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Director's Report to the National Advisory Council on Drug Abuse - May, 2006

Research Findings - Epidemiology and Etiology Research

Epidemiology of Smoking Behaviors in a National Young Adult Sample

This study describes the epidemiology of smoking behaviors in a national young adult sample and identifies common and unique demographic, social, and psychological correlates of daily smoking and lifetime and current nicotine dependence by race/ethnicity. Data are from the National Longitudinal Survey of Adolescent Health, wave III. Hispanic ethnicity, low education, parental and peer smoking, novelty seeking, early age of smoking onset, and pleasurable initial smoking experiences are significantly correlated with daily smoking and lifetime nicotine dependence. Depressive symptoms are uniquely associated with lifetime and current dependence. Few factors are highly associated with current dependence. Initial sensitivity to smoking has a significantly greater impact on daily smoking than on dependence. Correlates of smoking behaviors are mostly common across racial/ethnic groups, although parental and peer smoking are significant for Whites and Hispanics but not for African Americans. There are more common than unique correlates of each smoking stage and across racial/ethnic groups. Primary prevention and interventions addressing the factors tested could be uniform for most chronic smokers irrespective of dependence status and race/ethnicity. Hu, M., Davies, M., and Kandel, D. Epidemiology and Correlates of Daily Smoking and Nicotine Dependence Among Young Adults in the United States. Am J Public Health, 96(2), pp. 299-308, 2006.

Cigarette Smoking in Two American Indian Reservation Populations

This study describes the prevalence and correlates of cigarette smoking in two American Indian reservation populations using multinomial logistic regression on data from a population-based, cross-sectional study of Southwest and Northern Plains American Indians aged 15-54. 19% of Southwest men, 10% of Southwest women, 49% of Northern Plains men and 51% of Northern Plains women were current smokers. Male gender and younger age were associated with higher odds of smoking in the Southwest tribe, whereas current or former marriage and less time spent on a reservation were associated with higher odds of smoking in the Northern Plains population. Alcohol consumption was strongly associated with higher odds of smoking in both groups. Nez Henderson, P., Jacobsen, C., Beals, J. and the AI-SUPERPFP Team. Correlates of Cigarette Smoking Among Selected Southwest and Northern Plains Tribal Groups: The AI-SUPERPFP Study. Am J Public Health, 95, pp. 867-872, May 2005.

Exposure to Trauma Among Two American Indian Tribes

This study examined the prevalence of trauma in 2 large American Indian communities in an attempt to describe demographic correlates and to compare findings with a representative sample of the US population. The researchers determined differences in exposure to each of 16 types of trauma among 3084 tribal members aged 15 to 57 years through structured interviews. The researchers compared prevalence rates of trauma, by gender, across the 2 tribes and with a sample of the US general population. The researchers used logistic regression analyses to examine the relationships of demographic correlates to trauma exposure. Lifetime exposure rates to at least 1 trauma (62.4%-67.2% among male participants, 66.2%-69.8% among female participants) fell at the upper limits of the range reported by other researchers. Unlike the US general population, female and male American Indians exhibited equivalent levels of overall trauma exposure. Members of both tribes more often witnessed traumatic events, experienced traumas to loved ones, and were victims of physical attacks than their counterparts in the overall US population. Many American Indians live in adverse environments that place them at high risk for exposure to trauma and harmful health sequelae. Manson, S., Beals, J., Klein, S., Croy, C., and Croy, C. Social Epidemiology of Trauma Among 2 American Indian Reservation Populations. Am J Public Health, 95(5), pp. 851-859, 2005.

Psychosocial Adjustment Among Drug Using Suburban Adolescents

Despite ongoing concern about substance use during adolescence, very little is known about alcohol and drug use among teens living in affluent social settings. In this longitudinal study, cluster analysis was used to characterize patterns of substance use and change in other dimensions of psychosocial adjustment within a cohort of 292 high school students (54% girls) living in an affluent, suburban community. When compared with a cluster of students reporting minimal use, clusters reporting escalating, declining, and persistently high use consistently demonstrated relatively poorer psychosocial adjustment. Moreover, other dimensions of psychosocial adjustment remained relatively stable despite changes in substance use, and there were relations involving substance use and other aspects of psychosocial adjustment that may be specific to this social setting. McMahon, T. and Luthar, S. Patterns and Correlates of Substance Use Among Affluent, Suburban High School Students. J Clin Child Adolesc Psychol, 35(1), pp. 72-89, 2006.

Late Onset Antisocial Behavior and Risk for SUD

This study compared late onset antisocial behavior with the more commonly recognized two courses, persisting (beginning by early adolescence and continuing through late adolescence) and desisting (stopping by mid-adolescence) antisocial behavior, in terms of risk for later substance dependence and background risk factors (gender, IQ, socioeconomic status, parental antisocial behavior, and parental divorce). A population-based sample of 500 twins from the Minnesota Twin Family Study, evaluated at ages 17 and 20, was used. The results indicated that youths with late onsets were similar to those with persisting antisocial behavior and that both groups were at higher risk of later nicotine, alcohol, and cannabis dependence than controls; both also had similarly high levels of background risk factors. The late-onset group included a significant overrepresentation of females, whereas the persisting and desisting groups included more males. The authors conclude that late-onset antisocial behavior has many of the same negative correlates of persisting antisocial behavior but includes significantly more females. Clinical implications include the need to recognize this pathway, particularly for vulnerable young women, even though they do not meet criteria for the diagnosis of antisocial personality disorder, for both etiologic studies and preventive interventions. Marmorstein, N. and Iacono, W. Longitudinal Follow-Up of Adolescents with Late-Onset Antisocial Behavior: A Pathological Yet Overlooked Group. J Am Acad Child Adolesc Psychiatry, 44(12), pp. 1284-1291, 2005.

Familial and Peer Influences on Adolescent Substance Use

Parental, peer, and older siblings' contributions to adolescents' substance use were investigated with 2 waves of panel data from 225 African American families. Structural equation modeling showed that older siblings' behavioral willingness (BW) to use substances at Time 1 (T1) predicted target adolescents' Time 2 (T2) use, controlling for other T1 variables. Regression analyses revealed an interaction between targets and siblings' BW, such that targets were more likely to use at T2 if both they and their siblings reported BW at T1. This interaction was stronger for families living in high-risk neighborhoods. Finally, siblings' willingness buffered the impact of peer use on targets' later use: Low sibling BW was associated with less evidence of peer influence. Pomery, E., Gibbons, F., Gerrard, M., Cleveland, M., Brody, G. and Wills, T. Families and Risk: Prospective Analyses of Familial and Social Influences on Adolescent Substance Use. J Fam Psychol, 19(4), pp. 560-570, 2005.

Social Competence Among Children of Alcoholics

In the current study, the authors tested the hypothesis that children of alcoholic parents (COAs) show deficits in social competence that begin in early childhood and escalate through middle adolescence. A community sample of families with high levels of alcohol use disorder and control families was used (n=110 COAs and 263 controls). Teachers, parents, and children reported on the social competence of COAs and matched controls assessed from ages 6 to 15. Hierarchical linear growth models revealed different patterns of change in social competence across development as a function of the reporter of various indicators of competence. Moreover, female COAs showed deficits in social competence in early childhood that receded in adolescence and that varied across subtypes of parent alcoholism. Implications of these findings for understanding the development of social competence in children, and at-risk children in particular, are discussed. Hussong, A., Zucker, R., Wong, M., Fitzgerald, H., and Puttler, L. Social Competence in Children of Alcoholic Parents Over Time. Dev Psychol, 41(5), pp. 747-759, 2005.

Behavior Problems Among Maltreated Children

Maltreated children are at increased risk for behavior problems. This study examines a model in which shame mediates the potential relation between maltreatment and anger, and anger mediates the potential relation between shame and behavior problems. Participants were 177 children (ages 3 to 7 years) and their mothers, 90 of whom had histories of perpetrating neglect and/or physical abuse. Physical abuse, but not neglect, was related to increased shame during an evaluative task; shame was related to increased anger; and anger to teacher ratings of total behavior problems and externalizing problems. Age moderated the relation between physical abuse and adjustment, as abuse was related to more total problems only among the younger children. Anger was a significant mediator of shame and both behavior problems and externalizing problems. Shame, anger, age, and type of maltreatment appear to be important factors in explaining variance in behavioral adjustment following a history of maltreatment. Bennett, D., Sullivan, M., and Lewis, M. Young Children's Adjustment as a Function of Maltreatment, Shame, and Anger. Child Maltreat, 10(4), pp. 311-323, 2005.

Illicit Drug Use and HIV-1 Disease Progression: A Longitudinal Study in the Era of Highly Active Antiretroviral Therapy

This study assessed the association between longitudinal patterns of illicit drug use and clinical progression of HIV disease. Confidential computer-based interviews, which addressed illicit drug use and other factors, were completed by HIV-infected participants in Baltimore, Maryland, at 6-month intervals from 1998 onward. To assess this association, the authors used a random-effects model in which clinically defined opportunistic conditions were linked to self-reported periods of drug use, enabling four categories of drug use to be distinguished: nonusers, intermittent users during abstinent periods, intermittent users during active periods, and persistent users. Included in the analysis were 1,851 participants who completed > or = 1 survey. For participants who used drugs intermittently over time, the risk of developing new opportunistic conditions during periods of abstinence was similar to that for those who never used drugs (odds ratio = 1.2, 95% confidence interval: 0.9, 1.7). In contrast, compared with that for nonusers, the risk of opportunistic infection was significantly higher for intermittent drug users during periods of active use (odds ratio = 2.2, 95% confidence interval: 1.4, 2.9) and for persistent drug users (odds ratio = 1.9, 95% confidence interval: 1.2, 2.8). Active drug use is temporally linked to HIV disease progression and mortality. Effectively targeting and treating active substance abuse in HIV treatment settings may provide a mechanism to improve clinical outcomes. Lucas, G., Griswold, M., Gebo, K., Keruly, J., Chaisson, R and Moore, R. Illicit Drug Use and HIV-1 Disease Progression: A Longitudinal Study in the Era of Highly Active Antiretroviral Therapy. Am J Epidemiol, 163(5), pp. 412-420, 2006.

HIV/AIDS and Injection Drug Use in the Neighborhoods of Dar es Salaam, Tanzania

This study examines the intersection between needle-sharing practices and HIV recovered from used syringes collected from 73 heroin injection drug users (IDUs) in Dar es Salaam, Tanzania, between October 2003 and January 2004. To extract blood residue, syringes were flushed and 10 micro liters of solution mixed with 120 micro liters of a latex solution was placed on a Capillus HIV-1/2 slide. Thirty-five(57%) of the useable syringes tested positive for HIV antibodies. Results varied significantly: 90% of syringes tested HIV positive in a mixed-income neighborhood 2 kilometers from the city center; 0% of syringes tested HIV positive in the outlying areas. In addition, semi structured interviews were conducted with 51 IDUs. The interviews were content coded, and codes were collapsed into emergent themes regarding syringe-use practices. Injecting is a recent practice, particularly among heroin users in neighborhoods far from the city center. Sharing syringes has resulted in a high proportion of used syringes containing HIV-positive blood residue. Geographic distance is an indicator of recent adoption of IDU in neighborhoods and correlates strongly with the distribution of syringes containing HIV-positive blood residue. McCurdy, S.A., Ross, M.W., Kilonzo, G.P., Leshabari, M.T. and Williams, M.L. HIV/AIDS and Injection Drug Use in the Neighborhoods of Dar es Salaam, Tanzania. Drug Alcohol Depend, 82(1), pp. S23-S27, 2006.

Reductions in Hepatitis C Virus and HIV Infections Among Injecting Drug Users in New York City, 1990-2001

Researchers assessed trends in HIV, hepatitis C virus (HCV) and HIV/HCV infection among injecting drug users (IDU) from 1990 to 2001 in New York City. The 1990-2001-time period included a very large expansion of syringe exchange in New York City, from 250,000 to 3,000,000 syringes exchanged annually. Cross-sectional seroprevalence surveys were conducted of IDU entering drug abuse treatment in New York City, with sample sizes for HCV of 72 in 1990-1991 and 412 in 2000-2001. A structured risk behavior questionnaire was administered, and HIV and HCV testing were conducted. HCV testing was performed on de-linked stored serum samples. Findings showed that, over the 1990-2001 period, HIV prevalence declined from 54 to 13%. HCV prevalence declined from 80 to 59% among HIV-seronegative individuals, and from 90 to 63% overall. The estimated HCV incidence in 2000-2001 among new injectors was 18 per 100 person-years at risk. These results indicate that the large-scale expansion of syringe exchange was temporally associated with large reductions in both HIV and HCV prevalence. The prevalence and incidence of HCV, however, still remain at high levels among IDU in New York City. Des Jarlais, D., Perlis, T., Arasteh, K., Torian, L., Hagan, H., Beatrice, S., Smith, L., Wethers, J., Milliken, J., Mildvan, D., Yancovitz, S. and Friedman, S. Reductions in Hepatitis C Virus and HIV Infections Among Injecting Drug Users in New York City, 1990-2001. AIDS, 19(3), pp. S20-S25, 2005.

Behavioral Risk Exposure and Host Genetics of Susceptibility to HIV-1 Infection

Some individuals are readily infected with low HIV-1 exposure, whereas others appear less susceptible, suggesting that host genetics plays a role in the viral entry pathway. The matched case-control study design with measured risk exposures provides an avenue for discovering genes involved in susceptibility to infection. Researchers conducted a nested case-control study of African Americans (266 HIV-1 seroconverter cases and 532 seronegative controls from the AIDS Link to Intravenous Experience cohort), to examine the association between 50 single-nucleotide polymorphisms (SNPs) in 9 candidate genes (CCR5, CCR2, RANTES, MIP1A, MCP2, IL10, IFNG, MCSF, and IL2) and susceptibility to HIV-1 infection. To account for differential exposure propensities, risk behavior self-reported during semiannual visits was used to estimate a standardized cumulative risk exposure (SCRE). Individual SNPs were evaluated using conditional logistic-regression models, and the inferred haplotypes were assessed in the haplotype trend regression analyses after adjusting for age and SCRE. Four SNPs (CCR2-V64I, CCR5-2459, MIP1A+954, and IL2+3896) and specific haplotypes in the IL2 and CCR2/CCR5 regions were found to be significantly associated with HIV-1 infection susceptibility in different genetic models. These results suggest that genetic variants in associated host genes may play an important role in susceptibility to HIV-1 infection. Shrestha, S., Strathdee, S., Galai, N., Oleksyk, T., Fallin, M., Mehta, S., Schaid, D., Vlahov, D., O 'Brien, S., and Smith, M. Behavioral Risk Exposure and Host Genetics of Susceptibility to HIV-1 Infection. J Infect Dis, 193(1), pp. 16-26, 2006.

Longitudinal Predictors of Injection Cessation and Subsequent Relapse among a Cohort of Injection Drug Users in Baltimore, MD, 1988-2000

Researchers sought to determine predictors of injection drug use cessation and subsequent relapse among a cohort of injection drug users (IDUs). IDUs in Baltimore, MD were recruited through community outreach in 1988-1989. Among IDUs with at least three follow-up visits, parametric survival models for time to injection cessation (>/=6 months) and subsequent relapse were constructed. Of 1327 IDUs, 94.8% were African American, 77.2% were male, median age was 34 years, and 37.7% were HIV-infected. Among 936 (70.5%) subjects who ceased injection, median time from baseline to cessation was 4.0 years. Three-quarters subsequently resumed injection drug use, among whom median time to relapse was 1.0 year. Factors independently associated with a shorter time to cessation were: age <30 years, stable housing, HIV seropositivity, methadone maintenance treatment, detoxification, abstinence from cigarettes and alcohol, injecting less than daily, not injecting heroin and cocaine together, and not having an IDU sex partner. Factors independently associated with shorter time to injection relapse were male gender, homelessness, HIV seropositivity, use of alcohol, cigarettes, non-injection cocaine, sexual abstinence and having a longer time to the first cessation. These findings show how important it is to target cessation efforts among young IDUs and severely dependent, unstably housed, and HIV-infected individuals. Shah, N.G., Galai, N., Celentano, D., Vlahov, D. and Strathdee, S. Longitudinal Predictors of Injection Cessation and Subsequent Relapse among a Cohort of Injection Drug Users in Baltimore, MD, 1988-2000. Drug Alcohol Depend, available online 20 December 2005.

High Prevalence of Alcohol Use among Hepatitis C Virus Antibody Positive IDUs in 3 US Cities

IDUs acquire the majority of new hepatitis C virus (HCV) infections and frequently use alcohol. Alcohol abuse accelerates liver disease among HCV-infected persons, can reduce the effectiveness of treatment for HCV infection and may be a contradiction for HCV treatment. HCV seropositive, HIV-negative IDUs aged 28-35 years in Baltimore, New York City, and Seattle who were enrolled in a behavioral risk-reduction intervention trial underwent computerized self-interviews to assess baseline alcohol use and dependence and medical history. Researchers measured problem alcohol use using the 10-item Alcohol Use Disorders Identification Test (AUDIT) scale. Of 598 participants, 84% responded "false" to "it is safe for a person with HCV to drink alcohol." Problem drinking, defined as a score of 8 or higher on AUDIT, was identified in 37%. Correlates of scoring 8 or higher on AUDIT included homelessness, male gender, primarily injecting speedballs, having injected with used needles, prior alcohol treatment, and depression. Although most HCV positive IDUs appeared to be informed about their increased risk of liver disease from alcohol, 40% screened positive for problem alcohol use. These findings indicate how important it is to refer HCV-positive persons to effective alcohol treatment programs to reduce foture liver damage and improve eligibility for and treatment of HCV. Campbell, J.V., Hagan, H., Latka, M.H., Garfein, R.S., Golub, E.T., Coady, M.H., Thomas, D.L., and Strathdee, S.A. High Prevalence of Alcohol Use Among Hepatitis C Virus Antibody Positive IDUs in 3 US Cities. Drug Alcohol Depend, 81, pp. 259-265, 2006.

The Impact of Sex Partners' HIV Status on HIV Seroconversion in a Prospective Cohort of Injection Drug Users

The identification of individuals at highest risk of HIV infection is critical for targeting prevention strategies. This study evaluated the HIV status of the sex partners of IDUs and rates of subsequent HIV seroconversion among a prospective cohort study of IDUs. Researchers performed an analysis of the time to HIV infection among baseline HIV-negative IDUs enrolled in the Vancouver Injection Drug Users Study. IDUs were stratified based on whether or not they reported having an HIV-positive sex partner. Kaplan-Meier methods were used to estimate cumulative HIV incidence rates, and Cox regression was used to determine adjusted relative hazards (RHs) for HIV seroconversion. Of 1013 initially HIV-negative IDUs, 4.8% had an HIV-positive partner at baseline. After 18 months, the cumulative HIV incidence rate was significantly elevated among those who reported having an HIV-positive sex partner (23.4% vs. 8.1%; log-rank P < 0.001). In a Cox regression model adjusting for all variables that were associated with the time to HIV infection in univariate analyses, including drug use characteristics, having an HIV-positive sex partner (RH = 2.42 [95% confidence interval: 1.30 to 4.60]; P = 0.005) remained independently associated with time to HIV seroconversion. These findings indicate that having an HIV-positive sex partner was strongly and independently associated with seroconversion after adjustment for risk factors related to drug use. The findings may aid public health workers in their efforts to identify IDUs who should be targeted with education and prevention efforts and indicate the need for ongoing development of prevention interventions for IDU sex partners who are HIV discordant. Kerr, T., Stoltz, J., Strathdee, S., Li, K., Hogg, R., Montaner, J., and Wood, E. The Impact of Sex Partners' HIV Status on HIV Seroconversion in a Prospective Cohort of Injection Drug Users. J Acquir Immune Defic Syndr, 41(1), pp. 119-123, 2006.

Predictors of Early Initiation of Vaginal and Oral Sex Among Urban Young Adults in Baltimore, Maryland

Over the past three decades, most research on adolescent sexual behavior has focused on vaginal intercourse and related behaviors, including contraception and unintended pregnancy. In this study, researchers describe the prevalence and correlates of vaginal, oral, and anal sex in an epidemiologically defined population in Baltimore, Maryland. Young adults (ages 18-24), who had been enrolled in a behavioral intervention trial during elementary school, were interviewed by telephone between 1998 and 2002 to assess their sexual behavior. Of 1679 respondents interviewed, 70.8% were Black and 55% were women. Overall, 93% of the young adults reported vaginal intercourse, 78% reported receiving oral sex, 57% reported performing oral sex, and 10% reported receptive anal intercourse. Among men, 27% reported insertive anal intercourse. Blacks initiated vaginal intercourse at an earlier age than Whites; White women performed oral sex earlier than Black women. Significant interactions were observed between age of first vaginal partner and both gender and race/ethnicity. Blacks with older partners initiated sex at an earlier age than both Blacks with a partner the same age or younger and Whites. A relationship between older female sex partners and earlier vaginal sex initiation among men was observed. These findings indicate that older sex partners play an important role in sexual initiation among young adults. In light of the rates of oral and anal sex, sexual education and intervention programs should address the risk for unintended consequences of these behaviors. Ompad, D., Strathdee, S., Celentano, D. and Latkin, C. Predictors of Early Initiation of Vaginal and Oral Sex Among Urban Young Adults in Baltimore, Maryland. Arch Sex Behav, 35(1), pp. 53-65, 2006.

The Impact of Emotional Distress on HIV Risk Reduction among Women

This study evaluated whether 333 seronegative African American female drug users (aged 18-59 years) participating in an HIV intervention and with higher levels of emotional distress, specifically symptoms of depression and anxiety, reduced HIV risk behaviors to a lesser extent than those with lower levels of emotional distress. Participants were recruited between June 1998 and January 2001 from inner-city Atlanta (Georgia, U.S.) neighborhoods and were randomly assigned to one of two enhanced gender-specific and culturally specific HIV intervention conditions or to the NIDA standard condition. Participants were interviewed at baseline, post-intervention and at 6-month follow-up with a structured questionnaire including information on sociodemographics, sexual and drug-using behavior, and psychosocial characteristics. Despite a significant decline in symptoms of emotional distress during the study period, the women in this sample reported high levels of depressive and anxiety symptoms at baseline and 6-month follow-up. Higher levels of emotional distress were positively associated with post-intervention sexual and drug-taking risk. Women in both enhanced intervention conditions reduced their sexual and drug-taking risks more than women in the standard intervention. Those in the motivation intervention arm experienced a greater reduction in depressive symptoms, accompanied by a greater reduction in sexual risk behavior. Findings suggest the need for effective interventions and mental health resources among subgroups of high-risk women who may be most resistant to behavioral change. Sterk, C., Theall, K. and Elifson, K. The Impact of Emotional Distress on HIV Risk Reduction Among Women. Subst Use Misuse, 41(2), pp. 157-173, 2006.

Drug Treatment Disparities among Hispanic Drug-Using Women in Puerto Rico and New York City

This paper reports findings on 334 out-of-treatment drug users in Puerto Rico and 617 in New York City, at the 6-month follow-up interview of a longitudinal survey. Main outcomes were health care and drug treatment utilization since baseline, assessed by asking participants if they had received physical or mental health services (including HIV medications), and if they had been in methadone maintenance, inpatient or outpatient drug treatment, or drug treatment while incarcerated. Chi-square tests were used to evaluate associations between gender and other correlates. Logistic regression was used to calculate the contribution of each variable in predicting use of drug treatment. The analysis suggests that women in both sites were likely to suffer from disparities in health care and drug treatment utilization when compared with men, although women in New York utilized more drug treatment resources and were more embedded in the immediate family than their female peers in Puerto Rico. Further research to specify the impact of contextual factors at the organizational and community levels, among members of the same ethnic group residing in different sites, may prove valuable in identifying the health needs and factors that impede or facilitate drug-using women in obtaining the most appropriate treatment. Findings from these studies can help in developing appropriate public health policy and science-based drug treatment programs to eliminate such disparities as those identified in this study. Robles, R., Matos, T., Deren, S., Colón, H., Sahai, H., Marrero, C., Reyes, J., Andía, J., and Shepard, E. Drug Treatment Disparities among Hispanic Drug-Using Women in Puerto Rico and New York City. Health Policy, 75(2), pp. 159-169, 2006.

Correlates of Unsafe Syringe Acquisition and Disposal among Injection Drug Users in Baltimore, Maryland

Because multi-person syringe use is the most common vehicle for HIV and hepatitis C virus transmission among IDUs, safe sources of sterile syringes and safe methods of disposal are necessary to curb these epidemics. This study examined syringe acquisition and disposal in a cohort of IDUs in Baltimore. Between January 1, 1998 and December 31, 2001, 1034 participants reported on syringe acquisition at 3492 visits, and 953 reported on disposal at 2569 visits. Participants were 69.9% male, 93.9% African-American, and median age was 44. Syringes were acquired exclusively from unsafe sources at 32.3% of visits, while exclusively unsafe disposal was reported at 59.3% of visits. Significant correlates of unsafe acquisition were: attending shooting galleries, anonymous sex, sharing needles, smoking crack, and emergency room visits. Significant correlates of unsafe disposal were: injecting speedball, no methadone treatment, acquiring safely, and frequent injection. Having a primary source of medical care was associated with safe acquisition, but unsafe disposal. IDUs continue to acquire safely but dispose unsafely, especially among those with a primary source of care; this suggests that messages about safe disposal are not being disseminated as widely as those about acquisition. These data suggest the need for a more active program involving pharmacists, an expanded syringe access program, and better efforts to enhance safe disposal. Golub, E., Bareta, J., Mehta, S., McCall, L., Vlahov, D., and Strathdee, S. Correlates of Unsafe Syringe Acquisition and Disposal among Injection Drug Users in Baltimore, Maryland. Subst Use Misuse, 40(12), pp. 1751-1764, 2005.

Binge Drug Use Independently Predicts HIV Seroconversion among Injection Drug Users: Implications for Public Health Strategies

Several studies have highlighted risk factors that cause HIV vulnerability among IDUs; these studies in turn have prompted public health officials to take action to minimize these risks. In this study, researchers sought to evaluate the potential association between binge drug use and HIV seroconversion and, subsequently, risk factors associated with binge drug use among a cohort of IDUs. To do this, they performed analyses of (1) associations with HIV seroconversion and (2) associations with binge drug use among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS), a prospective cohort of IDU. Because serial measures for each individual were available, a time-updated Cox regression analysis was used to detect associations with HIV incidence and variables potentially associated with binge drug use were evaluated by using generalized estimating equations (GEE). Overall, 1548 IDU were enrolled into the VIDUS cohort between May 1996 and May 2003. There were 1013 individuals who were HIV seronegative at enrollment and had at least one follow-up visit; 125 (12%) became HIV positive during the study period for a cumulative incidence rate of 14% at 64 months after enrollment. In the final multivariate model, binge drug use [Adjusted Hazards Ratio: 1.61 (CI: 1.12, 2.31)] was independently associated with HIV seroconversion. In sub analyses, when associations with binge drug use were evaluated in GEE analyses, borrowing [Odds Ratio (OR): 153 (CI: 1.33-1.76)] and lending [OR: 1.73 (CI: 1.50-1.98)] syringes, sex trade work [OR: 1.14 (CI: 1.01-1.29)], frequent cocaine [OR: 2.34 (CI: 2.11-2.60)] and heroin [OR: 1.29 (CI: 1.17-1.43)] injection were independently associated with binge drug use and methadone [OR: 0.80 (CI: 0.71-0.89)] was protective against binge drug use. This study identified an independent association between binge drug use and HIV incidence and demonstrated several high-risk drug practices associated with bingeing. Given the unaddressed public health risks associated with bingeing, a public health response protocol must be developed to minimize the personal and public health risks associated with the binge use of drugs. Miller, C., Kerr, T., Frankish, J., Spittal, P., Li, K., Schechter, M., and Wood, E. Binge Drug Use Independently Predicts HIV Seroconversion among Injection Drug Users: Implications for Public Health Strategies. Subst Use Misuse, 41(2), pp. 199-210, 2006.

The Protective Role of Racial and Ethnic Identity and Africentricity in Drug Abuse by African-American Young Adults

In this study, the authors examined (a) the protective potential of multiple components of ethnic and racial identity and (b) the aspects of an Africentric orientation for moderating psycho behavioral risk and protective factors for drug use among a sample of 333 urban low-income African American young adults. Ethnic and racial identity and Africentric variables moderated the relationship between psycho behavioral variables and drug stage in 32.5% of the cases. Ethnic and racial identity and Africentric values for African American young adults seemed to be important as moderators of the association between psycho behavioral factors and young adult drug use. The authors suggested implications for future research and interventions. Brook, J., and Pahl, K. The Protective Role of Ethnic and Racial Identity and Aspects of an Africentric Orientation Against Drug Use Among African American Young Adults. J Genet Psychol, 166(3), pp. 329-345, 2005.

Physical Victimization Related to Alcohol and Cigarette Use

This study examined associations between two forms of peer victimization, physical and relational, and externalizing behaviors including drug use, aggression, and delinquent behaviors among a sample of 276 predominantly African American eighth graders attending middle school in an urban public school system. Regression analyses indicated that physical victimization was significantly related to cigarette and alcohol use but not to advanced alcohol and marijuana use; relational victimization contributed uniquely to all categories of drug use after controlling for physical victimization. Physical victimization was also significantly related to physical and relational aggression and delinquent behaviors, and relational victimization made a unique contribution in the concurrent prediction of these behaviors. Physical victimization was more strongly related to both categories of alcohol use, aggression, and to delinquent behaviors among boys than among girls. In contrast, relational victimization was more strongly related to physical aggression and marijuana use among girls than among boys, but more strongly related to relational aggression among boys than among girls. These findings provide information about the generalizability of prior research and have important implications for intervention efforts. This research was supported by Cooperative Agreement U81/CCU309966 from the Centers for Disease Control and Prevention (CDC). Sullivan, T., Farrell, A., and Kliewer, W. Peer Victimization in Early Adolescence: Association Between Physical and Relational Victimization and Drug Use, Aggression, and Delinquent Behaviors Among Urban Middle School Students. Dev Psychopathol, 18(1), pp. 119-137, 2006.

School Tobacco Policies and Student Smoking

This study examines the association between school policies regarding monitoring student behavior, severity of action taken for infraction of policies, and tobacco use by staff, and student smoking behavior and attitudes. Data on students' smoking behavior and attitudes were obtained from the 1999 and 2000 Monitoring the Future surveys of nationally representative samples of 8th-, 10th-, and 12th-grade students. Data on school policies and practices were obtained from administrators in those same schools. Hierarchical analyses using HLM5 were conducted. Strictness of monitoring was significantly negatively associated with daily cigarette use by middle school students. Permitting staff to smoke was significantly positively associated with students' daily cigarette use and negatively with their disapproval of cigarette use. This study's findings suggest that a multipronged approach to the prevention of student smoking should be implemented including clear written policies that regulate both student and staff behavior, monitoring of student behavior for compliance with policies, and the provision of prevention education and smoking cessation programs in supportive environments that discourage tobacco use by both students and staff. Kumar, R., O 'Malley, P., and Johnston, L. School Tobacco Control Policies Related to Students' Smoking and Attitudes Toward Smoking: National Survey Results, 1999-2000. Health Educ Behav, 32(6), pp. 780-794, 2005.

Psychiatric and Drug Use Disorders in Children of Antisocial Parents

The authors examined the prevalence of common externalizing and internalizing disorders in the pre-adolescent and late adolescent offspring of antisocial parents. Lifetime diagnoses for a sample of 11-year-old twins (958 males, 1042 females) and a sample of 17-year-old twins (1332 males, 1434 females) from the Minnesota Twin Family Study, as well as their parents, were obtained through in-person interviews. Odds ratios were calculated for the effect of the parent's diagnosis on the child's diagnosis, controlling for the effect of the co-parent's diagnosis. For the 11 year olds, antisocial behavior in either parent was associated with increased odds of a variety of externalizing disorders. For the 17 year olds, parental antisociality was associated with increased risk for a range of externalizing and internalizing disorders, including paternal antisociality with abuse and dependence on nicotine, alcohol, and drugs. This study extends the previous literature by using a population-based sample and looking at gender of both parents and offspring, finding that each parent has an effect net any effects of the co-parent. Herndon, R., and Iacono, W. Psychiatric Disorder in the Children of Antisocial Parents. Psychol Med, 35(12), pp. 1815-1824, 2005.

Relationships of Deterrence and Law Enforcement to Drug-Related Harms among Drug Injectors in US Metropolitan Areas

This study sought to understand associations of punitive policies to the population prevalence of injection drug users and to HIV seroprevalence among injectors. A lagged-cross-sectional analysis of metropolitan statistical area data was used to estimate drug injectors per capita and HIV seroprevalence among injectors in 89 large US metropolitan areas. Regressions were run on three measures of legal repressiveness (hard drug arrests per capita; police employees per capita; and corrections expenditures per capita) controlling for other metropolitan area characteristics. The study found no legal repressiveness measures were associated with injectors per capita; but all three measures of legal repressiveness were positively associated with HIV prevalence among injectors. These findings suggest that legal repressiveness may have little deterrent effect on drug injection and may have a high cost in terms of HIV and perhaps other diseases among injectors and their partners--and that alternative methods of maintaining social order should be investigated. Friedman, S., Cooper, H., Tempalski, B., Keem, M., Friedman, R., Flom, P. and Des Jarlais, D. Relationships of Deterrence and Law Enforcement to Drug-Related Harms among Drug Injectors in US Metropolitan Areas. AIDS, 20(1), pp. 93-99, 2006.

Marginalized and Socially Integrated Groups of IDUs in Hungary: Potential Bridges of HIV Infection

The discrepancy in HIV rates among Eastern and central European injecting drug users (IDUs) suggests that, in addition to risk behaviors, social contact patterns also play an important role. This study identifies two groups of IDUs in Budapest, Hungary, marginalized IDUs (M-IDUs) and socially integrated IDUs (SI-IDUs) and compares their HIV/hepatitis B virus (HBV)/hepatitis C virus (HCV) social and risk network characteristics, risk behaviors, and travel patterns. Between May 2003 and January 2004, 29 nontreatment-recruited young IDUs in Budapest participated in ethnographic interviews and focus groups. The mean age was 23.6 years (SD=3.6); eight were female and two Roma/Gypsy. Most injected heroin (n=23) and/or amphetamines (n=10) in the past 30 days. M-IDUs had no legal employment, injected heroin and sniffed glue, and stopped using drugs in treatment/prison. SI-IDUs had regular jobs or were students, injected heroin and sniffed cocaine, and stopped using drugs before exams/tests. Both M-IDUs and SI-IDUs shared injecting equipment on occasion and used condoms rarely. M-IDUs had a large social network of "buddies" and a small risk network of "friends". SI-IDUs had two separate large social networks of "buddies": a M-IDU and a non-IDU network; and a small risk network of "friends". Both groups reported monogamous sexual relationships. M-IDUs traveled within Hungary, whereas SI-IDUs traveled to Western Europe. If an HIV epidemic among IDUs in Hungary is not prevented, SI-IDUs may form a potential "bridge" of HIV infection between high-risk IDU populations and the low-risk general population, whereas M-IDUs may become cores of infection. These findings suggest that different approaches may be appropriate for M-IDUs and SI-IDUs to prevent HIV. Gyarmathy, V. and Neaigus, A. Marginalized and Socially Integrated Groups of IDUs in Hungary: Potential Bridges of HIV Infection. J Urban Health, 82(3-4), pp. iv101-iv112, 2005.

Hospitalizations for Metabolic Conditions, Opportunistic Infections, and Injection Drug Use among HIV Patients: Trends Between 1996 and 2000 in 12 States

Rapid changes in HIV epidemiology and highly active antiretroviral therapy (HAART) may have resulted in recent changes in patterns of inpatient utilization. This study examined trends in inpatient diagnoses and mortality in HIV patients. Serial cross-sectional analyses were conducted of HIV patients hospitalized in 1996, 1998, and 2000, using hospital discharge data from the Healthcare Costs and Utilization Project for 12 states. Each hospitalization was classified as an opportunistic illness, complication of injection drug use (IDU), liver-related complication, ischemic heart disease, cerebrovascular disease, non-Pneumocystis carinii pneumonia (PCP), diabetes, or chronic hepatitis C virus (HCV). Outcome measures were the number of hospital admissions and inpatient mortality. The study evaluated 316,963 admissions that occurred between 1996 and 2000, with an overall mortality of 7%. Hospitalizations for opportunistic infections significantly decreased from 40% to 27% of all HIV-related admissions. The overall proportion of IDU complications remained relatively stable (6%) each year. Hospitalizations increased for liver-related complications from 8% to 13% and for chronic HCV from 1% to 5% in this period. The number of hospitalizations for cerebrovascular disease and for ischemic heart disease was relatively negligible in all years. Overall, inpatient mortality decreased between 1996 and 2000. Relatively higher mortality was observed among African Americans, Hispanics, those with Medicaid, those with Medicare, and the uninsured, however. Opportunistic infections and liver-related complications were associated with greater inpatient mortality. Results do not show a significant recent rise in HIV-related inpatient utilization. Admissions to treat opportunistic infections have declined precipitously, consistent with the effects of HAART. Although not dramatic, liver-related disease is an increasing cause of hospitalization in HIV+ patients. Gebo, K., Fleishman, J., and Moore, R. Hospitalizations for Metabolic Conditions, Opportunistic Infections, and Injection Drug Use among HIV Patients: Trends Between 1996 and 2000 in 12 States. J Acquir Immune Defic Syndr, 40(5), pp. 609-616, 2005.

HIV, HBV, and HCV Infections Among Drug-Involved, Inner-City, Street Sex Workers in Miami, Florida

This study describes the rates of HIV, HBV, and HCV seropositivity among drug-involved, female street sex workers in low-income, inner-city sections of Miami, Florida; further, their sociodemographic characteristics, drug use, and sexual risk behaviors were assessed; and predictors of infection were reported. A sample of 586 sex workers was recruited through targeted sampling methods, interviewed, and counseled and tested for the presence of antibody to HIV, HBV, and HCV. Respondents' median age was 38 years, median time in sex work was 14 years, all were heavily involved in the use of alcohol and drugs, and 42% were homeless. More than half (51.0%) had engaged in unprotected vaginal sex in the past month. Prevalences were HIV, 22.4%; HBV, 53.4%; HCV, 29.7%. A multidimensional public health program must address not only issues related to unsafe sex, but also the problems of drug abuse, homelessness, and other lifestyle factors that contribute to risk behaviors. Inciardi, J., Surratt, H.L., and Kurtz, S.P. HIV, HBV, and HCV Infections Among Drug-Involved, Inner-City, Street Sex Workers in Miami, Florida. AIDS Behav, 10(2), pp. 139-147, March 2006.

HIV Risk Behavior among Amphetamine Injectors at U.S. Syringe Exchange Programs

The goal of this study was to compare HIV risk behaviors of amphetamine and non-amphetamine injectors at syringe exchange programs (SEP) in the United States and to identify factors associated with injection risk. The analysis is based on data from a random cross-section of participants at 13 SEPs in different parts of the country. All interviews were done using Audio Computer-Assisted Personal Interviewing technology. Amphetamine injectors differ from other SEP participants in that they are younger and more likely to be White, to have had a recent same sex partner, and to be homeless. Rates of injection risk behavior are higher among amphetamine injectors than other SEP participants, but rates of condom use are similar. Factors associated with injection risk behavior are amphetamine injection, homelessness, depression, and having a recent same-gender sexual partner (for both men and women). SEPs have been repeatedly demonstrated to reduce injection risk behavior, but some groups of program participants continue to be at elevated risk. These findings suggest that SEPs need to develop new approaches to outreach and education to address the needs of amphetamine injectors and other populations at persistent risk. Braine, N., Des Jarlais, D., Goldblatt, C., Zadoretzky, C., and Turner, C. HIV Risk Behavior among Amphetamine Injectors at U.S. Syringe Exchange Programs. AIDS Educ Prev, 17(6), pp. 515-524, 2005.

Sex, Touch, and HIV Risk Among Ecstasy Users

This study examined HIV risk among heavy and non-heavy ecstasy users, focusing specifically on touch and sexual behavior as part of the ecstasy experience. Structured interviews were conducted with 268 young adult (age 18-25) ecstasy users in Atlanta, Georgia. Heavy ecstasy users were more likely to have been tested for HIV than non-heavy users (79 vs. 68%). However, they also were more likely to perceive no chance of contracting HIV (36 vs. 26%). Touch, both sensual and sexual, was a significant part of the ecstasy experience. In addition, ecstasy use seemed to increase the sexual desire, however, not the ability to achieve an orgasm. Heavy users reported more sexual risk-taking than their non-heavy using counterparts. Results suggest that the setting of ecstasy use also may influence involvement in risk behaviors. Future longitudinal studies are needed on the relationship between ecstasy use, touch, sexual arousal and ability, and risk behavior. Theall, K.P., Elifson, K.W. and Sterk, C.E. Sex, Touch, and HIV Risk Among Ecstasy Users. AIDS Behav, 10(2), pp. 169-178, March 2006.

HIV/Hepatitis C Virus Co-infection in Drug Users: Risk Behavior and Prevention

Studies of HIV-positive patients have consistently shown that drug users, in particular injection drug users (IDU), are far more likely to have hepatitis C virus (HCV) infection than other patient groups. HIV incidence and prevalence in IDU has declined in recent years, but HCV remains endemic in this population. HCV antibody prevalence among non-injection users of drugs such as heroin and cocaine is between 5 and 30%, although there are scant data on specific transmission risk behavior. The control of HIV/HCV co-infection must address HCV prevention. Epidemiological studies have suggested that HCV prevalence in IDU is subject to various influences, some of which may be modifiable by interventions. However, studies have not shown consistent effects of various prevention strategies on HCV transmission, including studies of HCV screening and education, drug treatment or needle exchange. Although some large cross-sectional studies in regions where needle exchange is available to a large number of drug injectors have reported declining HCV prevalence, the scale of services needed is a matter of considerable debate and has not been systematically quantified. Priorities for research related to the prevention of HIV/HCV co-infection should include estimating the effect on disease occurrence of eliminating specific risk factors, and specifying the level of resources needed to alter HCV incidence. Hagan, H., Thiede, H., and Des Jarlais, D. HIV/Hepatitis C Virus Co-infection in Drug Users: Risk Behavior and Prevention. AIDS, 19(3), pp. S199-S207, 2005.

Stigmatization of Newly Emerging Infectious Diseases: AIDS and SARS

This study assessed relationships between sociodemographic characteristics and mental health status and knowledge of, being worried about, and stigmatization of 2 emerging infectious diseases: AIDS and SARS. A random-digit-dialed survey of 928 residents of the New York City metropolitan area was conducted as part of a study of the effects of the September 11, 2001, terrorist attacks. Questions added for this study concerned respondents' knowledge of, worry about, and support of stigmatizing actions to control AIDS and SARS. In general, respondents with greater personal resources (income, education, social support) and better mental health status had more knowledge, were less worried, and were less likely to stigmatize. This pattern held for both AIDS and SARS. The findings suggest that personal resources and mental health factors are likely to influence the public's ability to learn about, rationally appraise the threat of, and minimize stigmatization of emerging infectious diseases such as AIDS and SARS. Des Jarlais, D., Galea, S., Tracy, M., Tross, S., and Vlahov, D. Stigmatization of Newly Emerging Infectious Diseases: AIDS and SARS. Am J Public Health, 96(3), pp. 561-567, 2006.

Social Support and HIV-Related Injection Risk among Puerto Rican Migrant and Nonmigrant IDUs Recruited in New York City

This study compared associations between social support and HIV injection risk among Puerto Rican migrant (n=221) and nonmigrant (n=340) injection drug users in New York City. Practical and emotional support scales were developed from 8 items and examined by migrant status as predictors of risk. Bivariate and regression analysis were conducted with drug shooting gallery use, sharing needles, paraphernalia, and number of monthly injections as dependent variables. Migrants had lower emotional (2.82 vs 3.19, p=.002) and practical (1.87 vs 2.05, p=.051) support than nonmigrants. Controlling for age, sex, and homelessness, emotional support was negatively associated with injection frequency (standardized coefficient = -168, p=.020) and gallery use (AOR = .76, CI = .62-.94, p = .011) among migrants and with an almost 2-fold increase in sharing syringes (AOR=1.87, CI = 1.02-3.43, p=.041) among nonmigrants. These findings suggest that migrants have less support than nonmigrants do, but their support reduces risk and thus their likelihood of injection-related HIV infection. Mino, M., Deren, S., and Yeon-Kang, S. Social Support and HIV-Related Injection Risk among Puerto Rican Migrant and Nonmigrant IDUs Recruited in New York City. AIDS Educ Prev, 18(1), pp. 81-90, 2006.

Psychological Resilience after Disaster

Research on adult reactions to potentially traumatic events has focused almost exclusively on posttraumatic stress disorder (PTSD). Although there has been relatively little research on the absence of trauma symptoms, the available evidence suggests that resilience following such events may be more prevalent than previously believed. This study examined the prevalence of resilience, defined as having either no PTSD symptoms or one symptom, among a large (n= 2,752) probability sample of New York area residents during the 6 months following the September 11th terrorist attack. Although many respondents met criteria for PTSD, particularly when exposure was high, resilience was observed in 65.1% of the sample. Resilience was less prevalent among more highly exposed individuals, but the frequency of resilience never fell below one third even among the exposure groups with the most dramatic elevations in PTSD. Bonanno, G., Galea, S., Bucciarelli, A., and Vlahov, D. Psychological Resilience After Disaster. Psychol Sci, 17(3), pp. 181-186, 2006.

The Relationship Between Self-Reported Sexual Orientation and Behavior In a

Data are sparse on injection drug using (IDU) men who have sex with men (MSM). Previous literature suggests perceived taboos can result in an underreporting of atypical sexual orientation (i.e., bisexuality, homosexuality). As a result, HIV prevention programs have been difficult to mount, particularly programs for IDU-MSM. The association between self-reported sexual orientation and sexual behavior at semi-annual study visits was longitudinally assessed in a population of 1300 male IDUs in Baltimore during the period 1993 to 1998. Overall, a small minority (5%) of the male IDUs inconsistently reported their sexual orientation over time. Logistic regression analyses were performed, which yielded five significant predictors. These men tended to be older, to have been incarcerated, to have attended shooting galleries during follow-up, and were more than twice as likely to be HIV-seropositive (OR, 2.66; 95% CI, 1.62-4.36) compared with those who consistently reported their sexual orientation. Furthermore, men reporting inconsistent sexual orientation tended to engage in higher risk behaviors, suggesting that these men should be especially targeted for interventions. Washington, T., Galai, N., Cohn, S., Celentano, D., Vlahov, D., and Strathdee, S. The Relationship Between Self-Reported Sexual Orientation and Behavior In a Sample of Middle-Aged Male IDU. Arch Sex Behav, 35(1), pp. 67-74, 2006.

Needle-Sharing among Young IV Drug Users and Their Social Network Members: The Influence of the Injection Partner's Characteristics on HIV Risk Behavior

Injection drug use is a risk factor for HIV among adolescents and young adults, yet the interpersonal dynamics of needle-sharing among young injectors remain poorly understood. Research has focused on identifying the characteristics of injecting drug users (IDUs) that increase their risk of needle-sharing. Most studies have not taken into consideration IDUs' decisions to share needles with certain partners but not with other partners. This study examined partner characteristics associated with needle-sharing among 96 male and 77 female young adult IDUs who had shared needles previously. Men were most likely to share needles with partners who gave them emotional support, partners who they injected or who injected them, and partners with whom they had had sex. Women were most likely to share needles with partners who they injected or who injected them, partners with whom they had discussed HIV risk, and partners with whom they had had sex. Results indicate that needle-sharing occurs within the context of mutual injection rituals and close emotional and sexual relationships. These findings point to the need for targeted interventions to help young IDUs avoid needle-sharing with intimate partners. Unger, J.B., Kipke, M.D., De Rosa, C.J., Hyde, J., Ritt-Olson, A., and Montgomery, S. Needle-Sharing Among Young IV Drug Users and Their Social Network Members: The Influence of the Injection Partner's Characteristics on HIV Risk Behavior. Addict Behav, available online 3 February 2006.

Do Street Youths' Perceptions of Their Caregivers Predict HIV-Risk Behavior

This study examined street youths' perceptions of their caregivers and the association between these perceptions and HIV-risk behavior in a random probability sample of 715 12- to 23-year-old street youths from Los Angeles and San Diego, CA (mean age, 18.7 years). All participants had been homeless at some point during the past 12 months, with 70% recruited from nonshelter sites. Although youths reported high rates of hostility, unavailability, substance use, and legal problems among their caregivers, 86% reported that their caregivers had at least one attribute associated with support. Caregiver problems were associated with youth having had more sexual partners in the past 30 days and having higher risk drug use. High caregiver support was associated with more sexual partners and lower use of condoms with steady partners. Caregiver attributes did not predict condom use with transient partners. Darling, N., Palmer, R. and Kipke, M. Do Street Youths' Perceptions of Their Caregivers Predict HIV-Risk Behavior? J Fam Psychol, 19(3), pp. 456-464, 2005.

Alcohol and Other Drug Use in the US and Australia

Although youth drug and alcohol harm minimization policies in Australia are often contrasted with the abstinence and zero tolerance policies adopted in the United States, there has been little research directly comparing youth substance use behaviour in the two countries. Three state representative samples in Victoria, Australia (n = 7898) and in the US states of Oregon (n = 15,224) and Maine (n = 16,245) completed a common cross-sectional student survey. Rates of alcohol use (lifetime alcohol use, recent use in the past 30 days), alcohol use exceeding recommended consumption limits (binge drinking: five or more drinks in a session), other licit drug use (tobacco use), and norm-violating substance use (substance use at school, use in the past 30 days of marijuana or other illicit drug use) were compared for males and females at ages 12-17. Rates were lower (odds ratios 0.5-0.8) for youth in Maine and Oregon compared to Victoria for lifetime and recent alcohol use, binge drinking and daily cigarette smoking. However, rates of recent marijuana use and recent use of other illicit drugs were higher in Maine and Oregon, as were reports of being drunk or high at school. In contradiction of harm minimization objectives, Victoria, relative to the US states of Oregon and Maine, demonstrated higher rates of alcohol use exceeding recommended consumption limits and daily tobacco use. However, findings suggested that aspects of norm-violating substance use (substance use at school, marijuana use and other illicit drug use) were higher in the US states compared to Victoria. Toumbourou, J., Beyers, J., Catalano, R., Hawkins, J., Arthur, M., Evans-Whipp, T., Bond, L., and Patton, G. Youth Alcohol and Other Drug Use in the United States and Australia: A Cross-National Comparison of Three State-Wide Samples. Drug Alcohol Rev, 24(6), pp. 515-523, 2005.

Adverse Outcomes for Community Sample of Adolescents and Young Adults with Personality Disorder Not Otherwise Specified

This study investigated whether adolescents and young adults diagnosed with personality disorder not otherwise specified are at elevated risk for adverse outcomes, and whether this elevation in risk is comparable with that associated with the DSM-IV cluster A, B, and C personality disorders. A community-based sample of 693 mothers and their offspring were interviewed during the offspring's childhood, adolescence, and early adulthood. Offspring psychopathology, aggressive behavior, educational and interpersonal difficulties, and suicidal behavior were assessed. Individuals who met DSM-IV criteria for personality disorder not otherwise specified were significantly more likely than those without personality disorders to have concurrent axis I disorders and behavioral, educational, or interpersonal problems during adolescence and early adulthood. In addition, adolescents with personality disorder not otherwise specified were at significantly elevated risk for subsequent educational failure, numerous interpersonal difficulties, psychiatric disorders, and serious acts of physical aggression by early adulthood. Adolescents with personality disorder not otherwise specified were as likely to have these adverse outcomes as those with cluster A, B, or C personality disorders or those with axis I disorders. Adolescents and young adults in the general population diagnosed with personality disorder not otherwise specified may be as likely as those with DSM-IV cluster A, B, or C personality disorders to have axis I psychopathology and to have behavioral, educational, or interpersonal problems that are not attributable to co-occurring psychiatric disorders. Individuals with personality disorder not otherwise specified and individuals with DSM-IV cluster A, B, or C personality disorders are likely to be at substantially elevated risk for a wide range of adverse outcomes. Johnson, J., First, M., Cohen, P., Skodol, A., Kasen, S., and Brook, J. Adverse Outcomes Associated with Personality Disorder Not Otherwise Specified in a Community Sample. Am J Psychiatry, 162(10), pp. 1926-1932, 2005.

Dissociative Disorder in Adults with Impaired Functioning and Co-Occurring Axis I and Personality Disorders

The purpose of this study was to investigate the association of dissociative disorder (DD) with impaired functioning and co-occurring Axis I and personality disorders among adults. Psychiatric interviews were administered to a sample of 658 adult participants in a community-based longitudinal study. Depersonalization disorder (prevalence: 0.8%), dissociative amnesia (prevalence: 1.8%), dissociative identity disorder (prevalence: 1.5%), and dissociative disorder not otherwise specified (prevalence: 4.4%), evident within the past year, were each associated with impaired functioning, as assessed by the clinician-administered Global Assessment of Functioning Scale. These associations remained significant after controlling for age, sex, and co-occurring disorders. Individuals with anxiety, mood, and personality disorders were significantly more likely than individuals without these disorders to have DD, after the covariates were controlled. Individuals with Cluster A (DD prevalence: 58%), B (DD prevalence: 68%), and C (DD prevalence: 37%) personality disorders were substantially more likely than those without personality disorders to have DD. The authors concluded that DD is associated with clinically significant impairment among adults in the community. DD may be particularly prevalent among individuals with personality disorders. Johnson, J., Cohen, P., Kasen, S. and Brook, J. Dissociative Disorders Among Adults in the Community, Impaired Functioning, and Axis I and II Co-morbidity. J Psychiatr Res, 40(2), pp. 131-140, 2006.

Substance Using Peers Remain Important Predictor of Adult Abuse and Dependence

This study explores three avenues in early young adulthood through which adolescent problems may be linked to later substance use problems: problematic substance use, failure to assume adult roles and responsibilities, and exposure to pro-drug social influences. Participants (N = 1,986; 49% female) filled out surveys at ages 18, 23 and 29. Participants were 67% white, 9% black, 10% Hispanic and 8% Asian. Deviance, poor mental health, substance use, alcohol and other drug (AOD) problems, and school dropout were measured at age 18. AOD problems were also measured at age 23, as were role changes (e.g., marriage) and pro-drug social influences (e.g., friends use drugs). Indicators of substance abuse and dependence were measured at age 29. Demographics and family history of AOD were covariates. Reporting more deviant behavior and heavier drinking at age 18 was associated with a higher likelihood of abuse and dependence at age 29. Alcohol use and pro-drug social influences at age 23 appeared to mediate the effects of adolescent substance use; lack of role assumption did not. The effect of poor mental health at age 18 was not mediated by any set of variables but instead appeared to directly predict dependence at age 29. Findings highlight the importance of early young adult drinking and substance-using peers in continuing patterns of heavy substance use developed during adolescence and also underscore the long-term impact of poor mental health during adolescence on substance use problems in late young adulthood. D 'Amico, E., Ellickson, P., Collins, R., Martino, S., and Klein, D. Processes Linking Adolescent Problems to Substance-Use Problems in Late Young Adulthood. J Stud Alcohol, 66(6), pp. 766-775, 2005.

For Females, Marriage at Any Age is Protective from Alcohol Use

Previous research shows that marriage leads to reductions in alcohol use, especially for women. Because marriage prior to age 20 (early marriage) is a marker for deviance, the protective effects of marriage may not extend to those who marry in adolescence. This study compared the effects of marriage in adolescence versus young adulthood on alcohol consumption, negative alcohol-related consequences and heavy episodic drinking at age 29. They analyzed data from 1,138 women in a longitudinal cohort followed from ages 18 to 29. The original sample was recruited from 30 California and Oregon middle schools and first surveyed at age 13. Women who had not married, had married early or had married between ages 20 and 29 did not differ on alcohol use at age 18. Women who married as young adults were less likely than singles to engage in any alcohol use, heavy episodic drinking or experience negative consequences and reported less alcohol use at age 29. Women who married in adolescence reported fewer negative consequences at age 29 than did singles and (if they had not divorced) were less likely to engage in heavy episodic drinking or experience any negative consequences, reported fewer consequences and consumed less alcohol. The protective effects of marriage in young adulthood were observed whether or not women divorced. Parenthood and college attendance before age 23 did not explain the marriage effect. Results support role theory, which posits that individuals who marry are socialized into conventional adult roles that discourage deviant behavior. Bogart, L., Collins, R., Ellickson, P., Martino, S., and Klein, D. Effects of Early and Later Marriage on Women's Alcohol Use in Young Adulthood: A Prospective Analysis. J Stud Alcohol, 66(6), pp. 729-737, 2005.

Trajectories of Young Adult Concurrent Alcohol and Tobacco Use

This study examines the concurrent course of heavy alcohol use and tobacco use during early adulthood (ages 19-26). Panel data were drawn from the Monitoring the Future Project young adult sample (N=32,087). The authors applied growth mixture modeling to 4 waves of data to disentangle the effect of cohort and developmental stage on heavy drinking and smoking. The influence of covariates (sex, race, alcohol expectancies, delinquency, religiosity, and parent education) on the course of alcohol-tobacco co-morbidity was examined. Seven co-occuring trajectories of alcohol and tobacco use, controlling for secular changes occurring over 2 decades were identified. Associations between trajectory classes and risk factors were relatively unique to the substance being predicted. The association of smoking with alcohol expectancies and delinquency appeared to exist by virtue of smoking's co-morbidity with drinking. Although recent work characterizes drinking and smoking trajectories, this study is novel in exploring the course of concurrent drinking and smoking and establishes the feasibility of modeling co-morbidity and course with in a person-centered approach to data analysis. Jackson, K., Sher, K., and Schulenberg, J. Conjoint Developmental Trajectories of Young Adult Alcohol and Tobacco Use. J Abnorm Psychol, 114(4), pp. 612-626, 2005.

Personality Traits and Externalizing Disorders in Adolescence

The authors examined personality profiles among children who differed in their co-morbidity of externalizing disorders: attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD). 11- and 17-year-old male and female twins from a community sample of 2876 twin pairs in the Minnesota Twin Family Study were categorized as ADHD only, CD only, co-morbid CD-ADHD, and controls (no ADHD or CD) based on threshold and subthreshold CD and ADHD diagnoses assessed with structured interviews. Multivariate analyses were used to identify patterns of personality that differentiate these four diagnostic groups. The authors found that the co-morbid group had a pattern of personality marked by higher Negative Emotionality and lower Constraint than the other diagnostic groups. This pattern was evidenced across gender and age cohort. They concluded that an extreme personality profile may represent a liability toward the occurrence of ADHD and CD with more extreme profiles contributing to the occurrence of both disorders among boys and girls. The significance of this study lies in prediction and understanding of risk based on childhood psychiatric diagnosis and personality traits, given the findings from other groups that co morbid ADHD and CD represent a particularly strong risk group for substance use disorders. Significance is further strengthened by the use of a large, population-based sample and the extension of findings across ages and gender. Cukrowicz, K., Taylor, J., Schatschneider, C., and Iacono, W. Personality Differences in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, and Controls. J Child Psychol Psychiatry, 47(2), pp. 151-159, 2006.

Measuring Violence Risk and Outcomes among Mexican American Adolescent Females

Central to the development of culturally competent violence prevention programs for Hispanic youth is the development of psychometrically sound violence risk and outcome measures for this population. A study was conducted to determine the psychometric properties of two commonly used violence measures, in this case for Mexican American adolescent females. The Conflict Tactics Scales (CTS2) and the Past Feelings and Acts of Violence Scale (PFAV) were analyzed to examine their interitem reliability, criterion validity, and discriminant validity. A sample of 150 low-risk and 150 high-risk adolescent females was studied. Discriminant validity was indicated by the perpetrator negotiation scale and by the victim psychological aggression and sexual coercion scales of the CTS2 and the PFAV. Analysis indicates that the CTS2 scales and the PFAV demonstrate adequate reliability, whereas strong criterion validity was evidenced by eight of the CTS2 scales and the PFAV. Cervantes, R., Duenas, N., Valdez, A., and Kaplan, C. Measuring Violence Risk and Outcomes among Mexican American Adolescent Females. J Interpers Violence, 21(1), pp. 24-41, 2006.

Mexican American Youth and Adult Prison Gangs in a Changing Heroin Market

This article focuses on the interaction between the larger community's drug markets and youth and adult prison gangs, and the process that leads to specific adverse consequences both to the youth gangs as organizations and to individual members. Described is the emergence of a restructured heroin market dominated by an adult prison gang. A major consequence of this was the increasing use of heroin among Mexican American gang members and their transformation from autonomous youth gangs to extensions of the adult prison gangs or their demise. Data were collected from 160 members of 26 Mexican American youth gangs and key informants in San Antonio. Findings focus on organizational rules, drug market transformations, consequences on members, and the impact of heroin on the gang's organization. Discussed is how the dominance of prison gangs is related to the increased incarceration and recidivism rates of Mexican Americans and declining economic opportunities for urban minorities. Valdez, A. Mexican American Youth and Adult Prison Gangs in a Changing Heroin Market. Journal of Drug Issues, Fall pp. 843-867, 2005.

Reported Condom Use and Condom Use Difficulties in Street Outreach Samples of Men of Four Racial and Ethnic Backgrounds

The epidemiology of the HIV/AIDS epidemic in the United States has focused research attention on lesbian, gay, bisexual and transgendered communities as well as on racial and ethnic minorities. Much of that attention has, however, been focused on specific racial and ethnic groups, and specific sexual minorities. This paper reports on the results of a study that examined the association between condom use and partnership types among drug-using men from four major racial/ethnic groups. Self-reported data on sexual identity (homosexual, bisexual, and heterosexual) and condom use in the past three months were collected from 806 African Americans, Hispanic, Asian, and white men intercepted in public places in Houston, TX. Data indicated that condom use was lowest in African Americans and Hispanic men, bisexual men reported the highest levels of use, with heterosexual men reporting the lowest use. African Americans and Hispanic men reported generally that it was very difficult to use a condom during sexual contact, although the patterns for self-identified homosexual, heterosexual, and bisexual men varied across race/ethnicity. Homosexual African American men reported the least difficulty, and white homosexual men the most difficulty compared with heterosexual and bisexual peers. For homosexually identified men, there were considerable differences across race/ethnicity in the proportion of partners who never or rarely disagreed to use condoms, with Asians disagreeing least, and African Americans most. Within racial/ethnic groups, the levels of condom use and difficulty were similar for male and female partners, suggesting that it is sexual identity, rather than partner gender, that has impacted condom-use messages. These data suggest that racial/ethnic targeting of condom use is likely to be most efficacious in increasing condom use in men. Essien, E., Ross, M., Fernández-Esquer, M. and Williams, M. Reported Condom Use and Condom Use Difficulties in Street Outreach Samples of Men of Four Racial and Ethnic Backgrounds. Int J STD AIDS, 16(11), pp. 739-743, 2005.

Using Standardized Methods for Research on HIV and Injecting Drug Use in Developing/Transitional Countries: Case Study from the WHO Drug Injection Study

Successful cross-national research requires methods that are both standardized across sites and adaptable to local conditions. This study reports on the development and implementation of the methodology underlying the survey component of the WHO Drug Injection Study Phase II - a multi-site study of risk behavior and HIV seroprevalence among Injecting Drug Users (IDUs). Standardized operational guidelines were developed by the Survey Coordinating Center in collaboration with the WHO Project Officer and participating site Investigators. Throughout the duration of the study, survey implementation at the local level was monitored by the Coordinating Center. Surveys were conducted in 12 different cities. Prior rapid assessment conducted in 10 cities provided insight into local context and guided survey implementation. Where possible, subjects were recruited both from drug abuse treatment centers and via street outreach. While emphasis was on IDUs, non-injectors were also recruited in cities with substantial non-injecting use of injectable drugs. A structured interview and HIV counseling/testing were administered. Over 5,000 subjects were recruited. Subjects were recruited from both drug treatment and street outreach in 10 cities. Non-injectors were recruited in nine cities. Prior rapid assessment identified suitable recruitment areas, reduced drug users' distrust of survey staff, and revealed site-specific risk behaviors. Centralized survey coordination facilitated local questionnaire modification within a core structure, standardized data collection protocols, uniform database structure, and cross-site analyses. Major site-specific problems included: questionnaire translation difficulties; locating affordable HIV-testing facilities; recruitment from drug treatment due to limited/selective treatment infrastructure; access to specific sub-groups of drug users in the community, particularly females or higher income groups; security problems for users and interviewers, hostility from local drug dealers; and interference by local service providers. This study found that rapid assessment was helpful in paving the way for the survey. Central coordination of data collection was also crucial. While fully standardized methods may be a research ideal, local circumstances may require substantial adaptation of the methods to achieve meaningful local representation. Allowance for understanding of local context may increase rather than decrease the generalizability of the data. Des Jarlais, Perlis, Stimson, and Poznyak. Using Standardized Methods for Research on HIV and Injecting Drug Use in Developing/Transitional Countries: Case Study from the WHO Drug Injection Study. BMC Public Health, 6(1), pp. 54-87, 2006.

Assessing Parenting Behaviors Among Mothers with a History of Maltreatment

Parenting assessments (the Parent-Child Conflict Tactics Scale, CTSPC; and a mother-child observation) were examined for their ability to identify mothers with a history of physically abusing or neglecting their child. Participants were mothers of 139 children (age 3 to 6 years; 58 with a history of maltreatment). Mothers with a history of maltreatment reported higher scores on the Neglect, Nonviolent Discipline, and Psychological Aggression subscales of the CTSPC. These group differences, however, were limited to mothers who acknowledged a history of maltreatment, as mothers who concealed their maltreatment history rated themselves similar to controls. Observation of parental behaviors during a brief, non-stressful task did not discriminate mothers who maltreated from mothers who did not maltreat. The findings suggest that parental report using the CTSPC may be useful in assessing parenting behaviors among mothers with a history of maltreatment, although socially desirable responding is a significant problem. Bennett, D., Sullivan, M., and Lewis, M. Relations of Parental Report and Observation of Parenting to Maltreatment History. Child Maltreat, 11(1), pp. 63-75, 2006.

Sibling Contact is Source of Social Contagion for Smoking and Drinking

Prior research on sibling contagion for substance use has not attended to individual differences in the sibling relationship that may be influenced by genetic similarity. The authors utilizing data on a sample of twin and nontwin siblings participating in the National Longitudinal Study of Adolescent Health (Add Health). Although monozygotic twins had the highest levels of sibling contact and mutual friendships, the pattern of results for other sibling types were not consistent with genetic models, and biometric analysis indicated that shared environmental factors influenced these sibling relationship features. Application of DeFries-Fulker regression models provided evidence that sibling contact and mutual friendships represent a source of social contagion for adolescent smoking and drinking independent of genetic relatedness. The results are interpreted using a social contagion framework and contrasted with other competing models such as those focused on the equal environments assumption and niche selection. Rende, R., Slomkowski, C., Lloyd-Richardson, E., and Niaura, R. Sibling Effects on Substance Use in Adolescence: Social Contagion and Genetic Relatedness. J Fam Psychol, 19(4), pp. 611-618, 2005.

Serum Albumin as a Prognostic Indicator for HIV Disease Progression

Low albumin levels have been associated with HIV progression. The objective of this analysis was to confirm this association and to further examine the effect of albumin before and after HIV seroconversion on disease progression. The association was first examined among individuals already infected with HIV at entry into a community-based cohort (n = 453) and further assessed among HIV seroconverters with albumin concentrations measured after (n = 219) and before seroconversion (n = 138). The prognostic effect of albumin on AIDS, AIDS mortality, and all-cause mortality was examined using Cox regression. Among 453 HIV-infected individuals, albumin <35 g/liter was associated with faster progression to AIDS [adjusted relative hazard (ARH), 1.8; 95% confidence interval (CI), 1.2-2.8], AIDS mortality (ARH, 2.2; 95% CI, 1.3-3.8), and all-cause mortality (ARH, 2.4; 95% CI, 1.6-3.5). Analyses restricted to HIV seroconverters were similar. Preseroconversion levels of albumin did not predict outcomes, but HIV seroconversion appeared to lower albumin levels. These data show that albumin <35 g/liter after HIV seroconversion is associated with faster HIV disease progression and suggest that low albumin levels are probably a consequence of HIV infection rather than merely reflective of some individuals inherently having low albumin levels. Mehta, S., Astemborski, J., Sterling, T., Thomas, D., and Vlahov, D. Serum Albumin as a Prognostic Indicator for HIV Disease Progression. AIDS Res Hum Retroviruses, 22(1), pp. 14-21, 2006.

Facilitating Entry into Drug Treatment among Injection Drug Users Referred from a Needle Exchange Program: Results from a Community-Based Behavioral Intervention Trial

Researchers evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) vs passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% vs control: 26%, p=0.03). In a multivariate "intention to treat'' model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional ''as treated '' analyses revealed that participants who received 30min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also demonstrate the importance of more accessible programs such as mobile or office-based drug abuse treatment. Strathdee, S.A., Ricketts, E.P., Huettner, S., Cornelius, L. et al.,. Facilitating Entry into Drug Treatment among Injection Drug Users Referred from a Needle Exchange Program: Results from a Community-Based Behavioral Intervention Trial. Drug Alcohol Depend, available online 20 December 2005.

Elevated Rates of HIV infection among Young Aboriginal Injection Drug Users in a Canadian Setting

Recent reports have suggested that Aboriginal and American Indian people are at elevated risk of HIV infection. The present study compared socio-demographic and risk variables between Aboriginal and non-Aboriginal young (aged 13 - 24 years) IDUs and characterized the burden of HIV infection among young Aboriginal IDUs. Socio-demographic and risk variables were compared between Aboriginal and non-Aboriginal young IDUs. Data were collected through the Vancouver Injection Drug Users Study (VIDUS). Semi-annually, participants have completed an interviewer-administered questionnaire and have undergone serologic testing for HIV and Hepatitis C (HCV). To date over 1500 Vancouver IDU have been enrolled and followed, among whom 291 were aged 24 years and younger. Of the 291 young injectors, 80 (27%) were Aboriginal. In comparison to non-Aboriginal youth, Aboriginal youth were more likely to test seropositive for either HIV (20% vs 7%, p=>0.001) or Hepatitis C virus (HCV) (66% vs 38%, p=>0.001), be involved in sex work and live in the city ‘s IDU epi-centre at baseline. After 48 months of follow-up, Aboriginal youth experienced significantly higher HIV seroconversion rates than non-Aboriginal youth, 27.8 per ppy (95% CI: 13.4-42.2) vs. 7.0 per ppy (95% CI: 2.3-11.8) respectively (log-rank p=0.005) and the incidence density over the entire follow-up period was 12.6 per 100 pyrs (CI: 6.49-21.96) and 3.9 per 100 pyrs (CI: 1.8-7.3) respectively. These findings demonstrate that culturally relevant, evidence based prevention programs are urgently required to prevent HIV infection among Aboriginal youth. Miller, Strathdee, S., et al., Elevated Rates of HIV infection Among Young Aboriginal Injection Drug Users in a Canadian Setting. Harm Reduct J, 3(1), pp. 1-9, 2006.

Trends in GHB Abuse 1999 to 2003

This study examined California Poison Control System (CPCS) data to analyze changes in gamma-hydroxybutyrate (GHB) case reporting and compare the findings to other data sets including the data from the American Association of Poison Control Centers (AAPCC), Drug Abuse Warning Network (DAWN) and Monitoring the Future Study data on students and young adults. The investigators identified cases from the CPCS computerized database using standardized codes and key terms for GHB and congener drugs ("gamma butyrolactone," "1,4-butanediol," "gamma valerolactone"), and noted CPCS date, caller and exposure site, patient age and sex, reported coingestions, and outcomes. The CPCS data were compared to case incidence data from AAPCC and DAWN data and drug use prevalence from the Monitoring the Future survey data. A total of 1,331 patients identified from CPCS were included over the 5-year period (1999-2003). California Poison Control System-reported GHB exposures decreased by 76% from baseline (n=426) to the final study year (n=101). The absolute decrease was present across all case types, although there was a significant proportional decrease in routine drug abuse cases and an increase in malicious events, including GHB-facilitated sexual assault (P=.002). AAPCC data showed a similar decrease from 2001 to 2003. DAWN incidence flattened from 2001 to 2002. Monitoring the Future survey time trends were inconsistent across age groups. A precipitous decrease in case incidence for GHB for the CPCS was observed. In comparison with other data sources, the authors conclude that a true decrease in case incidence is likely. This could be due to decreased abuse rates or because fewer abusers seek emergency medical care. Case reporting may account for part of the decrease in the incidence of poison center contacts involving GHB. Anderson, I., Kim, S., Dyer, J., Burkhardt, C., Iknoian, J., Walsh, M., and Blanc, P. Trends in Gamma-Hydroxybutyrate (GHB) and Related Drug Intoxication: 1999 to 2003. Ann Emerg Med, 47(2), pp. 177-183, 2006.

Was There Unmet Mental Health Need after the September 11, 2001 Terrorist Attacks

This study examined the use of professionals for mental health problems among New York City residents who were directly affected by the September 11, 2001 terrorist attacks on the World Trade Center (WTC) or had a probable diagnosis of post-traumatic stress disorder (PTSD) or depression in its aftermath. Correlates of help seeking from professionals for mental health problems after the attacks and barriers to care were also assessed. Data were from a random digit dial telephone survey of 2,752 adults representative of the Greater New York Metropolitan area conducted 6 months after the September 11 terrorist attacks. Fifteen percent of those directly affected and 36% of those with probable PTSD or depression sought help from a professional for a mental health problem after the attacks. There was little new utilization of professionals for mental health problems after the attacks among persons who were not already receiving care prior to September 11. Barriers that prevented people from seeking help for mental health problems 6 months after the September 11 attacks included traditional barriers to care (e.g., cost) and barriers that are unique to the post-disaster context (e.g., the belief that others need the services more than oneself). This study suggests that there was potential unmet mental health need in New York City 6 months after the September 11 attacks on the WTC, but these findings should be tempered by research showing an apparent decrease in population-rates of PTSD. In the aftermath of a disaster, interventions should target persons with mental health needs who were not previously seeking help from a professional for a mental health problem. Stuber, Galea, Boscarino, and Schlesinger. Was There Unmet Mental Health Need After the September 11, 2001 Terrorist Attacks? Soc Psychiatry Psychiatr Epidemiol, pp. 1-11, 2006.


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