Bidirectional Associations Between Pain and Perceived Stress Among Veterans: Depressive Disorder as a Predisposing Factor.

OBJECTIVE: Military veterans who were injured in combat very often report pain along with co-occurring perceived stress and preexisting depressive disorder. The systems model of pain is a theoretical model suggesting that pain and perceived stress are bidirectionally associated at the within-person level, and associations are heightened among those with depressive disorder. However, the systems model of pain has not been adequately tested. Testing the systems model of pain could illuminate salient treatment targets for combat-injured veterans with pain and co-occurring psychological problems. METHODS: The present study empirically tests the systems model of pain among a sample of combat-injured veterans ( N = 902) surveyed five times during an 18-month period. We used a multigroup, autoregressive latent trajectory with structured residual statistical model to test the within-person associations between pain and perceived stress and determine whether associations differ between veterans with and without a positive screen for depressive disorder. RESULTS: In line with the systems model of pain, pain and perceived stress were bidirectionally associated only among combat-injured veterans with depressive disorder. Among such veterans, perceived stress was positively associated with subsequent pain ( b = 0.12; 95% confidence interval = 0.06-0.17), and pain was positively associated with subsequent perceived stress ( b = 0.44; 95% CI = 0.11-0.77). CONCLUSIONS: Our work highlights the interplay between pain and its psychological correlates among a particularly at-risk population. Clinicians addressing pain and perceived stress among combat-injured veterans should be prepared to identify and address depressive disorder.

Caseworker documentation of mothers in foster care: A case study in California.

BACKGROUND: Young people in foster care frequently experience early parenting, and U.S. law requires the documentation of parents in care. The extent to which the child protection system (CPS) has accurately collected information on parents in care remains largely unknown and has ramifications for the planning and delivery of services. OBJECTIVE: Using California as a case study, this study documented young mothers in care using birth records, determined the proportion of mothers correctly identified in CPS records, and compared characteristics and placements of mothers who were or were not identified. POPULATION: All mothers aged 15-21 years documented by vital birth records (2014 and 2019) were probabilistically linked to CPS records, yielding 3199 mothers in care. METHOD: We compared mothers who were or were not identified in CPS records using bivariate statistics. A chi-square test for trends examined differences in documentation over time. RESULTS: A third of mothers were not identified as such in CPS records (n = 1136). The proportion of mothers identified by caseworkers rose from 50 % in 2014 to 71.5 % in 2019 (p < .001). Nonminor dependent mothers and those placed in supervised independent living programs were more likely to be misclassified in CPS data. CONCLUSIONS: Motherhood may not be documented in CPS records; however, significant improvements were evident. Results suggest that all nonminor dependents should be informed of available services for expectant and parenting individuals, especially if they are living in less restrictive placements, given they are more likely to give birth and less likely to be identified in CPS records than minor dependents.

High Spirits? Exploring "Halloweekend" Alcohol and Cannabis Use Among Heavy-Drinking College Students.

OBJECTIVE: Specific events are associated with heavier and riskier substance use behaviors among college students, including holidays like Halloween, which may include several days of themed parties/events ("Halloweekend"). The current study compared drinking, pregaming (i.e., fast-paced drinking before going out for the night), cannabis use, same-day alcohol and cannabis co-use, and negative alcohol-related consequences over Halloweekend compared with two adjacent non-Halloween weekends among a sample of heavy-drinking university students. METHOD: Participants (N = 228; 65% female) provided 28 days of daily diary data. We used a three-level generalized linear mixed model (GLMM) approach estimating zero-inflated Conway-Maxwell Poisson regressions to assess the effect of weekend and specific weekend day on number of overall drinks, number of pregaming drinks, and negative alcohol-related consequences. Proportions tests assessed for differences in any cannabis use and daily co-use between Halloweekend and non-Halloween weekends. RESULTS: Zero-inflated portions of the GLMMs indicated that general drinking, pregaming, and negative consequences were most prevalent on Halloweekend and Fridays and Saturdays. Count portions of the models indicated that general drinking quantity was highest during these periods, and participants experienced a greater number of negative consequences on Halloweekend compared with the weekend before; no differences were observed in the quantity of pregaming drinks consumed across weekends or days. No significant differences in cannabis use or co-use were observed between weekends. CONCLUSIONS: Given risk associated with Halloweekend compared with weekends immediately before and after, interventions targeting alcohol use and pregaming on Halloweekend may be beneficial to reduce related harm for heavy-drinking students.

Changes in Household Challenges and Subsequent Child Welfare Report.

INTRODUCTION: Preventing child maltreatment and reducing adverse childhood experiences is critical for improving adult health. To inform prevention efforts, it is necessary to move beyond static risk models and instead model the dynamic changes in household challenges during the prebirth and early childhood periods. This study examined the effect of changes in the number of household challenges from prebirth (12 months before birth of a child) to early childhood (3 years after birth) period on the risk of a child maltreatment report by age 3 years. METHODS: This retrospective cohort study linked data from the Alaska 2009-2011 Pregnancy Risk Assessment Monitoring System, its 3-year follow-up survey, and administrative records through 2019. Participants were 1,699 birthing parents. Latent class analyses identified prebirth and early childhood low- and high-challenge respondent groups on the basis of the level of reported household challenges. The authors then modeled the relationships between group transition membership and the risk of maltreatment using latent transition analysis. Analyses were conducted in 2021. RESULTS: Households transitioning from a high-challenge-prebirth status to a low-challenge-early-childhood status had a lower predicted risk for child services report than households remaining in the high-challenges group. Transitioning from low- to high-challenges status predicted the highest risk for child services report than that of all other groups. CONCLUSIONS: To reduce the risk of child maltreatment and subsequent adverse childhood experiences, healthcare providers should screen parents for the presence of household challenges during both pregnancy and early childhood and connect patients to resources targeted at reducing those challenges and providing continuous familial support.

General cognitive ability assessment in the German National Cohort (NAKO) - The block-adaptive number series task.

Objectives. Evaluate the block-adaptive number series task of reasoning, as a time-efficient proxy of general cognitive ability in the Level-2 sample of the German National Cohort (NAKO), a population-based mega cohort.Methods. The number series task consisted of two blocks of three items each, administered as part of the touchscreen-based assessment. Based on performance on the first three items, a second block of appropriate difficulty was automatically administered. Scoring of performance was based on the Rasch model. Relations of performance scores to age, sex, education, study centre, language proficiency, and scores on other cognitive tasks were examined.Results. Except for one very difficult item, the data of the remaining 14 items showed sufficient fit to the Rasch model (Infit: 0.89-1.04; Outfit: 0.80-1.08). The resulting performance scores (N = 21,056) had a distribution that was truncated at very high levels of ability. The reliability of the performance estimates was satisfactory. Relations to age, sex, education, and the executive function factor of the other cognitive tasks in the NAKO supported the validity.Conclusions. The number series task provides a valid proxy of general cognitive ability for the Level-2 sample of the NAKO, based on a highly time-efficient assessment procedure.

Community disadvantage, family socioeconomic status, and racial/ethnic differences in maltreatment reporting risk during infancy.

BACKGROUND: Children are reported for maltreatment during infancy at elevated rates; research has established persistent racial/ethnic differences in the likelihood of reporting to the child protection system (CPS). OBJECTIVE: To model the influence of race/ethnicity and community disadvantage in CPS reporting during infancy. PARTICIPANTS/SETTING: A population-based dataset consisting of more than 1.2 million children born in California between 2012 and 2014. Vital birth records were probabilistically linked to administrative CPS records. American Community Survey data were used to measure community disadvantage. METHODS: For each child, we coded sociodemographic information from the birth record, assigned the child to a community using their residential address at birth, and captured maltreatment reports from child protection records. We employed a modified Poisson regression model to examine an infant's likelihood of being reported to CPS by race/ethnicity across levels of community disadvantage and after adjusting for individual-level covariates. RESULTS: Infants born in neighborhoods with the most concentrated disadvantage were reported to CPS at 7 times the rate of children born in the most advantaged neighborhoods (12.3% vs. 1.8%). After adjusting for individual-level covariates, we found that both Black and Hispanic infants born on public insurance were significantly less likely than White infants to be reported for maltreatment overall - and Black and Hispanic infants had a statistically equivalent or lower likelihood of reporting at the two extremes of neighborhood disadvantage. Among privately insured families, Hispanic infants continued to have a lower likelihood of reporting, but Black infants were reported at higher rates than White infants. This Black-White difference persisted in the most advantaged neighborhoods, but disappeared in the most disadvantaged neighborhoods. CONCLUSIONS: Capturing individual-level differences in socioeconomic status and associated risk factors is critical to understanding sources of racial/ethnic differences in CPS reporting, including when there is unwarranted variation or disparate treatment. Our findings suggest an elevated likelihood of maltreatment reporting among privately insured Black infants not explained by differences in observed risk or neighborhood, but no such differences were documented for Black or Hispanic infants on public insurance.

Associations between symptoms of posttraumatic stress disorder, pain, and alcohol use disorder among OEF/OIF/OND veterans.

BACKGROUND: Alcohol use disorder (AUD) is prevalent among Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veterans. Pain and posttraumatic stress disorder (PTSD) are highly comorbid and increase risk of AUD. Prior studies linking pain or PTSD to AUD have not explored interactions between pain and PTSD symptoms. METHODS: OEF/OIF/OND veterans (N = 1230) were recruited from social media websites for a cross-sectional study of health behavior. Pain was assessed using the Pain Outcomes Questionnaire. PTSD symptoms and PTSD symptom clusters were assessed using the Posttraumatic Stress Disorder Checklist for DSM-5. AUD symptoms were assessed with the AUD Identification Test. Linear regression models were used to test for main and interaction effects in the full sample and separately by sex. RESULTS: Both pain and PTSD symptoms were associated with increased AUD symptomology, though the relationship between pain and AUD was heighted at relatively low PTSD symptoms. With respect to PTSD symptom clusters, re-experiencing and negative cognitions and mood were associated with increased AUD symptomology. Interactions between pain and re-experiencing as well as pain and avoidance were revealed. Results for men mirrored the full sample, while an interaction between pain and negative cognitions and mood was associated with AUD in women. CONCLUSIONS: Results highlight associations between AUD, PTSD symptoms, and pain among veterans. While the relationship between pain and AUD appeared stronger in the context of low PTSD symptoms, both pain and PTSD symptoms were associated with increased AUD. Clinicians treating veterans with AUD should address the range of potential comorbidities.

Comparing the effectiveness of three substance use interventions for youth with and without homelessness experiences prior to treatment.

OBJECTIVE: Many adolescents and young adults receiving substance use treatment have experienced or are at risk for homelessness. It is unknown whether specific treatment approaches are more or less effective for youth experiencing homelessness (YEH) compared to stably housed youth. The present study compared the effectiveness of the Adolescent Community Reinforcement Approach, Motivational Enhancement Therapy combined with Cognitive-Behavioral Therapy (MET/CBT), and Treatment as Usual (TAU) for these two groups. Further subgroup differences were investigated by age, sex, and sexual and gender minority status. METHOD: YEH (n = 855) and a matched sample of stably housed youth (n = 855) were drawn from the Global Appraisal of Individual Needs, a nationwide substance use treatment data set. Multiple-group latent change score modeling was used to examine change in substance use frequency and related problems at baseline, 3-, 6-, and 12-month follow-ups. RESULTS: Results indicated significant declines in substance use frequency and problems during treatment for all intervention groups. The TAU group showed the greatest declines in substance use problems during treatment and the greatest declines in frequency post-treatment. Compared to stably housed youth, YEH entered treatment with greater substance use and problems, and had greater declines in substance use in the MET/CBT group only. Other differences were found by age and sex. CONCLUSIONS: Overall, all three substance use interventions appear to be effective in reducing substance use and related problems. TAU and MET/CBT may be particularly effective for YEH in treatment settings. Implications for future research and practice are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Reciprocal Relationship between Instrumental Support from Children and Self-Rated Health among Older Adults over Time in Rural China.

Objective: To investigate the dynamic interplay between instrumental support from children and self-rated health (SRH) among older adults over time in rural China. Methods: Data came from a regional representative, longitudinal study The Well-Being of Older People in Anhui Province collected in 2001, 2003, 2006, 2009, and 2012. At baseline, 1636 respondents reported having at least one child. Bivariate latent change score modeling was conducted, and sequential model comparison was used to assess the directionality of the reciprocal association. Results: Older adults who received higher levels of help with household chores from children tended to experience improvement in subsequent SRH, irrespective of gender. There is no evidence to support the influence of SRH on subsequent changes in instrumental support. Discussion: This study sheds light on the sequence of changes between support and health processes using population-based data within a specific sociocultural context.

Measuring the Incidence of Child Maltreatment Using Linked Data: A Two-State Comparison.

INTRODUCTION: Measuring and comparing the incidence of child maltreatment is challenging. Linkage of statewide birth cohorts with Child Protective Services reports to study incident child maltreatment over the life course are becoming more common. This study compares the reported incidence between 2 states derived from population-based administrative data linkages. METHODS: Linked births (2009-2011) with Child Protective Services records (2009-2015) and deaths in each state were used to compare the cumulative incidence of a Child Protective Services report before age 7 years. Given differences in population race structure and documented disparities of race groups in Child Protective Services data, variation was adjusted for using direct standardization. Unadjusted cumulative incidence, race cumulative incidence, and race-adjusted cumulative incidence were compared. Analyses were completed in 2018. RESULTS: Before age 7 years, 26.0% of Alaskan children and 19.0% of Californian children were reported to Child Protective Services (RR=1.37, p<0.001). Aside from Asian/Pacific Islanders, the cumulative incidence between states was similar for each race. The race-adjusted cumulative incidence indicated that children born in Alaska were 1.10 times as likely to experience a report before age 7 years compared with children in California. CONCLUSIONS: Much of the difference in risk for child maltreatment observed between Alaska and California is most likely due to variation in the population structure by race as opposed to modifiable factors. Standardization is a simple method to adjust for population structure differences. This study contributes to the growing body of knowledge regarding the use of linked administrative data to study maltreatment and provides insights into considerations for making comparisons or conducting cross-jurisdictional analyses based on commonly aligned data sets.

Addressing the opioid epidemic with behavioral interventions for adolescents and young adults: A quasi-experimental design.

OBJECTIVE: While several behavioral interventions have shown efficacy in opioid use disorder treatment, little is known regarding which behavioral interventions work best for youth, and if treatment responses vary by developmental age or sex. We explored latency to first episode of opioid use among adolescents and young adults following opioid use disorder treatment initiation with: (a) adolescent community reinforcement approach (A-CRA), (b) motivational enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) or CBT alone (MET/CBT or CBT alone), or (c) treatment as usual (TAU; 12-step facilitation, supportive therapy). METHOD: Adolescents and young adults (N = 785) entering treatment for opioid use disorder were followed for 1 year. Survival analysis was used to assess variation in latency to first episode of opioid use by treatment received, as well as moderation by age group and sex. RESULTS: Those receiving MET/CBT or CBT alone, and TAU fared better than those receiving A-CRA. For adolescent males, those receiving TAU or A-CRA had poorer outcomes compared with those receiving MET/CBT or CBT alone, while no differences were found between treatments for female adolescents. Female young adults receiving TAU had lower hazard of opioid use compared with those receiving A-CRA, and MET/CBT or CBT alone, and male young adults receiving A-CRA had higher hazard than those receiving TAU, and MET/CBT or CBT alone. CONCLUSIONS: Findings highlight different treatments may be more efficacious for youth based on developmental age and sex. Clinicians working with young people with opioid use disorder should consider patients' developmental stage and sex when considering treatment approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Income gains predict cognitive functioning longitudinally throughout later childhood in poor children.

Alleviating disadvantage in low-income environments predicts higher cognitive abilities during early childhood. It is less established whether family income continues to predict cognitive growth in later childhood or whether there may even be bidirectional dynamics. Notably, living in poverty may moderate income-cognition dynamics. In this study, we investigated longitudinal dynamics over 7 waves of data collection from 1,168 children between the ages of 4.6 and 12 years, 226 (19%) of whom lived in poverty in at least 1 wave, as part of the NICHD Study of Early Child Care and Youth Development. Two sets of dual change-score models evaluated, first, whether a score predicted change from that wave to the next and, second, whether change from 1 wave to the next predicted the following score. As previous comparisons have documented, poor children had substantially lower average starting points and cognitive growth slopes through later childhood. The first set of models showed that income scores did not predict cognitive change. In reverse, child cognitive scores positively predicted income change. We speculated that parents may reduce their work investment, thus reducing income gains, when their children fall behind. Second, income changes continued to positively predict higher cognitive scores at the following wave for poor children only, which suggests that income gains and losses continue to be a leading indicator in time of poor children's cognitive performance in later childhood. This study underlined the need to look at changes in income, allow for poverty moderation, and explore bidirectional income-cognition dynamics in middle childhood. (PsycINFO Database Record

Prenatal substance exposure diagnosed at birth and infant involvement with child protective services.

Infants have the highest rates of maltreatment reporting and entries to foster care. Prenatal substance exposure is thought to contribute to early involvement with child protective services (CPS), yet there have been limited data with which to examine this relationship or variations by substance type. Using linked birth, hospital discharge, and CPS records from California, we estimated the population prevalence of medically diagnosed substance exposure and neonatal withdrawal disorders at birth. We then explored the corresponding rates of CPS involvement during the first year of life by substance type after adjusting for sociodemographic and health factors. Among 551,232 infants born alive in 2006, 1.45% (n=7994) were diagnosed with prenatal substance exposure at birth; 61.2% of those diagnosed were reported to CPS before age 1 and nearly one third (29.9%) were placed in foster care. Medically diagnosed prenatal substance exposure was strongly associated with an infant's likelihood of being reported to CPS, yet significant variation in the likelihood and level of CPS involvement was observed by substance type. Although these data undoubtedly understate the prevalence of prenatal illicit drug and alcohol use, this study provides a population-based characterization of a common pathway to CPS involvement during infancy. Future research is needed to explicate the longer-term trajectories of infants diagnosed with prenatal substance exposure, including the role of CPS.

Theory-guided exploration with structural equation model forests.

Structural equation model (SEM) trees, a combination of SEMs and decision trees, have been proposed as a data-analytic tool for theory-guided exploration of empirical data. With respect to a hypothesized model of multivariate outcomes, such trees recursively find subgroups with similar patterns of observed data. SEM trees allow for the automatic selection of variables that predict differences across individuals in specific theoretical models, for instance, differences in latent factor profiles or developmental trajectories. However, SEM trees are unstable when small variations in the data can result in different trees. As a remedy, SEM forests, which are ensembles of SEM trees based on resamplings of the original dataset, provide increased stability. Because large forests are less suitable for visual inspection and interpretation, aggregate measures provide researchers with hints on how to improve their models: (a) variable importance is based on random permutations of the out-of-bag (OOB) samples of the individual trees and quantifies, for each variable, the average reduction of uncertainty about the model-predicted distribution; and (b) case proximity enables researchers to perform clustering and outlier detection. We provide an overview of SEM forests and illustrate their utility in the context of cross-sectional factor models of intelligence and episodic memory. We discuss benefits and limitations, and provide advice on how and when to use SEM trees and forests in future research. (PsycINFO Database Record

Prenatal Substance Exposure and Reporting of Child Maltreatment by Race and Ethnicity.

BACKGROUND: Substance exposure is thought to contribute to reports of suspected maltreatment made to child protective services (CPS) at or shortly after birth. There are limited data, however, on whether clinicians are more likely to report black and Hispanic substance-exposed infants compared with white infants. METHODS: We examined racial differences in diagnosed substance exposure and subsequent maltreatment reports by using linked birth, hospital discharge, and CPS records. Diagnostic codes were used to document substance exposure; CPS records provided information on maltreatment reports. Prevalence of infant exposure was calculated by race or ethnicity, substance type, and sociodemographic covariates. We estimated racial differences in maltreatment reporting among substance-exposed infants using multivariable models. RESULTS: In a 2006 population-based California birth cohort of 474 071 black, Hispanic, and white infants, substance exposure diagnoses were identified for 1.6% of infants (n = 7428). Exposure varied significantly across racial groups (P < .001), with the highest prevalence observed among black infants (4.1%) and the lowest among Hispanic infants (1.0%). Among white and Hispanic infants, the most frequently observed substances were amphetamine and cannabis; for black infants, cannabis was the most common, followed by cocaine. After adjusting for sociodemographic and pregnancy factors, we found that substance-exposed black and Hispanic infants were reported at significantly lower or statistically comparable rates to substance-exposed white infants. CONCLUSIONS: Although we were unable to address potential racial and ethnic disparities in screening for substances at birth, we found no evidence that racial disparities in infant CPS reports arise from variable responses to prenatal substance exposure.

White matter and memory in healthy adults: Coupled changes over two years.

Numerous cross-sectional studies have used diffusion tensor imaging (DTI) to link age-related differences in white matter (WM) anisotropy and concomitant decrements in cognitive ability. Due to a dearth of longitudinal evidence, the relationship between changes in diffusion properties of WM and cognitive performance remains unclear. Here we examine the relationship between two-year changes in WM organization and cognitive performance in healthy adults (N=96, age range at baseline=18-79 years). We used latent change score models (LCSM) to evaluate changes in age-sensitive cognitive abilities - fluid intelligence and associative memory. WM changes were assessed by fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) in WM regions that are considered part of established memory networks and exhibited individual differences in change. In modeling change, we postulated reciprocal paths between baseline measures and change factors, within and between WM and cognition domains, and accounted for individual differences in baseline age. Although baseline cross-sectional memory performance was positively associated with FA and negatively with RD, longitudinal effects told an altogether different story. Independent of age, longitudinal improvements in associative memory were significantly associated with linear reductions in FA and increases in RD. The present findings demonstrate the sensitivity of DTI-derived indices to changes in the brain and cognition and affirm the importance of longitudinal models for evaluating brain-cognition relations.

Ten-year longitudinal trajectories of older adults' basic and everyday cognitive abilities.

OBJECTIVE: To examine the longitudinal trajectories of everyday cognition and longitudinal associations with basic (i.e., laboratory and experimentally measured) cognitive abilities, including verbal memory, inductive reasoning, visual processing speed, and vocabulary. METHOD: Participants were healthy older adults drawn from the no-treatment control group (N = 698) of the Advanced Cognitive Training for the Independent and Vital Elderly (Willis et al., 2006) randomized trial and were assessed at baseline and 1, 2, 3, 5, and 10 years later. Analyses were conducted using latent growth models. RESULTS: Modeling revealed an overall inverted-U shape (quadratic) trajectory across cognitive domains. Among basic cognitive predictors, level and slope in reasoning demonstrated the closest association to level and slope of everyday cognition, and accounted for most of the individual differences in linear gain in everyday cognition. CONCLUSION: Everyday cognition is not buffered against decline, and is most closely related to inductive reasoning in healthy older adults. To establish the clinical utility of everyday cognitive measures, future research should examine these associations in samples with more cognitive impairment.

How representative is the ACTIVE sample? A statistical comparison of the ACTIVE sample and the HRS sample.

OBJECTIVE: This research is designed to examine demographic differences between the ACTIVE sample and the larger, nationally representative Health and Retirement Study (HRS) sample. METHOD: After describing some relevant demographics (age, education, sex, and race/ethnicity), we use three statistical methods to determine sample differences--logistic regression modeling (LRM), decision tree analysis (DTA), and post-stratification and raking methods. When some differences are found, we create sample weights that other researchers can use to adjust these differences. RESULTS: The ACTIVE sample is younger, more likely to be female, Black, and more highly educated than the HRS sample. Sample weights were created. DISCUSSION: By using the resulting sample weights, all results of ACTIVE analyses can be said to be nationally representative based on HRS demographics.

A latent change score analysis of a randomized clinical trial in reasoning training.

The authors analyzed longitudinal data from a cognitive training experiment--Advanced Cognitive Training for Independent and Vital Elderly--using several alternative contemporary statistical models to test dynamic hypotheses based on latent change scores. The analyses focused on pretest and posttest data for only the group who received Reasoning training compared with the No-Contact (control) group. The initial structural equation modeling (SEM) path model isolated several training effects and an important source of transfer of training, Near-->Far, but this transfer was not increased due to training. The subsequent models, which accounted for pretest differences and latent changes, implied that only the Near measurements were influenced by training, and the change transfer was small. Introduction of common factors for both Near and Far measurements showed the factor patterns were unaffected by training or time and suggested training was a broader effect than in any single variable. The bivariate analysis of common factors did not appear to alter the previous results. Addition of demographic covariates and latent mixture analysis of the trained group led to further results. The uses of contemporary SEMs with experimental data are discussed.