Pathways to adult marijuana and cocaine use: a prospective study of African Americans from age 6 to 42

Association Between Religiosity and Spirituality and Cocaine Use: A Systematic Review

Previous literature has evidenced a possible impact on health, mental health, and health-related faith behaviors due to the effects of an individual's spiritual dimension. The aim of this study is to collect and summarize all current data from observational studies regarding the association between religiosity or spirituality (R/S) and cocaine use (CU). A systematic literature search of analytical observational studies on the association between religiosity or spirituality and the use of cocaine was performed in PubMed and Scopus databases. Twenty observational studies were included in this review. Fifteen of the twenty observational studies found that a higher level of religiosity was associated with lower lifetime and actual cocaine use, both in adults and adolescents. However, one study conducted in a sexual minorities sample found that higher religiosity-measured as frequency of private religious activities such as prayer-was associated with a higher probability of cocaine use. Two studies found no evidence of any association between religiosity and cocaine use, and two found mixed results. This review found a possible protective role of religiosity on cocaine use, even if the cross-sectional nature of the greater part of the studies prevented drawing any casual relation. Future studies with a longitudinal approach are required. However, the support of activities aimed at broadening a religious attitude and beliefs could result in creating an environment protective for young people against cocaine use.

Racial, Ethnic, and Regional Disparities in Cocaine-Involved Overdose Deaths in the US, 1999-2020

BACKGROUND

Social inequalities among underrepresented communities may lead to higher overdose mortality involving cocaine use. We assessed the temporal trends in cocaine-involved overdose mortality rate in the US by race, ethnicity, and geographic region from 1999 to 2020.

METHODS

We conducted a cross-sectional study among adults in the US using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (1999 to 2020). To identify cocaine-involved overdose decedents, we used the International Classification of Diseases Code, 10th Revision-T40.5. We used Joinpoint regression to examine the trends in age-adjusted cocaine-involved overdose mortality rates (AAMR) by race, ethnicity, and geographic region and estimated annual percentage changes (APC).

RESULTS

Overall, cocaine-involved overdose mortality trends increased (APC, 11.3%; 95% CI, 0.6, 23.2) from 2017 to 2020. The latest trends have remained stable among Non-Hispanic Whites since 2017 (APC, 4.3%; 95% CI, -5.7%, 15.4%) but have significantly increased among Non-Hispanic Blacks (APC, 27.2%; 95% CI, 22.1%, 32.5%), Hispanics (APC, 26.9%; 95% CI, 20.6%, 33.5%), and American Indians/Alaska Natives (APC, 24.1%; 95% CI, 16.5%, 32.2%).

CONCLUSION

Cocaine-related overdose deaths in the US significantly increased between 2017 and 2020, but the increase was among racial and ethnic minorities and not among Non-Hispanic Whites. These findings suggest a need to address the US' longstanding racial and ethnic healthcare inequities.

Cohort Profile: The Woodlawn Study

The Woodlawn Study is an epidemiologically- defined community cohort study of 1242 Black Americans (51% female and 49% male), who were in first grade in 1966-67 in Woodlawn, a neighborhood of Chicago, Illinois. The study comprises extensive interview data over the life course including self-, mother-, and/or teacher-reported assessments at ages 6, 16, 32, 42, and 62 (in progress), administrative records (i.e., education, crime, and death records), and census data. These data cover a wide range of focal areas across the life course, including family environment, socioeconomic indicators, education, social integration (e.g., marriage, community engagement, religious involvement) and social support, employment, racial discrimination, substance use, crime/victimization, and mental and physical health, including mortality. Over the past 50 years, Woodlawn research has mapped cumulative disadvantage, substance use, and criminal offending and has identified key risk and protective factors of adversity, resilience, and success across the full life course. In turn, these findings have informed life course theory and policy for a population that experiences significant criminal and health disparities.

Prevalence and risk factors associated with psychostimulant use among Black individuals: A meta-analysis and systematic review

BACKGROUND

Psychostimulants (e.g., cocaine, amphetamine) are among the most widely used drugs globally with detrimental short and long-term physical, psychological and social consequences. There is limited data on psychostimulant use for various racial and ethnic groups, including Black people, and the challenges they face living as minorities overcoming historical challenges including increased incarceration associated with drug possession.

METHODS

Peer-reviewed articles were identified in five databases (APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, MEDLINE). Eligible studies were published in French or English, provided empiral data on psychostimulant use in Black individuals living in a minority context. The PRISMA guideline was used for structuring the review. Random-effects meta-analyses were generated to estimate the pooled prevalence of lifetime and periodic psychostimulant use among Black individuals using STATA 16.

RESULTS

Sixty-three studies published from 1991 to 2022 with a sample size of 139,683 Black individuals were included in the current meta-analysis. Results indicate a pooled prevalence estimate of 11.4% for any form of psychostimulant use among Black individuals. The pooled prevalence estimates were 12.4% (95% CI, 8.4% - 16.4%) for cocaine, 8.3% (95% CI, 0% - 19.1%) for amphetamines, and 11.4% (95% CI, 4.6% - 18.1%) for other stimulants. Prediction intervals for all psychostimulant types were highly heterogenous ranging from 0% to as high as 51.2% for amphetamine suggesting prevalence of use in some studies of Black people could be found to be as low as zero. Subgroup analyses were conducted to examine differences between age groups, gender, reference period, and type of assessment.

CONCLUSIONS

High prevalence rates of psychostimulant use among Black people argues for greater access to evidence-based treatments. However, current psychosocial interventions are suboptimal, warranting further study. Consideration needs to be given to the challenges of the large range of prediction intervals, living in urban areas, racial discrimination experiences, race-based stress, and sociodemographic characteristics, including poverty, education level, age, gender.

Adolescent Marijuana Dependence: The Role of Social Bonds and Social Learning Theory

Using the 2017 National Survey of Drug Use and Health (NSDUH) data, this research examines the extent to which social bonds and social learning theory predict adolescent marijuana dependence. Full information maximum likelihood (FIML) for logistic regression analyses were conducted in four models to test the competing theories. The results revealed partial support for both theories, such that adolescents with stronger parental bonds and negative definitions of substance use were less likely to be dependent on marijuana, while adolescents who associated with substance using peers were more likely to be dependent on marijuana. The multi-theoretical model suggested that only the social learning theory concepts of differential association and negative definitions were significant theoretical predictors of adolescent marijuana dependence. Additional analyses revealed that first using marijuana at 14 or 15 years old was also significantly related to adolescent marijuana dependence. Implications for future research and risk prevention programs are discussed.

Physical and psychosocial factors associated with psychostimulant use in a nationally representative sample of French adolescents: Specificities of cocaine, amphetamine, and ecstasy use

PURPOSE

Patterns of psychostimulant (PST) use, psychological and physical factors, and family relationships were investigated in a nationally representative sample of adolescents. The differences between users of cocaine (Cc), ecstasy/MDMA, and amphetamine (EA) were analyzed, taking into account gender differences.

METHODS

Substance use, psychological factors (lifetime suicide attempts, suicidal thoughts in the previous year, visits to a mental health professional), physical factors (health and body shape perceptions (BSP), body mass index (BMI)), and family relationships (existence of disagreements with parents, relationships with mother and father) were investigated in 26,351 17-year-old French adolescents.

RESULTS

Lifetime suicidal behavior was strongly associated with EA use only. Suicidal ideation in the previous year was associated with Cc use among both boys and girls and associated with EA use among girls. Compared to Cc users, more EA users were overweight, while more Cc users were underweight compared to EA users. BSP, BMI, and EA use were related in girls only. Having a good or very good relationship with both mother and father was negatively associated with Cc use in boys and girls. Girls who had a good or very good relationship with their fathers seemed to be less prone to use EA. Boys with a good or very good relationship with their mothers seemed to be less prone to use EA.

CONCLUSION

The results of the present study could serve as a basis for prevention and harm reduction strategies/programs targeting youth use and for the adaptation of these strategies/programs according to substance and gender.

Sociodemographic, neighborhood, psychosocial, and substance use correlates of cocaine use among Black adults: Findings from a pooled analysis of national data

OBJECTIVE

Cocaine use (CU) is serious a public health issue affecting U.S. adults, including Blacks. Cocaine-related overdose deaths have also trended upwards among this population. However, there remains a lack of research on correlates of CU among a nationally representative sample of Black adults.

METHODS

The current study examines the prevalence and correlates of past-year CU among Black adults aged 18 and older (N = 9,821). Data from the National Survey on Drug Use and Health (2015-2016) were used and a weighted logistic regression model was estimated.

RESULTS

Findings showed 2.4% of Black adults reported past-year CU-significantly higher than rates of CU among other assessed racial groups. Opioid use/misuse, encounters with drug dealers, easier access to cocaine, unemployment, and being 35 or older were associated with increased odds of CU. Greater risk perception of CU and religiosity were associated decreased odds of CU.

CONCLUSION

Results identified several correlates associated with past-year CU among Black adults. Findings suggest addressing CU among this population will likely require the development of multilevel prevention and intervention strategies and an increased focus on opioid use/misuse as opioids have been recently implicated in cocaine-related overdose deaths.

Substance Use and Obesity Trajectories in African Americans Entering Adulthood

INTRODUCTION

The transition to adulthood can be stressful for minority adolescents, and many may cope through unhealthy behaviors, including substance use and obesity-related behaviors. This study tested substance use and obesity trajectories over time in African American youth, longitudinal associations of trajectories with mental and physical health in adulthood, and whether self-control and sex predict trajectories.

METHODS

Two longitudinal studies of 516 and 992 African American adolescents. In Study 1, substance use and obesity trajectories were assessed from ages 19 to 25 years. At age 25 years, internalizing and externalizing problems, metabolic syndrome, and inflammatory biomarkers were measured. In Study 2, substance use and obesity trajectories were assessed from ages 17 to 29 years. Depression, delinquency, diabetes, blood pressure, and inflammatory biomarkers were measured at age 29 years. Data analyses were conducted in 2017.

RESULTS

Across both studies, the majority of African American adolescents evinced poor health behavior trajectories (latent class growth analyses), with 23%-27% showing increasing substance use over time, 18%-27% showing increasing obesity over time, and 9%-11% showing increases in both. ANCOVAs for trajectory analyses revealed that males were more likely to evince increasing substance use, with females more likely to show increasing obesity. Substance use trajectories were associated with poorer mental health in adulthood; obesity trajectories with poorer physical health in adulthood. Those with good health behavior trajectories had higher self-control in early adolescence.

CONCLUSIONS

The transition to adulthood is a vulnerable period for many African Americans. Given the commonalities of substance use and obesity in their rewarding/stress-relieving properties, similar prevention efforts may help stem the rise of both in these youth.

Predictors of initiation of nicotine, alcohol, cannabis, and cocaine use: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND AND OBJECTIVES

There may be substantial overlap in the risk factors for substance use and substance use disorders (SUD). Identifying risk factors for substance use initiation is essential for understanding the etiology and natural history of SUD and to develop empirically-based preventive interventions to reduce initiation.

METHODS

Analyses were done on Wave 1 participants of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n = 43,093). Estimates of the cumulative probability of substance use initiation were obtained separately for nicotine, alcohol, cannabis, and cocaine. Survival analyses with time-varying covariates were implemented to identify risk factors for substance initiation.

RESULTS

The lifetime cumulative probabilities of substance initiation were 45.5% for nicotine, 82% for alcohol, 19.6% for cannabis, and 6.4% for cocaine. Among respondents with lifetime nicotine use, 50% had used it by age 15.3, whereas for alcohol, cannabis, and cocaine the respective ages were 17.8, 16.6, and 19.8. Previous use of another substance, being male, having a cluster B personality disorder, family history of SUD, and being separated, divorced, or widowed increased the risk of use of all the substances assessed, whereas social anxiety disorder and some personality disorders were associated with specific substances.

DISCUSSION AND CONCLUSIONS

Although the age of substance use initiation varies by substance, in more than 50% of cases initiation of use occurs in the first two decades of life. Although most risk factors for substance use initiation are common across substances, some are substance-specific.

SCIENTIFIC SIGNIFICANCE

This information may help in the development of empirically-based preventive interventions. (Am J Addict 2018;27:477-484).

Social influences on health-related behaviour clustering during adulthood in two British birth cohort studies

Building upon evidence linking socio-economic position (SEP) in childhood and adulthood with health-related behaviours (HRB) in adulthood, we examined how pre-adolescent SEP predicted membership of three HRB clusters: "Risky", "Moderate Smokers" and "Mainstream" (the latter pattern consisting of more beneficial HRBs), that were detected in our previous work. Data were taken from two British cohorts (born in 1958 and 1970) in pre-adolescence (age 11 and 10, respectively) and adulthood (age 33 and 34). SEP constructs in pre-adolescence and adulthood were derived through Confirmatory Factor Analysis. Conceptualised paths from pre-adolescent SEP to HRB cluster membership via adult SEP in our path models were tested for statistical significance separately by gender and cohort. Adult SEP mediated the path between pre-adolescent SEP and adult HRB clusters. More disadvantaged SEP in pre-adolescence predicted more disadvantaged SEP in adulthood which was associated with membership of the "Risky" and "Moderate Smokers" clusters compared to the "Mainstream" cluster. For example, large positive indirect effects between pre-adolescent SEP and adult HRB via adult SEP were present (coefficient 1958 Women = 0.39; 1970 Women = 0.36, 1958 Men = 0.51; 1970 Men = 0.39; p < 0.01) when comparing "Risky" and "Mainstream" cluster membership. Amongst men we found a small significant direct association (p < 0.001) between pre-adolescent SEP and HRB cluster membership. Our findings suggest that associations between adult SEP and HRBs are not likely to be pre-determined by earlier social circumstances, providing optimism for interventions relevant to reducing social gradients in HRBs. Observing consistent findings across the cohorts implies the social patterning of adult lifestyles may persist across time.

Influência do grupo de pares e uso de drogas ilícitas entre adolescentes brasileiros: um estudo transversal

O estudo teve como objetivo examinar o uso de drogas ilícitas e as associações com fatores socioeconômicos e influência do grupo de pares entre adolescentes brasileiros de 15 a 19 anos de idade. Foi adotada uma amostra de clusters em dois estágios, com a seleção aleatória de escolas públicas e privadas entre os nove distritos administrativos de uma capital de estado, e a seleção aleatória de turmas em cada escola. A variável de desfecho foi o uso de drogas ilícitas, medido pela seguinte pergunta: “Você já usou drogas ilícitas (maconha, inalantes, hipnóticos, cocaína/crack, alucinógenos, anfetaminas e/ou opióides) alguma vez na vida?”. Os grupos de pares foram classificados como: escola, família, atividades religiosas e esportes/cultura. O nível socioeconômico foi avaliado com o Índice de Vulnerabilidade em Saúde (IVS) baseado em área. Foram analisados os dados de 91 adolescentes com o teste do qui-quadrado e regressão logística. A proporção global de uso de drogas ilícitas foi 15,2%. A heterogeneidade por gênero dentro de grupos (OR = 3,14; IC95%: 1,63-6,06), amizades baseadas em religião (OR = 0,36; IC95%: 0,17-0,75) e amizades baseadas em esportes/cultura (OR = 0,44; IC95%: 0,22-0,87) permaneceram associadas significativamente com o uso de drogas ilícitas. Os adolescentes que residiam em áreas menos vulneráveis mostraram maior probabilidade de uso de drogas ilícitas, quando comparados aos jovens em áreas mais vulneráveis. As amizades baseadas em religião e esportes/cultura parecem ter um efeito protetor contra o uso de drogas ilícitas. A heterogeneidade de gênero dentro de grupos e a residência em áreas menos vulneráveis aumentaram as chances de uso de drogas ilícitas por adolescentes.

Trends and correlates of cocaine use and cocaine use disorder in the United States from 2011 to 2015

BACKGROUND

Recent epidemiological data suggest a resurgence in cocaine use (CU) and cocaine-related problems in the United States. Demographic trends and correlates of problem CU are needed to determine potential factors that may be influencing the increased trend and to inform targeted prevention and intervention strategies.

METHODS

Trends in any past-year CU, weekly CU, and cocaine use disorder (CUD) were examined among persons aged ≥12 years using the National Survey on Drug Use and Health from 2011 to 2015. Logistic regression analyses were used to determine correlates of past-year and weekly CU and CUD among adolescents and adults.

RESULTS

The prevalence of past-year CU from 2011 to 2015 increased among females, ages 18-25, ages ≥50, non-Hispanic Blacks, and persons reporting low income, past-year tobacco use, past-year alcohol use, and past-month binge and heavy alcohol use. The prevalence of weekly CU increased among persons aged ≥50 years and persons reporting past-month heavy alcohol use. A significant increase in the prevalence of CUD was only found among persons aged ≥50 years. Adjusted logistic regression showed that older age, large metropolitan residence, past-year tobacco, alcohol, cannabis, and heroin use, and major depressive episode were associated with increased odds of CU or CUD among both adolescents and adults; however, sex and race/ethnicity correlates differed among adolescents and adults.

CONCLUSIONS

Findings have implications for increased monitoring of CU-related indicators among some high-risk groups, such as females, older adults, Blacks, and polysubstance users. Targeted screening and intervention strategies among these population subgroups may be needed.

The role of young adult social bonds, substance problems, and sexual risk in pathways between adolescent substance use and midlife risky sexual behavior among urban African Americans

African Americans are disproportionately affected by HIV/AIDS and other sexually transmitted infections relative to other racial groups. Although substance use has been linked to risky sexual behavior, the understanding of how these associations develop over the life course remains limited, particularly the role of social bonds. This study uses structural equation modeling to examine pathways from adolescent substance use to young adult sexual risk, substance problems, and social bonds and then to midlife risky sexual behavior among African American men and women, controlling for childhood confounders. Data come from 4 assessments, 1 per developmental period, of a community-based urban African American cohort (N = 1,242) followed prospectively from ages 6 to 42 years. We found that greater adolescent substance use predicts greater young adult substance problems and increased risky sexual behavior, both of which in turn predict greater midlife sexual risk. Although greater adolescent substance use predicts fewer young adult social bonds for both genders, less young adult social bonding is unexpectedly associated with decreased midlife risky sexual behavior among women and not related for men. Substance use interventions among urban African American adolescents may have both immediate and long-term effects on decreasing sexual risk behaviors. Given the association between young adult social bonding and midlife risky sex among females, number of social bonds should not be used as a criterion for determining whom to screen for sexual risk among African American women. Future studies should explore other aspects of social bonding in linking substance use and risky sexual behavior over time. (PsycINFO Database Record

Religious Coping and Substance Use: The Moderating Role of Sex

The objectives of this study were to ascertain whether positive and negative religious coping are associated with substance use and to determine whether sex moderates this association. This study utilized a cross-sectional design and examined 349 undergraduate students (103 males and 246 females) at a midsize southeastern university. Participants completed a demographic questionnaire, the Brief RCOPE, and the Drinking and Drug Habits Questionnaire. Results revealed a positive association between negative religious coping and substance use only for males. While positive religious coping was significantly negatively associated with substance use, sex did not moderate this association. These results suggest that males may be especially vulnerable to engaging in substance use when utilizing negative religious coping. It may be important for university counseling centers to be cognizant of the types of religious coping used by students, as well as sex differences regarding the association between negative religious coping and substance use.

Childhood academic ability in relation to cigarette, alcohol and cannabis use from adolescence into early adulthood: Longitudinal Study of Young People in England (LSYPE)

OBJECTIVES

Our aim was to determine the association between childhood academic ability and the onset and persistence of tobacco, alcohol and cannabis use across adolescence in a representative sample of English schools pupils. Previous research has produced conflicting findings.

DESIGN

Data from 7 years of the Longitudinal Study of Young People in England (LSYPE), 2004-2010 (age 13/14-19/20).

SETTING

Self-completion questionnaires during home visits, face-to-face interviews and web-based questionnaires.

PARTICIPANTS

Data from 6059 participants (3093 females) with information on academic ability around age 11 and health behaviours from age 13/14 to 16/17 (early adolescence) and from age 18/19 to 19/20 (late adolescence).

OUTCOME MEASURES

Regularity of cigarette smoking, alcohol drinking and cannabis use from early to late adolescence.

RESULTS

In multinomial logistic regression models adjusting for a range of covariates, the high (vs low) academic ability reduced the risk of persistent cigarette smoking (RR=0.62; CI 95% 0.48 to 0.81) in early adolescence. High (vs low) academic ability increased the risk of occasional (RR=1.25; CI 95% 1.04 to 1.51) and persistent (RR=1.83; CI 95% 1.50 to 2.23) regular alcohol drinking in early adolescence and persistent (RR=2.28; CI 95% 1.84 to 2.82) but not occasional regular alcohol drinking in late adolescence. High (vs low) academic ability was also positively associated with occasional (RR=1.50; CI 95% 1.22 to 1.83) and persistent (RR=1.91; CI 95% 1.57 to 2.34) cannabis use in late adolescence.

CONCLUSIONS

In a sample of over 6000 young people in England, high childhood academic at age 11 is associated with a reduced risk of cigarette smoking but an increased risk of drinking alcohol regularly and cannabis use. These associations persist into early adulthood, providing evidence against the hypothesis that high academic ability is associated with temporary 'experimentation' with substance use.

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

Background

Exposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.

Objectives

To synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.

Design

(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.

Settings

North America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.

Participants

A total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.

Interventions

Psychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.

Main outcome measures

Internalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.

Data sources

MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.

Review methods

A narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.

Results

The evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly < 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.

Conclusions

The evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.

Future work recommendations

There is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.

Study registration

This study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.

Funding

The National Institute for Health Research Public Health Research programme.

Life Course Pathways of Economic Hardship and Mobility and Midlife Trajectories of Health

We utilize over 40 years of prospective data from the Panel Study of Income Dynamics (N = 1,229) and repeated-measures latent class analysis to examine how long-term patterns of stability and change in economic hardship from childhood to adulthood are related to subsequent trajectories of midlife health. We review conceptual and methodological approaches to examining health inequality across the life course and highlight the contribution of a person-centered, disaggregated approach to modeling health and its association with long-term pathways of economic resources, including changing resources associated with mobility. Findings suggest those who experienced early mobility out of economic hardship were less likely than those in persistent economic hardship to experience a high-risk health trajectory, while experiencing later mobility did not lessen this risk. We conclude with a call for further investigation into the role of social mobility and the timing, degree, and direction of change in investigations of health inequality.

Pathways from Early Childhood Adversity to Later Adult Drug Use and Psychological Distress: A Prospective Study of a Cohort of African Americans

Drawing on the life course perspective, this research addresses the direct and indirect pathways between childhood adversity and midlife psychological distress and drug use across a majority of the life span in an African American cohort (N = 1,242) followed from age 6 to 42 (1966 to 2002). Results from structural equation models highlight the impact of low childhood socioeconomic status (SES), poor maternal mental health, and the role of first-grade maladaptation in launching a trajectory of social maladaptation from age 6 to 42. Specifically, for men, we found a direct pathway from early low SES to drug use in mid adulthood and an indirect pathway to psychological distress through first-grade maladaptation and adolescent poor mental health. For females, early SES affected first-grade maladaptation and low school bonds, which then predicted later drug use.

Psychosocial determinants of marijuana use among African American youth

This study examines the psychosocial determinants of marijuana use among youth. A total of 7,488 African American middle and high school students from 133 metropolitan private and public schools completed a survey assessing psychosocial factors associated with annual marijuana use. The PRIDE survey, a nationally recognized survey on substance use, was used to assess the frequency of marijuana use and the influence of psychosocial factors on marijuana use among African American students. Results indicated that 18.5% of African American youth used marijuana in the past year. Males were significantly more likely than females to report using marijuana. Engaging in risky behaviors, such as getting in trouble at school and with police and attending a party with alcohol and other drugs, were significantly correlated with annual marijuana use. Conversely, having multiple parent, teacher, and school protective factors reduced annual marijuana use in this population. Such findings may assist prevention specialists in developing interventions to reduce and prevent marijuana use.

Does depression and substance abuse co-morbidity affect socioeconomic status? Evidence from a prospective study of urban African Americans

Studies have established a graded association between mental health and socioeconomic status (SES). However, scarce research has examined the impact of substance use disorders (SUD) and depression comorbidity on SES. We use data from the Woodlawn Study, a longitudinal cohort study, which recruited a cohort of first graders from Chicago starting 1966-1967 (N=1242). Analyses focus on those interviewed in young adulthood and followed up through midlife. Regression analyses adjusting for childhood confounders showed that young adults with depression and SUD comorbidity had higher likelihood of having any periods of unemployment, higher likelihood of being unemployed for 3 or more months, and lower household income in midlife than those with neither disorder. Moreover, young adults with SUD without depression had higher odds of having any periods of unemployment and higher odds of being unemployed for 3 or more months than those with neither disorder. Findings point to the possibility of social selection where depression and SUD comorbidity contributes to a downward drift in SES. Clinical interventions that integrate the treatment of SUD and depression may be more effective at reducing socioeconomic disparities among minority populations.

Validity and Reliability Evidence of the TOCA–C in a Sample of Greek Students

Validity and reliability evidence of the Teacher Observation of Classroom Adaptation–Checklist (TOCA–C) was examined in 186 Greek students through exploratory factor analysis, divergent and concurrent validity, internal consistency, and test-retest reliability. The TOCA–C showed a high internal consistency for the three factors of Concentration Problems, Disruptive/Aggressive Behaviour, and Prosocial Behaviour (αs = .89−.96), and acceptable two-week test-retest reliability. The three-factor solution explained 74.50% of the total variance. Regarding divergent validity, a significant Sex × Disability interaction was evident for Disruptive Behaviour, with women scoring higher in ‘special’ and lower in ‘general’ schools compared to men. Main effects were significant across disability, but not across sex. Correlations with the Strengths and Difficulties Questionnaire suggested convergent and divergent validity evidence. The TOCA–C should be useful in testing Greek students with and without disabilities.

Do the adult criminal careers of African Americans fit the "facts"?

PURPOSE

A major gap in the criminal career research is our understanding of offending among African Americans, especially beyond early adulthood. In light of this gap, this study describes the criminal career patterns of a cohort of African American males and females.

METHODS

This paper uses official criminal history data spanning ages 17 to 52 from the Woodlawn Study, a community cohort of 1,242 urban African American males and females. We use basic descriptive statistics as well as group-based modeling to provide a detailed description of the various dimensions of their adult criminal careers.

RESULTS

We find cumulative prevalence rates similar to those for African Americans from national probability sample estimates, yet participation in offending extends farther into midlife than expected with a substantial proportion of the cohort still engaged in offending into their 30s.

CONCLUSIONS

The descriptive analyses contribute to the larger body of knowledge regarding the relationship between age and crime and the unfolding of the criminal career for African American males and females. The applicability of existing life course and developmental theories is discussed in light of the findings.

Examining moderation analyses in propensity score methods: application to depression and substance use

OBJECTIVE

This study provides guidance on how propensity score methods can be combined with moderation analyses (i.e., effect modification) to examine subgroup differences in potential causal effects in nonexperimental studies. As a motivating example, we focus on how depression may affect subsequent substance use differently for men and women.

METHOD

Using data from a longitudinal community cohort study (N = 952) of urban African Americans with assessments in childhood, adolescence, young adulthood, and midlife, we estimate the influence of depression by young adulthood on substance use outcomes in midlife, and whether that influence varies by gender. We illustrate and compare 5 different techniques for estimating subgroup effects using propensity score methods, including separate propensity score models and matching for men and women, a joint propensity score model for men and women with matching separately and together by gender, and a joint male/female propensity score model that includes theoretically important gender interactions with matching separately and together by gender.

RESULTS

Analyses showed that estimating separate models for men and women yielded the best balance and, therefore, is a preferred technique when subgroup analyses are of interest, at least in this data. RESULTS also showed substance use consequences of depression but no significant gender differences.

CONCLUSIONS

It is critical to prespecify subgroup effects before the estimation of propensity scores and to check balance within subgroups regardless of the type of propensity score model used. RESULTS also suggest that depression may affect multiple substance use outcomes in midlife for both men and women relatively equally.

Neighbourhood structural characteristics and crack cocaine use: exploring the impact of perceived neighbourhood disorder on use among African Americans

BACKGROUND

Crack cocaine use and associated negative social and health consequences remain a significant public health problem. Research that expands beyond the individual by considering the environmental context as a determinant of cocaine use is growing. The main objectives of this paper are to examine the effects of perceived neighbourhood disorder as an independent correlate of the frequency of recent crack cocaine use and whether its impact is mediated by use-related practices and social context of use among an African American adult sample in Atlanta (GA).

METHODS

Cross-sectional data were collected from 461 respondents who were recruited through active and passive community outreach from 70 disadvantaged urban neighbourhoods across Atlanta. Multivariable negative binomial regression was performed to assess the independent association of perceived neighbourhood disorder with crack cocaine use frequency and to explore potential mediation by use-related practices and social context of use.

RESULTS

Perceived neighbourhood disorder did not remain statistically significant after accounting for use-related practices and social context of use. Involvement in drug distribution and having traded sex were associated with increases in frequency of drug use, while using in safer places and using alone were associated with decreases in frequency of use.

CONCLUSION

The results show that perceived neighbourhood disorder is associated with frequency of crack cocaine use independently of socio-demographics. However, its significance was eliminated when controlling for use-related practices and the social context of use. Such practices and the social context of use may mediate the relationship between neighbourhood disorder and crack cocaine use. Future research is needed to more fully elucidate the links between individual and neighbourhood characteristics that are related to crack cocaine use and strategies to reduce use must consider the salience of use-related practices and the social context of use.

Demographic and socioeconomic correlates of powder cocaine and crack use among high school seniors in the United States

OBJECTIVES

Rates of powder cocaine and crack use have fluctuated among adolescents over recent decades. Little attention has been paid to recent trends, particularly regarding differences between users of powder cocaine and crack-two forms of the substance that are commonly reported together as "cocaine" use, despite having different effects and rates of adverse outcomes.

METHODS

We examined data from nationally representative samples of high school seniors who participated in the Monitoring the Future study during years 2005-2011 (weighted N = 65 717).

RESULTS

Many demographic and socioeconomic variables were similarly correlated with lifetime use of powder cocaine and crack. Income of >$50/week from job increased the odds for use, and income of >$50/week from sources other than a job more than doubled the odds for use. High religiosity, high parent education, identifying as black, and residing with one or two parents reduced odds for use. Hispanic students were at higher odds for use of crack and females were at lower odds for using powder cocaine. Among cocaine users, residing with one or two parents lowered odds for using both forms, and more religious students and Hispanics were at higher odds for crack-only use.

CONCLUSIONS

Those interested in preventing initiation and adverse consequences of cocaine use should take into account the overlapping, yet different risk profiles of powder cocaine and crack users when developing programming. This is particularly important when considering differences in legal consequences for these pharmacologically similar forms of cocaine.

Probability and predictors of remission from life-time prescription drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

While prescription drug use disorders (PDUD) has become an important and growing public health problem, little is known about their course. This study aims to estimate cumulative probability of remission from sedatives, tranquilizers, opioids and stimulants, and to identify predictors of remission across substances. Analyses were done for the sub-sample of individuals with lifetime history of abuse or dependence on sedatives (n = 402), tranquilizers (n = 372), opioids (n = 521), and stimulants (n = 765) at Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Cumulative probability estimates and hazard ratios for remission from PDUD were obtained for the general population. Lifetime cumulative probability estimates of remission were above 96% for all substances assessed. Half of the cases of PDUD remitted between 4 and 5 years after onset. Remission from PDUD was greater for younger individuals. Males exhibited lower hazards of remission for stimulants use disorder. A diagnosis of personality disorders decreased probability of remission for sedatives and stimulants. Only abuse or dependence on some prescription drugs decreased the probability of remission from other PDUD, whereas other drug disorders did not predict remission. A significant proportion of individuals with PDUD achieve remission at some point in their life-time. Predictors of remission were found to be mostly substance-specific rather than common across substances. The lower rates of remission among some subgroups of the population highlight the need to strengthen preventive and intervention efforts among vulnerable population subgroups.

Childhood and adolescent risk factors for comorbid depression and substance use disorders in adulthood

The comorbidity of major depression and substance use disorders is well documented. However, thorough understanding of prevalence and early risk factors for comorbidity in adulthood is lacking, particularly among urban African Americans. With data from the Woodlawn Study, which follows a community cohort of urban African Americans from ages 6 to 42, we identify the prevalence of comorbidity and childhood and adolescent risk factors of comorbid depression and substance use disorders, depression alone, and substance use disorders alone. Prevalence of comorbid substance use disorders and major depression in adulthood is 8.3% overall. Comorbidity in cohort men is twice that for women (11.1% vs. 5.7%). Adjusted multinomial regression models found few differences in risk factors for comorbidity compared to either major depression or a substance use disorder on its own. However, results do suggest distinct risk factors for depression without a substance use disorder in adulthood compared to a substance use disorder without depression in adulthood. In particular, low socioeconomic status and family conflict was related to increased risk of developing major depression in adulthood, while dropping out of high school was a statistically significant predictor of adult-onset substance use disorders. Early onset of marijuana use differentiated those with a substance use disorder with or without depression from those with depression without a substance use disorder in adjusted models. In conclusion, comorbid substance use disorders and depression are highly prevalent among these urban African Americans. Insight into the unique childhood and adolescent risk factors for depression compared to substance use disorders is critical to intervention development in urban communities. Results suggest that these programs must consider individual behaviors, as well as the early family dynamic.

A model of school problems, academic failure, alcohol initiation, and the relationship to adult heroin injection

The current study uses structural equation modeling to investigate factors associated with alcohol initiation and injection heroin use. Baseline data from the NEURO-HIV Epidemiologic Study in Baltimore, Maryland, were used. Participants were 404 injection heroin users (M(age) = 32.72) with a history of regular injection in their lifetime. Latent variables were created for self-reported school problems and academic failure. The final model indicated that greater school problems were associated with earlier alcohol initiation (ß = -0.22, p < .001) and earlier alcohol initiation was associated with greater frequency of recent heroin use (ß = -0.12, p < .05). Academic failure was directly related to greater frequency of recent heroin injection (ß = 0.15, p < .01). The results expand research investigating the relationship between adolescent behavior and illicit drug use in adulthood.

A prospective study of childhood and adolescent antecedents of homelessness among a community population of African Americans

Much is known about contemporaneous correlates of homelessness from studies of homeless individuals. However, few studies have prospectively examined early antecedents and prevalence of homelessness in community populations. We use data from a 35-year study of a community population of African Americans to examine relationships between homelessness and prior structural, family, school, and behavioral influences. Nearly 22% of males and 16% of females reported homelessness between ages 15 and 42, providing a rare estimate within an African American urban community population. In bivariate analyses, lower school bonds, depressed mood, violent behavior, and running away in adolescence are predictive for both males and females. Teen parenting and angry mood are unique influences for females, while for males, poor first grade classroom conduct and adolescent substance use are unique risks. In multivariate analyses, poor classroom conduct and weaker school bonds predict homelessness among males, while teen parenting does so for females. Running away before age 15 is strongly predictive of later homelessness for both males and females. These results reveal the relative influence of multiple, interrelated early risks on homelessness and confirm our hypothesis that factors linked to other poor outcomes also relate to homelessness, underscoring another benefit to early prevention efforts.

Antecedents and consequences of marijuana use trajectories over the life course in an African American population

BACKGROUND

We examined developmental trajectories of marijuana use among a cohort of urban African Americans followed from first grade to mid adulthood. We compared risk factors in childhood and adolescence and consequences in mid adulthood across trajectory groups.

METHODS

Using semiparametric group-based mixture modeling, five marijuana trajectories for men (n=455) and four trajectories for women (n=495) were identified extending from adolescence to young adulthood (age 32). We labeled the four trajectory groups similar for men and women "abstainers," "adolescent only users," "early adulthood decliners," and "persistent users." We named the unique fifth group for men "late starters."

RESULTS

Multivariate multinomial logistic regressions show that childhood problem behaviors, adolescent family involvement, and dropping out of high school differentiated trajectory membership. Analyses comparing the trajectory groups on behavioral, social, and health outcomes at age 42 revealed that for both men and women, those in the persistent trajectory had the most problems, and those in the early adult decliner group also had specific problems. Male late starters also had poor outcomes.

CONCLUSIONS

The findings point to the value of identifying specific patterns of substance use over the life course and understanding the differences in their correlates and consequences. The implications of these findings are discussed.

Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND

This study aims to estimate general and racial-ethnic specific cumulative probability of developing dependence among nicotine, alcohol, cannabis or cocaine users, and to identify predictors of transition to substance dependence.

METHODS

Analyses were done for the subsample of lifetime nicotine (n=15,918), alcohol (n=28,907), cannabis (n=7389) or cocaine (n=2259) users who participated in the first and second wave of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Discrete-time survival analyses were implemented to estimate the cumulative probability of transitioning from use to dependence and to identify predictors of transition to dependence.

RESULTS

The cumulative probability estimate of transition to dependence was 67.5% for nicotine users, 22.7% for alcohol users, 20.9% for cocaine users, and 8.9% for cannabis users. Half of the cases of dependence on nicotine, alcohol, cannabis and cocaine were observed approximately 27, 13, 5 and 4 years after use onset, respectively. Significant racial-ethnic differences were observed in the probability of transition to dependence across the four substances. Several predictors of dependence were common across the four substances assessed.

CONCLUSIONS

Transition from use to dependence was highest for nicotine users, followed by cocaine, alcohol and cannabis users. Transition to cannabis or cocaine dependence occurred faster than transition to nicotine or alcohol dependence. The existence of common predictors of transition dependence across substances suggests that shared mechanisms are involved. The increased risk of transition to dependence among individuals from minorities or those with psychiatric or dependence comorbidity highlights the importance of promoting outreach and treatment of these populations.

Quantification of the influence of friends and antisocial behaviour in adolescent consumption of cannabis using the ZINB model and data mining

Cannabis is the most consumed illegal drug in Europe and its repercussions are more important when taken up at an early age. The aim of this study is to analyse and quantify the predictive value of different personal, family and environmental variables on the consumption of cannabis in adolescence. The sample is made up of 9284 adolescents (47.1% boys and 52.9% girls) with an average age of 15.59 years (SE=1.17). The ZINB model highlights, as factors that increase the number of joints consumed per week, consumption by the peer group, nights out during the week, gender, the production of forbidden behaviour and the use of other substances, whereas the risk factors for the consumption of cannabis are consumption by friends, ease of access, production of forbidden behaviour and the use of other substances. Association rules highlight the relationship between cannabis consumption, ease of access, production of forbidden behaviour and tobacco consumption. Finally, decision trees enable us to predict cannabis consumption as well as the number of joints an adolescent will consume per week based on the production of forbidden behaviour, consumption of other substances and number of friends who consume cannabis. The results of this work have practical implications concerning the prevention of cannabis consumption in an adolescent population.

Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions

AIM

To estimate the general and racial/ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances.

DESIGN

Data were collected from structured diagnostic interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version.

SETTING

The 2001-2002 National Epidemiological Survey of Alcohol and Related Conditions (NESARC) surveyed a nationally representative sample from US adults (n = 43,093) selected in a three-stage sampling design.

PARTICIPANTS

The subsamples of individuals with life-time DSM-IV diagnosis of dependence on nicotine (n = 6937), alcohol (n = 4781), cannabis (n = 530) and cocaine (n = 408).

MEASUREMENTS

Cumulative probability estimates of dependence remission for the general population and across racial/ethnic groups. Hazard ratios for remission from dependence.

FINDINGS

Life-time cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively. Males, Blacks and individuals with diagnosis of personality disorders and history of substance use comorbidity exhibited lower hazards of remission for at least two substances.

CONCLUSIONS

A significant proportion of individuals with dependence on nicotine, alcohol, cannabis or cocaine achieve remission at some point in their life-time, although the probability and time to remission varies by substance and racial/ethnic group. Several predictors of remission are shared by at least two substances, suggesting that the processes of remission overlap. The lower rates of remission of individuals with comorbid personality or substance use disorders highlight the need for providing coordinated psychiatric and substance abuse interventions.

Social integration in young adulthood and the subsequent onset of substance use and disorders among a community population of urban African Americans

AIMS

This paper examines the association between social integration in young adulthood and the later onset of substance use and disorders through mid-adulthood. Design Data come from a community cohort of African Americans followed longitudinally from age 6-42 years with four assessment periods.

SETTING

The cohort all lived in the Woodlawn neighborhood of Chicago in 1966, an urban disadvantaged setting.

PARTICIPANTS

All Woodlawn first graders in 1966 were asked to participate; 13 families declined (n = 1242).

MEASUREMENT

Substance use was measured via interview at age 42 and includes the onset of alcohol and drug use disorders and the onset of cocaine/heroin use between ages 32 and 42 years. Social integration measures were assessed via interview at age 32 and include social roles (employee, spouse, parent), participation in religious and social organizations and a measure of overall social integration. Control variables were measured in childhood and later in the life course.

FINDINGS

Multivariate regression analyses suggest that unemployment, being unmarried, infrequent religious service attendance and lower overall social integration in young adulthood predict later adult-onset drug use disorders, but not alcohol use disorders once confounders are taken into consideration. Unemployment and lower overall social integration predict onset of cocaine/heroin use later in adulthood.

CONCLUSIONS

Results show meaningful onset of drug use and substance use disorders during mid-adulthood and that social integration in young adulthood seems to play a role in later onset of drug use and drug disorders, but not alcohol disorders.

The impact of early school behavior and educational achievement on adult drug use disorders: a prospective study

Few longitudinal studies have examined the effects of education on drug use disorders among community populations of African Americans. This study explores the impact of multiple early education indicators on later problem drug use in an African American population followed for more than 35 years. The initial cohort comprised all 1st graders (N=1242, 51% female) living in the Woodlawn community of Chicago in 1966. Follow-up assessments were conducted in adolescence (1975-76), early adulthood (1992-93), and mid adulthood (2002-03). One or both adult interviews were completed by 1053 individuals providing information for identifying lifetime drug use disorders. Logistic regression with multiple imputation revealed several important relationships between early education indicators and DSM-III-R/DSM-IV drug use disorders. Specifically, the risk for adult problem drug use was related to: underachievement in 1st grade; low 7th and 8th grade standardized math scores; both suspension from and skipping school in adolescence; not having a high school diploma (compared to having a college degree), and having a diploma or GED (compared to having a college degree). Also, 1st graders characterized as shy by their teachers were less likely to develop problem drug use in adulthood. Results indicate potential opportunities for targeted intervention at multiple life stages.