Joshua Breslau

RAND Corporation, Santa Monica, California, United States

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Publications (53)225.73 Total impact

  • Karen R Flórez, Kathryn Pitkin Derose, Joshua Breslau, Beth Ann Griffin, Ann C Haas, David E Kanouse, Brian D Stucky, Malcolm V Williams
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    ABSTRACT: Substance use patterns among Latinos likely reflect changes in attitudes resulting from acculturation, but little is known about Latinos' attitudes regarding drug addiction. We surveyed a church-based sample of Latinos and African Americans (N = 1,235) about attitudes toward drug addiction and socio-demographics. Linear regression models compared Latino subgroups with African-Americans. In adjusted models, Latinos had significantly higher drug addiction stigma scores compared to African Americans across all subgroups (US-born Latinos, β = 0.22, p < .05; foreign-born Latinos with high English proficiency, β = 0.30, p < .05; and foreign-born Latinos with low English proficiency, β = 0.49, p < .001). Additionally, Latinos with low English proficiency had significantly higher mean levels of drug use stigma compared Latinos with high proficiency (both foreign-born and US-born). In this church-affiliated sample, Latinos' drug addiction stigma decreases with acculturation, but remains higher among the most acculturated Latinos compared to African-Americans. These attitudes may pose a barrier to treatment for Latino drug users.
    Journal of immigrant and minority health / Center for Minority Public Health. 01/2015;
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    ABSTRACT: Home to about 15 million people, the US-Mexico border area has suffered stresses from increased border security efforts and a costly drug war in Mexico. Whether immigration patterns add to increasing levels of anxiety for the Mexican population and the Mexican-origin individuals living in the US-Mexico border and near the border is unknown. We used the US-Mexico Study on Alcohol and Related Conditions (UMSARC), a cross-sectional survey (2011-2013) of individuals living in border and non-border cities of the US (n=2,336) and Mexico (n=2,460). In Mexico respondents were asked if they ever migrated to the US or have a family member living in the US (328) or not (2,124), while in the US respondents were asked if they were born in Mexico (697), born in the US with no US-born parents (second generation, 702) or born in the US with at least one US-born parent (third generation, 932). The prevalence and risk factors for symptoms of anxiety using the Beck Anxiety Inventory (>=10) were obtained. Mexicans with no migrant experience had a prevalence of anxiety and adjusted prevalence ratio (PR) within the last month of 6.7% (PR=reference), followed by Mexicans with migration experience of 13.1% (PR=1.8), Mexican-born respondents living in the US of 17.3% (PR=2.6), US born Mexican-Americans of 2nd generation of 18.6% (PR=3.3) and finally US born 3rd+ generation of 25.9% (PR=3.8). Results help to identify regions and migration patterns at high risk for anxiety and may help to unravel causal mechanisms that underlie this risk.
    Journal of Psychiatric Research 12/2014; · 4.09 Impact Factor
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    ABSTRACT: The aim of this study is to investigate differences in the beliefs about the causes of schizophrenia between Aymara and non-Aymara patients with schizophrenia and their primary caregivers. Ethnic background plays an important role in the formation of beliefs regarding the causes of schizophrenia, and there have been no prior studies on such beliefs among the Aymara, an indigenous community with a population of about 2 million people living in the Andes. We focused on three systems of beliefs distinguished in the literature: biological, psychosocial and magical-religious.
    International Journal of Social Psychiatry 08/2014; · 1.15 Impact Factor
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    ABSTRACT: In treated cohorts, individuals with bipolar disorder are more likely to report childhood adversities and recent stressors than individuals without bipolar disorder; similarly, in registry-based studies, childhood adversities are more common among individuals who later become hospitalized for bipolar disorder. Because these types of studies rely on treatment-seeking samples or hospital diagnoses, they leave unresolved the question of whether or not social experiences are involved in the etiology of bipolar disorder. We investigated the role of childhood adversities and adulthood stressors in liability for bipolar disorder using data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=33 375). We analyzed risk for initial-onset and recurrent DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) manic episodes during the study's 3-year follow-up period. Childhood physical abuse and sexual maltreatment were associated with significantly higher risks of both first-onset mania (odds ratio (OR) for abuse: 2.23; 95% confidence interval (CI)=1.71, 2.91; OR for maltreatment: 2.10; CI=1.55, 2.83) and recurrent mania (OR for abuse: 1.55; CI=1.00, 2.40; OR for maltreatment: 1.60; CI=1.00, 2.55). In addition, past-year stressors in the domains of interpersonal instability and financial hardship were associated with a significantly higher risk of incident and recurrent mania. Exposure to childhood adversity potentiated the effects of recent stressors on adult mania. Our findings demonstrate a role of social experiences in the initial onset of bipolar disorder, as well as in its prospective course, and are consistent with etiologic models of bipolar disorder that implicate deficits in developmentally established stress-response pathways.Molecular Psychiatry advance online publication, 22 April 2014; doi:10.1038/mp.2014.36.
    Molecular Psychiatry 04/2014; · 15.15 Impact Factor
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    ABSTRACT: Epidemiological evidence suggests that early menarche, defined as onset of menses at age 11 or earlier, has increased in prevalence in recent birth cohorts and is associated with multiple poor medical and mental health outcomes in adulthood. There is evidence that childhood adversities occurring prior to menarche contribute to early menarche.
    International Journal of Pediatric Endocrinology 01/2014; 2014(1):14.
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    ABSTRACT: This study explored the presence and characteristics of natural mentors among 197 homeless youth and the association between natural mentoring relationships and youth functioning. Few studies have explored protective factors in the lives of homeless youth and how these may buffer against poor health outcomes. Relationships with natural mentors have been shown to have protective effects on adolescent functioning among the general adolescent population, and, thus, warrant further investigation with homeless youth. Results from this study revealed that 73.6% of homeless youth have natural mentoring relationships, split between kin and non-kin relationships. Having a natural mentor was associated with higher satisfaction with social support and fewer risky sexual behaviors. Findings suggest that natural mentors may play a protective role in the lives of homeless youth and should be considered an important source of social support that may enhance youth resilience.
    Journal of Health Care for the Poor and Underserved 01/2014; 25(3):1121-38. · 1.10 Impact Factor
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    ABSTRACT: Studies examining the relationship between neighborhood social disorder and health often rely on multiple informants. Such studies assume interchangeability of the latent constructs derived from multiple-informant data. Existing methods examining this assumption do not clearly delineate the uncertainty at individual levels from that at neighborhood levels. We propose a multilevel variance component factor model that allows this delineation. Data come from a survey of a representative sample of children born between 1983 and 1985 in the inner city of Detroit and nearby middle-class suburbs. Results indicate that the informant-level models tend to exaggerate the effect of places because of differences between persons. Our evaluations of different methodologies lead to the recommendation of the multilevel variance component factor model whenever multiple-informant reports can be aggregated at a neighborhood level. Copyright © 2013 John Wiley & Sons, Ltd.
    Statistics in Medicine 09/2013; · 2.04 Impact Factor
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    ABSTRACT: Objectives. We examined differences in the use of mental health services, conditional on the presence of psychiatric disorders, across groups of Mexico's population with different US migration exposure and in successive generations of Mexican Americans in the United States. Methods. We merged surveys conducted in Mexico (Mexican National Comorbidity Survey, 2001-2002) and the United States (Collaborative Psychiatric Epidemiology Surveys, 2001-2003). We compared psychiatric disorders and mental health service use, assessed in both countries with the Composite International Diagnostic Interview, across migration groups. Results. The 12-month prevalence of any disorder was more than twice as high among third- and higher generation Mexican Americans (21%) than among Mexicans with no migrant in their family (8%). Among people with a disorder, the odds of receiving any mental health service were higher in the latter group relative to the former (odds ratio = 3.35; 95% confidence interval = 1.82, 6.17) but the age- and gender-adjusted prevalence of untreated disorder was also higher. Conclusions. Advancing understanding of the specific enabling and dispositional factors that result in increases in mental health care may contribute to reducing service use disparities across ethnic groups in the United States. (Am J Public Health. Published online ahead of print July 18, 2013: e1-e9. doi:10.2105/AJPH.2012.301169).
    American Journal of Public Health 07/2013; · 3.93 Impact Factor
  • The Journal of Clinical Psychiatry 07/2013; 74(7):741-3. · 5.81 Impact Factor
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    ABSTRACT: Objective: To study immigration, U.S. nativity, and return migration as risk factors for violence among people of Mexican origin in the U.S. and Mexico. Methods: Cross-sectional surveys in the United States (2001-2003; n=1,213) and Mexico (2001-2002; n=2,362). Discrete time survival models were used. The reference group was Mexicans living in Mexico without migrant experience or a migrant relative. Results: Mexican immigrants in the U.S. have lower risk for any violence (hazard ratio [HR] = 0.5, 95% confidence interval [95%CI] 0.4-0.7). U.S.-born Mexican-Americans were at higher risk for violence victimization of a sexual nature (for sexual assault, HR = 2.5, 95%CI 1.7-3.7). Return migrants were at increased risk for being kidnapped or held hostage (HR = 2.8, 95%CI 1.1-7.1). Compared to those without a mental disorder, those with a mental disorder were more likely to suffer any violence (HR = 2.3, 95%CI 1.9-2.7), regardless of the migrant experience. Conclusions: The impact of immigration on the occurrence of violence is more complex than usually believed. Return migrants are more likely to suffer violence such as being held hostage or beaten by someone other than a partner.
    Revista Brasileira de Psiquiatria 04/2013; 35(2):161-8. · 1.64 Impact Factor
  • Archives of internal medicine 12/2012; 172(22):1760-2. · 11.46 Impact Factor
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    Archives of general psychiatry 11/2012; 69(11):1179-81. · 12.26 Impact Factor
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    ABSTRACT: Objectives. We examined migration-related changes in smoking behavior in the transnational Mexican-origin population. Methods. We combined epidemiological surveys from Mexico (Mexican National Comorbidity Survey) and the United States (Collaborative Psychiatric Epidemiology Surveys). We compared 4 groups with increasing US contact with respect to smoking initiation, persistence, and daily cigarette consumption: Mexicans with no migrant in their family, Mexicans with a migrant in their family or previous migration experience, migrants, and US-born Mexican Americans. Results. Compared with Mexicans with a migrant in their family or previous migration experience, migrants were less likely to initiate smoking (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.38, 0.83) and less likely to be persistent smokers (OR = 0.41; 95% CI = 0.26, 0.63). Among daily smokers, the US-born smoked more cigarettes per day than did Mexicans with a migrant in their family or previous migration experience for men (7.8 vs 6.5) and women (8.6 vs 4.3). Conclusions. Evidence suggests that smoking is suppressed among migrants relative to the broader transnational Mexican-origin population. The pattern of low daily cigarette consumption among US-born Mexican Americans, noted in previous research, represents an increase relative to smokers in Mexico.
    American Journal of Public Health 09/2012; 102(11):2116-2122. · 3.93 Impact Factor
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    ABSTRACT: Mexican immigrants in the US do not have increased risk for alcohol use or alcohol use disorders when compared to Mexicans living in Mexico, but they are at higher risk for drug use and drug use disorders. It has been suggested that both availability and social norms are associated with these findings. We aimed to study whether the opportunity for alcohol and drug use, an indirect measure of substance availability, determines differences in first substance use among people of Mexican origin in both the US and Mexico, accounting for gender and age of immigration. Data come from nationally representative surveys in the United States (2001-2003) and Mexico (2001-2002) (combined n=3432). We used discrete time proportional hazards event history models to account for time-varying and time-invariant characteristics. The reference group was Mexicans living in Mexico without migration experience. Female immigrants were at lower risk of having opportunities to use alcohol if they immigrated after the age of 13, but at higher risk if they immigrated prior to this age. Male immigrants showed no differences in opportunity to use alcohol or alcohol use after having the opportunity. Immigration was associated with having drugs opportunities for both sexes, with larger risk among females. Migration was also associated with greater risk of using drugs after having the opportunity, but only significantly for males. The impacts of immigration on substance use opportunities are more important for drugs than alcohol. Public health messages and educational efforts should heed this distinction.
    Drug and alcohol dependence 05/2012; 125 Suppl 1:S4-11. · 3.60 Impact Factor
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    ABSTRACT: BACKGROUND: Axis IV is for reporting 'psychosocial and environmental problems that may affect the diagnosis, treatment and prognosis of mental disorders'. No studies have examined the prognostic value of Axis IV in DSM-IV.Method We analyzed data from 2497 participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) with major depressive episode (MDE). We hypothesized that psychosocial stressors predict a poor prognosis of MDE. Secondarily, we hypothesized that psychosocial stressors predict a poor prognosis of anxiety and substance use disorders. Stressors were defined according to DSM-IV's taxonomy, and empirically using latent class analysis (LCA). RESULTS: Primary support group problems, occupational problems and childhood adversity increased the risks of depressive episodes and suicidal ideation by 20-30%. Associations of the empirically derived classes of stressors with depression were larger in magnitude. Economic stressors conferred a 1.5-fold increase in risk for a depressive episode [95% confidence interval (CI) 1.2-1.9]; financial and interpersonal instability conferred a 1.3-fold increased risk of recurrent depression (95% CI 1.1-1.6). These two classes of stressors also predicted the recurrence of anxiety and substance use disorders. Stressors were not related to suicidal ideation independent from depression severity. CONCLUSIONS: Psychosocial and environmental problems are associated with the prognosis of MDE and other Axis I disorders. Although DSM-IV's taxonomy of stressors stands to be improved, these results provide empirical support for the prognostic value of Axis IV. Future work is needed to determine the reliability of Axis IV assessments in clinical practice, and the usefulness of this information to improving the clinical course of mental disorders.
    Psychological Medicine 05/2012; · 5.43 Impact Factor
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    ABSTRACT: Twin studies suggest that conduct disorder (CD) is under substantial genetic influence, which is stronger for aggressive than for nonaggressive symptoms. Studies of migrating populations offer an alternative strategy for separating environmental and genetic influences on psychiatric disorders. To examine variation in the prevalence of CD associated with migration from Mexico to the United States and to determine whether this variation is similar for aggressive and nonaggressive CD symptoms and symptom profiles. The prevalences of CD, different types of CD symptoms, and CD symptom profiles were compared across 3 generations of people of Mexican origin with increasing levels of exposure to American culture: families of origin of migrants (residing in Mexico), children of Mexican migrants raised in the United States, and Mexican-American children of US-born parents. General population surveys conducted in Mexico and the United States using the same diagnostic interview. Adults aged 18 to 44 years in the household population of Mexico and the household population of people of Mexican descent in the United States. Conduct disorder criteria, assessed using the World Mental Health version of the Composite International Diagnostic Interview. Compared with the risk in families of origin of migrants, risk of CD was lower in the general population of Mexico (odds ratio [OR], 0.54; 95% CI, 0.19-1.51), higher in children of Mexican-born immigrants who were raised in the United States (OR, 4.12; 95% CI, 1.47-11.52), and higher still in Mexican-American children of US-born parents (OR, 7.64; 95% CI, 3.20-18.27). The association with migration was markedly weaker for aggressive than for nonaggressive symptoms. The prevalence of CD increases dramatically across generations of the Mexican-origin population after migration to the United States. This increase is of larger magnitude for nonaggressive than for aggressive symptoms, consistent with the suggestion that nonaggressive symptoms are more strongly influenced by environmental factors than are aggressive symptoms.
    Archives of general psychiatry 12/2011; 68(12):1284-93. · 12.26 Impact Factor
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    ABSTRACT: Exposure to Western popular culture is hypothesized to increase risk for eating disorders. This study tests this hypothesis with respect to the proposed diagnosis of binge eating disorder (BED) in an epidemiological sample of people of Mexican origin in Mexico and the U.S. Data come from the Mexico National Comorbidity Survey, National Comorbidity Survey Replication, and National Latino and Asian American Survey (N = 2268). Diagnoses were assessed with the WMH-CIDI. Six groups were compared: Mexicans with no migrant family members, Mexicans with at least one migrant family member, Mexican return-migrants, Mexican-born migrants in the U.S., and two successive generations of Mexican-Americans in the U.S. The lifetime prevalence of BED was 1.6% in Mexico and 2.2% among Mexican-Americans. Compared with Mexicans in families with migrants, risk for BED was higher in US-born Mexican-Americans with two U.S.-born parents (aHR = 2.58, 95% CI 1.12-5.93). This effect was attenuated by 24% (aHR = 1.97, 95% CI 0.84-4.62) with adjustment for prior-onset depressive or anxiety disorder. Adjustment for prior-onset conduct disorder increased the magnitude of association (aHR = 2.75, 95% CI 1.22-6.20). A similar pattern was observed for binge eating. Among respondents reporting binge eating, onset in the U.S. (vs. Mexico) was not associated with prevalence of further eating disorder symptoms. Migration from Mexico to the U.S. is associated with an increased risk for BED that may be partially attributable to non-specific influences on internalizing disorders. Among respondents reporting binge eating in either country, similar levels of further symptoms were endorsed, suggesting some cross-cultural generalizability of criteria.
    Journal of Psychiatric Research 11/2011; 46(1):31-7. · 4.09 Impact Factor
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    ABSTRACT: Background: Prior studies have found that natural mentoring relationships can be a significant protective factor for adolescents, but the role of natural mentors has not been explicitly examined among runaway homeless youth (RHY). This study explores the presence of important non-parental adults or natural mentors among RHY and associations with social connectedness, self-esteem, and health status. Methods: Youth ages 14 21 who were currently homeless or have experienced homelessness in the past 12 months (N = 144) were recruited from community agencies that serve RHY. Participants completed audio computer-assisted interview (ACASI) surveys about natural mentors, connectedness, self-esteem, health risk behaviors, and health status. Descriptive, bivariate, and multiple regression analyses were conducted. Results: Majority of participants (73.6%) reported having natural mentors; 41.9% non-kin, 26.4% kin, and 4.9% foster parents. Fifty-eight percent have known their mentors longer than one year and 45.8% connect with their mentors at least weekly. A natural mentoring relationship was associated with higher satisfaction in social support even with controlling for family connectedness. Those who were more connected with their mentors reported higher self-esteem, lower psychological distress, and higher levels of family connectedness. Conclusion: Despite being marginalized, many RHY in this study are connected with non-parental adults who may serve as a critical source of social support. Findings have implications for public health nurses in promoting resilience among RHY by recognizing the contributions of important non-parental adults and exploring practices and policies to encourage meaningful connections among vulnerable youth and caring adults in the community.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: To study the impact of mental disorders on failure in educational attainment in Mexico. Diagnoses and age of onset for each of 16 DSM-IV disorders were assessed through retrospective self-reports with the Composite International Diagnostic Instrument (CIDI) during fieldwork in 2001-2002. Survival analysis was used to examine associations between early onset DSM-IV/CIDI disorders and subsequent school dropout or failure to reach educational milestones. More than one of two Mexicans did not complete secondary education. More than one-third of those who finished secondary education did not enter college, and one of four students who entered college did not graduate. Impulse control disorders and substance use disorders were associated with higher risk for school dropout, secondary school dropout and to a lesser degree failure to enter college. Anxiety disorders were associated with lower risk for school dropout, especially secondary school dropout and, to a lesser degree, primary school dropout. The heterogeneity of results found in Mexico may be due to the effect of mental disorders being diminished or masked by the much greater effect of economic hardship and low cultural expectations for educational achievement. Future research should inquire deeper into possible reasons for the better performance of students with anxiety disorders in developing countries.
    Revista Panamericana de Salud Pública 11/2011; 30(5):477-83. · 0.85 Impact Factor
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    ABSTRACT: Suicide is the 11th leading cause of death in the USA. Suicide rates vary across ethnic groups. Whether suicide behavior differs by ethnic groups in the USA in the same way as observed for suicide death is a matter of current discussion. The aim of this report was to compare the lifetime prevalence of suicide ideation and attempt among four main ethnic groups (Asians, Blacks, Hispanics, and Whites) in the USA. Suicide ideation and attempts were assessed using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). Discrete time survival analysis was used to examine risk for lifetime suicidality by ethnicity and immigration among 15 180 participants in the Collaborative Psychiatric Epidemiological Surveys (CPES), a group of cross-sectional surveys. Suicide ideation was most common among Non-Hispanic Whites (16.10%), least common among Asians (9.02%) and intermediate among Hispanics (11.35%) and Non-Hispanic Blacks (11.82%). Suicide attempts were equally common among Non-Hispanic Whites (4.69%), Hispanics (5.11%) and Non-Hispanic Blacks (4.15%) and less common among Asians (2.55%). These differences in the crude prevalence rates of suicide ideation decreased but persisted after control for psychiatric disorders, but disappeared for suicide attempt. Within ethnic groups, risk for suicidality was low among immigrants prior to migration compared to the US born, but equalized over time after migration. Ethnic differences in suicidal behaviors are explained partly by differences in psychiatric disorders and low risk prior to arrival in the USA. These differences are likely to decrease as the US-born proportion of Hispanics and Asians increases.
    Psychological Medicine 10/2011; 42(6):1175-84. · 5.43 Impact Factor

Publication Stats

1k Citations
225.73 Total Impact Points


  • 2011–2014
    • RAND Corporation
      Santa Monica, California, United States
    • Boston Children's Hospital
      • Division of General Pediatrics
      Boston, MA, United States
  • 2011–2012
    • Harvard University
      • Department of Society, Human Development, and Health
      Boston, MA, United States
  • 2007–2012
    • Instituto Nacional de Psiquiatría
      Ciudad de México, The Federal District, Mexico
    • CSU Mentor
      Long Beach, California, United States
  • 2007–2011
    • Davis School District
      Davis, California, United States
    • University of California, Davis
      • Department of Internal Medicine
      Davis, CA, United States
  • 2008
    • California State University, Sacramento
      Sacramento, California, United States
  • 2004–2008
    • Harvard Medical School
      • • Department of Psychiatry
      • • Department of Health Care Policy
      Boston, Massachusetts, United States
  • 2006
    • Virginia Commonwealth University
      • Department of Healthcare Policy and Research
      Richmond, Virginia, United States