Chioun Lee

Childhood Abuse as a Risk Factor for Sleep Problems in Adulthood: Evidence from a U.S. National Study

BackgroundAccumulating evidence indicates that stress impairs sleep quality. Few studies, however, have examined the extent to which early life stress can jeopardize sleep in adulthood.PurposeGuided by a life course epidemiological perspective on health, this study examined associations between childhood abuse and adult sleep problems.MethodsWe used data from 835 respondents in the National Survey of Midlife Development in the United States (MIDUS). Self-report measures assessed the frequency of physical, emotional, and sexual abuse in childhood, as well as global and component indicators of sleep problems in adulthood.ResultsHaving experienced all three types of childhood abuse—even infrequently—was associated with global sleep pathology, as well as specific types of sleep problems. Reports of both frequent physical and frequent emotional abuse—even in the absence of sexual abuse—were also associated with poor sleep.ConclusionsChildhood abuse is a risk factor for individuals’ long-term sleep problems.

Racial differences in trajectories of heavy drinking and regular marijuana use from ages 13 to 24 among African-American and White males

BACKGROUND Although there are significant differences in prevalence of substance use between African-American and White adolescents, few studies have examined racial differences in developmental patterns of substance use, especially during the important developmental transition from adolescence to young adulthood. This study examines racial differences in trajectories of heavy drinking and regular marijuana use from adolescence into young adulthood. METHODS A community-based sample of non-Hispanic African-American (n=276) and non-Hispanic White (n=211) males was analyzed to identify trajectories from ages 13 to 24. RESULTS Initial analyses indicated race differences in heavy drinking and regular marijuana use trajectories. African Americans were more likely than Whites to be members of the nonheavy drinkers/nondrinkers group and less likely to be members of the early-onset heavy drinkers group. The former were also more likely than the latter to be members of the late-onset regular marijuana use group. Separate analyses by race indicated differences in heavy drinking for African Americans and Whites. A 2-group model for heavy drinking fit best for African Americans, whereas a 4-group solution fit best for Whites. For regular marijuana use, a similar 4-group solution fit for both races, although group proportions differed. CONCLUSIONS Within-race analyses indicated that there were clear race differences in the long-term patterns of alcohol use; regular marijuana use patterns were more similar. Extended follow ups are needed to examine differences and similarities in maturation processes for African-American and White males. For both races, prevention and intervention efforts are necessary into young adulthood.

Racial differences in the consequences of childhood maltreatment for adolescent and young adult depression, heavy drinking, and violence.

PURPOSE This study examined racial differences in the consequences of childhood maltreatment for depression, heavy drinking, and violence during adolescence and young adulthood among black and white young men. METHODS Data were obtained from the Pittsburgh Youth Study, a prospective longitudinal study of urban males (N = 971, 56% black). Childhood maltreatment was defined as substantiated physical or sexual abuse, physical neglect, emotional maltreatment, or moral/legal/educational maltreatment, with the first referral before 12 years of age. Self-reports of depressive symptoms and heavy drinking (consuming more than six drinks on a single occasion) and official, parent, and self-reports of violent offending were assessed between 12 and 17 years of age (adolescence) and at 24/25 years of age (young adulthood). Regression analyses were conducted to examine childhood maltreatment and race, as well as maltreatment-by-race interactions, as predictors of the three outcomes. RESULTS Prevalence of childhood maltreatment was higher for black than for white boys; however, there were no racial differences in timing, type, severity, and chronicity of maltreatment. When socioeconomic status and cohort were controlled, childhood maltreatment significantly predicted depressive symptoms and violence in adolescence but none of the outcomes in young adulthood. Race was a significant predictor of heavy drinking and violence during adolescence, and of all three outcomes in young adulthood. No significant race-by-maltreatment interaction effects were found. CONCLUSIONS Childhood maltreatment has similar negative consequences for black and white male youth during adolescence. Extending intervention efforts through adolescence is important to alleviate these problems among victims.

Acculturation among Mexican-heritage preadolescents: A latent class analysis

This study applies advanced conceptualization and measurement to an analysis of acculturation among 1,632 Mexican-heritage preadolescents. We assessed whether - and how - multiple measures combine to form a latent acculturation construct that groups individuals into classes; and determine how many and what classes (or types) of acculturation are experienced by this sample of 5(th) graders. Measures included attitudinal, behavioral, and linguistic acculturation, generation status, time in the U.S., ethnic identification, and contact with the culture of origin. The analysis identified five classes of acculturation, differing in size and characterized by specific measures of acculturation: less acculturated, moderately bicultural, strongly bicultural, highly acculturated, and marginalized. Although most youths fell into the first four classes, consonant with their exposure to American society, a small minority of youths fell into the last class. Despite substantial exposure to U.S. culture and recent exposure to Mexican culture, these youth showed little affinity for either culture.

Substance Use Trajectories of Black and White Young Men from Adolescence to Emerging Adulthood: A Two-Part Growth Curve Analysis

This study examined trajectories of substance use among Black and White young men (N = 983) from adolescence to emerging adulthood using two-part growth curve analysis. Controlling for parental socioeconomic status, Blacks were significantly less likely to use alcohol and hard drugs than Whites at age 17 and drank significantly fewer drinks. The alcohol prevalence gap between Blacks and Whites further increased over time. Blacks in the older cohort had higher growth in the frequency of alcohol use than Whites. Blacks and Whites did not differ in prevalence of marijuana use, although Blacks in the younger cohort reported higher growth in prevalence and higher frequency at age 17. Different prevention approaches may be needed to reduce substance use among Blacks and Whites.

Exploring the Intersection of Neighborhood Racial and Economic Composition and Individual Race on Substance Use Among Male Adolescents

This article examines how Blacks and Whites living in neighborhoods with divergent racial and income profiles differed in early onset (by age 14 years) and adolescent lifetime prevalence (by age 18 years) of substance use, with longitudinal data from 473 high-risk boys (58% Black). A latent profile analysis identified four neighborhood classes: Black, lower-income; racially mixed, middle-income; White, middle-income; and White, upper-income. Bivariate analyses showed that Blacks living in racially mixed, middle-income neighborhoods reported the lowest rates of tobacco and marijuana use. Whites living in White, upper-income neighborhoods reported higher substance use prevalence, particularly marijuana. Findings suggest that substance use prevention efforts are critical for Whites in upper-income communities.

The importance of examining movements within the US health care system: sequential logit modeling

BackgroundUtilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements.MethodsThe sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage), having a perceived need for specialty care (i.e., second stage), and utilization of specialty care (i.e., third stage). In the sequential logit model, all stages are nested within the previous stage.ResultsGender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62) or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20) were significant barriers to utilization of specialty care.ConclusionsUse of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities diminish to non-significance. Findings from this study represent how Americans use the health care system and more precisely reveals the disparities and inequalities in the U.S. health care system.

Spousal Breadwinning Across 30 Years of Marriage and Husbands’ Health: A Gendered Life Course Stress Approach:

Objective: Wives increasingly outearn their husbands, and gender relations theory suggests this arrangement may undermine men’s well-being. We explore how long-term histories of spousal breadwinning may be associated with older men’s self-rated mental and physical health, and risk of nine health diagnoses. Method: Using 30 years of couple-level income data from the Health and Retirement Study (n = 1,095 couples), we use latent class analyses to identify six classes that differ with respect to the timing and level of wife breadwinning. We link these classes to older husbands’ later-life health. Results: Classes that transitioned from husband breadwinning to wife breadwinning in early or later adulthood were associated with husbands’ poorer overall physical health and risk of cardiometabolic and stress-related diseases. Patterns persist net of sociodemographics, depressive symptoms, health behaviors, and adolescent health. Discussion: Violating cultural expectations, such as the masculinity ideal of male breadwinning, is associated with older men’s poorer health.