Lack of Diversity in Research on Females with Ehlers-Danlos Syndromes: Recruitment Protocol for a Quantitative Online Survey

BACKGROUND

Ehlers-Danlos syndromes (EDS) are a group of connective tissue disorders caused by fragile lax collagen. Current EDS research lacks racial and ethnic diversity. The lack of diversity may be associated with the complexities of conducting a large international study on an underdiagnosed condition and a lack of EDS health care providers who diagnose and conduct research outside of the United States and Europe. Social media may be the key to recruiting a large diverse EDS sample. However, studies that have used social media to recruit have not been able to recruit diverse samples.

OBJECTIVE

This study aims to discuss challenges, strategies, outcomes, and lessons learned from using social media to recruit a large sample of females with EDS.

METHODS

Recruitment on social media for a cross-sectional survey examining dyspareunia (painful sexual intercourse) in females was examined. Inclusion criteria were (1) older than 18 years of age, (2) assigned female at birth, and (3) diagnosed with EDS. Recruitment took place on Facebook and Twitter (now X), from June 1 to June 25, 2019.

RESULTS

A total of 1178 females with EDS were recruited from Facebook (n=1174) and X (n=4). On Facebook, participants were recruited via support groups. A total of 166 EDS support groups were identified, 104 permitted the principal investigator to join, 90 approved posting, and the survey was posted in 54 groups. Among them, 30 of the support groups posted in were globally focused and not tied to any specific country or region, 21 were for people in the United States, and 3 were for people outside of the United States. Recruitment materials were posted on X with the hashtag #EDS. A total of 1599 people accessed the survey and 1178 people were eligible and consented. The average age of participants was 38.6 (SD 11.7) years. Participants were predominantly White (n=1063, 93%) and non-Hispanic (n=1046, 92%). Participants were recruited from 29 countries, with 900 (79%) from the United States and 124 (11%) from Great Britain.

CONCLUSIONS

Our recruitment method was successful at recruiting a large sample. The sample was predominantly White and from North America and Europe. More research needs to be conducted on how to recruit a diverse sample. Areas to investigate may include connecting with more support groups from outside the United States and Europe, researching which platforms are popular in different countries, and translating study materials into different languages. A larger obstacle to recruiting diverse samples may be the lack of health care providers that diagnose EDS outside the United States and Europe, making the pool of potential participants small. There needs to be more health care providers that diagnose and treat EDS in countries that are predominantly made up of people of color as well as research that specifically focuses on these populations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/53646.

Latent class analysis of emergency department patients engaged in telehealth peer recovery support services and associations of identified classes with post-discharge outcomes

BACKGROUND

People with substance use disorders (SUDs) frequently use emergency department (ED) services. Despite evidence demonstrating that post-discharge SUD treatment linkage effectively reduces the number of ED re-presentations, relatively few hospitals have implemented interventions to identify and connect patients with SUDs to appropriate care. ED-based peer recovery support specialist (PRSS) interventions have emerged as a promising approach for hospitals, but more research is needed to understand the extent to which these interventions meet the needs of patients who present to the ED for different reasons and with various underlying concerns.

METHOD

A retrospective cohort analysis used data from a telehealth PRSS program in 15 EDs within one Indiana hospital system. The study included 2950 ED patients who engaged with telehealth PRSS services between September 2018 and September 2021. Latent class analysis identified patterns of patient characteristics associated with post-discharge PRSS engagement and ED re-presentations. Covariate predictors and distal outcomes were assessed to examine the associations between class membership, demographic factors, and patient outcomes.

RESULTS

The study team selected a six-class model as the best fit for the data. Class 1, representing patients with opioid use disorder and mental health diagnoses who presented to the ED for an opioid overdose, was used as the reference class for all other statistical tests. Multinomial logistic regression analysis demonstrated significant associations between covariate predictors, outcomes, and class membership. Regression results also demonstrate PRSSs had greater success contacting patients with prior year ED use and patients with a successful post-discharge PRSS contact were less likely to re-present to the ED.

CONCLUSION

Results highlight the heterogeneity of patients with SUDs and emphasize the need for tailored interventions to address patient-specific needs more effectively. They also provide support for the perceived utility of PRSS engagement for ED patients.

Associations between day-level affect profiles and same-day substance use among young adults

OBJECTIVE

Emotions play a critical role in health risk behaviors, including substance use. However, current research often focuses exclusively on average levels of positive and negative affect, neglecting the complexity of daily emotional patterns. By capturing multiple dimensions of affect, including arousal and discrete states, we can improve our understanding of proximal predictors of substance use. The present study demonstrates the utility of a novel methodological approach for assessing affect patterns in daily life in relation to alcohol and cannabis use.

METHOD

Daily diary data from N = 154 young adults who reported recent heavy episodic drinking and simultaneous use of alcohol and cannabis were analyzed using a mixed-indicator latent profile analysis to identify and describe day-level affective patterns and outcomes.

RESULTS

Results revealed five distinct day-level profiles of affect: undifferentiated negative affect days, undifferentiated positive affect days, high-arousal positive affect days, mixed affect days, and low reactivity days. Undifferentiated positive affect days, high-arousal positive affect days, and low reactivity days were associated with significantly greater odds of same-day alcohol use compared to days characterized by undifferentiated negative affect (χ² = 10.55, p = .032).

CONCLUSIONS

Findings suggest that daily affect patterns differentially impact alcohol use and can inform the development of interventions for problematic substance use. Additionally, the innovative methodological approach employed herein could be applicable for investigating the role of emotion in other health behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors associated with transitions in tobacco product use states among young adults aged 18-29 years

BACKGROUND AND OBJECTIVES

This study examined young adults' tobacco use transitions based on their past 30-day use states, and identified factors associated with their transitions.

METHODS

Participants (N = 12377) were young adults aged 18-29 years at Wave 1 of the Population Assessment of Tobacco and Health (PATH) study. Self-reported tobacco use states were categorized by the number of past-month use days (0, 1-4, 5-8, 9-12, 13-30 days) for cigarettes, electronic cigarettes [e-cigarettes], traditional cigars, filtered cigars, cigarillos, smokeless tobacco (SLT), and hookah. Multistate Markov models examined transitions between use states across Waves 1-5 of unweighted PATH data and multinomial logistic regressions examined predictors of transitions.

RESULTS

Most young adults remained nonusers across adjacent waves for all products (88%-99%). Collapsed across waves, transitioning from use at any level to nonuse (average 46%-67%) was more common than transitioning from nonuse to use at any level (average 4%-10%). Several factors that predicted riskier patterns of use (i.e., transitioning to use and/or remaining a user across adjacent waves) were similar across most products: male, Black, Hispanic, lower education levels, and lower harm perceptions. In contrast, other factors predicted riskier patterns for only select products (e.g., e-cigarette and SLT use among Whites).

DISCUSSION AND CONCLUSIONS

Few sampled young adults escalated their tobacco use over time, and escalations for many products were predicted by similar factors.

SCIENTIFIC SIGNIFICANCE

Prevention and regulatory efforts targeted towards adolescents should continue, but also be expanded into young adulthood. These same efforts should consider both shared and unique factors that influence use transitions.

Stressful Life Events and Patterns of Polysubstance Use Among U.S. Late Middle-Aged and Older Adults: A Latent Class Analysis

The goals of this study were to identify patterns of polysubstance use and their associations with stressful life events among U.S. late middle-aged and older adults and examine whether gender moderates these associations. Adults aged 50 and older (N = 14,738) from the National Epidemiological Survey on Alcohol and Related Conditions-III were included. Latent class analysis was conducted to identify patterns of polysubstance use. Weighted multinomial logistic regression was estimated with a generalized structural equation model. Three different polysubstance use patterns (non-users/low substance users; cannabis and excessive alcohol users; painkiller and sedative/tranquilizer misusers) were identified. Higher levels of stressful life events were associated with patterns of polysubstance use. Gender moderated the association between stressful life events and co-misusing painkillers and sedatives/tranquilizers (p < 0.05). Substance use prevention efforts should consider aging adults' patterns of polysubstance use and associated stressful life events when designing and implementing gender-specific polysubstance use prevention interventions.

Estimating the Effects of a Complex, Multidimensional Moderator: An Example of Latent Class Moderation to Examine Differential Intervention Effects of Substance Use Services

Improvements in substance use disorder recovery may be achieved by recognizing that effective interventions do not work equally well for all individuals. Heterogeneity of intervention effects is traditionally examined as a function of a single variable, such as gender or baseline severity. However, responsiveness to an intervention is likely a result of multiple, intersecting factors. Latent class moderation enables the examination of heterogeneity in intervention effects across subgroups characterized by profiles of characteristics. This study analyzed data from adolescents (aged 13 to 18 years old) who needed treatment for cannabis use (n = 14,854) and participated in the Global Appraisal of Individual Needs to evaluate differential effects of substance use services on cannabis use outcomes. We demonstrate an adjusted three-step approach using weights that account for measurement error; sample codes in Mplus and Latent Gold are provided and data are publicly available. Indicators of the latent class moderator comprised six contextual (e.g., recovery environment risk) and individual (e.g., internal mental distress) risk factors. The latent class moderator comprised four subgroups: low risk (21.1%), social risk (21.1%), environmental risk (12.5%), and mixed risk (45.2%). Limited moderation of associations between level of care and any past 90-day cannabis use were observed. In predicting number of cannabis use-days, compared to individuals with low risk, those with environmental risk showed improved outcomes from intensive outpatient care whereas individuals with social risk and mixed risk showed improved outcomes from residential care (all compared to early intervention/outpatient care). Latent class moderation holds potential to elucidate heterogeneity in intervention effectiveness that otherwise may go undetected.

Longitudinal transitions in adolescent polytobacco use across waves 1-4 of the Population Assessment of Tobacco and Health study

AIMS

This study aims to identify adolescent patterns of polytobacco use and measure transitions between patterns over time.

DESIGN

Longitudinal analysis using data derived from waves 1-4 (2013-18) of the Population Assessment of Tobacco and Health (PATH) study. Transitions in tobacco use patterns were examined via latent transition analysis, and then, socio-demographic characteristics were used to predict transitions via logistic regression.

SETTING

United States.

PARTICIPANTS

Participants included 975 adolescents who used at least one tobacco product at any wave (W1 mean age = 13.29, standard deviation = 0.86; W4 54.2% male; 54.5% white, 25.9% Hispanic).

MEASUREMENTS

Measurements included past 30-day use of cigarettes, electronic cigarettes (e-cigs), traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco (SLT) or hookah.

FINDINGS

Six latent classes were identified. Cigarette users (43.5-58.8%) and SLT users (50.8-79.6%) tended to persist in their use over time. E-cig users began to probably transition to non-users (80.0%), but became more likely to persist in this use over time (31.1%). Non-users at a given wave were most likely to transition to e-cig users (8.5-43.7%) or cigarette users (6.7-28.6%). Cigarillo/poly-users and hookah/poly-users displayed more variable transition patterns. Adolescents were more likely to transition to non-use (versus become/remain e-cig users) if they were older (cigarette users, SLT users), younger (e-cig users), other race (SLT users), male (SLT users) or had less-educated parents (SLT users) compared with their counterparts. Hispanic (versus white) cigarette users were more likely to transition to non-users than to persist in this use.

CONCLUSIONS

Among adolescents in the United States, patterns of tobacco use characterized by the use, mainly, of single, specific products appear to be stable, particularly by late adolescence. In contrast, patterns characterized by polytobacco use appear to be more variable and may represent experimentation without specialization.

Greater lifetime stressor exposure is associated with poorer mental health among sexual minority people of color

BACKGROUND

Research has shown that sexual minority people of color experience pervasive and sometimes severe life stressors that increase their risk of experiencing mental health problems, and that can contribute to lifelong health disparities. However, no studies in this population have investigated stressor exposure occurring over the entire lifespan. Moreover, it remains unknown whether these stressor-health effects differ based on the timing or types of stressors experienced.

PURPOSE

The purpose of this study is to examine how cumulative lifetime stressor exposure is associated with mental health among Black, Latinx, and biracial Black-Latinx sexual minority persons.

METHOD

Participants were 285 ethnic/racial minority young adults (Mage  = 25.18 years old, SD = 1.94, age range = 19-29 years), who completed the Stress and Adversity Inventory for Adults to assess for retrospective reports of lifetime stressor count and severity. The Brief Symptom Inventory was used to assess participants' symptoms of anxiety, depression, and somatization, which were the main outcomes. Most participants identified as cisgender male (94.7%) and gay (74.2%), with the remaining participants identifying as transgender or genderqueer/nonbinary for gender and bisexual/pansexual, queer, or another sexual orientation.

RESULTS

Multiple regression analyses indicated that experiencing more-and more severe-stressors across the lifespan was related to greater anxiety, depressive, and somatization symptoms. These effects were robust while controlling for race/ethnicity, sexual orientation, education, and employment status, and they differed based on stressor exposure timing, type, primary life domain, and core social-psychological characteristic.

CONCLUSION

Greater cumulative lifetime stressor exposure is related to poorer mental health among sexual minority people of color. Screening for lifetime stressors may thus help identify at-risk persons and provide an opportunity to intervene to help mitigate or prevent mental health disparities in multiply stigmatized adults.

Socioecological Predictors of Change in Adolescent Tobacco Use Across Waves 1-4 of the Population Assessment of Tobacco and Health Study

BACKGROUND

Despite decreases in adolescents' cigarette use over the past decade, overall rates of adolescent tobacco use have increased. Research examining adolescents' changes across a range of tobacco products reflective of the current market, as well as multilevel predictors of use trajectories is needed.

METHODS

Data derive from Waves 1-4 (W1-4; 2013-2018) of the Population Assessment of Tobacco and Health (PATH) study. Participants included 975 adolescents who used ≥1 tobacco product (cigarettes, electronic cigarettes [ECIGs], traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco [SLT], hookah) at any wave (W1 Mage = 13.29 [0.86], 54.2% male; 54.5% White, 25.9% Hispanic).

RESULTS

Utilizing latent growth curve modeling (separate models per product), adolescents displayed increases in their past 30-day use of all tobacco products from W1-4. Greater W1 use was predicted by identifying as non-Hispanic (cigarettes); lower parent education (SLT); greater externalizing problems (cigarillos); greater motives (all products except cigarillos); greater youth-reported household smoking rules (cigarillos); and greater isolation (ECIGs). More use across time (i.e., higher slope) was predicted by older age (cigarettes); identifying as male (ECIGs, SLT), Black (vs. White; cigarillos), White (vs. Black, Hispanic; ECIGs, SLT); fewer externalizing problems (SLT); fewer motives (ECIGs); fewer youth-reported rules (cigarillos, SLT); and greater geographic isolation (cigarettes, SLT).

DISCUSSION

Although some individual-level factors (i.e., motives, externalizing problems) predicted greater W1 use (i.e., intercept) only, interpersonal- (parent rules) and community-level (geographic isolation) factors were associated with changes in use over time (i.e., slope). Intervention efforts may address such factors to reduce adolescents' escalations in use.

Patterns of opioid use behaviors among patients seen in the emergency department: Latent class analysis of baseline data from the POINT pragmatic trial

INTRODUCTION

The nation's overdose epidemic has been characterized by increasingly potent opioids resulting in more emergency department (ED) encounters over time. ED-based opioid use interventions are growing in popularity; however, they tend to treat people who use opioids as a homogenous population. The current study sought to understand heterogeneity among people who use opioids who encounter the ED by identifying qualitatively different subgroups among participants in an opioid use intervention clinical trial at baseline and examining associations between subgroup membership and multiple correlates.

METHODS

Participants were from a larger pragmatic clinical trial of the Planned Outreach, Intervention, Naloxone, and Treatment (POINT) intervention (n = 212; 59.2 % male, 85.3 % Non-Hispanic White, mean age = 36.6 years). The study employed latent class analysis (LCA) using five indicators of opioid use behavior: preference for opioids, preference for stimulants, usually use drugs alone, injection drug use, and opioid-related problem at ED encounter. Correlates of interest included participants' demographics, prescription histories, health care contact histories, and recovery capital (e.g., social support, naloxone knowledge).

RESULTS

The study identified three classes: (1) noninjecting opioid preferers, (2) injecting opioid and stimulant preferers, and (3) social nonopioid preferers. We identified limited significant differences in correlates across the classes: differences existed for select demographics, prescription histories, and recovery capital but not for health care contact histories. For example, members of Class 1 were the most likely to be a race/ethnicity other than non-Hispanic White, oldest on average, and most likely to have received a benzodiazepine prescription, whereas members of Class 2 had the highest average barriers to treatment and members of Class 3 were the least likely to have been diagnosed with a major mental health illness and had the lowest average barriers to treatment.

CONCLUSIONS

LCA identified distinct subgroups among POINT trial participants. Knowledge of such subgroups assists with the development of better-targeted interventions and can help staff to identify the most appropriate treatment and recovery pathways for patients.

Preliminary effectiveness and implementation outcomes of the IMARA-South Africa sexual health intervention on adolescent girls and young women: A pilot randomized trial

Family-based interventions may help reduce the risk of HIV and other sexually transmitted infections (STI) among adolescent girls and young women (AGYW) in sub-Saharan Africa but few have been tested. We examined the preliminary effectiveness and implementation outcomes of Informed, Motivated, Aware, and Responsible Adolescents and Adults-South Africa (IMARA-SA), an evidence-based intervention for South African AGYW (15-19 years) and their female caregivers. We piloted IMARA-SA in the Western Cape using an individually randomized experimental design and average follow-up at 11 months. Primary outcomes were HIV Testing and Counselling (HTC) uptake, STI incidence (gonorrhea, chlamydia), and pre-exposure prophylaxis (PrEP) uptake. Secondary outcomes were self-reported sexual risk behavior (condom use at last sex, consistency of condom use, substance use during sex, and number of sexual partners) and PrEP adherence. We examined four implementation outcomes: reach, feasibility, acceptability, and fidelity. Data from 59 AGYW (mean = 17.2 years) were analyzed at baseline (n = 29 from IMARA-SA, 30 from a health promotion control group). At follow-up, 51 (86%) completed surveys and 39 (66%) presented for HTC, STI testing, and/or PrEP. Compared to controls, fewer IMARA-SA participants tested positive for an STI (22% versus 38%), more IMARA-SA participants took up PrEP (68% versus 45%), and four of five secondary outcomes favored the IMARA-SA group at follow-up. These differences did not reach statistical significance. HTC uptake at follow-up was 100% in both groups. All AGYW-FC dyads agreed to participate in the study (reach). In the IMARA-SA group, 76% of dyads completed the intervention (feasibility), and over 76% of acceptability ratings from AGYW and their FC had the highest Likert rating. Fidelity of intervention delivery was 95%. IMARA-SA is a promising strategy for reducing HIV/STI risk among South African AGYW. We found strong evidence of reach, feasibility, acceptability, and fidelity. A fully powered randomized controlled trial is warranted. Trial registration: Clinical trials.gov registration number: NCT05504954.

Health and service utilization among a sample of gender-diverse youth of color: the TRUTH study

BACKGROUND

While there is growing research considering the experiences of transgender youth whose identities align with the gender binary, especially among young trans women, there are significantly fewer studies that accurately capture data about nonbinary youth, and even fewer studies capturing the experiences of transgender and gender diverse (TGD) youth of color. The purpose of this research was to assess the prevalence of sexual health behaviors, mental health challenges, substance use, and healthcare utilization among Black/African American, Latinx, Asian/Pacific Islander, indigenous and multi-racial/ethnic TGD youth, who have been largely underrepresented in research.

METHODS

A total of 108 TGD youth ages 16-24 were recruited into the Trans Youth of Color Study (TRUTH). Each participant completed a 90-min survey administered by a research assistant with more sensitive information collected using ACASI. In addition to a completing a survey administered by research staff, participants also participated in specimen collection, which included urine sampling to assess recent substance use without a prescription, self-collected rectal/frontal and throat swabs to test for gonorrhea and chlamydia, and a blood draw to test for recent use of drugs, gonorrhea and chlamydia, and syphilis. The sample was recruited at public venues, community outreach and referral, through social media outreach, and via participant referral. Cross-sectional analyses were from a single study visit.

RESULTS

Compared to rates among their cisgender peers, participants reported experiencing adverse social and structural determinants of health-e.g. food insecurity (61%), housing instability (30%), and limited access to healthcare (26% had no place to go for healthcare)-and elevated rates of illicit drug use (19-85%), mental health problems (e.g. 60% self-reported depression), and involvement in sexual risk-related behaviors (e.g. among those reporting penetrative sex 57-67% reported sex without a condom).

CONCLUSIONS

This study adds descriptions of both mental and sexual health outcomes of a non-clinical sample of TGD youth to the literature, particularly among young transgender men and gender nonbinary youth, who have frequently been excluded from previous studies of sexual health. The findings document experiences and behaviors among TGD youth that contribute to mental and sexual health concerns, including rates of substance use, and healthcare utilization.

Triadic family structures and their day-to-day dynamics from an adolescent perspective: A multilevel latent profile analysis

Relationship structure (patterns of relative closeness among multiple family members) and dynamics (changes in relationship structures overtime) are two main aspects of family system functioning, yet empirical tests of these concepts lag behind theory. Recent growth in advanced methods for complex data structures makes it possible to empirically capture structures and dynamics within multiple family relationships overtime. To answer how relationship structure may fluctuate from day to day, this study used multilevel latent profile analysis (MLPA) as an innovative and feasible method to capture mother-father-adolescent (MFA) relationship structures and dynamics on a daily basis. Using daily adolescent reports of mother-father (MF), mother-adolescent (MA), and father-adolescent (FA) closeness from 144 two-parent families for up to 21 days, we identified six day-level MFA structures: Cohesive (33% of days; three close dyads), Mother-Centered (9%; closer MF, average MA, less close FA), Adolescent-Centered (4%; less close MF, closer MA and FA), MA-Coalition (3%; closer MA, less close MF and FA), Disengaged (23%; three less close dyads), and Average (28%; three approximately average dyads). We identified five types of MFA dynamics at the family level: Stable Cohesive (35% of families; exhibited Cohesive structure most days), Stable Disengaged (20%; Disengaged structure most days), Stable MA-Coalition (3%; MA-Coalition structure most days), Stable Average (24%; Average structure most days), and Variable (17%; varied among multiple structures). Methodologically, daily diary designs and MLPA can be useful tools to empirically examine concrete hypotheses of complex, non-linear processes in family systems. Substantive and methodological implications are discussed.

Psychosocial predictors of longitudinal changes in tobacco and cannabis use among young adults

INTRODUCTION

In recent years, cigarette use has decreased, but alternative tobacco product and cannabis use has increased in young adults. Thus, research regarding intraindividual changes in tobacco product and cannabis use in this population, and related psychosocial predictors, is warranted.

METHODS

We analyzed data from 3,006 young adults (Mage = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 60.2% racial/ethnic minority) in a 2-year, 5-wave longitudinal study (2018-2020). Latent growth modeling analyzed the outcomes of past 6-month use of cigarettes, e-cigarettes, traditional cigars, little cigars/cigarillos, smokeless tobacco (SLT), hookah, and cannabis across Waves 1-5 among all participants; psychosocial predictors included depressive symptoms, adverse childhood experiences (ACEs), and personality traits.

RESULTS

Results indicated decreases in likelihood of using each tobacco product over time, but no significant change in likelihood of cannabis use. Psychosocial predictors of baseline use across products included depressive symptoms and extraversion, as well as ACEs and openness for nearly all products (e.g., except traditional cigars). Psychosocial predictors of less decreases in use likelihood over time included: for cigarettes and traditional cigars, ACEs; for e-cigarettes, extraversion; for little cigars/cigarillos, depressive symptoms and extraversion; for SLT, openness; and for hookah, neuroticism (controlling for sociodemographics). Predictors of greater decreases in likelihood of use over time included: for e-cigarettes and hookah, conscientiousness; and for cannabis, agreeableness.

CONCLUSIONS

Interventions to reduce young adults' use might target distinct risk/protective factors for using different products (and combinations). Moreover, results regarding decreasing likelihood of using tobacco products but not cannabis over time warrant replication and explanation in other samples.

A Trans Youth of Color Study (TRUTH) to Measure Health and Wellness: Protocol for a Longitudinal Observation Study (Preprint)

BACKGROUND

Growing research on transgender youth is accounting for the variety of ways in which young people define their genders and sexualities. Because of this growing representation, more research is needed to understand how intersectional identities and stigma affect risk for HIV acquisition along the HIV care continuum and engagement in mental and physical health care. Little is known about accessibility to HIV-related prevention services of nonbinary and transmasculine youth, and further understanding of the impacts on transfeminine people-those who have historically faced the highest prevalence of HIV positivity-is crucial.

OBJECTIVE

The overarching aims of the Trans Youth of Color Study are to conduct longitudinal research with a cohort of transgender minority youth (TGMY), explore factors that aid in the prevention of new HIV infection and transmission, and reduce HIV- and AIDS-related disparities by focusing on successful engagement in care. Findings from this research will be used to inform the development of new interventions designed to engage TGMY in the HIV prevention and care continua.

METHODS

Longitudinal research (baseline and follow-up assessments every 6 months for 3 waves of data collection) followed a cohort (N=108) of transgender youth of color recruited in Los Angeles, California, United States. Participants were recruited using multiple community-informed strategies, such as from local venues, social media, and participant referral. In addition to self-report surveys, urine was collected to assess recent use of illicit drugs, and blood, rectal, and throat swabs were collected to test for current sexually transmitted infection and HIV infection. Additional blood and plasma samples (10 mL for 4 aliquots and 1 pellet) were collected and stored for future research.

RESULTS

Participants in the Trans Youth of Color Study were recruited between May 25, 2018, and December 7, 2018. Baseline and longitudinal data are being analyzed as of August 2022.

CONCLUSIONS

The findings from this research will inform adaptations to existing evidence-based HIV prevention interventions and help to guide new interventions designed to engage TGMY, especially those who are Black, Indigenous, or people of color, in the HIV prevention and care continua.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39207.

Body Image Concerns, Correlates, and Community Connection Among Black and Latinx Sexual Minority Cisgender Men and Transgender/Gender Nonconforming Young Adults

AbstractPurpose: We extended the focus on body image research beyond cisgender, White sexual minority men (SMM) by describing body image concerns among Black and Latinx SMM and transgender/gender nonconforming (TGNC) adults and by examining protective effects of community connection. Methods: From 2016 to 2020, 447 Black and Latinx SMM (94%) and TGNC (6%) individuals in Los Angeles provided data semiannually. Participant endorsement of any body image concerns was determined by five body image codes (weight, fitness, appearance, body area dissatisfaction, and general body image) applied to participants' open-ended lists of health and body concerns. Fixed effects multivariable logistic regression was performed to examine the association between gay and racial/ethnic community connection and odds of any body image concerns, accounting for multiple records per person. An interaction term between gay and racial/ethnic community connection approximated the protective effect of connection to multiple, intersecting communities. Results: The majority of participants (51%) reported a body image concern, most commonly weight concerns, at least once across three years. Body image concerns were more common among Latinx participants (χ² = 17.79, p < 0.001) and participants experiencing food insecurity (χ² = 4.11, p = 0.04) and unmet basic financial needs (χ² = 10.56, p = 0.001). Gay community connection was protective against body image concerns, but only for participants who had high racial/ethnic community connection (adjusted odds ratio = 0.87, p = 0.05). Conclusion: Body image concerns were notable, especially among those with low community connection and higher socioeconomic burden. These findings suggest that building connections within SMM/TGNC and racial/ethnic communities may aid in building a support network that buffers against body image concerns.

Transitions in tobacco use profiles among adolescents: Results from the Population Assessment of Tobacco and Health (PATH) study waves 3 and 4

INTRODUCTION

Despite increases in adolescents' polytobacco use, little work has utilized recent national data to examine transitions in polytobacco use over time or predictors of such transitions.

METHODS

Data derived from the Population Assessment of Tobacco and Health (PATH) study. Participants used at least one tobacco product (cigarettes, electronic cigarettes [ECIGs], traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco [SLT], hookah) at Wave 3 (W3; 2015-2016) or 4 (W4; 2016-2018) and had Wave 1 (W1) data (N = 1072; Mage= 13.71, SD =1.71, 46.4% female; 56.6% White, 23.2% Hispanic). Latent transition analysis (LTA) examined probabilities of transitioning between classes across waves and sociodemographic correlates of transitions.

RESULTS

Five latent classes were identified: Low Users (n = 372, 34.7% W3; n = 249, 23.3% W4), ECIG Users (n = 256, 23.8% W3; n = 286, 26.7% W4), Cigarette Users (n = 215, 20.1% W3; n = 293, 27.3% W4), SLT Users (n = 91, 8.5% W3; n = 92, 8.6% W4), and Polytobacco Users (n = 138, 12.9% W3; n = 152, 14.1% W4). Cigarette Users and SLT Users displayed the highest probabilities for class stability. Low Users were most likely to transition to ECIG Users or Cigarette Users, whereas Polytobacco Users were most likely to transition to Low Users. ECIG Users were likely to transition to Low Users or Cigarette Users. Older and White adolescents were more likely to display riskier transitions.

CONCLUSIONS

Although Cigarette Users and SLT Users remained largely stable in membership, findings demonstrate greater movement across polytobacco use classes relative to previous research and suggest that ECIGs may be the most common entry point to tobacco use.

Intersecting racism and homonegativism among sexual minority men of color: Latent class analysis of multidimensional stigma with subgroup differences in health and sociostructural burdens

RATIONALE

Applying an intersectional framework to quantitative public health research among Black and Latino sexual minority men requires analysis that considers interlocking, multidimensional systems of racist and homonegative oppression that fundamentally subvert health. In this study, person-centered methods reflected the complexity of intersecting stigma and how subgroups experience that intersection differently.

METHODS

Data were from a cohort of 435 Black and Latino sexual minority young men (mean age = 22.3 years) in the Healthy Young Men's Cohort Study in Los Angeles, United States. Participants provided data semiannually on five occasions spanning 24 months from 2016 to 2019. The marginal approach to longitudinal latent class analysis was used to identify latent classes indicated by multidimensional experiences of racism (e.g., police harassment, workplace discrimination, sexual objectification) and homonegativism (e.g., violence, family rejection, identity concealment) during the transition to adulthood. Associations between sociostructural burdens (e.g., socioeconomic status, food insecurity, unstable housing) and class incidents were investigated. Prevalence of mental health care needs, chronic health conditions, and overall self-reported health were compared among classes.

RESULTS

Five latent classes were identified: Minimal Stigma (26% of person records), Select Social Stigma (22%), Homonegativism (17%), Multiform Racism (24%), and Compound Stigma (11%). Sociostructural burdens were generally associated with 1.69-3.75 times higher odds of Select Social Stigma, Homonegativism, Multiform Racism, and Compound Stigma class incidents relative to Minimal Stigma. The Compound Stigma class had the greatest sociostructural burden, highest mental health care needs, and highest odds of sleep and gastrointestinal disorders, but classes did not differ in overall self-reported health.

CONCLUSION

These results exemplify how sociostructural burdens are interconnected with intersectional stigma experiences that together erode the health of Black and Latino sexual minority young men.

Stress and Affect as Daily Risk Factors for Substance Use Patterns: an Application of Latent Class Analysis for Daily Diary Data

At the population level, use of multiple substances (or "co-use") is prevalent in young adulthood and linked with increased risk for experiencing substance-related harms. Less understood is the heterogeneity of substance use behaviors within individuals and across days, as well as the proximal predictors of these daily use patterns. The present study applied latent class analysis to daily diary data to identify daily substance use patterns and compare day-level class membership based on day-level stress and positive and negative affect among a higher-risk sample of young adult substance users. Participants (n = 152) completed up to 13 daily assessments of stress, affect, and substance use behavior. Among substance use days, five classes of days were identified: cannabis (some alcohol; 43% of days), alcohol-only (26%), vaping (some alcohol, cannabis; 24%), stimulant + alcohol (some cannabis, vaping; 4%), and cigarette-only (3%) days. Days with lower levels of perceived stress were significantly more likely to be alcohol-only Days relative to being days characterized by cigarette use, cannabis use, or multiple drug combinations. Days with higher levels of stress and negative affect were more likely to be cigarette-only days relative to cannabis and vaping days. Study findings document the wide range of substance use and co-use behaviors exhibited among young adults in daily life and highlight the importance of considering risk factors that correspond to days of problematic use patterns.

Linking racism and homonegativity to healthcare system distrust among young men of color who have sex with men: Evidence from the Healthy Young Men's (HYM) study

BACKGROUND

Experiences with racism predict healthcare system distrust among people of color, but Black and Latino young men who have sex with men (YMSM) also experience overlapping forms of stigma associated with their sexual identities and behaviors (i.e., homonegativity and internalized homonegativity). These forms of minority stress may drive healthcare system distrust among Black and Latino YMSM but have received far less attention.

OBJECTIVES

To examine the associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust among a community sample of Black and Latino YMSM.

METHODS

Data came from waves 2-4 (years 2017-2018) of the Healthy Young Men's study, a longitudinal cohort study of Black and Latino YMSM living in Los Angeles County. Data across waves (n = 424, n_obs = 1272) were combined and analyzed using a fixed effects approach and adjusting for repeated measures across participants. A series of regression models that added sets of covariates (demographics, syndemic indicators, and health-related factors) were tested to examine associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust.

RESULTS

Adjusting for demographics and syndemic indicators, racism, but not homonegativity or internalized homonegativity, was associated with healthcare system distrust. Adjustment for health-related factors had little impact on results.

CONCLUSIONS

Among Black and Latino YMSM, greater exposure to racism is associated with greater healthcare system distrust. Efforts to strengthen healthcare system trust should explicitly target the institutional policies that disproportionately harm people of color.

Exploring Triadic Family Relationship Profiles and Their Implications for Adolescents' Early Substance Initiation

This study examined combinations of warmth and hostility in mother-father-adolescent triadic relationships when adolescents were in 6th grade and associations with adolescent middle school substance initiation. We conducted a latent profile analysis with a sample of 687 two-parent families (52.4% of adolescents were female, mean age = 11.27 at 6th grade). These analyses revealed five profiles of triadic relationships, labeled as: cohesive families (46%, high warmth and low hostility in all three dyads), compensatory families (24%, low interparental warmth but high parent-adolescent warmth), disengaged families (13%, average to low warmth and hostility in three dyads), distressed families (9%, high hostility and low warmth in all three dyads), and conflictual families (8%, high hostility and average warmth in all three dyads). There were significant differences across triadic relationship profiles in rate of alcohol initiation during middle school. Specifically, adolescents in distressed families and conflictual families initiated alcohol at higher rates than adolescents in other types of families. Cohesive families and compensatory families initiated alcohol at the lowest rates among all five types of families. Similar patterns appeared for drunkenness and cigarettes. Implications for family-based interventions to decrease adolescent substance use and future research directions are discussed.

A Latent Transition Analysis of Self-Reported Reasons for Marijuana Use During Young Adulthood

Individuals' reasons for marijuana use have been linked to their risk for continued use and development of disordered use. Although individuals tend to have multiple reasons for use, co-occurrence of reasons is not always accounted for in analytic approaches. Latent transition analysis (LTA) is ideal for modeling transitions in co-occurring reasons. Using longitudinal panel data from Monitoring the Future, LTA was used to identify profiles of self-reported reasons for marijuana use among young adults, examine transitions between profiles, and determine whether cohort, gender, race/ethnicity, parent education, grade of first marijuana use, and 4-year college attendance predicted transitions between profiles. Data included senior year cohorts from 1976-2009 and were collected at ages 19/20, 21/22, and 23/24 (weighted n = 7,294; 55.9% female; 79.3% White). Five latent classes were identified: Non-Users and individuals with Experimental, Typical, Get High + Relax, and Escape + Coping Reasons. Transitions among Non-Users, Experimental Reasons, and Typical Reasons were common; generally, those with earlier cohort membership, early initiation, college non-attending parents, and college attendance were more likely to make transitions to higher-risk classes. As the legalization of recreational marijuana use continues to expand, change over time in reasons for use should be considered carefully as interventions are developed and implemented.

Barriers impacting the POINT pragmatic trial: the unavoidable overlap between research and intervention procedures in "real-world" research

Background

This manuscript provides a research update to the ongoing pragmatic trial of Project POINT (Planned Outreach, Intervention, Naloxone, and Treatment), an emergency department-based peer recovery coaching intervention for linking patients with opioid use disorder to evidence-based treatment. The research team has encountered a number of challenges related to the “real-world” study setting since the trial began. Using an implementation science lens, we sought to identify and describe barriers impacting both the intervention and research protocols of the POINT study, which are often intertwined in pragmatic trials due to the focus on external validity.

Method

Qualitative data were collected from 3 peer recovery coaches, 2 peer recovery coach supervisors, and 3 members of the research team. Questions and deductive qualitative analysis were guided by the Consolidated Framework for Implementation Research (CFIR).

Results

Nine unique barriers were noted, with 5 of these barriers impacting intervention and research protocol implementation simultaneously. These simultaneous barriers were timing of intervention delivery, ineffective communication with emergency department staff, lack of privacy in the emergency department, the fast-paced emergency department setting, and patient’s limited resources. Together, these barriers represent the intervention characteristics, inner setting, and outer setting domains of the CFIR.

Conclusion

Results highlight the utility of employing an implementation science framework to assess implementation issues in pragmatic trials and how this approach might be used as a quality assurance mechanism given the considerable overlap that exists between research and intervention protocols in real-world trial settings. Previously undocumented changes to the trial design that have been made as a result of the identified barriers are discussed.

Individual Differences in Adolescent Coping: Comparing a Community Sample and a Low-SES Sample to Understand Coping in Context

Coping that is adaptive in low-stress environments can be ineffective or detrimental in the context of poverty. Identifying coping profiles among adolescents facing varying levels of stress can increase understanding of when and for whom coping may be most adaptive. The present study applied latent profile analysis (LPA) to identify coping profiles in two distinct samples of adolescents: a community sample of youth aged 11–16 years (N = 374, M_age = 13.14, 53% girls), and a low-SES sample of youth aged 12–18 years (N = 304, M_age = 14.56, 55% girls). The ten coping subscales of the Responses to Stress Questionnaire were included as indicators in the LPAs (problem solving, emotion regulation, emotion expression, acceptance, positive thinking, cognitive restructuring, distraction, denial, wishful thinking, and avoidance). Five profiles were identified in the community sample: Inactive, Low Engagement, Cognitive, Engaged, and Active Copers. All but the Low Engagement Copers profile were also identified in the low-SES sample, suggesting that adolescents employ similar coping strategies across contexts, but fewer low-SES adolescents engage in lower levels of coping. Profiles differed by gender and symptoms of internalizing psychopathology. Inactive copers in both samples were more likely to be male. Engaged Copers reported the lowest symptom levels whereas Active Copers reported higher symptoms. Cognitive Copers reported higher levels of anxious and depressive symptoms in the low-SES sample only, suggesting that this pattern of coping may be protective only in less stressful contexts. Elucidating within-person coping patterns is a promising avenue for targeting interventions to those most likely to benefit.

Substance use and mental health outcomes during emerging adulthood among individuals with different patterns of child maltreatment

The aim of the current study was to identify patterns of child maltreatment experienced prior to age 18 and examine the relationship between those patterns and substance use and mental health disorders among emerging adults. Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III. The analytic sample consisted of 5,194 adults between 18 to 25 years old. Latent class analysis revealed a 3-class model: Rare Maltreatment (59%); Occasional Maltreatment, Rare Sexual Abuse (37%); and Frequent Maltreatment, Some Sexual Abuse (4%). Risk for substance use disorders and poor mental health was higher for the two classes who experienced maltreatment, however those with Frequent Maltreatment had higher risk for poor mental health, but not substance use disorders compared to those with Occasional Maltreatment. Patterns of child maltreatment are important predictors of substance use and mental health disorders in emerging adulthood, but different patterns may necessitate specific intervention efforts.

IMARA: A mother-daughter group randomized controlled trial to reduce sexually transmitted infections in Black/African-American adolescents

Black/African-American girls are infected with sexually transmitted infections (STIs) at higher rates than their White counterparts. This study tested the efficacy of IMARA, a mother-daughter psychosocial STI/HIV prevention program, on adolescent Black/African-American girls’ incident STIs at 12 months in a 2-arm group randomized controlled trial. Black/African-American girls 14–18 years old and their primary female caregiver were eligible for the study. Girls provided urine samples to test for N. gonorrhoeae, C. trachomatis, and T. vaginalis infection at baseline and 12-months. Mother-daughter dyads were randomly assigned to IMARA (n = 118) or a time-matched health promotion control program (n = 81). Retention at 12-months was 86% with no difference across arms. Both interventions were delivered over two consecutive Saturdays totaling 12 hours. Girls who received IMARA were 43% less likely to contract a new STI in the 12-month post-intervention period compared with those in the health promotion control program (p = .011). A secondary follow-up intent-to-treat analysis provided additional support for the protective effect of IMARA, albeit with a similar magnitude of 37% (p = .014). Findings provide early evidence for IMARA’s efficacy, such that IMARA protected against STIs at 12-months among adolescent Black/African-American girls. Future research should examine the mechanisms associated with reduced STIs.

Different Types of Childhood Experience with Mothers and Caregiving Outcomes in Adulthood

OBJECTIVE AND BACKGROUND

The current study examines the types of childhood experiences with mothers (i.e., maternal abuse, affection, discipline) among caregivers of aging mothers, and investigates whether membership in specific latent classes, particularly maternal maltreatment, is associated with psychological functioning among caregivers.

METHOD

Using data from the Midlife in the United States (MIDUS), we used the Bolck, Croon, and Hagenaars (BCH) approach of latent class analysis (LCA) to predict distal outcomes.

RESULTS

We identified four latent classes (prevalence rate noted): "Affectionate and authoritative" (65%), "affectionate and permissive" (11%), "emotionally abusive and neglectful" (8%), and "emotionally/physically abusive and authoritative" (16%). Caregivers in the "emotionally/physically abusive and authoritative" class endorsed high probabilities of both maternal affection and abuse and were most negatively affected across the three psychological functioning outcomes (i.e., self-rated mental health, psychological distress, and psychological well-being).

CONCLUSION AND IMPLICATIONS

In support of the life course perspective, our findings emphasized the importance of examining adult children caregivers' early life experiences with aging mothers and how those experiences can impact the psychological effects of caregiving. This study suggests specific practice implications; for example, assessment tools for evaluating caregiver burden should consider life course factors such as caregivers' childhood experiences with aging parents.

Constellations of family risk for long-term adolescent antisocial behavior

Adolescent antisocial behavior (ASB) can have long-term individual and societal consequences. Much of the research on the development of ASB considers risk and protective factors in isolation or as cumulative indices, likely overlooking the co-occurring and interacting nature of these factors. Guided by theories of ASB risk (i.e., coercive family process, disengagement), this study uses latent profile analysis to evaluate whether there are subgroups of families in the population that conform to specific constellations of risk factors prescribed by established theories of risk for ASB, and whether subgroup membership confers differential risk for different ASBs. We leveraged a large sample of adolescents in Fall, Grade 6 (N = 5,300; M_age = 11.8; 50.9% female) for subgroup analysis, and predicted aggression, antisocial peer behavior, and substance use in Spring, Grade 8. Four family profiles were identified: Coercive (15%), characterized by high family conflict, low positive family climate, low parental involvement, low effective discipline, low adolescent positive engagement, and low parental knowledge; Disengaged (41%), characterized by low positive family climate, low parental involvement, low adolescent positive engagement, and low parental knowledge; Permissive (11%), characterized by high parental involvement, low effective discipline, high adolescent positive engagement, high parental knowledge, and high family conflict; and High Functioning (34% prevalence). In turn, group membership predicted long-term outcomes. Adolescents in Coercive families were at highest risk for ASB during Grade 8, followed by those in Disengaged and Permissive profiles; all three of which were at greater risk than adolescents in High Functioning families for every outcome. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A latent class analysis of heavy substance use in Young adulthood and impacts on physical, cognitive, and mental health outcomes in middle age

BACKGROUND

This study examines whether longitudinal patterns of persistent or experimental heavy substance use across young adulthood were associated with physical and mental health in midlife.

METHODS

Data (N = 21,347) from Monitoring the Future from adolescence (age 18) to midlife (age 40) were used. Repeated measures latent class analysis modeled patterns of patterns of cigarettes, alcohol, marijuana, and other illicit drugs across young adulthood (ages 18-30). Latent classes were then used as predictors of physical health problems, cognitive problems, self-rated health, and psychological problems in midlife (age 40), while controlling for sociodemographic variables (i.e., gender, race/ethnicity, parental education).

RESULTS

Identified classes were "Extreme Heavy Users" (3.9%), "Early Young Adult Users" (8.9%), "Cigarette Smokers" (9.2%), "All But Cigarette Smokers" (5.0%), "Frequent Alcohol Bingers" (10.4%), and "Not-Heavy Users" (62.6%). Extreme Heavy Users, Early Young Adult Users, and Cigarette Smokers had significantly poorer overall health based on a number of physical conditions and self-rated health. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers had more cognitive problems than other classes. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers were more likely to see a health professional for a psychological problem.

CONCLUSIONS

Patterns of heavy substance use were associated with health across decades. Regular cigarette smokers and heavy users across substances and ages had the worst health in midlife, although even those with time-limited use during young adulthood were at risk for later physical and cognitive health problems.

Changes in externalizing and internalizing symptoms among African American female adolescents over 1 year following a mother-daughter sexual health intervention

OBJECTIVE

African American female adolescents face disparities compared with White peers in the interrelated areas of mental health symptoms and sexually transmitted infection (STI) acquisition. IMARA (Informed, Motivated, Aware and Responsible about AIDS) is a group-based mother-daughter intervention addressing these factors among African American teenagers. Previous work demonstrated that female adolescents who received IMARA were 43% less likely than controls to evidence a new STI at 1 year. This report aimed to provide the 1st test of IMARA on externalizing and internalizing symptoms and an exploratory analysis of whether symptom improvements were associated with the protective effect of treatment against future STIs.

METHOD

Female African Americans aged 14-18 years (M = 16; N = 199) were randomly assigned to IMARA or a health promotion control group matched for time and structure. They completed the Youth Self-Report of externalizing and internalizing symptoms at baseline and at 6 and 12 months and were tested for STIs at baseline and 12 months; positive cases were treated. Hierarchical linear modeling tested symptom change over time, including the moderating effects of baseline symptoms.

RESULTS

Among participants who entered with high versus lower externalizing symptoms, those who received IMARA showed a slightly greater decrease in externalizing scores relative to the control (p = .035). For these youth, symptom improvements appeared to be associated with IMARA's protective effect against new STIs. Treatment was not associated with internalizing symptom change (p > .05).

CONCLUSION

IMARA shows promise in modestly reducing self-reported externalizing symptoms, although only for participants with high scores at baseline. The possibility that externalizing symptom improvement is linked with reduced STI acquisition warrants future examination. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Childhood socioeconomic status, comorbidity of chronic kidney disease risk factors, and kidney function among adults in the midlife in the United States (MIDUS) study

Background

There is a lack of empirical effort that systematically investigates the clustering of comorbidity among known risk factors (obesity, hypertension, diabetes, hypercholesterolemia, and elevated inflammation) of chronic kidney disease (CKD) and how different types of comorbidity may link differently to kidney function among healthy adult samples. This study modeled the clustering of comorbidity among risk factors, examined the association between the clustering of risk factors and kidney function, and tested whether the clustering of risk factors was associated with childhood SES.

Methods

The data were from 2118 participants (ages 25–84) in the Midlife in the United States (MIDUS) Study. Risk factors included obesity, elevated blood pressure (BP), high total cholesterol levels, poor glucose control, and increased inflammatory activity. Glomerular filtration rate (eGFR) was estimated from serum creatinine, calculated with the CKD-EPI formula. The clustering of comorbidity among risk factors and its association with kidney function and childhood SES were examined using latent class analysis (LCA).

Results

A five-class model was optimal: (1) Low Risk (class size = 36.40%; low probability of all risk factors), (2) Obese (16.42%; high probability of large BMI and abdominally obese), (3) Obese and Elevated BP (13.37%; high probability of being obese and having elevated BP), (4) Non-Obese but Elevated BP (14.95%; high probability of having elevated BP, hypercholesterolemia, and elevated inflammation), and (5) High Risk (18.86%; high probability for all risk factors). Obesity was associated with kidney hyperfiltration, while comorbidity between obesity and hypertension was linked to compromised kidney filtration. As expected, the High Risk class showed the highest probability of having eGFR < 60 ml/min/1.73 m² (P = .12; 95%CI = .09–.17). Finally, higher childhood SES was associated with reduced probability of being in the High Risk rather than Low Risk class (β = − 0.20, SE = 0.07, OR [95%CI] = 0.82 [0.71–0.95]).

Conclusion

These results highlight the importance of considering the impact of childhood SES on risk factors known to be associated with CKD.

Inverse Propensity Score Weighting with a Latent Class Exposure: Estimating the Causal Effect of Reported Reasons for Alcohol Use on Problem Alcohol Use 16 Years Later

Latent class analysis (LCA) has proven to be a useful tool for identifying qualitatively different population subgroups who may be at varying levels of risk for negative outcomes. Recent methodological work has improved techniques for linking latent class membership to distal outcomes; however, these techniques do not adjust for potential confounding variables that may provide alternative explanations for observed relations. Inverse propensity score weighting provides a way to account for many confounders simultaneously, thereby strengthening causal inference of the effects of predictors on outcomes. Although propensity score weighting has been adapted to LCA with covariates, there has been limited work adapting it to LCA with distal outcomes. The current study proposes a step-by-step approach for using inverse propensity score weighting together with the "Bolck, Croon, and Hagenaars" approach to LCA with distal outcomes (i.e., the BCH approach), in order to estimate the causal effects of reasons for alcohol use latent class membership during the year after high school (at age 19) on later problem alcohol use (at age 35) with data from the longitudinal sample in the Monitoring the Future study. A supplementary appendix provides evidence for the accuracy of the proposed approach via a small-scale simulation study, as well as sample programming code to conduct the step-by-step approach.

Age trends in alcohol use behavior patterns among U.S. adults ages 18-65

INTRODUCTION

Although much of the work on risky alcohol use behaviors, such as heavy drinking, focuses on adolescence and young adulthood, these behaviors are associated with negative health consequences across all ages. Existing studies on age trends have focused on a single alcohol use behavior across many ages, using methods such as time-varying effect modeling, or a single age period with many behaviors, using methods such as latent class analysis. This study integrates aspects of both modeling approaches to examine age trends in alcohol use behavior patterns across ages 18-65.

METHODS

Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to identify past-year alcohol use behavior patterns among a nationally representative sample of U.S. adults (n = 30,997; 51.1% women; 63.5% White Non-Hispanic) and flexibly estimate nonlinear trends in the prevalences of those patterns across ages 18-65.

RESULTS

Five patterns were identified: Non-Drinkers, Frequent Light Drinkers, Infrequent Heavy Episodic Drinkers, Frequent Heavy Episodic Drinkers, and Extreme Drinkers. Pattern prevalences were allowed to vary flexibly across the entire age range. Prevalences of the Infrequent Heavy Episodic and Extreme Drinkers peaked around ages 22-24, but peaked for Frequent Heavy Episodic Drinkers around age 49. Non-Drinkers were most prevalent across all ages except during the early 20 s when Extreme Drinkers were more prevalent. Around ages 24-30, the Non-, Frequent Light, and Extreme Drinkers were approximately equally prevalent.

CONCLUSIONS

The approach used here holds promise for understanding characteristics associated with behavior patterns at different ages and long-term age trends in complex behaviors.

Social cohesion and peer acceptance predict student-athletes' attitudes toward health-risk behaviors: A within- and between-group investigation

OBJECTIVES

Collegiate student-athletes often engage in health-risk behaviors such as alcohol misuse and hazing, but the literature in this domain lacks evidence pertaining to how peers shape attitudes towards such behaviors. We investigated how peer acceptance and social cohesion relate to attitudes towards alcohol use, marijuana use, drinking and driving, playing through a concussion, performance enhancing substance use, and hazing.

DESIGN

Cross-sectional survey.

METHODS

Participants were 387 NCAA athletes from 23 intact teams. Multilevel modeling was used to examine the extent that health-risk attitudes clustered within teams and enabled us to disentangle individual-level and group-level effects of peer acceptance and social cohesion.

RESULTS

Intraclass correlation coefficients revealed that health-risk attitudes clustered within teams. At the individual-level, student-athletes who perceived higher levels of peer acceptance, relative to teammates, held riskier attitudes towards alcohol use, playing through a concussion, and hazing. Meanwhile, those who perceived higher levels of social cohesion relative to teammates held less risky attitudes towards playing through a concussion. At the group-level, teams with greater peer acceptance held less risky attitudes towards playing through a concussion, whereas teams with greater social cohesion held riskier attitudes toward playing through a concussion.

CONCLUSIONS

These data indicated that health-risk behaviors may cluster within teams, and that peer acceptance and cohesiveness are differentially associated with attitudes toward risky behavior. Given that peer influence is a multilevel phenomenon, it is prudent that prevention efforts leverage social processes within teams, while reducing pressures to engage in risky behaviors.

Online Sexual Experiences Predict Subsequent Sexual Health and Victimization Outcomes Among Female Adolescents: A Latent Class Analysis

Adolescents' online sexual experiences (e.g., pornography use, sexual chatting, sexualized social media use, and nude image exchange) provide a new context for sexual socialization. Traditionally, online sexual experiences are often aggregated averages, which neglect their complexity and fail to identify individual differences in the experience. Moreover, the lack of longitudinal research in this area has failed to determine if these experiences predict later offline sexual health and violence outcomes. An analysis of two waves of surveys completed by ethnically and socioeconomically diverse female adolescents (N = 296; 49% maltreated; aged 14-16 years) participating in a larger cross-sequential study was conducted to address these gaps. Established latent classes from the prerequisite study of online sexual experiences at Time 1 were Online Abstinent (low probability of any online sexual experiences), Online Inclusive (high probability of all online sexual experiences), Attractors (high probability of attracting attention from others), and Seekers (high probability of seeking out sexual content and interaction). Class membership uniquely predicted HIV risk, number of physically violent romantic partners, and the occurrence of sexual assault at Time 2. Although membership in risker online sexual experience classes predicted later offline risk and victimization, this was especially true for maltreated participants. These findings demonstrate the advantages of examining online sexual experiences in a way that emphasizes their complexity and individual differences in influential susceptibility.

A Focus on the HIV Care Continuum Through the Healthy Young Men's Cohort Study: Protocol for a Mixed-Methods Study

BACKGROUND

No group is at greater risk for acquiring HIV than young men who have sex with men (YMSM), particularly black or African American (AA) and Hispanic or Latino (L) YMSM living in inner cities, who account for the largest number of new HIV infections each year. Although pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and treatment as prevention hold enormous promise for changing the course of the epidemic, AA/L-YMSM are the least likely population to be receiving primary health care and HIV prevention/care and are the least likely to be using PrEP and PEP.

OBJECTIVE

The overarching aim of the Healthy Young Men's (HYM) cohort study is to conduct longitudinal research with a cohort of AA/L-YMSM to prevent new HIV infections, reduce transmission, and reduce HIV/AIDS-related disparities by focusing on successful engagement in care. Findings from this research will be used to inform the development of new interventions designed to engage AA/L-YMSM in the HIV prevention and care continua.

METHODS

Longitudinal research (baseline and follow-up assessments every 6 months for a total of 8 waves of data collection) is ongoing with a new cohort of 450 high-risk AA/L-YMSM in Los Angeles. Participants were recruited using a venue-based and social media sampling design. In addition to self-report surveys, the study protocol includes the collection of urine to assess recent use of illicit drugs and the collection of blood and rectal/throat swabs to test for current sexually transmitted infection (STI)/HIV infection. An additional sample of blood/plasma (10 mL for 4 aliquots and 1 pellet) is also collected and stored in the HYM cohort study biorepository for future research. By design, we recruited 400 HIV-negative participants and 50 HIV-positive (HIV+) participants. This mixed-methods study design includes collection and triangulated analysis of quantitative, qualitative, and biological measures (ie, drug use, STI/HIV testing, and adherence to antiretroviral therapy among HIV+ participants) at baseline and every 6 months. The HYM cohort study will provide a platform from which new and emerging biomedical prevention strategies (eg, PrEP, rectal microbicides, and PEP) and other HIV prevention and care engagement interventions can be developed and evaluated with AA/L-YMSM.

RESULTS

To date, all participants in the HYM cohort study have been recruited and baseline assessment has been conducted.

CONCLUSIONS

The findings from this research will be used to inform the development of new and/or adaptation of existing evidence-based HIV prevention interventions and interventions designed to engage this population in the HIV prevention and care continua.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/10738.

A Latent Class Analysis of Online Sexual Experiences and Offline Sexual Behaviors Among Female Adolescents

This study used latent class analysis to identify patterns (i.e., classes) across a broad range of online sexual experiences among female adolescents (n = 312) and to explore offline sexual behavior and substance use correlates of as well as maltreatment differences in class membership. The following four classes were identified: Online Abstinent, Online Inclusive, Attractors, and Seekers. Maltreated female adolescents were more likely to be members of the Online Inclusive class and less likely to be members of the Online Abstinent class than nonmaltreated female adolescents. Offline sexual behaviors and substance use differentially predicted class membership. These results suggest online sexual experiences vary greatly and should not be aggregated together as a global risk factor for all female adolescents.

Change and Stability of Emotional Health of Rural Pennsylvania Youth During High School

PURPOSE

Few prior studies have examined change in emotional health of high school students in a rural context. Considering the multifaceted nature of emotional health, this research aims to identify the patterns and explore change and stability of the emotional health of rural Pennsylvania youth. It also investigates the influence of family, peers, school, and the community environment on rural adolescents' emotional health.

METHODS

Using panel data from the Rural Youth Education Project, we employed latent transition analysis to examine changes in patterns of rural students' self-reported emotional health from 9^th grade to 11^th grade (N = 1,294).

FINDINGS

Four distinct emotional health subgroups for rural adolescents were identified. Over half of the youth in the sample felt emotionally well, or positive, in both 9^th and 11^th grades. Roughly 60% of rural youth remained in the same emotional health category from 9^th to 11^th grade, but a substantial minority experienced change in emotional health. One-fifth reported lower emotional health status in 11^th grade, and one-fifth indicated more positive emotions in 11^th than in 9^th grade. We found strong evidence of family, school, community, and peer influences on the emotional health of rural youth in 9^th grade.

CONCLUSIONS

The results suggest that while a large share of rural youth exhibit positive emotional health and remain positive across their high school years, a substantial share of rural youth experience changing emotional health. The study underscores the important role that family, peers, school, and the community environment play for rural youth's emotional health over time.

Financial stress response profiles and psychosocial functioning in low-income parents

Parenting in the context of poverty is accompanied by heightened stress and heightened stakes. How parents respond to poverty-related stress has important implications for family functioning, but research investigating individual differences in low-income mothers' and fathers' responses to financial stress and their associations with parents' concurrent psychosocial adaptation is lacking. A better understanding of differences in stress responses among low-income parents is required to develop and tailor prevention programs that meet these families' needs. This study applies latent profile analysis (LPA) to identify and describe profiles of financial stress responses (problem solving, emotion regulation, emotion expression, cognitive restructuring, positive thinking, acceptance, distraction, denial, avoidance, wishful thinking, rumination, intrusive thoughts, emotional arousal, physiologic arousal, impulsive action, emotional numbing, cognitive interference, escape, and inaction) and examines associations between profile membership and psychosocial functioning in low-income parents. Five profiles were identified that were distinguished by self-reported voluntary and involuntary financial stress responses: active (32% of sample), low (11%), high (11%), negative cognitive (NC; 17%), and average (29%) responders. Notable differences emerged on measures of life stress, economic hardship, psychopathology, and social support, with individuals in the NC responders profile reporting the most difficulty and members of the active responders profile reporting the greatest adaptation. These findings offer a more nuanced understanding of how mothers and fathers respond to chronic poverty-related stress and have valuable implications for intervention efforts to promote adaptive stress responses and psychosocial functioning in low-income families. (PsycINFO Database Record

Linking Patterns of Substance Use With Sexual Risk-Taking Among Female Adolescents With and Without Histories of Maltreatment

PURPOSE

This study aimed to determine the associations between patterns of substance use and sexual risk-taking among female adolescents with and without histories of maltreatment.

METHODS

Data are from a prospective cohort study examining the impact of maltreatment on subsequent female adolescent sexual health (N = 504). Participants averaged 18.24 years in age (SD = 1.12), and approximately 63% had substantiated incidences of maltreatment filed with Child Protective Services prior to age 18. The present study used latent class analysis to examine patterns in adolescent substance use, and negative binomial regression models to examine the links between patterns of substance use and sexual risk-taking and to determine whether these associations were moderated by adolescents' maltreatment status.

RESULTS

Six classes emerged from latent class analysis labeled as follows: abstainers (25% of sample); polysubstance users-early initiators (13%); polysubstance users-late initiators (23%); alcohol and cannabis users-late initiators (9%); alcohol users-late initiators (18%); and tobacco users (12%). Patterns of adolescent polysubstance use were associated with the highest levels of sexual risk-taking, and patterns of late-initiated polysubstance use, late-initiated alcohol use, and tobacco use were more strongly related to sexual risk-taking for female adolescents with histories of maltreatment.

CONCLUSIONS

This study is the first to determine the specific patterns of substance use that are more strongly related to sexual risk-taking for maltreated female adolescents. By doing so, this study demonstrates how a person-centered approach can facilitate our understanding of how to best leverage sexual risk-taking prevention efforts.

Latent Classes of Maltreatment: A Systematic Review and Critique

This article reviews and critically evaluates available research on latent classes of maltreatment. Three major databases (PsycINFO, Web of Knowledge, and Academic Search Complete) were used to identify studies on latent classes of maltreatment published before June 1, 2016. Of 365 potentially relevant studies, 14 met inclusion criteria for review. Our analysis was guided by the following questions: (a) What observed indicators are being used to model classes of maltreatment? (b) What are the most commonly identified classes of maltreatment? and (c) What are the predictors and outcomes of classes of maltreatment? Across the studies, findings demonstrated how person-centered methods (i.e., latent class/profile analysis) may facilitate the study of maltreatment by concurrently addressing several methodological limitations common to the study of maltreatment, while also addressing heterogeneity in experiences of maltreatment. After providing an account of existing trends within the literature employing person-centered methodology in the study of maltreatment, we offer a critique of extant research, note recent methodological developments, and make numerous recommendations for future research using person-centered approaches to understanding maltreatment.

Profiles of adolescent religiousness using latent profile analysis: Implications for psychopathology

Prior research has documented robust associations between adolescent religiousness/spirituality (R/S) and psychopathology outcomes including externalizing and internalizing symptomatology, yet no previous studies have examined these associations with adolescent R/S profiles using a person-centred approach. We examined whether there are identifiable subgroups characterized by unique multidimensional patterns of R/S experiences and how these experiences may be related to externalizing and internalizing symptomatology. The sample consisted of 220 Appalachian adolescents between 12 and 18 years old who were primarily White and primarily Christian. Latent profile analysis revealed three profiles of adolescent R/S: high religiousness (28.4%), introjectors (47.6%), and low religiousness (24.0%). These profiles were differentially related to internalizing and externalizing symptomatology such that the high religiousness group was significantly lower than the introjectors with respect to internalizing and externalizing symptomatology and lower than the low religiousness group in externalizing symptomatology. Implications and suggestions for future research using person-centred approaches to better understand differential developmental trajectories of religious development are provided. Statement of contribution What is already known Prior research has demonstrated a negative relationship between adolescent religiousness and spirituality (R/S) and psychopathology. Numerous studies document the differential relationships between aspects of R/S and psychopathology; however, few have done so from a person-centred perspective. There are several theories that outline how R/S to study R/S when paying specific attention to culture. Saroglou's Big Four dimensions of religion (believing, bonding, behaving, and belonging) posits that these four dimensions (1) are able to delimit religion from proximal constructs; (2) translate major distinct dimensions of religiousness; (3) can be seen across cultural contexts; and (4) are good candidates to study cultural variability in religion due to their diversity; however, to the authors' knowledge there has been no attempt to synthesize the Big Four dimensions and person-centred work. What the present study adds The present study found three profiles of adolescent R/S: high religiousness, low religiousness, and of particular interest, the introjectors. Those high in introjection seem to have a partial internalization of religiousness due to their low score in private practices but moderate to high scores on other aspects of religiousness. This group would not have been found through the use of traditional data analysis techniques or even through structural equation models. Importantly, those in the introjector group were also significantly higher in internalizing symptomatology than those in the high religiousness group, and higher in externalizing symptomatology than both the high religiousness and low religiousness. This 'u-shaped' pattern in which those in the middle-range of R/S were the worst off would also not have been found using traditional data analysis techniques.

Reasons for Marijuana Use Among Young Adults and Long-Term Associations With Marijuana Use and Problems

OBJECTIVE

This study examines reasons for marijuana use among young adults age 19/20 in the United States and the extent to which patterns of reasons are associated with marijuana use and problems 15 years later.

METHOD

The national Monitoring the Future study provided data on marijuana users at age 19/20 who were also surveyed at age 35 (n = 2,288; 50% women; 83% White). Latent class analysis was used to identify distinct patterns of reasons for marijuana use, which were then used as predictors of later marijuana use and problems.

RESULTS

Five latent classes described the following patterns of reasons for marijuana use at age 19/20: Experimental, Get High + Relax, Typical, Typical + Escape, and Coping + Drug Use. Highest risk for later marijuana use and problems was found for people with Coping + Drug Use and Get High + Relax reasons in young adulthood; those with Experimental reasons were at lowest risk for later use or problems.

CONCLUSIONS

Coping and getting high emerged as strong predictors of later marijuana use and problems. Results support the predictive value of self-reported reasons for using marijuana among young adults.

Contemporary alcohol use patterns among a national sample of U.S. adult drinkers

The aim of the current article is to identify subgroups of adult drinkers characterized by typical drinking patterns. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to classify drinkers based on several indicators of drinking. Past-year drinkers aged 18-64 were included (n = 22,776). Latent class analysis revealed a 5-class model: Occasional, Light Drinkers (28%), Frequent Drinkers (25%), Infrequent Drinkers with Occasional Binging (5%), Frequent Drinkers with Occasional Binging (22%), and High-Intensity Drinkers (20%). Although most were Light Drinkers, many engaged in excessive drinking. Given the potential risk for harm, prevention efforts are warranted particularly for High-Intensity Drinkers.

Longitudinal patterns of marijuana use across ages 18-50 in a US national sample: A descriptive examination of predictors and health correlates of repeated measures latent class membership

BACKGROUND

This descriptive study identified latent classes of longitudinal marijuana use from ages 18 through 50 among a national sample; examined covariate associations with class membership regarding use/non-use, use intensity, and use duration; and described associations between identified latent classes and age 50 health outcomes.

METHODS

The study involved collection and primary analysis of data from 9831 individuals first surveyed as 12th graders in the national Monitoring the Future study and followed through modal age 50. Repeated measures latent class analysis was used to identify latent classes based on self-reported past 12-month marijuana use.

RESULTS

Seven latent classes of marijuana use from ages 18 to 50 were identified including Non-users (44%), two classes characterized by shorter-term use patterns (totaling 28%), and four classes characterized by longer-term moderate or heavy use (totaling 28%). Use reduction appeared particularly likely during early and late 20s. Gender, parental education, alcohol/cigarette use, religious commitment, and marital status differentiated use/non-use, use intensity, and use duration after high school. In non-causal models controlling for covariates, longer-term marijuana use classes (where use extended into the late 20s or beyond) were associated with significantly higher odds of negative health outcomes at age 50.

CONCLUSIONS

Approximately 28% of the national sample reported longer-term moderate/heavy marijuana use, which was associated with negative health outcomes at age 50. The early and late 20s may be especially important periods for marijuana use prevention and intervention efforts, which may be strengthened by recognition of characteristics that appear to have significant associations with persistent use.

Comparing the Performance of Improved Classify-Analyze Approaches For Distal Outcomes in Latent Profile Analysis

Several approaches are available for estimating the relationship of latent class membership to distal outcomes in latent profile analysis (LPA). A three-step approach is commonly used, but has problems with estimation bias and confidence interval coverage. Proposed improvements include the correction method of Bolck, Croon, and Hagenaars (BCH; 2004), Vermunt's (2010) maximum likelihood (ML) approach, and the inclusive three-step approach of Bray, Lanza, & Tan (2015). These methods have been studied in the related case of latent class analysis (LCA) with categorical indicators, but not as well studied for LPA with continuous indicators. We investigated the performance of these approaches in LPA with normally distributed indicators, under different conditions of distal outcome distribution, class measurement quality, relative latent class size, and strength of association between latent class and the distal outcome. The modified BCH implemented in Latent GOLD had excellent performance. The maximum likelihood and inclusive approaches were not robust to violations of distributional assumptions. These findings broadly agree with and extend the results presented by Bakk and Vermunt (2016) in the context of LCA with categorical indicators.

The dynamics of internalizing and externalizing comorbidity across the early school years

High rates of comorbidity are observed between internalizing and externalizing problems, yet the developmental dynamics of comorbid symptom presentations are not yet well understood. This study explored the developmental course of latent profiles of internalizing and externalizing symptoms across kindergarten, first grade, and second grade. The sample consisted of 336 children from an urban, low-income community, selected based on relatively high (61%) or low (39%) aggressive/oppositional behavior problems at school entry (64% male; 70% African American, 20% Hispanic). Teachers reported on children's symptoms in each year. An exploratory latent profile analysis of children's scores on aggression/oppositionality, hyperactivity/inattention, anxiety, and social withdrawal symptom factors revealed four latent symptom profiles: comorbid (48% of the sample in each year), internalizing (19%-23%), externalizing (21%-22%), and well-adjusted (7%-11%). The developmental course of these symptom profiles was examined using a latent transition analysis, which revealed remarkably high continuity in the comorbid symptom profile (89% from one year to the next) and moderately high continuity in both the internalizing and externalizing profiles (80% and 71%, respectively). Internalizing children had a 20% probability of remitting to the well-adjusted profile by the following year, whereas externalizing children had a 25% probability of transitioning to the comorbid profile. These results are consistent with the hypothesis that a common vulnerability factor contributes to developmentally stable internalizing-externalizing comorbidity, while also suggesting that some children with externalizing symptoms are at risk for subsequently accumulating internalizing symptoms.

Early Adolescent Trajectories of Impulsiveness and Sensation Seeking in Children of Fathers with Histories of Alcohol and Other Substance Use Disorders

BACKGROUND

Problem substance use often begins in adolescence. This vulnerability likely stems, at least partially, from relatively rapid increases in sensation seeking occurring in early to mid-adolescence and more gradual improvements in impulse control occurring through later adolescence. Better understanding how these processes develop in high-risk youth may lead to enhanced substance use disorder treatment and prevention strategies.

METHODS

We characterized trajectories of self-reported impulsivity and sensation seeking in 305 FH+ youths who at minimum had a father with a history of alcohol or other drug use disorders and 81 youths with no family histories of substance use disorders (FH-). Assessments started at ages 10 to 12 and continued at 6-month intervals for up to 42 months. In addition, a subset of 58 FH+ youths who began alcohol or other drug use before age 15 (FH+ Users) were compared to 58 FH+ propensity-matched adolescents who did not initiate substance use before age 15 (FH+ Non-Users).

RESULTS

Compared to FH- youths at preadolescence, FH+ youths reported higher general impulsivity and higher impulsivity related to poor planning and attention. Over time, there were no differential effects of FH status on changes in impulsivity or sensation seeking across adolescence. FH+ Users had smaller decreases in general impulsivity and impulsivity related to restlessness and fidgeting across adolescence than FH+ Non-Users. FH+ Users also had greater increases in sensation seeking across adolescence than FH+ Non-Users.

CONCLUSIONS

Increased impulsivity in FH+ youths may make them less able to regulate sensation seeking drives that peak in adolescence, which may contribute to their high risk for developing substance use disorders. Additionally, FH+ adolescents who initiate early use may be at increased risk in part due to increased impulsivity coupled with greater increases in sensation seeking.

Altered developmental trajectories for impulsivity and sensation seeking among adolescent substance users

A number of studies have associated impulsivity and sensation seeking with level of substance use and risk for developing a substance use disorder. These relationships may be particularly apparent during adolescence, when developmental changes in impulsivity and sensation seeking occur at the same time as increased opportunities for substance use. To examine this, the current study measured impulsivity and sensation seeking from pre-adolescence to mid-adolescence in a sample of youth, the majority of whom were identified as being at risk for developing a substance use disorder based on their family history of substance use disorders. Youth were separated into those who did (n=117) and did not (n=269) initiate substance use by mid-adolescence. Results showed that substance users were more impulsive and more sensation seeking during pre-adolescence, prior to any significant substance use, and that greater sensation seeking in pre-adolescence was related to heavier substance use by mid-adolescence. In addition, developmental trajectories for substance-using youth showed a greater increase in sensation seeking but a more modest decrease in impulsivity from pre-adolescence to mid-adolescence. Taken together, these results indicate that increased impulsivity and sensation seeking is apparent in adolescent substance users as early as pre-adolescence, that the difference between substance users and non-users becomes larger across early adolescence as their developmental trajectories diverge, and that greater sensation seeking in pre-adolescence may predict increased substance use by mid-adolescence.