Tyler Smith - Academia.edu (original) (raw)

Papers by Tyler Smith

Research paper thumbnail of Evaluating the Effects of Family–School Engagement Interventions on Parent–Teacher Relationships: A Meta-analysis

School Mental Health, 2022

Research paper thumbnail of The Effects of Family-School Partnership Interventions on Academic and Social-Emotional Functioning: a Meta-Analysis Exploring What Works for Whom

Educational Psychology Review, 2019

Family-school partnership (FSP) interventions capitalize on connections between families and scho... more Family-school partnership (FSP) interventions capitalize on connections between families and schools, as parents and teachers jointly promote child development through activities that bridge both settings. The current meta-analysis assessed the effects of FSP interventions on children’s academic and social-emotional competencies. From initial comprehensive search procedures (i.e., online reference databases, hand searches of relevant journals, and cited references) yielding over 19,000 abstracts, our study sample included 77 FSP intervention studies with 438 effect sizes. Studies including the following comprised our final sample: (1) an FSP intervention, (2) school-aged children, (3) academic and/or social-emotional outcomes, (4) a naturalistic setting, and (5) an experimental or quasi-experimental group design. Utilizing robust variance estimation (RVE), results revealed that FSP interventions significantly and positively impacted children’s academic achievement ( δ = .25 ) and behaviors ( δ = .30), social-behavioral competence ( δ = .32), and mental health ( δ = .34). Additionally, particular structural (i.e., home-based involvement) and relational (i.e., school to home communication, collaboration, bi-directional communication) components significantly contributed to FSP intervention effects. Mixed-effects meta-regression analyses were used to assess if effects of FSP intervention components were moderated by children’s grade or race/ethnicity. Results indicated that certain FSP intervention components (i.e., bi-directional communication, behavioral support) were more effective for older students. No significant moderation effects were found race/ethnicity, indicating that FSP intervention components were effective across participants. Overall, findings provide further support for the use of FSP interventions to support youth outcomes. Future meta-analyses should include single-case design studies and explore unique combinations of FSP intervention components.

Research paper thumbnail of The Effects of Teacher Training on Teachers’ Family-Engagement Practices, Attitudes, and Knowledge: A Meta-analysis

Journal of Educational and Psychological Consultation, 2018

When families are engaged in their education, children's academic, behavioral, and social-emotion... more When families are engaged in their education, children's academic, behavioral, and social-emotional development is indirectly supported. Many teacher-training programs (TTPs) focused on preparing teachers to communicate and work with families have been developed, although inconsistencies regarding their effectiveness exist. The current meta-analysis of 39 studies systematically analyzed the effects of TTPs on teachers' family-engagement practices, attitudes, and knowledge. TTPs included preservice university courses, teacher in-service, and professional development programs. Studies were coded for key sample, setting, and quality characteristics. Analyses revealed TTPs had a significant positive effect on all teacher family-engagement outcomes. Key intervention components were also determined (e.g., communication strategies, collaborative planning, and problem solving) and can be used to inform the development of future TTPs. Although results are promising, future TTPs should aim to improve methodological rigor and study quality.

Research paper thumbnail of Predictors of Intrusive Sexual Behaviors in Preschool-Aged Children

Journal of sex research, Jan 10, 2018

Intrusive sexual behaviors (ISBs) are a specific type of problematic sexual behavior characterize... more Intrusive sexual behaviors (ISBs) are a specific type of problematic sexual behavior characterized by the invasive nature of the acts (e.g., touching others' private parts, attempting intercourse; Friedrich, 1997). The limited amount of research on ISBs has focused on sexual abuse history as the primary predictor. However, Friedrich, Davies, Feher, and Wright (2003) found that ISBs in children up to age 12 were related to four broad conceptual factors: (a) exposure to sexual content, (b) exposure to violent behavior, (c) family adversity, and (d) child vulnerabilities. The current study sought to replicate Friedrich's study using a clinical sample of 217 preschool-aged children (ages two to six). Results supported variables from within the child vulnerabilities construct (externalizing behaviors, β= 0.032, p = 0.001), post-traumatic stress disorder (PTSD) criteria met (β = 0.177, p = 0.02), and an inverse relationship with age (β = -0.206, p = 0.024). These results highlight...

Research paper thumbnail of Isolating the association of sleep, depressive state, and other independent indicators for suicide ideation in United States teenagers

Archives of suicide research : official journal of the International Academy for Suicide Research, Jan 23, 2018

According to the Centers for Disease Control and Prevention, suicide is the second leading cause ... more According to the Centers for Disease Control and Prevention, suicide is the second leading cause of death in American teenagers, and is a growing public health concern. This study uses multivariable logistic regression to investigate the independent relationship between suicide ideation and sleep duration in teenagers using the 2015 Youth Behavior Risk Surveillance Study, controlling for demographic, behavioral, and other factors found to be associated. Sleep durations of 4-5 hours and 6-7 hours per night were associated with approximately 75-80% and 20-40% increased adjusted odds of suicide ideation, as compared to teens sleeping the recommended 8 hours or more, and should be considered as a potential important indicator for adolescent suicidal ideation in in primary-care screens.

Research paper thumbnail of Conflicts of Interest and Publication Bias

Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine, Sep 1, 2016

W e read with great interest the article published in JOEM on, ''Financial Conflicts of Interest ... more W e read with great interest the article published in JOEM on, ''Financial Conflicts of Interest and Study Results in Environmental and Occupational Health Research.'' 1 The authors reviewed 373 publications from 2012 and concluded that, when potential financial conflicts of interest were reported, nonsignificant study results, or ''negative findings,'' were more likely to be reported. In addition, 7 of 12 publications with US military affiliated authors shared ''negative findings.'' The authors concluded that investigators with financial conflicts of interest or military affiliations were more likely to report negative results from their work. We would like to respectfully share our concerns about these conclusions in the hope that readers will use care in interpreting the original article. We are, or we have been, militaryaffiliated investigators, and we fully acknowledge that this prompts our interest in the topic. We also have academic affiliations. When several students interpreted the recent JOEM publication as meaning that industry-sponsored and militaryaffiliated authors should not be viewed as credible, our concern was heightened. One methodologic concern about the original JOEM article relates to the determination of ''positive,'' ''negative,'' or ''mixed'' results. We appreciate that the two authors acknowledged challenges in determining how each reviewed study's results fit into one of these categories. Despite the close ties of the two authors, they disagreed on categorization of 14% of the publications they reviewed. 1 Each of us, at one time, has been principal investigator of the US military's large Millennium Cohort Study. 2 When we tried to categorize findings of Millennium Cohort publications, 3 we found approximately that 25% of abstracts noted some nonsignificant (''negative'') associations, but nearly all full reports had ''mixed''

Research paper thumbnail of Consistency in Physical Activity and Increase in Mental Health in Elderly over a Decade: Are We Achieving Better Population Health?

AIMS Medical Science, 2016

Objective : Over the past century, advances in medicine and public health have resulted in an ext... more Objective : Over the past century, advances in medicine and public health have resulted in an extraordinary increase in life expectancy. As a result, focus has shifted from infectious to chronic diseases. Though current guidelines for healthy behaviors among the elderly exist, it remains unclear whether this growing segment of the population has shifted their behaviors in response to public health campaigns. The objective of this study was to investigate mental health and physical activity trends that may be leading indicators for healthier living and increased life expectancy. Methods: Using nearly a decade of continuous serial cross-sectional data collected in the nationwide Behavioral Risk Factor Surveillance System, this study investigated trends of health behaviors and mental health in a population of nearly 750,000 who were 65 or older from 2003 through 2011. Weighted univariate and multivariable analyses were utilized including investigation of trend analyses over the decade, producing adjusted annual odds of physical activity and mental health. Results: A fter controlling for demographic and other factors, higher education and income, lower BMI, and current or previous smoking was associated with higher odds of adverse mental health and lower odds of physical activity engagement. Adjusted odds of adverse mental health climbed over the decade of observation whereas the odds of physical activity remained static. Conclusions: These data, encompassing a very large population over a decade of time, suggest that physical activity is stable though mental health challenges are on the rise in this older population. Public health campaigns may face greater barriers in an elderly population due to lifelong habits, dissemination and educational approaches, or decreasing gains. Further research should be conducted to identify more effective approaches towards increasing physical activity in this important and growing subset of the population and towards transforming behaviors earlier in life.

Research paper thumbnail of Adaptation and evaluation of the Liverpool Seizure Severity Scale and Liverpool Quality of Life battery for American epilepsy patients

Quality of Life Research, 1998

The Liverpool Seizure Severity Scale (LSSS) and the Liverpool Quality of Life (LQOL) battery were... more The Liverpool Seizure Severity Scale (LSSS) and the Liverpool Quality of Life (LQOL) battery were developed in Great Britain to assess the severity of seizure symptoms and the impact of epilepsy on patients' quality of life. The scales have been validated on British patients, but have not been validated for use with American patients. The objectives of this study were to adapt the scales to the American population and to evaluate their reliability and validity. After modifications recommended by focus groups with patients and epilepsy specialists, the scales were administered to a sample of 90 epilepsy patients who had experienced seizures within the previous 4 weeks. Comparisons of patients with generalized tonic-clonic seizures (n = 58) and partial seizures (n = 32) revealed significant differences on 9 of the 20 items on the LSSS as well as the total score. None of the six LQOL subscales (negative drug effects, positive drug effects, affect balance, sense of mastery, life fulfilment and impact of epilepsy) distinguished patients with different seizure types but five of the six subscales were significantly correlated with seizure severity. The internal consistency and test-retest reliability were adequate for both the LSSS and LQOL. Finally, five of the six LQOL scales were significantly correlated with independent measures of mental health, physical health and role functioning.

Research paper thumbnail of Examination of Post-Service Health-Related Quality of Life Among Rural and Urban Military Members of the Millennium …

Journal of Rural …, 2011

Little information exists on the health-related quality of life (HRQL) of U.S. veterans based on ... more Little information exists on the health-related quality of life (HRQL) of U.S. veterans based on rural (versus urban) status, especially those in younger age groups, and whether deployment influences this outcome. We addressed these questions in the Millennium Cohort Study, a prospective investigation of U.S. military personnel assessed first in 2001 and then subsequently every three years via self-administered questionnaires. Participants separated from the military at the time of the most recent survey were eligible (n = 10,738). HRQL was assessed using the SF-36V Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Rural status was assigned from zip codes using the Rural-Urban Commuting Area classification. The mean age of participants was 35 years (SD = 8.98). Compared with urban dwellers, rural residents reported significantly lower unadjusted mean PCS (49.80 vs. 50.42) and MCS (49.97 vs. 50.81) scores, but differences became nonsignificant after covariate adjustment. No interaction was seen between deployment and rural status. Rural status is not independently associated with HRQL among recent U.S. veterans.

Research paper thumbnail of Family process and child outcomes in a psychiatric sample: A narrative assessment

Infant Behavior and Development, 1996

Research paper thumbnail of Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study

Hypertension, 2009

High-stress situations, such as combat deployments, are a potential risk factor for hypertension.... more High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment–induced stress and hypertension. The Millennium Cohort baseline questionnaire (2001–2003) was completed by 77 047 US active-duty and Reserve/National Guard members. Follow-up was completed by 55 021 responders ≈3 years later (2004–2006). Multivariable logistic regression was used to estimate the 3-year risk of newly reported hypertension, adjusting for general and mental health, demographics, and occupational and behavioral characteristics. After applying exclusion criteria, our analyses included 36 061 service members. Subanalyses of deployers included 8829 participants. Newly reported hypertension was identified in 6.9% of the cohort between baseline and follow-up, many of whom had deployed on mi...

Research paper thumbnail of Trajectories of trauma symptoms and resilience in deployed US military service members: Prospective cohort study

British Journal of Psychiatry, 2012

BackgroundMost previous attempts to determine the psychological cost of military deployment have ... more BackgroundMost previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs.AimsThis study addressed these limitations using a population-based, prospective cohort of US military personnel deployed in support of the operations in Iraq and Afghanistan.MethodThe sample consisted of US military service members in all branches including active duty, reserve and national guard who deployed once (n= 3393) or multiple times (n= 4394). Self-reported symptoms of post-traumatic stress were obtained prior to deployment and at two follow-ups spaced 3 years apart. Data were examined for longitudinal trajectories using latent growth mixture modelling.ResultsEach analysis revealed remarkably similar post-traumatic stress trajectories across time. The most common pattern was low–stable post-traumatic stress or resilience (83.1% single deployers, 84.9% mult...

Research paper thumbnail of Application of latent semantic analysis for open-ended responses in a large, epidemiologic study

BMC Medical Research Methodology, 2011

Background The Millennium Cohort Study is a longitudinal cohort study designed in the late 1990s ... more Background The Millennium Cohort Study is a longitudinal cohort study designed in the late 1990s to evaluate how military service may affect long-term health. The purpose of this investigation was to examine characteristics of Millennium Cohort Study participants who responded to the open-ended question, and to identify and investigate the most commonly reported areas of concern. Methods Participants who responded during the 2001-2003 and 2004-2006 questionnaire cycles were included in this study (n = 108,129). To perform these analyses, Latent Semantic Analysis (LSA) was applied to a broad open-ended question asking the participant if there were any additional health concerns. Multivariable logistic regression was performed to examine the adjusted odds of responding to the open-text field, and cluster analysis was executed to understand the major areas of concern for participants providing open-ended responses. Results Participants who provided information in the open-ended text fi...

Research paper thumbnail of Assessing nonresponse bias at follow-up in a large prospective cohort of relatively young and mobile military service members

BMC Medical Research Methodology, 2010

Background: Nonresponse bias in a longitudinal study could affect the magnitude and direction of ... more Background: Nonresponse bias in a longitudinal study could affect the magnitude and direction of measures of association. We identified sociodemographic, behavioral, military, and health-related predictors of response to the first follow-up questionnaire in a large military cohort and assessed the extent to which nonresponse biased measures of association. Methods: Data are from the baseline and first follow-up survey of the Millennium Cohort Study. Seventy-six thousand, seven hundred and seventy-five eligible individuals completed the baseline survey and were presumed alive at the time of follow-up; of these, 54,960 (71.6%) completed the first follow-up survey. Logistic regression models were used to calculate inverse probability weights using propensity scores. Results: Characteristics associated with a greater probability of response included female gender, older age, higher education level, officer rank, active-duty status, and a self-reported history of military exposures. Ever smokers, those with a history of chronic alcohol consumption or a major depressive disorder, and those separated from the military at follow-up had a lower probability of response. Nonresponse to the follow-up questionnaire did not result in appreciable bias; bias was greatest in subgroups with small numbers. Conclusions: These findings suggest that prospective analyses from this cohort are not substantially biased by non-response at the first follow-up assessment.

Research paper thumbnail of Chemical Warfare and the Gulf War: A Review of the Impact on Gulf Veterans' Health

It is unlikely that Gulf War veterans are SUffering chronic effects from illnesses caused by chem... more It is unlikely that Gulf War veterans are SUffering chronic effects from illnesses caused by chemical warfare nerve agent exposure. Extensive investigation and review by several expert panels have determined that no evidence exists that chemical warfare nerve agents were used during the Gulf War. At no time before, during, or after the war was there confirmation of symptoms among anyone, military or civilian, caused by chemical warfare nerve agent exposure. However, studies of Gulf War veterans have found belief that chemical weapons were used, significantly associated with both severe and mildmoderate illnesses. The psychological impact of a chemical warfare attack, either actual or perceived, can result in immediate and long-term health consequences. The deployment or war-related health impact from life-threatening experiences of the Gulf War, including the perceived exposure to chemical warfare agents, should be considered as an important cause of morbidity among Gulf War veterans.

Research paper thumbnail of Evaluating the Effects of Family–School Engagement Interventions on Parent–Teacher Relationships: A Meta-analysis

School Mental Health, 2022

Research paper thumbnail of The Effects of Family-School Partnership Interventions on Academic and Social-Emotional Functioning: a Meta-Analysis Exploring What Works for Whom

Educational Psychology Review, 2019

Family-school partnership (FSP) interventions capitalize on connections between families and scho... more Family-school partnership (FSP) interventions capitalize on connections between families and schools, as parents and teachers jointly promote child development through activities that bridge both settings. The current meta-analysis assessed the effects of FSP interventions on children’s academic and social-emotional competencies. From initial comprehensive search procedures (i.e., online reference databases, hand searches of relevant journals, and cited references) yielding over 19,000 abstracts, our study sample included 77 FSP intervention studies with 438 effect sizes. Studies including the following comprised our final sample: (1) an FSP intervention, (2) school-aged children, (3) academic and/or social-emotional outcomes, (4) a naturalistic setting, and (5) an experimental or quasi-experimental group design. Utilizing robust variance estimation (RVE), results revealed that FSP interventions significantly and positively impacted children’s academic achievement ( δ = .25 ) and behaviors ( δ = .30), social-behavioral competence ( δ = .32), and mental health ( δ = .34). Additionally, particular structural (i.e., home-based involvement) and relational (i.e., school to home communication, collaboration, bi-directional communication) components significantly contributed to FSP intervention effects. Mixed-effects meta-regression analyses were used to assess if effects of FSP intervention components were moderated by children’s grade or race/ethnicity. Results indicated that certain FSP intervention components (i.e., bi-directional communication, behavioral support) were more effective for older students. No significant moderation effects were found race/ethnicity, indicating that FSP intervention components were effective across participants. Overall, findings provide further support for the use of FSP interventions to support youth outcomes. Future meta-analyses should include single-case design studies and explore unique combinations of FSP intervention components.

Research paper thumbnail of The Effects of Teacher Training on Teachers’ Family-Engagement Practices, Attitudes, and Knowledge: A Meta-analysis

Journal of Educational and Psychological Consultation, 2018

When families are engaged in their education, children's academic, behavioral, and social-emotion... more When families are engaged in their education, children's academic, behavioral, and social-emotional development is indirectly supported. Many teacher-training programs (TTPs) focused on preparing teachers to communicate and work with families have been developed, although inconsistencies regarding their effectiveness exist. The current meta-analysis of 39 studies systematically analyzed the effects of TTPs on teachers' family-engagement practices, attitudes, and knowledge. TTPs included preservice university courses, teacher in-service, and professional development programs. Studies were coded for key sample, setting, and quality characteristics. Analyses revealed TTPs had a significant positive effect on all teacher family-engagement outcomes. Key intervention components were also determined (e.g., communication strategies, collaborative planning, and problem solving) and can be used to inform the development of future TTPs. Although results are promising, future TTPs should aim to improve methodological rigor and study quality.

Research paper thumbnail of Predictors of Intrusive Sexual Behaviors in Preschool-Aged Children

Journal of sex research, Jan 10, 2018

Intrusive sexual behaviors (ISBs) are a specific type of problematic sexual behavior characterize... more Intrusive sexual behaviors (ISBs) are a specific type of problematic sexual behavior characterized by the invasive nature of the acts (e.g., touching others' private parts, attempting intercourse; Friedrich, 1997). The limited amount of research on ISBs has focused on sexual abuse history as the primary predictor. However, Friedrich, Davies, Feher, and Wright (2003) found that ISBs in children up to age 12 were related to four broad conceptual factors: (a) exposure to sexual content, (b) exposure to violent behavior, (c) family adversity, and (d) child vulnerabilities. The current study sought to replicate Friedrich's study using a clinical sample of 217 preschool-aged children (ages two to six). Results supported variables from within the child vulnerabilities construct (externalizing behaviors, β= 0.032, p = 0.001), post-traumatic stress disorder (PTSD) criteria met (β = 0.177, p = 0.02), and an inverse relationship with age (β = -0.206, p = 0.024). These results highlight...

Research paper thumbnail of Isolating the association of sleep, depressive state, and other independent indicators for suicide ideation in United States teenagers

Archives of suicide research : official journal of the International Academy for Suicide Research, Jan 23, 2018

According to the Centers for Disease Control and Prevention, suicide is the second leading cause ... more According to the Centers for Disease Control and Prevention, suicide is the second leading cause of death in American teenagers, and is a growing public health concern. This study uses multivariable logistic regression to investigate the independent relationship between suicide ideation and sleep duration in teenagers using the 2015 Youth Behavior Risk Surveillance Study, controlling for demographic, behavioral, and other factors found to be associated. Sleep durations of 4-5 hours and 6-7 hours per night were associated with approximately 75-80% and 20-40% increased adjusted odds of suicide ideation, as compared to teens sleeping the recommended 8 hours or more, and should be considered as a potential important indicator for adolescent suicidal ideation in in primary-care screens.

Research paper thumbnail of Conflicts of Interest and Publication Bias

Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine, Sep 1, 2016

W e read with great interest the article published in JOEM on, ''Financial Conflicts of Interest ... more W e read with great interest the article published in JOEM on, ''Financial Conflicts of Interest and Study Results in Environmental and Occupational Health Research.'' 1 The authors reviewed 373 publications from 2012 and concluded that, when potential financial conflicts of interest were reported, nonsignificant study results, or ''negative findings,'' were more likely to be reported. In addition, 7 of 12 publications with US military affiliated authors shared ''negative findings.'' The authors concluded that investigators with financial conflicts of interest or military affiliations were more likely to report negative results from their work. We would like to respectfully share our concerns about these conclusions in the hope that readers will use care in interpreting the original article. We are, or we have been, militaryaffiliated investigators, and we fully acknowledge that this prompts our interest in the topic. We also have academic affiliations. When several students interpreted the recent JOEM publication as meaning that industry-sponsored and militaryaffiliated authors should not be viewed as credible, our concern was heightened. One methodologic concern about the original JOEM article relates to the determination of ''positive,'' ''negative,'' or ''mixed'' results. We appreciate that the two authors acknowledged challenges in determining how each reviewed study's results fit into one of these categories. Despite the close ties of the two authors, they disagreed on categorization of 14% of the publications they reviewed. 1 Each of us, at one time, has been principal investigator of the US military's large Millennium Cohort Study. 2 When we tried to categorize findings of Millennium Cohort publications, 3 we found approximately that 25% of abstracts noted some nonsignificant (''negative'') associations, but nearly all full reports had ''mixed''

Research paper thumbnail of Consistency in Physical Activity and Increase in Mental Health in Elderly over a Decade: Are We Achieving Better Population Health?

AIMS Medical Science, 2016

Objective : Over the past century, advances in medicine and public health have resulted in an ext... more Objective : Over the past century, advances in medicine and public health have resulted in an extraordinary increase in life expectancy. As a result, focus has shifted from infectious to chronic diseases. Though current guidelines for healthy behaviors among the elderly exist, it remains unclear whether this growing segment of the population has shifted their behaviors in response to public health campaigns. The objective of this study was to investigate mental health and physical activity trends that may be leading indicators for healthier living and increased life expectancy. Methods: Using nearly a decade of continuous serial cross-sectional data collected in the nationwide Behavioral Risk Factor Surveillance System, this study investigated trends of health behaviors and mental health in a population of nearly 750,000 who were 65 or older from 2003 through 2011. Weighted univariate and multivariable analyses were utilized including investigation of trend analyses over the decade, producing adjusted annual odds of physical activity and mental health. Results: A fter controlling for demographic and other factors, higher education and income, lower BMI, and current or previous smoking was associated with higher odds of adverse mental health and lower odds of physical activity engagement. Adjusted odds of adverse mental health climbed over the decade of observation whereas the odds of physical activity remained static. Conclusions: These data, encompassing a very large population over a decade of time, suggest that physical activity is stable though mental health challenges are on the rise in this older population. Public health campaigns may face greater barriers in an elderly population due to lifelong habits, dissemination and educational approaches, or decreasing gains. Further research should be conducted to identify more effective approaches towards increasing physical activity in this important and growing subset of the population and towards transforming behaviors earlier in life.

Research paper thumbnail of Adaptation and evaluation of the Liverpool Seizure Severity Scale and Liverpool Quality of Life battery for American epilepsy patients

Quality of Life Research, 1998

The Liverpool Seizure Severity Scale (LSSS) and the Liverpool Quality of Life (LQOL) battery were... more The Liverpool Seizure Severity Scale (LSSS) and the Liverpool Quality of Life (LQOL) battery were developed in Great Britain to assess the severity of seizure symptoms and the impact of epilepsy on patients' quality of life. The scales have been validated on British patients, but have not been validated for use with American patients. The objectives of this study were to adapt the scales to the American population and to evaluate their reliability and validity. After modifications recommended by focus groups with patients and epilepsy specialists, the scales were administered to a sample of 90 epilepsy patients who had experienced seizures within the previous 4 weeks. Comparisons of patients with generalized tonic-clonic seizures (n = 58) and partial seizures (n = 32) revealed significant differences on 9 of the 20 items on the LSSS as well as the total score. None of the six LQOL subscales (negative drug effects, positive drug effects, affect balance, sense of mastery, life fulfilment and impact of epilepsy) distinguished patients with different seizure types but five of the six subscales were significantly correlated with seizure severity. The internal consistency and test-retest reliability were adequate for both the LSSS and LQOL. Finally, five of the six LQOL scales were significantly correlated with independent measures of mental health, physical health and role functioning.

Research paper thumbnail of Examination of Post-Service Health-Related Quality of Life Among Rural and Urban Military Members of the Millennium …

Journal of Rural …, 2011

Little information exists on the health-related quality of life (HRQL) of U.S. veterans based on ... more Little information exists on the health-related quality of life (HRQL) of U.S. veterans based on rural (versus urban) status, especially those in younger age groups, and whether deployment influences this outcome. We addressed these questions in the Millennium Cohort Study, a prospective investigation of U.S. military personnel assessed first in 2001 and then subsequently every three years via self-administered questionnaires. Participants separated from the military at the time of the most recent survey were eligible (n = 10,738). HRQL was assessed using the SF-36V Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Rural status was assigned from zip codes using the Rural-Urban Commuting Area classification. The mean age of participants was 35 years (SD = 8.98). Compared with urban dwellers, rural residents reported significantly lower unadjusted mean PCS (49.80 vs. 50.42) and MCS (49.97 vs. 50.81) scores, but differences became nonsignificant after covariate adjustment. No interaction was seen between deployment and rural status. Rural status is not independently associated with HRQL among recent U.S. veterans.

Research paper thumbnail of Family process and child outcomes in a psychiatric sample: A narrative assessment

Infant Behavior and Development, 1996

Research paper thumbnail of Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study

Hypertension, 2009

High-stress situations, such as combat deployments, are a potential risk factor for hypertension.... more High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment–induced stress and hypertension. The Millennium Cohort baseline questionnaire (2001–2003) was completed by 77 047 US active-duty and Reserve/National Guard members. Follow-up was completed by 55 021 responders ≈3 years later (2004–2006). Multivariable logistic regression was used to estimate the 3-year risk of newly reported hypertension, adjusting for general and mental health, demographics, and occupational and behavioral characteristics. After applying exclusion criteria, our analyses included 36 061 service members. Subanalyses of deployers included 8829 participants. Newly reported hypertension was identified in 6.9% of the cohort between baseline and follow-up, many of whom had deployed on mi...

Research paper thumbnail of Trajectories of trauma symptoms and resilience in deployed US military service members: Prospective cohort study

British Journal of Psychiatry, 2012

BackgroundMost previous attempts to determine the psychological cost of military deployment have ... more BackgroundMost previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs.AimsThis study addressed these limitations using a population-based, prospective cohort of US military personnel deployed in support of the operations in Iraq and Afghanistan.MethodThe sample consisted of US military service members in all branches including active duty, reserve and national guard who deployed once (n= 3393) or multiple times (n= 4394). Self-reported symptoms of post-traumatic stress were obtained prior to deployment and at two follow-ups spaced 3 years apart. Data were examined for longitudinal trajectories using latent growth mixture modelling.ResultsEach analysis revealed remarkably similar post-traumatic stress trajectories across time. The most common pattern was low–stable post-traumatic stress or resilience (83.1% single deployers, 84.9% mult...

Research paper thumbnail of Application of latent semantic analysis for open-ended responses in a large, epidemiologic study

BMC Medical Research Methodology, 2011

Background The Millennium Cohort Study is a longitudinal cohort study designed in the late 1990s ... more Background The Millennium Cohort Study is a longitudinal cohort study designed in the late 1990s to evaluate how military service may affect long-term health. The purpose of this investigation was to examine characteristics of Millennium Cohort Study participants who responded to the open-ended question, and to identify and investigate the most commonly reported areas of concern. Methods Participants who responded during the 2001-2003 and 2004-2006 questionnaire cycles were included in this study (n = 108,129). To perform these analyses, Latent Semantic Analysis (LSA) was applied to a broad open-ended question asking the participant if there were any additional health concerns. Multivariable logistic regression was performed to examine the adjusted odds of responding to the open-text field, and cluster analysis was executed to understand the major areas of concern for participants providing open-ended responses. Results Participants who provided information in the open-ended text fi...

Research paper thumbnail of Assessing nonresponse bias at follow-up in a large prospective cohort of relatively young and mobile military service members

BMC Medical Research Methodology, 2010

Background: Nonresponse bias in a longitudinal study could affect the magnitude and direction of ... more Background: Nonresponse bias in a longitudinal study could affect the magnitude and direction of measures of association. We identified sociodemographic, behavioral, military, and health-related predictors of response to the first follow-up questionnaire in a large military cohort and assessed the extent to which nonresponse biased measures of association. Methods: Data are from the baseline and first follow-up survey of the Millennium Cohort Study. Seventy-six thousand, seven hundred and seventy-five eligible individuals completed the baseline survey and were presumed alive at the time of follow-up; of these, 54,960 (71.6%) completed the first follow-up survey. Logistic regression models were used to calculate inverse probability weights using propensity scores. Results: Characteristics associated with a greater probability of response included female gender, older age, higher education level, officer rank, active-duty status, and a self-reported history of military exposures. Ever smokers, those with a history of chronic alcohol consumption or a major depressive disorder, and those separated from the military at follow-up had a lower probability of response. Nonresponse to the follow-up questionnaire did not result in appreciable bias; bias was greatest in subgroups with small numbers. Conclusions: These findings suggest that prospective analyses from this cohort are not substantially biased by non-response at the first follow-up assessment.

Research paper thumbnail of Chemical Warfare and the Gulf War: A Review of the Impact on Gulf Veterans' Health

It is unlikely that Gulf War veterans are SUffering chronic effects from illnesses caused by chem... more It is unlikely that Gulf War veterans are SUffering chronic effects from illnesses caused by chemical warfare nerve agent exposure. Extensive investigation and review by several expert panels have determined that no evidence exists that chemical warfare nerve agents were used during the Gulf War. At no time before, during, or after the war was there confirmation of symptoms among anyone, military or civilian, caused by chemical warfare nerve agent exposure. However, studies of Gulf War veterans have found belief that chemical weapons were used, significantly associated with both severe and mildmoderate illnesses. The psychological impact of a chemical warfare attack, either actual or perceived, can result in immediate and long-term health consequences. The deployment or war-related health impact from life-threatening experiences of the Gulf War, including the perceived exposure to chemical warfare agents, should be considered as an important cause of morbidity among Gulf War veterans.