 |
National Institute on Drug Abuse
Women and Sex/Gender Differences Research
Director's Report to Council
Research Findings Excerpts
May, 2003
|
 |
|
Behavioral Research |
Gonadectomy Has Opposite Effects on the Antinociceptive Effects of Opioids in Male and Female Rats
Greater sensitivity of males than females to the antinociceptive effects of mu opioids has been reported from clinical research, and is paralleled by findings from animal research with non-human primates and rodents. The basis for this sex difference is not fully accounted for by either pharmacokinetic factors, mu opioid binding affinity or receptor density. In an effort to examine the role of gonadal hormones, researchers at the University of North Carolina at Chapel Hill directly manipulated hormone levels via gonadectomy in F344 rats, which typically display relatively large sex differences in opioid antinociception, and in Sprague Dawley rats, which typically exhibit small differences. Given evidence that the magnitude of sex difference in opioid nociception is inversely related to the relative effectiveness of the opioid, the researchers examined the effects of both high-efficacy mu opioids (morphine and etorphine) and low-efficacy mu opioids (buprenorphine and dezocine) as well as mixed-action opioids with low efficacy at both mu and kappa opioid receptors (butorphanol and nalbuphine). Consistent with prior research, the researchers found greater opioid antinociception in intact males than intact females, with larger sex differences occurring with the less-effective opioids and in the F344 strain. In both strains, gonadectomy resulted in a decrease in opioid antinociception in males and an increase in females. The smallest effects were seen with high efficacy mu opioids, i.e., the magnitude of the decrease in males and the increase in females was inversely related to the relative effectiveness of the opioid. NIDA-grantee Theodore Cicero and colleagues (Cicero et al., 2002; February 2003 Directors Report) have shown that shortly after birth gonadectomy in males decreases morphines antinociception effect, while in females the combination of gonadectomy-plus-testosterone increases morphines antinociception effect -- reflecting the organizational effects of sex hormones in the early development of the rat brain. Taken together, these studies provide evidence that sex differences in opioid antinociception are due in part to the dual role played by gonadal hormones in sexual differentiation of the brain and in the acute response to opioids in adulthood. Terner, J.M., Barrett, A.C., Grossell, E., and Picker, M.J. Influence of Gonadectomy on the Antinociceptive Effects of Opioids in Male and Female Rats. Psychopharmacology, 163, pp.183-193, 2002.
Differential Subjective Effects of D-amphetamine by Gender, Hormone Level and Menstrual Cycle Phase
Prior research by Dr. Harriet de Wit and colleagues at the University of Chicago has shown that women report higher positive subjective effects of d-amphetamine in the follicular phase of the menstrual cycle when estrogen levels are high relative to progesterone than in the luteal phase when both hormones are high. She has also shown that exogenous administration of progesterone can produce moderate decreases in mood states. Thus, to further understand the role of estrogen and progesterone in producing the menstrual cycle modulation of the subjective effects of amphetamine and to examine possible sex differences, Dr. de Wit and her colleagues compared the subjective responses to d-amphetamine in males and females and also examined in women the correlation between these responses and endogenous levels of estrogen and progesterone during the follicular phase. Consistent with her prior study, the positive subjective responses, e.g. euphoria, feeling high, and wanting more drug, were higher in the follicular phase than the luteal. Further, subjective responses of women during the follicular phase did not differ from men, but were lower than men during the luteal phase. In the follicular phase, these stimulant effects were inversely related to salivary levels of progesterone, but were only weakly positively correlated with salivary estradiol. These data point to the role of the menstrual cycle in understanding sex differences in the subjective response to d-amphetamine and point to the role of progesterone in understanding variations in amphetamine responsivity among women. These findings have important implications for understanding the role the menstrual cycle in the use and escalation of d-amphetamine abuse as well as its role in treatment. White, T.L., Justice, A.J., and de Wit, Harriet. Differential Subjective Effects of D-amphetamine by Gender, Hormone Level and Menstrual Cycle Phase. Pharmacology, Biochemistry and Behavior, 73, pp. 729-741, 2002.
Influence of Estrus Cycle and Estradiol on Behavioral Sensitization to Cocaine in Female Rats
Several studies have shown that sensitization of locomotor response to cocaine and amphetamine is greater in females that males. Prior research by Dr. Kathryn Cunningham and colleagues at the University of Texas Medical Branch has shown that the acute locomotor response to cocaine in female rats is highest during proestrus when estrogen levels are highest. In a recent study, she examined the role of the estrus cycle in cocaine sensitization of the locomotor response. Following 5 days of twice daily injections of cocaine or saline and a three-day withdrawal period, the expression of locomotor sensitization was assessed via a challenge injection of cocaine. Compared to the saline group, sensitization of the locomotor response in the cocaine group was observed only in the diestrus phase when estrogen levels are lowest. In a second study, the researchers examined whether the presence or absence of estradiol would affect the development and expression of cocaine-induced locomotor sensitization. An ovariectomized group and an ovariectomized group given estradiol replacement were each given twice daily injections of cocaine for five days, and then were given a challenge injection of cocaine 3, 13, and 34 days after this treatment. During the five days of twice daily cocaine injections, the two groups developed similar levels of sensitization. After 3 days of withdrawal, neither group exhibited sensitization to the cocaine challenge, but after 13 and 34 days, both groups exhibited progressive sensitization. Again the estradiol-treated rats did not exhibit greater sensitization than the non-estradiol-treated rats. These data point to a role of the estrus cycle in the acute locomotor response to cocaine in females, but do not implicate estradiol in cocaine sensitization of the locomotor response. Sell, S.L., Thomas, M.L., and Cunningham, K.A. Influence of Estrous Cycle and Estradiol on Behavioral Sensitization to Cocaine in Female Rats. Drug and Alcohol Dependence, 67, pp. 281-290, 2002.
A Likely Neurobiological Substrate for Increased Maternal Aggression Produced by Chronic Cocaine Administration During Gestation
Females of most mammalian species aggressively protect their offspring from potential harm. Maternal aggressive behavior by lactating female rats consists of a characteristic set of postures, threats and attacks used to protect the young from intruders in the nest area. This behavior is generally adaptive, but previous research by Josephine Johns has shown that, following chronic gestational cocaine administration, rat dams can become so aggressive that they leave their young unprotected and vulnerable, or even cause injury to their offspring during interactions with an intruder. Dr. Johns has previously observed a decrease in oxytocin levels in the amygdala of rats chronically treated with cocaine during gestation. This observation, together with other evidence, led to her hypothesis that heightened aggressiveness in these animals might be caused by the deficit of oxytocin in the amygdala. To test the hypothesis, she implanted dams with bilateral cannulae into the central nucleus of the amygdala and infused them with an oxytocin antagonist (OTA) or vehicle 4 hours before testing. Maternal aggressive behavior was compared among drug-naïve dams infused with OTA, control animals infused with vehicle, and chronic cocaine-treated dams infused with vehicle only. Drug naïve animals infused with OTA behaved significantly more aggressively towards intruders compared to control animals, and at a level comparable to that of the cocaine-treated animals. The results suggest that disruption of oxytocin activity in the central amygdala may be sufficient to selectively increase maternal aggressive behavior. To further test her hypothesis that this mechanism could account for the behavior of cocaine-treated animals, Dr. Johns plans to determine whether oxytocin infusions in these animals will reverse their abnormal aggressiveness. Cocaine abuse by human mothers is correlated with a high incidence of child neglect and abuse. Dr. Johns research on the neurobiological substrates of these behaviors in an animal model may help identify possible therapeutic targets. Lubin, D.A., Elliott, J.C., Black, M.C., and Johns, J.M. An Oxytocin Antagonist Infused Into the Central Nucleus of the Amygdala Increases Maternal Aggressive Behavior. Behavioral Neuroscience, 117, pp. 195201, 2003.
|
|
Treatment Research and Development |
A History of Depression and Smoking Cessation Outcomes Among Women Concerned About Post-Cessation Weight Gain
Drs. Levine, Marcus, and Perkins at the University of Pittsburgh School of Medicine sought to document the prevalence of depression history among weight-concerned women smokers, and evaluate its effect on treatment outcome. They also evaluated the impact of baseline depressive symptoms and cessation-related changes in symptoms. Two hundred and nineteen women were classified as depression history positive (MDD+; 52%) or negative (MDD-) and received a group-based smoking cessation treatment. Findings showed that although MDD+ women were significantly more nicotine dependent, rates of continuous abstinence did not differ between MDD+ and MDD- women. However, MDD+ women were more likely to drop out of treatment prior to quitting. Irrespective of depression history, depressive symptoms were associated with abstinence. Women who reported an increase in depressive symptoms from pre- to post treatment were significantly less likely to be abstinent post treatment, suggesting that depressive symptoms are more predictive of outcome than previous disorder. Levine, M.D., Marcus, M.D., and Perkins, K.A. Nicotine & Tobacco Research, 5(1), pp. 69-76, 2003.
Pregnant Homeless Women More Challenged Upon Treatment Entry
Hendree Jones and colleagues at Johns Hopkins University School of Medicine found a number of important differences when they compared housed and homeless pregnant women at substance abuse treatment entry. Homeless pregnant women reported spending more money on cocaine and alcohol than pregnant women with permanent residences. They experienced three times the number of medical problems, and received only 65% of the social service income of the housed group. Significantly greater rates of psychopathology were observed including greater lifetime rates of anxiety and depression, histories of suicidal thoughts and attempts, and higher lifetime incidence of emotional, physical, and sexual abuse. Homeless pregnant women also left treatment at greater rates. Results suggest treatment programs may need special interventions to treat and engage homeless pregnant women. Tuten, M., Jones, H.E., and Svikis, D.S. Comparing Homeless and Domiciled Pregnant Substance Dependent Women on Psychosocial Characteristics and Treatment Outcomes. Drug and Alcohol Dependence, 69(1), pp. 95-99, 2003.
A Partners Drug Using Status Impacts Womens Drug Treatment Outcome
Drs. Michelle Tuten and Hendree Jones at Johns Hopkins University School of Medicine examined the role that male sexual partners play in the treatment outcome of drug dependent pregnant women. Pregnant women enrolled in a comprehensive treatment program with drug free or drug using male sexual partners completed a relationship survey and were compared on partner and psychosocial variables. Compared with male drug free partners, male drug using partners had more unemployment and more current legal involvement, less education, were less likely to be supportive of the pregnant womans recovery efforts and were more likely to give them money to buy drugs. Male drug free partners also had fewer medical, dental, legal, and transportation needs than male drug using partners. Data from treatment retention suggests that women with male drug using partners are retained in a comprehensive treatment for a shorter time than women with male drug free partners. A male partners drug using status should be considered when treating pregnant drug dependent women. Tuten, M. and Jones, H., Drug and Alcohol Dependence, pp. 1-4, March 2003.
Gender Differences Found with a Novel Cognitive-Behavioral Approach for Treatment-Resistant Drug Dependence
Many opiate-dependent patients continue illicit drug use despite the application of treatments that combine methadone administration, weekly counseling, and contingency reinforcement strategies. Dr. Pollack and colleagues tested a novel cognitive-behavioral treatment (CBT) designed to reduce illicit drug use among patients receiving methadone treatment. The CBT was a modification of a treatment designed to treat benzodiazepine dependence in patients with panic disorder, which was now focused to reduce sensitivity to interoceptive cues associated with drug craving and trained alternative responses to these cues. Twenty-three methadone maintenance patients were randomly assigned to either this novel CBT program or a program of increased counseling, such that the two programs of treatment were equated for therapist contact, assessment time, and contingency-reinforcement strategies. The new program was associated with significantly greater reductions in illicit drug use for women, but not for men measured by percentage of negative urine drug screens. The (CBT) program offered advantages to women who attended the treatment on the order of a very large (d = 1.00) effect size. Contrary to expectations, results indicated that intensified counseling with existing providers tended to offer better outcome than CBT-IC for men in our program (d = 0.89). Pollack, M.H., Penava, S.A., Bolton, E., Worthington III, J.J., Lanka, G., Farach Jr., F.J. and Otto, M.W. Journal of Substance Abuse Treat, 23(4), pp. 335-342, December 2002.
Cardiovascular and Subjective Effects of Smoked Cocaine Vary as a Function of Menstrual Cycle Phase
Few studies have systematically determined whether the response to cocaine in human females is related to hormonal fluctuations at different phases of the menstrual cycle. The goal of this study was to investigate the responses to repeated doses of smoked cocaine in women during two phases of the menstrual cycle using a within-subject design. Eleven non-treatment seeking female cocaine smokers were administered smoked cocaine during the follicular and mid-luteal phases of the menstrual cycle. The order of menstrual cycle phase was counterbalanced across women and the order of cocaine doses was randomized. During each phase, there were four cocaine administration sessions. During each session, participants could smoke up to six doses of cocaine (either 0, 6, 12, or 25 mg cocaine base, depending on the session) at 14-min intervals. Results obtained showed that the number of cocaine doses administered did not vary between the follicular and luteal phases. After cocaine administration, heart rate and several ratings - such as "good drug effect", "high", "stimulated", and "drug quality ratings" were increased more during the follicular phase than the luteal phase, although, for some measures, these effects varied based on the cocaine dose. Further, dysphoric mood during the luteal phase was improved after cocaine administration. These results indicate that the cardiovascular and subjective effects of repeated doses of smoked cocaine are complex and vary as a function of menstrual cycle phase and cocaine dose. Evans, S.M., Haney, M. and Foltin, R.W. The Effects of Smoked Cocaine During the Follicular and Luteal Phases of the Menstrual Cycle in Women. Psychopharmacology (Berl), 159(4), pp. 397-406, February 2002.
Maternal Vaccination Against Nicotine Reduces Nicotine Distribution to Fetal Brain in Rats
This study examined whether vaccination of female rats prior to pregnancy would reduce the distribution to fetal brain of a single nicotine dose administered during gestation. Female rats immunized with a nicotine conjugate vaccine received a single dose of nicotine 0.03 mg/kg i.v. on gestational day 16-22. Five minutes later, vaccinated rats had substantially higher bound and lower unbound serum nicotine concentration, and lower brain nicotine concentration than controls. Fetal brain nicotine concentration was reduced by 43% in vaccinated rats, comparable to the reduction in the maternal brain nicotine concentration. The whole fetus nicotine concentration was not altered by vaccination. A similar experiment was performed in which pregnant rats were passively immunized with rabbit nicotine-specific IgG 7 or 21 mg/kg just prior to nicotine dosing. The effects of passive immunization on nicotine distribution in the mother were IgG dose-related and the higher dose reduced nicotine distribution to fetal brain by 60%. These data suggest that vaccine effects on nicotine distribution to serum and brain are similar in pregnant female rats to those previously reported in adult males. Vaccination of female rats prior to pregnancy, or passive immunization during pregnancy, can reduce the exposure of fetal brain to a single dose of maternally administered nicotine. Keyler, D.E., Shoeman, D., LeSage, M.G., Calvin, A.D. and Pentel, P.R. Maternal Vaccination Against Nicotine Reduces Nicotine Distribution to Fetal Brain in Rats. J Pharmacol Exp Ther., February 11, 2003 [epub ahead of print].
Effects of Smoking Cessation on Reduction of Hormone Profiles and Bone Turnover in Postmenopausal Wome
A prospective study was conducted to evaluate the impact of smoking cessation on hormonal concentrations, sex hormone-binding globulin (SHBG) and markers of bone turnover in postmenopausal women. Sixty-six women who were either users or non-users of estrogen replacement therapy (ERT) were randomly assigned, using a weighted randomization scheme, to smoking cessation (SC) or to smoking cessation after 6 weeks of monitoring (wait-list control group, WLC). The study measured hormones [estrone, estradiol, testosterone, parathyroid hormone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS) and androstenedione] and SHBG, markers of bone turnover [procollagen peptide (PINP), bone alkaline phosphatase (BAP), and osteocalcin (OC), N- and C-terminal collagen cross-links (NTx and CTx)], and cotinine, at baseline and again at 6 weeks in women who reported smoking cessation and in women randomized to the WLC group. Analyses included 20 subjects who quit or significantly reduced their smoking and 18 subjects in the WLC group. After controlling for differences in age and ERT use between groups, we found a significant change in SHBG in the SC vs. the WLC group (-8% vs. +5%, respectively; p = 0.01), and in DHEA (-18% vs. -5%, respectively; p = 0.04), but not in other hormonal concentrations. Authors also noted a significant change in NTx in the SC vs. WLC group (-5% vs. +56%, respectively, p = 0.01), but not in other markers of bone turnover. Percentage changes in SHBG and NTx were correlated with changes in plasma cotinine (r = 0.48; p = 0.004 and r = 0.36; p = 0.04, respectively). Six weeks of smoking abstinence produces reductions in SHBG and NTx. This may partly explain how smoking contributes to osteoporosis in postmenopausal women. Oncken, C., Prestwood, K., Cooney, J.L., Unson, C., Fall, P., Kulldorff, M. and Raisz, L.G., Nicotine Tob. Res., 4(4), pp. 451-458, November 2002.
Effect of Maternal Smoking on Fetal Catecholamine Concentrations at Birth
Catecholamine concentrations in the fetal umbilical artery cord blood from the offspring of smokers were compared to the offspring of nonsmokers. Pregnant women who were self-identified as smokers (>/=10 cigarettes per day throughout pregnancy) or nonsmokers were recruited for study participation. Maternal blood was collected for cotinine concentrations. Umbilical artery cord blood was collected at delivery for arterial pH and catecholamine concentrations. Cord blood was obtained from 51 subjects, including 21 smokers and 30 nonsmokers. Median epinephrine concentrations [304 pg/mL versus 597 pg/mL (Mann-Whitney U = 170; p = 0.006)] and median norepinephrine concentrations [3148 pg/mL versus 6558 pg/mL (Mann-Whitney U = 191; p = 0.006)] were significantly lower in smokers compared with nonsmokers, respectively. After controlling for gestational age, route of delivery, and arterial pH, log-transformed epinephrine concentrations between smokers and nonsmokers were statistically significant (p = 0.03), with a similar trend for log-transformed norepinephrine concentrations (p = 0.07). Analyses of the data using cotinine <20 ng/mL to classify nonsmokers also showed differences in epinephrine concentrations between groups (p = 0.02). These results are consistent with results from animal studies showing that catecholamine concentrations may be affected by prenatal nicotine exposure. Further studies are needed to validate these findings and to examine the specific mechanism by which these differences may arise. Oncken ,C.A., Henry, K.M., Campbell, W.A., Kuhn, C.M., Slotkin, T.A. and Kranzler, H.R. Effect of Maternal Smoking on Fetal Catecholamine Concentrations at Birth. Pediatr Res. 53(1), pp. 119-124, January 2003.
|
|
Research on AIDS and Other Medical Consequences of Drug Abuse |
AIDS Research
Drug Use Patterns and STIs among Young Adults in a High-Risk Neighborhood of NYC
Researchers sought to examine whether and how drug users, particularly IDUs and crack smokers, may be a core group for some sexually transmitted infections (STIs). They conducted a cross-sectional survey on drug use and assays for HIV, hepatitis B and C, syphilis, gonorrhea, and other sexually transmitted infections among 363 young (18-24) adults in an impoverished New York City minority neighborhood with major drug markets. They found that hepatitis C and HIV were concentrated among IDUs and that herpes, syphilis, and hepatitis B increased among women in relation to hardest drug ever used. These findings suggest that using harder drugs (defined in increasing order of hardness as no drug use, marijuana use, non-injected heroin or cocaine use, crack smoking and injection drug use) is associated with some but not all of these STIs. The findings underscore the importance of targeted HIV prevention efforts to reduce unsafe sex and drug use among high-risk youth. Friedman, S.R., Flom, P.L., Kottiri, B.J., Zenilman, J., Curtis, R., Neaigus, A., Sandoval, M., Quinn, T. and Des Jarlais, D. Drug Use Patterns and Infection with Sexually Transmissible Agents Among Young Adults in a High-Risk Neighborhood in New York City. Addiction, 98, pp. 159-169, 2003.
Effectiveness of an HIV Intervention Among African American Women Who Use Crack
Researchers evaluated the effectiveness of an HIV intervention for African American women who use crack cocaine. Two hundred sixty-five women (aged 18-59 years) were randomly assigned to one of two enhanced intervention conditions or to the NIDA standard condition. A substantial proportion of women reported no past 30-day crack use at 6-month follow-up (100%-61%, p<.001). Significant decreases in the frequency of crack use; the number of paying partners, the number of times unsafe sex occurred with a paying partner; and sexual risks, such as trading sex for drugs, were reported over time. Significant increases in male condom use with sex partners were also observed, as well as decreases in casual partners refusal of condoms. These findings suggest that combined components of the culturally appropriate, gender-tailored HIV intervention are likely to be most effective in enhancing preventive behavior among similar high risk populations. Sterk, C., Theall, K., and Elifson, K. Effectiveness of a Risk Reduction Intervention Among African American Women Who Use Crack Cocaine. AIDS and Behavior, 15(1), pp. 15-32, 2003.
HIV Risk Reduction Among African American Women Who Inject Drugs
Researchers evaluated a community-based HIV intervention for African American women who are active IDUs. Seventy-one women (aged 20-54 years) were randomly assigned to one of two enhanced gender- and culturally-specific intervention conditions or to the NIDA standard condition. Substantial decreases (p<.001) were found in the frequency of drug use and the frequency of drug injection as well as in the sharing of injection works or water and the number of injections. Trading sex for drugs or money, having sex while high, and other sexual risk behaviors were also reduced significantly. Women in both enhanced intervention conditions were more likely to reduce their drug-using and sexual risk behaviors than were women in the standard condition. Results indicate the value of including additional components in interventions designed to reduce the risk of infection with HIV among women who inject drugs. Sterk, C., Theall, K., Elifson, K., and Kidder, D. HIV Risk Reduction Among African American Women Who Inject Drugs: A Randomized Controlled Trial. AIDS and Behavior, 7(1), pp. 73-86, 2003.
Norms, Social Networks, and HIV Risks Among Urban Disadvantaged Drug Users
This study sought to examine the relationship between condom use, norms, and social network characteristics among a sample of economically impoverished individuals at risk for acquiring and transmitting HIV. Participants were 1051 individuals from a drug using community in the USA. Eighty percent were current drug users; 17% were HIV seropositive. Reported condom use was strongly associated with peer norms about condom use (friends talking about condoms, encouraging condom use, and using condoms). Women were less likely than men to report that their friends used condoms. Injection drug use was negatively associated with peer norms about condom use, while church attendance and network characteristics were positively associated with condom-promoting norms. Network research and methodologies are useful for identifying specific ties that promote condom use norms in a population. The findings of the study have implications for norm change interventions among disadvantaged communities at high risk for HIV/AIDS. Latkin, C., Forman, V., Knowlton, A., and Sherman, S. Norms, Social Networks, and HIV-Related Risk Behaviors Among Urban Disadvantaged Drug Users. Social Science and Medicine, 56, pp. 465-476, 2003.
HIV+ Drug Users Unaware of Their Status: Who Gets Tested, Who Returns for Results
Researchers analyzed a subset of data collected from out-of-treatment HIV+ drug users (N=1,544) who participated in the NIDA-funded Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Study. They identified socio-demographic characteristics and drug use and sexual risk behaviors that differentiate HIV+ individuals who had obtained HIV testing in the past and those who had not and, among those who had been tested, what differentiates individuals who had returned to obtain their test results and those who had failed to return. In total, 33.4% of persons who tested HIV+ indicated that they had never been tested for HIV before. Persons who were HIV+ and more likely to have been tested in the past were: female, identified as gay or lesbian, had a history of arrests, were ever in drug treatment, had no IDU sex partner in the past month, and ever had a STD. Among HIV+ persons who reported prior HIV testing, 24.1% never returned for their test results. Persons who were HIV+ and more likely to return to obtain a past HIV test results were: not Hispanic, domiciled (not homeless), married, and recruited in a low HIV prevalence site. These findings suggest that out-of-treatment drug users who do not have contact with institutional systems (e.g., corrections) may need to be targeted for testing through hospital emergency rooms or outreach efforts. Efforts must also be made to shorten the interval between testing and providing test results so that transient individuals may obtain these results before moving on. Clearly, more needs to be done to improve interventions to encourage drug users to obtain HIV testing and counseling and to return for their test results. Strauss, S., Deren, S., Rindskoph, and Falkin, G. HIV-Positive Out-of-Treatment Drug Users Who Are Unaware of Their HIV Status: Predictors of Who Gets Tested and Who Returns for Test Results. J Drug Issues, pp. 1017-1032, Fall 2002.
Anemia in HIV-Infected Drug Abusing Women
Risk factors for anemia and cumulative incidence of anemia were examined in a longitudinal cohort study of 622 injection drug users (IDUs) (8885 visits) in Baltimore, Maryland, from 1988 to 2000. At enrollment, 19.6% subjects were anemic (16.1% of men and 30.5% of women, P<0.0001) and 8.4% had microcytic anemia (6.7% of men and 14.0% of women, P=0.006). Cumulative incidence of anemia was 82.2% (87.9% of men and 100% of women, P<0.0001) during a median of 7.5 years follow-up. Factors associated with anemia included age (per 5 year increase, odds ratio (OR)=1.22; 95% confidence interval (CI): 1.10,1.36), female gender (OR=1.62; 95% CI: 1.16, 2.27), CD4+ lymphocyte count <200 cells/microl (OR 1.85; 95% CI: 1.52, 2.24), weight loss (OR 1.55; 95% CI: 1.26, 1.91), oral thrush (OR 1.53; 95% CI: 1.21, 1.94), Mycobacterium avium complex infection (OR 1.30; 95% CI: 1.04, 1.64), and zidovudine use (OR 1.24; 95% CI: 1.04, 1.48). Higher body mass index (OR 0.92; 95% CI: 0.88, 0.95) and marijuana use (OR 0.75; 95% CI: 0.61, 0.92) were associated with a lower risk of anemia. The cumulative incidence of anemia is high among IDUs, and women are at highest risk of anemia, Semba, R.D., Shah, N., and Vlahov, D., Risk Factors and Cumulative Incidence of Anemia Among HIV-infected Injection Drug Users, Int. J. STD AIDS, 13(2), pp. 119-123, 2002.
Contextual Factors and Other Correlates of Sexual Risk of HIV Among African American Crack-Abusing Women
This study examined differences in contextual factors, substance use, sexual risk behaviors, and comorbid histories between African American, out of treatment crack abusing women who had either a single sexual partner or multiple partners. Bivariate analysis indicated that women with multiple partners were more likely than women with a single partner to be homeless, financially dependent, and to have histories of sexual, physical, and emotional abuse. Women with multiple partners reported higher levels of depression, anxiety and more symptoms of posttraumatic stress disorder. In multiple logistic regression analysis, being unemployed, difficult childhood, and number of days of crack use in the previous 30 days, longer crack runs, and more frequent unprotected fellatio were associated with increased odds of having multiple sexual partners. Being married or living as married was associated with decreased odds of having multiple sexual partners. The importance of assessing contextual and historical factors and implications for future research is discussed. Roberts, A.C., Wechsberg, W.M., Zule, W. and Burroughs, A.R. Contextual Factors and Other Correlates of Sexual Risk of HIV Among African American Crack-Abusing Women. Addictive Behaviors, 28, pp. 523-536, 2003.
Women, AIDS, and Protective Factors
This study compares the characteristics of out-of-treatment, homeless, crack-using African American women with those who are not homeless to determine what risks and protective factors differentiate the two groups. From 1999 to 2001, 683 out-of-treatment, African American crack-using women (of whom 219 were categorized as homeless) were interviewed and serologically tested. Risk factors that were examined include adverse childhood experiences, psychological distress, physical health, violence and victimization, drug use, and risky sex behaviors. Protective factors that were examined include marital status, education, public assistance, and the responsibility of caring for children. Overall, both groups of women started crack use in their mid twenties and started drug use with alcohol in their teenage years. Logistic regression analysis found that that variables associated with increased odds of being homeless are physical abuse before age 18, crack runs greater than 24 hours, income less than $500 in the last 30 days, depression, and current cigarette smoking. Protective factors found are marital status, living with children under 18, having had a physical in the past year, and receiving money from welfare in the last 30 days. Interventions designed for these women need to consider gender, cultural, and contextual issues that not only incorporate aspects of risk reduction related to violence, alcohol use, and comorbid conditions, but also linkages that will address housing issues, education and skills for independence. Wechsberg, W.M., Lam, W.K., Zule, W., Hall, G., Middlesteadt, R., and Edwards, J. Violence, Homelessness, and HIV Risk Among Crack-Using African American Women. Substance Use and Misuse, 38(3-6), pp. 671-701, 2003.
Effectiveness of Risk Reduction Interventions in Drug-Abusing Women
The primary objective of this study was to evaluate the effectiveness of an HIV intervention for African American women who use crack cocaine. Two hundred sixty five women (aged 18-59 years) were randomly assigned to one of two enhanced intervention conditions or to the National Institute on Drug Abuse standard condition. A substantial proportion of women reported no past 30-day crack use at 6-month follow-up (100%-61%, p <.001). Significant (p<.05) decreases in the frequency of crack use; the number of paying partners; the number of times vaginal, oral, or anal sex was had with a paying partner; and sexual risks, such as trading sex for drugs, were reported over time. Significant (p<.05) increases in male condom use with sex partners were observed, as well as decreases in casual partners refusal of condoms. Findings suggest that combined components of our culturally appropriate, gender-tailored intervention may be most effective at enhancing preventive behavior among similar populations. Sterk, C.E., Theall, K.P. and Elifson, K.W. Effectiveness of a Risk Reduction Intervention Among African American Women Who Use Crack Cocaine. AIDS Education and Prevention, 15(1), pp. 15-32. February 2003.
High Risk Sexual Behaviors among Heroin Sniffers Who Have No History of Injection Drug Use: Implications for HIV Risk Reduction
The purpose of this paper was to assess sexual behaviors which place heroin sniffers (HSs) at high risk for HIV infection. A stratified network-based sample was used to recruit HSs who had no history of injection drug use from the streets of South Florida, USA. HSs displayed a high HIV seroprevalence rate of 12.1%; women (18.1%) were more likely than men (8.7%) to test positive for HIV. Both men and women HSs engaged in considerable high-risk sex behavior, including high-risk sex for money or drugs exchange behavior. The use of crack cocaine was associated with increased sex for money or drugs exchange behavior among women. The need for intervention programs targeted toward HSs is discussed. Sanchez, J., Comerford, M., Chitwood, D.D., Fernandez, M.I. and McCoy, C.B. AIDS Care, 14(3), pp. 391-398, June 2002.
|
|
Research on AIDS and Other Medical Consequences of Drug Abuse |
Non-AIDS Research
Maternal Smoking During Pregnancy
University of Chicago researchers have reported on fluctuations in womens cigarette smoking during pregnancy, with special attention to implications for the design of clinical interventions and for research on the effects of fetal exposure to cigarettes. Data were analyzed from two independent projects, the National Health Interview Survey 1991 Pregnancy and Smoking Supplement (N=1426), and the Family Health and Development Project, the latter a small (N=60), prospective, clinic-based study. A substantial portion of the women in the large study showed a pattern of repeated cessation and relapse. In the smaller sample, fluctuations in smoking intensity were also substantial. While 48% quit or reduced smoking when they learned of their pregnancy, more than half changed smoking intensity multiple times. The investigators conclude that simple measures of smoking during pregnancy may lead to underestimation of possible fetal impact, and that brief smoking cessations early in pregnancy are likely to be inadequate for many women. Pickett, K.E., Wakschlag, L.S., Dai, L., and Leventhal, B.L. Fluctuations of Maternal Smoking During Pregnancy. Obstetrics and Gynecology, 101, pp. 140-147, 2003.
|
|
Epidemiology, Etiology and Prevention Research |
Racial/Ethnic and Gender Differences in the Incidence and Onset Age of DSM-IV Alcohol Use Disorder Symptoms among Adolescents
Several investigators have questioned the validity of the DSM-IV Alcohol Use Disorders criteria for diagnosing alcohol use problems among teenagers, with specific concerns about their utility across different subgroups. In the current study, authors examined whether particular racial/ethnic or gender subgroups varied in the incidence and onset age of Alcohol Use Disorder symptoms. Members of a sample composed of 1,045 community-dwelling "drinkers" (59.4% male; 13.8% black, 21.2% foreign-born Hispanic, 30.7% U.S.-born Hispanic and 33.6% non-Hispanic white) were interviewed retrospectively using the Composite International Diagnostic Interview. The first occurrence of each DSM-IV symptom in a participant was examined by race/ethnicity and gender. Discrete-time event history analysis compared onset patterns from ages 14 through 20 years. The cumulative incidence of Alcohol Abuse and Alcohol Dependence diagnoses, as well as one alcohol abuse symptom and four dependence symptoms, varied by race/ethnicity. The incidence of both diagnoses, as well as two alcohol abuse symptoms, varied by gender. Event history analysis revealed no significant subgroup variation in first onset patterns for only three of the eleven symptoms. Racial/ethnic variation, but not gender variation, was significant for three symptoms, and both racial/ethnic variation and gender variation was significant for the remaining five symptoms. Study authors findings indicate that most of the DSM-IV Alcohol Use Disorder symptoms, when applied to adolescents, demonstrate significant subgroup variation in incidence and onset age patterns. These results speak to the urgent need for additional research concerning the nosology and diagnosis of alcohol use problems among younger drinkers, especially among specific racial/ethnic and gender subgroups. Wagner, E.F., Lloyd, D.A., and Gil, A.G. Journal of Studies on Alcohol, 63, pp. 609-619, 2002.
Serotonergic Gene Variant and Family History of Antisocial Personality and Alcoholism Associated with Risk of Externalizing Problems
This genetic association study examined the relation between polymorphisms of the serotonin-transporter-linked promoter region (5HTTLPR) and externalizing behaviors (aggression, conduct disorder, and attention deficit disorder) in a sample of 87 adoptees at risk for externalizing and substance abuse by virtue of parental family history of antisociality and/or alcoholism. Results failed to show main effects between 5HTTLPR status and externalizing problems, but indicated several interactions between 5HTTLPR status and family history. The LL variant of 5HTTLPR was associated with an increased risk of externalizing in offspring of antisocial parents, whereas the SS or SL variants were associated with increased risk of externalizing in offspring of alcoholics. The gender of the adoptee also interacted with 5HTTLPR status, as an increased risk of externalizing was observed in males with LL and in females with SS or SL. Results indicated an interaction between this serotonergic gene and other forms of genetic diathesis (antisocial personality and alcoholism), thereby suggesting that epistasis (gene-by-gene interactions) may be involved in the etiology of externalizing problems. Cadoret., R., Langbehn, D., Caspers, K., Troughton, E.P., Yucuis, R., Sandhu, H.K., and Philibert, R. Associations of the Serotonin Transporter Promoter Polymorphism with Aggressivity, Attention Deficit, and Conduct Disorder in an Adoptee Population. Comprehensive Psychiatry, 44(2), pp. 88-101, 2003.
Adolescent Drug Use, Abuse, and Dependence: Epidemiology and Heterogeneity of Symptom Expression by Drug Type and Gender
This study evaluates symptom profiles based on DSM-IV abuse and dependence criteria for tobacco, alcohol and marijuana, including a gender comparison. Participants are 3,072 adolescents (12-18 years) drawn from three community-based family samples in Colorado. Age trends suggest that substance use is a developmental phenomenon, which increases almost linearly from early to late adolescence. Substance use disorders are less common than experimentation in adolescence, but approximately 1 in 4 adolescents in the oldest cohorts meets criteria for abuse for at least one substance, and 1 in 5 meets criteria for substance dependence. By age 18, nearly one in three adolescents report daily smoking and 8.6% meet criteria for tobacco dependence. Although alcohol is the most commonly abused substance (10%), a slightly larger proportion of adolescents meet criteria for dependence on marijuana (4.3%) than alcohol (3.5%). Males more frequently meet criteria for dependence on alcohol and marijuana in late adolescence, while females are more often nicotine dependent. A comparison of abuse and dependence symptom profiles shows variability across substances, and suggests that manifestations of a subset of symptoms are gender specific. Young, S.E., Corley, R.P., Stallings, M.C., Rhee, S.H., Crowley, T.J. and Hewitt, J.K. Substance Use, Abuse, and Dependence in Adolescence: Prevalence, Symptom Profiles and Correlates. Drug and Alcohol Dependence, 68(3), pp. 309-322, 2002.
Psychiatric and Substance Use Disorders in South Florida: Racial/Ethnic and Gender Contrasts in a Young Adult Cohort
Prevalence rates of psychiatric and substance use disorders among young adults in South Florida are presented. Unique aspects of the study include the large sample size, its ethnic diversity, and the fact that a substantial proportion of Hispanic participants were foreign born. This study builds on a previous cohort study of students who entered middle school in 1990. A random subsample of this representative cohort (N = 1803) was interviewed between 1998 and 2000 when most were between 19 and 21 years of age. Disorders were assessed through computer-assisted personal interviews utilizing the DSM-IV version of the Michigan Composite International Diagnostic Interview. More than 60% of the sample met lifetime criteria for 1 or more study disorders, and 38% did so within the preceding year. Childhood conduct and major depressive and alcohol abuse disorders were the most prevalent. Although rates of affective and anxiety disorders in females were double that in males, this gender difference disappeared when attention-deficit/hyperactivity disorder, conduct disorders, and antisocial personality disorders were also considered (46.6% vs. 45.7% for females vs. males, respectively). Substantially lower rates were observed among African Americans for depressive disorders and substance abuse and dependence. Among Hispanics, rates tend to be lower among the foreign-born in comparison with their US-born counterparts, particularly for the substance disorders. The documented presence of psychiatric and substance disorders in middle and high school populations emphasizes the importance of prevention efforts in school settings. Research on the origins of ethnic and nativity differences is called for. Turner, R.J., and Gil, A.G., Archives of General Psychiatry, 59, pp. 43-50, 2002.
Comorbid Depression and Conduct Disorder Associated with Increased Risk for SUD
Using data from a sample of 17 year old twins, subjects with a history of major depressive disorder and/or conduct disorder or neither were selected and school success and substance dependence examined. The combination of disorders was found to be particularly associated with school behavior problems, nicotine and drug dependence for both males and females. These findings, which are similar to those reported by other groups, point to a need to assess youth for both internalizing and externalizing disorders and awareness of the increased risk associated with their co-occurrence. Marmorstein, N.R. and Iacono, W.G. Major Depression and Conduct Disorder in a Twin Sample: Gender, Functioning, and Risk for Future Psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 42(2), pp. 225-233, 2003.
High School Failure Predicted by Deviance, Academic Competence and Tobacco Use
This study explored whether general (vs. specific) deviance and academic competence mediated the relationships between structural strain factors (gender, ethnicity and socioeconomic status (SES)) and 12th grade high school failure. Independent variables of structural strain and mediational variables of drug use, sexual involvement, school trouble, delinquency, and academic performance were assessed in a sample of 754 8th graders and used to predict 12th-grade high school dropout and number of missed months of school in 12th grade (reflecting a latent construct of High School Failure). High school failure was directly predicted by earlier General Deviance, poor Academic Competence, low Family SES, and tobacco use. All ethnic and gender differences in high school failure were mediated by deviance and academic ability or accounted for by Family SES discrepancies. Newcomb, M.D., Abbott, R. D., Catalano, R. F., Hawkins, J. D., Battin-Pearson, S. and Hill, K. Mediational and Deviance Theories of Late High School Failure: Process Roles of Structural Strains, Academic Competence, and General Versus Specific Problem Behaviors. J. of Counseling Psychology, 49(2), pp. 172-186, 2002.
Epidemiology of Gambling Participation in the United States
This study examined demographic patterns of gambling participation in the U.S. using a national telephone survey with 2,630 representative U.S. residents aged 18 or older. The sample as weighted for analysis was 48% male, 12% black, and 11% Hispanic. Respondents were questioned on 15 types of gambling: how often they played and how much they won or lost. Eighty-two percent reported having gambled in the past year. Lottery was the most commonly played game, while casino gambling accounted for the largest extent of gambling involvement. Men and women were equally likely to gamble in the past year, but men gambled more frequently and had larger wins and losses, particularly on sports betting and games of skill. Black respondents were less likely to report having gambled in the past year, but blacks who gambled did so more heavily than other racial groups. Blacks and Hispanics were more likely than average to be pathological gamblers. The rate of past year gambling declined with age, but extent of gambling involvement among gamblers did not vary with age. Rates of participation in most forms of gambling increased with socioeconomic status, but higher socioeconomic status gamblers had lower rates of pathological gambling, and lower extent of gambling involvement, particularly for lottery. New Englanders gambled more heavily than other Americans. Comparison with past studies showed an increase in overall gambling participation in the U.S., and large increases in rates of participation in lottery and casino gambling. Welte, J.W., Barnes, G.M., Wieczorek, W.F., Tidwell, M.C., and Parker, J. Gambling Participation in the U.S.Results from a National Survey. J. Gambling Studies, 18(4), pp. 313-337, 2002.
Effects of Alcohol Misuse on Gambling Patterns in Youth
This study hypothesized that alcohol misuse would predict a pattern of increased youth gambling or a pattern of stable high gambling after controlling for key sociodemographic, socialization and individual factors. Data were analyzed from two longitudinal studies of youth living in a western New York metropolitan area. Respondents' gambling at two times over the course of 12-18 months was classified into one of five gambling pattern groups, representing flat-low, increasing, flat-medium, flat-high and decreasing levels of gambling. Alcohol misuse among males predicted increasing gambling over time or a pattern of stability of high rates of gambling even after controlling for socioeconomic status, race, age, impulsivity and parental monitoring in the family study. Higher parental monitoring and lower alcohol misuse were significant in predicting a decreasing pattern of gambling among males in the male delinquency study. For females in the family study, alcohol misuse predicted an increasing pattern of gambling only when other factors such as high impulsivity or low parental monitoring were present. Results are consistent with the notion that gambling and alcohol misuse are prevalent among youth and may be part of a common problem behavior syndrome. Barnes, G.M., Welte, J.W., Hoffman, J.H., and Dintcheff, B.A. Effects of Alcohol Misuse on Gambling Patterns in Youth. Journal of Studies on Alcohol, 63(6), pp. 767-775, 2002.
Intimate Partner Violence and Substance Abuse Among Minority Women
This study describes the rates of lifetime and current intimate partner violence (IPV) among women awaiting care in an emergency department and explores the association between IPV and having a substance abuse problem, after controlling for demographic factors and history of childhood victimization. Face-to-face interviews were conducted with 143 low-level triaged women recruited from an inner-city emergency department. Nearly one-half reported ever experiencing IPV, and over 18% reported IPV during the year before the interview. Participants who were physically abused by their partner during the past year (15%, n = 21) were more likely than nonabused women (85%, n = 122) to report more alcohol-related problems on the Alcohol Use Disorders Identification Test (AUDIT) (4.9 vs. 2.4) and more drug-related problems on the Drug Abuse Severity Test (DAST) (3.0 vs. 1.3). In addition, sexually abused women (6%, n = 9) had higher AUDIT scores (6.4 vs. 2.5) than their counterparts (94%, n = 134). The findings have implications for how the intersecting public health problems of IPV and substance abuse should be taken into consideration in research and patient care protocols in emergency departments. El-Bassel, N., Gilbert, L., Witte, S., Wu, E., Gaeta, T., Schilling, R. and Wada, T. Intimate Partner Violence and Substance Abuse Among Minority Women Receiving Care from an Inner-City Emergency Department. Womens Health Issues, 13(1), pp. 16-22, 2003.
Exploring a Source of Deviance-Producing Strain for Females: Perceived Discrimination and General Strain Theory
While the oppression of women has been held by many feminist criminologists to be at the core of female crime, little research had explored the link between discrimination, generally, and gender-based discrimination, specifically, and female deviance. Using the framework of general strain theory (GST), this study used a sample of young adult females to explore whether self-reported measures of discrimination experiences were related to self-reported criminal activity and/or diagnoses of substance use disorders. Results indicated that a measure of major discrimination that included gender discrimination was a significant predictor of both crime and substance use disorders. Results indicated that a measure of major discrimination that included gender discrimination was a significant predictor of both crime and substance use disorders. These findings were interpreted as being supportive of GST and previous scholarship by other feminist criminologists. Eitle, D.J., Journal of Criminal Justice, 30, pp. 429-442, 2002.
Ethnographic Analysis of African-American Womens Pathways to Involvement in Drug Distribution
This is an exploratory ethnographic analysis to address the question of What factors in Black womens backgrounds lead them towards crack (and other drug) sales as a primary economic activity in adulthood? There is considerable overlap in womens pathways to involvement in drug distribution, including positive exposure to the local level informal economy during childhood, the historical positioning of Black women as producers and consumers within the informal sector, the impact of structural and cultural disinvestment, drug use, and early recruitment to and participation in street life. While drug use was a crucial variable in determining their subsequent involvements in distribution activities, this study indicates that most women sellers were engaged in lawbreaking prior to regular involvement in illicit drug use. All of the women acquired an early start in street life and an early introduction into the ways of making fast money. For these women, street life is a critical variable that mediates involvement in drug distribution. The study suggests that it was not merely the involvement of the domestic network or kinship group in extra-legal and illegal activities, but rather the lack of social and economic infrastructure and the absence of legitimate opportunity structures and employment at the neighborhood level that led African-American women to seek alternative avenues of income generation. Maher, L., Dunlap, E. and Johnson, B. Black Womens Pathways to Involvement in Illicit Drug Distribution and Sales: An Exploratory Ethnographic Analysis in Drugs and Crime Deviant Pathways, edited by S. Brochu, C. da Agra, and M-M. Cousineau, Ashgate, pp. 167-193, 2002.
Gender and Ethnic Differences in Students' Smoking, Drinking and Illicit Drug Use
Researchers affiliated with Monitoring the Future at the University of Michigan examined ethnic differences in licit and illicit drug use among American 8th, 10th and 12th grade students over the period from 1972 through 2002, with a particular focus on girls. The study used cross-sectional data from the large, ethnically diverse, nationally representative MTF samples of 8th, 10th and 12th graders including 40,416 8th grade girls and 37,977 8th grade boys; 35,451 10th grade girls and 33,188 10th grade boys; and 33,588 12th grade girls and 31,014 12th grade boys. Across ethnic groups, drug use was found to be highest among Native American girls and lowest among black and Asian American girls. Trend data suggested that there have been important changes in girls' drug use over time and girls' and boys' drug use patterns are converging. The authors concluded that drug use is widespread among American adolescent girls and that further research is needed to determine whether risk and protective factors identified in the past, using predominantly white samples, are also applicable to drug use among non-white girls. Wallace, J.M., Bachman, J.G., O'Malley, P.M., Schulenberg, J.E., Cooper, S.M. and Johnston, L.D. Gender and Ethnic Differences in Smoking, Drinking and Illicit Drug Use Among American 8th, 10th and 12th Grade Students, 1976-2000. Addiction, 98(2), pp. 225-234, 2003.
Relational and Physical Victimization Within Adolescent Friendships
This study examines relational and physical forms of victimization within dyadic relationships such as friendships. Results showed that boys were more physically victimized by their friends than were girls. Girls were more relationally than physically victimized by their friends. Friend victimization was related to adjustment difficulties for both boys and girls; however, friend physical victimization was particularly related to boys whereas friend relational victimization was particularly related to girls. Crick, N.R. and Nelson, D.A. Relational and Physical Victimization Within Friendships: Nobody Told Me Thered Be Friends Like These. Journal of Abnormal Child Psychology, 30(6), pp. 599-607, 2002
|
|
Prevention Research |
Generalizability of the Social Development Model
The social development model is a theory of behavior that has proven useful in explaining the etiology of delinquency, violence, and substance use among adolescents as well as early antisocial behavior among preadolescents. To test the models generalizability across gender and income groups, a section of the model representing prosocial influences in the etiology of problem behavior was compared for girls and boys and for children from low-income families and non low-income families. Using a sample of 851 elementary school-aged youth from the Raising Healthy Children study, multiple group structural equation modeling was used to assess differences across groups in both measurement of model constructs and hypothesized structural paths between constructs. For both sets of comparisons, overall similarity was found in both measurement and structural models, indicating the robustness of the social development model for different groups. While some studies of differences in the effects of social/interactional variables on problem behavior in adolescence have shown differences by gender and ethnicity, these findings indicate that generally the protective paths from early social skills and family socialization to problem behavior in the elementary school period appear to operate in much the same way in different gender and income groups. Fleming, C.B., Catalano, R.F., Oxford, M.L., and Harachi, T.W. A Test of Generalizability of the Social Development Model Across Gender and Income Groups with Longitudinal Data from the Elementary School Development Period. Journal of Quantitative Criminology, 18(4), pp. 423-439, 2002.
Parent Figure Transitions, Delinquency, and Drug Abuse
Children of substance abusing parents have an elevated risk for experiencing disruptions in household composition, including changes in primary caretakers. This study investigated whether changes in caretakers, also called parent figure transitions predicted the likelihood of delinquency and drug use among a sample of youth with parents receiving methadone treatment for opiate addiction. A sample of 67 youth was derived from the Focus on Families program, a family-based intervention study to prevent substance abuse in children of opiate-addicted parents. For this analysis, 67 children ages 9-14 were interviewed (mean age=11.4 years at baseline; 13.8 years at final interview). Controlling for baseline delinquency, child characteristics, family conflict, parental depression, and parent criminal history, a greater number of parenting disruptions during the longitudinal study period was associated with a higher probability of delinquent behavior. Gender moderated the effect of parent figure transitions in a parallel analysis for drug use. After accounting for baseline drug use and other confounders, only adolescent females had a higher likelihood of drug use as the number of family disruptions increased. A subgroup of youth who experienced tremendous family instability and had no single consistent parent figure during the study were at extreme risk for delinquent behavior. Keller, T.E., Catalano, R.F., Haggerty, K.P., and Fleming, C.B. Parent Figure Transitions and Delinquency and Drug Use Among Early Adolescent Children of Substance Abusers. American Journal of Drug and Alcohol Abuse, 28(3), pp. 399-427, 2002.
Peers Continue to Influence Substance Use in Young Adulthood
This study included data from 294 young adults, ages 19-25, and both a same- and an opposite-gender best friend or mate collected across three annual assessments. The similarity to and influence of the peer on the young adults substance use were explored. The authors found a similarity across time between both peers and the young adult in cigarette use, alcohol use, binge drinking and, in most cases, marijuana use. In prospective analyses, peer use predicted young adult cigarette use, binge drinking and problem use by the young adults. Results were generally consistent across gender and for both same- and opposite-gender peers. Andrews, J.A., Tildesley, E. Hops, H. and Li, F. The Influence of Peers on Young Adult Substance Use. Health Psychology, 21(4), pp. 349-357, 2002.
Gender and Ethnic Differences in Students' Smoking, Drinking and Illicit Drug Use
Researchers affiliated with Monitoring the Future at the University of Michigan examined ethnic differences in licit and illicit drug use among American 8th, 10th and 12th grade students over the period from 1972 through 2002, with a particular focus on girls. The study used cross-sectional data from the large, ethnically diverse, nationally representative MTF samples of 8th, 10th and 12th graders including 40,416 8th grade girls and 37,977 8th grade boys; 35,451 10th grade girls and 33,188 10th grade boys; and 33,588 12th grade girls and 31,014 12th grade boys. Across ethnic groups, drug use was found to be highest among Native American girls and lowest among black and Asian American girls. Trend data suggested that there have been important changes in girls' drug use over time and girls' and boys' drug use patterns are converging. The authors concluded that drug use is widespread among American adolescent girls and that further research is needed to determine whether risk and protective factors identified in the past, using predominantly white samples, are also applicable to drug use among non-white girls. Wallace, J.M., Bachman, J.G., O'Malley, P.M., Schulenberg, J.E., Cooper, S.M. and Johnston, L.D. Gender and Ethnic Differences in Smoking, Drinking and Illicit Drug Use Among American 8th, 10th and 12th Grade Students, 1976-2000. Addiction, 98(2), pp. 225-234, 2003.
|
|
Treatment Services Research |
Mental Health Problems and Sexual Abuse Among Adolescents in Foster Care: Relationship to HIV Risk Behaviors and Intentions
Adolescents in foster care present with multiple psychosocial and mental health problems that individually are associated with increased risk for HIV infection. However, few studies have examined the interrelationships among these problems and HIV risk behaviors in this population. This study examined the sexual abuse histories and mental health problems among 343 youths in foster care to determine their association with HIV-risk behaviors and behavioral intentions. Results indicated that 25% reported internalizing behaviors (withdrawn, somatic complaints, depressed), and 28.3% reported externalizing behaviors (delinquent and aggressive behaviors). Of the sample, 37% reported some form of prior sexual abuse. Multivariate analyses using simultaneous entry of variables indicated that controlling for demographic variables and behavioral intentions, externalizing behaviors showed the strongest relationship with HIV risk behaviors. Likewise, in the multivariate model, it was most strongly associated with behavioral intentions. Moreover, there was a significant race by gender interaction with Caucasian females engaging in more risky behaviors than their male counterparts, and youths of color. Auslander, W.F., McMillen, J.C., Elze, D., Thompson, R., Jonson-Reid, M., and Stiffman, A. Mental Health Problems and Sexual Abuse Among Adolescents in Foster Care: Relationship to HIV Risk Behaviors and Intentions. AIDS & Behavior, 6(4), pp. 351-359, 2002.
Costs and Benefits of Methadone Treatment: Gender Differences
This paper examines the role played by patient gender in affecting the cost savings of outpatient methadone treatment (OMT) in NIDA's Drug Abuse Treatment Outcome Studies (DATOS). Subjects were 144 women and 250 men from 8 cities and 16 programs. Female subjects were 30% African American, 43% Caucasian, and 26% Hispanic with an average age of 35.5 years. Male subjects were 35% African American, 40% Caucasian, and 24% Hispanic with an average age of 38 years. Women had greater reductions in crime costs than men. Greater net economic benefits to society were accrued by women than men. Results suggest that males might benefit from longer stays in methadone treatment. Flynn, P.M., Porto, J.V., Rounds-Bryant, J.L., and Kristiansen, P.L. Costs and Benefits of Methadone Treatment: Gender Differences for Discharged and Continuing Patients. Journal of Maintenance in the Addictions, 2(1/2), pp. 151-169, 2003.
|
|
Intramural Research |
Effects of Opioid Detoxification on Withdrawal and Pain in Hospitalized Heroin-Dependent AIDS Patients
With the growing role of intravenous drug use in the transmission of HIV infection, HIV-infected patients frequently present with comorbid opioid dependence. Yet, few empirical evaluations of the efficacy and consequences of opioid detoxification medications in medically ill HIV-infected patients have been reported. In a randomized, double blind clinical trial, IRP scientists evaluated the impact of three medications on the signs and symptoms of withdrawal and on pain severity in heroin-dependent HIV-infected patients (N=55) hospitalized for medical reasons on an inpatient AIDS service. Patients received a 3-day pharmacologic taper with intramuscular buprenorphine (n=21), oral clonidine (n=16), or oral methadone (n=18). Observer- and subject-rated opiate withdrawal scores decreased significantly following the first dose of medication and overall during treatment. Among all 55 subjects, self-reported and observer-reported pain decreased after treatment (on average OOWS scores declined 5.6 units and SOWS declined 4.77 units p<0.001 for both) with no indication of increased pain during medication taper. There were no significant differences of pain decline and other measures of withdrawal between the 3 treatment groups. Supplemental morphine was administered as medically indicated for pain to 45% of the patients; only 34% of men versus 62% of women received morphine (p< .05). These findings suggest buprenorphine, clonidine, and methadone regimens each decrease opioid withdrawal in medically ill HIV-infected patients. No differences between effectiveness of these treatment regimens were detected. Umbricht, A., Leslie, J.M., Tucker, M.J., Hoover, D.R., Chaisson, R.E. and Preston, K.L. Drug and Alcohol Dependence, 69, pp. 263-272, 2003.
[Previous Report][Index]
|
