Shu Xu
Shu Xu
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Clinical Associate Professor of Biostatistics
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Professional overview
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Dr. Shu Xu’s work represents a balance of both statistical and applied aspects of quantitative methodology. Her primary quantitative interests include evaluating and developing statistical methods for longitudinal data analysis. Specifically, Dr. Xu’s research focuses on various aspects of latent growth models, missing data methods, and causal inference models.
Dr. Xu has collaborated with substance use, family, and health researchers to advance and share her knowledge of quantitative methodology and pursue a better understanding of the social sciences and public health. She has conducted research with the Family Translational Research Group at NYU and the Methodology Center at the Pennsylvania State University.
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Education
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BS, Psychology, East China Normal University, Shanghai, ChinaMS, Quantitative Psychology, University of California, DavisPhD, Quantitative Psychology, University of California, Davis
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Areas of research and study
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BiostatisticsFamily researchLongitudinal Data AnalysisMissing Data MethodsMixture ModelsQuantitative Research
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Publications
Publications
A New Look at the Psychometrics of the Parenting Scale Through the Lens of Item Response Theory
AbstractLorber, M. F., Xu, S., Slep, A. M., Bulling, L., & O'Leary, S. G. (n.d.).Publication year
2014Journal title
Journal of Clinical Child and Adolescent PsychologyVolume
43Issue
4Page(s)
613-626AbstractThe psychometrics of the Parenting Scale's Overreactivity and Laxness subscales were evaluated using item response theory (IRT) techniques. The IRT analyses were based on 2 community samples of cohabiting parents of 3- to 8-year-old children, combined to yield a total sample size of 852 families. The results supported the utility of the Overreactivity and Laxness subscales, particularly in discriminating among parents in the mid to upper reaches of each construct. The original versions of the Overreactivity and Laxness subscales were more reliable than alternative, shorter versions identified in replicated factor analyses from previously published research and in IRT analyses in the present research. Moreover, in several cases, the original versions of these subscales, in comparison with the shortened versions, exhibited greater 6-month stabilities and correlations with child externalizing behavior and couple relationship satisfaction. Reliability was greater for the Laxness than for the Overreactivity subscale. Item performance on each subscale was highly variable. Together, the present findings are generally supportive of the psychometrics of the Parenting Scale, particularly for clinical research and practice. They also suggest areas for further development.A Randomized, Controlled Trial of the Impact of the Couple CARE for Parents of Newborns Program on the Prevention of Intimate Partner Violence and Relationship Problems
AbstractHeyman, R. E., Slep, A. M., Lorber, M. F., Mitnick, D. M., Xu, S., Baucom, K. J., Halford, W. K., & Niolon, P. H. (n.d.).Publication year
2019Journal title
Prevention ScienceVolume
20Issue
5Page(s)
620-631AbstractEffective, accessible prevention programs are needed for adults at heightened risk for intimate partner violence (IPV). This parallel group randomized controlled trial examines whether such couples receiving the American version of Couple CARE for Parents of Newborns (CCP; Halford et al. 2009) following the birth of a child, compared with controls, report fewer first occurrences of clinically significant IPV, less frequent physical and psychological IPV, and improved relationship functioning. Further, we test whether intervention effects are moderated by level of risk for IPV. Couples at elevated risk for IPV (N = 368) recruited from maternity units were randomized to CCP (n = 188) or a 24-month waitlist (n = 180) and completed measures of IPV and relationship functioning at baseline, post-program (when child was 8 months old), and two follow-ups (at 15 and 24 months). Intervention effects were tested using intent to treat (ITT) as well as complier average causal effect (CACE; Jo and Muthén 2001) structural equation models. CCP did not significantly prevent clinically significant IPV nor were there significant main effects of CCP on clinically significant IPV, frequency of IPV, or most relationship outcomes in the CACE or ITT analyses. Risk moderated the effect of CCP on male-to-female physical IPV at post-program, with couples with a planned pregnancy declining, but those with unplanned pregnancies increasing. This study adds to previous findings that prevention programs for at-risk couples are not often effective and may even be iatrogenic for some couples.A study on the relationship between adaptive ability and home environment in middle school
AbstractXu, S., Li, G., & Xu, V. S. (n.d.).Publication year
1999Journal title
In Learning and ResearchPage(s)
45Abstract~Association of Racial Discrimination With Adiposity in Children and Adolescents
AbstractCuevas, A. G., Krobath, D. M., Rhodes-Bratton, B., Xu, S., Omolade, J. J., Perry, A. R., & Slopen, N. (n.d.).Publication year
2023Journal title
JAMA network openVolume
6Issue
7Page(s)
e2322839AbstractImportance: Childhood obesity is a major public health issue and is disproportionately prevalent among children from minority racial and ethnic groups. Personally mediated racism (commonly referred to as racial discrimination) is a known stressor that has been linked to higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in adults, but little is known about the association of racial discrimination and childhood and adolescent adiposity. Objective: To assess the prospective association between self-reported experiences of racial discrimination and adiposity (BMI and waist circumference) in a large sample of children and adolescents in the Adolescent Brain Cognitive Development (ABCD) study. Design, Setting, and Participants: This cohort study used complete data from the ABCD study (2017 to 2019), involving a total of 6463 participants. The ABCD study recruited a diverse sample of youths from across the US, with rural, urban, and mountain regions. Data were analyzed from January 12 to May 17, 2023. Exposure: The child-reported Perceived Discrimination Scale was used to quantify racial discrimination, reflecting participants' perceptions of being treated unfairly by others or unaccepted by society based on their race or ethnicity. Main Outcomes and Measures: Weight, height, and waist circumference were measured by trained research assistants. BMI z scores were computed by applying the US Centers for Disease Control and Prevention's age and sex-specific reference standards for children and adolescents. Waist circumference (inches) was quantified as the mean of 3 consecutive measures. Measurements were taken from time 1 (ie, 2017 to 2019) and time 2 (ie, 2018 to 2020). Results: Of the 6463 respondents with complete data, 3090 (47.8%) were female, and the mean (SD) age was 9.95 (0.62) years. Greater racial discrimination exposure at time 1 was associated with higher BMI z score in both unadjusted (β, 0.05; 95% CI, 0.02-0.08) and adjusted regression models (β, 0.04; 95% CI, 0.01-0.08). Discrimination at time 1 was associated with higher waist circumference in unadjusted (β, 0.35; 95% CI, 0.15-0.54) and adjusted (β, 0.24; 95% CI, 0.04-0.44) models. Conclusions and Relevance: In this cohort study of children and adolescents, racial discrimination was positively associated with adiposity, quantified by BMI z score and waist circumference. Interventions to reduce exposure to racial discrimination in early life may help reduce the risk of excess weight gain across throughout life.Cannabis Use and the Onset of Cigarette and E-cigarette Use : A Prospective, Longitudinal Study among Youth in the United States
AbstractWeinberger, A. H., Zhu, J., Lee, J., Xu, S., & Goodwin, R. D. (n.d.).Publication year
2021Journal title
Nicotine and Tobacco ResearchVolume
23Issue
3Page(s)
609-613AbstractIntroduction: Cigarette use is declining among youth in the United States, whereas cannabis use and e-cigarette use are increasing. Cannabis use has been linked with increased uptake and persistence of cigarette smoking among adults. The goal of this study was to examine whether cannabis use is associated with the prevalence and incidence of cigarette, e-cigarette, and dual product use among U.S. youth. Methods: Data included U.S. youth ages 12-17 from two waves of the Population Assessment of Tobacco and Health (PATH) Study (Wave 1 youth, n = 13 651; Wave 1 tobacco-naive youth, n = 10 081). Weighted logistic regression models were used to examine the association between Wave 1 cannabis use and (1) Wave 1 prevalence of cigarette/e-cigarette use among Wave 1 youth and (2) Wave 2 incidence of cigarette/e-cigarette use among Wave 1 tobacco-naive youth. Analyses were run unadjusted and adjusted for demographics and internalizing/externalizing problem symptoms. Results: Wave 1 cigarette and e-cigarette use were significantly more common among youth who used versus did not use cannabis. Among Wave 1 tobacco-naive youth, Wave 1 cannabis use was associated with significantly increased incidence of cigarette and e-cigarette use by Wave 2. Conclusions: Youth who use cannabis are more likely to report cigarette and e-cigarette use, and cannabis use is associated with increased risk of initiation of cigarette and e-cigarette use over 1 year. Continued success in tobacco control-specifically toward reducing smoking among adolescents-may require focusing on cannabis, e-cigarette, and cigarette use in public health education, outreach, and intervention efforts. Implications: These data extend our knowledge of cigarette and e-cigarette use among youth by showing that cannabis use is associated with increased prevalence and incidence of cigarette and e-cigarette use among youth, relative to youth who do not use cannabis. The increasing popularity of cannabis use among youth and diminished perceptions of risk, coupled with the strong link between cannabis use and tobacco use, may have unintended consequences for cigarette control efforts among youth.Causal Inference in Latent Class Analysis
AbstractLanza, S. T., Coffman, D. L., & Xu, S. (n.d.).Publication year
2013Journal title
Structural Equation ModelingVolume
20Issue
3Page(s)
361-383AbstractThe integration of modern methods for causal inference with latent class analysis (LCA) allows social, behavioral, and health researchers to address important questions about the determinants of latent class membership. In this article, 2 propensity score techniques, matching and inverse propensity weighting, are demonstrated for conducting causal inference in LCA. The different causal questions that can be addressed with these techniques are carefully delineated. An empirical analysis based on data from the National Longitudinal Survey of Youth 1979 is presented, where college enrollment is examined as the exposure (i.e., treatment) variable and its causal effect on adult substance use latent class membership is estimated. A step-by-step procedure for conducting causal inference in LCA, including multiple imputation of missing data on the confounders, exposure variable, and multivariate outcome, is included. Sample syntax for carrying out the analysis using SAS and R is given in an appendix.Cigar Use Progression Among New Cigar Initiators : A Two-Part Growth Curve Analysis Among a Youth and Young Adult Cohort
AbstractCantrell, J., Xu, S., Kreslake, J., Liu, M., & Hair, E. (n.d.).Publication year
2022Journal title
Nicotine and Tobacco ResearchVolume
24Issue
1Page(s)
28-36AbstractIntroduction: Youth and young adults (YYAs) are at high risk of cigar use. This study's objective was to examine progression and sociodemographic differences in current cigar use and frequency among new cigar initiators. Aims and Methods: We conducted a two-part latent growth model among a nationally representative cohort of cigar initiators (aged 15-25) to examine 24-month trajectories of current cigar use and frequency (n = 1483). The cohort was recruited via address-based sampling with online data collection from 2014 to 2019 and surveyed approximately every 6 months. Results: The unconditional odds of current cigar use (ie, past 30-day use) within 6 months of initiation was 0.72 (95% confidence interval: 0.63, 0.82), corresponding to a probability of 42%. The odds of current use among recent cigar initiates declined 6 months after initiation and was followed by a stabilization in use over time. Among continued users, frequency (# days used in past 30 days) increased linearly over time but remained low (3.47 days/months at 24 months). Younger individuals, non-Hispanic African Americans, those with lower subjective financial status, and current users of cigarettes, other tobacco products and/or marijuana were at highest risk within 6 months of initiation. Males, younger users, and current cigarette smokers had the highest risk for cigar progression over time. Conclusions: This study is the first to examine longitudinal cigar use patterns among YYA cigar initiators. Findings emphasize the need for research across the cigar use spectrum and the importance of interventions targeted by age, stage of use, cigarette, other tobacco, and marijuana use and key sociodemographics to interrupt use pathways. Implications: This study is the first to examine progression of cigar use among YYAs who have newly initiated cigars. Results show a high probability of current cigar use within 6 months of initiation followed by a rapid decline and stabilization over time. Frequency increases among those who continue using cigars. Males, younger users, and current cigarette smokers had the highest risk for cigar progression over time. Findings emphasize the need for targeting interventions by age, stage of use, cigarette, other tobacco, and marijuana use and key sociodemographics to interrupt use pathways.Corrigendum to “Use of electronic nicotine delivery system (ENDS) devices among U.S. Youth and adults : Findings from the Population Assessment of Tobacco and Health Study Waves 1–5” [Addict. Behav. 139 (2023) 107588] (Addictive Behaviors (2023) 139, (S0306460322003549), (10.1016/j.addbeh.2022.107588))
AbstractXu, S., Jiang, N., Xu, V. S., Li, L., Cleland, C. M., & Niaura, R. S. (n.d.).Publication year
2025Journal title
Addictive BehaviorsAbstractThe authors regret in the original publication of the article “’Use of electronic nicotine delivery system (ENDS) devices among U.S. Youth and adults: Findings from the Population Assessment of Tobacco and Health Study Waves 1–5” in “Addictive Behaviors”, it has come to our attention that important conflict of interests were not disclosed by the authors. In the interest of transparency and accuracy, this corrigendum is issued to address and rectify this oversight. Dr. Niaura declares that between 2015 and 2020, they frequently communicated with Juul Labs personnel and attended several meetings with JUUL personnel as invited guests, at which they presented information pertaining to their scientific research. They did not receive any honoraria, reimbursements or compensation for attending these meetings, except for hospitality in the form of meals. Between 2015 and 2020 Dr. Niaura reported grants from a Westat subcontract and other grants from the NIH (NIDA-NCI-FDA) paid to their employers; receiving salary from the Steven Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, and New York University School of Global Public Health. Dr. Niaura was a scientific consultant on a grant which was awarded to Johns Hopkins University, from which they received consulting payments.E-cigarette use, systemic inflammation, and depression
AbstractFarrell, K. R., Karey, E., Xu, S., Gibbon, G., Gordon, T., & Weitzman, M. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
19AbstractBackground: E-cigarette use (vaping) is an emerging public health problem. Depression has been found to be associated with e-cigarette use, and vaping and depression are each associated with elevated systemic inflammation. To date, the role of inflammation in the relationship between vaping and depression has not been explored. Objective: To assess the independent associations between e-cigarette use, depression, and inflammation, and to investigate whether the likelihood of depression among current e-cigarette users is associated with systemic inflammation. Methods: Nationally representative NHANES data from 2015–2018 were used (n = 4961). Systemic inflammation was defined as serum C-reactive protein (CRP) ≥ 8.0 mg/L. Depressed individuals were characterized by a score ≥ 10 on the Patient Health Questionnaire-9 (PHQ-9). Current e-cigarette users were defined as individuals who vaped at least once in the past 30 days and these individuals were stratified by use: exclusive users (reported smoking less than 100 combustible cigarettes in their lifetime), dual users (reported current use of electronic and combustible cigarettes), and e-cigarette users who were previous smokers. Bivariate analyses were used to assess independent associations between vaping, depression, and inflammation; and weighted logistic regression analyses adjusting for BMI, sex, and economic status were used to determine the odds ratios (ORs) for depression by e-cigarette category stratified by differential CRP levels. Results: Depression occurred in 16.7% of all e-cigarette users vs. 5.0% of those who never used e-cigarettes (p < 0.001). In adjusted analyses, the following elevated ORs were found: all current e-cigarette users with CRPExamining the effects of cumulative environmental stressors on Gulf Coast child and adolescent health
AbstractXu, S., Meltzer, G. Y., Merdjanoff, A. A., Xu, V. S., Gershon, R., Emrich, C. T., & Abramson, D. (n.d.).Publication year
2023Journal title
Population and EnvironmentVolume
45Issue
3AbstractThis study examines how community-level cumulative environmental stress affects child and adolescent emotional distress and chronic health conditions both directly and indirectly through stressors at the household, family, and individual levels. Data comes from the Women and their Children’s Health (WaTCH) Study, which sought to understand the health implications of exposure to the 2010 Deepwater Horizon oil spill (DHOS) among a cohort of 596 mothers with children ages 10 to 17 in southeastern Louisiana. Community-level environmental stress was measured using a newly developed geospatial index. Household-level stressors included previous hurricane impacts, impacts of DHOS, degree of financial difficulty, and degree of housing physical decay. Family stressors included maternal depression, self-rated physical health, and degree of parenting stress. Child stress was based on perceived stress; child mental health was based on serious emotional disturbance; and child physical health was based on diagnosis of chronic illness. Structural equation modeling used weighted least squares means and variance and theta parameterization. Results showed a significant negative direct path between community-level cumulative environmental stress and child/adolescent serious emotional disturbance and chronic illness. However, the indirect relationship through household, family, and individual-level stressors was significant and positive for both child/adolescent serious emotional disturbance and chronic illness. These findings point to the centrality of the household and family in determining child and adolescent physical and mental health outcomes in communities exposed to frequent disasters and ongoing environmental stressors.Examining the effects of cumulative environmental stressors on Gulf Coast child and adolescent health
AbstractMeltzer, G., Merdjanoff, A. A., Xu, S., Gershon, R., Emrich, C., & Abramson, D. (n.d.).Publication year
2023Journal title
Population and EnvironmentVolume
45Abstract~High Sensitivity and Specificity Screening for Clinically Significant Intimate Partner Violence
AbstractHeyman, R. E., Baucom, K. J., Xu, S., Smith Slep, A. M., Snarr, J. D., Foran, H. M., Lorber, M. F., Wojda, A. K., & Linkh, D. J. (n.d.).Publication year
2020Journal title
Journal of Family PsychologyAbstractThe U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). The goal was to derive screeners that (1) are maximally brief, while still achieving high sensitivity and specificity; (2) assess perpetration and victimization when either men or women are reporting; and (3) use ICD-11/DSM-5 criteria as the reference standard. Random samples of active duty service members at 82 installations worldwide were obtained via e-mail invitation (2006: N = 54,543; 2008: N = 48,909); their response rates were excellent for long general population surveys with no payment (2006: 44.7%, 2008: 49.0%). The population of spouses at the participating installation was invited by mailed postcard (2006: N = 19,722; 2008: N = 12,127; response rates-2006: 12.3%, 2008: 10.8%). Clinically significant physical intimate partner violence can be effectively screened with as few as four items, with sensitivities >90% and specificities >95%; clinically significant psychological intimate partner violence can be screened with two items. Men and women can be screened with equivalent accuracy, as can those committing the violence and those victimized by it.Interrater agreement statistics with skewed data : Evaluation of alternatives to Cohen's kappa
AbstractXu, S., & Lorber, M. F. (n.d.).Publication year
2014Journal title
Journal of consulting and clinical psychologyVolume
82Issue
6Page(s)
1219-1227AbstractObjective: In this study, we aimed to evaluate interrater agreement statistics (IRAS) for use in research on low base rate clinical diagnoses or observed behaviors. Establishing and reporting sufficient interrater agreement is essential in such studies. Yet the most commonly applied agreement statistic, Cohen's, has a well known sensitivity to base rates that results in a substantial penalization of interrater agreement when behaviors or diagnoses are very uncommon, a prevalent and frustrating concern in such studies. Method: We performed Monte Carlo simulations to evaluate the performance of 5 of κ's alternatives (Van Eerdewegh's V, Yule's Y, Holley and Guilford's G, Scott's π, and Gwet's AC1), alongside κ itself. The simulations investigated the robustness of these IRAS to conditions that are common in clinical research, with varying levels of behavior or diagnosis base rate, rater bias, observed interrater agreement, and sample size. Results: When the base rate was 0.5, each IRAS provided similar estimates, particularly with unbiased raters. G was the least sensitive of the IRAS to base rates. Conclusions: The results encourage the use of the G statistic for its consistent performance across the simulation conditions. We recommend separately reporting the rates of agreement on the presence and absence of a behavior or diagnosis alongside G as an index of chance corrected overall agreement.Latent curve models: A structural equation perspective
AbstractXu, S., Blozis, S. A., Cho, Y., & Xu, V. S. (n.d.).Publication year
2010Journal title
Sociological Methods and ResearchVolume
39Page(s)
297Abstract~Longitudinal association between e-cigarette use and respiratory symptoms among US adults: Findings from the Population Assessment of Tobacco and Health Study Waves 4-5
AbstractXu, S., Karey, E., Xu, S., He, P., Niaura, R. S., Cleland, C. M., Stevens, E. R., Sherman, S. E., El-Shahawy, O., Cantrell, J., & Jiang, N. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
2Page(s)
e0299834AbstractWe assessed longitudinal effects of e-cigarette use on respiratory symptoms in a nationally representative sample of US adults by combustible tobacco smoking status.Native Hawaiian and Other Pacific Islanders : Disparities in the Prevalence of Multiple Chronic Conditions
AbstractXu, S., Cabrera, J. D., Cuevas, A. G., Xu, V. S., & Chang, V. W. (n.d.).Publication year
2025Journal title
American Journal of Health PromotionAbstractPurpose: To examine multimorbidity prevalence by race/ethnicity and unique health disparities for Native Hawaiian and Other Pacific Islanders (NHPI). Design: Cross-sectional study. Setting: This study uses combined data from the 2014 National Health Interview Survey (NHIS) and the 2014 NHPI-NHIS. Sample: 38,965 adults, including a representative sample of 2,026 NHPIs. Measures: Self-reported diagnoses of ten chronic conditions and race/ethnicity, including Non-Hispanic (NH) Whites, NH Blacks, NH Asians, NH NHPIs, Hispanics and NH Mixed Race. Covariates include age, sex, marital status, education, family income, and employment status. Analysis: We used multinomial logistic regression models to evaluate the adjusted association between race/ethnicity and number of chronic conditions: none, 1, and ≥ 2 (multimorbidity). Results: Compared to Whites, Asians and Hispanics (aRRR = 0.39, PNoxious family environments in relation to adult and childhood caries
AbstractLorber, M. F., Slep, A. M., Heyman, R. E., Xu, S., Dasanayake, A. P., & Wolff, M. S. (n.d.).Publication year
2014Journal title
Journal of the American Dental AssociationVolume
145Issue
9Page(s)
924-930AbstractBackground. The authors tested hypotheses that more noxious family environments are associated with poorer adult and child oral health. Methods. A community sample of married or cohabiting couples (N = 135) and their elementary school-aged children participated. Dental hygienists determined the number of decayed, missing and filled surfaces via oral examination. Subjective oral health impacts were measured by means of questionnaires completed by the parents and children. The parents completed questionnaires about interparental and parent-to-child physical aggression (for example, pushing) and emotional aggression (for example, derision), as well as harsh discipline. Observers rated the couples' hostile behavior in laboratory interactions. Results. The extent of women's and men's caries experience was associated positively with their partners' levels of overall noxious behavior toward them. The extent of children's caries experience was associated positively with the level of their mothers' emotional aggression toward their partners. Conclusions. Noxious family environments may be implicated in compromised oral health. Future research that replicates and extends these findings can provide the foundation to translate them into preventive interventions. Practical Implications. Noxious family environments may help explain the limitations of routine oral health preventive strategies. Interprofessional strategies that also address the family environment ultimately may prove to be more effective than are single modality approaches.On Fitting a Multivariate Two-Part Latent Growth Model
AbstractXu, S., Blozis, S. A., & Vandewater, E. A. (n.d.).Publication year
2014Journal title
Structural Equation ModelingVolume
21Issue
1Page(s)
131-148AbstractA 2-part latent growth model can be used to analyze semicontinuous data to simultaneously study change in the probability that an individual engages in a behavior, and if engaged, change in the behavior. This article uses a Monte Carlo (MC) integration algorithm to study the interrelationships between the growth factors of 2 variables measured longitudinally where each variable can follow a 2-part latent growth model. A SAS macro implementing Mplus is developed to estimate the model to take into account the sampling uncertainty of this simulation-based computational approach. A sample of time-use data is used to show how maximum likelihood estimates can be obtained using a rectangular numerical integration method and an MC integration method.Passive exposure to e-cigarette emissions is associated with worsened mental health
AbstractXu, S., Farrell, K. R., Weitzman, M., Karey, E., Lai, T. K., Gordon, T., & Xu, V. S. (n.d.).Publication year
2022Journal title
BMC public healthVolume
22Issue
1AbstractBackground: Cigarette smoking, secondhand cigarette smoke (SHS) exposure, and e-cigarette use (“vaping”) are each associated with increased rates of depressive symptoms and other internalizing mental health disorders. The prevalence of vaping has increased greatly, yet the mental health correlates of secondhand exposure to e-cigarette emissions are as yet to be investigated. This study examined the potential adverse mental health outcomes associated with different tobacco exposures (direct and passive), with a particular focus on the mental health correlates of secondhand exposure to e-cigarette emissions. Methods: The Population Assessment of Tobacco and Health Study data collected from a sample of 16,173 Wave 4 adults were used to test the hypothesis that secondhand e-cigarette emissions exposure is associated with increased odds of internalizing mental health disorders. Individuals were categorized as exclusive cigarette smokers, exclusive e-cigarette users, cigarette and e-cigarette dual users, exclusive noncombustible tobacco users, secondhand smoke exposed non-users, secondhand e-cigarette emissions exposed non-users, and non-users with no current SHS/secondhand e-cigarette aerosol exposure. Adjusted weighted logistic regression analysis was used to investigate the association between exposure type and internalizing problems as assessed by scores on the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), a widely used instrument for assessing mental health problems. Results: Cigarette smokers (AOR = 2.53, 95% CI: 2.19–2.92), e-cigarette users (AOR = 3.14, 2.41–4.09), dual users (AOR = 3.37, 2.85–4.00), noncombustible tobacco users (AOR = 1.48, 1.01–2.17), SHS exposed non-users (AOR = 1.63, 1.37–1.94), and secondhand e-cigarette emissions exposed non-users (AOR = 1.43, 1.03–1.99) were each associated with increased odds of moderate to severe internalizing mental health problems as compared to unexposed non-users. Odds of internalizing problems among SHS and secondhand e-cigarette emissions exposed non-users did not differ (p = 0.46). Conclusions: This is the first study, to our knowledge, to identify an association between recent secondhand exposure to e-cigarette emissions and mental health problems, and the risk is comparable to that of SHS. Corroboration of this relationship needs further research to explicate directionality and mechanisms underlying this association.Patterns of psychological health problems and family maltreatment among United States Air Force members
AbstractLorber, M. F., Xu, S., Heyman, R. E., Slep, A. M., & Beauchaine, T. P. (n.d.).Publication year
2018Journal title
Journal of Clinical PsychologyVolume
74Issue
7Page(s)
1258-1271AbstractObjectives:: We sought to identify subgroups of individuals based on patterns of psychological health problems (PH; e.g., depressive symptoms, hazardous drinking) and family maltreatment (FM; e.g., child and partner abuse). Method:: We analyzed data from very large surveys of United States Air Force active duty members with romantic partners and children. Results:: Latent class analyses indicated six replicable patterns of PH problems and FM. Five of these classes, representing ∼98% of survey participants, were arrayed ordinally, with increasing risk of multiple PH problems and FM. A sixth group defied this ordinal pattern, with pronounced rates of FM and externalizing PH problems, but without correspondingly high rates/levels of internalizing PH problems. Conclusions:: Ramifications of these results for intervention are discussed.Preadolescent drug use resistance skill profiles, substance use, and substance use prevention
AbstractHopfer, S., Hecht, M. L., Lanza, S. T., Tan, X., & Xu, S. (n.d.).Publication year
2013Journal title
Journal of Primary PreventionVolume
34Issue
6Page(s)
395-404AbstractThe aims of the current study were threefold: (1) specify the skills component of social influence prevention interventions for preadolescents, (2) examine the relationship between resistance skill profiles and substance use among preadolescents, and (3) evaluate whether subgroups of preadolescents based on their resistance skills and refusal confidence may be differentially impacted by the kiR prevention program. Latent class analysis showed a four-class model of 5th grader resistance skill profiles. Approximately half of preadolescents (53 %) were familiar with four prototypical resistance skills and showed confidence to apply these skills in real-world settings (highly competent profile); 15 % were familiar with resistance skills but had little confidence (skillful profile); 18 % were confident yet had little knowledge (confident profile); while 15 % had low knowledge and confidence (low competence profile). These skill profiles significantly predicted 8th grade recent substance use (2LL = -2,262.21, df = 3, p = .0005). As predicted by theory, the highly competent skill profile reported lower mean recent substance use than the population sample mean use. Latent transition analysis showed that although patterns of transiting into the highly competent skill profile over time were observed in the expected direction, this pattern was not significant when comparing treatment and control. Identifying skill profiles that predict recent substance use is theoretically consistent and has important implications for healthy and substance-free development.Predictors of Crosscutting Patterns of Psychological Health and Family Maltreatment
AbstractXu, S., Nichols, S. R., Rhoades, K. A., Lorber, M. F., Xu, V. S., Heyman, R. E., & Slep, A. M. (n.d.).Publication year
2023Journal title
Military MedicineVolume
188Issue
9-10Page(s)
3134-3142AbstractINTRODUCTION: Psychological problems and family maltreatment are significant public health problems. Although research focuses almost exclusively on either individual psychological problems or family maltreatment, there is substantial co-occurrence of these problems. Similarly, intervention services are often "siloed": individuals with mental health needs are referred for mental health services, individuals with family conflict are referred for family-based treatment, etc. These treatment "silos" may miss the larger picture of the co-occurrence of risk, promotion, and the problems themselves. In a previous paper, we used latent class analysis to identify subgroups of individuals with crosscutting patterns (i.e., classes) of psychological and family maltreatment problems. In this study, we explored the predictors of these latent classes. MATERIALS AND METHODS: Participants consisted of two large population samples of U.S. Air Force active duty members (ns = 27,895 and 30,841) who were married or cohabiting and had one or more children living in their household. Participants completed an anonymous community assessment survey, which included questionnaire items tapping personal, family, and community problems and well-being. Assessments were conducted in 2008 and 2011. All study procedures were approved by the authors' Institutional Review Board. We used exploratory factor analysis and latent class analysis to (1) identify higher-order factors of risk and promotive variables and (2) examine them as predictors of our previously identified latent classes. RESULTS: Findings indicated that individuals who reported better physical well-being as well as personal and family coping, relationship satisfaction, and support were more likely to be in the lowest-risk subgroup. Notably, individuals in the subgroup most at risk for serious violence and suicide, evidencing disinhibitory psychopathology, endorsed lower risk and higher promotive factors than those individuals in other high-risk subgroups who fell along the internalizing/externalizing continuum. CONCLUSIONS: These findings reinforce the need for integrated prevention and treatment of psychological and family maltreatment problems. Not only do these problems often co-occur, but their risk and promotive factors also tend to be intertwined. The unique (i.e., not on the continuum of the other five classes) problem profile of participants evidencing disinhibitory psychopathology is matched by a unique risk/promotive factor profile, and they will thus likely require a unique intervention approach.Prevalence and risk factors of PTSD symptoms : a 3-month follow-up study
AbstractShang, Z., Pan, X., Cheng, S., Yang, Y., Yan, W., Sun, L. L., Huang, H., Bai, Y., Xie, W., & Xu, S. (n.d.).Publication year
2024Journal title
Therapeutic Advances in PsychopharmacologyVolume
14AbstractBackground: During the peak of the epidemic, hospitalized patients frequently encountered significant health risks and potentially life-threatening circumstances, including uncertainty regarding treatment and the potential for complications. Objective: The present study aimed to explore the prevalence of post-traumatic stress disorder (PTSD) symptoms among hospitalized patients 3 months after discharge during the first peak of the epidemic, and the association of PTSD with disease-related characteristics. Design: A single-center and full-sample follow-up study was conducted on COVID-19 patients from the Optical Valley Branch of Maternal and Child Hospital of Hubei Province, Wuhan, China. Data were collected during their hospitalization and 3 months after discharge. Methods: PTSD symptoms were evaluated by primary care post-traumatic stress disorder (PC-PTSD), a total score of 3 or above was considered as clinically significant PTSD symptoms. Demographic and disease-related characteristics were collected to identify related associations with PTSD symptoms. Results: A total of 903 patients completed the follow-up survey, yielding a response rate of 63.5%. A total of 212 (23.5%) of the patients were positive in PC-PTSD screening. Univariate regression analysis identified several factors correlated with PTSD symptoms, including female gender, younger age, a lower body mass index (BMI), preexisting sleep problems, bereavement due to COVID-19, a severe clinical diagnosis, the presence of three or more clinical symptoms at disease onset, and residual respiratory symptoms after discharge. Notably, in the multivariate regression analysis, experiencing three or more clinical symptoms at onset emerged as a robust predictor of PTSD symptoms (OR = 2.09, 95% CI: 1.48–2.95). An intriguing finding was that patients who underwent radiological assessment post-discharge reported a higher incidence of PTSD symptoms, whereas those who underwent re-testing for IgG or IgM antibodies exhibited a lower prevalence of PTSD symptoms. Conclusion: Three months post-recovery, PTSD symptoms prevalence among COVID-19 patients was 23.5%. Those with three or more clinical symptoms at onset or residual respiratory symptoms post-discharge showed higher risk. These findings highlighted the long-term effect of COVID-19 on mental health, urging enhanced attention and interventions for survivors.Psychology of wearing face masks to prevent transition of COVID-19
AbstractSong, L. J., Xu, S., Sun, Z., & Liu, W. (n.d.).Publication year
2020Journal title
General PsychiatryVolume
33Issue
6Abstract~Recurrent Injecting Drug Use as a Mediator between Psychiatric Disorder and Non-Fatal Overdose
AbstractXu, S., Barnes, D. M., Xu, V. S., Cleland, C. M., McKnight, C. A., & Des Jarlais, D. (n.d.).Publication year
2022Journal title
Substance Use and MisuseVolume
57Issue
8Page(s)
1248-1256AbstractBackground: Unintentional drug overdose has increased markedly in the United States. Studies document an association between psychiatric disorder and unintentional overdose; we extend this research through a preliminary test of a causal model of recurrent injection drug use mediating this relationship. Methods: In a cross-sectional study of 241 adults in New York City with a possible current substance use disorder, we conducted conventional and Imai’s mediation analyses to examine if psychiatric disorder is associated with increased prevalence of ever overdosing and if recurrent injection drug use mediates this association. Our cross-sectional data permit the first step of assessing causal models: testing if statistical associations are consistent with the model. Results: Fifty-eight percent of the sample endorsed previous psychiatric disorder diagnosis and 35.7% reported ever overdosing. Imai’s mediation analysis showed that, adjusting for covariates, the total association between psychiatric diagnosis and ever overdosing (adjusted prevalence difference [aPD] = 0.16, 95% CI 0.04–0.28) was composed of a direct effect (aPD = 0.09, 95% CI −0.03 − 0.21, p = 0.136) and an indirect effect (aPD = 0.07, 95% CI 0.02–0.13). Recurrent injecting drug use contributed to 42% (ratio of indirect effect to total effect; 95% CI 12 − 100%, p = 0.02) of the association between psychiatric diagnosis and ever overdosing. Conventional mediation analysis produced similar results. Conclusions: Our results provide a warrant for taking the necessary next step for assessing a causal model using longitudinal data, potentially providing a strong rationale for intervening on psychiatric disorders to stem overdose.