Director's Report to Council - Research Findings Excerpts

September, 2007

Basic Neurosciences Research

Prenatal Cocaine Exposure and the Developing Brain

Children exposed to cocaine during gestation have a higher incidence of neurobehavioral deficits. The neurochemical bases of these deficits have not been determined but the pharmacology of cocaine and the nature of abnormalities suggest that disruptions in catecolaminergic systems may be involved. In a recent study, NIDA-supported researchers report that prenatal cocaine exposure resulted in lasting changes to the regulation and responsivity of rat locus coeruleus norepinephrine (NE) neurons. From these findings, the researchers speculate that a similar dysregulation of locus coeruleus NE neurons may occur in children exposed to cocaine during gestation, and this may explain, at least partly, the increased incidence of cognitive deficits that have been observed in these subjects. This study was conducted in pregnant rats that received intravenous injection of cocaine twice daily between gestational days 10 and 20 and the progeny was tested as juveniles. The researchers also observed that the locus coeruleus NE system was more responsive to stimuli, such as exposure to a mild stressor, in rats exposed to prenatal cocaine compared to rats exposed to saline solution. Elsworth, J.D., Morrow, B.A., Nguyen, V.T., Mitra, J., Picciotto, M.R., and Roth, R.H. Prenatal Cocaine Exposure Enhances Responsivity of Locus Coeruleus Norepinephrine Neurons: Role of Autoreceptors. Neuroscience 147, pp. 419-427, 2007.

Elevated Vulnerability of Male Adult to Drug Abuse after Prenatal Exposure to Cocaine Seen in Animal Model

It is estimated that for children born in the US 20% have been exposed to drugs of abuse in utero. Young adults who had in-utero drug exposure are more likely to abuse substances and show persistent affective and behavioral deficits; however, the biological bases of such deficits are not well understood. A team of NIDA supported researchers at Harvard University and Cornell University show that in animal models cocaine exposure during brain development changed dopaminergic neuron responses to cocaine in mice and increased their drug seeking behavior. Using brain stimulation-reward (BSR) method, Barry Kosofsky and colleagues report that the reinforcing effect of cocaine is greatly increased in adult male mice who were exposed to cocaine in utero. In pharmacological studies, these researchers demonstrate that a dopamine D1-receptor agonist has a similar effect as cocaine on these mice, indicating the involvement of limbic forebrain dopaminergic neural circuit in the BSR shift. Furthermore, they observed that a dopamine D2-receptor agonist had a biphasic effect on the threshold of BSR. Thus, the low doses increased the BSR threshold, but higher doses decrease the threshold. Similarly, they observed enhanced potency of the D2 agonist in the male adult mice that showed enhanced cocaine potency, which suggests adaptations in dopamine receptors may, in part, account for the changes in the rewarding potency of cocaine in adulthood after prenatal cocaine exposure. These results also provide biological evidence of developmental changes in the brain as consequences of early exposure to drugs of abuse. Malanga, C.J., Riday, T.T., Carlezon, W.A., and Kosofsky, B.E. Prenatal Exposure to Cocaine Increases the Rewarding Potency of Cocaine and Selective Dopaminergic Agonists in Adult Mice. Biological Psychiatry, 63(2), pp. 214-221, 2008.

Basic Behavioral Research

Low Dose Nicotine Pretreatment Increases Cocaine Reward in Adolescent but not Adult Rats

Prior animal behavioral studies have shown that compared to adult rats, adolescent rats exhibit greater sensitivity to nicotine's stimulant and rewarding effects and lesser sensitivity to nicotine's negative effects. In the present study, Dr. Frances Leslie and colleagues at the University of California at Irvine sought to determine if nicotine pretreatment differentially modulates cocaine self-administration in adolescent and adult rats. Male and female rats, aged postnatal day P28 and P86, were treated twice daily with nicotine (0.03 ug/kg/, i.v.) or saline daily for 4 days. At P32 and P90, the rats were tested for 5 consecutive days for acquisition of cocaine (0.2 or 0.5 mg/kg) self-administration. There were no main effects of sex or cocaine dose. In the first hour of acquisition, there was more cocaine self-administration by the adolescent nicotine-pretreatment group than by adolescent saline-pretreated animals or by adult nicotine and saline groups. Nicotine pretreatment also significantly enhanced cocaine self-administration in the adolescent, but not adult rats, across the first four of five sessions of cocaine self-administration. In a separate similar experiment with adolescent rats, nicotine pretreatment failed to enhance acquisition of sucrose operant responding, suggesting that nicotine's enhancement of cocaine self-administration does not merely reflect a generalized increase in appetitive responding. The authors conclude these findings suggest "that brief treatment with low doses of nicotine in early adolescence, but not adulthood, may cross-sensitize the brain to cocaine reward" (p.70). McQuown, S.C., Belluzzi, J.D., and Leslie, F.M. Low Dose Nicotine Treatment during Early Adolescence Increases Subsequent Cocaine Reward. Neurotoxicology and Teratology, 29, pp. 66-73, 2007.

Sex Differences in Adolescent-onset vs Adult-onset Nicotine Self-administration

Dr. Ed Levin and colleagues at Duke University previously reported higher levels of nicotine self-administration in adolescent female rats than in adult female rats. This enhancement of nicotine self-administration in adolescence was still observed when animals were tested as adults (Levin et al. Psychopharmacology, 169, pp. 141-149, 2003). To complement this previous study, Dr. Levin and his colleagues have now conducted a parallel study in males. They found that male adolescent rats, like female adolescent rats, self-administered more nicotine on a per kilogram basis than adults. Additionally, they found two important sex differences. First, males were more vulnerable to this adolescent enhancement effect than females: compared to adult onset nicotine self-administration, the adolescent enhancement was two-fold in females, but three-fold in males. Second, unlike the female rats that persisted in higher rates of self-administration when they became adults, male rats exhibit adult-like levels of nicotine self-administration after the adolescent period. Thus, male rats appear to be more vulnerable than females to the adolescent enhancement effect, but only females exhibited a persistence of this enhancement into adulthood. Levin, E.D., Lawrence, S.S., Petro, A., Horton, K., Rezvani, A.H., Seidler, F.J., and Slotkin, T.A. Adolescent vs. Adult-onset Nicotine Self-administration in Male Rats: Duration of Effect and Differential Nicotinic Receptor Correlates. Neurotoxicology and Teratology, 29, pp. 458-465, 2007.

Self-Control, Symptomatology and Substance Use in 9 yr Old Children

NIDA researcher, Rick Gibbons and colleagues, tested a theoretical model of how self-control constructs are related to psychological symptomatology and variables that predispose to involvement versus noninvolvement in substance use: willingness to use, affiliation with peers who use, and efficacy for resisting use. Data were obtained from a sample of 332 children, mean age = 9.3 years, who were interviewed in their homes. Overall, self-control constructs were significantly related to symptomatology or well-being. Moreover, the results showed significant pathways from symptomatology measures to predisposing factors plus a direct effect from poor self-control to lower resistance efficacy. The study was conducted with a diverse sample of children, and the results were obtained with control for relevant demographic characteristics, including ethnicity and parental education. The results may have implications for preventive interventions. The results suggest that self-control training components can be included in prevention programs focused on adolescent problem behaviors. The results for predisposing factors suggest that prevention programs for younger children can target perceptions of substance users and resistance efficacy, as there is evidence that both processes can be altered through family- or school-based interventions. Furthermore, prevention research may be designed to examine the implications of more distal factors (e.g., neighborhood disadvantage, racial discrimination), as well as more proximal factors such as peer affiliations. Finally, the present results suggest that cognitive and motivational processes are more salient for young boys, whereas social processes are more salient for young girls. These gender differences need to be replicated, but results of this type need exploration because of their implications for targeted prevention programs. Wills, T.A., Ainette, M.G., Mendoza, D., Gibbons, F.X., and Brody, G.H. Self-Control, Symptomatology, and Substance Use Precursors: Test of a Theoretical Model in a Community Sample of 9-Year-Old Children. Psychology of Addictive Behaviors, 21, pp. 205-215, 2007.

Behavioral and Brain Development Research

Demographic and Psychosocial Characteristics of Mothers Using Methamphetamine During Pregnancy: Preliminary Results from the Infant Development, Environment, and Lifestyle Study (IDEAL)

The psychological characteristics and caretaking environments of 131 women enrolled in the first longitudinal study of prenatal methamphetamine (MA) exposure and child development were examined. Preliminary results from this study found that prenatal MA use was associated with lower maternal perceptions on quality of life, greater likelihood of substance use among family and friends, increased risk for ongoing legal difficulties, and a markedly increased likelihood of developing a substance abuse disorder. Preliminary findings also suggest that MA using women are more likely to have multiple, intertwined psychosocial risks that may result in maladaptive parenting and caregiving. These factors may impact the developmental outcomes of affected children. Derauf, C., LaGasse, L.L., Smith, L.M., Grant, P., Shah, R., Arria, A., Huestis, M., Haning, W., Strauss, A., Della Grotta, S., Liu, J., and Lester, B.M. Demographic and Psychosocial Characteristics of Mothers Using Methamphetamine During Pregnancy: Preliminary Results of the Infant Development, Environment, and Lifestyle study (IDEAL). The American Journal of Drug and Alcohol Abuse, 33(2), pp. 281-289, 2007.

Impact of Prenatal Cocaine Exposure on Attention and Response Inhibition

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

Children's Language Trajectories Relative to Prenatal Cocaine Exposure

In this ongoing longitudinal study at Case Western Reserve University, language development was assessed at 1, 2, 4, and 6 years of age, and performance was analyzed for two groups of children based on cocaine exposure in utero (209 exposed, 189 not exposed). The groups were compared on receptive, expressive, and total language scores across time. Multiple potentially confounding and moderating factors were included in the analyses. A relationship between prenatal cocaine exposure and language development was seen over time for receptive, expressive, and total language scores, with cocaine exposure related to poorer performance. Analyses also indicated that prenatal tobacco exposure was related to lower receptive language scores, and that environmental factors were associated with language scores. The authors note that their findings are consistent with and extend the findings of other longitudinal studies of prenatal cocaine exposure and language development. In addition, it was noted that both the cocaine-exposed and nonexposed children declined in language performance over time, a result believed to be related to factors common to both groups (such as low SES, education, and poverty), and also consistent with findings from another prenatal cocaine exposure cohort study. Lewis, B.A., Kirchner, H.L., Short, E.J., Minnes, S., Weishampel, P., Satayathum, S., and Singer, L.T. Prenatal Cocaine and Tobacco Effects on Children's Language Trajectories. Pediatrics, 120(1), pp. e78-e85, 2007.

Prenatal Cocaine Exposure and Physical Growth Patterns to Age 8 Years

This report focuses on longitudinal growth patterns in a cohort of children observed from birth until 8 years of age following prenatal exposure to cocaine. Birth weight, length, and head circumference were recorded. Weight, length or height, and head circumference were assessed at 6, 12, 24, 48, 72, and 96 months of age. Analyses were reported for 202 primarily African American/ Caribbean children. Ninety of these children were classified as prenatally unexposed to cocaine, 38 as having heavier cocaine exposure (top quartile of meconium concentration for cocaine metabolites, and/or top quartile days of self-reported use during the entire pregnancy), and 74 as having lighter exposure. Prenatal cocaine and prenatal alcohol exposure were independently associated with lower weight, length, and head circumference at birth. The relationships between prenatal cocaine exposure and longitudinal growth patterns to 8 years of age were analyzed using multiple linear regression models, including covariates of gestational age, gender, ethnicity, age at assessment, current caregiver, birth mother's use of alcohol, marijuana, and tobacco during the pregnancy, and maternal pre-pregnancy weight and height indicators. The association of prenatal cocaine exposure and growth did not persist beyond the neonatal period. The authors report that although the rate of change in growth parameters for cocaine-exposed children (heavier exposure compared to unexposed, and lighter exposure compared to unexposed) exceeded those of unexposed children in the first two years and then lagged up to age 4, the negative association with cocaine ultimately largely dissipated by school age. The authors also note that their findings agree with school-age results from another cohort of children prenatally exposed to cocaine, and differ in some ways from the findings for two other study cohorts, adding that ongoing examination of growth patterns in their cohort as well as in cohorts from other studies will continue to clarify the potential impact of in utero cocaine exposure on growth patterns to school age and beyond. Lumeng, J.C., Cabral, H.J., Gannon, K., Heeren, T., and Frank, D.A. Pre-natal Exposures to Cocaine and Alcohol and Physical Growth Patterns to Age 8 Years. Neurotoxicology and Teratology, 29(4), pp. 446-457, 2007.

Visuospatial Working Memory in School-Aged Children Exposed in Utero to Cocaine

Among the neurocognitive impairments reported as associated with prenatal cocaine exposure, slower response time, and less efficient learning in school-aged children are common to findings from several laboratories. This study by Dr. Linda Mayes and her colleagues presents performance data on a spatial working memory task in 75 prenatally cocaine exposed (CE) and 55 nondrug-exposed (NDE) 8- to 10-year-old children. Children were administered a novel neuropsychological measure of immediate- and short-term memory for visuospatial information, the Groton Maze Learning Test (GMLT), a computer-based hidden maze learning test that consists of a "timed chase test" (a simple measure of visuomotor speed), eight learning trials followed by a delayed recall trial after an 8-minute delay and a reverse learning trial. Performance is expressed as correct moves per second and number of errors per trial. Across all trials, the cocaine-exposed group showed significantly slower correct moves per second and made significantly more errors. There were no significant main effects for amounts of alcohol, tobacco, or marijuana exposure. After an 8-minute delay and compared to the eighth trial, cocaine-exposed children showed less consolidation in learning compared to nonexposed children. When asked to complete the maze in reverse, cocaine-exposed children showed a greater decrement in performance (decreased correct moves per second and increased errors) compared to the eighth learning trial. Children exposed in utero to cocaine exhibit a possible impairment in procedural learning and diminished efficiency in creating and accessing an internal spatial map to master the hidden maze. Mayes, L., Snyder, P.J., Langlois, E., and Hunter, N. Visuospatial Working Memory in School-aged Children Exposed in Utero to Cocaine. Child Neuropsychology, 13(3), pp. 205-218, 2007.

Multivariate Examination of Brain Abnormality Using Structural and Functional MRI with Adolescents Prenatally-Exposed to Cocaine

This article presents a methodological framework for extracting regional brain features simultaneously from both structural and functional images as a means for detecting brain abnormalities, and reports on the application of this method with a sample of 25 adolescents who had been exposed to cocaine in utero and a socioeconomically-matched comparison group of 24 non-exposed adolescents. High-resolution 3D structural MRI and arterial spin labeling perfusion MRI were the imaging modalities used. The procedure involved a regional statistical feature extraction approach to capture discriminative features from voxel-wise morphometric and functional representations of brain images. This feature extraction method was used in conjunction with a hybrid feature selection method and a nonlinear support vector machine for the classification of brain abnormalities. The investigators conclude that the method is capable of accurately detecting spatially distributed and complex patterns of brain alterations associated with prenatal cocaine exposure in an adolescent sample. Fan, Y., Rao, H., Hurt., H., Giannetta, J., Korczykowski, M., Shera, D., Avants, B.B., Gee, J.C., Wang J., and Shen, D. Multivariate Examination of Brain Abnormality Using Both Structural and Functional MRI. Neuroimage, 36(4), pp. 1189-1199, 2007.

Abnormal Cortical Thickness and Brain-Behavior Correlation Patterns in Individuals with Heavy Prenatal Alcohol Exposure

Quantitative magnetic resonance imaging (MRI) studies in children with fetal alcohol spectrum disorders (FASDs) have shown regional patterns of dysmorphology, most prominent in parietal and posterior temporal cortices. Various methods of image analysis have been employed in these studies, but abnormalities in cortical thickness have not yet been mapped over the entire cortical surface in individuals with FASD. Further, relationships between cognitive dysfunction and cortical thickness measures have not yet been explored. In this study Dr. Elizabeth Sowell and her colleagues applied cortical pattern matching algorithms and techniques for measuring cortical thickness in millimeters to the structural brain MRI images of 21 subjects with heavy prenatal alcohol exposure (8-22 years, mean age 12.6 years), and 21 normally developing control subjects (8-25 years, mean age 13.5 years). Dissociable cognitive measures, of verbal recall and visuospatial functioning, were correlated with cortical thickness, and group by test score interactions were evaluated for predicting cortical thickness. Significant cortical thickness excesses of up to 1.2 mm were observed in the FASD subjects in large areas of bilateral temporal, bilateral inferior parietal, and right frontal regions. Significant group by test score interactions were found in right dorsal frontal regions for the verbal recall measure and in left occipital regions for the visuospatial measure. These results are consistent with earlier analyses from this and other research groups and, for the first time, show that cortical thickness is also increased in right lateral frontal regions in children with prenatal alcohol exposure. Further, the significant interactions show for the first time that brain-behavior relationships are altered as a function of heavy prenatal alcohol exposure. Sowell, E.R., Mattson, S.N., Kan, E., Thompson, P.M., Riley, E.P., and Toga, A.W. Abnormal Cortical Thickness and Brain-Behavior Correlation Patterns in Individuals with Heavy Prenatal Alcohol Exposure. Cerebral Cortex, 18(1), pp. 136-144, 2008.

fMRI of Verbal Learning in Children with Heavy Prenatal Alcohol Exposure

Dr. Elizabeth Sowell and her colleagues examined functional MRI activation patterns corresponding to verbal paired associate learning in a group of 11 children (between 8 and 13 years of age) with heavy prenatal alcohol exposure compared with 16 typically-developing children (between 7 and 15 years old). Among the typically developing children, prominent activation was observed in the left medial temporal lobe, left dorsal frontal lobe and bilateral posterior temporal cortices during learning and recall. Analyses revealed significantly less activation in left medial and posterior temporal regions and significantly more activation in right dorsal frontal cortex in the alcohol-exposed children relative to controls, even when group differences in memory test performance were statistically controlled. These results may indicate an increased reliance on frontal memory systems in the children with heavy prenatal alcohol exposure, perhaps compensating for dysfunctional medial temporal memory systems. These findings are consistent with neuropsychological and structural imaging studies, and provide the first evidence for brain activation abnormalities, independent of group performance differences, during verbal learning and recall in children with heavy prenatal alcohol exposure. Sowell, E.R., Lu, L.H., O'Hare, E.D., McCourt, S.T., Mattson, S.N., O'Connor, M.J., and Bookheimer, S.Y. Functional Magnetic Resonance Imaging of Verbal Learning in Children with Heavy Prenatal Alcohol Exposure. NeuroReport, 18(7), pp. 635-639, 2007.

Magnetic Resonance and Spectroscopic Imaging in Prenatal Alcohol-Exposed Children: Preliminary Findings in the Caudate Nucleus

This study was designed to identify and compare the neuroanatomical and neurochemical abnormalities that are associated with prenatal exposure to alcohol in both fetal alcohol syndrome (FAS)-diagnosed children and those diagnosed with fetal alcohol effects (FAE). MR data of three age-, gender- and race-balanced small groups of children (age range 9.6 to 12.7 years), FAS-diagnosed, FAE-diagnosed, and non-exposed controls, were compared. Effects of prenatal alcohol exposure, regardless of diagnosis, were found in the caudate nucleus. Specifically, a significantly smaller caudate nucleus was found for the FAS and FAE participants compared to the controls. In addition, the metabolite ratio of N-acetyl-aspartate to creatine (NAA/Cr), an indicator of neuronal function, in left caudate nucleus of both the FAS and FAE participants was elevated compared to the control group. Analysis of absolute concentrations revealed that the increase in the ratio of NAA/Cr was due to an increase in NAA alone. Although its exact function in the CNS is unknown, NAA is believed to be a neuronal marker due to its exclusive localization to neurons. Some also speculate a role for NAA in myelination. Elevated NAA in the prenatal alcohol-exposed participants could indicate a lack of normal programmed cell death, dendritic pruning and/or myelination during development. The present study demonstrates that prenatal alcohol-exposed children, with or without facial dysmorphology, have abnormal brain anatomy and chemistry. Corteses, B.M., Moore, G.J., Bailey, B.A., Jacobson, S.W., Delaney-Black, V., and Hannigan, J.H. Magnetic Resonance and Spectroscopic Imaging in Prenatal Alcohol-exposed Children: Preliminary Findings in the Caudate Nucleus. Neurotoxicology and Teratology, 28(5), pp. 597-606, 2006.

Smoking During Teenage Pregnancies and Behavioral Problems in Offspring

In this paper, Cornelius and colleagues at the University of Pittsburgh report on relationships between prenatal tobacco exposure (PTE) and school-age child behavior in a cohort of 357 offspring of teenage mothers. PTE was defined as any exposure across pregnancy for some of the analyses, and exposure within each trimester in other analyses. Interviews were conducted with the mothers at the fourth or fifth prenatal month visit and within 24-36 hours after delivery. Child exposure to environmental tobacco smoke (ETS) was assessed by urinary cotinine. Average age of the offspring in the analyses was 6.4 years. PTE (any exposure across pregnancy) was a significant predictor (p < .01) of increased activity (Routh Activity Scale) when controlling for other prenatal substance exposure, demographics, maternal psychological characteristics, home environment, and ETS. When controlling for the same factors, PTE (in each of the three trimesters) significantly (p < .01) predicted increased activity, and PTE (in the second trimester) significantly (p < .05) predicted attention problems (SNAP). ETS was not a significant predictor of behavioral outcomes when PTE was taken into account. The researchers indicate that their finding of an association of PTE with higher activity levels in exposed offspring agrees with results from animal and other human studies, and adds new evidence of the strength of this association given the extent of control for covariates in this study. Cornelius, M.D., Goldschmidt, L., DeGenna, N., and Day, N.L. Smoking During Teenage Pregnancies: Effects on Behavioral Problems in Offspring. Nicotine and Tobacco Research, 9(7), pp. 739-750, 2007.

Gender-Specific Effects of Prenatal and Adolescent Exposure to Tobacco Smoke on Auditory and Visual Attention

Smoking during pregnancy results in elevated risks of cognitive and auditory processing deficits and of smoking in the offspring. Preclinical studies have revealed that nicotine exposure in the prenatal and/or adolescent period results in a sex-specific pattern of reduction in cortical cholinergic markers. This study was designed to examine gender-specific effects of exposure to smoking in adolescents on auditory and visual attention. The sample consisted of 181 adolescent smokers and nonsmokers who had previously been exposed to maternal smoking or had not. The results demonstrated that both auditory and visual attention performance accuracy was decreased in females who were exposed to tobacco smoke during prenatal or adolescent development; however, the greatest deficits on these tasks were seen in female smokers who had also been exposed to tobacco smoke in the prenatal period (combined exposure). The pattern was somewhat different in males in that combined exposure resulted in greater deficits during the auditory attention conditions versus the visual processing tasks. Functional neuroimaging was conducted in a subset of 63 subjects while they were engaged in auditory and visual attentional tasks. In those adolescents with prenatal or adolescent exposure, activation of brain regions that support auditory attention was greater relative to controls with no exposure to tobacco smoke. The results of the functional imaging data suggest that reduced cortical cholinergic neurotransmission resulting from prenatal exposure or adolescent exposure to tobacco smoke results in a loss of efficiency in cortical regions that support auditory attention. This study supports the need for effective smoking prevention programs for women of childbearing age and for adolescents. Jacobsen, L., Slotkin, T., Mencl, W., Frost, S., and Pugh, K. Gender-Specific Effects of Prenatal and Adolescent Exposure to Tobacco Smoke on Auditory and Visual Attention. Neuropsychopharmacology, 32(12), 2453-2464, 2007.

The Adolescent Trials Network for HIV/AIDS Interventions: A Case Study of Developing Adolescent Health Community-Researcher Partnerships in Fifteen U.S. Communities

This article describes the partner selection process in 15 U.S. communities developing community-researcher partnerships for the Connect to Protect (C2P): Partnerships for Youth Prevention Interventions, an initiative of the Adolescent Trials Network for (HIV/AIDS) Interventions. Each site generated an epidemiological profile of urban youth in their community, selected a focus population and geographic area of youth at risk for HIV, conducted a series of successive structured interviews, and engaged in a process of relationship-building efforts culminating in a collaborative network of community agencies. Sites chose as their primary target population young women who have sex with men (n = 8 sites), young men who have sex with men (n = 6), and intravenous drug users (n = 1). Of 1162 agencies initially interviewed, 281 of 335 approached (84%) agreed to join the partnership (average 19/site). A diverse array of community agencies were represented in the final collaborative network; specific characteristics included: 93% served the sites' target population, 54% were predominantly youth oriented, 59% were located in the geographical area of focus, and 39% reported provision of HIV/STI (sexually transmitted infection) prevention services. Relationship-building activities, development of collaborative relationships, and lessons learned, including barriers and facilitators to partnership, are also described. Study findings address a major gap in the community partner research literature. Health researchers and policymakers need an effective partner selection framework whereby community-researcher partnerships can develop a solid foundation to address public health concerns. Straub, D.M., Deeds, B.G., Willard, N., Castor, J., Peralta, L., Francisco, V.T., Ellen, J., and the Adolescent Trials Network for HIV/AIDS Interventions. Partnership Selection and Formation: A Case Study of Developing Adolescent Health Community-Researcher Partnerships in Fifteen U.S. Communities. Journal of Adolescent Health, 40(6), 489-498, 2007.

Prototypical Images in Condom Scripts among AIDS-Bereaved Adolescents

Twenty-five HIV-negative late adolescents (13 women and 12 men) who had lost a parent to AIDS generated vignettes in which the characters were deciding whether to use a condom (condom scripts). Two clinically trained judges rated the interpersonal tone of the condom scripts on 17 semantic differential scales. Three other clinically trained raters described script characters' attributes by selecting from a list of 36 terms. Multidimensional scaling (MDS) and individual differences hierarchical classes analyses (INDCLAS) were used to inductively derive a typology of condom scripts. Two dimensions emerged from MDS analysis: incompatibility and inequality. Condom scripts culminating in unprotected sex depicted situations in which partners held unequal influence. INDCLAS results suggested a prototype for equal-influence condom scripts - excited male and assertive, powerful female, and for unequal-influence (unprotected sex) condom scripts - powerful, disengaged male and permissive female. These results inform the development of theoretical models and HIV prevention program materials. Reich, W.A. and Rubin, R.M. Prototypical Images in Condom Scripts among AIDS-bereaved Adolescents. AIDS Education and Prevention, 19(1), pp. 82-94, 2007.

Predictors of Repeat Pregnancy among HIV-1 Infected Women

In the Women and Infants Transmission Study (WITS), a prospective cohort study of HIV-infected pregnant women at six US mainland and Puerto Rican sites, changes in the HIV-1 epidemic have included higher income, better education, and better-controlled HIV disease among more recently enrolled women. Because these changes may alter the reproductive patterns of these women, an awareness of these women's current reproductive behaviors is essential. Predictors of repeat pregnancy among HIV-1-infected women enrolled in the Women and Infants Transmission Study (WITS) were investigated. Women enrolled in WITS without a history of sterilization were included. Using bivariate and multivariate analyses, predictors of a repeat pregnancy were modeled. Changes in risk factors for repeat pregnancy over time were examined and important predictors of repeat pregnancy were determined. Of 2246 eligible women, 22% had more than one WITS-enrolled pregnancy. In bivariate analyses, risk of repeat pregnancy was associated with younger age, lower educational status, higher CD4%, and lower viral loads. There was little change in risk factors for repeat pregnancy over time. HIV-1-infected women who are younger and healthier are more likely to have more than one pregnancy. Factors associated with repeat pregnancy among HIV-1-infected women have remained stable over time. Awareness of these factors will better equip healthcare providers to address the reproductive needs of HIV-1-infected women. Bryant, A.S., Leighty, R.M., Shen, X., Read, J.S., Brouwers, P., Turpin, D.B., LaRussa, P.S., Pacheco-Acosta, E., Paul, M.E., Vajaranant, M., Tuomala, R.E. and the Women and Infants Transmission Study. Predictors of Repeat Pregnancy among HIV-1 Infected Women. Journal of Acquired Immune Deficiency Syndrome, 44(1), pp. 87-92, 2007.

Heritability of Illicit Drug Use and Transition to Dependence in Southwest California Indians

The rates of drug use and dependence are high in Native Americans, but information is lacking regarding the etiology or clinical course in this high risk population. Dr. Cindy Ehlers conducted analyses from data obtained through a larger study conducted to determine risk factors for substance dependence in Southwest California (SWC) Indians. The analyses conducted in this project were designed to answer questions regarding the age of onset, prevalence and heritability of substance use in the following classes of illicit drugs: marijuana, cocaine, stimulants, sedatives, opiates, hallucinogens, phencyclidine (PCP), and solvents. Progression of substance use to dependence was also determined for each drug class in this community sample. Each participant in the sample which included 460 subjects (190 men and 270 women) was administered the Semi-Structured Assessment for the Genetics of Alcoholism. The participants in this sample reported the first used drugs were solvents and marijuana, which typically occurred at age 14-15. Ninety-one percent of the sample reported using at least one of the illicit drug classes with marijuana (88%) and stimulants (60%) being the most commonly tried substances. Using variance component methods from SOLAR, substantial heritability was found for marijuana, opiates, PCP, sedatives and stimulants, but the results were only modest for initiation to cocaine, hallucinogens, and solvents. The results from this study suggest that heritability of the initiation of substance use, in SWC Indians, may be similar to other population samples; however, once initiation of the substance has occurred, higher rates of dependence are seen in this population for marijuana, opiates and stimulants. Ehlers, C., Wall, T., Corey, L., Lau, P., Glider, D., and Wilhelmsen, K. Heritability of Illicit Drug Use and Transition to Dependence in Southwest California Indians. Psychiatric Genetics, 17(3), pp. 171-176, 2007.

Epidemiology And Etiology Research

This paper explores the magnitude of, and extent of overlap between, genetic, shared environmental and non-shared environmental influences on lifetime stimulant use and on stimulant abuse/dependence symptoms. It further explores the associations between stimulant use and cannabis use and the extent to which these associations can be attributed to common or correlated genetic and environmental influences. Data came from self report on lifetime stimulant use, DSM-IV abuse/dependence symptoms and corresponding measures of cannabis involvement collected from a sample of 6265 male and female Australian twins born between 1964 and 1971. Results showed that approximately one in five study participants reported lifetime stimulant use while 5% reported experiencing at least one symptom of abuse/dependence. Multivariate genetic model fitting indicated moderate genetic influences on stimulant use (40%) and symptoms (65%) while there was no evidence of sex differences in the magnitude of these influences. Despite moderate overlap, 65% of the genetic influence on stimulant abuse/dependence was specific to these symptomatologic outcomes. There were also strong genetic and shared environmental correlations between the factors associated with stimulant use and those associated with cannabis use. The authors conclude that there is evidence for both overlapping and distinct genetic factors contributing to stimulant use vs. abuse/dependence, which may have implications for opportunities for intervention, for example if those leading to initiation are in the personality realm and those leading to abuse/dependence are more metabolic. Moreover, the overlap in familial (genetic and environmental) risk factors for both stimulant and cannabis use suggests some degree of non-specificity in the risk for using these substances, although more study is needed. Lynskey, M., Grant, J., Li, L., Nelson, E., Bucholz, K., Madden, P., Statham, D., Martin, N., and Heath, A. Stimulant Use and Symptoms of Abuse/Dependence: Epidemiology and Associations with Cannabis Use--A Twin Study. Drug Alcohol Depend, 86(2-3), pp. 147-153, 2007.

Male-Female Differences in the Risk of Progression from First Use to Dependence upon Cannabis, Cocaine, and Alcohol

The authors extend prior reports about the risk of dependence on specific drugs by providing developmental-specific risk estimates for progression from first use to meeting criteria for DSM-III-R dependence upon cannabis, cocaine, or alcohol, as well as male-female differences. The data are from the National Comorbidity Survey, with a national probability sample of persons 15-44 years old in the United States, which included many respondents who used cannabis, cocaine and alcohol on at least one occasion (n=3558, 1337, and 6149, for cannabis, cocaine, and alcohol, respectively). Survival analysis procedures provided cumulative risk estimates of progression from first use to dependence upon each drug. The estimated risk of cannabis dependence among male cannabis users was 1% in the first year after first use, and reached a peak at 4% per year 2 years later, before declining. In contrast, the estimated risk of cannabis dependence among female cannabis users remained at 1% per year for 3 years, without the peak. For both male and female cocaine users, the estimated risk for developing cocaine dependence was 5 to 6% within the first year after first use. Thereafter, the estimated risk declined from the peak value, with a somewhat faster decline for females in the next 3 years after first use. For alcohol, the estimated risk period extended for many years after the first drink, with female drinkers becoming alcohol dependent at a rate of about 1% per year; with somewhat higher risk for male drinkers. For both male and female drinkers, the period of risk for developing alcohol dependence extended for a span of more than 20 years since first use; for cannabis and cocaine, the estimated period of risk was much shorter. There are male-female differences in the risk of becoming cannabis dependent during the first several years after initiation of cannabis use, less pronounced male-female differences for alcohol, and relatively smaller male-female differences for cocaine. These results should interest scientists whose focus is upon the origins of male-female differences in the occurrence of drug dependence. Wagner, F., and Anthony, J. Male-Female Differences in the Risk of Progression from First Use to Dependence Upon Cannabis, Cocaine, and Alcohol. Drug Alcohol Depend, 86(2-3), pp. 191-198, 2007.

Gender Differences in Criteria for Cannabis Abuse and Dependence

This study explored whether gender contributes to heterogeneity in the latent construct for abuse and dependence of cannabis, and furthermore, whether after accounting for differences in the mean scores of abuse and dependence across genders, there is any evidence for heterogeneity in the individual abuse and dependence criteria. The authors utilized data on criteria for cannabis abuse and dependence from the NESARC (National Epidemiological Survey on Alcohol and Related Conditions), a large, nationally representative sample including 8172 lifetime cannabis users. Analyses used factor analyses and modeling to examine dimensionality and gender heterogeneity. Results supported a unidimensional construct for cannabis abuse/dependence combined, rather than separate entities, which has also been found in prior research. The authors also identified two abuse (legal and hazard) and two dependence (quit and problems) criteria which showed significant gender heterogeneity; the abuse criteria exhibited higher thresholds in women and the dependence criteria in men. They concluded that the criteria that serve as indicators of DSM-IV cannabis abuse and dependence do not function identically in men and women and that certain criteria (e.g. hazardous use) require further refinement. These findings have important implications for the revision of the DSM criteria for abuse and dependence, both for questioning a distinction between abuse and dependence and for considering gender-sensitive diagnostic criteria in research and clinical settings. Agrawal, A., and Lynskey, M. Does Gender Contribute to Heterogeneity in Criteria for Cannabis Abuse and Dependence? Results from the National Epidemiological Survey on Alcohol and Related Conditions. Drug Alcohol Depend, 88(2-3), pp. 300-307, 2007.

Grandmother and Parent Influences on Child Self-Esteem

This study tests a model of intergenerational influences on childhood self-esteem that proposes paths from grandmothers' drug problems to grandchildren's self-esteem via parents' drug problems and parental adaptive child rearing and from grandmothers' maternal acceptance to grandchildren self-esteem via parents' unconventionality and adaptive child rearing. This longitudinal study uses data obtained from interviews with a New York City sample of black and Puerto Rican children (N = 149) and 1 of their parents and from mailed questionnaires or comparable interviews with those parents' mothers. Structural equation modeling was used to test the proposed model. The LISREL analysis found that, with 3 exceptions, all of the hypothesized paths were significant. The total effects analysis indicated that parents' adaptive child rearing was the strongest latent construct, a finding that was consistent with this construct's proximal position in the model. This study suggests that mothers' drug problems are not just near-term risks for their children, but also pose long-term risks for their children's future functioning as parents and thereby for their grandchildren. The authors conclude that the relative strength of parents' adaptive child rearing in this intergenerational model indicates that this area should be the focus of therapeutic intervention efforts, but addressing future grandmothers' drug problems may have positive effects on multiple generations. Brook, J., Ning, Y., Balka, E., Brook, D., Lubliner, E., and Rosenberg, G. Grandmother and Parent Influences on Child Self-Esteem. Pediatrics, 119(2), pp. 444-451, 2007.

Injecting and Sexual Risk Correlates of HBV and HCV Seroprevalence among New Drug Injectors

This study examines injecting and sexual risk correlates of hepatitis B (HBV) and hepatitis C (HCV) seroprevalence among new injecting drug users (IDUs) (age 18-30 years, injecting =300 lifetime drug injections. Among men only, HCV seropositivity was associated with >/=40 lifetime number of sex partners (among those never sharing injecting equipment). In this new IDU sample, HBV and HCV seroprevalence differed by gender and were considerably higher than HIV seroprevalence. The findings suggest that early interventions, targeting injecting and sexual risks and including HBV vaccination, are needed among new IDUs to prevent HBV, HCV and, potentially, HIV epidemics. Neaigus, A., Gyamarthy, A., Miller, M., Frajzyngier, V., Zhao, M., Friedman, S., and Des Jarlais, D. Injecting and Sexual Risk Correlates of HBV and HCV Seroprevalence Among New Drug Injectors. Drug Alcohol Depend, 89(2-3), pp. 234-243, 2007.

Comorbid Mental Disorders Associated with Nicotine Dependence in Pregnant Women

Dr. Renee Goodwin and colleagues investigated the association between mental disorders and cigarette use and nicotine dependence among pregnant women in the United States. Using a face-to-face general population survey, the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, 1516 women reporting a pregnancy in the past year were assessed for cigarette smoking and nicotine dependence, as well as DSM-IV-defined mood and anxiety disorders and personality disorders. They found that among pregnant women, 21.7% reported cigarette use and 12.4% met the criteria for nicotine dependence. Among pregnant women with cigarette use, 45.1% met criteria for at least one mental disorder, and among those with nicotine dependence, 57.5% met criteria for at least one other mental disorder. After adjusting for demographics and comorbidity, nicotine dependence during pregnancy significantly predicted any mental disorder (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.1-5.1), any mood disorder (OR 2.5, 95% CI 1.5-4.0), major depression (OR 2.07, 95% CI 1.3-3.4), dysthymia (OR 6.2, 95% CI 2.9-13.1), and panic disorder (OR 3.1, 95% CI 1.6-6.1) in the past year. No significant associations were found between nondependent cigarette use and mental disorders. These results suggest an association between mental disorders and nicotine dependence among pregnant women in the United States, a finding with implications for treatment and service provision. Goodwin, R., Keyes, K., and Simuro, N. Mental Disorders and Nicotine Dependence Among Pregnant Women in the United States. Obstet Gynecol, 109(4), pp. 875-883, 2007.

Peer and Parental Influences on Longitudinal Trajectories of Smoking among African Americans and Puerto Ricans

The purpose of this study was to identify distinct trajectories of smoking behavior during a period extending from adolescence (mean age = 14 years) to young adulthood (mean age = 26 years) among African American and Puerto Rican adolescents/young adults, to examine ethnic and gender differences in group membership, and to assess the ability of peer and parental smoking to distinguish among trajectory groups. A community-based sample of 451 African American and Puerto Rican adolescents was interviewed four times during adolescence and in early adulthood, covering a span of 12 years. For both ethnic/racial groups, four distinct trajectories were identified: Nonsmokers, maturing-out smokers, late-starting smokers, and early-starting continuous smokers. Compared with Puerto Ricans, African Americans were over-represented in the nonsmoking group, whereas Puerto Ricans were over-represented in the early-starting continuous group. Females were more likely than males to be early-starting continuous smokers than late starters. Adolescents who were exposed to peer and parental smoking in early adolescence were more likely to belong to trajectory groups characterized by higher levels of smoking. These findings show that exposure to peer and parental smoking in early adolescence constitutes a risk factor for engaging in elevated levels of smoking behavior at an early age and for continued smoking into adulthood for urban African Americans and Puerto Ricans. To be most effective, smoking prevention programs should address peer group and family influences on adolescent smoking. Brook, J., Pahl, K., and Ning, Y. Peer and Parental Influences on Longitudinal Trajectories of Smoking Among African Americans and Puerto Ricans. Nicotine Tob Res, 8(5), pp. 639-651, 2006.

Women Who Gave Birth as Unmarried Adolescents: Trends in Substance Use from Adolescence to Adulthood

The purpose of this study is to determine whether adolescent childbearing mothers "mature out" of substance use as they transition into adulthood, how their substance use compares to that of typical young women of the same ages, and whether there are different patterns of substance use evident in this vulnerable population. The data come from an ongoing longitudinal study of 240 young women who were unmarried, pregnant, and under age 18 at enrollment. They have been interviewed regularly from pregnancy through 11.5 years postpartum. The data are based on self-reported substance use verified by random urinalysis for drug metabolites. Substance use did not decline during the transition to adulthood nor into early adulthood. With the exception of alcohol, the prevalence of substance use was higher than that of a nationally representative sample of same-aged women. Three distinct patterns of substance use were identified: licit users (cigarettes and/or alcohol), marijuana users, and "hard" drug users. From these findings, the authors suggest that clinicians routinely assess substance use among young mothers who bore children as teenagers, and make referrals for appropriate treatment. Cigarette smoking is especially a cause for concern, given its widespread use and harmful effects for both mothers and their children. Although only a small proportion (about 5%) of young mothers used hard drugs consistently over time, this group will likely require comprehensive interventions that address multiple issues such as mental health and contextual factors to be effective. Future research should address reasons for continued substance use in this population. Gillmore, M., Gilchrist, L., Lee, J., and Oxford, M. Women Who Gave Birth as Unmarried Adolescents: Trends in Substance Use from Adolescence to Adulthood. J Adolesc Health, 39(2), pp. 237-243, 2006.

Twentieth Century Rises in Adult Cigarette Use in the U.S. Parallel Rises in Asthma in Children

The prevalence of asthma has increased at least 3-fold during the past several decades. However, the reason for this increase remains unknown. Renee Goodwin of Columbia University examined one possible factor that may be affecting the increase in prevalence of asthma among youth in the United States from 1900 to 2003. She hypothesized that (1) there has been a marked increase in smoking during the past century, (2) this increase in smoking has resulted in a substantial increase in exposure to environmental tobacco smoke among children, and (3) increased exposure to environmental tobacco smoke has contributed to the increase in childhood asthma. Using a sample of 4,500 children from the National Health Interview Survey, data on the incidence of asthma were aggregated and compared on an ecologic level with data on cigarette consumption from the American Lung Association. Her results suggest a parallel increase in the rates of cigarette use among adults and asthma in children. These findings show an increase in cigarette use during the past 4 birth cohorts, with subsequent leveling off at a population level with a progressively more prominent increase in cigarette use among women in the United States. She notes that future studies will be needed to confirm these ecological trends with community-level analyses in a variety of geographic regions. Goodwin, R. Environmental Tobacco Smoke and the Epidemic of Asthma in Children: The Role of Cigarette Use. Ann Allergy Asthma Immunol, 98(5), pp. 447-454, 2007.

Maternal Cigarette Smoking During Pregnancy and Child Aggressive Behavior

This study's objective was to examine the association between maternal smoking during pregnancy and childhood aggressive behavior in African-American and Puerto Rican children, as well as the relationship between maternal unconventional behavior, low maternal affection, and offspring aggression. Participants consisted of African-American and Puerto Rican children (N = 203; mean age = 8.6, SD = 0.87) and their mothers living in an inner city community. An interview consisting of a structured questionnaire was administered to the mothers and their children. Scales with adequate psychometric properties were adapted from previous validated measures. They included maternal smoking during pregnancy, maternal education, unconventionality, and warmth. Controlling for demographic factors, maternal unconventional behavior, and low maternal warmth, maternal smoking during pregnancy was associated with having offspring who were aggressive. Maternal unconventionality and warmth were independently related to childhood aggression. The authors suggest that although causal limitations are noted, it may be that a decrease in smoking during pregnancy is associated with a reduction in aggression in the offspring. Brook, D., Zhang, C., Rosenberg, G., and Brook, J. Maternal Cigarette Smoking During Pregnancy and Child Aggressive Behavior. Am J Addict, 15(6), pp. 450-456, 2006.

Long-Term Effects of Child Abuse and Neglect on Alcohol Use and Excessive Drinking in Middle Adulthood

The purpose of this study was to determine the long-term effects of child abuse and neglect on alcohol use in middle adulthood. Individuals with documented cases of childhood physical and sexual abuse and/or neglect (n = 500) and matched controls (n = 396) from a metropolitan county in the Midwest were followed and interviewed in middle adulthood. Outcomes were Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, diagnoses of alcohol abuse or dependence in young adulthood (age 29) and excessive drinking in middle adulthood (age 40). Women with documented histories of child abuse or neglect reported higher past-year typical quantity (p < .01) and past-month number of days drinking eight or more drinks (p < .05) than nonabused/nonneglected women. Controlling for parental alcohol/drug problems, the effect of child maltreatment on excessive drinking in middle adulthood was not significant for women. For women, the final structural equation model revealed an indirect path through alcohol diagnosis in young adulthood (p < .05) to excessive drinking in middle adulthood (p < .001) but no direct path from child abuse and neglect to excessive drinking in middle adulthood. For men, there were no significant paths from child abuse and neglect to alcohol diagnosis in young adulthood or excessive drinking in middle adulthood. For men and women, parental alcohol/drug problems had a significant indirect effect on the offspring's drinking in middle adulthood (p < .001) through young adult alcohol diagnosis (p < .001). In conclusion, consequences of abuse and neglect persist into middle adulthood for women, through continuation of earlier alcohol problems, suggesting the need for interventions throughout the life course. The influence of parental alcohol and drug problems warrants further attention. Widom, C., White, H., Czaja, S., and Marmorstein, N. Long-Term Effects of Child Abuse and Neglect on Alcohol Use and Excessive Drinking in Middle Adulthood. J Stud Alcohol Drugs, 68(3), pp. 317-326, 2007.

A Multiwave Multi-Informant Study of the Specificity of the Association between Parental and Offspring Psychiatric Disorders

The present study was conducted to investigate the specificity of the association between parental and offspring psychiatric disorders using epidemiological data from a series of parent and offspring interviews. A community-based sample of 593 mothers and their offspring from upstate New York were interviewed during the adolescence and early adulthood of the offspring. The children of parents with generalized anxiety disorder were at specifically elevated risk for anxiety disorders when co-occurring psychiatric disorders were controlled. The associations between parental and offspring antisocial, conduct, depressive, and substance use disorders were characterized by modest specificity. Children of parents with externalizing disorders were nearly as likely to develop internalizing disorders as they were to develop externalizing disorders. Children of parents with internalizing disorders were somewhat, but not significantly, more likely to develop internalizing disorders. These findings support the inference that children of parents with generalized anxiety disorder may be more likely to develop anxiety disorders than they are to develop other psychiatric disorders. However, when co-occurring psychiatric disorders are accounted for, the children of parents with depressive, disruptive, and substance use disorders may be as likely to develop other disorders as they are to develop the same type of disorder that their parents have had. Johnson, J., Cohen, P., Kasen, S., and Brook, J.A. Multiwave Multi-Informant Study of the Specificity of the Association Between Parental and Offspring Psychiatric Disorders. Compr Psychiatry, 47(3), pp. 169-177, 2006.

Predictors of Resilience in Abused and Neglected Children Grown-Up: The Role of Individual and Neighborhood Characteristics

This paper examines individual, family, and neighborhood level predictors of resilience in adolescence and young adulthood and describes changes in resilience over time from adolescence to young adulthood in abused and neglected children grown up. The sample includes documented cases of childhood physical and sexual abuse and neglect (n=676) from a Midwestern county area during the years 1967-1971 and information from official records, census data, psychiatric assessments, and self-reports were obtained through 1995. Analyses involve logistic regressions, replicated with Mplus to test for possible contextual effects. Almost half (48%) of the abused and neglected children in adolescence and nearly one-third in young adulthood were resilient. Over half of those who were resilient in adolescence remained resilient in young adulthood, whereas 11% of the non-resilient adolescents were resilient in young adulthood. Females were more likely to be resilient during both time periods. Being white, non-Hispanic decreased and growing up in a stable living situation increased the likelihood of resilience in adolescence, but not in young adulthood. Stressful life events and a supportive partner promoted resilience in young adulthood. Neighborhood advantage did not exert a direct effect on resilience, but moderated the relationship between household stability and resilience in adolescence and between cognitive ability and resilience in young adulthood. In conclusion, ecological factors appear to promote or interfere with the emergence and stability of resilience following childhood maltreatment. DuMont, K., Widom, C., and Czaja, S. Predictors of Resilience in Abused and Neglected Children Grown-Up: The Role of Individual and Neighborhood Characteristics. Child Abuse Negl, 31(3), pp. 255-274, 2007.

Growth Trajectories of Sexual Risk Behavior in Adolescence and Young Adulthood

Adolescence and young adulthood (ages 18-25 years) are periods of development and change, which include experimentation with and adoption of new roles and behaviors. Researchers investigated longitudinal trajectories of sexual risk behaviors across these time periods and how these trajectories may be different for varying demographic groups. They developed multilevel growth models of sexual risk behavior for a predominantly African American sample (n=847) that was followed for 8 years, from adolescence to young adulthood and investigated differences in growth parameters by race/ethnicity and gender and their interactions. The final model included linear and quadratic terms for both adolescence and young adulthood, indicating acceleration of sexual risk behaviors during adolescence and a peak and deceleration during young adulthood. African American males exhibited the highest rate of sexual risk behavior in ninth grade, yet had the slowest rate of growth. Compared with their White peers, African American males and females exhibited less sexual risk behavior during young adulthood. These results suggest that youths of different races/ethnicities and genders exhibit varying sexual risk behavior trajectories. Fergus, S., Zimmerman, M., and Caldwell, C. Growth Trajectories of Sexual Risk Behavior in Adolescence and Young Adulthood. Am J Public Health, 97(6), pp. 1096-1101, 2007.

Gender Differences in Injection Risk Behaviors at the First Injection Episode

This study sought to examine gender differences in drug injection equipment sharing at injecting initiation. Young injecting drug users in New York City (February 1999-2003) were surveyed about injection risk behaviors and circumstances at initiation. Analyses were gender-stratified and excluded participants who initiated alone. Multiple logistic regression estimated adjusted odds ratios. Participants (n=249) were 66% male and 82% White. Mean initiation age was 19.2; mean years since initiating was 3.0. Women were significantly more likely to cite social network influence as a reason for initiating, to have male and sex partner initiators, and to share injecting equipment than men. Among women, sharing any injection equipment was associated with initiation by a sex partner and having >/=2 people present. Among men, being injected by someone else predicted sharing any injection equipment, while using a legally obtained syringe was protective. Social persuasion stemming from sexual and/or social relationships with IDUs may increase women's risk of sharing injection equipment at initiation, and consequently, their early parenteral risk of acquiring blood-borne infections. Effective interventions should focus on likely initiates, especially women in injecting-discordant sex partnerships, and IDUs (potential initiators). Frajzyngier, V., Neaigus, A., Gyarmathy, V., Miller, M., and Friedman, S. Gender Differences in Injection Risk Behaviors at the First Injection Episode. Drug Alcohol Depend, 89(2-3), pp. 145-152, 2007.

An Examination of Pathways from Childhood Victimization to Violence: The Role of Early Aggression and Problematic Alcohol Use

Using prospective data from a cohort design study involving documented cases of child abuse and neglect and a matched control group, the researchers examine two potential pathways between childhood victimization and violent criminal behavior: early aggressive behavior and problematic drinking. Structural equation models, including controls for race/ethnicity, socioeconomic status, parental alcoholism, and parental criminality, revealed different pathways for men and women. For men, child maltreatment has direct and indirect (through aggressive behavior and problematic alcohol use) paths to violence. For women, problematic alcohol use mediates the relationship between childhood victimization and violence, and, independent of child maltreatment, early aggression leads to alcohol problems, which lead to violence. Interventions for victims of childhood maltreatment need to recognize the role of early aggressive behavior and alcohol problems as risk factors for subsequent violence. Widom, C., Schuck, A., and White, H. An Examination of Pathways from Childhood Victimization to Violence: The Role of Early Aggression and Problematic Alcohol Use. Violence Vict, 21(6), pp. 675-690, 2006.

Childhood Victimization and Illicit Drug Use in Middle Adulthood

Using a prospective cohort design, the authors examined in this study whether childhood victimization increases the risk for illicit drug use and related problems in middle adulthood. Court-documented cases of childhood physical and sexual abuse and neglect and matched controls (N = 892) were first assessed as young adults (mean age = 29 years) during 1989-1995 and again in middle adulthood (mean age = 40 years) during 2000-2002. In middle adulthood, abused and neglected individuals were about 1.5 times more likely than controls to report using any illicit drug (in particular, marijuana) during the past year and reported use of a greater number of illicit drugs and more substance-use-related problems compared with controls. The current results reveal the long-term impact of childhood victimization on drug use in middle adulthood. These new results reinforce the need for targeted interventions with abused and neglected children, adolescents, and adults, and particularly for women. Widom, C., Marmorstein, N., and White, H. Childhood Victimization and Illicit Drug Use in Middle Adulthood. Psychol Addict Behav, 20(4), pp. 394-403, 2006.

Consistency Between Adolescent Reports and Adult Retrospective Reports of Adolescent Marijuana Use: Explanations of Inconsistent Reporting Among an African American Population

This study examines the consistency of marijuana self-reports from adolescence and adulthood and what characterizes inconsistent reporting among a cohort of African American first graders followed longitudinally from age 6 to 32 (N=599, 51% female). Self-reported lifetime adolescent marijuana use (ages 16-17) and retrospective reports at age 32 were combined to categorize respondents as consistent reporters of nonuse (22%), consistent reporters of use (42%), adult recanters (19%), adolescent under reporters (8%), and inconsistent reporters of age of initiation (9%). Overall, about 64% of the population were consistent in their reports of adolescent marijuana use from adolescence to age 32. Multivariate logistic regression analyses found that recanters reported less marijuana use as adolescents, lower parental supervision during adolescence, lower deviant behavior as an adult, and stronger anti-drug values as adults than did consistent reporters. Adolescent under reporters reported less assault behaviors and less alcohol use as adolescents and had lower first grade math achievement than consistent reporters. Family background, depression, criminal arrests, and the field conditions of the interview were not related to inconsistent reporting. Ensminger, M., Juon, H., and Green, K. Consistency Between Adolescent Reports and Adult Retrospective Reports of Adolescent Marijuana Use: Explanations of Inconsistent Reporting Among an African American Population. Drug Alcohol Depend, 89(1), pp. 13-23, 2007.

Pubertal Maturation and Risk for Alcohol Use and Abuse

This study sought to examine the impact of various aspects of puberty on risk of using alcohol and developing alcohol use disorder (AUD). Data came from the Great Smoky Mountains Study, a longitudinal study of a representative sample of 1420 youth aged 9-13 at recruitment. Participants were interviewed annually to age 16. A parent was also interviewed. Information was obtained about use of a range of drugs including alcohol, drug abuse and dependence, other psychiatric disorders, life events, and a wide range of family characteristics. Pubertal hormones were assayed annually from blood samples, and morphological development was assessed using a pictorial measure of Tanner stage. The authors found that, controlling for age, Tanner stage predicted alcohol use and AUD in both boys and girls. The effect of morphological development was strongest in those who matured early. Early pubertal maturation predicted alcohol use in both sexes, and AUD in girls. The highest level of excess risk for alcohol use was seen in early maturing youth with conduct disorder and deviant peers. Lax supervision predicted alcohol use in early maturing girls, while poverty and family problems were predictive in early maturing boys. The authors conclude that, among the many biological, morphological, and social markers of increasing maturation, the visible signs of maturity are important triggers of alcohol use and AUD, especially when they occur early and in young people with conduct problems, deviant peers, problem families and inadequate parental supervision. These findings may help target those at greatest risk for early onset and progression of alcohol use and disorders. Costello, E., Sung, M., Worthman, C., and Angold, A. Pubertal Maturation and the Development of Alcohol Use and Abuse. Drug Alcohol Depend, 88, Suppl 1, pp. S50-S59, 2007.

Predictors of Drinking Immediacy Following Daily Sadness: An Application of Survival Analysis to Experience Sampling Data

Previous studies of daily assessments show modest mood-drinking covariation as a function of gender and coping motives; however previous analyses also assume a fixed interval across all individuals in the onset of drinking following negative mood. The current study used survival analysis and experience sampling methods to test whether gender and coping motives predicted shorter sadness-to-drinking intervals among those with greater alcohol-related drinking consequences. A sample of 85 college students (46% male; 78% Caucasian) completed daily assessments over 28 days. Survival analyses showed that women drank more on days following elevated sadness when they reported being motivated to drink to cope and having experienced alcohol-related consequences. For men, the two groups showing greater drinking risk following days of elevated sadness did not report alcohol-related consequences, with those reporting the presence of coping motives showing the greatest risk. Implications of these findings for self-medication mechanisms are discussed. Hussong, A. Predictors of Drinking Immediacy Following Daily Sadness: An Application of Survival Analysis to Experience Sampling Data. Addict Behav, 32(5), pp. 1054-1065, 2007.

Predictors of Unprotected Sex with Non-Cohabitating Primary Partners among Sheltered and Low-Income Housed Women in Los Angeles County

This study investigated cross-sectional associations of substance use, relationship abuse and HIV self-protective behavior with unprotected sex among 290 impoverished women with a non-cohabitating primary partner. Unprotected sex was associated with having a physically or psychologically abusive partner among low-income housed women, and having an abusive partner who also drank to intoxication among women living in shelters. Indicators of HIV self-protective behavior were associated with less frequent unprotected sex among sheltered women, even after accounting for abuse and substance use within the relationship. Results suggest the need for HIV-prevention interventions to address the problems of partner substance use and relationship abuse. Tucker, J., Wenzel, S., Elliott, M., and Hambarsoomian, K. Predictors of Unprotected Sex with Non-Cohabitating Primary Partners among Sheltered and Low-Income Housed Women in Los Angeles County. J Health Psychol, 11(5), pp. 697-710, 2006.

Gender-specific Correlates of Sex Trade Among Homeless and Marginally Housed Individuals in San Francisco

Sex exchange is a well-established risk factor for HIV infection. Little is known about how correlates of sex trade differ by biologic sex and whether length of homelessness is associated with sex trade. The researchers conducted a cross-sectional study among a sample of 1,148 homeless and marginally housed individuals in San Francisco to assess correlates of exchanging sex for money or drugs. Key independent variables included length of homelessness; use of crack, heroin or methamphetamine; HIV status; and sexual orientation. Analyses were restricted by biologic sex. In total, 39% of women and 30% of men reported a lifetime history of sex exchange. Methamphetamine use and greater length of homelessness were positively associated with a history of sex trade among women, while heroin use, recent mental health treatment, and homosexual or bisexual orientation were significantly associated with sex trade for men. Crack use was correlated with sex trade for both genders. Correlates of sex trade differ significantly according to biologic sex, and these differences should be considered in the design of effective HIV prevention programs. The researchers' findings highlight the critical need to develop long-term services to improve housing status for homeless women, mental health services for homeless men, and drug treatment services for homeless adults involved in sex work. Weiser, S., Dilworth, S., Neilands, T., Cohen, J., Bangsberg, D., and Riley, E. Gender-Specific Correlates of Sex Trade Among Homeless and Marginally Housed Individuals in San Francisco. J Urban Health, 83(4), pp. 736-740, 2006.

Ethnic Pride and Self-control Related to Protective and Risk Factors

The purpose of this study was to test a theoretical model of how ethnic pride and self-control are related to risk and protective factors. A community sample of 670 African American youth (mean age = 11.2 years) were interviewed on measures of cigarette smoking, alcohol use, and sexual behavior (lifetime to past month). Structural modeling analyses indicated parenting was related to self-control and self-esteem, and racial socialization was related to ethnic pride. Self-control and self-esteem variables were related to levels of deviance-prone attitudes and to perceptions of engagers in, or abstainers from, substance use and sexual behavior. The proximal factors (behavioral willingness, resistance efficacy, and peer behavior) had substantial relations to the criterion variables. Participant gender and parental education also had several paths in the model. Results were generally similar for the 2 outcome behaviors. In this population, self-esteem and self-control are related to parenting approaches and have pathways to attitudes and social perceptions that are significant factors for predisposing to, or protecting against, early involvement in substance use and sexual behavior. Wills, T., Murry, V., Brody, G., Gibbons, F., Gerrard, M., Walker, C., and Ainette, M. Ethnic Pride and Self-Control Related to Protective and Risk Factors: Test of the Theoretical Model for the Strong African American Families Program. Health Psychol, 26(1), pp. 50-59, 2007.

Racial/Ethnic and Socioeconomic Status Differences in Overweight and Health-Related Behaviors among American Students: National Trends 1986-2003

This article reports long-term trends by race/ethnicity and socioeconomic status (SES) in the percent of American students who are overweight and who engage in three health-related behaviors hypothesized to be associated with overweight. Data are from the Monitoring the Future annual surveys, using nationally representative samples of eighth, 10th, and 12th grade students. Participants include 62,156 eighth and 64,899 10th graders who completed the 1993-2003 surveys and 35,107 12th graders who completed the questionnaire form containing the measures pertaining to this study in the 1986-2003 surveys. Trends are presented separately by gender and grade level for different racial/ethnic and SES subgroups, in: (a) percent overweight (body mass index > or = 85th percentile), (b) percent who always or almost always eat breakfast, (c) percent who regularly exercise vigorously, and (d) average hours of weekday television viewing. The prevalence of overweight and of engaging in less healthy behaviors is considerably greater among youth from racial/ethnic minority backgrounds, of lower socioeconomic status, and in higher grades. Trends in overweight and these behaviors are found to vary substantially by gender, racial/ethnic group, socioeconomic status, and grade level. The study findings show well-established and persistent differences in the percent of racial/ethnic minority and low SES youth who are overweight and who's dietary and exercise habits are less healthy. Documentation of these problems may lead to research and policy agendas that will contribute both to understanding and to the reduction of these important health disparities. Delva, J., O'Malley, P., and Johnston, L. Racial/Ethnic and Socioeconomic Status Differences in Overweight and Health-Related Behaviors among American Students: National Trends 1986-2003. J Adolesc Health, 39(4), pp. 536-545, 2006.

Learning Disabilities and Intellectual Functioning in School-Aged Children with Prenatal Cocaine Exposure

Risk for developing a learning disability (LD) or impaired intellectual functioning by age 7 was assessed in full-term children with prenatal cocaine exposure drawn from a cohort of 476 children born full term and enrolled prospectively at birth. Intellectual functioning was assessed using the Wechsler Intelligence Scale for Children-Third Edition (Wechsler, 1991) short form, and academic functioning was assessed using the Wechsler Individual Achievement Test (WIAT; Wechsler, 1993) Screener by examiners blind to exposure status. LDs were categorized based on ability-achievement discrepancy scores, using the regression-based predicted achievement method described in the WIAT manual. The sample in this report included 409 children (212 cocaine-exposed, 197 non-cocaine-exposed) from the birth cohort with available data. Cumulative incidence proportions and relative risk values were estimated using STATA software (Statacorp, 2003). No differences were found in the estimate of relative risk for impaired intellectual functioning (IQ below 70) between children with and without prenatal cocaine exposure (estimated relative risk = .95; 95% confidence interval [CI] = 0.65, 1.39; p = .79). The cocaine-exposed children had 2.8 times greater risk of developing a LD by age 7 than non-cocaine-exposed children (95% CI = 1.05, 7.67; p = .038; IQ >/= 70 cutoff). Results remained stable with adjustment for multiple child and caregiver covariates, suggesting that children with prenatal cocaine exposure are at increased risk for developing a learning disability by age 7 when compared to their non-cocaine-exposed peers. Morrow, C., Culbertson, J., Accornero, V., Xue, L., Anthony, J., and Bandstra, E. Learning Disabilities and Intellectual Functioning in School-Aged Children with Prenatal Cocaine Exposure. Dev Neuropsychol, 30(3), pp. 905-931, 2006.

Examination of the Nicotine Metabolite Ratio in a Multiethnic/Multiracial Sample

The recent development of a noninvasive measure of nicotine metabolism, the nicotine metabolite ratio (trans-3 hydroxycotinine/cotinine), makes it possible to examine the association between rate of nicotine metabolism and smoking behavior in the general population. Dr. Denise Kandel and colleagues examined group differences in the ratio measured in urine and the association between the ratio and multiple measures of smoking behavior and nicotine dependence in a large, nationally representative sample of young adults. The sample included 900 daily smokers aged 18-26 years from wave III (2001-2002) of the National Longitudinal Survey of Adolescent Health. Nicotine dependence was measured by using the Fagerstroem Test for Nicotine Dependence. Females had higher nicotine metabolite ratios than males; Whites and Hispanics had higher nicotine metabolite ratios than African Americans or Asians. This finding is consistent with those from laboratory studies of older smokers based on intravenous infusion of nicotine. No significant association was found between the nicotine metabolite ratio and number of cigarettes smoked per day or nicotine dependence. The availability of a noninvasive measure makes possible systematic testing of causal hypotheses generated by laboratory studies in the general population. Kandel, D., Hu, M., Schaffran, C., Udry, J., and Benowitz, N. Urine Nicotine Metabolites and Smoking Behavior in a Multiracial/Multiethnic National Sample of Young Adults. Am J Epidemiol, 165(8), pp. 901-910, 2007.

Self-Control, Symptomatology, and Substance Use Precursors

The authors tested a theoretical model of how self-control constructs are related to psychological symptomatology and variables that predispose to involvement versus noninvolvement in substance use: willingness to use, affiliation with peers who use, and efficacy for resisting use. Data were obtained from a sample of 332 children (mean age = 9.3 years) who were interviewed in households. Structural equation modeling showed that good self-control was related to more positive well-being and less externalizing symptomatology, whereas poor self-control was related to more externalizing and to more internalizing symptomatology. Externalizing had paths to willingness and peer use, well-being had inverse paths to these variables, and poor self-control had a direct effect to lower resistance efficacy. Multiple-group analyses indicated gender differences in paths from symptomatology to predisposing factors. Implications for understanding vulnerability to substance use are discussed. Wills, T., Ainette, M., Mendoza, D., Gibbons, F., and Brody, G. Self-Control, Symptomatology, and Substance Use Precursors: Test of a Theoretical Model in a Community Sample of 9-year-old Children. Psychol Addict Behav, 21(2), pp. 205-215, 2007.

A Study of Latino Adolescent Health Behaviors and Weight in the United States of America

The authors examined, by gender, differences in being overweight among adolescents of Mexican, Puerto Rican, and other Latin American heritage who live in the United States of America, and investigated the relationships between these differences and socioeconomic status, health-related behaviors, and family characteristics. The study analyzed data from nationally representative samples of Latino 8th and 10th graders in the Monitoring the Future study from 1991 to 2004 (N = 11 265). Investigators found a higher proportion of Mexican-American girls were overweight than other Latin American girls, both before and after adjusting for many confounders. For both genders, being overweight was inversely associated with socioeconomic status and frequency of vigorous exercise, and positively associated with the amount of television viewing. No family characteristic variable examined was associated with overweight. Time spent exercising and time spent watching television are two potentially modifiable risk factors that, if targeted, may result in important reductions in overweight. The findings indicate the need to identify gender- and culturally-appropriate interventions that can increase physical activity and reduce sedentary activities among Latino adolescents, particularly in families of low socioeconomic status. Delva, J., O'Malley, P., and Johnston, L. Health-Related Behaviors and Overweight: A Study of Latino Adolescents in the United States of America. Rev Panam Salud Publica, 21(1), pp. 11-20, 2007.

Prevention Research

The Role of Gender and Acculturation on Drug-related Outcomes for "Keepin' it REAL" Prevention Program

This study examined whether the efficacy of the Keepin' it REAL school-based prevention program was moderated by gender, ethnicity, and acculturation. Data came from a randomized trial in Phoenix AZ middle schools involving 4622 mostly Latino 7th graders. Youth participated in the prevention program that involved 10 classroom lessons and 5 videos developed based on extensive input from youth. Previous research on the program has demonstrated its efficacy with regard to slowing initiation of drug use. In the current study, using multi-level mixed models, results for the total sample showed no gender differences in program effects on recent substance use. However, the program was more effective in fostering anti-drug norms among boys than among girls. Subgroup analyses indicated that there were more beneficial program effects for less acculturated boys than less acculturated girls. Specifically, there was less alcohol and cigarette use and stronger anti-drug norms post intervention for less acculturated boys in the intervention group than their female counterparts. It is notable that less acculturated Latino boys had higher baseline substance use rates and stronger pro-drug norms than less acculturated Latino girls, and the lower risk of use for less acculturated girls may have attenuated the potential for program effects. The results of this study, while generally verifying the efficacy of gender-inclusive prevention strategies, suggest that efforts may be strengthened by attending to the special risks and resilience of certain subgroups of female and male youth. Kulis, S., Yabiku, S.T., Marsiglia, F.F., Nieri, T., and Crossman, A. Differences By Gender, Ethnicity, and Acculturation in the Efficacy of the Keepin' it REAL Model Prevention Program. J Drug Educ, 37(2), pp. 123-144, 2007.

Effects of Iowa Strengthening Families Program on Internalizing Symptoms and Polysubstance Use in Adolescence

This study evaluated effects of the Iowa Strengthening Families Program, a family-focused universal preventive intervention, on growth patterns of adolescent internalizing (anxiety and depressive symptoms) and monthly polysubstance use (alcohol, tobacco, marijuana, inhalants, and other illicit drugs), as well as the association between internalizing and polysubstance growth factors. The sample consisted of rural Midwestern adolescents (N=383), followed from sixth through twelfth grade. Compared to the control group, the intervention group adolescents showed a slower rate of increase in internalizing symptoms and polysubstance use. Intervention effects on internalizing symptoms were similar for boys and girls; however, girls demonstrated a higher overall level and a greater rate of increase across time. The intervention slowed the rate of increase in polysubstance use significantly more for girls than for boys, although overall levels of use were lower in the intervention group for both genders. Associations between internalizing and polysubstance use growth factors were found for girls, but not for boys, suggesting gender differences in psychosocial development. Trudeau, L., Spoth, R., Randall, G.K., and Azevedo, K. Longitudinal Effects of a Universal Family-Focused Intervention on Growth Patterns of Adolescent Internalizing Symptoms and Polysubstance Use: Gender Comparisons. Journal of Youth and Adolescence, 36(6), pp. 725-740, 2007.

School-Level Influences on Discipline Referrals in First Grade

School discipline referrals (SDRs) may be useful in the early detection and monitoring of disruptive behavior problems to inform prevention efforts in the school setting, yet little is known about the nature and validity of SDRs in the early grades. For this descriptive study, SDR data were collected on a sample of first grade students who were at risk for developing disruptive behavior problems (n = 186) and a universal sample (n = 531) from 20 schools. Most SDRs were given for physical aggression and the predominant consequence was time out. As expected, boys and at-risk students were more likely to receive an SDR and to have more SDRs than were girls and the universal sample. A large difference between schools regarding the delivery of SDRs was found. A zero-inflated Poisson model clustered by school tested the prediction of school-level variables. Students in schools that had a systematic way of tracking SDRs were more likely to receive one. Also, schools with more low-income students and larger class sizes gave fewer SDRs. SDRs predicted teacher ratings, and to a lesser extent, parent ratings of disruptive behavior at the end of first grade. Thus, practitioners and researchers should examine school-level influences whenever first grade discipline referrals are used to measure problem behavior for the purpose of planning and evaluating interventions. Rusby, J.C., Taylor, T.K., and Foster, E.M. A Descriptive Study of School Discipline Referrals in First Grade. Psychol Sch, 44(4), pp. 333-350, 2007.

HIV Risk Reduction is Affected by Beliefs about HIV Treatment Efficacy

This study describes the sexual behavior of HIV-positive women within new versus more established relationships and determines whether beliefs about HIV antiretroviral therapy (ART) impact these behaviors. The Women's Interagency HIV Study is a longitudinal cohort study of HIV among women in the United States. Sexually active HIV-positive women (N = 1,090) completed interviews on beliefs and behaviors at 6-month intervals. Data were analyzed for the period between April 2002 and March 2003. Of 1,517 sexual partners reported, 32% were newly acquired within the previous 6 months. As compared with more established sexual relationships, newer partnerships were characterized by greater condom use consistency (odds ratio = 1.8, 95% confidence interval = 1.4-2.3). Holding beliefs that ART is protective for HIV transmission impacted the relationship between partner type and condom use. In established relationships, 63% reported consistent condom use if they believed that ART is not protective, whereas 54% reported consistent condom use if they believed that ART is protective. These findings highlight the importance of ongoing support for sexual risk reduction among women with HIV-infection and for strategies that reduce the strength of relationships between ART beliefs and sexual risk behavior. Wilson, T.E., Feldman, J., Vega, M.Y., Ghandi, M., Richardson, J., Cohen, M.H., McKaig, R., Ostrow, D., Robison, E., and Gange, S.J. Acquisition of New Sexual Partners Among Women With HIV Infection: Patterns of Disclosure and Sexual Behavior within New Partnerships. AIDS Educ Prev, 19(2), pp. 151-159, 2007.

Racial and Gender Differences in Adolescent Sexual Attitudes and Associations with Coital Debut

Delay of sexual debut is an important strategy in reducing the risk of negative adolescent health outcomes. Race and gender are known to be related to sexual behavior and outcomes, but little is known about how these characteristics affect sexual attitudes. This article examines differences in coital and pregnancy attitudes by gender and race, the influence of attitudes on transition to first coitus for each subgroup, and implications for prevention. Data are from Waves I and II of the National Longitudinal Study of Adolescent Health, limited to Non-Hispanic White and African American adolescents (n = 6652). The authors' factor analyzed attitude items, and examined effects of race, gender, and their interaction, controlling for sexual debut at Wave I. Next, sexual debut over time was predicted by attitudes for virgins (n = 3281) separately for each subgroup, controlling for covariates. Results showed that compared with boys, girls perceived less positive benefits from sex and more shame and guilt with sex, but had fewer negative perceptions about pregnancy. Compared with White boys, African American boys perceived less shame and guilt about sex; girls did not differ by race. Higher perceived benefits of sex increased the likelihood of sexual debut among African American girls. Perceived shame and guilt lowered the likelihood for White boys and girls. It was concluded that reinforcing protective attitudes through gender and race-specific programs may delay sexual intercourse, but more research is needed. Specifically, it will be important to examine whether there is an optimal coital age after which negative health outcomes are attenuated, and whether this differs by gender and race. Cuffee, J., Hallfors, D., and Waller, M. Racial and Gender Differences in Adolescent Sexual Attitudes and Longitudinal Associations with Coital Debut. J Adolesc Health, 41(1), pp. 19-26, 2007.

Mothers' Relational Schemas Predict Adolescent Antisocial Behavior

Relational schemas, as described and measured in this study, refer to automatic, unconscious response tendencies that reflect the nature of one's relationship to another person. In this research, these are measured through interpreting speech samples where a mother (biological, step, or adoptive) is describing her relationship with a target adolescent. These samples were assessed using the Family Affective Attitude Rating Scale for coding 5-minute speech samples. The internal consistency and validity of positive relational schema and negative relational schema scales were also evaluated. Data were collected from a multiethnic subsample of early-starting antisocial (n = 20) and successful (n = 20) urban adolescents and their families, using direct observations of parent-adolescent interactions, 5-minute speech samples, and questionnaires. The negative relational schema and positive relational schema scales were internally consistent, correlated reliably with critical and positive dimensions of 5-minute speech samples expressed emotion and with observed parent-adolescent interactions, and discriminated between antisocial and successful adolescents. The negative relational schema scale accounted for unique variance in adolescent antisocial behavior when controlling for previous problem behavior and observed coercion. A significant interaction was also found between negative relational schema rating and observed parent-adolescent dynamics when escalations in adolescent problem behavior were added to the model. Relational schema narratives provided unique information in the prediction of adolescent antisocial behavior and should be considered in the assessment of family dynamics and the design of interventions to prevent and treat adolescent behavior problems. Bullock, B., and Dishion, T. Family Processes and Adolescent Problem Behavior: Integrating Relationship Narratives Into Understanding Development and Change. J Am Acad Child Adolesc Psychiatry, 46(3), pp. 396-407, 2007.

Substance Use and Risk for Suicide

This study examined the association between onset of substance use and risk factors related to suicide. 1252 adolescents in two urban school districts completed surveys as part of a large, randomized controlled prevention effectiveness trial. Risk factors measured included depressive symptoms, suicide ideation, suicide ideation specifically with alcohol and/or drug use, endorsement of suicide as a personal option, and suicide attempt. Results from multivariate models controlling for current substance use and demographic characteristics indicated that earlier onset of hard drug use among boys was associated with all five suicide risk factors. In comparison, among girls, earlier onset of regular cigarette smoking, getting drunk, and hard drug use was associated with some suicide risk factors. The findings confirm the importance of screening for substance use in early adolescence. The association between early substance use and suicide risk factors differed by gender; both research and intervention efforts need to incorporate gender differences. Cho, H., Hallfors, D., and Iritani, B. Early Initiation of Substance Use and Subsequent Risk Factors Related to Suicide Among Urban High School Students. Addict Behav, 32(8), pp. 1628-1639, 2007.

Effects of Prenatal and Postnatal Parental Substance Use on Child Maltreatment

Parental substance use is a well-documented risk for children. However, little is known about specific effects of prenatal and postnatal substance use on child maltreatment and foster care placement transitions. In this study, the authors' unpacked unique effects of (a) prenatal and postnatal parental alcohol and drug use and (b) maternal and paternal substance use as predictors of child maltreatment and foster care placement transitions in a sample of 117 maltreated foster care children. Models were tested with structural equation path modeling. Results indicated that prenatal maternal alcohol use predicted child maltreatment and that combined prenatal maternal alcohol and drug use predicted foster care placement transitions. Prenatal maternal alcohol and drug use also predicted postnatal paternal alcohol and drug use, which in turn predicted foster care placement transitions. Findings highlight the potential integrative role that maternal and paternal substance use has on the risk for child maltreatment and foster care placement transitions. Smith, D., Johnson, A., Pears, K., Fisher, P., and DeGarmo, D. Child Maltreatment and Foster Care: Unpacking the Effects of Prenatal and Postnatal Parental Substance Use. Child Maltreat, 12(2), pp. 150-160, 2007.

Physical Environmental Influences on Early Externalizing Behaviors

Research on the development of externalizing behaviors during early childhood has focused on child and parenting factors. Fewer studies have investigated effects of aversive features of the micro-level physical environment, such as overcrowding and chaos in the home, and the macro-level environment, such as neighborhood quality. This study extends research on physical environmental factors by examining their association with children's early externalizing behaviors, and exploring how maternal monitoring may serve as a protective factor in such contexts. One hundred twenty male toddlers at high risk for developing early externalizing behaviors, participating in an ecologically-based family preventive intervention were followed from ages 2 to 5 years. Direct longitudinal associations were found for micro-level environmental factors beginning at age 2 and for neighborhood risk beginning at age 3. Maternal monitoring served as a protective factor for child externalizing behaviors in the context of neighborhood risk. Implications for prevention research and the development of early externalizing behaviors are discussed. Supplee, L.H., Unikel, E., and Shaw, D.S. Physical Environmental Adversity and the Protective Role of Maternal Monitoring in Relation to Early Child Conduct Problems. Journal of Applied Developmental Psychology, 28(2), pp. 166-183, 2007.

Ethnic Identity as a Predictor of Substance Use Norms and Behaviors

This paper explores whether ethnicity and three ethnic identity instruments are useful in predicting substance use outcomes among three samples of ethnically diverse middle school youth. Participants were 7th and 8th grade youth attending a multiethnic school in an urban low-income community who were subsampled from participants in a larger prevention research study. More than half of the participants in the research were of Hispanic origin. Results suggest that age, gender, and/or racial/ethnic group membership influenced the strength of ethnic identity. In addition, age, sex, and strength of ethnic identity influenced substance use norms and behaviors. In each case where effects were significant, a stronger sense of ethnic identity as measured by two of the instruments predicted more negative attitudes toward and less use of alcohol, cigarettes, and marijuana. Holley, L.C., Kulis, S., Marsiglia, F.F., and Keith, V.M. Ethnicity Versus Ethnic Identity: What Predicts Substance Use Norms and Behaviors. Journal of Social Work Practice in the Addictions, 6(3), pp. 53-79, 2006.

Quality of Parent-Child Interaction Predicts Child Problem Behaviors

This article reports on two exploratory studies where the hypothesis is tested that there will be an inverse relationship between the quality of parent-child interactions and adolescent problem behaviors. Study 1 involves survey data from Midwestern parents of boys (n=377) and girls (335) between the ages of 11 and 13 years. Study 2, conducted to replicate the findings of Study 1, was similarly constructed with parents of boys (n=279) and girls (n=269). The quality of parent child interactions latent construct was formed from indicators of effective child management and parent-child affective quality, both self-reported by parents. Child problem behaviors were assessed with indicator measures of aggressive and oppositional behavior, school-related problems, and problematic peer relations. Multisample latent variable structural equation modeling confirms that a higher level of parent-child interaction quality was associated with a lower level of problem behaviors. This relationship was significant for parent-reported behavior, for both boys and girls, in both Study 1 and Study 2. The amount of variance explained indicated a moderate relationship between these variables and is consistent with earlier studies indicating that parent-child interaction quality is associated with problem behaviors among rural dwelling early adolescents. Spoth, R., Neppl, T., Goldberg-Lillehoj, C., Jung, T., and Ramisetty-Mikler, S. Gender-Related Quality of Parent-Child Interactions and Early Adolescent Problem Behaviors: Exploratory Study with Midwestern Samples. Journal of Family Issues, 27(6), pp. 826-849, 2006.

Cross-sectional Study of Female Students Reporting Anabolic Steroid Use

The objective of this article was to determine the characteristics of female US high school students reporting anabolic steroid use. This paper reports findings from cross-sectional assessments collected as part of the 2003 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey database. The data come from a nationally representative sample of US high schools, and the focus was on Female students in grades 9 through 12 (n = 7544). Participants' self-reported anabolic steroid use was compared with other health-related behaviors and with sports participation. Prior or ongoing anabolic steroid use was reported by 5.3% of female high school students. Those adolescent girls had a marked increase in other health-compromising behaviors, including past 30-day use of alcohol (odds ratio [OR], 8.83; 95% confidence interval [CI], 5.49-14.20]), cigarettes (OR, 5.14; 95% CI, 3.14-8.42), marijuana (OR, 7.91; 95% CI, 5.20-12.04), cocaine (OR, 10.78; 95% CI, 6.18-18.81), and diet pills (OR, 4.86; 95% CI, 2.98-7.93). They were more likely to carry a weapon (OR, 7.54; 95% CI, 4.83-11.76), have had sexual intercourse before age 13 years (OR, 2.90; 95% CI, 1.58-5.33), and have had feelings of sadness or hopelessness almost every day for at least 2 consecutive weeks (OR, 4.13; 95% CI, 2.57-7.22). They were less likely to play school-sponsored team sports (OR, 0.52; 95% CI 0.34-0.80). Steroid users participating in sports shared the same problem behaviors as steroid users not participating in team athletics. Self-reported anabolic steroid use is not confined to adolescent girls in competitive athletics and is an indicator of adolescent girls with a marked increase in a cluster of other health-harming behaviors. Elliot, D.L., Cheong, J., Moe, E.L., and Goldberg, L. Cross-Sectional Study of Female Students Reporting Anabolic Steroid Use. Arch Pediatr Adolesc Med, 161(6), pp. 572-577, 2007.

A Review of Research on Caretaking of Children of Incarcerated Parents

This paper reviews the literature for research findings on caretaking-related problems associated with the absence of parents from the home following incarceration. It focuses on the impact of incarceration on the welfare and adjustment of urban African American children and on the assumption of caretaking responsibilities by other caretakers, principally maternal grandmothers. Noting the complex situational difficulties involved and the potential burdens associated with surrogate parenting in general, and with this population in particular, the service-provider implications of this parenting arrangement are considered in this review. Findings indicate that problems associated with incarceration of parents tend to be intergenerational and vary considerably in complexity and severity. To the extent that they impact the children involved, these issues should be addressed in coordinated service delivery focusing on prevention. Hanlon, T.E., Carswell, S.B., and Rose, M. Research on the Caretaking of Children of Incarcerated Parents: Findings and Their Service Delivery Implications. Children and Youth Services Review, 29(3), pp. 348-362, 2007.

The Role of Delinquency and Depressed Mood in Late Adolescent Substance Use

This study examines the extent to which delinquency and depressed mood, measured at ages 11, 12, 13, 14, and 16, predict problem substance use at age 18. This study also examines mediation of these effects through alcohol use at age 16 across gender. Participants were 429 rural youths (222 girls and 207 boys) and their families who participated in Project Family, a prevention research study. Problem substance use was defined through both youth and parent responses to survey items reflecting problems with alcohol and drug use. Both delinquency and depressed mood appeared to play a role in the development of problem substance use, but their effects may be moderated by gender and may vary throughout adolescence. Indirect positive effects of delinquency on problem substance use were observed for boys, while direct positive effects of depressed mood were observed for girls. These findings have potential implications for specific targets of early prevention and how these may differ for boys and girls. Mason, W., Hitchings, J., and Spoth, R. Emergence of Delinquency and Depressed Mood throughout Adolescence as Predictors of Late Adolescent Problem Substance Use. Psychol Addict Behav, 21(1), pp. 13-24, 2007.

Research on Behavioral & Combined Treatments for Drug Abuse Delay Discounting Predicts Postpartum Relapse to Cigarette Smoking Among Pregnant Women

Investigators conducted this study to examine whether delay discounting (DD), a measure of impulsivity, predicts treatment outcome among cigarette smokers. More specifically, the authors examined whether baseline discounting for hypothetical monetary rewards predicted smoking status at 24 weeks postpartum among women who discontinued smoking during pregnancy. Participants were 48 pregnant women who participated in a clinical trial examining the use of incentives to prevent postpartum relapse. Several sociodemographic characteristics (being younger, being less educated, and reporting a history of depression) assessed at study entry were associated with increased baseline DD, but in multivariate analyses only DD predicted smoking status at 24 weeks postpartum. Greater baseline DD was a significant predictor of smoking status at 24 weeks postpartum. DD was reassessed periodically throughout the study and did not significantly change over time among those who eventually resumed smoking or those who sustained abstinence. The results extend the association of DD with risk for substance abuse to pregnant and recently postpartum cigarette smokers and demonstrate a significant relationship between DD and treatment outcome. Yoon, J.H., Higgins, S.T., Sugerbaker, R.J., Thomas, C.S., and Badger, G.J. Delay Discounting Predicts Postpartum Relapse to Cigarette Smoking Among Pregnant Women. Experimental and Clinical Psychopharmacology, 15 (2), pp. 176-186, 2007.

If Substance Abuse Is a Chronic, Relapsing Condition, Substance Abuse Treatment May Need to Be Chronic and Addressing Relapse Too

Drs. Suniya Luthar of Columbia University, Nancy Suchman of Yale University, and Michelle Altomare published the results of a randomized clinical trial testing Relational Psychotherapy Mothers' Group (RPMG) for substance-abusing, methadone-maintained mothers with young children. A total of 60 mothers participated in RPMG and 67 participated in recovery training (RT). At 6 months after starting treatment, women in the RPMG group showed greater improvements in child maltreatment and cocaine abuse, and children of women in RPMG reported greater improvements in emotional adjustment than did other children. However, these treatment gains were not sustained once treatment was discontinued. These results lend support to the notion of substance abuse as a chronic, relapsing condition that may best be treated by ongoing monitoring and intervention. Luthar, S.S., Suchman, N.E., and Altomare, M. Relational Psychotherapy Mother's Group: A Randomized Clinical Trial for Substance Abusing Mothers. Development and Psychopathology, 19, pp. 243-261, 2007.

Research on Pharmacotherapies for Drug Abuse

Women and Men Do Not Appear to Differ in Response to the Discriminative-Stimulus Effects of d-Amphetamine

The results of animal and human laboratory studies are mixed regarding gender differences in response to stimulant drugs. This study performed a retrospective analysis of six studies conducted by this team that used identical procedures and methods. Thirteen women and 14 men learned to discriminate 15 mg of oral d-amphetamine, then the effects of a range of doses of d-amphetamine (0, 2.5, 5, 10, and 15 mg) alone and in combination with other drugs, were assessed. In these studies, d-amphetamine functioned as a discriminative stimulus and dose-dependently increased drug-appropriate responding. Women and men did not differ in their ability to discriminate d-amphetamine, but differed on participant-ratings of high (women < men), nausea (women > men) and sluggish (women < men); women also experienced greater increases in diastolic pressure than men following the administration of higher d-amphetamine doses (10 and 15 mg). Changes in menstrual cycle and hormone levels were not evaluated in the current study. Because the study results may have been confounded by the training procedures, future research should use other behavioral arrangements (e.g. drug self-administration) to determine if women and men respond differently to the effects of d-amphetamine. Vansickel, A.R., Lile, J.A., Stoops, W.W., and Rush, C.R. Similar Discriminative-Stimulus Effects of d-Amphetamine in Women and Men. Pharmacology, Biochemistry and Behavior, 87, pp. 289-296, 2007.

Biochemical and Virologic Parameters in Patients Co-infected with Hepatitis C and HIV Versus Patients with Hepatitis C Mono-infection

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

Sexual and Other Noninjection Risks for HBV and HCV Seroconversions among Noninjecting Heroin Users

Many heroin users do not inject drugs but may still be at risk of infection with Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV), via sexual or other non-injection related activity. Non-injecting heroin users (NIUs) in New York City who were recruited and prospectively followed during March 1996-February 2003 were tested for anti-HIV, anti-hepatitis B core antigen, and anti-HCV and were interviewed about their sexual and other non-injecting risk. A seroconversion is represented by the first positive test result after the last negative test result. Hazard ratios (HRs) (P<.05) were estimated by use of Cox proportional hazards regression. Of 253 HIV-negative participants, 2 seroconverted (0.29/100 person-years at risk [pyar]); of 184 HBV-negative participants, 16 (3.3/100 pyar); and, of 219 HCV-negative participants, 16 (2.7/100 pyar). Independent predictors of seroconversion were, for HBV, being a female who engages in unprotected receptive anal sex (HR, 6.8), having short-term sex partners (HR, 6.2), and being a male with male sex partners (HR, 5.7); for HCV, being a male who receives money/drugs for sex (HR, 5.6) and sharing non-injecting crack-use equipment (HR, 4.5). These findings suggest that NIUs are at considerable risk of HBV infection via high-risk sex; and, for HCV, via high-risk sexual activity and the sharing of non-injecting crack-use equipment. Interventions for NIUs should seek to reduce high-risk sexual activity and the sharing of non-injecting drug-use equipment. Neaigus, A., Gyarmathy, V., Zhao, M., Miller, M., Friedman, S., and Des Jarlais, D. Sexual and Other Non-injection Risks for HBV and HCV Seroconversions among Non-injecting Heroin Users. J Infect Dis, 195(7), pp. 1052-1061, 2007.

HIV Risk Behaviors among Rural Stimulant Users: Variation by Gender and Race/Ethnicity

Data were examined from a community sample of rural stimulant users (n = 691) in three diverse states to identify gender and racial/ethnic differences in HIV risk behaviors. Bivariate and logistic regression analyses were conducted with six risk behaviors as dependent variables: injecting drugs, trading sex to obtain money or drugs, trading money or drugs to obtain sex, inconsistent condom use, multiple sex partners, and using drugs with sex. Controlling for state, income, age, heavy drinking, and type of stimulant used, men had lower odds than women for trading sex to obtain money or drugs (adjusted odds ratio [AOR] =0.4, confidence interval [CI] = 0.28-0.59; p < .0001), greater odds than women for trading money or drugs to obtain sex (AOR = 44.4, CI = 20.30-97.09; p < .0001), greater odds than women of injecting drugs (adjusted odds ratio (AOR =1.6, CI = 1.11-2.42; p = .01), and lower odds than women of using condoms inconsistently (AOR = 0.6, CI = 0.35-0.92; p = .02); African Americans had lower odds than Whites of injecting drugs (AOR = .08, CI = 0.04-0.16; p < .0001), greater odds than Whites for trading sex to obtain money or drugs (AOR = 1.7, CI = 1.01-2.85; p = .04) and for trading money or drugs to obtain sex (AOR = 2.9,CI = 1.53-5.59; p = .001), and greater odds than Whites of using drugs with sex (AOR = 3.9, CI = 1.47-10.09; p = .006). These findings indicate HIV prevention efforts should be tailored to address gender and racial/ethnic differences in risk behaviors among rural stimulant users. Booth, B.M., Wright, P.B., Stewart, K.E., Fischer, E.P., Carlson, R.G., Falck, R., Wang, J., and Leukefeld, C.G. HIV Risk Behaviors Among Rural Stimulant Users: Variation by Gender and Race/Ethnicity. AIDS Educ Prev, 12(2), pp. 137-150, 2007.

Effects of Pregnancy on Nicotine Self-administration and Nicotine Pharmacokinetics in Rats

Dr. Pentel's group at Minneapolis Medical Research Foundation developed an animal model of smoking during pregnancy by initially characterizing nicotine self-administration (NSA) in pregnant rats. In addition, they also began to explore the effects of pregnancy on nicotine pharmacokinetics in rats. NSA decreased over the course of pregnancy with NSA significantly lower in the third trimester compared to nonpregnant controls. NSA remained suppressed for up to 10 days into lactation. Locomotor behavior was also significantly suppressed during the second and third trimesters and throughout lactation. Nicotine elimination was slower in pregnant females compared to nonpregnant females only in the third trimester. In conclusion, NSA, locomotor behavior, and nicotine elimination in rats are decreased during late pregnancy. The present study is the first to characterize NSA during pregnancy in animals, providing a potential model of maternal smoking in humans. Lesage, M.G., Keyler, D.E., Burroughs, D., and Pentel, P.R. Effects of Pregnancy on Nicotine Self-administration and Nicotine Pharmacokinetics in Rats. Psychopharmacology (Berl), July 7, 2007 [Epub ahead of print].

Maternal Separation Alters Drug Intake Patterns in Adulthood in Rats

Dr. Kuhar's group at Emory University, Atlanta, Georgia, examined the effects of maternal separation and drug intake patterns in adulthood in rats. Maternal separation/handling (MS/H) is an animal model of early life stress that causes profound neurochemical and behavioral alterations in pups that persist into adulthood. Many recent studies have used the MS/H model to study changes in drug effects in adulthood that are linked to behavioral treatments and stressors in the perinatal period. The drug effects focused on in this review are the reinforcing properties of the abused drugs, cocaine and alcohol. A striking finding is that variations in maternal separation and handling cause changes in ethanol and cocaine self-administration. Further, these changes indicate that various manipulations in the perinatal period can have long lasting effects of interest to biochemical pharmacologists. This article reviewed recent studies on ethanol and cocaine self-administration using the MS/H model and the neurochemical alterations that may play a role in the effects of MS/H on ethanol and cocaine self-administration. Studying the MS/H model can provide important clues into the vulnerability to drug abuse and perhaps identify a crucial window of opportunity for therapeutic intervention. Moffett, M.C., Vicentic, A., Kozel, M., Plotsky, P., Francis, D.D. and Kuhar, M.J. Maternal Separation Alters Drug Intake Patterns in Adulthood in Rats. Biochem Pharmacology, 73(3), pp. 321-330, 2007.

Services Research

Smoking Cessation via the Internet: a Randomized Clinical Trial of an Internet Intervention as Adjuvant Treatment in a Smoking Cessation Intervention

Internet interventions for smoking cessation are ubiquitous. Yet, to date, there are few randomized clinical trials that gauge their efficacy. To address this question, the authors performed a randomized clinical trial (N= 284, n= 140 in the treatment group, n= 144 in the control group) of an Internet smoking cessation intervention. Smokers were randomly assigned to receive either bupropion plus counseling alone, or bupropion and counseling in addition to 12 weeks of access to the Comprehensive Health Enhancement Support System for Smoking Cessation and Relapse Prevention (CHESS SCRP; a Web site which provided information on smoking cessation as well as support). It was found that access to CHESS SCRP was not significantly related to abstinence at the end of the treatment period (OR= 1.13, 95% CI 0.66-2.62) or at 6 months post quit (OR= 1.48, 95% CI 0.66-2.62). However, the number of times participants used CHESS SCRP per week was related to abstinence at both ends of treatment (OR= 1.79, 95% CI 1.25-2.56) and at the 6-month follow-up (OR= 1.59, 95% CI 1.06-2.38). Participants with access to CHESS SCRP logged in an average of 33.64 times (SD=30.76) over the 90-day period of access. Rates of CHESS SCRP use did not differ by ethnicity, level of education or gender (all p>.05). In sum, results suggest that participants used CHESS SCRP frequently and that CHESS SCRP use was related to success in smoking cessation. Japuntich, S., Zehner, M., Smith, S., Jorenby, D., Valdez, J., Fiore, M., Baker, T., and Gustafson, D. Smoking Cessation via the Internet: a Randomized Clinical Trial of an Internet Intervention as Adjuvant Treatment in a Smoking Cessation Intervention. Nicotine Tob Res, 8 Suppl 1, pp. S59-S67, 2006.

Organizational, but Not Client, Factors Associated with Substance Abuse Treatment Cost

This study uses data from the Alcohol and Drug Services Survey (ADSS) to estimate the statistical associations between organizational and client characteristics on per client and per day costs of outpatient substance abuse treatment. Variables examined include facility ownership, average length of stay, and visits per enrollment day, and client characteristics such as gender, age, and primary drug of abuse. The authors found several organizational characteristics were statistically significant in the model estimating cost per episode, including log of point prevalence client count (-0.53, p<.01), log of average length of stay (0.73, p<.01), log of visits per enrollment day (0.45, p<.01), log of labor cost index (0.50, p<.01), proportion of counselor time spent in direct counseling (-0.52, p<.01), and location outside a metropolitan area (-0.19. p<.05). None of the client variables are statistically significant in this model. These findings suggest there exists increasing returns to scale in outpatient substance abuse treatment indicating that mergers of substance abuse treatment programs may be economically beneficial. Beaston-Blaakman, A., Shepard, D., Horgan, C., and Ritter, G. Organizational and Client Determinants of Cost in Outpatient Substance Abuse Treatment. J Ment Health Policy Econ, 10(1), pp. 3-13, 2007.

Clinical Trials Network Research

AIDS Research in the NIDA Clinical Trials Network: Emerging Results

Prevention and treatment of HIV/AIDS among drug users continue to be vexing problems. Scientifically validated interventions have been developed to prevent and treat HIV/AIDS among substance users. The Clinical Trials Network (CTN) of the National Institute on Drug Abuse (NIDA) is conducting multi-site clinical trials, with emerging results that address both prevention and treatment of HIV/AIDS. This is a report of preliminary results from several of those trials, presented at a workshop of the College on Problems of Drug Dependence. Lawrence Brown surveyed over 120 CTN clinics and reports on the state of the clinics in treating HIV/AIDS and other infectious diseases. Robert Booth summarized preliminary data from over 600 participants in a multi-site trial of HIV and hepatitis C virus (HCV) interventions in drug detoxification settings. Donald Calsyn reported preliminary results from an effectiveness trial of a gender-specific, action-oriented, safer-sex group intervention for 575 men in drug treatment programs. Susan Tross reported on a similar study focusing on 515 women in 12 clinics. Yong Song presented the perspective of treatment programs in conducting clinical trials. Jacques Normand added comments from the perspective of the Director of the NIDA AIDS research program. Sorensen, J.L., Brown, L., Calsyn, D., Tross, S., Booth, R.E., Song, Y., and Normand, J. AIDS Research in the NIDA Clinical Trials Network: Emerging Results. News & Views Section Drug Alcohol Depend. 89(2-3), pp. 310-313, 2007.

International Research

Former NIDA INVEST Drug Abuse Research Fellows

Drug Use Opportunities and the Transition to Drug Use among Adolescents from the Mexico City Metropolitan Area

Benjet, C., Borges, G., Medina-Mora, M.E., Blanco, J., Zambrano, J., Orozco, R., Fleiz, C., Rojas, E. Drug Alcohol Depend. 2007 Mar 21; [Epub ahead of print]
INVEST Fellow: Guilherme Borges, Mexico, 1997-1998
The earliest stage of drug involvement is being presented with the opportunity to use drugs. During adolescence these opportunities increase. Because of the scarcity of data for the Mexican population, the aim is to estimate the prevalence of drug use opportunities among Mexican adolescents, the prevalence of drug use among those who were presented with the opportunity, and the socio-demographic correlates of both. A multistage probability survey was carried out among 12-17 year olds from Mexico City. Adolescents were administered the adolescent version of the World Mental Health Composite International Diagnostic Interview. The response rate was 71% (n=3005). Descriptive and logistic regression analyses were performed considering the multistage and weighted sample design. Twenty-nine percent have had the opportunity to try illicit drugs; of those presented with an opportunity, 18% have done so. Males, older adolescents, school drop-outs, and those whose parent has had drug problems are more likely to have been exposed to drug use opportunities while more religious adolescents are less likely. Given the chance to try drugs, older adolescents and school drop-outs are more likely to do so and those with high parental monitoring and religiosity are less likely. These results suggest that less substance use among females in Mexico may be due in part to fewer opportunities to use since females were equally likely to use drugs given the opportunity. Given the increase in opportunity among older adolescents, preventive efforts should start by age 12 and with special attention to adolescents who have dropped out of school. PMID: 17382489 [PubMed - as supplied by publisher]

Prophylactic Role for Complementary and Alternative Medicine in Perinatal Programming of Adult Health

Hodgson, D.M., Nakamura, T., and Walker, A.K. Forsch Komplementarmed. Apr;14(2), pp. :92-101, 2007. Epub 2007 Apr 23.
INVEST Fellow: Tamo Nakamura, Australia, 2002-2003
The health status of an individual in adulthood is proposed to be determined by events occurring in the prenatal and early postnatal period. A common early life event proven to have long lasting effects on the developing fetus is stress, including pain. Exposure of fetal and neonatal infants to repetitive psychological (e.g., maternal stress) or physiological (e.g., pain, infection, and noise) stress during this period is proposed to alter mechanisms involved in the regulation of stress, immunological maturation, pain perception, and cognition. Such changes, which persist into adulthood, may occur via alterations in the development of the hypothalamic-pituitary-adrenal (HPA) axis. This process is typically referred to as 'perinatal programming'. Ontogenic alterations in the development of the HPA-axis have been related to a number of adult pathologies such as cardiovascular disease, type 2 diabetes, asthma, as well as psychopathologies such as anxiety and depression. In this review, the effectiveness of complementary and alternative medicine (CAM), such as music, dietary supplements, massage and aromatherapy, in reducing perinatal stress in mothers and infants is examined. An emphasis is placed on these therapies as preventative measures which may be of value to individuals at risk of developing disease profiles associated with the consequences of adverse perinatal programming. The widening interest in perinatal programming and CAM suggests the potential for CAM to become a valuable tool in offsetting negative adult health outcomes resulting from perinatal programming associated with adverse gestational early life environments.

Parenting Interventions for Drug-Dependent Mothers and Their Young Children: The Case for an Attachment-Based Approach

Suchman, N., Pajulo, M., Decoste, C., and Mayes, L. Fam Relat. Apr; 55(2), pp. 211-226, 2006.
INVEST Fellow: Marjaterttu Pajulo, Finland, 2003-2004
Maternal substance abuse is the most common factor involved when children come to the attention of the child welfare system. Although there is a clear need for clinical trials to evaluate parenting interventions for drug-dependent women, few studies to date have systematically examined the efficacy of interventions for this population. The authors first review six published reports of outpatient interventions that aimed to enhance the caregiving skills of substance-abusing mothers caring for children between birth and 5 years of age. After discussing implications of these preliminary studies, they then describe an attachment-based intervention that addresses these implications and has demonstrated preliminary feasibility in a pilot trial.

Body Mass Index and the Prevalence of Metabolic Syndrome among Children and Adolescents in Two Mexican Populations

Halley Castillo, E., Borges, G., Talavera, J.O., Orozco, R., Vargas-Alemanm C., Huitron-Bravom G., Diaz-Montiel, J.C., Castanon, S., and Salmeron, J. J Adolesc Health. Jun; 40(6), pp. 521-526, 2007. Epub 2007 Mar 21, 2007.
INVEST Fellow: Guilherme Borges, Mexico, 1997-1998
The purpose of this study was to report the prevalence of metabolic syndrome (MS) among children and adolescents living in central Mexico, and its association with body mass index (BMI). In a sample of 1366 subjects from 7 to 24-years-old, a self-administered questionnaire was used to determined demographic characteristics. The definition of pediatric MS was determined using analogous criteria to Adult Treatment Panel III (ATPIII) as > or = 3 of the following: concentration of triglycerides > or = 100 mg/dL, HDL cholesterol < 45 mg/dL for males and < 50 mg/dL for females, waist circumference > or = 75th percentile (sex specific), glucose concentration > or = 110 to < 126 mg/dL, and systolic or diastolic blood pressure > or = 90th percentile (age, height, and sex specific). Most of the sample was in the 10-14- (32.4%) and the 15-19-year (35.4%) age groups, mostly females (57%), and 31% of this young sample was overweight (mean BMI = 21.6 kg/m2). About 1 in every 5 participants had full criteria for MS (19.2%, 95% confidence interval [CI]: 16.4-22.1 among females, and 20.2%, 95% CI: 17.1-23.7 among males), and only 1 in every 10 was free of any MS component. The most common component was a low HDL level, observed in 85.4% of the sample. Unfavorable fat distribution, as indicated by a large waist circumference, was present in 27.9% of the sample. About 66% of those 10-14-year-olds with a large BMI were positive for MS. MS and overweight are major problems for youth in Mexico. Immediate and comprehensive actions at home and schools are needed if Mexico wants to avoid the heavy burden that this disorder will have for its population in the near future.

Former HHH Drug Abuse Research Fellows

Brazilian Female Crack Users Show Elevated Serum Aluminum Levels

Pechansky, F., Kessler, F.H., Diemen, L., Bumaguin, D.B., Surratt, H.L., and Inciardi, J.A. Rev Bras Psiquiatr. Mar; 29(1), pp. 39-42, 2007.
HHH Fellow: Flavio Pechansky, Brazil, 1993-1994
There is no information in the literature on the impact of crack smoking using crushed aluminum cans as makeshift pipes, a common form of crack use in Brazil. Since aluminum intake is associated with neurological damage, the authors measured serum aluminum levels in crack smokers. The objective of this study was to ascertain the levels of aluminum in crack users who smoke on makeshift aluminum pipes. 71 female crack smokers, their mean age being 28.0 (+/- 7.7), provided information about their drug use, and had blood samples tested for serum aluminum level. 56 (79%) subjects smoked crack from crushed can pipes, while 15 (21%) smoked from other containers. Fifty-two (73.2%) out of the 71 subjects presented a serum aluminum level of 2 microg/l and 13 (18.3%) had a serum aluminum level of 6 microg/l cut-off point, which is above the reference value. When compared to non-drug users matched by their mean age and gender, they had similar median values and interquartile ranges for serum aluminum level [3 (2-4.6) for crack smokers; 2.9 (1.6-4.1) for controls], but with different means and standard deviations (4.7 +/- 4.9 and 2.9 +/- 1.7, respectively). Crack smokers have high serum aluminum level, but the authors are unsure of its complete association with aluminum cans. Further studies are needed. If such association is proven true in future research, further issues will be raised in dealing with this important disorder, including proper planning and evaluation of public health policies in this area.

Drug Consumption among Sexual Offenders against Females

Baltieri, D.A., and de Andrade, A.G. Int J Offender Ther Comp Criminol. 2007 Jul 5; [Epub ahead of print].
HHH Fellow: Arthur Guerra de Andrade, Brazil, 1991-1992
This article aims to evaluate the role of drug consumption among sexual offenders against females. Three groups of participants (N =133) comprising sexual offenders against girls, pubertal females, and women were examined with reference to history of drug and/or alcohol use, impulsivity level, sexual addiction, and recidivism risk. Sexual offenders against women were found to have significantly more difficulties with drug use, higher impulsivity level, and to be younger than the sexual offenders against girls and pubertal females. The combination of drug consumption and higher level of impulsivity may contribute to sexual aggression against adult females.

Alcohol and Drug Consumption Among Sexual Offenders

Baltieri, D.A., and de Andrade, A.G. Forensic Sci Int. 2007 Jun 12; [Epub ahead of print]
HHH Fellow: Arthur Guerra de Andrade, Brazil, 1991-1992
The purpose of this study was to evaluate the role of alcohol and drug consumption between sexual offenders against boys and girls. It was an observational, retrospective and cross-sectional study carried out by the Ambulatory for the treatment of sexual disorders of ABC Medical College, Santo Andre, Sao Paulo, Brazil (ABSex). The sample comprised 104 convicts, over 18 years old, sentenced only for sexual crimes against children (below 11 years old). Alcohol and drug consumption, sexual abuse history, sexual impulsivity, and risk of recidivism were evaluated. The sexual offenders against boys showed higher alcohol consumption problems than sexual offenders against girls (chi(2)=19.76, 1d.f., p<0.01). The severity of alcohol consumption was also significantly higher in the sexual offenders against non-related boys than in the sexual offenders against non-related girls (p=0.037, ANOVA). After adjustment for other variables, such as monthly income before the penalty and alcohol consumption at the moment of the crime, the alcohol consumption severity in sexual offenders against boys was significantly higher than in sexual offenders against girls (OR=1.05, CI 1.01-1.08, p<0.01). Alcohol use or abuse is associated with the perpetration of sexual aggression. The role of alcohol consumption seems to be greater in sexual offenders against boys than in girls and this can contribute to criminal recidivism.