The most critical unresolved issues associated with race, ethnicity, culture, and substance use

Family history of substance problems among African Americans: Associations with drug use, drug use disorder, and prescription drug misuse

A family history of substance problems is a well-known risk factor for substance use and use disorders; however, much of this research has been conducted in studies with predominantly White subjects. The aim of this study was to examine the associations between family history density of substance problems and drug use, risk for drug use disorder, and prescription drug misuse in a sample of African American adults. Results indicate that family history density of substance problems increased the risk for all drug outcomes in the full sample. However, when subgroup analyses by gender were conducted, family history was not a risk factor among men for prescription drug misuse.

Substance use related violent deaths among racial/ethnic groups in the United States

While prior research highlights the overlap of substance use and violent death, few examine this overlap among different racial/ethnic groups or how patterns change over time. This study examines how substance use related deaths differ by racial/ethnic groups in the United States. We use data from the National Violent Death Reporting System (NVDRS), which includes violent deaths from 43 states in the U.S., collected for the decade between 2009 and 2019 (N = 226,459). Fixed-effects multivariate models examined whether race/ethnicity was associated with substance use-related death over time, controlling for additional demographic and clinical factors. Results showed a significantly larger rate of increase over time for African American and Hispanic (any race) persons compared to White non-Hispanic persons for most types of substance use-related deaths. While current rates of substance use may show little variability between African American, Hispanic, and White non-Hispanic individuals, this research suggests that the consequences for substance use, including death, may be disproportional.

Race/ethnicity differences in risk and protective factors for marijuana use among U.S. adolescents

BACKGROUND

Little is known about how race and ethnicity influence marijuana-specific risk and protective factors in U.S. adolescents. We examined differences in risk and protective factors of marijuana use (MU) and their associations with MU by race/ethnicity.

METHODS

The present study used data from the 2015-2019 National Survey on Drug Use and Health. A total of 68,263 adolescents (aged 12 to 17 years) were divided into seven subgroups by race/ethnicity (White, Hispanic, Black, Asian, Native American, Native Hawaiian/Pacific Islander (NH/PI), and mixed race). Marijuana-specific risk and protective factors (RPFs) were examined, including perceived availability of marijuana, adolescents' perceived risk of MU and perceived disapproval of parents, peers, and close friends. Past-month, past-year, and lifetime MU were used as MU outcomes to examine the associations with RPFs as well as with race/ethnicity.

RESULTS

Overall, 6.85, 12.67, and 15.52% of the sample reported past-month, past-year, and lifetime MU respectively. Weighted adjusted logistic regression analyses revealed that mixed race adolescents reported the greatest perceived availability of marijuana, whereas Black and Asian adolescents had less access compared to White adolescents. The adolescents' perception of parental disapproval of MU was the lowest for Native American adolescents and highest for Asian adolescents. Mixed race adolescents experienced lower peer and close friend disapproval of MU while Black and Asian adolescents had higher. The MU risk perception was lower in most groups including Black, Hispanic, Native American, and mixed race adolescents, but not in Asian adolescents. Native American adolescents scored the highest on all MU outcomes, whereas Asian adolescents scored the lowest. Perceived availability of marijuana was associated with higher MU in all MU outcomes. Lower disapproval MU perceptions and lower MU risk perceptions were also associated with greater MU.

CONCLUSION

These findings suggest there is considerable heterogeneity of marijuana risk and protective factors and MU across race/ethnicity among U.S. adolescents.

Study of attention measured by event-related potential as a predictive factor of violence among patients with schizophrenia and substance use disorder

Background

The prediction of violence in patients with psychiatric disorders remains a challenging aspect in the field of clinical research. Many studies search the linkage between aggressive behavior and certain genetic conditions, impaired socio-emotional information processing, demographic, and clinical variables. To our knowledge, by far the relationship between aggressive behavior and impaired attention is not clear. Attention is one of the clinical variables that might have a relation to increased aggressive tendency in many psychiatric patients. So the purpose of this study is to measure the attention using ERP and search for its relation to violence in schizophrenic patients and patients with substance use disorder. This cross-sectional study was carried out on a sample of schizophrenic inpatients and patients with SUD (86 male patients) at the psychiatric department of Al-Hussein University Hospital, Cairo, Egypt.

Results

The majority of the sample lies in the age group 20–29 years old (38.4%), whereas MOAS showed that the higher tendency to violence was in the dual diagnosis of schizophrenia disorder with SUD followed by patients diagnosed with SUD.

Conclusion

Affected attention in both schizophrenic and SUD patients could be considered a potential risk factor of violence.

What is the alcohol, tobacco, and other drug prevalence among culturally and linguistically diverse groups in the Australian population? A national study of prevalence, harms, and attitudes

In Australia, one in three people are born overseas, and one in five households speak languages other than English. This study explores substance use prevalence, related harms, and attitudes among these large groups in the population. Analysis was conducted using cross-sectional data (N = 22, 696) from the 2013 National Drug Strategy Household Survey. General linear model and binary logistic regression were used to assess substance use and harms, using stabilized inverse propensity score weighting to control for potential confounding variables. Between culturally and linguistically diverse populations and the population born in Australia, United Kingdom, or New Zealand who speak only English at home, there is no statistically significant variation in the likelihood of current smoking; using analgesics, tranquilizers, or sleeping pills; or administering drugs via injection. Culturally diverse populations are less likely to drink alcohol or use cannabis or methamphetamines. No difference between these two major groups in the population is observed in substance-related abuse from strangers; but culturally diverse respondents are less likely to report substance-related abuse from known persons. Lower substance use prevalence is not observed among people from culturally diverse backgrounds who have mental health issues. Australian-, UK-, or New Zealand-born respondents who speak only English at home are more likely to oppose drug and tobacco policies, including a range of harm reduction policies. We discuss the practical and ethical limitations of this major Australian data set for examining the burden of drug-related harms experienced by specific migrant populations. Avenues for potential future research are outlined.

Alcohol use/abuse and help-seeking among U.S. adults: The role of racial-ethnic origin and foreign-born status

We used data from Wave 1 and Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions to examine racial-ethnic and nativity-based variations in alcohol use/abuse and treatment seeking while accounting for acculturation, stress, and social integration factors. The dependent variables included alcohol use, risky drinking, DSM-IV alcohol use disorder, and treatment seeking in the past 12 months. Racial-ethnic categories included African, European, Asian/Pacific Islander, Mexican, Puerto Rican, and other Hispanic/Latino. Acculturation, social stress, and social integration were assessed with previously validated, detailed measures. Bivariate probit models with sample selection were estimated for women and men. Immigrant status and origin associations with alcohol use/abuse and treatment seeking were strong and largely unaffected by other social factors. Europeans and men of Mexican origin had the highest while women of African, Asian/Pacific Islander, and Puerto Rican origins had the lowest rates of alcohol use/abuse. Years in the United States was associated with a higher risk of alcohol use/abuse for all immigrant groups. Foreign-born individuals were no less likely than U.S. natives to seek treatment if they were abusing or were dependent on alcohol. Further modeling of these relationships among specific immigrant groups is warranted. These findings inform alcohol rehabilitation and mental health services for racial-ethnic minorities and immigrants.

Cigarette-smoking trajectories of monoracial and biracial Blacks: Testing the intermediate hypothesis

Research on the cigarette-smoking patterns of biracial adolescents and young adults is severely limited. In this study, we tested the intermediate biracial substance-use hypothesis, which suggests that the prevalence of substance use among biracial individuals falls intermediate to their monoracial counterparts. We examined cigarette-smoking trajectories of a de-aggregated sample of biracial Black adolescents and young adults. We used longitudinal data from the National Longitudinal Study of Adolescent and Adult Health (Add Health; Harris et al., 2009). Our sample (N = 9,421) included 4 monoracial groups (Black, White, Hispanic, and American Indian [AI]) and 3 biracial groups (Black-AI, Black-Hispanic, and Black-White). Study hypotheses were tested using latent growth-curve modeling. We found some support for the intermediate biracial substance-use hypothesis for 2 of 3 biracial groups (Black-American Indian, Black-Hispanic) and 2 of 4 cigarette-use outcomes (lifetime cigarette use, number of cigarettes smoked during past month for regular smokers). The cigarette-use trajectories of biracial Blacks were significantly different from only 1 corresponding monoracial group. Black-AIs and Black Hispanics engage in lifetime cigarette use at comparable rates to monoracial Blacks. Black-Hispanic regular smokers' rate of cigarette smoking is comparable to the higher rates of Hispanics and not to the lower rates of Blacks. Knowledge of the origins, developmental course, and consequences of tobacco use among the biracial population may lead to effective intervention programs and policies for this group. (PsycINFO Database Record

Predicting High School Minority Adolescents' Drinking from Their Exposure to White Schoolmates: Differences and Similarities among Hispanic, Black, and Asian U.S. Adolescents

White students' drinking may constitute a risk factor for drinking among same-school minority adolescents. Our study examined data from 14,986 ethnic minority American high school students (56% female, mean age = 15.6). Models examined associations between school-level White student drinking and same-school Black, Hispanic, and Asian adolescents' drinking, as well as whether schools' proportions of White students and friendships with White schoolmates moderated these associations. Both school-level White students' drinking and minority students' friendships with White schoolmates were associated with levels of minority student drinking. But these associations were dependent upon levels of other study variables. In particular, there were higher associations between school-level risk factors and minorities' drinking when minority adolescents had high proportions of Whites among their friends.

Parental Support, Mental Health, and Alcohol and Marijuana Use in National and High-Risk African-American Adolescent Samples

African-American adolescents experience disproportionate rates of negative consequences of substance use despite using substances at average or below-average rates. Due to underrepresentation of African-American adolescents in etiological literature, risk and protective processes associated with their substance use require further study. This study examines the role of parental support in adolescents' conduct problems (CPs), depressive symptoms (DSs), and alcohol and marijuana use in a national sample and a high-risk sample of African-American adolescents. In both samples, parental support was inversely related to adolescent CPs, DSs, and alcohol and marijuana use. CPs, but not DSs, partially mediated the relation of parental support to substance use. Results were consistent across the national and high-risk samples, suggesting that the protective effect of parental support applies to African-American adolescents from a range of demographic backgrounds.

Experiences of and attitudes toward injecting drug use among marginalized African migrant and refugee youth in Melbourne, Australia

Little is known about injecting drug use (IDU) among people from culturally and linguistically diverse backgrounds in Australia. We interviewed 18 young people of African ethnicity (6 current/former injectors, 12 never injectors) about exposure and attitudes to IDU. Exposure to IDU was common, with IDU characterized as unnatural, risky and immoral. IDU was highly stigmatized and hidden from family and friends. There is a need for culturally appropriate programs to promote open dialogue about substance use to reduce stigma and prevent African youth who may use illicit drugs from becoming further marginalized.

Heavy alcohol consumption among marginalised African refugee young people in Melbourne, Australia: motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking

OBJECTIVE

Little is known about substance use among resettled refugee populations. This study aimed to describe motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking among marginalised African refugee young people in Melbourne, Australia.

DESIGN

Face-to-face interviews were conducted with 16 self-identified African refugees recruited from street-based settings in 2012-2013. Interview transcripts were analysed inductively to identify key themes.

RESULTS

Participants gathered in public spaces to consume alcohol on a daily or near-daily basis. Three key motivations for heavy alcohol consumption were identified: drinking to cope with trauma, drinking to cope with boredom and frustration and drinking as a social experience. Participants reported experiencing a range of health and social consequences of their alcohol consumption, including breakdown of family relationships, homelessness, interpersonal violence, contact with the justice system and poor health. Strategies for managing drinking included attending counselling or residential detoxification programmes, self-imposed physical isolation and intentionally committing crime in order to be incarcerated.

CONCLUSION

These findings highlight the urgent need for targeted harm reduction education for African young people who consume alcohol. Given the importance of social relationships within this community, use of peer-based strategies are likely to be particularly effective. Development and implementation of programmes that address the underlying health and psychosocial causes and consequences of heavy alcohol use are also needed.

A primer for using meta-analysis to consolidate research

The article provides an introduction to interpreting meta-analysis in the context of synthesizing results of studies that examine the role of culture on drug use behaviors. Topics reviewed include using effect size to indicate the strength of a relationship in a primary study, combining effects in weighted models to yield a summary effect, and understanding how study-level moderators help to explain the heterogeneity in effect dispersion across investigations. The advantages of meta-analytic procedures for consolidating preexisting knowledge are highlighted.

Acculturation, social self-control, and substance use among Hispanic adolescents

It is unclear how acculturation is related to self-control characteristics and whether part of the effect of acculturation on Hispanic adolescents' substance use behavior is mediated through lower self-control. We tested social self-control, peer substance use, and baseline substance use as mediators of the effect of Hispanic (predominantly Mexican or Mexican American) adolescents' level of U.S. acculturation on their substance use behavior 1 year later. In addition, we tested gender as a possible moderator of the pathways involved in the mediation model. Participants included 1,040 self-identified Hispanic/Latino adolescents (M = 14.7; SD = 0.90; 89% Mexican/Mexican American) recruited from nine public high schools. Acculturation was measured in terms of adolescents' extent of English language use in general, at home, with friends, and their use of the English-language entertainment media. Analyses were conducted using structural equation modeling and controlled for potential confounders such as age and parental education. Results indicated a statistically significant three-path mediation in which poor social self-control and peer substance use mediated the effects of acculturation on prospective substance use. Paths in the mediation model were not found to differ by gender. Our findings suggest that acculturation may influence adolescents' self-control characteristics related to interpersonal functioning, which may in turn influence their affiliation with substance-using friends and substance use behavior. Implications of the findings are discussed in terms of future research and prevention programming.

National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009

BACKGROUND

Pharmaceutical opioid related deaths have increased. This study aimed to place pharmaceutical opioid overdose deaths within the context of heroin, cocaine, psychostimulants, and pharmaceutical sedative hypnotics examine demographic trends, and describe common combinations of substances involved in opioid related deaths.

METHODS

We reviewed deaths among 15-64 year olds in the US from 1999-2009 using death certificate data available through the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Database. We identified International Classification of Disease-10 codes describing accidental overdose deaths, including poisonings related to stimulants, pharmaceutical drugs, and heroin. We used crude and age adjusted death rates (deaths/100,000 person years [p-y] and 95% confidence interval [CI] and multivariable Poisson regression models, yielding incident rate ratios; IRRs), for analysis.

RESULTS

The age adjusted death rate related to pharmaceutical opioids increased almost 4-fold from 1999 to 2009 (1.54/100,000 p-y [95% CI 1.49-1.60] to 6.05/100,000 p-y [95% CI 5.95-6.16; p<0.001). From 1999 to 2009, pharmaceutical opioids were responsible for the highest relative increase in overdose death rates (IRR 4.22, 95% CI 3.03-5.87) followed by sedative hypnotics (IRR 3.53, 95% CI 2.11-5.90). Heroin related overdose death rates increased from 2007 to 2009 (1.05/100,000 persons [95% CI 1.00-1.09] to 1.43/100,000 persons [95% CI 1.38-1.48; p<0.001). From 2005-2009 the combination of pharmaceutical opioids and benzodiazepines was the most common cause of polysubstance overdose deaths (1.27/100,000 p-y (95% CI 1.25-1.30).

CONCLUSION

Strategies, such as wider implementation of naloxone, expanded access to treatment, and development of new interventions are needed to curb the pharmaceutical opioid overdose epidemic.

Smoking trajectories among Koreans in Seoul and California: exemplifying a common error in age parameterization

Immigration to a nation with a stronger anti-smoking environment has been hypothesized to make smoking less common. However, little is known about how environments influence risk of smoking across the lifecourse. Research suggested a linear decline in smoking over the lifecourse but these associations, in fact, might not be linear. This study assessed the possible nonlinear associations between age and smoking and examined how these associations differed by environment through comparing Koreans in Seoul, South Korea and Korean Americans in California, United States. Data were drawn from population based telephone surveys of Korean adults in Seoul (N=500) and California (N=2,830) from 2001-2002. Locally weighted scatterplot smoothing (lowess) was used to approximate the association between age and smoking with multivariable spline logistic regressions, including adjustment for confounds used to draw population inferences. Smoking differed across the lifecourse between Korean and Korean American men. The association between age and smoking peaked around 35 years among Korean and Korean American men. From 18 to 35 the probability of smoking was 57% higher (95%CI, 40 to 71) among Korean men versus 8% (95%CI, 3 to 19) higher among Korean American men. A similar difference in age after 35, from 40 to 57 years of age, was associated with a 2% (95%CI, 0 to 10) and 20% (95%CI, 16 to 25) lower probability of smoking among Korean and Korean American men. A nonlinear pattern was also observed among Korean American women. Social role transitions provide plausible explanations for the decline in smoking after 35. Investigators should be mindful of nonlinearities in age when attempting to understand tobacco use.

Racial/Ethnic Differences in the Relationship Between Neighborhood Disadvantage and Adolescent Substance Use

Although social disorganization theory hypothesizes that neighborhood characteristics influence youth delinquency, the impact of neighborhood disadvantage on adolescent substance use and racial/ethnic differences in this relationship have not been widely investigated. The present study examines these issues using longitudinal data from 1,856 African American, Hispanic, and Caucasian adolescents participating in the Project on Human Development in Chicago Neighborhoods (PHDCN). The results indicated that neighborhood disadvantage did not significantly increase the likelihood of substance use for the full sample. When relationships were analyzed by race/ethnicity, one significant (p ≤ .10) effect was found; disadvantage increased alcohol use among African Americans only. The size of this effect differed significantly between African American and Hispanic youth. In no other cases did race/ethnicity moderate the impact of disadvantage on substance use. These results suggest that disadvantage is not a strong predictor of adolescent substance use, although other features of the neighborhood may affect such behaviors.

Low level of alcohol drinking among two generations of non-Western immigrants in Oslo: a multi-ethnic comparison

Background

Alcohol drinking is a risk factor for harm and disease. A low level of drinking among non-Western immigrants may lead to less alcohol-related harm and disease. The first aim of this study was to describe frequency of drinking in two generations of immigrants in Oslo, contrasting the result to drinking frequency among ethnic Norwegians. The second aim was to study how frequency of drinking among adult immigrants was associated with social interaction with their own countrymen and ethnic Norwegians, acculturation, age, gender, socioeconomic factors and the Muslim faith.

Method

The Oslo Health Study (HUBRO) was conducted during the period 2000 to 2002 and consisted of three separate surveys: a youth study (15-16-year-olds, a total of 7343 respondents, response rate 88.3%); adult cohorts from 30 to 75 years old (18,770 respondents, response rate 46%); the five largest immigrant groups in Oslo (aged 20–60 years, a total of 3019 respondents, response rate 39.7%). Based on these three surveys, studies of frequency of drinking in the previous year (four categories) were conducted among 15-16-year-olds and their parents’ generation, 30-60-year-old Iranians, Pakistanis, Turks and ethnic Norwegians. A structural equation model with drinking frequency as outcome was established for the adult immigrants.

Results

Adults and youth of ethnic Norwegian background reported more frequent alcohol use than immigrants with backgrounds from Iran, Turkey and Pakistan. Iranians reported a higher drinking frequency than Turks and Pakistanis. In the structural equation model high drinking frequency was associated with high host culture competence and social interaction, while high own culture competence was associated with low drinking frequency. Adult first-generation immigrants with a longer stay in Norway, those of a higher age, and females drank alcohol less frequently, while those with a higher level of education and work participation drank more frequently. Muslim immigrants reported a significantly lower drinking frequency than non-Muslims, although this did not apply to Iranians.

Conclusions

The existence and growth in Western societies of immigrant groups with low-level alcohol consumption contributed to a lower level of consumption at the population level. This may imply reduced drinking and alcohol-related harm and disease even among ethnic Norwegians.