Epidemiology of Youth Drug Abuse

Research Findings from February, 2005 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the epidemiology, etiology, and prevention research. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Sensation Seeking and Symptoms of Disruptive Disorder: Association with Nicotine, Alcohol, and Marijuana Use in Early and Mid-Adolescence

This cross-sectional study examined the association of Sensation Seeking (SS) and symptoms of Disruptive Disorders and investigated the associations of each with the risk of nicotine, alcohol, and marijuana use in a sample of 127 boys and 81 girls aged 11-14 years recruited from child psychiatry, pediatric adolescent, and pediatric family clinics. Results indicated that sensation seeking was correlated with Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD), however, when analyzed by gender, there was a significant correlation between SS and CD for boys, but no significant correlations between Sensation Seeking and any of the Disruptive Disorders for girls. Sensation seeking was associated with nicotine, alcohol, and marijuana use; ODD was associated with nicotine use; and Conduct Disorder was associated with alcohol and marijuana use for boys and girls, and smokeless tobacco use for boys. Results from a series of gender specific regression analyses found that SS and ODD predicted nicotine use by girls and SS and CD predicted alcohol and marijuana use by boys. For all other analyses of cigarette, alcohol, and marijuana use, SS was the only significant predictor. Measurement of Sensation Seeking and symptoms of Disruptive Disorder in clinic setting can help identify and characterize youth who are at increased risk for drug use during early and mid-adolescence. Martin, C.A., Kelly, T.H., Rayens, M.K., Brogli, B., Himelreich, K., Brenzel, A., Bingcang, C.M., and Omar, H. Psychological Reports, 84, pp. 1075-1082, 2004.

Drug Injection Practices Among High-Risk Youths: The First Shot of Ketamine

Little is known about ketamine injection practices, associated risk behaviors, or the demographic characteristics of ketamine injectors. This study employed an ethno-epidemiological methodology and interviewed 40 young (<25 years old) ketamine injectors in New York during 2000-2002 about ketamine injection initiation as well as histories of other injection drug use and involvement in the street economy. Ninety percent of the sample had a history of sniffing ketamine and 63% had a history of selling ketamine prior to ketamine injection initiation. This study compared two groups of ketamine users: 23 ketamine initiates (youths who initiated injection drug use with ketamine) and 17 other initiates (youths who initiated injection drug use with another drug, such as heroin, and later transitioned into ketamine injection). Results indicated that intramuscular injections were more common among ketamine initiates, whereas intravenous injections were more common among other initiates. Drug form and local knowledge within injection groups were important factors underpinning this relationship: liquid ketamine was injected primarily intramuscularly; powder ketamine was injected primarily intravenously virtually irrespective of injection drug use history. In addition, the comparison between ketamine initiates and other initiates revealed differences regarding knowledge about injecting drugs; risk behaviors at initiation; involvement in the street economy, including homelessness and experience dealing drugs; and city or location of ketamine injection initiation. These findings suggest that ketamine injection is an emerging practice among a new hidden population of injection drug users in cities throughout North America. Ketamine injector's variable risk knowledge and injection practices suggest risk for HIV, HCV, and HBV. Lankenau, S.E. and Clatts, M.C. Journal of Urban Health, 81(2), pp. 232-248, 2004. Epidemiology of Inhalant Use, Abuse, and Dependence among Youth Secondary analysis of data on adolescents aged 12-17 from 2000 and 2001 National Household Surveys on Drug Abuse found that inhalant use was common. Results showed that 0.4% of adolescents met DSM-IV inhalant abuse or dependence criteria in the past year. Inhalant abuse and dependence affected adolescents regardless of gender, age, race/ethnicity, and family income. The progression from inhalant use to abuse or dependence was related to early first use, use of multiple inhalants, and weekly inhalant use. Adolescents with inhalant use disorders reported coexisting multiple drug abuse and dependence, mental health treatment, and delinquent behaviors. Adolescents with an inhalant use disorder may represent a subgroup of highly troubled youth with multiple vulnerabilities. Because early use is associated with progression to abuse and dependence, prevention programs should target elementary school-age children. Wu, L.T., Pilowsky, D.J., and Schlenger, W.E. Inhalant Abuse and Dependence among Adolescents in the United States. J Am Acad Child Adolesc Psychiatry, 43, pp. 1206-1214, 2004.

Pubertal Stage Associated with Substance Use

The aim of this study was to ascertain the association between pubertal development and early adolescent substance use. Students completed questionnaires in school, in a cross-sectional survey of 5769 students age 10- to 15-year-old in the states of Washington, United States, and Victoria, Australia. The odds of lifetime substance use were almost twofold higher in midpuberty (Tanner stage III) and were threefold higher in late puberty (Tanner stage IV/V), after adjustment for age and school grade level. Recent substance use and substance abuse were higher in midpuberty and even more so in late puberty. Reporting most friends as substance users was more likely in the later stages of pubertal development, a relationship that accounted in part for the association found between later pubertal stage and substance abuse. Pubertal stage was associated with higher rates of substance use and abuse independent of age and school grade level. Early maturers had higher levels of substance use because they entered the risk period at an earlier point than did late maturers. The study findings support prevention strategies and policies that decrease recreational substance use within the peer social group in the early teens. Patton, G.C., McMorris, B.J., Toumbourou, J.W., Hemphill, S.A., Donath, S., and Catalano, R.F. Puberty and the Onset of Substance Use and Abuse. Pediatrics, 114, pp. 300-306, 2004.

Comparison of Substance Use in the US and Australia

This study compared risk and protective factors that influence youth substance use in Australia and the United States. The two countries have different policy orientations toward substance use: Australia has adopted harm-reduction policies, and the United States has adopted abstinence-focused policies. Cross-sectional survey data were collected from independent samples of adolescents in the states of Maine (N = 16,861) and Oregon (N = 15,542) in the United States and Victoria in Australia (N = 8442). Study results indicated that more adolescents in Victoria reported using cigarettes and alcohol, whereas more of the U.S. adolescents reported using marijuana. Exposure to risk and protective factors was generally similar in the cross-national samples. Most of the risk and protective factors were strongly associated with substance use to a similar degree in Victoria, Maine, and Oregon. However, among adolescents in Maine and Oregon peer/individual risk and protective factors associated with social detachment were more strongly related to substance use, and among adolescents in Victoria, family protective factors were less strongly related to alcohol use. Existing differences suggest that the abstinence policy context is associated with higher levels of illicit drug use and stronger relations between individual indicators of social detachment and substance use, whereas the harm reduction policy context is related to more cigarette and alcohol use, possibly from exposure to normative influences that are more tolerant of youth drug use. Beyers, J.M., Toumbourou, J.W., Catalano, R.F., Arthur, M.W. and Hawkins, J.D. A Cross-national Comparison of Risk and Protective Factors for Adolescent Substance Use: The United States and Australia. J Adolesc Health, 35, pp. 3-16, 2004.

The Natural History of Alcohol Use Disorders

This study examined clinically relevant research on the development, course and outcomes of adolescence alcohol use disorders (AUDs), using observational studies with adolescent samples selected for inclusion based on systematic assessment of AUDs and clinical relevance. Articles on childhood predictors, characteristics, course, complications and adult outcomes of adolescent AUDs were reviewed. Results indicate that the developmental trajectory toward adolescent AUDs begins with the emergence of childhood mental disorders. These problems are transmitted from parent to child in a developmentally specific fashion, reflect psychological dysregulation dimensions and predict adolescent AUDs. While most DSM-IV AUD diagnostic criterion items are valid for adolescents, tolerance and impaired control items are problematic, and some adolescents with significant alcohol problems are not identified by this diagnostic system. Understanding the psychosocial and biomedical complications that accompany AUDs requires attention to factors other than alcohol involvement itself, including childhood maltreatment and comorbid psychopathology. While some adolescents with AUDs manifest chronic alcohol dependence in adulthood, a substantial proportion overcome alcohol problems and transition to abstinence or normative drinking. While alcohol consumption may be the primary treatment focus, other important consequences, comorbidities and complications need to be addressed for successful developmental outcomes to result. Clark, D.B. The Natural History of Alcohol Use Disorders, Addiction, 99, pp. 5-22, 2004.

Antecedents and Outcomes of Marijuana Use Initiation during Adolescence

This study identified similarities and differences in risk factors for marijuana use initiation from grades 7 to 8, grades 8 to 9, and grades 9 to 10, and examined differences between earlier initiates, later initiates, and nonusers on various problem behaviors at grade 10. Longitudinal data were used to examine predictors and outcomes associated with marijuana initiation from grade 7 (N = 1,955) to grade 10 (N = 909). Participants completed yearly surveys to assess problem behaviors, social influences, and marijuana-related attitudes and behavior. Results showed that earlier initiates were more likely than later initiates to exhibit problem-related marijuana use, hard drug use, polydrug use, poor grades, and low academic intentions at grade 10. Across ages, initiation was predicted by smoking, frequency of marijuana offers, and poor grades. Results provided some evidence for a shift from familial to peer influence on marijuana initiation with increasing age. Marijuana-related beliefs were relatively weak predictors of initiation at all ages after controlling for pro-marijuana social influences and engagement in other types of substance use and delinquent behavior. Results emphasize the importance of early intervention and identify a wide range of potentially modifiable risk factors that may be targeted. Ellickson, P.L., Tucker, J.S., Klein, D.J., and Saner, H. Prev Med., 39, pp. 976-984, 2004.

Racial Identity, Parental Support and Alcohol Use

This study examined racial identity and parental support as predictors of alcohol use in a sample of 488 African American adolescents. Two dimensions of racial identity were investigated: (1) racial centrality (i.e., the significance that one places on race in defining oneself) and (2) private regard (i.e., the extent to which one feels positively about Black people). In addition, perceived support from mothers and fathers was examined. Multivariate results showed that private regard and father support were associated with less self-reported alcohol use after partialling out the effects of age and gender. An interaction between the two racial identity dimensions was also found such that private regard was associated with less alcohol use for adolescents who reported that race was a more central part of their identity. Caldwell, C.H., Sellers, R.M., Bernat, D.H., and Zimmerman M.A. Racial Identity, Parental Support, and Alcohol Use in a Sample of Academically At-risk African American High School Students. Am J Community Psychol, 34, pp. 71-82, 2004.

Religious Activity and Risk Behavior Among African American Adolescents

This study examines how religious activity is associated with risk behaviors, concurrently and developmentally among urban African American adolescents. Seven hundred and five African American youths were interviewed annually during high school. Retention rates for the study exceeded 90%. Frequency of religious activity, sexual intercourse, and alcohol, cigarette, and marijuana use were assessed at each wave. Growth curve analyses found negative concurrent associations between religious activity and each of the four risk behaviors. The developmental effects of religious activity varied by gender. Higher levels of religious activity in 9th grade predicted smaller increases in marijuana use among males and cigarette use among females. In addition, larger decreases in religious activity during high school were associated with greater increases in alcohol use among males and sexual intercourse among females. During high school, religious activity limits the development of certain types of risk behavior among African American youth, even after controlling for reciprocal effects. Steinman, K.J., and Zimmerman M.A. Religious Activity and Risk Behavior among African American Adolescents: Concurrent and Developmental Effects. Am J Community Psychol., 33, pp. 151-161, 2004.

Life Transitions Predict Depression and Alcohol Use

This study examined longitudinally the relationship between depressive symptoms and alcohol use in a sample of black youth. Participants were 458 black males and females interviewed annually during the high school years and then for 3 years during the transition to adulthood. The relationship was examined using growth curves with Hierarchical Linear Modeling. The results suggest that depressive symptoms decrease over time, whereas the use of alcohol increases. The findings also suggest that youths use alcohol as a way to cope with depressive symptoms and that males are more likely to use alcohol as self-medication. The results also indicate that changes in alcohol use do not predict depressive symptoms, but that life changes associated with the transition to adulthood, such as attending college, predict changes in depressive symptoms and alcohol use. Findings highlight the role of depressive symptoms for predicting alcohol use among black youth and the role of significant life transitions in altering the pattern of alcohol use presented previously by these youths. Repetto, P.B., Zimmerman, M.A., and Caldwell, C.H. A Longitudinal Study of the Relationship between Depressive Symptoms and Alcohol Use in a Sample of Inner-city Black Youth. J Stud Alcohol., 65, pp. 169-178, 2004.

Smoking Among New Yorican Adolescents

The authors identified longitudinal relationships between early risk and protective factors from the domains of family, personality, and peer influences and later tobacco use in Puerto Rican adolescents living in New York. Aspects of the ethnic minority experience as moderators of familial risk and protective factors were investigated. Participants were 282 female and 276 male Puerto Rican adolescents interviewed twice, 5 years apart. The authors used hierarchical regression analyses to identify a model with direct and indirect paths. Family, personality, peer, and early smoking domains were directly related to later adolescent smoking. Partial mediation occurred. The authors identified risk-protective and protective-protective interactions between variables from the ethnic minority experience and family domains. Interventions to reduce smoking among Puerto Rican adolescents should focus on multiple contexts, including aspects of the ethnic minority experience. Brook, J.S., Pahl, T., Balka, E.B, and Fei, K. Smoking Among New Yorican Adolescents: Time 1 Predictors of Time 2 Tobacco Use. Journal of Genetic Psychology, 165, pp. 324-340, 2004.

Racial/Ethnic Differences in Cigarette Smoking Initiation and Progression to Daily Smoking

Using data from the National Longitudinal Study of Adolescent Health, this study was designed to identify individual and contextual factors that influence cigarette smoking initiation and progression to daily smoking among non-Hispanic Black, Hispanic, and non-Hispanic White adolescents. Findings confirmed differences in patterns of smoking onset and progression to daily smoking among racial/ethnic groups. Hispanic youth had the highest rates of smoking onset, and White youth had the highest rates of progression to daily smoking. Black youth consistently had the lowest rates for both smoking outcomes. There were more common predictors than ethnic-specific predictors of adolescent smoking and individual factors were much more important predictors than contextual factors. The authors concluded that universal prevention and intervention efforts would reach most adolescents, regardless of race/ethnicity. Kandel, D.B., Kiros, G.E, Schaffran, C., and Hu, M.C. Racial/Ethnic Differences in Cigarette Smoking Initiation and Progression to Daily Smoking: A Multilevel Analysis. American Journal of Public Health, 94, pp. 128-135, 2004.

Trajectories of Substance Use and Dependence from Adolescence to Adulthood

This study describes trajectories of substance use and dependence from adolescence to adulthood. The participants were from a large existing sample from an ongoing study of parental alcoholism. The first assessment occurred when the age of participants ranged from 10.5 to 15.5 years. The follow-up assessments occurred 8 years later when participants were in emerging adulthood. Results suggest that a trajectory of heavy alcohol and drug use was most likely to result in substance dependence and was associated with familial alcoholism and lack of constraint. A trajectory of moderate alcohol use and experimental drug use was associated with some risk for alcohol dependence, although it was less likely to result in comorbid or persistent disorders and had a weaker link with familial alcoholism and personality risk. Chassin, L., Flora, D.B. and King, K.M. Trajectories of Alcohol and Drug Use and Dependence from Adolescence to Adulthood: The Effects of Familial Alcoholism and Personality. Journal of Abnormal Psychology, 113, pp. 483-498, 2004.

Surveillance of Drug Use among American Indian Adolescents

This study examined the trends in drug use among American Indian adolescents attending schools on, or near, Indian reservations in the United States, to provide comparisons with non-Indian youth, and to discuss implications for prevention. Reliable and valid school administered drug use surveys have been given every year for 25 years (1975-2000) to representative samples of Indian youth living on reservations, yielding a continuous record of trends in drug use. Comparisons are made with non-Indian youth with data from the Monitoring the Future project. Data were analyzed to obtain measures of lifetime prevalence ("ever tried a drug"), use in the last 30 days, and proportions at high risk and at moderate risk from their drug use. Comparisons utilized difference in proportion tests. Results showed that, from 1975 to 2000, reservation Indian youth show elevated levels of drug use for most illicit drugs compared with non-Indian youth. Despite higher levels of use, the trends showing increases and decreases in use over time mirror those shown by non-Indian youth. Indian youth who use drugs can be divided into moderate and high levels of use. The number of youth in the moderate category varies over time whereas the number in the high category remains relatively constant. These findings indicate a clear need for intensive efforts to reduce the levels of drug use among Indian youth. Although interventions must be tailored to the social and cultural milieu of Indian reservations, the rates of use vary over time in the same pattern as seen for non-Indian youth. Further, interventions must address the differing characteristics of high and moderate risk users of drugs. Beauvais, F., Jumper-Thurman, P., Helm, H., Plested, B. and Burnside, M. Surveillance of Drug Use among American Indian Adolescents: Patterns Over 25 Years. J Adolesc Health, 34, pp. 493-500, 2004.

Two Prevention Programs Reduce High Risk Behaviors Among African American Boys

This study was designed to test the efficacy of two programs to reduce high-risk behaviors, including drug use, delinquency, and high risk sexual behavior, among inner-city African-American youth. Students in grades 5 through 8 and their parents and teachers in twelve metropolitan Chicago schools were involved in a cluster randomized trial. The preventive interventions being tested were 1) a social development curriculum, focusing on social competence skills, and 2) a school/community intervention, consisting of the social development curriculum plus a school-wide climate and parent/community intervention. The control group received an attention-placebo. For boys, both programs significantly reduced violent behavior, provoking behavior, school delinquency, drug use, and recent sexual intercourse. The rate of condom use was increased among boys as well. The school/community intervention was significantly more effective than the curriculum-only intervention in reducing risk based on examination of a combined behavioral measure. There were no significant effects for girls. Flay, B.R., Gramlich, S., Segawa, E., Burns, J.L., and Holliday, M.Y. Effects of Two Prevention Programs on High Risk Behaviors among African American Youth. Archives of Pediatric and Adolescent Medicine, 158, pp. 377-384, 2004.

The Importance of Family-based Prevention Interventions in Rural Areas

There are several reasons to promote the implementation of evidence-based family-focused interventions in rural, small town or micropolitan communities. One key reason is research demonstrating that youth problem behaviors are especially prevalent in rural areas and that these problems can be effectively reduced though family-focused programs. For example, studies have found that rural youth are involved in tobacco, alcohol, and illegal substance use at rates that often exceed those of youth living in urban and suburban communities (America's Children, 2000Federal Interagency Forum on Child and Family Statistics, 2000; National Institute on Drug Abuse, 1997; Johnston, O'Malley, & Bachman, 2000, 2002). Further, earlier program evaluation research has demonstrated the effectiveness of several evidence-based family-focused programs among rural youth, including the reduction of substance use; related economic analyses also have shown that these programs are cost-beneficial. These programs focus on the enhancement of competencies related to reducing risk and increasing protective factors among families and youth. Meek, J., Lillehoj, C.J., Welsh, J. and Spoth, R. Rural Community Partnership Recruitment for an Evidence-based Family-focused Prevention Program: The PROSPER Project, Rural Mental Health, 29(2), pp. 23-28, 2004.

Adolescent Depression and Suicide Risk Are Associated with Sex and Drug Use Behavior

Although both depression and suicide in adolescents have been associated with drug use and early sexual intercourse, the relationship has not been systematically studied in a nationally representative sample. Sixteen patterns of combined sex and drug use behaviors were obtained through analysis of responses to Wave I of the National Longitudinal Study of Adolescent Health conducted from September 1994 through December 1995. Analyses tested correlations between behavior patterns and current depression, serious suicidal ideation, and previous suicide attempt, controlling for gender, race/ethnicity, family structure, and parent education. Compared to youth who abstain from risk behaviors, involvement in any drinking, smoking, and/or sexual activity was associated with significantly increased chances of depression, suicidal ideation, and suicide attempts. These problems were highest among youth who engaged in illegal drug use. There were few differences between boys and girls who abstain from sex and drug behaviors. Girls were less likely than boys to engage in high-risk behaviors, but those who did tended to be more vulnerable to depression, suicidal ideation, and suicide attempt. Hallfors, D.D., Waller, M.W., Ford, C.A., Halpern, C.T., Brodish, P.H., and Iritani, B. Adolescent Depression and Suicide Risk - Association with Sex and Drug Behavior. Am J of Preventive Med., 27(3), pp. 224-231, 2004.

Drug Use may be Mediated through Low Hostile Anger Control

The relationships among selected predictors of violence, including victimization, low conflict management efficacy, hostile anger and drug use were examined using data on 8th-, 10th-, and 12th-grade adolescents. The secondary analysis used a population-based, cross-sectional survey of health behaviors (N = 3,922). For each grade cohort, it was hypothesized that victimization and low conflict management efficacy would predict low hostile anger control, which would predict gateway drug use, and the subsequent development of hard drug use and violence. Overall model fit and the magnitude of specific paths were expected to increase across grades. Using structural equation modeling (SEM), results indicated acceptable model fit for 8th-grade (CFI = .95), 10th-grade (CFI = .93) and 12th-grade (CFI = .94) cohorts. Results suggest that the influence of relational victimization and conflict management efficacy on hard drug use may be mediated through low hostile anger control and gateway drug use. Weiner, M.D., Pentz, M.A., Skara, S.N., Li, C., Chou, C.P. and Dwyer, J.H. Relationship of Substance Use and Associated Predictors of Violence in Early, Middle, and Late Adolescence. Journal of Child & Adolescent Substance Abuse, 13(4), pp. 97-117, 2004.

Perceived Life Chances and Alcohol Use

The relationship between low perceived chances for success in life and binge drinking was examined in a sample of economically disadvantaged, predominantly black and Hispanic student, urban adolescents (N = 774) from 13 inner-city schools. Subjects completed confidential questionnaires in the 7th, 8th, and 9th grades. Eight items measured students' estimation of achieving certain adaptive life goals. Students who reported that they typically drink five or more drinks per drinking occasion were identified as binge drinkers. Results indicated that rates of binge drinking increased and perceived life chances decreased for both boys and girls from the 7th to 9th grade. Moreover, higher perceived life chances in the 7th grade predicted less binge drinking in the 8th grade, whereas binge drinking in the 8th grade predicted lower perceived life chances in the 9th grade, controlling for change over time in both variables. Griffin, K.W., Botvin, G.J., Nichols, T.R. and Scheier, L.M. Low Perceived Chances for Success in Life and Binge Drinking among Inner-city Minority Youth. Journal of Adolescent Health, 34, pp. 501-507, 2004.

Self-esteem and Alcohol Use

Prior studies have found inconsistent relationships between measures of self-concept and adolescent alcohol use. This study explored whether the link between various measures of self-concept and alcohol use depends on gender and whether negative rather than positive self-esteem (i.e., self-derogation) might be more useful in predicting alcohol use. Students (N = 1459) attending 22 middle and junior high schools in New York City completed surveys that included measures of efficacy, self-derogation, and alcohol use. Participants completed surveys at baseline, 1-year follow-up, and 2-year follow-up. Findings indicate that lower efficacy was related to greater self-derogation a year later across gender. Increased self-derogation predicted higher alcohol use for girls but not boys. These findings are congruent with a literature highlighting the importance of negative thoughts about the self in drinking behavior for women but not men. Epstein, J.A., Griffin, K.W. and Botvin, G.J. Efficacy, Self-derogation, and Alcohol Use among Inner-city Adolescents: Gender Matters. Journal of Youth & Adolescence, 33, pp. 159-166, 2004.

Post-September 11 Increases in Substance Use Persist in Manhattan

Early analyses following the September 11, 2001 terrorist attacks on New York City showed an increase in cigarette, alcohol, and marijuana use. To determine whether these increases would persist, a random-digit dial phone survey was conducted to estimate the prevalence of increased substance use among residents of New York City six to nine months after the attacks. Among 1,570 adults, 9.9% reported an increase in smoking, 17.5% an increase in alcohol use, and 2.7% an increase in marijuana use compared to the month before September 11. These increases were comparable to increases reported in the first one to two months after September 11. Persons who increased use of cigarettes were more likely than those who did not to report symptoms consistent with posttraumatic stress disorder (PTSD) in the past month (4.3% and 1.2% respectively). Depression was more common among those who increased use of cigarettes (14.6% and 5.2% respectively), alcohol (11.8% vs. 5.2%), and marijuana (34.1% vs. 5.3%). Among residents living in Manhattan below One Hundred Tenth Street, the prevalence of PTSD and depression declined by more than half in the first six months after September 11, while the increase in substance use did not decline substantially. These results suggest that the increase in substance use after a disaster may be a cause for public health concern in the long-term. Vlahov, D., Galea, S., Ahern, J., Resnick, H., Boscarino, J.A., Gold, J., Bucuvalas, M. and Kilpatrick, D. Consumption of Cigarettes, Alcohol, and Marijuana among New York City Residents Six Months After The September 11 Terrorist Attacks. American Journal of Drug and Alcohol Abuse, 30(2), pp. 385-407, 2004.

Manhattan Residents' Substance Abuse Increase Sustained After September 11 Attacks

This study compared reports of increased substance use in Manhattan 1 and 6 months after the September 11, 2001, terrorist attacks. Data from 2 random-digit-dial surveys conducted 1 and 6 months after September 11 showed that 30.8% and 27.3% of respondents, respectively, reported increased use of cigarettes, alcohol, or marijuana. These sustained increases in substance use following the September 11 terrorist attacks suggest potential long-term health consequences as a result of disasters. Vlahov, D., Galea, S., Ahern, J., Resnick, H. and Kilpatrick D. Sustained Increased Consumption Of Cigarettes, Alcohol, And Marijuana Among Manhattan Residents After September 11, 2001. American Journal of Public Health, 94(2), pp. 253-254, 2004.

Methamphetamine and Amphetamine Concentrations in Meconium of Neonates of Women Enrolled in the IDEAL Study of In Utero Methamphetamine Exposure

The Infant Development, Environment, and Lifestyle (IDEAL) study is a multi-center, longitudinal investigation of the effects of prenatal methamphetamine exposure. Meconium, a useful matrix for identifying in utero drug exposure, was employed to identify gestational drug use. Of the 13,808 mothers screened, 1631 were consented and 176 enrolled. MA exposed mothers (n=84) were identified by self-report of gestational MA use and/or GC/MS confirmation of MA, AMP, and/or MDMA in infant meconium. Comparison participants (n=92) were matched by race, birth weight, maternal education and type of insurance, denied amphetamines use and had negative meconium results. Among the 1631 mothers, self-reported use rates were 5.2% (amphetamines), 25% (tobacco) and 5.9% (cannabis). Positive meconium screening rates were 3.6% for any amphetamine, 20% cotinine and 11.2% cannabis. For specimens that screened positive, 40.7% of amphetamines and 20.2% of cannabis specimens were confirmed. On average, 68% of the meconium from neonates whose mothers reported 3rd trimester use had detectable MA, while detection rates were 10% for self-reported use during the 1st and/or 2nd trimesters. Mean +/- SD, median and range of MA concentrations were 3674 +/- 3406, 2623, 479 to 13,431 ng/g meconium and AMP 569 543, 403, 30 to 2000 ng/g meconium in infants whose mothers reported 3rd trimester use. However, the highest MA (19,376 and 16,976 ng/g) and AMP (2765 ng/g) concentrations were found in offspring born to women who reported MA use only in the 1st or 1st and 2nd trimesters, raising questions about the self-report. The log transformed meconium MA concentrations significantly correlated with the frequency of MA use in the 3rd trimester (r=0.645, P=0.004), although variability prevents prediction of frequency of use for an individual mother. AMP was always detected in MA positive meconium. In 55% of the GCMS positive samples, the ratios of amphetamine to MA were 0.1 to 0.2; 14% were less than 0.1 and 18% were 0.2 to 0.3. Meconium analysis for MA is a useful adjunct to self-report for identification of MA exposure; however, the greatest sensitivity was achieved with specimens collected from offspring of women who reported use in the 3rd trimester. Further research is needed to determine if there are additional MA metabolites in meconium that could improve the identification of MA-exposed infants. Zhao, Z., Liu, J., LaGasse, L.L., Derauf, C., Grant, P., Shah, R., Arria, A., Haning, W., Smith, L.M., Lester, B. and Huestis, M.A., Poster, 2004. Joint Meeting of the Society of Forensic Toxicologists and The International Association of Forensic Toxicologists, Washington, DC, August 28-September 3, 2004.