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Director's Report to the National Advisory Council on Drug Abuse - February, 2005



Research Findings - Epidemiology and Etiology Research

Cigarette Access for Minors Has Been Declining, But Remains High

Investigators from the Monitoring the Future Study examined trends in middle and high school students' perceived ease, methods, and locations of access to cigarettes, and assessed differences related to their sociodemographic characteristics and smoking status. Annual data from nationally representative samples of 8th-, 10th-, and 12th-grade students were analyzed for the 1997-2002 period. Analyses revealed that perceived ease of access decreased significantly among never and past smokers. Decreased individual purchasing in retail outlets, as well as decreased purchasing from vending machines, were reported by 8th- and 10th-grade students. All grades reported decreased purchasing from self-service placements of cigarettes. Decreases in access were not reported across all retailer types, and no significant increases were seen in the percent of underage purchasers who reported being asked to show identification. Both gender and ethnicity were significantly related to where and how underage youth reported obtaining cigarettes. Findings show that: (1) cigarette access for minors has been declining, but remains high; (2) perceived access to cigarettes clearly increases with level of smoking; and (3) policies to reduce such access may be having an impact as evidenced by decreased retail and vending machine purchases and self-service purchases. The authors conclude that states should continue to strengthen efforts to reduce youth cigarette access, especially in the areas of confirming buyer age via identification checks, and should make efforts to decrease access across all retailer types. Johnston, L.D., O'Malley, P.M., and Terry-McElrath, Y.M. Methods, Locations, and Ease of Cigarette Access for American Youth, 1997-2002. American Journal of Preventive Medicine, 27, pp. 267-276, 2004.

Stress Burden and the Lifetime Incidence of Psychiatric Disorder in Young Adults: Racial and Ethnic Contrasts

With the exception of studies of individual traumatic events, the significance of stress exposure in psychiatric disorder previously has not been effectively examined. The purpose of this study was to address the hypothesis that accumulated adversity represents an important risk factor for the subsequent onset of depressive and anxiety disorders. Analyses were conducted on a community-based study of psychiatric and substance use disorders among a large, ethnically diverse cohort representative of young adults in South Florida. Adversity was estimated with a count of major and potentially traumatic events experienced during one's lifetime and prior to the onset of disorder. Most interviews took place in the homes of participants, with 30% conducted by telephone. The authors obtained a random sample of individuals aged 18 to 23 years from a previously studied representative sample of young adolescents. Because participants in the prior study were predominantly boys, a supplementary sample of girls was randomly obtained from the early-adolescence school class rosters. A total of 1803 interviews were completed, representing a success rate of 70.1%. Results indicated that the level of lifetime exposure to adversity was found to be associated with an increased risk of subsequent onset of depressive and/or anxiety disorder. This association remained clearly observable when childhood conduct disorder, attention-deficit/hyperactivity disorder, prior substance dependence, and posttraumatic stress disorder were held constant and when the possibility of state dependence effects was considered. This evidence suggests that high levels of lifetime exposure to adversity are causally implicated in the onset of depressive and anxiety disorders. Turner, R.J., and Lloyd, D.A. Stress Burden and the Lifetime Incidence of Psychiatric Disorder in Young Adults: Racial and Ethnic Contrasts. Arch Gen Psychiatry, 61, pp. 481-488, 2004.

Abuse Experiences in a Community Sample of Young Adults

This study documents significant associations among lifetime abuse experiences, psychiatric diagnoses, and sexual risk behaviors in a multiethnic community sample of young men and women (N = 1803) in South Florida. Self-report data were collected via structured interviews as part of a longitudinal follow-up of a larger school-based study. Participants were grouped according to extent of lifetime abuse experiences. Cumulative lifetime abuse experiences were associated with increased risk for a broad range of individual lifetime psychiatric disorders, as well as cumulative lifetime psychiatric disorders. Both cumulative abuse experiences and cumulative psychiatric disorders were independently associated with (a) higher levels of sexual risk behaviors and (b) higher risk for lifetime sexually transmitted diseases (STDs). Implications for selective prevention of sexual risk behaviors and STDs among young adults with histories of abuse and psychiatric disorders are discussed. Tubman, J.G., Montgomery, M.J., Gil, A.G., Wagner, E.F. Abuse Experiences in a Community Sample of Young Adults: Relations with Psychiatric Disorders, Sexual Risk Behaviors, and Sexually Transmitted Diseases. Am J Community Psychol, 34, pp. 147-162, 2004.

Risk and Protective Factors related to Physical Violence Against Impoverished Women

Violence represents a significant threat to the health of impoverished women. Few studies have examined what characteristics might be associated with increased risk of violence or protection from physical violence directed at such women, although this information is important in informing violence prevention and intervention efforts. According to the authors, this is the first study that has prospectively examined, in representative probability samples of impoverished women, multiple risk and protective factors to understand their relative importance to physical victimization. Study participants were 810 women in Los Angeles County, 402 in shelters and 408 in Section 8 low-income housing, who completed structured interviews at baseline and 6-month follow-up. Significant (p < .05) multivariate predictors of physical violence experienced during the 6 months prior to follow-up interview were physical or sexual violence experienced as a child, physical violence experienced during the 6 months prior to baseline interview, having multiple sexual partners, psychological distress, and poor social support. Results of this study highlight the persistence of physical violence in the lives of impoverished women and plausible, prospective risk factors for this violence. Findings also highlight opportunities to reduce women's risk of experiencing violence through enhancing women's social support and mental health. Wenzel, S.L., Tucker, J.S., Elliott, M.N., Marshall, G.N., and Williamson, S.L. Physical Violence Against Impoverished Women: A Longitudinal Analysis of Risk and Protective Factors. Women's Health Issues, 14, pp. 44-54, 2004.

Early-adolescent Substance Use and Subsequent Young-adult Substance Use Disorders and Psychiatric Disorders

This study examined the associations among early-adolescent substance use, subsequent young-adult substance use disorders, and psychiatric disorders among a community sample of males. Early-adolescent data were collected in classroom surveys (1990-1993), and young-adult data were collected in face-to-face interviews (1998-2000). Results showed strong associations between early-adolescent substance use and young-adult substance use disorders and psychiatric disorders. The magnitudes of these associations varied by racial/ethnic group and were strongest among African Americans and foreign-born Hispanics, who reported the lowest early-adolescent substance use. These findings suggest that early-adolescent substance use is most strongly associated with a later pattern of dysfunction among the racial/ethnic groups that reported the lowest levels of early use. The implications of these findings in the context of primary and secondary prevention are discussed. Gil, A.G., Wagner, E.F., and Tubman, J.G. Associations Between Early-adolescent Substance Use and Subsequent Young-adult Substance Use Disorders and Psychiatric Disorders among a Multiethnic Male Sample in South Florida. Am J Public Health, 94, pp. 1603-1609, 2004.

The Co-occurrence of Violence, Substance Use and Disorder, and HIV-Risk Behavior among Sheltered and Low-income Housed Women in Los Angeles County

Violence against women, substance use and disorder, and HIV represent three significant threats to the health of women, yet little is known about the extent of these epidemics among indigent women. This study investigates and documents differences in the prevalence and co-occurrence of physical and sexual violence, substance use and disorder, and HIV risk behavior in sizable probability samples of sheltered homeless and low-income housed women. Retrospective self-reports were obtained through structured interviews with stratified random samples of women residing in shelters (N = 460) and low-income housing (N = 438) in Los Angeles County, California. Results indicated that sheltered women were more likely than housed women to report experiencing physical and sexual violence, substance use and disorder, HIV risk behavior, and co-occurrence of these problems in the past year. Differences remained when propensity weights were used to equate the groups on demographic and background characteristics. Findings suggest remarkable need for services among communities of indigent women. Higher rates of problems among women in shelters highlight the importance of differentiating among subgroups of indigent women in community-based prevention and intervention activities and tentatively suggest a protective influence of housing. Wenzel, S.L., Tucker, J.S., Elliott, M.N., Hambarsoomians, K., Perlman, J., Becker, K., Kollross, C., Golinelli, D. Prevalence and Co-occurrence of Violence, Substance Use and Disorder, and HIV Risk Behavior: A Comparison of Sheltered and Low-income Housed Women in Los Angeles County. Prev Med., 39, pp. 617-624, 2004.

The Influence of Social and Work Exchange Relationships on Organizational Citizenship Behavior

Previous studies explain situational antecedents of organizational citizenship behavior (OCB) using social exchange theory. However, the effects of factors such as perceptions of job characteristics on OCB seem to require a different explanatory mechanism. This article proposes that these effects can be explained through a new exchange relationship called work exchange. A theory for the situational antecedents of OCB that includes economic, work, and social exchange relationships is developed. The theory is tested using structural equations. Cardona, P., Lawrence, B.S., and Bentler, P.M. The influence of social and work exchange relationships on organizational citizenship behavior. Group and Organization Management, 29, pp. 219-247, 2004.

Child Sexual Abuse and HIV: An Integrative Risk Reduction Approach

In recent years, researchers have noted a significant association between child sexual abuse (CSA) and HIV. This association has important implications for HIV prevention and intervention. First, the fact that women who contract HIV are more likely to have been sexually abused as children suggests a continuum of victimization, such that early victimization may confer greater sexual risk-taking and likelihood of revictimization, resulting in HIV infection. Thus, the possible pathways between CSA and HIV need to be elucidated in order to prevent further negative outcomes. Second, the implications for HIV research and intervention are significant. Sexual abuse during childhood is associated with disturbances in the self that pervade an individual's development, and these disturbances are likely to maintain HIV risk behaviors unless ameliorated. Therefore, individuals who are HIV-positive and have a history of child sexual abuse may face "double jeopardy" for negative outcomes, including additional risks for reinfection, sexual revictimization, physical impairment, and non-adherence to HIV treatment that are beyond those associated with HIV infection. Intervention approaches for HIV-positive women with sexual abuse histories need to consider pathways of risk, ameliorate the disruptions in development that result from CSA, and address the additional additive and interactive influences of HIV and CSA on health outcomes. This chapter presents a brief overview of the consequences of CSA that may lead to higher risk for HIV, offers a critique of early intervention paradigms, and presents an integrative risk-reduction approach for HIV-positive women with CSA histories, currently in clinical trial, that addresses the link between CSA and HIV in a developmental and cultural context. Finally, preliminary findings from the intervention and implications for future directions are discussed. Chin, D., Wyatt, G., Carmona, J. V., Loeb, T.B., and Myers, H. Child Sexual Abuse and HIV: An Integrative Risk Reduction Approach. In L. Koenig, A. O'Leary, L. Doll, and Pecquegnat, (Eds.), From Child Sexual Abuse to Adult Sexual Risk: Trauma, Revictimazation, and Intervention, pp. 233-250. Washington D.C.: American Psychological Association, 2004.

An EM Algorithm for Fitting Two-level Structural Equation Models

Maximum likelihood is an important approach to analysis of two-level structural equation models. Different algorithms for this purpose have been available in the literature. In this paper, the authors present a new formulation of two-level structural equation models and develop an EM algorithm for fitting this formulation. This new formulation covers a variety of two-level structural equation models. As a result, the proposed EM algorithm is widely applicable in practice. A practical example illustrates the performance of the EM algorithm and the maximum likelihood statistic. Liang, J., and Bentler, P. M. An EM Algorithm for Fitting Two-level Structural Equation Models. Psychometrika, 69, pp. 101-122, 2004.

Adolescent Predictors of Young Adult and Adult Alcohol Involvement and Dysphoria in a Prospective Community Sample of Women

The adolescent predictors of later alcohol involvement (AI), dysphoria (D), and their shared association (AD) among women have not been adequately established. Three waves of data from an ethnically diverse community sample of women, assessed over 16 years are used to study how various psychosocial factors in adolescence influenced later drinking, depression, and their shared association. Structural equation models revealed that several adolescent ecodevelopmental and social development model variables influenced their later outcome in young adulthood and adulthood. The strongest relation was between adolescent Social Conformity and adult AD (b = -.46) over a 16-year period, emphasizing the impact of this construct. Numerous other relations were revealed. For instance, less satisfaction with school during adolescence predicted adult AI. Having a good bond to the family in adolescence predicted a lower quantity of alcohol consumed during adulthood. Lower satisfaction with "what you want to be" during adolescence predicted young adult D. Higher levels of adolescent relationship satisfaction and school satisfaction predicted less suicidal ideation as an adult. Prevention interventions focusing on increasing socially conforming attitudes and on strengthening relationships both in and out of the home during adolescence are likely to be effective in reducing aspects of AI, D, and AD for women in the general community. Locke, T. F., and Newcomb, M.D. Adolescent Predictors of Young Adult and Adult Alcohol Involvement and Dysphoria in a Prospective Community Sample of Women. Prevention Science, 5, pp. 151-168, 2004.

Tobacco Smoking and Depressive Symptomatology

Whereas an association between cigarette smoking and depression has been established in Anglo populations, replication of tobacco-depression associations in countries where smoking is growing may provide important new insights. The objectives of this study were to estimate the association of depressive symptomatology with tobacco smoking, number of cigarettes smoked daily, and smoking cessation in a representative sample of the Mexican population. The data come from the Third National Addictions Survey (1998) conducted by the Mexican Ministry of Health, representative of Mexico's civilian population residing in cities and towns with 2500+ inhabitants, aged 18-64. Part of a multi-stage, stratified, probability sample, 1935 men and women answered a version of the survey that also included the CES-D depression scale. Analyses addressed the survey's complex design and controlled for income and educational level. The results showed that, among women only, current smokers had twice the odds of elevated depressive symptomatology than never smokers (OR 2.1, 95% CI 1.3-3.5, p = 0.002). For men, only those smoking a pack or more a day had greater odds of depressive symptomatology (OR 5.9, 95% CI 1.6-21.9, p = 0.008). Overall, former smokers who ceased smoking within 6 months had lower odds of depressive symptomatology than current smokers (OR 0.4, 95% CI 0.1-1.0, p = 0.042). These findings add to the accumulating evidence for the association between smoking and depression in different cultures and populations. Benjet, C., Wagner, F.A., Borges, G.G., and Medina-Mora, M.E. The Relationship of Tobacco Smoking with Depressive Symptomatology in the Third Mexican National Addictions Survey. Psychol Med, 34, pp. 881-888, 2004.

Child Maltreatment, Parent Alcohol- and Drug-related Problems, Polydrug Problems, and Parenting Practices: A Test of Gender Differences and Four Theoretical Perspectives

The authors tested how adverse childhood experiences (child maltreatment and parent alcohol- and drug-related problems) and adult polydrug use (as a mediator) predict poor parenting in a community sample (237 mothers and 81 fathers). These relationships were framed within several theoretical perspectives, including observational learning, impaired functioning, self-medication, and parentification-pseudomaturity. Structural models revealed that child maltreatment predicted poor parenting practices among mothers. Parent alcohol- and drug-related problems had an indirect detrimental influence on mothers' parenting practices through self-drug problems. Among fathers, emotional neglect experienced as a child predicted lack of parental warmth and more parental neglect, and sexual abuse experienced as a child predicted a rejecting style of parenting. Locke, T.F. and Newcomb, M.D. Child Maltreatment, Parent Alcohol- and Drug-related Problems, Polydrug Problems, and Parenting Practices: A Test of Gender Differences and Four Theoretical Perspectives. Journal of Family Psychology, 18, pp. 120-134, 2004.

Psychosocial Antecedents of Injection Risk Reduction

This study is based on a collaboration with the Integrated Substance Abuse Program at UCLA. In this study, the authors used the AIDS Risk Reduction Model (ARRM) to test a mediated stage-based longitudinal structural equation model analyzing the impact of intention to change injection risk behaviors on 6-month outcomes in a sample of 294 HIV-negative opiate addicted individuals currently in treatment. The ARRM predicts less occurrence of AIDS risk behaviors through a three-stage process: (1) perceiving one's behavior as risky and recognizing one's skills to reduce the behavior, (2) forming an intention to change behavior, and (3) acting on that intention. Stage 1 ARRM constructs of AIDS knowledge, susceptibility, fear of AIDS and Peer Norms were hypothesized to predict Stage 1 end points of perceived risk, response efficacy, and self-efficacy as well as baseline risk behavior. These constructs predicted Stage 2 (intended risk reduction) which, in turn, predicted the Stage 3 outcome of injection risk behaviors. Prior behavior, continuous participation in treatment, and the effect of gender were also included in the model. Intended risk reduction and continuous participation in treatment significantly predicted less injection risk behavior at Stage 3. Stage 1 constructs of greater self-efficacy, less baseline risk behavior, less susceptibility and greater fear of AIDS predicted intentions to reduce risk as did female gender. Leverage points for change in this highly vulnerable population are discussed in the article. Longshore, D., Stein, J.A. and Conner, B.T. Psychosocial Antecedents of Injection Risk Reduction: A Multivariate Analysis. AIDS Education and Prevention 16, pp. 53-66, 2004.

The Motivation, Skills, and Decision-Making Model of Drug Abuse Prevention

This article summarizes the theoretical basis for targeted prevention programs as they apply to different high-risk groups. The authors explain the advantages and disadvantages of different definitions of risk and discuss strategies for preventing drug use related problems in high-risk youth. Productive prevention programs for many at-risk groups share similar components, including those that address motivation, skills, and decision making. Key aspects of these three components are examined and linked to theories in clinical psychology, social psychology, sociology, and chemical dependence treatment. Among a total of 29 promising targeted prevention programs, the authors describe examples of empirically evaluated, intensive interventions that have made a positive impact on the attitudes and behavior of multiple problem youth. Incorporating the perspectives of multiple disciplines appears essential for progress in drug abuse and o ther problem behavior prevention. Sussman, S., Earleywine, M., Wills, T., Cody, C., Biglan, T., Dent, C. W. and Newcomb, M. D. The Motivation, Skills, and Decision-making Model of Drug Abuse Prevention. Substance Use and Misuse, 39, pp. 1971-2016, 2004.

Estimating Numbers of Injecting Drug Users in Metropolitan Areas

Researchers estimated the population prevalence of current injection drug users (IDUs) in 96 large US metropolitan areas to facilitate structural analyses of its predictors and sequela. They also assessed the extent to which drug abuse treatment and HIV counseling and testing are made available to drug injectors in each metropolitan area. The total number of current IDUs in the US was estimated and the large metropolitan area total was allocated among large metropolitan areas using four different multiplier methods. Mean values were used as best estimates, and their validity and limitations were assessed. Prevalence of drug injectors per 10,000 population varied from 19 to 173 (median 60; interquartile range 42-87). Proportions of drug injectors in treatment varied from 1.0% to 39.3% (median 8.6%); and the ratio of HIV counseling and testing events to the estimated number of IDUs varied from 0.013 to 0.285 (median 0.082). The researchers concluded that, despite limitations in the accuracy of the estimates, they can be used for structural analyses of the correlates and predictors of the population density of drug injectors in metropolitan areas and for assessing the extent of service delivery to drug injectors. In addition, although service provision levels varied considerably, few if any metropolitan areas seemed to be providing adequate levels of services. Friedman, S., Tempalski, B., Cooper, H., Perlis, T., Keem, M., Friedman, R., and Flom, P. Estimating Numbers of Injecting Drug Users in Metropolitan Areas for Structural Analyses of Community Vulnerability and for Assessing Relative Degrees of Service Provision for Injecting Drug Users. J Urban Health, 81, pp. 377-400, 2004.

A New Measure of Linkage Between Two Sub-Networks

In this paper, researchers discuss social networks and links between groups of people with and without certain characteristics, such as people who "link" those with and without HIV infection; or who link injecting drug users with non-injecting drug users. They propose new measures of this linkage (for individuals and for entire networks) and discuss reasons why their measures are superior to existing measures by providing examples. The authors argue that existing measures of linkage between networks, such as centrality (including closeness centrality and "betweenness" centrality) make no distinction between nodes in different groups, and thus cannot measure which nodes connect the two groups, nor the extent to which they do so. Their new measures, although limited in applicability to binary data and to two groups, have potential for helping to trace HIV infection from networks of drug injectors to the general population. Moreover, they may ultimately help to identify characteristics of individuals in networks that are correlated with linkage to other networks, and thereby suggest how people with those characteristics might be better targeted for HIV prevention interventions. Flom, P., Friedman, S., Strauss, S. and Neaigus, A. A New Measure of Linkage Between Two Sub-Networks. Connections, 26, pp. 62-70, 2004.

Perceived Adverse Consequences Associated with MDMA/Ecstasy Use in Young Polydrug Users

The use of MDMA/Ecstasy has increased among young people in many industrialized nations around the world since the mid-1990s. In this paper, researchers describe how young people characterize perceived long-term consequences associated with Ecstasy. They used three data sources for this work (qualitative interviews, pile sorts, and quantitative data on subjective memory impairment). Contrary to expectations, Ecstasy was classified midway between drugs perceived to be the most and least risky. Risks associated with Ecstasy use included two popular myths implying forms of brain damage—"draining spinal fluid" and "creating holes in brains". Qualitative results indicated that some young people are concerned about the potential affects of the drug on memory and as a cause of depression. About 20% (82) of the participants (N =402) "agreed" or "strongly agreed" that Ecstasy has impaired their memories. Public health concerns about the potential adverse consequences of Ecstasy use have increased, along with a growing convergence of findings from neuropsychological studies that indicates a possible relationship between Ecstasy use and memory impairment and/or as contributing to other cognitive problems, but whether MDMA causes damage to serotonergic neurons in humans remains in question. Nonetheless, concern among young users about the adverse consequences of Ecstasy use may provide opportunities for reducing the prevalence of its use and the potential harm that it may cause. Carlson, R., McCaughan, J., Falk, R., Wang, J., Siegel, H., and Daniulaityte, R. Perceived Adverse Consequences Associated with MDMA/Ecstasy Use Among Young Polydrug Users in Ohio: Implications for Intervention. Intl J Drug Policy, 15, pp. 265-274, 2004.

Barriers to Intervention Among Young MDMA/Ecstasy Users

In the past several years, the use of MDMA ("Ecstasy") has increased substantially in the U.S. and in many countries around the world. Although this increase has been associated with the dance club and rave scenes, MDMA use has also expanded into new settings, and the diversity of users has grown. Given the increasing, although as yet unclear, evidence that MDMA is potentially neurotoxic and may lead to adverse psychological consequences, understanding how active users perceive the risks associated with MDMA can help to inform prevention and intervention approaches. Based on audiotaped focus groups and individual interviews conducted with 30 users in Central Ohio, this study found that, beyond the risk of obtaining something potentially deadly instead of MDMA, most users minimize or discount potential risks of neurotoxicity or psychological problems from MDMA use. As more people use MDMA without developing obvious adverse consequences, and others observe their "benign" experiences as meaning that MDMA is not a harmful drug, the more that others may in turn be willing to use it. Participants in this study appeared to want information on the risks associated with MDMA use so they could make their own decisions about future use. Because MDMA is often used among small groups of friends, providing accurate information to peer leaders about MDMA, who can then disseminate the information to their peers, may be a promising approach for discouraging potential users from doing so. Carlson, R., Falck, R., McCaughan, J., and Siegal, H. MDMA/Ecstasy Use Among Young People in Ohio: Perceived Risk and Barriers to Intervention. J Psychoactive Drugs, 36, pp. 181-189, 2004.

Correlates of Sex Trading Among Drug-Using Men Who Have Sex with Men

Researchers examined correlates of trading sex for money, drugs, and shelter, or food among drug-using men who have sex with men (MSM). They used street-based outreach and snowball sampling techniques to recruit 387 MSM in Long Beach, California, as part of a randomized trial of an HIV prevention intervention for MSM who engage in high-risk sex and drug use. Audio computer-assisted self-interviewing questionnaires were completed by all of the men. The mean age of the participants was 37.8 (SD=8.9); more than half (57.6%) were African American, 29.7% were white, and 12.7% were Latino. The association of predictors with sex trading was assessed with _2 tests and multiple logistic regression. Sex-trading prevalence was 62.5% (95% confidence interval=57.7%, 67.4%), and was associated with crack use, injection drug use, childhood maltreatment, non-gay self-identification, and homelessness (adjusted odds ratios=3.72, 2.28, 2.62, 2.21, and 1.88, respectively). Multiple risk factors are associated with sex trading among MSM, suggesting that interventions that address sex trading among MSM must also target potential use of crack cocaine and injection drug use, as well as homelessness and childhood maltreatment. Interventions are also needed to target non-gay-identified MSM who engage in sex trading. Newman, P., Rhodes, R., and Weiss, R. Correlates of Sex Trading Among Drug-Using Men Who Have Sex with Men. Am J Public Health, 94, pp. 1998-2003, 2004.

HIV Risk Practices Among Needle Exchange Users and Nonusers in Chicago

Researchers sought to assess associations between needle exchange program (NEP) use and drug injection risk practices. Between 1997-2000, they recruited injecting drug users (IDUs) from NEPs and from an area with no NEP, interviewed them about risk practices, and provided counseling and testing for HIV. The risk practices of "regular NEP users" — those who obtained at least half of their needles from an NEP (n = 558) —were compared with those of IDUs who did not use an NEP (n = 175). In multivariate analysis, regular NEP users, compared with NEP nonusers, were less likely to receptively share needles (adjusted odds ratio [AOR], 0.30; 95% CI, 0.19-0.46); lend used needles (AOR, 0.47; 95% CI, 0.31-0.71); share cookers (AOR, 0.39; 95% CI, 0.25-0.61), cottons (AOR, 0.48; 95% CI, 0.32-0.72), or water (AOR, 0.41; 95% CI, 0.27-0.63); or use a needle for >1 injection (0.15; 95% CI, 0.08-0.27). Among those who shared needles, regular NEP users were significantly more likely to do so for a smaller proportion of injections, with fewer partners and persons socially closer, and to have always bleached used needles before injecting. These findings indicate that regular NEP use is associated with less frequent and lower risk HIV injection risk practices. Ouellet, L., Huo, D. and Bailey, S. HIV Risk Practices Among Needle Exchange Users and Nonusers in Chicago. J Acquir Immune Defic Syndr, 37, pp. 1187-1196, 2004.

Hepatitis C Virus Infection Among Injection Drug Users: Survival Analysis of Time to Seroconversion

Time to hepatitis C virus (HCV) seroconversion in initially seronegative IDUs has not been directly measured, and public health planning would benefit from specifying the window of opportunity for prevention of infection, and factors that affect timing of infection. In this study, researchers followed 484 HCV antibody-negative IDUs in Seattle, Washington a median of 2.1 years to observe seroconversion. They examined time to HCV seroconversion in relation to subject characteristics using the Kaplan-Meier method and Cox proportional hazards regression. A weighted-average time to HCV seroconversion was calculated among new injectors (injecting <2 years) using seroprevalence and seroincidence data. There were 134 HCV seroconversions (11.6 per 100 person-years at risk; the 25th percentile of time to seroconversion was 26.2 months). Injection with a syringe used by another injector (adjusted hazards ratio= 1.8; 95% confidence interval=1.3-3.0) and sharing a cooker or cotton (1.8; 1.0 -3.1) were associated with time to HCV seroconversion. Using the estimate of the mean time to seroconversion from first injection in new injectors who were HCV antibodynegative at enrollment (5.4 years), and the midpoint between first injection and study enrollment in new injectors who were HCV antibody-positive at enrollment (0.6 years), the weighted-average time to seroconversion after beginning to inject was estimated to be 3.4 years. These findings indicate that the period of susceptibility to HCV infection in the majority of drug injectors appears to be long enough to justify the allocation of substantial resources toward interventions to reduce injection-related risk behavior in these individuals. Hagan, H., Thiede, H., and Des Jarlais, D. Hepatitis C Virus Infection Among Injection Drug Users: Survival Analysis of Time to Seroconversion. Epidemiology, 15, pp. 543-549, 2004.

HIV Incidence Among High-Risk Puerto Rican Drug Users: A Comparison of East Harlem, New York, and Bayamon, Puerto Rico

Significant differences in HIV-related risk behaviors have been found between Puerto Rican drug users in New York City (NY) and Puerto Rico (PR). Researchers undertook an examination of HIV incidence rates and characteristics of seroconverters in each location. Baseline and follow-up interviewing and HIV testing were conducted in 1998 to 2002 with seronegative PR IDUs and crack smokers from East Harlem, NY (n = 455) and Bayamón, PR (n = 268). There were a total of 32 seroconverters, 9 in NY and 23 in PR, for seroconversion rates of 0.88/100 person-years at risk (pyr; 95% CI, 0.31-1.45) in NY and 3.37/100 pyr (95% CI, 2.02-4.72) in PR (P < 0.001). In PR, variables significantly related to seroconversion were younger age and using shooting galleries. Being in methadone treatment was protective against seroconversion. In NY, crack use was significantly related to seroconversion. The researchers conclude that the higher seroconversion rate found in PR indicates a need to enhance HIV prevention efforts, including increasing methadone treatment and access to sterile syringes, and to focus on reducing HIV transmission in the Caribbean by targeting the drug use-HIV epidemic and sexual risk behaviors in both locations. Deren, S., Kag, S., Colon, H., Andia, J., and Robles, R. HIV Incidence Among High-Risk Puerto Rican Drug Users: A Comparison of East Harlem, New York, and Bayamon, Puerto Rico. J Acquir Immune Defic Syndr, 36, pp. 1067-1074, 2004.

An HIV Prevalence-Based Model for Estimating Urban Risk Populations of IDUs and MSM

Issues of cost and complexity have limited the study of the population size of men who have sex with men (MSM) and injection drug users (IDUs), two groups at clearly increased risk for human immunodeficiency virus (HIV) and other acute and chronic diseases. In this study, researchers developed a prototypical, easily applied estimation model for these populations and applied it to Miami, Florida. This model combined HIV prevalence estimates, HIV seroprevalence rates, and census data to make plausible estimates of the number and proportion of MSM and IDUs under a number of assumptions. Sensitivity analyses were conducted to test the robustness of the model. The model suggests that approximately 9.5% (plausible range 7.7%-11.3%) of Miami males aged 18 years or older are MSM (point estimate, N = 76,500), and 1.4% (plausible range 0.9%-1.9%) of the total population aged 18 years or older are IDUs (point estimate, N= 23,700). Males may be about 2.5 times more likely than females to be IDUs. The estimates were reasonably robust to biases. The model was used to develop MSM and IDU population estimates in selected urban areas across Florida and should be replicable in other medium-to-large urban areas. Such estimates could be useful for behavioral surveillance and resource allocation, including enhanced targeting of community-based interventions for primary and secondary HIV prevention. Lieb, S., Friedman, S., Zeni, M., Chitwood, D., Liberti, T., Gates, G., Metsch, L., Maddox, L., and Kuper, T. An HIV Prevalence-Based Model for Estimating Urban Risk Populations of IDUs and MSM. J Urban Health, 81, pp. 401-415, 2004.

Adolescent Onset Bipolar Disorder Associated with Risk for Substance Use Disorder

This study further investigated the previously reported elevated risk for substance use disorders (SUD) among children and adolescents with bipolar disorder (BPD), addressing some of the previous methodological weaknesses. The authors compared 57 subjects with early onset BPD with controls of similar age and socioeconomic status. Bipolar disorder was found to constitute a significant risk factor for substance use disorder in adolescence; this relationship held even when conduct disorder (commonly associated with both BPD and SUD) was taken into account. Moreover, as previously reported, adolescent-onset BPD rather than childhood-onset was the greater predictor. Although early onset bipolar disorder is relatively rare among the mental disorders, it is severe; thus, this study points to a potent risk factor that may help identify a high-risk group that could benefit from early intervention for bipolar disorder with possible implications for preventing SUD. Wilens, T.E., Biederman, J., Kwon, A., Ditterline, J., Forkner., P., Moore, H., Swezey, A., Snyder, L., Henin, A., Wozniak, H., and Faraone, S.V. Risk for Substance Use Disorders in Adolescents with Bipolar Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43, pp. 1380-1386, 2004.

Age at First Use and Psychopathology as Risk Factors for Substance Use Disorder

This paper explores the issue of early drug use as a risk factor for adolescent substance use disorder (SUD), and the possible role of comorbid conduct problems in explaining this association. Sophisticated statistical tests were applied to longitudinal data from a large population-based sample, the Great Smoky Mountains Study, assessed annually between ages 9 and 16. Of note, drug use before age 13 was a strong predictor of transition to SUD, and early use remained a risk factor even in the absence of conduct disorder. Boys with a history of depression were at increased risk for SUD, and girls with anxiety experienced an increased risk at age 16. Findings from such large population-based studies can help target populations at higher risk for drug abuse for appropriate preventive interventions. Sung, M., Erkanli, A., Angold, A., and Costello, E.J. Effects of Age at First Substance Use and Psychiatric Comorbidity on the Development of Substance Use Disorders. Drug and Alcohol Dependence, 75, pp. 287-299, 2004.

Relationship Between Early Cannabis Use and Later Use and Abuse of Other Illicit Substances

This study drew on genetic epidemiologic data to assess the relationship between early marijuana use and later use and abuse/dependence of other illicit substances. Several approaches to the data were employed to test whether they better fit the "gateway" model, in which early marijuana use has a causal role in subsequent drug abuse, or a correlated liabilities model, in which early marijuana use and later drug abuse both result from common vulnerability factors. Similar to other studies, they found a strong association between early cannabis use and the later use, abuse, and dependence of other illicit drugs. Further analyses and model-fitting found that one twin's early cannabis use was significantly associated with the second twin's later drug abuse, that genetic factors probably influence both early cannabis use and other drug abuse, and that the correlated liabilities model fit the data well. The authors compare their findings with those of Lynskey and colleagues, noting some differences in methodology and alternative interpretations of the discordant twin findings. These results led the authors to conclude that the relationship between early cannabis use and later drug abuse is largely influenced by correlated genetic and environmental factors, but that a causal influence of early marijuana use cannot be ruled out. Further study of this area, perhaps using prospective data, may further enhance the understanding of this issue, which has important preventive implications. Agrawal, A., Neale, M.C., Gardner, C.O., Prescott, C.A., and Kendler, K.S. A Twin Study of Early Cannabis Use and Subsequent Use and Abuse/Dependence of Other Illicit Drugs. Psychological Medicine, 34, pp. 1227-1237, 2004.

Shared Risks for Different Forms of Drugs

This study used a genetically informative design to investigate whether subjects using different forms of the same drug can appropriately be combined in epidemiologic studies. Drawing on data from a population-based sample of male and female same-sex twin pairs, they compared the genetic, shared environmental, and unique environmental overlap between 1) marijuana and hashish, and 2) intranasal and crack cocaine. Cannabis and cocaine each showed complete overlap in genetic factors between the different forms, and substantial overlap on shared environmental factors. Unique environmental factors were moderately similar for forms of cannabis and only modestly similar for forms of cocaine. These findings suggest that the choice of marijuana vs. hashish, or intranasal cocaine vs. crack, is largely due to unique environmental influences and not familial (inherited) tendencies, and that these different forms of each drug can be appropriately combined in epidemiologic studies. Agrawal, A., Prescott, C.A., and Kendler, K.S. Forms of Cannabis and Cocaine: A Twin Study. American J. Med. Genetics, 129B, pp. 125-128, 2004.

The Epidemiology of Dual Diagnosis

This literature review shows mental disorders to be significantly related to alcohol and drug use disorders. The strongest associations involve externalizing mental disorders and alcohol-drug dependence. Mental disorders are associated with alcohol-drug use, problems among users, dependence among problem users, and persistence among people with lifetime dependence. These dual diagnoses are associated with severity and persistence of both mental and alcohol-drug disorders. A wider range of mental disorders is associated with nicotine dependence. Most people with dual diagnosis report their first mental disorder occurred at an earlier age than their first substance disorder. Prospective studies confirm this temporal order, although significant predictive associations are reciprocal. Analyses comparing active and remitted mental disorders suggest that some primary mental disorders are markers and others are causal risk factors for secondary substance disorders. The article closes with a discussion of ways epidemiologic research can be used to help target and evaluate interventions aimed at preventing secondary substance use disorders by treating early-onset primary mental disorders. Kessler R.C. Biological Psychiatry, 56, pp. 730-737, 2004.

The National Comorbidity Survey Replication (NCS-R): Background and Aims

The National Comorbidity Survey Replication (NCS-R) is a new nationally representative community household survey of the prevalence and correlates of mental disorders in the US. The NCS-R was carried out a decade after the original NCS. The NCS-R repeats many of the questions from the NCS and also expands the NCS questioning to include assessments based on the more recent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostics system American Psychiatric Association, 1994). The NCS-R was designed to (1) investigate time trends and their correlates over the decade of the 1990s and (2) expand the assessment of the prevalence and correlates of mental disorders beyond the assessment in the baseline NCS in order to address a number of important substantive and methodological issues that were raised by the NCS. This paper presents a brief review of these aims. Kessler R.C., and Merikangas K.R. International Journal of Methods in Psychiatric Research, 13, pp. 60-68, 2004.

The US National Comorbidity Survey Replication (NCS-R): Design and Field Procedures

The National Comorbidity Survey Replication (NCS-R) is a survey of the prevalence and correlates of mental disorders in the US that was carried out between February 2001 and April 2003. Interviews were administered face-to-face in the homes of respondents, who were selected from a nationally representative multi-stage clustered area probability sample of households. A total of 9,282 interviews were completed in the main survey and an additional 554 short non-response interviews were completed with initial non-respondents. This paper describes the main features of the NCS-R design and field procedures, including information on fieldwork organization and procedures, sample design, weighting and considerations in the use of design-based versus model-based estimation. Empirical information is presented on non-response bias, design effect, and the trade-off between bias and efficiency in minimizing total mean-squared error of estimates by trimming weights. Kessler, R.C., Berglund, P., Chiu, W.T., Demler, O., Heeringa, S., Hiripi, E., Jin, R., Pennell, B.E., Walters, E.E., Zaslavsky, A. and Zheng, H. International Journal of Methods in Psychiatric Research, 13, pp. 69-92, 2004.

Mate Similarity for Substance Dependence and Antisocial Personality Disorder

Substance dependence (SD) and antisocial personality disorder (ASPD) are highly comorbid and aggregate in families. Mating assortment may be an important process contributing to this familial aggregation. Authors hypothesized that symptom counts of substance dependence, antisocial personality disorder, and retrospectively assessed conduct disorder (CD) would be correlated significantly among parents of youth in treatment for substance use and conduct problems and, separately, among parents of community controls. Authors examined SD, ASPD, and CD among 151 pairs of parents of adolescents in treatment for substance use and conduct problems, and in 206 pairs of parents of control subjects. For average dependence symptoms (ADS) (the sum of across-drug substance dependence symptoms divided by the number of substance categories meeting minimum threshold use) mother-father correlations were 0.40 for patients and 0.28 for controls. Mother-father correlations for ASPD symptom count were 0.33 for patients and 0.26 for controls and for CD symptom count were 0.31 for patients and 0.10 for controls. Spousal correlations for ADS and ASPD, suggest substantial non-random mating. Results support gender differences in homogamy for SD. Behavior genetic studies of these disorders need to account for assortment to avoid biases in estimates of genetic and environmental effects. Sakai, J.T., Stallings, M.C., Mikulich-Gilbertson, S.K., Corley, R.P., Young, S.E., Hopfer, C.J. and Crowley T.J. Drug and Alcohol Dependence, 16, pp. 165-175, 2004.

Pharmacogenetics of Nicotine Metabolism in Twins: Methods and Procedures

This article describes a pharmacogenetic investigation of nicotine metabolism in twins. One hundred and thirty-nine twin pairs (110 monozygotic and 29 dizygotic) were recruited and assessed for smoking status, zygosity, and health conditions known or suspected to affect drug metabolism. Participants underwent a 30-minute infusion of stable isotope-labeled nicotine and its major metabolite, cotinine, followed by an 8-hour in-hospital stay. Blood and urine samples were taken at regular intervals for analysis of nicotine, cotinine, and metabolites by gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry and subsequent characterization of pharmacokinetic phenotypes. DNA was genotyped to confirm zygosity and for variation in the primary gene involved in nicotine metabolism, CYP2A6. Univariate and multivariate biometric analyses planned for the future will determine genetic and environmental influences on each pharmacokinetic measure individually and in combination with each other, and in the presence and absence of covariates, including measured genotype. When the analyses are completed, this study will result in a more complete characterization of the impact of genetic and environmental influences on nicotine and cotinine metabolic pathways than has heretofore been reported. The approach taken, with its use of a quantitative model of nicotine metabolism, highly refined metabolic phenotypes, measured genotype, and advanced tools for biometric genetic analysis, provides a model for the use of twins in next-generation studies of complex drug-metabolism phenotypes. Swan, G.E., Benowitz, N.L., Jacob, P. III, Lessov, C.N., Tyndale, R.F., Wilhelmsen, K., Krasnow, R.E., McElroy, M.R., Moore, S.E., and Wambach, M. Twin Research, 7, pp. 435-448, 2004.

Defining Nicotine Dependence for Genetic Research: Evidence from Australian Twins

The authors used items of the DSM-IV and of the Heaviness of Smoking Index to characterize the nicotine dependence phenotype and to identify salient symptoms in a genetically informative community sample of Australian young adult female and male twins. Phenotypic and genetic factor analyses were performed on nine dependence symptoms (the seven DSM-IV substance dependence criteria and the two Heaviness of Smoking Index (HSI) items derived from the Fagerstrom Tolerance Questionnaire, time to first cigarette in the morning and number of cigarettes smoked per day). Phenotypic and genetic analyses were restricted to ever smokers. Results showed that phenotypic nicotine dependence symptom covariation was best captured by two factors with a similar pattern of factor loadings for women and men. In genetic factor analysis item covariation was best captured by two genetic but one shared environmental factor for both women and men; however, item factor loadings differed by gender. All nicotine dependence symptoms were substantially heritable, except for the DSM-IV criterion of 'giving up or reducing important activities in order to smoke', which was weakly familial. The findings suggest that the salient behavioral indices of nicotine dependence are similar for women and men. DSM-IV criteria of tolerance, withdrawal, and experiencing difficulty quitting and HSI items time to first cigarette in the morning and number of cigarettes smoked per day may represent the most highly heritable symptoms of nicotine dependence for both women and men. Lessov, C.N., Martin, N.G., Statham, D.J., Todorov, A.A., Slutske, W.S., Bucholz, K.K., Heath, A.C., and Madden, P.A. Psychological Medicine, 34, pp. 865-879, 2004.

The Association between Parental Alcoholism and Adolescent Psychopathology: A Systematic Examination of Parental Comorbid Psychopathology

The relationship between parental alcohol dependence (with and without comorbid psychopathology) and adolescent psychopathology was examined in a sample of 665 adolescents (13-17 years old) and their parents. Results indicated that adolescents who had parents diagnosed with alcohol dependence only did not significantly differ from adolescents who had parents with no psychopathology in regard to any of the measures of psychological symptomatology (substance use, conduct disorder, and depression) or clinical diagnoses (alcohol dependence, marijuana dependence, conduct disorder, or depression) assessed. In contrast, adolescents who had parents diagnosed with alcohol dependence and either comorbid drug dependence or depression were more likely to exhibit higher levels of psychological symptomatology. In addition, adolescents who had parents diagnosed with alcohol dependence, depression, and drug dependence were most likely to exhibit psychological problems. These findings underscore the importance of considering parental comorbid psychopathology when examining the relationship between parental alcoholism and offspring adjustment. Ohannessian, C.M., Hesselbrock, V.M., Kramer, J., Kuperman, S., Bucholz, K.K., Schuckit, M.A. and Nurnberger, J.I. Journal of Abnormal Child Psychology 32, pp. 519-533, 2004.

Depression, Suicidal Ideation, and Suicide Attempt in Twins Discordant for Cannabis Dependence and Early-onset Cannabis Use

Previous research has reported both a moderate degree of comorbidity between cannabis dependence and major depressive disorder (MDD) and that early-onset cannabis use is associated with increased risks for MDD. The purpose of this study was to examine whether associations between both lifetime cannabis dependence and early cannabis use and measures of MDD, suicidal ideation, and suicide attempt persist after controlling for genetic and/or shared environmental influences. Drawn from a general population sample of twins (median age, 30 years), 277 same-sex twin pairs discordant for cannabis dependence and 311 pairs discordant for early-onset cannabis use (before age 17 years). The results showed that individuals who were cannabis dependent had odds of suicidal ideation and suicide attempt that were 2.5 to 2.9 times higher than those of their non-cannabis-dependent co-twin. Additionally, cannabis dependence was associated with elevated risks of MDD in dizygotic but not in monozygotic twins. Those who initiated cannabis use before age 17 years had elevated rates of subsequent suicide attempt (odds ratio, 3.5 [95% confidence interval, 1.4-8.6]) but not of MDD or suicidal ideation. Early MDD and suicidal ideation were significantly associated with subsequent risks of cannabis dependence in discordant dizygotic pairs but not in discordant monozygotic pairs. These findings suggest that the comorbidity between cannabis dependence and MDD likely arises through shared genetic and environmental vulnerabilities predisposing to both outcomes. In contrast, associations between cannabis dependence and suicidal behaviors cannot be entirely explained by common predisposing genetic and/or shared environmental predispositions. Previously reported associations between early-onset cannabis use and subsequent MDD likely reflect shared genetic and environmental vulnerabilities, although it remains possible that early-onset cannabis use may predispose to suicide attempt. Lynskey, M.T., Glowinski, A.L., Todorov, A.A., Bucholz, K.K., Madden, P.A., Nelson, E.C., Statham, D.J., Martin, N.G. and Heath A.C. Archives of General Psychiatry, 61, pp. 1026-1032, 2004.

Neurobehavior Disinhibition in Childhood Predicts Suicide Potential and Substance Use Disorder by Young Adulthood

The objectives of this study were to (1) determine whether two factors that are established components of the risk for substance use disorder (SUD) also impact on the risk for suicide; and (2) evaluate whether SUD manifest by early adulthood predicts suicide propensity. Neurobehavior disinhibition assessed in 227 boys at ages 10-12 and 16 and parental history of SUD were prospectively evaluated to determine their association with the risk for SUD and suicide propensity between ages 16 and 19. The results indicated that neurobehavior disinhibition at age 16 predicts suicide propensity between ages 16 and 19 (p = .04). A trend was observed (p = .08) for SUD manifest between ages 16 and 19 to predict suicide propensity during the same period. Maternal SUD is directly associated with son's SUD risk but not suicide propensity. Paternal SUD predicts son's neurobehavior disinhibition that, in turn, predisposes to SUD. A direct relation between paternal SUD and son's suicide propensity was not observed. These findings suggest that neurobehavior disinhibition, a component of the liability of SUD, is also associated with suicide risk. These results are discussed within a neurobehavioral framework in which prefrontal cortex dysfunction is hypothesized to underlie the risk for these two outcomes. Tarter, R.E., Kirisci, L., Reynolds, M., and Mezzich, A. Drug and Alcohol Dependence 76, S45-S52, 2004.

Post-traumatic Stress Disorder, Drug Dependence, and Suicidality among Male Vietnam Veterans with a History of Heavy Drug Use

This study examines the roles of post-traumatic stress disorder (PTSD) and drug dependence in non-fatal suicidality (i.e., suicidal ideation and suicide attempt) among Vietnam veterans in their adult years. The sample includes male veterans deployed to Vietnam, including an oversample of those who tested positive for opiates at their return (N = 642). PTSD, substance abuse, suicidality, and other psychopathology are analyzed using three waves of survey and military data covering the time period from early adolescence to middle adulthood. Measures include the onset and recency of each of the lifetime DSM-IV PTSD symptom criteria, and yearly symptom measures of DSM-IV dependence for alcohol and eight classes of psychoactive substances. Survival and hazard models are applied to assess the effects of drug dependence, PTSD, and other psychopathology on the duration of suicidality. Longitudinal models estimate the casual relationships among PTSD, drug dependence, and suicidality over a 25-year period. Results show evidence of strong continuity of PTSD, drug dependence, and suicidality over time. The causal role of drug dependence on PTSD and suicidality is limited to young adulthood. Evidence is stronger for self-medication in later adulthood. The results indicate that a life-course perspective is needed for the combined treatment of PTSD and drug dependence for severely traumatized populations. Price, R.K., Risk, N.K., Haden, A.H., Lewis, C.E. and Spitznagel, E.L. Drug and Alcohol Dependence 76, 31-43, 2004.

Making a Structured Psychiatric Diagnostic Interview Faithful to the Nomenclature

Psychiatric diagnostic interviews to be used in epidemiologic studies by lay interviewers have, since the 1970s, attempted to operationalize existing psychiatric nomenclatures. How to maximize the chances that they do so successfully has not previously been spelled out. In this article, the authors discuss strategies for each of the seven steps involved in writing, updating, or modifying a diagnostic interview and its supporting materials: 1) writing questions that match the nomenclature's criteria, 2) checking that respondents will be willing and able to answer the questions, 3) choosing a format acceptable to interviewers that maximizes accurate answering and recording of answers, 4) constructing a data entry and cleaning program that highlights errors to be corrected, 5) creating a diagnostic scoring program that matches the nomenclature's algorithms, 6) developing an interviewer training program that maximizes reliability, and 7) computerizing the interview. For each step, the authors discuss how to identify errors, correct them, and validate the revisions. Although operationalization will never be perfect because of ambiguities in the nomenclature, specifying methods for minimizing divergence from the nomenclature is timely as users modify existing interviews and look forward to updating interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, Eleventh Revision. Robins, L.N., and Cottler, L.B. American Journal of Epidemiology, 15, pp. 808-813, 2004.

The Homeless Supplement to the Diagnostic Interview Schedule: Test-Retest Analyses

This study sought to extend previous work on reliability of self-reported residential history in a homeless population with high rates of drug abuse. The latest version of the Homeless Supplement to the Diagnostic Interview Schedule (DIS/HS) was used to achieve reliability on homelessness experience, use of shelters, transience, and recent residential patterns. Homeless study volunteers were recruited for a test-retest study from a drop-in day centre for mentally ill homeless people (N = 25) and a substance abuse day programme (N = 30). They were administered the instrument approximately one to two days apart. Kappa and intraclass correlation analyses were performed to assess reliability. Overall, the reliabilities of most variables were acceptable, ranging from fair to excellent. Six items were reconstructed to achieve reliability and two were dropped. Substance dependence and adult antisocial behaviour patterns did not affect reliability on most items. This study has developed a reliable self report instrument for measuring residential history that can be used with homeless and drug abusing populations. Replication is needed in larger, more representative samples and comparison of reliability with other psychiatric and cognitive characteristics. North, C.S., Eyrich, K.M., Pollio, D.E., Foster, D.A., Cottler L.B. and Spitznagel E.L. International Journal of Methods in Psychiatric Research, 13, pp. 184-191, 2004.

The Association of Sexual Dysfunction and Substance Use among a Community Epidemiological Sample

This study examines the prevalence of DSM-III sexual dysfunctions and their association with comorbid drug and alcohol use in a community epidemiologic sample. The data for these analyses are based on the Epidemiological Catchment Area Project, a multistage probability study of the incidence and prevalence of psychiatric disorders in the general population conducted in 1981-83. Only the sample of 3,004 adult community residents in the St. Louis area was queried on DSM-III sexual dysfunctions of inhibited orgasm, functional dyspareunia (painful sex), inhibited sexual excitement (i.e., lack of erection/arousal), and inhibited sexual desire. There was a prevalence rate of 11% for inhibited orgasm, 13% for painful sex, 5% for inhibited sexual excitement, 7% for inhibited sexual desire, and 26% for any of these sexual dysfunctions (14% for men and 33% for women). The prevalence of qualifying lifetime substance use among the population was 37%, with males meeting more drug and alcohol use criteria than females. After controlling for demographics, health status variables, and psychiatric comorbidity (depression disorder, generalized anxiety disorder, antisocial personality disorder, and residual disorders), inhibited orgasm was associated with marijuana and alcohol use. Painful sex was associated with illicit drug use and marijuana use. Inhibited sexual excitement was more likely among illicit drug users. Inhibited sexual desire was not associated with drug or alcohol use. Johnson, S.D., Phelps, D.L. and Cottler, L.B. Archives of Sexual Behavior, 33, pp. 55-63, 2004.

Epidemiology of Inhalant Use, Abuse, and Dependence among Youth

Secondary analysis of data on adolescents aged 12-17 from 2000 and 2001 National Household Surveys on Drug Abuse found that inhalant use was common. Results showed that 0.4% of adolescents met DSM-IV inhalant abuse or dependence criteria in the past year. Inhalant abuse and dependence affected adolescents regardless of gender, age, race/ethnicity, and family income. The progression from inhalant use to abuse or dependence was related to early first use, use of multiple inhalants, and weekly inhalant use. Adolescents with inhalant use disorders reported coexisting multiple drug abuse and dependence, mental health treatment, and delinquent behaviors. Adolescents with an inhalant use disorder may represent a subgroup of highly troubled youth with multiple vulnerabilities. Because early use is associated with progression to abuse and dependence, prevention programs should target elementary school-age children. Wu, L.T., Pilowsky, D.J., and Schlenger, W.E. Inhalant Abuse and Dependence among Adolescents in the United States. J Am Acad Child Adolesc Psychiatry, 43, pp. 1206-1214, 2004.

Alcohol and Marijuana Use and Teen HIV Risk Behavior

While many studies have demonstrated an association between substance use and sexual activity among teens and young adults, few studies have attempted to estimate causal effects. This study employed two complementary research approaches, the bivariate probit regression model and an individual fixed-effects regression model to explore this issue through analysis of data from the 1997 cohort of the National Longitudinal Survey of Youth (NLSY). To test the robustness of their estimates using NLSY data, the authors obtained estimates of the effect of substance use and sexual behavior using a sample of young adults drawn from the National Longitudinal Survey of Adolescent Health (Ad-Health) and found similar results. The authors concluded that the positive associations between substance use and sexual behavior and risky sexual behavior are unlikely to reflect true causal relationships and are more likely to reflect the influence of omitted variables. Grossman, M., Kaestner, R., and Markowitz, S. Get High and Get Stupid: The Effect of Alcohol and Marijuana Use on Teen Sexual Behavior. Review of Economics of the Household, 2, pp. 411-439, 2004.

Males at Greater Risk for Violence, Females Higher Risk of PTSD

This study estimated the cumulative occurrence of traumatic events and posttraumatic stress disorder (PTSD), using fourth edition (DSM-IV) criteria, in a high-risk sample of young people in urban United States. The epidemiological sample (n = 2,311) was recruited in 1985-1986 at entry into first grade of a public school system of a large mid-Atlantic city. Participants were interviewed about history of trauma and PTSD in 2000-2002 when their mean age was 21 years (n = 1,698). The authors found that the lifetime occurrence of assaultive violence was 62.6% in males and 33.7% in females. The risk of assaultive violence in males (but not females) varied by childhood area of residence within the city; the occurrence of other traumas did not vary by area of childhood residence. Females had a higher risk of PTSD than males following assaultive violence (odds ratio = 4.0, 95% confidence interval 2.0-8.3), but not following other traumas. A comparison of the results from this largely inner-city sample with the results from a recent study of a largely suburban sample in another region of the United States in which the same criteria and measures of trauma and PTSD were used suggested the possibility that males' risk for assaultive violence and females' risk for PTSD following exposure to assaultive violence might vary by characteristics of the social environment. Breslau, N., Wilcox, H.C., Storr, C.L., Lucia, V.C., and Anthony, J.C. Trauma Exposure and Posttraumatic Stress Disorder: A Study of Youths in Urban America. J Urban Health, 81, pp. 530-544, 2004.

Early Childhood Misbehavior Associated with Risk of Becoming Tobacco Dependent

In this study, the authors focused on signs of early childhood misbehavior that might be linked to the risk of becoming tobacco-dependent. Standardized teacher ratings of misbehavior were obtained for an epidemiologic sample of first graders entering an urban mid-Atlantic public school system in 1985 and 1986. Fifteen years later, 1,692 of the students were reassessed. As adults, 962 participants indicated that they had tried tobacco at least once; 66% of the 962 had become daily users. Latent class analysis of items on the Fagerstrom Test for Nicotine Dependence gave evidence of three classes pertinent to tobacco dependence syndrome in smokers by young adulthood: one nondependent class of smokers (50% of smokers), a class of smokers experiencing a moderate number of dependence features (31%), and a third class that was more severely affected (19%), as manifest in the need to smoke immediately after waking and smoking when ill. With or without adjustment for covariates, higher levels of teacher-rated childhood misbehavior at entry into primary school were associated with a modest excess risk of becoming tobacco-dependent by young adulthood (risk ratio = 1.6, 95% confidence interval: 1.1, 2.5). Interventions that seek to improve childhood behavior might reduce early onset tobacco smoking and risk of tobacco dependence among smokers. Storr, C.L., Reboussin, B.A., and Anthony, J.C. Am J Epidemiol, 15, 160, pp. 126-130, 2004.

Tobacco Dependence in the First Two Years of Use

This study pursued a line of large-sample epidemiological research on tobacco dependence syndromes that may appear during the first 2 years of tobacco smoking, as clinical features begin to emerge. A specific focus was a possible excess risk of tobacco dependence associated with early-onset smoking. Data came from public use files of the 1995-1998 National Household Surveys on Drug Abuse. Analyses were based on responses from 2,993 smokers, that is, those whose age at onset of tobacco smoking was either equal to the age at the time of the interview (n=1,030) or within 1 year of the age at the interview (n=1,963). Findings from latent class analysis best support a model with three classes of smokers; features of tobacco dependence are prominent in just two of these classes, which in aggregate constitute 29% of the recent-onset smokers. Earlier-onset tobacco smokers may have a modestly higher probability of expressing dependence features within 2 years of smoking onset, compared with later-onset smokers (i.e., those starting after age 20). Clinical features of tobacco dependence emerge within 1-2 years after the onset of smoking. If the three-class model of tobacco dependence is correct, early-onset smoking may confer modest excess risk of becoming tobacco dependent during the first 2 years after smoking onset. Storr, C.L., Zhou, H., Liang, K.Y., and Anthony, J.C. Nicotine Tob Res., 6, pp. 533-545, 2004.

Methodological Advances for Developmental Data

These methodological studies addressed two issues commonly found in human developmental datasets: a failure to capitalize on the measurement of time when using latent class analysis and avoiding the identification of spurious latent classes in structural equation mixture modeling. In one study the authors demonstrate both analytically and empirically that classic techniques for probing interactions in multiple regression can be generalized to LCA. A worked example is presented, and the use of these techniques is recommended whenever estimating conditional LCAs in practice. In another study the authors identify 3 conditions that may lead to the estimation of spurious latent classes in SEMM. They indicate that when the objective of a SEMM analysis is the identification of latent classes, these conditions should be considered as alternative hypotheses and results should be interpreted cautiously. Curran, P.J., Bauer, D.J., and Willoughby, M.T. Testing Main Effects and Interactions in Latent Curve Analysis, Psychol Methods, 9, pp. 220-37, 2004. See also: Bauer, D.J., and Curran, P.J. The Integration of Continuous and Discrete Latent Variable Models: Potential Problems and Promising Opportunities. Psychol Methods, 9, pp. 3-29, 2004.

Pubertal Stage Associated with Substance Use

The aim of this study was to ascertain the association between pubertal development and early adolescent substance use. Students completed questionnaires in school, in a cross-sectional survey of 5769 students age 10- to 15-year-old in the states of Washington, United States, and Victoria, Australia. The odds of lifetime substance use were almost twofold higher in midpuberty (Tanner stage III) and were threefold higher in late puberty (Tanner stage IV/V), after adjustment for age and school grade level. Recent substance use and substance abuse were higher in midpuberty and even more so in late puberty. Reporting most friends as substance users was more likely in the later stages of pubertal development, a relationship that accounted in part for the association found between later pubertal stage and substance abuse. Pubertal stage was associated with higher rates of substance use and abuse independent of age and school grade level. Early maturers had higher levels of substance use because they entered the risk period at an earlier point than did late maturers. The study findings support prevention strategies and policies that decrease recreational substance use within the peer social group in the early teens. Patton, G.C., McMorris, B.J., Toumbourou, J.W., Hemphill, S.A., Donath, S., and Catalano, R.F. Puberty and the Onset of Substance Use and Abuse. Pediatrics, 114, pp. 300-306, 2004.

Comparison of Substance Use in the US and Australia

This study compared risk and protective factors that influence youth substance use in Australia and the United States. The two countries have different policy orientations toward substance use: Australia has adopted harm-reduction policies, and the United States has adopted abstinence-focused policies. Cross-sectional survey data were collected from independent samples of adolescents in the states of Maine (N = 16,861) and Oregon (N = 15,542) in the United States and Victoria in Australia (N = 8442). Study results indicated that more adolescents in Victoria reported using cigarettes and alcohol, whereas more of the U.S. adolescents reported using marijuana. Exposure to risk and protective factors was generally similar in the cross-national samples. Most of the risk and protective factors were strongly associated with substance use to a similar degree in Victoria, Maine, and Oregon. However, among adolescents in Maine and Oregon peer/individual risk and protective factors associated with social detachment were more strongly related to substance use, and among adolescents in Victoria, family protective factors were less strongly related to alcohol use. Existing differences suggest that the abstinence policy context is associated with higher levels of illicit drug use and stronger relations between individual indicators of social detachment and substance use, whereas the harm reduction policy context is related to more cigarette and alcohol use, possibly from exposure to normative influences that are more tolerant of youth drug use. Beyers, J.M., Toumbourou, J.W., Catalano, R.F., Arthur, M.W. and Hawkins, J.D. A Cross-national Comparison of Risk and Protective Factors for Adolescent Substance Use: The United States and Australia. J Adolesc Health, 35, pp. 3-16, 2004.

Low Parent Involvement Related to Youth Substance Abuse

This study developed a scale-based method for identifying adolescents with low-parent involvement and examined effects on the development and course of alcohol use disorders (AUDs). The participants were 361 adolescents (ages 14 to 17 years) from two-parent families recruited from clinical and community sources. Cluster analysis of questionnaire items describing mother and father involvement identified 75 adolescents with low-parent involvement (i.e., Neglect). Compared with reference adolescents, Neglect adolescents were significantly more likely to be influenced by social pressure to drink alcohol. Among community participants, Neglect adolescents were more likely to develop AUDs. Among adolescents receiving treatment for AUDs, those in the Neglect group showed more improvement during a 1-year follow-up period. The results indicate that inadequate parent involvement may be a form of neglect. Clark, D.B., Thatcher, D.L., and Maisto, S.A. Adolescent Neglect and Alcohol Use Disorders in Two-Parent Families. Child Maltreatment 9, pp. 357-370, 2004.

The Natural History of Alcohol Use Disorders

This study examined clinically relevant research on the development, course and outcomes of adolescence alcohol use disorders (AUDs), using observational studies with adolescent samples selected for inclusion based on systematic assessment of AUDs and clinical relevance. Articles on childhood predictors, characteristics, course, complications and adult outcomes of adolescent AUDs were reviewed. Results indicate that the developmental trajectory toward adolescent AUDs begins with the emergence of childhood mental disorders. These problems are transmitted from parent to child in a developmentally specific fashion, reflect psychological dysregulation dimensions and predict adolescent AUDs. While most DSM-IV AUD diagnostic criterion items are valid for adolescents, tolerance and impaired control items are problematic, and some adolescents with significant alcohol problems are not identified by this diagnostic system. Understanding the psychosocial and biomedical complications that accompany AUDs requires attention to factors other than alcohol involvement itself, including childhood maltreatment and comorbid psychopathology. While some adolescents with AUDs manifest chronic alcohol dependence in adulthood, a substantial proportion overcome alcohol problems and transition to abstinence or normative drinking. While alcohol consumption may be the primary treatment focus, other important consequences, comorbidities and complications need to be addressed for successful developmental outcomes to result. Clark, D.B. The Natural History of Alcohol Use Disorders, Addiction, 99, pp. 5-22, 2004.

Antecedents and Outcomes of Marijuana Use Initiation during Adolescence

This study identified similarities and differences in risk factors for marijuana use initiation from grades 7 to 8, grades 8 to 9, and grades 9 to 10, and examined differences between earlier initiates, later initiates, and nonusers on various problem behaviors at grade 10. Longitudinal data were used to examine predictors and outcomes associated with marijuana initiation from grade 7 (N = 1,955) to grade 10 (N = 909). Participants completed yearly surveys to assess problem behaviors, social influences, and marijuana-related attitudes and behavior. Results showed that earlier initiates were more likely than later initiates to exhibit problem-related marijuana use, hard drug use, polydrug use, poor grades, and low academic intentions at grade 10. Across ages, initiation was predicted by smoking, frequency of marijuana offers, and poor grades. Results provided some evidence for a shift from familial to peer influence on marijuana initiation with increasing age. Marijuana-related beliefs were relatively weak predictors of initiation at all ages after controlling for pro-marijuana social influences and engagement in other types of substance use and delinquent behavior. Results emphasize the importance of early intervention and identify a wide range of potentially modifiable risk factors that may be targeted. Ellickson, P.L., Tucker, J.S., Klein, D.J., and Saner, H. Prev Med., 39, pp. 976-984, 2004.

Pathways From Physical Childhood Abuse To Partner Violence In Young Adulthood

Analyses investigated several competing hypotheses about developmental pathways from childhood physical abuse and early aggression to intimate partner violence (IPV) for young adult males and females at age 24. Potential intervening variables included: adolescent violence (age 15 to 18), negative emotionality at age 21, and quality of one's relationship with an intimate partner at age 24. At the bivariate level, nearly all variables were associated in the expected directions. However, tests of possible intervening variables revealed only a few significant results. For males, a strong direct effect of abuse on later partner violence was maintained in each model. For females, the quality of one's relationship with an intimate partner did appear to mediate the effect of childhood abuse on later violence to a partner, raising the possibility of gender differences in developmental pathways linking abuse to IPV. Herrenkohl, T.I., Mason, W.A., Kosterman, R., Lengua, L.J., Hawkins, J.D. and Abbott R.D. Violence and Victims, 19, pp. 123-136, 2004.

Adolescent Heavy Drinkers More Likely to be Obese Young Adults

This study examined the association of trajectories of heavy episodic drinking (at least five alcoholic drinks on one occasion) during adolescence with health status and practices at age 24. Data were from a longitudinal panel of 808 youths interviewed between 10 and 24 years of age. Results indicated four distinct trajectories of adolescent heavy episodic drinking were identified: nonheavy drinkers, late onsetters, escalators and chronic heavy drinkers. Overall, young adults who did not engage in heavy episodic drinking during adolescence had the lowest occurrence of health problems and were most likely to engage in safe health behaviors at age 24. Chronic and late-onset heavy episodic drinking during adolescence had negative effects on health status and practices at age 24. Adolescent chronic heavy drinkers were more likely to be overweight or obese and to have high blood pressure at age 24 than those who did not drink heavily in adolescence. Late-onset heavy drinkers were less likely to engage in safe driving practices at age 24 and were more likely to have been ill in the past year than adolescents who did not drink heavily. These health disparities remained even after current frequency of heavy episodic drinking at age 24, other adolescent drug use, ethnicity, gender and family poverty were controlled. Oesterle, S., Hill, K.G., Hawkins, J.D., Guo, J., Catalano, R.F., and Abbott, R.D. Adolescent Heavy Episodic Drinking Trajectories and Health in Young Adulthood. J Stud Alcohol., 65, pp. 204-212, 2004.

Attitudes toward Alcohol and Drug-free Experience among College Students

This study examined prospective relations between attitudes toward alcohol use and drug-free experience and alcohol consumption and problems in 231 undergraduate students (73% women). Attitude toward drug-free experience was hypothesized to moderate the alcohol attitude--behavior relationship. Participants were assessed twice, separated by a 30-day interval. Attitude toward alcohol use at Time 1 was associated with alcohol consumption at Time 2. Time 1 attitude toward alcohol use and the interaction between the attitude variables were associated with problems at Time 2, indicating that attitude toward alcohol use was less associated with alcohol problems among participants with more positive attitudes toward drug-free experience. Attitude toward drug-free experience acted as a protective factor, reducing the relationship between alcohol attitude and alcohol-related problems. Simons, J.S., and Gaher, R.M. Attitudes toward Alcohol and Drug-free Experience among College Students: Relationships with Alcohol Consumption and Problems. Am J Drug Alcohol Abuse, 30, pp. 461-471, 2004.

Racial Identity, Parental Support and Alcohol Use

This study examined racial identity and parental support as predictors of alcohol use in a sample of 488 African American adolescents. Two dimensions of racial identity were investigated: (1) racial centrality (i.e., the significance that one places on race in defining oneself) and (2) private regard (i.e., the extent to which one feels positively about Black people). In addition, perceived support from mothers and fathers was examined. Multivariate results showed that private regard and father support were associated with less self-reported alcohol use after partialling out the effects of age and gender. An interaction between the two racial identity dimensions was also found such that private regard was associated with less alcohol use for adolescents who reported that race was a more central part of their identity. Caldwell, C.H., Sellers, R.M., Bernat, D.H., and Zimmerman M.A. Racial Identity, Parental Support, and Alcohol Use in a Sample of Academically At-risk African American High School Students. Am J Community Psychol, 34, pp. 71-82, 2004.

Religious Activity and Risk Behavior Among African American Adolescents

This study examines how religious activity is associated with risk behaviors, concurrently and developmentally among urban African American adolescents. Seven hundred and five African American youths were interviewed annually during high school. Retention rates for the study exceeded 90%. Frequency of religious activity, sexual intercourse, and alcohol, cigarette, and marijuana use were assessed at each wave. Growth curve analyses found negative concurrent associations between religious activity and each of the four risk behaviors. The developmental effects of religious activity varied by gender. Higher levels of religious activity in 9th grade predicted smaller increases in marijuana use among males and cigarette use among females. In addition, larger decreases in religious activity during high school were associated with greater increases in alcohol use among males and sexual intercourse among females. During high school, religious activity limits the development of certain types of risk behavior among African American youth, even after controlling for reciprocal effects. Steinman, K.J., and Zimmerman M.A. Religious Activity and Risk Behavior among African American Adolescents: Concurrent and Developmental Effects. Am J Community Psychol., 33, pp. 151-161, 2004.

Life Transitions Predict Depression and Alcohol Use

This study examined longitudinally the relationship between depressive symptoms and alcohol use in a sample of black youth. Participants were 458 black males and females interviewed annually during the high school years and then for 3 years during the transition to adulthood. The relationship was examined using growth curves with Hierarchical Linear Modeling. The results suggest that depressive symptoms decrease over time, whereas the use of alcohol increases. The findings also suggest that youths use alcohol as a way to cope with depressive symptoms and that males are more likely to use alcohol as self-medication. The results also indicate that changes in alcohol use do not predict depressive symptoms, but that life changes associated with the transition to adulthood, such as attending college, predict changes in depressive symptoms and alcohol use. Findings highlight the role of depressive symptoms for predicting alcohol use among black youth and the role of significant life transitions in altering the pattern of alcohol use presented previously by these youths. Repetto, P.B., Zimmerman, M.A., and Caldwell, C.H. A Longitudinal Study of the Relationship between Depressive Symptoms and Alcohol Use in a Sample of Inner-city Black Youth. J Stud Alcohol., 65, pp. 169-178, 2004.

Greater Opportunity to Buy Illegal Drugs in Disadvantaged Neighborhoods

This study investigated whether subgroups of people living in disadvantaged neighborhoods may be more likely to come into contact with drug dealers as compared with persons living in more advantaged areas, with due attention to male-female and race-ethnicity differences. The study used standardized survey data collected using stratified, multistage area probability sampling with a nationally representative sample of household residents age 12 or older (n = 25,500). Evidence supports an inference that women are less likely to be approached by someone selling illegal drugs. The study found no more than modest and generally null racial and ethnicity differences, even for residents living within socially disadvantaged neighborhoods, where chances to buy illegal drugs are found to be more common. Limitations of survey data always merit attention, but this study evidence lends support to the inference that physical and social characteristics of a neighborhoods can set the stage for opportunities to become involved with drugs. Storr, C.L., Chen, C.Y., and Anthony, J.C. "Unequal Opportunity": Neighborhood Disadvantage and the Chance to Buy Illegal Drugs. J Epidemiol Community Health, 58, pp. 231-237, 2004.

Cigarette Smoking and Depressive Symptoms: A Longitudinal Study of Adolescents and Young Adults

Cigarette smoking and depressive symptoms have been shown to be related in previous research. This paper examined the relationship between cigarette smoking and depressive symptoms in a longitudinal sample of 688 adolescents and young adults through surveys conducted over 13 years. The results indicate that a history of earlier cigarette smoking in adolescence predicts later depressive symptoms in the late twenties. The study also suggests that depressive symptoms during adolescence predict cigarette smoking in the late twenties but not above and beyond prior smoking. These results help clarify and expand current knowledge on the links between cigarette smoking and depression. The results point to several clinical implications for treatment of both cigarette smoking and depressive symptoms among both adolescents and young adults. Brook, J.S., Brook, D.W., Schuster, E., and Zhang, C. Cigarette Smoking and Depressive Symptoms: A Longitudinal Study of Adolescents and Young Adults. Psychological Reports, 95, pp. 159-166, 2004.

Tobacco Use and Health in Young Adulthood

This prospective longitudinal study examines the association between lifetime tobacco use and subsequent health problems by age 30. The authors interviewed a community group of 749 participants from upstate New York at mean ages of 14, 16, 22, and 27 years. Daily tobacco use during any of the time periods, as well as the number of periods of daily tobacco use, were significantly associated with increased risk for respiratory ailments, neurobehavioral and cognitive problems, and general malaise. The results suggested that daily tobacco use, either during childhood, adolescence, the early 20s, or a combination of those times, predicted health problems by age 30. Effective smoking prevention programs that begin in childhood are imperative to prevent the occurrence of later health problems. Brook, J.S., Brook, D.W., Zhang, C., and Cohen, P. Tobacco Use and Health in Young Adulthood. Journal of Genetic Psychology, 165, pp. 310-323, 2004.

Smoking Among New Yorican Adolescents

The authors identified longitudinal relationships between early risk and protective factors from the domains of family, personality, and peer influences and later tobacco use in Puerto Rican adolescents living in New York. Aspects of the ethnic minority experience as moderators of familial risk and protective factors were investigated. Participants were 282 female and 276 male Puerto Rican adolescents interviewed twice, 5 years apart. The authors used hierarchical regression analyses to identify a model with direct and indirect paths. Family, personality, peer, and early smoking domains were directly related to later adolescent smoking. Partial mediation occurred. The authors identified risk-protective and protective-protective interactions between variables from the ethnic minority experience and family domains. Interventions to reduce smoking among Puerto Rican adolescents should focus on multiple contexts, including aspects of the ethnic minority experience. Brook, J.S., Pahl, T., Balka, E.B, and Fei, K. Smoking Among New Yorican Adolescents: Time 1 Predictors of Time 2 Tobacco Use. Journal of Genetic Psychology, 165, pp. 324-340, 2004.

Course and Psychosocial Correlates of Personality Disorder Symptoms in Adolescence

Personality disorder symptoms were investigated in a community sample of young people (n=714) to assess their relationship over time with well-being during adolescence and the emergence of intimacy in early adulthood. Drawing on Erikson's theory of psychosocial development, changes in adolescent well-being were conceptualized as indirect indicators of identity consolidation. Cluster B personality disorder symptoms (borderline, histrionic, and narcissistic symptoms) were conceptualized to represent "identity diffusion" - i.e., maladaptive personality traits that usually resolve during the identity crisis of adolescence. Latent growth models were used in two age cohorts to assess (1) interrelationships between Cluster B symptoms, well-being, and intimacy at mean ages 13.8 and 18.6 years; and (2) associations between their developmental trajectories over the next 6 years. As expected, higher personality disorder symptoms were associated with lower well-being during adolescence, and declines in personality disorder symptoms over time were associated with corresponding gains in well-being. Consistent with Erikson's developmental theory, there was an inverse relationship between Cluster B symptoms and intimacy that increased in strength as young people entered adulthood. As an indicator of successful identity consolidation, well-being was significantly associated with intimacy in female adolescents and young adults. Crawford, T.N., Cohen, P., Johnson, J.G., Sneed, J.R., and Brook, J.S. The Course and Psychosocial Correlates of Personality Disorder Symptoms in Adolescence: Erikson's Developmental Theory Revisited. Journal of Youth and Adolescence, 33, pp. 373-387, 2004.

Paternal Psychiatric Symptoms and Early Maladaptive Paternal Behavior

Data from the Children in the Community Study, a community-based longitudinal study were used to investigate associations between paternal psychiatric disorders and child-rearing behaviors. Paternal psychiatric symptoms and behavior in the home were assessed among 782 families during the childhood and adolescence of the offspring. Paternal anxiety, disruptive, mood, personality, and substance use disorders were independently associated with specific types of maladaptive paternal behavior in the home during the child-rearing years after paternal age, education, income, co-occurring paternal psychiatric symptoms, offspring age, sex, intelligence, temperament, and psychiatric symptoms were controlled statistically. Paternal psychiatric disorders that were present by mean offspring age 14 were associated with elevated risk for maladaptive paternal behavior in the home at mean age offspring 16, after prior maladaptive paternal behavior was controlled statistically. These findings suggest that paternal psychiatric disorder may be an important determinant of maladaptive paternal behavior in the home during the child-rearing years. Improved recognition and treatment of paternal psychiatric disorders may help to reduce the amount of maladaptive parenting behavior than many children and adolescents might otherwise be likely to experience. Johnson, J.G., Cohen, P., Kasen, S., and Brook, J.S. Paternal Psychiatric Symptoms and Maladaptive Paternal Behavior in the Home During the Child Rearing Years. Journal of Child and Family Studies, 13, pp. 421-437, 2004.

Association between Television Viewing and Sleep Problems during Adolescence and Early Adulthood

The purpose of this prospective, longitudinal study was to investigate directional hypotheses regarding the association between television viewing and sleep problems during adolescence and early adulthood. A community-based sample of 759 mothers from upstate New York and their offspring were interviewed during the early adolescence, middle adolescence, and early adulthood of the offspring. Television viewing and sleep problems during adolescence and early adulthood were measured using the Disorganizing Poverty Interview and the age-appropriate versions of the Diagnostic Interview Schedule for Children. Results showed that adolescents who watched 3 or more hours of television per day during adolescence were at a significantly elevated risk for frequent sleep problems by early adulthood. This elevation in risk remained significant after offspring age, sex, previous sleep problems, offspring psychiatric disorders, offspring neglect, parental educational level, parental annual income, and parental psychiatric symptoms were controlled statistically. Adolescents who reduced their television viewing from 1 hour or longer to less than 1 hour per day experienced a significant reduction in risk for subsequent sleep problems. Sleep problems during adolescence were not independently associated with subsequent television viewing when prior television viewing was controlled. Johnson, J.G., Cohen, P., Kasen S., First, M.B., and Brook, J.S. Association between Television Viewing and Sleep Problems during Adolescence and Early Adulthood. Archives of Pediatrics and Adolescent Medicine, 158, pp. 562-568, 2004.

Racial/Ethnic Differences in Cigarette Smoking Initiation and Progression to Daily Smoking

Using data from the National Longitudinal Study of Adolescent Health, this study was designed to identify individual and contextual factors that influence cigarette smoking initiation and progression to daily smoking among non-Hispanic Black, Hispanic, and non-Hispanic White adolescents. Findings confirmed differences in patterns of smoking onset and progression to daily smoking among racial/ethnic groups. Hispanic youth had the highest rates of smoking onset, and White youth had the highest rates of progression to daily smoking. Black youth consistently had the lowest rates for both smoking outcomes. There were more common predictors than ethnic-specific predictors of adolescent smoking and individual factors were much more important predictors than contextual factors. The authors concluded that universal prevention and intervention efforts would reach most adolescents, regardless of race/ethnicity. Kandel, D.B., Kiros, G.E, Schaffran, C., and Hu, M.C. Racial/Ethnic Differences in Cigarette Smoking Initiation and Progression to Daily Smoking: A Multilevel Analysis. American Journal of Public Health, 94, pp. 128-135, 2004.

Substance Abusers' Parenting and Their Children's Externalizing Problems

This study examined associations between substance abusers' (N= 261) parenting and their children's (N=399) rule-breaking, aggressive, and oppositional behavior, and attention problems. Findings suggest that parent monitoring predicted rule-breaking behavior and use of inconsistent discipline predicted ratings of all measured externalizing syndromes (rule-breaking, aggressive/oppositional behavior, and attention problems). Stanger, C., Dumenci, L., Kamon, J. and Burstein, M. Parenting and Children's Externalizing Problems in Substance-Abusing Families. Journal of Clinical Child and Adolescent Psychology, 33, pp. 590-600, 2004.

Trajectories of Substance Use and Dependence from Adolescence to Adulthood

This study describes trajectories of substance use and dependence from adolescence to adulthood. The participants were from a large existing sample from an ongoing study of parental alcoholism. The first assessment occurred when the age of participants ranged from 10.5 to 15.5 years. The follow-up assessments occurred 8 years later when participants were in emerging adulthood. Results suggest that a trajectory of heavy alcohol and drug use was most likely to result in substance dependence and was associated with familial alcoholism and lack of constraint. A trajectory of moderate alcohol use and experimental drug use was associated with some risk for alcohol dependence, although it was less likely to result in comorbid or persistent disorders and had a weaker link with familial alcoholism and personality risk. Chassin, L., Flora, D.B. and King, K.M. Trajectories of Alcohol and Drug Use and Dependence from Adolescence to Adulthood: The Effects of Familial Alcoholism and Personality. Journal of Abnormal Psychology, 113, pp. 483-498, 2004.

Parent Support, Peer Support and Adolescent Substance Use

Using a multi-ethnic sample of adolescents, this study tested comparative effects of parent and peer support (confiding and emotional) on adolescent substance use with data from two assessment points. Results suggest parent support was inversely related to substance use and peer support was positively related to substance use (suppression effect). Effects were mediated through pathways involving self-control and risk-taking tendency. Wills, T.A., Resko, J.A., Ainette, M.G. and Mendoza, D. Role of Parent Support and Peer Support in Adolescent Substance Use: A Test of Mediated Effects. Psychol Addict Behav., 18, pp. 122-134, 2004.

Behavioral Undercontrol and Parenting

This study examined the associations among parental alcoholism, behavioral undercontrol, and parenting in the development of drug use disorders in emerging adulthood. Findings suggest that parental alcoholism is associated with less parental discipline and more adolescent behavioral undercontrol, which in turn raises the risk of later drug disorders. Parent support has a protective buffering effect on the link between undercontrol and drug use disorders, except in cases of high levels of behavioral undercontrol. King, K.M., and Chassin, L. Mediating and Moderating Effects of Adolescent Behavioral Undercontrol and Parenting in the Prediction of Drug Use Disorders in Emerging Adulthood. Psychology of Addictive Behaviors, 18, pp. 239-249, 2004.

Antisocial Parental Behavior, Problematic Parenting and Aggressive Offspring Behaviour During Adulthood

Data from a 25-year community-based prospective longitudinal study were used to investigate the role of problematic parenting in the association between a history of antisocial parental behavior and subsequent offspring aggression during adulthood. Parents with a history of antisocial behavior were significantly more likely than other parents to engage in two or more types of problematic child-rearing behavior. Problematic parenting was associated with offspring aggression during adulthood after a history of antisocial parental behavior was controlled statistically. Antisocial parental behavior was associated with aggressive offspring behavior during adulthood before, but not after, problematic parenting was controlled. These findings support the hypothesis that problematic parenting tends to mediate the association between antisocial parental behavior and subsequent offspring aggression. Johnson, J.G., Smailes, E.M., Cohen, P., Kasen, S., and Brook, J.S. Antisocial Parental Behavior, Problematic Parenting and Aggressive Offspring Behaviour During Adulthood: A 25-year Longitudinal Investigation. British Journal of Criminology Advance Access http://bjc.oupjournals.org doi:10.1093/bjc/ azh041 published June 7, 1-16 pp. 2004.

Surveillance of Drug Use among American Indian Adolescents

This study examined the trends in drug use among American Indian adolescents attending schools on, or near, Indian reservations in the United States, to provide comparisons with non-Indian youth, and to discuss implications for prevention. Reliable and valid school administered drug use surveys have been given every year for 25 years (1975-2000) to representative samples of Indian youth living on reservations, yielding a continuous record of trends in drug use. Comparisons are made with non-Indian youth with data from the Monitoring the Future project. Data were analyzed to obtain measures of lifetime prevalence ("ever tried a drug"), use in the last 30 days, and proportions at high risk and at moderate risk from their drug use. Comparisons utilized difference in proportion tests. Results showed that, from 1975 to 2000, reservation Indian youth show elevated levels of drug use for most illicit drugs compared with non-Indian youth. Despite higher levels of use, the trends showing increases and decreases in use over time mirror those shown by non-Indian youth. Indian youth who use drugs can be divided into moderate and high levels of use. The number of youth in the moderate category varies over time whereas the number in the high category remains relatively constant. These findings indicate a clear need for intensive efforts to reduce the levels of drug use among Indian youth. Although interventions must be tailored to the social and cultural milieu of Indian reservations, the rates of use vary over time in the same pattern as seen for non-Indian youth. Further, interventions must address the differing characteristics of high and moderate risk users of drugs. Beauvais, F., Jumper-Thurman, P., Helm, H., Plested, B. and Burnside, M. Surveillance of Drug Use among American Indian Adolescents: Patterns Over 25 Years. J Adolesc Health, 34, pp. 493-500, 2004.


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