Cheryl L. Addy

Frequency of obsessive-compulsive disorder in a community sample of young adolescents.

OBJECTIVE To investigate the frequency and phenomenology of obsessive-compulsive disorder (OCD) and subclinical OCD in young adolescents. METHOD A two-stage epidemiological study originally designed to investigate adolescent depression was conducted between 1986 and 1988 in the southeastern United States. In the first stage, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Childrens Global Assessment Scale were administered to 488 mother-child pairs. RESULTS The prevalences of OCD and subclinical OCD were found to be 3% and 19%, respectively. Prevalences were similar in males and females. Females reported more symptoms of compulsions although males reported more obsessions. About 55% of adolescents with OCD reported both obsessions and compulsions. The most common compulsions were arranging (56%), counting (41%), collecting (38%), and washing (17%). Major depressive disorder (45%), separation anxiety (34%), dysthymia (29%), suicidal ideation (15%), and phobia (8%) were the diagnoses most frequently comorbid with OCD. CONCLUSIONS Findings suggest that OCD is not infrequent among adolescents and that the characteristic comorbidity and symptomatology of OCD may facilitate earlier identification and treatment by clinicians.

Associations of Perceived Social and Physical Environmental Supports With Physical Activity and Walking Behavior

We evaluated perceived social and environmental supports for physical activity and walking using multivariable modeling. Perceptions were obtained on a sample of households in a southeastern county. Respondents were classified according to physical activity levels and walking behaviors. Respondents who had good street lighting; trusted their neighbors; and used private recreational facilities, parks, playgrounds, and sports fields were more likely to be regularly active. Perceiving neighbors as being active, having access to sidewalks, and using malls were associated with regular walking.

The CES-D as a Screen for Depression and Other Psychiatric Disorders in Adolescents

The performance of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screen for depression was explored in a two-stage epidemiological study of adolescents. The study consisted of a CES-D screening stage completed by a school sample of 2,465 young adolescents and a structured psychiatric interview stage completed by 332 mother-adolescent pairs. Adolescents with interview validated depression had elevated screening scores (mean = 31.10, SD = 11.30) compared with individuals with no disorder (mean = 21.01, SD = 11.77). Using receiver operating characteristic curves, a cut point of 12 for males produced the best overall screening characteristics (sensitivity = 0.85, specificity = 0.49), while for females, a cut point of 22 was optimal (sensitivity = 0.83, specificity = 0.77).

Moderate physical activity patterns of minority women: the Cross-Cultural Activity Participation Study.

Using data from 12 days of detailed physical activity records (PA records), we analyzed the physical activity patterns of 141 African American and Native American women, ages 40 and older, enrolled in the Cross-Cultural Activity Participation Study. PA records were completed every other month for three consecutive 4-day periods. The proportion of women who met the 1993 Centers for Disease Control and Prevention and the American College of Sports Medicine recommendation to accumulate at least 30 minutes of moderate intensity activity during most days of the week (at least 3 days of the 4-day periods) ranged from 63% to 70%. Nearly one third of women met the recommendation for more than one 4-day period. On days when subjects accumulated at least 30 minutes of moderate activity, time spent in moderate activity was 112 minutes/day. Most women performed household chores (95%, median = 24 minutes/day), walking for exercise (87%, median = 30 minutes/day), occupational (65%, median = 37 minutes/day), child care (53%, median = 32 minutes/day), and lawn and garden activities (51%, median = 43 minutes/day). Fewer than 25% reported conditioning and sports activities. In general, more Native Americans than African Americans were active in moderate activities. In conclusion, definitions used to characterize regular physical activity should be consistent among studies, and physical activity surveys among women should include occupation-related and home-related activities.

Directly Observed Physical Activity Levels in Preschool Children

BACKGROUND Millions of young children attend preschools and other structured child development programs, but little is known about their physical activity levels while in those settings. The purpose of this study was to describe the physical activity levels and demographic and school-related correlates of physical activity in children attending preschools, using a direct observation measurement system. METHODS The Observational System for Recording Physical Activity in Children-Preschool Version was used to measure physical activity levels and related factors in four hundred ninety-three 3- to 5-year-old children in 24 preschools. A minimum of six hundred 30-second observation intervals were recorded for each child. Physical (height/weight) and demographic data also were collected. RESULTS Children engaged in moderate-to-vigorous physical activity (MVPA) during less than 3% of the observation intervals and were sedentary during more than 80% of the observation intervals. Boys were more likely than girls to engage in MVPA (p = .01), and 3-year-old boys were more active than 4- and 5-year-old boys (p = .01). The preschool that a child attended explained 27% of the variance in activity levels. CONCLUSIONS The study indicates that young children are physically inactive during most of their time in preschool. The preschool that a child attended was a stronger predictor of physical activity level than any other factor examined. Additional research is needed to identify the characteristics of preschools in which children are more active.

Epidemiology of musculoskeletal injuries among sedentary and physically active adults

PURPOSE This study describes the types and frequencies of musculoskeletal injuries among a cohort of adults with above average activity levels who were enrolled in the Aerobics Center Longitudinal Study (Dallas, TX). METHODS Participants were adults aged 20-85 yr who completed a baseline clinical examination (1970-1982) and returned a mailed follow-up survey in 1986. Participants (5,028 men, 1,285 women) were measured for aerobic fitness, height, and body weight during the baseline examination. They reported detailed information about their physical activity levels and injury experiences on the follow-up survey (1986). An injury was defined as any self-reported soft tissue or bone injury that occurred within the previous 12 months. Activity-related injuries were those injuries participants attributed to participation in a formal exercise program. RESULTS A quarter of all participants reported a musculoskeletal injury. Of these, 83% were activity-related. More than 66% of activity-related injuries occurred in the lower extremity; the knee was listed as the joint most often affected. There were no significant sex differences in the prevalence of injury, regardless of cause. Sport participants had the highest proportion of all-cause and activity-related musculoskeletal injuries among both men and women. Self-perceived severe injuries had a significant negative impact on physical activity levels since almost 1/3 of subjects reported permanently stopping their exercise program after injury. CONCLUSION These results suggest the need for developing and implementing injury prevention programs targeted toward moderately active adults.

Posttraumatic stress disorder in adolescents after Hurricane Andrew.

OBJECTIVE To examine rates and correlates of posttraumatic stress disorder (PTSD) in adolescents after Hurricane Andrew. METHOD A random-digit dialing sample of 158 Hispanic, 116 black, and 104 white adolescent-parent pairs were surveyed in high- and low-impact areas within Dade County, Florida, 6 months after Hurricane Andrew. Subjects completed a structured telephone interview focused on within-disaster experiences and emotional reaction, disaster-related losses, lifetime exposure to violent or traumatic events, recent stressful experiences, and psychiatric symptomatology. RESULTS Approximately 3% of males (95% confidence interval 0.4 to 5.3) and 9% of females (95% confidence interval 4.6 to 13.7) met the criteria for PTSD. Rates were highest among blacks (8.3%, 95% confidence interval 2.3 to 14.2) and Hispanics (6.1%, 95% confidence interval 2.2 to 9.9) and increased with age (odds ratio of 1.34, 95% confidence interval 1.04 to 1.72) and the number of undesirable events reported (odds ratio of 1.38, 95% confidence interval 1.21 to 1.57). CONCLUSIONS While only a relatively small percentage of adolescents reported symptoms consistent with a diagnosis of PTSD, most reported some posttraumatic symptoms. Postdisaster planning should recognize that common stressful events occurring after disasters may be more strongly associated with PTSD than magnitude of contact with the actual disaster.

Prevalence of PTSD in a community sample of older adolescents

OBJECTIVE To examine prevalence and correlates of trauma and posttraumatic stress disorder (PTSD) symptoms and diagnosis in older adolescents aged 16 through 22 years. METHOD The second cycle of a longitudinal epidemiological study in the Southeast included a semistructured interview assessing PTSD symptomatology administered to 490 adolescents. RESULTS Approximately 3% of female subjects and 1% of male subjects satisfied the DSM-IV criteria for PTSD. Females reported more traumatic events than males, and black subjects reported more events than white subjects. Being female (odds ratio = 12.32), experiencing rape or child sexual abuse (odds ratio = 49.37), and witnessing an accident or medical emergency (odds ratio = 85.02) were associated with increased risk of PTSD. CONCLUSIONS While relatively few adolescents satisfy the criteria for PTSD, most subjects who experienced a traumatic event reported some PTSD symptoms. Specific types of traumatic events were associated with occurrence of PTSD.

The relationship between pedometer-determined ambulatory activity and body composition variables.

OBJECTIVE: To examine the relationship between pedometer-determined ambulatory activity (steps/day) and body composition variables body mass index (BMI) and percentage body fat).DESIGN: Secondary analysis of a cross-sectional objective activity monitoring study for up to 21 consecutive days.SUBJECTS: A total of 109 apparently healthy adults (eight African American males, 23 African-American females, 33 Caucasian males, 45 Caucasian females), age 44.9±15.8 y, BMI=26.9±5.1 kg/m2.MEASUREMENTS: Pedometer-assessed ambulatory activity (steps/day), height and weight, and percentage body fat by bioelectrical impedance.RESULTS: Analyzed as both a continuous and a categorical variable (determined using 25th and 75th percentiles for distribution for steps/day), ambulatory activity was consistently related to body composition variables. Steps/day was inversely correlated with BMI and percentage body fat (r=−0.30, and r=−0.27, respectively, both P<0.01). The consistency of the relationship was also evident when examined using accepted BMI cut-off points for normal-weight, overweight, and obese categories.CONCLUSIONS: Individuals in this small sample with values greater than approximately 9000 steps/day are more frequently classified as normal weight for height. Individuals with values less than approximately 5000 steps/day are more frequently classified as obese. These findings require further corroborative investigation but provide preliminary cutoff points for identifying individuals at risk who may benefit from appropriate physical activity intervention.

Incidence and Predictors of Suicidal Behaviors in a Longitudinal Sample of Young Adolescents

OBJECTIVE This analysis examines 1-year transition probabilities and baseline predictors for suicidal behaviors in young adolescents. METHOD Adolescents from a two-stage, community-based longitudinal study were classified into suicidal behavior categories (attempt, plan, ideation, and none) for baseline and follow-up years. Transition probabilities for movement among categories were calculated, and polytomous logistic regression analysis was used to examine predictors of suicidal behaviors. RESULTS Among those with no suicidal behaviors at baseline, 1-year incidence rates were 1.3% for attempts and 1.7% each for plans and ideation. Increasing family cohesion was protective for suicide attempts (odds ratio [OR] = 0.9). Female subjects were more likely than males to report plans (OR = 8.9) and ideation (OR = 4.1). Increasing impulsivity (OR = 2.3), prior suicidal behavior (OR = 10.6), and undesirable life events (OR = 1.1) were significant predictors of plans. CONCLUSIONS While there are a number of predictors of suicidal behaviors, the false-positive rate is high. Focusing on proximal risk factors, particularly stressors in adolescent development, may overlook the fundamental role of underlying mental disorder and familial factors--both biological and environmental. Suicide and suicidal behaviors are the result of a constellation of adverse factors requiring a range of interventions for prevention.