Greater social jetlag predicts poorer NIH Toolbox crystallized cognitive and academic performance in the Adolescent Brain Cognitive Development (ABCD) study

Academic performance plays a crucial role in long-term educational attainment and occupational function. Chronotype refers to an individual's daily tendencies for times for waking, activity, and sleep. Social jetlag reflects the mismatch between an individual's chronotype and their social schedule. Because school typically starts early in the morning, later chronotype is often associated with daytime sleepiness, insufficient sleep, and poor academic performance. However, the relationship between academic performance, chronotype, and social jetlag has not been extensively examined in large samples like the Adolescent Brain Cognitive Development (ABCD) study. We hypothesized that greater social jetlag would predict poorer cognitive and academic performance. Year 2 (ages 11-14) cross-sectional data from the ABCD cohort (n = 6,890 adolescents) were used to evaluate academic performance (i.e. self-reported past year grades), NIH Toolbox cognitive performance measures, chronotype, and social jetlag from the Munich Chronotype Questionnaire. We found that later chronotype and greater social jetlag predicted poorer cognitive and academic performance with small effect sizes. Our findings emphasize the importance of individual differences in chronotype and social jetlag when designing class schedules, as aligning school activities with student optimal sleep-wake times may contribute to improved academic performance.

How Does Parental Monitoring Reduce Adolescent Substance Use? Preliminary Tests of Two Potential Mechanisms

OBJECTIVE

The purpose of this study was to test two non-exclusive mechanisms by which parental monitoring might reduce teen substance use. The first mechanism (M1) is that monitoring increases punishment for substance use since parents who monitor more are more likely to find out when substance use occurs. The second mechanism (M2) is that monitoring directly prevents/averts teens from using substances in the first place for fear that parents would find out.

METHOD

A total of 4,503 teens ages 11-15 years old in 21 communities across the United States completed a survey reporting on parents' monitoring/knowledge and teens' substance use.

RESULTS

We found no support for M1: Parents with greater parental monitoring were not more likely to be aware when the teen had used substances (odds ratios = 0.79-0.93, ps = .34-.85), so they could not have increased the rate of punishment. We found support for M2: When asked directly, teens identified instances in which they planned to or had a chance to use substances but did not because their parents got in the way or would have found out (p < .01). Had all those opportunities for substance use occurred rather than been averted by parents, the prevalence of substance use in the sample would have been 1.4 times higher.

CONCLUSIONS

In this community-based sample of teens, we failed to support prior punishment-centric theories of how monitoring might reduce teen substance use. Rather, monitoring may directly discourage teens from using substances regardless of whether it increases parents' awareness of substance use or results in more punishment. Replication in other samples and contexts is needed.

Building towards an adolescent neural urbanome: Expanding environmental measures using linked external data (LED) in the ABCD study

Many recent studies have demonstrated that environmental contexts, both social and physical, have an important impact on child and adolescent neural and behavioral development. The adoption of geospatial methods, such as in the Adolescent Brain Cognitive Development (ABCD) Study, has facilitated the exploration of many environmental contexts surrounding participants' residential locations without creating additional burdens for research participants (i.e., youth and families) in neuroscience studies. However, as the number of linked databases increases, developing a framework that considers the various domains related to child and adolescent environments external to their home becomes crucial. Such a framework needs to identify structural contextual factors that may yield inequalities in children's built and natural environments; these differences may, in turn, result in downstream negative effects on children from historically minoritized groups. In this paper, we develop such a framework - which we describe as the "adolescent neural urbanome" - and use it to categorize newly geocoded information incorporated into the ABCD Study by the Linked External Data (LED) Environment & Policy Working Group. We also highlight important relationships between the linked measures and describe possible applications of the Adolescent Neural Urbanome. Finally, we provide a number of recommendations and considerations regarding the responsible use and communication of these data, highlighting the potential harm to historically minoritized groups through their misuse.

Relating neighborhood deprivation to childhood obesity in the ABCD study: Evidence for theories of neuroinflammation and neuronal stress

OBJECTIVE

We evaluated whether relationships between area deprivation (ADI), body mass index (BMI) and brain structure (e.g., cortical thickness, subcortical volume) during preadolescence supported the immunologic model of self-regulation failure (NI) and/or neuronal stress (NS) theories of overeating. The NI theory proposes that ADI causes structural alteration in the brain due to the neuroinflammatory effects of overeating unhealthy foods. The NS theory proposes that ADI-related stress negatively impacts brain structure, which causes stress-related overeating and subsequent obesity.

METHOD

Data were gathered from the Adolescent Brain Cognitive Development Study (9 to 12 years old; n = 3,087, 51% male). Linear mixed-effects models identified brain regions that were associated with both ADI and BMI; longitudinal associations were evaluated with mediation models. The NI model included ADI and BMI at 9 to 10 years old and brain data at 11 to 12 years old. The NS model included ADI and brain data at 9 to 10 years old and BMI at 11 to 12 years old.

RESULTS

BMI at 9 to 10 years old partially mediated the relationship between ADI and ventral diencephalon (DC) volume at 11 to 12 years old. Additionally, the ventral DC at 9 to 10 years old partially mediated the relationship between ADI and BMI at 11 to 12 years old, even in youth who at baseline, were of a healthy weight. Results were unchanged when controlling for differences in brain structure and weight across the 2-years.

CONCLUSION

Greater area deprivation may indicate fewer access to resources that support healthy development, like nutritious food and nonstressful environments. Our findings provide evidence in support of the NI and NS theories of overeating, specifically, with greater ADI influencing health outcomes of obesity via brain structure alterations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sociocultural influences on alcohol expectancies in early adolescence: Findings from the ABCD study

OBJECTIVE

Alcohol expectancies (AE) during early adolescence predict early alcohol use initiation and problem drinking both cross-sectionally and prospectively well into adulthood. Yet, our understanding of the sociocultural factors associated with AE during this development period remains limited. This study examines associations between AE and sociocultural factors across various domains (i.e., individual, family, peer, school, community, and culture) in a demographically diverse sample of 10- to 14-year-old youth in the Adolescent Brain Cognitive Development Study (ABCD Study).

METHOD

This cross-sectional study used 2-year follow-up data from the ABCD Release 3.0 for N = 5,322 early adolescents (Mage = 12 years [SD = 0.6]; 47% male). Approximately 60% identified as non-Hispanic/Latinx White, 17% as Hispanic/Latinx, 11% as non-Hispanic/Latinx Black, 2% as non-Hispanic/Latinx Asian, and 11% as mixed/other race-ethnicity. Separate models for positive and negative AE outcomes were conducted using linear mixed-effect models while controlling for demographic covariates.

RESULTS

Positive AE were most strongly associated with familism, followed by other peer, school, community, and cultural level factors. Negative AE were most strongly associated with the peer-level factor of relational victimization and the individual-level factor of negative life events, followed by other peer, school, and community-level factors.

CONCLUSION

The present findings reveal the potential constellation of sociocultural factors that may serve as targets for modifying AE during the middle school years. Study results also underscore the need for future research that integrates cultural factors into our understanding of alcohol use risk and resilience during early adolescence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Parental knowledge/monitoring and adolescent substance use: A causal relationship?

OBJECTIVE

Many studies have shown that parental knowledge/monitoring is correlated with adolescent substance use, but the association may be confounded by the many preexisting differences between families with low versus high monitoring. We attempted to produce more rigorous evidence for a causal relation using a longitudinal design that took advantage of within-family fluctuations in knowledge/monitoring during the COVID-19 pandemic.

METHOD

Youth (N = 8,780, age range = 10.5-15.6 years) at 21 sites across the United States completed up to seven surveys over 12 months. Youth reported on their parents' knowledge/monitoring of their activities and their substance use in the past month. Regressions were fit to within-family changes in youth-perceived knowledge/monitoring and substance use between survey waves. By analyzing within-family changes over time, we controlled for all stable, a priori differences that exist between families with low versus high levels of youth-perceived knowledge/monitoring.

RESULTS

Youth initially denying substance use were significantly more likely to start reporting use when they experienced a decrease in the level of perceived knowledge/monitoring (relative risk [RR] = 1.18, p < .001). Youth initially endorsing substance use were significantly more likely to stop reporting use when they experienced an increase in the level of perceived knowledge/monitoring (RR = 1.06; p < .001). Associations were similar or larger when adjusting for several time-varying potential confounders.

CONCLUSION

In a large, sociodemographically diverse sample, within-family changes in youth-perceived parental knowledge/monitoring over time were robustly associated with changes in youths' engagement in substance use. Findings lend support to the hypothesis that parent knowledge/monitoring is causally related to substance involvement in early adolescence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of the COVID-19 pandemic on screen time and sleep in early adolescents

OBJECTIVE

During the COVID-19 pandemic, adolescents and families have turned to online activities and social platforms more than ever to maintain well-being, connect remotely with friends and family, and online schooling. However, excessive screen use can have negative effects on health (e.g., sleep). This study examined changes in sleep habits and recreational screen time (social media, video gaming), and their relationship, before and across the first year of the pandemic in adolescents in the Adolescent Brain Cognitive Development (ABCD) Study.

METHOD

Mixed-effect models were used to examine associations between self-reported sleep and screen time using longitudinal data of 5,027 adolescents in the ABCD Study, assessed before the pandemic (10-13 years) and across six time points between May 2020 and March 2021 (pandemic).

RESULTS

Time in bed varied, being higher during May-August 2020 relative to pre-pandemic, partially related to the school summer break, before declining in October 2020 to levels lower than pre-pandemic. Screen time steeply increased and remained high across all pandemic time points relative to pre-pandemic. Higher social media use and video gaming were associated with shorter time in bed, later bedtimes, and longer sleep onset latency.

CONCLUSIONS

Sleep behavior and screen time changed during the pandemic in early adolescents. More screen time was associated with poorer sleep behavior, before and during the pandemic. While recreational screen usage is an integral component of adolescent's activities, especially during the pandemic, excessive use can have negative effects on essential health behaviors, highlighting the need to promote balanced screen usage. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Acculturative Orientations Among Hispanic/Latinx Caregivers in the ABCD Study: Associations With Caregiver and Youth Mental Health and Youth Brain Function

Background

Population-based neuroscience offers opportunities to examine important but understudied sociocultural factors such as acculturation. Acculturation refers to the extent to which an individual retains their cultural heritage and/or adopts the receiving society's culture and is particularly salient among Hispanic/Latinx immigrants. Specific acculturative orientations have been linked to vulnerability to substance use, depression, and suicide and are known to influence family dynamics between caregivers and their children.

Methods

Using data from first- and second-generation Hispanic/Latinx caregivers in the Adolescent Brain Cognitive Development (ABCD) Study (N = 1057), we examined how caregivers' acculturative orientation affects their mental health, as well as the mental health and brain function of their children. Neuroimaging analyses focused on regions associated with self- and affiliation-based social processing (ventromedial prefrontal cortex, insula, and temporoparietal junction).

Results

We identified 2 profiles of caregiver acculturation: bicultural (retains heritage culture while adopting U.S. culture) and detached (discards heritage culture and rejects U.S. culture). Bicultural caregivers exhibited fewer internalizing and externalizing problems than detached caregivers; furthermore, youth exhibited similar internalizing effects across caregiver profiles. In addition, youth with bicultural caregivers displayed increased resting-state brain activity (i.e., fractional amplitude of low-frequency fluctuations and regional homogeneity) in the left insula, which has been linked to psychopathology; however, differences in long-range functional connectivity were not significant.

Conclusions

Caregiver acculturation is an important familial factor that has been linked to significant differences in youth mental health and insula activity. Future work should examine sociocultural and neurodevelopmental changes across adolescence to assess health outcomes and determine whether localized, corticolimbic brain effects are ultimately translated into long-range connectivity differences.

Pandemic-Related Changes in the Prevalence of Early Adolescent Alcohol and Drug Use, 2020-2021: Data From a Multisite Cohort Study

PURPOSE

Evaluate changes in early adolescent substance use from May 2020 to May 2021 during the coronavirus disease 2019 pandemic using data from a prospective nationwide cohort: the Adolescent Brain Cognitive Development Study.

METHODS

In 2018-2019, 9,270 youth aged 11.5-13.0 completed a prepandemic assessment of past-month alcohol and drug use, then up to seven during-pandemic assessments between May 2020 and May 2021. We compared the prevalence of substance use among same-age youth across these eight timepoints.

RESULTS

Pandemic-related decreases in the past-month prevalence of alcohol use were detectable in May 2020, grew larger over time, and remained substantial in May 2021 (0.3% vs. 3.2% prepandemic, p <.001). Pandemic-related increases in inhalant use (p = .04) and prescription drug misuse (p < .001) were detectable in May 2020, shrunk over time, and were smaller but still detectable in May 2021(0.1%-0.2% vs. 0% pre-pandemic). Pandemic-related increases in nicotine use were detectable between May 2020 and March 2021 and no longer significantly different from prepandemic levels in May 2021 (0.5% vs. 0.2% prepandemic, p = .09). There was significant heterogeneity in pandemic-related change in substance use at some timepoints, with increased rates among youth identified as Black or Hispanic or in lower-income families versus stable or decreased rates among youth identified as White or in higher-income families.

DISCUSSION

Among youth ages 11.5-13.0 years old, rates of alcohol use remained dramatically reduced in May 2021 relative to prepandemic and rates of prescription drug misuse and inhalant use remained modestly increased. Differences remained despite the partial restoration of prepandemic life, raising questions about whether youth who spent early adolescence under pandemic conditions may exhibit persistently different patterns of substance use.

Family Well-Being During the COVID-19 Pandemic: The Risks of Financial Insecurity and Coping

During the COVID-19 pandemic, families have experienced unprecedented financial and social disruptions. We studied the impact of preexisting psychosocial factors and pandemic-related financial and social disruptions in relation to family well-being among N = 4091 adolescents and parents during early summer 2020, participating in the Adolescent Brain Cognitive DevelopmentSM Study. Poorer family well-being was linked to prepandemic psychosocial and financial adversity and was associated with pandemic-related material hardship and social disruptions to routines. Parental alcohol use increased risk for worsening of family relationships, while a greater endorsement of coping strategies was mainly associated with overall better family well-being. Financial and mental health support may be critical for family well-being during and after a widespread crisis, such as the COVID-19 pandemic.

Location matters: Regional variation in association of community burden of COVID-19 with caregiver and youth worry

Our study characterized associations between three indicators of COVID-19's community-level impact in 20 geographically diverse metropolitan regions and how worried youth and their caregivers in the Adolescent Brain Cognitive Development℠ Study have been about COVID-19. County-level COVID-19 case/death rates and monthly unemployment rates were geocoded to participants' addresses. Caregivers' (vs. youths') COVID-19-related worry was more strongly associated with COVID-19's community impact, independent of sociodemographics and pre-pandemic anxiety levels, with these associations varying by location. Public-health agencies and healthcare providers should avoid adopting uniform "one-size-fits-all" approaches to addressing COVID-19-related emotional distress and must consider specific communities' needs, challenges, and strengths.

Parental Knowledge/Monitoring and Depressive Symptoms During Adolescence: Protective Factor or Spurious Association?

Parental knowledge/monitoring is negatively associated with adolescents' depressive symptoms, suggesting monitoring could be a target for prevention and treatment. However, no study has rigorously addressed the possibility that this association is spurious, leaving the clinical and etiological implications unclear. The goal of this study was to conduct a more rigorous test of whether knowledge/monitoring is causally related to depressive symptoms. 7940 youth (ages 10.5-15.6 years, 49% female) at 21 sites across the U.S. completed measures of parental knowledge/monitoring and their own depressive symptoms at four waves 11-22 weeks apart during the COVID-19 pandemic. First, monitoring and depression were examined in standard, between-family regression models. Second, within-family changes in monitoring and depression between assessments were examined in first differenced regressions. Because the latter models control for stable, between-family differences, they comprise a stronger test of a causal relation. In standard, between-family models, parental monitoring and youths' depressive symptoms were negatively associated (standardized [Formula: see text]= -0.22, 95% CI = [-0.25, -0.20], p < 0.001). In first-differenced, within-family models, the association shrunk by about 55% (standardized [Formula: see text]= -0.10, 95% CI = [-0.12, -0.08], p < 0.001). The magnitude of within-family association remained similar when adjusting for potential time-varying confounders and did not vary significantly by youth sex, age, or history of depressive disorder. Thus, in this community-based sample, much of the prima facie association between parental knowledge/monitoring and youths' depressive symptoms was driven by confounding variables rather than a causal process. Given the evidence to date, a clinical focus on increasing parental knowledge/monitoring should not be expected to produce meaningfully large improvements in youths' depression.

Age-related changes and longitudinal stability of individual differences in ABCD Neurocognition measures

Temporal stability of individual differences is an important prerequisite for accurate tracking of prospective relationships between neurocognition and real-world behavioral outcomes such as substance abuse and psychopathology. Here we report age-related changes and longitudinal test-retest stability (TRS) for the Neurocognition battery of the Adolescent Brain and Cognitive Development (ABCD) study, which included the NIH Toolbox (TB) Cognitive Domain and additional memory and visuospatial processing tests administered at baseline (ages 9-11) and two-year follow-up. As expected, performance improved significantly with age, but the effect size varied broadly, with Pattern Comparison and the Crystallized Cognition Composite showing the largest age-related gain (Cohen's d:.99 and.97, respectively). TRS ranged from fair (Flanker test: r = 0.44) to excellent (Crystallized Cognition Composite: r = 0.82). A comparison of longitudinal changes and cross-sectional age-related differences within baseline and follow-up assessments suggested that, for some measures, longitudinal changes may be confounded by practice effects and differences in task stimuli or procedure between baseline and follow-up. In conclusion, a subset of measures showed good stability of individual differences despite significant age-related changes, warranting their use as prospective predictors. However, caution is needed in the interpretation of observed longitudinal changes as indicators of neurocognitive development.

The Pandemic's Toll on Young Adolescents: Prevention and Intervention Targets to Preserve Their Mental Health

PURPOSE

Adolescence is characterized by dramatic physical, social, and emotional changes, making teens particularly vulnerable to the mental health effects of the COVID-19 pandemic. This longitudinal study identifies young adolescents who are most vulnerable to the psychological toll of the pandemic and provides insights to inform strategies to help adolescents cope better in times of crisis.

METHODS

A data-driven approach was applied to a longitudinal, demographically diverse cohort of more than 3,000 young adolescents (11-14 years) participating in the ongoing Adolescent Brain Cognitive Development Study in the United States, including multiple prepandemic visits and three assessments during the COVID-19 pandemic (May-August 2020). We fitted machine learning models and provided a comprehensive list of predictors of psychological distress in individuals.

RESULTS

Positive affect, stress, anxiety, and depressive symptoms were accurately detected with our classifiers. Female sex and prepandemic internalizing symptoms and sleep problems were strong predictors of psychological distress. Parent- and youth-reported pandemic-related psychosocial factors, including poorer quality and functioning of family relationships, more screen time, and witnessing discrimination in relation to the pandemic further predicted youth distress. However, better social support, regular physical activities, coping strategies, and healthy behaviors predicted better emotional well-being.

DISCUSSION

Findings highlight the importance of social connectedness and healthy behaviors, such as sleep and physical activity, as buffering factors against the deleterious effects of the pandemic on adolescents' mental health. They also point to the need for greater attention toward coping strategies that help the most vulnerable adolescents, particularly girls and those with prepandemic psychological problems.

Resilience to COVID-19: Socioeconomic Disadvantage Associated With Positive Caregiver-Youth Communication and Youth Preventative Actions

Socioeconomic disadvantage is associated with larger COVID-19 disease burdens and pandemic-related economic impacts. We utilized the longitudinal Adolescent Brain Cognitive Development Study to understand how family- and neighborhood-level socioeconomic disadvantage relate to disease burden, family communication, and preventative responses to the pandemic in over 6,000 youth-caregiver dyads. Data were collected at three timepoints (May-August 2020). Here, we show that both family- and neighborhood-level disadvantage were associated with caregivers' reports of greater family COVID-19 disease burden, less perceived exposure risk, more frequent caregiver-youth conversations about COVID-19 risk/prevention and reassurance, and greater youth preventative behaviors. Families with more socioeconomic disadvantage may be adaptively incorporating more protective strategies to reduce emotional distress and likelihood of COVID-19 infection. The results highlight the importance of caregiver-youth communication and disease-preventative practices for buffering the economic and disease burdens of COVID-19, along with policies and programs that reduce these burdens for families with socioeconomic disadvantage.

Clouding up cognition?: Secondhand cannabis and tobacco exposure related to cognitive functioning in youth

Background

Increasing legalization of cannabis, in addition to longstanding rates of tobacco use, raises concerns for possible cognitive decrements from secondhand smoke or environmental exposure, although little research exists. We investigate the relation between cognition and secondhand and environmental cannabis and tobacco exposure in youth.

Methods

The Adolescent Brain Cognitive Development (ABCD) Study year 2 follow-up (N = 5580; 48% female) cognitive performance and secondhand or environmental cannabis or tobacco exposure data were used. Principal components analysis identified a global cognition factor. Linear mixed-effects models assessed global cognition and individual cognitive task performance by cannabis and/or tobacco environmental exposure. Sociodemographics and other potential confounds were examined. p values were adjusted using the false discovery rate method.

Results

Global cognition was not related to any exposure group after testing corrections and considering confounds. Beyond covariates and family- and site-level factors, secondhand tobacco was related to poorer visual memory (p = .02), and environmental tobacco was associated with poorer visuospatial (p = .02) and language (p = .008) skills. Secondhand cannabis was related to cognition, but not after controlling for potential confounders (p > .05). Environmental cannabis was related to better oral reading (p = .01). Including covariates attenuated effect sizes.

Conclusions

Secondhand tobacco exposure was associated with poorer visual memory, while environmental tobacco exposure was related to poorer language and visuospatial skills. Secondhand cannabis was not related to cognition after controlling for sociodemographic factors, but environmental cannabis exposure was related to better reading. Because, to our knowledge, this is the first known study of its kind and thus preliminary, secondhand cannabis should continue to be investigated to confirm results.

An update on the assessment of culture and environment in the ABCD Study®: Emerging literature and protocol updates over three measurement waves

Advances in our understanding of risk and resilience factors in adolescent brain health and development increasingly demand a broad set of assessment tools that consider a youth's peer, family, school, neighborhood, and cultural contexts in addition to neurobiological, genetic, and biomedical information. The Culture and Environment (CE) Workgroup (WG) of the Adolescent Brain Cognitive Development (ABCD) Study curates these important components of the protocol throughout ten years of planned data collection. In this report, the CE WG presents an update on the evolution of the ABCD Study® CE protocol since study inception (Zucker et al., 2018), as well as emerging findings that include CE measures. Background and measurement characteristics of instruments present in the study since baseline have already been described in our 2018 report, and therefore are only briefly described here. New measures introduced since baseline are described in more detail. Descriptive statistics on all measures are presented based on a total sample of 11,000+ youth and their caregivers assessed at baseline and the following two years. Psychometric properties of the measures, including longitudinal aspects of the data, are reported, along with considerations for future measurement waves. The CE WG ABCD® components are an essential part of the overall protocol that permits characterization of the unique cultural and social environment within which each developing brain is transactionally embedded.

Adolescent Brain Cognitive Development (ABCD) study Linked External Data (LED): Protocol and practices for geocoding and assignment of environmental data

Our brain is constantly shaped by our immediate environments, and while some effects are transient, some have long-term consequences. Therefore, it is critical to identify which environmental risks have evident and long-term impact on brain development. To expand our understanding of the environmental context of each child, the Adolescent Brain Cognitive Development (ABCD) Study® incorporates the use of geospatial location data to capture a range of individual, neighborhood, and state level data based on the child's residential location in order to elucidate the physical environmental contexts in which today's youth are growing up. We review the major considerations and types of geocoded information incorporated by the Linked External Data Environmental (LED) workgroup to expand on the built and natural environmental constructs in the existing and future ABCD Study data releases. Understanding the environmental context of each youth furthers the consortium's mission to understand factors that may influence individual differences in brain development, providing the opportunity to inform public policy and health organization guidelines for child and adolescent health.

Substance use patterns in 9-10 year olds: Baseline findings from the adolescent brain cognitive development (ABCD) study

BACKGROUND

The Adolescent Brain Cognitive Development ™ Study (ABCD Study®) is an open-science, multi-site, prospective, longitudinal study following over 11,800 9- and 10-year-old youth into early adulthood. The ABCD Study aims to prospectively examine the impact of substance use (SU) on neurocognitive and health outcomes. Although SU initiation typically occurs during teen years, relatively little is known about patterns of SU in children younger than 12.

METHODS

This study aims to report the detailed ABCD Study® SU patterns at baseline (n = 11,875) in order to inform the greater scientific community about cohort's early SU. Along with a detailed description of SU, we ran mixed effects regression models to examine the association between early caffeine and alcohol sipping with demographic factors, externalizing symptoms and parental history of alcohol and substance use disorders (AUD/SUD).

PRIMARY RESULTS

At baseline, the majority of youth had used caffeine (67.6 %) and 22.5 % reported sipping alcohol (22.5 %). There was little to no reported use of other drug categories (0.2 % full alcohol drink, 0.7 % used nicotine, <0.1 % used any other drug of abuse). Analyses revealed that total caffeine use and early alcohol sipping were associated with demographic variables (p's<.05), externalizing symptoms (caffeine p = 0002; sipping p = .0003), and parental history of AUD (sipping p = .03).

CONCLUSIONS

ABCD Study participants aged 9-10 years old reported caffeine use and alcohol sipping experimentation, but very rare other SU. Variables linked with early childhood alcohol sipping and caffeine use should be examined as contributing factors in future longitudinal analyses examining escalating trajectories of SU in the ABCD Study cohort.

Associations of developmental imbalance between sensation seeking and premeditation in adolescence and heavy episodic drinking in emerging adulthood

BACKGROUND

Dual systems theories suggest that greater imbalance between higher reward sensitivity and lower cognitive control across adolescence conveys risk for behaviors such as heavy episodic drinking (HED). Prior research demonstrated that psychological analogues of these systems, sensation seeking and premeditation, change from childhood through emerging adulthood, and each has been independently linked with HED. However, few studies have assessed whether change over time in these developing analogues is prospectively associated with HED. Moreover, we know of no research that has shown whether within-person differences between higher sensation seeking and relatively lower premeditation across the adolescent period predict HED in emerging adulthood.

METHODS

Prospective data from the National Consortium on Alcohol and NeuroDevelopment in Adolescence study (n = 715) were used to examine the association of sensation seeking and premeditation with HED among adolescents ages 16 to 20 years. We used novel applications of latent difference score modeling and growth curve analysis to test whether increasing sensation seeking, premeditation, and their imbalance over time are associated with HED across the study period, and whether these associations differed by sex.

RESULTS

Whereas premeditation increased linearly from adolescence through emerging adulthood across sexes, males reported growth and females reported decline in sensation seeking. Sensation seeking in adolescence (and not premeditation) was associated with higher levels of HED by emerging adulthood. Importantly, greater imbalance between sensation seeking and premeditation was associated with higher levels of HED by emerging adulthood though we note that variability capturing this imbalance correlated highly (r = 0.86) with baseline levels of sensation seeking.

CONCLUSIONS

Developmental imbalance between higher sensation seeking and lower premeditation in late adolescence may be a risk factor for greater HED in emerging adulthood.

Risk factors associated with curiosity about alcohol use in the ABCD cohort

Curiosity and intent to use alcohol in pre-adolescence is a risk factor for later experimentation and use, yet we know little of how curiosity about use develops. Here, we examine factors that may influence curiosity about alcohol use, as it may be an important predictor of later drinking behavior. Cross-sectional data on youth ages 10-11 from the ongoing Adolescent Brain Cognitive Development℠ (ABCD) Study Year 1 follow-up were used (n = 2,334; NDA 2.0.1). All participants were substance-naïve at time of assessment. Group factor analysis identified latent factors across common indicators of risk for early substance use (i.e., psychopathology and trait characteristics; substance use attitudes/behaviors; neurocognition; family and environment). Logistic mixed-effect models tested associations between latent factors of risk for early substance use and curiosity about alcohol use, controlling for demographics and study site. Two multidimensional factors were significantly inversely and positively associated with greater curiosity about alcohol use, respectively: 1) low internalizing and externalizing symptomatology coupled with low impulsivity, perceived neighborhood safety, negative parental history of alcohol use problems, and fewer adverse life experiences and family conflict; and 2) low perceived risk of alcohol use coupled with lack of peer disapproval of use. When assessing all risk factors in an overall regression, lack of perceived harm from trying alcohol once or twice was associated with greater likelihood of alcohol curiosity. Taken together, perceptions that alcohol use causes little harm and having peers with similar beliefs is related to curiosity about alcohol use among substance-naïve 10-11-year-olds. General mental health and environmental risk factors similarly increase the odds of curiosity for alcohol. Identification of multidimensional risk factors for early alcohol use may point to novel prevention and early intervention targets. Future longitudinal investigations in the ABCD cohort will determine the extent to which these factors and curiosity predict alcohol use among youth.

A Comprehensive Overview of the Physical Health of the Adolescent Brain Cognitive Development Study Cohort at Baseline

Physical health in childhood is crucial for neurobiological as well as overall development, and can shape long-term outcomes into adulthood. The landmark, longitudinal Adolescent Brain Cognitive Development Study^SM (ABCD study^®), was designed to investigate brain development and health in almost 12,000 youth who were recruited when they were 9-10 years old and will be followed through adolescence and early adulthood. The overall goal of this paper is to provide descriptive analyses of physical health measures in the ABCD study at baseline, including but not limited to sleep, physical activity and sports involvement, and body mass index. Further this summary will describe how physical health measures collected from the ABCD cohort compare with current normative data and clinical guidelines. We propose this data set has the potential to facilitate clinical recommendations and inform national standards of physical health in this age group. This manuscript will also provide important information for ABCD users and help guide analyses investigating physical health including new avenues for health disparity research as it pertains to adolescent and young adult development.

P1638Predictors of in-hospital and late mortality in acutely decompensated chronic heart failure

Background

Heart failure (HF) is a global pandemic, and the cause of the greater health expenditure on hospitalization.

Purpose

To determine, in patients admitted due to decompensated heart failure (dHF), the predictors of in-hospital and late all-cause mortality.

Methods

Retrospective and longitudinal observational study of consecutive patients admitted with a diagnosis of dHF in a General Hospital between 2000–2015. Primary objective was in-hospital and late mortality.

Results

A total of 3705 patients were included (76.9 + 10.1 years, 54.1% women). Diabetes was present in 1611 (43.5%) patients, hypertension in 3210 (86.6%), active smoking in 221 (6%), COPD in 989 (26.7%), neoplasms in 415 (11.2%), chronic renal failure (CRF) in 628 (17%), previous myocardial infarction (pMI) in 449 (12.1%), stroke in 416 (11.2%), previous heart failure (pHF) in 1015 (27.4%), atrial fibrillation in 1672 (45.1%). A total of 239 (6.5%) lived in a nursing home (NH). The rate of 6-months readmission due to heart failure was 473 (12.8%). The in-hospital all-cause mortality rate was 9.3% (345). During a median follow-up of 930 days (RI 230–2611), 2165 (58.4%) patients died.

The following variables were independent predictors of in-hospital mortality (Odds ratio, 95% CI): age 1.03 (1.02–1.05), basal creatinine 1.18 (1.01–1.39) and urea 1.014 (1.011–1.018) (model AUC 0.78 (0.75–0.81)). We identified the following predictors of late mortality (Hazard ratio, 95% CI): age 1,029 (1,022–1,035), diabetes mellitus 1,13 (1,02–1,25), COPD 1,15 (1,03–1,28), neoplasms 1,17 (1,008–1,361), pMI 1.19 (1.02–1.38), pHF 1.25 (1.12–1.39), NH 1.24 (1.03–1.49), readmission 1.73 (1.51–1.97), urea 1.003 (1.001–1.005) (model AUC 0.73 (0.71–0.75)).

Conclusions

In-hospital mortality was significantly associated with age and markers of renal function, while for late mortality the predictors were comorbidities, hospital readmissions and living in a nursing home.

Matrix Metalloproteinase 1 as a Novel Biomarker for Monitoring Hepatocellular Carcinoma in Liver Transplant Patients

INTRODUCTION

Orthotopic liver transplantation (LT) is considered to be one of the few curative treatments available for early stages of hepatocellular carcinoma (HCC). Alfa-fetoprotein (AFP) is the most-used biomarker for HCC despite low sensitivity and specificity. Matrix metalloproteinase 1 (MMP-1) has been considered to be involved in the process of vascular invasion of the malignant cells. The objective of this study was to assess the use of MMP-1 for the management of HCC patients for LT.

METHODS

Levels in serum of MMP-1 (ng/mL) and AFP (ng/mL) were assessed in 20 HCC patients (Milan criteria) before and 1, 6, and 12 months after LT.

RESULTS

There was a strong significant correlation between levels of MMP-1 and levels of AFP (ρ = .954; P ≤ .05). There were statistical differences in the levels of MMP-1 and APF between the pre-transplantation and post-transplantation groups (1 and 12 months). Increments of both markers 6 months after LT compared with the levels 1 month after LT were detected in 4 of the 20 HCC patients. The detection of recurrence by means of imaging was coincident with the increment of both markers 6 months after LT in 3 of those 4 patients.

CONCLUSIONS

After 12 months of follow-up, levels of MMP-1 were comparable to AFP levels after LT. Levels of both markers increase 6 months after LT in patients showing recurrence, indicating discriminatory power to predict relapse and thus serving as valuable markers for HCC monitoring. MMP-1 could be useful in the management of HCC after LT.

Bacterial pore-forming toxins: the (w)hole story?

Pore-forming toxins (PFTs) are the most common class of bacterial protein toxins and constitute important bacterial virulence factors. The mode of action of PFT is starting to be better understood. In contrast, little is known about the cellular response to this threat. Recent studies reveal that cells do not just swell and lyse, but are able to sense and react to pore formation, mount a defense, even repair the damaged membrane and thus survive. These responses involve a variety of signal-transduction pathways and sophisticated cellular mechanisms such as the pathway regulating lipid metabolism. In this review we discuss the different classes of bacterial PFTs and their modes of action, and provide examples of how the different bacteria use PFTs. Finally, we address the more recent field dealing with the eukaryotic cell response to PFT-induced damage.

Combined bronchoalveolar lavage and transbronchial lung biopsy: safety and yield in ventilated patients

The aim of this study was to evaluate the safety and diagnostic yield of bedside bronchoalveolar lavage (BAL) combined with fibrescopic transbronchial lung biopsy (TBLB) in determining the aetiology of pulmonary infiltrates in mechanically ventilated patients. The records of 38 mechanically ventilated patients who underwent BAL/TBLB to investigate unexplained pulmonary infiltrates were retrospectively reviewed. Patients were divided into two groups: immunocompetent (group 1: n = 22; group 1a: n = 11, late acute respiratory distress syndrome (ARDS); group 1b: n = 11, no ARDS) and immunocompromised (group 2, n=16). The procedure allowed a diagnosis in 28 patients (74%), inducing therapeutic modification in 24 (63%) and confirmation of clinical diagnosis in four (11%). In groups 1a, 1b and 2, diagnosis was obtained in 11 out of 11 (fibroproliferation), seven out of 11 and 10 out of 16 patients, and therapy changed in 11 out of 11 (administration of steroids), six out of 11 and seven out of 16 patients, respectively. Pneumothorax occurred in nine patients (four of group 1a), bleeding in four (<35 mL), and transient hypotension in two. No fatalities were procedure-related. Combined bronchoalveolar lavage/transbronchial lung biopsy is of diagnostic and therapeutic value in mechanically ventilated patients with unexplained pulmonary infiltrates, excluding those with late acute respiratory distress syndrome. Although complications are to be expected, the benefits of the procedure appear to exceed the risks in patients in whom a histological diagnosis is deemed necessary.

Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care?

OBJECTIVES

Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a cause of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD) treated with corticosteroids. For these patients admission in intensive care unit (ICU) is often required for life-support and mechanical ventilation. Whether this approach improves outcome is unknown.

DESIGN AND SETTING

Retrospective study in a university hospital intensive care unit.

PATIENTS

Between November 1993 and December 1997, 23 COPD patients were admitted in our ICU and received antifungal agents for possible IPA.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

The clinical features and the outcome were reviewed. Diagnosis of IPA was classified as confirmed (positive lung tissue biopsy and/or autopsy) or probable (repeated isolation of Aspergillus from the airways with consistent clinical and radiological findings). Among the 23 patients treated for Aspergillus, 16 fulfilling these criteria for IPA were studied. Steroids had been administered at home to all patients but one and were increased during hospitalization in all. Twelve patients suffered a worsening of their bronchospasm precipitating acute respiratory failure. During ICU stay all patients required mechanical ventilation for acute respiratory failure. Although amphotericin B deoxycholate was started when IPA was suspected (0.5-1.5 mg/kg per day), all patients died in septic shock (n = 5) or in multiple-organ failure.

CONCLUSIONS

The poor prognosis of intubated COPD patients with IPA, in spite of antifungal treatment suggests that further studies are required to define the limits and indications for ICU management of these patients.

Prospective, randomized trial of template-assisted versus undirected written recording of physician records in the emergency department

STUDY OBJECTIVE

To determine whether use of the T-System (Emergency Services Consultants, Irving, TX) template-generated medical documentation system (1) decreases physician evaluation time in the emergency department, (2) increases gross billing under the 1997 Health Care Financing Administration guidelines by minimizing downcoding caused by inadequate documentation, and (3) increases physician satisfaction with the documentation process, compared with the undirected written narrative format.

METHODS

A prospective, randomized, unblinded, controlled, convenience trial of documentation with the T-System of ED templates versus undirected written documentation was conducted in the ED of a county-owned, university-affiliated hospital. All patients seen between the hours of 7 AM and 10 PM during a 16-day period were included. The intervention was varying the method of documentation of the emergency physician. Adequacy of randomization to the 2 documentation groups was assessed by comparing ED triage classification, patient disposition, level of training of the evaluating physician, and whether ED consultation with other services occurred. Outcome measurements included emergency physician total evaluation and treatment time, professional bill, and satisfaction, as evaluated by a questionnaire completed after the study period. The 2 documentation groups were compared by an intention-to-treat analysis and by Student's t test and the median test as appropriate.

RESULTS

A total of 1,228 patient encounters were included. Emergency physician total evaluation and treatment time with template-directed documentation was 4.6 minutes less than with undirected recording, a difference that was not significant (95% confidence interval [CI], -9.2 to 18.3). Gross billing was $29. 60 more per patient (95% CI, $22.20 to $37.00) with the T-System, as assessed by our hospital coders. This difference was caused by a mean.50 (95% CI,.39 to.60) higher level of evaluation and management coding. Physicians preferred the T-System (P <.0005).

CONCLUSION

Use of template-assisted documentation in the ED was associated with higher gross billing and physician satisfaction but no significant decrease in emergency physician total evaluation time.

Evaluation of lymphocyte activation by flow cytometric determination of interleukin-2 (CD25) receptor

Lymphocyte response to mitogens is a habitually-used test in the evaluation of the immune system. The usual method with [3H]thymidine yields results which are difficult to interpret. In our search for an alternative, we examined the feasibility of determining T lymphocyte activation by measuring interleukin-2 receptor (CD25) expression with flow cytometry. We found a good correlation between CD25 molecule expression and the dose of phytohemagglutinin, however, there was no correlation between disintegrations per minute produced by [3H]thymidine uptake and the percentage of CD25 expressed by cells.

Chronic intracerebral haematoma

Chronic intracerebral haematoma is a rare entity. The natural history of this condition is unclear and its diagnosis is difficult. Two cases of chronic intracerebral haematoma from different sources are reported. We discuss the controversies about its pathogenesis, clinical presentation, CT diagnosis and treatment.