Carolyn Diguiseppi

Carolyn Diguiseppi
University of Colorado | UCD · Department of Epidemiology, Colorado School of Public Health

MD, MPH, PhD

About

218
Publications
21,662
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11,206
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Introduction
Carolyn DiGuiseppi currently works at the Department of Epidemiology, Colorado School of Public Health, University of Colorado. Carolyn does research in Epidemiology and Public Health. Current projects include 'Study to Explore Early Development,' 'Screening and Linkage to Services for Autism,' and 'Longitudinal Research on Aging Drivers.'

Publications

Publications (218)
Article
Background: Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality. Methods: This prospective two-arm randomized trial enrolled English-speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagno...
Article
Introduction Mobility is closely tied to the ability to safely drive. In older adulthood, many people begin to avoid difficult driving situations, such as driving at night, during rush hour, on freeways, or in unfamiliar areas. Reasons for such avoidance include driving self-regulation (SR; an intentional response to perceived difficulty), lifestyl...
Article
Background: Current knowledge about parental reasons for allowing child participation in research comes mainly from clinical trials. Fewer data exist on parents' motivations to enrol children in observational studies. Objectives: Describe reasons parents of preschoolers gave for participating in the Study to Explore Early Development (SEED), a U...
Article
The heterogeneous nature of children with symptoms of autism spectrum disorder (ASD) makes it difficult to identify risk factors and effective treatment options. We sought to identify behavioral and developmental features that best define the heterogeneity and homogeneity in 2–5-year-old children classified with ASD and subthreshold ASD characteris...
Article
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Aging is associated with an increase in avoidance of challenging driving situations (e.g., driving at night, during rush hour, on freeways, and in unfamiliar areas). Such avoidance behavior may be due to driving self-regulation (SR), an intentional response to perceived declining abilities, or it may be due to other factors such as lifestyle change...
Article
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Background Decision-making about when to stop driving for older adults involves assessment of driving risk, availability of support or resources, and strong emotions about loss of independence. Although the risk of being involved in a fatal crash increases with age, driving cessation can negatively impact an older adult’s health and well-being. Dec...
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Introduction: Social isolation is a modifiable risk factor for negative health outcomes among older adults. This work assessed the relationship between geography (i.e., urban vs. non-urban residence) and social isolation in a cohort of older drivers. Methods: The AAA LongROAD cohort with 2,989 older adult drivers from across the country were includ...
Article
The association of autism spectrum disorder (ASD) with self-reported maternal cannabis use from 3 months pre-conception to delivery (“peri-pregnancy”) was assessed in children aged 30–68 months, born 2003 to 2011. Children with ASD (N = 1428) were compared to children with other developmental delays/disorders (DD, N = 1198) and population controls...
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Importance: Multiple studies have reported that people with autism spectrum disorder (ASD) are at a higher risk for self-injurious behavior and suicide. However, the magnitude of this association varies between studies. Objective: To appraise the available epidemiologic studies on the risk of self-injurious behavior and suicidality among childre...
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Recent research indicates that children with autism are at increased risk of maltreatment. We examined news media reports on homicide incidents involving children with autism as victims in the United States between 2000 and 2019. Of the 52 victims studied, 47 (90.4%) were male. Age of victims ranged from 2 to 20 years (mean = 10.4 ± 5.3 years). Par...
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Emerging evidence suggests that atypical changes in driving behaviors may be early signals of mild cognitive impairment (MCI) and dementia. This study aims to assess the utility of naturalistic driving data and machine learning techniques in predicting incident MCI and dementia in older adults. Monthly driving data captured by in-vehicle recording...
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Background The present study aims to clarify relationships of maternal psychiatric conditions and selective serotonin reuptake inhibitors (SSRI) use during preconception and pregnancy with risk of neurodevelopmental disorders in offspring. Methods We used data from the Study to Explore Early Development, a multisite case-control study conducted in...
Article
As people age, some of the commonly experienced psychomotor, visual, and cognitive declines can interfere with the ability to safely drive, often leading to situational avoidance of challenging driving situations. The effect of hearing impairment on these avoidance behaviors has not been comprehensively studied. Data from the American Automobile As...
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Potentially inappropriate medications (PIMs) identified by the American Geriatrics Society should generally be avoided by older adults because of ineffectiveness or excess risk of adverse effects. Few studies have examined the effects of PIMs on driving safety measured by prospectively and objectively collected driving data. Data for this study cam...
Article
Background and objectives: Pica, the repeated ingestion of nonfood items, can be life-threatening. Although case reports describe pica in children with autism spectrum disorder (ASD) or intellectual disability (ID), there has been little systematic study of pica prevalence. We assessed pica in children 30 to 68 months of age (median = 55.4 months)...
Article
Despite evidence that balance and strength training and other multicomponent exercise classes reduce the risk and rate of falls and fall-related injuries, few older adults participate. To increase uptake of balance- and strength-based fall-prevention classes, we designed and implemented a social marketing program, delivered through churches. Divers...
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Better information is needed about how declines in sensory and cognitive function affect older drivers. This study assessed how hearing loss affects engagement in four challenging driving patterns. Data from the AAA Longitudinal Research on Aging Drivers study was used, including objectively-measured driving; three measures of hearing: reported hea...
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Background: The potential for impaired driving due to medication use can occur at any age, though older adults are more likely to take multiple prescribed medications and experience side effects that may affect driving ability. The purpose of this study was to characterize the relationship between medications and driving safety behaviors. Methods...
Article
Background Pica, the repeated ingestion of nonfood items, can result in gastrointestinal (GI) outcomes. Children with autism spectrum disorder (ASD) and other developmental disabilities (DDs) are disproportionately affected by both pica and GI symptoms. Study of the inter-relationship between pica, GI symptoms, and ASD/DD is limited. Objective/Hyp...
Article
Lay abstract: Young children with autism spectrum disorder can benefit from early detection and intervention to moderate autism spectrum disorder's effect on their development. Routine screening with standardized instruments facilitates early identification. However, many screen-positive children do not receive referrals for evaluation, complete d...
Article
Background: Opioid medications are important therapeutic options to mitigate the harmful effects of pain but can also impair driving ability. We sought to explore opioid use, pain levels, and driving experiences among older drivers. Methods: Cognitively intact drivers ages 65 to 79 years were recruited for the multisite AAA Longitudinal Research...
Preprint
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Background The reported prevalence of autism spectrum disorder (ASD) has increased markedly in the past two decades and children with autism are at increased risk of unintentional injury and self-inflicted injury. The risk of assaultive injury in children with autism, however, has not been well described. Our objective was to examine the characteri...
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The study sought to understand the relationship between in-vehicle technologies (IVTs) and self-regulatory behaviors among older drivers. In a large multi-site study of 2990 older drivers, self-reported data on the presence of IVTs and avoidance of various driving behaviors (talking on a mobile phone while driving, driving at night, driving in bad...
Article
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The US older adult population is projected to considerably increase in the future, and continued driving mobility is important for health aspects in populations with fewer transportation alternatives. This study evaluated whether frailty is associated with low-mileage driving (<1865 miles per year) and driving cessation among older adults. Baseline...
Article
Objectives: (1) Report the occurrence of wandering, or leaving a supervised space, among children with confirmed autism spectrum disorder (ASD), other developmental delay (DD) with a previous but unconfirmed ASD diagnosis (DDprevASD), DD without a previous ASD diagnosis, and a population comparison group (POP) at an age when wandering is no longer...
Article
Introduction The present study uses data from the American Automobile Association (AAA) Longitudinal Research on Aging Drivers (LongROAD) study to assess the association of the frailty phenotype with reduced driving space and involvement in motor vehicle crashes. Methods The LongROAD study is a multisite prospective cohort study of participants ag...
Article
Background: Congenital heart defects (CHDs), the most common type of birth defect in the United States, are increasing in prevalence in the general population. Though CHD prevalence at birth has been well described in the United States at about 1%, little is known about long-term survival and prevalence of CHDs beyond childhood. This study aimed t...
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The crash rate per mile driven among older adults is higher than that of most age groups and comparable to that of the youngest, most inexperienced drivers. The low-mileage bias posits that the elevated rate among older adults results from an increased rate among those who accrue the fewest annual miles. This study evaluated whether low physical ca...
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When older adults reduce their driving, there can be subsequent decreases in life satisfaction. In this cross-sectional study, we used baseline data from the multi-site Longitudinal Research on Aging Drivers (LongROAD) study to examine whether social support moderates the negative association between reduced driving and life satisfaction. The outco...
Article
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Background: Potentially Inappropriate Medication (PIM) use has been studied in a variety of older adult populations across the world. We sought to examine the prevalence and correlates of PIM use in older drivers. Methods: We applied the American Geriatrics Society 2015 Beers Criteria to baseline data collected from the "brown-bag" review of med...
Article
Background Evidence about injury management and outcomes in children with autism spectrum disorder (ASD) is limited. Method Cross-sectional analyses included children aged 30–68 months with at least one medically attended injury. Standardized diagnostic instruments determined ASD cases. Parent-reported injury treatments and outcomes were examined...
Article
Studies over the past two decades have attempted to document and understand factors related to crashes involving older drivers to develop more effective countermeasures to reduce the frequency and severity of these crashes. Studies in which vehicle acceleration data can be recorded have begun to explore the relationship between rapid deceleration e...
Article
This study examined cannabis use and driving outcomes among older drivers in Colorado, which has legalized medical and recreational use. The associations of self-reported past-year cannabis use with diverse driving outcomes were assessed in 598 drivers aged 65-79 (51% female, 70% with postsecondary education), using regression analysis to adjust fo...
Article
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Background: There are approximately 42 million licensed drivers aged 65 years or older in the United States, who face unique age-related risks while driving. While physical activity affects several chronic conditions thought to be associated with motor vehicle crashes (MVCs), it is unclear if increased physical activity leads to fewer MVCs. This st...
Article
Background: Older adult drivers may experience decreases in driving safety with age or health status change. Discussing driving safety may help them plan for driving restriction and eventual cessation. Here, we sought to examine conversations between older adults and their family members and physicians. Methods: In this multi-site cross-sectiona...
Article
Objective: This study examines the prevalence of self-reported driving while intoxicated (DWI) among drivers aged 65 and older. Method: This cross-sectional study was based on baseline data from the AAA Longitudinal Research on Aging Drivers (LongROAD) study, a multisite prospective cohort study of 2,990 older adult drivers. Alcohol-related variabl...
Article
Background Studies that examine the role of factors documented before self-injurious behaviors (SIB) occur are important in establishing a temporal relationship between these factors and SIB. Using data from a population-based surveillance system of 8-year-olds with autism spectrum disorder (ASD), we: (1) explored potential associations between SIB...
Article
Studies report inconsistent findings on the relationship between ASD and breastfeeding. We explored associations between ASD and breastfeeding initiation (yes/no) and duration (months categorized in tertiles) in the Study to Explore Early Development, a community‐based case–control study in six sites in the Unites States. We adjusted for various ch...
Article
Evidence suggests that older driver safety may be improved by good vehicle maintenance, in-vehicle advanced technologies, and proper vehicle adaptations. This study explored the prevalence of several measures of vehicle maintenance and damage among older drivers through inspection of their vehicles. We also investigated the prevalence of in-vehicle...
Article
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The original version of this article unfortunately contained a mistake in Table 2. The "Time of use" should be the column header with the corresponding row with "N = 126" belonging to the "Peri-pregnancy" row. The "Preconception" row should be the row with "N = 17", "Trimester 1" should be the "N = 29" row, "Trimester 2" should be the "N = 25" row,...
Article
Background and objectives: Balancing both driver mobility and safety is important for the well-being of older adults. However, research on the association of physical function with these 2 driving outcomes has yielded inconsistent findings. This study examined whether physical functioning of older drivers, as measured by the Short Physical Perform...
Article
Balance training decreases fall risk among older adults, but few participate in such training. We examined the association of exposure to social marketing to promote balance classes, personal characteristics and other factors, with older adults' balance class participation. Adults aged ⩾60 years were eligible for this case-control study if they att...
Article
Objective: Whether physical access to psychotropic medication via prescription (ie, prescribed access) is associated with use of psychotropic medication as a means of subsequent suicide attempt remains unclear. In a population of suicide attempters, we investigated whether prescribed access to any psychotropic medication increased the likelihood o...
Conference Paper
Evidence about injury outcomes in children with autism spectrum disorder (ASD) is limited. We compared injury treatments and outcomes in children with ASD versus typically-developing (TD) controls. Children aged 30–68 months were recruited from education and health providers and randomly sampled birth certificates. Cases were determined using estab...
Conference Paper
Marijuana use among older adults has increased over the past decade. Describe marijuana use and driving outcomes among older drivers in Colorado, which has legalized medical and recreational use. We examined the association of self-reported past-year marijuana use and driving outcomes in 598 drivers aged 65–79 (mean 70.6 years; 51 percent female, 7...
Article
Self-reported measures of driving behavior are often relied upon in research. Such measures are known to be significantly related to objective driving behavior, but little is known about what other factors may play a role in how well objective predict subjective measures. Data from the Longitudinal Research on Aging Drivers (LongROAD) study were us...
Article
Immune system abnormalities have been widely reported among children with autism spectrum disorder (ASD), which may increase the risk of childhood infections. The Study to Explore Early Development (SEED) is a multisite case‐control study of children aged 30–69 months, born in 2003–2006. Cases are children previously diagnosed and newly identified...
Article
We surveyed self-reported lifetime health conditions (using National Health and Aging Trends Study questions) and related driving reduction in a large multi-site older driver cohort (n = 2990) from the AAA Longitudinal Research on Aging Drivers (LongROAD) Study’s baseline assessment. Those reporting reduced driving (n = 337) largely attributed redu...
Article
To describe the long‐term effect of steroid treatment on weight in nonambulatory males with Duchenne Muscular Dystrophy (DMD), we identified 392 males age 7–29 years with 4,512 weights collected after ambulation loss (176 steroid‐naïve and 216 treated with steroids ≥6 months) from the Muscular Dystrophy Surveillance, Tracking, and Research Network...
Article
Opioid use during pregnancy is associated with suboptimal pregnancy outcomes. Little is known about child neurodevelopmental outcomes. We examined associations between maternal opioid prescriptions preconception to delivery (peri-pregnancy) and child’s risk of ASD, developmental delay/disorder (DD) with no ASD features, or ASD/DD with autism featur...
Article
We examined associations between child body mass index at 2–5 years and maternal pre-pregnancy body mass index, gestational weight gain, and rapid weight gain during infancy in children with autism spectrum disorder, developmental delays, or population controls. The Study to Explore Early Development is a multi-site case–control study of children,...
Article
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This study explored whether ASD phenotypes in the child were associated with a history of anxiety or depression in the mother. We hypothesized that an ASD profile in children characterized by mild delays and increased rates of dysregulation would be associated with preexisting maternal anxiety or depression. Participants were 672 preschool children...
Article
Driving is the preferred source of personal transportation for older adults. However, personal transportation is not limited to owning and operating a car and can be conceptualized as utilization of different modes of transportation to meet personal mobility needs. The aims of this study are to describe the types and number of alternate transport s...
Article
Objective: To examine whether falls are associated with the subsequent ability to work among workers 65 years and older. Methods: This longitudinal cohort study followed older workers enrolled in the Health and Retirement Study. Outcomes included time to health-related work limitation and to labor force exit. Results: After adjustment multiple...
Article
The exploratory study reported here was intended to examine: how strongly subjectively reported driving avoidance behaviors (commonly referred to as self-regulation) and exposure were related to their objectively measured counterparts and whether it depended on the specific behavior; the extent to which gender and age play a role in the association...
Article
Participant attrition can limit inferences drawn from study results and inflate research costs. We examined factors associated with completion of the Study to Explore Early Development (2007-2011), a multiple-component, case-control study of risk factors for autism spectrum disorder in preschoolers, conducted in California, Colorado, Georgia, Maryl...
Article
We compared the prevalence of self-injurious behaviors (SIB) in preschoolers aged 30–68 months with autism spectrum disorder (ASD) (n = 691) versus other developmental delays and disorders (DD) (n = 977) accounting for sociodemographic, cognitive, and medical factors. SIB prevalence was higher in ASD versus all DD [adjusted odds-ratio (aOR) 2.13 (9...
Article
Background: Severity of workplace injury tends to increase with age. Whether older workers who experience a workplace injury or illness exit the labor force sooner than comparable peers is not established. Methods: A case-cohort study design and complementary log-log model were used to identify factors associated with average time to early subst...
Article
Full-text available
This study examined caregiver-reported medically-attended injuries among 30–68 month old children with autism spectrum disorder (ASD) compared to general population (POP) and non-ASD developmental disorders (DD) controls in the Study to Explore Early Development. Injuries were common in ASD cases (32.3%) as well as POP (30.2%) and DD (27.8%) contro...
Article
The autism spectrum disorder phenotype varies by social and communication ability and co-occurring developmental, behavioral, and medical conditions. Etiology is also diverse, with myriad potential genetic origins and environmental risk factors. Examining the influence of parental broader autism phenotype—a set of sub-clinical characteristics of au...
Article
The purpose of the present study was to gain a better understanding of the types of in-vehicle technologies being used by older drivers as well as older drivers' use, learning, and perceptions of safety related to these technologies among a large cohort of older drivers at multiple sites in the United States. A secondary purpose was to explore the...
Article
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Background: As an important indicator of mobility, driving confers a host of social and health benefits to older adults. Despite the importance of safe mobility as the population ages, longitudinal data are lacking about the natural history and determinants of driving safety in older adults. Methods: The Longitudinal Research on Aging Drivers (L...
Article
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Previous studies of associations between ASD and conception using assisted reproductive technology (ART) are inconsistent and few studies have examined associations with other infertility treatments or infertility disorders. We examined associations between ASD and maternal/paternal infertility disorders and numerous maternal treatments among 1538...
Article
Objectives: To prospectively validate and refine the 5-item "CRASH" screening tool for identifying older drivers needing a behind-the-wheel (BTW) test. Design: Prospective observational study. Setting: Geriatric and internal medicine primary care clinics affiliated with a tertiary care hospital and a local BTW program. Participants: Cognitiv...
Article
Background: As the workforce ages, occupational injuries from falls on the same level will increase. Some industries may be more affected than others. Methods: We conducted a cross-sectional study using data from the Bureau of Labor Statistics to estimate same-level fall injury incidence rates by age group, gender, and industry for four sectors:...
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The Social Communication Questionnaire (SCQ) and the Social Responsiveness Scales (SRS) are commonly used screeners for autism spectrum disorder (ASD). Data from the Study to Explore Early Development were used to examine variations in the performance of these instruments by child characteristics and family demographics. For both instruments, speci...
Article
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Lay summary: Gluten free diets (GFDs) are commonly used as an alternative therapy for autism spectrum disorder (ASD); however, the effectiveness is still uncertain which makes it important to know who tries this type of diet. We found that one in five preschool aged children with ASD had ever used a GFD. Children with gastrointestinal conditions a...
Article
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Autism spectrum disorder (ASD) diagnosis relies on parent-reported and clinician-observed instruments. Sometimes, results between these instruments disagree. The broader autism phenotype (BAP) in parent-reporters may be associated with discordance. Study to Explore Early Development data (N = 712) were used to address whether mothers with BAP and c...
Article
Background: Prenatal alcohol exposure can affect neurodevelopment, but few studies have examined associations with autism spectrum disorder (ASD). Methods: We assessed the association between maternal alcohol use and ASD in the Study to Explore Early Development, a multi-site case-control study of children born between September 2003 and August...