Correlates of cocaine/crack use among inner-city incarcerated adolescents

Crack and Cocaine Use among Adolescents in Psychiatric Treatment: Associations with HIV Risk

Crack and cocaine use among adults has been associated with co-occurring psychiatric disorders as well as other drug use and unprotected sex. However, this issue is relatively unstudied in adolescents. This study collected data from 282 adolescents (mean age=14.9 years) treated in intensive psychiatric treatment settings to understand the relationship between crack/cocaine use and HIV risk. Thirteen percent of youth reported ever using crack or cocaine. Use was not associated with age, gender, race/ethnicity or SES. After controlling for known factors that influence unprotected sex, the odds that those with a history of crack/cocaine use engaged in inconsistent condom use was six times greater than that for those youth who did not ever use. Thus, crack/cocaine use is prevalent even among younger adolescents with psychiatric disorders who are not in drug treatment. Its use is associated with high rates of sexual and other risk behaviors. A history of use should alert clinicians to a wide variety of possible behavioral risks. These results can also inform future adolescent HIV prevention intervention development.

Sexual orientation and adolescent substance use: a meta-analysis and methodological review

AIMS

Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature.

METHODS

Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software.

RESULTS

LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohen's d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables.

CONCLUSIONS

The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown.

Crack across Canada: Comparing crack users and crack non-users in a Canadian multi-city cohort of illicit opioid users

AIMS

To examine possible differences between crack users and crack non-users across Canada.

DESIGN

Cohort study of illicit opioid and other drug users in five cities across Canada.

SETTING

Vancouver, Edmonton, Toronto, Montreal and Quebec City, Canada.

PARTICIPANTS

Regular illicit opioid and other street drug users not in treatment at time of assessment.

MEASUREMENTS

Participants (n = 677) were assessed at baseline (2002) by way of an interviewer-administered questionnaire, a psychiatric diagnostic instrument (Composite International Diagnostic Interview), and salivary antibody tests for infectious disease.

FINDINGS

Approximately half the sample had used crack in the past 30 days, although prevalence rates differed strongly between study sites. When examined by discriminant analysis, crack users in the study population were more likely to have: no permanent housing, have illegal and sex work income, indicate physical health problems and hepatitis C virus (HCV) antibodies, use walk-in clinics, use heroin and to have been arrested and in detention (in past year). They were less likely to report depressive symptoms, and use Dilaudid (hydromorphone) and alcohol.

CONCLUSION

These results illustrate crack users' pronounced social marginalization (as expressed by homelessness and high involvement in illegal activities) as well as extensive health problems compared to non-crack users in the Canadian context. The development of targeted interventions-addressing the dynamics of social marginalization-of this population is urgently needed.

Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need

In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.

Marijuana use and HIV risk among adolescent offenders: the moderating effect of age

PURPOSE

This study examined gender and age as potential moderators of the association between marijuana use and human immunodeficiency virus (HIV) risk among 272 adolescent offenders.

METHODS

Analyses were based on biological and self-report measures of both marijuana use and HIV risk.

RESULTS

Results revealed that the association between marijuana use and HIV risk was moderated by age but not gender across both biological and self-report measures. Specifically, marijuana use was associated with a higher occurrence of HIV risk among younger but not older adolescent offenders.

IMPLICATIONS

These findings provide meaningful information that can be used to guide future research as well as interventions with adolescent offenders.

Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need

In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.

Smack, crack, and score: two decades of NIDA-funded drugs and crime research at NDRI 1974-1994

Since 1972, National Development and Research Institutes (NDRI) has been fortunate to have on its staff outstanding researchers involved in studying the relationship between drugs and criminality. This paper describes federally-funded research conducted by them. The drug-crime nexus has been an ongoing focus along with drug-user treatment evaluation and AIDS research. Over the two decades, NDRI has had about 20 major "drugs and crime" grants. Key research findings are presented from studies related to violent and nonviolent crime; prison-based treatment; drug use detection; and the use and distribution of heroin, crack, and methadone.

Alcohol and cocaine interactions and aggressive behaviors

This chapter presents (1) a review of several studies on the relationship between violent/aggressive behavior and the use of cocaine and/or the use of alcohol; and (2) findings from our study of cocaine-dependent men, illustrating deviant and violent behavior before and during cocaine addiction careers. As had been found in previous research, use of alcohol and cocaine seemed to increase the likelihood of the cocaine users in our sample engaging in deviant or violent behaviors. The extent of deviant or violent behavior, in our sample, during periods of cocaine use, periods of cocaine-alcohol use, periods of alcohol use only, and periods of abstinence for both alcohol and cocaine are discussed. Changes in the nature of the deviant or violent behaviors prior to and after the onset of cocaine addiction are also described.

Characteristics of pregnant substance abusers in two cities in the northeast

This study examined the drug use patterns of pregnant women in two inner city sites, selected to overrepresent cocaine users. Women who used cocaine were much more likely to have used some combination of cigarettes, alcohol, and marijuana in addition to cocaine during pregnancy. There was little difference in the patterns of drug use in the two study sites, Trenton, New Jersey, and northwestern Philadelphia. A number of demographic and lifestyle variables of cocaine users, soft drug users (cigarettes, alcohol, and/or marijuana), and abstainers were compared. The cocaine-using group was significantly older and had more children, had less stable and more isolated living situations, was less likely to be employed and more likely to be receiving public assistance during pregnancy, and was more likely to have a higher drug- and alcohol-using social environment and family history than soft drug users or abstainers. Of significance was that many of the high-risk lifestyle factors exhibited by cocaine users were also seen, albeit to a lesser extent, among the soft drug users. These findings have implications for the timing of intervention strategies that would be most effective.

Measuring Cocaine Use by Hair Analysis among Criminally-Involved Youth

The study examined the utility of hair analysis for determining the prevalence of cocaine use in a high-risk population. Personal interviews and scalp hair specimens were obtained from 121 male youths who had been in jail in New York City and were followed-up in the community after their release. Using the standard cutoff, 51% of the hair specimens were classified positive for cocaine at a mean concentration of 87.6 nanograms per 10 milligrams of hair. Using the detection limit of the test, 67% were positive for cocaine. Only 23% of the youths reported any use of cocaine or crack during the previous 3 months and only 36% reported any lifetime use, indicating a substantial rate of underreporting. Associations were found between cocaine in hair and several behavioral variables: number of prior arrests ( p=.08, trend), rearrest after release from jail ( p<.05), not continuing education ( p<.01), and no legal employment ( p<.01). Hair analysis is a promising new epidemiological tool for obtaining more valid measures of illicit drug use in difficult-to-study populations.