Higher Rates Of Substance Use Research Articles

Substance Use and Sexual Risk Differences among Older Bisexual and Gay Men with HIV

Bisexual and gay men are disproportionately affected by HIV/AIDS. Research typically combines these groups into the category of men who have sex with men, and little is known about between-group differences. HIV-positive populations are aging and have high rates of substance use compared to non-infected peers, while substance use among older adults has increased and is associated with unprotected intercourse. Among a sample of 239 HIV-positive bisexual and gay men aged 50 and older, bisexual men were more likely to report cigarette, cocaine, crack, and heroin use compared with gay men. However, bisexual men were less likely to use crystal meth, club drugs, poppers (nitrate inhalers), and erectile dysfunction (ED) medications compared to gay men. While bisexual men reported lower rates of unprotected sex, logistic regression analysis found that current use of poppers and ED drugs, which were higher among gay men, explained this difference. Implications for education and prevention programs are discussed.

Pre-Employment Drug Testing for Hospitality Sales Positions: Who's Buying In?

Pre-employment drug testing in the workplace has often been adopted by hospitality organizations both nationally and internationally due to the acceptance of conventional wisdom that drug-using workers have substantially lower productivity rates. While research consistently finds hospitality employees display higher rates of substance use, limited hospitality research has been conducted on the topic of pre-employment drug testing in this industry, and applicant and employee responses to this practice have yet to be investigated. Emerging themes based on employee comments are explored, including perceptions of fairness, necessity, and value. Suggestions for future theoretical-based research are offered, and implications for hospitality industry decision makers are discussed.

Differences in Sexual Health, Risk Behaviors, and Substance Use Among Women by Sexual Identity

Lesbian women may perceive themselves to be at lower risk for sexually transmitted infections (STIs) and use reproductive health care at lower rates compared with heterosexual women. Therefore, STIs in sexual minority women may go undetected. The prevalence and risk factors of urogenital STIs in women of different sexual orientations were investigated. This is a cross-sectional study of women attending the STI clinic of Howard Brown Health Center in Chicago, Illinois. Women were eligible for inclusion in this study if they reported a sexual identity and were screened for urogenital gonorrhea (GC)/chlamydia (CT) in the clinic between January 2008 and December 2011. Among the 669 women studied, the urogenital prevalence of GC was 1.5% and that of CT was 5.2%. Gonorrhea and CT were only diagnosed in women with recent male sex partners, but sexual identity was not necessarily consistent with sexual partner sex, and women of all sexual orientations were diagnosed as having STIs. Bisexual and heterosexual women had similar diagnosis and STI history rates, whereas lesbian women had a significantly lower history of STIs. Bisexual women had more sex partners than heterosexual or lesbian women, and their partners were less likely to be monogamous. Compared with heterosexual women, sexual minority women had twice the odds of drug use in the last year. Chlamydia and GC were diagnosed in sexual minority women, and several cases would have been missed if lesbian women were not tested for STIs. High rates of substance use among sexual minority women highlight the need for targeted interventions.

Prescription drug misuse among homeless youth

BackgroundPrescription drug misuse (PDM) is highly prevalent among youth in the U.S., and can have serious health consequences. Homeless youth are a particularly vulnerable population with high rates of substance use. However, PDM has not been studied in a sample comprised exclusively of homeless youth. MethodsA sample of 451 homeless youth recruited from drop-in centers in Los Angeles, CA, provided information on substance use, mental health, service utilization, trauma, and sexual risk behavior. Multivariable logistic regression assessed correlates of past month PDM. ResultsNearly 50% reported lifetime PDM and 21.6% reported PDM in the past month. The most frequently used prescriptions in the past month were: opioids only (24.5%), sedatives only (23.4%), and stimulants only (10.6%); 14.9% used some combination of these three types of prescription medications. Homeless youth reported that prescriptions were most commonly obtained for free from friends or relatives (24.5%). Foster care involvement was associated with decreased PDM, while hard drug use, suicidal ideation, and unprotected sex were associated with increased PDM. ConclusionsHomeless youth report high rates of PDM, and access these medications most frequently from friends and family. PDM among homeless youth clusters with other risk factors, including hard drug use, unprotected sex, and suicidal ideation. Surprisingly, foster care history was associated with decreased PDM. Programs aimed at preventing PDM among homeless youth should recognize the clustering of risk behaviors, assess prescription use/access when providing mental health services, and educate the general public about proper disposal of prescriptions.

Adolescent Substance Use Initiation

Using cluster analysis, 717 students who reported that they had never smoked and the nondrinking 292 students who reported that they had never drank alcohol were classified into four profile groups based on their Pros and Cons of not using and temptation to use. Profiles were labeled Most Protected, Least Positive, Most Negative, and Most Tempted. Profile groups differed significantly on peer pressure, family communication, and use of 11 Transtheoretical Model (TTM) processes of prevention, and applied experiential and behavioral strategies to prevent the onset of smoking and alcohol use. The largest and most consistent differences were on the processes with the Most Protected using more than the Least Positive and Most Tempted groups. Being more actively engaged with the processes of prevention helps to explain why the Most Protected group has had the least amount of substance use over time while the Most Tempted and Least Positive groups had the highest rates of substance use. The consistency and size of differences on the processes support the hypothesis that Most Protected youth may be those who proactively protect themselves from substance use initiation.

Sex and Gender in the 1980s Heavy Metal Scene: Groupies, Musicians, and Fans Recall Their Experiences

Groupies, heavy metal musicians, and highly devoted fans (metalheads) were some of the most salient identity groups for teenagers and emerging adults in the 1980s—the tail end of the Baby Boom and the beginning of the newly emerging Generation X. Met with appalled reactions from conventional society, the heavy metal scene nevertheless appeared to help at least some disenchanted youth negotiate turbulent times. The present study of 144 middle-aged 1980s groupies, metal fans, and professional musicians used both quantitative and qualitative data to develop insights into the developmental processes of these emerging adults of the 1980s. Metalheads described their childhood experiences, including maltreatment, their sexual and substance use activities in the 1980s, identity issues, and reported on current indicators of adjustment, such as education, mental health, and happiness. The results confirm that youth involved in the metal scene had high rates of substance use, risky sexual behaviors, and especially for groupies, traumatic childhood experiences, as well as drug dependence and sexual violence during their groupie days. However, despite their trauma and risky behaviors, participants were able to thrive and develop healthy adult lives, from which they look back fondly on those 1980s experiences. The richness of these data provide insights into the search for identity for marginalized youth, and provide hypotheses for future research on the understudied developmental processes of such adolescent style cultures.

A Comparison of Substance Use Behaviors of Hispanic Men by Sexual Orientation.

Substance use is a public health concern in the United States. Hispanic men in the United States experience disproportionate rates of substance use when compared to other ethnic groups. Previous research with the general population of Hispanic men has identified factors that are related and may contribute to substance use. In addition, Hispanic men who have sex with men (HMSM) may experience additional social factors that may result in substance use. Despite the body of research on substance use among Hispanic men, no study to date has compared the substance use behaviors of Hispanic men by sexual orientation. The purpose of this study was to compare the substance use behaviors of Hispanic men by sexual orientation. A cross-sectional descriptive design was used to collect data from 164 community-dwelling Hispanic men (i.e., 77 heterosexual men and 87 HMSM) who resided in the South Florida area. Participants completed standardized measures of substance use and demographic characteristics. Findings suggested that heterosexual men had higher rates of substance use when compared to MSM. No differences were found among the two groups of men in terms of alcohol intoxication. Religion, education, and income were not predictors of substance use. When health insurance status was controlled, MSM were less likely to report substance use. As a population, Hispanic men continue to experience health disparities in terms of substance use. Because substance use renders Hispanic men at risk for other health issues, more research is needed to understand the co-occurring health disparities experienced by Hispanic men who reside in the United States.

Understanding the elevated risk of substance use by adolescents in special education and residential youth care: the role of individual, family and peer factors

Adolescents who attend special education for behavioural problems (SEB) and adolescents who live in a residential youth care institution (RYC) are characterised by behavioural disorders and problematic family backgrounds and have an increased risk for substance use. Though it is likely that the high rates of substance use in SEB/RYC settings might be inherent to the risk profile of these adolescents, little is known about the actual role the risk profile has in explaining substance use. The present study examined the extent to which the elevated risk of substance use in SEB/RYC can be explained by high levels of individual, family, and peer risk indicators that are known to characterise their risk profile. Self-report questionnaires from 531 adolescents in RYC (50 % male; mean age 14.7) and 603 adolescents in SEB (81 % male; mean age 14.1) were compared with information from 1,905 adolescents attending special education for students with learning disabilities (SEL) (56 % male; mean age 14.1). Results show that adolescents in SEB/RYC reported higher levels of daily smoking, weekly alcohol consumption, cannabis and hard drug use, as well as greater prevalence of individual, family and peer factors. Though individual, family and in particular peer risk indicators all explain some of the variance in substance use, the differences between adolescents in SEB/RYC compared with SEL remained significant and substantial, with the exception of heavy alcohol consumption. These findings suggest that deviant peer affiliation, in particular, plays a role in explaining high substance use levels in SEB/RYC and those factors relevant to the residential settings and special education schools might also contribute to substance use in these high-risk groups.

Attention Problems in Childhood and Adult Substance Use

To assess the link between childhood attention problems (AP) and substance use 18 years later. This cohort study was conducted in a community sample of 1103 French youths followed from 1991 to 2009. Exposures and covariates were childhood behavioral problems (based on parental report at baseline), early substance use, school difficulties, and family adversity. Outcome measures were regular tobacco smoking, alcohol problems, problematic cannabis use, and lifetime cocaine use (based on youth reports at follow-up). Individuals with high levels of childhood AP had higher rates of substance use (regular tobacco smoking, alcohol problems, problematic cannabis use, and lifetime cocaine use). However, when taking into account other childhood behavioral problems, early substance use, school difficulties, and family adversity, childhood AP were related only to regular tobacco smoking and lifetime cocaine use. Early cannabis exposure was the strongest risk factor for all substance use problems. This longitudinal community-based study shows that, except for tobacco and cocaine, the association between childhood AP and substance use is confounded by a range of early risk factors. Early cannabis exposure plays a central role in later substance use.

Altered Reward Processing in Adolescents With Prenatal Exposure to Maternal Cigarette Smoking

Higher rates of substance use and dependence have been observed in the offspring of mothers who smoked during pregnancy. Animal studies indicate that prenatal exposure to nicotine alters the development of brain areas related to reward processing, which might be a risk factor for substance use and addiction later in life. However, no study has examined the effect of maternal smoking on the offspring's brain response during reward processing. To determine whether adolescents with prenatal exposure to maternal cigarette smoking differ from their nonexposed peers in the response of the ventral striatum to the anticipation or the receipt of a reward. An observational case-control study. Data were obtained from the IMAGEN Study, a European multicenter study of impulsivity, reinforcement sensitivity, and emotional reactivity in adolescents. The IMAGEN sample consists of 2078 healthy adolescents (age range, 13-15 years) recruited from March 1, 2008, through December 31, 2011, in local schools. We assessed an IMAGEN subsample of 177 adolescents with prenatal exposure to maternal cigarette smoking and 177 nonexposed peers (age range, 13-15 years) matched by sex, maternal educational level, and imaging site. Response to reward in the ventral striatum measured with functional magnetic resonance imaging. In prenatally exposed adolescents, we observed a weaker response in the ventral striatum during reward anticipation (left side, F = 14.98 [P < .001]; right side, F = 15.95 [P < .001]) compared with their nonexposed peers. No differences were found regarding the responsivity of the ventral striatum to the receipt of a reward (left side, F = 0.21 [P = .65]; right side, F = 0.47 [P = .49]). The weaker responsivity of the ventral striatum to reward anticipation in prenatally exposed adolescents may represent a risk factor for substance use and development of addiction later in life. This result highlights the need for education and preventive measures to reduce smoking during pregnancy. Future analyses should assess whether prenatally exposed adolescents develop an increased risk for substance use and addiction and which role the reported neuronal differences during reward anticipation plays in this development.

Advances in the science of adolescent drug involvement

Adolescence is a developmental period characterized by relatively high rates of substance use and substance use disorders. Precise assessment and classification of adolescent drug use behaviors are essential in gaining an accurate understanding of the nature and extent of adolescent drug use, and possible intervention or treatment needs. There has been a select group of recently published research reports and manuscripts that address critical and emerging issues pertaining to the classification and assessment of alcohol and other drug use behaviors among adolescents. An overview of these publications is provided and their clinical relevance is discussed. The paper will focus on recent research, most from the United States, that addresses four main issues. One is the application of the new DSM-5 criteria to adolescents, including the advantages and disadvantages of the new criteria for substance use disorders. The second issue pertains to advances in instrumentation that provide new tools for researchers and clinicians in assessing substance use in adolescents. A significant public health issue is addressed as the third theme in the paper - screening for alcohol abuse in college settings. Finally, the paper reviews how the emerging science of brain development can inform the assessment process. Recent advances in the adolescent drug abuse assessment field continue to inform clinical service and research. As a whole, these advances have strengthened the field, but continued research is needed to further refine assessment practices and standards and to better understand how to define a substance use disorder in youth.

Where and When Adolescents Use Tobacco, Alcohol, and Marijuana: Comparisons by Age, Gender, and Race

This study examined the location and time of adolescent use of cigarettes, alcohol, and marijuana. Age, gender, and racial differences in location and time of use were studied for each substance. Using cross-sectional data collected through the schoolwide Pride Survey, 20,055 students between the ages of 10 and 19 years (53.6% female, 55.1% Black, 44.9% White) in one metropolitan area reported on their frequency of cigarette, alcohol, and marijuana use, as well as the location and time of use of each substance. Chi-square tests compared the rates, locations, and times for each substance across boys and girls; Black and White students; and early, middle, and late adolescents. Older adolescents reported higher rates of substance use at friends' homes, at school, and in cars and lower rates of alcohol use at home compared with younger youth. Males were more likely to report alcohol and marijuana use at school and on weeknights and alcohol use in cars, whereas females were more likely to report alcohol and marijuana use on the weekends. No gender differences emerged for times and locations of cigarette use. Compared with Black youth, White adolescents were more likely to use all substances at friends' homes and on weekends; to smoke cigarettes at school, in the car, and on weeknights; and to use alcohol at home. Black adolescents were more likely to report using alcohol at home, at school, in cars, during and after school, and on weeknights and were more likely to report using marijuana at school. The location and time of adolescent substance use vary substantially by age, gender, and race. These differences may help tailor substance use prevention and intervention programs to specific subgroups of youth to improve program effectiveness.

Substance Use Trends and Treatment Among Israeli School Dropouts

Widespread international concern exists about school dropout and substance use among high risk youth. This article examines the issue in Israel and the impact of a 90 day treatment program on a prospective sample of youth. A cohort of 77 youths completed a self-report questionnaire prior to receiving substance abuse treatment. These youth were compared to those attending and disengaged from school. With the exception of inhalants that tend to be a substance more commonly used by youth in school, dropouts report much higher rates of substance use especially those referred to treatment. For this population, the impact of a 90 day residential treatment program was evaluated. Results show the potential such treatment has on reducing substance use. Given the paucity of literature on this topic, this paper makes an initial contribution to understanding a growing problem of youth who have dropped out of school and who are substance users.

Child Abuse, Street Victimization, and Substance Use Among Homeless Young Adults.

Although previous research documents high rates of child abuse, street victimization, and substance use among homeless youth, few studies have investigated these three constructs simultaneously, and thus little is known about how various forms of victimization are uniquely associated with substance use among this population. The purpose of this article is to examine the relationship among child sexual and physical abuse, street victimization, and partner violence with substance use among 172 homeless young adults. Path analysis results revealed that males and those who reported parental drug problems were significantly more likely to have higher rates of substance use. Those who suffered more childhood physical and sexual abuse and those who experienced more types of relationship violence were more likely to report greater frequency of substance use. The intersection of various forms of victimization with substance use may have important implications for service providers working with this population.

Do Protease Inhibitors Increase Preterm Births in Human Immunodeficiency Virus-Infected Patients?

Objective: To compare preterm delivery (PTD) rates in HIV-infected patients on a protease inhibitor (PI)-based and a PI-sparing regimen. Study Design: This is a retrospective review of records of HIV-infected pregnant women between 2000 and 2007 at University Hospital, Newark, NJ. Patients were grouped according to PI exposure during pregnancy. Rates of preterm birth were compared, and the analysis was performed irrespectively of the etiology or indication of the preterm birth. Multivariate analysis including substance use, PI use, initial CD4 count, and history of PTD was performed. Results: There were 129 pregnant women in the PI group and 59 in the PI-sparing group. The PTD rate did not differ between the PI group and PI-sparing group (27.9% vs 25.4%, P = 0.72). 28.6% of those who delivered preterm had a previous PTD compared to 8.4% of those who delivered at term (P = 0.0019). Patients who delivered preterm had a higher rate of substance use (37.3% vs 19.7%, P = 0.0128). In the multivariate analysis, only history of PTD was significant (P = 0.018). Conclusion: Contrary to other studies, PIs were not associated with PTD. Other known risk factors of PTD, specifically past PTD and substance use, should be considered and targeted for risk reduction during pregnancy.

1931 – Attention problems in childhood and substance use 18 years later

Introduction Attention Deficit/Hyperactivity Disorder (ADHD) has been linked to substance use disorders later in life. However, the unique contribution of ADHD is not clarified yet. Insufficient research in this area has considered first substance use, associated behavioral problems and female gender in longitudinal and community settings. Aims To study the association between childhood attention problems and substance use 18 years later. Method Using a French community sample of 1103 youths followed from 1991 to 2009, we tested associations between childhood attention problems (dimensional constructs) and substance use between ages 22 and 35, adjusting for potential childhood and family confounders. Results Individuals with high levels of childhood attention problems presented higher rates of substance use (regular tobacco smoking, alcohol abuse/dependence, cannabis problematic use, cocaine lifetime use). However, when taking into account other childhood behavioral problems, early substance use, academic difficulties and family adversity, childhood attention problems were only related to regular tobacco smoking and cocaine lifetime use. Conclusions This longitudinal community-based study shows that, except for tobacco and cocaine, the association between childhood attention problems and substance use is confounded by a range of early risk factors.

The HAWK2 Program: A Computer-Based Drug Prevention Intervention for Native American Youth

Background: American Indians and Alaska Natives (AI/ANs) have some of the highest rates of substance use compared with other ethnic groups. Native American youth start experimenting with drugs at younger ages, continue to use them after initial experimentation, and thus seem to mirror the same drug use patterns as their older peers. Despite the seriousness of the problem, there is a lack of evidence-based drug prevention interventions for AI/AN youth. Objectives: This review article describes the process by which an existing evidence-based, culturally relevant drug prevention intervention was transformed into a low-cost, computerized intervention digitized in order to extend its reach to Native American youth in reservations and rural locations. Methods: The intervention, titled HAWK2 (Honoring Ancient Wisdom and Knowledge2: Prevention and Cessation) is aimed at young Native children in elementary school settings (grades 4 and 5) and uses engaging multimedia features such as games, animations, and video clips to impart substance abuse prevention knowledge and skills training. The development of this intervention was a collaborative process involving the participation of community experts, research scientists, school teachers, and practitioners, as well as Native youth. Specific examples are provided to illustrate the development processes. Results: Initial feedback from practitioners and youth suggest the feasibility and acceptability of computer-based interventions by Native youth and practitioners. Scientific Significance: Computer-based interventions are a cost-effective way of engaging youth in prevention programming. Future studies of HAWK2 will provide an important means of testing the long-term effectiveness of self-administered, computer-based interventions for AI/AN youth.

Alcohol and Substance Use History Among ADHD Adults

Objective: To profile substance use, personality, service use, and employment in adults with ADHD. Method: The sample consisted of 216 consecutive referrals to an adult ADHD service and classified with ADHD, partially or fully remitted ADHD, or no ADHD. Normal controls (n = 33) were recruited from a general practitioner’s center. Participants completed measures of alcohol and illicit substance use, employment, service use, ADHD symptoms, and personality. Results: High rates of substance use were found in participants with current ADHD diagnoses. ADHD participants showed increased rates of personality trait or disorder scores and unemployment. There was some indication that those with ADHD and substance-related impairment place higher demand on services. Individuals with partially remitted ADHD showed similar substance use to those with current ADHD, whereas those in full remission were comparable with normal controls. Conclusion: Although ADHD symptoms may remit with time, individuals retaining persisting or partial symptoms have substantial needs in adulthood.

Multidimensionality Matters: An Effective HIV, Hepatitis C, and Substance-Use Prevention Program for Minority Parolees

African Americans and Hispanics are more likely than Whites to be incarcerated, and are also disparately affected by HIV, hepatitis C, and substance use. Reaching these populations as they leave prison is important given high rates of substance use and sexual risk-taking behaviors among U.S. prisoners. A 12-session, culturally appropriate, evidence-based, small-group intervention was administered successfully with minority parolees. Participants experienced lasting improvements in HIV and hepatitis C knowledge, condom use, and resource knowledge after participating in the Holistic Health Recovery Program. Collaborative service providers and program multidimensionality are credited for the program's success, high retention rate, and positive reception.

Hotel workers’ substance use and abuse

This study investigates the usage of tobacco, alcohol, and cannabis among hotel employees in the resort city of Eilat. Data obtained from a sample of 458 respondents, drawn from three hotel chains, provides evidence of workers’ substance consumption in light of their socio-demographic backgrounds and specific job characteristics. The results indicate a higher rate of substance use among study participants in comparison to the average in Israeli society. Substance use was found to be the most prevalent among young, single male employees with relatively low levels of education. In terms of job characteristics, front-of-the-house employees were more prone to binge drinking than back-of-the house employees. It is suggested that work-related programs and policies, such as sensible drinking workshops and smoking cessation programs, may help prevent alcohol misuse and reduce extensive substance use among hotel staff.