Repeated Measures Latent Class Analysis Research Articles

Trajectories of perinatal depression among women living with HIV in Uganda.

Perinatal depression affects one-third of pregnant women living with HIV (WLH). We examined patterns of treatment response to a novel stepped model of depression care among WLH with perinatal depression in Uganda. As part of the Maternal Depression Treatment in HIV (M-DEPTH) cluster randomised controlled trial, 191 women were enrolled across four antenatal care clinics assigned to provide stepped care including behavioural and antidepressant therapy (ADT), and another 200 across four clinics assigned to provide usual care. They were assessed for depression severity using the Patient Health Questionnaire (PHQ-9) at enrolment and multiple times over 12 months of follow-up. We used repeated measures latent class analysis (LCA) to identify discrete trajectories of depression symptoms, while multinomial regression analyses measured correlates of class membership. The LCA identified three trajectories among those in the treatment group: mildly depressed individuals who improved (MiD-I) (n = 143, 75%), moderately depressed individuals who improved (MoD-I) (n = 33, 17%), and moderately depressed individuals who remained depressed (MoD-R) (n = 15, 8%). Membership in MiD-I was associated with lower levels of intimate partner violence at baseline (P = 0.04) and month 6 (P < 0.001), and less recent trauma exposure (P = 0.03) at baseline. At month 6, social support was lowest in MoD-R, while the degree of negative problem-solving orientation was highest (both P < 0.001) in this class. The LCA also identified three trajectories among those in the usual care comparison group: mildly depressed (MiD) (n = 62, 31%), moderately depressed (MoD) (n = 71, 35%), and seriously depressed (SiD) (n = 67, 34%), with each experiencing slight improvement. Recent traumas at baseline were highest in SiD (P < 0.001); this group also reported the lowest positive problem-solving orientation and highest negative problem-solving orientation (P < 0.001) at baseline. Depression symptom trajectories among women with perinatal depression are related to modifiable factors such as problem-solving orientation and interpersonal dynamics, with the latter including intimate partner violence and social support. Most treatment recipients were characterised by trajectories indicating recovery from depression. ClinicalTrials.Gov (NCT03892915).

Patterns of antidepressant use among older adults in Northern Ireland: An administrative data study.

ObjectiveOver recent decades, there has been a noticeable increase in the prescription of antidepressant medications, particularly among older adults. This study examines the relationship between health outcomes and patterns of antidepressant use among older adults in Northern Ireland (NI). ApproachParticipants included all (General Practitioner) GP-registered hospital patients aged fifty-five years and above on 01/01/2010 (n =395,872). Administrative data linkage included demographic information (age, sex; urbanicity); data on antidepressant use from the NI Enhanced Prescribing Database (EPD); and hospital patient admissions/discharges. Repeated measures latent class analysis (RMLCA) identified patterns of antidepressant use (2010 to 2020) in relation to the association between these patterns and health-related outcomes in 2021. ResultsRMLCA identified four latent classes : long-term antidepressant use (17.4%); decreasing antidepressant use (7.1%); increasing antidepressant use (8.4%); no-antidepressant use (67.1%). Those in the long-term and increasing antidepressant use’ classes had the highest average number of hospital visits and recorded chronic conditions in 2021. ConclusionFindings show that two distinct subgroups (comprising 26% of the hospital population) were disproportionately impacted by increased antidepressant prescription rates. Because of their increased likelihood of experiencing higher ill-health, these people are crucial targets for additional psychosocial support. ImplicationsAnalyses of this kind emphasize the importance of widening access to administrative data, enabling researchers to identify and examine at-risk groups allowing more targeted policymaking to better address their needs. Data for this project was provided by the HSC Honest Broker Service; any views or opinions presented are solely those of the author.

Patterns of antidepressant prescribing and health-related outcomes among older adults in Northern Ireland: an administrative data study

Objectives This study identifies patterns of antidepressant prescribing and subsequent hospital admissions from 2010 to 2018 amongst older adults in Northern Ireland (NI). Method Participants comprised all General Practitioner (GP)-registered adults aged fifty-five years and above on 01/01/2010 (n = 386,119). Administrative data linkage included demographic information; antidepressant prescribing data from the NI Enhanced Prescribing Database (EPD); and hospital patient admissions. Repeated measures latent class analysis (RMLCA) identified patterns of antidepressant prescribing (from 2010 to 2018). Results RMLCA identified four latent classes: decreasing antidepressant prescribing (5.9%); increasing antidepressant prescribing (8.0%); no-antidepressant prescribing (68.7%); and long-term antidepressant prescribing (17.5%). Compared with those in no-antidepressant prescribing class, persons in the remaining classes were more likely to be female and younger, and less likely to live in either rural areas or less-deprived areas. Compared with no-antidepressant prescribing, those with increasing antidepressant prescribing were 60% and 52% more likely to be admitted to hospital in 2019 and 2020, respectively, and their admission rate per year was 11% and 8% higher in 2019 and 2020, respectively. Similarly, those with long-term prescriptions were 70% and 67% more likely to be admitted to hospital in 2019 and 2020, respectively, and their admission rate per year was 14% and 9% higher in 2019 and 2020, respectively. Conclusion Findings show that approximately 26% of the NI hospital admissions population were impacted by sustained or increasing antidepressant prescribing. Because of their increased likelihood of hospitalization, these individuals may benefit from psychosocial support and social prescribing alternatives to psychopharmacological treatment.

S125 - Socioeconomic Marginalization and Overdose Risk: A Gender-Stratified Repeated Measures Latent Class Analysis Among Men and Women who Use Drugs

S125 - Socioeconomic Marginalization and Overdose Risk: A Gender-Stratified Repeated Measures Latent Class Analysis Among Men and Women who Use Drugs

Identifying latent classes of physical activity profiles over time among adolescents in Ontario, Canada

BackgroundPhysical activity behaviours are known to be highly correlated. Adolescents who participate in one type of physical activity (e.g., physical education) have a greater likelihood of participating in other physical activities (e.g., organized sports); however, little research has examined participation rates in various physical activity behaviours concurrently. This study identified longitudinal physical activity profiles among secondary school aged youth in Ontario, Canada.MethodsWe used data from the COMPASS Study, a school-based prospective cohort study of adolescents in Canada. Using a repeated measures latent class analysis, Ontario students who participated in grade 9 PE in 2015-16 were analysed through to 2018-19 (n = 1,917). Latent classes were defined by: PE participation, guideline adherence (≥ 60 min/day of moderate to vigorous activity over the last 7 days), and sport participation (varsity, community, and/or intramural). Multinomial logistic regression models were used to examine associations between latent class membership and student characteristics.ResultsThree distinct latent classes were identified for females and four were identified for males. These classes were: (1) Guidelines (high probability of guideline adherence; females: 44%; males: 16%), (2) PE & Sports (high probability of PE and sport participation; females: 33%; males: 43%), (3) Guidelines & Sports (high probability of guideline adherence and sport participation; females: 23%; males: 23%;), and (4) Inactive (low probability of all physical activity indicators; males: 18%). Strength training, sleep, and English grade were associated with class membership among females. Ethno-racial identity, weekly spending money, strength training, and English and math grades were associated with class membership among males.ConclusionsFindings suggest that latent physical activity profiles differ by sex. Guideline adherence was the most common class among females, indicating high levels of independent physical activity, whereas PE & Sport participation was the most common class among males, indicating greater tendency towards organized activities. Additionally, a substantial number of male students were not engaging in any physical activity. Participation in both PE and sports did not necessarily lead to meeting physical activity guidelines, highlighting that these activities alone may not be providing sufficient levels of physical activity that align with current recommendations for Canadian youth.

Patterns of Socioeconomic Marginalization among People Who Use Drugs: A Gender-Stratified Repeated Measures Latent Class Analysis.

Socioeconomic factors are important correlates of drug use behaviors and health-related outcomes in people who use drugs (PWUD) residing in urban areas. However, less is known about the complex overlapping nature of socioeconomic conditions and their association with a range of individual, drug use, and health-related factors in men and women who use drugs. Data were obtained from two community-recruited prospective cohorts of PWUD. Using a gender-stratified approach, we conducted repeated measures latent class analyses (RMLCA) to identify discrete latent socioeconomic subgroups. Multivariable generalized estimating equations were then used to identify correlates of class membership. Between June 2014 and December 2018, RMLCA of 9844 observations from 1654 participants revealed five distinct patterns of socioeconomic status for both men and women. These patterns were primarily distinguished by variations in income, material and housing security, income generation activity, exposure to violence, criminal justice involvement, and police contact. Across gender, progressive increases in exposure to multiple dimensions of socioeconomic disadvantage were found to be associated with frequent use of opioids and stimulants, accessing social services, and being hepatitis C virus antibody-positive. Similar but less congruent trends across gender were observed for age, binge drug use, engagement with opioid agonist therapy, and living with HIV. Gendered patterns of multiple and overlapping dimensions of socioeconomic adversity aligned with patterns of frequent drug use and health-related concerns, highlighting priority areas for gender-inclusive, multilevel responses to mitigate health disparities and meet the diverse socioeconomic needs of urban-dwelling men and women who use drugs.

Longitudinal clustering of health behaviours and their association with multimorbidity in older adults in England: A latent class analysis.

Health-risk behaviours such as smoking, unhealthy nutrition, alcohol consumption, and physical inactivity (termed SNAP behaviours) are leading risk factors for multimorbidity and tend to cluster (i.e. occur in specific combinations within distinct subpopulations). However, little is known about how these clusters change with age in older adults, and whether and how cluster membership is associated with multimorbidity. Repeated measures latent class analysis using data from Waves 4-8 of the English Longitudinal Study of Ageing (ELSA; n = 4759) identified clusters of respondents with common patterns of SNAP behaviours over time. Disease status (from Wave 9) was used to assess disorders of eight body systems, multimorbidity, and complex multimorbidity. Multinomial and binomial logistic regressions were used to examine how clusters were associated with socio-demographic characteristics and disease status. Seven clusters were identified: Low-risk (13.4%), Low-risk yet inactive (16.8%), Low-risk yet heavy drinkers (11.4%), Abstainer yet inactive (20.0%), Poor diet and inactive (12.9%), Inactive, heavy drinkers (14.5%), and High-risk smokers (10.9%). There was little evidence that these clusters changed with age. People in the clusters characterised by physical inactivity (in combination with other risky behaviours) had lower levels of education and wealth. People in the heavy drinking clusters were predominantly male. Compared to other clusters, people in the Low-risk and Low-risk yet heavy drinkers had a lower prevalence of all health conditions studied. In contrast, the Abstainer but inactive cluster comprised mostly women and had the highest prevalence of multimorbidity, complex multimorbidity, and endocrine disorders. High-risk smokers were most likely to have respiratory disorders. Health-risk behaviours tend to be stable as people age and so ought to be addressed early. We identified seven clusters of older adults with distinct patterns of behaviour, socio-demographic characteristics and multimorbidity prevalence. Intervention developers could use this information to identify high-risk subpopulations and tailor interventions to their behaviour patterns and socio-demographic profiles.

LONGITUDINAL Polysubstance use PATTERNS and non-fatal overdose: A repeated measures latent class analysis

Polysubstance use (PSU) is common among people who use opioids (PWUO) and has been associated with drug-related harms. We aimed to identify latent longitudinal PSU classes among a cohort of PWUO and characterize non-fatal overdose risks among different sub-classes over time. We used longitudinal data (2005-2018) from three ongoing prospective cohorts of people who use drugs in Vancouver, Canada. The primary outcome of interest was self-reported non-fatal overdose during the past six months. The primary exposure of interest was longitudinal PSU patterns among PWUO, obtained from repeated measures latent class analysis (RMLCA) of weekly substance use-related outcome indicators. Multivariable generalized estimating equations models were built to assess the association between latent PSU class membership and non-fatal overdose, adjusting for potential sociodemographic, behavioural, and structural confounders. 2627 PWUO were included in the analysis, and 1094 (41.6%) had experienced at least one non-fatal overdose during the study period. RMLCA revealed five distinct latent longitudinal PSU classes, including low/infrequent use (Class 1; 30%), primarily opioid and methamphetamine use (Class 2; 22%), primarily cannabis use (Class 3; 15%), primarily opioid and crack use (Class 4; 29%), and frequent PSU (Class 5; 4%). In comparison with Class 1 (low), membership in all latent PSU classes except Class 3 (cannabis) was associated with increased odds of non-fatal overdose: Class 2 (opioids+meth) vs. Class 1 (Adjusted odds ratios [aOR]=2.20, 95% confidence intervals [CI]: 1.51-3.22), Class 4 (opioids+crack) vs. Class 1 (aOR=1.06, 95% CI: 0.85-1.33), and Class 5 (frequent) vs. Class 1 (aOR=2.39, 95% CI: 1.92-2.97). Our findings highlighted the heterogeneous characteristics of PWUO in terms of patterns of PSU and non-fatal overdose risk. The diverse nature of PWUO and the potential additive or multiplicative impact of using several substances on overdoses should be reflected across the substance use treatment continuum and care provision.

Association between longitudinal patterns of child maltreatment experiences and adolescent substance use

BackgroundAlthough there is a well-established link between child maltreatment and adolescent substance use, it remains unclear if and how longitudinal patterns of maltreatment experiences are associated with substance use in adolescence. ObjectiveThe purpose of the study was to examine how distinct patterns of longitudinal maltreatment experiences are associated with adolescent substance use. Participants and settingThe participants were 899 adolescents from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). MethodsWe conducted repeated measures latent class analysis (RMLCA) to identify patterns of physical abuse, sexual abuse, and neglect from birth to age 17 and their relations to tobacco, alcohol, and marijuana use at age 18. ResultsRMLCA identified three physical abuse classes (Stable low physical abuse; School age peak physical abuse; Physical abuse primarily in infancy/toddlerhood), two sexual abuse classes (Stable no/low sexual abuse; School age peak sexual abuse), and three neglect classes (High neglect in childhood; Neglect primarily in infancy/toddlerhood; Neglect primarily at school age). Adolescents in the school age peak physical abuse class showed greater alcohol, cigarette, and marijuana use, compared to other physical abuse classes. Similarly, adolescents in the school age peak sexual abuse class showed greater substance use than those in the stable no/low sexual abuse class. Lastly, adolescents in the neglect primarily in infancy/toddlerhood class showed significantly less substance use than those in the other two neglect classes. ConclusionsFindings highlight the importance of early intervention and ongoing maltreatment prevention.

Longitudinal clustering of risk behaviours and their association with multimorbidity in older adults

Abstract Smoking, unhealthy nutrition, alcohol consumption, and physical inactivity (SNAP risk behaviours) are leading risk factors for multimorbidity and tend to cluster within specific subpopulations. Little is known about how these clusters change with age in older adults and their association with multimorbidity. Repeated measures latent class analysis using data from Waves 4-8 of the English Longitudinal Study of Ageing (n = 4759) identified clusters of respondents with common patterns of SNAP behaviours over time. Disease status (from Wave 9) was used to assess eight body system disorders, multimorbidity, and complex multimorbidity. Logistic regressions examined how clusters were associated with socio-demographic characteristics and disease status. Seven clusters were identified: Low-risk (13.4%), Low-risk yet inactive (16.8%), Low-risk yet heavy drinkers (11·4%), Abstainer yet inactive (20%), Poor diet and inactive (12.9%), Inactive, heavy drinkers (14.5%), and High-risk smokers (10·9%). There was little evidence these clusters changed with age. Clusters characterised by physical inactivity (in combination with other risky behaviours) were associated with lower levels of education and wealth. The heavy drinking clusters were predominantly male. Compared to other clusters, Low-risk and Low-risk yet heavy drinkers had a lower prevalence of all diseases studied. In contrast, the Abstainer but inactive cluster comprised mostly women and had the highest prevalence of multimorbidity, complex multimorbidity, and endocrine disorders. High-risk smokers were most likely to have respiratory disorders. Health-risk behaviours tend to be stable as people age and ought to be addressed early. By identifying seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics, and disease prevalence, our study provides valuable information for identifying high-risk subpopulations and tailoring interventions to their behaviour patterns and socio-demographic profiles. Key messages • We identified seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics and disease prevalence. • Health-risk behaviours tend to be stable as people age and ought to be addressed early.

Women’s Configurations of Family, Work, and Education: Mapping Diverse Pathways Throughout Adulthood

We investigate how women’s family, work, and education statuses are configured over the life course, defining different pathways throughout adulthood. Using data from the National Longitudinal Study of Adolescent and Adult Health, we conduct a repeated measures latent class analysis to explore the various pathways of family, work, and education that women take between their late teens and early forties. Additionally, we investigate the extent to which these pathways vary by race and socioeconomic background. We find seven distinct pathways. In three of the pathways, women are likely to become mothers at an earlier age, but differ in terms of education and work patterns. Three other pathways include women who focus primarily on college in early adulthood, but differ in terms of their work and family patterns. An additional pathway comprises women who remain largely independent while working and continuing education into adulthood. Pathways vary significantly by race, parents’ education, and early family poverty. This study highlights the fluidity of women’s work and educational experiences across adulthood, and articulates significant nuances in the different combinations of women’s family, work, and education across demographic backgrounds.

Can High and Consistent School-Related Protective Factors Prevent Cannabis Use Among American Indian Middle School Students?

High cannabis use rates among American Indian (AI) adolescents necessitate the identification of factors that protect against early cannabis initiation. Data collected from 279 AI middle school students attending reservation-based schools in 2018 and 2019 were analyzed. Three waves of data, with approximately 6 months between each, were used. A repeated measures latent class analysis examined a school-related protective factor index over three waves. The predictive power of lifetime cannabis use on school protection class membership was estimated, along with differences in past month cannabis use at follow-up 2 across school protection classes while holding baseline use constant. Four school protection classes were identified: high, moderate, low, and declining protection. Abstinence at baseline was associated with an increased odds of membership in the high protection class compared to the moderate and low protection classes. Students with consistent and high school protection throughout middle school were significantly less likely to report past month cannabis use at follow-up 2 compared to other classes. Maintaining a high level of school protection throughout middle school substantially lowers the odds of cannabis use among AI adolescents. Interventions to promote school-related protective factors in this population are essential and should be designed and tested.

Latent class analysis of maternal depression from pregnancy through early childhood: Differences in children's executive functions.

Prenatal and postpartum depression are highly prevalent worldwide, and emerging evidence suggests they contribute to impairments in children's executive functions. Studies of maternal depression, however, have focused on the postpartum and postnatal periods with relatively less consideration of prenatal influences on child development. This study of the large population-based Avon Longitudinal Study of Parents and Children U.K. cohort estimates latent classes of maternal depression across the prenatal, postpartum, and postnatal periods to capture heterogeneity in the developmental timing and length of maternal depression, as well as to test whether latent classes differ in children's executive function impairments in middle childhood. Repeated measures latent class analysis yielded five groups demonstrating unique patterns of change in maternal depression from pregnancy through early childhood (n = 13,624). Latent classes differed in executive functions at age 8 among a subsample of children (n = 6,870). Children exposed to chronic maternal depression beginning in utero showed the most impairments in inhibitory control while accounting for child sex, verbal IQ, parents' highest education level, and average family income in childhood. The critical roles of the timing and length of children's exposure to maternal depression are discussed in relation to executive function development, prevention, and intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Impact of Longitudinal Substance Use Patterns on the Risk of Opioid Agonist Therapy Discontinuation: A Repeated Measures Latent Class Analysis

AbstractPolysubstance use is prevalent among individuals on opioid agonist treatment (OAT), yet past studies have focused primarily on distinct substances and their association with OAT retention. Data was collected from two prospective cohorts between 2005 and 2020 in Vancouver, Canada. Among 13,596 visits contributed by 1445 participants receiving OAT, we employed repeated measures latent class analysis using seven indicators and identified four longitudinal substance use classes. Using marginal structural Cox modeling, we found that compared to the primarily crack use class, the two opioid and stimulant use classes carried a higher risk of OAT discontinuation, while the primarily cannabis and crack use class had a lower OAT discontinuation risk. Our findings highlight the need for integrated treatment strategies to manage the co-use of opioids and stimulants during receipt of OAT and suggest future research should explore the potential of cannabis as a harm reduction strategy or adjunctive treatment to OAT.Word count: 150/150.

Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study.

Insomnia is a common condition affecting more than a third of the US population. However, the link between insomnia symptoms and stroke is understudied and the underlying mechanism remains unclear. This study aimed to investigate the relationship between insomnia symptoms and the incidence of stroke. The Health and Retirement Study, a survey of Americans older than 50 years and their spouses, from 2002 to 2020 was used as the data source. Only those who were stroke-free at baseline were included in this study. The exposure variable was insomnia symptoms and was derived from self-reported sleep-related factors including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated-measures latent class analysis was used to identify insomnia trajectories over time. To investigate the relationship between insomnia symptoms and stroke events reported during the follow-up period, Cox proportional hazards regression models were used. Mediation analyses of comorbidities were performed using causal mediation within a counterfactual framework. A total of 31,126 participants were included with a mean follow-up of 9 years. The mean age was 61 years (SD = 11.1) and 57% were females. Insomnia symptom trajectories remained constant over time. Compared with those with no insomnia symptoms, an increased risk of stroke was observed for those with insomnia symptom scores ranging from 1 to 4 and 5 to 8 (hazard ratio (HR) = 1.16, 95% confidence interval (CI) 1.02-1.33) and (HR = 1.51, 95% CI 1.29-1.77), respectively, indicating a dose-response relationship. The association was stronger in participants younger than 50 years (HR = 3.84, 95% CI 1.50-9.85) than in those aged 50 years and older (HR = 1.38, 95% CI 1.18-1.62), comparing those with insomnia symptoms ranging from 5 to 8 with those with no insomnia symptoms. This association was mediated by diabetes, hypertension, heart disease, and depression. Insomnia symptoms were associated with an increased risk of stroke, especially in adults younger than 50 years, and the risk was mediated by certain comorbidities. Increased awareness and management of insomnia symptoms may contribute to the prevention of stroke occurrence.

Longitudinal latent polysubstance use patterns among a cohort of people who use opioids in Vancouver, Canada.

Polysubstance use (PSU) practices are increasing among people who use opioids (PWUO). However, several aspects of longitudinal PSU patterns among PWUO remain understudied. This study aims to identify person-centred longitudinal patterns of PSU among a cohort of PWUO. Using longitudinal data (2005-2018) from three prospective cohort studies including people who use drugs in Vancouver, Canada, we used repeated measures latent class analysis to identify different PSU classes among PWUO. Multivariable generalised estimating equations models weighted by the respective posterior membership probabilities were applied to identify covariates of membership in different PSU classes over time. Overall, 2627 PWUO (median age at baseline: 36 [quartile 1-3: 25-45]) were included between 2005 and 2018. We found five distinct PSU patterns, including low/infrequent probability of regular substance use (Class 1; 30%), primarily opioid and methamphetamine use (Class 2; 22%), primarily cannabis use (Class 3; 15%), primarily opioid and crack use (Class 4; 29%) and frequent PSU (Class 5; 4%). Membership in Class 2, 4 and 5 was positively associated with several behavioural and socio-structural adversities. Findings of this longitudinal study suggest PSU is the norm among PWUO and highlights the heterogeneous characteristics of PWUO. The diversities within the population of PWUO need to be recognised in addiction care and treatment as well as optimising resource allocation in the response to the overdose crisis.

Insomnia Symptoms Trajectories and increased risk of Stroke: A Prospective Cohort Study (P1-5.021)

<h3>Objective:</h3> To investigate the trajectory of insomnia symptoms over time and their association with stroke events. <h3>Background:</h3> Insomnia is a frequent disorder affecting over one-third of the U.S population. However, the association between insomnia symptoms and stroke is less studied and it is unclear whether insomnia symptoms remain constant or change over time. <h3>Design/Methods:</h3> We used the Health and Retirement Study from 2002 to 2020. The independent variable was insomnia symptoms classified on a scale ranging from 0 to 8 and including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated measures latent class analysis was used to identify subgroups among the study participants with different insomnia trajectories over time. Cox proportional hazards regression models were employed to investigate the association between the subgroup of insomnia symptoms and stroke events. <h3>Results:</h3> A total of 31,126 participants were included with a mean follow-up of 9 years. Three subgroups of insomnia symptoms were identified based on 3 consecutive measurements of insomnia symptoms at 2-year intervals. The subgroups were named: “constantly no symptoms”, “constantly low symptoms”, and “constantly high insomnia symptoms”. Compared to participants classified as “constantly no symptoms”, participants classified as “constantly low symptoms” had an increased risk of stroke (hazard ratio (HR) = 1.15, 95% confidence interval (CI): 1.00, 1.32). Similarly, compared to participants classified as “constantly no symptoms”, participants classified as “constantly high symptoms” had an increased risk of stroke (HR= 1.42, 95% CI: 1.22, 1.64). <h3>Conclusions:</h3> Our findings indicate that insomnia symptoms remain constantly reported over time in this population. There is a need for better awareness and management of insomnia symptoms to prevent stroke occurrence. <b>Disclosure:</b> Dr. Sawadogo has nothing to disclose. Prof. Adera has nothing to disclose.

CBT-based Online Self-help Training to Reduce Fear and Distress After Cancer (CAREST Randomized Trial): 24 Months Follow-up Using Latent Growth Models and Latent Class Analysis.

Psychological distress (PD) and fear of cancer recurrence (FCR) are common consequences of surviving cancer. Online self-help training could help many cancer survivors deal with PD and FCR at low costs. To evaluate the long-term effectiveness of the CAncer REcurrence Self-help Training (CAREST trial) to reduce PD and FCR. Moreover, to evaluate the relation between FCR and PD across time and identify subgroups representing different change trajectories in FCR over time and their predictors. This multicenter randomized controlled trial included 262 female breast cancer survivors, assigned to online self-help training or care as usual. Participants completed questionnaires at baseline and four times during the 24-month follow-up. The primary outcomes were PD and FCR (Fear of Cancer Recurrence Inventory). Latent growth curve modeling (LGCM) and repeated measures latent class analysis (RMLCA) were performed, both according to the intention-to-treat principle. LGCM showed no differences between the average latent slope in both groups for both PD and FCR. The correlation between FCR and PD at baseline was moderate for the intervention group and strong for the CAU group and did not significantly decrease over time in both groups. RMLCA revealed five latent classes and several predictors of class membership. We did not find a long-term effect of the CBT-based online self-help training in reducing PD or FCR, nor in their relation. Therefore, we recommend adding professional support to online interventions for FCR. Information about FCR classes and predictors may contribute to improvement of FCR interventions.

Patterns of Change in Parental Health Literacy in Relation to Children's Oral Health.

Although health literacy (HL) skills may change over time, most research treats HL as a constant, using baseline HL to predict other health-related constructs. Few studies have explored change in HL over time. We examined person-level differences in HL trajectories. We identified subgroups (latent classes) based on longitudinal assessments of HL and examined the association of class membership with demographic and oral health variables. We used four measurement waves of parental HL data, reflecting the risk of limited HL, collected as part of an intervention to reduce dental decay in American Indian children (N = 579 parent-child dyads at baseline). Repeated measures latent class analysis (RMLCA) models were estimated to identify subgroups of HL trajectories over time. We examined class membership in association with baseline demographics and with 36-month assessments of parental oral health knowledge, beliefs, and behaviors as well as pediatric oral health. A four-class model best fit the data. The largest class (high HL; 49.7% of the sample) was characterized by high levels of HL at all waves. A second class (improving HL; 17.7%) improved over all waves. The remaining two classes were characterized as moderate HL (20%) and low HL (12.6%) and maintained relatively stable HL levels over time. Higher educational attainment was associated with membership in the high HL and improving HL classes. Older age among this young-adult sample and higher income also were associated with high HL class membership. Parents in the high HL and improving HL classes exhibited more favorable performance on measures of oral health knowledge, beliefs, and behavioral adherence than did those in the other classes. Class membership was not associated with pediatric oral health. RMLCA demonstrated person-level variability in HL trajectories. Longitudinal patterns were associated with baseline demographics and prospectively with parental oral health knowledge, beliefs, and behaviors, but not with pediatric oral health. [HLRP: Health Literacy Research and Practice. 2023;7(2):e89-e98.].

Trajectories of resilience among young children involved with child protective services.

Although child maltreatment is associated with short- and long-term maladaptive outcomes, some children are still able to display resilience. Currently, there is a limited understanding of how children's resilience changes over time after experiencing maltreatment, especially for young children. Therefore, the current study used a longitudinal, multidimensional approach to examine trajectories of resilience among very young children involved in child protective services and determine whether placement setting and caregiving behaviors are associated with resilience trajectories. This study used data from National Survey of Child and Adolescent Well-Being I and conducted repeated measures latent class analysis, focusing on children under 2 years old at baseline (n = 1,699). Results suggested that there were three trajectories of resilience: increasing resilience, decreasing resilience, and stable, low resilience. Caregiver cognitive stimulation was related to increasing trajectories of resilience compared to both decreasing and stable, low resilience. These findings illustrate the importance of caregiving behaviors for promoting resilience among a particularly vulnerable population.