Publications (12)33.17 Total impact
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Article: Sustained Effects of the Communities That Care System on Prevention Service System Transformation.
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ABSTRACT: Objectives. We examined whether the Communities That Care (CTC) system sustained effects 1.5 years after study funding ended on prevention system constructs expected to be important for community-level reductions in drug use and antisocial behaviors among youths. Methods. Data were from a community trial of 24 towns in the United States randomized to either the CTC intervention or control conditions. Participants were 928 community key leaders interviewed at 1 to 4 waves from 2001 to 2009. Intervention activities, including training and technical assistance, were conducted between 2003 and 2008 in the CTC communities. Results. Leaders from CTC communities reported higher levels of adoption of a science-based approach to prevention and a higher percentage of funding desired for prevention activities in 2009 than did leaders in control communities. CTC communities showed a higher increase over time in community norms against adolescent drug use as well as adoption of a science-based approach compared with control communities. Conclusions. These findings indicated that CTC implementation produced enduring transformation of important prevention system constructs in intervention communities, which might, in turn, produce long-term reductions in youth problem behaviors. (Am J Public Health. Published online ahead of print July 19, 2012: e1-e7. doi:10.2105/AJPH.2011.300567).American Journal of Public Health 06/2012; · 3.93 Impact Factor -
Article: Associations between household and neighborhood income and anxiety symptoms in young adolescents.
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ABSTRACT: A better understanding of the role of both family- and neighborhood-level socioeconomic characteristics in the development of anxiety disorders is important for identifying salient target populations for intervention efforts. Little research has examined the question of whether associations between anxiety and socioeconomic status (SES) differ depending upon the level at which SES is measured or way in which anxiety manifests. We studied associations between both household- and neighborhood-level income and four different manifestations of anxiety in a community sample of young adolescents. We conducted a cross-sectional analysis of data on 498 subjects aged 11-13 from a cohort study of Seattle-area middle school students. Generalized estimating equations were used to examine the association between both annual household income and neighborhood median income and each of four anxiety subscale scores from the multidimensional anxiety scale for children (MASC): physical symptoms, harm avoidance, social anxiety, and separation/panic anxiety. A negative association was found between household income and scores on two of the four MASC subscales-physical symptoms and separation/panic anxiety. In contrast, at equivalent levels of household income, adolescents living in higher income neighborhoods reported higher physical and harm avoidance symptom scores. The role that SES plays in the development of childhood anxiety appears to be complex and to differ depending on the specific type of anxiety that is manifest and whether income is evaluated at the household or neighborhood level.Depression and Anxiety 05/2012; 29(9):824-32. · 4.18 Impact Factor -
Article: Identifying comorbid depression and disruptive behavior disorders: comparison of two approaches used in adolescent studies.
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ABSTRACT: Interest in commonly co-occurring depression and disruptive behavior disorders in children has yielded a small body of research that estimates the prevalence of this comorbid condition and compares children with the comorbid condition and children with depression or disruptive behavior disorders alone with respect to antecedents and outcomes. Prior studies have used one of two different approaches to measure comorbid disorders: (1) meeting criteria for two DSM or ICD diagnoses or (2) scoring .5 SD above the mean or higher on two dimensional scales. This study compares two snapshots of comorbidity taken simultaneously in the same sample with each of the measurement approaches. The Developmental Pathways Project administered structured diagnostic interviews as well as dimensional scales to a community-based sample of 521 11-12 year olds to assess depression and disruptive behavior disorders. Clinical caseness indicators of children identified as "comorbid" by each method were examined concurrently and 3-years later. Cross-classification of adolescents via the two approaches revealed low agreement. When other indicators of caseness, including functional impairment, need for services, and clinical elevations on other symptom scales were examined, adolescents identified as comorbid via dimensional scales only were similar to those who were identified as comorbid via DSM-IV diagnostic criteria. Findings suggest that when relying solely on DSM diagnostic criteria for comorbid depression and disruptive behavior disorders, many adolescents with significant impairment will be overlooked. Findings also suggest that lower dimensional scale thresholds can be set when comorbid conditions, rather than single forms of psychopathology, are being identified.Journal of psychiatric research 05/2012; 46(7):873-81. · 3.72 Impact Factor -
Article: Validation of the normalized difference vegetation index as a measure of neighborhood greenness.
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ABSTRACT: To assess the validity of a Geographic Information Systems (GIS) measure, the Normalized Difference Vegetation Index (NDVI), as a measure of neighborhood greenness for epidemiologic research. Using remote-sensing spectral data, NDVI was calculated for a 100-m radial distance around 124 residences in greater Seattle. The criterion standard was rating of greenness for corresponding residential areas by 3 environmental psychologists. Pearson correlations and regression models were used to assess the association between the psychologists' ratings of greenness and NDVI. Analyses were also stratified by residential density to assess whether the correlations differed between low and high density. The mean NDVI among this sample of residences was 0.27 (standard deviation [SD], 0.11; range, -0.04 to 0.54), and the mean psychologist rating of greenness was 2.84 (SD, 0.98; range, 1-5). The correlation between NDVI and expert ratings of greenness was high (r = 0.69). The correlation was equivalently strong within each strata of residential density. NDVI is a useful measure of neighborhood greenness. In addition to showing a strong correlation with expert ratings, this measure has practical advantages, including availability of data and ease of application to various boundaries, which would aid in replication and comparability across studies.Annals of epidemiology 12/2011; 21(12):946-52. · 2.95 Impact Factor -
Article: Emotional health predictors of substance use initiation during middle school.
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ABSTRACT: This study aimed to evaluate whether emotional health factors, including anxiety and depression, stress, and social support, are associated with earlier youth initiation of alcohol and illicit substances during middle school (from the sixth to the eighth grade). Data for this study were from the Developmental Pathways Project, a longitudinal study of 521 youth sampled from the Seattle Public Schools. Discrete time survival analyses were used to assess the effects of depression, anxiety, stress, and support on initiation of substance use, measured every 6 months at five time points between sixth and eighth grade. Youth who had initiated prior to sixth grade had significantly higher levels of depressive symptoms. In multivariate survival analyses controlling for child race/ethnicity, gender, and socioeconomic status, and accounting for conduct problems, youth who reported higher levels of separation anxiety/panic symptoms were at decreased risk for early alcohol initiation. Children with higher levels of perceived teacher support had a significantly lower risk of alcohol initiation during early follow-up periods. Recent stressful life events in Grade 6 were associated with significantly greater risk of initiating an illicit substance by Grade 8. The current findings highlight the role of stress in the initiation of illicit substance use and suggest that teacher support is associated with lower risk for very early alcohol use. Future research examining anxiety as a predictor of substance use should distinguish between subtypes of anxiety.Psychology of Addictive Behaviors 10/2011; 26(2):351-7. · 2.09 Impact Factor -
Article: Drug use and risk among youth in different rural contexts.
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ABSTRACT: This study compared levels of drug use and risk and protective factors among 18,767 adolescent youths from communities of less than 50,000 in population living either on farms, in the country but not on farms, or in towns. Current alcohol use, smokeless tobacco use, inhalant use, and other illicit drug use were more prevalent among high school-aged youths living on farms than among those living in towns. Prevalence of drug use did not significantly vary across youths living in different residential contexts among middle school youths. While risk and protective factors showed associations of similar magnitude with drug use across residential location, high school students living on farms were exposed to greater numbers of risk factors across multiple domains than were students living in towns. The findings suggest that outreach to farm-dwelling youths may be particularly important for interventions seeking to prevent adolescent drug use in rural settings.Health & Place 02/2011; 17(3):775-83. · 2.67 Impact Factor -
Article: Age-varying association between statin use and incident Alzheimer's disease.
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ABSTRACT: To determine whether risk reduction of statins for Alzheimer's disease (AD) varies by age or presence of apolipoprotein E (APOE) epsilon4 allele. A cohort of cognitively intact elderly participants was assessed biennially for dementia and AD. Community based. Three thousand three hundred ninety-two members of a health maintenance organization (HMO) aged 65 and older and without dementia. Statin use was identified from the HMO pharmacy database, and proportional hazards models were applied with statin use as a time-dependent covariate to assess the association between statins and AD and the modifying effects of age and the APOE epsilon4 allele. Over an average of 6.1 years of follow-up of 3,099 participants, 263 participants developed probable AD. The adjusted hazard ratio (aHR) for statin use was 0.62 (95% confidence interval (CI)=0.40-0.97) for AD in models including demographic characteristics and vascular risk factors as covariates. The strength of the association between statins and AD diminished with age (statin-by-age at entry interaction P=.04); the aHR in those younger than 80 was 0.44 (95% CI=0.25-0.78), versus 1.22 (95% CI=0.61-2.42) for aged 80 and older. The interaction term for statin use-by-APOE epsilon4 was not significant (P=.65). This enlarged study confirms earlier findings that statin therapy in early old age, but not in late age, may be associated with a lower risk of AD. The relationship between statin use and AD was consistent across APOE genotypes.Journal of the American Geriatrics Society 07/2010; 58(7):1311-7. · 3.74 Impact Factor -
Article: Criterion validity of the Short Mood and Feelings Questionnaire and one- and two-item depression screens in young adolescents.
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ABSTRACT: The use of short screening questionnaires may be a promising option for identifying children at risk for depression in a community setting. The objective of this study was to assess the validity of the Short Mood and Feelings Questionnaire (SMFQ) and one- and two-item screening instruments for depressive disorders in a school-based sample of young adolescents. Participants were 521 sixth-grade students attending public middle schools. Child and parent versions of the SMFQ were administered to evaluate the child's depressive symptoms. The presence of any depressive disorder during the previous month was assessed using the Diagnostic Interview Schedule for Children (DISC) as the criterion standard. First, we assessed the diagnostic accuracy of child, parent, and combined scores of the full 13-item SMFQ by calculating the area under the receiver operating characteristic curve (AUC), sensitivity and specificity. The same approach was then used to evaluate the accuracy of a two-item scale consisting of only depressed mood and anhedonia items, and a single depressed mood item. The combined child + parent SMFQ score showed the highest accuracy (AUC = 0.86). Diagnostic accuracy was lower for child (AUC = 0.73) and parent (AUC = 0.74) SMFQ versions. Corresponding versions of one- and two-item screens had lower AUC estimates, but the combined versions of the brief screens each still showed moderate accuracy. Furthermore, child and combined versions of the two-item screen demonstrated higher sensitivity (although lower specificity) than either the one-item screen or the full SMFQ. Under conditions where parents accompany children to screening settings (e.g. primary care), use of a child + parent version of the SMFQ is recommended. However, when parents are not available, and the cost of a false positive result is minimal, then a one- or two-item screen may be useful for initial identification of at-risk youth.Child and Adolescent Psychiatry and Mental Health 02/2010; 4(1):8. -
Article: The impact of the First Steps prenatal care program on birth outcomes among women receiving Medicaid in Washington State.
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ABSTRACT: To evaluate the effectiveness of "First Steps", Washington State's expanded Medicaid prenatal and post-partum care program, we conducted a retrospective population-based cohort study using birth and hospital discharge records from Washington State for 1999-2002. Birth outcomes of 19,668 First Steps participants receiving Medicaid were compared to those of 56,728 non-participating mothers receiving Medicaid. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the association between First Steps participation and low birth weight (<2500g), preterm birth (<37 weeks gestation), small for gestational age (<10th percentile in birth weight for Washington State infants of same gestational age and sex), and infant mortality (death prior to 12 months). Adjusted for potential confounders of maternal age, race/ethnicity, education, marital status, parity, place of residence, foreign birth, and participation in other benefit programs, infants of women participating in First Steps were less likely to be of low birth weight (OR=0.92, 95% CI: 0.84-1.00). Among Hispanic women, compared to non-participants, participants had a reduced odds of low birth weight (OR=0.79, 95% CI: 0.67-0.94) and preterm birth (OR=0.85, 95% CI: 0.74-0.98). These results suggest that participation in First Steps among Medicaid recipients may be particularly effective among Hispanic mothers.Health Policy 04/2009; 92(1):49-54. · 1.51 Impact Factor -
Article: Recruiting patients with breast cancer and their families to behavioral research in the post-HIPAA period.
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ABSTRACT: To describe a process for, response rates of, and indicated interest in recruiting patients with breast cancer and their spouses and family members from a clinical setting into behavioral and psychiatric research studies since the Health Insurance Portability and Accountability Act (HIPAA) regulations have taken effect. Published articles, books and book chapters, MEDLINE, government agency information and HIPAA regulatory Web sites, and survey data. Response rates among the three target groups--patients, spouses and partners, and female first-degree relatives--were 77%, 95%, and 88%, respectively. Interest was high in the three target groups, with 77%, 87%, and 65% of responding patients, spouses and partners, and female first-degree relatives, respectively. Taken together, these data indicate that high participation rates can be expected from patients with breast cancer and their families in clinical settings.Implications for Nursing: Regulations pose barriers to patient and family recruitment, but thoughtful systems actually can improve rates of recruitment.Oncology Nursing Forum 10/2007; 34(5):1049-54. · 1.91 Impact Factor -
Article: Age-varying association between blood pressure and risk of dementia in those aged 65 and older: a community-based prospective cohort study.
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ABSTRACT: To assess variation in the association between blood pressure (BP) and risk for dementia across a spectrum of older ages and to examine BP changes before dementia onset. Prospective cohort study. A large health maintenance organization in Seattle, Washington. A cohort of 2,356 members of a large health maintenance organization aged 65 and older who were initially without dementia. Dementia diagnosis was assessed biennially, and systolic (SBP) and diastolic BP (DBP) were measured at baseline and at four follow-up assessments. Cox proportional hazards models were used to estimate hazard ratios (HRs) for dementia and Alzheimer's disease (AD) associated with baseline BP in different age groups. Within the youngest age group (65-74 at enrollment) a greater risk for dementia was found in participants with high SBP (> or = 160 mmHg) (hazard ratio (HR) = 1.60, 95% confidence interval (CI) = 1.01-2.55) or borderline-high DBP (80-89 mmHg) (HR = 1.59, 95% CI = 1.07-2.35) than for those with normal BP (SBP < 140 mmHg and DBP < 80 mmHg). The dementia risk associated with SBP declined with increasing age (SBP-by-age interaction, P=.01). SBP declined similarly with aging in subjects who developed dementia and those who did not. Thus, in this sample, the association between SBP and dementia risk was not dependent on when BP was measured in relation to onset of dementia. High SBP was associated with greater risk of dementia in the young elderly (< 75) but not in older subjects. Adequate control of hypertension in early old age may reduce the risk for dementia.Journal of the American Geriatrics Society 08/2007; 55(8):1161-7. · 3.74 Impact Factor -
Article: Measurement matters in the association between early adolescent depressive symptoms and body mass index.
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ABSTRACT: The objectives of this study were to examine associations between depressive symptoms and body mass over 1 year during early adolescence and to assess how the associations might differ depending upon whether self-reported or directly measured height and weight were used. Participants were 446 sixth-grade Seattle students. Depressive symptoms were assessed using the Mood and Feelings Questionnaire. Regression models were used to examine whether baseline depression status was associated with 12-month body mass index (BMI; using self-reported height and weight) and whether baseline overweight status was associated with 12-month depressive symptom score. Analyses were rerun among a subsample (n=165) who had height and weight directly measured. Using BMI derived from self-reported values, depressed males had a significantly lower BMI than nondepressed males, while depressed females had a significantly higher BMI than nondepressed females, after adjusting for covariates. Among a subsample using measured height and weight values, however, depression was no longer associated with BMI in either gender. Baseline overweight status did not predict 12-month depression score. Observed associations between depression and subsequent BMI were explained by differential misclassification of self-reported height and weight by depression status and gender. Direct measurement of height and weight may be necessary to ensure validity in studies of adolescent depression and weight-related outcomes.General Hospital Psychiatry 30(5):458-66. · 2.74 Impact Factor
Top co-authors
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Institutions
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2011–2012
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University of Washington Seattle
- School of Social Work
Seattle, WA, USA
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