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The overall goal of this study is to introduce latent class analysis (LCA) as an alternative approach to latent subgroup analysis. Traditionally, subgroup analysis aims to determine whether individuals respond differently to a treatment based on one or more measured characteristics. LCA provides a way to identify a small set of underlying subgroups characterized by multiple dimensions which could, in turn, be used to examine differential treatment effects. This approach can help to address methodological challenges that arise in subgroup analysis, including a high Type I error rate, low statistical power, and limitations in examining higher-order interactions. An empirical example draws on N  = 1,900 adolescents from the National Longitudinal Survey of Adolescent Health. Six characteristics (household poverty, single-parent status, peer cigarette use, peer alcohol use, neighborhood unemployment, and neighborhood poverty) are used to identify five latent subgroups: Low Risk, Peer Risk, Economic Risk, Household & Peer Risk, and Multi-Contextual Risk. Two approaches for examining differential treatment effects are demonstrated using a simulated outcome: 1) a classify-analyze approach and, 2) a model-based approach based on a reparameterization of the LCA with covariates model. Such approaches can facilitate targeting future intervention resources to subgroups that promise to show the maximum treatment response.

This study identified profiles of 13 risk factors across child, family, school, and neighborhood domains in a diverse sample of children in kindergarten from four US locations (n = 750; 45% minority). It then examined the relation of those early risk profiles to externalizing problems, school failure, and low academic achievement in Grade 5. A person-centered approach, latent class analysis, revealed four unique risk profiles, which varied considerably across urban African American, urban White, and rural White children. Profiles characterized by several risks that cut across multiple domains conferred the highest risk for negative outcomes. Compared to a variable-centered approach, such as a cumulative risk index, these findings provide a more nuanced understanding of the early precursors to negative outcomes. For example, results suggested that urban children in single-parent homes that have few other risk factors (i.e., show at least average parenting warmth and consistency and report relatively low stress and high social support) are at quite low risk for externalizing problems, but at relatively high risk for poor grades and low academic achievement. These findings provide important information for refining and targeting preventive interventions to groups of children who share particular constellations of risk factors.

Although numerous evidence-based programs (EBPs) have been proven effective in research trials and are being widely promoted through federal, state, and philanthropic dollars, few have been “scaled up” in a manner likely to have a measurable impact on today’s critical social problems. The Interactive Systems Framework for Dissemination and Implementation (ISF) explicates three systems that are critical in addressing the barriers that prevent these programs from having their intended public health impact. In this article we describe the relevance of these systems in a real-world context with a specific focus on the Prevention Support System (PSS). We expand on the ISF model by presenting funders and policy-makers as active and engaged stakeholders, and demonstrate how a state-level PSS has used empirical evidence to inform general and program-specific capacity-building and support interactions among researchers, funders, and practitioners in Pennsylvania. By embracing this expanded ISF framework as a conceptual model for the wide-scale dissemination and support of EBPs, and recognizing the need for a distinct state-level PSS, Pennsylvania has created an infrastructure to effectively address the primary barriers to moving from lists of EBPs to achieving population-level public health improvement.

Youth in underserved, urban communities are at risk for a range of negative outcomes related to stress, including social-emotional difficulties, behavior problems, and poor academic performance. Mindfulness-based approaches may improve adjustment among chronically stressed and disadvantaged youth by enhancing self-regulatory capacities. This paper reports findings from a pilot randomized controlled trial assessing the feasibility, acceptability, and preliminary outcomes of a school-based mindfulness and yoga intervention. Four urban public schools were randomized to an intervention or wait-list control condition (n=97 fourth and fifth graders, 60.8% female). It was hypothesized that the 12-week intervention would reduce involuntary stress responses and improve mental health outcomes and social adjustment. Stress responses, depressive symptoms, and peer relations were assessed at baseline and post-intervention. Findings suggest the intervention was attractive to students, teachers, and school administrators and that it had a positive impact on problematic responses to stress including rumination, intrusive thoughts, and emotional arousal. [PUBLICATION ABSTRACT]

The transition from high school to college provides a potentially critical window to intervene and reduce risky behavior among adolescents. Understanding the motivations (e.g., social, coping, enhancement) behind high school seniors' alcohol use could provide one important avenue to reducing risky drinking behaviors. In the present study, latent class analysis was used to examine the relationship between different patterns of drinking motivations and behaviors in a sample of 12th graders (N = 1,877) from the 2004 Monitoring the Future survey. Unlike previous variable-centered analyses, this person-centered approach identifies types of motivations that cluster together within individuals and relates membership in these profiles to drinking behaviors. Results suggest four profiles of drinking motivations for both boys and girls, including Experimenters, Thrill-seekers, Multi-reasoners, and Relaxers. Early initiation of alcohol use, past year drunkenness, and drinking before 4 P.M. were associated with greater odds of membership in the Multi-reasoners class as compared to the Experimenters class. Although the strength of these relationships varied for boys and girls, findings were similar across gender suggesting that the riskiest drinking behavior was related to membership in the Multi-reasoners class. These findings can be used to inform prevention programming. Specifically, targeted interventions that tailor program content to the distinct drinking motivation profiles described above may prove to be effective in reducing risky drinking behavior among high school seniors.

Actively pursuing important goals predicts positive affect and well-being (Emmons, 1986, \"J. Pers. Soc. Psychol.\" 51: 1058-1068; Emmons and King, 1988, \"J. Pers. Soc. Psychol.\" 54: 1040-1048; Salmela-Aro and Nurmi, 1997, \"J. Adult Dev.\" 4: 179-188). College-bound high school graduates (n=943) completed the ULTRA Orientation Survey prior to college. Planned alcohol use differed by gender, fraternity/sorority participation, and Honors membership. Students who appraised academic goals as more important and less difficult/stressful planned to consume less alcohol in their 1st year of college. Greater importance and lower difficulty/stressfulness of social goals predicted more planned drinking. Relationships of personal goals with drinking remained after controlling for group differences, and academic and social goal importance predicted plans to drink after controlling for alcohol use during high school senior year. The discussion focuses on the impact of goal appraisals on risk behavior, niche selection during the transition to college, and implications for the prevention of heavy drinking.

The development of self-regulation skills during early childhood lays the foundation for healthy development and future well-being. Recently, executive function (EF) skills, a set of inter-related abilities used in coordinated, goal-directed behavior, have been highlighted as integral components of young children’s growing competence. However, very little is known about the role children’s early context and experiences within the family play in the emergence of EF skills. The goal of the present study was to examine how demographic and familial risks at 2 and 6 months related to EF competence at 36 months in a large, diverse sample of primarily low-income, non-urban families from Pennsylvania and North Carolina. This study used an innovative person-centered methodological approach, latent class analysis (LCA), to model profiles of infants’ home environment in order to: (1) better understand how various combinations of ecological risks predicted future EF skills, and (2) more accurately identify subgroups of young children who were most at-risk for EF deficits. Given the diversity within our sample, we also explored how these associations varied across ethnic groups. Results showed that the following six ecological risk profiles best captured the diverse experiences of these families: (1) Married, Low Risk, (2) Married, Stressed & Depressed, (3) Poor & Married, (4) Poor & Unmarried, (5) Poor & Single, and (6) Poor, Single, Multi-Problem. Membership in the early risk profiles was meaningfully associated with EF skills at 36 months. Specifically, profiles characterized by poor, unmarried mothers were at the highest risk for future EF problems. Mediation analyses revealed that much of the influence of early demographic and familial risks on later EF skills may be transmitted through low parental sensitivity and responsiveness to their children during infancy and children’s emerging language skills during toddlerhood. However, important differences across ethnic groups were found for some mediators, including maternal negative intrusiveness and children’s language skills. The findings suggest that the early home environment may prove to be an especially fruitful context for the promotion of future EF skills. Additionally, positive parenting behaviors, including positive engagement and responsivity, should be emphasized and targeted to families that are poor and having an unmarried caregiver. If replicated, the results hold much promise for informing the more accurate and efficient use of scarce intervention resources in the future.

BackgroundThe long-term effectiveness of Head Start remains a topic of debate. Previous research with families of children enrolling in Head Start at three years of age has shown patterns of familial risk moderate the short-term effects of Head Start suggesting some children benefit more than others. However, we know little about patterns of risk that moderate Head Start’s effectiveness for children who first enroll in Head Start at four-year-old and even less about risk factors that moderate the long-term effectiveness of Head Start.ObjectiveIn the current study, we sought to address these gaps by examining differential treatment effects of Head Start on elementary school outcomes for subgroups of children who first enrolled in Head Start at age four.MethodsLatent class analysis (LCA) was used to identify subgroups of children from the four-year-old cohort of the Head Start Impact Study (N = 2,108) based on family risk variables in preschool (e.g., maternal depression). Weighted regression analyses were then conducted to assess if the effects of Head Start on end of pre-kindergarten, kindergarten, 1st, and 3rd grade academic and social-emotional outcomes varied by latent class membership.ResultsWhile a subsample of children attending Head Start experienced sustained benefits, others had worse outcomes in elementary school, and predominantly any initial benefits of Head Start were not sustained into elementary school.ConclusionIrrespective of patterns of familial risk, initial benefits gained via Head Start for children first enrolling in at four-years of age typically fade out during elementary school.

Black/African American individuals experience high rates of posttraumatic stress disorder (PTSD), which is frequently chronic and undertreated in this population. Intimate relationships are a salient resource for Black/African American adults’ psychological well-being. To help advance health equity, this study serves as an initial, proof-of-concept investigation of patient outcomes among Black/African American adults who received a disorder-specific couple therapy for PTSD. Participants were a subsample of seven Black/African American adults (mean age = 40.56 years, SD = 10.18; 85.7% male) who participated in an uncontrolled trial of an abbreviated, intensive, multi-couple group version of cognitive-behavioral conjoint therapy for PTSD with 24 military dyads. Treatment was delivered over 2 days in a weekend retreat format. Assessments were administered at baseline, 1 month post-retreat, and 3 months post-retreat. There were large and significant decreases in patients’ PTSD symptoms based on clinicians’ and patients’ ratings (ds −1.37 and −1.36, respectively) by the 3-month follow-up relative to baseline. There were also large and significant decreases in patients’ depressive, anxiety, and anger symptoms (ds −1.39 to −1.93) and a large, marginally significant decrease in patients’ insomnia (d = −0.85; p = 0.083). Patients reported a medium, non-significant increase in relationship satisfaction (d = 0.68; p = 0.146) and a large, marginally significant increase in joint dyadic coping (d = 0.90; p = 0.069). Findings offer preliminary evidence that treating PTSD within a couple context is a relevant strategy to reduce PTSD and comorbid symptoms among partnered Black/African American adults and a promising approach to enhance relationships.