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Director's Report to the National Advisory Council on Drug Abuse - February, 2010



Research Findings - Epidemiology and Etiology Research

Motives for Nonmedical Use of Prescription Opioids among High School Seniors in the United States: Self-treatment and Beyond

This study assessed motives for nonmedical use of prescription opioids among US high school seniors and examined associations between motives for nonmedical use and other substance use behaviors. Data were obtained from nationally representative samples of US high school seniors (modal age 18 years) surveyed during the spring of their senior year via self-administered questionnaires. Data were collected in public and private high schools. The sample consisted of 5 cohorts (2002-2006) of 12,441 high school seniors. Self-reports of motives for nonmedical use of prescription opioids and substance use behaviors were examined. More than 1 in every 10 high school seniors reported nonmedical use of prescription opioids and 45% of past-year nonmedical users reported "to relieve physical pain" as an important motivation. The odds of heavy drinking and other drug use were lower among nonmedical users of prescription opioids motivated only by pain relief compared with nonmedical users who reported pain relief and other motives and those who reported non-pain relief motives only. The odds of medical use of prescription opioids were lower among nonmedical users who reported only non-pain relief motives compared with other types of nonmedical users. The findings indicate motives should be considered when working with adolescents who report nonmedical use of prescription opioids. The authors stress that future efforts are needed to identify adolescents who may need appropriate pain management and those at increased risk for prescription opioid abuse. McCabe S, Boyd C, Cranford J, Teter C. Motives for nonmedical use of prescription opioids among high school seniors in the United States: Self-treatment and beyond. Arch Pediatr Adolesc Med. 2009;163(8):739-744.

Specific Sex Drug Combinations Contribute to the Majority of Recent HIV Sero-conversions among MSM in the MACS

New HIV infections continue to be observed among men who have sex with men (MSM). Understanding the convergence of risky sexual behaviors and use of stimulants and erectile dysfunction drugs with HIV seroconversion may provide new focus to prevention interventions. During the follow-up period (1998-2008) of the Multicenter AIDS Cohort Study (MACS), researchers identified 57 HIV seroconversions among 1667 initially HIV-seronegative men. Time to seroconversion was modeled using Cox proportional hazards regression analysis for 7 combinations of drug use (including inhaled nitrites or "poppers", stimulants, and erectile dysfunction drugs) at the current or previous semiannual visit, adjusting for other risk factors, specifically sexual behavior, alcohol and other drug use, and depression. Model-based adjusted attributable risks were then calculated. Results showed that risk of seroconversion increased linearly with the number of unprotected receptive anal sex partners (URASP), with hazard ratios ranging from 1.73 [95% confidence interval (CI): 0.75 to 4.01] for 1 partner, to 4.23 (95% CI: 1.76 to 10.17) for 2-4 partners, and to 14.21 (95% CI: 6.27 to 32.20) for 5+ partners, independent of other risk factors. After adjustment, risks for seroconversion increased from 2.99 (95% CI: 1.02 to 8.76) for men who reported using stimulants only (1 drug) to 8.45 (95% CI: 2.67 to 26.71) for men who reported using all 3 sex drugs. The use of any of the 7 possible sex drug combinations accounted for 63% of the 9-year HIV seroincidence in the MACS. When contributions of increased URASP and combination drug use were analyzed together, the total attributable risk for HIV seroconversion was 74%, with 41% attributable to URASP alone and a residual of 33% due to other direct or indirect effects of drug use. These findings highlight the role of drug use, particularly use of poppers, stimulants, and erectile dysfunction drugs, in the significantly increased risk for HIV seroconversion in the MACS cohort. These data reinforce the importance of implementing focused interventions that target drug reduction as part of comprehensive and efficacious HIV prevention strategies. Ostrow D, Plankey M, Cox C, Li X, Shoptaw S, Jacobson L, Stall R. Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. J Acquir Immune Defic Syndr. 2009;51(3):349-355.

HIV Preexposure Prophylaxis in the United States: Impact on Lifetime Infection Risk, Clinical Outcomes, and Cost-Effectiveness

The combination of tenofovir and emtricitabine shows promise as HIV preexposure prophylaxis (PrEP). Researchers sought to forecast clinical, epidemiologic, and economic outcomes of PrEP, taking into account uncertainties regarding efficacy, the risks of developing drug resistance and toxicity, behavioral disinhibition, and drug costs. They adapted a computer simulation of HIV acquisition, detection, and care to model PrEP among men who have sex with men and are at high risk of HIV infection (i.e., 1.6% mean annual incidence of HIV infection) in the United States. Base-case assumptions included 50% PrEP efficacy and monthly tenofovir-emtricitabine costs of $753. They used sensitivity analyses to examine the stability of results and to identify critical input parameters. In a cohort with a mean age of 34 years, PrEP reduced lifetime HIV infection risk from 44% to 25% and increased mean life expectancy from 39.9 to 40.7 years (21.7 to 22.2 discounted quality-adjusted life-years). Discounted mean lifetime treatment costs increased from $81,100 to $232,700 per person, indicating an incremental cost-effectiveness ratio of $298,000 per quality-adjusted life-year gained. Markedly larger reductions in lifetime infection risk (from 44% to 6%) were observed with the assumption of greater (90%) PrEP efficacy. More-favorable incremental cost-effectiveness ratios were obtained by targeting younger populations with a higher incidence of infection and by improvements in the efficacy and cost of PrEP. These data suggest that PrEP could substantially reduce the incidence of HIV transmission in populations at high risk of HIV infection in the United States. Although it is unlikely to confer sufficient benefits to justify the current costs of tenofovir-emtricitabine, price reductions and/or increases in efficacy could make PrEP a cost-effective option in younger populations or populations at higher risk of infection. Given recent disappointments in HIV infection prevention and vaccine development, additional study of PrEP-based HIV prevention is warranted. Paltiel A, Freedberg K, Scott C, Schackman B, Losina E, Wang B, Seage G, Sloan C, Sax P, Walensky R. HIV preexposure prophylaxis in the United States: Impact on lifetime infection risk, clinical outcomes, and cost-effectiveness. Clin Infect Dis. 2009;48(6):806-815.

Trends in Multidrug Treatment Failure and Subsequent Mortality among Antiretrovira Therapy-Experienced Patients with HIV Infection in North America

Although combination antiretroviral therapy continues to evolve, with potentially more effective options emerging each year, the ability of therapy to prevent multiple regimen failure and mortality in clinical practice remains poorly defined. In this analysis, 16 cohorts representing over 60 sites, including the AIDS Linked to the IntraVenous Experience (ALIVE) and the Johns Hopkins HIV Clinical Cohort (JHHCC) studies, contributed data on all individuals who initiated combination antiretroviral therapy. Researchers identified those individuals who experienced virologic failure (defined as a HIV RNA level >1000 copies/mL), received modified therapy, and subsequently had a second episode of virologic failure. Multivariate Cox regression was used to assess factors associated with time to second regimen failure and the time to death after the onset of second regimen failure. Of the 42,790 individuals who received therapy, 7159 experienced a second virologic failure. The risk of second virologic failure decreased from 1996 (56 cases per 100 person-years) through 2005 (16 cases per 100 person-years. The cumulative mortality after onset of second virologic failure was 26% at 5 years and decreased over time. A history of AIDS, a lower CD4 (+) T cell count, and a higher plasma HIV RNA level were each independently associated with mortality. Similar trends were observed when analysis was limited to the subset of previously treatment-naive patients. These findings indicate that, although the rates of multiple regimen failure have decreased dramatically over the past decade, mortality rates for those who have experienced failure on at least 2 regimens have remained high. Plasma HIV RNA levels, CD4(+) T cell counts at time of treatment failure, and a history of AIDS remain independent risk factors for death, which underscores the importance of these factors as targets for those in need of more-aggressive therapeutic interventions. Deeks S, Gange S, Kitahata M, et al. Trends in multidrug treatment failure and subsequent mortality among antiretroviral therapy-experienced patients with HIV infection in North America. Clin Infect Dis. 2009;49(10):1582-1590.

Associations Between Alcohol and Depression In Adolescents

Alcohol use-related problems and depressive symptoms are clearly associated with each other, but data on the nature of this association have been inconsistent. In addition, the possible moderating effects of age and gender have not been comprehensively examined. The goals of this study were to clarify: (i) how depressive symptoms affect the levels and trajectory of alcohol use-related problems, (ii) how alcohol use-related problems affect the levels and trajectory of depressive symptoms, and (iii) whether there are differences in these associations at different points in development or between males and females. Participants for this study were drawn from the National Longitudinal Study of Adolescent Health (Add Health) data set (wave 1 of data collection in 1994 to 1995), a community-based sample of 20,728 adolescents followed from adolescence through early adulthood. Multilevel models were used to assess how each problem affected the level and rate of change in the other problem over time; gender was considered as a possible moderator of these associations. The results indicated that alcohol use-related problems and depressive symptoms had reciprocal, positive associations with each other during the period from early adolescence through early adulthood; however, these effects differed somewhat by gender and age. High levels of depressive symptoms were associated with higher initial levels of alcohol problems (particularly among females), as well as faster increases in alcohol problems over time among males. High levels of alcohol problems were associated with higher initial levels of depressive symptoms (particularly among females) as well as less curvature in the slope of depressive symptoms, so that although there was a large difference between people with high and low depressive symptoms in early adolescence, by early adulthood the difference was smaller (particularly among females). These results highlight the importance of examining gender and age in studies of associations between affective disorders and substance use disorders. Marmorstein, N. Longitudinal associations between alcohol problems and depressive symptoms: Early adolescence through early adulthood. Alcohol Clin Exp Res. 2009;33(1):49-59.

Role of GABRA2 Across Behavior By Parental Monitoring

As investigators identify genes involved in psychiatric disorders, they are also studying how the risk associated with susceptibility genes manifests across development and in conjunction with the environment. These analyses aim to characterize the pathway of risk associated with GABRA2, a gene previously associated with adult alcohol dependence, to test for an association between GABRA2 and trajectories of externalizing behavior from adolescence to young adulthood and for moderation of genetic effects by parental monitoring. Data were analyzed from the Child Development Project; a community-based sample of families enrolled at 3 sites in Nashville and Knoxville, Tennessee, and Bloomington, Indiana, as children entered kindergarten in 1987 and 1988, with yearly assessments conducted since that time. A saliva sample was collected for DNA at the 2006 follow-up, with a 93% response rate in the target sample. The analyses reported in this paper were on the white subset of the sample (n = 378). Growth mixture modeling was conducted using Mplus to identify trajectories of externalizing behavior and to test for effects of GABRA2 sequence variants and parental monitoring. Parental monitoring was measured at 11 years of age; Child Behavior Checklist youth reports of externalizing behavior at ages 12, 14, 15, 16, 17, 19, 20, 21, and 22 years. Two classes of externalizing behavior emerged: a stable high externalizing class and a moderate decreasing externalizing behavior class. The GABRA2 gene was associated with class membership, with subjects who showed persistent elevated trajectories of externalizing behavior more likely to carry the genotype previously associated with increased risk of adult alcohol dependence. A significant interaction with parental monitoring emerged; the association of GABRA2 with externalizing trajectories diminished with high levels of parental monitoring. These findings underscore the importance of studying genetic effects across development and of identifying environmental factors that moderate risk. Dick D, Latendresse S, Lansford J, Budde J, Goate A, Dodge K, Pettit G, Bates J. Role of GABRA2 in trajectories of externalizing behavior across development and evidence of moderation by parental monitoring. Arch Gen Psychiatry 2009;66(6):649-657.

GABRA2 and Risk for Substance Abuse and Dependence

A number of studies have shown that genetic variation at GABRA2 alters vulnerability to alcohol dependence. The exact identity of the causal variant (s) and the relationship of these variants to other forms of substance use and behavioral illness are, however, uncertain. This study analyzed genotype data from 516 individuals from the Iowa Adoption Studies, a large longitudinal case and control adoption study of substance use. Thirty-nine single nucleotide polymorphisms encompassing the GABRA2 locus were analyzed with respect to their lifetime history of three common forms of substance use dependence [alcohol dependence (AD), nicotine dependence (ND), and cannabis dependence (CD)] and relevant exposure variables. Using regression analysis, substantial evidence was found that both GABRA2 genotype and haplotype are significantly related to vulnerability to AD, ND, and CD, with the strongest relationships noted with respect to ND. Consistent with earlier studies suggesting exposure is an important step in the development of substance use, investigators found the inclusion of substance exposure data in analytic models markedly increased the strength of the genetic associations of GABRA2 haplotype with substance use. Finally, genetic effects were markedly more pronounced in females than in males. Investigators conclude that genetic variation at or near the GABRA2 locus significantly affects vulnerability not only to AD, but to other forms of substance use including ND and CD, and that the effects may be sex dependent. Philibert R, Gunter T, Beach S, Brody G, Hollenbeck N, Andersen A, Adams W. Role of GABRA2 on risk for alcohol, nicotine, and cannabis dependence in the Iowa Adoption Studies. Psychiatr Genet. 2009;119(2):91-98.

Predictors of Drug Abuse Among Alcoholics

Individuals with alcohol dependence (AD) are at increased risk for developing dependence on illicit and prescription drugs. The goal of this cross-sectional study was to identify factors associated with drug dependence among individuals with AD. Data were collected from 1998 to 2002. The sample consisted of 855 adults (mean ages for males and females were 42.6 and 42.4, respectively) from the Irish Affected Sib Pair Study of Alcohol Dependence, who were treated in inpatient or outpatient alcohol treatment programs and met Diagnostic and Statistical Manual of Mental Disorders criteria for lifetime AD. The investigators studied predictors of dependence on six classes of drugs: cannabis, sedatives, stimulants, cocaine, opioids, and hallucinogens. Potential predictors examined included gender, age, education, and socioeconomic status; the personality traits of extraversion, neuroticism, and novelty seeking; conduct disorder, major depressive disorder, nicotine dependence, age at onset of alcohol use, early illicit drug use, and parental AD. Nicotine dependence, depression that began before substance use and drug use before age 19 each increased the risk for dependence on several substance classes. Male gender, younger age, maternal AD, fewer years of education, higher neuroticism scores, conduct disorder, and early alcohol use each increased the risk of dependence on one or more substance classes. Among individuals in treatment for AD, cigarette smoking, early onset of major depression, and early drug use were associated with increased risk for drug dependence. These results suggest individuals with these risk factors may benefit from more intensive screening to prevent the onset of, or to identify and treat, drug dependence. Sintov N, Kendler K, Walsh D, Patterson D, Prescott C. Predictors of illicit substance dependence among individuals with alcohol dependence. J Stud Alcohol Drugs 2009;70(2):269-278.

Concurrent Partnerships and HIV Prevalence Disparities by Race: Linking Science and Public Health Practice

Biological and behavioral risk factors fail to explain racial disparities in rates of HIV and other STIs. Analysis of network "connectivity," by contrast, suggests a way to gain an understanding of sexual networks and how they may influence disease spread. In this study, researchers found that concurrent sexual partnerships explained the disproportionately high prevalence of HIV and other sexually transmitted infections among African Americans. The persistence of such racial disparities would also require strong assortative mixing by race. They used data from 4 nationally representative US surveys (the National Health and Social Life Survey, the National Survey of Men and its companion, the National Survey of Women, the National Survey of Family Growth, and wave 3 of Add Health). The studies provided comparable data on concurrency and assortative mixing to allow for comparisons of adults 20-38 years and young adults 19 to 25 years. They found consistent support for both elements of this hypothesis; specifically, using a data-driven network simulation model, they showed that the levels of concurrency and assortative mixing observed produced a 2.6-fold racial disparity in the epidemic potential among young African American adults. The simulations were in accord with observed survey data: reported rates of concurrency among African American men and women age 20-38 years were on average 3.5 and 2.1 times higher than those among white men and white women, respectively; and rates of concurrency among African American men and women age 19-25 years were on average 2.9 and 1.4 times higher than those among white men and white women, respectively. These findings suggest that it is not only an individual's behavior that defines his or her risk, but it is his or her partner's behavior and ultimately his or her position in a sexual network. Understanding sexual networks and the interactional contexts that constrain behavioral changes is important for the development of effective HIV prevention interventions to reduce racial disparities in HIV and other STIs. Morris M, Kurth A, Hamilton D, Moody J, Wakefield S. Concurrent partnerships and HIV prevalence disparities by race: Linking science and public health practice. Am J Public Health 2009;99(6):1023-1031.

Assessment of Liver Fibrosis by Transient Elastography in Persons with Hepatitis C Virus Infection or HIV-Hepatitis C Virus Coinfection

Transient elastography is a novel, noninvasive method for staging liver fibrosis. Researchers compared elastography with histologic methods among hepatitis C virus (HCV)-infected and human immunodeficiency virus (HIV)-HCV-coinfected participants in the urban, predominantly black study population. Participants were recruited from the AIDS Linked to the Intravenous Experience (ALIVE) and the Johns Hopkins HIV Clinical Cohort (JHHCC) studies, and underwent elastography to determine liver stiffness measurements. Liver biopsy specimens were staged F0-F4 in accordance with the Metavir score. Diagnostic accuracy and determination of liver stiffness cutoff values, compared with histologic methods, were determined by receiver operating characteristic analysis. Logistic regression methods identified parameters associated with discordant classification status. Of 192 participants, 139 (72%) were coinfected with HIV and HCV, 121 (63%) had insignificant fibrosis, and 48 (25%) had cirrhosis. Overall, the area-under-the-curve receiver operating characteristic was 0.87 for detection of both significant fibrosis (95% confidence interval, 0.82-0.92) and cirrhosis (95% confidence interval, 0.81-0.93). With use of cutoff values of 9.3 kPa for fibrosis and 12.3 kPa for cirrhosis, 79%-83% of participants were correctly classified by liver stiffness measurement (compared with histologic methods); accuracy appeared to be higher among HIV-uninfected participants than among HIV-infected participants. Most discordance occurred when liver stiffness measurements indicated liver disease and histologic examination did not (in 16% of participants); those with discordant results were more likely to have attributes that increased the odds of significant fibrosis, such as elevated serum fibrosis markers or HIV-related immunosuppression, compared with persons in whom low fibrosis was predicted by both examination of a biopsy specimen and elastography. These findings indicate that, for most HCV-infected persons, fibrosis stage predicted by elastography is similar to that predicted by examination of a biopsy specimen. Elastography-based measurement of liver stiffness holds promise to expand liver disease screening and monitoring, particularly among injection drug users. Kirk G, Astemborski J, Mehta S, et al. Assessment of liver fibrosis by transient elastography in persons with Hepatitis C virus infection or HIV-Hepatitis C virus coinfection. Clin Infect Dis. 2009;48(7):963-972.

Association Between CNR1 and Cannabis Dependence Symptoms in Young Adults

This study examined the genetic association between variation in the cannabinoid receptor 1 (CNR1) gene and cannabis dependence symptoms. Adolescent and young adult subjects were recruited from three settings: a treatment program for youth with substance use disorders, the criminal justice system, and the community. A case-control sample was interviewed and consisted of 224 cases who endorsed at least one dependence symptom and 108 controls who tried cannabis but endorsed no symptoms. A family-based sample of 219 families was also analyzed. Case-control analysis identified a nominal association between SNP rs1049353 and having one or more cannabis dependence symptoms (p=.029), but the association did not hold up in a combined sample. Family-based analysis found a trend for the same SNP (p=.07). The authors did not replicate a previous report that SNP rs806380 was associated with the development of cannabis dependence. These results provide inconclusive evidence of association between rs1049353/rs806380 and the development of cannabis dependence, and underscore the importance of replicating results of genetic association studies. Additional family-based studies are needed to clarify the role of the CNR1 gene, and its various SNPs, in the development of cannabis use disorders. Hartman C, Hopfer C, Haberstick B, et al. The association between cannabinoid receptor 1 gene (CNR1) and cannabis dependence symptoms in adolescents and young adults. Drug Alcohol Depend. 2009;104(1-2):11-16.

Subtypes of Nonmedical Prescription Drug Misuse

This study used three characteristics (i.e., motive, route of administration, and co-ingestion with alcohol) of nonmedical prescription drug misuse across four separate classes (i.e., pain, sedative/anxiety, sleeping, and stimulant medications) to examine subtypes and drug related problems. A Web survey was self-administered by a randomly selected sample of 3639 undergraduate students attending a large Midwestern 4-year U.S. university. Self-treatment subtypes were characterized by motives consistent with the prescription drug's pharmaceutical main indication, oral only routes of administration, and no co-ingestion with alcohol. Recreational subtypes were characterized by recreational motives, oral or non-oral routes, and co-ingestion. Mixed subtypes consisted of other combinations of motives, routes, and co-ingestion. Among those who reported nonmedical prescription drug misuse, approximately 13% were classified into the recreational subtype, while 39% were in the self-treatment subtype, and 48% were in the mixed subtype. There were significant differences in the subtypes in terms of gender, race and prescription drug class. Approximately 50% of those in subtypes other than self-treatment screened positive for drug abuse. The odds of substance use and abuse were generally lower among self-treatment subtypes than other subtypes. The authors conclude that the findings indicate subtypes should be considered when examining nonmedical prescription drug misuse, especially for pain medication. McCabe S, Boyd C, Teter C. Subtypes of nonmedical prescription drug misuse. Drug Alcohol Depend. 2009;102(1-3):63-70.

Correlates of Later-Onset Cannabis Use in the NESARC

Much of the research surrounding correlates of cannabis initiation has focused on adolescent and young adult populations. However, there is growing evidence that cannabis onset occurs later in life as well and little is known of the risk and protective influences that are associated with late-onset cannabis initiation. The investigators used data on 34,653 individuals that participated in both the first wave and the 3-year follow-up (3YFU) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Univariate and multivariate logistic regression was used to examine the association between cannabis initiation at 3YFU and socio-demographic, religious/pro-social and psychiatric measures. Analyses were also conducted in age bands to further distinguish across the lifespan. Of the 27,467 lifetime abstainers at wave one, 1509 had initiated cannabis use at 3YFU. Consistent associations between divorce, religious attendance, volunteer/community service, alcohol abuse/dependence, nicotine dependence and cannabis initiation were noted in the full sample and across age-bands. Religious and pro-social activities were negatively associated with late-onset cannabis onset while divorce and alcohol and nicotine-related problems were positively associated with later onset. Agrawal A, Lynskey MT. Correlates of later-onset cannabis use in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 2009;1-4.

Evidence for Associations between Polymorphisms in Cannabinoid Receptor 1 Gene and Cannabis Dependence

Genomic studies of cannabis use disorders have been limited. The cannabinoid receptor 1 gene (CNR1) on chromosome 6q14-15 is an excellent candidate gene for cannabis dependence due to the important role of the G-protein coupled receptor encoded by this gene in the rewarding effects of Delta9-tetrahydrocannabinol. Previous studies have found equivocal evidence for an association between SNPs in CNR1 and a general vulnerability to substance use disorders. Researchers investigated the association between 9 SNPs spanning CNR1 and cannabis dependence in 1,923 individuals. Two SNPs that were previously associated with cannabis dependence in other studies were also significant with this phenotype in our analyses [rs806368 (P = 0.05) and rs806380 (P = 0.009)]. Haplotype analyses revealed the association to be largely driven by the SNP rs806380. These results suggest a role for the cannabinoid receptor 1 gene in cannabis dependence. Agrawal A, Wetherill L, Dick D, et al. Evidence for association between polymorphisms in the cannabinoid receptor 1 (CNR1) gene and cannabis dependence. Am J Med Genet B Neuropsychiatr Genet. 2009;150B(5):736-740.

Burden of Psychiatric Morbidity among Lesbian, Gay, and Bisexual Individuals in the California Quality of Life Survey

In recent population-based surveys, minority sexual orientation has been identified as a potential risk indicator for psychiatric morbidity. However, methodological limitations in studies to date have led to concerns that current estimates are biased due to inadequate measurement of sexual orientation and uncontrolled confounding from prevalent HIV infection. In the present study, the researchers investigate associations between sexual orientation and mental health/substance use morbidity using information obtained from 2,272 individuals, including 652 sexual orientation minorities, age 18 to 72 years, interviewed in the California Quality of Life Survey. Results confirm that minority sexual orientation is a risk indicator for psychiatric morbidity. However, levels of increased risk vary within this subpopulation by both gender and patterns of sexual orientation expression. Among gay/bisexual men, much of this greater burden is related to concurrent HIV infection. Reducing excess mental health morbidity risk among sexual orientation minorities could result in possibly a 5% to 11% reduction in the burden of the disorders assessed here among the adult population. Sexual orientation represents an important, but relatively understudied, individual characteristic shaping risk for psychiatric morbidity. Cochran S, Mays V. Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey. J Abnorm Psychol. 2009;118(3):647-658.

Alcohol Consumption Indices of Genetic Risk for Alcohol Dependence

Previous research has reported a significant genetic correlation between heaviness of alcohol consumption and alcohol dependence (AD), but this association might be driven by the influence of AD on consumption rather than the reverse. Researchers tested the genetic overlap between AD symptoms and a heaviness of consumption measure among individuals who do not have AD. A high genetic correlation between these measures would suggest that a continuous measure of consumption may have a useful role in the discovery of genes contributing to dependence risk. Factor analysis of five alcohol use measures was used to create a measure of heaviness of alcohol consumption. Quantitative genetic analyses of interview data from the 1989 Australian Twin Panel (n = 6257 individuals; M = 29.9 years) assessed the genetic overlap between heaviness of consumption, DSM-IV AD symptoms, DSM-IV AD symptom clustering, and DSM-IV alcohol abuse. Genetic influences accounted for 30%-51% of the variance in the alcohol measures and genetic correlations were .90 or higher for all measures, with the correlation between consumption and dependence symptoms among nondependent individuals estimated at .97 (95% confidence interval: .80-1.00). Heaviness of consumption and AD symptoms have a high degree of genetic overlap even among nondependent individuals in the general population, implying that genetic influences on dependence risk in the general population are acting to a considerable degree through heaviness of use and that quantitative measures of consumption will likely have a useful role in the identification of genes contributing to AD. Grant JD, Agrawal A, Bucholtz K, et al. Alcohol consumption indices of genetic risk for alcohol dependence. Biol Psychiatry. 2009;1-6.

Pathways Between Nonmedical Opioid Use/Dependence and Psychiatric Disorders

This study was designed to address the knowledge gap regarding the temporal ordering between nonmedical opioid use and dependence and psychiatric disorders. Data were gathered in a face-to-face survey of the United States conducted in the 2001-2002 (NESARC wave 1). Participants were household and group quarters residents aged 18 years and older (n=43,093). Cox proportional hazards models with time-dependent covariates were used to investigate potential pathways between lifetime nonmedical opioid use/dependence and psychiatric disorders. Analysis revealed that preexisting psychiatric disorders (mood disorders, major depressive disorder, bipolar I disorder, anxiety disorders, panic and generalized anxiety disorders) were associated with an increased risk of nonmedical opioid use, with hazard ratios ranging from 2.2[95% CI=1.6-3.1] (any anxiety disorder) to 3.1[95% CI=2.4-2.4] (bipolar I disorder). Preexisting nonmedical opioid use was associated with an increased risk of onset of psychiatric disorders, with hazard ratios ranging from 2.8[95% CI=2.2-3.6] (generalized anxiety disorder) to 3.6[95% CI=2.6-4.9] (bipolar I disorder), adjusted for demographics and other illegal drug use. Nonmedical use of opioids led to the development of dependence more often among individuals with preexisting psychiatric disorders, hazard ratios were particularly strong for generalized anxiety disorder (HR=10.8, 95% CI=4.9-23.7) and bipolar I disorder (HR=9.7, 95% CI=5.4-17.3). Preexisting opioid dependence resulting from nonmedical opioid use was associated with an increased risk of onset of psychiatric disorders, with hazard ratios ranging from 4.9[95% CI=3.0-7.9] (mood disorders) to 8.5[95% CI=4.5-16.0] (panic disorder), adjusted for demographics and alcohol and/or other illegal drug dependence. The authors conclude that the study findings suggest a general vulnerability to nonmedical opioid use and major psychopathologies and provide evidence for a ''self-medication'' model for dependence resulting from nonmedical opioid use with bipolar disorder and generalized anxiety disorder. Martins S, Keyes K, Storr C, Zhu H, Chilcoat H. Pathways between nonmedical opioid use/dependence and psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend. 2009;103(1-2):16-24.

Extra-medical Stimulant Dependence among Recent Initiates

Researchers sought to examine estimates for the risk of becoming stimulant dependent within 24 months after first extra-medical (EM) use of a stimulant drug compound. The study estimates are derived from a representative sample of United States residents ages 12 and older (N=166,737) obtained from the 2003 to 2005 National Surveys on Drug Use and Health. A total of 1700 respondents were found to have used stimulants extra-medically for the first time within 24 months prior to assessment. Approximately 5% of these recent-onset EM users had become stimulant dependent since onset of EM use. As hypothesized, alcohol dependence cases were found to have experienced an excess risk of becoming stimulant dependent soon after onset of stimulant drug use; there was no robust male-female difference in risk. Independently, initiates who had used multiple types of stimulants extra-medically, and methamphetamine users, were more likely to have become stimulant dependent soon after onset of use; by comparison, EM users of methylphenidate (Ritalin) were less likely to have developed rapid-onset dependence. These epidemiologic findings help quantify the continuing public health burden associated with new onsets of extra-medical stimulant use. O'Brien M, Anthony J. Extra-medical stimulant dependence among recent initiates. Drug Alcohol Depend. 2009;104(1-2):147-155.

Stable Factors in Externalizing Behaviors in Preadolescent Girls

Relatively little is known about the factor structure of disruptive behavior among preadolescent girls. The present study reports on exploratory and confirmatory factor analyses of disruptive girl behavior over four successive data waves as rated by parents and teachers in a large, representative community sample of girls (N = 2,451). Five factors were identified from in-home interviews parent ratings (oppositional behavior/conduct problems, inattention, hyperactivity/impulsivity, relational aggression, and callous-unemotional behaviors), and four factors were identified derived from teacher ratings (oppositional behavior/conduct problems/callous-unemotional behaviors, inattention, hyperactivity/impulsivity, and relational aggression). There was a high degree of consistency of items loading on equivalent factors across parent and teacher ratings. Year-to-year stability of factors between ages five and 12 was high for parent ratings (ICC = 0.70 to 0.88), and slightly lower for teacher ratings (ICC = 0.56 to 0.83). These findings are discussed in terms of possible adjustment to the criteria for children's disruptive behavior disorders found in the Diagnostic and Statistical Manual for Mental Disorders. Loeber R, Pardini D, Hipwell A, Stouthamer-Loeber M, Keenan K, Sembower M. Are there stable factors in preadolescent girls' externalizing behaviors? J Abnorm Child Psychol. 2009;37(6):777-791.

Juvenile Offenders' Alcohol and Marijuana Risk and Protective Factor Effects

The current study modeled trajectories of substance use from ages 15 to 20 among 1,095 male serious juvenile offenders (M age = 16.54; 42% African-American, 34% Latino, 20% European-American, and 4% other ethnic/racial backgrounds) and prospectively predicted trajectories from risk and protective factors before and after controlling for time spent in a supervised setting. Results indicated that supervised time suppressed age-related growth in substance use. Trajectories of offenders with no supervised time and low levels of supervised time increased in substance use across age, whereas offenders with high levels of supervised time showed no growth. Almost all risk and protective factors had effects on initial substance use but only adolescent history of substance use, impulse control, and psychosocial maturity had an effect on change in substance use over time. Findings highlight the importance of formal sanctions and interventions superimposed on normal developmental processes in understanding trajectories of substance use among serious juvenile offenders. Mauricio A, Little M, Chassin L, Knight G, Piquero A, Losoya S, Vargas-Chanes D. Juvenile offenders' alcohol and marijuana trajectories: Risk and protective factor effects in the context of time in a supervised facility. J Youth Adolesc. 2009;38(3):440-453.

Methamphetamine Use and Rates of Incarceration among Street-Involved Youth in a Canadian Setting: a Cross-Sectional Analysis

Concerns over rising use of methamphetamine, especially among street-involved youth, and the links between exposure to the correctional system and risks for increased drug use led researchers to assess the relationship between ever using methamphetamine and reporting ever being incarcerated among youth in Vancouver, Canada. They looked at the relationship between ever being imprisoned and ever using methamphetamine using a multivariate logistic regression analysis while also controlling for potentially confounding secondary demographic, social and behavioral variables. Of the 478 youth recruited into the study between September 2005 and October 2006, 385 (80.5%) reported ever being incarcerated overnight or longer. In the multivariate model, methamphetamine use was independently associated with ever being incarcerated (adjusted Odds Ratio: 1.79, 95% Confidence Interval [CI]: 1.03 - 3.13). These findings indicate that incarceration was common in this cohort and strongly linked with ever using methamphetamine, underscoring the need for the development of novel public policies such as community-based drug treatment, to address the use of methamphetamine among street youth. Milloy M, Kerr T, Buxton J, Montaner J, Wood E. Methamphetamine use and rates of incarceration among street-involved youth in a Canadian setting: A cross-sectional analysis. Subst Abuse Treat Prev Policy. 2009;4:17-23.

Identifying Hidden Sexual Bridging Communities in Chicago

Bridge populations can play a central role in the spread of human immunodeficiency virus (HIV) by providing transmission links between higher and lower prevalence populations. While social network methods are well suited to the study of bridge populations, analyses tend to focus on dyads (i.e., risk between drug and/or sex partners) and ignore bridges between distinct subpopulations. This study takes initial steps toward moving the analysis of sexual network linkages beyond individual and risk group levels to a community level in which Chicago's 77 community areas were examined as subpopulations for the purpose of identifying potential bridging communities. Of particular interest are "hidden" bridging communities; that is, areas with above-average levels of sexual ties with other areas but whose below-average AIDS prevalence may hide their potential importance for HIV prevention. Data for this analysis came from the first wave of recruiting at the Chicago Sexual Acquisition and Transmission of HIV Cooperative Agreement Program site. Between August 2005 and October 2006, respondent-driven sampling was used to recruit users of heroin, cocaine, or methamphetamine, men who have sex with men regardless of drug use, the sex partners of these two groups, and sex partners of the sex partners. In this cross-sectional study of the sexual transmission of HIV, participants completed a network-focused computer-assisted self-administered interview, which included questions about the geographic locations of sexual contacts with up to six recent partners. Bridging scores for each area were determined using a matrix representing Chicago's 77 community areas and were assessed using two measures: non-redundant ties and flow betweenness. Bridging measures and acquired immunodeficiency syndrome (AIDS) case prevalence rates were plotted for each community area on charts representing four conditions: below-average bridging and AIDS prevalence, below-average bridging and above-average AIDS prevalence, above-average bridging and AIDS prevalence, and above-average bridging and below-average AIDS prevalence (hidden bridgers). The majority of the 1,068 study participants were male (63%), African American (74%), and very poor, and the median age was 44 years. Most (85%) were sexually active, and 725 provided useable geographic information regarding 1,420 sexual partnerships that involved 57 Chicago community areas. Eight community areas met or came close to meeting the definition of hidden bridgers. Six areas were near the city's periphery, and all eight areas likely had high inflows or outflows of low-income persons displaced by gentrification. The results suggest that further research is warranted on the use of this methodology to duplicate the analysis in other cities. Youm Y, Mackesy-Amiti M, Williams C, Ouellet L. Identifying hidden sexual bridging communities in Chicago. J Urban Health. 2009;86 Suppl 1:107-120.

Evaluation of Human Immunodeficiency Virus Biomarkers: Inferences from Interval and Clinical Cohort Studies

Among individuals infected with the human immunodeficiency virus (HIV), biomarkers that predict mortality are also used to determine the time when antiretroviral therapy is initiated. No studies have evaluated the impact of the frequency of marker measurements for either their predictive value of mortality or how they may influence inference of the effect of therapy initiation in analyses from observational data. Researchers identified 244 persons who were contemporaneously enrolled in both the ALIVE (AIDS Linked to the IntraVenous Experience study, an interval cohort) and the Johns Hopkins HIV Clinical Cohort (JHHCC) between 1995 and 2004. Data from each study were used separately in 2 ways: Researchers applied time-dependent proportional hazards models to examine the predictive associations between markers and mortality, and marginal structural models to examine the causal inference of therapy on mortality. They used biomarkers to derive inverse probability weights. The timing frequencies of marker measurements in the interval cohort (CD4 interquartile range = 175-194 days) were less heterogeneous than in the clinical cohort (interquartile range = 38-121 days). Despite this, results were concordant for CD4 (R = 0.537 [95% confidence interval = 0.345-0.707] and (R = 0.488 [0.297-0.666], respectively). Similar concordance was found for the HIV-1 RNA and hemoglobin analyses. When evaluating the causal effect of highly active antiretroviral therapy (HAART), the relative hazards were 0.34 for the interval cohort study (95% CI = 0.15-0.77) and 0.27 for the clinical cohort study (0.11-0.66). Utilizing a unique co-enrollment of patients in two different types of cohort studies, they found empirical evidence that inferences drawn from these different structures are similar. Lau B, Gange S, Kirk G, Moore R. Evaluation of human immunodeficiency virus biomarkers: Inferences from interval and clinical cohort studies. Epidemiology. 2009;20(5):664-672.

HIV Transmission Networks

Over the past several years one segment of the complex field of HIV transmission dynamics - heterosexual networks - has dominated theoretical and empirical investigation. This paper provides an overview of recent work on HIV risks and networks, with a focus on recent findings in heterosexual network dynamics. Qualitative (ethnographic) assessments have demonstrated the heterogeneity and complexity of heterosexual connections, particularly in Africa, where tradition, official polygamy, and unofficial multiperson arrangements have led to concurrency of sexual partnerships. Data from a large, quantitative study on Likoma Island, Malawi, are examined to demonstrate the considerable, interlocking sexual connections that arise from a high-concurrency sexual setting, even with a low average number of partnerships (low degree) of long duration. Such settings, as suggested by ethnographic studies, may be common in Africa as well as other regions of the world. Combined with newer information about transmissibility during acute and early infection, such studies may provide plausible explanations for endemic transmission and possibly for rapid HIV propagation. The review concludes with a discussion of high-concurrency, low-degree networks. Their relevance to heterosexual transmission, and possible extension to other epidemiologic settings, reinforces the heterogeneity and complexity of HIV transmission dynamics. Rothenberg R. HIV transmission networks. Curr Opin HIV AIDS. 2009;24(4):260-265.

Homonegativity, Substance Use, Sexual Risk Behaviors, and HIV Status in Poor and Ethnic Men Who have Sex with Men in Los Angeles

This study evaluates associations between internalized homonegativity and demographic factors, drug use behaviors, sexual risk behaviors, and HIV status among men who have sex with men (MSM) and with men and women (MSM/W). Participants were recruited in Los Angeles County using respondent-driven sampling (RDS) and completed the Internalized Homonegativity Inventory (IHNI) and questionnaires on demographic and behavioral factors. Biological samples were tested for HIV and for recent cocaine, methamphetamine, and heroin use. The 722 MSM and MSM/W participants were predominantly African American (44%) and Hispanic (28%), unemployed (82%), homeless (50%), and HIV positive (48%) who used drugs in the past 6 months (79.5%). Total and Personal Homonegativity, Gay Affirmation, and Morality of Homosexuality IHNI scores were significantly higher for African American men than for other ethnicities, for MSM/W than for MSM, for recent cocaine users than for recent methamphetamine users, and for HIV-seronegative men than for HIV-seropositive men. Linear regression showed the Gay Affirmation scale significantly and inversely correlated with the number of sexual partners when controlling for effects of ethnicity/race and sexual identification, particularly for men who self-identified as straight. Highest IHNI scores were observed in a small group of MSM/W (n = 62) who never tested for HIV. Of these, 26% tested HIV positive. Findings describe ways in which internalized homophobia is a barrier to HIV testing and associated HIV infection; such distinctions have importance for informing targeted HIV prevention efforts that aim to increase HIV testing, counseling, and behavioral change. Shoptaw S, Weiss R, Munjas B, Hucks-Ortiz C, Young S, Larkins S, Victorianne G, Gorbach P. Homonegativity, substance use, sexual risk behaviors, and HIV status in poor and ethnic men who have sex with men in Los Angeles. J Urban Health 2009;86 Suppl1:77-92.

Hepatitis C Virus Infection among Drug Injectors in St. Petersburg, Russia: Social and Molecular Epidemiology of an Endemic Infection

Researchers sought to understand the epidemiology and transmission patterns of hepatitis C virus (HCV), the predominant blood borne-pathogen infecting injection drug users (IDUs), in a part of the former Soviet Union. The authors recruited a cross-sectional respondent-driven sample of 387 IDUs in late 2005 through 2006, and administered a survey to collect demographic, medical, and general and dyad-specific drug injection and sexual behavioral data. Blood samples were also collected to detect antibodies to HCV and to amplify viral RNA for molecular analysis. The molecular data, including genotypes, were analyzed spatially and linkage patterns were compared to the social linkages obtained by respondent-driven sampling (RDS) for chains of respondents and among the injection dyads. HCV infection was ubiquitous: 94.6% of IDUs were HCV-seropositive. Among the 209 viral sequences amplified, genotype 3a predominated (n = 119, 56.9%), followed by 1b (n = 61, 29.2%) and 1a (n = 25, 11.9%). There was no significant clustering of genotypes spatially. Neither genotypes nor closely related sequences were clustered within RDS chains. Analysis of HCV sequences from dyads failed to find associations of genotype or sequence homology within pairs. Genotyping reveals that there have been at least five unique introductions of HCV genotypes into the IDU community in St. Petersburg. Analysis of prevalent infections does not appear to correlate with the social networks of IDUs, suggesting that simple approaches to link these networks to prevalent infections, rather than incident transmission, is unlikely to prove meaningful. On a more positive note, the majority of IDUs were infected with 3a genotype, which is associated with sustained virological response to antiviral therapy. Paintsil E, Verevochkin S, Dukhovlinova E, et al. Hepatitis C virus infection among drug injectors in St. Petersburg, Russia: Social and molecular epidemiology of an endemic infection. Addiction 2009;104(111):1881-1890.

Sexual Orientation, Substance Use Behaviors and Substance Dependence in the United States

The research team assessed past-year prevalence rates of substance use behaviors and substance dependence across three major dimensions of sexual orientation (identity, attraction and behavior) in a large national sample of adult women and men in the United States. Data were collected from structured diagnostic face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV). Prevalence estimates were based on data collected from the 2004-2005 (wave 2) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) which was comprised of a sample of 34,653 adults aged 20 years and older. Approximately 2% of the population self-identified as lesbian, gay or bisexual; 4% reported at least one life-time same-sex sexual partner and 6% reported same-sex sexual attraction. Although non-heterosexual orientation was generally associated with a higher risk of substance use and substance dependence, the majority of sexual minority respondents did not report substance use or meet criteria for DSM-IV substance dependence. There was considerable variation in substance use outcomes across sexual orientation dimensions; these variations were more pronounced among women than among men. Results support previous research findings on heightened risk of substance use and substance dependence among some sexual minority groups and point to the need for research that examines the reasons for such differences. Results also highlight important gender differences and question previous findings indicating uniformly higher risk for substance dependence among sexual minorities. Risks appear to vary based on gender and how sexual orientation is defined. Findings have implications for more effective prevention and intervention efforts that target subgroups at greatest risk. McCabe S, Hughes T, Bostwick W, West B, Boyd C. Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction 2009;104(8):1333-1345.

HIV Seroprevalence in a Sample of Tanzanian Intravenous Drug Users

Injection drug use has gradually been emerging in sub-Saharan Africa. The purpose of this study was to assess the factors associated with increased risk of testing HIV-positive in a sample of injection drug users (IDUs) in Dar es Salaam, Tanzania. Participants were recruited by a trained outreach worker or were referred by IDUs who had completed the study. Blood specimens and self-reported socioeconomic and behavioral data were collected from 315 male and 219 female IDUs. Data were analyzed using univariate odds ratios and multivariate logistic regression modeling. Forty-two percent of the sample tested HIV-positive. Several socioeconomic, injection, and sexual factors were found to be associated with increased odds of testing HIV-positive. Multivariate analysis showed that having had sex more than 81 times in past 30 days, earning less than 100,000 shillings (US$76) in the past month, residency in Dar es Salaam for less than 5 years, and injecting for 3 years were independently associated with the greatest risk of infection. The rate of HIV infection in this sample of IDUs was found to be very high, suggesting that injection drug use may be an increasingly important factor in the continuing epidemic in sub-Saharan Africa, especially given the risky needle use practices and sexual networks of IDUs. Williams M, McCurdy S, Bowen A, Kilonzo G, Atkinson J, Ross M, Leshabari M. HIV seroprevalence in a sample of Tanzanian intravenous drug users. AIDS Educ Prev 2009;21(5):474-483.

Correlates of Unsafe Equipment Sharing among Injecting Drug Users in St. Petersburg, Russia

Researchers assessed the urban environment, social norms and individual correlates of unsafe injecting among injecting drug users (IDUs) in St. Petersburg, Russia. Between December 2004 and January 2007, 446 IDUs were interviewed in St. Petersburg, Russia. Prevalence of hepatitis C (HCV) was 96% and HIV 44%; 17% reported receptive syringe sharing after an HIV-infected IDU, 49% distributive syringe sharing, 76% sharing cookers, 73% sharing filters and 71% syringe-mediated drug sharing when not all syringes were new. Urban environmental characteristics correlated with sharing cookers and syringe-mediated sharing, and social norms correlated with receptive and distributive syringe sharing and sharing cookers. Individual correlates included cleaning used syringes (all 5 dependent variables) and self-report of HIV infection (receptive and distributive syringe sharing). These findings show that HIV status disclosure is an unreliable but frequently used HIV prevention method among IDUs in St. Petersburg, who reported alarmingly high levels of injecting equipment sharing. Voluntary counseling and testing should be widely available for this population. Ethnography would help in assessing the effectiveness of the syringe cleaning process and informing development of prevention interventions that incorporate urban environmental factors and social norms, including peer education and social network interventions. Gyarmathy V, Li N, Tobin K, et al. Correlates of unsafe equipment sharing among injecting drug users In St. Petersburg, Russia. Eur Addict Res. 2009;15(3):163-170.

Youth Living with HIV and Partner-Specific Risk for the Secondary Transmission of HIV

Secondary transmission remains a significant concern among HIV-infected youth. Little is known, however, about partner-specific sexual risk behaviors for the secondary transmission of HIV and how they may differ between the 2 largest subgroups of HIV-positive youth, women-who-have-sex-with-men (WSM) and men-who-have-sex-with-men (MSM). During 2003-2004, researchers recruited a convenience sample of HIV-infected youth, 13 to 24 years of age, from 15 Adolescent Medicine Trials Network clinical sites, with approximately 10 to 15 youth recruited at each site. Participants completed an ACASI survey including questions about sex partners in the past year. Cross-sectional data analyses, including bivariate and multivariable regressions using generalized estimating equations, compared recent partner-specific sexual risk behaviors between WSM and MSM. Of 409 participants, 91% (371), including 176 WSM and 195 MSM, were included in the analysis. Ninety-two percent (163 WSM, 177 MSM) provided information on characteristics of their sexual partners. There were significant differences between the 2 groups in recent partner-specific sexual risk behaviors: lower rates of condom use at last sex among WSM (61% WSM vs. 78% MSM; P = 0.0011); a larger proportion of the sex partners of MSM reported as concurrent (56% MSM vs. 36% WSM; P = 0.0001); and greater use of hard drugs at last sex by MSM and/or their partner (18% MSM vs. 4% WSM; P = 0.0008). When measuring risk as a composite measure of sexual risk behaviors known to be associated with HIV transmission, both groups had high rates of risky behaviors, 74.7% among young MSM compared to 68.1% of WSM. These data suggest that recent partner-specific sexual risk behaviors for HIV transmission are high among young infected MSM and WSM, indicating the importance of offering interventions to reduce the secondary transmission of HIV to all HIV-positive youth in care. Moreover, the differences in risk behaviors between young MSM and WSM suggest that population-specific interventions are warranted. Jennings J, Ellen J, Deeds B, et al. Youth living with HIV and partner-specific risk for the secondary transmission of HIV. Sex Transm Dis. 2009;36(7):439-444.

Impulsivity and Later Risky Sexual Behaviors and Drug Abuse

Researchers examined a mediational model of the inter-relationship of drug use, sexual risk, and impulsivity in a longitudinal sample of 89 18-20 year old Minnesotans, recruited at ages 7-11 in 1991, almost half of whom displayed highly disruptive behaviors as children. They chose a mediational model because emerging evidence suggests that impulsivity is an underlying risk factor for many youth health risk problems, including sexual risk behaviors. They found that the three target variables were significantly related to each other, yet the association of drug use and sexual risk was significantly reduced (although not to zero) when controlled by impulsivity, suggesting a partial meditational model. These findings support the view that the association of drug use and sexual risk behaviors is partially mediated by impulsivity, as well as the broader theory that youth with deficits in self-regulatory behavioral systems have a greater likelihood of engaging in risky behaviors. This work adds to previous research on the role of impulsivity in the genesis of substance abuse, and supports the utility of dimensional approaches to understanding risk. Winters KC, Botzet A, Fahnhorst T, Bamuel L, Lee S. Impulsivity and its relationship to risky sexual behaviors and drug abuse. J Child Adolesc Subst Abuse 2009;18(1):43-56.

Calculation of P-values for Genome-Wide Analysis

Linkage analysis in multivariate or longitudinal contexts presents both statistical and computational challenges. The permutation test can be used to avoid some of the statistical challenges, but it substantially adds to the computational burden. Utilizing the distributional dependencies between p (defined as the proportion of alleles at a locus that are identical by descent (IBD) for a pairs of relatives, at a given locus) and the permutation test, this study reports on a new method of efficient permutation. The distribution of p for a sample of relatives at locus x is estimated as a weighted mixture of p drawn from a pool of ''representative'' p distributions observed at other loci. The weighting scheme is then used to sample from the distribution of the permutation tests at the representative loci to obtain an empirical P-value at locus x (which is asymptotically distributed as the permutation test at loci x). This weighted mixture approach greatly reduces the number of permutation tests required for genome-wide scanning, making it suitable for use in multivariate and other computationally intensive linkage analyses. In addition, because the distribution of p is a property of the genotypic data for a given sample and is independent of the phenotypic data, the weighting scheme can be applied to any phenotype (or combination of phenotypes) collected from that sample. The validity of this approach is demonstrated through simulation. Medland S, Schmitt J, Webb B, Kuo P, Neale M. Efficient calculation of empirical p-values for genome-wide linkage analysis through weighted permutation. Behav Genet. 2009;39(1):91-100.

Differences in Sexual Identity, Risk Practices, and Sex Partners between Bisexual Men and Other Men among a Low-Income Drug-Using Sample

Men who have sex with men and women (MSMW) represent an important target population for understanding the spread of HIV because of the inherent bridging aspect of their sexual behavior. Despite their potential to spread HIV between gender groups, relatively little recent data have been reported about this population as a subgroup distinct from men who have sex with men only. This paper analyzes data from the Chicago site of Sexual Acquisition and Transmission of HIV Cooperative Agreement Program to characterize 343 MSMW in terms of their demographics, drug use, sexual risk behavior, sexual identity, and sex partners. Results show the MSMW sample to be extremely disadvantaged; to have high rates of drug use, including injection and crack use; to report more female than male sex partners; to not differ from gay and heterosexual men in rates of condom use; and, for the most part, to report sexual identities that are consistent with their sex behavior. MSMW represent an important high risk subpopulation in the HIV epidemic that should be targeted for risk reduction interventions. Williams C, Mackesy-Amiti M, McKirnan D, Ouellet L. Differences in sexual identity, risk practices, and sex partners between bisexual men and other men among a low-income drug-using sample. J Urban Health 2009;86 Suppl 1:93-106.

Substance Use Treatment Outcomes in a Sample of Male Serious Juvenile Offenders

This study examined drug-treatment-related reductions in alcohol and marijuana use, cigarette smoking, and nondrug offending among male adolescents who had been adjudicated of a serious (almost exclusively felony) offense. Sample included 429 male adolescent juvenile offenders from an ongoing longitudinal study of desistance from crime (Pathways to Desistance Project). Results indicated that the "real-world" drug treatments that these adolescents experienced had significant effects on substance use, which could not be explained solely by incarceration in controlled environments. However, effects on cigarette smoking and criminal offending were found only for treatments that included family involvement. Results suggest that involving families in adolescents' treatment may be useful for promoting desistence from criminal offending in this population. Chassin L, Knight G, Vargas-Chanes D, Lasoya SH, Naranjo D. Substance use treatment outcomes in a sample of male serious juvenile offenders. J Subst Abuse Treat. 2009;36(2):183-194.

Latina Mother-Daughter Relations Under Influence of Substances

Associations among mother-daughter attachment, mother and daughter substance abuse, and daughter's sexual behavior under the influence of drugs and alcohol were investigated among 158 adult U.S. Latina daughters. Latina daughters were sampled from four mother-daughter dyad types: substance abusing mother and daughter, substance abusing mother only, substance abusing daughter only, and non-substance-abusing mother and daughter. Substance abusing daughters with substance abusing mothers, and daughters who were less strongly attached to their mothers, reported more sex under the influence of drugs. Age, marital status, substance abuse, and mother's substance abuse all influenced the daughter's sex under the influence of alcohol. An unexpected positive association between attachment and sex under the influence of alcohol was found for daughters who were more closely attached to a substance abusing mother. Rosa MD, Dillon FR, Rojas P, Schwartz SJ, Duan R. Latina mother-daughter dyads: Relations between attachment and sexual behavior under the influence of alcohol or drugs. Arch Sex Behav. 2009:1-15.

Predictors of DSM and Fagerstrom-defined Nicotine Dependence in African American and Puerto Rican Young Adults

This study examined the psychosocial predictors of nicotine dependence, as defined by a variant of the criteria employed in the DSM-IV-specifically that of the University of Michigan Composite International Diagnostic Interview (UM-CIDI)-and the Fagerstrom Test for Nicotine Dependence (FTND). The study conducted interviews with a community sample of African American and Puerto Rican young adults (N=475; mean age=26). Predictor variables included physiologically based psychosocial (i.e., depressive symptoms and family problems with smoking) as well as social-behavioral psychosocial (i.e., rebelliousness and partner's problems with smoking) predictors of nicotine dependence. Using multiple regression analyses, UM-CIDI-defined dependence was predicted by each of the four psychosocial variables, while FTND-defined dependence was predicted only by the social-behavioral variables. These findings bear out the disparate dimensions of nicotine dependence each measure taps. Brook J, Koppel J, Pahl K. Predictors of DSM and Fagerstrom-defined nicotine dependence in African American and Puerto Rican young adults. Subst Use Misuse 2009;44(6):809-822.

Longitudinal Analysis of Movie Exposure to Alcohol Cues and Adolescent Alcohol Problems

The authors tested a theoretical model of how exposure to alcohol cues in movies predicts level of alcohol use (ever use plus ever and recent binge drinking) and alcohol-related problems. A national sample of younger adolescents (baseline N=6,522) was interviewed by telephone with 4 repeated assessments spaced at 8-month intervals. A structural equation modeling analysis performed for ever-drinkers at Time 3 (N=961) indicated that, controlling for a number of covariates, movie alcohol exposure at Time 1 was related to increases in peer alcohol use and adolescent alcohol use at Time 2. Movie exposure had indirect effects to alcohol use and problems at Times 3 and 4 through these pathways, with direct effects to problems from Time 1 rebelliousness and Time 2 movie exposure also found. Prospective risk-promoting effects were also found for alcohol expectancies, peer alcohol use, and availability of alcohol in the home; protective effects were found for mother's responsiveness and for adolescent's school performance and self-control. Theoretical and practical implications are discussed. Wills T, Sargent J, Gibbons F, Gerrard M, Stoolmiller M. Movie exposure to alcohol cues and adolescent alcohol problems: A longitudinal analysis in a national sample. Psychol Addict Behav. 2009;(1):23-35.

Prenatal Smoking, Maternal Mental Health, and Childhood Asthma among Puerto Rican Youth

Childhood asthma is a major public health problem, with mainland and island Puerto Rican children having the highest asthma rates of any ethnic group in the United States. The objective of the study was to examine the relationship between maternal mental health problems, prenatal smoking, and risk of asthma among children in Puerto Rico and the Bronx, New York. A cross-sectional community-based study was conducted in the South Bronx in New York City and the San Juan Standard Metropolitan Area in Puerto Rico. Participants were Puerto Rican children 5 to 13 years of age and their adult caretakers with probability samples of children 5 to 13 years of age and their caregivers drawn at two sites: the South Bronx in New York City (n = 1,135) and San Juan and Caguas, Puerto Rico (n = 1,351). Self-reported maternal mental health problems (vs. none reported) were associated with significantly higher levels of prenatal smoking (p < 0.0001). Both maternal mental health problems and prenatal smoking contributed to increased asthma risk; however after adjusting for prenatal smoking, the relationship between maternal mental health problems and childhood asthma was no longer statistically significant. These results suggest that prenatal smoking may partly explain the observed relationship between maternal psychopathology and childhood asthma. Goodwin R, Canino G, Ortega A, Bird H. Maternal mental health and childhood asthma among Puerto Rican youth: The role of prenatal smoking. J Asthma 2009;6(7):726-730.

Intentions to Quit Smoking among Youth in Substance Abuse Treatment Programs

Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SUD) youths' intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SUD treatment. Participants were 178 adolescents who were in inpatient (n=90) or outpatient (n=88) SUD treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD=1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale). SUD youth intention to quit smoking averaged 4.9 out of 10 (SD=3.2), comparable to intention to quit drinking (M=5.3, SD=3.6), but lower than their intention to quit using drugs (M=6.0, SD=3.4). Teens' intentions to quit smoking were associated with nicotine dependence (r=-.30, p<.01) and smoking cessation related self-efficacy (r=.36, p<.01), but not with pretreatment substance use severity (r=-.15). Controlling for nicotine dependence, teens' intentions to quit smoking were positively related to smoking cessation self-efficacy (pr=.26, p<.01) and intention to quit using illicit drugs (pr=.15, p<.05), but unrelated to intention to quit drinking. Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly. Ramo DE, Prochaska JJ, Myers MG. Intentions to quit smoking among youth in substance abuse treatment. Drug Alcohol Depend. 2009;1-3.

Initial Investigation into Coping with Temptations and Adolescent Smoking Cessation

Although a great deal of research focuses on adolescent cigarette smoking little is known about the process by which adolescents attempt to stop smoking. Resisting temptations to smoke is one of the key challenges encountered by individuals who attempt smoking cessation. A large body of literature has examined coping with temptation among adult smokers, and research on this issue for adolescents is lacking. To further our understanding in this area, the present study reports on an initial examination of the Smoking Temptation Coping Questionnaire (STCQ). The STCQ, which assesses coping in a social pressure situation involving cigarettes, was adapted from the Temptation Coping Questionnaire, a brief self-report measure of adolescent coping with temptations to use alcohol and other drugs. The present study included 109 adolescent participants (aged 14-19 years) in a naturalistic study of smoking self-change. Participants completed baseline and 6-month follow-up interviews. Exploratory factor analysis of the STCQ coping scale yielded a single factor including six strategies for coping with temptations. Analyses provided support for the concurrent, predictive, and construct validity of the STCQ. In particular, the coping scale score significantly predicted prospective duration of abstinence for adolescents who engaged in smoking cessation efforts. These results provide preliminary support for the utility of the STCQ. In addition, findings support the role of temptation coping in the adolescent smoking cessation process. Myers M, Macpherson L. Coping with temptations and adolescent smoking cessation: An initial investigation. Nicotine Tob Res. 2009;11(8):940-944.

Prospective Study of Cigarette Smoking Initiation among Chinese and Korean American Students in College

The present study was a prospective investigation of baseline influences on initial smoking and transition to established smoking among 267 Asian-American college students who had not smoked prior to college. Students of Chinese (52%) or Korean (48%) descent were enrolled during their freshman year in college. Data for the present study were collected during four annual in-person interviews. Two main outcomes were included: initial use of a cigarette, which reflected having first smoked a cigarette (more than a puff) during college, and established smoking, which was defined as having smoked at least 100 cigarettes. Over the course of the study, 25% of baseline never-smokers tried their first cigarette, and 9% became established smokers. Overall, men were significantly more likely to experiment and progress to established smoking. Baseline alcohol and drug use, behavioral undercontrol, and parental smoking predicted smoking experimentation but not established smoking. Students of Korean ethnicity were more likely to become established smokers. However, acculturation was not a significant predictor of experimentation or established smoking after accounting for the effects of other predictors. These findings suggest a need for efforts to prevent smoking uptake among Asian American college students. Myers M, Doran N, Trinidad D, Wall T, Klonoff EA. Prospective study of cigarette smoking initiation during college: Chinese and Korean American students. Health Psychol. 2009;28(4):448-456.

Simultaneous Recruitment of Drug Users and Men Who have Sex with Men in the United States and Russia Using Respondent-Driven sampling: Sampling Methods and Implications

The Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATHCAP) examined the role of drug use in the sexual transmission of the human immunodeficiency virus (HIV) from traditional high-risk groups, such as men who have sex with men (MSM) and drug users (DU), to lower risk groups in three US cities and in St. Petersburg, Russia. SATHCAP employed respondent-driven sampling (RDS) and a dual high-risk group sampling approach that relied on peer recruitment for a combined, overlapping sample of MSM and DU. The goal of the sampling approach was to recruit an RDS sample of MSM, DU, and individuals who were both MSM and DU (MSM/DU), as well as a sample of sex partners of MSM, DU, and MSM/DU and sex partners of sex partners. The approach efficiently yielded a sample of 8,355 participants, including sex partners, across all four sites. At the US sites-Los Angeles, Chicago, and Raleigh-Durham-the sample consisted of older (mean age = 41 years), primarily black MSM and DU (both injecting and non-injecting); in St. Petersburg, the sample consisted of primarily younger (mean age = 28 years) MSM and DU (injecting). The US sites recruited a large proportion of men who have sex with men and with women, an important group with high potential for establishing a generalized HIV epidemic involving women. The advantage of using the dual high-risk group approach and RDS was, for the most part, the large, efficiently recruited samples of MSM, DU, and MSM/DU. The disadvantages were a recruitment bias by race/ethnicity and income status (at the US sites) and under-enrollment of MSM samples because of short recruitment chains (at the Russian site). Iguchi M, Ober A, Berry S, et al. Simultaneous recruitment of drug users and Men Who have Sex with Men in the United States and Russia using respondent-driven sampling: Sampling methods and implications. J Urban Health 2009;86Suppl 1:5-31.

Effect of Cigarette Smoking on HIV Acquisition, Progression, and Mortality

Cigarette smoking is more common among those with HIV compared with the general population. However, it remains unclear whether smoking alters the natural history of HIV infection, or if unique health consequences related to smoking occurs in the context of HIV. In this article, researchers review the literature on the effect of smoking on acquisition of HIV, progression of HIV to AIDS, and mortality. Although there was significant heterogeneity in the study populations evaluated, they found little evidence that cigarette smoking increases the risk for acquiring HIV. Two studies observed that smoking was associated with more rapid CD4 cell count declines, but most data suggest that smoking does not accelerate progression to clinical AIDS. The most consistent finding was an increased risk for respiratory infections in smokers. Although no effect of smoking was seen with AIDS-related mortality, findings related to all-cause mortality were inconclusive. Owing to an increase in chronic non-AIDS outcomes in the post-highly active antiretroviral therapy (HAART) era, smoking is likely an increasingly important contributor to morbidity and mortality in HIV-infected populations. Future investigation of the biological and clinical effects of smoking, and of preventive approaches to reduce the heavy burden among individuals with HIV is warranted. Marshall M, McCormack M, Kirk G. Effect of cigarette smoking on HIV acquisition, progression, and mortality. AIDS Educ Prev. 2009;1(3 Suppl):28-39.

Persistence and Change in Disparities in HIV Infection among Injection Drug Users in New York City after Large-Scale Syringe Exchange Programs

Researchers examined racial/ethnic disparities in HIV infection among injection drug users (IDUs) before and after implementation of large-scale syringe exchange programs in New York City. Participants were recruited from IDUs entering the Beth Israel drug detoxification program in New York City, with n=1203 recruited from 1990 through 1994, prior to large-scale syringe exchange programs (pre-exchange). They were compared with n=1109 participants who began injecting in 1995 or later, who were interviewed 995 through 2008 (post-exchange). There were large differences in HIV prevalence among pre-exchange vs post-exchange participants (African Americans, 57% vs 15%; Hispanics, 53% vs 5%; Whites, 27% vs 3%). Pre- and post-exchange relative disparities of HIV prevalence were similar for African Americans vs Whites (adjusted odds ratio [AOR] = 3.46, 95% confidence interval [CI] = 2.41, 4.96 and AOR = 4.02, 95% CI = 1.67, 9.69, respectively) and Hispanics vs Whites (AOR = 1.76, 95% CI = 1.49, 2.09 and AOR = 1.49, 95% CI = 1.02, 2.17). Racial/ethnic group differences in risk behavior did not explain differences in HIV prevalence. The findings suggest that new interventions are needed to address continuing disparities in HIV infection among IDUs. Self-reported risk behaviors by themselves may not be adequate outcome measures for evaluating interventions to reduce racial/ethnic disparities in HIV infection. Des Jarlais D, Arasteh K, Hagan H, McKnight C, Perlman D, Friedman S. Persistence and change in disparities in HIV infection among injection drug users In New York City after large-scale syringe exchange programs. Am J Public Health 2009;Suppl 2:445-451.

Bridging Sexual Boundaries: Men Who have Sex with Men and Women in a Street-Based Sample in Los Angeles

This study sought to determine the potential contribution of bisexual men to the spread of HIV in Los Angeles. Researchers compared the characteristics and behaviors of men who have sex with men and women (MSMW) to men who have sex with only women (MSW) and men who have sex with only men (MSM) in Los Angeles. Men (N = 1,125) who participated in one of the two waves of data collection from 2005 to 2007 at the Los Angeles site for NIDA's Sexual Acquisition and Transmission of HIV-Cooperative Agreement Program (SATHCAP) were recruited using Respondent Driven Sampling (RDS). Participants completed ACASI and received oral HIV rapid testing with confirmatory blood test by Western Blot. They also provided urine specimens for detection of recent powder cocaine, crack cocaine, methamphetamine, or heroin use. MSM, MSW, or MSMW were defined by the gender of their sex partner/s in the past 6 months. Men were mostly of low income, unemployed, and minority, with many homeless; 66% had been to jail or prison, 29% had ever injected drugs, and 25% had used methamphetamine in the past 30 days. The sample had high HIV prevalence: 12% of MSMW, 65% of MSM, and 4% of MSW. Overall, HIV-positive MSM had more unprotected anal intercourse (UAI) with partners of any HIV status; among HIV-positive MSMW, more had UAI with HIV-negative and HIV status unknown female partners than male partners. Findings highlight the interconnectedness of sexual and drug networks in this sample of men-as most have partners who use drugs and they use drugs themselves. A concentration of risk was found among impoverished minority men, who were heavily involved in drug use, sex trading, and having sex with either gender. Findings also suggest an embedded core group of drug-using MSMW who, driven by their pressing need for drugs and money, may concentrate the epidemic among men and women like themselves who have few resources. Gorbach P, Murphy R, Weiss R, Hucks-Ortiz C, Shoptaw S. Bridging sexual boundaries: Men Who Have Sex With Men and Women in a street-based sample In Los Angeles. J Urban Health 2009;6 Suppl 1:63-76.

Drug Choice, Spatial Distribution, HIV Risk, and HIV Prevalence among Injection Drug Users in St. Petersburg, Russia

The HIV epidemic in Russia has been driven by the unsafe injection of drugs, predominantly heroin and the ephedrine derived psychostimulants. Understanding differences in HIV risk behaviors among injectors associated with different substances has potentially important implications for prevention programs. Researchers examined behaviors associated with HIV risk among 900 IDUs who inject heroin, psychostimulants, or multiple substances in 2002. Study participants completed screening questionnaires that provided data on sociodemographics, drug use, place of residence and injection- and sex-related HIV risk behaviors. HIV testing was performed and prevalence was modeled using general estimating equation (GEE) analysis. Individuals were clustered by neighborhood and disaggregated into three drug use categories: Heroin Only Users, Stimulant Only Users, and Mixed Drug Users. Among Heroin Only Users, younger age, front/backloading of syringes, sharing cotton and cookers were all significant predictors of HIV infection. In contrast, sharing needles and rinse water were significant among the Stimulant Only Users. The Mixed Drug Use group was similar to the Heroin Only Users with age, front/back loading, and sharing cotton significantly associated with HIV infection. These differences became apparent only when neighborhood of residence was included in models run using GEE. The type of drug injected was associated with distinct behavioral risks. Risks specific to Stimulant Only Users appeared related to direct syringe sharing. The risks specific to the other two groups are common to the process of sharing drugs in preparation to injecting. These findings point to the need for increased efforts in HIV prevention education for IDUs in St. Petersburg that take into account the ways that neighborhood differences may influence risky injecting behaviors and preferences for different drugs. Kruse G, Barbour R, Heimer R, et al. Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia.Harm Reduct J. 2009;6:22-29.

Potential Bridges of Heterosexual HIV Transmission from Drug Users to the General Population in St. Petersburg, Russia: Is it Easy to be a Young Female?

The epidemic of HIV in St. Petersburg is currently concentrated among injection drug users (IDUs) but may be penetrating into the general population. Non-IDUs who have IDU sex partners (SP) could be potential bridges in an expanding epidemic. To investigate potential bridges, researchers recruited a convenience sample of 288 non-IDUs whose HIV diagnosis was attributed to sexual transmission and determined the proportion that had IDUs among their SP (IDU SP ever (lifetime) and IDU SP in the last year were the key variables for this analysis). The interaction of gender and age was found to be a significant predictor of having lifetime IDU SP (p = 0.006, chi (2) test) and IDU SP in the last year (p = 0.05, chi (2) test): females aged 26 and younger were more likely to have both lifetime IDU SP and IDU SP in the last year. Among the group of young females, 46% reported ever having an IDU SP. Of young women reporting ever having an IDU SP, 85% also reported at least one lifetime non-IDU SP. Among the females aged 26 or younger, a lower level of education (odds ratio [OR] = 2.7, confidence interval [CI] = 1.1-6.7), being born in St. Petersburg (OR = 2.9, CI = 1.2-7.2), and alcohol use in the last 30 days (OR = 3.5, CI = 1.3-9.6) were significant correlates for ever having had an IDU SP. The findings underscore the need to expand HIV prevention to target this potential bridging population and prevent further transmission. Toussova O, Shcherbakova I, Volkova G, Niccolai L, Heimer R, Kozlov A. Potential bridges of heterosexual HIV transmission from drug users to the general population in St. Petersburg, Russia: Is it easy to be a young female? J Urban Health 2009; 86 Suppl 1:121-130.

The Potential for Bridging of HIV Transmission in the Russian Federation: Sex Risk Behaviors and HIV Prevalence among Drug Users (DUs) and their Non-DU Sex Partners

The HIV epidemic that began in Russia in the mid-1990s has been concentrated mostly among drug users (DUs). Recent evidence of increasing HIV cases among non-DUs attributed to sexual behavior raises potential concern about a more generalized epidemic. This analysis examined the potential for HIV transmission from DUs to their non-DU sex partners, based on data collected during 2005-2008 in St. Petersburg, Russia. A total of 631 DUs were recruited into the sample with an HIV prevalence of 45%. A majority (84%) of DUs reported being sexually active in the past 6 months, and the DU status of their sex partners was reported as: 54% DU, 40% non-DU, and 6% unknown DU status. In 41% of partnerships with an HIV-negative or unknown status partner not known to be DU (potential bridging partnerships), the last reported intercourse was unprotected. Female DUs with potential bridging partnerships were more likely than male DUs to be younger and report homelessness and to have multiple or new sex partners. Many non-DU sex partners of DUs enrolled in the study reported new sex partners in the past 6 months (66%), unprotected intercourse at last sex (60%), and multiple sex partners in the past 6 months (48%). HIV prevalence in this group was 15% (eight out of 53). The high prevalence of HIV among DUs, their sexual contact with non-DUs, and the high-risk sexual behaviors of this potential bridging population together indicate the real potential for an increasingly generalized epidemic. Niccolai L, Shcherbakova I, Toussova O, Kozlov A, Heimer R. The potential for bridging of HIV transmission in the Russian Federation: Sex risk behaviors and HIV prevalence among drug users (DUs) and their non-DU sex partners. J Urban Health 2009; 86 Suppl 1:131-143.

Behaviorally Bisexual Men and their Risk Behaviors with Men and Women

Gay and bisexual men are often treated as a homogenous group; however, there may be important differences between them. In addition, behaviorally bisexual men are a potential source of HIV infection for heterosexual women. In this study, 97 men who use drugs and have sex with men only (MSM) were compared to 175 men who use drugs and have sex with men and women (MSMW). The 175 MSMW were also compared to 772 men who have sex with women only (MSW). Bivariate and multiple logistic regression analyses were performed to assess correlates of MSMW risk behaviors with men and with women as well as whether MSMW, compared with MSW, engaged in more risky behaviors with women. Compared with MSM, MSMW were less likely to be HIV-positive or to engage in unprotected receptive anal intercourse. In contrast, MSMW were more likely than MSW to be HIV-positive and to engage in anal intercourse with their female partners; however, rates of unprotected anal intercourse were similar. The study findings suggest that there may be important differences in HIV risk behaviors and HIV prevalence between MSM and MSMW as well as between MSMW and MSW. Zule W, Bobashev G, Wechsberg W, Costenbader E, Coomes C. Behaviorally bisexual men and their risk behaviors with men and women. J Urban Health 2009; Suppl 1:48-62.

Staphylococcus Aureus in the Community: Colonization versus Infection

Antibiotic-resistant Staphylococcus aureus infections have increased dramatically in the community, yet S. aureus nasal colonization has remained stable. The objectives of this study were to determine if S. aureus colonization is a useful proxy measure to study disease transmission and infection in community settings, and to identify potential community reservoirs. Randomly selected households in Northern Manhattan completed a structured social network questionnaire and provided nasal swabs that were typed by pulsed field gel electrophoresis to identify S. aureus colonizing strains. The main outcome measures were: 1) colonization with S. aureus; and 2) recent serious skin infection. Risk factor analyses were conducted at both the individual and household levels; logistic regression models identified independent risks for household colonization and infection. The 321 surveyed households contained 914 members; S. aureus prevalence was 25% and MRSA was 0.4%. More than 40% of households were colonized. Recent antibiotic use was the only significant correlate for household colonization (p = .002). Seventy-eight (24%) households reported serious skin infection. In contrast with colonization, five of the six risk factors that increased the risk of skin infection in the household at the univariate level remained independently significant in multivariable analysis: international travel, sports participation, surgery, antibiotic use and towel sharing. S. aureus colonization was not significantly associated with serious skin infection in any analysis. Among multiperson households with more than one person colonized, 50% carried the same strain. Given the absence of an association between S. aureus nasal colonization and serious skin infection, further exploration is needed to identify the venues or body sites involved in transmission. The magnitude of colonization and infection within the household also suggests that households are an underappreciated and substantial community reservoir. Miller M, Cook H, Furuya E, Bhat M, Lee M, Vavagiakis P, Visintainer P, Vasquez G, Larson E, Lowy F. Staphylococcus aureus in the community: Colonization versus infection. PLoS One 2009; 4(8):6708-6717.

The Impact of Incarceration upon Adherence to HIV Treatment among HIV-Positive Injection Drug Users: A Qualitative Study

HIV-positive injection drug users (IDU) often do not derive the full benefits of highly active antiretroviral therapy (HAART). Among IDU, recent incarceration has been associated with discontinuation of HAART for non-clinical reasons. Researchers sought qualitative information on experiences with HAART among HIV-positive IDU who had been recently incarcerated within provincial prisons in British Columbia to identify factors influencing adherence to treatment. Twelve in-depth qualitative interviews were conducted with males recruited from a cohort study (ACCESS) involving over 450 HIV-positive IDU. All participants had been incarcerated after initiating HAART. Audio-recorded interviews were conducted to examine experiences of taking HAART in prison, with particular attention to adherence and experiences of treatment discontinuation. Participant accounts described situations where adherence to HIV treatment was compromised in custody. A small number of participants reported treatment interruptions that lasted over a week when they were unable to obtain HIV medications through institutional healthcare. Short-term interruptions in treatment were said to be common during intake into the correctional system and at the point of release from custody. High levels of HIV discrimination motivate prisoners to hide the fact that they are HIV-positive by making efforts to take medications discreetly, which may result in missed doses. The current study identified contextual factors within correctional environments that may hinder individuals' ability to adhere to HAART. The findings suggest that improved health services and coordination with community care providers are needed to enhance the quality of HIV treatment within correctional environments. Small W, Wood E, Betteridge G, Montaner J, Kerr T. The impact of incarceration upon adherence to HIV treatment among HIV-positive injection drug users: a qualitative study. AIDS Care 2009;1(6):708-714.

HIV Testing and Conspiracy Beliefs Regarding the Origins of HIV among African Americans

Conspiracy beliefs regarding the origins of HIV are common among African Americans, and have been associated with engaging in HIV risk behaviors as well as with earlier diagnosis among HIV patients. This study sought to examine the association of HIV serostatus testing with conspiracy beliefs. A total of 1430 African Americans from low-income neighborhoods with high rates of drug use were surveyed in 1997-1999 in face-to-face interviews. Two 4-point items assessed if participants agreed that "AIDS was started by an experiment that went wrong" and "AIDS was created to kill blacks and poor folks." A binary variable indicated if the respondent agreed with the statements. On average, 22.5% of the sample endorsed conspiracy beliefs, 4.0% of whom reported not having had an HIV test, compared to 7.7% of those who did not endorse conspiracy beliefs. In multivariable logistic regression modeling, never having had an HIV test was significantly associated with conspiracy beliefs (adjusted odds ratio [AOR] = 0.43, 95% confidence interval [CI] = 1.3-4.3), having a high school education (AOR = 0.55, CI = 0.35-0.84), having depression (AOR = 1.61, CI = 1.02-2.52), female gender (AOR = 0.54, CI = 0.34-0.86), younger age, and a history of injection drug use (AOR = 0.36, CI = 0.23-0.56), but not sex risk behaviors (multiple partners, irregular condom use). Individuals who have conspiracy beliefs are more likely to have been tested for HIV, however, which may partially explain why HIV-positive individuals who endorsed conspiracy beliefs were more likely to have an earlier diagnosis compared to those who did not endorse such beliefs. Bohnert A, Latkin C. HIV testing and conspiracy beliefs regarding the origins of HIV among African Americans. AIDS Patient Care STDS 2009;23(9):759-763.

Validating the Multidimensional Measure of Cultural Identity for Latinos

The psychometric properties of the Multidimensional Measure of Cultural Identity Scales for Latinos (MMCISL; Félix-Ortiz, Newcomb, & Myers, 1994) have never been examined in an adult Latina sample representing various levels of nativity and nationality. The rationale for the study was to confirm the factor structure and psychometric properties of the MMCISL with a predominantly immigrant sample of Latina mothers and daughters (n = 316). Adequate reliability estimates were found for six of the original ten scales. Confirmatory factor analyses provided evidence of construct validity for the reliable scales. The Preferred Latino Affiliation scale was the only scale to meet strict measurement invariance criteria across mothers and daughters. Criterion validity was evidenced by relations between the Familiarity with Latino Culture scale and all criterion variables. Dillon F, Félix-Ortiz M, Rice C, De La Rosa M, Rojas P, Duan R. Validating the multidimensional measure of cultural identity scales for Latinos among Latina mothers and daughters. Cultur Divers Ethnic Minor Psychol. 2009;15(2):191-201.

Influence of Gender, Sexual Orientation, and Need on Treatment Utilization for Substance Use and Mental Disorders: Findings from the California Quality of Life Survey

Prior research has shown a higher prevalence of substance use and mental disorders among sexual minorities, however, the influence of sexual orientation on treatment seeking has not been widely studied. Researchers used a model of help-seeking for vulnerable populations to investigate factors related to treatment for alcohol or drug use disorders and mental health disorders, focusing on the contributions of gender, sexual orientation, and need. Survey data were obtained from a population-based probability sample of California residents that oversampled for sexual minorities. Logistic regression was used to model the enabling, predisposing, and need-related factors associated with past-year mental health or substance abuse treatment utilization among adults aged 18-64 (N=2,074). Compared with individuals without a diagnosed disorder, those with any disorder were more likely to receive treatment. After controlling for both presence of disorder and other factors, lesbians and bisexual women were most likely to receive treatment and heterosexual men were the least likely. Moreover, a considerable proportion of sexual orientation minorities without any diagnosable disorder, particularly lesbians and bisexual women, also reported receiving treatment. This study highlights the need to better understand the factors beyond meeting diagnostic criteria that underlie treatment utilization among sexual minorities. Future research should also aim to ascertain the effects of treatment provided to sexual minorities with and without diagnosable disorders, including the possibility that the provision of such treatment may reduce the likelihood of their progression to greater severity of distress, disorders, or impairments in functioning. Grella C, Greenwell L, Mays V, Cochran S. Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: Findings from the California Quality of Life Survey. BMC Psychiatry 2009; 9(9):52-62.

Longitudinal Prospective Cohort Study on Differences in Substance Abuse in US vs Immigrant Hispanic Adolescents

The current study was conducted to ascertain whether the effects of nativity (i.e., U.S. born vs. immigrant) on Hispanic adolescent substance use is mediated by ecological processes such as family functioning, school connectedness, and perceived peer substance use. The effects of family, peer, and school processes on adolescent substance use were examined in a nationally representative sample of 742 (358 male, 384 female) Hispanic youth (mean age = 15.9; SD = 1.8). Results from a structural equation model indicated that the higher rates of substance use among U.S.-born Hispanics (compared with foreign-born Hispanics) are partially mediated by perceived peer substance use (as measured by the adolescent). The results also showed that perceived peer substance use and school connectedness mediate the relationship between family processes and substance use, suggesting that family processes may offset some of the deleterious effects of negative peer selection on adolescent substance use. These findings imply that public health behavioral interventions to prevent substance use among both U.S.-born and foreign-born Hispanics may need to attend to multiple ecological processes, including family, school, and peers. Prado G, Huang S, Schwartz S, Maldonado-Molina M, Bandiera F, de la Rosa M, Pantin H. What accounts for differences in substance use among U.S.-born and immigrant Hispanic adolescents? : Results from a longitudinal prospective cohort study. J Adolesc Health 2009; 145(2):118-125.

A Prospective Three Generational Study of Fathers' Constructive Parenting

This prospective, intergenerational study considered multiple influences on 102 fathers' constructive parenting of 181 children. Fathers in the 2nd generation (G2) were recruited as boys on the basis of neighborhood risk for delinquency and assessed through early adulthood. The fathers' parents (G1) and the G2 mothers of G3 also participated. A multiagent, multimethod approach was used to measure G1 and G2 constructive parenting (monitoring, discipline, warmth, and involvement), G2 positive adolescent adjustment, and problem behavior in all 3 generations, including G3 difficult temperament and externalizing problems in early and middle childhood, respectively. Path modeling supported direct transmission of G1 constructive parenting of G2 in late childhood to G2 constructive parenting of G3 in middle childhood. Of note, G1 parenting indirectly influenced G2 parenting through G2 positive adjustment but not through G2 adolescent antisocial behavior. G1 parenting influenced G2 parenting in both early and middle childhood of G3. G2 parenting influenced G3 problem behavior but not vice versa. Intergenerational continuities in parenting persisted, even when additional influences were considered. These findings suggest that transmission pathways are not limited to life-course adversity. Rather, constructive parenting is maintained, in part, by engendering positive adjustment in offspring. Kerr D, Capaldi D, Pears K, Owen L. A prospective three generational study of fathers' constructive parenting: Influences from family of origin, adolescent adjustment, and offspring temperament. Dev Psychol. 2009;(5):1257-1275.

Behavioral Problems and the Occurrence of Tobacco, Cannabis, and Coca Paste Smoking in Chile: Evidence Based on Multivariate Response Models for School Survey Data

In this study the researchers estimate suspected links between youthful behavioral problems and smoking of tobacco, cannabis, and coca paste. In the Republic of Chile, school-attending youths were sampled from all 13 regions of the country, with sample size of 46,907 youths from 8th to 12th grades. A Generalized Estimating Equations (GEE) approach to multiple logistic regression was used to address three interdependent response variables, tobacco smoking, cannabis smoking, and coca paste smoking, and to estimate associations. Drug-specific adjusted slope estimates indicate that youths at the highest levels of behavioral problems are an estimated 1.1 times more likely to have started smoking tobacco, an estimated 1.6 times more likely to have started cannabis smoking, and an estimated 2.0 times more likely to have started coca paste smoking, as compared to youths at the lowest level of behavioral problems (p<0.001). In Chile, there is an association linking behavioral problems with onsets of smoking tobacco and cannabis, as well as coca paste; strength of association is modestly greater for coca paste smoking. Caris L, Anthony C, Ros-Bedoya C, Anthony J. Behavioral problems and the occurrence of tobacco, cannabis, and coca paste smoking in Chile: Evidence based on multivariate response models for school survey data. Drug Alcohol Depend. 2009;104(1-2):50-55.


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