|| Bridging Science and Culture to Improve Drug Abuse Research in Minority Communities
This Conference was held at the Wyndham Franklin Plaza hotel in Philadelphia, P.A., September 24-26, 2001.
The Importance of Using Ethnically and Regionally Specific Language in Surveys
Andrew Morral, Ph.D.
Adolescents' drug use reports are among the most closely observed indicators of the Nation's drug-use problems. There is evidence, however, that these self-reports suffer from considerable underreporting. A portion of this underreporting could result from the use in surveys of drug terms and classifications (e.g., psilocybin, hallucinogens, or psychedelics) that are unfamiliar to youths who refer to drugs using street terms (e.g., Shrooms). This evidence will be presented along with strategies for improving the measurement of adolescent drug use by using ethnically and regionally specific drug terms. New results will be presented from an ongoing study of adolescents that contrasts the use of standard drug terminology with ethnically specific drug terms. These results suggest that a portion of adolescents' drug-use underreporting may result from unfamiliar, abstract, or confusing drug terminology on surveys rather than from adolescents' intentions to conceal their drug use.
This research is supported by the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, through the Persistent Effects of Treatment Study (PETS, Contract No. 270-97-7011).
Drug Use in Asian American/Pacific Islander Populations: Incidence, Prevalence, and Data Needs
Rumi Kato Price, Ph.D., M.P.E., Nathan K. Risk, M.A., Mamie Mee Wong, Ph.D., Renee Storm Klingle, Ph.D.
Drug abuse research on Asian Americans and Pacific Islanders (AAPIs) lacks systematic information on prevalence and incidence and knowledge about their predictors. Nonetheless, fragmented evidence points to increasing substance abuse among some AAPI subgroups, contrary to the image of Asians as a model minority. We analyzed seven large national and State groups of survey data with sample sizes ranging from 13,000 to 390,000 to better understand the nature and source of differential rates of substance use and abuse within AAPIs and across major ethnic/racial minorities. Across major substances, results show that (1) prevalence and incidence rates are the lowest in the aggregated Asians among major racial groups, (2) using disaggregated Asian subgroups, Japanese rates are highest within Asians (very close to those for Whites) corresponding to the rankings of several acculturation indices, (3) the differential rates are due in a large part to the size of mixed-race subgroups, among whom up to a fourfold increase is observed, and (4) mixed-heritage AAPIs are at increased risk for substance use, even after controlling for cultural protective factors and socioeconomic measures. The results point to the importance of (1) rethinking ethnic/racial classifications in assessing differential substance use and abuse, (2) studying substance abuse in mixed-heritage adolescents, and (3) studying detailed processes of decays in social-environmental and potentially genetic protective factors.
Price RK, Risk NK, Wong MW, Klingle RS. (under review) Substance use and abuse in Asian American and Pacific Islanders (AAPIs): Preliminary results from three national surveys. Public Health Reports.
Tabulation Working Group Interagency Committee for the Review of Standards for Data on Race and Ethnicity. (1999) Draft Provisional Guidance on the Implementation of the 1997 Standards for the Collection of Federal Data on Race and Ethnicity. Washington, DC: Office of Management and Budget.
Zane NWS, Huh-Kim J. (1998) Addictive behaviors. In L.C. Lee, N.W.S. Zane (eds.), Handbook of Asian American Psychology. Newbury Park, CA: Sage, pp. 527-554.
Violence and Drug Use: A Tangled Web
Merrill C. Singer, Ph.D.
In popular and media conception, violence and drug use are intimately related and have been depicted as such since early in the 20th century. Broad acceptance of this allegedly inherent entwinement has been used often to launch panicked warnings about the potential consequences of drug use in minority communities. While this social practice dates at least to the early 20th century and social concern about cocaine use among southern African Americans and marijuana use among southwestern Latinos, it remains today as part of the underlying rationale for the intensive policing of minority neighborhoods and the associated high arrest and incarceration rates among inner-city African American and Latino males. Research findings, however, are more complicated and suggest that the relationship between violence and drug use is complex, multifaceted, and mediated by a variety of structural factors. Notably, the relationship is not unidirectional: Violence can lead to individual changes in drug use patterns, including both heightened and lowered levels of use; conversely, drug use can contribute to various kinds of violence. At the same time, research affirms that most drug use does not notably enhance levels of violence, the relationship between particular drugs and violence changes over time, and alcohol is far more likely than illicit drugs to be associated with violence. In light of the misuses to which dead-certain assertions concerning the association between drug use and violence have been put, a more cautious, research- and reality-based approach is urged.
Establishing Research Partnerships Between Minority and Majority Universities
Ken Harewood, Ph.D., Allyn Howlett, Ph.D.
Academic partnerships thrive on the participation of students serving as liaisons in research collaborations between institutions. We have identified challenges to establishing research partnerships between minority and majority universities and are developing strategies to overcome these impediments: (1) Students at the minority institution have limited observations of ongoing research activities on campus, and this has led to confusion over their role in the laboratory. We are overcoming this by creating a "research environment" with expectations comparable to those of a majority graduate program. (2) Typical M.S. level coursework at the minority institution emphasizes level I or II cognitive skills (identify, recognize, describe, and summarize). Students must be challenged to move beyond this to level III cognitive skills (evaluate, synthesize, apply, analyze, and predict) in order to foster the "research thinking process." (3) Minority institution students who enter Ph.D. programs at majority institutions begin the program with no "head start" from their B.S. or M.S. work. Coursework articulation and integration of research projects would move the student into an advanced position when entering the Ph.D. phase of their training. We are striving to develop faculty research collaborations between institutions so that students can work on aspects of the project at both institutions.
Research was supported by National Institute on Drug Abuse cooperative agreement U24-DA12385.
Drug Use and Dependence in a Population of Urban, African American Young Adults: Prevalence, Correlates, Comorbidity, and Unmet Drug Treatment Service Needs
Nicholas S. Ialongo, Ph.D., Carolyn Furr-Holden, Ph.D., Beth McCreary, Ph.D., Sharon Lambert, Ph.D.
The National Household Survey on Drug Abuse (NHSDA) and the National Comorbidity Study (NCS) (Kessler et al., 1994) represent the most recent and comprehensive efforts to ascertain the prevalence of drug use and dependence, respectively, in the United States. However, the sampling strategies employed in the NHSDA and the NCS have proven less informative regarding the prevalence of drug use and dependence among economically disadvantaged, minority populations because relatively few were assessed. In this presentation, we will describe the prevalence of drug use and dependence in an epidemiologically defined population of 1,181 predominantly poor African Americans ages 19 to 22 years living in the greater Baltimore, Maryland, metropolitan area between 1999 and 2000. The correlates of drug use and dependence, their comorbidity with mental disorders, and unmet drug treatment need will also be presented.
The Effect of Race, Neighborhood, and Social Networks on Initiation of Injection Drug Use
Crystal M. Fuller, Ph.D., Luisa Borrell, D.D.S., Ph.D., Sandro Galea, M.D., David Vlahov, Ph.D.
Injection drug users (IDUs) are at high risk of adverse health consequences, namely, transmission of blood-borne pathogens (such as human immunodeficiency virus [HIV] and hepatitis C virus [HCV]) as well as fatal drug overdose. HIV and HCV transmission typically occurs within the first 2 years of initiating injection drug use (Nicolosi et al., 1992; Nelson et al., 1995; Garfein et al., 1996). Thus, identifying high-risk practices and other social characteristics contributing to age of initiation of injection and HIV infection could provide an opportunity for early interventions. Our research, consistent with other studies, has shown race effects with respect to age at initiation of injection, and HIV seroprevalence (Fuller et al, 2001; Kral et al., 2000; Des Jarlais et al., 1999). Although White drug users tend to progress into illicit drug use at an earlier age, HIV seroprevalence remains highest among Black drug users (Fuller et al., 2001). Our analysis involved the effect of individual and contextual characteristics on age of initiation of injection drug use and subsequent HIV infection among young, recently initiated IDUs. Specifically, we investigated (1) the extent to which age of initiation of injection was associated with individual-level characteristics (e.g., race, social networks, high-risk injection, and sexual practices) and contextual-level characteristics (e.g., neighborhood racial composition and concentration of poverty) and (2) the extent to which HIV seroprevalence was associated with these individual and contextual effects among young IDUs.
Des Jarlais DC, Friedman SR, Perlis T, Chapman TF, Sotheran JL, Paone D, Monterroso E, Neaigus A. (1999) Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 20:67-72.
Fuller C, Vlahov D, Arria AM, Ompad D, Garfein R, Strathdee SA. (2001) Factors associated with adolescent initiation of injection drug use. Public Health Reports (suppl 1) 116:136-145.
Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. (1996) Viral infections in short-term injection drug users: The prevalence of the hepatitis C, hepatitis B, human immunodeficiency virus, and human T-lymphotropic viruses. American Journal of Public Health 86(5):655-661.
Kral AH, Lorvick J, Edlin BR. (2000) Sex- and drug-related risk among populations of younger and older injection drug users in adjacent neighborhoods in San Francisco. Journal of Acquired Immune Deficiency Syndrome 24:162-167.
Nelson KE, Vlahov D, Solomon L, Cohn S, Munoz A. (1995) Temporal trends of incident human immunodeficiency virus infection in a cohort of injection drug users in Baltimore, Maryland. Archives of Internal Medicine 155:1305-1311.
Nicolosi A, Leite MLC, Molinari S, Lazzarin A. (1992) Incidence and prevalence trends of HIV infection in intravenous drug users attending treatment centers in Milan and northern Italy, 1986-1990. Journal of Acquired Immune Deficiency Syndrome 5:365-373.
Being the "Other": Majority Researcher Issues
Philip A. Fisher, Ph.D.
In this presentation, a model for majority (Caucasian) researchers conducting prevention research in minority communities will be offered. The model represents the confluence of two theoretical perspectives—participatory action research and post-colonial theory. The presentation will describe the challenges inherent in moving away from investigator-driven models, within which the values of the investigator may exert an undermining influence on the process in spite of the sensitivity of the investigator. Descriptions will be provided of specific mechanisms that can be employed to facilitate community-based research that is truly inclusive and that avoids the cultural hegemony that has been present in prior research. Examples will be given from an ongoing collaboration with a Native American community of the manner in which these mechanisms can be implemented in ways that facilitate high-quality science, community control over the research process, and positive social change. Consideration will be given to the implications of employing this approach for both majority researchers and communities.
Community-Based Research: A Minority Researcher's Personal Observations
Frank Yuan Wong, Ph.D.
Based on his professional as well as personal experience, the speaker will address career development (e.g., academic vs. applied research, what to study, whom to study, etc.) within the contexts of intra- and inter-group psychology. Other issues discussed will include community welfare vis-ą-vis professional practices and scientific standards. Recommendations will be targeted to aspiring minority researchers.
Social and Racial Disparities in HIV Infections Among Injection Drug Users
Ricky N. Bluthenthal, Ph.D.
In the United States, African Americans and Hispanics are 6 to 16 times more likely to contract AIDS through injection drug use than Whites. Further, injection drug use has accounted for at least 36 percent and perhaps as much as 47 percent of adult AIDS cases among African Americans and Hispanics. Epidemiologic studies have also consistently found HIV infection associated with poverty and homelessness among drug injectors. Despite these data, studies of HIV risk, prevalence, and incidence have focused almost exclusively on individual-level characteristics and behaviors as predictors of HIV infection. An increasing number of studies have found HIV risk and infection among drug injectors to be associated with issues such as racial segregation, urban unemployment, law enforcement practices, welfare reform, and restrictions on promising HIV prevention strategies (such as syringe-exchange programs). This presentation will provide a framework for understanding how larger social, political, and economic forces have contributed to the disproportionate impact of HIV/AIDS on African American and Hispanic injection drug users. Research challenges to be addressed include methods for collecting and considering data from institutional and secondary sources (e.g., police, U.S. census) and consideration of the limits of individual-focused HIV prevention strategies for impoverished populations.
Bluthenthal RN, Lorvick J, Kral AH, Erringer ER, Kahn JG. (1999) Collateral damage in the war on drugs: HIV risk behaviors among injection drug users. International Journal of Drug Policy 10:25-38.
Curtis R, Friedman SR, Neaigus A, Jose B, Goldstein M, Idefonso G. (1995) Street level drug market structure and HIV risk. Social Networks 17:219-228.
Ouellet LJ, Jimenez AD, Johnson WA, Wiebel W. (1991) Shooting galleries and HIV disease: Variations in places for injecting illicit drugs. Crime and Delinquency 37:64-85.
HIV and Drugs in Special Populations
Clyde B. McCoy, Ph.D.
Background. Although recent data indicate that AIDS cases are decreasing in general in the United States, HIV rates continue to increase among specific subpopulations including women, minorities, and drug users. South Florida provides a unique snapshot of the HIV/AIDS epidemic because of its diverse urban and rural populations.
Methods. Data from the Miami CARES cohort collected on 3,555 out-of-treatment chronic drug users assessed sociodemographic variables and HIV and drug use behaviors in three south Florida urban and rural communities (Miami, Belle Glade, and Immokalee).
Findings. The spread of HIV between and within these three areas was correlated with injection drug use, crack-cocaine use, and exchange of sex for money. Rural drug-using minority women in particular continue to practice HIV risk behaviors and are at extremely high risk for HIV transmission. A number of social, cultural, and psychological characteristics may predispose rural migrants to engaging in HIV risk behaviors.
Conclusions. The recent downturn in AIDS deaths is hopeful, yet the increasing incidence of HIV among certain subpopulations remains troubling and should force policymakers to be more diligent in advancing public health policies and strategies available for the effective reduction of HIV transmission, especially recognizing the large diversity of the affected groups.
Edlin BR, Irwin KL, Faruque S, McCoy CB, Word C, Serrano Y, Inciardi JA, Bowser BP, Schilling R, Holmberg SD, Multicenter Crack Cocaine and HIV Infection Study Team. (1994) Intersecting epidemics: Crack cocaine use and HIV infection in inner-city young adults. New England Journal of Medicine. November 24 (21):1422-1427.
McCoy CB, Inciardi JA. (1995) In Sex, Drugs, and the Continuing Spread of AIDS. Los Angeles: Roxbury Publishing Co.
McCoy CB, Metsch LR, McCoy HV, Lai S. (1999) A gender comparison of HIV and drug use across the rural-urban continuum. Population Research and Policy Review 18(1-2):71-87.
Partner Abuse and Sexual Risk Behavior Among Women on Methadone
Nabila El-Bassel, D.S.W.
Partner abuse and HIV risks have emerged as intersecting epidemics that threaten the welfare of inner-city African American and Latino communities. Among the groups disproportionately affected by these trends are minority women in methadone maintenance treatment programs (MMTPs) (El-Bassel et al., 2000a; El-Bassel et al., 2000b; Gilbert et al., 2000). The purpose of this paper is to examine the relationship between sexual HIV risk behavior and partner violence in a random sample of 417 women recruited from MMTPs. Eighty-seven percent of the women in the study reported ever being physically abused, 42 percent reported ever being injured by their intimate partners, and 69 percent of the women reported ever being sexually abused. Although a large number of these women (60 percent) reported that their intimate partners engaged in HIV risk behaviors, only 18 percent always used condoms with them. The findings showed that women who reported history of STDs, had multiple sexual partners and were HIV-positive, or exchanged sex for money or drugs were more likely to be physically abused by an intimate partner than by their counterparts. HIV prevention for women must address the issue of physical and sexual abuse by an intimate partner, particularly when intervention strategies are being developed for drug-involved women who are at a high level of risk for partner violence.
El-Bassel N, Gilbert L, Rajah V, Foleno A, Frye V. (2000a) Fear and violence: Raising the HIV stakes. AIDS Education and Prevention 12(2):154-170.
El-Bassel N, Gilbert L, Wada T, Witte S, Schilling RF. (2000b) Drug abuse and partner violence among women in methadone treatment. Journal of Family Violence 15(3):209-225.
Gilbert L, El-Bassel N, Rajah V, Fontdevila J, Foleno A, Frye V. (2000) The converging epidemics of drug use, HIV and partner violence: A conundrum for methadone maintenance treatment. Mount Sinai Journal of Medicine 67(5-6):452-464.
Lifetime Cumulative Adversity and Drug Dependence: Racial/Ethnic Contrasts
R. Jay Turner, Ph.D.
A number of studies have reported a linkage between stress, measured in terms of recent life events, and drug use and abuse. However, on the face of it, the expectation that variations in exposure to social stress, either within or across such statuses as race and ethnicity, can be meaningfully captured by a simple count of recent life events seems hard to justify. Indeed, our own prior research has demonstrated two important points: (1) When measured more comprehensively, social stress accounts for dramatically more variation in mental health and substance use outcomes than has typically been reported and assumed to obtain. (2) Reliance on checklists of recent life events systematically underestimates stress exposure among African Americans and persons of lower socioeconomic status. The present paper considers the significance for drug dependence disorder of exposure to major and potentially traumatic events over childhood and adolescence based on a large, ethnically diverse sample of individuals in the transition to adulthood. A large array of differing major events was found to be associated with increased risk for the subsequent onset of drug dependence, and the accumulation of such adversities significantly increases such risk. Racial/ethnic variations in lifetime exposure to such events are reported, along with racial/ethnic variations in their risk significance.
The Power of Gender in Drug Abuse Research, Prevention, and Treatment
Hortensia Amaro, Ph.D.
Increasingly, investigators are addressing research questions regarding possible sex and gender differences that may be important to understanding risk factors for substance use and prevention strategies as well as the process of addiction and its treatment. This presentation will review recent research on gender differences in substance use and abuse and discuss the limitations of existing research and knowledge gaps.
The Power of Faith as a Protective Factor Against Drug Abuse
John M. Wallace, Jr., Ph.D.
This presentation uses data from nationally representative samples of American young people to explore the relationship between religion and adolescent substance use. More specifically, the presentation examines the epidemiology of religion among American youth and then describes the conceptual framework that guides the investigation and examines empirically the relationship between adolescent drug use and organizational, behavioral, and attitudinal measures of religiosity.