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

September, 1999

Research Findings

Epidemiology, Etiology, and Prevention Research

In the Past 6 Months

• Despite the leveling epidemic, consequences of cocaine use have increased among aging users in some cities; increases among younger age groups in some indicators in several areas have been reported recently.

• New heroin use among young populations continues to be reported in several cities; in general, prices continue to decline as purity increases.

• Marijuana indicators continue to escalate across the country.

• Use of "Club drugs," especially GHB and MDMA, continue to be reported across the country.

• Despite its appearance in midwestern and southern rural areas, abuse of methamphetamine remains a predominantly western problem; however, indicators suggest declines in some areas.

The 46th meeting of the Community Epidemiology Work Group (CEWG) was held in Vancouver, British Columbia, Canada on June 8-11, 1999.

The CEWG, established by NIDA in 1976 is a network of researchers from 21 U.S. metropolitan areas and selected foreign countries which meets semiannually to report surveillance data and discuss the current epidemiology of drug abuse. The following are highlights of the 46th meeting:

• Cocaine - Cocaine remains the Nation's dominant drug problem, driven mainly by aging users who continue to experience adverse consequences. Recent indicators show a mixed picture. Mortality figures increased in six cities (Chicago, Detroit, Honolulu, Phoenix, San Francisco, and Seattle) and declined or remained stable in four (Miami, Minneapolis/St. Paul, Philadelphia, and San Diego). Emergency department (ED) mentions increased significantly in four cities (Atlanta, Dallas, Philadelphia, and Washington, DC) and declined significantly in one (San Francisco). The largest shift was a 46-percent increase in Dallas. Nonsignificant increases were reported in the majority of the other cities. Among treatment admissions, cocaine (including crack) is now the foremost primary drug of abuse (excluding alcohol-only but including alcohol-in-combination) in only 8 of the 21 CEWG areas. Among adult arrestees, cocaine-positive urinalysis percentages declined in the majority of cities, especially among males in Chicago, New York City, and St. Louis, and among females in St. Louis; percentages increased, however, for males in Philadelphia and Detroit and for females in Houston. Increases generally corresponded to increases in self-reported powder cocaine use and declines in self-reported crack use. Among younger age groups, recent slight increases in some indicators have been reported: ED mentions in Dallas, Denver, and Phoenix; treatment admissions in Los Angeles; school survey data of Texas border youth; and arrestee urinalysis data in Atlanta, Los Angeles, New Orleans, Phoenix, and San Antonio. Changing sales strategies in some cities, such as New York, are masking cocaine activity that would normally appear on law enforcement indicators.

• Heroin - Heroin indicators show mixed trends. Mortality figures1 increased in seven cities (Chicago, Detroit, Miami, Minneapolis/St. Paul, Phoenix, San Francisco, and Seattle) and declined in three (Honolulu, Philadelphia, and San Diego). Heroin ED rates2 per 100,000 population increased significantly in six cities (Atlanta, Denver, Miami, Newark, New Orleans, and Washington, DC) and nonsignificantly in another six cities; conversely, rates declined significantly in San Francisco and nonsignificantly in seven other cities. During that same time period, heroin as a percentage of total ED mentions remained generally stable, except for increases in Newark and Chicago. Heroin is now the predominant primary drug problem (excluding alcohol-only, but including alcohol-in-combination) in 8 of the 21 CEWG areas: Baltimore, Boston, Detroit, Los Angeles, Newark, New York, Phoenix, and San Francisco. Opiate-positive screens among arrestees3 remained relatively low and generally stable; they often involved polydrug use. Heroin purity increased4 in nearly every city, while prices generally declined. Purity increases were particularly large in Detroit, New Orleans, and Philadelphia. Younger populations are increasingly initiating heroin use in several cities, including New York, where street informants indicate a steady increase in young buyers. In Boston and other Massachusetts areas, new and younger users are reportedly progressing from snorting to injecting. A Chicago study identified a high percentage of suburban youth, particularly young women, who are injectors. Suburban heroin activity is also reported around the Baltimore area, both among youth and young professionals.

• Marijuana - Marijuana now accounts for more than 10 percent of total ED mentions in 12 cities (Atlanta, Boston, Chicago, Dallas, Detroit, Los Angeles, Miami, New Orleans, Philadelphia St. Louis, San Diego, and Washington, DC), up from just 6 cities a year earlier--the result of increases2 in 7 cities; no significant declines were noted. Marijuana is the predominant primary drug treatment problem in three cities (Denver, Seattle, and Minneapolis/St. Paul). Treatment percentages decreased in New Orleans, Newark, Chicago, and Seattle and increased in San Diego. Among adult male arrestees, marijuana-positive findings were equal to or exceeded cocaine-positives in 10 cities; percentages declined substantially in 2 cities and increased in 13. In many cities, marijuana use appears to be increasing among youth, as is reflected in the percentages of juvenile arrestees testing positive for the drug: in six of the seven CEWG sites where ADAM tests juveniles, the percentage testing positive for marijuana was substantially greater than in the adult population. In Boston, cannabis is reportedly as available as alcohol, and use among adolescents is common, approaching that of cigarettes among older students. Blunt usage continues to grow or retain popularity in Chicago, Minneapolis/St. Paul, New York City, Philadelphia, and Seattle. Marijuana is combined with crack in Chicago ("primos" or "diablitos"), Philadelphia ("turbo"), and Houston (where it is a declining fad among young people); with PCP in Chicago ("wicky sticks" or "donk"), Minneapolis/St. Paul ("happy stick"), New York, Philadelphia ("loveboat" or "wet"), and St. Louis; with formaldehyde in Minneapolis/St. Paul and Seattle; with PCP plus formaldehyde in Houston ("fry," "amp," "water-water"); and with psilocybin mushrooms in Minneapolis/St. Paul. Marijuana combinations are not frequently reported in Denver, but the drug reported to be used to come down from or temper excited highs.

• Stimulants - Despite its appearance in midwestern and southern rural areas, methamphetamine remains concentrated in the West. However, indicators suggest some declines in that region. Available mortality figures1 show methamphetamine-related deaths declined in four cities (Honolulu, Philadelphia, San Diego, and Seattle) and increased in three (Minneapolis/St. Paul, Phoenix, and San Francisco). Following increases in 1997, methamphetamine ED mentions2 declined significantly in six cities (Denver, Los Angeles, Minneapolis/St. Paul, Phoenix, San Francisco, and Seattle) and increased only in Dallas. Methamphetamine remains the number-one primary drug treatment problem in San Diego and Honolulu. Methamphetamine-positive percentages among arrestees3 remained stable across most sites, except for San Diego, where levels declined notably. Methamphetamine users are heterogeneous, consisting of many small subgroups, as suggested by ethnographic data in Atlanta. Furthermore, use patterns and contexts vary widely, depending on population, location, and history of use, as suggested by ethnographic research in Seattle. Injecting remains the predominant route of administration in several areas, including San Francisco and Denver; however, it has been declining somewhat while snorting or smoking have been increasing. Mexico remains the source of methamphetamine for many areas; however, local clandestine methamphetamine labs also proliferate in several areas, including parts of Arizona, Minnesota, Texas, and Washington State.

• Methylenedioxymethamphetamine (MDMA) - ("ecstasy," "blue lips," "blue kisses," "white dove,""E,"and "XTC") availability is reported, primarily as a club drug at "raves" and dance parties, in Atlanta, Austin, Boston, Chicago, Dallas, Detroit, Houston, Miami, St. Louis, Seattle, and Washington, DC. Young cohorts of users have been identified in several of those cities. Reports of increases in indicators of use of the drug continue in Boston and throughout Massachusetts. Though it is not readily available in Newark, it is becoming trendy on college campuses across New Jersey. In New Orleans, the drug is less available than crystal methamphetamine. In Austin, where it is often crushed and re-pressed with methamphetamine, psilocybin mushrooms, or LSD, three types of MDMA are available: "liquid ecstasy"; "chocolate sprinkles,"a heroin-based white pill with brown spots popular in the topless bar scene and in gay bars; and a nickel-sized wafer form. MDMA is used with methamphetamine, LSD, and marijuana in Washington, DC, where law enforcement officers recently noted increased trafficking. Methylenedioxy-amphet-amine (MDA) is reportedly available in St. Louis. Methylphenidate (Ritalin) is readily obtainable in Boston, Chicago, Detroit, and Minneapolis/St. Paul. It is crushed and snorted in Detroit and Minneapolis/St. Paul, and it is mixed with heroin instead of cocaine and injected as a "speedball" in Chicago. Phenmetrazine (Preludin) is also reportedly injected in Chicago. Despite concern about sibutramine (Meridia), a new weight loss drug, there were no reports of diversion or abuse.

• Depressants - Gamma-hydroxy butyrate (GHB), a central nervous system depressant, continues to be reported across the country, with recipes for its manufacture easily accessible on the Internet. GHB has been increasingly involved in poisonings, overdoses, date rapes, and fatalities in Boston, Denver, Los Angeles, South Florida, San Diego, Seattle, and parts of Arizona and Texas. It is available at gyms, nightclubs, raves, gay male party venues, or on college campuses in Atlanta, Baltimore, Boston, Chicago, Denver, Detroit, Los Angeles, Miami, Minneapolis/St. Paul, Newark, New Orleans, San Diego, San Francisco, Seattle, and parts of Arizona and Texas. GHB is available in several forms: clear liquid, white powder, tablets, and capsules. It is used in combination with ketamine or MDMA in Detroit; alcohol in South Florida and New Orleans; and alcohol and ketamine in a "G and B" in Minneapolis. Gamma butyrolactone (GBL) is contained in commercial products (Blue Nitro, Renew-Trient, and ReVivarin); it metabolizes into GHB and produces clinical symptoms identical to GHB. The drug was responsible for overdoses, poisonings, and hospitalizations in Detroit, South Florida, Minneapolis, Newark, and in Texas, where it was also responsible for a death.

  Another club drug, ketamine ("Special K" or "vitamin K") is reported in cities such as Baltimore, Boston, Detroit, Miami, Minneapolis/St. Paul, Newark, New Orleans, New York City, and San Diego. It is injected intramuscularly by young, white, middle-class needle exchange clients in Boston; converted into a white powder and snorted in Minnesota; injected, smoked, or mixed in beverages in New Orleans; and boiled down to crystal form and snorted as an alternative to cocaine in New York City. Ketamine has been responsible for deaths in New Orleans and San Diego.

  Clonazepam (Klonopin or Rivotril) was recently mentioned in hospital emergencies in New York City; in Texas, it is used by juveniles in combination with beer, just as flunitrazepam (Rohypnol) has been used. Alprazolam (Xanax, or "sticks"), along with clonazepam, has replaced flunitrazepam among adolescents in Miami, where "xanax candy bars" have caused several medical emergencies. In New York City, it is the most sought-after diverted prescription pharmaceutical and has almost replaced diazepam on the street. Diazepam is the most readily available and frequently used pharmaceutical depressant on the street in Chicago; it is the leading psychoactive prescription drug in New York City ED mentions; and is injected with heroin in Seattle. Flunitrazepam is common in Atlanta, popular among hard-core heroin and cocaine users in Los Angeles, continues to be abused in New Orleans, and is beginning to emerge in treatment indicators among youth along the Texas-Mexico border. In New Jersey, flunitrazepam no longer appears to be a problem. Trazedone (Desyrel) has been involved in numerous poisonings and one death in Detroit.

  Depressants are used in Chicago in combination with a variety of drugs including heroin, cocaine, methamphetamine, or alcohol. In Miami, the use of diverted Schedule III and IV medications associated with concomitant upper and downer abuse appears on the rise, with "rolling and trolling" the rage among the "young and unknowing." Benzodiazepines are used in Phoenix to reduce "the edge" from cocaine or methamphetamine.

• Hallucinogens - Ethnographic, ED, law enforcement, and survey data suggest continued low-level abuse of lysergic acid diethylamide (LSD) and phencyclidine (PCP). Hallucinogen use appears to be increasing in Massachusetts, where lifetime use among students has been rising since 1994. In Chicago, primary hallucinogen admissions are increasing; LSD use in New Orleans is reportedly on the rise; the drug has sporadically reappeared in St. Louis-area high schools and rural areas. A new form of LSD appearing as a hard plastic translucent bubble pack with colors of light blue or red was reported in Detroit. In Texas, blotter acid is available on sugar cubes and triangular window panes, in a gel tab form called "jelly bean" that is popular in clubs, and in liquid form that is becoming more common around university and club scenes.

  PCP use appears to be increasing in Chicago, where it is sprayed on a tobaccolike substance ("mint leaf" or "love leaf"), used as a dip on cigarettes ("sherm sticks"), or mixed with marijuana ("wicky stick" or "donk"). It appeared in 1997 ED mentions for the first time this decade in Minneapolis; a resurgence of manufacturing, mostly by African-American street gangs, is noted in Los Angeles. PCP-related ED mentions are declining in New York City, where it is available as a powder sprinkled on green mint leaves or on marijuana and as a liquid in small shaker bottles. It continues to be used as a dip on marijuana joints in St. Louis. Psilocybin mushrooms ("shrooms") were reported by Minneapolis law enforcement agencies.

• Other Drugs - Dextromethorphan (DXM) abuse is reported by teens in Boston, apparently encouraged by mentions on the Internet. In addition to the readily available store-bought liquid, DXM is available in Minneapolis as a white powder packaged in clear, unmarked capsules. Use of ephedrine, nitrous oxide, and other inhalants (including propane) is reported in Detroit. One accidental death in Minnesota was attributed to inhalation of an industrial solvent, and inhalant abuse has declined among students in grades 6, 9, and 12 since 1995. Toluene "huffing" is reportedly common among white males in their preteens or early teens in Philadelphia; in Texas, use of inhalants such as liquid or spray paint and correction fluid is increasing among school students. Khat seizures continue in Detroit; khat first appeared in Minnesota in 1997, and interceptions have increased in recent years.

1. Mortality figures are for 1997 versus 1998 and were available in 10 reporting areas.

2. Emergency department mentions are for 20 CEWG cities in the Drug Abuse Warning Network (DAWN) of SAMHSA's Office of Applied Studies; comparisons are for first half 1997 versus preliminary estimates for first half 1998; changes are noted only when statistically significant at p<0.05.

3. Arrestee urinalysis data are for the 18 CEWG cities in the National Institute of Justice's Arrestee Drug Abuse Monitoring (ADAM) program; comparisons are for 1997 versus 1998; changes are noted only when they are ³ 5 percentage points.

4. Heroin price and purity information are from the Drug Enforcement Administration (DEA) Domestic Monitor Program; comparisons are for 1997 versus 1998.

Adolescent Substance Abuse and Psychiatric Comorbidity: Timing and Gender

This study used state of the art evaluation methods to assess a large population based sample longitudinally, relating the development of drug abuse to pre-existing psychiatric disorder, other risk factors, and sex. Boys, but not girls, who later developed dependence or abuse began substance use at earlier ages. Disruptive behavior disorders and depression were both associated with higher rates and earlier onset of substance use and abuse in both sexes, while anxiety predicted later onset of smoking. Family history of drug problems was the strongest correlate of early onset. Boys and girls showed much similarity in the course of early drug use and abuse, and in associated psychopathology. This study is notable for the size of the sample and the sophistication of the methodology and analyses, enabling new observations about development and gender in regard to onset of substance use problems. Costello, E.J., Erkanli, A., Federman, E., and Angold, A. The Development of Psychiatric Comorbidity with Substance Abuse in Adolescents: Effects of Timing and Sex. Journal of Clinical Child Psychology, 28, pp. 298-311, 1999.

Juvenile Substance Abuse, Delinquency, and Internalizing Problems

Longitudinal data from the Pittsburgh Youth Study on boys ages 7 to 18 were analyzed to examine the co-occurrence of persistent substance use with other problem behaviors, including attention deficit hyperactivity disorder, delinquency, and internalizing problems such as depression and anxiety. Developmental differences were found. Among preadolescents, those who continued to use drugs tended to be persistent delinquents, and half this group displayed persistent internalizing problems as well. Among adolescents, a third persisted in drug use without manifesting other problems. Substance use was least common among those with persistent internalizing problems only. While delinquency and internalizing problems predicted persistent drug use in preadolescents, and persistent delinquency predicted substance use in adolescents, ADHD was not a predictor of persistent substance use or delinquency. This study adds important findings to the literature on comorbidity and prediction of substance use problems in youth. Loeber, R., Stouthamer-Loeber, M., and White, H.R. Developmental Aspects of Delinquency and Internalizing Problems and Their Association with Persistent Juvenile Substance Use Between Ages 7 and 18. Journal of Clinical Child Psychology, 28, pp. 322-332, 1999.

Maternal Smoking During Pregnancy And Offspring Psychopathology

Data from a longitudinal study of depressed probands and normal controls were used to replicate findings from several other reports of an association between maternal smoking during pregnancy and attention deficit hyperactivity disorder, conduct disorder, and substance abuse in offspring. Among offspring of mothers who reported smoking 10 or more cigarettes per day during pregnancy, boys showed a significantly increased risk of early onset conduct disorder, and girls a significant increase in adolescent drug dependence. Controlling for several relevant factors such as maternal substance abuse and parental diagnosis did not alter the findings. Thus, findings from several other studies were supported, underscoring concerns about the potential impact of prenatal exposure to maternal smoking. Weissman, M.M., Warner, V., Wickramaratne, P.J., Kandel, D.B. Maternal Smoking During Pregnancy and Psychopathology in Offspring Followed to Adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 38, pp. 892-899, 1999.

Association between Maternal Smoking During Pregnancy and Attention Deficit Hyper-activity Disorder

This study extends previous findings regarding maternal smoking and ADHD in offspring, by studying the siblings of probands in a high-risk (ADHD) sample. Maternal smoking during pregnancy was associated with over four times the risk of ADHD in offspring (OR 4.4) even when controlling for parental ADHD, parental IQ, and socioeconomic status. These findings replicate those of these authors and others. If confirmed in other populations and using other methods, these findings have implications for the need for prevention and smoking cessation programs for women of child-bearing age. Milberger, S., Biederman, J., Faraone, S.V., and Jones, J. Further Evidence Of An Association Between Maternal Smoking During Pregnancy And Attention Deficit Hyperactivity Disorder: Findings From A High- Risk Sample Of Siblings. Journal of Clinical Child Psychology, 27, pp. 352-358, 1998.

Deviance Training

Aggregating high-risk youth into groups can increase their substance use involvement and delinquency. Two random assignment studies are reviewed that reveal three-year and 30-year negative effects. These effects are most likely secondary to using high-risk peer groups to intervene. Analysis of videotaped interactions in the three-year outcome study and archival data in the 30-year study suggests that interest in and verbal and non-verbal expressions of deviancy within the group may increase investment in a delinquent lifestyle. "Deviance training" is defined as contingent positive reactions to rule breaking discussions. This study suggests a need for caution in using interventions that aggregate high-risk children in prevention and treatment. Dishion, T.J., McCord, J., and Poulin, F. Iatrogenic Effects that Aggregate High Risk Youth. American Psychologist, Vol. 54, September 1999. Deviance Training Among Anti-Social Boys One of the key risk factors in the etiology of adolescent problem behavior is association with deviant peers. This study examined the early adolescent friendships of 206 Oregon Youth Study boys who were recruited into the study at ages 9-10 from schools in neighborhoods with high rates of delinquency. Data were collected again at ages 13-14 and 15-16. Results suggest that boys identified as anti-social in childhood showed poor-quality friendships at ages 13 -14 and were the most vulnerable to subsequent peer influences in the following two years. Boys with both poor-quality friendships and a high level of delinquency at age 13-14 escalated in delinquent behavior in the subsequent two years. This study suggests that problem behavior in early adolescence, on occasion, functions to initiate and establish friendships. This process of deviancy training is highly related to an adolescent metamorphosis, in that early patterns of antisocial behavior turn into drug abuse and other forms of problem behavior. Poulin, F., Dishion, T.J., and Hass, E. The Peer Influence Paradox: Friendship Quality and Deviance Training Within Male Adolescent Friendships. Merrill-Palmer Quarterly, 45(1), pp. 42-61, 1999.

Many Problem Behaviors Form Single Construct

This study explored whether multiple problem behaviors form a single construct and whether the developmental model of antisocial behavior (Patterson and colleagues) generalizes to the development of other problem behaviors. Longitudinal data obtained from 204 adolescents and parents support a single construct for problem behavior comprised of youth antisocial behavior, high-risk sexual behavior, academic failure and substance use. Further, the data support the developmental model of antisocial behavior. That is, families experiencing high levels of conflict are more likely to have adolescents who engage in an array of problem behaviors at a two-year follow-up. This relationship was mediated by low levels of parent-child involvement, poor parental monitoring, and association by the adolescent with deviant peers. Ary, D.V., Duncan, T. E., Duncan, S.C., and Hops, H. Adolescent Problem Behavior: The Influence of Parents and Peers. Behavior Research and Therapy, 37, pp. 217-230, 1999.

Family Processes and Deviant Peers Related to Wide Array of Problem Behaviors

This study used structural equation modeling to evaluate a model of family and peer influence on problem behaviors using longitudinal data obtained from 523 adolescents. The study found that families with high levels of conflict were less likely to have high levels of parent-child involvement. Such family conditions resulted in less adequate parental monitoring of adolescent behavior, making associations with deviant peers more likely. In turn, a lack of parental monitoring and association with deviant peers accounted for 46% of the variance in engagement in a variety of problem behaviors including substance use, antisocial behavior, academic failure, and risky sexual behavior. Although association with deviant peers was the most proximal social influence on problem behavior, parental monitoring and family factors (conflict and involvement) were key parenting practices that influenced this development process. Ary, D.V., Duncan, T.E., Biglan, A., Metzler, C. W., Noell, J. W., and Smolkowski, K. Development of Adolescent Problem Behavior. Journal of Abnormal Child Psychology, 27, pp. 141-150, 1999.

Association Between Hyperactivity and Executive Cognitive Functioning in Childhood and Substance Use in Early Adolescence

To determine whether deficient executive cognitive functioning (ECF) in association with high behavioral activity level increases the liability to substance abuse, researchers at the Center for Education and Drug Abuse Treatment (CEDAR) compared a high-risk (HR) group having fathers with a lifetime DSM-III-R diagnosis of a psychoactive substance use disorder with a low-average-risk (LAR) group whose fathers had neither psychoactive substance use disorder nor another adult Axis I psychiatric disorder. ECF and behavioral activity were measured using neuropsychological tests, activity monitor, diagnostic interview, and informant ratings when the subjects were 10 to 12 years of age. Alcohol, tobacco, and cannabis use were measured at 2-year follow-up. Findings indicate that at baseline the HR group had a significantly higher behavioral activity level and exhibited poorer performance on ECF tests than the LAR group. By early adolescence, HR subjects had a higher lifetime rate of tobacco and cannabis use and earlier age at onset of cannabis use. ECF capacity, but not behavioral activity level, predicted tobacco and cannabis use, total number of drugs ever tried, and severity of drug involvement. ECF accounted for additional variance beyond the effects of conduct problems on these outcomes. Whereas behavioral activity and ECF capacity in late childhood distinguishes HR from LAR youth, childhood ECF capacity is the more salient predictor of drug use in early adolescence. Aytaclar, S., Tarter, R.E., Kirisci, L., and Lu, S. Journal of the American Academy of Child and Adolescent Psychiatry, 38(2), pp. 172-178, 1999.

Changing Patterns of Drug Use Among U.S. Military Recruits Before and After Enlistment

The U.S. armed forces adopted "zero tolerance" policies concerning illicit drug use in 1980 and later developed policies to discourage tobacco and alcohol abuse. This article examines drug use among young active-duty recruits both before and after enlistment compared with non-military age-mates, and documents historical shifts in such drug use across 2 decades. Analyses employed longitudinal panel data from 20 nationally representative samples of high school seniors (cohorts of 1976-1995), each surveyed just before graduation and again within 2 years. Separate analyses for men (n = 12,082) and women (n = 15,345) contrasted those who entered military service, college, and civilian employment. Illicit drug use declined more among young military recruits than among their civilian counterparts. Analyses of male recruits at multiple time periods showed (1) declines in the prevalence of marijuana use and cocaine use after the initiation of routine military drug testing and (2) lower proportions of smokers of half a pack or more of cigarettes per day who entered service after the initiation of tobacco bans during basic training. Recent military drug policies appear to deter illicit drug use among enlistees and discourage some smokers from enlisting. Bachman, J.G., Freedman-Doan, P., O'Malley, P.M., Johnston, L.D., and Segal, D.R., American Journal of Public Health, 89(5), pp. 672-677, 1999.

Cigarette Smoking Among U.S. High School Seniors

This study identified high school seniors at low, moderate, and high risk for cigarette use to examine changes in the prevalence of daily smoking within risk groups from 1976 to 1995. Data were taken from the Monitoring the Future Project's national surveys of high school seniors. Risk classification was based on grade-point average, truancy, nights out per week, and religious commitment. Logistic regression models were used to estimate trends for all seniors and separately for White (n = 244,221), African American (n =41,005), and Hispanic (n=18,457) male and female subgroups. Risk group distribution (low = 45%, moderate = 30%, high = 25%) changed little over time. Between 1976 and 1990, greater absolute declines in smoking occurred among high-risk students (17 percentage points) than among low-risk students (6 percentage points). Particularly large declines occurred among high-risk African Americans and Hispanics. Smoking increased in all risk groups in the 1990s. Among high school seniors, a large part of the overall change in smoking occurred among high-risk youth. Policies and programs to reduce smoking among youth must have broad appeal, especially to those at the higher end of the risk spectrum. An, L.C., O'Malley, P.M., Schulenberg, J.E., Bachman, J.G., and Johnston, L.D. American Journal of Public Health, 89(5), pp. 699-705, 1999.

Investigation of Family Associations Between ADHD And Substance Use Disorders

This paper reports on findings using the family study method to test hypotheses regarding familial associations between attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD). The risk for ADHD did not differ by SUD family status, and the risk for SUD did not differ by ADHD family status, but each disorder was associated with a significantly increased risk for that disorder in family members. These findings are consistent with independent transmission of ADHD and SUD in families. However, the probands are young adolescents, and follow up is needed to see if an association emerges as they pass through the age of risk for SUD. Milberger, S., Faraone, S.V., Biederman, J., Chu, M.P., Wilens, T. Familial Risk Analysis of the Association Between Attention Deficit Hyperactivity Disorder and Psychoactive Substance Use Disorders. Archives of Pediatric and Adolescent Medicine, 152, pp. 945-951, 1998.

Initial Drug Opportunities and Transitions to First Use

Researchers at Johns Hopkins University examined initial opportunities to try selected drugs and transitions from first opportunity to first use of those drugs. Target drugs were marijuana, cocaine, heroin, and hallucinogens. Investigators examined sex and race-ethnicity differences in estimates of having a drug opportunity, and in the probability of progressing from having an opportunity to try a drug to actually using the drug. Self-report interview data collected for the National Household Surveys on Drug Abuse (NHSDA) from 1979 to 1994 were analyzed. Results showed that an estimated 51% of US residents have had an opportunity to try marijuana; comparative estimates for cocaine, hallucinogens, and heroin are 23, 14, and 5%, respectively. Among those who eventually used each drug, the vast majority made the transition from first opportunity to first use within 1 year. Males were more likely than females to have opportunities to try these drugs, but were not more likely than females to progress to actual use once an opportunity occurred. Time trends indicate recent increases from 1990 to 1994 in the estimated probability of using an illicit drug once an opportunity occurs, particularly for hallucinogens. This study sheds light on the epidemiology of the earliest stages of drug involvement in the USA. Van Etten, M.L., and Anthony, J.C. Comparative Epidemiology of Initial Drug Opportunities and Transitions to First Use: Marijuana, Cocaine, Hallucinogens and Heroin. Drug and Alcohol Dependence, 54(2), pp. 117-125, 1999.

Salivary Cortisol Responses in Prepubertal Boys: The Effects of Parental Substance Abuse and Association with Drug Use Behavior During Adolescence

Using male index cases from the CEDAR sample, researchers extended earlier observation of decreased cortisol reactivity to an anticipated stressor in sons of fathers with a substance use disorder (SUD), examined whether salivary cortisol underresponsivity in these high-risk prepubertal boys is an adaptation to the stress associated with having a father with a current SUD, and tested whether prepubertal cortisol underreactivity might be associated with subsequent drug use behavior during adolescence. Preadolescent salivary cortisol responses were examined in the context of risk-group status, paternal substance abuse offsets, and subsequent adolescent drug use behavior. The results confirmed a decreased salivary cortisol response to an anticipated stressor among sons of SUD fathers. Lower anticipatory cortisol levels were found for boys whose fathers had a current SUD or an SUD that ended between the boys' 3rd to 6th birthdays than for sons of control fathers. Lower preadolescent anticipatory cortisol responses also were associated with regular monthly cigarette smoking and regular monthly marijuana use during adolescence. The investigators concluded that cortisol hyporeactivity as an adaptation to chronic stress may be a key component of the intergenerational transmission of substance abuse liability. Moss, H.B., Vanyukov, M., Yao J.K., and Kirillova, G.P. Biological Psychiatry, 45(10), pp. 1293-1299, 1999.

Inhalant Use and Delinquent Behavior Among Adolescents

To evaluate the association between inhalant use and delinquent or criminal behavior, an analysis of a large statewide sample survey of high school students was conducted. Five groups were identified based on reported drug use: inhalant experimenters, other drug experimenters, inhalant users, other drug users and non-users. Inhalant users were compared with other drug users and inhalant experimenters with other drug experimenters on measures of problem behavior. Over 13,000 students in grades 7-12 participated in the 1993 survey on drug use. Three measures of problem behavior were included: drinking and drug-taking, "trouble behavior", and minor criminal activity. Among upper (9-12) grade level students only, both inhalant users and inhalant experimenters reported more minor criminal activity than other drug users and other drug experimenters, respectively. A similar trend was noted for trouble behavior. The same was not found for drinking and drug-taking behavior. The findings suggest that inhalant use is categorically different from other drug use, and that it has more in common with general delinquency than with general drug use. Prevention and treatment strategies should take this into consideration. Mackesy-Amiti, M.E. and Fendrich, M. Addiction, 94(4), pp. 555-564, 1999.

Adolescent Drug Use and Adult Drug Problems in Women

The authors studied effects of variables assessed in adolescence on problems from drug use in adulthood in a community sample of women. One focus of this 13-year longitudinal study was moderators, which were hypothesized to exacerbate, or attenuate, the effects of early drug consumption on later drug problems. Potential moderators were sensation seeking, social conformity, academic orientation, parental support, depression, and drug problems in parents. Direct and mediating effects of these variables, as well as of drug consumption, were also evaluated. Results showed that most of the significant effects involved sensation seeking and social conformity. In addition, adolescent drug use significantly predicted adult polydrug problems. The effects of sensation seeking are consistent with the view that this variable reflects a sensitivity to drug use, which makes it more likely that drug use gets translated into drug abuse. Stacy, A.W., and Newcomb, M.D. Experimental and Clinical Psychopharmacology, 7(2), pp. 160-173, 1999.

Substance Use Established by Ages 14-15 Can Be Predicted by Academic and Social Behavior Displayed at Ages 7-9

This study examined early school-based academic and social variables with concurrent family conflict in predicting adolescent alcohol and other drug use. Children (N=335) were assessed initially in grades 2-4 on academic-related and social behavior variables using teacher ratings and rankings, peer nominations and ratings and direct observation of playground and classroom behavior. They were reassessed in grades 9-10, using interviews and questionnaires to determine the initiation and sequence of their use of alcohol, tobacco, marijuana and other hard drugs. In analyses done independently for males and females, lifetime abstainers were compared with adolescents who had used: (1) only alcohol; (2) alcohol and tobacco; (3) alcohol, tobacco and marijuana; and (4) all three plus other hard drugs. The drug classifications represent a normative-deviant continuum of adolescent drug use. Constructs were developed for early academic and social predictors as well as concurrent family conflict. Results showed more wide-ranging academic and social difficulties during elementary school for children falling at the more deviant end of the drug use continuum. For girls, the concurrent home environment appeared to moderate the effect of early academic and social variables. In effects, substance use established by ages 14-15 could be predicted by academic and social behavior displayed at ages 7-9. Hops, H., Davis, B., and Lewin, L.M. The Development of Alcohol and Other Substance Use: A Gender Study of Family and Peer Context. Journal of Studies on Alcohol, pp. 22-31, Supplement, 13 March 1999.

High Rate of Coexisting Psychiatric Disorders among Adolescents with Substance Use Disorders in the Community

To investigate the extent to which adolescents in the community with current substance use disorders (SUD) experience co-occurring psychiatric disorders, diagnostic data were obtained from probability samples of 401 children and adolescents, aged 14 to 17 years, and their mothers/caretakers, who participated in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Results indicate the rates of mood and disruptive behavior disorders are much higher among adolescents with current SUD than among adolescents without SUD. Comparison with adult samples suggests that the rates of current comorbidity of SUD with psychiatric disorders are the same among adolescents as adults, and lower for lifetime disruptive disorders/antisocial personality disorder among adolescents than adults. The high rate of coexisting psychiatric disorders among adolescents with SUD in the community needs to be taken into account in prevention and treatment programs.. Kandel, D.B., Johnson, J.G., Bird, H.R., Weissman, M.M., Goodman, S.H., Lahey, B.B., Regier, D.A., and Schwab-Stone, M.E. Psychiatric Comorbidity among Adolescents with Substance Use Disorders: Findings from the MECA Study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(6), pp. 693-699, 1999.

Flunitrazepam Becoming Health Concern to Sexually Active Young Women in Southwestern U.S.

Flunitrazepam [Rohypnol"] is a short-acting benzodiazepine with general properties similar to those of diazepam. In a cross-sectional survey to determine prevalence, patterns, correlates and physical effects of voluntary flunitrazepam use in a sample of sexually active adolescent and young women 14 to 26 years of age (N=904) using university-based ambulatory reproductive health clinics, lifetime use was reported by 5.9% (n = 53) of subjects, with frequency of use ranging from 1 to 40 times. Flunitrazepam was taken most often with alcohol (74%), and 49% took this substance with other illicit drugs. Logistic regression analyses controlling for age and race/ethnicity found that users were significantly more likely than were nonusers to report lifetime use of marijuana (odds ratio [OR] = 3.6) or LSD (OR = 5.2), having a peer or partner who used flunitrazepam (OR = 21.7), pressure to use flunitrazepam when out with friends (OR = 2.7), and a mother who had at least a high school education (OR = 2.6). Finally, 10% of voluntary users reported experiencing subsequent physical or sexual victimization. Voluntary use of flunitrazepam is becoming a health concern to sexually active young women who reside in the southwestern United States. Young women who have used LSD or marijuana in the past or who have a peer or partner who used this drug appear to be at the greatest risk. Rickert, V.I., Wiemann, C.M., Berenson, A.B. Prevalence, Patterns, and Correlates of Voluntary Flunitrazepam Use. Pediatrics 103(1), pp. E61-E65, 1999.

Estimation of the Prevalence of Substance Use Problems Among Nurses Using Capture-Recapture Methods

This study estimated the lifetime prevalence of substance use problems among registered nurses using capture-recapture methods with two separate items indicating a history of substance use problems from the same questionnaire. Capture-recapture methods yielded an estimate of 6.4% of nurses with a history of substance use problems, a 22% increase in the estimate from the data as collected. Among respondents indicating no history of problems, a substantial number reported substance use behavior that was as high as those in the reported problem group, suggesting that the estimate of additional unreported cases (from capture-recapture) is plausible. This estimate provides valuable information for planning preventive initiatives for nurses, and the methodology should invite further consideration of multiple measures of a variable as sources to estimate prevalence using capture-recapture methods. Trinkoff, A., Zhou, Q. and Storr, C. Journal of Drug Issues, 29(1), pp. 187-198, 1999.

Prospective Study of Tobacco Smoking and Substance Dependencies Among Samples of ADHD and Non-ADHD Participants

This study focused on a group of young adults who as children had attention deficit/hyperactivity disorder (ADHD) and are at high risk for heavy use of licit and illicit substances. The study participants were part of a longitudinal study of the life histories of 492 children, one third who were identified as hyperactive in 1974 and whose childhood symptom ratings and medical histories were used to establish the Diagnostic and Statistical Manual of Mental Disorders (3rd edition. revised; DSM-III-R) ADHD diagnoses. The objectives of the study centered on describing (a) developmental history of tobacco use among ADHD and non-ADHD participants in a longitudinal sample, (b) the characteristic adult patterns of tobacco use from early adolescence through early adulthood, and (c) the relationship between ADHD status and tobacco and substance dependence outcomes. Adult data were obtained for 81% of the original 492 participants. Lifetime and current tobacco use were assessed from child, adolescent, and adult data, yielding eight measures of smoking status. The study showed that participants with and without ADHD did not differ in age of initiation to smoking, but there was a significant difference in the age smoking regularly began. By age 17, 46% of all participants with ADHD, as contrasted with 24% of the age-mate controls, reported smoking cigarettes daily. In adulthood, the proportion of participants with ADHD who were current smokers (42%) continued to exceed that of the age -mate controls. They were significantly different lifetime tobacco dependence rates - 40% compared to 19% for age mate controls. The rates for cocaine dependence were 21% for participants with ADHD and 10% for age mate controls. The rates for stimulants were 20% for participants with ADHD and 11% for age mate controls. Results were interpreted to support a possible link between ADHD treatment histories, and levels of tobacco smoking and tobacco dependence in adulthood. Lambert, N.and Hartsough, C. Journal of Learning Disabilities 31(6) pp. 533-544, 1998.

Cloninger's Constructs Related to Substance Use Level and Problems in Late Adolescence

Cloninger's constructs of novelty seeking, harm avoidance, task-reward dependence, and social reward dependence have been related to smoking and alcohol use in adolescence and adulthood. A study at Yeshiva University tested the role of these constructs as mediators related to substance use level and substance use problems. Participants were 1,225 adolescents with average age of 15.5 years. Structural modeling showed indirect effects for novelty seeking, harm avoidance, and task reward dependence, mediated through self-control; harm avoidance also had an inverse direct path to substance use level. Social reward dependence had a positive direct path to coping motives for substance use. Good self-control had inverse paths to negative life events and deviant peer affiliations; poor self-control had positive paths to negative life events and coping motives; and risk taking had positive paths to coping motives and peer affiliations. These findings suggest that substance abuse prevention programs should incorporate components focusing on beliefs about the functions of substance use and that treatment programs for substance abusers should include self-control training that targets behavior patterns such as anger proneness and impulsive responding. Wills, T.A., Sandy, J.M., and Shinar, O. Cloninger's Constructs Related to Substance Use Level and Problems in Late Adolescence: A Mediational Model Based on Self-Control and Coping Motives. Experimental and Clinical Psychopharmacology, 7(2), pp. 122-134, 1999.

Drinking and Driving Among U.S. High School Seniors

This article reports the prevalence of, and trends in, driving after drinking and riding in a car with a driver who has been drinking among American high school seniors, based on data from more than a decade (1984-1997) of annual national surveys. Logistic regression was used to assess the effects of demographic factors (gender, region of country, population density, parental education and race/ethnicity) and selected "lifestyle" factors (religious commitment, high school grades, truancy, illicit drug use, evenings out per week, and miles driven per week). Rates of adolescent driving after drinking and riding with a driver who had been drinking declined significantly from the mid-1980s to the early or mid-1990s, but the declines have not continued in recent years. Rates of driving or riding after drinking were higher among high school seniors who are male, White, living in the western and northeastern regions of the United States, and living in rural areas. Truancy, number of evenings out, and illicit drug use all related significantly positively with the dependent variables, whereas grade point average and religious commitment had a negative relationship. Miles driven per week related positively to driving after drinking. O'Malley, P.M., and Johnston L.D. American Journal of Public Health, 89(5), pp. 678-684, 1999.

Family History of Substance Use Disorder Moderates Relation between Cognitive Distortions and Aggressive Behavior and Aggressive Behavior and Drug Use for Adolescent Boys

The purpose of this study was to determine whether the relations between (a) cognitive distortions and aggressive behavior, (b) cognitive distortions and drug use, and (c) aggressive behavior and drug use are moderated by a family history of a substance use disorder (SUD) in adolescent boys. Participants were 165 boys aged 15-17 years with (FH+; N=75) and without (FH-; N=90) a family history of SUD. Results indicated that a family history of SUD moderated the relation between cognitive distortions and aggressive behavior and the relation between aggressive behavior and drug use. Family history of SUD did not moderate the relation between cognitive distortions and drug use; however, cognitive distortions were positively related to drug use within both groups. Giancola, P.R., Mezzich, A..C., Clark, D.B., and Tarter, R.E. Cognitive Distortions, Aggressive Behavior, and Drug Use in Adolescent Boys With and Without a Family History of a Substance Use Disorder. Psychology of Addictive Behaviors, 13(1), pp. 22-32, 1999.

Adolescent School Experiences and Dropout, Adolescent Pregnancy, and Young Adult Deviant Behavior

Predictive effects of school experiences were studied over a 7-year interval in a random community sample of 452 adolescents, 12 through 18 years of age. Outcomes examined included dropping out of school, adolescent pregnancy, engaging in criminal activities, criminal conviction, antisocial personality disorder, and alcohol abuse. Logistic regression showed academic achievement, academic aspirations, and learning-focused school settings to be related to a decline in deviant outcomes independent of the effects of disadvantaged socioeconomic background, low intelligence, childhood conduct problems, and having deviant friends during adolescence. Associations between school conflict and later deviancy were mediated by deviant peer relationships in adolescence and other school characteristics. Prior research reporting continuity of childhood conduct problems and the influence of adolescent affiliations with deviant peers on negative outcomes was supported. Implications for using the school context in risk factor research and the practical applications of such research for intervention are discussed. Kasen, S., Cohen, P., and Brook, J.S. Journal of Adolescent Research, 13 (1), pp. 49-72, 1998.

Resisting Temptations To Smoke: Results Using Within-Subjects Analyses

This study used within-subjects analyses to examine resisted temptations to smoke and lapses, providing a methodological advance over most previous studies of cigarette smoking relapse. One hundred thirty participants who lapsed within one month after a self initiated cessation attempt were questioned about both a resisted temptation to smoke and their first lapse. Participants were much more likely to report using coping strategies during the resisted temptation than during the lapse, and those who reported coping during both situations were more likely to report that they used multiple strategies and combined cognitive and behavioral strategies during the resisted temptation. Participants were more likely to report that the lapse was precipitated by others' smoking, but this difference was not significant when the sample was restricted to participants who reported a specific close call. Results support previously reported findings that the use or nonuse of coping strategies during a temptation to smoke is the variable most strongly associated with its outcome. Bliss, R.E., Garvey, A.J., and Ward, K.D. Psychology of Addictive Behaviors, 13 (2), pp. 143-151, 1999.

Parents Educational Attainment Influences Prevention Assessment Attrition

This study examined whether family risk factors predict attrition in a prevention intervention project that incorporated procedures to increase retention in assessment and intervention activities. Data from 667 rural families collected in four waves were analyzed. Data consisted of young adolescent and parent reports of internalizing and externalizing problems, observer rating of distress in parent-child interactions, and family socioeconomic status (SES). SES was a significant predictor of assessment attrition: follow-up analyses indicated that this relationship was due to lower educational attainment rather than income. None of the social-emotional or SES factors examined predicted intervention participation. Spoth, R., Goldberg, C., and Redmond, C. Engaging Families in Longitudinal Preventive Intervention Research: Discrete-Time Survival Analysis of Socioeconomic and Social-Emotional Risk Factors. Journal of Clinical and Consulting Psychology, 67(1), pp. 157-163, 1999.

Interpersonal Aggression in Urban Minority Youth

This study examined perceived social environmental and personal control variables as predictors of interpersonal aggression in urban minority youth. Perceived environmental factors including neighborhood risk, friends' delinquency, and parental monitoring practices, were examined as direct predictors of aggression and as indirect predictors mediated by anger control skills and risk-taking characteristics. The sample consisted of 452 primarily African-American sixth graders attending New York City public schools. Results of structural equation modeling indicated that perceived higher levels of parental monitoring were directly associated with less aggression and had an indirect effect mediated through better anger control skills. Perceived neighborhood risk and friends' delinquency were directly associated with more aggression and were indirectly effected through greater individual risk-taking. Griffin, K.W., Scheier, L.M., Botvin, G.J., Diaz, T. and Miller, N. Interpersonal Aggression in Urban Minority Youth: Mediators of Perceived Neighborhood, Peer, and Parental Influences. Journal of Community Psychology 27(3), pp. 281-296, 1999.

Drug Use Among Puerto Ricans: Ethnic Identity as a Protective Factor

This study assessed the relationship of multiple drug risks, Puerto Rican identity, and drug use. Structured interviews were conducted with 555 Puerto Rican males and females whose mean age was 19. Each risk factor and two ethnic variables were related to drug use. Regressions showed that cultural knowledge, being culturally active, group attachment, and identification with Puerto Ricans offset the impact of risk factors on drug use. Ethnic variables also enhanced the protective effect of other protective factors. In sum, the results substantiate expanding risk-buffering models to include ethnic identity and the protective role of ethnic identity for Puerto Rican youth. Brook, J. S., Whiteman, M., Balka, E. B., Win, P. T., and Gursen, M. D. Journal of Hispanic Research, 20(2), pp. 241-254, 1998.

Different Characteristics Associated with Reported Versus Unreported Cases of Childhood Rape; Few Cases of Childhood Rape Actually Reported to Authorities

This study was to examine whether there would be differences in reported versus unreported cases of childhood rape on incident characteristics including life threat, physical injury, identity of the perpetrator, frequency of assault(s), and rates of posttraumatic stress disorder or major depression. Using a telephone interview, a national probability sample of 4,008 (weighted) adult women was screened for a history of completed rape in childhood. Respondents were also assessed for DSM-III-R diagnoses of major depressive episode and/or posttraumatic stress disorder (PTSD), and substance use. Three hundred forty-one (8.5%) of these women were victims of at least one rape prior to the age of 18, for a total of 437 completed rapes. Of these 437 rape incidents, 52 (11.9%) were reported to the police or other authorities. Significant differences were obtained between reported versus nonreported cases on incident characteristics, including life threat, physical injury, identity of the perpetrator. Reported cases were more likely to involve life threat and/or physical injury, and were more likely to have been committed by a stranger than nonreported cases. No significant differences between reported and nonreported cases were found concerning whether the rape involved a single incident versus series of events, or rates of PTSD or major depression. Findings suggest that different characteristics are associated with reported versus unreported cases of childhood rape. Hanson, R.F., Resnick, H.S., Saunders, B.E., Kilpatrick, D.G., and Best, C. Factors Related to the Reporting of Childhood Rape. Child Abuse and Neglect 23(6) pp. 559-569, 1999.

Vulnerability to Drug Use Among Latino Adolescents

In this study, risk and protective factor indices were developed to examine vulnerability to drug use among Latino high school students. Survey data were collected from 516 Latino 9th and 10th grade youth in the Los Angeles area. Frequency and quantity of use data were collected for cigarettes, alcohol, marijuana, inhalants, cocaine, and other illicit drugs. Few gender differences emerged in prevalence of drug use and about 25% were already involved in heavy drug use. Seventeen variables were examined for inclusion in a risk factor index (RFI) or protective factor index (PFI). Bivariate, multivariate, and structural equation models (SEM) were employed in the analysis of data. All of the variables except for one were more risk-inducing than protective for these Latino youth. However, as a group, the PFI predicted several types of drug use for boys and girls, and moderated the adverse effects of the RFI. At a high level of risk, a high level of protection was associated with reduced use for some types of drugs. In the SEM, vulnerability to drug use as indicated by the RFI and PFI was strongly associated with drug use for both boys and girls and more strongly related to drug use than the RFI or PFI alone. These results have exciting implications for intervention. Felix-Ortiz, M. and Newcomb, M.D. Journal of Community Psychology, 27(3), pp. 257-280, John Wiley & Sons, Inc., 1999.

Effect of Parent-Child Relations on Child Oppositional Behavior

This study is one of a series modeling sequences of intervention effects on parenting or family protective processes influencing various distal child outcomes. It was hypothesized that (1) positive parent-child affective quality would have a direct negative effect on child oppositional behavior both concurrently and across time, (2) that over time child oppositional behavior would have a negative effect on positive parent-child affective quality, and (3) that child's sense of mastery would have a negative effect on oppositional behavior. Data were obtained from family members participating in a family competency building intervention studies. The model was tested twice with independent samples. Sample one (n=171) participated in a pilot study of the Preparing for the Drug Free Years Intervention (PDFY); sample two (n=361) participating in a longitudinal evaluation of the PDFY. Attendance in the intervention was used as a control factor, with those in control groups being scored zero. Results of covariance structure modeling were generally consistent with the hypothesized model for both samples. Consistent with prior research, parent-child affective quality played a significant role in oppositional behavior. However, the opposite was not true in this general population study. That is, adolescent oppositional behavior did not have a strong negative effective on subsequent parent-child affective quality. There was also a weaker than expected relationship between sense of mastery and oppositional behavior. Spoth, R., Redmond, C., Shin, C., and Huck, S. A. Protective Process Model of Parent-Child Affective Quality and Child Mastery Effects on Oppositional Behaviors: A Test and Replication. Journal of School Psychology, 37(1), pp. 49-71, 1999.

Victimization--Socioeconomic Impact of Interpersonal Violence on Women

Prospective data from a nationally representative sample of women were used to examine 4 objective indexes of social adjustment following direct, interpersonal crime. Household income, marital status, employment, and education level were evaluated as risk factors for, and outcomes of victimization. Data were collected in 3 waves at 1-year intervals, and 2,863 women completed all 3 waves. Results indicate that women experience increased risk for victimization when income is below poverty level and when newly divorced. Further, victimization appears to increase women's risk for unemployment, reduced income, and divorce. The cyclical nature of victimization is discussed. Byrne, C.A., Resnick, H.S., Kilpatrick, D.G., Best, C.L., and Saunders, B.E. The Socioeconomic Impact of Interpersonal Violence on Women. Journal of Consulting and Clinical Psychology 67(3), pp. 362-366, 1999.

Family and Peer Correlates of Behavioral Self-Regulation in Boys at Risk for Substance Abuse

A study at CEDAR focused on behavioral self-regulation (BSR), which was operationally defined as the degree to which one can control one's own activity and reactivity to environmental stimuli. BSR has been posited to be an important determinant of the onset of adolescent substance abuse. The goal of this study was to clarify particular family and peer correlates of BSR in at-risk sons. Subjects were 10-12-year-old sons of substance-abusing fathers (high-average risk [HAR]; n = 176) and normal controls (low-average risk [LAR]; n = 199). A BSR latent trait was developed using multiple measures and multiple informants. Analyses included separate hierarchical linear regressions for HAR and LAR groups. In the hierarchical linear model for HAR sons, family dysfunction and deviant peer affiliation were significantly associated with BSR, whereas for LAR sons, only peer affiliation was significantly associated with BSR. These findings suggest that empirical, theory-guided interventions to prevent worsening of BSR in HAR boys should address specific interpersonal family, and peer factors. Dawes, M., Clark, D., Moss, H. Kirisci, L., and Tarter, R. American Journal of Drug and Alcohol Abuse, 25(2), pp. 219-237, 1999.

The Validity of Drug Use Reporting Based on Hair Tests

Hair specimens were collected from 322 subjects and analyzed as part of an experimental study administering household surveys during 1997 to a high-risk community sample of adults from Chicago, Illinois. Toxicologic results were compared with survey responses about use of cocaine and heroin. About 35% of the sample tested positive for cocaine, and 4% tested positive for heroin. Sample prevalence estimates of cocaine use based on toxicological results were nearly five times the survey-based estimates of past month use and nearly four times the survey-based estimates of past year use. With the hair test results as the standard, cocaine and heroin use were considerably underreported in the survey. Underreporting was more of a problem for cocaine than for heroin. Among those who tested positive, survey disclosure of cocaine use was associated with higher levels of cocaine detected in hair. In general, when recent drug use was reported, it was usually detected in hair. When a drug was detected in hair, use was usually not reported in the survey. When heroin was detected in hair, cocaine was almost always detected as well. Fendrich, M., Johnson, T.P., Sudman, S., Wislar, J.S., and Spiehler, V. Validity of Drug Use Reporting in a High-Risk Community Sample: A Comparison of Cocaine and Heroin Survey Reports with Hair Tests. American Journal of Epidemiology, 149(10), pp. 955-962, 1999.

Social Influence and Psychological Determinants of Smoking Among Inner-City Adolescents

Adolescent economically disadvantaged households appear at high risk for smoking. This study focused on a sample of economically disadvantaged adolescents attending New York City schools (N=1875). Longitudinal predictors of smoking from four domains (socio-demographic background, social influences, social and personal competence, and individual differences) were tested. Social influences to smoke from mothers and friends both predicted smoking one year later. Poor decision-making skills and low psychological well-being also predicted subsequent smoking. Results suggest that training adolescents to resist social influences to smoke, problem solve, make sound decisions, and to cope with psychological distress are key components for effective smoking prevention approaches. Epstein, J.A., Botvin, G.J., and Diaz, T. Social Influence and Psychological Determinants of Smoking Among Inner-City Adolescents. Journal of Child & Adolescent Substance Abuse, 8(3), pp. 1-19, 1999.

Marijuana Use Among Minority Youths Living in Public Housing Developments

Youths residing in public housing developments are at heightened risk for drug use. The purpose of this study was to develop and test a model of marijuana etiology with adolescents (N=624) residing in public housing. African-American and Hispanic seventh graders completed questionnaires about their marijuana use, social influences to smoke marijuana, and sociodemographic and psychosocial characteristics. Results indicate that social influences, such as friends' marijuana use and perceived ease of availability of marijuana significantly predicted both occasional and future intentions to use marijuana. Individual characteristics such as anti-marijuana attitudes and drug refusal skills also predicted marijuana use. The findings imply that effective prevention approaches that target urban youths residing in public housing developments should provide them with an awareness of social influences to use marijuana, correct misperceptions about the prevalence of marijuana smoking, and train adolescents in relevant psychosocial skills. Williams, C, Epstein, J., Botvin, G.J., and Ifill-Williams, M. Marijuana Use Among Minority Youths Living in Public Housing Developments. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 76(1), pp. 85-101, 1999.

Comparison of Live and Video Prevention Messages

A Perception of Performance Scale was developed to compare delivery of a single drug prevention message which was modified into one of two modalities: live performance versus video performance. Scale development was undertaken in a pilot study with 334 undergraduate students at a large university in the southwestern U.S. Exploratory and Confirmatory Factor Analysis showed the scale had three dimensions; identification, interest, and realism with reliabilities of .86, .89 and .90, respectively. The main study consisted of 465 students (52% female, 75% European American, 12% Hispanic, and 13% other) in a single high school who were randomly assigned to either performance condition. Results indicate that live performance was significantly more interesting and realistic than video performance, suggesting that live performance may be a more effective medium for engaging high school aged youth. Miller, M., Hecht, M. & Stiff, J. An Exploratory Measurement of Engagement of Live and Film Media. Journal of the Illinois Speech and Theatre Association, 49, pp. 69-83, 1998.

The Role of Personal Relationships in Drug Resistance

The purpose of this study was to better understand the role of adolescents' personal relationships in drug offer scenarios. More than 2,000 junior high school students from 31 schools participated in a questionnaire study that asked them to describe a time when they were offered drugs. Results indicate that adolescents are most frequently offered drugs by close associates (same-sex friends, romantic partners, and brothers or male cousins), with offers from family members or romantic partners being particularly difficult to resist. Although simpler offers were the most frequent type of offer, nonverbal presentation of the drug was the most effective. Students typically resisted by saying no and leaving the situation, but these strategies were not as effective across all relational partners. Response complexity (more involved than simple answers of 'no') was a better predictor of resistance than offer complexity. Trost, M.R., Langan, E.J., & Kellar-Guenter, Y. Not Everyone Listens When You 'Just Say No': Drug Resistance in Relational Context. Journal of Applied Communication Research, 27, pp. 120-138, 1999.

Close Parent-Child Bond Mitigates Risks of Adolescent Drug Use and Delinquency

A study was conducted to identify general and differentiating risk and protective factors from domains of culture and ecology, peer, family, and personality, related to adolescent delinquency and marijuana use, and to examine the protective role of the parent-child mutual attachment in offsetting cultural and ecological risk factors, leading to less delinquency and marijuana use. The study design consisted of a cross-sectional analyses of interview data collected in Colombia. A total of 2837 Colombian adolescents, 12 to 17 years of age participated. Adolescents were interviewed in their homes. Independent variables included measures from 4 domains: culture and ecology, peer, family, and personality. The dependent variables were delinquency and marijuana use. Results show that several risk factors, such as tolerance of deviance and sensation seeking, were similarly related to both delinquency and marijuana use, suggesting that a common cause underlies the propensity to engage in different deviant behaviors. Some risk factors were more involved in delinquency and other risk factors were more highly related to the adolescent's marijuana use. Finally, when violence is endemic and illegal drugs are readily available, a close parent-child bond was capable of mitigating these risk factors, leading to less marijuana use and delinquency. The findings have implications for public health policy related to interventions in countries in which violence and drug use are prevalent. The results point to intervention procedures aimed at adolescents vulnerable to marijuana use and delinquency as well as efforts aimed at specific vulnerabilities in these areas. For example, reducing the risk factors and enhancing the protective factors for marijuana use and delinquency may result in less adolescent marijuana use and delinquency. Brook, J., Brook, D., De La Rosa, M., Whiteman, M., and Montoya, I. The Role of Parents in Protecting Colombian Adolescents from Delinquency and Marijuana Use. Arch Pediatr Adolesc Med, 153(5), pp. 457-64, 1999.

Substance Abuse as a Predictor of VA Medical Care Utilization among Vietnam Veterans

The primary objective of this research was to determine whether Vietnam veterans who had alcohol or drug use problems prior to, during, or immediately after the war, used Veteran's Administration (VA) health care services more intensively during the next two decades than Vietnam veterans without these behaviors. The secondary objective was to identify predictors of VA health services utilization among data collected at service discharge. Logistic and ordinary least squares regression were used to model the effect of predisposing, enabling, and need factors on utilization of VA health services (N=571). Results show that Vietnam veterans who had substance use problems, whether before or immediately after Vietnam, used VA health care services more intensively during the next two decades than Vietnam veterans without these behaviors. Depression and psychiatric care seeking were also important predictors. These findings suggest that more research is needed to evaluate the impact of health system characteristics and private sector use on the predictive ability of the models. Virgo, K.S., Price, R.K., Spitznagel, E.L., and Ji, T.H. The Journal of Behavioral Health Services & Research. 26(2), pp. 126-139, 1999.

Adolescent Marijuana Use Found Incompatible with Assumption of Adult Roles

A longitudinal study examined the relationship between marijuana use and the assumption of adult roles, as well as the relationship between assuming adult roles and the likelihood of later marijuana use. Data were collected at 5 points in time from childhood through early adulthood (late 20s) by means of a structured questionnaire. Participants' marijuana use and the assumption of adult roles, including employment, marriage, parenthood, and living arrangements, were measured, and the data were analyzed with logistic regression analyses. A history of marijuana use was associated with an increased risk of adopting more unconventional adult roles, such as postponement of marriage, having a child out of wedlock, and unemployment. These results suggest that frequent prior marijuana use may adversely affect one's ability to successfully assume conventional adult roles. Furthermore, controlling for earlier marijuana use, marriage during early adulthood significantly decreased the risk of later marijuana use. Brook, J., Richter, L., Whiteman, M., and Cohen, P. Consequences of Adolescent Marijuana Use: Incompatibility with the Assumption of Adult Roles. Genet Soc Gen Psychol Monogr, 125(2), pp. 193-207, 1999.

Job Strain and Non-Medical Drug Use

In this study, the Karasek demand/control hypothesis of job strain, initially used in research on cardiovascular health, was extended to drug use. Full time nurses (n=2,375), all participants in a national anonymous mailed survey, were an estimated 1.5 times more likely to be a recent non-medical drug user if they had a high strain job as compared to nurses in low strain jobs. The psychosocial work environment might influence whether nurses become and remain non-medical drug users, over and above the risk modifying functions related to nurses' individual vulnerabilities and their greater access to controlled substances. Storr, C.L., Trinkoff, A.M., and Anthony, J.C. Drug and Alcohol Dependence, 55, pp. 45 -51, 1999.

NIDA Home | Site Map | Search | FAQs | Accessibility | Privacy | FOIA (NIH) | Employment | Print Version _ The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services. Questions? See our Contact Information. Last updated on Wednesday, May 23, 2007.