Director's Report to the National Advisory Council on Drug Abuse
May, 2001
Research Findings
Epidemiology, Etiology and Prevention Research
A Model of Smoking Among Inner-City Adolescents: The Role of Personal Competence and Perceived Social Benefits of Smoking
Based on current trends, smoking will remain a major public health problem in the 21st century. Effective smoking prevention approaches offer the best hope for decreasing the rise in adolescent smoking rates. Competence enhancement approaches to smoking prevention are among the most successful. Yet, there is not a full understanding of how effective prevention approaches work. This study tested whether a deficiency in competence (poor decision-making skills and low personal efficacy) is linked to acquiring beliefs in the perceived benefits of smoking and whether these perceived benefits are then related to subsequent smoking. A sample of 1,459 students attending 22 middle and junior high schools in New York City participated. Students completed surveys at baseline, 1-year follow-up and 2-year follow-up during a regular class period. They self-reported smoking, decision-making skills, personal efficacy and beliefs in the perceived benefits of smoking. The tested structural equation model had a good fit and was parsimonious and consistent with the theory underlying the competence approach to smoking prevention. This research highlights the importance of addressing decision-making skills, personal efficacy, and beliefs in the social benefits of smoking within adolescent smoking prevention programs. Epstein, J.A., Griffin, K.W. and Botvin, G.J. A Model of Smoking Among Inner-City Adolescents: The Role of Personal Competence and Perceived Social Benefits of Smoking. Preventive Medicine, 31(2), pp. 107-114, 2000.
Preventing Illicit Drug Use in Adolescents: Long-Term Follow-Up Data from a Randomized Control Trial of a School Population
National survey data indicate that illicit drug use has steadily increased among American adolescents since 1992. This upward trend underscores the need for identifying effective prevention approaches capable of reducing the use of both licit and illicit drugs. The present study examined long-term follow-up data from a large scale randomized prevention trial to determine the extent to which participation in a cognitive-behavioral skills-training prevention program led to less illicit drug use than for untreated controls. Data were collected by mail from 447 individuals who were contacted after the end of the 12th grade, 6.5 years after the initial pretest. Results indicated that students who received the prevention program (Life Skills Training) during junior high school reported less use of illicit drugs than controls. Prevention effects were also found for specific illicit drugs including the use of hallucinogens and narcotics. This study shows that significant prevention effects are observable 5.5 years after the primary year of intervention. Botvin, G.J., Griffin, K.W., Diaz, T., Scheier, L.H., Williams C. and Epstein, J.A. Preventing Illicit Drug Use in Adolescents: Long-Term Follow-Up Data from a Randomized Control Trial of a School Population. Addictive Behaviors, 25(5), pp. 769-774, 2000.
Family Risk and Resiliency Factors, Substance Use, and the Drug Resistance Process in Adolescence
Recent approaches to drug prevention have emphasized risk and resiliency factors. Two models have been developed to explain these factors, one which posits that separate elements make up each set and the other which posits that a single factor can be either a risk or a resiliency factor depending on, for example, if it is present (resiliency) or absent (risk). This study tested these models and attempted to compare the effects of risk and resiliency across gender and ethnicity. Results support the model in which risk and resiliency are discrete sets of factors and demonstrate that overall resiliency factors play a larger role than risk factors in substance use and drug resistance processes. However, gender proved to be an important moderator of these effects. For adolescent males, resiliency has an indirect effect on overall substance use through age of first use, while risk has a direct effect on overall substance use. For adolescent females, resiliency has a direct effect on overall substance use and risk has an indirect effect through age of first use. This indicates that while early interventions are important for both genders, resiliency factors must be dealt with before initiation of substance use for males. Findings did not differ substantially across ethnicity, although the small African-American sample size may have limited power to detect differences. Moon, D.G., Jackson, K.M. and Hecht, M.L. Family Risk and Resiliency Factors, Substance Use, and the Drug Resistance Process in Adolescence. Journal of Drug Education, 30(4), pp. 373-398, 2000.
Verifying Drug Abuse Prevention Program Effects Using Reciprocal Best Friend Reports
Considerable research suggests that social influences-based drug abuse prevention programming has produced the most consistently successful preventive effects. However, a common criticism of this literature is that most prevention intervention studies rely solely on self-reported substance use. The purpose of this study was to assess the effects of normative education, arguably the most successful component of social influence based prevention programs, on alcohol and cigarette consumption using both self- and reciprocal best friend reports of substance use. Analyses of subsamples of data from 11,995 students participating in the Adolescent Alcohol Prevention Trial revealed that normative education significantly delayed the onset of alcohol use across the eighth, ninth, and tenth grades among public school students. A similar but somewhat less robust pattern was found for cigarette use. These results suggest that self-report bias does not account for previous findings and demonstrate rather convincingly that normative education is an effective drug prevention strategy for public school settings. Donalson, S.I., Thomas, C.W., Graham, J.W., Au, J.G. and Hansen, W.B. Verifying Drug Abuse Prevention Program Effects Using Reciprocal Best Friend Reports. Journal of Behavioral Medicine, 23(6), pp. 585-601, 2000.
Effectiveness of Monetary Incentives for Recruiting Adolescents to an Intervention Trial to Reduce Smoking
This study's objective was to evaluate the effect of monetary incentives on response rates of adolescents to a smoking-related survey as the first step toward participation in an intervention trial. A sample of 4,200 adolescent members of a managed care organization were randomized to one of four incentive groups: a $2 cash group, a $15 cash group, a $200 prize drawing group, or a no-incentive group. Group-specific response rates and willingness to be contacted about future study activities were compared. Incentives increased survey response rates (55% response without incentive verses a 69% response with incentives), with response of 74% in the $15 cash group, 69% in the token group, and 63% with a prize incentive. Incentives did not adversely affect willingness of adolescents to be contacted about a smoking intervention, (65% willing with incentives verses 60% without). In terms of costs per additional survey completed, token and prize groups were marginally more expensive than the no-incentive group ($0.40 and $1.42, respectively) while the large cash incentive was substantially more costly ($11.37). Monetary incentives improve response rates to a mailed survey, without adverse impact on willingness to further participate in intervention activities. However, a variety of issues must be considered when using incentives for recruitment to intervention studies. Martinson, B.C., Lazovich, D., Lando, H.A., Perry, C.L., McGovern, P.G. and Boyle, R.G. Effectiveness of Monetary Incentives for Recruiting Adolescents to an Intervention Trial to Reduce Smoking. Preventive Medicine, 31(6), pp. 706-713, 2000.
Television Campaigns Impact Adolescent Marijuana Use
This study evaluated the effectiveness of targeted televised public service announcement campaigns in reducing marijuana use among sensation-seeking adolescents. Sensation-seeking has been identified as a personality characteristic associated with the need for novel, complex, ambiguous, and emotionally intense stimuli and the willingness to take risks to obtain such stimulation. People ranked high on the need for sensation are more associated with the risk for drug use than those ranked low. This study designed special advertising to address sensation-seekers with anti-marijuana messages. Two televised anti-marijuana campaigns were conducted in 1 county and 1 campaign in the comparison community. Personal interviews were conducted with 100 randomly selected teenagers monthly in each county for 32 months. All 3 campaigns reversed upward developmental trends in 30-day marijuana use among high-sensation seekers. As expected, low-sensation seekers had low use levels and no campaign effects were evident. Televised campaigns with high reach and frequency that use PSAs designed for and targeted at high-sensation-seeking adolescents can significantly reduce substance use in this high-risk population. Palmgreen, P., Donohew, L., Lorch, P., Hoyle, R.H. and Stephenson, M.T. American Journal of Public Health, 91(2), pp. 292-296, 2001.
Ethnic Identity Among Early Adolescents
A measure of ethnic identity, the Multigroup Ethnic Identity Measure (MEIM; J.S. Phinney, 1992), was examined with a sample of 2,184 11-15 yr olds who self-identified with a single race or ethnic group (mono-racial, n=1,812) or with 2 or more racial or ethnic groups (multi-racial, n=372). The psychometric properties and mean differences on the MEIM for White, mono-racial minority, and multi-racial early adolescents were investigated. Two factors were identified: (1) identification and (2) exploration. Identification was represented by items that reflect a sense of belonging and pride in an individual's ethnic group. Exploration was represented by items that characterize a search for ethnic group identity and participation in ethnic practices. Results show reliabilities for the 2 subscales with alpha = .84 for most individuals from mono-racial minority groups and multi-racial subgroups scored similarly on overall ethnic identity. Spencer, M.S., Icard, L.D., Harachi, T.W., Catalano, R.F., and Oxford, M. Ethnic Identity among Mono-racial and Multi-racial Early Adolescents. J. Early Adolescence 20(4), pp. 365-387, 2000.
Predictors of Early High School Dropout
This study compared the adequacy of 5 theories for predicting dropping out of high school before grade 10. These theories include full mediation by academic achievement and direct effects related to general deviance, deviant affiliations, family socialization, and structural strains. Models were used to test these theories on prospective data from an ethnically diverse urban sample. Poor academic achievement mediated the effect of all independent factors, although general deviance, bonding to antisocial peers, and socioeconomic status also retained direct effects on dropping out. Therefore, none of the theories were fully adequate to explain the data, although partial support was obtained for each theory. Battin-Pearson, S., Newcomb, M.D., Abbott, R.D., Hill, K.G., Catalano, R.F., and Hawkins, J. D. Predictors of Early High School Dropout: A Test of Five Theories. J. Educational Psychology 92(3), pp. 568-582, 2000.
Male Adolescent Friendships and Aggression Toward Female Partners
Deviancy training was examined as a risk factor for physical and psychological aggression toward a female partner among boys and young men in the Oregon Youth Study. Hostile talk about women during videotaped male friendship interactions was hypothesized to indicate a process by which aggression toward women is reinforced within male peer networks with both antisocial behavior and hostile talk being predicted to be associated with later aggression toward a female partner. Prospective developmental models were tested from 9-20 years of age through young adulthood. Findings indicated that the relation of deviant peer association in adolescence and later aggression toward a partner was mediated by antisocial behavior; observed hostile talk about women with male peers explained additional variance in aggression toward a partner. Aggression Toward Female Partners by At-Risk Young Men: The Contribution of Male Adolescent Friendships. Capaldi, D.M., Dishion, T.J., Stoolmiller, M., and Yoerger, K. Dev. Psych., 37(1), pp. 61-73, 2000.
Deviant Friendships and Problem Behavior
This study examines adult reports of externalizing and internalizing psychopathology at home and school in a sample of 224 high-risk adolescent boys and girls (mean age 12 yrs). Four groups of young adolescents were defined, based on the consistency of teacher and parent Child Behavior Checklist reports: normal, internalizing, externalizing only, and co-morbid. Group comparisons revealed the co-morbid and externalizing groups were more engaged in a deviant peer group and were observed in higher levels of deviancy training with their friends, compared to other young adolescent groups. In general, elevated levels of arrest, drug use, and sexual promiscuity were associated with cross-setting consistency in externalizing disorders. Co-morbid youth, however, showed the highest levels of sexual promiscuity in middle adolescence, compared to all other groups. These findings are consistent with a developmental account of adolescent maladjustment and suggest that emotional disturbance in early adolescence might exacerbate youth vulnerability, especially to deviancy training within friendships. Dishion, T.J. Cross-Setting Consistency in Early Adolescent Psychopathology: Deviant Friendships and Problem Behavior Sequelae. J. Personality, 68 (6), pp. 1109-1126, 2000.
Family Engagement in Preventive Interventions
There has been limited investigation of family engagement in preventive interventions for general populations. Families in eligible general populations can differ to a significant degree in intervention preferences and beliefs that influence their motivation to engage in interventions or in intervention evaluations. Also, a number of stable family member characteristics, such as internalizing/externalizing problems, have not been predictive of family engagement. Educational attainment has been predictive, but the differences between participants and non-participants tend to be small. In addition, there are several common barriers to engagement, including family scheduling conflicts, which place practical limits on participation levels and need to be carefully addressed through engagement techniques. Spoth, R. and Redmond, C. J. Research on Family Engagement in Preventive Interventions: Toward Improved Use of Scientific Findings in Primary Prevention Practice. Primary Prevention, 21(2), pp. 267-284, 2000.
Influences on Enrollment in Family-Focused Prevention Research
This study is an extension of a previously supported model of family context and health belief predictors of parents' inclination to enroll in preventive interventions. The extended model addresses limitations in the prior investigation: i.e. the role intervention-related beliefs and stated inclinations to actually enroll in a skills training intervention research project. Model testing was conducted with a sample of 635 parents of 6th graders who completed a prospective participation factor survey and were recruited for an intervention research project 6 months later. All but one of the primary hypothesized effects were supported. Both stated inclination to enroll in an intervention and in the research project had significant positive effects on actual project enrollment occurring 6 months later. Perceived intervention benefits and barriers had significant effects on both types of stated inclination to enroll. The model also suggests an additional path linking educational attainment with actual enrollment. Spoth, R., Redmond, C., and Chungyeol, S. Modeling Factors Influencing Enrollment in Family-Focused Preventive Intervention Research. Prevention Science, 1(4), pp. 213-226, 2000.
Community Readiness
Communities are at many different stages of readiness for implementing drug abuse prevention programs, and this readiness is a major factor in determining whether a local program can be effectively implemented and supported by the community. The community readiness model was developed to meet research needs (e.g., matching treatment and control communities for an experimental intervention) as well as to provide a practical tool to help communities mobilize for change. The model defines 9 stages of community readiness ranging from "no awareness" of the problem to "professionalization" in the response to the problem within the informant interviews, with questions on 6 different dimensions related to a community's readiness to mobilize to address a specific issue. Edwards, R.W., Jumper-Thurman, P., Plested, B.A., Oetting, E.R., and Swanson, L. Community Readiness: Research to Practice. J. Community Psychology, 28(3), pp. 291-307, 2000.
Methods to Decrease Attrition in Longitudinal Studies with Adolescents
This article presents a summary of methods to decrease attrition in longitudinal school-based studies conducted with adolescents beginning junior high schools or middle schools. These include collection of contact information about students, additional days to collect data from absentee students, data collection in new high schools once students graduate from junior high schools or middle schools, sending questionnaires by mail, and conducting telephone or home interviews. Epstein, J.A. and Botvin, G.J. Methods to Decrease Attrition in Longitudinal Studies with Adolescents. Psychological Reports, 87 (1), pp. 139-140, 2000.
Predicting Regular Cigarette Use Among Continuation High School Students
The objective of this study was to provide a 1-year prospective examination of social, behavioral, intrapersonal and demographic factors that predict transition from experimental to regular cigarette use among continuation high school students. A cohort of 252 students completed baseline and 1-year followup questionnaires on health behaviors. Results showed relatively low smoking prevalence estimates, intention to smoke in the next year, violence perpetration, perceived stress, sensation seeking, and male gender predicted the transition to regular use 1 year later. It was concluded that intrapersonal variables may be relatively important in predicting the progression from experimental to regular smoking. Skara, S., Sussman, S., and Dent, C.W. Predicting Regular Cigarette Use among Continuation High School Students. American Journal of Health Behavior, 25(2), pp. 147-156, 2001.
Concurrent Prediction of Drug Use Among High-Risk Youth
Correlates of drug use were examined in a continuation high school sample (n = 1.315), using canonical correlation analysis. Fourteen demographic, attitude/belief. and psychosocial pressure/anxiety-type variables were included as concurrent predictors. Eight drug-use-related measures were also placed into the analysis as outcome variables. Two factors were revealed. White ethnicity, not being Latino, all attitude/belief measures, and family conflict and depression showed relatively high loadings on the first predictor factor, and were associated with all drug-use measures. Latino ethnicity and being relatively unacculturated (i.e., tending to speak Spanish), most of the attitude/belief measures (but not sensation seeking or spirituality), and perceived peer approval to use drugs, trait anxiety, and depression showed relatively high loadings on the second predictor factor, and were associated with the hard-drug-use measures. These results suggest that there is a subgroup of unacculturated Latino youth who are anxious, who perceive they will achieve peer approval by using drugs, and who tend to use hard drugs. Indicated drug abuse prevention strategies may need to be tailored to this subgroup when developing and implementing programming. McCuller, W.J., Sussman, S., Dent, C.W., and Teran, L. Concurrent Prediction of Drug Use Among High-Risk Youth. Addictive Behaviors, 26(1), pp. 137-142, 2001.
Implications of Aggressive Children's Positively Biased Relatedness Views for Future Relationships
The present study examined the tendency of aggressive children to generalize the positive bias in their perceptions of relatedness across different interpersonal relationships. Secondly, it examined the implications of distorted perceptions of relatedness for quality of aggressive children's future relationships. Subjects included 62 second and third grade children nominated and rated by teachers as aggressive. Self- and others' appraisals of relationship quality were gathered across four interpersonal domains (i.e., mother, teacher, mentor, and peer). Children's positively biased perceptions of social relatedness were concordant across adult relationship domains but not across the peer domain, suggesting that children's relationships with adults and peers represent somewhat distinct socialization contexts. As expected, children who inflate levels of social relatedness establish less close relationships with novel partners (mentors). The findings emphasize the need for clinicians to focus on mental representations while planning interventions with aggressive children. Prasad-Gaur, A., Hughes, J.N., and Cavell, T. Implications of Aggressive Children's Positively Biased Relatedness Views for Future Relationships. Child Psychiatry and Human Development, 31(3), pp. 215-231, 2001.
Social Cognitive Differences Between Aggressive-Rejected and Aggressive-Nonrejected Children
This study investigated differences in social cognitive processing between 2 subtypes of aggressive children: those rejected by their peers and those not rejected. Children in Grades 2-4 classified as aggressive-rejected (AR; n = 34) or aggressive-nonrejected (AN; n = 55), on the basis of teacher ratings of aggression, were administered the Social Cognitive Assessment Profile--Revised (SCAP--R) as a measure of attribution, solution type, outcome expectancy, and self-efficacy for aggressive solutions. The results indicate that aggressive children, in general, have a broad range of social cognitive deficits and distortions. Further, AN children are more likely to believe that aggression leads to positive outcomes and are more confident in their ability to use aggression toward a peer. The pattern of social cognitive differences between AR and AN children is similar to that typically found between proactively and reactively aggressive children. Also AN children appear to have a distinct pattern of social cognitive biases that reflect antisocial beliefs likely to support the use of aggression to obtain desired goals. Yoon, J.S., Hughes, J.N., Cavell, T.A., and Thompson, B. Social Cognitive Differences Between Aggressive-Rejected and Aggressive-Nonrejected Children. Journal of School Psychology, 38(6), pp. 551-570, 2000.
Patterns and Temporal Changes in Peer Affiliation Among Aggressive and Nonaggressive Children
The behavior and affiliation patterns of 118 highly, moderately, and nonaggressive 7-8 yr old children were examined over the course of a 6-week summer school program. During free play, participants did not selectively associate on the basis of behavioral similarity, but initial mutual friendship choices did show a preference for similarly behaved peers. Nonreciprocated friendships at the beginning and end of the program and mutual friendships at the end revealed a preference of all children to befriend non aggressive peers. Moderately aggressive children increased their number of mutual friendships and their association with nonaggressive peers during free play, whereas highly aggressive children lost mutual friends. The aggressiveness of a child's playmates predicted the likelihood of that child behaving inappropriately during free play. Results suggest that selective affiliation may be the result of peer rejection rather than an active process of seeking similarly aggressive peers. Hektner, J.M., August, G.J., and Realmuto, G.M. Patterns and Temporal Changes in Peer Affiliation Among Aggressive and Nonaggressive Children Participating in a Summer School Program. Journal of Clinical Child Psychology, 29(4), pp. 603-614, 2000.
Clinical Correlates of Heavy Tobacco Use Among Adolescents
Investigators affiliated with the CEDAR Center at the University of Pittsburgh conducted a study to determine the clinical factors differentiating adolescents with heavy smoking (10 cigarettes/day) from adolescents with light smoking. A study group of 812 adolescents were recruited from adolescent alcoholism treatment centers and from the community. Logistic regression analyses demonstrated that adolescents with heavy smoking, compared with adolescents with light smoking, were significantly more likely to be Caucasian American and to exhibit drug-use disorders, alcohol-use disorders, and conduct disorder. The findings suggest that the clinical correlates of heavy smoking among adolescents are generally similar to those for smoking at any level (vs. nonsmokers), except that heavy smoking is more strongly associated with Caucasian American ethnicity. Also, depressive disorders were associated with smoking at any level in the sample, but depressive disorders were not associated with heavy smoking. Cornelius, J.R., Lynch, K., Martin, C.S., Cornelius, M.D., and Clark, D.B. Clinical Correlates of Heavy Tobacco Use Among Adolescents. Addictive Behaviors, 26, pp. 273-277, 2001.
Tobacco Use Among Argentinean High School Students
This study assessed the prevalence and correlates of tobacco use among high school students in Buenos Aires, Argentina. Anonymous, self-administered questionnaires were given to 3,909 8th and 11th graders in a stratified random sample of 49 public and private schools. The instrument included items from American surveys, translated and validated among Argentinean teens. Multiple logistic regression analysis was used to estimate possible effects on smoking behavior of environment, students' personal characteristics, and their knowledge, beliefs, and attitudes regarding smoking. Of 8th and 11th graders, 20% and 43%, respectively, were classified as current smokers. Overall, 29% of males and 32% of females were current smokers. Students attending public schools were more likely to smoke than those in private schools (p < .05). Current smoking was associated with having a best friend who smokes, reporting that more than 50% of friends of the same sex smoke, having positive attitudes and beliefs toward smoking, and having a positive intention to smoke within the next year (all p < .001). Over 20% of the 8th graders in our sample were current smokers; prevention efforts must therefore start early. Morello, P., Duggan, A., Adger, H. Jr, Anthony, J.C., and Joffe, A. Tobacco Use Among High School Students in Buenos Aires, Argentina. American Journal of Public Health, 91(2), pp. 219-224, 2001.
Drug Use By Adolescent Mexican Americans and Adolescents in Mexico
Investigators at UCLA compared high school students in Baja California Norte (BCN), Mexico (n = 775), with Mexican American students in Los Angeles (LA), California (n = 516). The students' use of cigarettes, alcohol, marijuana, cocaine, inhalants, and other illicit drugs were compared, because these vary by gender, country, and their age of first drug use and are influenced by demographic variables, individual characteristics, and environmental influences. More BCN students than LA students had used alcohol, but more LA than BCN students had used illicit drugs and initiated drug use earlier. When demographic variables were influential, they were most powerful and increased the risk for drug use more than environmental factors or individual characteristics. Environmental factors were most influential for boys' drug use, whereas environmental and demographic variables were most influential for girls' drug use. Felix-Ortiz, M., Villatoro-Velazquez, J.A., Medina-Mora, M.E., and Newcomb, M.D. Adolescent Drug Use in Mexico and Among Mexican American Adolescents in the United States: Environmental Influences and Individual Characteristics. Cultural Diversity and Ethnic Minority Psychology, 7(1), pp. 27-46, 2001.
Modeling Suspected Influences on Youthful Drug Involvement
In longitudinal behavioral studies it is common to have multiple categorical indicators for measuring a theoretical construct of interest. In this study, researchers at Johns Hopkins illustrate the application of a latent class model that accounts for the structure in a set of correlated, categorical variables measured at discrete time periods, drawing information from these variables to form a smaller number of latent classes. The dependence of the resulting latent class model parameters on suspected factors over time is simultaneously modeled using a baseline-category logistic regression model. Estimation of the model parameters is achieved using an estimating equations procedure. A motivating example is provided from a longitudinal study of suspected linkages between monitoring or supervision by parents and the occurrence of drug use behaviors in an epidemiologic sample of school-attending youths. The latent class analyses extracted three subgroups representing youths in different stages of drug involvement. At the beginning of the study, the cohort of 8 to 10 year olds with little or no drug involvement were the most prevalent subgroup. By the end of the study, when these youths were 11 to 13 years old, the majority of youths had not only tried alcohol but had opportunities to use tobacco cigarettes, marijuana and inhalants. The model showed that drug involvement developed over time, starting with alcohol and then progressing to opportunity to use tobacco cigarettes, use of cigarettes, and finally opportunities to use internationally controlled drugs such as marijuana. These results are consistent with the model proposed by Kandel of stages of drug use, but in addition, the results provide evidence that opportunity to use drugs deserves consideration in the pathway leading toward serious drug involvement. Reboussin, B.A. and Anthony, J.C. Latent Class Marginal Regression Models for Modeling Youthful Drug Involvement and its Suspected Influences. Statistics in Medicine, 20(4), pp. 623-639, 2001.
Correlates of Mental Health Service Utilization and Unmet Need Among Male Adolescents
Researchers at the University of Pittsburgh sought to identify the correlates of mental health services utilization and unmet need for these services among a sample of adolescent males. They hypothesized that their findings would replicate and extend those of the recent Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study, which found that parental factors play a major role in their children's unmet mental health care needs. The study involved an evaluation of mental health service utilization and unmet need during the prior 2 years, as reported by the subjects at a follow-up assessment at age 16. Four factors were found to predict increased mental health services utilization, including attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) among the adolescent males, the father's alcohol use disorder, and the mother's amphetamine use disorder. One factor was found to predict decreased utilization, the father's cannabis use disorder. Four factors significantly predicted unmet treatment need, including conduct disorder, the mother's amphetamine use disorder, a higher number of siblings, and a parental history of having had a childhood anxiety disorder. The results of this study suggest that parental psychopathology, parental substance abuse, the presence of conduct disorder, and an increased number of siblings act as barriers to adequate mental health treatment among adolescents. These findings confirm the crucial role that parental factors play in the treatment utilization and the unmet treatment need of their children, and also suggest that an increased number of siblings can also be associated with unmet treatment need. Cornelius, J.R., Pringle, J., Jernigan, J., Kirisci, L., and Clark, D.B. Correlates of Mental Health Service Utilization and Unmet Need Among a Sample of Male Adolescents. Addictive Behaviors, 26(1), pp. 11-19, 2001.
Developmental Factors in Liability to Adolescent Substance Use Disorders
Investigators at CEDAR reviewed the literature on the complex sequence of maturational, psychosocial, and neuroadaptive processes that lead to substance use disorders (SUD) in adolescence and constructed a synthesis of findings. After introducing the concepts of liability to SUD and epigenesis, they present a theory of how affective, cognitive, and behavioral dysregulation in late childhood is exacerbated during early and middle adolescence by family and peer factors, as well as puberty, leading to substance use. Continued exacerbation of the three components of dysregulation by drug and non-drug stressors during late adolescence is posited to result in neuroadaptations that increase the likelihood of developing SUD, particularly in high-risk individuals. Implications for etiologic research as well as clinical and preventive interventions are discussed. Dawes, M.A., Antelman, S.M., Vanyukov, M.M., Giancola, P., Tarter, R.E., Susman, E.J., Mezzich, A., and Clark, D.B. Developmental Sources of Variation in Liability to Adolescent Substance Use Disorders. Drug and Alcohol Dependence, 61(1), pp. 3-14, 2000.
Role of Conduct Disorder in Neuropsychological Deficits in Female Adolescents with Substance Use Disorder
CEDAR-affiliated researchers sought to determine whether neuropsychological deficits in female adolescents are more closely related to a diagnosis of a substance use disorder (SUD) or a conduct disorder (CD). Subjects were 470 female adolescents between the ages of 14 and 18 years. They were categorized into one of four groups: (1) SUD-only (n =63), (2) CD-only (n = 58), (3) SUD+CD (n = 239) and (4) normal control (n = 110). The groups were compared on multiple neuropsychological measures covering four cognitive domains: general intelligence, executive functioning, language competence and academic achievement. The findings were consistent across all measures. Multivariate analyses of variance revealed significant group differences for all four neuropsychological domains. Univariate tests indicated that the two CD groups equally exhibited the poorest performance of all four groups on nearly all measures of intelligence, executive functioning, language competence and academic achievement. The SUD-only group performed better than the two CD groups but not as well as the control group. Socioeconomic status and chronological age were statistically controlled for in all analyses. These findings suggest that the neuropsychological deficits in this sample of female adolescents with SUD are more closely related to CD, or antisociality in general, than to SUD. Future studies assessing the neuropsychological functioning of persons with SUD should make efforts to measure comorbid antisociality. Giancola, P.R. and Mezzich, A.C. Neuropsychological Deficits in Female Adolescents with a Substance Use Disorder: Better Accounted for by Conduct Disorder? Journal of Studies on Alcohol, 61(6), pp. 809-817, 2000.
Antisociality, Substance Dependence, and the DRD5 Gene
Researchers at the University of Pittsburgh reported a pilot population-based study of a microsatellite polymorphism at the DRD5 locus in adult European-Americans that showed its association with childhood symptom counts for oppositional defiant disorder (ODD) in males and females and adult antisocial personality disorder (ASPD) in females. No association with childhood conduct disorder symptom count was observed. ODD mediated the genotype-ASPD relationship in females. Neither ODD nor ASPD significantly mediated the relationship between the genotype and the liability to substance dependence (SD). The data suggest involvement of the DRD5 locus in the variation and sexual dimorphism of SD liability and antisociality and in the developmental continuity of antisociality. Vanyukov, M.M., Moss, H.B., Kaplan, B.B., Kirillova, G.P., and Tarter, R.E. Antisociality, Substance Dependence, and the DRD5 Gene: A Preliminary Study. American Journal of Medical Genetics, 96(5), pp. 654-658, 2000.
"Recanting" Prior Drug Use Reports in a Longitudinal Survey
Investigators at the University of Illinois at Chicago examined follow-up data from surveys in 1988, 1992 and 1994 in order to estimate the prevalence and explore the correlates of retest artifact (denial) of drug use among National Longitudinal Survey of Youth respondents who disclosed lifetime cocaine or marijuana use in 1984. In the cocaine use cohort, 42% denied lifetime cocaine use during at least one follow-up wave. In the marijuana use cohort, about 29% denied lifetime marijuana use during at least one follow-up wave. Denial either leveled off (cocaine) or diminished (marijuana) between the second and third follow-up interviews. The most consistent predictors of denial in both longitudinal and cross-sectional models and across substances were race/ethnicity (black informants had increased rates of denial) and marital status (married respondents had increased rates of denial). Other predictors of denial included interviewer characteristics (social attribution), interview mode, and drug salience. The findings with respect to marijuana reporting trends parallel increased willingness of public officials to retrospectively disclose this behavior in the popular press. Fendrich, M. and Kim, J.Y.S. Multiwave Analysis of Retest Artifact in the National Longitudinal Survey of Youth Drug Use. Drug and Alcohol Dependence, 62, pp. 239-253, 2001.
Bystander Effects in CASI and PAPI Surveys of Substance Use
In a special issue of Substance Use and Misuse devoted to methodological issues in measurement of drug use, researchers at the University of Wisconsin at Madison reported an investigation of the influence of bystanders on self-administered interviews asking about the use of alcohol and illicit drugs. Interview participants were adolescents and young adults living in urban and suburban areas of the United States. Participants were assigned randomly to either a computerized or a paper-and-pencil self-administered interview. Results show that the impact of bystanders during the interview varies according to the identity of the bystander, age of the person interviewed, and the mode of interview. When a parent was present during the interview, survey participants were less likely to report the use of alcohol and marijuana. The influence of parents was stronger for adolescents than for young adults. The use of computer-assisted self-administered interviewing, compared to interviews with paper-and-pencil forms, reduced the effects due to the presence of parents during the interview. The presence of siblings during the interview had a small, negative effect on reports of using alcohol or illicit drugs. Among married or cohabiting respondents, the presence of the husband, wife, or live-in partner had no influence on reports of alcohol use or drug use. Aquilino, W.S., Wright, D.L., and Supple, A.J. Response Effects Due to Bystander Presence in CASI and Paper-and-Pencil Surveys of Drug Use and Alcohol Use. Substance Use & Misuse, 35(6-8), pp. 845-867, 2000.
The Association Between Cigarette Smoking and Drug Abuse in the United States
Cigarette smoking has been identified as an independent risk factor for many human diseases. However, the association between cigarette smoking and illegal drug use has not been thoroughly investigated. Investigators have analyzed the 1994 National Household Survey on Drug Abuse to clarify whether cigarette smoking has any effect on the initiation of illegal drug use. Data from 17,809 respondents completing the 1994 "new" (1994-B) questionnaire were analyzed. Logistic regression analyses were performed with the use of statistical package SUDAAN, taking into consideration the multistage sampling design. The results show that those who had smoked cigarettes were far more likely to use cocaine (OR = 7.5; 95% CI: 5.7-9.9), heroin (OR = 16.0; 95% CI: 6.8-37.9), crack (OR = 13.9; 95% CI: 7.9-24.5) and marijuana (OR = 7.3; 95% CI: 6.2-8.7). The associations are consistent across age-strata and remain after adjusting for race and gender. This study suggests that cigarette smoking may be a gateway drug to illegal drug use. Lai, S., Lai, H., Page, J.B., McCoy, C.B. The Association between Cigarette Smoking and Drug Abuse in the United States. J Addict Dis , 19(4) pp. 11-24, 2000.
Stalking as a Variant of Intimate Violence: Implications From a Young Adult Sample
There is a limited but growing literature which suggests that stalking is a variant of intimate violence. The purpose of this study was to examine physical, psychological, and stalking victimization and perpetration among males and females. Alcohol use was also examined. The sample was 46 male and 84 female undergraduate students who reported stalking victimization and perpetration after a difficult breakup, and psychological and physical victimization and perpetration during that specific relationship. Overall, 27% of the sample study was classified into the stalking victimization group, which is consistent with other stalking prevalence rates among college samples. For females, stalking victimization was significantly associated with physical and psychological abuse victimization. For males, stalking victimization was significantly associated with psychological abuse victimization. However, there was also a strong significant reciprocal relationship of stalking and psychological abuse victimization and perpetration, especially for males. Also, alcohol use was significantly associated with victimization and perpetration of stalking and psychological abuse for males. The data from this study contribute to the hypothesis that stalking is a variant of or extension of intimate violence, especially for females. Implications and recommendations for future research are discussed. Stalking as a Variant of Intimate Violence: Implications from a Young Adult Sample, Violence Vict, 15(1), pp. 91-111, 2000.
Variation in Youthful Risks of Progression From Alcohol and Tobacco to Marijuana and to Hard Drugs Across Generations
Much research has documented that youthful substance use typically follows a sequence starting with use of alcohol or tobacco or both and potentially proceeding to marijuana and then hard drug use. This study explicitly examined the probabilities of progression through each stage and their covariates. A secondary analysis of data from the National Household Survey on Drug Abuse (1979-1997) was conducted with particular sensitivity to the nature of substance use progression, sampling procedures, and reliability of self-report data. Results showed that progression to marijuana and hard drug use was uncommon among persons born before World War II. The stages phenomenon essentially emerged with the baby boom and rose to a peak among persons born around 1960. Subsequently, progression risks at each stage declined. Progression risks were also higher among younger initiators of alcohol, tobacco, or marijuana use. The recent increase in youthful marijuana use has been offset by lower rates of progression to hard drug use among youths born in the 1970s. Dire predictions of future hard drug abuse by youths who came of age in the 1990s may be greatly overstated. Golub, A., and Johnson, B.D. Variation in Youthful Risks of Progression from Alcohol and Tobacco to Marijuana and to Hard Drugs Across Generations. Am J Public Health, 91(2), pp. 225-232 2001.
Trauma, Drugs and Violence Among Juvenile Offenders
Trauma typically occurs when one experiences a situation where life has been threatened or lost. If the trauma is not resolved, negative residual effects may result in alcohol and drug use, involvement in violent activities as well as the development of mental health problems such as posttraumatic stress disorder (PTSD). This study examined the link between trauma, drug use, and violence among youth. Results from interviews with 414 juveniles remanded to the Office of Children and Family Services (formerly New York State Division For Youth) for assault, sexual assault, robbery or homicide, document the trauma experienced by these youth, as well as how it correlated with their drug usage and participation in violent, illegal activities. Discussion of these findings, their implications for understanding and intervening, and recommendations for future research are highlighted. Crimmins, S.M., Cleary, S.D., Brownstein, H.H., Spunt, B.J., Warley, R.M. Trauma, Drugs and Violence Among Juvenile Offenders. J Psychoactive Drugs, 32(1) pp. 43-54, 2000.
Perceived Risk of Cocaine Use and Experience with Cocaine Are Found to Cluster in U.S. Neighborhoods but Findings Do Not Hold for Larger Geographic Areas
Population-based data from six years of the National Household Surveys on Drug Abuse public use files were employed to study whether experience with cocaine and the perception of risk associated with cocaine use cluster within neighborhoods and cities in the U.S. The alternating logistic regressions model was used to quantify the extent of geographic concentration. Perceptions of the harm associated with cocaine use and actual experience with cocaine tend to cluster within neighborhoods; once within-neighborhood concentration is taken into account, there is little evidence of residual concentration with cities. Petronis, K.R., and Anthony, J.C. Perceived Risk of Cocaine Use and Experience With Cocaine: Do They Cluster Within US Neighborhoods and Cities?, Drug and Alcohol Dependence, 57, pp. 183-192, 2000.
Drug Use 50% More Common Among Households with Welfare Recipients
This study examined the prevalence of drug use in a nationally representative sample of 1,989 recipients and 6,840 nonrecipients of four welfare programs. Data from the 1995 National Household Survey on Drug Abuse (NHSDA) were analyzed using the conditional form of multiple logistic regression with matching of respondents on neighborhood of residence. Weighted proportions and variances accounting for the complex sample design of the NHSDA survey were estimated using the Taylor series linearization method. The results indicate that drug use is 50% more common in household with welfare recipients than in nonwelfare households. Programs making welfare eligibility dependent on the recipient's working toward a drug-free lifestyle are worth examining, although a vigilant eye must be kept on the potential unintended consequences. Delva, J., Neumark, Y.D., Furr, C.D.M., and Anthony, J.C. Drug Use Among Welfare Recipients in the U.S. American Journal of Drug Alcohol Abuse, 26(2), pp. 335-342, 2000.
Panama: Odds of Drug Use Among School-Attending Youths Increases When Another in Same School Uses Drugs
The first epidemiological investigation of clustering of tobacco, alcohol, inhalant, and other drug involvement has been conducted using data from Panama's 1996 National Youth Survey on Alcohol and Drug Use. Clustering was estimated with the Alternating Logistic Regression method. Adjusted estimates of pair-wise cross-product ratios (PWCPR), a measure of clustering, show modest clustering (i.e., PWCPR >1.0) at the school level for tobacco smoking (PWCPR = 1.41; 95% confidence internal, CI = 1.22-1.64), alcohol consumption (PWCPR = 1.33; 95% CI = 1.22-1.45), use of inhalants, (PWCPR = 1.35; 95% CI = 1.07-1.69), and other drug use (PWCPR = 1.38; 95% CI = 1.14-1.68). These findings provide preliminary evidence that the odds of drug use among school-attending youths increase when another in the same school uses drugs, and suggest a new line of research on within-school diffusion that should include the identification of school-level factors that contribute to student drug use. Delva, J., Bobashev, G., Gonzalez, G., Cedeno, M, and Anthony, J.C. Clusters of Drug Involvement in Panama: Results from Panama's 1996 National Youth Survey. Drug and Alcohol Dependence, 60, pp 251-257, 2000.
Childhood Depression and Adult Personality Disorder
This study extends previous findings of the risks posed by childhood major depressive disorder and other psychopathological features for later personality disorder (PD) in a random sample of 551 youths. Self-reports and mother reports were used to evaluate DSM-III-R (Axes I and II) psychiatric disorders at mean ages of 12.7, 15.2, and 21.1 years. Logistic regression was used to examine the independent effects of major depressive disorder in childhood or adolescence on 10 PDs in young adulthood. Results indicate that the odds of dependent, antisocial, passive-aggressive, and histrionic PDs increased by more than 13, 10, 7, and 3 times, respectively, given prior major depressive disorder. Those effects were independent of age, sex, disadvantaged socioeconomic status, a history of child maltreatment, nonintact family status, parental conflict, preexisting PD in adolescence, and other childhood or adolescent Axis I psychopathological features, including disruptive and anxiety disorders. In addition, odds of schizoid and narcissistic PD increased by almost 6 times and odds of antisocial PD increased by almost 5 times given a prior disruptive disorder, and odds of paranoid PD increased by 4 times given a prior anxiety disorder. Personality disorders may represent alternative pathways of continuity for major depressive disorder and other Axis I disorders across the child-adult transition. Kasen, S., Cohen, P., Skodol, A.E., Johnson, J.G., Smailes, E. and Brook, J.S. Childhood Depression and Adult Personality Disorder: Alternative Pathways of Continuity. Arch. Gen. Psychiatry, 58(3), pp. 231-236, 2001.
Network Therapy for Addiction
Network therapy was developed as a specialized type of combined individual and group therapy to ensure greater success in the office-based treatment of addicted patients by using both psychodynamic and cognitive-behavioral approaches to individual therapy while engaging the patient in a group support network composed of family members and peers. This article outlines the role of group cohesiveness as a vehicle for engaging patients in this treatment; the patient's family and peers are used as a therapeutic network, joining the patient and therapist at intervals in therapy sessions. This network is managed by the therapist to provide cohesiveness and support, to undermine denial, and to promote compliance with treatment. The author presents applications of the network technique designed to sustain abstinence and describes means of stabilizing the patient's involvement. Some specific techniques discussed include ambulatory detoxification, disulfiram and naltrexone administration, relapse prevention, and contingency contracting. Also discussed are recent research on the use of psychiatric residents and counselors for treatment, and use of the Internet in dissemination. Galanter, M. and Brook, D. Network Therapy for Addiction: Bringing Family and Peer Support into Office Practice. Int J Group Psychother, 51(1), pp. 101-122, 2001.
Marijuana Use Among Black and Puerto Rican Adolescents
This study used a longitudinal design to assess the relationship between Black and Puerto Rican adolescent generational status (first generation vs. second generation) and specific psychosocial factors predicting later marijuana use. In addition, the interactive effects of adolescent generational status and psychosocial risk and protective factors on later marijuana use were assessed. Structured interviews were conducted with 108 Black males and females and 392 Puerto Rican males and females whose mean age at Time 1 and Time 2 was 14 and 19, respectively. Correlation analyses showed that various psychosocial variables (i.e., personality, family, peer, and the ecological setting) were related to later marijuana use. Regression analysis showed that the personality and family domains had a direct relationship with young adult marijuana use. In contrast, the impact of the generational status of the adolescent on later marijuana use was mediated by the psychosocial variables. The findings also indicated that the risk for drug use among second generation American adolescents (American-born children of immigrant parents) was offset by a number of protective factors stemming from the domains of personality, family, and ecology. Chappin, S.R., and Brook, J.S. The Influence of Generational Status and Psychosocial Variables on Marijuana Use among Black and Puerto Rican Adolescents. Hispanic Journal of Behavioral Sciences, 23(1), pp. 22-36, 2001.
Sex and Drug-related Risk Among Younger and Older Injection Drug Users in San Francisco
Dr. Kral and colleagues compared injection and sex-related risk behaviors of younger and older injection drug users (IDUs) in two adjacent neighborhoods. IDUs were recruited from street settings in two adjacent neighborhoods in San Francisco in April 1997. All participants were interviewed using a standardized questionnaire and were tested for HIV antibodies. Injection and sex related risk behaviors were compared between younger IDUs (<30 years old; n=56) and older IDUs (30 years or older; n=116). Younger IDUs were more likely to be white, be homeless, have injected amphetamines, and have been arrested in the past year. Older IDUs were more likely to be African American and smoke crack cocaine, and they had injected a mean of 18 years longer. Younger IDUs were more likely to have shared syringes in the past month (52% vs. 10%; p<0.05), report drug overdose in the past 15 months (39% vs. 7%; p<0.05), and to have had unprotected vaginal intercourse in the past 6 months (77% vs. 53%; p<0.05). After control of confounding factors using logistic regression analysis, all these associations remained significant. There is an urgent need for innovative prevention programs that target younger, homeless IDUs. Kral, A.H., Lorvick, J., and Edlin, B.R. Sex and Drug-related Risk Among Younger and Older Injection Drug Users in San Francisco. Journal of Acquired Immune Deficiency Syndromes, 24, pp. 162-167, 2000.
The Suspected Association Between Methamphetamine ('ice') Smoking and Frequent Episodes of Alcohol Intoxication: Data from the 1993 National Household Survey on Drug Abuse
Drs. Furr, Delva and Anthony at Johns Hopkins University estimated the strength of association between frequent episodes of alcohol intoxication and recent smoking of methamphetamine ('ice'). Using the 1993 National Household Survey on Drug Abuse, a total of 101 ice smokers were matched on neighborhood of residence to 816 non-smokers. Based upon conditional logistic regression analyses, persons with daily episodes of alcohol intoxication were estimated to have been five times more likely to smoke ice, as compared with non-drinkers or drinkers with little or no history of alcohol intoxication. This estimate includes statistical adjustment for potential confounders (e.g. age, sex) and was statistically significant (P=0.01). The association between frequent alcohol intoxication and 'ice smoking' offers an intriguing lead for a broad range of new research. Furr, C.D., Delva J., and Anthony J.C. The Suspected Association Between Methamphetamine ('ice') Smoking and Frequent Episodes of Alcohol Intoxication: Data from the 1993 National Household Survey on Drug Abuse. Drug Alcohol Depend., 59(1)10, pp. 89-93, 2000.
The Use of the Case-Crossover Design in Studying Illicit Drug Use
Drs. Wu and Anthony, using a case-crossover design, studied time-varying exposures that cause transient excess risk of acute health events. It is a variant of case-control and subject-as-own-control research designs, involving use of information about exposure history of each case to estimate the transient effect. This design can help to reduce sampling bias otherwise introduced in the selection of controls, as well as confounding bias that might be derived from enduring individual characteristics, especially personality traits and other long-standing inherited or acquired vulnerabilities. Authors found that when the subject is used as his or her own control, these personal vulnerabilities can be matched. In this paper they discuss strengths and weaknesses of the case-crossover design and suggest applications of the case-crossover design in epidemiologic studies on suspected hazards of illicit drug use, and in studies of drug use and co-occurring psychiatric disturbances. They conclude that the case-crossover design can play a useful role, but it discloses a need to secure fine-grained measurements in epidemiologic research on psychiatric comorbidity. As explained in the paper, they believe the case-crossover method may be of use to several disciplines: criminologists who study the drugs-crime nexus; services researchers; clinicians who seek to understand treatment entry and compliance behavior; and to etiologists interested in polydrug use. Wu, L.T., and Anthony, J.C., The Use of the Case-Crossover Design in Studying Illicit Drug Use. Substance Use Misuse. May-Jun, 35(6-8), pp. 1035-1050, 2000.
Differential Recall of Intimate Partner Violence
Research on intimate partner violence (IPV) has found that partners often do not agree about the occurrence of IPV, with abusive male partners reporting lower levels than their abused female partners. Among the reasons suggested for these differences are: denial or self-deception, fear of legal sanctions, and gender differences in recall of interpersonal events. This qualitative study focused on the factors that account for gender differences in recall of male-to-female partner conflict. Interviews were conducted with battered women recruited from a shelter, male batterers in an intervention program, and equal numbers of men and women recruited from the community who had no history of IPV in their relationships. Subjects were asked an open-ended questionnaire and then asked questions based on their response. The main results of this study indicate that participants believe that women remember more than men, both choose what they want to remember, and both remember that they were right in the conflict. Participants suggested that women tend to focus on the emotional aspects of a fight and remember fights longer. 19% of respondents suggested that substance abuse might contribute to distorted recollections of partner violence. The female victims group, in particular, mentioned the intentional forgetting of fights. The overall significance of this study is that it suggests mechanisms underlying partner disagreement about IPV that have not previously been considered. Armstrong, T.G., Heiderman, G., Corcoran, K.J., Fisher, B., Medina, K.L. and Schafer, J. Disagreement About the Occurrence of Male-to-Female Intimate Partner Violence: A Qualitative Study. J. Fam. Comm. Health, 24(1), pp. 55-75, April 2001.
Partner Violence Among Mexican American Women
The prevalence of intimate partner violence (IPV) and associated risk and protective factors among Mexican-American women was studied using data from a cross-sectional household survey of U.S. residents of Mexican origin. The analysis includes data from women who were involved in an intimate relationship with a male partner and who answered questions about violence (n=1155). Approximately two fifths of the women were U.S. born. The self-reported prevalence of physical abuse by a current partner was 10.7%. Multivariate analysis showed that U.S birthplace, young age, urban residence, and having 4 or more children were associated with physical abuse. Social support and regular church attendance were protective. A consistent association was found between IPV and higher acculturation, e.g., years in U.S., country of schooling, dominant language. It is suggested that aspects of traditional Mexican culture may serve a protective function for families. Lown, E.A. and Vega, W.A. Prevalence and Predictors of Physical Partner Abuse among Mexican-American Women, A. J. Pub. Health, 91, pp. 441-445, 2001.
Community Level Effects on Prevalence of Substance Use During Pregnancy
Multilevel logistic regression models were used to analyze individual and community correlates of prenatal substance use. This study analyzed a subset of data from the California Perinatal Substance Exposure Study (PSE), the subjects in this study (n=10,611) are the subset of women identified as white, non-Hispanic (n=10,611) and Black/African-American (n=2,669) from the larger multiethnic sample (n=29,494); Latinas were not included in this study. Using census data, the proportion of zip code residences receiving public assistance was attached to each respondent's data in the PSE data file. Analyses showed that, except for alcohol, levels of neighborhood public assistance had an independent, significant effect on prevalence of substance use; increasing levels of neighborhood poverty increased the likelihood of a pregnant woman testing positive. Black women had higher predicted prevalence rates for alcohol and cocaine, while White women had higher predicted risks for tobacco, marijuana, and amphetamines. After controlling for neighborhood public assistance levels, no racial differences were seen in the category overall illicit drug use or opiate use. Future more detailed studies are needed to determine if neighborhood poverty effects on substance use are due to compositional effects, e.g., greater access to drugs, greater overall deviance, etc. or contextual factors, e.g., increased stresses associated with poor housing, lack of social services, etc. Finch, B.K., Vega, W.A., and Koldny, B. Substance Use During Pregnancy in the State of California, USA, Soc. Sci. Med. 52, pp. 571-583, 2001.
High Potency Marijuana Use Among Urban Youth
This paper describes cultural factors associated with the use of high-potency marijuana among inner-city youth in a midsized northeastern city. The investigators note that while high-potency marijuana has been available and used nationally for over a decade, surveys of drug use do not include items on what "new marijuana" contains and how and under what circumstances it is used. This paper, based on data from an ethnographic and epidemiological study of pathways to heavy drug use among youth and young adults, examines the sociocultural context of new marijuana use as an emergent trend. After considering the street market for high-potency marijuana, social rituals and meanings surrounding its distribution and use, and links with hip hop culture, the paper concludes with a critical analysis of the ways in which the drug market drives drug sales, drug use and drug-use sequencing in inner-city neighborhoods. Schensul, J.J., Huebner, C., Singer, M., Snow, M., Feliciano, P., and Broomhall, L. The High, the Money, and the Fame: The Emergent Social Context of "New Marijuana" Use among Urban Youth. Medical Anthropology, 18, pp. 389-414, 2000.
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