Kelly L. Donahue

Familial Confounding of the Association Between Maternal Smoking During Pregnancy and Offspring Substance Use and Problems

CONTEXT Previous epidemiological, animal, and human cognitive neuroscience research suggests that maternal smoking during pregnancy (SDP) causes increased risk of substance use/problems in offspring. OBJECTIVE To determine the extent to which the association between SDP and offspring substance use/problems depends on confounded familial background factors by using a quasi-experimental design. DESIGN We used 2 separate samples from the United States and Sweden. The analyses prospectively predicted multiple indices of substance use and problems while controlling for statistical covariates and comparing differentially exposed siblings to minimize confounding. SETTING Offspring of a representative sample of women in the United States (sample 1) and the total Swedish population born during the period from January 1, 1983, to December 31, 1995 (sample 2). PATIENTS OR OTHER PARTICIPANTS Adolescent offspring of the women in the National Longitudinal Survey of Youth 1979 (n = 6904) and all offspring born in Sweden during the 13-year period (n = 1,187,360). MAIN OUTCOME MEASURES Self-reported adolescent alcohol, cigarette, and marijuana use and early onset (before 14 years of age) of each substance (sample 1) and substance-related convictions and hospitalizations for an alcohol- or other drug-related problem (sample 2). RESULTS The same pattern emerged for each index of substance use/problems across the 2 samples. At the population level, maternal SDP predicted every measure of offspring substance use/problems in both samples, ranging from adolescent alcohol use (hazard ratio [HR](moderate), 1.32 [95% CI, 1.22-1.43]; HR(high), 1.33 [1.17-1.53]) to a narcotics-related conviction (HR(moderate), 2.23 [2.14-2.31]; HR(high), 2.97 [2.86-3.09]). When comparing differentially exposed siblings to minimize genetic and environmental confounds, however, the association between SDP and each measure of substance use/problems was minimal and not statistically significant. CONCLUSIONS The association between maternal SDP and offspring substance use/problems is likely due to familial background factors, not a causal influence, because siblings have similar rates of substance use and problems regardless of their specific exposure to SDP.

Individual and Partner Correlates of Sexual Satisfaction and Relationship Happiness in Midlife Couples: Dyadic Analysis of the International Survey of Relationships

The current research reports a dyadic analysis of sexual satisfaction, relationship happiness, and correlates of these couple outcomes in a large multinational dataset consisting of 1,009 midlife heterosexual couples (2,018 individuals) recruited in Japan, Brazil, Germany, Spain, and the United States (Heiman et al., 2011). Actor-Partner Interdependence Models (Kenny, Kashy, & Cook, 2006) identified correlates of sexual satisfaction that included individuals’ reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one’s own and one’s partner’s orgasm; better sexual functioning; and greater relationship happiness. Even after controlling for individual-level effects, partners’ reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one’s own and one’s partner’s orgasm; better sexual functioning; and greater relationship happiness contributed significantly to predicting and understanding individuals’ sexual satisfaction. Correlates of relationship happiness included individuals’ reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one’s own and one’s partner’s orgasm; better sexual functioning; and greater sexual satisfaction, and once again, even after controlling for individual-level effects, partners’ reports of each of these correlates contributed significantly to predicting and understanding individuals’ relationship happiness. Interactions of individual and partner effects with participant gender are also reported. Current results demonstrate empirically that the partner “matters” to an individual’s sexual satisfaction and relationship happiness and indicate that a comprehensive understanding of factors contributing to these couple outcomes requires a couple-level research strategy. Partner effects, even when controlling for individual effects, were consistently observed, and explanation of sexual satisfaction and relationship happiness always depended on identifying and understanding mutual and concurrent individual and partner influences.

Why Does Early Sexual Intercourse Predict Subsequent Maladjustment? Exploring Potential Familial Confounds

OBJECTIVE Previous studies have found an association between early age at first sexual intercourse and subsequent psychosocial maladjustment. Using a quasi-experimental approach, we examined the extent to which this observed association may be due to familial confounds not explored in prior research. METHODS Using a population-based cohort of Swedish adult twins (ages 19-47; N = 12,126), we examined the nature of the association between early sexual intercourse (i.e., first intercourse occurring before age 16) and various outcomes reflecting psychosocial health, including substance use, depression, criminal convictions, and adolescent childbearing. We used two methods--discordant-twin analyses and bivariate twin modeling--to estimate the extent to which genetic and environmental confounds explained observed associations. RESULTS Individuals who engaged in early intercourse were at greater risk for most of the adverse psychosocial health outcomes measured in this study. However, twin pairs discordant for engaging in early intercourse did not differ significantly in their risk for psychosocial maladjustment. Our results indicated that early age at first sexual intercourse and subsequent psychosocial maladjustment may be associated because of familial factors shared by twins. CONCLUSIONS Early intercourse may be associated with poor psychosocial health largely due to shared familial influences rather than through a direct causal connection. Therefore, effective and efficient interventions should address other risk factors common to early intercourse and poor psychosocial health.

Vaccinating Sons against HPV: Results from a U.S. National Survey of Parents

Purpose The quadrivalent HPV vaccination was approved for use in males ages 9 to 26 in 2009 and recommended for routine administration in 2011. The purpose of this study was to uncover predictable commonalities amongst parents who chose to vaccinate their 11–17 year old sons against HPV. Methods We compiled data from a U.S. national sample of 779 parents with sons 11–17 years old using a web-based survey to gather information about behavioral and sociodemographic factors which predicted receipt of 1 or more HPV vaccine doses based on parental report. Predictors were first modeled individually for univariable associations. Significant predictors (p<0.10) were combined in a multivariable model. Results In the adjusted model, independent predictors included receipt of flu vaccination, health insurance coverage and sexual health topic discussions with sons. Sons who had received a flu shot in the last two years more frequently received at least one dose of the vaccine (OR 1.82; 95% CI 1.45–2.26). Sons covered by private health insurance had decreased odds of HPV vaccination (OR 0.56 95% CI 0.37–0.83). Lastly, parents who had discussed sexual health topics with their sons were more likely to vaccinate (OR 1.61; 95% CI 1.37–1.89). Conclusions Male vaccination rates in the U.S. have increased, but males continue to be under-immunized. Utilization of health care is an important factor in HPV vaccine uptake; therefore, health care providers should use every contact as an opportunity to vaccinate. Communication about sexual health topics may provide a forum for parents and health care providers to have conversations about HPV vaccination as those more comfortable discussing these topics may also be more comfortable discussing HPV vaccination.

Childhood Behavior Problems and Adolescent Sexual Risk Behavior: Familial Confounding in the Child and Adolescent Twin Study in Sweden (CATSS)

OBJECTIVE Previous studies have found associations between childhood behavior problems and adolescent sexual risk behavior. Using a quasi-experimental approach, we examined the extent to which this association may be due to between-family differences (i.e., unmeasured familial confounds) not adequately explored in prior research. METHODS We used data from a longitudinal, population-based cohort of young twins in Sweden (first assessment: age 9 or 12 years; second assessment: age 15; n = 2,388). We explored the nature of the association between symptom scores for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) at age 9 or 12 and the likelihood of having had sexual intercourse and number of sexual partners by age 15. Two-level mixed-effects models were used to estimate the effect of symptom score on each outcome after controlling for potential unmeasured familial confounds. RESULTS Higher ADHD, ODD, and CD scores were associated with significantly increased likelihood of sexual intercourse by age 15. Higher ADHD and ODD scores were also associated with increased number of sexual partners. After controlling for unmeasured familial confounds, however, behavior problems were no longer significantly associated with either outcome. CONCLUSION The association between childhood behavior problems and sexual risk behaviors may be due to characteristics shared within families. Hence, prevention strategies aimed at reducing these behaviors might need to address broader risk factors that contribute to both behavior problems and a greater likelihood of sexual risk behavior.

Familial Factors, Victimization, and Psychological Health Among Sexual Minority Adolescents in Sweden

OBJECTIVES To determine the influences of victimization experience and familial factors on the association between sexual minority status and psychological health outcomes among adolescents. METHODS We used data from the Child and Adolescent Twin Study in Sweden, a prospective, population-based study of all twins born in Sweden since 1992. Cross-sectional analyses included individuals who completed assessments at age 18 years (n = 4898) from 2000 to 2013. We also compared psychological health among sexual minority adolescents and their nonminority co-twins. RESULTS Sexual minority adolescents were more likely than were unrelated nonminority adolescents to report victimization experiences, including emotional abuse, physical abuse or neglect, and sexual abuse. Sexual minority adolescents also reported significantly more symptoms of anxiety, depression, attention-deficit/hyperactivity disorder, disordered eating, and substance misuse in addition to increased parent-reported behavior problems. Victimization experience partially mediated these associations. However, when controlling for unmeasured familial confounding factors by comparing sexual minority adolescents to their same-sex, nonminority co-twins, the effect of sexual minority status on psychological health was almost entirely attenuated. CONCLUSIONS Familial factors-common genetic or environmental influences-may explain decreased psychological adjustment among sexual minority adolescents.

Predictors of influenza vaccination in the U.S. among children 9–13 years of age

BACKGROUND AND OBJECTIVES U.S. estimates of seasonal influenza (flu) vaccine uptake in 2014-2015 were 62% for 5-12year olds, dropping to 47% for 13-17year olds. The Healthy People 2020 goal for these age groups is 80%. It is important to understand factors associated with influenza vaccination, especially for those ages where rates begin to decline. The objective of this study was to identify factors associated with influenza vaccination acceptance in 9-13year old children. METHODS An online U.S. survey of mothers of children aged 9-13 assessed childrens influenza vaccine uptake in the previous season, healthcare utilization, sociodemographics, and vaccine attitudes. Multivariable logistic regression identified independent predictors of influenza vaccine status. RESULTS There were 2363 respondents (Mean age=38years old). Referent children were 57% female and 66% non-minority race/ethnicity with a mean age of 10.6years. By maternal report, 59% of children had received an influenza vaccine in the previous season. Predictors of influenza vaccine uptake included a recommendation or strong recommendation from a health care provider, seeing a health care provider in the past year, positive attitudes regarding the influenza vaccine, and being a minority race. Child gender, age, insurance coverage, and whether the child had a regular healthcare provider were not associated with influenza vaccine uptake (p=n.s.). CONCLUSIONS This sample reported overall rates of influenza vaccine uptake similar to national surveillance data, but still lower than national goals. Provider recommendations along with health attitudes and seeing a health care provider were associated with vaccine uptake. Promising interventions may include more directive physician messaging for influenza vaccine uptake in youth, encouraging more regular well-child visits during the adolescent years, and promoting influenza vaccination at alternative sites.

One-Year Follow-Up of Girls with Precocious Puberty and Their Mothers: Do Psychological Assessments Change over Time or with Treatment?

Background: To determine whether psychological characteristics of girls with variations of early puberty and their mothers change over time and with treatment in girls with central precocious puberty (CPP). Methods: Girls with CPP, premature adrenarche (PA), and early normal puberty (ENP) completed psychological assessments at baseline and after 1 year along with their mothers. All girls with CPP were treated with GnRH analogs. Psychological effects of group and time were examined using 2 × 3 mixed ANOVAs. Results: Sixty-two subjects aged 7.5 ± 1.4 years (range 4.8–10.5) were enrolled, of whom 36 (15 with CPP, 8 with PA, and 13 with ENP) completed 1-year follow-up assessments. Psychological measures were normal in all girls. No significant group differences were found for any measure of girls’ psychological functioning at either time point. However, across all groups there was change over time with a decrease in perceived physical competence (p < 0.001) and an increase in perceived maternal acceptance (p = 0.001). Conclusion: No abnormalities in psychological functioning were found among girls with variations of early puberty, and all groups were in the normal range. Our results are largely reassuring regarding concerns of adverse psychological consequences of early puberty in girls.