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

Research Findings - Epidemiology and Etiology Research

Genetic and Environmental Influences on Drug Availability

This study used data from a study of twins to investigate the sources of individual differences in drug availability (DA). Subjects were 1788 adult males from the Mid-Atlantic Twin Registry who participated in a structured telephone interview that included retrospective assessments of DA (cigarette, alcohol, marijuana, cocaine and stimulants) between ages 8 and 25. The authors fitted a biometric dual change score (DCS) model, adapted for ordinal data, to model latent growth and estimate the genetic and environmental components of variance over time. They found that DA, despite being considered an environmental risk factor, is under both genetic and environmental control. For cigarette, alcohol, marijuana and cocaine availability, there was an overall increase in additive genetic variance and a decline in shared environmental variance over time. Non-shared environmental variance remained steady. Stimulant availability did not follow this pattern; rather, there was an upswing in shared environmental effects with increasing age. The authors conclude that the rise in additive genetic variance over time coincides with acceleration in the expression of individual differences, probably brought on by an increase in personal freedom and a reduction in social constraints. This work demonstrates the role of gene-environment correlations in understanding the influence of environmental factors on initiation of drug abuse, as individuals seek out certain environments based in part on genetic propensity. Gillespie, N., Kendler, K., Prescott, C., Aggen, S., Gardner, C., Jacobson, K., and Neale, M. Longitudinal Modeling of Genetic and Environmental Influences on Self-Reported Availability of Psychoactive Substances: Alcohol, Cigarettes, Marijuana, Cocaine and Stimulants. Psychol Med, 37(7), pp. 947-959, 2007.

A Twin Study of Peer Deviance

Peer-group deviance is strongly associated with externalizing behaviors. This study sought to clarify genetic and environmental contributions to peer-group deviance in twins from mid-childhood through early adulthood. Participants were members of male-male pairs from the population-based Virginia Twin Registry personally interviewed in 1998-2004 (n = 1802). Data were collected through retrospective assessments using a life-history calendar, on self-reported peer-group deviance at ages 8-11, 12-14, 15-17, 18-21, and 22-25 years. The results showed that mean and variance of peer-group deviance increased substantially with age. Genetic effects on peer-group deviance showed a strong and steady increase over time. Family environment generally declined in importance over time. Individual-specific environmental influences on peer-group deviance levels were stable in the first 3 age periods and then increased as most twins left home. When standardized, the heritability of peer-group deviance is approximately 30% at ages 8 to 11 years and rises to approximately 50% across the last 3 time periods. Both genes and shared environment contributed to individual differences in the developmental trajectory of peer-group deviance. However, while the correlation between childhood peer-group deviance levels and the subsequent slope of peer-group deviance over time resulting from genetic factors was positive, the same relationship resulting from shared environmental factors was negative. The authors concluded that as male twins mature and create their own social worlds genetic factors play an increasingly important role in their choice of peers, while shared environment becomes less influential. The individual-specific environment increases in importance when individuals leave home. Individuals who have deviant peers in childhood, as a result of genetic vs shared environmental influences, have distinct developmental trajectories. Understanding the risk factors for peer-group deviance will help clarify the etiology of a range of externalizing psychopathology. Kendler, K., Jacobson, K., Gardner, C., Gillespie, N., Aggen, S., and Prescott, C. Creating a Social World: A Developmental Twin Study of Peer-Group Deviance. Arch. Gen. Psych. 64(8), pp. 958-965, 2007.

The Relationship Between Lifetime Abuse and Suicidal Ideation in a Sample of Injection Drug Users

This study examined the relationship between lifetime abuse and suicidal ideation in a sample of 245 injection drug users who attended the Baltimore Needle Exchange Program and received a referral for opiate agonist therapy. Data were obtained from baseline interviews and HIV antibody tests. The sample mean age was 42.2 (SD = 8.1); 77% were African American; 69% were male. Overall, 27% reported thoughts of suicide in the last six months, and lifetime emotional, physical and sexual abuse was reported by 17%, 12% and 10%, respectively. In bivariate analyses, recent suicidal ideation was associated with emotional (odds ratio [OR] = 3.2; p = 0.001), physical (OR = 2.5; p = 0.026), and sexual abuse (OR = 5.0; p < 0.001). In multiple logistic regression models controlling for HIV status and Center for Epidemiological Studies Depression (CES-D) score, individuals who experienced emotional abuse were more than twice as likely to report recent suicidal ideation (adjusted odds ratio [AOR] = 2.6; p = 0.011); those who experienced sexual abuse were four times more likely to report suicidal ideation (AOR = 4.0; p = 0.004). These findings suggest that emotional and sexual abuse might be risk factors for suicidality among IDUs and also might suggest that suicide prevention should be an integral part of drug treatment for treatment-seeking IDUs. Lloyd, J., Ricketts, E., Havens, J., Cornelius, L., Bishai, D., Huettner, S., Latkin, C., and Strathdee, S. The Relationship Between Lifetime Abuse and Suicidal Ideation in a Sample of Injection Drug Users. J. Psychoactive Drugs, 39(2), pp. 159-166, 2007.

A Twin Study of Delinquent Peer Affiliation

This study used genetic epidemiologic approaches to evaluate whether the association between delinquent peer affiliation and conduct problems may occur because of shared genetic liability. Data came from 553 monozygotic and 558 dizygotic (same sex and opposite sex) twin pairs, over half female, aged 11 to 18 years, recruited from community based samples in Colorado, assessed through self-report for delinquent peer affiliation and conduct problems. The authors investigated whether genes contribute to both delinquent peer affiliation and the correlation between delinquent peer affiliations and conduct problems. Modeling found that delinquent peer affiliation was influenced by genetic, shared environmental and non-shared environmental factors; genetic factors also contributed to the correlation between delinquent peer affiliations and conduct problems, providing evidence for genotype-environment correlation. The magnitude of the genetic variance of conduct problems was contextually dependent on levels of delinquent peer affiliation and was greater at higher levels of delinquent peer affiliation. Thus, this study adds to the growing literature showing that many putative environmental risks for drug abuse correlate with individuals "genotypes". Button, T., Corley, R., Rhee, S., Hewitt, J., Young, S., and Stallings, M. Delinquent Peer Affiliation and Conduct Problems: A Twin Study. J Abnorm. Psychol., 116(3), pp. 554-564, 2007.

ADHD Risk for Heavy Drinking and Alcohol Use Disorder is Age Specific

This study was designed to assess age specificity in the risk for heavy drinking and alcohol use disorder (AUD) among adolescents and young adults with Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosed in childhood. Children diagnosed with ADHD (n=364 probands) were interviewed an average of 8 years later in the Pittsburgh ADHD Longitudinal Study, either as adolescents (11-17 years old) or as young adults (18-28 years of age). Demographically similar age-matched participants without ADHD were recruited as adolescents (n=120) or as adults (n=120) for comparison with the probands. Alcohol involvement was assessed comprehensively to include measures of heavy drinking that are standard in alcoholism research and prognostic of later alcohol-related problems. Results revealed age specificity in the association such that episodic heavy drinking (measured as 5+ drinks per occasion), drunkenness, DSM-IV AUD symptoms, and DSM-IV AUD were elevated among 15- to 17-year-old probands, but not among younger adolescents. Among young adults, drinking quantity and AUD were elevated among probands with antisocial personality disorder. Childhood predictors indexing antisocial behavior were also examined. Authors concluded that the age- specificity of these findings helps to explain prior inconsistencies across previous studies regarding risk for alcohol-related outcomes among children with ADHD. Molina, B., Pelham, W., Gnagy, E., Thompson, A., and Marshal, M. Attention-Deficit/ Hyperactivity Disorder Risk for Heavy Drinking and Alcohol Use Disorder Is Age Specific. Alcohol Clin. Exp. Res., 31(4), pp. 643-654, 2007. Cocaine Use and Educational Achievement: Understanding a Changing Association Authors compared trends in cocaine use over the past 2 decades across levels of education in a population-based US sample of adults. Data from 1979-2002 NHSDA/NSDUH were analyzed to investigate cocaine use and educational achievement among adults 19-50 years old. Investigators found that significant inverse associations between educational achievement and cocaine use after 1990 were driven by dramatic decreases in persistent cocaine use among more highly educated adults, whereas persistent cocaine use remained relatively unchanged among those who did not finish high school. This emerging health disparity highlights the need for improved interventions that target persistent cocaine users with low educational achievement. Harder, V., and Chilcoat, H. Cocaine Use and Educational Achievement: Understanding a Changing Association over the Past 2 Decades. Am J Public Health, 97(10), pp. 1790-1793, 2007.

Conduct and Attentional Problems and Risk for Later SUDs

This paper examines the linkages between conduct problems and attentional problems in middle childhood and adolescence and later substance use, abuse and dependence in young adulthood. Data were gathered over the course of a 25-year longitudinal study of a 1977 birth cohort of 1265 New Zealand born children. These data included: (a) measures of conduct and attentional problems in middle childhood (7-9 years) and adolescence (14-16 years); (b) measures of substance use, abuse and dependence from 18-25 years; and (c) confounding social, family and related factors. Statistical modeling produced a consistent set of results showing: (i) conduct problems in childhood and adolescence were generally related to later substance use, abuse and dependence even after control for attentional problems and confounders; (ii) attentional problems were largely unrelated to later substance use, abuse and dependence after control for conduct problems and confounders. The authors conclude that conduct problems in both middle childhood and adolescence are related to increased risks of longer-term substance use, abuse and dependence, and that any association between early attentional problems and later substance use, abuse and dependence is largely mediated via the association between conduct and attentional problems. This paper joins a growing literature on population-based samples studied longitudinally which finds that attentional problems in the absence of other disruptive behavior problems (including conduct disorder) does not confer increased risk for substance use problems. Fergusson, D., Horwood, L., and Ridder, E. Conduct and Attentional Problems in Childhood and Adolescence and Later Substance Use, Abuse and Dependence: Results of a 25-Year Longitudinal Study. Drug Alcohol Depend, 88 Suppl 1 (N/A), pp. S14-S26, 2007.

Family Study of Bipolar and Substance Use Disorders

This study follows up on previous findings that juvenile bipolar disorder (BPD) is a risk for substance use disorders (SUD), by examining the expression of both disorders in families of youth with BPD to evaluate the familial risk mechanism. Data were gathered from 108 adolescent BPD probands with 187 parents (34 with SUD and 58 parents) and 96 control probands with 177 parents using structured interviews. They compared the prevalence of BPD and SUD with Cox proportional hazards models with time to onset of BPD or SUD as the dependent variable and proband diagnosis (Control, BPD, or BPD+SUD) as the independent variable. The parents of the proband youth with BPD (without SUD) and BPD+SUD were more likely to develop BPD than the parents of control subjects [omnibus test chi2=10.18, p=.006]; no differences were found between the two bipolar groups. Parents of proband youth with BPD and with BPD+SUD were more likely than relatives of control subjects to develop SUD [omnibus test chi2=14.69, p<.001]; however, no differences between the parents of the two proband bipolar groups were found. Within the parents of proband youth with BPD+SUD, higher risk of SUD was found in parents with BPD than in those without BPD [chi2=8.39, p=.004], although the frequency of BPD was low in this group of parents. The authors conclude that bipolar disorder and SUD are prevalent in the first-degree relatives of adolescents with BPD, and that adults with BPD were more likely to manifest SUD with preliminary evidence of BPD and SUD co segregation. Wilens, T., Biederman, J., Adamson, J., Monuteaux, M., Henin, A., Sgambati, S., Santry, A., and Faraone, S. Association of Bipolar and Substance Use Disorders in Parents of Adolescents with Bipolar Disorder. Biol. Psychiatry, 62(2), pp. 129-134, 2007.

Prevalence of Illicit Use and Abuse of Prescription Stimulants, Alcohol, and Other Drugs among College Students: Relationship with Age at Initiation of Prescription Stimulants

This study examined associations between age at initiation of prescription stimulants and illicit use and abuse of prescription stimulants, alcohol, and other drugs among college students in the United States. Data were collected through a web-based survey of college students attending a large university. The web-based survey was sent to a random sample of 5389 undergraduate college students plus an additional 1,530 undergraduate college student's of various ethnic backgrounds over a 2-month period. Alcohol abuse was assessed by including a modified version of the Cut Down, Annoyance, Guilt, Eye-opener (CAGE) instrument. Drug use-related problems were assessed with a slightly modified version of the Drug Abuse Screening Test, short form (DAST-10). The final sample consisted of 4580 undergraduate students (66% response rate). For the analyses, five subgroups were created based on age at initiation of prescription stimulant use: no prescription stimulant use, grades kindergarten (K)-4, grades 5-8, grades 9-12, and college. Undergraduate students to whom stimulants were prescribed in grades K-4 reported similar rates of alcohol and other drug use compared with that of the group that had no prescription stimulant use. For example, students who started prescription stimulants in grades K-4 were no more likely to report co-ingestion of alcohol and illicit prescription stimulants (odds ratio [OR] 1.4, 95% confidence interval [CI] 0.2-11.5, NS] than the group that had no prescription stimulant use. However, undergraduate students whose prescription stimulant use began in college had significantly higher rates of alcohol and other drug use. For example, students who started a prescription stimulant in college were almost 4 times as likely (OR 3.7, 95% CI 1.9-7.1, p<0.001) to report at least three positive indicators of drug abuse on the DAST-10 compared with the group that had no prescription stimulant use. These results indicate that initiation of prescription stimulants during childhood is not associated with increased future use of alcohol and other drugs. Kaloyanides, K., McCabe, S., Cranford, J., and Teter, C. Prevalence of Illicit Use and Abuse of Prescription Stimulants, Alcohol, and Other Drugs among College Students: Relationship with Age at Initiation of Prescription Stimulants. Pharmacotherapy, 27(5), pp. 666-674, 2007.

Methodological Issues in Assessing Cannabis Dependence in Community Surveys

The researchers probed issues relating to classification of drug dependence in epidemiologic studies with respect to cannabis dependence, making use of data from the cross-sectional United States National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a household survey of 43,093 adults aged 18 years and over. Specifically, they simulated a social impairment/ maladaptation ''gated '' assessment of cannabis dependence, and the end result was a very modest reduction in the estimated prevalence of cannabis dependence. This suggests that for every 10,000 general population survey respondents there would be no more than 12 cases of cannabis dependence without the above-referenced impairments/maladaptations. Patterns of association linking suspected background characteristics to the prevalence of cannabis dependence were not appreciably different when the ''gated '' and ''ungated '' approaches were applied. In summary, there are reasons to take the ungated approach in detailed research on cannabis use and dependence. Nevertheless, in panoramic mental health surveys, the inefficiency of an ''ungated '' approach must be balanced against the anticipated yield of cannabis dependence cases who lack social role impairments or socially maladaptive behaviors'. Degenhardt, L., Cheng, H., and Anthony, J. Assessing Cannabis Dependence in Community Surveys: Methodological Issues. Int. J. Methods Psychiatr. Res., 16(2), pp. 43-51, 2007.

Externalizing Symptoms Among Children of Alcoholic Parents: Entry Points for an Antisocial Pathway to Alcoholism

The authors examined heterogeneity in risk for externalizing symptoms in children of alcoholic parents (COA), as it may inform the search for entry points into an antisocial pathway to alcoholism. That is, they tested whether the number of alcoholic parents in a family, the comorbid subtype of parental alcoholism, and the gender of the child predicted trajectories of externalizing symptoms over the early life course, as assessed in high-risk samples of children of alcoholic parents and matched controls. Data from the Michigan Longitudinal Study provided 596 children from 338 families, and Adolescent/Adult Family Development Project 454 adolescents and their parents, both with COA and matched controls assessed over multiple waves. Through integrative analyses of these independent, longitudinal studies, they showed that children with either an antisocial alcoholic parent or 2 alcoholic parents were at greatest risk for externalizing symptoms. Moreover, children with a depressed alcoholic parent did not differ from those with an antisocial alcoholic parent in reported symptoms. These findings were generally consistent across mother, father, and adolescent reports of symptoms; child gender and child age (ages 2-17); and the 2 independent studies examined. Multi-alcoholic and comorbid-alcoholic families may thus convey a genetic susceptibility to dysregulation along with environments that both exacerbate this susceptibility and provide few supports to offset it. Hussong, A., Wirth, R., Edwards, M., Curran, P., Chassin, L., and Zucker, R. Externalizing Symptoms Among Children of Alcoholic Parents: Entry Points for An Antisocial Pathway to Alcoholism. J.Abnorm. Psychol.,116, pp. 529-542, 2007.

Social Capital or Networks, Negotiations, and Norms? A Neighborhood Case Study

"Social capital" has been critiqued as distracting attention from inequalities and policies that produce ill health. Researchers examined another dimension often included in the concept of social capital--social network ties and their associated communication patterns. They present a case study of Bushwick, a community of 100,000 people in Brooklyn NY, to suggest that the network aspect of "social capital" is useful to understand the active, on-the-ground processes by which residents of some neighborhoods beset by poverty, racial/ethnic subordination, and internal divisions (that themselves arise from inequalities and state policies) work out ways to defend their own and others' safety and health. They use a combination of population-representative survey data for young adults; sexual network survey data; and ethnography to show that Bushwick residents (including drug users and dealers) have used social network ties, communication, and normative pressures to reduce the extent to which they are put at risk by the drug trade and by drug-use-related HIV/AIDS in spite of conflicting interests, disparate values, and widespread distrust both of other community members and of dominant social institutions. This was done by "intravention" health communications, development of protective norms, informal negotiations, and other forms of adjustments within and among various groups--but it occurred in the absence of trust or consensus in this community. The findings suggest both (1) that social network interpretations of "social capital" might be better conceptualized in dialectic terms as collective action to survive in a harsh social order, and (2) that the social capital theory emphasis on trust and consensus as important causal factors for lowering drug-related risks at the community level may be a romanticized and erroneous perspective. Friedman, S., Mateu-Gelabert, P., Curtis, R., Maslow, C., Bolyard, M., Sandoval, M., and Flom, P. Social Capital or Networks, Negotiations, and Norms? A Neighborhood Case Study. Am. J. Prev. Med., 32(6 Suppl), pp. S160-S170, 2007.

Marijuana Use Patterns Among African-American Middle-School Students: A Longitudinal Latent Class Regression Analysis

Authors sought to describe patterns of marijuana involvement during the middle-school years from the first chance to try marijuana down through the early stages of experiencing health and social problems from marijuana use in a sample of African-American adolescents. A total of 488 urban-dwelling African-American middle-school students were interviewed in sixth, seventh and eighth grades as part of a longitudinal field study. Longitudinal latent class models were used to identify subgroups (classes) of adolescents with similar patterns of marijuana involvement. Three classes were identified; little or no involvement (prevalence 85%, 71%, 55% in sixth, seventh and eighth grade, respectively), marijuana exposure opportunity (12%, 19% and 26%), and marijuana use and problems (2%, 9% and 19%). High levels of aggressive/ disruptive behavior exhibited as early as first grade and moderate to high levels of deviant peer affiliation were associated with an increased risk of marijuana exposure opportunities in middle-school. Moderate to high levels of aggressive/disruptive behavior and deviant peer affiliation, moderate to low levels of parent monitoring and high levels of perceived neighborhood disadvantage were associated with an increased risk of marijuana use and problems. Significant interactions with grade provided evidence that the influences of parent monitoring and neighborhood disadvantage decrease through the middle-school years. Although not statistically significant, the magnitude of the effects of deviant peer affiliation on marijuana use and problems increased two-fold from sixth to eighth grade. These findings highlight the importance of marijuana exposure opportunities in the pathway to marijuana use and problems and the potential to intervene on behaviors exhibited as early as first grade. It also underscores the importance of developing interventions that are sensitive to the strong influence of parents at entry into middle-school and the shift to peer influences by the end of middle-school. Reboussin, B., Hubbard, S., and Ialongo, N. Marijuana Use Patterns Among African-American Middle-School Students: A Longitudinal Latent Class Regression Analysis. Drug Alcohol Depend., 90(1), pp. 12-24, 2007.

Direct and Indirect Associations of Neighborhood Disorder with Drug Use and High-Risk Sexual Partners

On a macrosocial level, neighborhood characteristics have been found to be associated with the prevalence of HIV and other blood borne and sexually transmitted infections. The current study used structural equation modeling to examine the relationship between neighborhood social and physical disorder and high-risk sexual partners. A cohort (N=838) recruited for an HIV prevention study of drug users in Baltimore, Maryland was interviewed about their neighborhood characteristics, drug use, depressive symptoms (using the Centers for Epidemiological Studies Depression Scale), and HIV/sexually transmitted infection risk behaviors of exchanging sex for money or drugs, having multiple sexual partners, and having partners who injected drugs or smoked crack cocaine. Data were analyzed in 2/2005, with models indicating statistically significant direct associations between neighborhood disorder and psychologic distress, neighborhood disorder and sexual risk behaviors, and neighborhood disorder and drug use. There were also significant indirect associations of neighborhood disorder on sexual risk behaviors. These results highlight the importance of viewing drug use, chronic stress, depression and hopelessness, and infectious diseases such as HIV and hepatitis C as interlinked epidemics that are fostered by neighborhood social and physical disorder. Neighborhood, network, and community level interventions are needed to address these intertwined public health issues. Latkin, C., Curry, A., Hua, W., and Davey, M. Direct and Indirect Associations of Neighborhood Disorder with Drug Use and High-Risk Sexual Partners. Am. J. Prev. Med., 32(6 Suppl), pp. S234-S241, 2007.

Neighborhood Socioeconomic Status, Personal Network Attributes, and Use of Heroin and Cocaine

Drug abuse is a significant public health problem and is associated with numerous negative health and social consequences. Examining the social context of drug use represents a burgeoning avenue of research in drug abuse. This study investigates the effects of neighborhood disadvantage and network factors on current heroin and cocaine use among a predominantly African-American adult sample residing in Baltimore City. It employs a cross-sectional, multilevel design using data from two sources: the SHIELD Study, a network-oriented HIV intervention in Baltimore City and the 1990 U.S. Decennial Census. The sample consisted of 1305 adults from 249 neighborhoods (census block groups) across Baltimore City. Multilevel logistic regression analysis was performed to examine personal network and neighborhood effects on current heroin and cocaine use. Neighborhood poverty was found to be significantly associated with current heroin and cocaine use (odds ratio [OR]=1.51, confidence interval [CI]=1.06-2.15). Social support (OR=0.80, CI=0.69-0.92) and having ties to employed people (OR=0.47, CI=0.24-0.92) were protective of current drug use, but did not buffer negative effects of neighborhood poverty in the face of negative drug influences in the network (OR=8.62, CI=5.81-12.79). The contexts of neighborhoods and networks represent key determinants in understanding the social epidemiology of drug abuse. Network attributes have strong influences on drug use, and neighborhood poverty may increase odds of use. Further research is warranted to determine other aspects of neighborhood environments that may put individuals at risk for drug use and abuse. Williams, C., and Latkin, C. Neighborhood Socioeconomic Status, Personal Network Attributes, and Use of Heroin and Cocaine. Am J Prev Med, 32(6 Suppl), pp. S203-S210, 2007.

Methamphetamine Use and Risky Sexual Behaviors During Heterosexual Encounters

This study examined the association between event-level methamphetamine use and heterosexual risk behaviors. Data on 1213 heterosexual encounters were collected using audio-computer assisted self interviews from 703 injecting drug users in North Carolina. Data were obtained by asking participants a series of questions about the last time that they had sex. Although participants were interviewed at up to 3 time points, data were analyzed at the event level rather than as longitudinal because the interest was in the co-occurrence of methamphetamine use and sexual risk behaviors. Multivariate generalized estimating equations models were developed to examine the association between co-occurring methamphetamine use and each of 6 heterosexual risk behaviors. Methamphetamine was used in 7% of encounters. Methamphetamine use by either or both partners was associated with an increased likelihood of anal intercourse (odds ratio [OR] = 2.41, 95% confidence interval [CI] = 1.29-4.53), vaginal and anal intercourse (OR = 2.41, 95% CI = 1.22-4.77), and sex with a new partner (OR = 1.98, 95% CI = 1.09-3.61). In addition to these behaviors, methamphetamine use by both partners was also significantly associated with unprotected intercourse with a new partner (OR = 5.20, 95% CI = 2.09-12.93) and unprotected anal intercourse (OR = 4.63, 95% CI = 1.69-12.70). These findings underscore the influential role of methamphetamine use on increasing sexual risk-taking, especially when both partners are using it. Zule, W., Costenbader, E., Meyer, W., and Wechsberg, W. Methamphetamine Use and Risky Sexual Behaviors During Heterosexual Encounters. Sex Transm. Dis., 34(9), pp. 689-694, 2007.

Personality Disorders in Early Adolescence and the Development of Later Substance Use Disorders in the General Population

Assessments of personality disorder (PD) and conduct disorder (CD) in a random community sample at mean age 13 were employed to predict subsequent substance abuse disorder (SUD), trajectories of symptoms of abuse or dependence on alcohol, marijuana, or other illicit substances, and hazard of initiating marijuana use over the subsequent decade. Personality disorders and conduct disorder were associated with diagnoses and symptoms of SUDs in every model and their effects were independent of correlated family risks, participant sex, and other Axis I disorders. Specific elevated PD symptoms in early adolescence were also associated with differential trajectories of already initiated SUD symptoms as well as elevated risk for future onset of SUD symptoms. For several models the greatest of these effects were shown for borderline PD and for conduct disorder, the predecessor of adult antisocial PD. Passive-aggressive PD also showed independent elevation effects on substance use symptoms for alcohol and marijuana. Analyses over 30 years suggest that Cluster B PD (borderline, histrionic, narcissistic) are independent risks for development of SUD and warrant clinical attention. Cohen, P., Chen, H., Crawford, T., Brook, J., and Gordon, K. Personality Disorders in Early Adolescence and the Development of Later Substance Use Disorders in The General Population. Drug Alcohol Depend., 88 Suppl 1, pp. S71-S84, 2007.

Psychosocial Functioning after Adolescent SUD

The authors examined whether substance use disorder (SUD) before age 19 was associated with functioning at age 30. Participants (N = 773, about 60% female) came from a sample initially drawn randomly from representative high school samples in urban and rural western Oregon. They were assessed twice during adolescence at average ages of 16 and 17, and again at ages 24 and 30. The authors found that eight of 14 adult measures were associated with adolescent SUD: education, unemployment, income, risky sexual behavior, suicide attempt, coping, stressful life events, and global adjustment. After adolescent comorbidity and functioning and adult SUD were controlled for, education and unemployment remained associated with adolescent SUD diagnoses, and three variables emerged as significant: being a parent (significant only for participants without adult SUD), being currently married, and having decreased life satisfaction (significant only for participants with adult SUD). The authors do not postulate a causal relationship between adolescent SUD and these numerous functioning difficulties at age 30; some appear to be related to recurrent SUD, comorbid adolescent disorders, or functioning problems already evident in adolescence. Moreover, either pre-existing conditions or the neurotoxic effects of drugs in adolescence could contribute to the subsequent educational and employment problems observed. Nonetheless, further explication of these relationships may point to opportunities for intervention with substance-abusing adolescents and young adults. Rohde, P., Lewinsohn, P., Seeley, J., Klein, D., Andrews, J., and Small, J. Psychosocial Functioning of Adults Who Experienced Substance Use Disorders as Adolescents. Psychol. Addict. Behav., 21(2), pp. 155-164, 2007.

Developmental Trajectory Classes for SUD

This study sought to explicate factors underlying the tendency for neurobehavioral disinhibition to predict substance use disorders. Data were drawn from a longitudinal study of boys from ages 10-12 to 22 years studied by the Center for Education and Drug Abuse Research. Neurobehavior disinhibition, parental SUD, socioeconomic status, and affiliation with deviant peers were measured at baseline. Approval of socially non-normative behavior was measured at ages 10-12, 12-14, 16, and 19 years. Three trajectory classes culminating in substance use disorder (SUD) were discerned. Two high-risk trajectories, indicated by increasing approval of antisociality and progressive social maladjustment during adolescence (SUD rate = 72.7%) and stable high level of disturbance (SUD rate = 85%), were identified. Individual characteristics (neurobehavior disinhibition) in conjunction with contextual factors (low socioeconomic status, parental SUD, affiliation with deviant friends) promote approval of antisociality during adolescence and a high rate of SUD by young adulthood. Kirisci, L., Tarter, R., Mezzich, A., and Vanyukov, M. Developmental Trajectory Classes in Substance Use Disorder Etiology. Psychol. Addict. Behav. 21(3), pp. 287-296, 2007.

Self-Medication in Individuals with ADHD

Studies report increased rates of cigarette and substance use in youths with Attention-Deficit/Hyperactivity Disorder (ADHD), though the mechanism of risk remains unclear. The present study tests the hypothesis that ADHD individuals "self-medicate" with cigarettes and substances of abuse. As part of five- and ten-year case-control longitudinal family studies of ADHD, responses to the Drug Use Screening Inventory (DUSI) were examined for evidence of self-medication. DUSI data were obtained from 90 ADHD probands (58% male) and 96 control probands (52% male), all between ages 15 and 25. Thirty-six percent of subjects reported self-medication, 25% used to get high, and 39% had unknown motivation. No significant differences were found between ADHD and controls in motivation. ADHD symptoms did not differ between self-medicators and subjects using to get high. DUSI problem scores were higher in ADHD (versus controls), those using to get high (versus self-medicators), and subjects using alcohol (versus other substances). More than one-third of adolescents and young adults endorsed using cigarettes and substances for self medication. The authors urge more studies to clarify the role of self-medication in substance use disorders. Wilens, T., Adamson, J., Sgambati, S., Whitley, J., Santry, A., Monuteaux, M., and Biederman, J. Do Individuals with ADHD Self-Medicate with Cigarettes and Substances of Abuse? Results from a Controlled Family Study of ADHD. Am. J. Addict., 16 Suppl 1, pp. 14-21, 2007.

State Anti-Tobacco Advertising and Smoking Outcomes by Gender and Race/Ethnicity

Investigators examined overall and gender- and racial/ethnic-specific relationships between exposure to state-sponsored anti-tobacco televised advertising and smoking-related outcomes among US middle and high school students using five years of cross-sectional nationally representative data. Nationally representative 8th, 10th, and 12th grade student sample data for 1999-2003 were merged with commercial ratings data on mean potential audience exposure to network and cable television anti-tobacco advertising across the 74 largest US designated market areas, resulting in a final sample size for analysis of 122,340. Associations between state-sponsored anti-tobacco televised advertising exposure and youth smoking-related beliefs and behaviors' were modeled while controlling for relevant individual and environmental factors as well as other televised tobacco-related advertising. Authors found higher potential for exposure to state anti-tobacco advertising within the previous four months was generally associated with decreasing odds of current smoking across groups. In addition, such exposure was related, to varying degrees, with decreased perceptions that most/all friends smoked, stronger five-year intentions not to smoke, and increased perceived harm of smoking. These relationships appeared possibly to be weaker for Asian students. The results from these analyses indicate that state anti-tobacco advertising significantly relates to beneficial outcomes -- especially regarding current smoking behaviour -- among US youth as a whole. Terry-McElrath, Y., Wakefield, M., Emery, S., Saffer, H., Szczypka, G., O 'Malley, P., Johnston, L., Chaloupka, F., and Flay, B. State Anti-tobacco Advertising and Smoking Outcomes by Gender and Race/ethnicity. Ethn. Health, 12(4), pp. 339-362, 2007.

Case Ascertainment of Alcohol Dependence in General Population Surveys

Similar to their report on case ascertainment of cannabis dependence, the authors focus this analysis on alcohol dependence, and issues surrounding methods of classification, making use of data from the cross-sectional US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a household survey with 44,093 adult participants. NESARC alcohol dependence assessments were ''ungated '', but allowed simulation of a ''gated '' approach; the end result was a robust decrement in the estimated prevalence of this condition. Nonetheless, patterns of association linking suspected background characteristics to prevalence of alcohol dependence were not appreciably different when the gated and ungated estimates were contrasted. Authors concluded while there are reasons to take the ungated approach in detailed research on alcohol use and dependence, in panoramic mental health surveys the inefficiency of an ungated approach must be balanced against the anticipated yield of cases who have experienced alcohol dependence without alcohol related social role impairments or other maladaptation, particularly when the dependence syndromes without these consequences are sometimes thought to lack clinical significance. Degenhardt, L., Bohnert, K., and Anthony, J. Case as Certainment of Alcohol Dependence in General Population Surveys: 'Gated ' Versus 'Ungated ' Approaches. Int. J. Methods Psychiatr. Res., 16(3), pp. 111-123, 2007.

Nationwide Increase in the Number of Hospitalizations for Illicit Injection Drug Use-Related Infective Endocarditis

Infective endocarditis is a potentially fatal consequence of illicit injection drug use. Researchers examined survey data and estimated that the number of hospitalizations for injection drug use-related infective endocarditis increased by 38%-66% in the United States between 2000-2001 and 2002-2003, a period during which the number of at-risk persons (i.e., injection drug users) remained stable. They interpret these findings to suggest that increasing methamphetamine use and/or drug injection frequency may have increased the incidence of infective endocarditis among active injection drug users. Cooper, H., Brady, J., Ciccarone, D., Tempalski, B., Gostnell, K., and Friedman, S. Nationwide Increase in the Number of Hospitalizations for Illicit Injection Drug Use-Related Infective Endocarditis. Clin. Infect. Dis., 45(9), pp. 1200-1203, 2007.

Perceptions of Financial Payment for Research Participation among African-American Drug Users in HIV Studies

Financial compensation for participating in research is controversial, especially when participants are recruited from economically disadvantaged and/or marginalized populations such as drug users. Little is known about these participants' own views regarding payment for research participation. The objective of the study was to elicit underserved minority drug users' views about monetary payments for participating in research. Semi-structured in-depth interviews about motivations for and perceptions of participation in research were conducted among 37 adult, economically disadvantaged African-American crack cocaine smokers. Participants were recruited from among those taking part in three HIV prevention studies. Interviews were conducted at one of 2 research field offices located in underserved minority neighborhoods in Houston, Texas. Interviews lasting 30-45 min were recorded, transcribed, coded, and analyzed for categories and themes using both conventional and directed qualitative content analysis. The study found that participants viewed monetary payment for research as essential to attract participation and desirable to provide optional income. Payment for research participation was perceived as one potential income source among others. Participants considered self-determination a prerogative for themselves and others. They rejected the notion of payment for participation as encouraging drug use or as inducing risk taking. Researchers should be aware of participants' views of their desires and capacity for autonomous decisions about financial compensation for research. Payment for research participation appears to be part of the "informal economy" that has been observed in underserved communities. Slomka, J., McCurdy, S., Ratliff, E., Timpson, S., and Williams, M. Perceptions of Financial Payment for Research Participation among African-American Drug Users in HIV Studies. J. Gen. Intern. Med., 22(10), pp. 1403-1409, 2007.

Gender Differences in Social Network Influence among Injection Drug Users: Perceived Norms and Needle Sharing

Whereas substantial research has linked perceived norms and HIV sexual risk behavior, less attention has been given to the relationship between perceived norms and injection drug practices. This study investigated the relationship between needle sharing and perceived norms in a sample of injection drug users. Data were collected through face-to-face interviews with 684 injectors from the STEP Into Action (STEP) project in Baltimore, Maryland. Logistic regression was used to assess the associations between perceived norms (descriptive and injunctive norms) and needle sharing. Results were stratified by gender. Descriptive norms were significantly related to needle sharing among males (AOR = 1.58, 95%CI = 1.20-2.40) and females (AOR = 1.78; 95%CI = 1.24-2.55). Whereas injunctive norms were significantly associated with needle sharing among men (AOR = 1.30 95%CI = 1.05-1.61), this association was not significant among women (AOR = 0.99; 95%CI = 0.74-1.31). These findings suggest the utility of peer education interventions that promote norms regarding risk reduction among injection drug users. The data also provide support for gender-specific HIV prevention interventions. Davey-Rothwell, M., and Latkin, C. Gender Differences in Social Network Influence among Injection Drug Users: Perceived Norms and Needle Sharing. J. Urban Health, 84(5), pp. 691-703, 2007.

HCV Synthesis Project: Preliminary Analyses of HCV Prevalence in Relation to Age and Duration of Injection

Early acquisition of hepatitis C virus (HCV) infection appears to affect a substantial proportion of IDUs--between 20 percent and 90 percent. Analyzing the range of HCV prevalence estimates in new injectors may help identify factors that can be modified to reduce HCV transmission. The HCV Synthesis Project is a meta-analysis of studies of HCV epidemiology and prevention in drug users worldwide. In this preliminary analysis, researchers examined data from 127 studies of IDUs that reported HCV prevalence in relation to age or year since onset of drug injection, analyzing heterogeneity and calculating summary statistics where appropriate. Six studies reported gender-specific HCV prevalence rates among young or new injectors; the group mean prevalence was 47 percent for men and 44 percent for women (NS). Group mean age for HCV-negatives was 24.7 years (range 24-28) and 26.1 years (range 21-31) for HCV-positives (n=8 studies). Data were examined from 13 studies that compared HCV prevalence among young injectors to older injectors using 5-year age categories; substantial variation was present within these categories such that measures of central tendency were not calculated. Similarly, among studies reporting HCV prevalence among IDUs in relation to 1-year intervals of duration of injection (<1 year, <2 years, and <3 years), considerable variability was observed. Notably, there were studies in each category that reported prevalence of 70 percent or higher among recent-onset drug injectors. These findings confirm previous studies reporting high risk of acquiring HCV shortly after onset of injection; thus, HCV prevention programmes must emphasize methods to reach new injectors. Future research should (1) report data on time to infection in depth, (2) provide detailed information on study methodology, and (3) characterize the research setting with respect to underlying factors that affect injection practices and networks. This will permit synthesis of a greater number of studies and may lead to the identification of factors that impede HCV transmission. Hagan, H., Des Jarlais, D., Stern, R., Lelutiu-Weinberger, C., Scheinmann, R., Strauss, S., and Flom, P. HCV Synthesis Project: Preliminary Analyses of HCV Prevalence in Relation to Age and Duration of Injection. Int. J. Drug Policy, 18(5), pp. 341-351, 2007.

Developing the Diagnostic and Statistical Manual V: Statistics and Nosology

This report describes the developments resulting from a Launch and Methodology Conference hosted by the American Psychiatric Institute for Research and Education (APIRE) to discuss the role statistics might play in the eventual revision of the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the Ninth Edition of the International Classification of Diseases (ICD9). The conference consisted of talks on specific topics by statisticians and epidemiologists from North America and Great Britain, followed by group discussion by experts in nosology and psychopathology. Specific themes related to the future interaction between statisticians and nosologists in DSM-V development arose as a result of that meeting, such as (1) the nature of the statistician/nosologist interaction; (2) specific areas of concern in that interaction, and (3) the use of novel and complex statistical methods to challenge and inspire new avenues of thinking among nosologists. Both disciplines are recognized for their expertise and necessity in this process of attempting to accurately capture the nature of disorder, and respond to the needs and experience of clinicians and patients, and authors note that communication between nosologists and statisticians should start early and continue throughout the revision process. Kraemer, H., Shrout, P., and Rubio-Stipec, M. Developing The Diagnostic and Statistical Manual V: What Will. Soc. Psychiatry Psychiatr. Epidemiol., 42(4), pp. 259-267, 2007.

Rate of Methadone Use among Aboriginal Opioid Injection Drug Users

Previous studies have shown elevated rates of health-related harms among Aboriginal people who use injection drugs such as heroin. Methadone maintenance therapy is a potentially effective intervention to address the harms of heroin injection. This study assessed the rate of methadone use in a cohort of opioid injection drug users in Vancouver and investigated whether methadone use was associated with Aboriginal ethnic background. Using data collected as part of the Vancouver Injection Drug Users Study (May 1996-November 2005), researchers evaluated whether Aboriginal ethnic background was associated with methadone use using generalized estimating equations and Cox regression analysis. They compared methadone use among Aboriginal and non-Aboriginal injection drug users at the time of enrollment and during the follow-up period, and evaluated the time to first methadone use among people not using methadone at enrollment. During the study period, 1603 injection drug users (435 Aboriginal, 1168 non-Aboriginal) were recruited. At enrollment, 54 (12.4%) Aboriginal participants used methadone compared with 247 (21.2%) non-Aboriginal participants (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.38-0.73, p < 0.001). Among the 1351 (84.3%) participants who used heroin, Aboriginal people were less likely to use methadone throughout the follow-up period (adjusted OR 0.60, 95% CI 0.45-0.81, p < 0.001). Among people using heroin but who were not taking methadone at enrollment, Aboriginal ethnic background was associated with increased time to first methadone use (adjusted relative hazard 0.60, 95% CI 0.49-0.74, p < 0.001). Methadone use was lower among Aboriginal than among non-Aboriginal injection drug users. Culturally appropriate interventions with full participation of the affected community are required to address this disparity. Wood, E., Montaner, J., Li, K., Barney, L., Tyndall, M., and Kerr, T. Rate of Methadone Use Among Aboriginal Opioid Injection Drug Users. CMAJ, 177(1), pp. 37-40, 2007.

Attention-Deficit Hyperactivity Disorder Moderates the Life Stress Pathway to Alcohol Problems in Children of Alcoholics

Parent alcoholism is a well-established risk factor for the development of pathological alcohol involvement in youth, and life stress is considered to be one of the central mechanisms of the parent alcoholism effect; however, little is known about the moderators of the life stress pathway. Attention-deficit hyperactivity disorder (ADHD) has also been shown to predict pathological alcohol involvement, however, little is known about whether or not ADHD interacts with parent alcoholism to increase offspring risk. The goals of this study were to examine stressful life events as mediators of the relationship between parent alcoholism and adolescent pathological alcohol involvement, and to examine whether or not this mediated pathway was stronger for adolescents with ADHD than for adolescents without ADHD. Participants were 142 adolescents with a childhood ADHD diagnosis (probands) and 100 demographically matched control adolescents without childhood ADHD. Probands, controls, and at least 1 parent were interviewed about drinking behavior; probands and controls were interviewed about negative life events. A moderated mediation paradigm was used to test the hypotheses using ordinary least squares regression. Results showed that the relationships between parent alcoholism and 2 of the stress variables ("family" stress and "peer" stress) were significant for probands only, and that stress in the probands mediated the parent alcoholism effect on offspring alcohol involvement. These results provide preliminary support for the hypothesis that offspring characteristics might moderate the life stress pathway to alcoholism, and indicate that ADHD may serve to facilitate the transmission of pathological alcohol use from parent to child. Marshal, M., Molina, B., Pelham, W., and Cheong, J. Attention-Deficit Hyperactivity Disorder Moderates the Life Stress Pathway to Alcohol Problems in Children of Alcoholics. Alcohol Clin. Exp. Res., 31(4), pp. 564-574, 2007.

Childhood Neurobehavior Disinhibition Amplifies the Risk of Substance Use Disorder: Interaction of Parental History and Prenatal Alcohol Exposure

Authors examined the influence of parental substance use disorder (SUD) and mother ''s alcohol consumption during pregnancy on neurobehavior disinhibition (ND) measured in 284 10- to 12-year-old boys. The extent to which ND predicted SUD outcome 7 to 9 years later was also determined. SUD was documented in each parent and as the outcome variable in their 19-year-old sons. Average daily alcohol consumption during the mother's pregnancy was recorded using a structured interview. ND was assessed using indicators of behavior under control, affect modulation and executive cognitive functions. Authors found paternal SUD and the interaction between maternal SUD and alcohol consumption during pregnancy predicted child's ND score. ND at 10 to 12 years of age was a significant predictor of SUD at age 19. Authors concluded that the disinhibitory disturbance associated with risk of SUD has both transmissible and teratogenic causes. Chapman, K., Tarter, R., Kirisci, L., and Cornelius, M. Childhood Neurobehavior Disinhibition Amplifies the Risk of Substance Use Disorder: Interaction of Parental History and Prenatal Alcohol Exposure. J. Dev. Behav. Pediatr., 28(3), pp. 219-224, 2007.

Modeling the Pathways Linking Childhood Hyperactivity and Substance Use Disorder in Young Adulthood

Authors modeled direct and mediated pathways linking childhood hyperactivity and substance use disorder (SUD). Boys (n = 112) were administered the revised Drug Use Screening Inventory at age 12-14 years and the Structured Clinical Interview for DSM-IV at age 22 years. Six newly derived scales having established heritability were conceptually organized into internalizing and externalizing pathways to SUD emanating from childhood hyperactivity. Authors found hyperactivity directly predicts SUD. Neuroticism, conduct problems, and their respective manifestations of social withdrawal and school problems mediated the association between hyperactivity and SUD. Hyperactivity also predicted neuroticism that, in turn, predicted low self-esteem leading to social withdrawal and SUD. These results indicate that hyperactivity is a diathesis for both internalizing and externalizing disturbances that, in turn, portend differential expression of psychosocial maladjustment presaging SUD. Tarter, R., Kirisci, L., Feske, U., and Vanyukov, M. Modeling the Pathways Linking Childhood Hyperactivity and Substance Use Disorder in Young Adulthood. Psychol. Addict. Behav., 21(2), pp. 266-271, 2007.

Impact of Prenatal Cocaine Exposure on Attention and Response Inhibition

Authors examined the influence of prenatal cocaine exposure on attention and response inhibition measured by continuous performance tests (CPTs) at ages 5 and 7 years. The baseline sample consisted of 253 cocaine-exposed and 223 non-cocaine-exposed children enrolled prospectively at birth and assessed comprehensively through age 7 years in the longitudinal Miami Prenatal Cocaine Study. This report includes a sub sample of 415 children (219 cocaine-exposed, 196 non-cocaine-exposed) who completed at least one CPT assessment at ages 5 and/or 7 years. Prenatal cocaine exposure was measured by maternal self-report and maternal and infant bioassays. Deficits in attention and response inhibition are estimated in relation to prenatal cocaine exposure using generalized estimating equations within the general linear model. Results indicate cocaine-associated increases in omission errors at ages 5 and 7 as well as increases in response times for target tasks (i.e., slower reaction times) and decreased consistency in performance at age 7. There were no demonstrable cocaine-associated deficits in commission errors. Estimates did not change markedly with statistical adjustment for selected prenatal and postnatal covariates. Evidence supports cocaine-associated deficits in attention processing through age 7 years. Accornero, V., Amado, A., Morrow, C., Xue, L., Anthony, J., and Bandstra, E. Impact of Prenatal Cocaine Exposure on Attention and Response Inhibition as Assessed by Continuous Performance Tests. J. Dev. Behav. Pediatr., 28(3), pp. 195-205, 2007.

Building Path Diagrams for Multilevel Models

The authors propose a path diagramming approach for multilevel models that seeks to provide a formal structure for deriving the underlying equations as well as provide a mechanism for clearly and efficiently communicating the model structure, assumptions, and empirical results. The authors begin with a description of the core components of their proposed diagramming system and establish tracing rules for the direct derivation of model equations, then demonstrate their approach using several published empirical multilevel applications. The authors conclude that these path diagrams can be expanded logically to incorporate cross-classified structures, multivariate models for multiple outcome variables, and multilevel models with mediating pathways as areas for future research. Curran, P., and Bauer, D. Building Path Diagrams for Multilevel Models. Psychol. Methods, 12(3), pp. 283-297, 2007.

Interval and Clinical Cohort Studies: Epidemiological Issues

Cohort studies based upon clinic populations and medical records are becoming more abundant due in part to an increasing trend toward electronic medical records and advancement in information technology. This design has been utilized in the HIV setting to great success and involves following individuals as they access medical care. These clinical cohort designs have not been compared to the classic interval cohort design in which individuals are followed at specified intervals that are unrelated to the participants' ongoing health care. The interval and clinical cohort designs are distinguished and the advantages and disadvantages inherent in each design are discussed. Lau, B., Gange, S., and Moore, R. Interval and Clinical Cohort Studies: Epidemiological Issues. AIDS Res. Hum. Retroviruses, 23(6), pp. 769-776, 2007.

Club Drug Use in Los Angeles among Young Men Who have Sex with Men

Little is known about young men who have sex with men and their use of club drugs and the risk factors associated with such use. A structured survey was administered in 2005 to 496 young men who were 18-22 years old (40% were 18-19 years old); self-identified as with a same-sex sexuality (83%), bisexual (16%), and/or had had sex with a man (97%); Caucasian (35%), African American (24%), and Latino of Mexican descent (40%). Subjects were recruited from gay-identified venues in Los Angeles, California, using a venue-based probability sampling design. Descriptive statistics revealed a high prevalence of drug and club drug use. Regression analyses revealed risk factors associated with recent club drug use, including place of residence, religiosity, disclosure of sexuality to family, frequency of attendance at bars/clubs, and involvement in sexual exchange and street economy. Limitations and implications of this research are discussed. Kipke, M., Weiss, G., Ramirez, M., Dorey, F., Ritt-Olson, A., Iverson, E., and Ford, W. Club Drug Use in Los Angeles among Young Men Who have Sex with Men. Subst. Use Misuse, 42(11), pp. 1723-1743, 2007.

Impact of Social Network Characteristics on High-Risk Sexual Behaviors among Non-injection Drug Users

Sexually active non-injection drug users in New York City and their sexual partners or fellow drug users (N = 264) were recruited from 2002 to 2005, and associations between social network characteristics, sexual risk behaviors and sexual practices, and drug use were examined. Results suggest having a drug-centered social network, i.e., a network that includes a high proportion of individuals who provide, receive, or use drugs, increases the risk of engaging in high-risk sexual behaviors. The study's limitations are noted and longitudinal studies are needed to ascertain whether these associations are causal. Pilowsky, D., Hoover, D., Hadden, B., Fuller, C., Ompad, D., Andrews, H., de Leon, C., Hoepner, L., Xia, Q., and Latkin, C. Impact of Social Network Characteristics on High-Risk Sexual Behaviors among Non-injection Drug Users. Subst. Use Misuse, 42(11), pp. 1629-1649, 2007.

Harm Reduction Theory: Users' Culture, Micro-Social Indigenous Harm Reduction, and the Self-Organization and Outside-Organizing of Users' Groups

This paper discusses the user side of harm reduction, focusing to some extent on the early responses to the HIV/AIDS epidemic in each of four sets of localities-New York City, Rotterdam, Buenos Aires, and sites in Central Asia. Using available qualitative and quantitative information, researchers present a series of vignettes about user activities in four different localities regarding reducing drug-related harm. Some of these activities have been micro-social (small group) activities; others have been conducted by formal organizations of users that the users organized at their own initiative. In spite of the limitations of the methodology, the data suggest that users' activities have helped limit HIV spread. These activities are shaped by broader social contexts, such as the extent to which drug scenes are integrated with broader social networks and the way the political and economic systems impinge on drug users' lives. Drug users are active agents in their own individual networks, and potentially in helping to protect wider communities. Researchers and policy makers can work together to help develop ways to enable and support both micro-social and formally organized action by users. Friedman, S., deJong, W., Rossi, D., Touze, G., Rockwell, R., Des Jarlais, D., and Elovich, R. Harm Reduction Theory:Users' Culture, Micro-Social Indigenous Harm Reduction, and the Self-Organization and Outside-Organizing of Users' Groups. Int. J. Drug Policy, 18, pp. 107-117, 2007.

Three Types of Adherence to HIV Antiretroviral Therapy and their Association with AIDS Diagnosis, Medication Side-effects, Beliefs about Antiretroviral Therapy, and Beliefs about HIV Disease

One hundred and ninety-three adults with HIV taking antiretroviral therapy completed a questionnaire on demographics, health beliefs, medication side-effects, and adherence to dose, schedule, and dietary instructions. Three health beliefs indices were identified: antiretroviral therapy (ART) benefits, ART adherence self-efficacy, and beliefs about future HIV-related health concerns. Patients who experienced medication side-effects reported strong beliefs that HIV infection would cause them future health problems or distrust in the benefits of ART. AIDS diagnosis obtained through medical records or medication side-effects were not related to any of the three types of adherence. Beliefs about future HIV-related health concerns were associated with suboptimal dose adherence. Beliefs about ART benefits were associated with suboptimal schedule and dietary instructions adherence. Older age and partner were protective factors of schedule adherence. Data suggest that health beliefs may vary across type of adherence and that adherence behaviours may be a coping strategy to adjust antiretroviral therapy to one's daily living. Schoennesson, L., Williams, M., Ross, M., Diamond, P., and Keel, B. Three Types of Adherence to HIV Antiretroviral Therapy and their Association with AIDS Diagnosis, Medication Side-effects, Beliefs about Antiretroviral Therapy, and Beliefs about HIV Disease. Int. J. STD AIDS, 18(6), pp. 369-373, 2007.

HIV-Related Communication and Perceived Norms: An Analysis of the Connection among Injection Drug Users

Although research has consistently shown a link between perceived norms and HIV risk behaviors, research examining interpersonal variables that may contribute to perceived norms is sparse. Verbal communication is an important mechanism for establishing, altering, and maintaining norms. In this study researchers assessed the association between HIV-related communication and perceived norms. Baseline data from 684 drug injectors enrolled in the STEP into Action (STEP) study were analyzed. Multivariate results revealed that injection drug users who talked to their drug partners about HIV were less likely to perceive that they engaged in risky injection behavior (beta = -1.53, SE = 0.29, p < .001). Exchanging sex for money or drugs (beta = 15.83, SE = 7.02, p = .024), going to a shooting gallery (beta = 17.03, SE = 6.79, p = .013), and having an IDU sex partner (beta = 15.34, SE = 6.58, p = .020) were associated with the belief that peers practiced risky drug behaviors. These findings may be used to develop peer education HIV prevention interventions for drug users. Davey-Rothwell, M., and Latkin, C. HIV-Related Communication and Perceived Norms: An Analysis of the Connection among Injection Drug Users. AIDS Educ. Prev., 19(4), pp. 298-309, 2007.

Injection Drug Users' Strategies to Manage Perceptions of Personal Risk: How do IDUs See HIV as Having Affected Them?

The U.S. public health community is in its 3rd decade of seeking to prevent and treat HIV/AIDS. Injection drug users (IDUs) are central to targeted HIV prevention interventions as approximately one third of new U.S. infections are attributable to injection drug use. Targeted behavior change efforts are often explicitly built upon the risk perception of targeted individuals. In this article, researchers consider the efficacy of behavior change based on IDUs' perceptions of elevated risk. Their qualitative analysis of 28 interviews with HIV negative IDUs' in inner city Baltimore suggests that participants did not see themselves as personally affected by HIV. Rather, respondents constructed accounts in which they differentiated themselves from the type of people who are so affected, thereby creating a less stigmatizing identity. These findings suggest that effective HIV prevention should explicitly acknowledge and address the stigmatized IDU identity, rather than assuming readiness for behavior change. Smith, K., Lillie, T., and Latkin, C. Injection Drug Users' Strategies to Manage Perceptions of Personal Risk: How Do IDUs See HIV as Having Affected Them? AIDS Educ. Prev., 19(3), pp. 245-257, 2007.

Nonmedical Use of Prescription Stimulants and Drug-Related Problems Among College Students

This college-based study compared nonmedical users of prescription stimulants to other types of drug users regarding drug use related problems. A Web survey was self-administered in 2005 by a probability sample of 3,639 full-time undergraduate students (68% response rate) at a large public Midwestern 4-year university in the United States. The survey consisted of measures to assess substance use and misuse, including a modified version of the Drug Abuse Screening Test (DAST-10). Nonmedical users of prescription stimulants were more likely than other drug users to report polydrug use. Nonmedical users of prescription stimulants had over four times greater odds than other drug users to experience three or more DAST-10 items in the past 12 months (AOR=4.61, 95% CI=3.28-6.48). Among nonmedical users of prescription stimulants, those who used prescription stimulants via intranasal and other non-oral routes of administration had greater odds than oral only users to experience three or more DAST-10 items in the past 12 months. The investigators conclude that study findings suggest that the majority of nonmedical users of prescription stimulants are polydrug users and should be screened for potential drug abuse or dependence, especially those who report non-oral routes of administration. McCabe, S., and Teter, C. Drug Use Related Problems Among Nonmedical Users of Prescription Stimulants: A Web-based Survey of College Students from a Midwestern University. Drug Alcohol Depend., 91(1), pp. 69-76, 2007.

Trends in Non-medical Use of Anabolic Steroids by U.S. College Students

This study assessed the prevalence, trends, and student- and college-level characteristics associated with the non-medical use of anabolic steroids (NMAS) among U.S. college students. Data were collected through self-administered mail surveys, from 15,282, 14,428, 13,953, and 10,904 randomly selected college students at the same 119 nationally representative colleges in 1993, 1997, 1999 and 2001, respectively. The prevalence of lifetime, past-year and past-month NMAS was 1% or less and generally did not change significantly between 1993 and 2001, with one exception: past-year NMAS increased significantly among men from 1993 (0.36%) to 2001 (0.90%). Multiple logistic regression analyses revealed that lifetime and past-year NMAS were associated with student-level characteristics such as being male and participation in intercollegiate athletics. Lifetime and past-year NMAS were also positively associated with several risky behaviors, including cigarette smoking, illicit drug use, drinking and driving, and DSM-IV alcohol use disorders. Nearly 7 out of every 10 lifetime non-medical users of anabolic steroids met past-year criteria for a DSM-IV alcohol use disorder. Although the overall prevalence of NMAS remained low between 1993 and 2001, findings suggest that continued monitoring is necessary because male student-athletes are at heightened risk for NMAS and this behavior is associated with a wide range of risky health behaviors. The characteristics associated with NMAS have important implications for future practice and research. McCabe, S., Brower, K., West, B., Nelson, T., and Wechsler, H. Trends in Non-medical Use of Anabolic Steroids by U.S. College Students: Results from Four National Surveys. Drug Alcohol Depend., 90(2-3), pp. 243-251, 2007.

Exploring Wine Shops as a Venue for HIV Prevention in Urban India

Addressing male heterosexual risk is a high priority for HIV prevention efforts in India. Particularly in urban India, which draws men for employment opportunities, these efforts are gaining momentum with a focus on understanding possible risk facilitators such as alcohol use. However, little is known about venues where such efforts might be targeted. Researchers explored community-based alcohol outlets or "wine shops" in Chennai, India, as potential venues. They conducted ethnographic research with wine shop staff and clients to understand alcohol use and sexual behaviors and surveyed 118 wine shop patrons to quantify these risk behaviors and plan an appropriate intervention. Results show that wine shops are a venue where social and sexual networks converge; reports and observations of regular and heavy drinking were frequent. Over 50% of patrons surveyed reported three or more sexual partners in the past 3 months, and 71% of all patrons reported a history of exchanging sex for money. Condom use history was low overall but, in the adjusted analyses, was significantly higher (OR = 20.1) among those who reported that their most recent partner was a sex worker and lower (OR = 0.28) among those who reported they drank to feel disinhibited. The data suggest that wine shops may be an appropriate location to target men for HIV prevention interventions. The researchers include discussion of how these findings helped design such an intervention in Chennai. Sivaram, S., Johnson, S., Bentley, M., Srikrishnan, A., Latkin, C., Go, V., Solomon, S., and Celentano, D. Exploring Wine Shops as a Venue for HIV Prevention in Urban India . J. Urban Health, 84(4), pp. 563-576, 2007.

Initiation into Methamphetamine Use for Young Gay and Bisexual Men

Research over the past 10 years has suggested that methamphetamine use has become a significant problem and is associated with risky sexual behaviors among gay and bisexual men. In order to better understand initiation into methamphetamine use among gay and bisexual men, qualitative analyses were performed on a sample of young gay and bisexual men (ages 18-29) in New York City. Participants were recruited as part of a larger study which used time-space sampling to enroll club-going young adults who indicated recent club drug (ecstasy, ketamine, GHB, methamphetamine, cocaine, and/or LSD) use. The data for this paper are derived from the qualitative interviews of 54 gay and bisexual male methamphetamine users. At initiation (1) methamphetamine was used in a social, non-sexual setting for a majority of the participants; (2) participants expressed limited knowledge of methamphetamine; and (3) many participants used cocaine as a basis for comparison when describing various effects of the drug. These study findings have implications for prevention approaches. The understanding that at initiation methamphetamine was not solely used as a sexual enhancement for members of this community may enable health workers to more accurately target potential users when putting forth intervention efforts. The investigators recommend that future research should (1) aim to gain a better understanding of the role that methamphetamine plays in non-sexual contexts, particularly among gay and bisexual men who may not be part of the club "scene;" and, (2) explore the relationship between attitudes towards methamphetamine and other drugs, particularly cocaine, among gay and bisexual men. Parsons, J., Kelly, B., and Weiser, J. Initiation into Methamphetamine Use for Young Gay and Bisexual Men. Drug Alcohol Depend., 90(2-3), pp. 135-144, 2007.


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