Darin J. Erickson

Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: a prospective analysis.

The authors examined the relationship over time of posttraumatic stress disorder (PTSD) and depression symptoms in a sample of Gulf War veterans. A large sample (N = 2,949) of Gulf War veterans was assessed immediately following their return from the Gulf region and 18-24 months later. Participants completed a number of self-report questionnaires including the Mississippi Scale for Combat-Related PTSD (T. M. Keane, J. M. Caddell, & K. L. Taylor, 1988) and the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983) at both time points and an extended and updated version of the Laufer Combat Scale (M. Gallops, R. S. Laufer, & T. Yager, 1981) at the initial assessment. A latent-variable, cross-lag panel model found evidence for a reciprocal relation between PTSD and Depression. Follow-up models examining reexperiencing, avoidance-numbing, and hyperarousal symptoms separately showed that for reexperiencing and avoidance-numbing symptoms, the overall reciprocal relation held. For hyperarousal symptoms, however, the association was from early hyperarousal to later depression symptoms only.

Relationship of psychiatric status to Gulf War veterans' health problems.

OBJECTIVE A growing body of research has shown that there are important links between certain psychiatric disorders and health symptom reporting. Two disorders in particular (posttraumatic stress disorder (PTSD) and major depression) have been the most widely implicated to date, and this association has sometimes been used to explain the occurrence of ill-defined medical problems and increased somatic symptoms in certain groups, most recently Gulf War veterans. METHODS Structured psychiatric diagnostic interviews were used to examine the presence of major psychiatric (axis I) disorders and their relation to health symptom reporting in a well-characterized, stratified subset of Gulf War veterans and a non-Gulf-deployed veteran comparison group. RESULTS Rates of most psychiatric disorders were substantially lower than national comorbidity estimates, consistent with prior studies showing heightened physical and emotional well-being among active-duty military personnel. Rates of PTSD and major depression, however, were significantly elevated relative to the veteran comparison group. The diagnosis of PTSD showed a small but significant association with increased health symptom reports. However, nearly two-thirds of Gulf participants reporting moderate to high health symptoms had no axis I psychiatric diagnosis. CONCLUSIONS Results suggest that rates of psychiatric illness were generally low with the exception of PTSD and major depression. Although PTSD was associated with higher rates of reported health problems, this disorder did not entirely account for symptoms reported by participants. Factors other than psychiatric status may play a role in Gulf War health problems.

Stress-response-dampening effects of alcohol: attention as a mediator and moderator.

The present study sought to characterize alcohols stress-response-dampening (SRD) effects on multiple measures of stress and whether these effects are mediated by reductions in sustained attention and, further, whether baseline levels of sustained attention moderate SRD. One hundred six men consumed either an alcohol (0.70 g/kg) or a placebo beverage prior to learning that they would deliver a self-disclosing speech. Structural equation models controlling for multiple baseline periods indicated that alcohol directly reduced self-reported anxiety and skin conductance levels in response to the stressor. Alcohols effect on reducing heart rate response, in contrast, was indirect and mediated by effects on prestress baseline. As hypothesized, differences in sustained attention partially mediated the effects of alcohol on skin conductance (but not heart rate or self-reported anxiety) and served as a moderator of alcohols effects on skin conductance response. Findings are discussed in terms of theoretical links among alcohol consumption, specific cognitive abilities, and stress reactivity.

Risk factors for multisymptom illness in US Army veterans of the Gulf War.

This research study examined the prevalence of symptoms and identified risk factors for reported symptoms among a group of Army Gulf War (GW) veterans. A survey was mailed to all members of the Ft. Devens cohort in 1997, representing the third assessment of a group that consisted of 2949 US Army soldiers deployed to the Gulf, and was studied initially in 1991. A total of 1290 subjects responded to the mailed survey; aggressive follow-up methods to address non-response bias were employed. Subjects were classified as having multisymptom illness if they reported symptoms from at least two of three symptom categories (fatigue, mood-cognition, musculoskeletal). Sixty percent of the respondents met criteria for multisymptom illness. Female gender, lower levels of education, psychological symptoms, self-reported use of a medical clinic in the Gulf, ingestion of anti-nerve gas pills (pyridostigmine bromide), anthrax vaccination, tent heaters, exposure to oil fire smoke, and chemical odors were significantly related to multisymptom illness in logistic regression analyses. Analyses in which subjects were stratified by level of psychological symptoms revealed different sets of GW-service environmental exposures and suggest that subgroups of GW veterans may have different sets of risk factors.

Handheld Computers A Feasible Alternative to Paper Forms for Field Data Collection

Recent advances in handheld computer hardware and software may provide alternatives to paper-based data collection methods. The authors compared data collected with paper forms to data collected with handheld computer-based forms in a field observation study of alcohol purchase attempts at 47 community festivals in a large metropolitan area. Agreement between data collected with paper forms and data collected with handheld computers was greater than 95%. Computer-based forms handled branching patterns better and yielded data that were immediately available for analyses. Paper forms handled written comments better. Handheld computers are a feasible alternative to paper forms for field data collection.

Adolescent Smoking Trajectories: Results from a Population-Based Cohort Study

PURPOSE To identify distinct smoking trajectories during adolescence and assess how smoking-related factors relate to trajectory membership. METHODS The sample includes 3637 youth from across the state of Minnesota. Measures include tobacco use, smoking behaviors of parents and friends, youth smoking-related attitudes and beliefs, and home smoking policies. A cohort-sequential design was used to identify smoking trajectories, including five cohorts of youth (ages 12-16) followed for 3 years. RESULTS Six distinct trajectories of tobacco use were found: nonsmokers (54%), triers (17%), occasional users (10%), early established (7%), late established (8%), and decliners (4%). Several factors were associated with increased likelihood of being in a smoking trajectory group (vs. the nonsmoking group): parental smoking, friend smoking, greater perceptions of the number of adults and teenagers who smoke, and higher functional meaning of tobacco use. In contrast, higher perceived difficulty smoking in public places, negative perceptions of the tobacco industry, and home smoking policies were associated with less likelihood of being in one of the smoking trajectories (vs. the nonsmoking trajectory). CONCLUSIONS Adolescents exhibit diverse patterns of smoking during adolescence and tobacco-related influences were strong predictors of trajectory membership.

Implementation of NIAAA College Drinking Task Force Recommendations: How Are Colleges Doing 6 Years Later?

BACKGROUND In 2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) College Drinking Task Force issued recommendations to reduce heavy drinking by college students, but little is known about implementation of these recommendations. Current discussion about best strategies to reduce student drinking has focused more on lowering the minimum legal drinking age as advocated by a group of college and university presidents called the Amethyst Initiative than the NIAAA recommendations. METHODS A nationally representative survey of administrators was conducted at 351 4-year colleges in the United States to ascertain familiarity with and progress toward implementation of NIAAA recommendations. Implementation was compared by enrollment size, public or private status, and whether the school president signed the Amethyst Initiative. RESULTS Administrators at most colleges were familiar with NIAAA recommendations, although more than 1 in 5 (22%) were not. Nearly all colleges use educational programs to address student drinking (98%). Half the colleges (50%) offered intervention programs with documented efficacy for students at high risk for alcohol problems. Few colleges reported that empirically supported, community-based alcohol control strategies including conducting compliance checks to monitor illegal alcohol sales (33%), instituting mandatory responsible beverage service (RBS) training (15%), restricting alcohol outlet density (7%), or increasing the price of alcohol (2%) were operating in their community. Less than half the colleges with RBS training and compliance checks in their communities actively participated in these interventions. Large colleges were more likely to have RBS training and compliance checks, but no differences in implementation were found across public/private status or whether the college president signed the Amethyst Initiative. CONCLUSIONS Many colleges offer empirically supported programs for high-risk drinkers, but few have implemented other strategies recommended by NIAAA to address student drinking. Opportunities exist to reduce student drinking through implementation of existing, empirically based strategies.

The Association Between Density of Alcohol Establishments and Violent Crime Within Urban Neighborhoods

BACKGROUND Numerous studies have found that areas with higher alcohol establishment density are more likely to have higher violent crime rates, but many of these studies did not assess the differential effects of type of establishments or the effects on multiple categories of crime. In this study, we assess whether alcohol establishment density is associated with 4 categories of violent crime and whether the strength of the associations varies by type of violent crime and by on-premise establishments (e.g., bars, restaurants) versus off-premise establishments (e.g., liquor and convenience stores). METHODS Data come from the city of Minneapolis, Minnesota in 2009 and were aggregated and analyzed at the neighborhood level. Across the 83 neighborhoods in Minneapolis, we examined 4 categories of violent crime: assault, rape, robbery, and total violent crime. We used a Bayesian hierarchical inference approach to model the data, accounting for spatial auto-correlation and controlling for relevant neighborhood demographics. Models were estimated for total alcohol establishment density as well as separately for on-premise establishments and off-premise establishments. RESULTS Positive, statistically significant associations were observed for total alcohol establishment density and each of the violent crime outcomes. We estimate that a 3.9 to 4.3% increase across crime categories would result from a 20% increase in neighborhood establishment density. The associations between on-premise density and each of the individual violent crime outcomes were also all positive and significant and similar in strength as for total establishment density. The relationships between off-premise density and the crime outcomes were all positive but not significant for rape or total violent crime, and the strength of the associations was weaker than those for total and on-premise density. CONCLUSIONS Results of this study, combined with earlier findings, provide more evidence that community leaders should be cautious about increasing the density of alcohol establishments within their neighborhoods.

Evaluating a model of youth physical activity.

OBJECTIVE To explore the relationship between social influences, self-efficacy, enjoyment, and barriers and physical activity. METHODS Structural equation modeling examined relationships between parent and peer support, parent physical activity, individual perceptions, and objectively measured physical activity using accelerometers among a sample of youth aged 10-17 years (N = 720). RESULTS Peer support, parent physical activity, and perceived barriers were directly related to youth activity. The proposed model accounted for 14.7% of the variance in physical activity. CONCLUSIONS The results demonstrate a need to further explore additional individual, social, and environmental factors that may influence youths regular participation in physical activity.

Complying With the Minimum Drinking Age: Effects of Enforcement and Training Interventions

This article summarizes the proceedings of a symposium presented at the 2004 Research Society on Alcoholism meeting in Vancouver, British Columbia, organized by Alexander C. Wagenaar and chaired by Mark S. Goldman. The purpose of the symposium was to present the design and outcomes from a recently completed multi-community controlled time-series trial entitled Complying with the Minimum Drinking Age (CMDA), which tested two approaches for enhancing the effectiveness of the legal drinking age policy: training of alcohol retailers, and police enforcement at alcohol establishments. Specific presentations were: (1) Introduction and Overview of the CMDA project by Alexander C. Wagenaar, (2) CMDA Interventions by Traci L. Toomey, (3) CMDA Measurement, Statistical Methods and Results by Darin J. Erickson, and (4) Conclusions, Implications and Future Applications by Alexander C. Wagenaar. Results from the trial show: (1) minimal effects of the brief version of Alcohol Risk Management training for alcohol outlet management, (2) significant effects of enforcement checks in reducing sales of alcohol to youth, (3) a concentration of effects in specific alcohol outlets experiencing an enforcement check with little diffusion of effects to other outlets in the community not experiencing a check, and (4) a substantial decay of enforcement effects over the three months following a specific check. In short, results showed significant and substantial specific deterrence effects, and little training effects. Results also illustrated the utility and strength of the controlled time-series trial research design. Additional research on temporal and geospatial distribution of community-level intervention effects is warranted.