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

Environmental enrichment enhances ethanol preference over social reward in male swiss mice: Involvement of oxytocin-dopamine interactions

The impact of environmental enrichment (EE) on natural rewards, including social and appetitive rewards, was investigated in male Swiss mice. EE, known for providing animals with various stimuli, was assessed for its effects on conditioned place preference (CPP) associated with ethanol and social stimuli. We previously demonstrated that EE increased the levels of the prosocial neuropeptide oxytocin (OT) in the hypothalamus and enhanced ethanol rewarding effects via an oxytocinergic mechanism. This study also investigated the impact of EE on social dominance and motivation for rewards, measured OT-mediated phospholipase C (PLC) activity in striatal membranes, and assessed OT expression in the hypothalamus. The role of dopamine in motivating rewards was considered, along with the interaction between OT and D1 receptors (DR) in the nucleus accumbens (NAc). Results showed that EE mice exhibited a preference for ethanol reward over social reward, a pattern replicated by the OT analogue Carbetocin. EE mice demonstrated increased social dominance and reduced motivation for appetitive taste stimuli. Higher OT mRNA levels in the hypothalamus were followed by diminished OT receptor (OTR) signaling activity in the striatum of EE mice. Additionally, EE mice displayed elevated D1R expression, which was attenuated by the OTR antagonist (L-368-889). The findings underscore the reinforcing effect of EE on ethanol and social rewards through an oxytocinergic mechanism. Nonetheless, they suggest that mechanisms other than the prosocial effect of EE may contribute to the ethanol pro-rewarding effect of EE and Carbetocin. They also point towards an OT-dopamine interaction potentially underlying some of these effects.

Cohort Profile: The Woodlawn Study

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

Can Early Disadvantage Be Overcome? A Life Course Approach to Understanding How Disadvantage, Education, and Social Integration Impact Mortality into Middle Adulthood Among a Black American Cohort

Health equity research has identified fundamental social causes of health, many of which disproportionately affect Black Americans, such as early life socioeconomic conditions, neighborhood disadvantage, and racial discrimination. However, the role of life course factors in premature mortality among Black Americans has not been tested extensively in prospective samples into later adulthood. To better understand how social factors at various life stages impact mortality, this study examines the effect of life course poverty, neighborhood disadvantage, and discrimination on mortality and factors that may buffer their effect (i.e., education, social integration) among the Woodlawn cohort (N = 1242), a community cohort of urban Black Americans followed since 1966. Taking a life course perspective, we analyze mortality data for deaths through age 58 years old, as well as data collected at ages 6, 16, 32, and 42. At age 58, 204 (16.4%) of the original cohort have died, with ages of death ranging from 9 to 58.98 (mean = 42.9). Cox proportional hazard models adjusting for confounders show statistically significant differences in mortality risk based on timing and persistence of poverty; those who were never poor or poor only in early life had lower mortality risk at ages 43-58 than those who were persistently poor from childhood to adulthood. Education beyond high school and high social integration were shown to reduce the risk of mortality more for those who did not experience poverty early in their life course. Findings have implications for the timing and content of mortality prevention efforts that span the full life course.

The Potential for Prevention Science in Middle and Late Adulthood: a Commentary on the Special Issue of Prevention Science

This commentary on the special issue of Prevention Science, "Toward a Lifespan Prevention Science: A Focus on Middle and Late Adulthood" reviews the studies included in the issue, compares findings, and makes recommendations for future directions in this emerging field. Articles in this issue addressed a number of the key elements of prevention science, including identifying proximal and distal risk and protective factors that play a role in middle and late adult health and well-being, providing preliminary evidence for a preventive intervention to moderate stress reactivity, and proposing a theoretical approach to preventing substance misuse across the lifespan. Our commentary centers around three critical areas for mid and later life prevention science: the importance of theory building, a focus on alcohol and its role in midlife health, and health disparities. Each of the articles in this issue touched on at least one of these areas. We conclude that a focus on prevention in mid and later life has strong potential, and further research is needed.

Unemployment and Substance Use: An Updated Review of Studies from North America and Europe

Since the industrial revolution, the relationship between unemployment and psychiatric disorders has been a subject of high interest. Currently, regarding the correlation between unemployment and substance-use disorders (SUDs), only older, often isolated and fragmented research results are available in the literature. This review was based on an extensive literature search of the European and North American literature in most relevant databases for "unemployment" and "substance use" related to "drugs", "alcohol", "nicotine", and "tobacco" between November 2022 and January 2023, according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) guidelines. A total of 59,117 papers were identified, of which only 33 articles were identified as relevant to the research objective. The literature showed significantly higher prevalence rates of SUDs involving divergent psychotropic substances among unemployed people. Unemployment was found to be a risk factor for SUD, and vice versa. However, the correlation between unemployment and relapses or smoking cessation was inconsistent. In addition, there appeared to be a mild effect of business cycles on SUD. The results showed significant multifaceted correlations between unemployment and SUD, indicating that prevention and early intervention are required to prevent harmful psychosocial consequences, such as social disintegration and severe psychiatric disorders.

Religion, spirituality, and risk for incident posttraumatic stress disorder, suicidal ideation, and hazardous drinking in U.S. military veterans: A 7-year, nationally representative, prospective cohort study

While religion and spirituality (R/S) have been linked to positive mental health outcomes, most studies have employed cross-sectional designs, which do not allow one to evaluate the utility of R/S in predicting these outcomes. To address this gap, this study analyzed data from a 7-year nationally representative, prospective cohort study of U.S. military veterans to examine the effects of R/S on the development of incident mental health outcomes in this population. Specifically, we examined the association between organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiosity (IR), and the risk of incident PTSD, suicidal ideation (SI), and hazardous drinking (HD). Multivariable logistic regression analyses revealed that ORA predicted a lower incidence of PTSD and SI; NORA a greater risk of developing HD; and IR a lower risk of developing HD. These results suggest that religion and spirituality, assessed in a nationally representative sample of military veterans, predict risk of developing PTSD, SI, and HD, over and above sociodemographic factors and perceived social support. Clinical implications and strategies for incorporating R/S into mental health assessment and interventions in this population are discussed.

Influence of Family and Community Socioeconomic Status on the Risk of Adolescent Drug Use

Background: Adolescent drug use increases the risk of mental, physical and social problems later in life and so it is important to understand its complex etiology that likely includes socioeconomic status (SES). We undertook the present analysis using data from a population-based retrospective cohort study to examine the influence of family and community SES in relation to adolescent drug use. We hypothesized that lower levels of community and parental SES would increase the risk of use and that there would be stronger associations for the more proximate family-level factors. Methods: We used self-administered questionnaires (N=1,402) to obtain information on use of marijuana, inhalants, heroin, cocaine/crack, psychedelics/hallucinogens, Ritalin without a prescription, and club drugs during adolescence. Family SES was gathered from birth certificate data on maternal educational level and paternal occupation. Community SES characteristics at birth, age 10 and age 18 were obtained from the US Census Bureau. Results: An increased risk of adolescent drug use was associated with lower maternal education, non-white collar occupations among fathers, and lower community median income, and poverty and unemployment levels at age 18. The strongest associations were seen for the use of multiple drugs (Risk Ratio (RR): 1.7, 95% CI: 1.4-2.2), inhalants (RR: 2.5, 95% CI: 1.5-2.2), crack/cocaine (RR: 2.8, 95% CI: 1.7-4.5), psychedelics/hallucinogens (RR: 1.8, 95% CI: 1.4-2.4), and club/designer drugs (RR: 1.8, 95% CI: 1.2-2.7) among adolescents whose mothers had only a high school education. Conclusions: These results suggest that use of certain drugs during adolescence is associated with both family and community SES measures. However, maternal education appears to have the greatest influence on use, suggesting that a multi-level approach that engages mothers is needed to prevent adolescent drug use.

Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions

COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.

The Relationships Among Social Capital, HIV Self-Management, and Substance Use in Women

Women living with HIV (WLHIV) face unique challenges to successfully self-manage HIV including substance use and limited social capital. We conducted a 6-month mixed-methods study to describe how social capital influences HIV self-management and substance use among WLHIV. Participants completed a self-report survey and in-depth interview at baseline, and 3 and 6 months. Descriptive statistics, t-tests, and generalized estimating equations (GEEs) were used to examine quantitative relationships. Qualitative data were analyzed using qualitative description. Current substance users reported lower social capital compared with past substance users (2.63 vs. 2.80; p = .34). Over time, substance use and social capital were associated with HIV self-management (Wald χ² = 28.43; p < .001). Qualitative data suggest that HIV self-management is influenced by overlapping experiences with social capital, including influential trust, community, and value of self can be complicated by ongoing substance use. Social capital can facilitate improved HIV self-management; however, substance use and trauma can weaken this relationship.

Gender and age differences in the associations between family social roles and excessive alcohol use

BACKGROUND

Familial social roles are known to have important links with both acute and chronic excessive alcohol use. However, whether and how these links vary across adulthood and by gender is not well understood and would provide insight into populations most at risk for excessive alcohol use.

METHODS

This study used data from those ages 18 to 60 in the National Epidemiologic Study of Alcohol and Related Conditions-III survey (N=28,475). We examined the gender- and age-varying associations of current marital status (married vs. divorced/separated vs. never married) and parental status (parent vs. not) with acute (binge drinking) and chronic (exceeding weekly drinking guidelines) excessive alcohol use using time-varying effect modelling.

RESULTS

Both marital and parental statuses were inversely associated with acute and chronic excessive alcohol use at most ages, however the magnitude of these associations and gender differences in these associations varied by age. There were greater differences between adults who were married vs. never married and parents vs. not in excessive alcohol use during young adulthood as compared to later adulthood. The association of parental status with acute excessive alcohol use was stronger for women compared to men in young adulthood.

CONCLUSIONS

Gender and age should be considered when examining risk and protective factors, particularly in examining the role of parenthood in acute excessive alcohol use. These findings will help target populations most at risk for chronic and acute excessive alcohol use.

Change in employment status and cocaine use treatment outcomes: A secondary analysis across six clinical trials

BACKGROUND

Unemployment is a chronic problem among treatment seeking substance users and is associated with poor treatment response. Most studies that have examined the relationship between employment and treatment outcomes for substance use disorders have done so by considering employment at only one specific point in time (e.g., upon entering treatment). There is a lack of research on how change in employment status over time is associated with substance use treatment outcomes. The aim of this study was to evaluate both static employment status and change in employment status over time as predictors of cocaine use treatment outcomes.

METHODS

We utilized data pooled from six randomized clinical trials evaluating treatment for cocaine use disorders (n = 553). Multiple general linear mixed models were conducted to determine the association of baseline, end-of-treatment, and change in employment status (from baseline to end-of-treatment) with treatment outcomes.

RESULTS

Treatment outcomes did not differ by baseline employment status but were significantly better for those employed versus unemployed at the end-of-treatment. In regard to change in employment status over time, those who were unemployed at baseline and acquired employment by end-of-treatment had significantly better treatment outcomes during active treatment and follow-up, as compared to those who were unemployed at baseline and remained unemployed by end-of-treatment.

CONCLUSION

Our findings suggest that end-of-treatment employment status may be an important marker of good outcome among those unemployed at treatment entry and support the incorporation of interventions designed to promote employment by substance use disorders treatment programs.

Prevalence of and risk factors for substance use among Afghan refugees in Iran: An exploratory study

Afghan refugees may be a high-risk group for substance use problems. However, research is scarce in this area, specifically among Afghan refugees in one of their main host countries, Iran. This study aimed to estimate the prevalence of substance use among this population and explore the associated risk factors using a mixed-methods design. Findings suggest that 4.2% of the surveyed households had at least one adult member using illicit drugs. Moreover, results show that substance use among Afghans had statistically significant associations with illiteracy, lack of documentation, living in slum areas, and multidimensional poverty. Policy implications are discussed and recommendations provided.

Neurocognitive Precursors of Substance Misuse Corresponding to Risk, Resistance, and Resilience Pathways: Implications for Prevention Science

Studies of substance misuse prevention generally focus on characteristics that typify risk, with the assumption that the prevalence of the problem will be optimally reduced by identifying, targeting, and reducing or eliminating risk factors. However, this risk-centered approach neglects variations in individual-level and environmental characteristics that portend differential pathways that are distinguishable by timing of substance use initiation (e.g., early versus delayed), the likelihood of use escalation versus eventual desistance, and enduring abstinence, despite exposure to significant risk factors. Considering the various underpinnings of these distinct substance use trajectories is critical to a more nuanced understanding of the effects, potency, and malleability of factors that are known to increase risk or confer protection. Here, we discuss three pathways relative to substance use patterns and predictors in the context of adversity, a well-known, highly significant influence on propensity for substance misuse. The first pathway is designated as "high risk" based on early onset of substance use, rapid escalation, and proneness to substance use disorders. Individuals who defy all odds and eventually exhibit adaptive developmental outcomes despite an initial maladaptive reaction to adversity, are referred to as "resilient." However, another categorization that has not been adequately characterized is "resistant." Resistant individuals include those who do not exhibit problematic substance use behaviors (e.g., early onset and escalation) and do not develop substance use disorders or other forms of psychopathology, despite significant exposure to factors that normally increase the propensity for such outcomes (e.g. trauma and/or adversity). In this paper, we apply this conceptualization of risk, resistance, and resilience for substance misuse to a more fine-grained analysis of substance use pathways and their corresponding patterns (e.g., non-use, initiation, escalation, desistance). The significance of the progression of neurocognitive functioning over the course of development is discussed as well as how this knowledge may be translated to make a science-based determination of intervention targets. This more encompassing theoretical model has direct implications for primary prevention and clinical approaches to disrupt risk pathways and to optimize long-term outcomes.

Trends and mental health correlates of nonmedical opioid use among criminal justice-involved African American men

BACKGROUND

The Centers for Disease Control and Prevention has deemed nonmedical opioid use (NMOU) an epidemic. Population-based survey data indicate high rates of NMOU among Caucasians, however, these estimates exclude incarcerated samples and may underestimate use among criminal justice-involved African Americans. Despite opioid-associated risks of co-occurring mental illness and mortality, to our knowledge, this is the first study to examine NMOU and mental health among a sample of African American men receiving corrections-based substance use disorder (SUD) treatment in jail, prison, or the community.

METHOD

We conducted a cross-sectional study examining trends and mental health correlates of NMOU during the year prior to each participant's incarceration, across five cohorts of African American men (N = 4021) enrolled in corrections-based SUD treatment between the years, 2010 and 2014. A series of chi-square, ANOVAs, correlations, and logistic regression models were conducted.

RESULTS

Over 20% of our sample reported NMOU during the year prior to incarceration. On average, participants were 36-years-old, earned 13 years of education, and were generally unemployed, prior to incarceration. We found a statistically significant positive linear trend between NMOU prior to incarceration and cohort year. The final stepwise multivariate regression model was significant and revealed, older age was associated with lower odds of NMOU. More years of education and frequent mental health symptoms were associated with significantly increased odds of NMOU.

DISCUSSION

Our findings are unique in that extant literature has primarily described NMOU as a 'White suburban' problem. Culturally-adapted behavioral interventions and medication assisted therapies are discussed.

Marihuana y drogas ilícitas en jóvenes mexicanos: Factores de riesgo y protección asociados a la edad de inicio del consumo

Objetivo: Determinar factores de riesgo y protección asociados a la edad de inicio del consumo de mariguana y drogas ilícitas en jóvenes mexicanos. Método: Se analizaron datos de 40,366 jóvenes participantes de la Encuesta de Cohesión Social para la Prevención de la Violencia y la Delincuencia (ECOPRED). Las variables asociadas con la edad de inicio del consumo de mariguana y otras drogas ilícitas fueron determinadas mediante dos modelos de riesgos proporcionales. Resultados: La edad mediana de inicio en consumo de drogas ilícitas osciló entre los 15 y 18 años, mientras que en consumo de marihuana fue de 17 años. En ambos modelos, tener un par consumidor de marihuana fue el factor más fuertemente asociado al inicio de consumo. Discusión: La edad de inicio de consumo revelada en el presente estudio resultó similar a aquella propuesta en investigaciones previas. A pesar de las diferencias de factores en cada modelo, tener un par consumidor de marihuana y el consumo previo de tabaco (variable moderadora) resultaron los factores más fuertemente asociados en ambos modelos.

From childhood adversity to problem behaviors: Role of psychological and structural social integration

BACKGROUND

Childhood adversity (CA) is associated with problem behaviors in adolescence, but the mediators, that is, those factors that help build resilience and prevent some children who experience CA from engaging in problem behaviors, await more exploration, including social integration. The aim of this study was to identify the association between CA and adolescent problem behaviors, and to further examine the mediating role of social integration distinctly as psychological and structural integration.

METHODS

Data used were from the Taiwan Education Panel Survey, a core panel of 4,261 students (age 13) surveyed in 2001 and followed for three more waves until age 18. For psychological integration, an average score was calculated to represent adolescents' feelings about their school. Structural integration was constructed using several items about adolescents' school and extracurricular activities. We used structural equation modeling with the diagonally weighted least squares method to examine the effect of CA on the primary outcome: adolescent problem behaviors via social integration.

RESULTS

The hypothesized structural equation model specifying the path from CA to adolescent problem behavior had good fit. Respondents with one CA were indirectly linked to problem behaviors via psychological but not structural integration (e.g. the level of participation in school and non-school activities). On mediation analysis, psychological integration significantly mediated the paths from one CA to all six problem behaviors (all P < 0.05).

CONCLUSION

The presence of only one CA was indirectly associated with problem behavior via psychological integration; two or more CA were not associated with significant paths to problem behaviors. The contribution of social integration is crucial to an adolescent's development from CA to problem behaviors. To form supportive social relationships to achieve better health, we suggest that those adolescents who have been exposed to CA should be helped to join more teams and take part in more activities, thereby increasing their opportunities for social interaction, and improving their communication skills.

Effect of social housing and oxytocin on the motivation to self-administer methamphetamine in female rats

Social housing has been shown to attenuate the motivation for cocaine in female, but not male rats. Here we investigate the potential mechanisms mediating the effect of social housing on the response to methamphetamine (METH). Female rats were individually or socially (pair) housed. The dopamine (DA) response to an acute METH infusion (0.3mg/kg, i.v.) was investigated using in vivo microdialysis in the nucleus accumbens with or without oxytocin (OT; 0.3mg/kg, i.p.) 30min prior to METH. The effects of social housing and OT on self-administered METH (0.06mg/kg/inf) was investigated. The METH-induced DA response was higher in individually housed compared to socially-housed females. On the other hand, individually housed females had a significantly higher breaking point (BP) than socially-housed females. Two weeks of OT treatment reduced BP in both groups. Reinstatement to METH was more pronounced in isolates compared to socially-housed females. More of the socially-housed females had very low BP than did the individually housed females. OT was most effective in reducing BP in females with moderate to high BP, irrespective of housing conditions. These data show that social housing attenuates escalation of METH intake and reinstatement of METH seeking in female rats, and that chronic OT treatment can reduce motivation for METH.

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

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

Developmental pathways from child maltreatment to adolescent marijuana dependence: Examining moderation by FK506 binding protein 5 gene (FKBP5)

The current study examined the prospective association between child maltreatment and the development of substance use disorder in adolescence with the aim of investigating pathways underlying this relation, as well as genetic moderation of these developmental mechanisms. Specifically, we tested whether youth who experienced maltreatment prior to age 8 were at risk for the development of marijuana dependence in adolescence by way of a childhood externalizing pathway and a childhood internalizing pathway. Moreover, we tested whether variation in FK506 binding protein 5 gene (FKBP5) CATT haplotype moderated these pathways. The participants were 326 children (n =179 maltreated; n = 147 nonmaltreated) assessed across two waves of data collection (childhood: ages 7-9 and adolescence: ages 15-18). Results indicated that higher levels of child externalizing symptoms significantly mediated the effect of child maltreatment on adolescent marijuana dependence symptoms for individuals with one or two copies of the FKBP5 CATT haplotype only. We did not find support for an internalizing pathway from child maltreatment to adolescent marijuana dependence, nor did we find evidence of moderation of the internalizing pathway by FKBP5 haplotype variation. Findings extend previous research by demonstrating that whether a maltreated child will traverse an externalizing pathway toward substance use disorder in adolescence is dependent on FKBP5 genetic variation.

Social integration and health insurance status among African American men and women

Using 2010 national data, we investigate the relationship between social integration and health insurance for African American adults. During the previous year 21.6% of men and 19.8% of women lacked continuous health insurance. The effect of marital status, income, and employment on insurance coverage differed by age and gender. Additionally, frequency of church attendance was positively associated with continuous health insurance for women aged 51-64. Spiritual/religious identity was marginally associated with insurance status for men aged 36-50. As provisions of the Affordable Care Act take effect, implementation programs should expand enrollment efforts to include the conjugal unit and the church.

Family transitions and changes in drinking from adolescence through mid-life

AIMS

To examine how changes in social roles, particularly in the family, predict rises and falls in alcohol consumption from ages 16 to 50 years.

DESIGN

Longitudinal data from the National Child Development Study.

SETTING

The birth cohort includes 99% of British infants born in 1 week in 1958. Participants After initial assessment of 17,415 infants, the cohort was interviewed at ages 7, 11, 16, 23, 33, 42, 46, and 50. This study uses the six adolescent to adult waves (n = 7212 women, 7377 men).

MEASUREMENTS

Alcohol use [i.e. quantity consumed in past week and heavy daily drinking), symptoms of problem drinking (i.e. Cut-down, Annoyed, Guilt, Eye-opener (CAGE)] and social roles (i.e. union formation, parenthood and employment).

FINDINGS

Estimates from fixed-effects models demonstrate that alcohol use is lower when women reside with child(ren) under age 5, compared to occasions when they do not [estimate = -0.38, 95% confidence interval (CI) = -0.43, -0.32 for past week units; odds ratio (OR) = 0.47, CI = 0.36, 0.62 for heavy-daily drinking; OR = 0.66, CI = 0.50, 0.87 for CAGE symptoms]. Associations are similar for men (estimate = -0.29, CI = -0.36, -0.23; OR = 0.64, CI = 0.53, 0.77; OR = 0.69, CI = 0.51, 0.94, respectively). When women and men are married, working and residing with young child(ren), past week units (estimate = -0.51, CI = -0.61, -0.41 for women; estimate = -0.34, CI = -0.44, -0.25 for men), heavy-daily drinking (OR = 0.49, CI = 0.30, 0.79 for women; OR = 0.47, CI = 0.35, 0.64 for men) and CAGE (OR = 0.44, CI = 0.23, 0.83 for women; OR = 0.39, CI = 0.18, 0.82 for men) are lower compared to occasions when they are not in these roles.

CONCLUSIONS

From late adolescence to mid-life, women and men in Britain are most at risk for higher levels of alcohol consumption and problem drinking when family roles are absent.

Neighborhood characteristics and the initiation of marijuana use and binge drinking

BACKGROUND

This study examines whether residential neighborhood characteristics influence the initiation of marijuana use and binge drinking, and if these neighborhood factors heighten or dampen peer influences on substance use.

METHODS

Predictors of marijuana (N=6516) and binge drinking (N=6630) initiation over a 1-year period were identified using data from the National Longitudinal Study of Adolescent Health. Participants were of ages 12-19 years at baseline. The main predictor variables were neighborhood characteristics, using both objective (proportion of households below the poverty line and female-headed, unemployment rate, residential stability) and subjective (perceived cohesion and safety) measures. Binge drinking was defined as 5 or more drinks in a row.

RESULTS

Initiation occurred for 12.9% of adolescents in the case of marijuana and 16.4% for binge drinking. Marijuana initiation was more likely among adolescents who lived in neighborhoods with a higher unemployment rate, and binge drinking initiation was more likely among those who perceived greater safety in their neighborhood, after adjusting for other neighborhood characteristics, demographics, friend characteristics, and behavioral and family risk factors. There was no evidence that neighborhood context moderates the associations of peer factors on initiation.

CONCLUSIONS

Select neighborhood characteristics appear relevant to the initiation of marijuana use and binge drinking, although the mechanisms appear to be distinct for each substance. If these results are found to be robust, future research should aim to better understand how neighborhood context influences the initiation of adolescent substance use in order to inform prevention efforts.

Latent classes of heroin and cocaine users predict unique HIV/HCV risk factors

BACKGROUND

Patterns of heroin and cocaine use vary and may be associated with unique risk factors for bloodborne infections.

METHODS

Latent class analysis identified sub-populations of 552 heroin and cocaine users in Baltimore, Maryland. Using latent class regression, these classes were analyzed for associations with demographic characteristics, risky behaviors, Hepatitis C, and HIV.

RESULTS

Three classes were found: Crack/Nasal-Heroin users (43.5%), Polysubstance users (34.8%), and Heroin Injectors (21.8%). Compared to Polysubstance users, Crack/Nasal-Heroin users were almost 7 times more likely to identify as Black (OR=6.97, 95% CI=4.35-11.2). Sharing needles was over 2.5 times more likely among Polysubstance users than among Heroin Injectors (OR=2.66, 95% CI=1.49-4.75). Crack/Nasal-Heroin users were 2.5 times more likely than Polysubstance users to exchange drugs for sex (OR=2.50, 95% CI=1.22-5.13). Crack/Nasal-Heroin users were less likely than Heroin Injectors to have Hepatitis C (OR=0.10, 95% CI=0.06-0.18), but no significant differences were found for HIV.

CONCLUSIONS

Subpopulations of cocaine and heroin users differed in demographic classifications, HIV-risk behaviors, and Hepatitis C infection. All subpopulations included substantial numbers of HIV-positive individuals. Findings provide further evidence that non-injection drug users face significant infectious disease risk.

Tobacco, alcohol, cannabis and other illegal drug use among young adults: the socioeconomic context

BACKGROUND

Low socioeconomic position predicts risk of substance abuse, yet few studies tested the role of preexisting familial and individual characteristics.

METHODS

Data come from the TEMPO (Trajectoires Epidémiologiques en Population) study (community sample in France, 1991-2009, n=1103, 22-35 years in 2009) set up among offspring of participants of an epidemiological study (GAZEL). Past 12-month substance use was assessed in 2009 by self-completed mail survey: regular tobacco smoking, alcohol abuse (AUDIT), cannabis use, problematic cannabis use (CAST), other illegal drug use. Socioeconomic position was defined by educational attainment, occupational grade, employment stability and unemployment. Covariates included demographics (age, sex, relationship status, parenthood), family background (parental income, parental tobacco smoking, parental alcohol use), and juvenile characteristics (psychological problems, academic difficulties) measured longitudinally.

RESULTS

35.8% of study participants were regular smokers, 14.3% abused alcohol, 22.6% used cannabis (6.3% had problematic cannabis use) and 4.1% used other illegal drugs. Except for alcohol abuse, substance use rates were systematically higher in individuals with low, rather than intermediate/high, socioeconomic position (age and sex-adjusted ORs from 1.75 for cannabis use to 2.11 for tobacco smoking and 2.44 for problematic cannabis use). In multivariate analyses these socioeconomic disparities were decreased, but remained statistically significant (except for illegal drugs other than cannabis).

CONCLUSIONS

Tobacco smoking, alcohol, cannabis and polysubstance use are common behaviors among young adults, particularly those experiencing socioeconomic disadvantage. Interventions aiming to decrease substance abuse and reduce socioeconomic inequalities in this area should be implemented early in life.

The Impact of Adolescent Deviance on Marital Trajectories

Marriage is a key life event that has numerous benefits. Recent research extends these benefits to include desistance from crime and drug use yet there has been little investigation regarding whether deviant behavior in adolescence impacts long-term marital patterns. Since rates of marriage are low among African Americans and rates of adolescent deviance and crime are high, we investigate the long-term relationship between the two drawing on longitudinal data from the Woodlawn cohort of urban African Americans. This article investigates whether serious adolescent delinquency and marijuana use predict marital trajectories, controlling for known correlates. Multivariate findings indicate that within this African-American population, deviance predicts the probability of marriage, stability of marriage, and timing of marriage for men yet deviance relates solely to the probability of marriage for women.

Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality

Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late career. The risk of death was highest during the first 10 years of follow-up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors.