Higher Odds Of Membership Research Articles

Depression Treatment Trajectories and Associated Social Determinants: A Three-Year Follow-Up Study in 66,540 Older Adults Undergoing First-Time Depression Treatment in Denmark.

This study aimed to describe depression treatment patterns, identify unique trajectory groups using a group-based trajectory approach, and explore associated social determinants in older adults undergoing first-time depression treatment during a 3-year follow-up. This Danish register-based cohort study included all adults aged ≥ 65 who initiated depression treatment by redeeming first-time antidepressant prescriptions (no prescriptions in the last 10years) between 2006 and 2015. The outcome of interest during the 2-year follow-up was depression treatment, assessed as antidepressant prescriptions redemptions and psychiatric hospital contacts for depression. Latent class growth analyses were applied to model treatment trajectories during 3years. Multinomial logistic regression analyses were used to analyze adjusted associations between social determinates and trajectory group membership. Among the 66,540 older adults (55.2% females, mean age: 77.3years), we identified three distinct groups with unique patterns of depression treatment trajectories: 'brief-treatment' where individuals stopped depression treatment within 6months (33.7%); 'gradual-withdrawal' (26.5%) where treatment was gradually stopped over 2years; and 'persistent-treatment' where individuals continued depression treatment for the entire 3years (39.8%). Females, single-person households, and residents of less-urbanized regions were associated with higher odds of membership in the 'persistent-treatment' group, while older age, widowhood or separation, and non-Danish ethnicities were associated with lower odds. Three distinct patterns of depression treatment trajectories were identified in older adults, indicating differential clinical courses of depression-potentially influenced by social determinants, including sex, marital status, urban residence, and ethnicity. Early patient stratification and targeted interventions are crucial in depression care for older adults.

Sex Differences in Postinjury Health Profiles Among U.S. Military Personnel Following Deployment-Related Concussion.

Background: Women in the U.S. military are now authorized to serve in direct combat occupations. This may increase their risk of combat injuries, such as concussion, in future conflicts. Knowledge of sex differences in health profiles after concussion is paramount for military medical planning efforts. The purpose of this study was to assess sex-related differences in health profiles among U.S. military personnel following deployment-related concussion. Materials and Methods: We conducted a retrospective study of service members who sustained a concussion during combat deployment between 2004 and 2013. Postinjury diagnoses were abstracted from outpatient encounters in electronic health records for 24 months after concussion. We used hierarchical clustering to identify clusters, termed "health profiles," and logistic regression to determine whether sex predicted membership in the health profiles. Results: The study sample included 346 women and 4536 men with deployment-related concussion. Five postinjury health profiles were identified and classified as no morbidity, back pain, tinnitus/memory loss, posttraumatic stress disorder/postconcussion syndrome, and multimorbidity. Women relative to men had higher odds of membership in the back pain (odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.05-1.67) and multimorbidity profiles (OR = 1.44; 95% CI = 1.03-2.00) and lower odds than men in the tinnitus/memory loss profile (OR = 0.62; 95% CI = 0.42-0.91). Conclusions: Postinjury health profiles among U.S. service members differ by sex following deployment-related concussion, particularly with a higher burden of multimorbidity among women than men, which may require interdisciplinary care. Women also had higher odds of membership in the back pain profile and lower odds in the tinnitus/memory loss profile than men. To prepare for future military operations where women may have greater exposure to combat, continued research elucidating health-related sex differences after deployment-related concussion is imperative.

A Cluster Analysis of Oral and Cognitive Health Indicators in the CLSA: An Exploratory Study on Cholinergic Activity as the Link.

Poor oral health has been suggested as a risk factor for cognitive decline. Yet, biologically plausible mechanisms explaining this relationship remain unknown. We aimed (1) to identify oral and cognitive health clustering patterns among middle-aged to elderly Canadians and (2) to investigate the extent to which these patterns could be explained by bone mineral density (BMD), a proxy measure of the cholinergic neurons' activity. This cross-sectional study used baseline data from the Comprehensive cohort of the Canadian Longitudinal Study of Aging (CLSA). Oral health was assessed by a self-report questionnaire, and 7 task-based instruments measured cognitive health. We identified oral and cognitive health clusters, our outcome variables, using latent class analysis. Two sets of multivariate logistic regression and 95% confidence intervals were used to investigate whether BMD explains the odds of membership in a certain oral and cognitive health group. The final models were adjusted for socioeconomic, health, and lifestyle factors. Our study sample (N = 25,444: 13,035 males, 12,409 females) was grouped into 5 and 4 clusters based on the oral health status and performance on the cognitive tasks, respectively. After adjusting for all potential covariates, increase in BMD was not associated with higher odds of membership in classes with better oral health (odds ratio [OR] = 1.58 [95% confidence interval {CI}: 0.85-2.92]) and cognitive health (OR = 1.61 [95% CI: 1-2.6]) compared with the groups with the least favorable oral and cognitive health status, respectively. Middle-aged and elderly Canadians show different oral and cognitive health profiles, based on their denture-wearing status and performance on cognitive tests. No evidence could be found to support BMD in place of cholinergic neurons' activity as the common explanatory factor behind the association between oral health and cognitive health. This study is probably the first of its kind to shed light on the cholinergic system as a potential pathway influencing oral and cognitive health. Our findings may support the notion that any potential association between poor oral health and cognitive health might be explained by common contributors, helping clinicians to find the common risk factors for both conditions.

Identifying and describing trajectories of alcohol use frequency and binge drinking frequency among those age 15-30 in a national cohort of U.S. adolescents: a group-based trajectory modeling approach.

Analyzing long-term trajectories of alcohol use has the potential to strengthen policy and intervention priorities and timing. We identified and described trajectories of alcohol use and binge drinking frequency from mid-adolescence to early adulthood and measured the association of the role of early drinking initiation with trajectory membership. Longitudinal cohort study SETTING: United States PARTICIPANTS: The National Longitudinal Survey of Youth 1997 is a nationally representative cohort of youth age 12-16 at baseline. The analytic sample included individuals who participated in >2 annual interviews between age 15 and 30 (n=8,809). Participants self-reported the number of days in the past 30 days they: (1) drank alcohol and (2) binge drank [>5 drinks in one occasion]. We used group-based trajectory modeling to identify distinct trajectories from age 15-30 of past 30-day drinking and past 30-day binge drinking. Using multinomial logistic regression, we evaluated associations between early drinking initiation (≤14 years) and key demographics with trajectory membership. We identified 5 past 30-day drinking groups: late-escalating (16.0%), moderate-frequency (19.0%), high-frequency (11.1%), low-frequency (35.4%) and no/infrequent (18.4%). Early drinking initiation (versus later) was associated with higher odds of membership in the moderate (adjusted multinomial odds ratio [aMOR] = 4.32; 95% confidence interval [CI]: 3.65, 5.12) and high-frequency groups (aMOR = 4.17; 95%CI: 3.50, 4.97) than in the no/infrequent comparator trajectory. We identified 5 groups with distinct binge drinking frequency patterns: later escalating (9.9%), high-frequency (3.9%), low frequency (28.7%), earlier onset (9.5%), and no/infrequent (48.0%). Early initiation was associated with increased odds of membership in earlier onset and high-frequency groups compared with the no/infrequent group. For both outcomes additional differences in probability of group membership were identified by gender, racial identity, parental factors (religiosity, high school completion), and household characteristics (household size, income, and region of residence). Youth in the United States appear to follow heterogeneous drinking and binge drinking trajectories from adolescence into adulthood. These may include higher-use trajectories as well as trajectories with different escalation timing (e.g., earlier vs. later). Early initiation of drinking may increase risk of membership in higher- and earlier-use trajectory groups.

Latent Profile Analysis of Patients Entering Interdisciplinary Pain Treatment: Subgroup Patterns and Relations with Gender, Race, and Opioid Use

This study aimed to utilize profiling analysis to explore subgroups of patients entering a pain rehabilitation program (PRP) based on pre-treatment physical and emotional functioning. A secondary aim was to examine relations between gender, race, and opioid use with subgroup "membership," with potential treatment implications. N=113 patients who entered a 3-week, interdisciplinary PRP completed baseline assessments of pain, mood, pain coping, opioid misuse, and a 6-minute walk test. Latent profile analysis was utilized to identify subgroup profiles. One profile was added at a time; fit indices were examined after each step. Within-group means were examined to describe groups. Multinomial logistic regression was utilized to examine relations between profile "membership" and gender, race, and opioid use. Fit indices (AIC/BIC) indicated a 4-profile solution. Classification quality was good (entropy=.89). Within-group means revealed patterns: Group 1 (n=50) had high pain and poorer physical functioning but low distress; Group 2 (n=14) had favorable scores across measures; Group 3 (n=21) had moderate pain, high interference and distress, poor pain coping, but higher physical functioning; Group 4 (n=28) had the least favorable scores across measures. Women had higher odds of membership in Group 2 or 4 than 1 (p<.01). Opioid use was associated with lower likelihood of membership in Group 2 compared to all others (p<.01). White participants had higher odds of being in Group 3 compared to Groups 1 or 4; African Americans had higher odds of being in Group 4 than 3 (p<.01). These analyses offer preliminary evidence that patients may enter interdisciplinary pain treatment with distinct "profile" patterns of physical and emotional functioning. Gender and race differences were observed. Opioid use was lowest in the highest functioning subgroup. A more nuanced understanding of subgroup patterns prior to pain treatment has implications for tailored interventions, including gender and disparity-informed treatment. Support from Duke Endowment Grant.

Cannabis use disorder trajectories and their prospective predictors in a large population-based sample of young Swiss men.

Cannabis use disorder (CUD) is frequent in adolescence and often goes into remission towards adulthood. This study aimed to estimate trajectories of CUD severity (CUDS) in Swiss men aged from 20 to 25years and to identify prospective predictors of these trajectories. Latent class growth analysis of self-reported CUDS in a cohort study with three data collection waves. A general population sample of young Swiss men. A total of 5987 Swiss men assessed longitudinally at the mean ages of 20, 21.5 and 25years. Latent CUDS in the last 12months was measured at each wave with the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Predictors of CUDS trajectories, measured at age 20, were from six domains: factors related to cannabis use, family, peers, other substance use, mental health and personality. We distinguished four CUDS trajectories: stable-low (88.2%), decreasing (5.2%), stable-high (2.6%) and increasing (4.0%). Predictors were generally associated with higher odds of membership in the decreasing and stable-high trajectory (versus the stable-low), and to a lesser degree with higher odds of membership in the increasing trajectory. Bivariate predictors of persistent high CUDS (stable-high versus decreasing trajectory) were major depression severity [odds ratio (OR)=1.19, 95% confidence interval (CI)=1.01, 1.40], attention deficit hyperactivity disorder severity (OR=1.25, 95% CI=1.04, 1.51), antisocial personality disorder severity (OR = 1.18, 95 % CI = 1.04, 1.34), relationship with parents (OR=0.74, 95% CI=0.63, 0.88), number of friends with drug problems (OR=1.33, 95% CI=1.11, 1.60) and the personality dimensions neuroticism-anxiety (OR= 1.35, 95% CI=1.11, 1.65) and sociability (OR=0.78, 95% CI=0.62, 0.97). Factors associated with persistent cannabis use disorder in young Swiss men include cannabis use, cannabis use disorder severity, mental health problem severity, relationship with parents (before the age of 18), peers with drug problems and the personality dimensions neuroticism-anxiety and sociability at or before age 20. Effect sizes may be small, and predictors are mainly associated with persistence via higher severity at age 20years.

55 Profiles of Sleep Problems among Young Children with Autism Spectrum Disorders

Abstract Background Sleep problems are more common and severe among children with autism spectrum disorder (ASD) compared to their typically developing peers. The goal of this study was to characterize sleep problems profiles and their clinical correlates, based on a five-factor model of the Children’s Sleep Habits Questionnaire (CSHQ) among preschool children with ASD. Objectives (1) To describe empirically-derived patterns (i.e., latent profiles) of sleep problems among young children with ASD; and (2) To examine relations between family cumulative risk and emotional-behavioral dysregulation symptoms and sleep profile membership. Design/Methods The study included 318 three-to-five year old children (M= 49.45 months; SD = 5.77). Latent profile analysis was used to identify and describe profiles of sleep problems. Sleep problems were assessed using a previously established CSHQ five-factor model: (1) Bedtime Routine; (2) Sleep Onset &amp; Duration; (3) Night Waking; (4) Morning Waking; and (5) Sleep Disordered Breathing, with higher scores indicating greater problems. We assess whether profile membership was associated with dysregulation difficulties (CBCL 1.5-5) and family cumulative risk index (CRI; constructed based on socioeconomic status, maternal distress, family functioning, and other related factors) using a three-step method (Vermunt &amp; Magidson, 2013). Results A five-profile model of children’s sleep problems showed the best fit (Figure 1). Profile 1, Nighttime Sleep Problems (28%), consisted of children with scores around the sample mean, except relatively lower scores on Morning Waking. Profile 2, Severe Sleep Problems (25%), consisted of children with relatively high scores across all sleep problems. Profile 3, Low Sleep Problems (18%), included children with the lowest levels of all sleep problems. Profile 4, Moderate Sleep Problems (17%), included children with all sleep problem levels near the sample mean. Profile 5, Morning Waking Problems (12%), consisted of children with low scores on Bedtime Routine problems but pronounced Morning Waking problems. Dysregulation difficulties (Wald = 13.90; p = .001) and family CRI (Wald = 13.27; p =.001) emerged as significant predictors of profile membership. Higher CRI was associated with higher odds of membership in Profile 2 (Severe Sleep Problems), and lower scores for dysregulation difficulties were associated with higher odds of membership in Profile 3 (Low Sleep Problems). Conclusion Children with ASD present distinct profiles of sleep problems that differ, not only by overall severity, but also by relative severity across types of sleep problems. Children’s dysregulation and family risk should be considered in examining children’s sleep.

Perceived barriers to pre-exposure prophylaxis use and the role of syndemic factors among female sex workers in the Mexico-United States border region: a latent class analysis

ABSTRACTFemale sex workers (FSWs) experience syndemic factors (e.g., polydrug use, hazardous alcohol consumption, client-perpetrated violence, depression, and sexually transmitted infections) that often heighten vulnerability to HIV and limit healthcare utilization. We hypothesized that syndemic factors will limit FSWs’ uptake of pre-exposure prophylaxis (PrEP). From 2016 to 2017, 295 HIV-negative FSWs were enrolled in a behavioral HIV prevention trial in Tijuana and Ciudad Juarez, Mexico, underwent STI testing, and completed surveys on syndemic factors and perceived barriers to PrEP use. Syndemic scores (0–5) were calculated by summing syndemic factors. Latent class analysis (LCA) was used to identify homogeneous classes with respect to perceived barriers to PrEP use. We identified four classes: (1) perceived healthcare access barriers (8.3%), (2) perceived financial barriers (18.7%), (3) high level of perceived barriers (19.9%), and (4) low level of perceived barriers (53.0%) to PrEP use. Those experiencing three (adjusted odds ratio [aOR] = 3.63, 95% confidence interval [CI] = 1.24–10.67) and four or five (aOR = 6.30, 95% CI = 1.70–23.35) syndemic factors had a higher odds of membership in the class characterized by a high level of perceived barriers than in the class characterized by a low level of perceived barriers. Addressing syndemic factors may maximize PrEP’s impact among FSWs along Mexico’s northern border.

Reasons for Vaping Among U.S. 12th Graders

IntroductionVaping has recently increased in popularity among adolescents. Little is known about heterogeneity of vapers, particularly in terms of why they vape. Identifying major subgroups of adolescent vapers by reasons for vaping is important to understand adolescent vaping behavior and to identify those most at risk for other substance use. MethodsMonitoring Future data from 2015 and 2016 were used in a latent class analysis to identify subgroups of 12th graders based on their endorsement of 10 potential reasons for vaping. Multinomial regression with a latent class outcome was used to predict class membership. ResultsThree distinct classes of vapers were identified: adolescents who were (1) Vaping to Experiment (29.4%), (2) Vaping to Replace Cigarettes (7.3%), and (3) Vaping for Taste + Entertainment (63.4%). Vaping only flavors was associated with lower odds of membership and cigarette use was associated with higher odds of membership in the Vaping to Replace Cigarettes subgroup, and marijuana was associated with lower odds of membership in the Vaping to Experiment subgroup, compared with the Vaping for Taste + Entertainment subgroup. ConclusionsThis study identified multiple subgroups of vapers based on reasons for vaping. Whereas a small subgroup vaped for reasons related to cigarette use, most adolescent vapers reported vaping for reasons unrelated to cigarette use. There were considerable differences in primary reasons for vaping and risk for traditional cigarette and other substance use, suggesting different intervention strategies may be needed for different subgroups of vapers.

Association of long-term patterns of depressive symptoms and attention/executive function among older men with and without human immunodeficiency virus.

Older HIV-infected men are at higher risk for both depression and cognitive impairments, compared to HIV-uninfected men. We evaluated the association between longitudinal patterns of depressive symptoms and attention/executive function in HIV-infected and HIV-uninfected men aged 50+years to understand whether HIV infection influenced the long-term effect of depression on attention/executive function. Responses to the Center for Epidemiologic Studies-Depression scale and attention/executive function tests (Trail Making Test Part B and Symbol Digit Modalities Test) were collected semiannually from May 1986 to April 2015 in 1611 men. Group-based trajectory models, stratified by HIV status, were used to identify latent patterns of depressive symptoms and attention/executive function across 12years of follow-up. We identified three depression patterns for HIV-infected and HIV-uninfected men (rare/never 50.0 vs. 60.6%, periodically depressed 29.6 vs. 24.5%, chronic high 20.5 vs.15.0%, respectively) and three patterns of attention/executive function for HIV-infected and HIV-uninfected men (worst-performing 47.4 vs. 45.1%; average 41.9 vs. 47.0%; best-performing 10.7 vs. 8.0%, respectively). Multivariable logistic regression models were used to assess associations between depression patterns and worst-performing attention/executive function. Among HIV-uninfected men, those in the periodically depressed and chronic high depressed groups had higher odds of membership in the worst-performing attention/executive function group (adjusted odds ratio [AOR]=1.45, 95% CI 1.04, 2.03; AOR=2.25, 95% CI 1.49, 3.39, respectively). Among HIV-infected men, patterns of depression symptoms were not associated with patterns of attention/executive function. Results suggest that HIV-uninfected, but not HIV-infected, men with chronic high depression are more likely to experience a long-term pattern of attention/executive dysfunction.

Gestational exposure to phthalates and gender-related play behaviors in 8-year-old children: an observational study.

BackgroundPhthalates, used in a variety of consumer products, are a group of chemicals that are ubiquitous in the environment, and their metabolites are detectable in most humans. Some phthalates have anti-androgenic properties; a prior study reported an association between gestational exposure to phthalates and reduced masculine behaviors in preschool boys.MethodsConcentrations of 9 phthalate metabolites were measured in urine collected at 16 and 26 weeks’ gestation from pregnant women enrolled in the HOME Study, a prospective pregnancy and birth cohort. Measures of gender-related play were collected at 8 years of age, including the Gender Identity Questionnaire (GIQ) completed by mothers, and the Playmate and Play Style Preferences Structured Interview (PPPSI) completed by children. We examined these measures as continuous variables using both bivariate and multivariable approaches with adjustment for covariates. Additional analyses included logistic regression of GIQ and PPPSI scores dichotomized by sex at the lower 25th percentile, indicating the least typical behavior.ResultsMothers’ phthalate metabolite concentrations during pregnancy were similar to the reported national average among US women. All children scored within a typical range on both measures of gender-related play behavior. No statistically significant associations were found between averaged maternal phthalate metabolite concentrations and continuous PPPSI scores or any GIQ scores. For the dichotomized PPPSI; higher maternal monoethyl phthalate (MEP) concentrations were associated with more typical play behaviors for females (OR = 0.70, CI = 0.51–0.97). In contrast, higher maternal mono-isobutyl phthalate (MiBP) concentrations were associated with higher odds of membership in the least typical play behaviors group for males (OR = 1.69, CI = 1.00–2.86).ConclusionsIn this sample of typically developing children, higher maternal urinary MEP concentrations during pregnancy were associated with more typical gender-related play behaviors in both males and females, and increased urinary MiBP concentrations were associated with less masculine gender-related play behaviors in males.

Trajectories of alcohol use over time among adults with alcohol dependence

This study sought to identify trajectories of drinking behavior change over time in a sample of adults with current alcohol use disorder (AUD). We conducted secondary analyses of seven waves of data from a prospective longitudinal study of 364 adults (mean age=44.0years, SD=12.8years) who met criteria for DSM-IV alcohol dependence (AD), 74.4% of whom were entering alcohol treatment. Participants were followed for 2 1/2 to 3years with in-person interviews every 6months. Results from latent class growth analyses of drinks per drinking day over 3years indicated five trajectory classes: 1) Moderate Baseline→Slow Decline; 2) Heavy Baseline→Stable Abstinent; 3) Heavy Baseline→Slow Decline; 4) Heaviest Baseline→Steep Decline, and 5) Heaviest Baseline→Stable Heavy. Findings are consistent with previous research and suggest that these trajectory classes might represent longitudinal phenotypes of alcohol involvement across diverse samples. Treatment modality, Alcoholics Anonymous involvement, and purpose in life were associated with diverse trajectories of drinking behavior among adults with AD. AA involvement was associated with higher odds of membership in trajectory classes that showed declines in drinking from baseline, and having higher purpose in life predicted lower odds of membership in the Heaviest Baseline→Stable Heavy class. AA involvement predicts different pathways of recovery characterized by stable abstinence, steep declines, and/or slower declines in drinking over time. Higher purpose in life may protect against chronic heavy drinking by strengthening motivations to pursue goals that are unrelated to substance use.