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National Institute on Drug Abuse
Women and Sex/Gender Differences Research
Director's Report to Council
Research Findings Excerpts
May, 2002
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Behavioral Research |
The Effects of Smoked Cocaine during the Follicular and Luteal Phases of the Menstrual Cycle in Women
Dr. Suzette Evans and colleagues of the New York State Psychiatric Institute and the College of Physicians and Surgeons of Columbia University have found that phase of the menstrual cycle is a determinant of cocaine craving as well as of the subjective response to smoked cocaine. Eleven females research volunteers who were currently using cocaine were recruited for participation in this study. Their mean amount spent per week on cocaine was $397 and their average use was 3-4 days per week. Each subject was tested in both the luteal and the follicular phase and in each phase subjects received four cocaine sessions in which they could smoke up to six doses of cocaine (either 0, 6, 12, for 25 mg cocaine base) at 14-min intervals. Under placebo conditions, resting heart rate, reports of dysphoria (e.g, ratings of "depressed," "irritable," "miserable"), and cocaine craving were greater during the luteal phase than in the follicular. Following cocaine administration, luteal phase dysphoric ratings were dose-dependently improved. Cocaine craving was greater during the luteal phase than during the follicular under 3mg and 25 mg, but not after 12 mg at which time craving was higher in the follicular phase. Cocaine-produced ratings of mood states (alert, friendly, self-confident, social, talkative), positive drug effects (good drug effect, high, stimulated), and drug quality ratings were generally greater during the follicular phase than the luteal phase. Heart rate increase was also greater during the follicular phase. Plasma cocaine levels increased with increasing cocaine dose, but did not differ in the follicular and luteal phases. The differential subjective effects of cocaine in the luteal and follicular phases as well as the cocaine-produced amelioration of mild luteal phase dysphoria observed in this study warrant investigation of the mechanisms underlying these effects as well as an exploration of treatment implications of these findings. Evans, S.M., Haney, M, and Foltin, R.W. The Effects of Smoked Cocaine during the Follicular and Luteal Phases of the Menstrual Cycle in Women. Psychopharmacology, 159, pp. 397-406, 2002.
Chronic Sucrose Intake Enhances Nicotine-Induced Antinociception in Female But Not Male Long-Evans Rats
Previous work has shown that in rats and mice, chronic consumption of palatable foods and fluids enhances the antinociceptive effects of morphine and other opioid agonists. Dr. Robin Kanarek and her colleague, Silvia Mandilo, of Tufts University have now shown that this effect extends to nicotine-induced antinociception. They found that nicotine administration produced dose-related increases in antiociception, but only in female subjects. Other animal studies have also shown sex differences in response to nicotine, e.g, females exhibit a greater antinociceptive effect of centrally-administered nicotine, a greater effect of nicotine on food intake and body weight, and greater motivation to self-administer nicotine. In the present study, the authors speculate that the sucrose enhancement of nicotine-induced antinociception in females, but not males, could be due to the fact that because female rats are smaller than males, their percent daily calories obtained from sucrose was greater. This study, along with prior research demonstrating sucrose enhancement of opioid-induced antinociception, highlights the need for additional research on the role of diet in effects of psychoactive drugs as well as highlights the importance of examining the role of gender in these effects. Mandilo, S. and Kanarek, R.B. Chronic Sucrose Intake Enhances Nicotine-Induced Antinociception in Female but not Male Long-Evans Rats. Pharmacology, Biochemistry and Behavior, 68, pp. 211-219, 2001.
Ketaconazole Suppresses Food Restriction-Induced Increases in Heroin Self-Administration in Rats: Sex Differences
In animal laboratory studies, augmentation of drug self-administration by food restriction is well established, although the mechanism for this effect is not well understood. Given that food restriction produces an increase in corticosterone, it has been hypothesized that food deprivation is a stressor and thus acts as other stressors to elevate drug self-administration. This hypothesis was tested in a recent study by Dr. Marilyn Carroll and colleagues at the University of Minnesota who sought to determine whether ketaconazole, a corticosterone synthesis blocker, would suppress the increase in heroin self-administration produced by food restriction. In both male and female rats, heroin self-administration was increased approximately two-fold by food restriction. Under conditions of food satiation, ketaconazole had no effect on heroin self-administration in either males or females. Under conditions of food restriction, ketaconazole suppressed the food-restriction increase in heroin self-administration in females, but not males. This outcome in females lends support to the hypothesis that stress mediates the effects of food restriction on increased drug self-administration, and also has implications for the development for medications to be used in opiate abuse. Carroll, M.E., Campbell, U.C., and Heideman, P. Ketaconazole Suppresses Food Restriction-Induced Increases in Heroin Self-Administration in Rats: Sex Differences. Experimental and Clinical Psychopharmacology, 9, pp. 307-316, 2001.
Sex Differences in the Effects of Baclofen on the Acquisition of Intravenous Cocaine Self-Administration in Rats
Previous work by Dr. Marilyn Carroll and colleagues at the University of Minnesota has shown that female rats acquire i.v. cocaine self-administration faster than male rats and that a larger percentage of female than male rats acquire cocaine self-administration. These researchers now report that baclofen differentially affects acquisition of i.v. cocaine self-administration in male and female rats. Prior animal studies have shown the GABA agonist, baclofen, to be effective in reducing both the maintenance of i.v. cocaine self-administration as well as the reinstatement of i.v. cocaine self-administration following extinction. Dr. Carroll and her colleagues have now extended baclofen's effects to the acquisition phase of i.v. cocaine self-administration. They found that baclofen not only reduced the rate of acquistion of i.v. cocaine self-administration, but it also reduced the percentage of subjects that acquired i.v. cocaine self-administration. For both outcomes, the reduction was greater in females than males. Whereas 77.7% of the males met criterion for acquisition of cocaine self-administration under baclofen, only 15.4% of the females met criterion. These data join a growing body of behavioral research with animals indicating sex differences in drug effects. Campbell, U.C., Morgan, A.D., and Carroll, M.E. Sex Differences in the Effects of Baclofen on the Acquisition of Intravenous Cocaine Self-administration in Rats. Drug and Alcohol Dependence, 66, pp. 61-69, 2002.
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Treatment Research and Development |
A Promising Intervention For A Daunting Problem: Comment On Silverman Et Al. (2001)
Researcher Steve Higgins from the University of Vermont provided a commentary on Kenneth Silverman's Therapeutic Workplace Intervention. He asserted that the therapeutic workplace represents a creative and promising new approach to drug abuse treatment that to the author's knowledge, is the first intervention that has been shown in a randomized clinical trial to significantly reduce cocaine abuse among pregnant women. He commended the rigor of the work and the science-based approach that integrates concepts and principles from several behavioral science literatures. He remarked that the intervention offers a potentially practical way of extending incentive-based drug abuse treatments to community clinics and suggested that the report has the potential to provoke serious consideration of what more might be done to combat chronic unemployment and drug abuse in poor communities. Higgins, S.T. Experimental and Clinical Psychopharmacology, 9, pp. 27-28, 2001.
Clinical Features of Pathological Gambling in an Addictions Treatment Cohort
Dr. James Langenbucher and colleagues at the Rutgers Center for Alcohol Studies examined the prevalence and descriptive psychopathology of pathological gambling in a heterogeneous treatment sample of 372 substance users. Of all participants, about 14% of men and 10% of women were identified by the South Oaks Gambling Screen (SOGS) as likely pathological gamblers (PGs). Compared with the 323 participants who were not pathological gamblers (NPGs), the 49 PGs showed more disturbance than NPGs on some measures of premorbid risk, pathological substance use, social consequences of use, and psychiatric comorbidity. Gambling status may be an important comorbid condition in addictions treatment settings and a significant covariate in research. Langenbucher, J., Bavly, L., Labouvie, E., Sanjuan, P.M., and Martin, C.S. Psychology of Addictive Behaviors, 15, pp. 77-79, 2002.
Interest in and Obstacles to Pursuing Work Interest in and Obstacles to Pursuing Work Among Unemployed Dually Diagnosed Individuals
This study investigated interest in and perceived barriers to pursuing work, and the utilization of vocational rehabilitation services among 130 unemployed members of a dual recovery self-help fellowship. Members generally expressed high interest in working, although they perceived multiple barriers to attaining and maintaining employment. Based on a path model predicting interest in working, both substance use status and physical health rating were found to be significant contributors to interest in working. As expected, mental health symptoms and greater perceived obstacles (e.g., stigma, fear of failure, and insufficient skills) were significant contributors to perceived difficulty in pursuing work, whereas substance use, physical health, and recency of employment were not. Finally, perceived barriers to pursuing work, but not interest in work, were related to utilizing vocational rehabilitation services. There was also a significant gender difference, with men more likely than women to use these vocational rehabilitation services. Laudet, A.B., Magura, S., Vogel, H.S., Knight, E. L.. Substance Use & Misuse, 37, pp. 145-170, 2002.
Quantitative EEG (QEEG) Defined a Group of Treatment-receptive Cocaine-Dependent Males and Females
Dr. Leslie Prichep and colleagues at NYU School of Medicine used EEG analyzed by sophisticated quantitative measures and somatosensory evoked potential features to group 16 female and 41 male cocaine-dependent subjects into three clusters. All subjects were in treatment and had been drug free for 5 to 14 days. The clusters were compared on a median split of length-of-stay ( 25 weeks) in treatment. Eighty percent of the subjects in one cluster remained in treatment more than 25 weeks, while only 22% and 35% of the subjects in the other clusters did. There were no differences among the clusters in length or amount of cocaine use. The EEG patterns of the clusters differed in a number of ways of relative and absolute power in various frequency bands. Understanding the bases of these electrocortigrams will aid in understanding the individual differences among recovering cocaine-dependent individuals. Prichep, L.S., Alper, K.R., Sverdlov, L., Kowalik, S.C., John, E.R., Merkin, H., Tom, M.L., Howard, B., and Rosenthal, M.S. Clin Electroenceph, 33(1), pp. 8-20, 2002.
Fluoxetine was Shown to Reduce the Probability of Dropout and Increase the Probability of Abstinence in Smoking Cessation Treatment
Hitsman and colleagues demonstrated in a two-level dose (30 mg and 60 mg) of fluoxetine that there was a dose-response improvement in dropout and abstinence rates and a behavioral treatment paradigm. The study was devised to answer questions of whether side effects to such treatment would have the opposite, deleterious effect or would have a positive effect at the lower dose and a negative effect at the higher dose. In further analysis it was shown that the probability of improved performance was correlated linearly with blood levels (for moderate levels and above) for both men and women, though men had an overall better outcome. Hitsman, B., Spring, B., Borelli, B., Niura, R., and Papandonatos, G.D., Exptl Clin Psychopharm, 9(4), pp. 355-362, 2001.
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Research on AIDS and Other Medical Consequences of Drug Abuse |
HIV/AIDS Risk Behaviors among Female Jail Detainees: Implications for Public Health Policy
Women are currently a primary focus in the battle against HIV/AIDS. This study examines the sex- and IDU-HIV/AIDS risk behaviors of female jail detainees and assesses the potential impact of interventions targeting this population. A sample of 948 participants stratified by charge type (i.e., felony vs. misdemeanor) and by race/ethnicity formed be basis of this study. Results indicate that non-hispanic white women, women arrested for less serious charges, women who have prior arrests, women arrested on drug charges, and women with severe mental disorders are at especially high risk for sexual and IDU transmission of HIV/AIDS. Investigators conclude that many women at particular risk of HIV/AIDS - women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorder - will eventually cycle through the jail. Because most jail detainees return to their communities within days, providing HIV/AIDS education in the jail must become a public health priority. McClelland, G.M., Teplin, L.A., Abram, K.M., and Jacobs, N. American Journal of Public Health, 92(5), pp. 818-825, 2002.
Psychiatric Symptoms, Health Services, and HIV Risk Factors among Homeless Women
The authors determined whether psychiatric symptoms and lack of health and/or social services contacts were associated with HIV risk behaviors among a probability sample of homeless women. Women were interviewed regarding socioeconomic indicators, psychiatric symptoms, health and/or social services contacts, and past-year HIV risk behaviors. Overall, 8 percent of the women injected drugs, 64 percent engaged in unprotected sex, and 22 percent traded sex. Substance abuse was positively associated with injection drug use and trading sex. Homeless women with case managers were less likely to inject drugs. Although barriers to obtaining drug treatment were associated with trading sex, women attending self-help meetings for substance abuse were also more likely to trade sex. Homeless women who are substance abusers are vulnerable to HIV risk behaviors. Risk reduction interventions for homeless women should be implemented through substance abuse and intensive case management programs. Kilbourne, A.M., Herndon, B., Andersen, R.M., Wenzel, S.L., and Gelberg, L. Journal of Health Care for the Poor and Underserved, 13(1), pp. 49-65, February 2002.
Differential Predictors of Emotional Distress in HIV-infected Men and Women
Changes in the AIDS epidemic in many areas of the United States require information about the experience of the growing segment of women afflicted. The authors compared patterns of emotional distress between men and women with symptomatic HIV and examined potential predictors of different levels of vulnerability. A sample of 126 low socioeconomic men and women seeking care from HIV treatment centers was surveyed using measures of physical and psychological well-being. Women had more HIV symptoms, poorer functioning, and greater disruptions in physical and psychosocial well-being. Physical health status and optimism were primary predictors of emotional distress in both men and women. More than 50% of men and women had scores indicative of clinical anxiety. Approximately 1 out of 10 had clinically relevant scores for depression. Gender differences may provide potentially useful information for tailoring assessment interventions for emotional distress in people infected with HIV. van Servellen, G., Aguirre, M., Sarna, L., and Brecht, M.L. Western Journal of Nursing Research, 24(1), pp. 49-72, February 2002.
Drug Use During Pregnancy and Short-Term Maternal Outcomes
Findings from the largest study of illicit drug use during pregnancy have replicated many of the associations found in studies involving smaller samples. Over a 2-year period, 19,079 mother-infant pairs were screened after delivery for cocaine and opiate exposure at four clinical centers, located in Detroit, Memphis, Miami, and Providence. Of those screened, 16,988 met eligibility criteria, and 11,811 agreed to participate. Analyses involved 8,627 mother-infant pairs, based on ability to confidently classify participants as exposed or not exposed. Exposure was defined as admission of use of cocaine or opiates or both, or the presence of cocaine or opiate metabolites in meconium (using gas chromatography-mass spectroscopy methodology). Nonexposure was defined as a negative drug use history by interview and a negative immunoassay screen. Exposed mothers had a significantly higher risk of infections, including syphilis, gonorrhea, hepatitis, and HIV; psychiatric, nervous, and emotional disorders; and abruptio placenta. However, it should be noted that in this large, sociodemographically diverse cohort study, the prevalence of these risk outcomes was lower than typically reported in previous reports. The authors point out that although the prevalence of serious and life-threatening medical outcomes is low in drug-abusing pregnant women, disadvantaged social and environmental conditions that are often characteristic of the lifestyle of these women may compound these problems. Bauer, C.R., Shankaran, S., Bada, H.S., et al. The Maternal Lifestyle Study: Drug Exposure During Pregnancy and Short-Term Maternal Outcomes. American Journal of Obstetrics and Gynecology, 186, pp. 487-495, 2002.
Gender-Related Social Factors Associated with Syringe Sharing Among Injecting Partners
The study of social networks has become an increasingly utilized method of examining the relationship between injection drug users' social environment and risk of HIV. This study examined relational aspects of two injection drug users (IDUs) within a single social network as they relate to sharing syringes. Data presented in this study were derived from baseline interviews of 508 IDUs from Baltimore, MD. Analyses were performed separately for male and female participants in aneffort to understand gender differences in social aspects of syringe sharing. Among this sample, women shared syringes with a significantly higher percentage of injecting partners compared to men. In separate multilevel logistic regression models, significant variables associated with males' and females' syringe sharing were: sharing drugs daily with female injecting partners, injecting partners' provision of drugs when indexes' were withdrawing, being sexual partners, and injecting partners' injecting speedballs. Factors associated with male injecting dyads sharing of syringes were: being kin, injecting partners' injection of heroin and daily drug use, and drinking alcohol together. Results from this study demonstrate the usefulness of examining relationship characteristics of injecting dyads related to syringe sharing as they differ between men and women. Sherman, S.G., Latkin, C.A., and Gielan, A.C. Social Factors Related to Syringe Sharing Among Injecting Partners:A Focus on Gender. Subst Use Misuse, 36(14), pp. 2113-2136, 2001.
Gender Differences in HIV Risk Behaviors of PR IDUs and Awareness of Serostatus
Researchers examined HIV injection and sex-related risk behaviors among Puerto Rican injecting drug users by gender, separately for those who were aware of being HIV positive and those who believed they were seronegative or were unaware of their serostatus. The participants (N= 873; 561 in New York and 312 in Puerto Rico) were recruited from January 1998 to July 1999 in the two sites by street outreach workers. Of the participants, 81% were males and 19% self-reported that they were previously told that they had been infected with HIV. More significant gender differences in risk behaviors were found in bivariate analyses among those who were not told they were infected than among those who were aware of their HIV+ status. The factors related to HIV risk behaviors between males and females differed after controlling for the impacts of other variables in multivariate analysis. Among those who were never told they were infected, men were more involved in risky injection behaviors than women. Even among those who knew they were HIV+, men were more likely than women to engage in distributive sharing of injection equipment. Men also used paraphernalia and shared their needles/syringes or paraphernalia with others. Regardless of awareness of infection, women were more likely than men to engage in sex, to exchange sex for drugs or money, and to have multiple sexual partners. The levels of unsafe injection and sexual practices found in this study indicate a critical need for continuing intervention programs to reduce the risk of becoming HIV infected in these communities. Kang, S.Y., Deren, S., Andia, J., Colon, H.M., and Robles, R. Gender Differences in HIV Risk Behaviors Among Puerto Rican Drug Injectors by Awareness of HIV Seropositive Status. AIDS and Behavior, 5(3), pp. 241-249, 2001.
Public Health and Criminal Justice Policy Issues Related to High-Risk Women
Researchers have documented the linkages between sex-for-crack exchanges, prostitution, and rising rates of HIV and other sexually transmitted diseases among cocaine-dependent women. As crack began to fade from the headlines in the 1990s, however, it was assumed by many that crack had declined in popularity in the street drug culture. In this study, researchers describe crack use, street crime, and sex-for-drug exchanges collected during the mid-1990s in Miami, Florida from interviews with a sample of 851 multi-ethnic/racial women. Of the women, 708 or 83.2% were cocaine dependent and reported trading sex (defined as periodic exchange of sex for money or drugs, as opposed to regular or commercial sex work) in the past 30 days. All the women also had criminal histories, used illicit drugs 2-3 years before the initiation of reported criminal activity, and traded sex before the initiation of crack cocaine. The women are at high risk for HIV/AIDS, given their histories of injecting drug use, sex with an IDU who is HIV+, unprotected sex, and number of sex partners. Recent studies of HIV infection among crack-using women in Miami have reported HIV prevalence as high as 24% in non-sex traders and 35% in sex traders. The authors conclude that crack use continues to occupy a prominent place in the culture of drug-dependent women in Miami. They argue that their data contradict the argument that legalizing drugs would reduce crime associated with drug use, and suggest instead that drug addiction is a disorder of the whole person, including cognitive problems, psychological dysfunctions, and educational and employment deficits. Moreover, they found significant gaps in conventional HIV prevention outreach activities: of 53women participating in focus groups, almost none had ever come into contact with an HIV prevention outreach worker, largely because outreach occurs during the day and early evening and sex trading occurs late at night. The HIV prevention messages must also be made more relevant to the lives, culture, and concerns of the drug-involved women they are intended to reach. Inciardi, J.A. and Surratt, H.L. Drug Use, Street Crime, and Sex-Trading Among Cocaine-Dependent Women: Implications for Public Health and Criminal Justice Policy. J Psychoactive Drugs, 33(4), pp. 379-389, 2001.
Health Care Utilization in Female African-American Crack Cocaine Users
Researchers examined utilization of health care services by urban female African-American crack cocaine users recruited for a larger study developing HIV risk reduction interventions. Structured interviews were conducted with 149 women at a community-based field site. Nearly all women regularly sought health care during the past year, although only 40% had any type of health insurance. Two-thirds had no regular primary care provider, with the highest percentage among women who did not have health insurance. Typically, women received care at public hospital outpatient clinics or emergency rooms and the most common care issues were female-related health issues and substance use. Many women reported having had routine exams such as general medical, pelvic, or pap smear in the past 2 years. However, fewer had dental, eye or mammogram exams during that same time period, with many never having had such exams. Twenty-three percent of the women reported a lifetime diagnosis of a mental illness. Analyses by amount of crack use indicated that those who used most were least likely to be insured, and most likely to seek care at hospital emergency rooms. Multivariate analyses revealed that self-rated health and having a minor child predicted amount of health care received in the past year. Many female African American crack cocaine users are not receiving important health care exams and services. Steps must be taken to improve preventive and primary care to female African American crack cocaine users prior to the necessity of care in a more expensive hospital setting. Kidder, D.P., Elifson, K.W., and Sterk, C.E. Health Care Utilization in Female African-American Crack Cocaine Users. Women and Health, 34(1), pp. 79-97, 2001.
High Prevalence of Iron Deficiency and Anemia Among Female Injection Drug Users with or Without HIV Infection
Based on the fact that anemia is associated with HIV disease progression and high mortality, Semba et al. measured hemoglobin and plasma ferritin in a cohort of 136 HIV+ and 61 HIV-negative women IDUs in Baltimore, Maryland. The prevalence of anemia was 44.1% and 26.2%; iron deficiency was 37.5% and 42.6%; and the iron deficiency anemia 20.6% and 14.7%, in HIV+ and HIV- women, respectively. The overall prevalence of hepatitis C infection was 90.5%. Iron deficiency accounted for 46.7% and 56.1% of the anemia among HIV+ and HIV- negative female IDUs. The iron deficiency accounted for about half of the anemia among female IDUs. However, they stated that although iron supplementation is indicated for anemia in patients, such treatment should be approached with caution in women co-infected with HIV and hepatitis C virus, because iron supplementation and overload have been associated with increased progression of HIV infection, worsening of hepatitis C infection and higher mortality. Semba, R., Shah, N., Strathdee, S.A., and Vlahov, D. JAIDS, 29, pp. 142-144, 2002.
Use of Highly Active Antiretroviral Therapy in HIV-Infected Women: Impact of HIV Specialist Care
The objectives of this analysis were to evaluate factors associated with use of HIV specialist care by women, and to determine whether medical indications for therapy validate lower rates of antiretroviral use in women not using HIV specialty care. Results indicate that 81% of 273 women included in the analysis used HIV specialists vs. 19% who did not. Predictors of use of specialty care included having health insurance, not being an IDU, and the presence of depression (p< =.05). Medical indications for therapy were comparable between the users of HIV specialty care vs. non-users, but the use of HAART was significantly greater for those women using specialty care (27%) vs. those who did not (7.8%). Lower rates of HAART and other antiretroviral therapies (ART) at all CD4 cell count levels occurred in women not receiving specialty care. In the six months prior to study interview, women who utilized specialty care received significantly more advice to initiate ART vs. those not receiving such care (RR, 2.4). Among women with CD4 cells <500 who were current IDUs, the proportion receiving HAART was very low, irregardless of whether or not they were in specialty care (14% vs. 17%, p=NS). For women with CD4 cells <500 who were not IDUs, 31% in specialty care received HAART vs. 0% not in specialty care (p=.002). The overall low level of HAART use (23%) and use of any ART (47%) in this study of HIV-infected women indicate that substantial gaps remain for HIV-infected women in access to specialty care and therapy. Gardner, L.I., Holmberg, S.D., Moore, J., Arnsten, J.H., Mayer, K.H., Rompolo, A., Schuman, P., Smith, D.K. for the HIV Epidemiology Research Study Group, JAIDS, 29, pp. 69-75, 2002.
Effects of Fetal and Adolescent Nicotine Exposure on CNS Vulnerability
It is widely believed that nicotine is a neuroteratogen that targets synaptic function during critical developmental stages. Recent studies indicate that central nervous system (CNS) vulnerability extends into adolescence, the time that smoking typically commences. In the past year, NIDA supported researchers, Dr. Theodore Slotkin and his associates at Duke University Medical Center have demonstrated that nicotine administration during development alters the functioning of the serotonergic (5-HT) systems, the neurotransmitter pathway closely associated with depression, throughout the brain. Dr. Slotkin examined indices of the development of 5-HT projections and 5-HT presynaptic activity following prenatal and adolescent nicotine exposure of rats. These studies used the nicotine dose rates that replicate the plasma nicotine levels found in smokers. Fetal nicotine exposure (gestational days 4-21) showed a decrease in the cerebrocortical binding of paroxetine (PXT), a marker for the 5-HT transporter, indicative of a decrease in nerve terminals in that region. This effect lasted into adulthood. There was a corresponding increase in PXT binding in the midbrain and brainstem, the region containing the 5-HT cell bodies that project to the cerebral cortex, a pattern typical of reactive sprouting in response to nerve terminal damage. After adolescent nicotine treatment (postnatal days 30-47), PXT binding was reduced in the hippocampus and striatum instead of the cerebral cortex, again accompanied by increased binding in the midbrain and brainstem. These effects within each region were gender selective, although both males and females displayed abnormalities. Superimposed on this overall effect, there were transient changes of 5-HT transporter expression likely due to the acute stimulant effects of nicotine. Additional studies showed that withdrawal from adolescent nicotine treatment led to suppression of activity in the cerebral cortex and activation in the midbrain. These results indicate that both fetal and adolescent nicotine exposure elicit apparent damage to 5-HT projections with reactive increases in regions containing 5-HT cell bodies. These findings are important as long-term changes in 5-HT innervation and /or synaptic activity may play a role in the subsequent development of depression in the offspring of women who smoke during pregnancy or in adolescent smokers. Xu, Z., Seidler, F.J., Ali, S.F., Slikker Jr., W., and Slotkin, T.A. Fetal and Adolescent Nicotine Administration: Effects on CNS Serotonergic Systems. Brain Research, 914, pp.166-178, 2001.
Offspring of Women who Smoke during Pregnancy Show Behavioral Abnormalities
Behavioral abnormalities, including increased incidence of attention deficits, learning disabilities, and cognitive dysfunction are shown by the offspring of women who smoke. Researchers at Duke University Medical Center, Dr. Theodore Slotkin and his team recently reported alterations in cellular morphology and regional architecture in the juvenile and adolescent brain regions involved in learning and memory (hippocampus) and in pain pathways (somatosensory cortex) in rats previously exposed to nicotine prenatally. These investigations were designed to compare the vulnerabilities of neuronal populations arising from different germinal zones as well as similar types of cells located in different regions. Their data showed that prenatal nicotine exposure, at blood levels comparable to those seen in human smokers or in user of transdermal nicotine patches, elicited structural abnormalities in the hippocampus and somatosensory cortex before the reemergence of functional deficits. Nicotine appeared to target specific sub-regions and cell types, including cells with postnatal birth dates, indicating that exposure alters the program for brain cell development and for architectural assembly of critical regions involved in learning and memory. Roy, T.S., Seidler, F.J. and Slotkin, T.A. Prenatal Nicotine Exposure Evokes Alterations of Cell Structure in Hippocampus and Somatosensory Cortex. J. Pharmacology Experimental Therapeutics, 300, pp. 124-133, 2002.
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Epidemiology, Etiology and Prevention Research |
Psychiatric and Substance Use Disorder in South Florida: Racial/Ethnic and Gender Contrasts in a Young Adult Cohort
Authors present their findings of a sub-sample (N = 1,803) of students who entered middle school in 1990, and were interviewed between 1998 and 2000. Using the computer-assisted personal interviews, subjects psychiatric and substance use disorders were evaluated using the DSM IV. Investigators found that over 60% of the sample met lifetime criteria for one or more disorders. Childhood conduct and major depressive alcohol abuse disorders were the most prevalent. The rates of affective and anxiety disorders in females were double that in males, however once attention deficit disorders, conduct disorders, and antisocial personality disorders were considered, the gender difference disappeared. Lower rates were reported among African Americans for depressive disorders and substance abuse dependence. Among Hispanics, rates were found to be lower among the foreign born in comparison with their US born counterparts, especially for substance abuse disorders. This study emphasizes the need for prevention efforts in the school setting and the notion that more research needs to be done on the origins of ethnic and nativity differences. Turner, R.J., Gil, A.G. Archives General Psychiatry, 59, pp. 43-50, 2002.
Inhalant Abuse Among Three Groups of Adolescents
Analyses involving participants from three ethnic populations over the course of ten years suggest that a number of social and perceptual correlates of inhalant use operate similarly across Mexican American, American Indian, and non-Latino white adolescents. These analyses suggest that peer factors, including peer sanctions, peer use, and peer encouragement, were particularly important, though less so for Mexican American and Indian youth. Increased perception of harm is also correlated with less inhalant use for all groups. These data suggest that the historically higher rates of inhalant use for males as compared to females no longer prevail. Furthermore, for the American Indian sample, for both lifetime and 30-day prevalence, males were less likely to have used inhalants than females. Overall, American Indian adolescents participating in the survey showed decreasing rates of inhalant use over time. Beauvais, F., Wayman J.C., Jumper-Thurman, P., Plested, B., and Helm, H. Inhalant Abuse Among American Indian, Mexican American, and Non-Latino White Adolescents. American Journal of Drug and Alcohol Abuse, 28, pp. 171-187, 2002.
Early-Adolescent Risk Factors of Youth Violence Mediate Childhood Risks
Analyses were conducted to assess whether risk factors for youth violence measured at 10 yrs of age influenced later violence directly or indirectly through predictors measured in early adolescence (14 yrs of age). Analyses revealed that many childhood risks--which included teacher-rated hyperactivity/low attention, teacher-rated antisocial behavior, parental attitudes favorable to violence, involvement with antisocial peers, low family income, and availability of drugs in a neighborhood--had strong and persistent effects on later violence. However, mediation effects also were noted for most factors. Male gender and low neighborhood attachment measured at 10 yrs of age were the only 2 risks that appeared not to be mediated partially by predictors at 14 yrs of age. School and peer predictors of violence measured at 14 yrs of age were the strongest mediators of the earlier risk factors. Those predictors consistently added to the explanatory power of each model that was tested. Herrenkohl, T.I., Guo, J., Kosterman, R., Hawkins, J.D., Catalano, R.F., and Smith, B.H. Journal of Early Adolescence, 21(4), pp. 447-469, 2001.
Persistence of Violence In The Transition To Adulthood
Researchers examined violent behavior from ages 13-21 yrs and identified predictors at age 10. Logistic regression was used to assess predictors of developmental patterns of violence. The sample is from a study of 808 youth interviewed annually from age 10 to 16 yrs, and again at ages 18 and 21. Over 28% of the youth in the sample reported nonviolence throughout adolescence and into early adulthood. Most youth (55%) engaged in violence in adolescence but desisted from violence in early adulthood, while 16% persisted in violent behavior at age 21. Violence in adolescence was best predicted by male gender, Asian American ethnicity (a protective factor), childhood fighting, early individual characteristics, and early antisocial influences. Adult persistence of violence was best predicted by male gender, early school achievement (which was protective), and early antisocial influences. Early prosocial development was also protective against violence persistence for females. Implications for prevention are discussed. Kosterman, R., Graham, J.W., Hawkins, J.D., Catalano, R.F., and Herrenkohl, T.I., Violence & Victims,16(4), pp. 355-369, 2001.
Deviant Peer Association and Aggression toward Female Partner
Deviancy training was examined as a risk factor for physical and psychological aggression toward a female partner among boys and young men in the Oregon Youth Study. Hostile talk about women during videotaped male friendship interaction was hypothesized to indicate a process by which aggression toward women is reinforced within male peer networks. Both antisocial behavior and hostile talk were predicted to be associated with later aggression toward a female partner. Prospective developmental models were tested from 9Ð10 years of age through young adulthood. Findings indicated that the relation of deviant peer association in adolescence and later aggression toward a partner was mediated by antisocial behavior; observed hostile talk about women with male peers explained additional variance in aggression toward a partner. Capaldi, D.M., Dishion, T.J., Stoolmiller, M., and Yoerger, K. Aggression Toward Female Partners by at-risk Young Men: The Contribution of Male Adolescent Friendships. Developmental Psychology, 37(1), pp. 61-73, 2001.
Gender Labels and Gender Identity Predict Drug Use
This article examines the intertwined roles of gender labels and gender identity in predicting drug use behaviors and experiences of middle school students in a large, ethnically diverse, southwestern city. Gender labels refers to male vs. female while gender identity refers to a subjective sense of maleness/masculinity or femaleness/femininity. Gender labels by themselves appear to be more salient in explaining differences in self-reported drug use than two of the three gender identity measures examined. Boys used more drugs, used them more frequently and were more likely to use marijuana and hard drugs. However, masculine dominance also is associated with drug use, especially for boys. Such boys report more drug use and exposure. Gender identity measures do not supersede gender labels in predicting drug outcomes. However, labels and identity together are more powerful predictors than separately. Kulis, S., Marsiglia, F.F., and Hecht, M.L. Gender Labels and Gender Identity as Predictors of Drug Use Among Ethnically Diverse Middle School Students. Youth and Society, 33(3), pp. 442-475, 2002.
Relationship Quality Of Aggressive Children And Their Siblings
Sibling influence on the learning and enactment of aggressive behavior has been consistently demonstrated in studies of sibling relationships. Available evidence suggests that, compared with nonaggressive children's sibling interactions, the sibling interactions of aggressive children are marked by more frequent, intense, and prolonged aggressive behaviors. Although research on normative and aggressive children's sibling interactions has increased recently, a number of limitations in this literature were addressed in this study by: (1) including both an aggressive and nonaggressive comparison group, (2) examining both positive and negative features of sibling relationships, (3) employing a multi method/multi-informant approach to data collection, and (4) utilizing an improved self-report method. In support of their hypotheses and consistent with previous research, results showed that aggressive children's sibling relationships were marked by higher levels of observed conflict and lower levels of self-reported positive features. When gender was examined, results showed that older brother/younger sister dyads were characterized by higher levels of negative features and lower levels of positive features. Aguilar, B., O'Brien, K.M., August, G.J., et al. Relationship Quality of Aggressive Children and Their Siblings: A Multi-Informant, Multi-Measure Investigation. Journal of Abnormal Child Psychology, 29 (6), pp. 479-489, 2001.
Binge Drinking Trajectories from Adolescence to Emerging Adulthood in a
High-Risk Sample: Predictors and Substance Abuse Outcomes
This study describes binge-drinking trajectories from adolescence to emerging adulthood in 238 children of alcoholics and 208 controls. Mixture modeling identified three trajectory groups: early-heavy (early onset, high frequency), late moderate (later onset, moderate frequency), and infrequent (early onset, low frequency). Nonbingers were defined a priori. The early-heavy group was characterized by parental alcoholism and antisociality, peer drinking, drug use, and (for boys) high levels of externalizing behavior, but low depression. The infrequent group was elevated in parent alcoholism and (for girls) adolescent depression, whereas the nonbinger and late-moderate groups showed the most favorable adolescent psychosocial variables. All 3 drinking trajectory groups raised risk for later substance abuse or dependence compared with the nonbingers, with the early-heavy group at highest risk. Chassin, L., Pitts, S.C., Prost, J. Journal of Consulting & Clinical Psychology, 70(1), pp. 67-78, 2002.
Developmental Trajectories of Cigarette Use
This study identified developmental trajectories of cigarette smoking from early adolescence into young adulthood, and delineated whether risk factors derived from a social learning-problem behavior framework could differentiate among trajectories. Participants (N=374) were interviewed five times from age 12 until age 30/31. Using growth mixture modeling, three trajectory groups were identified - heavy/regular, occasional/maturing out, and non/experimental smokers. Being a female, having higher disinhibition, receiving lower grades, and more frequent use of alcohol or drugs significantly increased the probability of belonging to a smoking trajectory group compared with being a nonsmoker. Higher disinhibition and receiving lower grades also differentiated regular smokers from the rest of the sample. None of the risk factors distinguished occasional from regular smokers. When models were tested separately by sex, disinhibition, other drug use, and school grades were associated with smoking for both sexes. On the other hand, environmental factors, including socioeconomic status, parent smoking and friend smoking, were related to smoking for females but not for males. Sex differences in developmental trajectories and in smoking behavior among regular smokers were notable. The occasional/maturing out group was made up of more females than males and may relate to women stopping or reducing smoking when they begin to have children. In contrast, women were more likely to start regular smoking earlier than males and being female significantly differentiated smokers from nonsmokers. Future research should examine transitions and turning points from adolescence to adulthood that may affect cessation and escalation differently for males and females. White, H.R., Pandina, R.J., and Chen, P.H.
Developmental Trajectories of Cigarette Use from Early Adolescence into Young Adulthood. Drug Alcohol Depend., 65, pp. 167-178, 2002.
Emotional Distress Both Contributes To And Is Influenced By Cigarette Smoking
Empirical evidence regarding the causal nature of the relationship between emotional distress and tobacco use in male and female adolescents provides support for both the distress-to-use and the use-to-distress hypotheses. Using a cross-lagged model with 3 waves of data from 2,961 adolescents followed into young adulthood, the authors tested the hypothesis that this relationship changes over time. As hypothesized, emotional distress in Grade 10 was associated with increased smoking in Grade 12 for both boys and girls. Smoking in Grade 12 was, in turn, associated with increased emotional distress in young adulthood. The addition of 3 factors (rebelliousness, deviance, and family problems) to the model did not alter the results. Results suggest that the relationship between tobacco use and emotional distress is a dynamic one in which distress initially leads to use but then becomes exacerbated by it over time, Orlando, M., Ellickson, P.L., and Jinnett, K., Journal of Consulting & Clinical Psychology, 69(6), pp. 959-970, 2001.
Primary Mental Disorders are Significant Predictors of First Onset of Subsequent Substance User Disorders
Kessler and colleagues present results of analyses of patterns of comorbidity between mental disorders and substance use disorders utilizing data from seven epidemiologic surveys carried out in six countries including the U.S., Canada, Brazil, Mexico, Germany and the Netherlands. Results are consistent across the surveys in showing that strong comorbidities exist between mental disorders and substance use disorders, that mental disorders are typically temporally primary and that primary mental disorders are significant predictors of the first subsequent onset of substance use disorders. Only active mental disorders, not remitted disorders, predict subsequent substance use, problems, and dependence. These findings suggest that there is something about the mental disorders themselves rather than about determinants of these disorders, that promotes substance disorders. Further analyses revealed that mental disorders are less powerful predictors of first drug use than of progressing from use to problem use and from problem use to dependence. Simulations suggest that primary mental disorders are associated with 54.7% of all drug dependence among men and 47.8% among women in these surveys. Conduct disorder and adult antisocial behavior are responsible for these cases among men, while anxiety disorders and mood disorders are also important among women. The authors conclude that the study results suggest that early interventions to treat mental disorders might be effective in reducing the number of people who would otherwise become dependent on drugs. Kessler, R.C., Aguilar-Gaxiola, S., Andrade, L., Bijl, R., Borges, G., Caraveo-Anduaga, J., DeWit, D., Kolody, B., Merikangas, K., Molnar, B., Vega, W., Walters, E., Wittchen, H. and Ustun, T. Mental-Substance Cormorbidities in the ICPE Surveys. Psychiatria Fennica, 32(supplement 2), pp. 62-79, 2001.
Childhood Adversities Associated with Risk for Eating Disorders or Weight Problems during Adolescence or Early Adulthood
This community-based prospective longitudinal study was conducted to investigate the association between childhood adversities and problems with eating or weight during adolescence and early adulthood. A sample of 782 mothers and their offspring were interviewed during the childhood, adolescence, and early adulthood of the offspring. Childhood maltreatment, eating problems, environmental risk factors, temperament, maladaptive parental behavior, and parental psychopathology were assessed during childhood and adolescence. Eating disorders and problems with eating or weight in the offspring were assessed during adolescence and early adulthood. A wide range of childhood adversities were associated with elevated risk for eating disorders and problems with eating or weight during adolescence and early adulthood after the effects of age, childhood eating problems, difficult childhood temperament, parental psychopathology, and co-occurring childhood adversities were controlled statistically. Numerous unique associations were found between specific childhood adversities and specific types of problems with eating or weight, and different patterns of association were obtained among the male and female subjects. Maladaptive paternal behavior was uniquely associated with risk for eating disorders in offspring after the effects of maladaptive maternal behavior, childhood maltreatment, and other co-occurring childhood adversities were controlled statistically. The authors conclude that childhood adversities may contribute to greater risk for the development of eating disorders and problems with eating and weight that persist into early adulthood. Maladaptive paternal behavior may play a particularly important role in the development of eating disorders in offspring. Johnson, J.G., Cohen, P., Kasen, S., and Brook, J.S. Am J Psychiatry, 159(3), pp. 394-400, March 2002.
Adolescent Life Events as Predictors of Adult Depression
Among adults, life events predict future episodes of major depression as well as a range of anxiety disorders. While studies have begun to examine this issue in adolescents, few studies rely upon prospective epidemiological designs to document relationships between adolescent life events and adult major depression. A sample of 776 young people living in Upstate New York received DSM-based psychiatric assessments and an assessment of life events in 1986. Psychopathology was again assessed in 1992. This study examined the predictive relationship between life events in 1986 and depression as well as anxiety in 1992, controlling for depression/anxiety in 1986. Results show that adolescent life events predicted an increased risk for major depression diagnosis in adulthood. When analyzed continuously, an association emerged with symptoms of major depression as well as with symptoms of generalized anxiety disorder. However, this association with generalized anxiety disorder was limited to females. Pine, D.S., Cohen, P., Johnson, J.G., and Brook, J.S. J Affect Disord, 68(1), pp. 49-57, February 2002.
Gender Differences in Juvenile Arrestees' Drug Use, Self-Reported Dependence, and Perceived Need for Treatment
The authors examined gender differences in drug use, self-reported dependence, and perceived need for treatment in a national sample of juvenile arrestees and detainees between the ages of nine and 18 years. A sample of 4,644 boys and girls, drawn from the Juvenile Drug Use Forecasting Survey from 1992 to 1995, was matched by sex within each of seven sites by survey year. In anonymous interviews, respondents were asked about their living arrangements, drug use, and need for drug treatment. Questions about drug use covered marijuana, cocaine, crack, heroin, crystal methamphetamine, amphetamines, and phencyclidine (PCP). Logistic regression was used to identify significant predictors of drug dependence and perceived need for treatment. Results showed that girls were significantly more likely than boys to report dependence but were no more likely to report a need for treatment. Among those who reported current, frequent drug use, girls were significantly less likely than boys to report a need for treatment. Girls who reported having more severe drug problems were more likely than their male counterparts to report dependence and a need for treatment. The authors conclude that clinicians should assess and reduce barriers to treatment perceived by girls in particular to engage them in services before their drug use escalates. Kim, J.Y., and Fendrich, M. Psychiatr Serv, 53(1), pp. 70-75, January 2002.
Sex-Specific Predictors of Suicidality Among Runaway Youth
This study examined predictors of suicidality (ideation and attempts) among 348 adolescent runways (197 boys; 56% African American; Mean age = 16) using sex-specific models that tested the impact of the three domains of the Social Action Model: individual characteristics, interpersonal influences, and life events. Twenty-five percent of the girls and 14% of the boys had attempted suicide at least once. Male suicidality was mainly predicted by individual characteristics: identifying as gay, emotional distress, fewer conduct problems, and avoidant reasons for drug use. The interpersonal influence of suicidal friends also predicted suicidality. Variables from all three domains influenced girls: individual characteristics of lower age, lower self-esteem, and emotional distress; interpersonal influence of suicidal friends; and life events of having lived on the streets and assaults. Findings suggest some sex-specific interventions, but decreasing emotional distress and lessening the influence of suicidal friends may be useful for both boys and girls. Leslie, M.B., Stein, J.A., and Rotheram-Borus, M.J. J Clin Child Psychol, 31(1), pp. 27-40, March 2002.
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12-step Program Participation and Effectiveness: Do Gender and Ethnic Differences Exist?
Although 12-Step is increasingly utilized as a recovery resource and is viewed by many addiction specialists as an integral component of treatment and long-term recovery, questions regarding participation and effectiveness of 12-Step programs for women and ethnic minorities have been raised. Utilizing data from the Los Angeles Target Cites Evaluation Project (n = 356), participants in adult outpatient alcohol and drug treatment were followed for 24 months and rates of 12-Step participation and effectiveness were assessed for all gender and ethnic groups. Contrary to reports that 12-Step is more appropriate for European-American males, statistical analyses reveals that women and ethnic minorities are equally likely to attend 12-Step programs, and to recover in conjunction with such participation as European-American males. Although 12-Step may not appeal to all seeking to cease alcohol and drug use, the clinical implications for treatment providers and other addiction specialists points to the benefits of integrating 12-Step components into traditional treatment programs and recommending 12-Step participation for clients of all gender and ethnic groups. Hillhouse, M.P., and Fiorentine, R. J Drug Issues, 31(3), pp. 767-780, 2001.
Patient Characteristics and Treatment Outcomes for African American, Hispanic, and White Adolescents in DATOS-A
The author attempted to extend what is known about adolescent substance abusers in adolescent-oriented substance abuse treatment by describing and comparing background and pretreatment characteristics and posttreatment outcomes of African American (n = 213), Hispanic (n = 108), and White adolescent (n = 773) substance abusers who participated in the Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A). The pretreatment data indicated that patients in each group were similar only with respect to basic demographics (gender, age and primary drug use) but differed in terms of referral source, involvement with the criminal justice system and prevalence of mental disorders. Posttreatment comparisons revealed significant racial/ethnic differences in serious posttreatment criminal behavior, only. Logistic regression results indicated that African American adolescents had a lower likelihood of engaging in serious illegal activity as compared to White adolescents during the posttreatment period. Rounds-Bryant, J.L., and Staab, J. Journal of Adolescent Research, 16(6), pp. 624-641, 2001.
Social Support Systems of Women Offenders who Use Drugs: A Focus on the Mother-daughter Relationship
Conceptually, social support among very heavily drug-involved women is complex and multidimensional. The authors examine the structure and function of the social support systems of women offenders (N = 100) who used drugs during the last 6 months before entering court-mandated drug-free treatment programs. These systems typically contain about nine supporters, almost equally divided between men and women, and about half of the women's supporters are family members. The women identify parents and partners as their major providers of practical help and advice. They look most to their partners for a sympathetic ear, and to their parents for affirmation of their self-worth. Overall, two-thirds of the women identify their mothers as among their supporters. These mothers are often anxious to do whatever they can to help their daughters stop using drugs. Paradoxically, the assistance many mothers give their daughters in providing money or basic life necessities often enables the daughter's drug use. Although many daughters appreciate their mother's help, there is an element of distrust and control in many of the mother-daughter relationships, and some daughters receive unwanted help from their mothers. Drug treatment providers can benefit from understanding their clients' social support systems, especially the dynamics of important relationships with main pretreatment supporters, such as parents. By gaining this understanding and helping their clients to effectively accept and use social support. Strauss, S.M., and Falkin, G.P. American Journal of Drug and Alcohol Abuse, 27(1), pp. 65-89, 2001.
The Relationship Between Partner Abuse and Substance Use among Women Mandated to Drug Treatment
The authors investigates the relationship between substance use and partner abuse among women (N = 1,025) who entered drug-treatment programs through the criminal justice systems in New York City and Portland, Oregon. Self-report data on substance use and partner abuse indicate that although the rate of partner abuse in both cities is well above the national average, the less substance-involved women in Portland reported more abuse than their New York counterparts. The relationship between partner abuse and substance use during conflicts varies within the population of women offenders who are heavily drug-involved, with women in Portland reporting a greater direct link between partner abuse and substance use. There is a need for drug-treatment providers to understand their clients' victimization histories and the relationship between partner abuse and substance use in order to engage clients in the treatment process and help them learn how to avoid being victimized in the future. Wilson-Cohn, C., Strauss, S.M., and Falkin, G.P. Journal of Family Violence, 17(1), pp. 91-105, March 2002.
Correlates of Poverty and Partner Abuse Among Women on Methadone
The association between poverty and experiences of partner abuse among 204 women recruited from methadone maintenance treatment programs was explored. Research showed that extreme poverty was prevalent and associated with partner abuse. Providers of methadone maintenance programs need to incorporate poverty indicators in their assessment because extreme poverty seems to correlate with all forms of partner abuse. The impact of welfare reform on partner violence should be on the agendas of policy makers and researchers. Moreno, C.L., El-Bassel, N., Gilbert, L., and Wada, T. Violence Against Women, 8(4), pp. 455-475, April 2002.
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