Midwestern Community Sample Research Articles

Abstract 14041: Caring for Infants With Complex Single Ventricle: Impact on Families

Objective: Outcomes for infants with single ventricle (SV) heart defects have steadily improved in recent decades, but there is still significant mortality and morbidity during the interstage period between stage 1 Norwood hospitalization discharge and stage 2 palliation at 4-6 months of age. The impact on families during this period of infant home surveillance is unknown. The aim of this study was to evaluate parental quality of life (QOL) and family functioning among parents of infants with SV during the interstage period. Methods: Parents (n= 32) completed the PedsQL Family Impact Module (FIM) via a web link or by telephone at 6 weeks post Norwood discharge and again prior to Stage 2 surgery. Higher scores indicate less negative impact. Data were compared to published norms for a Midwestern community sample of parents. Results: Median age at Norwood was 5 days (range 1-50) with a median hospital length of stay (LOS) of 28.5 days (range 14-102). Total FIM, family functioning, and parental QOL scores were not significantly lower than community norms. Across scales however, the SV parents had significantly worse scores related to worry (64.4 ± 20.6 vs 78.1 ± 20.1, p<.001), communication (74.0 ± 23.5 vs 81.9 ± 17.7, p=0.01) and daily activities (53.6 ± 30.2 vs 63.2 ± 22.5, p=0.02) at 6 wks. Interestingly, the mean scale score for family relationships was significantly higher in the SV parents than community norms at 6 wks (82.7 ± 14.4 vs 67.0 ± 19.4, p<.001) and pre-Stage 2 (76.3 ± 21.6 vs 67.0 ± 19.4, p=0.01). There was no significant change in any FIM scale scores between 6 wk and pre-Stage 2 assessments except parental physical functioning scores declined (p=0.004).Total FIM, including parental QOL and family functioning scores, were not significantly associated with Norwood hospital LOS. Most parents (97%) reported daily monitoring of their infant’s oxygen saturation at home was helpful and 22% felt monitoring decreased their stress. Conclusion: Care of an infant with SV has a significant impact on families throughout the interstage period with improved outcomes related to supportive family relationships. Home monitoring by parents with ongoing assessment of family concerns by healthcare providers may further support families caring for infants with single ventricle.

Associations between deployment, military rank, and binge drinking in active duty and Reserve/National Guard US servicewomen

BackgroundPrior studies of mostly male U.S. service members suggest service characteristics such as deployment with combat exposure and lower rank may be a risk factor for alcohol misuse. However, these relationships have not been examined among servicewomen who may be at high risk for experiencing deployment-related stressors and associated health consequences. This cross-sectional report of US servicewomen in the Reserve or National Guard (RNG) and active component (AC) sought to examine these associations. MethodsA Midwestern community sample of currently serving and veteran servicewomen (N=1339) completed structured telephone interviews. The Generalized Linear Model was used to examine associations between service characteristics, any binge drinking, and frequency of recent binge drinking after adjusting for demographics. ResultsAfter adjusting for demographics, deployment to Iraq or Afghanistan was associated with greater odds of reporting a binge drinking episode, compared to no deployment, among servicewomen in the AC but not RNG. Deployment to Iraq or Afghanistan was also associated with more days binge drinking in both groups compared to servicewomen not deployed. Lower ranking servicewomen also reported higher odds of a binge drinking episode and higher frequency of binge drinking in both the RNG and AC. ConclusionsService characteristics including deployment to Iraq or Afghanistan (vs. those not deployed) and lower rank (vs. officers) may be a risk factor for recent binge drinking and higher frequency of binge drinking among servicewomen, after adjusting for demographic covariates. Public health and clinical implications are discussed.

Post-sexual assault health care utilization among OEF/OIF servicewomen.

Few who experience sexual assault seek health care immediately. Yet many become heavy users of health care resources in the years postassault because sexual violence has been linked with both acute and chronic health consequences. Our objective was to investigate servicewomen's medical and mental health (MH) care utilization after sexual assault in-military (SAIM) and identify reasons for not seeking care. In a retrospective cross-sectional Midwestern community sample of OEF/OIF Active Component and Reserve/National Guard servicewomen, currently serving and veterans, computer-assisted telephone interviews were conducted with 207 servicewomen who experienced SAIM. A quarter (25%) received post-SAIM MH care and 16% medical care. Utilization of medical care tended to be sooner (within the first month) and MH care later (6 mo to 1+ y). Most sought care on a military base, a third from civilian providers, and 10% sought MH from Veterans Health Administration. Servicewomen were more likely to have utilized medical care if they had experienced a completed SAIM and made a Department of Defense SAIM report and MH care if they were white, experienced on-duty SAIM, and made a Department of Defense SAIM report. The most common reason for not seeking medical care was due to belief that care was not needed. Reasons for not utilizing medical or MH care included embarrassment, confidentiality concerns, and fear of adverse career consequences. Few servicewomen utilized post-SAIM care, thus assault-specific health consequences were likely unaddressed. Given the severe and chronic consequences of sexual assault, our findings emphasize need for military, Veterans Health Administration, and civilian providers to query SAIM history to provide timely and optimal care.

Teen tobacco use: research and regulatory gaps.

Teen tobacco use: research and regulatory gaps.

Reporting sexual assault in the military: who reports and why most servicewomen don't.

Public and congressional attention to the Department of Defense's (DoD's) efforts to prevent and respond to sexual assault in the military (SAIM) is increasing. To promote reporting, the DoD offers (1) restricted reporting, allowing confidential reporting to designated military personnel without triggering an official investigation, and (2) unrestricted reporting, which initiates a criminal investigation. To identify factors associated with officially reporting SAIM by examining demographic, military, and sexual assault characteristics and survey reporting perceptions and experiences. Differences between active component (AC) (full-time active duty) and Reserve and National Guard (RNG) were explored. A Midwestern community sample of currently serving and veteran servicewomen (1,339) completed structured telephone interviews. RNG interviews were conducted March 2010 to September 2010 and AC interviews from October 2010 to December 2011. Data were analyzed in 2013. Logistic regression analyses examined demographic, military, and SA characteristics related to SAIM reporting. Bivariate statistics tested differences between AC and RNG. A total of 205 servicewomen experienced SAIM and 25% reported. More AC servicewomen experienced SAIM, but were no more likely to report than RNG servicewomen. Restricted reporting was rated more positively, but unrestricted reporting was used more often. Reporters' experiences corroborated non-reporters' concerns of lack of confidentiality, adverse treatment by peers, and beliefs that nothing would be done. Officers were less likely to report than enlisted servicewomen. Actual and perceived reporting consequences deter servicewomen from reporting. SAIM undermines trust in military units, mission readiness, and the health and safety of all service members.

Implicit and explicit attitudes predict smoking cessation: Moderating effects of experienced failure to control smoking and plans to quit.

The current study tested implicit and explicit attitudes as prospective predictors of smoking cessation in a Midwestern community sample of smokers. Results showed that the effects of attitudes significantly varied with levels of experienced failure to control smoking and plans to quit. Explicit attitudes significantly predicted later cessation among those with low (but not high or average) levels of experienced failure to control smoking. Conversely, however, implicit attitudes significantly predicted later cessation among those with high levels of experienced failure to control smoking, but only if they had a plan to quit. Because smoking cessation involves both controlled and automatic processes, interventions may need to consider attitude change interventions that focus on both implicit and explicit attitudes.

Multiple trajectories of cigarette smoking and the intergenerational transmission of smoking: A multigenerational, longitudinal study of a midwestern community sample.

To investigate the relation between developmental phenotypes of parental smoking (trajectories of smoking from adolescence to adulthood) and the intergenerational transmission of smoking to their adolescent children. A longitudinal, multigenerational study of a midwestern community sample followed individuals from adolescence into adulthood and was combined with Web-based assessment of participants' spouses and adolescent children. Mixture modeling identified multiple trajectories of smoking, and path analyses related these trajectories to adolescents' smoking (beyond both parents' current smoking). Potential mediations were parental education and adolescents' personality characteristics. The outcome measure was adolescent smoking. A parent's smoking trajectory had a unique effect on their adolescent's smoking, beyond both parents' current smoking and the parent's educational attainment. However, although adolescents' personality characteristics were related both to adolescent smoking and to their parents' smoking, these characteristics could not explain the effects of the parent's smoking trajectory. Parents whose smoking had an early onset, steep acceleration, high levels of smoking, and persistence over time had the highest risk for intergenerational transmission of smoking to their adolescent children.

“Deviance proneness” and adolescent smoking 1980 versus 2001: Has there been a “hardening” of adolescent smoking?

In a midwestern community sample, we tested for evidence of “hardening” of adolescent cigarette smoking between 1980 and 2001 by comparing adolescent smokers and nonsmokers at these two times on measures indicative of “deviance proneness” in Jessor and Jessor's [Jessor, R., & Jessor, S. L. (1977). Problem behavior and psychosocial development: A longitudinal study of youth. NY: Academic Press] problem behavior theory. Results produced support for some “hardening” of adolescent smoking, but this was largely confined to younger cohorts. Changing social norms that are reflected in a lowered prevalence of adolescent smoking may have restricted smoking behavior to a somewhat more “deviance prone” segment of the adolescent population. Results illustrate the potential utility of considering changes in the larger social and historical context when studying the development of adolescent risk behavior.

From adolescence to adulthood: Age-related changes in beliefs about cigarette smoking in a Midwestern community sample.

The current study used a cohort-sequential design to examine age-related changes in health-relevant beliefs from the middle school years through age 37 in a large, midwestern, community sample (N=8,556). Results suggest systematic age-related changes such that beliefs in the personalized risks of smoking declined in middle school and then increased, beliefs in generalized health risks increased beginning in the middle school years, and values placed on health as an outcome decreased in the high school years and then increased. These findings suggest that intervention programs must counter declining personalized risk perceptions among middle school students and declining values placed on health among high school age students.

From adolescence to adulthood: age-related changes in beliefs about cigarette smoking in a midwestern community sample.

The current study used a cohort-sequential design to examine age-related changes in health-relevant beliefs from the middle school years through age 37 in a large, midwestern, community sample (N=8,556). Results suggest systematic age-related changes such that beliefs in the personalized risks of smoking declined in middle school and then increased, beliefs in generalized health risks increased beginning in the middle school years, and values placed on health as an outcome decreased in the high school years and then increased. These findings suggest that intervention programs must counter declining personalized risk perceptions among middle school students and declining values placed on health among high school age students.

The natural history of cigarette smoking from adolescence to adulthood in a midwestern community sample: Multiple trajectories and their psychosocial correlates.

The natural history of cigarette smoking from adolescence to adulthood in a midwestern community sample: Multiple trajectories and their psychosocial correlates.

The natural history of cigarette smoking from adolescence to adulthood in a midwestern community sample: Multiple trajectories and their psychosocial correlates.

Previous research on the natural history of smoking has focused on overall group trajectories without considering the possibility of risk subgroup variation. To address this limitation, the authors of the present study aimed to identify subgroups with varying trajectories of smoking behavior. The authors accomplished this within a cohort-sequential study of a large community sample (N = 8,556) with measurements spanning ages 11-31. After removing 2 a priori groups (abstainers and erratics), the authors empirically identified 4 trajectory groups--early stable smokers, late stable smokers, experimenters, and quitters--and psychosocial variables from adolescence and young adulthood were significantly distinguished among them. Given recent advances in quantitative methods, it is now feasible to consider subgroups of trajectories within an overall longitudinal design.

Prospective predictors of quit attempts and smoking cessation in young adults.

This study examined prospective predictors of attempts to quit smoking and successful quitting among those who attempted to quit (n = 700), using a long-term longitudinal study of the natural history of cigarette smoking in a midwestern community sample. Participants, originally surveyed in 6th-12th grade (1980-1983), were followed up in 1987 and 1994. Results showed that amount of smoking, gender, education, health beliefs about smoking, value on healthy lifestyle, motives for smoking, reasons for quitting, and occupancy of young adult social roles were significant predictors of cessation. However, there were different predictors of attempts to quit and successful quitting among those who attempted to quit. From a public health perspective, both predictors of quit attempts and predictors of successful quitting among attempters are useful targets for intervention.

Four pathways to young-adult smoking status: Adolescent social-psychological antecedents in a midwestern community sample.

Evaluated the ability of social-psychological factors, measured in adolescence, to predict young-adult smoking outcomes. Results showed substantial continuity in the antecedents of adolescent and young-adult smoking but important discontinuities as well. Beliefs in the negative social consequences of smoking and beliefs about academic success and independence were important to adolescent but not to adult smoking. Conversely, beliefs in the negative health consequences of smoking were more important to adult smoking than to adolescent smoking. Results also showed an appreciable amount of smoking onset after the high school years, as well as an appreciable amount of adolescent smoking that did not persist into young adulthood. Antecedents of late-onset smoking and of nonpersistent smoking are described.

Four pathways to young-adult smoking status: Adolescent social-psychological antecedents in a midwestern community sample.

Four pathways to young-adult smoking status: Adolescent social-psychological antecedents in a midwestern community sample.

The Prevalence of Attention Deficit Disorders in a Rural Midwestern Community Sample of Nine-Year-Old Children

The authors interviewed 114 9-year-old children and their parents from a midwestern rural community population using the Diagnostic Interview Schedule for Children (DISC) and DISC-Parent (DISC-P). Four boys (4%) were diagnosed as having attention deficit disorder with hyperactivity (ADDH) by DISC and 14 children (9 boys, 5 girls) (12%) by DISC-P. Only two children received ADDH diagnosis by DISC and DISC-P. Several other DSM-III diagnoses were present in the ADDH group as well as in children with other DSM-III diagnoses. The sample size was not large enough to make adequate comparisons with previous estimates of prevalence.