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

September, 2000

Research Findings

Epidemiology, Etiology and Prevention Research

Community Epidemiology Work Group

The 48th biannual meeting of the Community Epidemiology Work Group (CEWG), chaired by Mr. Nicholas J. Kozel, DESPR, was held in Baltimore, Maryland on June 13-16, 2000. The CEWG is composed of researchers from 21 metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas; emerging drugs of abuse; vulnerable populations and factors that may place people at risk of drug use and abuse; and, negative health and social consequences. Reports are based on drug abuse indicator data, such as morbidity and mortality information, treatment data and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health data, local and State survey information and research findings from ethnographic studies.

The following are highlights from the meetings:

IN THE PAST 6 MONTHS...

Cocaine indicators suggest declining or stable trends in most areas.

Heroin indicators are mixed. Younger populations continue to initiate use in several cities, and some are shifting from snorting to injecting.

Marijuana indicators suggest continued elevated levels, with generally stable or mixed trends in most CEWG sites.

Methamphetamine consequences continue to decline in western and central CEWG sites; indicators remain low in the East but may be trending upward.

"Club drugs," especially GHB, GBL, MDMA, and ketamine, continue to spread across the country. MDMA availability is high and increasing in many CEWG areas, and its quality and content often varies widely.

Cocaine/Crack - Although some indicators increased slightly in a number of CEWG areas during the last reporting period, most cocaine indicators during this reporting period declined or were stable. Cocaine deaths1 were relatively stable, except in Detroit, where they decreased substantially, and Phoenix, where 1999 deaths outnumbered cumulative deaths for 1993-1998. After increasing in many sites during the last 6-month period, cocaine emergency department (ED) mentions2 decreased significantly in seven cities (Atlanta, Dallas, Chicago, New Orleans, New York, San Francisco, and Washington, DC). Nonsignificant ED decreases were reported in the majority of other cities; only two significant increases were noted (in St. Louis and Baltimore). Cocaine is the primary drug of choice for treatment admissions3 in six CEWG sites, excluding Baltimore where heroin and cocaine admissions are evenly distributed. Cocaine treatment and ED admissions tend to involve relatively older people, and the 35-and-older cohort seems to be increasing in many sites. Mixed trends were found in cocaine-positive urinalysis percentages4 among adult male arrestees, with increases at two sites (Dallas and Washington, DC), declines at three (Chicago, Los Angeles, Philadelphia), and stable trends at the rest; the drug is now surpassed by marijuana in all but six cities. By contrast, among female arrestees, cocaine is still the most commonly detected drug in all but one city (San Diego); levels increased in four cities (Chicago, Dallas, Minneapolis/St. Paul, and Phoenix) and declined in Los Angeles and Seattle. Speedball (crack combined with heroin) injections continue to be reported in some cities, including Baltimore, Boston, Denver, Miami, New York City, St. Louis, San Francisco, Seattle, and Washington, DC. High purity and greater availability of cocaine hydrochloride (HCl) may be driving the increase in HCl indicators in some sites, including Denver, Miami (among youth), Minneapolis/St. Paul, and Newark, and the decrease in crack indicators in some cities, such as Boston, Denver, Miami (possibly among youth), and Newark.

Heroin - Heroin indicators show mixed trends. Heroin mortality figures1 were mixed, with deaths increasing notably in three areas (Detroit, Minneapolis/St. Paul, and Phoenix), declining in two (Miami and Seattle), and stable in two. ED indicators2 were also mixed, with 10 cities showing decreases (2 significant-Miami and Baltimore) and 10 cities showing increases (2 significant-San Francisco and Washington, DC). Heroin is the predominant drug of choice among treatment admissions3 in three reporting sites, excluding Baltimore, where cocaine and heroin admissions are evenly distributed, and Seattle, where heroin and marijuana admissions are even distributed. Opiate-positive urinalysis levels4 among adult males remained relatively low (ranging from 3.4 to 20.1 percent-positive) and stable in most cities, except for Atlanta and Washington, DC, where opiate-positive levels increased, and in Philadelphia and Seattle, where levels declined. Conversely, among adult females, opiate-positive levels increased substantially in six cities (Chicago, Minneapolis/St. Paul, New Orleans, Phoenix, San Diego, and Washington, DC); they declined notably in Detroit. Heroin purity5 ranges from 10.7 percent in Miami to 72 percent in Philadelphia. Purity trended mostly upward or remained stable: increases were particularly steep in five cities (Detroit, Los Angeles, Newark, New Orleans, and Phoenix); a decline was notable in Denver (by 22.4 percentage points). Price trends were mixed. A troubling development is the continued reporting of increases of heroin use among young populations in many CEWG cities, including Atlanta (mostly white youth who snort), Baltimore, Boston (mostly young adults who inject and some high school students who snort), Chicago, Denver (youth who primarily snort or smoke), Detroit (suburban youth), Newark, Seattle (young injectors), and Washington, DC. In Boston, Chicago, Denver, Miami, and Washington, DC, snorting seems to be increasing and is often the initial route of administration for many young, new users; conversely, injecting is on an upward trend in Baltimore (among suburban youth), Boston (among youth), Minneapolis/St. Paul, Newark, New York City, and Seattle (among younger users), and many CEWG ethnographers note that heroin snorters often progress to injecting.

Marijuana - After several periods of increasing indicators, marijuana indicators are mixed or stable in most CEWG sites. Marijuana ED mentions2 increased significantly in three cities (Baltimore, Philadelphia, and Phoenix) and nonsignificantly in five others; they declined significantly in five cities (San Diego, San Francisco, New Orleans, Dallas, and Chicago) and declined nonsignificantly or remained level in seven cities. Marijuana is the predominant drug treatment problem3 in two areas (Colorado and Minneapolis/St. Paul), and in Seattle, heroin and marijuana admissions are evenly distributed. Treatment admissions-in particular, clients who use only marijuana-seem to be increasing in many CEWG areas. However, the proportion of marijuana treatment admissions referred by the criminal justice system is very high in most reporting areas when compared with other drug clients. Among adult male arrestees4, marijuana has now surpassed cocaine as the most commonly detected drug in the majority of CEWG cities. Positive findings continue to increase-sharply in six cities (Atlanta, Chicago, Los Angeles, Miami, Phoenix, and Seattle); and levels declined in three (Dallas, Philadelphia, and Washington, DC). Levels also increased or remained stable among female arrestees, except for one notable decline in Seattle. Juvenile arrestee levels exceeded adult marijuana-positive levels at all four sites where juveniles were tested. Marijuana blunts continue to be common in many CEWG areas, including Boston, Chicago (especially among African-American youth), New York City (especially among African-American youth), Washington, DC (especially among youth), and parts of Texas. Marijuana also continues as a delivery medium for other drugs: blunts are often laced with PCP ("3750s") in Chicago and with crack in Chicago, New York City, and parts of Texas. In Texas, marijuana/embalming fluid/PCP combinations are reported, and joints are sometimes dipped in codeine cough syrup. High-quality marijuana is available in most CEWG areas, and potency continues to increase in many.

Stimulants - Methamphetamine ("crystal meth," "ice") remains concentrated in the West and, to a lesser extent, in some rural areas elsewhere. In the West, most indicators continued showing the declines reported since 1998. Declining indicators are most likely related to low purity levels in some western and central sites and increased law enforcement attention; however, reports of manufacturers switching from the "cold method" to the "Nazi method" of production may warrant attention. The latter method produces high-purity methamphetamine, which may lead to future increased health consequences. (In San Diego, for example, purity increased in just the past few months.) In the East, methamphetamine indicators remain low, but ethnographic and law enforcement evidence continue to report slight increases in availability, especially in rural areas, among whites, and among youth at clubs, raves, and college parties. Methamphetamine ED mentions2 declined significantly in eight cities (Atlanta, Denver, Dallas, Chicago, New Orleans, Phoenix, San Diego, and San Francisco), decreased nonsignificantly in four cities, and increased nonsignificantly in only three cities (Philadelphia, St. Louis, and Boston). Methamphetamine remains the number-one primary drug problem among treatment admissions in Honolulu and San Diego3, although in San Diego most methamphetamine indicators continued to decline. Methamphetamine-positive percentages among adult male arrestees4 remained relatively low and stable, except in San Diego, where they declined notably; percentages among adult female arrestees increased notably in San Diego and Seattle and declined notably in Phoenix. In Seattle, youth are reportedly "mega-dosing" on pseudoephedrine, and in Texas, ephedrine abuse seems to be rising, especially among young adults.

Methylenedioxymethamphetamine (MDMA) ("ecstasy"), used primarily as a club drug at raves, dance clubs, and college scenes, is reportedly increasing in almost every CEWG city-an increase most likely driven by two factors: high availability due to large shipments from the Netherlands and other European countries; and the perception that it is a relatively harmless drug (known as the "hug drug" in Miami and the "love drug" in Minneapolis/St. Paul). In Boston and New York City, it seems to be spreading outside the club scene to the streets. Being under the influence of MDMA is referred to as "rolling" in cities across the Nation (including Chicago; Miami, where MDMA use is also referred to as "blowing up"; Minneapolis/St. Paul; and Washington, DC). In many cities, MDMA quality varies widely, and it frequently consists of entirely different substances, ranging from caffeine to dextromethorphan (DXM). For example, in Chicago, the ecstasy-like substance paramethoxyamphetamine (PMA) was involved in the deaths of two suburban youths who mistakenly thought the substance was true MDMA. In Washington, DC, where MDMA is taken by a wide range of age groups, some circular tablets are thought to be MDMA plus mescaline, some triangular tablets are thought to be heroin plus MDMA, and "nexus" tablets were verified by the DEA to be LSD plus MDMA. In Phoenix, a large quantity of high-quality MDMA, known as "candy canes" for their red and white stripes, was seized. Some older users in New York City prefer MDMA to cocaine because it lasts longer and is considered safer. Almost all cities reporting 1999 poison center data recorded an increase in MDMA-related calls since 1998. Most MDMA is taken orally in tablet form, but snorting has been reported (in Atlanta and Chicago), as has injecting (in Atlanta) and anal suppository (in Chicago).

Methylphenidate (Ritalin) abuse may be increasing. Eight sites reported its abuse, primarily among youth who crush tablets and snort them, including Baltimore (among middle and high school students), Boston (especially in middle- and upper-class communities), Detroit (where one 14-year-old died in 1999 due to prolonged use, and where poison center calls are rising), Minneapolis/St. Paul, Phoenix, and parts of Texas. African-Americans on Chicago's South Side inject it, sometimes with heroin or heroin and cocaine. White injecting drug users (IDUs) in Chicago inject phenmetrazine (Preludin).

Depressants - Problems associated with rave and club drugs have risen dramatically in 1999. Gamma-hydroxybutyrate (GHB, a central nervous system depressant) and two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (1,4 BDL, also called tetramethylene) have been increasingly involved in poisonings, overdoses, drug rapes and other criminal behaviors, or fatalities in nearly every CEWG city and their surrounding suburban and rural areas. These products, obtainable over the Internet and sometimes still sold in health food stores, are available at some gyms, nightclubs, raves, gay male party venues, on college campuses, or on the street. They are commonly mixed with alcohol, which may cause unconsciousness, have a short duration of action, and are not easily detectable on routine hospital toxicology screens. New esters and analogs of GHB continue to appear, even after Federal and State laws removed the sale of these drugs. In 1999, GHB accounted for 32 percent of illicit drug-related poison center calls in Boston-a number larger than that for MDMA. Conversely, in Chicago and San Francisco, GHB use is reportedly low compared with MDMA use, although GHB overdoses seem frequent compared with overdoses related to other club drugs. Even though it may be difficult to distinguish from water, several cities reported law enforcement indicators of GHB, including seizures of large amounts in Minneapolis/St. Paul and Phoenix. Withdrawal, addiction, and treatment indicators are emerging in several areas, including Miami and Minneapolis/St. Paul.

Use of the tranquilizer ketamine ("Special K" or "vitamin K"), also available and common in the club, rave, and party scene, is increasingly reported in numerous cities, including Atlanta, Baltimore (where users are predominantly white youth from middle- and upper-socioeconomic backgrounds), Boston (where some white, middle-class youth inject it, it is used as a heroin adulterant, and it may have been involved in some overdose deaths), Chicago (where it is available in powder form), Minneapolis/St. Paul (where injecting is reported), Newark, New York City (where it is available on the street, is either snorted or injected, and is sometimes mistaken for cocaine HCl), Phoenix, San Diego, Texas, and Washington, DC. In Detroit and St. Louis, veterinary break-ins for ketamine have increased in the past year. Clonazepam (Klonopin or Rivotril) and alprazolam (Xanax) use, in various combinations, is reported in Boston, where diverted prescription drug seizures have increased sharply after a recent rash of pharmacy break-ins. Those two drugs have replaced flunitrazepam (Rohypnol) among adolescents in Miami; similarly, in parts of Texas, clonazepam continues to replace flunitrazepam, especially in combination with beer. Flunitrazepam continues to be a problem among treatment admissions in Texas, particularly among young Hispanic males along the Mexican border, and it has been involved in numerous poison control calls. It also remains available in Atlanta, Minneapolis/St. Paul, and New Orleans. Recent deaths in Seattle have involved concomitant injection of heroin and a depressant, typically diazepam.

Hallucinogens-Lysergic acid diethylamide (LSD) ED mentions increased significantly in six cities (Baltimore, Detroit, Minneapolis/St. Paul, Phoenix, and Washington, DC); no significant declines were recorded. In several CEWG areas, LSD used in combination with other club drugs continues to be reported among youth. For example, in south Florida, "rolling and trolling," combining LSD and MDMA, continues. In Texas, MDMA dealers also sell LSD. In Minneapolis/St. Paul for the first time, LSD has been sold on soda crackers, and in Phoenix, it is sold in "Sweet Breath" (a breath freshener) dropper bottles. Phencyclidine (PCP) ED mentions were mixed, with two significant increases (in Chicago and Dallas) and two significant declines (in Miami and San Francisco). Among arrestees, PCP-positive findings remained generally stable, except for a decrease in Philadelphia and, following a decade of marked decline, an upturn in Washington, DC. The recent increases in the Dallas PCP indicators (including ADAM, ED, and poison center data) may reflect the use of marijuana cigarettes dipped in embalming fluid containing PCP. PCP continues to be smoked with marijuana in Chicago (known there as "wicky stick" or "donk"), Minneapolis/St. Paul, New York City, and St. Louis. In New York City, it is also sold as a liquid in small shaker bottles; in Phoenix, six deaths in 1999 were related to PCP. Psilocybin mushrooms ("shrooms") and mescaline are common among adolescents and young adults in Boston. Peyote is readily available in Phoenix. In 1999, Texas poison centers reported calls involving the hallucinogenic plants, morning glories.

Other drugs - Cough medicines with DXM are commonly abused ("robo tripping") by teens in Boston and Minneapolis/St. Paul, where DXM is reportedly also available as a powder in clear capsules. In Atlanta, inhalants are increasingly used among club goers; in Detroit, nitrous oxide and propane use continues to be reported; in Phoenix, several deaths involving inhalants occurred in 1999, and in Texas, poppers, spray paint, gas, glue, and freon are reportedly abused. Needle exchange personnel in areas surrounding Boston report steroid injection among young male body builders. In Atlanta, law enforcement sources note the potential for abuse of the anabolic steroid clenbuterol (Spiropent) by weight lifters.

1 Mortality figures are for 1998 versus 1999 projections (based on first-half-year 1999 data) and were available in six reporting areas.

2 Emergency department mentions are for 20 CEWG cities in the Drug Abuse Warning Network (DAWN) of SAMHSA's Office of Applied Studies; comparisons are for 1997 vs 1998 estimates, except for age group comparisons, which are for 1996 vs 1998; changes are noted only when statistically significant at p<0.05.

3 Treatment admission figures are primary drug of abuse as a percentage of total admissions; total admissions exclude alcohol-only but include alcohol-in-combination. Comparisons generally are for first-half-1998 vs first-half-1999 data.

4 Arrestee urinalysis data are for the 18 CEWG cities in the National Institute of Justice's Arrestee Drug Abuse Monitoring (ADAM) program; comparisons are for 1998 vs first-half-1999; first-half-1999 data are preliminary; changes are noted only when they are _5 percentage points.

5 Heroin price and purity information are for 19 CEWG cities in the Drug Enforcement Administration (DEA) Domestic Monitor Program (DMP); comparisons are for 1998 vs first-half-1998.

Maternal Smoking During Pregnancy and Toddler's Negative Behavior

This study extends previous studies by looking at the effect of the mother's smoking during pregnancy on her toddler's negative behavior. A survey consisting of a structured questionnaire was administered to the mothers of 2-year-old toddlers. Subjects were drawn from a community sample, as part of a larger study of mothers and their children. Participants consisted of 99 toddlers and their mothers taken from a community sample. Fifty-two of the mothers smoked throughout pregnancy, while 47 either stopped smoking during pregnancy or started smoking after childbirth. Measures included assessment of smoking behavior, the mother's personality/behavior, perinatal variables, demographic variables, and aspects of the mother-child relationship. Using logistic regression analyses, maternal smoking during pregnancy was found to be related to negativity in the child, controlling for demographic factors, perinatal factors, maternal personality attributes, and the mother-child relationship. Findings suggest that maternal smoking during pregnancy has an adverse effect on the child's negativity, and that a decrease in maternal smoking during pregnancy might be expected to lead to a decrease in the child's negativity. The relationship of maternal smoking during pregnancy and early childhood negativity to other problem behaviors remains to be explored. Brook, J.S., Brook, D.W., and Whiteman, M. The Influence of Maternal Smoking During Pregnancy on the Toddler's Negativity. Arch Pediatr Adolesc Med, 154(4), pp. 381-385, 2000.

Effects of Parent Personality, Upbringing, and Marijuana Use on the Parent-Child Relationship

This study examined predictors of the quality of the parent-child attachment relationship among a sample of 248 young adults with children. In this longitudinal study, data were collected during early adulthood in 1992 and in 1996/1997 via a structured questionnaire. Using logistic regression and multiple regression analyses, the authors assessed the extent to which participants' personality attributes, substance use, and relationships with their mothers predicted the quality of the parent-child bond. Results showed that participants with certain personality attributes (e.g., high sensitivity), less frequent marijuana use, or a close relationship with their mothers had a greater likelihood of having a close parent-child attachment relationship with their own children at a later time. Analyses also showed that the risk of earlier substance use on the parent-child relationship was offset by protective factors in the parents' personality domain. In addition, protective factors in the various parental domains synergistically interacted with a low frequency of marijuana use, relating to a closer parent-child attachment relationship. The findings suggest that certain parenting styles are transmitted across generations and interventions in the personality and drug use domains can help increase the likelihood that parents will form close attachment relationships with their own children. Brook, J.S., Richter, L., and Whiteman, M. Effects of Parent Personality, Upbringing, and Marijuana Use on the Parent-Child Attachment Relationship. J Am Acad Child Adolesc Psychiatry, 39(2), pp. 240-248, 2000.

Needle Sharing Among HIV+ and HIV- Female Injection Drug Users

This study examined the psychosocial risk and protective factors related to needle-sharing behavior among HIV+ (N = 96) and HIV- (N = 128) female intravenous drug users (IDUs). Participants in this longitudinal study were interviewed individually at two points in time, with a 6-month interval between interviews. The interviewers used a structured questionnaire, which included psychosocial measures and questions about drug and sexual risk behaviors. Data were analyzed using Pearson correlations and hierarchical regression analyses. The findings supported a developmental model in which the psychosocial domains and HIV status predicted T1 (initial) needle-sharing behavior, which in turn was related to T2 (follow-up) needle-sharing behavior. In addition, the relationship between personality and peer risk factors and T2 needle sharing was buffered by family-related protective factors. While HIV-positive status had a direct effect on T1 needle sharing with strangers, its effect was mediated by all of the psychosocial variables in its relation to T1 needle sharing with familiar people. Comparisons of these results were made with a companion study of male IDUs. The results suggest several intervention and treatment approaches that can be implemented at different points in the developmental pathways leading to risky needle-sharing practices among female IDUs. Brook, D.W., Brook, J.S., Richter, L., Masci, J.R., and Roberto, J. Needle Sharing: A Longitudinal Study of Female Injection Drug Users. Am J Drug Alcohol Abuse, 26(2), pp. 263-281, 2000.

Pathways to Condom Use Among Male Injection Drug Users

This longitudinal study examined the psychosocial risk and protective factors involved in condom use among 265 male IDUs. Subjects were individually interviewed at two points in time using a structured questionnaire, which included psychosocial measures and questions about drug use and condom use. Data were analyzed using Pearson correlations and hierarchical regression analyses. T1 condom use was the most powerful predictor of T2 condom use, with or without control on other variables. T1 family support for condom use, friends' support for condom use, adaptive coping with AIDS or the threat of AIDS, and planning to use condoms were significantly related to T2 condom use. Protective father factors enhanced the effects of other protective psychosocial factors, increasing T2 condom use. The results suggest several approaches for changing risk-taking sexual behavior in male IDUs: enhancing coping abilities, selecting peers who take fewer risks, and planning to use condoms. Brook, D.W., Brook, J.S., Rosenberg, G., Whiteman, M., Masci, J.R., Roberto, J., and de Catalogne, J. Longitudinal Pathways to Condom Use: A Psychosocial Study of Male IDUs. Addict Dis, 19(1), pp. 55-69, 2000.

Adolescent Personality and Social-Environmental Antecedents to Drug Use in the Late Twenties

This research focused on the interrelation of the parent-child attachment, drug use in the late twenties, unconventionality, friends' drug use, and the young adult's use of drugs. Data were collected from participants at 4 points in time: early adolescence, late adolescence, early 20s, and late 20s. Data were collected from mothers at the 3 points in time that corresponded with the first 3 collections of data from their children. Both the youths and their mothers were individually interviewed. The findings indicated that the effect of parent-child mutual attachment was mediated through early adolescent personality attributes of greater responsibility, less rebelliousness, and intolerance of deviance. These non-drug-prone personality and behavioral attitudes, in turn, insulated the young adult from affiliating with drug-using peers, and these attitudes were related to less drug use in the early 20s and ultimately in the late 20s. The results suggest that interventions focused on enhancing parent-child mutual attachment should result in a reduction of the risk factors conducive to drug use during the late 20s. The fact that these findings cover a decade and a half, from early adolescence to the late 20s, underscores the significance of placing drug use in a perspective that includes familial and behavioral aspects. Brook, J.S., Whiteman, M., Finch, S., and Cohen, P. Longitudinally Foretelling Drug Use in the Late Twenties: Adolescent Personality and Social-Environmental Antecedents. J Genet Psychol, 161(1), pp. 37-51, 2000.

Pathways into Prostitution Among Female Jail Detainees and Mental Health Services

To explore the service needs of women in jail, the authors examined three pathways into prostitution: childhood sexual victimization, running away, and drug use. Studies typically have explored only one or two of these pathways, and the relationships among the three points of entry remain unclear. Data on 1,142 female jail detainees were used to examine the effects of childhood sexual victimization, running away, and drug use on entry into prostitution and their differential effects over the life course. Two distinct pathways into prostitution were identified. Running away had a dramatic effect on entry into prostitution in early adolescence, but little effect later in the life course. Childhood sexual victimization, by contrast, nearly doubled the odds of entry into prostitution throughout the lives of women. Although the prevalence of drug use was significantly higher among prostitutes than among non-prostitutes, drug abuse did not explain entry into prostitution. Running away and childhood sexual victimization provide distinct pathways into prostitution. The findings suggest that women wishing to leave prostitution may benefit from different mental health service strategies depending on which pathway to prostitution they experienced. McClanahan, S.F., McClelland, G.M., Abram, K.M., and Teplin, L.A. Pathways into Prostitution Among Female Jail Detainees and their Implications for Mental Health Services. Psychiatr Serv, 50(12), pp. 1606-1613, 1999.

Risk Factors for Homelessness Among Indigent Urban Adults with No History of Psychotic Illness

This study identified risk factors for homelessness among indigent urban adults without dependent children and with no history of psychotic illness. A match-control study, stratified by sex, of 200 newly homeless men and women and 200 indigent men and women with no history of homelessness was conducted in New York City. Newly homeless case subjects were recruited from shelter assessment centers in New York City. Never-homeless control subjects, selected from public assistance centers, were single adults applying for home relief. Control subjects were matched with case subjects according to ethnicity, age, and sex. Trained interviewers employed standardized research instruments to probe 3 domains of risk factors: Symptom severity and substance use disorder, family support and functioning, and prior use of services. Significant interaction effects by sex were present for symptom severity, heroin use disorder, and prior service use. Greater numbers of the homeless of both sexes lacked a high school diploma and had less income from all sources, including from their families, than of the never homeless. Newly homeless men and women with no history of psychotic illness differed from their never-homeless counterparts in the 3 domains investigated, but socioeconomic factors were also important. Caton, C., Hasin, E., Shrout, P., Opler, L., Hirshfield, M., Dominguez, B., and Felix, A. Risk Factors for Homelessness Among Indigent Urban Adults with No History of Psychotic Illness: A Case-Control Study. American Journal of Public Health, 90, pp. 258-263, 2000.

Psychopathy among Mexican American Gang Members: A Comparative Study

High-risk Mexican American males were assessed for levels of psychopathy. The Hare Psychopathy Checklist-Screening Version was compared in a random sample of gang members with a matched community sample of violent non-gang members and samples of forensic and psychiatric patients and undergraduate students. More than half of the gang sample was categorized as low, 44% as moderate, and only 4% as high on psychopathy. The gang members had higher scores on the total, affective, and behavioral scores than non-gang members. High scores on adolescent antisocial behavior, poor behavioral control, and lack of remorse were found in both samples. Gang members scored twice as high as non-gang members on lack of empathy. Both samples were lower on psychopathy than the forensics and higher than psychiatric patients and undergraduates. The results provide grounds for early intervention efforts for this high-risk population. Valdez, A., Kaplan, C. and Cordina, E. Pschopathy among Mexican American Gang Members: A Comparative Study. International Journal of Offender Therapy and Comparative Criminology, 44(1), pp. 46-58, 2000.

Homelessness and Gender in Out-of-Treatment Drug Users

This study examines 5225 out-of-treatment crack users and drug injectors drawn from five different geographic areas to examine selected factors associated with homelessness. Of these crack users, 27% considered themselves undomiciled, and 60% had previously entered some type of drug treatment. Logistic regression found that substance abusers who were married, female, and persons of color were less likely to be without a home when other variables were controlled. Trading sex for money and perceived chance of getting acquired immunodeficiency syndrome (AIDS) were associated positively with homelessness, while participating in methadone detoxification and methadone maintenance programs seemed to offer some protection from homelessness. Royse, D., Leukefeld, C., Logan, T.K., Dennis, M., Wechsberg, W., Hoffman, J., and Cottler, L. Homelessness and Gender In Out-of-Treatment Drug Users. American Journal of Drug and Alcohol Abuse, 26(2) pp. 283-96, 2000.

Sexual and Drug Use Behaviors Among Female Crack Users: A Multi-Site Sample

The purpose of this paper was to compare female crack users who report exchanging sex for drugs and/or money with female crack users who did not report exchanging sex for drugs and/or money. A multi-site sample (n = 4667) of female crack users who participated in the National Institute on Drug Abuse (NIDA) AIDS Cooperative Agreement Project from 20 sites were interviewed. Statistical analysis compared two groups on selected variables of interest: women crack users who reported exchanging sex for drugs and/or money (n = 2658) and women crack users who did not report exchanging sex (n = 2009). Results indicated that both groups of women had frequent unprotected sex. However, women who exchanged sex had more sexual partners, had sex more often, used drugs before and during sex more often, and had a higher rate of STDs than women who did not exchange sex. In addition, African-American women, homeless women, and women who reported past substance abuse treatment were about twice as likely to exchange sex. Regional differences were also examined. Logan, T.K. and Leukefeld, C. Sexual and Drug Use Behaviors among Female Crack Users: A Multi-Site Sample. Drug and Alcohol Dependence, 58(3), pp. 237-45, 2000.

"Drug Dependence" and Death

Illicit drug use and dependence often are associated with premature death, but available evidence comes mainly from clinical samples. Researchers at Johns Hopkins University examined drug-related mortality experience over 14 years in a United States community sample. Following probability sampling, 3,481 adult community household residents were recruited for the 1981 NIMH Baltimore Epidemiologic Catchment Area survey. Follow-up occurred in 1993-1996. Survival analyses were used to estimate median age at death and relative risk of dying in relation to drug use and dependence as assessed in 1981 using the Diagnostic Interview Schedule (DIS). Of 166 respondents who met criteria for a lifetime drug abuse or dependence diagnosis, 11 had died by 1995. Cases categorized by the DIS with "drug dependence" were more likely to have died and to have a younger median age at death (p < .05), with and without statistical adjustment for confounding variables. Higher levels of drug involvement also were associated with increased age- adjusted mortality. For example, a greater proportion of surviving cases had met criteria for cannabis disorder only while barbiturate and opiate dependence were more common among the decedents. The evidence favors the hypothesis that DIS-elicited "drug dependence," as well as subthreshold drug use, help to account for premature death in this community sample. Neumark, Y.D., Van Etten, M.L., and Anthony, J.C. "Drug Dependence" and Death: Survival Analysis of the Baltimore ECA Sample from 1981 to 1995. Substance Use & Misuse, 35(3), pp. 313-327, 2000.

Drug Use Among Welfare Recipients

Another study at Johns Hopkins examined the prevalence of drug use in a nationally representative sample of 1989 recipients and 6840 nonrecipients of four welfare programs. Data from the 1995 National Household Survey on Drug Abuse (NHSDA) were analyzed using the conditional form of multiple logistic regression with matching of respondents on neighborhood of residence. Weighted proportions and variances accounting for the complex sample design of the NHSDA survey were estimated using the Taylor series linearization method. The results indicate that drug use is 50% more common in households with welfare recipients than in neighboring households in which no members received such assistance. Drug use was highest among recipients of multiple programs, particularly those who reported receiving food stamps. These findings provide new and up-to-date evidence of higher drug use among our society's most economically disadvantaged families. They also suggest that legal policies enacted in some states to enforce drug testing and deny welfare benefits to persons testing positive for drugs might have important consequences in addressing drug use in this population, although constitutional issues must be considered. Delva, J., Neumark, Y.D., Furr, C.D.M., and Anthony, J.C. Drug Use Among Welfare Recipients in the United States. American Journal of Drug and Alcohol Abuse, 26(2), pp. 335-342, 2000.

Temperament and Antisocial Behavior in Sons of Fathers With and Without a History of Substance Abuse

A study using data from the University of Pittsburgh CEDAR sample was conducted to determine the relations between different dimensions of temperament, and their interactions, with antisocial behavior (ASB) in 351 preadolescent boys with (n=175) or without (n=176) a family history of a substance use disorder (SUD) and to determine whether these relationships are moderated by family history of SUD. Participants were administered the Revised Dimensions of Temperament Survey (DOTS-R) and multiple measures of ASB. Factor analysis reduced the DOTS-R subscales into three factors: Rhythmicity, Behavioral Regulation, and Positive Affectivity. Boys with a family history of SUD demonstrated lower scores on the Behavioral Regulation factor and increased levels of ASB compared to those without a family history of SUD. Results also indicated that above and beyond the effects of age and socioeconomic status, low rhythmicity, low behavioral regulation, and low positive affectivity, as well as some of their higher order interactive effects, are important indicators of different types of ASB and, in some cases, only in boys with a family history of SUD. These findings suggest that ASB and SUD prevention efforts should include components aimed at improving the regulation of behavior, increasing positive affectivity, and improving the rhythmicity of daily eating, sleeping, and other routine behaviors. Giancola, P.R. Temperament and Antisocial Behavior in Preadolescent Boys with or Without a Family History of a Substance Use Disorder. Psychology of Addictive Behaviors, 14(1), pp. 56-68, 2000.

Psychopathology and Substance-Related Problems During Early Adolescence

Another study with the CEDAR sample examined the chronological and statistical relations among onsets of psychopathology, alcohol and cannabis use, and substance-related problem from late childhood through early adolescence. Boys of fathers with substance use disorder (SUD; high average risk: n = 177) and without SUD (low average risk: n = 203) were compared using survival analysis. Proportional hazard models indicated that antisocial disorders were predicted by risk group (i.e., positive or negative family history of SUD). Antisocial disorders mediated the observed relation between risk group and substance-related problems. Negative affect disorders were predicted by risk group but did not predict substance involvement in early adolescence. Results support a model in which paternal SUD predisposes to increased antisocial and negative affect disorders in boys, and antisocial disorders lead to substance-related problems in early adolescence. Clark, D.B., Parker, A.M., and Lynch, K.G. Psychopathology and Substance-related Problems During Early Adolescence: A Survival Analysis. Journal of Clinical Child Psychology, 28(3), pp. 333-341, 1999.

Stressful Life Events and Development of Drug Use in Adolescents

In a study of the increase in drug use during early and mid-adolescence, investigators examined the cumulative effects of stressful life experiences over time taking into account possible moderating factors such as sex, income, family attachment, self-esteem, and mastery. Using 4 years of panel data from the Family Health Study (n=651 adolescents ages 11-14 during Year 1), they estimated a hierarchical growth curve model that examined the time-varying effects of stressful life events and peer relations on drug use. Stressful life events were measured by a checklist of 16 items derived from the Junior High Life Experiences Survey and the Family Inventory of Life Events and Life Changes; they included incidents such as death, illness, or accidents among family or friends, changes of school or residence, parental divorce or separation, and family financial problems. The results indicated that experiencing a high number of life events over time is related to a significant "growth" of drug use, even after controlling for "growth" due to age or peer relations. In addition, this relationship is moderated by family attachment; high levels of attachment serve to diminish this growth significantly. Hoffmann, J.P., Cerbone, F.G., and Su, S.S. A Growth Curve Analysis of Stress and Adolescent Drug Use. Substance Use & Misuse, 35(5), pp. 687-716, 2000.

Effects of Interviewer Characteristics on Telephone Survey Drug Use Responses

Researchers at the University of Illinois at Chicago analyzed data from 3,714 participants in a 1993 Illinois statewide substance abuse treatment needs assessment random-digit-dialing telephone survey to determine the effects of interview characteristics on rates of reporting of drug use. They examined the utility of social attribution and social desirability models for detecting the presence of interviewer effects. The specific outcome variables of interest were reports of lifetime and 18-month composite drug use. Analyses focused on the direct effects of individual interviewer characteristics (to assess social attribution) and a summary measure of interviewer-respondent similarity (to assess social distance). Random effects regression models were used to control for respondent clustering by interviewer. Results were most consistent with a social distance model and suggested that the degree of dissimilarity (social distance) between respondent and interviewer may decrease the probability of respondents reporting substance use behavior. Johnson, T.P., Fendrich, M., Shaligram, C., Garcy, A., and Gillespie, S. An Evaluation of the Effects of Interviewer Characteristics in an RDD Telephone Survey of Drug Use. Journal of Drug Issues, 30(1), pp. 77-101, 2000.

Natural History of Cigarette Smoking from Adolescence to Adulthood

Previous research on the natural history of smoking has focused on overall group trajectories without considering the possibility of risk subgroup variation, but recent advances in quantitative methods have made it feasible to consider subgroups of trajectories within an overall longitudinal design. Taking advantage of these advances, researchers at Arizona State University used data from a cohort-sequential study of a large community sample (N = 8,556) with measurements spanning ages 11-31 and sought to identify subgroups with varying trajectories of smoking behavior. After removing 2 a priori groups (abstainers and erratics), the investigators empirically identified 4 trajectory groups -- early stable smokers (characterized by smoking onset at age 12-13 and continuation on smoking at subsequent ascertainments), late stable smokers (who typically reach a criterion of weekly smoking around age 18 and remained stable through the course of the study), experimenters (who typically initiated smoking early but had discontinued cigarette use by the age of 20), and quitters (who started smoking at an age between that of the early-stable and late-stable groups and achieved a high level of cigarette use but quit around the age of 25). The study also identified psychosocial variables from adolescence and young adulthood that distinguished among these groups. Chassin, L., Presson, C.C., Pitts, S.C., and Sherman, S.J. The Natural History of Cigarette Smoking from Adolescence to Adulthood in a Midwestern Community Sample: Multiple Trajectories and Their Psychosocial Correlates. Health Psychology, 19(3), pp. 223-231, 2000.

Early Onset of Substance Use Among African American Children

This research tested predictions from a self-regulation model of factors relevant for early onset of tobacco and alcohol use with a community sample of 889 African American children (mean age = 10.5 years), a population for whom relatively little evidence is available at early ages. Criterion variables were peer substance use, willingness to use substances, and resistance efficacy (intention to refuse substance offers). Structural modeling indicated effects of temperament dimensions were mediated through self-control and risk-taking constructs, which were related to school involvement, life events, and perceived vulnerability to harmful effects of substances. Peer use was predicted by life events, poor self-control, and parent-child conflict; willingness to use substances was predicted by life events, risk taking, and (inversely) parental support; and resistance efficacy was predicted by perceived vulnerability and (inversely) poor self-control. Findings are discussed with reference to theoretical models of early protection and vulnerability processes. Wills, T.A., Gibbons, F.X., Gerrard, M., and Brody, G.H. Protection and Vulnerability Processes Relevant for Early Onset of Substance Use: A Test Among African American Children. Health Psychology, 19(3), pp. 253-263, 2000.

Predictors of Continued Smoking

To test the hypothesis that high daily cigarette consumption and addiction to smoking are risk factors for the long-term continuation of smoking, a team of researchers from Harvard, the University of Jyvaskyla and the University of Rochester used longitudinal data from 986 male smokers participating in the Normative Aging Study. They entered cigarettes per day, psychological addiction, age, and education into a survival analysis as predictors of continued smoking over a 25- year period. Findings indicate that younger men and those who smoked more cigarettes per day were more likely to remain smokers in the long term. Addiction and education level were not significant predictors of continued smoking. The researchers concluded that heavier smokers are more at risk than lighter smokers for long-term smoking. It is therefore very important to provide smoking cessation treatments for heavy smokers as early as possible after the initiation of smoking. Nordstrom, B.L., Kinnunen, T., Utman, C.H., Krall, E.A., Vokonas, P.S., and Garvey, A.J. Predictors of Continued Smoking Over 25 Years of Follow-up in the Normative Aging Study. American Journal of Public Health, 90(3), pp. 404-406, 2000.

Use of Case-Crossover Designs and Alternating Logistic Regression in Drug Abuse Studies

Researchers at Johns Hopkins University published two papers on methods for studying illicit drug use. The first deals with the use of the case-crossover design, which was developed to study time-varying exposures that cause transient excess risk of acute health events. It is a variant of case-control and subject-as-own- control research designs, involving use of information about exposure history of each case to estimate the transient effect. This kind of self-control design can help to reduce sampling bias otherwise introduced in the selection of controls, as well as confounding bias that might be derived from enduring individual characteristics, especially personality traits and other long-standing inherited or acquired vulnerabilities. When the subject is used as his or her own control, these personal vulnerabilities are matched. This paper discusses strengths and weaknesses of the case-crossover design and suggests applications of the case-crossover design in epidemiologic studies on suspected hazards of illicit drug use, and in studies of drug use and co-occurring psychiatric disturbances. The authors conclude that the case-crossover design can play a useful role, but it discloses a need to secure fine-grained measurements in epidemiologic research on psychiatric comorbidity. They also argue that this method may be of use to criminologists who study the drugs-crime nexus, to services researchers and clinicians who seek to understand treatment entry and compliance behavior, and to etiologists interested in polydrug use. The second article describes the alternating logistic regression (ALR) method and places this method in the context of other statistical approaches to the analysis of complex survey data, including the conditional form of logistic regression with matching on neighborhood characteristics. Unlike conditional logistic regression, the ALR method provides for an explicit estimation of the magnitude of clustering of drug use within neighborhoods and within subgroups of the neighborhood defined by male-female or age indicators, with and without covariate adjustments. The application of these ALR methods is illustrated with estimates for the magnitude of clustering of daily marijuana use and weekly marijuana use within neighborhoods of the United States, based on data from the National Household Survey on Drug Abuse samples from 1990 through 1996. (1) Wu, L.T. and Anthony, J.C. The Use of the Case-Crossover Design in Studying Illicit Drug Use. Substance Use & Misuse, 35(6-8), pp. 1035-1050, 2000. (2) Bobashev, G.V. and Anthony, J.C. Use of Alternating Logistic Regression in Studies of Drug-Use Clustering. Substance Use & Misuse, 35(6-8), pp. 1051-1073, 2000.

Developmental Taxonomy of Marijuana Users

This study applied cluster analysis to a community-based sample of marijuana users followed from adolescence to mid-30's, to create a taxonomy for marijuana use similar to those proposed for alcohol. Four groups with distinguishing characteristics emerged: early onset (age 15)-heavy use; early onset-light use; mid onset (age 16)-heavy use; and late onset (age 19.5)-light use. Of note, early onset of use did not in itself signify risk for later drug dependence; a concurrent psychiatric problem was strongly associated with risk for dependence in the early onset group, and absence of psychopathology distinguished the users who did not progress to heavy use. Association with marijuana-using peers and peer delinquency also distinguished those early users who progressed to heavy use. These findings add to our understanding about the course and risk for marijuana use, and make important distinctions among different typologies. Kandel, D.B., and Chen, K. Types of Marijuana Users by Longitudinal Course. Journal of Studies on Alcohol, 61, pp. 367-378, 2000.

Genetics of Smoking Initiation vs. Persistence

Using data from three different cultural groups, this study analyzed twin data to assess genetic influences on smoking initiation vs. persistence in several age groups and both sexes. While the contributions of genetics to smoking persistence was very similar among the various age groups and both sexes, findings suggest that the genetic factors accounting for variance in smoking initiation differ from those accounting for smoking persistence. This suggests that future studies seeking to find genes for smoking behavior will need to differentiate between those for initiation and those for persistence, and that identifying genes for persistence may have great public health significance. Madden, P.A. F., Heath, A.C., Pedersen, N.L., Kaprio, J., Koskenvuo, M.J., and Martin, N.G. The Genetics of Smoking Persistence in Men and Women: A Multicultural Study. Behavior Genetics, 29, pp. 423-431, 1999.

Adolescent Substance Use and Later Health Status

This paper critically reviews the literature on the hypothesized relationship between drug use and physical health status, and uses data from a 20 year follow up of adolescents to examine key mediators in the relationship. There was evidence for a persistent relationship between drug use in adolescence and detrimental adult health status, whether psychological maladjustment was controlled for or treated as an intervening variable. Including adolescent deviance as a mediator reduced the relationship between drug use and later health status to non-significance, and modeling showed adolescent deviance to be a significant intervening construct. Thus, the authors conclude that it is the deviant lifestyle, with effects such as risk-taking, poor diet, and poor medical care, that accounts for the relationship between substance use and adult health status, rather than a unique effect of drug ingestion. Spohn, R.E., and Kaplan, H.B. Adolescent Substance Use and Adult Health Status. Advances in Medical Sociology, 7, pp. 45-65, 2000.

Adolescent Religiousness and Substance Use

The authors used data from the Mid-Atlantic School Age Twin Study to examine associations between religiousness and substance use. Adolescent religiousness was at least somewhat inversely correlated with drug and alcohol use and with other behavior problems. Religiousness was also related to lower peer conduct problems and drug use, and strongly negatively correlated with sensation seeking, especially in females. From analysis of this twin data, religiousness in adolescents appears to be largely a function of shared environmental factors, with only modest heritability; thus it may prove more important in protecting against initial adolescent use than against more heritable later drug use problems if drugs are initiated. D'Onofrio, B.M., Murrelle, L., Eaves, L.J., McCullough, M.D., Landis, J.L., and Maes, H.H. Adolescent Religiousness and its Influence on Substance Use: Preliminary Findings from the Mid-Atlantic School Age Twin Study. Twin Research, 2, pp. 156-168, 1999.

Cross-national Comparisons of the Prevalences and Correlates of Mental and Substance Use Disorders

Researchers at Harvard University, other U.S. and foreign research institutions and the World Health Organization (WHO) have formed an International Consortium in Psychiatric Epidemiology (ICPE) in order to carry out cross-national comparative studies of the prevalences and correlates of mental disorders. This article describes the findings of surveys in seven countries in North America (Canada and USA), Latin America (Brazil and Mexico), and Europe (Germany, Netherlands, and Turkey), using a version of the WHO Composite International Diagnostic Interview (CIDI) to generate diagnoses. The results are reported using DSM-III-R and DSM-IV criteria without diagnostic hierarchy rules for mental disorders and with hierarchy rules for substance-use disorders. Prevalence estimates varied widely--from >40% lifetime prevalence of any mental disorder in Netherlands and the USA to levels of 12% in Turkey and 20% in Mexico. Comparisons of lifetime versus recent prevalence estimates show that mental disorders were often chronic, although chronicity was consistently higher for anxiety disorders than for mood or substance-use disorders. Retrospective reports suggest that mental disorders typically had early ages of onset, with estimated medians of 15 years for anxiety disorders, 26 years for mood disorders, and 21 years for substance-use disorders. All three classes of disorders were positively related to a number of socioeconomic measures of disadvantage (such as low income and education, unemployed, unmarried). Analysis of retrospective age-of-onset reports suggest that lifetime prevalences had increased in recent cohorts, but the increase was less for anxiety disorders than for mood or substance-use disorders. Delays in seeking professional treatment were widespread, especially among early- onset cases, and only a minority of people with prevailing disorders received any treatment. The authors conclude that there is a need for demonstration projects of early outreach and intervention programs for people with early-onset mental disorders, as well as quality assurance programs to look into the widespread problem of inadequate treatment. Andrade, L., Caraveo-Anduaga, J.J., Berglund, P., Bijl, R., Kessler, R.C., Demler, O., Walters, E., Kylyc, C., Offord, D., Ustun, T.B., and Wittchen, H.U. Cross-national Comparisons of the Prevalences and Correlates of Mental Disorders. Bulletin of the World Health Organization, 78(4), pp. 413-426, 2000.

Panic Attacks and Suicide

This study investigated the association of panic attacks and suicide attempts in a community-based sample of 13-14-year-old adolescents. The data are from a survey of 1,580 students in an urban public school system located in the mid-Atlantic region of the United States. Logistic regression methods were used to estimate associations between panic attacks and suicidal ideation and suicide attempts. Controlling for demographic factors, major depression, the use of alcohol, and the use of illicit drugs, the authors found that adolescents with panic attacks were three times more likely to have expressed suicidal ideation and approximately two times more likely to have made suicide attempts than were adolescents without panic attacks. This new epidemiologic research adds to the evidence of an association between panic attacks and suicide attempts during the middle years of adolescence. Pilowsky, D.J., Wu, L.T., and Anthony, J., Panic Attacks and Suicide Attempts in Mid-Adolescence. American Journal of Psychiatry, 156, pp. 1545-1549, 1999.

Weight Gain after Smoking Cessation

Smoking cessation usually results in weight gain. Nicotine gum therapy has been found to reduce weight gain in the first months after cessation, but its long-term effects are not fully known. The present study randomly assigned 608 smokers to receive placebo, 2 or 4 mg nicotine gum. In a follow-up analysis to the short-term weight change results reported in a previous paper, the authors examined the effects of the nicotine gum on weight change for 1 year after cessation among the 921-year abstainers. The authors found that weight change showed some variation with gum dose (active vs. placebo), but that weight change appeared to depend more strongly on the percentage of pre-cessation cotinine levels replaced by the nicotine gum. Participants who replaced higher proportions of their pre-cessation cotinine during the gum therapy period gained less weight during the first year post-cessation than those who replaced less cotinine, with those who replaced greater than 90% of their continue gaining only 1.7 kg by 1 year post-cessation. These findings suggest that future research is warranted to determine whether sufficiently high levels of nicotine replacement can help to permanently reduce cessation-related weight gain. Nordstrom, B.L., Kinnunen, TY. Utman, C.H., and Garvey, A. Long-Term Effects of Nicotine Gum on Weight Gain after Smoking Cessation. Nicotine & Tobacco Research, 1, pp. 259 -268, 1999.

Perceived Risk of Cocaine Use

This study investigates whether experience with cocaine and the perception of risk associated with cocaine use might tend to cluster within neighborhoods and cities in the US. Population-based data from six years of the National Household Surveys on Drug Abuse public use files were examined. The alternating logistic regressions model was used to quantify the extent of geographic concentration. Perceptions of the harm associated with cocaine use and actual experience with cocaine tend to cluster within neighborhoods; once within-neighborhood concentration is taken into account, there is little evidence of residual concentration within cities. Petronis, K.R., and Anthony, J. Perceived Risk of Cocaine Use and Experience with Cocaine: Do They Cluster Within US Neighborhoods and Cities? Drug and Alcohol Dependence, 57, pp. 183-192, 2000.

Initiation of Alcohol and Marijuana Use

Guided by the social development model, this study examined dynamic patterns and predictors of alcohol and marijuana use initiation. The sample was derived from a longitudinal study of 808 youth interviewed annually from 10 to 16 years of age and at 18 years of age. Rate of alcohol initiation rose steeply up to the age of 13 years and then increased more gradually; most participants had initiated by 13 years of age. Marijuana initiation showed a different pattern, with more participants initiating after the age of 13 years. The study showed that: (1) the risk of initiation spans the entire course of adolescent development; (2) young people exposed to others who use substances are at higher risk for early initiation; (3) proactive parents can help delay initiation; and (4) clear family standards and proactive family management are important in delaying alcohol and marijuana use, regardless of how closely bonded a child is to his or her mother. Kosterman R., Hawkins J.D., Guo J., Catalano R.F., and Abbott, R.D. The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence. American Journal of Public Health, 90(3), pp. 360-366, 2000.

Ethnic and Gender Differences and Similarities in Adolescent Drug Behaviors

This study examined relationships among ethnicity, gender, drug use, and resistance to drug offers in a sample of 2,622 African American, Mexican American, and White American seventh graders. Findings included: first, the adolescents did not possess large or sophisticated repertoires of drug resistance strategies. Second, most offers came from acquaintances in contrast to data on older adolescents where offers generally come from intimate friends. Third, ethnicity had significant effects on use and the offer process. Mexican Americans received more offers, used more drugs, and were more likely to be offered drugs by peers, family members and at parties. European Americans were more likely to receive drug offers from acquaintances and at friends' homes and on the street. African Americans were more likely to receive offers from dating partners and parents, and in the park, and were more likely to resist offers of drugs-using explanations. Fourth, gender significantly affected drug offers and types of offers. Males were more at risk for offers and use at a younger age. Offers of drugs to males were more likely to come from parents or other males, while offers to females were more likely to come from other females or dating partners. Males were also more likely to receive drug offers that appealed to their social standing or self-image whereas females received either simple offers or those that minimize effects. Finally, offers of drugs to males were more likely to be made in public, while those to females were more likely to occur in private. Moon, D.G., Hecht M.L., Jackson, K.M., and Spellers R.E. Ethnic and Gender Differences and Similarities in Adolescent Drug Use and Refusals of Drug Offers. Substance Use and Misuse. 34 (8), pp. 1059-1083, 1999.

Prediction of Violent Behavior

Using a developmental framework, this study replicates earlier research on risk factors for youth violence and explores the effects of risks for other problem behaviors on violence. Data from the Seattle Social Development Project (SSDP), a prospective study involving a panel of youths followed since 1985 were used. Potential risk factors for violence at age 18 years were measured at ages 10, 14, and 16 years. Risk factors in the individual, family, school, peer and community domains and violence were examined at each age to assess changes in their strength of prediction over time. Attention was also given to the additive strength of increasing numbers of risk factors in the prediction of violence at age 18 years. A final set of analyses explored the extent to which youths were correctly classified as having committed a violent act (or not) at age 18 on the basis of their overall level of risk at ages 10, 14, and 16 years. At each age, risk factors strongly related to later violence were distributed among the five domains. Ten of 15 risk factors measured at age 10 years; 20 of 25 at age 14; and 19 of 21 at age 16 years were significantly predictive of violence at age 18. Many constructs predicted violence from more than one developmental point. Hyperactivity (parent rating), low academic performance, peer delinquency, and availability of drugs in the neighborhood predicted violence from ages 10, 14, and 16 years. Analyses of the additive effects of risk factors revealed that youths exposed to multiple risks were more likely than others to engage in later violence. Youths exposed to more than five risk factors at each age were seven times more likely at age 20, nearly 11 times more likely at age 16 and 10 times more likely at age 14 years to have been violent than youths exposed to fewer than two risk factors at each age. Despite information gained from all significant risk factors, the overall accuracy in predicting which youth would go on to commit violent acts was limited. Herrenkohl, T .I., Maguin, E., Hill, K.G., Hawkins, J.D., Abbott, R.D., and Catalano, R.F. Developmental Risk Factors for Youth Violence. Journal of Adolescent Health, 26(3), pp. 176-186, 2000.

Peer Behavioral Assessments Predict Later Problems

This study assessed whether peer-ratings of behavioral reputation predicted teacher-rated behavioral adjustment and academic achievement four years later. In a prospective, longitudinal design with a community sample of 213 disruptive and 104 nondisruptive children, peers were asked to assess behavioral reputation. Regression analyses showed that peer ratings of aggressive-disruptive, sensitive-isolated, and social etiquette behaviors were the best predictors of later externalizing and internalizing problems and adaptive skills, respectively. The peer-rated problematic behaviors continued to be related to these outcomes, even when parent and teacher ratings of behavior problems at baseline were included in the equation with peer ratings. However, behavioral reputation was not related to academic achievement. Realmuto, G.M., August, G.J., and Hektner, J.M. Predictive Power of Peer Behavioral Assessment for Subsequent Maladjustment in Community Samples of Disruptive and Nondisruptive Children. Journal of Child Psychology and Psychiatry and Allied Disciplines 41(2), pp. 181-190, 2000.

Identifying Suicidal Risk Among Potential High School Dropouts

This study examined the validity of the Suicide Risk Screen (SRS) for identifying suicide-risk youths among potential high school dropouts. Five hundred eighty-one potential dropouts, aged 14 to 20 years, participated in a 3-stage case identification protocol. Randomly selected students completed a questionnaire containing the SRS and participated in an assessment interview. Validity measures included Reynolds' Suicide Ideation Questionnaire (SIQ-JR) and two clinical rating scales, the Direct Suicide Risk (DSR) and Clinical Risk Assessment (CRA). Suicide-risk severity was significantly associated with categorization defined by the SRS criteria. Of seven SRS elements, depression, suicidal ideation, and suicide threats predicted all validity measures. Suicide attempts predicted the DSR and CRA, but not Reynolds' SIQ-JR. Drug involvement, though relatively weaker, consistently predicted all validity measures. No additional psychosocial indicators improved the prediction of SIQ-JR or the DSR. Family support, likelihood of dropout, and risky behaviors, however, were additional predictors of the CRA ratings. Thompson, E.A. and Eggert, L.L. Using the Suicide Risk Screen to Identify Suicidal Adolescents Among Potential High School Dropouts. J American Academic Child Adolescent Psychiatry 38 (12), pp. 1506-1514, 1999.

Using the Community Readiness Model

The stage of readiness of a community for implementing drug abuse prevention programs is a major factor in determining whether the program will be effectively implemented and supported by the community. The Community Readiness Model was developed to meet research needs, (e.g., matching treatment and control communities for an experimental intervention) as well as to provide a tool to help communities mobilize for change. The model defines nine stages of readiness ranging from "no awareness" of the problem to "professionalization" in the response to the problem. Assessment of the stage of readiness is accomplished through key informant interviews, involving questions on six dimensions of community readiness. Fieldwork with communities has resulted in effective strategies for successful implementation efforts at each stage of readiness. Communities that achieve a stage of readiness where focal efforts can be initiated, can then train teams in the use of the community readiness model. These teams can then develop culturally appropriate goals and activities that use local resources to guide the community to more advanced levels of readiness, eventually leading to the long-term sustainability of community efforts. Edwards, R.W., Jumper-Thurman, P., Plested, B.A., Oetting, E.R., and Swanson, L. Community Readiness: Research to Practice. Journal of Community Psychology, 28(3), pp. 291-307, 2000.

Rural and Minority Communities at Low-levels of Readiness for Drug Prevention Programs

An assessment of community readiness for drug use prevention in rural communities indicated that most rural communities are at relatively low stages of readiness. Minority communities were particularly low in readiness, with only 2% having functioning drug prevention programs. Rural communities at different levels of readiness require different types of programs to increase readiness, i.e., communities at the "no awareness" stage require analysis of the historical and cultural issues that support tolerance of drug use, those at the "denial" and "vague awareness" stages need specific information about local problems, and communities at the "preplanning" and "preparation" stages need information about effective programs, help in identifying resources, and assistance with staff training. In addition, building and maintaining effective programs requires continued evolution of readiness through the stages of "initiation", "stabilization", "confirmation and expansion", and "professionalization". Plested, B., Smitham, D.M., Jumper-Thurman, P., Oetting, E.R., and Edwards, R.W. Readiness for Drug Use Prevention in Rural Minority Communities. Substance Use & Misuse, 34(4-5), pp. 521-544, 1999.

Results of a Community Intervention to Prevent Adolescent Tobacco Use

This study consisted of an experimental evaluation of a comprehensive community wide program to prevent adolescent tobacco use. Eight pairs of small Oregon communities were randomly assigned to receive a school-based prevention program or the school-based program plus a community program. The community program included: (a) media advocacy, (b) youth anti-tobacco activities, (c) family communications about tobacco use, and (d) reduction of youth access to tobacco. Effects were assessed through five annual surveys (time 1-5) of seventh through ninth grade students, ages 12-15 years. The main outcome measure used was the prevalence of self-reported smoking and smokeless tobacco use in the week before assessment. The results showed that the community program had significant effects on the prevalence of weekly cigarette use at times 2 and 5 and the effect approached significance at time 4. An effect on the slope of prevalence across time points was evident only when time 2 data points were eliminated from the analysis. The intervention affected the prevalence of smokeless tobacco among grade 9 boys at time 2. There were also significant effects on the slope of alcohol use among ninth graders and the quadratic slope of marijuana for all students. Biglan, A., Ary, D.V., Smolkowski, K., Duncan, T., and Black, C. A Randomized Controlled Trial of a Community Intervention to Prevent Adolescent Tobacco Use. Tobacco Control, 9 (1), pp. 24-32, 2000.

Institutionalizing Drug Abuse Prevention Through Policy Change

This article summarizes community policies that have been effective in decreasing youth drug use, the contribution of community organization to policy change, and the role of policy change on institutionalizing community-based prevention efforts. Two types of policy change are considered: implementation and regulations. Implementation policies are aimed at institutionalizing prevention programs, usually through raising funds, requiring standard implementation, and creating a formal non-profit organization to implement programs. Regulatory policies include all formal laws, regulations, and ordinances aimed directly at decreasing drug use, for example, regulations which enforce the monitoring of drug-free zones. Results of studies suggest that regulatory policies show the most immediate effect on youth tobacco and alcohol use. However, implementation policies have more potential for long-term effects on use. Community organization appears to stimulate change in both types of policy. As yet unresolved is whether policy change contributes to long-term community prevention efforts. Recent research identified barriers to the translation of evidence-based prevention into practice including: (a) a lack of perceived empowerment by community leaders to continue prevention work; (b) insufficient preparation of community leaders for adoption of evidence-based programs; (c) the tendency to continue using ineffective approaches because of the past investment; and (d) a general perception that no proscribed evidence-based approach can work because each community has its own unique needs. Despite these barriers, several factors that may expedite movement in this direction emerged from case studies: (a) identification of a local "champion" for prevention; (2) development of local resources to sustain prevention; (3) feedback about prevention program effects; and (4) strategic use of supportive mass media. Pentz, M.A. Institutionalizing Community-Based Prevention Through Policy Change. J Community Psychology. 28 (3), pp. 257-270, 2000.

The Participatory Intervention Model

This article examines the participatory approach for conceptualizing and implementing research-based interventions, the primary aim of which is the development of acceptable and sustainable prevention change efforts. The Participatory Intervention Model (PIM), rooted in participatory action research, provides a mechanism for integrating theory, research, and practice and for promoting involvement of stakeholders. PIM has demonstrated the capacity for promoting intervention acceptability, bridging the gap between research and practice, addressing cultural diversity, fostering partnerships, promoting disciplined reflective practice, and integrating the multiple roles of the school psychologist in international sexual-risk prevention work. Nastasi B.K.,Varjas, K., Schensul, S.L., Silva, K.T., Schensul, J.J., and Ratnayake, P. The Participatory Intervention Model: A Framework for Conceptualizing and Promoting Intervention Acceptability. School Psychology Quarterly. 15 (2), pp. 207-232, 2000.

Developing Attachment through Prosocial Family Activities

Child attachment to parents has been shown to reduce the likelihood of problem behaviors, such as substance abuse, through enhancing resiliency. Research examining attachment and its relationship to antisocial behavioral outcomes in adolescents has been shaped largely by social control theorists who have theorized that attachment to prosocial others inhibits the expression of antisocial behavioral outcomes. This paper expands the literature by investigating the development of child attachment to parent(s) during the early elementary school years. The social development model posits that consistently applied opportunities for prosocial interactions and involvement with family, praise and recognition by parents, and child social and decision-making skills, predict future level of attachment. Results indicate that level of attachment in grade one or two is the strongest predictor of attachment in grade three or four. In addition, the socializing activities of parents (opportunities and involvement) had a strong positive relationship with rewards, which was a significant predictor of attachment in grade three or four over and above the effects of prior attachment. Only child skill was unrelated to reward. This may be due to the developmental status of the children and parents expectations. Oxford, M.L., Harachi, T.W., Catalano, R.F., Haggerty, K.P., and Abbott, R.D. Early Elementary School-aged Child Attachment to Parents: A Test of Theory and Implications for Prevention. Prevention Science, 1(2), pp. 61-69, 2000.

Parenting Skills Program Successful in Changing Behavior

This study explored the effectiveness of using trained, supervised group leaders who were not mental health clinicians to lead an intervention developed for parents of at-risk middle school students. The program was evaluated in a randomized controlled trial in eight small communities. Three hundred three parents were randomly assigned to immediate treatment or a wait-list condition. Latent growth modeling showed that participation in the program led to significant improvements in problem-solving interactions. Parents' over-reactivity and laxness toward their children's behavior were reduced and their feelings toward their children improved significantly as a function of treatment. Parent-reported antisocial behavior was also reduced. Thus, evidence was found for the effectiveness of using non mental health clinicians to aid in behavior change. Irvine, A.B., Biglan, A., Smolkowski, K., Metzler, C.W., and Ary, D.V. The Effectiveness of a Parenting Skills Program for Parents of Middle School Students in Small Communities. Journal of Consulting and Clinical Psychology 67(6), pp. 811-825, 1999.

Outcomes of a Secondary Preventive Intervention with Aggressive Children

Teacher-identified aggressive children were randomly assigned to one of two treatment conditions, both of which involved college student mentors. The experimental condition (PrimeTime) combined therapeutic mentoring, training in problem-solving skills, and consultation with parents and teachers. The comparison treatment (Standard Mentoring) relied solely on the skills of minimally trained, unsupervised mentors. Both interventions lasted 16 months. The goal was to examine the efficacy of the PrimeTime intervention and the soundness of the model of change. Outcome assessments (at posttreatment and at one-year follow-up) were based on parent-, teacher-, and peer-reports of children's aggression and others' acceptance, as well as on children's self-rated competence and acceptance by others. Outcome analyses revealed small gains for both treatments and provided only partial support for the efficacy of the PrimeTime intervention. Analyses of change processes supported the conceptual model but also identified iatrogenic effects that may have attenuated the therapeutic impact of PrimeTime. The discussion highlights the importance of testing both intervention efficacy and putative mechanisms of change when evaluating newly developed treatment models. Cavell, T.A., and Hughes, J.N. Secondary Prevention as Context for Assessing Change Processes in Aggressive Children. Journal of School Psychology, 38 (3), pp. 199-235, 2000.

A Manualized Preventive Intervention for Juvenile Offenders

Multi-problem families are often unprepared to provide support for recovering juvenile offenders that can prevent recidivism and associated negative outcomes, including substance abuse. Despite this, juvenile courts often return juvenile offenders to their families during parole, probation, and as an alternative to prosecution. This article provides information on a manual that describes Prosocial Family Therapy (PFT), a method of multisystemic care for juvenile offenders based on theories of risk and protective factors and therapy process. PFT integrates specific parent training techniques and nonspecific family therapy strategies. It includes techniques for reinforcing positive behaviors, skills training in communication, and strategies for motivating behavior change. Additionally, the manual describes how courts, schools, community agencies, and residential treatment centers can provide comprehensive care to juvenile offenders, ensure protocol adherence, and assess clinical significance of results. Blechman, E.A. and Vryan, K.D. Prosocial Family Therapy: A Manualized Preventive Intervention for Juvenile Offenders. Aggression and Violent Behavior 5(4), pp. 343-378, 2000.

Peer Clique Participation and Social Status in Preadolescence

A method is described to identify peer cliques based on a consensus of group members. It provides quantitative measures of preadolescents' involvement in cliques and their association with peers who often get in trouble. The relationship between peer rejection and participation in peer cliques was of primary interest. Characteristics of peer cliques were assessed for 824 fourth-grade youth as a function of their sociometric status, gender, and aggressiveness. Rejected youth were less central members of their group than were average-status peers; however, aggressive preadolescents were no less centrally involved than their non-aggressive peers. Rejected preadolescents also belonged to smaller cliques and to cliques comprised of other low-status peers. Aggression was the primary factor associated with being a central member of deviant peer cliques. Bagwell, C.L., Coie, J.D., Terry, R.A., and Lochman, J.E. Peer Clique Participation and Social Status in Preadolescence. Merrill-Palmer Quarterly-Journal of Developmental Psychology, 46 (2), pp. 280-305, 2000.

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