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The aim of the current study was to evaluate the eleven year longitudinal association between students identified in first grade as having academic and behavior problems and distal outcomes in twelfth grade. The study extends prior research that identified latent classes of academic and behavior problems in a longitudinal community sample of 678 predominately African American first-grade students. The type and number of classes identified in first grade differed by gender, but results indicated that students within the classes of behavior and academic problems had long-term negative outcomes in the twelfth grade. The class with co-occurring academic and behavior problems in first grade had the greatest risk for negative distal outcomes for both boys and girls including higher likelihood of special education placement, mental health service use, poor academic achievement, and school dropout. Implications for prevention, early intervention, and current practices in schools are discussed.

Social and environmental influences on gambling behavior are important to understand because localities can control the sanction and location of gambling opportunities. This study explores whether neighborhood disadvantage is associated with gambling among predominantly low-income, urban young adults and to explore if we can find differences in physical vs. compositional aspects of the neighborhood. Data are from a sample of 596 young adults interviewed when they were 21–22 years, who have been participating in a longitudinal study since entering first grade in nine public US Mid-Atlantic inner-city schools (88 % African Americans). Data were analyzed via factor analysis and logistic regression models. One third of the sample (n = 187) were past-year gamblers, 42 % of them gambled more than once a week, and 31 % had gambling-related problems. Those living in moderate and high disadvantaged neighborhoods were significantly more likely to be past-year gamblers than those living in low disadvantaged neighborhoods. Those living in high disadvantaged neighborhoods were ten times more likely than those living in low disadvantaged neighborhoods to have gambling problems. Factor analysis yielded a 2-factor model, an “inhabitant disadvantage factor” and a “surroundings disadvantage factor.” Nearly 60 % of the sample lived in neighborhoods with high inhabitants disadvantage (n = 375) or high surroundings disadvantage (n = 356). High inhabitants disadvantage was associated with past-year frequent gambling (odds ratios (aOR) = 2.26 (1.01, 5.02)) and gambling problems (aOR = 2.81 (1.18, 6.69)). Higher neighborhood disadvantage, particularly aspects of the neighborhood concerning the inhabitants, was associated with gambling frequency and problems among young adult gamblers from an urban, low-income setting.

This study explored the cross sectional association between adverse life events and gambling in a sample of 515 urban adolescents (average age 17, 55% male, 88% African American). Approximately half of the sample had gambled in the past year (51%); 78% of the gamblers gambled monthly and 39% had a gambling-related problem. On the other hand, 88% of the sample had experienced at least one life event in the past year, and those experiencing events tended to live in more disadvantaged neighborhoods. The mere acknowledgement of experiencing a stressful life event in the past year (yes/no) was not associated with an increase in odds of being a gambler, with gambling more frequently, or with having a gambling problem. However, when the context of the event was considered, an association was found between directly experiencing threatening and deviant/violent types of events and frequent gambling (OR > 2). Additionally, the probability of being a gambler increased as the number of events experienced increased (aOR = 1.07, 95% CI = 1.01, 1.13, P = 0.013), but problems among gamblers were not associated with the number of events experienced (aOR = 1.01, 95% CI = 0.92, 1.11, P = 0.876). During adolescence, life events appear to be connected more with the frequency of gambling rather than with problems related to gambling.

Genotype scores that predict relevant clinical outcomes may detect other disease features and help direct prevention efforts. We report data that validate a previously established v1.0 smoking cessation quit success genotype score and describe striking differences in the score in individuals who display differing developmental trajectories of use of common addictive substances. In a cessation study, v1.0 genotype scores predicted ability to quit with P=0.00056 and area under receiver-operating characteristic curve 0.66. About 43% vs 13% quit in the upper vs lower genotype score terciles. Latent class growth analyses of a developmentally assessed sample identified three latent classes based on substance use. Higher v1.0 scores were associated with (a) higher probabilities of participant membership in a latent class that displayed low use of common addictive substances during adolescence (P=0.0004) and (b) lower probabilities of membership in a class that reported escalating use (P=0.001). These results indicate that: (a) we have identified genetic predictors of smoking cessation success, (b) genetic influences on quit success overlap with those that influence the rate at which addictive substance use is taken up during adolescence and (c) individuals at genetic risk for both escalating use of addictive substances and poor abilities to quit may provide especially urgent focus for prevention efforts.

OBJECTIVE Using a longitudinal design, the authors of this study examined the relationship between externalizing problems and impulsivity in early childhood and symptoms of disordered eating in late adolescence. METHOD Participants were urban, African American first-grade girls (N = 119) and their parents who were participating in a longitudinal study examining the prevention of disruptive behaviors. Impulsivity, conduct problems, and oppositional defiant behavior were assessed by parent report via structured interview questions. At 9-year follow-up, bulimic symptoms were measured by the Eating Disorder Inventory. A hierarchical regression analysis was conducted to determine the longitudinal association among impulsivity, conduct problems, and oppositional defiant behavior and bulimic symptoms. RESULTS Parental report of impulsivity in first-grade girls, but not conduct problems or oppositional defiant behavior, was associated with self-reported bulimic symptoms in the girls in late adolescence (p < .04). CONCLUSIONS These results extend previous findings of a concurrent relationship between impulsivity and dysfunctional eating behaviors to a minority sample and further indicate that behavioral impulsivity in early childhood may be used to identify children for targeted prevention of disordered eating.

A teen who starts working for pay while still in school may be more than 8 times as likely to report tobacco use than peers who don't start working while in school.

Examined speculation that stimulant medication may serve to undermine self-efficacy and engender external or unknown explanations of control and dysphoria in children with attention deficit hyperactivity disorder (ADHD). More specifically, as part of a larger double blind, placebo trial of the effectiveness of the psychostimulants and various adjunctive treatments for ADHD, we assessed the effects of methylphenidate on self-perceptions of competence, control, and dysphoria in 48 children with ADHD. In contrast to placebo, although methylphenidate resulted in significantly greater amelioration of a number of the core features of ADHD, we found no evidence of a decrease in perceived competence or an increase in external or unknown explanations of control or dysphoria at posttest 14 weeks later.

This article is about the course of depressive symptoms during a classroom-based randomized preventive field trial aimed at improving reading achievement among first-grade children in an urban population of mixed ethnicity and lower middle to low socioeconomic status. In the fall, children reported high levels of depressive symptoms, a risk factor for major depressive disorder. There was a linear relationship in the fall between depressive symptoms and achievement test scores. Among male children in intervention classrooms whose gain in achievement was at least the national average, depression from fall to spring was decreased, compared to those whose achievement gain was lower. Among female children both in the control and in the intervention classrooms, there was also a significant relationship between gain in achievement and the course of depression.

The present study used a person-centered latent variable approach to classify types of perfectionism among 6th-grade African American children living in an urban setting. In particular, the authors were interested in determining whether an adaptive subtype could be found and validated against external criteria. The authors also attempted to identify any developmental precursors that could reliably differentiate the perfectionist subtypes. A social learning and competence framework was used to select potential 1st-grade risk and protective factors for future perfectionism profiles. Four classes best described the children's perfectionism scores in 6th grade. Three of these classes resembled the profiles most commonly seen in prior perfectionism research (Non-Critical/Adaptive, Critical/Maladaptive, and Non-Perfectionist). The fourth class, Non-Striving, was characterized by extremely low levels of reported personal standards. Sixth-grade correlates confirmed the distinctiveness of these classes. In particular, the Critical/Maladaptive and Non-Striving classes had higher rates of internalizing symptoms and disorders. Additionally, several 1st-grade predictors suggested unique developmental origins of these classes. The Critical/Maladaptive class was characterized by lower academic skills and elevated teacher-rated attention problems, hyperactivity, shyness, and peer rejection. The Non-Striving class had higher rates of family alcohol problems and lower levels of parent praise. Implications regarding the universal and culture-specific origins and effects of perfectionism are discussed.

This study examines the growth of neighborhood disorder and subsequent marijuana use among urban adolescents transitioning into young adulthood.Data are derived from a longitudinal sample of 434 predominately African American 12th graders followed-up at 2 years after high school. The data are rich in repeated measures documenting substance use and misuse and neighborhood characteristics. Growth mixture modeling was used to examine how neighborhood disorder trajectories, measured through the presence of abandoned buildings on the blocks where participants reside, influence subsequent drug use beginning in late adolescence and into young adulthood.A four-class solution characterizing neighborhood growth was selected as the final model and included rapidly improving, slightly improving, always-good, and deteriorating neighborhoods. Young adults living in neighborhoods that had been deteriorating over time were 30% more likely to use marijuana 2 years after high school than adolescents living in always-good neighborhoods (odds ratio = 1.30, p = .034). There was no relationship between living in a neighborhood that was improving and marijuana use.This study identified a salient and malleable neighborhood characteristic, abandoned housing, which predicted elevated risk for young-adult marijuana use. This research supports environmental strategies that target abandoned buildings as a means to improve health and health behaviors for community residents, particularly young-adult substance use.

Considerable research has documented the effects of community violence exposure on adolescents’ behavior and mental health functioning, yet there has been less research on the process by which early risks increase the likelihood that youth will be exposed to community violence. The current study used data from a community epidemiologically-defined sample of 623 urban youth followed from first grade through adolescence to examine the process by which early-onset aggressive behavior and poor academic readiness influenced risk for community violence exposure. Consistent with transactional developmental theories, early-onset aggressive and disruptive behavior was associated with poor academic readiness; these early risks contributed to later peer rejection, and subsequent conduct problems and greater affiliation with deviant peers, which in turn increased youths’ exposure to community violence. Having an enhanced understanding of the risk process directs attention to potential targets for preventive interventions for youth at risk for subsequent exposure to violence.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which is most often diagnosed in childhood with symptoms often persisting into adulthood. Elevated rates of substance use disorders have been evidenced among those with ADHD, but recent research focusing on the relationship between subtypes of ADHD and specific drugs is inconsistent. We propose a latent transition model (LTM) to guide our understanding of how drug use progresses, in particular marijuana use, while accounting for the measurement error that is often found in self-reported substance use data. We extend the LTM to include a latent class predictor to represent empirically derived ADHD subtypes that do not rely on meeting specific diagnostic criteria. We begin by fitting two separate latent class analysis (LCA) models by using second-order estimating equations: a longitudinal LCA model to define stages of marijuana use, and a cross-sectional LCA model to define ADHD subtypes. The LTM model parameters describing the probability of transitioning between the LCA-defined stages of marijuana use and the influence of the LCA-defined ADHD subtypes on these transition rates are then estimated by using a set of first-order estimating equations given the LCA parameter estimates. A robust estimate of the LTM parameter variance that accounts for the variation due to the estimation of the two sets of LCA parameters is proposed. Solving three sets of estimating equations enables us to determine the underlying latent class structures independently of the model for the transition rates and simplifying assumptions about the correlation structure at each stage reduces the computational complexity.

The association between experiences of adverse life events and adolescent depressive symptoms has been well documented. However, this association is not consistently observed in urban and low income African American youth. In addition, mechanisms linking life event stress and African American adolescents' depressive symptoms have received little attention. This study examined past year violent and nonviolent life events assessed in 6th grade as predictors of 7th grade depressive symptoms among a community epidemiologically defined sample of 447 (47% girls) urban African American adolescents. Depressive symptoms were assessed twice, at a 1-year interval, and initial depressive symptoms were controlled in the analyses. Control-related beliefs were examined as mediators of the association between life events and depressive symptoms, and gender was examined as a moderator of the association between control-related beliefs and depressive symptoms. Associations among study variables were examined in a series of models, from general to more specific. A model in which nonviolent and violent life events were examined separately and control and contingency beliefs examined as one latent variable was the most informative about the etiology of depressive symptoms in a sample of urban, African American youth. Implications of the findings for preventive interventions and future research are discussed.

Developmental models highlight the impact of early risk factors on both the onset and growth of substance use, yet few studies have systematically examined the indirect effects of risk factors across several domains, and at multiple developmental time points, on trajectories of substance use and adult adjustment outcomes (e.g., educational attainment, mental health problems, criminal behavior). The current study used data from a community epidemiologically defined sample of 678 urban, primarily African American youth, followed from first grade through young adulthood (age 21) to test a developmental cascade model of substance use and young adult adjustment outcomes. Drawing upon transactional developmental theories and using growth mixture modeling procedures, we found evidence for a developmental progression from behavioral risk to adjustment problems in the peer context, culminating in a high-risk trajectory of alcohol, cigarette, and marijuana use during adolescence. Substance use trajectory membership was associated with adjustment in adulthood. These findings highlight the developmental significance of early individual and interpersonal risk factors on subsequent risk for substance use and, in turn, young adult adjustment outcomes.

In longitudinal studies, outcome trajectories can provide important information about substantively and clinically meaningful underlying subpopulations who may also respond differently to treatments or interventions. Growth mixture analysis is an efficient way of identifying heterogeneous trajectory classes. However, given its exploratory nature, it is unclear how involvement of latent classes should be handled in the analysis when estimating causal treatment effects. In this paper, we propose a 2-step approach, where formulation of trajectory strata and identification of causal effects are separated. In Step 1, we stratify individuals in one of the assignment conditions (reference condition) into trajectory strata on the basis of growth mixture analysis. In Step 2, we estimate treatment effects for different trajectory strata, treating the stratum membership as partly known (known for individuals assigned to the reference condition and missing for the rest). The results can be interpreted as how subpopulations that differ in terms of outcome prognosis under one treatment condition would change their prognosis differently when exposed to another treatment condition. Causal effect estimation in Step 2 is consistent with that in the principal stratification approach (Frangakis and Rubin, 2002) in the sense that clarified identifying assumptions can be employed and therefore systematic sensitivity analyses are possible. Longitudinal development of attention deficit among children from the Johns Hopkins School Intervention Trial (Ialongo et al., 1999) will be presented as an example.

Treatment noncompliance and missing outcomes at posttreatment assessments are common problems in field experiments in naturalistic settings. Although the two complications often occur simultaneously, statistical methods that address both complications have not been routinely considered in data analysis practice in the prevention research field. This paper shows that identification and estimation of causal treatment effects considering both noncompliance and missing outcomes can be relatively easily conducted under various missing data assumptions. We review a few assumptions on missing data in the presence of noncompliance, including the latent ignorability proposed by Frangakis and Rubin (Biometrika 86:365–379, 1999), and show how these assumptions can be used in the parametric complier average causal effect (CACE) estimation framework. As an easy way of sensitivity analysis, we propose the use of alternative missing data assumptions, which will provide a range of causal effect estimates. In this way, we are less likely to settle with a possibly biased causal effect estimate based on a single assumption. We demonstrate how alternative missing data assumptions affect identification of causal effects, focusing on the CACE. The data from the Johns Hopkins School Intervention Study (Ialongo et al., Am J Community Psychol 27:599–642, 1999) will be used as an example.

The present study examined the developmental trajectories of youth depression and anxiety symptoms from 6th through 12th grade in a low-income, urban sample (N = 141; mean age = 11.75 years; 88.7% African American). The study also tested the independent contribution of parent mood disorders, anxiety disorders, and substance use disorders assessed in early childhood to initial levels and rate of change in depression and anxiety symptoms from 6th through 12th grade. Possible gender differences in symptom course and strength of parent psychopathology predictors were examined using multiple-group analysis. Results indicated that depression symptoms declined over time for males, whereas depression symptoms initially declined, but then increased for females. In contrast, male and female adolescents each showed a decline in anxiety symptoms throughout adolescence. Findings also indicated that parent mood disorders were the only predictor of youth depression and anxiety symptoms for male and female adolescents in 6th grade. Parent anxiety disorders uniquely predicted the rate of change in depression symptoms among male adolescents. These results underscore the importance of targeting parents with mood and anxiety disorders in urban families in order to reduce the risk for internalizing difficulties in their adolescent youth.

Purpose To examine the associations between the size and quality of African-American adolescents' social networks and their mental health service use, and to examine whether these social network characteristics moderate the association between need for services because of emotional or behavioral difficulties and use of services. Method Participants were a community sample of African-American adolescents ( N = 465; 46.2% female; mean age, 14.78) initially recruited in 1st grade for participation in an evaluation of two preventive intervention trials. Social network influences and adolescents' mental health service use in schools and community were accessed. Results A significant positive association between adolescents' perception that their social network was helpful and their use of school mental health services was identified. The significant associations between need for services for anxiety, depression, or behavior problems, and school and outpatient service use were moderated by size of the social network. Specifically, among youth in need of services for anxiety or depression, school-based service use was higher for those with larger social networks. Conclusions Implications for enhancing access to formal mental health services include further examination of key social network influences that potentially serve as facilitators or barriers to formal help-seeking. The findings also suggest that it might be important to integrate social network members into interventions to address the mental health needs of adolescents.

This study examined the longitudinal association between contextual stress and health risk behaviors and the role of protective factors in a community epidemiologically-defined sample of urban African American adolescents (N = 500; 46.4% female). Structural equation modeling was used to create a latent variable measuring contextual stress (community violence, neighborhood disorder, and experiences with racial discrimination). Contextual stress in 8th grade was associated with aggressive behavior and substance use 2 years later for boys. For girls, contextual stress predicted later substance use, but not aggressive behavior. High academic competence and self-worth reduced the impact of contextual stress on substance use for boys. Implications for intervention and directions for future research on health risk behaviors among African American adolescents are discussed.

This study modeled children's trajectories of teacher rated aggressive-disruptive behavior problems assessed at six time points between the ages of 6 and 11 and explored the likelihood of being exposed to DSM-IV qualifying traumatic events and posttraumatic stress disorder (PTSD) in 837 urban first graders (71% African American) followed-up for 15 years. Childhood trajectories of chronic high or increasing aggressive-disruptive behavior distinguished males more likely to be exposed to an assaultive violence event as compared to males with a constant course of low behavior problems (OR(chronic high) = 2.8, 95% CI = 1.3, 6.1 and OR(increasing) = 4.5, 95% CI = 2.3, 9.1, respectively). Among females, exposure to traumatic events and vulnerability to PTSD did not vary by behavioral trajectory. The findings illustrate that repeated assessments of disruptive classroom behavior during early school years identifies more fully males at increased risk for PTSD-level traumatic events, than a single measure at school entry does.

Individuals not fully complying with their assigned treatments is a common problem encountered in randomized evaluations of behavioral interventions. Treatment group members rarely attend all sessions or do all “required” activities; control group members sometimes find ways to participate in aspects of the intervention. As a result, there is often interest in estimating both the effect of being assigned to participate in the intervention, as well as the impact of actually participating and doing all of the required activities. Methods known broadly as “complier average causal effects” (CACE) or “instrumental variables” (IV) methods have been developed to estimate this latter effect, but they are more commonly applied in medical and treatment research. Since the use of these statistical techniques in prevention trials has been less widespread, many prevention scientists may not be familiar with the underlying assumptions and limitations of CACE and IV approaches. This paper provides an introduction to these methods, described in the context of randomized controlled trials of two preventive interventions: one for perinatal depression among at-risk women and the other for aggressive disruptive behavior in children. Through these case studies, the underlying assumptions and limitations of these methods are highlighted.

Experiences with racism are a common occurrence for African American youth and may result in negative self perceptions relevant for the experience of depressive symptoms. This study examined the longitudinal association between perceptions of racism and depressive symptoms, and whether perceived academic or social control mediated this association, in a community epidemiologically-defined sample of urban African American adolescents (N = 500; 46.4% female). Structural equation modeling revealed that experiences with racism were associated with low perceived academic control, which in turn was associated with increased depressive symptoms. Findings suggest that experiences with racism can have long lasting effects for African American youth’s depressive symptoms, and highlight the detrimental effects of experiences with racism for perceptions of control in the academic domain. Implications for intervention are discussed.

This study explores gender differences in lifetime and recent substance use/internalizing behavior, childhood externalizing behavior, and gambling preferences among African-American youth gamblers. Data are from a prospective study of a community sample of 452 urban African-American youths who began at entry into first grade and were followed for ten years. Gambling was associated with high teacher ratings of childhood externalizing behaviors among males and with high parent ratings of childhood impulsivity and hyperactivity among both genders. Internalizing behavior was associated with female gambling. No male-female differences in substance use/lifetime conduct disorder among gamblers were noted. Gambling preferences/frequency differed across genders.

Cluster randomized trials (CRTs) have been widely used in field experiments treating a cluster of individuals as the unit of randomization. This study focused particularly on situations where CRTs are accompanied by a common complication, namely, treatment noncompliance or, more generally, intervention nonadherence. In CRTs, compliance may be related not only to individual characteristics but also to the environment of clusters individuals belong to. Therefore, analyses ignoring the connection between compliance and clustering may not provide valid results. Although randomized field experiments often suffer from both noncompliance and clustering of the data, these features have been studied as separate rather than concurrent problems. On the basis of Monte Carlo simulations, this study demonstrated how clustering and noncompliance may affect statistical inferences and how these two complications can be accounted for simultaneously. In particular, the effect of the intervention on individuals who not only were assigned to active intervention but also abided by this intervention assignment (complier average causal effect) was the focus. For estimation of intervention effects considering noncompliance and data clustering, an ML-EM estimation method was employed.

Assessed the separate and combined effects of behavioral parent training and cognitive-behavioral self-control therapy with 42 elementary school age children diagnosed as having attention deficit hyperactivity disorder. Subjects were randomly assigned to behavioral parent training (PT), self-control instruction (SC), or a combination of the two treatments (PT + SC). The combined treatment produced significantly more treatment responders at follow-up than either of the single-modality treatments in terms of parent reports of behavioral problems in the home. No treatment, however, had a significantly greater effect on school behavior than any other treatment.

OBJECTIVE. We sought to determine whether Healthy Steps for Young Children has sustained treatment effects at 5.5 years, given early findings demonstrating enhanced quality of care and improvements in selected parenting practices. METHODS. Healthy Steps was a clinical trial that incorporated developmental specialists and enhanced developmental services into pediatric care in the first 3 years of life. A total of 5565 children were enrolled at birth and followed through 5.5 years. Healthy Steps was evaluated at 6 randomization and 9 quasi-experimental sites. Computer-assisted telephone interviews were conducted with mothers when Healthy Steps children were 5.5 years of age. Outcomes included experiences seeking care, parent response to child misbehavior, perception of child's behavior, and parenting practices to promote development and safety. Logistic regression was used to estimate overall effects of Healthy Steps, adjusting for site and baseline demographic characteristics. RESULTS. A total of 3165 (56.9%) families responded to interviews (usual care: n = 1441; Healthy Steps: n = 1724). Families that had received Healthy Steps services were more satisfied with care (agreed that pediatrician/nurse practitioner provided support, 82.0% vs 79.0%; odds ratio: 1.25 [95% confidence interval: 1.02–1.53]) and more likely to receive needed anticipatory guidance (54.9% vs 49.2%; odds ratio: 1.33 [95% confidence interval: 1.13–1.57]) (all P < .05). They also had increased odds of remaining at the original practice (65.1% vs 61.4%; odds ratio: 1.19 [95% confidence interval: 1.01–1.39]). Healthy Steps families reported reduced odds of using severe discipline (slap in face/spank with object, 10.1% vs 14.1%; odds ratio: 0.68 [95% confidence interval: 0.54–0.86]) and increased odds of often/almost always negotiating with their child (59.8% vs 56.3%; odds ratio: 1.20 [95% confidence interval: 1.03–1.39]). They had greater odds of reporting a clinical or borderline concern regarding their child's behavior (18.1% vs 14.8%; odds ratio: 1.35 [95% confidence interval: 1.10–1.64]) and their child reading books (59.4% vs 53.6%; odds ratio: 1.16 [95% confidence interval: 1.00–1.35]). There were no effects on safety practices. CONCLUSIONS. Sustained treatment effects, albeit modest, are consistent with early findings. Universal, practice-based interventions can enhance quality of care for families with young children and can improve selected parenting practices beyond the duration of the intervention.

Using prospective data, we tested the hypothesis that early depressed mood was associated with an increased risk for initiation of alcohol use. In addition, we examined whether these associations varied according to the youths' report that alcohol consumption occurred with or without parental permission.The participants for these analyses were students, ages 9 to 13 years old, participating in a longitudinal study in an urban sample of public schools (n=2311). As part of the prospective annual assessments of the students, in 1990 through 1994, data on depressive mood and alcohol use were gathered. Logistic regression models were used to assess the association between the level of baseline depressed mood in 1990 and initiation of alcohol use between 1991 through 1994 in the sample of youth at risk for new onset drinking (n=1526). Other characteristics assessed in the analyses included age, sex, race-ethnicity, alcohol use by peers, neighborhood environment, and receipt of subsidized lunch.Higher level of early depressed mood was associated with an earlier and increased estimated risk of initiating alcohol use without parental permission for boys but not for girls. Depressed mood was not associated with alcohol use initiation that occurred with parental sanctions.Findings from the current study support the hypothesis that among urban youth, early depressed mood influences the initiation of alcohol consumption without parental permission for boys.

This paper reports the impact of two first- and second-grade classroom based universal preventive interventions on the risk of Suicide Ideation (SI) and Suicide Attempts (SA) by young adulthood. The Good Behavior Game (GBG) was directed at socializing children for the student role and reducing aggressive, disruptive behavior. Mastery Learning (ML) was aimed at improving academic achievement. Both were implemented by the teacher.The design was epidemiologically based, with randomization at the school and classroom levels and balancing of children across classrooms. The trial involved a cohort of first-grade children in 19 schools and 41 classrooms with intervention at first and second grades. A replication was implemented with the next cohort of first grade children with the same teachers but with little mentoring or monitoring.In the first cohort, there was consistent and robust GBG-associated reduction of risk for suicide ideation by age 19-21 years compared to youths in standard setting (control) classrooms regardless of any type of covariate adjustment. A GBG-associated reduced risk for suicide attempt was found, though in some covariate-adjusted models the effect was not statistically robust. No statistically significant impact on these outcomes was found for ML. The impact of the GBG on suicide ideation and attempts was greatly reduced in the replication trial involving the second cohort.A universal preventive intervention directed at socializing children and classroom behavior management to reduce aggressive, disruptive behavior may delay or prevent onset of suicide ideation and attempts. The GBG must be implemented with precision and continuing support of teachers.

Background Age of onset of substance use disorders in adolescence and early adulthood could be associated with higher rates of adult criminal incarceration in the U.S., but evidence of these associations is scarce. Methods Propensity score matching was used to estimate the association between adolescent-onset substance use disorders and the rate of incarceration, as well as incarceration costs and self-reported criminal arrests and convictions, of young men predominantly from African American, lower income, urban households. Age of onset was differentiated by whether onset of the first disorder occurred by age 16. Results Onset of a substance use disorder by age 16, but not later onset, was associated with a fourfold greater risk of adult incarceration for substance related offenses as compared to no disorder (0.35 vs. 0.09, P = 0.044). Onset by age 16 and later onset were both positively associated with incarceration costs and risk of arrest and conviction, though associations with crime outcomes were more consistent with respect to onset by age 16. Results were robust to propensity score adjustment for observable predictors of substance use in adolescence and involvement in crime as an adult. Conclusion Among young men in this high risk minority sample, having a substance use disorder by age 16 was associated with higher risk of incarceration for substance related offenses in early adulthood and with more extensive criminal justice system involvement as compared to having no disorder or having a disorder beginning at a later age.

The present study investigated the pathways between attention problems and depressive symptoms, particularly the role of academic incompetence, among a community sample of urban African American children. Results supported the hypothesized path models from inattention to depressive symptoms for girls and boys. Academic performance in the spring of first grade mediated the relationship between inattention in fall of first grade and depressive symptoms in spring of 3rd grade. The effects held when controlling for conduct problems and academic competence in first grade suggesting the path was specific to attention problems rather than a more general externalizing or school readiness pathway. Implications for designing interventions and prevention strategies for children with attention problems and depressive symptoms are discussed.

The authors prospectively examined childhood antecedents of exposure to traumatic events to estimate the risk of posttraumatic stress disorder (PTSD) among those exposed to trauma.Two consecutive cohorts of children entering first grade of a public school system in a large mid-Atlantic city in the mid-1980s were followed into young adulthood (mean age=21). Exposure to traumatic events and PTSD were assessed in 75% of the original cohort (N=1,698). Childhood assessments, conducted upon entry into the first grade, included standardized measures of reading readiness, teacher ratings of behavioral problems, and child self-reports about depression and anxiety. Family characteristics were assessed by parental report.Young adults who had been rated by their first grade teacher as having aggressive/disruptive behavior problems were more likely to experience traumatic assaultive violence events (e.g., being mugged/threatened with a weapon, badly beaten-up) (relative risk=2.6) but not PTSD following trauma exposure. Youths with high levels of self-rated depressive and anxious feelings in first grade were more likely to experience PTSD once exposed to trauma (relative risk=1.5). Youths who scored in the highest quartile on a reading test in the first grade were at lower risk for exposure to assaultive violence traumas.Childhood behavioral and depressive/anxious problems may influence the risk for PTSD directly by increasing the vulnerability to the PTSD effects of trauma exposure, and indirectly by increasing the likelihood of exposure to assaultive violence.

Exposure to chronic or severe acute stressors throughout the lifespan has been linked with numerous negative behavioral, emotional, cognitive, and physical consequences. Adolescence is considered to be a particularly vulnerable period given that the brain is experiencing dramatic developmental change during this time. The present study examined a sample of adolescents (N=125) considered to be at high risk for stress exposures and drug use by virtue of their environment and low income levels to identify possible neurocognitive (i.e., impulsivity, delay of gratification, emotional perception, and risky decision-making) and social competency mechanisms that may mediate this relationship. Using Mplus, a mediational model was tested using full information maximum likelihood estimates. Risky decision-making and poor social competency skills were related to previous stressful experiences; however, only social competencies mediated the effect of stressors on reports of past year marijuana, alcohol, and polydrug use. As such, stress appears to exert its negative impact through alterations in abilities to generate and execute prosocial decisions and behaviors. Interventions that directly address the effects of stress on social competencies may be especially important for children who have experienced adversity including those exposed to parental divorce, parental psychopathology, neglect or abuse, parental death, and poverty.

Taxometrics is a statistical tool that can be used to discern categories from continua. Taxometric analyses (MAXCOV and MAXEIG) were conducted in a large nonclinical sample (N=1,215) to determine whether extreme anxiety forms a distinct psychopathological category, an anxiety taxon. Anxiety was operationalized with self-report measures of subjective anxiety, anxious cognitive style, physiological arousal, and anxiety-related impairment. Procedures consistently identified a taxon with a prevalence of approximately 11%. Examination of the taxon's convergent and discriminant validity revealed that it reflects general distress rather than physiological arousal. Taxon membership showed some evidence of incremental validity. Language: en

Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition, recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.

Objective To examine the specificity of components of anxiety sensitivity (phrenophobia, fear of cardiovascular sensations, and fear of unsteadiness) to anxiety and depression in a sample of African-American adolescents. Method Participants were 527 African-American adolescents (238 females, mean age 13.8 years) who were originally recruited as first graders in 1993 to 1994 for participation in the second-generation Johns Hopkins Prevention Intervention Research Center trials. Youths completed measures of anxiety sensitivity and anxious and depressive symptoms in the spring of 2001. Associations between anxiety sensitivity and depression and anxiety were examined using hierarchical linear regressions. Results Anxiety sensitivity as a unitary construct was positively associated with symptoms of anxiety after adjusting for symptoms of depression. Fear of unsteadiness showed specificity to anxiety after adjusting for depression and phrenophobia. Phrenophobia was positively associated with anxiety and depression, after adjusting for the other symptom and fears of physical sensations. Conclusions Specificity of anxiety sensitivity to anxiety in a sample of African-American adolescents furthers understanding of the nature of anxiety sensitivity in this group and the potential roles of components of anxiety sensitivity in the development of psychopathology in general.

This article reports on the short-term impact of a school-based program using older adult volunteers and aimed at improved academic achievement and reduced disruptive classroom behavior in urban elementary school students. The Experience Corps® Baltimore (Maryland) program places a critical mass of older adult volunteers, serving 15 hours or more per week, in public schools to perform meaningful and important roles to improve the educational outcomes of children and the health and well-being of the volunteers. This article reports on the preliminary impact of the program on children in grades K-3. A total of 1,194 children in grades K-3 from six urban elementary schools participated in this pilot trial. At follow-up, third grade children whose schools were randomly selected for the program had significantly higher scores on a standardized reading test than children in the control schools, and there was a nonsignificant trend for improvement in alphabet recognition and vocabulary ability among kindergarten children in the program. Office referrals for classroom misbehavior decreased by about half in the Experience Corps schools, but remained the same in the control schools. Teachers had somewhat more favorable attitudes toward senior volunteers as a result of having older volunteers in the classroom, although the difference between the intervention and control schools was not statistically significant. In this pilot trial, the Experience Corps program led to selective improvements in student reading/academic achievement and classroom behavior while not burdening the school staff.

Objective To evaluate the utility of a teacher-rating instrument (TOCA-R) of aggressive behavior during elementary school years in identifying boys at risk for later violence. Method A community epidemiological sample of 415 public school boys was rated at six time points during elementary school regarding their level of aggressive/disruptive behavior. Violence was measured using juvenile police and court records. Results The risk for later violence varied as a function of the boys’ level of aggressive behavior. This relationship peaked in third grade, where more aggressive boys compared to less aggressive boys were twice as likely to commit later violent acts. In respect to identifying at-risk boys, three intervention scenarios were compared. When minimizing false positives, the optimal test was found in the fall of first grade, with 83% of the high-risk compared to 22% of the low-risk boys later having a violent arrest record. When minimizing false negatives, the optimal test was found in the spring of fourth grade (30% of the high-risk boys versus 0% of the low-risk boys). Focusing on both false positives and false negatives, the optimal test was found in the spring of third grade (52% of the high-risk boys versus 14% of the low-risk boys). Conclusions Early levels of aggressive behavior are strong and robust predictors of later violence but are of limited utility in the early identification of boys at risk. Consequently, universal interventions followed by selected/indicated interventions based on a multistage assessment promise the highest utility in preventing youth violence. Future research is needed to identify other indicators that can strengthen the screening utility of aggressive behavior.

The present study used general growth mixture modeling to identify pathways of antisocial behavior development within an epidemiological sample of urban, primarily African American boys. Teacher-rated aggression, measured longitudinally from 1st to 7th grade, was used to define growth trajectories. Three high-risk trajectories (chronic high, moderate, and increasing aggression) and one low-risk trajectory (stable low aggression) were found. Boys with chronic high and increasing trajectories were at increased risk for conduct disorder, juvenile and adult arrest, and antisocial personality disorder. Concentration problems were highest among boys with a chronic high trajectory and also differentiated boys with increasing aggression from boys with stable low aggression. Peer rejection was highest among boys with chronic high aggression. Interventions with boys with distinct patterns of aggression are discussed.

The objectives of the present study were four-fold. First, to determine the lifetime, last year, and 6-month prevalence and demographic correlates of suicidal behavior in a defined population of urban, African American young adults. Second, to determine the degree of mental health service utilization among attempters. Third, to study the comorbidity between mental disorders and suicidal behavior, along with the variation in the numbers and types of psychiatric disorders associated with attempts versus ideation only. Fourth, to examine gender differences in the psychiatric diagnoses associated with attempts and ideation. Data relevant to each of these objectives were gathered through structured interviews of 1,157 economically disadvantaged, African American young adults. Lifetime, last year, and 6-month prevalence rates for attempts were 5.3%, 1.2%, and 0.4%, respectively, whereas the lifetime and 6-month prevalence of ideation were 14% and 1.9%, respectively. Approximately two thirds of those who reported lifetime ideation, and a similar proportion of those who reported lifetime attempts, had a history of at least one lifetime psychiatric disorder. There were no gender differences in terms of the degree of risk for suicidal behavior (ideation or attempts) associated with any of the comorbid psychiatric diagnoses assessed. Despite the severity of most attempts, few attempters received mental health services in their lifetime or at the time of their most recent attempt.

Objective To examine the characteristics associated with barriers to children's mental health services, focusing on the effect of children's psychosocial problems on parents. Method Data come from a first-grade, prevention-intervention project conducted in Baltimore, Maryland. Analyses were restricted to 116 families who participated in seventh-grade interviews and indicated the index child needed services. The Services Assessment for Children and Adolescents was used to measure barriers to children's mental health services. Results More than 35% of parents reported a barrier to mental health services. Types of barriers included those related to structural constraints, perceptions of mental health, and perceptions of services (20.7%, 23.3%, and 25.9%, respectively). Although parenting difficulties were associated with all barriers (structural: OR=10.63, 95% CI: 2.37, 47.64; mental health: OR=8.31, 95% CI: 1.99, 34.79; services: OR=5.22, 95% CI: 1.56, 17.51), additional responsibilities related to attendance at meetings was associated only with structural barriers (OR = 5.49, 95% CI: 1.22, 24.59). Conclusions Researchers and policymakers interested in increasing children's access to mental health services should consider strategies to reduce barriers related to perceptions about mental health problems and services, in addition to structural barriers. Particular attention should be given to programs that focus on the needs of families who are most affected by their child's psychosocial problems.

A primary objective of the present study was to determine the validity of first graders' self-reports of depressed mood and feelings. To that end, the prognostic power of first grade self-reports of depressed mood and feelings was examined with respect to later psychopathology and adaptive functioning in a population of urban school children (N = 946). First grade self-reports of depressed mood predicted later child academic functioning, the need for and use of mental health services, suicidal ideation, and a diagnosis of major depressive disorder by age 14. The prognostic power of these early self-reports suggests that children as young as 5 or 6 years of age are capable of providing valid reports of depressed mood and feelings.

In this chapter we elaborate on the principles and theoretical perspectives that have formed the foundation for the Johns Hopkins University Prevention Intervention Research Center’s (JHU-PIRC) work over the last decade. During this time, we fielded two sets of classroom-based, universal preventive intervention trials in 28 Baltimore City schools with three cohorts of first graders. We also fielded a universal, or primary, preventive intervention trial, along with a nested mental health services intervention, in three Baltimore Head Start centers. In each trial, the focus was on the early risk behaviors of poor academic readiness and aggressive and shy behavior and their distal correlates of antisocial behavior, substance abuse, and anxious and depressive symptoms and disorders. We believe the principles and perspectives that have guided our preventive and services interventions work are equally applicable to researchers in the child clinical and pediatric psychology arenas. As will become apparent, we advocate an interdisciplinary approach to mental health research, which requires an integration of the life course developmental, public health, community epidemiological, and experimental trials perspectives. We provide the reader with examples from our own research as well as that of others that we hope will highlight the strengths of our developmental epidemiological framework and its applicability to the challenges faced by child clinical and pediatric psychology researchers. Among the topics addressed are: (1) the need for grounding our clinical and basic research in developmental theory (Coie et al., 1993; Kellam & Rebok, 1992; Reid, 1993; Sandler et al., 1992); (2) the use of intervention trials as tests of our etiologic models of development and psychopathology (Coie et al., 1993; Kellam & Rebok, 1992; Reid, 1993; Sandler et al, 1992); (3) the benefits of a public health perspective with respect to the dissemination and acceptance of interventions found to be efficacious in research settings (Kellam & Rebok, 1992); (4) the pitfalls associated with the use of clinic samples and samples of convenience in clinical research and research on development and psychopathology (Greenley & Mechanic, 1976; Greenley, Mechanic, & Clearly, 1987); and (5) economically and logistically feasible methods for defining and selecting research populations in accord with epidemiological principles (Gordis, 1996).

In a community-defined, epidemiologic sample in East Baltimore, we examined grandmothers' rates of co-residence and their involvement in four parenting activities. Co-residence rates exceeded the national average. Six types of family households with grandmothers were identified, and their frequency varied by race. Neither grandmother age nor employment was associated with grandmothers' parenting involvement, although family structure was. Grandmothers who were the sole parent (21%) or co-parent with a grandfather (6.5%) were most involved in child care and had the fewest number of helpers. Grandmothers living with single mothers (41%) were the next most involved, while grandmothers in mother/father households (9%) were least involved.

This study investigates the levels and rates of growth of conduct problem behaviors over time in an urban sample of American youth. Our hypotheses focused on differences between the sexes and between youths with and those without early use of alcohol without parental permission.Data for this study are from an ongoing epidemiologic study of urban public school students, recruited originally at the time of their entry into Grades 1-2 between 1985 and 1987. Each spring, from 1991 to 1993, a total of 1,212 students were interviewed privately for this study. A total of 408 (54.2% female, 84.7% black) respondents met study criteria as either an "early unsanctioned alcohol user" or an "abstainer." These youths constitute the analytic subsample.Estimates from longitudinal growth modeling analyses showed that boys and girls had different initial levels of conduct problem behaviors, but similar rates of growth. Both the initial level of conduct problem behaviors and the rates of growth were greater for early unsanctioned alcohol users as compared to abstainers. In a combined analysis the difference between early unsanctioned alcohol users and abstainers seemed to offset the initially observed sex difference.Early alcohol use without parental permission was associated with higher levels of conduct problem behaviors by the ages of 10-12 years and higher rates of growth in those behaviors during the transition from late childhood to early adolescence for both boys and girls, although the levels differed by sex. It may be that unsanctioned early alcohol use puts youths on an accelerated pathway of conduct problem behaviors and development of conduct disorder in adolescence.