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INTRODUCTION: We aimed to identify profiles of modifiable, late‐life lifestyle health behaviors related to subsequent maintenance of cognition and explore sociodemographics and health characteristics as effect modifiers. METHODS: Analyses used data from 715 older adults without baseline dementia from the Rush Memory and Aging Project and with lifestyle health behaviors (physical activity, cognitive activity, healthy diet, social activity) at baseline and ≥ 2 annual assessments of cognition. We used latent profile analysis to group participants based on behavior patterns and assessed change in cognition by group. RESULTS: Three latent profiles were identified: high (n = 183), moderate (n = 441), and low (n = 91) engagement in health behaviors. Compared to high engagement, the moderate (mean difference [MD] = ‐0.02, 95% CI = [‐0.03;‐0.0002], p = 0.048) and low (MD = ‐0.06, 95% CI = [‐0.08;‐0.03], p < 0.0001) groups had faster annual rates of decline in global cognition, with no significant effects modifiers (vascular risk factors, apolipoprotein E [APOE] ε4, motor function). DISCUSSION: Avoiding low levels of lifestyle health behaviors may help maintain cognition. Highlights: Latent profile analysis (LPA) captures lifestyle health behaviors associated with cognitive function.Such behavior include physical activity, cognitive activity, healthy diet, social activity.We used LPA to examine associations of behaviors and cognitive function over time.Older adults with low lifestyle health behaviors showed more rapid decline.To a lesser degree, so did those with moderate lifestyle health behaviors.Vascular conditions and risks, APOEε4, or motor function did not modify the effect. [ABSTRACT FROM AUTHOR]

The global pandemic of coronavirus disease 2019 (COVID‐19) affected many aspects of randomized controlled trials, including recruiting and screening participants. The purpose of this paper is to (a) describe adjustments to recruitment and screening due to COVID‐19, (b) compare the proportional recruitment outcomes (not completed, ineligible, and eligible) at three screening stages (telephone, health assessment, and physical activity assessment) pre‐ and post‐COVID‐19 onset, and (c) compare baseline demographic characteristics pre‐ and post‐COVID‐19 onset in the Working Women Walking program. The design is a cross‐sectional descriptive analysis of recruitment and screening data from a 52‐week sequential multiple assignment randomized trial (SMART). Participants were women 18–70 years employed at a large urban medical center. Recruitment strategies shifted from in‐person and electronic to electronic only post‐COVID‐19 onset. In‐person eligibility screening for health and physical activity assessments continued post‐COVID‐19 onset with Centers for Disease Control and Prevention precautions. Of those who expressed interest in the study pre‐ and post‐COVID‐19 onset (n = 485 & n = 269 respectively), 40% (n = 194) met all eligibility criteria pre‐COVID‐19 onset, and 45.7% (n = 123) post‐COVID‐19 onset. Although there were differences in the proportions of participants who completed or were eligible for some of the screening stages, the final eligibility rates did not differ significantly pre‐COVID‐19 versus post‐COVID‐19 onset. Examination of differences in participant demographics between pre‐ and post‐COVID‐19 onset revealed a significant decrease in the percentage of Black women recruited into the study from pre‐ to post‐COVID‐19 onset. Studies recruiting participants into physical activity studies should explore the impact of historical factors on recruitment. [ABSTRACT FROM AUTHOR]

Background: Lifestyle health behaviors, such as physical activity, cognitive activity, healthy diet, and social engagement, can improve cognition in older adults. We aim to identify profiles of late‐life lifestyle health behaviors related to subsequent maintenance of cognition and explore sociodemographics and health characteristics as effect modifiers. Method: Analyses were conducted using data from 715 older adult participants from the Rush Memory and Aging Project who were dementia‐free at the first concurrent assessment of self‐reported lifestyle health behaviors (physical activity, cognitive activity, dietary habits, and social engagement) and with ³2 annual cognitive tests to assess changes in cognition. Neuropsychological test scores were grouped to form summary measures of global cognition, and five domains (episodic memory, semantic memory, working memory, perceptual speed, visuospatial memory). First, each participant was assigned to a specific group based on the initial levels of lifestyle behaviors using a latent profile analysis. Then, we assessed change in cognition among groups using linear mixed‐effects models adjusted for sex, education, and age at baseline. In additional models, we examined potential effect modifiers, including motor function, vascular risk factors (hypertension, diabetes, smoking), and vascular diseases (stroke, cardiac disease, congestive heart failure, claudication). Result: Three groups were identified: high engagement in behaviors (n = 183), moderate engagement (n = 441), and low engagement (n = 91). Participants in the high group were more likely to be women, younger, and with higher educational level, compared to the low group. Compared to the high group, the low group had a faster annual rate of decline in global cognition (mean difference [MD] = ‐0.06 [‐0.08;‐0.03], p<.0001) after full adjustment. In addition, compared to the high group, the low group showed a faster rate of decline in episodic memory, semantic memory, and perceptual speed, while the moderate group had a faster rate of decline for episodic memory only. There were no significant effects modifiers by any sociodemographic, motor function, or vascular health factor. Conclusion: Classification in the moderate or high engagement group was related to better maintenance of cognition over time. Future research should examine multidomain intervention strategies that promote adoption of higher engagement in health behaviors targeting at least moderate levels. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe our Activation and Coordination Team (ACT) model for interprofessional care coordination in primary care and examine feasibility of using ACT medical and social complexity criteria to categorize patients into Quadrants that determine resource utilization. Research questions were: (a) Are there significant differences in demographic, medical, and social characteristics by Quadrant; (b) Do patients with combined high medical and social complexity differ from those with either high medical or social complexity; and (c) Is there an association between initial screening risk level and ACT Complexity Quadrant placement? Design: Cross‐sectional, descriptive. Sample: Patients (N = 167) aged 18–65 enrolled in an urban Medicaid managed care network. Measurements: Screening and comprehensive health risk assessment questionnaires and clinical data collection from electronic health records. Results: Patient characteristics differed significantly by Quadrant. Combined medical and social complexity produced greater impact than additive effects. Patients who initially screened low risk nevertheless met ACT criteria for medical and/or social complexity. Conclusions: Greater effects for individuals with medical and social issues are due to interactions among factors. Traditional screening may miss patients with complex needs who need care coordination. Care coordination skills should be incorporated into population health curricula. [ABSTRACT FROM AUTHOR]

Background: Premature infants are susceptible to oxidative stress, increasing the risk for serious morbidities. High-dose human milk (HM) feedings decrease morbidity risks and may reduce oxidative stress in this population. The purpose of this study was to compare oxidative stress using serial urinary F2 -isoprostane concentrations in predominantly HM and preterm formula (PF)-fed premature infants over the first 21 days of life (DOL), while controlling for perinatal oxidative stress exposures including bovine-based human milk fortifier (HMF) or PF introduction to predominantly HM-fed infants.Methods: This was a quasi-experimental design that categorized 22 premature infants into mutually exclusive comparison groups based on exposure to HM and PF. Serial urine samples (before and after first feeding, and DOL 7, 14, and 21) were used to determine urine F2 -isoprostane concentrations measured by enzyme-linked immunosorbent assays. We analyzed data using Mann-Whitney U test, Wilcoxon rank test, and multilevel models.Results: Comparing the predominantly HM-fed and predominantly PF-fed groups over time, median F2 -isoprostane concentrations decreased significantly in the predominantly HM group (P = .003) and increased significantly in the predominantly PF group (P = .01). Perinatal oxidant exposures and the introduction of HMF did not affect results.Conclusions: Our results demonstrate that predominantly HM feedings were associated with decreased oxidative stress, whereas PF feedings increased oxidative stress in premature infants, even after controlling for perinatal oxidant exposures of HMF or PF introduction. [ABSTRACT FROM AUTHOR]

Abstract: The link between relationship violence and aspects of neighborhood concentrated disadvantage (e.g., percent of unemployed adults, percent of families below poverty level), has been established. However, the literature examining neighborhood social processes, including informal social control and social cohesion, in relation to adolescent dating violence has shown mixed results with a limited theoretical foundation and methodology. Using a social disorganization theoretical framework, this study examined the mediating role of these neighborhood social processes in the relation between concentrated disadvantage and adolescent dating violence within an urban context. Participants included 605 adult residents in 30 census tracts and 203 adolescents from neighborhoods on the West and South sides of Chicago. Neighborhood‐level concentrated disadvantage was measured via Census data, adult residents reported on neighborhood social processes, and youth reported on dating violence. Informal social control was negatively associated with dating violence, and social cohesion was positively associated with dating violence. A multilevel mediation model showed that concentrated disadvantage was related to higher levels of dating violence via lower levels of informal social control. These results extend social disorganization theory to dating violence within an urban context, while also highlighting the important role of neighborhood processes on relationship violence. Implications for research and intervention programming are discussed. [ABSTRACT FROM AUTHOR]

A longitudinal randomized controlled trial tested whether access to permanent housing reduces child maltreatment among inadequately housed families under investigation for child abuse and neglect. The study followed homeless and child welfare-involved families randomly assigned to receive a referral for housing subsidies plus housing case management ( n = 75, 196 children) or housing case management alone ( n = 75, 186 children). Latent growth models examined change in caregiver-reported frequencies of psychological aggression, physical abuse, and neglect toward children at five time points across 2.5 years. Intent-to-treat analyses suggested treatment differences for minor assault and neglect that approached significance; families randomly assigned to permanent housing plus case management exhibited marginally greater declines compared to families referred for housing case management only. Caregiver psychological aggression remained high over time, regardless of treatment condition. No evidence indicated higher risk families benefitted more from permanent housing. Results show some promise of permanent housing and highlight the complex needs of homeless families under investigation for child maltreatment. Findings emphasize the importance of continued involvement from the child welfare system to connect families with important resources. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment disproportionately affects women compared to men, and cardiovascular disease (CVD) increases risk. Physical activity and cognitive training may have synergistic effects on cognition when delivered together. However, no multimodal intervention has targeted older women (≥65) with CVD or has utilized a scalable lifestyle approach. Our study seeks to evaluate the efficacy of MindMoves, a 24‐week multimodal intervention, on cognition and serum biomarkers in 254 older women with CVD. However, effects of the COVID‐19 pandemic complicated implementation of our original in‐person trial protocol. The purpose of this paper is to describe protocol modifications made by our interdisciplinary team in response to COVID‐19, Method: We employ a 2x2 factorial randomized controlled trial design to determine independent and combined efficacies of Mind (cognitive training with BrainHQ) and Move (lifestyle physical activity with goal self‐monitoring and nurse‐led group meetings) interventions. Outcome measures of cognition and serum biomarkers (brain‐derived neurotrophic factor, vascular endothelial growth factor, insulin‐like growth factor 1) are collected at baseline, 24, 48, and 72 weeks. Nurse scientists oversee interventions, cardiologists refer women ≥65 years with CVD and no cognitive impairment from clinics, and a cognitive neurologist and neuropsychologist oversee outcome measures. Pandemic‐related protocol changes were implemented to maximize study integrity and participant/staff safety. Targeted mailings were added to in‐person recruitment strategies. Screening activities shifted to phone. In‐person data collection was modified for phone/virtual settings, including accelerometer mailing (device measure of physical activity), neurocognitive tests validated for phone use, and home‐based participant‐administered dried blood spot collection for serum biomarkers. Women are now provided and trained to use iPad tablets to complete intervention activities virtually (e.g., Move group meetings). Result: The anticipated number of participants (19) in the first cohort was recruited without disruption, in the original timeline. Participants completed all phone‐based questionnaires and mailed devices were returned. Randomization occurred as planned. Intervention activities are ongoing, including phone‐based orientations and ≥90% attendance at virtual meetings. Conclusion: The modified trial protocol is being successfully implemented during the COVID‐19 pandemic. Results will demonstrate efficacy of pivoting from in‐person to virtual delivery of a lifestyle‐focused multimodal intervention in at‐risk older women with CVD. [ABSTRACT FROM AUTHOR]

Neighborhoods are important contexts for understanding development and behavior, but cost and difficulty have challenged attempts to develop measures of neighborhood social processes at the neighborhood level. This article reports the development, reliability, and validity of Neighborhood Matters, a collection of instruments assessing three aspects of neighborhood social processes, namely, norms (five subscales), informal social control (six subscales and total scale), social connection (two subscales), as well as individual scales for assessing neighborhood change, neighborhood resources, and neighborhood problems. Six hundred six residents of Chicago, chosen at random from 30 neighborhoods (defined by US Census tracts), completed the measures. Neighborhoods were selected randomly from pools that balanced poverty and predominant (African-American vs. Latino Hispanic) ethnicity. Within each neighborhood 20 individuals were selected at random, balanced by age (18-24 vs. 30+) and gender. Scaling and item analysis permitted reduction of the number of items in each scale. All subscales had individual-level internal consistency in excess of .7. Generalizability theory analysis using random effects regression models found significant shared variance at the neighborhood level for three norms subscales, four informal social control subscales, both social connection subscales, and the neighborhood change, resources and problems scales. Validity analyses found significant associations between neighborhood-level scores on multiple Neighborhood Matters scales and neighborhood levels of violent, property, and drug-related crime. Discussion focuses on potential applications of the Neighborhood Matters scales in community research. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the prevalence of inadequate housing that threaten out-of-home placement among families under investigation by child welfare. Data came from the National Survey of Child and Adolescent Well-Being, a nationally representative longitudinal survey of child welfare-involved families. Child protective services caseworkers as well as caregivers provided information on families whose child remained in the home after initial investigation ( N = 3,867). Multilevel latent class analyses tested the presence of inadequately housed subgroups using 4 housing problem indicators at baseline. Logistic regressions assessed convergent and predictive validity. A two class latent solution best fit the data. Findings indicated that inadequate housing contributed to risk for out-of-home placement in approximately 16 % of intact families under investigation by child protective services. These families were 4 times more likely to need housing services 12 months later. Federal legislation emphasizes integration of social services as necessary to end homelessness. This study demonstrates overlap across public agencies. Enhanced coordination of child welfare and housing services facilitates interventions to prevent and mitigate homelessness. [ABSTRACT FROM AUTHOR]

This study tested five hypotheses related to the accuracy of students' perceptions of school norms for aggression and nonviolent problem-solving strategies with two cohorts ( ns = 852 and 968) of 6th-grade students in 12 schools. Students consistently overestimated peer normative support for aggression and underestimated peer normative support for nonviolent problem-solving strategies. This effect remained significant in tests of moderation by gender, ethnicity, and aggression level. Tests for moderation by the degree of provocation (e.g., if a student was hit first) and a test measuring actual norms from eighth graders and perceived norms from seventh graders suggested that the discrepancy was not due to self-serving bias or social desirability. Longitudinal analysis found that the discrepancy remained through 8th grade. The discrepancy between actual and perceived norms has implications for risk and violence prevention, which are discussed. [ABSTRACT FROM AUTHOR]

Data from 1,087 adolescent participants in three waves of the National Longitudinal Study of Adolescent Health were used to examine the effects of peer selection and socialization processes in adolescence on later reports of sexually transmitted infections (STI) and unintended pregnancies. Friends' attitudes and behavior were assessed with friends' reports. Among male adolescents, there was evidence for selection effects on STI diagnoses and socialization effects on reports of unintended pregnancy, both involving friends' attitudes. Among female adolescents, there was evidence for long-term effects of both socialization and selection processes involving same-sex friends' attitudes. Discussion focuses on the importance of peer and individual attitudes as potential intervention targets. [ABSTRACT FROM AUTHOR]

Objectives. To develop and evaluate a feedback method for reducing empathic errors in psychotherapy. Design. Randomized controlled trial conducted in a university-affiliated out-patient psychiatric clinic. Methods. Sixteen non-psychotic patients treated for Axis I disorders by 12 psychiatry residents were randomly assigned to intervention and control conditions. In both conditions, at the end of each session, patients rated their own functioning on the Global Assessment of Functioning scale, and therapists predicted patients' ratings. Patients predicted their therapist's accuracy and therapists rated their confidence in their own predictions. In the intervention condition, therapists and patients reviewed their respective ratings from the previous session together. In the control condition, ratings were given directly to the investigator without being reviewed by either patients or therapists. Results. Therapists in the intervention condition showed greater overall accuracy than controls as well as evidence of increasing empathy later in therapy on the Barrett-Lennard empathy subscale. Patients in the control group perceived their therapists as significantly more or less accurate than was warranted according to the accuracy measure (over-/under-idealization). Therapists in the control group were more likely than those in the intervention group to overestimate their own accuracy (overconfidence). Affective responses to the instrument were positive overall and did not differ by condition. Conclusion. An intervention such as the one tested in this study may be a practical and useful method for improving accuracy of understanding in a variety of training and clinical settings. [ABSTRACT FROM AUTHOR]

This study examined parenting variables as protective factors to reduce the influence of school and peer risk factors on adolescents' aggression. Five waves of data spanning 3 years were collected from 5,581 students at 37 schools who began the 6th grade in 2001 or 2002. Class-level and perceived school norms supporting aggression, delinquent peer associations, parental support for fighting and support for nonviolence, and parental involvement were each associated with physical aggression across all waves. Each parenting variable moderated 1 or more risk factors, with the magnitude of many effects varying by gender and decreasing over time. Implications for the role parents may play in reducing the impact of school and peer risk factors for aggression are discussed. [ABSTRACT FROM AUTHOR]

Although there has been wide dissemination of research-based psychosocial prevention programs, a similarly strong research base to guide program implementation has been lacking. Program implementation has been particularly difficult for schools, due partly to insufficient understanding of how school ecologies interact with these programs. This study examined the effects of multiple dimensions of school climate on level and rate of change in implementation of a violence prevention intervention across three school years. Using multi-level modeling, the study found that teacher-reported support between staff and among teachers and students predicted higher average levels of implementation. Teacher-reported administrative leadership predicted greater growth in implementation across 3 years. Findings offer implications for an ecological model of program implementation that considers school-level contextual effects on adoption and sustainability of new programs in schools. [ABSTRACT FROM AUTHOR]

This study investigated peer selection and socialization effects on sexual behavior and attitudes using 1,350 15- to 18-year-old students participating in two waves of the National Longitudinal Study of Adolescent Health. Regarding socialization effects, friends' intercourse without condoms predicted later individual intercourse without condoms positively. Friends' attitudes about the costs of sex predicted later individual attitudes positively and intercourse without condoms negatively. The latter relation was stronger for females than for males. Regarding selection effects, individual attitudes predicted later friends' attitudes positively, but the strength of this effect varied by ethnicity. The results suggest that adolescents socialize friends to have similar sexual attitudes and behavior but tend to select friends based on similar attitudes rather than similar behaviors. [ABSTRACT FROM AUTHOR]