Drug abuse and illicit drug use in Puerto Rico

A comparison of the prevalence of psychiatric disorders in Puerto Rico with the United States and the Puerto Rican population of the United States

PURPOSE

The manuscript compares the rates of psychiatric disorder among island Puerto Ricans, the US population and US Puerto Ricans in order to examine whether social support explains differences in psychiatric disorder among these three groups.

METHODS

Unadjusted and adjusted rates for sociodemographic factors and social support of main psychiatric disorders are compared among three population-based psychiatric epidemiology studies carried in Puerto Rico (PR) and the United States (US) as part of the NCS-R and NLAAS studies.

RESULTS

Comparison of adjusted rates showed island Puerto Ricans had similar overall rates of psychiatric disorder as those of the US, lower rates of anxiety disorders, but higher rates of substance use disorders. US Puerto Ricans had higher rates of adjusted anxiety and depression but not of overall psychiatric disorder, as compared to the island. When the rates of disorder were adjusted also for social support, the differences between these two groups disappeared.

CONCLUSIONS

The findings suggest that social support is a variable worthy of further exploration for explaining differences in disorder prevalence particularly among Puerto Ricans depending on where they live.

Illegal drug use and its correlates in San Juan, Puerto Rico

BACKGROUND

Data on the prevalence and correlates of illegal drug use in Puerto Rico are now almost 20 years old.

OBJECTIVES

This study sought to estimate the 12-month prevalence of illegal and non-prescribed medical drug use in San Juan, Puerto Rico and identify sociodemographic correlates of use.

METHODS

Data are from a random household sample of 1510 individuals, 18-64 years of age in San Juan, Puerto Rico.

RESULTS

The 12-month prevalence of any illegal or non-prescribed drug use was 16.5%. Prevalence among men (20.7%) was higher than among women (12.9%; chi² = 16.308; df = 1; p < .01). Prevalence for specific drugs ranged from 11.2% for marijuana to 0.2% for methadone.

RESULTS

of the multiple logistic regression analysis showed that male gender (OR = 1.67, 95CI = 1.21-2.3; p < .01), age 18-29 (OR = 2.39; 95CI = 1.35-4.23; p < .01), age 30-39 (OR = 1.93; 95CI = 1.01-3.69; p < .05), low (OR = 2.03; 95CI = 1.36-3.02; p < .001) and medium (OR = 1.50; 95CL = 1.01-2.23; p < .05) family cohesion/pride, and no religious preference (OR = 1.99; 95CI = 1.23-3.22; p < .01) increased the odds of drug use. Annual family income of $40,000-$60,000 (OR = 0.45; 95CI = 0.21-0.93; p < .05) and $60,001 and more (OR = 0.35; 95CI = 0.13-0.94; p > .05) were negatively associated with drug use compared to annual income up to $10,000.

CONCLUSIONS

As in many other places in the U.S., drug use in San Juan, Puerto Rico is high, affecting about 1 in 6 adults in the population. The highest prevalence is for marijuana use, which cannot be medically prescribed and of which recreational use is illegal on the island.

Roman Catholic Priests as Referral Sources and Treatment Aides for Hispanics with Substance Misuse/Abuse Problems

This self-administered mail survey study, conducted along the USA-Mexico border, examines Roman Catholic Priests' involvement in aiding Hispanic individuals with substance abuse problems. The Priests were found to be highly involved or willing to be involved in: (1) participating in juramentos (pledge usually to Virgin of Guadalupe, with Priest as witness, to temporarily abstain from substance use), (2) providing referrals, and (3) working with family and/or treatment resources in the community in order to help the person seeking their help. Fluency in Spanish, regardless of Hispanic ethnicity, was found to positively impact involvement in juramentos, providing referrals, and willingness to work with community resources.

Children exposed to alcohol-related problems and DSM-5 alcohol use disorder in San Juan, Puerto Rico

This article estimates the proportion of children (17 and younger) exposed to an adult with an alcohol problem or alcohol use disorder (AUD) in San Juan, Puerto Rico. Data are from a household random sample of 1,510 individuals 18-64 years of age. A total of 20.9% of children in sample households were exposed to an adult with an alcohol problem, and 5.7% were exposed to an adult with DSM-5 AUD. These considerable proportions suggest that alcohol treatment and family support programs should include help for adults in the family, and special support for exposed children in the household.

Family cohesion and pride, drinking and alcohol use disorder in Puerto Rico

BACKGROUND

The extended multigenerational family is a core value of Hispanic culture. Family cohesion/pride can have protective effects on drinking- and drug-use-related behavior among Hispanics.

OBJECTIVES

To examine the association between family cohesion/pride, drinking, binge drinking, and DSM-5 alcohol use disorder (AUD) in Puerto Rico.

METHODS

Data are from a household random sample of 1510 individuals 18-64 years of age in San Juan, Puerto Rico.

RESULTS

Bivariate analyses showed that family cohesion/pride was not associated with the average number of drinks consumed per week but was associated with binge drinking among men. Family cohesion/pride was also associated with DSM-5 AUD. Results of the multivariate analyses were consistent with these bivariate results for DSM-5 AUD. Respondents with low (OR = 2.2, 95CL = 1.21-3.98; p < .01) and medium (OR = 1.88; 95CL = 1.12-3.14; p < .01) family cohesion/pride were more likely than those with high family cohesion/pride to have a positive diagnosis of DSM-5 AUD. More liberal drinking norms and positive attitudes toward drinking were also strong predictors of the average number of drinks consumed per week. More liberal drinking norms also predicted binge drinking, and DSM-5 AUD.

CONCLUSIONS

Higher family cohesion/pride may have a protective effect against DSM-5 AUD. This may have practical implications for clinical and prevention programs. As long as high cohesion is not enabling drinking, these programs can enhance and support family cohesion/pride to help clients in treatment and recovery and prevent drinking problems.

The dimensionality of DSM5 alcohol use disorder in Puerto Rico

AIMS TO

Test the dimensionality and measurement properties of lifetime DSM-5 AUD criteria in a sample of adults from the metropolitan area of San Juan, Puerto Rico.

DESIGN

Cross-sectional study with survey data collected in 2013-2014.

SETTING

General population.

PARTICIPANTS

Random household sample of the adult population 18 to 64years of age in San Juan, Puerto Rico (N=1510; lifetime drinker N=1107).

MEASUREMENT

DSM-5 alcohol use disorder (2 or more criteria present in 12months).

RESULTS

Lifetime reports of AUD criteria were consistent with a one-dimensional model. Scalar measurement invariance was observed across gender, but measurement parameters for tolerance varied across age, with younger ages showing a lower threshold and steeper loading.

CONCLUSIONS

Results provide support for a unidimensional DSM-5 AUD construct in a sample from a Latin American country.

Hispanic Use of Juramentos and Roman Catholic Priests as Auxiliaries to Abstaining from Alcohol Use/Misuse

This self-administered mail survey study conducted along the US-Mexico border replicates and expands on research conducted in Florida regarding the prevalence of juramento use as an intervention technique for alcohol misuse. Juramentos are pledges to abstain from alcohol use for a time determined by the user. The pledge is usually to the Virgin of Guadalupe and is often done in the presence of a Roman Catholic Priest. As in Florida, the majority of Priests along the border reported they were familiar with the practice of juramentos and had already witnessed at least one. The majority of Priests who had done juramentos viewed them as effective. Since the vast majority of Priest indicated that they would begin or continue witnessing juramentos, this makes juramentos and Roman Catholic Priests a viable culturally sensitive aide for treatment among Hispanics, in particular those of Mexican descent.

Xylazine as a drug of abuse and its effects on the generation of reactive species and DNA damage on human umbilical vein endothelial cells

Human xylazine (XYL) abuse among addicts has received great interest due to its potential toxic effects upon addicts and the need to understand the mechanism of action associated with the potential health effects. XYL is an alpha-2 agonist restricted to veterinarian applications, without human medical applications. Our previous work demonstrated that XYL and its combination with cocaine (COC) and/or 6-monoacetylmorphine (6-MAM) induce cell death through an apoptotic mechanism. The aim of this study was to determine the effect of xylazine on the generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) as well as DNA damage on endothelial cell. Human umbilical vein endothelial cells (HUVEC) were treated with XYL (60 μM), COC (160 μM), 6-MAM (160 μM), camptothecin (positive control, 50 μM), XYL/COC (50 μM), XYL/6-MAM (50 μM), and XYL/COC/6-MAM (40 μM) for a period of 24 hours. Generation of intracellular ROS, RNS, and DNA fragmentation were analyzed using a fluorometric assay. Results reveal that XYL and 6-MAM increase levels of ROS; no induction of RNS production was observed. The combination of these drugs shows significant increase in DNA fragmentation in G2/M phase, while XYL, COC, and 6-MAM, without combination, present higher DNA fragmentation in G0/G1 phase. These findings support that these drugs and their combination alter important biochemical events aligned with an apoptotic mechanism of action in HUVEC.

The Virgin of Guadalupe as an ancillary modality for treating Hispanic substance abusers: Juramentos in the United States

During a 6-month research study of substance abuse outreach and retention methods in Mexico, the authors learned about the common practice of a self-control mechanism to abstain from substance abuse: Juramentos. Juramentos are pledges usually made to the Virgin of Guadalupe in the presence of a Catholic priest. The Jurado promises not to drink during a specified period of time. The authors discuss the dynamics of Juramentos and present data from an exploratory study indicating that Juramentos are being used among Mexican migrants in Florida and may provide a culturally sensitive adjunct for treatment of Mexican and other Hispanic clients in the United States.

Substance use and HIV risk in a sample of severely mentally Ill Puerto Rican women

Latinos, and Puerto Ricans in particular, have been disproportionately impacted by HIV/AIDS. Severe mental illness (SMI) is associated with an increase in HIV risk. Relatively little research has focused on the role of SMI among Puerto Rican injection drug users (IDUs) and non-IDUs in susceptibility to and transmission of HIV and there are few published reports on HIV risk among Latina SMI. We conducted a longitudinal mixed methods study with 53 Puerto Rican women with schizophrenia, bipolar disorder, or major depression to examine the cultural context of HIV risk and HIV knowledge, beliefs, and behaviors among a larger study with Puerto Rican and Mexican women with serious mental illness (SMI). There was a high prevalence of past and current substance use and a high prevalence of substance use-associated HIV risk behaviors, such as unprotected sexual relations with an IDU. The violence associated with substance use frequently increased participants' HIV risk. Choice of substance of abuse depended on cost, availability, and use within the individual participant's network. Participants attributed their substance use to the need to relieve symptoms associated with their mental illness, ameliorate unpleasant feelings, and deaden emotional pain. HIV prevention interventions for poorer Puerto Rican women with SMI must target the individuals themselves and others within their networks if the women are to be supported in their efforts to reduce substance use-related risk. The content of any intervention must address past and current trauma and its relationship to substance use and HIV risk, as well as strategies to prevent HIV transmission.

Stigmatization of illicit drug use among Puerto Rican health professionals in training

Social stigma continues to be a barrier for health promotion in our society. One of the most stigmatized health conditions in our time continues to be addiction to illicit drug use. Although it has been widely recognized as a health concern, criminalizing approaches continue to be common in Puerto Rico. Health professionals need to engage in challenging the stigma of illicit drug use in order to foster policies and government efforts with health-oriented approaches. Still, personal stigmatizing attitudes among them continue to be a barrier for the implementation of this agenda. Therefore, the main objectives of this study were to document stigma towards illicit drug use among a sample of health professionals in training, and explore differences in such attitudes among participants from different areas of training. In order to achieve this objective we carried out a sequential mixed method approach with a sample of 501 health professionals in training or practice from the disciplines of medicine, nursing, psychology and social work. Results evidence the continued existence of stigmatizing attitudes among this population. We discuss some of the implications for public health and potential strategies for action.

Evaluating motivational enhancement therapy adherence and competence among Spanish-speaking therapists

Despite the fact that the number of Hispanic individuals in need of treatment for substance use problems is increasing internationally, no studies have investigated the extent to which therapists can provide empirically supported treatments to Spanish-speaking clients with adequate fidelity. Twenty-three bilingual Hispanic therapists from five community outpatient treatment programs in the United States were randomly assigned to deliver either three sessions of motivational enhancement therapy (MET) or an equivalent number of drug counseling-as-usual (CAU) sessions in Spanish to 405 Spanish-speaking clients randomly assigned to these conditions. Independent ratings of 325 sessions indicated the adherence/competence rating system had good to excellent interrater reliability and indicated strong support for an a priori defined fundamental MET skill factor. Support for an advanced MET skill factor was relatively weaker. The rating scale indicated significant differences in therapists' MET adherence and competence across conditions. These findings indicate that the rating system has promise for assessing the performance of therapists who deliver MET in Spanish and suggest that bilingual Spanish-speaking therapists from the community can be trained to implement MET with adequate fidelity and skill using an intensive multisite training and supervision model.

Prevalence and correlates of dual diagnoses in U.S. Latinos

AIM

To examine the population prevalence, patterns of onset, and important demographic covariates for dual (co-occurring) diagnoses of substance and non-substance mental disorders.

DESIGN

A nationally representative sample of U.S. Latino adults was interviewed face-to-face.

MEASUREMENTS

Estimates were made using data from the National Latino and Asian Services Survey (NLAAS) using the World Health Organization CIDI, DSM-IV criteria, for case ascertainment.

FINDINGS

U.S. born Latinos are much more likely to report a dual diagnoses than are foreign born Latinos in both sexes; 16.88% vs. 5.02% for males (p<0.000), and 7.48% vs. 0.58% for women (p<.000). Total dual diagnoses prevalence was 6.79%, with non-substance mental disorder occurring first 70% of the time, with an earlier age of onset for U.S. Latinos. Immigrants were less likely to be positive for dual diagnoses (OR=0.234, p=<0.0001), or any substance disorder diagnosis (OR=0.261, p=<.0001), if they reported lifetime substance use when compared to U.S. born Latinos.

CONCLUSIONS

Latino adults residing in the U.S. have one-fourth the risk of dual diagnoses compared to the U.S. population. Most of this difference is accounted for by lower rates of substance and non-substance disorders and a lower propensity for progression from substance use to substance use disorders, combined with a later age of onset for mental disorders among immigrants. Immigrant women rarely reported dual diagnoses. We recommend bio-behavioral models and transnational studies to identify life course factors contributing to dual diagnoses among U.S. born Latinos.

Substance use and behaviour disorders in Puerto Rican youth: a migrant family study

BACKGROUND

Hispanics in the USA have higher rates of substance use disorders than similar ethnic groups residing in Latin American nations, and recent evidence suggests an increase in substance use among US Hispanic youth. This investigation examines the familial and societal correlates of this increase by comparing Puerto Rican families residing in the mainland USA and Puerto Rico.

METHODS

Using migrant and controlled family study methods, 279 probands in San Juan and 236 probands in New Haven were recruited from treatment clinics and the general community to compose four diagnostic groups: drug abuse/dependence; alcohol abuse/dependence; psychiatric controls; unaffected controls. 806 biological offspring aged 12-17 were then directly interviewed.

RESULTS

Total rates for alcohol use were greater among San Juan youth than their migrant counterparts. By contrast, US migrant adolescents were more likely to use cannabis. A strong association was observed between parental and child substance use at both sites, particularly for boys, and offspring of probands with drug use disorders were at greatest risk for substance use and related disorders. Familial aggregation patterns did not vary substantially by site.

CONCLUSIONS

Despite societal influences on the magnitude and patterns of substance use in migrant youth, the consistent influence of parental disorders across sites reveals that the cross-generational transmission of substance use disorders in prior studies extends to Hispanic families and is an important factor to consider in the development of prevention strategies.

Social Relationships, Social Assimilation, and Substance-Use Disorders among Adult Latinos in the U.S

Based on social control perspectives and results from prior studies we test hypotheses about the extent to which characteristics of family and social networks are associated with substance use disorders (SUD), and whether these associations vary by sex. In this study SUD is alcohol or illicit drug abuse or dependence as defined by criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association. With nationally representative data of adult Latinos from the National Latino and Asian American Survey (NLAAS), we found that respondents' language use with family, rather than language proficiency, appears to be a more efficient proxy for social assimilation to represent differential levels of risk of SUD. SUD was positively associated with problematic family relations for men but not women, and SUD was positively associated with more frequent interactions with friends for women but not men. The results suggest that the salient features of social assimilation associated with SUD include the context of language use and transformations in family and social network relationships that differ in important ways between Latino men and women.

Patterns of substance use onset among Hispanics in Puerto Rico and the United States

PURPOSE

Examine patterns of progression in substance use among Hispanic youth 13 to 17 years of age from two longitudinally representative studies.

METHOD

Patterns of substance use among youth in Puerto Rico were examined using a longitudinal study (n=663) of adolescents living on the island. The National Longitudinal Study of Youth was used to examine patterns of substance use among Hispanics living in the United States (n=1,445). Latent transition analysis was used to estimate the probability of membership in each stage of substance use and incidence of transitions between different substance use stages over time.

RESULTS

Six stages best described the heterogeneity in substance use among youth in Puerto Rico. Five stages were sufficient to describe patterns of substance use among youth in the United States. Youth living in Puerto Rico reported lower rates of smoking and illicit drug use, but higher rates of alcohol use, when compared with rates among Hispanics in the United States.

DISCUSSION

Similar patterns of substance use were identified for Hispanic youth living in the United States and youth living in Puerto Rico.

Association between parental and individual psychiatric/substance use disorders and smoking stages among Puerto Rican adolescents

OBJECTIVE

To examine the associations between parental and individual psychiatric disorders and smoking stages among Puerto Rican youth from migrant and non-migrant families.

METHOD

Analyses were conducted drawing on data collected as part of a migrant family study examining youth at high and low risk for substance use disorders based on the presence or absence of a parental history of substance abuse or dependence. Parents and their offspring were recruited in San Juan, Puerto Rico (n=450) and New Haven, CT, USA (n=350).

RESULTS

Experimental smoking among adolescent offspring was associated with parent proband disorders. In contrast, regular smoking behavior, defined as at least weekly smoking for a month or more, and DSM-IV nicotine dependence were more strongly associated with the adolescents' own psychiatric disorders. With the exception of anxiety disorders, significant bivariate associations were shown between each psychiatric/substance use disorder and nicotine dependence. Once comorbidity was statistically controlled, only attention deficit hyperactivity disorder (ADHD), and alcohol and drug use disorders were significantly associated with nicotine dependence. After controlling for adolescents' psychiatric comorbidity, there was an association between parental disorders and both experimental and regular smoking in their adolescent offspring.

CONCLUSIONS

By combining family and migrant research strategies within a single study, the present investigation was able to simultaneously examine familial, individual and sociocultural factors that may play a role in development and/or persistence of smoking behavior among Puerto Rican adolescents.

Hispanic drug abuse in an evolving cultural context: an agenda for research

Drug abuse in the U.S. Hispanic population appears to be in a dynamic state of acceleration, although there are differences in drug use patterns between U.S.-born and foreign-born Hispanics, and across Hispanic subgroups (i.e., Mexican, Cuban, Puerto Rican, and Central or South American). An understanding of the consequences of cultural adjustments for drug use is needed to effectively anticipate the scope and dimensions of illicit drug use in the largest, rapidly growing, minority group in the U.S. This paper provides an epidemiologic overview of current Hispanic drug use, summarizes research on the relationship between culture change and drug use, organized according to individual, social (i.e., family and peer group), and community level influences on drug use, and offers a systematic agenda for future research.

Illicit drug use research in Latin America: epidemiology service use, and HIV

The purpose of this article is to review the research status of illicit drug use and its data sources in Latin America, with particular attention to the research that has been produced in the past 15 years in epidemiology of illicit drug use services utilization, and relationship between HIV and drug use. This article complements the series of articles that are published in this same volume which examine drug abuse research (epidemiology, prevention, and treatment) and HIV prevention in Latinos residing in the United States. This review resulted from extensive international and national searches using the following databases: Current Contents Connect, Social and Behavioral Sciences; EBSCO; EMBASE(R) Psychiatry; Evidence Based Medicine (through OVID); Medline, Neurosciences, PsychINFO, Pubmed, BIREME/PAHO/WHO--Virtual Health Library, and SciELO. Papers selected for further review included those published in Spanish, English, and Portuguese in peer-reviewed journals. From the evidence reviewed, it was found that the published research literature is heavily concentrated on descriptive epidemiologic surveys, providing primarily prevalence rates and general information on associated factors. Evidence on patterns of service delivery and HIV prevention and treatment is limited. The cumulative scope of this research clearly indicates variability in quantity and quality of research across Latin American nations and the need for greater uniformity in data collection elements, methodologies, and the creation of international collaborative research networks.

Prevalence studies of substance-related disorders: a systematic review of the literature

OBJECTIVE

To present the results of a systematic review of literature published between January 1, 1980, and December 31, 2000, that reports epidemiologic estimates of substance-related disorders.

METHOD

We conducted a literature search of substance-related epidemiologic studies, using medline and HealthSTAR databases and applying a set of predetermined inclusion and exclusion criteria to identify relevant studies. We extracted and analyzed prevalence and incidence data for heterogeneity.

RESULTS

A total of 19 prevalence studies of substance-related disorders met inclusion criteria for this review. Heterogeneity analyses revealed significant variability across 1-year and lifetime prevalence of both alcohol and other substance use disorders. The corresponding 1-year and lifetime pooled rates were 6.6 per 100 and 13.2 per 100, respectively, for alcohol use disorders and 2.4 per 100 and 2.4 per 100, respectively, for other substance use disorders. We observed variability among countries and also among regions within the same country. In contrast to other drug problems, alcohol use disorders were substantially more common, were more likely to occur among male subjects, and were more likely to be associated with abuse symptoms. For other drugs, dependence was consistently more prevalent than abuse.

CONCLUSIONS

Studies using rigorous and comparable methodologies report significant variability in rates of alcohol and other substance use disorders. These data suggest that different policies and regional practices are associated with variability in rates of disorders. Policy-makers and health planners require regular, regionally sensitive estimates of prevalence rates to respond effectively to unique patterns of need in their constituencies.

A Comparison of Hispanic and Anglo Calls to a Gambling Help Hotline

Prevalence studies have found that problem gamblers tend to be non-Caucasians. Nevertheless, information on non-Caucasian gambling patterns and problems is virtually non-existent. Data collected during years 1992-1998 on Hispanic (N = 209) and Anglo (N = 5311) problem gamblers calling the Florida Council on Compulsive Gambling Hotline for help is examined to provide information on one such non-Caucasian group: Hispanics. A sharp difference in the number of Hispanic and Anglo callers was found during this six year period (3.8% Hispanic and 96.2% Anglo). Differences were also found in the likelihood of Hispanics calling about their own problems, having gone for previous help, and types of gambling activities. Similarities were found between the two groups regarding age, marital status, and the three most cited problems caused by gambling: problems with family, inability to pay bills and going into debt. Anglos were significantly more likely to "engage in illegal activities for gambling money" and "problems with job." Group differences caution against using Anglo based prevention and treatment programs with Hispanics populations.

Factors associated with heroin addiction among male adults in Lahore, Pakistan

The objective of this matched case control study was to evaluate the factors associated with heroin addiction among male heroin addicts of age 15 to 35 years in Lahore. A total of 233 heroin addicts, matched on neighborhood controls, were enrolled at a case control ratio of 1:2. Multivariate conditional logistic regression analysis was carried out to study the independent relationship of hypothesized factors with heroin addiction. The factors associated with heroin addiction were parental disharmony (i.e. occasional fights versus no fights: adjusted matched odds ratio (adj. mOR) = 4.3, 95% CI: 2.4-7.8; frequent fights versus no fights: adj. mOR = 6.0, 95% CI: 2.8-16.6), drug using peers (adj. mOR = 5.6, 95% CI, 2.6-12.1), alcohol use (adj. mOR = 4.2, 95% CI, 2.3-7.6). use of over the counter available drugs (adj. mOR = 4.1, 95% CI, 1.8-10.6), father's absence (adj. mOR = 2.9, 95% CI, 1.6-5.5), non-formal schooling of the mother (adj. mOR = 2.8, 95% CI, 1.7-4.7), non-formal schooling of the respondent (adj. mOR = 2.4, 95% CI, 1.5-3.8), and the presence of a drug user among similar age group family members (adj. mOR = 2.4, 95% CI, 1.3-4.8). It is recommended that public health strategies be formulated based on various facets of the problem revealed by this and previous research to prevent illicit drug use.

Patterns of drug use among young men in Piedmont (Italy)

Increasing alarm is shown regarding patterns of polydrug use among young people, particularly regarding recreational drugs. Prevalence of recreational drug usage in Europe is not clearly defined, varying for ecstasy, from 0.2% (Finland, 1995) to 9.2% (UK, 1995) and suggesting a tendency to increase in the last years. The aim of this study is to present patterns of polydrug use among a sample of the general population of young males in Piedmont (Northern Italy), focusing particularly on ecstasy consumption. A cross sectional study was carried out between September and November 1998 on a continuous sample of 3274 18-year-old conscripts. A self-administered anonymous questionnaire on socio-demographic characteristics and substances use was submitted during routine tests. Results showed that the overall lifetime prevalence of drug use is 36.6%; prevalence of polydrug use is 30% and the more frequently associated drugs are LSD, cocaine, inhalants and ecstasy. One hundred and forty five (4.6%) subjects reported having taken ecstasy at least once in their life; 20 of the 145 (13.8%) suffered from negative effects and three (2%) presented to a hospital or to a physician. The risk of ever taking ecstasy is inversely related to father's education, with a trend that is quite similar to that of heroin consumption but that is different from the trend for cannabis. In conclusion the four major results of this study are: (i) a prevalence of drug consumption similar to other European estimates, with a clear tendency to polydrug use; (ii) for ecstasy, a very high association rate with other substances; (iii) the moderately high prevalence of self-reported symptoms, and (iv) a social distribution of use similar to the one observed for heroin. This last consideration suggests that a high level of attention and further research should be addressed to the natural history of ecstasy use.

The validity of drug use responses in a household survey in Puerto Rico: comparison of survey responses of cocaine and heroin use with hair tests

BACKGROUND

Despite the widespread use of household surveys to assess the epidemiology of illicit drug use and abuse, there is very little information about the willingness of respondents to disclose their use of drugs in household studies outside the US.

METHODS

As part of a household study of substance use disorders in Puerto Rico, we collected hair specimens from a sub-sample of 114 respondents. Hair specimens were screened using a radio immunoassay. Screened-positive specimens were confirmed using gas chromatography/mass spectrometry.

RESULTS

Using hair-test results as the standard, specificity of self-reports was 98% or higher for both drugs. The sensitivity of all self-reports was low, although lifetime use reports had somewhat higher sensitivities. The sensitivity of self-reports of recent cocaine use was particularly low, 7.1%. The sensitivity of heroin use reports was somewhat higher, 33.3% for recent use and 66.7% for lifetime use. The estimate of recent cocaine use based on hair tests was 13.7 times the estimate generated from interview reports. For heroin use, the test-based estimate was 2.9 times the rate generated from the interview reports. A shift from the cut-off level of 0.2 ng/mg to 0.5 ng/mg had only a marginal improvement on validity, with sensitivity increasing from 7.1% to 11.1% for self-reported recent cocaine use.

CONCLUSIONS

The results suggest that drug users, for the most part, are not willing to disclose their use of drugs in household surveys in Puerto Rico. Methods to increase the willingness of respondents to disclose their use of drugs are needed.

Prevalence and correlates of substance use disorders among older adolescents in Puerto Rico and the United States: a cross-cultural comparison

Although there are substantial data on adolescent substance use, little systematic research has studied the prevalence of adolescent substance disorders in general populations, let alone cultural differences in disorder prevalence. In this paper we report the prevalence and correlates of alcohol and drug use and disorder among older adolescents on Puerto Rico (PR) and in the United States (US). Data come from an island-wide survey of the PR general residential population (15-18 year old subsample, unweighted N=922) fielded in 1997, and from the National Comorbidity Survey of the US household population (15-18 year old subsample, unweighted N=641), fielded in 1991. Both surveys used a similar standardized interview based on the Composite International Diagnostic Interview (CIDI) to generate DSM-IV diagnoses. Bivariate analyses and logistic regression were used. The major findings are: (1) US youth report higher rates of lifetime alcohol and drug use and substance-related disorder than PR youth; (2) the transition to abuse or dependence occurs for one-third of US drinkers, one-fifth of drinkers in PR, and about one-half of the drug users in both US and PR; (3) there are marked variations across sites in the types of symptoms substance users are likely to experience; (4) with the exception of family income, most correlates operate similarly in both sub-samples; and (5) the majority of both US and PR youth with a past year substance use disorder did not report any service utilization in the past year.

Alcohol use among Dominican and Puerto Rican adolescents residing in New York City: role of Hispanic group and gender

Hispanic groups are often aggregated when examining adolescent drinking. The objective of this study was to determine the roles of Hispanic group (Puerto Rican versus Dominican) and gender in alcohol use among inner-city youth. Sixth and seventh graders in 22 New York City schools who identified themselves as Puerto Rican or Dominican completed self-report questionnaires at two assessments (N = 849 at baseline; N = 678 at 1-year follow-up). Dominican adolescents generally engaged in more alcohol use than Puerto Rican adolescents. In a number of cases, gender moderated the effect of Hispanic group on drinking. Specifically, Dominican boys reported greater use than Dominican girls, but use was similar across gender for Puerto Rican adolescents. These findings highlight the importance of considering Hispanic group and gender when examining adolescent drinking.

Alcohol and drug use, and depression among Hispanic men in early adulthood

Community research and clinical practice have shown that alcohol and drug use and depression are interrelated. Among Hispanics, acculturation may play a role in these relationships. To investigate these relationships as well as alcohol-related problems, we interviewed 288 Puerto Rican, Dominican, and Colombian men in early adulthood. No significant differences emerged in the proportions of abstainers across the three groups. Colombians drank significantly more frequently and had more alcohol-related problems than Dominicans. Dominicans were at least risk for and least likely to have alcohol-related problems. Puerto Ricans were much more likely to use drugs than the other Hispanic men. Drug use was associated with an increased likelihood of heavy drinking which, in turn, increased the risk of drug use and depression. Acculturation decreased the risk of drug use. Results are discussed in terms of implications for community psychology research and interventions.

Psychosocial correlates of drug use among Puerto Rican youth: generational status differences

This study investigates the role of several social psychological variables which could help explain the process by which Puerto Rican adolescents become vulnerable to drug use involvement with exposure to a host society, New York City, where the prevalence of drug use is higher than in the society of origin. Puerto Rico. To study how acculturation affects the psychosocial factors associated with adolescent drug use, four generational status groups of Puerto Rican students living in two settings--New York City and San Juan, Puerto Rico--were surveyed: New York Ricans (New York City-born Puerto Ricans); New York migrants (island-born Puerto Ricans living in New York); Puerto Rican islanders (adolescents who had never lived outside of Puerto Rico); and Puerto Rican immigrants (New York City-born youngsters of Puerto Rican parentage whose families had returned to live on the Island). A theoretical model developed to explain adolescent problem behavior, which posits a continuum of antecedent, intrapersonal, interpersonal and perceived environment dimensions theoretically conducive to adolescent drug use, guided the analysis. Analysis of variance was used to test for generational status group differences in each of the psychosocial risk factors. The relationship between generational status, the intervening psychosocial variables, and drug use were explored through multiple regression analyses. The data showed that Puerto Rican youth's generational status was systematically related to differences in the occurrences of the social psychological risk factors for adolescent drug use involvement. With greater exposure to the New York City environment, Puerto Rican youngsters were more likely to report problems in parental socialization, personal control and perceived environment domains. Each of the psychosocial characteristics was associated with the students' drug use involvement, and these relationships were conditioned by generational status. New York Ricans exhibited the greatest susceptibility to drug use involvement in the presence of weakening of parental controls, increased tolerance of deviance and drug use, increased unconventionality with respect to school and church, and peer use of legal and illegal drugs. Sociodemographic and psychosocial variables together explained 47% of the variance in the drug use involvement of Puerto Rican adolescents.