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A new emissive guanosine analog CF3thG, constructed by a single trifluoromethylation step from the previously reported thG, displays red-shifted absorption and emission spectra compared to its precursor. The impact of solvent type and polarity on the photophysical properties of CF3thG suggests that the electronic effects of the trifluoromethyl group dominate its behavior and demonstrates its susceptibility to microenvironmental polarity changes. In vitro transcription initiations using T7 RNA polymerase, initiated with CF3thG, result in highly emissive 5'-labeled RNA transcripts, demonstrating the tolerance of the enzyme toward the analog. Viability assays with HEK293T cells displayed no detrimental effects at tested concentrations, indicating the safety of the analog for cellular applications. Live cell imaging of the free emissive guanosine analog using confocal microscopy was facilitated by its red-shifted absorption and emission and adequate brightness. Real-time live cell imaging demonstrated the release of the guanosine analog from HEK293T cells at concentration-gradient conditions, which was suppressed by the addition of guanosine.

BackgroundIn contrast to prior research, our study presents longitudinal comparisons of the EQ-5D-5L and Patient-Reported Outcomes Measurement Information System (PROMIS) preference (PROPr) scores. This fills a gap in the literature, providing a much-needed understanding of these preference-based measures and their applications in healthcare research. Furthermore, our study provides equations to estimate one measure from the other, a tool that can significantly facilitate comparisons across studies.MethodsWe administered a health survey to 4,098 KnowledgePanel® members living in the United States. A subset of 1,256 (82% response rate) with back pain also completed the six-month follow-up survey. We then conducted thorough cross-sectional and longitudinal analyses of the two measures, including product-moment correlations between scores, associations with demographic variables, and health conditions. To estimate one measure from the other, we used ordinary least squares (OLS) regression with the baseline data from the general population.ResultsThe correlation between the EQ-5D-5L and PROPr scores was 0.69, but the intraclass correlation was only 0.34 because the PROPr had lower (less positive) mean scores on the 0 (dead) to 1 (perfect health) continuum than the EQ-5D-5L. The associations between the two preference measures and demographic variables were similar at baseline. The product-moment correlation between unstandardized beta coefficients for each preference measure regressed on 22 health conditions was 0.86, reflecting similar patterns of unique associations. Correlations of change from baseline to 6 months in the two measures with retrospective perceptions of change were similar. Adjusted variance explained in OLS regressions predicting one measure from the other was 48%. On average, the predicted values were within a half-standard deviation of the observed EQ-5D-5L and PROPr scores. The beta-binomial regression model slightly improved over the OLS model in predicting the EQ-5D-5L from the PROPr but was equivalent to the OLS model in predicting the PROPr.ConclusionDespite substantial mean differences, the EQ-5D-5L and PROPr have similar cross-sectional and longitudinal associations with other variables. We provide the OLS regression equations for use in cost-effectiveness research and meta-analyses. Future studies are needed to compare these measures with different conditions and interventions to provide more information on their relative validity.

Abstract: There is increasing interest in measuring “whole person” health and deriving an overall summary score. Underlying physical and mental health dimensions have been found consistently in prior studies of self-reported health, but it is unclear whether a single underlying health factor is supported across health domains. We examine the dimensionality of nine domains from the Patient-Reported Outcomes Measurement Information System (PROMIS®)-29 + 2 profile measure, the PROMIS social isolation scale, the Personal Wellbeing Index, and the EQ-5D-5L preference score in a sample of 1256 adults with back pain in the United States: mean age was 55 (range 18–94), 52% female, 74% non-Hispanic White, 61% were married or living with a spouse, and the highest level of education completed for 35% of the sample was a high school degree or general education diploma. The sample reported substantially more pain intensity, pain interference, and worse physical function than the U.S. general population. Product-moment correlations among the measures ranged from 0.25 to 0.83 (median correlation = 0.52). A bifactor model showed that a general health factor accounted for most of the covariation among measures, but physical function, pain interference, and pain intensity loaded slightly more on the physical health group factor than on the general health factor. The study provides some support for combining multiple aspects of self-reported health into an overall indicator of whole-person health.

PurposeThe Patient-Reported Outcomes Measurement Information System® (PROMIS)-16 assesses the same multi-item domains but does not include the pain intensity item in the PROMIS-29. We evaluate how well physical and mental health summary scores estimated from the PROMIS-16 reproduce those estimated using the PROMIS-29.MethodsAn evaluation of data collected from 4130 respondents from the KnowledgePanel. Analyses include confirmatory factor analysis to assess physical and mental health latent variables based on PROMIS-16 scores, reliability estimates for the PROMIS measures, mean differences and correlations of scores estimated by the PROMIS-16 with those estimated by the PROMIS-29, and associations between differences in corresponding PROMIS-16 and PROMIS-29 scores by sociodemographic characteristics.ResultsA two-factor (physical and mental health) model adequately fits the PROMIS-16 scores. Reliability estimates for the PROMIS-16 measures were slightly lower than for the PROMIS-29 measures. There were minimal differences between PROMIS physical and mental health summary scores estimated using the PROMIS-16 or the PROMIS-29. PROMIS-16 and PROMIS-29 score differences by sociodemographic characteristics were small. Using the PROMIS pain intensity item when scoring the PROMIS-16 produced similar estimates of physical and mental health summary scores.ConclusionThe PROMIS-16 provides similar estimates of the PROMIS-29 physical and mental health summary scores. The high reliability of these scores indicates they are accurate enough for use with individual patients.

BackgroundAn increasing number of states have laws for the legal sale of recreational and medical cannabis out of brick-and-mortar storefront locations. Given the proliferation of cannabis outlets and their potential for impact on local economies, neighborhood structures, and individual patterns of cannabis use, it is essential to create practical and thorough methods to capture the location of such outlets for research purposes. However, methods used by researchers vary greatly between studies and often do not include important information about the retailer’s license status and storefront signage. ObjectiveThe aim of this study was to find methods for locating and observing cannabis outlets in Los Angeles County after the period when recreational cannabis retailers were granted licenses and allowed to be open for business. MethodsThe procedures included searches of online cannabis outlet databases, followed by methods to verify each outlet’s name, address, license information, and open status. These procedures, conducted solely online, resulted in a database of 531 outlets. To further verify each outlet’s information and collect signage data, we conducted direct observations of the 531 identified outlets. ResultsWe found that 80.9% (430/531) of these outlets were open for business, of which 37.6% (162/430) were licensed to sell cannabis. Unlicensed outlets were less likely to have signage indicating the store sold cannabis, such as a green cross, which was the most prevalent form of observed signage. Co-use of cannabis and tobacco/nicotine has been found to be a substantial health concern, and we observed that 40.6% (175/430) of cannabis outlets had a tobacco/nicotine outlet within sight of the cannabis outlet. Most (350/430, 81.4%) cannabis outlets were located within the City of Los Angeles, and these outlets were more likely to be licensed than outlets outside the city. ConclusionsThe findings of this study suggest that online searches and observational methods are both necessary to best capture accurate and detailed information about cannabis outlets. The methods described here can be applied to other metropolitan areas to more accurately capture the availability of cannabis in an area.

PURPOSE: The Patient-Reported Outcomes Measurement and Information System (PROMIS®): includes the PROMIS-29 physical and mental health summary and the PROMIS global physical and mental health scores. It is unknown how these scores coincide with one another. This study examines whether the scores yield similar or different information. METHODS: The PROMIS-29 and the PROMIS global health items were administered to 5804 adults from Amazons Mechanical Turk (MTurk) in 2021-2022 and to 4060 adults in the Ipsos KnowledgePanel (KP) in 2022. RESULTS: The median age of those in MTurk (KP) was 36 (54) and 53% (50%) were male. Mean T-scores on the PROMIS-29 and PROMIS global physical health scales were similar, but PROMIS global mental health was 3-4 points lower than the PROMIS-29 mental health summary score. Product-moment correlations ranged from 0.69 to 0.81 between the PROMIS-29 physical health and PROMIS global physical health scales and 0.56-0.69 between the mental health scales. Multi-trait multimethod analyses indicated that only a small proportion of the correlations between the two methods of measuring mental health were significantly more highly correlated with one another than correlations between physical and mental health. CONCLUSIONS: PROMIS-29 and PROMIS global mental health scales provide different information and, therefore, study conclusions may vary depending on which measure is used. Interpretation of results needs to consider that the PROMIS-29 mental health scale is a weighted combination of specific domains while the PROMIS global mental health scale is based on general mental health perceptions. Further comparisons of methods of assessing mental health are needed.

Abstract: Background: The Patient-Reported Outcomes Measurement and Information System (PROMIS®) global health items (global-10) yield physical and mental health scale scores and the PROMIS-Preference (PROPr) scoring system estimated from PROMIS domain scores (e.g., PROMIS-29 + 2) produces a single score anchored by 0 (dead or as bad as being dead) to 1 (full health). A link between the PROMIS global-10 and the PROPr is needed. Methods: The PROMIS-29 + 2 and the PROMIS global-10 were administered to 4102 adults in the Ipsos KnowledgePanel in 2022. The median age was 52 (range 18–94), 50% were female, 70% were non-Hispanic White, and 64% were married or living with a partner. The highest level of education completed for 26% of the sample was a high school degree or general education diploma and 44% worked full-time. We estimated correlations of the PROPr with the PROMIS global health items and the global physical and mental health scales. We examined the adjusted R2 and estimated correlations between predicted and observed PROPr scores. Results: Product-moment correlations between the PROMIS global health items and the PROPr ranged from 0.50 to 0.63. The PROMIS global physical health and mental health scale scores correlated 0.74 and 0.60, respectively, with the PROPr. The adjusted R2 in the regression of the PROPr on the PROMIS global health items was 64%. The equated PROPr preference scores correlated (product-moment) 0.80 (n = 4043; p

Emerging adulthood shapes personal, professional, and overall well-being through identity exploration. This study addresses a gap in the minority identity literature by investigating how urban AI/AN emerging adults think about their identity and discussing challenges and protective factors associated with exploring their identity holistically. This mixed-methods study created a sampling framework based on discrimination experiences, cultural identity, social network support, mental health, and problematic substance use. We recruited 20 urban AI/AN emerging adults for interviews. We sought to gain deeper insights into their experiences and discussions surrounding identity formation and exploration. We provide descriptives for demographic characteristics and conducted a thematic analysis of the qualitative data from the interviews. Four themes emerged: a) being an urban AI/AN emerging adult means recognizing that ones identity is multifaceted; b) a multifaceted identity comes with tension of living in multiple worlds; c) the trajectory of ones identity grows over time to a deeper desire to connect with Native American culture; and d) understanding ones Native American background affects ones professional trajectory. Findings underscore the importance of developing programs to support well-being and identity development through cultural connection for urban AI/AN emerging adults.

The 21kD GTPase Rac is an evolutionarily ancient regulator of cell shape and behavior. Rac2 is predominantly expressed in hematopoietic cells where it is essential for survival and motility. The hyperactivating mutation Rac2E62K also causes human immunodeficiency, although the mechanism remains unexplained. Here, we report that in Drosophila, hyperactivating Rac stimulates ovarian cells to cannibalize neighboring cells, destroying the tissue. We then show that hyperactive Rac2E62K stimulates human HL60-derived macrophage-like cells to engulf and kill living T cell leukemia cells. Primary mouse Rac2+/E62K bone-marrow-derived macrophages also cannibalize primary Rac2+/E62K T cells due to a combination of macrophage hyperactivity and T cell hypersensitivity to engulfment. Additionally, Rac2+/E62K macrophages non-autonomously stimulate wild-type macrophages to engulf T cells. Rac2E62K also enhances engulfment of target cancer cells by chimeric antigen receptor-expressing macrophages (CAR-M) in a CAR-dependent manner. We propose that Rac-mediated cell cannibalism may contribute to Rac2+/E62K human immunodeficiency and enhance CAR-M cancer immunotherapy.

OBJECTIVES: Assess associations between social networks and urban American Indian/Alaska Native emerging adults alcohol, cannabis, and opioid use and intentions. METHOD: American Indian/Alaska Native participants ages 18-25 (N = 150; 86% female) were recruited across the United States from 12/20 to 10/21 via social media. Participants named up to 15 people whom they talked with most over the past 3 months and reported who (a) used alcohol and cannabis heavily or used other drugs (e.g., opioid use), (b) engaged in traditional practices, and (c) provided support. They also reported past 3-month alcohol, cannabis, and opioid use and intentions to use. RESULTS: Having a higher proportion of network members engaging in regular cannabis and heavy alcohol use (but not other drugs) was associated with more frequent cannabis use and stronger cannabis use intentions. Participants with higher proportions of members engaging in heavy alcohol use, regular cannabis use, or other drug use and who did not engage in traditional practices were more likely to report cannabis use and greater intentions to use cannabis and drink alcohol. In contrast, participants with higher proportions of network members engaging in traditional practices and who did not report heavy alcohol use, regular cannabis use, or other drug use were less likely to report intentions to use cannabis or drink alcohol. CONCLUSIONS: Findings emphasize what many studies have shown among various racial/ethnic groups-having network members who use substances increases the chance of use. Findings also highlight that traditional practices may be an important part of the prevention approach for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

BackgroundThe extent to which different measures of back pain impact represent an underlying common factor has implications for decisions about which one to use in studies of pain management and estimating one score from others.AimsTo determine if different self-report back pain impact measures represent an underlying pain latent variable and estimate associations with it.MethodSeven pain impact measures completed by Amazon Mechanical Turk adults are used to estimate internal consistency reliability and associations: Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), short form of the Örebro Musculoskeletal Pain Questionnaire (OMPQ), Subgroups for Targeted Treatment (STarT) Back Tool, the Graded Chronic Pain Scale (GCPS) disability score, PEG (Pain intensity, interference with Enjoyment of life, interference with General activity), and Impact Stratification Score (ISS).ResultsThe sample of 1,874 adults with back pain had an average age of 41 and 52% were female. Sixteen percent were Hispanic, 7% non-Hispanic Black, 5% non-Hispanic Asian, and 71% non-Hispanic White. Internal consistency reliability estimates ranged from 0.710 (OMPQ) to 0.923 (GCPS). Correlations among the measures ranged from 0.609 (RMDQ with OMPQ) to 0.812 (PEG with GCPS). Standardized factor loadings on the pain latent variable ranged from 0.782 (RMDQ) to 0.870 (ISS).ConclusionsScores of each measure can be estimated from the others for use in research.

BackgroundResearchers have implemented multiple approaches to increase data quality from existing web-based panels such as Amazon's Mechanical Turk (MTurk).ObjectiveThis study extends prior work by examining improvements in data quality and effects on mean estimates of health status by excluding respondents who endorse 1 or both of 2 fake health conditions ("Syndomitis" and "Chekalism").MethodsSurvey data were collected in 2021 at baseline and 3 months later from MTurk study participants, aged 18 years or older, with an internet protocol address in the United States, and who had completed a minimum of 500 previous MTurk "human intelligence tasks." We included questions about demographic characteristics, health conditions (including the 2 fake conditions), and the Patient Reported Outcomes Measurement Information System (PROMIS)-29+2 (version 2.1) preference-based score survey. The 3-month follow-up survey was only administered to those who reported having back pain and did not endorse a fake condition at baseline.ResultsIn total, 15% (996/6832) of the sample endorsed at least 1 of the 2 fake conditions at baseline. Those who endorsed a fake condition at baseline were more likely to identify as male, non-White, younger, report more health conditions, and take longer to complete the survey than those who did not endorse a fake condition. They also had substantially lower internal consistency reliability on the PROMIS-29+2 scales than those who did not endorse a fake condition: physical function (0.69 vs 0.89), pain interference (0.80 vs 0.94), fatigue (0.80 vs 0.92), depression (0.78 vs 0.92), anxiety (0.78 vs 0.90), sleep disturbance (-0.27 vs 0.84), ability to participate in social roles and activities (0.77 vs 0.92), and cognitive function (0.65 vs 0.77). The lack of reliability of the sleep disturbance scale for those endorsing a fake condition was because it includes both positively and negatively worded items. Those who reported a fake condition reported significantly worse self-reported health scores (except for sleep disturbance) than those who did not endorse a fake condition. Excluding those who endorsed a fake condition improved the overall mean PROMIS-29+2 (version 2.1) T-scores by 1-2 points and the PROMIS preference-based score by 0.04. Although they did not endorse a fake condition at baseline, 6% (n=59) of them endorsed at least 1 of them on the 3-month survey and they had lower PROMIS-29+2 score internal consistency reliability and worse mean scores on the 3-month survey than those who did not report having a fake condition. Based on these results, we estimate that 25% (1708/6832) of the MTurk respondents provided careless or dishonest responses.ConclusionsThis study provides evidence that asking about fake health conditions can help to screen out respondents who may be dishonest or careless. We recommend this approach be used routinely in samples of members of MTurk.

Alzheimer's disease (AD) pathologies were discovered in the accessible neurosensory retina. However, their exact nature and topographical distribution, particularly in the early stages of functional impairment, and how they relate to disease progression in the brain remain largely unknown. To better understand the pathological features of AD in the retina, we conducted an extensive histopathological and biochemical investigation of postmortem retina and brain tissues from 86 human donors. Quantitative examination of superior and inferior temporal retinas from mild cognitive impairment (MCI) and AD patients compared to those with normal cognition (NC) revealed significant increases in amyloid β-protein (Aβ42) forms and novel intraneuronal Aβ oligomers (AβOi), which were closely associated with exacerbated retinal macrogliosis, microgliosis, and tissue atrophy. These pathologies were unevenly distributed across retinal layers and geometrical areas, with the inner layers and peripheral subregions exhibiting most pronounced accumulations in the MCI and AD versus NC retinas. While microgliosis was increased in the retina of these patients, the proportion of microglial cells engaging in Aβ uptake was reduced. Female AD patients exhibited higher levels of retinal microgliosis than males. Notably, retinal Aβ42, S100 calcium-binding protein B+ macrogliosis, and atrophy correlated with severity of brain Aβ pathology, tauopathy, and atrophy, and most retinal pathologies reflected Braak staging. All retinal biomarkers correlated with the cognitive scores, with retinal Aβ42, far-peripheral AβOi and microgliosis displaying the strongest correlations. Proteomic analysis of AD retinas revealed activation of specific inflammatory and neurodegenerative processes and inhibition of oxidative phosphorylation/mitochondrial, and photoreceptor-related pathways. This study identifies and maps retinopathy in MCI and AD patients, demonstrating the quantitative relationship with brain pathology and cognition, and may lead to reliable retinal biomarkers for noninvasive retinal screening and monitoring of AD.

IntroductionThe Impact Stratification Score (ISS) is a measure of the impact of chronic low back pain (LBP) consisting of nine Patient-Reported Outcomes Measurement Information System (PROMIS-29) items, but no studies have examined the ISS or its association with psychological symptoms in military samples. This study examines longitudinal associations between psychological symptoms and the ISS among military service members.Material and methodsThe study involved secondary data analysis of a sample of active duty U.S. military service members aged 18-50 years with LBP (n = 733). Participants completed the PROMIS-29 at three time points during treatment: baseline (time 1, T1), week 6 of treatment (time 2, T2), and week 12 of treatment (time 3, T3). The impact of LBP was quantified using the ISS (ranging from 8 = least impact to 50 = greatest impact). Psychological symptoms were assessed as PROMIS-29 anxiety and depression scores. Separate autoregressive cross-lagged models examined reciprocal associations of ISSs with anxiety, depression, and emotional distress scores from T1 to T3.ResultsWithin each time point, the ISS was significantly and positively correlated with anxiety and depression. In autoregressive cross-lagged models, anxiety and depression predicted the ISS at the next time point and associations were similar in magnitude (e.g., anxiety T2 to ISS T3: β = 0.12, P

Among those with low back pain (LBP), individuals with chronic LBP (CLBP) face different treatment recommendations and incur the majority of suffering and costs. However, the way CLBP has been defined varies greatly. This study used a scoping review and qualitative and quantitative analyses of data from LBP patients to explore this variation. CLBP in most recent randomized controlled trials (RCTs) was defined by duration of pain, most commonly ≥3 months. However, individuals with LBP most often define CLBP by frequency. CLBP has also been defined using a combination of duration and frequency (16% of RCTs and 20% of individuals), including 6% of recent RCTs that followed the NIH Pain Consortium research task force (RTF) definition. Although not a defining characteristic of CLBP for individuals, almost 15% of recent RCTs required CLBP to have a healthcare provider diagnosis. In our LBP sample moving from ≥3 months to the RTF definition reduced the CLBP group size by 25% and resulted in a group that used more pain management options and reported worse health across all outcome measures. A pain duration definition offers ease of application. However, refinements to this definition (eg, RTF) can identify those who may be better intervention targets. PERSPECTIVE: This article presents the definitions used for CLBP by researchers and individuals, and the impact of these definitions on pain management and health outcomes. This information may help researchers choose better study inclusion criteria and clinicians to better understand their patients' beliefs about CLBP.

ObjectiveTo crosswalk the National Institutes of Health (NIH) Pain Consortium's Research Task Force proposed Impact Stratification Score (ISS) to the PEG (Pain Intensity, Interference With Enjoyment of Life, Interference With General Activity) Scale.DesignCross-sectional data collected in 2021. Ordinary least squares regression analyses of ISS and PEG.SettingAmazon Mechanical Turk workers.Participants1931 adults with back pain with an average age of 41 (range, 19-77); 48% were female, 16% Hispanic, 7% non-Hispanic Black, 5% non-Hispanic Asian, and 71% non-Hispanic White (N=1931).InterventionsNot applicable.Main outcome measuresThe Patient-Reported Outcomes Measurement Information System (PROMIS)-29+2 v2.1 survey that includes the ISS, and the 3-item PEG.ResultsThe ISS and PEG had a correlation coefficient of 0.74. The ISS accounted for 55% of the adjusted variance in the PEG and the standardized average deviation between observed and predicted scores (normalized mean absolute error) was 0.53. Likewise, the PEG explained 55% of the variance in the ISS with a normalized mean absolute error of 0.52.ConclusionsThis study provides a crosswalk between the ISS and PEG that can be used to predict one from the other. The regression equations can facilitate comparisons in studies that use different measures.

Many people believe that “living happily ever after” involves finding a romantic partner. Regardless, it seems obvious that at least some single people are happier than some coupled people. But how likely is it, and what factors predict whether singles will be as happy as their coupled peers? The present paper addressed these questions via a secondary analysis of an existing cross-sectional dataset (N = 2,000) of coupled (n = 1,438) and single (n = 562) adults. We identified 10 candidate predictors of life satisfaction, seven of which were significant in multiple regression models. Using the seven significant predictors as indicators in latent profile analysis (LPA), we identified four distinct profiles (or groups) of coupled adults and six distinct profiles of single adults. We then further conceptualized these profiles in terms of interpersonal indicators (friend satisfaction, closest friend intimacy, family satisfaction, and romantic satisfaction) and intrapersonal indicators (self-esteem, perceived stress, and physical health). Some profiles had very favorable levels of interpersonal and intrapersonal indicators and some had very unfavorable levels, while several profiles fell in between the two extremes with a range of nuances. Overall, people with favorable levels were happier than those with unfavorable levels—regardless of their relationship status, but disadvantages in one area (e.g., self-esteem) could be offset by advantages in another area (e.g., friendship satisfaction). Most importantly, in comparing single and coupled profiles directly, we found that the vast majority of single adults follow a range of life satisfaction patterns (from happy to unhappy) that is nearly identical to that of their coupled peers.

In homage to the life and work of Ed Diener (1946–2021), the present study assessed the dimensions of the tripartite model (positive affect, negative affect, and life satisfaction) and two additional dimensions (domain satisfaction and happiness) to investigate the structure of subjective well-being using exploratory factor analysis and the bifactor model. Specifically, we tested whether these five dimensions belong to an essentially unidimensional subjective well-being construct. Towards this goal, we used a large, previously collected dataset closely matched to the U.S. census (N = 2,000, ages 18–65+ ; 52.4% female; 66.3% White; 14.9% Hispanic; 12% Black) and selected 24 items representing the five dimensions. Our results showed that all 24 items were internally consistent and highly correlated. Exploratory factor analyses revealed there were five underlying factors best characterizing the data. When fit to the bifactor model, a strong underlying general subjective well-being factor emerged. Additionally, general factor scores were highly reliable according to conventional reliability standards. A confirmatory factor analysis also supported the bifactor structure of subjective well-being. Overall, our findings suggest all 24 items from the five dimensions reflect one essentially unidimensional construct, which can be combined into a single subjective well-being score. Domain satisfaction and subjective happiness both belong to subjective well-being in the same way that the original three dimensions of life satisfaction, negative affect, and positive affect do.

OBJECTIVE: Sleep is a multi-dimensional health behavior associated with elevated risk of substance use. This is the first study to utilize a latent class approach to characterize sleep health across multiple dimensions and across time from late adolescence to emerging adulthood, and to examine associations with alcohol and cannabis use trajectories. METHODS: The sample included 2995 emerging adults (mean ages = 18 to 24 years across six waves of data collection; 54% female) who provided data on sleep dimensions (quality, duration, and social jetlag) and frequency and consequences of alcohol and cannabis use. Longitudinal latent class analysis (LLCA) models characterized participants according to the three sleep dimensions. Latent growth models examined trajectories of frequency and consequences of alcohol or cannabis use over time among emergent sleep classes, with and without controlling for covariates. RESULTS: LLCA models identified four sleep classes: good sleepers (n = 451; 15.2%); untroubled poor sleepers (n = 1024; 34.2%); troubled, moderately good sleepers (n = 1056; 35.3%); and suboptimal sleepers (n = 460; 15.4%). Good sleepers reported significantly lower levels of alcohol or cannabis use and consequences, and less of an increase in alcohol consequences as compared to suboptimal sleepers. CONCLUSIONS: Persistent poor sleep health was associated with higher levels of alcohol and cannabis use and consequences, and greater increases in alcohol-related consequences during the transition from late adolescence to emerging adulthood. Findings have important clinical implications, highlighting that addressing multi-dimensional sleep health may be an important, novel target of intervention to reduce substance use frequency and consequences.

It is challenging to synthesize findings across studies of pain impact. This study develops a link to estimate the Patient-Reported Outcomes Measurement Information System (PROMIS) global health measure from the 3-item Pain intensity, interference with Enjoyment of life, interference with General activity (PEG) scale. The PROMIS and PEG items were administered to 795 adults (average age = 51; 54% female, 79% White). We estimated correlations among the PEG and PROMIS items and conducted factor analysis to identify the best subset of PROMIS items for linking to the PEG. An item response theory graded response model was estimated to link the PEG with the 4-item PROMIS global physical health scale. A categorical single-factor model and a bifactor model provided support for a single dimension for the PEG and PROMIS global physical health items. The product-moment correlation between estimated PROMIS global physical health scale from the PEG and the actual global physical health score was .74. The mean difference between estimated PROMIS global physical health scale score from the PEG and the observed global physical health score was less than a T-score point. This study makes it possible to estimate the average global physical health for group-level comparisons in research that includes the PEG. PERSPECTIVE: This article describes an empirical link of the PEG to the PROMIS global physical health scale that makes it possible to estimate the average global physical health in studies that include the PEG. This link can facilitate comparisons among studies that have not administered the PEG or the PROMIS global health scale.

ObjectiveIn this study, we examined the impact of a range of methods to improve data quality on the demographic and health status representativeness of Amazon Mechanical Turk (MTurk) samples.MethodsWe developed and field-tested a general survey of health on MTurk in 2017 among 5755 participants and 2021 among 6752 participants. We collected information on participant demographic characteristics and health status and implemented different quality checks in 2017 and 2021.ResultsAdding data quality checks generally improves the representativeness of the final MTurk sample, but there are persistent differences in mental health and pain conditions, age, education, and income between the MTurk population and the broader US population.ConclusionWe conclude that data quality checks improve the data quality and representativeness.

BackgroundIn 2014, the National Institutes of Health Pain Consortium Research Task Force recommended that patients with chronic low back pain (CLBP) be stratified by its impact on their lives. They proposed the Impact Stratification Score (ISS) to help guide therapy and facilitate study comparability. The ISS has been evaluated as a continuous measure, but not for use as a stratification or classification scheme.ObjectivesIdentify the characteristics of successful schemes to inform the use of the ISS for stratification or classification.Study designScoping review of the peer-reviewed literature.MethodsSearch of PubMed, CINAHL, and APA PsycInfo to identify patient self-report-based classification schemes applicable to CLBP. Data were captured on the methods used for each scheme's development, the domains covered, their scoring criteria and what the classification has successfully measured. The study was reviewed and approved by the RAND Human Subjects Protection Committee (2019-0651-AM02).ResultsThe search identified 87 published articles about the development and testing of 5 classification schemes: 1) The Subgroups for Targeted Treatment (STarT) Back Screening Tool, 2) Multiaxial Assessment of Pain, 3) Graded Chronic Pain Scale, 4) Back Pain Classification Scale, and 5) Chronic Pain Risk Score. All have been shown to be predictive of future outcomes and the STarT Back has been found useful in identifying effective classification-specific treatment. Each scheme had a different classification scoring structure, was developed using different methods, and 3 included domains not found in the ISS.LimitationsExpanding the search to other databases may have identified more classification schemes. Our minimum number of publications inclusion criterion eliminated dozens of cluster analyses, some of which may have eventually been replicated.ConclusionsThe methods used to develop these successful classification schemes, especially those that use straightforward scoring schemes, should be considered for use in the development of a scheme based on the ISS.

The quality of individuals’ social relationships consistently predicts greater well-being. But little is known about the relative importance of different relationship types for life satisfaction, including the relative importance of friendships compared to other types of relationships. Some have theorized that one intimate relationship is all you need. However, romantic partners, family, and friends may contribute uniquely or interactively to well-being. The current study assessed life satisfaction and relationship satisfaction in survey data collected from a large, diverse sample of respondents. Satisfaction with each type of relationship was significantly and independently associated with life satisfaction, over and above other variables in the model. Friendship (not family) interacted with intimate relationships: when respondents were highly satisfied with their intimate relationships, they were happy with their lives regardless of friendship quality. But when they were unhappy with their intimate relationships, they were only happy with their lives if they had good friends.

BackgroundTrajectory studies have consistently shown that alcohol and cannabis (AC) use during emerging adulthood (EA) affect functioning; however, few studies examine whether racial/ethnic disparities may occur at similar levels of use.MethodsWe conducted web-based surveys across five waves from mean age 18.3 through 22.6. The sample (N = 2945) is 55% female, 46% Hispanic, 23% Asian, 23% White, 6% multi-racial (MR)/other, and 2% Black.MeasurementsPast month substance use was defined as number of days used. Outcomes at age 22.6 included negative consequences, delinquency, physical ailments and health, depression and anxiety, peer relationship functioning, life satisfaction, employment, and education.ResultsCompared to White EAs, Hispanic, Asian, and MR/other EAs reported less initial alcohol use; Hispanic and Asian EAs reported less initial cannabis use, whereas Black EAs reported more cannabis use. Greater initial frequency and increased frequency of AC use were associated with poorer outcomes (e.g., worse mental health). In terms of disparities, compared to White EAs, Hispanic EAs reported poorer physical health at the same levels of AC use; Hispanic, Asian, and MR/other EAs reported greater alcohol consequences and delinquency; Black, Hispanic, Asian and MR/other EAs reported lower life satisfaction; and Hispanic and MR/other EAs were less likely to pursue education beyond high school (although Asian EAs were more likely).ConclusionsFindings emphasize that trajectories of AC use during EA are associated with a range of functional outcomes. Disparities in functioning at similar levels of AC use highlight the importance of reaching racially/ethnically diverse EAs with prevention and intervention programming.

BackgroundIn 2014, the National Institute of Health Pain Consortium's research task force on research standards for chronic low back pain (CLBP) proposed a measure that could be used to stratify patients by the impact CLBP has on their lives, namely the Impact Stratification Score (ISS). This study examines the dimensionality of the ISS and support for its single total score, and evaluates its overall psychometric properties.MethodsThe sample included 1677 chiropractic patients being treated for CLBP and chronic neck pain, had an average age of 49, 71% female, and 90% White. Study participants completed the PROMIS-29 v2.1 profile survey that contains the 9 ISS items. The ISS was evaluated using item-total correlations, Cronbach's alpha, factor analysis (i.e., correlated factors and bifactor models), and item response theory (IRT). Reliability indices and item properties were evaluated from bifactor and IRT models, respectively.ResultsItem-total correlations were high (0.64-0.84) with a Cronbach's alpha of 0.93. Eigenvalues suggested the possibility of two factors corresponding to physical function and pain interference/intensity. Bifactor model results indicated that data were essentially unidimensional, primarily reflecting one general construct (i.e., impact) and that after accounting for 'impact' very little reliable variance remained in the two group factors. General impact scores were reliable (omegaH = .73). IRT models showed that items were strong indicators of impact and provided information across a wide range of the impact continuum and offer the possibility of a shorter 8-item ISS. Finally, it appears that different aspects of pain interference occur prior to losses in physical function.ConclusionsThis study presents evidence that the ISS is sufficiently unidimensional, covers a range of chronic pain impact and is a reliable measure. Insights are obtained into the sequence of chronic pain impacts on patients' lives.

Singles are an understudied yet growing segment of the adult population. The current study aims to expand the lens of relationship science by examining the well-being of unpartnered, single adults using latent profile analysis. We recruited singles (N = 4,835) closely matched to the United States census (ages 18-65; 57.5% female; 71.1% White; 14.5% Black; 13.8% Hispanic) for an exploratory cross-sectional survey using five variables that strongly predict well-being (friendship satisfaction, family satisfaction, self-esteem, neuroticism, and extraversion). All five variables significantly predicted life satisfaction for the full sample. Latent profile analyses detected 10 groups (or profiles) of singles. Half of the profiles were happy (above the full sample mean of life satisfaction) and half of the profiles were unhappy (below the mean). Each profile had its own unique patterns relating to personal relationships, self-esteem, and personality traits. The happiest profile had the best relationships, self-esteem, and personality, while the unhappiest profile had the worst relationships, self-esteem, and personality. The profiles in between these two extremes had more nuanced patterns. For example, one relatively happy profile in the middle had high friendship satisfaction but low family satisfaction, while an adjacent profile showed the opposite pattern. Overall, singles who had positive relationships-both with themselves and others-were happiest.

BackgroundNonmedical use of prescription opioids (defined as taking opioid medications for hedonic effects or in a manner other than prescribed) and the use of heroin have emerged in recent years as major public health concerns in the United States. Of particular concern is the prevalence of opioid use among emerging adults (ages 18-25), as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development. Data from 2015 show that American Indian/Alaska Native (AI/AN) people have the highest rates of diagnosis for opioid use disorders (OUDs). One recent study found that the overdose death rate among urban-dwelling AI/AN individuals was 1.4 times higher compared to those living in rural areas. To date, there are no evidence-based prevention programs addressing opioid use among urban AI/AN emerging adults that integrate culturally-appropriate strategies with evidence-based treatment. Traditions and Connections for Urban Native Americans (TACUNA) builds on our prior work with AI/AN communities across California to develop and evaluate culturally appropriate programming to address opioid, alcohol, and cannabis use among urban AI/AN emerging adults.Methods/designIn a randomized controlled trial, 18-25 year old urban AI/AN emerging adults will receive either TACUNA (n = 185), which comprises three virtual workshops utilizing motivational interviewing, social network visualization, and integrating traditional practices and a wellness circle, or one virtual culturally sensitive opioid education workshop (n = 185). We will evaluate intervention effects on primary outcomes of frequency of opioid, alcohol, and cannabis use, as well as secondary outcomes of social network characteristics and cultural connectedness, over a 12-month period.DiscussionThis project has the potential to expand the range and effectiveness of opioid, alcohol, and cannabis services for urban AI/AN emerging adults by addressing the opioid epidemic and use of other substances at both the community and individual level. In addition, it provides important culturally grounded conceptual and practical information to advance the field of substance use interventions and enhance resiliency among this population.Trial registrationClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020 https://clinicaltrials.gov/ct2/show/record/NCT04617938 .

ObjectiveEvaluate the Impact Stratification Score (ISS) measure of low back pain impact that assesses physical function, pain interference, and pain intensity.DesignSecondary analyses of a prospective comparative effectiveness trial of active-duty military personnel with low back pain.SettingA Naval hospital at a military training site (Pensacola, Florida) and two military medical centers: 1) Walter Reed National Military Medical Center (Bethesda, Maryland); and 2) San Diego Naval Medical Center.SubjectsThe 749 active-duty military personnel had an average age of 31 years, 76% were male, and 67% were white.MethodsParticipants completed questionnaires at baseline, 6 weeks later, and 12 weeks later. Measures included the ISS, Roland-Morris Disability Questionnaire (RMDQ), PROMIS-29 v1.0 satisfaction with social role participation scale, and single-item ratings of average pain, feeling bothered by low back pain in the past week, and a rating of change in low back pain.ResultsInternal consistency reliability for the ISS was 0.92-0.93 at the three time points. The ISS correlated 0.75 to 0.84 with the RMDQ, 0.51 to 0.78 with the single-item ratings, and -0.64 to -0.71 with satisfaction with social role participation. The ISS was responsive to change on the three single items. The area under the curve for the ISS predicting improvement on the rating of change from baseline to 6 weeks later was 0.83.ConclusionsThis study provides support for the reliability and validity of the ISS as a patient-reported summary measure for acute, subacute, and chronic low back pain. The ISS is a useful indicator of low back impact.

IntroductionThe Impact Stratification Score (ISS) is a measure of the impact of chronic low back pain (LBP) consisting of nine Patient-Reported Outcomes Measurement Information System (PROMIS-29) items, but no studies have examined the ISS or its association with psychological symptoms in military samples. This study examines longitudinal associations between psychological symptoms and the ISS among military service members.Material and methodsThe study involved secondary data analysis of a sample of active duty U.S. military service members aged 18-50 years with LBP (n = 733). Participants completed the PROMIS-29 at three time points during treatment: baseline (time 1, T1), week 6 of treatment (time 2, T2), and week 12 of treatment (time 3, T3). The impact of LBP was quantified using the ISS (ranging from 8 = least impact to 50 = greatest impact). Psychological symptoms were assessed as PROMIS-29 anxiety and depression scores. Separate autoregressive cross-lagged models examined reciprocal associations of ISSs with anxiety, depression, and emotional distress scores from T1 to T3.ResultsWithin each time point, the ISS was significantly and positively correlated with anxiety and depression. In autoregressive cross-lagged models, anxiety and depression predicted the ISS at the next time point and associations were similar in magnitude (e.g., anxiety T2 to ISS T3: β = 0.12, P

ObjectiveTo link scores from 2 condition-specific measures for chronic low back pain (CLBP), the Oswestry Disability Index (ODI) and the Roland-Morris Disability Questionnaire (RMDQ), to Patient Reported Outcomes Measurement Information System (PROMIS) physical function, pain interference, and pain intensity scores.DesignOrdinary least squares regression analyses of existing data to link the PROMIS scores with the ODI and RMDQ.SettingNot applicable.ParticipantsSamples of adults with CLBP (N=2279) obtained from the Center for Excellence in Research for Complementary and Integrative Health (CERC) Study (n=1677), the Assessment of Chiropractic Treatment for Low Back Pain and Smoking Cessation in Military Active Duty Personnel (ACT) (n=384), and the pain subsample of the PROMIS 1 Wave 2 Pain and Depression study (PROMIS 1 W2) (n=218).InterventionsNot applicable.Main outcome measuresPROMIS physical function, pain interference, and pain intensity (CERC, ACT, and PROMIS 1 W2), ODI (CERC and PROMIS 1 W2), and RMDQ (ACT and PROMIS 1 W2).ResultsIn predicting PROMIS scores, the ODI model R2 values ranged from 0.26-0.56 and the RMDQ model R2 values ranged from 0.13-0.50. ODI and RMDQ models were the least precise in predicting the PROMIS pain intensity score (R2 value range, 0.13-0.41) relative to the other PROMIS scores. Models with the 3 PROMIS scores as predictors yielded R2 values ranging from 0.64-0.68 and 0.46-0.58 for the ODI and RMDQ, respectively. Models using combined data from 2 studies (ie, PROMIS 1 W2 and ACT, or PROMIS 1 W2 and CERC) tended to be more precise than models using only a single study sample.ConclusionsModel results reported here can be used to translate PROMIS physical function, pain interference, and pain intensity scores to and from the ODI and RMDQ. The empirical linkages can facilitate comparisons across CLBP interventions and broaden interpretation of study results.