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Director's Report to the National Advisory Council on Drug Abuse - May, 2008

Research Findings - Epidemiology and Etiology Research

Specificity of Genetic Factors for Dependence on Licit and Illicit Drugs

Although genetic risk factors have been found to contribute to dependence on both licit and illicit psychoactive substances, we know little of how these risk factors interrelate. This study sought to clarify the structure of genetic and environmental risk factors for symptoms of dependence on cannabis, cocaine, alcohol, caffeine, and nicotine in males and females. Four thousand eight hundred sixty-five adult members of male-male and female-female pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders were assessed for lifetime symptoms of abuse of and dependence on cannabis, cocaine, alcohol, caffeine, and nicotine by structured interview. Controlling for greater symptom prevalence in males, genetic and environmental parameters could be equated across sexes. Two models explained the data well. The best-fit exploratory model contained 2 genetic factors and 1 individual environmental factor contributing to all substances. The first genetic factor loaded strongly on cocaine and cannabis dependence; the second, on alcohol and nicotine dependence. Nicotine and caffeine had high substance-specific genetic effects. A confirmatory model, which also fit well, contained 1 illicit drug genetic factor--loading only on cannabis and cocaine--and 1 licit drug genetic factor loading on alcohol, caffeine, and nicotine. However, these factors were highly intercorrelated (r = + 0.82). Large substance-specific genetic effects remained for nicotine and caffeine. The authors conclude that the pattern of genetic and environmental risk factors for psychoactive substance dependence was similar in males and females, and that genetic risk factors for dependence on common psychoactive substances cannot be explained by a single factor. Rather, two genetic factors-one predisposing largely to illicit drug dependence, the other primarily to licit drug dependence-are needed. Furthermore, a large proportion of the genetic influences on nicotine and particularly caffeine dependence appear to be specific to those substances. Kendler, K., Myers, J., and Prescott, C. Specificity of Genetic and Environmental Risk Factors for Symptoms of Cannabis, Cocaine, Alcohol, Caffeine, and Nicotine Dependence. Arch. Gen. Psychiatry, 64(11), pp. 1313-1320, 2007.

Assessment of Cocaine and Other Drug Dependence in the General Population

There is a need for large-scale epidemiological surveys to be faithful to diagnostic specifications and to limit time- and participant-burden associated with each section of potentially lengthy interviews. This study examined whether one "gating" approach devised for recent large-scale international psychiatric surveys results in a reduced number of identified cases of drug dependence and/or biases in the estimated associations with background characteristics. Data were analyzed from a recently released cross-sectional, nationally representative household survey, the United States National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Participants included 43,093 English speaking adults aged 18 years and over. The primary outcome measures included dependence upon cocaine and other illegal drug dependence, defined in two ways: "ungated" and "gated". "Ungated" dependence included all persons meeting criteria for DSM-IV dependence, without regard for DSM-IV drug abuse clinical features. "Gated" dependence required at least one feature of DSM-IV drug abuse. There was no statistically robust decrement in the estimated prevalence of cocaine or other drug dependence using a "gated" assessment. Patterns of association of cocaine dependence with background characteristics were not appreciably different when the gated and ungated approaches were applied. In panoramic mental health surveys, the inefficiency of an ungated approach must be balanced against the anticipated number of cases of dependence without associated social role impairments or harm. In this study, the reduction in the number of identified cocaine dependence cases appeared to be so small that even in a sample of over 40,000 participants, attenuation in population prevalence would prove difficult to detect. Degenhardt, L., Bohnert, K., and Anthony, J. Assessment of Cocaine and Other Drug Dependence in the General Population: Drug Alcohol Depend., 93(3), pp. 227-232, 2008.

Neighborhood Income and Income Distribution and the Use of Cigarettes, Alcohol, and Marijuana

Evidence about the relationship between contextual variables and substance use is conflicting. Relationships between neighborhood income and income distribution and the prevalence and frequency of substance use in 59 New York City (NYC) neighborhoods were assessed while accounting for individual income and other socio-demographic variables. Measures of current substance use (in the 30 days prior to the survey) were obtained from a random-digit-dial phone survey of adult residents of NYC and data from the 2000 U.S. Census to calculate median neighborhood income and income distribution (assessed using the Gini coefficient). Among 1355 respondents analyzed (female=56.2%, mean age=40.4), 23.9% reported cigarette, 40.0% alcohol, and 5.4% marijuana use in the previous 30 days. In ecologic assessment, neighborhoods with both the highest income and the highest income maldistribution had the highest prevalence of drinking alcohol (69.0%) and of smoking marijuana (10.5%) but not of cigarette use; there was no clear ecologic association between neighborhood income, income distribution, and cigarette use. In multilevel multivariable models adjusting for individual income, age, race, sex, and education, high neighborhood median income and maldistributed neighborhood income were both significantly associated with a greater likelihood of alcohol and marijuana use but not of cigarette use. Both high neighborhood income and maldistributed income also were associated with greater frequency of alcohol use among current alcohol drinkers. These observations suggest that neighborhood income and income distribution may play more important roles in determining population use of alcohol and marijuana than individual income, and that determinants of substance use may vary by potential for drug dependence. Further research should investigate specific pathways that may explain the relationship between neighborhood characteristics and use of different substances. Galea, S., Ahern, J., Tracy, M., and Vlahov, D. Neighborhood Income and Income Distribution and the Use of Cigarettes, Alcohol, and Marijuana. Am. J. Prev. Med., 32 (6 Suppl), pp. S195-S202, 2007.

Incidence of Drug Problems in Young Adults Exposed to Trauma and Posttraumatic Stress Disorder

Most estimated associations of posttraumatic stress disorder (PTSD) with DSM-IV drug dependence and abuse are from cross-sectional studies or from prospective studies of adults that generally do not take into account suspected causal determinants measured in early childhood. This study examined risk for incident drug disorders associated with prior DSM-IV PTSD. A multiwave longitudinal study was conducted among a sample of young adults first assessed at entry to first grade of primary school in the fall semesters of 1985 and 1986, with 2 young adult follow-up assessments. Participants were young adults (n = 988; aged 19-24 years) free of clinical features of DSM-IV drug use disorders at the first young adult assessment and therefore at risk for newly incident drug use disorders during the 1-year follow-up period. During the 12-month interval between the 2 young adult follow-up assessments, several outcomes were assessed, including: newly incident (1) DSM-IV drug abuse or dependence; (2) DSM-IV drug abuse; (3) DSM-IV drug dependence; and (4) emerging dependence problems (1 or 2 newly incident clinical features of DSM-IV drug dependence), among subjects with no prior clinical features of drug use disorders. Prior PTSD (but not trauma only) was associated with increased risk for drug abuse or dependence (adjusted relative risk, 4.9; 95% confidence interval, 1.6-15.2) and emerging dependence problems (adjusted relative risk, 4.9; 95% confidence interval, 1.2-20.1) compared with the no-trauma group controlling for childhood factors. Subjects with PTSD also had a greater adjusted relative risk for drug abuse or dependence compared with subjects exposed to trauma only (adjusted relative risk, 2.0; 95% confidence interval, 1.1-3.8) controlling for childhood factors. Association of PTSD with subsequent incident drug use disorders remained substantial after statistical adjustment for early life experiences and predispositions reported in previous studies as carrying elevated risk for both disorders. Posttraumatic stress disorder might be a causal determinant of drug use disorders, possibly representing complications such as attempts to self-medicate troubling trauma-associated memories, nightmares, or painful hyperarousal symptoms. Reed, P., Anthony, J., and Breslau, N. Incidence of Drug Problems in Young Adults Exposed to Trauma and Posttraumatic Stress Disorder: Do Early Life Experiences and Predispositions Matter? Arch. Gen. Psychiatry, 64(12), pp. 1435-1442, 2007.

Study Describes Current Patterns of Extra-Medical Drug Use

In 1994, epidemiological patterns of extra-medical drug use in the United States were estimated from the National Comorbidity Survey. This paper describes such patterns based upon more recent data from the National Comorbidity Survey Replication (NCS-R). The NCS-R was a nationally representative face-to-face household survey of 9282 English-speaking respondents, aging 18 years and older, conducted in 2001-2003 using a fully structured diagnostic interview, the WHO Composite International Diagnostic Interview (CIDI) Version 3.0. The estimated cumulative incidence of alcohol use in the NCS-R was 92%; tobacco, 74%; extra-medical use of other psychoactive drugs, 45%; cannabis, 43% and cocaine, 16%. Statistically robust associations existed between all types of drug use and age, sex, income, employment, education, marital status, geography, religious affiliation and religiosity. Very robust birth cohort differences were observed for cocaine, cannabis, and other extra-medical drug use, but not for alcohol or tobacco. Trends in the estimated cumulative incidence of drug use among young people across time suggested clear periods of fluctuating risk. These epidemiological patterns of alcohol, tobacco, and other extra-medical drug use in the United States in the early 21st century provide an update of NCS estimates from roughly 10 years ago, and are consistent with contemporaneous epidemiological studies. New findings on religion and religiosity, and exploratory data on time trends, represent progress in both concepts and methodology for such research. These estimates lead to no firm causal inferences, but contribute to a descriptive epidemiological foundation for future research on drug use and dependence across recent decades, birth cohorts, and population subgroups. Degenhardt, L., Chiu, W., Sampson, N., Kessler, R., and Anthony, J. Epidemiological Patterns of Extra-Medical Drug Use in the United States: Evidence from the National Comorbidity Survey Replication, 2001-2003. Drug Alcohol Depend., 90 (2-3), pp. 210-223, 2007.

Lifetime Prevalence and Age-of-Onset Distributions of Mental Disorders in the World Health Organization's World Mental Health Survey Initiative

Data are presented on the lifetime prevalence, projected lifetime risk, and age-of-onset distributions of mental disorders in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Face-to-face community surveys were conducted in 17 countries in Africa, Asia, the Americas, Europe, and the Middle East. The combined numbers of respondents were 85,052. Lifetime prevalence, projected lifetime risk, and age of onset of DSM-IV disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI), a fully-structured lay administered diagnostic interview. Survival analysis was used to estimate lifetime risk. Median and inter-quartile range (IQR) of age of onset is very early for some anxiety disorders (7-14, IQR: 8-11) and impulse control disorders (7-15, IQR: 11-12). The age-of-onset distribution is later for mood disorders (29-43, IQR: 35-40), other anxiety disorders (24-50, IQR: 31-41), and substance use disorders (18-29, IQR: 21-26). Median and IQR lifetime prevalence estimates are: anxiety disorders 4.8-31.0% (IQR: 9.9-16.7%), mood disorders 3.3-21.4% (IQR: 9.8-15.8%), impulse control disorders 0.3-25.0% (IQR: 3.1-5.7%), substance use disorders 1.3-15.0% (IQR: 4.8-9.6%), and any disorder 12.0-47.4% (IQR: 18.1-36.1%). Projected lifetime risk is proportionally between 17% and 69% higher than estimated lifetime prevalence (IQR: 28-44%), with the highest ratios in countries exposed to sectarian violence (Israel, Nigeria, and South Africa), and a general tendency for projected risk to be highest in recent cohorts in all countries. These results document clearly that mental disorders are commonly occurring. As many mental disorders begin in childhood or adolescence, interventions aimed at early detection and treatment might help reduce the persistence or severity of primary disorders and prevent the subsequent onset of secondary disorders. Kessler, R., Angermeyer, M., Anthony, J., DE Graaf, R., Demyttenaere, K., Gasquet, I., DE Girolamo, G., Gluzman, S., Gureje, O., Haro, J., Kawakami, N., Karam, A., Levinson, D., Medina Mora, M., Oakley Browne, M., Posada-Villa, J., Stein, D., Adley Tsang, C., Aguilar-Gaxiola, S., Alonso, J., Lee, S., Heeringa, S., Pennell, B., Berglund, P., Gruber, M., Petukhova, M., Chatterji, S., and Ustuen, T. Lifetime Prevalence and Age-of-Onset Distributions of Mental Disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry, 6(3), pp. 168-176, 2007.

Screening for Drug Abuse Among Medical and Nonmedical Users of Prescription Drugs in a Probability Sample of College Students

This study examined the prevalence of medical and nonmedical use of 4 classes of prescription drugs (opioid, stimulant, sleeping, and sedative or anxiety) and assessed probable drug abuse among 4 mutually exclusive groups of medical and nonmedical use of prescription drugs. Data were obtained from a 2005 self-administered Web-based survey of college students from a large, Midwestern 4-year university. The survey used a probability sample design, yielded a 68% response rate and a final sample of 3639 college students. The sample had a mean age of 19.9 years, and respondents were 53.6% female, 67.4% white, 12.1% Asian, 6.0% African American, 4.2% Hispanic, and 10.2% other racial categories. Medical and nonmedical use of prescription drugs was measured. Probable drug abuse was assessed using a modified version of the Drug Abuse Screening Test, Short Form. A total of 40.1% of respondents reported no lifetime use of at least 1 of 4 classes of prescription drugs, 39.7% reported medical use only, 15.8% reported both medical and nonmedical use, and 4.4% reported nonmedical use only. The odds of a positive screening result for drug abuse were greater among medical and nonmedical users (adjusted odds ratio, 5.5; 95% confidence interval, 3.4-7.3) and nonmedical users only (adjusted odds ratio, 6.5; 95% confidence interval, 4.0-10.6) compared with nonusers. The odds of a positive screening result for drug abuse did not differ between medical users only and nonusers. These findings suggest that nonmedical users of prescription drugs are at heightened risk for drug abuse, whereas medical users without a history of nonmedical use are generally not at increased risk. The authors conclude that drug abuse screening should be routine for college students, especially among individuals with any history of nonmedical use of prescription drugs. McCabe, S. Screening for Drug Abuse Among Medical and Nonmedical Users of Prescription Drugs in a Probability Sample of College Students. Arch. Pediatr. Adolesc. Med., 162(3), pp. 225-231, 2008.

Misperceptions of Non-medical Prescription Drug Use Among College Students

This study compared undergraduate students' perceived versus actual prevalence rates of non-medical use of marijuana, prescription opioids and prescription stimulants. In 2005, a randomly selected sample of 3639 college students self-administered a Web survey regarding their substance use behaviors and attitudes (68% response rate). Analysis showed that the majority of undergraduate students overestimated the prevalence of non-medical use of prescription stimulants (70.2%) and prescription opioids (69.9%) and marijuana use (50.5%) among peers on their campus. The mean difference between perceived versus actual past-year use was considerably greater for non-medical use of prescription stimulants (mean difference=12.2, 95% CI=11.7-12.7) and prescription opioids (mean difference=8.8, 95% CI=8.3-9.2) than marijuana (mean difference=2.9, 95% CI=2.2-3.6). Multivariate regression analysis revealed overestimation of non-medical use of prescription drugs was significantly associated with gender and medical use of prescription drugs. The authors conclude that the study results provide strong evidence of misperception of non-medical prescription drug use among college students and suggest that future research and prevention efforts should assess the impact of correcting misperceived norms on reducing non-medical prescription drug use. McCabe, S. E. Misperceptions of Non-medical Prescription Drug Use: A Web Survey of College Students. Addict. Behav., 33, pp. 713-724, 2008.

Association Between Early Onset of Non-medical Use of Prescription Drugs and Subsequent Prescription Drug Use and Dependence

This study examined the associations between early onset of non-medical use of prescription drugs (NMUPD) (i.e. sedatives, tranquilizers, opioids, stimulants) and the development of prescription drug abuse and dependence in the United States. Data were collected from structured diagnostic interviews using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Use Disorder and Associated Disabilities Interview Schedule: Diagnostic and Statistical Manual version IV (DSM-IV). National prevalence estimates were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n = 43,093). NESARC included a nationally representative cross-sectional sample of civilian non-institutionalized adults aged 18 years or older in the United States, of whom 52% were women, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American or of other racial background. Analyses revealed that a higher percentage of individuals who began using prescription drugs non-medically at or before 13 years of age were found to have developed prescription drug abuse and dependence as compared with those individuals who began using at or after 21 years of age. Multivariate logistic regression analyses indicated that the odds of developing any life-time prescription drug abuse among non-medical users was reduced by approximately 5% with each year non-medical use was delayed [adjusted odds ratio (AOR) = 0.95, 95% CI = 0.94, 0.97], and that the odds of developing any lifetime prescription drug dependence were reduced by about 2% with each year onset was delayed (AOR = 0.98, 95% CI = 0.96, 1.00) when controlling for relevant covariates. The authors conclude that early onset of NMUPD was a significant predictor of prescription drug abuse and dependence. These findings reinforce the importance of developing prevention efforts to reduce NMUPD and diversion of prescription drugs among children and adolescents. McCabe, S., West, B., Morales, M., Cranford, J., and Boyd, C. Does Early Onset of Non-medical Use of Prescription Drugs Predict Subsequent Prescription Drug Abuse and Dependence? Results from a National Study. Addiction, 102(12), pp. 1920-1930, 2007.

Nonmedical Use of Prescription Stimulants Among College Students: Associations with Attention-Deficit-Hyperactivity Disorder and Polydrug Use

This study examined nonmedical use of prescription stimulants (NPS), in a cohort of first year college students at a large public university and assessed whether NPS and overuse of a medically prescribed stimulant for ADHD were independently associated with an increased risk of other illicit drug use and dependence on alcohol and marijuana. A cohort of 1253 first-year college students aged 17-20 years completed a 2-hour personal interview to ascertain medical use and overuse of prescription stimulants, NPS, nonmedical use of other prescription drugs and illicit drug use, and dependence on alcohol and marijuana. Comparisons were made among nonusers, nonmedical users, and medical users of prescription stimulants for ADHD (ADHD+), some of whom overused their drug. Of 1208 students who were not using prescription stimulants medically for ADHD (ADHD-), 218 (18.0%) engaged in NPS. Of 45 ADHD+ students, 12 (26.7%) overused their ADHD drug at least once in their lifetime, and seven (15.6%) nonmedically used someone else 's prescription stimulants at least once in their lifetime. Among 225 nonmedical users, NPS was infrequent and mainly associated with studying, although 35 (15.6%) used prescription stimulants to party or to get high. Lifetime NPS was associated with past-year other drug use. Both NPS and overuse of prescribed stimulants for ADHD were independently associated with past-year use of five drugs, controlling for sociodemographic characteristics; NPS was also associated with alcohol and marijuana dependence. These findings suggest that physicians should be vigilant for possible overuse and/or diversion of prescription stimulants for ADHD among college students who are medical users of these drugs, as well as the occurrence of illicit drug use with NPS. The authors recommend that comprehensive drug prevention activities that involve parents as well as college personnel should be encouraged to raise awareness of NPS and its association with illicit drug use. Arria, A., Caldeira, K., O'Grady, K., Vincent, K., Johnson, E., and Wish, E. Nonmedical Use of Prescription Stimulants among College Students: Associations with Attention-Deficit-Hyperactivity Disorder and Polydrug Use. Pharmacotherapy, 28(2), pp. 156-169, 2008.

Non-prescribed Use of Pain Relievers Among Adolescents in the United States

This study examined gender-specific prevalences, patterns, and correlates of non-prescribed use of pain relievers (mainly opioids) in a representative sample of American adolescents (N=18,678). Data were drawn from the public use data file of the 2005 U.S. National Survey on Drug Use and Health, a survey of non-institutionalized American household residents. Patterns of non-prescribed use of prescription pain relievers were examined, and logistic regression procedures were conducted to identify correlates of non-prescribed use. Analysis showed that approximately one in 10 adolescents aged 12-17 years reported non-prescribed use of pain relievers in their lifetime (9.3% in males and 10.3% in females). The mean age of first non-prescribed use was 13.3 years, which was similar to the mean age of first use of alcohol and marijuana but older than the age of first inhalant use. Among all non-prescribed users, 52% reported having used hydrocodone products (Vicodin, Lortab, Lorcet, and Lorcet Plus, and hydrocodone), 50% had used propoxyphene (Darvocet or Darvon) or codeine (Tylenol with codeine), and 24% had used oxycodone products (OxyContin, Percocet, Percodan, and Tylox). Approximately one quarter (26%) of all non-prescribed users had never used other non-prescribed or illicit drugs. There were gender variations in correlates of non-prescribed use. These findings indicate that use of non-prescribed pain relievers occurs early in adolescence. The authors suggest that research is needed to understand whether early use of non-prescribed pain relievers is related to later drug use. Wu, L., Pilowsky, D., and Patkar, A. Non-Prescribed Use of Pain Relievers among Adolescents in the United States. Drug Alcohol Depend., 94(1-3), pp. 1-11, 2008.

Specificity of Psychosocial Risk Factors for Child Psychiatric Disorders

Most psychosocial risk factors appear to have general rather than specific patterns of association with common childhood and adolescence disorders. However, previous research has typically failed to 1) control for comorbidity among disorders, 2) include a wide range of risk factors, and 3) examine sex by developmental stage effects on risk factor-disorder associations. This study tests the specificity of putative psychosocial risk factors while addressing these criticisms. Eight waves of data from the Great Smoky Mountains Study (N = 1,420) were used, covering children in the community age 9-16 years old. Youth and one parent were interviewed up to seven times using the Child and Adolescent Psychiatric Assessment, providing a total of 6,674 pairs of interviews. A wide range of putative neighborhood, school, peer, family, and child risk factors, and common and comorbid youth disorders were assessed. The authors found that a majority of putative risk factors were specific to one disorder or one disorder domain. A unique or ''signature set '' of putative risk factors was identified for each disorder. Several putative risk factors were associated with a disorder in preadolescent males, preadolescent females, adolescent males, or adolescent females only. They conclude that there is a need to define risk factors and disorders narrowly, to control comorbidity and other risk factors, and to consider developmental patterns of specificity by sex. This may augment efforts in the prevention arena. Shanahan, L., Copeland, W., Costello, E., and Angold, A. Specificity of Putative Psychosocial Risk Factors for Psychiatric Disorders in Children and Adolescents. J. Child. Psychol. Psychiatry, 49(1), pp. 34-42, 2008.

Family Risk for ADHD and SUD

This study sought to examine the bidirectional comorbidity between attention deficit hyperactivity disorder (ADHD) and psychoactive substance use disorder (alcohol or drug abuse or dependence). First-degree relatives from a large group of pediatrically and psychiatrically referred boys with (112 probands, 385 relatives) and without (105 probands, 358 relatives) ADHD were comprehensively assessed by blind raters with structured diagnostic interviews. Familial risk analysis examined the risks in first-degree relatives for ADHD, psychoactive substance use disorder, alcohol dependence, and drug dependence after stratifying probands by the presence and absence of these disorders. The authors found that ADHD in the proband was consistently associated with a significant risk for ADHD in relatives. Drug dependence in probands increased the risk for drug dependence in relatives irrespective of ADHD status, whereas alcohol dependence in relatives was predicted only by ADHD probands with comorbid alcohol dependence. In addition, ADHD in the proband predicted drug dependence in relatives, and drug dependence in comparison probands increased the risk for ADHD in relatives. Both alcohol dependence and drug dependence bred true in families without evidence for a common risk between these disorders. The authors conclude that these patterns of familial risk suggest that the association between ADHD and drug dependence is most consistent with the hypothesis of variable expressivity of a common risk between these disorders, whereas the association between ADHD and alcohol dependence is most consistent with the hypothesis of independent transmission of these disorders. Findings also suggest specificity for the transmission of alcohol and drug dependence. These conclusions are consistent with recently published findings from genetic epidemiologic studies. Biederman, J., Petty, C., Wilens, T., Fraire, M., Purcell, C., Mick, E., Monuteaux, M., and Faraone, S. Familial Risk Analyses of Attention Deficit Hyperactivity Disorder and Substance Use Disorders. Am. J. Psychiatry, 165(1), pp. 107-115, 2008.

Trajectories of Cigarette Smoking among African Americans and Puerto Ricans from Adolescence to Young Adulthood: Associations with Dependence on Alcohol and Illegal Drugs

This study predicts that heterogeneous smoking trajectories covering four time points pose differential risks for dependence on alcohol and illegal drugs in young adulthood in an African American and Puerto Rican community sample (N = 475). The trajectory analysis yielded four smoking groups: nonsmokers, maturing out smokers, late-starting smokers, and early-starting continuous smokers. The early starting continuous group was more likely to become both alcohol- and drug-dependent in young adulthood than the other groups. Late-starting smokers were at higher risk than nonsmokers for drug dependence. Interventions are necessary from preadolescence through late adolescence to reduce the numbers of early and late smokers and their specific risks for substance dependence. Brook, J., Balka, E., Ning, Y., and Brook, D. Trajectories of Cigarette Smoking Among African Americans and Puerto Ricans from Adolescence to Young Adulthood: Associations with Dependence on Alcohol and Illegal Drugs. Am. J. Addict., 16(3), pp. 195-201, 2007.

The Formation of a Socioeconomic Disparity: A Case Study of Cocaine and Marijuana Use in the 1990s'

Around 1990, the reputation of cocaine use changed from glamorous to undesirable, and at the same time, a socioeconomic disparity in cocaine use emerged. This study examined (1) whether the socioeconomic disparity was created by differential incidence, differential cessation, or both, (2) whether a socioeconomic disparity also developed in marijuana use, and (3) whether disparities formed across race, Hispanic ethnicity, and/or gender. The analyses center on 6544 respondents aged 14-21 in 1979 in the National Longitudinal Survey of 1979 that provided information on past-year use of powder cocaine and marijuana use before and after 1990--specifically, in 1984, 1988, 1992, 1994, and 1998. Both differential incidence and differential cessation across education contributed to the formation of the socioeconomic disparity in cocaine use, although differential cessation played a more influential role in this cohort. A socioeconomic disparity in marijuana use also came about around the same time. No emerging disparities by race, Hispanic ethnicity, or gender were observed. This case study suggests that the redefinition of a health behavior as unhealthy will result in a socioeconomic disparity in the behavior across socioeconomic strata as a result of both differential incidence and cessation, but disparities will not necessarily form by race, ethnicity, or gender. Miech, R., and Chilcoat, H. The Formation of A Socioeconomic Disparity: A Case Study of Cocaine and Marijuana Use in the 1990s. Am. J. Prev. Med., 32 (6 Suppl), pp. S171-s176, 2007.

Personality, Adrenal Steroid Hormones, and Resilience in Maltreated Children

In this investigation, resilience in adaptive functioning among maltreated and nonmaltreated low-income children (N = 677) was examined in relation to the regulation of two stress-responsive adrenal steroid hormones, cortisol and dehydroepiandrosterone (DHEA), as well as the personality constructs of ego resiliency and ego control. Maltreatment status was not related to differences in average levels of morning or afternoon cortisol or DHEA. However, lower morning cortisol was related to higher resilient functioning, but only in nonmaltreated children. In contrast, among physically abused children, high morning cortisol was related to higher resilient functioning. Morning and afternoon DHEA was negatively related to resilient functioning. Although diurnal change in cortisol was not related to resilience, for DHEA, maltreated children with high resilience showed an atypical rise in DHEA from morning to afternoon. Morning and afternoon cortisol/DHEA ratios were positively related to resilient functioning, but did not interact with maltreatment status. Ego resiliency and ego control strongly differentiated maltreated and nonmaltreated children, and the personality variables were substantially predictive of resilience. When considered together, demonstrated effects of personality, cortisol, and DHEA maintained independent contributions in predicting resilience among high-risk youth. Cicchetti, D., and Rogosch, F. Personality, Adrenal Steroid Hormones, and Resilience in Maltreated Children: A Multilevel Perspective. Dev. Psychopathol., 19(3), pp. 787-809, 2007.

Tripling of Methamphetamine/Amphetamine Use among Homeless and Marginally Housed Persons, 1996-2003

Methamphetamine/amphetamine (MA)-related morbidity and mortality have been increasing in the United States. MA use is associated with high-risk sexual behavior and syringe-sharing practices. Homeless and marginalized housed persons (H/M) have high rates of substance use and mental health disorders, but little is known about trends of MA use among the H/M. The objective of this study was to quantify increases in MA use among H/M in San Francisco and to determine which demographic and behavioral subgroups have experienced the greatest increases in MA use. Researchers conducted serial cross-sectional population-based studies in three waves: 1996-1997, 1999-2000, and 2003 and studied 2,348 H/M recruited at shelters and lunch lines. The main outcome was self-reported current (30-day) MA use. There was a tripling of current MA use among H/M persons from 1996 to 2003, with a 7-fold increase in smoked MA use. MA use doubled or tripled in most demographic and behavioral subgroups, whereas it quadrupled in those under age 35. There was a 5-fold increase among HIV-infected persons. The increase in MA use among H/M places a vulnerable population at additional increased risk for HIV infection and MA-use related morbidity and mortality. In particular, among HIV-infected H/M, the increase in MA use has important public health implications for the development and secondary transmission of drug-resistant HIV related to a synergism of neurocognitive decline, poor adherence to HIV medications, and increased sexual risk behavior. These findings are important for clinicians caring for H/M persons, to inquire about MA use, refer interested MA users to MA dependence treatment programs, and provide targeted HIV sexual risk reduction counseling. HIV-infected H/M MA users should be closely monitored for adherence to HIV or other chronic medications, to avoid unnecessary morbidity and mortality. The results also point to the need for research to elucidate the most effective prevention and treatment for MA use and dependence among the H/M. Das-Douglas, M., Colfax, G., Moss, A., Bangsberg, D., and Hahn, J. Tripling of Methamphetamine/Amphetamine Use among Homeless and Marginally Housed Persons, 1996-2003. J. Urban Health, 85(2), pp. 239-249, 2008.

Alcohol-use Disorders and Nonmedical Use of Prescription Drugs Among U.S. College Students

This study examined: 1) the association between DSM-IV, alcohol-use disorders (AUDs) and nonmedical use of prescription drugs (NMPD) among U.S. college students, and 2) individual-level and college-level characteristics associated with the co-occurrence of AUDs and NMPD. Data were collected from self-administered mail surveys, sent to a random sample of approximately 14,000 college students from a nationally representative sample of 119 U.S. colleges and universities. Analyses revealed that the prevalence of past-year NMPD was highest among those with AUDs: multivariate logistic regression analyses indicated that college students with past-year DSM-IV alcohol abuse only (adjusted odds ratio [AOR]=4.46, 95% confidence interval [CI]=3.59-5.55) and students with past-year DSM-IV alcohol dependence (AOR=9.17, 95% CI=7.05-11.93) had significantly increased odds of NMPD in the past year compared with students without AUDs. The co-occurrence of AUDs and NMPD was more likely among college students who were male, white, earned lower grade point averages, and attended co-ed colleges and institutions located in Southern or Northeastern U.S. regions. These findings provide evidence that NMPD is more prevalent among those college students with AUDs, especially individuals with past-year DSM-IV alcohol dependence. The authors conclude that the assessment and treatment of AUDs among college students should take into account other forms of drug use such as NMPD. McCabe, S., West, B., and Wechsler, H. Alcohol-use Disorders and Nonmedical Use of Prescription Drugs among U.S. College Students. J. Stud. Alcohol Drugs, 68(4), pp. 543-547, 2007.

The Occurrence of Cannabis Use Disorders and Other Cannabis-related Problems Among First-year College Students

This study reports the prevalence of cannabis use disorders (CUD) and other cannabis-related problems in a large cohort (n=1253) of first-year college students, 17 to 20 years old, at one large public university in the mid-Atlantic region of the U.S. Interviewers assessed past-year cannabis use, other drug use, and cannabis-related problems (including DSM-IV criteria for CUD). The prevalence of CUD was 9.4%(wt) among all first-year students and 24.6% among past-year cannabis users (n=739). Among 474 cannabis users who reported cannabis use >/=5 times in the past year, concentration problems (40.1%), driving while high (18.6%) and missing class (13.9%) were among the most prevalent cannabis-related problems, even among those who endorsed no CUD criteria. Placing oneself at risk for physical injury was also commonly reported (24.3%). The study results show that a significant proportion of cannabis-using college students met diagnostic criteria for disorder. Even in the absence of disorder, users appear to be at risk for potentially serious cannabis-related problems. The authors conclude that these findings highlight the need for improved screening and early intervention for drug-related problems among first-year college students. Caldeira, K., Arria, A., O 'Grady, K., Vincent, K., and Wish, E. The Occurrence of Cannabis Use Disorders and Other Cannabis-related Problems among First-year College Students. Addict. Behav., 33(3), pp. 397-411, 2008.

Rapid Increase in the Diagnosis of Youth Bipolar Disorder

Although bipolar disorder may have its onset during childhood, little is known about national trends in the diagnosis and management of bipolar disorder in young people. The purpose of this study was to present national trends in outpatient visits with a diagnosis of bipolar disorder and to compare the treatment provided to youth and adults during those visits. Investigators compared rates of growth between 1994-1995 and 2002-2003 in visits with a bipolar disorder diagnosis by individuals aged 0 to 19 years vs those aged 20 years or older. For the period of 1999 to 2003, we also compare demographic, clinical, and treatment characteristics of youth and adult bipolar disorder visits. Patient visits from the National Ambulatory Medical Care Survey (1999-2003) with a bipolar disorder diagnosis (n = 962) were assessed drawn from outpatient visits to physicians in office-based practice. Visits with a diagnosis of bipolar disorder by youth (aged 0-19 years) and by adults (aged > or = 20 years) were assessed. The study indicated the estimated annual number of youth office-based visits with a diagnosis of bipolar disorder increased from 25 (1994-1995) to 1003 (2002-2003) visits per 100,000 population, and adult visits with a diagnosis of bipolar disorder increased from 905 to 1679 visits per 100,000 population during this period. In 1999 to 2003, most youth bipolar disorder visits were by males (66.5%), whereas most adult bipolar disorder visits were by females (67.6%); youth were more likely than adults to receive a comorbid diagnosis of attention-deficit/hyperactivity disorder (32.2% vs 3.0%, respectively; P < .001); and most youth (90.6%) and adults (86.4%) received a psychotropic medication during bipolar disorder visits, with comparable rates of mood stabilizers, antipsychotics, and antidepressants prescribed for both age groups. There has been a recent rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings. This increase highlights a need for clinical epidemiological reliability studies to determine the accuracy of clinical diagnoses of child and adolescent bipolar disorder in community practice. Moreno, C., Laje, G., Blanco, C., Jiang, H., Schmidt, A., and Olfson, M. National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth. Arch. Gen. Psychiatry, 64(9), pp. 1032-1039, 2007.

The Impact of Sociodemographic Factors and Psychiatric Disorders on Maternal Smoking During Pregnancy

Maternal smoking during pregnancy increases birth complication risk and has long-term developmental consequences for child development. This study investigated the relative importance of sociodemographic factors and psychiatric disorders for smoking among 453 pregnant women in the National Epidemiological Survey on Alcohol and Related Conditions. Women with less than a high school education and those with current-year nicotine dependence had the highest risk of smoking (90.5%), compared with women with a college degree and without nicotine dependence (3.9%). More effective and accessible interventions for nicotine dependence among pregnant smokers are needed. Gilman, S., Breslau, J., Subramanian, S., Hitsman, B., and Koenen, K. Social Factors, Psychopathology, and Maternal Smoking During Pregnancy. Am. J. Public Health, 98(3), pp. 448-453, 2008.

Exposure to Smoking Depictions in Movies: Its Association with Established Adolescent Smoking

This longitudinal study of a representative US adolescent sample was designed to assess the association between exposure to movie smoking and established adolescent smoking. Adolescents were surveyed by telephone in their homes. Participants included sixty-five hundred twenty-two US adolescents aged 10 to 14 years at baseline, who were resurveyed at 8 months (8M) (n = 5503), 16 months (16M) (n = 5019), and 24 months (24M) (n = 4575). The main Exposure measured was exposure to smoking in 532 box-office hits released in the 5 years prior to the baseline survey. The outcome measure was established smoking (having smoked more than 100 cigarettes during lifetime). Of 108 incident established smokers with data at the 24M survey, 85% were current (30-day smokers) and 83% endorsed at least 1 addiction symptom. Established smoking incidence was 7.4, 15.8, and 19.7 per 1000 person-years of observation for the baseline-to-8M, 8M-to-16M, and 16M-to-24M observation periods, respectively. In a multivariate survival model, risk of established smoking was predicted by baseline exposure to smoking in movies with an adjusted overall hazard ratio of 2.04 (95% confidence interval, 1.01-4.12) for teens in the 95th percentile of movie-smoking exposure compared with the 5th percentile. This effect was independent of age; parent, sibling, or friend smoking; and sensation seeking. Teens low on sensation seeking were more responsive to the movie-smoking effect (hazard ratio, 12.7; 95% confidence interval, 2.0-80.6) compared with teens who were high on sensation seeking (hazard ratio, 1.01; 95% confidence interval, 0.4-2.6). In this national US adolescent sample, exposure to smoking in movies predicted risk of becoming an established smoker, an outcome linked with adult dependent smoking and its associated morbidity and mortality. Sargent, J., Stoolmiller, M., Worth, K., Dal Cin, S., Wills, T., Gibbons, F., Gerrard, M., and Tanski, S. Exposure to Smoking Depictions in Movies: Its' Association with Established Adolescent Smoking. Arch. Pediatr. Adolesc. Med., 161(9), pp. 849-856, 2007.

Getting Into Ecstasy: Comparing Moderate and Heavy Young Adult Users

In this article, the authors examine factors associated with initial and present Ecstasy use among young adults. Face-to-face structured interviews were conducted in Atlanta, Georgia among 261 active Ecstasy users. The median age at which respondents first heard of Ecstasy was 16 years, whereas the median age of first Ecstasy use was 18 years. Initial Ecstasy use frequently involved polydrug use, including alcohol (50.4%). In terms of their current use, 47.5% of respondents were considered heavy Ecstasy users (using on 10 or more separate occasions in the last 90 days). White respondents, those who used more than one pill during their initial use, and those who used again within one month after their initial use were more likely to be current heavy Ecstasy users. Women, those who waited a longer time between initial and subsequent Ecstasy use, and those who considered themselves in the upper SES bracket were less likely to be current heavy Ecstasy users. A better understanding of initial and current Ecstasy use patterns, including polydrug use, is essential for effective prevention and intervention efforts. Sterk, C., Theall, K., and Elifson, K. Getting Into Ecstasy: Comparing Moderate and Heavy Young Adult Users. J. Psychoactive Drugs, 39(2), pp. 103-113, 2007.

Social Anxiety and Risk for Alcohol and Cannabis Dependence

Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUDs) and cannabis dependence. However, the temporal sequencing of these disorders has not been extensively studied to determine whether SAD serves as a specific risk factor for problematic substance use. The present study examined these relationships after controlling for theoretically-relevant variables (e.g., gender, other Axis I pathology) in a longitudinal cohort over approximately 14 years. The sample was drawn from participants in the Oregon Adolescent Depression Project., who were originally recruited as adolescents from high schools in 1987-89, at a mean age of 16.6 years. The sample, half female, was followed at ages 24 and 30; the final data point was collected from 816 participants, 59% women, 59% Caucasian. After excluding those with substance use disorders at baseline, SAD at study entry was associated with 6.5 greater odds of cannabis dependence (but not abuse) and 4.5 greater odds of alcohol dependence (but not abuse) at follow-up after controlling for relevant variables (e.g., gender, depression, conduct disorder). The relationship between SAD and alcohol and cannabis dependence remained even after controlling for other anxiety disorders. Other anxiety disorders and mood disorders were not associated with subsequent cannabis or alcohol use disorder after controlling for relevant variables. Among the internalizing disorders, SAD appears to serve as a unique risk factor for the subsequent onset of cannabis and alcohol dependence. Buckner, J., Schmidt, N., Lang, A., Small, J., Schlauch, R., and Lewinsohn, P. Specificity of Social Anxiety Disorder as a Risk Factor for Alcohol and Cannabis Dependence. J. Psychiatr. Res., 42(3), pp. 230-239, 2008.

Correlates of Cannabis Initiation in Young Women

As rates of cannabis use have increased in young women over the last decade, the authors sought to characterize the potential correlates of onset of cannabis use during emerging adulthood. Using data from 1065 females (collected 1994-2005) who participated in both the baseline (ages 16-23) and follow-up wave (ages 20-29) of interviews of the Missouri Adolescent Female Twin Study, they examined the associations between correlates from the peer, parental and individual domains and new onsets of cannabis use, using logistic regression. Univariate models revealed that initiation of cannabis use was associated with alcohol and cigarette use at baseline, peer attitude towards alcohol/cigarette/ cannabis use, peer substance use and other aspects of impulse-disinhibited behavior. However, multivariate stepwise modeling retained only the significant influences of alcohol use at baseline and peer attitudes towards cannabis as correlates of cannabis initiation. The authors concluded that having peers with favorable attitudes towards alcohol, cigarette and cannabis use is an important correlate of initiation of cannabis use in women, and that prevention and intervention efforts need to take this into account when developing drug resistance training programs for adolescents. Agrawal, A., Lynskey, M., Bucholz, K., Madden, P., and Heath, A. Correlates of cannabis initiation In a Longitudinal Sample of Young Women: The Importance of Peer Influences. Prev. Med., 45(1), pp. 31-34, 2007.

Misuse and Diversion of Stimulants Prescribed for ADHD

This paper provides a systematic review of the literature to evaluate the extent and characteristics of stimulant misuse and diversion in attention-deficit/hyperactivity disorder (ADHD) and non-ADHD individuals. The review covered available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search. It identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school- and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, "get high," or to experiment. The authors conclude that individuals both with and without ADHD misuse stimulant medications. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants. Wilens, T., Adler, L., Adams, J., Sgambati, S., Rotrosen, J., Sawtelle, R., Utzinger, L., and Fusillo, S. Misuse and Diversion of Stimulants Prescribed for ADHD: A Systematic Review of the Literature. J. Am. Acad. Child Adolesc. Psychiatry, 47(1), pp. 21-31, 2008.

Race/Ethnicity and Gender Differences in Drug Use and Abuse Among College Students

This study examined race/ethnicity and gender differences in drug use and abuse for substances other than alcohol among undergraduate college students. A probability-based sample of 4,580 undergraduate students at a Midwestern university completed a cross-sectional Web-based questionnaire that included demographic information and several substance use measures. Male students were more likely to report drug use and abuse than female students. Hispanic and White students were more likely to report drug use and abuse than Asian and African American students prior to coming to college and during college. Results of multiple logistic regression analysis for past 12-month illicit use of prescription drugs or illicit drugs revealed that after controlling for race, there was no statistically significant effect of gender. With respect to race, results using African Americans as the reference group showed that, controlling for gender, the odds of past 12-month drug use were statistically significantly higher among Whites (OR=1.86) and Hispanics (OR=2.14). The authors conclude that the findings of the present study reveal several important racial/ethnic differences in drug use and abuse that need to be considered when developing collegiate drug prevention and intervention efforts. McCabe, S., Morales, M., Cranford, J., Delva, J., McPherson, M., and Boyd, C. Race/Ethnicity and Gender Differences in Drug Use and Abuse Among College Students. J. Ethn. Subst. Abuse, 6(2), pp. 75-95, 2007.

Racial and Ethnic Changes in Heroin Injection in the United States: Implications for the HIV/AIDS Epidemic

Racial/ethnic differences in drug injection prevalence contribute to disparities in HIV infection rates in the US between Whites, Blacks and Hispanics. This study examined trends in the demographic characteristics of heroin injection drug users (IDUs) that may impact future HIV rates. Descriptive analyses were conducted of (1) the national Treatment Episode Data Set for 1992-2004 and of the 2002-2004 baseline data from (2) CIDUS-III, a 5-city study that recruited 3285 young IDUs, and (3) NIHU-HIT, a Chicago study of 647 young noninjecting heroin users. Between 1992 and 2004, heroin was the injected drug most often reported at admission to drug treatment. During this period, the proportion of admissions reporting injection declined 44% among Blacks but only 14% for Whites. The peak age for heroin IDUs in treatment increased 10 years for Blacks while declining over 10 years for Whites. CIDUS-III enrolled about 8 times more White (64%) than Black (8%) young IDUs despite recruiting two-thirds of the sample in cities where Blacks constituted 27-64% of the population. Blacks comprised 53% of noninjecting heroin users in the Chicago NIHU-HIT, but only 2% of Chicago's CIDUS-III sample of heroin IDUs. Among current noninjecting heroin users, Whites were more likely than Blacks to have ever injected (X(d.f.=1)(2)=17.1, p<0.001). Qualitative data supported greater resistance to injection among young Blacks than Whites. These findings suggest that, among heroin users, young Blacks are resisting injection while young Whites exhibit the opposite tendency. New research should investigate reasons for this trend and its impact on the HIV epidemic and future service needs. Broz, D., and Ouellet, L. Racial and Ethnic Changes in Heroin Injection in the United States: Implications for the HIV/AIDS Epidemic. Drug Alcohol Depend., 94(1-3), pp. 221-233, 2008.

Intimate Partner Violence Perpetration against Main Female Partners among HIV-Positive Male Injection Drug Users

Intimate partner violence (IPV) against women is a serious public health and social problem and is associated with a host of adverse health outcomes and behaviors, including HIV risk behaviors, among women who are victimized. Historically, research has focused on correlates of IPV victimization among women; thus, there is less information on the role of men in perpetrating IPV, particularly among men at risk for transmitting HIV to their female partners. The authors assessed the self-reported prevalence and correlates of perpetration and threat of perpetration of physical and/or sexual IPV against a main female partner among 317 HIV-positive men who were current injection drug users (IDUs). More than 40% of men reported perpetrating physical (39%) and/or sexual (4%) violence against their main female partners in the past year. Multivariate analyses revealed that low education, homelessness, psychologic distress, and unprotected sex with main and nonmain HIV-negative female partners were positively associated with IPV perpetration against main female partners. These findings reveal that IPV perpetration is prevalent among HIV-positive male IDUs and associated with sexual HIV transmission risk behaviors. IPV assessment and treatment among HIV-positive men in HIV care is recommended as a way to prevent IPV perpetration and victimization and to reduce potential HIV transmission. Frye, V., Latka, M., Wu, Y., Valverde, E., Knowlton, A., Knight, K., Arnsten, J., and O 'Leary, A. Intimate Partner Violence Perpetration against Main Female Partners among HIV-Positive Male Injection Drug Users. J. Acquir. Immune Defic. Syndr., 46 Suppl 2, pp. S101-S109, 2007.

Blood Contamination in Children's Saliva: Prevalence, Stability, and Impact on the Measurement of Salivary Cortisol, Testosterone, and Dehydroepiandrosterone

The prevalence, stability, and impact of blood contamination in children's saliva on the measurement of three of the most commonly assayed hormones were examined. Participants were 363 children (47% boys; ages 6-13 years) from economically disadvantaged families who donated saliva samples on 2 days in the morning, midday, and late afternoon. Samples (n=2178) were later assayed for cortisol (C), testosterone (T), and dehydroepiandrosterone (DHEA). To index the presence of blood (and its components) in saliva, samples were assayed for transferrin. Transferrin levels averaged 0.37 mg/dl (SD=0.46, range 0.0-5.5, Mode=0), and were: (1) highly associated within individuals across hours and days, (2) positively correlated with age, (3) higher for boys than girls, (4) higher in PM than AM samples, and (5) the highest (>1.0 mg/dl) levels were rarely observed in samples donated from the same individuals. Transferrin levels were associated with salivary DHEA and C, but less so for T. As expected, the relationships were positive, and explained only a small portion of the variance. Less than 1% of the statistical outliers (+2.5 SDs) in salivary hormone distributions had correspondingly high transferrin levels. The researchers conclude that blood contamination in children's saliva samples is rare, and its effects on the measurement of salivary hormones is small. Guidelines and recommendations are provided to steer investigators clear of this potential problem in special circumstances and populations. Granger, D., Cicchetti, D., Rogosch, F., Hibel, L., Teisl, M., and Flores, E. Blood Contamination in Children's Saliva: Prevalence, Stability, and Impact on the Measurement of Salivary Cortisol, Testosterone, and Dehydroepiandrosterone. Psychoneuroendocrinology, 32(6), pp. 724-733, 2007.

Puberty is Associated with Changes in the Form and Frequency of Self-Harm

A cross-sectional survey of 12- to 15-year-olds in 300 secondary schools in the U.S. state of Washington in February-April 2002 and the Australian state of Victoria was conducted to ascertain the association between pubertal stage and deliberate self-harm. A total of 3,332 students in grades 7 and 9 provided complete data on episodes of deliberate self-harm in the previous 12 months and pubertal stage. Pubertal stage was assessed with the Pubertal Development Scale, The prevalence of deliberate self-harm was 3.7% with a more than twofold higher rate in females. Late puberty was associated with a more than fourfold higher rate of self-harm (odds ratio 4.6, 95% confidence interval 1.5-14) after adjustment for age and school grade level. In contrast age had a protective association (odds ratio 0.7, confidence interval 0.4-1.0). The sharpest rises in prevalence across puberty were for self-laceration and self-poisoning in females. Higher rates of depressive symptoms, frequent alcohol use, and initiation of sexual activity largely accounted for the association between self-harm and pubertal stage in multivariate models. Puberty is associated with changes in the form and frequency of self-harm. For adolescents with a gap between puberty and brain development, risk factors such as early sexual activity and substance abuse may be particularly potent. Patton, G., Hemphill, S., Beyers, J., Bond, L., Toumbourou, J., McMorris, B., and Catalano, R. Pubertal Stage and Deliberate Self-harm in Adolescents. J. Am. Acad. Child Adolesc. Psychiatry, 46(4), pp. 508-514, 2007.

Sexual Abstinence in Adolescence Predicts Adult Mental Health Differentially for Males and Females

Investigators examined whether adolescent sexual abstinence predicts better adult mental health. 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not males; three adolescent factors, educational prospects, family bonding, and unconventionality were investigated as explanatory variables of this relationship. The abstinence-mental health relationship was nonsignificant when educational prospects was included in multivariate models, and marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls' who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems. Bogart, L., Collins, R., Ellickson, P., and Klein, D. Association of Sexual Abstinence in Adolescence with Mental Health in Adulthood. J. Sex Res., 44(3), pp. 290-298, 2007.

Adolescent Work Related to Slight Decreases in Problem Behavior

Researchers have found mixed support for documenting whether work is protective or harmful during adolescence. This study of 592 African American youth (53% female; M = 14.8 years, SD = .60) examined the association between work and problem behaviors. Youth were followed from mid-adolescence to young adulthood over eight Waves (90% response rate over the first four Waves and a 68% response rate across all eight Waves). Investigators explored three competing operationalizations of work: work history (never worked, worked), work intensity (no work, 20 h or less, and 21 h or over), and work trajectories (never worked, episodic work, stopped working, late starter, and consistent worker). Non-working youth reported higher marijuana use during young adulthood than their working counterparts. Nonworkers reported lower self-acceptance during young adulthood than those working greater number of hours per week. Differences in work trajectories for cigarette use, depression, and anxiety during adolescence imply that when and for how long youth work are also important factors to explore. The findings lend tentative support to the work benefits perspective and suggest that the association between work and problem behaviors may depend in part on how work is measured. Bauermeister, J. A., Zimmerman, M. A., Barnett, T. E., and Caldwell, C. H. Working in High School and Adaptation in the Transition to Young Adulthood among African American Youth. J. Youth Adolescence, 36 pp. 877-890, 2007.

Individual Action and Community Context: the Health Intervention Project

HIV risk-reduction efforts have traditionally focused on the individual. The need for including the role of the social context and community is being recognized. Social capital provides social relationships and potential resources that may hinder or trigger risk or protective health behaviors, especially for individuals with limited economic means. Sixty-five adult inner-city female drug users, who were included in a woman-focused HIV risk-reduction intervention trial, participated in in-depth interviews in Atlanta, Georgia, between 2002 and 2004. The interviews focused on the women's individual behavioral changes during the 6 months since completion of the intervention as well as on the impact of community conditions. Topics discussed were sexual and drug use behaviors, social relationships, social capital, and community physical and social infrastructure. The data were analyzed using the constant comparison methods. The respondents indicated that poor physical and social infrastructure led to alienation and negatively affected their behavioral change efforts. Social capital and social support mediated these negative influences. Drug-related violence was especially debilitating in their efforts to reduce HIV risk associated with crack cocaine or injection drug use and associated sexual behavior. Environmental conditions and opportunity structures played salient roles in the women's success. Individual actions and community context must be considered simultaneously when facilitating and assessing behavioral interventions. Sterk, C., Elifson, K., and Theall, K. Individual Action and Community Context: the Health Intervention Project. Am. J. Prev. Med., 32(6 Suppl), pp. S177-S181, 2007.

Identifying Injection Drug Users at Risk of Nonfatal Overdose

Drug overdose is the second leading cause of accidental deaths among U.S. adults aged 15-64 years. Emergency physicians have a unique opportunity to provide overdose prevention interventions, because habitual drug users are in frequent need of medical care. The authors evaluated associations between individual-level risk factors and experiencing an overdose in the past six months to determine which characteristics and behaviors may be most predictive of overdose. They used data from a sample of street-recruited habitual drug users who participated in face-to-face interviews about overdose from November 2001 to February 2004. This analysis was restricted to 772 respondents who had been injecting for at least one year and who had injected heroin within the past two months. A total of 16.6% of participants had overdosed in the past six months. Characteristics and behaviors that were independently associated with an increased risk of a recent overdose were having had a prior overdose (odds ratio [OR], 28.58; 95% confidence interval [CI] = 14.10 to 57.96), using cocaine/crack in the past six months (OR, 2.07; 95% CI = 1.25 to 3.45), using alcohol in the past six months (OR, 1.90; 95% CI = 1.01 to 3.57), experiencing serious withdrawal symptoms in the past two months (OR, 2.70; 95% CI = 1.58 to 4.61), and younger age. Drug users who have previously experienced a nonfatal overdose are at very high risk of experiencing future overdoses. Further longitudinal studies are needed to identify robust predictors of overdose risk over time in habitual drug users, but these data suggest that drug users who have overdosed warrant aggressive prevention efforts such as agonist maintenance treatment or provision of take-home naloxone. Coffin, P., Tracy, M., Bucciarelli, A., Ompad, D., Vlahov, D., and Galea, S. Identifying Injection Drug Users at Risk of Nonfatal Overdose. Acad. Emerg. Med., 14(7), pp. 616-623, 2007.

Large Percentage of Daily Smokers Remain Non-Nicotine Dependent

Current theoretical models of nicotine dependence assume a close relationship between use and dependence; however, previous data suggest that many daily smokers fail to develop nicotine dependence as currently defined. To determine what percentage of daily smokers fail to meet DSM-IV criteria for nicotine dependence within their lifetime, how non-dependence relates to duration and quantity of cigarette use, and whether other tobacco use and/or specific dependence criteria differentiate never-dependent and dependent smokers a cross-sectional study was conducted. Data were collected via personal interview from a nationally representative sample of 8213 past year daily smokers were analyzed. Results indicated that approximately 39.4% of daily smokers never reached nicotine dependence. While the probability of remaining non-dependent decreased with smoking quantity and duration since the onset of daily smoking, a substantial portion of individuals (37.7%) who reported smoking >or=10 cigarettes per day and began smoking daily >or=10 years prior, remained never nicotine dependent. The absence of nicotine dependence in heavy daily smokers may result from limitations in the measurement of dependence and/or nicotine exposure. Alternatively, some individuals may be relatively resistant to becoming nicotine dependent despite extensive use. The latter explanation would have important implications for understanding the nature of nicotine dependence. Donny, E., and Dierker, L. The Absence of DSM-IV Nicotine Dependence in Moderate-to-Heavy Daily Smokers. Drug Alcohol Depend., 89(1), pp. 93-106, 2007.

Cigarette Smoking Rates in an Adolescent Treatment Sample at Eight-Year Follow Up

This study examined the relationship between cigarette smoking and alcohol use outcomes over an 8-year period following treatment for adolescent alcohol and other drug (AOD) use disorders. A sample of 166 adolescents were recruited during inpatient AOD abuse treatment. Included were 123 (74% of the full sample) participants, of whom 41% were female, 81% identified themselves as White and who averaged 15.9 years of age (SD = 1.3) when entering treatment. Using interviews conducted at the time of treatment and 2-, 4-, 6- and 8-years post-treatment, the investigators found that 26% of participants had quit smoking for > 1 year at the 8-year assessment, while 44% reported persistent smoking over time. Overall smoking rates decreased significantly over time. Those with the highest alcohol involvement trajectory reported significantly greater likelihood of persistent smoking as well as higher current smoking and cigarette consumption across time points. The investigators reported that the significant declines observed in smoking from adolescence into young adulthood were contrary to expectations, indicating that this behavior may be less stable than previously thought among adolescent AOD abusers. Smoking involvement over time was greater within the highest alcohol use trajectory, consistent with previous evidence for a positive relationship between these behaviors'. However, when compared with the general population smoking rates remained very high regardless of alcohol involvement. Thus, individuals treated for AOD abuse as adolescents remained at elevated risk for tobacco related disease regardless of post-treatment AOD use outcomes. Myers, M., Doran, N., and Brown, S. Is Cigarette Smoking Related to Alcohol Use During the 8 Years Following Treatment for Adolescent Alcohol and Other Drug Abuse? Alcohol Alcohol, 42(3), pp. 226-233, 2007.

Adult Smokers in Colombia: Who Isn't Giving It Up?

Without ongoing surveillance systems to assess tobacco product demand and exposure levels, many low and middle income countries monitor smoking via periodic cross-sectional surveys. In this article, the authors provide updated estimates for the prevalence of adult smoking in Colombia and contribute additional information useful for tobacco control initiatives. Data are from the 2003 Colombian National Study of Mental Health (NSMH). A national probability sample of 4426 adults (age 18-65) was assessed via a computer-assisted interview. An estimated 49% of the adult population had smoked at least once in their lifetimes; one in three adults (31%) had smoked regularly. Nearly half of regular smokers had been able to quit (44%; 95% CI=40-48). Several personal and smoking-related characteristics were associated with failing to quit: being a younger age, employed as compared to being a homemaker, and a history of daily use. Quitters and non-quitters were equivalent with respect to sex, educational status, and age of smoking onset. These findings may help guide tobacco control activities in Colombia and other low and middle income countries. Storr, C., Cheng, H., Posada-Villa, J., Aguilar-Gaxiola, S., and Anthony, J. Adult Smokers in Colombia: Who Isn't Giving It Up? Addict Behav., 33(3), pp. 412-421, 2008.

Health Status of Illicit Stimulant Drug Users in Rural Ohio

The SF-8 health survey was used to assess the physical and mental health status of a community sample of not-in-treatment, illicit stimulant drug-using adults (n = 249) living in rural Ohio. Physical health status scores indicative of poor health were present in 30.5% of the sample. Poor physical health was associated with older age (OR = 1.06; 95% C.I. = 1.02-1.11), chronic disease (OR = 2.24, 95% C.I. = 1.14-4.40), and frequent opioid use (OR = 3.14, 95% C.I. = 1.16-8.50). Poor mental health status scores were present in 63.9% of the sample. Men were less likely (OR = 0.25, 95% C.I. = 0.11-0.53), and Whites more likely (OR = 3.97, 95% C.I. = 1.56-10.13), to have poor mental health scores. Frequency and type of drug use had no measurable effect on mental health status. These findings suggest that physical and mental health problems are likely to be pervasive among nonmedical drug users in rural areas. Falck, R., Wang, J., and Carlson, R. Health Status of Illicit Stimulant Drug Users in Rural Ohio. J. Psychoactive Drugs, Suppl 4, pp. 401-405, 2007.

Depressive Symptomatology in Young Adults with a History of MDMA Use: A Longitudinal Analysis

Research suggests that methylenedioxymethamphetamine (MDMA)/ ecstasy can cause serotonin depletion as well as serotonergic neurodegradation that may result in depression. This longitudinal study used the Beck Depression Inventory (BDI-II) to assess depressive symptomatology every six months over a two-year period among a community sample of young adult MDMA/ecstasy users (n = 402). Multilevel growth modeling was used to analyze changes in BDI scores. Between baseline and 24 months, the mean BDI score declined from 9.8 to 7.7. Scores varied significantly across individuals at baseline and declined at a rate of 0.36 points every six months. Persons with higher baseline scores were more likely to have their scores decrease over time. Several factors were significantly associated with score levels, independent of time: gender - men's scores were lower than women's; ethnicity - whites' scores were lower than those of non-whites; education - persons with at least some university education had scores that were lower than those without any college experience; benzodiazepines - current users' scores were higher than non-users; opioids - current users' scores were higher than non-users; and cumulative ecstasy use - people who had used MDMA more than 50 times had scores that were higher than persons who had used the drug less often. The results reported here show low levels of depressive symptoms among a sample that, after 24 months, consisted of both current and former MDMA users. The low and declining mean scores suggest that for most people MDMA/ecstasy use does not result in long-term depressive symptomatology. Falck, R., Jichuan Wang, and Carlson, R. Depressive Symptomatology in Young Adults with a History of MDMA Use: A Longitudinal Analysis. J. Psychopharmacol., 22(1), pp. 47-54, 2008.

Associations among Correlates of Schedule Adherence to Antiretroviral Therapy (ART): A Path Analysis of a Sample of Crack Cocaine Using Sexually Active African-Americans with HIV Infection

Adherence to HIV medication regimens is a function of multiple dimensions including psychological functioning, social support, adherence self-efficacy and optimism regarding treatment. Active substance use can also negatively affect adherence. An understanding of the nature of the associations among the correlates of adherence can better inform the design of interventions to improve adherence. This study developed an exploratory path model of schedule adherence using data from a sample of 130 African-American HIV-positive crack cocaine users on highly active antiretroviral therapy (ART). The model was based on the Transactional Model of Stress and Coping developed by Lazarus and Folkman. Following the theory, the effects of psychological distress on schedule adherence were found to be mediated by patients' relationship with their doctor and optimism towards antiretroviral treatment. Adherence was also associated with patients' self-efficacy regarding their medical regimen which, in turn, was associated with their social support. Atkinson, J., Schoennesson, L., Williams, M., and Timpson, S. Associations among Correlates of Schedule Adherence to Antiretroviral Therapy (ART): A Path Analysis of a Sample of Crack Cocaine Using Sexually Active African-Americans with HIV Infection. AIDS Care, 20(2), pp. 260-269, 2008.

An Investigation of a Personal Norm of Condom-Use Responsibility among African American Crack Cocaine Smokers

The purpose of this study was to investigate the unique contribution of a personal norm of condom-use responsibility to the formation of intentions to reduce risks for HIV by using male condoms during vaginal sex. Data were collected from 402 male and 157 female heterosexual African American crack cocaine smokers in Houston, Texas, US. Two structural equation models of the intention to use a condom with the last sex partner were estimated. One model included measures of condom-use attitudes, subjective norms and condom-use self-efficacy. A second model included these three measures and a fourth measure of a personal norm of condom-use responsibility. Separate models were estimated for men and women. The addition of a personal norm of condom-use responsibility provided a significantly better fit to the data than did models including only outcome expectations, subjective norms and self-efficacy. Results also showed distinctly different underlying cognitive structures of condom-use intention for men and women. A personal norm of condom-use responsibility had a strong direct effect on men's intentions to use condoms with the last sex partner. Other variables appeared to have no direct effect on men's intentions. Women's intentions were strongly influenced by a personal norm and social subjective norms. Situational self-efficacy and outcome expectations had weaker, yet significant, effects on women's intentions. These findings suggest promising directions for the development of sexual risk reduction interventions that emphasize the effect of condom-use responsibility on men's intentions to use condoms. Williams, M., Bowen, A., Ross, M., Timpson, S., Pallonen, U., and Amos, C. An Investigation of a Personal Norm of Condom-Use Responsibility Among African American Crack Cocaine Smokers. AIDS Care, 20(2), pp. 225-234, 2008.

Personal and Partner Measures in Stages of Consistent Condom Use among African-American Heterosexual Crack Cocaine Smokers

Measures of personal condom use and use by last sex partner were examined in five stages of change for consistent condom use among 449 urban sexually active, heterosexual, African-American crack smokers. The measures included participants'' personal and last sex partner's perceived responsibility, personal and perceived negative attitudes, and participants' self-efficacy to use condoms. The relationships between measures and stages were examined using analyses of variance and multivariate logistic regression. Over 90% of participants did not use condoms consistently. Two-thirds of the inconsistent users were in the precontemplation stage. The rest were equally divided between contemplation and preparation stages. Personal responsibility outperformed other measures in initial intention to become a regular condom user; partner's perceived responsibility dominated continued intention and actual consistent condom use. Negative attitudes and self-efficacies had strong relationships to the stages of consistent condom use in univariate analyses but these relationships became substantially weaker when the responsibility, attitude, and self-efficacy concepts were entered simultaneously into multivariate analyses. Pallonen, U., Williams, M., Timpson, S., Bowen, A., and Ross, M. Personal and Partner Measures in Stages of Consistent Condom Use among African-American Heterosexual Crack Cocaine Smokers. AIDS Care, 20(2), pp. 212-220, 2008.

An Examination of Perceived Norms and Exchanging Sex for Money or Drugs among Women Injectors in Baltimore, MD

Injection drug users who exchange sex for money or drugs may serve as a bridge group for transmitting HIV between injectors and non-injectors. While many individual characteristics have been linked to exchanging sex, little attention has been given to the influence of social network members. The present study assessed the relationship between exchanging sex and perceptions of peers' sex exchange behaviour and attitude toward sex exchange. The sample was composed of 267 women heroin and cocaine injectors in Baltimore, MD, USA. The results indicate that women who believed that their friends exchanged sex were more than twice as likely to exchange sex in the past 90 days (95% CI: 1.49-2.70). Participants who thought their peers disapproved of sex exchange were 20% less likely to exchange sex (95% CI: 0.67-0.95). These findings suggest the need for peer education interventions that promote norms about safer behaviours. Davey-Rothwell, M., and Latkin, C. An Examination of Perceived Norms and Exchanging Sex for Money or Drugs among Women Injectors in Baltimore, MD. Int. J. STD AIDS, 19(1), pp. 47-50, 2008.

Income Generating Activities of People who Inject Drugs

Injection drug users (IDU) commonly generate income through prohibited activities, such as drug dealing and sex trade work, which carry significant risk. However, little is known about the IDUs who engage in such activities and the role of active drug use in perpetuating this behavior. Researchers evaluated factors associated with prohibited income generation among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS) using logistic and linear regression. They examined which sources of income respondents would eliminate if they did not require money to pay for drugs. Among 275 IDUs, 145 (53%) reported engaging in prohibited income generating activities in the past 30 days. Sex work and drug dealing accounted for the greatest amount of income generated. Non-aboriginal females were the group most likely to report prohibited income generation. Other variables independently associated with prohibited income generation include daily heroin injection (AOR=2.3) and daily use of crack cocaine (AOR=3.5). Among these individuals, 68 (47%) indicated they would forgo these earnings if they did not require money for illegal drugs, with those engaged in sex trade work (62%) being most willing to give up their illegal source of income. These findings suggest that the costs associated with illicit drugs are compelling IDUs, particularly those possessing markers of higher intensity addiction, to engage in prohibited income generating activities. These findings also point to an opportunity to explore interventions that relieve the financial pressure of purchasing illegal drugs and reduce engagement in such activities, such as low threshold employment and expansion of prescription and substitution therapies. Debeck, K., Shannon, K., Wood, E., Li, K., Montaner, J., and Kerr, T. Income Generating Activities of People who Inject Drugs. Drug Alcohol Depend., 91(1), pp. 50-56, 2007.

Cocaine- and Opiate-Related Fatal Overdose in New York City, 1990-2000

In New York City (NYC), the annual mortality rate is higher for accidental drug overdoses than for homicides; cocaine and opiates are the drugs most frequently associated with drug overdose deaths. This study assessed trends and correlates of cocaine- and opiate-related overdose deaths in NYC during 1990-2000. Data were collected from the NYC Office of the Chief Medical Examiner (OCME) on all fatal drug overdoses involving cocaine and/or opiates that occurred between 1990-2000 (n = 8,774) and classified into three mutually exclusive groups (cocaine only; opiates-only; cocaine and opiates). Risk factors for accidental overdose were examined in the three groups and compared using multinomial logistic regression. Overall, among decedents ages 15-64, 2,392 (27.3%) were attributed to cocaine only and 2,825 (32.2%) were attributed to opiates-only. During the interval studied, the percentage of drug overdose deaths attributed to cocaine only fell from 29.2% to 23.6% while the percentage of overdose deaths attributed to opiates-only rose from 30.6% to 40.1%. Compared to New Yorkers who fatally overdosed from opiates-only, fatal overdose attributed to cocaine-only was associated with being male (OR = 0.71, 95% CI 0.62-0.82), Black (OR = 4.73, 95% CI 4.08-5.49) or Hispanic (OR = 1.51, 95% CI 1.29-1.76), an overdose outside of a residence or building (OR = 1.34, 95% CI 1.06-1.68), having alcohol detected at autopsy (OR = 0.50, 95% CI 0.44-0.56) and older age (55-64) (OR = 2.53 95% CI 1.70-3.75)). As interventions to prevent fatal overdose become more targeted and drug specific, understanding the different populations at risk for different drug-related overdoses will become more critical. Bernstein, K., Bucciarelli, A., Piper, T., Gross, C., Tardiff, K., and Galea, S. Cocaine- and Opiate-Related Fatal Overdose in New York City, 1990-2000. BMC Public Health, 7(147), pp. 31-42, 2007.

The Sociology of Ecstasy Drug Markets

The study conducted 120 in-depth interviews with men and women in the San Francisco Bay area that sold five or more doses of Ecstasy five or more times in the six months prior to the interview. The research focused on the circumstances and motivations surrounding initiation of sales, sales settings, seller and buyer characteristics and their relationships and social identities. The social class of Ecstasy drug sellers, mostly White, male, middle class, educated, in school, or employed and housed, protected them from having to take the risks of public sales, or selling to unknown persons and therefore from exposure to the criminal justice system and community social stigma. Ecstasy dealers in this study did not have sophisticated, planned sales practices because they sold primarily to their friends, and Ecstasy use was sporadic rather than daily. Business transactions were sporadic and informal. If a dealer's customers were friends and family, the perception of risk would remain low; the sales practices would remain relaxed and informal. This paper suggests that drug seller social characteristics and the availability of sale setting types are critical to developing a sociological understanding of drug markets. Sales, P., and Murphy, S. San Francisco's Freelancing Ecstasy Dealers: Towards a Sociological Understanding of Drug Markets. Journal of Drug Issues, 37(4), pp. 919-950, 2007.

Sampling and Recruitment in Multilevel Studies among Marginalized Urban Populations: The IMPACT Studies

Illicit drug use in urban settings is a major public health problem. A range of individual level factors are known to influence drug use and its consequences, and a number of recent studies have suggested that the neighborhood in which an individual lives may also play a role. However, studies seeking to identify neighborhood-level determinants of drug use, particularly among marginalized urban populations, need to overcome significant challenges, particularly in the area of sampling and recruitment. One key issue is defining functional neighborhoods that are relevant to local residents. Another arises from the need to sample a representative or even a diverse population when studying marginalized groups such as illicit drug users. These are common problems that raise particular challenges when both need to be addressed in the same study. For example, many sampling approaches for neighborhood-level studies have included some form of random sample of households, but this may systematically overlook marginalized populations. On the other hand, the sampling approaches commonly used in studies of hidden populations such as chain referral, snow ball, and more recently, respondent-driven sampling, typically expand beyond a geographic "neighborhood." In this paper, researchers describe the organization and rationale for the IMPACT Studies [the Inner-City Mental Health Study predicting HIV/AIDS, Club, and Other Drug Transitions studies are aimed at determining the association between neighborhood-level characteristics and substance abuse, HIV and other pathogens, and PTSD]. Ompad, D., Galea, S., Marshall, G., Fuller, C., Weiss, L., Beard, J., Chan, C., Edwards, V., and Vlahov, D. Sampling and Recruitment in Multilevel Studies among Marginalized Urban Populations: The IMPACT Studies. J. Urban Health, 85(2), pp. 268-280, 2008.

Gender Differences in Drug Use and Sexual Risk Behaviors among Non-Injecting Heroin Users in Puerto Rico

During the 1990s non-injected heroin use (NIHU) increased notably in several countries. However, few studies have actually examined the drug-using practices and other problem behaviors of NIHUs. In this study, researchers compared male and female NIHUs from Puerto Rico across a number of domains. Recruitment proceeded through visits to drug-copping areas and the local hangouts in their vicinity. Subjects were eligible if they were 18 to 25 years old, had never injected any drugs, and had recently used heroin or cocaine. Study participants were administered a computer-assisted personal interview. Of the 412 NIHUs recruited at the time of this study, 74 (18.0%) were females. Female NIHUs were more likely to report sexual assaults and more likely to manifest severe symptomatology of PTSD than male NIHUs (35.1% vs. 3.6%, p<.01, and 40.5% vs. 25.7%, p=.01, respectively). Females were less likely to report a source of emotional support than males (86.5% vs. 95.3%, p<.01). Close to one in four of the females (23.0%) reported a history of sexually transmitted infections, compared to three percent of the males (p<.01). HIV seroprevalence among females was 4.3% compared to 0.6% among males (p=.01). These findings suggest that female heroin users have a host of different needs compared to male heroin users. Given the scarcity of existing programs for female drug users in Puerto Rico, designing supportive systems that effectively address the specific needs of drug-using women should become a high-priority public health issue. Sosa-Zapata, I., Colon, H., Robles, R., and Cabassa, M. Gender Differences in Drug Use and Sexual Risk Behaviors among Non-Injecting Heroin Users in Puerto Rico., P. R. Health Sci. J., 26(3), pp. 205-211, 2007.

Potential Risk Factors for Injecting among Mexican American Non-Injecting Heroin Users

Researchers examined potential risk factors for initiating, resuming, and transitioning to injecting in a prospective cohort study of 300 Mexican American non-injecting heroin users (NIUs) with distinct injecting histories (i.e., never vs. former injectors). Participants were recruited using multiple sampling approaches, including respondent driven sampling and outreach. The majority of participants were male (77%) and the average age was 22 years (females were significantly older, at 23 years, compared to males, at 21 years, p<.001). NIUs with an injecting history were more likely to use heroin with an IDU, and women were significantly more likely than men to have an IDU sex partner. The young age of the study sample and length of use of non-injecting heroin (for many, more than 4 years of use) suggest the NIU population is at high risk for transitioning to injection drug use. The study also found the cultural characteristic of "fatalism" -- a belief that one's fate is determined by destiny and is inevitable -- among study participants. Former injectors reported that they expected one day to acquire or transmit an infectious disease, including HIV, HBV, or HCV. Attitudes about injecting, perceived vulnerability for infections, fatalism, and length of time using non-injection heroin were found to be important factors for predicting resumption of injecting among former IDUs. These findings bring to light culturally unique risk factors for injecting that may be incorporated into interventions appropriate to the cultural and social context of the Mexican American community. Valdez, A., Neaigus, A., and Cepeda, A. Potential Risk Factors for Injecting among Mexican American Non-Injecting Heroin Users. J. Ethn. Subst. Abuse, 6(2), pp. 49-73, 2007.

The Impact of Education and Race/Ethnicity Differences on Alcohol Dependence

This study attempts to clarify social inequalities in alcohol dependence by investigating SES and race-ethnicity effects on the development of alcohol dependence following first alcohol use. The literature has shown that while lower socioeconomic status (SES) is related to higher risk for alcohol dependence, minority race-ethnicity is often associated with lower risk. Cross-sectional data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). Survival analysis was used to model alcohol dependence onset according to education, race-ethnicity and their interaction. Compared with non-Hispanic whites, age-adjusted and sex-adjusted risks of alcohol dependence were lower among Blacks and Hispanics and higher among American Indians. Individuals without a college degree had higher risks of alcohol dependence than individuals with a college degree or more; however, the magnitude of risk varied significantly by race-ethnicity; odds ratios for less than a college degree were 1.12, 1.46, 2.24, 2.35 and 10.99 among Hispanics, whites, Blacks, Asians, and American Indians, respectively. There was no association between education and alcohol dependence among Hispanics. Race-ethnicity differences in the magnitude of the association between education and alcohol dependence suggest that aspects of racial-ethnic group membership mitigate or exacerbate the effects of social adversity. Gilman, S., Breslau, J., Conron, K., Koenen, K., Subramanian, S., and Zaslavsky, A. Education and Race-Ethnicity Differences in the Lifetime Risk of Alcohol Dependence. J. Epidemiol. Community Health, 62(3), pp. 224-230, 2008.

Family and School Associations of Emotional Distress for Asian-American Sexual Minority Youth

This study examined family and school correlates of emotional distress among Asian-American sexual minority youth in the Midwestern United States. Responses from 91 predominantly Asian-American youth who participated in a state-wide, school-based census survey, the 2001 Minnesota Student Survey (MSS), and reported recent same-gender sexual activity were analyzed. The students ranged in age from 13-19 years and 37% of respondents were female. Results showed that sexual minority youth who perceived lower levels of family caring and those with negative perceptions of school climate reported lower self-esteem, which was associated with greater emotional distress. These results highlight the importance of safe and caring environments, and culturally sensitive support for Asian-American sexual minority adolescents., Homma, Y., and Saewyc, E. The Emotional Well-Being of Asian-American Sexual Minority Youth in School. J. LGBT Health Res., 3(1), pp. 67-78, 2007.

The Health and Health Behaviors of Young Men Who Have Sex with Men

This study examined the range of health and mental health problems for which young men who have sex with men (YMSM) may be at risk. An audio-computer-assisted survey was administered to a large, ethnically diverse sample of 526 YMSM (aged 18-24 years) recruited from bars, clubs, and other social venues using a venue-based probability sampling method. Subjects reported a range of health and mental health problems, and involvement in health-compromising behaviors, such as overweight/obesity, depression, and suicidal thoughts/attempts, and many were found to have high rates of sexually transmitted infections. Moreover, many reported not having insurance coverage and/or limited access to care. Many of the health concerns and risks reported by these young men are preventable and can be addressed by any number of sectors, including health care and social service providers, religious organizations, schools, and employers. Kipke, M., Kubicek, K., Weiss, G., Wong, C., Lopez, D., Iverson, E., and Ford, W. The Health and Health Behaviors of Young Men Who Have Sex with Men. J. Adolesc. Health, 40(4), pp. 342-350, 2007.

Challenges to HIV Prevention among Men Who Have Sex with Transgender Women

Although transgender women are acknowledged as a priority population for HIV prevention, there is little knowledge regarding men who have sex with transgender women (MSTGWs). MSTGWs challenge conventional sexual orientation categories in public health and HIV prevention research, and warrant increased attention from the public health community. This study utilized qualitative techniques to assess how MSTGWs describe their sexual orientation identities, and to explore the correspondence between men's identities and sexual behaviors with transgender women. The investigators conducted in-depth semi-structured individual interviews with 46 MSTGWs in San Francisco. They observed a diversity in the ways participants identified and explained their sexual orientation, and found no consistent patterns between how men described their sexual orientation identity versus their sexual behavior and attraction to transgender women. Findings from this qualitative study question the utility of category-based approaches to HIV prevention with MSTGWs and offer insights into developing HIV interventions for these men. Operario, D., Burton, J., Underhill, K., and Sevelius, J. Men Who Have Sex with Transgender Women: Challenges to Category-Based HIV Prevention. AIDS Behav., 12(1), pp. 18-26, 2008.

Alcohol Intoxication Related to Divorce

This study tested the relationships between various forms of substance use during marriage and subsequent divorce among US young adults. Three waves of survey data collected at approximately ages 18, 23 and 29 years were used. Using multivariate logistic regression and controlling for factors present at the two early waves, investigators tested for prospective relationships between substance use at the second assessment and divorce by the third. Study participants were drawn from a longitudinal panel following adolescents on the west coast of the United States into young adulthood. The analytic subsample consisted of the 454 individuals currently married at the age 23 survey. Predictors were past-year frequency of alcohol intoxication, marijuana use and cigarette use, as well as any hard drug use in the past year. Covariates included substance use prior to marriage, demographic and socio-economic factors, marital discord and religiosity. Controlling for other factors, more frequent alcohol intoxication during marriage was an independent predictor of later divorce. Frequency of marijuana use had a significant bivariate relationship with divorce that was not significant in the multivariate model. These data are consistent with the notion that alcohol intoxication is related causally to divorce among young adults. Collins, R., Ellickson, P., and Klein, D. The Role of Substance Use in Young Adult Divorce. Addiction, 102(5), pp. 786-794, 2007.

A Folk Model of Treatment Readiness among Drug Users in Ohio

Despite the benefits of substance abuse treatment, only a small proportion of drug users actually enter treatment. Understanding "readiness" is critical for engaging drug users in treatment and for involving them in the recovery process. This paper reports findings from ethnographic interviews with 35 active drug users as they were entering treatment services, including descriptions of how they perceive readiness for treatment. Drug users expressed readiness for treatment in terms that reflect twelve step programs -- a folk model of treatment. A better understanding of drug users' perceptions about drug treatment can help to inform interventions designed to improve readiness for treatment. Redko, C., Carlson, R., and Rapp, R. A Folk Model of Treatment Readiness among Drug Users in Ohio. J. Ethn. Subst. Abuse, 6(2), pp. 15-40, 2007.


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