National Institute on Drug Abuse
Director's Report to the National Advisory Council on Drug Abuse
September, 1997
Research Findings
Epidemiology, Etiology and Prevention Research
Antisocial Behavior and Affiliation with Adult Boyfriends Predicts Female Adolescents' Substance Use and Risky Sexual Behavior
In a study of pathways to substance use and risky sexual behavior, investigators at the Center for Education and Drug Abuse Research (CEDAR) at the University of Pittsburgh used behavioral, psychiatric interview, and self-report measures to index behavioral dysregulation, negative affectivity, childhood victimization, internalizing symptomatology, antisocial behavior, affiliation with adult boyfriends, and outcome variables in 125 substance abusing female adolescents and 78 controls 14-18 years old. Results of structural equation modeling indicated that behavioral dysregulation, negative affectivity, and childhood victimization were related to substance use and risky sexual behavior. Age of menarche was correlated with affiliation with an older boyfriend and risky sexual behavior. Antisocial behavior mediated the associations of behavioral dysregulation, negative affectivity and childhood victimization with substance use and risky sexual behavior. Affiliation with an adult boyfriend was directly associated with substance use and accounted for the relationship between chronological age and risky sexual behavior. From a prevention and treatment standpoint, these results suggest that reducing dysregulation through behavior modification procedures developed for conduct-disordered children might provide a mechanism for interrupting the development of substance use and risky sexual behavior in young females. Mezzich A.C., Tarter, R.E., Giancola, P.R., Lu, S., Kirisci, L., and Parks, S. Substance Use and Risky Sexual Behavior in Female Adolescents. Drug and Alcohol Dependence, 14; 44 (2-3), pp. 157-166, 1997.
Predictors of Substance Use in Children of Substance Abusers
The social development model (Catalano and Hawkins 1996) hypothesizes that strong bonds to prosocial others and institutions contribute to prosocial behavior, while strong bonds to antisocial others and institutions contribute to antisocial behavior. Consistent with this perspective, previous research indicates that bonding to parents and child substance use are negatively associated for children of substance abusers. This paper examines the interactive relationship between parent drug use, bonding to parents and child substance use in a longitudinal study of families headed by substance abusers in methadone treatment for opiate addiction. Bonding to parents and child substance use are moderately negatively correlated in children whose parents ceased using drugs but are weakly positively correlated in children whose parents continued using drugs. These results support the social development model and suggest that family interventions for preventing substance use in children of substance abusers should focus on reducing parent drug use and promote bonding to parents who are abstinent. Fleming, C.B., Brewer, D.D., Gainey, R.R., Haggerty, K.P., and Catalano, R.F. Parent Drug Use and Bonding to Parents as Predictors of Substance Use in Children of Substance Abusers. Journal of Child and Adolescent Substance Abuse, In press.
Inclusion of Drug Use Data From School Dropouts
This study examined, across three racial/ethnic groups, how the inclusion of data on drug use of dropouts can alter estimates of adolescent drug use rates. Self-report rates of lifetime prevalence and use in the previous 30 days were obtained from Mexican American, White non-Hispanic, and Native American students (n=738) and dropouts (n=774). Rates for the age cohort (students and dropouts) were estimated with a weighted correction formula. Rates of use reported by dropouts were 1.2 to 6.4 times higher than those reported by students. Corrected rates resulted in changes in relative rates of use by different ethnic groups. When only in-school data are available, errors in estimating drug use among groups with high rates of school dropout can be substantial. Correction of student-based data to include drug use of dropouts leads to important changes in estimated levels of drug use and alters estimates of the relative rates of use for racial/ethnic minority groups with high dropout rates. Swaim, R.C., Beauvais, F., Chavez, E.L., and
Oetting, E.R. The Effect of School Dropout Rates on Estimates of Adolescent Substance Use Among Three Racial/Ethnic Groups. American Journal of Public Health, 87, pp. 51-55, 1997.
Psychiatric Disorders Associated with Substance Use Among Children and Adolescents
The relationships between specific quantities and frequencies of alcohol, cigarette, and illicit substance use and substance use (SUD) and other psychiatric disorders were investigated among 1,285 randomly selected children and adolescents, aged 9 to 18, and their parents, from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Logistic regressions indicated that daily cigarette smoking, weekly alcohol consumption, and any illicit substance use in the past year were each independently associated with an elevated likelihood of diagnosis with SUD and other psychiatric disorders (anxiety, mood, or disruptive behavior disorders), controlling for sociodemographic characteristics (age, gender, ethnicity, family income). The associations between the use of specific substances and specific psychiatric disorders varied as a function of gender. Kandel, D. B., Johnson, J. G., Bird, H. R., Canino, G., Goodman, S. H., Lahey, B. B., Regier, D. A., and Schwab-Stone, M. Psychiatric Disorders Associated with Substance Use Among Children and Adolescents: Findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Journal of Abnormal Child Psychology, 25 (2), pp. 121-132, 1997.
Psychopathology in Preadolescent Sons of Fathers with Substance Use Disorders
Investigators at CEDAR examined the relationships between offspring and parental psychopathology by comparing the psychiatric disorders of preadolescent boys of fathers with and without substance use disorders (SUDs). Fathers (i.e., probands) of boys 10-12 years old were recruited to represent families of boys with paternal SUD (high risk or HR: n = 113) and boys without paternal SUD (low average risk or LAR: n = 170). These boys (i.e., index cases) and their biological parents were administered structured diagnostic interviews, and diagnoses were determined by the best-estimate method. Disruptive behavior disorders and anxiety disorders were found to be more prevalent in HR than in LAR index cases. Logistic regression analyses indicated that parental childhood psychiatric disorders were more strongly predictive of boys' psychiatric disorders than were parental adulthood psychiatric disorders, including SUDs. These findings suggest that disruptive behavior disorders and anxiety disorders may be important targets for early intervention to prevent the development of SUD, as well as the morbidity associated with these disorders. Clark, D.B., Moss, H.B., Kirisci, L., Mezzich, A.C., Miles, R., Ott, P. Psychopathology in Preadolescent Sons of Fathers with Substance Use Disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 36 (4), pp. 495-502, 1997.
The Influence of Spouses' Behavior and Marital Dissolution on Marijuana Use: Causation or Selection
Similarity between spouses may result from prior similarity (selection) or interpersonal influence (causation) or both. Spouses' mutual influences on marijuana use were studied in a two-wave longitudinal cohort of 490 married pairs, using data obtained twice from each spouse over a 5.5 year interval. To estimate processes during marriage free of sample selection bias, marriages that dissolved during the interval were used, and the impact of divorce on the drug use of the spouse was analyzed using reinterview data. Causation effects of spouse (or event) were distinguished from selection effects involved in assortative mating (or divorce) using models with and without controls for latent individual propensities to use marijuana. Marital selection effects were found to predominate over causation effects, and divorce was found to affect spouses' continued marijuana use. These findings have implications for understanding the persistence of drug use in adulthood, gender differences in the relationship of substance use with marriage and divorce, and the study of interpersonal influences. Yamaguchi, K., and Kandel, D. The Influence of Spouses' Behavior and Marital Dissolution on Marijuana Use: Causation or Selection. Journal of Marriage and the Family, 59, pp. 22-36, 1997.
Correlates of College Student Marijuana Use
In a study to determine which personal student background and college characteristics are associated with marijuana use, researchers used data from a self-administered survey mailed to a national representative sample of 17592 students at 140 American colleges. One of four (24.8%) students reported using marijuana within the past year. Rates of use among the colleges ranged from zero percent at the lowest use schools to 54 percent at the highest use schools. Multiple regression models, constructed to determine the college and student characteristics predicting marijuana use, suggest that use was higher among students at non-commuter colleges and at colleges with pubs on campus. Student characteristics associated with marijuana use included being single, white, spending more time at parties and socializing with friends, and less time studying. Marijuana use was higher among students who participate in other high-risk behaviors such as binge drinking, cigarette smoking and having multiple sexual partners, and among students who perceived parties as important, and religion and community service as not important. The study points to the social nature of drug use in college, and demonstrates that this behavior is of continuing concern for public health. Bell, R., Wechsler, H., and Johnston, L.D. Correlates of College Student Marijuana Use: Results of a US National Survey. Addiction, 92 (5), pp. 571-581, 1997.
Predictors of Problem Drinking and Alcohol Dependence in a Population-Based Sample of Female Twins
To identify characteristics associated with problem drinking (PD) and alcohol dependence (AD) in women, researchers at Virginia Commonwealth University studied 2,163 white women aged 17-55 from the population-based Virginia Twin Registry. Measures were selected from a clinical interview and questionnaires to reflect five domains associated with alcoholism in prior studies: demographic characteristics, personality, health, and personal and family history of psychopathology. Logistic and linear regression analyses were used to predict PD and DSM-III-R defined AD. Multiple regression models were found to account for 19% of the variance in PD (significant predictors included: higher parental education-particularly among younger women, being the primary breadwinner, less frequent church attendance, higher scores on measures of neuroticism, extroversion and interpersonal dependency, history of major depression and social phobia, paternal PD and maternal treatment for emotional problems); 9% of the variance in diagnosis of AD (predicted by generalized anxiety, paternal depression and maternal PD); and 20% of the variance in number of symptoms of AD (predicted by the interaction of younger age and less-educated parents, higher neuroticism and mastery, lower optimism, generalized anxiety and agoraphobia, and maternal PD). The authors concluded that characteristics and parental psychopathology are important predictors of PD and AD independent of their effect on risk for affective and anxiety disorders. Many characteristics found to be associated with PD and AD in bivariate analyses were not significant when considered in the context of other predictors. Future studies of the etiology of alcoholism among women should simultaneously study measures from a variety of domains. Prescott, C.A., Neale, M.C., Corey, L.A., and Kendler, K.S. Predictors of Problem Drinking and Alcohol Dependence in a Population-based Sample of Female Twins. Journal of Studies of Alcohol, 58 (2), pp. 167-181, 1997.
Weekly Marijuana Use as a Risk Factor for Initial Cocaine Use
The gateway hypothesis argues that adolescents begin experimenting with cigarettes or alcohol, progress to marijuana use and finally to other illicit substance use. Although prior research has supported this hypothesis, studies have not examined the effects of weekly marijuana use on subsequent use of illicit substances such as cocaine and have not attempted to identify psychosocial mediators of relationships among substances. The current study used longitudinal national survey data with six assessment periods and a comprehensive set of psychosocial risk factors for substance use to examine relationships between cocaine and marijuana use using discrete-time survival analysis for multiwave longitudinal data. The results show that weekly marijuana use, as opposed to initial marijuana use, is an independent risk factor for initial cocaine use. Weekly marijuana users were over ten times more likely to initiate cocaine within the next year. The results also show that many psychosocial predictors are not predictive of initial cocaine use after controlling for prior weekly marijuana use. However, the association between weekly marijuana use and cocaine use is, in part, mediated by delinquent attitudes. The authors conclude that weekly marijuana use is a risk factor for cocaine use of equal or greater magnitude compared to other risk factors for initial cocaine use such as deviant peer bonding and attitudes toward deviance. These findings argue for some revision of the gateway hypothesis and psychosocial theories of substance use. In addition, the current research shows support for clinical observations that suggest that regular use of any illicit substance is likely to spawn experimentation with other illicit substances. Miller, T. Q., and Volk, R. J. Weekly Marijuana Use as a Risk Factor for Initial Cocaine Use: Results from a Six Wave National Survey. Journal of Child and Adolescent Substance Abuse, 5 (4), pp. 55-78, 1996.
Understanding Delinquency and Substance Abuse among Children of Drug Users
Criminological theories and research have stressed the importance of family factors in understanding delinquency and substance use. Much work has documented the elevated risk of various problem behaviors faced by the children of drug users, as well as the factors that mediate their risk. This study examined a unique sample of high-risk children whose parents were receiving methadone treatment for opiate addiction. A model was developed and tested to estimate the impact of positive family management practices, maternal attachment, and deviant peers on delinquency, initiation of substance use, and misbehavior involving school and police sanctions. Positive family management practices showed little effect on reducing problem behaviors among these children of methadone clients, unlike in the general population. Similarly, the effect of maternal attachment was relatively weak and varied with age of the child. Gainey, R.R., Catalano, R.F., Haggerty, K.P., Hoppe, M.J. Deviance Among the Children of Heroin Addicts in Treatment: Impact of Parents and Peers. Deviant Behavior: An Interdisciplinary Journal, 18, pp. 143-159, 1997.
Cigarette Smoking Among Mexican American Youth
A self-report survey of cigarette use among 10th- and 12th-grade Mexican American students found no differences in rates of use by migrant status. Male students reported higher levels of lifetime, experimental, and daily smoking than female students, and 12th-grade students reported higher levels of daily smoking than 10th-grade students. A socialization model of cigarette use based on peer cluster theory was evaluated using structural equation methods, examining the effects of family strength, family tobacco use, school adjustment, religious identification, and peer tobacco associations. The basic latent-structure socialization model was supported in all groups, but final models including specific effects identified both unique and common relationships by gender and migrant status. Common patterns across groups suggest that completely different prevention programs may not be necessary for these youth. However, program elements based on subtle group differences may serve to tailor prevention efforts and make them more effective. Swaim, R.C., Oetting, E.R., and Casas, J.M. Cigarette Use Among Migrant and Nonmigrant Mexican American Youth: A Socialization Latent- Variable Model. Health Psychology, 15, pp. 269-281, 1996.
Predictors of Continued Drug Use During and After Treatment for Opiate Addiction
Many persons treated for opiate addiction continue to use drugs during and after treatment. It may be possible to improve outcomes by addressing patient characteristics that predict continued use. This review uses meta-analytic techniques to identify risk factors for continued drug use in patients treated for opiate abuse. A thorough search of the published literature yielded 69 studies that reported information on the bivariate association between one or more independent variables and continued use of illicit drugs during and after treatment for opiate addiction. Most of the patient variables summarized have weak longitudinal relationships with continued drug use, although several variable display moderate longitudinal associations. Ten variables show statistically significant and longitudinally predictive relationships with continued use, including: high level of pretreatment opiate/drug use, prior treatment for opiate addiction, no prior abstinence from opiates, abstinence from/light use of alcohol, depression, high stress, unemployment/employment problems, association with substance abusing peers, short length of treatment, and leaving treatment prior to completion. Several other variables may be potentially longitudinally predictive. To prevent relapse, treatment interventions should address multiple variables because no single variable strongly predicts continued use. Brewer, D.D., Catalano, R.F., Haggerty, K.P., Gainey, R.R., and Fleming C.B. A Meta-Analysis of Predictors of Continued Drug Use During and After Treatment for Opiate Addiction. Addiction, In press.
Familial Aggregation of Depressive Symptoms, Antisocial Behavior, and Alcohol Abuse
This paper describes results from an ongoing family study of adolescent boys and their families designed to investigate potential risk factors for substance abuse. The sample currently includes 251 individuals: 39 male treatment probands and their families and 34 control families matched by age and geographic location (zip code). The adolescent treatment probands have severe drug and alcohol related problems and were recruited through a residential rehabilitation program. Probands and participating family members are given a structured interview that assesses alcohol and drug problems, and various psychiatric symptoms. Data were analyzed to examined the coaggregation of depressive symptoms, antisocial behavior, and alcohol misuse. Multivariate pedigree analyses were performed using a model that allowed for the estimation of vertical familial transmission, residual sibling resemblance, and assortative mating. Spouse correlations were estimated at .57, .21, and .31 for antisocial behavior, depressive symptoms, and alcohol abuse, respectively. Residual sibling environment (i.e., sibling resemblance unaccounted for by parent-offspring transmission) was not found for alcohol problem symptoms, but did contribute to resemblance for antisocial behavior and depressive symptoms. The proportion of variance accounted for by vertical familial transmission was estimate at approximately 30 to 40%. More important, correlations among the transmissible family factors for these psychiatric syndromes ranged from .58 to .73, suggesting substantial overlap among the underlying familial antecedents for these disorders. Stallings, M. C., Cherny, S. S., Miles, D. R., Hewitt, J. K., and Fulker, D. W. The Familial Aggregation of Depressive Symptoms, Antisocial Behavior, and Alcohol Abuse. American Journal of Medical Genetics, 74, pp.183-191, 1997.
Intervening with Drug-Addicted Parents
Parents in methadone treatment were offered an experimental intervention, Focus on Families, designed to reduce their risk of relapse and their children's risk of substance use. Experimentally assigned volunteers participated in systematic group training in relapse prevention and parenting skills, and received home-based case management services. Immediate posttreatment outcome results reported here include analyses of covariance controlling for baseline measures. Analyses show experimental parents held more family meetings to discuss family fun, displayed stronger refusal/relapse coping skills, demonstrated stronger sense of self-efficacy in role-playing situations, and had lower levels of opiate use than control subjects. No significant differences in family bonding, family conflict, or other measures of drug use were found. The utility of intervening with drug-addicted parents in methadone treatment is discussed in light of these findings. Catalano, R.F., Haggerty, K.P., Gainey, R.R., Hoppe, M.J. Reducing Parental Risk Factors for Children's Substance Misuse: Preliminary Outcomes with Opiate Addicted Parents. Substance Use & Misuse, 32(6), pp. 699-721, 1997.
Substance Abuse Disorders Among Runaway and Homeless Youth
Systematic sampling methods were used to recruit a sample of 432 homeless youth from both service and natural 'hang-out' sites. According to DSM-III criteria, 71% of respondents were classified as having alcohol and/or illicit 'drug abuse' disorders. The results from multivariate logistic regression analyses indicated that cumulative length of time of use is positively associated with an "abuse" disorder. The implications of these findings and recommendations for service interventions are discussed. Kipke, M.D., Montgomery, S.B., Simon, T.R., and Iverson, E.F. "Substance Abuse" Disorders Among Homeless and Runaway Youth. Substance Use & Misuse, 32(7&8) pp. 969-986, 1997.
Prevalence and Demographic Correlates of Past Year Dependence on Four Substances
Dr. Denise Kandel and her associates conducted secondary analyses based on three aggregated waves (1991, 1992 and 1993) of nationally representative samples of the general population aged 12 and over interviewed in the National Household Survey on Drug abuse (N=87,915). An approximate measure of DSM-IV drug-specific past-year dependence for each drug class was derived from self-reported symptoms of dependence, data on frequency and quantity of use, and drug-related problems. Although the measure of dependence has limitation, the inclusion of cigarettes, the large number of cases and the wide age range of respondents permitted drug, age, gender and ethnic comparisons on liability for dependence not otherwise possible. Five major findings were obtained regarding rates of dependence experienced among last year users of each drug class: (1) nicotine is more addictive than alcohol, marijuana and cocaine; (2) among adolescents, rates of dependence on alcohol, marijuana and cocaine are higher among females than males; (3) among adults, rates of dependence are higher among males than among females for alcohol and marijuana, but lower for nicotine; (4) adolescent females are significantly more at risk for dependence on alcohol and marijuana than any other age group of women; (5) whites are more likely than any other ethnic group to be dependent on nicotine and blacks to be dependent on cocaine. This is the first report in the literature in which the liability for dependence could be compared among adolescents and adults, and nicotine dependence could be systematically compared with dependence on other drugs. Adolescent girls constitute an especially high risk group for drug dependence. Kandel, D.B., Chen, K., Warner, L., Kessler, R., Grant, B. Prevalence and Demographic Correlates of Symptoms of Dependence on Cigarettes, Alcohol, Marijuana and Cocaine in the U.S. Population. Drug and Alcohol Dependence, 44, pp. 11-29, 1997.
Developmental Correlates of Alcohol and Tobacco Use
Since the use of tobacco and alcohol during childhood predicts the heavy use of these substances and use of illicit drugs during adolescence, this cross sectional survey was used to identify developmental correlates of alcohol and tobacco use among elementary school children. Results were based on information obtained from 1470 third and fifth grade students. Children's current alcohol and tobacco use was strongly related to low scores of several measures of child competence; both self report and teacher rated. Use of these substances was also associated with less effective parenting behaviors and with parental use of alcohol and tobacco. The researchers conclude that childrens' early experience with tobacco and alcohol is associated with weak competence development and exposure to socializing factors that promote risk taking. Interventions to prevent early use of alcohol and tobacco is needed. Jackson, C., Henriksen L., Dickinson, D., and Levine, D.W. Early Use of Alcohol and Tobacco: Relation to Child Competence and Parental Behavior. American Journal of Public Health, 87, pp 359-364, 1997.
Family Functioning Can Be Protective Against Narcotic Addiction
A retrospective case-control study of male narcotic addicts, equally divided between White and Black subjects, showed that, during early teen age, intact family structure deterred later addiction at statistically significant levels. Strong attachment to father or father figure, positive home atmosphere, strong parental adherence to traditional ethical norms, and expected weak parental disapproval of misbehavior by subjects were also identified as significant deterrents of later addiction. Nurco, D. and Lerner, M. Vulnerability to Narcotic Addiction: Family Structure and Functioning. Journal of Drug Issues, 26(4), pp. 1007-1025, 1996.
Nicotine Withdrawal in Women
Associations between self-report symptom profiles for nicotine withdrawal, personality (TPQ, EPQ-R), life-time history of psychopathology and smoking history were examined in data obtained from 553 female adult Australian twins (246 regular smokers), ages 32-48 years, who had participated in a telephone interview survey that included life-time assessments of smoking history, nicotine dependence, and symptoms of withdrawal. Two hundred and two respondents were from high-risk pairs where either the respondent or the respondent's co-twin had reported a life-time history of alcohol dependence; 351 were from control pairs. Latent class analysis was used to identify subtypes ('classes') of smokers reporting similar withdrawal symptom profiles. Three major classes were identified which appeared to represent a continuum from mild to severe nicotine withdrawal. Smokers from the severe withdrawal class were best characterized by hands shaking and by the prominence of depressive features. There were marked increases in lifetime alcohol dependence rates as a function of severity class. In contrast, significantly elevated rates of major depression, conduct disorder and anxiety disorder were observed only among smokers from the most severe withdrawal class. Neuroticism was the only personality factor strongly associated with the development of withdrawal symptoms. Madden, P. A. F., Bucholz, K. K., Dinwiddie, S. H., Slutske, W. S., Bierut, L. J., Statham, D. J., Dunne, M. P., Martin, N. G., and Heath, A. C. Nicotine Withdrawal in Women. Addiction, 92 (7), pp. 889-902, 1997.
Maturing Out of Substance Use: Selection and Self-Correction
The third decade of life is a period when individuals are held responsible for taking an active role in controlling and optimizing their developmental prospects and outcomes. It is also a period when most young adults mature out of various problem behaviors including delinquency, illicit drug use, and heavier alcohol use. Self-regulation of development and maturing out of substance use are assumed to be linked to (a) self-correction and (b) selection and differential association. By age 28 to 31, the vast majority of participants in the Rutgers Health and Human Development Project reported significant decreases in their own alcohol and drug use, decreases in their friends' substance use, and increases in the number of married friends. Reductions in use were more pronounced among individuals who remained married since their early twenties, those who became married, and those who became parents. Self-corrective changes in substance use are facilitated by the selection of, and differential association with, friends who are also married and have children by age 30. However, some degree in continuity of use is also evidenced by individuals tending to select friends and/or spouses on the basis of shared behavioral norms. Labouvie, E. Maturing Out of Substance Use: Selection and Self-Correction. Journal of Drug Issues, 26, pp. 457-476, 1996.
Parent Substance Use As A Predictor of Adolescent Use: A Six-Year Lagged Analysis
The present study investigated the role of parental use of alcohol, cigarettes, and marijuana on lagged change in the specific substance abuse of their adolescent offspring over a six year period. The analyses also examined the relative influence of mothers and fathers and their interaction as moderated by marital status and age and gender of the adolescent. A generalized estimating equations approach was employed to estimate regression coefficients through an iterative weighted least squares algorithm. Findings indicated that, when employed as time varying covariates, parental substance use resulted in substance-specific effects on fluctuations in the adolescent's own use. Age, parent marital status, and each parent's marijuana use independently were found to significantly affect adolescent marijuana use. In contrast, the complex relationship between parent and adolescent use of alcohol and cigarettes showed variation by substance, age, and gender text. The results suggest that parent use of substances must be considered risk factors with particular effects on their younger offspring. Thus, prevention efforts should be directed at middle childhood and include components aimed at parents as well as their children. Hops, H., Duncan, T. E., Duncan, S. C., Stoolmiller, M. Parent Substance Use As A Predictor of Adolescent Use: A Six-Year Lagged Analysis. Ann Behavior Medicine, 18 (3) pp. 157-164, 1996.
Intervention and Prevention of Steroid Use in Adolescent Athletes
A study involving high school football players was conducted to test the hypothesis that those with an intent to use steroids had features/characteristics that distinguished them from players who did not. Thirty-one football teams in the Portland, Oregon area participated in the study. One quarter of the participants (n=279) fell into the category of high-intent as measured by a questionnaire. Comparison and evaluation between high and low intent groups uncovered many similarities, such as demographics, physical measurements and knowledge questions about weight training and sports nutrition. They did differ, however, on several variables. A greater number of high intent users currently were using amino acid supplements (27% versus 16%) which has been postulated as a behavior which precedes steroid use. Also, the students with higher intent had higher levels of alcohol and marijuana use. Psychological trait differences were also uncovered with high intent players scoring higher on dimensions of hostility, impulsivity, and a "win-at-all-costs" attitude. Finally, despite similar physical measures, high intent athletes were less satisfied with their current weight. These differences provide a needs assessment to identify curricular components for an intervention to prevent steroid use. Elliott D. and Goldberg L., Intervention and Prevention of Steroid Use in Adolescents. The American Journal of Sports Medicine, 24(6), S-46, 1996.
Testing a Multi-Stage Model for the Adoption of Alcohol and Tobacco Behaviors by Children
A staged model of smoking adoption has been widely applied in studies of adolescent smoking. The present study applied this model to examine the preliminary stages of tobacco and alcohol use by children. Using discriminant analysis, factors associated with abstinence, initiation and experimentation stages of tobacco and alcohol use were compared in a sample of 1272 fourth and sixth grade children. Modeling of use by best friends and the perceived prevalence of use among same-age peers were most strongly related to the initiation and experimentation stages of tobacco and alcohol use. Other key factors were offers from parents and friends, adjustment to school and behavioral self-regulation. The weakest factors were parent modeling and self-esteem. The initiation and experimentation stages were not as highly differentiated among children as other studies have found them to be among adolescents. This suggests that if initiation occurs during childhood, progression to experimentation is more likely than if initiation begins during adolescence. Therefore, development of prevention programs that simultaneously influence children's risk of alcohol and tobacco use by targeting the common risk factors for preliminary use of these substances are suggested. Jackson, C. Initiation and Experimental Stages of Tobacco and Alcohol During Late Childhood: Relation to Peer, Parent and Personal Risk Factors. Addictive Behaviors, 22, pp. 1-14, 1997.
Smokeless Tobacco: Demographic Differences in Prevalence and Place in Drug Involvement Continuum
In a study of 2,525 Southern California high school seniors, Dr. Brian Flay and his affiliates examined patterns of smokeless tobacco (ST) use and the place of ST in a unidimensional model of drug involvement based on latent trait analysis. Among male students, lifetime ST use was reported by 31.9% of Whites, 3.0% of Blacks, and 16.1% of Hispanics; among females, comparable rates were 6.3%, 1.8%, and 1.9% for these respective racial/ethnic groups. In the total sample, the ordering of drugs along the hypothesized involvement continuum was, from least to most involved: alcohol, cigarettes, marijuana, ST, LSD, "uppers", cocaine, "downers", PCP, and heroin. Analyses showed that although ST use fits the unidimensional model of drug involvement, the place of ST use along the continuum of drug involvement is not stable and differs by gender and ethnicity. Particularly for males, ST use is likely to be preceded by soft drug use and followed by hard drug use; for females, however, ST use is closely associated with hard drug use. The analyses also revealed that the fit of the unidimensional model and the location of ST use along the dimension vary with different ethnic groups. Hu, F.B., Hedeker, D., Day, L.E., Flay, B.R., Siddiqui, O., Sussman, S., and Richardson, J. Patterns of Use of Smokeless Tobacco and the Unidimensional Model of Drug Involvement. Addictive Behavior, 22 (2), pp. 257-261, 1997.
Childhood Abuse and Inhalant Use
Two ethnographic studies of drug-involved adults were analyzed to evaluate the association between child-abuse victimization and levels of involvement in inhalant use. Historical accounts of childhood exposure to physical or sexual abuse were compared among nonusers of inhalants (n = 197), light inhalant users (n = 64), and heavy inhalant users (n = 24). Heavy inhalant use was found to be associated with history of any child abuse (adjusted odds ratio [OR] = 4.6) and physical abuse (adjusted OR = 3.8). Light inhalant use showed no association with child-abuse history. The authors concluded that childhood abuse may be an important correlate of extensive involvement in inhalant use and suggest that carefully designed longitudinal methods be used to further research this relationship. Fendrich, M., Mackesy-Amiti, M.E., Wislar, J.S., and Goldstein, P.J. Childhood Abuse and the Use of Inhalants: Differences by Degree of Use. American Journal of Public Health, 87 (5), pp. 765-769, 1997.
ADHD and Early Initiation of Smoking
The association between attention-deficit hyperactivity disorder (ADHD) and cigarette smoking in children and adolescents was evaluated. Subjects were 6- to 17-year-old boys with DSM-III-R ADHD (n = 128) and non-ADHD comparison boys (n = 109) followed prospectively for 4 years into mid-adolescence. Information on cigarette smoking was obtained in a standardized manner blind to the proband's clinical status. Cox proportional hazard models were used to predict cigarette smoking at follow-up using baseline characteristics as predictors. Findings indicate that ADHD was a significant predictor of cigarette smoking at follow-up into mid-adolescence. ADHD also was associated with an early initiation of cigarette smoking even after controlling for socioeconomic status, IQ, and psychiatric comorbidity. In addition, among children with ADHD, there was a significant positive association between cigarette smoking and conduct, major depressive, and anxiety disorders. Thus, ADHD, particularly the comorbid subtype, is a significant risk factor for early initiation of cigarette smoking in children and adolescents. Considering the prevalence and early childhood onset of ADHD, these findings highlight the importance of smoking prevention and cessation programs for children and adolescents with ADHD. ADHD Is Associated with Early Initiation of Cigarette Smoking in Children and Adolescents. Milberger, S., Biederman, J., Faraone, S.V., Chen, L., and Jones, J. Journal of American Academy of Child and Adolescence Psychiatry, 36 (1), pp. 37-44, 1997.
Profiles of Children as a Function of Aggression
It was hypothesized that reactive and proactive types of antisocial youths would differ in developmental histories, concurrent adjustment, and social information processing patterns. In Study 1, examination of 585 boys and girls who were classified into groups called reactive aggressive, proactive aggressive, pervasively aggressive (combined type) and nonaggressive revealed distinct profiles. Only the reactive aggressive group demonstrated histories of physical abuse and early onset of problems, adjustment problems in peer relations and inadequate encoding and problem solving processing patterns. Only the proactive aggressive group demonstrated a processing pattern of anticipating positive outcomes for aggressing. In Study 2, 50 psychiatrically impaired chronically violent boys classified as reactively violent or proactively violent demonstrated differences in age of onset of problem behavior, adjustment problems and processing problems. Dodge, K.A., Lochman, J.E., Harnish, J.D., Bates, J.E. and Pettit, G.S. Reactive and Proactive Aggression in School Children and Psychiatrically Impaired Chronically Assaultive Youth. Journal of Abnormal Psychology, 106(1), pp. 37-51, 1997.
Protective Factors and Alcohol Abstinence
Two waves of data from a family-focused prevention intervention project were used to test a model of the influence of protective factors on young adolescent's tendency toward alcohol abstinence. Prior theoretical and empirical work guided the specification of hypothesized effects of the protective factors -- affectional relationship with parents, affiliation with prosocial peers, and mastery-esteem -- on tendency toward alcohol abstinence. The tested model controlled for pre-intervention measures and included specified interrelations of protective factors across time. Structural equation analysis indicated that the model fit the data. The hypothesized relationship between affectional relation with parents and prosocial peer relations was not supported. However, there was support for the cross-time effects of affectional relationship with parents and prosocial peer affiliation on young adolescents mastery esteem. Moreover, participation in the intervention was associated with child's report of a positive affectional relationship with parents. Spoth, R., Redmond, C., and Hockaday, C. Protective Factors and Young Adolescent Tendency to Abstain from Alcohol Use: A Model Using Two Waves of Intervention Study Data. American Journal of Community Psychology, 24(6) pp. 749 771, 1996.
Effect of Parents and Peers on Alcohol Refusal in Adolescents
This paper describes the specification and testing of a model of protective parent and peer factors in peer refusal skills. Two modifiable protective factors suggested by relevant research on adolescent substance use - child attachment with parents and association with peers having prosocial norms--were incorporated as independent variables in the model. The effects of parent and child attendance at skills training interventions were also assessed. Covariance structure modeling of data from a sample of 209 families participating in a controlled study of family-oriented skills intervention was used to test two versions of the model, one version addressing attachment and skills training attendance specific to mothers and one specific to fathers. Following two indicated modifications of the original model, strong fits with the data were achieved for both mother and father versions of the model; hypothesized protective factor effects and skills training effects were significant. Spoth, R., Yoo, S., Kahn, J., and Redmond, C. A Model of the Effects of Protective Parent and Peer Factors on Young Adolescent Alcohol Refusal. The Journal of Primary Prevention, 16(4), pp. 373-394, 1996.
Shared and Unshared Risk Factors in African American and Puerto Rican Youth
A study was conducted to examine the shared and unshared psychosocial risk factors related to stage of drug use and delinquency. The sample consisted of 655 African American and 600 Puerto Rican male and female adolescents. Net regression analysis was used to analyze the data. The results showed that adolescent stages of drug use and delinquency reflect shared and unshared risk factors. Among the shared risk factors were low adolescent and peer achievement, low father identification, and a poor school environment. The magnitude of the risk factors for adolescent delinquency was generally greater than for stage of drug use. Risk factors showing a stronger relationship to delinquency than to drug use included tolerance of deviance, low ego integration, parent-child conflict, low mother identification, and particularly, peer deviance. Only father alcohol use and peer marijuana use had a stronger relationship to adolescent drug use than to delinquency. Since delinquency encompasses a greater variety of behaviors than does drug use, it is easier for more diverse factors to contribute more strongly to delinquency than to drug use. The findings support a socialization hypothesis (from parent to personality to behavior) as well as a dispositional model (from child to parent or peer to behavior). The support of both models suggests that there is a reciprocal influence between adolescent personality and parent or peer factors in their impact on problem behavior. Overall, a reduction in many adolescent risk factors will lead to a decrease in both delinquency and drug use. Brook, J.S., Whiteman, M., Balka, E.B., et al. Drug Use and Delinquency: Shared and Unshared Risk Factors in African American and Puerto Rican Adolescents. Journal of Genetic Psychology, 158(1), pp. 25-39, 1997.
Alcohol, Drugs, and Aggressive Crime among Mexican-American, Black, and White Male Arrestees in Texas
In this study, investigators analyzed existing data from the 1992 Drug Use Forecasting (DUF) system to understand the relationship between aggressive crime and substance abuse among Mexican-American, Black, and White male arrestees in Dallas, Houston, and San Antonio, Texas. The aim of the analysis was to predict the outcome of aggressive crime from drug and alcohol-related and ethnic group variables within the total male sample (n=2,364). Ethnicity was found to be significantly related to aggressive crime. Mexican American arrestees were more likely to be arrested for aggressive crime than Blacks or Whites. Drug and alcohol use effects were found across all ethnic groups. The subgroup of arrestees who drank alcohol frequently and tested positive for drugs was less likely to be charged for aggressive crime than were the other subgroups. Specific ethnic subcultural and ecological influences are discussed which may influence the study findings. The findings indicate the heterogeneous character of the alcohol and drug using population related to aggression. The authors observe that the heterogeneity becomes more obvious when examining differences between the ethnic groups, likely because of the mix of socioeconomic, environmental, and cultural factors which distinguish ethnic communities independent of the pharmacological effects of the various substances. Such variability between subculturally defined groups requires detailed ethnographic field studies to describe the context of drug taking, drinking, and aggressive behavior. Valdez, A., Yin, Z., and Kaplan, C. A Comparison of Alcohol, Drugs, and Aggressive Crime among Mexican-American, Black, and White Male Arrestees in Texas. American Journal of Drug and Alcohol Abuse, 23(2), pp. 249-265, 1997.
Why Families Decline Program Participation
This study extends a line of programmatic research on families who decline participation in interventions and assessment components of family-focused prevention projects. Parents responding to a brief telephone interview (N=459) identified the most important of 28 barriers concerning project assessments, intervention-related time demands and logistic requirements, beliefs and attitudes about interventions, and family member influences. Results demonstrated that several time-related factors, logistic requirements, and family member influences were important barriers. Findings also showed that socio demographic factors were associated with unfavorable attitudes about interventions and their assessments. Implications for the development of effective recruitment strategies and for future research are presented. Spoth, R., Redmond, C., Hockaday, C., and Shin, C.Y. Barriers to Participation in Family Skills Prevention Interventions and Their Evaluation: A Replication and Extension. Family Relations, 45, pp. 247-254, 1996.
Juvenile Drug Traffickers: Characterization and Substance Use Patterns
Juveniles involved in drug trafficking have been reported to be more likely to be seriously immersed in substance abuse and delinquent behavior than nonsellers. Investigators studied the substance use patterns of juveniles incarcerated for drug trafficking offenses in Virginia (N = 240) and characterized juvenile drug traffickers based upon their delinquent, social, psychological, educational and medical histories, making comparisons with a demographically similar control group (N = 433). The results indicated that the most frequently sold substance was cocaine (93%), either powered or crack, while alcohol and marijuana were the drugs most often used by the juvenile drug traffickers. The juvenile drug traffickers showed lower levels of aggressivity, violence and delinquency when compared to other incarcerated juveniles from their community. In addition, the juvenile drug traffickers had higher ratings on social and psychological functioning. Characteristics that did not correlate well with drug trafficking were physical health, intellectual functioning and academic achievement. The results of this study indicate that juvenile drug traffickers tend to use the drugs that they sell, and generally present as higher functioning and better adjusted in almost every area evaluated, when compared to their incarcerated delinquent peers. McLaughlin, C. R., Smith, B. W., Reiner, S. M., Waite, D. E., and Glover, A. W. Juvenile Drug Traffickers: Characterization and Substance Use Patterns. Free Inquiry In Creative Sociology, 24 (1), pp. 3-10, 1996.
Health Services Utilization by Clinical Homeless, Community Homeless, and Domiciled Clinic Samples
Clinic-based studies on the health of the homeless have often been used to represent the health status of the all homeless people. Although convenient and economical, such studies may not generalize to the wider homeless community. Investigators in this study contrasted 216 homeless and 212 domiciled free clinic users, and 531 community homeless persons on latent variables representing alcohol and drug use, mental and physical health, appearance, life satisfaction, and health services utilization (HSU). Homeless clinic patients were found to equal the community homeless sample in alcohol problems and drug use, poor health, mental illness, mental health services utilization, and life satisfaction but exceeded them in HSU and cleanliness. Homeless clinic users reported more substance abuse, poorer health, greater mental illness and mental HSU, less cleanliness, and lower life satisfaction than domiciled patients. These findings suggest that the homeless subpopulation receiving services in the free clinic resembled to a great extent the greater population of homeless people residing in the area. Thus, researchers may feel comfortable extrapolating to the wider homeless community from homeless clinic attendees, especially those attending a convenient, free facility. Stein, J.A., Gelberg, L. Contrasting Clinical Homeless Samples with Domiciled Clinic Users and Community Homeless Persons: Issues of Comparability and Representativeness. Health Psychology, 16, pp. 155-162, 1997.
Gender and Hostility Effects on Alcohol Use and Aggression
In a study at Rutgers, investigators working with Dr. Robert Pandina used a series of nested structural equation models to examine the interrelationships among alcohol use, aggressive behavior, and episodes of acute alcohol-related aggression. Both prior aggressive behavior and prior alcohol use predicted later episodes of acute alcohol-related aggression. In addition, early aggressive behavior predicted later alcohol use, but alcohol use was not related to subsequent increases in aggressive behavior. Gender interaction effects were significant. Prior alcohol use was a better predictor of alcohol related aggression for females, while prior aggression was a better predictor for males. However, the relationships among alcohol use and aggression did not vary by levels of hostility as measured by the SCL-90R. In sum, these data suggested that the nature and direction of the relationship between alcohol use, aggression, and alcohol-related aggression over time are conditioned by gender. White, H. R., and Hansell, S. The Moderating Effects of Gender and Hostility on the Alcohol Aggression Relationship. Journal of Research on Crime and Delinquency, 33, pp. 451 472, 1996.
Friendships and Violent Behavior During Adolescence
This study investigated the extent to which interpersonal processes within male friendships are associated with violent behavior patterns during adolescence. Researchers observed participants (206 boys) at ages 13 14, 15-16, and 17-18, discussing problem solving situations with a close friend. Although the boys typically brought in different friends for each of the three assessments, considerable continuity in the boys' behaviors were found, most notably in the topics discussed. In particular, the tendency of a dyad to engage in deviant and violent talk was uniquely associated with violence in adolescence, controlling for childhood antisocial behavior and coercive disciple practices in the home. These findings suggest that adolescent violence is embedded within enduring social interactional patterns of friendship, where the faces change but the process remain the same. Dishion, T.J., Eddy, J.M., Li, F., and Spracklen, K. Friendships and Violent Behavior During Adolescence. Social Development, 6(2), pp. 207-223, 1997.
Narcotic Addicts' Parenting Practices
This survey study of male and female narcotic addicts participating in methadone maintenance programs examined self-reported retrospective data on parental behavior experienced by addicts during their adolescent years. These findings were contrasted with the addicts' self-report of their current parenting practices with their own adolescent children. Results showed addicts as perceiving their mothers as significantly more functional in their parenting practices than their fathers on indices of parental involvement, attachment, and responsibility. Significant parenting differences between addicts and their parents were reported for the three indices mentioned, as well as for parent discipline and punitive actions, with the addicts rating their current parenting practices as more effective than those of their parents. Reported parenting practices were further analyzed in the context of how the ratings of parental functioning were related to problems of drug and alcohol abuse exhibited in the home. Findings are discussed in terms of the implications for prevention and treatment approaches with addicts and their children. Nurco, D.N., Blatchley, R.J., Hanlon, T.E., O'Grady, K.E., and McCarren, M. The Family Experiences of Narcotic Addicts and their Subsequent Parenting Practices. The American Journal of Drug and Alcohol Abuse, In press.
Effects of a Localized Antidrug Media Campaign
The authors report a study designed to determine whether antidrug campaigns that have been localized can effect variables associated with adolescent drug use. An experiment was conducted with sets of matched communities with populations between 5000 and 30,000 distributed throughout the United States. Seventh- through twelfth-grade students in experimental communities were exposed to a year-long campaign followed by a survey. The targeted variables were perceived influence of media messages on "favorability" toward substance use and drug-related intentions, perceived harm of substance use, parental sanctions against substance use, parent-child communication about substance use, peer encouragement to use substances, and peer sanctions against substance use. Recall of the media campaign was low. However, adolescents with low and moderate levels of drug use who recalled individual campaign spots showed beneficial effects on targeted variables in comparison to students who did not recall the campaigns and control students who were not exposed to the campaigns. The implications of the findings for further research and public policy are discussed. Kelly, K.J., Swaim, R.C., and Wayman, J.C. The Impact of a \Localized Antidrug Media Campaign on Targeted Variables Associated With Adolescent Drug Use. Journal of Public Policy and Marketing, 15, pp. 238-251, 1997.
Mental Health Distress Among Homeless Youth
This study assessed depression, self esteem, ADHD, suicidality, self-injurious behaviors, as well as alcohol and other drug abuse disorders in a sample of runaway and homeless youth in Los Angeles. Results indicated a high prevalence of mental health problems within the sample; 64% clinically depressed, 62% reporting suicidal ideation, 39% reporting previous suicide attempts and 49%, self-injurous behaviors. Demographically, African-American youth were at lower risk of suicidal ideation and self-injurous behavior than other racial/ethnic groups. Younger youths were at increased risk of self-injurous behaviors while older youth and females were more likely to be clinically depressed. Risk factors for a drug disorder included ethnicity other than African-American, homelessness for a year or more, suicidality, self-injurous behaviors, depression and low self-esteem. For alcohol disorders increased risk is associated with being a white male, being homeless, and reporting suicidality and injurous behaviors. Mental health and substance abuse disorders were found to be highly correlated. The need for service programs and policies to address these problems are discussed. Unger, J. B., Kipke, M.D., Simon, T.R., Montgomery, S.B., Iverson, E. And Johnson, C.J. Homeless Youth in Los Angeles: Prevalence of Mental Health Problems and the Relationship Between Mental Health Distress and Substance Abuse Disorders. American Journal of Community Psychology, In press.
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