Tracy Sbrocco

Factor structure of the Anxiety Sensitivity Index among African American college students

This study examined the factor structure of the Anxiety Sensitivity Index (ASI) among African American college students. Confirmatory factor analysis indicated the 3-factor solution commonly found among other populations did not fit the data for African Americans. Although an exploratory factor analysis indicated the presence of a Mental Incapacitation factor, the Physical Concerns factor was divided into unsteady and cardiovascular concerns. Items typically comprising the Social factor were reflective of emotional controllability among African Americans. The ASI was also moderately correlated with measures of anxiety and depression providing only weak evidence of convergent and discriminate validity of the ASI for African Americans. Although support for the multidimensional nature of AS was found, the factor composition differs for African Americans.

Cognitive–Behavioral Group Therapy Versus a Wait-List Control in the Treatment of African American Women with Panic Disorder

This study examined the efficacy of group Panic Control Therapy (PCT; D. H. Barlow & M. G. Craske, 1994) for African Americans. Twenty-five African American women were assigned to either a treatment or wait-list control (WLC). Treatment was 11 group sessions, and wait-list participants did not receive any treatment for the same duration. At pretreatment, both groups were moderately anxious and depressed. At posttreatment, the PCT group experienced a significant reduction in panic frequency, avoidance behavior, state and trait anxiety, and anxiety sensitivity. There was no significant change on these variables for the WLC. There was a trend for change in depression among the PCT group only. On average, 54% of the treated group was classified as recovered, 17% as improved but not recovered, and 27% as unimproved. As many as 95% of the WLC were unimproved. The overall effect size of the study was comparable to that reported in previous studies of cognitive treatments incorporating interoceptive exposure with White Americans. These preliminary results suggest that CBT for panic is effective with African American women with panic disorder.

Parental bonding and anxiety: differences between African American and European American college students.

Empirical evidence suggests that early home environments characterized by low care and high overprotection are positively associated with the adult expression of anxiety. While available evidence supports this position for European Americans, there has been no examination of the relationship between perceived parental rearing practices and anxiety among African Americans despite the theoretical assertion that African American parenting environments may be characterized as somewhat more overprotective than European Americans. This study investigated the relationship between maternal rearing patterns and trait and state measures of anxiety and depression among a sample of 59 African American and 55 European American college students. Results indicated that both groups reported similar levels of anxiety, depression, perceived care, and perceived overprotection. European Americans exhibited the typical pattern of a negative relationship between anxiety, depression, and care and a positive relationship between anxiety and overprotection. African Americans evidenced a similar negative relationship between anxiety, depression, and care, but no relationship between anxiety, depression, and overprotection. Furthermore, specific aspects of ethnic identity (i.e., ethnic achievement, ethnic behaviors) were found to be negatively associated with measures of trait anxiety among African Americans but not European Americans.

Targeted prevention of excess weight gain and eating disorders in high-risk adolescent girls: a randomized controlled trial

BACKGROUND The high prevalence and incidence of obesity and eating disorders in US adolescent girls are serious health problems. Because of the shared risk factors for obesity and eating disorders, a targeted prevention of both conditions is a priority. OBJECTIVE We determined whether an adapted interpersonal psychotherapy prevention program is more efficacious for reducing excess weight gain and worsening disordered eating than health education in adolescent girls at high risk of obesity and eating disorders. DESIGN A parallel-group, randomized controlled trial was conducted between September 2008 and January 2013 in a university-based laboratory and a federal research hospital. The study included 113 adolescent (12-17-y-old) girls deemed at high risk of adult obesity and eating disorders because of a body mass index (BMI) between the 75th and 97th percentiles and reports of episodes of a loss of control over their eating. Girls were randomly assigned to participate in an adapted interpersonal psychotherapy or a health-education group program for 12 weekly 90-min group sessions. Follow-up assessments occurred immediately after group programs and at 6 and 12 mo. RESULTS Participation in both conditions was associated with decreases in expected BMI gain, age-adjusted BMI metrics, the percentage of fat by using dual-energy X-ray absorptiometry, symptoms of depression and anxiety, and the frequency of loss-of-control eating over 12 mo of follow-up (Ps < 0.001) with no group difference. In follow-up analyses, interpersonal psychotherapy was more efficacious than health education at reducing objective binge eating at the 12-mo follow-up (P < 0.05). CONCLUSIONS The intervention with adolescent girls with loss-of-control eating is associated with lower age-adjusted BMI and percentage of adiposity as well as improved mood symptoms over 1 y. Interpersonal psychotherapy further reduced objective binge eating. Additional research is needed to elucidate the mechanisms by which physical and psychological improvements were observed. This trial was registered at clinicaltrials.gov as NCT00680979.

Treating ethnic minority adults with anxiety disorders: current status and future recommendations.

The past three decades have witnessed an increase in the number of empirical investigations examining the phenomenology of anxiety and related conditions. There has also been an increase in efforts to understand differences that may exist between ethnic groups in the expression of the anxiety disorders. In addition, there is now substantial evidence that a variety of treatment approaches (most notably behavioral and cognitive behavioral) are efficacious in remediating anxiety. However, there continues to be comparatively few treatment outcome studies investigating the efficacy of anxiety treatments among minority populations. In this paper, we review the extant treatment outcome research for African American, Hispanic/Latino[a] American, Asian American, and Native Americans suffering with one of the anxiety disorders. We discuss some of the specific problems with the research in this area, and then provide specific recommendations for conducting treatment outcome research with minority populations in the future.

Obesity and the US military family.

This review discusses the current knowledge and future directions regarding obesity within the US military family (i.e., active‐duty servicemembers, as well as military spouses, children, retirees, and veterans). The increasing rates of overweight and obesity within the US military adversely impact military readiness, limit recruitment, and place a significant financial burden on the Department of Defense.

Pre-meal affective state and laboratory test meal intake in adolescent girls with loss of control eating

Loss of control eating confers risk for excess weight gain and exacerbated disordered eating. Affect theory proposes that loss of control eating is used to cope with negative mood states. Self-report data suggest that negative affect may contribute to the etiology of loss of control eating, but this theory has not been well-tested using laboratory paradigms. We examined associations between pre-meal affective states and intake during a laboratory test meal. One-hundred and ten adolescent girls with reported loss of control eating whose body mass index fell between the 75th and 97th percentile for age and sex completed state mood ratings prior to a test-meal. Results indicated that pre-meal state negative affect was associated with greater carbohydrate and less protein consumption, as well as greater snack and dessert and less fruit and dairy intake. All girls experienced significant decreases in negative affect from pre- to post-meal, but intake during the meal was unassociated with post-meal affect. In support of affect theory, negative affective states reported among girls with loss of control may be a driving factor for increased energy-dense food intake, which may play a role in excess weight gain.

The Impact of Nurse Case Management Home Visitation on Birth Outcomes in African-American Women

UNLABELLED The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, Department of the Navy, Department of Defense or the U. S. government. Dr. Wells is a military service member (employee of the U.S. government). This work was prepared as a part of her official duties. Title 17, USC Section 101 defines a U.S. government work as a work prepared by a military service member or employee of the U.S. government as part of the persons official duties. Despite substantial reductions in U.S. infant mortality rates, racial disparities persist, with black Americans experiencing 2.4 times the rate of their white counterparts. Low birthweight and preterm delivery contribute to this disparity. METHODS To examine the association between antepartum nurse case management home visitation and the occurrence of low birthweight and preterm deliveries in African-American women in Montgomery County, MD, a retrospective cohort study was conducted using existing data from 109 mothers who were enrolled in the Black Babies Start More Infants Living Equally Healthy (SMILE) program. Logistic regression analysis was used. RESULTS Women who received antepartum home visits were 0.37 (CI 0.15-0.94) times less likely to experience preterm delivery than women who did not receive antepartum home visits. The effect of antepartum home visits on preterm delivery was independent of level of prenatal care, negative life events and number of prior live births. There was no significant association between antepartum home visits and low birthweight. CONCLUSION Antepartum home visits appeared to be protective against preterm delivery and could contribute to reducing racial disparities in infant mortality. Further study is needed to understand and replicate specific program components that may contribute to improved birth outcomes in African-American women.

Adapting Interpersonal Psychotherapy for the Prevention of Excessive Weight Gain in Rural African American Girls

OBJECTIVE To obtain focus group data regarding the perspectives of rural African American (AA) girls, parents/guardians, and community leaders on obesity, loss of control (LOC) eating, relationships, and interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG). METHODS 7 focus groups (N = 50 participants) were moderated and the transcripts analyzed by Westat researchers using widely accepted methods of qualitative and thematic analysis. A session was held with experts in health disparities to elucidate themes. RESULTS Participants understood LOC eating; however, they had culturally specific perceptions including usage of alternative terms. Relationships were highly valued, specifically those between mothers and daughters. IPT-WG program components generally resonated with participants, although modifications were recommended to respect parental roles. Experts interpreted focus group themes and discussed potential barriers and solutions to recruitment and participation. CONCLUSION Findings suggest that adapting IPT-WG may be acceptable to rural AA families. This research is the first step in developing a sustainable excessive weight gain and binge eating disorder prevention program for rural AA adolescents.

Excess Weight Gain Prevention in Adolescents: Three-Year Outcome Following a Randomized Controlled Trial.

Objective: Interpersonal psychotherapy (IPT) prevents weight gain in adults with obesity and binge-eating-disorder, and is especially effective among those with increased psychosocial problems. However, IPT was not superior to health education (HE) to prevent excess weight gain at 1-year follow-up in 113 adolescent girls at high-risk for excess weight gain because of loss-of-control eating and high body mass index (BMI; kg/m2; Tanofsky-Kraff et al., 2014). Method: Participants from the original trial were recontacted 3 years later for assessment. At baseline, adolescent- and parent-reported social-adjustment problems and trait anxiety were evaluated. At baseline and follow-ups, BMIz and adiposity by dual-energy x-ray absorptiometry were obtained. Results: Nearly 60% were reassessed at 3 years, with no group differences in participation (ps ≥ .70). Consistent with 1 year, there was no main effect of group on change in BMIz/adiposity (ps ≥ .18). In exploratory analyses, baseline social-adjustment problems and trait-anxiety moderated outcome (ps < .01). Among girls with high self-reported baseline social-adjustment problems or anxiety, IPT, compared to HE, was associated with the steepest declines in BMIz (p < .001). For adiposity, girls with high or low anxiety in HE and girls with low anxiety in IPT experienced gains (ps ⩽ .03), while girls in IPT with high anxiety stabilized. Parent-reports yielded complementary findings. Conclusion: In obesity-prone adolescent girls, IPT was not superior to HE in preventing excess weight gain at 3 years. Consistent with theory, exploratory analyses suggested that IPT was associated with improvements in BMIz over 3 years among youth with high social-adjustment problems or trait anxiety. Future studies should test the efficacy of IPT for obesity prevention among at-risk girls with social-adjustment problems and/or anxiety.