Publications by authors named "Bethany C Bray"

54 Publications

Anhedonia and Substance Use Disorders by Type, Severity, and With Mental Health Disorders.

J Addict Med 2021 Jul 16. Epub 2021 Jul 16.

Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA (SWS, STL); Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD (SWS, JWB, DHE); The University of Illinois at Chicago, Center for Dissemination and Implementation Science, Chicago, IL (BCB); The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA (STL).

Objectives: Anhedonia can accompany substance use disorders (SUDs); its severity may vary by substance type, severity of SUD symptoms, or psychiatric comorbidity. The goal of this study was to clarify the contribution of each.

Methods: Data were from participants aged 18 to 65 years in the National Epidemiologic Survey on Alcohol and Related Conditions III (n = 30,999; 51% women), a cross-sectional, nationally representative sample reporting lifetime DSM-5 symptoms and lifetime anhedonia. We used logistic regression to test how anhedonia was associated with specific SUDs and psychiatric disorders in respondents with one lifetime diagnosis. We used latent class analysis to assess the association of anhedonia with patterns of comorbidity in all respondents.

Results: Opioid use disorder (OUD) had the greatest odds of anhedonia relative to other SUDs (ORs [95% CIs]): mild alcohol use disorder (AUD) (3.33 [1.74, 6.38]), moderate/severe AUD (2.73 [1.41, 5.30]), and cannabis use disorder (3.21 [1.43, 7.19]), though not significantly greater than stimulant use disorder (2.44 [.88, 6.73]). Anhedonia was more likely in mood disorders and post-traumatic stress disorder (PTSD) than in any SUD, except for PTSD versus OUD (OR [95% CIs] = .98 [.47, 2.02]). In latent class analysis analyses, the poly disorder class, which included SUDs and other diagnoses, had greater odds of anhedonia than the Poly SUD (ORs [95% CIs] = 1.62 [1.25, 2.09] and AUD 2.89 [2.40, 3.48]) classes.

Conclusions: People with OUD or a lifetime history of mood disorder or PTSD may be most likely to present to SUD treatment with anhedonia.
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http://dx.doi.org/10.1097/ADM.0000000000000891DOI Listing
July 2021

Linking racism and homonegativity to healthcare system distrust among young men of color who have sex with men: Evidence from the Healthy Young Men's (HYM) study.

Soc Sci Med 2021 Jul 10;284:114219. Epub 2021 Jul 10.

Center for Dissemination and Implementation Science, University of Illinois at Chicago, 818 South Wolcott Ave., Chicago, IL, 60612, USA.

Background: Experiences with racism predict healthcare system distrust among people of color, but Black and Latino young men who have sex with men (YMSM) also experience overlapping forms of stigma associated with their sexual identities and behaviors (i.e., homonegativity and internalized homonegativity). These forms of minority stress may drive healthcare system distrust among Black and Latino YMSM but have received far less attention.

Objectives: To examine the associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust among a community sample of Black and Latino YMSM.

Methods: Data came from waves 2-4 (years 2017-2018) of the Healthy Young Men's study, a longitudinal cohort study of Black and Latino YMSM living in Los Angeles County. Data across waves (n = 424, n = 1272) were combined and analyzed using a fixed effects approach and adjusting for repeated measures across participants. A series of regression models that added sets of covariates (demographics, syndemic indicators, and health-related factors) were tested to examine associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust.

Results: Adjusting for demographics and syndemic indicators, racism, but not homonegativity or internalized homonegativity, was associated with healthcare system distrust. Adjustment for health-related factors had little impact on results.

Conclusions: Among Black and Latino YMSM, greater exposure to racism is associated with greater healthcare system distrust. Efforts to strengthen healthcare system trust should explicitly target the institutional policies that disproportionately harm people of color.
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http://dx.doi.org/10.1016/j.socscimed.2021.114219DOI Listing
July 2021

Predictors of Attendance Patterns in a Universal Family-Based Preventive Intervention Program.

J Prim Prev 2021 May 20. Epub 2021 May 20.

Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL, USA.

Achieving sustained engagement in family-based preventive intervention programs is a serious challenge faced by program implementers. Despite the evidence supporting the effectiveness and potential population-level impacts for these programs, their actual impact is limited by challenges around retention of participants. In order to inform efforts to better retain families, it is critical to understand the different patterns of attendance that emerge across the duration of program implementation and the factors that are associated with each attendance pattern. In this study, we identified latent classes of attendance patterns across the seven program sessions of the Strengthening Families Program: For Parents and Youth Ages 10-14 (SFP 10-14). Youth and their parents who attended at least one SFP 10-14 program session together were included in the analysis. Four distinct classes emerged: First-Session Attenders (7%), Early Attenders (9%), Declining-High Attenders (18%), and Consistent-High Attenders (66%). An examination of individual, family, and sociodemographic predictors of class membership revealed that adolescent school bonding predicted families having relatively high attendance, adolescent involvement with deviant peers predicted early dropout, and family low-income status predicted early dropout. Findings point to the need for potential targeted strategies for retaining these groups, such as involving school personnel, employing brief interventions to identify and address barriers at the outset, and leveraging the positive influence of Consistent-High Attenders. Findings also shed light on ways to reach those who may continue to drop out early, such as restructuring program content to address critical material early in the program. This study adds to the growing body of literature that seeks to understand for whom, when, and in which ways program dropout occurs.
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http://dx.doi.org/10.1007/s10935-021-00636-1DOI Listing
May 2021

Substance use and mental health outcomes during emerging adulthood among individuals with different patterns of child maltreatment.

Emerg Adulthood 2020 Dec 17;8(6):542-547. Epub 2020 Feb 17.

The Methodology Center, The Pennsylvania State University.

The aim of the current study was to identify patterns of child maltreatment experienced prior to age 18 and examine the relationship between those patterns and substance use and mental health disorders among emerging adults. Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III. The analytic sample consisted of 5,194 adults between 18 to 25 years old. Latent class analysis revealed a 3-class model: Rare Maltreatment (59%); Occasional Maltreatment, Rare Sexual Abuse (37%); and Frequent Maltreatment, Some Sexual Abuse (4%). Risk for substance use disorders and poor mental health was higher for the two classes who experienced maltreatment, however those with Frequent Maltreatment had higher risk for poor mental health, but not substance use disorders compared to those with Occasional Maltreatment. Patterns of child maltreatment are important predictors of substance use and mental health disorders in emerging adulthood, but different patterns may necessitate specific intervention efforts.
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http://dx.doi.org/10.1177/2167696819830481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990388PMC
December 2020

Barriers impacting the POINT pragmatic trial: the unavoidable overlap between research and intervention procedures in "real-world" research.

Trials 2021 Feb 4;22(1):114. Epub 2021 Feb 4.

Department of Psychology, Indiana University Purdue University Indianapolis, 402 N. Blackford St., Indianapolis, IN, 46202, USA.

Background: This manuscript provides a research update to the ongoing pragmatic trial of Project POINT (Planned Outreach, Intervention, Naloxone, and Treatment), an emergency department-based peer recovery coaching intervention for linking patients with opioid use disorder to evidence-based treatment. The research team has encountered a number of challenges related to the "real-world" study setting since the trial began. Using an implementation science lens, we sought to identify and describe barriers impacting both the intervention and research protocols of the POINT study, which are often intertwined in pragmatic trials due to the focus on external validity.

Method: Qualitative data were collected from 3 peer recovery coaches, 2 peer recovery coach supervisors, and 3 members of the research team. Questions and deductive qualitative analysis were guided by the Consolidated Framework for Implementation Research (CFIR).

Results: Nine unique barriers were noted, with 5 of these barriers impacting intervention and research protocol implementation simultaneously. These simultaneous barriers were timing of intervention delivery, ineffective communication with emergency department staff, lack of privacy in the emergency department, the fast-paced emergency department setting, and patient's limited resources. Together, these barriers represent the intervention characteristics, inner setting, and outer setting domains of the CFIR.

Conclusion: Results highlight the utility of employing an implementation science framework to assess implementation issues in pragmatic trials and how this approach might be used as a quality assurance mechanism given the considerable overlap that exists between research and intervention protocols in real-world trial settings. Previously undocumented changes to the trial design that have been made as a result of the identified barriers are discussed.
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http://dx.doi.org/10.1186/s13063-021-05065-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859893PMC
February 2021

Individual Differences in Adolescent Coping: Comparing a Community Sample and a Low-SES Sample to Understand Coping in Context.

J Youth Adolesc 2021 Apr 25;50(4):693-710. Epub 2021 Jan 25.

University of Illinois at Urbana-Champaign, Champaign, IL, USA.

Coping that is adaptive in low-stress environments can be ineffective or detrimental in the context of poverty. Identifying coping profiles among adolescents facing varying levels of stress can increase understanding of when and for whom coping may be most adaptive. The present study applied latent profile analysis (LPA) to identify coping profiles in two distinct samples of adolescents: a community sample of youth aged 11-16 years (N = 374, M = 13.14, 53% girls), and a low-SES sample of youth aged 12-18 years (N = 304, M = 14.56, 55% girls). The ten coping subscales of the Responses to Stress Questionnaire were included as indicators in the LPAs (problem solving, emotion regulation, emotion expression, acceptance, positive thinking, cognitive restructuring, distraction, denial, wishful thinking, and avoidance). Five profiles were identified in the community sample: Inactive, Low Engagement, Cognitive, Engaged, and Active Copers. All but the Low Engagement Copers profile were also identified in the low-SES sample, suggesting that adolescents employ similar coping strategies across contexts, but fewer low-SES adolescents engage in lower levels of coping. Profiles differed by gender and symptoms of internalizing psychopathology. Inactive copers in both samples were more likely to be male. Engaged Copers reported the lowest symptom levels whereas Active Copers reported higher symptoms. Cognitive Copers reported higher levels of anxious and depressive symptoms in the low-SES sample only, suggesting that this pattern of coping may be protective only in less stressful contexts. Elucidating within-person coping patterns is a promising avenue for targeting interventions to those most likely to benefit.
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http://dx.doi.org/10.1007/s10964-021-01398-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074358PMC
April 2021

A Latent Transition Analysis of Self-Reported Reasons for Marijuana Use During Young Adulthood.

Eval Health Prof 2021 Mar 30;44(1):9-24. Epub 2020 Dec 30.

Institute for Social Research, 1259The University of Michigan, Ann Arbor, MI, USA.

Individuals' reasons for marijuana use have been linked to their risk for continued use and development of disordered use. Although individuals tend to have multiple reasons for use, co-occurrence of reasons is not always accounted for in analytic approaches. Latent transition analysis (LTA) is ideal for modeling transitions in co-occurring reasons. Using longitudinal panel data from Monitoring the Future, LTA was used to identify profiles of self-reported reasons for marijuana use among young adults, examine transitions between profiles, and determine whether cohort, gender, race/ethnicity, parent education, grade of first marijuana use, and 4-year college attendance predicted transitions between profiles. Data included senior year cohorts from 1976-2009 and were collected at ages 19/20, 21/22, and 23/24 (weighted = 7,294; 55.9% female; 79.3% White). Five latent classes were identified: Non-Users and individuals with Experimental, Typical, Get High + Relax, and Escape + Coping Reasons. Transitions among Non-Users, Experimental Reasons, and Typical Reasons were common; generally, those with earlier cohort membership, early initiation, college non-attending parents, and college attendance were more likely to make transitions to higher-risk classes. As the legalization of recreational marijuana use continues to expand, change over time in reasons for use should be considered carefully as interventions are developed and implemented.
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http://dx.doi.org/10.1177/0163278720984514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923687PMC
March 2021

IMARA: A mother-daughter group randomized controlled trial to reduce sexually transmitted infections in Black/African-American adolescents.

PLoS One 2020 2;15(11):e0239650. Epub 2020 Nov 2.

Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America.

Black/African-American girls are infected with sexually transmitted infections (STIs) at higher rates than their White counterparts. This study tested the efficacy of IMARA, a mother-daughter psychosocial STI/HIV prevention program, on adolescent Black/African-American girls' incident STIs at 12 months in a 2-arm group randomized controlled trial. Black/African-American girls 14-18 years old and their primary female caregiver were eligible for the study. Girls provided urine samples to test for N. gonorrhoeae, C. trachomatis, and T. vaginalis infection at baseline and 12-months. Mother-daughter dyads were randomly assigned to IMARA (n = 118) or a time-matched health promotion control program (n = 81). Retention at 12-months was 86% with no difference across arms. Both interventions were delivered over two consecutive Saturdays totaling 12 hours. Girls who received IMARA were 43% less likely to contract a new STI in the 12-month post-intervention period compared with those in the health promotion control program (p = .011). A secondary follow-up intent-to-treat analysis provided additional support for the protective effect of IMARA, albeit with a similar magnitude of 37% (p = .014). Findings provide early evidence for IMARA's efficacy, such that IMARA protected against STIs at 12-months among adolescent Black/African-American girls. Future research should examine the mechanisms associated with reduced STIs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239650PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605636PMC
January 2021

A latent class analysis of heavy substance use in Young adulthood and impacts on physical, cognitive, and mental health outcomes in middle age.

Drug Alcohol Depend 2020 07 27;212:108018. Epub 2020 Apr 27.

The University of Illinois at Chicago, Center for Dissemination and Implementation Science, Room 302 SRH, M/C 579, 818 South Wolcott Avenue, Chicago, IL 60612, USA.

Background: This study examines whether longitudinal patterns of persistent or experimental heavy substance use across young adulthood were associated with physical and mental health in midlife.

Methods: Data (N = 21,347) from Monitoring the Future from adolescence (age 18) to midlife (age 40) were used. Repeated measures latent class analysis modeled patterns of patterns of cigarettes, alcohol, marijuana, and other illicit drugs across young adulthood (ages 18-30). Latent classes were then used as predictors of physical health problems, cognitive problems, self-rated health, and psychological problems in midlife (age 40), while controlling for sociodemographic variables (i.e., gender, race/ethnicity, parental education).

Results: Identified classes were "Extreme Heavy Users" (3.9%), "Early Young Adult Users" (8.9%), "Cigarette Smokers" (9.2%), "All But Cigarette Smokers" (5.0%), "Frequent Alcohol Bingers" (10.4%), and "Not-Heavy Users" (62.6%). Extreme Heavy Users, Early Young Adult Users, and Cigarette Smokers had significantly poorer overall health based on a number of physical conditions and self-rated health. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers had more cognitive problems than other classes. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers were more likely to see a health professional for a psychological problem.

Conclusions: Patterns of heavy substance use were associated with health across decades. Regular cigarette smokers and heavy users across substances and ages had the worst health in midlife, although even those with time-limited use during young adulthood were at risk for later physical and cognitive health problems.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293917PMC
July 2020

Childhood socioeconomic status, comorbidity of chronic kidney disease risk factors, and kidney function among adults in the midlife in the United States (MIDUS) study.

BMC Nephrol 2020 05 19;21(1):188. Epub 2020 May 19.

Department of Human Development and Family Studies/ Center for Healthy Aging, The Pennsylvania State University, 405 Biobehavioral Health (BBH) Building, University Park, PA, 16802, USA.

Background: There is a lack of empirical effort that systematically investigates the clustering of comorbidity among known risk factors (obesity, hypertension, diabetes, hypercholesterolemia, and elevated inflammation) of chronic kidney disease (CKD) and how different types of comorbidity may link differently to kidney function among healthy adult samples. This study modeled the clustering of comorbidity among risk factors, examined the association between the clustering of risk factors and kidney function, and tested whether the clustering of risk factors was associated with childhood SES.

Methods: The data were from 2118 participants (ages 25-84) in the Midlife in the United States (MIDUS) Study. Risk factors included obesity, elevated blood pressure (BP), high total cholesterol levels, poor glucose control, and increased inflammatory activity. Glomerular filtration rate (eGFR) was estimated from serum creatinine, calculated with the CKD-EPI formula. The clustering of comorbidity among risk factors and its association with kidney function and childhood SES were examined using latent class analysis (LCA).

Results: A five-class model was optimal: (1) Low Risk (class size = 36.40%; low probability of all risk factors), (2) Obese (16.42%; high probability of large BMI and abdominally obese), (3) Obese and Elevated BP (13.37%; high probability of being obese and having elevated BP), (4) Non-Obese but Elevated BP (14.95%; high probability of having elevated BP, hypercholesterolemia, and elevated inflammation), and (5) High Risk (18.86%; high probability for all risk factors). Obesity was associated with kidney hyperfiltration, while comorbidity between obesity and hypertension was linked to compromised kidney filtration. As expected, the High Risk class showed the highest probability of having eGFR < 60 ml/min/1.73 m (P = .12; 95%CI = .09-.17). Finally, higher childhood SES was associated with reduced probability of being in the High Risk rather than Low Risk class (β = - 0.20, SE = 0.07, OR [95%CI] = 0.82 [0.71-0.95]).

Conclusion: These results highlight the importance of considering the impact of childhood SES on risk factors known to be associated with CKD.
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http://dx.doi.org/10.1186/s12882-020-01846-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236129PMC
May 2020

Changes in externalizing and internalizing symptoms among African American female adolescents over 1 year following a mother-daughter sexual health intervention.

J Consult Clin Psychol 2020 Jun 5;88(6):495-503. Epub 2020 Mar 5.

Center for Dissemination and Implementation Science.

Objective: African American female adolescents face disparities compared with White peers in the interrelated areas of mental health symptoms and sexually transmitted infection (STI) acquisition. IMARA (Informed, Motivated, Aware and Responsible about AIDS) is a group-based mother-daughter intervention addressing these factors among African American teenagers. Previous work demonstrated that female adolescents who received IMARA were 43% less likely than controls to evidence a new STI at 1 year. This report aimed to provide the 1st test of IMARA on externalizing and internalizing symptoms and an exploratory analysis of whether symptom improvements were associated with the protective effect of treatment against future STIs.

Method: Female African Americans aged 14-18 years ( = 16; = 199) were randomly assigned to IMARA or a health promotion control group matched for time and structure. They completed the Youth Self-Report of externalizing and internalizing symptoms at baseline and at 6 and 12 months and were tested for STIs at baseline and 12 months; positive cases were treated. Hierarchical linear modeling tested symptom change over time, including the moderating effects of baseline symptoms.

Results: Among participants who entered with high versus lower externalizing symptoms, those who received IMARA showed a slightly greater decrease in externalizing scores relative to the control ( = .035). For these youth, symptom improvements appeared to be associated with IMARA's protective effect against new STIs. Treatment was not associated with internalizing symptom change ( > .05).

Conclusion: IMARA shows promise in modestly reducing self-reported externalizing symptoms, although only for participants with high scores at baseline. The possibility that externalizing symptom improvement is linked with reduced STI acquisition warrants future examination. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/ccp0000491DOI Listing
June 2020

Constellations of family risk for long-term adolescent antisocial behavior.

J Fam Psychol 2020 Aug 13;34(5):587-597. Epub 2020 Feb 13.

Department of Human Development and Family Studies.

Adolescent antisocial behavior (ASB) can have long-term individual and societal consequences. Much of the research on the development of ASB considers risk and protective factors in isolation or as cumulative indices, likely overlooking the co-occurring and interacting nature of these factors. Guided by theories of ASB risk (i.e., coercive family process, disengagement), this study uses latent profile analysis to evaluate whether there are subgroups of families in the population that conform to specific constellations of risk factors prescribed by established theories of risk for ASB, and whether subgroup membership confers differential risk for different ASBs. We leveraged a large sample of adolescents in Fall, Grade 6 ( = 5,300; = 11.8; 50.9% female) for subgroup analysis, and predicted aggression, antisocial peer behavior, and substance use in Spring, Grade 8. Four family profiles were identified: (15%), characterized by high family conflict, low positive family climate, low parental involvement, low effective discipline, low adolescent positive engagement, and low parental knowledge; (41%), characterized by low positive family climate, low parental involvement, low adolescent positive engagement, and low parental knowledge; (11%), characterized by high parental involvement, low effective discipline, high adolescent positive engagement, high parental knowledge, and high family conflict; and (34% prevalence). In turn, group membership predicted long-term outcomes. Adolescents in Coercive families were at highest risk for ASB during Grade 8, followed by those in Disengaged and Permissive profiles; all three of which were at greater risk than adolescents in High Functioning families for every outcome. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/fam0000640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375013PMC
August 2020

Exploring Triadic Family Relationship Profiles and Their Implications for Adolescents' Early Substance Initiation.

Prev Sci 2020 05;21(4):519-529

Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA.

This study examined combinations of warmth and hostility in mother-father-adolescent triadic relationships when adolescents were in 6th grade and associations with adolescent middle school substance initiation. We conducted a latent profile analysis with a sample of 687 two-parent families (52.4% of adolescents were female, mean age = 11.27 at 6th grade). These analyses revealed five profiles of triadic relationships, labeled as: cohesive families (46%, high warmth and low hostility in all three dyads), compensatory families (24%, low interparental warmth but high parent-adolescent warmth), disengaged families (13%, average to low warmth and hostility in three dyads), distressed families (9%, high hostility and low warmth in all three dyads), and conflictual families (8%, high hostility and average warmth in all three dyads). There were significant differences across triadic relationship profiles in rate of alcohol initiation during middle school. Specifically, adolescents in distressed families and conflictual families initiated alcohol at higher rates than adolescents in other types of families. Cohesive families and compensatory families initiated alcohol at the lowest rates among all five types of families. Similar patterns appeared for drunkenness and cigarettes. Implications for family-based interventions to decrease adolescent substance use and future research directions are discussed.
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http://dx.doi.org/10.1007/s11121-019-01081-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166145PMC
May 2020

Age trends in alcohol use behavior patterns among U.S. adults ages 18-65.

Drug Alcohol Depend 2019 12 28;205:107689. Epub 2019 Oct 28.

The Methodology Center, The Pennsylvania State University, 404 Health and Human Development Bldg, University Park, PA, 16802, United States; Edna Bennett Piece Prevention Research Center, The Pennsylvania State University, 302 Biobehavioral Health Bldg, University Park, PA 16802, United States; Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Bldg, University Park, PA 16802, United States. Electronic address:

Introduction: Although much of the work on risky alcohol use behaviors, such as heavy drinking, focuses on adolescence and young adulthood, these behaviors are associated with negative health consequences across all ages. Existing studies on age trends have focused on a single alcohol use behavior across many ages, using methods such as time-varying effect modeling, or a single age period with many behaviors, using methods such as latent class analysis. This study integrates aspects of both modeling approaches to examine age trends in alcohol use behavior patterns across ages 18-65.

Methods: Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to identify past-year alcohol use behavior patterns among a nationally representative sample of U.S. adults (n = 30,997; 51.1% women; 63.5% White Non-Hispanic) and flexibly estimate nonlinear trends in the prevalences of those patterns across ages 18-65.

Results: Five patterns were identified: Non-Drinkers, Frequent Light Drinkers, Infrequent Heavy Episodic Drinkers, Frequent Heavy Episodic Drinkers, and Extreme Drinkers. Pattern prevalences were allowed to vary flexibly across the entire age range. Prevalences of the Infrequent Heavy Episodic and Extreme Drinkers peaked around ages 22-24, but peaked for Frequent Heavy Episodic Drinkers around age 49. Non-Drinkers were most prevalent across all ages except during the early 20 s when Extreme Drinkers were more prevalent. Around ages 24-30, the Non-, Frequent Light, and Extreme Drinkers were approximately equally prevalent.

Conclusions: The approach used here holds promise for understanding characteristics associated with behavior patterns at different ages and long-term age trends in complex behaviors.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.107689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957076PMC
December 2019

Social cohesion and peer acceptance predict student-athletes' attitudes toward health-risk behaviors: A within- and between-group investigation.

J Sci Med Sport 2019 Dec 13;22(12):1280-1286. Epub 2019 Jul 13.

Pennsylvania State University, Department of Kinesiology, United States.

Objectives: Collegiate student-athletes often engage in health-risk behaviors such as alcohol misuse and hazing, but the literature in this domain lacks evidence pertaining to how peers shape attitudes towards such behaviors. We investigated how peer acceptance and social cohesion relate to attitudes towards alcohol use, marijuana use, drinking and driving, playing through a concussion, performance enhancing substance use, and hazing.

Design: Cross-sectional survey.

Methods: Participants were 387 NCAA athletes from 23 intact teams. Multilevel modeling was used to examine the extent that health-risk attitudes clustered within teams and enabled us to disentangle individual-level and group-level effects of peer acceptance and social cohesion.

Results: Intraclass correlation coefficients revealed that health-risk attitudes clustered within teams. At the individual-level, student-athletes who perceived higher levels of peer acceptance, relative to teammates, held riskier attitudes towards alcohol use, playing through a concussion, and hazing. Meanwhile, those who perceived higher levels of social cohesion relative to teammates held less risky attitudes towards playing through a concussion. At the group-level, teams with greater peer acceptance held less risky attitudes towards playing through a concussion, whereas teams with greater social cohesion held riskier attitudes toward playing through a concussion.

Conclusions: These data indicated that health-risk behaviors may cluster within teams, and that peer acceptance and cohesiveness are differentially associated with attitudes toward risky behavior. Given that peer influence is a multilevel phenomenon, it is prudent that prevention efforts leverage social processes within teams, while reducing pressures to engage in risky behaviors.
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http://dx.doi.org/10.1016/j.jsams.2019.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825540PMC
December 2019

Social cohesion and peer acceptance predict student-athletes' attitudes toward health-risk behaviors: A within- and between-group investigation.

J Sci Med Sport 2019 Dec 13;22(12):1280-1286. Epub 2019 Jul 13.

Pennsylvania State University, Department of Kinesiology, United States.

Objectives: Collegiate student-athletes often engage in health-risk behaviors such as alcohol misuse and hazing, but the literature in this domain lacks evidence pertaining to how peers shape attitudes towards such behaviors. We investigated how peer acceptance and social cohesion relate to attitudes towards alcohol use, marijuana use, drinking and driving, playing through a concussion, performance enhancing substance use, and hazing.

Design: Cross-sectional survey.

Methods: Participants were 387 NCAA athletes from 23 intact teams. Multilevel modeling was used to examine the extent that health-risk attitudes clustered within teams and enabled us to disentangle individual-level and group-level effects of peer acceptance and social cohesion.

Results: Intraclass correlation coefficients revealed that health-risk attitudes clustered within teams. At the individual-level, student-athletes who perceived higher levels of peer acceptance, relative to teammates, held riskier attitudes towards alcohol use, playing through a concussion, and hazing. Meanwhile, those who perceived higher levels of social cohesion relative to teammates held less risky attitudes towards playing through a concussion. At the group-level, teams with greater peer acceptance held less risky attitudes towards playing through a concussion, whereas teams with greater social cohesion held riskier attitudes toward playing through a concussion.

Conclusions: These data indicated that health-risk behaviors may cluster within teams, and that peer acceptance and cohesiveness are differentially associated with attitudes toward risky behavior. Given that peer influence is a multilevel phenomenon, it is prudent that prevention efforts leverage social processes within teams, while reducing pressures to engage in risky behaviors.
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http://dx.doi.org/10.1016/j.jsams.2019.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825540PMC
December 2019

A Focus on the HIV Care Continuum Through the Healthy Young Men's Cohort Study: Protocol for a Mixed-Methods Study.

JMIR Res Protoc 2019 Jan 24;8(1):e10738. Epub 2019 Jan 24.

Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States.

Background: No group is at greater risk for acquiring HIV than young men who have sex with men (YMSM), particularly black or African American (AA) and Hispanic or Latino (L) YMSM living in inner cities, who account for the largest number of new HIV infections each year. Although pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and treatment as prevention hold enormous promise for changing the course of the epidemic, AA/L-YMSM are the least likely population to be receiving primary health care and HIV prevention/care and are the least likely to be using PrEP and PEP.

Objective: The overarching aim of the Healthy Young Men's (HYM) cohort study is to conduct longitudinal research with a cohort of AA/L-YMSM to prevent new HIV infections, reduce transmission, and reduce HIV/AIDS-related disparities by focusing on successful engagement in care. Findings from this research will be used to inform the development of new interventions designed to engage AA/L-YMSM in the HIV prevention and care continua.

Methods: Longitudinal research (baseline and follow-up assessments every 6 months for a total of 8 waves of data collection) is ongoing with a new cohort of 450 high-risk AA/L-YMSM in Los Angeles. Participants were recruited using a venue-based and social media sampling design. In addition to self-report surveys, the study protocol includes the collection of urine to assess recent use of illicit drugs and the collection of blood and rectal/throat swabs to test for current sexually transmitted infection (STI)/HIV infection. An additional sample of blood/plasma (10 mL for 4 aliquots and 1 pellet) is also collected and stored in the HYM cohort study biorepository for future research. By design, we recruited 400 HIV-negative participants and 50 HIV-positive (HIV+) participants. This mixed-methods study design includes collection and triangulated analysis of quantitative, qualitative, and biological measures (ie, drug use, STI/HIV testing, and adherence to antiretroviral therapy among HIV+ participants) at baseline and every 6 months. The HYM cohort study will provide a platform from which new and emerging biomedical prevention strategies (eg, PrEP, rectal microbicides, and PEP) and other HIV prevention and care engagement interventions can be developed and evaluated with AA/L-YMSM.

Results: To date, all participants in the HYM cohort study have been recruited and baseline assessment has been conducted.

Conclusions: The findings from this research will be used to inform the development of new and/or adaptation of existing evidence-based HIV prevention interventions and interventions designed to engage this population in the HIV prevention and care continua.

International Registered Report Identifier (irrid): DERR1-10.2196/10738.
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http://dx.doi.org/10.2196/10738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365874PMC
January 2019

Financial stress response profiles and psychosocial functioning in low-income parents.

J Fam Psychol 2018 06;32(4):517-527

Department of Psychology, The Pennsylvania State University.

Parenting in the context of poverty is accompanied by heightened stress and heightened stakes. How parents respond to poverty-related stress has important implications for family functioning, but research investigating individual differences in low-income mothers' and fathers' responses to financial stress and their associations with parents' concurrent psychosocial adaptation is lacking. A better understanding of differences in stress responses among low-income parents is required to develop and tailor prevention programs that meet these families' needs. This study applies latent profile analysis (LPA) to identify and describe profiles of financial stress responses (problem solving, emotion regulation, emotion expression, cognitive restructuring, positive thinking, acceptance, distraction, denial, avoidance, wishful thinking, rumination, intrusive thoughts, emotional arousal, physiologic arousal, impulsive action, emotional numbing, cognitive interference, escape, and inaction) and examines associations between profile membership and psychosocial functioning in low-income parents. Five profiles were identified that were distinguished by self-reported voluntary and involuntary financial stress responses: active (32% of sample), low (11%), high (11%), negative cognitive (NC; 17%), and average (29%) responders. Notable differences emerged on measures of life stress, economic hardship, psychopathology, and social support, with individuals in the NC responders profile reporting the most difficulty and members of the active responders profile reporting the greatest adaptation. These findings offer a more nuanced understanding of how mothers and fathers respond to chronic poverty-related stress and have valuable implications for intervention efforts to promote adaptive stress responses and psychosocial functioning in low-income families. (PsycINFO Database Record
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http://dx.doi.org/10.1037/fam0000403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995125PMC
June 2018

Inverse Propensity Score Weighting with a Latent Class Exposure: Estimating the Causal Effect of Reported Reasons for Alcohol Use on Problem Alcohol Use 16 Years Later.

Prev Sci 2019 04;20(3):394-406

The Methodology Center, Penn State, 404 Health & Human Development Bldg., University Park, PA, 16802, USA.

Latent class analysis (LCA) has proven to be a useful tool for identifying qualitatively different population subgroups who may be at varying levels of risk for negative outcomes. Recent methodological work has improved techniques for linking latent class membership to distal outcomes; however, these techniques do not adjust for potential confounding variables that may provide alternative explanations for observed relations. Inverse propensity score weighting provides a way to account for many confounders simultaneously, thereby strengthening causal inference of the effects of predictors on outcomes. Although propensity score weighting has been adapted to LCA with covariates, there has been limited work adapting it to LCA with distal outcomes. The current study proposes a step-by-step approach for using inverse propensity score weighting together with the "Bolck, Croon, and Hagenaars" approach to LCA with distal outcomes (i.e., the BCH approach), in order to estimate the causal effects of reasons for alcohol use latent class membership during the year after high school (at age 19) on later problem alcohol use (at age 35) with data from the longitudinal sample in the Monitoring the Future study. A supplementary appendix provides evidence for the accuracy of the proposed approach via a small-scale simulation study, as well as sample programming code to conduct the step-by-step approach.
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http://dx.doi.org/10.1007/s11121-018-0883-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139077PMC
April 2019

Change and Stability of Emotional Health of Rural Pennsylvania Youth During High School.

J Rural Health 2018 06 16;34(3):322-332. Epub 2018 Feb 16.

The Methodology Center, The Pennsylvania State University, University Park, Pennsylvania.

Purpose: Few prior studies have examined change in emotional health of high school students in a rural context. Considering the multifaceted nature of emotional health, this research aims to identify the patterns and explore change and stability of the emotional health of rural Pennsylvania youth. It also investigates the influence of family, peers, school, and the community environment on rural adolescents' emotional health.

Methods: Using panel data from the Rural Youth Education Project, we employed latent transition analysis to examine changes in patterns of rural students' self-reported emotional health from 9 grade to 11 grade (N = 1,294).

Findings: Four distinct emotional health subgroups for rural adolescents were identified. Over half of the youth in the sample felt emotionally well, or positive, in both 9 and 11 grades. Roughly 60% of rural youth remained in the same emotional health category from 9 to 11 grade, but a substantial minority experienced change in emotional health. One-fifth reported lower emotional health status in 11 grade, and one-fifth indicated more positive emotions in 11 than in 9 grade. We found strong evidence of family, school, community, and peer influences on the emotional health of rural youth in 9 grade.

Conclusions: The results suggest that while a large share of rural youth exhibit positive emotional health and remain positive across their high school years, a substantial share of rural youth experience changing emotional health. The study underscores the important role that family, peers, school, and the community environment play for rural youth's emotional health over time.
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http://dx.doi.org/10.1111/jrh.12296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021226PMC
June 2018

Linking Patterns of Substance Use With Sexual Risk-Taking Among Female Adolescents With and Without Histories of Maltreatment.

J Adolesc Health 2018 05 1;62(5):556-562. Epub 2018 Feb 1.

Department of Human Developmental and Family Studies, The Pennsylvania State University, University Park, Pennsylvania; University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Purpose: This study aimed to determine the associations between patterns of substance use and sexual risk-taking among female adolescents with and without histories of maltreatment.

Methods: Data are from a prospective cohort study examining the impact of maltreatment on subsequent female adolescent sexual health (N = 504). Participants averaged 18.24 years in age (SD = 1.12), and approximately 63% had substantiated incidences of maltreatment filed with Child Protective Services prior to age 18. The present study used latent class analysis to examine patterns in adolescent substance use, and negative binomial regression models to examine the links between patterns of substance use and sexual risk-taking and to determine whether these associations were moderated by adolescents' maltreatment status.

Results: Six classes emerged from latent class analysis labeled as follows: abstainers (25% of sample); polysubstance users-early initiators (13%); polysubstance users-late initiators (23%); alcohol and cannabis users-late initiators (9%); alcohol users-late initiators (18%); and tobacco users (12%). Patterns of adolescent polysubstance use were associated with the highest levels of sexual risk-taking, and patterns of late-initiated polysubstance use, late-initiated alcohol use, and tobacco use were more strongly related to sexual risk-taking for female adolescents with histories of maltreatment.

Conclusions: This study is the first to determine the specific patterns of substance use that are more strongly related to sexual risk-taking for maltreated female adolescents. By doing so, this study demonstrates how a person-centered approach can facilitate our understanding of how to best leverage sexual risk-taking prevention efforts.
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http://dx.doi.org/10.1016/j.jadohealth.2017.11.293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5930059PMC
May 2018

A Latent Class Analysis of Online Sexual Experiences and Offline Sexual Behaviors Among Female Adolescents.

J Res Adolesc 2018 09 20;28(3):731-747. Epub 2017 Nov 20.

The Pennsylvania State University.

This study used latent class analysis to identify patterns (i.e., classes) across a broad range of online sexual experiences among female adolescents (n = 312) and to explore offline sexual behavior and substance use correlates of as well as maltreatment differences in class membership. The following four classes were identified: Online Abstinent, Online Inclusive, Attractors, and Seekers. Maltreated female adolescents were more likely to be members of the Online Inclusive class and less likely to be members of the Online Abstinent class than nonmaltreated female adolescents. Offline sexual behaviors and substance use differentially predicted class membership. These results suggest online sexual experiences vary greatly and should not be aggregated together as a global risk factor for all female adolescents.
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http://dx.doi.org/10.1111/jora.12364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960611PMC
September 2018

Latent Classes of Maltreatment: A Systematic Review and Critique.

Child Maltreat 2018 02 6;23(1):3-24. Epub 2017 Sep 6.

3 The Methodology Center, Penn State, State College, PA, USA.

This article reviews and critically evaluates available research on latent classes of maltreatment. Three major databases (PsycINFO, Web of Knowledge, and Academic Search Complete) were used to identify studies on latent classes of maltreatment published before June 1, 2016. Of 365 potentially relevant studies, 14 met inclusion criteria for review. Our analysis was guided by the following questions: (a) What observed indicators are being used to model classes of maltreatment? (b) What are the most commonly identified classes of maltreatment? and (c) What are the predictors and outcomes of classes of maltreatment? Across the studies, findings demonstrated how person-centered methods (i.e., latent class/profile analysis) may facilitate the study of maltreatment by concurrently addressing several methodological limitations common to the study of maltreatment, while also addressing heterogeneity in experiences of maltreatment. After providing an account of existing trends within the literature employing person-centered methodology in the study of maltreatment, we offer a critique of extant research, note recent methodological developments, and make numerous recommendations for future research using person-centered approaches to understanding maltreatment.
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http://dx.doi.org/10.1177/1077559517728125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614894PMC
February 2018

Comparing the Performance of Improved Classify-Analyze Approaches For Distal Outcomes in Latent Profile Analysis.

Methodology (Gott) 2016 Oct 5;12(4):107-116. Epub 2016 Dec 5.

The Methodology Center, The Pennsylvania State University, University Park, PA, USA.

Several approaches are available for estimating the relationship of latent class membership to distal outcomes in latent profile analysis (LPA). A three-step approach is commonly used, but has problems with estimation bias and confidence interval coverage. Proposed improvements include the correction method of Bolck, Croon, and Hagenaars (BCH; 2004), Vermunt's (2010) maximum likelihood (ML) approach, and the inclusive three-step approach of Bray, Lanza, & Tan (2015). These methods have been studied in the related case of latent class analysis (LCA) with categorical indicators, but not as well studied for LPA with continuous indicators. We investigated the performance of these approaches in LPA with normally distributed indicators, under different conditions of distal outcome distribution, class measurement quality, relative latent class size, and strength of association between latent class and the distal outcome. The modified BCH implemented in Latent GOLD had excellent performance. The maximum likelihood and inclusive approaches were not robust to violations of distributional assumptions. These findings broadly agree with and extend the results presented by Bakk and Vermunt (2016) in the context of LCA with categorical indicators.
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http://dx.doi.org/10.1027/1614-2241/a000114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473653PMC
October 2016

Patterns of high-intensity drinking among young adults in the United States: A repeated measures latent class analysis.

Addict Behav 2017 11 5;74:134-139. Epub 2017 Jun 5.

The Methodology Center, College of Health and Human Development, The Pennsylvania State University, 406 Health and Human Development Building, University Park, PA 16802, USA.

Objective: Using a national sample of young adults, this study identified latent classes of alcohol use including high-intensity drinking (10+ drinks) from ages 18 to 25/26, and explored associations between time-invariant covariates measured at age 18 and class membership.

Method: Longitudinal data from the national Monitoring the Future study were available for 1078 individuals (51% female) first surveyed as 12th grade students in 2005-2008, and followed through modal age 25/26. Repeated measures latent class analysis was used to identify latent classes based on self-reported alcohol use: no past 30-day drinking, 1-9 drinks per occasion in the past 2weeks, and 10+ drinks per occasion.

Results: Four latent classes of alcohol use from ages 18 to 25/26 were identified: (1) Non-Drinkers (21%); (2) Legal Non-High-Intensity Drinkers (23%); (3) Persistent Non-High-Intensity Drinkers (40%); and (4) High-Intensity Drinkers (16%). Membership in the High-Intensity Drinkers class was characterized by higher than average probabilities of high-intensity drinking at all ages, with the probability of high-intensity drinking increasing between ages 18 and 21/22. Both gender and race/ethnicity significantly differentiated class membership, whereas neither parental education (a proxy for socioeconomic status) nor college plans at 12th grade showed significant associations.

Conclusions: More than one in seven individuals who were seniors in high school experienced a long-term pattern of high-intensity drinking lasting into middle young adulthood. Young adult high-intensity drinking is often preceded by high-intensity drinking in high school, suggesting the importance of screening and prevention for high-intensity drinking during adolescence.
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http://dx.doi.org/10.1016/j.addbeh.2017.06.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550283PMC
November 2017

Contemporary alcohol use patterns among a national sample of U.S. adult drinkers.

J Addict Dis 2017 Oct-Dec;36(4):222-226. Epub 2017 Jun 8.

a The Methodology Center, The Pennsylvania State University , University Park , Pennsylvania , USA.

The aim of the current article is to identify subgroups of adult drinkers characterized by typical drinking patterns. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to classify drinkers based on several indicators of drinking. Past-year drinkers aged 18-64 were included (n = 22,776). Latent class analysis revealed a 5-class model: Occasional, Light Drinkers (28%), Frequent Drinkers (25%), Infrequent Drinkers with Occasional Binging (5%), Frequent Drinkers with Occasional Binging (22%), and High-Intensity Drinkers (20%). Although most were Light Drinkers, many engaged in excessive drinking. Given the potential risk for harm, prevention efforts are warranted particularly for High-Intensity Drinkers.
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http://dx.doi.org/10.1080/10550887.2017.1338816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656524PMC
June 2018

Profiles of adolescent religiousness using latent profile analysis: Implications for psychopathology.

Br J Dev Psychol 2017 03;35(1):91-105

Virginia Tech, Blacksburg, Virginia, USA.

Prior research has documented robust associations between adolescent religiousness/spirituality (R/S) and psychopathology outcomes including externalizing and internalizing symptomatology, yet no previous studies have examined these associations with adolescent R/S profiles using a person-centred approach. We examined whether there are identifiable subgroups characterized by unique multidimensional patterns of R/S experiences and how these experiences may be related to externalizing and internalizing symptomatology. The sample consisted of 220 Appalachian adolescents between 12 and 18 years old who were primarily White and primarily Christian. Latent profile analysis revealed three profiles of adolescent R/S: high religiousness (28.4%), introjectors (47.6%), and low religiousness (24.0%). These profiles were differentially related to internalizing and externalizing symptomatology such that the high religiousness group was significantly lower than the introjectors with respect to internalizing and externalizing symptomatology and lower than the low religiousness group in externalizing symptomatology. Implications and suggestions for future research using person-centred approaches to better understand differential developmental trajectories of religious development are provided. Statement of contribution What is already known Prior research has demonstrated a negative relationship between adolescent religiousness and spirituality (R/S) and psychopathology. Numerous studies document the differential relationships between aspects of R/S and psychopathology; however, few have done so from a person-centred perspective. There are several theories that outline how R/S to study R/S when paying specific attention to culture. Saroglou's Big Four dimensions of religion (believing, bonding, behaving, and belonging) posits that these four dimensions (1) are able to delimit religion from proximal constructs; (2) translate major distinct dimensions of religiousness; (3) can be seen across cultural contexts; and (4) are good candidates to study cultural variability in religion due to their diversity; however, to the authors' knowledge there has been no attempt to synthesize the Big Four dimensions and person-centred work. What the present study adds The present study found three profiles of adolescent R/S: high religiousness, low religiousness, and of particular interest, the introjectors. Those high in introjection seem to have a partial internalization of religiousness due to their low score in private practices but moderate to high scores on other aspects of religiousness. This group would not have been found through the use of traditional data analysis techniques or even through structural equation models. Importantly, those in the introjector group were also significantly higher in internalizing symptomatology than those in the high religiousness group, and higher in externalizing symptomatology than both the high religiousness and low religiousness. This 'u-shaped' pattern in which those in the middle-range of R/S were the worst off would also not have been found using traditional data analysis techniques.
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http://dx.doi.org/10.1111/bjdp.12183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5531039PMC
March 2017

Longitudinal patterns of marijuana use across ages 18-50 in a US national sample: A descriptive examination of predictors and health correlates of repeated measures latent class membership.

Drug Alcohol Depend 2017 Feb 24;171:70-83. Epub 2016 Nov 24.

Institute for Social Research, University of Michigan, PO Box 1248, Ann Arbor, MI 48106-1248, USA; Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48106-1043, USA. Electronic address:

Background: This descriptive study identified latent classes of longitudinal marijuana use from ages 18 through 50 among a national sample; examined covariate associations with class membership regarding use/non-use, use intensity, and use duration; and described associations between identified latent classes and age 50 health outcomes.

Methods: The study involved collection and primary analysis of data from 9831 individuals first surveyed as 12th graders in the national Monitoring the Future study and followed through modal age 50. Repeated measures latent class analysis was used to identify latent classes based on self-reported past 12-month marijuana use.

Results: Seven latent classes of marijuana use from ages 18 to 50 were identified including Non-users (44%), two classes characterized by shorter-term use patterns (totaling 28%), and four classes characterized by longer-term moderate or heavy use (totaling 28%). Use reduction appeared particularly likely during early and late 20s. Gender, parental education, alcohol/cigarette use, religious commitment, and marital status differentiated use/non-use, use intensity, and use duration after high school. In non-causal models controlling for covariates, longer-term marijuana use classes (where use extended into the late 20s or beyond) were associated with significantly higher odds of negative health outcomes at age 50.

Conclusions: Approximately 28% of the national sample reported longer-term moderate/heavy marijuana use, which was associated with negative health outcomes at age 50. The early and late 20s may be especially important periods for marijuana use prevention and intervention efforts, which may be strengthened by recognition of characteristics that appear to have significant associations with persistent use.
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http://dx.doi.org/10.1016/j.drugalcdep.2016.11.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263048PMC
February 2017

Reasons for Marijuana Use Among Young Adults and Long-Term Associations With Marijuana Use and Problems.

J Stud Alcohol Drugs 2016 11;77(6):881-888

Institute for Social Research, University of Michigan, Ann Arbor, Michigan.

Objective: This study examines reasons for marijuana use among young adults age 19/20 in the United States and the extent to which patterns of reasons are associated with marijuana use and problems 15 years later.

Method: The national Monitoring the Future study provided data on marijuana users at age 19/20 who were also surveyed at age 35 (n = 2,288; 50% women; 83% White). Latent class analysis was used to identify distinct patterns of reasons for marijuana use, which were then used as predictors of later marijuana use and problems.

Results: Five latent classes described the following patterns of reasons for marijuana use at age 19/20: Experimental, Get High + Relax, Typical, Typical + Escape, and Coping + Drug Use. Highest risk for later marijuana use and problems was found for people with Coping + Drug Use and Get High + Relax reasons in young adulthood; those with Experimental reasons were at lowest risk for later use or problems.

Conclusions: Coping and getting high emerged as strong predictors of later marijuana use and problems. Results support the predictive value of self-reported reasons for using marijuana among young adults.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088171PMC
http://dx.doi.org/10.15288/jsad.2016.77.881DOI Listing
November 2016

The dynamics of internalizing and externalizing comorbidity across the early school years.

Dev Psychopathol 2016 11;28(4pt1):1033-1052

Pennsylvania State University.

High rates of comorbidity are observed between internalizing and externalizing problems, yet the developmental dynamics of comorbid symptom presentations are not yet well understood. This study explored the developmental course of latent profiles of internalizing and externalizing symptoms across kindergarten, first grade, and second grade. The sample consisted of 336 children from an urban, low-income community, selected based on relatively high (61%) or low (39%) aggressive/oppositional behavior problems at school entry (64% male; 70% African American, 20% Hispanic). Teachers reported on children's symptoms in each year. An exploratory latent profile analysis of children's scores on aggression/oppositionality, hyperactivity/inattention, anxiety, and social withdrawal symptom factors revealed four latent symptom profiles: comorbid (48% of the sample in each year), internalizing (19%-23%), externalizing (21%-22%), and well-adjusted (7%-11%). The developmental course of these symptom profiles was examined using a latent transition analysis, which revealed remarkably high continuity in the comorbid symptom profile (89% from one year to the next) and moderately high continuity in both the internalizing and externalizing profiles (80% and 71%, respectively). Internalizing children had a 20% probability of remitting to the well-adjusted profile by the following year, whereas externalizing children had a 25% probability of transitioning to the comorbid profile. These results are consistent with the hypothesis that a common vulnerability factor contributes to developmentally stable internalizing-externalizing comorbidity, while also suggesting that some children with externalizing symptoms are at risk for subsequently accumulating internalizing symptoms.
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http://dx.doi.org/10.1017/S0954579416000687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319409PMC
November 2016
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