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

Research Findings - Epidemiology and Etiology Research

Community Epidemiology Work Group

The 55th meeting of the Community Epidemiology Work Group (CEWG), chaired by Moira O'Brien, DESPR, was held in Atlanta, Georgia, on December 9-12, 2003. 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 for 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.

Polydrug abuse, where different drugs are used in combination or sequence to achieve specific desired effects, was identified during meeting discussions as a significant and troubling trend across localities. Examples of polydrug abuse reported include the mixture of MDMA and Viagra known as "sextasy" (Atlanta), combination of PCP, opium, and crystal methamphetamine known as "red devil dust" (Texas), and the practice by some dealers of pulverizing OxyContin pills and mixing the powder with heroin to enhance the high (New York City).

Methamphetamine abuse was identified as an issue of great concern by CEWG members. Abuse indicators remain high in Hawaii and west coast areas, and show methamphetmine use is spreading eastward. Seizures of methamphetamine labs were reported in most CEWG areas/States, and reports of methamphetamine abuse came from as fareast and south as Miami, New Orleans, New York and Philadelphia. "Ice," the most potent form, has increased in availability in areas of North Texas, Minneapolis, Phoenix, and San Diego.

Cocaine/Crack continues to be widely available and a major problem in most CEWG areas. Rates of ED mentions per 100,000 population in 2002 were higher for cocaine than for any other drug in 17 CEWG areas. Two exceptions were San Francisco and Newark where rates of heroin mentions were higher than those for cocaine. In Philadelphia, crack users report use of the drug in combination with malt liquor, or other drugs including marijuana, heroin, or alprazolam.

Heroin abuse indicators remained relatively stable in most CEWG areas, continuing at high levels in particular areas and relatively low levels in others. Heroin indicators tended to be highest in northeastern/mid-Atlantic areas where high purity powder from South America was available. However, heroin indicators were also relatively high in two west coast areas (San Francisco and Seattle) where black tar heroin predominates and purity levels are comparatively low.

Opiates (other than heroin) abuse indicators continue to trend upward. Rates of ED narcotic analgesic/combinations mentions per 100,000 population rose significantly in 14 CEWG areas from 2000 to 2002 with rates particularly high in Baltimore, New Orleans, Boston, Detroit and Seattle.

Marijuana abuse indicators remained at high, but fairly stable levels, in most CEWG areas. In 2002, rates of marijuana ED mentions per 100,000 populations were highest in Philadelphia (150), Detroit (146), St. Louis (124) and Boston (119). From 2001 to 2002, rates of marijuana ED mentions increased significantly in three areas (Baltimore, Miami and Newark), but decreased significantly in four (Chicago, Dallas, San Francisco, and Seattle).

MDMA (methylenedioxymethamphetamine) or ecstasy abuse showed some evidence for declines in use and/or consequences. MDMA ED mentions decreased significantly in nine CEWG areas from 2001 to 2002 and increased significantly between 2001 and 2002 in only one CEWG area: New Orleans. Concern remains regarding the spread of use to new populations (increased use reported among African-American and Hispanic populations in Atlanta, Chicago, New York, Texas, and Washington, DC), use of MDMA in combination or sequence with other drugs, and "unintentional" combinations or unknown content of pills taken since ecstasy tablets often contain drugs other than MDMA and users may not know what drug or drugs they are taking.

PCP abuse was identified as a trend emerging in some metropolitan areas that bears watching. In 2002, rates of PCP ED mentions per 100,000 increased significantly for the coterminous US and in 6 CEWG areas including Washington, DC (31), Philadelphia (25), Baltimore (5), Dallas (4), Newark (7) and St. Louis (6). A high DAWN ED was also reported for Los Angeles (11). A panel was convened during the December 2003 CEWG meeting to explore the issue of PCP abuse. A DEA representative provided current information on PCP production and distribution in the US. CEWG members from Washington DC and Los Angeles discussed PCP abuse in their respective areas. A presentation by a NIDA grantee conducting research in Hartford, CT, described the emergence of PCP abuse in the Hartford area. Panel presentations and discussions reported that PCP in liquid form is often combined with other substances, including formaldehyde, and then added to marijuana or tobacco cigarettes. Often users do not know the exact contents of the substance they are using. The panel stressed the importance of coordinating information from police labs in localities where PCP is reported as a problem to learn more about the actual ingredients of substances purported to be or to include PCP. The panel stressed the need for educational strategies to alert users and their networks to the risks of using PCP and PCP-related substances.

Neurobehavior Disinhibition in Childhood Predicts Substance Use Disorder in Young Adulthood

The development of substance use disorder (SUD) was prospectively investigated in 66 boys having fathers with SUD and 104 boys having fathers with no adult psychiatric disorder. Evaluations were conducted to determine the context in which neurobehavior disinhibition in relation to parental SUD, parental neglect of the child and child's social maladjustment culminated in a DSM-III-R diagnosis of SUD. A neurobehavior disinhibition latent trait reflecting prefrontal cortex disturbance was derived using indicators of behavior undercontrol, affect dysregulation and executive cognitive functioning in the boys when they were 10-12 and again at 16 years of age. The data were analyzed to determine whether the score on the neurobehavior disinhibition construct mediates the association between father's and mother's SUD and son's SUD. Several key results emerged. First, SUD in the mother and father predicted neurobehavior disinhibition in the son. Second, the neurobehavior disinhibition score of the sons at ages 10-12 predicted SUD at age 19. Third, neurobehavior disinhibition, in conjunction with social maladjustment and drug use frequency, mediated the association between paternal and maternal SUD and son's SUD. Fourth, neurobehavior disinhibition was unrelated to neglect of the child by either the father or mother; however, paternal but not maternal neglect at age 10-12 predicted SUD at age 19. These findings suggest that prefrontal cortex dysfunction contributes to SUD liability. Tarter R.E., Kirisci L., Habeych M., Reynolds M. and Vanyukov M. Neurobehavior Disinhibition in Childhood Predisposes Boys to Substance Use Disorder by Young Adulthood: Direct and Mediated Etiologic Pathways. Drug and Alcohol Dependence, 73, pp. 121-132, 2004.

SUD Among Mental Disorders Increases Risk for Later Depression

The authors used retrospective psychiatric data from population-based samples of men and women to assess degree and time periods of risk for major depressive disorder posed by prior or co-occurring psychiatric disorder. The disorders studied included psychoactive substance use disorders, alcohol dependence, generalized anxiety disorder, panic disorder, phobia, and conduct disorder. Although the highest risk for depression was associated with co-occurring disorder, elevated risk for depression was associated with prior episodes of any of the studied disorders, regardless of the length of time from the first disorder to depression. Thus, SUD, like the anxiety and conduct disorders also studied, poses a lifetime increase in risk for depression. This suggests that the public health impact of preventing substance use disorders may extend to a possible impact on rates of depression, which is also a very costly and debilitating disorder. Hettema, J.M., Prescott, C.A., and Kendler, K.S. The Effects of Anxiety, Substance Use and Conduct Disorders on Risk of Major Depressive Disorder. Psychological Medicine, 33, pp.1423-1432, 2003.

Family Transmission of Marijuana Use, Abuse, and Dependence

This is the first family study to specifically examine the familial aggregation of marijuana use, abuse, and dependence. Subjects included adolescents recruited from residential and day treatment programs for youths with conduct and substance problems, matched controls, and all available family members. A total of 2,546 individuals from 781 families were interviewed with structured research instruments. Risk ratios of relatives of clinical cases were calculated compared with controls, for marijuana use, abuse, or dependence. Spousal, parent-offspring, and sibling correlations and the proportion of variance attributable to parent-offspring transmission were estimated using structural equation modeling. The results indicated that, for all three measures, the risk ratios were elevated in the family members of clinical probands, with estimates ranging from 1.5 to 3.3. Spousal correlations ranged from 0.33 to 0.70. Parent-offspring correlations ranged from 0.17 to 0.30. Sibling correlations ranged from 0.34 to 0.44. The proportion of variance attributable to factors transmitted from parents to children ranged between 25% and 44%. Results demonstrate significant parent-offspring transmission of risk, sibling environmental influences, and assortative mating for all three levels of marijuana use. Hopfer C.J., Stallings M.C., Hewitt J.K., and Crowley T.J. Family Transmission of Marijuana Use, Abuse, and Dependence. Journal of the American Academy of Child and Adolescent Psychiatry, 42, pp. 834-834, 2003.

Substance Use Among Adults 35 Years of Age: Prevalence, Adulthood Predictors, and Impact of Adolescent Substance Use

Using national longitudinal panel data from the Monitoring the Future study, this study examines the prevalence of substance use among American adults aged 35 years, and assesses the impact of adolescent substance use and adulthood predictors. Logistic regressions were conducted to assess the impact of demographics, life experiences, and adolescent substance use on smoking, heavy drinking, prescription drug misuse, marijuana use, and cocaine use at 35 years of age. Results indicate that factors related to increased likelihood of substance use include high school use, unemployment, and non-custodial parenthood. Lower use was associated with being female, a college graduate, a professional, married, or a custodial parent. Among those aged 35 years, substance use was still fairly prevalent and was a function of adulthood roles, experiences, and previous use. Merline A.C., O'Malley P.M., Schulenberg J.E., Bachman J.G. and Johnston L.D. Substance Use Among Adults 35 Years of Age: Prevalence, Adulthood Predictors, and Impact of Adolescent Substance Use. American Journal of Public Health, 94(1), pp. 96-102, 2004.

How Academic Achievement, Attitudes, and Behaviors Relate to the Course of Substance Use During Adolescence: A 6-Year, Multiwave National Longitudinal Study

Self-report data regarding alcohol, cigarette, and marijuana use were collected biennially from ages 14 to 20 in a nationally representative panel sample of adolescents (N = 1,897) from the Monitoring the Future study. Growth curve analyses were performed using hierarchical linear modeling to consider psychosocial background, motivation and school attitudes, and parental and peer influences at age 14 as predictors of concurrent substance use and change in substance use. Results indicate that school misbehavior and peer encouragement of misbehavior were positively associated with substance use at age 14 and with increased use over time; school bonding, school interest, school effort, academic achievement, and parental help with school were negatively associated. The protective effects of positive school attitudes and perceptions of high status connected to academics were stronger for low-achieving compared with high-achieving youth. Implications for a developmental perspective on substance use etiology and prevention are discussed. Bryant A.L., Schulenberg J.E., O'Malley P.M., Bachman J.G., and Johnston L.D. How Academic Achievement, Attitudes, and Behaviors Relate to the Course of Substance Use During Adolescence: A 6-Year, Multiwave National Longitudinal Study. Journal of Research on Adolescence, 13(3), pp. 361-397, 2003.

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

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

Stress Exposure, Race, and Young Adult Male Crime

A recent revision of strain theory, Robert Agnew's (1992) general strain theory (GST), has stimulated research testing its principles, central to which is the notion that exposure to stressors is positively associated with criminal behavior. The present research extends prior scholarship in three important ways: (1) assessing the role that race and ethnicity play in understanding the stress-crime relationship, (2) testing GST principles on an underexamined group of crime prone individuals (i.e., young adults), (3) examining the stress-crime association with a substantially more comprehensive set of measures of stressors than prior evaluations. Central to the study's findings is the result that racial differences in criminal involvement are largely reducible to exposure differences, with blacks typically exposed to significantly more stressful events over their lifetimes than members of other racial/ethnic groups. Eitle, D. and Turner, R.J. Stress Exposure, Race, and Young Adult Male Crime. Sociological Quarterly, 44, pp. 243-269, 2003.

Patterns of Sexual Risk Behaviors and Psychiatric Disorders in a Community Sample of Young Adults

This cross-sectional study documents significant associations between patterns of sexual risk behaviors and psychiatric diagnoses in a multiethnic community sample of young adults (N =1803) in South Florida. Self-report data regarding sexual behavior and psychiatric symptoms were collected in structured interviews in a follow-up of an earlier school-based study. Cluster analysis was used to group participants with regard to levels of sexual risk behaviors during the past year. Chi-square analysis and ANOVA identified significant associations between cluster membership and (a) lifetime and (b) past year diagnoses for affective disorders, conduct disorder, antisocial personality disorder, alcohol abuse/dependence, marijuana abuse/dependence, and other drug abuse/dependence. In addition, higher levels of sexual risk behaviors were associated with higher levels of cumulative lifetime psychiatric disorders. Implications for selected prevention of sexually transmitted diseases (STDs) and the treatment of psychiatric disorders in young adulthood are discussed. Tubman, J.G., Gil, A.G., Wagner, E. F., and Artigues, H. Patterns of Sexual Risk Behaviors and Psychiatric Disorders in a Community Sample of Young Adults. Journal of Behavioral Medicine, 26, pp. 473-500, 2003.

Cumulative Adversity and Post-Traumatic Stress Disorder: Evidence From A Diverse Community Sample Of Young Adults

The authors hypothesized that history of adversities, whether objectively traumatic or not, predicts risk for first-onset of PTSD. Survival analysis in a community sample of 1803 young adults revealed risk is associated with retrospectively reported adverse experiences that occurred in years prior to the focal traumatic event. Analyses control for clustering of events proximal to onset. Implications for etiology and preventive intervention are noted. Lloyd, D.A. and Turner, R.J. Cumulative Adversity and Post-Traumatic Stress Disorder: Evidence From A Diverse Community Sample Of Young Adults. American Journal of Orthopsychiatry, 73, pp. 381-391, 2003.

The Deterrence Hypothesis Reexamined: Sports Participation and Substance Use Among Young Adults

The widely held notion that sports participation reduces subsequent risk of substance use is evaluated with longitudinal survey data of a representative sample of 1,172 youth when they were in their preteen and young adult years. Unlike previous inquiries into the deterrence hypothesis, the present study controls for other major factors previously found to be predictive of alcohol and drug use, such as family structure and stress exposure. Results of analyses revealed that contrary to the deterrence hypothesis, playing high school sports does not appear to be a protective factor that lowers one's involvement in young adult alcohol or drug use--with one exception. Subgroup analyses revealed that among blacks, the greater the extent of high school sports participation the less the risk of substance use. In direct contradiction to the deterrence hypothesis, playing high school sports was found to be positively associated with alcohol use for whites, even in the context of other major predictors of alcohol use. Further analyses revealed that the positive association between sports participation and alcohol use appeared to exist only for white males. These findings cast doubt about the contention that playing high school sports is protective against alcohol and illegal substance use. Eitle, D., Turner, R.J. and Eitle, T.M. The Deterrence Hypothesis Reexamined: Sports Participation and Substance Use Among Young Adults. Journal of Drug Issues, 33, pp. 193-222, 2003.

BIS/BAS Levels and Psychiatric Disorder: An Epidemiological Study

Behavioral inhibition and behavioral activation levels have been theorized to relate to a broad range of psychopathologies. To date, however, studies have focused on a single diagnosis, and the measures used to assess different psychopathologies have varied greatly. This study assessed how levels of behavioral inhibition and behavioral activation relate to lifetime diagnoses of depression, anxiety, drug abuse and dependence, alcohol abuse and dependence, attention deficit hyperactivity disorder, and conduct disorder. A representative community sample of 1803 individuals between the ages of 19 and 21 in the Miami area was surveyed with the Composite International Diagnostic Interview and the Behavioral Inhibition and Behavioral Activation Scales (BIS/BAS; Carver & White, 1994). Results supported the role of BIS as a vulnerability factor for depression and anxiety and for BAS Fun-Seeking for drug abuse and non-comorbid alcohol diagnoses. Other models were not supported. Goals in understanding BIS and BAS are described, including the need for prospective studies with a broader array of behavioral indices. Johnson, S.L., Turner, R.J. and Iwata, N. BIS/BAS Levels and Psychiatric Disorder: An Epidemiological Study. Journal of Psychopathology and Behavioral Assessment, 25, pp. 25-36, 2003.

The Pursuit of Socially Modifiable Contingencies in Mental Health

The effort to understand the meanings of the well-demonstrated linkages between mental health and one's locations in the social structure has commanded a great deal of research attention over the past half century. Findings support the conclusion that differences in exposure to social stress represent a much more critical contingency in mental health and substance use outcomes than has generally been assumed. In addition, reported results indicate that the lifetime experience of multiple adversities is quite common among young people in South Florida and, presumably, elsewhere and the likelihood that the compelling linkage observed between cumulative adversity and risk for psychiatric and substance disorders is causal in nature. Evidence also suggests that differences in exposure to adversity may account for much of the observed association between psychiatric disorder and substance dependence. It is suggested that the development of interventions in the service of stress prevention or reduction should command a greater proportion of the attention of researchers and interventionists. Turner, R.J. The Pursuit of Socially Modifiable Contingencies in Mental Health. Journal of Health and Social Behavior, 44, pp. 1-17, 2003.

Cumulative Adversity and Drug Dependence in Young Adults: Racial/Ethnic Contrasts

This study assesses the effects of cumulative exposure to stressors as a risk factor for drug dependence, and evaluates whether race/ethnic differences in exposure to stressful events contributes to race/ethnic differences in prevalence of drug dependence. Data were analyzed cross-sectionally from a community survey of lifetime adverse experiences and substance and psychiatric disorders among young adults. Data were collected between 1997-2000 in Miami-Dade County, Florida. The sample size is 1,803 former Miami-Dade Public School students, 93% of whom were between ages 19 and 21 when interviewed. Males and females of Cuban origin, other Caribbean basin Hispanics, African-Americans, and non-Hispanic Whites are equally represented. Drug dependence disorder was assessed by DSM-IV criteria using the Composite International Diagnostic Interview, and a 41-item checklist of lifetime exposure to major and potentially traumatic experiences was used to measure cumulative adversity. Both measures include age at time of first occurrence. The lifetime rate of drug dependence disorder (total 14.3%) did not vary significantly (p>.05) by socioeconomic group. The rate for males (17.6%) was significantly greater than female rate (10.9%). The African-American rate (6.5%) was dramatically lower than non-Hispanic White (17.0%), Cuban (18.1%) and non-Cuban Hispanic (16.0%) rates despite their dramatically higher exposure to adversity. Twenty eight of 33 individual adversities were associated with the subsequent onset of drug dependence (p<.05). Cumulative lifetime exposure was greatest for males and for African-Americans, and was inversely associated with socioeconomic level. Multivariate discrete-time event history analysis revealed significant independent effects of distal (>1 year earlier) and proximal (previous year) exposure to adverse events (p<.05), controlling for childhood conduct disorder, ADHD, and prior psychiatric disorder. Lifetime cumulative exposure to distant as well as more recent adversity predicts risk of subsequent drug dependence, though it does not explain ethnic group differences in risk. Implications are that distal and proximal stressful events should both be included when measuring stress exposure. Turner, R.J., and Lloyd, D. Cumulative Adversity and Drug Dependence in Young Adults: Racial/Ethnic Contrasts. Addiction, 98, pp. 305-315, 2003.

Status Variations in Stress Exposure Among Young Adults: Implications for the Interpretation of Prior Research

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

Substance Use, Dependence, and Service Utilization Among the US Uninsured Non-Elderly Population

Investigators examined the prevalence and correlates of substance use, dependence, and service utilization among uninsured persons aged 12 to 64 years. Using the 1998 National Household Survey on Drug Abuse, the investigators found an estimated 80% of the uninsured non-elderly persons reported being uninsured for more than 6 months in the prior year. Within this data sample, only 9% of the uninsured persons who were dependent on alcohol or drugs had received any substance abuse services in the past year. Non-Hispanic Whites were estimated to be 3 times more likely than Blacks to receive substance abuse services. In conclusion, compared with the privately insured, uninsured persons had increased odds of having alcohol/drug dependence and appeared to face substantial barriers to health services for substance use problems. Wu, L.T., Kouzis, A.C., and Schlenger, W.E. Substance Use, Dependence, and Service Utilization Among the US Uninsured Non-Elderly Population. American Journal of Public Health, 93(12), pp. 2079-2085, 2003.

Intravenous Drug Use Among Street-Based Sex Workers: A High-Risk Behavior for HIV Transmission

The goal of this study was to determine the correlates and prevalence of intravenous drug users among Street-Based Sex Workers (SSW's) in Ho Chi Minh City. A cross sectional study was conducted among SSW's in Ho Chi Minh City during December 2000. The SSW's were interviewed and tested for HIV-1. HIV prevalence among sex workers in Ho Chi Minh City has increased rapidly, from 6.5% in 1999 to 18.1% in 2000. This study examined whether injecting drug use among street-based sex workers (SSW's) in Ho Chi Minh City is a high-risk factor for HIV infection. The study findings showed HIV-1 seroprevalence was 16.3%. Regression analysis indicated that injecting drugs and being younger than 25 years of age were independently associated with HIV seropositivity. The investigators concluded that young SSW's who inject drugs are at the greatest risk of contracting HIV and acting as a bridge for HIV to the sexually active population. Nguyen, A.T., Nguyen, T.H., Pham, K.C., Le Truong, G., Bui, D.T., Hoang, T.L., Tobi, S., and Roger, D., Intravenous Drug Use Among Street-Based Sex Workers: A High-Risk Behavior for HIV Transmission. Sexually Transmitted Diseases, 31(1), pp. 15-19, 2004.

Substance Use References in the Lyrics of Favorite Songs of African-American Adolescents

Concerns have been raised regarding the effect of media messages on health risk behaviors, particularly given that media with explicit content are often marketed toward adolescents under the age of 18 (Federal Trade Commission 2000). The goal of this study was to investigate the extent to which drug-related references were present in popular songs nominated by a sample of African-American adolescents. To address this issue, secondary data analyses were performed using data originally collected by the Reaching Adolescents, Parents, and Peers project (Project RAPP). In the spring of 1997, participants reported their five favorite songs. Songs that were nominated five or more times by the sample (popular songs) were coded for genre and drug-related content. Of the 93 popular songs, the most popular genres were R&B (34%), gangsta rap (32%), and non-gangsta rap (27%). The majority of rap (68%) and gangsta rap (80%) songs contained at least one reference to illicit drugs, whereas few R & B songs did (6%). Marijuana and stimulants were the most commonly referred to drugs. These findings substantiate the need for more research on the potential relationship between exposure to media messages and drug use among adolescents. Brookshire, C.D., Stevens, E., Bryant, S., Browne, D.C., and Clubb, P. Substance Use References in the Lyrics of Favorite Songs of African-American Adolescents. Journal of Young Investigators, 1(1), pp 1-7, 2003.

Inner-City, Welfare-Needy, Drug-Using Households and Welfare Reform

This study reports ethnographic observations made from 1995-2001 on welfare-needy subjects, i.e., subjects lacking long-term stable employment and with little prospect of attaining it, who use illicit drugs or are members of a household containing a drug user. The authors suggest that the prevalence of drug-using, welfare-needy households has been greatly underestimated in the literature because subjects such as these have been unable to maintain continuous AFDC/TANF support, avoid participating in surveys, or do not disclose the full extent of their substance use in surveys. This study suggests that welfare reform is not helping welfare-needy, drug-using subjects gain economic independence through employment. Rather, subjects experience welfare reform "incentives" as "punishments" by a welfare system that does not understand their needs. Welfare reform has resulted in drug-using subjects in the inner city being cut off welfare, and this in turn has caused hardship and increased reliance on the underground economy. Dunlap, E., Golub, A. and Johnson, B.D. The Lived Experience of Welfare Reform in Drug-Using Welfare-Needy Households in Inner-City New York. Journal of Sociology and Social Welfare, 30(3), pp. 39-58, 2003.

Childhood Compelled Sex and Its Relationship to Structural Disadvantage, Subcultural Norms, Violence, and Illicit Drug Use in Inner City Households

There are a number of studies that have linked child sexual abuse to various adverse outcomes, including substance abuse. This study is a retrospective, qualitative study that seeks to understand the etiology, significance, and response to early compelled sex within the social context of poor, inner-city, predominantly African-American households (approximately 72 households) in New York City. Adult sexual contact with girls was widespread, even the norm in many impoverished households, although it is not accepted behavior by everyone living in the inner city. 61% of female subjects reported having compelled sex by age 13. Typically this activity took place regularly over time and fit within the young girl's sexual development pathway leading to independent sexuality. Many adults do not regard compelled sex as a major problem, and compelled sex is consistent with other subcultural behaviors, including violence and the ever-present threat of violence. The primacy of drug use in the lives of many inner-city residents also supports the acceptance of these subcultural norms and the commodification of sexual behavior (exchange of sex for food, rent money, drugs). Dunlap, E., Golub, A. and Johnson, B. Girls' Sexual Development in the Inner City: From Compelled Childhood Sexual Contact to Sex-for-Things Exchanges. Journal of Child Sexual Abuse, 12(2), pp. 73-96, 2003.

Drug Use by Juvenile Detainees: Comparison of Self-Report and Urinalysis Data

1,829 youth in the Cook County Juvenile Temporary Detention Center were interviewed using the Diagnostic Interview Schedule for Children (DISC 2.3) to gather information on substance use, and 1,745 of these subjects provided urine samples for drug analysis using Enzyme-Multiplied Immunoassay Tests (EMIT-10 panel). Most subjects knew they would be urine tested when they were interviewed. 77.3% reported cannabis use in the past 6 months, 90.1% reported lifetime use. Self-report of other substances was less common, 8.0% reported use of other substances in the past 6 months, 13.0% lifetime. Two-thirds of detainees' urines tested positive for any drug; 65.9% tested positive for cannabis, 4.8% for cocaine, and 1.1% for hallucinogens. Overall, the veracity of self-report was high; among those who tested positive for any substance, 87.7 had reported use in the past 6 months and 94.1% had reported lifetime use. The veracity figures for cannabis were quite similar, 87.6% past 6 months, 94.1% lifetime; and these numbers account for the high veracity seen overall. Veracity figures for drugs other than cannabis were 27.5% for past 6 months and 37.8% lifetime. In general, younger detainees, African-American detainees, and detainees with recent drug arrests lacked veracity in self-reporting drug use. The authors suggest that self-report and urinalysis should be used together along with other data such as information about substance abuse treatment, records of drug-related arrests and charges, and information from families and schools to identify those youth in greatest need of intervention. McClleland, G.M., Teplin, L.A., and Abram, K.M. Detection and Prevalence of Substance Use Among Juvenile Detainees. OJJDP Juvenile Justice Bulletin, March, pp. 1-14, 2004.

Substance Use Disorders Related to Attempted Suicide in Adolescents

This study examined the effects of psychiatric disorders on attempted suicide among adolescents with substance use disorders (SUD). Age of onset for psychiatric disorders, age of first suicide attempt, and the relationship of psychiatric disorder with attempted suicide were investigated in a sample of 503 adolescents with DSM-IV defined SUD (age range: 12.2-19.0 years). Results indicated that males who attempted suicide had a significantly earlier onset of alcohol use disorders (AUD) and significantly more mood, AUD, and disruptive behavior disorder symptoms compared to non-attempting males. Females who attempted suicide had a significantly earlier onset and higher counts of mood disorders and SUD symptoms compared to non-attempting females. Hazard analysis revealed that mood disorders represent the highest psychiatric risk for attempted suicide in both the genders. Attention deficit-hyperactivity disorder (ADHD) increased the risk for attempted suicide among males. The interaction of mood disorder and AUD increased the risk for attempted suicide among females. The investigators conclude that clinicians should closely monitor SUD adolescents for suicide risk and be aware of gender differences for suicidal behavior based on course and severity of psychiatric disorder in this population. Kelly, T.M., Cornelius, J.R. and Clark, D.B. Psychiatric Disorders and Attempted Suicide Among Adolescents with Substance Use Disorders. Drug And Alcohol Dependence, 73(1), pp. 87-97, 2004.

Substance Use Related to Early Marriage

Prior work indicates that substance use is related to adolescent marriage. This study describes two different processes that may account for this relationship and hypothesize patterns of association that would be consistent or inconsistent with each. Using data from a study that followed west coast youth from 7th grade to young adulthood (N = 3,324), investigators assessed the effects of cigarette, alcohol, and marijuana use in 7th and 10th grade on the probability of marriage prior to age 20. When gender, race, and SES were controlled, cigarette use in adolescence, but not other substance use, was associated with early marriage. Low educational attainment and early unwed parenthood each uniquely mediated this association. These results suggest that the link between substance use and early marriage reflects a disposition toward risky or unconventional behavior, not the judgment-impairing effects of drug and alcohol use. Martino, S.C., Collins, R.L., and Ellickson, P.L. Substance Use and Early Marriage. Journal of Marriage and the Family, 66(1), pp. 244-257, 2004.

Higher Rates of Consent Obtained When Consent Forms Returned in School

Many school-based research efforts require active parental consent for student participation. Maximizing rates of consent form return and agreement is an important issue, because sample representativeness may be compromised when these rates are low. This article compares two methods for obtaining active parental consent: return of consent forms in the mail versus return by students to their classrooms. The methods were tested in a pilot study of 46 schools (1,058 students), with half of the schools randomly allocated to each of the alternative methods. A hierarchical nonlinear model of consent form return and agreement rates suggests that the student delivered method is more successful at producing higher rates of consent form return and agreement to participate in the study, after controlling for school-level characteristics. McMorris, B.J., Clements, J., Evans-Whipp, T., Gangnes D., Bond, L., Toumbourou, J.W., and Catalano, R.F. A Comparison of Methods to Obtain Active Parental Consent For An International Student Survey. Evaluation Review, 28(1), pp. 64-83, 2004.

Predictors of Offspring Nonparticipation in a Twin-Family Study

This study examines an important methodologic issue for family studies of substance abuse - whether parents' alcoholism is associated with offspring nonresponse to telephone interviews. In 1999, the first wave of a longitudinal study of offspring of alcoholic twins was conducted via telephone interview with members of the Vietnam Era Twin Registry. The target offspring sample consisted of 2,096 male and female children, of whom 1,270 were successfully interviewed. Offspring response status was classified as participation, refusal or unavailable/no consent. Stepwise logistic regression models were used to identify variables that were significantly associated with one or both types of offspring nonparticipation. A multinomial logit procedure with backward deletion was then used to build a model of the three levels of child response. The results showed that paternal alcoholism was not significantly associated with offspring nonresponse. However, offspring nonparticipation because of not being located, or being deceased, disabled or unavailable was associated with current paternal smoking, paternal divorce and paternal marital status. The most important conclusion to be drawn from current results is that the alcohol abuse and dependence history of fathers should not bias analyses in family studies of alcoholism when data are collected via telephone interview. Scherrer, J.E., Waterman, B.M., Heath, A.C., Bucholz, K.K., True, W.R. and Jacob, T. Are Substance Use, Abuse and Dependence Associated with Study Participation? Predictors of Offspring Nonparticipation in a Twin-Family Study. Journal of Studies on Alcohol, 65, pp. 140-144, 2004.

Alcohol, Tobacco, and Other Drug Use among Asian American and Pacific Islander Adolescents in California and Hawaii

Prior research suggests that the lowest rates of alcohol, tobacco, and other drug (ATOD) use are often reported for Asian Americans/Pacific Islanders (AAPIs), compared to other Whites. These low rates are, however, often based upon samples with small representations of AAPIs, or represented by only one or two AAPI groups. This study investigates drug use among specific AAPI subgroups (Chinese, Filipino, Japanese, and Pacific Islander/Native Hawaiian) using data from school surveys collected from nearly 82,000 9th grade students in California and nearly 5,000 10th grade students in Hawaii. Results showed that ATOD rates were lowest for the Chinese adolescents and highest among the White and Pacific Islanders/Native Hawaiians reported among the highest. Similar variation was found for need for alcohol and other drug treatment for these groups. In summary, AAPIs clearly constitute heterogeneous groups characterized by a wide range of ATOD behaviors and treatment needs. Wong, M.M., Klingle, R.S., and Price, R.K. Alcohol, Tobacco, and Other Drug Use among Asian American and Pacific Islander Adolescents in California and Hawaii. Addictive Behaviors, 29, pp.127-141, 2004.

Antisocial Behavior, Depressive Symptoms, and Partner Violence

This study examined the extent to which antisocial behavior and depressive symptoms were associated between romantic partners, and whether the partner's antisocial behavior and depressive symptoms affected the individual's aggression toward the partner. Questions were examined concurrently and longitudinally for 79 couples from a young, at-risk sample. There were reliable associations between partners' antisocial behavior and depressive symptoms. Women's antisocial behavior and depressive symptoms were significantly related to concurrent levels of men's physical and psychological aggression. Women's depressive symptoms remained significant in predicting men's psychological aggression over time. Overall, men's risk factors had little effect on their partners' aggression. Findings suggest that interventions to reduce partner violence need to consider the potential influence of partner, as well as perpetrator characteristics. Kim, H.K., and Capaldi, D.M. The Association of Antisocial Behavior and Depressive Symptoms between Partners and Risk for Aggression in Romantic Relationships. Journal of Family Psychology, 18, pp. 82-96, 2004.

Review of Twin and Adoption Studies of Adolescent Substance Use

This paper reviews studies of adolescent substance use and abuse with twin and adoption studies. Results were presented by design, sample, and stage of drug use. Of 19 studies that used adolescent samples, 18 examined initiation or use of substances and 1 examined abuse. Of the 7 retrospective studies using adult samples, 6 examined problematic behaviors such as substance dependence. Genetic and shared environmental influences on adolescent substance use appear to be moderated by the specific substance, age, gender, specific contexts, religiousness, and region. There is some evidence for a common genetic influence on substance use across substances. Genetic influences on adolescent substance use may act through an influence on disinhibited behavior. Shared environment contributed to adolescent substance use consistently across all adolescent samples and common shared environmental factors influenced initiation into tobacco and alcohol use. While parental alcohol use had a small influence on adolescent shared environment, sibling influences were substantial. In summary, twin and adoption studies have increased our understanding of genetic and environmental influences on adolescent substance use and its initiation, although more studies focusing on clinical syndromes of abuse and dependence are needed. Hopfer, C.J., Crowley, T.J., and Hewitt, J.K. Review of Twin and Adoption Studies of Adolescent Substance Use. Journal of the American Academy of Child and Adolescent Psychiatry, 42, pp. 710-719, 2003.

Daily Smoking and the Subsequent Onset of Psychiatric Disorders

Recent research has demonstrated that smokers are at an elevated risk for psychiatric disorders. This study extends the enquiry by examining the specificity of the psychiatric sequelae of smoking, and the variability in the likelihood of these sequelae by proximity and intensity of smoking. Data come from the National Comorbidity Survey (NCS), a representative sample of the US population 15-54 years of age. The Smoking Supplement was administered to a representative subset of 4,414 respondents. A modified World Health Organization-Composite International Diagnostic Interview was used to measure DSM-III-R disorders. Age of onset was determined by retrospective reports. Survival analysis with smoking variables as time-dependent covariates was used to predict the subsequent onset of specific psychiatric disorders. Results indicated that the estimated effects of daily smoking varied across psychiatric disorders. For mood disorders, daily smoking predicted subsequent onset, with no variation between current versus past smokers or by smoking intensity. In the case of panic disorder and agoraphobia, current but not past smoking predicted subsequent onset; furthermore, the risk of these disorders in past smokers decreased with increasing time since quitting. For substance use disorders, current but not past smoking predicted subsequent onset, with no variation by time since quitting or smoking intensity. The data suggest that smoking cessation programs would not prevent the onset of mood disorder, as ex-smokers do not differ from current smokers in their risk for these disorders. In comparison, daily smoking might be a risk factor in panic disorder and agoraphobia, conditions that might be preventable by smoking cessation. Additionally, current smoking might serve as a marker for targeting interventions to prevent alcohol and drug disorders. Breslau, N., Novak, S.P., and Kessler, R.C. Daily Smoking and the Subsequent Onset of Psychiatric Disorders. Psychological Medicine, 34, pp. 323-333, 2004.

Psychiatric Disorders and Stages of Smoking

This study examined the role of DSM-III-R psychiatric disorders in predicting the subsequent onset of daily smoking, smokers' progression to nicotine dependence, and the persistence of smoking. The Tobacco Supplement of the National Comorbidity Survey was administered to a representative subsample of 4,414 persons 15-54 years of age. Psychiatric disorders and information on age of onset of psychiatric disorders, daily smoking, and smoking cessation were ascertained with the World Health Organization's Composite International Diagnostic Interview. Age of onset was determined by retrospective reports. Results showed that active psychiatric disorders predicted an increased risk for the first onset of daily smoking and for smokers' progression to nicotine dependence. The increased risk applied across most of the disorders examined in the study, including major depression, anxiety disorders, and substance use disorders. Persons with four or more active disorders were at higher risk for daily smoking (O.R.: 2.1 vs. 1.4) and for nicotine dependence (O.R.: 2.9 vs. 1.4) than were persons with one active disorder. With few exceptions, remitted (i.e., past) disorders did not predict the subsequent onset of daily smoking. Preexisting psychiatric disorders did not influence smokers' potential for quitting; the persistence of smoking in the year preceding the interview was unrelated to history of psychiatric disorders. The results suggest the possibility of additional and previously unrecognized public health benefits in that early treatment of mental disorders may be beneficial in preventing daily smoking. Breslau, N., Novak, S.P., and Kessler, R.C. Psychiatric Disorders and Stages of Smoking. Biological Psychiatry, 55, pp. 69-76, 2004.

Smoking Progression and Physical Activity

This study examined the association between changes in physical activity and changes in smoking among adolescents. Smoking progression, physical activity, demographic factors, and covariates were assessed in 978 high school students participating in a longitudinal cohort study of the predictors of smoking adoption. Analyses used latent growth modeling with the parallel processes smoking progression and physical activity as our method, with smoking progression measured as an ordered categorical variable. Results indicated that higher levels of physical activity reduced the odds of progressing to smoking or a higher level of smoking by nearly 1.5. Although no race differences were found, being male increased the odds of smoking progression by 1.32. These findings indicate that higher levels of physical activity may reduce the risk of smoking during adolescence, and that youth smoking prevention initiatives should consider incorporating strategies to promote physical activity to prevent smoking experimentation and escalation. Audrain-McGovern, J., Rodriguez, D., and Moss, H.B. Smoking Progression and Physical Activity. Cancer Epidemiology, Biomarkers, and Prevention, 12, pp. 1121-1129, 2003.

Development and Validation of the Michigan Nicotine Reinforcement Questionnaire

Positive- and negative-reinforcement consequences of smoking were assessed using a self-report inventory. Data from 429 current smokers (348 women, 81 men) were subjected to an exploratory factor analysis, with concurrent validation of resulting scales in 288 current smokers (235 women, 53 men), controlling for sex and age. The solution with three factors - positive reinforcement, negative reinforcement, and smoking patterns - provided the clearest and most interpretable factor solution. The Michigan Nicotine Reinforcement Questionnaire (M-NRQ), which yields positive- and negative-reinforcement scales, was developed based on these results. Positive-reinforcement smoking was associated with higher scores on novelty seeking, reward dependence, alcohol dependence, and pleasurable sensations upon early smoking experimentation, and with lower scores on displeasurable sensations and nausea upon early smoking experimentation. Negative-reinforcement smoking was associated with higher scores for nicotine dependence, depression, anxiety, and harm avoidance. The M-NRQ has potential as a diagnostic tool for individualizing behavioral intervention and pharmacotherapy and also may be useful in identifying new phenotypes for genetic research on smoking. Pomerleau, O.F., Fagerstrom, K.O., Marks, J.L., Tate, J.C., and Pomerleau, C.S. Development and Validation of a Self-Rating Scale for Positive- and Negative-Reinforcement Smoking: The Michigan Nicotine Reinforcement Questionnaire. Nicotine and Tobacco Research, 5, pp. 711-718, 2003.

Correlates of Pathological Gambling

This study examined correlates of gambling among respondents of a random-digit-dial telephone survey that was conducted in 1999-2000 with a representative sample of the U.S. population aged 18 or older. This report uses data from the 2,168 respondents who gambled in the year before the interview. Gambling measures included the Diagnostic Interview Schedule (DIS)-IV for pathological gambling, frequency of 15 types of gambling, and size of win or loss on the last occasion. Other measures included the quantity and frequency of alcohol consumption, frequency of illicit drug use and criminal offending, and the DIS-IV for alcohol and drug abuse and dependence. Results showed that casino gambling is associated with a high risk of gambling pathology. Lottery, cards, and bingo are associated with a moderately high risk of gambling pathology. Participation in a greater number of types of gambling is strongly predictive of gambling pathology, even after frequency of gambling and size of win or loss are taken into account. Alcohol abuse is strongly predictive of gambling pathology, even with gambling behaviors held constant. Minority and low socioeconomic status (SES) group members have higher levels of gambling pathology than other groups after all other factors are considered. Welte, J.W., Barnes, G.M., Wieczorek, W.F., Tidwell, M.C., and Parker, J.C. Risk Factors for Pathological Gambling. Addictive Behaviors, 29, pp. 323-335, 2004.

Drug Test Feasibility in a General Population Household Survey

This study focuses on evaluating the feasibility of drug testing in a general population survey. First the PIs explore the nature of drug test participation and refusal among survey participants drawing comparisons across different procedures. They examine three factors that may potentially influence drug test participation in epidemiological surveys: drug disclosure concerns, test-specific factors, and factors associated with the decision to participate in surveys and variables associated with participation and reaction. Their analyses evaluate the impact of the main experimental condition of the study, subject incentives, on drug test refusal and subjects' reactions to drug test participation, and provide test-specific comparisons. Models of the drug test reactions are compared with models of drug test refusal. Participants, ages 18-40 years residing in Chicago, were recruited to participate in three different biological tests (hair, oral fluid, and urine) presented in random order subsequent to completing an interview. Subjects had the option of participating in zero to three different tests and were randomly assigned to a low (US $10 per test) or high (US $20 per test) incentive condition. Over 90 percent of the sample participated in at least one test, usually the oral fluid test. Associations between refusal status and two variables, socioeconomic status and presence of children in the household, provided partial support for the notion that drug test participation parallels the survey response process in general. Incentive level did not directly increase drug test participation. Reporting of recent illicit drug use was associated with participation in only one procedure, hair testing. Type of test offered and individual differences in willingness to be drug tested were important predictors of drug test refusal and subject reaction to testing requests. Compared with urine and hair testing, oral fluid testing had lower refusal rates and was generally more acceptable to respondents in a general population survey. The overall findings underscore the feasibility of conducting multiple drug tests with modest incentives in the context of epidemiological surveys on drug abuse. Despite specific between-test differences, overall drug test participation rates were high in this study. Fendrich, M., Johnson, T.P., Wislar, J.S., and Hubbell, A. Drug Test Feasibility in a General Population Household Survey. Journal of Drug and Alcohol Dependence, 73, pp. 237-250, 2004.

The Culture of Affluence: Psychological Costs of Material Wealth

This study collates evidence on the nature of problems among the wealthy and their likely causes, specifically, disturbances among affluent children and the characteristics of their families and neighborhoods. Children of affluence are generally presumed to be at low risk. However, recent studies have suggested problems in several domains - notably, substance use, anxiety, and depression, with two potential causes: pressures to achieve and isolation from parents (both literal and emotional). The PI concludes that, although a few samples of high-SES teenagers have shown elevated levels of depression, anxiety, and substance use, it is possible that these problems reflect normative complaints in the culture of upper-class suburbia rather than serious psychopathology. Longitudinal research will be critical in illuminating this issue, identifying the degree to which high self-reported distress among suburban teens does in fact presage subsequent deterioration in critical domains, by affecting their school grades, for example, or leading to diagnosable mental illness. Also, it is not clear whether the problems suggested represent a largely suburban phenomenon or might generalize to high-SES children in large cities. Luthar, S.S. The Culture of Affluence: Psychological Costs of Material Wealth. Child Development, 74, pp. 1581-1593, 2003.


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