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ObjectiveThe relationship between smoking and adolescents' peer relationships is complex, with studies showing increased risk of smoking for adolescents of both very high and very low social position. A key question is whether the impact of social position on smoking depends on an adolescent's level of coping motives (i.e., their desire to use smoking to mitigate negative affect).MethodWe assessed how social position predicts nicotine dependence in a longitudinal sample (N = 3,717; 44.8% male; mean age = 13.41 years) of adolescent lifetime smokers measured between 6th and 12th grades. Using both social network analysis and multilevel modeling, we assessed this question at the between-person and within-person level, hypothesizing that within-person decreases in social position would lead to increased risk of nicotine dependence among those with high levels of coping motives.ResultsIn contrast to our hypotheses, only interactions with the between-person measures of social position were found, with a slight negative relationship at low levels of coping motives. In addition, the main effect of coping motives was considerably stronger than that of social position at the between-person level, and social position had no significant within-person main effect on nicotine dependence risk.ConclusionsThese results suggest that adolescents with higher overall levels of social position among their peers may have slightly decreased risk for nicotine dependence, but only when coping motives are low. Counter to expectations, higher levels of nicotine dependence risk were not linked to fluctuations in social position.

Studies document inequitable tobacco retailer density by neighborhood sociodemographics, but these findings may not be robust to different density measures. Policies to reduce density may be less equitable depending on how the presence of store types differs by neighborhood characteristics. We built a 2018 list of probable tobacco retailers in the United States and calculated four measures of density for all census tracts (N = 71,495), including total count, and number of retailers per 1,000 people, square mile, and kilometers of roadway. We fit multivariable regression models testing associations between each density measure and tract-level sociodemographics. We fit logistic regression models testing associations between sociodemographics and the presence of a tobacco-selling pharmacy or tobacco shop. Across all measures, tracts with a greater percentage of residents living below 150% of the federal poverty level (FPL) had higher density. A higher percentage of Black residents, Hispanic or Latino residents, and vacant housing was inconsistently associated with density across measures. Neighborhoods with a greater percentage of Black residents had a lower odds of having a pharmacy (adjusted odds ratio [aOR] = 0.96, 95% confidence interval [CI; 0.95, 0.97]) and tobacco shop (aOR = 0.87, CI [0.86, 0.89]), while those with a greater percentage of residents living below 150% FPL had greater odds of having a tobacco shop (aOR = 1.18, CI [1.16, 1.20]). Researchers and policymakers should consider how various measures of retailer density may capture different aspects of the environment. Furthermore, there may be an inequitable impact of retailer-specific policies on tobacco availability.

The current study examined whether social status and social integration, two related but distinct indicators of an adolescent's standing within a peer network, mediate the association between risky symptoms (depressive symptoms and deviant behavior) and substance use across adolescence. The sample of 6,776 adolescents participated in up to seven waves of data collection spanning 6th to 12th grades. Scores indexing social status and integration were derived from a social network analysis of six schools and subsequent psychometric modeling. Results of latent growth models showed that social integration and status mediated the relation between risky symptoms and substance use and that risky symptoms mediated the relation between social standing and substance use during the high school transition. Before this transition, pathways involving deviant behavior led to high social integration and status and in turn to substance use. After this transition, both deviant behavior and depressive symptoms led to low social integration and status and in turn greater substance use. These findings suggest that the high school transition is a risky time for substance use related to the interplay of increases in depressive symptoms and deviant behavior on the one hand and decreases in social status and integration on the other.

In the study of adolescent health, it is useful to derive indices of social dynamics from sociometric data, and to use these indices as predictors of health risk behaviors. In this manuscript, we introduce a flexible latent variable model as a novel way of obtaining estimates of social integration and social status from school-based sociometric data. Such scores provide the flexibility of a regression-based approach while accounting for measurement error in sociometric indicators. We demonstrate the utility of these factor scores in testing complex hypotheses through a combination of structural equation modeling and survival models, showing that deviance mediates the relationship between social status and smoking onset hazard at the transition to high school.

Background: Nurse navigation can improve quality of cancer care and reduce racial disparities in care outcomes. Addressing persistent structurally-rooted disparities requires research on strategies that support patients by prompting structural changes to systems of care. We applied a novel conceptualization of social support to an analysis of racial equity-focused navigation and patient-reported outcomes. Method: We applied an antiracism lens to create a theory-informed definition of system-facing social support: intervening in a care system on a patient's behalf. Participants were adults with early-stage breast or lung cancer, who racially identified as Black or White, and received specialized nurse navigation (n = 155). We coded navigators' clinical notes (n = 3,251) to identify instances of system-facing support. We then estimated models to examine system-facing support in relation to race, perceived racism in health care settings, and mental health. Results: Twelve percent of navigators' clinical notes documented system-facing support. Black participants received more system-facing support than White participants, on average (b = 0.78, 95% confidence interval [CI]: [0.25, 1.31]). The interaction of race*system-facing support was significant in a model predicting perceived racism in health care settings at the end of the study controlling for baseline scores (b = 0.05, 95% CI [0.01, 0.09]). Trends in simple slopes indicated that among Black participants, more system-facing support was associated with slightly more perceived racism; no association among White participants. Discussion: The term system-facing support highlights navigators' role in advocating for patients within the care system. More research is needed to validate the construct system-facing support and examine its utility in interventions to advance health care equity. [ABSTRACT FROM AUTHOR]

ObjectiveThe current study examined whether an adolescent's standing within a school-bounded social network moderated the association between depressive symptoms and substance use across adolescence as a function of developmental and demographic factors (gender, parental education, and race/ethnicity).MethodThe sample of 6,776 adolescents participated in up to seven waves of data collection spanning 6th to 12th grade.ResultsResults of latent growth models showed that lower integration into the social network exacerbates risk for depression-related substance use in youth, particularly around the high school transition, but social status acted as both a risk factor and a protective factor at different points in development for different youth. Findings also varied as a function of youth gender and parental education status.ConclusionsTogether these findings suggest that lower integration into the social network exacerbates risk for depression-related substance use in youth, particularly around the high school transition in general as well as just before the high school transition in those with lower parental education or just after the high school transition in males. Thus, the risky impact of social isolation appears more consistent across this period. Social status, however, showed a more varied pattern and further study is needed to understand the sometimes risky and sometimes protective effects of social status on depression-related substance use.

Author(s): Sarah Treves-Kagan [sup.1] , Amber Peterman [sup.2] , Nisha C Gottfredson [sup.1] , Andrés Villaveces [sup.3] , Kathryn E. Moracco [sup.1] , Suzanne Maman [sup.1] Author Affiliations: (1) grid.10698.36, [...], Intimate partner violence (IPV) effects over a third of Latin American women and results in significant health, economic and social consequences. While theory suggests that increasing the status of women, in their homes and neighborhoods, should prevent IPV, little empirical work has tested this in South America, in particular examining neighborhood-level indicators. We conduct multilevel analysis to identify predictors of recent emotional and physical and/or sexual IPV within a longitudinal sample of 1312 low-income women living in northern Ecuador, near the Colombian border. Status indicators, measured at the household and neighborhood-level, included women's asset ownership, intra-household decision making, labor force participation, and education, age, and salary relative to male partner. Females' increasing participation in household decision-making (between time 1 and time 2) was associated with decreased risk of physical and/or sexual (AOR: 0.41, 95% CI: 0.21, 0.78) and emotional IPV (AOR: 0.57, 95% CI: 0.30, 1.06), although the latter was marginally significant. Increases in neighborhood-level decision-making was protective against emotional IPV (AOR: 0.78, 95% CI: 0.61, 0.99). Women with lower education than their partners were significantly more likely to experience IPV than women with the same or more education as their partner. Indicators of economic status of women were not associated with IPV outcomes in the expected directions. Findings support policies and interventions seeking to raise the status of women as a mechanism to reduce IPV. Future research can explore economic empowerment and IPV, as well as the interaction between household and neighborhood-level factors.

Author(s): Sabeeh A. Baig [sup.1] , Seth M. Noar [sup.2] [sup.3] , Nisha C. Gottfredson [sup.1] , Allison J. Lazard [sup.2] [sup.3] , Kurt M. Ribisl [sup.1] [sup.3] , Noel [...], To select promising health messages, formative research has often relied on perceived message effectiveness (PME) scales assessing either of two related constructs, message perceptions (persuasive potential) and effects perceptions (potential for behavioral impact). We sought to examine their incremental criterion validity within a comparative framework. Participants were 703 U.S. adult smokers (ages [Formula omitted] 21) who received anti-smoking or comparable control (littering) messages on their cigarette packs for 3 weeks. Structural equation models examined both PME constructs as simultaneous correlates of outcomes from the UNC Tobacco Warnings Model. Message perceptions demonstrated incremental criterion validity with attention, an early behavioral antecedent ( [Formula omitted] = 0.82, p < .001). Effects perceptions demonstrated incremental criterion validity with later behavioral antecedents (range [Formula omitted] = 0.74-0.87, all p < .01) and quitting behaviors ( [Formula omitted] = 0.36-0.66, all p < .001). Formative research on anti-smoking messages may benefit from focusing on effects perceptions to characterize potential for behavior change.

Author(s): Anna E. Austin [sup.1] [sup.2] , Nisha C. Gottfredson [sup.3] , Adam J. Zolotor [sup.4] , Carolyn T. Halpern [sup.1] , Stephen W. Marshall [sup.2] [sup.5] , Jared W. [...], Objectives Our objective was to identify preconception and prenatal predictors of early experiences of co-occurring risk and protective factors to help target prevention efforts to the highest-need families prior to the birth of the child. Methods Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage project and the 2012-2014 Alaska Child Understanding Behaviors Survey. We used latent class analysis and Vermunt&apos;s three-step approach to examine predictors of latent classes of risk and protective factors among Alaska children. Results Among children of Alaska Native/American Indian mothers, financial (OR 2.02, 95% CI 1.04, 3.90) and partner stress (OR 2.06, 95% CI 1.02, 4.10) prior to childbirth, maternal education < 12 years (OR 2.29, 95% CI 1.05, 4.96), and maternal substance use (OR 2.52, 95% CI 1.30, 4.89) were associated with a higher likelihood of membership in a high risk/moderate protection class as compared to a low socioeconomic status/high protection class. Among children of non-Native mothers, partner stress prior to childbirth (OR 3.92, 95% CI 1.08, 14.19), maternal education < 12 years (OR 2.69, 95% CI 1.24, 5.81), maternal substance use (OR 2.69, 95% CI 1.24, 5.81), younger maternal age (OR 0.87, 95% CI 0.80, 0.95), and a greater number of children (OR 1.62, 95% CI 1.09, 2.41) were associated with a higher likelihood of membership in a moderate risk/high protection class as compared to a low risk/moderate protection class. Conclusions Results can inform eligibility criteria for prenatal home visiting programs and prenatal screening in Alaska to ensure prevention programming and referrals are directed to families most in need of additional support.

Researchers commonly collect repeated measures on individuals nested within groups such as students within schools, patients within treatment groups, or siblings within families. Often, it is most appropriate to conceptualize such groups as dynamic entities, potentially undergoing stochastic structural and/or functional changes over time. For instance, as a student progresses through school, more senior students matriculate while more junior students enroll, administrators and teachers may turn over, and curricular changes may be introduced. What it means to be a student within that school may thus differ from 1 year to the next. This article demonstrates how to use multilevel linear models to recover time-varying group effects when analyzing repeated measures data on individuals nested within groups that evolve over time. Two examples are provided. The 1st example examines school effects on the science achievement trajectories of students, allowing for changes in school effects over time. The 2nd example concerns dynamic family effects on individual trajectories of externalizing behavior and depression. (Contains 9 tables, 4 figures, and 8 footnotes.)

Structural equation models are commonly used to estimate relationships between latent variables. Almost universally, the fitted models specify that these relationships are linear in form. This assumption is rarely checked empirically, largely for lack of appropriate diagnostic techniques. This article presents and evaluates two procedures that can be used to visualize and detect nonlinear relationships between latent variables. The first procedure involves fitting a linear structural equation model and then inspecting plots of factor score estimates for evidence of nonlinearity. The second procedure is to use a mixture of linear structural equation models to approximate the underlying, potentially nonlinear function. Targeted simulations indicate that the first procedure is more efficient, but that the second procedure is less biased. The mixture modeling approach is recommended, particularly with medium to large samples. (Contains 5 figures, 4 tables, and 2 footnotes.)