Associations between frequency of exposure to peer-generated alcohol-related posts and alcohol use within a social network of college students

Peer alcohol use, commonly assessed via perceptions of how many drinks peers consume, is a robust predictor of college drinking. These perceptions are formed by in-person exposure to peer drinking but also may be affected by seeing alcohol-related content (ARC) shared on peer social media accounts. Most research assesses exposure by asking about the frequency of ARC sharing by a whole friend group, potentially missing influences from specific friends. Social network methods collect information about specific friends and their behavior but few studies have used these methods to examine the effects of ARC on drinking, nor have they examined potential moderators of this relationship. The purpose of this study was to examine whether perceived frequency of exposure to ARC shared by social network members on social media is associated with participant alcohol use after controlling for network members' self-reported alcohol use, and if participant gender and relationship qualities with network members moderate this association. Participants were 994 college students (Mage = 21.17, SD = 0.47; 61.8 % female; 55.4 % White; 12.3 % Hispanic) who completed a web-based survey. Due to the social network design, network autocorrelation analyses were conducted, which revealed that greater perceived frequency of exposure to network member ARC was significantly associated with higher alcohol quantity above and beyond network members' alcohol use. Peer ARC had a unique association with drinking behavior independent of in-person peer alcohol use, although the cross-sectional design precludes making causal inferences. Clinicians delivering alcohol interventions to college students may wish to discuss exposure to ARC as another important source of peer influence and how media literacy may help reduce the effects.

High-risk neighbourhoods and behaviour outcomes in children born extremely preterm

AIM

Study the association between neighbourhood risk and behaviour in extreme preterm (EPT) children. We hypothesised that EPT children living in high-risk neighbourhoods have increased risk of clinical range behaviour problems at age 30-36 months.

METHODS

Retrospective analyses of Child Behavior Checklist (CBCL)scores for 739 EPTs born 2005-2016. Addresses were geocoded to identify census block groups and create high versus low-risk groups. Regression analyses assessed the impact of neighbourhood risk on behaviour.

RESULTS

Children from high-risk (N = 272, 39%) and low-risk (N = 417, 61%) neighbourhoods were compared. In adjusted analyses, odds of clinical range scores remained greater in high-risk neighbourhoods for Emotionally Reactive (OR: 4.32, CI: 1.13, 16.51), Somatic Complaints (2.30, CI 1.11,4.79), Withdrawn (OR: 2.56, CI: 1.21, 5,42), Aggressive Behaviour (OR: 4.12, CI: 1.45, 11.68), Internalising (OR: 1.96, CI: 1.17, 3.28), and Total score (OR: 1.86, OR: CI: 1.13, 3.07). Cognitive delay was higher in high-risk neighbourhoods and a risk factor for Attention Problems (2.10,1.08, 4.09). Breast milk was protective for Emotionally Reactive (OR: 0.22, CI: 0.06, 0.85) and Sleep Problems (OR: 0.47, CI:0.24, 0.94).

CONCLUSION

Neighbourhood risk provided an independent contribution to preterm adverse behaviour outcomes with cognitive delay an additional independent risk factor. Breast milk at discharge was protective.

Mental Health Status of Rhode Island Middle School and High School Students Before Versus During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic negatively affected adolescent mental health due to school closures, isolation, family loss/hardships, and reduced health care access.

METHODS

We compared adolescent mental health in Rhode Island before versus during the pandemic, separately among middle and high schoolers. This serial cross-sectional study used Youth Risk Behavior Survey data from 2019 and 2021 (N = 7403). Multivariable logistic regression models estimated the association between year and mental health status, adjusting for sociodemographics.

RESULTS

Middle schoolers in 2021 had higher odds of ever seriously considering suicide (22.6% vs 16.7%) and ever attempting suicide (9.3% vs 6.1%) compared to 2019. Among high schoolers, those in 2021 had higher odds of experiencing persistent sadness/hopelessness in the past year (37.4% vs 32.0%). However, high schoolers in 2019 and 2021 had similar odds of considering suicide in the past year, while those in 2021 had lower odds of having attempted suicide in the past year (8.5% vs 14.6%).

CONCLUSION

The COVID-19 pandemic may have worsened multiple aspects of adolescent mental health in Rhode Island, particularly among middle schoolers.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Promoting school connectedness, creating supportive environments, and diversifying the mental health workforce may help overcome adverse pandemic effects.

Pandemic Preparedness and the Workforce: Employer Experiences with Long COVID

BACKGROUND

Although viral infections, including SARS-CoV-2, can cause persistent symptoms and functional limitations, the impact of post-viral syndromes on workplaces is uncertain.

METHODS

We conducted a cross-sectional study of workplaces in Rhode Island in the D&B Hoovers database (September-October 2022). Eligible workplaces had ≥1 contact with a valid email address and ≥2 paid employees. Participants completed a survey on the impact of Long COVID (post-viral syndrome of SARS-CoV-2) on their workplace.

RESULTS

Of 6,149 eligible workplaces, 484 (8%) participated. Awareness of Long COVID among workplace leaders was limited. Overall, 28% of workplaces had any employees report having Long COVID. Of those, 14% had ≥1 employee discontinue employment, 45% had ≥1 employee reduce their workload, and 22% had ≥1 employee request an accommodation due to having Long COVID; 80% of employers reported improvement in employee productivity with accommodations.

CONCLUSION

Pandemic preparations for the long-term impacts of post-viral syndromes should consider workplace settings.

Maternal smoking during pregnancy, offspring smoking, adverse childhood events, and risk of major depression: a sibling design study

BACKGROUND

Evidence of a biologically plausible association between maternal smoking during pregnancy (MSP) and the risk of depression is discounted by null findings from two sibling studies. However, valid causal inference from sibling studies is subject to challenges inherent to human studies of MSP and biases particular to this design. We addressed these challenges in the first sibling study of MSP and depression conducted among adults past the peak age for the onset of depression, utilizing a prospectively collected and biologically validated measure of MSP and accounting for non-shared as well as mediating factors.

METHODS

We fit GEE binomial regression models to correct for dependence in the risk of depression across pregnancies of the same mother. We also fit marginal structural models (MSM) to estimate the controlled direct effect of MSP on depression that is not mediated by the offspring's smoking status. Both models allow the estimation of within- and between-sibling risk ratios.

RESULTS

The adjusted within-sibling risk ratios (RR_W) from both models (GEE: RR_W = 1.97, CI 1.16-3.32; MSM: RR_W = 2.08, CI 1.04-4.17) evinced an independent association between MSP and risk of depression. The overall effects from a standard model evinced lower associations (GEE: RR_T = 1.12, CI 0.98-1.28; MSM: RR_T = 1.18, CI 1.01-1.37).

CONCLUSIONS

Based on within-sibling information free of unmeasured shared confounders and accounting for a range of unshared factors, we found an effect of MSP on the offspring's risk of depression. Our findings, should they be replicated in future studies, highlight the importance of considering challenges inherent to human studies of MSP and affective disorders.

Systemic Challenges in Internship Training for Health-Service Psychology: A Call to Action From Trainee Stakeholders

The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

High-Risk Neighborhoods and Neurodevelopmental Outcomes in Infants Born Preterm

OBJECTIVE

To study the association between neighborhood risk and moderate to severe neurodevelopmental impairment (NDI) at 22-26 months corrected age in children born at <34 weeks of gestation. We hypothesized that infants born preterm living in high-risk neighborhoods would have a greater risk of NDI and cognitive, motor, and language delays.

STUDY DESIGN

We studied a retrospective cohort of 1291 infants born preterm between 2005 and 2016, excluding infants with congenital anomalies. NDI was defined as any one of the following: a Bayley Scales of Infant and Toddler Development-III Cognitive or Motor composite score <85, bilateral blindness, bilateral hearing impairment, or moderate-severe cerebral palsy. Maternal addresses were geocoded to identify census block groups and create high-risk versus low-risk neighborhood groups. Bivariate and regression analyses were run to assess the impact of neighborhood risk on outcomes.

RESULTS

Infants from high-risk (n = 538; 42%) and low-risk (n = 753; 58%) neighborhoods were compared. In bivariate analyses, the risk of NDI and cognitive, motor, and language delays was greater in high-risk neighborhoods. In adjusted regression models, the risks of NDI (OR, 1.43; 95% CI, 1.04-1.98), cognitive delay (OR, 1.62; 95% CI, 1.15-2.28), and language delay (OR, 1.58; 95% CI, 1.15-2.16) were greater in high-risk neighborhoods. Breast milk at discharge was more common in low-risk neighborhoods and was protective of NDI in regression analysis.

CONCLUSIONS

High neighborhood risk provides an independent contribution to preterm adverse NDI, cognitive, and language outcomes. In addition, breast milk at discharge was protective. Knowledge of neighborhood risk may inform the targeted implementation of programs for socially disadvantaged infants.

Evaluating Housing Characteristics Associated With Childhood Lead Exposure in Providence, Rhode Island

OBJECTIVE

This research aims to take an in-depth look into the child, housing, and neighborhood characteristics associated with Providence children's likelihood of having elevated blood lead levels (BLLs).

DESIGN AND SETTING

The 2019 Providence, Rhode Island, Property Tax Assessor's database, containing each property owner's address, was geocoded and spatially joined with the 2017-2019 blood lead tests for children aged 0 to 6 years from the Rhode Island Department of Health.

MAIN OUTCOME MEASURES

The prevalence of elevated BLLs (≥5 μg/dL) overall, as well as by property type, number of properties owned, owner occupancy, assessed value, and neighborhood rates of old housing and poverty, was computed. We assessed the relationship between having elevated BLLs and these housing and neighborhood characteristics, adjusting for gender, age at test, and test method.

RESULTS

We found that, compared with children living in properties with landlords who owned only one property, children living in properties with landlords who owned 4 or more properties had lower odds of having elevated BLLs (odds ratio = 0.98; 95% confidence interval, 0.97-0.99). The proportion of houses built pre-1950 in the neighborhood was associated with increased odds of elevated BLLs. There was no significant association between owner-occupancy status and property type with children having elevated BLLs.

CONCLUSIONS

Children living in properties with landlords who owned 4 or more properties were less likely to have elevated BLLs. This association may suggest that the current lead legislation is having some impact, but public health efforts should address lead exposure in properties that are currently exempt from the law.

Frequent Emergency Department Use by Children

OBJECTIVES

Frequent use of the emergency department (ED) is often targeted as a quality improvement metric. The objective of this study was to assess ED visit frequency by the demographic and health characteristics of children who visit the ED to better understand risk factors for high ED utilization.

METHODS

The majority of pediatric ED services in Rhode Island are provided by a hospital network that includes the state's only children's hospital. Using 10 years of data (2005-2014) from this statewide hospital network, we examined ED use in this network for all children aged 0 to 17 years. Patients' home addresses were geocoded to assess their neighborhood characteristics.

RESULTS

Between 2005 and 2014, 17,844 children visited 1 or more of the network EDs at least once. In their year of maximum use, 67.8% had only 1 ED visit, 20.1% had 2 visits, 6.9% had 3 visits, and 5.2% had 4 or more visits. In the adjusted multinomial logistic regression model, age, race/ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the ED were found to be significantly associated with increased visit frequency.

CONCLUSIONS

Risk factors for frequent ED use by children include age, race/ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the hospital. To decrease frequent pediatric ED use, improved medical management of complex medical problems is needed, but it is also essential to address modifiable social determinants of health care utilization in this population.

Trajectories of early alcohol use milestones: Interrelations among initiation and progression

BACKGROUND

Alcohol use shows age-graded patterning, with normative use progressing through characteristic milestones of escalating use or severity. Despite some knowledge about the timing of milestone attainment and sequencing across milestones, there is a gap in our understanding of the earliest stages of use. This study characterizes the timing, sequencing, and speed of progression through milestones beginning with the first sip of alcohol.

METHODS

Sixth through eighth graders (N = 1023; 52% female; 76% White; M = 12.23 years old) completed web surveys through the end of high school. Participants reported on alcohol experiences including the first sip, full drink, consumption of 3+ drinks/occasion (heavy drinking), being drunk, and experiencing acute consequences, from which milestone age and speed of progression (duration) were calculated. Milestone prevalence, sequencing, and timing were characterized, and associations between age of attainment and speed of progression were examined. We also examined whether milestone timing and progression varied by sex and racial/ethnic group.

RESULTS

Overall, milestones followed the expected ordering with the exception of heavy drinking (3+ drinks/occasion) and being drunk, which appear to index similar experiences. An earlier age of attainment was associated with an increased likelihood of attaining each of the milestones. In contrast, once a milestone was achieved, there was reduced risk of initiation of subsequent adjacent milestones for individuals with an earlier first sip and full drink, and earlier initiation was associated with a longer duration to subsequent milestones. Girls were more likely to attain all milestones than boys, but there was no sex difference in the age of attainment. In contrast, Hispanic youth reported earlier ages of initiation than White non-Hispanic youth, but the likelihood of attainment did not vary by race/ethnicity. Rapid progression was observed in females but did not vary by race/ethnicity.

DISCUSSION

Risks associated with early drinking are complex, with little support for normative ordering of milestones beyond the first sip. Although early drinking is associated with an increased risk of subsequent drinking, it does not appear to place the drinker on an accelerated course to heavier use. A nuanced understanding of risks associated with milestone timing may inform intervention efforts.

Seroprevalence of SARS-CoV-2 Antibodies in Rhode Island From a Statewide Random Sample

Objectives. To characterize statewide seroprevalence and point prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Rhode Island.Methods. We conducted a cross-sectional survey of randomly selected households across Rhode Island in May 2020. Antibody-based and polymerase chain reaction (PCR)-based tests for SARS-CoV-2 were offered. Hispanics/Latinos and African Americans/Blacks were oversampled to ensure adequate representation. Seroprevalence estimations accounted for test sensitivity and specificity and were compared according to age, race/ethnicity, gender, housing environment, and transportation mode.Results. Overall, 1043 individuals from 554 households were tested (1032 antibody tests, 988 PCR tests). The estimated seroprevalence of SARS-CoV-2 antibodies was 2.1% (95% credible interval [CI] = 0.6, 4.1). Seroprevalence was 7.5% (95% CI = 1.3, 17.5) among Hispanics/Latinos, 3.8% (95% CI = 0.0, 15.0) among African Americans/Blacks, and 0.8% (95% CI = 0.0, 2.4) among non-Hispanic Whites. Overall PCR-based prevalence was 1.5% (95% CI = 0.5, 3.1).Conclusions. Rhode Island had low seroprevalence relative to other settings, but seroprevalence was substantially higher among African Americans/Blacks and Hispanics/Latinos. Rhode Island sits along the highly populated northeast corridor, making our findings broadly relevant to this region of the country. Continued monitoring via population-based sampling is needed to quantify these impacts going forward.

Childhood Overweight/Obesity and the Physical Activity Environment in Rhode Island

OBJECTIVE

This study seeks to better understand the relationship between the physical activity environment and child overweight/obesity in Rhode Island.

METHODS

Using geographic information systems (GIS), this study calculated distances from residences to physical activity resources to assess the relationship distance has with childhood overweight/obesity.

RESULTS

Mean distances in high-risk towns ranged from 0.61 to 3.15 miles compared to physical activity resources in low-risk towns, where distances ranged from 1.25 to 7.43 miles. For each additional mile to reach the closest indoor facility, there is a 0.41 (95% CI: -0.78, -0.03) percentage point decrease in the child overweight/obesity rate.  Conclusion: High-risk block groups and towns have higher rates of child overweight/obesity and show shorter distances to physical activity resources. This study demonstrates that simply having physical activity structures in place is not enough to reduce child overweight/obesity and further research should examine the quality and usage patterns of these resources.

Neighborhood risk: Socioeconomic status and hospital admission for pediatric burn patients

BACKGROUND

Burn injury continues to cause significant morbidity and mortality in the US pediatric population. Many studies using inpatient samples have found a relationship between low socioeconomic status (SES) and burn injury. The purpose of our study was to evaluate the association between SES and the likelihood of admission for Emergency Department (ED) visits for pediatric burn injury.

STUDY DESIGN

A retrospective database review of pediatric ED visits for burn injury from a statewide hospital system, from January 1, 2005 to December 31, 2014. SES was assigned using an eight factor Neighborhood Risk Index (NRI) created from census block group data, with a higher score indicative of lower SES. The outcome measure was ED visits admitted to inpatient care.

RESULTS

We analyzed a sample of 1845 pediatric ED visits for burn injuries. Most visits were discharged from the ED (88.4%) while 10.5% were admitted to inpatient care and 1.0% were transferred to another hospital. In a multivariable logistic regression model, patients from high risk areas (>75th percentile NRI) had 1.58 higher odds of inpatient admission compared to patients from low risk areas (<75th percentile NRI; 95% CI: 1.08-2.30), after adjusting for age, gender, ethnicity, distance to the hospital, and previous ED visit for burn injury in the past 30 days. In addition, for every 1-mile increase in distance, a child's likelihood of admission increased by 6% (95% CI: 4-9%).

CONCLUSIONS

Children with a burn injury from the highest risk socioeconomic areas in Rhode Island had a higher likelihood of inpatient admission. Further research is needed to determine what factors associated with socioeconomic status impact this finding.

A Spatial Analysis of the Food Environment and Overweight and Obesity Among Rhode Island Youth

BACKGROUND

This study examined how proximity to food sources differed at the block group and town level, stratified by socioeconomic risk, and how the average distance to a food source was associated with child overweight and obesity rates in Rhode Island.

METHODS

Eight correlated variables from the 2014-2018 American Community Survey were used to measure high and low socioeconomic risk at the block group and town level. Linear regression models were used to assess the association between mean driving distance to food sources and prevalence of child overweight and obesity.

RESULTS

All food sources were closer to residences in the high-risk group than the low-risk group at the block group and town level. Convenience stores, sit-down restaurants, and snack and beverage stores showed the largest associations with prevalence of overweight and obesity.

CONCLUSION

Efforts to better understand the food environment are needed to address overweight and obesity among youth.

Neighborhood Inequality and Emergency Department Use in Neonatal Intensive Care Unit Graduates

Neonatal intensive care unit graduates residing in high-risk neighborhoods were at increased risk of emergency department use and had higher rates of social/environmental risk factors. Distances to primary care provider and emergency department did not contribute to emergency department use. Knowledge of neighborhood risk is important for preventative service reform.

Lability in Parent- and Child-Based Sources of Parental Monitoring Is Differentially Associated with Adolescent Substance Use

Parental knowledge about adolescents' whereabouts and activities remains one of the strongest predictors of reduced adolescent substance use. A recent study found that across middle childhood and adolescence, parental knowledge is characterized by fluctuations on a year-to-year basis, termed lability, even more-so than by linear trends, and that lability too is a predictor of adolescent substance use (Lippold et al., Dev. Psychol. 17, 274-283, 2016). The present study replicates Lippold et al. (Dev. Psychol. 17, 274-283, 2016) by quantifying developmental change and lability in parental knowledge across adolescence and examining associations with drinking, smoking, and other drug use later in adolescence, and extends the study by examining the sources of knowledge: child disclosure, parental solicitation, and parental control, separately. Using a community-based sample of 1023 youth in the Northeastern region of the USA, all three sources of knowledge were characterized by developmental change and lability. In general, higher levels and steeper developmental declines in knowledge were associated with substance use outcomes. Findings for child disclosure replicated the prior findings: increased lability of child disclosure predicted substance use. Unexpectedly, decreased lability of parental solicitation and control was associated with worse substance use outcomes. Findings suggest different mechanisms by which lability in child- and parent-driven cultivation of knowledge is associated with substance use. If replicated in studies that address causality, these mechanisms could be leveraged for prevention/intervention efforts. For example, increasing the consistency of child disclosure may help prevent substance use, but teaching parents to be more responsive to time-specific challenges with adolescents may be more effective than increasing the consistency of parents' knowledge-building parenting behaviors.

Real-time neurochemical measurement of dynamic metabolic events during cardiac arrest and resuscitation in a porcine model

This work describes a fully-integrated portable microfluidic analysis system for real-time monitoring of dynamic changes in glucose and lactate occurring in the brain as a result of cardiac arrest and resuscitation.

Adolescent Access to Patient-Centered Medical Homes

OBJECTIVES

To analyze the distribution of patient-centered medical homes (PCMHs) among US adolescents, and to examine whether disparities exist among subgroups.

STUDY DESIGN

Data on adolescents ages 12-17 years (n = 34 601) from the 2011-2012 National Survey of Children's Health were used in this cross-sectional study to determine what proportion had access to a PCMH. Multivariable logistic regression was used to calculate the odds of having a PCMH, adjusting for sociodemographic characteristics and special health care needs. Comparisons were made to distribution of PCMH in 2007.

RESULTS

Although most US adolescents had a usual source of care (91%), only about one-half (51%) had access to a PCMH. Disparities in the prevalence of PCMHs were seen by race/ethnicity, poverty, and having special health care needs. There were lower adjusted odds in having a PCMH for Hispanic (aOR, 0.56; 95% CI, 0.45-0.68) and black adolescents (aOR, 0.55; 95% CI, 0.46-0.66) compared with white adolescents. Those living below 4 times the poverty level had lower adjusted odds of PCMH access. Adolescents with 3-5 special health care needs had lower adjusted odds (aOR, 0.43; 95% CI, 0.35-0.52) of having a PCMH compared with adolescents without any special health care needs. Other than receiving family centered care, every component of PCMH was slightly lower in 2011-2012 compared with 2007.

CONCLUSIONS

PCMH access was lower among minorities, those living in poverty, and those with multiple special health care needs. These disparities in PCMH access among these typically underserved groups call for further study and interventions that would make PCMHs more accessible to all adolescents.

Clinical translation of microfluidic sensor devices: focus on calibration and analytical robustness

We present approaches to facilitate the use of microfluidics outside of the laboratory, in our case within a clinical setting and monitoring from human subjects, where the complexity of microfluidic devices requires high skill and expertise and would otherwise limit translation. Microfluidic devices show great potential for converting complex laboratory protocols into on-chip processes. We demonstrate a flexible microfluidic platform can be coupled to microfluidic biosensors and used in conjunction with clinical microdialysis. The versatility is demonstrated through a series of examples of increasing complexity including analytical processes relevant to a clinical environment such as automatic calibration, standard addition, and more general processes including system optimisation, reagent addition and homogenous enzyme reactions. The precision and control offered by this set-up enables the use of microfluidics by non-experts in clinical settings, increasing uptake and usage in real-world scenarios. We demonstrate how this type of system is helpful in guiding physicians in real-time clinical decision-making.

3D printed microfluidic device for online detection of neurochemical changes with high temporal resolution in human brain microdialysate

This paper presents the design, optimisation and fabrication of a mechanically robust 3D printed microfluidic device for the high time resolution online analysis of biomarkers in a microdialysate stream at microlitre per minute flow rates. The device consists of a microfluidic channel with secure low volume connections that easily integrates electrochemical biosensors for biomarkers such as glutamate, glucose and lactate. The optimisation process of the microfluidic channel fabrication, including for different types of 3D printer, is explained and the resulting improvement in sensor response time is quantified. The time resolution of the device is characterised by recording short lactate concentration pulses. The device is employed to record simultaneous glutamate, glucose and lactate concentration changes simulating the physiological response to spreading depolarisation events in cerebrospinal fluid dialysate. As a proof-of-concept study, the device is then used in the intensive care unit for online monitoring of a brain injury patient, demonstrating its capabilities for clinical monitoring.

Neighborhood Risk and Hospital Use for Pediatric Asthma, Rhode Island, 2005-2014

Introduction

Studies consistently show that children living in poor neighborhoods have worse asthma outcomes. The objective of our study was to assess the association between negative neighborhood factors (ie, neighborhood risk) and pediatric asthma hospital use.

Methods

This retrospective study used data from children aged 2 to 17 years in a statewide (Rhode Island) hospital network administrative database linked to US Census Bureau data. We defined an asthma visit as an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code of 493 in any diagnosis field. We used 8 highly correlated measures for each census-block group to construct an index of neighborhood risk. We used maps and linear regression to assess the association of neighborhood risk with average annual census-block–group rates of asthma emergency department visits and hospitalizations. We used multivariable analyses to identify child characteristics and neighborhood risk associated with an asthma revisit, accounting for the child’s sociodemographic information, season, and multiple measurements per child.

Results

From 2005 through 2014, we counted 359,195 visits for 146,889 children. Of these, 12,699 children (8.6%) had one or more asthma visits. Linear regression results showed 1.18 (95% confidence interval, 1.06–1.30) more average annual emergency departments visits per 100 children and 0.41 (95% confidence interval, 0.34–0.47) more average annual hospitalizations per 100 children in neighborhoods in the highest-risk index quintile than in neighborhoods in the lowest-risk index quintile.

Conclusion

Interventions to improve asthma outcomes among children should move beyond primary care or clinic settings and involve a careful evaluation of social context and environmental triggers.

Development of a Minimally Invasive Microneedle-Based Sensor for Continuous Monitoring of β-Lactam Antibiotic Concentrations in Vivo

Antimicrobial resistance poses a global threat to patient health. Improving the use and effectiveness of antimicrobials is critical in addressing this issue. This includes optimizing the dose of antibiotic delivered to each individual. New sensing approaches that track antimicrobial concentration for each patient in real time could allow individualized drug dosing. This work presents a potentiometric microneedle-based biosensor to detect levels of β-lactam antibiotics in vivo in a healthy human volunteer. The biosensor is coated with a pH-sensitive iridium oxide layer, which detects changes in local pH as a result of β-lactam hydrolysis by β-lactamase immobilized on the electrode surface. Development and optimization of the biosensor coatings are presented, giving a limit of detection of 6.8 μM in 10 mM PBS solution. Biosensors were found to be stable for up to 2 weeks at -20 °C and to withstand sterilization. Sensitivity was retained after application for 6 h in vivo. Proof-of-concept results are presented showing that penicillin concentrations measured using the microneedle-based biosensor track those measured using both discrete blood and microdialysis sampling in vivo. These preliminary results show the potential of this microneedle-based biosensor to provide a minimally invasive means to measure real-time β-lactam concentrations in vivo, representing an important first step toward a closed-loop therapeutic drug monitoring system.

The influence of depression status on weekly exercise in children ages 6 to 17 years

Exercise has been found to be an effective treatment for mild to moderate depression. The purpose of this study is to explore the relationship between depression status and weekly exercise in children ages 6 to 17 years stratifying by age and sex using a large nationally representative sample. The study data (n = 65,059) came from the 2011-12 National Survey of Children's Health. Depression categories were current, former, and no history of diagnosed depression. Exercise categories were exercising ≤6 days a week and 7 days a week. Multivariable regression stratified by age and by sex was conducted on the weighted survey data. Among children age 6 to 17, 95.2% were never depressed, 2.1% were formerly depressed, and 2.8% were currently depressed and 28.0% exercised daily. Currently depressed children had 0.75 (95% CI 0.56, 1.00) times and formerly depressed children had 1.09 (95% CI 0.76, 1.57) times the adjusted odds of exercising daily compared to never depressed children. Stratified separately by sex and by age, females and children age 12 to 17 with current depression had 0.63 (95% CI 0.42, 0.94) and 0.48 (95% CI 0.35, 0.66) times the adjusted odds of exercising daily compared to their counterparts with no depression. This study indicates a significant difference in daily exercise habits between currently depressed children age 12 to 17 and females compared to their never depressed counterparts. Healthcare workers should be aware of the possible heightened risk of physical inactivity for depressed female children and children age 12 to 17.

Cognitive risk factors of electronic and combustible cigarette use in adolescents

INTRODUCTION

Cognitive susceptibility to cigarette smoking has been demonstrated to predict future cigarette initiation in adolescents. Examining this construct prior to tobacco product initiation may provide useful information on the differential risk of individuals initiating cigarette vs. e-cigarette products. Additionally, examining how susceptibility and tobacco product use relate to perceived harm cognitions will increase understanding of risk predisposition among adolescents.

METHOD

Data were taken from a longitudinal study of middle school students (n = 1023; age = 12.1, 52.2% female, 72.1% white) in the Northeastern U.S. Likelihood of e-cigarette and cigarette ever-use in high school was examined as a function of a validated index of cigarette smoking susceptibility among tobacco naïve students in middle school. Prospective associations between cognitive susceptibility to smoking and subsequent perceived harm of e-cigarettes (assessed in high school), and cross-sectional associations between concurrent tobacco product ever-use status and perceived harm of e-cigarettes were examined.

RESULTS

Adolescents classified as susceptible to cigarette smoking in middle school were more likely to initiate use of cigarettes (OR = 2.53) and e-cigarettes (OR = 1.95) as compared to adolescents classified as non-susceptible; cigarette smoking susceptibility did not differentially predict use of one product over the other. Adolescents endorsing e-cigarette use, reported significantly less perceived harm associated with e-cigarettes vs. cigarettes, while those who endorsed cigarette only or dual use did not.

CONCLUSION

Our data indicate that cognitive susceptibility to cigarette smoking may index a broad risk factor for using either cigarettes or e-cigarettes in the future, and is prospectively associated with perceived harm of e-cigarette use. Overall, those who used any tobacco product perceived e-cigarettes as less harmful when compared to abstainers. Individual facets of perceived harm (addiction potential and harm vs. cigarettes) differ between cigarette only users and e-cigarette users and may help to explain the choice to use one product vs. the other.

IMPLICATIONS

This is the first study to examine prospective associations between cognitive susceptibility to cigarette smoking, predating tobacco use, and subsequent likelihood of cigarette vs. e-cigarette initiation. This study demonstrates that initiation of either product is elevated among youth who are susceptible to smoking; thus susceptibility to smoking may serve as a useful marker of vulnerability to tobacco product use. Furthermore, this study provides novel information on the relationship between tobacco product onset and specific harm perceptions associated with e-cigarettes versus cigarettes among adolescents.

A High-Performance Application Specific Integrated Circuit for Electrical and Neurochemical Traumatic Brain Injury Monitoring

This paper presents the first application specific integrated chip (ASIC) for the monitoring of patients who have suffered a Traumatic Brain Injury (TBI). By monitoring the neurophysiological (ECoG) and neurochemical (glucose, lactate and potassium) signals of the injured human brain tissue, it is possible to detect spreading depolarisations, which have been shown to be associated with poor TBI patient outcome. This paper describes the testing of a new 7.5 mm2 ASIC fabricated in the commercially available AMS 0.35 μm CMOS technology. The ASIC has been designed to meet the demands of processing the injured brain tissue's ECoG signals, recorded by means of depth or brain surface electrodes, and neurochemical signals, recorded using microdialysis coupled to microfluidics-based electrochemical biosensors. The potentiostats use switchedcapacitor charge integration to record currents with 100 fA resolution, and allow automatic gain changing to track the falling sensitivity of a biosensor. This work supports the idea of a "behind the ear" wireless microplatform modality, which could enable the monitoring of currently non-monitored mobile TBI patients for the onset of secondary brain injury.

Pediatric Emergency Department Utilization and Reliance by Insurance Coverage in the United States

OBJECTIVES

For many children, the emergency department (ED) serves as the main destination for health care, whether it be for emergent or nonurgent reasons. Through examination of repeat utilization and ED reliance (EDR), in addition to overall ED utilization, we can identify subpopulations dependent on the ED as their primary source of health care.

METHODS

Nationally representative data from the 2010 to 2014 Medical Expenditure Panel Survey were used to examine the annual ED utilization of children age 0 to 17 years by insurance coverage. Overall utilization, repeat utilization (two or more ED visits), and EDR (percentage of all health care visits that occur in the ED) were examined using multivariate models, accounting for weighting and the complex survey design. High EDR was defined as having > 33% of outpatient visits in a year being ED visits.

RESULTS

A total of 47,926 children were included in the study. Approximately 12% of children visited an ED within a 1-year period. A greater number of children with public insurance (15.2%) visited an ED at least once, compared to privately insured (10.1%) and uninsured (6.4%) children. Controlling for covariates, children with public insurance were more likely to visit the ED (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.40-1.73) than children with private insurance, whereas uninsured children were less likely (aOR = 0.64, 95% CI = 0.51-0.81). Children age 3 and under were significantly more likely to visit the ED than children age 15 to 17, whereas female children and Hispanic and non-Hispanic other race children were significantly less likely to visit the ED than male children and non-Hispanic white children. Among children with ED visits, 21% had two or more visits to the ED in a 1-year period. Children with public insurance were more likely to have two or more visits to the ED (aOR = 1.53, 95% CI = 1.19-1.98) than children with private insurance whereas there was no significant difference in repeat ED utilization for uninsured children. Publicly insured (aOR = 1.70, 95% CI = 1.47-1.97) and uninsured children (aOR = 1.90, 95% CI = 1.49-2.42) were more likely to be reliant on the ED than children with private insurance.

CONCLUSIONS

Health insurance coverage was associated with overall ED utilization, repeat ED utilization, and EDR. Demographic characteristics, including sex, age, income, and race/ethnicity were important predictors of ED utilization and reliance.

Exposure to Alcohol Content in Movies and Initiation of Early Drinking Milestones

BACKGROUND

Exposure to alcohol content in movies has been shown to be associated with adolescent use of alcohol, including earlier onset. This study examined the influence of movie alcohol exposure on subsequent alcohol onset, considering the social context (whether the movie was viewed with a friend or parent). We examined whether media's influence holds across a spectrum of early drinking milestones: sipping (but not consuming a full drink of) alcohol, consuming a full drink of alcohol, and engaging in heavy episodic drinking (HED).

METHODS

Data were taken from a sample of 882 middle school youth (52% female; 24% non-White) enrolled in an ongoing study on alcohol initiation and progression. Exposure to alcohol content in films was measured using a method that combines content analysis and random assignment of movie titles to youth surveys. The hazard of initiating alcohol use (sip, full drink, HED) as a function of exposure was estimated using survival analysis. Associations were adjusted for demographic, personality, and social influence factors known to be associated with both movie exposure and alcohol use.

RESULTS

Exposure to alcohol content was common. Hours of exposure prospectively predicted earlier onset of alcohol involvement across all outcomes. Viewing movies with friends appeared to augment the media exposure effect, in contrast to viewing movies with parents, which was not a significant predictor of initiation.

CONCLUSIONS

Exposure to alcohol in films is involved in the entry into early stages of alcohol involvement. Findings support further investigation into the role of the media in underage drinking, especially in the context of consuming media with friends and peers. Limiting media exposure and/or stronger Federal Trade Commission oversight of movie ratings should be a priority for preventing underage drinking.

Visualizing Patterns and Trends of 25 Years of Published Health Literacy Research

Background:

With an increase in the number of disciplines contributing to health literacy scholarship, we sought to explore the nature of interdisciplinary research in the field.

Objective:

This study sought to describe disciplines that contribute to health literacy research and to quantify how disciplines draw from and contribute to an interdisciplinary evidence base, as measured by citation networks.

Methods:

We conducted a literature search for health literacy articles published between 1991 and 2015 in four bibliographic databases, producing 6,229 unique bibliographic records. We employed a scientometric tool (CiteSpace [Version 4.4.R1]) to quantify patterns in published health literacy research, including a visual path from cited discipline domains to citing discipline domains.

Key Results:

The number of health literacy publications increased each year between 1991 and 2015. Two spikes, in 2008 and 2013, correspond to the introduction of additional subject categories, including information science and communication. Two journals have been cited more than 2,000 times—the Journal of General Internal Medicine (n = 2,432) and Patient Education and Counseling (n = 2,252). The most recently cited journal added to the top 10 list of cited journals is the Journal of Health Communication (n = 989). Three main citation paths exist in the health literacy data set. Articles from the domain “medicine, medical, clinical” heavily cite from one domain (health, nursing, medicine), whereas articles from the domain “psychology, education, health” cite from two separate domains (health, nursing, medicine and psychology, education, social).

Conclusions:

Recent spikes in the number of published health literacy articles have been spurred by a greater diversity of disciplines contributing to the evidence base. However, despite the diversity of disciplines, citation paths indicate the presence of a few, self-contained disciplines contributing to most of the literature, suggesting a lack of interdisciplinary research. To address complex and evolving challenges in the health literacy field, interdisciplinary team science, that is, integrating science from across multiple disciplines, should continue to grow. [Health Literacy Research and Practice. 2017;1(4):e182–e191.]

Plain Language Summary:

The addition of diverse disciplines conducting health literacy scholarship has spurred recent spikes in the number of publications. However, citation paths suggest that interdisciplinary research can be strengthened. Findings directly align with the increasing emphasis on team science, and support opportunities and resources that incentivize interdisciplinary health literacy research.

Simultaneous monitoring of potassium, glucose and lactate during spreading depolarization in the injured human brain - Proof of principle of a novel real-time neurochemical analysis system, continuous online microdialysis

Spreading depolarizations occur spontaneously and frequently in injured human brain. They propagate slowly through injured tissue often cycling around a local area of damage. Tissue recovery after an spreading depolarization requires greatly augmented energy utilisation to normalise ionic gradients from a virtually complete loss of membrane potential. In the injured brain, this is difficult because local blood flow is often low and unreactive. In this study, we use a new variant of microdialysis, continuous on-line microdialysis, to observe the effects of spreading depolarizations on brain metabolism. The neurochemical changes are dynamic and take place on the timescale of the passage of an spreading depolarization past the microdialysis probe. Dialysate potassium levels provide an ionic correlate of cellular depolarization and show a clear transient increase. Dialysate glucose levels reflect a balance between local tissue glucose supply and utilisation. These show a clear transient decrease of variable magnitude and duration. Dialysate lactate levels indicate non-oxidative metabolism of glucose and show a transient increase. Preliminary data suggest that the transient changes recover more slowly after the passage of a sequence of multiple spreading depolarizations giving rise to a decrease in basal dialysate glucose and an increase in basal dialysate potassium and lactate levels.

Parental divorce and initiation of alcohol use in early adolescence

Parental divorce/separation is among the most commonly endorsed adverse childhood events. It has been shown to increase subsequent risk of alcohol dependence and problems across adolescence and early adulthood, but its influence on early stages of alcohol involvement has only recently been explored. In the present study, we examined whether time to first full drink was accelerated among youth who experienced parental divorce/separation. To determine specificity of risk, models controlled for perceived stress as well as family history of alcoholism, current parental drinking, and internalizing and externalizing problems. Developmental specificity in terms of timing of both parental divorce and first drink was also examined. Participants were 931 middle-school students (488 girls, 443 boys) who were enrolled in a prospective study on drinking initiation and progression (52% female; 23% non-White, 11% Hispanic). Students indicated whether and at what age they had consumed a full drink of alcohol. Parental divorce/separation was coded from a parent-reported life-events inventory and was grouped based on age experienced (ages 0-5, ages 6-9, age 10+). Cox proportional hazard models showed increased risk for onset of drinking as a function of divorce/separation, even controlling for stress, parental alcohol involvement, and psychopathology. There was no evidence for developmental specificity of the divorce/separation effect based on when it occurred nor in timing of first drink. However, the effect of parental divorce/separation on initiation was magnified at higher levels of parental drinking. Given the rates of parental divorce/separation and its association with increased risk of early drinking, investigation of the mechanisms underlying this link is clearly warranted. (PsycINFO Database Record

Alcohol Consumption Milestones: Comparing First- Versus Last-Reported Age of Onset

Multiple assessments of age of onset of alcohol use milestones may produce inconsistent reports, yielding potentially different results, depending on the report utilized. Using data from a prospective study of 1,023 middle-school students, we modeled risk of onset of four drinking milestones as a function of multiple correlates of alcohol use and compared models using first versus last reported age for each milestone. . While forward telescoping was evident, no significant differences were obtained for any models examined. Substantive conclusions about associations of correlates of early drinking are not greatly impacted by misreporting age of first use.

Contextual influences on early drinking: Characteristics of drinking and nondrinking days

Research characterizing the adolescent drinking context is limited, often relies on samples of current drinkers reporting on recent/last or typical drinking experiences, and provides little information about the context of very early use. The present study uses repeated monthly assessments to describe the context of drinking days and matched nondrinking days to determine the unique risk associated with different drinking-related characteristics. Additionally, we used latent class analysis to empirically identify key configurations of drinking-related characteristics and both family- and nonfamily-related environmental characteristics (social context, physical location, source of alcohol). Data included 688 days (344 drinking days, 344 nondrinking days) from 164 middle-school students enrolled in a prospective study on drinking initiation and progression (62% female; 26% non-White, 11% Hispanic). Results supported 4 patterns: (a) heavier drinking occurring in a peer context, lighter drinking occurring in (b) a family context or (c) a peer context, and (d) drinking alcohol obtained at home without permission. Latent classes varied as a function of gender, age, peer norms, and parenting behaviors as well as alcohol type and perceived alcohol availability. Findings indicated that highly endorsed contexts were not necessarily the riskiest ones, and simply targeting an oft-reported source of alcohol, physical location, or social context may not be an effective strategy for reducing underage drinking. Additionally, although greater monitoring and anticipated parent reaction to drinking are typically protective against adolescent drinking, we found they were associated with parent-sanctioned drinking, suggesting the role of parenting practices must be considered in the context of drinking pattern. (PsycINFO Database Record

High-Performance Bioinstrumentation for Real-Time Neuroelectrochemical Traumatic Brain Injury Monitoring

Traumatic brain injury (TBI) has been identified as an important cause of death and severe disability in all age groups and particularly in children and young adults. Central to TBIs devastation is a delayed secondary injury that occurs in 30-40% of TBI patients each year, while they are in the hospital Intensive Care Unit (ICU). Secondary injuries reduce survival rate after TBI and usually occur within 7 days post-injury. State-of-art monitoring of secondary brain injuries benefits from the acquisition of high-quality and time-aligned electrical data i.e., ElectroCorticoGraphy (ECoG) recorded by means of strip electrodes placed on the brains surface, and neurochemical data obtained via rapid sampling microdialysis and microfluidics-based biosensors measuring brain tissue levels of glucose, lactate and potassium. This article progresses the field of multi-modal monitoring of the injured human brain by presenting the design and realization of a new, compact, medical-grade amperometry, potentiometry and ECoG recording bioinstrumentation. Our combined TBI instrument enables the high-precision, real-time neuroelectrochemical monitoring of TBI patients, who have undergone craniotomy neurosurgery and are treated sedated in the ICU. Electrical and neurochemical test measurements are presented, confirming the high-performance of the reported TBI bioinstrumentation.

The prospective association between sipping alcohol by the sixth grade and later substance use

OBJECTIVE

Although there is a clear association between early use of alcohol and short- and long-term adverse outcomes, it is unclear whether consumption of minor amounts of alcohol (less than a full drink) at a young age is prognostic of risk behaviors in later adolescence.

METHOD

Data were taken from 561 students enrolled in an ongoing prospective web-based study on alcohol initiation and progression (55% female; 25% White non-Hispanic). Based on a combination of monthly and semiannual surveys, we coded whether participants sipped alcohol before sixth grade and examined associations between early sipping and alcohol consumption by fall of ninth grade, as well as other indices of problem behavior. Participants also reported on the context of the first sipping event.

RESULTS

The prevalence of sipping alcohol by fall of sixth grade was 29.5%. Most participants indicated that their first sip took place at their own home, and the primary source of alcohol was an adult, usually a parent. Youth who sipped alcohol by sixth grade had significantly greater odds of consuming a full drink, getting drunk, and drinking heavily by ninth grade than nonsippers. These associations held even when we controlled for temperamental, behavioral, and environmental factors that contribute to proneness for problem behavior, which suggests that sipping is not simply a marker of underlying risk.

CONCLUSIONS

Our findings that early sipping is associated with elevated odds of risky behaviors at high school entry dispute the idea of sipping as a protective factor. Offering even just a sip of alcohol may undermine messages about the unacceptability of alcohol consumption for youth.

Advance care planning as a shared endeavor: completion of ACP documents in a multidisciplinary cancer program

OBJECTIVE

We examined the roles of oncology providers in advance care planning (ACP) delivery in the context of a multidisciplinary cancer program.

METHODS

Semi-structured interviews were conducted with 200 women with recurrent and/or metastatic breast or gynecologic cancer. Participants were asked to name providers they deemed important in their cancer care and whether they had discussed and/or completed ACP documentation. Evidence of ACP documentation was obtained from chart reviews.

RESULTS

Fifty percent of participants self-reported completing an advance directive (AD) and 48.5% had named a healthcare power of attorney (HPA), 38.5% had completed both, and 39.0% had completed neither document. Among women who self-reported completion of the documents, only 24.0% and 14.4% of women respectively had documentation of an AD and HPA in their chart. Completion of an AD was associated with number (adjusted odds ratio [AOR] = 1.49) and percentage (AOR = 6.58) of providers with whom the participant had a conversation about end-of-life decisions. Participants who named a social worker or nurse practitioner were more likely to report having completed an AD. Participants who named at least one provider in common (e.g., named the same oncologist) were more likely to have comparable behaviors related to naming a HPA (AOR = 1.13, p = 0.011) and completion of an AD (AOR = 1.06, p = 0.114).

CONCLUSIONS

Despite the important role of physicians in facilitating ACP discussions, involvement of other staff was associated with a greater likelihood of completion of ACP documentation. Patients may benefit from opportunities to discuss ACP with multiple members of their cancer care team. Copyright © 2015 John Wiley & Sons, Ltd.

Surveying multiple health professional team members within institutional settings: an example from the nursing home industry

Quality improvement and cost containment initiatives in health care increasingly involve interdisciplinary teams of providers. To understand organizational functioning, information is often needed from multiple members of a leadership team since no one person may have sufficient knowledge of all aspects of the organization. To minimize survey burden, it is ideal to ask unique questions of each member of the leadership team in areas of their expertise. However, this risks substantial missing data if all eligible members of the organization do not respond to the survey. Nursing home administrators (NHA) and directors of nursing (DoN) play important roles in the leadership of long-term care facilities. Surveys were administered to NHAs and DoNs from a random, nationally representative sample of U.S. nursing homes about the impact of state policies, market forces, and organizational factors that impact provider performance and residents' outcomes. Responses were obtained from a total of 2,686 facilities (response rate [RR] = 66.6%) in which at least one individual completed the questionnaire and 1,693 facilities (RR = 42.0%) in which both providers participated. No evidence of nonresponse bias was detected. A high-quality representative sample of two providers in a long-term care facility can be obtained. It is possible to optimize data collection by obtaining unique information about the organization from each provider while minimizing the number of items asked of each individual. However, sufficient resources must be available for follow-up to nonresponders with particular attention paid to lower resourced, lower quality facilities caring for higher acuity residents in highly competitive nursing home markets.

Continuum of mammography use among US women: classification tree analysis

OBJECTIVES

To identify women with low mammography utilization.

METHODS

We used Classification Tree Analysis among women aged 42-80 from the 2008 Behavioral Risk Factor Surveillance System (N = 169,427) to identify sub-groups along a continuum of screening.

RESULTS

Women with neither a primary care provider nor health insurance had the lowest utilization (33.9%) and were 2.8% of the sample. Non-smoking women aged 55-80, with a primary care provider, health insurance, and income of $75,000 or more had the highest utilization (90.7%) and comprised 5% of the sample.

CONCLUSION

As access to primary care providers and health insurance increases with the Affordable Care act, classification tree analyses may help to identify women of high priority for intervention.

Primary prevention of lead poisoning: protecting children from unsafe housing

OBJECTIVES

We examined the effects of changes in Rhode Island's Lead Hazard Mitigation Law in 2005 on children's blood lead levels.

METHODS

We used 2005 to 2009 data from Rhode Island's Lead Elimination Surveillance System; city tax assessor records in Central Falls, Pawtucket, Providence, and Woonsocket, Rhode Island; and records of conformance to the state's lead hazard mitigation law, to assess the extent to which legislation changes resulted in minimizing children's exposure to lead.

RESULTS

During the 5-year study, the proportion of properties that complied with the new law increased for properties that housed young children. However, the majority of rental properties did not comply with the law. Children's lead levels declined by approximately 1 microgram per deciliter on average in properties that did comply, demonstrating that the law could have a protective effect for children.

CONCLUSIONS

Legislation changes increased the proportion of properties that were certified as nonhazardous, leading to decreased blood lead levels for children living in these properties. However, legislation cannot be a highly effective primary prevention strategy if it does not cover all properties where children live and is not strictly enforced.

Point and click, carefully: investigating inconsistent response styles in middle school and college students involved in web-based longitudinal substance use research

This study investigated inconsistent responding to survey items by participants involved in longitudinal, web-based substance use research. We also examined cross-sectional and prospective predictors of inconsistent responding. Middle school (N = 1,023) and college students (N = 995) from multiple sites in the United States responded to online surveys assessing substance use and related variables in three waves of data collection. We applied a procedure for creating an index of inconsistent responding at each wave that involved identifying pairs of items with considerable redundancy and calculating discrepancies in responses to these items. Inconsistent responding was generally low in the Middle School sample and moderate in the College sample, with individuals showing only modest stability in inconsistent responding over time. Multiple regression analyses identified several baseline variables-including demographic, personality, and behavioral variables-that were uniquely associated with inconsistent responding both cross-sectionally and prospectively. Alcohol and substance involvement showed some bivariate associations with inconsistent responding, but these associations largely were accounted for by other factors. The results suggest that high levels of carelessness or inconsistency do not appear to characterize participants' responses to longitudinal web-based surveys of substance use and support the use of inconsistency indices as a tool for identifying potentially problematic responders.

A transdisciplinary approach to protocol development for tobacco control research: a case study

The increasing complexity of scientific problems related to lifestyle risk factors has prompted substantial investments in transdisciplinary or team science initiatives at the biological, psychosocial, and population levels of analysis. To date, the actual process of conducting team science from the perspectives of investigators engaged in it has not been well documented. We describe the experience of developing and implementing data collection protocols using the principles of transdisciplinary science. The New England Family Study Transdisciplinary Tobacco Use Research Center was a 10-year collaboration involving more than 85 investigators and consultants from more than 20 disciplines as well as more than 50 research staff. We used a two-phase process in which all the study personnel participated in the developing and testing of 160 instruments. These instruments were used in 4,378 assessments with 3,501 participants. With substantial effort, it is possible to build a team of scientists from diverse backgrounds that can develop a set of instruments using a shared conceptual approach, despite limited or no experience working together previously.

Pregnant and moving: understanding residential mobility during pregnancy and in the first year of life using a prospective birth cohort

To examine residential mobility (i.e., moving) during pregnancy and in the first year of an infant's life using a large, prospective birth cohort in Rhode Island. Participants were recruited from Women and Infants Hospital of Rhode Island between January 5, 2009 and March 19, 2009. Residential histories were collected from mothers in-person immediately post-partum and by phone at 7 months and at 13 months post-partum. Of 1,040 mothers interviewed at birth, 71% (n = 740) completed the 13 month follow-up interview. Forty-one percent of mothers (n = 300) moved at least once between conception and 1 year post-partum, with the number of moves ranging from 0 to 8. Among movers, 69.0% moved once, 21.0% moved twice, and 10.0% moved three or more times. Mothers who moved tended to be younger, have fewer children, were not White, and had lower household incomes than those who did not move. Mothers who moved during pregnancy had 2.05 (95% CI: 1.40-2.98) times the odds of moving post-partum than mothers who had not moved in the antenatal period. There were statistical differences across socio-demographic groups with regard to when, where, and why mothers moved. Forty percent of movers during pregnancy (n = 61) moved for at least one negative reason, while 32.2% of movers during infancy (n = 64) relocated under negative circumstances. A substantial proportion of mothers moved pre- and post-partum, frequently under negative circumstances. Study findings have important implications for obstetric and pediatric providers who seek to understand, retain, and improve the health of their patient populations.

Continuous online microdialysis using microfluidic sensors: dynamic neurometabolic changes during spreading depolarization

Microfluidic glucose biosensors and potassium ion selective electrodes were used in an in vivo study to measure the neurochemical effects of spreading depolarizations (SD), which have been shown to be detrimental to the injured human brain. A microdialysis probe implanted in the cortex of rats was connected to a microfluidic PDMS chip containing the sensors. The dialysate was also analyzed using our gold standard, rapid sampling microdialysis (rsMD). The glucose biosensor performance was validated against rsMD with excellent results. The glucose biosensors successfully monitored concentration changes, in response to SD wave induction, in the range of 10-400 μM with a second time-resolution. The data show that during a SD wave, there is a time delay of 62 ± 24.8 s (n = 4) between the onset of the increase in potassium and the decrease in glucose. This delay can be for the first time demonstrated, thanks to the high-temporal resolution of the microfluidic sensors sampling from a single tissue site (the microdialysis probe), and it indicates that the decrease in glucose is due to the high demand of energy required for repolarization.

Online rapid sampling microdialysis (rsMD) using enzyme-based electroanalysis for dynamic detection of ischaemia during free flap reconstructive surgery

We describe an enzyme-based electroanalysis system for real-time analysis of a clinical microdialysis sampling stream during surgery. Free flap tissue transfer is used widely in reconstructive surgery after resection of tumours or in other situations such as following major trauma. However, there is a risk of flap failure, due to thrombosis in the flap pedicle, leading to tissue ischaemia. Conventional clinical assessment is particularly difficult in such ‘buried’ flaps where access to the tissue is limited. Rapid sampling microdialysis (rsMD) is an enzyme-based electrochemical detection method, which is particularly suited to monitoring metabolism. This online flow injection system analyses a dialysate flow stream from an implanted microdialysis probe every 30 s for levels of glucose and lactate. Here, we report its first use in the monitoring of free flap reconstructive surgery, from flap detachment to re-vascularisation and overnight in the intensive care unit. The on-set of ischaemia by both arterial clamping and failure of venous drainage was seen as an increase in lactate and decrease in glucose levels. Glucose levels returned to normal within 10 min of successful arterial anastomosis, whilst lactate took longer to clear. The use of the lactate/glucose ratio provides a clear predictor of ischaemia on-set and subsequent recovery, as it is insensitive to changes in blood flow such as those caused by topical vasodilators, like papaverine. The use of storage tubing to preserve the time course of dialysate, when technical difficulties arise, until offline analysis can occur, is also shown. The potential use of rsMD in free flap surgery and tissue monitoring is highly promising.

Figure