INTRODUCTION: The impact of marijuana use has become a national topic with the increase in state’s legalizing or decriminalizing the use of the drug. To understand the impact this new trend may have on the population, it is necessary to characterize the interaction between marijuana use and health outcomes. Previous research has focused on the acute effects of marijuana on mental health and longitudinal impacts of marijuana use in the adolescent population. However there are no previously published studies on the impact of early onset marijuana use on adult mental health. AIM: This study aims to determine the prevalence of early onset marijuana use and if there is a statically significant association between early onset marijuana use (<14 years old) and increased prevalence of adverse mental health outcomes in adult life. METHODS: This study was conducted using data from the 2014 National Survey on Drug Use and Health. The study population included 41, 285 participants 18 or older at the time of the cross-sectional survey. Adult mental health outcomes were modeled for both early onset marijuana users and non-early onset marijuana users using a multiple logistic regression model to calculate both adjusted and unadjusted odds ratios (AOR’s, OR’s) with 95% confidence intervals. Statistical analysis was performed to examine the association between early onset marijuana use and negative adult mental health outcomes including serious mental illness, any mental illness and lifetime depressive episodes. RESULTS: This study found that in adults aged 18 and older the prevalence of early onset marijuana use was 8.3%. The prevalence of early onset marijuana use varies by gender, with a prevalence of 5.1(95% CI 4.7-5.2) for males and 3.3(95% CI 3.1-3.5) for females. Early onset marijuana use had a statistically significant association with all three indicators of poor adult mental health. The AOR for early onset marijuana use and serious mental illness was 2.3(95% CI 1.972-2.758). The association between early onset marijuana use and adult depressive episode had an AOR of 2.1(95% CI1.906-2.389). DISCUSSION: These findings suggest that early onset marijuana use is a risk factor for adverse mental health outcomes in adulthood. Consistent with findings from other nationally representative surveys, the prevalence of early onset marijuana use is higher in males than females. Early onset marijuana use is associated with increased odds of past year serious mental illness and past year any mental illness. This suggests that legislature considering marijuana legalization must also consider policies addressing under age use of the drug. Further longitudinal research is needed to father assess the association between early onset marijuana use and adult mental health.

ABSTRACT Current guidelines published by the Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP) recommend empiric antibiotics for all neonates born to mothers with a diagnosis of chorioamnionitis due to the risk of early onset sepsis (EOS). EOS is difficult to diagnose due to nonspecific symptoms and a lack of reliable tests, can progress quickly, and is potentially fatal or have neurodevelopmental consequences for survivors. Antibiotics are frequently prescribed in the hospital and are lifesaving in the setting of a serious infection. Conversely, overuse of antibiotics has potential negative effects to individuals and the population as a whole. Antibiotic resistant infections are a consequence of antibiotic misuse, are costly and difficult to treat, and pose a risk to patients hospitalized. To examine this problem at The University of Vermont Medical Center (UVMMC) a retrospective chart review was preformed. Data on the maternal risk factors associated with EOS were collected in addition to clinical characteristics of their neonates and entered into a neonatal early onset sepsis (NEOS) calculator to determine the specific risk of infection to each infant. Treatment of the infant was compared to the NEOS calculator and CDC recommendations. Using posterior probability to determine a more specific risk profile better targets antibiotic therapy to ensure all infants that need treatment receive it, while reducing the number of infants treated empirically. UVMMC currently treats 78% of infants according to CDC guidelines. Use of the NEOS calculator would reduce antibiotic treatment to 18% of term neonates born to mothers with a diagnosis of chorioamnionitis. Using a new tool to determine risk of EOS may safely reduce the number of infants receiving antibiotic treatment.

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Young onset dementia (YOD) affects not only the person diagnosed, but the family unit as a whole. It is estimated that as many as 500,000 people in the United States have YOD and around 250,000 children are involved in caring for these people. A child of a parent with YOD can begin to experience negative effects when the child begins to take part in caregiving for the person with young onset dementia (PWYOD). Feelings of stress, anger, fear of the future, depression, social isolation, and increasing responsibility of caring for the PWYOD can be felt by children as caregivers. Research shows that children of people with YOD have reported an extreme lack of support and decreased communication within the family. The purpose of this thesis was to examine current interventions designed to improve coping for children of parents with YOD. A review of literature using CINAHL, Medline, and PsychINFO was conducted to gather peer-reviewed articles and journals relating to interventions to help children of parents with YOD cope. However, no studies have discussed interventions specifically for the child. Therefore, information was pulled from 5 studies regarding what children of people with YOD feel has helped them, in their respective experiences, to deal with the stresses of a parent with YOD. Research suggests that individualized care should be provided for these children based on: age, developmental stage, and experience. Children have reported that they cope by spending time away from the home, participating in extracurricular activities, and spending time with friends. Clear communication by all members of the family is also reported to be vital in easing the stresses of caring for a parent with YOD. While children have developed these coping mechanisms, interventions need to be formally designed and their effect on improving coping examined. Analyzing the experiences of the children with parents with YOD is necessary for clinicians to gain insight into what interventions worked for this population, and what interventions need to be created for further and more individualized support.

The purpose of this study was to investigate the presentation and outcome of anorexia nervosa (AN) within the pediatric population. A retrospective chart review of individuals who were admitted for the first time to hospital between 2000-2005 for treatment of AN was completed. Individuals were classified as Early Pediatric AN (admitted <14 years old) or Later Pediatric AN (≥14 years old). It was hypothesized that the Early Pediatric AN group would have a less severe presentation, as measured by percent ideal body weight (%IBW) and medical stability at admission, and better outcome as measured by rate of weight gain post-discharge, number of hospitalizations and the Morgan-Russell General Outcome Scale rating. The study contained a total of 207 cases, larger than many previous studies in pediatric AN. The study found that younger age at presentation was associated with admission at a higher %IBW but not medical stability. Age at presentation did not predict rate of weight gain or rehospitalization; however, the Early Pediatric AN group had a better outcome on the Morgan-Russell scale.

The purpose of this study was to investigate the presentation and outcome of anorexia nervosa (AN) within the pediatric population. A retrospective chart review of individuals who were admitted for the first time to hospital between 2000-2005 for treatment of AN was completed. Individuals were classified as Early Pediatric AN (admitted <14 years old) or Later Pediatric AN (≥14 years old). It was hypothesized that the Early Pediatric AN group would have a less severe presentation, as measured by percent ideal body weight (%IBW) and medical stability at admission, and better outcome as measured by rate of weight gain post-discharge, number of hospitalizations and the Morgan-Russell General Outcome Scale rating. The study contained a total of 207 cases, larger than many previous studies in pediatric AN. The study found that younger age at presentation was associated with admission at a higher %IBW but not medical stability. Age at presentation did not predict rate of weight gain or rehospitalization; however, the Early Pediatric AN group had a better outcome on the Morgan-Russell scale.

Conduct problems are among the most prevalent psychiatric conditions identified in outpatient mental health centers (Frick 1998b; Kazdin, 1995; Loeber, Burke, Lahey, Waters, & Zera, 2000). Despite a long history of examining risk factors associated with conduct problems, many studies have focused exclusively on adolescent onset conduct problems and few studies have sought to examine relationships among risk factors across several domains. Furthermore, few studies have been conducted to examine protective factors thought to mitigate the risk for children who are thought to be at a high risk of manifesting conduct problems. By gaining an understanding of risk and protective factors associated with early onset conduct problems, clinicians can develop and appropriately target interventions to those children at a high risk of developing conduct problems as well as those who are already displaying symptoms associated with early onset conduct problems. The purpose of the present study was to identify factors associated with an increased risk of early onset conduct problems across several domains and to develop a statistical model describing the relationships among these latter domains and risk factors. Furthermore, the present research used these identified risk factors in order to study factors that may offer protective benefits to children who are at a high risk of developing conduct problems at a younger age. The data used in the present study were from the National Survey of Children's Health database which contained data collected in 2007. These data were analyzed using a confirmatory factor analysis approach and multi-group structural equation modeling techniques. The results showed that living in a poorer quality neighborhood, coming from a lower socioeconomic status, and having a mother who reported overall fair or poorer mental health were all risk factors associated with reported early onset conduct problems. Protective factors identified included having a higher quality parent-child relationship and not having a history of involvement in special education. The implications of these findings are discussed as are future directions for research.

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This cross-sectional survey study investigates the relationship between school attachment (SA) and adolescents' age at first intercourse (DV), as well as the influence of SA on DV in comparison to the influences of parent attachment (PA), other parent and school factors, and individual factors. Early first intercourse is defined as prior to age 15. Participants are 1,757 mostly African-American and White 7th through 12th grade adolescent boys and girls in five rural counties of a Mid-Atlantic state. Bivariate correlations comparing SA and PA revealed significant and positive correlations between SA and DV (p<.001), as well as PA and DV (p<.001). Linear regressions including only SA and PA showed SA was most predictive of DV for adolescents reporting the lowest (p<.05) and highest (p<.001) levels of PA. For those reporting moderate attachment to parents, SA was not predictive of DV. Several ethnic and gender differences are discussed. Finally, when the influence of individual, parent, and school contexts was compared using entry in a regression by blocks, SA was no longer a significant predictor of DV, and school variables did not account for a significant portion in the variance of age at first intercourse. Parent attachment was a significant and negative predictor, indicating that other parent, individual, and community variables are more influential. Implications are discussed. / Master of Science