Epidemiology of Youth Drug Abuse

Research Findings from September, 2003 Director's Report

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

Ethnic Differences in Smoking Withdrawal Effects Among Adolescents

At the University of Memphis, smoking withdrawal effect information was collected from 75 adolescents making a quit attempt during a school-based smoking cessation program. A strong need to smoke was the most common withdrawal effect, followed by irritability and difficulty concentrating. Most participants experienced two or more withdrawal effects during the quit attempt, and withdrawal effects were evident in those smoking less than daily. Significant ethnic differences were found, with African Americans reporting significantly fewer withdrawal effects than Caucasians. After controlling for smoking frequency, African Americans were still less likely to report irritability, difficulty concentrating, and restlessness. Participants who chose to use nicotine replacement during the quit attempt were more likely to report difficulty concentrating, restlessness, and feeling miserable. Reidel, B.W., Robinson, L.A., Klesges, R.C. and McLain-Allen, G. Addictive Behaviors, 28(1), pp. 129-140, 2003.

Gambling Behavior in Adolescent Substance Abusers

Dr. Kaminer and colleagues from the University of Connecticut assessed the gambling behavior of 97 adolescents receiving outpatient treatment for substance use disorders. In this sample, 34% had never gambled, 57% were classified as non-pathological gamblers, 8% were identified as "in transition" gamblers, and 1% met criteria for pathological gambling. Adolescent boys were more likely to gamble than girls, and younger age of onset of gambling behavior was associated with being female, history of suicide attempts, more symptoms of Cluster B personality disorders, and other factors. Importantly, none of the gambling adolescents had ever been referred for treatment. While these findings suggest that the prevalence of gambling behavior among substance abusing adolescents is similar to a non-substance abusing population, they also suggest that identification and treatment of problematic gambling behavior is not being adequately addressed for this population. Kaminer, Y., Burleson, J.A.and Jadamec, A. Gambling Behavior in Adolescent Substance Abusers. Substance Abuse, 23, pp. 191-198, 2002.

Chronic Drug Use and Reproductive Health Care among Low-Income Women in Miami

In this study, researchers interviewed a stratified, network-referred sample of chronic drug-using women (CDUs) and socially and ethnically similar women who were not CDUs about reproductive health issues. Women who were not CDUs were significantly more likely to report a regular source of health care than CDUs. About one third of each group reported experiencing reproductive health problems (other than pregnancy) in the 12 months preceding their interview. Chronic drug users were twice as likely to report that these problems remained untreated. Measures of use of preventive services (physical exam, breast exam, pelvic exam, family planning visit) consistently showed lower use by CDUs. A higher proportion of women who were not CDUs reported pregnancies in the 12 months preceding interview. The 32 pregnant CDUs were much less likely to have received prenatal care than the 42 pregnant women who were not CDUs. For women who reported a pregnancy in the year preceding interview, logistic regression analysis showed a strong and robust negative effect of being a CDU on receiving prenatal care even when the effects of having a usual source of care and having third-party coverage were controlled. Crandall, L., Metsch, L., McCoy, C., Chitwood, D. and Tobias, H. Chronic Drug Use and Reproductive Health Care among Low-Income Women in Miami, Florida: A Comparative Study of Access, Need, and Utilization, J Behav Health Serv Res., 30(3), pp. 321-331, July-September 2003.

Student Drug Testing and Rates of Illicit Drug Use

Investigators at the University of Michigan conducted a study of the association between school drug testing practices and rates of drug use. They combined data from the 1998 through 2001 Monitoring the Future surveys, yielding a base of around 30,000 8th grade students in 260 schools, 23,000 10th grade students in 227 high schools, and 23,000 12th grade students in 235 high schools from across the nation. School drug testing policies and practices were determined from questionnaires administered to school administrators, and student drug use was ascertained from self-administered questionnaires. At each grade level studied, the investigators found virtually identical rates of drug use in the schools that have drug testing and the schools that do not. For example, in 12th grade, 36% of those in non-testing schools reported having used marijuana in the twelve months prior to the survey, versus 37% in the schools that did test. Additional analyses showed that in high schools that tested athletes, marijuana and other drug use by male athletes was not significantly different from use among male athletes in the great majority of high schools that do not test their athletes. The authors acknowledge that with only cross-sectional data they could not make definitive causal interpretations regarding the effects of drug testing; it is conceivable, for example, that the schools that instituted drug testing initially had higher use, and that drug testing reduced those levels. While the results are not conclusive, they indicate a lack of evidence for a preventive effect from student drug testing as it is commonly practiced. Yamaguchi, R., Johnston, L.D., and O'Malley, P.M. The Relationship Between Student Illicit Drug Use and School Drug-Testing Policies. Journal of School Health, 73(4), pp. 159-164, 2003.

HIV and AIDS Risk Behaviors in Juvenile Detainees

Detained youth may be at especially high risk for contracting HIV and AIDS. This study reports on the rates of HIV and AIDS sexual and drug risk behaviors among a group of juvenile detainees participating in the Northwestern Juvenile Project. Participants in this longitudinal study included 1829 youth (age 10-18) initially arrested and detained between 1995 and 1998 at the Cook County Juvenile Temporary Detention Center in Chicago, Ill. The random sample was stratified by gender, race/ethnicity, age, and charge severity. Information related to HIV and AIDS risk behavior was collected on 800 participants from the larger study. Results indicate 95% of the detained youth report engaging in 3 or more sexual and drug risk behaviors, and 65% report engaging in 10 or more risk behaviors. More than 90% of the males were sexually active; 61% had more than one sexual partner in the last three months. Significantly more males than females report engaging in the sexual risk behaviors examined in this study. No significant gender differences were found in the self-report data related to drug risk behaviors. Regarding race/ethnicity: African American males report engaging in significantly more sexual risk behaviors, although non-Hispanic Whites and Hispanics report participating in more drug risk behaviors. Among females, significantly more non-Hispanic Whites than African Americans or Hispanics report engaging in sexual risk behaviors, while Non-Hispanic Whites and Hispanics report participating in more drug risk behaviors. Over 50% of juveniles age 10-13 report engaging in both sexual and drug risk behaviors. These findings highlight the importance of developing effective sexual and drug-related HIV/AIDS risk reduction interventions for youth in the juvenile justice system. Teplin, L.A., Mericle, A.M., McCelland, G.M., and Abram, K.M. HIV and AIDS Risk Behaviors in Juvenile Detainees: Implications for Public Health Policy. American Journal of Public Health, 93(6), pp. 906-912, 2003.

Race/Ethnic Differences in the Effects of Cumulative Adversity on Drug Dependence in Young Adults

This study assesses the effects of cumulative exposure to stressors as a risk factor for drug dependence, and evaluates whether race/ethnic differences in exposure to stressful events contributes to race/ethnic differences in prevalence of drug dependence. Data were analyzed cross-sectionally from a community survey of lifetime adverse experiences and substance and psychiatric disorders among young adults. Data were collected between 1997-2000 in Miami-Dade County, Florida. The sample size is 1,803 former Miami-Dade Public School students, 93% of whom were between ages 19 and 21 when interviewed. Males and females of Cuban origin, other Caribbean basin Hispanics, African-Americans, and non-Hispanic Whites are equally represented. Drug dependence disorder was assessed by DSM-IV criteria using the Composite International Diagnostic Interview, and a 41-item checklist of lifetime exposure to major and potentially traumatic experiences were used to measure cumulative adversity. Both measures include age at time of first occurrence. The lifetime rate of drug dependence disorder (total 14.3%) did not vary significantly (p>.05) by socioeconomic group. The rate for males (17.6%) was significantly greater than female rate (10.9%). The African-American rate (6.5%) was dramatically lower than non-Hispanic White (17.0%), Cuban (18.1%) and non-Cuban Hispanic (16.0%) rates despite their dramatically higher exposure to adversity. Twenty eight of 33 individual adversities were associated with the subsequent onset of drug dependence (p<.05). Cumulative lifetime exposure was greatest for males and for African-Americans, and was inversely associated with socioeconomic level. Multivariate discrete-time event history analysis revealed significant independent effects of distal (>1 year earlier) and proximal (previous year) exposure to adverse events (p<.05), controlling for childhood conduct disorder, ADHD, and prior psychiatric disorder. Lifetime cumulative exposure to distant as well as more recent adversity predicts risk of subsequent drug dependence, though it does not explain ethnic group differences in risk. Implications are that distal and proximal stressful events should both be included when measuring stress exposure. Turner, R.J. and Lloyd, D. Cumulative Adversity and Drug Dependence in Young Adults: Racial/Ethnic Contrasts. Addiction, 98, pp. 305-315, 2003.

Life Skills Training Program Outcomes in a Rural, Midwest Youth Population

The purpose of this study is to extend earlier research by evaluating the effect of the Life Skills Training (LST) school-based preventive intervention on substance initiation and two related constructs, expectancies and refusal intentions, in a rural, Midwestern sample. The 15-session LST program (which is based on social cognitive/learning theory and problem behavior theory) was implemented during classroom periods by trained teachers using interactive teaching techniques. All seventh-grade students in 24 participating schools were recruited for participation in the study, and a total of 847 students were included in the growth curve analysis. The pretest, posttest, and follow-up assessments were conducted during the fall of the seventh grade, the spring of seventh grade, and the spring of eighth grade, respectively. The intervention significantly slowed the rate of increase in substance initiation and significantly slowed the rate of decrease in refusal intentions in both males and females. Notably, a stronger intervention effect was detected for females with regard to the rate of decrease in refusal intentions. Trudeau, L., Spoth, R., Lillehoj, C., Redmond, C., and Wickrama, K.A.S. Effects of a Preventive Intervention on Adolescent Substance Initiation, Expectancies, and Refusal Intentions. Prevention Science, 4(2), pp. 109-122, 2003.

Outcomes from the Child Development Project

The Child Development Project is a longitudinal, multisite study that examines the development of aggressive behavior disorders in children and adolescents. Families were recruited in two cohorts in 1987 and 1988 at three sites: Nashville, TN, Knoxville, TN, and Bloomington, IN. The original sample included 585 youths and their families. Results from several recent secondary data analyses are presented:

Neighborhood Structure, Parenting Processes, and Externalizing Behaviors
Associations among neighborhood structure, parenting processes, and the development of externalizing behavior problems were examined among youth age 11 to 13. Hierarchical linear modeling revealed that less parental monitoring was associated with more externalizing behavior problems at age 11, and more unsupervised time spent out in the community and less positive parental involvement were associated with increases in externalizing behavior at ages 12 and 13. The decrease in externalizing levels associated with more parental monitoring was significantly more pronounced when youths lived in neighborhoods with more residential instability. Beyers, J.M., Bates, J.E., Pettit, G.S. and Dodge, K.A. Neighborhood Structure, Parenting Processes, and the Development of Youths' Externalizing Behaviors: A Multilevel Analysis. American Journal of Community Psychology, 31, pp. 35-53, 2003.

Social Rejection and Antisocial Behavior
With a series of ANOVA models and path analysis, this paper examined the relationship between social rejection and growth in antisocial behavior over time. Several findings of note were reported. First, early peer rejection predicted growth in aggression over time. Second, early aggression moderated the effect of rejection, such that rejection exacerbated antisocial development only among children initially disposed toward aggression. Third, social information processing patterns were found to mediate partially the effect of early rejection on later aggression. Dodge, K.A., Lansford, J.E., Salzer Burks, V., Bates, J.E., Pettit, G.S., Fontaine, R. and Price, J.M. Peer Rejection and Social Information-Processing Factors in the Development of Aggressive Behavior Problems in Children. Child Development, 74, pp. 374-393, 2003.

Father Absence and Risk for Early Sexual Activity and Teenage Pregnancy
The impact of father absence on early sexual activity and teenage pregnancy was investigated in longitudinal studies in the United States and New Zealand. In both studies girls were studied prospectively from age 5 until age 18. Results from both datasets revealed that greater exposure to father absence was strongly associated with elevated risk for early sexual activity and adolescent pregnancy. After controlling for important covariates, there was a stronger and more consistent relationship between father absence and early sexual activity and teenage pregnancy than on other behavioral and mental health problems or academic achievement. Ellis, B.J., Bates, J.E., Dodge, K.A., Fergusson, D.M., Horwood, L.J., Pettit, G.S. and Woodward, L. Does Father Absence Place Daughters at Special Risk for Early Sexual Activity and Teenage Pregnancy? Child Development, 74, pp. 801-821, 2003.

Parents' Monitoring-Relevant Knowledge and Adolescents' Delinquent Behavior
This study examined relationships between parental knowledge and adolescent delinquent behavior over a period of 4 years beginning at age 14. Results showed that parental monitoring-relevant knowledge was negatively correlated with delinquent behaviors at baseline and increases over time in such knowledge were negatively correlated with increases in parent-reported delinquent behavior. Reciprocal correlations may indicate that low levels of parental knowledge predict increases in delinquent behavior and that high levels of delinquent behavior predict decreases in knowledge. Laird, R.D., Pettit, G.S., Bates, J.E. and Dodge, K.A. Parents' Monitoring-Relevant Knowledge and Adolescents' Delinquent Behavior: Evidence of Correlated Developmental Changes and Reciprocal Influences. Child Development, 74, pp. 752-768, 2003.

Gender Identity, Ethnicity, Acculturation, and Drug Use Among Adolescents in the Southwest

This article presents the findings of a survey completed by 1,351 predominantly Mexican-American middle school students residing in a large urban center in the U.S. Southwest. The study explored associations between drug use attitudes and behaviors and biological sex, gender identity, ethnicity and acculturation status. Based on the concepts of machismo and marianismo that have been used to describe Mexican populations, four dimensions of gender identity were measured: aggressive masculinity, assertive masculinity, affective femininity and submissive femininity. In explaining a variety of indicators of drug use behaviors and anti-drug norms, biological sex alone had limited explanatory power, while gender identity--often regardless of biological sex--was a better predictor. Aggressive masculinity was generally associated with higher risk of drug use, while the other three gender identity measures had selected protective effects. However, the impact of gender identity was strongly mediated by acculturation. Less acculturated Mexican-American students reported lower aggressive masculinity scores than non-Latinos. Less acculturated Mexican-American girls reported both the lowest aggressive masculinity scores and the highest submissive femininity scores. More acculturated Mexican-American students, along with the less acculturated Mexican-American boys, did not appear to be following a polarized approach to gender identity (machismo and marianismo), as was expected. The findings suggest that some aspects of culturally prescribed gender roles can have a protective effect against drug use behaviors and attitudes, possibly for both girls and boys. Kulis, S. Marsiglia, F.F., and Hurdle, D. Gender Identity, Ethnicity, Acculturation and Drug Use: Exploring Differences among Adolescents in the Southwest. Journal of Community Psychology, 31(2), pp. 167-188, 2003.

Effects of Ethnic Pride and Biculturalism on Drug Use Norms of Urban American Indian Adolescents

This study examined how strength of ethnic identity, multiethnic identity, and other indicators of biculturalism relate to the drug use norms of urban American Indian middle school students. Following the focus theory of norms, different categories of norms that may impact drug use are distinguished. Regression analysis of self-reports by 434 American Indian 7th graders attending middle schools in a large southwestern U.S. city show that those with a more intense sense of ethnic pride adhere more strongly to certain anti-drug norms, while those with negative feelings toward their ethnic or racial heritage have more permissive norms toward drug use. Compared to multi-ethnic American Indian students, those claiming only an American Indian identity report less certainty that they would refuse potential drug offers. Those who speak a language other than English with family and friends at least occasionally report that fewer of their friends are drug users. While American Indian students with better grades in school hold consistently stronger anti-drug norms, there are few differences by gender, socioeconomic status, or age. Kulis, S., Napoli, M. and Marsiglia, F.F. Ethnic Pride, Biculturalism, and Drug Use Norms of Urban American Indian Adolescents in the Southwest. Social Work Research, 26(2), pp. 101-112, 2002.