Laurie T. Martin

Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis.

OBJECTIVE Cognitive reserve has been proposed as important in the etiology of neuropsychiatric disorders. However, tests of the association between premorbid IQ and adult mental disorders other than schizophrenia have been limited and inconclusive. The authors tested the hypothesis that low childhood IQ is associated with increased risk and severity of adult mental disorders. METHOD Participants were members of a representative 1972-1973 birth cohort of 1,037 males and females in Dunedin, New Zealand, who were followed up to age 32 with 96% retention. WISC-R IQ was assessed at ages 7, 9, and 11. Research diagnoses of DSM mental disorders were made at ages 18, 21, 26, and 32. RESULTS Lower childhood IQ was associated with increased risk of developing schizophrenia spectrum disorder, adult depression, and adult anxiety. Lower childhood IQ was also associated with greater comorbidity and with persistence of depression; the association with persistence of generalized anxiety disorder was nearly significant. Higher childhood IQ predicted increased risk of adult mania. CONCLUSIONS Lower cognitive reserve, as reflected by childhood IQ, is an antecedent of several common psychiatric disorders and also predicts persistence and comorbidity. Thus, many patients who seek mental health treatment may have lower cognitive ability; this should be considered in prevention and treatment planning.

Educational attainment and cigarette smoking: a causal association?

BACKGROUND Despite abundant evidence that lower education is associated with a higher risk of smoking, whether the association is causal has not been convincingly established. METHODS We investigated the association between education and lifetime smoking patterns in a birth cohort established in 1959 and followed through adulthood (n = 1311). We controlled for a wide range of potential confounders that were measured prior to school entry, and also estimated sibling fixed effects models to control for unmeasured familial vulnerability to smoking. RESULTS In the full sample of participants, regression analyses adjusting for multiple childhood factors (including socioeconomic status, IQ, behavioural problems, and medical conditions) indicated that the number of pack-years smoked was higher among individuals with less than high school education [rate ratio (RR) = 1.58, confidence interval (CI) = 1.31, 1.91]. However, in the sibling fixed effects analysis the RR was 1.23 (CI = 0.80, 1.93). Similarly, adjusted models estimated in the full sample showed that individuals with less than high school education had fewer short-term (RR = 0.40; CI = 0.23, 0.69) and long-term (RR = 0.59; CI = 0.42, 0.83) quit attempts, and were less likely to quit smoking (odds ratio = 0.34; CI = 0.19, 0.62). The effects of education on quitting smoking were attenuated in the sibling fixed effects models that controlled for familial vulnerability to smoking. CONCLUSIONS A substantial portion of the education differential in smoking that has been repeatedly observed is attributable to factors shared by siblings that contribute to shortened educational careers and to lifetime smoking trajectories. Reducing disparities in cigarette smoking, including educational disparities, may therefore require approaches that focus on factors early in life that influence smoking risk over the adult life span.

The Impact of Parental Deployment on Child Social and Emotional Functioning: Perspectives of School Staff

PURPOSE Since 2001, many military families have experienced multiple and extended deployments. Little is known about the effect of parental deployment on the well-being of children, and few, if any, studies to date have engaged school staff to understand whether and how parental deployments affect the behavioral, social, and emotional outcomes of youth in the school setting. METHODS Focus groups and semi-structured interviews were conducted with teachers, counselors, and administrative staff at schools serving children from U.S. Army families (N=148 staff). Participants were queried about the academic, behavioral, and emotional issues faced by children of deployed soldiers. Data were analyzed for themes in these areas, with attention to differences by service component (Active Component vs. Army Reserve and National Guard). RESULTS Although some children seem to be coping well with deployment, school staff felt that childrens anxiety related to parental absence, increased responsibilities at home, poor mental health of some nondeployed parents, and difficulty accessing mental health services affected the ability of other students to function well in school. CONCLUSIONS School staff felt that parental deployment negatively affected social and emotional functioning for some children and youth, although they felt others were coping well. Future research should examine factors related to youth outcomes during parental deployment (e.g., mental health of the non-deployed parent) and assess the effects of deployment on other measures of behavior such as school engagement and academic performance.

Developing predictive models of health literacy.

INTRODUCTIONLow health literacy (LHL) remains a formidable barrier to improving health care quality and outcomes. Given the lack of precision of single demographic characteristics to predict health literacy, and the administrative burden and inability of existing health literacy measures to estimate health literacy at a population level, LHL is largely unaddressed in public health and clinical practice. To help overcome these limitations, we developed two models to estimate health literacy.METHODSWe analyzed data from the 2003 National Assessment of Adult Literacy (NAAL), using linear regression to predict mean health literacy scores and probit regression to predict the probability of an individual having ‘above basic’ proficiency. Predictors included gender, age, race/ethnicity, educational attainment, poverty status, marital status, language spoken in the home, metropolitan statistical area (MSA) and length of time in U.S.RESULTSAll variables except MSA were statistically significant, with lower educational attainment being the strongest predictor. Our linear regression model and the probit model accounted for about 30% and 21% of the variance in health literacy scores, respectively, nearly twice as much as the variance accounted for by either education or poverty alone.CONCLUSIONSMultivariable models permit a more accurate estimation of health literacy than single predictors. Further, such models can be applied to readily available administrative or census data to produce estimates of average health literacy and identify communities that would benefit most from appropriate, targeted interventions in the clinical setting to address poor quality care and outcomes related to LHL.

Cognitive performance in childhood and early adult illness: a prospective cohort study

Study objective: To evaluate whether cognitive performance in childhood is an early determinant of adult illness. Design: Prospective cohort study covering over 30 years. Setting: Providence, Rhode Island, USA. Participants: 633 people ages 30–39 followed up since birth as part of the Providence cohort of the national collaborative perinatal project. Main results: Higher cognitive performance at age 7 was related to a significantly reduced risk of serious illness in adulthood, OR = 0.65 (95%CI: 0.47 to 0.89) for a one standard deviation (15 point) increase in IQ score. This association was independent of both parental socioeconomic status and participant’s attained level of education. Conclusions: General cognitive performance may be an important and informative early determinant of adult health. Further evaluation of this association and mechanisms linking cognitive performance and health may provide new and innovative strategies to improve disease management and reduce morbidity.

Mental Disorders Among Gifted and Nongifted Youth: A Selected Review of the Epidemiologic Literature:

Given the ongoing debate over whether giftedness is associated with mental health disorders, there is a great need to highlight and compare results from the most methodologically rigorous studies. Surprisingly, the vast majority of literature reviews and background sections of research articles include studies that do not directly compare gifted and nongifted youth. Furthermore, almost no attention has been paid to how differences in the definitions of giftedness or mental health outcomes of interest affect the interpretation and comparison of studies. The authors apply an epidemiologic perspective for thinking about these issues, highlight many of the challenges of studying this population, and present results from meta-analyses that include the most methodologically rigorous studies comparing rates of depression, bipolar disorder, anxiety, suicide ideation, and attention deficit hyperactivity disorder (ADHD) between gifted and nongifted youth. They conclude with recommendations to strengthen research in this area. Putting the research to use Through this review we sought to provide concrete recommendations to strengthen future research on the mental health of gifted children. Most notably, future studies should assess large, population-based cohorts that include both gifted and nongifted individuals. Researchers should also move toward describing their study population according to their specific aptitudes, talents, skills or abilities, rather than using the general term ‘gifted’. Thinking more specifically about these relationships will not only help us to understand the association between giftedness and mental health, but will also increase the potential to effectively shape programs and policies for gifted youth, focusing resources on the most vulnerable.

Early manifestations of personality and adult health: a life course perspective.

OBJECTIVE The aim of this study is to investigate whether individual personality or temperamental qualities that emerge early and persist over the life course, predict adult midlife health. Specific childhood personality attributes considered include distress proneness, behavioral inhibition, and ability to stay focused on a task. DESIGN Prospective data are from 569 individuals followed from birth into adulthood. MAIN OUTCOME MEASURES Outcomes include two different measures of adult health: self-rated general health, and number of illnesses in adulthood. RESULTS Childhood personality attributes related to attention and distress were significantly associated with adult health, with stronger effects evident among women. Children with high attention reported better self-rated health (b = 0.12, p < .05) and fewer illnesses (b = -0.09, p < .01) as adults; more distress-prone children reported worse self-rated health (b = -0.15, p < .05) and more illnesses (b = 0.07, p < .09) as adults. CONCLUSION Associations between child personality attributes with both general self-rated health and number of illnesses in adulthood were maintained after taking account of childhood social environment and child health. Findings indicate that early emerging personality and related processes influence adult physical health, and suggest the potential value of interventions targeting early life development.

Child Outcome Measures in the Study of Child Care Quality

This article assesses whether there are methodological problems with child outcome measures that may contribute to the small associations between child care quality and child outcomes found in the literature. Outcome measures used in 65 studies of child care quality published between 1979 and December 2005 were examined, taking the previous review by Vandell and Wolfe (2000) as the starting point. Serious methodological problems were not pervasive for child outcome measures. However, methodological concerns were most prevalent among measures of socioemotional development. Furthermore, psychometric information on outcome measures was often missing from published reports, and health outcomes and approaches to learning were infrequently studied. Future research should address alignment issues between aspects of quality and the specific child outcomes chosen for study.

Beyond Reading Alone: The Relationship Between Aural Literacy And Asthma Management

OBJECTIVES to examine the relationship between literacy and asthma management with a focus on the oral exchange. METHODS study participants, all of whom reported asthma, were drawn from the New England Family Study (NEFS), an examination of links between education and health. NEFS data included reading, oral (speaking), and aural (listening) literacy measures. An additional survey was conducted with this group of study participants related to asthma issues, particularly asthma management. Data analysis focused on bivariate and multivariable logistic regression. RESULTS in bivariate logistic regression models exploring aural literacy, there was a statistically significant association between those participants with lower aural literacy skills and less successful asthma management (OR: 4.37, 95%CI: 1.11, 17.32). In multivariable logistic regression analyses, controlling for gender, income, and race in separate models (one-at-a-time), there remained a statistically significant association between those participants with lower aural literacy skills and less successful asthma management. CONCLUSION lower aural literacy skills seem to complicate asthma management capabilities. PRACTICE IMPLICATIONS greater attention to the oral exchange, in particular the listening skills highlighted by aural literacy, as well as other related literacy skills may help us develop strategies for clear communication related to asthma management.

Literacy Skills and Calculated 10-Year Risk of Coronary Heart Disease

BackgroundCoronary heart disease (CHD) is a leading cause of morbidity and mortality. Reducing the disease burden requires an understanding of factors associated with the prevention and management of CHD. Literacy skills may be one such factor.ObjectivesTo examine the independent and interactive effects of four literacy skills: reading, numeracy, oral language (speaking) and aural language (listening) on calculated 10-year risk of CHD and to determine whether the relationships between literacy skills and CHD risk were similar for men and women.DesignWe used multivariable linear regression to assess the individual, combined, and interactive effects of the four literacy skills on risk of CHD, adjusting for education and race.ParticipantsFour hundred and nine English-speaking adults in Boston, MA and Providence, RI.MeasuresTen-year risk of coronary heart disease was calculated using the Framingham algorithm. Reading, oral language and aural language were measured using the Woodcock Johnson III Tests of Achievement. Numeracy was assessed through a modified version of the numeracy scale by Lipkus and colleagues.Key ResultsWhen examined individually, reading (p = 0.007), numeracy (p = 0.001) and aural language (p = 0.004) skills were significantly associated with CHD risk among women; no literacy skills were associated with CHD risk in men. When examined together, there was some evidence for an interaction between numeracy and aural language among women suggesting that higher skills in one area (e.g., aural language) may compensate for difficulties in another resulting in an equally low risk of CHD.ConclusionsResults of this study not only provide important insight into the independent and interactive effects of literacy skills on risk of CHD, they also highlight the need for the development of easy-to use assessments of the oral exchange in the health care setting and the need to better understand which literacy skills are most important for a given health outcome.