The idiosyncratic definition of nicotine dependence.
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Adolescent↗
Biomedical subjects
N Breslau
Publications and source records attributed to N Breslau.
Sex differences in posttraumatic stress disorder.
BACKGROUND: Epidemiologic surveys in the general population documented a higher rate of posttraumatic stress disorder (PTSD) in women than in men. To date, the finding has received little scientific attention. This study examines the extent to which sex differences in PTSD might be explained by previously identified risk factors and whether the sex difference in PTSD varied by age at exposure to traumatic events. METHODS: The NIMH-DIS (NIMH Diagnostic Interview Schedule, Version III Revised) was used to measure DSM-IIIR disorders in a random sample of 1007 young adults. Cox proportional hazards models were used to estimate changes in the hazards ratio for PTSD associated with sex when potential risk factors were included. RESULTS: Lifetime prevalence of exposure to traumatic events and number of traumatic events did not vary by sex. The prevalence of PTSD was higher for women than for men exposed to traumatic events (hazards ratio, 2.3; 95% confidence interval, 1.5-3.6). Preexisting anxiety disorders or major depressive disorders played a part in the observed sex difference in PTSD. Family history of anxiety disorder and early separation from parents, although significant risk factors for PTSD in subjects of both sexes, were unrelated to the sex difference in PTSD. The sex difference in PTSD was markedly greater if exposure occurred in childhood than later on. CONCLUSIONS: Posttraumatic stress disorder is more likely to develop in females than in males after exposure to a traumatic event. Susceptibility to PTSD in females might be greater in childhood than after age 15 years. Explanations of the sex difference might involve characteristics of individuals and of the traumatic experiences.
Adult↗
Does psychiatric history bias mothers' reports? An application of a new analytic approach.
OBJECTIVE: To evaluate whether mothers' psychiatric history biases reports of their children's behavior problems, mothers' and teachers' reports of children's behavior problems were compared using a recently developed statistical approach. METHOD: Child Behavior Checklists and Teacher's Report Forms were completed by mothers and teachers, respectively, about 801 six-year-old children. Mother's history of major depression, anxiety disorders, and substance use disorder was assessed by using the National Institute of Mental Health Diagnostic Interview Schedule. Generalized estimating equations were used for data analysis. RESULTS: According to both teachers and mothers, maternal history of major depression was associated with more internalizing problems; the association was significantly stronger when mothers were the informants. Mothers with history of any psychiatric disorder reported more externalizing problems in their children than expected, whereas teachers' reports of externalizing behaviors were unrelated to maternal psychiatric history. These findings could not be explained by variations in children's behaviors across settings. CONCLUSION: The generalized estimating equation models enabled simultaneous examination of whether children of depressed mothers have excess behavior problems and whether depressed mothers overreport behavior problems in their children. The results indicate that children of depressed mothers have more internalizing problems. In addition, depressed mothers overstate and overgeneralize their offspring's behavior problems. This study broadens the concerns with reporting bias beyond maternal depression to include other psychiatric problems. The results emphasize the potential for bias in family history studies that rely on informants.
Adult↗
Large same-year effects: fact or artefact.
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Depressive Disorder↗
Daytime sleepiness: an epidemiological study of young adults.
OBJECTIVES: Although excessive daytime sleepiness is associated with increased risks for accidents, decreased productivity, and interpersonal difficulties, information on its epidemiology is scarce. This paper examines correlates of and suspected risk factors for daytime sleepiness from a longitudinal epidemiological study of young adults. METHODS: The sample consisted of 1007 randomly selected young adults from a large health maintenance organization in southeast Michigan. Data were gathered in personal interviews conducted with 97% of the sample 5.5 years after baseline. Information on sleep characteristics in the last 2 weeks, including daytime sleepiness, nocturnal sleep onset, snoring, and hours of sleep, was collected on a self-administered instrument. Psychiatric disorders were measured by the National Institute of Mental Health's Diagnostic Interview Schedule. RESULTS: The average length of nocturnal sleep on weekdays was 6.7 hours. Daytime sleepiness was inversely related to hours of sleep and positively related to the ease of falling asleep at night; it varied significantly by employment and marital status. Snoring was associated with increased daytime sleepiness, as was recent major depression. CONCLUSIONS: Factors that might increase daytime sleepiness among young adults include social factors (being single and being employed full time) and pathological conditions (frequent snoring and major depression).
Adult↗
Low birth weight and neurocognitive status at six years of age.
We examined the relationship between low birth weight (LBW) (< or = 2500 g) and specific neurocognitive abilities at 6 years of age in a large-scale nonconcurrent prospective study. In 1990-1992, we randomly selected and evaluated LBW and normal birth weight (NBW) children from the 1983-1985 newborn lists of two major hospitals in southeast Michigan, one serving an urban and the other a suburban population. LBW children (n = 473) scored significantly lower than NBW children (n = 350) on tests measuring language, spatial, fine motor, tactile, and attention abilities, controlling for population site, race, maternal IQ, and education. Gradient relationships were observed across levels of LBW with language, spatial, tactile, and attention tests. Exploratory analysis, using general additive models, revealed that test performance varied within birth weight levels and that performance continued to improve with increased birth weight well above 3000 g. Follow-up assessments as the children mature will shed light on the persistence of these associations and their implications for learning disorders.
Attention↗
Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults.
In a longitudinal epidemiological study of young adults, we estimated the association between sleep disturbance and psychiatric disorders, cross-sectionally and prospectively. A random sample of 1200 was drawn from all 21-30-year-old members of a large health maintenance organization (HMO) in Michigan; 1007 were interviewed in 1989 and 979 were reinterviewed in 1992. Lifetime prevalence of insomnia alone was 16.6%, of hypersomnia alone, 8.2%, and of insomnia plus hypersomnia, 8%. The gender-adjusted relative risk for new onset of major depression during the follow-up period in persons with history of insomnia at baseline was 4.0 (95% confidence interval [CI] 2.2-7.0) and in persons with baseline history of hypersomnia, 2.9 (95% CI 1.5-5.6). When history of other prior depressive symptoms (e.g., psychomotor retardation or agitation, suicidal ideation) was controlled for, prior insomnia remained a significant predictor of subsequent major depression. Complaints of 2 weeks or more of insomnia nearly every night might be a useful marker of subsequent onset of major depression.
Adult↗
Comparison of nonrandomized trials with slow-release sodium fluoride with a randomized placebo-controlled trial in postmenopausal osteoporosis.
The results of slow-release sodium fluoride (SR-NaF) treatment in two nonrandomized trials involving 65 patients with postmenopausal osteoporosis from the primary site and 121 patients from collaborative sites were compared with those obtained from 54 treated patients and 56 patients taking placebo from a randomized controlled trial. Spinal fracture data were analyzed separately in mild to moderate bone loss of lumbar spine (baseline L2-L4 bone density [BD] > or = 65% young normal) and in severe bone loss (BD < 65%). Since demographic and fracture data were similar among fluoride-treated patients from the three trials at each stratum of bone loss, their data were combined. In mild to moderate bone loss, SR-NaF treatment in the combined group virtually eliminated new spinal fractures with 96.6% of patients remaining fracture-free. The Fluoride group had a markedly lower individual vertebral fracture rate (0.025 vs. 0.188/patient year, p = 0.0001) and group vertebral fracture rate (0.029 vs. 0.175/patient year, relative risk [RR] 0.12, p = 0.0001) than the Placebo group. In severe bone loss, the combined treated group had a significantly lower new spinal fracture rate than the Placebo group, although the differences were not as marked (group vertebral fracture rate of 0.150 vs. 0.276/patient year, RR 0.54, p = 0.03). In the combined fluoride-treated group, the L2-L4 bone mass rose by 4-6%/year for 4 years, and the femoral neck BD increased by 1-2%/year during first 2 years. The radial shaft BD did not change. The Placebo group did not show a change in bone mass at any site. The prevalence (percentage) of patients with related gastrointestinal side effects and nonvertebral fracture rates did not differ significantly between the combined SR-NaF group and the Placebo group (hip fracture rate of 0.0045/patient year in SR-NaF and 0.0053/patient year in Placebo; appendicular fracture other than hip (see text) rate of 0.0193/patient year in SR-NaF and 0.0159/patient year in Placebo). A subgroup analysis showed a low baseline L2-L4 BD, high prevalent spinal fractures, and reduced body weight to be important determinants of the development of spinal fracture during SR-NaF treatment. Concomitant medications (estrogen, vitamin D, thiazide and thyroid hormone) were not independent predictors of the spinal fracture risk. Only 17% of fluoride-treated patients were nonresponders (new spinal fractures or a fall/no change in L2-L4 bone mass). Thus, the effects of SR-NaF treatment on the spinal fracture rate from nonrandomized trials were similar to those of the treated group of the randomized trial but different from those of the Placebo group. The similarity of response of nonrandomized trials with that of the randomized controlled trial and the resultant combined analysis further validate the efficacy and safety of SR-NaF in the treatment of postmenopausal osteoporosis.
Bone Density↗
Psychiatric sequelae of low birth weight at 6 years of age.
The study examined the association between low birth weight (LBW) (< or = 2,500 g) and attention deficit hyperactivity disorder (ADHD) in two socioeconomically disparate populations. LBW and normal birth weight (NBW) children from the 1983 to 1985 newborn lists of an urban and a suburban hospital in Southeast Michigan were randomly selected. A total of 823 children, 473 LBW and 350 NBW, participated. Data were gathered in 1990 to 1992, when the children were 6 to 7 years of age. The National Institute of Mental Health Diagnostic Interview Schedule for children-Parent version (DISC-P) was used to elicit information on DSM-III-R diagnoses of simple phobia, overanxious, separation anxiety, oppositional defiant, and ADHD. Teachers' ratings of behavior problems were obtained. LBW was associated with ADHD but not with childhood anxiety disorders or oppositional defiant disorder. The association was stronger in the urban than in the suburban population. Data from teachers' ratings revealed an association between LBW and attention problems. The prognostic significance of the observed psychopathology at 6 years of age requires follow-up assessment as the children mature.
Attention Deficit Disorder with Hyperactivity↗
Potential barriers to parent monitoring: social disadvantage, marital status, and maternal psychiatric disorder.
OBJECTIVE: To test whether social disadvantage, marital status, and history of psychiatric disorder might impair mothers' monitoring and supervision of their children. METHOD: An epidemiological sample of 673 mothers of 8- through 11-year-old children, who had been participants in a longitudinal study of children's development, completed standardized telephone interviews about their monitoring and supervision of children. Indicators of social disadvantage also were collected in the telephone interview, and maternal history of psychiatric disorder had been assessed using the National Institute of Mental Health Diagnostic Interview Schedule, administered when the children were 6 years old. RESULTS: Mothers who were never married were twice as likely to be in the lowest quintile of parent monitoring as those who were married (31% versus 16%, p = .001); a similar distribution was found for mothers who did not complete high school compared with those who attended college (31% versus 15%, respectively, p = .001). Mother's history of substance use disorder, anxiety disorder, or major depression was also linked to lower levels of monitoring. Mothers of girls reported higher levels of monitoring than mothers of boys (p < .001). CONCLUSIONS: This study indicates that social disadvantage and maternal psychiatric disorder could have a negative influence on mothers' monitoring behaviors. Although the causal role of these factors is still unclear, interventions that target parenting behaviors should be designed to take them into account.
Child↗
Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers.
OBJECTIVES: To collect available international data on nicotine dependence as defined by the Fagerström Test of Nicotine Dependence, and to compare levels of dependence among countries and categories of smokers. DATA SOURCES: Published and unpublished studies known to the authors and a search of EMBASE from 1985-1995. STUDY SELECTION: Studies included were those based on a nationally representative sample of a country's population, or a sample of smokers seeking cessation assistance. DATA SYNTHESIS: Smokers who seek help in stopping smoking are much more dependent than the average smoker. Men consistently score higher on dependence than women. Ex-smokers appear to have lower dependence than current smokers. A country with low smoking prevalence, the United States, seems to have smokers with higher dependence scores than countries where smoking is more prevalent (such as Austria and Poland). CONCLUSIONS: Successful tobacco control may result in a higher dependence among the remaining smokers (due to selective quitting by low-dependent smokers). The remaining highly dependent smokers may need more intensive treatment.
Culture↗
Further evidence on the link between migraine and neuroticism.
Epidemiologic studies have demonstrated an association between migraine and neuroticism. In this report, we examine prospectively whether higher levels of neuroticism, measured at baseline by the Eysenck Personality Questionnaire, signaled increased risk for first incidence of migraine during a 5-year follow-up interval. The sample was randomly selected from the list of young adult members of a large Health Maintenance Organization in southeast Michigan. Follow-up data were available on 972 subjects, 97.2% of the initial sample. Neuroticism predicted the first incidence of migraine in females. The relative risk for migraine in females scoring in the highest quartile of the neuroticism scales versus the lowest quartile was 4.0 (95% CI 1.6, 10.3). Controlling for history of major depression and anxiety disorders at baseline reduced the estimate to 2.9 (95% CI 1.1, 7.7). Neuroticism did not predict migraine in males, although the results in males were limited greatly by the small number of incidence cases. Neuroticism might be causally related to migraine, or alternatively, might be an early correlate with shared etiologies.
Adult↗
Smoking cessation in young adults: age at initiation of cigarette smoking and other suspected influences.
OBJECTIVES: Previous research has suggested that early smoking initiation predicts longer duration of smoking, heavier daily consumption, and increased chances of nicotine dependence. This report set out to estimate the relationship between smoking cessation and age of initiation, as well as nicotine dependence, sex, race, and education. METHODS: A sample of 1007 young adults was randomly selected from a large health maintenance organization in southeast Michigan. Hazard ratios of quitting associated with age at smoking initiation were estimated among 414 persons who smoked daily for 1 month or more. RESULTS: With potential confounders controlled for, the likelihood of cessation was significantly higher in smokers who initiated smoking after age 13. The hazard ratio for quitting associated with smoking initiation at ages 14 to 16 was 1.6 and with initiation at or after age 17 was 2.0, compared with initiation at or before 13 years of age. Factors that decreased the likelihood of cessation were nicotine dependence and low education. CONCLUSIONS: Public policy to discourage early smoking, if it succeeds in delaying the initiation of smoking, might contribute to the reduction of smoking-related mortality and morbidity by increasing the potential for quitting.
Adolescent↗
Are smokers with alcohol disorders less likely to quit?
OBJECTIVES: This study examined the likelihood of smoking cessation in smokers with a prior history of alcoholism. METHODS: Data came from an epidemiologic study of 1007 young adults, randomly selected from those insured in a large health maintenance organization (HMO) in southeast Michigan. Cox proportional hazards models with time-dependent covariates were used to estimate the hazards ratios of quitting in smokers with current and past alcoholism, with smokers with no history of alcoholism as a reference. Sex, race, and education were controlled. RESULTS: Smokers with active alcoholism in the preceding year were 60% less likely to quit than were smokers with no history of alcoholism. In contrast, smokers whose alcoholism had remitted were at least as likely to quit as smokers with no history of alcoholism. Compared with persistent alcoholism, remission of alcoholism was associated with more than a threefold increase in the likelihood of subsequent smoking cessation. CONCLUSIONS: The findings suggest that discontinuation of alcoholism might increase the potential for successful smoking cessation.
Adult↗
The latent dimensionality of DIS/DSM-III-R nicotine dependence: exploratory analyses.
Decisions on DSM-IV criteria for alcohol dependence were based in part on latent structure analyses of field survey data on alcohol problems. Analogously, to investigate the latent structure of nicotine dependence in an epidemiological sample, we carried out a dichotomous item factor analysis of DSM-III-R symptom data gathered from 394 young adults who reported a history of sustained daily smoking. Smokers and their dependence symptoms were identified by means of the NIMH Diagnostic Interview Schedule version III revised, administered to a random sample of 1007 21-30-year-olds who were members of a health maintenance organization in the Detroit area. Comparing different latent structure models using LISCOMP software with bootstrap re-sampling, followed by multiple logistic regression, we found that a two-factor model indicating a 'general dependence' and a 'failed cessation' dimension best accounted for the observed data. Current smoking status (persistent vs. past smoking) was associated with the two factors independently. Replication and additional research on construct, discriminant and convergent validity are needed.
Adult↗
Alcohol disorders in young adulthood: effects of transitions into adult roles.
Using data gathered prospectively, the authors examined whether transitions in two major adult social roles, marriage and parenthood, influence the risk of developing (1) DSM-III-R alcohol disorder and (2) symptoms of alcohol disorder. Additionally, the potential impact of these transitions on persistence of alcohol disorder was examined. In the study, 1,007 members (21 to 30 years old) of a large health maintenance organization located in southeast Michigan were interviewed initially in 1989, 979 of whom were reinterviewed in 1992. Incidence of alcohol disorder symptoms was significantly higher among those who remained single (RR = 2.1) or became divorced (RR = 6.0) during the follow-up period, compared to those getting or staying married. Those who were never parents through the follow-up were also at increased risk (RR = 2.5), relative to those who became parents for the first time. Similar results were obtained for the incidence and persistence of an alcohol disorder. Transitions into adult roles, such as marriage and parenthood, appear to reduce the risk of developing alcohol disorder or related symptoms in young adulthood. These transitions also reduce the likelihood that an existing alcohol disorder will persist.
Adult↗
Sex differences in depression: a role for preexisting anxiety.
The role of anxiety disorders in the development of sex differences in major depression is analyzed. Data come from a longitudinal epidemiologic study of young adults in the Detroit, Michigan area. The Diagnostic Interview Schedule, revised according to DSM-III-R, was used at baseline to measure lifetime psychiatric disorders and at follow-up to measure psychiatric disorders during the 3.5-year interval since baseline assessment. Consistent with previous reports, the lifetime prevalence of major depression was nearly two-fold higher in females than in males. The sex difference was primarily in major depression comorbid with anxiety disorders. Results from Cox-proportional hazards models, with time-dependent covariates, showed that prior anxiety disorder increased the risk for subsequent major depression in both sexes, with no evidence of an interaction. History of anxiety disorder, including number of prior anxiety disorders, accounted for a considerable part of the observed sex difference in major depression. Controlling for prior anxiety reduced by more than 50% the coefficient that estimates the association between gender and major depression. The results suggest that the higher occurrence of anxiety disorders in females than males beginning early in life might explain in large part the higher female risk for major depression. They emphasize the need for further research on sex differences in anxiety disorders.
Adult↗
Psychiatric comorbidity of smoking and nicotine dependence.
Recent epidemiologic studies have revealed that comorbidity of psychiatric disorders is far more pervasive than previously suspected. Strong associations have been reported between specific substance use disorders and between any mental disorder and any substance use disorder. This report focuses on comorbidity of nicotine dependence, a substance use disorder on which little epidemiologic information is available. Data come from an epidemiologic study of approximately 1000 young adults in southeast Michigan, in which the NIMH-DIS, revised according to DSM-III-R, was used. Lifetime prevalence of nicotine dependence was 20%. Males and females with nicotine dependence had increased odds for alcohol and illicit drug disorders, major depression, and anxiety disorders, compared with nondependent smokers and nonsmokers combined. Major depression and any anxiety disorder were associated specifically with nicotine dependence. Increased odds for alcohol or illicit drug disorders were observed also in nondependent smokers, compared to nonsmokers. History of early conduct problems increased the odds for nicotine dependence among smokers. Potential mechanisms in the comorbidity of nicotine dependence are discussed.
Adolescent↗