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Director's Report to the National Advisory Council on Drug Abuse - September, 2002

Research Findings - Epidemiology, Etiology and Prevention Research

Child, Parent, and Peer Predictors of Early-Onset Substance Use: A Multisite Longitudinal Study

The purpose of this study was to identify kindergarten-age predictors of early-onset substance use from demographic, environmental, parenting, child psychological, behavioral, and social functioning domains. Data from a longitudinal study of 295 children were gathered using multiple-assessment methods and multiple informants in kindergarten and 1st grade. Annual assessments at ages 10, 11, and 12 reflected that 21% of children reported having initiated substance use by age 12. Results from longitudinal logistic regression models indicated that risk factors at kindergarten include being male, having a parent who abused substances, lower levels of parental verbal reasoning, higher levels of over activity, more thought problems, and lower social problem-solving skills. Children with no risk factors had less than a 10% chance of initiating substance use by age 12, whereas children with 2 or more risk factors had greater than a 50% chance of initiating substance use. Results highlight the potential preventive value of early identification of children at risk for substance use. Kaplow, J.B., Curran, P.J., and Dodge, K.A. Journal of Abnormal Child Psychology, 30(3), pp. 199-216, 2002.

Part-time Work, Social Activities, Health Behaviors, and Substance Use

University of Michigan researchers examined adolescents' part-time work intensity and its relation to participation in various activities as well as substance use. Numerous studies have found that part-time work during adolescence is associated with higher rates of cigarette, alcohol, and illicit drug use. The investigators contrasted two hypotheses regarding mechanisms underlying this observation (1) the "time trade-off perspective," and (2) "the precocious development perspective." Nationally representative data were drawn from the Monitoring the Future project from 8th, 10th and 12th grade students (overall N approximate to 380,000) to address the research questions. Work intensity was found to be linked to more time spent on unstructured social activities, and to less time spent engaged in sports, health behaviors, and school-related activities. Social time use and health behaviors were found to partially mediate the relationship between work hours and substance use. Overall, results provide evidence for a combination of both perspectives. Safron, D.J., Schulenberg, J.E., and Bachman, J.G. Part-Time Work and Hurried Adolescence: The Links Among Work Intensity, Social Activities, Health Behaviors, and Substance Use. Journal of Health and Social Behavior, 42, pp. 425-449, 2001.

Community Epidemiology Work Group

The 52nd biannual meeting of the Community Epidemiology Work Group (CEWG), chaired by Nicholas J. Kozel, was held in Philadelphia, PA on June 11-14, 2002. The CEWG is composed of researchers from 21 metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas, emerging drugs of abuse, vulnerable populations and factors that may place people at risk of drug abuse, and negative health and social consequences. Reports are based on a variety of drug abuse indicator data, such as morbidity and mortality information, treatment data and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health data, local and State survey information, and findings from focus groups and qualitative research studies. The following are highlights from the meeting:

Cocaine/Crack indicators remained high, with a possible resurgence in Boston, increases in Miami and New York, and decreases or stabilization in other CEWG areas.

Heroin indicators increased in Atlanta, Miami, Minneapolis, New Orleans, New York, and Philadelphia and remained high in areas such as Boston, Baltimore, and San Francisco.

Narcotic Analgesic Indicators, especially narcotic analgesics including hydrocodone and oxycodone, continue to rise. DAWN death mentions involving narcotic analgesics/ combinations peaked in 16 CEWG areas, and in 8, exceeded the death mentions for cocaine and heroin.

Marijuana indicators increased in Chicago, Honolulu, Minneapolis, New York, Philadelphia, Phoenix, St. Louis, and San Francisco, but leveled off in other CEWG areas.

Methamphetamine indicators continue to remain at elevated levels in Hawaiian, West Coast, and Southwest CEWG areas. High proportions of adult female arrestees tested methamphetamine- positive in Honolulu, San Diego, and Phoenix (45, 36, and 29 percent, respectively). Rates of DAWN ED methamphetamine/speed mentions per 100,000 population were highest in San Francisco (14) and San Diego (13).

MDMA (methylenedioxymethamphetamine or "ecstasy") indicators continue to rise in most CEWG areas and to spread beyond the young White populations frequenting "raves." Past-year use by 12th graders rose from 5.6 percent in 1998 to 8.2 percent in 2000 in the most recent Monitoring the Future Study, and large percentage increases in lifetime use are estimated from National Household Survey data. Several CEWG sites continue to report that ecstasy is often adulterated with drugs other than MDMA.

Drug Treatment as a Crime Fighting Tool

The researchers model and empirically investigate the extent to which a change in drug use that results from treatment reduces crime and whether a change in drug use is causally related to change in crime. They analyze the change in drug use and crime pre and post treatment in a multi-site data set of 3,502 inner-city drug users entering treatment. Drug treatment apparently may be an effective crime-fighting tool. Treatment reduces not only the crime of drug possession but also crime-for-profit. Bonet, M.J., Sindelar, J.L. The Journal of Mental Health Policy and Economics, 4, pp. 175-188, 2001.

Maternal Smoking During Pregnancy: Not a Stable Phenomenon

Pickett and her colleagues examined smoking fluctuation during pregnancy in the Family Health and Development Project (FHDP), a prospective study of 92 pregnant women, and the National Health Interview Survey 1991 Pregnancy and Smoking Supplement (NHIS-S), a population-based survey of women who had given birth in the previous five years. The authors examined categories of amount smoked for each month in the FHDP and fluctuations in overall smoking status across pregnancy in the NHIS-S. Fluctuations in smoking status were substantial, only 11.5% of women in the FHDP had consistent smoking status throughout pregnancy. While many women quit or reduced their smoking upon learning of their pregnancy (58%), nearly half changed smoking status multiple times. In the NHIS-S, first quit attempts were most frequent in the first trimester. Nearly 40% of women made a serious quit attempt but 44% relapsed during pregnancy. Among women who quit for >1 week, the duration of time off cigarettes varied from 1 to 2 weeks (34%) to 8+ weeks (32%). Smoking during pregnancy is a complex and variable behavior for many women. Average or one-time measures of smoking may lead to substantial misclassification of fetal exposure. The determinants of smoking fluctuation and the significance of multiple variations in dosage and timing of exposure for predicting the risk of adverse outcomes deserve further study. Pickett, K.E., Wakschlag, L.S., and Leventhal, B.L. Maternal Smoking During Pregnancy: Not a Stable Phenomenon. Society for Pediatric and Perinatal Epidemiologic Research, Paediatric and Perinatal Epidemiology, 15, A1-A38, 2001.

Genetic and Environmental Factors in Cannabis Use

This study used data from a national probability sample of twins and siblings to replicate findings from three prior population-based twin studies regarding genetic and environmental contributions to cannabis use. Monozygotic twins showed the greatest resemblance for last year cannabis use, with significant but weaker resemblance between dizygotic twins and among siblings. Evidence was strongest for a genetic contribution and likely supportive of a family-environment role as well. The findings were consistent with the prior twin studies and thus validate use of such samples to study gene and environment contributions to understanding drug abuse. Kendler, K.S., Neale, M.C., Thornton, L.M., Aggen, S.H., Gilman, S.E., and Kessler, R.C. Cannabis Use in the Last Year in a US National Sample of Twin and Sibling Pairs. Psychological Medicine, 32, pp. 551-554, 2002.

A Novel Opioid Maintenance Program for Prisoners: Preliminary Findings

Effective post incarceration treatment for individuals with preincarceration heroin dependence is urgently needed because relapse typically follows release. This article presents first-year findings from a unique 2-year pilot study of opioid agonist maintenance treatment initiated in prison and continued in the community. Incarcerated males with preincarceration heroin dependence were randomly assigned to Levo-alpha-acetylmethadol (LAAM) maintenance or control conditions 3 months before release. Approximately 92% of eligible inmates volunteered to participate; 36 of 58 subjects who were eligible and randomly assigned to LAAM maintenance successfully initiated treatment. Twenty-eight of these continued on LAAM until release; 22 (78.6%) entered community-based maintenance treatment; and 11 (50%) remained in treatment at least 6 months post release. Changes in LAAM's labeling, because of its association with cardiac arrhythmias now makes it a second-line treatment for heroin dependence, unsuitable for treatment initiation. Nonetheless, study findings may also be applicable to methadone maintenance treatment, suggesting such treatment may be a promising means of engaging prisoners with preincarceration heroin dependence into continuing treatment. Kinlock, T.W., Battjes, R.J., Schwartz, R.P., J Subst Abuse Treat., 22(3), pp. 141-147, 2002.

Sensation Seeking, Lower Self Esteem, and Early Substance Use Associated with Early Pubertal Onset

Structured questionnaires were administered to 1,002 subjects (571 females and 431 males) who were followed from the 6th to the 10th grades and again at age 20 to investigate the relationship between early pubertal onset, substance use, sensation seeking, and self-esteem. In females, early pubertal onset was associated with greater cigarette use and lower self-esteem. In males, early pubertal onset was associated with elevated alcohol use and higher sensation seeking, with the opposite trends for late pubertal onset. Martin, C., Logan, T.K., Leukefeld, C., Milich, R., Omar, H., and Clayton, R. Adolescent and Young Adult Substance Use: Association With Sensation Seeking, Self Esteem and Retrospective Report of Early Pubertal Onset. A Preliminary Examination. International Journal of Adolescent Medicine & Health, 13(3), pp. 211-219, 2001.

Early Pubertal Maturation and Onset of Substance Use in Female Early Adolescents

Data from the National Longitudinal Study of Adolescent Health found important differences between early maturing females and their on-time and late-maturing counterparts in initiation of substance use . Twenty percent of the 7th grade females were identified as early maturers based on body changes (increased breast size and body curviness). During 7th grade, females in the early-maturing group were three times more likely to be in the most advanced group of substance users (involving alcohol use, drunkenness, cigarette use, and marijuana use) than are those in the on-time/late groups. Prevalence rates indicate that early maturers are more likely to have tried alcohol, tried cigarettes, been drunk, and tried marijuana. Prospective findings show that early developers are significantly more likely to transition out of the "No Substance Use" stage between 7th and 8th grade (47% for early developers versus 22% for on-time and late developers). In addition, early developers are more likely to advance in substance use in general, regardless of their level of use at grade 7. Lanza, S.T. and Collins, L.M. Pubertal Timing and the Onset of Substance Use in Females During Early Adolescence. Prevention Science, 3(1), pp. 69-82, 2002.

Elevated Testosterone Levels and Nicotine Use In Young Women

The relationship of testosterone levels, carbon monoxide (CO) levels, current and adolescent nicotine use, and histories of pubertal onset was examined in 30 young adult female smokers. Subjects completed questionnaires regarding nicotine use in the 7th through 10th grades, and again at age 21 as part of a cohort study of drug use. In addition, history of pubertal onset was obtained at age 21, as were testosterone and CO levels. Testosterone levels were positively correlated with cigarette use in the last 30 days, CO levels, and cigarette use reported in the 7th and 10th grades, and negatively correlated with age of pubertal onset. Martin, C., Logan, T.K., Portis, C., Leukefeld, C.G., Lynam, D., Staton, M., Brogli, B., Flory, K., and Clayton, R.R. The Association of Testosterone with Nicotine Use In Young Adult Females. Addictive Behaviors, 26(2), pp. 279-283, 2001.

Stress and Smoking in Adolescence: A Test of Directional Hypotheses

This study conducted a comparative test of the hypotheses that (a) stress is an etiological factor for smoking and (b) cigarette smoking causes increases in stress. Participants were a sample of 1,364 adolescents, initially surveyed at mean age 12.4 years and followed at three yearly intervals. Measures of negative affect, negative life events, and cigarette smoking were obtained at all four assessments. Latent growth modeling showed negative affect was related to increase in smoking over time; there was no path from initial smoking to change in negative affect. Comparable results were found for negative life events, with no evidence for reverse causation. Wills, T.A., Sandy, J.M., and Yaeger, A.M. Health Psychology, 21(2), pp. 122-30, 2002.

Childhood Psychiatric Disorders Precede Alcohol and Opioid Dependence

This study used a retrospective design and a clinical sample of 47 adults in treatment for opioid or alcohol dependence, to evaluate the developmental relationship between substance use disorders and psychopathology. The majority of subjects reported psychopathology beginning in childhood, often prior to onset of drug use disorder. Several disorders typically onset before substance use disorder: attention deficit/hyperactivity disorder, multiple anxiety, and disruptive disorders. Depressive and bipolar disorders typically onset after substance use disorder. These findings add to the literature on child psychopathology risk factors for drug abuse, and point to possible opportunities for prevention and early intervention in childhood. Hahesy, A.L., Wilens, T.E., Biederman, J., Van Patten, S. L., and Spencer, T., Temporal Association Between Childhood Psychopathology and Substance Use Disorders: Findings from a Sample of Adults with Opioid or Alcohol Dependency. Psychiatry Research, 109, pp. 235-253, 2002.

Substance Use Outcomes of Childhood Learning Disabilities and ADHD

This preliminary study is one of very few to examine learning disabilities as a possible risk factor for substance use and related disorders. A clinic sample of 109 children with ADHD was followed into adolescence. Substance use was not predicted by childhood diagnoses of reading or math disability or by IQ/achievement discrepancy in children with ADHD. However, level of cognitive functioning may be an important predictor of later substance use disorders for children with ADHD. Children with ADHD who had higher IQs were more likely to try cigarettes, smoke daily, and have their first drink or cigarette at an early age, while children with higher reading achievement were less likely to develop alcohol disorders. Thus, this preliminary work points to possible avenues for identifying subgroups of children at increased risk for later substance abuse. Molina, B.S.G., and Pelham, W.E. Substance Use, Substance Abuse, and LD Among Adolescents with a Childhood History of ADHD. Journal of Learning Disabilities, 34, pp. 333-342, 2001.

Early Drug Use Predicted by Low Birth Weight

The authors used a prospective design and community-based sample to assess whether low birth weight predicted early drug use. A sample of 473 low birth weight and 350 normal birth weight children were assessed at ages 6 and 11. Early onset of drug use was significantly higher for low birth weight boys than for normal birth weight boys, and this finding held even when controlling for potential mediators or confounders such as IQ, externalizing disorders, ADHD, and maternal smoking. Thus, low birth weight in boys may prove to be a useful vulnerability marker for early drug use. Chilcoat, H.D., and Breslau, N. Low Birth Weight as a Vulnerability Marker for Early Drug Use. Experimental and Clinical Psychopharmacology, 10, pp. 104-112, 2002.

Four-Year Follow-Up of Multisystemic Therapy with Substance-Abusing and Substance-Dependent Juvenile Offenders

The authors examined the 4-year outcomes of an evidence-based treatment of substance-abusing juvenile offenders. Eighty of 118 substance-abusing juvenile offenders participated in a follow-up 4 years after participating in a randomized clinical trial comparing Multisystemic Therapy with usual community services. A multimethod (self-report, biological, and archival measures) assessment battery was used to measure the criminal behavior, illicit drug use, and psychiatric symptoms of participating young adults. Analyses demonstrated significant long-term treatment effects for aggressive criminal activity (0.15 versus 0.57 convictions per year) but not for property crimes. Findings for illicit drug use were mixed, with biological measures indicating significantly higher rates of marijuana abstinence for MST participants (55% versus 28% of young adults). Long-term treatment effects were not observed for psychiatric symptoms. These findings provide some support for the long-term effectiveness of Multisystemic therapy with substance-abusing juvenile offenders. Henggeler, S.W., Clingempeel, W.G., Brondino, M.J., and Pickrel, S.G. J Am Ac Child and Adoles Psychiatry, 41(7), pp. 868-874, 2002.

Meta-Analysis Finds Truancy Best Risk Indicator For Youth Substance Use

Increasingly schools are held responsible for implementing effective health promotion activities, such as drug abuse prevention efforts funded through the federal Safe and Drug-Free Schools program. Consequently, school districts use student surveys as a method for assessing trends and evaluating effects of programs on behavior. Because cost and practical concerns often preclude consistent population-based school survey sampling, risk indicators provide an essential tool in analyzing needs and selecting program evaluation measures. This paper examines three risk measures associated with substance use from among those commonly assessed by school surveys: truancy, grade point average, and recent sexual intercourse. Measures were compared using meta-analysis techniques, to assess their reliability across different survey instruments, different communities, and different points in time. Truancy was judged superior, because of its strong predictive value, particularly among younger students, and because rates can be compared to school records to assess sampling validity over time. Hallfors, D., Vevea, J.L., Iritani, B., Cho, H., Khatapoush, S., and Saxe, L. Truancy, Grade Point Average, and Sexual Activity: A Meta-Analysis of Risk Indicators for Youth Substance Use. Journal of School Health, 72(5), pp. 205-211, 2002.

Influence of Peers on Substance Use Continues Into Young Adulthood

Longitudinal data were collected from 294 young adults, ages 19-25, and a same- and opposite-gender best friend or mate across three assessments. Analysis assessed the similarity in drug use patterns between the young adult and his or her peers and the peers' influence on the young adult's drug use. Patterns of cigarette use, alcohol use, binge drinking and, in most cases, marijuana use were similar between the young adult and peers. In prospective analyses, peer use predicted young adult cigarette use, binge drinking and problem use by the young adults. Results were generally consistent across genders and for both same- and opposite-gender peers. Findings emphasize the contribution of peer influence to young adult substance use. Andrews, J.A., Tildesley, E. Hops, H. and Li, F.Z. Health Psychology, 21(4), pp. 349-357, 2002.

Peer Influence is Greater for Those Who Use Less in Earlier Adolescence

This study drew data from a national data set assessing alcohol use between the ages of 14 and 18. Results of growth mixture modeling revealed two developmental trajectories for alcohol use with significant differences in levels of use. Further analyses revealed that exposure to deviant peers had a differential effect on the alcohol use of those in the distinct groups. The prospective influence of deviant peers was greater for those adolescents who had lower initial use. Thus, the study suggests that there is heterogeneity in the developmental trajectory of adolescent alcohol use and that the influence of peers varies depending on the initial status of alcohol use and the subsequent trajectory. Li, F.Z., Barrera, M. Hops, H., and Fisher, K.J., Jouranl of Behavioral Medicine, 25(3), pp. 293-315, 2002.

Family Effects Decline While Peer Effects Increase Throughout Adolescence

This study examined the effects of sociodemographic, family and peer predictors on the developmental patterns of illicit drug initiation from ages 12-21. A diverse urban sample of 808 children was surveyed longitudinally beginning at age 10 in 1985 through age 21 in 1996. Analyses revealed that the risk for initiating illicit drug use increased steadily from the ages of 12 to 21. High family conflict, low family bonding, and high peers' antisocial activities predicted higher risk of initiation across this developmental period. The effect of family bonding began to decline after age 18, while the effect of peers' antisocial activities began to increase after age 15. Few gender and ethnic differences were found. Implications for prevention include the need to include family and peer factors in developmentally appropriate ways in interventions. Guo, J., Hill, K.G., Hawkins, J.D., Catalano, R.F., and Abbott, R.D. J. Am. Acad. Child Adolesc Psychiatry, 41(7), pp. 838-845, 2002.

Secure Attachment to Friends Predicts Fewer Problem Behaviors

Using a sample of low achieving African-American youth, this study explored how stability and change in adolescents' internal working models of their close friendships was related to functioning in multiple domains. These included psychological well-being, participation in problem behaviors, negative peer influences, school attitudes, and sexual behavior. Results indicated that adolescents with stable secure friendship orientations functioned better than those with insecure working models across all domains. The group for whom attachment status changed over time either resembled the stable-insecure group or fell between the two stable groups. The findings suggest that adolescents' friendship orientations change over time and are associated with deleterious outcomes. Further, they extend attachment theory to demonstrate the importance of secure attachment in relations with friends. Miller, A.L., Notaro, P.C., and Zimmerman, M.A. J. of Social and Personal Relationships, 19, pp. 207-233, 2002.

Relationships With Natural Mentors Associated with Resiliency

Drawing from a sample of 770 adolescents from a Midwestern city, this study found that 52% reported having a natural mentor. Those with natural mentors were less likely to use alcohol, smoke marijuana, or be involved in nonviolent delinquency, and had more positive attitudes toward school. Natural mentors had no apparent effect on anxiety or depression. Using the resiliency theory framework, natural mentors were found to have compensatory but not protective effects on school attitudes. Direct and indirect (mediated) effects were found for problem behaviors and school attitudes. This study supports the potential importance of natural mentors. Zimmerman, M.A., Bingenheimer, J.B., and Notaro, P.C. Am J of Community Psychology, 30, pp. 221-243, 2002.

A Case Study of Transmission of Conduct Norms for Drug Abuse, Sexual Violence, and Violence Across Four Generations of African-American Women

This case report ethnographic study describes how conduct norms for drug abuse, sexual exploitation, and violence are transmitted across generations in severely distressed households in inner-city New York through abuse, neglect, and negative role models. Young girls growing up in these households learn to accept violent physical and sexual assault, substance abuse and sales, and unstable households as effective conduct norms. The continual assault on young girls often leads to mortification of self, characterized by acceptance of their situation and socialization to these behaviors in adulthood. This socialization to accept and expect abusive relationships results in their treating their children no better than they had been treated as children and maintains the intergenerational transmission process of drug abuse/sales, sexual exploitation, and violence. This study suggests that addressing the problems of the inner city will necessitate, in addition to providing needed services such as improved education, policing, and job training, a cultural change in young girls growing up in distressed households. Dunlap, E., Golub, A., Johnson, B.D., and Wesley, D. Intergenerational Transmission of Conduct Norms for Drugs, Sexual Exploitation and Violence: A Case Study. Brit. J. Criminol., 42, pp. 1-20, 2002.

Family Functioning, Peer Affiliation, and Problem Behaviors in Children of Antisocial and Substance Dependent Fathers

This study examined associations between paternal substance dependence (SD), paternal antisocial personality disorder (APD), family functioning, peer environments, and child psychopathology. Children of fathers with SD (with or without APD) faired worse than those without SD on several measures of family functioning. Children of fathers with both SD and APD demonstrated the highest levels of externalizing and internalizing psychopathology as well as greater affiliation with deviant peers, which, in turn, was associated with psychopathology. Regression models indicate that paternal substance dependence/antisocial personality disorder status and the child's affiliation with deviant peers were most robustly associated with child psychopathology. Results support a developmental model of antisocial problems that implicates dysfunctional family processes and deviant peer associations as key factors in the development of antisocial problems. Research is needed to develop interventions that effectively enhance familial functioning and healthy peer relations. Moss, H.B., Lynch, K.G., Hardie, T.L., and Baron, D.A. American Journal of Psychiatry, 159, pp. 607-614, 2002.

Adolescent Substance Use and Adulthood Antisocial Behavior

This general-population, retrospective study investigated the plausibility of causal relationships between adolescent drug and alcohol misuse and antisocial personality disorder (ADP) among subgroups who reported childhood-onset conduct problems (CP), adolescent-onset CP, or no more than one symptom of CP. Data from the Epidemiological Catchment Area Study (N = 8,724) suggested that persons with childhood-onset CP are at much greater risk for ADP than persons with adolescent-onset CP. Also, being drunk by age 18 or having a drug use-related symptom before age 18 increased AAB risk, even after controlling for CP history and substance use-related disorder in adulthood. Results implicate both early-onset behavior problems and substance use problems as potential etiologic factors in adult antisocial behavior. Ridenour, T.A., Cottler, L.B., Robins, L.N., Compton, W.M., Spitznagel, E.L., and Cunningham-Williams, R.M. Journal of Abnormal Psychology, 111, pp. 144-155, 2002.

Meta-Analysis of Genetic and Environmental Influences on Antisocial Behavior

A meta-analysis of 51 twin and adoption studies was conducted to estimate the magnitude of genetic and environmental influences on antisocial behavior. The best fitting model included moderate proportions of variance due to additive genetic influences (.32), nonadditive genetic influences (.09), shared environmental influences (.16), and nonshared environmental influences (.43). The magnitude of familial influences (i.e., both genetic and shared environmental influences) was lower in parent-offspring adoption studies than in both twin studies and sibling adoption studies. Age and assessment method, but not gender, were significant moderators of the magnitude of genetic and environmental influences on antisocial behavior. Rhee, S.H., and Waldman, I.D. Psychological Bulletin, 128(3), pp. 490-529, 2002.

Early Onset Delinquency and Substance Dependence

This study used an epidemiological twin sample to examine delinquency subtypes in relation to the development of substance dependence. Alcohol, nicotine, and cannabis dependence symptoms were examined in 36 early-onset delinquent, 86 late onset delinquent, and 25 non-delinquent boys over a six year span from ages 11 to 17. Early onset delinquents showed earlier onset and faster rate of increase in cannabis and nicotine dependence, and both delinquent groups showed more rapid increase in alcohol dependence symptoms. Identifying subtypes at greater risk holds potential for early targeted interventions. Taylor, J., Malone, S., Iacono, W.G., and McGue, M. Development of Substance Dependence in Two Delinquency Subgroups and Nondelinquents From a Male Twin Sample. Journal of the American Academy of Child and Adolescent Psychiatry, 41, pp. 386-393, 2002.

Labor Supply of Poor Residents in Metropolitan Miami, Florida: The Role of Depression and the Co-Morbid Effects of Substance Use

A unique set of survey data was collected between 1996-1997 in crime-ridden and low-income neighborhoods of Miami-Dade County, Florida. A targeted sampling strategy was used to recruit chronic drug users (including injection drug users) and non-drug users to examine local health care delivery system characteristics in relation to the population of substance users. The final analysis sample included 1,274 adults aged 18 to 65. Depression significantly decreased the probability of being employed. Specifically, depression reduced the probability of employment by an average of 19 percentage points in both modes, from a sample average of 43 percent of the non-depressed to 24 percent for the depressed. Estimates from the Tobit models revealed that depression also significantly reduced the number of weeks worked. The findings also showed that the effects of depression on employment and annual weeks worked may be overestimated if the analysis does not account for the comorbid influence of substance use. Alexandre, P.K., and French, M.T. The Journal of Mental Health Policy and Economics, 4, pp. 161-173, 2001.

The Relationship Between Sexual and Physical Abuse and Substance Abuse Consequences

The authors examined the relationship between a history of physical and sexual abuse and drug and alcohol related consequences. Data came from 359 male and 111 female subjects recruited from an inpatient detoxification unit. The Inventory of Drug Use Consequences measured negative life consequences of substance use. Eighty-one percent of women and 69% of men reported past physical/sexual abuse, starting at a median age of 13 and 11, respectively. Physical and sexual abuse was associated with more substance abuse consequences. For men, age 17 or younger, age at first abuse was significantly associated with more substance abuse consequences than an older age at first abuse, or no abuse. For women, the association of abuse with substance use consequences was similar across all ages. Liebschutz, J., Savetsky, J.B., Saitz, R., Horton, N.J., Lloyd-Travaglini, C., and Samet, J.H. Journal of Substance Abuse Treatment, 22, pp.121-128, 2002.

New Ways to Handle Multivariate Linear Mixed-Effects Models With Missing Values

This article presents new computational techniques for analyzing multivariate longitudinal or clustered data with missing values which will benefit prevention researchers. Current methodology for analyzing linear mixed-effects models can accommodate imbalance or missing data in a single response variable, but it cannot handle missing values in multiple responses or additional covariates. A multivariate extension of a popular linear mixed-effects model is used to create multiple imputations of missing values for subsequent analyses by a straightforward and effective Markov chain Monte Carlo procedure. A new EM algorithm for parameter estimation that converges more rapidly than traditional EM algorithms is derived. Schafer, J.L. and Yucel, R. M. Computational Strategies for Multivariate Linear Mixed-Effects Models With Missing Values. Journal of Computational and Graphical Statistics, 11(2), pp. 421-442, 2002.

New Measurement Models for Dynamic Regimes

A dynamic intervention regime is a list of rules for how the level of intervention will be tailored over time to an individual's changing problem severity. In general, individuals who receive the highest level of intervention are the persons with the greatest problem severity and need. Thus, there is planned selection of the intervention dose. In addition to the planned selection, staff judgment results in unplanned selection of the intervention level. The methodology presented in this article allows the estimation of a mean response to a dynamic intervention regime under the assumption of sequential randomization. Murphy, S.A., Van Der Laan, and Robins, J.M. Marginal Mean Models for Dynamic Regimes. Journal of the American Statistical Association, 96, pp. 1410-1423, 2002.

Gender Differences in Relation Between Social Processes and Adolescent Sexual Behavior

This study examined gender-specific contextual and socioeconomic predictors of the timing of first intercourse among low achieving African-American youth. This three year longitudinal sample was comprised of 558 African-American high school students. For women, the significant predictors of timing of intercourse include age, mother's education, time with mother, and involvement in church activities. For males, the significant factors were school achievement, an interaction between living in an intact family and time with father, participation in family decision-making, and neighborhood poverty level. Males and females are differently affected by social control processes and neighborhood poverty plays a significant role in young African-American males' sexual behavior. Ramirez-Valles, J., Zimmerman, M.A., and Juarez, L. Youth and Society, 33(3), pp. 418-441, 2002.

School-Based vs. Family and School Based Prevention Outcomes

This study evaluated the effects of combining family and school-based competency-training intervention components on substance initiation . Thirty-six rural schools were randomly assigned to 1 of 3 conditions: (a) the classroom-based Life Skills Training (LST) program and the Strengthening Families Program for Parents and Children 10-14, (b) LST only, and (c) a control condition. Outcomes were examined one year post intervention, using a substance initiation index of lifetime use of alcohol, cigarettes, and marijuana and rates of use of individual substances. Intervention-control contrasts showed significant effects for both the combined and LST-only interventions on the substance initiation index and on marijuana initiation. The combined intervention students had lower substance initiation rates than the LST-only students, however differences between the two intervention conditions were significance only for the new alcohol user rate. Relative reduction rates for alcohol initiation were 30% for the combined intervention and 4% for LST only. These preliminary results suggest that the family-focused interventions may be particularly important in preventing the initial transition into alcohol use. Spoth, R.L., Redmond, C., Trudeau, L., and Shin, C. Longitudinal Substance Initiation Outcomes for a Universal Preventive Intervention Combining Family and School Programs. Psychology of Addictive Behaviors, 31, pp. 129-134, 2002.

Alcohol and Gambling Pathology among U.S. Adults: Prevalence, Demographic Patterns and Comorbidity

This study was designed to determine the prevalence and demographic distribution of problem gambling, pathological gambling, alcohol abuse and alcohol dependence in the United States, and to examine the co-occurrence of gambling pathology and alcohol pathology in the United States. A representative sample (N = 2,638) of U.S. adults age 18 and older was surveyed in the year 2000 using computer-assisted telephone interviewing. Gambling pathology and alcohol dependence were assessed by the South Oaks Gambling Screen (SOGS) and the Diagnostic Interview Schedule (DIS). Current pathological gambling had an overall prevalence of 1.3% as measured by the DIS and 1.9% as measured by the SOGS, with a higher prevalence among minorities and lower socioeconomic status (SES) respondents. Current pathological gambling and alcohol dependence were correlated, and the highest correlation was found among higher SES respondents. These epidemiologic data indicate that the prevalence of current pathological gambling in the United States is higher than previously estimated, with minorities and lower SES Americans have higher than average rates. Welte, J., Barnes, G., Wieczorek, W., Tidwell, M.C., and Parker, J. Journal of Studies on Alcohol, 62(5), pp. 706-712, 2001.

Adolescent Binge-Drinking Trajectories and Substance Abuse in Adulthood

This study describes binge-drinking trajectories from adolescence to early adulthood in 238 children of alcoholics and 208 controls. Mixture modeling identified three trajectory groups of drinkers: early-heavy (early onset, high frequency), late-moderate (later onset, moderate frequency), and infrequent (early onset, low frequency). The early-heavy group was characterized by parental alcoholism and antisociality, peer drinking, drug use, and (for boys) high levels of externalizing behavior, but low depression. The infrequent group was elevated in parent alcoholism and (for girls) adolescent depression, whereas the nonbinger and late-moderate groups showed the most favorable adolescent psychosocial variables. All three drinking trajectory groups raised risk for later substance abuse or dependence compared with the nonbingers, with the early-heavy group at highest risk. Chassin, L., Pitts, S.C., and Prost, J. Journal of Consulting and Clinical Psychology, 70(1), pp. 67-78, 2002.

Most Rape Victims Express Rape-Related HIV Risk Concerns

A sample of 62 recent rape victims who had received post-rape medical care were interviewed an average of 6 weeks after being raped to assess fear or concern about contracting HIV as a result of rape. Fifty-seven of the 62 women (91.9%) reported some degree of initial fear or post-rape concern about contracting HIV; and 45 of the 62 women (72.6%) reported that they were extremely fearful or concerned about contracting HIV. Women who were extremely fearful or concerned about contracting HIV were more likely to have been raped by a stranger. Reported fear/concern was not simply a function of current intensity of intrusive or avoidance symptoms of post-traumatic stress disorder. Fifty-one women (82.3%) wanted more information about HIV at post-rape medical treatment visits. Resnick, H., Monnier, J., Seals, B., Holmes, M., Nayak, M., Walsh, J., Weaver, T.L., Acierno, R., and Kilpatrick, D.G. Rape-Related HIV Risk Concerns Among Recent Rape Victims. Journal of Interpersonal Violence, 17(7), pp. 746-759, 2002.

Patterns of Assault In a Sample of Recent Rape Victims

Intimate partner assault patterns are not well understood in recent rape victims. In an effort to examine these patterns, 47 rape victims seeking care from a forensic medical examination facility were sampled across three assessment points (6 weeks post-assault, 3 months post-assault, and 6 months post-assault). Index rape, prior rape and physical assault, and new rape and subsequent physical assault were classified by victims' relationships to their perpetrators. At the initial medical exam, 17 women had been past victims of domestic violence. Six women were victims of intimate partner violence during the 6 months after the index rape. Monnier, J., Resnick, H.S., Kilpatrick, D.G., Seals, B., and Holmes, M. Violence against Women, 8(5), pp. 585-596, 2002.

The Relationship Between Distress and Resource Loss Following Rape

Rape is a prevalent traumatic stressor, with an estimated 12 million U.S. adult women reporting the experience of rape in their lifetimes. It has been identified as a risk factor for development of a range of negative mental health and physical health outcomes. Previous studies have demonstrated that women who are victims of interpersonal violence experience subsequent disruption in resources (e.g., unemployment, reduced income, divorce) following victimization. The present study examined the impact of resource loss on violent crime victims. Subjects were 57 women over the age of 18 who were recent victims of rape. Results indicate that psychological distress is followed by increased resource loss for rape victims. These results suggest that distress may be an underlying mechanism for resource loss in victims of sexual assault. Monnier, J., Resnick, H.S., Kilpatrick, D.G., and Seals, B. Violence & Victims, 17(1), pp. 85-92, 2002.

Alcohol and Drug Use among College Students

Monitoring the Future (MTF) researchers at the University of Michigan reported on the extent of alcohol use and other drug use among American college students. MTF plus four additional data sources were examined to estimate recent levels of alcohol and other drug use among college students: Harvard School of Public Health College Alcohol Study (CAS), the Core Institute (CORE), Monitoring the Future (MTF), National College Health Risk Behavior Survey (NCHRBS) and National Household Survey on Drug Abuse (NHSDA). Alcohol use rates were found to be very high among college students; approximately two of five American college students were heavy drinkers, defined as having had five or more drinks in a row in the past 2 weeks. Alcohol use is higher among male than female students. According to race/ethnicity, white students are highest in heavy drinking, black students are lowest and Hispanic students are intermediate. Use of alcohol--but not cigarettes, marijuana and cocaine--is higher among college students than among noncollege age-mates. Longitudinal data show that, while in high school, students who go on to attend college have lower rates of heavy drinking than do those who will not attend college. Both groups increase their heavy drinking after high school graduation, but the college students increase distinctly more and actually surpass their nonstudent age-mates. Trend data from 1980 to 1999 show some slight improvement in recent years. The authors concluded that, despite improvements in the past 20 years, colleges need to do more to reduce heavy alcohol use among students. O'Malley, P.M. and Johnston, L.D. Epidemiology of Alcohol and Other Drug Use among American College Students. Journal of Studies on Alcohol, Supplement 14, pp. 23-39, 2002.


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