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Introduction This study examines the associations of neighborhood environments with BMI, HbA1c, and diabetes across 6 years in Hispanic/Latino adults. Methods Participants from the Hispanic Community Health Study/Study of Latinos San Diego site (n=3,851, mean age=39.4 years, 53.3% women, 94.0% Mexican heritage) underwent assessment of metabolic risk factors and diabetes status (categorized as normoglycemia, prediabetes, and diabetes) at baseline (2008–2011) and approximately 6 years later (2014–2017). In the Study of Latinos Community and Surrounding Areas Study ancillary study (2015–2020), participant baseline addresses were geocoded, and neighborhoods were defined using 800-meter circular buffers. Neighborhood variables representing socioeconomic deprivation, residential stability, social disorder, walkability, and greenness were created using Census and other public databases. Analyses were conducted in 2020–2021. Results Complex survey regression analyses revealed that greater neighborhood socioeconomic deprivation was associated with higher BMI (β=0.14, p

Introduction A 6-week mindfulness training course, the Mind–Body Medicine (MBM) pilot program for staff, was implemented at a large military treatment facility to examine the preliminary efficacy of the program in reducing stress and burnout in military healthcare professionals. Materials and Methods A retrospective analysis was conducted of data collected from a single-arm prospective MBM pilot program. The program was designed to help staff members increase their awareness of burnout and its consequences and to learn how to utilize mindfulness-based self-care practices as a means for reducing stress and preventing burnout at work. Participants attended a 2-hour MBM group each week for a total duration of 6 weeks. Assessments of stress, resilience, anxiety, somatic symptoms, functional impairment, sleep quality, quality of life, and burnout were administered at baseline (T1), upon completion of the 6-week program (T2), and at least 3 months after program completion (T3). Multilevel modeling was used as the primary statistical model to assess changes in outcomes. Fifty-nine staff members completed assessments at T1, 31 (52.5%) at T2, and 17 (28.8%) at T3. Results Participants showed improvements on scores of perceived stress, resilience, anxiety, somatic symptoms, quality of life, and burnout variables from T1 to T2 and from T1 to T3 (P Conclusions Results from this pilot suggest that the MBM program has the potential to reduce occupational stress and burnout and improve well-being in military healthcare professionals.

We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23–80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = −0.32, p < .01, 95% CI −0.49, −0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = −0.35, p =

Objective This study examines the impact of training therapists to deliver “An Individualized Mental Health Intervention for Autism Spectrum Disorder (ASD)” (AIM HI) for children with autism spectrum disorder on caregiver outcomes and the mediating role of changes in caregiver outcomes on child outcomes. Method Data were drawn from a cluster randomized trial conducted in 29 publicly funded mental health programs randomized to receive AIM HI training or usual care. Therapists were recruited from enrolled programs and child/caregiver participants enrolled from therapists’ caseloads. Participants included 202 caregivers of children 5 to 13 years of age with autism spectrum disorder. Caregiver strain and sense of competence were assessed at baseline and 6 month postbaseline. Child behaviors were assessed at baseline and 6, 12, and 18 months postbaseline. Therapist delivery of evidence-based intervention strategies were assessed between baseline and 6 months. Results A significant training effect was observed for caregiver sense of competence, with AIM HI caregivers reporting significantly greater improvement relative to usual care. There was no significant training effect for caregiver strain. Observer-rated therapist delivery of evidence-based interventions strategies over 6 months mediated training effects for sense of competence at 6 months. Changes in sense of competence from baseline to 6 months was associated with reduced child challenging behaviors at 6 months and mediated child outcomes at 12 and 18 months. Conclusion Combined with research demonstrating effectiveness of therapist AIM HI training on child outcomes, this study provides further evidence of the positive impact of training community therapists in the AIM HI intervention. Clinical trial registration information Effectiveness and Implementation of a Mental Health Intervention for ASD (AIM HI); https://clinicaltrials.gov/ ; NCT02416323.

Depression is common in people with fibromyalgia (FM) and osteoarthritis (OA) and has been linked to adverse health outcomes in these conditions. The purpose of this study was to examine differences in predictors of depression among individuals with FM and OA using a range of health, demographic, and psychological variables. Of the total 963 participants, 600 were diagnosed with FM, and 363 with OA. The Quality of Well-Being Scale (QWB) was used to assess health status. The Fibromyalgia Impact Questionnaire (FIQ) and the Arthritis Impact Measurement Scale (AIMS) were used to measure disease-specific impact. Additionally, participants completed self-efficacy and helplessness assessments. Depression was measured using the Center for Epidemiological Studies Scale (CES-D). The results of a moderated linear regression showed that higher depression scores were associated with lower health status and a greater condition impact, especially in the FM group. Self-efficacy and helplessness predicted depression in both groups, but more strongly in FM. White participants with OA were more depressed than their non-White counterparts, while the opposite was true for FM. These findings indicate that improving health status and psychological well-being might alleviate depression in both FM and OA.

OBJECTIVE/BACKGROUND: Short and long sleep duration, later sleep midpoint, and greater intra-individual sleep variability are associated with lower physical activity, but previous research lacks objective and concurrent assessment of sleep and physical activity. This cross-sectional study examined whether sleep duration, midpoint, and variability in duration and midpoint were related to wrist actigraphy-measured physical activity. PARTICIPANTS: Participants were 2156 Hispanics/Latinos in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sueño Ancillary Study. METHODS: Participants wore Actiwatch devices to measure sleep and physical activity via the wrist for ≥5 days. Physical activity was defined as minutes/day in the upper quartile of the sampling distribution’s non-sleep activity, capturing light to vigorous physical activity. RESULTS: An inverse linear relationship between sleep duration and physical activity was found such that each additional sleep hour related to 29 fewer minutes of physical activity (B = −28.7, SE=3.8), p < 0.01). Variability in sleep midpoint was also associated with physical activity; with each 1 hour increase in variability there were 24 more minutes of physical activity (B = 24.2, SE=5.6, p < 0.01). In contrast, sleep midpoint and variability in duration were not associated with physical activity. Sensitivity analyses identified an association of short sleep duration and greater variability in sleep duration with greater accelerometry-derived moderate-to-vigorous physical activity measured at the HCHS/SOL baseline (M=2.1 years before the sleep assessment). CONCLUSIONS: Findings help clarify inconsistent prior research associating short sleep duration and sleep variability with greater health risks but also contribute novel information with simultaneous objective assessments.

Recently developed accelerometer devices have been used in large epidemiological studies for continuous and objective monitoring of physical activities. Typically, physical movements are summarized as minutes in light, moderate, and vigorous physical activities in each wearing day. Because of preponderance of zeros, zero-inflated distributions have been used for modeling the daily moderate or higher levels of physical activity. Yet, these models do not fully account for variations in daily physical activity and cannot be extended to model weekly physical activity explicitly, while the weekly physical activity is considered as an indicator for a subject's average level of physical activity. To overcome these limitations, we propose to use a zero-inflated Poisson mixture distribution that can model daily and weekly physical activity in same family of mixture distributions. Under this method, the likelihood of an inactive day and the amount of exercise in an active day are simultaneously modeled by a joint random effects model to incorporate heterogeneity across participants. If needed, the method has the flexibility to include an additional random effect to address extra variations in daily physical activity. Maximum likelihood estimation can be obtained through Gaussian quadrature technique, which is implemented conveniently in an R package GLMMadaptive. Method performances are examined using simulation studies. The method is applied to data from the Hispanic Community Health Study/Study of Latinos to examine the relationship between physical activity and BMI groups and within a participant the difference in physical activity between weekends and weekdays.

Background: Systemic sclerosis has negative implications for quality of life, and coping is a mechanism by which individuals can adapt more successfully to illness. This study (1) identified coping profiles in patients with systemic sclerosis and (2) examined distress and disability correlates of the profiles. Methods: A sample of 93 patients with confirmed diagnoses of systemic sclerosis received clinical examinations and reported on coping, psychological distress, and health-related disability. Latent profile analysis was used to identify coping-based profile groups. The profile groups were then compared on psychological distress and health-related disability, controlling for disease severity. Results: A two-profile solution was supported: Active Copers emphasized problem-focused, social support, counting blessings, and religious approaches to coping with systemic sclerosis. Passive Copers emphasized blaming self and others, avoidance, and wishful thinking approaches to coping. Active Copers reported significantly less psychological distress than Passive Copers, but no significant differences were found for health-related disability. Discussion: The findings identify multidimensional patterns of coping that are differentially related to psychological distress in systemic sclerosis patients. These findings can inform coping-based interventions for patients with systemic sclerosis.

OBJECTIVE Improvement in health-related quality of life (HRQoL) is a public health goal of Healthy People 2020. Hispanics living in the United States are at risk for poor HRQoL, but the causes and correlates of this risk are not well understood. Thus, the present study examined individual-level psychosocial and neighborhood-level built environment correlates of physical and mental HRQoL among Hispanic adults. METHOD A community sample of Hispanic adults (N = 383) completed self-report health-related questionnaires, and census tract was used to collect data on neighborhood-level built environment variables. Multilevel modeling was used to examine individual-level psychosocial (language preference, religiosity, subjective social status, discrimination, and number of years lived in the United States) and neighborhood-level built-environment (the retail food environment, proximity to alcohol retailers, and tobacco retailer density) correlates of physical and mental HRQoL. RESULTS Higher subjective social status was significantly associated with better HRQoL, and more experiences with discrimination were significantly associated with lower HRQoL. For physical HRQoL, these relationships were stronger in neighborhoods with a higher density of tobacco retail outlets. CONCLUSIONS Findings from this study suggest that subjective social status and discrimination play important roles in HRQoL among Hispanics, in particular in neighborhoods with a higher density of tobacco retail outlets. This study highlights the importance of considering neighborhood context, and in particular neighborhood disadvantage, when examining the relationship between social status, discrimination and HRQoL among Hispanics. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Neighborhood-level socioeconomic deprivation can increase risk for higher blood pressure or hypertension, while greater neighborhood safety and walkability may protect against hypertension. Large-scale prospective research, particularly among Hispanics/Latinos, is lacking. We examined cross-sectional and prospective associations between neighborhood environments and blood pressure and hypertension among 3851 Hispanic/Latinos enrolled in the Hispanic Community Health Study/Study of Latinos San Diego, CA cohort. Addresses from Visit 1 (2008-2011) were geocoded and neighborhood characteristics were determined as part of the SOL CASAS ancillary study. Home addresses were geocoded and home areas created using 800m circular radial buffers. Neighborhood indices socioeconomic deprivation, residential stability, and social disorder were created using Census and other publicly available data. Walkability was computed as density of intersections, retail spaces, and residences. Greenness was measured via satellite imagery using the Normalized Difference Vegetation Index. Visit 1 and Visit 2 (2014-2017) clinical outcomes included systolic (SBP) and diastolic (DBP) blood pressure, as well as prevalent and 6-year incident hypertension, defined as SBP/DBP ≥140/90mmHg or antihypertensive medication use. Complex survey regression models adjusted for covariates revealed cross-sectional associations between greater walkability and lower SBP (B=-0.05; 95% CI: -0.09, -0.003). In prospective analyses, greater neighborhood social disorder was related to increasing SBP (B=0.05; 95% CI: 0.01, 0.09) and DBP (B=0.07; 95% CI: 0.02, 0.12) over time. Greater socioeconomic deprivation (OR=1.47; 95% CI: 1.06, 2.04) and greater social disorder (OR=1.25; 95% CI: 1.02, 1.54) were associated with higher odds of incident hypertension. All other associations were not significant. Beyond individual-level characteristics, greater neighborhood social disorder and socioeconomic deprivation were related to adverse changes in blood pressure over 6 years among Hispanics/Latinos. Neighborhood social environment may help identify, or be an area for future intervention for, cardiovascular risk among Hispanics/Latinos.

The English and Spanish versions of the Multidimensional Health Locus of Control scales have not been psychometrically evaluated for use with Hispanic Americans. Hispanic American adults ( N = 436) completed the English ( n = 210) or Spanish ( n = 226) Multidimensional Health Locus of Control scales. A multiple-group confirmatory factor analysis did not support equivalent four-factor structures for Spanish- and English-speaking Hispanic Americans. Follow-up exploratory factor analyses of the 24 items supported an 18-item, four-factor structure for English-speaking Hispanic Americans and a 22-item, three-factor structure for Spanish-speaking Hispanic Americans. These results suggest caution when using the Multidimensional Health Locus of Control scales with Hispanic Americans.

Despite the neurocognitive risks of aging with HIV, initial cross-sectional data suggest a subpopulation of older people with HIV (PWH) possess youthful neurocognition (NC) characteristic of SuperAgers (SA). Here we characterize longitudinal NC trajectories of older PWH and their convergent validity with baseline SA status, per established SuperAging criteria in PWH, and baseline biopsychosocial factors. Growth mixture modeling (GMM) identified longitudinal NC classes in 184 older (age ≥ 50-years) PWH with 1-5 years of follow-up. Classes were defined using 'peak-age' global T-scores, which compare performance to a normative sample of 25-year-olds. 3-classes were identified: Class 1A pesar de los riesgos neurocognitivos de envejecer con VIH, datos transversales iniciales sugieren que una subpoblación de personas con VIH (PCV) de edad mayor posee neurocognición (NC) juvenil, característica de los Súper-Ancianos (SA). Aquí nosotros caracterizamos trayectorias longitudinales de NC en PCV mayores y su validez convergente con su status de referencia de SA, según los criterios establecidos en PCV, y factores biopsicosociales en la base de referencia. El modelo de mezclas Gaussianas (GMM) identificó clases longitudinales de NC en 184 PCV mayores (edad ≥ 50-años) con 1–5 años de seguimiento. Las clases fueron definidas utilizando puntuaciones-T (T-scores) globales de “edad pico”, que comparan el desempeño con una muestra normativa de personas de 25 años de edad. 3-clases fueron identificadas: Clase 1

Lindsay, R., Roesch, S., Strathdee, S., Rangel, M., Staines-Orozco, H., Abramovitz, D., Ulibarri, M., & Rusch, M. (2015). Correlates of unprotected sex by client type among female sex workers that inject drugs in Tijuana and Ciudad Juarez, Mexico. The International Journal Of Alcohol And Drug Research, 4 (2), 159-169. doi: http://dx.doi.org/10.7895/ijadr.v4i2.208 Aims: Risk environment factors may influence unprotected sex between female sex workers who are also injection drug users (FSW-IDUs) and their regular and non-regular clients differently. Our objective is to identify correlates of unprotected vaginal sex in the context of client type. Methods: A cross-sectional survey of 583 FSW-IDUs in Tijuana and Ciudad Juarez, Mexico, was analyzed using negative binomial regression to determine physical, social, economic, and policy risk-environment factors that affect the frequency of unprotected sex with regular and non-regular clients. Results: Median number of unprotected vaginal sex acts in the past month among FSW-IDUs and their regular and non-regular clients was 11 (IQR 3–30) and 13 (IQR 5–30), respectively. Correlates differed by site and client type and were most closely associated with the risk environment. In Tijuana, social factors (e.g., injecting drugs with clients) were independently associated with more unprotected sex. Factors independently associated with less unprotected sex across client type and site included social and economic risk environment factors (e.g., receiving more money for unprotected sex). In the policy risk environment, always having free access to condoms was independently associated with less unprotected sex among non-regular clients in Tijuana (Risk rate ratio = 0.64; 95% confidence interval 0.43–0.97). Conclusions: Primarily physical, social, and economic risk-environment factors were associated with unprotected vaginal sex between FSW-IDUs and both client types, suggesting potential avenues for intervention.

BACKGROUND: The present nationwide study used latent class analysis (LCA) to identify classes of cancer patient navigators (CPNs) and examined whether class membership and 12 indicators were related to navigator role retention. METHOD: Using data of 460 CPNs from the United States, LCA identified classes (or, in other words, homogenous subgroups) of CPNs with the following indicators: type of CPN (clinical vs. non-clinical), education level, area(s) of the cancer care continuum in which the CPN provided patient navigation, region and urbanity where the CPN provided services, organizational work setting, and patient navigation program funding source. The relationships of navigator retention with class membership and each indicator were examined with chi-square tests. RESULTS: The LCA found three classes of CPNs. Class 1 and class 3 were conceptualized as distinct homogeneous subgroups of clinical CPNs, which appeared to mainly differ on their likelihood of engagement in outreach, survivorship, palliative care, and end of life patient navigation. Class 2 was conceptualized as a non-clinical CPN subgroup, which primarily was distinct based on their high endorsement of employment in programs which are at least partially funded by grants and engagement in earlier stages of patient navigation (e.g., early detection). Provision of survivorship and treatment patient navigation were related to navigator role retention, with senior CPNs providing these patient navigation services more than novice CPNs. CONCLUSION: The present study highlights three distinct classes of CPNs, provides initial information regarding determinants of navigator retention, and makes a number of recommendations for future patient navigation research.

Highlights • Newly-developed measures of crime, environmental context, and activity are valid. • Factorial validity of measures supported across four across age groups. • Minimal measurement redundancy found across measures., Valid and reliable measures are needed to better understand the relationship between physical activity and crime. This paper provides a comprehensive psychometric evaluation of measures developed in the Safe and Fit Environments (SAFE) Study to assess a crime-PA conceptual framework. In addition to assessing the basic psychometric properties of each measure (e.g., variable distributions [item/scale level], internal consistency reliability), this study formally examined the measurement validity and invariance of measures across four age groups using confirmatory factor analysis. The sample (n = 2173) included 336 Adolescents (aged 12–17), 532 Young adults (aged 18–39), 838 Middle Age Adults, and 467 Older Adults (aged 66+). The psychometric evaluation of (sub)scales showed consistent factorial validity and internal consistency reliability across the majority of the measures and across the four age groups. Specifically, 14 of the 17 measures displayed statistically and practically significant factor loadings and internal consistency values in the overall sample and across the age groups. The pattern of correlations for each (sub)scale with other (sub)scales/indexes largely did not exhibit redundancy across measures. The findings expanded upon the test–retest reliability evaluation reported in Patch et al. (2019), and clarified key aspects of the construct validity of these indicators. The latter bodes well for potential utility of these indicators in future predictive models.

Classroom Pivotal Response Teaching (CPRT) is a naturalistic behavioral intervention for students with autism spectrum disorder (ASD) that was systematically adapted for teacher use. In this study, the authors evaluate outcomes of a large randomized trial training teachers ( n = 126) to use CPRT. Training involved 12 hours of small group sessions and additional 1:1 coaching in each teacher’s classroom. Overall, CPRT fidelity was significantly higher at the end of the training year relative to the observation year ( B = 0.24, p = .001) and teachers report using CPRT an average of 47 minutes per day. Moderator analyses indicate that training, teacher, and classroom- and school-level characteristics affected CPRT fidelity. Teachers report high overall satisfaction ( M = 4.37, SD = 0.45; 1-5 Likert-type scale) and confidence in their ability to use CPRT with their students ( M = 4.2, SD = 0.57). In this study, the authors indicate the acceptability and feasibility of the CPRT training protocol and adds to the limited number of school-based randomized controlled trials (RCTs) evaluating interventions for students with ASD.

This longitudinal prospective study examined the relationship between child maltreatment as per reports to child protective services (CPS) and adolescent self-reported marijuana use, and the association between relationships with mothers and fathers and use of marijuana. The association between relationships with parents early in childhood (ages 6-8 years) and during adolescence with adolescent marijuana use were also probed. Another aim examined whether relationships with parents moderated the link between child maltreatment and youth marijuana use. The sample included 702 high risk adolescents from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a consortium of 5 studies related to maltreatment. Children were recruited at age 4 or 6 years together with their primary caregiver. Some were recruited due to their risk for child maltreatment, others were already involved with CPS, and children in one site had been placed in foster care. Logistic regression analysis was performed using youth self-report of marijuana use as the criterion variable and child maltreatment and the relationships with parents as predictor variables, controlling for youths’ perceptions of peer substance use and parental monitoring, parental substance use, race/ethnicity, sex and study site. Approximately half the youth had used marijuana. Most of them described quite positive relationships with their mothers and fathers. Participant marijuana Use was associated with a poorer quality of relationship with mother during adolescence, and with peer and parental substance use. A better relationship with father, but not mother, during adolescence attenuated the connection between Child Maltreatment and youth Marijuana Use.

Background Many Latinos in the U.S. do not meet dietary recommendations for healthy eating. Family systems theory posits that the family environment affects family members' dietary behaviors. Moreover, research suggests that children's acculturation is associated with Latina mothers' dietary intake and behaviors. Purpose This longitudinal study examined the effect of the family environment on Latina mothers’ dietary intake and behaviors. Further, we examined whether these effects differed between mothers of assimilated versus bicultural children. Methods Secondary data were collected at three time points (baseline, and four and 10 months' post-baseline) from 162 culturally traditional and bicultural Latina mothers residing in Imperial County, California, U.S. Participants were enrolled in the delayed treatment group of a randomized controlled trial. Mothers' daily fruit, vegetable, and sugary beverages intake, percent of calories from fat, weekly away-from-home eating, and percent of weekly grocery dollars spent on fruits and vegetables were examined. The family environment was measured by family expressiveness and family interactions around food. Separate autoregressive cross-lagged models examined the effects of the family environment on dietary outcomes, adjusting for sociodemographic variables. Interactions between the family environment and children's acculturation were also tested. Results Less positive family interactions around food at baseline predicted more frequent away-from-home eating four months later among mothers of assimilated children. More family expressiveness at four months predicted more grocery dollars spent on fruits and vegetables at ten months among mothers of bicultural children. Conclusions Findings suggest the importance of a positive family environment on socially-bound dietary behaviors (e.g., away-from-home eating) exhibited by the mother. Family interventions aimed at improving dietary intake and associated behaviors should promote a positive family environment around food and consider the moderating role of children's acculturation.

Children in foster care are at risk for externalizing and internalizing behavior problems. The KEEP foster parent training intervention has been found to effectively reduce parental reports of daily child behavior problems. The aims of this investigation were to (a) examine the effectiveness of the KEEP intervention at reducing behavior problems among children in foster care, as assessed by the Child Behavior Checklist (CBCL), during implementation of the intervention by a community agency using a randomized design and (b) determine whether the intervention is effective at reducing internalizing forms of behavior problems. Foster and kinship families were randomly assigned to either the KEEP intervention or usual services. The KEEP intervention was delivered by a community agency. Child behavior problems were assessed via the CBCL at baseline and at the end of the intervention (4 months after baseline). Data from 310 foster and kinship families with children aged between 5 and 12 years were analyzed using hierarchical linear modeling. The KEEP intervention was effective at reducing the proportion of children in the borderline group for rule-breaking between baseline and follow-up. The intervention was also effective at reducing internalizing problems, as indicated by reductions in internalizing raw scores and the proportion of children in the borderline group over the course of the intervention. These findings suggest the KEEP intervention can provide foster parents with the tools to manage a broad range of behavior problems even as the intervention was delivered by a community agency.

Objective Rapid Eye Movement Sleep Behavior Disorder (RBD) is common in Parkinson’s Disease (PD) and is associated with cognitive impairment; however, the majority of the evidence on the impact of RBD on multidomain cognitive batteries in PD is cross-sectional. This study evaluated the longitudinal impact of probable RBD (pRBD) on cognitive, psychiatric, and functional outcomes in people with PD. Method Case–control study. A total of 65 people with PD completed the study protocol at baseline and 16-to-47-month follow-up. Participants were classified as pRBD+ (n = 25) or pRBD− (n = 40) based on an established cutoff of 6 on the RBD Sleep Questionnaire (RBDSQ). Participants also completed a) comprehensive cognitive testing, b) self-report measures of depression, anxiety, and apathy, and c) performance-based and other-report forms of instrumental activities of daily living. Results Baseline mean age was 67.8 (SD = 8.1; range = 45–86) and baseline mean years of education was 16.4 (SD = 2.1; range = 12–20). The two groups did not differ on measured demographic characteristics. Baseline mean T-scores for cognitive tests were in the average range (46–55). Hierarchical linear models tested group differences in cognitive and functional decline from baseline to follow-up, controlling for appropriate demographic and psychiatric variables. Compared to the pRBD− group, pRBD+ participants showed greater decline in attention/working memory (r = −0.31; p = 0.01) and UPSA financial skills (r = −0.31; p = 0.01). No other group differences approached significance. Conclusions RBD may differentially affect attention/working memory and financial abilities in PD. Results underscore the importance of regular RBD screening in older adults with PD in order to triage symptomatic patients to appropriate cognitive and medical interventions.

The Drive for Muscularity Scale (DMS) is a commonly used measure used to assess the pursuit of muscularity. However, the factor structure of this measure has yet to be confirmed in a sample of sexual minority women. Moreover, the invariance of this measure across gender has also yet to be explored. The aim of the present study was, therefore, to conduct a confirmatory factor analysis (CFA) of the DMS in samples of both cisgender sexual minority men and women, and subsequently evaluate the measurement invariance by gender. The sample consisted of 962 cisgender sexual minority young adult men (N = 479) and women (N = 483). A series of CFAs were conducted, assessing both the one-factor and two-factor solutions of the DMS, with and without the inclusion of item 10 (“I think about taking anabolic steroids”). Across cisgender sexual minority young adult men and women, the 14-item two-factor solution demonstrated most appropriate fit, although the 15-item two-factor solution was also adequate among only women. Measurement invariance analyses indicated that the 14-item two-factor DMS can be used in samples of both cisgender sexual minority men and women. The present study was novel in exploring the factor structure of the DMS in sexual minority women and measurement invariance by gender; however, future research is needed to further corroborate these findings and assess measurement invariance by sexual orientation and race.

Objective The present study aimed to investigate the factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in a large sample of cisgender sexual minority men and women, and subsequently, to evaluate measurement invariance by gender. Method The sample consisted of 962 sexual minority adult men (n = 479) and women (n = 483) who completed online self-report surveys. Confirmatory factor analysis was conducted using two previously supported factor structures (Friborg et al.'s four-factor model and Grilo et al.'s brief three-factor model) as well as the original four-factor structure of the EDE-Q. Results Results indicated that the best fitting models were Friborg et al.'s four-factor model (CFI = .974, RMSEA = .098, SRMR = .0 70) and Grilo et al.'s brief three-factor model (CFI = .999, RMSEA = .049, SRMR = .017). The model fit of both factor structures were nearly identical when examined separately for men and women. The original four-factor structure could not be supported in this sample. Measurement invariance analyses further indicated that the best fitting models were invariant by gender in sexual minority individuals. Internal consistency was adequate for all subscales of Friborg et al.'s and Grilo et al.'s models. Discussion The present study provides support for the use of the EDE-Q in sexual minority men and women. Additionally, findings demonstrate that the EDE-Q performs similarly in sexual minority men and women. Future research is needed to further evaluate measurement invariance of the EDE-Q by sexual orientation, gender identity, and race.

Background Although there is increasing investment to implement evidence-based practices (EBPs) in public systems across the USA, continued or sustained use of EBPs after initial implementation remains a challenge. The low integration of EBPs in routine practice severely limits their public health impact, highlighting the need to understand factors that affect the return on costly investments in EBP implementation. This study aims to (1) characterize trajectories of EBP delivery volume through a reimbursement-driven implementation and (2) examine impacts of system-level policy regulatory activity and state-level mental health services funding on the implementation reimbursement strategy. Methods This study involved secondary data analyses. Psychotherapy administrative claims and regulatory site visit data from the Los Angeles County Department of Mental Health and California state mental health expenditures were extracted from 2010 to 2017. Multilevel regression examined EBP claims volume over time with state expenditures and regulatory compliance as predictors. Results EBP claims volume trajectories demonstrated a rapid initial increase, followed by a period of decrease, and a small increase in the final year. State mental health expenditures increased across time reflecting increased funding availability. State mental health expenditures and system regulatory compliance were inversely related to EBP claims volume. Conclusions The impact of reimbursement-driven EBP implementation strategy is sensitive to multiple outer-context determinants. At the system level, commitment to fidelity of implementation regulations resulted in reduced use of the reimbursement strategy. Alternative reimbursement streams not tied to EBPs coupled with an expanded array of reimbursable services also impacted the use of the reimbursement strategy to implement EBPs.

Pragmatic measures of therapist delivery of evidence-based practice (EBP) are critical to assessing the impact of large-scale, multiple EBP implementation efforts. As an initial step in the development of pragmatic measurement, the current study examined the concordance between therapist and observer ratings of items assessing delivery of EBP strategies considered essential for common child EBP targets. Possible EBP-, session-, and therapist-levels factors associated with concordance were also explored. Therapists and independent observers rated the extensiveness of therapist (n = 103) EBP strategy delivery in 680 community psychotherapy sessions in which six EBPs were used. Concordance between therapist- and observer-report of the extensiveness of therapist EBP strategy use was at least fair (ICC ≥ .40) for approximately half of the items. Greater therapist-observer concordance was observed in sessions where a structured EBP was delivered and in sessions where therapists reported being able to carry out planned activities. Findings highlighted conditions that may improve or hinder therapists' ability to report on their own EBP strategy delivery in a way that is consistent with independent observers. These results can help inform the development of pragmatic therapist-report measures of EBP strategy delivery and implementation efforts more broadly.

The purpose of the current study was to examine the potential mediating effects of internalizing and externalizing problems at ages 14, 16 and 18 between types of childhood maltreatment and alcohol and marijuana use problems and disorders in young adulthood. Data were from 473 young adults who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Path analysis was conducted to examine pathways between maltreatment type (birth through age 12), internalizing and externalizing problems at three time points during adolescence, and alcohol and marijuana problem use in young adulthood. Findings indicated significant pathways between physical abuse and internalizing problems at 14, which was associated with alcohol-related substance use disorder in adulthood. Externalizing problems and internalizing problems at age 14 mediated the relationship between physical abuse and marijuana-related symptoms in young adulthood. Emotional and sexual abuse were not associated with substance use problems. Implications for practice are discussed.

In the US, nearly 11% of adults were living with diagnosed diabetes in 2017, and significant type 2 diabetes (T2D) disparities are experienced by socioeconomically disadvantaged, racial/ethnic minority populations, including Hispanics. The standard 15-minute primary care visit does not allow for the ongoing self-management support that is needed to meet the complex needs of individuals with diabetes. “Team-based” chronic care delivery is an alternative approach that supplements physician care with contact from allied health personnel in the primary care setting (e.g., medical assistants; MAs) who are specially trained to provide ongoing self-management support or “health coaching.” While rigorous trials have shown MA health coaching to improve diabetes outcomes, less is known about if and how such a model can be integrated within real world, primary care clinic workflows. Medical Assistant Health Coaching for Type 2 Diabetes in Diverse Primary Care Settings – A Pragmatic, Cluster-Randomized Controlled Trial will address this gap. Specifically, this study compares MA health coaching versus usual care in improving diabetes clinical control among N=600 at-risk adults with T2D, and is being conducted at four primary care clinics that are part of two health systems that serve large, ethnically/racially, and socioeconomically diverse populations in Southern California. Electronic medical records are used to identify eligible patients at both health systems, and to examine change in clinical control over one year in the overall sample. Changes in behavioral and psychosocial outcomes are being evaluated by telephone assessment in a subset (n=300) of participants, and rigorous process and cost evaluations will assess potential for sustainability and scalability. ClinicalTrials.gov: NCT02643797 (registered November 30, 2015: https://clinicaltrials.gov/ct2/show/NCT02643797?term=philis-tsimikas&rank=10) Trial registration: NCT02643797

IMPORTANCE: Publicly funded mental health services play an important role in addressing co-occurring mental health problems in children with autism spectrum disorder (ASD); however, therapists report lacking training to effectively serve this complex population. OBJECTIVE: To test the effectiveness of training community therapists in An Individualized Mental Health Intervention for ASD (AIM HI) on challenging behaviors across 18 months among children with ASD and identify moderators and mediators of any intervention effects. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized trial conducted in 29 publicly funded outpatient and school-based mental health programs in southern California from 2012 to 2017. Programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Therapist participants were recruited from enrolled programs, and child participants were recruited from participant therapists’ caseloads. Data were analyzed from 202 children with ASD who were aged 5 to 13 years. INTERVENTIONS: The AIM HI protocol is a package of parent-mediated and child-focused strategies aimed to reduce challenging behaviors in children with ASD who are 5 to 13 years old. It was designed for delivery in publicly funded mental health services based on a systematic assessment of therapist training needs and child clinical needs. The therapist training and consultation process takes approximately 6 months and includes an introductory workshop, 11 structured consultation meetings as the therapist delivers AIM HI with a current client, and case-specific performance feedback from trainers. MAIN OUTCOMES AND MEASURES: Child participants were assessed for challenging behaviors using the Eyberg Child Behavior Inventory (ECBI) and Social Skills Improvement System (SSIS) Competing Problem Behaviors scales based on parent report at baseline and at 6-month intervals for 18 months. Outcomes were analyzed using intent-to-treat models. RESULTS: In total, 202 children with ASD (mean [SD] age, 9.1 [2.4] years; 170 [84.2%] male; 121 [59.9%] Latinx) were eligible, enrolled, and included in the analyses. Statistically significant group by time interactions for the ECBI Intensity (B = −0.38; P = .02) and ECBI Problem (B = −1.00; P = .005) scales were observed, with significantly larger decreases in ECBI Intensity scores in the AIM HI group (B = −1.36; P

Background Multimorbidity affects four of ten US adults and eight of ten adults ages 65 years and older, and frequently includes both cardiometabolic conditions and behavioral health concerns. Hispanics/Latinos (hereafter, Latinos) and other ethnic minorities are more vulnerable to these conditions, and face structural, social, and cultural barriers to obtaining quality physical and behavioral healthcare. We report the protocol for a randomized controlled trial that will compare Mi Puente (My Bridge), a cost-efficient care transitions intervention conducted by a specially trained Behavioral Health Nurse and Volunteer Community Mentor team, to usual care or best-practice discharge approaches, in reducing hospital utilization and improving patient reported outcomes in Latino adults with multiple cardiometabolic conditions and behavioral health concerns. The study will examine the degree to which Mi Puente produces superior reductions in hospital utilization at 30 and 180 days (primary aim) and better patient-reported outcomes (quality of life/physical health; barriers to healthcare; engagement with outpatient care; patient activation; resources for chronic disease management), and will examine the cost effectiveness of the Mi Puente intervention relative to usual care. Methods Participants are enrolled as inpatients at a South San Diego safety net hospital, using information from electronic medical records and in-person screenings. After providing written informed consent and completing self-report assessments, participants randomized to usual care receive best-practice discharge processes, which include educational materials, assistance with outpatient appointments, referrals to community-based providers, and other assistance (e.g., with billing, insurance) as required. Those randomized to Mi Puente receive usual-care materials and processes, along with inpatient visits and up to 4 weeks of follow-up phone calls from the intervention team to address their integrated physical-behavioral health needs and support the transition to outpatient care. Discussion The Mi Puente Behavioral Health Nurse and Volunteer Community Mentor team intervention is proposed as a cost-effective and culturally appropriate care transitions intervention for Latinos with multimorbidity and behavioral health concerns. If shown to be effective, close linkages with outpatient healthcare and community organizations will help maximize uptake, dissemination, and scaling of the Mi Puente intervention. Trial registration ClinicalTrials.gov: NCT02723019. Registered on 30 March 2016.

The Pearlin Mastery (PM) Scale is frequently used in health research to assess individuals’ personal mastery or the extent to which they believe they are in control of their own lives. It has been adapted from English into multiple languages including Spanish. However, no studies have assessed the psychometric properties of Spanish translations of the scale. This analysis evaluated structural validity and measurement invariance of the original Spanish translation of the PM Scale in two groups of Spanish-speaking individuals receiving primary care at community clinics in Florida. Confirmatory factor analysis (CFA) indicated that the 5-item version used in the literature yields a unidimensional factor structure as expected; however, multiple-group CFA revealed that the PM Scale items did not load equivalently on the factor across samples. This indicates that the Spanish version of the PM Scale may not measure mastery consistently across groups, possibly due to differences in respondents’ semantic understanding of items or differences in the meaning of the construct itself. Findings suggest that researchers seeking to measure personal mastery in Spanish-speaking participants from diverse cultural backgrounds should consider alternative approaches including the development of new instruments.

This study evaluated the psychometric properties of the Spanish version of the God Locus of Health Control scale, a measure of the extent to which an individual believes God has control over one’s health, among a sample of churchgoing Latinas ( N = 398). Confirmatory factor analysis showed support for a one-factor structure and internal consistency reliability, as measured by Cronbach’s coefficient alpha, was good. Evidence for convergent validity was demonstrated by significant correlations in the expected magnitudes and directions with two measures of perceived religious involvement in health. These results suggest that the God Locus of Health Control scale can be used to examine the extent to which God is perceived to control an individual’s health among Latinas.

Home visitation (HV) interventions may hold promise to improve parenting and prevent child maltreatment recidivism in families reported to child protective services (CPS) with young children, but this has rarely been studied. Findings are presented from an 18-month randomized controlled trial in which intact families ( N = 122) with at least one CPS report were provided with a facilitated connection to a paraprofessional evidence-based HV program or usual care services from child protection. Results are reported for changes in maternal stress, depression, and social support outcomes and repeat reports to CPS. No significant changes were found in maternal outcomes by group. Among nondepressed mothers or families without multiple CPS reports prior to study enrollment, HV was associated with a significantly lower likelihood of CPS report recidivism. These results indicate potential for HV to prevent maltreatment recidivism but suggest that higher intensity intervention is warranted for mothers exhibiting significant depressive symptoms or families with extensive CPS histories.

Introduction Youth with a history of child maltreatment use substances and develop substance use disorders at rates above national averages. Thus far, no research has examined pathways from maltreatment to age of substance use initiation for maltreated youth. We examined the longitudinal impact of maltreatment in early childhood on age of alcohol and marijuana use initiation, and whether internalizing and externalizing behaviors at age 8 mediates the link between maltreatment and age of substance use initiation. Materials and methods Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 8, 12, and 18. Maltreatment was assessed through reviews of administrative records and youth self-reports. Behavior problems were assessed with the Child Behavior Checklist. Age of substance use initiation was assessed with the Young Adult version of the Diagnostic Interview Schedule for Children. Results Path analyses indicated mediated effects from a history of maltreatment to age at first alcohol and marijuana use through externalizing behaviors. Considering type of maltreatment, direct effects were found from physical abuse to age of alcohol initiation, and mediated effects were found from sexual abuse and neglect to initial age of alcohol and marijuana use through externalizing behaviors. Direct effects for marijuana use initiation and indirect effects through internalizing behavior problems were not significant for either substance. Conclusions Externalizing behavior is one pathway from childhood maltreatment to age of substance use initiation. Services for maltreated youth should incorporate substance use prevention, particularly among those with early externalizing problems.

The present study evaluated the psychometric properties of the Spanish versions of the Perceived Religious Influence on Health Behavior scale and the Illness as Punishment for Sin scale in a sample of churchgoing Latina women (N= 404). For the Perceived Religious Influence on Health Behavior scale, confirmatory factor analysis provided support for the expected one- factor model, internal consistency reliability was good, and there was evidence of convergent validity. For the Illness as Punishment for Sin scale, confirmatory factor analysis provided support for the expected one-factor model, but on a revised, seven-item version of the measure. Internal consistency reliability and convergent validity for this revised version were good. It is recommended that future studies use the Perceived Religious Influence on Health Behavior scale and the revised Illness as Punishment for Sin scale when examining these constructs among Latina women.

Objective This study examined clinical adaptations reported by community therapists to multiple evidence-based practices (EBPs) currently implemented in children's mental health services. Based on an item set informed by Stirman and colleagues' model (2015), 2 factors emerged describing Augmenting adaptations and Reducing/Reordering adaptations. We used multilevel modeling to examine therapist- and practice-level predictors of therapist reports of each type of adaptation. Method Data were drawn from an online survey, including a novel therapist report measure of EBP adaptations, completed by 572 therapists (89.2% female, Mage = 37.08 years, 33.4% non-Hispanic White) delivering EBPs in the context of a system-driven, fiscally mandated implementation effort. Results Analyses revealed that the 2 types of therapist adaptations (Augmenting and Reducing/Reordering) could be readily discriminated, with therapists reporting significantly more Augmenting than Reducing/Reordering adaptations. Therapists of Hispanic/Latino ethnicity and with fewer years of experience reported more extensive Augmenting adaptations, but no therapist background characteristics were associated with Reducing/Reordering adaptations. Therapists' general attitudes that EBPs diverged from their personal approach to therapy were associated with reporting more Augmenting and Reducing/Reordering adaptations. In contrast, negative perceptions toward the specific EBP predicted Reducing/Reordering adaptations, but not Augmenting adaptations. Conclusions Community therapist reports suggest that most adaptations undertaken involve engaging with the practice to augment the fit of the EBPs for local contexts; however, when practices were perceived negatively, therapists were more likely to make adaptations reducing or rearranging components. (PsycINFO Database Record

Objective The structure of neurocognition is explored by examining the neurocognitive domains underlying comprehensive neuropsychological assessment of cognitively healthy individuals. Method Exploratory factor analysis was conducted on the adult normative dataset of an expanded Halstead-Reitan Battery (eHRB), comprising Caucasian and African American participants. The factor structure contributions of the original HRB, eHRB expansion, and Wechsler intelligence scales were compared. Demographic effects were examined on composite factor scores calculated using confirmatory factor analysis. Results The full eHRB had an eight-factor structure, with latent constructs including: 'working memory', 'fluency', 'verbal episodic memory', 'visuospatial cognition' (visuospatial memory and problem solving), 'perceptual-motor speed' (speed for processing visual/tactile material and hand-motor execution), 'perceptual attention' (attention to sensory-perceptual information), 'semantic knowledge' (knowledge acquired through education and culturally-based experiences), and 'phonological decoding' (grapheme-phoneme processing essential for sounding-out words). 'Perceptual-motor speed' and 'perceptual attention' were most negatively associated with age, whereas 'semantic knowledge' and 'phonological decoding' were most resistant to aging. 'Semantic knowledge' showed the greatest dependence on demographic background, including education and ethnicity. Gender differences in cognitive performances were negligible across all domains except 'phonological decoding' with women slightly outperforming men. The original HRB contributed four neurocognitive domains, the eHRB expansion three domains, and the Wechsler scales one additional domain but with restructuring of verbal factors. Conclusion Eight neurocognitive domains underlie performance of healthy cognitive individuals during comprehensive neuropsychological assessment. These domains serve as framework for understanding the constructs measured by commonly-used neuropsychological tests and may represent the structure of neurocognition.

Objective.To evaluate the structural validity of the Rheumatology Attitudes Index (RAI), a widely used measure of rheumatic disease–related helplessness in patients with systemic sclerosis (SSc).Methods.Patients with physician-confirmed SSc from the University of California, Los Angeles (UCLA) Scleroderma Quality of Life Study (n = 208) received clinical examinations and completed self-report questionnaires. The structural validity of the RAI was examined through confirmatory and exploratory factor analysis (CFA/EFA).Results.A tenable factor structure was not identified through CFA or EFA.Conclusion.The present structural analysis did not support the use of the RAI with SSc patients.

Author(s): Meacham, Meredith C; Roesch, Scott C; Strathdee, Steffanie A; Lindsay, Suzanne; Gonzalez-Zuniga, Patricia; Gaines, Tommi L | Abstract: Introduction and aimsPatterns of polydrug use among people who inject drugs (PWID) may be differentially associated with overdose and unique human immunodeficiency virus (HIV) risk factors. Subgroups of PWID in Tijuana, Mexico, were identified based on substances used, route of administration, frequency of use and co-injection indicators.Design and methodsParticipants were PWID residing in Tijuana age ≥18 years sampled from 2011 to 2012 who reported injecting an illicit substance in the past month (n = 735). Latent class analysis identified discrete classes of polydrug use characterised by 11 indicators of past 6 months substance use. Multinomial logistic regression examined class membership association with HIV risk behaviours, overdose and other covariates using an automated three-step procedure in mplus to account for classification error.ResultsParticipants were classified into five subgroups. Two polydrug and polyroute classes were defined by use of multiple substances through several routes of administration and were primarily distinguished from each other by cocaine use (class 1: 5%) or no cocaine use (class 2: 29%). The other classes consisted primarily of injectors: cocaine, methamphetamine and heroin injection (class 3: 4%); methamphetamine and heroin injection (class 4: 10%); and heroin injection (class 5: 52%). Compared with the heroin-only injection class, memberships in the two polydrug and polyroute use classes were independently associated with both HIV injection and sexual risk behaviours.Discussion and conclusionsSubstance use patterns among PWID in Tijuana are highly heterogeneous, and polydrug and polyroute users are a high-risk subgroup who may require more tailored prevention and treatment interventions. [Meacham MC, Roesch SC, Strathdee SA, Lindsay S, Gonzalez-Zuniga P, Gaines TL. Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico. Drug Alcohol Rev 2018;37:128-136].

This study examined the psychometric properties of the Perceived Stress Scale-10 among 436 community-dwelling Hispanic Americans with English or Spanish language preference. Multigroup confirmatory factor analysis examined the factorial invariance of the Perceived Stress Scale-10 across language groups. Results supported a two-factor model (negative, positive) with equivalent response patterns and item intercepts but different factor covariances across languages. Internal consistency reliability of the Perceived Stress Scale-10 total and subscale scores was good in both language groups. Convergent validity was supported by expected relationships of Perceived Stress Scale-10 scores to measures of anxiety and depression. These results support the use of the Perceived Stress Scale-10 among Hispanic Americans.

This study utilized a person-centered approach and latent profile analysis to investigate relationships among personality, attrition, and performance. Personality data from 4763 Army recruits were used to create personality profiles or classes, which were then linked with supervisor's job performance ratings of discipline and effort as well as 24- and 48-month attrition. The latent profile analyses identified 5 personality profiles/classes, 3 of which (i.e., Resilient, Overcontrolled, Undercontrolled) have been commonly found in previous person-centered studies of personality. The results indicated that the Resilient class had significantly higher discipline ratings and significantly lower attrition than the Overcontrolled and Undercontrolled classes. Using the person-centered approach, the results showed that the classes developed using a relatively new personality measure and latent profile analysis predicted significant differences on important work outcomes such as performance ratings and attrition. Applied implications and future research directions are discussed.

Objective: The Brief Satisfaction With Appearance Scale measures two dimensions (Dissatisfaction with Appearance and Social Discomfort) of body image dissatisfaction in systemic sclerosis. This study examined the structural validity of the Brief Satisfaction With Appearance Scale across limited and diffuse systemic sclerosis subtypes, compared body image dissatisfaction by systemic sclerosis subtype, and identified the significant sociodemographic and medical correlates of body image dissatisfaction and whether they differed by subtype. Methods: Participants were 183 adults participating in the University of California, Los Angeles Scleroderma Quality of Life Study with limited cutaneous ( n = 101) or diffuse cutaneous ( n = 82) systemic sclerosis who received clinical examinations and completed questionnaires. Multiple-group confirmatory factor analysis, multivariate analysis of variance, and structural equation modeling were used. Results: The Brief Satisfaction With Appearance Scale’s two-factor structure fit well for both subtypes. Patients with diffuse systemic sclerosis reported greater body image dissatisfaction on both factors than patients with limited disease. Greater Dissatisfaction with Appearance was associated with younger age and being unmarried for limited patients, and with younger age and increased finger/hand skin involvement for diffuse patients. Greater Social Discomfort was associated with younger age and being unmarried for both subtypes. Conclusion: The Brief Satisfaction With Appearance Scale scores can be meaningfully compared across limited and diffuse systemic sclerosis. Patients with diffuse disease reported more body image dissatisfaction than those with limited disease. Findings demonstrate that both medical and sociodemographic variables are associated with body image dissatisfaction in systemic sclerosis and can be used to identify which patients may be at increased risk for body image dissatisfaction.

Background Research in autism spectrum disorders (ASD) has identified a need to understand key components of complex evidence-based practices (EBP). One approach involves examining the relationship between component use and child behavior. Aims This study provides initial evidence for identifying key components in a specific EBP, Pivotal Response Training (PRT). We examined which components were related to child response and evaluated relationships between provider characteristics, child characteristics and component intensity. Methods Trained coders reviewed archival videos (n = 278) for PRT fidelity and child behavior. We completed multi-level regression and latent profile analysis to examine relationships between intensity of individual or combinations of PRT components and child behavior, and moderators of component use. Results Analyses indicated differential relationships between specific components and child behaviors which may support methods of altering intensity of components to individualize intervention. Profile analysis suggested relatively intensive use of most PRT components, especially antecedent strategies, may maximize child responsivity. Providers with postgraduate education trended toward higher intensity component use. Child characteristics did not moderate use. Implications Careful examination of key components of ASD interventions may helps clarify the mechanisms of action. Recommendations specific to PRT implementation and use of the methodology for other interventions are discussed.