Higher perceived stress during admission is associated with shorter retention in short-term residential substance use disorder treatment

Introduction

Over one million people in the U.S. received residential treatment for a substance use disorder (SUD) in 2020. Longer treatment retention is associated with better outcomes (e.g., reduced substance use). Entering treatment with higher stress may be associated with shorter retention. This paper examines the impact of perceived stress at admission on SUD treatment retention in short-term residential treatment.

Methods

A sample of 271 treatment episodes with admissions between October 2019 and February 2020 were collected from de-identified records of an urban mid-Atlantic adult 28-day short-term residential SUD treatment facility. Treatment completion involved finishing 28 days. Sociodemographic, substance use, perceived stress, and treatment discharge variables were analyzed. Bivariate analyses examined differences between treatment completion and early discharge, and Cox regression investigated the effect of perceived stress on treatment retention with covariates.

Results

The sample was primarily male (73.8%) and non-Hispanic Black (71.6%). A majority used heroin as their primary substance (54.6%) and reported polysubstance use (72.3%). About half (51.3%) completed treatment, and completed an average of 18.7 (SD = 10.7) days. Those who prematurely discharged from treatment stayed an average of 8.9 (SD = 7.0) days. The Cox regression model found that higher perceived stress (adjusted hazard ratio (AHR) = 1.028; 95% CI = [1.005, 1.053], p =.019) and a race/ethnicity other than non-Hispanic Black (AHR = 1.546, 95% CI = [1.037, 2.305], p =.033) predicted premature discharge.

Conclusions

Perceived stress at admission is associated with shorter treatment retention. Early stress management interventions may help increase treatment retention.

Utilizing User Preferences in Designing the AGILE (Accelerating Access to Gender-Based Violence Information and Services Leveraging on Technology Enhanced) Chatbot

INTRODUCTION

Technology advancements have enhanced artificial intelligence, leading to a user shift towards virtual assistants, but a human-centered approach is needed to assess for acceptability and effectiveness. The AGILE chatbot is designed in Kenya with features to redefine the response towards gender-based violence (GBV) among vulnerable populations, including adolescents, young women and men, and sexual and gender minorities, to offer accurate and reliable information among users.

METHODS

We conducted an exploratory qualitative study through focus group discussions (FGDs) targeting 150 participants sampled from vulnerable categories; adolescent girls and boys, young women, young men, and sexual and gender minorities. The FGDs included multiple inquiries to assess knowledge and prior interaction with intelligent conversational assistants to inform the user-centric development of a decision-supportive chatbot and a pilot of the chatbot prototype. Each focus group comprised 9-10 members, and the discussions lasted about two hours to gain qualitative user insights and experiences. We used thematic analysis and drew on grounded theory to analyze the data.

RESULTS

The analysis resulted in 14 salient themes composed of sexual violence, physical violence, emotional violence, intimate partner violence, female genital mutilation, sexual reproductive health, mental health, help-seeking behaviors/where to seek support, who to talk to, and what information they would like, features of the chatbot, access of chatbot, abuse and HIV, family and community conflicts, and information for self-care.

CONCLUSION

Adopting a human-centered approach in designing an effective chatbot with as many human features as possible is crucial in increasing utilization, addressing the gaps presented by marginalized/vulnerable populations, and reducing the current GBV epidemic by moving prevention and response services closer to people in need.

Building Equitable Community-Academic Partnerships for Opioid Recovery Research: Lessons Learned from Stakeholder Engagement With Peer and Provider Organizations

Forming equity-based community-academic partnerships focused on recovery research is a time- consuming and challenging endeavor, but one well worth the care and effort required. Through building trusting relationships, vital research collaborations emerge, which are driven by expressed community needs and supported with university resources. This article describes the stakeholder engagement process utilized by a university-based and opioid-focused initiative entitled Innovations in Recovery through Infrastructure Support (IRIS). IRIS developed a diverse and representative network of clinical providers, peer recovery workers, academics, and other behavioral health leaders. The process was informed by community-based participatory research (CBPR) practices and principles aimed at creating equitable partnerships. Lessons learned include the need to reshape the relationship between research and the community through an acknowledgment of harms committed by academia, as well as the importance of maintaining an approach of humility, accountability, and patience with the partnership process. Concrete benefits that go beyond the long-term promise of change, including compensating partners financially for their time, help ensure equity. A commitment to always asking "Who's missing?" and then filling those gaps builds a broad network inclusive of the various constituencies that make up the recovery support system. As IRIS builds on these lessons learned and plans next steps, we share our experience to support others engaged in forming community-academic partnerships through deep stakeholder engagement and use of participatory approaches within and outside of recovery research.

Voices from the Youth in Kenya Addressing Mental Health Gaps and Recommendations

Studies including adolescents and young people (AYP) enhance the relevance of research results, benefit stakeholders, and inform future research. There exists a mental health gap in services for AYP living in low and middle-income countries. This study aims to identify mental health challenges faced by adolescents and young people in Kenya, develop practical recommendations to mitigate these issues, and reduce the mental health burden among this population. We convened an AYP-led meeting that involved 41 participants. The meeting objectives were to (1) identify efforts to support existing national and regional strategic priorities and review goals for addressing mental health needs among AYPs, (2) develop immediate action plans for strengthened mental health services, (3) review and strengthen country-level coordination mechanisms, and (4) identify how participating county experiences can inform mental health services in Kenya. Ministry of Health (MoH) officials from national and county levels, academic experts, and implementing partner agencies involved in mental health services participated in the meeting. The team, including AYP representatives, identified various mental health challenges among the AYA and recommended interventions aimed towards improving their mental health situation in the country. The challenges were clustered into three themes and comprehensively reviewed to establish the precipitating factors to mental health outcomes among AYPs in Kenya and provide recommendations. The themes included (1) legislative, (2) service provider/Ministry of Health, and (3) adolescent/individual-level factors. To bridge the mental health gap in the country and scale up mental health outcomes, the stakeholders recommended interventions within the context of the three clusters. The key suggestions included an increase in insurance financing, acceleration of community health interventions, the establishment of adolescent-friendly spaces, the training of adolescent youth champions, interactive service provision models, implementation of the existing mental health policies and structures, the development of comprehensive assessment tools, well equipped mental health departments in health facilities, the enhancement of telehealth services and digital villages, the mobilization of a functional mental health response team, and the development of a mental health database.

Suicidal behavior in Mexican adolescents: A test of a latent class model using two independent probability samples

Suicidal behavior is a serious health issue that affects the adolescent population and that may be prevented through evidence-based approaches. There are many risk factors involved in suicidal behavior, but there are few studies encompassing the complex relationships between them. This study tested the similarity between two latent class models from two different epidemiological samples of middle-school students and evaluated if the multinomial regression model replicated the associations between the classes and the psychosocial variables. Data of 4013 adolescents from the Mexican states of Campeche and Querétaro were included in LCA to characterize suicide behavior and associated factors. The most likely latent class membership was used as the outcome in multinomial regression models. The model with data from Querétaro was consistent with the previous LC model from Campeche. The four latent classes were nearly identical for both populations and can be defined as follows: 1) "No Problems," included 73% of the adolescents; 2) "Drug Use Only," comprised 7% of the adolescents; 3) "Suicidal Behavior, No Depression," captured 8% of the adolescents (25% reported binge drinking in the past month, 50% self-inflicted injuries, and 43% low-lethality suicide attempt); 4) "Depression and Suicidal Behavior," comprised 12% of the sample (66% met criteria for Major Depressive Episode, 28% reported binge drinking in the past month, and 11% had a high-lethality suicide attempt). The congruence between the models and the consistency with identified factors highlight the need for appropriate and effective prevention strategies to minimize risk factors and reinforce protective factors in the adolescent population.

Children as innovators: harnessing the creative expertise of children to address practical and psychosocial challenges of the coronavirus disease 2019 (COVID-19) pandemic – COVISION study protocol

Background: We are currently in a period of transition, from the pre-COVID-19 (coronavirus disease 2019) era and the initial reactive lockdowns, to now the ongoing living with and potentially the after COVID-19 period. Each country is at its own individual stage of this transition, but many have gone through a period of feeling adrift; disconnected from normal lives, habits and routines, finding oneself betwixt and between stages, similar to that of liminality. Children and young people have been particularly affected.

Aim: To increase the understanding of home and community-based strategies that contribute to children and young people’s capacity to adjust to societal changes, both during and after pandemics. Moreover, to identify ways in which children’s actions contribute to the capacity of others to adjust to the changes arising from the pandemic. The potential for these activities to influence and contribute to broader social mobilisation will be examined and promoted.

Research design: To achieve the aim of this study, a participatory health research approach will be taken. The overarching theoretical framework of the COVISION study is that of liminality. The study design includes four work packages: two syntheses of literature (a rapid realist review and scoping review) to gain an overview of the emerging international context of evidence of psychosocial mitigations and community resilience in pandemics, and more specifically COVID-19; qualitative exploration of children and young people’s perspective of COVID-19 via creative outlets and reflections; and participatory learning and action through co-production.

Comparison of suicide attempts among nationally representative samples of Mexican adolescents 12 months before and after the outbreak of the Covid-19 pandemic

BACKGROUND

There is serious concern over the increase in mental health problems during the coronavirus disease 2019 (Covid-19) pandemic.

METHODS

Based on data from two Mexican National Health and Nutrition Surveys conducted in 2018-2019 and 2020 (n = 17,925 and 4,913, respectively), we estimated the prevalence of suicide attempts among adolescents 10-19 years old in the previous year. We constructed a multivariate logistic regression model adjusted by sociodemographic characteristics and contextual variables for the Covid-19 pandemic.

RESULTS

The prevalence of suicide attempts in the previous year was similar in both surveys. We found that women, youth in urban localities and individuals living in households where a family member had lost her/his job as a result of the Covid-19 contingency were more likely to attempt suicide compared to their counterparts. On the other hand, attending classes online proved to be a protective factor (aOR=0.3, 95% CI=0.1, 0.8, p = 0.022).

LIMITATIONS

The principal limitation of our study concerned the restricted size of our sample for the 2020 survey wave.

CONCLUSIONS

Population-level policies aimed at providing economic protection and helping youth to return to school would exert a favorable impact on the mental health and suicidal behavior of youths.

Children as innovators: harnessing the creative expertise of children to address practical and psychosocial challenges of the coronavirus disease 2019 (COVID-19) pandemic – COVISION study protocol

Background: We are currently in a period of transition, from the pre-COVID-19 (coronavirus disease 2019) era and the initial reactive lockdowns, to now the ongoing living with and potentially the after COVID-19 period. Each country is at its own individual stage of this transition, but many have gone through a period of feeling adrift; disconnected from normal lives, habits and routines, finding oneself betwixt and between stages, similar to that of liminality. Children and young people have been particularly affected. Aim: To increase the understanding of home and community-based strategies that contribute to children and young people’s capacity to adjust to societal changes, both during and after pandemics. Moreover, to identify ways in which children’s actions contribute to the capacity of others to adjust to the changes arising from the pandemic. The potential for these activities to influence and contribute to broader social mobilisation will be examined and promoted. Research design: To achieve the aim of this study, a participatory health research approach will be taken. The overarching theoretical framework of the COVISION study is that of liminality. The study design includes four work packages: two syntheses of literature (a rapid realist review and scoping review) to gain an overview of the emerging international context of evidence of psychosocial mitigations and community resilience in pandemics, and more specifically COVID-19; qualitative exploration of children and young people’s perspective of COVID-19 via creative outlets and reflections; and participatory learning and action through co-production.

Comparative Analysis of Lifetime Suicide Attempts among Mexican Adolescents, over the Past 12 Years

OBJECTIVE

To compare the occurrence of suicide attempts across nationally representative samples of the Mexican adolescent population over the past 12 years, and to analyze its association with sociodemographic, lifestyle and mental-health indicators.

METHODOLOGY

Data were drawn from the 2006, 2012 and 2018 National Health and Nutrition Surveys (n = 25,056; 21,509; and 17,925 adolescents, respectively). Estimates were based on standardized measurements.

RESULTS

The estimated lifetime prevalence rates of suicide attempts were 1.1% in 2006, 2.7% in 2012, and 3.9% in 2018, indicating a 3.4-fold increase. Across the three survey periods, women yielded rates nearly three times higher than men. Lifetime prevalence grew the most among adolescents aged 13-15 years. Compared to the other respondents, the odds of lifetime suicide attempts proved seven times as high for those who had been sexually abused during their childhood, five times as high for those who had been diagnosed with a depressive disorder, three times as high for those who had suffered physical aggression and twice as high for those who had smoked 100+ cigarettes in their lifetimes and those who consumed alcohol.

CONCLUSION

The sharp increase in suicide attempts in Mexico calls for an urgent public-health response via universal and targeted interventions supported by national policy and sustained federal funding.

Psychosocial Correlates of Suicidal Behavior among Adolescents under Confinement Due to the COVID-19 Pandemic in Aguascalientes, Mexico: A Cross-Sectional Population Survey

Background: Suicide and suicidal behaviors were already a global public health problem, producing preventable injuries and deaths. This issue may worsen due to the COVID-19 pandemic and may differentially affect vulnerable groups in the population, including children, adolescents, and young adults. The current study evaluated the association of affective variables (depression, hopelessness, and anxiety), drug use (alcohol, tobacco, and others), emotional intelligence, and attachment with suicidal behaviors. Methods: A state-wide survey included 8033 students (51% female, 49% male; mean age of 16 years) from science and technology high-schools using a standardized questionnaire that was distributed online. Multinomial logistic regression models tested associations between suicidal behaviors and several covariates. The analyses accommodated the complex structure of the sample. Results: Approximately 21% of all students reported a suicidal behavior (11% with a low-lethality suicide attempt, 6% with self-injuries, and 4% with a high-lethality suicide attempt). Variables associated with higher odds of suicidal behavior included: female sex, depression, hopelessness, anxiety, alcohol and tobacco use, childhood trauma, and having to self-rely as issues affecting attachment, and low self-esteem. Security of attachment was associated with lower odds of suicidal behavior. Conclusions: The complexity of suicidal behavior makes it clear that comprehensive programs need to be implemented.

Understanding suicidal behavior and its prevention among youth and young adults in Mexico

Suicide rates in Mexico have increased and have more than doubled in the state of Aguascalientes over the past 10 years. Few studies have been able to control for family, neighborhood, and occupational environment factors that may confound the association between psychosocial characteristics and suicidal behavior. We study suicidal behavior among adolescents and young adults in Mexico utilizing epidemiologic research strategies to overcome prior research deficiencies. In a case-control study with youth and adults 14-42 years of age, recent cases of severe suicidal behavior (n = 150) were individually matched with up to three controls who had never had a suicidal attempt by age and sex, as well as within familial, neighborhood, and occupational contexts (n = 353). Data were collected through standardized face-to-face interviews to measure suicidal behavior and several covariates, including family relations, psychological resources, hopelessness, depression, self-esteem, stress, impulsivity, anxiety, and substance use. All measures demonstrated good to excellent precision and accuracy. Compared with their matched controls, cases perceived life events as more stressful and had worse depression and familial relationships; poorer development of affective, religious, and social resources; higher levels of hopelessness and impulsive behavior; and lower self-esteem. Evidence from multivariate analysis suggests highly probable MDE combined with low self-esteem and the use of two or more drugs in the past month more clearly differentiate cases and controls and, therefore, may best predict suicidal attempt among adolescents and young adults in Aguascalientes, Mexico.

Addressing Tobacco Use in Underserved Communities Through a Peer-Facilitated Smoking Cessation Program

Communities Engaged and Advocating for a Smoke-Free Environment (CEASE) is a long-standing research partnership between a university and the neighboring community that was established to reduce tobacco use among poor and underserved residents. The CEASE tobacco cessation program was implemented in four phases, with each new phase applying lessons learned from the previous phases to improve outcomes. This study describes CEASE's community-based approach and reports results from implementing the second phase of the intervention which, among other things, varied in the type of incentives, setting, and providers used. CEASE implemented a mixed-methods study following the Community-Based Participatory Research (CBPR) approach. During Phase II, a total of 398 smokers were recruited into two 12-session group counseling interventions facilitated by trained peers in community venues, which differed in the type of incentives used to increase participation and reward the achievement of milestones. At 12-week follow-up, 21% of all participants reported not smoking, with a retention rate (i.e., attendance at six or more of the 12 cessation classes offered) of 51.9%. No significant differences in cessation outcomes were found between the two study arms. Using a CBPR approach resulted in a peer-led model of care with improved outcomes compared to Phase I, which was provided by clinicians. The combined use of monetary and non-monetary incentives was helpful in increasing participation in the program but did not significantly impact smoking cessation. A CBPR approach can increase the acceptability and effectiveness of cessation services for underserved populations.

Factors associated with tobacco, alcohol, and other drug use among youth living in West Central Mexico

AIM

To determine the prevalence of drug and substance abuse among high school students in Jalisco and its association with the severity of health, behavior and psychosocial problems in order to provide evidence for possible prevention and treatment needs.

METHODS

A multi-stage random sample of Jalisco high school students was given a paper-and-pencil survey based upon an adapted version of the drug use screening inventory (DUSI) (n = 24699; n = 2832). The DUSI showed adequate psychometric characteristics in this population. The statistical analyses accommodated the complex survey design with attention to unequal probability of selection and clustering of participants within schools and regions.

RESULTS

An estimated 44% of the students had smoked tobacco, one in five students was a current smoker, and one in four students used to smoke but had not smoked for one year or more. By contrast, 6.8% of the students reported having used marijuana, cocaine, or both. Behavioral problems, deviant peer affiliation, and troubled families were independently associated with drug use. One in two students who used tobacco or alcohol had used these drugs in the past year (46% and 54%, respectively), and one in four students who used marijuana or cocaine in their lifetime had used those drugs in the past year (28% in both cases).

CONCLUSION

The rates of cocaine use as well as the proportion of current users were higher than expected among high school students and indicate changing patterns of drug use in Mexico. These results corroborate that the general trend of drug use by youth in Mexico is increasing. Results from this study help us better understand the needs of at-risk youth and the need for new treatment and prevention strategies.

Suicide behavior and associated psychosocial factors among adolescents in Campeche, Mexico

Suicide is an important public health problem that requires a preventive approach. The present study aimed at assessing suicidal behaviors and their relations with other psychosocial factors in Campeche, Mexico, in order to inform the design of potential preventive interventions. A multistage probability sample of 2386 students representative of all middle schools of the state of Campeche, Mexico, took a standardized, paper-and-pencil survey covering selected psychosocial constructs including suicide behavior, depression, drug use, familial relationships, locus of control, impulsivity, and self-esteem, among others. Latent classes were identified and multinomial logistic regression was used to analyze associations between class membership and psychosocial covariates. An estimated 8% of the middle school population in Campeche had three or more psychosocial problems in the past month including drug use, major depression episode symptoms, as well as suicidal problems like attempts and self-inflicted injuries. Four latent classes were identified, one with lowest risk and three with varying characteristics in terms of binge alcohol and other drug use, depression, and suicide behaviors. Associations between psychosocial covariates and latent class were observed, as predicted based on a multi-dimensional theoretical framework. Heterogeneity across "High-Risk" groups and their potential determinants highlight the need for differentiated, specialized efforts ranging from universal to indicated interventions. Given the high level of risk factors in this population, universal preventive interventions should aim at building resiliency among youth by helping them develop an array of coping resources, as well as by creating a more nurturing psychosocial environment.

Improving the health of African Americans in the USA: an overdue opportunity for social justice

Using a modified social ecological model, we conducted a review of the literature and nationwide statistics on African American health. We discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. The mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels. Incarceration and mental health care issues are highlighted as priorities to be addressed. African Americans remain the least healthy ethnic group in the USA, a somber legacy of years of racial and social injustice and a formidable challenge to equitable health care for all. Systemic causes of suboptimal black health require equally systemic solutions; positive trends in black health indicators seem to be driven by social development programs, economic investment in education, participation of African Americans in policy, and decision-making and expansion of access to health care.

Nonmedical use of prescription drugs in emerging adulthood: differentiating sex from gender

Male-female variations in health-behavior continue to be of national and international significance with men generally being more likely to be engaged in behaviors that enhance risk across an array of preventable diseases and injuries as well as premature deaths. The literature has identified non-medical use of prescription drugs (NMUPD) as a developing and particularly dangerous substance use behavior among college students. The literature has reported sex differences (male; female) in NMUPD but has yet to explain how gender-orientation (e.g., masculine, feminine) might impact NMUPD. The purpose of this study is to address this gap by examining the influence of gender-orientation on NMUPD. Using survey data collected during the 2013-2014 academic year from a convenience sample of college students at a mid-sized Midwestern university, we examine the association of gender-orientation with NMUPD (N=796). To do this, we separate masculine and feminine scales from the BEM Sex Role Inventory and use logistic regression to test whether masculine or feminine gender characteristics influence the likelihood of NMUPD (lifetime measure of any use and by category). This analysis shows that self-identified characteristics associated with masculinity increase the odds of NMUPD while femininity is associated with lower odds of NMUPD. Findings from this study increase our knowledge of gender-orientation and sex interactions as factors that might influence NMUPD thus demonstrating the importance of differentiating sex from gender-orientation.

A Community-Based Participatory Research on Smoking Cessation Intervention for Urban Communities

Smoking disproportionally affects minority and underserved populations but only a handful of interventions tailored to these populations have demonstrated effectiveness in real-life situations. We use community-based participatory research (CBPR) to test two interventions delivered by a community-based health care center.

METHODS

Participants randomly assigned to individual or group-based intervention for smoking cessation (N= 400). Both included cessation counseling and health education, a contingency behavioral program, Nicotine Replacement Therapy, and health care for other comorbidities. Smoking cessation was verified by expired carbon monoxide at the end of the program.

RESULTS

No differences were observed between the two treatment modalities (8.9% and 8.6%, respectively). Those with greater attendance had 1.4 times better odds of cessation per additional session. Retention and follow up proved to be challenging with this population.

[Depression among adolescents. A hidden problem for public health and clinical practice]

Depression is an important public health problem that requires more and better attention. In the present work we review epidemiologic studies of depression among adolescents in Mexico and discuss strategies that may help in earlier identification and referral of potential cases for timely care. In summary, depressive symptoms are prevalent among adolescents and adults in Mexico as in many other countries, with a higher ratio of female cases. Young people experiencing the most challenging socio-urban situations have higher rates of depression. Even though depressive disorders are more prevalent among females, consequences may be even worse for males. The authors posit that, among males, stigma attached to depression might lead to attempts to hide depressive symptoms by masking them through high-risk behaviors (e.g., alcohol, drug use, and violence, among others). Women may have higher rates of suicide attempts, but the case-fatality rate of suicide attempts is higher among males. Despite of barriers and resource scarcity among healthcare and educational institutions, it is necessary to continue to develop alternatives that will lead to better attention of mental health issues among the youth, even when their mental health needs are not expressed directly or their chief complaints are in regard to "other" health issues.

Depressive symptoms among adolescents and older adults in Mexico City

PURPOSE

Determine the structure of depressive symptoms among adolescents and older adults through the person-centered approach of latent class analysis (LCA).

METHODS

The study is based on data from two independent samples collected in Mexico City (2,444 adolescents and 2,223 older adults) which included the revised version of the CES-D. The presence or absence of depressed mood (dysphoria), diminished pleasure (anhedonia), drastic change in weight, sleep problems, thinking and concentration difficulties, excessive or inappropriate guilt, fatigue, psychomotor agitation/retardation, and suicide ideation were used in LCA to determine the structure of depressive symptoms for adolescents and older adults.

RESULTS

Adolescents reported higher excessive or inappropriate guilt compared to older adults, while older adults had higher proportions of anhedonia, sleep problems, fatigue, and psychomotor agitation/retardation. Similar proportions were found in other symptoms. The LCA analysis showed the best fit with four latent classes (LC): LC 1, "symptoms suggestive of major depressive episode (MDE)" with prevalence of 5.9 % (n = 144) and 10.3 % (n = 230) among adolescents and older adults, respectively; LC 2, "probable MDE symptoms" 18.2 % (n = 446) and 23.0 % (n = 512); LC 3, "possible MDE" 27.7 % (n = 676) and 21.8 % (n = 485); LC 4, "without significant depressive symptoms" 48.2 % (n = 1,178) and 44.8 % (n = 996). The differences in item thresholds between the two groups (adolescents vs. older adults) were statistically significant (Wald test = 255.684, df = 1, p < 0.001).

CONCLUSIONS

This study documented important similarities and differences in the structure of depressive symptoms between adolescents and older adults that merit acknowledgment, further study, and consideration of their potential clinical and public health implications.

Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study

OBJECTIVE

Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms.

METHODS

A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health.

RESULTS

A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant.

CONCLUSIONS

Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.

Late-life depressive symptoms: prediction models of change

BACKGROUND

Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms.

METHODS

Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms.

RESULTS

A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations.

CONCLUSIONS

New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms.

LIMITATIONS

The study has not included clinical evaluations and nutritional assessments.

Race/ethnicity and sex differences in progression from drinking initiation to the development of alcohol dependence

BACKGROUND

Prior studies on the course of alcohol use disorders have reported a "telescoping" effect with women progressing from drinking initiation to alcohol dependence faster than men. However, there is a paucity of population-based analyses that have examined progression to alcohol dependence comparing race/ethnicity subgroups, and little is known about whether the telescoping effect for women varies by race/ethnicity. We examined whether a telescoping effect is present in the general population comparing race/ethnicity subgroups and comparing men and women stratified by race.

METHODS

This study uses data from Wave I of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to compare a nationally representative sample of White, Black and Hispanic adults 18-44 years of age (n=21,106). Time to event analyses compare the risk of alcohol initiation, onset of alcohol dependence, and the transition from initial use to onset of alcohol dependence in the three race/ethnicity groups and for males and females in each race/ethnicity group.

RESULTS

Whites were younger than Blacks and Hispanics of the same sex at drinking onset and progressed to alcohol dependence at a faster rate than both Blacks and Hispanics. In addition, we found no evidence of a telescoping effect in women for any race/ethnicity group.

CONCLUSIONS

The present study illustrates differences in the course of transition from alcohol initiation to the development of dependence by race/ethnicity but not sex. Our findings highlight the need for additional study of factors resulting in race/ethnicity differences in order to inform culturally relevant prevention and intervention initiatives.

Childhood predictors of first chance to use and use of cannabis by young adulthood

AIMS

To prospectively examine the linkage between childhood antecedents and progression to early cannabis involvement as manifest in first chance to try it and then first onset of cannabis use.

METHODS

Two consecutive cohorts of children entering first grade of a public school system of a large mid-Atlantic city in the mid 1980s (n=2311) were assessed (mean age 6.5 years) and then followed into young adulthood (15 years later, mean age 21) when first chance to try and first use were assessed for 75% (n=1698) of the original sample. Assessments obtained at school included standardized readiness scores (reading; math) and teacher ratings of behavioral problems. Regression and time to event models included covariates for sex, race, and family disadvantage.

RESULTS

Early classroom misconduct, better reading readiness, and better math readiness predicted either occurrence or timing of first chance to try cannabis, first use, or both. Higher levels of childhood concentration problems and lower social connectedness were not predictive.

CONCLUSIONS

Childhood school readiness and behavioral problems may influence the risk for cannabis smoking indirectly via an increased likelihood of first chance to use. Prevention efforts that seek to shield youths from having a chance to try cannabis might benefit from attention to early predictive behavioral and school readiness characteristics. When a youth's chance to try cannabis is discovered, there are new windows of opportunity for prevention and intervention.

Cost-effective analysis of genotyping using oral cells in the geriatric population

We evaluated the cost-effectiveness of using buccal swab brushes in comparison with blood samples for obtaining DNA for large epidemiological studies of the elderly population. The data reported here are from the third phase of the Integral Study of Depression among the Elderly in Mexico City's Mexican Institute of Social Security, conducted in 2007. The total cost of the two procedures was determined. The measurement of effectiveness was the quality and quantity of DNA measured in ng/μL and the use of this DNA for the determination of apolipoprotein E (APO E) polymorphism by PCR. Similar rates of amplification were obtained with the two techniques. The cost of the buccal swab brushes, including sample collection and DNA extraction, was US$16.63, compared to the cost per blood sample of US$23.35. Using the buccal swab, the savings was US$6.72 per patient (P < 0.05). The effectiveness was similar. Quantity and quality of DNA obtained were similar for the oral and blood procedures, demonstrating that the swab brush technique offers a feasible alternative for large-scale epidemiological studies.

Early sexual experience and later onset of illegal drug use among African American students on HBCU campuses

Few studies examine whether early sexual experience is associated with subsequent illegal drug use among adolescents. A sample of 7,372 African American students who had not used illegal drugs before the age of 14 were identified in the dataset of the 2001 Historically Black Colleges and Universities (HBCU) Substance Use Survey. Using self-reported ages of onset, discrete-time survival models estimated the hazard of illegal drug use onset after age 13 subsequent to first sexual intercourse. Early sex was modestly associated with subsequent illegal drug initiation, particularly among females. Drug use prevention services should be provided to youth engaged in early sexual activity.

[Psychosocial correlates of drug abuse and dependence among young Mexicans]

OBJECTIVE

to test that drug abuse and dependence would be greater among those who have: higher depression, a family with dysfunctional cohesion and adaptability, greater exposure to stressful situations; maladaptive coping strategies.

METHODS

a case-control study design was used, with three controls matched to each case by on age, sex, and neighborhood of residence. The sample included 218 cases and 677 controls.

RESULTS

cases of drug abuse and dependence were estimated to have higher odds of elevated depression symptoms, as well as high psychosocial stress from maladaptive school adjustment, compared to controls. Cases of drug dependence had higher odds to maladaptive family cohesion and adaptation, as well as higher odds of exposure to high-impact stress related to family separations, as well as family communication problems.

CONCLUSIONS

findings indicate that drug abuse and dependence are significantly related to maladaptative adjustment indicators, family disfunctionality and affective disorders.

Racial/ethnic differences in parental concern about their child's drug use in a nationally representative sample in the United States

INTRODUCTION

Parental concern and negative attitudes toward drug use may prevent youth from being involved in drug use. However, few studies have addressed parental concern about children's drug use and its possible variation by race/ethnicity. In this study, we explored the potential racial/ethnic differences in parental concern about their children's drug use with a nationally representative sample.

METHODS

The data were from the 2003 National Survey of Children's Health, a random household telephone survey of parents of children up to age 17 (n = 102353). The analytic sample was restricted to parents of children aged 6 to 17 years (n = 61046). Multivariate logistic regression models, controlling for children's age, gender, family structure, and family poverty level, were fitted, simultaneously accommodating the complex survey design.

RESULTS

Parents of African American and Hispanic children expressed more concern than parents of white children, even after controlling for potential confounders (adjusted odds ratio (AOR), 1.9; 95% CI, 1.8-2.1 and AOR, 1.9; 95% Cl, 1.7-2.1, respectively).

CONCLUSIONS

The level of parental concern about adolescent drug use was different across race/ethnicity groups. The results may have implications for parental participation in school-based adolescent prevention programs.

Opportunities to use drugs and stages of drug involvement outside the United States: Evidence from the Republic of Chile

BACKGROUND

Studying youthful drug involvement in the Republic of Chile, we sought to replicate North American research findings about the earliest stages of drug involvement (e.g., initial opportunities to use tobacco and alcohol, and transitions leading toward illegal drug use).

METHODS

A nationally representative multistage probability sample of middle and high school students was drawn; 30,490 youths completed surveys that assessed age at first drug exposure opportunities and first actual drug use. Cox discrete-time survival models accommodate the complex sample design and provide transition probability estimates.

RESULTS

An estimated 39% of the students had an opportunity to use cannabis, and 70% of these transitioned to actual cannabis use. The probability of cannabis use and the conditional probability of cannabis use (given opportunity) are greater for users of alcohol only, tobacco only, and alcohol plus tobacco, as compared to non-users of alcohol and tobacco. Male-female differences in cannabis use were traced back to male-female differences in drug exposure opportunities.

CONCLUSION

In Chile as in North America, when cannabis use follows alcohol and tobacco use, the mechanism may be understood in two parts: users of alcohol and tobacco are more likely to have opportunities to try cannabis, and once the opportunity occurs, they are more likely to use cannabis. Male-female differences do not seem to be operative within the mechanism that governs transition to use, once the chance to use cannabis has occurred.

Social networks and health-related quality of life: a population based study among older adults

OBJECTIVE

To examine the relationship between components of social networks and health-related quality of life (HRQL) in older adults with and without depressive symptoms.

MATERIAL AND METHODS

Comparative cross-sectional study with data from the cohort study 'Integral Study of Depression', carried out in Mexico City during 2004. The sample was selected through a multi-stage probability design. HRQL was measured with the SF-36. Geriatric Depression Scale (GDS) and the Short Anxiety Screening Test (SAST) determined depressive symptoms and anxiety. T-test and multiple linear regressions were conducted.

RESULTS

Older adults with depressive symptoms had the lowest scores in all HRQL scales. A larger network of close relatives and friends was associated with better HRQL on several scales. Living alone did not significantly affect HRQL level, in either the study or comparison group.

CONCLUSIONS

A positive association between some components of social networks and good HRQL exists even in older adults with depressive symptoms.

Depressed mood and the effect of two universal first grade preventive interventions on survival to the first tobacco cigarette smoked among urban youth

INTRODUCTION

As part of an evaluation of two first-grade, universal preventive interventions whose proximal targets were early learning and behavior, we investigated the influence of depressed mood, the interventions, and their interaction on survival to the first tobacco cigarette smoked through age 19. One intervention focused on improving teacher behavior management and instructional skills (Classroom-Centered, CC) as a means of improving student behavior and learning and the other on the family-school partnership (FSP). Variation in the relationship between depressed mood and first cigarette smoked by gender and grade was also examined.

METHODS

Self-reports of smoking behavior and depressed mood were collected on an annual basis from grade 6 through age 19. The present analyses were restricted to the 563 youth who had never smoked by grade 6, or 83% of the original sample of first grade participants. Discrete-time survival analysis was used to examine the effects of depressed mood and the interventions on survival to the first tobacco cigarette smoked.

RESULTS

Depressed mood was associated with reduced survival time to the first cigarette smoked (adjusted hazard ratio, aHR: 1.4; 95% CI: 1.1-1.9), whereas the CC intervention prolonged survival time (aHR: 0.8; 95% CI: 0.7-0.9). No significant variation in the effect of depressed mood on survival was found by gender or grade, nor was the effect of the CC intervention moderated by depressed mood.

CONCLUSIONS

Strategies to prevent tobacco cigarette smoking should include both a focus on depressed mood in adolescence as well as on early success in elementary school.

Depressive symptoms among older adults in Mexico City

BACKGROUND

Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries.

OBJECTIVE

To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider.

DESIGN

Cross-sectional, multistage community survey.

PARTICIPANTS

A total of 7,449 persons aged 60 years and older.

MEASUREMENTS

Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire.

MAIN RESULTS

The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = -20.2, 95% CI = -21.3, -19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2).

CONCLUSIONS

According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.

[Application of the revised version of the Center of Epidemiological Studies Depression Scale in adolescent students from Mexico City]

OBJECTIVE

To assess the internal consistency, as well as the construct, concurrent and external consistency of the Center for Epidemiologic Studies Depression Scale (CES-D-R) in Mexican adolescents.

MATERIAL AND METHODS

The data are from two samples of middle-school students from Mexico City. The questionnaire included the CES-D-R and other scales for suicide problems, peer and family violence, and drug use.

RESULTS

The sample included 1,549 students (mean age 14 years, SD=1.2). The CES-D-R showed a six-factor structure (explained variance, 55%) with an excellent internal consistency (a=0.93), a significant discriminative power for opposite scores (z=-3.695, p<0.001), and a positive significant correlation with the Roberts Suicidal Ideation Scale (r=0.685, p<0.001).

CONCLUSIONS

The CES-D-R has excellent psychometric characteristics for Mexican adolescents and therefore is deemed as an adequate tool for the assessment of depressive symptoms in large samples to detect mental health needs and design preventive interventions.

Male-female differences in the risk of progression from first use to dependence upon cannabis, cocaine, and alcohol

INTRODUCTION

We extend prior reports about the risk of dependence on specific drugs by providing developmental-specific risk estimates for progression from first use to meeting criteria for DSM-III-R dependence upon cannabis, cocaine, or alcohol, as well as male-female differences.

METHODS

The data are from the National Comorbidity Survey, with a national probability sample of persons 15-44 years old in the United States, which included many respondents who used cannabis, cocaine and alcohol on at least one occasion (n=3558, 1337, and 6149, for cannabis, cocaine, and alcohol, respectively). Survival analysis procedures provided cumulative risk estimates of progression from first use to dependence upon each drug.

RESULTS

The estimated risk of cannabis dependence among male cannabis users was 1% in the first year after first use, and reached a peak at 4% per year 2 years later, before declining. In contrast, the estimated risk of cannabis dependence among female cannabis users remained at 1% per year for 3 years, without the peak. For both male and female cocaine users, the estimated risk for developing cocaine dependence was 5 to 6% within the first year after first use. Thereafter, the estimated risk declined from the peak value, with a somewhat faster decline for females in the next 3 years after first use. For alcohol, the estimated risk period extended for many years after the first drink, with female drinkers becoming alcohol dependent at a rate of about 1% per year; with somewhat higher risk for male drinkers. For both male and female drinkers, the period of risk for developing alcohol dependence extended for a span of more than 20 years since first use; for cannabis and cocaine, the estimated period of risk was much shorter.

COMMENT

There are male-female differences in the risk of becoming cannabis dependent during the first several years after initiation of cannabis use, less pronounced male-female differences for alcohol, and relatively smaller male-female differences for cocaine. These results should interest scientists whose focus is upon the origins of male-female differences in the occurrence of drug dependence.

Examining racial and ethnic disparities in site of usual source of care

Little is known about why minorities have a lower propensity to use private doctors' offices for their usual source of care than non-Hispanic whites. This study used the 2001 Commonwealth Fund's Health Care Quality Survey of adults to determine if this disparity is due to racial and ethnic differences in attitudes about health and healthcare, and perceptions of racial and ethnic discrimination in healthcare. We found that race and ethnic disparities at the site of the usual source of care persisted even after controlling for individuals' attitudes about health and healthcare, and their perceptions about racial and ethnic discrimination in healthcare. We found that the impact of attitudes and perceptions did vary by subgroups. These factors were important for Asians' site of usual source of care but had little impact on African Americans' site of usual of care. However, despite their differential impact by race and ethnicity, attitudes and perceptions were not the source of observed disparities in site of care. Therefore, in addition to focusing on provider-patient relationships, perhaps future research and policymakers should focus on system-level factors to explain and increase minority use of care in private physicians' offices.

Violent victimization and drug involvement among Mexican middle school students

AIMS

To answer the following research questions: (a) is there an association between violent victimization and exposure to opportunities to use marijuana, inhalants and cocaine and (b) is there an association between violent victimization and actual drug use among youth with drug-using opportunities?

DESIGN

Cross-sectional survey.

SETTING

Two middle schools located in the Historic Downtown area of Mexico City.

PARTICIPANTS

The entire body of students (n = 767; mean age 13.8 years, 52% males).

MEASUREMENTS

Qualitative research was used to develop questions on drug exposure opportunities and violent victimization. Standardized questions on life-time alcohol, tobacco, marijuana, inhalant drugs and cocaine use were also included, as well as questions on violent victimization and other covariates.

FINDINGS

One-quarter (25%) of students had an opportunity to try marijuana, inhalant drugs or cocaine; 35% who had an opportunity actually used at least one drug. In this sample, 59% had been victimized violently. Youth who had been victimized had greater odds of opportunities to use drugs compared to those who had not been victimized [adjusted odds ratio (OR) = 3.8; 95% confidence interval (CI), 2.4, 6.1]. Once exposure opportunity is taken into consideration, no association was evident between violent victimization and actual drug use (adjusted OR = 0.9; 95% CI, 0.4, 2.1).

CONCLUSIONS

It is possible to trace back the association between violent victimization and drug use to differences in exposure to opportunities. Limitations considered, this study suggests interventions to improve micro and macro contexts, such as families, schools and communities, so young people can have better places to live and develop.

Gender and the tobacco-depression relationship: a sample of African American college students at a Historically Black College or University (HBCU)

This study examined the relationship between tobacco use and depression and its possible variation by gender among African American young adults. A paper-and-pencil survey was administered to African American college students graduating in 2003 from a Historically Black College or University (HBCU). Tobacco use measures included lifetime involvement. Depression symptoms were assessed using a revised version of the CES-D. Male smokers were found to be four times more likely to be depressed than male non-smokers (OR=4.4; 95% CI, 1.4, 14.3; p=0.012). However, female smokers were not more likely to be depressed than female non-smokers (OR=1.0; 95% CI, 0.5, 2.1). Findings from this study suggest the need of gender-specific tobacco or depression interventions among HBCU students.

Psicopatología en familiares de tres generaciones: un estudio epidemiológico en la Ciudad de México

OBJECTIVE

To estimate the risk of psychiatric disorders across three family generations.

MATERIAL AND METHODS

The research design corresponds to a "family history study" and is based upon a household survey conducted in 1995, on a representative sample of Mexico City's adult population aged 18 - 65 years (n=1932). Briefly, a standardized assessment of adults' lifetime prevalence of psychiatric disorders was obtained using an amended version of the Composite International Diagnostic Interview, CIDI. In addition, all respondents provided information on their parents' psychiatric history of anxiety, affective disorders, and substance-use disorders.Also, respondents who had 4-16 year old children living in the same household were interviewed using a standardized questionnaire that included specific questions on their children's psychiatric symptoms (n=925 parents, corresponding to 1686 children and adolescents). Familial psychopathology across generations was defined as follows: a) history of psychiatric disorders only in grandparents; b) history of psychiatric disorders in one parent only (mother or father); and, c) history of psychiatric disorders history in grandparents and in parent. The risk of psychiatric morbidity was estimated via odds ratios obtained from logistic regression models with and without random-effects and using Generalized Estimation Equations with robust variance estimation.

RESULTS

The risk for psychopathology in the offspring across generations was estimated to be two to three times higher when psychiatric disorders occurred among the parents. The risk of psychiatric disorders was estimated to be higher when comorbidity among different types of disorders was present. Conclusions. The results suggest that the risk for developing psychopathology across generations is at least moderate and relatively stable. Familial transmission of psychopathology across three generations seems to resemble a genetic mixed model.

Early alcohol or tobacco onset and transition to other drug use among students in the state of Morelos, Mexico

In this study, we explored if patterns in the transition from alcohol/tobacco in the Mexican State of Morelos, Mexico are similar to those observed in other countries.

METHODS

The data were from a representative sample of youth age 11-21 years (n = 13,105), who participated in a paper-and-pencil survey in middle schools, high schools, and colleges in the State of Morelos, Mexico. Drug use was assessed via the standardized instrument mostly used in Mexican student surveys. Cox's models for discrete time-survival analyses, stratified by school and age group were used to estimate the risk of drug use in relation to age of alcohol and tobacco use initiation by gender, while accommodating the complex survey design.

RESULTS

About 5% of the students were estimated to have used drugs in their life. Male early users of alcohol or tobacco were more likely to use other drugs, compared to students who did not have an early alcohol or tobacco onset.

COMMENT

Further studies on social mechanisms might help to account for observed similarities in patterns of drug involvement in different countries, even in the context of important differences in rates of drug use.

The relationship of tobacco smoking with depressive symptomatology in the Third Mexican National Addictions Survey

BACKGROUND

While an association between cigarette smoking and depression has been established in Anglo populations, replication of tobacco-depression associations in countries where smoking is growing may provide important new insights. The objectives of this study were to estimate the association of depressive symptomatology with tobacco smoking, number of cigarettes smoked daily, and smoking cessation in a representative sample of the Mexican population.

METHOD

The data come from the Third National Addictions Survey (1998) conducted by the Mexican Ministry of Health, representative of Mexico's civilian population residing in cities and towns with 2500+ inhabitants, aged 18-64. Part of a multi-stage, stratified, probability sample, 1935 men and women answered a version of the survey that also included the CES-D depression scale. Analyses addressed the survey's complex design and controlled for income and educational evel.

RESULTS

Among women only, current smokers had twice the odds of elevated depressive symptomatology than never smokers (OR 2.1, 95% CI 1.3-3.5, p = 0.002). For men, only those smoking a pack or more a day had greater odds of depressive symptomatology (OR 5.9, 95% CI 1.6-21.9, p = 0.008). Overall, former smokers who ceased smoking within 6 months had lower odds of depressive symptomatology than current smokers (OR 0.4, 95% CI 0.1-1.0, p = 0.042).

CONCLUSIONS

These findings add to the accumulating evidence for the association between smoking and depression in different cultures and populations.

Inicio en el consumo de alcohol y tabaco y transición a otras drogas en estudiantes de Morelos, México

OBJECTIVE

To estimate the cumulative probability of occurrence of first use of alcohol and tobacco, and the risk of transition to illegal drugs (marijuana, cocaine, and heroine, among others), in adolescents and young adults, in Morelos State, Mexico.

MATERIAL AND METHODS

A cross-sectional study was conducted during schoolyear 1998-1999, among 13 293 students aged 11-24 years, selected from public schools by probabilistic multistage sampling. Data were collected on sociodemographic, health status, and substance abuse variables, using a validated self-applied questionnaire. Data were restructured to assemble a synthetic cohort for discrete time survival analysis. Associations were assessed with hazard rates and 95% confidence intervals obtained by means of multivariate Cox regression models.

RESULTS

Sixty percent of males started drinking alcohol at 17 years of age, and smoking tobacco at 18 years of age, on average. Women started using alcohol and tobacco one year after men. Utilization of illicit drugs occurred at 19 years of age on average in 5% of women and 13% of men. Nine out of every 100 illicit drug users started directly using illicit drugs without previous use of alcohol and/or tobacco. In general, alcohol or tobacco users were at greater risk of starting drug use than nonusers (RR=6.72; 95 % confidence interval [CI]=4.13-10.93).

CONCLUSIONS

Study findings suggest that interventions to decrease drug abuse should go together with efforts to delay initiation of alcohol and tobacco use. The innovative method used in this study yields epidemiologic evidence relating early use of alcohol and tobacco with initiation of illegal drugs in Mexican students.

Into the world of illegal drug use: exposure opportunity and other mechanisms linking the use of alcohol, tobacco, marijuana, and cocaine

Drawing upon an "exposure opportunity" concept described by Wade Hampton Frost, the authors studied two mechanisms to help account for prior observations about the "stepping-stone" or "gateway" sequences that link the use of alcohol, tobacco, marijuana, and cocaine. Data were obtained from four nationally representative and independent cross-sectional samples of US household residents (n = 44,624 persons aged 12-25 years). Data were gathered using standardized self-report methods and were analyzed via survival methods. Results indicated that users of tobacco and alcohol were more likely than nonusers to have an opportunity to try marijuana and were more likely to actually use marijuana once a marijuana opportunity had occurred. Opportunity to use cocaine was associated with prior marijuana smoking. Among young people with a cocaine opportunity, those who had used marijuana were more likely to use cocaine than were those with no history of marijuana use. The observed associations did not seem to arise solely as a result of young drug users' seeking out opportunities to use drugs. Applying Frost's epidemiologic concept of exposure opportunity, the authors offer new epidemiologic evidence on the sequences that link earlier use of alcohol and tobacco to later illegal drug involvement.

Marijuana use and the risk of Major Depressive Episode. Epidemiological evidence from the United States National Comorbidity Survey

BACKGROUND

This is an epidemiological study of a possible causal role of marijuana use in the development of Major Depressive Episode (MDE). Male-female differences in the suspected causal association have also been studied.

METHOD

Data are from 6,792 National Comorbidity Survey participants aged 15-45 years, assessed via the University of Michigan modified version of the Composite International Diagnostic Interview (UM-CIDI). Survival analysis methods were used to estimate cumulative risk of MDE by levels of marijuana use and to estimate suspected causal associations after adjustment for other influences.

RESULTS

The risk of first MDE was moderately associated with the number of occasions of marijuana use and with more advanced stages of marijuana use. Relative to never users, non-dependent marijuana users had 1.6 times greater risk of MDE (95 % Confidence Interval: 1.1, 2.2), even with statistical adjustment for sex, birth cohorts, alcohol dependence, and history of daily tobacco smoking.

CONCLUSIONS

There was male-female variation in the degree of association between stage of marijuana involvement and MDE, but the strength of the association is modest at best.

From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine, and alcohol

The focal point of this paper is the transition from drug use to drug dependence. We present new evidence on risk for starting to use marijuana, cocaine, and alcohol, as well as risks for progression from first drug use to the onset of drug dependence, separately for each of these drugs. Data from the National Comorbidity Survey (NCS) were analyzed. The NCS had a representative sample of the United States population ages 15-54 years (n = 8,098). Survival analysis techniques were used to provide age- and time-specific risk estimates of initiating use of marijuana, cocaine, and alcohol, as well as of becoming dependent on each drug. With respect to risk of initiating use, estimated peak values for alcohol and marijuana were found at age 18, about two years earlier than the later peak in risk of initiating cocaine use. With respect to risk of meeting criteria for the clinical dependence syndrome, estimated peak values for alcohol and marijuana were found at age 17-18. Peak values for cocaine dependence were found at age 23-25. Once use began, cocaine dependence emerged early and more explosively, with an estimated 5-6% of cocaine users becoming cocaine dependent in the first year of use. Most of the observed cases of cocaine dependence met criteria for dependence within three years after initial cocaine use. Whereas some 15-16% of cocaine users had developed cocaine dependence within 10 years of first cocaine use, the corresponding values were about 8% for marijuana users, and 12-13% for alcohol users. The most novel findings of this study document a noteworthy risk for quickly developing cocaine dependence after initial cocaine use, with about one in 16 to 20 cocaine users becoming dependent within the first year of cocaine use. For marijuana and alcohol, there is a more insidious onset of the drug dependence syndrome.

Exposure opportunity as a mechanism linking youth marijuana use to hallucinogen use

The aim of this study is to shed light upon an observed association between the use of marijuana and hallucinogens (e.g. LSD), with a specific focus on the idea that two separate mechanisms might link marijuana use to hallucinogen use: (1) greater hallucinogen exposure opportunity for marijuana users versus nonusers; (2) increased probability of hallucinogen use for marijuana users versus nonusers, once the opportunity to use hallucinogens has occurred. This work is based on a novel analysis of retrospective, self-report data from more than 40000 young participants in the 1991-1994 National Household Surveys on Drug Abuse (NHSDA), with discrete time survival analysis models. Youths who had used marijuana were substantially more likely than nonusers to have the opportunity to use hallucinogens (estimated unadjusted relative risk, uRR=16.3; 95%. Confidence interval (CI)=14.3-18.6). Once an opportunity to use hallucinogens occurred, marijuana users were more likely than nonusers to initiate hallucinogen use (uRR=12.6; 95% CI=9.0-17.6). This evidence provides a more complete view of interconnections between marijuana use and hallucinogen use, and helps to clarify the pivotal role for drug exposure opportunities. Important next steps will be to understand what accounts for variation in the exposure opportunities experienced by marijuana users, and to understand why some marijuana users do not progress even when they have a chance to do so.

PSYCHOMETRIC PROPERTIES AND CONSTRUCT VALIDITY OF A SPANISH LANGUAGE SCALE FOR SCREENING ANTISOCIAL PERSONALITY

The psychometric properties and construct validity of a Spanish self-report scale for screening antisocial personality (ASP) are evaluated. Evidence for validity was sought by comparing a household and an emergency room (ER) sample. Nine hundred and twenty men and women were part of a multistage, stratified, probability sample drawn from all 18–65 year olds in a city in Mexico. ER participants were 1511 patients 18–65 years of age sampled from the three main hospital emergency rooms in that city. Results suggest an adequate internal consistency and a one-factor structure. Significantly more ASP cases were identified in the ER compared to the household sample, the injured compared to the household sample, the injured compared to the sick, in those whose injuries involved violence, those who had used drugs in the previous 12 months, those who were moderate to heavy drinkers, and those who were alcohol dependent. The advantages and limitations of the scale are discussed. Limitations notwithstanding, the evidence suggests that as an initial evaluation, the Spanish Language Screen for Antisocial Personality could be valuable for reaching large Spanish-speaking populations.

The association of tobacco smoking and depression in adolescence: evidence from the United States

INTRODUCTION

We examine a suspected causal association between tobacco smoking and depression. Using data from the National Household Survey on Drug Abuse (NHSDA), we explore variation in depression severity among current and former smokers compared to nonsmokers. We focus on the association between time since last smoke in former smokers and depression severity, to examine whether the level of tobacco-depression relationship might vary in a time-dependent fashion.

METHODS

Our cross-sectional data come from three public use files of the U.S. National Household Survey on Drug Abuse (NHSDA), collected with different respondents each year from 1994 to 1996, for participants 12-17 years old (N = 13,827). Ordinal logistic regression is used to assess the association between severity of depression and cigarette smoking among former and current smokers.

RESULTS

Current smokers had the highest odds for depression, followed by former smokers, then nonsmokers. Females had higher odds of depression compared to males. The odds of depression varied in subgroups of former smokers. Odds of depression were lower with more elapsed time since last smoke.

DISCUSSION

We add new evidence on depression in association with tobacco smoking. Teens who quit smoking may reduce their odds of depressed mood, but more research is needed before a definite causal path can be established.

Early onset and recent drug use among children of parents with alcohol problems: data from a national epidemiologic survey

There is good evidence that children of parents with alcohol problems have more drug involvement, plus related mental health and behavioral problems. In this study, we sought to estimate the degree to which these children might be more likely to initiate drug use precociously. A sample of 2888 parent-child pairs was identified within public data files of the National Household Survey on Drug Abuse (NHSDA), 1995-1997. Alcohol dependence of one parent was assessed by that parent's report of three or more dependence manifestations. Independently, one randomly selected 12-17 year-old child of the parent answered self-report survey questions on age at first use of tobacco, alcohol, and marijuana. In analyses contrasting 114 children of alcohol dependent parents (AD+) with 2774 other children (AD-), youths with alcohol dependent parents had higher odds than other kids to have used tobacco in the past year (odds ratio, OR=3.2, 95% confidence interval, CI=2.05-4.98), as well as alcohol (OR=1.6, 95% CI=1.05-2.50), and marijuana (OR=2.9, 95% CI=1.71-4.90). Survival analyses were used to clarify excess risk of early-onset drug use. For example, by age 17, an estimated 73% of AD+ children had smoked tobacco cigarettes, 70% had started drinking, and 41% had smoked marijuana, versus 44%, 57%, and 26% of AD- children, respectively. This new evidence helps build a case that children of parents with alcohol problems experience precocious drug use.

Depression in late life: a hidden public health problem for Mexico?

Depression is one of the most important causes of disability in the world, causes considerable suffering, and problems associated with depression are extremely costly to society. Depression is one of the most common and debilitating illnesses of older people that is frequently overlooked. The most recent epidemiological study in Mexico estimated the lifetime prevalence of major depressive episodes among people 18 to 54 years old to be 7.8%, only second to alcohol dependence (8.2%). A previous study found that older adults tend to have higher levels of depression than younger adults. There are important gaps of information about depression among the elderly. Along with refined measurement approaches, further research is needed on risk and protective factors for depression as these factors might highlight the areas that need to be targeted. Addressing depression among the elderly can significantly contribute in reduced health care costs, lowered disability, morbidity and mortality. This could yield important savings, freeing resources that might become available for the attention of important health carè needs.