National Institute on Drug Abuse
Director's Report to the National Advisory Council on Drug Abuse
Epidemiology, Etiology and Prevention Research
Monitoring the Future (MTF) Study
Results from the 1999 MTF were released on December 17, 1999. The major findings are summarized below. For more information, go to http://www.nida.nih.gov. The study findings are also available in a NIDA-published report: Johnston, L.D., O'Malley, P.M., & Bachman, J.G. (2000). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 1999. NIH publication 00-4690. Rockville, MD: National Institute on Drug Abuse. This report is available on the internet at http://monitoringthefuture.org/.
Results from the 1999 MTF suggest that, with a few exceptions, use of marijuana and most other illicit drugs remained unchanged from 1998 to 1999 among 8th, 10th, and 12th graders. There were however, notable increases in the use of MDMA (ecstasy) among 12th graders and steroids among 8th and 10th graders. With a few exceptions, use of alcohol, and cigarettes also generally remained unchanged. In addition, for a third year in a row, attitudes toward use of illicit drugs, alcohol, and cigarettes generally remained unchanged or improved in all three grades, although attitudes about steroid use eroded somewhat among high school seniors.
Illicit Drug Use
- Data from the 1999 MTF indicate the rates of illicit drug use remained largely unchanged in 1998 and 1999. Illicit drug use had increased between 1991 and 1996, and slowed between 1996 and 1997. Many differences between 1998 and 1999 were not statistically significant. However, there were notable increases in MDMA and steroids.
- Lifetime, past year, and past month use of any illicit drug did not change from 1998 to 1999 in any of the three grades. However, among 8th graders the 1999 past month rate of 12.2 percent, represented a statistically significant decrease from the high mark of 14.6 percent reached in 1996. Similar results were found for lifetime and past year any illicit use statistics between 1996 and 1999.
- Lifetime, past year, and past month use of marijuana/hashish did not change in any grade between 1998 and 1999. In 1999, lifetime rates of marijuana/hashish were 49.7, 40.9, and 22.0 percent for 12th, 10th, and 8th graders respectively.
- In 1998, lifetime and past year use of crack increased among 8th graders to its highest levels since 1991, the first year data were available for students in this grade. In 1999, past year use of crack declined to 1.8 percent (down from 2.1 percent in 1998). When examining subgroups, declines in past year use occurred among 8th graders residing in the South and West census regions (2.5% and 2.6% in 1998 to 1.9% and 1.8% in 1999 respectively).
- There were no statistically significant differences in inhalant use between 1998 and 1999. During the 9 years for which data are available for 8th graders, lifetime, past year, and past month inhalant use appears to have peaked in 1995. Inhalant use continues to be generally more prevalent among 8th graders than the two higher grades.
- Increases in the use of MDMA (ecstasy) were observed for the first time since 1996, when collection of data on this drug was initiated. Lifetime, past year, and past month use increased between 1998 and 1999 among 12th graders. Lifetime: from 5.8 percent to 8.0 percent; past year: from 3.6 percent to 5.6 percent; past month: from 1.5 percent to 2.5 percent. The increase in past year use among 12th graders occurred among females (2.7% to 5.6%), those residing in the Northeast (3.7% to 9.4%), and those residing in large metropolitan statistical areas (MSAs) (3.2% to 6.1%).
- Past year use among 10th graders also increased (from 3.3 percent in 1998 to 4.4 percent in 1999). The increase in past year use among 10th graders occurred among females (2.9% to 4.2%), those residing in the Northeast (3.8% to 7.0%), and those residing in large metropolitan statistical areas (2.5% to 5.2%).
- Past year use of Rohypnol among 8th graders decreased from 0.8 percent in 1998 to 0.5 percent in 1999. A survey question about Rohypnol, sometimes referred to as the "date rape" drug, was first asked in 1996. While a statistically significant change occurred for 8th graders, it should be kept in mind that these rates are quite small. The 1999 rate for both 10th and 12th graders was 1.0 percent, which was not a statistically significant change from the 1998 rates.
- Use of ice (crystal methamphetamine) in the past year decreased to 1.9 percent among 12th graders in 1999 (it was 3.0 percent in 1998).
- Past year, and past month use of use of steroids increased among 8th and 10th graders. Past year use increased from 1.2 percent in 1998 to 1.7 percent in 1999 for both 8th and 10th graders. Past month use remains under one percent in 8th and 10th grades in spite of increases in 1999 (e.g., 0.5 percent in 1998 to 0.7 percent in 1999 among 8th graders). Also, lifetime use of steroids increased among 10th graders (from 2.0 percent in 1998 to 2.7 percent in 1999). Increases in past year steroid use among 8th graders occurred among males (1.6% to 2.5%) and whites (1.1% to 1.5%). The increase in past year use among 10th graders occurred among males (1.9% to 2.8%).
- Use of marijuana, cocaine, other cocaine, inhalants, heroin, other narcotics, hallucinogens, LSD, PCP, amphetamines, barbiturates, and tranquilizers remained stable for all three grades and all recency-of-use categories (lifetime, past year, past month, and daily use where measured).
- Alcohol use has generally remained stable in the past few years among 8th and 10th graders, and more recently among 12th graders, though at levels which most people would find unacceptably high.
- Daily alcohol use decreased for 12th graders. Use among these students decreased from 3.9 percent in 1998 to 3.4 percent in 1999.
- After decreasing to 38.3 percent in 1998, the proportion of 10th graders reporting having been drunk sometime during the past year increased to 40.9 percent in 1999.
- Also more 8th graders in 1999 had 5 or more drinks in a row during the past two weeks (from 13.7 percent in 1998 to 15.2 percent in 1999). An increase also occurred among males (from 14.4% to 16.4%).
Cigarettes and Smokeless Tobacco
- Use of cigarettes during the past month among 8th graders decreased 1.6 percentage points to 17.5 percent in 1999.
- Between 1997 and 1998, 10th graders' lifetime, past month, and daily use of cigarettes in the past month decreased from 60.2%, 29.8%, and 18.0% in 1997 to 57.7%, 27.6%, and 15.8% in 1998 respectively. Between 1998 and 1999, these rates did not change statistically (the 1999 rates were 57.6%, 25.7%, and 15.9%). However, past month use, decreased among 8th graders (from 19.1% in 1998 to 17.5% in 1999).
- In 1997, daily cigarette use in the past month among seniors was at its highest level since 1979 (24.6% in 1997 vs. 25.4% in 1979). In 1998, seniors' daily smoking decreased to 22.4% and smoking a half-pack or more cigarettes per day decreased from 14.3% to 12.6%. In 1999 seniors' rate of smoking did not change statistically (daily smoking=23.1% and 1/2 pack +/day=13.2%).
- African American students continue to have the lowest rates of smoking. Past month smoking among 8th, 10th, and 12th grade whites and Hispanics is around double or more the rate among their African American peers. For example, in 1999, 14.9 percent of African American seniors report current smoking compared to 40.1 percent of white and 27.3 percent of Hispanic seniors.
Perceived Harm, Disapproval, and Perceived Availability
- Among 8th and 10th graders, there were several changes in the perceived risk and disapproval that were in the favorable direction. Notable changes in perceived availability among 12th graders were found, all favorable. The one notable exception was steroids.
- The perceived harm in trying crack once or twice decreased among 12th graders, declining to 48.2 percent in 1999 from 52.2 percent in 1998.
- Disapproval of using smokeless tobacco regularly increased among 8th and 10th graders. Perceived availability of cigarettes decreased among 8th graders.
- Perceived harmfulness of taking steroids decreased 6 percentage points among 12th graders to 62.1 percent in 1999 (down from 68.1 in 1998). This drop marks the largest attitudinal change ever observed in the MTF.
- In the 1999 survey, more 8th and 10th graders reported personal disapproval of people taking inhalants once or twice. (8th graders: from 83.0 to 85.2 percent; 10th graders: from 85.6 to 88.4 percent).
- Perceived availability of several drugs decreased among seniors; perception of "fairly easy" or "very easy" access decreased for cocaine, LSD, PCP, other psychedelics, amyl/butyl nitrites, heroin, and tranquilizers. The only increase in perceived availability occurred for steroids among 10th graders (from 33.0 percent in 1998 to 35.9 percent in 1999).
- For many drugs, there have been significant increases between 1991 and 1997. The most dramatic case was the change in marijuana use from 1991 to 1997. For 8th graders, past year use of this substance has nearly tripled, from 6.2% in 1991 to 17.7% in 1997. However, between 1996 and 1999, use rates declined for students in this grade. Among sophomores, past year use has more than doubled from 15.2 percent in 1992 to 34.8 percent in 1997, with a statistically significant decrease occurring in 1998 (31.1 percent) and remaining unchanged in 1999. Past year use among seniors has almost doubled from 21.9 percent in 1992 to 38.5 percent in 1997, and remained unchanged in 1998 and 1999 at 37.5 percent and 37.8 percent respectively.
- Between 1991 and 1996, all three grade levels reported increased use of cigarettes. So far, the high mark for cigarette use (lifetime, past month, daily, and _ pack or more per day) appears to have occurred in 1996 for 8th and 10th graders only. Between 1997 and 1998, statistically significant decreases were observed for 10th graders and 12th graders, while estimates among 8th graders did not change. In 1999, past month use decreases among 8th graders (from 19.1 percent in 1998 to 17.5 percent in 1999). All other differences were not statistically significant.
Long-Term Trends (seniors only)
- After more than a decade of declining use (1980-1992), marijuana use rose from 1993 to 1995, remained level from 1995 to 1996, increased again from 1996 to 1997, and remained unchanged in 1998 and 1999. For past year prevalence, self-reported marijuana use by seniors peaked at 50.8 percent in 1979 and then declined to a low of 21.9 percent in 1992. Past year marijuana use then increased steadily to 38.5 percent in 1997 with no change in the 1998 and 1999 rate (37.5 percent in 1998, 37.8 percent in 1999).
- Among seniors in the class of 1997, daily cigarette smoking reached 24.6 percent, its highest level since 1979, when 25.4 percent of seniors reported daily cigarette use. Daily smoking decreased between 1979 and 1980 (21.3 percent) and then remained basically level for many years. During the early 1990's increases were observed, followed by a decrease in 1998 to 22.4 percent. In 1999 the daily rate was 23.1 percent, which is statistically unchanged from the 1998 rate.
Methodological Note: In 1998, Monitoring the Future questionnaires were changed from confidential (i.e., with some identifying information being gathered) to anonymous for half of the 8th and 10th grade samples. Assuming higher rates of self-reporting of drug use when questionnaires are anonymous, this change may have resulted in some overestimation of increases and underestimation of decreases. For example, results from the matched half-sample of 8th graders receiving the anonymous questionnaires in both 1998 and 1999, showed a 1.4 percentage point decline in past year marijuana use while the full sample showed a decline of 0.4 percentage points. However, the change was not statistically significant in either case
The 47th biannual meeting of the Community Epidemiology Work Group (CEWG), was held in Los Angeles, California on December 14-17, 1999. The CEWG is composed of researchers from 21 metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas; emerging drugs of abuse; vulnerable populations and factors that may place people at risk of drug use and abuse; and, negative health and social consequences. Reports are based on drug abuse indicator data, such as morbidity and mortality information, treatment data and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health data, local and State survey information and research findings from ethnographic studies. The following are highlights from the meeting:
IN THE PAST 6 MONTHS...
Following several reporting periods of stable or declining trends, some indicators of cocaine abuse show slight rebounds in many cities; increases among younger age groups in some indicators warrant watching. Some indicators, however, continue to suggest declining or stable trends.
Heroin indicators are mixed. Younger populations continue to initiate use in several cities, and some are shifting from snorting to injecting.
Marijuana indicators suggest generally stable or increasing trends in most CEWG sites.
Declines in methamphetamine consequences are reported in most CEWG sites, especially as reflected in ED data.
"Club drugs," especially GHB, GBL, and MDMA, continue to spread across the country.
Cocaine - Following several reporting periods of stable or declining cocaine trends, mortality, emergency department (ED), and female arrestee urinalysis indicators suggest slight increases in many cities. Based on partial-1999 data, cocaine-related mortality(i) appears to be increasing in three cities (Philadelphia, Phoenix and Seattle) and declining or stable in four (Honolulu, Miami, Minneapolis/St. Paul and San Diego). Cocaine ED mentions(ii) increased significantly in five cities (Dallas, Los Angeles, Philadelphia, Phoenix, and Washington, DC), with the largest shift a 45-percent increase in Dallas. Nonsignificant ED increases were reported in the majority of the other cities; no significant declines were noted. Disturbingly, cocaine ED mentions per 100,000 population in the 12-17 age group increased sharply in four cities (Baltimore, Boston, Dallas, and Denver). By contrast, treatment admission figures(3) show generally declining or stable trends. Generally declining or stable trends were also found in cocaine-positive urinalysis percentages(4) among adult male arrestees, except in Miami and Washington, DC, where levels increased; the drug is now surpassed by marijuana in all but six cities. By contrast, among female arrestees, cocaine is still the most commonly detected drug in all but one city (San Diego); levels increased in six cities (Dallas, Detroit, Minneapolis, Philadelphia, Phoenix, and San Diego) and declined only in Los Angeles. Crack injection continues to be reported in some cities, including Boston, New York, and Washington, DC. Increased availability of cocaine hydrochloride (HCl) is reported in some cities, including Boston, Dallas, Denver, Philadelphia, and Phoenix.
Heroin - Heroin indicators show mixed trends. Mortality figures(1) declined slightly in 5 cities (Honolulu, Minneapolis/St. Paul, Philadelphia, San Diego, and Seattle) and increased only in Phoenix. Heroin ED mentions(2) declined significantly in only one city (San Francisco) and increased significantly in four (Miami, New Orleans, Newark, and Washington, D.C.). Heroin is the predominant drug of choice among treatment admissions(3) (excluding alcohol-only, but including alcohol-in-combination) in 6 of 18 reporting sites. Opiate-positive urinalysis levels(4) among adult males remained relatively low and stable in most cities, excluding Washington, D.C., where opiate-positive levels among adult males more than doubled. Similarly, among adult females, opiate-positive levels remained relatively stable, except in Chicago (where they declined notably) and in Minneapolis and New Orleans (where levels more than doubled). Heroin purity(5) remained stable or declined in most cities; prices fluctuated. Purity declines were particularly steep in three western cities (Denver, Los Angeles, and San Francisco); conversely, purity more than doubled in Miami. Younger populations are increasingly initiating heroin use in many CEWG cities, including Atlanta, Baltimore (especially among suburbanites), Boston (where ethnographic sources report high school students snorting heroin), Denver (where ethnographic sources report college students increasingly using heroin and street youth switching from methamphetamine to heroin use), Philadelphia (where new users are often adolescents), St. Louis, San Diego, San Francisco, and Seattle (where young injectors are increasing). In Atlanta, Baltimore, Chicago, Denver, and New York, the proportion of treatment clients who snort is increasing; conversely, in Newark and Seattle (among younger users), injecting is on an upward trend. In Boston and Miami, new and younger users are reportedly progressing from snorting to injecting. On Chicago's South Side, reports of heroin/cocaine combinations ("speedballs" or "John Belushi") increased, and the proportion of treatment admissions who reported snorting rose dramatically. In Washington, DC, a variant of heroin, nicknamed "bag delight," dissolves without heat.
Marijuana - Marijuana ED mentions(2) increased significantly in 3 cities (Dallas, Philadelphia, and San Diego) and nonsignificantly in 10 others; they remained level in 4 cities; and they declined significantly in only 1 city (New Orleans) and nonsignificantly in 2 cities. Marijuana is the predominant primary drug treatment problem3 in four cities (Denver, Minneapolis/St. Paul, New Orleans, and Seattle). Treatment percentages increased (5-9 percentage points) in three cities (Denver, Philadelphia, and San Diego) and remained relatively stable elsewhere. Among adult male arrestees(4), marijuana has now surpassed cocaine as the most commonly detected drug in the majority of CEWG cities; positive findings increased sharply in four cities (Atlanta, Los Angeles, Miami, and Washington, DC) and remained relatively stable elsewhere. Levels also remained relatively stable among female arrestees, except for notable increases in four cities (Chicago, Denver, Minneapolis, and New Orleans) and a decline in Seattle. Juvenile arrestee levels also remained relatively stable, but they exceeded adult marijuana-positive levels at all four sites where juveniles were tested. In some cities, such as Denver, increased potency resulting from genetic plant manipulation may have contributed to increased consequences, especially among older users who had started smoking marijuana in their teens and have recently resumed use. Marijuana is increasingly used as a delivery medium for other psychoactive drugs. For example, in Chicago, blunts are often laced with either crack or PCP ("3750s"). Marijuana/crack combinations are also reported in Boston, Minneapolis/St. Paul ("fireweed"), and parts of Texas; and marijuana/PCP combinations are also reported in Minneapolis/St. Paul ("happy stick"), Philadelphia ("loveboat" or "wet"), and New York. In Philadelphia, blunts are also laced with cocaine HCl ("turbo"). Marijuana/embalming fluid combinations are reported in Minneapolis/St. Paul ("wets" or "amp"), New York ("duck foot," which also includes the pesticide DDT), and parts of Texas (where this combination also includes PCP). In Texas, joints are also dipped in codeine cough syrup.
Stimulants - Methamphetamine ("crystal meth, "ice") remains concentrated in the West and, to a lesser extent, in some rural areas elsewhere. In the West, recent indicators suggest declines, possibly related to national and community prevention programs, stricter precursor laws, increased clandestine lab seizures, and declining methamphetamine potency. In the East, methamphetamine indicators remain low, but ethnographic and law enforcement evidence indicates a slight increase in availability, especially in rural areas and among whites. Mortality figures(1) show methamphetamine-related deaths remained relatively stable, except in Minneapolis/St. Paul and San Diego where they declined, and in Honolulu and Phoenix where they increased. Methamphetamine ED mentions(2) declined in six cities (Denver, Los Angeles, Phoenix, San Diego, San Francisco, and Seattle) and increased significantly only in Dallas. Methamphetamine remains the number-one primary drug problem among treatment admissions in Honolulu and San Diego(3), although in San Diego most methamphetamine indicators declined. Methamphetamine-positive percentages among adult male arrestees(4) increased notably in only two cities (San Diego and Seattle); percentages among adult female arrestees decreased notably in Phoenix. Methamphetamine users are heterogeneous, consisting of many small subgroups, as suggested by ethnographic data in Atlanta, where methamphetamine indicators appeared for the first time among arrestees. In Minneapolis/St. Paul, "snow," methamphetamine that allegedly contains extra lithium and produces hallucinations, is available. In Phoenix, where lab seizures recently increased dramatically, 2-phenethylamine is present in seizures, and ephedra, an herb, is used as a precursor.
Methylenedioxymethamphetamine (MDMA) ("ecstasy," "E," "Florida dove," "Mitsubishi," "red devils," "white dove," "XTC"), used primarily as a club drug at raves, dance clubs, and college scenes, seems to be increasing in Boston, Miami, New Orleans, New York, and parts of Texas; it is also reportedly available in Atlanta, Chicago, Minneapolis/St. Paul, New Jersey, Phoenix, St. Louis, Seattle, and Washington, DC. In Boston, it seems to be spreading outside the club scene. In Minneapolis/St. Paul, respirator masks rubbed with menthol-based cold ointments are worn after taking MDMA, a practice believed to heighten the drug's effect. In Atlanta, the content of what is sold as MDMA may vary widely. In Miami, Washington, DC, and parts of Texas, LSD and MDMA are combined in a pill form called "nexus," and in Chicago, homemade MDMA is sold as "wigits." Methylphenidate (Ritalin) is abused by young adults in Minneapolis/St. Paul and in middle- and upper-class communities in Boston; African-Americans in Chicago sometimes inject it with heroin or heroin and cocaine. White IDUs in Chicago inject Phenmetrazine (Preludin).
Depressants - Problems associated with "rave" and "club drugs" have dramatically risen in 1999. Gamma-hydroxybutyrate (GHB, a central nervous system depressant) and two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (1,4 BDL, also called tetramethylene) have been increasingly involved in poisonings, overdoses, drug rapes, other criminal behaviors, and fatalities in nearly every CEWG city and their surrounding suburban and rural areas. These products, obtainable over the Internet and sometimes still sold in health food stores, are also available at gyms, nightclubs, raves, gay male party venues, on college campuses, or on the street. They are commonly mixed with alcohol, have a short duration of action, and are not easily detectible on routine hospital toxicology screens. GBL is available in commercial products such as Blue Nitro, Renew-Trient, and Revivarent G, while 1,4 butanediol is sold in products such as Enliven, Weight Belt Cleaner, and Revitalize Plus. New esters and analogs continue to appear as Federal and State laws remove the sale of these drugs. The tranquilizer ketamine ("Special K" or "vitamin K"), also common in the club, rave, and party scene, is reported in numerous cities, including Baltimore (where users are predominantly suburban white youth from middle- and upper-socioeconomic backgrounds), Boston (where some white middle-class youth inject it, it is also used as a heroin adulterant, and it may have been involved in some overdose deaths), Minneapolis/St. Paul (where small amounts appear in crime labs), New York (where it is available on the street, it is either snorted or injected, and it is sometimes mistaken for cocaine HCl), Newark, and Phoenix. Clonazepam (Klonopin or Rivotril) and alprazolam (Xanax, or "sticks") use, in various combinations and with alcohol, has recently increased in Boston, where diverted prescription drug seizures have increased sharply after a recent rash of pharmacy break-ins. Those two drugs have replaced flunitrazepam (Rohypnol) among adolescents in Miami; similarly, in parts of Texas, clonazepam continues to replace flunitrazepam, especially in combination with beer. Flunitrazepam continues to be a problem among treatment admissions in Texas, particularly among young Hispanic males along the Mexican border, and it has been involved in numerous poison control calls. Seizures of that drug have increased during the past year in New Orleans, where it remains common among white upper-class high school and college students. It is also widely available in Atlanta, where it arrives via couriers from Mexico or by mail through Florida from South America. Diazepam remains the most readily available and frequently used pharmaceutical depressant in Chicago; in New York, however, it is now second to alprazolam as the leading psychoactive prescription drug. Recent deaths in Seattle have involved concomitant injection of heroin and a depressant, typically diazepam.
Hallucinogens - Despite relatively low numbers in traditional data sources, qualitative data suggest that hallucinogen use is not uncommon among adolescents and young adults. Emergency department mentions generally declined for both lysergic acid diethylamide (LSD) (significantly in Baltimore, New Orleans, and San Francisco) and phencyclidine (PCP) (significantly in seven cities: Denver, Detroit, Miami, Minneapolis/St. Paul, New York, San Francisco, and Washington, DC); however, PCP mentions increased significantly in Dallas and New Orleans. Among arrestees, PCP-positive findings remained generally stable, except for a slight increase in Dallas and, following a decade of marked decline, a marked upturn in Washington, DC. The recent increases in the Dallas PCP indicators may reflect the use of marijuana cigarettes dipped in embalming fluid containing PCP. PCP is often smoked with marijuana, as continues to be reported in Chicago ("wicky stick" or "donk"), New York, and St. Louis. Some medical emergencies in south Florida have involved LSD abused with "rolls" (MDMA and cocaine). In parts of Texas, LSD is sometimes mixed with other drugs such as MDMA, diazepam, and Demenex (a diet pill from Mexico), and it is sometimes sold with methamphetamine. LSD in Dallas is becoming more available in the young adult nightclub scene. In Seattle, LSD and mushrooms turn up frequently at local concerts or raves. Psilocybin mushrooms ("shrooms") and mescaline are common among adolescents and young adults in Boston. In New York, the term "eaters" refers to teenagers and young adults who use locally grown mushrooms, which are sometimes dipped in or treated with PCP, LSD, or methamphetamine. Peyote is readily available in Phoenix.
Other drugs-A substance with mild hallucinogenic effects, called "red rock opium," "red run," and "red stuff," is smoked in Baltimore in combination with marijuana. It contains dracorhodin, a compound found in the plant Daemonorops draco ("dragon's blood"), used in varnishes and stains, as an herbal medicine, and to make incense. Teenagers in south Florida occasionally abuse two local anticholinergic plants, "devil's trumpet" and "angel's trumpet," by various routes (orally or via smoking), for their hallucinogenic properties. The plants' toxic effects have led to at least three medical emergencies. Jimson weed was involved in one recent death and several poison center calls per month in Phoenix. Cough medicines with dextromethorphan (DXM) are commonly abused by teens in Boston and Minneapolis/St. Paul ("robo tripping"). "Huffing" of toluene and other solvents continues among youth in Philadelphia. Three of four recent inhalant deaths in Phoenix involved toluene. Inhalant deaths also continue to be reported in Texas. Sildenafil citrate (Viagra) is reportedly used as a recreational drug in Boston. Needle exchange personnel in areas surrounding Boston report steroid injection among young male body builders. In Atlanta, law enforcement sources note the potential for abuse of the anabolic steroid clenbuterol (Spiropent) by weight lifters.
(1) Mortality figures are for 1998 versus 1999 projections (based on first-half-year 1999 data) and were available in six reporting areas.
(2) Emergency department mentions are for 20 CEWG cities in the Drug Abuse Warning Network (DAWN) of SAMHSA's Office of Applied Studies; comparisons are for 1997 versus 1998 estimates, except for age group comparisons, which are for 1996 versus 1998; changes are noted only when statistically significant at pÐ0.05.
(3) Treatment admission figures are primary drug of abuse as a percentage of total admissions; total admissions exclude alcohol-only but include alcohol-in-combination. Comparisons generally are for first-half-1998 versus first-half-1999 data.
(4) Arrestee urinalysis data are for the 18 CEWG cities in the National Institute of Justice's Arrestee Drug Abuse Monitoring (ADAM) program; comparisons are for 1998 versus first-half-1999; first-half-1999 data are preliminary; changes are noted only when they are _5 percentage points.
(5) Heroin price and purity information are for 19 CEWG cities in the Drug Enforcement Administration (DEA) Domestic Monitor Program (DMP); comparisons are for 1998 versus first-half-1998.
Effects of Adolescent Substance Use on Autonomy, Positive Activity Involvement, and Perceived Competence in Young Adulthood
Researchers at Arizona State University used data from a longitudinal study of a children of alcoholics and demographically matched controls to test the relationship between adolescent alcohol and drug use and later young adult autonomy, positive activity involvement, and perceived competence. Participants were assessed in three annual interviews in adolescence (mean age: 12.7 years at Time 1) and then again 5-7 years later, in young adulthood (median age: 20 years). Path analyses and latent growth curve models were used to test the effects of adolescent substance use on both self-reported and collateral-reported outcomes, controlling for correlated risk factors (parental alcoholism, adolescent psychopathology, and parental support), preexisting levels of the outcome, and concurrent young adult substance use. Results showed that adolescent drug and alcohol use were associated with lowered levels of young adult autonomy, positive action, and competence, and that these effects remained significant after controlling for a variety of adolescent risk factors, concurrent young adult drug use, and preexisting levels of youth adult outcome variables. Alcohol use effects were more complex. Adolescent heavy drinking was associated with less positive adult outcomes, but more in collateral reports than in self- reported outcomes. Moreover. young adult heavy drinking was either uncorrelated with or positively correlated with higher levels of perceived competence, suggesting different developmental significance of alcohol use in adolescence than in young adulthood. These findings suggest that prevention of drug abuse in adolescents can not only have proximal benefits such as reductions in impaired driving but also improve psychosocial outcomes such as autonomy and competence. Chassin, L., Pitts, S.C., and DeLucia, C. The Relation of Adolescent Substance Use to Young Adult Autonomy, Positive Activity Involvement, and Perceived Competence. Development and Psychopathology, 11(4), pp. 915-932, 1999.
Competence Skills Help Deter Smoking Among Inner City Adolescents
This study tested whether higher levels of general competence are linked to more frequent use of refusal assertiveness, that is in turn related to less subsequent smoking among inner city adolescents. It was based on a longitudinal study conducted during a 3-year middle school or junior high school period. A sample of 1459 students attending 22 middle (ages 11-14 years) and junior high (ages 12-15 years) schools in New York City participated. Students completed surveys at baseline, one year follow up, and two year follow up. The students self reported smoking, decision making skills, personal efficacy, and refusal assertiveness. Teams of three to five data collectors administered the questionnaire following a standardized protocol. These data were collected in school during a regular 40 minute class period. Results from structural equation modeling showed that decision making and personal efficacy (that is, general competence) predicted higher refusal assertiveness and this greater assertiveness predicted less smoking at the two year follow up. The tested model had a good fit and was parsimonious and consistent with theory. The authors concluded that smoking prevention programs often teach refusal skills in order to help youth resist peer pressure to smoke. The present findings suggest that teaching general competence skills may help to reduce smoking because youth with better personal efficacy and decision making skills are better able to implement smoking refusal strategies. Epstein, J.A., Griffin, K.W., Botvin, G.J. Competence Skills Help Deter Smoking Among Inner City Adolescents. Tobacco Control, 9(1), pp. 33-39, 2000.
The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence
This study, guided by the social development model, examined the dynamic patterns and predictors of alcohol and marijuana use onset. Survival analysis and complementary log-log regression were used to model hazard rates and etiology of initiation with time-varying covariates. The sample was derived from a longitudinal study of 808 youth interviewed annually from 10 to 16 years of age and at 18 years of age. Alcohol initiation rose steeply up to the age of 13 years and then increased more gradually; most participants had initiated by 13 years of age. Marijuana initiation showed a different pattern, with more participants initiating after the age of 13 years. This study showed that: (1) the risk of initiation spans the entire course of adolescent development; (2) young people exposed to others who use substances are at higher risk for early initiation; (3) proactive parents can help delay initiation; and (4) clear family standards and proactive family management are important in delaying alcohol and marijuana use, regardless of how closely bonded a child is to his or her mother. Kosterman, R., Hawkins, J.D., Guo, J., Catalano, R.F., and Abbott, R.D. The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence. American Journal of Public Health, 90(3), pp. 360-366, 2000.
Developmental Associations between Substance Use and Violence
In a study of the developmental associations between substance use and violence, investigators focused on the trends in each behavior throughout adolescence, how the behaviors covaried over time, and the symmetry of associations taking into account frequency and severity of each behavior. They also examined whether changes in one behavior affected changes in the other behavior over time. Six years of annual data were analyzed for 506 boys who were in the 7th grade at the first assessment. Concurrent associations between frequency of substance use and violence were relatively strong throughout adolescence and were somewhat stronger for marijuana than alcohol, especially in early adolescence. Type or severity of violence was not related to concurrent alcohol or marijuana frequency, but severity of drug use was related to concurrent violence frequency. Depending, to some degree, on the age of the subjects, the longitudinal relationships between substance use and violence were reciprocal during adolescence and slightly stronger for alcohol and violence than for marijuana and violence. Further, increases in alcohol use were related to increases in violence; however, when early alcohol use was controlled, increases in marijuana use were not related to increases in violence. Only in early adolescence was the longitudinal relationship between marijuana use and later violence especially strong. The strength of the longitudinal associations between violence and substance use did not change when common risk factors for violence and substance use were controlled. Overall, the data lend more support for a reciprocal than for a unidirectional association between substance use and violence. Prevention efforts should be directed at aggressive males who are multiple-substance users in early adolescence. White, H.R., Loeber, R., Stouthamer-Loeber, M., Farrington, D.P. Developmental Associations between Substance Use and Violence. Development and Psychopathology, 11(4), pp. 785-803, 1999.
Tobacco Smoking and Depressed Mood in Late Childhood and Early Adolescence
Building on previous observations about a suspected causal association linking tobacco smoking with depression, investigators at Johns Hopkins University used prospective data to study the temporal sequencing of tobacco smoking and depressed mood in late childhood and early adolescence. The sample consisted of 1731 youths (aged 8-9 to 13-14 years) attending public schools in a mid-Atlantic metropolitan area; they were assessed at least twice from 1989 to 1994. Survival analysis was used to examine the temporal relationship from antecedent tobacco smoking to subsequent onset of depressed mood, as well as from antecedent depressed mood to subsequent initiation of tobacco use. Tobacco smoking signaled a modestly increased risk for the subsequent onset of depressed mood but antecedent depressed mood was not associated with a later risk of starting to smoke tobacco cigarettes. This evidence is consistent with a possible causal link from tobacco smoking to later depressed mood in late childhood and early adolescence, but not vice versa. Wu, L.T. and Anthony, J.C. Tobacco Smoking and Depressed Mood in Late Childhood and Early Adolescence. American Journal of Public Health, 89(12),
pp. 1837-1840, 1999.
Tobacco Smoking and Other Suspected Antecedents of Nonmedical Psychostimulant Use in the United States, 1995
This study investigates the extent to which tobacco smoking is associated with the nonmedical use of psychostimulants and the temporal order of the age of first use for tobacco and psychostimulants within a nationally representative sample of United States household residents. At the same time, alcohol use and other suspected determinants of psychostimulant use are investigated and held constant, using multiple regression models. Data were taken from public use files of the 1995 National Household Survey on Drug Abuse. Conditional logistic regression analyses were performed to derive estimated relative odds of using stimulants for tobacco smokers versus nonsmokers, holding constant other potentially distorting influences. The study found an independent association between tobacco smoking and nonmedical use of stimulant drugs, with and without adjustment for suspected confounding variables. Additional variables identified as being associated with lifetime stimulant use included lifetime alcohol use, being male, being 18-24 years of age, and not being married. This study provides recent evidence on tobacco smoking as one of the potentially malleable risk factors for the nonmedical use of stimulant drugs. Wu, L.T. and Anthony, J.C. Tobacco Smoking and Other Suspected Antecedents of Nonmedical Psychostimulant Use in the United States, 1995. Substance Use & Misuse, 34(9), pp. 1243-1259, 1999.
Male Twin Study of Substance Use and Disorders
This study used data from personal interviews of 1198 male-male twin pairs from a population-based registry to investigate sources of individual differences in risk. Models were fit to the data to assess the relative contributions of genetic and familial-environmental factors to use, heavy use, abuse and dependence of several categories of substances. Findings suggest that the use of any drug, cannabis and hallucinogens are influenced by both genetic and environmental factors, while twin resemblance for use of sedatives, stimulants, cocaine, and opiates, and heavy use, abuse, and dependence of most substances, resulted from only genetic factors. Heritability of risk ranged between 60 and 80 percent. A number of potential limitations and biases were considered and discussed. This study adds importantly to the growing body of data supporting genetic factors as powerful predictors of drug use disorder liability, and has important implications for prevention and treatment. Kendler, K.S., Karkowski, L.M., Neale, M.C., and Prescott, C.A. Illicit Psychoactive Substance Use, Heavy Use, Abuse, and Dependence in a US Population-Based Sample of Male Twins. Archives of General Psychiatry, 57, pp. 261-269, 2000.
Drug Problems and Psychological Distress Among a Community Sample of Adults
Although the comorbidity of drug abuse and psychological distress is well established in adult treatment samples, the directionality of this association is in question. There is less evidence that this relationship exists among community samples of adults. The prospective relationships between psychological distress and drug problems (e.g., alcohol, marijuana, and cocaine) were examined in a community sample of 470 adults. Results addressed three theories -- self-medication/self-derogation, impaired functioning and general deviance -- to explain the relationship between drug use and psychological distress. Although the latent construct of polydrug problems was largely unaffected by psychological distress and generally had no effect on psychological distress, several specific effects emerged. Providing support for the impaired-functioning theory, adults who abused drugs early on experienced later impaired functioning, anxiety, suicidal ideation, psychoticism, hostility, and decreased purpose in life four years later, providing support for both the self-medication and self-derogation theories. Those who experienced aspects of psychological distress (e.g., dysphoria, suicidal ideation) reported drug problems four years later. Moderate cross-sectional support was also found for the general deviance theory in that social conformity reduced or eliminated the associations between polydrug problems and the measures of psychological distress. Implications of these findings are discussed. Newcomb, M.D., Vargas-Carmona, J., and Galaif, E.R. Drug Problems and Psychological Distress Among a Community Sample of Adults: Predictors, Consequences, or Confound? Journal of Community Psychology, 27(4), pp. 405-429, 1999.
Childhood Peer Rejection and Aggression Predicting Delinquency in Adolescence
In this study sociometric surveys were completed at third grade for a predominantly low-socioeconomic status, urban sample of African American boys and girls, and youth reports of delinquency were gathered at grades 6, 8, and 10. Results showed that patterns of association between childhood peer rejection and aggression and delinquency severity varied by gender. For boys, the additive effect of childhood peer rejection and aggression was a strong predictor of more serious delinquency, whereas for girls only aggression predicted more serious delinquency. For boys, the combination of peer rejection and aggression was associated with felony assaults, and aggression was associated with a wide variety of offenses during adolescence, whereas for girls only peer rejection predicted involvement in minor assault. Results of the study were discussed in terms of the early starter pathway of antisocial behavior as it relates to peer rejection and aggression for boys, differing predictive patterns for girls, and implications for intervention with children with emotional and behavioral disorders. Miller-Johnson, S., Coie, J.D., Maumary-Gremaud, A., Lochman, J., and Terry, R. Relationship Between Childhood Peer Rejection and Aggression and Adolescent Delinquency Severity and Type Among African American Youth. Journal of Emotional and Behavioral Disorders, 7 (3), pp. 137-146, 1999.
Outcomes of Universal Family-Focused Preventive Interventions: One- and Two-Year Follow-ups of a Controlled Study
This article summarizes the literature on alcohol initiation outcomes of universal family interventions and examines the long-term effects of the Iowa Strengthening Families Program (ISFP), a drug abuse prevention program. The ISFP was a longitudinal, controlled efficacy study with 446 families from 22 rural school districts. Alcohol initiation has been shown to be a precursor to drug initiation. In this study, a four-item index of alcohol initiation was used (Alcohol Initiation Index - AII), with low scores representing a lower level of initiation. Higher- and lower-dosage intervention groups were compared on individual initiation behaviors. AII scores were significantly lower among intervention group adolescents than among control group adolescents (e.g., onset of drinking without parental permission, onset of drunkenness) ranged from approximately 30% to 60% lower) at one- and two-year follow-up assessments. Intervention dosage-related initiation differences were evident only at the one-year follow-up. Spoth, R., Redmond, C., & Lepper, H. Alcohol Initiation Outcomes of Universal Family-Focused Preventive Interventions: One- and Two-Year Follow-ups of a Controlled Study. Journal of Studies on Alcohol, (Suppl. 13), pp. 103-111, 1999.
Predicting Violent Behavior
Data from the Seattle Social Development Project (SSDP), a prospective study involving a panel of youths followed since 1985 were used to replicate and extend findings on risk factors for youth. Data on potential risk factors for violence at age 18 years were measured at ages 10, 14, and 16 years. Changes in the strength of prediction over time were examined in the individual, family, school, peer and community domains. Attention was also given to the additive strength of increasing numbers of risk factors in the prediction of violence at age 18 years and the correct classification of youth having committed a violent act. At each age, risk factors strongly related to later violence were distributed among the five domain areas. Ten of 15, 20 of 25, and 19 of 21, risk factors measures at ages 10, 14, and 16, respectively were predictive of violent acts at age 18. Several risk factors were important across time, for example hyperactivity, low academic performance, peer delinquency, and availability of drugs in the neighborhood predicted violence at ages 10, 14, and 16 years. Analyses of the additive effects of risk factors revealed that youths exposed to multiple risks were more likely than others to engage in later violence. Compared to youth exposed to fewer than 2 risk factors, those exposed to 5 or more were 7 times more likely to have been violent at age 20 and 10 times more likely to have been violent at ages 14 and 16. The overall accuracy of predicting youths that would go on to commit violent acts was limited. Herrenkohl, T.I., Maguin, E., Hill, K.G., Hawkins, J.D., Abbott, R.D., and Catalano, R.F. Developmental Risk Factors for Youth Violence. Journal of Adolescent Health, 26(3), pp. 176-186, 2000.
Predictors of Youth Violence
Adolescents are more likely to perpetrate and be victimized by interpersonal violence than any other age group. Researchers from the University of Washington and the Research Institute on Addictions, Buffalo, NY have examined the risk factors in the individual, family, school, peer and community domains that predict youth violence at age 18. In a prospective study from the Seattle Social Development Project, data on risk factors were collected at ages 10, 14, and 16 and used to predict violent behavior at age 18. Of the eleven constructs measured at all three ages, four consistently predicted later violence: hyperactivity (parent rating), low academic performance, peer delinquency, and availability of drugs. Risk factors for violence at age 18 were identified as early as age 10, but the strength of the associations between risk factors and violence at age 18 years generally increased at ages 14 and 16 years. Paralleling findings from research on delinquency, mental health disorders, and substance use, youths exposed to multiple risks at each developmental point were more likely to engage in violence at age 18. Taken together these findings provide strong justification for directing preventive interventions to populations exposed to high numbers of risks. Herrenkohl, T.I., Maguin, E., Hill, K.G., Hawkins, J.D., Abbott, R.D., and Catalano, R.F. Developmental Risk Factors for Youth Violence. J. of Adolescent Health, 25(1), pp. 1-11, 1999.
Effects of Confidential Versus Anonymous Survey Procedures on Reporting of Drug Use and Related Attitudes and Beliefs
This study examines the question, "If young people are asked to report their use of drugs, what survey procedures are most likely to produce truthful responses?" This issue was particularly salient because the Monitoring the Future Study was changing from a confidential to a fully anonymous procedure for 8th and 10th grade students. Nationally representative samples of 8th and 10th grade students were surveyed, some in anonymous conditions and some in confidential conditions. Sample sizes were 18,667 8th graders (49.8 percent in anonymous) and 15,419 10th graders (48.9 percent in anonymous). Results show that 10th grade students surveyed with the confidential procedures were just as willing to report their drug-using behaviors as were those surveyed using anonymous procedures. Among 8th graders, results show that at most there was only a very modest mode of administration effect and quite possibly no effect at all. These findings are reassuring for school-based surveys that use confidential conditions to research student drug use and related attitudes and beliefs. O'Malley, P.M., Johnston, L.D., Bachman, J.G., and Schulenberg, J. A Comparison of Confidential Versus Anonymous Survey Procedures: Effects on Reporting of Drug Use and Related Attitudes and Beliefs in a National Study of Students. Journal of Drug Issues 30(1), pp. 35-54, 2000.
Initial Positive Impact of Using Fast Track with A High Risk Child Sample
Fast Track is a multisite, multicomponent preventive intervention for young children at high risk for long-term antisocial behavior. Based on a comprehensive developmental model, the intervention included a universal-level classroom program plus social skills training, academic tutoring, parent training, and home visiting to improve competencies and reduce problems in a high-risk group of children selected in kindergarten. Results at the end of first grade showed moderate positive effects on children's social, emotional, and academic skills, peer interactions and social status, and conduct problems and special-education use. Parents reported less use of physical discipline, greater ease and/or satisfaction in parenting, more positive involvement with their children, and increased school involvement. There was minimal evidence of differential intervention effects across child gender, race, site, and cohort. Bierman, K.L., Coie, J.D., Dodge, K.A., Greenberg, M.T., Lochman, J.E., McMahon, R.J., and Pinderhughes, E.E. Initial Impact of the Fast Track Prevention Trial for Conduct Problems: I. The High-Risk Sample. Journal of Consulting and Clinical Psychology, 67 (5), pp. 631-647, 1999.
Effectiveness of the PATHS Curriculum and Teacher Consultation in the Fast Track Prevention Model
In this study the authors examined the effectiveness of the universal component of the Fast Track prevention model: the PATHS (Promoting Alternative Thinking Strategies) curriculum and teacher consultation. They used a randomized clinical trial involving 198 intervention and 180 comparison classrooms from neighborhoods with greater than average crime in 4 U.S. locations. In the intervention schools, first grade teachers delivered a 57-lesson social competence intervention focused on self-control, emotional awareness, peer relations, and problem solving. Findings indicated significant effects on peer ratings of aggression and hyperactive-disruptive behavior and observer ratings of classroom atmosphere. Quality of implementation predicted variation in assessments of classroom functioning. Bierman, K.L., Coie, J.D., Dodge, K.A., Greenberg, M.T., Lochman, J.E., McMahon, R.J., Pinderhughes, E.E. Initial Impact of the Fast Track Prevention Trial for Conduct Problems: II. Classroom Effects. Journal of Consulting and Clinical Psychology, 67 (5), pp. 648-657, 1999.
Dynamics of Alcohol and Marijuana Initiation
The Seattle Social Development Project has followed the initiation of alcohol and marijuana prospectively in 808 subjects beginning in fifth grade (10 _ years old) and continuing through age 18. A large portion of the participants were from low-income households; half of the subjects participated in the school free-lunch program. The sample was gender balanced and the ethnic composition was 46% Caucasian, 24% African American, 21% Asian American, and 3% from other ethnic groups. The social development model provided the framework for examining etiology, and this analysis focused on individual, family, and peer constructs. At age 10 _, 25% of the sample had tried alcohol and 3% had tried marijuana. Alcohol initiation rose relatively quickly to about age 13, by which time the cumulative initiation rate was 64%. From age 13 to 18 the rate of initiation slowed. In contrast, marijuana initiation remained relatively flat through age 13, and then the rate of initiation increased over the next 5 years until by age 18, 50% of the sample had initiated marijuana use. Asian American ethnicity reduced the likelihood of alcohol use, as did strong parental norms about teen alcohol use, while alcohol use by peers and associates increased the likelihood of initiation. For marijuana, African Americans and Native Americans were more likely to initiate use and Asian Americans were less likely to initiate use than Caucasians. Males were more likely to initiate use, as were those who had previously initiated alcohol use. Parents' proactive family management inhibited initiation as did teens' own norms against marijuana use, but marijuana use by acquaintances and siblings was a strong predictor of initiation. This study suggests that prevention efforts should span the entire adolescent period, with alcohol prevention efforts directed toward preteen years and marijuana prevention efforts focused on later teen years. Prevention efforts should encourage clear family standards and proactive management as well as address the influence of peers, siblings, and other acquaintances who use drugs and alcohol. Kosterman, R., Hawkins, J.D., Guo, J., Catalano R.F., and Abbott, R.D. The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence. American Journal of Public Health, 90, pp. 360-366, 2000.
Protective Effect of Social-Environmental Factors on Future Drug Use
This research focuses on the interrelation of the parent-child attachment, unconventionality, friends' drug use, and the young adult's use of drugs. Data were collected from participants at 4 points in time: early adolescence, late adolescence, early 20s, and late 20s. Data were collected from mothers at the 3 points in time that corresponded with the first 3 collections of data from their children. Both the youths and their mothers were individually interviewed. The findings indicated that the effect of parent-child mutual attachment was mediated through early adolescent personality attributes of greater responsibility, less rebelliousness, and intolerance of deviance. These non-drug-prone personality and behavioral attitudes, in turn, insulated the young adult from affiliating with drug-using peers, and these attitudes were related to less drug use in the early 20s and ultimately in the late 20s. The results suggest that interventions focused on enhancing parent-child mutual attachment should result in a reduction of the risk factors conducive to drug use during the late 20s. The fact that these findings cover a decade and a half, from early adolescence to the late 20s, underscores the significance of placing drug use in a perspective that includes familial and behavioral aspects. Brook, J.S., Whiteman, M., Finch, S., and Cohen, P. Longitudinally Foretelling Drug Use in the Late Twenties: Adolescent Personality and Social-Environmental Antecedents. J. Genet. Psychol., 161(1), pp. 37-51, 2000.
The Course of Well-Being and Substance Use During the Transition to Young Adulthood
This study examines the impact of social roles and contexts on health and well-being between the senior year of high school (age 18) and 4 years post-high school (age 22) using multicohort national panel data drawn from the Monitoring the Future study. The project has surveyed nationally representative samples of about 17,000 high school seniors each year in the United States since 1975 using questionnaires administered in classrooms. About 2,400 individuals are randomly selected from each senior year cohort for follow-up. The panel sample used in this study consisted of 17 consecutive cohorts of respondents who were surveyed as high school seniors from 1976 through 1992 and who participated in the first two biennial follow-up surveys. The purpose was to determine the extent to which the individual-level courses of well-being and substance use during the transition from adolescence to young adulthood varied as a function of cohort, gender, and life paths. Results showed that during this transition, well-being increased significantly (i.e., self-esteem, self-efficacy, and social support increased; self-derogation, fatalism, and loneliness decreased) as did substance use (i.e., cigarette, alcohol, and marijuana use; binge drinking). However, self-efficacy did not increase as much in the more recent cohorts compared with the earlier ones. Over time, absolute levels of well-being have changed little, and the same is true for gender and life-path differences in well-being. Substance use was higher in the earlier cohorts than in the later, generally representing period effects. For nearly all measures, men reported higher levels of well-being and substance use compared with women. Among the life paths, there were many overall differences in both well-being as well as substance use. Schulenberg, J., O'Malley, P.M., Bachman, J.G., and Johnston, L.D. "Spread Your Wings and Fly": The Course of Well-Being and Substance Use During the Transition to Young Adulthood. In L. J. Crockett & R. K. Silbereisen (Eds.), Negotiating Adolescence in Times of Social Change. New York: Cambridge University Press, pp. 224-255, 2000.
Predicting Boys' Externalizing Behavior and Risk of Developing Substance Use Disorder
Applying an ontogenetic framework for understanding the development of substance use disorders (SUD), researchers at the Pennsylvania State University and the University of Pittsburgh examined individual traits in family context to identify processes that account for the relationship between fathers' substance use (SUD+ or SUD-) status and sons' externalizing behaviors. Results obtained from SUD+ (n = 89) and SUD- (n = 139) families show that fathers' abusive propensities toward their sons mediated the relationship between fathers' SUD+ status and sons' externalizing behavior scale (EBS) scores 2 years later. Thus, fathers' abusive propensities toward their sons may reflect a process in which SUD liability is transmitted, in part, through a harsh, unnurturing family. Individual traits, family contextual variables, and deviant peer affiliations accounted for 58 percent of the variance on sons' EBS scores. The authors speculate that children reared in harsh, controlling family contexts may develop callous traits such as lack of empathy for others, and such traits in children have been associated with greater levels of conduct problems. They conclude that family-based prevention programs that take account of members' temperament traits and the abusive propensities of parents toward offspring may help to reduce children's liability to Conduct Disorder and Substance Use Disorder outcomes. Blackson, T.C., Butler, T., Belsky, J., Ammerman, R.T., Shaw, D.S., and Tarter, R.E. Individual Traits and Family Contexts Predict Sons' Externalizing Behavior and Preliminary Relative Risk Ratios for Conduct Disorder and Substance Use Disorder Outcomes. Drug and Alcohol Dependence, 56(2), pp. 115-131, 1999.
Hormonal and Behavioral Homeostasis in Boys at Risk for Substance Abuse
A study at the Center for Education and Drug Abuse Research (CEDAR) at the University of Pittsburgh examined the influences of cortisol reactivity, androgens, age-corrected pubertal status, parental personality, and family and peer dysfunction on behavioral self-regulation (BSR) in boys at high average risk (HAR) and low average risk (LAR) for substance abuse. Differences between risk groups in cortisol and androgen concentrations, and cortisol reactivity were also examined. Subjects were 10-12-year-old sons of substance abusing fathers (HAR; n = 150) and normal controls (LAR; n = 147). A multidimensional construct of BSR was developed based on multiple measures and multiple informants. Boys reported on family dysfunction and deviant behavior among their peers. Parents reported on their propensity to physically abuse their sons, and their own number of DSM-III-R Antisocial Personality Disorder symptoms. Endocrine measures included plasma testosterone, dihydrotestosterone, and salivary cortisol. HAR boys, compared to LAR boys, had lower mean concentrations for testosterone, dihydrotestosterone, salivary cortisol prior to evoked related potential testing, and lower cortisol reactivity. The number of maternal Antisocial Personality Disorder symptoms, parental potential for physical abuse, degree of family dysfunction, and peer delinquency were significantly associated with BSR. Parental aggression, antisocial personality symptoms, and parental physical abuse potential are likely to influence sons' behavioral dysregulation and homeostatic stress reactivity. These key components of liability are posited to increase the likelihood of developing suprathreshold Psychoactive Substance Use Disorder (PSUD). The authors suggest that interventions to prevent exacerbation of poor behavioral self regulation should address family dysfunction and deviant peer affiliation as well as the severity of current BSR impairment. Dawes, M.A., Dorn, L.D., Moss, H.B., Yao, J.K., Kirisci, L., Ammerman, R.T., and Tarter, R.E. Hormonal and Behavioral Homeostasis in Boys at Risk for Substance Abuse. Drug and Alcohol Dependence, 55(1-2), pp. 165-176, 1999.
Deprivation and Deviance
Using multivariate logistic regression, this study estimated models showing that negative self-feelings, induced by perception of relative economic deprivation, motivate adoption of deviant behavior patterns including property crimes, violence, and drug use. Stiles, B.L., Liu, X., and Kaplan, H.B. Relative Deprivation and Deviant Adaptations: The Mediating Effects of Negative Self-Feeling. Journal of Research in Crime and Delinquency, 37, pp. 64-90, 2000.
Predictors of Polydrug Use Among Four Ethnic Groups: A 12-Year Longitudinal Study
Adolescent risk and protective constructs associated with adult polydrug use among four ethnic groups were examined. Both mean and relational differences among the constructs were examined by ethnic group. Teenage polydrug use was a significant predictor of adult polydrug use for Caucasians, African-Americans, and Latinos. Although this relationship was not evident for Asians, teenage alcohol use increased adult cigarette use, and early religiosity increased adult alcohol use. Early parental support/bonding predicted less adult polydrug use for Caucasians. For Latinos, general social conformity and low liberalism decreased cigarette use as an adult. In general, the implications of the results are that prevention strategies should emphasize the reduction of teenage drug use to decrease adult polydrug use among Caucasians, Latinos, and African-Americans. Future research should examine other possible risk and protective conditions related to adult polydrug use among diverse populations. Galaif, E.R. and Newcomb, M.D. Predictors of Polydrug Use Among Four Ethnic Groups: A 12-Year Longitudinal Study. Addictive Behaviors, 24(5) pp. 607-631, 1999.
The Association of Current Stimulant Use with Demographic, Substance Use, Violence-related, Social and Intrapersonal Variables Among High Risk Youth
This article reports the association of current stimulant use with demographic, other substance use, violence-related, social and intrapersonal variables among a large sample of high risk adolescents. A total of 21.4% of the sample reported using stimulants in the last 30 days. In a final, multivariable model, nonredundant concurrent predictors of current stimulant use were reports that friends use stimulants, reports that stimulants were likely to be used again in the next 12 months, use of alcohol, hallucinogens, or cocaine in the last 30 days, use of alcohol or other drugs to feel more safe, and reports of depression in the last week. Being above the median on none to all seven of these correlates predicted from 0% to 85% of those who were above the median on current stimulant use. One may speculate that programming for these stimulant-using youth should include treatment of multiple substances, depression, and correction of social-cognitive misperceptions. Sussman, S., Dent, C.W., and Stacy, A.W. The Association of Current Stimulant Use with Demographic, Substance Use, Violence-related, Social and Intrapersonal Variables Among High Risk Youth. J Addictive Behavior, 24(6), pp. 741-748, 1999.
The Association of Group Self-identification and Adolescent Drug Use in Three Samples Varying in Risk
This study provides a cross-sectional analysis of the relations between group self-identification and adolescent drug use in three samples of youth: comprehensive high-school, continuation high school, and runaway/street youth. Youth identified with discrete groups in all three samples, and similar general groups were formed. In most comparisons, a high-risk group showed greater levels of drug use than did other groups. This is the first study to demonstrate that group self-identification (a) is a generalizable construct across different types of adolescent samples, (b) is related to use of drugs other than tobacco, and (c) remains a significant correlate of drug use controlling for its relations with demographic variables and several other psychosocial variables. Sussman, S., Simon, T.R., Stacy, A.W., Dent, C.W., Ritt, A., Kipke, M.D., Montgomery, S.B., Burton, D. and Flay, B.R. The Association of Group Self-identification and Adolescent Drug Use in Three Samples Varying in Risk. J Applied Sociology Psychology, 29 (8), pp. 1555-1581, 1999.
Parent-Child Conversations About Tobacco Use
In this study parents engaged their 6th- and 8th-grade daughters in a conversation about tobacco, using a pamphlet designed to encourage effective family communication about tobacco. Results indicated that parent-daughter conversations about tobacco use were successfully carried out in a nonaversive manner. The conversations were perceived to have gone well, with very little conflict reported. The daughters reported that the parental advice was helpful and they did not resist receiving such advice. The pamphlet topics most frequently discussed included: consequences of smoking as experienced by friends and relatives, difficulty of quitting, promotional tactics of tobacco companies, making rules about tobacco use, and deciding on the consequences of rules adherence or violation. Ary, D.V., James, L., and Biglan, A. Parent-Daughter Discussions to Discourage Tobacco Use: Feasibility and Content. Adolescence, 34 (134), pp. 275-282, 1999.
Relationship Between Group Self-Identification Adolescent Drug Use
This study examined the relationship between group self-identification and adolescent drug use in three samples of youth: comprehensive high-school, continuation high-school, and runaway/street youth. Youth identified with discrete and generally similar groups in all three samples. A high-risk group in each of the samples showed greater levels of drug use than did other groups in most comparisons. This is the first study to demonstrate that group self-identification is a generalizable construct across different types of adolescent samples, is related to use of drugs other than tobacco, and remains a significant correlate of drug use controlling for its relations with demographic variables and several other psychosocial variables. Sussman, S., Simon, T.T., Stacy, A.W., Dent, C.W., Ritt, A., Kipke, M.D., Montogomery, S.B., Burton, D., and Flay, B.R. The Association Group Self-identification and Adolescent Drug Use in Three Samples Varying in Risk. Journal of Applied Social Psychology, 29(8), pp. 1555-1581, 1999.
After-School Self-Care and Adolescent Smoking
This study examined the independent contributions of the setting and the intensity of after-school self-care to the cigarette smoking behaviors of 2,352 ninth graders. The authors found that the intensity of the self-care experience was significantly associated with adolescent smoking behavior irrespective of the typical setting of the adolescents' after-school activities. The findings indicated that a nonpermissive parenting style, family rule-setting about cigarettes, and in absentia parental monitoring may reduce the likelihood of cigarette smoking among both latchkey and nonlatchkey adolescents. Targeting these aspects of the home lives of all adolescents has the potential to reduce smoking behaviors among latchkey as well as nonlatchkey children. Mott, J.A., Crowe, P.A., Richardson, J., and Flay, B. After-School Supervision and Adolescent Cigarette Smoking: Contributions of the Setting and Intensity of After-School Self-Care. Journal of Behavioral Medicine, 22(1), pp. 35-58, 1999.
A Social Stress Model for Substance Abuse in Immigrant Hispanic Women
The authors used cross-sectional interview-administered surveys of 60 low-income predominantly Mexican-American women to examine the independent variables of stress, social support and influences, personal competencies and community resource utilization patterns in relation to the outcome variable of alcohol and drug use (alcohol, cigarettes, marijuana, cocaine and opiates). Their findings suggested that the levels of drug use in this study sample were lower than in the general USA population regardless of pregnancy status. Results of bivariate correlations indicated that women with higher drug use indices had more lenient attitudes regarding drug use and were more likely to have family and friends that used alcohol and drugs. Women who used alcohol themselves and whose partners used alcohol and drugs reported significantly higher levels of stress, weaker social support and lower levels of self-esteem. Lindenberg, C.S., Strickland, O., Solorzano, R., Galvis, C., Dreher, M., and Darrow, V.C. Correlates of Alcohol and Drug use Among Low-Income Hispanic Immigrant Childbearing Women Living in the USA. International Journal of Nursing Studies, 36 (1), pp. 3-11, 1999.
Cultural Sensitivity in Prevention Research
This article raises several issues commonly encountered in preventive intervention research in the US--from key conceptual issues surrounding the construct of race, ethnicity, culture, and minority status, to the conceptualization, design, recruitment, measurement, delivery, data analysis, interpretation, and dissemination of an intervention project--and suggests possible solutions aimed at fostering genuine cultural sensitivity while satisfying the demands of rigorous scientific inquiry. The article is an attempt to stimulate discussion in the area of cultural sensitivity, which should be of concern to all psychologists interested in applied and preventive intervention. Dumas, J.E., Rollock, D, Prinz, R.J., Hops, H., and Blechman, E.A. Cultural Sensitivity: Problems and Solutions in Applied and Preventive Intervention. Applied & Preventive Psychology, 8, pp. 175-196, 1999.
Long-term Outcomes of Two Universal Parenting Prevention Interventions
The present investigation extends prior work that reported findings on two universal family-focused preventive intervention programs. At posttest, each had direct effects on one proximal parenting outcome (intervention-targeted parenting behavior) and indirect effects on two global/distal outcomes (parent-child affective quality and general child management). A replication of the previously tested parenting outcome model was conducted with one-year follow-up data using procedures identical to those in the earlier study. Results of the present study (N = 404 families) indicate that statistically significant effects on parenting behaviors were sustained at the one-year period following the posttest. Redmond, C., Spoth, R., Shin, C., and Lepper, H. Modeling Long-Term Parent Outcomes of Two Universal Family-Focused Preventive Interventions: One-Year Follow-up Results. Journal of Consulting and Clinical Psychology, 67(6), pp. 975-984, 1999.
Drug Use and Personality Factors Affect Parent-Child Attachment Relationship
In this longitudinal study, data were collected during early adulthood in 1992 and in 1996/1997 via a structured questionnaire. The researchers assessed the extent to which participants' personality attributes, substance use, and relationships with their mothers predicted the quality of the parent-child bond. Participants with certain personality attributes (e.g., high sensitivity), less frequent marijuana use, or a close relationship with their mothers were found to have a greater likelihood of having a close parent-child attachment relationship with their own children at a later time. Results also showed that the risk of earlier substance use on the parent-child relationship was offset by protective factors in the parents' personality domain. In addition, protective factors in the various parental domains synergistically interacted with a low frequency of marijuana use, relating to a closer parent-child attachment relationship. The findings suggest that certain parenting styles are transmitted across generations and interventions in the personality and drug use domains can help increase the likelihood that parents will form close attachment relationships with their own children. Brook, J.S., Richter, L., and Whiteman, M. Effects of Parent Personality, Upbringing, and Marijuana Use on the Parent-Child Attachment Relationship. J. Am. Acad. Child. Adolesc. Psychiatry, 39(2), pp. 240-248, 2000.
Family Structure and Educational Attainment
This study used structural equation modeling to account for the relationship between family structure during adolescence and educational attainment in adulthood. The investigators found that intact family of origin was associated with better financial situation in the parental home and a positive school experience, which in turn were associated with later entry into adult work and marriage roles, and finally to continuing educational attainment beyond high school. Chen, Z. and Kaplan, H.B. Explaining the Impact of Family Structure During Adolescence on Adult Educational Attainment: A Longitudinal Study. Applied Behavioral Science Review, 7, pp. 23-40, 1999.
Survival Sex Among Runaway and Homeless Youth
Investigators at Research Triangle Institute analyzed data on 12-21-year-olds from a nationally representative sample of shelter youths and a multi-city sample of street youths to determine the prevalence and correlates of survival sex. "Survival sex" refers to the selling of sex to meet subsistence needs, including sex to get drugs or money to get drugs. Results indicated that approximately 28 percent of street youths and 10 percent of shelter youths reported having participated in survival sex, which was associated with age, days away from home, victimization, criminal behaviors, substance use, suicide attempts, sexually transmitted disease, and pregnancy. These findings highlight the need to develop services that provide alternatives to the sex trade as a means of meeting economic needs for runaway and homeless youth. It was concluded that intensive and ongoing services are needed to provide resources and residential assistance for these youth. Green, J.M., Ennett, S.T., and Ringwalt, C.L. Prevalence and Correlates of Survival Sex Among Runaway and Homeless Youth. American Journal of Public Health, 89, pp. 1406-1409, 1999.
Psychosocial Predictors of Current Drug Use, Drug Problems, and Physical Drug Dependence in Homeless Women
Risk and protective factors associated with three qualitatively different drug use constructs describing a continuum of drug use were studied among a sample of 1,179 homeless women. Relationships among positive and negative sources of social support, positive and negative coping strategies, depression, and the drug constructs of current drug use, drug problems, and physical drug dependence were assessed using structural equation models with latent variables. Current drug use was predicted by more negative social support (from drug-using family/friends), depression, and less positive coping. Drug problems were predicted by more negative coping, depression, and less positive coping. Physical drug dependence was predicted by more negative social support and depression and less positive social support. Results highlighted the importance of investigating both the positive and negative dimensions of psychosocial functioning, while suggesting that empowering homeless women and offering tangible resources for coping with the stress of being homeless may be beneficial to them. Galaif, E.R., Nyamathi, A.M., and Stein, J.A. Psychosocial Predictors of Current Drug Use, Drug Problems, and Physical Drug Dependence in Homeless Women. Addictive Behaviors, 24(6), pp. 801-814, 1999.
Parentification and its Impact on Adolescent Children of Parents with AIDS
Parentification refers to children or adolescents assuming adult roles before they are emotionally or developmentally ready to manage those roles successfully. An assessment of the predictors and outcomes of parentification was made among adolescent children of Parents with AIDS (PWAs) in two phases. In Phase 1, relationships among parental AIDS-related illness, parent drug use, parent and adolescent demographics, and parentification indicators (parental, spousal, or adult role-taking) were assessed among 183 adolescent-parent pairs (adolescents: 11 to 18 years, M = 14.8 years, 54 percent female; parents: 80 percent female). Adult role-taking was associated with maternal PWAs, female adolescents, and greater parent drug use. Greater parental AIDS-related illness predicted more spousal and parental role-taking. Parent drug use predicted more parental role-taking. In Phase 2, the impact of parentification on later adolescent psychological adjustment was examined (N = 152 adolescents). Adult role-taking predicted more internalized emotional distress; parental role-taking predicted externalized problem behaviors, sexual behavior, alcohol and marijuana use, and conduct problems. Given these dysfunctional outcomes, interventions to mitigate parentification among children of PWAs are discussed. Stein, J.A., Riedel, M., Rotheram-Borus, M.J. Parentification and Its Impact on Adolescent Children of Parents with AIDS. Family Process, 38(2), pp. 193-208, 1999.
Multivariate Applications in Substance Use Research
Researchers at Indiana University and Arizona State University collaborated in editing a new book that introduces the latest advances in quantitative methods and illustrates how to apply these methods to address important questions in substance use research. The book brings together methodologists developing innovative quantitative methods with researchers who have collected data capable of addressing significant substance abuse issues. The book examines the use of state-of-the-art longitudinal techniques to assess change over time. Researchers studying the etiology, treatment, and prevention of substance use and abuse will find this volume useful in illustrating the application of current statistical techniques to enable them to make optimal use of their data. Indiana University's 20-year Smoking Project formed the basis of several of the chapters, in which authors studied the processes of initiation and progression of smoking and how they are relate to psychosocial development. With chapters by a number of well known substance abuse researchers, the volume covers use of latent curve methods for describing individual trajectories of adolescent substance use over time; methods for analyzing longitudinal data for individuals nested within groups such as families, classrooms, and treatment groups; how different patterns of missing data influence the interpretation of results; recent advances in longitudinal growth modeling; methods of studying mediation when there are multiple mediating pathways underlying an intervention effect; methods of identifying moderating relations in structural equation models; use of structural equation models to evaluate a preventive intervention; epidemic modeling techniques for understanding the spread of substance use in society; use of latent transition analysis to model substance use as a series of stages; and logistic regression methods of prospectively predicting smoking cessation. Rose, J.S., Chassin, L., Presson, C.C., and Sherman, S.J. (eds.) Multivariate Applications in Substance Use Research: New Methods for New Questions. Mahwah, NJ: Lawrence Erlbaum Associates, 2000.
The Impact of Interviewer Characteristics on Drug Use Reporting by Male Juvenile Arrestees
The impact of interviewer and subject effects on cocaine and marijuana use disclosure was evaluated in a sample of over 3,000 male juvenile arrestees. Analyses evaluated the viability of Social Attribution and Conditional Social Attribution models of interviewer effects. The viability of alternative models was investigated in the context of comparative analyses excluding and including statistical adjustments for the clustering of responses by interviewers. Interviewer effects were more salient in models predicting marijuana disclosure than in models predicting cocaine disclosure. Logistic regression analyses provided support for Social Attribution and Conditional Social Attribution models of interviewer effects. Models suggested large interviewer cluster effects. Cluster adjustment altered interpretation of effects for both cocaine and marijuana. Subject race/ethnicity effects were salient in models predicting disclosure for both drugs, but were especially large in models predicting cocaine disclosure. Fendrich, M., Johnson, T., Shaligram, C., and Wislar, J.S. The Impact of Interviewer Characteristics on Drug Use Reporting by Male Juvenile Arrestees. Journal of Drug Issues, 29(1) pp. 37-58, 1999.
Continued Smoking Over 25 Years
This study tested the hypothesis that high daily cigarette consumption and addiction to smoking are risk factors for the long-term continuation of smoking. Using longitudinal data from 986 male smokers, the investigators entered cigarettes per day, psychological addiction, age, and education into a survival analysis as predictors of continued smoking over a 25-year period. Younger men and those who smoked more cigarettes per day were more likely to remain smokers in the long term. Addiction and education level were not significant predictors of continued smoking. Heavier smokers are more at risk than lighter smokers for long-term smoking. It is therefore very important to provide smoking cessation treatments for heavy smokers as early as possible after the initiation of smoking. Nordstrom, B.L., Kinnunen, T., Utman, C.H., Krall, E.A., Vokonas, P.S., Garvey, A.J. Predictors of Continued Smoking Over 25 Years of Follow-Up in the Normative Aging Study. American Journal of Public Health, 90(3), pp. 404-406, 2000.
Prevention of Post-Rape Psychopathology
The authors developed an acute time-frame hospital-based video intervention to minimize anxiety during forensic rape exams, and prevent post-rape posttraumatic stress disorder (PTSD), panic, and anxiety. Results of preliminary data indicated that psychological distress at the time of the exam was strongly related to PTSD symptomatology 6 weeks post-rape, and the video intervention successfully reduced distress during forensic exams. Resnick, H., Acierno, R., Holmes, M., Kilpatrick, D.G., and Jager, N. Prevention of Post-Rape Psychopathology: Preliminary Findings of a Controlled Acute Rape Treatment Study. Journal of Anxiety Disorders, 13 (4), pp. 359-370, 1999.
Limited Prosocial Information Exchange And Substance Use
This study assessed attitudes, drug use, and mental health status in pregnant, inner-city residents. Structured interviews revealed that the 38 substance users were more likely to report favorable attitudes toward drugs and polysubstance use, disengagement coping, depressive symptoms, negative affect, and antisocial behavior than were 45 nonusers. During videotaped interviews, trained observers coded less warmth and less prosocial information exchange (e.g., self-disclosure, question asking) among users. Factor analysis of measures of coping and its concomitants yielded a three-factor (prosocial, antisocial, asocial) solution, with substance users more likely to use asocial and antisocial coping. These results suggest that coping has emotional, social, and cognitive elements. This study is the first to demonstrate an association between a substance-using lifestyle and limited prosocial information exchange. Blechman, E.A., Lowell, E.S., Garrett, J. Prosocial Coping and Substance Use During Pregnancy. Addictive Behaviors, 24, pp. 99-109, 1999.
The Minnesota DARE PLUS Project:
Creating Community Partnerships to Prevent Drug Use and Violence The Minnesota DARE PLUS Project is a randomized trial of 24 schools and communities. Students in eight schools receive the usual junior high Drug Abuse Resistance Education (DARE) curriculum in the 7th grade; eight schools receive the curriculum with the addition of parent involvement, peer leadership, and community components in the 7th and 8th grades; eight schools serve as controls. This article describes the background and conceptualization, the curriculum, the added intervention components, and the evaluation strategy for the DARE PLUS Project. Perry, C.L., Komro, K.A., Veblen-Mortenson, S., Bosma, L., Munson, K, Stigler, M., Lytle, L.A., Forster, J.L., and Welles, S.L. The Minnesota DARE PLUS Project: Creating Community Partnerships to Prevent Drug Use and Violence. J. School Health. 70(3), pp. 84-88, 2000.
Perceived Invulnerability and Cigarette Smoking Among Adolescents
Adolescent perceptions of invulnerability toward smoking and nonsmoking-related health risks were examined among 432 continuation high school students. Smokers were less likely than nonsmokers to report feeling invulnerable to both smoking and nonsmoking-related health risks. Among the smokers, those who reported feeling invulnerable to smoking related health risks, compared to those who reported feeling vulnerable, smoked fewer cigarettes, were less addicted, were less likely to intend to smoke more in the future, attempted to quit fewer times in the past, valued their health more, and reported higher public body awareness. In a multiple logistic regression model, only high public body awareness, fewer previous attempts to quit, and being in the action stage of change (compared to being in the precontemplation stage of change) remained significant independent concurrent predictors of being in the invulnerable group. These results suggest, contrary to some previous work, that perceived invulnerability may be predictive of quitting tobacco use and may reflect relative invulnerability; that is, lighter use of tobacco. Milam, J.E., Sussman, S., Ritt-Olson, A., and Dent, C.W. Perceived Invulnerability and Cigarette Smoking Among Adolescents. J. Addictive Behaviors, 25 (1), pp. 71-80, 2000.
Examining Ethnic-Group Differences in the Predictors of Substance Use
The authors describe some approaches to studying ethnic-group differences in the predictors of substance use. They include probing for mediators, multisample analyses of structural models and an experimental trial of a preventive intervention. In their studies they found some ethnic-group differences as well as many similarities in the structure of constructs and the relationships between variables. It was noted that the challenge for researchers is using appropriate research methods for studying ethnicity, uncovering the basis for ethnic-group differences when they occur, knowing when statistical differences are meaningful, and acknowledging when developmental models are comparable. Barrera, M., Castro, F.G., and Biglan, A. Ethnicity, Substance Use, and Development: Exemplars for Exploring Group Differences and Similarities. Development and Psychopathology, 11 (4), pp. 805-822, 1999.
Health Correlates of Sexual Violence in Homeless Women
Researchers at RAND and UCLA documented the association of rape with specific health and substance use/abuse characteristics in a probability sample of 974 homeless women in Los Angeles County. Structured interviews were administered to women aged 15-44 who had spent at least one of the past 30 nights in non-traditional housing. Thirteen percent of the women reported being raped in the past year, and half of these women had been raped at least twice in the past year. Women reporting recent rape fared worse on every physical and mental health measure and were more likely to have a lifetime history of drug abuse or dependence and reports of recent drug use than other homeless women. These data indicate that sexual violence is a major problem confronting homeless women and that all homeless women who present with serious mental, physical, or substance abuse problems should be screened for violent experiences. Wenzel, S.L., Leake, B.D., and Gelberg, L., Health of Homeless women with Recent Experience of Rape. Journal of General Internal Medicine 15(4), 2000.
Women Who Use Crack Cocaine
FAST (Female Atlanta Study, N=149 women), a 4-year ethnographic study to develop a clearer understanding of the lives of female crack cocaine users, is presented in a way that captures how these women arrived at their use; how they survive under their current circumstances, such as the constant threat of HIV/AIDS and violence; how they develop and maintain intimate relationships; how they combine the multiple social roles of mother and drug user; and how--as they share their aspirations and expectations for the future--their stories underscore the effects of poverty, sexism, and racism on their lives. Many of the women recognize their own responsibility for ensuring positive change. Dr. Sterk includes an argument for a harm reduction approach and reminds the reader that the strength and courage of these women may be futile without social policies that are realistic and appropriate for women. Sterk, C. Women Who Use Crack Cocaine. Philadelphia, PA: Temple University Press,
pp. 242, 1999.
Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education
This monograph reviews findings from research on the epidemiology and etiology and of drug abuse among young people and drug abuse prevention programs. It presents the information in terms appropriate for policy makers, program designers and evaluators, and laymen to rethink approaches to prevention of drug abuse. She concludes there are fundamental problems with drug education because the foundations of conventional school-based drug education are fundamentally flawed. Many programs are based on the conviction that any use of illegal drugs is inherently pathological, an indication that something is wrong, whereas alternative explanations acknowledge the importance of culture. As a sociologist, she notes that American people and their children are bombarded with messages that encourage them to imbibe and medicate with a variety of substances, including alcohol, tobacco, caffeine, and prescription drugs. Fifty-one percent of Americans use alcohol regularly and one-third have tried marijuana at some time. Teenage drug use appears to mirror American proclivities. Dr. Rosenbaum's review of the literature arrives at a reality-based alternative: safety-first drug education. The first assumption of safety-first drug education is that teenagers can make responsible decisions if given honest, science-based drug education (students were motivated to quit using marijuana for health reasons or negative drug effects they themselves experienced or learned about from sources they trust). The second assumption of safety first is that total abstinence may not be a realistic alternative for all teenagers. Proclaiming a drug-free American culture by some arbitrary date is not deemed realistic, but reduction of drug use and drug problems is realistic and a key measure of success. A third assumption of safety-first drug education is to differentiate between use, abuse, and dependency. The youthful user must know he/she is not trapped and has a choice and can reduce use and influence the outcome. Dr. Rosenbaum's book provides scientific support for these positions and some guidelines for developing safety-first drug education to equip students with information they can trust and use as a the basis for making responsible decisions. Rosenbaum, M. Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education. San Francisco, CA: The Lindesmith Center, pp. 1-12, 1999.
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