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This study examined how race/ethnicity, sex/gender, and sexual orientation intersect under interlocking systems of oppression to socially pattern depression among US adults. With cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (NSDUH; n=234,722), we conducted design-weighted multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) under an intersectional framework to predict past-year and lifetime major depressive episode (MDE). With 42 intersectional groups constructed from seven race/ethnicity, two sex/gender, and three sexual orientation categories, we estimated age-standardized prevalence and excess/reduced prevalence attributable to two-way or higher interaction effects. Models revealed heterogeneity across groups, with prevalence ranging from 1.9-19.7% (past-year) and 4.5-36.5% (lifetime). Approximately 12.7% (past-year) and 12.5% (lifetime) of total individual variance were attributable to between-group differences, indicating key relevance of intersectional groups in describing the population distribution of depression. Main effects indicated, on average, people who were White, women, gay/lesbian, or bisexual had greater odds of MDE. Main effects explained most between-group variance. Interaction effects (past-year: 10.1%; lifetime: 16.5%) indicated a further source of heterogeneity around averages with groups experiencing excess/reduced prevalence compared to main effects expectations. We extend the MAIHDA framework to calculate nationally representative estimates from complex sample survey data using design-weighted, Bayesian methods.
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This study examined how race/ethnicity, sex/gender, and sexual orientation intersect to socially pattern depression among US adults. We used repeated, cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (NSDUH; n=234,772) to conduct design-weighted multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) for two outcomes: past-year and lifetime major depressive episode (MDE). With 42 intersectional groups constructed from seven race/ethnicity, two sex/gender, and three sexual orientation categories, we estimated group-specific prevalence and excess/reduced prevalence attributable to intersectional effects (i.e., two-way or higher interactions between identity variables). Models revealed heterogeneity between intersectional groups, with prevalence estimates ranging from 3.4-31.4% (past-year) and 6.7-47.4% (lifetime). Model main effects indicated that people who were Multiracial, White, women, gay/lesbian, or bisexual had greater odds of MDE. Additive effects of race/ethnicity, sex/gender, and sexual orientation explained most between-group variance; however, approximately 3% (past-year) and 12% (lifetime) were attributable to intersectional effects, with some groups experiencing excess/reduced prevalence. For both outcomes, sexual orientation main effects (42.9-54.0%) explained a greater proportion of between-group variance relative to race/ethnicity (10.0-17.1%) and sex/gender (7.5-7.9%). Notably, we extend MAIHDA to calculate nationally representative estimates to open future opportunities to quantify intersectionality with complex sample survey data.
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In a US national cohort study of cisgender sexual minority adolescents (SMAs), we prospectively (1) assessed whether within-person changes in homonegative school climate (i.e., school contextual factors that lead SMAs to feel unsafe or threatened) were associated with risk of probable body dysmorphic disorder (BDD) and (2) tested whether internalized homonegativity and negative expectancies mediated this association. Data came from consecutive time points (18-month, 24-month, 30-month) of the Adolescent Stress Experiences over Time Study (ASETS; N = 758). The Body Dysmorphic Disorder Questionnaire measured probable BDD. Sexual Minority Adolescent Stress Inventory subscales measured past 30-day minority stress experiences. Multilevel models were specified with person mean-centered predictor variables to capture within-person effects. Across one year of follow-up, 26.86% screened positive for probable BDD at least once. Model results indicated significant total (risk ratio [RR]=1.43, 95% credible interval [CI]=1.35-1.52) and direct effects (RR=1.18, 95% CI=1.05-1.34) of homonegative school climate. Internalized homonegativity was independently associated with probable BDD (RR=1.28, 95% CI=1.12-1.46) and mediated 49.7% (95% CI=12.4-82.0) of the total effect. There was limited evidence of mediation via negative expectancies. Implementing SMA-protective school policies and targeting internalized homonegativity in clinical practice may reduce the prevalence and incidence of probable BDD among cisgender SMAs.
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Transtornos Dismórficos Corporais , Minorias Sexuais e de Gênero , Humanos , Adolescente , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/epidemiologia , Estudos de Coortes , Imagem Corporal/psicologia , Instituições AcadêmicasRESUMO
Common stereotypes of those who desire or attempt to lose weight often center on the experience of White, thin women. However, prior studies have neglected how systems of oppression at intersection of race/ethnicity, gender, and weight status may interact to place certain subpopulations at elevated risk. Repeated cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 (n = 53,528), a population-representative sample of US adults, were used to 1) assess trends in past-year weight loss attempts using the Kendall-Mann trend test stratifying by race/ethnicity, gender, and weight status, and 2) estimate the adjusted prevalence of weight loss attempts over the combined 20-year period for combinations of race/ethnicity, gender, and weight status using logistic regression. There were significant monotonic trends from 1999 to 2018 for non-Hispanic Black men (43.8% to 67.8%, FDR adjusted p = .022) with an obese BMI, but not for any other groups. After adjusting for covariates, weight loss attempt prevalence was positively associated with BMI category for all race/ethnicity-gender combinations, although the degree of association differed. These findings underscore the need to use an intersectional lens in weight-related research. Despite limited long-term beneficial health impact, certain population subgroups, particularly Black men with an obese BMI, are increasingly trying to lose weight.
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Etnicidade , Redução de Peso , Adulto , Masculino , Feminino , Humanos , Prevalência , Inquéritos Nutricionais , Estudos Transversais , Obesidade/epidemiologiaRESUMO
INTRODUCTION: Child abuse is associated with adult obesity. Yet, it is unknown how the developmental timing and combination of abuse types affect this risk. This report examined how distinct child and adolescent abuse patterns were associated with incident obesity in young adulthood. METHODS: Data came from 7,273 participants in the Growing Up Today Study, a prospective cohort study in the U.S. with 14 waves from 1996 to 2016 (data were analyzed during 2020-2021). An abuse group variable was empirically derived using latent class analysis with indicators for child (before age 11 years) and adolescent (ages 11-17 years) physical, sexual, and emotional abuse. Risk ratios for obesity developing during ages 18-30 years were estimated using modified Poisson models. Associations of abuse groups with BMI across ages 18-30 years were then examined using mixed-effects models. All models were stratified by sex. RESULTS: Among women, groups characterized by abuse had higher BMIs entering young adulthood and greater changes in BMI per year across young adulthood. Groups characterized by multiple abuse types and abuse sustained across childhood and adolescence had approximately twice the risk of obesity as that of women in a no/low abuse group. Associations were substantially weaker among men, and only a group characterized by physical and emotional abuse in childhood and adolescence had an elevated obesity risk (risk ratio=1.38; 95% CI=1.04, 1.83). CONCLUSIONS: Obesity risk in young adulthood varied by distinct abuse groups for women and less strongly for men. Women who experience complex abuse patterns have the greatest risk of developing obesity in young adulthood.
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Maus-Tratos Infantis , Adulto , Masculino , Criança , Adolescente , Feminino , Humanos , Adulto Jovem , Estudos Prospectivos , Maus-Tratos Infantis/psicologia , Obesidade/epidemiologia , Índice de Massa Corporal , Razão de Chances , Fatores de RiscoRESUMO
BACKGROUND: Child maltreatment may be an important risk factor for eating disorder (ED) behaviors. However, most previous research has been limited to clinical, female, and cross-sectional samples, and has not adequately accounted for complex abuse patterns. OBJECTIVE: To determine whether women and men with distinct patterns of child and adolescent maltreatment have higher risks of developing ED behaviors in young adulthood than individuals with a low probability of maltreatment. PARTICIPANTS AND SETTING: Data came from 7010 U.S. women and men (95% White) in the Growing Up Today Study, a prospective, community-based cohort study (14 waves between 1996 and 2016). METHODS: We used a previously created maltreatment variable that was empirically derived using latent class analysis. Maltreatment groups were characterized as: "no/low abuse," "child physical abuse," "adolescent emotional abuse," "child and adolescent physical and emotional abuse," and "child and adolescent sexual abuse." We estimated risk ratios for ED behaviors developing in young adulthood using the modified Poisson approach with generalized estimating equations. We stratified models by sex. RESULTS: Groups characterized by maltreatment had elevated risks of incident ED behaviors compared with the "no/low abuse" group among both women and men. For women, risks tended to be strongest among the "child and adolescent sexual abuse" group. For men, risks tended to be strongest among the "child and adolescent physical and emotional abuse" group. Risks were particularly strong for purging behaviors. CONCLUSION: Risk of incident ED behaviors in young adulthood varied by distinct maltreatment groups. Detecting maltreatment early may help prevent EDs and subsequent maltreatment.
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Maus-Tratos Infantis , Transtornos da Alimentação e da Ingestão de Alimentos , Adolescente , Adulto , Criança , Maus-Tratos Infantis/psicologia , Estudos de Coortes , Estudos Transversais , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVE: Eating disorders (EDs) have high rates of psychiatric comorbidity. This study aimed to characterize longitudinal patterns of comorbidities in adults with EDs. METHODS: Sequence analysis and hierarchical clustering were applied to ages of onset and recency for select eating, substance, mood, and anxiety disorders from the 479 participants in the Collaborative Psychiatric Epidemiology Surveys with lifetime DSM-IV bulimia nervosa, binge eating disorder, or anorexia nervosa. External validators were compared across clusters using chi-square tests. RESULTS: Five clusters were identified among individuals with any lifetime ED based on longitudinal sequence of psychiatric disorder onset and remission, characterized as: (1) multi-comorbid with early onset of comorbid disorder (46%); (2) moderate preeminent anxiety with moderate comorbidity and low ED persistence (20%); (3) late ED onset with low comorbidity (15%); (4) early onset, persistent ED with low comorbidity (14%); and (5) chronic, early onset depression (5%). Clusters were well differentiated by significant differences in age, body mass index, race, and psychiatric indicators. CONCLUSIONS: This study demonstrates a new method to assess clustering of comorbidity among individuals with lifetime EDs. Having a psychiatric diagnosis prior to an ED was associated with greater psychopathology and illness duration. Information on timing of diagnoses may allow for more refined comorbidity classification.
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Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Estilo de Vida , Psicopatologia/métodos , Análise de Sequência/métodos , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Studies consistently report a higher prevalence of substance use disorders (SUDs) among women with eating disorders than control women. However, limited research exists on the prevalence of eating disorder symptoms and diagnoses in women with SUDs, especially in community-based populations. We examined the prevalence of eating disorder symptoms and diagnosis by the presence or absence of lifetime alcohol use disorder (AUD) and/or nicotine dependence (ND) in a community-based sample of women. METHODS: 3756 women (median age = 22 years) from the Missouri Adolescent Female Twin Study completed a modified semi-structured interview assessing lifetime DSM-IV psychiatric disorders and SUDs. Logistic regression models adjusted for demographic characteristics and other psychopathology, and robust standard errors accounted for the non-independence of twin data. RESULTS: In general, women with comorbid AUD and ND had a higher prevalence of eating disorder symptoms and diagnoses than women with AUD or ND Only, who in turn had a higher prevalence than those without either SUD. After adjustment for covariates, women with AUD and ND had significantly greater risk of broad anorexia nervosa (RRR = 3.17; 99 % CI = 1.35, 7.44), purging disorder (2.59; 1.24, 5.43), and numerous eating disorder symptoms than women with neither disorder. Significant differences emerged between individuals with both AUD and ND versus women with AUD Only or ND Only for some eating disorder symptoms. CONCLUSIONS: Women with lifetime AUD or ND diagnoses are at high risk for eating disorder symptoms and diagnoses, underscoring the importance of assessing eating disorder symptoms among women with these disorders.
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Alcoolismo/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Vida Independente/tendências , Tabagismo/epidemiologia , Adolescente , Alcoolismo/diagnóstico , Criança , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Humanos , Missouri/epidemiologia , Tabagismo/diagnóstico , Adulto JovemRESUMO
The current investigation assessed for moderating effects of childhood trauma on genetic and environmental contributions to timing of alcohol use initiation and alcohol use disorder in African American (AA) and European American (EA) women. Data were drawn from diagnostic telephone interviews conducted with 3786 participants (14.6% AA) in a longitudinal female twin study. Childhood trauma was defined alternately as child maltreatment and more broadly to include other events (e.g., witnessing violence). Phenotypic associations between childhood trauma and alcohol outcomes were estimated using logistic regression analyses. Twin modeling was conducted to test for moderating effects of childhood trauma on the contributions of genetic and environmental factors to timing of initiation and alcohol use disorder. Under both definitions, childhood trauma was associated with early initiation (relative risk ratios: 1.90, 1.72) and alcohol use disorder (odds ratios: 1.92, 1.76). Yet gene by environment effects were observed only for child maltreatment and timing of initiation in EA women, with heritable influences less prominent in those who had experienced child maltreatment (0.35, 95% CI: 0.05-0.66 vs. 0.52, 95% CI: 0.30-0.73). We found more similarities than differences in the association of childhood trauma with alcohol outcomes across racial/ethnic groups, trauma type, and stages of alcohol use. However, findings suggest that the relative contribution of genetic factors to alcohol outcomes differs by childhood maltreatment history in EA women specifically in the earliest stage of alcohol use.
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Alcoolismo/etiologia , Alcoolismo/genética , Negro ou Afro-Americano/psicologia , Maus-Tratos Infantis/psicologia , População Branca/psicologia , Adolescente , Alcoolismo/epidemiologia , Feminino , Humanos , Entrevistas como Assunto , Missouri/epidemiologia , Pesquisa Qualitativa , Adulto JovemRESUMO
The objective of this study was to examine whether previously observed associations of attention-deficit/hyperactivity disorder (ADHD) with eating disorders (EDs) are at least partially attributable to other underlying psychopathology. Data came from 4719 participants aged 18-44 years in the National Comorbidity Survey Replication and the National Survey of American Life. DSM-IV diagnoses were assessed using the World Health Organization Composite International Diagnostic Interview. Multinomial logistic regression assessed associations between DSM-IV lifetime and past-12 month diagnoses of ADHD with EDs in unadjusted models and in models adjusted for demographic variables and other psychopathology. Lifetime ADHD was strongly and significantly associated with lifetime bulimia nervosa (BN), binge eating disorder (BED), and any ED in unadjusted models, but not with anorexia nervosa or subthreshold BED. After adjusting for demographic variables and psychiatric comorbidities, all associations of lifetime ADHD with EDs were substantially attenuated, and only the association of ADHD with BN remained statistically significant. Similar results were found using past-12 month diagnoses. These results suggest that previously observed associations of ADHD with EDs might be due - at least in part - to additional psychiatric disorders that are often comorbid with both ADHD and EDs.
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Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/psicologia , Psicopatologia , Adulto JovemRESUMO
OBJECTIVE: This study aimed to determine the associations among paternal alcohol problems, separation, and educational attainment in European American and African American offspring and whether offspring early alcohol/tobacco/marijuana use influenced these associations. METHOD: Families with offspring ages 13-19 years at intake were selected from state birth records and screened by telephone to determine high-risk or low-risk status (with/without paternal heavy drinking). Families of men with two or more driving-under-the-influence offenses were added as a very-high-risk group. Data from 340 African American and 288 European American offspring who were not enrolled in school at their last interview were analyzed. Educational attainment was modeled as less than high school, high school only (reference category), and some college or higher. Separation was defined as offspring report of not having lived continuously in the same household with their biological father from birth to age 14. Analyses were stratified by race. RESULTS: In European Americans, neither family risk status nor early alcohol/tobacco/marijuana use was associated with educational outcomes. However, paternal separation significantly elevated the likelihood of not completing high school in all models (relative risk ratios [RRRs] = 6.0-8.1, p <.001). For African American offspring, likelihoods of high school noncompletion were elevated marginally for paternal separation in only one model, but significantly for early marijuana use (RRRs = 2.8-3.2, p < .05). Very-high-risk status significantly reduced the likelihood of post-high school education in an adjusted model (RRR = 0.4, p < .05). CONCLUSIONS: High school noncompletion was significantly associated with paternal separation in European Americans and with early marijuana use in African American offspring. In addition, very-high-risk status reduced the likelihood of post-high school education in African American offspring only, suggesting that research with ethnically diverse samples yields important differences when examining outcomes of both separation and substance use on offspring education.
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Transtornos Relacionados ao Uso de Álcool/epidemiologia , Pai , Fumar Maconha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Abuso de Maconha/epidemiologia , Razão de Chances , Risco , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVE: This study aims to determine whether the prevalence of lifetime and past 12-month DSM-IV eating disorders (ED) diagnoses differed by body mass index category among men and women in a general population sample. METHODS: Data from the Collaborative Psychiatric Epidemiology Surveys (n = 12 337 adults) were analysed using logistic regression. Analyses were conducted separately by gender. RESULTS: Lifetime ED prevalence was 2.22% in men and 4.93% in women. In both genders, the prevalence of any lifetime and past 12-month ED, binge eating disorder and recurrent binge eating was highest among obese individuals. Among obese men and women, lifetime and past 12-month ED prevalence was highest among those with class III obesity. CONCLUSION: Eating disorders were most prevalent among high-weight individuals. This information is important for planning targeted public health ED and obesity prevention and intervention activities, as well as for informing the clinical care of obese individuals. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Índice de Massa Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Successful identification of genetic risk factors in genomewide association studies typically has depended on meta-analyses combining data from large numbers of studies involving tens or hundreds of thousands of participants. This poses a challenge for research on Gene × Environment interaction (G × E) effects, where characterization of environmental exposures is quite limited in most studies and often varies idiosyncratically between studies. Yet the importance of environmental exposures in the etiology of many disorders-and especially alcohol, tobacco, and drug use disorders-is undeniable. We discuss the potential for "big-data" approaches (e.g., aggregating data from state databases) to generate consistent measures of neighborhood environment across multiple studies, requiring only information about residential address (or ideally residential history) to make progress in G × E analyses. Big-data approaches may also help address limits to the generalizability of existing research literature, such as those that arise because of the limited numbers of severely alcohol-dependent mothers represented in prospective research studies.
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Interpretação Estatística de Dados , Interação Gene-Ambiente , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/genética , Exposição Ambiental/efeitos adversos , Humanos , Estudos ProspectivosRESUMO
Few studies have assessed the association between attention-deficit hyperactivity disorder (ADHD) and eating disorders (ED) separately in men and women, especially in representative samples. Using data from the National Comorbidity Survey Replication, lifetime and past 12-month prevalence of Diagnostic and Statistical Manual of Mental Disorders IV, ADHD was compared in men and women with and without diagnoses of Diagnostic and Statistical Manual of Mental Disorders IV ED and any binge eating (BE) using logistic regression models adjusted for gender and age. In both sexes, those with lifetime and past 12-month BE and binge eating disorder had significantly higher prevalence of ADHD than those without BE and binge eating disorder, respectively. Women with lifetime and past 12-month bulimia nervosa and lifetime anorexia nervosa also had significantly higher prevalence of ADHD compared with women without these diagnoses. Given that ADHD invariably began earlier than the ED, ADHD may be an important risk factor for subsequent BE and related ED, and there may be opportunities for intervention among youth with ADHD. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno da Compulsão Alimentar/epidemiologia , Estudos de Casos e Controles , China/epidemiologia , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Ingestão de Alimentos , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Differences between African Americans (AAs) and European Americans (EAs) in the prevalence and age at onset of alcohol use and alcohol use disorder (AUD) have been documented, but distinctions in the timing of early stage transitions and contribution of various psychiatric and psychosocial risk factors to the progression from initiation to AUD have yet to be investigated. The current study characterized progression from alcohol use initiation-defined alternatively as first drink, first intoxication, and regular drinking onset-to AUD in AA and EA youth. METHODS: Psychiatric interviews were administered via telephone to 1,461 participants (56% AA, 44% EA) in a high-risk family study (50.3% female, mean age = 17.6 [SD = 3.8]). Cox proportional hazards regression analyses were conducted separately for the AA and EA subsamples to predict DSM-5 AUD as a function of age at alcohol use initiation, with age at first drink, age at first intoxication, and age at regular drinking onset as the point of origin in separate models. RESULTS: Across race/ethnicity, regardless of how it was measured, early alcohol use initiation predicted AUD, but hazard ratios (HRs) were lowest for first drink. Regular smoking and social anxiety disorder were significant predictors in both racial/ethnic groups, but associations with conduct disorder (all 3 models: HR range = 2.07 to 4.15) and major depressive disorder (regular drinking: HR = 4.51, confidence interval [CI]: 1.60 to 12.69 for AUD onset ≥ age 20) were specific to AAs. Posttraumatic stress disorder (HR = 5.38, CI: 1.44 to 20.08) and generalized anxiety disorder (HR = 7.35, CI: 2.31 to 23.34 for AUD onset ≤ age 17) were strongly associated with progression from regular drinking to AUD exclusively in EAs. CONCLUSIONS: Early alcohol use initiation is a marker of risk for AUD in both AA and EA youth, but the contributions of various psychiatric risk factors to the development of AUD are not universal across racial/ethnic groups.
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Comportamento do Adolescente/psicologia , Intoxicação Alcoólica/epidemiologia , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Negro ou Afro-Americano/psicologia , Consumo de Álcool por Menores/estatística & dados numéricos , População Branca/psicologia , Adolescente , Idade de Início , Progressão da Doença , Feminino , Humanos , Masculino , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: The aim of the current study was to determine whether the higher rates of childhood sexual abuse (CSA) but lower rates of cigarette smoking in African-American vs. European-American women can be explained in part by a lower magnitude of association between CSA and smoking in African-American women. METHODS: Data were drawn from a same-sex female twin study of substance use (n=3521; 14.3% African-American). Cox proportional hazards regression analyses using CSA to predict smoking initiation and progression to regular smoking were conducted separately by race/ethnicity. Co-twin status on the smoking outcome was used to adjust for familial influences on smoking (which may overlap with family-level influences on CSA exposure). RESULTS: After adjusting for co-twin status, CSA was associated with smoking initiation in European Americans (hazard ratio (HR)=1.43, 95% confidence intervals (CI): 1.26-1.62) and with smoking initiation ≤16 in African Americans (HR=1.70, CI: 1.26-2.29). CSA was associated with regular smoking onset ≤15 in European Americans (HR=1.63, CI: 1.21-2.18), with no change in HR after adjusting for co-twin status. In the African-American subsample, the HR for CSA was reduced to non-significance after adjusting for co-twin status (from HR=3.30, CI: 1.23-8.89 to HR=1.16, CI: 0.71-1.92 for regular smoking ≤15). CONCLUSIONS: CSA is associated with moderate elevation in risk for initiating smoking among African-American and European-American women. By contrast, CSA is associated with elevated risk for (adolescent onset) regular smoking only in European-American women. Furthermore, there is significant overlap between risk conferred by CSA and familial influences on regular smoking in African-American but not European-American women.
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Comportamento do Adolescente/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Abuso Sexual na Infância/estatística & dados numéricos , Fumar Cigarros/epidemiologia , População Branca/estatística & dados numéricos , Adolescente , Negro ou Afro-Americano/psicologia , Criança , Abuso Sexual na Infância/psicologia , Feminino , Humanos , Estudos Longitudinais , Missouri/epidemiologia , Modelos de Riscos Proporcionais , Fatores de Risco , Gêmeos/psicologia , Gêmeos/estatística & dados numéricos , População Branca/psicologiaRESUMO
BACKGROUND: Bulimic behaviors (i.e., binge eating and compensatory behaviors) and substance use frequently co-occur. However, the etiology underlying this association is poorly understood. This study evaluated the association between bulimic behaviors and early substance use, controlling for genetic and shared environmental factors. METHODS: Participants were 3,540 young adult women from the Missouri Adolescent Female Twin Study. A telephone adaptation of the Semi-Structured Assessment for the Genetics of Alcoholism interview assessed DSM-IV bulimic behaviors, substance use, and other psychological characteristics. Lifetime bulimic behaviors were examined in twin pairs concordant and discordant for early substance use. Logistic regressions were adjusted for the nonindependence of twin data, zygosity, age, body mass index, early menarche (onset before age 12), and early sex (first consensual sexual intercourse before age 15). RESULTS: In the entire study population, women who reported early use of alcohol or nicotine were more likely to engage in bulimic behaviors after adjusting for covariates. In 53 pairs of monozygotic twins discordant for alcohol experimentation before age 15, the twin who reported early alcohol experimentation had 3.21 (95% confidence interval = 1.54 to 6.67) times higher odds of reporting bulimic behaviors than the cotwin who did not report early alcohol experimentation, even after adjustment for covariates. CONCLUSIONS: Findings suggest that early alcohol experimentation may contribute to the development of bulimic behaviors via mechanisms extending beyond shared vulnerability, including individual-specific environmental experiences or causal pathways.
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Bulimia/diagnóstico , Bulimia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Gêmeos Dizigóticos , Gêmeos Monozigóticos , Adolescente , Fatores Etários , Estudos Transversais , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: We examined associations between parental separation during childhood and offspring alcohol involvement, adjusting for genetic and environmental risks specific to parental alcohol (AD) and cannabis/other illicit drug dependence (DD). METHODS: The sample consisted of 1,828 offspring of male twins from the Vietnam Era Twin (VET) Registry, who completed a telephone diagnostic interview. Cox proportional hazards regression analyses were conducted predicting onset of first use, transition from first use to first AD symptom, and transition from first use to AD diagnosis from paternal and avuncular AD and DD history, parental separation, and offspring and family background characteristics. Paternal/avuncular DD/AD was based on the DSM-III-R; offspring and maternal AD were based on DSM-IV criteria. RESULTS: Paternal DD/AD predicted increased offspring risk for all transitions, with genetic effects suggested on rate of transitioning to AD diagnosis. Parental separation was predictive of increased risk for early alcohol use, but a reduced rate of transition to both AD symptom onset and onset of AD. No interactions between separation and familial risk (indexed by paternal or avuncular DD/AD) were found. CONCLUSIONS: Findings highlight the contribution of both parental separation and paternal substance dependence in predicting timing of offspring alcohol initiation and problems across adolescence into early adulthood.
Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Relações Pai-Filho , Consumo de Álcool por Menores/estatística & dados numéricos , Adolescente , Adulto , Transtornos Relacionados ao Uso de Álcool/etiologia , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Medição de Risco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Despite substantial evidence that alcohol use disorder (AUD) and bulimic behaviors (i.e., binge eating and compensatory behaviors) co-occur, insufficient information exists regarding a possible shared etiology. Moreover, although numerous twin studies of European ancestry individuals have reported moderate heritability estimates for AUD and bulimic behaviors, with little evidence for shared environmental factors, research on genetic and environmental risk in African American (AA) individuals is lacking. METHODS: We investigated specific and overlapping genetic and environmental influences on AUD and bulimic behaviors in 3232 European American (EA; 55.38% monozygotic) and 549 AA (42.81% monozygotic) young adult female twins from the Missouri Adolescent Female Twin Study (age range=18-29 years). A structured clinical interview assessed lifetime DSM-5 AUD (minus craving) and bulimic behaviors. Biometrical twin modeling was conducted to generate age-adjusted estimates of genetic and environmental influences on AUD, bulimic behaviors, and their comorbidity. RESULTS: Estimates of genetic and environmental contributions on AUD and bulimic behaviors could be equated across EA and AA women. Additive genetic effects accounted for 59% (95% CI: 50%, 66%) and 43% (33%, 52%) of the variance in AUD and bulimic behaviors, respectively, with the remainder due to non-shared environmental effects. Shared genetic factors (rg=.33 (.18, .49)) were solely responsible for the correlation between phenotypes; the non-shared environmental correlation was not significant (re=.10 (-.05, .25)). CONCLUSIONS: Findings indicate similar magnitudes of genetic and environmental effects on AUD and bulimic behaviors for EA and AA women and implicate common genetic mechanisms underlying liability to these problem behaviors.
Assuntos
Alcoolismo/epidemiologia , Alcoolismo/genética , Negro ou Afro-Americano/genética , Bulimia/epidemiologia , Bulimia/genética , Gêmeos/genética , População Branca/genética , Adolescente , Adulto , Comorbidade , Meio Ambiente , Europa (Continente)/etnologia , Feminino , Humanos , Missouri/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: Childhood sexual abuse (CSA) is associated with elevated risk of early marijuana use and cannabis use disorder (CUD). Both the prevalence of CSA and the course of marijuana use differ between African Americans and European Americans. The current study aimed to determine whether these differences manifest in racial/ ethnic distinctions in the association of CSA with early and problem use of marijuana. METHOD: Data were derived from female participants in a female twin study and a high-risk family study of substance use (n = 4,193, 21% African-American). Cox proportional hazard regression analyses using CSA to predict initiation of marijuana use and progression to CUD symptom(s) were conducted separately by race/ethnicity. Sibling status on the marijuana outcome was used to adjust for familial influences. RESULTS: CSA was associated with both stages of marijuana use in African-American and European-American women. The association was consistent over the risk period (hazard ratio [HR] = 1.57, 95% confidence interval [CI] [1.37, 1.79] for initiation; HR = 1.51, 95% CI [1.21, 1.88] for CUD symptom onset) in European-American women. In African-American women, the HRs for initiation were 2.52 (95% CI [1.52, 4.18]) before age 15, 1.82 (95% CI [1.36, 2.44]) at ages 15-17, and nonsignificant after age 17. In the CUD symptom model, CSA predicted onset only at age 21 and older (HR = 2.17, 95% CI [1.31, 3.59]). CONCLUSIONS: The association of CSA with initiation of marijuana use and progression to problem use is stable over time in European-American women, but in African-American women, it varies by developmental period. Findings suggest the importance of considering race/ethnicity in prevention efforts with this high-risk population.