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Objective: Despite the importance of alcohol use norms as predictors of adolescent and college drinking, there has been little research on their development from childhood into adolescence. This study used parental and child beliefs regarding the acceptability of sipping, drinking, and drunkenness for children ages 8-16 years to establish age norms for these alcohol use behaviors and examined differences in the growth of these norms between parents and children.Method: Data were collected as part of an ongoing cohort-sequential longitudinal study of 452 families with children initially 8 or 10 years old followed over 10 waves covering the age span from age 8 to age 16 years. Children completed interviews every 6 months. Parents completed interviews annually. Latent growth modeling was performed on the mother, father, and child data.Results: Unconditional latent growth curve modeling showed that parental acceptance of child sipping increased with child age but that there was no increase in their acceptance of child drinking or drunkenness through age 16 years. In contrast, there was significant growth in children's acceptance of sipping, drinking, and drunkenness. Piecewise growth models with a transition at 11.5 or 12 years of age best described the development of child and adolescent alcohol use norms.Conclusions: From middle childhood into middle adolescence, there is increasing divergence between parents' acceptance of alcohol use by children and child/adolescent acceptance of alcohol use by people their age. [ABSTRACT FROM AUTHOR]

Background: This study compared six of the briefest screening instruments for detecting DSM-IV-defined Alcohol Use Disorder (AUD) among older adolescents treated in Emergency Departments (ED).Methods: The AUDIT-C, the RAPS4-QF, the FAST, the CRAFFT, the RUFT-Cut, and 2-Items from the Diagnostic and Statistical Manual IV of the American Psychiatric Association [American Psychiatric Association (1994). Diagnostic and Statistical Manual of Psychiatric Disorders, (1994) (DSM-IV). 4th ed. Washington D.C.: American Psychiatric Association] criteria for AUD (heretofore referred to as the DSM-IV 2-Item Scale) were evaluated against the criterion of a current DSM-IV diagnosis of either alcohol abuse or dependence. The instruments were administered to 181 alcohol-using older adolescents (57% males; age range 18-20 years) in an ED and compared using Receiver Operator Characteristic (ROC) analyses against the criterion of a current DSM-IV diagnosis of alcohol abuse or dependence.Results: Of these instruments, the DSM-IV 2-Item Scale performed best for identifying AUD (88% sensitivity and 90% specificity), followed by the FAST and the AUDIT-C.Conclusions: Two items from the DSM-IV criteria for AUD performed best for identifying ED-treated older adolescents with alcohol use disorders. The FAST and AUDIT-C performed well, but are longer and more difficult to score in the hectic environment of the Emergency Department. [ABSTRACT FROM AUTHOR]

Little information is available on alcohol use in children up to age 10, although rates appear to be low. This age-group is not without risk, however. In fact, numerous nonspecific and specific risk factors for subsequent alcohol use are prevalent in childhood. Alcohol-nonspecific risk factors include externalizing and internalizing behaviors, as well as environmental and social factors (e.g., stress, physical abuse, or other aspects of social interaction). Nonspecific childhood factors (i.e., predictors) are being identified to target specific population subgroups for preventive interventions. These efforts have identified a variety of predictors of drinking onset during childhood or early adolescence that predict adolescent and young-adult problem drinking, as well as adult alcohol use and alcohol use disorders. Alcohol-specific risk factors also are being identified, including children's beliefs and expectancies about alcohol, as well as childhood social contexts (e.g., modeling of alcohol use by parents, portrayal of alcohol use in the mass media, and growing up in a family with an alcoholic family member). Together, these specific and nonspecific influences play a heavy role in determining a child's risk of or resilience to later alcohol use and related problems. [ABSTRACT FROM AUTHOR]

Organophosphate (OP) compounds, a family of highly hazardous chemical compounds included in nerve agents and pesticides, have been linked to more than 250,000 annual deaths connected to various chronic diseases. However, a solid-state sensing system that is able to be integrated into a clothing system is rare in the literature. This study aims to develop a nanofiber-based solid-state polymeric material as a soft sensor to detect OP compounds present in the environment. Esters of polydiacetylene were synthesized and incorporated into a cellulose acetate nanocomposite fibrous assembly developed with an electrospinning technique, which was then hydrolyzed to generate more hydroxyl groups for OP binding. Scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FT-IR), Instron® tensile tester, contact angle analyzer, and UV–Vis spectroscopy were employed for characterizations. Upon hydrolysis, polydiacetylene esters in the cellulosic fiber matrix were found unaffected by hydrolysis treatment, which made the composites suitable for OP sensing. Furthermore, the nanofibrous (NF) composites exhibited tensile properties suitable to be used as a textile material. Finally, the NF composites exhibited colorimetric sensing of OP, which is visible to the naked eye. This research is a landmark study toward the development of OP sensing in a protective clothing system.

OBJECTIVES: To assess the contribution of road rage victimization and perpetration to collision involvement. METHODS: The relationship between self-reported collision involvement and road rage victimization and perpetration was examined, based on telephone interviews with a representative sample of 4897 Ontario adult drivers interviewed between 2002 and 2004. RESULTS: Perpetrators and victims of both any road rage and serious road rage had a significantly higher risk of collision involvement than did those without road rage experience. CONCLUSIONS: This study provides epidemiological evidence that both victims and perpetrators of road rage experience increased collision risk. More detailed studies of the contribution of road rage to traffic crashes are needed. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence and comorbidity of psychiatric disorders among 12-20 year-old patients treated in emergency departments. Methods: Two hundred-fifteen adolescents and young adults were recruited on weekends from two Level-1 trauma facilities located within a University-based medical center. Comprehensive psychiatric interviews were conducted with participants outside the emergency department. Latent class analysis was used to determine participant clusters based on DSM-IV psychiatric diagnoses and emergency treatment for an alcohol-related medical event as indicator variables, while controlling for covariates. Results: A three-cluster model: (1) n = 90, 42%; (2) n = 65, 31%; and (3) n = 57 (27%) provided the best fit to the data. None of the participants in Cluster 1 were treated for alcohol-related events. All members of Cluster 2 were treated for alcohol-related events but only 23% were diagnosed with an alcohol use disorder. Thirty-two members of Cluster 3 (56%) were treated for alcohol-related events and Cluster 3 members were significantly higher than members of Clusters 1 and 2 on rates of: (1) alcohol use disorders (Wald statistic = 30.1, p < .001), (2) drug use disorders (Wald statistic = 42.3, p < .001), and 3) disruptive behavior disorders (Wald statistic = 19.3, p < .001). Conclusions: One group treated in the ED in this study is at low risk for alcohol-related injury. Conversely, one at risk-group may require brief interventions of low intensity while the other at-risk group displays high rates of comorbid psychiatric disorders and frequently engages in risk-taking behaviors, placing them at highest-risk for experiencing alcoholrelated injuries. Reduction of alcohol-related injuries in young drinkers depends on differentiating high and low risk drinkers in the emergency department and providing, or referring them to appropriate treatment. [ABSTRACT FROM AUTHOR]

PURPOSE: To examine a wide range of demographic characteristics and psychosocial factors to determine the cross-sectional correlates of violence and longitudinal predictors of violent initiation among adolescent drinkers. METHODS: We conducted secondary analyses of the 1995 (Time 1) and 1996 (Time 2) in-home surveys of the National Longitudinal Study of Adolescent Health (Add Health). This study included a nationally representative school-based sample (N=18,924) of adolescents in grades 7-12. The analyses were restricted to adolescent drinkers (n = 8885). Two logistic regression models were constructed using a backward elimination procedure to identify statistically significant cross-sectional correlates of violence and prospective predictors of violence initiation. RESULTS: Half (49%) of all adolescent drinkers reported violent behavior at Time 1 and 15% of those who were not violent at Time 1 reported initiating violent behavior at Time 2. A total of 14 significant cross-sectional correlates of violence were identified that included measures of alcohol use, drug use and selling, exposure to drugs, delinquency, and poor school functioning. Four variables (high-volume drinking, illicit drug use, low grade point average, and having been suspended and/or expelled from school) were significant longitudinal predictors of the initiation of violent behavior. CONCLUSIONS: The factors significantly associated with violence pertain mostly to alcohol use, drug use and selling, exposure to drugs, delinquency, and poor school functioning. However, most of these problems and behaviors tend to occur in closer temporal proximity to violent behavior (i.e., within a year) and do not seem to developmentally precede initiation in violent behavior. [ABSTRACT FROM AUTHOR]

BACKGROUND: Early identification of alcohol use disorders (AUD) among emergency department (ED)-treated patients is important for facilitating intervention and further evaluation outside EDs. A number of brief screening instruments have been developed for identifying patients with AUD, but it is not clear whether they are practical and perform well with older adolescents in an ED setting. This study contrasted four brief screening instruments for detecting DSM-IV-defined AUD and tested a newly developed brief screen for use among ED-treated older adolescents. METHODS: The Alcohol Use Disorders Identification Test (AUDIT), the CAGE, the CRAFFT, and a modified RAPS-QF were given to 93 alcohol-using older adolescents (55% men; aged 18-20 years) in an ED. Receiver operator characteristic analyses were used to evaluate the performance of brief screens against the criterion of a lifetime DSM-IV alcohol abuse or dependence diagnosis. RESULTS: Of existing instruments, the AUDIT had the best overall performance in identifying AUD (sensitivity, 82%; specificity, 78%). A new, shorter screening instrument composed of two AUDIT items, two CRAFFT items, and one CAGE item (RUFT-Cut) performed as well as the AUDIT (sensitivity, 82%; specificity, 78%). CONCLUSIONS: Among existing alcohol screening instruments, the AUDIT performed best for identifying ED-treated older adolescents with alcohol use disorders. The RUFT-Cut is a brief screening instrument for AUD that shows promise for identifying ED-treated older adolescents who are in need of intervention or further evaluation. Future research should focus on use of the RUFT-Cut in other settings with larger, more diverse samples of adolescents. [ABSTRACT FROM AUTHOR]

Despite the current societal concern with underage drinking, little attention has been paid to alcohol use within the preadolescent population. This article presents the proceedings of a symposium held at the 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida, that was organized and chaired by John E. Donovan. The intent of the symposium was to kick start research on alcohol use among elementary school children by reviewing what is known regarding drinking in childhood. Presentations included (1) The Epidemiology of Children's Alcohol Use, by John E. Donovan; (2) The Validity of Children's Self-Reports of Alcohol Use, by Sharon L. Leech; (3) Predicting Onset of Drinking From Behavior at Three Years of Age: Influence of Early Child Expectancies and Parental Alcohol Involvement Upon Early First Use, by Robert A. Zucker; and (4) Parent, Peer, and Child Risk Factors for Alcohol Use in Two Cohorts of Elementary School Children, by Carol J. Loveland-Cherry. Presentations indicated the need for better nationwide surveillance of children's experience with alcohol; suggested that children's reports of their use of alcohol tend to be reliable and valid; supported children's alcohol use schemas and parental drinking and alcoholism at child age three as independent predictors of early onset drinking; and showed that onset of drinking before fourth or fifth grade, peer pressure, and parental norms and monitoring predict elementary student alcohol use and misuse. [ABSTRACT FROM AUTHOR]

Background: Although adolescent alcohol consumption has been found to be positively correlated with self-reported health problems, few studies have examined other health indicators. This study compared adolescents with alcohol use disorders (AUDs) and a community reference group on self-reported health problems, serum liver enzymes, and physical examination findings. The relevance of negative emotionality to understanding these health problems was also investigated.Methods: The subjects were adolescents with AUDs recruited from clinical programs and classified as having DSM-IV alcohol dependence (n = 71) or alcohol abuse (n = 57) and reference adolescents without AUDs recruited from community sources (n = 131). The assessment of health status included self-reported health problems in 15 areas; serum liver enzyme assays, including -glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase; and physical examination findings. Negative emotionality was determined by systematically combining scores from the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the Child Behavior Checklist, and the Multidimensional Personality Questionnaire.Results: Adolescent AUDs were associated with more self-reported health problems, higher -glutamyl transpeptidase and alanine aminotransferase levels, and more physical examination abnormalities. Negative emotionality was highly correlated with self-reported health problems, mediated the relationship between AUDs and self-reported health problems, and was not correlated with serum liver enzyme levels or physical examination abnormalities.Conclusions: These results indicated that AUDs during adolescence were associated with health problems, including modest but demonstrable liver injury. Self-reported health problems were probably best understood, in this context, as a negative emotionality manifestation. [ABSTRACT FROM AUTHOR]

Difficult temperament has been found to be related to substance use disorders in adolescents. This study tested the hypothesis that the quality of the parent-adolescent relationship mediates the association between difficult temperament and alcohol use disorder symptoms. The sample consisted of 438 adolescents aged 12 to 18 years, and their mothers. Structured diagnostic interviews were used to assess alcohol use disorder (AUD) symptoms. A series of multiple regression analyses were performed to test this mediational model separately for females and males. For both genders, difficult temperament was a significant predictor of AUD symptoms, and was negatively related to parent-adolescent relationship quality. For males, the relationship between difficult temperament and AUD symptoms was mediated by parent-adolescent relationship quality. For females, however, difficult temperament and parent adolescent relationship quality independently predicted the adolescents' AUD symptoms. These results suggest that alcohol abuse prevention and treatment programs should consider the role of basic temperamental characteristics in pathological drinking, and the possibility that parent-adolescent relationship quality may be a key point of intervention. [ABSTRACT FROM AUTHOR]

Abstract Background Recruitment to randomised controlled trials (RCTs) with very different treatment arms is often difficult. The ProtecT (Prostate testing for cancer and Treatment) study successfully used qualitative research methods to improve recruitment and these methods were replicated in five other RCTs facing recruitment difficulties. A similar qualitative recruitment investigation was undertaken in the SPARE (Selective bladder Preservation Against Radical Excision) feasibility study to explore reasons for low recruitment and attempt to improve recruitment rates by implementing changes suggested by qualitative findings. Methods In Phase I of the investigation, reasons for low levels of recruitment were explored through content analysis of RCT documents, thematic analysis of interviews with trial staff and recruiters, and conversation analysis of audio-recordings of recruitment appointments. Findings were presented to the trial management group and a plan of action was agreed. In Phase II, changes to design and conduct were implemented, with training and feedback provided for recruitment staff. Results Five key challenges to trial recruitment were identified in Phase I: (a) Investigators and recruiters had considerable difficulty articulating the trial design in simple terms; (b) The recruitment pathway was complicated, involving staff across different specialties/centres and communication often broke down; (c) Recruiters inadvertently used 'loaded' terminology such as 'gold standard' in study information, leading to unbalanced presentation; (d) Fewer eligible patients were identified than had been anticipated; (e) Strong treatment preferences were expressed by potential participants and trial staff in some centres. In Phase II, study information (patient information sheet and flowchart) was simplified, the recruitment pathway was focused around lead recruiters, and training sessions and 'tips' were provided for recruiters. Issues of patient eligibility were insurmountable, however, and the independent Trial Steering Committee advised closure of the SPARE trial in February 2010. Conclusions The qualitative investigation identified the key aspects of trial design and conduct that were hindering recruitment, and a plan of action that was acceptable to trial investigators and recruiters was implemented. Qualitative investigations can thus be used to elucidate challenges to recruitment in trials with very different treatment arms, but require sufficient time to be undertaken successfully. Trial Registration CRUK/07/011; ISRCTN61126465

Abstract Background Total joint replacement (TJR) of the hip or knee for osteoarthritis is among the most common elective surgical procedures. There is some inequity in provision of TJR. How decisions are made about who will have surgery may contribute to disparities in provision. The model of shared decision-making between patients and clinicians is advocated as an ideal by national bodies and guidelines. However, we do not know what happens within orthopaedic practice and whether this reflects the shared model. Our study examined how decisions are made about TJR in orthopaedic consultations. Methods The study used a qualitative research design comprising semi-structured interviews and observations. Participants were recruited from three hospital sites and provided their time free of charge. Seven clinicians involved in decision-making about TJR were approached to take part in the study, and six agreed to do so. Seventy-seven patients due to see these clinicians about TJR were approached to take part and 26 agreed to do so. The patients' outpatient appointments ('consultations') were observed and audio-recorded. Subsequent interviews with patients and clinicians examined decisions that were made at the appointments. Data were analysed using thematic analysis. Results Clinical and lifestyle factors were central components of the decision-making process. In addition, the roles that patients assigned to clinicians were key, as were communication styles. Patients saw clinicians as occupying expert roles and they deferred to clinicians' expertise. There was evidence that patients modified their behaviour within consultations to complement that of clinicians. Clinicians acknowledged the complexity of decision-making and provided descriptions of their own decision-making and communication styles. Patients and clinicians were aware of the use of clinical and lifestyle factors in decision-making and agreed in their description of clinicians' styles. Decisions were usually reached during consultations, but patients and clinicians sometimes said that treatment decisions had been made beforehand. Some patients expressed surprise about the decisions made in their consultations, but this did not necessarily imply dissatisfaction. Conclusions The way in which roles and communication are played out in decision-making for TJR may affect the opportunity for shared decisions. This may contribute to variation in the provision of TJR. Making the importance of these factors explicit and highlighting the existence of patients' 'surprise' about consultation outcomes could empower patients within the decision-making process and enhance communication in orthopaedic consultations.

Abstract Background Schools have been identified as an important place in which to support adolescent emotional health, although evidence as to which interventions are effective remains limited. Relatively little is known about student and staff views regarding current school-based emotional health provision and what they would like to see in the future, and this is what this study explored. Methods A random sample of 296 English secondary schools were surveyed to quantify current level of emotional health provision. Qualitative student focus groups (27 groups, 154 students aged 12-14) and staff interviews (12 interviews, 15 individuals) were conducted in eight schools, purposively sampled from the survey respondents to ensure a range of emotional health activity, free school meal eligibility and location. Data were analysed thematically, following a constant comparison approach. Results Emergent themes were grouped into three areas in which participants felt schools did or could intervene: emotional health in the curriculum, support for those in distress, and the physical and psychosocial environment. Little time was spent teaching about emotional health in the curriculum, and most staff and students wanted more. Opportunities to explore emotions in other curriculum subjects were valued. All schools provided some support for students experiencing emotional distress, but the type and quality varied a great deal. Students wanted an increase in school-based help sources that were confidential, available to all and sympathetic, and were concerned that accessing support should not lead to stigma. Finally, staff and students emphasised the need to consider the whole school environment in order to address sources of distress such as bullying and teacher-student relationships, but also to increase activities that enhanced emotional health. Conclusion Staff and students identified several ways in which schools can improve their support of adolescent emotional health, both within and outside the curriculum. However, such changes should be introduced as part of a wider consideration of how the whole school environment can be more supportive of students' emotional health. Clearer guidance at policy level, more rigorous evaluation of current interventions, and greater dissemination of good practice is necessary to ensure adolescents' emotional health needs are addressed effectively within schools.

Abstract Background The co-translational incorporation of selenocysteine into nascent polypeptides by recoding the UGA stop codon occurs in all domains of life. In eukaryotes, this event requires at least three specific factors: SECIS binding protein 2 (SBP2), a specific translation elongation factor (eEFSec), selenocysteinyl tRNA, and a cis-acting selenocysteine insertion sequence (SECIS) element in selenoprotein mRNAs. While the phylogenetic relationships of selenoprotein families and the evolution of selenocysteine usage are well documented, the evolutionary history of SECIS binding proteins has not been explored. Results In this report we present a phylogeny of the eukaryotic SECIS binding protein family which includes SBP2 and a related protein we herein term SBP2L. Here we show that SBP2L is an SBP2 paralogue in vertebrates and is the only form of SECIS binding protein in invertebrate deuterostomes, suggesting a key role in Sec incorporation in these organisms, but an SBP2/SBP2L fusion protein is unable to support Sec incorporation in vitro. An in-depth phylogenetic analysis of the conserved L7Ae RNA binding domain suggests an ancestral relationship with ribosomal protein L30. In addition, we describe the emergence of a motif upstream of the SBP2 RNA binding domain that shares significant similarity with a motif within the pseudouridine synthase Cbf5. Conclusion Our analysis suggests that SECIS binding proteins arose once in evolution but diverged significantly in multiple lineages. In addition, likely due to a gene duplication event in the early vertebrate lineage, SBP2 and SBP2L are paralogous in vertebrates.

Abstract Background The slogan "Suicide prevention is everyone's business" has been used in a number of campaigns worldwide in recent years, but most research into suicide prevention has focused on the role of medical professionals in identifying and managing risk. Little consideration has been given to the role that lay people can play in suicide prevention, or to the resources they need in order to do so. The majority of people who take their own lives are not under the care of specialist mental health services, and around half have not had recent contact with their general practitioner. These individuals are not known to be 'at risk' and there is little or no opportunity for clinical intervention. Family members and friends may be the only ones to know that a person is troubled or distressed, and their capacity to recognise, assess and respond to that distress is therefore vitally important. This study aims to discover what the suicidal process looks like from the point of view of relatives and friends and to gain insight into the complex and difficult judgements that people have to make when trying to support a distressed individual. Methods/Design The study uses qualitative methods to build up a detailed picture of 15–20 completed suicides, aged 18–34. Data are gathered by means of in-depth interviews with relatives, friends and others who knew the deceased well. In each case, as many informants as possible are sought using a purposive snowballing technique. Interviews focus on the family and social network of the deceased, the ways in which relatives and friends interpreted and responded to his/her distress, the potential for intervention that may have existed within the lay network and the knowledge, skills and other resources that would have helped members to support the distressed individual more effectively. Discussion The study will inform interventions to promote public mental health awareness and will provide a basis on which to develop community-focussed suicide prevention strategies.

Abstract Background Poor recruitment and retention of participants in randomised controlled trials (RCTs) is problematic but common. Clear and detailed reporting of participant flow is essential to assess the generalisability and comparability of RCTs. Despite improved reporting since the implementation of the CONSORT statement, important problems remain. This paper aims: (i) to update and extend previous reviews evaluating reporting of participant recruitment and retention in RCTs; (ii) to quantify the level of participation throughout RCTs. Methods We reviewed all reports of RCTs of health care interventions and/or processes with individual randomisation, published July–December 2004 in six major journals. Short, secondary or interim reports, and Phase I/II trials were excluded. Data recorded were: general RCT details; inclusion of flow diagram; participant flow throughout trial; reasons for non-participation/withdrawal; target sample sizes. Results 133 reports were reviewed. Overall, 79% included a flow diagram, but over a third were incomplete. The majority reported the flow of participants at each stage of the trial after randomisation. However, 40% failed to report the numbers assessed for eligibility. Percentages of participants retained at each stage were high: for example, 90% of eligible individuals were randomised, and 93% of those randomised were outcome assessed. On average, trials met their sample size targets. However, there were some substantial shortfalls: for example 21% of trials reporting a sample size calculation failed to achieve adequate numbers at randomisation, and 48% at outcome assessment. Reporting of losses to follow up was variable and difficult to interpret. Conclusion The majority of RCTs reported the flow of participants well after randomisation, although only two-thirds included a complete flow chart and there was great variability over the definition of "lost to follow up". Reporting of participant eligibility was poor, making assessments of recruitment practice and external validity difficult. Reporting of participant flow throughout RCTs could be improved by small changes to the CONSORT chart.

OBJECTIVE: Blood alcohol concentrations (BACs) in children after consumption of different numbers of standard drinks of alcohol have not been estimated previously. The goal was to determine the number of drinks at each age that led to a BAC of > or =80 mg/dL, the National Institute on Alcohol Abuse and Alcoholism criterion for binge drinking. METHODS: The updated Widmark equation to estimate BAC was modified to take account of the differing body composition (total body water) and accelerated rates of ethanol elimination of children. The modified formula was used with 1999-2002 National Health and Nutrition Examination Survey data to estimate BACs for >4700 children and adolescents from 9 through 17 years of age, for intake levels of 1 to 5 standard drinks. RESULTS: The estimated BACs for children after consumption of just 3 standard drinks within a 2-hour period were between 80 and 139 mg/dL for boys 9 to 13 years of age and for girls 9 to 17 years of age, indicating substantial potential alcohol impairment. With 5 drinks within 2 hours (the level used to define binge drinking among college students), children 9 to 13 years of age were estimated to have BACs 2 to 3 times the adult legal limit for intoxication of 80 mg/dL. CONCLUSION: Binge drinking should be defined as > or =3 drinks for 9- to 13-year-old children, as > or =4 drinks for boys and > or =3 drinks for girls 14 or 15 years of age, and as > or =5 drinks for boys and > or =3 drinks for girls 16 or 17 years of age. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for COVID-19, utilizes receptor binding domain (RBD) of spike glycoprotein to interact with angiotensin (Ang)-converting enzyme 2 (ACE2). Altering ACE2 levels may affect entry of SARS-CoV-2 and recovery from COVID-19. Decreased cell surface density of ACE2 leads to increased local levels of Ang II and may contribute to mortality resulting from acute lung injury and fibrosis during COVID-19. Studies published early during the COVID-19 pandemic reported that people with cystic fibrosis (PwCF) had milder symptoms, compared to people without CF. This finding was attributed to elevated ACE2 levels and/or treatment with the high efficiency CFTR modulators. Subsequent studies did not confirm these findings reporting variable effects of CFTR gene mutations on ACE2 levels. Transforming growth factor (TGF)-β signaling is essential during SARS-CoV-2 infection and dominates the chronic immune response in severe COVID-19, leading to pulmonary fibrosis. TGF-β1 is a gene modifier associated with more severe lung disease in PwCF but its effects on the COVID-19 course in PwCF is unknown. To understand whether TGF-β1 affects ACE2 levels in the airway, we examined miRNAs and their gene targets affecting SARS-CoV-2 pathogenesis in response to TGF-β1. Small RNAseq and micro(mi)RNA profiling identified pathways uniquely affected by TGF-β1, including those associated with SARS-CoV-2 invasion, replication, and the host immune responses. TGF-β1 inhibited ACE2 expression by miR-136-3p and miR-369-5p mediated mechanism in CF and non-CF bronchial epithelial cells. ACE2 levels were higher in two bronchial epithelial cell models expressing the most common CF-causing mutation in CFTR gene F508del, compared to controls without the mutation. After TGF-β1 treatment, ACE2 protein levels were still higher in CF, compared to non-CF cells. TGF-β1 prevented the modulator-mediated rescue of F508del-CFTR function while the modulators did not prevent the TGF-β1 inhibition of ACE2 levels. Finally, TGF-β1 reduced the interaction between ACE2 and the recombinant spike RBD by lowering ACE2 levels and its binding to RBD. Our data demonstrate novel mechanism whereby TGF-β1 inhibition of ACE2 in CF and non-CF bronchial epithelial cells may modulate SARS-CoV-2 pathogenicity and COVID-19 severity. By reducing ACE2 levels, TGF-β1 may decrease entry of SARS-CoV-2 into the host cells while hindering the recovery from COVID-19 due to loss of the anti-inflammatory and regenerative effects of ACE2. The above outcomes may be modulated by other, miRNA-mediated effects exerted by TGF-β1 on the host immune responses, leading to a complex and yet incompletely understood circuitry., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Micro(mi)RNAs are short, non-coding RNAs that mediate the RNA interference (RNAi) by post-transcriptional mechanisms. Specific miRNAs are recruited to the cytoplasmic RNA induced silencing complex (RISC). Argonaute2 (Ago2), an essential component of RISC, facilitates binding of miRNA to the target-site on mRNA, followed by cleaving the miRNA-mRNA duplex with its endonuclease activity. RNAi is mediated by a specific pool of miRNAs recruited to RISC, and thus is referred to as the functional pool. The cellular levels of many miRNAs are affected by the cytokine Transforming Growth Factor-β1 (TGF-β1). However, little is known about whether the TGF-β1 affects the functional pools of these miRNAs. The Ago2-miRNA-co-IP assay, discussed in this manuscript, is designed to examine effects of TGF-β1 on the recruitment of miRNAs to RISC and it helps to determine whether changes in the cellular miRNA levels correlate with changes in the RISC-associated, functional pools. The general principles of the assay are as follows. Cultured cells treated with TGF-β1 or vehicle control are lysed and the endogenous Ago2 is immunoprecipitated with immobilized anti-Ago2 antibody, and the active miRNAs complexed with Ago2 are isolated with a RISC immunoprecipitation (RIP) assay kit. The miRNAs are identified with quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) using miRNA-specific stem-looped primers during reverse transcription, followed by PCR using miRNA-specific forward and reverse primers, and TaqMan hydrolysis probes.

Mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene lead to cystic fibrosis (CF). The most common mutation F508del inhibits folding and processing of CFTR protein. FDA-approved correctors rescue the biosynthetic processing of F508del-CFTR protein, while potentiators improve the rescued CFTR channel function. Transforming growth factor (TGF-β1), overexpressed in many CF patients, blocks corrector/potentiator rescue by inhibiting CFTR mRNA in vitro. Increased TGF-β1 signaling and acquired CFTR dysfunction are present in other lung diseases. To study the mechanism of TGF-β1 repression of CFTR, we used molecular, biochemical, and functional approaches in primary human bronchial epithelial cells from over 50 donors. TGF-β1 destabilized CFTR mRNA in cells from lungs with chronic disease, including CF, and impaired F508del-CFTR rescue by new-generation correctors. TGF-β1 increased the active pool of selected micro(mi)RNAs validated as CFTR inhibitors, recruiting them to the RNA-induced silencing complex (RISC). Expression of F508del-CFTR globally modulated TGF-β1-induced changes in the miRNA landscape, creating a permissive environment required for degradation of F508del-CFTR mRNA. In conclusion, TGF-β1 may impede the full benefit of corrector/potentiator therapy in CF patients. Studying miRNA recruitment to RISC under disease-specific conditions may help to better characterize the miRNAs utilized by TGF-β1 to destabilize CFTR mRNA.

Background: Prenatal cocaine exposure (PCE) has been linked to child/adolescent behavior problems and substance use in several longitudinal cohort studies. It is unclear whether these effects extend into adulthood and influence young adult behavior problems and substance use and, if so, whether they are mediated by childhood and adolescent experiences., Methods: These data are from an ongoing longitudinal study of individuals born to women who were recruited early in pregnancy. Trimester-specific data on prenatal drug exposure were obtained. Caregivers and offspring were assessed at delivery and at 1, 3, 7, 10, 15, and 21 years postpartum. This report is from age 21, when 225 offspring (52% females; 54% African American, 46% Caucasian) reported on behavior problems, emotion regulation, and substance use., Results: There were significant direct associations between PCE and early initiation of marijuana, 21-year emotion regulation problems, arrest history, and Conduct Disorder. The relation between PCE and young adult internalizing behavior was mediated by adolescent mood symptoms. The association between PCE and 21-year marijuana use was mediated by early initiation of marijuana use., Conclusions: PCE has both direct and indirect long-term associations with young adult development. Using statistical models that considered the complex interrelationships among PCE and adult outcomes, we demonstrated that the direct effects of PCE on young adult emotion regulation problems, arrest history, and Conduct Disorder are not completely explained by earlier adolescent behavior. Moreover, the analyses suggesting mediated pathways from PCE to young adult problems identify crucial variables to target interventions for exposed children and adolescents., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Competing Interests: Declaration of interests None.

Objective: Most studies of adolescent drinking focus on single alcohol use behaviors (e.g., high-volume drinking, drunkenness) and ignore the patterning of adolescents' involvement across multiple alcohol behaviors. The present latent class analyses (LCAs) examined a procedure for empirically determining multiple cut points on the alcohol use behaviors in order to establish a typology of adolescent alcohol involvement., Method: LCA was carried out on six alcohol use behavior indicators collected from 6,504 7th through 12th graders who participated in Wave I of the National Longitudinal Study of Adolescent Health (AddHealth). To move beyond dichotomous indicators, a "progressive elaboration" strategy was used, starting with six dichotomous indicators and then evaluating a series of models testing additional cut points on the ordinal indicators at progressively higher points for one indicator at a time. Analyses were performed on one random half-sample, and confirmatory LCAs were performed on the second random half-sample and in the Wave II data., Results: The final model consisted of four latent classes (never or non-current drinkers, low-intake drinkers, non-problem drinkers, and problem drinkers). Confirmatory LCAs in the second random half-sample from Wave I and in Wave II support this four-class solution. The means on the four latent classes were also generally ordered on an array of measures reflecting psychosocial risk for problem behavior., Conclusions: These analyses suggest that there may be four different classes or types of alcohol involvement among adolescents, and, more importantly, they illustrate the utility of the progressive elaboration strategy for moving beyond dichotomous indicators in latent class models.

Background: Sipping or tasting alcohol is one of the earliest alcohol-use behaviors in which young children engage, yet there is relatively little research on this behavior. Previous cross-sectional analyses determined that child sipping or tasting is associated with the child's attitude toward sipping and with a family environment supportive of alcohol use, but not with variables reflecting psychosocial proneness for problem behavior as formulated in Problem Behavior Theory (Jessor and Jessor, Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth, 1977, Academic Press, New York). This study extended these analyses longitudinally to identify antecedent predictors of the childhood initiation of sipping or tasting alcohol in a multiwave study., Methods: A sample of 452 children (238 girls) aged 8 or 10 and their families was drawn from Allegheny County, PA, using targeted-age directory sampling and random digit dialing procedures. Children were interviewed using computer-assisted interviews. Antecedent variables collected at baseline (Wave 1) were examined as predictors of the initiation of sipping/tasting alcohol in childhood (before age 12) among Wave 1 abstainers (n = 286)., Results: Ninety-four children initiated sipping/tasting alcohol in a nonreligious context between baseline and turning age 12. Initiation of sipping/tasting did not generally relate to baseline variables reflecting psychosocial proneness for problem behavior. Instead, as found in the previous cross-sectional analyses, the variables most predictive of initiating sipping/tasting were perceived parents' approval for child sipping, parents' reported approval for child sipping, parents' current drinking status, and children's attitudes toward sipping/tasting alcohol., Conclusions: These longitudinal analyses replicate the earlier cross-sectional results. Young children's sipping/tasting of alcohol reflects parental modeling of drinking and parental approval of child sipping and does not represent a precocious manifestation of a psychosocial proneness to engage in problem behavior., (Copyright © 2014 The Authors. Alcoholism: Clinical and Experimental Research published by Wiley Periodicals, Inc. on behalf of Research Society on Alcoholism.)

Purpose: There have been few reports of the development of alcohol involvement from childhood through adolescence. We examined the ages at which children first sipped or tasted alcohol, drank, had three or more drinks in a row, had five or more drinks in a row, were drunk, or had alcohol problems, to describe the types of drinking experience exhibited at each age from 8.5 through 18.0 years. Sipping and three or more drinks per occasion have been understudied to date., Methods: We collected 14 waves of longitudinal data from 452 children aged 8 or 10 years, randomly sampled from Allegheny County, Pennsylvania. Ages of initiating each alcohol use behavior were determined, and the data were coded to reflect the child's status on each behavior at each age. We determined types of alcohol use experience using latent class analyses., Results: From age 8.5 to 12.5 years, there were two latent classes: abstainers and sippers. The percentage of sippers increased to 67% by age 12.5 years. From ages 13.0 to 18.0, we identified three latent classes: abstainers, sippers/light drinkers, and drinkers with drunkenness. At ages 13.5-15.5 years, drinkers in the latter class reported drunkenness with just three to four drinks per occasion. By age 18 years, sippers/light drinkers comprised 55% of the sample and drinkers with drunkenness comprised 38%., Conclusions: Childhood experience with alcohol was surprisingly widespread. Sipping or tasting alcohol was common by age 12 years. A quarter of the sample drank before age 15 years. Experience of intoxication increased throughout adolescence, even among those who had ever consumed just three to four drinks on an occasion., (Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The study of alcohol use by children ages 12 and younger has been very limited. This article summarizes information from U.S. national and statewide surveys on the prevalence of alcohol use among children in grades 6 and lower, data on health conditions wholly attributable to alcohol, the prevalence of children's treatment admissions for alcohol abuse, and their rates of presentation at emergency departments for acute alcohol intoxication. Factors hampering the estimation of alcohol burden in this population include the lack of ongoing national surveys of alcohol use and problems in children, the hand-me-down nature of alcohol assessments in this population, and the lack of studies to establish whether there is a causal relationship between childhood-onset drinking and morbidity and mortality in adolescence and later in life that would permit determination of alcohol-attributable fractions. This article concludes that although the alcohol burden in childhood is low, it may be augmented by both referred alcohol burden through parental drinking and alcohol abuse and by deferred alcohol burden from longer-term consequences of early use.

Background: Pronounced differences in drinking behavior exist between African Americans and European Americans. Disinhibited personality characteristics are widely studied risk factors for alcohol use outcomes. Longitudinal studies of children have not examined racial differences in these characteristics and in their rates of change or whether these changes differentially relate to adolescent alcohol use., Methods: Latent growth curve modeling was performed on 7 annual waves of data on 447 African American and European American 8- and 10-year-old children followed into adolescence as part of the Tween to Teen Project. Both mother and child data were examined., Results: European Americans had higher initial levels of (β = 0.22, p < 0.001) and greater growth in sensation seeking (β = 0.16, p < 0.05) compared with African Americans. However, African American children had higher initial levels of impulsivity compared with European American children (β = -0.27 and -0.16, p < 0.01). Higher initial levels of sensation seeking (β = 0.18, p < 0.01) and greater growth in both sensation seeking (β = 0.24, p < 0.01) and impulsivity (β = 0.30 to 0.34, p < 0.01) related to subsequent frequency of alcohol use. The association between race and alcohol use was partially mediated by initial levels of sensation seeking (β = 0.04, p < 0.05; 95% CI: 0.004 to 0.078). Additionally, sharper increases in sensation seeking predicted greater levels of subsequent alcohol use for European Americans (β = 0.33, p < 0.001) but not for African Americans (β = -0.15, ns)., Conclusions: This study revealed different developmental courses and important racial differences for sensation seeking and impulsivity. Findings highlight the possibility that sensation seeking at least partly drives early alcohol use for European American but not for African American adolescents., (Copyright © 2012 by the Research Society on Alcoholism.)

Objective: Routine alcohol screening of adolescents in pediatric settings is recommended, and could be facilitated by a very brief empirically validated alcohol screen based on alcohol consumption. This study used national sample data to test the screening performance of 3 alcohol consumption items (ie, frequency of use in the past year, quantity per occasion, frequency of heavy episodic drinking) in identifying youth with alcohol-related problems., Methods: Data were from youth aged 12 to 18 participating in the annual National Survey on Drug Use and Health from 2000 to 2007. The screening performance of 3 alcohol consumption items was tested, by age and gender, against 2 outcomes: any Diagnostic and Statistical Manual, Fourth Edition alcohol use disorder symptom ("moderate"-risk outcome), and a diagnosis of Diagnostic and Statistical Manual, Fourth Edition alcohol dependence ("high"-risk outcome)., Results: Prevalence of the 2 outcomes increased with age: any alcohol use disorder symptom ranged from 1.4% to 29.2%; alcohol dependence ranged from 0.2% to 5.3%. Frequency of drinking had higher sensitivity and specificity in identifying both outcomes, compared with quantity per occasion and heavy episodic drinking frequency. For both outcomes, results indicate the utility of similar cut points for drinking frequency for males and females at each age. Age-specific frequency cut points, however, are recommended for both moderate- and high-risk outcomes to maximize screening performance., Conclusions: Drinking frequency provides an empirically supported brief screen to efficiently identify youth with alcohol-related problems.

Objective: There is relatively little research on the childhood antecedent predictors of early-onset alcohol use. This study examined an array of psychosocial variables assessed at age 10 and reflecting Problem Behavior Theory as potential antecedent risk factors for the initiation of alcohol use at age 14 or younger., Method: A sample of 452 children (238 girls) ages 8 or 10 and their families was drawn from Allegheny County, PA, using targeted-age directory sampling and random-digit dialing procedures. Children and parents were interviewed using computer-assisted interviews. Logistic regression analyses were used to examine the age-10 univariate and multivariate predictors of the initiation of alcohol use by age 14 or younger., Results: Twenty-five percent of the sample reported having more than a sip or a taste of alcohol in their life by age 14. Sex, race, and age cohort did not relate to early drinking status. Children with two parents were less likely to initiate drinking early. Early initiation of drinking related significantly to an array of antecedent risk factors (personality, social environment, and behavioral) assessed at age 10 that reflect psychosocial proneness for problem behavior. In the multivariate model, the variables most predictive of early-onset drinking were having a single parent, sipping or tasting alcohol by age 10, having parents who also started drinking at an early age, and parental drinking frequency., Conclusions: Initiation of alcohol use by age 14 reflects childhood psychosocial proneness to engage in problem behavior as measured by Problem Behavior Theory and having a family environment conducive to alcohol use.

Objective: The strongest predictor of adolescent alcohol use is affiliation with friends who drink, use other drugs, or engage in deviant behavior. Most studies measure this variable using adolescent perceptions of friend problem behavior, but some research suggests these perceptions may be inaccurate. The current study's objective was to determine the concordance between adolescent perceptions of their friend's drinking, smoking, and deviant behavior and the friend's self-report. Relationship characteristics and demographic variables were explored as predictors of report concordance., Method: Participants (targets) were 232 adolescents ages 13 or 15 (53% girls) from Wave 9 of the Tween to Teen Project. At least one reciprocally endorsed friend participated for 59% of target adolescents (n = 232/390). Targets completed computer-assisted interviews. Friends completed telephone interviews., Results: The relations between target perceptions of friend and friend self-reports of drinking and smoking were statistically significant (p < .001), but concordance was driven largely by agreement regarding the absence of behavior. Although 22% of friends drank and 8.6% smoked, fewer than 60% of targets perceived these behaviors. Deviant behavior reports correlated moderately (r = .45), with 51% of adolescents underreporting friend deviance. There were few predictors of report concordance., Conclusions: Adolescents and their friends generally provided concordant reports of one another's drinking and smoking behaviors, but most agreement concerned the absence of behavior; most targets provided underreports of their friend's engagement in deviant behaviors. These findings suggest that adolescent perceptions of friends' problem behavior do not exaggerate the involvement of their friends in these behaviors.

Alcohol expectancies are important predictors of alcohol involvement in both adolescents and adults, yet little research has examined the social origins and transmission of these beliefs. This paper examined alcohol outcome expectancies collected in a cohort-sequential longitudinal study of 452 families with children followed over seven waves. Children completed interviews every 6 months, and parents completed interviews annually. Eighteen of 27 alcohol expectancies were highly consensual, being endorsed by significantly more than 67% of the mothers and fathers. These consensual expectancies were also highly stable over a 3-year period. Over the same period, children increased their adoption of both the positive and negative consensual alcohol expectancies. Unconditional latent growth modeling showed that piece-wise growth models with a transition at age 12 fit the data best. Both the positive and negative consensual expectancies were adopted at a faster rate between ages 8.5 and 11.5 than between ages 12 and 13.5. For negative expectancies, there was no further growth between ages 12 and 13.5. Taken together, these findings support the conceptualization of alcohol outcome expectancies as socially shared and transmitted beliefs., (Copyright (c) 2009 APA, all rights reserved.)

Teenage mothers may not "mature out" of substance use during young adulthood, and this non-normative trajectory of use may contribute to negative outcomes for teenage mothers and their offspring. Pregnant teenagers (age range=12-18 years; 68% Black) were recruited from a prenatal clinic and interviewed about their substance use, and subsequently re-interviewed six and ten years later (n=292). Consistent with the literature, early tobacco and marijuana use were risk factors for young adult use. Other substance use, peer adolescent use and mental health indicators were more important than race and socioeconomic status (SES) in determining which teenage mothers would use tobacco, engage in binge drinking, and use marijuana as young adults. However, race and SES were significant predictors of quitting tobacco use and marijuana use by the 10-year follow-up. Depression was associated with both persistent tobacco use and marijuana use in teenage mothers. These results illustrate the long-term consequences of teenage childbearing and identify modifiable risk factors for later health risks that should be addressed among younger mothers.

Developmental pathways to underage drinking emerge before the second decade of life. Many scientists, however, as well as the general public, continue to focus on proximal influences surrounding the initiation of drinking in adolescence, such as social, behavioral, and genetic variables related to availability and ease of acquisition of the drug, social reinforcement for its use, and individual differences in drug responses. In the past 20 years, a considerable body of evidence has accumulated on the early (often much earlier than the time of the first drink) predictors and pathways of youthful alcohol use and abuse. These early developmental influences involve numerous risk, vulnerability, promotive, and protective processes. Some of these factors are not related directly to alcohol use, whereas others involve learning and expectancies about later drug use that are shaped by social experience. The salience of these factors (identifiable in early childhood) for understanding the course and development of adult alcohol and other drug use disorders is evident from the large and growing body of findings on their ability to predict adult clinical outcomes. This review summarizes the evidence on early pathways toward and away from underage drinking, with a particular focus on the risk and protective factors and the mediators and moderators of risk for underage drinking that become evident during the preschool and early school years. It is guided by a developmental perspective on the aggregation of risk and protection and examines the contributions of biological, psychological, and social processes within the context of normal development. Implications of this evidence for policy, intervention, and future research are discussed.

Little attention has been paid to alcohol use by children aged 12 and younger. The present article summarizes findings on the prevalence of alcohol use from US national and statewide surveys of children in grades 6 and younger based on reports located in searches of the literature and the Internet. Four national surveys and seven statewide surveys of children's alcohol and drug use were located that present rates of lifetime sipping and tasting, lifetime experience of more than a sip, alcohol use in the past year, use in the past month, and use in the past week. Prevalence rates decrease with the level of involvement assessed. Alcohol use increases with age, doubling between grades four and six, with the largest jump in prevalence between grades five and six. At each grade level, boys are more likely to have used alcohol than girls. African-American children are nearly as likely as white and Hispanic children to have used alcohol. Over the past decade or so, the prevalence of both lifetime and current alcohol use has been declining in children. The failure to assess intensity of children's use hampers evaluation of the level of risk experienced by children. There is a need for ongoing nationwide surveillance of alcohol use in this population and for greater education of parents regarding the dangers of introducing children to alcohol use.

This study examined the demographic and psychosocial correlates of alcohol-related physical fighting and other physical fighting to determine if the predictors for aggressive behaviors are similar or different when alcohol is involved. Analyses were based on the National Longitudinal Study of Adolescent Health which is a nationally representative school based sample of adolescents in grades 7 through 12 (N=18,924). The current analyses were restricted to current drinkers who could be grouped into three categories of involvement in physical fights (n=8866): no fighting; fighting not related to alcohol use; fighting related to alcohol use. Regression models were computed using a backward-elimination procedure. Overall, 38% of adolescent drinkers reported fighting, including 12% who reported alcohol-related fighting and 26% who reported other physical fighting. Non-Hispanic African-American adolescents were most likely to report other physical fighting (37.1%) but they were least likely to report alcohol-related fighting (8.2%). The correlates of alcohol-related fighting differed by age and race/ethnicity. Moreover, since the correlates of alcohol-related fighting pertain mostly to the frequency and quantity of alcohol use and to having alcohol-related problems, prevention efforts that seek to reduce alcohol use or delay alcohol use initiation may also reduce alcohol-related fighting.

Background: Studies of alcohol-positive patients in emergency departments are not clear on the relationship between alcohol use disorder (AUD) symptoms and risk for injury., Method: Two-hundred three young adults (118 males (58%); mean age = 19.4 years) who were treated in two Level-1 emergency departments (ED) received comprehensive psychiatric interviews and completed the Alcohol Use Disorders Identification Test (AUDIT) and the Cognitive Appraisal of Risky Events (CARE)., Results: Males diagnosed with the AUD symptom of "drinking more or over a longer period than intended" are at greatest risk for requiring emergency care for an alcohol-related medical problem (OR = 10.8, 95% CI = 1.2,94.3, p < .04). Risk-taking behaviors increase risk for an alcohol-related medical event for both genders (OR = 2.6, 95% CI=1.1,5.6.1, p < .03). Alcohol use disorder severity related negatively to risk for experiencing an alcohol-related medical problem (OR = 0.6, 95% CI = 0.4,0.9, p < .04)., Conclusions: Young adults treated for alcohol-related medical problems often exhibit DSM-IV defined symptoms of AUD and are engaging in risk-taking behaviors and should be referred for an in-depth assessment of alcohol use disorders and risk-taking activities.

This study examined demographic and psychosocial factors to determine the predictors of fighting attributed to alcohol use among adolescent drinkers. Analyses were based on the National Longitudinal Study of Adolescent Health which is a nationally representative sample of adolescents in Grades 7 through 11. The prospective analyses were restricted to those adolescent drinkers who participated in both data waves (n=6041) collected in 1995 and 1996. A logistic regression model was constructed using a backward elimination procedure to identify the significant predictors of initiating fighting attributed to alcohol use at Time 2 (1996). We found that frequent drinking, high-volume drinking, trouble in school, low college expectations and weekly involvement in sports were significant predictors of initiating fighting attributed to alcohol use. These findings suggest that prevention efforts targeting the reduction of frequent and heavy alcohol use may be particularly useful strategies for preventing fighting attributed to alcohol use.

Longitudinal research studies focused on alcohol use initiation in adolescence were reviewed to determine which variables function as antecedent predictors or risk factors. Only studies that focused on time-1 abstainers were included. Classes of risk factors examined include sociodemographic, family, peer, personality, and behavioral variables. The most consistent antecedent risk factors for starting to drink in adolescence were parental and peer approval and models for drinking and drug use as well as adolescents' own prior involvement in delinquent behavior. There was little evidence for gender differences in risk factors for alcohol use initiation. Secondary analyses of existing longitudinal data sets are encouraged to examine whether there are ethnic/racial differences in the risk factors for starting to drink and to establish those factors that serve a protective or buffering function, delaying onset of alcohol use in adolescence.

This study investigated consumption patterns, alcohol-related problems and predictors of problematic drinking among older adolescents. Two-hundred eighty older adolescents (148 males, mean +/- SD age = 18.5 [1.8] years) treated in two Emergency Departments (ED) completed the Alcohol Use Disorders Inventory Test (AUDIT) to identify problem drinkers. Logistic regression was used to determine predictors of problem drinker status. Higher rates of problem drinking were found among participants who were treated for physical assaults or for acute alcohol intoxication than were found among participants treated for medical illness. Being alcohol-positive in the ED, increasing frequency of drunkenness, and being treated for physical assault were predictive of problematic drinking after controlling for demographic variables. In conclusion, older adolescents who present for treatment of an assault-related injury or acute alcohol intoxication, who are alcohol-positive in the ED, and who report getting intoxicated once a month or more are likely to have a severe drinking problem.

Objective: This study was undertaken to explore the characteristics of young patients treated in emergency departments (EDs) who follow through with an evaluation for psychiatric disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and to investigate differences in rates of psychiatric disorders between ED-treated adolescents and demographically similar adolescents recruited from the community., Method: Sixty three older adolescents (40 males) who were treated at two urban university hospital EDs were matched one-to-one on age, gender and race with 63 adolescents recruited from the community for participation in studies at an alcohol research center. Comprehensive psychiatric interviews were conducted with both groups., Results: ED-treated adolescents were diagnosed with higher rates of current alcohol use disorders (AUDs), current drug use disorders and current major depression than were community controls. The ED sample had a particularly high rate of the DSM-IV "hazardous use" of alcohol symptom. ED-treated adolescents also had a higher rate of lifetime comorbid alcohol use disorders and drug use disorders, as well as a higher rate of lifetime comorbid alcohol use disorders and major depression, compared with the community controls., Conclusions: Adolescents who are treated in EDs should be routinely assessed for the presence of AUD, drug involvement and depressive disorders.

Aims: Few studies have examined the adequacy of adult-validated alcohol screening measures when used with adolescents and young adults. A total of 103 subjects (55 males, 48 females) participated in a study of alcohol use among under-aged drinkers conducted in two emergency departments., Methods: Participants completed three brief screening instruments for problematic alcohol use: the Alcohol Use Disorders Identification Test (AUDIT); a modified version of the TWEAK; and the CAGE., Results and Conclusions: Missing data on the TWEAK, lower internal consistency for the TWEAK and CAGE, and the better ability of the AUDIT to differentiate problem drinkers from non-problem drinkers, suggest that the AUDIT performs best in screening for problematic alcohol use among under-aged drinkers treated in emergency departments.

Objective: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item instrument designed by the World Health Organization to assess problematic drinking. The objective of this study was to conduct confirmatory factor analysis of the AUDIT in a sample of adolescents and young adults who were treated in emergency departments., Method: Adolescents and young adults (N= 103, 55 males), ranging in age from 12 to 20.9 years (mean [SD] age = 17.5 [2.1]), completed the AUDIT. Confirmatory factor analyses were conducted using LISREL 8.20 software to test the one-factor, two-factor and three-factor solutions for the AUDIT reported in the literature., Results: Goodness-of-fit indices indicated that a correlated two-factor solution, consisting of a consumption factor and an alcohol-related-problems factor, provides the best fit to the data. The three-factor solution fits the data equally well, but Factor 2 (dependency) and Factor 3 (problems) correlate 1.00. The one-factor solution did not provide a good fit to the data., Conclusions: Our findings support those of others who have reported that the AUDIT assesses a consumption factor and an alcohol-related problems factor among primary care patients at risk for problematic drinking behavior.

Four hundred eighty-two adolescents who were diagnosed with at least one mental disorder were studied to determine the predictors of suicidal ideation and suicide attempts. Major depression was predictive of suicidal ideation and suicide attempts for both genders. Chronic stress was found predictive of male suicidal ideation, while low self-esteem and high family dysfunction were found to be predictive of suicidal ideation in females. Statistical trends suggest that females with comorbid alcohol use/conduct disorder were approximately three times more likely to have attempted suicide than those with only one of these conditions. Clinicians working with adolescents should be aware that, while depression remains the number one clinical risk forsuicidal behavior, risk factors for suicidal ideation may be different than those for attempted suicide and may vary by gender.

This study examined the concurrent validity and clinical correlates of the Constructive Thinking Inventory (CTI), a measure of experiential coping, in 551 adolescents aged 14-18 years with and without Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) substance use disorders (SUDs). The CTI was correlated with depression, anxiety, and conduct problems. After controlling for demographics and comorbid lifetime psychiatric disorders, the CTI scales of Behavioral Coping and Categorical Thinking distinguished adolescents with and without SUDs. Implications of these findings for assessment and treatment are discussed.

Objective: Research conducted in the 1970s demonstrated that Problem Behavior Theory could account for approximately 40% of the variance in problem drinking in both local and national sample studies. The present analyses sought to determine whether the personality, perceived environment, and behavior variables of the framework continue to contribute to the explanation of problem drinking among contemporary American youth., Method: Correlational and multiple regression analyses were performed on six separate databases collected at different times between 1972 and 1992. Due to sociodemographic differences among the samples, separate analyses were performed for male and female adolescents, and age, ethnicity and socioeconomic status were statistically controlled., Results: There was considerable consistency across the samples in both the partial correlations and the partial multiple correlations, and this result held for both genders. Not only did the framework account for the same percentage of the variance (40%) in problem drinking in the 1992 data as it did in the 1972 data, but the results for the intervening years were consistent as well., Conclusions: The consistency of results over a 20-year period confirms that the social-psychological meaning of adolescent involvement in problem drinking has remained stable despite changes in the larger sociohistorical context.