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Context Puerto Rico is the United States' largest territory, home to nearly 4 million American citizens. Yet it has remained largely on the outskirts of US health policy, including the Affordable Care Act (ACA). This article presents an overview of Puerto Rico's health care system and a comparative analysis of coverage and access to care in Puerto Rico and the mainland United States. Methods We analyzed 2011-2012 data from the Behavioral Risk Factor Surveillance System, and 2012 data from the American Community Survey and its counterpart, the Puerto Rico Community Survey. Among adults 18 and older, we examined health insurance coverage; access measures, such as having a usual source of care and cost-related delays in care; self-reported health; and the receipt of recommended preventive services, such as cancer screening and glucose testing. We used multivariate regression models to compare Puerto Rico and the mainland United States, adjusted for age, income, race/ethnicity, and other demographic variables. Findings Uninsured rates were significantly lower in Puerto Rico (unadjusted 7.4% versus 15.0%, adjusted difference: −12.0%, p < 0.001). Medicaid was far more common in Puerto Rico. Puerto Rican residents were more likely than those in the mainland United States to have a usual source of care and to have had a checkup within the past year, and fewer experienced cost-related delays in care. Screening rates for diabetes, mammograms, and Pap smears were comparable or better in Puerto Rico, while colonoscopy rates were lower. Self-reported health was slightly worse, but obesity and smoking rates were lower. Conclusions Despite its far poorer population, Puerto Rico outperforms the mainland United States on several measures of coverage and access. Congressional policies capping federal Medicaid funds to the territory, however, have contributed to major budgetary challenges. While the ACA has significantly increased federal resources in Puerto Rico, ongoing restrictions on Medicaid funding and premium tax credits are posing substantial health policy challenges in the territory. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Schools are increasingly being called upon to address cyberbullying and its consequences. This study compares cyberbullying and school bullying trends and examines help-seeking among cyberbullying victims. METHODS We analyzed self-report data over 4 surveys (2006-2012) from more than 16,000 students in 17 MetroWest Boston high schools. Using generalized estimating equations, we examined school and cyberbullying victimization trends by sex, grade, and sexual orientation. RESULTS From 2006 to 2012, cyberbullying increased from 15% to 21% (p < .001). In 2006, school bullying was 1.7 times higher than cyberbullying (26% versus 15%); by 2012, school bullying and cyberbullying were similar (23% versus 21%). Cyberbullying increased more among girls (17% to 27%; p < .001) than boys (12% to 15%; p < .001). There was no net increase in school bullying among girls (26% in 2006 and 2012) and a decrease among boys (25% to 18%; p < .001). Sexual minorities were more likely than heterosexuals to be bullied at school and online at every survey. Only 33% of cyberbullying victims told an adult; more victims told parents/non-school adults (29%) than school adults (17%). CONCLUSIONS Despite decreases in school bullying, cyberbullying rose steadily, particularly among girls. Increased attention to sociodemographic differences in bullying could promote help-seeking and positive online behavior. [ABSTRACT FROM AUTHOR]

Background Our goal was to assess the prevalence of 9 different types of precipitating circumstances among suicide decedents, and examine the association between circumstances and postmortem blood alcohol concentration ( BAC ≥ 0.08 g/dl) across U.S. ethnic groups. Methods Data come from the restricted 2003 to 2011 National Violent Death Reporting System, with postmortem information on 59,384 male and female suicide decedents for 17 U.S. states. Results Among men, precipitating circumstances statistically associated with a BAC ≥ 0.08 g/dl were physical health and job problems for Blacks, and experiencing a crisis, physical health problems, and intimate partner problem for Hispanics. Among women, the only precipitating circumstance associated with a BAC ≥ 0.08 g/dl was substance abuse problems other than alcohol for Blacks. The number of precipitating circumstances present before the suicide was negatively associated with a BAC ≥ 0.08 g/dl for Whites, Blacks, and Hispanics. Conclusions Selected precipitating circumstances were associated with a BAC ≥ 0.08 g/dl, and the strongest determinant of this level of alcohol intoxication prior to suicide among all ethnic groups was the presence of an alcohol problem. [ABSTRACT FROM AUTHOR]

This study aimed to confirm whether the well-known income disparities in oral health seen over the life course are indeed absent in 9- to 11-yr-old children, and to explore the role of access to dental care in explaining the age-profile of the income gradient in child oral health. We used data from the 2007 United States National Survey of Children's Health. Income gradients in parental reports of children's decayed teeth or cavities, toothache, broken teeth, bleeding gums, and fair/poor condition of teeth were assessed in stratified analyses according to age of child (1-5, 6-8, 9-11, 12-14, and 15-17 yr), using survey logistic regression to control for family-, parental-, and child-level covariates. Health insurance status and use of preventive dental care were the indicators for children's access to dental care. The adjusted ORs for the effect of family income on having decayed teeth or cavities, toothache, and fair/poor condition of teeth were not significant in 9- to 11-yr-old children. Different age-patterns were found for broken teeth and bleeding gums. The attenuation of the income gradients in having decayed teeth or cavities, toothache, and fair/poor condition of teeth, previously seen in 9- to 11-yr-old children, was also seen in 15- to 17-, 12- to 14-, and 6- to 8-yr-old children, respectively, after controlling for children's access to dental care. This study supports the attenuation of income inequalities in oral health in 9- to 11-yr-old children. Access to dental care could attenuate income gradients in oral health in other age groups. [ABSTRACT FROM AUTHOR]

Objectives To compare risk-adjusted differences between men and women 30 and 60 days after hip fracture surgery in not walking, ability to return home in a community-dwelling subset, not walking in a nursing home resident subset, and mortality within 60 days. Design Cohort study. Setting Data were from a randomized clinical trial that compared two blood transfusion protocols after hip fracture. Participants Individuals with hip fracture (N = 2,016; 489 (24%) male). Measurements Walking, dwelling, and mortality were determined in telephone follow-up 30 and 60 days after randomization, which occurred within 3 days of surgery. Sex differences for each outcome were compared using univariate and multivariate regression adjusting for potential confounders. Results Men were younger ( P < .001) and more likely to have comorbidity ( P = .003) than women at the time of hip fracture and to die within 60 days, even after risk adjustment (odds ratio ( OR) = 1.76, 95% confidence interval ( CI) = 1.15-2.69). After risk adjustment, male survivors were as likely as female survivors not to walk ( OR = 1.03, 95% CI = 0.78-1.34) and no less likely to return home ( OR = 0.90, 95% CI = 0.69-1.17) 60 days after hip fracture. No differences were noted between male and female nursing home residents in not walking within 60 days ( OR = 0.95, 95% CI = 0.32-2.86). Conclusion Although men experience higher mortality, male survivors can expect recovery of walking ability similar to that of female survivors and are as likely to return to community living. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea. Design Cross-sectional. Setting Cardiovascular Health Study. Participants Community-dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1%); nonwhite, n = 199 (4.5%); obese, n = 788 (17.9%); history of smoking, n = 2,410 (54.6%)). Measurements Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade ≥2), age, sex, ethnicity, obesity, smoking, frailty status (Fried-defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease. Results Poor performance on the single chair stand was established in 369 (8.4%) and moderate to severe exertional dyspnea in 773 (17.5%). Prefrail status was established in 2,210 (50.1%), frail status in 360 (8.2%), arthritis in 2,241 (51.4%), high cardiopulmonary risk in 2,469 (55.9%), spirometric impairment in 1,076 (24.4%), kidney disease in 111 (2.5%), depression in 107 (2.4%), and stroke in 93 (2.1%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio ( OR) = 3.48, 95% confidence interval ( CI) = 2.78-4.36; adjusted OR = 1.85, 95% CI = 1.41-2.41). Conclusion Poor performance on a single chair stand was associated with an adjusted 85% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders. [ABSTRACT FROM AUTHOR]

Objectives To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment. Design Longitudinal cohort study. Setting Health and Retirement Study ( HRS). Participants HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N = 16,186). Measurements Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality. Results The 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2% returned home without home care services, and 33.8% transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2% transitioned to the hospital, and 25.3% returned home without services. There were 2,139 transitions to death, and 58.7% of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital. Conclusion In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition. [ABSTRACT FROM AUTHOR]

Background Few epidemiologic studies have examined a full range of adolescent psychiatric disorders in the general population. The association between psychiatric symptom clusters (PSCs) and DSM-IV alcohol use disorders (AUDs) among adolescents is not well understood. Methods This study draws upon the public-use data from the 2000 National Household Survey on Drug Abuse, including a study sample of 19,430 respondents aged 12 to 17. Logistic regression and exploratory structural equation modeling assess the associations between PSCs and DSM-IV AUDs by gender. The PSCs are based on brief screening scales devised from the Diagnostic Interview Schedule for Children Predictive Scales. Results Several PSCs were found to be significantly associated with DSM-IV AUDs, including separation anxiety, generalized anxiety, depression, oppositional defiant disorder, and conduct disorder among both genders, and panic disorder and obsessive/ compulsive disorder among females. Consistent with the literature, the analysis of PSCs yields 3 factors identical for both genders-2 internalizing factors (fear and anxiety-misery) and 1 externalizing factor. Adolescents who scored higher on the externalizing factor tended to have higher levels of the AUD factor. Female adolescents who scored higher on the internalizing misery factor and lower on the internalizing fear factor also tended to have higher levels of the AUD factor. Conclusions The associations that we found between PSCs and AUDs among adolescents in this study are consistent with those found among adults in other studies, although gender may moderate associations between internalizing PSCs and AUDs. Our findings lend support to previous findings on the developmentally stable associations between disruptive behaviors and AUDs among adolescents as well as adults in the general population. [ABSTRACT FROM AUTHOR]

Objectives To identify depressive symptom trajectories and factors associated with trajectory group membership in the very old segment of the rapidly growing and long-living Mexican-American population. Design Latent growth curve modeling was used to identify depressive symptom trajectories and multinomial logistic regression to identify factors associated with trajectory group membership. Setting Data spanning three waves and 7 years (2004-05, 2007-08, 2010-11) drawn from the Hispanic Established Populations for Epidemiologic Studies of the Elderly; homes of Mexican-origin elderly adults. Participants Community-dwelling Mexican Americans aged 75 and older living in the southwestern United States (N = 1,487). Measurements The 20-item version of the Center for Epidemiologic Studies Depression Scale. Results Three trajectory groups were identified: low throughout, increasing, and high but decreasing. Activity of daily living disability was the strongest predictor of depressive symptoms, followed by social support. Foreign-born individuals were at greater risk than those who are U.S. born for high but decreasing depressive symptoms than for low depressive symptoms. Conclusion Early detection and treatment of chronic disabling conditions, especially heart disease, cancer, visual impairment, and cognitive impairment, and increasing access to social participation should be the focus of treatment and intervention strategies for depression in very old Mexican Americans. [ABSTRACT FROM AUTHOR]

Aims To measure changes over time in cigarette smoking uptake prevalence and timing during young adulthood (ages 19-26 years), and associations between time-invariant/-varying characteristics and uptake prevalence/timing. Design Discrete-time survival modeling of data collected from United States high school seniors (modal age 17/18) enrolled in successive graduating classes from 1976 to 2005 and participating in four follow-up surveys (to modal age 25/26). Setting The longitudinal component of the Monitoring the Future study. Participants A total of 10 758 individuals reporting no life-time smoking when first surveyed as high school seniors. Measurements Smoking uptake (any, experimental, occasional and regular); socio-demographic variables; marital, college and work status; time spent socializing. Findings The percentage of young adults moving from non-smoker to experimental smoking [slope estimate 0.11, standard error (SE) = 0.04, P = 0.005] or occasional smoking (slope estimate 0.17, SE = 0.03, P < 0.001) increased significantly across graduating classes; the percentage moving from non-smoker to regular smoker remained stable. All forms of smoking uptake were most likely to occur at age 19/20, but uptake prevalence at older ages increased over time [e.g. cohort year predicting occasional uptake at modal age 25/26 adjusted hazard odds ratio (AHOR) = 1.05, P = 0.002]. Time-invariant/-varying characteristics had unique associations with the timing of various forms of smoking uptake (e.g. at modal age 21/22, currently attending college increased occasional uptake risk (AHOR = 2.11, P < 0.001) but decreased regular uptake risk (AHOR = 0.69, P = 0.026). Conclusions Young adult occasional and experimental smoking uptake increased in the United States for non-smoking high school seniors graduating from 1976 to 2005. Smoking uptake for these cohorts remained most likely to occur at age 19/20, but prevalence of uptake at older ages increased. [ABSTRACT FROM AUTHOR]

Objectives To describe the characteristics of home-based primary care practices: staffing, administrative, population served, care practices, and quality of care challenges. Design Survey of home-based primary care practices. Setting Home-based primary care practices in the United States. Participants Members of the American Academy of Home Care Medicine and nonmember providers identified by surveyed members. Measurements A 58-item questionnaire that assessed practice characteristics, care provided by the practice, and how the quality of care that the practice provided was assessed. Results Survey response rate was 47.9%, representing 272 medical house calls practices. Mean average daily census was 457 patients (median 100 patients, range 1-30,972 patients). Eighty-eight percent of practices offered around-the-clock coverage for urgent concerns, 60% held regularly scheduled team meetings, 89% used an electronic medical record, and one-third used a defined quality improvement process. The following factors were associated with practices that used a defined quality improvement process: practice holds regularly scheduled team meetings to discuss specific patients (odds ratio ( OR) = 2.07, 95% confidence interval ( CI) = 1.02-4.21), practice conducts surveys of patients ( OR = 8.53, 95% CI = 4.07-17.88), and practice is involved in National Committee for Quality Assurance patient-centered medical home ( OR = 3.27, 95% CI = 1.18-9.07). Ninety percent of practices would or might participate in quality improvement activities that would provide them timely feedback on patient and setting-appropriate quality indicators. Conclusions There is a substantial heterogeneity of home-based primary care practice types. Most practices perform activities that lend themselves to robust quality improvement efforts, and nearly all indicated interest in a national registry to inform quality improvement. [ABSTRACT FROM AUTHOR]

Honor means 'high respect; esteem,' but it has different associations for different cultures. In honor cultures (Turkey), esteem depends on one's own perception of self-worth and on other people's opinions. In those cultures, honor is easily lost and difficult to regain. In dignity cultures (northern America), esteem mainly depends on the individual and cannot be taken away by others. One way to lose honor in Turkey is through behaviors that may be seen as 'potentially improper.' Thus, we expected that posting pictures of such behaviors on Facebook (e.g., at a party; with one's boyfriend/girlfriend) and letting others see them would be less likely in Turkey than in the northern United States. Moreover, we investigated whether honor endorsement was the reason for this difference. We examined participants' posting intentions and actual Facebook behaviors. As expected, Turkish participants were less willing to post and let others (especially their relatives) see their potentially improper pictures compared with northern Americans. Moreover, honor endorsement negatively predicted the willingness to post such pictures only in Turkey, especially for women. This suggests that in honor cultures, the concern for losing honor could be the underlying reason for avoiding social media postings that could be potentially perceived as improper. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives To examine receipt of colorectal cancer ( CRC) screening according to age and life expectancy ( LE) in adults aged 65 and older. Design Population-based survey. Setting United States. Participants Community dwelling adults aged 65 and older who participated in the 2008 or 2010 National Health Interview Survey (N = 7,747). Measurements Receipt of CRC screening (e.g., colonoscopy within 10 years) was examined according to age and LE (≥10 and <10 years), adjusting for sociodemographic characteristics and survey year. Frequency of CRC screening was also examined according to age and LE at time of screening (e.g., age at colonoscopy rather than at interview). Participants screened when they were aged 75 and older or had less than a 10-year LE were considered to have received screening inconsistent with guidelines. Results Overall, 38.5% of participants had less than a 10-year LE; 40.2% were aged 75 and older, and 56.3% had received recent CRC screening (90.1% by colonoscopy). CRC screening was higher in 2010 (58.9%) than 2008 (53.7%, P <.001) and was associated with longer LE and younger age, although 51.1% of adults aged 75 and older reported receiving CRC screening, as did 50.9% of adults with less than a 10-year LE. Based on age and LE at time of screening (rather than at interview), 28.4% of CRC screening of adults aged 65 and older was targeted to those aged 75 and older and those with less than a 10-year LE. Of adults aged 65 to 75 with a 10-year LE or more (adults recommended for screening by guidelines), 39.2% had not recently been screened. Conclusion Older adults with little chance of benefit because of limited LE commonly undergo CRC screening, whereas many adults aged 65 to 75 with a 10-year LE or greater are not screened. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between sleep complaints, use of sleep-promoting medications, and persistent severe fatigue ( PSF). Design Analysis of data from the National Health Aging Trends Study. Setting Contiguous United States. Participants A representative sample of Medicare beneficiaries aged 65 and older. Measurements Difficulty initiating sleep, difficulty staying asleep, use of sleep-promoting medications, demographic characteristics, presence of pain, use of pain medications, depression, chronic medical disease, physical activity level, and Short Physical Performance Battery score measured at baseline. The outcome of interest was PSF (fatigue that limits daily activities reported at baseline and 12-month follow-up). Results Of 8,245 participants at baseline, 7,075 completed 12-month follow-up; 31% reported severe fatigue at baseline and 31% at follow-up, and 19% reported PSF. In a logistic regression model, difficulty staying asleep some nights (odds ratio ( OR) = 1.32, 95% confidence interval ( CI) = 1.08-1.60) and most nights or every night ( OR = 1.40, 95% CI = 1.09-1.79) and use of sleep-promoting medications most nights or every night ( OR = 1.35, 95% CI = 1.08-1.67) independently predicted PSF. Conclusion The results indicate greater risk of PSF in older adults with difficulty staying asleep and those who use sleep-promoting medications. These findings underscore the significance of sleep problems and present potential targets for interventional studies that aim to improve fatigue in older adults. [ABSTRACT FROM AUTHOR]

Previous research suggests that the likelihood of runaway episodes among children in out-of-home care varies across different communities/regions. However, the potential regional variation has rarely been reflected in attempts to understand runaway episodes in out-of-home care systems. The current study examines the effects of child characteristics, family characteristics and child welfare system-related characteristics on the likelihood of runaway episodes among children in out-of-home care, while accounting for county-level variations in the risk of runaway behaviours. The authors employed multilevel analyses using data on children aged 12-17 from the 2009 AFCARS database. Results demonstrate that the likelihood of runaway episodes varied across counties. Accounting for county variation, children's ages, gender, diagnosed clinical conditions, family structures, number of removals, number of placements, removal manner, and case plan goals significantly predicted runaway status. Implications are discussed. [ABSTRACT FROM AUTHOR]

There has been growing concern about racial and ethnic disparities in completion rates of advance directives ( ADs) in community-dwelling older populations. Although differences in AD completion rates between non-Hispanic whites and African Americans have been reported, not much is known about the awareness and completion of ADs in other groups of ethnic minorities. Using a sample of community-dwelling Korean-American older adults (n = 675) as a target, factors associated with their awareness and completion of ADs were explored. Guided by Andersen's behavioral health model, predisposing (age, sex, marital status, education), need (chronic conditions, functional disability), and enabling (health insurance, acculturation) variables were included in the separate logistic regression models of AD awareness and AD completion. In both models, acculturation was found to be a significant predictor; those who were more acculturated were more likely to be aware of ADs and to have completed ADs. This study contributes to the knowledge about the role of acculturation in explaining AD awareness and completion in Korean-American older adults and provides recommendations for possible AD educational interventions for this older adult minority population. [ABSTRACT FROM AUTHOR]

Objectives To determine whether sleep-disordered breathing ( SDB), a group of disorders common in older adults characterized by breathing pauses during sleep often accompanied by hypoxemia, is associated with cognitive decline. Design Population-based longitudinal study. Setting Six centers in the United States. Participants Community-dwelling older men (N = 2,636; aged 76.0 ± 5.3) without probable mild cognitive impairment or dementia followed for 3.4 ± 0.5 years. Measurements SDB was measured using in-home polysomnography: nocturnal hypoxemia (≥1% of sleep time with oxygen saturation (SaO2) <90%, oxygen desaturation index ( ODI: number of oxygen desaturations of ≥3% per hour of sleep)) and apnea-hypopnea index ( AHI, number of apneas and hypopneas at ≥3% desaturation per hour of sleep). Cognitive decline was measured using the Modified Mini-Mental State Examination (3 MS) and the Trail-Making Test Part B (Trails B) at baseline and two follow-up points. Associations between predictors and cognitive decline were examined using linear mixed models adjusted for multiple confounders. Models were further adjusted for potential mediators (sleep duration, sleep fragmentation, resting SaO2). Results Nocturnal hypoxemia was related to greater decline on the 3 MS. Men with 1% or more of sleep time with SaO2 less than 90% had an adjusted annualized decline of 0.43 points, compared with 0.25 for men in the reference group ( P = .003). For each 5-point increase in ODI, there was an average annualized decline of 0.36 points ( P = .01). Results were robust to further adjustment for potential mediators. The association between AHI and cognitive decline did not reach significance. No associations were seen with SDB and decline on the Trails B. Conclusion In older community-dwelling men, there was a modest association between nocturnal hypoxemia and global cognitive decline, suggesting the importance of overnight oxygenation for cognitive function. [ABSTRACT FROM AUTHOR]

Background Previous studies showed that poor sleep prospectively predicted alcohol-related problems and illicit drug use in adolescents and young adults (Wong and Brower, 2012; Wong et al., 2010). However, more work needs to be done to elucidate the nature of these problems. The purpose of this study was to examine whether sleep difficulties and hours of sleep prospectively predicted several serious substance-related problems, for example, binge drinking, driving under the influence of alcohol, and risky sexual behavior. Methods Study participants were 6,504 adolescents from the National Longitudinal Study of Adolescent Health. Data were collected from interviews and questionnaires. This study analyzed data from the first 3 waves of data (T1: 1994 to 1995; T2: 1996; T3: 2001 to 2002). In all analyses, we used sleep difficulties at a previous wave to predict substance-related problems at a subsequent wave, while controlling for substance-related problems at a previous wave. Results Holding T1 alcohol-related problems constant, sleep difficulties at T1 significantly predicted alcohol-related interpersonal problems, binge drinking, gotten drunk or very high on alcohol, driving under the influence of alcohol, getting into a sexual situation one later regretted due to drinking, ever using any illicit drugs, and drug-related problems at T2. T1 hours of sleep negatively predicted T2 alcohol-related interpersonal problems and binge drinking. The relationship between T2 sleep variables and T3 substance-related problems was consistent with previous waves, although the effect was weaker. Conclusions Sleep difficulties and hours of sleep are a significant predictor of a number of substance-related problems. It may be useful to educate adolescents about the importance of sleep, sleep hygiene, and the potential consequences of poor sleep on drinking and related behaviors. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether a novel definition of spirometric respiratory impairment from the Global Lung Initiative ( GLI) is strongly associated with respiratory symptoms and, in turn, frequently establishes symptomatic respiratory disease. Design Cross-sectional. Setting Third National Health and Nutrition Examination Survey. Participants Community-dwelling individuals aged 40 to 80 (N = 7,115). Measurements GLI-defined spirometric respiratory impairment (airflow obstruction and restrictive pattern), dyspnea on exertion ( DOE), chronic bronchitis ( CB), and wheezing. Results Prevalence rates were 12.7% for airflow obstruction, 6.2% for restrictive pattern, 28.6% for DOE, 12.6% for CB, and 12.9% for wheezing. Airflow obstruction was associated with DOE (adjusted odds ratio ( aOR) = 1.69, 95% confidence interval (CI) = 1.42-2.02), CB ( aOR = 1.92, 95% CI = 1.62-2.29), and wheezing ( aOR = 2.50, 95% CI = 2.08-3.00), and restrictive pattern was associated with DOE ( aOR = 1.75, 95% CI = 1.36-2.25), CB ( aOR = 1.39, 95% CI = 1.08-1.78), and wheezing ( aOR = 1.53, 95% CI = 1.15-2.04). Nonetheless, among participants who had airflow obstruction and restrictive pattern, only a minority had DOE (38.6% and 45.5%), CB (23.3% and 15.9%), and wheezing (24.4% and 19.1%), yielding a positive predictive value (PPV) of only 53% for any respiratory symptom in the setting of any spirometric respiratory impairment. In addition, most participants who had DOE (73.0%), CB (67.8%), and wheezing (66.8%) did not have airflow obstruction or restrictive pattern, yielding a PPV of only 26% for any spirometric respiratory impairment in the setting of any respiratory symptom. The results differed only modestly when stratified according to age (40-64 vs 65-80). Conclusion GLI-defined spirometric respiratory impairment increased the likelihood of respiratory symptoms but was nonetheless a poor predictor of respiratory symptoms. Similarly, respiratory symptoms were poor predictors of GLI-defined spirometric respiratory impairment. Hence, a comprehensive assessment is needed when evaluating respiratory symptoms, even in the presence of spirometric respiratory impairment. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to evaluate a selection and programmatic intervention designated 'Conditional Admissions' ( CA), which is intended to expand access to medical education for individuals from under-represented ethnic, racial and rural groups. Further aims were to establish principles of practice designed to increase access for under-represented groups based on an empirical comparison of programmatic changes made to CA in 2005, and to quantify the costs associated with its implementation. Methods Data for all students admitted between 1999 and 2009 ( n = 3227) were compiled; these included demographic data, undergraduate college performance grades, medical school performance indicators, and information on honours, residency placement and md degree completion. To examine the outcomes of the CA intervention, students were divided into two cohorts of those admitted through the CA initiative during 1999-2004 and 2005-2009, respectively, and analysed for differences. Costs associated with CA were also calculated. Results There were 274 students admitted through CA (8.5% of all admittances) during 1999-2009; of these, 81.4% were from under-represented ethnic or racial backgrounds and 18.6% were from rural backgrounds. These students had more hours of science coursework, lower science and cumulative grade point averages ( GPAs), and lower mean Medical College Admission Test ( MCAT) scores than non- CA students. However, first-time pass rates and mean scores on the US Medical Licensing Examination ( USMLE) Step 1 and USMLE Step 2 Clinical Knowledge increased significantly in the CA cohort during 2005-2009. Additional costs incurred per student ranged between US$849 and US$3801. Conclusions Interventions such as CA can significantly increase diversity in the physician workforce. Interventions must be based on careful assessment of academic preparedness, as well as on non-academic factors that contribute to ability to successfully manage the rigors of medical education. Furthermore, the selection and subsequent professional development of students must nurture commitment to addressing the health care needs of diverse communities. Equity must be viewed as a means of increasing fairness for both prospective medical students and the residents of communities that may benefit from the eventual service. [ABSTRACT FROM AUTHOR]

Aims To compare three missing data strategies: (i) the latent growth model that assumes the data are missing at random ( MAR) model; (ii) the Diggle- Kenward missing not at random ( MNAR) model, where dropout is a function of previous/concurrent urinalysis ( UA) submissions; and (iii) the Wu- Carroll MNAR model where dropout is a function of the growth factors. Design Secondary data analysis of a National Drug Abuse Treatment Clinical Trials Network trial that examined a 7-day versus 28-day taper (i.e. stepwise decrease in buprenorphine/naloxone) on the likelihood of submitting an opioid-positive UA during treatment. Setting 11 out-patient treatment settings in 10 US cities. Participants A total of 516 opioid-dependent participants. Measurements Opioid UAs provided across the 4-week treatment period. Findings The MAR model showed a significant effect ( B = −0.45, P < 0.05) of trial arm on the opioid-positive UA slope (i.e. 28-day taper participants were less likely to submit a positive UA over time) with a small effect size ( d = 0.20). The MNAR Diggle- Kenward model demonstrated a significant ( B = −0.64, P < 0.01) effect of trial arm on the slope with a large effect size ( d = 0.82). The MNAR Wu- Carroll model showed a significant ( B = −0.41, P < 0.05) effect of trial arm on the UA slope that was relatively small ( d = 0.31). Conclusions This performance comparison of three missing data strategies (latent growth model, Diggle- Kenward selection model, Wu- Carrol selection model) on sample data indicates a need for increased use of sensitivity analyses in clinical trial research. Given the potential sensitivity of the trial arm effect to missing data assumptions, it is critical for researchers to consider whether the assumptions associated with each model are defensible. [ABSTRACT FROM AUTHOR]

CONTEXT In the United States, abortion opponents have supported legislation requiring that abortion patients be offered the opportunity to view their preprocedure ultrasound. Little research has examined women's interest in and emotional response to such viewing. METHODS Data from 702 women who received abortions at 30 facilities throughout the United States between 2008 and 2010 were analyzed. Mixed-effects multinomial logistic regression analysis was used to determine which characteristics were associated with being offered and choosing to view ultrasounds, and with reporting positive or negative emotional responses to viewing. Grounded theory analytic techniques were used to qualitatively describe women's reports of their emotional responses. RESULTS Forty-eight percent of participants were offered the opportunity to view their ultrasound, and nulliparous women were more likely than others to receive an offer (odds ratio, 2.3). Sixty-five percent of these women (31% overall) chose to view the image; nulliparous women and those living in a state that regulates viewing were more likely than their counterparts to do so (1.7 and 2.5, respectively). Some 213 women reported emotional responses to viewing; neutral emotions (fine, nothing) were the most commonly reported ones, followed by negative emotions (sad, guilty, upset) and then positive emotions (happy, excited). Women who visited clinics with a policy of offering viewing had increased odds of reporting a negative emotion (2.6). CONCLUSIONS Ultrasound viewing appears not to have a singular emotional effect. The presence of state regulation and facility policies matters for women's interest in and responses to viewing. [ABSTRACT FROM AUTHOR]

Objectives: Tooth retention has improved over the past few decades, but it is not known whether these trends have been observed across all demographic/socioeconomic subgroups. We examined number of missing teeth among dentate individuals (n = 9, 113) as well as edentulism and systematically modeled their trends over time by using clinical examination data. Methods: We investigated the association between social stratification and trends in tooth retention among adults ages 50+ from 1988 to 2004, using four waves of the National Health and Nutrition Examination Surveys (NHANES) (n = 11 812). Results: The prevalence of edentulism declined from 24.6% in NHANES III (1988-1994) to 17.4% in 2003-2004, and the mean number of missing teeth declined from 8.19 to 6.50. Older participants, Blacks, the less educated and those with lower income were higher on both edentulism and number missing teeth. Both edentulism and number of missing teeth declined over time, but their patterns varied. For edentulism, age and socioeconomic related disparities decreased over time due to more decline among older and low-income participants. For missing teeth, there was less decrement among older and low-income participants, resulting in increased age and socioeconomic related disparities. Conclusions: Our study found disparities in trends of tooth loss across demographic/socioeconomic strata. Findings suggest that racial/ethnic disparities are partially explained by socioeconomic status. Interventions designed to improve oral health for older adults, particularly those with low levels of income, need special attention. [ABSTRACT FROM AUTHOR]

Purpose Population data concerning smoking rates of adolescents and adults in the United States and Korea (South Korea) has highlighted the need for attention to this age group. This study compared the risk factors related to smoking and examined the gender differences with other risk factors in smoking among American and Korean adolescents between 2005 and 2011. Organizing Construct and Methods Participants were students in grades 9-11 selected from nationally representative surveys conducted in 2005 and 2011. Findings In 2011, similar risk factors for current smoking were identified in American and Korean adolescents. These included male gender, school grade, depression, experience of alcohol drinking, current use of alcohol, use of glue or other inhalants, and experience of sexual intercourse. Among Korean adolescents, weight perception and weight control were unique risk factors for current smoking. Interactions with gender and other risk factors in each nation were revealed. Conclusions These risk factors, their change from earlier years, and gender differences should be recognized in the screening of vulnerable individuals for smoking and formulating effective intervention programs. Clinical Relevance These results will provide information for the design and implementation of cessation programs for adolescents in these countries. [ABSTRACT FROM AUTHOR]

Background There is little information about pregnancy-related changes in alcohol use and factors contributing to changes among women with unwanted pregnancies. This study describes changes in alcohol use from before pregnancy recognition to during pregnancy and identifies important predictors of alcohol use severity among women with unwanted pregnancies. Methods Data are from the Turnaway Study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010, some of whom were denied care because they were past the gestational limit of the facility where they were recruited and were still pregnant at the baseline interview, 1 week after termination seeking. Predictors of alcohol use severity (a latent variable) were identified. Results About 56% of the total sample reported any alcohol use the month before pregnancy recognition, with 23% reporting 6 or more drinks on an occasion. Among the total sample, 35% of those drinking before pregnancy recognition had quit and 20% had reduced 1 week after termination seeking. Among those denied terminations and still pregnant, 71% had quit and 14% had reduced. In a multivariate model predicting alcohol severity, younger age, still pregnant, 1 or more previous births, later gestation, childhood physical abuse, and marijuana and other drug use were associated with lower severity; having completed college, tobacco use, and recent physical violence were associated with higher severity. Conclusions The proportion of the total sample drinking before pregnancy recognition is similar to national samples of women of childbearing age, while the proportion binge drinking appears higher. Of women denied terminations, who were still pregnant, the proportion having quit is similar to other populations of pregnant women. More research is needed to examine whether pregnant women may be substituting alcohol for marijuana and other drugs. Interventions focusing on alcohol use severity during pregnancy may need to also focus on tobacco. [ABSTRACT FROM AUTHOR]

Objectives To describe patterns of, and factors associated with, statin use and discontinuation in nursing home ( NH) residents progressing to advanced dementia and followed for at least 90 days. Design Retrospective inception cohort using a dataset linking 2007 to 2008 Minimum Data Set ( MDS) to Medicare denominator and Part D files. Setting All NHs in five states ( Minnesota, Massachusetts, Pennsylvania, California, Florida). Participants NH residents with dementia. Measurements Residents who developed advanced dementia were observed from baseline (date of progression to very severe cognitive impairment with eating problems) and followed for at least 90 days to statin discontinuation or death. Logistic regression was used to identify baseline factors associated with statin use. Cox proportional hazard regression was used to identify factors associated with time to statin discontinuation. Results Of 10,212 residents, 16.6% (n = 1,699) used statins. Greater odds of statin use were associated with having diabetes mellitus (adjusted odds ratio ( AOR) = 1.24, 95% confidence interval ( CI) = 1.09-1.40), stroke ( AOR = 1.31, 95% CI = 1.16-1.48), and hypertension ( AOR = 1.35, 95% CI = 1.18-1.54); hospice enrollment was associated with lower odds ( AOR = 0.75, 95% CI = 0.64-0.89). In follow-up, 37.2% (n = 632) discontinued statins. Median time to discontinuation was 36 days (interquartile range 12-110 days). Shorter time to discontinuation was associated with hospitalization in past 30 days (adjusted hazard ratio ( AHR) = 1.67, 95% CI = 1.40-1.99) and more daily medications ( AHR = 1.02, 95% CI = 1.01-1.04). When statins were discontinued, 15.0% (n = 95) of residents stopped only statins, and 47.5% (n = 300) stopped at least one other medication. Conclusion Most NH residents who use statins at the time of progression to advanced dementia continue use in follow-up. [ABSTRACT FROM AUTHOR]

Background Oppositional defiant disorder ( ODD) has components of both irritability and defiance. It remains unclear whether children with variation in these domains have different adult outcomes. This study examined the concurrent and predictive validity of classes of oppositional defiant behavior. Methods Latent class analysis was performed on the oppositional defiant problems scale of the Child Behavior Checklist in two samples, one in the US (the Achenbach Normative Sample, N = 2029) and one in the Netherlands (the Zuid-Holland Study, N = 2076). A third sample of American children (The Vermont Family Study, N = 399) was examined to determine concurrent validity with DSM diagnoses. Predictive validity over 14 years was assessed using the Zuid-Holland Study. Results Four classes of oppositional defiant problems were consistent in the two latent class analyses: No Symptoms, All Symptoms, Irritable, and Defiant. Individuals in the No Symptoms Class were rarely diagnosed concurrently with ODD or any future disorder. Individuals in the All Symptoms Class had an increased frequency of concurrent childhood diagnosis of ODD and of violence in adulthood. Subjects in the Irritable Class had low concurrent diagnosis of ODD, but increased odds of adult mood disorders. Individuals in the Defiant Class had low concurrent diagnosis of ODD, but had increased odds of violence as adults. Conclusions Only children in the All Symptoms class were likely to have a concurrent diagnosis of ODD. Although not diagnosed with ODD, children in the Irritable Class were more likely to have adult mood disorders and children in the Defiant Class were more likely to engage in violent behavior. [ABSTRACT FROM AUTHOR]

Background Few studies assess reliability and validity of lifetime alcohol measures. We undertook extended test-retest analyses of retrospective lifetime drinking measures and of incremental predictive ability of lifetime heavy drinking (days 5+ drinks) in teens, 20s, and 30s for current (12-month) alcohol use disorders ( AUDs). Methods A subset (31.4%; 962 men, 1,220 women) of the 2005 U.S. National Alcohol Survey ( NAS; N11) completed a follow-up survey ( N11 T) by phone or mail (mean delay of 2.7 years). Both surveys assessed lifetime drinking. Results In N11 T, drinking status was reported consistently by 94.7% of N11 current drinkers, 85.5% of ex-drinkers, and 74.4% of lifetime abstainers (93.5% overall). Cumulative number of prior heavy drinking days (teens through 30s) were moderately consistent (Pearson's ρ = 0.6, p < 0.001, n = 1,636). Reliability was lower for younger respondents under 30 and higher for Whites versus Blacks and Hispanics ( ρ = 0.68 vs. ρ = 0.56 vs. ρ = 0.56, both p = 0.01), but did not differ by gender. Heavy drinking days in teens correlated 0.63 ( p < 0.001) for those aged 20 or older, higher for women than men and for Whites versus ethnic minorities. Heavy drinking days in the 20s and 30s reported by those 30 and older and 40 and older correlated at 0.63 and 0.67, respectively, being higher for Whites. Age of drinking onset and of lifetime maximum quantity reports were also consistent (0.65, 0.73), higher for women versus men, for those older than 29 versus younger, and for Whites versus Blacks and Hispanics. In N11, controlling for gender, age, ethnicity, and current 5+ frequency, cumulative prior 5+ days (teens to age 39) predicted current alcohol-related consequences and dependence (both p = 0.003). Conclusions Measurements of earlier heavy drinking are feasible, efficient, and reasonably reliable, albeit with some individual imprecision. Prior drinking data improve prediction of current AUDs, adjusting for demographics and current drinking. [ABSTRACT FROM AUTHOR]

Context The Food and Drug Administration (FDA) Safety and Innovation Act has recently relaxed conflict-of-interest rules for FDA advisory committee members, but concerns remain about the influence of members' financial relationships on the FDA's drug approval process. Using a large newly available data set, this study carefully examined the relationship between the financial interests of FDA Center for Drug Evaluation and Research (CDER) advisory committee members and whether members voted in a way favorable to these interests. Methods The study used a data set of voting behavior and reported financial interests of 1,379 FDA advisory committee members who voted in CDER committee meetings that were convened during the 15-year period of 1997-2011. Data on 1,168 questions and 15,739 question-votes from 379 meetings were used in the analyses. Multivariable logit models were used to estimate the relationship between committee members' financial interests and their voting behavior. Findings Individuals with financial interests solely in the sponsoring firm were more likely to vote in favor of the sponsor than members with no financial ties (OR = 1.49, p = 0.03). Members with interests in both the sponsoring firm and its competitors were no more likely to vote in favor of the sponsor than those with no financial ties to any potentially affected firm (OR = 1.16, p = 0.48). Members who served on advisory boards solely for the sponsor were significantly more likely to vote in favor of the sponsor (OR = 4.97, p = 0.005). Conclusions There appears to be a pro-sponsor voting bias among advisory committee members who have exclusive financial relationships with the sponsoring firm but not among members who have nonexclusive financial relationships (ie, those with ties to both the sponsor and its competitors). These findings point to important heterogeneities in financial ties and suggest that policymakers will need to be nuanced in their management of financial relationships of FDA advisory committee members. [ABSTRACT FROM AUTHOR]

Background We examined the prevalence of obesity in adults with intellectual disabilities (ID) compared with the general population, and the factors associated with obesity and weight management status, comparing individuals with ID who were overweight or obese to those who were not. Methods We analysed baseline data (n = 1450) from the ongoing 4-year Longitudinal Health and Intellectual Disabilities Study (LHIDS) using a multivariate approach. Measures included body mass index (BMI), demographics, level of ID, diagnoses related to ID, health behaviours (i.e. physical activity, dietary habits, smoking, and alcohol consumption), various health parameters (e.g. mobility limitation, medications), and residential type and location. Results Compared with the general population, adults (≥18 years) with ID had a higher prevalence of obesity (38.3% vs. 28%) and morbid obesity (7.4% vs. 4.2%). Being female (AOR = 1.40, 95% CI = 1.09--1.81), having Down syndrome (AOR = 2.53, 95% CI = 1.86--3.45), taking medications that cause weight gain (AOR = 1.80, 95% CI = 1.38--2.37), engaging in less moderate physical activity (AOR = 0.89, 95% CI = 0.79--0.99), and drinking greater amounts of soda (AOR = 1.20, 95% CI = 1.02--1.42) were associated with higher rates of obesity. Conclusion Adults with ID, in general, have a high risk of developing obesity, and women with ID have a high risk of developing morbid obesity. Health promotion initiatives should target individuals with the greatest risk. [ABSTRACT FROM AUTHOR]

Objectives To describe new users of antihypertensive medications and identify predictors of combination therapy initiation in older Americans. Design Retrospective observational cohort study. Setting Population-based study using U.S. Medicare fee-for-service healthcare claims (2007-2010). Participants Medicare beneficiaries aged 65 and older with no recent diagnoses, procedures, or medications for cardiovascular disease who newly initiated an antihypertensive therapy (n = 275,493; 210,605 initiated monotherapy, 64,888 initiated combination therapy). Measurements Multivariable Poisson regression was used to assess factors associated with initiation of combination therapy versus monotherapy, including participant characteristics, prescriber characteristics, and participant encounters with the healthcare system. Results Initiation of combination therapy increased from 21.9% in 2007 to 24.7% in 2010. The most frequently initiated combinations were angiotensin-converting enzyme inhibitors with thiazide (29.7%) and angiotensin II receptor antagonists with thiazide (18.7%). Blacks (prevalence ratio ( PR) = 1.48, 95% confidence interval ( CI) = 1.45-1.51 vs whites), individuals seeing a generalist ( PR = 1.10, 95% CI = 1.07-1.14), individuals seeing more than one doctor ( PR = 3.38, 95% CI = 3.33-3.44), and participants with no pharmacy claims in the previous 6 months ( PR = 1.34, 95% CI = 1.30-1.37 vs ≥3 unique drug classes) were more likely to initiate combination therapy, whereas those who had more outpatient visits in the previous 12 months were less likely to initiate combination therapy (per five visits, PR = 0.82, 95% CI = 0.80-0.83). Conclusion Nearly one in four new users of antihypertensive medications aged 65 and older started treatment with combination therapy. Blacks, individuals living in the south, and those with fewer outpatient physician office visits were more likely to initiate combination therapy. Further research is needed to determine whether this approach to managing hypertension is being well targeted to individuals who will require combination treatment. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between cognition and levels of cystatin C in persons with chronic kidney disease ( CKD). Design Prospective observational study. Setting Chronic Renal Insufficiency Cohort Cognitive Study. Participants Individuals with a baseline cognitive assessment completed at the same visit as serum cystatin C measurement (N = 821; mean age 64.9, 50.6% male, 48.6% white). Measurements Levels of serum cystatin C were categorized into tertiles; cognitive function was assessed using six neuropsychological tests. Scores on these tests were compared across tertiles of cystatin C using linear regression and logistic regression to examine the association between cystatin C level and cognitive performance (1 standard deviation difference from the mean). Results After multivariable adjustment for age, race, education, and medical comorbidities in linear models, higher levels of cystatin C were associated with worse cognition on the modified Mini-Mental State Examination, Buschke Delayed Recall, Trail-Making Test Part (Trails) A and Part B, and Boston Naming ( P < .05 for all). This association remained statistically significant for Buschke Delayed Recall ( P = .01) and Trails A ( P = .03) after additional adjustment for estimated glomerular filtration rate (e GFR). The highest tertile of cystatin C was associated with greater likelihood of poor performance on Trails A (odds ratio ( OR) = 2.17, 95% confidence interval ( CI) = 1.16-4.06), Trails B ( OR = 1.89, 95% CI = 1.09-3.27), and Boston Naming ( OR = 1.85, 95% CI = 1.07-3.19) than the lowest tertile after multivariate adjustment in logistic models. Conclusion In individuals with CKD, higher serum cystatin C levels were associated with worse cognition and greater likelihood of poor cognitive performance on attention, executive function, and naming. Cystatin C is a marker of cognitive impairment and may be associated with cognition independent of e GFR. [ABSTRACT FROM AUTHOR]

Aims The US Veterans Health Administration [Veterans Affairs (VA)] used performance measures and electronic clinical reminders to implement brief intervention for unhealthy alcohol use. We evaluated whether documented brief intervention was associated with subsequent changes in drinking during early implementation. Design Observational, retrospective cohort study using secondary clinical and administrative data. Setting Thirty VA facilities. Participants Outpatients who screened positive for unhealthy alcohol use [Alcohol Use Disorders Identification Test Consumption (AUDIT-C ≥ 5)] in the 6 months after the brief intervention performance measure (n = 22 214) and had follow-up screening 9–15 months later (n = 6210; 28%). Measurements Multi-level logistic regression estimated the adjusted prevalence of resolution of unhealthy alcohol use (follow-up AUDIT-C <5 with ≥2 point reduction) for patients with and without documented brief intervention (documented advice to reduce or abstain from drinking). Findings Among 6210 patients with follow-up alcohol screening, 1751 (28%) had brief intervention and 2922 (47%) resolved unhealthy alcohol use at follow-up. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental health conditions, poor health and more severe unhealthy alcohol use than those without (P-values < 0.05). Adjusted prevalences of resolution were 47% [95% confidence interval (CI) = 42–52%] and 48% (95% CI = 42–54%) for patients with and without documented brief intervention, respectively (P = 0.50). Conclusions During early implementation of brief intervention in the US Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening. [ABSTRACT FROM AUTHOR]

Aims Within-country temporal changes in alcohol consumption in the United States, Finland and Norway were examined to assess (i) whether a change in mean alcohol consumption is accompanied by a change in the prevalence of heavy drinkers, (ii) whether this mean change reflects a collective displacement in the whole distribution of consumption and (iii) whether collective displacement is found for both an upward and a downward shift in mean consumption. Methods We applied repeated cross-sectional survey data on distribution measures for estimated annual alcohol consumption from national population sample surveys covering 30–40-year periods in two countries with increasing trends in mean consumption (Finland and Norway) and one country with decreasing trends (the United States). Results There was a strong positive association (P < 0.001) between changes in mean consumption and changes in the prevalence of heavy drinkers in all three countries. Moreover, a change in mean consumption was accompanied by a consumption change in the same direction in all consumer categories in all three countries, i.e. a collective displacement. The regression coefficients were approximately 1. Conclusions Drinkers at all levels of consumption appear to move in concert, both up and down the consumption scale, in Finland, Norway and the United States, as predicted by Skog’s theory of the collectivity of drinking cultures. [ABSTRACT FROM AUTHOR]

Background Being able to investigate the relationship between underage drinkers' preferences for particular brands and their exposure to advertising for those brands would represent a significant advance in alcohol marketing research. However, no previous national study has examined the relationship between underage youth exposure to brand-specific alcohol advertising and consumption of those brands. Methods We conducted a cross-sectional, Internet-based survey of a national sample of 1,031 youth, ages 13-20, who had consumed at least 1 drink of alcohol in the past 30 days. We ascertained all alcohol brands consumed by respondents in the past 30 days. The main outcome measure was brand-specific consumption during the past 30 days, measured as a dichotomous variable. The main predictor variable was exposure to brand-specific alcohol advertising on television. The respondents reported which of 20 television shows popular with youth they had watched during the past 30 days. For each respondent, we calculated a standard measure of potential exposure to the brand-specific alcohol advertising that aired on those shows during the preceding 12 months, based on Nielsen (New York, NY) estimates of the youth audience for each show's telecasts. Results Compared to no brand-specific advertising exposure, any exposure was associated with an increased likelihood of brand-specific consumption (adjusted odds ratio 3.02; 95% confidence interval: 2.61-3.49) after controlling for several individual- and brand-level variables. When measured as a continuous variable, the relationship between advertising exposure and brand consumption was nonlinear, with a large association at lower levels of exposure and diminishing incremental effects as the level of exposure increased. Conclusions There is a robust relationship between youth's brand-specific exposure to alcohol advertising on television and their consumption of those same alcohol brands during the past 30 days. This study provides further evidence of a strong association between alcohol advertising and youth drinking behavior. [ABSTRACT FROM AUTHOR]

Background Alcohol-impaired driving among college students represents a significant public health concern, yet little is known about specific theoretical and individual difference risk factors for driving after drinking among heavy drinking college students. This study evaluated the hypothesis that heavy drinkers with elevated alcohol demand would be more likely to report drinking and driving. Method Participants were 207 college students who reported at least 1 heavy drinking episode (4/5 or more drinks in 1 occasion for a woman/man) in the past month. Participants completed an alcohol purchase task that assessed hypothetical alcohol consumption across 17 drink prices and an item from the Young Adult Alcohol Consequences Questionnaire that assessed driving after drinking. Results In binary logistic regression models that controlled for drinking level, gender, ethnicity, age, and sensation seeking, participants who reported higher demand were more likely to report driving after drinking. Conclusions These results provide support for behavioral economics models of substance abuse that view elevated/inelastic demand as a key etiological feature of substance misuse. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To estimate ethnic differences in three components of alcohol use disorder and alcohol dependence course (onset, persistence and recurrence) in a developmental framework. Design Longitudinal data from The National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), collected using face-to-face interviews. Setting Civilian non-institutionalized US population aged 18 years and older, with oversampling of Hispanics, blacks and those aged 18-24 years. Participants Individuals who completed both NESARC assessments, were not life-long abstainers and were either white ( n = 17 458), black ( n = 4995), US-born Hispanic ( n = 2810) or Hispanic-born outside the United States ( n = 2389). Measurements Alcohol dependence (AD) and alcohol use disorder (AUD; abuse or dependence) onset, persistence and recurrence were examined using the Alcohol Use Disorders and Associated Disabilities Interview Schedule, DSM-IV version. Findings Among men: relative to whites aged 18-29, AUD onset and persistence were elevated only in US-born Hispanics aged 40 years and older; odds were reduced for all non-US-born Hispanics, older whites, most blacks and US-born Hispanics aged 30-39. For AD, onset risk was elevated for all younger minority men and only reduced among non-US-born aged Hispanics 40 or older. For women: compared to young whites, non-US-born Hispanics were at decreased AUD and AD onset risk; AUD and AD onset and persistence were increased for older blacks and US-born Hispanics. Conclusions In the United States, ethnic differences in alcohol disorder transitions (onset, persistence, and recurrence) vary across age, gender and whether a broad (alcohol use disorder) or narrow (alcohol dependence) alcohol definition is used. Evidence of increased risk for some transitions in minority groups suggests that attention should be paid to the course of alcohol use disorders, and that differences in prevalence should not be assumed to reflect differences in specific transitions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented concerning a study examining the association between dual sensory impairment of vision and hearing impairment in older adults and negative health outcomes including cognitive decline, physical disability, and hospitalization, as well as the burden of disease.

This study focuses on (a) American 8th-, 10th-, and 12th-grade students' access to, and use of, substance abuse counseling services via schools and (b) associations between such access and student substance use prevalence. From 1999 through 2003, student data were obtained from the Monitoring the Future study; and school data were obtained through the Youth, Education, and Society study, resulting in nationally representative data from 113,008 students in 855 public and private schools. Results indicate that in contrast to relatively stable student heavy-drug use prevalence rates, internal counseling availability and participation decreased significantly over time, as did reported student referral to external counseling. Availability of internal counseling, as well as student participation in both internal and external referrals, differed significantly by school characteristics-school level, grade size, sector, population density, school socioeconomic status, majority student body race/ethnicity, and geographical region. Student use of counseling services did not show any relationships with school-level heavy drinking rates; however, student participation in external counseling referrals was positively associated with school-level prevalence rates for the use of illicit drugs other than marijuana and showed indications of a similar relationship with marijuana prevalence rates. The decreasing access to, and use of, counseling, the lower probability of counseling availability in middle schools, and the lack of association between heavy-alcohol use rates and counseling services, all suggest missed opportunities and a greater need for counseling services to reduce high-risk drug use. [ABSTRACT FROM AUTHOR]

The article discusses research which was conducted to investigate telomere length and the clinical phenotype of frailty in older adults undergoing cardiac surgery. Researchers evaluated 53 patient who were scheduled to undergo cardiac surgerys. They found that there was no association between telomere length and frailty and that several factors could explain the lack of an association.

Summary: Background: Effects of food environments (FEs) on childhood obesity are mixed. Objectives: To examine the association of residential FEs with childhood obesity and variation of the association across gender and urbanicity. Methods: We used the US Early Childhood Longitudinal Study—Kindergarten Cohort data, with 9440 kindergarteners followed up from 1998 to 2007. The Dun and Bradstreet commercial datasets in 1998 and 2007 were used to construct 12 FE measures of children, ie, changes in the food outlet mix and density of supermarkets, convenience stores, full‐service restaurants, fast‐food restaurants, retail bakery, dairy‐product stores, health/dietetic food stores, confectionery stores, fruit/vegetable markets, meat/fish markets, and beverage stores. Two‐level mixed‐effect and cluster robust logistic regression models were fitted to examine associations. Results: Decreased exposures to full‐service restaurants, retail bakeries, fruit/vegetable markets, and beverage stores were generally obesogenic, while decreased exposure to dairy‐product stores was generally obesoprotective; the magnitude and statistical significance of these associations varied by gender and urbanicity of residence. Higher obesity risk was associated with increased exposure to full‐service restaurants among girls, and with decreased exposures to fruit/vegetable markets in urban children, to beverage stores in suburban children, and to health/dietetic food stores in rural children. Mixed findings existed between genders on the associations of fruit/vegetable markets with child weight status. Conclusion: In the United States, exposure to different FEs seemed to lead to different childhood obesity risks during 1998 to 2007; the association varied across gender and urbanicity. This study has important implications for future urban design and community‐based interventions in fighting the obesity epidemic. [ABSTRACT FROM AUTHOR]