Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and Multiple Sclerosis severity.

Intro: Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to Multiple Sclerosis (MS) features; yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated. Aim: To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience. Methods: Adults with MS (N=924) participated in an online survey through the National MS Society listserv. Structural Equation Modeling was used to examine the direct and indirect effect of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity and interference), via resilience, mental health (anxiety and depression), sleep disturbance, and smoking. Results: The final analytic model had excellent fit (GFI=0.998). Lifetime stressors had a direct relationship with MS severity (ß=0.27, p<.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of mediation was significant (ß=0.45). Conclusions: This work provides foundational evidence to inform conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve disease course.

Allostatic Load, Morbidity, and Mortality Among Older Adults: A Multi-Wave Analysis From the National Health and Aging Trends Study.

Although allostatic load (AL) is a key concept to reflect physiologic wear and tear from stress, older adults are underrepresented in AL-related research, especially the oldest old (≥80). Further, attenuative factors are often unaccounted for. This longitudinal analysis using data from National Health and Aging Trends Study investigated relationships of AL in 2017 and multi-wave (1) comorbidity accumulation using multilevel Poisson modeling and (2) mortality risk using survival analysis. By year five (2022), each incremental AL increase that older adults (n = 3614) experienced was associated with a 47% increase in comorbidity (p < .001), and a 33% increased mortality risk (p < .001). This research supports a shift to a more proactive, health promotion/risk mitigation paradigm through informing intervention research targeting AL, which is currently scarce. Identifying potentially modifiable and key driving factors influencing the relationship between AL and health among older adults is an important next step to inform intervention design.

Fatigue, pain interference, and psychiatric morbidity in multiple sclerosis: The role of childhood stress.

BACKGROUND: Multiple sclerosis (MS) is a progressive, autoimmune disease of the central nervous system that affects nearly one million Americans. Despite the existence of immunomodulatory therapies to slow physical and cognitive disability progression, interventions to ameliorate common symptoms of MS, including fatigue and pain, remain limited. Poor understanding of risk factors for these symptoms may contribute to treatment challenges. In recent years, childhood stress has been investigated as a risk factor for chronic autoimmune conditions including MS; yet remarkably few studies have investigated the relationship between childhood stressors and chronic MS symptoms. Our aim was to examine clusters of stressors and three key features of MS: fatigue, pain interference, and psychiatric morbidity. METHODS: Cross-sectional data were collected from a sample of People with MS (PwMS) via a national web-based survey that assessed the presence and type of childhood stressors and MS clinical features. Hierarchical block regression was used to assess associations among emotional, physical, and environmental childhood stressors and three clinical features commonly experienced by PwMS. RESULTS: N = 719 adults with MS (aged 21-85) completed the survey. Childhood emotional and physical stressors were significantly associated with overall presence of fatigue (p = 0.02; p<0.03) and pain interference (p<0.001; p<0.001) in adulthood, as well as the magnitude of both outcomes. Environmental stressors (p<0.001), in addition to emotional (p<0.001) and physical (p<0.001) stressors were significantly associated with psychiatric morbidity in PwMS. CONCLUSION: Childhood stress may predict fatigue, psychiatric morbidity, and pain in adults with MS. Further research is needed to show cause and effect; however, if an association exists, strategies to mitigate the impact of childhood stress could offer new pathways to reduce the severity of these symptoms. Broadly, this work adds to the body of evidence supporting upstream preventive measures to help address the stress on children and families.

Associations among stressors across the lifespan, disability, and relapses in adults with multiple sclerosis.

INTRODUCTION: Stress and adversity during childhood, adolescence, and adulthood could impact the present and future health and well-being of people with multiple sclerosis (PwMS); however, a lifespan approach and nuanced stressor data are scarce in this nascent area of research. Our aim was to examine relationships among comprehensively measured lifetime stressors and two self-reported MS outcomes: (1) disability and (2) relapse burden changes since COVID-19 onset. METHODS: Cross-sectional data were collected from a nationally distributed survey of U.S.-based adults with MS. Hierarchical block regressions were used to sequentially evaluate contributions to both outcomes independently. Likelihood ratio (LR) tests and Akaike information criterion (AIC) were used to evaluate additional predictive variance and model fit. RESULTS: A total of 713 participants informed either outcome. Most respondents (84%) were female, 79% had relapsing remitting multiple sclerosis (MS), and mean (SD) age was 49 (12.7) years. Childhood (R2  = .261, p < .001; AIC = 1063, LR p < .05) and adulthood stressors (R2  = .2725, p < .001, AIC = 1051, LR p < .001) contributed significantly to disability, above and beyond prior nested models. Only adulthood stressors (R2  = .0534, p < .001; AIC = 1572, LR p < .01) significantly contributed above the nested model for relapse burden changes since COVID-19. CONCLUSIONS: Stressors across the lifespan are commonly reported in PwMS and could contribute to disease burden. Incorporating this perspective into the "lived experience with MS" could facilitate personalized health care by addressing key stress-related exposures and inform intervention research to improve well-being.

Peer Recovery Coaches Perceptions of Their Work and Their Implications for Training, Support and Personal Recovery.

The peer recovery workforce, including individuals in sustained recovery from substance use, has grown rapidly in the previous decades. Peer recovery coaches represent a scalable, resource-efficient, and acceptable approach to increasing service delivery, specifically among individuals receiving substance use services in low-resource communities. Despite the potential to improve access to care in traditionally underserved settings, there are a number of barriers to successfully integrating peer recovery coaches in existing recovery services. The current study presents results from two focus groups composed of peer recovery coaches. Findings suggest that peer recovery coaches report discordance between their perceived role and their daily responsibilities and experience both inter- and intrapersonal challenges that impact their own recovery processes. These results point to several promising policy and structural changes that may support and enhance this growing workforce.

Relationships between childhood trauma and multiple sclerosis: A systematic review.

OBJECTIVE: Adverse Childhood Experiences (ACEs), such as physical, emotional, and sexual abuse trigger inflammatory changes and have been associated with many causes of morbidity and mortality, including autoimmune diseases. Although Multiple Sclerosis (MS) is a debilitating neurological autoimmune disease, literature linking ACEs and MS is understudied. The aim of this review was to examine the 1) state of the literature, and 2) relationships between childhood adversity and the prevalence and physical clinical features of MS (e.g., age at onset, relapses, pain, fatigue, disability). METHODS: A comprehensive search was preformed through five databases and by hand using the ancestry and descendancy approach for connections to papers published through January 20th, 2022. Studies were screened by independent reviewers using Rayyan.ai, and critically appraised for both quality and reporting transparency. RESULTS: Twelve studies examined relationships between any ACE(s) and the prevalence or physical clinical features of MS. There was considerable variance in the measurement of stressors, confounders, and categorization of MS; however most studies (n = 10) demonstrated an association between ACEs and MS (alone or grouped with other similar diagnoses), or physical clinical features. CONCLUSION: Although there are few studies in this area, it is of quickly growing interest. These results should be cautiously interpreted, yet highlight the need for continued work to disentangle and discern true associations.

The importance of assessing life stress exposure in multiple sclerosis: A case report.

This case report describes associations between childhood adversity, adult stress exposure, and Multiple Sclerosis (MS) to highlight the intersection between mental health and neurological illness in persons with MS (PwMS). We focus on a high-adversity, high-resource patient who self-referred to mental health services for depression and suicidal ideation, without ever being screened for past or current stress exposure. MS and common comorbid symptoms (e.g., fatigue, depression, suicidality) may be affected by adversity and compounded by pandemic-related stressors, including socio-political and economic sequelae. This case illustrates the potential benefit of screening for lifetime stressors as a mechanism to improve case conceptualizations, enable referrals to mental health specialists to promote coping and resiliency, reduce future MS morbidity, and illuminate stress as an important research focus that deserves further exploration in PwMS.

Creating a 'choose your topic' massive open online course: an innovative and flexible approach to delivering injury prevention education.

BACKGROUND: A pediatric injury prevention course has not been available as a massive open online course (MOOC). Creating a comprehensive topic course is particularly challenging because the traditional, week-by-week linear curriculum design is often a barrier to learners interested in only specific topics. We created a novel, flexible course as both a 'choose your topic' MOOC for the public learner and a Small Private Online Course (SPOC) for medical students. METHODS: We describe creating 'Injury Prevention for Children and Teens', a course of 59 video learning segments within eight modules taught by a multidisciplinary panel of 25 nationally-recognized experts. Completion tracking and course evaluations were collected. RESULTS: In 2.5 years, 4,822 learners from 148 countries have enrolled. Two-thirds of learners were female. Median age of learners was 31 years. For engagement, 19.3% (n = 932) of learners attempted quizzes, and 5.2% (n = 252) participated in online forum discussions. Medical professionals (n = 162) claimed an average of 13 credit hours per learner. Over 200 senior medical students have taken the SPOC. CONCLUSION: 'Injury Prevention for Children and Teens' is a novel approach to injury prevention education that is broad, science-based, accessible, and not cost-prohibitive for a diverse group of global learners.

Interpersonal Trauma Exposure and Interpersonal Problems in Adolescent Posttraumatic Stress Disorder.

Traumatic experiences have been differentiated as interpersonal (i.e., the direct result of actions by other people) or noninterpersonal (i.e., other life-threatening events, such as severe accidents). Interpersonal trauma exposure generally has been shown to be associated with more severe posttraumatic stress disorder (PTSD) symptoms than noninterpersonal trauma exposure. Interpersonal problems also tend to be associated with trauma exposure and PTSD symptoms, but it is unclear whether a mediating association exists between trauma type, interpersonal problems, and PTSD symptoms. A clinical sample of 4,275 adolescents (age range: 12-18 years) from the National Child Traumatic Stress Network Core Data Set were classified as having experienced interpersonal trauma, noninterpersonal trauma, or both. Interpersonal problems were operationalized by social problem behaviors (e.g., immature and dependent behaviors) and aggressive behaviors on the Child Behavior Checklist. The results of path analyses showed that cumulative interpersonal trauma exposure was both directly and indirectly associated with PTSD symptoms via social problem behaviors but not aggressive behaviors, total effect ß = .20, 95% CI [.17, .23]. In a second model, path analyses showed that cumulative interpersonal trauma exposure was associated directly and indirectly via PTSD symptoms with social problem behaviors, total effect ß = .15, 95% CI [.11, .18], and aggressive behaviors, total effect ß = .13, 95% CI [.09, .17]. These findings suggest that during adolescence, interpersonal problems play an important role in the association between interpersonal trauma exposure and PTSD symptoms.

School Attachment and Violent Attitudes Preventing Future Violent Behavior Among Youth.

Evidence derived from social information theories support the existence of different underlying cognitive mechanisms guiding violent behavior through life. However, a few studies have examined the contribution of school variables to those cognitive mechanisms, which may help explain violent behavior later in life. The present study examines the relationship between school attachment, violent attitudes, and violent behavior over time in a sample of urban adolescents from the U.S. Midwest. We evaluated the influence of school attachment on violent attitudes and subsequent violent behavior. We used structural equation modeling to test our hypothesis in a sample of 579 participants (54.9% female, 81.3% African American). After controlling for gender and race, our results indicated that the relationship between school attachment and violent behavior over time is mediated by violent attitudes. The instrumentalization of the school context as a learning environment aiming to prevent future violent behavior is also discussed.

Examining contextual and relational factors influencing perceptions of societal and interpersonal mattering among rural youth.

Researchers have shown that interpersonal and societal mattering have important implications for adolescent development. Yet, few researchers have focused on what predicts mattering, particularly societal mattering, and even fewer have studied mattering among rural youth. Thus, the purpose of this study is to explore how perceived contextual and relationship factors affect rural youths' perceptions of societal and interpersonal mattering. Participants for this study were 381 middle school youth from two rural school districts in Michigan. Using structural equation modeling, we found that more positive perceptions regarding opportunities for youth involvement, availability of community resources, student input in decision-making at school, and support for autonomy at school were associated with greater perceptions of societal mattering. In addition, greater support from friends, higher quality parent-child communication, and more parental involvement were associated with a greater sense of interpersonal mattering. This study identifies important relational and contextual factors that can be enhanced in an effort to foster greater perceptions of interpersonal and societal mattering among rural youth, and ultimately help us to promote positive youth development.

Substance use and mental health predictors of patterns of non-partner youth violence among high-risk urban youth.

OBJECTIVE: This study examined the association between baseline substance use and mental health, and non-partner violence trajectories among youth presenting to an urban emergency department who screened positive for drug use. Non-partner violence is physically violent victimization or aggression involving someone other than a dating partner. METHODS: Group-based trajectory modeling was used to identify longitudinal trajectories of non-partner violence in N = 599 youth (14-24 years old) at baseline, 6, 12, 18 and 24 month follow-ups. Multinomial logistic regression analyses were used to examine associations between baseline substance use and mental health conditions (i.e., anxiety, depression, and post-traumatic stress disorder [PTSD]), and non-partner violence trajectories. RESULTS: Six trajectory groups were identified for non-partner violence. Binge drinking and cannabis, illicit drug, nonmedical prescription stimulant, and polysubstance use in the 30 days leading up to their initial ED visit were associated with the likelihood of medium to high non-partner violence group membership during the two years following their ED visit. Post-traumatic stress disorder (PTSD) and depression/anxiety at baseline were also associated with greater risk of belonging to medium to high non-partner violence trajectory groups. CONCLUSIONS: Our findings highlight distinct trajectories of violent behavior, with roughly 60 % of young adults belonging to one of the non-partner violence groups. Although general trajectory trends were of decreasing violent behavior, the constellation of baseline risk factors differentially predicted group membership. These findings indicate that violence does not operate in a vacuum; interventions to reduce violence should also address previous trauma, substance use, and mental health issues.

Longitudinal pathway from violence exposure to firearm carriage among adolescents: The role of future expectation.

INTRODUCTION: Exposure to violence is a risk factor for firearm carriage. Youth exposed to violence also have difficulty envisioning positive future outcomes (e.g., educational outcomes), which can increase the likelihood of firearm carriage over time. Researchers, however, have not yet examined whether changes in exposure to violence over time can influence the developmental trajectories of firearm carriage. To address this gap, we (1) examined the longitudinal association between exposure to violence and firearm carriage (grades 9 to 12) and then (2) examined whether changes in future expectations mediated this longitudinal association. METHOD: The longitudinal association between exposure to violence and firearm carriage through future expectations was examined among 850 adolescents from the Flint Adolescent Study. Participants were recruited from four high schools in a midwestern city in the United States. Parallel latent growth models and latent growth mediation models were estimated. RESULTS: A positive association was observed between the rate of change in exposure to violence and firearm carriage. Exposure to violence also indirectly increased the risk for firearm carriage over time by decreasing future expectation in the 9th grade. CONCLUSIONS: Our results support the idea that helping youth develop positive attitude about educational success may help reduce firearm carriage. Increasing positive expectations about future may help prevent firearm carriage within the context of violence exposure.

Feasibility and acceptability of a future-oriented empowerment program to prevent substance use and school dropout among school-disengaged youth.

OBJECTIVE: To evaluate the feasibility and acceptability of a health promotion program to prevent school dropout and substance use among middle school-aged youth who display early warning signs of school disengagement. INTERVENTION: Youth Empowerment Solutions for Positive Futures (YES-PF), an intensive, theoretically driven, 5-week summer enrichment program, aims to prevent school dropout and substance use by promoting youth empowerment, school engagement, and future orientation. DESIGN AND SAMPLE: Using a pre-post-intervention design, we test feasibility and acceptability with 6th and 7th grade students (n = 43) who exhibited early warning signs for school disengagement (e.g., chronic absenteeism) in two school districts. MEASURES: Program evaluation components included: (a) program session forms completed by facilitators; (b) post-program interviews with facilitators; (c) post-intervention program evaluation surveys with youth; (d) attendance; and (e) baseline and post-intervention surveys with youth to assess behavioral and psychosocial outcomes. RESULTS: Facilitators routinely delivered core component lesson activities. Acceptability and program satisfaction were evidenced in strong program attendance by youth. Youth participants reported higher levels of leadership efficacy (p < .05) and a greater sense of control over their lives and potential problems (p < .01). CONCLUSIONS: YES-PF was feasible and acceptable to school personnel and youth. Program refinement, based on implementation findings, is discussed.

A Critical Review of Anti-Bullying Programs in North American Elementary Schools.

BACKGROUND: Bullying behavior is a concern among school-aged youth and anti-bullying programs have been implemented in schools throughout North America. Most anti-bullying programs are delivered to adolescent youth because antisocial-aggressive behaviors are typically associated with this developmental stage. This paper is a review of empirically evaluated school-based bullying prevention and intervention programs in North American elementary schools. METHODS: We conducted a systematic, critical review of bullying prevention programming. Data were analyzed to determine the study method, intervention components, measurement of bullying, aggression, or peer victimization, outcomes measured, and results. RESULTS: Our review resulted in the identification of 10 interventions aimed at youth in grades K-6 enrolled in North American elementary schools. Effective intervention strategies targeted a variety of bullying behaviors using diverse mechanisms and included a school-and community-wide approach. Direct outcomes of the reviewed evaluations were centered on bullying, aggression, and victimization. Indirect outcomes of review evaluations included strategies for bystanders, school achievement, perceived school safety, and knowledge or attitudes about bullying. CONCLUSIONS: Recommendations for promising practices in effective bullying intervention programming are offered. The review concludes with suggestions for supporting school health staff and in-service teachers drawn from the body of research, and offers direction for future study.

Purpose and mastery as predictors of perceived health and substance use problems.

We explored whether purpose in life and mastery predicted perceived physical health and problematic substance use among a sample of emerging adults who reported ever using alcohol or drugs. We examined perceived stress and coping as potential mediators of these associations and explored whether parental support moderated any of these associations. In a sample of emerging adults from across the United States (N = 2,564; M age = 20.87, standard deviation = 1.75; 49.6% male), purpose in life and mastery were associated with better-perceived health and fewer negative consequences of drug use via lower perceived stress and coping. In addition, parental support modified the relationship between purpose in life and stress and coping. The findings suggest potential health benefits associated with a greater purpose in life and mastery and indicate that parental support may enhance these associations.

Summer School, School Disengagement, and Substance Use During Adolescence.

INTRODUCTION: Youth who fall behind academically are at increased risk for school disengagement, school dropout, and substance use. Summer school is an opportunity for youth to complete needed coursework yet has not been utilized as a venue for substance use prevention. To date, little is known about the rates of summer school attendance among adolescents or the relationship between summer school attendance, school disengagement, and substance use. The purpose of this study is to assess the characteristics of summer school attendance over the past 20 years and to examine the associations between summer school attendance, indicators of school disengagement, and recent substance use among eighth-grade students. METHODS: Data from the Monitoring the Future cross-sectional study of eighth-grade students (1997-2016; n=111,033) was used to examine the association between summer school attendance and recent substance use (e.g., past 2-week/30-day marijuana use). Bivariate associations controlling for sociodemographics and school disengagement (e.g., truancy) were assessed. Analyses were completed in 2018. RESULTS: School disengagement and substance use were associated with summer school attendance; however, when controlling for indicators of school disengagement, summer school attendance was not associated with substance use. Interaction effect models found that summer school attendance weakened the association between indicators of school disengagement and substance use. CONCLUSIONS: These findings suggest that students with a high propensity to use substances do attend summer school. Summer school may be a venue to deliver information on the risk of alcohol or other drugs to a population of at-risk students.

Age-Specific Associations Between Violence Exposure and Past 30-Day Marijuana and Alcohol Use.

Using data from a cohort study of students at risk for high school dropout, we examined associations between violence exposure and past 30-day alcohol and marijuana use. We used varying-coefficient regression with person-level fixed effects to estimate how those associations changed within-person across ages approximately 14-23. Generally, violence perpetration was most strongly associated with substance use, within-person. Substance use became increasingly associated with both observed violence and violence perpetration during early/middle adolescence; this increase continued longer into development (age 18+) for alcohol use. Across most of the age range studied here, violence victimization was minimally associated with within-person changes in substance use. Results indicate age-specific associations between violence exposure and alcohol and other drug use, which may be useful for informing prevention strategies.

Racial discrimination and cortisol in African American emerging adults: The role of neighborhood racial composition.

OBJECTIVES: African American (AA) emerging adults may become more vulnerable to the consequences of racial discrimination (discrimination) as many begin to occupy racially mixed contexts. Little is known, however, about whether the effect of discrimination on cortisol concentration varies by neighborhood racial composition. We evaluated whether the percentage of White neighbors qualified the association between discrimination and overall cortisol concentration. METHOD: We used self-report data from the Flint Adolescent Study and block-level census data linked to the participant's home address. Our sample consisted of 241 AA emerging adults (56.8% Female; 19-22 year olds). We used multilevel regression analyses to evaluate whether the percentage of White neighbors modified the association between discrimination and overall cortisol concentration. RESULTS: Discrimination experienced in the past year, but not chronic discrimination was linked to lower cortisol concentrations among AA emerging adults living in neighborhoods with a high concentration of White neighbors. Specifically, past year discrimination was negatively associated among AAs residing in neighborhoods with 46.9% of White residents or higher. CONCLUSIONS: Our results lay the foundation for future research on racial health disparities by suggesting that contextual factors such as neighborhood racial composition can shape the influence race-based discrimination has on health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).