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

Research Findings - Epidemiology and Etiology Research

Substance Use Among ADHD Adults

Diagnosing ADHD in adults is difficult when the diagnostician cannot establish an onset prior to the DSM-IV criterion of age seven or if the number of symptoms does not achieve the DSM threshold for diagnosis. These diagnostic issues are an even larger concern for clinicians faced with adults with substance use disorders (SUD). The present study compared four groups of adults: full ADHD subjects who met all DSM-IV criteria for childhood onset ADHD (n=127), late onset ADHD subjects who met all criteria except the age at onset criterion (79), subthreshold ADHD subjects who did not meet full symptom criteria (41), and non-ADHD subjects who did not meet any of the above criteria (123). Subjects were between the ages of 18 and 55, and were recruited from psychiatric clinic referrals and advertisements. Diagnoses were by the Structured Clinical Interview for DSM-IV, and the Drug Use Severity Index (DUSI) was used for self-report of substance use. The authors found that cigarette and marijuana use was significantly greater in all ADHD groups relative to non-ADHD controls. Although usage rates of other drugs failed to reach significance, the ADHD groups were more likely to have used each drug (except alcohol) compared with the non-ADHD group. The late onset and full ADHD groups were more likely to have endorsed ever having a problem due to use of cigarettes, alcohol, or marijuana and reported more trouble resisting use of drugs or alcohol. The full ADHD group was more likely than the other groups to have reported 'getting high' as their reason for using their preferred drug. The authors conclude that adults with ADHD have elevated rates of substance use and related impairment, and that their data about late onset ADHD provides further support for the idea that the DSM-IV age at onset criterion is too stringent. In contrast, they surmised that subthreshold ADHD seems to be a milder form of the disorder, or perhaps a heterogeneous group of true ADHD cases and false positives. Faraone, S., Wilens, T., Petty, C., Antshel, K., Spencer, T., and Biederman, J. Substance Use among ADHD Adults: Implications of Late Onset and Subthreshold Diagnoses. Am. J. Addict., 16 Suppl 1, pp. 24-34, 2007.

Developmental Trajectories of Young Adult Poly-Substance Use

Despite the prominence of comorbidity among substances and the recent attention focused on trajectory-based approaches to characterizing developmental change, little research in the substance use field has simultaneously considered both course and comorbidity. Using nationally representative panel data from the Monitoring the Future Project (MTF; n = 32,087; 56% female; 82% Caucasian), authors identified developmental courses of heavy drinking, smoking, and marijuana use using 4 waves of data spanning ages 18 to 26 in a multi-cohort young adult sample. Comorbidity was examined by cross-classifying group membership in substance use trajectories. Finally, the extent to which risk factors (sex, race, alcohol expectancies, delinquency, sensation seeking, depressive affect, religiosity, academic achievement, and parent education) accounted for combinations of comorbidity that occurred at a rate greater than chance was examined. For each substance, authors identified 4 courses of substance use that were largely consistent with those found in the literature (chronic high use, late-onset use, developmentally limited use, and low-use), with a fifth moderate smoking group. Heavy drinking, smoking, and marijuana use were each highly associated, and distinct patterns of comorbidity were evident, with greatest agreement along the diagonal. All risk factors explained comorbidity to some degree, with delinquency, sensation seeking, alcohol expectancies, and religion in particular predicting combinations of comorbidity that were characterized by early onset and chronic high use. Cross-substance trajectory concordance was high, with parallel changes in substance use over emerging adulthood. This suggests similar developmental timing of use, perhaps due to the experience of developmental transitions that have a common influence on use of different substances. Prediction of combinations of comorbidity characterized by early onset and persistently high use suggests that to some extent, individuals use multiple substances because of a common vulnerability to each, rather than directional relations among substances (e.g., cross-tolerance, cueing). Jackson, K., Sher, K., and Schulenberg, J., Conjoint Developmental Trajectories of Young Adult Substance use. Alcohol Clin. Exp. Res., 32(5), pp. 723-737, 2008.

High School Drinking Mediates the Relationship Between Parental Monitoring and College Drinking

This study examined whether parental monitoring indirectly exerts a protective effect on college drinking by reducing high school alcohol consumption. A longitudinal cohort of 1,253 male and female students, ages 17 to 19, attending a large, public, mid-Atlantic university was studied at two time points. First, data on high school parental monitoring and alcohol consumption were gathered via questionnaire during the summer prior to college entry. Second, during the first year of college, past-year alcohol consumption was measured via a personal interview. Multiple regression models tested the relationship between parental monitoring and past year alcohol use (i.e., number of drinks per drinking day). Holding constant demographics, SAT score, and religiosity, parental monitoring had a significant protective effect on both high school and college drinking level. However, the association between parental monitoring and college drinking level became non-significant once high school drinking level was held constant. While parental monitoring did not directly influence college alcohol consumption, evidence for mediation was observed, whereby parental monitoring had an indirect influence on college drinking through reductions in high school drinking. The authors conclude that initiatives that promote effective parenting might be an important strategy to curb high-risk drinking among older adolescents. Arria, A., Kuhn, V., Caldeira, K., O'Grady, K., Vincent, K., Wish, E., and Wish, E. High School Drinking Mediates the Relationship Between Parental Monitoring and College Drinking: A Longitudinal Analysis. Subst. Abuse Treat. Prev. Policy, 3, pp. 6, 2008.

Genetic and Environmental Influences on Substance Use over Development

The authors sought to expand our understanding of the changing roles of environmental and genetic influences on psychoactive substance use (PSU) through development from early adolescence through middle adulthood. Data were gathered using a retrospective assessment by life history calendar, from a total of 1796 members of male-male pairs from the population-based Virginia Adult Twin Study of Psychiatric and Substance Use Disorder, interviewed between 1998 and 2004, when the twins were ages 24 to 62 years old. Data were analyzed with univariate and bivariate structural modeling. Levels of use of alcohol, caffeine, cannabis, and nicotine were recorded for every year of the respondent''s life. For nicotine, alcohol, and cannabis, modeling found that familial environmental factors were critical in influencing use in early adolescence and gradually declined in importance through young adulthood. Genetic factors, by contrast, had little or no influence on PSU in early adolescence and gradually increased in their effect with increasing age. The sources of individual differences in caffeine use changed much more modestly over time. Substantial correlations were seen among levels of cannabis, nicotine, and alcohol use and specifically between caffeine and nicotine. In adolescence, those correlations were strongly influenced by shared effects from the familial environment. However, as individuals aged, more and more of the correlation in PSU resulted from genetic factors that influenced use of both substances. The authors conclude that these results support an etiologic model for individual differences in PSU in which initiation and early patterns of use are strongly influenced by social and familial environmental factors while later levels of use are strongly influenced by genetic factors. The substantial correlations seen in levels of PSU across substances are largely the result of social environmental factors in adolescence, with genetic factors becoming progressively more important through early and middle adulthood. Kendler, K., Schmitt, E., Aggen, S., and Prescott, C., Genetic and Environmental Influences on Alcohol, Caffeine, Cannabis, and Nicotine Use from Early Adolescence to Middle Adulthood. Arch. Gen. Psychiatry, 65(6), pp. 674-682, 2008.

Drugs and Driving by American High School Seniors

The aim of this study was to report trends from 2001 to 2006 in the percentage of all high school seniors who drive after using marijuana, other illicit drugs, or alcohol or who are exposed as passengers to such behaviors. A second objective is to examine demographic and psychosocial correlates of these behaviors. The data were obtained from the Monitoring the Future study, in which nationally representative samples of high school seniors have been surveyed annually since 1975 (approximately 14,000-16,000 seniors per year between 2001-2006). In 2006, 30% of high school seniors reported exposure to a drugged or drinking driver in the past 2 weeks, down from 35% in 2001. Exposure was demonstrated to be widespread as defined by demographic characteristics (population density, region of the country, socioeconomic status, race/ethnicity, and family structure). Individual lifestyle factors (religiosity, grade point average, truancy, frequency of evenings out for fun, and hours of work) showed considerable association with the outcome behaviors. O'Malley, P., and Johnston, L. Drugs and Driving by American High School Seniors, 2001-2006. J. Stud. Alcohol Drugs, 68(6), pp. 834-842, 2007.

Neighborhood Effects on Smoking Moderated by Prosocial Activities

Investigators examined the association between neighborhood characteristics and cigarette use among 824 ninth graders and explored the protective effects of participation in prosocial activities to better understand strengths in adolescents' lives and help identify protective factors for the prevention of adolescent smoking. Investigators interviewed ninth graders who had grade point averages of 3.0 or lower and who were not developmentally disabled. Participants' addresses were geocoded so that interview data could be linked to 1990 US census data on neighborhood characteris-tics. Neighborhood disadvantage and the percentage of Black residents in a neighborhood had different effects on cigarette smoking among Black and White adolescents. Living in a neighborhood with a high percentage of Black residents had favorable effects for Blacks but not for Whites. For both groups, a low percentage of Black residents was a risk factor for cigarette use, and risk effects were higher in the more disadvantaged neighborhoods. Involvement in prosocial activities moderated neighborhood risks. Neighborhood effects on adolescent cigarette use were contingent upon both contextual and individual characteristics. Participation in prosocial activities had a protective effect among adolescents in high-risk neighborhoods. Engaging adolescents in such activities may help offset the adverse effects of living in a disadvantaged neighborhood. Xue, Y., Zimmerman, M., and Caldwell, C. Neighborhood Residence and Cigarette Smoking among Urban Youths: The Protective Role of Prosocial Activities. Am. J. Public Health, 97(10), pp. 1865-1872, 2007.

Predictors of the Degree of Drug Treatment Coverage for Injection Drug Users in 94 Metropolitan Areas in the United States

Researchers conducted a secondary analysis of drug treatment data, including estimated numbers of injection drug users in treatment, for 94 large metropolitan statistical areas (MSAs) in the United States. Treatment coverage for IDU varied from 1.1 to 39.3 percent, and only nine MSAs provided coverage greater than 20 percent. In multiple regression analysis, one general resource (lower long term debt per capital) was weakly related to treatment coverage. A lower percentage of drug users in treatment who are non-injectors and a greater percentage of the non-Hispanic White population strongly predicted treatment coverage for IDU (standardized beta>.20). These findings suggest that, in conditions of scarce treatment coverage for drug injectors, an indicator of epidemiologic need (such as per capita extent of AIDS among IDU) is not likely to predict treatment coverage. Competition for treatment slots by non-injectors may reduce injectors' access to treatment, however. Metropolitan finances, as well as social, structural, political, and other budgetary factors may also interact as potential barriers to expanding drug treatment for drug injectors. Friedman, S., Tempalski, B., Brady, J., Friedman, J., Cooper, H., Flom, P., McGrath, M., Gostnell, K., and Des Jarlais, D. Predictors of the Degree of Drug Treatment Coverage for Injection Drug Users in 94 Metropolitan Areas in the United States. Int. J. Drug Policy, 18(6), pp. 475-485, 2007.

School Truancy Predicts Drug Use

This study examined the relationship between truancy and the onset of drug use in a cohort of 304 youth ages 12-15 participating in the Denver Youth Survey, a longitudinal sample of 1528 youth who grew up in socially disorganized neighborhoods of Denver, CO. The DYS was conducted from 1988 to 1992. This cohort, born in 1976, was one of five cohorts participating in the DYS, and the only one assessed each year between ages 12 and 15, the time that adolescents are legally required to be in school. The study used discrete time survival analysis to assess the effect of truancy on initiation of drug use after adjusting for several potential confounders. Results indicated that in this population, truancy was a significant predictor of initiation of alcohol, tobacco, and marijuana use. The robust effect of truancy persisted after controlling for potential confounders, including school performance, school isolation, association with delinquent peers, personal delinquent values, parental monitoring, and family attachment. Although this study cannot point to a causal relationship, the effect may be at least in part due to the unsupervised, unmonitored time with peers that truancy affords a young person. The findings suggest that keeping youth in school every day is likely to have many beneficial effects. Effective truancy prevention efforts may also help to prevent or delay the onset of drug use among adolescents. Henry, K., and Huizinga, D. Truancy's, Effect on the Onset of Drug use Among Urban Adolescents Placed at Risk. J. Adolesc. Health, 40(4), pp. 358e9-358e17, 2007.

Association Between Psychiatric Disorders and Smoking Stages

Investigators examined the prevalence of smoking behaviors and their association with specific psychiatric disorders in a representative sample of 8,568 youth from behavioral health clinics in Puerto Rico. A complex sampling design was used to select the sample, and analyses were conducted to account for the unequal selection probability, stratification, and clustering. All analyses were weighted back to the clinical population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0. More than one third of the sample reported experience with cigarette smoking, and approximately one quarter reported smoking at least once per week (23.4%). As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages. These were the only disorders that remained significantly associated with nicotine dependence after controlling for comorbidity. The findings confirm the need for screening of smoking behavior and nicotine dependence in treatment settings and the integration of psychiatric/substance use treatments with smoking cessation. Dierker, L., Sledjeski, E., Botello-Harbaum, M., Ramirez, R., Chavez, L., and Canino, G. Association between Psychiatric Disorders and Smoking Stages within a Representative Clinic Sample of Puerto Rican Adolescents. Compr. Psychiatry, 48(3), pp. 237-244, 2007.

Social Networks, Norms, and 12-Step Group Participation

Researchers assessed associations among frequency of attending a 12-step program, perceived social norms, and social network structure among 931 heroin and cocaine users from March 2004 to March 2006. They classified 197 (21%) as Frequent Attenders (FA), 229 (25% as Infrequent Attenders (IA), and 505 (54%) as Non-Attenders (NA). Significant differences were found among the 3 groups: Participants who reported that most or all of their drug partners attended 12-step groups were > 10 times more likely to be frequent attenders compared to individuals who did not go to Narcotics Anonymous (NA). Frequent Attenders also had the highest average total network size of 9.3 individuals while Non-Attenders had the lowest (8.1 individuals). Those who perceived that their drug-using 'buddies' went to Narcotics Anonymous were more likely to attend a 12-step program; this association held regardless of attendance level and after adjusting for social network structure. These findings highlight the effectiveness of 12-step programs for developing more social relationships, which then lead to more frequent attendance. Individuals who are trying to control their drug use should be encouraged to affiliate with others in recovery or attending a 12-step program. Davey-Rothwell, M., Kuramoto, S., and Latkin, C. Social Networks, Norms, and 12-Step Group Participation. Am. J. Drug Alc. Abuse, 34(2), pp. 185-193, 2008.

Social Context of Drinking and Alcohol Problems Among College Students

This study examined how social contexts of drinking are related to alcohol use disorders, other alcohol-related problems, and depression among college students. Data were analyzed from a longitudinal cohort of 1,253 undergraduate students attending a University in the mid-Atlantic region. Logistic regression models controlling for drinking frequency measured the association between social context and problems among the 728 current drinkers (students who had consumed alcoholic beverages on 5 or more days during the past 12 months) in the cohort. Drinking for social facilitation was associated with drinking and driving and housing violations. Drinking in the context of motor vehicles was associated with alcohol abuse/ dependence. Drinking in a context of emotional pain was associated with clinical depression. The authors conclude that alcohol-free programming that fulfills needs for conviviality and addresses early signs of depression might reduce alcohol problems among college students. Beck, K., Arria, A., Caldeira, K., Vincent, K., O 'Grady, K., and Wish, E. Social Context of Drinking and Alcohol Problems Among College Students. Am. J. Health Behav., 32(4), pp. 420-430, 2008.

Long-term Trends in Adolescent and Young Adult Smoking in the US

The authors sought to describe long-term adolescent and young adult smoking trends and patterns by analyzing adolescent data from Monitoring the Future, 1976 to 2005, and young adult (aged 18-24 years, roughly 16,000 students per year) data from the National Health Interview Survey, 1974 to 2005 (n~1800-5600), overall and in subpopulations to identify trends in current cigarette smoking prevalence. Five metapatterns emerged (1) a large increase and subsequent decrease in overall smoking over the past 15 years, (2) a steep decline in smoking among Blacks through the early 1990s, (3) a gender gap reversal among older adolescents and young adults who smoked over the past 15 years, (4) similar trends in smoking for most subgroups since the early 1990s, and (5) a large decline in smoking among young adults with less than a high school education. Long-term patterns for adolescent and young adult cigarette smoking were decidedly nonlinear, and the authors found evidence of a cohort effect among young adults. Continued strong efforts and a long-term societal commitment to tobacco use prevention are needed, given these unprecedented declines in smoking among most subpopulations since the mid- to late 1990s. Nelson, D., Mowery, P., Asman, K., Pederson, L., O 'Malley, P., Malarcher, A., Maibach, E., and Pechacek, T. Long-Term Trends in Adolescent and Young Adult Smoking in the United States: Metapatterns and Implications. Am. J. Public Health, 98(5), pp. 905-915, 2008.

Associations between Adolescent Bipolar Disorder and Substance Use Disorders

This study used a case-control design to evaluate the risk for substance use disorders and cigarette smoking associated with bipolar disorder in adolescents. Subjects included adolescents with bipolar disorder (n=105, age 13.6+/-2.5 years [mean]; 70% male) and without bipolar disorder ('controls'; n=98, age 13.7+/-2.1 years; 60% male). Rates of substance use and other disorders were assessed with structured interviews (KSADS-E for subjects younger than 18, SCID for 18-year-old subjects). The authors found that bipolar disorder was associated with a significant age-adjusted risk for any substance use disorder, alcohol abuse, drug abuse and dependence, and cigarette smoking, independent of attention deficit/hyperactivity disorder, multiple anxiety, and conduct disorder (CD). The primary predictor of substance use disorders in bipolar youth was older age. They conclude that adolescent bipolar disorder is a significant risk factor for substance use disorders and cigarette smoking, independent of psychiatric comorbidity, and recommend that clinicians should carefully screen adolescents with bipolar disorder for substance and cigarette use. Wilens, T., Biederman, J., Adamson, J., Henin, A., Sgambati, S., Gignac, M., Sawtelle, R., Santry, A., and Monuteaux, M., Further Evidence of an Association between Adolescent Bipolar Disorder with Smoking and Substance Use Disorders: A Controlled Study. Drug Alcohol Depend., 95(3), pp. 188-198, 2008.

Factors Associated with HIV Viral Load in a Respondent Driven Sample in Los Angeles

This study used a modified version of the Behavioral Model for Vulnerable Populations to examine the predisposing, enabling, and need factors associated with detectable viral load (VL) among HIV positive persons participating in NIDA's Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATHCAP) at the Los Angeles, California research site. HIV status was measured using saliva and confirmed by blood. Of 797 persons enrolled, 193 were HIV positive and provided VL counts. A hierarchical multivariate logistic regression approach was used to demonstrate that homelessness and recent substance abuse, particularly methamphetamine abuse, were negatively associated with VL. The negative association of homelessness on VL was weakened, however, when participants were able to access and use HIV medication. Mediation analysis showed that methamphetamine use was a significant predictor of detectable viral load, regardless of having access to HIV medication, underscoring the importance of addressing substance abuse among those who are HIV positive is needed to improve biological outcomes. King, Larkins, Hucks-Ortiz, Wang, Gorbach, Veniegas, and Shoptaw. Factors Associated with HIV Viral Load in a Respondent Driven Sample in Los Angeles. AIDS Behav., E-pub, pp. 1-9, 2007.

Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal

Researchers compared drug-injecting risk for HIV, hepatitis B, and hepatitis C among IDU in Newark, NJ and New York City to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent HIV and other parenterally transmitted infections among IDUs. Over the period of data collection (2004-2006), syringe distribution programs were illegal in Newark and legal in NYC. IDU were recruited in both cities, serotested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences were estimated controlling for potential city confounders. IDUs in Newark (n = 214) vs. NYC (n = 312) were more likely to test seropositive for HIV (26% vs. 5%; AOR = 3.2; 95% CI = 1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR = 4.4; 95% CI = 2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR = 3.0; 95% CI = 1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR = 0.004; 95% CI = 0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR = 74.0; 95% CI = 29.9, 183.2), to inject with another IDU''s used syringe (AOR = 2.3; 95% CI = 1.1, 5.0), and to reuse syringes (AOR = 2.99; 95% CI = 1.63, 5.50). These findings demonstrate that IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors in localities where syringe distribution programs are illegal. When these programs are legal and accessible, however, IDUs who are not in drug treatment will access them to reduce their risks of parenterally acquiring or transmitting HIV, HBV, and HCV. Neaigus, A., Zhao, M., Gyarmathy, V., Cisek, L., Friedman, S., and Baxter, R. Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal. J. Urban Health, 85(3), pp. 309-322, 2008.

Individual, Social, and Environmental Influences Associated with HIV Infection Among Injection Drug Users in Tijuana, Mexico

Researchers examined correlates of HIV infection among injection drug users (IDUs) in Tijuana, Mexico, a city bordering the United States, which is situated on major migration and drug trafficking routes. IDUs aged > or =18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and structured interviews. Weighted logistic regression identified correlates of HIV infection. Of 1056 IDUs, the median age was 37 years, 86% were male, and 76% were migrants. HIV prevalence was higher in female participants than in male participants (8% vs. 3%; P = 0.01). Most IDUs testing HIV-positive were previously unaware of their serostatus (93%). IDUs reported injecting with a median of 2 people in the prior 6 months and had been arrested for having injection stigmata (ie, 'track-marks') a median of 3 times. Factors independently associated with HIV infection were being female, syphilis titers consistent with active infection, larger numbers of recent injection partners, living in Tijuana for a shorter duration, and being arrested for having track-marks. These findings reveal the range of individual, social, and environmental factors that are independently associated with HIV infection among IDUs in Tijuana. They point to the need to intervene not solely on individual risk behaviors but on social processes that drive these behaviors, including problematic policing practices. Strathdee, S., Lozada, R., Pollini, R., Brouwer, K., Mantsios, A., Abramovitz, D., Rhodes, T., Latkin, C., Loza, O., Alvelais, J., Magis-Rodriguez, C., and Patterson, T. Individual, Social, and Environmental Influences Associated with HIV Infection among Injection Drug Users in Tijuana, Mexico. J Acquir Immune Defic Syndr, 47(3), pp. 369-376, 2008.

A Randomized Intervention Trial to Reduce the Lending of Used Injection Equipment Among Injection Drug Users Infected with Hepatitis C

Researchers evaluated the efficacy of a peer-mentoring behavioral intervention designed to reduce risky distributive injection practices (e.g., syringe lending, unsafe drug preparation) among injection drug users with hepatitis C virus (HCV) infection. A randomized trial with a time-equivalent attention-control group was conducted among 418 HCV-positive injection drug users aged 18 to 35 years in 3 US cities. Participants reported their injection-related behaviors at baseline and at 3- and 6-month follow-ups. Compared with the control group, intervention-group participants were less likely to report distributive risk behaviors at 3 months (odds ratio [OR]=0.46; 95% confidence interval [CI]=0.27, 0.79) and 6 months (OR=0.51; 95% CI=0.31, 0.83), a 26% relative risk reduction, but were no more likely to cite their HCV-positive status as a reason for refraining from syringe lending. Effects were strongest among intervention-group participants who had known their HCV-positive status for at least 6 months. Peer mentoring and self-efficacy were significantly increased among intervention-group participants, and intervention effects were mediated through improved self-efficacy. This behavioral intervention reduced unsafe injection practices that may propagate HCV among injection drug users. Latka, M., Hagan, H., Kapadia, F., Golub, E., Bonner, S., Campbell, J., Coady, M., Garfein, R., Pu, M., Thomas, D., Thiel, T., and Strathdee, S. A Randomized Intervention Trial to Reduce the Lending of Used Injection Equipment among Injection Drug Users Infected with Hepatitis C. Am. J. Public Health, 98(5), pp. 853-861, 2008.

Circumstances of First Crystal Methamphetamine Use and Initiation of Injection Drug Use Among High-Risk Youth

Despite the widely noted increases in crystal methamphetamine (CM) use, there are few studies on circumstances of first CM use or correlates of use among high-risk populations (e.g. street-involved youth). Street-involved youth in Vancouver, Canada, were enrolled in a study called the At-Risk Youth Study (ARYS) prospective cohort. Extensive outreach produced a representative sample of Vancouver street youth who use illicit drugs. Researchers examined circumstances of first CM use and factors associated with CM use among the cohort. They found that, among 478 participants, 339 (70.9%) had used CM previously. Despite intensive covariate adjustment, a history of CM use was associated independently with having initiated injection drug use [OR = 3.15 (95% CI: 1.89-5.2); p < 0.001]. Among those who had used CM, route of first administration included: 11 (3.2%) oral ingestion; 25 (7.4%) injected; 105 (31.0%) snorted; 231 (68.1%) smoked. The proportion of respondents reporting current CM injection was significantly greater than the proportion reporting injection as the route for first CM use (18.3% vs. 7.4%; McNemar's test p < 0.001). Ability to obtain CM the first time was reported as 'very easy' or 'easy ' by 93.5% and 5.3% of participants, respectively. These findings indicate that crystal methamphetamine use was independently associated with injection drug use, and that significant increases in injecting as the primary mode of administration were observed when patterns of use were considered longitudinally. The easy accessibility of CM and its common use during transition into injection drug use demonstrate the need for innovative drug policy to address this growing concern. Wood, E., Stoltz, J., Zhang, R., Strathdee, S., Montaner, J., and Kerr, T. Circumstances of First Crystal Methamphetamine Use and Initiation of Injection Drug Use among High-Risk Youth. Drug Alcohol Rev, 27(3), pp. 270-276, 2008.

Predicting Hospitalization among HIV-Infected Antiretroviral Naive Patients Starting HAART: Determining Clinical Markers and Exploring Social Pathways

In the era of highly active antiretroviral therapy (HAART), hospitalization as a measure of morbidity has become of increasing interest. The objectives of this study were to determine clinical predictors of hospitalization among HIV-infected persons initiating HAART and to explore the impact of gender and drug use on hospitalization. The analysis was based on a cohort of HIV-positive individuals initiating HAART between 1996 and 2001. Information on hospitalizations was obtained through data linkage with the BC Ministry of Health. Cox-proportional hazard models were used to assess variables associated with time to hospitalization. A total of 1,605 people were eligible and 672 (42%) were hospitalized for one or more days. The final multivariate model indicated that there was an increased risk of hospitalization among those with high baseline HIV RNA (HR for > 100,000 copies/mL: 1.26; 95%CI: 1.16-1.59) or low CD4 cell counts (HR [95% CI] compared to > or = 200 cells/mm3: 1.62 [1.28-2.06] and 1.29 [1.07-1.56] for < 50 and 50-199 cells/mm(3), respectively). Other factors, including adherence, previous hospitalization, gender and injection drug use remained predictive of hospitalization. These findings highlight the importance of closely monitoring patients starting therapy with low CD4 cell counts in order to mediate or prevent outcomes requiring hospitalization. Fielden, S., Rusch, M., Levy, A., Yip, B., Wood, E., Harrigan, R., Goldstone, I., Guillemi, S., Montaner, J., and Hogg, R. Predicting Hospitalization among HIV-Infected Antiretroviral Naive Patients Starting HAART: Determining Clinical Markers and Exploring Social Pathways. AIDS Care, 20(3), pp. 297-303, 2008.

Patterns of Opioid Analgesic Dependence Symptoms

This study examined symptoms of dependence related to the extramedical use of opioid analgesic medications. The 2002-2003 public data-files of the National Survey on Drug Use and Health were used to identify 7810 extramedical opioid analgesic users in the past-year. Latent Class Analysis was used to empirically define classes of past-year extramedical opioid analgesic users based on observed clustering of DSM-IV defined clinical dependence features; multinomial logistic regression was used to describe differences across these groups. The best-fitting four-class model identified classes that differed quantitatively and qualitatively, with 2% of the users in Class 4 (most severe) and 84% in Class 1 (least severe). Classes 2 and 3 had parallel symptom profiles, but those in Class 3 reported additional problems. Adolescents (12-17 year olds) were at higher odds of being in Class 3 versus older age groups; females were two times as likely to be in Classes 2 and 4, and those with mental health problems were at higher odds of belonging to the more severe classes. Differences by type of past year opioid users were also detected. This study sheds light on the classification and distribution of extramedical opioid analgesic dependence symptoms in the US general population and identifies significant subgroups. Ghandour, L., Martins, S., and Chilcoat, H. Understanding the Patterns and Distribution of Opioid Analgesic Dependence Symptoms Using a Latent Empirical Approach. Int. J. Methods Psychiatr. Res., 17(2), pp. 89-103, 2008.

Neurosyphilis in a Clinical Cohort of HIV-1-Infected Patients

Researchers sought to describe the risk factors, clinical presentation, and long-term follow up of patients enrolled in a clinical cohort of HIV-infected patients who were diagnosed and treated for neurosyphilis. They collected comprehensive demographic, clinical, and therapeutic data from all patients between 1990 and 2006. Patients were diagnosed with neurosyphilis if they had positive syphilis serologies and any of the following: (a) one or more cerebrospinal fluid abnormalities on lumbar puncture [white blood cells >10/microl; protein >50 mg/dl; reactive venereal diseases research laboratory], or (b) an otherwise unexplained neurological finding. Of the 231 newly diagnosed syphilis cases, 41 neurosyphilis cases met entry criteria. Their median age was 38.6 years, 79.1% were male, 90% African American, 42% IDU, 48% heterosexual, and 51% had prior history of syphilis). Risk factors for neurosyphilis included a CD4 cell count of less than 350 cells/ml at the time of syphilis diagnosis (odds ratio: 2.87; 95% confidence interval: 1.18-7.02), a rapid plasma regain titer >1: 128 (2.83; 1.11-7.26), and male sex (2.46; 1.06-5.70). Use of any highly active antiretroviral therapy before syphilis infection reduced the odds of neurosyphilis by 65% (0.35; 0.14-0.91). Sixty-three percent of cases presented with early neurosyphilis and the median time to neurosyphilis diagnosis was 9 months. Symptomatic patients had more cerebrospinal fluid abnormalities on initial lumbar puncture than asymptomatic patients (P = 0.01). Follow-up lumbar puncture within 12 months revealed that only 38% had resolution of all cerebrospinal fluid abnormalities. At 1 year, 38% had persistence of their major symptom despite adequate treatment for neurosyphilis. Twelve of 41 (29%) patients were retreated for syphilis. This study found that early neurosyphilis was common in this cohort. Highly active antiretroviral therapy to reverse immunosuppression may help mitigate neurological complications of syphilis. Ghanem, K., Moore, R., Rompalo, A., Erbelding, E., Zenilman, J., and Gebo, K. Neurosyphilis in a Clinical Cohort of HIV-1-Infected Patients. AIDS, 22(10), pp. 1145-1151, 2008.

Peer Environment Mediates Parental History and Individual Risk in the Etiology of Cannabis Use Disorder in Boys

Previous research has shown that a trait termed neurobehavior disinhibition (ND) measured in childhood predicts substance use disorder by young adulthood. The present investigation extends these findings by determining the degree to which peer environment mediates the association between ND and development of cannabis use disorder (CUD). ND was measured in a sample of 216 boys 10-12 years of age. The peer environment was assessed at age 16. Current CUD was determined at age 22. Paternal and maternal SUD predicted son's ND which, in turn, predicted son's peer environment and, subsequently, son's cannabis use frequency and CUD. Peer environment mediated the association between ND and cannabis use and ND and CUD. Maternal and paternal SUD predicted the peer environment. Parental SUD, son's ND, and son's peer environment predicted CUD at age 22 with 84% accuracy. Feske, U., Tarter, R., Kirisci, L., Gao, Z., Reynolds, M. and Vanyukov, M. Peer Environment Mediates Parental History and Individual Risk in the Etiology of Cannabis Use Disorder in Boys: A 10-Year Prospective Study. Am. J. Drug Alc. Abuse, 34(3), pp. 307-320, 2008.

Substance Use among Asian Americans and Pacific Islanders Sexual Minority Adolescents: Findings from the National Longitudinal Study of Adolescent Health

Researchers assessed the prevalence, incidence, and correlates of substance use among Asian American individuals transitioning from adolescence to young adulthood. Data were obtained from the National Longitudinal Study of Adolescent Health, Wave II (1996) and Wave III (2001). Information on substance use was abstracted from a nationally representative sample of 1108 Asian Americans and Pacific Islanders (AAPIs) from both Waves. Weighted prevalence, incidence, and patterns of smoking, binge drinking, marijuana use, and other drug use were analyzed by sexual orientation and gender. Multiple logistic regression analyses were conducted to investigate the unique contribution of being a sexual minority in relation to four types of substance use by gender. A link between sexual orientation and substance use behaviors among AAPIs did not emerge until young adulthood. Significant increases in the incidence and prevalence of all four types of substance use (tobacco, binge drinking, marijuana, and other drugs) were found among sexual minority AAPIs. Specifically being an AAPI sexual minority young woman, compared with being a heterosexual young woman, a heterosexual young man, or a sexual minority young man, was significantly associated with substance use after controlling for demographic characteristics, problem behaviors, and substance use during adolescence. The highest prevalence of substance use was found among AAPI sexual minority women. These findings bring new light to the importance of sexual orientation in the design of substance abuse programs. Hahm, H., Wong, F., Huang, Z., Ozonoff, A., and Lee, J. Substance Use among Asian Americans and Pacific Islanders Sexual Minority Adolescents: Findings from the National Longitudinal Study of Adolescent Health. J. Adolesc. Health, 42(3), pp. 275-283, 2008.

Smoking Tobacco Along with Marijuana Increases Symptoms of Cannabis Dependence

User practices/rituals that involve concurrent use of tobacco and marijuana - smoking blunts and 'chasing' marijuana with tobacco - are hypothesized to increase cannabis dependence symptoms. For this project, ethnographers administered group surveys to a diverse, purposive sample of marijuana users who appeared to be 17-35 years old. The setting in which the study took place was New York City, including non-impoverished areas of Manhattan, the transitional area of East Village/Lower East Side, low-income areas of northern Manhattan and South Bronx, and diverse areas of Brooklyn and Queens. Participants were 481 marijuana users ages 14-35, 57% male, 43% female; 27% White, 30% Black, 19% Latino, 5% Asian, 20% of other/multiple race. Among many other topics, group surveys measured cannabis dependence symptoms; frequencies of chasing, blunt smoking, joint/pipe smoking, using marijuana while alone, and general tobacco use; and demographic factors. Authors found blunt smoking and chasing marijuana with tobacco were each uniquely associated with five of the seven cannabis dependence symptoms. Across symptoms, predicted odds were 2.4-4.1 times greater for participants who smoked blunts on all 30 of the past 30 days than for participants who did not smoke blunts in the past 30 days. Significant increases in odds over the whole range of the five-point chasing frequency measure (from never to always) ranged from 3.4 times to 5.1 times. Using tobacco with marijuana contributes to cannabis dependence symptoms. Treatment for cannabis dependence may be more effective if it addresses the issue of concurrent tobacco use. Ream, G., Benoit, E., Johnson, B., and Dunlap, E. Smoking Tobacco along with Marijuana Increases Symptoms of Cannabis Dependence. Drug Alcohol Depend., 95(3), pp. 199-208, 2008.

Prescription Opioid Use, Misuse, and Diversion Among Street Drug Users in New York City

This study documents patterns of prescription opioid (PO) use, misuse, and diversion among street drug users, and begins to indicate how drug culture practices interact with the legitimate therapeutic goals of PO prescriptions (e.g. pain management). The authors completed interviews inquiring about the reasons for use of POs and illicit drugs with 586 street drug users. Ethnographers wrote extensive field notes about subjects' complex patterns of PO use. Methadone was used (71.9%) and sold (64.7%) at a higher level than OxyContin, Vicodin, and Percocet, used by between 34% and 38% of the users and sold by between 28% and 41% of the sellers. Recent PO use is associated with the recency of using heroin and cocaine (p<.001). Half of the heroin/cocaine sellers sold POs, and one quarter of the PO sellers only sold POs. Subjects were classified into four groups by whether they diverted POs or used POs to relieve pain or withdrawal rather than for euphoria. This classification was associated with frequency of PO use, whether POs were obtained from doctors/pharmacies or from drug dealers and family members, and those mostly likely to use POs for pain and withdrawal. POs are an important component of street drug users '' drug-taking regimes, especially those who are Physically Ill Chemical Abusers (PICA). Future research is needed to model PO use, misuse, and diversion among this population. Davis, W. and Johnson, B. Prescription Opioid Use, Misuse, and Diversion among Street Drug Users in New York City. Drug Alcohol Depend., 92(1-3), pp. 267-276, 2008.

Assessment of Risk for Substance Use Disorder Consequent to Consumption of Illegal Drugs

Previous research has shown that the trait neurobehavior disinhibition (ND), which consists of affect, behavior, and cognitive indicators of self-regulation, is a significant predictor of substance use disorder (SUD) between childhood and young adulthood. The authors evaluated the psychometric properties of the ND trait in 278 boys evaluated at ages 10-12 and 16 years. ND scores significantly predicted SUD and outcomes that commonly manifest in tandem with SUD by age 19, such as violence, arrests, committing crime while intoxicated, and concussion injury. In addition to predictive validity, the ND trait was found to have good construct, discriminative, and concurrent validity, as well as good test-retest and internal reliability. The ND trait may be useful for detecting youths at high risk for developing SUD and related outcomes. Mezzich, A., Tarter, R., Feske, U., Kirisci, L., McNamee, R. and Day, B. Assessment of Risk for Substance Use Disorder Consequent to Consumption of Illegal Drugs: Psychometric Validation of the Neurobehavior Disinhibition Trait. Psych. Addict. Behav. 21(4), pp. 508-515, 2007.

The Role of Gender and Family on Long-Term Patterns of Drug Use among an Urban African-American Cohort

The current study uses longitudinal data from a community cohort of African-American inner-city males and females followed from first grade through mid-adulthood (n=1242 at baseline). It identifies the substance use patterns through mid-adulthood, including lifetime prevalence, age of onset and termination, and sequencing of substance classes, as well as the risk of initiation of substance use changes over the life course using survival analysis. It also investigates whether early family structure and process play a role in drug use initiation throughout the life course, and whether the relationship between family factors and drug initiation differs by gender. Overall, among the general trends of use, the authors find a considerable amount of abstention with over 40% of the participants never using illegal drugs by mid-adulthood, over 70% never using cocaine, and over 90% never using heroin. With respect to onset, the authors find a long-term influence of early family factors on substance use, particularly for females. Family discipline in childhood and family cohesion and parental rule setting during adolescence seem to be key factors in predicting later substance use for females. The implica-tions of these findings for future research and policy are discussed. Doherty, E., Green, K., Reisinger, H., and Ensminger, M. Long-Term Patterns of Drug Use among an Urban African-American Cohort: the Role of Gender and Family. J. Urban Health, 85(2), pp. 250-267, 2008.

Factors Related to Correctional Facility Incarceration Among Active Injection Drug Users in Baltimore

The authors investigated the moderating effect of impulse control on the association between drug use and incarceration among active injection drug users (IDU). The study sample consisted of 282 IDUs aged 15-50 years from the Baltimore metropolitan region who reported injection drug use within the past 6 months and indicated that heroin or speedball was their drug of choice. Impulse control was measured using commission error standardized scores from the Test of Variables of Attention (TOVA). Incarceration was obtained using self-reported lifetime history of incarceration in correctional facilities. Findings indicated that impulse control moderated the association between years of injection drug use and incarceration in correctional facilities adjusting for ethnicity, gender, estimated pre-morbid intelligence, and age of first injection use. Specifically, among individuals who were intact in impulse control, four or more years of injection drug use was associated with incarceration (AOR=4.97, 95% CI: 2.02-12.23). This finding was not observed among individuals with impaired impulse control (AOR=0.57, 95% CI: 0.10-3.23). Furthermore, impulse control moderated the association between regular cocaine use and incarceration. Among individuals who had a history of cocaine use, individuals with low impulse control but not impaired were more likely to have reported time in a correctional facility (AOR=6.28, 95% CI: 1.68-23.60). There was no association among individuals with impaired or intact impulse control. Results highlight the importance of considering cognitive measures of impulse control in addressing negative outcomes associated with drug use. Severtson, S., and Latimer, W. Factors Related to Correctional Facility Incarceration among Active Injection Drug Users in Baltimore, MD. Drug Alcohol Depend., 94(1-3), pp. 73-81, 2008.

Investigating the Long-Term Influence of Adolescent Delinquency on Drug Use Initiation

Prior research has found a positive relationship between delinquency and early onset of drug use. However, little is known about the influence of delinquency on drug initiation through mid-adulthood. This paper investigates the long-term relationship between serious adolescent delinquency and the onset of marijuana and cocaine use among an epidemiologically defined community sample of African American males and females followed from first grade (n=1242) through age 42 (n=833). Using propensity score methods authors match individuals on several etiological variables that may explain both delinquency and drug use in an attempt to examine the extent to which there may be a causal link between delinquency and drug use initiation. Through a comparison of survival curves on the unmatched and matched samples of serious delinquents and non-serious delinquents, authors found evidence that serious adolescent delinquency has at least some causal influence on drug use initiation that extends into mid-life. These findings suggest that the prevention of delinquency in adolescence should be included in behavioral interventions and other approaches to reduce and prevent substance use. Doherty, E., Green, K., and Ensminger, M. Investigating the Long-term Influence of Adolescent Delinquency on Drug Use Initiation. Drug Alcohol Depend., 93(1-2), pp. 72-84, 2008.

The MAOA Promoter Polymorphism, Disruptive Behavior Disorders, and Early Onset Substance Use Disorder: Gene-Environment Interaction

Conduct, oppositional defiant, and attention deficit hyperactivity disorders, reflecting early antisociality and behavior dysregulation, are predictive of substance use disorders. Liabilities to these disorders share genetic and environmental variance. Parenting characteristics have been shown to influence development of antisociality, moderated by variation at the MAOA gene, which has also been associated with the risk for substance use disorders. To extend these findings, the authors tested the relationships between the MAOA promoter polymorphism (variable number tandem repeat), indices of child's perception of paternal and maternal parenting, and disruptive behavior disorders and substance use disorders. A sample of 148 European-American males was assessed prospectively at ages from 10-12 to 18-19 years and genotyped for the monoamine oxidase A variable number tandem repeat. The Diagnostic and Statistical Manual of mental disorders-III-R diagnoses were obtained using standard methodology. Parenting was assessed using a scale summarizing the child's evaluation of the parenting style (parent's behavior toward him, parental emotional distance and involvement). Correlation, logistic regression, and Cox proportional hazard regression analysis were used to determine the relationships between the variables. The strength of association between parenting index and conduct and attention deficit hyperactivity disorders depended on the MAOA genotype. Unlike earlier findings, the parenting-risk relationships were observed in the 'high' rather than 'low-activity' genotypes. The strength and direction of relationships depended on the parental sex. The MAOA polymorphism's association with the risk for substance use disorders was detected when parenting was controlled for. The results are consistent with the contribution of the MAOA gene, parenting style, and their interactions to variation in the risk for early onset behavior disorders and liability to substance use disorders. Vanyukov, M., Maher, B., Devlin, B., Kirillova, G., Kirisci, L., Yu, L., and Ferrell, R. The MAOA Promoter Polymorphism, Disruptive Behavior Disorders, and Early Onset Substance Use Disorder: Gene-Environment Interaction. Psychiatr. Genet., 17(6), pp. 323-332, 2007.

Differences in Attitudes Towards Drugs Between Adolescent Ecstasy Users Compared to Marijuana Users

Perceived risk and attitudes about the consequences of drug use, perceptions of others expectations and self-efficacy influence the intent to try drugs and continue drug use once use has started. The authors examine associations between adolescents' attitudes and beliefs towards ecstasy use. Because most ecstasy users have a history of marijuana use, the association was estimated for three groups of adolescents: non-marijuana/ecstasy users, marijuana users (used marijuana at least once but never used ecstasy) and ecstasy users (used ecstasy at least once). Data come from 5049 adolescents aged 12-18 years old who had complete weighted data information in Round 2 of the Restricted Use Files (RUF) of the National Survey of Parents and Youth (NSPY). Data were analyzed using jackknife weighted multinomial logistic regression models. Adolescent marijuana and ecstasy users were more likely to approve of marijuana and ecstasy use as compared to non-drug using youth. Adolescent marijuana and ecstasy users were more likely to have close friends who approved of ecstasy as compared to non-drug using youth. The magnitudes of these two associations were stronger for ecstasy use than for marijuana use in the final adjusted model. The authors' final adjusted model shows that approval of marijuana and ecstasy use was more strongly associated with marijuana and ecstasy use in adolescence than perceived risk in using both drugs. Information about the risks and consequences of ecstasy use need to be presented to adolescents in order to attempt to reduce adolescents' approval of ecstasy use as well as ecstasy experimentation. Martins, S., Storr, C., Alexandre, P., and Chilcoat, H. Do Adolescent Ecstasy Users have Different Attitudes towards Drugs when Compared to Marijuana Users? Drug Alcohol Depend., 94(1-3), pp. 63-72, 2008.

Physical Maturation, Peer Environment, and the Ontogenesis of Substance Use Disorders

The risk for substance use disorders (SUD) is transmissible between generations via both genetic and environmental mechanisms. One path that is hypothesized to mediate this transmission and include both types of mechanisms is through faster physiological maturation, leading to sub-optimal self-regulation, affiliation with deviant peers, and higher risk for conduct disorder (CD). Extending prior research, this hypothesis was tested in a longitudinal sample of 478 males whose fathers were affected with SUD or psychiatrically normal was assessed prospectively at ages from 9-13 to 17-20. The DSM-III-R diagnoses were obtained using standard methodology. Blood testosterone was assayed by radioimmunoassay, and Tanner staging was used to evaluate sexual maturation. Peer deviance was evaluated by the Peer Delinquency Scale. Correlation and path analysis, Cox proportional hazard regression, and growth curve modeling were used to determine the relationships between the variables. The data support the hypothesis that parental SUD liability influences the rate of physiological maturation in offspring, which in turn is related to affiliation with deviant peers and an elevated rate of the development of CD and SUD. Kirillova, G., Vanyukov, M., Kirisci, L., and Reynolds, M. Physical Maturation, Peer Environ-ment, and the Ontogenesis of Substance Use Disorders. Psych.Res. 158(1), pp. 43-53, 2008.

Reciprocal Influence of Parent Discipline and Child 's Behavior on Risk for Substance Use Disorder

This study aimed at determining the association of father's and mother's (parental) substance use disorder (SUD) and discipline styles and son's neurobehavioral disinhibition (ND) with son's SUD from childhood (age 10-12) to young adulthood (age 19). It was hypothesized that (1) parental discipline styles and son's ND mediate the association between parental SUD and son's SUD, (2) son's ND mediates the association between parental discipline styles and son's SUD, and (3) parental discipline styles mediate the association between ND and SUD in the son. Two-hundred-sixty-three families including a 10-12 year-old son and both parents participated in the study. The authors found that mother's discipline styles predicted father's discipline styles, son's ND predicted mother's instilling guilt positively and father's punishment negatively, son's ND mediated the association between father's SUD and punishment and son's SUD, and mother's SUD predicted son's ND and SUD. The reciprocal prediction between son's ND and father's punishment and prediction of father's punishment by mother's punishment point to the need for family-based interventions that take into account the quality of specific dyadic interactions pertaining to discipline behaviors that amplify the risk for SUD in male children. Mezzich, A., Tarter, R., Kirisci, L., Feske, U., Day, B., and Gao, Z. Reciprocal Influence of Parent Discipline and Child's Behavior on Risk for Substance Use Disorder: a Nine-Year Prospective Study. Am. J. Drug Alcohol Abuse, 33(6), pp. 851-867, 2007.

Premature Mortality among Males with Substance Use Disorders

The objective of this study was to assess whether the presence of substance use disorder (SUD) or antisocial personality disorder (ASP) is associated with early mortality among males (fathers) in a predominantly community sample, using a 15-year prospective longitudinal study design. The authors conducted a prospective longitudinal study of adolescents and their fathers. The adolescent subjects were recruited at age 10-12 years, with follow-up evaluations at ages 14, 16, 19, 22, and 25. Questions were asked about paternal mortality during each of those visits. The study sample for this study was the 769 fathers of the adolescent subjects, who included N=341 fathers with a DSM-III-R diagnosis of SUD and N=428 control fathers without a SUD. 89% of these fathers were recruited from the community, and 11% were recruited from clinical sources. Comorbidity patterns were described. A multivariate Cox regression analysis was performed with the father's age at death or last assessment as the dependent variable, and education, SUD, and ASP as the independent variables. Lower education level, the presence of a substance use disorder, and the presence of antisocial personality disorder were significantly associated with earlier mortality. Most subjects died from medical illnesses, as opposed to drug overdoses or accidents, which is different from the pattern often noted in clinical samples. The results of this study demonstrate that the presence of SUD, the presence of ASP, and a lower education level were associated with early mortality in this primarily community-based sample, which extends previous reports of similar findings in clinical samples. The magnitude of the prematurity of the deaths was less than that generally noted in previous studies involving clinical samples, and the causes of death were also somewhat different from those noted in clinical samples. The majority of cases of mortality in the SUD sample resulted from medical illnesses rather than from accidents or overdoses. Cornelius, J., Reynolds, M., Martz, B., Clark, D., Kirisci, L., and Tarter, R. Premature Mortality among Males with Substance Use Disorders. Addict. Behav., 33(1), pp. 156-160, 2008.

Relationship Between Newspaper Coverage of Tobacco Issues and Smoking Attitudes and Behavior among American Teens

Geographic variation in youth smoking prevalence suggests that community-level factors influence risk of tobacco use. Authors examined the extent to which newspaper coverage of tobacco issues is related to youth smoking attitudes and behaviors. Authors conducted a content analysis of 8390 newspaper articles on tobacco issues from 386 daily newspapers circulating at 5% or more in 2001-3 Monitoring the Future (MTF) survey communities. This resulted in the creation of community level measures of news volume, content and valence. Associations between news and youth outcomes were assessed using logistic regression analyses adjusting for individual, geographic and tobacco policy factors linked to youth smoking and attitudes. The sample consisted of 98,747 youth participating in the nationally representative school-based MTF annual surveys between 2001 and 2003. Main outcomes included perceived harm of smoking, perceived peer smoking, disapproval of smoking, smoking within the past 30 days, daily cigarette consumption. In the five months preceding survey administration, newspapers in MTF communities published an average of 11.9 tobacco related articles (range 0-55.7). Each 10-article increase in newspaper volume over the five-month period was associated with increased odds of perceiving great harm from smoking (OR = 1.04, p<0.01) and disapproving of smoking (OR = 1.04, p<0.05) and decreased odds of perceiving most or all friends smoke (0.94, p<0.01) and smoking in the past 30 days (OR = 0.93, p<0.001). No consistent association was found between the content or valence of coverage and youth smoking outcomes. Findings support gaining and keeping tobacco on the media agenda as an important tool for tackling youth smoking. Smith, K., Wakefield, M., Terry-McElrath, Y., Chaloupka, F., Flay, B., Johnston, L., Saba, A., and Siebel, C., Relation between Newspaper Coverage of Tobacco Issues and Smoking Attitudes and Behavior among American Teens. Tob. Control, 17(1), pp. 17-24, 2008.

Sex Work and HIV Status among Transgender Women: Systematic Review and Meta-Analysis

Transgender women are a key risk group for HIV, and epidemiologic studies have attributed high rates of HIV infection to behaviors associated with sex work in this population. This systematic review compared HIV prevalence among transgender female sex workers (TFSWs) with prevalence among transgender women who do not engage in sex work, male sex workers, and biologically female sex workers. The researchers conducted systematic searches of six electronic databases. They extracted data, appraised methodologic quality, assessed hetero-geneity, and organized meta-analyses by comparison groups. They identified 25 studies among 6405 participants recruited from 14 countries. The overall crude HIV prevalence was 27.3% in TFSWs, 14.7% in transgender women not engaging in sex work, 15.1% in male sex workers, and 4.5% in female sex workers. Meta-analysis indicated that TFSWs experienced significantly higher risk for HIV infection in comparison to all other groups, and particularly in comparison to female sex workers. Significant heterogeneity was found among the included studies, along with methodologic limitations and imprecise definitions of sex work and gender. This study suggests that TFSWs could benefit from targeted HIV prevention interventions, HIV testing, and interventions to help reduce the risk of contracting or transmitting HIV. Operario, D., Soma, T., and Underhill, K. Sex Work and HIV Status among Transgender Women: Systematic Review and Meta-Analysis. J. Acquir. Imm. Defic. Syndr., 48(1), pp. 97-103, 2008.

Positive Deviance Control-Case Life History: A Method to Develop Grounded Hypotheses about Successful Long-Term Avoidance of Infection

Prevalence rates for long-term injection drug users in some localities surpass 60% for HIV and 80% for HCV. Researchers conducting a project called 'Staying Safe' sought to develop grounded hypotheses on why some injectors avoid infection with either virus. They recruited 25 drug injectors who have injected drugs 8 - 15 years in New York City, of whom 17 have remained without antibody to either HIV or HCV; 3 are double-positives; and 5 are positive for HCV but not HIV. They then compared serostatus groups using detailed biographical timelines and narratives; information on how subjects maintain access to physical resources and social support; their strategies and tactics to remain safe; how they handle problems of addiction and demands by drug dealers and other drug users; and how their behaviors and strategies do or do not become socially-embedded practices. These grounded theory and life-history analysis techniques allow for comparisons among injectors who are doubly-uninfected with those infected with both viruses or only with HCV. Two emerging themes and initial hypotheses seem most salient for further study and potential use in improving preventive interventions: 1) Staying uninfected is not simply a question of social structure or social position. It involves agency by drug injectors, including sustained hard work and adaptation to changing circumstances. 2) Multiple intentionalities contribute to remaining uninfected, including balancing addiction, income, withdrawal, other drug users who want to share drugs, and knowing the risks for HIV (and perhaps HCV) infection. Focusing on a single goal in prevention might be sub-optimal when other (competing) needs and intentionalities are at play. This study has begun the work of identifying strategies and tactics that some doubly-uninfected, long-term IDUs have developed to avoid infection. The methods developed and used for the study lend themselves to refinement and testing through, e.g., cohort studies on behavioral change, risk reduction, prevention, and treatment among IDU. The grounded hypotheses methodology used in the study, a positive deviance control-case life history method, might also be useful to identify other strategies to avoid infections, such as like genital herpes among sex workers. Friedman, S., Mateu-Gelabert, P., Sandoval, M., Hagan, H., and Des Jarlais, D. Positive Deviance Control-Case Life History: A Method to Develop Grounded Hypotheses about Successful Long-Term Avoidance of Infection. BMC Public Health, 8, pp. 94-104, 2008.

Pathways to Depression: The Impact of Neighborhood Violent Crime on Inner-City Residents in Baltimore, Maryland, USA

Crime and neighborhood disorder may negatively impact the health of urban residents. Neighborhoods with high levels of violent crime may also increase residents' risk of experiencing violence. Most studies supporting the assertion that neighborhood disorder impacts mental health have used residents' own ratings of their neighborhoods. The present study examines the relationships among block-group level crime, perceived neighborhood disorder, violence experienced in the neighborhood, and depression. The sample comprising the current and former drug users (n=786) nested in 270 block groups within Baltimore, Maryland. Using path analysis, researchers tested the hypothesis that neighborhood violent crime has a direct impact on experiences of violence. They also hypothesized that neighborhood violence had a direct and indirect impact on depressive symptoms. Results support a model in which violence is associated with psychological distress through perceptions of neighborhood disorder, and through experiences of violence. They conclude that community and structural level interventions are needed to decrease neighborhood crime and improve residents' perception of their neighborhood. Curry, A., Latkin, C., and Davey-Rothwell, M. Pathways to Depression: The Impact of Neighborhood Violent Crime on Inner-City Residents in Baltimore, Maryland, USA. Soc. Sci. Med., 67(1), pp. 23-30, 2008.

Improved Injection Network Ascertainment with Supplementary Elicitation Techniques

Prior research indicates that injection drug users forget substantial proportions of their injection partners when asked to recall them. Such under-reporting hampers ascertainment of the injection networks that underlie transmission of blood-borne pathogens as well as contact-tracing efforts for disease control. In this study, researchers evaluated supplementary elicitation techniques--a set of prompting strategies and recall cues--for use in contacting injection partners. Sixty-one index drug injectors in Seattle participated in the study. The supplementary partner elicitation techniques enhanced recall of injection partners substantially and identified persons relevant to transmission of blood-borne pathogens. As a set, the supplementary techniques elicited additional partners from 70% of injectors, and the additional partners elicited represent a 75% increase on average. Drug injectors who recalled many partners before administration of the supplementary techniques tended to report more additional partners in response to the supple-mentary techniques than injectors who freely recalled few partners. In addition, partners elicited by the supplementary techniques were as likely as freely recalled partners to test positive for hepatitis C virus antibody and engage in risk behavior with indexes. Furthermore, the supple-mentary techniques were found effective for enhancing connectivity in the observed injection network. Brewer, D., Hagan, H., and Hough, E. Improved Injection Network Ascertainment with Supplementary Elicitation Techniques. Int. J. STD AIDS, 19(3), pp. 188-191, 2008.

Exploring Drug Users' Attitudes and Decisions Regarding Hepatitis C (HCV) Treatment in the U.S.

Individuals with a history of injecting drugs are at the highest risk of becoming infected with the hepatitis C virus (HCV), with studies of patients in methadone maintenance treatment programmes (MMTPs) reporting that 60-90 percent of intravenous drug users (IDUs) have the virus. Fortunately, HCV therapy has been shown to be effective in 42-82 percent of all patients with chronic HCV infection, including IDUs. While the decision to start HCV therapy requires significant consideration, little research exists that explores the attitudes of drug users toward HCV therapy. This paper examines how drug users perceive the treatment, as well as the processes by which HCV-positive individuals weigh the advantages and disadvantages of starting the HCV medications. Interviews were conducted with 164 patients from 14 drug treatment programmes throughout the United States. Both uninfected and HCV-positive drug users described a pipeline of communication among their peers that conveys largely negative messages about the medications that are available to treat HCV. Although many of the HCV-positive individuals said that these messages heightened their anxiety about the side effects and difficulties of treatment, some patients said that their peers helped them to consider, initiate HCV treatment, or both. Gaining a better understanding of drug users perceptions of HCV treatment is important, because so many of them, particularly IDUs, are already infected with HCV and may benefit from support in addressing their HCV treatment needs. In addition, currently uninfected drug users will likely remain at high risk for contracting HCV and may need to make decisions about whether or not to start the HCV medical regimen in the future. Munoz-Plaza, C., Strauss, S., Astone-Twerell, J., Jarlais, D., Gwadz, M., Hagan, H., Osborne, A., and Rosenblum, A. Exploring Drug Users' Attitudes and Decisions Regarding Hepatitis C (HCV) Treatment in the U.S. Int. J. Drug Policy, 19(1), pp. 71-78, 2008.

Stimulant Use and Sexual Risk Behaviors for HIV in Rural North Carolina

While literature exists on sexual risks for HIV among rural populations, the specific role of stimulants in increasing these risks has primarily been studied in the context of a single drug and/or racial group. This study explores the use of multiple stimulants and sexual risk behaviors among individuals of different races and sexual identities in rural North Carolina. In-depth interviews were conducted with 41 individuals (40% female, 54% African America, 44% White, 40% younger than 34 years and 30% 45 years of age or older) in 3 rural North Carolina counties between June 2004 and December 2005. Data were transcribed and imported for analysis using the software system, AskSam. With marijuana, stimulants, including powder cocaine, crack, and methamphetamine were the most frequently used illicit drugs in these counties. Powder cocaine use was more closely associated with White participants, crack with African Americans, and both were more commonly used by female participants. Participants reported 3 overlapping behaviors involving stimulant use that may be associated with increased risk of HIV infection: engaging in sex while using drugs, sex trading, and group sex. Nearly half of participants reported engaging in group sex activity. HIV risk through injection appears to be low in these rural counties. However, nearly all study participants reported some form of sexual risk behavior that may increase transmission of HIV and other sexually transmitted infections, indicating the clear nexus between substance abuse and risky sexual behaviors. Zule, W., Costenbader, E., Coomes, C., Meyer, W., Riehman, K., Poehlman, J., and Wechsberg, W. Stimulant Use and Sexual Risk Behaviors for HIV in Rural North Carolina. J. Rural Health, 23 Suppl, pp. 73-78, 2007.

HIV Risks Associated with Incarceration among Injection Drug Users: Implications for Prison-Based Public Health Strategies

Recent policy announcements in Canada and the United States may potentially affect the risk environment for HIV transmission among incarcerated injection drug users (IDU). Researchers sought to evaluate the potential impact of incarceration on HIV risk behavior among the IDU enrolled in a prospective cohort study. They examined patterns of incarceration among 1247 IDU participants enrolled in a 6-year prospective cohort study in Vancouver, Canada, and tested for potential associations between HIV risk behavior and incarceration. Correlates of incarceration were identified using generalized estimating equations (GEE). At baseline, factors significantly associated with incarceration included daily injection heroin and injection cocaine use and inconsistent condom use with casual sexual partners. In a GEE analysis, factors independently associated with incarceration included: used syringe borrowing (adjusted odds ratio [AOR] = 1.36; [95% CI: 1.16-1.60]), used syringe lending (AOR = 1.31; [95% CI: 1.12-1.55]) and inconsistent condom use with casual sexual partners (AOR = 1.16; [1.02-1.33]). All variables P < 0.05. Incarceration was independently associated with HIV transmission and acquisition behaviors. These findings suggest that increased rates of incarceration of IDU may be associated with increased HIV transmission among this group. Werb, D., Kerr, T., Small, W., Li, K., Montaner, J., and Wood, E. HIV Risks Associated with Incarceration among Injection Drug Users: Implications for Prison-Based Public Health Strategies. J. Public Health (Oxf), 30(2), pp. 126-132, 2008.

Associations Between Outpatient and Inpatient Service Use Among Persons with HIV Infection: A Positive or Negative Relationship?

This observational study sought to examine the prospective association between frequency of outpatient visits and subsequent inpatient admissions. It used medical record data on 13,942 patients with HIV infection seen in 10 HIV specialty care sites across the United States, following a cohort of HIV-infected patients who were in care in the first half of 2001. Numbers of inpatient admissions and outpatient visits were calculated for each patient for each 3-month period, from 2001 through 2004. Negative binomial and logistic regression analyses using random-effects models examined the effects of inpatient admissions and outpatient visits in the previous period on inpatient and outpatient service utilization, controlling for background characteristics and HIV disease stage. The study found that, for 3-month periods, between 5 and 9 percent of patients had an inpatient admission. The linear association between number of outpatient visits and any inpatient admission in the subsequent period was positive (adjusted odds ratio=1.05; 95 percent confidence interval [CI]=1.04, 1.06). However, patients with no prior outpatient visits had significantly greater admission rates than those with one prior visit. Hospitalization rates were also higher among those with a prior hospitalization and those with more advanced HIV disease. These results suggest a J-shaped relationship between outpatient use and inpatient use among persons with HIV disease. Those in worse health have greater utilization of both inpatient and outpatient care. However, having no outpatient visits may also increase the likelihood of subsequent hospitalization. Although outpatient care cannot be justified as a cost-saving mechanism, maintaining regular clinical monitoring of patients is important. Fleishman, J., Moore, R., Conviser, R., Lawrence, P., Korthuis, P., and Gebo, K. Associations Between Outpatient and Inpatient Service Use among Persons with HIV Infection: A Positive or Negative Relationship? Health Serv. Res., 43(1 Pt 1), pp. 76-95, 2008.

Methamphetamine and Poly-Substance Use among Gym-Attending Men who have Sex with Men in New York City

The aim of this study is to describe patterns of methamphetamine and other drug use and to delineate psychosocial and demographic factors associated with use in a sample of MSM attending gyms in New York City. Active recruitment strategies were used to sample 311 MSM. Participants completed a one-time survey regarding health risks and health promotion. Methamphetamine use in the last 6 months was reported by 23.8% of men. Inhalation and smoking were the most common modes of administration, and 84% of men reported more than one mode of use. Study participants indicated a variety of other substances used, including but not limited to alcohol, inhalant nitrates, and 3,4 methylenedioxymethamphetamine (MDMA). Compared to nonusers, methamphetamine users were more likely to report being black or Latino, depressed, HIV-positive, perceiving more benefits of unprotected sex, and understanding masculinity in sexual terms. These data suggest that health-risk behaviors are common among MSM who are regularly using a gym and are indicative of the complexities of health issues for this segment of the population. Halkitis, P., Moeller, R., Siconolfi, D., Jerome, R., Rogers, M., and Schillinger, J. Methamphetamine and Poly-Substance Use among Gym-Attending Men who have Sex with Men in New York City. Ann. Behav. Med., 35(1), pp. 41-48, 2008.

Analysis of HIV Medication Adherence in Relation to Person and Treatment Character-istics Using Hierarchical Linear Modeling

This study examined person characteristics, treatment level variables, and illicit drug use to help explain HIV antiviral adherence patterns in a community-based, non-drug-treatment-seeking sample of men who have sex with men (MSM). Adherence data were gathered for 300 MSM (diverse in age and race/ethnicity) eight times over the course of 1 year using electronic monitoring. Treatment and person level characteristics were assessed at baseline using computer-administered surveys, and drug usage was established using a diagnostic inventory. Longitudinal data were analyzed with Hierarchical Linear Modeling. Over the year in which participants were assessed, adherence rates were relatively stable and high (means: 82% to 90%) at each time point. Lower adherence rates were evident among those who were drug users, black identified, older, and by pill burden. Individuals on HIV antiretroviral therapy demonstrated consistent although not optimal adherence rates. In this study, adherence to treatment appears to be impacted by the circumstances that the individual brings to the treatment behavior, suggesting that interventions should address life social and intrapersonal circumstances that may interfere with adherence behaviors. Halkitis, P., Palamar, J., and Mukherjee, P. Analysis of HIV Medication Adherence in Relation to Person and Treatment Characteristics Using Hierarchical Linear Modeling. AIDS Patient Care STDS, 22(4), pp. 323-335, 2008.

Peer Norms and Sharing of Injection Paraphernalia among Puerto Rican Injection Drug Users in New York and Puerto Rico

This study examines the influence of peer norms on sharing of injection paraphernalia (e.g., indirect sharing behaviors, including sharing of cookers, cotton, rinse water and back/front loading) among Puerto Rican injection drug users (IDUs) in Bayamon, Puerto Rico, and East Harlem, New York City. Data were collected from 873 Puerto Rican IDUs recruited in the two locations by outreach workers. Multiple logistic regression was conducted using sociodemographic and other control variables (e.g., education, frequency of injection, pooling money to buy drugs, use of needle exchange program, injection in galleries and syringe sharing behaviors) and two types of norms related to sharing of injection paraphernalia-encouraging risk norms (what others approve) and objecting to risk norms (what others disapprove). One type of norms, encouraging or approval norms, was associated with indirect sharing in New York but not in Puerto Rico. Pooling money to buy drugs, use of shooting galleries and syringe sharing were associated with indirect sharing in both locations. These findings suggest that prevention programs to reduce indirect sharing behaviors should take into consideration different types of risk norms in order to reduce indirect sharing risk behaviors. Andia, J., Deren, S., Robles, R., Kang, S., and Colon, H. Peer Norms and Sharing of Injection Paraphernalia among Puerto Rican Injection Drug Users in New York and Puerto Rico. AIDS Educ. Prev., 20(3), pp. 249-257, 2008.

Self-Reported HIV Testing Behaviors among a Sample of Southeast Asians in an Urban Setting in the United States

Given the growing HIV/AIDS epidemic in Asia, there has been concern in recent years over the HIV/AIDS risks of Asian and Pacific Islander (AAPI) migrating populations to the United States. Little is known, however, about existing HIV risks among non-MSM AAPIs. This study examined self-reported HIV testing behaviors and their correlates among a sample of 604 Southeast Asians adults living in a U.S. urban setting. The HIV testing rate among the sample was 30.8%, lower than the median HIV testing rate in the U.S. adult population by state and in the AAPI MSM population. A low sexually transmitted infection (STI) testing rate as a proxy for low perceived sexual risks and a dearth of HIV knowledge were associated with the low HIV testing rate. Traditional health care access measures, such as availability of medical insurance and a personal doctor, did not explain the low HIV testing rate in this predominantly immigrant population. Culturally and linguistically appropriate HIV prevention campaigns may help to increase awareness of HIV/STI risk and improve the HIV testing HIV rate in this AAPI population. Huang, Z., Wong, F., De Leon, J., and Park, R. Self-Reported HIV Testing Behaviors among a Sample of Southeast Asians in an Urban Setting in the United States. AIDS Educ. Prev., 20(1), pp. 65-77, 2008.

Risk Factors for Distress in the Adolescent Children of HIV-Positive and HIV-Negative Drug-Abusing Fathers

Researchers examined comorbid drug addiction and HIV infection in the father as related to his adolescent child's psychological distress. Individual structured interviews were administered to 505 HIV-positive and HIV-negative drug-abusing fathers (mean age 42; 76% lifetime IDU; 42% HIV positive) and one of their children, aged 12-20 (54% male; 50% African American; 37% Latino). Structural equation modeling tested an hypothesized model linking paternal latent variables, ecological factors and adolescent substance use to adolescent distress. Results demonstrated a direct pathway between paternal distress and adolescent distress, as well as an indirect pathway; namely, paternal distress was linked with impaired paternal teaching of coping skills to the child, which in turn was related to adolescent substance use and, ultimately, to the adolescent's distress. There was an additional association between paternal drug addiction/HIV and adolescent distress, which was mediated by both ecological factors and adolescent substance use. The direct effect of paternal drug addiction/HIV on the child's substance use may suggest the adolescent's role modeling of the father's risk behaviors and/or a genetic diathesis for substance use, shared by father and child. Findings suggest an increased risk of distress in the adolescent children of fathers with comorbid drug addiction and HIV/AIDS, which may be further complicated by paternal distress. Brook, D., Brook, J., Rubenstone, E., Zhang, C., Castro, F., and Tiburcio, N. Risk Factors for Distress in the Adolescent Children of HIV-Positive and HIV-Negative Drug-Abusing Fathers. AIDS Care, 20(1), pp. 93-100, 2008.

Pooling Data From Multiple Longitudinal Studies: The Role of Item Response Theory in Integrative Data Analysis

There are a number of significant challenges researchers encounter when studying development over an extended period of time, including subject attrition, the changing of measurement structures across groups and developmental periods, and the need to invest substantial time and money. Integrative data analysis is an emerging set of methodologies that allows researchers to overcome many of the challenges of single-sample designs through the pooling of data drawn from multiple existing developmental studies. This approach is characterized by a host of advantages, but this also introduces several new complexities that must be addressed prior to broad adoption by developmental researchers. In this article, the authors focus on methods for fitting measurement models and creating scale scores using data drawn from multiple longitudinal studies. The authors performed an analysis of repeated measures of internalizing symptomatology that were pooled from three existing developmental studies. The sample was pooled from the Michigan Longitudinal Study (n=512 ages 10-17), the Adolescent/Adult Family Development Project (n=830, ages 10-33), and the Alcohol and Health Behavior Project (n=485, ages 17-23) for a total sample of 1827 participants who were each assessed between 1-5 times, resulting in a total of 7377 person-by-time observations. The authors conclude that the simultaneous integration of multiple developmental data sets is recommended and should be considered for testing a broad range of theoretically derived research hypotheses. Advantages include increases in power, greater heterogeneity in participant demographics, broader psychometric assessment of theoretical constructs, longer longitudinal windows, opportunity to test hypotheses not originally considered, and cost/time effectiveness. Curran, P., Hussong, A., Cai, L., Huang, W., Chassin, L., Sher, K., and Zucker, R. Pooling Data from Multiple Longitudinal Studies: The Role of Item Response Theory in Integrative Data Analysis. Dev. Psychol., 44(2), pp. 365-380, 2008.

Defining Risk Heterogeneity for Internalizing Symptoms Among Children of Alcoholic Parents

Adopting a developmental epidemiology perspective, the current study examines sources of risk heterogeneity for internalizing symptomatology among children of alcoholic parents (COAs). Parent-based factors, including comorbid diagnoses and the number of alcoholic parents in the family, as well as child-based factors, namely child gender, formed the indicators of heterogeneity. Following a novel approach to cross-study methods, the authors present a three-stage analysis involving measurement development using item response theory, examination of study effects on latent trajectories over time using latent curve modeling, and prediction of these latent trajectories testing our theoretically derived hypotheses in two longitudinal investigations across both mother- and self-reported symptomatology. Data used were the Michigan Longitudinal Study (596 children from 338 families ) and the Adolescent/Adult Family Development Project (454 adolescents and their families). Authors replicated previous findings that parent alcoholism has a unique effect on child internalizing symptoms, above and beyond those of both parent depression and antisocial personality disorder. However, they also found important subgroup differences, explaining heterogeneity within COAs risk profile in terms of the number of alcoholic parents in the family, comorbid diagnoses for the alcoholic parent and, for self-reported symptoms, child gender. Such factors serve to refine the definition of risk among COAs, suggesting a more severely impaired target group for preventive interventions, identifying the significance of familial alcoholism in individual differences underlying internalizing symptoms over time, and further specifying the distal risk matrix for an internalizing pathway to alcohol involvement. Hussong, A., Flora, D., Curran, P., Chassin, L., and Zucker, R. Defining Risk Heterogeneity for Internalizing Symptoms among Children of Alcoholic Parents. Dev. Psychopathol., 20(1), pp. 165-193, 2008.

Disaggregating the Distal, Proximal, and Time-Varying Effects of Parent Alcoholism on Children's Internalizing Symptoms

The authors tested whether children show greater internalizing symptoms when their parents are actively abusing alcohol by combining observations over ages 2 through 17 from two longitudinal studies of children of alcoholic parents and matched controls recruited from the community. This integrative analysis included data from the Michigan Longitudinal Study (n=596 children from 338 families) and the Adolescent/Adult Family Development Project (454 adolescents and their parents). Using a mixed modeling approach, investigators tested whether children showed elevated mother- and child-reported internalizing symptoms (a) at the same time that parents showed alcohol-related consequences (time-varying effects), (b) if parents showed greater alcohol-related consequences during the study period (proximal effects), and (c) if parents had a lifetime diagnosis of alcoholism that predated the study period (distal effects). No support for time-varying effects was found; proximal effects of mothers' alcohol-related consequences on child-reported internalizing symptoms were found and distal effects of mother and father alcoholism predicted greater internalizing symptoms among children of alcoholic parents. Hussong, A., Cai, L., Curran, P., Flora, D., Chassin, L., and Zucker, R. Disaggregating the Distal, Proximal, and Time-Varying Effects of Parent Alcoholism on Children's Internalizing Symptoms. J. Abnorm. Child Psychol., 36(3), pp. 335-346, 2008.

The Relationship Among Cardiovascular Risk Factors, Diet Patterns, Alcohol Consumption, and Ethnicity Among Women Aged 50 Years and Older

This study used cluster analysis to examine diet patterns and the association between diet patterns and the presence of major cardiovascular disease (CVD) risk factors among women over 50 years of age. Data from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2001-2002 were used. Women 50 years and older were included (n=1,313), and the following major CVD risk factors were examined: being overweight or obese (body mass index >24.9), having elevated systolic blood pressure (>120 mm Hg), and having low levels of high-density lipoprotein cholesterol (<50 mg/dL [<1.30 mmol/L]). Dietary patterns were derived by cluster analysis using data from a 24-hour dietary recall. Odds Ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression to determine the probability of having a risk factor according to diet pattern while accounting for race/ethnicity, physical activity, age, and smoking. Cluster analysis generated six nonoverlapping diet patterns labeled: Pasta and Yellow Vegetables; Sweets; Beef, Starches, Fruits, and Milk; Frozen Meals, Burritos, and Pizza; Meat Dishes; and Soft Drinks and Poultry. The majority of the women were grouped in the Sweets diet pattern. Factors associated with adequate levels of high-density lipoprotein cholesterol included being non-Hispanic African American (OR 0.59, 95% CI 0.44 to 0.81; P<0.0001), alcohol consumption (OR 0.76, 95% CI 0.69 to 0.84; P<0.0001), and being assigned to the Sweets diet pattern (OR 0.27, 95% CI 0.14 to 0.50; P<0.0001) or Meat dishes diet pattern (OR 0.94, 95% CI 0.54 to 1.65; P<0.0075). The Sweets pattern was also associated with having normal systolic blood pressure levels (OR 0.51, 95% CI 0.34 to 0.76; P<0.0001). Individuals grouped in the Beef, Starches, and Milk diet pattern were more likely to have an adequate body mass index (OR 0.42, 95% CI 0.23 to 0.77; P<0.0032). Significant associations between dietary patterns and major CVD risk factors were observed. Food and nutrition professionals can use this information to assess unhealthful food choices observed in the dietary patterns to guide nutrition recommendations and help reduce the incidence of CVD risk factors. Future research should aim to evaluate dietary intake via complementary methods (ie, dietary patterns and nutrient assessment) to better understand diet-disease relationships. Lopez, E., Rice, C., Weddle, D., and Rahill, G. The Relationship among Cardiovascular Risk Factors, Diet Patterns, Alcohol Consumption, and Ethnicity among Women Aged 50 Years and Older. J. Am. Diet. Assoc., 108(2), pp. 248-256, 2008.

Prevalence of Smoking and Drinking among Older Adults in Seven Urban Cities in Latin America and the Caribbean

In 2000, a representative sample of the elderly population (60 years or older) was selected from seven urban cities in Latin America and the Caribbean: Buenos Aires (Argentina), Mexico City (Mexico), Santiago (Chile), Havana (Cuba), Montevideo (Uruguay), Bridgetown (Barbados), and Sao Paulo (Brazil) to examine the prevalence of smoking and drinking in this population. A face-to-face interview was uniformly administered in the respective official languages. A total of 10,577 older adults were included in this study. The elderly in Havana had the highest prevalence of smoking (46.5% of men and 21.5% women). The highest prevalence of daily drinking was in Buenos Aires (19%). In contrast, only 1.5% of respondents in Mexico City and 2.3% of respondents in Havana consumed alcohol daily. Smoking and daily drinking were highly prevalent among older adults. As the older adult population grows steeply, the health behavior of this population starts carrying important implications for health care systems. Kim, S., De La Rosa, M., Rice, C., and Delva, J. Prevalence of Smoking and Drinking among Older Adults in Seven Urban Cities in Latin America and the Caribbean. Subst. Use Misuse, 42(9), pp. 1455-1475, 2007.

Substance Use in Marital Dyads: Premarital Assortment and Change Over Time

The purpose of this study was to examine change in substance use with marriage, premarriage similarity in substance use between spouses, and the role of spouse use in predicting changes in use with marriage. Nationally representative samples of high school seniors were followed longitudinally through age 35. The sample consisted of 2,169 adults from eight senior-year cohorts (1977-1984) from the Monitoring the Future study who completed a questionnaire at least once before their first marriage and at 2-year intervals at four consecutive points in time after marriage. Results indicate significant reductions in use with marriage for cigarette smoking, heavy drinking, and marijuana use. Both men and women reported reductions in all three substances following marriage. Changes in women's use followed a linear pattern. Although men's decreases in cigarette smoking and heavy drinking were initially rapid and then decelerated, their decrease in marijuana use accelerated over time. Declines in use for both genders were associated with getting married to individuals who also decreased their use. Those with higher premarriage levels of substance use experienced greater reductions in use. A significant association between respondent and spouse premarital use suggests assortative mating takes place for all three substances. This study affirms and further qualifies the presence of a marriage effect on substance use using multiwave and multicohort national data. Results suggest that the effects of marriage on smoking, heavy drinking, and marijuana use are related to one's own initial levels of use and the direction of change in the spouse's use. These findings have important implications for life span theoretical advances as well as interventions aimed at the marital dyad. Merline, A., Schulenberg, J., O'Malley, P., Bachman, J., and Johnston, L. Substance Use in Marital Dyads: Premarital Assortment and Change Over Time. J. Stud. Alcohol Drugs, 69(3), pp. 352-361, 2008.

Adolescent Ecstasy and Other Drug Use in the National Survey of Parents and Youth: The Role of Sensation-Seeking, Parental Monitoring and Peer's Drug Use

The association between high sensation-seeking, close friends' drug use and low parental monitoring with ecstasy (MDMA) use in adolescence was examined in a sample of US household-dwelling adolescents aged 12-18 years (N=5049). The authors also tested whether associations were of stronger magnitude than associations between these correlates and marijuana or alcohol/tobacco use in adolescence. Data from Round 2 of the National Survey of Parents and Youth (NSPY) Restricted Use Files (RUF) was analyzed via Jackknife weighted multinomial logistic regression models. High sensation-seekers were more likely to be ecstasy, marijuana, and alcohol/tobacco users, respectively, as compared to low sensation-seekers. High sensation-seeking and close friends' drug use were more strongly associated with ecstasy as compared to marijuana and alcohol/tobacco use. Low parental monitoring was associated with marijuana use and alcohol/tobacco use and there was a trend for it to be associated with ecstasy use. Ecstasy use is strongly associated with peer drug use and more modestly associated with high sensation-seeking. School prevention programs should target high-sensation-seeking adolescents and also encourage them to affiliate with non-drug using peers. Martins, S., Storr, C., Alexandre, P., and Chilcoat, H. Adolescent Ecstasy and Other Drug Use in the National Survey of Parents and Youth: The Role of Sensation-Seeking, Parental Monitoring and Peer's Drug Use. Addict. Behav., 33(7), pp. 919-933, 2008.

Movie Smoking Exposure and Smoking Onset: A Longitudinal Study of Mediation Processes in a Representative Sample of U.S. Adolescents

The authors tested 2 mechanisms for the relation of movie smoking exposure with onset of cigarette smoking in adolescence. Longitudinal data with 8-month follow-up were obtained from a representative sample of 6,522 U.S. adolescents, ages 10-14 years. Structural modeling analysis based on initial nonsmokers, which controlled for 10 covariates associated with movie exposure, showed that viewing more smoking in movies was related to increases in positive expectancies about smoking and increases in affiliation with smoking peers, and these variables were both related to smoking onset. A direct effect of movie exposure on smoking onset was also noted. Mediation findings were replicated across cross-sectional and longitudinal analyses. Tests for gender differences indicated that girls showed larger effects of movie exposure for some variables. Wills, T., Sargent, J., Stoolmiller, M., Gibbons, F., and Gerrard, M. Movie Smoking Exposure and Smoking Onset: A Longitudinal Study of Mediation Processes in a Representative Sample of U.S. Adolescents. Psychol. Addict. Behav., 22(2), pp. 269-277, 2008.

The Effect of Early Cognitions on Cigarette and Alcohol Use During Adolescence

This study predicts cigarette and alcohol use in adolescence from the development of children's cognitions in the elementary years. Using latent growth modeling, the authors examined a model using data from 712 participants in the Oregon Youth Substance Use Project, who were in the 2nd through 5th grade at the 1st assessment and followed for 6 annual or semiannual assessments over 7 years. Growth in children's prototypes and subjective norms in the elementary years (Times 1 through 4) were related to their substance use in adolescence (Time 6) through their willingness and intentions (Time 5) to smoke and drink. Across the sample, for both substances, the intercept and slope of prototypes were either indirectly related to use through willingness or directly related to use. Both the intercept and slope of subjective norms were indirectly related to use of both substances through both willingness and intentions and directly related to cigarette use. Results suggest that elementary children have measurable cognitions regarding substance use that develop during the elementary years and predict use later in adolescence. These findings emphasize the need for prevention programs targeted at changing children's social images of substance users and encouraging more accurate perceptions of peers' use. Andrews, J., Hampson, S., Barckley, M., Gerrard, M., and Gibbons, F. The Effect of Early Cognitions on Cigarette and Alcohol Use during Adolescence. Psychol. Addict. Behav., 22(1), pp. 96-106, 2008.

Suicidal Ideation Among Juvenile Detainees

This study examined suicidal ideation, suicide attempts, lethality of suicide attempts and the relationship between psychiatric disorder and recent attempts in newly detained juveniles. The sample included 1,829 juveniles, ages 10 to 18 years, sampled after intake to a detention center in Chicago, IL. Interviewers administered the Diagnostic Interview Schedule for Children to assess for thoughts of death, suicidal ideation, suicide plans, lifetime suicide attempts, number of attempts, age at first attempt, attempts within the past 6 months, method of suicide attempts and psychiatric disorder. Data indicated that more than one third of juvenile detainees and nearly half of females had felt hopeless or thought about death in the 6 months before detention. Approximately 1 in 10 (10.3%, 95% confidence interval: 7.7%-12.8%) juvenile detainees had thought about committing suicide in the past 6 months, and 1 in 10 (11.0%, 95% confidence interval: 8.3%-13.7%) had ever attempted suicide. Recent suicide attempts were most prevalent in females and youths with major depression and generalized anxiety disorder. Fewer than half of detainees with recent thoughts of suicide had told anyone about their ideation. Identifying youths at risk for suicide, especially those suffering from depressive and anxiety disorders, is a crucial step in preventing suicide. Abram, K., Choe, J., Washburn, J., Teplin, L., King, D., and Dulcan, M. Suicidal. Ideation and Behaviors among Youths in Juvenile Detention. J. Am. Acad. Child. Adolesc. Psych., 47(3), pp. 291-300, 2008.

The Drinking Culture of Alcohol Use

Binge drinking is a substantial health problem. Community norms about drinking may influence individual drinking problems. This study examined the relation between aspects of the neighborhood drinking culture and individual alcohol use by using data from the New York Social Environment Study conducted in 2005. The sample consisted of 4,000 New York City residents greater than 18 year of age. Methods to address social stratification and social selection, both of which are challenges to interpreting neighborhood research were applied. In adjusted models, permissive neighborhood drinking norms were associated with moderate drinking (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.05, 1.55) but not binge drinking; however, social network and individual drinking norms accounted for this association. By contrast, permissive neighborhood drunkenness norms were associated with more moderate drinking (OR = 1.20, 95% CI: 1.03, 1.39) and binge drinking (OR = 1.92, 95% CI: 1.44, 2.56); the binge drinking association remained after adjustment for social network and individual drunkenness norms (OR = 1.58, 95% CI: 1.20, 2.08). Drunkenness norms were more strongly associated with binge drinking for women than for men (p(interaction) = 0.006). Propensity distributions and adjustment for drinking history suggested that social stratification and social selection, respectively, were not plausible explanations for the observed results. Results suggest that further epidemiologic studies investigating the social and structural factors that shape harmful drinking may inform efforts targeting the problematic aspects of alcohol consumption. Ahern, J., Galea, S., Hubbard, A., Midanik, L., and Syme, S. Culture of Drinking and Individual Problems with Alcohol Use. Am. J. Epidemiol., 167(9), pp. 1041-1049, 2008.

Prevalence of Recent Illicit Substance Use and Reporting Bias among MSM and Other Urban Males

This study explores whether the high rates of self-reported substance use among men who have sex with men (MSM) when compared to other males may be an artifact of reporting bias. The reported past month prevalence rates of marijuana, cocaine, heroin, methamphetamine, Ecstasy, and Ketamine use were compared between a sample of MSM (n=216) and a general household sample of men (n=241). Participants were all between 18 to 55 years old, and all resided in Chicago. The researchers compared rates of self-reported use, and test-corrected rates based on the results of drug testing using urine and oral fluid tests. While MSM over 30 years old were significantly more likely than other men in this age group to report past month use of cocaine, test-corrected rates of use were equivalent. On the other hand, test-corrected estimates confirmed elevated rates of Ketamine and Ecstasy use in the MSM sample. Differential disclosure of substance use between MSM and other males may in some cases lead to distorted conclusions about differences in substance use between these groups. The researchers suggest that the use of biological testing in epidemiological studies of substance use can reduce the uncertainty of such comparisons. Mackesy-Amiti, M., Fendrich, M., and Johnson, T.P. Prevalence of Recent Illicit Substance Use and Reporting Bias among MSM and Other Urban Males. Addict. Behav., 33, pp. 1055-1060, 2008.

Vicarious Exposure to Terrorist Attacks and Substance Use: Results from an Urban Household Survey

Traumatic events and exposure to disasters can have profound effects upon mental health, including posttraumatic stress disorder (PTSD) and drug and alcohol use. This study investigated the impact of the 9/11 attacks on substance use among a sample of 627 participants between the ages of 18 and 40 years in Chicago, Illinois. The study design utilized a cross-sectional, audio-computer-assisted self-interview survey conducted in 2001 and 2002. Biological samples, including samples of saliva and urine, were also collected for drug toxicological analyses. Compared to pre-9/11 interviewees, post-9/11 interviewees showed significantly less self-reported marijuana use, marijuana use per test results, and cocaine use per test results. This study contributes to a better understanding of the relationship between exposure to trauma and substance use and highlights the need for additional subsequent research to elucidate further the nature of this relationship. Lippert, A., Fendrich, M., and Johnson, T. Vicarious Exposure to Terrorist Attacks and Substance Use: Results from an Urban Household Survey. J. Urban Health, 85(3), pp. 411-427, 2008.


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