Integrating Person-Centered and Variable-Centered Approaches in the Study of Developmental Courses and Transitions in Alcohol Use: Introduction to the Special Section

Mental-Health Trajectories of U.S. Parents With Young Children During the COVID-19 Pandemic: A Universal Introduction of Risk

Parents of young children were a subgroup of the population identified early in the pandemic as experiencing significant mental-health symptoms. Using a longitudinal sample of 3,085 parents from across the United States who had a child or children age 0 to 5, in the present study, we identified parental mental-health trajectories from April to November 2020 predicted by pre-COVID-19 cumulative risk and COVID-19-specific risk factors. Both growth-mixture modeling and latent-growth-curve modeling were used to test the relationship between risk factors and parent mental health. Pre-COVID-19 cumulative risk and COVID-19-specific risks of financial strain, decreased employment, and increased family conflict were salient risk factors predicting poor mental-health trajectories across both modeling approaches. These finding have public-health implications because prolonged exposure to mental-health symptoms in parents constitutes a risk factor for child development.

Co-occurrence, stability and manifestation of child and adolescent mental health problems: a latent transition analysis

Background

Complex constellations of socio-emotional and behavioural problems (i.e., mental health problems) in childhood and adolescence are common and heighten the risk for subsequent personality, anxiety and mood disorders in adulthood. Aims of this study included the examination of patterns of mental health problems (e.g., externalizing-internalizing co-occurrence) and their transitions to reported mental disorders by using a longitudinal person-centered approach (latent class and latent transition analysis).

Methods

The sample consisted of 1255 children and adolescents (51.7% female, mean age = 12.3 years, age range 8–26 years) from three time points of the comprehensive mental health and wellbeing BELLA study. Children and their parents completed the German SDQ (Strength and Difficulties Questionnaire, Goodman, 1997) and reported on diagnoses of ADHD, depression, and anxiety.

Results

Latent class analysis identified a normative class, an emotional problem class, and a multiple problem class. According to latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time; 14.7% of individuals showed a persistent pattern of mental health problems. Diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class.

Conclusions

Results highlight the need for early prevention of mental health problems to avoid accumulation and manifestation in the transition to adolescence and young adulthood.

"In-between orthorexia" profile: the co-occurrence of pathological and healthy orthorexia among male and female non-clinical adolescents

BACKGROUND

The profile of adolescents with orthorexic eating behaviors remains to be explored. This study is the first to explore the typology of Lebanese adolescents from a large non-clinical sample based on orthorexia nervosa (ON) and healthy orthorexia (HO).

METHOD

A total of 555 adolescents (aged between 15 and 18 years) completed a set of questionnaires assessing orthorexic behaviors, self-esteem, stress, depressive and anxiety symptoms. Cluster analysis based on ON and HO scores was used to identify the typology of the sample. More precisely, this analysis was used to reveal and distinguish between naturally occurring subgroups of individuals with different orthorexic eating profiles, within the studied sample. Further, a series of one-way ANOVA was used to compare observed clusters based on their scores on used questionnaires. This analysis was used to capture the behavioral and psychological differences between previously yielded subgroups of individuals.

RESULTS

Cluster analysis based on ON and HO scores yielded 3 distinct groups: "Low orthorexia", "Moderate in-between orthorexia" and "High in-between orthorexia". While the first group represented individuals with no particular (healthy or pathological) interest in healthy eating, the two latter groups represented those with respectively moderate and high degrees of an interest in healthy eating that has both pathological and healthy aspects. Significant differences between clusters regarding their levels of stress, depression, anxiety and self-esteem was observed, yet they were found to be negligible due to poor effect sizes.

CONCLUSION

Findings from this study suggest that ON and HO can indeed co-occur among adolescents, that this co-occurrence can be experienced at different severity levels. Low effect sizes for ANOVA comparisons may suggest the possibility of the co-occurrence of ON and HO reducing the negative effects of ON behavior to some degree. The potential role of confusion around what constitutes "healthy eating" in the emergence of these "in-between orthorexia" profiles is put forward.

Conduct problems among children in low-income, urban neighborhoods: A developmental psychopathology- and RDoC-informed approach

Conduct problems are associated with numerous negative long-term psychosocial sequelae and are among the most frequent referrals for children's mental health services. Youth residing in low-income, urban communities are at increased risk for conduct problems, but not all youth in these environments develop conduct problems, suggesting heterogeneity in risk and resilience processes and developmental pathways. The present study used a developmental psychopathology- and Research Domain Criteria (RDoC)-informed approach for conceptualizing risk and resilience for conduct problems among children from low-income, urban neighborhoods. Participants were 104 children (M = 9.93 ± 1.22 years; 50% male; 96% African American, 4% Latinx). We assessed four constructs reflecting cognitive and neurobiological processes associated with conduct problems using multiple levels of analysis and informants: autonomic nervous system reactivity, limbic system/orbitofrontal cortical functioning, dorsolateral prefrontal cortical functioning, and conduct problems. Latent profile analysis identified four profiles: typically developing (TD, n = 34); teacher-reported conduct problems (TCP, n = 14); emotion processing (EP, n = 27); and emotion expression recognition (EER, n = 29). External validation analyses demonstrated that profiles differed on various indices of conduct problems in expected ways. The EP profile exhibited lower levels of emotional lability and callous–unemotional behaviors, and higher levels of prosocial behavior. The TD profile demonstrated elevated emotional lability. Implications for etiological and intervention models are presented.

Separation Anxiety Symptom Profiles and Parental Accommodation Across Pediatric Anxiety Disorders

Parental accommodation refers to ways in which caregivers modify their behavior to decrease child distress in the short-term. Accommodation is prevalent among anxious youth and related to decreased treatment and functional outcomes. Although separation anxiety disorder (SAD) is associated with increased accommodation, SAD is not a predictor of treatment response, suggesting that a diagnosis of SAD alone may not be enough to clarify the relationship between accommodation and separation anxiety symptoms within a clinical context. Participants were youth with a primary anxiety disorder (N = 186; aged 7-17) enrolled in an outpatient anxiety clinic. Latent class analysis was used to extract profiles from parent-reported SAD symptoms using the Anxiety Disorders Interview Schedule for DSM-IV/5. Profiles were compared on pre-treatment accommodation. Low, moderate, and interfering SAD classes emerged. Interfering SAD was associated with high accommodation. Results help to clarify the association between SAD and accommodation and has implications for personalized intervention.

Internalizing and externalizing disorders in childhood and adolescence: A latent transition analysis using ALSPAC data

BACKGROUND

Research examining the association between internalizing and externalizing dimensions of psychopathology has relied heavily on variable-centered analytical techniques. Person-centered methodologies complement the variable-centered approach, and may help explain the medium-to-large correlations that exist between higher order dimensions of psychopathology. What little person-centered research exists has been cross-sectional and utilized adult samples. The present study sought to take a person-centered approach to the modeling of psychiatric comorbidity during a key developmental phase; middle childhood through adolescence.

METHODS

Analysis was conducted on data from the Avon Longitudinal Study of Parents and Children (ALSPAC, N=9282). Latent transition analysis (LTA) was conducted using eight DSM-IV disorders assessed at ages 7.5 and 14years as measured indicators.

RESULTS

At both time points, a four class solution provided the best fit, with classes labeled as (i) normative, (ii) primarily internalizing, (iii) primarily externalizing, and (iv) high-risk/multimorbid. There was considerable individual-level stability across time, with approximately 80% of children remaining in the same class at both time points. Those in the internalizing class at baseline were more likely to transition to a less severe class (i.e., the normative class).

CONCLUSIONS

Person-centered methodologies demonstrate that the association between internalizing and externalizing is accounted for by a sub-population at high risk for experiencing psychiatric comorbidity, and 'cross-class' disorders which link the internalizing and externalizing spectra.

FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers

Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.

Panic symptom profiles in social anxiety disorder: a person-centered data-analytic approach

Panic attacks (PAs) are prevalent among individuals with social anxiety disorder (SAD), but the clinical utility of panic symptom profiles is unclear. The aims of the present investigation were to empirically define panic symptom profiles in a treatment-seeking sample of individuals with SAD (N = 280) and to assess the associations of observed panic symptom profiles with clinical features of SAD. Results of a latent class analysis revealed four distinct panic symptom profiles: low panic symptoms, high typical SAD-related panic, high cardiac sensations and paresthesias, and moderate panic. Comparisons of external validators across latent classes indicated that the classes were differentially associated with clinical features of SAD. The present findings suggest that individuals with SAD experience distinct patterns of panic symptoms that may be clinically useful in conducting diagnostic assessments and determining treatment targets.

Developmental trajectories of bullying and social dominance in youth

OBJECTIVE

Bullying is increasingly conceptualized as strategic behavior motivated by a desire to gain social dominance in the peer group. Cross-sectional research has shown that relative to their peers bullies are higher in social dominance as indexed by resource control, and are often perceived as powerful and "cool." However, research examining the developmental relationship between bullying and resource control is lacking. The present longitudinal study fills this gap in the literature.

METHOD

Using a three wave design, participants (N=394) were followed from late childhood into early adolescence. Joint trajectory analyses were used to test whether groups with distinct developmental trajectories of bullying and resource control can be identified, and how these trajectories are related.

RESULTS

For both bullying and resource control three groups emerged (high, medium, and low), indicating that bullies and social dominants do not constitute one homogeneous group. More intense bullying is associated with higher levels of social dominance. Being consistently high in bullying is almost synonymous with being consistently high in resource control, whereas the reverse is not the case.

CONCLUSIONS

Findings suggest that high bullying leads to the attainment of high social dominance, and do not support the view that children high in social dominance engage in bullying to maintain their dominant position.

PRACTICE IMPLICATIONS

This study further underscores the need for interventions targeting mechanisms by which the peer group assigns social dominance to bullies.

Predicting 10-year alcohol use trajectories among men age 50 years and older

OBJECTIVE

To describe common 10-year drinking trajectories followed by men age 50 years or older and identify risk factors for those trajectories.

DESIGN

Longitudinal data were used to derive a semiparametric group-based model.

PARTICIPANTS

Men from the Health and Retirement Study age 50-65 years in 1998 who completed three or more of the six interviews conducted from 1998 to 2008, including our 1998 baseline interview.

MEASUREMENTS

Biannual data on number of drinks per drinking day were used to derive drinking trajectories. Risk factors included baseline age, race, ethnicity, education, marital status, retirement, smoking, binge drinking, vigorous exercise, body mass index, depression, pain, self-reported health, and chronic disease.

RESULTS

The best-fitting model included consistent infrequent drinkers and nondrinkers (40.6% of cohort), increasing drinkers (5.5%), decreasing drinkers (7.6%), consistent at-risk drinkers (15.6%), and consistent moderate drinkers (30.7%). Adjusted logistic regression models comparing men with similar 1998 drinking levels who subsequently followed different trajectories identified significant risks associated with age, education, smoking, binge drinking, depression, pain, and self-reported health. To illustrate, odds ratios (ORs) and 95% confidence intervals (95% CIs) suggest that baseline infrequent drinkers were less likely to follow an increasing drinkers trajectory if they were older (OR: 0.57, 95% CI: 0.38-0.82) and smoked cigarettes (OR: 0.47, 95% CI: 0.30-0.74). Baseline drinkers were less likely to follow a decreasing trajectory if they reported more than 12 years of education (OR: 0.58, 95% CI: 0.42-0.82) and thought that their health was excellent or very good (OR: 0.54, 95% CI: 0.39-0.76).

CONCLUSION

Only 30.7% of older men in this cohort were moderate drinkers throughout the follow-up. Many older men may benefit from brief counseling on the risks and benefits of drinking.

Empirically defined patterns of executive function deficits in schizophrenia and their relation to everyday functioning: a person-centered approach

Executive function (EF) deficits in schizophrenia (SZ) are well documented, although much less is known about patterns of EF deficits and their association to differential impairments in everyday functioning. The present study empirically defined SZ groups based on measures of various EF abilities and then compared these EF groups on everyday action errors. Participants (n = 45) completed various subtests from the Delis-Kaplan Executive Function System (D-KEFS) and the Naturalistic Action Test (NAT), a performance-based measure of everyday action that yields scores reflecting total errors and a range of different error types (e.g., omission, perseveration). Results of a latent class analysis revealed three distinct EF groups, characterized by (a) multiple EF deficits, (b) relatively spared EF, and (c) perseverative responding. Follow-up analyses revealed that the classes differed significantly on NAT total errors, total commission errors, and total perseveration errors; the two classes with EF impairment performed comparably on the NAT but performed worse than the class with relatively spared EF. In sum, people with SZ demonstrate variable patterns of EF deficits, and distinct aspects of these EF deficit patterns (i.e., poor mental control abilities) may be associated with everyday functioning capabilities.

Antecedents and consequences of marijuana use trajectories over the life course in an African American population

BACKGROUND

We examined developmental trajectories of marijuana use among a cohort of urban African Americans followed from first grade to mid adulthood. We compared risk factors in childhood and adolescence and consequences in mid adulthood across trajectory groups.

METHODS

Using semiparametric group-based mixture modeling, five marijuana trajectories for men (n=455) and four trajectories for women (n=495) were identified extending from adolescence to young adulthood (age 32). We labeled the four trajectory groups similar for men and women "abstainers," "adolescent only users," "early adulthood decliners," and "persistent users." We named the unique fifth group for men "late starters."

RESULTS

Multivariate multinomial logistic regressions show that childhood problem behaviors, adolescent family involvement, and dropping out of high school differentiated trajectory membership. Analyses comparing the trajectory groups on behavioral, social, and health outcomes at age 42 revealed that for both men and women, those in the persistent trajectory had the most problems, and those in the early adult decliner group also had specific problems. Male late starters also had poor outcomes.

CONCLUSIONS

The findings point to the value of identifying specific patterns of substance use over the life course and understanding the differences in their correlates and consequences. The implications of these findings are discussed.

Zur Struktur naturwissenschaftlichen Wissens von Grundschulkindern

Zusammenfassung. In der Frage, wie naturwissenschaftliches Wissen von Grundschulkindern beschaffen ist, haben sich zwei konkurrierende Positionen etabliert. Der Kohärenzansatz betont in Analogie zu wissenschaftlichen Theorien die Integriertheit und Strukturiertheit des anfänglichen naturwissenschaftlichen Wissens, wohingegen der Fragmentierungsansatz das Wissen als idiosynkratisch und aus vielen unverbundenen Einzelelementen bestehend ansieht. Aufbauend auf neuere Studien, die zur Untersuchung des naturwissenschaftlichen Wissens von Grundschulkindern personenzentrierte Analysen genutzt haben, wurde in der vorliegenden Studie ein Analyseansatz gewählt, der die personen- und die variablenzentrierte Sichtweise verbindet und somit die Beschreibung sowohl qualitativer als auch quantitativer Unterschiede im Wissen erlaubt. Es zeigte sich erstens, dass die genutzten Faktor-Mischverteilungsmodelle geeignet sind, das naturwissenschaftliche Wissen von Grundschulkindern zu beschreiben. Zweitens fanden sich Hinweise, dass Fragmentierungs- und Kohärenzansatz nicht unbedingt alternativ zu verstehen sind, sondern das Wissen von Subgruppen mit qualitativ unterschiedlichem Wissen beschreiben können. Drittens zeigte sich, dass Lerngelegenheiten im Unterricht eine wichtige Bedeutung für die Beschaffenheit naturwissenschaftlichen Wissens von Grundschulkindern haben.

Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥ 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3% of sample), "Decreasing Drinkers" (5.9%), "Stable Drinkers" (24.2%), and "Non/Infrequent Drinkers" (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

Uncovering multiple pathways to substance use: a comparison of methods for identifying population subgroups

This paper describes and compares a selection of available modeling techniques for identifying homogeneous population subgroups in the interest of informing targeted substance use intervention. We present a nontechnical review of the common and unique features of three methods: (a) trajectory analysis, (b) functional hierarchical linear modeling (FHLM), and (c) decision tree methods. Differences among the techniques are described, including required data features, strengths and limitations in terms of the flexibility with which outcomes and predictors can be modeled, and the potential of each technique for helping to inform the selection of targets and timing of substance intervention programs.

Alcohol trajectories over three years in a Swedish residence hall student population

Although it is known that college students have a high alcohol consumption, less is known about the long-term drinking trajectories amongst college students and, in particular, students living in residence halls, known to be high-risk drinkers. Over four consecutive years, the drinking habits of 556 Swedish residence hall students were analyzed. The main instruments for measuring outcome were AUDIT (Alcohol Use Identification Disorders Test), SIP (Short Index of Problems) and eBAC (estimated Blood Alcohol Concentration). The drinking trajectories among Swedish residence hall students showed stable and decreasing drinking patterns, with age and gender being predictors of group membership.

Social-ecological influences on patterns of substance use among non-metropolitan high school students

Patterns of substance use are examined in a sample of over 1,200 youth in a non-metropolitan region of New England. Self-reported history and frequency of alcohol, tobacco, marijuana, inhalants, pain medications, and other hard drug use was assessed for 9th and 10th grade students. Latent class analyses identified four patterns of substance use: non-users (22%), alcohol experimenters (38%), occasional polysubstance users (29%), and frequent polysubstance users (10%). Contextual risk and protective factors in the individual, family, peer, and community domains predicted substance use patterns. Youth report of peer substance use had the largest effects on substance use class membership. Other individual characteristics (e.g., gender, antisocial behavior, academic performance, perceived harm from use), family characteristics (e.g., parental drinking, parental disapproval of youth use), and community characteristics (e.g., availability of substances) demonstrated consistent effects on substance use classes. Implications for prevention are discussed from a social-ecological perspective.

From categorical to dimensional diagnostics: deficiency-oriented versus person-centred diagnostics

The problem of inhomogeneous categories and the difficulty of drawing boundaries as well as individual progression of the severity of psychopathologic phenomena necessitate a change of paradigm from categorical to dimensional diagnostics. Not only pathogenetic factors but also disorder maintaining factors such as the stigmatization and the significance of the disorder for the patient must be factored into the diagnostic process to ensure therapy relevancy. In addition to this deficiency-oriented approach holistic person-centred diagnostics focuses on the integration of resources, i.e. the abilities and skills, talents and inclinations of the patient, in order to adequately help a patient to resume/live an autonomous life that is as happy as possible.

The use of risk assessment to predict recurrent maltreatment: a Classification and Regression Tree Analysis (CART)

Research has suggested that recurrent maltreatment may be best predicted by a combination of factors that vary across families. The present study set out to determine whether a pattern-centered analytic approach would better predict families at high risk for recurrence when compared to logistic regression methods. Archival data from substantiated investigations during 2003 were collected from a Connecticut Department of Children and Families county branch. Families (n = 244) with a substantiated index case were followed for 18 months to identify the presence of additional substantiated cases within the CPS system. Classification and Regression Tree (CART) analyses revealed that prior CPS involvement was the best predictor of recurrent maltreatment. Further, risk items that were associated with recurrence were different for families with and without previous CPS investigations. Families with only prior unsubstantiated CPS investigations and poor child visibility within the community were at high risk for recurrence. Families without prior CPS involvement that were not actively involved in case planning and had a history of domestic violence were at high risk for recurrence. These findings suggest that pattern-centered analyses may be a useful approach to informing site-specific predictors of maltreatment recurrence by creating clear decision points that delineate high risk subgroups.

Identifying social drinkers likely to consume alcohol during pregnancy: findings from a prospective cohort study

To prevent fetal alcohol syndrome, some social drinkers who may become pregnant need more than a brief caution, but they can be difficult to detect in clinical settings. National Longitudinal Survey of Youth data from 754 women who completed up to four alcohol history interviews during their college-age years (18-21), and semiparametric group-based models were used to identify groups more likely to drink during a future pregnancy. Two drinking trajectories were observed. About 87% of the women were occasional or nondrinkers during their college-age years; 13% were frequent drinkers. Among first-births to women 22 yr. and older, the adjusted odds ratio for alcohol use during that pregnancy for frequent drinkers versus occasional and nondrinkers was 2.29 (95% confidence interval: 1.25-4.17). This finding suggests women who report frequent drinking during their college-age years may require additional assistance to reduce their risk of drinking during subsequent pregnancies.

Understanding the transmission of attachment using variable- and relationship-centered approaches

The interrelations of maternal attachment representations, mother-infant interaction in the home, and attachment relationships were studied in 99 adolescent mothers and their 12-month-old infants. A q-factor analysis was used to identify emergent profiles of mother and infant interaction. Traditional multivariate statistical analyses were complemented by a relationship-based approach utilizing latent class analysis. The results confirmed many theoretical predictions linking interaction with autonomous maternal representations and secure attachment, but failed to support a mediating role for maternal sensitivity. Strong associations were found between mothers displaying nonsensitive and disengaged interaction profiles, infants who did not interact harmoniously with the mother and preferred interaction with the visitor, unresolved maternal representations, and disorganized attachment relationships. Moreover, maternal nonsensitive and disengaged interaction in the home mediated the association between unresolved representations and disorganization. The results of the latent class analysis were consistent with these findings and revealed additional, empirically derived associations between attachment classifications and patterns of interactive behavior, some of which prompt a reconsideration of our current understanding of attachment transmission in at-risk populations.

Conjoint developmental trajectories of young adult alcohol and tobacco use

Developmental and etiological advances have set the stage for considering trajectories of problem behavior across the life course, but little work thus far addresses co-occurring problem behavior trajectories. Although recent work characterizes drinking and smoking trajectories, none has explored the course of concurrent drinking and smoking. Using panel data from the Monitoring the Future Project (N=32,087), the authors applied growth mixture modeling to 4 waves of heavy drinking and smoking in a young-adult sample. The authors extracted a single latent group membership factor from heavy drinking and smoking. Associations between trajectory classes and risk factors were relatively unique to the substance being predicted. The association of smoking with alcohol expectancies and delinquency appeared to exist by virtue of smoking's comorbidity with drinking.

Initiation and course of alcohol consumption among adolescents and young adults

This chapter takes a normative developmental perspective on the etiology of alcohol use, focusing on the initiation and course of alcohol use (rather than alcohol use disorders) during adolescence and early adulthood. We review evidence regarding the sequelae and meaning of the age of initiation of alcohol use, consider variable- and pattern-centered approaches to modeling trajectories describing the course of alcohol use across adolescence and young adulthood, and offer developmental conceptualizations of risk and protective factors for alcohol use and related problems.

Trajectories of dynamic predictors of disorder: their meanings and implications

Developmental psychopathologists are increasingly focused on characterizing heterogeneity of trajectories of psychological disorders across the life course (e.g., developmentally limited vs. chronic forms of disorder). Although the developmental significance of trajectories has been highlighted, there has been little attention to relations between trajectories and their etiologically and clinically relevant time-varying covariates (dynamic predictors). Depending upon the functional relation between a disorder and a dynamic predictor, we expect to see different trajectories of dynamic predictors. Thus, we propose a taxonomy of trajectories of dynamic predictors of course of disorder and provide an initial investigation into its validity. Using a mixed-gender, high-risk sample of young adults followed over 7 years, we identified dynamic predictors that covary with the course of alcohol use disorder (AUD). Based on a logically derived classification to facilitate interpretation of findings, three comparison groups were examined: persons whose AUD "remitted" (n = 33), those with a chronic AUD (n = 29), and nondiagnosers (n = 274). We hypothesized seven patterns of dynamic prediction (stable vulnerability indicators, course trackers, deterioration markers, developmentally specific variables, developmental lag markers, course-referenced variables, and recovery behaviors) and found evidence for five of them. The interpretation of markers of risk for development and course of AUDs and their implications for prevention, early intervention and formal/self-change treatments are discussed.

Smoking onset in adolescence: a person-centered analysis with time-varying predictors

Predictions from smoking-specific versus contextual models of smoking onset were tested with data from a 4-wave sample with 1,364 adolescents. Predictor variables were derived from stress-coping theory, social influence theory, and problem-behavior theory. In addition to groups of abstainers and experimenters, cluster analysis of smoking data indicated 3 groups who showed onset either in 7th grade (early onset), 9th grade (intermediate onset), or 10th grade (late onset). Almost all study variables discriminated the smoking groups from the abstainers. The onset groups were discriminated by Group X Time interactions showing differential changes in predictors (increases in risk factors and declines in protective factors), which occurred just prior to onset. The results generally support a contextual model of the onset process.

Clinical relevance of heavy drinking during the college years: cross-sectional and prospective perspectives

This study investigated the clinical relevance of heavy drinking during the college years and beyond on concurrent and prospective alcohol-related problems in a high-risk sample (N = 377). Measures of heavy drinking and alcohol-related problems were significantly correlated cross-sectionally over the study frame, regardless of how these constructs were operationalized. However, the magnitude of the association between heavy drinking and alcohol-related problems declined substantially over time, with the most pronounced decrease following the college years. Despite this cross-sectional decrease in the association between heavy drinking and alcohol-related problems over time, heavy drinking during the college years significantly and substantially predicted alcohol-use disorders up to 10 years later. Implications for assessment of heavy drinking as well as prevention of problematic alcohol use in college students are discussed.