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At the population level, use of multiple substances (or "co-use") is prevalent in young adulthood and linked with increased risk for experiencing substance-related harms. Less understood is the heterogeneity of substance use behaviors within individuals and across days, as well as the proximal predictors of these daily use patterns. The present study applied latent class analysis to daily diary data to identify daily substance use patterns and compare day-level class membership based on day-level stress and positive and negative affect among a higher-risk sample of young adult substance users. Participants (n = 152) completed up to 13 daily assessments of stress, affect, and substance use behavior. Among substance use days, five classes of days were identified: cannabis (some alcohol; 43% of days), alcohol-only (26%), vaping (some alcohol, cannabis; 24%), stimulant + alcohol (some cannabis, vaping; 4%), and cigarette-only (3%) days. Days with lower levels of perceived stress were significantly more likely to be alcohol-only Days relative to being days characterized by cigarette use, cannabis use, or multiple drug combinations. Days with higher levels of stress and negative affect were more likely to be cigarette-only days relative to cannabis and vaping days. Study findings document the wide range of substance use and co-use behaviors exhibited among young adults in daily life and highlight the importance of considering risk factors that correspond to days of problematic use patterns.

Objective African American female adolescents face disparities compared with White peers in the interrelated areas of mental health symptoms and sexually transmitted infection (STI) acquisition. IMARA (Informed, Motivated, Aware and Responsible about AIDS) is a group-based mother-daughter intervention addressing these factors among African American teenagers. Previous work demonstrated that female adolescents who received IMARA were 43% less likely than controls to evidence a new STI at 1 year. This report aimed to provide the 1st test of IMARA on externalizing and internalizing symptoms and an exploratory analysis of whether symptom improvements were associated with the protective effect of treatment against future STIs. Method Female African Americans aged 14-18 years (M = 16; N = 199) were randomly assigned to IMARA or a health promotion control group matched for time and structure. They completed the Youth Self-Report of externalizing and internalizing symptoms at baseline and at 6 and 12 months and were tested for STIs at baseline and 12 months; positive cases were treated. Hierarchical linear modeling tested symptom change over time, including the moderating effects of baseline symptoms. Results Among participants who entered with high versus lower externalizing symptoms, those who received IMARA showed a slightly greater decrease in externalizing scores relative to the control (p = .035). For these youth, symptom improvements appeared to be associated with IMARA's protective effect against new STIs. Treatment was not associated with internalizing symptom change (p > .05). Conclusion IMARA shows promise in modestly reducing self-reported externalizing symptoms, although only for participants with high scores at baseline. The possibility that externalizing symptom improvement is linked with reduced STI acquisition warrants future examination. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objectives Anhedonia can accompany substance use disorders (SUDs); its severity may vary by substance type, severity of SUD symptoms, or psychiatric comorbidity. The goal of this study was to clarify the contribution of each. Methods Data were from participants aged 18 to 65 years in the National Epidemiologic Survey on Alcohol and Related Conditions III (n = 30,999; 51% women), a cross-sectional, nationally representative sample reporting lifetime DSM-5 symptoms and lifetime anhedonia. We used logistic regression to test how anhedonia was associated with specific SUDs and psychiatric disorders in respondents with one lifetime diagnosis. We used latent class analysis to assess the association of anhedonia with patterns of comorbidity in all respondents. Results Opioid use disorder (OUD) had the greatest odds of anhedonia relative to other SUDs (ORs [95% CIs]): mild alcohol use disorder (AUD) (3.33 [1.74, 6.38]), moderate/severe AUD (2.73 [1.41, 5.30]), and cannabis use disorder (3.21 [1.43, 7.19]), though not significantly greater than stimulant use disorder (2.44 [.88, 6.73]). Anhedonia was more likely in mood disorders and post-traumatic stress disorder (PTSD) than in any SUD, except for PTSD versus OUD (OR [95% CIs] = .98 [.47, 2.02]). In latent class analysis analyses, the poly disorder class, which included SUDs and other diagnoses, had greater odds of anhedonia than the Poly SUD (ORs [95% CIs] = 1.62 [1.25, 2.09] and AUD 2.89 [2.40, 3.48]) classes. Conclusions People with OUD or a lifetime history of mood disorder or PTSD may be most likely to present to SUD treatment with anhedonia.

Background South African adolescent girls and young women (AGYW) report significant mental distress and sexual and reproductive health concerns. Mental health problems and trauma symptoms are consistently associated with sexual and reproductive health behavior. Despite their intersection, few interventions address them simultaneously or engage female caregivers (FC) as collaborators. This study presents findings from a pilot test of an empirically supported culturally adapted family-based HIV-prevention program, Informed Motivated Aware and Responsible Adolescents and Adults- South Africa (IMARA-SA), on AGYW anxiety, depression, and trauma. Methods Sixty 15–19-year-old AGYW (mean age = 17.1 years) and their FC from outside Cape Town were randomized to IMARA-SA or a health promotion control program. AGYW reported their anxiety using the GAD-7, depression using the PHQ-9, and trauma using the PC-PTSD-5 at baseline and follow-up (6–10 months post). Both interventions were delivered by Xhosa-speaking Black South African women in groups over 2 days for approximately 10 h. We examined intervention effects using zero-inflated negative binomial regression for anxiety, multinomial logistic regression for depression, and logistic regression for trauma. Results At baseline, groups did not differ in demographic characteristics but AGYW randomized to IMARA-SA had higher depression scores than controls (p = 0.04) and a greater proportion screened positive for PTSD (p = .07). Controlling for baseline mental health scores, AGYW who received IMARA-SA compared to controls had significantly fewer anxiety symptoms at follow-up (adjusted incidence rate ratio for count model = 0.54, 95% CI = 0.29–0.99, p = 0.05), were less likely to report at least one depressive symptom relative to no symptoms (relative risk ratio = 0.22, 95% CI = 0.05, 0.95, p = 0.04), and were less likely to report symptoms of PTSD relative to no symptoms, but this difference was not statistically significant. Conclusions Mental health is implicated in risky sexual behavior, and reducing emotional distress can mitigate exposure to poor sexual and reproductive health outcomes. This pilot study yielded promising findings for the mental health impact of IMARA-SA, justifying replication in a larger randomized trial. Trial registration ClinicalTrials.gov Number NCT04758390, accepted 17/02/2021.

Rationale. Applying an intersectional framework to quantitative public health research among Black and Latino sexual minority men requires analysis that considers interlocking, multidimensional systems of racist and homonegative oppression that fundamentally subvert health. In this study, person-centered methods reflected the complexity of intersecting stigma and how subgroups experience that intersection differently. Methods Data were from a cohort of 435 Black and Latino sexual minority young men (mean age = 22.3 years) in the Healthy Young Men's Cohort Study in Los Angeles, United States. Participants provided data semiannually on five occasions spanning 24 months from 2016 to 2019. The marginal approach to longitudinal latent class analysis was used to identify latent classes indicated by multidimensional experiences of racism (e.g., police harassment, workplace discrimination, sexual objectification) and homonegativism (e.g., violence, family rejection, identity concealment) during the transition to adulthood. Associations between sociostructural burdens (e.g., socioeconomic status, food insecurity, unstable housing) and class incidents were investigated. Prevalence of mental health care needs, chronic health conditions, and overall self-reported health were compared among classes. Results Five latent classes were identified: Minimal Stigma (26% of person records), Select Social Stigma (22%), Homonegativism (17%), Multiform Racism (24%), and Compound Stigma (11%). Sociostructural burdens were generally associated with 1.69–3.75 times higher odds of Select Social Stigma, Homonegativism, Multiform Racism, and Compound Stigma class incidents relative to Minimal Stigma. The Compound Stigma class had the greatest sociostructural burden, highest mental health care needs, and highest odds of sleep and gastrointestinal disorders, but classes did not differ in overall self-reported health. Conclusion These results exemplify how sociostructural burdens are interconnected with intersectional stigma experiences that together erode the health of Black and Latino sexual minority young men.

Achieving sustained engagement in family-based preventive intervention programs is a serious challenge faced by program implementers. Despite the evidence supporting the effectiveness and potential population-level impacts for these programs, their actual impact is limited by challenges around retention of participants. In order to inform efforts to better retain families, it is critical to understand the different patterns of attendance that emerge across the duration of program implementation and the factors that are associated with each attendance pattern. In this study, we identified latent classes of attendance patterns across the seven program sessions of the Strengthening Families Program: For Parents and Youth Ages 10-14 (SFP 10-14). Youth and their parents who attended at least one SFP 10-14 program session together were included in the analysis. Four distinct classes emerged: First-Session Attenders (7%), Early Attenders (9%), Declining-High Attenders (18%), and Consistent-High Attenders (66%). An examination of individual, family, and sociodemographic predictors of class membership revealed that adolescent school bonding predicted families having relatively high attendance, adolescent involvement with deviant peers predicted early dropout, and family low-income status predicted early dropout. Findings point to the need for potential targeted strategies for retaining these groups, such as involving school personnel, employing brief interventions to identify and address barriers at the outset, and leveraging the positive influence of Consistent-High Attenders. Findings also shed light on ways to reach those who may continue to drop out early, such as restructuring program content to address critical material early in the program. This study adds to the growing body of literature that seeks to understand for whom, when, and in which ways program dropout occurs.

Background This manuscript provides a research update to the ongoing pragmatic trial of Project POINT (Planned Outreach, Intervention, Naloxone, and Treatment), an emergency department-based peer recovery coaching intervention for linking patients with opioid use disorder to evidence-based treatment. The research team has encountered a number of challenges related to the “real-world” study setting since the trial began. Using an implementation science lens, we sought to identify and describe barriers impacting both the intervention and research protocols of the POINT study, which are often intertwined in pragmatic trials due to the focus on external validity. Method Qualitative data were collected from 3 peer recovery coaches, 2 peer recovery coach supervisors, and 3 members of the research team. Questions and deductive qualitative analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Results Nine unique barriers were noted, with 5 of these barriers impacting intervention and research protocol implementation simultaneously. These simultaneous barriers were timing of intervention delivery, ineffective communication with emergency department staff, lack of privacy in the emergency department, the fast-paced emergency department setting, and patient’s limited resources. Together, these barriers represent the intervention characteristics, inner setting, and outer setting domains of the CFIR. Conclusion Results highlight the utility of employing an implementation science framework to assess implementation issues in pragmatic trials and how this approach might be used as a quality assurance mechanism given the considerable overlap that exists between research and intervention protocols in real-world trial settings. Previously undocumented changes to the trial design that have been made as a result of the identified barriers are discussed.

Young men who have sex with men (YMSM), especially YMSM of color, are at increased risk for a wide range of threats to their health and well-being. In this study, we recruited and surveyed an urban sample of 448 young African American/Black (Black), Hispanic/Latino (Latino), and multi-racial/ethnic YMSM, ages 16-24 years (mean = 22.3 years), about stressful life events, their health and mental health, their access to and utilization of care, and their involvement in risk-related behaviors. We found that the majority reported experiences of racism (87%) and homophobia (76%). A high percentage reported food insecurity/hunger (36%), residential instability (15%), financial hardship (63%), and conflict with family/friends (62%). The prevalence of risk behaviors was also high, including recent use of tobacco (46%), alcohol (88%), and marijuana (72%), and 41% tested positive for 1+ drugs. Furthermore, 26% tested positive for 1+ sexually transmitted infections (STIs). Over half (56%) reported being worried about their health, 33% reported having a chronic health condition and 31% a mental health condition, and 45% had wanted/needed mental health services during the past year. Further, 17% reported suicidal ideation/had planned a suicide attempt and 26% had ever engaged in self-injurious behaviors. Significant differences by race/ethnicity and HIV status included residential status/food insecurity, type of racism/homophobia, drug use, and STIs. These findings demonstrate how vulnerable this population is with respect to a wide range of structural and social determinants of health that may be important drivers of behavioral, health, mental health outcomes, and potentially long-term health disparities.

This study estimated latent classes (ie, unobserved subgroups in a population) of people who use drugs in Vancouver, Canada, and examined how these classes relate to phylogenetic clustering of hepatitis C virus (HCV) infection. HCV antibody-positive people who use drugs from two cohorts in Vancouver, Canada (1996-2012), with a Core-E2 sequence were included. Time-stamped phylogenetic trees were inferred, and phylogenetic clustering was determined by time to most common recent ancestor. Latent classes were estimated, and the association with the phylogenetic clustering outcome was assessed using an inclusive classify/analyse approach. Among 699 HCV RNA-positive participants (26% female, 24% HIV+), recent drug use included injecting cocaine (80%), injecting heroin (70%), injecting cocaine/heroin (ie, speedball, 38%) and crack cocaine smoking (28%). Latent class analysis identified four distinct subgroups of drug use typologies: (i) cocaine injecting, (ii) opioid and cocaine injecting, (iii) crack cocaine smoking and (iv) heroin injecting and currently receiving opioid substitution therapy. After adjusting for age and HIV infection, compared to the group defined by heroin injecting and currently receiving opioid substitution therapy, the odds of phylogenetic cluster membership was greater in the cocaine injecting group (adjusted OR [aOR]: 3.06; 95% CI: 1.73, 5.42) and lower in the crack cocaine smoking group (aOR: 0.06; 95% CI: 0.01, 0.48). Combining latent class and phylogenetic clustering analyses provides novel insights into the complex dynamics of HCV transmission. Incorporating differing risk profiles associated with drug use may provide opportunities to further optimize and target HCV treatment and prevention strategies.

The aim of the current study was to identify patterns of child maltreatment experienced prior to age 18 and examine the relationship between those patterns and substance use and mental health disorders among emerging adults. Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III. The analytic sample consisted of 5,194 adults between 18 and 25 years old. Latent class analysis revealed a three-class model: Rare Maltreatment (59%); Occasional Maltreatment, Rare Sexual Abuse (37%); and Frequent Maltreatment, Some Sexual Abuse (4%). Risk of substance use disorders and poor mental health was higher for the two classes who experienced maltreatment; however, those with Frequent Maltreatment had higher risk of poor mental health, but not substance use disorders compared to those with Occasional Maltreatment. Patterns of child maltreatment are important predictors of substance use and mental health disorders in emerging adulthood, but different patterns may necessitate specific intervention efforts.

Background There is a lack of empirical effort that systematically investigates the clustering of comorbidity among known risk factors (obesity, hypertension, diabetes, hypercholesterolemia, and elevated inflammation) of chronic kidney disease (CKD) and how different types of comorbidity may link differently to kidney function among healthy adult samples. This study modeled the clustering of comorbidity among risk factors, examined the association between the clustering of risk factors and kidney function, and tested whether the clustering of risk factors was associated with childhood SES. Methods The data were from 2118 participants (ages 25–84) in the Midlife in the United States (MIDUS) Study. Risk factors included obesity, elevated blood pressure (BP), high total cholesterol levels, poor glucose control, and increased inflammatory activity. Glomerular filtration rate (eGFR) was estimated from serum creatinine, calculated with the CKD-EPI formula. The clustering of comorbidity among risk factors and its association with kidney function and childhood SES were examined using latent class analysis (LCA). Results A five-class model was optimal: (1) Low Risk (class size = 36.40%; low probability of all risk factors), (2) Obese (16.42%; high probability of large BMI and abdominally obese), (3) Obese and Elevated BP (13.37%; high probability of being obese and having elevated BP), (4) Non-Obese but Elevated BP (14.95%; high probability of having elevated BP, hypercholesterolemia, and elevated inflammation), and (5) High Risk (18.86%; high probability for all risk factors). Obesity was associated with kidney hyperfiltration, while comorbidity between obesity and hypertension was linked to compromised kidney filtration. As expected, the High Risk class showed the highest probability of having eGFR 2 (P = .12; 95%CI = .09–.17). Finally, higher childhood SES was associated with reduced probability of being in the High Risk rather than Low Risk class (β = − 0.20, SE = 0.07, OR [95%CI] = 0.82 [0.71–0.95]). Conclusion These results highlight the importance of considering the impact of childhood SES on risk factors known to be associated with CKD.

This study examined combinations of warmth and hostility in mother-father-adolescent triadic relationships when adolescents were in 6(th) grade and associations with adolescent middle school substance initiation. We conducted a latent profile analysis with a sample of 687 two-parent families (52.4% of adolescents were female, mean age = 11.27 at 6(th) grade). These analyses revealed five profiles of triadic relationships, labeled as: Cohesive Families (46%, high warmth and low hostility in all three dyads), Compensatory Families (24%, low interparental warmth but high parent-adolescent warmth), Disengaged Families (13%, average to low warmth and hostility in three dyads), Distressed Families (9%, high hostility and low warmth in all three dyads), and Conflictual Families (8%, high hostility and average warmth in all three dyads). There were significant differences across triadic relationship profiles in rate of alcohol initiation during middle school. Specifically, adolescents in Distressed Families and Conflictual Families initiated alcohol at higher rates than adolescents in other types of families. Cohesive Families and Compensatory Families initiated alcohol at the lowest rates among all five types of families. Similar patterns appeared for drunkenness and cigarettes. Implications for family-based interventions to decrease adolescent substance use and future research directions are discussed.

Parenting in the context of poverty is accompanied by heightened stress and heightened stakes. How parents respond to poverty-related stress has important implications for family functioning, but research investigating individual differences in low-income mothers' and fathers' responses to financial stress and their associations with parents' concurrent psychosocial adaptation is lacking. A better understanding of differences in stress responses among low-income parents is required to develop and tailor prevention programs that meet these families' needs. This study applies latent profile analysis (LPA) to identify and describe profiles of financial stress responses (problem solving, emotion regulation, emotion expression, cognitive restructuring, positive thinking, acceptance, distraction, denial, avoidance, wishful thinking, rumination, intrusive thoughts, emotional arousal, physiologic arousal, impulsive action, emotional numbing, cognitive interference, escape, and inaction) and examines associations between profile membership and psychosocial functioning in low-income parents. Five profiles were identified that were distinguished by self-reported voluntary and involuntary financial stress responses: active (32% of sample), low (11%), high (11%), negative cognitive (NC; 17%), and average (29%) responders. Notable differences emerged on measures of life stress, economic hardship, psychopathology, and social support, with individuals in the NC responders profile reporting the most difficulty and members of the active responders profile reporting the greatest adaptation. These findings offer a more nuanced understanding of how mothers and fathers respond to chronic poverty-related stress and have valuable implications for intervention efforts to promote adaptive stress responses and psychosocial functioning in low-income families. (PsycINFO Database Record

Adolescent antisocial behavior (ASB) can have long-term individual and societal consequences. Much of the research on the development of ASB considers risk and protective factors in isolation or as cumulative indices, likely overlooking the co-occurring and interacting nature of these factors. Guided by theories of ASB risk (i.e., coercive family process, disengagement), this study uses latent profile analysis to evaluate whether there are subgroups of families in the population that conform to specific constellations of risk factors prescribed by established theories of risk for ASB, and whether subgroup membership confers differential risk for different ASBs. We leveraged a large sample of adolescents in Fall, Grade 6 (N = 5,300; Mage = 11.8; 50.9% female) for subgroup analysis, and predicted aggression, antisocial peer behavior, and substance use in Spring, Grade 8. Four family profiles were identified: Coercive (15%), characterized by high family conflict, low positive family climate, low parental involvement, low effective discipline, low adolescent positive engagement, and low parental knowledge; Disengaged (41%), characterized by low positive family climate, low parental involvement, low adolescent positive engagement, and low parental knowledge; Permissive (11%), characterized by high parental involvement, low effective discipline, high adolescent positive engagement, high parental knowledge, and high family conflict; and High Functioning (34% prevalence). In turn, group membership predicted long-term outcomes. Adolescents in Coercive families were at highest risk for ASB during Grade 8, followed by those in Disengaged and Permissive profiles; all three of which were at greater risk than adolescents in High Functioning families for every outcome. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

OBJECTIVE: This paper examines whether multidimensional indicators of objective and subjective socioeconomic status (SES) across the life course can be categorized into latent classes of SES mobility and tests the associations of these categories with inflammation markers among White and Black adults. METHODS: Data are from 592 non-Hispanic White and 158 non-Hispanic Black participants who completed both the baseline survey and biomarkers assessment of the Midlife in the United States (MIDUS) Refresher study. Groups of different SES mobility were examined using latent class analysis. RESULTS: White and Black participants showed different patterns of SES mobility. Among Blacks, the latent classes were: 1) Objectively Always High (24.71%; high objective SES across the life course), 2) Subjectively Always High (6.48%; high subjective and low objective SES across the life course), 3) Downwardly Mobile (35.84%; high childhood SES, low adult SES, and 4) Always Low (32.97%; low childhood SES, education, and adult SES). Among Whites, the latent classes were: 1) Always High (52.17%; high childhood SES, high education, high adult SES), 2) Upwardly Mobile (18.14%; low childhood SES, high education, high adult SES), 3) Subjectively Downward (27.74%; high childhood SES, high education, high objective adult SES, low subjective adult SES), and 4) Always Low (1.95%; low childhood SES, education, and adult SES). SES mobility was associated with inflammation in White (Wald χ(2)’s [3] = 12.89-17.44, p < .050), but not in Black adults (Wald χ(2)’s [3] = 2.79-7.22, p > .050). CONCLUSION: The lack of SES mobility differentiation on inflammation is an indication of diminished return for the most affluent class among Black participants.

Introduction Although much of the work on risky alcohol use behaviors, such as heavy drinking, focuses on adolescence and young adulthood, these behaviors are associated with negative health consequences across all ages. Existing studies on age trends have focused on a single alcohol use behavior across many ages, using methods such as time-varying effect modeling, or a single age period with many behaviors, using methods such as latent class analysis. This study integrates aspects of both modeling approaches to examine age trends in alcohol use behavior patterns across ages 18–65. Methods Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to identify past-year alcohol use behavior patterns among a nationally representative sample of U.S. adults (n = 30,997; 51.1% women; 63.5% White Non-Hispanic) and flexibly estimate nonlinear trends in the prevalences of those patterns across ages 18–65. Results Five patterns were identified: Non-Drinkers, Frequent Light Drinkers, Infrequent Heavy Episodic Drinkers, Frequent Heavy Episodic Drinkers, and Extreme Drinkers. Pattern prevalences were allowed to vary flexibly across the entire age range. Prevalences of the Infrequent Heavy Episodic and Extreme Drinkers peaked around ages 22–24, but peaked for Frequent Heavy Episodic Drinkers around age 49. Non-Drinkers were most prevalent across all ages except during the early 20 s when Extreme Drinkers were more prevalent. Around ages 24–30, the Non-, Frequent Light, and Extreme Drinkers were approximately equally prevalent. Conclusions The approach used here holds promise for understanding characteristics associated with behavior patterns at different ages and long-term age trends in complex behaviors.

Black/African-American girls are infected with sexually transmitted infections (STIs) at higher rates than their White counterparts. This study tested the efficacy of IMARA, a mother-daughter psychosocial STI/HIV prevention program, on adolescent Black/African-American girls' incident STIs at 12 months in a 2-arm group randomized controlled trial. Black/African-American girls 14-18 years old and their primary female caregiver were eligible for the study. Girls provided urine samples to test for N. gonorrhoeae, C. trachomatis, and T. vaginalis infection at baseline and 12-months. Mother-daughter dyads were randomly assigned to IMARA (n = 118) or a time-matched health promotion control program (n = 81). Retention at 12-months was 86% with no difference across arms. Both interventions were delivered over two consecutive Saturdays totaling 12 hours. Girls who received IMARA were 43% less likely to contract a new STI in the 12-month post-intervention period compared with those in the health promotion control program (p = .011). A secondary follow-up intent-to-treat analysis provided additional support for the protective effect of IMARA, albeit with a similar magnitude of 37% (p = .014). Findings provide early evidence for IMARA's efficacy, such that IMARA protected against STIs at 12-months among adolescent Black/African-American girls. Future research should examine the mechanisms associated with reduced STIs.

Background This study examines whether longitudinal patterns of persistent or experimental heavy substance use across young adulthood were associated with physical and mental health in midlife. Methods Data (N = 21,347) from Monitoring the Future from adolescence (age 18) to midlife (age 40) were used. Repeated measures latent class analysis modeled patterns of patterns of cigarettes, alcohol, marijuana, and other illicit drugs across young adulthood (ages 18–30). Latent classes were then used as predictors of physical health problems, cognitive problems, self-rated health, and psychological problems in midlife (age 40), while controlling for sociodemographic variables (i.e., gender, race/ethnicity, parental education). Results Identified classes were “Extreme Heavy Users” (3.9%), “Early Young Adult Users” (8.9%), “Cigarette Smokers” (9.2%), “All But Cigarette Smokers” (5.0%), “Frequent Alcohol Bingers” (10.4%), and “Not-Heavy Users” (62.6%). Extreme Heavy Users, Early Young Adult Users, and Cigarette Smokers had significantly poorer overall health based on a number of physical conditions and self-rated health. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers had more cognitive problems than other classes. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers were more likely to see a health professional for a psychological problem. Conclusions Patterns of heavy substance use were associated with health across decades. Regular cigarette smokers and heavy users across substances and ages had the worst health in midlife, although even those with time-limited use during young adulthood were at risk for later physical and cognitive health problems.

PURPOSE: To identify patterns of behavioral adherence among 388 African Americans who participated in the Weight Loss Maintenance trial and examine associated psychosocial factors. METHODS: Using repeated measures latent class analysis, we modeled patterns of adherence to recommendations regarding fruit and vegetable, total fat, and saturated fat intake and physical activity at baseline, 6, and 18 months. Latent classes were compared on the SF-36 (mental health composite and vitality subscale), Perceived Stress Scale, and PHQ-8 at each time point. RESULTS: Three distinct latent classes emerged: Nutrition Adherers (n = 96); Physical Activity Adherers (n = 61); and Non-Adherers (n = 231). All groups showed initial improvement in psychosocial measures followed by relapse. Non-Adherers had significantly lower mean mental health and vitality scores and higher depression scores than adherers at 6 and 18 months. CONCLUSION: Psychological well-being should be addressed with African Americans in weight loss treatment to enhance behavior change and improve weight loss outcomes.

Background: No group is at greater risk for acquiring HIV than young men who have sex with men (YMSM), particularly black or African American (AA) and Hispanic or Latino (L) YMSM living in inner cities, who account for the largest number of new HIV infections each year. Although pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and treatment as prevention hold enormous promise for changing the course of the epidemic, AA/L-YMSM are the least likely population to be receiving primary health care and HIV prevention/care and are the least likely to be using PrEP and PEP. Objective: The overarching aim of the Healthy Young Men’s (HYM) cohort study is to conduct longitudinal research with a cohort of AA/L-YMSM to prevent new HIV infections, reduce transmission, and reduce HIV/AIDS-related disparities by focusing on successful engagement in care. Findings from this research will be used to inform the development of new interventions designed to engage AA/L-YMSM in the HIV prevention and care continua. Methods: Longitudinal research (baseline and follow-up assessments every 6 months for a total of 8 waves of data collection) is ongoing with a new cohort of 450 high-risk AA/L-YMSM in Los Angeles. Participants were recruited using a venue-based and social media sampling design. In addition to self-report surveys, the study protocol includes the collection of urine to assess recent use of illicit drugs and the collection of blood and rectal/throat swabs to test for current sexually transmitted infection (STI)/HIV infection. An additional sample of blood/plasma (10 mL for 4 aliquots and 1 pellet) is also collected and stored in the HYM cohort study biorepository for future research. By design, we recruited 400 HIV-negative participants and 50 HIV-positive (HIV+) participants. This mixed-methods study design includes collection and triangulated analysis of quantitative, qualitative, and biological measures (ie, drug use, STI/HIV testing, and adherence to antiretroviral therapy among HIV+ participants) at baseline and every 6 months. The HYM cohort study will provide a platform from which new and emerging biomedical prevention strategies (eg, PrEP, rectal microbicides, and PEP) and other HIV prevention and care engagement interventions can be developed and evaluated with AA/L-YMSM. Results: To date, all participants in the HYM cohort study have been recruited and baseline assessment has been conducted. Conclusions: The findings from this research will be used to inform the development of new and/or adaptation of existing evidence-based HIV prevention interventions and interventions designed to engage this population in the HIV prevention and care continua. International Registered Report Identifier (IRRID): DERR1-10.2196/10738

Individuals with a family history of substance use disorders (Family History Positive) are more likely to have early-onset substance use (i.e., prior to age 15), which may contribute to their higher rates of substance use disorders. One factor that may differentiate Family History Positive youth who engage in early-onset substance use from other Family History Positive youth is exposure to stressors. The aim of this study was to quantify how exposure to stressors from age 11–15 varies as a function of family history of substance use disorders and early-onset substance use. Self-reported stressors were prospectively compared in a sample of predominately (78.9 %) Hispanic youth that included 68 Family History Positive youth (50 % female) who initiated substance use by age 15 and demographically matched non-users with (n = 136; 52.9 % female) and without (n = 75; 54.7 % female) family histories of substance use disorders. Stressors were assessed at 6-month intervals for up to 4 years. Both the severity of stressors and the degree to which stressors were caused by an individual’s own behavior were evaluated. All three groups differed from one another in overall exposure to stressors and rates of increase in stressors over time, with Family History Positive youth who engaged in early-onset substance use reporting the greatest exposure to stressors. Group differences were more pronounced for stressors caused by the participants’ behavior. Family History Positive users had higher cumulative severity of stressors of this type, both overall and across time. These results indicate greater exposure to stressors among Family History Positive youth with early-onset substance use, and suggest that higher rates of behavior-dependent stressors may be particularly related to early-onset use.

Background. We have demonstrated previously that patterns of behavioral adherence in the first 6 months of behavioral lifestyle interventions were associated with significant weight loss at 18 months. In this article, we extend this work to examine patterns of behavioral adherence over 18 months and to explore baseline demographic and psychosocial predictors. Method. Latent class analysis was applied separately to the Weight Loss Maintenance and PREMIER trials data to examine patterns of adherence to the following recommendations: (1) consuming ≥9 servings of fruits and vegetables per day, (2) ≤25% of energy from total fat, (3) ≤7% energy from saturated fat, and (4) ≥180 minutes of moderate-to-vigorous physical activity per week. Multinomial logistic regression was used to test demographic and psychosocial predictors of latent class membership. Results. Four distinct subgroups with common patterns of behavioral adherence were identified in each trial including, Behavioral Maintainers, who maintained adherence to all behavioral recommendations for 1 year, Nonresponders, who did not adhere to the recommendations at any time point, and latent classes that reflected patterns of adherence to one or two behaviors or behavioral relapse. A significantly higher proportion of Behavioral Maintainers sustained ≥5% weight loss for 1 year compared with Nonresponders. Participants with higher vitality scores at baseline were more likely to belong to a latent class with long-term adherence to one or more recommendations than the Nonresponders class. Conclusions. Regular assessment of health behaviors and psychosocial measures such as vitality may help identify nonresponders and inform treatment tailoring to improve long-term behavioral and weight outcomes.

Purpose The purpose of this study was to examine transitions in gambling participation from late adolescence into emerging adulthood and to identify factors (i.e., gender, race, intervention status, lunch status, conduct disorder, parental monitoring, neighborhood environment, and substance use) that might influence these transitions. Methods Markov modeling was used to describe the movement between past-year gambling states (i.e., nongambling and gambling) across 5 years. Annual data on the past-year gambling behavior and substance use were collected from 515 young men and women starting at the age of 17 years. Results Past-year gambling declined from 51% prevalence at the age of 17 years to 21% prevalence at the age of 22 years. Participants who reported no past-year gambling at a particular annual assessment had more than an 80% probability of also reporting no past-year gambling at the following assessment. Men were 1.07–2.82 times more likely than women to transition from past-year nongambling to gambling year to year, and women were 1.27–5.26 times more likely than men to transition from past-year gambling to nongambling year to year. In addition, gender and past-year tobacco use interacted such that men who used tobacco were most likely (and men who did not use tobacco least likely) to gamble at baseline. Conclusions Transition rates between gambling states appear to be relatively stable over time from late adolescence into emerging adulthood; however, men and those who engage in substance use may be at an increased risk of gambling participation.

Individuals with a family history of substance use disorder (FH+) show impaired frontal white matter as indicated by diffusion tensor imaging (DTI). This impairment may be due to impaired or delayed development of myelin in frontal regions, potentially contributing to this population's increased risk for developing substance use disorders. In this study, we examined high angular resolution DTI and proton magnetic resonance spectroscopy data from the anterior corona radiata were collected in 80 FH+ and 34 FH- youths (12.9 ± 1.0 years old). White matter integrity indices included fractional anisotropy (FA), N-acetylaspartate (NAA), and total choline (tCho). Lower FA suggests decreased myelination. Decreased NAA coupled with higher tCho suggests impaired build-up and maintenance of cerebral myelin and consequently greater breakdown of cellular membranes. We found FH+ youths had lower FA (P < 0.0001) and NAA (P = 0.017) and higher tCho (P = 0.04). FH density (number of parents and grandparents with substance use disorders) was negatively correlated with FA (P < 0.0001) and NAA (P = 0.011) and positively correlated with tCho (P = 0.001). FA was independently predicted by both FH density (P = 0.006) and NAA (P = 0.002), and NAA and tCho were both independent predictors of FH density (P < 0.001). Our finding of lower frontal FA in FH+ youths corresponding to lower NAA and increased tCho is consistent with delayed or impaired development of frontal white matter in FH+ youths. Longitudinal studies are needed to determine how these differences relate to substance use outcomes.

High rates of comorbidity are observed between internalizing and externalizing problems, yet the developmental dynamics of comorbid symptom presentations are not yet well understood. This study explored the developmental course of latent profiles of internalizing and externalizing symptoms across kindergarten, first grade, and second grade. The sample consisted of 336 children from an urban, low-income community, selected based on relatively high (61%) or low (39%) aggressive/oppositional behavior problems at school entry (64% male; 70% African American, 20% Hispanic). Teachers reported on children's symptoms in each year. An exploratory latent profile analysis of children's scores on aggression/oppositionality, hyperactivity/inattention, anxiety, and social withdrawal symptom factors revealed four latent symptom profiles: comorbid (48% of the sample in each year), internalizing (19%–23%), externalizing (21%–22%), and well-adjusted (7%–11%). The developmental course of these symptom profiles was examined using a latent transition analysis, which revealed remarkably high continuity in the comorbid symptom profile (89% from one year to the next) and moderately high continuity in both the internalizing and externalizing profiles (80% and 71%, respectively). Internalizing children had a 20% probability of remitting to the well-adjusted profile by the following year, whereas externalizing children had a 25% probability of transitioning to the comorbid profile. These results are consistent with the hypothesis that a common vulnerability factor contributes to developmentally stable internalizing–externalizing comorbidity, while also suggesting that some children with externalizing symptoms are at risk for subsequently accumulating internalizing symptoms.

Introduction Smokers' social networks vary in size, composition, and amount of exposure to smoking. The extent to which smokers' social networks change after a quit attempt is unknown, as is the relation between quitting success and later network changes. Methods Unique types of social networks for 691 smokers enrolled in a smoking-cessation trial were identified based on network size, new network members, members' smoking habits, within network smoking, smoking buddies, and romantic partners' smoking. Latent transition analysis was used to identify the network classes and to predict transitions in class membership across 3 years from biochemically assessed smoking abstinence. Results Five network classes were identified: Immersed (large network, extensive smoking exposure including smoking buddies), Low Smoking Exposure (large network, minimal smoking exposure), Smoking Partner (small network, smoking exposure primarily from partner), Isolated (small network, minimal smoking exposure), and Distant Smoking Exposure (small network, considerable nonpartner smoking exposure). Abstinence at years 1 and 2 was associated with shifts in participants' social networks to less contact with smokers and larger networks in years 2 and 3. Conclusions In the years following a smoking-cessation attempt, smokers' social networks changed, and abstinence status predicted these changes. Networks defined by high levels of exposure to smokers were especially associated with continued smoking. Abstinence, however, predicted transitions to larger social networks comprising less smoking exposure. These results support treatments that aim to reduce exposure to smoking cues and smokers, including partners who smoke. Implications Prior research has shown that social network features predict the likelihood of subsequent smoking cessation. The current research illustrates how successful quitting predicts social network change over 3 years following a quit attempt. Specifically, abstinence predicts transitions to networks that are larger and afford less exposure to smokers. This suggests that quitting smoking may expand a person's social milieu rather than narrow it. This effect, plus reduced exposure to smokers, may help sustain abstinence.

This study investigated how patterns of traits in self and ideal leader profiles were related to one another, beyond the individual effects of each trait. Latent profile analysis (LPA) was used to identify and describe profiles of self leader and ideal leader perceptions. Four profiles for self leader perceptions (Prototypical, Laissez-Faire, Narcissistic, Anti-Prototypical) and four profiles for ideal leader perceptions (Prototypical, Laissez-Faire, Autocratic, Anti-Prototypical) were identified. Additional analyses examined the association between self and ideal leader profiles; gender, leadership self efficacy, and narcissism were added to the model as predictors of that association. Prototypical and Laissez-Faire self leaders tended to prefer an ideal leader who was similar to themselves, whereas Narcissistic and Anti-Prototypical self leaders had more diffuse preferences in ideal leaders. Gender, leadership self efficacy, and narcissism were only associated with self leader profiles. Results support, yet contribute beyond, previous findings for the similarity hypothesis.

Depression and anxiety are highly prevalent disorders in patients after an acute coronary syndrome (ACS).1-7 Depression and anxiety co-occur, appear to inhibit recovery, and have a negative impact on social functioning and capacity to perform activities of daily living in patients who develop an ACS.3,4,6,8-14 Even though these conditions are prevalent in patients with an ACS, and are associated with poorer quality of life, these disorders are not fully recognized and adequately treated in clinical settings. Moreover, the effectiveness of intervention programs designed to increase quality and length of life after an ACS still needs to be evaluated across multiple domains.2,6,11 In addition, a patient’s level of functioning may interact with his or her depression and/or anxiety to determine an intervention’s effectiveness.2,6,11 Assessing the effectiveness of an intervention program across multiple domains, namely by considering the remission of symptoms of depression, anxiety, and impaired functioning simultaneously over time, may provide a more accurate assessment of its overall impact on health. Other investigators such as the Enhanced Recovery in Coronary Heart Disease (ENRICHD) group have investigated the effectiveness of cognitive behavioral therapy (CBT) in reducing depressive symptoms as well as improving functioning in patients after an ACS.1,12 However, to our knowledge, there are no reports on the effect of CBT where the symptoms of depression, anxiety, and impaired functioning are considered simultaneously over time. The current study is designed to supplement the results of previously reported clinical trials primarily by considering the effect of CBT treatment on multiple outcomes simultaneously. This approach provides a way to examine the impact of treatment on patient well-being more holistically. That is, this approach takes a developmental perspective where multiple aspects of patient well-being are modeled simultaneously and dynamically. The current study has 3 primary objectives. The first is to use latent class analysis (LCA) and latent transition analysis (LTA) to identify and describe subgroups of patients characterized by similar patterns of depression, anxiety, and functional impairment as well as to describe change over time in subgroup membership. The second is to use these same methodologies to determine whether patients receiving CBT report improvement in the 3 domains simultaneously compared to the control group. The third is to examine whether sex and age predict remission of depression, anxiety, and functional impairment. Generalized estimating equations are used to address the third objective.

Objective: To identify symptom profiles of depression and anxiety in patients with an acute coronary syndrome (ACS), to examine changes in symptom profiles over time, and finally, to examine the effects of age and sex on patients' symptom profiles. Methods: One hundred ACS patients with mild to severe symptoms of depression and/or anxiety at 1 month post-hospital discharge were enrolled in a randomized trial of cognitive behavioral therapy. Latent class and latent transition analyses were used to identify symptom profiles and describe change over the time in profile membership. Results: A two-class solution was selected to describe depression and anxiety symptom profiles. Class I (76% of patients at baseline) was labeled “depression and some anxiety symptoms.” Class II (24% of patients at baseline) was labeled “anxiety and some depression symptoms.” Approximately 25% of patients in the treatment condition transitioned from the depression and some anxiety symptoms class to the anxiety and some depression symptoms class at follow-up compared to 10% of patients in the control condition at follow-up; nearly 50% of patients in the control condition showed worsening of symptoms as compared to 28% in the treatment condition. Results suggested age differences in the probabilities of transitioning between the classes; older patients were more likely to continue having depression and some anxiety symptoms at the time of follow-up. Conclusions: Identifying symptom profiles of depression and anxiety in patients with an ACS may improve diagnostic practices and help to design tailored interventions.

Marijuana use is typically initiated during adolescence, which is a critical period for neural development. Studies have reported reductions in prepulse inhibition (PPI) among adults who use marijuana chronically, although no human studies have been conducted during the critical adolescent period.This study tested PPI of acoustic startle among adolescents who were either frequent marijuana users or naïve to the drug (Controls). Adolescents were tested using two intensities of prepulses (70 and 85 dB) combined with a 105 dB startle stimulus, delivered across two testing blocks.There was a significant interaction of group by block for PPI; marijuana users experienced a greater decline in the PPI across the testing session than Controls. The change in PPI of response magnitude for users was predicted by change in urine THC/creatinine after at least 18 h of abstinence, the number of joints used during the previous week before testing, as well as self-reported DSM-IV symptoms of marijuana tolerance, and time spent using marijuana rather than participating in other activities.These outcomes suggest that adolescents who are frequent marijuana users have problems maintaining prepulse inhibition, possibly due to lower quality of information processing or sustained attention, both of may contribute to continued marijuana use as well as attrition from marijuana treatment.

Social Anxiety Disorder (SAD) and Autism Spectrum Disorders (ASD) are fairly common psychiatric conditions that impair the functioning of otherwise healthy young adults. Given that the two conditions frequently co-occur, measurement of the characteristics unique to each condition is critical. This study evaluated the structure and construct overlap of two screening measures of SAD and ASD. Results from 623 young adults indicated that separable, though highly correlated, factors can be derived from the two measures related to social anxiety and social difficulties. The ASD screening measure also taps unique factors related to restricted interests and attention to details, theory of mind deficits, and a preference for routine. Recommendations are provided for accurate screening of symptoms of both SAD and ASD.

This paper analyzes the association between latent classes of SES trajectories across the life course and health and well-being in adulthood using latent class analysis (LCA) approach. This study utilized data from 863 (Mage = 50.84) participants who participated in the biomarkers assessment of MIDUS Refresher study. Baseline model assessment indicated that the four-class model is the best among other models. The classes are always high (high in all life course SES indicators), always low (low in all life course SES indicators), upwardly mobile (low childhood SES, high adult SES), and subjectively downward (high childhood and objective adult SES, low subjective adult SES). The association between latent classes and health and well-being indicated that childhood is a sensitive period of health in adulthood. Accumulation of socioeconomic risk across the life course is associated with worse health and well-being. Finally, upward mobility is associated with higher well-being but higher inflammatory burden.

Substantial uncertainties surround the sensitivities and specificities of diagnostic techniques for urinary schistosomiasis. We used latent class (LC) modeling to address this problem. In this study, 220 adults in three villages northwest of Accra, Ghana were examined using five Schistosoma haematobium diagnostic measures: microscopic examination of urine for detection of S. haematobium eggs, dipsticks for detection of hematuria, tests for circulating antigens, antibody tests, and ultrasound scans of the urinary system. Testing of the LC model indicated non-invariance of the performance of the diagnostic tests across different age groups, and measurement invariance held for males and females and for the three villages. We therefore recommend the use of LC models for comparison between and the identification of the most accurate schistosomiasis diagnostic tests. Furthermore, microscopy and hematuria dipsticks were indicated through these models as the most appropriate techniques for detection of S. haematobium infection.

INTRODUCTION The purpose of this study was to examine transitions in smoking from adolescence into emerging adulthood and to identify factors that might influence these transitions, specifically, movement into and out of light and intermittent smoking. METHODS This study used Markov models to examine movement across three stages of smoking (nonsmoking, light and intermittent smoking, and heavy smoking) from adolescence into emerging adulthood. Biannual data were collected from 990 young men and women from the 12th grade until 2 years after high school. RESULTS At each timepoint, most youth were nonsmokers. Those who were heavy smokers in 12th grade had a 79% chance of also being heavy smokers 2 years after high school. Between 17% and 21% of participants were light and intermittent smokers at each timepoint, and the likelihood of remaining so at the next timepoint ranged from 56% to 72%. Less than one-half of the 12th-grade light and intermittent smokers were light and intermittent smokers 2 years later, and 3% of the sample were light and intermittent smokers across all assessments. Prevalence and transition rates did not differ by gender. College attendees reported less smoking than nonattendees before and after their transition to college, and attendees compared with nonattendees who smoked were less likely to transition from light and intermittent to heavy smoking and remain heavy smokers. Binge drinking was significantly related to 12th-grade smoking stage and to transitions from nonsmoking to smoking. Overall, few emerging adults maintained light and intermittent smoking consistently over time. DISCUSSION Light and intermittent smoking during emerging adulthood may not be the same phenomenon as light and intermittent smoking in adulthood.

Inhalant use by adolescents is cause for concern due to the early age of inhalant use initiation and the many short- and long-term health consequences that can occur concurrently with and subsequent to use. However, inhalant use research has been limited relative to the literature available on other drug use.The present research examined long-term trends in inhalant use prevalence, demographic risk factors of inhalant use, and median grade level of first use.Monitoring the Future data from 1991 to 2011, which includes information drawn from United States eighth, tenth, and twelfth graders, were examined. The total sample comprised more than one million participants. Results were examined descriptively with figures and quantitatively with mixed-effects regression models of the effect of time on use rates.Inhalant use prevalence rates generally declined over the selected period. Though rates of use by males and females decreased significantly, the proportion of females among lifetime users increased significantly. Whites, Hispanics, and members of uncategorized "other" ethnicities showed the highest prevalence rates. Although the proportion of Whites among lifetime users decreased significantly, the proportion of Hispanics and "other" ethnicities increased significantly. The median first use was between sixth and ninth grade.Results suggest a need to tailor inhalant use treatment and prevention programs to the needs of specific demographic groups and to target interventions early to prevent youth inhalant use. Strengths, limitations, and directions for future research are discussed.

A number of studies have associated impulsivity and sensation seeking with level of substance use and risk for developing a substance use disorder. These relationships may be particularly apparent during adolescence, when developmental changes in impulsivity and sensation seeking occur at the same time as increased opportunities for substance use. To examine this, the current study measured impulsivity and sensation seeking from pre-adolescence to mid-adolescence in a sample of youth, the majority of whom were identified as being at risk for developing a substance use disorder based on their family history of substance use disorders. Youth were separated into those who did (n = 117) and did not (n = 269) initiate substance use by mid-adolescence. Results showed that substance users were more impulsive and more sensation seeking during pre-adolescence, prior to any significant substance use, and that greater sensation seeking in pre-adolescence was related to heavier substance use by mid-adolescence. In addition, developmental trajectories for substance-using youth showed a greater increase in sensation seeking but a more modest decrease in impulsivity from pre-adolescence to mid-adolescence. Taken together, these results indicate that increased impulsivity and sensation seeking is apparent in adolescent substance users as early as pre-adolescence, that the difference between substance users and non-users becomes larger across early adolescence as their developmental trajectories diverge, and that greater sensation seeking in pre-adolescence may predict increased substance use by mid-adolescence.

Background Problem substance use often begins in adolescence. This vulnerability likely stems, at least partially, from relatively rapid increases in sensation seeking occurring in early to mid-adolescence and more gradual improvements in impulse control occurring through later adolescence. Better understanding how these processes develop in high-risk youth may lead to enhanced substance use disorder treatment and prevention strategies. Methods We characterized trajectories of self-reported impulsivity and sensation seeking in 305 FH+ youths who at minimum had a father with a history of alcohol or other drug use disorders and 81 youths with no family histories of substance use disorders (FH−). Assessments started at ages 10 to 12 and continued at 6-month intervals for up to 42 months. In addition, a subset of 58 FH+ youths who began alcohol or other drug use before age 15 (FH+ Users) were compared to 58 FH+ propensity-matched adolescents who did not initiate substance use before age 15 (FH+ Non-Users). Results Compared to FH− youths at preadolescence, FH+ youths reported higher general impulsivity and higher impulsivity related to poor planning and attention. Over time, there were no differential effects of FH status on changes in impulsivity or sensation seeking across adolescence. FH+ Users had smaller decreases in general impulsivity and impulsivity related to restlessness and fidgeting across adolescence than FH+ Non-Users. FH+ Users also had greater increases in sensation seeking across adolescence than FH+ Non-Users. Conclusions Increased impulsivity in FH+ youths may make them less able to regulate sensation seeking drives that peak in adolescence, which may contribute to their high risk for developing substance use disorders. Additionally, FH+ adolescents who initiate early use may be at increased risk in part due to increased impulsivity coupled with greater increases in sensation seeking.

BACKGROUND: Youths with family histories of alcohol and other drug use disorders (FH+) are at increased susceptibility for developing substance use disorders relative to those without such histories (FH-). This vulnerability may be related to impaired adolescent development of impulse control and elevated risk-taking. However, no previous studies have prospectively examined impulse control and risk-taking in FH+ youth across adolescence. METHODS: A total of 386 pre-adolescents (305 FH+, 81 FH-; aged 10 to 12) with no histories of regular alcohol or other drug use were compared on behavioral measures of impulsivity including delay discounting, response initiation (Immediate Memory Task), response inhibition impulsivity (GoStop Impulsivity Paradigm), and risk-taking (Balloon Analogue Risk Task-Youth). Youths completed these laboratory tasks every 6 months, allowing for the examination of 10- to 15-year-olds. Hierarchical linear modeling was used to characterize the development of impulse control and risk-taking as shown in performance of these tasks throughout adolescence. RESULTS: We found that (i) FH+ youths had increased levels of delay discounting and response inhibition impulsivity at study entry; (ii) regardless of FH status, all youths had relatively stable delay discounting across time, improvements in response inhibition and response initiation impulsivity, and increased risk-taking; and (iii) although FH+ youths had increased response inhibition impulsivity at pre-adolescence, these differences were negligible by mid-adolescence. CONCLUSIONS: Heightened delay discounting in FH+ pre-adolescents coupled with normal adolescent increases in risk-taking may contribute to their increased susceptibility toward problem substance use in adolescence. Language: en

Nomenclature for substance use disorder (SUD) consequent to using inhalants (SUD-I) remains obscure for multiple reasons including lacking nosology evidence, parsing inhalants between DSM drug classes, controversy over key diagnostic features, and scant utilization in applied settings. Central goals of DSM-5 revisions were to “…provide the best available description of how [the] disorders are expressed…,” “aid in the accurate diagnosis and treatment…,” and “alleviate … misunderstandings” (APA, 2013, p. xli and p. xlii, respectively). This study evaluated how well these goals were accomplished specifically for SUD-I. DSM-5 and DSM-IV nomenclatures for SUD-I were patterned after diagnostic criteria designed for other drug classes. However, inhalants are distinct among addictive substances in multiple ways. As a drug class, ‘inhalants’ encompasses thousands of compounds. Most inhalants are legal to possess at any age, inexpensive, easily obtained, and their intense intoxication typically lasts only a few minutes per dose. Their ubiquity for their manufactured uses helps conceal inhalant misuse (Dinwiddie, 1994). All of these features likely contribute to the onset and inhalant use (IU) at younger ages relative to other substances. Although IU poses manifold serious health risks (e.g., asphyxiation, ataxias, cardiac arrest, cerebral atrophy, chemical burns, reduced immune function, kidney failure, neuropathy), conventional wisdom considers IU to not be dangerous. Consequently, parents, teachers and even health professionals are generally not knowledgeable about or vigilant for signs of IU (Sikes, Walley, McBride, Fusco, Cole & Lauka, 2011). For example, development of prevention and treatment programs for SUD-I has lagged compared to other SUDs and has largely occurred outside the U.S. (Gruenewald, Johnson, Shamblen, Ogilvie, & Collins, 2009; Ridenour & Howard, 2012). Neglect of SUD-I also is evident in rudimentary research. Prevalence of DSM-III-R SUD-I dependence was reported as 0.3% in the early 1990s (Anthony, Warner, & Kessler, 1994) and DSM-IV dependence as < 0.1% and abuse as 0.3% in the early 2000s (Compton, Conway, Stinson, Colliver & Grant, 2005). However, these nomenclatures categorized aerosols, solvents and most gases as SUD-I in aggregate whereas nitrous oxide and nitrites were categorized as “other” substances. Thus, SUD-I prevalence in aggregate and for specific inhalant types remains largely unknown. Moreover, little psychometric evidence is available for SUD-I assessment. DSM-IV versus DSM-5 A prerequisite to researching SUD-I epidemiology, etiology, treatment and prevention is establishing a diagnostic nomenclature, which was the focus of the present study. Extant nosology research on SUD-I is largely grounded in DSM-IV nomenclature, as most SUD-I studies have occurred during the last decade. Considerable revisions to SUD-I occurred in DSM-5. For example, DSM-IV dependence and abuse diagnoses were combined into a single disorder that is graded in terms of severity. Item response theory studies of DSM-IV SUD criteria using mostly clinical samples support this revision across many drug classes and for adolescents (e.g., Gelhorn et al. 2008; Hartman et al., 2008; Hasin, Fenton, Beseler, Park, & Wall, 2012; Martin, Chung, Kirisci, & Langenbucher, 2006; Saha et al., 2012). Studies of SUD-I also support this revision (Ridenour, Bray & Cottler, 2007); extant IRT studies of SUD-I criteria were of juveniles involved with the criminal justice system (Perron et al., 2010) or general population adults (Kerridge et al., 2011). DSM-5 revisions also eliminated the DSM-IV criterion of substance use causing legal problems and added a “craving” criterion (APA, 2013). Recent studies demonstrated that legal problems correlate highly with SUD-I (Kerridge et al., 2011; Perron et al., 2010); however, this finding has not always been replicated (Ridenour et al., 2007) and in samples recruited outside of the justice system, the prevalence of the legal problems criterion is 2.0% or less (Kerridge et al., 2011; Ridenour et al., 2007). Thus, the utility of legal problems as a diagnostic criterion for SUD-I remains unclear. The craving criterion is included in International Classification of Diseases (10th Edition; WHO, 1990); however, to our knowledge, no nosology evidence exists pertaining to a craving criterion for SUD-I. An additional debate focusses on whether SUD-I withdrawal exists (which DSM-IV and -5 both exclude). Symptoms which typify withdrawal from substances other than inhalants highly discriminated general-population adults with DSM-IV SUD-I dependence from adults with abuse or only IU (Perron et al., 2011). However, no cluster of a distinct set of withdrawal symptoms has been found to comprise a syndrome per se (Perron et al., 2011; Ridenour et al., 2007). A final deliberation involves parsing of putative types of inhalants into different drug classes. DSM-IV and -5 exclude from SUD-I the nitrite inhalants (amyl, butyl, and isobutyl nitrites) and nitrous oxide (a gas), which are assigned to the “other (or unknown)” class. The “other” class consists of drugs for which “the extent and range of induced disorders are uncertain” (p. 584; APA, 2013). Present Study Toward finalizing SUD-I nomenclature, study aims were to quantify differences between DSM-IV and DSM-5 nomenclatures; test the hypothesis that (a) different putative types of inhalants and (b) SUD-I criteria of DSM-IV and DSM-5 manifest a single construct; and contribute to the literature evidence from a community-recruited sample of older adolescents and young adults, the age range of greatest SUD incidence (Chen, O’Brien, & Anthony, 2005; Grant, Dawson, Stinson, Chou, Dufour & Pickering, 2004). Moreover, it was hypothesized that kappa of .6 (good reliability) or greater occurs between ‘gold standard’ structured and unstructured clinical interviews of SUD-I. Finally, DSM-IV and DSM-5 nomenclatures were compared in terms of the number persons each renders who meet at least one criterion, but not a diagnosis (so-called diagnostic orphans) (Degenhardt, Coffey, Carlin, Swift, & Patton, 2008; Harford, Yi, & Grant, 2010).

Stress has been linked to a broad range of psychopathology including alcohol and drug dependence. Recent advances in our understanding of how stress interacts with biological systems involved in addiction has generated even greater interest in stress assessment among addiction researchers. The Stressful Life Events Schedule (SLES) capitalizes on the strengths and avoids the pitfalls of self-report checklist and interview-based stress assessments. Because the SLES depends on consensus ratings of a research team, this study examined rater agreement of stressful event ratings across the first year using the SLES. Individual ratings of stressful events were compared between two experienced and three new raters. Ratings were analyzed for life events generated from interviews of 70 adolescent psychiatric inpatients and 62 healthy adolescents. Inexperienced raters, with backgrounds in addiction research, reliably rated stressful events and rater agreement improved over a year’s time. Recommendations for successfully adopting the SLES for consensus rating are discussed.

As more young people are identified with autism spectrum diagnoses without co-occurring intellectual disability (i.e. high-functioning autism spectrum disorder; HFASD), it is imperative that we begin to study the needs of this population. We sought to gain a preliminary estimate of the scope of the problem and to examine psychiatric risks associated HFASD symptoms in university students. In a large sample ( n = 667), we examined prevalence of ASD in students at a single university both diagnostically and dimensionally, and surveyed students on other behavioral and psychiatric problems. Dependent upon the ascertainment method, between .7 per cent and 1.9 per cent of college students could meet criteria for HFASD. Of special interest, none of the students who were found to meet diagnostic criteria ( n = 5) formally for HFASD in this study had been previously diagnosed. From a dimensional perspective, those students scoring above the clinical threshold for symptoms of autism ( n = 13) self-reported more problems with social anxiety than a matched comparison group of students with lower autism severity scores. In addition, symptoms of HFASD were significantly correlated with symptoms of social anxiety, as well as depression and aggression. Findings demonstrate the importance of screening for autism-related impairment among university students.

Heterogeneity is observed in the patterns of cognition in Alzheimer’s disease (AD). Such heterogeneity might suggest the involvement of different etiological pathways or different host responses to pathology. A total of 627 subjects with mild/moderate AD underwent cognitive assessment with the Mini-Mental State Examination (MMSE) and the Dementia Rating Scale-2 (DRS-2). Latent class analysis (LCA) was performed on cognition subscale data to identify and characterize cognitive subgroups. Clinical, demographic, and genetic factors were explored for association with class membership. LCA suggested the existence of four subgroups; one group with mild and another with severe global impairment across the cognitive domains, one group with primary impairments in attention and construction, and another group with primary deficits in memory and orientation. Education, disease duration, age, Apolipoprotein E-ε4 (APOE ε4) status, gender, presence of grasp reflex, white matter changes, and early or prominent visuospatial impairment were all associated with class membership. Our results support the existence of heterogeneity in patterns of cognitive impairment in AD. Our observation of classes characterized by predominant deficits in attention/construction and memory respectively deserves further exploration as does the association between membership in the attention/construction class and APOE ε4 negative status. (JINS, 2010, 16, 233–243.)

Publisher Summary This chapter focuses primarily on the dependence and abuse/harmful use diagnoses because they are the most widely used diagnoses for identification of persons with addiction. Corresponding diagnoses from the DSM-IV and ICD-10 systems will be presented side by side to highlight their differences. Because DSM-IV provides a greater description of the disorders, characterizations of the diagnoses are quoted from the DSM-IV. Classification of adolescent substance use disorders (SUDs) and related disorders has greatly improved. However, large gaps remain in the understanding of these disorders, including basic questions regarding the generalization of existing SUD classification nomenclature to adolescents. Existing data suggest that classification schemes developed for adults do not generalize to adolescents. For this reason, “skip out” formats ought to be avoided in the assessment of adolescent SUDs. In spite of significant advances in theory and assessment, basic demographic variables such as gender, age, and socioeconomic status continue to be characteristics associated with trends in substance use. Other domains that ought to be evaluated to obtain a comprehensive assessment of an individual's SUDs include medical history and current health status, comorbid psychiatric disorders and family history of psychiatric disorders, family functioning, and social functioning and support. A great deal of research remains to be conducted before a classification, nomenclature, and assessment of adolescent SUDs will be completed. Better understanding of SUDs should also enhance treatment for the disorders as well as the understanding of the course, etiology and prevention of SUDs.