Missing Opportunities in the Screening of Alcohol Use and Problematic Use, and the Provision of Brief Advice and Treatment Information Among Individuals With Alcohol Use Disorder.

OBJECTIVES: The aim of this study was to identify sociodemographic and substance-related factors associated with being screened, receiving advice or treatment information from healthcare providers, among individuals who met the criteria for the past 12-month alcohol use disorder (AUD). METHODS: The 2015-2019 National Survey on Drug Use and Health data were analyzed to identify factors associated with being (1) asked about alcohol used among adults with AUD, who visited a healthcare provider within the past 12 months, and were not receiving AUD treatment (sample 1, n = 13,321); (2) asked about problematic use; (3) advised to reduce consumption; and (4) offered alcohol treatment information, among those in sample 1 who were asked about their use (n = 6,905). RESULTS: About half (52.9%) in sample 1 were asked about their alcohol use. Among them, 21.6% were asked about problematic use, 17.7% were advised to reduce alcohol consumption, and 7.6% were offered information. The odds of being asked about alcohol use among male participants were 0.72 times the odds of female participants; however once asked, male participants showed greater odds of being asked about problematic use (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI] = 1.29-1.82), advised to reduce consumption (aOR = 1.64, 95% CI = 1.24-2.16), and offered treatment information (aOR = 1.77, 95% CI = 1.34-2.35). As compared with non-Hispanic White participants, other racial/ethnic groups were less likely to be asked about alcohol use; however, once asked, no differences were observed for other outcomes. CONCLUSIONS: Significant gaps in the screening and provision of advice or treatment information were identified, particularly for racial/ethnic and sex subgroups. Reducing barriers for effective screening could help address AUD-related disparities.

Exploring the associations between serious psychological distress and the quantity or frequency of tobacco, alcohol, and cannabis use among pregnant women in the United States.

Serious Psychological Distress (SPD) and prenatal exposure to substances are associated with adverse outcomes for pregnant individuals and their developing offspring. This study aims to examine the relationship between SPD and quantity, or frequency of substance use among pregnant women in the United States (US). Descriptive and negative binomial regression analyses of the 2015-2019 National Survey on Drug Use and Health (NSDUH) were conducted among 3373 pregnant women (18 to 44 years old) to examine the association between SPD and (1) average number of cigarettes smoked in the past 30 days, (2) number of days of binge drinking in the past 30 days, and (3) number of days of cannabis use in the past 30 days. About 6% of the study population experienced SPD in the past 30 days. Compared to pregnant women who did not report SPD, pregnant women experiencing SPD showed greater rates in the number of cigarettes smoked during the past 30 days (IRR = 2.1, 95%CI = 1.1, 4.5), the number of days of binge drinking in the past 30 days (IRR = 5.1, 95%CI = 1.7, 15.4), and the number of days of cannabis use in the past 30 days (IRR = 2.9, 95%CI = 1.3, 6.5). Our results extend findings from prior research by documenting an association between SPD and the quantity and frequency of substance use among pregnant women in the US. Individual and structural interventions addressing SPD and/or substance might help reduce the impact of these comorbid conditions on expectant parents and their offspring.

Socio-demographic Correlates of Electronic Cigarette and Cannabis Co-use Among Naïve and Tobacco Adolescent Users.

The increasing co-use of e-cigarette and cannabis among youth has become a public health challenge. The present analyses aimed to identify prevalence and correlates of past-month co-use of e-cigarettes and cannabis among adolescents with and without prior tobacco use. For this panel study, 5 years of cross-sectional data (2014-2018) were used from 8th, 10th-, and 12th-grade adolescents in the Monitoring the Future study, a nationally representative survey of U.S. students. We examined prevalence and correlates of e-cigarettes and cannabis co-use among adolescents who had ever used tobacco (n = 15,136) and among those who had never used tobacco (n = 56,525). Adolescents who had ever used tobacco showed significantly higher rates of e-cigarettes and cannabis co-use compared to adolescents who had never used tobacco (17.1% vs. 2.2%, p < 0.01). Results from adjusted multinomial regression models showed that overall, Black and Hispanic adolescents tobacco users were less likely than Whites to co-use e-cigarettes and cannabis. Black adolescents who had used tobacco previously were more likely than Whites to have used cannabis exclusively. Black and Hispanic tobacco-naïve adolescents were more likely than Whites to have used cannabis exclusively, while Black tobacco-naïve adolescents were less likely to use e-cigarettes exclusively or co-use e-cigarettes and cannabis. Overall, males and twelve graders were more likely than males and eight graders to use or co-use cannabis or e-cigarettes, respectively. Among lifetime tobacco users, higher levels of parental education were associated with co-use of cannabis and e-cigarettes. Racial/ethnic-specific patterns of e-cigarette and cannabis co-use depends on adolescents' prior experience with tobacco. The higher rates of use and co-use of e-cigarettes and cannabis among prior tobacco users suggest that targeted interventions are needed for this group. Identified socio-demographic groups at higher risk of co-use of e-cigarettes and cannabis need to be further studied.

Polysubstance use profiles among US adults using Kratom (Mitragyna speciosa): A latent class analysis using The National Survey on Drug Use and Health (NSDUH).

BACKGROUND AND OBJECTIVES: Kratom (Mitragyna speciosa) use is associated with polysubstance use (PSU) and use disorders. However, additional research on PSU heterogeneity in populations using this novel psychoactive substance is necessary. The authors investigated patterns of past 12-month PSU among US adults reporting past 12-month use of kratom and at least one additional substance. METHODS: Latent class models were fit using 2019 National Survey on Drug Use and Health (NSDUH) data which was collected from 412 US adults reporting past 12-month use of kratom and at least one of 11 additional substances. RESULTS: Three distinct profiles were identified: "marijuana/alcohol/tobacco" (63.3%), "marijuana/alcohol/tobacco + psychedelics" (19.3%), and "marijuana/alcohol/tobacco + psychedelics/heroin/prescriptions" (17.4%). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This is the first epidemiological study in which a latent class analysis was used to identify unique PSU profiles among US adults using kratom and other substances. Understanding the profiles of people using kratom in relation to the use of other drugs might help guide screening interventions, treatment needs, and policy.

Kratom Use Among U.S. Adolescents: Analyses of the 2019 National Survey on Drug Use and Health.

BACKGROUND: Kratom (Mitragyna speciosa) is an opioid-like psychoactive substance not approved by the U.S. Food and Drug Administration that could be used due to its euphoric, stimulant, and analgesic effects. Kratom is gaining popularity in the U.S. and becoming a reason of concern among pediatricians. METHODS: Data from the 2019 National Survey on Drug Use and Health were analyzed to estimate the prevalence and identify correlates of lifetime and past 12-month kratom use among 13,397 U.S. adolescents. Multivariable logistic regression models were conducted to assess the associations of interest. RESULTS: Lifetime and past 12-month prevalence of kratom use was .44% (95% confidence interval [CI] .32-.60) and .27% (95% CI .18-.40), respectively. Past 12-month cigarette use was associated with lifetime kratom use (adjusted odds ratio 2.60, 95% CI 1.07-6.35). Past 12-month cannabis use was associated with past 12-month kratom use (adjusted odds ratio 2.48, 95% CI 1.15-5.35). CONCLUSIONS: This first report on the epidemiology of adolescent kratom use provides a baseline to assess kratom use trends in future years and identify potential correlates of use among adolescents.

Risky decision-making as an antecedent or consequence of adolescent cannabis use: findings from a 2-year longitudinal study.

BACKGROUND AND AIMS: Although poor decision-making (DM) has been correlated with problematic cannabis use (CU), cross-sectional designs make it difficult to determine whether poor DM represents an antecedent and/or consequence of CU. The current study measured bidirectional associations between CU and DM among adolescents over 2 years and compared these findings to those observed with episodic memory, which is consistently reported as a consequence of CU. We also measured the role of DM as a risk factor for cannabis use disorder (CUD) onset. DESIGN: Two-year longitudinal study with five bi-annual assessments. PARTICIPANTS: Participants were 401 adolescents aged 14-17 years at baseline. SETTING: Miami, Florida, USA. MEASUREMENTS: CU frequency and CUDs were assessed at each time-point through the Drug Use History Questionnaire and Structured Clinical Interview for DSM-IV, respectively. Neurocognition was assessed at odd time-points throughout the Iowa Gambling Task, Game of Dice Task and Cups Task [decision-making (DM)] and the Wechsler Memory Scale IV and California Verbal Learning Test II (episodic memory). We used latent growth curve modeling to examine bidirectional influences between CU and neurocognition over time. We applied discrete time survival analyses to determine whether baseline DM predicted CUD onset. FINDINGS: Greater lifetime CU frequency was associated with poorer episodic memory at baseline (bs = -14.84, -16.44, Ps = 0.038, 0.021). Greater CU escalation predicted lesser gains in immediate episodic memory (b = -0.05, P = 0.020). Baseline DM did not predict CU escalation (b = 0.07, P = 0.421), nor did escalation in CU predict changes in DM (b = 0.02, P = 0.352). Baseline DM also did not predict CUD onset (adjusted OR = 1.01, 95% confidence interval = 0.98-1.06). CONCLUSIONS: This study replicates findings that poorer episodic memory in adolescents appears to be a consequence of cannabis use, even among adolescents at earlier stages of use. Poor decision-making does not appear to be either a consequence of or a risk factor for escalating cannabis use or onset of cannabis use disorder among adolescents.

Shared Environmental Influences on Electronic Cigarette Use Among Adolescent and Young Adult Females.

INTRODUCTION: Electronic cigarettes are now the most commonly used form of tobacco product among youth in the United States. Current evidence suggests that although e-cigarettes are perceived as less harmful and preferred over combustible cigarettes by adolescents, adolescents who try e-cigarettes are at greater risk of transitioning to combustible cigarettes. The genetic and environmental contributions to liability for e-cigarette use have not yet been examined using a behavioral genetic design. METHODS: Behavioral genetic models of lifetime and current e-cigarette use and friends who use e-cigarettes were examined among female monozygotic and dizygotic twins. RESULTS: A total of 41 female twin pairs (65.9% monozygotic twins; age = 19.7, SD = 1.6) with complete data on the study variables were included in the present analyses. The majority of the sample (68.1%) had at least some friends who use e-cigarettes. Additive genetic effects on e-cigarette use were not present, but the shared environment explained 98.7% of the variance in lifetime e-cigarette use, 96.6% in current e-cigarette use, and 94.9% in affiliation with friends who use e-cigarettes. CONCLUSION: This first study on the behavioral genetics of e-cigarette use among adolescents and young adults suggest that environmental factors shared by twins within a family seem to play a predominant role in the initial stages of e-cigarette use, a finding that is consistent with what has been found for tobacco. The findings emphasize the importance of continuing population-based tobacco control interventions to reduce the burden of e-cigarette use among adolescents. IMPLICATIONS: The shared environment significantly influences the initiation and regular use of electronic cigarettes and affiliation with friends who use electronic cigarettes among adolescent and young adult females. These findings underscore the importance of formulating preventive interventions that mitigate the social effects of familial influences on e-cigarette use through social skills training, education on harms of e-cigarettes for young people, or altering social norms regarding initiation of novel tobacco products.

Perceived Risk of Weekly Cannabis Use, Past 30-Day Cannabis Use, and Frequency of Cannabis Use Among Pregnant Women in the United States.

BACKGROUND: While accumulated evidence has shown that the prevalence of cannabis use among pregnant women in the US has increased in recent years, little is known about the specific subpopulations affected. The aim of this study was to estimate the prevalence and correlates of the perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of past 30-day cannabis use among US pregnant women. METHODS: We analyzed data from 2,247 pregnant women 14 to 44 years of age surveyed in the 2015 to 2017 cross-sectional National Survey on Drug Use and Health. Analyses account for the sampling design. Primary outcomes included perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of cannabis use. We conducted multivariable logistic and negative binomial regression models to assess the associations between the primary outcomes and multiple correlates. RESULTS: Among US pregnant women, 21.6% (95% CI=19.4, 23.8) did not perceive any risk associated with weekly cannabis use, 5.3% (95% CI=4.2, 6.5) used cannabis in the past 30 days, and among past-month users, the average number of days of use was 15.6 (95% CI=13.5, 17.7). Pregnant women living below the poverty line were both more likely to perceive no risk of weekly cannabis use (aOR=1.8; 95% CI=1.3, 2.5) and use cannabis more often in the past 30 days (aOR=2.9; 95% CI=1.5, 5.7) than pregnant women within an income bracket of more than two times the federal poverty threshold. Age, race, trimester of pregnancy, co-use of tobacco and/or alcohol were also associated with these outcomes. CONCLUSION: Younger age, living in poverty, early trimester of pregnancy, and co-use of tobacco and/or alcohol increased the odds of cannabis use among pregnant women. As cannabis legalization spreads and cannabis use is increasingly perceived as safe, there is a growing need for research to determine the reasons why women in the identified at-risk subgroups are using cannabis during pregnancy.

'Time to first tobacco cigarette soon after waking' occurs more often among underage newly incident smokers in the United States, 2004-2017.

AIMS: Time to first cigarette (TTFC) after waking is a highly regarded and readily measured manifestation of a tobacco dependence process. We aim to estimate short TTFC as it occurs very soon after the onset of cigarette smoking (CS) in a community sample of newly incident smokers, all 12-21 years of age, and to study risk variation with the age of CS onset. METHODS: United States National Surveys on Drug Use and Health, 2004-2017, drew large nationally representative samples of 12-to-21-year-old community residents, and used computerized self-interviews to measure tobacco cigarette smoking, the Fagerstrom TTFC construct, and related variables. A 'short' TTFC was defined as smoking the first cigarette after waking up within 30 min vs. 'long' TTFC or smoking more than 30 min. We studied 8188 newly incident smokers, all assessed within six months after the first puff. Estimated age-specific cumulative incidence proportions (CIP) and odds ratios (OR) are estimated and compared, with due attention to complex survey design and weights. RESULTS: Among underage newly incident smokers (12-17 years old), an estimated 5.2% experienced short TTFC within 6 months after CS onset (95% CI = 4.4%, 6.2%), versus 3.7% for older new smokers (18-21 years; 95% CI = 2.8%, 4.6%). Underage smokers are 1.5 times more likely to develop short TTFC compared to older initiates (95% CI = 1.1, 2.1). No male-female variations are seen, but exploratory analysis disclosed findings that involve Census-defined race-ethnicity subgroups. Non-Hispanic African-American initiates are twice as likely to develop short TTFC, and Hispanic initiates are less likely to develop short TTFC, as compared with non-Hispanic White smokers. CONCLUSIONS: Based on US community samples our study offers new evidence about TTFC formation observed within six months after the first puff when cigarette smoking starts before age 18 years.

Sex differences in driving under the influence of cannabis: The role of medical and recreational cannabis use.

BACKGROUND: Existing evidence suggest that cannabis may impair driving and is the most prevalent drug identified in drivers. Males exhibit an excess risk for driving under the influence of drugs or alcohol compared to females. We assessed sex differences in the association between the reason for cannabis use (medical, recreational, or both) and driving under the influence of cannabis (DUIC). METHODS: A sample of 17,405 past 12-month cannabis users (18 + years old) were analyzed from the 2016-17 National Survey on Drug Use and Health. Multivariable logistic regression was used to assess the interaction of sex and reason for cannabis use on DUIC using predicted probabilities. RESULTS: Among cannabis users in the sample, 88.1% used for recreational reasons, 7.8% used for medical reasons, and 4.1% used for medical and recreational reasons. The probability of DUIC was as low as 20% among female medical only users, and as high as 40% among male combined medical and recreational users. Females showed more similar probabilities of DUIC across reasons of use (range 20% to 25%s) than males (range 28% to 40%). The difference in the probability of DUIC between combined medical and recreational users and recreational only users was significantly greater among males than among females (Δ 0.1, p < 0.05). CONCLUSIONS: The observed effects of sex and reasons for cannabis use on DUIC suggests a need for targeted educational interventions, particularly among males reporting combined medical and recreational marijuana use.

Risky sexual behavior among adolescents: The role of decision-making, problems from cannabis use and externalizing disorder symptoms.

INTRODUCTION: Previous research has demonstrated that externalizing symptoms, cannabis use problems, and poor decision-making abilities are each independently related to risky sexual behavior (RSB). However, few studies have examined the joint effect of these factors on RSB among a sample of adolescents. METHODS: The current study addresses this gap in the literature by examining how externalizing disorder symptoms, cannabis use, and decision-making abilities interact to predict RSB among a sample of adolescents (n = 204; Mage = 15.5) at-risk for escalation in cannabis use. Poisson regression was used for all analyses, and simple slope difference tests were used for all post-hoc analyses. RESULTS: A greater number of externalizing symptoms, more problems from cannabis use, and more risk disadvantageous choices on the Cups Task (CT) total trials and more risk disadvantageous choices on the CT-gain trials predicted greater RSB endorsement. Findings also highlight significant interactions between cannabis use problems and CT-total and -gain trial performance, as well as between cannabis use problems and externalizing symptoms in predicting RSB. CONCLUSION: Current treatment and prevention approaches to reduce RSB among adolescents may benefit from incorporating techniques that improve decision-making skills.

Mortality among heroin users and users of other internationally regulated drugs: A 27-year follow-up of users in the Epidemiologic Catchment Area Program household samples.

BACKGROUND: In contrast to research on more restricted samples of drug users, epidemiological studies open up a view of death rates and survivorship of those who have tried heroin a few times, with no acceleration toward sustained use patterns often seen in treatment and criminal justice samples. At their best, epidemiological estimates of heroin effects on risk of dying are not subject to serious selection biases faced with more restricted samples. METHODS: Data are from 7207 adult participants aged 18-48 years in United States Epidemiologic Catchment Area Program field surveys, launched in 1980-1984. US National Death Index (NDI) records through 2007 disclosed 723 deaths. NDI enabled estimation of heroin-associated risk of dying as well as survivorship. RESULTS: Estimated cumulative mortality for all 18-48 year old participants is 3.9 deaths per 1000 person-years (95% confidence interval, CI=3.7, 4.2), relative to 12.4 deaths per 1000 person-years for heroin users (95% CI=8.7, 17.9). Heroin use, even when non-sustained, predicted a 3-4 fold excess of risk of dying prematurely. Post-estimation record review showed trauma and infections as top-ranked causes of these deaths. CONCLUSIONS: Drawing strengths from epidemiological sampling, standardized baseline heroin history assessments, and very long-term NDI follow-up, this study of community-dwelling heroin users may help clinicians and public health officials who need facts about heroin when they seek to prevent and control heroin outbreaks. Heroin use, even when sporadic or non-sustained, is predictive of premature death in the US, with expected causes of death such as trauma and infections.

Drug use disorders in the polydrug context: new epidemiological evidence from a foodborne outbreak approach.

As epidemiologists studying foodborne illness outbreaks, we do not ask luncheon attendees to say which food caused their illnesses. Instead, we use measurement and analysis methods to estimate food-specific risk variations. Here, we adapt the foodborne outbreak approach to develop new estimates of drug use disorder risk for single-drug and polydrug users, without attributing the syndrome to a specific drug when multiple drugs have been used. We estimate drug use disorder risk for cannabis-only users as a reference value. We then derive comparative relative risk estimates for users of other drug subtypes, including polydrug combinations. Data are from the 2002 to 2003 U.S. National Comorbidity Survey Replication, a nationally representative sample of household residents (18+ years), with standardized drug use and drug dependence assessments. Multiple logistic regression provides odds ratio estimates of relative risk. With this approach, for every 1000 cannabis-only users, an estimated 17 had become cases (1.7%). By comparison, polydrug users and cocaine-only users had much greater cumulative incidence (>10%), even with adjustment for covariates and local area matching (P < 0.001). Using this approach, we find exceptionally low risk for cannabis-only users and greater risk for polydrug and cocaine-only users.

Membresía a barras bravas y su influencia en el uso de drogas / Barras bravas membership and its influence on drug use

Objetivos. Identificar los factores asociados con la membresía a las barras bravas, la incidencia del uso de drogas y la asociación entre membresía y uso de drogas. Materiales y métodos. Se analizan los datos reportados por 1303 adolescentes escolares que participaron en dos etapas (T1 y T2) de un estudio longitudinal realizado en 23 colegios de Bogotá, Colombia entre 2006 y 2007, seleccionados a partir de un muestreo probabilístico estratificado por conglomerados. Se implementaron modelos de regresión logística para estudiar las asociaciones de interés. Resultados. En T1, 8,2% de los encuestados reportaron membresía a las barras bravas. Luego de un año de seguimiento, el 14,2% y el 4,6% de los estudiantes que afirmaron y negaron respectivamente pertenecer a una barra brava, iniciaron el consumo de drogas. La asociación entre membresía a las barras bravas e inicio del uso de drogas permanece después de ajustar por múltiples factores de confusión (RRA: 2,4; IC 95%: 1,2 - 4,7). En el análisis estratificado por sexo, esta asociación permanece significativa únicamente en las mujeres (RRA: 6,1; IC 95%: 2,5 - 15,3). Conclusiones. La membresía a las barras bravas mostró incrementar el riesgo de inicio del uso de drogas, particularmente en las mujeres. Los hallazgos implican que se deben focalizar los esfuerzos preventivos hacia las mujeres en dichos contextos.

Objectives. To identify the factors associated with barras bravas (soccer fans clubs) membership, the incidence in drug use and the association between membership and drug use. Materials and methods. This report analyzed data from 1303 adolescent scholars who participated in two stages (T1 and T2) of a longitudinal study done in 23 schools of Bogota during 2006- 2007, selected through a probabilistic sampling stratified by clusters. Logistic regression models were implemented in order to evaluate the associations of interest. Results. In T1, 8,2% of the surveyed students reported barras bravas membership. After one year of follow-up, 14,2% of barras bravas members, and 4,6% of non-members, initiated drug use. The association between barras bravas membership and drug use onset remained significant after adjusting for multiple confounding factors (ARR=2,4; 95%CI=1,2-4,7). Sex-stratified analysis indicated that this association remained statistically significant only for females (ARR=6,1; 95%CI=2,5-15,3). Conclusions. Barras bravas membership increases the risk of drug use onset, particularly among females. The findings imply that preventive efforts should be focused on females in these contexts.

Drug use opportunities as opportunities for drug use prevention: Bogotá, Colombia a case in point.

BACKGROUND: As drugs become more ubiquitous and fewer resources are available for drug prevention and treatment, understanding the early stages of drug use involvement becomes increasingly important for prevention efforts. This study aims to explore the concept of drug use opportunity, and to disentangle, from a socio-ecological perspective, the factors associated with experiencing a drug use opportunity. METHODS: Data from 2279 standardized questionnaires administered in 23 schools in Bogotá was analyzed. Schools were selected in a multistage probability cluster sample. Multilevel logistic regression modeling estimated the effects of multiple level factors on the likelihood of having experienced an opportunity to use illicit drugs or inhalants. RESULTS: One-third of respondents (32.1%) reported having had an opportunity to use drugs. Even among those who perceived drugs to be readily available and/or expressed intentions to use drugs in the near future, most reported never having experienced an opportunity to use drugs. For most of the drugs assessed, peer drug use, cigarette smoking, alcohol drinking, problematic behavior, and degree of school safety were the strongest correlates of having had a drug use opportunity. CONCLUSIONS: Despite living in an environment of high drug availability, most adolescents do not experience opportunities to use drugs. The likelihood of experiencing an opportunity is influenced by multiple interacting individual and macro-social factors, just as drug use is. Drug use opportunities were mainly promoted by friends, suggesting the need to consider their role within close social networks, alongside that of drug suppliers, in the design of intervention activities and drug policy development.

Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

BACKGROUND: This study aims to estimate general and racial-ethnic specific cumulative probability of developing dependence among nicotine, alcohol, cannabis or cocaine users, and to identify predictors of transition to substance dependence. METHODS: Analyses were done for the subsample of lifetime nicotine (n=15,918), alcohol (n=28,907), cannabis (n=7389) or cocaine (n=2259) users who participated in the first and second wave of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Discrete-time survival analyses were implemented to estimate the cumulative probability of transitioning from use to dependence and to identify predictors of transition to dependence. RESULTS: The cumulative probability estimate of transition to dependence was 67.5% for nicotine users, 22.7% for alcohol users, 20.9% for cocaine users, and 8.9% for cannabis users. Half of the cases of dependence on nicotine, alcohol, cannabis and cocaine were observed approximately 27, 13, 5 and 4 years after use onset, respectively. Significant racial-ethnic differences were observed in the probability of transition to dependence across the four substances. Several predictors of dependence were common across the four substances assessed. CONCLUSIONS: Transition from use to dependence was highest for nicotine users, followed by cocaine, alcohol and cannabis users. Transition to cannabis or cocaine dependence occurred faster than transition to nicotine or alcohol dependence. The existence of common predictors of transition dependence across substances suggests that shared mechanisms are involved. The increased risk of transition to dependence among individuals from minorities or those with psychiatric or dependence comorbidity highlights the importance of promoting outreach and treatment of these populations.

Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

AIM: To estimate the general and racial/ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances. DESIGN: Data were collected from structured diagnostic interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. SETTING: The 2001-2002 National Epidemiological Survey of Alcohol and Related Conditions (NESARC) surveyed a nationally representative sample from US adults (n = 43,093) selected in a three-stage sampling design. PARTICIPANTS: The subsamples of individuals with life-time DSM-IV diagnosis of dependence on nicotine (n = 6937), alcohol (n = 4781), cannabis (n = 530) and cocaine (n = 408). MEASUREMENTS: Cumulative probability estimates of dependence remission for the general population and across racial/ethnic groups. Hazard ratios for remission from dependence. FINDINGS: Life-time cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively. Males, Blacks and individuals with diagnosis of personality disorders and history of substance use comorbidity exhibited lower hazards of remission for at least two substances. CONCLUSIONS: A significant proportion of individuals with dependence on nicotine, alcohol, cannabis or cocaine achieve remission at some point in their life-time, although the probability and time to remission varies by substance and racial/ethnic group. Several predictors of remission are shared by at least two substances, suggesting that the processes of remission overlap. The lower rates of remission of individuals with comorbid personality or substance use disorders highlight the need for providing coordinated psychiatric and substance abuse interventions.

Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the United States.

The prevalence of obesity, diabetes, and cardiovascular disease is reaching epidemic proportions among Hispanics in the United States. Health care providers play an important role in motivating patients to make healthful lifestyle changes to reduce the burden of such conditions. Data from the US 2000 National Health Interview Survey was analyzed to determine differences in report of physician-provided physical activity and/or dietary advice by level of English proficiency among obese Hispanics or those who reported having diabetes or cardiovascular disease and who contacted a physician during the past year (n=1,186). Only one third of the sample reported receiving advice to increase their physical activity or to improve their dietary habits; one fifth reported receipt of advice about both. English-proficient Hispanics were about 50% more likely to report receiving advice on physical activity (adjusted odd ratio [AOR]=1.5; 95% confidence interval [CI]: 1.1 to 2.1), diet (AOR=1.5; 95% CI: 1.1 to 2.2) or both (AOR=1.6; 95% CI: 1.1 to 2.3), as compared with limited English-proficient Hispanics, after controlling for health insurance coverage and number of visits to a physician during the last year. Sex, age, region of residence, level of education, annual family income, and smoking status were not significantly associated with receiving physical activity and/or dietary advice. In order to address racial health disparities, and lower the burden of chronic illness, culturally sensitive strategies must be implemented to enhance delivery of effective health-promotion messages by physicians, particularly among at-risk communities.

Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the United States.

The prevalence of obesity, diabetes, and cardiovascular disease is reaching epidemic proportions among Hispanics in the United States. Health care providers play an important role in motivating patients to make healthful lifestyle changes to reduce the burden of such conditions. Data from the US 2000 National Health Interview Survey was analyzed to determine differences in report of physician-provided physical activity and/or dietary advice by level of English proficiency among obese Hispanics or those who reported having diabetes or cardiovascular disease and who contacted a physician during the past year (n=1,186). Only one third of the sample reported receiving advice to increase their physical activity or to improve their dietary habits; one fifth reported receipt of advice about both. English-proficient Hispanics were about 50% more likely to report receiving advice on physical activity (adjusted odd ratio [AOR]=1.5; 95% confidence interval [CI]: 1.1 to 2.1), diet (AOR=1.5; 95% CI: 1.1 to 2.2) or both (AOR=1.6; 95% CI: 1.1 to 2.3), as compared with limited English-proficient Hispanics, after controlling for health insurance coverage and number of visits to a physician during the last year. Sex, age, region of residence, level of education, annual family income, and smoking status were not significantly associated with receiving physical activity and/or dietary advice. In order to address racial health disparities, and lower the burden of chronic illness, culturally sensitive strategies must be implemented to enhance delivery of effective health-promotion messages by physicians, particularly among at-risk communities.

Hand washing among school children in Bogotá, Colombia.

OBJECTIVES: We assessed hand-washing behaviors and intentions among school children in Bogotá, Colombia, to help identify and overcome barriers to proper hygiene practices. METHODS: Data on hand-washing behavior and intentions and individual and contextual factors were collected from 2042 sixth- through eighth-grade students in 25 schools in Bogotá via anonymous questionnaires. A member of the school administration or teaching staff completed a questionnaire about the school environment. Site inspections of bathroom facilities were conducted. RESULTS: Only 33.6% of the sample reported always or very often washing hands with soap and clean water before eating and after using the toilet. About 7% of students reported regular access to soap and clean water at school. A high level of perceived control was the strongest predictor of positive hand-washing intentions (adjusted odds ratio [AOR]=6.0; 95% confidence interval [CI]=4.8, 7.5). Students with proper hand-washing behavior were less likely to report previous-month gastrointestinal symptoms (OR=0.8; 95% CI=0.6, 0.9) or previous-year school absenteeism (OR=0.7; 95% CI=0.6, 0.9). CONCLUSIONS: Scarcity of adequate facilities in most schools in Bogotá prevents children from adopting proper hygienic behavior and thwarts health promotion efforts. The current renovation program of public schools in Bogotá provides a unique opportunity to meet the challenges of providing a supportive environment for adoption of healthy behaviors.