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Objective: Despite adverse health consequences associated with early substance use initiation, less is known about the influence of genetic risk on initiation and environmental characteristics that may moderate these associations, particularly among African Americans. We examined whether genetic risk for alcohol and cannabis use disorder, and nicotine dependence, is associated with age of initiation of these substances, and whether community disadvantage and parental monitoring moderate these associations in a sample of African American youth., Method: Participants (n=1,017; 56% female) were initially recruited for an elementary school-based universal prevention intervention trial. At age ~20, participants reported on age of initiation of alcohol, tobacco, and cannabis use and provided a saliva or blood sample. At age ~12, caregiver reports on parental monitoring were obtained, along with census-tract data to measure community disadvantage. Hypotheses were tested using Cox Proportional Hazard Models., Results: Higher alcohol use disorder PRS was associated with later alcohol initiation (HR=0.78, 95% CI =0.65-0.94). Cannabis use disorder and nicotine dependence PRSs were not associated with initiation of these substances. We observed an interaction between the cannabis use disorder PRS and parental monitoring; among individuals with high cannabis use disorder PRS, high monitoring was associated with earlier cannabis initiation, whereas among individuals with low PRS, low monitoring was associated with earlier initiation., Conclusions: Findings largely indicate that PRS for substance use disorders are not associated with age of initiation among African American youth. Parental monitoring may influence the association between cannabis use disorder PRS and age of cannabis initiation, but replication of our findings is warranted.

Background: Inadequate sleep is associated with all-cause mortality in the general population. Substance use has adverse effects on sleep, and insomnia symptoms are common among people with HIV. Therefore, persons who inject drugs may face a heightened risk of adverse outcomes from inadequate sleep. We evaluated the association of inadequate sleep with mortality among persons who inject drugs in a long-standing community cohort., Methods: Participants were from the AIDS Linked to the IntraVenous Experience (ALIVE) study, a cohort of persons who inject drugs in Baltimore, Maryland, USA. From 2005-2020, perceived sleep adequacy and duration were assessed semiannually using survey. Mortality data were obtained through linkage to the National Death Index-Plus. Cause of death was independently characterized and validated by three physicians. Hazards of all-cause and cause-specific mortality were evaluated using Cox regression accounting for repeated measurements., Results: A total of 2633 participants were included, with a median age at entry of 45.8years; 32.5% were female, and 75% were Black. After adjustment for demographics, mental health, and comorbidities, inadequate sleep was associated with a 32% greater hazard of all-cause mortality (hazard ratio: 1.32, 95% confidence interval: 1.12-1.55) and a 67% greater hazard of HIV/infectious disease-related deaths (hazard ratio: 1.67, 95% confidence interval: 1.15-2.42). Short (<6 hours) and long (≥8 hours) duration of sleep were both associated with higher hazard of all-cause and chronic disease-related mortality (all p < .05)., Conclusions: Sleep plays a critical role in longevity in persons who inject drugs. Research is needed to determine whether interventions targeting sleep improve health and longevity in persons who inject drugs., Competing Interests: Declaration of conflicts of interest Adam Spira received payment for serving as a consultant for Merck, received honoraria from Springer Nature Switzerland AG for guest editing special issues of Current Sleep Medicine Reports, and is a paid consultant to Sequoia Neurovitality, BellSant, Inc, and Amissa, Inc. No other conflict of interest is reported., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: For patients with opioid use disorder (OUD), primary care can serve as a pathway to medication for OUD (MOUD). No community-based studies have examined whether people with OUD engaged in primary care are more likely to a) initiate or b) continue MOUD., Methods: Data were collected 2014-2020 from two subsamples of the AIDS Linked to the Intravenous Experience (ALIVE) cohort, a community-recruited cohort of people from Baltimore who have injected drugs: 1) people who reported past-six-month illicit opioid use and no MOUD (360 participants, 789 study visits), and 2) people who reported MOUD and no illicit opioid use in the past six months (561 participants, 2027 visits). Logistic regression was used to estimate associations of past six-month self-reported primary care engagement, respectively, with a) initiating MOUD, b) continuing MOUD, and c) cessation from illicit opioid use without initiating MOUD., Results: Among 360 persons not on MOUD treatment (28 % female, 26 % under 50, 59 % actively injecting drugs), primary care engagement was not associated with either cessation from illicit opioid use or initiating MOUD. Similarly, among persons on MOUD (40 % female, 22 % under 50, 6 % actively injecting drugs) primary care engagement was not associated with continued treatment., Conclusions: Our findings implicate missed opportunities to initiate and maintain buprenorphine treatment in primary care settings., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024. Published by Elsevier B.V.)

Our understanding of associations between family-level risk factors and children's stress physiology is largely derived from studies that apply "mean-based" rather than "person-level" approaches. In this study, we employed group-based trajectory modeling, a person-centered approach, to identify children with similar patterns of stress-related sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis activation, and explored associations between these patterns and maternal psychosocial risk. Participants were five-year-old children (N=147; 52 % female; 62 % Black/African American) and their mothers. Children's saliva was sampled four times during a series of emotional stressor tasks and later assayed for sAA and cortisol, indexing SNS and HPA activity, respectively. Mothers reported their depressive and anxiety symptoms, parenting stress, financial stress, and income. Results revealed two task-related patterns of change for sAA (Low-Stable vs. High-Increasing) and cortisol (Low-Stable vs. High-Decreasing) concentrations. Children from families with lower income were more likely to exhibit the High-Increasing SNS pattern, [OR=0.78, 95 % CI (0.64, 0.95)], and children of mothers reporting more anxiety symptoms [OR=1.06, 95 % CI (1.00, 1.12)] and more parenting stress [OR=1.04, 95 % CI (1.00, 1.07)] were more likely to show the High-Decreasing HPA pattern. Implications of this person-centered approach and findings for advancing our understanding of associations between family-level risk factors and children's stress physiology are discussed., Competing Interests: Declaration of Competing Interest DAG is founder and chief scientific and strategy advisor at Salimetrics LLC and Salivabio LLC, and these relationships are managed by the policies of the committees on conflict of interest at the Johns Hopkins University School of Medicine and the University of California, Irvine. The other authors report no conflicts of interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Early exposure to socioeconomic distress is hypothesized to reinforce decision making that prioritizes immediate, relative to delayed, rewards (i.e., delay discounting); yet these relations have not been examined longitudinal across the vulnerable adolescent period. This study is one of the first to utilize objective and subjective measures to evaluate the relative effects of environmental disadvantage and the potential protective effects of perceived environmental support on delay discounting. A diverse (48.4% White; 46.7% female) sample of participants (N = 246) reported on their home addresses at baseline when they were, on average, 11.96 years old (SD age  = 0.88); Youth then reported perceived environmental supports at baseline and delay discounting annually from ages 13 to 18. A socioeconomic distress index was derived from census tract rates of unemployment, income, educational attainment, and lone parenthood. Greater socioeconomic distress was associated with a greater propensity to discount delayed rewards at baseline. Findings also suggest greater perceived higher environmental support was associated with decreasing rates of delay discounting across adolescence for youth from highly socioeconomically distressed areas. These results highlight potential future avenues for preventative and intervention efforts to improve positive youth outcomes., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Adverse childhood experiences (ACEs) contribute to numerous negative health outcomes across the life course and across generations. Here, we extend prior work by examining the association of maternal ACEs, and their interaction with financial stress and discrimination, with methylation status within eight differentially methylated regions (DMRs) in imprinted domains in newborns. ACEs, financial stress during pregnancy, and experience of discrimination were self-reported among 232 pregnant women. DNA methylation was assessed at PEG10 / SGCE, NNAT, IGF2, H19, PLAGL1 , PEG3 , MEG3-IG , and DLK1/MEG3 regulatory sequences using pyrosequencing. Using multivariable linear regression models, we found evidence to suggest that financial stress was associated with hypermethylation of MEG3-IG in non-Hispanic White newborns; discrimination was associated with hypermethylation of IGF2 and NNAT in Hispanic newborns, and with hypomethylation of PEG3 in non-Hispanic Black newborns. We also found evidence that maternal ACEs interacted with discrimination to predict offspring PLAGL1 altered DMR methylation, in addition to interactions between maternal ACEs score and discrimination predicting H19 and SGCE/PEG10 altered methylation in non-Hispanic White newborns. However, these interactions were not statistically significant after multiple testing corrections. Findings from this study suggest that maternal ACEs, discrimination, and financial stress are associated with newborn aberrant methylation in imprinted gene regions.

Childhood adversity can have detrimental impacts on life course mental and physical health. Timing, nature, severity, and chronicity of adversity are thought to explain much of the variability in health and developmental outcomes among exposed individuals. The current study seeks to characterize heterogeneity in adverse experiences over time at the individual, family, and neighborhood domains in a cohort of predominantly Black children (85% Black and 15% White, 46.2% girls, 67.2% free/reduced lunch in first grade), and to examine associations with mental health from sixth grade to age 26. Participants were part of a randomized universal preventive interventions trial in first grade with prospective follow-up through early adulthood. Separate models characterized heterogeneity in adversity in elementary, middle, and high schools. Changes in adversity over time and relationships with mental health (anxiety, depression, suicidal behaviors) were investigated using a random-intercept latent transition analysis (RI-LTA). We identified three-class solutions in early childhood, middle school, and high school. Generally, both a higher and a lower poly-adversity class were observed at each time point, with varying nature of adversity characterized by the third class. RI-LTA indicated prevalent within-individual changes in adverse exposure over time and differential associations with mental health and suicidal behaviors. Results suggest that treating adverse exposures as a static construct may limit the ability to characterize salient variation over time. Identifying complexity in adverse experiences and their relation to health and well-being is key for developing and implementing effective prevention and early intervention efforts to mitigate negative effects through the life course. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Delay discounting quantifies an individual's preference for smaller, short-term rewards over larger, long-term rewards and represents a transdiagnostic factor associated with numerous adverse health outcomes. Rather than a fixed trait, delay discounting may vary over time and place, influenced by individual and contextual factors. Continuous, real-time measurement could inform adaptive interventions for various health conditions., Objective: The goals of this paper are 2-fold. First, we present and validate a novel, short, ecological momentary assessment (EMA)-based delay discounting scale we developed. Second, we assess this tool's ability to reproduce known associations between delay discounting and health behaviors (ie, substance use and craving) using a convenience-based sample., Methods: Participants (N=97) were adults (age range 18-71 years), recruited on social media. In phase 1, data were collected on participant sociodemographic characteristics, and delay discounting was evaluated via the traditional Monetary Choice Questionnaire (MCQ) and our novel method (ie, 7-item time-selection and 7-item monetary-selection scales). During phase 2 (approximately 6 months later), participants completed the MCQ, our novel delay discounting measures, and health outcomes questions. The correlations between our method and the traditional MCQ within and across phases were examined. For scale reduction, a random number of items were iteratively selected, and the correlation between the full and random scales was assessed. We then examined the association between our time- and monetary-selection scales assessed during phase 2 and the percentage of assessments that participants endorsed using or craving alcohol, tobacco, or cannabis., Results: In total, 6 of the 7 individual time-selection items were highly correlated with the full scale (r>0.89). Both time-selection (r=0.71; P<.001) and monetary-selection (r=0.66; P<.001) delay discounting rates had high test-retest reliability across phases 1 and 2. Phase 1 MCQ delay discounting function highly correlated with phase 1 (r=0.76; P<.001) and phase 2 (r=0.45; P<.001) time-selection delay discounting scales. One or more randomly chosen time-selection items were highly correlated with the full scale (r>0.94). Greater delay discounting measured via the time-selection measure (adjusted mean difference=5.89, 95% CI 1.99-9.79), but not the monetary-selection scale (adjusted mean difference=-0.62, 95% CI -3.57 to 2.32), was associated with more past-hour tobacco use endorsement in follow-up surveys., Conclusions: This study evaluated a novel EMA-based scale's ability to validly and reliably assess delay discounting. By measuring delay discounting with fewer items and in situ via EMA in natural environments, researchers may be better able to identify individuals at risk for poor health outcomes., (©Amanda Luken, Jill A Rabinowitz, Jonathan L Wells, David W Sosnowski, Justin C Strickland, Johannes Thrul, Gregory D Kirk, Brion S Maher. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.02.2024.)

We sought to explore whether genetic risk for, and self-reported, short sleep are associated with biological aging and whether age and sex moderate these associations. Participants were a subset of individuals from the Baltimore Longitudinal Study of Aging who had complete data on self-reported sleep ( n  = 567) or genotype ( n  = 367). Outcomes included: Intrinsic Horvath age, Hannum age, PhenoAge, GrimAge, and DNAm-based estimates of plasminogen activator inhibitor-1 (PAI-1) and granulocyte count. Results demonstrated that polygenic risk for short sleep was positively associated with granulocyte count; compared to those reporting <6 hr sleep, those reporting >7 hr demonstrated faster PhenoAge and GrimAge acceleration and higher estimated PAI-1. Polygenic risk for short sleep and self-reported sleep duration interacted with age and sex in their associations with some of the outcomes. Findings highlight that polygenic risk for short sleep and self-reported long sleep is associated with variation in the epigenetic landscape and subsequently aging.

Maternal exposure to childhood adversity is associated with detrimental health outcomes throughout the lifespan and may have implications for offspring. Evidence links maternal adverse childhood experiences (ACEs) to detrimental birth outcomes, yet the impact on the infant's epigenome is unclear. Moreover, maternal sleep habits during pregnancy may influence this association. Here, we explore whether restless sleep during pregnancy moderates the association between exposure to maternal childhood adversity and infant epigenetic age acceleration in 332 mother-infant dyads (56% female; 39% Black; 25% Hispanic). During the 2 nd trimester, mothers self-reported childhood adversity and past-week restless sleep; DNA methylation from umbilical vein endothelial cells was used to estimate five epigenetic clocks. Multivariable linear regression was used to test study hypotheses. Despite no evidence of main effects, there was evidence of an interaction between maternal ACEs and restless sleep in predicting infant epigenetic age acceleration using the EPIC Gestational Age clock. Only infants whose mothers reported exposure to both ACEs and restless sleep demonstrated accelerated epigenetic aging. Results provide preliminary evidence that maternal childhood adversity and sleep may influence the infant epigenome., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests.

Background: We aimed to identify distinct trajectories of tobacco, cannabis, and their co-use among African Americans, and to investigate whether these patterns were associated with polygenic risk scores (PRS) for tobacco and cannabis use., Method: Participants (N=428 participants; 50.9% male) were initially recruited for an elementary school-based prevention in a Mid-Atlantic city when they were in first grade. From ages 14-26, participants reported on their frequency of tobacco and cannabis use in the past year during annual assessments. DNA was collected from participants at age 21. PRS for smoking heaviness (i.e., cigarettes per day) and lifetime cannabis use were created based on genome-wide association study results derived from Liu et al. (2019) and Pasman et al. (2018), respectively., Results: We identified five distinct trajectories of tobacco and cannabis co-use, including (1) Low Tobacco and Cannabis Use, (2) Adolescent Limited Tobacco and Cannabis Use, (3) Experimental Cannabis, Young Adult Increasing Tobacco, (4) Experimental Tobacco, Young Adult Increasing Cannabis, and (5) High, Chronic Tobacco and Cannabis Use. Compared to the Low Tobacco and Cannabis Use subgroup, individuals in the High, Chronic Tobacco and Cannabis Use subgroup had greater PRS for smoking heaviness, and individuals in the Experimental Cannabis, Young Adult Increasing Tobacco subgroup had higher PRS for lifetime cannabis use., Conclusions: Polygenic risk for lifetime cannabis use and smoking heaviness is associated with the developmental progression of tobacco and cannabis co-use among African Americans, furthering knowledge on the etiology of co-use in this population., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Dimensional models of adversity, whereby experiences lie along dimensions of threat and deprivation, are increasingly popular; however, their empirical validation is limited. In a sample of emerging adults (N=1,662; M age =20.72; 53% female; 72% Black), we conducted exploratory factor analyses using adversities derived from items probing family relationships and a validated assessment of traumatic events. Resulting factors were used to test associations with odds of lifetime diagnosis of a substance use disorder, other mental health disorders, and suicide attempt. Results supported a four-factor solution: threat (non-betrayal) , emotional deprivation, sexual assault, and threat (betrayal) . Threat (betrayal) summary scores were most strongly associated with increased odds of substance use and other disorders, whereas sexual assault was most strongly associated increased odds of lifetime suicide attempt. Findings provide some empirical support for categorizing adversity along dimensions of threat and deprivation. However, it also suggests the possibility of further divisions within these dimensions., Competing Interests: The authors have no conflicts of interest to declare.

Background: To examine whether financial stress during pregnancy mediates the association between maternal exposure to adverse childhood experiences (ACEs) and three birth outcomes (i.e., gestational age, birth weight, and admission to the neonatal intensive care unit [NICU])., Methods: Data were obtained from a prospective cohort study of pregnant women and their infants in Florida and North Carolina. Mothers (n = 531; M age at delivery = 29.8 years; 38% Black; 22% Hispanic) self-reported their exposure to childhood adversity and financial stress during pregnancy. Data on infant gestational age at birth, birth weight, and admission to the NICU were obtained from medical records within 7 days of delivery. Mediation analysis was used to test study hypotheses, adjusting for study cohort, maternal race, ethnicity, body mass index, and tobacco use during pregnancy., Results: There was evidence of an indirect association between maternal exposure to childhood adversity and infant gestational age at birth (b = -0.03, 95% CI = -0.06 - -0.01) and infant birth weight (b = -8.85, 95% CI = -18.60 - -1.28) such that higher maternal ACE score was associated with earlier gestational age and lower infant birth weight through increases in financial distress during pregnancy. There was no evidence of an indirect association between maternal exposure to childhood adversity and infant NICU admission (b = 0.01, 95% CI = -0.02-0.08)., Conclusions: Findings demonstrate one pathway linking maternal childhood adversity to a potentially preterm birth or shorter gestational age, in addition to low birth weight at delivery, and present an opportunity for targeted intervention to support expecting mothers who face financial stress., (© 2023. The Author(s).)

Background: There are limited data on whether modifiable social factors foster psychological resilience and mental well-being among people who use drugs following Big Events. We examined the temporal association of pre-pandemic perceived social support with psychological resilience and negative mental health symptoms during the COVID-19 pandemic among people with a history of injection drug use., Methods: Between June and September 2020, we conducted a telephone survey among 545 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-based cohort of adults with a history of injection drug use. Leveraging data from study visits in 2018-early 2020, associations of pre-pandemic perceived social support with psychological resilience scores (range=1-5) and the probability of negative mental health symptoms during the pandemic were assessed using multivariable linear and modified Poisson regression models, respectively., Results: Participants' median age was 58 years, 38.2% were female, 83.3% identified as Black, and 30.3% were living with HIV. During the pandemic, 14.5% had low (<3) resilience scores, 36.1% experienced anxiety, and 35.8% reported increased loneliness. Compared to participants in the lowest tertile of pre-pandemic social support, participants in the highest tertile had higher mean resilience scores (β = 0.27 [95% CI = 0.12, 0.43]), a lower probability of anxiety (prevalence ratio [PR] = 0.71 [95% CI = 0.52, 0.96]), and a lower probability of increased loneliness (PR = 0.62 [95% CI = 0.45, 0.84])., Conclusions: Pre-pandemic perceived social support was associated with greater psychological resilience and generally better mental well-being during the pandemic. Interventions that improve social support may foster psychological resilience and protect the mental well-being of people who use drugs, especially during periods of social disruption., Competing Interests: Conflict of interest statement None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Adverse childhood experiences (ACEs) have been associated with worse sleep, but existing literature is limited by use of predominantly White samples, lack of objective sleep measurement, and use of non-standardized questionnaires. We investigated associations between retrospectively reported ACEs and sleep in adulthood in a sample of 43 adults 20-53 years of age, free from chronic conditions, with a Body mass index (BMI) ≥ 25 (Mean age = 33.14 [SD = 10.05], 74% female, 54% Black). Sleep efficiency (SE), total sleep time (TST), wake after sleep onset (WASO), and sleep onset latency (SOL), were measured by actigraphy and daily diary. Global sleep quality and insomnia severity were measured by questionnaires. Sleepiness, fatigue, and sleep quality were also measured by daily diary. Adjusting for demographic characteristics and BMI, ACEs were significantly associated with poorer global sleep quality and diary measures of greater daytime sleepiness, fatigue, and poorer sleep quality. There were no significant associations between ACEs and SE, TST, WASO, or SOL measured by diary or actigraphy. Findings suggest that ACEs are associated with worse sleep perception and daytime functioning in adulthood. Larger prospective studies are needed to replicate these findings, examine racial/ethnic differences, and determine temporal associations between ACEs, sleep, and health (e.g., BMI)., (© 2022 John Wiley & Sons Ltd.)

Objective: To determine associations between adverse childhood experiences (ACEs) at age 5 years and healthcare utilization patterns at age 9 years., Study Design: We conducted a secondary analysis using longitudinal data from the Fragile Families and Child Wellbeing Study. Caregivers (n = 2521) provided data on their child's ACEs at age 5 years and on 4 types of healthcare utilization at age 9 years: past-year well visits, dental visits, primary care sick visits for injury or illness, and emergency room (ER) visits. Logistic regression analysis was used to examine the association between ACEs at age 5 and each type of healthcare utilization, adjusting for relevant sociodemographic covariates., Results: Among the 2521 children (51% male, 48% Non-Hispanic Black), 77% had ≥1 ACE at age 5. Children with ≥4 ACEs had lower odds of a dental visit (aOR, 0.51; 95% CI, 0.29-0.91) and higher odds of a primary care sick visit (aOR, 1.77; 95% CI, 1.20-2.64) and an ER visit (aOR, 1.70; 95% CI, 1.11-2.59) compared with children with no reported ACEs., Conclusion: Our findings demonstrate suboptimal healthcare utilization patterns among families with ACEs and indicate a need for targeted interventions that support appropriate healthcare utilization for children who endure adversity., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Injection drug use (IDU) is prevalent in the US and is associated with substantial risk of blood-borne infections, morbidity, and mortality. However, the spectrum of its biologic effects on DNA methylation in blood is not well characterized., Methods: 401 participants (M age = 47.9; 68% male; 90% African American) over several timepoints (1054 visits) were drawn from a longitudinal cohort of people who inject drugs. DNA methylation was measured among buffy coat samples from the 1054 visits. Compared to samples collected after ≥ 6 months of abstinence, separate EWAS were conducted for active injecting of any drug, quantitative injection frequency, injecting of heroin and injecting of cocaine. Linear mixed effect models were used and analyses were adjusted for repeated measurements and key technical, biological, and sociodemographic characteristics., Results: We found epigenome-wide significant CpG sites associated with active injection (cg10636246, AIM2, p = 2.33 × 10 -8 ) and injection intensity (cg13117953, p = 4.30 × 10 -8 ). We found converging evidence that cg10636246 (AIM2), cg23110600 (PRKCH), cg03546163 (FKBP5), cg04590956 (GMCL1), and cg16317961 (MAPRE2) were among the top 0.1% significantly differentially methylated CpG sites shared across the five EWAS. Top ranked CpGs among the five EWAS were enriched (p < 0.0001) in AIM2 inflammasome complex, T cell migration, insulin regulation and epinephrine synthesis pathways. During periods of active injection, samples had 0.46 years of epigenetic age acceleration relative to the abstinence period, within the same subject (p = 0.03)., Conclusions: Findings from this study demonstrate modest, common, and specific effects on DNA methylation during a relatively short time between periods of active drug injection and abstinence., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Childhood adversity is associated with the onset of harmful adult substance use and related health problems, but most research on adversity has been conducted in general population samples. This study describes the prevalence of adverse childhood experiences in a cohort of people who have injected drugs and examines the association of these adverse experiences with medical comorbidities in adulthood., Methods: Six hundred fifty three adults were recruited from a 30-year cohort study on the health of people who have injected drugs living in and around Baltimore, Maryland (Median age = 47.5, Interquartile Range = 42.3-52.3 years; 67.3% male, 81.1% Black). Adverse childhood experiences were assessed retrospectively in 2018 via self-report interview. Lifetime medical comorbidities were ascertained via self-report of a provider diagnosis. Multinomial logistic regression with generalized estimating equations was used to examine the association between adversity and comorbid conditions, controlling for potential confounders., Results: Two hundred twelve participants (32.9%) reported 0-1 adverse childhood experiences, 215 (33.3%) reported 2-4, 145 (22.5%) reported 5-9, and 72 (11.1%) reported ≥10. Neighborhood violence was the most commonly reported adversity (48.5%). Individuals with ≥10 adverse childhood experiences had higher odds for reporting ≥3 comorbidities (Adjusted Odds Ratio = 2.9, 95% CI = 1.2 - 6.8, p = .01)., Conclusions: Among people who have injected drugs, adverse childhood experiences were common and associated with increased occurrence of self-reported medical comorbidities. Findings highlight the persistent importance of adversity for physical health even in a population where all members have used drugs and there is a high burden of comorbidity., (© 2022. The Author(s).)

This study examined the feasibility, acceptability, and efficacy of a video game-based digital therapeutic combining applied behavior analysis techniques and gaze-contingent eye tracking to target emotion recognition in youth with autism spectrum disorder (ASD). Children aged 4-14 years with ASD were randomized to complete Lookware™ (n = 25) or a control video game (n = 29). Results from a 2 × 2 mixed ANOVA revealed that children in the intervention condition demonstrated significant improvements in emotion recognition from pre- to post-intervention compared to children in the control condition, F(1,52) = 17.48, p < 0.001. Children and staff perceived high feasibility and acceptability of Lookware™. Study results demonstrated the feasibility, acceptability, and preliminary efficacy of Lookware™., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Although preclinical models reveal the neurobiological pathways altered through opioid abuse, comprehensive assessments of gene expression in human brain samples are needed. Moreover, less is known about gene expression in response to fatal overdose. The primary goal of the present study was to compare gene expression in the dorsolateral prefrontal cortex (DLPFC) between brain samples of individuals who died of acute opioid intoxication and group-matched controls., Methods: Postmortem tissue samples of the DLPFC from 153 deceased individuals ( M age  = 35.4; 62% male; 77% European ancestry). Study groups included 72 brain samples from individuals who died of acute opioid intoxication, 53 psychiatric controls, and 28 normal controls. Whole transcriptome RNA-sequencing was used to generate exon counts, and differential expression was tested using limma-voom . Analyses were adjusted for relevant sociodemographic characteristics, technical covariates, and cryptic relatedness using quality surrogate variables. Weighted correlation network analysis and gene set enrichment analyses also were conducted., Results: Two genes were differentially expressed in opioid samples compared to control samples. The top gene, NPAS4 , was downregulated in opioid samples (log 2 FC = -2.47, adj. p  = .049) and has been implicated in opioid, cocaine, and methamphetamine use. Weighted correlation network analysis revealed 15 gene modules associated with opioid overdose, though no intramodular hub genes were related to opioid overdose, nor were pathways related to opioid overdose enriched for differential expression., Conclusions: Results provide preliminary evidence that NPAS4 is implicated in opioid overdose, and more research is needed to understand its role in opioid abuse and associated outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s). Published by Elsevier B.V.)

Study Objective: Adverse childhood experiences (ACEs) are associated with sleep problems in adulthood, but less research has focused on ACEs and sleep during adolescence. The goal of the present study was to explore associations between ACEs reported at ages 5 and 9 years, and sleep (ie, total sleep time (TST), social jetlag, and insomnia symptoms) at age 15., Methods: Participants comprised 817 families from the Fragile Families and Child Wellbeing Study, a nationally representative sample of children born to unwed parents. Number of ACEs was constructed from primary-caregiver reports at ages 5 and 9, and sleep measures (ie, TST, social jetlag, and insomnia symptoms) were derived from adolescent-reported sleep behaviors at age 15., Results: Adjusting for sex and race/ethnicity, ACEs at age 9 were associated with longer weekend TST (B = 0.16, 95% CI = 0.04, 0.28), more social jetlag (B = 0.17, 95% CI = 0.07, 0.27), and higher odds of trouble falling asleep ≥3 times per week (Odds Ratio = 1.24, 95% CI = 1.01, 1.53). In females only, ACEs were associated with greater school night TST (B = 0.12, 95% CI = 0.01, 0.23). Results were similar after further adjustment for symptoms of anxiety and depression. Associations among ACEs, social jetlag, and insomnia symptoms appeared strongest among Non-Hispanic Black adolescents., Conclusion: ACEs appear to be related to multiple aspects of sleep in adolescence. Additional research is needed to confirm these associations and examine the extent to which sleep disturbances associated with ACEs account for later health outcomes., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Adverse childhood experiences (ACEs) are associated with short- and long-term psychological health, but most research, to date, relies on retrospective self-reports during adulthood to test this association. Moreover, there is limited evidence on how ACEs group together and differentially influence mental health, as well as factors that promote positive outcomes in the context of ACEs. The present study used secondary data of children and their biological parents from the Fragile Families and Child Wellbeing Study ( N = 3,487; M age = 9.30, SD = .40 years; 52% male) to test if meaningful subgroups of ACE exposure existed at age 9, and if positive adolescent functioning moderated the association between ACE exposure class membership at age 9 and adolescent depressive symptoms at age 15. Results revealed three distinct classes: an impoverished and interpersonally abused class, a single-parent and impoverished class, and a low adversity class. Positive adolescent functioning moderated the association between class membership and depressive symptoms. Specifically, individuals in the impoverished and interpersonally abused and low adversity classes had the highest levels of depressive symptoms at low levels of positive functioning, and the lowest levels of depressive symptoms at high levels of positive functioning. Results support prior evidence that children experiencing interpersonal abuse group together into a latent class and provide a nuanced perspective on factors that promote positive functioning in the context of various constellations of ACEs., Competing Interests: Conflicts of interest None of the authors report any conflicts of interest.

Background: Opioid abuse poses significant risk to individuals in the United States and epigenetic changes are a leading potential biomarker of opioid abuse. Current evidence, however, is mostly limited to candidate gene analysis in whole blood. To clarify the association between opioid abuse and DNA methylation, we conducted an epigenome-wide analysis of DNA methylation in brain samples of individuals who died from acute opioid intoxication and group-matched controls., Methods: Tissue samples were extracted from the dorsolateral prefrontal cortex of 153 deceased individuals (M age = 35.42; 62 % male; 77 % European ancestry). The study included 72 opioid samples, 53 psychiatric controls, and 28 normal controls. The epigenome-wide analysis was implemented using the Illumina MethylationEPIC BeadChip; analyses adjusted for sociodemographic characteristics, negative control principal components, ancestry principal components, cellular composition, and surrogate variables. Horvath's epigenetic age and Levine's PhenoAge were calculated, and gene set enrichment analyses were performed., Results: Although no CpG sites survived false-discovery rate correction for multiple testing, 13 sites surpassed a relaxed significance threshold (p < 1.0 × 10 -5 ). One of these sites was located within Netrin-1, a gene implicated in kappa opioid receptor activity. There was an association between opioid use and accelerated PhenoAge (b = 2.24, se = 1.11, p = .045). Gene set enrichment analyses revealed enrichment of differential methylation in GO and KEGG pathways broadly related to substance use., Conclusions: Netrin-1 may be associated with opioid overdose, and future research with larger samples across stages of opioid use will elucidate the complex genomics of opioid abuse., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Childhood adversity is linked to shortened telomere length (TL), but behavioral indicators of telomere attrition remain unclear. This study examined the association between adverse childhood experiences (ACEs) and child TL, and if ACEs were indirectly associated with TL through children's self-regulatory abilities (i.e., effortful control and self-control). Hypotheses were tested using national data from teachers, parents, and their children (N = 2,527; M age  = 9.35, SD = .36 years). More ACEs were uniquely associated with short TL, and low self-control mediated the association between more ACEs and short TL. While longitudinal studies are needed to strengthen claims of causation, this study identifies a pathway from ACEs to TL that should be explored further., (© 2020 Society for Research in Child Development.)

Introduction: Compared with the general smoking population, low-income smokers face elevated challenges to success in evidence-based smoking cessation treatment. Moreover, their children bear increased disease burden. Understanding behavioral mechanisms related to successful reduction of child tobacco smoke exposure (TSE) could inform future smoking interventions in vulnerable, underserved populations., Methods: Smoking parents were recruited from pediatric clinics in low-income communities and randomized into a multilevel intervention including a pediatric clinic intervention framed in best clinical practice guidelines ("Ask, Advise, Refer" [AAR]) plus individualized telephone counseling (AAR + counseling), or AAR + control. Mediation analysis included treatment condition (independent variable), 12-month child cotinine (TSE biomarker, criterion), and four mediators: 3-month end-of-treatment self-efficacy to protect children from TSE and smoking urge coping skills, and 12-month perceived program (intra-treatment) support and bioverified smoking abstinence. Analyses controlled for baseline nicotine dependence, depressive symptoms, child age, and presence of other residential smokers., Results: Participants (n = 327) included 83% women and 83% African Americans. Multilevel AAR + counseling was associated with significantly higher levels of all four mediators (ps < .05). Baseline nicotine dependence (p < .05), 3-month self-efficacy (p < .05) and 12-month bioverified smoking abstinence (p < .001) related significantly to 12-month child cotinine outcome. The indirect effects of AAR + counseling intervention on cotinine via self-efficacy for child TSE protection and smoking abstinence (ps < .05) suggested mediation through these pathways., Conclusions: Compared with AAR + control, multilevel AAR + counseling improved all putative mediators. Findings suggest that fostering TSE protection self-efficacy during intervention and encouraging parental smoking abstinence may be key to promoting long-term child TSE-reduction in populations of smokers with elevated challenges to quitting smoking., Implications: Pediatric harm reduction interventions to protect children of smokers from tobacco smoke have emerged to address tobacco-related health disparities in underserved populations. Low-income smokers experience greater tobacco-related disease burden and more difficulty with smoking behavior change in standard evidence-based interventions than the general population of smokers. Therefore, improving knowledge about putative behavioral mechanisms of smoking behavior change that results in lower child exposure risk could inform future intervention improvements., (Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2019.)

The Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) is a widely used measure of sociocultural factors affecting body image. Despite evidence sociocultural appearance ideals and pressures might differ between White and Black women, the SATAQ-4's invariance has not been formally evaluated. The current study examined its measurement invariance across White and Black college women. Women (N = 730; 68.5 % White, 31.5 % Black), recruited from a large, public university in the United States completed measures online. Confirmatory factor analysis (CFA) showed the original five-factor structure was adequate in each group, and it appeared equivalent across groups. However, full metric invariance was not supported. Factor loadings on one item differed, suggesting differences in how this item contributed to thin-ideal internalization between groups. Similarly, one threshold differed, suggesting Black women who mostly agreed they wanted a "very thin" body had more thin-ideal internalization than White women with the same rating. These results suggest comparisons between these groups on the thin-ideal internalization subscale should be interpreted cautiously, as group differences could reflect some measurement bias. Given appearance pressures and ideals extend beyond thinness, particularly for Black women, future research should consider refining or developing culturally sensitive measures, to enhance relevance between and within racial/ethnic groups., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

National trends show that African American adolescents, relative to most other demographic groups, are more religious, and show fewer declines in religiosity, despite drastic decreases in religiosity among youth over the past 25 years. These broad findings are limiting because they fail to acknowledge religious heterogeneity among African American teens. Further, there are few empirical investigations of the transmission of religiosity within African American families. Building on a recent study that identified three distinctive profiles of intrinsic religiosity in a sample of low-income African American adolescents who were followed over four years (N = 326; Youth M age  = 12.1, SD = 1.6 years; 54% female), the present study examined contributions of maternal religiosity and family emotional climate in distinguishing these profiles. Univariate analyses revealed that maternal religious attendance and commitment, adolescents' felt acceptance from mothers and the emotional climate in the home differentiated youth who retained high levels of intrinsic religiosity (41%) from youth who declined in religiosity (37%) or who had low levels of religiosity (22%). Multivariate analyses showed that after accounting for demographic covariates, felt acceptance from mothers differentiated adolescents with high versus low levels of religiosity; both maternal religious attendance and felt acceptance from mothers distinguished adolescents who retained high levels of religiosity from youth who declined in religiosity. Implications for family dynamics in African American adolescent religious development and well-being are discussed.

Background: This study investigated the effects of a multi-level smoking intervention on mediators of long-term abstinence in parental smokers, including smoking cessation self-efficacy, smoking urge coping, and perceived support to quit smoking., Methods: This is a secondary analysis of data from a randomized trial that recruited parental smokers from pediatric clinics in low-income communities (N = 327, 83% women, 83% African American, 79% below poverty level). Following clinical practice guidelines for tobacco intervention ("Ask, Advise, Refer" [AAR]), pediatricians asked all parents about child tobacco smoke exposure (TSE), advised about TSE harms and benefits of reducing TSE, and referred smokers to cessation resources. Eligible parents were then randomized to additional telephone-based smoking behavior counseling (AAR + counseling) or nutrition education (AAR + control). Bioverified 7-day point prevalence smoking abstinence and perceived counselor support were assessed at 12-month follow-up; cessation self-efficacy and urge coping were assessed at 3-month follow-up., Results: Relative to AAR + control, AAR + counseling was associated with higher self-efficacy, urge coping, and perceived support to quit (all p's<.001). Self-efficacy, but no other mediators, had a significant positive effect on 12-month bioverified smoking abstinence (p < .001). The indirect effect of intervention on 12-month abstinence via self-efficacy suggested mediation via this pathway (p = .002)., Conclusion: Results suggest that all putative treatment pathways were improved more by the multi-level AAR + counseling than the clinic-level AAR + control intervention. Further, self-efficacy at end-of-treatment prospectively predicted long-term cessation, suggesting that building of self-efficacy through treatment may be key to sustained cessation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Robust associations between adverse childhood experiences and shortened telomere length exist, but few studies have examined factors that may moderate this association, particularly with a resilience framework. The present study examined the association between exposure to childhood sexual abuse (and abuse severity) and mean telomere length, and whether social support and optimism moderated this association. The sample included 99 White monozygotic female twins, ranging in age from 35 to 70 (M age  = 52.74, SD = 8.55 years), who provided a blood sample for telomere assay, and data on their childhood sexual abuse history, trait optimism, and current social support. Linear mixed effects models were employed to test study hypotheses. There were no effects of exposure to abuse or abuse severity on mean telomere length, nor were there main or moderating effects of optimism, in analyses of the full sample. However, in analyses that only included women exposed to abuse, there was an abuse type × support interaction: among women who experienced abuse in forms other than intercourse, higher levels of social support were associated with longer mean telomere length. Findings from the current study clarify the role of childhood sexual abuse in telomere attrition, and identify one factor that may protect against the negative biological effects of childhood sexual abuse.

Recent evidence suggests parent-adolescent discrepancies regarding adolescent disclosure can provide insight into parent-child relations and adolescent adjustment. However, pathways linking discrepancies to adjustment are not well known. We tested a model linking parent-adolescent discrepancies in disclosure to adolescent substance use through affiliation with deviant peers. Using three annual waves of data from a community-based study (N = 357; 91% African American; 53% female; M age  = 13.13 years, SD = 1.62 years at baseline), findings revealed that adolescent-reported secrecy and deviant peer affiliation were positively associated with substance use one and two years later, respectively, but there was no evidence of mediation. The results highlight associations of adolescent secrecy and adjustment, and the role peers play in adolescent substance use behaviors.

Maternal prenatal stress has been linked to a variety of infant postnatal outcomes, partially through alterations in fetal HPA axis functioning; yet the underlying pathobiology remains elusive. Current literature posits DNA methylation as a candidate mechanism through which maternal prenatal stress can influence fetal HPA axis functioning. The goal of this systematic review was to summarize the literature examining the associations among maternal prenatal stress, DNA methylation of commonly studied HPA axis candidate genes, and infant HPA axis functioning. Results from the review provided evidence for a link between various maternal prenatal stressors, NR3C1 methylation, and infant stress reactivity, but findings among other genes were limited, with mixed results. An original study quality review tool revealed that a majority of studies in the review are adequate, and emphasizes the need for future research to consider study quality when interpreting research findings., (© 2018 Wiley Periodicals, Inc.)

Victimization is linked to externalizing outcomes in adolescents and recent theorizing suggests that sleep plays a role in this relationship; however, there is little evidence examining sleep as a mediator. This study examines associations between victimization experiences and changes in aggression, delinquency, and drug use. Data were obtained from three waves of a school-based study with middle-school youth (n = 785; 55 % female; 20 % African American; M = 12.32, SD = .51 years at T1), and path analyses were used to test the key hypotheses. Analyses controlling for major life events, demographic factors, and school site revealed that victimization indirectly affected delinquency and drug use, but not aggression, through its relationship with sleep problems. Further, the effects of sleep problems on drug use were specific to females. These data suggest that intervening to address sleep problems resulting from victimization may serve to reduce some forms of externalizing behavior.