Examining Multiple Health Behaviors

Health behaviors have been extensively studied as predictors of disease; however, these behaviors may interact and intersect to amplify or ameliorate risks of predicted disease outcomes. Breadth of study is needed to examine how single antecedents may act to influence multiple health behaviors, and how multiple health behaviors may predict other behaviors and/or interact to influence the occurrence of disease outcomes. Better understanding of how behaviors interact and impact health is necessary to identify the appropriate leverage points for the evolution of health behavior theory, and the promotion of multiple health behavior change

Maternal Adverse and Protective Childhood Experiences and Prenatal Smoking

Prenatal smoking is associated with adverse pregnancy and birth outcomes as well as health problems in early childhood. Recent research determined that maternal adverse childhood experiences (ACEs) increase the odds of smoking during pregnancy. We consider the role of protective and compensatory childhood experiences (PACEs) in an effort to examine the extent to which positive childhood experiences are protective factors for maternal smoking behaviors. Between 2015-2018, 309 pregnant women in Oklahoma recruited from high-risk prenatal clinics, childbirth education classes, and social media were surveyed about their childhood experiences and smoking behaviors during pregnancy. Ordinal regression analysis was used to examine the association between ACEs, PACEs, and prenatal smoking frequency. Similar to prior studies, we found women with more ACEs reported smoking more frequently during pregnancy. Women with more PACEs reported significantly less frequent prenatal smoking. With both ACEs and PACEs in the model, however, ACEs was no longer a significant predictor of maternal prenatal smoking. Our findings suggest that protective and compensatory childhood experiences may be more salient for prenatal smoking behaviors than adverse childhood experiences. Identifying protective factors for pregnancy health risk behaviors such as smoking can offer a target for intervention and prevention

Predictors of breath alcohol concentrations in college parties

Abstract Background Alcohol use and subsequent consequences are harmful for individual college students. Other students and the university can also be negatively impacted by the consequences of alcohol use. Method A field-based study was used to assess the alcohol use environment at college parties. Researchers replicated a previous study by driving and walking a route to identify parties primarily on Thursday, Friday, and Saturday evenings between 9:00 PM and 1:00 AM across an academic year. Parties were randomly sampled. Hosts were asked for permission to enter the party at each sampled location. A census of partygoers was attempted at each party. Participants were asked to complete a brief survey and give a breath sample. All participants were recruited into a follow-up survey. Bivariate and multivariate analyses of individual-level and party-level factors associated with intoxication are presented. Results The research team identified 29 parties: 16 were approached, and 12 were surveyed. Overall, 112 participants were surveyed for a response rate of approximately 28.7% of partygoers. Controlling for demographic characteristics, consumption of shots of liquor/spirits was significantly associated with a five times greater risk for intoxication. Notably, drinking games were protective of breath alcohol concentration (BrAC) risk in this model. Individuals who reported engaging in drinking games were 74% less likely to report a BrAC above the U.S. legal limit, while controlling for underage drinking in the model. Several party characteristics were identified that increased overall BrAC at the parties, including whether the party was themed, if it was a Greek life party, and whether there were illicit drugs present. Notably, when intoxication is examined by gender and party theme, women are significantly more likely to be intoxicated at themed parties: 75% were above 0.08 at themed parties compared to 35% above 0.08 at non-themed parties. Conclusions Field-based data collection methods can, and should, be modified to conduct needs assessment and evaluation of prevention programs on college campuses. The findings on this campus were different than the originally sampled campus. Prevention programs should target unique risks identified on each campus, and to respond to problematic party behaviors with comprehensive programming rather than policy-level bans

Modelling Opportunity: An Examination of Quadratic Effects of Adolescent Venezuelan Substance Use

Introduction and Aims Numerous studies have found a linear relationship between an exposure opportunity and age of first drug use. This study further tests this relationship by exploring whether a quadratic exposure opportunity best fits the data on age of first use and whether gender moderates this relationship. That is, is there a peak age in which the transition to use occurs for male compared to female adolescents? Design and Methods A sample of 1716 adolescents from 14 public and private schools, representative of two school districts in Caracas, Venezuela, was examined using a zero‐inflated Poisson modelling approach to test for quadratic effects. A series of models were tested for each set of substances (alcohol, tobacco and other drugs) to assess whether a quadratic model has better predictive ability than linear models and to test whether gender moderates the quadratic relationship. Results After controlling for common covariates, the quadratic models for alcohol indicated the peak age of transition from an exposure opportunity to use was 10‐years of age in this Venezuelan sample. Gender did not moderate these models suggesting an important move toward gender equality in substance use. Discussion and Conclusions Focused efforts on preventing exposure to alcohol use during these windows of rapid transition is likely to have the greatest impact on delaying age of onset, which will reduce the overall prevalence of alcohol related problems among adolescents

Opportunities to Use Drugs and the Transition to Drug Use Among Adolescents From Caracas, Venezuela

Few studies have examined exposure to drug use and the lag between exposure and use. This paper estimates prevalence of opportunity to use a substance, for use, and for use given an opportunity to use among a sample of Venezuelan adolescents. Several covariates on the opportunity to use and the transition to use are also examined. Findings show that lifetime prevalence of substance use among Venezuelan adolescents increases dramatically and more closely resembles rates among US and European samples when having had an opportunity to use was taken into account. A majority of youth who transitioned to use did so the same year exposure occurred, and females had a shorter time difference compared to males. Covariates primarily predicted exposure rather than having used after controlling for exposure, and their effects varied by substance. Implications for prevention efforts are discussed

Trauma across generations: a novel look at adverse childhood experiences using the Behavioral Risk Factor Surveillance System

Introduction: The adverse childhood experiences (ACEs) study was one of the first to demonstrate the robust, life-long effects of family dysfunction, child maltreatment, and neglect during childhood. The initial study of well-educated, middle-class adults indicated that early life traumatic events are common and frequently co-occur with more than 66% reporting having at least 1 ACE and over 20% with 3 or more. Subsequent studies representative of the general population have identified higher rates of 3 or more ACEs. There is a dose-response relationship with the ACEs accumulated and a range of adverse health outcomes including, but not limited to, pulmonary disease, cardiovascular disease, cancer, depression, substance misuse, and suicide. The effects of ACEs appear to drive lasting behavioral and biological adaptations that may increase the risk for ACEs in future generations.Methods: To assess this theory, we performed a cross-sectional analysis using data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS)— a nationally representative survey performed in the United States. ACEs were collected in 28 states and Washington D.C. To assess trends in ACEs by year of birth, we summed the ACE items from the BRFSS ACEs module and calculated the mean number of ACEs by reported participant age with survey design and sampling weights provided by BRFSS. To determine participants' year of birth, we subtracted the reported age from the survey year (2020). We then used an auto-regressive integrated moving average (ARIMA) to forecast the birth year when US residents surpass a mean of 3 cumulative ACEs— a benchmark in which multiple studies have shown the disparities in comorbid diseases and disrupted education increases significantly.Results: Of the participants reporting ACEs (n=116,378; N=63,076,717), the average number of participants per yearly age from 18-79 was 1714.6 (SD=535.9) and 10,071 respondents in the 80+ grouping (Supplement 1). The mean number of ACEs reported by participants 80 years or older (born in or before 1940) was 0.79 (95%CI 0.74-0.85), while the highest ACEs were reported by respondents who were 22 years of age (born in 1998; Figure 1). The forecasted model shows that individuals born in 2018 will, on average, surpass a cumulative of 3 ACEs.Discussion: The accumulation of ACEs across the past 80 years supports behavioral and biological theories regarding the transmission of intergenerational trauma. Further, these analyses estimate that U.S. children born in 2018 will, on average, experience more than 3 ACEs. Implementation of resilience practices is necessary in order to prevent the continued intergenerational accumulation of ACEs and associated mental and physical comorbidities. CDC Guidelines for Preventing ACEs include strengthening economic support to families, teaching skills(social-emotional learning, parenting, healthy relationships) to families, and early intervention by trauma-informed primary care and victim-centered services may affect this trajectory. Not all children exposed to ACEs experience poor health outcomes; indeed, future research target inclusion of measures and interventions on protective factors associated with resilienc

The Effects of Requiring Parental Consent for Research on Adolescents\u27 Risk Behaviors: A Meta-Analysis

PURPOSE: Requiring parental consent may result in sampling biases that confound scientific conclusions and stifle the representation of children most at risk for adverse outcomes. This study aims to investigate whether active parental consent, compared with passive parental consent, creates a bias in response rate, demographic makeup, and adverse outcomes in adolescent samples. METHODS: A meta-analysis was performed on peer-reviewed articles and unpublished dissertations from 1975 to 2016 in five computerized databases ERIC, PsycINFO, MEDLINE, PubMed and ProQuest. Quantitative studies were retained if they included the following keywords: active consent (or informed consent or parental consent), passive consent (or waiver of consent), risk behavior, adolescen*. RESULTS: Fifteen studies were identified with a total number of 104,074 children. Results showed (1) response rates were significantly lower for studies using active consent procedure than those using passive consent procedure (Z = 3.05, p = .002); (2) more females, younger participants, and less African-Americans were included in studies using active consent procedures than studies using passive procedures (Z = -2.73, p = .006; Z = -12.06, p \u3c .00001; Z = 2.19, p = .03, respectively); (3) studies with passive consent procedures showed higher rates of self-reported substance use than studies using active consent procedures (Z = 3.07, p = .002). CONCLUSIONS: Requiring active parental consent can lead to a systematic bias in the sample where the population under study is misrepresented. Institutional review board committees should collaborate with researchers to find solutions that protect minors without silencing the voice of high-risk youth in the literature

Adverse childhood experiences and subjective cognitive decline: An analysis of the Behavioral Risk Factor Surveillance System

Background: Cognitive functioning plays a crucial role in maintaining a healthy, active, and independent lifestyle. A 2017 study found the total net cost of care for an individual with dementia was 175% more than a person without dementia 1 . With an aging population and increasing rates of dementia in the U.S., improved etiology of cognitive decline is pertinent to establishing preventative measures, and therefore slowing increasing rates. The aim of this study was to determine the association between domains of Adverse Childhood Experiences (ACEs), and subjective cognitive decline (SCD) in a representative sample of the US adult population.Methods: Data was obtained from the 2019 and 2020 Behavioral Risk Factor Surveillance Survey (N=18,096; > 45 years). ACEs were summed and categorized into 0, 1-2, and 3+ for ACE accumulation analysis. Among individuals reporting one ACE, domains of adversity (Family Mental Illness, Family Substance Abuse, Family Incarceration, Parental Divorce, Intimate Partner Violence, Emotional Abuse, Physical Abuse, and Sexual Abuse) were compared to those reporting 0 ACEs. We estimated prevalence of ACEs among individuals responding to the SCD questions within BRFSS and used multivariate logistic regression to determine the association between ACE domains and SCD.Results: Our sample included 178,441 respondents representing a population estimate of 38,215,839. Among respondents aged 45 and over, 10.14% (n = 18,096; N = 3,960,992) reported experiencing cognitive decline. Mean ACE scores among participants reporting cognitive decline were 2.61 compared to an ACE score 1.44 in participants not reporting cognitive decline, a statistically significant difference (P<.001).Compared to individuals reporting 0 ACEs, individuals reporting 1-2 ACEs were more likely to report frequently experiencing memory (OR: 1.59; 95%CI 1.43-1.76) and even greater among those reporting 3 or more ACEs (OR: 3.58; 95%CI: 3.23-3.96). Individuals reporting 3 or more ACEs were also significantly more likely to report frequent difficulties with ADLs, needing assistance with ADLs, and experiencing social limitations due to cognitive decline compared to individuals with no ACEs. Further, those with higher ACEs scores were significantly less likely to have spoken with a healthcare provider about their cognitive decline. Among individuals reporting 1 ACE of family mental illness, family substance abuse, family incarceration, emotional abuse, and physical abuse had significantly greater odds of reporting memory loss compared to individuals with no ACEs. Individuals with 1 ACE of parental divorce were less likely to get help with ADLs when needed, and individuals reporting 1 ACE of sexual abuse were significantly less likely to experience social limitations compared to those with no ACEs.Conclusions: Having multiple ACEs was significantly associated with higher odds of cognitive decline and associated limitation of social activity and inversely associated with getting help when it is needed. Further, many ACE domains were associated with SCD—a novel addition to the literature and the methodology used herein. Interventions focused on improving cognitive health and preventing cognitive decline should consider the potential role of ACEs among affected population