Trends in cigarette use, by serious psychological distress status in the United States, 1998-2013.

OBJECTIVES: The study compared trends in current and heavy cigarette smoking between adults with and without serious psychological distress (SPD). METHODS: This study examined data from 480,024 adults aged 18years or older in the 1998-2013 National Health Interview Survey (NHIS) public use files. SPD is defined as having a Kessler-6 score of 13 or higher in the past month. Trends in the prevalence of current smoking and heavy smoking for 2-year time periods were assessed among those with versus those without SPD using logistic regression; tests of interaction terms determined whether smoking trends differed by SPD status. RESULTS: The prevalence of current smoking decreased over time among adults without SPD (adjusted odds ratio [AOR]=0.97, 95% CI=0.97-0.98), but remained stable among adults with SPD (AOR=1.01, 95% CI=0.99-1.03). Both groups had significant declines in heavy smoking over time; however, the rates of decline were greater among adults without versus with SPD (AOR=0.87, 95% CI=0.86-0.88 and AOR=0.91, 95% CI=0.88-0.94, respectively). CONCLUSIONS: The prevalence of current smoking is not declining among adults with SPD, and the prevalence of heavy smoking is not declining as quickly among adults with SPD as compared with those without SPD. Smoking cessation efforts may need to target these populations and tailor programs accordingly.

Suicidal ideation, suicide attempt, and occupations among employed adults aged 18-64years in the United States.

OBJECTIVE: Approximately 70% of all US suicides are among working-age adults. This study was to determine whether and how 12-month suicidal ideation and suicide attempt were associated with specific occupations among currently employed adults aged 18-64 in the U.S. METHODS: Data were from 184,300 currently employed adults who participated in the 2008-2013 National Surveys on Drug Use and Health (NSDUH). NSDUH provides nationally representative data on suicidal ideation and suicide attempt. Descriptive analyses and multivariable logistic regressions were conducted. RESULTS: Among currently employed adults aged 18-64 in the U.S., 3.5% had suicidal ideation in the past 12months (3.1% had suicidal ideation only, and 0.4% had suicidal ideation and attempted suicide). Compared with adults in farming, fishing, and forestry occupations (model adjusted prevalence (MAP)=1.6%), adults in the following occupations were 3.0-3.6 times more likely to have suicidal ideation in the past year (model adjusted relative risks (MARRs)=3.0-3.6): lawyers, judges, and legal support workers (MAP=4.8%), social scientists and related workers (MAP=5.4%), and media and communication workers (MAP=5.8%). CONCLUSIONS: Among employed adults aged 18-64 in the U.S., the 12-month prevalence of suicidal ideation varies by occupations. Adults in occupations that are at elevated risk for suicidal ideation may warrant focused suicide prevention.

Prevalence and correlates of past 12-month suicide attempt among adults with past-year suicidal ideation in the United States.

OBJECTIVE: To examine the prevalence and correlates of attempting suicide in the past 12 months among adults with past-year suicidal ideation in the United States. METHOD: Data were from 229,600 persons aged 18 years or older who participated in the 2008-2012 National Survey on Drug Use and Health. Among them, 12,300 reported having past-year suicidal ideation, and over 2,000 of those reported attempting suicide within the past 12 months prior to survey interview. Descriptive analyses and pooled and stratified (by suicide plan and major depressive episode [MDE]) multivariate logistic regression models were applied. Major depressive episode was based on assessments of individual diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS: Among persons aged 18 years or older in the United States, 3.8% reported having suicidal ideation in the past 12 months. Among past-year suicidal ideators, 13.2% attempted suicide in the past 12 months. The prevalence of past 12-month suicide attempt among past-year ideators with MDE was higher than among those without MDE (14.1% vs 12.0%). Past 12-month suicide attempt was more common among ideators with a suicide plan than among ideators without a plan (37.0% vs 3.7%). However, the prevalence of suicide attempt was higher among ideators with a plan but without MDE than among ideators with a plan and MDE (42.1% vs 32.9%). Compared with ideators without a plan, ideators with a plan had a higher (adjusted odds ratio [AOR] = 2.2; 95% confidence interval [CI], 1.47-3.45) suicide attempt risk among those without MDE (AOR = 22.4; 95% CI,16.55-30.27) than among those with MDE (AOR = 10.7; 95% CI, 7.91-14.49). CONCLUSIONS: Among adult suicidal ideators, factors associated with their progression from ideation to suicide attempt may vary by their suicide plan and major depression status. Focusing attention on high-risk subgroups may be warranted.

The relation between tobacco taxes and youth and young adult smoking: what happened following the 2009 U.S. federal tax increase on cigarettes?

BACKGROUND: On April 1, 2009, the federal government raised cigarette taxes from $0.39 to $1.01 per pack. This study examines the impact of this increase on a range of smoking behaviors among youth aged 12 to 17 and young adults aged 18 to 25. METHODS: Data from the 2002-2011 National Survey on Drug Use and Health (NSDUH) were used to estimate the impact of the tax increase on five smoking outcomes: (1) past year smoking initiation, (2) past-month smoking, (3) past year smoking cessation, (4) number of days cigarettes were smoked during the past month, and (5) average number of cigarettes smoked per day. Each model included individual and state-level covariates and other tobacco control policies that coincided with the tax increase. We examined the impact overall and by race and gender. RESULTS: The odds of smoking initiation decreased for youth after the tax increase (odds ratio (OR)=0.83, p<0.0001). The odds of past-month smoking also decreased (youth: OR=0.83, p<0.0001; young adults: OR=0.92, p<0.0001), but the odds of smoking cessation remained unchanged. Current smokers smoked on fewer days (youth: coefficient=-0.97, p=0.0001; young adults: coefficient=-0.84, p<0.0001) and smoked fewer cigarettes per day after the tax increase (youth: coefficient=-1.02, p=0.0011; young adults: coefficient=-0.92, p<0.0001). CONCLUSIONS: The 2009 federal cigarette tax increase was associated with a substantial reduction in smoking among youths and young adults. The impact of the tax increase varied across male, female, white and black subpopulations.

Prevalence of alcohol dependence among US adult drinkers, 2009-2011.

INTRODUCTION: Excessive alcohol consumption is responsible for 88,000 deaths annually and cost the United States $223.5 billion in 2006. It is often assumed that most excessive drinkers are alcohol dependent. However, few studies have examined the prevalence of alcohol dependence among excessive drinkers. The objective of this study was to update prior estimates of the prevalence of alcohol dependence among US adult drinkers. METHODS: Data were analyzed from the 138,100 adults who responded to the National Survey on Drug Use and Health in 2009, 2010, or 2011. Drinking patterns (ie, past-year drinking, excessive drinking, and binge drinking) were assessed by sociodemographic characteristics and alcohol dependence (assessed through self-reported survey responses and defined as meeting ≥3 of 7 criteria for dependence in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS: Excessive drinking, binge drinking, and alcohol dependence were most common among men and those aged 18 to 24. Binge drinking was most common among those with annual family incomes of $75,000 or more, whereas alcohol dependence was most common among those with annual family incomes of less than $25,000. The prevalence of alcohol dependence was 10.2% among excessive drinkers, 10.5% among binge drinkers, and 1.3% among non-binge drinkers. A positive relationship was found between alcohol dependence and binge drinking frequency. CONCLUSION: Most excessive drinkers (90%) did not meet the criteria for alcohol dependence. A comprehensive approach to reducing excessive drinking that emphasizes evidence-based policy strategies and clinical preventive services could have an impact on reducing excessive drinking in addition to focusing on the implementation of addiction treatment services.

Mental health treatment patterns among adults with recent suicide attempts in the United States.

OBJECTIVES: We examined mental health treatment patterns among adults with suicide attempts in the past 12 months in the United States. METHODS: We examined data from 2000 persons, aged 18 years or older, who participated in the 2008 to 2012 National Survey on Drug Use and Health and who reported attempting suicide in the past 12 months. We applied descriptive analyses and multivariable logistic regression models. RESULTS: In adults who attempted suicide in the past year, 56.3% received mental health treatment, but half of those who received treatment perceived unmet treatment needs, and of the 43.0% who did not receive mental health treatment, one fourth perceived unmet treatment needs. From 2008 to 2012, the mental health treatment rate among suicide attempters remained unchanged. Factors associated with receipt of mental health treatment varied by perceived unmet treatment need and receipt of medical attention that resulted from a suicide attempt. CONCLUSIONS: Suicide prevention strategies that focus on suicide attempters are needed to increase their access to mental health treatments that meet their needs. To be effective, these strategies need to account for language and cultural differences and barriers to financial and treatment delivery.

Are tobacco control policies effective in reducing young adult smoking?

PURPOSE: We examined the influence of tobacco control program funding, smoke-free air laws, and cigarette prices on young adult smoking outcomes. METHODS: We use a natural experimental design approach that uses the variation in tobacco control policies across states and over time to understand their influence on tobacco outcomes. We combine individual outcome data with annual state-level policy data to conduct multivariable logistic regression models, controlling for an extensive set of sociodemographic factors. The participants are 18- to 25-year-olds from the 2002-2009 National Surveys on Drug Use and Health. The three main outcomes are past-year smoking initiation, and current and established smoking. A current smoker was one who had smoked on at least 1 day in the past 30 days. An established smoker was one who had smoked 1 or more cigarettes in the past 30 days and smoked at least 100 cigarettes in his or her lifetime. RESULTS: Higher levels of tobacco control program funding and greater smoke-free-air law coverage were both associated with declines in current and established smoking (p < .01). Greater coverage of smoke-free air laws was associated with lower past year initiation with marginal significance (p = .058). Higher cigarette prices were not associated with smoking outcomes. Had smoke-free-air law coverage and cumulative tobacco control funding remained at 2002 levels, current and established smoking would have been 5%-7% higher in 2009. CONCLUSIONS: Smoke-free air laws and state tobacco control programs are effective strategies for curbing young adult smoking.

Mental health surveillance among children--United States, 2005-2011.

Mental disorders among children are described as "serious deviations from expected cognitive, social, and emotional development" (US Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau. Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and National Institutes of Health, National Institute of Mental Health; 1999). These disorders are an important public health issue in the United States because of their prevalence, early onset, and impact on the child, family, and community, with an estimated total annual cost of $247 billion. A total of 13%-20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994-2011 has shown the prevalence of these conditions to be increasing. Suicide, which can result from the interaction of mental disorders and other factors, was the second leading cause of death among children aged 12-17 years in 2010. Surveillance efforts are critical for documenting the impact of mental disorders and for informing policy, prevention, and resource allocation. This report summarizes information about ongoing federal surveillance systems that can provide estimates of the prevalence of mental disorders and indicators of mental health among children living in the United States, presents estimates of childhood mental disorders and indicators from these systems during 2005-2011, explains limitations, and identifies gaps in information while presenting strategies to bridge those gaps.

Differences in the prevalence rates and correlates of alcohol use and binge alcohol use among five Asian American subpopulations.

BACKGROUND: This study (1) estimated the prevalence of alcohol and binge alcohol use among adult Asian Americans by sub-ethnicity; (2) examined alcohol drinking patterns among these subpopulations; and (3) investigated sub-ethnic differences in characteristics associated with alcohol and binge alcohol use. METHOD: Data from 8900 Asian Americans aged 18 or older who participated in the 2002-2008 National Surveys on Drug Use and Health (NSDUHs) were analyzed. Descriptive analyses and multivariate logistic regression modeling were applied. RESULTS: Korean Americans (51.8%) and Japanese Americans (49.7%) reported higher rates of past-month alcohol use than Chinese Americans (42.0%), Filipino Americans (37.9%), and Asian Indian Americans (34.0%). Korean Americans (24.6%) reported the highest rate of past-month binge alcohol use, followed by Filipino Americans (14.5%), Japanese Americans (14.2%), Asian Indian Americans (10.1%), and Chinese Americans (8.1%). Among these examined Asian Americans, foreign-born Chinese, Filipino, and Asian Indian Americans were less likely to have past-month alcohol use than their corresponding U.S. born counterparts; and only foreign-born Asian Indian Americans were less likely to have past-month binge alcohol use than their U.S. born counterparts. Males were 3-5 times more likely to have binge alcohol use than females among examined Asian American subpopulations except for Korean Americans. Korean Americans were more likely to have binge alcohol use than the other examined sub-ethnic Asian Americans. CONCLUSIONS: Adult Asian Americans are heterogeneous in sociodemographic characteristics and alcohol and binge alcohol use. These differences suggest the need for sub-ethnically specific prevention and treatment programs for alcohol use problems among Asian American subpopulations.

Suicidal thoughts and behaviors among adults aged ≥18 years--United States, 2008-2009.

PROBLEM/CONDITION: Suicidal thoughts and behaviors are important public health concerns in the United States. In 2008, a total of 36,035 persons died as a result of suicide, and approximately 666,000 persons visited hospital emergency departments for nonfatal, self-inflicted injuries. State-level data on suicide-related issues are needed to help establish program priorities and to evaluate the effectiveness of suicide prevention strategies. Public health surveillance with timely and consistent exchange of data between data collectors and prevention program implementers allows prevention program practitioners to implement effective prevention and control activities. REPORTING PERIOD: January 1, 2008-December 31, 2009. DESCRIPTION OF SYSTEM: The National Survey on Drug Use and Health (NSDUH) is a national- and state-level survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects data on health-risks related to the use of illicit drugs, alcohol, and tobacco; initiation of substance use; substance use disorders and treatment; health care; and mental health. This report summarizes data on responses to questions concerning suicidal thoughts and behaviors contained in the mental health section among sampled persons aged ≥18 years in all 50 states and the District of Columbia. This report analyzes data on the prevalence of suicidal thoughts, planning, and attempts by age, sex, race/ethnicity, and state from 92,264 respondents in the 2008 and 2009 NSDUH. RESULTS: Prevalence estimates of suicidal thoughts and behaviors varied by sociodemographic factors, region, and state. During 2008-2009, an estimated 8.3 million (annual average) adults aged ≥18 years in the United States (3.7% of the adult U.S. population) reported having suicidal thoughts in the past year. The prevalence of having suicidal thoughts ranged from 2.1% in Georgia to 6.8% in Utah. An estimated 2.2 million (annual average) adults in the United States (1.0% of the adult U.S. population) reported having made suicide plans in the past year. The prevalence of reports of suicide planning ranged from 0.1% in Georgia to 2.8% in Rhode Island. An estimated 1 million (annual average) adults in the United States (0.5% of the U.S. adult population) reported making a suicide attempt in the past year. The prevalence of reports of suicide attempts ranged from 0.1% in Delaware and Georgia to 1.5% in Rhode Island. The prevalence of suicidal thoughts, suicide planning, and suicide attempts was significantly higher among young adults aged 18-29 years than it was among adults aged ≥30 years. The prevalence of suicidal thoughts was significantly higher among females than it was among males, but there was no statistically significant difference for suicide planning or suicide attempts. INTERPRETATION: The findings in this report indicate that substantial variations exist at the regional and state level in the prevalence of adults who had suicidal thoughts, made plans to attempt suicide, and attempted suicide in the past year. Geographic differences in prevalence might be attributable to selective migration, sociodemographic composition of the population, or the local social environment (e.g., social relationship indicators such as divorce rates or resources for access to health care). These findings emphasize the importance of continued surveillance to collect locally relevant data on which to base prevention and control activities. PUBLIC HEALTH ACTION: A better understanding of the patterns of the precursors to suicide is crucial to planning and evaluating a broad spectrum of suicide prevention efforts. These results can be used by state health departments and federal agencies to measure progress toward achieving national and state health objectives (e.g., those outlined in the National Strategy for Suicide Prevention). Continued surveillance is needed to design, implement, and evaluate public health policies and programs that can lead to a reduction in morbidity and mortality related to suicide-related thoughts and behaviors. Possible strategies to implement could include universal strategies (e.g., public education campaigns that focus on improving recognition of suicide risk) and indicated strategies (e.g., cognitive-behavioral therapy) that address the needs of persons exhibiting certain risk factors (e.g., persons who have made suicide attempts).

Correlates of perceiving a need for treatment among adults with substance use disorder: results from a national survey.

Although millions of adults meet criteria for substance use disorder (SUD) in the U.S., only a fraction receive treatment. This may be due to individuals with SUD not perceiving a need for treatment. In order to distinguish persons with SUD who perceive a need for treatment from those who do not, correlates for the perceived need for treatment were assessed for respondents with alcohol use disorder only, drug use disorder only and both alcohol and drug use disorder. Data were from the combined 2005-2009 datasets of the National Survey on Drug Use and Health. Logistic regression models were used to calculate odds ratio and 95% confidence intervals. Results demonstrated that among respondents who need treatment but did not receive treatment for alcohol use disorder, drug use disorder and both alcohol and drug use disorders, 3.3%, 8.3% and 12.4% perceived a need for treatment, respectively. No single socio-demographic correlate was predictive of perceiving a need across the three subpopulations suggesting that screenings for substance use disorder should be done in a setting where the general population may be accessed, e.g. primary care settings. Correlates associated with perceiving a need for treatment for all three subpopulations included psychological distress, disorder severity and substance type. Although respondents with greater disorder severity were more likely to perceive a need for treatment, a large proportion of those still do not perceive a need for treatment. Screening and brief interventions would facilitate treatment entry among those with the most severe disorders.

Mortality associated with illegal drug use among adults in the United States.

OBJECTIVES: To examine all-cause and cause-specific mortality over a 15-year follow-up period in relation to at-baseline reported lifetime use of illegal drugs from five classes (marijuana, cocaine, heroin, hallucinogens, and inhalants) among adults in the United States (US) household population. METHODS: The study involved 20,983 sample adults who responded to the 1991 National Health Interview Survey Drug and Alcohol Use supplemental questionnaire and also met the eligibility criteria for mortality follow-up. Cox proportional hazards models were estimated to examine the relationships. RESULTS: Adults who at baseline reported lifetime heroin use were at significantly higher risk of all-cause death over the follow-up period (hazard rate ratio or HR = 2.02; 95% confidence interval or CI 1.26-3.23), compared with those who did not report using drugs from any of the five classes, even after adjusting for age, sex, race, education, marital status, cigarette smoking status, and alcohol use status. Those who at baseline reported lifetime cocaine (no heroin) use had a significantly higher rate of death associated with human immunodeficiency virus diseases over the follow-up period than nonusers of drugs from any of the five classes. Several limitations of the analysis are discussed. CONCLUSIONS: Further research is needed to understand and track the elevated mortality associated with illegal drug use and the correlates of drug-poisoning deaths.

Serious psychological distress and mental health service use among community-dwelling older U.S. adults.

OBJECTIVES: This study examined the prevalence and predictors of past-year serious psychological distress and receipt of mental health services among community-dwelling older adults in the United States. METHODS: The sample included 9,957 adults aged 65 or older from the 2004-2007 National Survey on Drug Use and Health. Serious psychological distress was defined as having a score of 13 or higher on the K6 scale of nonspecific psychological distress. Descriptive analyses and logistic regression modeling were applied. RESULTS: Among community-dwelling older adults, 4.7% had serious psychological distress in the past year. Among those with past-year serious psychological distress, 37.7% received mental health services in the past year (4.8% received inpatient services, 15.8% received outpatient services, and 32.1% received prescription medications) (weighted percentages). Logistic regression results suggested that among older adults with serious psychological distress, receipt of mental health services was more likely among women, non-Hispanic whites, those who were married, those who were highly educated, Medicare-Medicaid dual beneficiaries, those with a major depressive episode, and those with more general medical conditions. CONCLUSIONS: These results suggest the need to screen for mental health problems among older adults and to improve the use and the quality of their mental health services. Since 2008 significant changes have revolutionized payment for mental health care and may promote access to mental health care in this population. Further studies are needed to assess trends in mental health service utilization among older adults and in the quality of their mental health care over time.

The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration study design and field procedures.

The Mental Health Surveillance Study (MHSS) is an ongoing initiative by the Substance Abuse and Mental Health Services Administration (SAMHSA) to monitor the prevalence of serious mental illness (SMI) among adults in the USA. In 2008, the MHSS used data from clinical interviews to calibrate mental health data from the National Survey on Drug Use and Health (NSDUH) for estimating the prevalence of SMI based on the full NSDUH sample. The clinical interview used was the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV; SCID). NSDUH interviews were administered via audio computer-assisted self-interviewing (ACASI) to a nationally representative sample of the population aged 12 years or older. A total of 46,180 NSDUH interviews were completed with adults aged 18 years or older in 2008. The SCID was administered by mental health clinicians to a sub-sample of 1506 adults via telephone. This paper describes the MHSS calibration study procedures, including information on sample selection, instrumentation, follow-up, data quality protocols, and management of distressed respondents.

Development of a brief mental health impairment scale using a nationally representative sample in the USA.

A psychometric analysis was conducted to reduce the number of items needed to assess the disability associated with mental disorders using the World Health Organization Disability Assessment Schedule (WHODAS). The WHODAS was to be used in the Substance Abuse and Mental Health Services Administration National Survey on Drug Use and Health (NSDUH), beginning in 2008, as part of a screening algorithm to produce estimates of the prevalence of serious mental illness (SMI) in the US adult population. The goal of the work presented in this paper was to create a parsimonious screening scale from the full 16-item WHODAS that was administered to 24,156 respondents (aged 18+) in the 2002 NSDUH. Exploratory factor analysis showed that WHODAS responses were unidimensional. A two-parameter polytomous Item Response Theory model showed that all 16 WHODAS items had good item discrimination (slopes greater than 1.0) for each response option. Analysis of item difficulties and differential item function across socio-demographic categories was then used to select a subset of eight items to create a short version of the WHODAS. The Pearson correlation between scores in the original 16-item and reduced eight-item WHODAS scales was 0.97, documenting that the vast majority of variation in total scale scores was retained in the reduced scale.

The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration analysis.

The Mental Health Surveillance Study (MHSS) is an ongoing initiative by the Substance Abuse and Mental Health Services Administration to develop and implement methods for measuring the prevalence of serious mental illness (SMI) among adults in the USA. The 2008 MHSS used data from clinical interviews administered to a sub-sample of respondents to calibrate mental health screening scale data from the National Survey on Drug Use and Health (NSDUH) for estimating the prevalence of SMI in the full NSDUH sample. The mental health scales included the K6 screening scale of psychological distress (administered to all respondents) along with two measures of functional impairment (each administered to a random half-sample of respondents): the World Health Organization Disability Assessment Schedule (WHODAS) and the Sheehan Disability Scale (SDS). The Structured Clinical Interview for DSM-IV (SCID) was administered to a sub-sample of 1506 adult NSDUH respondents within 4 weeks of completing the NSDUH interview. Results indicate that while SMI prediction accuracy of the K6 is improved by adding either the WHODAS or the SDS to the prediction equation, the models with the WHODAS are more robust. The results of the calibration study and methods used to derive prevalence estimates of SMI are presented.

Associations between duration of illicit drug use and health conditions: results from the 2005-2007 national surveys on drug use and health.

PURPOSE: To estimate and compare prevalence rates of lifetime health conditions by inferred duration of illicit drug use among the general U.S. adult population and to investigate associations between duration of use of each specific illicit drug (marijuana, cocaine, heroin, hallucinogens, or inhalant) and each lifetime health condition after controlling for potential confounding factors. METHODS: Data from respondents aged 35 to 49 (N = 29,195) from the 2005-2007 National Surveys on Drug Use and Health (NSDUH) were analyzed. RESULTS: The prevalence rates of a broad range of health conditions by duration of use of specific illicit drug among persons 35 to 49 years of age in the United States were estimated and compared. After adjustment for potential confounding factors, the results of 20 multivariate logistic regression models indicated positive associations between duration of marijuana use and anxiety, depression, sexually transmitted disease (STD), bronchitis, and lung cancer; between duration of cocaine use and anxiety and pancreatitis; between duration of heroin use and anxiety, hepatitis, and tuberculosis; between duration of hallucinogen use and tinnitus and STD; and between duration of inhalant use and anxiety, depression, HIV/AIDS, STD, tuberculosis, bronchitis, asthma, sinusitis, and tinnitus. CONCLUSIONS: This study provides initial analyses on the relationships between illicit drug use and health conditions based on a large nationally representative sample. These results can help prepare for treating health problems among former and continuing illicit drug users.

Substance use disorder among older adults in the United States in 2020.

AIMS: This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020. DESIGN: Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002-06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020. SETTING: Non-institutionalized US residences. PARTICIPANTS: Representative sample of the US civilian, non-institutionalized population. MEASUREMENTS: Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. FINDINGS: Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002-06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups. CONCLUSIONS: Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder.

Substance use among women: associations with pregnancy, parenting, and race/ethnicity.

OBJECTIVE: To examine the association of pregnancy and parenting (0- to 2-year-old child) statuses with past 30-day use of alcohol, cigarettes and marijuana, psychotherapeutics and cocaine among American women aged 18-44, overall and by race/ethnicity. METHODS: Five years of data (2002-2006) from the National Survey on Drug Use and Health (NSDUH) were pooled. Binary logistic regression analyses stratified by race/ethnicity were performed to examine the relationships adjusting for age, marital status, education and family income. RESULTS: Overall, past 30-day alcohol, cigarette, marijuana, psychotherapeutic or cocaine use was substantially lower among pregnant women, particularly in their second or third trimesters, than among their parenting or non-pregnant counterparts. Logistic regression analysis suggested a strong negative association between pregnancy status and substance use, with no considerable variations in the magnitude of the relationship by race/ethnicity for most measures. The relationship between parenting status and substance use was in the same direction, but relatively weak, and not statistically significant for non-Hispanic (NH) blacks for any measures except for alcohol use. Regardless of pregnancy and parenting statuses, NH white women reported substance use at the highest rates, followed by Hispanics and NH blacks. CONCLUSIONS: There is indirect evidence of postpregnancy resumption in substance use. Pregnant and parenting women, regardless of race/ethnicity, could benefit from prevention efforts focusing on cessation rather than temporary abstinence from substance use.