the first part of a larger study of heroin users in public and private treatment.