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Director's Report to the National Advisory Council on Drug Abuse - February, 2004

Research Findings - Epidemiology and Etiology Research

Predictors of Adolescent Substance Use in Children with ADHD

This study followed up 142 subjects who had been assessed and treated for attention deficit/hyperactivity disorder (ADHD) in childhood, to assess risk for substance use in adolescence (ages 13-18) compared with matched adolescent controls without ADHD. As noted by the authors, previous studies of the risks associated with ADHD have resulted in discrepant findings, particularly when conduct problems, often associated with ADHD, are taken into account. To help address these issues, this study assessed the roles of two key components of ADHD, inattention and impulsivity-hyperactivity, separately, as well as the roles of persistence of ADHD and of the development of conduct disorder in adolescence. Several important findings emerged. First, in this sample, childhood ADHD was associated with greater use and abuse of alcohol, and heavier and earlier use of tobacco and other drugs. Second, childhood inattention was a significant predictor of most categories of adolescent substance use even when controlling for childhood impulsivity-hyperactivity and oppositional-conduct disorder symptoms (ODD/CD), although the latter predicted illicit drug use. Third, while those ADHD subjects who developed conduct disorder showed the highest levels of substance use and related problems, those with persistent ADHD without conduct disorder also showed significantly elevated levels of substance use. Thus, this study suggests that ADHD may pose a risk for substance use problems separately from its relationship to conduct disorder, and points to particular features, namely severe inattention problems and persistence of ADHD symptoms into adolescence, that may identify those at elevated risk. Molina, B.S.G., and Pelham, W.E. Childhood Predictors of Adolescent Substance Use in a Longitudinal Study of Children with ADHD. J Abnorm Psychol, 112, pp. 497-507, 2003.

Prevalence and Development of Psychiatric and Substance Use Disorders in Childhood and Adolescence

The authors used longitudinal data from a representative community sample of 1420 nine through sixteen year olds, to describe the prevalence and continuity of psychiatric disorders over time. Several significant findings were reported. By age 16, over a third (36.7%) of subjects met DSM-IV criteria for one or more disorders, and those with one disorder were 3 times more likely to have the same or another diagnosis at later waves. Rates of comorbidity were high, with one quarter (25.5%) diagnosed with 2 or more disorders at one time. Almost all disorders showed significant rates of continuity over time. Continuity from one diagnosis to another was significant between anxiety and depressive disorders, and from anxiety and conduct disorder to substance abuse, in girls. Substance use disorders increased with age and were more prevalent in boys than girls. The sample, while representative, does not represent the American population, but prevalence rates were comparable to those in several other studies. The notable points from this study relate particularly to the findings regarding continuity: that in a representative sample, only anxiety and conduct disorders predicted substance use disorders, and only in girls. This has important implications for improving our understanding of the etiology of adolescent drug abuse, for identifying those children at particular risk, and for developing and testing effective childhood interventions to prevent later drug abuse. Costello, E.J., Mustillo, S., Erkanli, A., Keeler, G., and Angold, A. Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence. Arch Gen Psychiatry, 60, pp. 837-844, 2003.

Poverty Influences Some Forms of Child Psychopathology

The authors took advantage of a natural experiment to test the role of social selection vs. social causation of childhood psychopathology. During the course of their longitudinal study, the opening of a casino on an Indian reservation provided an income supplement to a subsample that moved 14% of the study families out of poverty. The findings confirmed previous reports of an inverse relationship between family income and child psychiatric diagnoses and symptoms, in both Indian and non-Indian children. Those children whose families moved out of poverty with the income supplement demonstrated drops in their psychiatric symptoms to the low levels of children who were never poor, while those whose families remained poor continued to have the high levels of symptoms seen in other poor children. These findings applied specifically to conduct and oppositional defiant disorders; anxiety and depressive disordered showed no significant change. Findings were replicated in non-Indian children whose families moved out of poverty during the same period. Given that this income supplement was not the result of family characteristics, the findings support a social causation theory for behavioral disorders in children. Because conduct and oppositional defiant disorders are strongly associated with risk for drug abuse, this study has significant implications for understanding drug abuse etiology and targeted interventions. Costello, E.J., Compton, S.N., Keeler, G. and Angold, A. Relationships Between Poverty and Psychopathology. JAMA, 290, pp. 2023-2029, 2003.

Genetic and Environmental Risk Factors in Men and Women

The authors used data on psychiatric syndromes from interviews with 5600 male-male and female-female twin pairs from a population-based registry to study patterns of comorbidity. They sought to gain better understanding of the contributions of genetic and environmental risk factors to etiology of internalizing and externalizing disorders, and to test for gender differences in these patterns and contributions. Model-fitting identified two genetic factors, one for externalizing disorders (alcohol and drug dependence, antisocial and conduct disorders) and one for internalizing disorders (major depression, generalized anxiety disorder, and phobia). Among internalizing disorders, one genetic factor loaded heavily for major depression and generalized anxiety, the other for phobia. Of the ten syndromes studied, alcohol dependence and drug abuse/dependence appear to be influenced by specific genes. Shared environmental factors were strongest for conduct disorder and antisocial behavior. Of note, all of the models showed no sex differences. Thus, genetic factors appear to underlie the tendency toward psychiatric comorbidity, and development of specific disorders may be related to individual experiences; however, for the drug use disorders, there appear to be specific genes as well, and the strongest psychiatric risk factors (conduct and antisocial disorders) are the most influenced by shared environmental influences. These findings support both genetic and environmental approaches to understanding and intervening with drug abuse vulnerability. Kendler, K.S., Prescott, C.A., Myers, J. and Neale, M. The Structure of Genetic and Environmental Risk Factors for Common Psychiatric and Substance Use Disorders in Men and Women. Arch Gen Psychiatry, 60, pp. 929-937, 2003.

Co-Occurrence of Alcohol, Drug, and Psychiatric Disorders Among U.S. Residents of Mexican Origin

This study examined comorbidity in Mexican immigrants and US-born Mexican-Americans, an ethnic group who comprise 66% of the Latino population of the US. Subjects were selected from urban and rural areas of Fresno County, CA; and the weighted sample was composed of 60% immigrants and 40% US-born and had 46.6% females and 53.4% males. Comorbidity refers to co-occurrence of any two diagnoses; whereas the term dual diagnoses refers to co-occurrence of a substance abuse disorder (alcohol or drug) and non-substance use psychiatric disorder. The dominant pattern observed was dual diagnoses of a non-substance use psychiatric disorder with alcohol abuse or dependence. Co-occurring lifetime rates of alcohol or other drug disorders with non-substance use psychiatric disorders, or both, were 8.3% for men and 5.5% for women and were 12.3% for the US born and 3.5% for immigrants. Alcohol abuse or dependence with co-occurring psychiatric disorders is a primary disorder among Mexican-origin adult males (7.5% lifetime prevalence). Mexican-origin females have negligible rates of alcohol or drug abuse and dependence disorders. US-born men and women are almost equally likely to have co-occurring disorders involving substances. Among all sex and nativity subgroups, individuals with drug abuse or dependence disorders have very high comorbidity rates. Comorbidity is expected to increase in the Mexican-origin population owing to acculturation effects; therefore, early preventive interventions and culturally competent treatment services for low-income youth and adults are needed. Vega, W.A., Sribney, W.M. and Achara-Abrahams, I. Co-Occurring Alcohol, Drug, and Other Psychiatric Disorders Among Mexican-Origin People in the United States. Am J Public Health, 93(7), pp. 1057-1064, 2003.

An Enumeration Approach for Prevalence Estimates of Cocaine and Heroin Users and Operatives

Better estimates of crack, powder cocaine and heroin using and/or selling populations are needed to provide appropriate levels of services to these hidden populations. The prevalence of crack, powder cocaine, and heroin users and operatives (drug dealers and others involved in drug sales and distribution activities) was estimated in the Central Harlem area of New York City using an enumeration method. Central Harlem was divided into 45 primary sampling units (PSUs), and two years of police department data on drug-related allegations were used to classify the PSUs as having high, middle, and low levels of allegations. In 9 randomly selected PSUs (three from each level), interviewers used chain referral sampling procedures that were steered by using a nomination technique. Within sampled PSUs, 657 respondents nominated 5756 others for a total of 6413. Seven indicators identified 1007 unique individuals among 2835 nominated by two or more respondents, totaling to 4585 unique persons. These drug users and operatives were divided by the total number of persons in these PSUs according to the 1990 census to estimate the number of drug users and distributors in the 36 PSUs not sampled and for all 98725 residents of Central Harlem. Approximately 13.4% of Central Harlem residents were estimated to be users of crack, powder cocaine and/or heroin with no roles in drug distribution. Approximately 6.7% of Central Harlem residents were estimated to be operatives of these drugs, some of whom may also have been users. This study demonstrates that enumeration techniques can used to project prevalence estimates for crack, powder cocaine, and heroin users and operatives in a large urban geographic area. Rees Davis, W., Johnson, B.D., Randolph, D., and Liberty, H.J. An Enumeration Method of Determining the Prevalence of Users and Operatives of Cocaine and Heroin in Central Harlem. Drug Alcohol Depend, 72(1), pp. 45-58, 2003.

Comorbid Substance Use and Psychiatric Disorders Among Juvenile Detainees

To estimate the prevalence of comorbid psychiatric disorders in the past 6 months, the Diagnostic Interview Schedule for Children Version 2.3 was administered to 1,829 randomly selected detainees (1172 males, 657 females, aged 10-18) in the Cook County Juvenile Temporary Detention Center. Overall, more than 10 percent of males and almost 14 percent of females had a substance abuse disorder and a major mental disorder, such as psychosis, manic episode, or major depressive episode. Approximately 600 of these 1,829 young people had substance abuse disorders and behavioral disorders. In the subset of 305 youth with major mental disorders, more than 50 percent of females and nearly 75 percent of males also reported a substance abuse disorder. When the subset of 874 youth with substance abuse disorders was examined, 30 percent of the females and 21.4 percent of the males were found to also have a major mental disorder. About 25 percent of juvenile justice system detainees with major mental disorders reported that their psychiatric problem preceded their substance abuse disorder by more than 1 year. Almost 67 percent of females and more than 54 percent of males developed their mental and drug abuse disorders within the same year. Overall, these findings point to the need for assessment and treatment of juvenile detainees with comorbid substance abuse and mental health disorders. Abram, K.M., Teplin, L.A., McClelland, G.M. and Dulcan, M.K. Comorbid Psychiatric Disorders in Youth in Juvenile Detention. Arch Gen Psychiatry, 60(11), pp. 1097-1108, 2003.

Executive Functioning and Temperament in Adolescent Females with Substance Use Disorders

This study was designed to assess the role of temperament in the association between executive functioning (EF) and adolescent females substance use disorders (SUD). The sample included 340 drug using females between 14 and 18 years of age. This included 240 adolescent females with SUD diagnoses. Results suggest that temperament mediates the association between EF and adolescent females' drug use. Furthermore, EF and temperament interact to account for unique variance in drug use involvement, above and beyond the main effects of age, EF, and temperament. Interestingly, the investigators found that low EF was only significantly related to increased drug use involvement for participants with a "good" temperament and not for those with a difficult temperament. Participants with a difficult temperament exhibited significantly greater drug use involvement than those with a good temperament. In conclusion, these findings suggest that a difficult temperament may be a more important risk factor for adolescent females' drug use than low EF. Giancola, P.R. and Mezzich, A.C. Executive Functioning, Temperament, and Drug Use Involvement in Adolescent Females with a Substance Use Disorder. J Child Psychol Psychiatry, 44(6), pp. 857-866, 2003.

Predictive Value of Mild Disorders: Implications for DSM-V

High prevalence estimates in epidemiological surveys have led to concerns that the DSM system is overly inclusive and that mild cases should be excluded from future DSM editions. The purpose of this study is to demonstrate that the DSM-III-R disorders in the baseline National Comorbidity Survey (NCS) can be placed on a severity gradient that has a dose-response relationship with outcomes assessed a decade later in the NCS follow-up survey (NCS-2) and that no inflection point exists at the mild severity level. The NCS was a nationally representative household survey of DSM-III-R disorders in the 3-year time span 1990-1992. The NCS-2 is a follow-up survey of 4375 NCS respondents (76.6% conditional response rate) reinterviewed in 2000 through 2002. The NCS-2 outcomes include hospitalization for mental health or substance disorders, work disability due to these disorders, suicide attempts, and serious mental illness. Twelve-month NCS/DSM-III-R disorders were disaggregated into 3.2% severe, 3.2% serious, 8.7% moderate, and 16.0% mild case categories. Results indicated that all 4 case categories were associated with statistically significantly elevated risk of the NCS-2 outcomes compared with baseline noncases, with odds ratios of any outcome ranging monotonically from 2.4 to 15.1 for mild to severe cases. This graded association between mental illness severity and later clinical outcomes suggests that the retention of mild cases in the DSM is important to represent the fact that mental disorders vary in severity, and that cost-effectiveness analysis should include recognition that treatment of mild cases might prevent a substantial proportion of future serious cases. Kessler, R.C., Merikangas, K.R., Berglund, P., Eaton, W.W., Koretz, D.S., and Walters, E.E. Mild Disorders Should Not Be Eliminated From the DSM-V. Arch Gen Psychiatry, 60, pp. 1117-1122, 2003.

Liability to Substance Use Disorders: An Overview

Variation in the risk for and severity of substance use disorders (SUD) in the population is caused by multiple organismic (genetic, biochemical, psychological) and environmental factors. Whereas drug- or drug-class-specific liability mechanisms exist, a substantial proportion of variance in the risk is shared between specific liabilities, reflecting mechanisms that determine common liability to SUD. Data from epidemiologic, clinical, psychological, physiological, biochemical, and family and genetic studies reviewed in this paper indicate the existence of mechanisms and characteristics shared in common by liabilities to SUD related to different drugs. These mechanisms can be conceptualized as common liability to SUD, a latent trait accounting for a substantial portion of variation in SUD risk and severity and determined by all factors influencing the probability of SUD development. Vanyukov, M.M., Tarter, R.E., Kirisci, L., Kirillova, G.P., Maher, B.S., Clark, D.B. Liability to Substance Use Disorders: 1. Common Mechanisms and Manifestations. Neurosci Biobehav Rev, 27, pp. 507-515, 2003.

Liability to Substance Use Disorders: A Quantitative Approach

Liabilities to complex disorders present difficulties in measurement related to the arbitrariness of diagnostic threshold definitions and problems with discrimination between trait values, especially within the 'normal' individuals. The inability to quantitatively estimate the risk for a disorder, such as substance use disorders (SUD), is an obstacle for studying etiological (e.g. genetic) mechanisms and developing efficient prevention and treatment measures. Based on the concept of common liability to SUD, this paper delineates an application of the longitudinal family/high-risk design and item response theory to the development of a continuous index of liability. The method has been tested in both simulation study and empirical data. The approach described affords the opportunity to quantitatively estimate the risk for SUD at an early age and before any drug exposure. This method is also applicable to measuring liabilities to other complex disorders, especially those with relatively late onset. Vanyukov, M.M., Kirisci, L., Tarter, R.E., Simkevitz, H.F., Kirillova, G.P., Maher, B.S. and Clark, D.B. Liability to Substance Use Disorders: 2. A Measurement Approach. Neurosci Biobehav., Rev 27, pp. 517-526, 2003.

Cortisol, Personality, and Aggressive Behavior in Adolescent Males

This study tested the hypothesis that low resting salivary cortisol concentration in preadolescent boys would be associated with aggressive behavior later in adolescence. It also tested whether personality traits mediate this relation. Resting salivary cortisol concentrations from 314 boys (10-12 years of age) were assayed. When the boys reached 15 to 17 years of age these concentrations were analyzed in the context of personality traits, measured with the Multidimensional Personality Questionnaire, and aggressive behavior, measured with the Youth Self-Report inventory. Low cortisol in preadolescence was associated with low harm avoidance, low self-control, and more aggressive behavior 5 years later, during middle adolescence. Low self-control was identified as the primary personality mediator of the relation between low cortisol and later aggressive behavior. Results suggest that low resting cortisol concentrations in adolescent males are predictive of clinically important personality factors. Shoal, G.D., Giancola, P.R. and Kirillova, G.P. Salivary Cortisol, Personality, and Aggressive Behavior in Adolescent Boys: A 5-Year Longitudinal Study. J Am Acad Child Adolesc Psychiatry, 42, pp. 1101-1107, 2003.

Meta-Analysis of Models of Comorbidity using Family Study Data

Knowledge regarding the causes of comorbidity between two disorders has a significant impact on research regarding the classification, treatment, and etiology of the disorders. Two main analytic methods have been used to test alternative explanations for the causes of comorbidity in family studies: biometric model fitting and family prevalence analyses. Unfortunately, the conclusions of family studies using these two methods have been conflicting. This meta-analysis of 42 family studies examined the validity of family prevalence analyses in testing alternative comorbidity models: the alternate forms model, the correlated liabilities model, and the three independent disorders model. Results suggest that some analyses may be valid tests of the alternate forms model (i.e., two disorders are alternate manifestations of a single liability), but that none of the analyses are valid tests of the correlated liabilities model (i.e., a significant correlation between the risk factors for the two disorders) or the three independent disorders model (i.e., the comorbid disorder is a third, independent disorder). Findings suggest that family studies using family prevalence analyses may have made incorrect conclusions regarding the etiology of comorbidity between disorders. Rhee, S.H., Hewitt, J.K., Corley, R.P., and Stallings, M.C. The Validity of Analyses Testing the Etiology of Comorbidity Between Two Disorders: A Review of Family Studies. J Child Psychol Psychiatry, 44, pp. 612-636, 2003.

Perceived Temptation to Use Drugs and Actual Drug Use Among Women

Perceived level of temptation to use drugs under specified circumstances has received little or no attention. Data from this study of 125 adult women drug users residing in the Atlanta, Georgia metropolitan area are derived from Project FAST - an intergenerational study of drug use among 250 women conducted between 1997 and 2000 that examined substance use, psychological and psychosocial functioning, and a variety of HIV-related risk behaviors among women and their adult daughters. Four dyad groups were identified with approximately equal numbers of women being recruited for each dyad group: (1) drug-using mothers who had drug-using daughters; (2) drug-using mothers with non-using daughters; (3) drug-using daughters with non-using mothers; and (4) non-using mothers who had non-using daughters. The study described here examined 16 specific items assessing temptations to use drugs and compared perceptions to actual drug use behaviors. Marital status was the only statistically significant predictor of women's drug use. Women's age, race, educational attainment, childhood maltreatment history, psychosocial profiles, exposure to substance abusers, and interpersonal relationships had no significant impact upon the amount of drugs used, once the effects of their levels of temptation to use drugs and marital status were known and taken into account. It may be that the effects of women's temptations to use drugs under specified circumstances may be related more closely to the actual contexts in which they find themselves having to make decisions about whether or not to use drugs than other variables that could also affect such decisions. Items assessing their temptation level are more salient to their drug use process than whether or not they belonged to a particular racial/ethnic group and whether or not they have strong interpersonal support networks. Five key findings have specific implications for substance abuse prevention and treatment programs: (1) women who were married or living as married reported nearly twice the amount of drug use as women whose marital status was other-than-married; (2) greater drug use was reported by people who said that they would be tempted to use drugs if they were hanging around in their neighborhood; (3) greater drug use was reported by women who said that they would be tempted to use drugs when they were celebrating and feeling happy; (4) women who said that they would be tempted to use drugs when they were waking up and facing a difficult day reported more drug use than those who said that they would not be tempted to use drugs under such a circumstance; and (5) the greatest drug use was reported by women who felt that they would be tempted to use drugs if they found themselves in a place where everyone else was using drugs. These findings suggest that there is a close relationship between temptations to use drugs in specific circumstances and actual drug usage. Women who reported the greatest amounts of drug use tended to have the greatest need for training/education to help them to acquire the skills to avoid using drugs in various situations. Klein, H., Elifson, K.W., and Sterk, C.E. Perceived Temptation to Use Drugs and Actual Drug Use Among Women, J Drug Issues, Winter, pp. 161-191, 2003.

Religiosity and Drug Use Disorders

This study sought to clarify the dimensions of religiosity and relate these dimensions to risk for psychiatric and substance use disorders, using a population-based sample. Factor analysis of 78 questionnaire items on religiosity revealed seven underlying factors. Social religiosity and thankfulness were associated with reduced risk for both internalizing and externalizing and drug use disorders. General religiosity, belief in an involved God, forgiveness, and viewing God as a judge were all associated with reduced risk for externalizing (including drug use) disorders, and unvengefulness was associated with reduced risk for internalizing disorders. Of note, these findings, in a population-based sample, conform with previous reports that high levels of religious involvement are associated with reduced risk for drug use disorders. While this study cannot illuminate the possible causal relationships between these characteristics, it lays groundwork for further exploration. Kendler, K.S., Liu, X., Gardner, C.O., McCullough, M.E., Larson, D., and Prescott, C.A. Dimensions of Religiosity and Their Relationship to Lifetime Psychiatric and Substance Use Disorders. Am J Psychiatry, 160, pp. 496-503, 2003.

Recanting of Substance Use Reports In a Longitudinal Prevention Study

This study analyzed recanting of substance use reports for lifetime use of alcohol, alcohol to get drunk, cigarettes, marijuana and cocaine in an 8-wave panel study designed to evaluate the Drug Abuse Resistance Education (DARE) program in the state of Illinois. Although this phenomenon has been identified elsewhere, the current analysis of recanting is a unique attempt to track this behavior over the entire course of adolescence. Overall, rates of recanting for specific drugs was extremely high, ranging from 45% for lifetime reports of alcohol use to 81% for lifetime reports of cocaine use. Most recanting occurred in the wave immediately following the wave of first disclosure. Paralleling results from other studies, race/ethnicity was an important correlate of recanting in both bivariate and multivariate analyses. African American respondents had higher rates of recanting than White subjects. Even after controlling for the number of follow-up waves, the later the wave of first disclosed lifetime drug use, the lower the probability that drug use would be recanted ever (for all substances) or in the wave immediately following first disclosure (for reports of ever having been drunk or for lifetime marijuana or cocaine use). One important limitation of this study is that it is focused on a sample attending schools in one particular state (Illinois) in the United States during one particular time period. Fendrich, M. and Rosenbaum D.P. Recanting of Substance Use Reports in a Longitudinal Prevention Study. Drug Alcohol Depend, 20, pp. 241-253, 2003.

Marijuana Use Affects Completion of High School

Cross-sectional research has shown a link between adolescent substance use and educational motivation. The purpose of the current study was to examine this link in a longitudinal sample of African American youth. The study examined the interrelationships between alcohol and both marijuana use and school motivation over the high school years and their effect on graduation in 681 African American adolescents (50.8% female). School motivation was shown to relate to subsequent alcohol use throughout high school and marijuana use early in high school. School motivation did not affect graduation status, but alcohol and marijuana use were related to a lower likelihood of graduating from high school. Some gender differences and differences among those who had tried alcohol or marijuana at the first wave as opposed to those who had not tried each substance were found. The findings support a systems model where school experiences can affect substance use, which, in turn, can affect the completion of high school. Zimmerman, M.A., Schmeelk-Cone, K.H. A Longitudinal Analysis of Adolescent Substance Use and School Motivation Among African American Youth. J Res Adolesc, 13(2), pp. 185-210, 2003.

Tryptophan Ratio Related to Suicidal Behavior in Prospective Study

A lower ratio of tryptophan to other amino acids in serum (tryptophan ratio), established as an index of serotonin precursor available to the brain, has been shown to be associated with increased suicidal behavior in cross-sectional studies. The purpose of this study was to conduct the first prospective examination of the utility of the tryptophan ratio along with clinical variables in predicting suicidal behavior in high-risk and reference adolescents. Adolescents with alcohol use disorders (AUDs) and prior suicidal attempts (n=20), adolescents with AUDs without suicide attempts (n=20), and community controls with neither of these characteristics (n=20) were matched on demographic variables. These groups were not significantly different on the tryptophan ratio at baseline. Of 56 subjects who completed follow-up assessments, six had suicidal behavior in the follow-up period. The tryptophan ratio, along with demographic and clinical variables, was examined using Cox regression with a backward stepwise variable elimination procedure. In the final model, the tryptophan ratio and major depressive disorder both significantly contributed to the prediction of suicidal behavior. This finding suggests that the tryptophan ratio may improve the identification of adolescents at high risk for suicidal behavior. Clark, D.B. Serum Tryptophan Ratio and Suicidal Behavior in Adolescents: A Prospective Study. Psychiatry Res, 119(3), pp. 199-204, 2003.

Physical and Sexual Abuse, Depression and Alcohol Use Disorders in Adolescents: Onsets and Outcomes

This study examined the relationships among physical and sexual abuse (PS Abuse), major depressive disorder (MDD), and alcohol use disorders (AUD) in adolescence, as well as related young adult outcomes. Adolescents (mean age: 16.4 years; range: 14-18 years) were recruited from clinical and community sources and classified into four groups: (1) AUD+PS Abuse (n=154), (2) AUD only (n=255), (3) PS Abuse only (n=74), and (4) Controls (n=268). Subjects were longitudinally assessed through young adulthood (age 19 years or older). Measures included interview assessments of DSM-IV AUD and MDD, classified as "primary" or "secondary", and questionnaire measures of alcohol consumption and depression. Primary MDD preceded AUD whereas secondary MDD had a later onset than AUD. PS Abuse accelerated the onsets of primary MDD, secondary MDD and AUD. While affected adolescents had typically improved in both alcohol consumption and depression at the young adult assessment, the majority of those with adolescent AUD had AUDs in young adulthood, and MDD remained common in those with a history of PS Abuse. These results indicate that MDD among adolescents with AUD may be partly attributable to PS Abuse. Clark, D.B., DeBellis, M.D., Lynch, K.G., Cornelius, J.R and Martin, C.S. Physical and Sexual Abuse, Depression and Alcohol Use Disorders in Adolescents: Onsets and Outcomes. Drug Alcohol Depend, 69(1) pp. 51-60, 2003.

Racial/Ethnic Differences in Smoking Accounted for, in Part, by Social Influence

Using data from a longitudinal panel of nearly 3000 adolescents to predict current smoking among young adults, this study tested whether considering variables that tap prior social bonds and influences eliminates race/ethnicity as a significant predictor of current smoking. At age 23, African Americans and Asians exhibited substantially lower rates of current smoking than Whites and Hispanics. Controlling for social influences during high school, particularly exposure to siblings and friends who smoked plus parental disapproval of smoking, accounted for these differences. Social bonding variables, in contrast, had a limited effect on these differences. Interventions aimed at decreasing adolescent vulnerability to prosmoking influences, reducing overall levels of peer cigarette use, and helping parents better convey their disapproval of smoking should help curb young adult smoking and diminish racial/ethnic differences in tobacco use. Ellickson, P.L., Perlman, M. and Klein, D.J. Explaining Racial/Ethnic Differences in Smoking During the Transition to Adulthood. Addict Behav., 28(5), pp. 915-931, 2003.

Role Models and Psychosocial Outcomes Among African American Adolescents

The authors examined who 679 African American ninth-graders (aged 14-17 yrs) from urban environments look up to and how their role model choices relate to substance use, delinquency, academic engagement, and psychological well-being. Male adolescents without male role models and females identifying brothers as role models reported the most problem behavior. Adolescents with paternal male role models had the most positive school outcomes, no differences were found in psychological well-being among adolescents in terms of their male role models. The presence of female role models, in contrast, was associated with psychological well-being such that adolescents with maternal role models reported the least distress. Adolescents without female role models had the lowest grades and most negative school attitudes. These findings remained when parental support, family conflict, and father presence in the household were controlled, suggesting role model effects are separate from parenting effects. Findings support and expand on the notion that having someone to look up to is critical for African American youths' development. Bryant, A.L. and Zimmerman, M.A. Role Models and Psychosocial Outcomes Among African American Adolescents. J Adolesc Res., 18(1), pp. 36-67, 2003.

Predictors of the Transition to Regular Smoking

This study identified predictors of the transition from experimentation to regular smoking in middle adolescence, late adolescence, and young adulthood. Students completed self-report surveys assessing the following potential predictors of the transition to regular smoking from grades 8 to 10, grades 10 to 12, and grades 12 to age 23 years: demographic characteristics, smoking-related attitudes, behaviors and environment, other problem behaviors; academic orientation; parental bonding; and mental health. Regression techniques which adjust for weighting and clustering of observations were used to determine the independent associations of the predictor variables on subsequent smoking status. Risk factors for the transition to regular smoking during middle adolescence included being white, prosmoking attitudes, friend smoking, weak academic orientation, and less parental support. During late adolescence, being African-American was protective, whereas risk factors included prosmoking attitude, drinking, non-intact nuclear family, and less parental support. Risk factors in young adulthood include younger age and prosmoking attitudes. Results point to several smoking-related attitudes, social influences, and behaviors that prevention efforts may target to curb the escalation of smoking. Tucker, J.S., Ellickson, P.L., and Klein, D.J. Predictors of the Transition to Regular Smoking During Adolescence and Young Adulthood, J Adolesc Health, 32(4), pp. 314-324, 2003.

Protective Factors Against Serious Violent Behavior in Adolescence

This study used data from the Seattle Social Development Project to examine factors in adolescence that affect the probability of violent behavior at age 18 among youths who received high teacher ratings of aggression at age 10. The study found a lower probability of violence among youths at age 18 was associated with attendance at religious services, good family management by parents, and bonding to school at age 15. A higher probability of later violence was associated with living in a disorganized neighborhood and having the opportunity for and involvement with antisocial peers at age 15. The likelihood of violence at age 18 among aggressive youths was reduced when they were exposed to multiple protective factors at age 15, even for those simultaneously exposed to risk factors. Herrenkohl, T.I., Hill, K.G., Chung, I.J., Guo, J., Abbott, R. and Hawkins, J.D. Protective Factors Against Serious Violent Behavior in Adolescence: A Prospective Study of Aggressive Children. Soc Work Res., 27(3), pp. 179-191, 2003.

Stress Related to Anxiety, Depression and Antisocial Behavior in African American Youth

Few researchers have studied trajectories of stress over time in relation to psychosocial outcomes and behaviors among adolescents. A sample of African American adolescents were assessed longitudinally on perceived stress, psychological well-being, support, antisocial behaviors, and academic success. Patterns of stress over 4 time points were developed using a cluster-analytic approach. Differences among the trajectory clusters were examined using psychosocial outcomes and behaviors. Adolescents with chronic levels of stress reported more anxiety and depression, engaged in antisocial behaviors, and reported less active coping than youth in other trajectories. Adolescents with low levels of stress over time reported fewer psychological problems, perceived more social support, and were more likely to graduate from high school than those with higher stress levels over time. The study also found that an increase in stress coincided with a lack of support and more psychological problems over time. Schmeelk-Cone, K.H. and Zimmerman, M.A. A Longitudinal Analysis of Stress in African American Youth: Predictors and Outcomes of Stress Trajectories. J Youth Adolesc., 32(6), pp. 419-430, 2003.

Racial Identity and Academic Attainment Among African American Adolescents

This study explored the relationships between racial identity and academic outcomes for African American adolescents. In examining race beliefs, the study differentiated among (a) importance of race (centrality), (b) group affect (private regard), and (c) perceptions of societal beliefs (public regard) among 606 African American 17-year-old adolescents. Using cluster analysis, profiles of racial identity variables were created (labeled buffering/defensive, low connectedness/high affinity, idealized, and alienated), and these profile groups were related to educational beliefs, performance, and later attainment (high school completion and college attendance). The alienated group showed the lowest percentage of individuals attending post-secondary education, while the buffering-defensive group showed the highest college attendance. Also, the relationships between academic attitudes and academic attainment differed across groups. The paper discusses the need to consider variation in how minority youth think about group membership in order to better understand academic development. Chavous, T.M., Bernat, D. H. Schmeelk-Cone, K., Caldwell, C.H., Kohn-Wood, L. and Zimmerman, M.A. Racial Identity and Academic Attainment Among African American Adolescents, Child Dev., 74(4), pp. 1076-1090, 2003.

Common Predictors of Cigarette Smoking, Alcohol Use, Aggression, and Delinquency Among Inner-City Minority Youth

The present study examined the prevalence rates and common predictors of substance use, aggression, and delinquency among inner-city minority youth entering middle school. A survey was administered to 6th grade students (N = 5423) from 42 New York City schools. Aggressive behaviors were reported most frequently, followed by delinquent behaviors, alcohol use, and cigarette smoking. Across all behavioral outcomes, social and environmental influences explained the largest proportion of variance, followed by individual characteristics and skills, bonding to conventional institutions, and demographic variables. For the majority of predictor variables there was substantial overlap in patterns of prediction across outcomes. These findings indicate that several factors that correspond to the predominant psychosocial theories of adolescent development explain variation across different problem behavior outcomes among inner-city minority youth. Griffin, K.W., Botvin, G.J., Scheier, L.M., Doyle, M.M. and Williams, C. Common Predictors of Cigarette Smoking, Alcohol Use, Aggression, and Delinquency Among Inner-City Minority Youth. Addictive Behaviors, 28, pp. 1141-1148, 2003.

Preventing Tobacco and Alcohol Use Among Elementary School Students

The present study examined the effectiveness of a substance abuse prevention program in preventing tobacco and alcohol use among elementary school students in grades 3 through 6. The prevention program teaches social resistance skills and general personal and social competence skills. Rates of substance use behavior, attitudes, knowledge, normative expectations, and related variables were examined among students (N = 1090) from 20 schools that were randomly assigned to either receive the prevention program (9 schools, n = 426) or serve as a control group (11 schools, n = 664). Data were analyzed at both the individual-level and school-level. Individual-level analyses controlling for gender, race, and family structure showed that intervention students reported less smoking in the past year, higher anti-drinking attitudes, increased substance use knowledge and skills-related knowledge, lower normative expectations for smoking and alcohol use, and higher self-esteem at the posttest assessment, relative to control students. School-level analyses showed that the annual prevalence rate was 61% lower for smoking and 25% lower for alcohol use at the posttest assessment in schools that received the prevention program when compared with control schools. In addition, mean self-esteem scores were higher in intervention schools at the posttest assessment relative to control schools. Findings indicate that a school-based substance abuse prevention approach previously found to be effective among middle school students is also effective for elementary school students. Botvin, G.J., Griffin, K.W., Paul, E. and Macaulay, A.P. Preventing Tobacco and Alcohol Use Among Elementary School Students through Life Skills Training. Journal of Child & Adolescent Substance Abuse, 12, pp. 1-17, 2003.

Stress Exposure Among Young Adults

Life events checklists have been the predominant method for estimating variations in stress exposure. It is unknown, however, whether such inventories are equally meaningful for estimating differences in exposure between men and women, African-Americans and Whites, and those in lower and higher SES categories. In this paper, authors employ a wider range of measures of stress - recent life events, chronic stressors, lifetime major events and discrimination stress - to examine the extent to which these dimensions collectively yield conclusions about status variations in stress exposure that are similar to or different from estimates based only on a life events checklist. Our analyses of data collected from 899 young men and women of African American and non-Hispanic White ancestry suggest that status differences in exposure to stress vary considerably by the measure of stress that is employed. Although women are more exposed to recent life events than men, males report more major events and discrimination stress than females. Our results also reveal that life event measures tend to substantially under-estimate differences between African-Americans and non-Hispanic Whites in exposure to stress. A similar pattern also holds for SES. When stress is more comprehensively estimated, level of exposure profoundly affects ethnic differences in depressive symptomatology, accounts for almost half of the difference by SES, but contributes little to the explanation of the gender difference in distress. The implications of these findings for the debate over the relative mental health significance of exposure and vulnerability to stress are discussed. Turner, R.J. and Avison, W.R. Status Variations in Stress Exposure Among Young Adults: Implications for the Interpretation of Prior Research. Journal of Health and Social Behavior, 44, pp. 488-505, 2003.

Sports Participation and Substance Abuse In Young Adults

The widely held notion that sports participation reduces subsequent risk of substance use is evaluated with longitudinal data of a representative sample of youth when they were in their preteen and young adult years. Unlike previous inquiries into the deterrence hypothesis, the present study controls for other major factors previously found to be predictive of alcohol and drug use. Results of analyses revealed that contrary to the deterrence hypothesis, playing high school sports does not appear to be a protective factor that lowers one's involvement in young adult alcohol or drug use--with one exception. Subgroup analyses revealed that among blacks, the greater the extent of high school sports participation, the less the risk of substance use. In direct contradiction to the deterrence hypothesis, playing high school sports was found to be positively associated with alcohol use for whites, even in the context of other major predictors of alcohol use. Further analyses revealed that the positive association between sports participation and alcohol use appeared to exist only for white males. The implications of these results are discussed. Eitle, D., Turner, R.J. and Eitle, T.M. The Deterrence Hypothesis Reexamined: Sports Participation and Substance Abuse Young Adults. Journal of Drug Issues, 33, pp. 193-222, 2003.


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