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Background: Little is known about marijuana advertising exposure among users in the U.S. We examined the prevalence of advertising exposure among young adult marijuana users through traditional and new media, and identified characteristics associated with seeking advertisements., Methods: We conducted a cross-sectional survey of 18-34 year-old past-month marijuana users in the U.S. using a pre-existing online panel (N=742). The survey queried about passively viewing and actively seeking marijuana advertisements in the past month, sources of advertisements, and marijuana use characteristics., Results: Over half of participants were exposed to marijuana advertising in the past month (28% passively observed advertisements, 26% actively sought advertisements). Common sources for observing advertisements were digital media (i.e., social media, online, text/emails; 77%). Similarly, those actively seeking advertisements often used Internet search engines (65%) and social media (53%). Seeking advertisements was more common among those who used medically (41% medical only, 36% medical and recreational) than recreational users (18%), who used concentrates or edibles (44% and 43%) compared to those who did not (20% and 19%), and who used multiple times per day (33%) compared to those who did not (19%) (all p<0.01)., Conclusions: Exposure to marijuana advertising among users is common, especially via digital media, and is associated with medical use, heavier use, and use of novel products with higher THC concentrations (i.e., concentrates) or longer intoxication duration (i.e., edibles). As the U.S. marijuana policy landscape changes, it will be important to examine potential causal associations between advertising exposure and continuation or frequency/quantity of use., (Copyright © 2017 Elsevier B.V. All rights reserved.)

We examined substance use onset and associations with pregnancy by age 15 years. Participants were girls ages 15 years or younger (weighted n = 8319) from the 1999-2003 Youth Risk Behavior Surveillance System (YRBS). Multivariable logistic regression examined pregnancy as a function of substance use onset (i.e., age 10 years or younger, 11-12, 13-14, and age 15 years) for alcohol, cigarettes and marijuana, controlling for race/ethnicity and metropolitan location. Of girls pregnant by age 15 years (3% of the sample, weighted n = 243), 16% had smoked marijuana by age 10 years and over 20% had smoked cigarettes and initiated alcohol use by age 10 years. In the multivariable analysis, marijuana use by age 14 years and/or cigarette smoking by age 12 years clearly distinguished girls who became pregnant by age 15 years and is perhaps due to a common underlying risk factor., (Copyright © 2012 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

OBJECTIVE: To examine the prognostic value of different comorbidity coding schemes for predicting survival of newly diagnosed elderly cancer patients. MATERIALS AND METHODS: We analyzed data from 8,867 patients aged 65 years of age or older, newly diagnosed with cancer. Comorbidities present at the time of diagnosis were collected using the Adult Comorbidity Evaluation-27 index (ACE-27). We examined multiple scoring schemes based on the individual comorbidity ailments, and their severity rating. Harrell's c index and Akaike Information Criterion (AIC) were used to evaluate the performance of the different comorbidity models. RESULTS: Comorbidity led to an increase in c index from 0.771 for the base model to 0.782 for a model that included indicator variables for every ailment. The prognostic value was however much higher for prostate and breast cancer patients. A simple model which considered linear scores from 0 to 3 per ailment, controlling for cancer type, was optimal according to AIC. CONCLUSION: The presence of comorbidity impacts on the survival of elderly cancer patients, especially for less lethal cancers, such as prostate and breast cancers. Different ailments have different impacts on survival, necessitating the use of different weights per ailment in a simple summary score of the ACE-27.

Purpose: This study examined the associations between health risk behaviors (i.e., substance use behaviors, physical violence, or carried a weapon) and multiple adolescent pregnancies (i.e., experiencing or causing more than one pregnancy)., Methods: We analyzed 1999-2003 data (3 years: 1999, 2001, and 2003) from the National Youth Risk Behavior Survey, a nationally representative survey of high school students (N = 14,211 participants). Multinomial logistic regression was used to compare one and multiple pregnancies versus no pregnancies. Logistic regression was used to compare multiple pregnancies versus one pregnancy., Results: A dose-response relationship was observed between multiple adolescent pregnancies and health risk behaviors; the more risk behaviors endorsed, the greater likelihood of experiencing or causing multiple adolescent pregnancies. Participants who engaged in a "high" degree of risk behaviors were significantly more likely to have experienced or caused multiple adolescent pregnancies than no pregnancies (or only one pregnancy) versus youth who endorsed no risk behaviors. Earlier sexual debut and more lifetime sexual partners were also associated with increased risk of endorsing multiple adolescent pregnancies., Conclusions: The health risk behaviors examined in our study can provide warning signs to influential persons who can potentially deliver important prevention messages to at-risk adolescents., (Copyright © 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: This study was conducted to examine associations with contraception methods used at last sexual intercourse among US adolescents., Study Design: Data consisted of sexually active adolescents (9th-12th grade, weighted n=24,638) from the 1999-2007 Youth Risk Behavior Surveillance System (YRBSS). We performed multinomial multivariable logistic regression analyses with condom users at last sexual intercourse as the reference group., Results: Males who used alcohol, cigarettes, marijuana and cocaine were more likely to use no method/unsure of method (OR=2.4, CI=1.7-3.4) or rely on withdrawal (OR=2.6, CI=1.5-4.3). Females with six or more sexual partners were more likely to rely on withdrawal (OR=2.9, CI=2.1-3.9) or contraception methods that offer no STI protection [i.e., birth control pills: OR=1.9, CI=1.4-2.5; and depot medroxyprogesterone acetate (DMPA, marketed as Depo-Provera): OR=2.6, CI=1.6-4.2]. Earlier age of sexual debut was also associated with nonuse., Conclusion: Prevention efforts should focus on at-risk adolescents including substance-using males, females with six or more sexual partners, and those who initiate sexual intercourse at an early age., (Copyright © 2010 Elsevier Inc. All rights reserved.)

OBJECTIVES: To determine the combined effect of age and comorbidity on receipt of chemotherapy and its impact on survival in elderly patients with stage III colorectal cancer (CRC). MATERIALS AND METHODS: All patients over age 65 with Stage III CRC diagnosed 1996-2006 were identified from the Barnes-Jewish Hospital Oncology Data Services registry. An age/comorbidity staging system was created using the ACE-27 comorbidity index and data from both Stage II and III CRC. The staging system was then applied to patients with Stage III CRC. Odds of receiving chemotherapy were calculated, and survival analyses determined the impact of chemotherapy on overall survival in each age/comorbidity stage. RESULTS: 435 patients with Stage III CRC were evaluated [median age 75 years (range 65-99)]. Advancing age/comorbidity stage (Alpha, Beta, Gamma) was associated with decreasing odds of receiving chemotherapy for Stage III CRC [Odds Ratio 0.83 (95% CI, 0.51-1.35) for Beta and 0.14 (95% CI, 0.08-0.24) for Gamma, compared to Alpha]. Chemotherapy was associated with lower risk of death in each of the age/comorbidity stages, compared to those who underwent surgery only. The hazard ratio for death in patients who did not receive chemotherapy, relative to those who did, within each age/comorbidity stage was 1.8 [95%CI 1.06-3.06] for Alpha, 2.24 [95%CI 1.38-3.63] for Beta and 2.10 [95% CI 1.23-3.57] for Gamma. CONCLUSION: While stage III CRC patients with increasing age and comorbidity are less likely to receive chemotherapy, receipt of chemotherapy is associated with a lower risk of death.

Purpose: This study examined the associations between social, behavioral, and environmental factors and adolescent parenthood., Methods: We analyzed data from a subsample of participants, 18-30 years of age (n=7,937), who took part in the 2001-2002 National Epidemiologic Study on Alcohol and Related Conditions, a nationally representative survey of adults. An extended Cox proportional hazards model was used to model time until becoming an adolescent parent (i.e., age at which first child was born if < or =18 years). Predictor variables of interest included initiation of alcohol, marijuana, cocaine, and daily cigarette use, age of earliest conduct disorder symptom, having a parent with alcohol and/or drug problems, parental death, divorce and/or separation, race/ethnicity, and gender., Results: Several variables were associated with adolescent parenthood, including initiation of daily cigarette smoking, age of first antisocial/conduct disorder symptom, and race/ethnicity. Parental alcohol/drug problems and parental death were also associated with adolescent parenthood for women. A significant interaction between initiation of daily cigarette smoking and ethnicity was present for women. Daily cigarette smoking was associated with adolescent parenthood to a greater degree than nondaily cigarette smoking for white and Hispanic women but not African American women. No significant associations were found between adolescent parenthood and initiation of drinking, marijuana, or cocaine and parental divorce/separation., Conclusions: Prevention efforts should focus on adolescents who are at highest risk of adolescent parenthood., (Copyright 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: This study examined gender and racial/ethnic differences in sexual debut., Study Design: We analyzed 1999-2007 data from the Youth Risk Behavior Surveillance System (YRBSS), a cross-sectional, nationally representative survey of students in Grades 9-12 established by the Centers for Disease Control and Prevention. The Kaplan-Meier method was used to compute the probability of survival (not having become sexually active) at each year (age 12 through 17), and separate estimates were produced for each level of gender and racial/ethnic group., Results: African-American males experienced sexual debut earlier than all other groups (all tests of significance at p<.001) and Asian males and females experienced sexual debut later than all groups (all tests of significance at p<.001). By their 17th birthday, the probability for sexual debut was less than 35% for Asians (females 28%, males 33%) and less than 60% for Caucasians (58% females, 53% males) and Hispanic females (59%). The probability for sexual debut by their 17th birthday was greatest for African Americans (74% females, 82% males) and Hispanic males (69%)., Conclusions: These results demonstrate a need for sexual education programs and policy to be sensitive to the roles of race and ethnicity in sexual debut.

Background: Epidemiologic studies have shown that the consumption of soy foods may be associated with a reduction in cancer risk in humans., Objective: The purpose of this study was to conduct a meta-analysis on the association between soy consumption and prostate cancer risk in men., Design: We systematically reviewed studies obtained through a thorough Medline literature search and identified 15 epidemiologic publications on soy consumption and 9 on isoflavones in association with prostate cancer risk. We extracted the most adjusted relative risks (RRs) and odds ratios (ORs) of the highest and the lowest reported categories of intake from each study and conducted this analysis using a random-effects model in which studies with smaller SEEs are given greater weight in the summary measure., Results: Our analysis of studies on soy intake yielded a combined RR/OR of 0.74 (95% CI: 0.63, 0.89; P = 0.01). When separately analyzed, studies on nonfermented soy foods yielded a combined RR/OR of 0.70 (95% CI: 0.56, 0.88; P = 0.01) and those on fermented soy foods yielded a combined RR/OR of 1.02 (95% CI: 0.73, 1.42; P = 0.92). The analysis of studies on isoflavones yielded a combined RR/OR of 0.88 (95% CI: 0.76, 1.02; P = 0.09). Further separate analyses showed a combined RR/OR of 0.52 (95% CI: 0.34, 0.81; P = 0.01) from studies with Asian populations and 0.99 (95% CI: 0.85, 1.16; P = 0.91) from studies with Western populations., Conclusions: The results of this analysis suggest that consumption of soy foods is associated with a reduction in prostate cancer risk in men. This protection may be associated with the type and quantity of soy foods consumed.

Among the many stresses that undocumented Latino immigrants experience, worries about their legal status and preoccupation with disclosure and deportation can heighten the risk for emotional distress and impaired quality of health. To better document these effects, this study examined the relationship between deportation concern and emotional and physical well-being among a group of Latino immigrants in a midwestern city. One-hundred-forty-three persons were recruited through community sources. Fifty-six participants (39%) expressed concern with seeking services for fear of deportation, while 87 did not endorse this concern. Measures of emotional distress, Hispanic immigrant stress and subjective health status were administered. Results indicate that Latino immigrants with concerns about deportation are at heightened risk of experiencing negative emotional and health states (particularly anger), Hispanic immigrant stress associated with extrafamilial factors and substandard health status. Findings inform policymakers of culturally relevant stressors of undocumented Latino immigrants that help to create and perpetuate the health and mental health disparities of this group.

This study was conducted to test the validity of a measure that has potential to bridge research on the addictive liability of drugs and on individuals' liability to addiction, which to date have evolved in largely parallel arenas. The length of time between onset of abuse and dependence (LOTAD) has evolved from recent findings on transitions through levels of addiction; it was hypothesized that shorter LOTAD is indicative of greater addictive liability. Hypotheses were based on animal studies and human studies. Retrospective data from the DSM-IV Substance Use Disorders Work Group were reanalyzed using configural frequency analysis, survival curves, bivariate Kendall's tau associations, and linear regression. The sample consisted of participants recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). The shortest LOTADs were observed for disorders related to use of cocaine and opiates, followed by cannabis and then alcohol regardless of the subsample that was analyzed. As hypothesized, females and early initiators of drug use had shorter LOTADs compared to men and other initiators of drug use; no consistent differences in LOTAD were observed between African-Americans and Caucasians. None of the LOTAD variance associated with differences between drugs could be accounted for by gender, early use of the drug, or ethnicity. Specific areas of research where LOTAD might be useful as well as how LOTAD might be improved are discussed.

Objective: To estimate the lifetime and past year prevalence rates of major psychiatric disorders in a sample of older youths in the foster care system, to examine the timing of disorder onset and system entry, and to explore variations in past year prevalence rates., Method: Using the Diagnostic Interview Schedule for DSM-IV, interviews were conducted with 373 17-year-old youths (90% of those eligible) in one state's foster care system between December 2001 and June 2003., Results: : Sixty-one percent of the youths qualified as having at least one psychiatric disorder during their lifetime; of these youths, 62% reported onset of their earliest disorder before entering the foster care system. In addition, 37% of youths met criteria for a psychiatric disorder in the past year. The number of types of maltreatment experienced was the most robust predictor of psychiatric disorder among several maltreatment variables. There were no differences in prevalence rates for youths in kinship care and those in nonkin foster families., Conclusions: Older youths in the foster care system have disproportionately high rates of lifetime and past year psychiatric disorders. Results support recommendations for initial and periodic mental health assessments for these youths and mechanisms to continue mental health services for young adults transitioning out of the foster care system.

This study examines the roles of post-traumatic stress disorder (PTSD) and drug dependence in non-fatal suicidality, i.e., suicidal ideation and suicide attempt, among Vietnam veterans in their adult years. The sample includes male veterans deployed to Vietnam, including an oversample of those who tested positive for opiates at their return (n = 642). PTSD, substance abuse, suicidality, and other psychopathology are analyzed using three waves of survey and military data covering the time period from early adolescence to middle adulthood. Measures include the onset and recency of each of the lifetime DSM-IV PTSD symptom criteria, and yearly symptom measures of DSM-IV dependence for alcohol and eight classes of psychoactive substances. Survival and hazard models are applied to assess the effects of drug dependence, PTSD, and other psychopathology on the duration of suicidality. Longitudinal models estimate the casual relationships among PTSD, drug dependence, and suicidality over a 25-year period. Results show evidence of strong continuity of PTSD, drug dependence, and suicidality over time. The causal role of drug dependence on PTSD and suicidality is limited to young adulthood. Evidence is stronger for self-medication in later adulthood. The results indicate that a life course perspective is needed for the combined treatment of PTSD and drug dependence for severely traumatized populations.

Labrador retrievers (42 of original 48) were used to assess the effects of lifetime diet restriction on glucose tolerance at ages 9-12 y. Restricted-fed (RF) dogs were fed 75% of the same diet consumed by control-fed (CF) pair-mates. An intravenous glucose tolerance test was done annually (maximal stimulation, nonsteady-state). Diet treatment, age, and interactions were fixed effects. Statistical procedures used included mixed-model, repeated-measures ANOVA; least-squares means; Tukey's multiple comparison; paired t tests; and Spearman rank correlations. Glucose k-value and half-life, and insulin sensitivity (total, and 9, 10, 11 y, and per lean mass) were higher (P < 0.05) in RF than in CF dogs. Late-phase insulin release [area under the curve (AUC) 30-120 min] was less (P < 0.05) in RF than in CR dogs. Early-phase insulin release (AUC 0-5 min), y 12 insulin sensitivity and insulinogenic index did not differ between RF and CF dogs. Insulin peak, delta and total AUC increased (P < 0.05) with age, whereas the glucose k-value and glucose half-life were not affected by age. Insulin sensitivity was negatively, and insulin AUC 30-120 min, peak and delta glucose were positively correlated with body weight, body condition score, fat mass, percentage of fat and abdominal fat/total tissue. Higher insulinogenic indices tended (P = 0.053) to be associated with greater median survival and dogs with higher insulin sensitivity were at lower (P < 0.05) risk of dying or receiving chronic disease treatment. Time to first osteoarthritis treatment or death was greater with lower basal glucose and higher insulin sensitivity (P < 0.05), but diet restriction explained most of this relationship's variation. Glucose disposal efficiency and insulin response were associated with increased quality and length of life in diet-restricted dogs.

Objective: To investigate the clinical characteristics of depression in preschool children., Method: One hundred seventy-four subjects between the ages of 3.0 and 5.6 years were ascertained from community and clinical sites for a comprehensive assessment that included an age-appropriate psychiatric interview for parents. Modifications were made to the assessment of major depressive disorder (MDD) criteria so that age-appropriate manifestations of symptom states could be captured. Typical and "masked" symptoms of depression were investigated in three groups: depressed (who met all MDD criteria except duration criterion), those with nonaffective psychiatric disorders (who met criteria for attention-deficit/hyperactivity disorder and/or oppositional defiant disorder), and those who did not meet criteria for any psychiatric disorder., Results: Depressed preschool children displayed "typical" symptoms and vegetative signs of depression more frequently than other nonaffective or "masked" symptoms. Anhedonia appeared to be a specific symptom and sadness/irritability appeared to be a sensitive symptom of preschool MDD., Conclusions: Clinicians should be alert to age-appropriate manifestations of typical MDD symptoms and vegetative signs when assessing preschool children for depression. "Masked" symptoms of depression occur in preschool children but do not predominate the clinical picture. Future studies specifically designed to investigate the specificity and sensitivity of the symptoms of preschool depression are now warranted.