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Director's Report to the National Advisory Council on Drug Abuse - May, 2003

Research Findings - Epidemiology and Etiology Research

Community Epidemiology Work Group

The 53rd meeting of the Community Epidemiology Work Group (CEWG), chaired by Nicholas Kozel, DESPR, was held in Miami, Florida on December 10-13, 2002. The CEWG is composed of researchers from 21 metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas, emerging drugs of abuse, vulnerable populations and factors that may place people at risk of drug abuse, and negative health and social consequences. Reports are based on a variety of drug abuse indicator data such as morbidity and mortality information, treatment data and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health data, local and State survey information, and findings from qualitative research studies.

Cocaine/Crack continues to be the predominant illicit drug in most CEWG areas, despite declining indicators in recent years. There were reports in seven areas that powder cocaine was more available and cheaper in street markets than in past years.

Heroin abuse indicators increased among young White and suburban populations in several CEWG areas. White powdered heroin from South America is the predominant type available in areas east of the Mississippi River, while black tar is the predominant type in areas on the west side.

Other Opiate abuse indicators continue to trend upward, with increased use of controlled substances reported in almost all CEWG areas. Oxycodone, hydrocodone, and methadone abuse indicators increased in most CEWG areas. Research efforts are underway in some areas to assess the extent to which these drugs are diverted to illicit markets and are being abused.

Methamphetamine abuse indicators remained high in Hawaii, all west coast CEWG areas, and Phoenix. Abuse of the drug has continued to spread to Denver, Detroit, and Minneapolis/St. Paul, and there is increased evidence that it is spreading to populations in east coast areas (e.g., Atlanta, Miami, New York City, and Washington DC).

Marijuana abuse indicators continued to increase in 10 CEWG areas. In 2001, high proportions of clients entering treatment programs in Minneapolis/St. Paul (49.2 percent), Colorado (40.6), New Orleans (37.5), Seattle (34.4), St. Louis (33.3), Hawaii (28.6), Texas (26.0), Illinois (25.9), San Diego (25.9), and New York (25.2) were primary marijuana abusers.

MDMA (methylenedioxymethamphetamine) abuse continues to spread to different populations, and is being sold around schools and street corners in urban, suburban, and rural communities. Increasingly, pills and capsules marketed as "ecstasy" contain other drugs (e.g., amphetamines, methamphetamine, phencyclidine [PCP], ketamine) with or without MDMA.

Benzodiazepine abuse indicators have been increasing in most CEWG areas. Alprazolam (Xanax) is reportedly widely used by cocaine/crack, heroin, and polydrug-abusing populations.

Illicit Drug Escalation Associated with Early-Onset Cannabis Use in a Twin Sample

This study examined whether the association between early cannabis use and subsequent progression to use of other drugs and drug abuse/dependence persists after controlling for genetic, shared environmental influences, and other risk factors. Data come from a cross-sectional survey (conducted between 1996 and 2000) among an Australian national volunteer sample of 311 young adult monozygotic and dizygotic same-sex twin pairs discordant for early cannabis use (i.e., before age 17). Findings indicate early cannabis use is associated with increased risk of other drug use, alcohol dependence, and drug abuse/dependence. Controlling for known risk factors (early-onset alcohol or tobacco use, parental conflict/separation, childhood sexual abuse, conduct disorder, major depression, and social anxiety) had only negligible effects on these results. The authors interpret these results as being consistent with the "gateway theory" of drug use. The major strength of this study is the twin design, which assumes that twins share the same environment and family experiences, and that monozygotic pairs share the same genetic risk. Limitations include the cross-sectional design and unmeasured but potentially important environmental effects that are unique (i.e., nonshared) to marijuana using twins such as peer and social contexts in which cannabis is used. Lynskey, M.T., Heath, A.C., Bucholz, K.K., Slutske, W.S., Madden, P.A. F., Nelson, E.C., Statham, D.J., and Martin, N.G. Journal of the American Medical Association, 289, pp. 427-433, 2003.

Racial/Ethnic and Gender Differences in the Incidence and Onset Age of DSM-IV Alcohol Use Disorder Symptoms among Adolescents

Several investigators have questioned the validity of the DSM-IV Alcohol Use Disorders criteria for diagnosing alcohol use problems among teenagers, with specific concerns about their utility across different subgroups. In the current study, authors examined whether particular racial/ethnic or gender subgroups varied in the incidence and onset age of Alcohol Use Disorder symptoms. Members of a sample composed of 1,045 community-dwelling "drinkers" (59.4% male; 13.8% black, 21.2% foreign-born Hispanic, 30.7% U.S.-born Hispanic and 33.6% non-Hispanic white) were interviewed retrospectively using the Composite International Diagnostic Interview. The first occurrence of each DSM-IV symptom in a participant was examined by race/ethnicity and gender. Discrete-time event history analysis compared onset patterns from ages 14 through 20 years. The cumulative incidence of Alcohol Abuse and Alcohol Dependence diagnoses, as well as one alcohol abuse symptom and four dependence symptoms, varied by race/ethnicity. The incidence of both diagnoses, as well as two alcohol abuse symptoms, varied by gender. Event history analysis revealed no significant subgroup variation in first onset patterns for only three of the eleven symptoms. Racial/ethnic variation, but not gender variation, was significant for three symptoms, and both racial/ethnic variation and gender variation was significant for the remaining five symptoms. Study authors' findings indicate that most of the DSM-IV Alcohol Use Disorder symptoms, when applied to adolescents, demonstrate significant subgroup variation in incidence and onset age patterns. These results speak to the urgent need for additional research concerning the nosology and diagnosis of alcohol use problems among younger drinkers, especially among specific racial/ethnic and gender subgroups. Wagner, E.F., Lloyd, D.A., and Gil, A.G. Journal of Studies on Alcohol, 63, pp. 609-619, 2002.

Genetic and Environmental Risk Factors for Drug Problems in Adoptees

Applying survival analysis methodology to age-of-onset data from an adoption study (N=196), authors present evidence that risks for both drug use and drug problems (DSM abuse or dependence) are elevated when combined antisocial personality (ASP) and substance abuse is present in the same biological parent. It is increased not only in comparison to adoptees with no known biological risk, but also when compared to adoptees with a biological background for only substance problems or only ASP. Neither of these later groups showed a statistically higher risk when compared with controls. Among adoptees with recurrent drug use, adolescent aggressivity is also elevated when the combined substance abuse/ASP biological diathesis is present. Statistical control for aggressivity diminished but did not eliminate the predictive significance of the combined biological diathesis for drug problems. The authors also verify, using more refined methodology, our previous reports of gender and adverse adoptive environmental influences on drug-related outcomes in these subjects. A biology-environment interaction could not be documented since power to do so was rather low. The authors argue that the observed biological associations are broadly consistent with generalization to other substances of an alcoholism phenotype similar to Cloninger's Type II or Babor's Type B. Langbehn, D.R., Cadoret, R.J., Caspers, K., Troughton, E.P., and Yucuis, R. Genetic and Environmental Risk Factors for the Onset of Drug Use and Problems in Adoptees. Drug and Alcohol Dependence, 69(2), pp. 151-67, 2003.

Serotonergic Gene Variant and Family History of Antisocial Personality and Alcoholism Associated with Risk of Externalizing Problems

This genetic association study examined the relation between polymorphisms of the serotonin-transporter-linked promoter region (5HTTLPR) and externalizing behaviors (aggression, conduct disorder, and attention deficit disorder) in a sample of 87 adoptees at risk for externalizing and substance abuse by virtue of parental family history of antisociality and/or alcoholism. Results failed to show main effects between 5HTTLPR status and externalizing problems, but indicated several interactions between 5HTTLPR status and family history. The LL variant of 5HTTLPR was associated with an increased risk of externalizing in offspring of antisocial parents, whereas the SS or SL variants were associated with increased risk of externalizing in offspring of alcoholics. The gender of the adoptee also interacted with 5HTTLPR status, as an increased risk of externalizing was observed in males with LL and in females with SS or SL. Results indicated an interaction between this serotonergic gene and other forms of genetic diathesis (antisocial personality and alcoholism), thereby suggesting that epistasis (gene-by-gene interactions) may be involved in the etiology of externalizing problems. Cadoret., R., Langbehn, D., Caspers, K., Troughton, E.P., Yucuis, R., Sandhu, H.K., and Philibert, R. Associations of the Serotonin Transporter Promoter Polymorphism with Aggressivity, Attention Deficit, and Conduct Disorder in an Adoptee Population. Comprehensive Psychiatry, 44(2), pp. 88-101, 2003.

Adolescent Drug Use, Abuse, and Dependence: Epidemiology and Heterogeneity of Symptom Expression by Drug Type and Gender

This study evaluates symptom profiles based on DSM-IV abuse and dependence criteria for tobacco, alcohol and marijuana, including a gender comparison. Participants are 3,072 adolescents (12-18 years) drawn from three community-based family samples in Colorado. Age trends suggest that substance use is a developmental phenomenon, which increases almost linearly from early to late adolescence. Substance use disorders are less common than experimentation in adolescence, but approximately 1 in 4 adolescents in the oldest cohorts meets criteria for abuse for at least one substance, and 1 in 5 meets criteria for substance dependence. By age 18, nearly one in three adolescents report daily smoking and 8.6% meet criteria for tobacco dependence. Although alcohol is the most commonly abused substance (10%), a slightly larger proportion of adolescents meet criteria for dependence on marijuana (4.3%) than alcohol (3.5%). Males more frequently meet criteria for dependence on alcohol and marijuana in late adolescence, while females are more often nicotine dependent. A comparison of abuse and dependence symptom profiles shows variability across substances, and suggests that manifestations of a subset of symptoms are gender specific. Young, S.E., Corley, R.P., Stallings, M.C., Rhee, S.H., Crowley, T.J. and Hewitt, J.K. Substance Use, Abuse, and Dependence in Adolescence: Prevalence, Symptom Profiles and Correlates. Drug and Alcohol Dependence, 68(3), pp. 309-322, 2002.

Psychiatric and Substance Use Disorders in South Florida: Racial/Ethnic and Gender Contrasts in a Young Adult Cohort

Prevalence rates of psychiatric and substance use disorders among young adults in South Florida are presented. Unique aspects of the study include the large sample size, its ethnic diversity, and the fact that a substantial proportion of Hispanic participants were foreign born. This study builds on a previous cohort study of students who entered middle school in 1990. A random subsample of this representative cohort (N = 1803) was interviewed between 1998 and 2000 when most were between 19 and 21 years of age. Disorders were assessed through computer-assisted personal interviews utilizing the DSM-IV version of the Michigan Composite International Diagnostic Interview. More than 60% of the sample met lifetime criteria for 1 or more study disorders, and 38% did so within the preceding year. Childhood conduct and major depressive and alcohol abuse disorders were the most prevalent. Although rates of affective and anxiety disorders in females were double that in males, this gender difference disappeared when attention-deficit/hyperactivity disorder, conduct disorders, and antisocial personality disorders were also considered (46.6% vs. 45.7% for females vs. males, respectively). Substantially lower rates were observed among African Americans for depressive disorders and substance abuse and dependence. Among Hispanics, rates tend to be lower among the foreign-born in comparison with their US-born counterparts, particularly for the substance disorders. The documented presence of psychiatric and substance disorders in middle and high school populations emphasizes the importance of prevention efforts in school settings. Research on the origins of ethnic and nativity differences is called for. Turner, R.J., and Gil, A.G., Archives of General Psychiatry, 59, pp. 43-50, 2002.

Drug Use and the Risk of Major Depressive Disorder, Alcohol Dependence, and Substance Use Disorders

The Children in the Community Study is a prospective longitudinal study investigating the association between early drug use (childhood, adolescence, and early 20's) and later psychiatric disorders (in the late twenties). Utilizing data from a community-based sample of 736 adults (50% female) from upstate New York, the subjects were interviewed at mean ages of 14 years, 16 years, 22 years, and 27 years. Psychiatric disorders, measured by age-appropriate versions of the University of Michigan Composite International Diagnostic Interview (UM-CIDI), and participant drug use were assessed. Adolescent and young adult tobacco use was significantly associated with an increased risk of alcohol dependence and substance use disorders (SUDs) at mean age 27, but not with new episodes of major depressive disorder (MDD). Earlier alcohol use significantly predicted later MDD, alcohol dependence and SUDs in the late twenties, as did early marijuana use and other illicit drug use. Except for the effect of tobacco use on MDD, early drug use was significantly related to later psychiatric disorders, even after statistically controlling for age, gender, parental education, family income, and prior episodes of MDD and SUDs. Results suggest that early drug use is associated with and predicts later psychiatric disorders. Preventive implications stem from the importance of studying a range of psychiatric disorders in the context of substance use assessed over a wide age range. Brook, D.W., Brook, J.S., Zhang, C., Cohen, P. and Whiteman, M. Drug Use and the Risk of Major Depressive Disorder, Alcohol Dependence, and Substance Use Disorders. Archives of General Psychiatry, 59, pp. 1039-1044, 2002.

Zygosity Diagnosis in the Absence of Genotypic Data: An Approach Using Latent Class Analysis

This study applies a latent class analyses for zygosity diagnosis in the absence of genotypic data using secondary data from a young adult Australian twin cohort (N = 2094 complete pairs and 519 singleton twins from same-sex pairs with complete responses to all zygosity items). The application of latent class analysis (LCA), fitting a 2-class model, yields results showing good concordance with traditional methods of zygosity diagnosis, but with certain important advantages. These include the ability, in many cases, to assign zygosity with specified probability on the basis of responses of a single informant, and the ability to quantify the probability of misassignment of zygosity, allowing prioritization of cases for genotyping as well as identification of cases of probable laboratory error. Out of 242 twins (from 121 like-sex pairs) where genotypic data were available for zygosity confirmation, only a single case was identified of incorrect zygosity assignment by the latent class algorithm. Zygosity assignment for that single case was identified by the LCA as uncertain (probability of being a monozygotic twin only 76%), and the co-twin's responses clearly identified the pair as dizygotic (probability of being dizygotic 100%). Findings highlight the application of LCA for zygosity assignment or confirmation in the absence of genotypic data, or as a safeguard against sample duplication. Heath, A.C., Nyholt, D.R., Neuman, R., Madden, P.A., Bucholz, K.K., Todd, R.D., Nelson, E.C., Montgomery, G.W., and Martin. N.G. Zygosity Diagnosis In The Absence of Genotypic Data: An Approach Using Latent Class Analysis. Twin Research, 6(1), pp. 22-26, 2003.

Meta-analysis Finds Childhood Stimulant Therapy Associated with Reduced Risk for Later Drug Use Disorders

This study used meta-analytic techniques to address the question as to the long-term impact of childhood stimulant therapy for attention deficit hyperactivity disorder on the risk for developing subsequent substance use disorders (SUD). Five studies were identified with long-term outcomes of medicated and unmedicated subjects. Overall results found a reduction in risk for SUD in individuals treated with stimulants; a greater protective effect was found in studies that followed subjects into adolescence than into adulthood. The authors note several possible confounding factors that may temper these findings, in particular the naturalistic (non-randomized) nature of the treatment samples; there may be significant differences between treated and untreated subjects on important variables such as family history of SUD, severity of illness, and comorbidity. Thus, while this study may provide some reassurance, further study of this important public health question is needed. Wilens, T.E., Faraone, S.V., Biederman, J. and Gunawardene, S. Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-Analytic Review of the Literature. Pediatrics, 111(1), pp. 179-185, 2003.

Comorbid Depression and Conduct Disorder Associated with Increased Risk for SUD

Using data from a sample of 17 year old twins, subjects with a history of major depressive disorder and/or conduct disorder or neither were selected and school success and substance dependence examined. The combination of disorders was found to be particularly associated with school behavior problems, nicotine and drug dependence for both males and females. These findings, which are similar to those reported by other groups, point to a need to assess youth for both internalizing and externalizing disorders and awareness of the increased risk associated with their co-occurrence. Marmorstein, N.R. and Iacono, W.G. Major Depression and Conduct Disorder in a Twin Sample: Gender, Functioning, and Risk for Future Psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 42(2), pp. 225-233, 2003.

Personal Competence Skills, Distress, and Well-Being as Determinants of Substance Use in a Predominantly Minority Urban Adolescent Sample

Several previous studies have investigated the relationship between psychological distress and substance use among youth. However, less research has investigated the potentially protective role of psychological well-being on adolescent substance use, and the extent to which personal competence skills may promote well-being. The present study examined personal competence skills, psychological distress and well-being, and adolescent substance use over a three-year period in a predominantly minority sample of urban students (N = 1,184) attending 13 junior high schools in New York City. Structural equation modeling indicated that greater competence skills predicted less distress and greater well-being over time. While psychological well-being was associated with less subsequent substance use, distress did not predict later substance use. Findings indicate that competence skills promote resilience against early stage substance use in part by enhancing psychological well-being, and suggest that school-based prevention programs should include competence enhancement components in order to promote resilience. Griffin, K.W., Botvin, G.J., Scheier, L M., Epstein, J.A., and Diaz, T. Prevention Science, 3, pp. 23-33, 2002.

Positive Impact of Competence Skills and Psychological Wellness in Protecting Inner-city Adolescents from Alcohol Use

Research has shown that competence enhancement prevention programs for substance use are effective in reducing alcohol use and other problem behaviors. However, less is known about the mechanisms by which high competence helps youth avoid negative outcomes. This study explored whether greater competence is associated with increased levels of psychological wellness that in turn deters subsequent alcohol use. Specifically, 1,459 students attending 22 middle and junior high schools in New York City completed surveys that included measures of competence (decision making, self-efficacy), psychological wellness, and alcohol use. Students completed surveys at baseline, 1-year follow-up, and 2-year follow-up. Data collectors administered the questionnaire following a standardized protocol during a regular 40-min class period. On the basis of a longitudinal structural equation model, adolescents who were highly competent reported greater psychological wellness, which was then associated with less drinking. These findings highlight the potential of alcohol prevention programs designed to enhance competence and psychological wellness. Epstein, J.A., Griffin, K.W. and Botvin, G.J. Positive Impact of Competence Skills and Psychological Wellness in Protecting Inner-city Adolescents from Alcohol Use. Prevention Science, 3, pp. 95-104, 2002.

Earlier Marijuana Use and Later Problem Behavior in Colombian Youth

The study examined the relationship between earlier adolescent marijuana use and later adolescent behavioral problems. A community-based sample of Colombian adolescents was interviewed in 1995-1996 and 1997-1998. The time 2 (T2) sample consisted of 1151 males and 1075 females. The psychosocial measures assessed adolescent problem behavior, the peer and sibling social network, and ecological/ environmental stress and cultural domains. Logistic regression analyses included controls on demographic and time 1 (T1) dependent measures. The findings suggest that T1 adolescent marijuana use was associated with increased risks for T2 adolescent difficulty at work or school, violent experiences, peer marijuana use, and sibling marijuana problems. This study provides important evidence in this cohort of the specific relationship between T1 adolescent marijuana use and (T2) adolescent problem behavior in a society in which drug use, crime, violence, and low educational attainment are pervasive. Similar findings have been shown in previous research with U.S. adolescents. The findings suggest that early adolescent marijuana use is associated with an increase in problem behavior during later adolescence. Brook, J.S., Brook, D.W., Rosen, Z. and Rabbitt, C.R. Earlier Marijuana Use and Later Problem Behavior in Colombian Youth. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (4), pp. 1-8, 2003.

Marijuana Use Among the Adolescent Children of High-Risk Drug-Abusing Fathers

This study examines marijuana use among children of male drug abusers. Subjects were 83 African-American and European-American male drug abusers (the majority of whom were injection drug users) and their children. Thirty-one of the fathers were HIV-positive and 52 were HIV-negative. Using logistic regression analyses, the authors explored cross-sectionally the relationship between four psychosocial domains (i.e., paternal attributes, adolescent problem behaviors, father-adolescent relations, and the environment) and adolescent marijuana use. The father's use of illegal drugs and his failure to cope adaptively predicted adolescent marijuana use, while a close father-child bond predicted less adolescent marijuana use. Adolescent problem behaviors predicted an increased likelihood of marijuana use. Furthermore, hierarchical regression analysis demonstrated that the adolescent's problem behavior mediated the associations between the father-adolescent relationship as well as environmental factors with adolescent marijuana use. Reducing the risk factors and enhancing the protective factors within each of the domains could help reduce marijuana use among the adolescent children of drug-abusing fathers. Moreover, if a father is a drug abuser, it is important to help him establish a close bond with his child in order to help attenuate the influence of his drug use on the child's marijuana use. Brook, D.W., Brook, J.S., Richter, L., Whiteman, M. and Arencibia-Mireles, O. Marijuana Use Among the Adolescent Children of High-Risk Drug-Abusing Fathers. The American Journal on Addictions, 11, pp. 95-110, 2002.

Tobacco Use as a Predictor of Illicit Drug Use and Drug-Related Problems in Colombian Youth

To examine the extent to which personality and peer factors mediate the relationship between early cigarette use and later illicit drug use, as well as associated drug use problems, in a population of Colombian adolescents. A longitudinal study (2-year interval), using face-to-face structured interviews was begun in 1996 using a community-based sample, randomly selected from census data in three cities in Colombia, South America. The participants were 2,837 adolescents with a mean age of 15.0 (SD +/- 1.6) years at time 1 (T1). Males comprised 52% of the sample and 65% resided with two parents. Approximately 78% (N = 2,226) completed the second structured interview 2 years later (T2). The main outcome measures were marijuana use, other illicit drug use, and associated drug use problems at T2. Three series of logistic regressions were conducted. The odds of marijuana use (adjusted odds ratio [AOR] = 1.64-2.01; confidence interval [CI]: 1.11-2.94), other illicit drug use (AOR = 1.77-2.49; CI: 1.03-4.19), and associated drug use problems (AOR = 2.25-3.47; CI: 1.45-5.26) at T2, was increased two- to three-fold among adolescents reporting cigarette use at T1, with control on the demographic, personality, and peer factors, as well as T1 drug use variables. Earlier adolescent cigarette smoking was directly associated with later marijuana use, other illicit drug use, and problems with drug use. Siqueira, L.M. and Brook, J.S. Tobacco Use as a Predictor of Illicit Drug Use and Drug-related Problems in Colombian Youth. Journal of Adolescent Health, 32, pp. 50-57, 2003.

Early and Mid-adolescence Risk Factors for Later Substance Abuse by African Americans and European Americans

This study examined the relationship between risk factors experienced during adolescence by African Americans and European Americans and DSM-IV alcohol dependence and marijuana abuse or dependence in early adulthood. The authors followed a cohort of adolescents from 1990-91 (grades 6 and 7) to 1998-2000 (ages 19-21), evaluating risk factors during early adolescence as predictors of DSM-IV alcohol dependence and marijuana abuse and dependence. African Americans had higher exposure to school, family structure, delinquency, and psychosocial factors. School factors and drug-use modeling of peers and family were the most important risk factors for marijuana abuse or dependence for both European and African Americans. Personal, familial, and social context factors during early adolescence affect adult drug-use problems, particularly for African Americans. Levels of drug use are lower among African Americans, but exposure to risks is higher and there are clear differences in the long-range impact of risk factors. These findings highlight the importance of developing and timing appropriate prevention efforts. Gil, A., Vega, W., and Turner, R.J. Public Health Reports, 117, Supplement 1:S15-S29, 2002.

Risk and Protective Factors of Adolescent Drug Use: Implications for Prevention Programs

The first purpose of this chapter is to identify the risk and protective factors related to adolescent drug use. The framework is derived from the family interactional theory. Operating within a developmental framework, the authors explore the interrelations of risk factors related to drug use. In addition, they elucidate the protective factors that mitigate adolescents' vulnerability to drug use. A second goal of the chapter was to elucidate the implications of etiological research for prevention, treatment, public policy, and research. In so doing, authors build heavily on a number of the major studies that have been conducted in the last decade. Finally, they present several prevention programs that have successfully incorporated the findings of etiological research into their prevention programs. Brook, J.S., Richter, L.and Whiteman, M. In Z. Sloboda and W.J. Bukoski (eds.), Handbook of Drug Abuse Prevention: Theory, Science and Practice, pp. 265-287, New York: Plenum, 2003.

Coping in Adolescent Children of HIV-Positive and HIV-Negative Substance Abusing Fathers

This study examines the coping techniques of adolescents whose fathers are at risk for contacting the HIV virus or have the HIV virus. Adolescent coping is an important aspect of the adolescent's vulnerability or resilience to drug use and abuse and associated problems. The data for this study was taken from an epidemiological study of fathers who are substance abusers and their adolescent offspring. Adolescents were asked questions regarding their ability to cope with the knowledge that their fathers have AIDS or may contract it. Adolescent adaptive coping was found to be positively related to the adolescents' conventionality, intrapersonal and interpersonal adjustment, and infrequent or no use of marijuana. Adolescent adaptive coping was also associated with paternal adaptive coping, a close father-child bond, and under some conditions, less paternal drug use. Furthermore, for every additional psychosocial risk factor beyond a minimal number, there is a doubling in the odds ratio of the adolescent using maladaptive techniques of coping. Knowledge of such relationships helps guide intervention and policy procedures for adolescents who are at risk because their fathers are HIV-positive or may contract HIV. Brook, D.W., Brook, J.S., Arencibia-Mireles, O., Whiteman, M., Pressman, M. and Rubenstone, E. Coping in Adolescent Children of HIV-Positive and HIV-Negative Substance Abusing Fathers. The Journal of Genetic Psychology, 163 (1), pp. 5-23, 2002.

Alcohol Use in Adolescents Whose Fathers Abuse Drugs

This study examined the interrelation of several domains, including father attributes, father-child relations, peer influences, environmental factors, and youth personality, as they related to adolescent alcohol use. Several aspects of the father-child relationship were also examined as possible protective factors against adolescent drinking. Subjects consisted of 204 HIV-positive and HIV-negative drug-abusing fathers and their adolescent children between the ages of 12 and 20. Data were collected via individual structured interviews of both the fathers and the youth. Results indicated that several items from each domain were related to adolescent drinking, and that an affectionate father-child bond had a protective effect. Moreover, hierarchical regression analyses demonstrated that the youth's personality mediated between all other domains and adolescent alcohol use. There was also a direct effect of peer influences on adolescent drinking. Findings extend the literature on the specific mechanisms which link parental substance use with adolescent alcohol use in a high-risk population. Brook, D.W., Brook, J.S., Rubenstone, E. and Zhang, C. Alcohol Use in Adolescents Whose Fathers Abuse Drugs. Journal of Addictive Diseases, 22, pp. 11-33, 2003.

Intergenerational Transmission of Risks for Problem Behavior

The intergenerational transmission of risk factors for problem behaviors was examined across three generations. Two hundred fifty-four 2-year-old toddlers, one or two of their parents, and one grandmother of each toddler were studied. Grandmothers and parents were individually interviewed. Data were analyzed for the male and female toddlers combined. Correlations and hierarchical multiple regression analyses were performed. Findings indicate that the grandmother-parent relationship, parental personality attributes, marital harmony, and drug use and the parent-toddler relationship, predict the toddlers' behavior. The investigation provides evidence for a longitudinal, intergenerational process whereby the grandmother-parent relationship and the parents' personality and behavioral attributes are transmitted across generations through their association with the parent-child relationship. Brook, J.S., Balka, E.B., Whiteman, M. and Zheng, L. Intergenerational Transmission of Risks for Problem Behavior. Journal of Abnormal Child Psychology, 30(1), pp. 65-76, 2002.

Maladaptive Parenting and the Association Between Parental and Offspring Psychiatric Disorders

A longitudinal study was conducted to investigate the role of maladaptive parental behavior and the association between parent and offspring psychiatric disorders. Psychosocial and psychiatric interviews were carried out in a representative community sample of 593 biological parents and their offspring from two counties in the state of New York in 1975, 1983, 1985-86, and 1991-93. In 1975, the mean age of offspring was 6 years. Maladaptive parental behavior was assessed in 1975, 1983, and 1985-86. Parent and offspring psychiatric symptoms were assessed in 1983, 1985-86, and 1991-93. Maladaptive parental behavior substantially mediated a significant association between parental and offspring psychiatric symptoms. Parents with psychiatric disorders had higher levels of maladaptive behavior in the household than did parents without psychiatric disorders. Maladaptive parental behavior, in turn, was associated with increased offspring risk for psychiatric disorders during adolescence and early adulthood. Most of the youths that experienced high levels of maladaptive parental behavior during childhood had psychiatric disorders during adolescence or early adulthood, independent of whether or not their parents had psychiatric disorders. In contrast, the offspring of parents with psychiatric disorders were not at increased risk for psychiatric disorders unless there was a history of maladaptive parental behavior. Maladaptive parental behavior is associated with increased risk for the development of psychiatric disorders among the offspring of parents with and without psychiatric disorders. Maladaptive parental behavior appears to be an important mediator of the association between parental and offspring psychiatric symptoms. Johnson, J.G., Cohen, P., Kasen, S., Smailes, E. and Brook, J.S. Maladaptive Parenting and the Association Between Parental and Offspring Psychiatric Disorders. Zeitschrift fr Psychosomatische Medizin und Psychotherapie, 48, pp. 396-410, 2002.

Adolescent Substance Use Related to Risky Sex Behaviors in Early Adulthood

This study examined the developmental relationship between adolescent substance use and risky sexual behavior in young adulthood. A sample of 808 children was surveyed at age 10 and followed prospectively to age 21 years. Different trajectory groups were identified, including binge-drinking, cigarette smoking, marijuana use, and the use of other illicit drugs. Membership in these groups significantly predicted risky sexual behavior at age 21, after other substance use and early measures of sexual behavior were controlled. Early binge-drinkers had significantly more sex partners than non-binge drinkers. Late onset binge-drinkers and marijuana users had significantly more sex partners and were less likely to use condoms consistently than those who did not binge drink or use marijuana. Experimenters in cigarette smoking, who did not escalate smoking, were more likely to use condoms consistently than nonsmokers. In contrast, the use of other illicit drugs in adolescence did not predict risky sexual behavior at age 21. Guo, J., Chung, I., Hill, K.G., Hawkins, J.D., Catalano, and Abbott, R.D. Developmental Relationships Between Adolescent Substance Use and Risky Sexual Behavior in Young Adulthood. J. of Adolescent Health, 31(4), pp. 354-362, 2002.

Peers Continue to Influence Substance Use in Young Adulthood

This study included data from 294 young adults, ages 19-25, and both a same- and an opposite-gender best friend or mate collected across three annual assessments. The similarity to and influence of the peer on the young adult's substance use were explored. The authors found a similarity across time between both peers and the young adult in cigarette use, alcohol use, binge drinking and, in most cases, marijuana use. In prospective analyses, peer use predicted young adult cigarette use, binge drinking and problem use by the young adults. Results were generally consistent across gender and for both same- and opposite-gender peers. Andrews, J.A., Tildesley, E. Hops, H. and Li, F. The Influence of Peers on Young Adult Substance Use. Health Psychology, 21(4), pp. 349-357, 2002.

Academic Beliefs and Behaviors Related to Increased Cigarette and Marijuana Use

This study examined substance use between 10th and 12th grades in a predominantly African American sample of 785 adolescents from an urban environment. Psychological distress, academic factors, and perceptions of parents and peers were used to examine 10th-grade substance use and changes in use. Results indicated that low achievement and motivation, high truancy, and perceptions of peer substance use were associated with higher 10th-grade substance use. Growth curve analyses revealed that adolescents who perceived negative school attitudes among peers were more likely to increase their cigarette and marijuana use. Among high-achieving students, low motivation was a risk factor for increased cigarette use. Bryant, A.L., and Zimmerman, M.A. Examining the Effects of Academic Beliefs and Behaviors on Changes in Substance Use Among Urban Adolescents. J. of Educational Psychology, 94 (3), pp. 621-637, 2002.

High School Failure Predicted by Deviance, Academic Competence and Tobacco Use

This study explored whether general (vs. specific) deviance and academic competence mediated the relationships between structural strain factors (gender, ethnicity and socioeconomic status (SES)) and 12th grade high school failure. Independent variables of structural strain and mediational variables of drug use, sexual involvement, school trouble, delinquency, and academic performance were assessed in a sample of 754 8th graders and used to predict 12th-grade high school dropout and number of missed months of school in 12th grade (reflecting a latent construct of High School Failure). High school failure was directly predicted by earlier General Deviance, poor Academic Competence, low Family SES, and tobacco use. All ethnic and gender differences in high school failure were mediated by deviance and academic ability or accounted for by Family SES discrepancies. Newcomb, M.D., Abbott, R. D., Catalano, R. F., Hawkins, J. D., Battin-Pearson, S. and Hill, K. Mediational and Deviance Theories of Late High School Failure: Process Roles of Structural Strains, Academic Competence, and General Versus Specific Problem Behaviors. J. of Counseling Psychology, 49(2), pp. 172-186, 2002.

Negative Affectivity and Drug Use in Adolescent Boys: Moderating and Mediating Mechanisms

Using data from the Center on Education and Drug Abuse Research, this investigation examined the relation between negative affectivity and drug use in adolescent boys. In Study 1, 311 boys (15-17 years old) completed inventories of negative affectivity, positive affectivity, constraint, delinquency, peer delinquency, and drug use. Negative affectivity was positively related to drug use, but only for individuals exhibiting high peer delinquency or low constraint. Study 2 examined mechanisms for this relation by following up 143 of the participants at ages 17-20 years. Delinquency and peer delinquency mediated the relation between negative affectivity and later drug use. These findings suggest that the relation between negative affectivity and drug use is best understood within the context of other drug use risk factors. Shoal, G.D. and Giancola, P.R. Negative Affectivity and Drug Use in Adolescent Boys: Moderating and Mediating Mechanisms. Journal of Personality and Social Psychology, 84(1), pp. 221-233, 2003.

Epidemiology of Gambling Participation in the United States

This study examined demographic patterns of gambling participation in the U.S. using a national telephone survey with 2,630 representative U.S. residents aged 18 or older. The sample as weighted for analysis was 48% male, 12% black, and 11% Hispanic. Respondents were questioned on 15 types of gambling: how often they played and how much they won or lost. Eighty-two percent reported having gambled in the past year. Lottery was the most commonly played game, while casino gambling accounted for the largest extent of gambling involvement. Men and women were equally likely to gamble in the past year, but men gambled more frequently and had larger wins and losses, particularly on sports betting and games of skill. Black respondents were less likely to report having gambled in the past year, but blacks who gambled did so more heavily than other racial groups. Blacks and Hispanics were more likely than average to be pathological gamblers. The rate of past year gambling declined with age, but extent of gambling involvement among gamblers did not vary with age. Rates of participation in most forms of gambling increased with socioeconomic status, but higher socioeconomic status gamblers had lower rates of pathological gambling, and lower extent of gambling involvement, particularly for lottery. New Englanders gambled more heavily than other Americans. Comparison with past studies showed an increase in overall gambling participation in the U.S., and large increases in rates of participation in lottery and casino gambling. Welte, J.W., Barnes, G.M., Wieczorek, W.F., Tidwell, M.C., and Parker, J. Gambling Participation in the U.S.--Results from a National Survey. J. Gambling Studies, 18(4), pp. 313-337, 2002.

Effects of Alcohol Misuse on Gambling Patterns in Youth

This study hypothesized that alcohol misuse would predict a pattern of increased youth gambling or a pattern of stable high gambling after controlling for key sociodemographic, socialization and individual factors. Data were analyzed from two longitudinal studies of youth living in a western New York metropolitan area. Respondents' gambling at two times over the course of 12-18 months was classified into one of five gambling pattern groups, representing flat-low, increasing, flat-medium, flat-high and decreasing levels of gambling. Alcohol misuse among males predicted increasing gambling over time or a pattern of stability of high rates of gambling even after controlling for socioeconomic status, race, age, impulsivity and parental monitoring in the family study. Higher parental monitoring and lower alcohol misuse were significant in predicting a decreasing pattern of gambling among males in the male delinquency study. For females in the family study, alcohol misuse predicted an increasing pattern of gambling only when other factors such as high impulsivity or low parental monitoring were present. Results are consistent with the notion that gambling and alcohol misuse are prevalent among youth and may be part of a common problem behavior syndrome. Barnes, G.M., Welte, J.W., Hoffman, J.H., and Dintcheff, B.A. Effects of Alcohol Misuse on Gambling Patterns in Youth. Journal of Studies on Alcohol, 63(6), pp. 767-775, 2002.

Intimate Partner Violence and Substance Abuse Among Minority Women

This study describes the rates of lifetime and current intimate partner violence (IPV) among women awaiting care in an emergency department and explores the association between IPV and having a substance abuse problem, after controlling for demographic factors and history of childhood victimization. Face-to-face interviews were conducted with 143 low-level triaged women recruited from an inner-city emergency department. Nearly one-half reported ever experiencing IPV, and over 18% reported IPV during the year before the interview. Participants who were physically abused by their partner during the past year (15%, n = 21) were more likely than nonabused women (85%, n = 122) to report more alcohol-related problems on the Alcohol Use Disorders Identification Test (AUDIT) (4.9 vs. 2.4) and more drug-related problems on the Drug Abuse Severity Test (DAST) (3.0 vs. 1.3). In addition, sexually abused women (6%, n = 9) had higher AUDIT scores (6.4 vs. 2.5) than their counterparts (94%, n = 134). The findings have implications for how the intersecting public health problems of IPV and substance abuse should be taken into consideration in research and patient care protocols in emergency departments. El-Bassel, N., Gilbert, L., Witte, S., Wu, E., Gaeta, T., Schilling, R. and Wada, T. Intimate Partner Violence and Substance Abuse Among Minority Women Receiving Care from an Inner-City Emergency Department. Women's Health Issues, 13(1), pp. 16-22, 2003.

Two-Dimensional Nature of Psychopathy in Adjudicated Youths

This study sought to clarify the nature of two dimensions associated with psychopathic traits (a callous/unemotional factor [C/U] and an impulsivity/conduct problems factor [I/CP]) with social-cognitive problems in incarcerated adolescents. One hundred sixty-nine male and female adjudicated youths were recruited for participation. Self-report measures and archival data were used to assess psychopathic traits, emotional distress, behavioral dysregulation, social-cognitive processes, and delinquency severity. Analyses demonstrated that the I/CP factor is associated with increased levels of dysregulated behavior, while the C/U dimension is related to deficits in empathy. The two factors exhibited differential relations with measures of emotional distress and fearfulness. C/U traits were associated with an increased focus on the positive aspects of aggression and a decreased focus on the negative aspects of hostile acts. Findings remained after controlling for demographic characteristics, abuse history, intellectual abilities, and delinquency severity. Results provide support for the two-dimensional nature of psychopathy in youths and suggest that C/U traits are associated with lower emotional distress and a specific social information-processing pattern. Pardini, D.A., Lochman, J.E., and Frick, P.J. Callous/Unemotional Traits and Social-Cognitive Processes in Adjudicated Youths. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), pp. 364-371, 2003.

Minnesota Twin Family Study Focuses on Substance Abuse and Related Problems

As part of a special issue of the journal Twin Research, the authors provide an overview of their study, to which NIDA has contributed significant support. This is a large longitudinal study of twins and parents, with a parallel study of adoptive and biologically related siblings and their parents. Subjects participate in an intensive assessment battery including physiologic measures of endophenotype, psychopathology and personality, cognition, and environmental factors. DNA is being collected for future candidate gene studies. Numerous findings regarding behavioral undercontrol, heritability, environmental protective factors, personality and substance abuse, and psychophysiologic markers of risk have been published. The principal researchers have fostered the research development of many junior investigators, and they outline opportunities for collaborations with other research groups. Iacono, W.G. and McGue, M. Minnesota Twin Family Study. Twin Research, 5(5), pp. 482-487, 2002.

Overview of the National Comorbidity Survey

This chapter presents an overview of the research program associated with the U.S. National Comorbidity Survey (NCS). This research program includes the baseline NCS, the NCS-2, and NCS-R, the NCS-A, and the WMH2000. The baseline NCS (1990-1992) was the first nationally representative mental health survey in the Unites States to use a fully structured research diagnostic interview to assess the prevalences and correlates of DSM-III-R disorders, including substance use disorders. The NCS-2 is a 10-year follow-up of the baseline NCS designed to study patterns and predictors of mental and substance use disorders, and to evaluate the effects of primary mental disorders in predicting the onset and course of secondary substance use disorders. Carried out in conjunction with the NCS-2, the NCS-R is a replication of the baseline NCS with a new nationally representative sample of 10,000 respondents, and the NCS-A is a survey of a nationally representative sample of 10,000 adolescents. Finally, the WMH2000 is a centralized cross-national analysis of World Mental Health surveys administered to nationally representative samples from 28 countries. Kessler, R.C. and Walters, E. The National Comorbidity Survey. In M.T. Tsuang and M. Tohen (Eds.) Textbook in Psychiatric Epidemiology (2nd Ed.), pp. 343-361, 2002.

Exploring a Source of Deviance-Producing Strain for Females: Perceived Discrimination and General Strain Theory

While the oppression of women has been held by many feminist criminologists to be at the core of female crime, little research had explored the link between discrimination, generally, and gender-based discrimination, specifically, and female deviance. Using the framework of general strain theory (GST), this study used a sample of young adult females to explore whether self-reported measures of discrimination experiences were related to self-reported criminal activity and/or diagnoses of substance use disorders. Results indicated that a measure of major discrimination that included gender discrimination was a significant predictor of both crime and substance use disorders. Results indicated that a measure of major discrimination that included gender discrimination was a significant predictor of both crime and substance use disorders. These findings were interpreted as being supportive of GST and previous scholarship by other feminist criminologists. Eitle, D.J., Journal of Criminal Justice, 30, pp. 429-442, 2002.

Exposure to Community Violence and Young Adult Crime: The Effects of Witnessing Violence, Traumatic Victimization, and Other Stressful Life Events

Evidence has accumulated that young people in America are witness to considerable violence at home and in the community. This study is the first to examine the association between witnessing community violence and criminal behavior in a representative sample of young adults. In addition, the authors consider whether receiving traumatic news, witnessing domestic violence, experiencing accidents, and being the direct victim of domestic and community-based violence are independently associated with young adult crime. The results indicate that recent exposure to violence in the community along with a history of receiving traumatic news, direct victimizations in the community, recent life events, and associations with criminal peers increase the risk for young adult criminal offending. The implications of these results are discussed. Eitle, D. and Turner, R.J. Journal of Research in Crime and Delinquency, 39, pp. 214-237, 2002.

Perceived Discrimination, Social Stress and Depression in the Transition to Adulthood: Racial Contrasts

We consider the association between racial discrimination and depression in a relatively comprehensive assessment of general social stress. Data for this investigation come from a sample of Miami-Dade County young adults; the present analyses are limited to African American and white non-Hispanic respondents. Findings indicate that perceptions of discrimination are strongly related to psychological distress. Surprisingly, however, these perceptions contribute almost nothing to an understanding of the origins of racial differences in depression. It appears that differences in lifetime adversity and in exposure to recent and chronic stressors capture those variations in personal history and circumstance which are linked to and arise from social disadvantage and which are relevant to mental health. Variations in these more general forms of social stress account for observed racial differences in depressive symptomatology. Taylor, J., and Turner, R.J. Social Psychological Quarterly, 65, pp. 213-225, 2002.

Race/Ethnicity and Depressive Symptoms In Community-Dwelling Young Adults: A Differential Item Functioning Analysis

To examine variations in the manifestation of depressive symptomatology across racial/ethnic groups, analyses of differential item functioning (DIF) on the Center for Epidemiologic Studies Depression Scale (CES-D) were separately conducted for representative samples of young adults in the following groups: African-Americans (n = 434), Hispanics born in the US (n = 493), and Hispanics born outside the US (n = 395). Non-Hispanic whites (n = 463) were employed as the reference group in all analyses. The effects of gender and age were controlled. DIF analyses indicated that: (1) about half of the CES-D items functioned differently among non-Hispanic whites compared to each of the other racial/ethnic groups; (2) the manifestation of symptoms seemed to be similar for both Hispanic groups, except for low positive affect; (3) African-Americans tended to favor somatic symptoms over affective (depressive) symptoms; (4) Immigrant Hispanics appeared to inhibit the expression of positive affect, and thus more high scorers on the total CES-D were observed within this subgroup. In contrast, no differences were observed when only negative items were considered. The use of positive affect items might artifactually induce spurious differences among people who were born outside the United States or North America. Turner, R.J., Lloyd, D.A. and Iwata, N. Psychiatry Research, 110, pp. 281-289, 2002.

Ethnographic Analysis of African-American Women's Pathways to Involvement in Drug Distribution

This is an exploratory ethnographic analysis to address the question of "What factors in Black women's backgrounds lead them towards crack (and other drug) sales as a primary economic activity in adulthood?" There is considerable overlap in women's pathways to involvement in drug distribution, including positive exposure to the local level informal economy during childhood, the historical positioning of Black women as producers and consumers within the informal sector, the impact of structural and cultural disinvestment, drug use, and early recruitment to and participation in street life. While drug use was a crucial variable in determining their subsequent involvements in distribution activities, this study indicates that most women sellers were engaged in lawbreaking prior to regular involvement in illicit drug use. All of the women acquired an early start in street life and an early introduction into the ways of making "fast" money. For these women, street life is a critical variable that mediates involvement in drug distribution. The study suggests that it was not merely the involvement of the domestic network or kinship group in extra-legal and illegal activities, but rather the lack of social and economic infrastructure and the absence of legitimate opportunity structures and employment at the neighborhood level that led African-American women to seek alternative avenues of income generation. Maher, L., Dunlap, E. and Johnson, B. Black Women's Pathways to Involvement in Illicit Drug Distribution and Sales: An Exploratory Ethnographic Analysis in Drugs and Crime Deviant Pathways, edited by S. Brochu, C. da Agra, and M-M. Cousineau, Ashgate, pp. 167-193, 2002.

Youth Report and Census Measures of Neighborhood Context Show Correspondence

This study sought to determine whether survey data could be used to measure neighborhood context. Using a non-representative sample of youth, the consistency was explored between measures of neighborhood disadvantage/disorganization developed from the national census and from surveys of youth given the same year. Results showed strong correspondence between the contemporaneous measures, suggesting that survey data can be used to measure neighborhood factors. Herrenkohl, T.I., Hawkins, J.D., Abbott, R.D. and Guo, J.J. Correspondence Between Youth Report and Census Measures of Neighborhood Context. Community Psychology, 30(3), pp. 225-233, 2002.

Childhood Factors Predict Offense Trajectories

Using data from a longitudinal study of youth followed since 1985, this study identified childhood predictors of different offense trajectories. Five offense trajectories were identified including nonoffenders, late onsetters, desisters, escalators, and chronic offenders. Results indicated that among initial nonoffenders at age 13, late onsetters were distinguished from non-offenders by individual factors such as aggressive behavior and/or being anxious/depressed measured at ages 10 and 12. Among youth already delinquent at age 13, escalators were distinguished from desisters by peer, school, and neighborhood factors. Chung, I., Hill, K.G., Hawkins, J.D., Gilchrist, L.D. and Nagin, D.S. Identifying and Predicting Offending Trajectories among Poor Children. J. of Research in Crime and Delinquency, 39(1), pp. 60-90, 2002.

Gender and Ethnic Differences in Students' Smoking, Drinking and Illicit Drug Use

Researchers affiliated with Monitoring the Future at the University of Michigan examined ethnic differences in licit and illicit drug use among American 8th, 10th and 12th grade students over the period from 1972 through 2002, with a particular focus on girls. The study used cross-sectional data from the large, ethnically diverse, nationally representative MTF samples of 8th, 10th and 12th graders including 40,416 8th grade girls and 37,977 8th grade boys; 35,451 10th grade girls and 33,188 10th grade boys; and 33,588 12th grade girls and 31,014 12th grade boys. Across ethnic groups, drug use was found to be highest among Native American girls and lowest among black and Asian American girls. Trend data suggested that there have been important changes in girls' drug use over time and girls' and boys' drug use patterns are converging. The authors concluded that drug use is widespread among American adolescent girls and that further research is needed to determine whether risk and protective factors identified in the past, using predominantly white samples, are also applicable to drug use among non-white girls. Wallace, J.M., Bachman, J.G., O'Malley, P.M., Schulenberg, J.E., Cooper, S.M. and Johnston, L.D. Gender and Ethnic Differences in Smoking, Drinking and Illicit Drug Use Among American 8th, 10th and 12th Grade Students, 1976-2000. Addiction, 98(2), pp. 225-234, 2003.

Relational and Physical Victimization Within Adolescent Friendships

This study examines relational and physical forms of victimization within dyadic relationships such as friendships. Results showed that boys were more physically victimized by their friends than were girls. Girls were more relationally than physically victimized by their friends. Friend victimization was related to adjustment difficulties for both boys and girls; however, friend physical victimization was particularly related to boys whereas friend relational victimization was particularly related to girls. Crick, N.R. and Nelson, D.A. Relational and Physical Victimization Within Friendships: Nobody Told Me There'd Be Friends Like These. Journal of Abnormal Child Psychology, 30(6), pp. 599-607, 2002.


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