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Full-Text Articles in Clinical Epidemiology

Anemia And It's Associated Factors Among Adolescents In Kuwait, Lemia Shaban, Abdullah Al-Taiar, Abdur Rahman, Reem Al-Sabah, Olusegun Mojiminiyi Jan 2020

Anemia And It's Associated Factors Among Adolescents In Kuwait, Lemia Shaban, Abdullah Al-Taiar, Abdur Rahman, Reem Al-Sabah, Olusegun Mojiminiyi

Community & Environmental Health Faculty Publications

We estimated the prevalence of anemia among school children and investigated factors associated with this problem in Kuwait. A cross-sectional study was conducted on 1415 adolescents randomly selected from middle schools in Kuwait. Hemoglobin, iron, ferritin, folate and vitamin B-12, in addition to many other laboratory indicators, were measured in a venous blood sample. Data on risk factors for anemia were collected from parents and adolescents. Multiple logistic regression was used to investigate factors associated with anemia. The prevalence of anemia was 8.06% (95% CI: 6.69-9.60%), which was significantly higher among females compared to males (10.96% vs. 5.04%; p < 0.001). Mean (SD) Hb level was 133.7 (9.89) g/L and 130.00 (10.48) g/L among males and females, respectively (p < 0.001). The prevalence of mild, moderate and severe anemia was 5.94%, 1.91% and 0.21%, respectively. Gender, age, iron concentration and ferritin were associated with anemia in multivariable analysis. These data indicate that anemia among school children in Kuwait is of mild public health significance. Further reduction in anemia in school girls should focus on correcting iron deficiency. Surveillance systems for anemia may consider using a cut-off point that is specific for the method of blood sampling and the method of Hb measurement.


Empowerment-Based Positive Youth Development: A New Understanding Of Healthy Development For African American Youth, Raphael Travis Jr., Tamara Leech Jun 2013

Empowerment-Based Positive Youth Development: A New Understanding Of Healthy Development For African American Youth, Raphael Travis Jr., Tamara Leech

Department of Public Health Scholarship and Creative Works

A shift occurred in research about adolescents in the general population. Research is moving away from deficits toward a resilience paradigm and understanding trajectories of positive youth development. This shift has been less consistent in research and practice with African American youth. A gap also exists in understanding whether individual youth development dimensions generate potential in other dimensions. This study presents an empowerment-based positive youth development model. It builds upon existing research to present a new vision of healthy development for African American youth that is strengths-based, developmental, culture-bound, and action-oriented. It emphasizes the relationship between person and environment, the …


Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie Wilson Dec 2010

Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie Wilson

Coralie J Wilson

This paper is the second from a larger multi-cite study developed and led by the third author which explores factors that influence adolescents' help-seeking intentions. Specifically, this paper investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems. A cross sectional self-report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales. A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and …


Predicting Adolescents’ Future Intentions To Seek Help For Mental Health Problems., Coralie J. Wilson Dec 2010

Predicting Adolescents’ Future Intentions To Seek Help For Mental Health Problems., Coralie J. Wilson

Frank Deane

This study examined whether high school students’ current symptoms of general psychological distress, self-rated social problem-solving skills, and recent help-seeking experiences predict their future intentions to seek help for a mental health problem. At Time 1, 98 high school students, aged 12-17 years, completed the study self-report survey that included measures of psychological distress, social problem-solving skill, and recent help-seeking behaviour. At Time 2, three weeks later, the same students completed measures of help-seeking intentions. Students with more severe levels of distress symptoms at Time 1 had lower intentions to seek help for a mental health problem at Time 2. …


Predicting Adolescents’ Future Intentions To Seek Help For Mental Health Problems., Coralie J. Wilson Dec 2010

Predicting Adolescents’ Future Intentions To Seek Help For Mental Health Problems., Coralie J. Wilson

Coralie J Wilson

This study examined whether high school students’ current symptoms of general psychological distress, self-rated social problem-solving skills, and recent help-seeking experiences predict their future intentions to seek help for a mental health problem. At Time 1, 98 high school students, aged 12-17 years, completed the study self-report survey that included measures of psychological distress, social problem-solving skill, and recent help-seeking behaviour. At Time 2, three weeks later, the same students completed measures of help-seeking intentions. Students with more severe levels of distress symptoms at Time 1 had lower intentions to seek help for a mental health problem at Time 2. …


Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie J. Wilson Dec 2010

Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie J. Wilson

Frank Deane

This paper is the second from a larger multi-cite study developed and led by the third author which explores factors that influence adolescents' help-seeking intentions. Specifically, this paper investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems. A cross sectional self-report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales. A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and …


Peer-Led, School-Based Nutrition Education For Young Adolescents: Feasibility And Process Evaluation Of The Teens Study, Mary Story, Leslie A. Lytle, Amanda Birnbaum, Cheryl L. Perry Oct 2009

Peer-Led, School-Based Nutrition Education For Young Adolescents: Feasibility And Process Evaluation Of The Teens Study, Mary Story, Leslie A. Lytle, Amanda Birnbaum, Cheryl L. Perry

Department of Public Health Scholarship and Creative Works

Peer education has become a popular strategy for health promotion interventions with adolescents, but it has not been used widely in school‐based nutrition education. This paper describes and reports on the feasibility of the peer leader component of school‐based nutrition intervention for young adolescents designed to increase fruit and vegetable intakes and lower-fat foods. About 1,000 seventh‐grade students in eight schools received the nutrition intervention. Of these, 272 were trained as peer leaders to assist the teacher in implementing the activities. Results from a multicomponent process evaluation based on peer leader and classroom student feedback, direct classroom observation, and teacher …


Recently Arrested Adolescents Are At High Risk For Sexually Transmitted Diseases, Christopher Salvatore, Steven Belenko, Richard Dembo, Doris Weiland, Matthew Rollie, Alexandra Hanlon, Kristina Childs Aug 2008

Recently Arrested Adolescents Are At High Risk For Sexually Transmitted Diseases, Christopher Salvatore, Steven Belenko, Richard Dembo, Doris Weiland, Matthew Rollie, Alexandra Hanlon, Kristina Childs

Department of Justice Studies Faculty Scholarship and Creative Works

Adolescent offenders may be at high risk for sexually transmitted diseases (STDs). With previous research and interventions focused on incarcerated adolescents, data are needed on STD prevalence and risk factors among newly arrested youth released to the community, a far larger subgroup.Participants were recruited from all arrested youth processed at the Hillsborough County, Florida Juvenile Assessment Center during the last half of 2006 (506 males, 442 females). Participants voluntarily providing urine samples for drug testing as part of standard protocol were also consented to having their specimens split and tested for chlamydia and gonorrhea, using an FDA-approved nucleic acid amplification …


Reducing Adolescents' Perceived Barriers To Treatment And Increasing Help-Seeking Intentions: Effects Of Classroom Presentations By General Practitioners., Coralie J. Wilson Dec 2007

Reducing Adolescents' Perceived Barriers To Treatment And Increasing Help-Seeking Intentions: Effects Of Classroom Presentations By General Practitioners., Coralie J. Wilson

Coralie J Wilson

The Building Bridges to General Practice (BBGP) program is an outreach initiative (written by the first author). It aims to reduce young peoples’ perceived knowledge- and belief-based barriers to engaging in treatment and to increase their behavioral intentions to consult a general medical practitioner (GP) for physical and psychological problems. By increasing intentions, the BBGP program aims to increase actual consultations with a GP for both types of problem. The current paper is the first of a series that report results from a larger multi-cite research project, developed and led by the first author, which examines the impact of BBGP …


Reducing Adolescents' Perceived Barriers To Treatment And Increasing Help-Seeking Intentions: Effects Of Classroom Presentations By General Practitioners., Coralie J. Wilson Dec 2007

Reducing Adolescents' Perceived Barriers To Treatment And Increasing Help-Seeking Intentions: Effects Of Classroom Presentations By General Practitioners., Coralie J. Wilson

Frank Deane

The Building Bridges to General Practice (BBGP) program is an outreach initiative (written by the first author). It aims to reduce young peoples’ perceived knowledge- and belief-based barriers to engaging in treatment and to increase their behavioral intentions to consult a general medical practitioner (GP) for physical and psychological problems. By increasing intentions, the BBGP program aims to increase actual consultations with a GP for both types of problem. The current paper is the first of a series that report results from a larger multi-cite research project, developed and led by the first author, which examines the impact of BBGP …


Girls' Perception Of Physical Environmental Factors And Transportation: Reliability And Association With Physical Activity And Active Transport To School, Kelly R. Evenson, Amanda Birnbaum, Ariane L. Bedimo-Rung, James Sallis, Carolyn C. Voorhees, Kimberly Ring, John P. Elder Sep 2006

Girls' Perception Of Physical Environmental Factors And Transportation: Reliability And Association With Physical Activity And Active Transport To School, Kelly R. Evenson, Amanda Birnbaum, Ariane L. Bedimo-Rung, James Sallis, Carolyn C. Voorhees, Kimberly Ring, John P. Elder

Department of Public Health Scholarship and Creative Works

Background

Preliminary evidence suggests that the physical environment and transportation are associated with youth physical activity levels. Only a few studies have examined the association of physical environmental factors on walking and bicycling to school. Therefore, the purpose of this study was (1) to examine the test-retest reliability of a survey designed for youth to assess perceptions of physical environmental factors (e.g. safety, aesthetics, facilities near the home) and transportation, and (2) to describe the associations of these perceptions with both physical activity and active transport to school.

Methods

Test and retest surveys, administered a median of 12 days later, …


Scale Development For Perceived School Climate For Girls’ Physical Activity, Amanda Birnbaum, Kelly R. Evenson, Robert W. Motl, Rod K. Dishman, Carolyn C. Voorhees, James F. Sallis, John P. Elder, Marsha Dowda May 2005

Scale Development For Perceived School Climate For Girls’ Physical Activity, Amanda Birnbaum, Kelly R. Evenson, Robert W. Motl, Rod K. Dishman, Carolyn C. Voorhees, James F. Sallis, John P. Elder, Marsha Dowda

Department of Public Health Scholarship and Creative Works

Objectives: To test an original scale assessing perceived school climate for girls' physical activity in middle school girls. Methods: Confirmatory factor analysis (CFA) and structural equation modeling (SEM). Results: CFA retained 5 of 14 original items. A model with 2 correlated factors, perceptions about teachers' and boys' behaviors, respectively, fit the data well in both sixth and eighth-graders. SEM detected a positive, significant direct association of the teacher factor, but not the boy factor, with girls' self-reported physical activity. Conclusions: School climate for girls' physical activity is a measurable construct, and preliminary evidence suggests a relationship with physical activity.


Scale Development For Perceived School Climate For Girls’ Physical Activity, Amanda Birnbaum, Kelly R. Evenson, Robert W. Motl, Rod K. Dishman, Carolyn C. Voorhees, James F. Sallis, John P. Elder, Marsha Dowda May 2005

Scale Development For Perceived School Climate For Girls’ Physical Activity, Amanda Birnbaum, Kelly R. Evenson, Robert W. Motl, Rod K. Dishman, Carolyn C. Voorhees, James F. Sallis, John P. Elder, Marsha Dowda

Department of Public Health Scholarship and Creative Works

Objectives: To test an original scale assessing perceived school climate for girls' physical activity in middle school girls. Methods: Confirmatory factor analysis (CFA) and structural equation modeling (SEM). Results: CFA retained 5 of 14 original items. A model with 2 correlated factors, perceptions about teachers' and boys' behaviors, respectively, fit the data well in both sixth and eighth-graders. SEM detected a positive, significant direct association of the teacher factor, but not the boy factor, with girls' self-reported physical activity. Conclusions:School climate for girls' physical activity is a measurable construct, and preliminary evidence suggests a relationship with physical activity.


Predictors Of Violent Behavior In An Early Adolescent Cohort: Similarities And Differences Across Genders, Jonathan L. Blitstein, David M. Murray, Leslie A. Lytle, Amanda Birnbaum, Cheryl L. Perry Apr 2005

Predictors Of Violent Behavior In An Early Adolescent Cohort: Similarities And Differences Across Genders, Jonathan L. Blitstein, David M. Murray, Leslie A. Lytle, Amanda Birnbaum, Cheryl L. Perry

Department of Public Health Scholarship and Creative Works

The authors assessed a cohort of 2,335 students from the Minneapolis, Minnesota, area to identify predictors of violent behavior and to determine whether the predictors varied by gender. The sample was 76% White; boys and girls were equally represented. The majority lived with two parents. A measure of violent behavior collected at the end of the eighth-grade year (2000) was entered into Poisson regression against baseline data collected at the beginning of the seventh-grade year (1998). Predictors of violent behavior influencing both boys and girls included depressive symptoms, perceived invulnerability to negative future events, paternal nonauthoritative behavior, and drinking alcohol. …


The Role Of Peer Social Network Factors And Physical Activity In Adolescent Girls, Carolyn C. Voorhees, David Murray, Greg Welk, Amanda Birnbaum, Kurt M. Ribisi, Carolyn C. Johnson, Karin Allor Pfeiffer, Brit Saksvig, Jared B. Jobe Mar 2005

The Role Of Peer Social Network Factors And Physical Activity In Adolescent Girls, Carolyn C. Voorhees, David Murray, Greg Welk, Amanda Birnbaum, Kurt M. Ribisi, Carolyn C. Johnson, Karin Allor Pfeiffer, Brit Saksvig, Jared B. Jobe

Department of Public Health Scholarship and Creative Works

Objective: To study the relationship between peer-related physical activity (PA) social networks and the PA of adolescent girls.

Methods: Cross-sectional, convenience sample of adolescent girls. Mixed-model linear regression analyses to identify significant correlates of self-reported PA while accounting for correlation of girls in the same school.

Results: Younger girls were more active than older girls. Most activity-related peer social network items were related to PA levels. More PA with friends was significantly related to self-reported PA in multivariate analyses.

Conclusions: Frequency of PA with friends was an important correlate of PA among the peer network variables …


Can Hopelessness And Adolescents’ Beliefs And Attitudes About Seeking Help Account For Help Negation?, Coralie J. Wilson Dec 2004

Can Hopelessness And Adolescents’ Beliefs And Attitudes About Seeking Help Account For Help Negation?, Coralie J. Wilson

Frank Deane

Avoidance of appropriate help is common in acutely suicidal samples and has been confirmed in nonclinical samples but factors that contribute to this help negation effect remain unclear. The current study is the second in series from the first author's larger PhD research program. In a sample of 269 nonclinical Australian high school students, the current study examines the impact of hopelessness, previous mental health care, beliefs, and attitudes toward professional psychological help on the help negation relationship. Results revealed that suicidal ideation significantly predicted lower help seeking intentions and that although hopelessness could not explain the help negation effect, …


Help Seeking For Mental Health Problems In Adolescence And Early Adulthood., Coralie J. Wilson Dec 2004

Help Seeking For Mental Health Problems In Adolescence And Early Adulthood., Coralie J. Wilson

Coralie J Wilson

EXECUTIVE SUMMARY Adolescence and young adulthood are critical life stages for mental health, as this is the period when most mental health problems and mental disorders have their peak incidence. It is also a time of increased suicidal ideation and frequency of suicide attempts. Despite the importance of adolescence and young adulthood in the aetiology of mental disorders, there is evidence that young people may be poorly informed about mental health and are unlikely to consult a professional for their mental health problems. Help-seeking is a term used to refer to the behaviour of actively seeking help from other people. …


Can Hopelessness And Adolescents’ Beliefs And Attitudes About Seeking Help Account For Help Negation?, Coralie J. Wilson Dec 2004

Can Hopelessness And Adolescents’ Beliefs And Attitudes About Seeking Help Account For Help Negation?, Coralie J. Wilson

Coralie J Wilson

Avoidance of appropriate help is common in acutely suicidal samples and has been confirmed in nonclinical samples but factors that contribute to this help negation effect remain unclear. The current study is the second in series from the first author's larger PhD research program. In a sample of 269 nonclinical Australian high school students, the current study examines the impact of hopelessness, previous mental health care, beliefs, and attitudes toward professional psychological help on the help negation relationship. Results revealed that suicidal ideation significantly predicted lower help seeking intentions and that although hopelessness could not explain the help negation effect, …


Predicting Adolescents’ Intake Of Fruits And Vegetables, Leslie A. Lytle, Sherri Varnell, David M. Murray, Mary Story, Cherly Perry, Amanda Birnbaum, Martha Y. Kubik Jul 2003

Predicting Adolescents’ Intake Of Fruits And Vegetables, Leslie A. Lytle, Sherri Varnell, David M. Murray, Mary Story, Cherly Perry, Amanda Birnbaum, Martha Y. Kubik

Department of Public Health Scholarship and Creative Works

Objective

To explore potential predictors of adolescent fruit and vegetable intake by expanding on current theory and drawing from other adolescent research.

Design

This research reports on the baseline and interim data from a school-based intervention study. Data were collected through surveys administered to students at the beginning and end of their 7th-grade year.

Setting

The students attended 16 public schools in Minnesota.

Participants

Data were collected on 3878 students; approximately half were female and 67% were white. All students in the 7th-grade cohort were invited to participate in the surveys and over 94% completed both surveys.

Variables Measured

Our …


School Functioning And Violent Behavior Among Young Adolescents: A Contextual Analysis, Amanda Birnbaum, Leslie A. Lytle, Peter J. Hannan, David M. Murray, Cheryl L. Perry, Jean L. Foster Jun 2003

School Functioning And Violent Behavior Among Young Adolescents: A Contextual Analysis, Amanda Birnbaum, Leslie A. Lytle, Peter J. Hannan, David M. Murray, Cheryl L. Perry, Jean L. Foster

Department of Public Health Scholarship and Creative Works

This paper examines associations between overall school functioning and the frequency of violent behaviors among young adolescents (ages 10–14). The sample included 16 middle schools participating in an unrelated intervention study (on nutrition) in Minneapolis, Minnesota. A School Functioning Index developed to characterize schools’ overall stability, performance, and demographics was constructed using data from public archives and school administrator surveys. Data on violent behaviors and other variables were collected in student surveys in fall 1998 and spring 1999. We used multilevel modeling to assess the effect of school functioning on violent behavior after adjusting for known individual-level covariates of violent …


Correlates Of Suicide Risk In Juvenile Detainees And Adolescent Inpatients, Charles A. Sanislow, Carlos M. Grilo, Dwain C. Fehon, Seth R. Axelrod, Thomas H. Mcglashan Jan 2003

Correlates Of Suicide Risk In Juvenile Detainees And Adolescent Inpatients, Charles A. Sanislow, Carlos M. Grilo, Dwain C. Fehon, Seth R. Axelrod, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

OBJECTIVE: To compare correlates of risk for suicidal behavior in juvenile detainees with those in another high-risk group, adolescent psychiatric inpatients.

METHOD: Eighty-one adolescents in a short-term juvenile detention center were contrasted with a matched group of 81 adolescent psychiatric inpatients on a clinical assessment battery of established instruments including a measure for risk of suicidal behavior.

RESULTS: Juvenile detainees and adolescent psychiatric inpatients reported similar levels of distress on measures of suicide risk, depression, impulsivity, and drug abuse. After controlling for depression, impulsivity and drug abuse remained significantly associated with suicide risk scores in the juvenile detention group, but …


Crisis Intervention Services In Juvenile Detention Centers, Charles A. Sanislow, John Chapman, Thomas H. Mcglashan Dec 2002

Crisis Intervention Services In Juvenile Detention Centers, Charles A. Sanislow, John Chapman, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

The prevalence of mental disorders among juvenile detainees is estimated to be as high as 60 percent, and reports suggest that adolescents who are detained have a three- to fourfold risk of suicide. The transfer of juveniles who commit serious offenses to the adult legal system and the problems of overwhelmed child care agencies appear to have precipitated a shift in the composition of populations in juvenile detention centers. Adolescents are often detained for minor legal charges that occur in the context of severe behavioral problems and family stress. We report on a collaborative venture between a state juvenile justice …


Perceptions Of The Family Mealtime Environment And Adolescent Mealtime Behavior: Do Adults And Adolescents Agree?, Kerri N. Boutelle, Leslie A. Lytle, David M. Murray, Amanda Birnbaum, Mary Story May 2001

Perceptions Of The Family Mealtime Environment And Adolescent Mealtime Behavior: Do Adults And Adolescents Agree?, Kerri N. Boutelle, Leslie A. Lytle, David M. Murray, Amanda Birnbaum, Mary Story

Department of Public Health Scholarship and Creative Works

The family mealtime environment has great potential to affect the eating behaviors of youth in the family. It is difficult to determine the important elements of a healthy mealtime environment because a valid assessment of the family environment is so difficult to obtain. The objective of this study is to examine the level of agreement between adult and adolescent perceptions of the family mealtime environment and adolescent mealtime behavior. A telephone survey was used to query adult and adolescent family members about how they perceive the family mealtime environment and the adolescent's mealtime behavior. A convenience sample of 282 adult/adolescent …


Adolescent Opinions About Reducing Help-Seeking Barriers And Increasing Engagement., Coralie Wilson Dec 2000

Adolescent Opinions About Reducing Help-Seeking Barriers And Increasing Engagement., Coralie Wilson

Coralie J Wilson

Effective mental illness prevention programs are important for the safety of youth and adolescents. Research suggests that programs should facilitate appropriate help-seeking by lowering help-seeking barriers. This study used focus groups to obtain high school student opinions about actual help-seeking behaviors, reducing adolescent help-seeking barriers, raising sensitive issues with adolescents, and increasing appropriate help-source engagement. Transcript analysis revealed several themes. Relationship and trust were key approach factors for current help-seeking. Memories of successful prior helping episodes were also important. Education about appropriate help-seeking, presented in ways consistent with those currently used by adolescents (e.g., through peer networks), might reduce help-seeking …


Adolescent Opinions About Reducing Help-Seeking Barriers And Increasing Engagement., Coralie J. Wilson Dec 2000

Adolescent Opinions About Reducing Help-Seeking Barriers And Increasing Engagement., Coralie J. Wilson

Frank Deane

Effective mental illness prevention programs are important for the safety of youth and adolescents. Research suggests that programs should facilitate appropriate help-seeking by lowering help-seeking barriers. This study used focus groups to obtain high school student opinions about actual help-seeking behaviors, reducing adolescent help-seeking barriers, raising sensitive issues with adolescents, and increasing appropriate help-source engagement. Transcript analysis revealed several themes. Relationship and trust were key approach factors for current help-seeking. Memories of successful prior helping episodes were also important. Education about appropriate help-seeking, presented in ways consistent with those currently used by adolescents (e.g., through peer networks), might reduce help-seeking …


Psychological And Behavioral Functioning In Adolescent Psychiatric Inpatients Who Report Histories Of Childhood Abuse, Carlos M. Grilo, Charles A. Sanislow, Dwain C. Fehon, Steve Martino, Thomas H. Mcglashan Mar 1999

Psychological And Behavioral Functioning In Adolescent Psychiatric Inpatients Who Report Histories Of Childhood Abuse, Carlos M. Grilo, Charles A. Sanislow, Dwain C. Fehon, Steve Martino, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: The purpose of this study was to examine psychological and behavioral functioning in psychiatrically hospitalized adolescents who report histories of childhood abuse. Method: Three hundred twenty-two subjects completed an assessment battery of psychometrically well-established instruments. Childhood abuse was assessed by using the childhood abuse scale of the Millon Adolescent Clinical Inventory. Childhood abuse scores of 30 or less and 70 or greater were used to create two study groups—no abuse (N=93) and high abuse (N=70), respectively. The two study groups were compared demographically and on the battery of instruments. Results: The two groups differed substantially on most measures of …