Director's Report to Council - Research Findings Excerpts

May, 2008

Basic Behavioral Research

Sex Differences and Hormonal Factors in the Acquisition and Maintenance of Cocaine Self-administration in Adolescent Rat

Previous research has reported that females more rapidly acquire self-administration than males, that a greater percentage of females acquire self-administration, and that females exhibit greater motivation for cocaine as assessed via a progressive ratio (PR) schedule. Additionally, cocaine self-administration in females is modulated by estrogen, whereas testosterone has not been found to play a role in cocaine self-administration in males. Dr. Wendy Lynch compared these behavioral outcomes in male and female rats during adolescence. Replicating prior findings with adult rats, female adolescents acquired cocaine self-administration more rapidly than males, a greater percentage of females than males acquired self-administration, and females received more infusions than males under the PR schedule. In females, serum estradiol concentration, but not progesterone concentration, was positively correlated with number of infusions obtained under the PR schedule, and for four of the five rats it accounted for 50% of the variance in number of infusions. Additionally, number of infusions varied with the estrus cycle. In males however, serum testosterone was unrelated to the number of infusions. In a parallel control study, Dr. Lynch compared acquisition of lever-pressing for sucrose reinforcement and subsequent behavior under a PR schedule in adolescent males versus females, in order to assess potential sex differences in general learning and motivation. She found that males and females did not differ in the rate of acquisition, nor did they differ in the number of pellets received under the PR schedule. This research suggests that the observed sex differences in cocaine self-administration in adults, as well as the modulation by estrogen and the estrus cycle, are reflective of sex differences and underlying mechanisms that are present in adolescents. The contribution of the organization and activational effects of gonadal hormones in these sex differences remains to be understood. Lynch, W.J. Acquisition and Maintenance of Cocaine Self-Administration in Adolescent Rats: Effects of Sex and Gonadal Hormones. Psychopharmacology, 197, pp. 237-246, 2008.

Personality and Gender Moderate Amphetamine's Effects on Risk Taking

Dr. Harriet de Wit and her colleagues examined how gender and personality (temperament) moderate the effects of d-amphetamine on risk taking, measured by performance on the BART (Balloon Analogue Risk Task). Previous research indicates that stimulant drugs can either increase or decrease impulsive behavior, depending upon a number of factors including gender and variation in personality traits related to reward and punishment sensitivity. The present study assessed personality using the Multidimensional Personality Questionnaire Brief Form, because this questionnaire is an empirically derived measurement instrument that assesses three orthogonal factors related to reward sensitivity, behavioral impulsivity, and negative affect. These include the personality dimensions of Agentic Positive Emotionality (AgPEM), which is thought to reflect individual differences in the function of ascending VTA dopamine projections that modulate behavioral approach and incentive motivation; Constraint (CON), which measures impulsive spontaneity and approach-versus-avoidance of physical harm, which could be relevant to drug-induced changes in the relative frequency of impulsive choices versus successful impulse control; and Negative Emotionality (NEM), which measures anxiety proneness, interpersonal alienation and aggression, which could be relevant to drug-induced changes in aggressive impulsive behavior. Forty healthy men and women, aged 18 to 35, completed the BART after ingesting placebo or d-amphetamine (10, 20 mg). There were three main findings. First, for male participants, there were strong, positive correlations between the personality trait of AgPEM and amphetamine-induced increases in risk taking on the BART risk task. Second, there was evidence of discriminant validity, as correlations between AgPEM and drug-induced risk behavior were significantly greater than correlations with trait CON and trait NEM in the same participants. Third, 20 mg d-amphetamine significantly decreased risk behavior in men with scores in the lower half of the distribution for AgPEM, and significantly increased risk behavior in men with scores in the upper half of the distribution on AgPEM. The drug did not affect risk taking in women. Overall, the current findings suggest that the personality trait of AgPEM could constitute a preexisting risk factor (neural, metabolic, or behavioral characteristics) for amphetamine-induced changes in risk-taking in healthy young adult males, and could affect behavioral responses to stimulant drugs when used recreationally or therapeutically. White, T.L., Lejuez, C.W., and de Wit, H. Personality and Gender Differences in Effects of d-Amphetamine on Risk Taking. Experimental and Clinical Psychopharmacology, 15, pp. 599-609, 2007.

Behavioral and Brain Development Research

Prenatal Cocaine Exposure, Gender, and Preadolescent Substance Use and Other Health Risk Behaviors

Dr. Michael Lewis and his colleagues examined prenatal cocaine exposure, gender, and environmental risk as predictors of self-reported substance use, aggression, and a disregard for safety precautions on the Youth Risk Behavior Survey in a sample of 10.5 year olds (n = 154, including 60 who were prenatally exposed to cocaine). Gender tended to moderate the effects of prenatal cocaine exposure because exposure effects were found for boys but not girls. Boys who were prenatally exposed to cocaine reported engaging in more high-risk behavior. In examining individual outcomes, cocaine exposed boys had the highest scores for aggression, substance use, and a disregard for safety precautions, although these differences were significant only for the composite health risk behavior measure. The findings extend earlier work showing that prenatal cocaine exposure places boys at risk for problems of inhibitory control, emotional regulation, and antisocial behavior. Research is needed to examine whether the effects of prenatal cocaine on health risk behaviors persist into adolescence, when such behaviors tend to increase. Bennett, D., Bendersky, M., and Lewis, M. Preadolescent Health Risk Behavior as a Function of Prenatal Cocaine Exposure and Gender. Journal of Behavioral Pediatrics, 28(6), pp. 467- 472, 2007.

Longitudinal Analysis of the Effects of Prenatal Cocaine Exposure on Growth

Dr. Gale Richardson and her colleagues at the University of Pittsburgh investigated the effects of prenatal cocaine exposure on offspring growth from 1 through 10 years of age using a repeated-measures growth-curve model. Cross-sectional analyses showed that children exposed to cocaine during the first trimester (n = 99) were smaller on all growth parameters at 7 and 10 years, but not at 1 or 3 years, than the children who were not exposed to cocaine during the first trimester (n = 125). The longitudinal analyses indicated that the growth curves for the 2 groups diverged over time: children who were prenatally exposed to cocaine grew at a slower rate than children who were not exposed. These analyses controlled for other factors associated with child growth. This is the first study of the long-term effects of prenatal cocaine exposure to conduct longitudinal growth-curve analyses using four time points in childhood. Children who were exposed to cocaine during the first trimester grew at a slower rate than those who were not exposed. These findings indicate that prenatal cocaine exposure has a lasting effect on child development. Richardson, G.A., Goldschmidt, L., and Larkby, C. Effects of Prenatal Cocaine Exposure on Growth: A Longitudinal Analysis. Pediatrics, 120(4), pp. e1017-1027, 2007.

fMRI and Working Memory in Adolescents with Prenatal Cocaine Exposure

This fMRI study examined prefrontal cortex activation during task performance on an n-back task with 34 adolescents, 17 who were exposed to cocaine and 17 who were not exposed. Five functionally derived regions of interest (ROI) were defined; in addition, 2 a priori anatomical ROIs were generated for Brodmann regions 10 and 46. Groups had similar performance on the n-back task (P >/= .4), with both showing a fewer number of correct responses on the 2-back than the 1-back (P < .001), indicating increased demands on working memory with greater task difficulty. In functionally derived ROIs, imaging results showed increased activation for both groups in the 2-back versus the 1-back condition. In anatomical ROIs, both groups showed greater activation in the 2-back versus the 1-back condition, with activation in the non-exposed group proportionally greater for the left prefrontal region (P = .05). In this sample of adolescents, participants who were exposed to cocaine and participants who were not exposed were similar in performance on an executive function task and in fMRI activation patterns during task performance. Hurt, H., Giannetta, J.M., Korczykowski, M., Hoang, A., Tang, K.Z., Betancourt, L., Brodsky, N.L., Shera, D.M., Farah, M.J., and Detre, J.A. Functional Magnetic Resonance Imaging and Working Memory in Adolescents with Gestational Cocaine Exposure. Journal of Pediatrics, 152(3), pp. 371-377, 2008.

Smoking During Teenage Pregnancies and Offspring Behavioral Problems

Dr. Nancy Day and her colleagues at the University of Pittsburgh prospectively examined the relationship between prenatal tobacco exposure (PTE) and child behavior in a birth cohort of 357 offspring of teenage mothers. PTE was defined as any exposure across pregnancy and, in separate analyses, exposure within each trimester. Outcomes included measures of behavior problems, activity, and attention. On average, the children were 6.4 years of age, 48% were females, and 69% were Black. Data on maternal tobacco and other substance use were collected prenatally and postnatally: 46% of the mothers smoked in the first trimester and 58% smoked 6 years later. Child urinary cotinine measured exposure to environmental tobacco smoke (ETS). PTE predicted significantly increased offspring activity; impulsivity; and aggression, externalizing, and total behavior problems in step 1. PTE remained a significant predictor of increased activity when maternal psychological characteristics, home environment, and ETS were added. The results were similar when PTE was examined by trimesters, although later pregnancy tobacco exposure predicted the most behavioral outcomes. In the final model, PTE (all three trimesters) and PTE (second trimester) were significant predictors of increased activity and attention problems, respectively. Other predictors of child behavior included maternal anxiety, depression, hostility, and home environment. ETS was not a significant predictor of child behavior when PTE was considered. Smoking during pregnancy among adolescents is a significant predictor of increased activity and attention problems in their offspring after controlling for covariates in the prenatal and current environments. Smoking cessation interventions are recommended for this population to avoid the effects of PTE on the offspring of pregnant adolescents. This is particularly important because these mothers will likely become pregnant again and many will increase their level of tobacco use as they mature. Cornelius, M.D., Goldschmidt, L., DeGenna, N., and Day, N.L. Smoking During Teenage Pregnancies: Effects on Behavioral Problems in Offspring. Nicotine and Tobacco Research, 9(7), pp. 739-750, 2007.

Volumetric MRI Study of Brain in Children with Intrauterine Exposure to Cocaine, Alcohol, Tobacco, and Marijuana

This study used volumetric MRI to study brain volumes of thirty-five 10- to 14-year-old children with (n=14) and without (n=21) intrauterine exposure to cocaine, alcohol, cigarettes, or marijuana. Volumetric MRI was performed to determine the effect of prenatal drug exposure on volumes of cortical gray matter; white matter; subcortical gray matter; cerebrospinal fluid; and total parenchymal volume. Head circumference was also obtained. Analyses of each individual substance were adjusted for demographic characteristics and the remaining 3 prenatal substance exposures. Regression analyses adjusted for demographic characteristics showed that children with intrauterine exposure to cocaine had lower mean cortical gray matter and total parenchymal volumes and smaller mean head circumference than comparison children. After adjustment for other prenatal exposures, these volumes remained smaller but lost statistical significance. Similar analyses conducted for prenatal ethanol exposure adjusted for demographics showed significant reduction in mean cortical gray matter; total parenchymal volumes; and head circumference, which remained smaller but lost statistical significance after adjustment for the remaining 3 exposures. Notably, prenatal cigarette exposure was associated with significant reductions in cortical gray matter and total parenchymal volumes and head circumference after adjustment for demographics that retained marginal significance after adjustment for the other 3 exposures. Finally, as the number of exposures to prenatal substances grew, cortical gray matter and total parenchymal volumes and head circumference declined significantly with smallest measures found among children exposed to all 4. These data suggest that intrauterine exposures to cocaine, alcohol, and cigarettes are individually related to reduced head circumference; cortical gray matter; and total parenchymal volumes as measured by MRI at school age. Adjustment for other substance exposures precludes determination of statistically significant individual substance effect on brain volume in this small sample; however these substances may act cumulatively during gestation to exert lasting effects on brain size and volume. Rivkin, M.J., Davis, P.E., Lemaster, J.L., Cabral, H.J., Warfield, S.K., Mulkern, R.V., Robson, C.D., Rose-Jacobs, R., and Frank, D.A. Volumetric MRI Study of Brain in Children with Intrauterine Exposure to Cocaine, Alcohol, Tobacco, and Marijuana. Pediatrics, 121(4), pp. 741-750, 2008.

Methadone Maintenance and Breastfeeding in the Neonatal Period

In a sample of methadone-maintained breastfeeding women and a matched group of formula-feeding women, this study evaluated concentrations of methadone in breast milk among breastfeeding women and concentrations of methadone in maternal and infant plasma in both groups. Eight methadone-maintained (dose: 50-105 mg/day), lactating women provided blood and breast milk specimens on days 1, 2, 3, 4, 14, and 30 after delivery, at the times of trough and peak maternal methadone levels. Eight matched formula-feeding subjects provided blood samples on the same days. Infant blood samples for both groups were obtained on day 14. Urine toxicological screening between 36 weeks of gestation and 30 days after the birth confirmed that subjects were not using illicit substances in the perinatal period. Concentrations of methadone in breast milk were low (range: 21.0-462.0 ng/mL) and not related to maternal dose. There was a significant increase in methadone concentrations in breast milk over time for all 4 sampling times. Concentrations of methadone in maternal plasma were not different between groups and were unrelated to maternal dose. Concentrations of methadone in infant plasma were low (range: 2.2-8.1 ng/mL) in all samples. Infants in both groups underwent neurobehavioral assessments on days 3, 14, and 30; there were no significant effects of breastfeeding on neurobehavioral outcomes. Fewer infants in the breastfed group required pharmacotherapy for neonatal abstinence syndrome, but this was not a statistically significant finding. Results contribute to the recommendation of breastfeeding for methadone-maintained women. Jansson, L.M., Choo, R., Velez, M.L., Harrow, C., Schroeder, J.R., Skakleya, D.M., and Huestis, M.A., Methadone Maintenance and Breastfeeding in the Neonatal Period. Pediatrics, 121(1), pp. 106-114, 2008.

Impact of Prenatal Cocaine Exposure on Attention and Response Inhibition as Assessed by Continuous Performance Tests

This longitudinal study examined the influence of prenatal cocaine exposure on attention and response inhibition measured by continuous performance tests (CPTs) at ages 5 and 7 years. The sample included 415 children from the Miami Prenatal Cocaine Study (219 cocaine-exposed, 196 non-cocaine-exposed as determined by maternal self-report and infant bioassays). Children were enrolled prospectively at birth and assessed comprehensively through age 7 years. Deficits in attention and response inhibition were estimated in relation to prenatal cocaine exposure using generalized estimating equations within the general linear model. Results indicate cocaine-associated increases in omission errors at ages 5 and 7 as well as increases in response times for target tasks (i.e., slower reaction times) and decreased consistency in performance at age 7. There were no demonstrable cocaine-associated deficits in commission errors. Estimates did not change markedly with statistical adjustment for selected prenatal and postnatal covariates. Evidence supports cocaine-associated deficits in attention processing through age 7 years. Accornero, V.H., Amado, A.J., Morrow, C.E., Xue, L., Anthony, J.C., and Bandstra, E.S. Impact of Prenatal Cocaine Exposure on Attention and Response Inhibition as Assessed by Continuous Performance Tests. Journal of Developmental Behavioral Pediatrics, 28(3), pp. 195-205, 2007.

P3 Components of the Event-Related Potential and Marijuana Dependence in Southwest California Indians

Marijuana use and abuse is very high in Native Americans; however, little is known about neurobiological measures that are associated with marijuana addiction in this population. This study utilized event-related potentials to examine the responses to a facial recognition task in an adult sample of 317 Southwest California (SWC) Indians with (1) no drug dependence diagnosis; (2) marijuana use, but not other drug dependence diagnosis; and (3) marijuana dependence, as well as other drug dependence diagnosis. After taking age, gender, and the presence of a lifetime diagnosis of alcohol dependence into consideration; an increased latency in the P350 and P450 component peaks was found in those individuals with a diagnosis of marijuana dependence and also marijuana dependence co-morbid with other drug dependence. The amplitudes of these late component peaks were not associated with a diagnosis of marijuana dependence. Women appeared to be more impacted by a marijuana dependence diagnosis in that the P450 latencies were longer in females than in males which may be indicative of greater toxicity. The findings suggest that marijuana dependence may be associated with delays in the evaluation and identification of emotional stimuli in SWC Indians. Further longitudinal studies will be necessary to determine whether pre-disposing or co-morbid factors are a possible cause of the P300 latency effects in this high risk and understudied ethnic group. Ehlers, C., Gilder, D., and Phillips, E. P3 Components of the Event-Related Potential and Marijuana Dependence in Southwest California Indians. Addiction Biology, 13(11), pp. 130-142, 2008.

Clinical Neuroscience Research

Presence of a Social Stressor Inhibits the Ability to Learn from Bad Choices in a Gambling Task in Men More than in Women

Antoine Bechara and colleagues at University of Southern California used neuropsychological testing to investigate whether decision making during a task is disrupted by an emotional stressor unrelated to the task. Drug-dependent individuals typically encounter a variety of social stressors, some of which are self-initiated. Two groups of healthy volunteers played the Iowa Gambling Task, with one group anticipating having to give a public speech. Those who anticipated having to give a speech took longer to learn to make advantageous choices. In addition, a gender interaction was present later in the game. Stressed female participants exhibited more explicit knowledge and more advantageous performance than stressed males. These results indicate that effects of anticipatory stress on decision making are complex and depend on both the nature of the task and the individual. Preston, S.D., Buchanan, T.W., Stansfield, R.B., and Bechara, A. Effects Of Anticipatory Stress On Decision Making In A Gambling Task. Behavioral Neuroscience, 121(2), pp. 257-263, 2007.

Emotional Stimuli and Context Moderate Effects of Nicotine on Specific but Not Global Affects

David Gilbert and colleagues at the University of Southern Illinois investigated how nicotine interacts with the emotional and cognitive modulation of attention. The study involved the presence or absence of emotionally positive and negative stimuli and attentional choice to avoid attending to emotionally negative stimuli. Two groups of habitual smokers (32 per group) performed attentional tasks in which they either had the freedom to look back and forth at 2 simultaneously presented pictures or viewed single pictures without attentional choice. Blocks of pictures contained one of 4 combinations of picture types: a) emotionally negative + neutral, b) negative + positive, c) positive + neutral, or d) neutral + neutral. Participants wore a nicotine patch on one day and a placebo patch on a second day. Nicotine reduced anxiety most when negative pictures were presented in combination with neutral pictures, but it had no effect on anxiety when negative pictures were presented in combination with positive pictures and when negative pictures were not presented. In contrast, nicotine only reduced depressive affect when the participant had attentional choice between positive and negative pictures. Nicotine also enhanced positive affect and reduced negative affect as measured by the Positive and Negative Affect Schedule, but these effects were not moderated by task manipulations. Nicotine tended to enhance eye-gaze orientation to emotional pictures versus neutral pictures in women, but it had no significant effect on eye-gaze in men. Overall, the findings support the view that nicotine's ability to reduce specifically negative affect is moderated by overall emotional context and attentional freedom. Gilbert, D.G., Riise, H., Dillon, A., Huber, J., Rabaanovich, N.E., and Sugai, C. Exp. Clin. Psychopharmacol., 16(1), pp. 33-42, 2008.

Interactions Between Genotype and Retrospective ADHD Symptoms Predict Lifetime Smoking Risk in a Sample of Young Adults

Joseph McClernon and colleagues at Duke University investigated whether ADHD symptoms interact with candidate gene variation to predict smoking risk. Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with an increased risk of smoking, and genetic studies have identified similar candidate genes associated with both ADHD and smoking phenotypes. Participants were a subsample of individuals from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of adolescents followed from 1995 to 2002. The sample analyzed included a subset from Add Health of 1,900 unrelated individuals with genotype data. Multiple logistic regression was used to examine relationships between self-reported ADHD symptoms, genotype, and lifetime history of regular smoking. Polymorphisms in the Dopamine D2 receptor gene and, the MAO-A gene (females only) interacted with retrospective reports of ADHD symptoms in contributing to risk for smoking. Trends were observed for interactions between the Dopamine D4 receptor gene and the MAO-A gene (males only) and ADHD symptoms to predict smoking risk. No main effect for any of these polymorphisms was observed. No main effects or interactions with CYP2A6, DAT, and SLC6A4 genes were found. These findings suggest that genotypes associated with catecholamine neurotransmission interact with ADHD symptoms to predict lifetime smoking risk in a sample of young adults. McClernon, F.J., Fuemmeler, B.F., Kollins, S.H., Kail, M.E., and Ashley-Koch, A.E. Nicotine Tob. Res., 10(1), pp. 117-127, 2008.

Epidemiology And Etiology Research

Specificity of Genetic Factors for Dependence on Licit and Illicit Drugs

Although genetic risk factors have been found to contribute to dependence on both licit and illicit psychoactive substances, we know little of how these risk factors interrelate. This study sought to clarify the structure of genetic and environmental risk factors for symptoms of dependence on cannabis, cocaine, alcohol, caffeine, and nicotine in males and females. Four thousand eight hundred sixty-five adult members of male-male and female-female pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders were assessed for lifetime symptoms of abuse of and dependence on cannabis, cocaine, alcohol, caffeine, and nicotine by structured interview. Controlling for greater symptom prevalence in males, genetic and environmental parameters could be equated across sexes. Two models explained the data well. The best-fit exploratory model contained 2 genetic factors and 1 individual environmental factor contributing to all substances. The first genetic factor loaded strongly on cocaine and cannabis dependence; the second, on alcohol and nicotine dependence. Nicotine and caffeine had high substance-specific genetic effects. A confirmatory model, which also fit well, contained 1 illicit drug genetic factor--loading only on cannabis and cocaine--and 1 licit drug genetic factor loading on alcohol, caffeine, and nicotine. However, these factors were highly intercorrelated (r = + 0.82). Large substance-specific genetic effects remained for nicotine and caffeine. The authors conclude that the pattern of genetic and environmental risk factors for psychoactive substance dependence was similar in males and females, and that genetic risk factors for dependence on common psychoactive substances cannot be explained by a single factor. Rather, two genetic factors-one predisposing largely to illicit drug dependence, the other primarily to licit drug dependence-are needed. Furthermore, a large proportion of the genetic influences on nicotine and particularly caffeine dependence appear to be specific to those substances. Kendler, K., Myers, J., and Prescott, C. Specificity of Genetic and Environmental Risk Factors for Symptoms of Cannabis, Cocaine, Alcohol, Caffeine, and Nicotine Dependence. Arch. Gen. Psychiatry, 64(11), pp. 1313-1320, 2007.

Neighborhood Income and Income Distribution and the Use of Cigarettes, Alcohol, and Marijuana

Evidence about the relationship between contextual variables and substance use is conflicting. Relationships between neighborhood income and income distribution and the prevalence and frequency of substance use in 59 New York City (NYC) neighborhoods were assessed while accounting for individual income and other socio-demographic variables. Measures of current substance use (in the 30 days prior to the survey) were obtained from a random-digit-dial phone survey of adult residents of NYC and data from the 2000 U.S. Census to calculate median neighborhood income and income distribution (assessed using the Gini coefficient). Among 1355 respondents analyzed (female=56.2%, mean age=40.4), 23.9% reported cigarette, 40.0% alcohol, and 5.4% marijuana use in the previous 30 days. In ecologic assessment, neighborhoods with both the highest income and the highest income maldistribution had the highest prevalence of drinking alcohol (69.0%) and of smoking marijuana (10.5%) but not of cigarette use; there was no clear ecologic association between neighborhood income, income distribution, and cigarette use. In multilevel multivariable models adjusting for individual income, age, race, sex, and education, high neighborhood median income and maldistributed neighborhood income were both significantly associated with a greater likelihood of alcohol and marijuana use but not of cigarette use. Both high neighborhood income and maldistributed income also were associated with greater frequency of alcohol use among current alcohol drinkers. These observations suggest that neighborhood income and income distribution may play more important roles in determining population use of alcohol and marijuana than individual income, and that determinants of substance use may vary by potential for drug dependence. Further research should investigate specific pathways that may explain the relationship between neighborhood characteristics and use of different substances. Galea, S., Ahern, J., Tracy, M., and Vlahov, D. Neighborhood Income and Income Distribution and the Use of Cigarettes, Alcohol, and Marijuana. Am. J. Prev. Med., 32 (6 Suppl), pp. S195-S202, 2007.

Study Describes Current Patterns of Extra-Medical Drug Use

In 1994, epidemiological patterns of extra-medical drug use in the United States were estimated from the National Comorbidity Survey. This paper describes such patterns based upon more recent data from the National Comorbidity Survey Replication (NCS-R). The NCS-R was a nationally representative face-to-face household survey of 9282 English-speaking respondents, aging 18 years and older, conducted in 2001-2003 using a fully structured diagnostic interview, the WHO Composite International Diagnostic Interview (CIDI) Version 3.0. The estimated cumulative incidence of alcohol use in the NCS-R was 92%; tobacco, 74%; extra-medical use of other psychoactive drugs, 45%; cannabis, 43% and cocaine, 16%. Statistically robust associations existed between all types of drug use and age, sex, income, employment, education, marital status, geography, religious affiliation and religiosity. Very robust birth cohort differences were observed for cocaine, cannabis, and other extra-medical drug use, but not for alcohol or tobacco. Trends in the estimated cumulative incidence of drug use among young people across time suggested clear periods of fluctuating risk. These epidemiological patterns of alcohol, tobacco, and other extra-medical drug use in the United States in the early 21st century provide an update of NCS estimates from roughly 10 years ago, and are consistent with contemporaneous epidemiological studies. New findings on religion and religiosity, and exploratory data on time trends, represent progress in both concepts and methodology for such research. These estimates lead to no firm causal inferences, but contribute to a descriptive epidemiological foundation for future research on drug use and dependence across recent decades, birth cohorts, and population subgroups. Degenhardt, L., Chiu, W., Sampson, N., Kessler, R., and Anthony, J. Epidemiological Patterns of Extra-Medical Drug Use in the United States: Evidence from the National Comorbidity Survey Replication, 2001-2003. Drug Alcohol Depend., 90 (2-3), pp. 210-223, 2007.

Screening for Drug Abuse Among Medical and Nonmedical Users of Prescription Drugs in a Probability Sample of College Students

This study examined the prevalence of medical and nonmedical use of 4 classes of prescription drugs (opioid, stimulant, sleeping, and sedative or anxiety) and assessed probable drug abuse among 4 mutually exclusive groups of medical and nonmedical use of prescription drugs. Data were obtained from a 2005 self-administered Web-based survey of college students from a large, Midwestern 4-year university. The survey used a probability sample design, yielded a 68% response rate and a final sample of 3639 college students. The sample had a mean age of 19.9 years, and respondents were 53.6% female, 67.4% white, 12.1% Asian, 6.0% African American, 4.2% Hispanic, and 10.2% other racial categories. Medical and nonmedical use of prescription drugs was measured. Probable drug abuse was assessed using a modified version of the Drug Abuse Screening Test, Short Form. A total of 40.1% of respondents reported no lifetime use of at least 1 of 4 classes of prescription drugs, 39.7% reported medical use only, 15.8% reported both medical and nonmedical use, and 4.4% reported nonmedical use only. The odds of a positive screening result for drug abuse were greater among medical and nonmedical users (adjusted odds ratio, 5.5; 95% confidence interval, 3.4-7.3) and nonmedical users only (adjusted odds ratio, 6.5; 95% confidence interval, 4.0-10.6) compared with nonusers. The odds of a positive screening result for drug abuse did not differ between medical users only and nonusers. These findings suggest that nonmedical users of prescription drugs are at heightened risk for drug abuse, whereas medical users without a history of nonmedical use are generally not at increased risk. The authors conclude that drug abuse screening should be routine for college students, especially among individuals with any history of nonmedical use of prescription drugs. McCabe, S. Screening for Drug Abuse Among Medical and Nonmedical Users of Prescription Drugs in a Probability Sample of College Students. Arch. Pediatr. Adolesc. Med., 162(3), pp. 225-231, 2008.

Misperceptions of Non-medical Prescription Drug Use Among College Students

This study compared undergraduate students' perceived versus actual prevalence rates of non-medical use of marijuana, prescription opioids and prescription stimulants. In 2005, a randomly selected sample of 3639 college students self-administered a Web survey regarding their substance use behaviors and attitudes (68% response rate). Analysis showed that the majority of undergraduate students overestimated the prevalence of non-medical use of prescription stimulants (70.2%) and prescription opioids (69.9%) and marijuana use (50.5%) among peers on their campus. The mean difference between perceived versus actual past-year use was considerably greater for non-medical use of prescription stimulants (mean difference=12.2, 95% CI=11.7-12.7) and prescription opioids (mean difference=8.8, 95% CI=8.3-9.2) than marijuana (mean difference=2.9, 95% CI=2.2-3.6). Multivariate regression analysis revealed overestimation of non-medical use of prescription drugs was significantly associated with gender and medical use of prescription drugs. The authors conclude that the study results provide strong evidence of misperception of non-medical prescription drug use among college students and suggest that future research and prevention efforts should assess the impact of correcting misperceived norms on reducing non-medical prescription drug use. McCabe, S. E. Misperceptions of Non-medical Prescription Drug Use: A Web Survey of College Students. Addict. Behav., 33, pp. 713-724, 2008.

Association Between Early Onset of Non-medical Use of Prescription Drugs and Subsequent Prescription Drug Use and Dependence

This study examined the associations between early onset of non-medical use of prescription drugs (NMUPD) (i.e. sedatives, tranquilizers, opioids, stimulants) and the development of prescription drug abuse and dependence in the United States. Data were collected from structured diagnostic interviews using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Use Disorder and Associated Disabilities Interview Schedule: Diagnostic and Statistical Manual version IV (DSM-IV). National prevalence estimates were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n = 43,093). NESARC included a nationally representative cross-sectional sample of civilian non-institutionalized adults aged 18 years or older in the United States, of whom 52% were women, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American or of other racial background. Analyses revealed that a higher percentage of individuals who began using prescription drugs non-medically at or before 13 years of age were found to have developed prescription drug abuse and dependence as compared with those individuals who began using at or after 21 years of age. Multivariate logistic regression analyses indicated that the odds of developing any life-time prescription drug abuse among non-medical users was reduced by approximately 5% with each year non-medical use was delayed [adjusted odds ratio (AOR) = 0.95, 95% CI = 0.94, 0.97], and that the odds of developing any lifetime prescription drug dependence were reduced by about 2% with each year onset was delayed (AOR = 0.98, 95% CI = 0.96, 1.00) when controlling for relevant covariates. The authors conclude that early onset of NMUPD was a significant predictor of prescription drug abuse and dependence. These findings reinforce the importance of developing prevention efforts to reduce NMUPD and diversion of prescription drugs among children and adolescents. McCabe, S., West, B., Morales, M., Cranford, J., and Boyd, C. Does Early Onset of Non-medical Use of Prescription Drugs Predict Subsequent Prescription Drug Abuse and Dependence? Results from a National Study. Addiction, 102(12), pp. 1920-1930, 2007.

Non-prescribed Use of Pain Relievers among Adolescents in the United States

This study examined gender-specific prevalences, patterns, and correlates of non-prescribed use of pain relievers (mainly opioids) in a representative sample of American adolescents (N=18,678). Data were drawn from the public use data file of the 2005 U.S. National Survey on Drug Use and Health, a survey of non-institutionalized American household residents. Patterns of non-prescribed use of prescription pain relievers were examined, and logistic regression procedures were conducted to identify correlates of non-prescribed use. Analysis showed that approximately one in 10 adolescents aged 12-17 years reported non-prescribed use of pain relievers in their lifetime (9.3% in males and 10.3% in females). The mean age of first non-prescribed use was 13.3 years, which was similar to the mean age of first use of alcohol and marijuana but older than the age of first inhalant use. Among all non-prescribed users, 52% reported having used hydrocodone products (Vicodin, Lortab, Lorcet, and Lorcet Plus, and hydrocodone), 50% had used propoxyphene (Darvocet or Darvon) or codeine (Tylenol with codeine), and 24% had used oxycodone products (OxyContin, Percocet, Percodan, and Tylox). Approximately one quarter (26%) of all non-prescribed users had never used other non-prescribed or illicit drugs. There were gender variations in correlates of non-prescribed use. These findings indicate that use of non-prescribed pain relievers occurs early in adolescence. The authors suggest that research is needed to understand whether early use of non-prescribed pain relievers is related to later drug use. Wu, L., Pilowsky, D., and Patkar, A. Non-Prescribed Use of Pain Relievers among Adolescents in the United States. Drug Alcohol Depend., 94(1-3), pp. 1-11, 2008.

Specificity of Psychosocial Risk Factors for Child Psychiatric Disorders

Most psychosocial risk factors appear to have general rather than specific patterns of association with common childhood and adolescence disorders. However, previous research has typically failed to 1) control for comorbidity among disorders, 2) include a wide range of risk factors, and 3) examine sex by developmental stage effects on risk factor-disorder associations. This study tests the specificity of putative psychosocial risk factors while addressing these criticisms. Eight waves of data from the Great Smoky Mountains Study (N = 1,420) were used, covering children in the community age 9-16 years old. Youth and one parent were interviewed up to seven times using the Child and Adolescent Psychiatric Assessment, providing a total of 6,674 pairs of interviews. A wide range of putative neighborhood, school, peer, family, and child risk factors, and common and comorbid youth disorders were assessed. The authors found that a majority of putative risk factors were specific to one disorder or one disorder domain. A unique or ''signature set '' of putative risk factors was identified for each disorder. Several putative risk factors were associated with a disorder in preadolescent males, preadolescent females, adolescent males, or adolescent females only. They conclude that there is a need to define risk factors and disorders narrowly, to control comorbidity and other risk factors, and to consider developmental patterns of specificity by sex. This may augment efforts in the prevention arena. Shanahan, L., Copeland, W., Costello, E., and Angold, A. Specificity of Putative Psychosocial Risk Factors for Psychiatric Disorders in Children and Adolescents. J. Child. Psychol. Psychiatry, 49(1), pp. 34-42, 2008.

The Formation of a Socioeconomic Disparity: A Case Study of Cocaine and Marijuana Use in the 1990s'

Around 1990, the reputation of cocaine use changed from glamorous to undesirable, and at the same time, a socioeconomic disparity in cocaine use emerged. This study examined (1) whether the socioeconomic disparity was created by differential incidence, differential cessation, or both, (2) whether a socioeconomic disparity also developed in marijuana use, and (3) whether disparities formed across race, Hispanic ethnicity, and/or gender. The analyses center on 6544 respondents aged 14-21 in 1979 in the National Longitudinal Survey of 1979 that provided information on past-year use of powder cocaine and marijuana use before and after 1990--specifically, in 1984, 1988, 1992, 1994, and 1998. Both differential incidence and differential cessation across education contributed to the formation of the socioeconomic disparity in cocaine use, although differential cessation played a more influential role in this cohort. A socioeconomic disparity in marijuana use also came about around the same time. No emerging disparities by race, Hispanic ethnicity, or gender were observed. This case study suggests that the redefinition of a health behavior as unhealthy will result in a socioeconomic disparity in the behavior across socioeconomic strata as a result of both differential incidence and cessation, but disparities will not necessarily form by race, ethnicity, or gender. Miech, R., and Chilcoat, H. The Formation of A Socioeconomic Disparity: A Case Study of Cocaine and Marijuana Use in the 1990s. Am. J. Prev. Med., 32 (6 Suppl), pp. S171-s176, 2007.

Rapid Increase in the Diagnosis of Youth Bipolar Disorder

Although bipolar disorder may have its onset during childhood, little is known about national trends in the diagnosis and management of bipolar disorder in young people. The purpose of this study was to present national trends in outpatient visits with a diagnosis of bipolar disorder and to compare the treatment provided to youth and adults during those visits. Investigators compared rates of growth between 1994-1995 and 2002-2003 in visits with a bipolar disorder diagnosis by individuals aged 0 to 19 years vs those aged 20 years or older. For the period of 1999 to 2003, we also compare demographic, clinical, and treatment characteristics of youth and adult bipolar disorder visits. Patient visits from the National Ambulatory Medical Care Survey (1999-2003) with a bipolar disorder diagnosis (n = 962) were assessed drawn from outpatient visits to physicians in office-based practice. Visits with a diagnosis of bipolar disorder by youth (aged 0-19 years) and by adults (aged > or = 20 years) were assessed. The study indicated the estimated annual number of youth office-based visits with a diagnosis of bipolar disorder increased from 25 (1994-1995) to 1003 (2002-2003) visits per 100,000 population, and adult visits with a diagnosis of bipolar disorder increased from 905 to 1679 visits per 100,000 population during this period. In 1999 to 2003, most youth bipolar disorder visits were by males (66.5%), whereas most adult bipolar disorder visits were by females (67.6%); youth were more likely than adults to receive a comorbid diagnosis of attention-deficit/hyperactivity disorder (32.2% vs 3.0%, respectively; P < .001); and most youth (90.6%) and adults (86.4%) received a psychotropic medication during bipolar disorder visits, with comparable rates of mood stabilizers, antipsychotics, and antidepressants prescribed for both age groups. There has been a recent rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings. This increase highlights a need for clinical epidemiological reliability studies to determine the accuracy of clinical diagnoses of child and adolescent bipolar disorder in community practice. Moreno, C., Laje, G., Blanco, C., Jiang, H., Schmidt, A., and Olfson, M. National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth. Arch. Gen. Psychiatry, 64(9), pp. 1032-1039, 2007.

The Impact of Sociodemographic Factors and Psychiatric Disorders on Maternal Smoking During Pregnancy

Maternal smoking during pregnancy increases birth complication risk and has long-term developmental consequences for child development. This study investigated the relative importance of sociodemographic factors and psychiatric disorders for smoking among 453 pregnant women in the National Epidemiological Survey on Alcohol and Related Conditions. Women with less than a high school education and those with current-year nicotine dependence had the highest risk of smoking (90.5%), compared with women with a college degree and without nicotine dependence (3.9%). More effective and accessible interventions for nicotine dependence among pregnant smokers are needed. Gilman, S., Breslau, J., Subramanian, S., Hitsman, B., and Koenen, K. Social Factors, Psychopathology, and Maternal Smoking During Pregnancy. Am. J. Public Health, 98(3), pp. 448-453, 2008.

Getting Into Ecstasy: Comparing Moderate and Heavy Young Adult Users

In this article, the authors examine factors associated with initial and present Ecstasy use among young adults. Face-to-face structured interviews were conducted in Atlanta, Georgia among 261 active Ecstasy users. The median age at which respondents first heard of Ecstasy was 16 years, whereas the median age of first Ecstasy use was 18 years. Initial Ecstasy use frequently involved polydrug use, including alcohol (50.4%). In terms of their current use, 47.5% of respondents were considered heavy Ecstasy users (using on 10 or more separate occasions in the last 90 days). White respondents, those who used more than one pill during their initial use, and those who used again within one month after their initial use were more likely to be current heavy Ecstasy users. Women, those who waited a longer time between initial and subsequent Ecstasy use, and those who considered themselves in the upper SES bracket were less likely to be current heavy Ecstasy users. A better understanding of initial and current Ecstasy use patterns, including polydrug use, is essential for effective prevention and intervention efforts. Sterk, C., Theall, K., and Elifson, K. Getting Into Ecstasy: Comparing Moderate and Heavy Young Adult Users. J. Psychoactive Drugs, 39(2), pp. 103-113, 2007.

Social Anxiety and Risk for Alcohol and Cannabis Dependence

Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUDs) and cannabis dependence. However, the temporal sequencing of these disorders has not been extensively studied to determine whether SAD serves as a specific risk factor for problematic substance use. The present study examined these relationships after controlling for theoretically-relevant variables (e.g., gender, other Axis I pathology) in a longitudinal cohort over approximately 14 years. The sample was drawn from participants in the Oregon Adolescent Depression Project., who were originally recruited as adolescents from high schools in 1987-89, at a mean age of 16.6 years. The sample, half female, was followed at ages 24 and 30; the final data point was collected from 816 participants, 59% women, 59% Caucasian. After excluding those with substance use disorders at baseline, SAD at study entry was associated with 6.5 greater odds of cannabis dependence (but not abuse) and 4.5 greater odds of alcohol dependence (but not abuse) at follow-up after controlling for relevant variables (e.g., gender, depression, conduct disorder). The relationship between SAD and alcohol and cannabis dependence remained even after controlling for other anxiety disorders. Other anxiety disorders and mood disorders were not associated with subsequent cannabis or alcohol use disorder after controlling for relevant variables. Among the internalizing disorders, SAD appears to serve as a unique risk factor for the subsequent onset of cannabis and alcohol dependence. Buckner, J., Schmidt, N., Lang, A., Small, J., Schlauch, R., and Lewinsohn, P. Specificity of Social Anxiety Disorder as a Risk Factor for Alcohol and Cannabis Dependence. J. Psychiatr. Res., 42(3), pp. 230-239, 2008.

Correlates of Cannabis Initiation in Young Women

As rates of cannabis use have increased in young women over the last decade, the authors sought to characterize the potential correlates of onset of cannabis use during emerging adulthood. Using data from 1065 females (collected 1994-2005) who participated in both the baseline (ages 16-23) and follow-up wave (ages 20-29) of interviews of the Missouri Adolescent Female Twin Study, they examined the associations between correlates from the peer, parental and individual domains and new onsets of cannabis use, using logistic regression. Univariate models revealed that initiation of cannabis use was associated with alcohol and cigarette use at baseline, peer attitude towards alcohol/cigarette/cannabis use, peer substance use and other aspects of impulse-disinhibited behavior. However, multivariate stepwise modeling retained only the significant influences of alcohol use at baseline and peer attitudes towards cannabis as correlates of cannabis initiation. The authors concluded that having peers with favorable attitudes towards alcohol, cigarette and cannabis use is an important correlate of initiation of cannabis use in women, and that prevention and intervention efforts need to take this into account when developing drug resistance training programs for adolescents. Agrawal, A., Lynskey, M., Bucholz, K., Madden, P., and Heath, A. Correlates of Cannabis Initiation in a Longitudinal Sample of Young Women: The Importance of Peer Influences. Prev. Med., 45(1), pp. 31-34, 2007.

Race/Ethnicity and Gender Differences in Drug Use and Abuse Among College Students

This study examined race/ethnicity and gender differences in drug use and abuse for substances other than alcohol among undergraduate college students. A probability-based sample of 4,580 undergraduate students at a Midwestern university completed a cross-sectional Web-based questionnaire that included demographic information and several substance use measures. Male students were more likely to report drug use and abuse than female students. Hispanic and White students were more likely to report drug use and abuse than Asian and African American students prior to coming to college and during college. Results of multiple logistic regression analysis for past 12-month illicit use of prescription drugs or illicit drugs revealed that after controlling for race, there was no statistically significant effect of gender. With respect to race, results using African Americans as the reference group showed that, controlling for gender, the odds of past 12-month drug use were statistically significantly higher among Whites (OR=1.86) and Hispanics (OR=2.14). The authors conclude that the findings of the present study reveal several important racial/ethnic differences in drug use and abuse that need to be considered when developing collegiate drug prevention and intervention efforts. McCabe, S., Morales, M., Cranford, J., Delva, J., McPherson, M., and Boyd, C. Race/Ethnicity and Gender Differences in Drug Use and Abuse Among College Students. J. Ethn. Subst. Abuse, 6(2), pp. 75-95, 2007.

Intimate Partner Violence Perpetration against Main Female Partners among HIV-Positive Male Injection Drug Users

Intimate partner violence (IPV) against women is a serious public health and social problem and is associated with a host of adverse health outcomes and behaviors, including HIV risk behaviors, among women who are victimized. Historically, research has focused on correlates of IPV victimization among women; thus, there is less information on the role of men in perpetrating IPV, particularly among men at risk for transmitting HIV to their female partners. The authors assessed the self-reported prevalence and correlates of perpetration and threat of perpetration of physical and/or sexual IPV against a main female partner among 317 HIV-positive men who were current injection drug users (IDUs). More than 40% of men reported perpetrating physical (39%) and/or sexual (4%) violence against their main female partners in the past year. Multivariate analyses revealed that low education, homelessness, psychologic distress, and unprotected sex with main and nonmain HIV-negative female partners were positively associated with IPV perpetration against main female partners. These findings reveal that IPV perpetration is prevalent among HIV-positive male IDUs and associated with sexual HIV transmission risk behaviors. IPV assessment and treatment among HIV-positive men in HIV care is recommended as a way to prevent IPV perpetration and victimization and to reduce potential HIV transmission. Frye, V., Latka, M., Wu, Y., Valverde, E., Knowlton, A., Knight, K., Arnsten, J., and O 'Leary, A. Intimate Partner Violence Perpetration against Main Female Partners among HIV-Positive Male Injection Drug Users. J. Acquir. Immune Defic. Syndr., 46 Suppl. 2, pp. S101-S109, 2007.

Blood Contamination in Children's Saliva: Prevalence, Stability, and Impact on the Measurement of Salivary Cortisol, Testosterone, and Dehydroepiandrosterone

The prevalence, stability, and impact of blood contamination in children's saliva on the measurement of three of the most commonly assayed hormones were examined. Participants were 363 children (47% boys; ages 6-13 years) from economically disadvantaged families who donated saliva samples on 2 days in the morning, midday, and late afternoon. Samples (n=2178) were later assayed for cortisol (C), testosterone (T), and dehydroepiandrosterone (DHEA). To index the presence of blood (and its components) in saliva, samples were assayed for transferrin. Transferrin levels averaged 0.37 mg/dl (SD=0.46, range 0.0-5.5, Mode=0), and were: (1) highly associated within individuals across hours and days, (2) positively correlated with age, (3) higher for boys than girls, (4) higher in PM than AM samples, and (5) the highest (>1.0 mg/dl) levels were rarely observed in samples donated from the same individuals. Transferrin levels were associated with salivary DHEA and C, but less so for T. As expected, the relationships were positive, and explained only a small portion of the variance. Less than 1% of the statistical outliers (+2.5 SDs) in salivary hormone distributions had correspondingly high transferrin levels. The researchers conclude that blood contamination in children's saliva samples is rare, and its effects on the measurement of salivary hormones is small. Guidelines and recommendations are provided to steer investigators clear of this potential problem in special circumstances and populations. Granger, D., Cicchetti, D., Rogosch, F., Hibel, L., Teisl, M., and Flores, E. Blood Contamination in Children's Saliva: Prevalence, Stability, and Impact on the Measurement of Salivary Cortisol, Testosterone, and Dehydroepiandrosterone. Psychoneuroendocrinology, 32(6), pp. 724-733, 2007.

Puberty is associated with Changes in the Form and Frequency of Self-Harm

A cross-sectional survey of 12- to 15-year-olds in 300 secondary schools in the U.S. state of Washington in February-April 2002 and the Australian state of Victoria was conducted to ascertain the association between pubertal stage and deliberate self-harm. A total of 3,332 students in grades 7 and 9 provided complete data on episodes of deliberate self-harm in the previous 12 months and pubertal stage. Pubertal stage was assessed with the Pubertal Development Scale, The prevalence of deliberate self-harm was 3.7% with a more than twofold higher rate in females. Late puberty was associated with a more than fourfold higher rate of self-harm (odds ratio 4.6, 95% confidence interval 1.5-14) after adjustment for age and school grade level. In contrast age had a protective association (odds ratio 0.7, confidence interval 0.4-1.0). The sharpest rises in prevalence across puberty were for self-laceration and self-poisoning in females. Higher rates of depressive symptoms, frequent alcohol use, and initiation of sexual activity largely accounted for the association between self-harm and pubertal stage in multivariate models. Puberty is associated with changes in the form and frequency of self-harm. For adolescents with a gap between puberty and brain development, risk factors such as early sexual activity and substance abuse may be particularly potent. Patton, G., Hemphill, S., Beyers, J., Bond, L., Toumbourou, J., McMorris, B., and Catalano, R. Pubertal Stage and Deliberate Self-harm in Adolescents. J. Am. Acad. Child Adolesc. Psychiatry, 46(4), pp. 508-514, 2007.

Sexual Abstinence in Adolescence Predicts Adult Mental Health Differentially for Males and Females

Investigators examined whether adolescent sexual abstinence predicts better adult mental health. 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not males; three adolescent factors, educational prospects, family bonding, and unconventionality were investigated as explanatory variables of this relationship. The abstinence-mental health relationship was nonsignificant when educational prospects was included in multivariate models, and marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls' who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems. Bogart, L., Collins, R., Ellickson, P., and Klein, D. Association of Sexual Abstinence in Adolescence with Mental Health in Adulthood. J. Sex Res., 44(3), pp. 290-298, 2007.

Adolescent Work Related to Slight Decreases in Problem Behavior

Researchers have found mixed support for documenting whether work is protective or harmful during adolescence. This study of 592 African American youth (53% female; M = 14.8 years, SD = .60) examined the association between work and problem behaviors. Youth were followed from mid-adolescence to young adulthood over eight Waves (90% response rate over the first four Waves and a 68% response rate across all eight Waves). Investigators explored three competing operationalizations of work: work history (never worked, worked), work intensity (no work, 20 h or less, and 21 h or over), and work trajectories (never worked, episodic work, stopped working, late starter, and consistent worker). Non-working youth reported higher marijuana use during young adulthood than their working counterparts. Nonworkers reported lower self-acceptance during young adulthood than those working greater number of hours per week. Differences in work trajectories for cigarette use, depression, and anxiety during adolescence imply that when and for how long youth work are also important factors to explore. The findings lend tentative support to the work benefits perspective and suggest that the association between work and problem behaviors may depend in part on how work is measured. Bauermeister, J. A., Zimmerman, M. A., Barnett, T. E., and Caldwell, C. H. Working in High School and Adaptation in the Transition to Young Adulthood among African American Youth. J. Youth Adolescence, 36, pp. 877-890, 2007.

Individual Action and Community Context: the Health Intervention Project

HIV risk-reduction efforts have traditionally focused on the individual. The need for including the role of the social context and community is being recognized. Social capital provides social relationships and potential resources that may hinder or trigger risk or protective health behaviors, especially for individuals with limited economic means. Sixty-five adult inner-city female drug users, who were included in a woman-focused HIV risk-reduction intervention trial, participated in in-depth interviews in Atlanta, Georgia, between 2002 and 2004. The interviews focused on the women's individual behavioral changes during the 6 months since completion of the intervention as well as on the impact of community conditions. Topics discussed were sexual and drug use behaviors, social relationships, social capital, and community physical and social infrastructure. The data were analyzed using the constant comparison methods. The respondents indicated that poor physical and social infrastructure led to alienation and negatively affected their behavioral change efforts. Social capital and social support mediated these negative influences. Drug-related violence was especially debilitating in their efforts to reduce HIV risk associated with crack cocaine or injection drug use and associated sexual behavior. Environmental conditions and opportunity structures played salient roles in the women's success. Individual actions and community context must be considered simultaneously when facilitating and assessing behavioral interventions. Sterk, C., Elifson, K., and Theall, K. Individual Action and Community Context: the Health Intervention Project. Am. J. Prev. Med., 32(6 Suppl), pp. S177-S181, 2007.

Cigarette Smoking Rates in an Adolescent Treatment Sample at Eight-Year Follow Up

This study examined the relationship between cigarette smoking and alcohol use outcomes over an 8-year period following treatment for adolescent alcohol and other drug (AOD) use disorders. A sample of 166 adolescents were recruited during inpatient AOD abuse treatment. Included were 123 (74% of the full sample) participants, of whom 41% were female, 81% identified themselves as White and who averaged 15.9 years of age (SD = 1.3) when entering treatment. Using interviews conducted at the time of treatment and 2-, 4-, 6- and 8-years post-treatment, the investigators found that 26% of participants had quit smoking for > 1 year at the 8-year assessment, while 44% reported persistent smoking over time. Overall smoking rates decreased significantly over time. Those with the highest alcohol involvement trajectory reported significantly greater likelihood of persistent smoking as well as higher current smoking and cigarette consumption across time points. The investigators reported that the significant declines observed in smoking from adolescence into young adulthood were contrary to expectations, indicating that this behavior may be less stable than previously thought among adolescent AOD abusers. Smoking involvement over time was greater within the highest alcohol use trajectory, consistent with previous evidence for a positive relationship between these behaviors'. However, when compared with the general population smoking rates remained very high regardless of alcohol involvement. Thus, individuals treated for AOD abuse as adolescents remained at elevated risk for tobacco related disease regardless of post-treatment AOD use outcomes. Myers, M., Doran, N., and Brown, S. Is Cigarette Smoking Related to Alcohol Use During the 8 Years Following Treatment for Adolescent Alcohol and Other Drug Abuse? Alcohol Alcohol, 42(3), pp. 226-233, 2007.

Adult Smokers in Colombia: Who Isn't Giving It Up?

Without ongoing surveillance systems to assess tobacco product demand and exposure levels, many low and middle income countries monitor smoking via periodic cross-sectional surveys. In this article, the authors provide updated estimates for the prevalence of adult smoking in Colombia and contribute additional information useful for tobacco control initiatives. Data are from the 2003 Colombian National Study of Mental Health (NSMH). A national probability sample of 4426 adults (age 18-65) was assessed via a computer-assisted interview. An estimated 49% of the adult population had smoked at least once in their lifetimes; one in three adults (31%) had smoked regularly. Nearly half of regular smokers had been able to quit (44%; 95% CI=40-48). Several personal and smoking-related characteristics were associated with failing to quit: being a younger age, employed as compared to being a homemaker, and a history of daily use. Quitters and non-quitters were equivalent with respect to sex, educational status, and age of smoking onset. These findings may help guide tobacco control activities in Colombia and other low and middle income countries. Storr, C., Cheng, H., Posada-Villa, J., Aguilar-Gaxiola, S., and Anthony, J. Adult Smokers in Colombia: Who Isn't Giving It Up? Addict Behav., 33(3), pp. 412-421, 2008.

Depressive Symptomatology in Young Adults with a History of MDMA Use: A Longitudinal Analysis

Research suggests that methylenedioxymethamphetamine (MDMA)/ ecstasy can cause serotonin depletion as well as serotonergic neurodegradation that may result in depression. This longitudinal study used the Beck Depression Inventory (BDI-II) to assess depressive symptomatology every six months over a two-year period among a community sample of young adult MDMA/ecstasy users (n = 402). Multilevel growth modeling was used to analyze changes in BDI scores. Between baseline and 24 months, the mean BDI score declined from 9.8 to 7.7. Scores varied significantly across individuals at baseline and declined at a rate of 0.36 points every six months. Persons with higher baseline scores were more likely to have their scores decrease over time. Several factors were significantly associated with score levels, independent of time: gender - men's scores were lower than women's; ethnicity - whites' scores were lower than those of non-whites; education - persons with at least some university education had scores that were lower than those without any college experience; benzodiazepines - current users' scores were higher than non-users; opioids - current users' scores were higher than non-users; and cumulative ecstasy use - people who had used MDMA more than 50 times had scores that were higher than persons who had used the drug less often. The results reported here show low levels of depressive symptoms among a sample that, after 24 months, consisted of both current and former MDMA users. The low and declining mean scores suggest that for most people MDMA/ecstasy use does not result in long-term depressive symptomatology. Falck, R., Jichuan Wang, and Carlson, R. Depressive Symptomatology in Young Adults with a History of MDMA Use: A Longitudinal Analysis. J. Psychopharmacol., 22(1), pp. 47-54, 2008.

An Investigation of a Personal Norm of Condom-Use Responsibility among African American Crack Cocaine Smokers

The purpose of this study was to investigate the unique contribution of a personal norm of condom-use responsibility to the formation of intentions to reduce risks for HIV by using male condoms during vaginal sex. Data were collected from 402 male and 157 female heterosexual African American crack cocaine smokers in Houston, Texas, US. Two structural equation models of the intention to use a condom with the last sex partner were estimated. One model included measures of condom-use attitudes, subjective norms and condom-use self-efficacy. A second model included these three measures and a fourth measure of a personal norm of condom-use responsibility. Separate models were estimated for men and women. The addition of a personal norm of condom-use responsibility provided a significantly better fit to the data than did models including only outcome expectations, subjective norms and self-efficacy. Results also showed distinctly different underlying cognitive structures of condom-use intention for men and women. A personal norm of condom-use responsibility had a strong direct effect on men's intentions to use condoms with the last sex partner. Other variables appeared to have no direct effect on men's intentions. Women's intentions were strongly influenced by a personal norm and social subjective norms. Situational self-efficacy and outcome expectations had weaker, yet significant, effects on women's intentions. These findings suggest promising directions for the development of sexual risk reduction interventions that emphasize the effect of condom-use responsibility on men's intentions to use condoms. Williams, M., Bowen, A., Ross, M., Timpson, S., Pallonen, U., and Amos, C. An Investigation of a Personal Norm of Condom-Use Responsibility Among African American Crack Cocaine Smokers. AIDS Care, 20(2), pp. 225-234, 2008.

An Examination of Perceived Norms and Exchanging Sex for Money or Drugs among Women Injectors in Baltimore, MD

Injection drug users who exchange sex for money or drugs may serve as a bridge group for transmitting HIV between injectors and non-injectors. While many individual characteristics have been linked to exchanging sex, little attention has been given to the influence of social network members. The present study assessed the relationship between exchanging sex and perceptions of peers' sex exchange behaviour and attitude toward sex exchange. The sample was composed of 267 women heroin and cocaine injectors in Baltimore, MD, USA. The results indicate that women who believed that their friends exchanged sex were more than twice as likely to exchange sex in the past 90 days (95% CI: 1.49-2.70). Participants who thought their peers disapproved of sex exchange were 20% less likely to exchange sex (95% CI: 0.67-0.95). These findings suggest the need for peer education interventions that promote norms about safer behaviours. Davey-Rothwell, M., and Latkin, C. An Examination of Perceived Norms and Exchanging Sex for Money or Drugs among Women Injectors in Baltimore, MD. Int. J. STD AIDS, 19(1), pp. 47-50, 2008.

Income Generating Activities of People who Inject Drugs

Injection drug users (IDU) commonly generate income through prohibited activities, such as drug dealing and sex trade work, which carry significant risk. However, little is known about the IDUs who engage in such activities and the role of active drug use in perpetuating this behavior. Researchers evaluated factors associated with prohibited income generation among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS) using logistic and linear regression. They examined which sources of income respondents would eliminate if they did not require money to pay for drugs. Among 275 IDUs, 145 (53%) reported engaging in prohibited income generating activities in the past 30 days. Sex work and drug dealing accounted for the greatest amount of income generated. Non-aboriginal females were the group most likely to report prohibited income generation. Other variables independently associated with prohibited income generation include daily heroin injection (AOR=2.3) and daily use of crack cocaine (AOR=3.5). Among these individuals, 68 (47%) indicated they would forgo these earnings if they did not require money for illegal drugs, with those engaged in sex trade work (62%) being most willing to give up their illegal source of income. These findings suggest that the costs associated with illicit drugs are compelling IDUs, particularly those possessing markers of higher intensity addiction, to engage in prohibited income generating activities. These findings also point to an opportunity to explore interventions that relieve the financial pressure of purchasing illegal drugs and reduce engagement in such activities, such as low threshold employment and expansion of prescription and substitution therapies. Debeck, K., Shannon, K., Wood, E., Li, K., Montaner, J., and Kerr, T. Income Generating Activities of People who Inject Drugs. Drug Alcohol Depend., 91(1), pp. 50-56, 2007.

Gender Differences in Drug Use and Sexual Risk Behaviors among Non-Injecting Heroin Users in Puerto Rico

During the 1990s non-injected heroin use (NIHU) increased notably in several countries. However, few studies have actually examined the drug-using practices and other problem behaviors of NIHUs. In this study, researchers compared male and female NIHUs from Puerto Rico across a number of domains. Recruitment proceeded through visits to drug-copping areas and the local hangouts in their vicinity. Subjects were eligible if they were 18 to 25 years old, had never injected any drugs, and had recently used heroin or cocaine. Study participants were administered a computer-assisted personal interview. Of the 412 NIHUs recruited at the time of this study, 74 (18.0%) were females. Female NIHUs were more likely to report sexual assaults and more likely to manifest severe symptomatology of PTSD than male NIHUs (35.1% vs. 3.6%, p<.01, and 40.5% vs. 25.7%, p=.01, respectively). Females were less likely to report a source of emotional support than males (86.5% vs. 95.3%, p<.01). Close to one in four of the females (23.0%) reported a history of sexually transmitted infections, compared to three percent of the males (p<.01). HIV seroprevalence among females was 4.3% compared to 0.6% among males (p=.01). These findings suggest that female heroin users have a host of different needs compared to male heroin users. Given the scarcity of existing programs for female drug users in Puerto Rico, designing supportive systems that effectively address the specific needs of drug-using women should become a high-priority public health issue. Sosa-Zapata, I., Colon, H., Robles, R., and Cabassa, M. Gender Differences in Drug Use and Sexual Risk Behaviors among Non-Injecting Heroin Users in Puerto Rico., P.R. Health Sci. J., 26(3), pp. 205-211, 2007.

Potential Risk Factors for Injecting among Mexican American Non-Injecting Heroin Users

Researchers examined potential risk factors for initiating, resuming, and transitioning to injecting in a prospective cohort study of 300 Mexican American non-injecting heroin users (NIUs) with distinct injecting histories (i.e., never vs. former injectors). Participants were recruited using multiple sampling approaches, including respondent driven sampling and outreach. The majority of participants were male (77%) and the average age was 22 years (females were significantly older, at 23 years, compared to males, at 21 years, p<.001). NIUs with an injecting history were more likely to use heroin with an IDU, and women were significantly more likely than men to have an IDU sex partner. The young age of the study sample and length of use of non-injecting heroin (for many, more than 4 years of use) suggest the NIU population is at high risk for transitioning to injection drug use. The study also found the cultural characteristic of "fatalism" -- a belief that one's fate is determined by destiny and is inevitable -- among study participants. Former injectors reported that they expected one day to acquire or transmit an infectious disease, including HIV, HBV, or HCV. Attitudes about injecting, perceived vulnerability for infections, fatalism, and length of time using non-injection heroin were found to be important factors for predicting resumption of injecting among former IDUs. These findings bring to light culturally unique risk factors for injecting that may be incorporated into interventions appropriate to the cultural and social context of the Mexican American community. Valdez, A., Neaigus, A., and Cepeda, A. Potential Risk Factors for Injecting among Mexican American Non-Injecting Heroin Users. J. Ethn. Subst. Abuse, 6(2), pp. 49-73, 2007.

The Impact of Education and Race/Ethnicity Differences on Alcohol Dependence

This study attempts to clarify social inequalities in alcohol dependence by investigating SES and race-ethnicity effects on the development of alcohol dependence following first alcohol use. The literature has shown that while lower socioeconomic status (SES) is related to higher risk for alcohol dependence, minority race-ethnicity is often associated with lower risk. Cross-sectional data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). Survival analysis was used to model alcohol dependence onset according to education, race-ethnicity and their interaction. Compared with non-Hispanic whites, age-adjusted and sex-adjusted risks of alcohol dependence were lower among Blacks and Hispanics and higher among American Indians. Individuals without a college degree had higher risks of alcohol dependence than individuals with a college degree or more; however, the magnitude of risk varied significantly by race-ethnicity; odds ratios for less than a college degree were 1.12, 1.46, 2.24, 2.35 and 10.99 among Hispanics, whites, Blacks, Asians, and American Indians, respectively. There was no association between education and alcohol dependence among Hispanics. Race-ethnicity differences in the magnitude of the association between education and alcohol dependence suggest that aspects of racial-ethnic group membership mitigate or exacerbate the effects of social adversity. Gilman, S., Breslau, J., Conron, K., Koenen, K., Subramanian, S., and Zaslavsky, A. Education and Race-Ethnicity Differences in the Lifetime Risk of Alcohol Dependence. J. Epidemiol. Community Health, 62(3), pp. 224-230, 2008.

Family and School Associations of Emotional Distress for Asian-American Sexual Minority Youth

This study examined family and school correlates of emotional distress among Asian-American sexual minority youth in the Midwestern United States. Responses from 91 predominantly Asian-American youth who participated in a state-wide, school-based census survey, the 2001 Minnesota Student Survey (MSS), and reported recent same-gender sexual activity were analyzed. The students ranged in age from 13-19 years and 37% of respondents were female. Results showed that sexual minority youth who perceived lower levels of family caring and those with negative perceptions of school climate reported lower self-esteem, which was associated with greater emotional distress. These results highlight the importance of safe and caring environments, and culturally sensitive support for Asian-American sexual minority adolescents., Homma, Y., and Saewyc, E. The Emotional Well-Being of Asian-American Sexual Minority Youth in School. J. LGBT Health Res., 3(1), pp. 67-78, 2007.

Challenges to HIV Prevention among Men Who Have Sex with Transgender Women

Although transgender women are acknowledged as a priority population for HIV prevention, there is little knowledge regarding men who have sex with transgender women (MSTGWs). MSTGWs challenge conventional sexual orientation categories in public health and HIV prevention research, and warrant increased attention from the public health community. This study utilized qualitative techniques to assess how MSTGWs describe their sexual orientation identities, and to explore the correspondence between men's identities and sexual behaviors with transgender women. The investigators conducted in-depth semi-structured individual interviews with 46 MSTGWs in San Francisco. They observed a diversity in the ways participants identified and explained their sexual orientation, and found no consistent patterns between how men described their sexual orientation identity versus their sexual behavior and attraction to transgender women. Findings from this qualitative study question the utility of category-based approaches to HIV prevention with MSTGWs and offer insights into developing HIV interventions for these men. Operario, D., Burton, J., Underhill, K., and Sevelius, J. Men Who Have Sex with Transgender Women: Challenges to Category-Based HIV Prevention. AIDS Behav., 12(1), pp. 18-26, 2008.

Fast Track Randomized Controlled Trial to Prevent Externalizing Psychiatric Disorders: Findings From Grades 3 to 9

This study tests the efficacy of the Fast Track Program in preventing antisocial behavior and psychiatric disorders among groups varying in initial risk. Schools within four sites (Durham, NC; Nashville, TN; Seattle, WA; and rural central Pennsylvania) were selected as high-risk institutions based on neighborhood crime and poverty levels. After screening 9,594 kindergarteners in these schools, 891 highest risk and moderate-risk children (69% male and 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention (begun in 1991 with three yearly cohorts) included parent behavior-management training, child social-cognitive skills training, reading tutoring, home visiting, mentoring, and a universal classroom curriculum. Outcomes included criterion counts and psychiatric diagnoses after grades 3, 6, and 9 for conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, any externalizing disorder, and self-reported antisocial behavior. Grade 9 outcomes were assessed between 2000 and 2003, depending upon cohort. Significant interaction effects between intervention and initial risk level were found at each age but most strongly after grade 9. Assignment to intervention had a significant positive effect in lowering criterion count scores and diagnoses for conduct disorder, attention-deficit/hyperactivity disorder, and any externalizing disorder, and lowering antisocial behavior scores, but only among those at highest risk initially. Prevention of serious antisocial behavior can be efficacious across sex, ethnicity, and urban/rural residence, but screening is essential. Bierman, K.L., Coie, J.D., Dodge, K.A., Foster, E.M., Greenberg, M.T., Lochman, J.E., McMahon, R.J., and Pinderhughes, E.E. Fast Track Randomized Controlled Trial to Prevent Externalizing Psychiatric Disorders: Findings from Grades 3 to 9. J. Am. Acad. Child Adolesc. Psychiatry, 46(10), pp. 1250-1262, 2007.

Cueing Prenatal Providers to Counsel Pregnant Women with Behavioral Health Risks

This study examined the impact of the Health in Pregnancy (HIP) computer program on prenatal providers' counseling about behavioral risks with patients, in particular risk for intimate partner violence (IPV) during pregnancy. English-speaking women 18 years or older, less than 26-weeks pregnant, and receiving prenatal care at one of five participating clinics in the San Francisco area, were randomized in parallel groups in a controlled trial. Participants reporting one or more risks were randomized to intervention or control in stratified blocks. Providers received summary "cueing sheets" alerting them to their patient's risk(s) and suggesting counseling statements. Thirteen percent (37/286) of the sample reported current IPV. Provider cueing resulted in 85% of the IPV-intervention group reporting discussions with their provider, compared to 23.5% of the control group (p<0.001). Thus IPV discussions were influenced strongly by cueing providers. Provider cueing may be an effective and appropriate adjunct to routine risk counseling in prenatal care. Calderon, S., Gilbert, P., Jackson, R., Kohn, M., and Gerbert, B. Cueing Prenatal Providers Effects on Discussions of Intimate Partner Violence. Am. J. Prev. Med., 34(2), pp. 134-137, 2008.

Brief Interventions for College Students Can Influence Multiple Health Behaviors

This study examined the effects of brief image-based interventions, including a multiple behavior health contract, a one-on-one tailored consultation, and a combined consultation plus contract intervention, for impacting multiple health behaviors of students in a university health clinic. A total of 155 college students attending a major southern university were recruited to participate in a study evaluating a health promotion program titled Project Fitness during the fall 2005 and spring 2006. The majority of the participating students were female (66%), with a mean age of 19 years. The sample was diverse, with a slight majority being Caucasian (52%), followed by Hispanic (14%), African American (11%), and Asian youth (7%). Participants were randomly assigned to one of three treatments as they presented at the clinic: 1) a multiple behavior health contract, 2) a one-on-one tailored consultation, or 3) a combined consultation plus contract intervention. Baseline and 1-month post-intervention data were collected using computer-assisted questionnaires in a quiet office within the student health clinic. Omnibus repeated-measures analyses of variance were significant for drinking driving behaviors, F(2,136) = 4.43, p = .01, exercise behaviors, F(5,140) = 6.12, p = .00, nutrition habits, F(3,143) = 5.37, p = .00, sleep habits, F(2,144) = 5.03, p = .01, and health quality of life, F(5,140) = 3.09, p = .01, with improvements on each behavior across time. Analysis of group-by-time interaction effects showed an increase in the use of techniques to manage stress, F (2,144) = 5.48, p = .01, and the number of health behavior goals set in the last 30 days, F (2,143) = 5.35, p = .01, but only among adolescents receiving the consultation, or consultation plus contract. Effect sizes were consistently larger across health behaviors, and medium in size, when both consult and contract were used together. Brief interventions using a positive goal image of fitness, and addressing a number of health habits using a contract and consultation strategy alone, or in combination, have the potential to influence positive changes in multiple health behaviors of college students attending a university primary health care clinic. Werch, C., Bian, H., Moore, M., Ames, S., DiClemente, C., and Weiler, R. Brief Multiple Behavior Interventions in a College Student Health Care Clinic. J. Adolesc. Health, 41(6), pp. 577-585, 2007.

Diet Initiation Predicts Smoking Initiation Among Adolescent Females

This study was aimed at examining the relation between dieting and smoking initiation among adolescents. Prospective data from a nationally representative study were used. Specifically, the study used two waves (1994 to 1996) of the National Longitudinal Study of Adolescent Health. The sample included 7795 non-Latino Caucasian and non-Latino African-American adolescents. Dieting status was the independent variable and trying smoking and initiation of regular smoking were the dependent variables. Covariates included age, ethnicity, overweight status, false self-perception about being overweight, and availability of cigarettes at home. Logistic regression and latent transition analyses were used. Females had a higher prevalence of dieting (55%) when compared with males (25%). Dieting initiation was a significant predictor for initiation of regular smoking among females (OR = 1.94, p = .010), but not among males. Inactive dieting was a significant predictor among males (OR = 1.74, p = .031), but not among females. Compared to nondieters, initiating and consistent female dieters reported a higher probability of transitioning to having tried regular smoking, although results from logistic regression suggested that the association between consistent dieting and initiation of regular smoking was not significant. This analysis suggests that there is a positive relation between initiating dieting and initiating regular smoking among females, but among males it is the inactive dieters who show a positive relationship. Results illustrate the importance of examining the association between dieting and the initiation of regular smoking. Maldonado-Molina, M., Komro, K., and Prado, G. Prospective Association Between Dieting and Smoking Initiation among Adolescents. Am. J. Health Promot., 22(1), pp. 25-32, 2007.

Systemic Factors that Influence Screening for Prenatal Behavioral Risks

This study examined how systemic factors might facilitate or impede providers' ability to screen for and intervene on prenatal behavioral risks. Eight focus groups of 60 prenatal care providers were convened to explore methods for assessing and counseling pregnant women about tobacco, alcohol, and illicit drug use. Because practice setting was often mentioned as either an inducement or barrier to risk prevention, a re-analysis of focus group transcripts to examine systemic factors was conducted. Results indicated that practice setting strongly influenced providers' behavior, and settings differed by continuity of care, availability of resources, and organized support for risk prevention. The most striking contrasts were found between private practice and a large HMO. Thus, each setting had features that facilitated prevention counseling. Understanding such systemic factors could lead to improved risk prevention practices during pregnancy across all health care settings. Gilbert, P., Herzig, K., Thakar, D., Viloria, J., Bogetz, A., Danley, D., Jackson, R., and Gerbert, B. How Health Care Setting Affects Prenatal Providers' Risk Reduction Practices: A Qualitative Comparison of Settings. Women Health, 45(2), pp. 41-57, 2007.

Measuring Community-Wide Prevention Collaboration

This study assesses a measure of community-wide collaboration on prevention-specific activities (i.e., prevention collaboration) in context of the theory of community change used in the Communities That Care prevention system. Using data from a sample of 599 community leaders across 41 communities, the measure was examined with regard to its factor structure, associations with other concurrent community-level measures, and prediction by individual- and community-level characteristics. Results of multilevel confirmatory factor analysis provide evidence for the construct validity of the measure and indicate significant (p < .05) associations with concurrent validity criteria. Female community leaders reported significantly higher levels of prevention collaboration and community leaders sampled from religious organizations reported lower levels of prevention collaboration than did their respective counterparts. Although no community-level characteristics were associated significantly with prevention collaboration, community clustering accounted for 20-28% of the total variation in the measure. Findings support the use of this measure in assessing the importance of collaboration in community-based prevention initiatives. Brown, E., Hawkins, J., Arthur, M., Abbott, R., and Van Horn, M. Multilevel Analysis of a Measure of Community Prevention Collaboration. Am. J. Community Psychol., 41(1-2), pp. 115-126, 2008.

Antisocial Psychopathy and HIV Risk Among Alcohol and Other Drug (AOD) Abusing Adolescent Offenders

While the consensus is that HIV prevalence has remained low among adolescent offenders, the prevalence of STDs and HIV transmission risk behaviors is alarming, particularly for those abusing alcohol and other drugs and those displaying antisocial or conduct disorder characteristics. In the current study, 269 male and 110 female inner city, culturally diverse alcohol and other drug (AOD) abusing adolescent offenders completed measures of (a) psychopathy, using the Millon Adolescent Clinical Inventory (MACI) (b) HIV transmission risk behavior, (c) prevention skills and attitudes and (d) social desirability. Results showed that those with high levels of psychopathy reported more AOD use, overall unprotected sex and more sexual activity when influenced by alcohol and/or marijuana. High psychopathy adolescent offenders also reported lower self-efficacy and sexual response-efficacy, less favorable safer sex and condom attitudes and less favorable intentions to engage in safer sex behaviors, when controlling for social desirability. Data suggest that adolescent offenders, who are either in court-ordered treatment or detention, should be assessed for psychopathy and provided with tailored risk reduction interventions, geared toward attitudinal and behavioral change. A discussion of integrating neurobiological measures to improve the next generation of tailored interventions for this risk group is offered in conclusion. Malow, R.M., Devieux, J., Rosenberg, R., Nair, M., McMahon, R., Brown, E.J., and Kalichman, S.C. Antisocial Psychopathy and HIV Risk Among Alcohol and Other Drug (AOD) Abusing Adolescent Offenders. American Journal of Infectious Diseases, 3(4), pp. 230-239, 2007.

Drinking By High School Seniors: Implications for Prevention

The transition from high school to college provides a potentially critical window to intervene and reduce risky behavior among adolescents. This study examined high school seniors' motivations (e.g., social, coping, enhancement) for alcohol use and patterns of use. Latent class analysis was used to examine the relationship between different patterns of drinking motivations and behaviors in a sample of 12th graders (N = 1,877) from the 2004 Monitoring the Future survey. A person-centered approach was used to identify types of motivations that cluster together within individuals and relates membership in these profiles to drinking behaviors. Results suggest four profiles of drinking motivations for both boys and girls, including Experimenters, Thrill-seekers, Multi-reasoners, and Relaxers. Early initiation of alcohol use, past year drunkenness, and drinking before 4 P.M. were associated with greater odds of membership in the Multi-reasoners class as compared to the Experimenters class. Although the strength of these relationships varied for boys and girls, findings were similar across gender suggesting that the riskiest drinking behavior was related to membership in the Multi-reasoners class. These findings can be used to inform prevention programming. Specifically, targeted interventions that tailor program content to the distinct drinking motivation profiles described above may prove to be effective in reducing risky drinking behavior among high school seniors. Coffman, D., Patrick, M., Palen, L., Rhoades, B., and Ventura, A. Why Do High School Seniors Drink? Implications for a Targeted Approach to Intervention. Prev. Sci., 8(4), pp. 241-248, 2007.

Sexual Behavior During Emerging Adulthood

Emerging adults (M = 18.99 years, SD = .50) completed cross-sectional questionnaires (N = 943) and targeted follow-up telephone surveys (N = 202) across the transition to college. Gender, personal goals (dating, friendship, academic), and past sexual behavior were examined as predictors of reasons to have and not to have sex. Men rated Self-focused reasons to have sex as more important; women rated Partner-focused reasons to have sex and Ethical reasons not to have sex as more important. Importance of Pregnancy/ STD reasons not to have sex did not differ by gender. Before college entrance, sexual history and personal goals predicted endorsement of reasons for/against sex. Personal goals predicted first intercourse during freshman year. Limitations of the study include the single university sample and use of closed-ended self-report measures. Personal goals and reasons for/against sex are associated with sexual behavior and should be addressed in programs designed to promote sexual health among emerging adult college students. Patrick, M., Maggs, J., and Abar, C. Reasons to Have Sex, Personal Goals, and Sexual Behavior During the Transition to College. J. Sex Res., 44(3), pp. 240-249, 2007.

Relation of Executive Function to Risk Behaviors in Female College Students

Relations among executive function, behavioral approach sensitivity, emotional decision making, and risk behaviors (alcohol use, drug use, and delinquent behavior) were examined in single female college students (N = 72). Hierarchical multiple regressions indicated a significant Approach Sensitivity x Working Memory interaction in which higher levels of alcohol use were associated with the combination of greater approach tendency and better working memory. This Approach Sensitivity x Working Memory interaction was also marginally significant for drug use and delinquency. Poor emotional decision making, as measured by a gambling task, was also associated with higher levels of alcohol use, but only for individuals low in inhibitory control. Findings point to the complexity of relations among aspects of self-regulation and personality and provide much needed data on neuropsychological correlates of risk behaviors in a nonclinical population. Patrick, M.E., Blair, C., and Maggs, J.L. Executive Function, Approach Sensitivity, and Emotional Decision Making as Influences on Risk Behaviors in Young Adults. J. Clin. Exp. Neuropsychol., 30(4), pp. 449-462, 2008.

Four Developmental Trajectories of Adolescent Physical Aggression

Latent growth mixture modeling was used to identify discrete patterns of physical aggression from Grades 7 to 11 among a sample of 1,877 youth (952 boys and 925 girls). These middle school students were participating in a field trial designed to test the effects of a drug prevention program. This study included only those students who were randomly assigned to the control condition schools. Students completed annual paper-and-pencil surveys in school at Grades 7 through 11. Four trajectory classes adequately explained the development of physical aggression in both boys and girls: Low/No Aggression; Persistent High Aggression; Desisting Aggression, characterized by decreasing risk throughout adolescence; and Adolescent Aggression, characterized by low early risk that increases until Grade 9, levels out, and then declines in late adolescence. Girls were less likely than boys were to be in any trajectory besides the Low/No Aggression trajectory. Parental supervision, deviant peer association, academic orientation, impulsivity, and emotional distress at Grade 7 were all strongly associated with trajectory class membership. These associations did not differ by gender. These findings strongly suggest that the processes involved in the development of physical aggression in adolescence operate similarly in boys and girls. Martino, S., Ellickson, P., Klein, D., McCaffrey, D., and Edelen, M. Multiple Trajectories of Physical Aggression among Adolescent Boys and Girls. Aggress. Behav., 34(1), pp. 61-75, 2008.

Indirect Measures of Alcohol-related Cognitions Predict Use

Recently there has been increased interest in the role of implicit cognitive processes in the development of addictive behaviors. In this study, the authors compared 3 indirect measures of alcohol-related cognitions in the prospective prediction of alcohol use in at-risk adolescents. Implicit alcohol-related cognitions were assessed in 88 Dutch at-risk adolescents ranging in age from 14 to 20 years (51 males, 37 females) by means of varieties of word association tasks, Implicit Association Tests, and Extrinsic Affective Simon Tasks adapted for alcohol use. Alcohol use and alcohol-related problems were measured with self-report questionnaires at baseline and after 1 month. Results showed that the indirect measures predicted unique variance in prospective alcohol use after controlling for the direct measure of alcohol-related cognitions and background variables. The results indicate that the word association tasks were the best indirect measure of alcohol-related cognitions. These indirect measures appear to assess cognitive motivational processes that affect behavior in ways not reflected by direct measures of alcohol-related cognitions. Thush, C., Wiers, R., Ames, S., Grenard, J., Sussman, S., and Stacy, A. Apples and Oranges? Comparing Indirect Measures of Alcohol-Related Cognition Predicting Alcohol Use in At-Risk Adolescents. Psychol. Addict. Behav., 21(4), pp. 587-591, 2007.

Response Inconsistencies for Sex and Drug Use Behaviors Among South African High School Students

This study aims to describe patterns of inconsistent reports of sexual intercourse among a sample of South African adolescents. Consistency of reported lifetime sexual intercourse was assessed using five semiannual waves of data. Odds ratios related inconsistent reporting to demographic variables and potential indicators of general and risk-behavior-specific reliability problems. Participants were high school students from Mitchell's Plain, a low-income township near Cape Town, South Africa. Students (N = 2,414) were participating in a research trial of a classroom-based leisure, life skill, and sexuality education program. The sample for the present study was restricted to participants who reported lifetime sexual intercourse in at least one of the first four survey assessments (n = 713). This subsample was mostly male (69%) and "colored" (mix of African, Asian, and European ancestry) and had a mean age at baseline of 14 years. Of the sexually active participants in the sample, nearly 40% reported being virgins after sexual activity had been reported at an earlier assessment. Inconsistent reporting could not be predicted by gender or race or by general indicators of poor reliability (inconsistent reporting of gender and birth year). However individuals with inconsistent reports of sexual intercourse were more likely to be inconsistent reporters of substance use. These results suggest that researchers need to undertake efforts to deal specifically with inconsistent risk behavior data. These may include modification of data collection procedures and use of statistical methodologies that can account for response inconsistencies. Palen, L., Smith, E., Caldwell, L., Flisher, A., Wegner, L., and Vergnani, T. Inconsistent Reports of Sexual Intercourse among South African High School Students. J. Adolesc. Health, 42(3), pp. 221-227, 2008.

Research On Behavioral & Combined Treatments For Drug Abuse

Craving, Withdrawal, and Smoking Urges on Days Immediately Prior to Smoking Relapse

Dr. Allen and colleagues at the University of Minnesota conducted this study to identify temporal patterns of standardized symptom scores (for craving, withdrawal, and smoking urges) that would either refute or support the assumption that these factors are key contributors to relapse in smokers. Data were analyzed from 137 female smokers, aged 18-40 years, who completed 30 days of a protocol for a longitudinal smoking cessation trial. All subjects were followed post quit date, regardless of their subsequent smoking status. Measures of craving, withdrawal and smoking urges were completed at baseline and daily for 30 days, beginning on their quit date. A total of 26 women quit smoking and 11 relapsed. A consistent symptom severity pattern was observed, in which craving, withdrawal, and smoking urges increased leading up to the day of relapse and then subsided quickly. These findings suggest an association between patterns of symptom intensity and relapse. The authors conclude that frequent symptom monitoring might be clinically important for relapse prevention. Allen, S.S., Bade, T., Hatsukami, D., and Center, B. Craving, Withdrawal, and Smoking Urges on Days Immediately Prior to Smoking Relapse. Nicotine & Tobacco Research, 10(1), pp. 35-45, 2008.

Cigarette Smoking in Opioid-Using Patients Presenting for Hospital-Based Medical Services

The authors examined cigarette smoking practices in 126 out-of-treatment opioid users presenting at a hospital for non-psychiatric medical services. In general, the study found the prevalence of smoking (92%) to be comparable to that reported in methadone treatment samples. Nineteen percent preferred unfiltered cigarettes. Women were more likely to smoke menthol cigarettes; men were more likely to smoke unfiltered cigarettes. Caucasians tended to smoke more than other ethnicities and exhibited greater dependence. The authors conclude that opioid users are a particularly high-risk group for continued smoking and they highlight the need for treatment programs to include smoking cessation interventions. Haas, A.L., Sorensen, J.L., Hall, S.M., Lin, C., Delucchi, D., Sporer, K., and Chen, T. Cigarette Smoking in Opioid-Using Patients Presenting for Hospital-Based Medical Services. The American Journal on Addictions, 17, pp. 65-69, 2008.

Older Versus Younger Treatment-Seeking Smokers

The purpose of this study was to describe treatment seeking smokers aged 50 years or older and compare them with younger smokers (aged<50) presenting to the same smoking treatment facility during the same time period. The subjects (n=810) were participating in one of two studies: one was limited to smokers aged 50 years or older; the other was open to smokers aged 18 years or older. As predicted, smokers aged 50+ were more tobacco dependent, had better psychological functioning, and had poorer physical functioning than those aged <50. Contrary to predictions, no differences were found in motivation to quit cigarette smoking or in alcohol use. Women aged 50+ were less likely to report marijuana use than women aged <50, and less likely than men to receive a positive diagnosis for alcohol abuse. Despite higher scores on measures of tobacco dependence, older smokers were less likely to be diagnosed as tobacco dependent or as having tobacco withdrawal using DSM-IV criteria. Rates of alcohol abuse and dependence were high in both age groups, but were higher for smokers aged <50. Hall, S.M., Humflet, G.L., Gorecki, J.A., Munoz, R.F., Reus, V.I., and Prochaska, J.J. Older Versus Younger Treatment-Seeking Smokers: Differences in Smoking Behavior, Drug and Alcohol Use, and Psychosocial and Physical Functioning. Nicotine & Tobacco Research, 10(3), pp. 463-470, 2008.

Message Framing for Smoking Cessation

Research on message framing tests whether or not gain-framed messages (i.e., emphasizing the benefits of quitting smoking) are more persuasive in promoting cessation than loss-framed messages (i.e., emphasizing the costs of continuing to smoke). The authors conducted this study to examine how gender differences in perceptions of risk of quitting smoking influence the effects of framed interventions. Participants were 249 adult smokers (129 females, 120 males) in a clinical trial of message framing for smoking cessation with bupropion. The results showed that women reported a higher perceived risk of cessation than men. Participants who anticipated high risks associated with quitting smoking reported fewer days to relapse. Further, females in the gain-framed condition who reported low perceived risks of cessation had a greater number of days to relapse, as opposed to females in the loss-framed condition. These findings suggest that message framing interventions for smoking cessation should consider the influence of gender and risk perceptions associated with quitting on the effectiveness of framed interventions. Toll, B.A., O'Malley, S.S., Mazure, C.M., Latimer, A., McKee, S.A. Message Framing for Smoking Cessation: The Interaction of Risk Perceptions and Gender. Nicotine & Tobacco Research, 10(1), pp. 195-200, 2008.

Research On Pharmacotherapies For Drug Abuse

Cocaine Users Differ from Normals on Cognitive Tasks which Show Poorer Performance During Drug Abstinence

In this publication, seventeen non-treatment seeking cocaine-dependent individuals participated in three-week longitudinal inpatient studies of cognitive changes during drug use and abstinence. Protocols included three days drug-free baseline, three days cocaine self-administration, and two weeks complete abstinence. A repeatable cognitive battery showed attention and delayed verbal recognition memory but not working memory to be impaired in cocaine users compared to age- and sex-matched normative values. Attention was significantly poorer during the first and second week of abstinence compared to days on which cocaine was used, suggesting that certain cocaine-induced impairments may be acutely normalized by cocaine use, but may resurface during abstinence. Pace-Schott E.F., Morgan P.T., Malison R.T., Hart C.L., Edgar C., Walker M., and Strickgold R. Cocaine Users Differ from Normals on Cognitive Tasks which Show Poorer Performance During Drug Abstinence. Am. J. of Drug and Alcohol Abuse, 34(1), pp. 109-121, 2008.

Treatment of Opioid-Dependent Pregnant Women: Clinical and Research Issues

This article addresses common questions that clinicians face when treating pregnant women with opioid dependence. Guidance, based on both research evidence and the collective clinical experience of the authors, which include investigators in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project, is provided to aid clinical decision making. The MOTHER project is a double-blind, double-dummy, flexible-dosing, parallel-group clinical trial examining the comparative safety and efficacy of methadone and buprenorphine for the treatment of opioid dependence in pregnant women and their neonates. The article begins with a discussion of appropriate assessment during pregnancy and then addresses clinical management stages including maintenance medication selection, induction, and stabilization; opioid agonist medication management before, during, and after delivery; pain management; breast-feeding; and transfer to aftercare. Lastly, other important clinical issues including managing co-occurring psychiatric disorders and medication interactions are discussed. Jones, H.E., Martin, P.R., Heil, S.H., Kaltenbach., Selby, P., Coyle, M.G., Stine, S.M., O'Grady, K.E., Arria, A.M., and Fischer, G. Treatment of Opioid-Dependent Pregnant Women: Clinical and Research Issues. J. Substance Abuse Treat., Jan 11, 2008.

Opioid Use Disorder in the United States: Insurance Status and Treatment Access

In the United States, insurance status and rates of treatment for individuals with opioid use disorder are unknown. This study employed a cross-sectional survey: 2002-2004 National Survey on Drug Use and Health (NSDUH). Bivariate and multivariate associations between demographics, treatment and insurance status and presence or absence of opioid use disorder were investigated. On unadjusted analysis, young respondents, respondents of Hispanic ethnicity (OR 1.5; 95% CI 1.1-2.2), unemployed respondents (OR 2.6; 95% CI 1.8-3.8) and respondents with Medicaid (OR 4.5; 95% CI 2.5-8.3) or lack of insurance (OR 3.2; 95% CI 1.8-5.9) were more likely to have opioid use disorder. On unadjusted analysis among those with any substance use disorder, 12-16 year olds were more likely to have opioid use disorder (OR 3.4; 95% CI 2.0-5.8) than a non-opioid substance use disorder, as were women (OR for men 0.6; 95% CI 0.5-0.7) and unemployed respondents (OR 1.5; 95% CI 1.02-2.1). Only 15.2% of those with past-year opioid use disorder received treatment in the past year. Respondents treated for opioid use had higher rates of Medicaid (p<0.01), Medicare (p<0.01) and other public assistance (p=0.01) compared with those treated for other substances. Treatments for opioid use were more likely to be hospital (p=0.04) and inpatient rehabilitation (p=0.02) settings compared to treatment for other substance use. Among those with opioid use disorder, not being employed was independently associated with receiving treatment (AOR 3.5; 95% CI 1.4-8.5). The authors conclude that in the U.S., high rates of unemployment, Medicaid and uninsurance among those with opioid use disorder and low rates of treatment suggest that efforts to expand treatment must include policy strategies to help reach a population with significant barriers to treatment access. Becker, W.C., Fiellin, D.A., Merrill, J.O., Schulman, B., Finkelstein, R., Olsen, Y. et al. Opioid Use Disorder in the United States: Insurance Status and Treatment Access. Drug Alcohol Depend., 94, pp. 207-213, 2008.

Riluzole and D-amphetamine Interactions in Humans

In preclinical studies, medications which decrease glutamate release have been shown to block some of the effects of psychostimulants. One such medication is riluzole, marketed for the treatment of Amyotrophic Lateral Sclerosis (ALS). The goal of this study was to determine riluzole's effects on acute physiological and subjective responses to d-amphetamine in healthy volunteers. Seven male and 5 female subjects participated in an outpatient double-blind, placebo-controlled, crossover study. Across 4 sessions, subjects were randomly assigned to a sequence of 4 oral treatments: placebo, 20 mg D-amphetamine alone, 100 mg riluzole alone, or d-amphetamine plus riluzole. Outcome measures included heart rate, blood pressure, plasma cortisol, performance on the Sustained Attention to Response Test (SART), and subjective measures. D-amphetamine increased heart rate, blood pressure and plasma cortisol levels while inducing psychostimulant-type subjective effects. On the SART, d-amphetamine enhanced the speed of correct responses but also significantly increased the number of errors of commission. Riluzole at 100 mg did not block the typical subjective and physiological responses to 20 mg D-amphetamine. Riluzole alone induced amphetamine-like subjective responses. On the SART test, riluzole increased the number errors of commission, but unlike d-amphetamine, did not speed reaction time. The mechanism accounting for these findings is unclear, but may involve processes other than decreased glutamate release by riluzole. The effects of glutamate medications on psychostimulant responses need to be further examined. Sofuoglu, M., Waters, A.J., Mooney, M., and Kosten, T. Riluzole and D-amphetamine Interactions in Humans. Prog. Neuropsychopharmacol. Biol. Psychiatry, 32, pp. 16-22, 2008.

Therapeutic Drug Monitoring of Nortriptyline in Smoking Cessation: A Multistudy Analysis

Multiple, controlled clinical trials support the efficacy of nortriptyline as a smoking cessation agent. Although therapeutic plasma nortriptyline concentrations (PNCs) are known for the treatment of depression, little is known about PNCs in smoking cessation treatment. PNCs from three randomized, placebo-controlled smoking cessation trials (N=244) were analyzed both separately and pooled. PNCs normalized for dose and weight were associated with cigarettes per day and race, but not with sex or age. Greater smoking was associated with decreased normalized PNCs. In addition, both Asian and black populations had significantly higher normalized PNCs than the white populations. Weak and inconsistent associations between PNCs and self-reported side effects were observed. PNCs were linearly related to end of treatment and long-term biochemically verified smoking abstinence. Maximum therapeutic effects were observed over a range of plasma concentrations somewhat lower than those found effective for the treatment of depression. Mooney, M.E., Reus, V.I., Gorecki, J., Hall, S.M., Humfleet, G.L., Munoz, R.F. et al. Therapeutic Drug Monitoring of Nortriptyline in Smoking Cessation: A Multistudy Analysis. Clin. Pharmacol. Ther., 83, pp. 436-442, 2008.

Research On Medical Consequences Of Drug Abuse & Co-Occurring Infections (HIV/AIDS, HCV)

Impact of Drug Abuse Treatment Modalities on Adherence to ART/HAART Among a Cohort of HIV Seropositive Women

Methadone maintenance is associated with improved adherence to antiretroviral therapies among HIV-positive illicit drug users; however, little information exists on whether adherence is associated with different drug abuse treatment modalities. Using longitudinal data from the Women's Interagency HIV Study, the authors evaluated the relationship between drug abuse treatment modality and adherence to antiretroviral therapies. In prospective analyses, individuals who reported accessing any drug abuse treatment program were more likely to report adherence to antiretroviral regimens > or = 95% of the time (AOR = 1.39, 95% CI =1.01-1.92). Involvement in either a medication-based or medication-free program was similarly associated with improved adherence. Drug abuse treatment programs, irrespective of modality, are associated with improved adherence to antiretroviral therapies among drug users. Concerted efforts to enroll individuals with drug use histories in treatment programs are warranted to improve HIV disease outcomes. Kapadia, F., Vlahov, D., Wu, Y., Cohen, M.H., Greenblatt, R.M., Howard, A.A., Cook, J.A., Goparaju, L., Golub, E., Richardson, J., and Wilson, T.E. Impact of Drug Abuse Treatment Modalities on Adherence to ART/HAART Among a Cohort of HIV Seropositive Women. Am. J. Drug Alcohol Abuse, 34(2), pp.161-170, 2008.

Attribution of Menopause Symptoms in Human Immunodeficiency Virus-Infected or At-Risk Drug-Using Women

The objective of this study was to examine the relationship of human immunodeficiency virus (HIV) and attribution of menopausal symptoms. Peri- and postmenopausal women participating in a prospective study of HIV-infected and at-risk midlife women (the Ms. Study) were interviewed to determine whether they experienced hot flashes and/or vaginal dryness and to what they attributed these symptoms. Of 278 women, 70% were perimenopausal; 54% were HIV-infected; and 52% had used crack, cocaine, heroin, and/or methadone within the past 5 years. Hot flashes were reported by 189 women and vaginal dryness was reported by 101 women. Overall, 69.8% attributed hot flashes to menopause and 28.7% attributed vaginal dryness to menopause. In bivariate analyses, age 45 years and older was associated with attributing hot flashes and vaginal dryness to menopause, and postmenopausal status and at least 12 years of education were associated with attributing vaginal dryness to menopause, but HIV status was not associated with attribution to menopause. In multivariate analysis, significant interactions between age and menopause status were found for both attribution of hot flashes (P = 0.019) and vaginal dryness (P = 0.029). Among perimenopausal women, older age was independently associated with attribution to menopause for hot flashes (adjusted odds ratio = 1.2, 95% CI: 1.1-1.4, P = 0.001) and vaginal dryness (adjusted odds ratio = 1.3, 95% CI: 1.1-1.6, P = 0.011). None of the tested factors were independently associated with attribution to menopause among postmenopausal women. The authors conclude that tailored health education programs may be beneficial in increasing the knowledge about menopause among HIV-infected and drug-using women, particularly those who are perimenopausal. Johnson, T.M., Cohen, H.W., Howard, A.A., Santoro, N., Floris-Moore, M., Arnsten, J.H., Hartel, D.M., and Schoenbaum, E.E. Attribution of Menopause Symptoms in Human Immunodeficiency Virus-Infected or At-risk Drug-Using Women. Menopause, 15(3), pp. 551-557, 2008.

Co-Morbid Medical and Psychiatric Illness and Substance Abuse in HCV-Infected and Uninfected Veterans

Comorbidities may affect the decision to treat chronic hepatitis C virus (HCV) infection. The authors undertook this study to determine the prevalence of these conditions in the HCV-infected persons compared with HCV-uninfected controls. Demographic and comorbidity data were retrieved for HCV-infected and -uninfected subjects from the VA National Patient Care Database using ICD-9 codes. Logistic regression was used to determine the odds of comorbid conditions in the HCV-infected subjects. HCV-uninfected controls were identified matched on age, race/ethnicity and sex. The authors identified 126,926 HCV-infected subjects and 126,926 controls. The HCV-infected subjects had a higher prevalence of diabetes, anemia, hypertension, chronic obstructive pulmonary disease (COPD)/asthma, cirrhosis, hepatitis B and cancer, but had a lower prevalence of coronary artery disease and stroke. The prevalence of all psychiatric comorbidities and substance abuse was higher in the HCV-infected subjects. In the HCV-infected persons, the odds of being diagnosed with congestive heart failure, diabetes, anemia, hypertension, COPD/asthma, cirrhosis, hepatitis B and cancer were higher, but lower for coronary artery disease and stroke. After adjusting for alcohol and drug abuse and dependence, the odds of psychiatric illness were not higher in the HCV-infected persons. The prevalence and patterns of comorbidities in HCV-infected veterans are different from those in HCV-uninfected controls. The association between HCV and psychiatric diagnoses is at least partly attributable to alcohol and drug abuse and dependence. These factors should be taken into account when evaluating patients for treatment and designing new intervention strategies. Butt, A.A., Khan, U.A., McGinnis, K.A., Skanderson, M., and Kent Kwoh, C. Co-morbid Medical and Psychiatric Illness and Substance Abuse in HCV-infected and Uninfected Veterans. J. Viral Hepat., 14(12), pp. 890-896, 2007.

Biochemical and Virologic Parameters in Patients Co-Infected with Hepatitis C and HIV Versus Patients with Hepatitis C Mono-Infection

Previous studies of patients with hepatitis C virus (HCV) infection looking at the effect of human immunodeficiency virus (HIV) co-infection on biochemical parameters and HCV RNA level have shown conflicting results. Accurate characterization of the effect of HIV is important for evaluation and treatment of HCV in co-infected persons. The authors studied 315 HCV mono-infected and 75 HCV-HIV co-infected subjects to determine the effect of HIV on biochemical parameters and HCV RNA and to determine the predictors of elevated serum alanine aminotransferase (ALT) levels and HCV RNA levels. Results showed that the co-infected subjects were more likely to be African-American (55% vs 26%, P < 0.0005), have used injection drugs (68% vs 60%, P = 0.02), have detectable HCV RNA (84% vs 70.5%, P = 0.018), have HCV RNA levels >6 log10 IU/mL (60% vs 38%, P = 0.001), and have lower mean serum ALT levels (50.4 IU/mL vs 73.7 IU/mL, P = 0.006). In multivariable analyses, the following factors predicted an ALT level >50 IU/mL: log10 HCV RNA (OR, 1.15; 95% CI, 1.00 to 1.32); HIV co-infection (OR, 0.48; 95% CI, 0.25 to 0.89); and having ever been treated for HCV (OR, 1.92; 95% CI, 1.16 to 3.18). The only significant predictor of HCV RNA level >6 log10 IU/mL was HIV co-infection (OR, 2.75; 95% CI, 1.46 to 5.15). Significant predictors of having a detectable HCV RNA level were female sex (OR, 3.81; 95% CI, 1.18 to 12.25); HIV co-infection (2.45; 95% CI, 1.14 to 5.26); and ever being treated for HCV (OR, 1.96; 95% CI, 1.10 to 3.48). The authors conclude that HCV-HIV co-infected persons have higher HCV RNA levels but lower serum ALT levels than HCV mono-infected patients. Criteria for performing liver biopsy and treating HCV infection in co-infected patients may need to be revisited. Butt, A.A., Tsevat, J., Ahmad, J., Shakil, A.O., Mrus, J.M. Biochemical and Virologic Parameters in Patients Co-infected with Hepatitis C and HIV Versus Patients with Hepatitis C Mono-infection. Am. J. Med. Sci. 333(5), pp. 271-275, 2007.

The Insulin-like Growth Factor Axis and Risk of Liver Disease in Hepatitis C Virus/HIV-Co-Infected Women

Insulin-like growth factor (IGF) I stimulates the proliferation of hepatic stellate cells (HSC), the primary source of extracellular matrix accumulation in liver fibrosis. In contrast, insulin-like growth factor binding protein (IGFBP) 3, the most abundant IGFBP in circulation, negatively modulates HSC mitogenesis. To investigate the role of the IGF axis in hepatitis C virus (HCV)-related liver disease among high-risk patients, the authors prospectively evaluated HCV-viremic/HIV-positive women. This study comprised a cohort investigation in which total IGF-I and IGFBP-3 were measured in baseline serum specimens obtained from 472 HCV-viremic/HIV-positive subjects enrolled in the Women's Interagency HIV Study, a large multi-institutional cohort. The aspartate aminotransferase to platelet ratio index (APRI), a marker of liver fibrosis, was assessed annually. Normal APRI levels (< 1.0) at baseline were detected in 374 of the 472 HCV-viremic/HIV-positive subjects tested, of whom 302 had complete liver function test data and were studied. IGF-I was positively associated [adjusted odds ratio comparing the highest and lowest quartiles (AORq4-q1), 5.83; 95% confidence interval (CI) 1.17-29.1; Ptrend = 0.03], and IGFBP-3 was inversely associated (AORq4-q1, 0.13; 95% CI 0.02-0.76; Ptrend = 0.04), with subsequent (incident) detection of an elevated APRI level (> 1.5), after adjustment for the CD4 T-cell count, alcohol consumption, and other risk factors. The authors conclude that high IGF-I may be associated with increased risk and high IGFBP-3 with reduced risk of liver disease among HCV-viremic/HIV-positive women. Strickler, H.D., Howard, A.A., Peters, M., Fazzari, M., Yu, H., Augenbraun, M., French, A.L., Young, M., Gange, S., Anastos, K., and Kovacs, A. The Insulin-like Growth Factor Axis and Risk of Liver Disease in Hepatitis C virus/HIV-co-infected Women. AIDS, 22(4), pp. 527-531, 2008.

Immune Status at Presentation to Care Did not Improve among Antiretroviral-Naive Persons from 1990 to 2006

Human immunodeficiency virus (HIV) prevention initiatives to improve access to HIV services have increased over time. Despite this, >250,000 cases of HIV infection in the US are undiagnosed, and many infected persons do not present for care until their HIV infection is advanced. Late presentation may increase the risk of HIV transmission and make HIV infection more difficult to treat effectively. With more effective HIV therapy, it has been the hope that patients might present earlier in their disease course. To assess immune status and time of HIV diagnosis in patients who newly presented for care, researchers analyzed data for the period 1990-2006 from patients who were antiretroviral naive at presentation to the Johns Hopkins HIV Clinic in Baltimore, Maryland. They compared CD4 (+) cell count and time from HIV diagnosis at presentation by demographic characteristics at enrollment. The median presenting CD4(+) cell count decreased from 371 cells/mm(3) during 1990-1994 to 276 cells/mm(3) during 2003-2006 (P<.01) overall and decreased within individual demographic groups. There was also a decrease in the median time from HIV diagnosis to presentation for care (271 days in 1990-1994 to 196 days in 2003-2006; P<.01). Multivariate analysis revealed that, in addition to CD4(+) cell count at presentation, male sex was associated with lower CD4(+) cell counts (-93 cells/mm(3)), as was black race (-71 cells/mm(3)) and older age (-20 cells/mm(3) per 10 years). These findings show that there has been a decrease in time from diagnosis of HIV infection to presentation for care, coupled with an increase in the severity of immunodeficiency at time of presentation, over the past 16 years in Maryland. The findings highlight the urgent need to develop effective strategies for providing earlier HIV testing and referral into care. Keruly, J., and Moore, R. Immune Status at Presentation to Care Did not Improve among Antiretroviral-Naive Persons from 1990 to 2006. Clin.Infect. Dis., 45(10), pp. 1369-1374, 2007.

Herpes Simplex Virus-2 and HIV among Noninjecting Drug Users in New York City

This study sought to examine the relationship between herpes simplex virus 2 (HSV-2) seroprevalence and HIV seroprevalence among noninjecting heroin and cocaine users in New York City. Four hundred sixty-two noninjecting cocaine and heroin users were recruited from a drug detoxification program in New York City. Smoking crack cocaine, intranasal use of heroin, and intranasal use of cocaine were the most common types of drug use. A structured interview was administered and a serum sample was collected for HIV and HSV testing. HIV prevalence was 19% (95% CI 15%-22%) and HSV-2 seroprevalence was 60% (95% CI 55%-64%). The adjusted risk ratio for the association between HSV-2 and HIV was 1.9 (95% CI 1.21%-2.98%). The relationship between HSV-2 and HIV was particularly strong among females, among whom 86% were HSV-2 seropositive, 23% were HIV seropositive, and all HIV seropositives were also HSV-2 seropositive. The findings suggest that HSV-2 is an important factor in sexual transmission of HIV among noninjecting cocaine and heroin users in New York City, especially among females. The estimated population attributable risk for HIV infection attributable to HSV-2 infection in this sample was 38%, underscoring the importance of programs to manage HSV-2 infection as part of comprehensive HIV prevention for noninjecting drug users. Des Jarlais, D., Hagan, H., Arasteh, K., McKnight, C., Perlman, D., and Friedman, S. Herpes Simplex Virus-2 and HIV among Non Injecting Drug Users in New York City. Sex Transm. Dis., 34(11), pp. 923-927, 2007.

Factors Associated with the Prevalence and Incidence of Trichomonas Vaginalis Infection among African American Women in New York City Who Use Drugs

Trichomoniasis vaginalis, the most prevalent nonviral sexually transmitted infection, is associated with negative reproductive outcomes and increased HIV transmission and may be overrepresented among African Americans. A total of 135 African American women who used drugs were screened for Trichomonas vaginalis on >/=2 occasions between March 2003 and August 2005. Women were administered a structured questionnaire in a community-based research center, underwent serological testing for HIV and HSV-2, and were screened for Neisseria gonorrhoeae and Chlamydia trachomatis. Fifty-one women (38%) screened positive for T. vaginalis at baseline. Twenty-nine (31%) of 95 women with negative results of baseline tests became infected, for an incidence of 35.1 cases per 100 person-years at risk (95% confidence interval [CI], 23.5-49.0). Prevalent infection was associated with drug use in the past 30 days, and incident infection was associated with sexual behavior in the past 30 days, namely having >1 male sex partner. Women who reported having >1 partner were 4 times as likely as women with fewer partners to acquire T. vaginalis (hazard ratio, 4.3; 95% CI, 2.0-9.4). These findings suggest that T. vaginalis may be endemic in this community of African American women. A control strategy that includes T. vaginalis screening in nonclinical settings and rapid point-of-care testing could contribute to the disruption of transmission of this pathogen. Miller, M., Liao, Y., Gomez, A. M., Gaydes, C., and D'Mellow, D. Factors Associated with the Prevalence and Incidence of Trichomonas Vaginalis Infection Among African American Women in New York City Who Use Drugs. J. Infect. Dis., 197(4), pp. 503-509, 2008.

Risk Factors for Methadone Outside Treatment Programs: Implications for HIV Treatment among Injection Drug Users

Diversion of methadone outside treatment programs occurs, yet reasons for use of ''street methadone '' are characterized poorly. Self-medication for withdrawal symptoms is one plausible hypothesis. Among HIV-infected drug users, some antiretroviral medications can reduce potency of methadone, yet any association between such effects and the use of supplemental methadone sources remains undetermined. This study sought to estimate the frequency and risk factors for use of street methadone. Injection drug users (IDUs) recruited through extensive community outreach in 1988-89 and 1994 were followed semi-annually with questionnaires about health history, use of licit and illicit drugs including methadone and HIV-related assays. Analyses were performed using generalized estimating equation logistic regression. Of 2811 IDUs enrolled and eligible for analysis, 493 people reported use of street methadone over 12,316 person-years of follow-up (4.0/100 person-years). In multivariate analyses, street methadone use was more common among women, whites, those 40-59 years old, those who reported withdrawal symptoms, past methadone program attendance (6-12 months before visit), recent heroin injection with or without cocaine (but not cocaine alone), smoking or sniffing heroin and reported trading sex. Street methadone was not associated with HIV infection or treatment. The results suggest that older IDUs still using heroin may be using street methadone to treat signs of withdrawal. The absence of a higher rate of street methadone use in HIV seropositive IDUs reveals that antiretroviral/methadone interactions are not a primary determinant of use outside of treatment settings. Vlahov, D., O 'Driscoll, P., Mehta, S., Ompad, D., Gern, R., Galai, N., and Kirk, G. Risk Factors for Methadone Outside Treatment Programs: Implications for HIV Treatment among Injection Drug Users. Addiction, 102(5), pp. 771-777, 2007.

A Ten-Year Analysis of the Incidence and Risk Factors for Acute Pancreatitis Requiring Hospitalization in an Urban HIV Clinical Cohort

To assess the incidence of and risk factors for acute pancreatitis in HIV-infected patients in the contemporary highly active antiretroviral therapy (HAART) era, researchers evaluated all cases of acute pancreatitis requiring hospitalization between 1996 and 2006 in a cohort receiving care from Johns Hopkins Hospital's HIV clinic. A nested, case-control analysis was employed for initial episodes of acute pancreatitis, and conditional logistic regression was used to assess risk factors. Of 5970 patients followed for 23,460 person-years (PYs), there were 85 episodes of acute pancreatitis (incidence: 3.6 events/1000 PYs). The incidence of pancreatitis from 1996 to 2000 was 2.6 events/1000 PYs; the incidence from 2001 to 2006 was 5.1 events/1000 PYs (p = 0.0014, comparing rates in two time periods). In multivariate regression, factors associated with pancreatitis included female gender (adjusted odds ratio [AOR] 2.96 [1.69, 5.19]; p < 0.001); stavudine [an antiretroviral therapy} use (AOR 2.19 [1.16, 4.15]; p = 0.016); aerosolized pentamidine use (OR 6.27; [1.42, 27.63]; p = 0.015); and a CD4 count <50 cells/mm(3) (AOR 10.47 [3.33, 32.90]; p < 0.001). Race/ethnicity, primary HIV risk factor, HIV-1 RNA, and newer HAART regimens were not associated with an increased risk of pancreatitis after adjustment for the above factors. Pancreatitis remains a significant cause of morbidity in the HIV population in the HAART era. Acute pancreatitis is associated with female gender, severe immunosuppression, and stavudine and aerosolized pentamidine usage. Of note, newer antiretrovirals were not associated with an increased risk of pancreatitis. Riedel, D., Gebo, K., Moore, R., and Lucas, G. A Ten-Year Analysis of the Incidence and Risk Factors for Acute Pancreatitis Requiring Hospitalization in an Urban HIV Clinical Cohort. AIDS Patient Care STDS, 22(2), pp. 113-121, 2008.

Services Research

Primary Medical Care Reduces HIV Risk Behaviors in Adults with Addictions

Human immunodeficiency virus (HIV) risk behaviors are prevalent in persons with addictions. This study assessed whether exposure to primary medical care is associated with decreases in HIV risk behaviors. This was a prospective 2-year cohort study of 298 adults with addictions. Outcomes evaluated were sex and drug-related HIV risk behaviors, measured by the Risk Assessment Battery. The predictor variables were the cumulative number of primary care visits (0, 1, > or = 2). Associations were tested using regression models for correlated data. It was found that in women, receipt of primary care was associated with less sex risk behavior (mean decrease 2.1, p < or = 0.1). Among women and men, > or = 2 primary care visits was associated with lower odds of any drug risk behavior (OR = 0.37, p = 0.03). From this study it is shown that exposure to primary care can impact HIV risk behavior favorably among adults with addictions. Takizawa, C., Cheng, D., Samet, J., Winter, M., Larson, M., and Saitz, R. Primary Medical Care and Reductions in HIV Risk Behaviors in Adults with Addictions. J. Addict. Dis., 26(3), pp. 17-25, 2007.

Unprotected Sex Among Ukrainian Addicts Forecasts Escalated HIV Infection Rates

From June 2004 through November 2006, outreach workers recruited 1557 Ukrainian IDUs, including 526 from Kiev, 494 from Odessa, and 537 from Makeevka/Donesk. Participants were administered a standardized computer-assisted interview assessing HIV-related drug and sex risk behaviors, self-efficacy for practicing safe sex, and HIV knowledge. Overall, 80% of the participants were sexually active in the 30-day period before their interview. They also engaged in high-risk sex behavior with 53% reporting anal or vaginal sex without a condom, 27% having sex with more than 1 partner, 41% having an IDU sex partner, and 37% having an HIV-positive sex partner or a partner whose HIV status they did not know. Overall, serology found significantly more women (40%) compared to men (32%) were HIV-positive. Men were twice as likely to have multiple sex partners (X2 = 33.42, df =1; p< .001). The extremely high HIV prevalence rate in Ukraine and in this cohort, combined with their recent high-risk sex behaviors, forecasts not only a continuance of the AIDS epidemic in the region but an escalation. Booth, R., Lehman, W., Brewster, J., Sinitsyna, L., and Dvoryak, S. Gender Differences in Sex Risk Behaviors among Ukraine Injection Drug Users. J. Acquir. Immune Defic. Syndr., 46(1), pp. 112-117, 2007.

Long-term Drug Abstinence Is Related to Psychiatric Trajectory

This study examines psychiatric trajectories of individuals entering chemical dependency treatment in a private, managed care health plan, and estimates relationships among those trajectories, individual characteristics, and abstinence (in the 30 days prior to follow-up) from drugs over 9 years. The original sample consisted of 1,204 adult men and women who met criteria for alcohol or other drug dependence or abuse and were admitted to treatment between April 1994 and April 1996. Interview data were collected at 6 mo., and 1, 5, 7, and 9 years after intake. This study is based on the 934 clients who had at least one follow-up interview within in 1 year and another between years 1 and 9. Psychiatric outcomes were measured using the ASI Psychiatric Composite scale. Other variables included age, gender, race/ethnicity, income, education, marital status, employment status, all seven ASI composite scores, and dependence and abuse measures based on the Diagnostic Interview Schedule for Psychoactive Substance Dependence. Four discrete trajectory groups of clients with homogenous longitudinal traits based on their patterns of psychiatric status over time were identified: consistent low-severity, deteriorating, improving, and consistent high-severity. Results, reported as odds ratios (OR), indicate that compared to clients in low severity groups, those in the deteriorating (OR = 0.61, 95% CI: 0.42 - 0.87), improving (OR = 0.61, 95% CI = 0.40-0.93) and high-severity (OR = 0.43, 95% CI: 0.29-0.66) all had lower levels of abstinence at follow-up. A higher ASI Drug Composite score was also negatively associated with attaining abstinence at follow-up. Variables associated with higher follow-up abstinence rates included higher index treatment length of stay, higher ASI Medical Composite score, being female, being married at follow-up, and being employed at follow-up. Age demonstrated a non-linear effect, with those aged 30-39 years and 50 to 59 years experiencing better outcomes than those aged 40-49 years in comparison to those younger than 30 years of age. These results suggest that careful attention be paid to client's psychiatric status during treatment assessment, treatment, and aftercare. Chi, F.W., and Weisner, C.M. Nine-Year Psychiatric Trajectories and Substance Use Outcomes. Eval. Rev., 32(1), pp. 39-58, 2008.

Provider-Level Effects on Psychiatric Inpatient Length of Stay for Youth with Mental Health and Substance Abuse Disorders

Previous research on inpatient care for children and adolescents with emotional or behavioral problems indicates that patient-level factors predict length of stay (LOS) poorly. This analysis examines whether patient-level factors are poor predictors of LOS, because LOS is primarily determined by facilities rather than patients. This study uses Tennessee Medicaid claims data from 1996 to 2001. The data include information on 14,162 observations related to 8,400 patients (age 12-21) from 163 hospitals. The researchers estimate log LOS using a cross-classified model. Covariates include admission-level characteristics (age, diagnosis, qualification for Medicaid, year), patient-level characteristics (gender, race), and facility characteristics (facility type). Results suggest that variation in LOS is attributable to facility-level factors (51%), time-invariance patient-level factors (5%), factors that vary across admissions (42%), and a correlation between patient-level and facility-level factors (5%). About half of the variation in LOS is explained by facility-level factors. Given the vulnerable nature of youth who are in need of inpatient psychiatric care, it may be particularly important to monitor provider-level processes and outcomes. Gifford, E. J., and Foster, E. M. Provider-level Effects on Psychiatric Inpatient Length of Stay for Youth with Mental Health and Substance Abuse Disorders. Med. Care, 46 pp. 240-246, 2008.

Substance Abuse Treatment Provider Views of "Culture": Implications for Behavioral Health Care in Rural Settings

Mandates for culturally competent substance abuse and mental health services call for behavioral health providers to recognize and engage cultural issues. These efforts to incorporate culture typically focus on client culture, but provider views of culture can also influence the provision of services. Analysis of 42 semi-structured interviews with behavioral health providers suggests that culture is considered by many to be an obstacle to help seeking and treatment of substance-abusing youth. Although some providers do not highlight cultural issues, others conceptualize culture in terms of (a) generalized Hispanic cultural attributes, (b) male-dominant gender roles, and (c) the culture of poverty. Quintero, G.A., and Lilliott, E. Substance Abuse Treatment Provider Views of "Culture": Implications for Behavioral Health Care in Rural Settings. Qual. Health Res., 17(9), pp. 1256-1267, 2007.

Exposure to Secondhand Smoke At Home and in Public Places in Syria: A Developing Country's Perspective

This study employs sensitive methods to address the issue of exposure to secondhand smoke among children and women in an understudied developing country setting (Syria). The study combines data collected by the Syrian Center for Tobacco Studies as part of two international studies conducted in 2006: by Johns Hopkins and the Roswell Park Cancer Institute. The authors employed objective measures (hair nicotine, and ambient household nicotine assessed by passive monitors) to assess children's and mother's exposure to secondhand smoke at home, and used the TSI SidePak personal aerosol monitor to sample respirable suspended particles less than 2.5 micron diameter (PM(2.5)) in the air in public places (40 restaurants/cafes in Aleppo). Mean level of hair nicotine was 11.8 ng/mg among children (n = 54), and was higher if the mother was a smoker (19.4 +/- 23.6 ng/mg) than nonsmoker (5.2 +/- 6.9 ng/mg) (p < .05). Children's hair nicotine level was strongly correlated with ambient household nicotine and number of cigarettes smoked daily in the house (r = .54 and r = .50, respectively, p < .001), and also was related to having a father who smoked in the children's presence. In public places, average PM(2.5) in the monitored 40 hospitality venues was 464 microg/m(3) and correlated with smoker density measured as cigarettes-waterpipes/100 m(3) (r = .31, p = 0.049). Thus, children in Syria are exposed to high levels of secondhand smoke at home, in which mothers smoking plays a major role. Also, levels of respirable hazardous particles are high in public hospitality venues, putting customers and workers at serious health risks. Maziak, W., Ali, R., Fouad, M., Rastam, S., Wipfl, H., Travers, M., Ward, K., and Eissenberg, T. Exposure to Secondhand Smoke at Home and in Public Places in Syria: A Developing Country 's Perspective. Inhal. Toxicol., 20(1), pp. 17-24, 2008.

A Ten-Year Analysis of the Incidence and Risk Factors for Acute Pancreatitis Requiring Hospitalization in an Urban HIV Clinical Cohort

To assess the incidence of and risk factors for acute pancreatitis in HIV-infected patients in the contemporary highly active antiretroviral therapy (HAART) era, the researchers evaluated all cases of acute pancreatitis requiring hospitalization between 1996 and 2006 in patients followed at Johns Hopkins Hospital's HIV clinic. A nested, case-control analysis was employed for initial episodes of acute pancreatitis, and conditional logistic regression was used to assess risk factors. Of 5,970 patients followed for 23,460 person-years (PYs), there were 85 episodes of acute pancreatitis (incidence: 3.6 events/1000 PYs). The incidence of pancreatitis from 1996 to 2000 was 2.6 events/1000 PYs; the incidence from 2001 to 2006 was 5.1 events/1000 PYs (p= 0.0014, comparing rates in two time periods). In multivariate regression, factors associated with pancreatitis included female gender (adjusted odds ratio [AOR] 2.96 [1.69, 5.19]; p< 0.001); stavudine use (AOR 2.19 [1.16, 4.15]; p 0.016); aerosolized pentamidine use (OR 6.27; 1.42, 27.63]; p 0.015); and CD4 count less than 50 cells/mm3 (AOR 10.47 [3.33, 32.90]; p<0.001). Race/ethnicity, HIV risk factor, HIV-1 RNA, and newer non-nucleoside reverse transcriptase inhibitors (NNRTI) - and protease inhibitor (PI)-based HAART regimens were not associated with an increased risk of pancreatitis after adjustment for the above factors. Pancreatitis remains a significant cause of morbidity in the HIV population in the HAART era. Acute pancreatitis is associated with female gender, severe immunosuppression, and stavudine and aerosolized pentamidine usage. Newer anti-retrovirals, articularlyatazanavir, lopinivir/ritonavir, tenofovir, abacavir, and efavirenz, were not associated with an increased risk of pancreatitis. Riedel, D.J., Gebo, K.A., Moore, R.D., and Lucas, G.M. A Ten-Year Analysis of the Incidence and Risk Factors for Acute Pancreatitis Requiring Hospitalization in an Urban HIV Clinical Cohort. AIDS Patient Care STDS, 22(2), pp. 113-121, 2008.

Uncovering Patterns of HIV Risk Through Multiple Housing Measures

Understanding the relationships between housing and HIV has been limited by reliance on a single housing indicator based on current living arrangements (e.g., stable, unstable, or homeless). This paper examines the cross-sectional and longitudinal relationships between five housing indicators (objective housing stability, subjective housing stability, supportive housing, number of residences in the last 6 months, and housing services needs) and four HIV risk behaviors (hard drug use, needle sharing, sex exchange, and unprotected intercourse) among women at-risk for HIV and with recent criminal justice system involvement (n = 493). In cross-sectional analyses, each risk behavior was associated with multiple indicators of poor housing, and the patterns of association varied by risk behavior. In the longitudinal analyses, changes in risk behavior were associated with changes in housing status since the previous assessment. These indicators reflect different aspects of housing and are uniquely associated with different risk behaviors. The relationships between housing and HIV risk are complex, and both constructs must be recognized as multidimensional. Weir, B.W., Bard, R.S., O'Brien, K., Casciato, C.J., and Stark, M.J. Uncovering Patterns of HIV Risk Through Multiple Housing Measures. AIDS Behav., 11, pp. S31-S44, 2007.

Decline in Availability of Tailored Outpatient Care for Women from 1995 to 2005

Tailoring substance abuse treatment to women often leads to better outcomes. This investigation sought to depict recent changes in outpatient substance abuse treatment (OSAT) tailoring to women. Data were from 2 waves of a national OSAT unit survey (N = 618 in 1995, N = 566 in 2005). Multiple logistic regressions with generalized estimating equations test associations between unit and contextual attributes and tailoring to women. Two measures of tailoring to women declined significantly between 1995 and 2005: availability of single sex therapy (from 66% to 44% of units) and percent of staff trained to work with women (from 42% to 32% of units). No aspect of tailoring to women became more common. Methadone treatment (O.R. =2.3; p<.001), and private for-profit status (O.R. = .23 to .49; p<.01) and government managed care financing (O.R. = 3.64; p<.001) were associated with higher odds of tailoring to women. Campbell, C., Wells, R., Alexander, J., Jiang, L., Nahra, T., and Lemak, C. Tailoring of Outpatient Substance Abuse Treatment To Women, 1995-2005. Med. Care, 45(8), pp. 775-780, 2007.

Comparison of Demographic and Clinical Characteristics Between Opioid-dependent Individuals Admitted to a Community-based Treatment Setting and Those Enrolled in a Research-based Treatment Setting

Despite the significant developments in pharmacotherapy and behavioral treatments for addiction, the dissemination of new treatment methods into the community has been slow. It has been pointed out that treatments developed in research settings may be impractical in community treatment settings, which might help explain the transition lag. Screening and recruitment of participants for research studies might partially explain this, as there is evidence that substance-abusing individuals who participate in clinical research are different on a number of measures from treatment seekers. However, no study has directly compared treatment seekers with research participants drawn from similar populations using prospective methods. This study compared the demographic characteristics, drug use and psychosocial problem severity levels, and personality traits of opioid-dependent individuals seeking help in a community setting (n = 502) with those of opioid-dependent individuals in a primarily research-based drug abuse treatment setting (n = 459); both settings offered a similar set of treatment services (opioid agonist medication and counseling). Although the overall findings revealed numerous similarities between the groups, differences were also observed. Most notably, there were significantly fewer women in the research sample than in the community-based treatment sample. Other differences included a modest but statistically significant increase in psychosocial problem severity levels in the community-based treatment sample and higher drug use problem severity levels in the research sample. Interestingly, many of these differences were strongest in women as compared with men. Carroll, C.P., Kidorf, M., Strain, E.C., and Brooner, R.K. Comparison of Demographic and Clinical Characteristics Between Opioid-dependent Individuals Admitted to a Community-based Treatment Setting and Those Enrolled in a Research-based Treatment Setting. J. Subst. Abuse Treat., 33 pp. 355-361, 2007.

Clinical Trials Network Research

Addressing Ethnic Disparities in Drug Abuse Treatment in the Clinical Trials Network

Ethnic minorities have significantly higher rates of unmet needs for treatment of substance use disorders and are often underrepresented in clinical trials and treatment research. The National Drug Abuse Treatment Clinical Trials Network (CTN) was established in 1999 to conduct research in a wide variety of community based treatment programs across the United States. Through its size and scope, the CTN provides a unique opportunity to address a variety of underserved populations, and in particular to evaluate access to and effectiveness of treatments for ethnic minorities. The CTN has continually sought to reduce barriers to all its studies and has attended carefully to recruitment and retention of women and ethnic minority groups. This article describes a symposium from the June 2006 CPDD annual meeting that included four presentations on ongoing CTN activities and strategies used to address the issues of ethnic disparities. Kathleen Carroll described a protocol developed specifically to address retention in treatment among Spanish-speaking substance users. Ray Daw described the special issues raised in clinical research among American Indian communities, including those encountered by a CTN protocol that was adapted on site so it could be implemented among American Indian communities. Kathryn Magruder summarized results of a secondary analysis of CTN data, evaluating rates of retention among ethnical minorities. And Lawrence Brown described a secondary analysis of a CTN survey study on national practices regarding the availability of specialized treatment for sexually transmitted diseases in drug abuse treatment, focusing specifically on services for ethnic minorities. Carroll, K.M., Rosa, C., Brown, Jr., L.S., Daw, R., Magruder, K.M., Beatty, L. Addressing Ethnic Disparities in Drug Abuse Treatment in the Clinical Trials Network. Drug Alcohol Depend., 90(1), pp. 101-106, 2007.

Improving the Transition from Residential to Outpatient Addiction Treatment: Gender Differences in Response to Supportive Telephone Calls

Substance use relapse rates are often high in the first months after discharge from inpatient substance abuse treatment, and patient adherence to aftercare plans is often low. Four residential addiction treatment centers participated in a feasibility study designed to estimate the efficacy of a post-discharge telephone intervention intended to encourage compliance with aftercare. A total of 282 participants (100 women, 182 men) with substance use disorders were included in this secondary analysis. The findings revealed that women were more likely than men to attend aftercare. This "gender effect" persisted after adjustment for a number of potential mediators. Carter, R.E., Haynes, L.F., Back, S.E., Herrin, A.E., Brady, K.T., Leimberger, J.D., Sonne, S.C., Hubbard, R.L., and Liepman, M.R. Improving the Transition from Residential to Outpatient Addiction Treatment: Gender Differences in Response to Supportive Telephone Calls. Am. J. Drug Alcohol Abuse, 34(1), pp. 47-59, 2008.

No Smoking Allowed: Integrating Smoking Cessation with Treatment

Substance abuse counselors, programs, and treatment systems are considering how to address smoking and nicotine dependence in the populations they serve. This article reports on the results from a survey within the National Drug Abuse Treatment Clinical Trials Network (CTN) that assessed whether the surveyed treatment agency provided smoking cessation treatment as part of their regular services. The survey also assessed the attitudes of staff regarding the feasibility of offering smoking cessation treatment. Analyses explored those factors associated with whether or not smoking cessation services were provided, and factors that predict staff attitudes toward smoking cessation treatment in these drug treatment strategies. Overall, the study found that smoking cessation treatment was more likely to be available in units that offered other ancillary services, including detoxification. Additionally, clinics that provide smoking cessation care were more likely to have a staff with a supportive attitude toward such services. This was especially true in clinics with a high number of pregnant women, but the proportion of youth admissions was neither a predictor for staff attitudes nor for the provision of smoking cessation services. Overall, this study presents some challenges to the treatment field to focus on evidence-based services regarding smoking cessation treatment, and raises some ethical issues as well. Fuller, B.E., and Guydish, J. No Smoking Allowed: Integrating Smoking Cessation with Treatment. Counselor, 9(1), pp. 22-27, 2008.

International Research

Publications By Former Nida Invest Drug Abuse Research Fellows

Cross-National Prevalence and Risk Factors for Suicidal Ideation, Plans and Attempts

INVEST Fellow: Guilherme Borges (Mexico, 1997-1998)
Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide - suicidal ideation, plans and attempts - are not well known, especially in low- and middle-income countries. The aim of this study was to report on the prevalence and risk factors for suicidal behaviors across 17 countries. A total of 84, 850 adults were interviewed regarding suicidal behaviors and socio-demographic and psychiatric risk factors. Results showed that the cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. Interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries. The authors conclude that there is cross-national variability in the prevalence of suicidal behaviors, but strong consistency in the characteristics and risk factors for these behaviors. These findings have significant implications for the prediction and prevention of suicidal behaviors. Nock, M.K., Borges, G., Bromet, E.J., Alonso, J., Angermeyer, M., Beautrais, A., Bruffaerts, R., Chiu, W.T., de Girolamo, G., Gluzman, S., de Graaf, R., Gureje, O., Haro, J.M., Huang, Y., Karam, E., Kessler, R.C., Lepine, J.P., Levinson, D., Medina-Mora, M.E., Ono, Y., Posada-Villa, J., and Williams, D. Br. J. Psychiatry.192, pp. 98-105, 2008.

Suicide Ideation, Plan, and Attempt in the Mexican Adolescent Mental Health Survey

INVEST Fellow: Guilherme Borges (Mexico, 1997-1998)
No representative data among adolescents in Mexico exist on the prevalence and risk factors for suicide ideation, plan, and attempt despite a recent increase in suicide deaths. Data are presented from the Mexican Adolescent Mental Health Survey, a representative household survey of 3,005 adolescents ages 12 to 17 in metropolitan Mexico City who were gathered in 2005, regarding lifetime prevalence and age-of-onset distributions of suicide ideation, plan, and attempt and demographic and psychiatric disorders risk factors. Lifetime ideation was reported by 11.5% of respondents, whereas 3.9% reported a lifetime plan and 3.1% a lifetime suicide attempt. Onset of suicidality started around age 10 and at age 15 showed the highest hazards. Suicide ideators were more likely to report a plan and attempt within the first year of onset of ideation. Suicidality was more likely to occur among females. The presence of one or more mental disorders was strongly related to suicide ideation, plan, and attempt. Among ideators only dysthymia was consistently related to a plan and attempt. The authors conclude that intervention efforts should focus on assessment and target adolescents with mental disorders, particularly mood disorders, to be effective in prevention. Borges, G., Benjet, C., Medina-Mora, M.E., Orozco, R., and Nock, M. J. Am. Acad. Child Adolesc. Psychiatry, 47(1), pp. 41-52, 2008.

Publications by Former NIDA Hubert H. Humphrey Drug Abuse Research Fellows

Hypotension Caused by Therapeutic Doses of Venlafaxine: Case Report and Proposed Pathophysiological Mechanisms

HHH Fellow: Arthur Guerra de Andrade (Brazil, 1991-1992)
Although venlafaxine is usually associated with modest increases in blood pressure and not so often clinical hypertension, there are a few reported cases of hypotension related to overdoses of this specific antidepressant. The case study of a young female patient with a history of Major Depressive Disorder who initiated treatment with venlafaxine 75 mg/day and developed hypotension when the dosage was titrated up to 225 mg/day is described. The patient did not present comorbid diseases nor use other medication. A temporal association and a dose-dependent relationship between the hypotension and the use of venlafaxine is shown. To the best of the knowledge of the authors, this is the first case report that specifically associates regular doses of venlafaxine with the presence of hypotension. A pathophysiological mechanism is proposed, involving the participation of presynaptic alpha2-adrenergic receptors and the presence of a possible genetic polymorphism of cytochrome P4502D6, which is associated with lower drug metabolization, to explain the relationship between venlafaxine in regular dosage and development of hypotension. Alexandrino-Silva, C., Maua, F.H., De Andrade, A.G., and De Toledo Ferraz Alves, T.C. Hypotension caused by therapeutic doses of venlafaxine: case report and proposed pathophysiological mechanisms. J. Psychopharmacol, 22(2), Epub 2008 Jan 21.

Drugs and Fatal Traffic Accidents in the Czech Republic

HHH Fellow: Tomas Zabransky (Czech Republic, 2003-2004)
The aim of the study was to determine the prevalence of psychotropic drug use in active participants in traffic accidents who died during the accident or shortly after it due to injuries resulting from the accident. A special mortality register containing data of all forensic autopsies was analyzed. The studied sample consisted of persons who died during traffic accidents and were active participants in those ones (pedestrians, cyclists, or drivers), and were toxicologically tested during the forensic examination. The sample consisted of 1,213 cases, 1,039 (85.7%) males and 174 (14.3%) females who died in 2003-2005. Ethanol was found in 34.7% of cases, however a significant declining trend over the years was noted. The proportion of positive detections for any psychotropic drug other than alcohol was 7.2%; benzodiazepines were found most frequently (3.6%), followed by cannabis (2.2%), and stimulants (1.7% of the sample). Positive findings of ethanol were significantly more common among males, whereas positive benzodiazepine tests were more frequent in females. Positive cases were significantly younger than negative ones for ethanol, volatile substances, stimulants, and cannabis; in cases of positive medicaments tests, the positive cases were significantly older than the negatives. Mravci-k, V., Vorel, F., and Zabransky, T. Cent. Eur. J. Public Health, 15(4), pp. 158-162, 2007.

Schizophrenia Modifying the Expression of Gender Identity Disorder

HHH Fellow: Arthur Guerra de Andrade (Brazil, 1991-1992)
According to the Brazilian Federal Medical Association, transsexualism is recognized as a gender identity disorder if a long-term diagnostic therapeutic process has demonstrated that the transposition of gender roles is irreversible, and if only hormonal and surgical procedures are appropriate to relieve the stress associated with the gender identity. Although such treatment will only be initiated with caution and after a long phase of intense diagnostic screening, the differentiation between pure identity disorders and transsexual feelings secondary to an ongoing psychopathologic process, such as schizophrenia, can be arduous for many health professionals. The aim of this article was to report a case of a female patient with schizophrenia and transsexualism and the risks of a potential diagnostic confusion. A 19-year-old black woman, with an 8-year history of undifferentiated schizophrenia and intense gender dysphoria, was referred for sex reassignment surgery evaluation in the Ambulatory for the Treatment of Sexual Disorders of the ABC Medical School. After a more adequate antipsychotic treatment, her masculine behavior has persisted, but her desire to change her own genital organs has decreased. A better acceptance of the multiplicity of possible genders should neither contribute to inadequate interpretations of the signs and symptoms of our patients nor facilitate dangerous clinical or surgical recommendations. Baltieri, D.A., and De Andrade, A.G. Schizophrenia Modifying the Expression of Gender Identity Disorder. J. Sex Med., December 7, 2007, Epub ahead of print.

Intramural Research

Chemistry and Drug Metabolism, CPTRB

Methadone Maintenance and Breastfeeding in the Neonatal Period

Lactation among methadone-maintained women is frequently challenged due to lack of knowledge and guidelines regarding this practice. In methadone-maintained breastfeeding women and a matched group of formula-feeding women, IRP scientists evaluated breast milk methadone concentrations and concentrations of methadone in maternal and infant plasma in both groups. Eight methadone-maintained (dose range 50-105 mg/day), lactating women provided blood and breast milk on days 1, 2, 3, 4, 14 and 30 after delivery at expected trough and peak times. Paired foremilk and hindmilk specimens were obtained at each sampling time. Eight matched formula-feeding subjects had blood drawn the same days. Infant blood for both groups was obtained on day 14. Urine toxicology between 36 weeks gestation and 30 days post-partum confirmed that subjects were not using illicit substances in the perinatal period. Concentrations of methadone in breast milk were low (range 21.0-462.0 ng/mL) and not related to maternal dose. There was a significant increase in methadone concentrations in breast milk over time for all six sampling times. Maternal methadone plasma concentrations were not different between groups and unrelated to maternal dose. Infant methadone plasma concentrations were low in all specimens (range 2.2 - 8.1 ng/mL). Infants in both groups had neurobehavioral assessments on days 3, 14 and 30; there were no significant effects of breastfeeding on neurobehavioral outcomes. Fewer infants in the breastfed group required pharmacotherapy for neonatal abstinence syndrome, but this was not a statistically significant finding. Results contribute to the recommendation of breastfeeding for methadone-maintained women. Jansson, L.M., Choo, R.E., Velez, M., Harrow, C., Schroeder, J., Shakleya, D.M. and Huestis, M.A. Methadone Maintenance and Breastfeeding in the Neonatal Period. Pediatrics, 121, pp. 106-114, 2008.

Validation and Application of a Novel Method for the Determination of Buprenorphine, Norbuprenorphine and Their Glucuronide Conjugates in Human Meconium

A novel liquid chromatography tandem mass spectrometry (LCMSMS) method for buprenorphine, norbuprenorphine, and glucuronidated conjugates' quantification in meconium was developed and fully validated. Maternal self-report, the most common mechanism for identifying drug-exposed neonates is less reliable than biological monitoring of maternal and infant specimens. Meconium, the highly complex neonatal fecal material, is easy and non-invasive to collect and has higher sensitivity and specificity than urine to detect in utero drug exposure. Controlled administration of illicit drugs during pregnancy is unethical and unsafe, and administration of licit medications is recommended only as needed. Buprenorphine administration to pregnant opiate addicts to reduce illicit drug use and craving provides an important opportunity to study disposition of this drug in the maternal-fetal dyad. It is unknown whether buprenorphine dose is correlated to buprenorphine and/or metabolite concentrations in meconium, and if meconium concentrations predict neonatal outcomes. This research has not been possible due to the lack of a validated, quantitative chromatographic method for measuring buprenorphine in this neonatal matrix. This method will enable the question of whether drug doses predict meconium drug concentrations, and whether drug concentrations correlate with onset, magnitude and duration of neonatal abstinence syndrome and other outcomes. These findings could improve clinical care in this vulnerable population. Development of this new biomarker assay for buprenorphine and metabolites in meconium is a critical step for conducting this research. This sensitive and specific method will monitor in utero buprenorphine exposure and determine if correlations exist between buprenorphine exposure and neonatal outcomes. Kacinko, S.L., Shakleya, D.M. and Huestis, M.A. Validation and application of a method for the determination of buprenorphine, norbuprenorphine, and their glucuronide conjugates in human meconium. Analytical Chemistry, 80, pp. 246-252, 2008.

MDMA, HMMA, MDA, and HMA Plasma Pharmacokinetics in Humans Following Controlled MDMA Administration

An extended pharmacokinetic analysis of MDMA or Ecstasy and three metabolites, HMMA, MDA and HMA, characterizing Cmax, Tmax, AUC()(), detection windows, t1/2, Vd/F, CL/F, and metabolite ratios for up to 143 h after oral MDMA dosing in young adults was performed. The aim of the study was to document whether non-linearity in MDMA pharmacokinetics occurred at recreational doses, and to characterize MDMA pharmacokinetics in African-Americans and women for the first time. Seventeen female and male participants received placebo, low (1.0 mg/kg), and high (1.6 mg/kg) oral MDMA doses in a double blind, randomized, balanced, within-subject design. Study strengths included metabolite measurements, concentrations after low and high doses, frequent and extended plasma sampling, and residence of participants on a closed research unit with 24-h monitoring to prevent self-administration of MDMA or other drugs. A fully validated 2D-GC/MS method simultaneously quantified MDMA and metabolites. Mean +/- SD maximum plasma concentrations (Cmax) were 162.9+/-39.8 and 171.9+/-79.5 ng/mL for MDMA and HMMA, respectively, after low and 291.8+/-76.5 and 173.5+/-66.3 ng/mL after high MDMA doses, demonstrating non-linear MDMA pharmacokinetics. Mean MDMA volume of distribution was constant for low and high doses; clearance was significantly higher after the low dose. MDMA primarily affects the serotonergic system, acting as an indirect monoaminergic agonist; however, the mechanism(s) by which MDMA causes toxicity are not fully understood. Non-linearity in MDMA dose-concentration relationships and wide variability between subjects at typical recreational doses could contribute to observed MDMA toxicity. Preliminary data on gender differences in drug elimination also were noted. Kolbrich, E.A., Goodwin, R.S., Gorelick, D.A., Hayes, R.J., Stein, E.A., and Huestis, M.A. Presentation, 2008. American Academy of Forensic Sciences (AAFS) Annual Meeting, Washington, DC, February 18-22, 2008.

Nicotine Psychopharmacology Unit, Treatment Section, Clinical Pharmacology and Therapeutics Research Branch

Nicotine Enhances Mood and Cognition in Smokers

The discovery of the role of nicotinic receptors in attention and memory has led to the testing of nicotinic analogs as cognitive enhancing agents in patient populations. Empirical information about nicotine's ability to enhance elements of attention and memory in normal individuals might guide development of therapeutic uses of nicotine in cognitively-impaired populations. The purpose of this study was to determine the effect of nicotine on continuous attention, working memory, and computational processing in tobacco-deprived and nondeprived smokers. A total of 28 smokers (14 men, 14 women) participated in a double-blind, placebo-controlled, within-subject study, in which they were overnight (12 h) tobacco deprived at one session and smoked ad libitum before the other session. At each session, participants received 0, 1, and 2 mg nicotine via nasal spray in random order at 90-min intervals. Before and after each dose, a battery of cognitive, subjective, and physiological measures was administered, and blood samples were taken for plasma nicotine concentration. Overnight tobacco deprivation resulted in impaired functioning on all cognitive tests and increased self-reports of tobacco craving and negative mood; nicotine normalized these deficits. In the nondeprived condition, nicotine enhanced performance on the Continuous Performance Test and Arithmetic Test in a dose-related manner, but had no effect on working memory. In general, women were more sensitive than men to the subjective effects of nicotine. These results provide an unequivocal determination that nicotine enhanced attentional and computational abilities in nondeprived smokers and suggest these cognitive domains as substrates for novel therapeutic indications. Myers, C.S., Taylor, R.C., Moolchan, E.T., and Heishman, S.J. Dose-related Enhancement of Mood and Cognition in Smokers Administered Nicotine Nasal Spray. Neuropsychopharmacology, 33, pp. 588-598, 2008.