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Director's Report to the National Advisory Council on Drug Abuse - September, 2007



Research Findings - Epidemiology and Etiology Research

Who is Becoming Hallucinogen Dependent Soon after Hallucinogen Use Starts?

This study, based upon epidemiological survey data from the United States (U.S.) National Household Surveys on Drug Abuse (NHSDA) from 2000 to 2001, presents new estimates for the risk of developing a hallucinogen dependence syndrome within 24 months after first use of any hallucinogen (median elapsed time approximately 12 months). Subgroup variations in risk of becoming hallucinogen dependent also are explored. Estimates are derived from the NHSDA representative samples of non-institutionalized U.S. residents ages 12 and older (n=114,241). A total of 2035 respondents had used hallucinogens for the first time within 24 months prior to assessment. An estimated 2-3% of these recent-onset hallucinogen users had become dependent on hallucinogens, according to the NHSDA DSM-IV computerized diagnostic algorithm. Controlling for sociodemographic and other drug use covariates, very early first use of hallucinogens (age 10-11 years) is associated with increased risk of hallucinogen dependence (p<0.01). Excess risk of developing hallucinogen dependence was found in association with recent-onset use of mescaline; excess risk also was found for recent-onset users of ecstasy and of PCP. This study's evidence is consistent with prior evidence on a tangible but quite infrequent dependence syndrome soon after the start of hallucinogen use; it offers leads that can be confirmed or disconfirmed in future investigations. Stone, A., O'Brien, M., De La Torre, A., and Anthony, J. Who is Becoming Hallucinogen Dependent Soon after Hallucinogen Use Starts? Drug Alcohol Depend, 87(2-3), pp. 153-163, 2007.

Twin Study of Stimulant Use/Abuse and Associations with Cannabis

This paper explores the magnitude of, and extent of overlap between, genetic, shared environmental and non-shared environmental influences on lifetime stimulant use and on stimulant abuse/dependence symptoms. It further explores the associations between stimulant use and cannabis use and the extent to which these associations can be attributed to common or correlated genetic and environmental influences. Data came from self report on lifetime stimulant use, DSM-IV abuse/dependence symptoms and corresponding measures of cannabis involvement collected from a sample of 6265 male and female Australian twins born between 1964 and 1971. Results showed that approximately one in five study participants reported lifetime stimulant use while 5% reported experiencing at least one symptom of abuse/dependence. Multivariate genetic model fitting indicated moderate genetic influences on stimulant use (40%) and symptoms (65%) while there was no evidence of sex differences in the magnitude of these influences. Despite moderate overlap, 65% of the genetic influence on stimulant abuse/dependence was specific to these symptomatologic outcomes. There were also strong genetic and shared environmental correlations between the factors associated with stimulant use and those associated with cannabis use. The authors conclude that there is evidence for both overlapping and distinct genetic factors contributing to stimulant use vs. abuse/dependence, which may have implications for opportunities for intervention, for example if those leading to initiation are in the personality realm and those leading to abuse/dependence are more metabolic. Moreover, the overlap in familial (genetic and environmental) risk factors for both stimulant and cannabis use suggests some degree of non-specificity in the risk for using these substances, although more study is needed. Lynskey, M., Grant, J., Li, L., Nelson, E., Bucholz, K., Madden, P., Statham, D., Martin, N., and Heath, A. Stimulant Use and Symptoms of Abuse/Dependence: Epidemiology and Associations with Cannabis Use--A Twin Study. Drug Alcohol Depend, 86(2-3), pp. 147-153, 2007.

Childhood Antecedents of Exposure to Traumatic Events and Posttraumatic Stress Disorder

The authors prospectively examined childhood antecedents of exposure to traumatic events to estimate the risk of posttraumatic stress disorder (PTSD) among those exposed to trauma. Two consecutive cohorts of children entering first grade of a public school system in a large mid-Atlantic city in the mid-1980s were followed into young adulthood (mean age=21). Exposure to traumatic events and PTSD were assessed in 75% of the original cohort (N=1,698). Childhood assessments, conducted upon entry into the first grade, included standardized measures of reading readiness, teacher ratings of behavioral problems, and child self-reports about depression and anxiety. Family characteristics were assessed by parental report. Young adults who had been rated by their first grade teacher as having aggressive/ disruptive behavior problems were more likely to experience traumatic assaultive violence events (e.g., being mugged/threatened with a weapon, badly beaten-up) (relative risk=2.6) but not PTSD following trauma exposure. Youths with high levels of self-rated depressive and anxious feelings in first grade were more likely to experience PTSD once exposed to trauma (relative risk=1.5). Youths who scored in the highest quartile on a reading test in the first grade were at lower risk for exposure to assaultive violence traumas. Childhood behavioral and depressive/anxious problems may influence the risk for PTSD directly by increasing the vulnerability to the PTSD effects of trauma exposure, and indirectly by increasing the likelihood of exposure to assaultive violence. Storr, C., Ialongo, N., Anthony, J., and Breslau, N. Childhood Antecedents of Exposure to Traumatic Events and Posttraumatic Stress Disorder. Am J Psychiatry, 164(1), pp. 119-125, 2007.

Effect of Televised, Tobacco Company-Funded Smoking Prevention Advertising on Youth Smoking-Related Beliefs, Intentions, and Behavior

The authors examined the association between exposure to televised youth smoking prevention advertising and youths' smoking beliefs, intentions, and behaviors. They obtained commercial television ratings data from 75 US media markets to determine the average youth exposure to tobacco company youth-targeted and parent-targeted smoking prevention advertising, then merged these data with nationally representative school-based survey data (n = 103,172) gathered from 1999 to 2002. Multivariate regression models controlled for individual, geographic, and tobacco policy factors, and other televised anti-tobacco advertising. There was little relation found between exposure to tobacco company-sponsored, youth-targeted advertising and youth smoking outcomes. Among youths in grades 10 and 12, during the 4 months leading up to survey administration, each additional viewing of a tobacco company parent-targeted advertisement was, on average, associated with lower perceived harm of smoking (odds ratio [OR]=0.93; confidence interval [CI]=0.88, 0.98), stronger approval of smoking (OR=1.11; CI=1.03,1.20), stronger intentions to smoke in the future (OR=1.12; CI=1.04,1.21), and greater likelihood of having smoked in the past 30 days (OR=1.12; CI=1.04,1.19). Exposure to tobacco company youth-targeted smoking prevention advertising generally had no beneficial outcomes for youths. Exposure to tobacco company parent-targeted advertising may have harmful effects on youth, especially among youths in grades 10 and 12. Wakefield, M., Terry-McElrath, Y., Emery, S., Saffer, H., Chaloupka, F., Szczypka, G., Flay, B., O'Malley, P., and Johnston, L. Effect of Televised, Tobacco Company-Funded Smoking Prevention Advertising on Youth Smoking-Related Beliefs, Intentions, and Behavior. Am J Public Health, 96(12), pp. 2154-2160, 2006.

Marker or Mediator? The Effects of Adolescent Substance Use on Young Adult Educational Attainment

The purpose of this study was to test the effects of adolescent substance use on college attendance and completion by young adulthood in the context of the behavioral and familial risk factors that influence substance use. Longitudinal data were collected from a community sample of children of alcoholics (248) and matched controls (206) at three adolescent assessments (micro(age) = 13-15) and a long-term follow-up in young adulthood (micro(age) = 25). College attendance and degree completion by age 25 were self-reported in young adulthood. During adolescence, self-reports of alcohol and drug use were assessed with log-transformed quantity/frequency measures; substance use risk factors [e.g. parental monitoring, externalizing and internalizing symptoms and Diagnostic and Statistical Manual version III (DSM-III) diagnosis of parental alcoholism] were assessed by both self- and parent-report, and adolescent reading achievement was assessed using a standardized assessment of reading achievement (Wide Range Achievement Test). Growth curve modeling results suggest that mean levels and growth in adolescent substance use mark, or identify, those adolescents who are at risk for reduced odds of attending and completing college. Moreover, adolescent substance use was not merely a marker of risk, in that growth in drug use (but not alcohol use) significantly mediated the effects of parental alcoholism and early externalizing behavior on later college completion, partially explaining the effects of these risk factors on college completion. The authors concluded that the current study provides evidence for both the marker and the mediator hypotheses, and identifies multiple pathways to higher educational attainment. Furthermore, the findings point to the importance of studying the effects of adolescent substance use in a broader developmental context of its correlated risk factors to specify more effectively the key pathways to later developmental outcomes. King, K., Meehan, B., Trim, R., and Chassin, L. Marker or Mediator? The Effects of Adolescent Substance Use on Young Adult Educational Attainment. Addiction, 101(12), pp. 1730-1740, 2006.

Male-Female Differences in the Risk of Progression from First Use to Dependence upon Cannabis, Cocaine, and Alcohol

The authors extend prior reports about the risk of dependence on specific drugs by providing developmental-specific risk estimates for progression from first use to meeting criteria for DSM-III-R dependence upon cannabis, cocaine, or alcohol, as well as male-female differences. The data are from the National Comorbidity Survey, with a national probability sample of persons 15-44 years old in the United States, which included many respondents who used cannabis, cocaine and alcohol on at least one occasion (n=3558, 1337, and 6149, for cannabis, cocaine, and alcohol, respectively). Survival analysis procedures provided cumulative risk estimates of progression from first use to dependence upon each drug. The estimated risk of cannabis dependence among male cannabis users was 1% in the first year after first use, and reached a peak at 4% per year 2 years later, before declining. In contrast, the estimated risk of cannabis dependence among female cannabis users remained at 1% per year for 3 years, without the peak. For both male and female cocaine users, the estimated risk for developing cocaine dependence was 5 to 6% within the first year after first use. Thereafter, the estimated risk declined from the peak value, with a somewhat faster decline for females in the next 3 years after first use. For alcohol, the estimated risk period extended for many years after the first drink, with female drinkers becoming alcohol dependent at a rate of about 1% per year; with somewhat higher risk for male drinkers. For both male and female drinkers, the period of risk for developing alcohol dependence extended for a span of more than 20 years since first use; for cannabis and cocaine, the estimated period of risk was much shorter. There are male-female differences in the risk of becoming cannabis dependent during the first several years after initiation of cannabis use, less pronounced male-female differences for alcohol, and relatively smaller male-female differences for cocaine. These results should interest scientists whose focus is upon the origins of male-female differences in the occurrence of drug dependence. Wagner, F., and Anthony, J. Male-Female Differences in the Risk of Progression from First Use to Dependence Upon Cannabis, Cocaine, and Alcohol. Drug Alcohol Depend, 86(2-3), pp. 191-198, 2007.

Pathways Between Ecstasy Initiation and Other Drug Use

This study aims to shed light on drug use pathways associated with ecstasy use initiation. Data from 54,573 respondents aged 12-21 years old from the 2002-2003 National Survey on Drug Use and Health (NSDUH) public use data files were analyzed via Cox proportional hazards models with time-dependent covariates. Findings showed that marijuana, cocaine, and heroin were significant independent predictors of subsequent ecstasy use. Earlier ecstasy initiation was significantly associated with subsequent other illegal drug initiation (marijuana, cocaine and heroin). The strength of the association was greater for the pathway from earlier marijuana initiation to subsequent ecstasy initiation as compared to the pathway in the opposite direction. The pathway from earlier ecstasy initiation to subsequent cocaine and heroin initiation was also stronger as compared to pathways in the opposite directions. Pathways between ecstasy initiation and marijuana, cocaine and heroin initiation seem to be independent of the association between drug use and psychiatric symptoms/deviant behaviors. Ecstasy initiation seems to play a role in the subsequent initiation of cocaine and heroin. Martins, S., Ghandour, L., and Chilcoat, H. Pathways Between Ecstasy Initiation and Other Drug Use. Addict Behav, 32(7), pp. 1511-1518, 2007.

Gender Differences in Criteria for Cannabis Abuse and Dependence

This study explored whether gender contributes to heterogeneity in the latent construct for abuse and dependence of cannabis, and furthermore, whether after accounting for differences in the mean scores of abuse and dependence across genders, there is any evidence for heterogeneity in the individual abuse and dependence criteria. The authors utilized data on criteria for cannabis abuse and dependence from the NESARC (National Epidemiological Survey on Alcohol and Related Conditions), a large, nationally representative sample including 8172 lifetime cannabis users. Analyses used factor analyses and modeling to examine dimensionality and gender heterogeneity. Results supported a unidimensional construct for cannabis abuse/dependence combined, rather than separate entities, which has also been found in prior research. The authors also identified two abuse (legal and hazard) and two dependence (quit and problems) criteria which showed significant gender heterogeneity; the abuse criteria exhibited higher thresholds in women and the dependence criteria in men. They concluded that the criteria that serve as indicators of DSM-IV cannabis abuse and dependence do not function identically in men and women and that certain criteria (e.g. hazardous use) require further refinement. These findings have important implications for the revision of the DSM criteria for abuse and dependence, both for questioning a distinction between abuse and dependence and for considering gender-sensitive diagnostic criteria in research and clinical settings. Agrawal, A., and Lynskey, M. Does Gender Contribute to Heterogeneity in Criteria for Cannabis Abuse and Dependence? Results from the National Epidemiological Survey on Alcohol and Related Conditions. Drug Alcohol Depend, 88(2-3), pp. 300-307, 2007.

DSM-IV Abuse and Dependence Criteria: Factor and Item Response Analyses

This paper questions the assumptions underlying DSM that drug abuse and dependence are distinct entities and that the same criteria apply to all drugs. They used a population-based sample of males to test these ideas using factor analysis and item response theory. A total of 4234 males born from 1940 to 1974 from the population-based Virginia Twin Registry were assessed for DSM-IV drug use, abuse and dependence criteria for cannabis, sedatives, stimulants, cocaine and opiates. For each drug class, the pattern of endorsement of individual criteria for abuse and dependence, conditioned on initiation and use, could be best explained by a single factor. There were large differences in individual item performance across substances in terms of item difficulty and discrimination. Cocaine users were more likely to have encountered legal, social, physical and psychological consequences. The authors conclude that the DSM-IV abuse and dependence criteria, within each drug class, are not distinct but best described in terms of a single underlying continuum of risk. Furthermore, because individual criteria performed very differently across substances in IRT analyses, they conclude that the assumption that these items are measuring equivalent levels of severity or liability with the same discrimination across different substances is unsustainable. These findings have implications for nosology, phenotyping, and clinical research. Gillespie, N., Neale, M., Prescott, C., Aggen, S., and Kendler, K. Factor and Item-Response Analysis DSM-IV Criteria for Abuse of and Dependence on Cannabis, Cocaine, Hallucinogens, Sedatives, Stimulants and Opioids. Addiction, 102(6), pp. 920-930, 2007.

Grandmother and Parent Influences on Child Self-Esteem

This study tests a model of intergenerational influences on childhood self-esteem that proposes paths from grandmothers' drug problems to grandchildren's self-esteem via parents' drug problems and parental adaptive child rearing and from grandmothers' maternal acceptance to grandchildren self-esteem via parents' unconventionality and adaptive child rearing. This longitudinal study uses data obtained from interviews with a New York City sample of black and Puerto Rican children (N = 149) and 1 of their parents and from mailed questionnaires or comparable interviews with those parents' mothers. Structural equation modeling was used to test the proposed model. The LISREL analysis found that, with 3 exceptions, all of the hypothesized paths were significant. The total effects analysis indicated that parents' adaptive child rearing was the strongest latent construct, a finding that was consistent with this construct's proximal position in the model. This study suggests that mothers' drug problems are not just near-term risks for their children, but also pose long-term risks for their children's future functioning as parents and thereby for their grandchildren. The authors conclude that the relative strength of parents' adaptive child rearing in this intergenerational model indicates that this area should be the focus of therapeutic intervention efforts, but addressing future grandmothers' drug problems may have positive effects on multiple generations. Brook, J., Ning, Y., Balka, E., Brook, D., Lubliner, E., and Rosenberg, G. Grandmother and Parent Influences on Child Self-Esteem. Pediatrics, 119(2), pp. 444-451, 2007.

Injecting and Sexual Risk Correlates of HBV and HCV Seroprevalence among New Drug Injectors

This study examines injecting and sexual risk correlates of hepatitis B (HBV) and hepatitis C (HCV) seroprevalence among new injecting drug users (IDUs) (age 18-30 years, injecting =300 lifetime drug injections. Among men only, HCV seropositivity was associated with >/=40 lifetime number of sex partners (among those never sharing injecting equipment). In this new IDU sample, HBV and HCV seroprevalence differed by gender and were considerably higher than HIV seroprevalence. The findings suggest that early interventions, targeting injecting and sexual risks and including HBV vaccination, are needed among new IDUs to prevent HBV, HCV and, potentially, HIV epidemics. Neaigus, A., Gyamarthy, A., Miller, M., Frajzyngier, V., Zhao, M., Friedman, S., and Des Jarlais, D. Injecting and Sexual Risk Correlates of HBV and HCV Seroprevalence Among New Drug Injectors. Drug Alcohol Depend, 89(2-3), pp. 234-243, 2007.

The Transition from Injection to Non-Injection Drug Use: Long-Term Outcomes among Heroin and Cocaine Users in New York City

Researchers sought to characterize heroin and cocaine users in New York City who have changed from injection to non-injection drug administration and to identify factors associated with long-term non-injection use. They conducted 2 cross-sectional studies of heroin and cocaine users in New York City. New admissions were recruited at drug abuse treatment programs (2000-04) and respondent-driven sampling was used to recruit drug users from the community (2004). Both injecting and non-injecting drug users participated in each study. ''Former injectors'' were defined operationally as people who had used heroin and/or cocaine in the 6 months prior to the interview and who had injected illicit drugs in the past, but whose most recent injection was more than 6 months before the study interview. "Current'' injectors were defined as people who had injected heroin and/or cocaine in the 6 months prior to the interview. A structured interview on drug use history was administered, and a serum sample was collected and tested for HIV. The study found that a total of 104 former injectors were recruited for the drug abuse treatment program study, and 229 current injectors were recruited for the community recruitment study; 160 former injectors and 1731 current injectors were recruited from the drug abuse treatment study. Compared with the current injectors, former injectors were older and more likely to be African American. The former injectors reported long intervals since their most recent injection, a mean of 8 years in the drug abuse treatment program study and a mean of 12 years in the community recruitment study. The most common reasons for stopping injection drug use included concerns about health, social stigmatization and self-image, and preference for intranasal use as a route of drug administration. The results were highly consistent across the two studies. These findings suggest that the transition from injection to non-injection use appears to be a relatively stable behavior change for many former injectors, who report a decade or more without injecting. Developing a greater understanding of the transition from injection to stable non-injection drug use may provide insights into the natural histories of drug use and addiction. Des Jarlais, D., Arasteh, K., Perlis, T., Hagan, H., Heckathorn, D., Mcknight, C., Bramson, H., and Friedman, S. The Transition from Injection to Non-Injection Drug Use: Long-Term Outcomes among Heroin and Cocaine Users in New York City. Addiction, 102(5), pp. 778-785, 2007.

Comorbid Mental Disorders Associated with Nicotine Dependence in Pregnant Women

Dr. Renee Goodwin and colleagues investigated the association between mental disorders and cigarette use and nicotine dependence among pregnant women in the United States. Using a face-to-face general population survey, the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, 1516 women reporting a pregnancy in the past year were assessed for cigarette smoking and nicotine dependence, as well as DSM-IV-defined mood and anxiety disorders and personality disorders. They found that among pregnant women, 21.7% reported cigarette use and 12.4% met the criteria for nicotine dependence. Among pregnant women with cigarette use, 45.1% met criteria for at least one mental disorder, and among those with nicotine dependence, 57.5% met criteria for at least one other mental disorder. After adjusting for demographics and comorbidity, nicotine dependence during pregnancy significantly predicted any mental disorder (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.1-5.1), any mood disorder (OR 2.5, 95% CI 1.5-4.0), major depression (OR 2.07, 95% CI 1.3-3.4), dysthymia (OR 6.2, 95% CI 2.9-13.1), and panic disorder (OR 3.1, 95% CI 1.6-6.1) in the past year. No significant associations were found between nondependent cigarette use and mental disorders. These results suggest an association between mental disorders and nicotine dependence among pregnant women in the United States, a finding with implications for treatment and service provision. Goodwin, R., Keyes, K., and Simuro, N. Mental Disorders and Nicotine Dependence Among Pregnant Women in the United States. Obstet Gynecol, 109(4), pp. 875-883, 2007.

The Impact of Retail Cigarette Marketing Practices on Youth Smoking Uptake

Authors sought to examine the differential associations of cigarette retail marketing practices on youth smoking uptake. Analyses from 1999 through 2003 Monitoring the Future surveys involved 109,308 students and data on retail cigarette marketing collected from 966 communities in which the students reside, as part of the Bridging the Gap Initiative: Research Informing Practice and Policy for Healthy Youth Behavior. A total of 26,301 students were selected for this study and the exposures of Point-of-sale advertising, promotions, prices, and placement were evaluated. Using a smoking uptake measure to account for stages that identify the process by which adolescents begin smoking, odds ratios and confidence intervals were calculated through generalized ordered logit analyses, with weighted data that controlled for demographic and socioeconomic characteristics and accounted for clustering at the community level. Higher levels of advertising, lower cigarette prices, and greater availability of cigarette promotions were associated with smoking uptake. Advertising increased the likelihood of youth initiating smoking, price increased the likelihood of smoking at most levels of uptake, and availability of promotions increased the likelihood that youth will move from experimentation to regular smoking. Cigarette retail marketing practices increase the likelihood of smoking uptake. These findings suggest that specific restrictions on retail cigarette marketing may reduce youth smoking. Slater, S., Chaloupka, F., Wakefield, M., Johnston, L., and O'Malley, P. The Impact of Retail Cigarette Marketing Practices on Youth Smoking Uptake. Arch Pediatr Adolesc Med, 161(5), pp. 440-445, 2007.

Peer and Parental Influences on Longitudinal Trajectories of Smoking among African Americans and Puerto Ricans

The purpose of this study was to identify distinct trajectories of smoking behavior during a period extending from adolescence (mean age = 14 years) to young adulthood (mean age = 26 years) among African American and Puerto Rican adolescents/young adults, to examine ethnic and gender differences in group membership, and to assess the ability of peer and parental smoking to distinguish among trajectory groups. A community-based sample of 451 African American and Puerto Rican adolescents was interviewed four times during adolescence and in early adulthood, covering a span of 12 years. For both ethnic/racial groups, four distinct trajectories were identified: Nonsmokers, maturing-out smokers, late-starting smokers, and early-starting continuous smokers. Compared with Puerto Ricans, African Americans were over-represented in the nonsmoking group, whereas Puerto Ricans were over-represented in the early-starting continuous group. Females were more likely than males to be early-starting continuous smokers than late starters. Adolescents who were exposed to peer and parental smoking in early adolescence were more likely to belong to trajectory groups characterized by higher levels of smoking. These findings show that exposure to peer and parental smoking in early adolescence constitutes a risk factor for engaging in elevated levels of smoking behavior at an early age and for continued smoking into adulthood for urban African Americans and Puerto Ricans. To be most effective, smoking prevention programs should address peer group and family influences on adolescent smoking. Brook, J., Pahl, K., and Ning, Y. Peer and Parental Influences on Longitudinal Trajectories of Smoking Among African Americans and Puerto Ricans. Nicotine Tob Res, 8(5), pp. 639-651, 2006.

Women Who Gave Birth as Unmarried Adolescents: Trends in Substance Use from Adolescence to Adulthood

The purpose of this study is to determine whether adolescent childbearing mothers "mature out" of substance use as they transition into adulthood, how their substance use compares to that of typical young women of the same ages, and whether there are different patterns of substance use evident in this vulnerable population. The data come from an ongoing longitudinal study of 240 young women who were unmarried, pregnant, and under age 18 at enrollment. They have been interviewed regularly from pregnancy through 11.5 years postpartum. The data are based on self-reported substance use verified by random urinalysis for drug metabolites. Substance use did not decline during the transition to adulthood nor into early adulthood. With the exception of alcohol, the prevalence of substance use was higher than that of a nationally representative sample of same-aged women. Three distinct patterns of substance use were identified: licit users (cigarettes and/or alcohol), marijuana users, and "hard" drug users. From these findings, the authors suggest that clinicians routinely assess substance use among young mothers who bore children as teenagers, and make referrals for appropriate treatment. Cigarette smoking is especially a cause for concern, given its widespread use and harmful effects for both mothers and their children. Although only a small proportion (about 5%) of young mothers used hard drugs consistently over time, this group will likely require comprehensive interventions that address multiple issues such as mental health and contextual factors to be effective. Future research should address reasons for continued substance use in this population. Gillmore, M., Gilchrist, L., Lee, J., and Oxford, M. Women Who Gave Birth as Unmarried Adolescents: Trends in Substance Use from Adolescence to Adulthood. J Adolesc Health, 39(2), pp. 237-243, 2006.

A Prospective Study of the Effects of Age of Initiation of Alcohol and Drug Use on Young Adult Substance Dependence

Previous cross-sectional research has disagreed about whether an adolescent's age of onset of alcohol use is a unique predictor of later alcohol dependence or whether it is merely a correlate of those factors that produce alcohol dependence. The current study tests this question in a longitudinal sample, and extends the literature by testing whether age of onset of alcohol and drug use predicts alcohol and drug dependence. Data from an ongoing study of children of alcoholics and matched controls (n = 395) were collected during three annual interviews during adolescence and two 5-year follow-ups in young adulthood. Taking a first drink of alcohol at or before age 13 was unrelated to the odds of alcohol and drug dependence when the adolescent did not also participate in early drug use or when correlated risk factors were taken into account. On the other hand, early drug use elevated the odds of drug dependence by young adulthood, even while controlling for shared risk factors. The current study provides support for the notion that early-adolescent onset of alcohol use is a marker of risk for later dependence rather than a causal influence. Moreover, it provides evidence for the impact of early drug use on drug-substance dependence. Implications for theory and intervention are discussed. King, K., and Chassin, L. A Prospective Study of the Effects of Age of Initiation of Alcohol and Drug Use on Young Adult Substance Dependence. J Stud Alcohol Drugs, 68(2), pp. 256-265, 2007.

Twentieth Century Rises in Adult Cigarette Use in the U.S. Parallel Rises in Asthma in Children

The prevalence of asthma has increased at least 3-fold during the past several decades. However, the reason for this increase remains unknown. Renee Goodwin of Columbia University examined one possible factor that may be affecting the increase in prevalence of asthma among youth in the United States from 1900 to 2003. She hypothesized that (1) there has been a marked increase in smoking during the past century, (2) this increase in smoking has resulted in a substantial increase in exposure to environmental tobacco smoke among children, and (3) increased exposure to environmental tobacco smoke has contributed to the increase in childhood asthma. Using a sample of 4,500 children from the National Health Interview Survey, data on the incidence of asthma were aggregated and compared on an ecologic level with data on cigarette consumption from the American Lung Association. Her results suggest a parallel increase in the rates of cigarette use among adults and asthma in children. These findings show an increase in cigarette use during the past 4 birth cohorts, with subsequent leveling off at a population level with a progressively more prominent increase in cigarette use among women in the United States. She notes that future studies will be needed to confirm these ecological trends with community-level analyses in a variety of geographic regions. Goodwin, R. Environmental Tobacco Smoke and the Epidemic of Asthma in Children: The Role of Cigarette Use. Ann Allergy Asthma Immunol, 98(5), pp. 447-454, 2007.

Maternal Cigarette Smoking During Pregnancy and Child Aggressive Behavior

This study's objective was to examine the association between maternal smoking during pregnancy and childhood aggressive behavior in African-American and Puerto Rican children, as well as the relationship between maternal unconventional behavior, low maternal affection, and offspring aggression. Participants consisted of African-American and Puerto Rican children (N = 203; mean age = 8.6, SD = 0.87) and their mothers living in an inner city community. An interview consisting of a structured questionnaire was administered to the mothers and their children. Scales with adequate psychometric properties were adapted from previous validated measures. They included maternal smoking during pregnancy, maternal education, unconventionality, and warmth. Controlling for demographic factors, maternal unconventional behavior, and low maternal warmth, maternal smoking during pregnancy was associated with having offspring who were aggressive. Maternal unconventionality and warmth were independently related to childhood aggression. The authors suggest that although causal limitations are noted, it may be that a decrease in smoking during pregnancy is associated with a reduction in aggression in the offspring. Brook, D., Zhang, C., Rosenberg, G., and Brook, J. Maternal Cigarette Smoking During Pregnancy and Child Aggressive Behavior. Am J Addict, 15(6), pp. 450-456, 2006.

Personality Risk Factors Associated with Trajectories of Tobacco Use

The purpose of this longitudinal, prospective study was to evaluate trajectories of smoking in a cohort of African-American and Puerto Rican young adults and describe personality and behavioral factors associated with specific smoking trajectory group membership. Participants consisted of African-American and Puerto Rican male and female young adults (N = 451, mean age 26) from an inner-city community. Data were collected at four time points over a period of 13 years using structured interviews. Interviews took place within the schools and the participants' homes. Scales with adequate psychometric properties were adapted from previously validated measures. Variables that were examined for this study came from the domains of internalizing behaviors, externalizing behaviors, drug use, and demographic information. Data were analyzed using latent growth mixture modeling to explore discrete smoking trajectories. Logistic regression analyses were then used to examine the risk factors associated with the various smoking trajectory groups. Four trajectory groups were determined to best fit the data: nonsmokers, maturing-out smokers, late-starting smokers, and early-starting continuous smokers. Subjects who were unconventional, experienced intrapersonal distress, and used alcohol and illegal drugs were more likely to belong to one of the smoking trajectory groups than to the nonsmoking group. The early-starting continuous group scored highest on these personal risk attributes. The long-term impact of unconventional behavior, intrapersonal distress, and drug use on developmental trajectories of smoking support the importance of early intervention and prevention. Brook, J., Ning, Y., and Brook, D. Personality Risk Factors Associated with Trajectories of Tobacco Use. Am J Addict, 15(6), pp. 426-433, 2006.

Long-Term Effects of Child Abuse and Neglect on Alcohol Use and Excessive Drinking in Middle Adulthood

The purpose of this study was to determine the long-term effects of child abuse and neglect on alcohol use in middle adulthood. Individuals with documented cases of childhood physical and sexual abuse and/or neglect (n = 500) and matched controls (n = 396) from a metropolitan county in the Midwest were followed and interviewed in middle adulthood. Outcomes were Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, diagnoses of alcohol abuse or dependence in young adulthood (age 29) and excessive drinking in middle adulthood (age 40). Women with documented histories of child abuse or neglect reported higher past-year typical quantity (p < .01) and past-month number of days drinking eight or more drinks (p < .05) than nonabused/nonneglected women. Controlling for parental alcohol/drug problems, the effect of child maltreatment on excessive drinking in middle adulthood was not significant for women. For women, the final structural equation model revealed an indirect path through alcohol diagnosis in young adulthood (p < .05) to excessive drinking in middle adulthood (p < .001) but no direct path from child abuse and neglect to excessive drinking in middle adulthood. For men, there were no significant paths from child abuse and neglect to alcohol diagnosis in young adulthood or excessive drinking in middle adulthood. For men and women, parental alcohol/drug problems had a significant indirect effect on the offspring's drinking in middle adulthood (p < .001) through young adult alcohol diagnosis (p < .001). In conclusion, consequences of abuse and neglect persist into middle adulthood for women, through continuation of earlier alcohol problems, suggesting the need for interventions throughout the life course. The influence of parental alcohol and drug problems warrants further attention. Widom, C., White, H., Czaja, S., and Marmorstein, N. Long-Term Effects of Child Abuse and Neglect on Alcohol Use and Excessive Drinking in Middle Adulthood. J Stud Alcohol Drugs, 68(3), pp. 317-326, 2007.

A Multiwave Multi-Informant Study of the Specificity of the Association Between Parental and Offspring Psychiatric Disorders

The present study was conducted to investigate the specificity of the association between parental and offspring psychiatric disorders using epidemiological data from a series of parent and offspring interviews. A community-based sample of 593 mothers and their offspring from upstate New York were interviewed during the adolescence and early adulthood of the offspring. The children of parents with generalized anxiety disorder were at specifically elevated risk for anxiety disorders when co-occurring psychiatric disorders were controlled. The associations between parental and offspring antisocial, conduct, depressive, and substance use disorders were characterized by modest specificity. Children of parents with externalizing disorders were nearly as likely to develop internalizing disorders as they were to develop externalizing disorders. Children of parents with internalizing disorders were somewhat, but not significantly, more likely to develop internalizing disorders. These findings support the inference that children of parents with generalized anxiety disorder may be more likely to develop anxiety disorders than they are to develop other psychiatric disorders. However, when co-occurring psychiatric disorders are accounted for, the children of parents with depressive, disruptive, and substance use disorders may be as likely to develop other disorders as they are to develop the same type of disorder that their parents have had. Johnson, J., Cohen, P., Kasen, S., and Brook, J.A. Multiwave Multi-Informant Study of the Specificity of the Association Between Parental and Offspring Psychiatric Disorders. Compr Psychiatry, 47(3), pp. 169-177, 2006.

How Substance Use Differs among American Secondary Schools

The purpose of this study was to examine (1) the extent to which student drug use and related measures vary among American secondary schools, and (2) how substance use varies among schools by certain school characteristics. Data come from the Monitoring the Future project's annual surveys of nationally representative samples of 8th-, 10th-, and 12th-grade students from 1991 to 2002. The results show that the preponderance of variance in drug use and related variables lies within schools; only a relatively small amount of variance is between schools. Although the variance lies primarily within schools, there remain important school-to-school differences in the extent to which students are exposed to drug use. The analyses of school characteristics show that schools do indeed differ in drug use by their students, particularly by school type, socioeconomic status, and race/ethnicity. Eighth and 10th grade (but not 12th grade) students in public schools are more likely to be cigarette smokers than students in private schools. Students in public middle schools are at higher risk for use of alcohol and marijuana; however, among 12th graders, students in Catholic schools are at higher risk. School size is generally unrelated to substance use, with few exceptions. For the most part, there is a negative association between school socioeconomic status and student substance use among 8th graders; but by 12th grade, the association tends to be positive or not significant. Racial/ethnic composition is significantly associated with student substance use, with majority African American schools typically showing the lowest rates of use at all grades. O'Malley, P., Johnston, L., Bachman, J., Schulenberg, J., and Kumar, R. How Substance Use Differs Among American Secondary Schools. Prev Sci, 7(4), pp. 409-420, 2006.

Predictors of Resilience in Abused and Neglected Children Grown-Up: The Role of Individual and Neighborhood Characteristics

This paper examines individual, family, and neighborhood level predictors of resilience in adolescence and young adulthood and describes changes in resilience over time from adolescence to young adulthood in abused and neglected children grown up. The sample includes documented cases of childhood physical and sexual abuse and neglect (n=676) from a Midwestern county area during the years 1967-1971 and information from official records, census data, psychiatric assessments, and self-reports were obtained through 1995. Analyses involve logistic regressions, replicated with Mplus to test for possible contextual effects. Almost half (48%) of the abused and neglected children in adolescence and nearly one-third in young adulthood were resilient. Over half of those who were resilient in adolescence remained resilient in young adulthood, whereas 11% of the non-resilient adolescents were resilient in young adulthood. Females were more likely to be resilient during both time periods. Being white, non-Hispanic decreased and growing up in a stable living situation increased the likelihood of resilience in adolescence, but not in young adulthood. Stressful life events and a supportive partner promoted resilience in young adulthood. Neighborhood advantage did not exert a direct effect on resilience, but moderated the relationship between household stability and resilience in adolescence and between cognitive ability and resilience in young adulthood. In conclusion, ecological factors appear to promote or interfere with the emergence and stability of resilience following childhood maltreatment. DuMont, K., Widom, C., and Czaja, S. Predictors of Resilience in Abused and Neglected Children Grown-Up: The Role of Individual and Neighborhood Characteristics. Child Abuse Negl, 31(3), pp. 255-274, 2007.

Growth Trajectories of Sexual Risk Behavior in Adolescence and Young Adulthood

Adolescence and young adulthood (ages 18-25 years) are periods of development and change, which include experimentation with and adoption of new roles and behaviors. Researchers investigated longitudinal trajectories of sexual risk behaviors across these time periods and how these trajectories may be different for varying demographic groups. They developed multilevel growth models of sexual risk behavior for a predominantly African American sample (n=847) that was followed for 8 years, from adolescence to young adulthood and investigated differences in growth parameters by race/ethnicity and gender and their interactions. The final model included linear and quadratic terms for both adolescence and young adulthood, indicating acceleration of sexual risk behaviors during adolescence and a peak and deceleration during young adulthood. African American males exhibited the highest rate of sexual risk behavior in ninth grade, yet had the slowest rate of growth. Compared with their White peers, African American males and females exhibited less sexual risk behavior during young adulthood. These results suggest that youths of different races/ethnicities and genders exhibit varying sexual risk behavior trajectories. Fergus, S., Zimmerman, M., and Caldwell, C. Growth Trajectories of Sexual Risk Behavior in Adolescence and Young Adulthood. Am J Public Health, 97(6), pp. 1096-1101, 2007.

Gender Differences in Injection Risk Behaviors at the First Injection Episode

This study sought to examine gender differences in drug injection equipment sharing at injecting initiation. Young injecting drug users in New York City (February 1999-2003) were surveyed about injection risk behaviors and circumstances at initiation. Analyses were gender-stratified and excluded participants who initiated alone. Multiple logistic regression estimated adjusted odds ratios. Participants (n=249) were 66% male and 82% White. Mean initiation age was 19.2; mean years since initiating was 3.0. Women were significantly more likely to cite social network influence as a reason for initiating, to have male and sex partner initiators, and to share injecting equipment than men. Among women, sharing any injection equipment was associated with initiation by a sex partner and having >/=2 people present. Among men, being injected by someone else predicted sharing any injection equipment, while using a legally obtained syringe was protective. Social persuasion stemming from sexual and/or social relationships with IDUs may increase women's risk of sharing injection equipment at initiation, and consequently, their early parenteral risk of acquiring blood-borne infections. Effective interventions should focus on likely initiates, especially women in injecting-discordant sex partnerships, and IDUs (potential initiators). Frajzyngier, V., Neaigus, A., Gyarmathy, V., Miller, M., and Friedman, S. Gender Differences in Injection Risk Behaviors at the First Injection Episode. Drug Alcohol Depend, 89(2-3), pp. 145-152, 2007.

An Examination of Pathways from Childhood Victimization to Violence: The Role of Early Aggression and Problematic Alcohol Use

Using prospective data from a cohort design study involving documented cases of child abuse and neglect and a matched control group, the researchers examine two potential pathways between childhood victimization and violent criminal behavior: early aggressive behavior and problematic drinking. Structural equation models, including controls for race/ethnicity, socioeconomic status, parental alcoholism, and parental criminality, revealed different pathways for men and women. For men, child maltreatment has direct and indirect (through aggressive behavior and problematic alcohol use) paths to violence. For women, problematic alcohol use mediates the relationship between childhood victimization and violence, and, independent of child maltreatment, early aggression leads to alcohol problems, which lead to violence. Interventions for victims of childhood maltreatment need to recognize the role of early aggressive behavior and alcohol problems as risk factors for subsequent violence. Widom, C., Schuck, A., and White, H. An Examination of Pathways from Childhood Victimization to Violence: The Role of Early Aggression and Problematic Alcohol Use. Violence Vict, 21(6), pp. 675-690, 2006.

Childhood Victimization and Illicit Drug Use in Middle Adulthood

Using a prospective cohort design, the authors examined in this study whether childhood victimization increases the risk for illicit drug use and related problems in middle adulthood. Court-documented cases of childhood physical and sexual abuse and neglect and matched controls (N = 892) were first assessed as young adults (mean age = 29 years) during 1989-1995 and again in middle adulthood (mean age = 40 years) during 2000-2002. In middle adulthood, abused and neglected individuals were about 1.5 times more likely than controls to report using any illicit drug (in particular, marijuana) during the past year and reported use of a greater number of illicit drugs and more substance-use-related problems compared with controls. The current results reveal the long-term impact of childhood victimization on drug use in middle adulthood. These new results reinforce the need for targeted interventions with abused and neglected children, adolescents, and adults, and particularly for women. Widom, C., Marmorstein, N., and White, H. Childhood Victimization and Illicit Drug Use in Middle Adulthood. Psychol Addict Behav, 20(4), pp. 394-403, 2006.

Consistency Between Adolescent Reports and Adult Retrospective Reports of Adolescent Marijuana Use: Explanations of Inconsistent Reporting Among an African American Population

This study examines the consistency of marijuana self-reports from adolescence and adulthood and what characterizes inconsistent reporting among a cohort of African American first graders followed longitudinally from age 6 to 32 (N=599, 51% female). Self-reported lifetime adolescent marijuana use (ages 16-17) and retrospective reports at age 32 were combined to categorize respondents as consistent reporters of nonuse (22%), consistent reporters of use (42%), adult recanters (19%), adolescent under reporters (8%), and inconsistent reporters of age of initiation (9%). Overall, about 64% of the population were consistent in their reports of adolescent marijuana use from adolescence to age 32. Multivariate logistic regression analyses found that recanters reported less marijuana use as adolescents, lower parental supervision during adolescence, lower deviant behavior as an adult, and stronger anti-drug values as adults than did consistent reporters. Adolescent under reporters reported less assault behaviors and less alcohol use as adolescents and had lower first grade math achievement than consistent reporters. Family background, depression, criminal arrests, and the field conditions of the interview were not related to inconsistent reporting. Ensminger, M., Juon, H., and Green, K. Consistency Between Adolescent Reports and Adult Retrospective Reports of Adolescent Marijuana Use: Explanations of Inconsistent Reporting Among an African American Population. Drug Alcohol Depend, 89(1), pp. 13-23, 2007.

Early Age of First Sexual Intercourse and Affiliation with Deviant Peers Predict Development of SUD

Researchers sought to assess whether early onset of sexual intercourse and affiliation with deviant peers serve as predictors of the development of SUD, using a prospective longitudinal study of adolescents recruited at the age of 10-12 years, with follow-up evaluations at ages 14, 16, 19, 22, and 25. The sample included 136 male subjects. Cox regression analyses were performed, with age of first intercourse, neurobehavioral disinhibition, exposure to drugs in the neighborhood, and deviant activities of peers as factors in the analyses. Earlier age at first intercourse and deviant activities of peers each predicted a significantly higher risk of subsequently developing a SUD (Wald=8.3, df=1, p=0.004; Wald=7.5, df=1, p=0.006, respectively). The results of this study add evidence to the theory that early onset of sexual intercourse and affiliation with deviant peers predict the early development of substance use disorders, using a prospective longitudinal study design. Cornelius, J., Clark, D., Reynolds, M., Kirisci, L., and Tarter, R. Early Age of First Sexual Intercourse and Affiliation with Deviant Peers Predict Development of SUD: A Prospective Longitudinal Study. Addict Behav, 32(4), pp. 850-854, 2007.

Religiosity and Adolescent Substance Use

The authors tested hypothesized pathways from religiosity to adolescent substance use (tobacco, alcohol, and marijuana) with data from samples of middle school (n = 1,273) and high school students (n = 812). Confirmatory analysis of measures of religiosity supported a 2-factor solution with behavioral aspects (belonging, attendance) and personal aspects (importance, value, spirituality, forgiveness) as distinct factors. Structural modeling analyses indicated inverse indirect effects of personal religiosity on substance use, mediated through more good self-control and less tolerance for deviance. Religiosity was correlated with fewer deviant peer affiliations and nonendorsement of coping motives for substance use but did not have direct effects on these variables. Parental support and parent-child conflict also had significant effects (with opposite direction) on substance use, mediated through self-control and deviance-prone attitudes. Implications for prevention research are discussed. Walker, C., Ainette, M., Wills, T., and Mendoza, D. Religiosity and Substance Use: Test of an Indirect-Effect Model in Early and Middle Adolescence. Psychol Addict Behav, 21(1), pp. 84-96, 2007.

Childhood Adversity, Poly-Substance Use, and Disordered Eating in Adolescent Latinas

This study examined among Latina adolescents the effects of sexual abuse, physical/ emotional abuse, neglect, disconnection from family, and parental alcohol problems on poly-substance use and disordered eating, and whether five individual characteristics explain or differentiate these outcomes. Data from a community sample of 361 Latina adolescents were analyzed using structural equation modeling. Physical/emotional abuse predicted poly-substance use and weight concerns, and these associations were mediated by impaired current attachment. Disconnection from family predicted bulimic behaviors, and this association was mediated by dysphoria. One indirect path also emerged: Disconnection from family predicted low social conformity, and low social conformity predicted poly-substance use. Childhood sexual abuse did not uniquely predict any adverse outcome or individual characteristic examined. Dysphoria and impaired current attachment appear to play important roles in the development of substance use and disordered eating in Latina adolescents when physical/emotional abuse or disconnection from family predicts these outcomes. Dysphoria and low social conformity may differentiate the development of bulimic behaviors and poly-substance use, respectively, when family disconnection predicts these outcomes. Hodson, C., Newcomb, M., Locke, T., and Goodyear, R. Childhood Adversity, Poly-Substance Use, and Disordered Eating in Adolescent Latinas: Mediated and Indirect Paths in a Community Sample. Child Abuse Negl, 30(9), pp. 1017-1036, 2006.

Conceptual Issues in Studies of Resilience: Past, Present, and Future Research

The researchers begin this article by considering the following critical conceptual issues in research on resilience: (1) distinctions between protective, promotive, and vulnerability factors; (2) the need to unpack underlying processes; (3) the benefits of within-group experimental designs; and (4) the advantages and potential pitfalls of an overwhelming scientific focus on biological and genetic factors (to the relative exclusion of familial and contextual ones). The next section of the article is focused on guidelines for the selection of vulnerability and protective processes in future research. From a basic science standpoint, it is useful and appropriate to investigate all types of processes that might significantly affect adjustment among at-risk individuals. If the research is fundamentally applied in nature, however, it would be most expedient to focus on risk modifiers that have high potential to alter individuals' overall life circumstances. The final section of this article considers conceptual differences between contemporary resilience research on children versus adults. Issues include differences in the types and breadth of outcomes (e.g., the tendencies to focus on others ratings of competence among children and on self-reports of well-being among adults respectively). Luthar, S., Sawyer, J., and Brown, P. Conceptual Issues in Studies of Resilience: Past, Present, and Future Research. Ann N Y Acad Sci, 1094, pp. 105-115, 2006.

Modeling Adolescent Drug-Use Patterns in Cluster-Unit Trials with Multiple Sources of Correlation Using Robust Latent Class Regressions

This paper examines variation in adolescent drug-use patterns by using latent class regression analysis and evaluates the properties of an estimating-equations approach under different cluster-unit trial designs. A set of second-order estimating equations for latent class models under the cluster-unit trial design are proposed. This approach models the correlation within subclusters (drug-use behaviors), but ignores the correlation within clusters (communities). A robust covariance estimator is proposed that accounts for within-cluster correlation. Performance of this approach is addressed through a Monte Carlo simulation study, and practical implications are illustrated by using data from the National Evaluation of the Enforcing Underage Drinking Laws Randomized Community Trial. The example shows that the proposed method provides useful information about the heterogeneous nature of drug use by identifying two subtypes of adolescent problem drinkers. A Monte Carlo simulation study supports the proposed estimation method by suggesting that the latent class model parameters were unbiased for 30 or more clusters. Consistent with other studies of generalized estimating equation (GEE) estimators, the robust covariance estimator tended to underestimate the true variance of regression parameters, but the degree of inflation in the test size was relatively small for 70 clusters and only slightly inflated for 30 clusters. The proposed model for studying adolescent drug use provides an alternative to standard diagnostic criteria, focusing on the nature of the drug-use profile, rather than relying on univariate symptom counts. The second-order GEE-type estimation procedure provided a computationally feasible approach that performed well for a moderate number of clusters and was consistent with prior studies of GEE under the generalized linear model framework. Reboussin, B., Lohman, K., and Wolfson, M. Modeling Adolescent Drug-Use Patterns in Cluster-Unit Trials with Multiple Sources of Correlation Using Robust Latent Class Regressions. Ann Epidemiol, 16(11), pp. 850-859, 2006.

Predictors of Injection Drug Use Cessation Among Puerto Rican Drug Injectors in New York and Puerto Rico

More than half of all AIDS cases among Puerto Ricans have been attributed to injection drug use. Predictors of injection drug use cessation were examined among Puerto Rican injection drug users (IDUs) in New York and Puerto Rico. Analysis of baseline and 6-month follow-up data from 670 IDUs in NY and 316 in PR showed that 47% NY and 20% in PR reported cessation of injection at follow-up (p < .001). In multivariate analyses, having been in drug treatment since baseline was the only significant predictor of cessation for both sites (NY: AOR = 1.80; PR: AOR = 3.10). Increasing availability of methadone maintenance treatment, especially in PR, was indicated. Deren, S., Kang, S., Colon, H., and Robles, R. Predictors of Injection Drug Use Cessation Among Puerto Rican Drug Injectors in New York and Puerto Rico. Am J Drug Alcohol Abuse, 33(2), pp. 291-299, 2007.

Pubertal Maturation and Risk for Alcohol Use and Abuse

This study sought to examine the impact of various aspects of puberty on risk of using alcohol and developing alcohol use disorder (AUD). Data came from the Great Smoky Mountains Study, a longitudinal study of a representative sample of 1420 youth aged 9-13 at recruitment. Participants were interviewed annually to age 16. A parent was also interviewed. Information was obtained about use of a range of drugs including alcohol, drug abuse and dependence, other psychiatric disorders, life events, and a wide range of family characteristics. Pubertal hormones were assayed annually from blood samples, and morphological development was assessed using a pictorial measure of Tanner stage. The authors found that, controlling for age, Tanner stage predicted alcohol use and AUD in both boys and girls. The effect of morphological development was strongest in those who matured early. Early pubertal maturation predicted alcohol use in both sexes, and AUD in girls. The highest level of excess risk for alcohol use was seen in early maturing youth with conduct disorder and deviant peers. Lax supervision predicted alcohol use in early maturing girls, while poverty and family problems were predictive in early maturing boys. The authors conclude that, among the many biological, morphological, and social markers of increasing maturation, the visible signs of maturity are important triggers of alcohol use and AUD, especially when they occur early and in young people with conduct problems, deviant peers, problem families and inadequate parental supervision. These findings may help target those at greatest risk for early onset and progression of alcohol use and disorders. Costello, E., Sung, M., Worthman, C., and Angold, A. Pubertal Maturation and the Development of Alcohol Use and Abuse. Drug Alcohol Depend, 88 Suppl 1, pp. S50-S59, 2007.

Religiosity and Adolescent Substance Use

The authors use data from the Monitoring the Future study(MTF, N=16,595) and Youth, Education, and Society (related to the MTF study) and multilevel modeling data analytic techniques (HLM) to examine various unresolved issues in the ongoing debate, with a specific focus on the relationships between individual- and contextual-level (i.e., school) religiosity and adolescent's use of tobacco, alcohol, and marijuana. The results indicate first, that the higher adolescents' level of religiosity, the less likely they are to be current tobacco users, to engage in binge drinking, or to have used marijuana in the past year; second, that as the level of religiosity in a school increases, adolescents' frequency of cigarette use, binge drinking, and marijuana use decreases; third, that the religiosity of the school influences students' substance use, over and above their individual religiosity, but that this relationship exists only for marijuana; and fourth, that the strength of the relationship between individual-level religiosity and individual-level substance use varies depending upon the religiosity of the context, such that adolescents who are highly religious and in highly religious contexts are less likely to engage in binge drinking or marijuana use than those who are equally religious but in less religious contexts. Future research should seek to understand the mechanisms through which individual- and contextual-level religiosity influences young people's use of substances and other delinquent behaviors. Wallace, J.M., Yamaguchi, R., Bachman, J.G., O'Malley, P.M., Schulenberg, J.E., and Johnston, L.D. Religiosity and Adolescent Substance Use: The Role of Individual and Contextual Influences. Social Problems, 54(2), pp. 308-327, 2007.

Depression Ratings, Reported Sexual Risk Behaviors, and Methamphetamine Use Among Gay and Bisexual Men in an Outpatient Treatment Program

This study assessed relationships among dynamic changes tracked over time in methamphetamine use, depression symptoms, and sexual risk behaviors (unprotected anal intercourse) in a sample of 145 methamphetamine-dependent gay and bisexual males enrolled in a 16-week outpatient drug treatment research program. Participants were randomly assigned into 1 of 4 conditions: contingency management (CM), cognitive behavioral therapy (CBT; the control condition), combined CM and CBT, and a tailored gay-specific version of the CBT condition. Using latent growth curve models, the authors assessed the relationship of means (intercepts) and the slopes of the 3 measures of interest over time to test whether changes in methamphetamine use predicted declining rates of depression and risky sexual behavior in tandem. Participants with the greatest downward trajectory in methamphetamine use (urine verified) reported the greatest and quickest decreases in reported depressive symptoms and sexual risk behaviors. The control group reported the most methamphetamine use over the 16 weeks; the tailored gay-specific group reported a more rapidly decreasing slope in methamphetamine use than the other participants. Findings indicate that lowering methamphetamine use itself has a concurrent and synergistic effect on depressive symptoms and risky sexual behavior patterns. This suggests that some users who respond well to treatment may show improvement in these co-occurring problems without a need for more intensive targeted interventions. Jaffe, A., Shoptaw, S., Stein, J., Reback, C., and Rotheram-Fuller, E. Depression Ratings, Reported Sexual Risk Behaviors, and Methamphetamine Use: Latent Growth Curve Models of Positive Change Among Gay and Bisexual Men in an Outpatient Treatment Program. Exp Clin Psychopharmacol, 15(3), pp. 301-307, 2007.

Role of Social Support and Self-Efficacy in Treatment Outcomes Among Clients with Co-Occurring Disorders

The authors investigated the roles of social support and self-efficacy in a sample of 351 clients with co-occurring disorders in residential drug abuse treatment programs (53% male; 35% African American, 13% Hispanic), in an attempt to find intervening variables that may contribute to improvement in treatment outcomes among individuals with co-occurring disorders. They also explored how ethnicity and age influence self-efficacy and access to social support, as well as their relationships to the outcomes. Structural equation modeling was used to examine the impact of the demographics and baseline psychological status, substance use, social support, and self-efficacy on mental health and substance use outcomes 6 months after treatment entry. Time in treatment was included as a control. Greater social support at baseline predicted better mental health status and less heroin and cocaine use; greater self-efficacy predicted less alcohol and cocaine use. Older clients reported less social support. African-American ethnicity was associated with more cocaine use at baseline and follow-up; however, African Americans reported more self-efficacy, which moderated their cocaine use. The current study highlights the potential therapeutic importance of clients' personal resources, even among a sample of severely impaired individuals. Warren, J., Stein, J., and Grella, C. Role of Social Support and Self-Efficacy in Treatment Outcomes Among Clients with Co-Occurring Disorders. Drug Alcohol Depend, 89(2-3), pp. 267-274, 2007.

Alcohol Use and Health-Related Quality of Life among Youth in Taiwan

Researchers examined the extent to which the use of the three most commonly consumed drugs in Taiwan (i.e., alcohol, tobacco, and betel nut) is related with health-related quality of life among adolescents. They probed whether the relationship linking alcohol use with health-related quality varies by health-orientated domains (e.g., physical, social, or emotional) and if it differs with other drug involvement. The data for the study came from a representative sample of 2235 adolescents (aged 12-18 years) collected as part of the 2001 National Health Interview Survey (NHIS), conducted in Taiwan. Recent alcohol, tobacco, and betel nut experiences were assessed by face-to-face interview. The 36-item short form Health Survey (SF-36) was used to assess respondents' generic health status. Youth with recent alcohol use tend to experience a poorer level of health-related quality of life. The estimated associations were not constant over the eight domains of general health examined, and multivariate modeling with generalized linear models and generalized estimating equations found that the strongest inverse relationship appears in the domain of role limitation due to emotional problems (beta = -10.5, 95% confidence interval [CI]: -16.9-4.12, p < .001). Greater deleterious effects were not found among youth also using tobacco and/or betel nut. Alcohol use was shown to be associated with impaired levels of health-related quality of life in adolescents. Although the temporality between alcohol involvement and lower levels of mental health is not explicit, the findings suggest that youth who are actively drinking might be a possible target group to intervene and avert mental health-related problems. Chen, C., and Storr, C. Alcohol Use and Health-Related Quality of Life Among Youth in Taiwan. J Adolesc Health, 39(5), pp. 752.e9-752.e16, 2006.

Predictors of Drinking Immediacy Following Daily Sadness: An Application of Survival Analysis to Experience Sampling Data

Previous studies of daily assessments show modest mood-drinking covariation as a function of gender and coping motives; however previous analyses also assume a fixed interval across all individuals in the onset of drinking following negative mood. The current study used survival analysis and experience sampling methods to test whether gender and coping motives predicted shorter sadness-to-drinking intervals among those with greater alcohol-related drinking consequences. A sample of 85 college students (46% male; 78% Caucasian) completed daily assessments over 28 days. Survival analyses showed that women drank more on days following elevated sadness when they reported being motivated to drink to cope and having experienced alcohol-related consequences. For men, the two groups showing greater drinking risk following days of elevated sadness did not report alcohol-related consequences, with those reporting the presence of coping motives showing the greatest risk. Implications of these findings for self-medication mechanisms are discussed. Hussong, A. Predictors of Drinking Immediacy Following Daily Sadness: An Application of Survival Analysis to Experience Sampling Data. Addict Behav, 32(5), pp. 1054-1065, 2007.

Predictors of Unprotected Sex with Non-Cohabitating Primary Partners among Sheltered and Low-Income Housed Women in Los Angeles County

This study investigated cross-sectional associations of substance use, relationship abuse and HIV self-protective behavior with unprotected sex among 290 impoverished women with a non-cohabitating primary partner. Unprotected sex was associated with having a physically or psychologically abusive partner among low-income housed women, and having an abusive partner who also drank to intoxication among women living in shelters. Indicators of HIV self-protective behavior were associated with less frequent unprotected sex among sheltered women, even after accounting for abuse and substance use within the relationship. Results suggest the need for HIV-prevention interventions to address the problems of partner substance use and relationship abuse. Tucker, J., Wenzel, S., Elliott, M., and Hambarsoomian, K. Predictors of Unprotected Sex with Non-Cohabitating Primary Partners among Sheltered and Low-Income Housed Women in Los Angeles County. J Health Psychol, 11(5), pp. 697-710, 2006.

Gender-specific Correlates of Sex Trade Among Homeless and Marginally Housed Individuals in San Francisco

Sex exchange is a well-established risk factor for HIV infection. Little is known about how correlates of sex trade differ by biologic sex and whether length of homelessness is associated with sex trade. The researchers conducted a cross-sectional study among a sample of 1,148 homeless and marginally housed individuals in San Francisco to assess correlates of exchanging sex for money or drugs. Key independent variables included length of homelessness; use of crack, heroin or methamphetamine; HIV status; and sexual orientation. Analyses were restricted by biologic sex. In total, 39% of women and 30% of men reported a lifetime history of sex exchange. Methamphetamine use and greater length of homelessness were positively associated with a history of sex trade among women, while heroin use, recent mental health treatment, and homosexual or bisexual orientation were significantly associated with sex trade for men. Crack use was correlated with sex trade for both genders. Correlates of sex trade differ significantly according to biologic sex, and these differences should be considered in the design of effective HIV prevention programs. The researchers findings highlight the critical need to develop long-term services to improve housing status for homeless women, mental health services for homeless men, and drug treatment services for homeless adults involved in sex work. Weiser, S., Dilworth, S., Neilands, T., Cohen, J., Bangsberg, D., and Riley, E. Gender-Specific Correlates of Sex Trade Among Homeless and Marginally Housed Individuals in San Francisco. J Urban Health, 83(4), pp. 736-740, 2006.

Ethnic Pride and Self-control Related to Protective and Risk Factors

The purpose of this study was to test a theoretical model of how ethnic pride and self-control are related to risk and protective factors. A community sample of 670 African American youth (mean age = 11.2 years) were interviewed on measures of cigarette smoking, alcohol use, and sexual behavior (lifetime to past month). Structural modeling analyses indicated parenting was related to self-control and self-esteem, and racial socialization was related to ethnic pride. Self-control and self-esteem variables were related to levels of deviance-prone attitudes and to perceptions of engagers in, or abstainers from, substance use and sexual behavior. The proximal factors (behavioral willingness, resistance efficacy, and peer behavior) had substantial relations to the criterion variables. Participant gender and parental education also had several paths in the model. Results were generally similar for the 2 outcome behaviors. In this population, self-esteem and self-control are related to parenting approaches and have pathways to attitudes and social perceptions that are significant factors for predisposing to, or protecting against, early involvement in substance use and sexual behavior. Wills, T., Murry, V., Brody, G., Gibbons, F., Gerrard, M., Walker, C., and Ainette, M. Ethnic Pride and Self-Control Related to Protective and Risk Factors: Test of the Theoretical Model for the Strong African American Families Program. Health Psychol, 26(1), pp. 50-59, 2007.

Racial/Ethnic and Socioeconomic Status Differences in Overweight and Health-Related Behaviors among American Students: National Trends 1986-2003

This article reports long-term trends by race/ethnicity and socioeconomic status (SES) in the percent of American students who are overweight and who engage in three health-related behaviors hypothesized to be associated with overweight. Data are from the Monitoring the Future annual surveys, using nationally representative samples of eighth, 10th, and 12th grade students. Participants include 62,156 eighth and 64,899 10th graders who completed the 1993-2003 surveys and 35,107 12th graders who completed the questionnaire form containing the measures pertaining to this study in the 1986-2003 surveys. Trends are presented separately by gender and grade level for different racial/ethnic and SES subgroups, in: (a) percent overweight (body mass index > or = 85th percentile), (b) percent who always or almost always eat breakfast, (c) percent who regularly exercise vigorously, and (d) average hours of weekday television viewing. The prevalence of overweight and of engaging in less healthy behaviors is considerably greater among youth from racial/ethnic minority backgrounds, of lower socioeconomic status, and in higher grades. Trends in overweight and these behaviors are found to vary substantially by gender, racial/ethnic group, socioeconomic status, and grade level. The study findings show well-established and persistent differences in the percent of racial/ethnic minority and low SES youth who are overweight and who's dietary and exercise habits are less healthy. Documentation of these problems may lead to research and policy agendas that will contribute both to understanding and to the reduction of these important health disparities. Delva, J., O'Malley, P., and Johnston, L. Racial/Ethnic and Socioeconomic Status Differences in Overweight and Health-Related Behaviors among American Students: National Trends 1986-2003. J Adolesc Health, 39(4), pp. 536-545, 2006.

Suicidality, Depression, and Alcohol Use among Adolescents

This review compiles the existing literature on suicidality, depression, and alcohol use among adolescents spanning over the past 15 years. Both Problem Behavior Theory and Stress-coping Theory can explain the relationships among suicidality, depression and alcohol use. The prevention of suicidality is critical, especially during the early school years, when it is associated with depression and alcohol use. Suicidality, depression and alcohol use are three phenomenons that noticeably increase in adolescence marking this time period as an ideal opportunity for prevention efforts to commence. Future empirical work is needed that will further assess the impact of adolescent depression and alcohol use on suicidality. In sum, this review of empirical research highlights critical results and limitations, as well as indicates a need for continued efforts in preventing suicidality, depression, and alcohol use among adolescents. Galaif, E., Sussman, S., Newcomb, M., and Locke, T. Suicidality, Depression, and Alcohol Use among Adolescents: A Review of Empirical Findings. Int J Adolesc Med Health, 19(1), pp. 27-35, 2007.

Adolescent Adjustment over Six Years in HIV-Affected Families

The purpose of this study was to assess predictors of adjustment of adolescents of parents with HIV (PWH) at three and six years after the delivery of either a coping skills intervention or a standard care condition. A randomized controlled intervention trial was conducted with 288 parents with human immunodeficiency virus (HIV) and their adolescent children. Indicators of adolescent adjustment at both three and six years were examined as a function of intervention condition, demographics, prior behaviors, and parental bonds using structural equation modeling (SEM). Adolescent adjustment at six years was also examined as a function of death of the PWH. Authors found that youth in the intervention condition reported significantly less substance use three and six years later. In addition, positive parental bonds reported at baseline reduced emotional distress at three years and increased positive future expectations at six years. On the other hand, substance use at three years predicted heightened sexual risk behaviors, continued substance use, and lower future expectations at six years. Early emotional distress and being Latino predicted increased emotional distress at three years. Parental death by three years predicted more sexual risk behavior and lowered future expectations at six years. A time-limited, family based intervention with adolescents of PWH demonstrated both direct and indirect benefits lasting into early adulthood, especially in decreasing substance use, and identifies key risk factors for problematic adjustment, including the death of a PWH. Rotheram-Borus, M., Stein, J., and Lester, P. Adolescent Adjustment over Six Years in HIV-Affected Families. J Adolesc Health, 39(2), pp. 174-182, 2006.

Impact of Program Services on Treatment Outcomes of Patients with Comorbid Mental and Substance Use Disorders

This study examined the outcomes of individuals with co-occurring disorders who received drug treatment in programs that varied in their integration of mental health services. Patients treated in programs that provided more on-site mental health services and had staff with specialized training were expected to report less substance use and better psychological outcomes at follow-up. Participants with co-occurring disorders were sampled from 11 residential drug abuse treatment programs for adults in Los Angeles County. In-depth assessments of 351 patients were conducted at treatment entry and at follow-up six months later. Surveys conducted with program administrators provided information on program characteristics. Latent variable structural equation models revealed relationships of patient characteristics and program services with drug use and psychological functioning at follow-up. The authors found that individuals treated in programs that provided specific dual diagnosis services subsequently had higher rates of utilizing mental health services over six months and, in turn, showed significantly greater improvements in psychological functioning (as measured by the Brief Symptom Inventory and the RAND Health Survey 36-item short form) at follow-up. More use of psychological services was also associated with less heroin use at follow-up. African Americans reported poorer levels of psychological functioning than others at both time points and were less likely to be treated in programs that provided mental health services. These study findings support continued efforts to provide specialized services for individuals with co-occurring disorders within substance abuse treatment programs as well as the need to address additional barriers to obtaining these services among African Americans. Grella, C., and Stein, J. Impact of Program Services on Treatment Outcomes of Patients with Comorbid Mental and Substance Use Disorders. Psychiatr Serv, 57(7), pp. 1007-1015, 2006.

Predictors of Suicide Attempts: State and Trait Components

The authors examined the state and trait components of 3 predictors of suicide attempts (depression, hopelessness, and anxiety), and their relationship to suicidal behavior. Self-report questionnaire and interview data from 180 adolescents enrolled in a prospective naturalistic study were analyzed. Between 23% and 30% of the variance in the predictors was attributable to subjects' trait levels of these variables; the trait, as well as the state, components of the predictor variables were interrelated; and trait levels of these variables were consistently related to suicide attempts. To reduce long-term risk of suicide attempts, clinicians should focus not only on reducing short-term distress but also on reducing individuals' more enduring patterns (trait levels) of negative affectivity. Goldston, D., Reboussin, B., and Daniel, S. Predictors of Suicide Attempts: State and Trait Components. J Abnorm Psychol, 115(4), pp. 842-849, 2006.

Learning Disabilities and Intellectual Functioning in School-Aged Children with Prenatal Cocaine Exposure

Risk for developing a learning disability (LD) or impaired intellectual functioning by age 7 was assessed in full-term children with prenatal cocaine exposure drawn from a cohort of 476 children born full term and enrolled prospectively at birth. Intellectual functioning was assessed using the Wechsler Intelligence Scale for Children-Third Edition (Wechsler, 1991) short form, and academic functioning was assessed using the Wechsler Individual Achievement Test (WIAT; Wechsler, 1993) Screener by examiners blind to exposure status. LDs were categorized based on ability-achievement discrepancy scores, using the regression-based predicted achievement method described in the WIAT manual. The sample in this report included 409 children (212 cocaine-exposed, 197 non-cocaine-exposed) from the birth cohort with available data. Cumulative incidence proportions and relative risk values were estimated using STATA software (Statacorp, 2003). No differences were found in the estimate of relative risk for impaired intellectual functioning (IQ below 70) between children with and without prenatal cocaine exposure (estimated relative risk = .95; 95% confidence interval [CI] = 0.65, 1.39; p = .79). The cocaine-exposed children had 2.8 times greater risk of developing a LD by age 7 than non-cocaine-exposed children (95% CI = 1.05, 7.67; p = .038; IQ >/= 70 cutoff). Results remained stable with adjustment for multiple child and caregiver covariates, suggesting that children with prenatal cocaine exposure are at increased risk for developing a learning disability by age 7 when compared to their non-cocaine-exposed peers. Morrow, C., Culbertson, J., Accornero, V., Xue, L., Anthony, J., and Bandstra, E. Learning Disabilities and Intellectual Functioning in School-Aged Children with Prenatal Cocaine Exposure. Dev Neuropsychol, 30(3), pp. 905-931, 2006.

Testosterone Levels and Sexual Maturation Predict Substance Use Disorders in Adolescent Boys

Authors sought to determine whether testosterone level and sexual maturation in boys biased development of socially nonnormative behavior culminating in a substance use disorder (SUD). The subjects were 179 boys recruited in late childhood through a high-risk paradigm. Path analysis was used to evaluate the influence of testosterone level and sexual maturation in early adolescence (age 12-14) on attitudes toward antisociality, affiliation with deviant peers, and social potency in middle adolescence (age 16), illicit drug use by late adolescence (age 19), and SUD in young adulthood (age 22). Testosterone level predicted social potency and approval of aggressive/antisocial behavior. Sexual maturation mediated the relation between testosterone level in early adolescence and later affiliation with deviant peers. Social potency, approval of aggressive/antisocial behavior, and deviant peer affiliations predicted illicit drug use by late adolescence that in turn predicted SUD in young adulthood. This study demonstrated that pubertal processes in early adolescence influence the risk for SUD via effects on psychosocial functioning. Reynolds, M., Tarter, R., Kirisci, L., Kirillova, G., Brown, S., Clark, D., and Gavaler, J. Testosterone Levels and Sexual Maturation Predict Substance Use Disorders in Adolescent Boys: A Prospective Study. Biol Psychiatry, 61(11), pp. 1223-1227, 2007.

Examination of the Nicotine Metabolite Ratio in a Multiethnic/Multiracial Sample

The recent development of a noninvasive measure of nicotine metabolism, the nicotine metabolite ratio (trans-3 hydroxycotinine/cotinine), makes it possible to examine the association between rate of nicotine metabolism and smoking behavior in the general population. Dr. Denise Kandel and colleagues examined group differences in the ratio measured in urine and the association between the ratio and multiple measures of smoking behavior and nicotine dependence in a large, nationally representative sample of young adults. The sample included 900 daily smokers aged 18-26 years from wave III (2001-2002) of the National Longitudinal Survey of Adolescent Health. Nicotine dependence was measured by using the Fagerstroem Test for Nicotine Dependence. Females had higher nicotine metabolite ratios than males; Whites and Hispanics had higher nicotine metabolite ratios than African Americans or Asians. This finding is consistent with those from laboratory studies of older smokers based on intravenous infusion of nicotine. No significant association was found between the nicotine metabolite ratio and number of cigarettes smoked per day or nicotine dependence. The availability of a noninvasive measure makes possible systematic testing of causal hypotheses generated by laboratory studies in the general population. Kandel, D., Hu, M., Schaffran, C., Udry, J., and Benowitz, N. Urine Nicotine Metabolites and Smoking Behavior in a Multiracial/Multiethnic National Sample of Young Adults. Am J Epidemiol, 165(8), pp. 901-910, 2007.

Self-Control, Symptomatology, and Substance Use Precursors

The authors tested a theoretical model of how self-control constructs are related to psychological symptomatology and variables that predispose to involvement versus noninvolvement in substance use: willingness to use, affiliation with peers who use, and efficacy for resisting use. Data were obtained from a sample of 332 children (mean age = 9.3 years) who were interviewed in households. Structural equation modeling showed that good self-control was related to more positive well-being and less externalizing symptomatology, whereas poor self-control was related to more externalizing and to more internalizing symptomatology. Externalizing had paths to willingness and peer use, well-being had inverse paths to these variables, and poor self-control had a direct effect to lower resistance efficacy. Multiple-group analyses indicated gender differences in paths from symptomatology to predisposing factors. Implications for understanding vulnerability to substance use are discussed. Wills, T., Ainette, M., Mendoza, D., Gibbons, F., and Brody, G. Self-Control, Symptomatology, and Substance Use Precursors: Test of a Theoretical Model in a Community Sample of 9-year-old Children. Psychol Addict Behav, 21(2), pp. 205-215, 2007.

Measurement of Negative Consequences of Substance Use in Street Youth

The Rutgers Alcohol Problem Index (RAPI) was used to assess negative consequences due to both alcohol and drug use. Data were collected from 173 substance using homeless adolescents (13-19 years of age, 58% male) who were grouped based on the substances rated: alcohol only, alcohol and drugs, or drugs only. The RAPI retained good internal consistency across substance categories, exhibited strong measurement construct congruence, and good convergent validity based upon correlations with assessed DSM diagnostic criteria (both dependence and abuse). Discussion focuses on the RAPI as a reliable instrument for the measurement of negative consequences for alcohol and drug use. Ginzler, J., Garrett, S., Baer, J., and Peterson, P. Measurement of Negative Consequences of Substance Use in Street Youth: An Expanded Use of the Rutgers Alcohol Problem Index. Addict Behav, 32(7), pp. 1519-1525, 2007.

The Puerto Rico-New York Airbridge for Drug Users: Description and Relationship to HIV Risk Behaviors

This study examined mobility on the airbridge between New York (NY) and Puerto Rico (PR) for Puerto Rican drug users and its relationship to HIV risk. Over 1,200 Puerto Rican injection drug users (IDUs) and crack smokers were recruited by outreach workers in NY and PR; interview data included questions on mobility (lifetime residences and recent trips). Two-thirds of the NY sample had lived in PR; one-quarter of the PR sample had lived in NY; the most commonly sited reasons for moving were family-related. Fewer than 10% had visited the other location in the prior 3 years. Variables related to risk were number of moves, recent travel, and having used drugs in PR (all with p < 0.05). Implications included the need to enhance risk reduction efforts for IDUs in PR and address sexual risk among mobile drug users. Deren, S., Kang, S., Colon, H., and Robles, R. The Puerto Rico-New York Airbridge for Drug Users: Description and Relationship to HIV Risk Behaviors. J Urban Health, 84(2), pp. 243-254, 2007.

A Study of Latino Adolescent Health Behaviors and Weight in the United States of America

The authors examined, by gender, differences in being overweight among adolescents of Mexican, Puerto Rican, and other Latin American heritage who live in the United States of America, and investigated the relationships between these differences and socioeconomic status, health-related behaviors, and family characteristics. The study analyzed data from nationally representative samples of Latino 8th and 10th graders in the Monitoring the Future study from 1991 to 2004 (N = 11 265). Investigators found a higher proportion of Mexican-American girls were overweight than other Latin American girls, both before and after adjusting for many confounders. For both genders, being overweight was inversely associated with socioeconomic status and frequency of vigorous exercise, and positively associated with the amount of television viewing. No family characteristic variable examined was associated with overweight. Time spent exercising and time spent watching television are two potentially modifiable risk factors that, if targeted, may result in important reductions in overweight. The findings indicate the need to identify gender- and culturally-appropriate interventions that can increase physical activity and reduce sedentary activities among Latino adolescents, particularly in families of low socioeconomic status. Delva, J., O'Malley, P., and Johnston, L. Health-Related Behaviors and Overweight: A Study of Latino Adolescents in the United States of America. Rev Panam Salud Publica, 21(1), pp. 11-20, 2007.

A Comparison of Psychosocial and Behavioral Characteristics of Adolescent Male Bullies, Victims, and Bully-Victims

The authors sought to determine among male adolescents whether bully-victims would report the poorest psychosocial health, the worst attitudes toward school, more problem behavior (delinquency, weapons possession, and substance use), and more physical injury compared with bullies, victims, and neutral students. Ethnic differences in bullying category membership were also assessed. Employing multisample latent variable models, authors contrasted 1,312 males in grades 7-12 classified as bullies (n = 299), victims (n = 180), bully-victims (n = 195), and neutral (n = 638) on school attitudes, psychosocial health, problem behaviors, and physical injury. Hypotheses were generally confirmed, especially contrasts between bully-victims and neutrals. However, bullies did not have better school attitudes than bully-victims, and victims only marginally reported better psychological health than bully-victims. The boys of mixed ethnicity were more likely to be victims. Greater awareness of the problems associated with boys who both bully and are victimized is necessary for improved intervention. Stein, J., Dukes, R., and Warren, J. Adolescent Male Bullies, Victims, and Bully-Victims: A Comparison of Psychosocial and Behavioral Characteristics. J Pediatr Psychol, 32(3), pp. 273-282, 2007.


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