Parental Lifetime Research Articles

Racial Disparities in the Relationship between Parental Incarceration and Childhood Obesity.

Despite a developing literature on the consequences of parental incarceration, its effects on childhood obesity are not evident. Our research project fills this knowledge gap by describing the relationship between parental incarceration and childhood obesity among children aged 3 to 15 and determining if and how this association differs across race. We use four consecutive waves of data on 3,302 children from the Fragile Families and Child Wellbeing Study. Our analysis finds little evidence that parental incarceration influences the probability of obesity among all children as a group. Moreover, our findings reveal critical racial disparities in the relationship between parental incarceration and childhood obesity. In particular, parental lifetime incarceration is not associated with risks of obesity for White or Hispanic children but is associated with a significantly decreased chance of obesity for Black children. This research effort can initiate an interdisciplinary conversation on the important intersection of family and corrections in order to alleviate the intergenerational erosion of physical health and well-being.

Probiotic supplementation in healthy pre-school-aged children: Prevalence and predictors.

Probiotics have been shown to prevent or treat a number of paediatric health problems; however, not much is known about how probiotics are used in the community. This study aimed to describe the prevalence and main predictors of probiotic supplementation among healthy pre-school-aged children. Parents of 4- or 5-year-olds residing in the Australian Capital Territory (ACT) were invited to complete a web-based questionnaire between February and May 2020. There were 469 responses concerning 494 children eligible for analysis. Prevalence was categorised as lifetime exposure and recent exposure. Predictors were determined through multiple logistic regression modelling. Almost half (47.4%) of the children had ever been exposed to probiotics and 14.9% had taken probiotics in the previous month. The strongest predictors of lifetime probiotic exposure were parental lifetime probiotic use (OR 13.3; 95% CI 7.4-24.1) and an interaction between functional food consumption and parental lifetime probiotic use (OR 5.6; 95% CI 2.6-12.1). The strongest predictor of recent probiotic exposure was parental recent probiotic use (OR 13.3; 95% CI 5.7-30.8). This study illustrates the high prevalence of probiotic exposure among healthy pre-school-aged children in the ACT and emphasises the relationship between parental use of probiotics and exposure in children. These findings will allow comparison and analysis of trends over time. Practitioners should be aware of the evidence for and against probiotics as these findings suggest a high level of acceptability among parents.

Transgenerational effects of parent plant competition on offspring development in contrasting conditions.

Conditions during a parent's lifetime can induce phenotypic changes in offspring, providing a potentially important source of variation in natural populations. Yet, to date, biotic factors have seldom been tested as sources of transgenerational effects in plants. In a greenhouse experiment with the generalist annual Polygonum persicaria, we tested for effects of parental competition on offspring by growing isogenic parent plants either individually or in competitive arrays and comparing their seedling progeny in contrasting growth environments. Offspring of competing vs. non-competing parents showed significantly altered development, resulting in greater biomass and total leaf area, but only when growing in neighbor or simulated canopy shade, rather than sunny dry conditions. A follow-up experiment in which parent plants instead competed in dry soil found that offspring in dry soil had slightly reduced growth, both with and without competitors. In neither experiment were effects of parental competition explained by changes in seed provisioning, suggesting a more complex mode of regulatory inheritance. We hypothesize that parental competition in moist soil (i.e., primarily for light) confers specific developmental effects that are beneficial for light-limited offspring, while parental competition in dry soil (i.e., primarily for belowground resources) produces offspring of slightly lower overall quality. Together, these results indicate that competitive conditions during the parental generation can contribute significantly to offspring variation, but these transgenerational effects will depend on the abiotic resources available to both parents and progeny.

"Parenting Beyond the Veil": The Continued Parenting Relationship After a Child's Death Due to Cancer.

Background: Childhood cancer is the leading cause of illness-related death, leaving thousands of parents to experience bereavement. This article presents select findings about the nature of the continued parenting relationship, which is an essential theme of the parental bereavement experience. Method: Heideggerian phenomenology provided the philosophical underpinnings of this study, which aimed to describe the lived experience of bereaved parents who experienced the death of a child due to cancer. Van Manen's (1997) method guided data collection and analysis. Six parents participated in interviews to share what it has been like for them since their child's death. The researcher wrote analytic memos, documented detailed field notes, and used a member checking process to ensure trustworthiness of findings. Results: A structure of the lived experience of parental bereavement emerged, which included the essential theme of the continued parenting relationship. The parenting relationship continues throughout a parent's lifetime in spite of the child's physical absence, albeit in a different manner. This different nature of parenting is known as parenting beyond the veil. Bereaved parents continue to parent beyond the veil by engaging in meaningful activities, seeking activities that strengthen a deep connection with the child, and being open to comforting signs that enhance their continued relationship. Discussion: Parents believe sharing their experience can help nurses and other professionals understand the importance of their continued parenting relationship and their need to parent beyond the veil so that they can provide high quality care to bereaved parents in the future.

Lifetime Mental Health and Treatment Readiness among Parents of Children with Externalizing Behavior

Parental lifetime mental disorder symptoms were investigated as a moderator of the association between readiness for treatment and severity of child externalizing behaviors (EB) among 165 parents of clinic-referred children. Readiness and parental mental disorder symptoms were positively associated with greater child EB severity. Mental disorder symptoms moderated the association between parent readiness and child EB, such that among parents with fewer lifetime symptoms, greater readiness for treatment was associated with greater child EB severity. However, readiness was not associated with child EB severity at high levels of parental mental disorder symptoms. Implications for pre-treatment screening and tailoring behavioral parenting treatments are discussed.

356 Microbial origins in the developmental programming of offspring health

Abstract Adverse parental lifetime experiences, such as stress and malnutrition, are implicated in the risk for offspring metabolic, cardiovascular, and neurodevelopmental disorders. In recent years, the maternal microbiome has emerged as an important factor that affects maternal health and infant development during pregnancy and beyond. Using mouse models of maternal stress experience during pregnancy, we examined the hypothesis that maternal stress experience alters the composition of the maternal microbiota and this altered community is transmitted to offspring to mediate effects of prenatal stress. As maternal stress exposure exhibits disruptive effects on both in utero environment and maternal microbiota, it has been difficult to assess the mechanistic involvement of the maternal microbiome to the prenatal stress phenotype independent of stress effects on the fetal environment. To circumvent this, we developed a maternal microbiota transplantation method in which embryonic day 18.5 mouse pups were delivered by caesarean section, thereby preventing natural colonization, and then transplanted with various maternal microbiota communities via orogastric gavage. Transplantation of maternal microbiota from stressed dams into naïve pups delivered by caesarean section recapitulated phenotypes that resembled those seen in prenatally stressed males, including reduced body weight and increased neuroendocrine response to acute stressors. However, transplantation of control maternal vaginal microbiota into prenatally stressed pups delivered by caesarean section did not rescue the prenatal stress phenotype. We showed that the inability to rescue the prenatal stress phenotype is related to transcriptional reprogramming to pathways involved in the regulation of innate immunity in the fetal gut and brain prior to birth and colonization by maternal microbiota. These results are interesting in light of recent studies demonstrating a critical role of the maternal microbiome on homeostasis of immune cell populations in the offspring brain. As an important requirement for normal growth and development, metabolites produced by the maternal gut microbiota cross the placental barrier and gain access to fetal circulation. Thus, we examined the hypothesis that maternal stress experience during pregnancy significantly alters the availability of maternal gut microbiota-derived metabolites, thereby shifting the availability of these metabolites required for the developing brain. Metabolomic profiling of the maternal compartment and fetal brain showed stress-induced reduction in a class of microbiota-derived metabolites involved in immune homeostasis and chromatin remodeling. Indeed, functional profiling of immune populations in the fetal brain revealed an association between reduced metabolite availability and increased infiltration of proinflammatory monocytes in the fetal brain. Further, as the gut microbiome is fairly accessible within clinical settings, we are now also asking how our mouse model translates to humans in a cohort of pregnant women exposed to childhood adversity. Collectively, our results suggest that intergenerational transmission of stress exposure occur via the maternal microbiota through two novel mechanisms. First, stress alterations during pregnancy impact the available pool of maternal gut microbiota-derived metabolites necessary for normal prenatal growth and development. Second, transmission of stress-altered vaginal microbiota may alter critical immune and metabolic processes underlying neurodevelopment.

The association between parent-reported child disaster reactions and posttraumatic stress disorder in parent survivors of disasters and terrorism.

Disaster studies establishing an association between parent and child disaster reactions usually discuss results in terms of the influence of parents on their children. This study explores a complementary interpretation of this association by focusing on the potential influence of children on their parents. Investigations of 5 disasters and terrorist events included a combined sample of 556 survivor parents and their 1,066 children. Structured diagnostic interviews were administered to survivor parents to obtain diagnostic assessment of pre- and post-disaster psychiatric disorders. Parent survivors also provided information about their own demographics and disaster experiences and about each child's demographics, disaster-related experiences, and disaster reactions (posttraumatic stress symptoms, behavior changes, increased school behavior problems, and decline in grades). The results revealed an association of parent posttraumatic stress disorder with parent injury in the disaster, parent lifetime pre-disaster psychiatric disorder, parent direct exposure to disaster trauma, and each of 4 child disaster outcomes. The analysis suggests the potential for child factors to influence survivors' reactions. Clinicians should query survivors about their children's reactions and ascertain the need for services for the children. Future research should examine the potential that children's reactions influence parent outcomes.

Maternal antenatal stress and mental and behavioral disorders in their children

BackgroundMaternal antenatal stress, including symptoms of depression, anxiety and perceived stress, is associated with mental and behavioral problems in children. Whether it is associated with child mental and behavioral disorders remains uncertain. We examined if maternal antenatal symptoms of depression, anxiety and perceived stress were associated with mental and behavioral disorders in their children, if the associations varied according to gestational week, stress type, fluctuating or consistently high symptoms, and if they were driven by maternal or paternal lifetime mood or anxiety disorders. Methods3365 mothers participating in the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) study completed the Center for Epidemiologic Studies Depression Scale, the State Anxiety Inventory and the Perceived Stress Scale up to 14 times throughout pregnancy. The Care Register for Health Care provided data on mental and behavioral (including neurodevelopmental) disorders for their children from birth (11/07/2006–07/24/2010) until 12/31/2016 and for parental lifetime mood and anxiety disorders until 12/31/2016. ResultsThe hazard of any childhood mental and behavioral disorder (HR=1.91, 95% CI: 1.39–2.51) was significantly higher for children whose mothers reported consistently high in comparison to consistently low levels of all types of stress throughout pregnancy. The associations remained significant when adjusted for maternal and paternal lifetime mood and anxiety disorders (and their comorbidity and timing and mood disorder type). ConclusionMaternal antenatal stress is associated with higher risk of childhood mental and behavioral disorders. Efforts to reduce maternal antenatal stress should be given a high priority to improve child mental health.

Brain and placental transcriptional responses as a readout of maternal and paternal preconception stress are fetal sex specific

IntroductionDespite a wealth of epidemiological evidence that cumulative parental lifetime stress experiences prior to conception are determinant of offspring developmental trajectories, there is a lack of insight on how these previous stress experiences are stored and communicated intergenerationally. Preconception experiences may impact offspring development through alterations in transcriptional regulation of the placenta, a major determinant of offspring growth and sex-specific developmental outcomes. We evaluated the lasting influence of maternal and paternal preconception stress (PCS) on the mid-gestation placenta and fetal brain, utilizing their transcriptomes as proximate readouts of intergenerational impact. MethodsTo assess the combined vs. dominant influence of maternal and paternal preconception environment on sex-specific fetal development, we compared transcriptional outcomes using a breeding scheme of one stressed parent, both stressed parents, or no stressed parents as controls. ResultsInterestingly, offspring sex affected the directionality of transcriptional changes in response to PCS, where male tissues showed a predominant downregulation, and female tissues showed an upregulation. There was also an intriguing effect of parental sex on placental programming where paternal PCS drove more effects in female placentas, while maternal PCS produced more transcriptional changes in male placentas. However, in the fetal brain, maternal PCS produced overall more changes in gene expression than paternal PCS, supporting the idea that the intrauterine environment may have a larger overall influence on the developing brain than it does on shaping the placenta. DiscussionPreconception experiences drive changes in the placental and the fetal brain transcriptome at a critical developmental timepoint. While not determinant, these altered transcriptional states may underlie sex-biased risk or resilience to stressful experiences later in life.

Nonmedical Prescription Opioid Use by Parents and Adolescents in the US.

To date, intergenerational patterns of nonmedical prescription opioid (NMPO) use have not been examined. We investigate the association between parental and adolescent NMPO use in the United States. Data are from 35 000 parent-child dyads with an adolescent aged 12 to 17 years from the 2004-2012 nationally representative National Surveys on Drug Use and Health. Using multivariable logistic regression models, we estimated the association between self-reported parental and adolescent lifetime NMPO use, controlling for parental and adolescent use of other drugs, attitudes about drug use, parental and adolescent psychosocial risk factors, and sociodemographic characteristics. Controlling for other factors, parental NMPO use was associated with adolescent NMPO use (adjusted odds ratio [aOR] 1.30; 95% confidence interval [CI] 1.09-1.56). Mothers' use had a stronger association with adolescent use than fathers' use (aOR 1.62 [95% CI 1.28-2.056] versus aOR 0.98 [95% CI 0.74-1.24]). Associations between parental and adolescent NMPO use did not differ by adolescent sex or race and/or ethnicity. Parental lifetime smoking, low monitoring, and parent-adolescent conflict were uniquely associated with adolescent NMPO use (aOR 1.19-1.24) as were adolescent smoking, marijuana use, depression, delinquency, and perceived schoolmates' drug use (aOR 1.25-1.71). Perceived risk of drug use and religiosity were associated with lower rates of adolescent NMPO use (aOR 0.77-0.93). Use among older adolescents was higher than among younger adolescents (aOR 1.27; 95% CI 1.21-1.34). Parent-based interventions targeted at adolescent NMPO use should address parental NMPO use and smoking and promote positive parenting.

A neural biomarker, the error-related negativity, predicts the first onset of generalized anxiety disorder in a large sample of adolescent females.

An increased neural response to making mistakes has emerged as a potential biomarker of anxiety across development. The error-related negativity (ERN) is an event-related potential elicited when people make mistakes on simple laboratory-based reaction time tasks that has been associated with risk for anxiety. This study examined whether the ERN prospectively predicted the first onset of generalized anxiety disorder (GAD) over 1.5years in adolescent girls. The sample included 457 girls between the ages of 13.5 and 15.5years, with no history of GAD. At baseline, the ERN was measured using a flankers task. Psychiatric history of the adolescent and biological parent was assessed with diagnostic interviews, and the adolescent completed a self-report questionnaire regarding anxiety symptoms. Approximately 1.5years later, adolescents completed the same interview. An increased neural response to errors at baseline predicted first-onset GAD over 1.5years. The ERN was a significant predictor independent of other prominent risk factors, including baseline anxiety and depression symptoms and parental lifetime psychiatric history. Jointly the ERN and social anxiety symptoms provided the greatest power for predicting first-onset GAD. This study provides evidence for the utility of the ERN as a biomarker of risk for GAD during a key developmental period.

Parent and Child Trauma Symptoms During Child-Parent Psychotherapy: A Prospective Cohort Study of Dyadic Change.

Five randomized controlled trials have shown that child-parent psychotherapy (CPP) improves trauma symptoms in children. Less is known about parent symptoms or moderators of symptom change. In a sample of 199 parent (81% biological mother; 54% Latina/o) and child (aged 2 to 6 years; 52% male; 49% Latina/o) dyads who participated in an open treatment study of CPP, this study investigated whether parent and child symptoms similarly decreased during treatment and whether improvement was moderated by parent, child, and treatment characteristics. Parents completed baseline and posttreatment interviews regarding exposure to traumatic events, posttraumatic stress symptomatology (PTSS), and other mental health indices. Latent difference score analysis showed that PTSS significantly decreased by more than 0.5 SD for parents and children. The PTSS improvement in parents was associated with reductions in child avoidance, r = .19, p = .040, and hyperarousal, r = .33, p < .001. Girls showed a greater reduction than boys in reexperiencing, β = -.13, p = .018, and hyperarousal, β = -.20, p = .001. Contrary to expectations, parent and child improvement in PTSS was greater for those with fewer parental lifetime stressors, βrange = .15 to .33, and for those who participated in fewer treatment sessions, βrange = .15 to .21. The extent of improvement in parent PTSS varied based on clinician expertise, β = -.20, p = .009. Significant reductions in parent and child PTSS were observed during community-based treatment, with CPP and symptom improvement varying according to child, parent, and treatment characteristics.

Accounting for the impact of parent internalizing symptoms on Parent Training benefits: The role of positive parenting

Parent Training (PT) is not as effective for parents with histories of internalizing symptoms as it is for other parents. This study aimed to determine which dimensions of parenting, notably parenting efficacy, positive parenting, inconsistent discipline, and poor supervision, mediate the association between parent lifetime internalizing symptoms and post-PT child emotional and behavioral difficulties. One hundred fourteen parents (82% biological mothers) of children aged 9–12 years received PT at an urban children's mental health clinic. Parents reported their lifetime internalizing symptoms, pre- and post- PT parenting skills, and pre- and post- PT child difficulties. Positive parenting fully mediated the relation between parent lifetime internalizing symptoms and elevated child post-PT emotional and behavioral difficulties. Specifically, parents higher in internalizing symptoms reported lower positive parenting post-PT, which in turn predicted more child difficulties post-PT. Findings suggest that fostering positive parenting in PT may be particularly important for parents with histories of internalizing symptoms.

Parental depression and parent and child stress physiology: Moderation by parental hostility.

This study examined the moderating role of parental hostility on the associations between parental depression and the cortisol awakening response (CAR) and morning cortisol levels of both parents and children. 148 parents and 148 preschool-aged children provided salivary cortisol samples at waking, 30 and 45 min post-waking on two consecutive days. Parental depression was assessed using a clinical interview, and parental hostility was assessed using an observational parent-child interaction task. Results indicated that the combination of parental lifetime depression and high parental hostility was associated with lower morning cortisol levels in both parents and children. This interactive effect was present in children regardless of their exposure to parental depression. In addition, the combination of higher levels of parents' current depressive symptoms and parental hostility was associated with lower parent CAR. Lastly, parents' and children's lower morning cortisol levels were associated with parent-reported child externalizing symptoms. Findings demonstrate that parents and children have similar stress system functioning related to parental depression and the parenting context, as well as children's behavioral problems, which may play a role in the intergenerational transmission of risk for psychopathology.

Parent-child adrenocortical concordance in early childhood: The moderating role of parental depression and child temperament

This study examined biological concordance between parent and child morning cortisol and whether parent and child-level risk factors for depression moderated this association. Participants included 136 parents and their preschool-aged children. Parents and children obtained salivary cortisol samples at waking, and 30 and 45min post-waking across two days to assess the cortisol awakening response. Parental lifetime depression was assessed using a clinical interview and child temperamental negative emotionality (NE) and positive emotionality (PE) were assessed using an observational laboratory-based assessment. Results indicated significant parent-child concordance between both average cortisol levels and cortisol fluctuations across waking. Greater concordance was observed for dyads with parents with a lifetime history of depression and with children high in NE and PE. These parent- and child-level moderators were associated with different indices of concordance. Findings highlight the need to examine the role of parent and child risk factors for depression on parent-child adrenocortical concordance.

Associations of Perceived Parental Psychopathology with Mental Health Burden and Lifetime Drug Use in Gay, Bisexual, and other YMSM: The P18 Cohort Study

ABSTRACTParental mental health may be a critical component in understanding the overlapping health burdens of mental health symptomatology and drug use in young men who have sex with men (YMSM), yet studies of YMSM have not fully examined these associations. To understand these relationships, data drawn from a study of gay, bisexual, and other YMSM were used to examine associations between perceived parental psychopathology and the health of YMSM. Findings suggest that YMSM reporting at least one parent with perceived depression, manic depression, schizophrenia, or antisocial behavior anytime during their childhoods were more likely to report higher levels of both depressive symptomatology and post-traumatic stress disorder (PTSD) than those reporting no perception of any of these psychopathologies in their parents. Number of different drugs used in one’s life were higher among participants who perceived at least one parent as depressed. Mediation analyses indicated that the relationship between perceived parental depression and lifetime drug use of YMSM was mediated both by YMSM depression and YMSM PTSD. These results suggest that parental psychopathology plays an important role in the health of sexual minority men, a population with elevated levels of mental health burden and drug use across the lifespan.

Developmental sexual dimorphism and the evolution of mechanisms for adjustment of sex ratios in mammals.

Sex allocation theory predicts biased offspring sex ratios in relation to local conditions if they would maximize parental lifetime reproductive return. In mammals, the extent of the birth sex bias is often unpredictable and inconsistent, leading some to question its evolutionary significance. For facultative adjustment of sex ratios to occur, males and females would need to be detectably different from an early developmental stage, but classic sexual dimorphism arises from hormonal influences after gonadal development. Recent advances in our understanding of early, pregonadal sexual dimorphism, however, indicate high levels of dimorphism in gene expression, caused by chromosomal rather than hormonal differences. Here, we discuss how such dimorphism would interact with and link previously hypothesized mechanisms for sex-ratio adjustment. These differences between males and females are sufficient for offspring sex both to be detectable to parents and to provide selectable cues for biasing sex ratios from the earliest stages. We suggest ways in which future research could use the advances in our understanding of sexually dimorphic developmental physiology to test the evolutionary significance of sex allocation in mammals. Such an approach would advance our understanding of sex allocation and could be applied to other taxa.

The role of parental psychopathology and personality in adolescent non-suicidal self-injury

Adolescent non-suicidal self-injury (NSSI), a significant risk factor for suicidal behavior, is strongly associated with adolescent psychopathology and personality traits, particularly those characterized by poor self-regulation. Some parental psychopathology and personality traits have also been identified as risk factors for adolescent NSSI, but specific parental characteristics and mechanisms involved in this association have not been systematically examined. The current study comprehensively investigated the contribution of parental psychopathology and personality to adolescent NSSI using data from the baseline wave of the Adolescent Development of Emotion and Personality Traits (ADEPT) study of 550 adolescent girls (mean age = 14.39 years, SD = 0.63) and their biological parents. We first investigated whether parental lifetime psychiatric diagnoses, and personality and clinical (rumination, self-criticism, emotional reliance) traits were associated with adolescent NSSI. We also tested whether adolescent history of psychiatric illness, personality, and clinical traits mediated the associations between parental characteristics and adolescent NSSI. Parental substance use disorder, adult-ADHD symptoms, self-criticism, and lower agreeableness and conscientiousness were associated with offspring's NSSI. These associations were mediated through adolescent characteristics. In contrast, parental mood and anxiety disorders and neuroticism were unrelated to adolescent NSSI. The results suggest that parental traits and disorders characterized by self-regulatory difficulties and lack of support constitute risk factors for self-injury in adolescent girls, acting via adolescent traits. This demonstrates that parental influences play a significant role in the etiology of adolescent NSSI.

Blunted Neural Response to Rewards as a Prospective Predictor of the Development of Depression in Adolescent Girls.

A blunted neural response to rewards has recently emerged as a potential mechanistic biomarker of adolescent depression. The reward positivity, an event-related potential elicited by feedback indicating monetary gain relative to loss, has been associated with risk for depression. The authors examined whether the reward positivity prospectively predicted the development of depression 18 months later in a large community sample of adolescent girls. The sample included 444 girls 13.5-15.5 years old with no lifetime history of a depressive disorder, along with a biological parent for each girl. At baseline, the adolescents' reward positivity was measured using a monetary guessing task, their current depressive symptoms were assessed using a self-report questionnaire, and the adolescents' and parents' lifetime psychiatric histories were evaluated with diagnostic interviews. The same interview and questionnaire were administered to the adolescents again approximately 18 months later. A blunted reward positivity at baseline predicted first-onset depressive disorder and greater depressive symptom scores 18 months later. The reward positivity was also a significant predictor independent of other prominent risk factors, including baseline depressive symptoms and adolescent and parental lifetime psychiatric history. The combination of a blunted reward positivity and greater depressive symptom scores at baseline provided the greatest positive predictive value for first-onset depressive disorder. This study provides strong converging evidence that a blunted neural response to rewards precedes adolescent-onset depression and symptom emergence. Blunted neural response may therefore constitute an important target for screening and prevention.

Understanding the Association Between Chronic Obstructive Pulmonary Disease and Current Anxiety: A Population-Based Study

This study's objectives were to investigate the independent relationship between COPD and past-year Generalized Anxiety Disorder (GAD) in a population-based sample of adult Canadians and to identify significant correlates of GAD among COPD patients. A series of logistic regression analyses were conducted with a sample of 11,163 respondents aged 50+ from the 2012 Canadian Community Health Survey–Mental Health to determine the degree to which the direct association between COPD and GAD was attenuated by socio-demographic factors, social support, health behaviors, sleep problems, pain, functional limitations, and early childhood adversities. Additional analyses were completed using the sub-sample of those diagnosed with COPD (n = 746) to determine predictors of GAD. One in 17 (5.8%) of older individuals with COPD had past-year GAD, in comparison to 1.7% of those without (p < .001). The age-sex-race adjusted odds of GAD were four times higher for those with COPD compared to those without COPD (OR = 3.90, 95%CI: 2.64, 5.77). After full adjustment for 18 characteristics, these odds declined to 1.72 (95%CI: 1.10, 2.71). Factors associated with GAD among those with COPD include not having a confidant (OR = 7.85, 95%CI: 3.47, 17.75), exposure to parental domestic violence (OR = 5.63, 95% CI: 2.07, 15.34) and lifetime depressive disorders (OR = 3.59, 95% CI:1.61,7.98). Those with COPD have substantially higher odds of GAD even after most known risk factors for GAD are accounted for. These findings have implications for targeted outreach and screening, particularly for patients with pain and functional limitations. The importance of a multidisciplinary healthcare team is underscored by the multiple issues that may impact GAD among COPD patients.