Howard D. Chilcoat

Impact of Parent Monitoring on Initiation of Drug Use through Late Childhood

OBJECTIVEnTo examine whether parental supervision and monitoring in middle childhood might have a sustained impact on risk of drug use later in childhood and adolescence.nnnMETHODnAn epidemiological sample of 926 urban-dwelling youths were individually interviewed annually, beginning in 1989 when the children were 8 to 10 years old, continuing through 1992. Standardized questions measured drug use, parenting behaviors, and other suspected determinants of drug use.nnnRESULTSnSurvival analysis estimates indicated that children in the lowest quartile of parent monitoring initiated drug use at earlier ages. The contrast in risk of initiating alcohol, tobacco, or other drug use across levels of parent monitoring was greatest when children were under 11 years old; at older ages there was no difference in risk. However, in analyses focused specifically on marijuana, cocaine, and inhalant drugs, we observed a sustained higher risk of starting to use these drugs among youths who had been monitored at the lowest levels in middle childhood.nnnCONCLUSIONnThese results add to the chain of inference that effective supervision and monitoring in middle childhood by parents or guardians might induce a delay or prevent onset of drug use among youths living in urban areas, a hypothesis that now ought to be tested in rigorous field experiments.

Racial/Ethnic and Age Differences in Crack Use within Neighborhoods

Summary overviews of crack use in the U.S. indicate that the lifetime prevalence of crack use for African-Americans is 2-3 times that of White-Americans. However, a recent study that used interview data from the 1988 National Household Survey of Drug Abuse (NHSDA) found no racial/ethnic differences, once neighborhood was held constant. In light of an observed increase in crack use among African-Americans since 1988, we set out to determine whether differences existed between race/ethnicities, using data from the 1990 NHSDA. Employing a post-stratification procedure, we found no overall differences in lifetime prevalence of crack use for African-Americans relative to White-Americans (RO = 1.37, 95% CI = 0.82-2.29) but found that Hispanic-Americans had lower odds than whites (RO = 0.52, 95% CI = 0.28 - 0.96). However, stratification by age group indicated that African-Americans 30-34 years old had significantly higher odds of lifetime crack use than White-Americans in the same age strata when neighborhood i...

Understanding the use of diverted buprenorphine

BACKGROUNDnBuprenorphine is approved in many countries for the treatment of opioid use disorder (OUD), but problems with diversion and abuse exist. There is a need to understand how and why patients use diverted buprenorphine, and whether barriers to access contribute to illicit use.nnnMETHODSnAdults >18 years with DSM-IV criteria for substance use disorder and primarily using an opioid completed the online Survey of Key Informants Patients (SKIP) between August and September 2016. The survey included closed- and open-ended questions regarding reasons for buprenorphine use with and without a prescription, sources of buprenorphine, route of administration, and barriers to treatment.nnnRESULTSnOf 303 respondents, 175 (58%) reported a history of diverted buprenorphine use, 65 (37%) of whom reported never receiving a prescription. The most common reasons for illicit buprenorphine use were consistent with therapeutic use: to prevent withdrawal (79%), maintain abstinence (67%), or self-wean off drugs (53%). Approximately one-half (52%) reported using buprenorphine to get high or alter mood, but few (4%) indicated that it was their drug of choice. Among respondents who had used diverted buprenorphine, 33% reported that they had issues finding a doctor or obtaining buprenorphine on their own. Most (81%) of these participants indicated they would prefer using prescribed buprenorphine, if available.nnnCONCLUSIONSnAlthough 58% of survey respondents reported a history of using diverted buprenorphine, the most frequently cited reasons for non-prescription use were consistent with therapeutic use. Diversion was partially driven by barriers to access, and an unmet need for OUD treatment persists.

Low power? Use two-dimensional confidence regions as a graphical method for depicting uncertainty.

Prospective studies of rare outcomes, such as HIV seroconversion or obsessive-compulsive disorder, can often result in small sample sizes with limited power for detecting associations. For this reason, it is useful to develop graphical procedures that enable researchers to depict uncertainty around parameter estimates and examine the direction of association when statistical power is low. Classical procedures include the reporting of confidence intervals, which typically are derived from asymptotic normality of parameters estimated using large samples. In this paper, we present a likelihood-based procedure for the estimation of the confidence region of two parameters from a conditional logistic regression of a nested case-control study with a relatively small number of cases. Graphical depiction of the confidence regions provides an easily comprehensible procedure to quantify the uncertainty of the estimation based on small samples.