Li-Tzy Wu

Tobacco smoking and depressed mood in late childhood and early adolescence.

OBJECTIVES This study builds on previous observations about a suspected causal association linking tobacco smoking with depression. With prospective data, the study sheds new light on the temporal sequencing of tobacco smoking and depressed mood in late childhood and early adolescence. METHODS The epidemiologic sample that was studied consisted of 1731 youths (aged 8-9 to 13-14 years) attending public schools in a mid-Atlantic metropolitan area, who were assessed at least twice from 1989 to 1994. A survival analysis was used to examine the temporal relationship from antecedent tobacco smoking to subsequent onset of depressed mood, as well as from antecedent depressed mood to subsequent initiation of tobacco use. RESULTS Tobacco smoking signaled a modestly increased risk for the subsequent onset of depressed mood, but antecedent depressed mood was not associated with a later risk of starting to smoke tobacco cigarettes. CONCLUSIONS This evidence is consistent with a possible causal link from tobacco smoking to later depressed mood in late childhood and early adolescence, but not vice versa.

The epidemiology of at-risk and binge drinking among middle-aged and elderly community adults: National Survey on Drug Use and Health.

OBJECTIVE The purpose of this article was to estimate the prevalence, distribution, and correlates of at-risk alcohol use (especially binge drinking) among middle-aged and elderly persons in the United States and to compare at-risk alcohol use between women and men. METHOD Secondary analysis of the 2005 and 2006 National Survey on Drug Use and Health was conducted for 10,953 respondents aged 50 years and older. Among respondents, 6,717 were 50 to 64 years of age and 4,236 were > or =65 years. Social and demographic variables, alcohol use (including at-risk use), binge drinking, serious psychological distress, and self-rated health were assessed. RESULTS Overall, 66% of male respondents and 55% of female respondents reported alcohol use during the past year. At-risk alcohol use and binge drinking were more frequent among respondents 50 to 64 years of age relative to respondents aged 65 years or older. In the > or =65 years old age group, 13% of men and 8% of women reported at-risk alcohol use, and more than 14% of men and 3% of women reported binge drinking. Among male subjects, binge drinking compared with no alcohol use was associated with higher income and being separated, divorced, or widowed, while being employed and nonmedical use of prescription drugs were associated with binge drinking compared with no alcohol use among women. For all respondents, binge drinking relative to no alcohol use was associated with the use of tobacco and illicit drugs. Among women who reported using alcohol, being African American and less educated were associated with binge drinking, but race/ethnicity and educational level were not associated with binge drinking in men who reported using alcohol. CONCLUSIONS At-risk and binge drinking are frequently reported by middle-aged and elderly adults nationwide and are therefore of public health concern. Clinicians working with middle-aged and older adults should screen for binge drinking and coexisting use of other substances.

E-cigarette prevalence and correlates of use among adolescents versus adults: A review and comparison

Perceived safer than tobacco cigarettes, prevalence of electronic cigarette (e-cigarette) use is increasing. Analyses of cartridges suggest that e-cigarettes may pose health risks. In light of increased use and the potential for consequences, we searched Google Scholar and Pubmed in July of 2013 using keywords, such as e-cigarette and vaping, to compare differences and similarities in prevalence and correlates of e-cigarette use among adolescents (grades 6-12) versus adults (aged ≥18 years). Twenty-one studies focused on e-cigarette use. Ever-use increased among various age groups. In 2011, ever-use was highest among young adults (college students and those aged 20-28; 4.9%-7.0%), followed by adults (aged ≥18; 0.6%-6.2%), and adolescents (grades 6-12 and aged 11-19; <1%-3.3%). However, in 2012 adolescent ever-use increased to 6.8% and, among high school students, went as high as 10.0%. While the identified common correlate of e-cigarette use was a history of cigarette smoking, a notable proportion of adolescents and young adults who never smoked cigarettes had ever-used e-cigarettes. E-cigarette use was not consistently associated with attempting to quit tobacco among young adults. Adults most often reported e-cigarettes as a substitute for tobacco, although not always to quit. Reviewed studies showed a somewhat different pattern of e-cigarette use among young people (new e-cigarette users who had never used tobacco) versus adults (former or current tobacco users). Research is needed to better characterize prevalences, use correlates, and motives of use in different population groups, including how adolescent and young adult experimentation with e-cigarettes relates to other types of substance use behaviors.

The epidemiology of substance use and disorders among middle aged and elderly community adults: national survey on drug use and health.

OBJECTIVE To estimate the prevalence, distribution, and correlates of drug use among middle aged and elderly persons in the United States and to compare with alcohol use in this age group. SETTING The 2005 and 2006 National Surveys on Drug Use and Health. PARTICIPANTS A total of 10,953 subjects, age 50 years and older (6,717 subjects age 50-64 years and 4,236 subjects age 65+ years). MEASUREMENTS Social and demographic variables detailed assessment of alcohol and drug use and disorders (marijuana, cocaine, inhalants, hallucinogens, methamphetamine, and heroin), major depression, and self-rated health. RESULTS Nearly 60% of subjects used alcohol during the past year, 2.6% marijuana, and 0.41% cocaine. Both alcohol and drug use were far more frequent in subjects age 50-64 years and among men. Drug use, in contrast to alcohol use, was not associated with education but was more common among those not married and those with major depression. The prevalence of drug abuse or dependence in the 50+ age group was very low (only 0.33% for any abuse or dependence, 0.12% for marijuana abuse or dependence, and 0.18% for cocaine abuse or dependence). Nevertheless, the use of marijuana approached 4% in the 50-64 age group in comparison with 0.7% in the 65+ age group. CONCLUSIONS Drug use is not prevalent, although use is much more common in the middle aged, suggesting that prevalence may rise substantially in the 65+ age group as the younger cohort ages.

Illicit and Nonmedical Drug Use Among Older Adults: A Review:

Objective: Substance abuse among older adults is a looming public health concern. The number of Americans aged 50+ years with a substance use disorder is projected to double from 2.8 million in 2002-2006 to 5.7 million in 2020. The authors provide a review of epidemiological findings for this understudied area of research by focusing on illicit drug use disorders and nonmedical use of prescription drugs among adults aged 50+ years. Method: MEDLINE and PsychInfo were searched using keywords drug use, drug abuse, drug misuse, substance use disorder, and prescription drug abuse. Using the related-articles link, additional articles were screened for inclusion. This review included articles published between 1990 and 2010. Result: Results from multiple sources indicated a much higher rate of illicit drug use and nonmedical use of prescription drugs and drug-related treatment admissions for persons 50 to 64 years of age compared with adults 65+ years of age. Rates of treatment admissions involving primary use of illicit and misuse of prescription drugs have increased, while rates involving primary use of alcohol only have decreased. Alcohol, opioids/heroin, and cocaine were more likely than other substances to be associated with treatment use. Limited research data suggested the effectiveness of treatments, especially for women. Furthermore, older adults appeared to be less likely than younger adults to perceive substance use as problematic or to use treatment services. Discussion: There is robust evidence showing that an increased number of older adults will need substance abuse care in the coming decades. Increasing demands on the substance abuse treatment system will require expansion of treatment facilities and development of effective service programs to address emerging needs of the aging drug-using population.

The Relationship Between Employment and Substance Use Among Students Aged 12 to 17

PURPOSE To examine the association between employment status and substance use among students aged 12 to 17 years. METHODS Secondary analysis of data from the 1995 and 1996 National Household Surveys on Drug Abuse was conducted. The survey is a primary source of data on licit and illicit drug use among noninstitutionalized Americans aged 12 years or older. Participants are interviewed at their places of residence. Multiple logistic regression procedures yielded estimated associations. RESULTS About one in six adolescents reported both going to school and holding a job. Approximately one-fourth of students smoked cigarettes, and one-third consumed alcohol in the past year. An estimated 1.6% of students were current heavy cigarette smokers, and 2.6% were current heavy alcohol users. One-year prevalence estimates of any illicit drug use and heavy illicit drug use were 16.7% and 1.8%, respectively. Among students employed full time, prevalence estimates increased to 9.7% for heavy cigarette smoking, 13.1% for heavy alcohol use, 38.1% for any illicit drug use, and 5.0% for heavy illicit drug use. Logistic regression analyses supported relatively high rates of cigarette use, alcohol use, illicit drug use, and heavy substance use among working students. Mental health problems, especially externalizing behavioral syndromes, were found to coexist with the use and heavy use of substances. The observed associations varied somewhat by gender. CONCLUSIONS The workplace may be an appropriate venue for establishing substance use prevention and early intervention programs focused on younger workers, including adolescents who work part time.

Substance Abuse among Individuals with Intellectual Disabilities

Individuals with disabilities are a growing population that confronts multiple disadvantages from social and environmental determinants of health. In particular, the 7-8 million people in the U.S. with an intellectual disability (ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform prevention and treatment efforts for them. Although available research could inform future research efforts, studies are scattered across disciplines with the last review synthesizing findings written more than five years ago. To consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance users is comparatively high. Gaps in the research and population subgroups that warrant special attention are identified, such as individuals with borderline and mild ID, individuals with co-occurring mental illness, and individuals who are incarcerated. Compared with substance abusers without ID, ID substance abusers are less likely to receive substance abuse treatment or remain in treatment. Research is needed to better gauge the magnitude of substance use problems, identify prevention strategies, and specify treatment components that meet the unique needs of individuals with ID.

How do prescription opioid users differ from users of heroin or other drugs in psychopathology: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Objectives:To study substance use and psychiatric disorders among prescription opioid users, heroin users, and nonopioid drug users in a national sample of adults. Methods:Analyses of data from the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Results:Four groups were identified among 9140 illicit or nonprescribed drug users: heroin-other opioid users (1.0%; used heroin and other opioids), other opioid-only users (19.8%; used other opioids but never heroin), heroin-only users (0.5%; used heroin but never other opioids), and nonopioid drug users (78.7%; used drugs but never heroin or other opioids). After adjusting for variations in socioeconomic characteristics, history of substance abuse treatment, and familial substance abuse, heroin-other opioid users had greater odds of several substance use disorders (SUDs; cocaine, hallucinogen, sedative, amphetamine, and tranquilizer) when compared with the other groups; heroin-only users had reduced odds of sedative and tranquilizer use disorders when compared with other opioid-only users. Nonopioid drug users had reduced odds of all SUDs and other mental disorders (mood, anxiety, pathologic gambling, and personality) when compared with other opioid-only users. Past-year other opioid-only users also reported slightly lower scores on quality of life than past-year nonopioid drug users. Conclusions:All opioid users had higher rates of SUDs than nonopioid drug users, and these rates were particularly increased among heroin-other opioid users. The findings suggest the need to distinguish between these 4 groups in research and treatment as they may have different natural histories and treatment needs.

Substance Use, Dependence, and Service Utilization Among the US Uninsured Nonelderly Population

OBJECTIVES We examined the prevalence and correlates of substance use, dependence, and service utilization among uninsured persons aged 12 to 64 years. METHODS We drew study data from the 1998 National Household Survey on Drug Abuse. RESULTS An estimated 80% of uninsured nonelderly persons reported being uninsured for more than 6 months in the prior year. Only 9% of these uninsured persons who were dependent on alcohol or drugs had received any substance abuse service in the past year. Non-Hispanic Whites were an estimated 3 times more likely than Blacks to receive substance abuse services. CONCLUSIONS Compared with the privately insured, uninsured persons had increased odds of having alcohol/drug dependence and appeared to face substantial barriers to health services for substance use problems.

Screening for alcohol and drug use disorders among adults in primary care: a review.

Background The Patient Protection and Affordable Care Act of 2010 supports integration of substance abuse interventions and treatments into the mainstream health care system. Thus, effective screening and intervention for substance use disorders in health care settings is a priority. Objective This paper reviews the prevalence of alcohol and drug use disorders (abuse or dependence) in primary care settings and emergency departments, as well as current screening tools and brief interventions. Methods MEDLINE was searched using the following keywords: alcohol use, alcohol use disorder, drug use, drug use disorder, screening, primary care, and emergency departments. Using the related-articles link, additional articles were screened for inclusion. This review focuses on alcohol and drug use and related disorders among adults in primary care settings. Conclusion Screening, brief intervention, and referral for treatment are feasible and effective in primary care settings, provided that funding for screening is available, along with brief interventions and treatment facilities to which patients can be referred and treated promptly.