Jason Williams

RTI International, Durham, North Carolina, United States

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Publications (33)82.18 Total impact

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    ABSTRACT: Background: Inconsistent findings between studies of gender differences in mental health outcomes in military samples have left open questions of differential prevalence in posttraumatic stress disorder (PTSD) among all United States Army soldiers and in differential psychosocial and comorbid risk and protective factor profiles and their association with receipt of treatment. Methods: This study assesses the prevalence and risk factors of screening positive for PTSD for men and women based on two large, population-based Army samples obtained as part of the 2005 and 2008 U.S. Department of Defense Surveys of Health Related Behaviors among Active Duty Military Personnel. Results: The study showed that overall rates of PTSD, as measured by several cutoffs of the PTSD Checklist, are similar between active duty men and women, with rates increasing in both men and women between the two study time points. Depression and problem alcohol use were strongly associated with a positive PTSD screen in both genders, and combat exposure was significantly associated with a positive PTSD screen in men. Overall, active duty men and women who met criteria for PTSD were equally likely to receive mental health counseling or treatment, though gender differences in treatment receipt varied by age, race, social support (presence of spouse at duty station), history of sexual abuse, illness, depression, alcohol use, and combat exposure. Conclusions: The study demonstrates that the prevalence of PTSD as well as the overall utilization of mental health services is similar for active duty men compared with women. However, there are significant gender differences in predictors of positive PTSD screens and receipt of PTSD treatment.
    Journal of Women's Health 11/2015; DOI:10.1089/jwh.2014.5078 · 2.05 Impact Factor
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    ABSTRACT: Patterns of physical and psychological teen dating violence (TDV) perpetration, victimization, and related behaviors were examined with data from the evaluation of the Start Strong: Building Healthy Teen Relationships initiative, a dating violence primary prevention program targeting middle school students. Latent class and latent transition models were used to estimate distinct patterns of TDV and related behaviors of bullying and sexual harassment in seventh grade students at baseline and to estimate transition probabilities from one pattern of behavior to another at the 1-year follow-up. Intervention effects were estimated by conditioning transitions on exposure to Start Strong. Latent class analyses suggested four classes best captured patterns of these interrelated behaviors. Classes were characterized by elevated perpetration and victimization on most behaviors (the multiproblem class), bullying perpetration/victimization and sexual harassment victimization (the bully-harassment victimization class), bullying perpetration/victimization and psychological TDV victimization (bully-psychological victimization), and experience of bully victimization (bully victimization). Latent transition models indicated greater stability of class membership in the comparison group. Intervention students were less likely to transition to the most problematic pattern and more likely to transition to the least problem class. Although Start Strong has not been found to significantly change TDV, alternative evaluation models may find important differences. Latent transition analysis models suggest positive intervention impact, especially for the transitions at the most and the least positive end of the spectrum. Copyright © 2015. Published by Elsevier Inc.
    Journal of Adolescent Health 02/2015; 56(2 Suppl 2):S27-32. DOI:10.1016/j.jadohealth.2014.08.019 · 3.61 Impact Factor
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    ABSTRACT: This study reports on an independent evaluation of Start Strong: Building Healthy Teen Relationships, a multicomponent initiative targeting 11- to 14-year-olds. "Start Strong" was designed to focus on the developmental needs of middle school students and to enhance skills and attitudes consistent with promotion of healthy relationships and reduction of teen dating violence (TDV). The quasi-experimental evaluation design included data collection from four Start Strong schools and four comparison schools. Student surveys were collected at four waves of data at the beginning and the end of grades 7 and 8. Multilevel models used repeated observations nested within students who were, in turn, nested within schools to determine whether participation in Start Strong enhanced healthy skills and relationships and decreased TDV-related attitudes and behaviors. Short-term effects from waves 1 to 2 were statistically significant for increased parent-child communication and boy/girlfriend relationship satisfaction and support and decreased gender stereotypes and attitudes supporting TDV. Findings for acceptance of TDV and gender stereotypes persisted longitudinally. Results are promising and illustrate that a multicomponent, community-based initiative reduced risk factors predictive of TDV. Start Strong is innovative in its focus on early adolescence, which is a critical period in the transition to dating. The results inform future intervention efforts and underscore the need for further study of middle school students. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
    Journal of Adolescent Health 02/2015; 56(2 Suppl 2):S14-9. DOI:10.1016/j.jadohealth.2014.11.003 · 3.61 Impact Factor

  • Journal of Child and Family Studies 01/2015; DOI:10.1007/s10826-015-0231-6 · 1.42 Impact Factor
  • Laurel L. Hourani · Jason Williams · Robert Bray · Denise Kandel ·
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    ABSTRACT: This study examined gender differences in posttraumatic stress disorder (PTSD) symptoms and symptom clusters in the total U.S. active duty force. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel and based on 24,690 individuals: 17,939 men and 6,751 women from all services at 64 installations worldwide. The results indicated that women expressed more symptom distress than men across almost all the individual PTSD symptoms except for hypervigilance. Women also had significantly higher scores on all four PTSD Checklist, Civilian Version (PCL-C) factors examined, including Re-experiencing, Avoidance, Emotionally numb, and Hyperarousal. More women than men were distressed by combat experiences that had involved some type of hurt, such as being wounded, witnessing or engaging in acts of cruelty, engaging in hand-to-hand combat, and, to a lesser extent, handling dead bodies. Men who had been sexually abused had a greater number of symptoms and were consistently more distressed than women on both individual symptoms and symptom clusters. Gender differences were a predictor for the Emotionally numb factor in which men had higher scores after controlling for other demographics, combat experiences, sexual abuse history, and substance abuse. This study found that gender differences in PTSD symptoms of military personnel are both dependent on the type of trauma (combat vs. sexual abuse) experienced, the kind of combat exposures experienced, and the time when sexual abuse took place (before vs. after joining the military).
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: The U.S. population has shown increasing rates of overweight and obesity in recent years, but similar analyses do not exist for U.S. military personnel. It is important to understand these patterns in the military because of their impact on fitness and readiness. To assess prevalence and trends in overweight/obesity among U.S. servicemembers and to examine the associations of sociodemographic characteristics, exercise, depression, and substance use with these patterns. Analyses performed in 2013 used five large population-based health-related behavior surveys conducted from 1995 to 2008. Main outcome measures were overweight and obesity among active duty military personnel based on BMI. Combined overweight and obesity (BMI≥25) increased from 50.6% in 1995 to 60.8% in 2008, primarily driven by the rise in obesity (BMI≥30) from 5.0% to 12.7%. For overweight, military women showed the largest increase. For obesity, all sociodemographic groups showed significant increases, with the largest among warrant officers, senior enlisted personnel, and people aged 36-45 years. Adjusted multinomial logit analyses found that servicemembers aged 26 years and older, men, non-Hispanic blacks and Hispanics, enlisted personnel, married personnel, and heavy drinkers had the highest risk both for overweight and obesity. Combined overweight and obesity in active duty personnel rose to more than 60% between 1995 and 2008, primarily because of increased obesity. The high prevalence of overweight and obesity needs attention and has implications for DoD efforts to improve the health, fitness, readiness, and quality of life of the Active Forces. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
    American Journal of Preventive Medicine 11/2014; 48(2). DOI:10.1016/j.amepre.2014.08.033 · 4.53 Impact Factor
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    ABSTRACT: Objectives: We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. Methods: We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12,835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22,627). Results: HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Conclusions: Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention.
    American Journal of Public Health 07/2014; 104(9):e1-e9. DOI:10.2105/AJPH.2014.301971 · 4.55 Impact Factor
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    David P Mackinnon · Chondra M Lockwood · Jason Williams ·

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    ABSTRACT: Understanding which interventions work best for who is a critical, yet unresolved, issue in the prevention sciences. There has been a paucity of research on the processes (e.g., neurocognition, emotion regulation, and stress physiology) underlying socio-emotional competency skills that have repeatedly been shown to predict high-risk behaviors. Given growing evidence that a high level of brain plasticity characterizes the early stages of development, a transdisciplinary and translational investigation of this type has great potential for identifying individual level characteristics that may interfere with favorable outcomes, thus requiring more targeted and effective programming. The present study is the first in-depth school-based intervention trial to infuse relevant aspects of cognitive neuroscience with existing theories of developmental psychology and prevention science. The ultimate goal is to identify underlying conditions (inhibitory control, emotional regulation, and stress physiology) that may moderate intervention effects on behavior in the early years of schooling. Thus, we conducted a theory-driven examination of Promoting Alternative Thinking Strategies (PATHS), an evidence-based model with replicated effects on self-regulatory behaviors, to understand for whom the intervention works best. The PATHS program was implemented in two Baltimore City kindergarten (K) classrooms through first grade with an additional two demographically similar schools randomized to receive an active control condition (N > 300). These schools serve income neighborhoods with relatively low academic achievement and a high level of behavioral problems. Two cohorts of students received PATHS for two consecutive years, while the control schools received professional development workshops. Baseline testing was conducted in the fall for both K cohorts to assess background and behavioral factors, cognitive functioning, emotional regulation, and measures of skin conductance and heart rate variability. Testing was repeated at the completion of the school year and again after first grade and midway through second grade. Preliminary results reveal that certain measures of baseline inhibitory control, emotion regulation and physiology moderated the effects of the intervention on behavioral change. Children with the lowest level of IQ showed significantly greater improvements than higher functioning children and children in the control condition. However, deficits in other more complex IC and ER were predictive of worse outcomes. A potential theory-based explanation will be presented. This study represents a substantial innovation in the field with implications for improving behavioral self-regulation in young children.
    Society for Prevention Research 22nd Annual Meeting 2013; 05/2014
  • Robert M Bray · Janice M Brown · Jason Williams ·
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    ABSTRACT: Population-based Department of Defense health behavior surveys were examined for binge and heavy drinking among U.S. active duty personnel. From 1998-2008, personnel showed significant increases in heavy drinking (15% to 20%) and binge drinking (35% to 47%). The rate of alcohol-related serious consequences was 4% for nonbinge drinkers, 9% for binge drinkers, and 19% for heavy drinkers. Personnel with high combat exposure had significantly higher rates of heavy (26.8%) and binge (54.8%) drinking than their counterparts (17% and 45%, respectively). Heavy and binge drinking put service members at high risk for problems that diminish force readiness and psychological fitness.
    Substance Use &amp Misuse 07/2013; 48(10):799-810. DOI:10.3109/10826084.2013.796990 · 1.23 Impact Factor
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    ABSTRACT: Although there is growing recognition of the problem of dating violence, little is known about how it unfolds among young adolescents who are just beginning to date. This study examined classes (subgroups) and transitions between classes over three time points based on dating violence, bullying, and sexual harassment perpetration and victimization experienced by youth. The sample was ethnically diverse, consisting of 795 seventh-grade students from schools that were part of a multi-site, longitudinal evaluation of a dating violence initiative (50 % female; 27 % White, 32 % African American, 25 % Latino, 16 % other or multiple races). Results from latent transition analyses revealed five classes of students with distinct behavioral profiles: multi-problem (victimization and perpetration), bullying and sexual harassment (victimization and perpetration), bullying (victimization and perpetration) and sexual harassment (victimization only), bullying (victimization and perpetration), and a least problem group. The majority of classes were characterized by reports of both perpetration and victimization for at least one behavior. Girls were more likely to be in the less problematic classes. Class membership was fairly stable across the three time points. When students transitioned to a different class, the shift was most often from a more problematic to a less problematic class, particularly for girls. The findings support understanding dating violence within a dynamic, developmental process that recognizes related behaviors within and across individuals. Overall, the findings highlight the utility of person-oriented approaches to enhance our understanding of longitudinal profiles and transitions over time for dating violence and related behaviors.
    Journal of Youth and Adolescence 02/2013; 42(4). DOI:10.1007/s10964-013-9914-8 · 2.72 Impact Factor
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    ABSTRACT: Teen dating violence (TDV) is a major public health problem. Nationally representative data indicate that 1 in 10 high schoolers report being hit, slapped, or physically hurt by a dating partner in the last year. However, despite these alarming data among high school students, there is scant research investigating these behaviors among middle school students. This presentation reports on an independent evaluation of Start Strong: Building Healthy Teen Relationships (Start Strong), a national program of the Robert Wood Johnson Foundation in collaboration with Futures Without Violence. Start Strong is being implemented in 11 sites and targets promotion of healthy relationships as a way to prevent TDV among 11-to 14-year-olds in middle schools. Program components include: TDV school curriculum, social marketing, parent activities, and policy efforts. The quasi-experimental evaluation focused on 3 sites implementing the same curriculum (Safe Dates) with 7th graders. Comparison schools were selected that had similar demographics. This sample included 1430 7th graders (50.1% female; 24% White, 30% African American, 34% Latino, 12% multiple/other). Student data were collected on TDV risk and protective factors and behaviors. Baseline data indicate alarming rates of past 6-month TDV victimization and perpetration, with 37% of middle schoolers reporting psychological violence victimization, 31% reporting electronic aggression victimization, 15% reporting physical violence victimizationand 20% reporting psychological violence perpetration, 18% reporting electronic dating aggression perpetration, and 12% reporting physical dating violence perpetration. This presentation will also highlight baseline findings for TDV risk and protective factors. Subsequent analyses will include three additional waves of data.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    Janice M Brown · Jason Williams · Robert M Bray · Laurel Hourani ·
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    ABSTRACT: Current military personnel are at risk of developing serious mental health problems, including chronic stress disorders and substance use disorders, as a result of military deployment. The most frequently studied effect of combat exposure is post-traumatic stress disorder (PTSD). High-risk behaviors, including alcohol use and aggression, have been associated with PTSD, but the optimal cutoff score on the PTSD Checklist (PCL) for determining the risk for these behaviors has not been clearly delineated. Using postdeployment active duty (AD) and Reserve component military personnel, the relation between various cutoff scores on the PCL and engaging in high-risk behaviors was examined. AD personnel, for every outcome examined, showed significantly greater odds for each problem behavior when PCL scores were 30 or higher compared to those with PCL scores in the 17 to 29 range. A similar pattern was shown for Reserve component personnel with respect to several problem behaviors, although not for alcohol use behaviors. The differences in problem behaviors for these two populations may be an indication that deployment experiences and combat exposure affect them differently and suggest that despite lower critical PCL scores, AD personnel may be at higher risk for developing problems as a function of the deployment cycle.
    Military medicine 10/2012; 177(10):1184-90. DOI:10.7205/MILMED-D-11-00119 · 0.77 Impact Factor
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    ABSTRACT: Understanding the role of spirituality as a potential coping mechanism for military personnel is important given growing concern about the mental health issues of personnel returning from war. This study seeks to determine the extent to which spirituality is associated with selected mental health problems among active duty military personnel and whether it moderates the relationship between combat exposure/deployment and (a) depression, (b) posttraumatic stress disorder (PTSD), and (c) suicidality in active duty military personnel. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. Over 24,000 randomly selected active duty personnel worldwide completed an anonymous self-report questionnaire. High spirituality had a significant protective effect only for depression symptoms. Medium, as opposed to high or low, levels of spirituality buffered each of the mental health outcomes to some degree. Medium and low spirituality levels predicted depression symptoms but only among those with moderate combat exposure. Medium spirituality levels also predicted PTSD symptoms among those with moderate levels of combat exposure and predicted self-reported suicidal ideation/attempt among those never deployed. These results point to the complex relationship between spirituality and mental health, particularly among military personnel and the need for further research.
    Depression research and treatment 06/2012; 2012(5):425463. DOI:10.1155/2012/425463
  • Marian E Lane · Laurel L Hourani · Robert M Bray · Jason Williams ·
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    ABSTRACT: We examined stress levels and other indicators of mental health in reservists and active-duty military personnel by deployment status. We used data from the Department of Defense Health-Related Behaviors surveys, which collect comprehensive, population-based data for reserve and active-duty forces. Data were collected from 18 ,342 reservists and 16, 146 active-duty personnel. Overall, with adjustment for sociodemographic and service differences, reservists reported similar or less work and family stress, depression, and anxiety symptoms than did active-duty personnel. However, reservists who had been deployed reported higher rates of suicidal ideation and attempts than did active-duty personnel who had been deployed and higher rates of post-traumatic stress disorder symptomatology than did any active-duty personnel and reservists who had not been deployed. The highest rates of suicidal ideation and attempts were among reservists who had served in theaters other than Iraq and Afghanistan. Our results suggest that deployment has a greater impact on reservists than on active-duty members, thus highlighting the urgent need for services addressing reservists' unique postdeployment mental health issues. Also, deployment to any theater, not only Iraq or Afghanistan, represents unique threats to all service members' mental well-being.
    American Journal of Public Health 06/2012; 102(6):1213-20. DOI:10.2105/AJPH.2011.300280 · 4.55 Impact Factor
  • Laurel L. Hourani · Jason Williams · Robert Bray ·
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    ABSTRACT: Context: Deployment and trauma are associated with a number of mental health problems experienced by military personnel. Many of these co-occur, including posttraumatic stress disorder (PTSD), depression, suicidal ideation and attempt, alcohol and drug abuse, and anxiety. Although some of these comorbidities may be associated with combat-related traumas, others may be more associated with separate noncombat risk and protective factors. Such comorbidities pose increased treatment challenges; however, the prevalence and pattern of these comorbidities within the military are unknown. Objective: To (1) describe the prevalence and underlying structure of PTSD comorbid mental health conditions among active duty military personnel Design: Population-based, cross-sectional, anonymous survey Setting: 64 U.S. military installations worldwide Participants: 28,546 active duty military respondents from all branches of services stratified by gender, rank, and location Main Outcome Measures: Categorical models of comorbid PTSD conditions, including depression, generalized anxiety, serious psychological distress, suicidal ideation, and problem drinking Results: Almost 32% of personnel who met criteria for PTSD also met criteria for at least one of five other mental health problems; 75% of those with depression symptoms symptoms also met criteria for at least one of the other mental health problems. Latent class analysis models identified five classes of PTSD comorbidity among deployed personnel and four classes among nondeployed personnel. Separate profiles of risk and protective factors differentiated comorbid classes. Conclusion: Findings advance our understanding of the prevalence of co-occurring disorders with PTSD and how individual and military factors may influence both the risk of PTSD and co-occurring mental and substance use disorders.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: The U.S. military has traditionally had high rates of alcohol misuse and alcohol-related problems, necessitating effective treatment programs that minimize participant burden. Web-based interventions have shown promise as efficient treatment options for college students and adults but have not been widely evaluated in the military. This study evaluated the efficacy of two web-based alcohol interventions originally created for civilians and then adapted for U.S. military personnel. Two web-based alcohol interventions, Alcohol Savvy and Drinker's Check-Up, were adapted for use among military populations. The interventions were evaluated using a convenience sample of 3,070 active-duty military personnel at eight installations. Following a baseline survey, participants were assigned to one of three treatment conditions: (a) Alcohol Savvy, (b) Drinker's Check-Up, or (c) control (no program participation). Follow-up surveys were completed by 1,072 participants 1 month following baseline and by 532 participants 6 months following baseline. At 1-month follow-up, participants who completed the Drinker's Check-Up intervention had significant reductions in multiple measures of alcohol use relative to controls. Positive outcomes were found for average number of drinks consumed per occasion, frequent heavy episodic drinker status, and estimated peak blood alcohol concentration. These reductions in alcohol use at the 1-month follow-up were maintained at the 6-month follow-up. There were no statistically significant changes in alcohol use for participants who completed Alcohol Savvy. This study expands the literature on the effectiveness of web-based treatment for alcohol misuse. Findings indicate that web-based programs (Drinker's Check-Up in particular) can significantly decrease several indicators of alcohol use in U.S. military personnel.
    Journal of studies on alcohol and drugs 05/2011; 72(3):480-9. DOI:10.15288/jsad.2011.72.480 · 2.76 Impact Factor
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    ABSTRACT: To describe the prevalence and overlapping combinations in past thirty-day cigarette use, smokeless tobacco use, and cigar use in the active duty U.S. military. Data were taken from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. A total of 28,546 service members participated for a response rate of 70.6%. Analyses showed that 41.2% of active duty service members used one or more forms of tobacco in the past month. Cigarette use only was most prevalent (21.3%); other combinations were much lower ranging from 0.7% to 13.5%. Multinomial regression modeling yielded no consistent patterns in sociodemographic groups with higher risk of using one or more types of tobacco concurrently. Frequency and quantity of cigarette use were related to tobacco use patterns. From 60% to 67% of smokers were daily users of cigarettes only or cigarettes in combination with other tobacco types. The majority of cigarette users (54%-69%) smoked 15 or fewer cigarettes/day regardless of tobacco use patterns, but those who smoked at heaviest levels were most likely to use all 3 tobacco types (19%). Four of 10 service members place themselves at increased risk of tobacco-related illness and disease by using one or more types of tobacco. Daily cigarette smokers and very heavy smokers are at highest risk of using multiple tobacco types. Further research is needed to better understand the levels of use and the reasons for use of multiple types of tobacco.
    Nicotine & Tobacco Research 04/2011; 13(8):691-8. DOI:10.1093/ntr/ntr060 · 3.30 Impact Factor
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    ABSTRACT: Measurement invariance is typically assumed when assessing drinking-related constructs across distinct groups of respondents. However, measurement properties of motivations related to mood maintenance and stress relief may differ in those experiencing symptoms of depression or anxiety. Invariance of social and coping drinking motives were explored with a sample of 4133 junior enlisted Air Force and Navy personnel. Measurement did not differ in those with depression symptoms. In contrast, those with anxiety symptoms differed in measurement of both motives. The impact of non-equivalence was demonstrated with a mediation model in which anxiety and depression predicted drinking motives, which in turn predicted heavy drinking. Incorporation of the partial invariance of the social motives factor attenuated the estimate of the mediated effect of social drinking motives by almost half compared to the estimate with invariance assumed. These results suggest that lack of measurement invariance could seriously bias or alter conclusions from tests of theoretical models and highlight the need for researchers to carefully consider the measurement properties of their constructs prior to model estimation.
    Addictive behaviors 05/2010; 35(5):444-51. DOI:10.1016/j.addbeh.2009.12.012 · 2.76 Impact Factor
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    ABSTRACT: Studies have not examined the factor structure or measurement invariance of posttraumatic stress disorder (PTSD) symptomatology using population-based data. Confirmatory factor analysis of the PTSD Checklist-Civilian Version (PCL-C) was conducted in a representative sample of U.S. active duty military personnel (N = 15,593). Consistent with prior research, a 4-factor model consisting of reexperiencing, avoidance, emotional numbing, and arousal factors was superior to four alternative models. Measurement invariance was found for factor loadings, but not observed item intercepts when comparing personnel with and without a recent deployment (<or=12 months). Findings indicate differences in the level of observed responses across deployment subgroups that exceed what would be expected for individuals with similar PCL latent factors scores. Implications of results are discussed.
    Journal of Traumatic Stress 02/2010; 23(1):91-9. DOI:10.1002/jts.20492 · 2.72 Impact Factor

Publication Stats

3k Citations
82.18 Total Impact Points


  • 2008-2015
    • RTI International
      Durham, North Carolina, United States
  • 2007-2008
    • Research Triangle Park Laboratories, Inc.
      Raleigh, North Carolina, United States
  • 2004-2007
    • Arizona State University
      • Department of Psychology
      Phoenix, Arizona, United States