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National Institute on Drug Abuse

Director's Report to the National Advisory Council on Drug Abuse

September, 1996

Research Findings

Epidemiology, Etiology and Prevention Research

Executive Cognitive Functioning and Aggressive Behavior in Boys at High Risk for Substance Abuse

Deficiencies in executive cognitive functioning (ECF), defined as self regulation of goal-directed behavior, have been linked to antisocial personality disorder, substance use disorders, conduct disorder, attention deficit hyperactivity disorder, and other problems. To assess the relationship between ECF deficiencies and aggressive behavior and the interactive effects of ECF and family history of substance abuse, researchers at the Center for Education and Drug Abuse Research (CEDAR) collected multiple measures of executive cognitive functioning (ECF) and aggressive behavior from 291 10-12-year-old boys with and without a family history of substance abuse/dependence. Factor analysis of the ECF measures indicated loading on one factor. ECF was related to aggressive behavior even controlling for IQ and socio-economic status. Aggressive behavior also was related to the interaction of ECF and family history of substance abuse/dependence. These results suggest that programs to prevent and treat violent behavior in high risk groups should incorporate training in ECF's, including planning, attention, abstract reasoning, judgment, learning from experience, and cognitive self-monitoring. Giancola, P.R., Martin, C.S., Tarter, R.E., Pelham, W.E., and Moss, H.B. Executive Cognitive Functioning and Aggressive Behavior in Preadolescent Boys at High Risk for Substance Abuse/Dependence. Journal of Studies on Alcohol, 57: pp. 352-359, 1996.

Cognitive Deficits Associated with Drug Use in Adolescents

Scheier and Botvin used longitudinal data to model the relationships between several cognitive skills and drug use over time. A small but significant association was found between drug use and weak cognitive and affective self-management strategies in early adolescence; this relationship became stronger over time. The exacerbation of these cognitive weaknesses with increased drug use may contribute to impaired social, emotional, and psychological growth in late adolescence. As the authors note in their comment on a study of cognitive effects of heavy marijuana use, deficits in cognitive efficacy may actually precede and perhaps predispose to problematic drug use. Weaknesses in cognitive skills, and learning disabilities, may be undetected factors which underlie recognized risk factors such as low self-esteem, academic failure and school dropout; as such, further longitudinal studies and modeling, and perhaps early identification and intervention, are needed. Scheier, L.M. and Botvin, G.J. Effects of Early Adolescent Drug Use on Cognitive Efficacy in Early-Late Adolescence: A Developmental Structural Model. Journal of Substance Abuse, 7(4), pp. 379-40, 1995. Scheier, L.M. and Botvin, G.J. Cognitive Effects of Marijuana (letter). JAMA, 275(20), p. 1547, 1996.

Familial Factors in Female Drug Abuse/Dependency

Extending their research with males, Cadoret et al. studied genetic and environmental factors leading to drug abuse and dependency in female adoptees. Antisocial personality in a biologic parent was strongly related to the development of conduct disorder in female offspring; conduct disorder was associated with aggressive behavior, and both conduct disorder and aggression were strongly predictive of later drug abuse/dependence in the adoptees. Drug abuse/dependence was in turn correlated significantly with alcohol abuse/dependence. Environmental factors in the adoptive home were also found to be significant. Disturbed adoptive parenting contributed significantly to the development of aggression in the adoptees, which in turn resulted in increased risk of drug abuse/dependence. This relationship was complicated, however, by a finding suggesting selective (non-random) placement; adoptees from a biologic background of antisocial personality were less likely to be placed in a disturbed adoptive home. The environmental factors were thought to act independently of the genetic, thus offering an important avenue for preventive intervention through reducing aggressiveness early in life. Cadoret, R.J., Yates, W.R., Troughton, E., Woodworth, G., and Stewart, M.A. An Adoption Study of Drug Abuse/Dependency in Females. Comprehensive Psychiatry, 37 (2), pp. 88-94, 1996.

Identifying Adolescents at Risk of Escalating Their Substance Use

To assess risk factors for escalation of substance use, researchers at Yeshiva University grouped adolescents according to substance use patterns over three assessments and then examined variables differentiating the groups. The four groups--nonusers, minimal experimenters, late starters, and escalators--were identified through cluster analysis of changes in cigarette, alcohol, and marijuana use among a cohort of 1,184 eighth and ninth graders enrolled in public schools in Westchester County, NY. By modeling group differences based on variables from stress-coping theory, problem behavior theory, and peer-association theory, the researchers identified first-assessment measures predictive of subsequent escalation in substance use. Compared to nonusers and minimal experimenters, late starters and escalators had higher life stress, lower parental support, lower academic competence, more deviant attitudes, and more nonadaptive modes of coping; they also were higher in parental and peer substance use. Escalators scored lower on behavioral competence, positive control, and positive esteem. In contrast to the often cited study by Shedler and Block (1990), this study found that substance use experimenters, compared to nonusers, had higher stress, more maladaptive coping, more deviance-prone attitudes, lower levels of parental support, and lower levels of self control. Findings support the idea that some people enter adolescence with less parental support and more life stress, have less adaptive patterns of coping and competence, and tend to gravitate to groups of peer substance users. To the extent that these factors prevail and are not offset, these adolescents become involved in a network of active users. The experience-regulating function of substance use becomes more salient and they are primed to continue substance use at increasing rates. Wills, T.A., McNamara, G., Vaccaro, D. and Hirky, A.E. Escalated Substance Use: A Longitudinal Grouping Analysis from Early to Middle Adolescence. Journal of Abnormal Psychology, 105(2), pp. 166-180, 1996.

Effectiveness of School-Based Drug Prevention Programs

Effectiveness of different types of drug prevention was examined in a meta-analysis of 120 school-based programs in grades 5 through 12 that evaluated success on self-reported drug use measures. Hypothesis tests using Weighted Least Squares regressions were conducted on an a priori classification scheme that was based on program content and its delivery. Two major types of programs were identified: Interactive and Non-Interactive. Six other factors related to program effectiveness (sample size, targeted drug, type of control group, special populations, type of leader, and attrition) were included as covariates. The Interactive programs achieved significant changes on knowledge, attitudes and drug use, whereas the Non-Interactive programs affected only knowledge. The larger Interactive programs were less effective although still significantly superior to the Non-Interactive programs which suggests implementation failures. The clinically significant superiority of Interactive programs was observed for all adolescents, including various minority populations, and was equal for tobacco, alcohol, marijuana and illicit drugs. Tobler, N.S. and Stratton, H. Effectiveness of School-Based Drug Prevention Programs: A Meta-Analysis of the Research. The Journal of Primary Prevention, In Press.

Fatal Consequences of Cocaine and Opiate Use: Accidental Fatal Drug Overdoses in New York City: 1990-1992

Cocaine, often with opiates (predominantly heroin) and ethanol, caused almost 75% of accidental fatal drug overdoses in New York City from 1990 through 1992. This study assessed 1,986 cases in that period using data collected by the Office of the Chief Medical Examiner. This study excluded intentional (suicidal) fatal drug overdoses. Cocaine with opiates caused 752 (37.9%) deaths. Cocaine without opiates caused 629 (31.7%) deaths while opiates without cocaine caused 503 (25.3%) deaths. Drugs other than cocaine or opiates, predominantly benzodiazepines and antidepressants, caused 102 (5.1%) deaths. The highest cocaine overdose rates were found among African-American and Latino males. Rates of opiate overdose without cocaine did not differ in regard to race/ethnicity except for low rates among Asians. Males had higher overdose rates than women for all classes of drugs. The highest rates for cocaine and/or opiates were found among victims 35-44 years of age. The rates of overdose from cocaine and opiates increased from 1990-1992. A marked increase of cocaine overdoses in 1991 was followed by a slight decrease in 1992. The rates of overdoses from drugs other than cocaine or opiates showed no increase over time. Cocaine is the leading cause of accidental drug overdoses, unlike in the early 1980's when opiates prevailed as a cause of death. African-American and Latino males may be particularly susceptible to cocaine overdoses because of their exposure to crack in poor neighborhoods. Tardiff, K., Marzuk, P.M., Leon, A.C., Hirsch, C.S., Stajic, M., Portera, L., Hartwell, N., Accidental Fatal Drug Overdoses in New York City: 1990-1992. The American Journal of Drug and Alcohol Abuse, 22 (3), 1996.

Personality-Environment Constellations and Alcohol Use: A Process-Oriented Study of Intraindividual Change During Adolescence

Within an interactionist and process-oriented perspective, the salience of documented risk and protective factors in contributing to intraindividual changes in alcohol use behaviors and negative consequences of use during adolescence was tested. Participants (N=870) were from a longitudinal study of normal adolescent development, they were 12 or 15 years old at the first test and were retested twice at 3-year intervals (92% longitudinal retest rate). Person-environment constellations comprising high impulsivity, disinhibition, and deviant peer group associations, and to a lesser extent, low parental control, most strongly influenced high-risk developmental trajectories of use intensity and problems. Personality and environmental risk factors acted as mutual catalysts of alcohol use behaviors and consequences; that is, their co-occurrence increased the likelihood of sustained movement along problematic developmental trajectories. Pandina, R. Personality-Environment Constellations and Alcohol Use: A Process-Oriented Study of Intraindividual Change During Adolescence. Psychology of Addictive Behaviors, 9 (1),
pp. 23-35, 1995.

High School Students Who Use Crack and Other Drugs

The distinguishing characteristics of adolescents who have reached different stages of drug use, in particular the highest stage represented by crack, were studied in a representative sample of students in grades 7 to 12 from 53 New York State schools (N = 7,611). Students were classified in six mutually exclusive, cumulative categories of drug use: nonusers; alcohol and/or cigarette users only; marijuana users only; users of illicit drugs other than marijuana but neither cocaine nor crack; cocaine but not crack users; and crack users. Students who use illicit drugs show deficits in school performance, quality of family relationships and health, and increased psychological symptoms. Compared with nonusers, illicit drug users are more delinquent and more actively involved with their peers and live in social environments in which the perceived use of drugs by parents and other adolescents is more extensive. Crack users exhibit the lowest level of psychosocial functioning of any drug-using group. Delinquency and extent of perceived peer drug use consistently increase with each higher stage of use. There are stage-specific characteristics and common characteristics (delinquent participation, peer drug use) throughout the developmental sequence of drug use. Despite declines over the last two decades in the prevalence of the use of different drugs, young people who use drugs display characteristics over historical time similar to those of young drug users 20 years ago. Kandel, D.B., Davies, M. High School Students Who Use Crack and Other Drugs. Archives of General Psychiatry, 53, pp. 71-80, 1996.

Pathological Gambling Among Methadone Patients

Participation in various forms of gambling activities was assessed to establish the prevalence of pathological gambling in a sample of patients (N=117) enrolled in a large methadone maintenance treatment program in New York City. Respondents were interviewed with a protocol, that incorporates the South Oaks Gambling Screen, a validated, reliable instrument that offers a convenient means for screening populations of drug misusers, as well as general populations, for pathological gambling. Gambling was a common part of the regular activities of many methadone patients, Fifteen percent of a sample of methadone patients had some problem with gambling, and an additional 16% were probable pathological gamblers. Heroin and alcohol were the substances most likely to be used by the pathological gamblers-just prior to or while gambling; marijuana and cocaine were the substances next most likely to be used when gambling. About one-quarter had engaged in some type of crime or hustling activity to pay gambling debts or get money to be able to gamble; all of these individuals participated in multiple gambling-related criminal/hustling activities. These data suggest that a significant proportion of heroin addicts enrolled in methadone treatment programs may be pathological gamblers. For these individuals, pathological gambling may accompany and reinforce continued drug dependence, interfere with treatment engagement, and be a factor in relapse, yet it is likely that the vast majority of methadone patients who are pathological gamblers have not received and are not receiving treatment for their gambling pathology. Few pathological gamblers had ever asked someone for help with a gambling problem or had ever been to Gamblers Anonymous or a therapist for help with a gambling problem. Spunt, B.J., Lesieur, H., Hunt, D., Cahill, I. Pathological Gambling Among Methadone Patients. International Journal of the Addictions, 30 (8), pp. 929-962, 1995.

Contributions of Mothers and Fathers to Cigarette Smoking in Adolescence

There is a significant dose-related association between maternal smoking and children's smoking, especially among daughters. This finding has been obtained in a study of similarity on cigarette smoking among mothers, fathers, and young adolescents (mean age = 12.6 years) in a sample of 201 triads in which each respondent was interviewed independently. Both maternal smoking and quality of parent-child interaction affect lifetime smoking by the child, but only maternal smoking affects current smoking. Their maternal role modeling effect is stronger for daughters than for sons and persists with the inclusion in the model of perceived smoking by the adolescent's close friends. The observed familial concordance on smoking between parent and child cannot disentangle environmental from genetic effects. Intervention and prevention practices targeted toward preventing or reducing cigarette smoking among children tend to target the child's life skills, knowledge, attitudes about smoking, and resistance skills toward peer pressure. The investigation points to another important and neglected focus of intervention, namely, the smoking behavior of the youth's parents in early adolescence. Kandel, D.B., Wu, P. The Contributions of Mothers and Fathers to the Intergenerational Transmission of Cigarette Smoking in Adolescence. Journal of Research on Adolescence, 52, pp. 225-252, 1995.

Cigarette Use Among Migrant and Nonmigrant Mexican American Youth: A Socialization Latent-Variable Model

A self-report survey of cigarette use among 1,373 Mexican American 10th and 12th graders from migrant and non-migrant families in Southern California shows that children of migrant families use tobacco at about the same level as children of non-migrants. The strongest risk factor for tobacco use for Mexican American youth is having peers who use tobacco. Family tobacco use increases risk except among female children of migrant workers. Protective factors include having a family that shows a high level of caring and that closely monitors behavior, having good school adjustment and having a strong religious identification. Mexican American children who experiment with tobacco are likely to have already tried tobacco prior to the 11th grade. Rates for daily use continue to increase so tobacco addiction continues to grow through the 11th and 12th grades. Swaim, R.C., Oetting, E.R., Casas, M.J. Cigarette Use Among Migrant and Nonmigrant Mexican American Youth: A Socialization Latent Variable Model. Health Psychology, 15(4), pp. 269-281, 1996.

Children with Learning Disabilities in Need of Targeted School-Based Smoking Prevention Programs

NIDA prevention research grantees from the University of North Carolina conducted a study to assess whether children with learning disabilities should be included in school-based smoking prevention programs and whether the existing programs are appropriate for this special population. A sample was taken of 1,740 3rd and 5th grade children. Measures obtained included: initiation of smoking, peer pressure, level of self-esteem, and negative orientation towards school and each was significantly associated with smoking by all children; those with and without learning disabilities. Current smoking prevention curricula should address issues relevant to children with learning disabilities; however, additional research is needed to identify the special needs of these children and determine the type of smoking prevention program most likely to be effective with them. Robertson, S.B. and Jackson, C. Initiation of Cigarette Smoking Among Children With and Without Learning Disabilities. Journal of Developmental and Behavioral Pediatrics, In Press.

Substance Involvement Among Juvenile Murders

Substance involvement among incarcerated juvenile offenders was evaluated. Patterns of substance involvement among juvenile offenders were compared with patterns found in older offenders. Irrespective of age group, close to one-third of all homicide perpetrators reported that they were affected by alcohol prior to the offense. In every age group, alcohol was the substance showing the highest rate of "regular" lifetime use and the highest rate of ingestion in the week preceding the homicide. In many respects, the reported substance use patterns in the 16-17-year-old age group were closer to the patterns demonstrated by the oldest (36+) age group than they were to the adjacent 18-20-year-old group. Juvenile offenders were generally less substance involved than all but the oldest group of offenders. Almost all of the juveniles who were substance involved prior to the homicide attributed the homicide to the effects of those substances. Narrative accounts suggest that substances (almost always alcohol) escalated impulsive, spontaneous, violent, outbursts. Implications for the interpretation of self-reports about substance use provided by murderers were also discussed. Fendrich, M., et al. Substance Involvement Among Juvenile Murderers: Comparisons with Older Offenders Based on Interviews with Prison Inmates. The International Journal of the Addictions 30 (11), pp. 1363-1382, 1995.

Mechanisms of Noncompletion in Ethnographic Research on Drugs

Case files from two longitudinal ethnographic field studies of drug users were reviewed in order to examine mechanisms of noncompletion. Two general mechanisms, including investigator initiated termination and subject initiated withdrawal were explored. Subjects were terminated when patterns of incoherent or inconsistent responses were detected in interviews; subjects were also terminated when they stole from the field site or when they were jailed or hospitalized. The findings suggest that the initial phases of interviewing served as an important subject screening period for the researchers conducting the interviews. Most noncompletion in both studies fell under the category of subject initiated withdrawal. Analyses suggested that respondents who dropped out reported significantly less drug involvement and somewhat less extensive criminal involvement than those who completed the study. Women who dropped out were more likely to be married than women who completed the study. Men who dropped out were less likely to reside in shelters for the homeless than men who remained in the study. The studies' behavioral findings sharply contrast with findings from studies of attrition in conventional panel research on drug use. Implications for research on hidden populations were discussed. These findings suggest some important limitations in ethnographic research and underscore the importance of systematic descriptive accounts of noncompletion across a range of ethnographic studies. Fendrich, M., et al. Mechanisms of Noncompletion in Ethnographic Research on Drugs: Results from a Secondary Analysis. Journal of Drug Issues, 26 (1), pp. 23-44, 1996.

Pattern Reliability of Narcotics Addicts' Self-Reported Data

Pattern reliability, or the invariance of relationships among variables was investigated in this study. The consistency of theoretical constructs reflected by measures taken at two separate occasions can be tested using confirmatory factor analysis. Self-report data were obtained from 323 narcotics addicts in two face-to-face interviews conducted in 1974/75 and 1985/86. Through the testing of the invariance of measurement and structural models, pattern reliability was confirmed in one of the models developed. Explication of pattern reliability offers an alternative means of assessing validity of self-report data. Chih-Ping C., Yih-Ing H., & Anglin, M. D. Pattern Reliability of Narcotics Addicts' Self-Reported Data: A Confirmatory Assessment of Construct Validity and Consistency. The International Journal of the Addictions 31 (9), pp. 1189-1216, 1996.

A Three-Year Follow-Up of Drug Abuse Resistance Education (D.A.R.E.)

The longterm effectiveness of D.A.R.E. was assessed by contrasting 561 9th grade students who received the program in the 6th grade with 366 others who had not received the program. A follow-up survey assessed differences in latent variables representing central D.A.R.E. concepts such as self-esteem, resistance to peer pressure, delay of experimentation with drugs, and drug use. No significant differences were found between D.A.R.E. participants and controls. However, in general, students in both the D.A.R.E. group and the control group were doing well in terms of avoiding drugs--an encouraging outcome. The researchers concluded that D.A.R.E. could be exerting an influence in a more general way. At the time of the survey, over five-sixths of the students in the junior high schools had received the program: half of the ninth graders and all of the seventh and eighth graders. The only students in the junior high schools who had not received the program were the ninth graders in the control group. Due to diffusion, the contextual effect of this massive effort to treat every student with D.A.R.E. (plus the effects of other programs of drug education) may have created an anti-drug climate in the junior high schools. Over time, students in the control group may have caught up to those in the D.A.R.E. group. While mitigation of disadvantages does make sense, so does an interpretation that the effects wear off. It is consistent with earlier findings on maturation into the early teens in which maturation effects operate in a direction opposite to the tenets of D.A.R.E. (Dukes et al., 1995). Dukes, R., Ullman, J.B., Stein, J.A. A Three-Year Follow-Up of Drug Abuse Resistance Education (D.A.R.E.), Evaluation Review, 20, pp. 49-66, 1996.

Statistical Model for Detecting Loci for Drug Abuse and Dependence Using Affected Relative Pairs in a Genome Search

Family, twin, and adoption studies of substance abuse and dependency have demonstrated a significant role of genetic determinants. The current paper develops a general statistical model and test that can be used with traditional molecular techniques such as markers as well as the emerging GMS procedures. The model and test are designed to handle realistically complex genetic etiology and any mixture of relative types such as siblings, cousins, and grandparent-grandchildren, and also in the presence of phenocopies (i.e., misdiagnosis). Using affected pairs, the exact test controls for the elevated probability of false rejection of the null hypothesis when the entire genome is searched. This integrative model is the basis of a new research proposal written by the authors to search the human genome for the susceptibility genes underlying opioid dependency. Smalley, S.L., Woodward, J.A., Palmer, C.G.S. A General Statistical Model for Detecting Complex Trait Loci Using Affected Relative Pairs in a Genome Search. American Journal of Human Genetics, 58, pp. 844-860, 1996.

Inconsistencies in Lifetime Cocaine and Marijuana Use Reports Inconsistencies in responses to questions about lifetime cocaine and marijuana use asked of nearly 10,000 respondents from the United States in the National Longitudinal Survey of Youth in 1984 and 1988 were evaluated. Analyses showed that 14% of all responses on cocaine use and 17% of all responses on marijuana use were inconsistent in some way. The types of inconsistencies varied according to the substance; cocaine reports yielded more inconsistencies with regard to timing of first use, while for marijuana most of the inconsistencies were with respect to use disclosure. For both substances, lower level users were more likely to be inconsistent in their reports of drug use. Alternative methods for handling inconsistencies affected estimates of incidence and prevalence. Inconsistencies also varied according to respondent race/ethnicity. Implications of these findings for program evaluation were discussed. Fendrich, M. and Mackesy-Amiti M.E. Inconsistencies in Lifetime Cocaine and Marijuana Use Reports: Impact on Prevalence and Incidence. Addiction, 90, pp. 111-118, 1995.

Initiation and Maintenance of Tobacco Smoking: Changing Personality Correlates in Adolescence and Young Adulthood

Youthful smokers have been described as extroverted and peer-involved, whereas older smokers are often characterized as depressed and withdrawn. Recognizing this contradiction in personality correlates of smokers, the researchers examined cross-sectional and prospective associations between smoking and personality and social constructs assessed every four years in a sample (N = 461) originally recruited in junior high school. At Time 1, smoking was positively related to good Social Relations, Extroversion, Friends' Cigarette Use, and Cheerfulness. At Times 2-4, smoking was positively related to Depression and Friends' Cigarette Use, negatively correlated with good Social Relations, and unrelated to Extroversion. Cigarette Use was stable over time, but least stable between Times 1 and 2. Findings suggested the instability of early social smoking with peers; those who persist may smoke for tension-reduction and self-medication. Extrapolating from a use/abuse distinction, the researchers suggested that more attention should be paid to the precursors and correlates of addiction (abuse) or maintenance of the tobacco habit rather than onset since youthful experimentation may not continue. In view of the changing dynamics over time and early instability of cigarette smoking revealed in our analyses, an effective prevention program in junior high may be quite different from one that would be appropriate in senior high school. The results suggest that learning techniques for peer-resistance might be more applicable in the junior high setting, while teaching effective and positive stress-reduction and coping skills might be more useful for high school students. Stein, J.A., Newcomb, M.D., Bentler, P.M. Initiation and Maintenance of Tobacco Smoking: Changing Personality Correlates in Adolescence and Young Adulthood. Journal of Applied Social Psychology, 26, pp. 160-187, 1996.

Self-Generated Drug Outcomes in Continuation High School Students

The perceived outcomes of drug use were studied in a sample of high risk adolescents. Participants' self generated responses provided the actual words they used to describe drug outcomes as well as associative frequency norms valuable for future research. Outcomes were compared in terms of class of outcome (positive versus negative) and class of drug (alcohol, marijuana, cigarettes, cocaine, speed, and LSD). Although the studied drugs have divergent pharmacological effects, subjects self-generated some of the same outcomes (e.g., relaxation) across some of the drugs. In addition, outcomes self-generated as positive outcomes were very rarely also self-generated as negative outcomes. Regressions revealed that self-generated responses were not predicted by ethnicity, gender, or previous drug use. Many drug use outcomes appeared to be available in memory regardless of previous drug use or other characteristics. Memory availability (memory storage) does not necessarily imply memory accessibility (i.e., ease of retrieval). Other research has recently indicated that as drug use increases in frequency, positive outcomes of drug use become more strongly associated with drug use in memory, and thoughts about potential positive outcomes (e.g., relaxation) more readily trigger drug consistent thoughts and actions. Findings from the present study and other recent studies converge on the notion that memory associations regarding drug cues and outcomes may mediate drug use decisions, although memory availability (storage) of outcomes may not have any mediational or predictive effect. Taken together, these findings have implications for interventions because programs that merely increase the availability of knowledge or skills in memory (e.g., as indicated by typical tests of knowledge) are not likely to be optimally effective, whereas interventions that make program information highly accessible from memory in high-risk settings should show stronger effects. The findings across studies also suggest that interpretations and evaluations of the mediators of program effects should take into account manipulations of cognitive processes (e.g., memory access) that are likely to vary across program conditions rather than simply the program content that labels the condition (e.g., refusal assertion versus negative consequence information). Stacy, A.W., Galaif, E., Sussman, S., Dent, C.W. Self-Generated Drug Outcomes in Continuation High School Students. Psychology of Addictive Behaviors, 10, pp. 18-27, 1996.

Prevalence of Substance Abuse and Psychiatric Disorders are High Among Incarcerated Women

In-person interviews were conducted with a near census (N=805) of women felons entering prison in North Carolina between July 1991 and November 1992. Assessments were made for eight psychiatric disorders using the Composite International Diagnostic Interview as the primary assessment measure, and 25 percent of the women were reassessed for two of these disorders for purposes of validation. Results were then compared with data from the Epidemiologic Catchment Area (ECA) Study for the North Carolina site. The researchers found the most prevalent disorders to be alcohol and drug abuse and dependence. Rates for mood disorders, antisocial personality disorders, and lifetime exposures to traumatic events were also high. Rates of disorders were found to be greater among white women than among African Americans. The researchers conclude that women prisoners have major needs for both substance abuse and mental health treatment. Jordan, B. K., Schlenger, W.E., Fairbank, J.A., and Caddell, J.M. Prevalence of Psychiatric Disorders Among Incarcerated Women. Archives of General Psychiatry, 53, pp. 513-519, 1996.

Parental Modeling Major Factor in Childrens' Risk for Early Onset of Smoking

Research to examine the relationship between smoking and anti-smoking practices in terms of socialization variables was conducted. Among 3rd and 5th grade children, it was found that early onset of smoking increases with increase of exposure to parent smoking models, and it does not matter if parents are current or former smokers; quitting by parents does not eradicate the effects of modeling. Only when parents (whether current or former smokers) engaged in
anti-smoking socialization was the rate of smoking onset significantly reduced. Jackson, C. and Henriksen, L. Do As I Say: Parent Smoking, Anti-Smoking Socialization, and Smoking Onset Among Children. Addictive Behaviors, In Press.

Children's Early Use of Tobacco and Alcohol is related to Weak Competence Development and Socialization

Researchers at the University of North Carolina conducted cross sectional surveys to measure tobacco and alcohol use, multiple indicators of child competence, parent behaviors and parent modeling of tobacco and alcohol use. Children's tobacco and alcohol use was strongly related to low scores on child competence, both self-report and teacher rated as well as with less effective parenting behaviors and parental use of these substances. Jackson. C., Henriksen, L., Dickinson, D. and Levine, D. Early Use of Alcohol and Tobacco: Relation to Child Competence and Parental Behavior, American Journal of Public Health, In Press.

Women Who Kill in Drug Market Situations

Open ended and semi-structured interviews were used in a study with 215 women sentenced to prison in New York State for homicide, of which 19 women killed in drug market situations. The study was to explore the ways in which changing drug markets may have influenced women's involvement in lethal violence. Through qualitative analysis of the narratives offered by these women to explain their involvement in the killing, evidence was found that supports the conclusion that women will use violence, as will men, to protect or augment an economic interest in a drug market, From further analysis, however, it was concluded that even in a clearly economic context in which women are able to acquire their own economic interest, some women will kill or participate in a killing in connection with their relationship to a male business or intimate partner. That is, women who kill in the economic context of a drug market may kill for economic reasons, but the specific circumstance of involvement in a drug market does not necessarily negate the significance of gender. Brownstein, H.H., Spunt, B.J., Crimmins, S.M., Langley, S. Women Who Kill In Drug Market Situations. Justice Quarterly, 12, pp. 473-498, 1995.

Expectancy in Mediational Models of Cocaine Use

Several theoretical explanations of how expectancies may influence cocaine use were studied. Hypotheses from these approaches use trait (sensation seeking and social conformity), cognitive (expectancy), and state-like (depression and loneliness) constructs to explain cocaine use and its problem consequences. Constructs from these different approaches were compared as predictors of cocaine use among a community sample of adults. Results revealed that general and specific components of an expectancy construct predicted cocaine use independently from all other constructs. The general component of this construct represented expectancies for a variety of drugs in addition to cocaine. The specific component represented expectancies about cocaine use only. The results regarding the effects of the general component can be interpreted in terms of recent memory models of generalization processes in addictive behavior, although assessment of memory processes is needed to fully validate this contention. Another important finding involved mediational effects of expectancy. These findings suggested that expectancies may mediate the effects of certain personality constructs on cocaine use and abuse. The results contrast and integrate cognitive approaches to the explanation of drug use and other behaviors with trait and state approaches to personality. They also suggest that some form of cognitive processing of expected outcomes of drug use mediate and predict drug use behaviors. However, the measurement of cognitive processing effects through expectancy assessment does not reveal the precise form that this processing takes. Additional research is needed to specify exactly how cognitive processes predict and mediate drug use decisions. Stacy, A.W., Newcomb, M.D., and Bentler, P.M. Expectancy in Mediational Models of Cocaine Use. Personality and Individual Differences, 19, pp. 655-668, 1995.

A Theoretical Framework for Designing Effective Tuberculosis Control Strategies.

Dr. Blower and colleagues describe a theoretical framework to determine treatment levels for tuberculosis eradication, to assess the effects of noneradicating control, and to examine the global goals for controlling tuberculosis by the World Health Organization. The authors assess the effects of suboptimal control programs on the evolution of multi-drug resistant tuberculosis and define a new evaluation criterion to show how control strategies can be improved. They demonstrate that their new theoretical framework -- based on the maximum acceptable probability of treatment failure -- can be used to build tuberculosis transmission models for developing control strategies tailored to specific environments. In particular, treatment failure rates must be lower in developing countries than in developed countries. Blower, S.M., Small, P.M., and Hopewell, P.C. Control Strategies for Tuberculosis Epidemics: New Models for Old Problems. Science, July 1996.

Assessing and Tracking Family Histories of Alcoholism

This study sought to (1) determine the rates of family history of alcoholism among a community sample, using both specific questions and structured interviews, (2) document conversions from negative (FH-) to positive (FH+) alcoholism diagnoses among parents and grandparents of subjects, and (3) investigate the concordance between interview and questionnaire methods in assessing alcoholism in family members. Method: Information concerning alcoholism among relatives of a sample of 1,201 (620 female) probands was gathered longitudinally over a 13-year period, spanning adolescence into adulthood. At Times 1 through 3 of the study, information was gleaned from personal interviews with subjects, medical health forms and information from subjects' parents, which was used to determine a "best estimate diagnosis." At Time 4, the Family History Research Diagnostic Criteria (FH-RDC) interview was used. Results: The number of subjects having an alcoholic relative increased at each test time with the largest rise occurring at Time 4. Over 80% of subjects whose parent converted to FH+ at Time 4 had previously described that parent as a heavy or problem drinker. Conclusions: The higher than previously seen escalation in FH+ status occurring at Time 4 is speculated to be the result of one or more of the following: an actual increase in the number of relatives becoming alcoholic, a newfound awareness on the part of probands about alcohol-related problems, the fact that a global judgement or single behavior observation provides an inadequate indication of familial alcoholism, or that the FH-RDC may include a more global measure of "alcohol-related problems" or "problem drinking." Johnson , V. and Bennett, M.E. Assessing and Tracking Family Histories of Alcoholism. Journal of Studies of Alcohol, 56, pp. 654-660, 1995.

The Relationship Between Work-Specific and Generalized Stress and Alcohol and Marijuana Use Among Recent Entrants to the Labor Force

This study examined changes in alcohol and marijuana use and problems in relation to the transition into full-time work, and the effects of work-related and generalized stress among a group of recent entrants to the labor force. Data were obtained from a sample of males and females who were originally interviewed when they were eighteen years old and followed up twice more at three year intervals. The authors hypothesized that those who transit into and maintain a full-time job will not increase their level of consumption if they find the job to be the "right fit." The data indicated that when age, gender, and marital status were controlled, there were few significant effects of the transition to full-time work on use measure. Data from this study provide evidence of a stronger role for generalized stress over that of work-specific stress in predicting changes in drug use in young adulthood. Pandina, R. The Relationship Between Work-Specific and Generalized Stress and Alcohol and Marihuana Use Among Recent Entrants to the Labor Force. The Journal of Drug Issues, 25 (2), pp. 237 251, 1995.

Social Support Among Impoverished Women

Types of social support, their use and efficacy were assessed in a convenience sample of 3,021 homeless and drug addicted African American and Latino women. Type of support most commonly cited was someone who listens (78%) followed by someone who provides confidence (74%), advice (74%) and understanding (73%). Almost 30% of the women reported having at least one friend or neighbor with whom they could talk. However, only 12% could count on friends or neighbors to help in changing things. Only 20% had a husband or partner to confide in and receive emotional support from but their partners were less helpful when it came to explaining things or assisting with change. Professionals, such as counselors and social workers, were most helpful in facilitating change. Implications reveal that enabling factors and barriers to the use of support from professional agencies need to be explored with a view toward designing interventions that include strengthening effective social support in different populations of homeless women. Nyamathi, A., Bennett, C., Leake, B., Chen, S. Social Support Among Impoverished Women. Nursing Research, 44, pp. 376-378, 1995.

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