Disaggregating the distal, proximal, and time-varying effects of parent alcoholism on children's internalizing symptoms.

We tested whether children show greater internalizing symptoms when their parents are actively abusing alcohol. In an integrative data analysis, we combined observations over ages 2 through 17 from two longitudinal studies of children of alcoholic parents and matched controls recruited from the community. Using a mixed modeling approach, we tested whether children showed elevated mother- and child-reported internalizing symptoms (a) at the same time that parents showed alcohol-related consequences (time-varying effects), (b) if parents showed greater alcohol-related consequences during the study period (proximal effects), and (c) if parents had a lifetime diagnosis of alcoholism that predated the study period (distal effects). No support for time-varying effects was found; proximal effects of mothers' alcohol-related consequences on child-reported internalizing symptoms were found and distal effects of mother and father alcoholism predicted greater internalizing symptoms among children of alcoholic parents. Implications for the time-embedded relations between parent alcoholism and children's internalizing symptoms are discussed.

Externalizing symptoms among children of alcoholic parents: Entry points for an antisocial pathway to alcoholism.

The authors examined heterogeneity in risk for externalizing symptoms in children of alcoholic parents, as it may inform the search for entry points into an antisocial pathway to alcoholism. That is, they tested whether the number of alcoholic parents in a family, the comorbid subtype of parental alcoholism, and the gender of the child predicted trajectories of externalizing symptoms over the early life course, as assessed in high-risk samples of children of alcoholic parents and matched controls. Through integrative analyses of 2 independent, longitudinal studies, they showed that children with either an antisocial alcoholic parent or 2 alcoholic parents were at greatest risk for externalizing symptoms. Moreover, children with a depressed alcoholic parent did not differ from those with an antisocial alcoholic parent in reported symptoms. These findings were generally consistent across mother, father, and adolescent reports of symptoms; child gender and child age (ages 2 through 17); and the 2 independent studies examined. Multialcoholic and comorbid-alcoholic families may thus convey a genetic susceptibility to dysregulation along with environments that both exacerbate this susceptibility and provide few supports to offset it.

[Pilot study to evaluate blood glucose control by a model predictive control algorithm with variable sampling rate vs. routine glucose management protocol in peri- and postoperative period in cardiac surgery patients]. / Pilotní studie pro srovnání pocítacového algoritmu s variabilním intervalem merení glykémie a standardního protokolu pro intenzivní inzulínovou terapii v peri- a pooperacním období u kardiochirurgických pacientu.

BACKGROUND: Increased blood glucose levels are frequently observed in critically ill patients. Recent studies have shown that the normalization of glycemia by intensive insulin therapy decreases mortality, length of the hospitalization and number of complications. METHODS AND RESULTS: The aim of this pilot study was to compare blood glucose control by an automated model predictive control algorithm with variable sampling rate (eMPC) with routine glucose management protocol (RP) in peri- and postoperative period in cardiac surgery patients. 20 patients were included into this study (14 men and 6 women, mean age 68 +/- 10 let, BMI 28.3 +/- 5.0 kg/m2). 10 patients were randomized for treatment using eMPC algorithm and 10 patients for routine protocol. All patients underwent elective cardiac surgery and were treated with continuous insulin infusion to maintain glycemia in target range 4.4-6.1 mmol/l. The study duration was 24 hours. Mean blood glucose was significantly lower in eMPC vs. RP group (5.80 +/- 0.45 vs. 7.23 +/- 0.84 mmol/l, p < 0.05). Percentage of time in target range was significantly higher in eMPC vs. RP group (67.6 +/- 8.7% vs. 27.6 +/- 15.8%, p < 0.05). Percentage of time above the target range was higher in RP vs. eMPC group. Average insulin infusion rate was higher in eMPC vs. RP group (4.18 +/- 1.19 vs. 3.24 +/- 1.43 IU/hour, p < 0.05). Average sampling interval was significantly shorter in eMPC vs. RP group (1.51 +/- 0.24 vs. 2.03 +/- 0.16 hour, p < 0.05). No severe hypoglycaemia in either group occurred during the study. CONCLUSIONS: The results of our pilot study suggest that eMPC algorithm is more effective in maintaining euglycemia in peri- and post-operative period in patients after cardiac surgery and comparably safe as compared to RP.

Pancreatic beta-cell responsiveness during meal tolerance test: model assessment in normal subjects and subjects with newly diagnosed noninsulin-dependent diabetes mellitus.

A model-based method was developed to quantify pancreatic beta-cell responsiveness during a meal tolerance test (MTT). C peptide secretion was related in a linear fashion to glucose concentration, whereas the standard population model was used to derive transfer rate constants of the two compartmental model of C peptide kinetics. Two indexes of pancreatic beta-cell responsiveness were defined: 1) postprandial sensitivity M(I) (ability of postprandial glucose to stimulate beta-cell), and 2) basal sensitivity M0 (ability of fasting glucose to stimulate beta-cell). The method was evaluated using plasma glucose and C peptide measured over 180 min with a 10- to 30-min sampling interval during a MTT (75 g carbohydrates; 500 Cal) performed in 16 normal subjects (7 men and 9 women; age, 50 +/- 10 yr; body mass index, 29.2 +/- 3.6 kg/m2; fasting plasma glucose, 5.1 +/- 0.5 mmol/L; mean +/- SD) and 16 body mass index-matched subjects with newly diagnosed noninsulin-dependent diabetes mellitus (NIDDM; 15 men and 1 woman; age, 50 +/- 9 yr; body mass index, 29.3 +/- 3.7 kg/m2; fasting plasma glucose, 12.6 +/- 3.2 mmol/L). M(I) and M0 indexes were estimated with very good precision (coefficient of variation, < 15%). Subjects with NIDDM demonstrated lower postprandial sensitivity M(I) (17.7 +/- 11.4 vs. 90.0 +/- 43.3 x 10(-9)/min; NIDDM vs. normal, P < 0.001) and basal sensitivity M0 (5.4 +/- 2.2 vs. 10.3 +/- 4.9 x 10(-9)/min; P < 0.005). Deconvolution analysis documented that the relationship between C peptide secretion and glucose concentration is approximately linear during MTT in both normal subjects (plasma glucose range, 5-8 mmol/L) and subjects with NIDDM (12-17 mmol/L). We conclude that pancreatic responsiveness during glucose stimulation (M(I)) and under basal conditions (M0) can be obtained from this novel method during MTT in healthy and disease states.

The natural history of cigarette smoking: predicting young-adult smoking outcomes from adolescent smoking patterns.

Assessed the magnitude of risk that adolescent cigarette smoking carries for adult smoking. Using a longitudinal, prospective design, results indicate that even infrequent experimentation in adolescence significantly raises the risk for adult smoking and that regular (at least monthly) adolescent smoking raises the risk for adult smoking by a factor of 16 compared to nonsmoking adolescents. Relative risk was also increased by an early onset of smoking and by a stable, uninterrupted course from experimentation to regular smoking. Relative risk did not significantly vary by age or sex. The continuity of smoking behavior between adolescence and adulthood supports the importance of primary prevention programs directed at adolescent populations.

Four pathways to young-adult smoking status: adolescent social-psychological antecedents in a midwestern community sample.

Evaluated the ability of social-psychological factors, measured in adolescence, to predict young-adult smoking outcomes. Results showed substantial continuity in the antecedents of adolescent and young-adult smoking but important discontinuities as well. Beliefs in the negative social consequences of smoking and beliefs about academic success and independence were important to adolescent but not to adult smoking. Conversely, beliefs in the negative health consequences of smoking were more important to adult smoking than to adolescent smoking. Results also showed an appreciable amount of smoking onset after the high school years, as well as an appreciable amount of adolescent smoking that did not persist into young adulthood. Antecedents of late-onset smoking and of nonpersistent smoking are described.

Prospective predictors of quit attempts and smoking cessation in young adults.

This study examined prospective predictors of attempts to quit smoking and successful quitting among those who attempted to quit (n = 700), using a long-term longitudinal study of the natural history of cigarette smoking in a midwestern community sample. Participants, originally surveyed in 6th-12th grade (1980-1983), were followed up in 1987 and 1994. Results showed that amount of smoking, gender, education, health beliefs about smoking, value on healthy lifestyle, motives for smoking, reasons for quitting, and occupancy of young adult social roles were significant predictors of cessation. However, there were different predictors of attempts to quit and successful quitting among those who attempted to quit. From a public health perspective, both predictors of quit attempts and predictors of successful quitting among attempters are useful targets for intervention.

From adolescence to adulthood: age-related changes in beliefs about cigarette smoking in a midwestern community sample.

The current study used a cohort-sequential design to examine age-related changes in health-relevant beliefs from the middle school years through age 37 in a large, midwestern, community sample (N=8,556). Results suggest systematic age-related changes such that beliefs in the personalized risks of smoking declined in middle school and then increased, beliefs in generalized health risks increased beginning in the middle school years, and values placed on health as an outcome decreased in the high school years and then increased. These findings suggest that intervention programs must counter declining personalized risk perceptions among middle school students and declining values placed on health among high school age students.

The natural history of cigarette smoking from adolescence to adulthood in a midwestern community sample: multiple trajectories and their psychosocial correlates.

Previous research on the natural history of smoking has focused on overall group trajectories without considering the possibility of risk subgroup variation. To address this limitation, the authors of the present study aimed to identify subgroups with varying trajectories of smoking behavior. The authors accomplished this within a cohort-sequential study of a large community sample (N = 8,556) with measurements spanning ages 11-31. After removing 2 a priori groups (abstainers and erratics), the authors empirically identified 4 trajectory groups--early stable smokers, late stable smokers, experimenters, and quitters--and psychosocial variables from adolescence and young adulthood were significantly distinguished among them. Given recent advances in quantitative methods, it is now feasible to consider subgroups of trajectories within an overall longitudinal design.

The natural history of cigarette smoking from adolescence to adulthood: demographic predictors of continuity and change.

The current study examined the natural history of smoking from adolescence to adulthood in a community sample. Participants were from a longitudinal study (N = 4,035, 51.7% female, average age = 29 years). Group-level analyses showed a significant increase in smoking from adolescence to young adulthood and a nonsignificant decline after the mid-20s. Individual-level analyses showed that there was appreciable cessation and relapse but little new initiation in adulthood. Both adolescent and young adult smoking status were powerful predictors of adult smoking. Moreover, there was less cessation among less educated individuals and those with smoking parents, and more cessation among those who assumed adult social roles. The findings support the importance of prevention campaigns aimed at adolescent smoking and also suggest that those with lower educational attainment or with a family history of smoking are at heightened risk.

The relation between adolescent alcohol use and peer alcohol use: a longitudinal random coefficients model.

Longitudinal latent growth models were used to examine the relation between changes in adolescent alcohol use and changes in peer alcohol use over a 3-year period in a community-based sample of 363 Hispanic and Caucasian adolescents. Both adolescent alcohol use and peer alcohol use were characterized by positive linear growth over time. Not only were changes in adolescent alcohol use closely related to changes in peer alcohol use, but the initial status on peer alcohol use was predictive of later increases in adolescent alcohol use and the initial status on adolescent alcohol use was predictive of later increases in peer alcohol use. These results are inconsistent with models positing solely unidirectional effects between adolescent alcohol use and peer alcohol use.

Substance use and symptomatology among adolescent children of alcoholics.

This study assessed the magnitude and specificity of parental alcoholism as a risk factor for internalizing symptomatology, externalizing symptomatology, and alcohol and drug use in adolescence. We evaluated parents' and children's reports of symptomatology and children's reports of alcohol and drug use in a community sample of 454 adolescents. The results showed that parental alcoholism was a moderate to strong risk factor, with stronger risk associated with recent (rather than remitted) parental alcoholism. Multivariate analyses showed that the specificity of risk varied with the outcome measure. In predicting externalizing symptomatology, the risk associated with parental alcoholism was mediated by co-occurring parental psychopathology and environmental stress. However, in predicting alcohol use, the father's alcoholism was a specific risk factor above and beyond the more generalized effects of stress and family disruption.

Prospective differential prediction of adolescent alcohol use and problem use: examining the mechanisms of effect.

This prospective study tested the assertion that psychopathology would predict both adolescent alcohol use and problem use, whereas socialization factors would predict only use, and explored mechanisms by which predictors led to problem use in a community sample of families (N = 216). Externalizing symptoms, parental alcoholism, peer influences, and parental support were indirectly related to negative consequences through their effects on use level. Externalizing symptoms, internalizing symptoms, peer influences, and parental approval of use directly predicted consequences, controlling for the indirect effects through use level. Internalizing pathology potentiated the relation between consumption and consequences, whereas parental support and control mitigated this relation. Collectively, findings provided mixed support for the assertion that psychopathology would predict both use and problem use, whereas socialization factors would predict only use.

The relation of parent alcoholism to adolescent substance use: a longitudinal follow-up study.

The current study tested parent alcoholism effects on growth curves of adolescent substance use and examined whether parent and peer influences, temperamental emotionality and sociability, and stress and negative affect could explain parent alcoholism effects. Longitudinal latent growth curve modeling showed that adolescents with alcoholic fathers, boys, and adolescents with drug-using peers had steeper growth in substance use over time than did adolescents without alcoholic fathers, girls, and adolescents without drug-using peers. Data were consistent with father's monitoring and stress as possible mediators of paternal alcoholism effects. However, the direct effects of paternal alcoholism on substance use growth remained significant even after including the hypothesized mediators in the model. This suggests that other (unmeasured) mediators are necessary to fully explain paternal alcoholism risk for adolescents' escalating substance use over time.

A longitudinal study of children of alcoholics: predicting young adult substance use disorders, anxiety, and depression.

This study tested the specificity of parent alcoholism effects on young adult alcohol and drug abuse/dependence, anxiety, and depression, and tested whether adolescent symptomatology and substance use mediated parent alcoholism effects. Participants were from a longitudinal study in which a target child was assessed in adolescence and young adulthood with structured interview measures (N = 454 families at Time 1). Results showed unique effects of parent alcoholism on young adult substance abuse/dependence diagnoses over and above the effects of other parental psychopathology. There was some evidence of parent alcoholism effects on young adult depression and of maternal alcoholism effects on young adult anxiety, although these were not found consistently across subsamples. Mediational models suggested that parent alcoholism effects could be partially (but not totally) explained by adolescent externalizing symptoms.

Relation of parental alcoholism to early adolescent substance use: a test of three mediating mechanisms.

The current study assessed 3 hypothesized mediating mechanisms underlying the relation between parental alcoholism and adolescent substance use. Using structural equation modeling, we analyzed data obtained from a large community sample of adolescent children of alcoholics and a demographically matched comparison group. Results suggested that parental alcoholism influenced adolescent substance use through stress and negative affect pathways, through decreased parental monitoring, and through increased temperamental emotionality (which was associated with heightened negative affect). Both negative affect and impaired parental monitoring were associated with adolescents' membership in a peer network that supported drug use behavior. The data did not support a link between parental alcoholism and temperamental sociability.

A critical analysis of COA research.

Five experts respected for their significant contributions to the scientific literature on children of alcoholics (COA's) offer their perspectives in a panel discussion format. The panel members reflect on the historical roots of COA research and comment on its current status and future direction. Enriched by the panelists' variety of backgrounds, research interests, and approaches, the discussion emphasizes the need to consider multiple variables that influence the risk for alcoholism among COA's.

Effects of social support and conflict on adolescent children of alcoholic and nonalcoholic fathers.

Studies of positive and negative social ties usually are done in isolation of each other, precluding an understanding of their relative contributions to psychological functioning. This research evaluated the effects of adolescents' conflict with and social support from key relationships (parents, siblings, and best friends) on adolescents' self-esteem, substance use, and externalizing symptoms. Ss were 296 adolescents and their parents; 145 families had alcoholic fathers, and 151 had nonalcoholic parents. Support and conflict provided by each network member showed only a mild negative correlation. Support from parents, but not siblings or best friends, was related to adolescents' reports of substance use and externalizing. Conflict with parents was consistently related to externalizing behaviors. There was no evidence that conflict within a relationship neutralizes the effectiveness of the support it provides.

Do adolescent symptomatology and family environment vary over time with fluctuations in paternal alcohol impairment?

This study tested whether adolescent internalizing problems, externalizing problems, heavy alcohol use, fathers' parenting, and family conflict varied over time with fluctuations in fathers' alcohol impairment and also whether children of recovered alcoholic fathers differed from children of nonalcoholic fathers. Fathers and adolescent children (N = 267 families) were interviewed in 3 annual assessments. Results showed that adolescent symptomatology and the family environment did not vary over time as a function of different trajectories of paternal alcohol impairment. However, children of recovered alcoholic fathers exhibited more symptomatology than did children of nonalcoholic fathers. Even though paternal alcoholism has remitted in these families, children of recovered alcoholic fathers might remain on a general higher risk trajectory relative to children of nonalcoholic fathers.

Maternal socialization of adolescent smoking: the intergenerational transmission of parenting and smoking.

A longitudinal multigenerational design was used to examine the intergenerational transmission of smoking and the correlated transmission of parental support and control. Whether maternal socialization of adolescent smoking (both general parenting practices and smoking-specific strategies) would predict adolescent smoking both directly and indirectly by affecting peer affiliations was tested. There was strong evidence for the intergenerational transmission of cigarette smoking and for the relation between peer smoking and adolescent smoking. Both general parenting practices and smoking-specific discussion and punishment were significantly related to adolescents' smoking, especially for adolescent-reported parenting. Support for the intergenerational transmission of parenting practices emerged only in mothers' reports of support. Results suggest expanding current peer-focused prevention efforts to include parental socialization strategies.