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Director's Report to the National Advisory Council on Drug Abuse - February, 2006

Research Findings - Epidemiology and Etiology Research

Heritability Estimates Unchanged by Changes in Drug Prevalence

Researchers used data from a genetically informed sample to study whether changes in prevalence of drug use has an impact on rates of heritability. The lifetime history of use of tobacco, cannabis, cocaine, sedatives, and stimulants were assessed in 4826 twins from male-male and female-female pairs born in Virginia from 1934 to 1974. Using empirical methods based on prevalence by birth year, these twins were divided into three cohorts for each substance (e.g. for cannabis 1934-1953,1954-1968, and 1969-1974). Structural equation modeling was performed using the Mx software package. Prevalence rates for psychoactive substance use were found to differ substantially across cohorts, most markedly for cocaine, sedatives and stimulants, which were highest in the 1958-1963 cohort. However, for all substances, the best-fit model constrained estimates of the etiological role of genetic and environmental risk factors to be equal across both sex and cohort. That is, there was no evidence in this sample for any systematic relationship between heritability and prevalence of psychoactive substance use. These results suggest that the heritability of substance use may be a relatively stable characteristic of human populations and not highly variable as a result of changing patterns of drug accessibility and consumption. Kendler, K., Gardner, C., Jacobson, K., Neale, M. and Prescott, C. Genetic and Environmental Influences on Illicit Drug Use and Tobacco Use Across Birth Cohorts. Psychol Med, 35(9), pp. 1349-1356, 2005.

Differentiating Risk Factors for Drug Use and Drug Abuse/Dependence

This study asked whether there are risk factors that associate specifically with illicit drug use or illicit drug abuse/dependence, and whether the magnitude of the association is the same for use and abuse/dependence, across different categories of drugs. Data from 1943 female adult twins in a population-based Virginia sample were used to assess the association of 26 putative risk factors with use and abuse/dependence of six illicit psychoactive drugs. These factors, which include socio-demographic variables, religiosity, personality measures, childhood factors, and psychiatric diagnoses, were each examined in relation to drug use, abuse/dependence, or both. Several findings are notable: First, factors associate in similar patterns with different drug categories; second, there is a stronger association of significant socio-demographic factors with drug use, while the psychiatric diagnoses are more strongly associated with progression to abuse/dependence. Third, childhood sexual abuse was associated with drug use and with progression to abuse/dependence. This suggests complex, interacting pathways that determine drug habits in individuals. These results are hypothesis generating. Future studies of causal relationships may draw from the outcomes presented in these analyses. Agrawal, A., Gardner, C., Prescott, C. and Kendler, K. The Differential Impact of Risk Factors on Illicit Drug Involvement in Females. Soc Psychiatry Psychiatr Epidemiol, 40(6), pp. 454-466, 2005.

P300 Amplitude Does Not Mediate Association Between Parental SUD and Offspring Neurobehavioral Disinhibition

This study investigated whether the P300 amplitude of the event-related potential mediates the association between parental substance use disorder (SUD) and child's neurobehavioral disinhibition, a known risk factor for SUD. The P300 amplitude was recorded using an oddball task in sons of fathers having either lifetime SUD (n = 105) or no psychiatric disorder (n = 160). Neurobehavioral disinhibition was assessed using measures of affect regulation, behavior control, and executive cognitive function. Parental SUD and child's P300 amplitude accounted for, respectively, 16.6% and 16.8% of neurobehavioral disinhibition variance. Controlling for parental and child psychopathology, an association between parental SUD and child's P300 amplitude was not observed. It was concluded that the P300 amplitude does not mediate the association between parental SUD and child's neurobehavioral disinhibition. Habeych, M., Sclabassi, R., Charles, P., Kirisci, L. and Tarter, R. Association Among Parental Substance Use Disorder, p300 Amplitude, and Neurobehavioral Disinhibition in Preteen Boys at High Risk for Substance Use Disorder. Psychol Addict Behav, 19(2), pp. 123-130, 2005.

Childhood Risk Categories Predict Adolescent Substance Involvement

Childhood risks for adolescent substance involvement include parental substance use disorders (SUDs), psychological dysregulation and early tobacco and alcohol experimentation. This study was designed to identify childhood risk categories predicting accelerated adolescent substance involvement across drug types and stages. The index subjects were 560 children recruited from high risk (n = 266) or low risk (n = 294) families based on fathers' SUDs. Assessments were conducted at approximately ages 11 (baseline), 13, 16, and 19 years. Childhood predictors included parent SUDs, early tobacco or alcohol use (i.e., substance use), and neurobehavior disinhibition (ND) as determined by indicators of cognitive, affective and behavioral disinhibition. A cluster analysis defined five risk categories based on baseline characteristics as follows: (1) High (n = 31; 100% had both parents with SUDs, 100% had early substance use, and the mean ND score = 58.9); (2) Intermediate-High (n = 76; 45% had one parent with SUD, 100% early substance use and ND = 51.9); (3) Intermediate (n = 76; 100% both parents with SUDs, 0% early substance use and ND = 51.4); (4) Intermediate-Low (n = 161; 100% with one SUD parent; 0% early substance use and ND = 49.9) and; (5) Low (n = 216; no parental SUD, no early substance use and ND = 47.5). Compared with all other groups, children in the High-risk group had significantly accelerated substance involvement across all substance types and stages. The ordering of risk categories from low to high was also consistent for all substance involvement outcomes. The findings indicate that these five risk categories constitute general liability classes for adolescent substance involvement, and may identify homogeneous groups of children requiring distinct preventive interventions. Clark, D., Cornelius, J., Kirisci, L. and Tarter, R. Childhood Risk Categories for Adolescent Substance Involvement: A General Liability Typology. Drug Alcohol Depend, 77(1), pp. 13-21, 2005.

Neurobehavior Disinhibition in Adolescence Predicts Drug Abuse in Adulthood

This study extends prior research by determining whether variation in the developmental trajectories of liability to substance use disorder (SUD) is contributed by neurobehavioral disinhibition, parental substance use involvement, and demographic variables. The sample, participants in a long-term prospective investigation, consisted of 351 boys, evaluated at ages 10-12, 12-14, 16, 19, and 22, whose parents either had SUD or no adult psychiatric disorder. Neurobehavioral disinhibition in childhood, in conjunction with parental lifetime substance use/SUD, place the child at very high risk for SUD by age 22 if psychosocial maladjustment progresses in severity in early adolescence. These results indicate that monitoring social adjustment during the transition from childhood to mid-adolescence is important for identifying youth at very high risk for succumbing to SUD by young adulthood. Kirisci, L., Vanyukov, M. and Tarter, R. Detection of Youth at High Risk for Substance Use Disorders: A Longitudinal Study. Psychol Addict Behav, 19(3), pp. 243-252, 2005.

Comorbidity in Adults with ADHD and SUD

The objective of the study was to investigate the characteristics of adults with Attention Deficit Hyperactivity Disorder (ADHD) or substance use disorder (SUD), especially in the context of comorbid psychiatric disorders. Subjects were adults (n = 78) participating in a controlled family study of ADHD and SUD. Four groups were identified based on a diagnosis of ADHD or SUD: ADHD, SUD, ADHD + SUD, and neither ADHD nor SUD. All diagnoses were determined by structured clinical interview for DSM IV. Rates of psychiatric comorbidity were lowest in the controls, intermediate in the ADHD and SUD groups, and highest in the ADHD + SUD group. Relative to controls, the ADHD, SUD, and ADHD + SUD groups had higher rates of major depression, conduct disorder, antisocial personality disorder, agoraphobia and social phobia. Higher rates of psychiatric comorbidity, especially mood and anxiety disorders, exist in subjects with SUD + ADHD relative to subjects with SUD, ADHD, or controls. Clinicians need to be attentive to other psychiatric disorders that may occur in the large group of adults with ADHD + SUD. Wilens, T., Kwon, A., Tanguay, S., Chase, R., Moore, H., Faraone, S. and Biederman, J. Characteristics of Adults With Attention Deficit Hyperactivity Disorder Plus Substance Use Disorder: the Role of Psychiatric Comorbidity. Am J Addict, 14(4), pp. 319-327, 2005.

Risk of Becoming Cocaine Dependent 24 Months After First Use

This study explores estimates for the risk of becoming cocaine dependent within 24 months after first use of the drug, and study subgroup variation in this risk. The study estimates are based on the National Household Survey on Drug Abuse conducted during 2000-2001, with a representative sample of US residents aged 12 years and older (n=114 241). A total of 1081 respondents were found to have used cocaine for the first time within 24 months prior to assessment. Between 5 and 6% of these recent-onset users had become cocaine dependent since onset of use. Less [corrected] risk of recent cocaine dependence soon after onset of cocaine use was found for female subjects, young adults aged 21-25 years, and non-Hispanic Black/African-Americans. Use of crack-cocaine and taking cocaine by injection were associated with having become cocaine dependent soon after onset of use. These epidemiologic findings help to quantify the continuing public health burden associated with new onsets of cocaine use in the 21st century. O 'Brien, M., and Anthony, J. Risk of Becoming Cocaine Dependent: Epidemiological Estimates for the United States, 2000-2001. Neuropsychopharmacology, 30(5), pp. 1006-1018, 2005.

Experimental, Late and Continuous Smoking and Problem Behaviors During Adolescence, Late Adolescence and Early Adulthood

In this study, the authors assessed the relationship between adolescent tobacco smoking and measures of inner control, deviant behavior, and associating with deviant peers, which are indicators of problem behavior. African American (N = 333) and Puerto Rican (N = 329) early adolescents completed questionnaires in their classrooms in 1990 at Time 1 (T1) and were individually interviewed thereafter when they were late adolescents in 1995 at Time 2 (T2) and as young adults in 2000 at Time 3 (T3). The authors used ordinary least squares regression analysis to assess the comparative association of adolescent smoking patterns at T1 and T2 and the young adult outcomes at T3; they controlled for demographic variables, level of the outcome measure at T2, and marijuana use at T2. The analyses suggested that experimental tobacco smokers demonstrated more problem behaviors than did nonsmokers, and late and continuous smokers demonstrated more problem behaviors as young adults than did experimental smokers and nonusers. These findings may provide a useful guide to a next step that involves translational research. Brook, J., Balka, E., Rosen, Z., Brook, D. and Adams, R. Tobacco Use in Adolescence: Longitudinal Links to Later Problem Behavior Among African American and Puerto Rican Urban Young Adults. J Genet Psychol, 166(2), pp. 133-151, 2005.

Community-Based Study of HBV Immunization among Young Adults

A community-based study of the prevalence and correlates of hepatitis B virus (HBV) infection and immunization was conducted among young adults in a "drug supermarket" neighborhood in New York City. Four hundred eighty-nine young adults ages 18-24 years were recruited from Bushwick, Brooklyn through multistage household probability sampling (n = 332) and targeted sampling (n = 157), interviewed, and tested for three hepatitis B markers (HBsAg, anti-HBc, and anti-HBs). Serological evidence of HBV infection was found in 8.0% (6.0% in the household sample and 12.1% in the targeted sample) and of hepatitis B immunization in 19.6% (22.6% in the household sample and 13.4% in the targeted sample). HBV infection was higher among young adults who either used crack or injected drugs and among those who traded sex for money or drugs. Having Medicaid was significantly associated with lower odds of infection in the household sample and higher odds of immunization in the targeted sample. Although adolescent hepatitis B immunization has been a public health priority in the United States since 1995, nearly three-quarters of young adults in this community did not have serological evidence of being either exposed or immunized. Whereas subsequent younger generations benefited from universal childhood hepatitis B immunization, this particular cohort of young adults who live in communities like Bushwick presents a unique group for prevention intervention. Kottiri, B., Friedman, S., Euler, G., Flom, P., Sandoval, M., Neaigus, A., Des Jarlais, D. and Zenilman, J. A Community-Based Study of Hepatitis B Infection and Immunization Among Young Adults in a High-Drug-Use Neighborhood in New York City. J Urban Health, 82(3), pp. 479-487, 2005.

Receptive Syringe Sharing among IDUs during ESAP

Effective January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), which allows syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to persons 18 years of age or older and permits the possession of those syringes for the purposes of injecting drugs. In this study, researchers assessed changes in receptive syringe sharing since the inception of the ESAP. Sociodemographic characteristics and syringe use data regarding the last injection episode were combined from 3 projects (n = 1181) recruiting injection drug users in ongoing studies in Harlem and the Bronx in New York City from January 2001 through June 2003. These data were analyzed as serial cross sections by calendar quarter. Findings showed that receptive sharing decreased significantly over time, from 13.4% in the first quarter to 3.6% in the last quarter. Obtaining the last injection syringe from an ESAP source (mostly pharmacies) increased significantly over time, from 7.5% in the first quarter to 25.0% in the last quarter. In multiple logistic regression analysis, variables that were significantly associated with less receptive sharing were syringe exchange and ESAP syringe source as well as time since ESAP inception. Female gender and white race/ethnicity were significantly associated with greater receptive sharing. These data show that the increase in the use of pharmacies and other ESAP syringe sources in this sample has been accompanied by a decline in receptive sharing. Pouget, E., Deren, S., Fuller, C., Blaney, S., McMahon, J., Kang, S., Tortu, S., Andia, J., Des Jarlais, D. and Vlahov, D. Receptive Syringe Sharing Among Injection Drug Users in Harlem and the Bronx During the New York State Expanded Syringe Access Demonstration Program. J Acquir Immune Defic Syndr, 39(4), pp. 471-477, 2005.

Adolescent Rebellion and Academic Failure among High and Low Income Youth

This study addressed whether upper class, suburban teenagers (144 females, 120 males) can engage in various problem behaviors and still maintain adequate academic grades, because of environmental safety nets, unlike their low-income, inner-city counterparts (123 females, 101 males). Three problem behavior dimensions were assessed among tenth graders that is, substance use, delinquency, and low school engagement. Academic achievement was assessed in terms of grades across four major subjects. Variable-based analyses indicated unique links with grades for self-reported delinquency and school disengagement in high- and low-income samples, but for substance use only among the former. Person-based analyses showed that in both schools, grades were clearly compromised among youth with disturbances in all three-problem domains. In addition, in the suburban school only, grades were low in the cluster characterized chiefly by high substance use. Results are discussed in terms of stereotypes regarding risks (or lack thereof) stemming from families' socioeconomic status; implications for theory and interventions are discussed. Luthar, S. and Ansary, N. Dimensions of Adolescent Rebellion: Risks for Academic Failure Among High and Low-Income Youth. Dev Psychopathol, 17(1), pp. 231-250, 2005.

Urban Built Environment and Depression: A Multi-level Analysis

Researchers assessed the relations between characteristics of the neighborhood internal and external built environment and past six month and lifetime depression. Depression and sociodemographic information were assessed in a cross sectional survey of residents of New York City (NYC). All respondents were geocoded to neighborhood of residence. Data on the quality of the built environment in 59 NYC neighborhoods were collected from the United Status census, the New York City housing and vacancy survey, and the fiscal 2002 New York City mayor's management report. Among 1355 respondents, residence in neighborhoods characterized by a poor quality built environment was associated with greater individual likelihood of past six month and lifetime depression in multilevel models adjusting for individual age, race/ethnicity, sex, and income and for neighborhood level income. In adjusted models, persons living in neighborhoods characterized by poorer features of the built environment were 29%-58% more likely to report past six-month depression and 36%-64% more likely to report lifetime depression than respondents living in neighborhoods characterized by better features of the built environment. These findings suggest that living in neighborhoods characterized by a poor quality built environment is associated with a greater likelihood of depression. Future prospective work designed to assess potential mechanisms underlying these associations may guide public health and urban planning efforts aimed at improving population mental health. Galea, S., Ahern, J., Rudenstine, S., Wallace, Z. and Vlahov, D. Urban Built Environment and Depression: A Multilevel Analysis. J Epidemiol Community Health, 59(10), pp. 822-827, 2005.

Drug Use, Misuse, and the Urban Environment

Urbanization is probably the single most important demographic shift worldwide in the the past and new centuries. It represents a sentinel change from how most of the world's population has lived over the past several thousand years. As urban living becomes the predominant social context for the majority of the world's population, the very ubiquity of urban living promises to shape health directly and to indirectly affect what we typically consider risk factors or determinants of population health. Although a growing body of research is exploring how characteristics of the urban environment may be associated with health (e.g. depression) and risk behaviors (e.g. exercise patterns), relatively little research has systematically assessed how the urban environment may affect drug use and misuse. In this paper, the authors propose a conceptual framework for considering how different characteristics of the urban environment (e.g. collective efficacy, the built environment) may be associated with drug use and misuse, summarize the existing empiric literature that substantiates elements of this framework, and identify potential directions for future research. Galea, S., Rudenstine, S. and Vlahov, D. Drug Use, Misuse, and the Urban Environment. Drug Alcohol Rev, 24(2), pp. 127-136, 2005.

Neighborhood Factors and Crime

This study provides reliability information for a brief observational measure of physical disorder and determines its relation with neighborhood level crime and health variables after controlling for census based measures of concentrated poverty and minority concentration. Results come from psychometric analysis of block observation data comprising a brief measure of neighborhood physical disorder, and cross sectional analysis of neighborhood physical disorder, neighborhood crime and birth statistics, and neighborhood level poverty and minority concentration. The study was conducted in Pittsburgh, Pennsylvania, US (2000 population=334,563). Participants were selected from Pittsburgh neighborhoods (n=82) and their residents (as reflected in neighborhood level statistics). Results indicated that the physical disorder index showed adequate reliability and validity and was associated significantly with rates of crime, firearm injuries and homicides, and teen births, while controlling for concentrated poverty and minority population. In conclusion, this brief measure of neighborhood physical disorder may help increase our understanding of how community level factors reflect health and crime outcomes. Wei, E., Hipwell, A., Pardini, D., Beyers, J. and Loeber, R. Block Observations of Neighborhood Physical Disorder are Associated with Neighborhood Crime, Firearm Injuries and Deaths, and Teen Births. J Epidemiol Community Health, 59(10), pp. 904-908, 2005.

Heroin and HIV Risk in Tanzania

HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighborhood hangouts in facilitating this process. Their practices, interactions and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Semi-structured interviews were conducted during the months of February and July 2003 with 51 male and female injectors residing in 8 neighborhoods in the Dar es Salaam, Tanzania. Interviews were content coded and codes were collapsed into emergent themes around hangout places, initiation of heroin use, and progression to injecting. Interviews reveal that Dar es Salaam injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. One hangout place in particular, referred to as the ''geto '' (ghetto) is the main place where the organization and rules governing heroin use are produced. Three main types of heroin ''ghettoes '' are operating in Dar es Salaam. As users build a tolerance for the drug they move along a continuum of practices until they begin to inject. Injecting heroin is a comparatively recent practice in Africa and coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers, sniffers, and inhalers perceived need to escalate their use through a more effective and satisfying form of heroin ingestion. McCurdy, S., Williams, M., Kilonzo, G., Ross, M. and Leshabari, M. Heroin and HIV Risk in Dar es Salaam, Tanzania: Youth Hangouts, Mageto and Injecting Practices. AIDS Care, 17(1), pp. S65-S76, 2005.

Offending Trajectories Predict Drug Use

This longitudinal study examines the validity of differing offending pathways and the prediction from the pathways to substance use and depressive symptoms for 204 young men. Findings from this study indicated good external validity of the offending trajectories. Further, substance use and depressive symptoms in young adulthood (i.e., ages 23-24 through 25-26 years) varied depending on different trajectories of offending from early adolescence to young adulthood (i.e., ages 12-13 through 23-24 years), even after controlling for antisocial propensity, parental criminality, demographic factors, and prior levels of each outcome. Specifically, chronic high-level offenders had higher levels of depressive symptoms and engaged more often in drug use compared with very rare, decreasing low-level, and decreasing high-level offenders. Chronic low-level offenders, in contrast, displayed fewer systematic differences compared with the two decreasing offender groups and the chronic high-level offenders. The findings supported the contention that varying courses of offending may have plausible causal effects on young adult outcomes beyond the effects of an underlying propensity for crime. Capaldi, D. M., Wiesner, M., and Kim, H. K. Developmental Trajectories of Offending: Validation and Prediction to Young Adult Alcohol Use, Drug Use, and Depressive Symptoms. Developmental Psychopathology, 17 pp. 251-270, 2005.

Circumstances of Witnessed Drug Overdose in New York City: Implications for Intervention

Drug users frequently witness the nonfatal and fatal drug overdoses of their peers, but often fail to intervene effectively to reduce morbidity and mortality. Researchers assessed the circumstances of witnessed heroin-related overdoses in New York City (NYC) among a predominantly minority population of drug users. Among 1184 heroin, crack, and cocaine users interviewed between November 2001 and February 2004, 672 (56.8%) had witnessed at least one nonfatal or fatal heroin-related overdose. Of those, 444 (67.7%) reported that they or someone else present called for medical help for the overdose victim at the last witnessed overdose. In multivariable models, the respondent never having had an overdose her/himself and the witnessed overdose occurring in a public place were associated with the likelihood of calling for medical help. Fear of police response was the most commonly cited reason for not calling or delaying before calling for help (52.2%). Attempts to revive the overdose victim through physical stimulation (e.g., applying ice, causing pain) were reported by 59.7% of respondents, while first aid measures were attempted in only 11.9% of events. Efforts to equip drug users to manage overdoses effectively, including training in first aid and the provision of naloxone, and the reduction of police involvement at overdose events may have a substantial impact on overdose-related morbidity and mortality. Tracy, M., Piper, T., Ompad, D., Bucciarelli, A., Coffin, P., Vlahov, D. and Galea, S. Circumstances of Witnessed Drug Overdose in New York City: Implications for Intervention. Drug Alcohol Depend, 79(8), pp. 181-190, 2005.

Ethnic Differences in Nicotine Dependence among Adolescents Explained by Level of Consumption

Researchers sought to compare nicotine-dependent smokers identified by the modified Fagerstršm Tolerance Questionnaire (mFTQ) and a scale based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), in a multiethnic adolescent sample. A school survey was conducted on 6th- to 10th-grade students (N=15,007) in a large urban public school system. The two scales formed two distinct factors. Concordance between the two classifications of nicotine dependence was low. The DSM identified a much larger number of nicotine-dependent smokers than the mFTQ, mostly because smokers met dependence criteria at much lower levels of cigarettes consumed, especially when they were depressed. Rates of dependence were higher among whites than minority-group members, especially African Americans. Control for level of cigarette consumption attenuated or eliminated ethnic differences. This investigation provides some understanding of youths defined as dependent by each scale but cannot by itself indicate which scale better measures dependence. Differences in dependence rates among ethnic groups are accounted for mostly by quantity of cigarettes smoked. Kandel, D., Schaffran, C., Griesler, P., Samuolis, J., Davies, M. and Galanti, R. On the Measurement of Nicotine Dependence in Adolescence: Comparisons of the mFTQ and a DSM-IV-Based Scale. J Pediatr Psychol, 30(4), pp. 319-332, 2005.

An Emerging HIV Risk Environment: A Profile of an MSM POZ Party in New York City

This study sought to develop a preliminary epidemiological description of a men who have sex with men (MSM) "POZ Party," an emerging risk environment for HIV+ MSM. As part of a pilot study in New York City in 2003, data were collected using a brief, behavioral intercept survey at entry to POZ Party events. Domains included demographic characteristics, history of HIV infection, motivations for attending POZ parties, lifetime and recent exposure to drugs (including use during POZ Party events), and recent sexual practices (both within both POZ Party venues as well as in non-POZ Party venues). Predominantly white and over the age of 30, subjects in the sample included a broad range of years living with HIV infection. Motivations for using a POZ Party venue for sexual partnering included relief from burdens for serostatus disclosure, an interest in not infecting others, and opportunities for unprotected sexual exchange. High rates of unprotected sex with multiple partners were prevalent in the venue. Although the sample evidenced high rates of lifetime exposure to illicit drugs, relatively little drug use was reported in these sexual environments. These reports are consistent with evidence from direct observation at the venues themselves, in which no drug use was apparent. Findings suggest that serosorting among HIV+ MSM may reduce new HIV infections, a stated interest of both POZ Party organizers and participants alike. However, high rates of unprotected sex in these venues signal continued risk for STIs. Additionally, unprotected sexual contact with HIV partners and status unknown partners outside POZ Party venues heightens concern for diffusion of HIV super infection. Clatts, M., Goldsamt, L. and Yi, H. An Emerging HIV Risk Environment: A Preliminary Epidemiological Profile of an MSM POZ Party in New York City. Sex Transm Infect, 81(5), pp. 373-376, 2005.

A Longitudinal Study of Developmental Patterns and Family Influences on Daily Smoking Initiation

This study sought to examine developmental patterns and family influences on the risk of daily smoking initiation from adolescence to young adulthood. A gender-balanced, ethnically diverse urban sample of 808 children aged 10-11 years was surveyed in 1985 and followed prospectively to age 21 in 1996. Discrete-time survival analysis was used to assess the hazard of initiation of daily smoking during this time period, as well as the effects of family factors on the risk of daily smoking initiation. Less parental smoking, more strict family monitoring and rules, and stronger family bonding predicted a significantly lower risk of daily smoking initiation, controlling for socio-demographic background. The decline in the impact of family bonding over time was marginally significant; however, none of the interactions between family factors and time were significant, indicating generally consistent family influences on daily smoking from age 10 to 21. These findings indicate that parent smoking contributes to the onset of daily smoking in their teenagers even if parents practice good family management, hold norms against teen tobacco use, and do not involve their children in their own tobacco use. Smoking prevention programs should include components focused on parents of adolescents. To reduce risks for daily smoking among adolescents, it is important to encourage parents to stop or reduce their own smoking. In addition, these data indicate that parents can reduce their children's risk of daily smoking initiation by reducing family conflict, by maintaining strong bonds with their children, by setting clear rules, and by closely monitoring their children's behaviors. Hill, K., Hawkins, J., Catalano, R., Abbott, R. and Guo, J. Family Influences on the Risk of Daily Smoking Initiation. J Adolesc Health, 37(3), pp. 202-210, 2005.

Perceptions of Parenting and Preadolescent Adjustment in Low and High Income Families

This study focused on contextual variations in parenting dimensions salient for preadolescent adjustment. The sample consisted of 614 sixth graders from two communities, one low and the other high income. Parenting dimensions included those known to be significant in each socioeconomic context: isolation from parents (emotional and physical), and parental emphasis on achievements (overall expectations and emphasis on integrity over success). Adjustment outcomes included subjective well being as well as school competence. Results showed that, on average, affluent children can perceive their parents as emotionally and physically unavailable to the same degree that impoverished youth do. Ramifications on adjustment also seem to be similar: Closeness to parents was beneficial for all, just as criticism was deleterious. Even after considering the quality of parent-child relationships, parents' physical absence (e.g., at dinner) connoted vulnerability for distress and for poor school performance in both groups. A few parenting dimensions varied by context and gender and are discussed within the overall implications of the findings for future research and practice. Luthar, S. and Latendresse, S. Comparable "Risks" at the Socioeconomic Status Extremes: Preadolescents' Perceptions of Parenting. Dev Psychopathol, 17(1), pp. 207-230, 2005.

Adolescent Panic Attacks and Personality Disorders During Young Adulthood

The goal of this study was to determine the association between panic attacks in adolescence and the risk of personality disorders during young adulthood. Data were drawn from the Children in the Community Study, a longitudinal epidemiological study of psychopathology across the life-course in 717 individuals in the community. Multiple logistic regression analyses were used to determine the association between panic attacks during adolescence in 1983 and the risk of personality disorders during young adulthood in 1993, adjusting for differences in sociodemographic characteristics, adolescent personality disorders, and co-morbid depressive and substance use disorders. Panic attacks during adolescence (in 1983) were associated with an increased risk of any DSM-IV personality disorder (in 1993) during young adulthood, which persisted after adjusting for differences in sociodemographic characteristics, adolescent personality disorders, and co-morbid depressive and substance use disorders. Panic attacks were associated with a statistically significantly increased risk of Cluster A, B, and C personality disorders. These data provide initial evidence that panic attacks early in life are a marker or risk factor for the development of personality disorders in young adulthood. Replication of these findings is needed, as is more in-depth investigation into the mechanism of this link. If replicated in future research, these results may reveal a novel potential pathway for identifying youth at high risk for personality disorders. Goodwin, R., Brook, J., and Cohen, P. Panic Attacks and the Risk of Personality Disorder. Psychol Med, 35(2), pp. 227-235, 2005.

Predictors of Offspring Smoking

This study examined the interrelation of parental occupational status (blue- versus white-collar), parental education, parental smoking, parent-child relations, late adolescent tobacco use, and adult offspring smoking. A longitudinal data set was employed, composed of 603 participants who were first studied in childhood and then followed to mean age 27 years. Structural Equation Modeling (SEM) showed that the distal factors of parental blue-collar status, low parental educational achievement, and parental smoking were related to adult offspring smoking. Specifically, parental blue-collar status and parental smoking were mediated by the latent construct of the parent-child relationship, which in turn was mediated by smoking in late adolescence with respect to adult offspring smoking. Parental educational level was partially mediated by the parent-adolescent relationship but also had a direct path to adult offspring smoking. The most powerful predictor of offspring smoking in adulthood was smoking in late adolescence. Findings imply areas that may be targeted by intervention programs to decrease offspring tobacco use. Fagan, P., Brook, J., Rubenstone, E. and Zhang, C. Parental Occupation, Education, and Smoking as Predictors of Offspring Tobacco Use in Adulthood: A Longitudinal Study. Addict Behav, 30(3), pp. 517-529, 2005.

High Rates of ADHD in Offspring of Parents with ADHD and SUD

The authors used data from a study of the children of parents with and without substance use disorders (SUD)to evaluate the influence of parental SUD and ADHD on the risk for ADHD in offspring. Using structured psychiatric interviews, 96 families (183 youth; mean age 11.6 years) were assessed. The offspring were stratified into four groups based on parental status: children of parents with neither ADHD nor SUD, children of parents with SUD only, children of parents with ADHD only, and children of parents with both ADHD and SUD, and parental SUD and ADHD were used to predict ADHD in the offspring. The following rates of children with ADHD were reported: among children of parents with neither disorder (3%), children of parents with SUD (13%), children of parents with ADHD (25%), and children of parents with both ADHD and SUD (50%) (p = .001). Children of parents with ADHD or ADHD plus SUD were more likely to have ADHD in comparison with children of parents with neither diagnosis (p < 0.05). Children of parents with ADHD plus SUD were at greater risk of ADHD in comparison to children of parents with SUD only (p = 0.01). The results of this study seem to suggest that the offspring of SUD or ADHD parents are at elevated risk for ADHD compared to controls. The offspring of parents with both ADHD and SUD appear to be at the highest risk for ADHD, highlighting the need for careful screening of this group of youth for ADHD. As noted by the authors, these findings merit replication in larger samples and with alternative ascertainment methods. Wilens, T., Hahesy, A., Biederman, J., Bredin, E., Tanguay, S., Kwon, A. and Faraone, S. Influence of Parental SUD and ADHD on ADHD in Their Offspring: Preliminary Results From a Pilot-Controlled Family Study. Am J Addict, 14(2), pp. 179-187, 2005.

Ecstasy Use Among Hispanic and Black Substance Users in New York City

Surveillance data suggest that use of ecstasy in the U.S. is predominantly among white adolescent and young adults. To investigate ecstasy use among substance users in New York City, researchers added questions to ongoing efforts to recruit heroin and cocaine users. Of 715 participants recruited, 58.3% were IDUs. The median age was 32 (range 17-64), 76.4% were male, 49.0% were currently homeless, 62.4% were Hispanic, 27.3% were black, and 34.5% were born outside the United States. Overall, 23.4% used ecstasy in their lifetime and 11.9% had used in the last-6 months. In multivariate logistic regression, correlates of lifetime ecstasy use included younger age, being born in the U.S., and current homelessness. A significant interaction was found between injection drug use and race where, compared to black non-IDUs, Hispanic non-IDUs, white IDUs were significantly more likely to have a history of lifetime ecstasy use and black IDUs were significantly less likely. These findings are limited to persons who use other drugs, but suggest that further investigation of ecstasy use in minority populations is warranted. Ompad, D., Galea, S., Fuller, C., Edwards, V. and Vlahov, D. Ecstasy Use Among Hispanic and Black Substance Users in New York City. Subst Use Misuse, 40(9-10), pp. 1399-1407, 2005.

HIV Transmission Behaviors in Jail/Prison Among Puerto Rican Drug Injectors in New York and Puerto Rico

This study examined HIV risk behavior in jail/prison among Puerto Rican drug injectors in New York (NY, n = 300) and Puerto Rico (PR, n = 200), and its relationship with later drug and sex risk behaviors. During 3 years prior to interview, 66% of NY and 43% of PR samples were incarcerated at least once. While incarcerated, 5% of NY and 53% of PR injected drugs. Few reported engaging in sex inside jail/prison (5% in both sites). Of those who engaged in risk behaviors in jail/prison, almost all reported having unprotected sex and sharing injection equipment. The impact of jail/prison risk behaviors on risk behaviors after release differed between the two sites: they were more related to subsequent sex risk behaviors in NY, and subsequent injection risk behaviors in PR. The findings indicate a need for effective drug treatment programs inside jail/prisons to reduce HIV-related risk behaviors among drug injectors during incarceration and after release. Kang, S.Y, Deren, S., Andia, J., Col—n, H.M., Robles, R. and Oliver-Velez, D. HIV Transmission Behaviors in Jail/Prison Among Puerto Rican Drug Injectors in New York and Puerto Rico. AIDS Behav, 9(3), pp. 377-386, September 2005.

Association of Sex, Hygiene and Drug Equipment Sharing with Hepatitis C Infection Among Non-IDUs in New York City

Hepatitis C virus (HCV) rates are higher in non-injecting drug users (NIDUs) than general population estimates. Whether this elevated HCV rate is due to drug use or other putative risk behaviors remains unclear. In this study, recent NIDUs of heroin, crack and/or cocaine were street-recruited from 2000 to 2003 and underwent an interview and venipuncture for HCV antibody assays. Multiple logistic regression analyses were used to assess correlates for HCV infection. Of 740 enrollees, 3.9% were HCV positive. The median age (intraquartile range) was 30 (35-24) years, 70% were male and 90% were Black or Hispanic. After adjustment, HCV seropositives were significantly more likely than seronegatives to be older than 30 [adjusted odds ratio (AOR)=5.71], tattooed by a friend/relative/acquaintance [AOR=3.61], and know someone with HCV [AOR=4.29], but were less likely to have shared nail or hair clippers, razors or a toothbrush [AOR=0.32]. These findings suggest that non-commercial tattooing may be a mode of HCV transmission among NIDUs and education on the potential risk in using non-sterile tattooing equipment should be targeted toward this population. While no evidence was found for HCV transmission through NIDU equipment sharing or sexual risk behavior, further research is still warranted. Howe, C., Fuller, C., Ompad, D., Galea, S., Koblin, B., Thomas, D. and Vlahov, D. Association of Sex, Hygiene and Drug Equipment Sharing with Hepatitis C Virus Infection Among Non-Injecting Drug Users in New York City. Drug Alcohol Depend, 79(3), pp. 389-395, 2005.

Anti-Tobacco Advertising and Youth Beliefs and Behaviors

Recent state budget crises have dramatically reduced funding for state-sponsored antitobacco media campaigns. If campaigns are associated with reduced smoking, such cuts could result in long-term increases in state health care costs. Commercial ratings data on mean audience exposure to antitobacco advertising that appeared on network and cable television across the largest 75 media markets in the United States for 1999 through 2000 were combined with nationally representative survey data from school-based samples of youth in the contiguous 48 states. Multivariate regression models were used to analyze associations between mean exposure to state anti-tobacco advertising and youth smoking-related beliefs and behaviors, controlling for individual and environmental factors usually associated with youth smoking and other televised tobacco-related advertising. Mean exposure to at least 1 state-sponsored anti-tobacco advertisement in the past 4 months was associated with lower perceived rates of friends' smoking (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.58-0.88), greater perceived harm of smoking (OR, 1.25; 95% CI, 1.11-1.42), stronger intentions not to smoke in the future (OR, 1.43; 95% CI, 1.17-1.74), and lower odds of being a smoker (OR, 0.74; 95% CI, 0.63-0.88). The investigators assert that this study is the first to explore the potential impact of state-sponsored anti-tobacco media campaigns while controlling for other tobacco-related advertising and other tobacco control policies, and conclude that state-sponsored anti-tobacco advertising is associated with desired outcomes of greater anti-tobacco sentiment and reduced smoking among youth. The investigators caution that recent cuts in these campaigns may have future negative health and budgetary consequences. Emery, S., Wakefield, M., Terry-McElrath, Y., Saffer, H., Szczypka, G., O 'Malley, P., Johnston, L., Chaloupka, F. and Flay, B. Televised State-Sponsored Anti-Tobacco Advertising and Youth Smoking Beliefs and Behavior in the United States, 1999-2000. Arch Pediatr Adolesc Med, 159(7), pp. 639-645, 2005.

Cocaine Use Related to Panic Attacks

This study uses the case-crossover method to estimate the magnitude of excess occurrence of panic attacks during months of cocaine use vs. months of no cocaine use, motivated by a prior estimate that cocaine users have three-fold excess risk of panic attack. The self-report data on cocaine and panic are from assessments of a nationally representative sample of 1071 recent panic cases age 18 years or older identified as part of the National Household Surveys on Drug Abuse conducted in the United States during 1994-1997. Based on case-crossover estimates, cocaine use is associated with a three-to-four-fold excess occurrence of panic attack (estimated relative risk (RR) = 3.3, p = 0.049; 95% confidence interval: 1.0, 13.7). Year-by-year, the RR estimates from four independent yearly replicates (1994-1997) are 5.0, 2.0, 3.0, and 3.0. While there are several important limitations, this study adds new evidence about a previously reported suspected causal association linking cocaine use to occurrence of panic attacks, and illustrates advantages of the epidemiologic case-crossover approach and new directions in research on hazards of illegal drug use. O 'Brien, M., Wu, L. and Anthony, J. Cocaine Use and the Occurrence of Panic Attacks in the Community: A Case-Crossover Approach. Subst Use Misuse, 40(3), pp. 285-297, 2005.

Influences of Early Attachment, Depression, Illicit Drug Use, and Perceived Support on Drug-dependent Mothers' Parenting

In this study, the authors used an attachment framework to examine how drug-dependent mothers' early bonding experience, depression, illicit drug use, and perceived support work together to influence the family environment. The authors hypothesized that (a) depression and drug use function as proxies for a stronger risk factor, the perceived absence of support available in everyday life, and (b) associations between mothers' early bonding experience and family environment are mediated by perceptions of support and nurture available in everyday life. The authors used a "building block" analytic approach and data collected from 125 mothers enrolled in methadone maintenance to test hypotheses. They expected that associations between mothers' early bonding experience and their perceptions of relationships with their children would be mediated by their perceptions of support and nurture available in their everyday life. Each of these hypotheses was supported for the first outcome, mothers' perceptions of family adaptability. Few psychosocial factors were associated with the second outcome, mothers' perceptions of family cohesion, and a majority of mothers (87.2%) in the sample reported no cohesion in their relationships with their children. Although preliminary, the findings suggest that perceptions of relationships in everyday life play a critical role in the etiology of drug-dependent mothers' parenting. Suchman, N., McMahon, T., Slade, A. and Luthar, S. How Early Bonding, Depression, Illicit Drug Use, and Perceived Support Work Together to Influence Drug-Dependent Mothers' Care Giving. Am J Orthopsychiatry, 75(3), pp. 431-445, 2005.


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