Marina Tolou-Shams

Neuropsychological performance of individuals dependent on crack-cocaine, or crack-cocaine and alcohol, at 6 weeks and 6 months of abstinence.

BACKGROUND Little data exist on the neuropsychological effects of crack-cocaine dependence or crack-cocaine and alcohol dependence. This study examined cognitive function in abstinent crack dependent and crack and alcohol dependent individuals at 6 weeks and 6 months abstinence. METHODS a comprehensive neuropsychological battery, including the MicroCog computerized assessment, was administered to 20 abstinent crack dependent subjects, 37 abstinent crack and alcohol dependent subjects, and 29 normal controls. Depression was examined as a covariate, and the association between substance use variables and neuropsychological performance was examined. RESULTS the two substance dependent groups had similar neuropsychological profiles at 6 weeks abstinent, with both groups exhibiting significant cognitive impairment in a wide range of functions compared to controls. The substance dependent groups were still impaired significantly at 6 months of abstinence. Only mild effects of depression on neuropsychological performance were observed. CONCLUSIONS crack dependence and crack and alcohol dependence may lead to severe and persistent neuropsychological deficits over a wide range of domains. The strongest predictor of brain damage associated with substance dependence in this sample was dose (particularly quantity and duration of peak dose).

Is the Web the culprit? Cognitive escape and Internet sexual risk among gay and bisexual men.

Men who have Sex with Men (MSM) who find partners on the Internet tend to be sexually risky. A “cognitive escape” perspective maintains that feeling overwhelmed by rigorous sexual norms may lead one to cognitively disengage from these demands as a coping strategy. We thus proposed that the Internet might facilitate less restrained behavior among men whose psychological characteristics make them vulnerable to “escape”-based risk. We tested this in a socio-economically and ethnically diverse cross sectional survey sample of MSM, n=817. Men who sought sex on-line reported more unprotected sex and sexually transmitted infections, controlling for demographics and overall number of sex partners. Consistent with an escape perspective, partner choice and sexual context, alcohol and drug use, and “burnout” or fatigue over sexual safety mediated the relationship between Internet use and sexual risk. The Internet is not an isolated source of risk; interventions must address the psychosocial aspects of this venue.

A Review of HIV Prevention Interventions for Juvenile Offenders

OBJECTIVE To conduct a critical review of all HIV prevention intervention studies conducted with adolescents in juvenile justice settings to inform future intervention development. METHOD PubMed and PsycInfo database searches were conducted for peer-reviewed, published HIV prevention intervention studies with juvenile offenders. RESULTS Sixteen studies were identified (N = 3,700 adolescents). Half of the projects utilized rigorous methodologies to determine intervention effect on behavior change, such as conducting a randomized controlled trial (n = 8). Nine studies reported behaviors at least 3 months post-intervention and five out of nine showed decreases in sexual risk behavior. CONCLUSIONS Several HIV prevention programs with juvenile offenders have led to sexual risk reduction, although effect sizes are modest. Most existing programs have neglected to address the impact of family, mental health, and substance use on HIV risk. More work is needed to develop evidence-based interventions that include HIV prevention strategies relevant and appropriate for the juvenile justice setting.

Adolescent Sexual Risk: Factors Predicting Condom Use Across the Stages of Change

This study examined factors associated with high-risk adolescents’ movement toward or away from adopting consistent condom use behavior using the Transtheoretical Model Stages of Change. Participants drawn from the inactive comparison condition of a randomized HIV prevention trial (Project SHIELD) responded to items assessing pros and cons of condom use, peer norms, condom communication, and perceived invulnerability to HIV. Participants were categorized based on their condom use behavior using the Transtheoretical Model. Multiple logistic regressions found that progression to consistent condom use was predicted by continuing to perceive more advantages to condom use, reporting greater condom use communication with partners, and less perceived invulnerability to HIV. Movement away from adopting consistent condom use was predicted by a decrease in perceived advantages to condom use, increased perceived condom disadvantages, and fewer condom discussions. Future interventions may be tailored to enhance these factors that were found to change over time.

Mental Health and HIV Risk Among African American Adolescents : The Role of Parenting

Summary The family system is integral to adolescent mental health and HIV risk. However, few studies have addressed family variables and adolescent outcomes among African American families. This study tested a longitudinal model of parenting, adolescent mental health, and adolescent HIV risk, among a community sample of low-income, urban African American families from the Collaborative HIV prevention and AdolescentMental Health Project (CHAMP). Consistent with general adolescent population data, we expected less parental monitoring, greater psychological control and less positive parenting to increase risk for adolescent depression and conduct problems. We hypothesized that these variables would in turn increase rates of HIV risk. We followed one hundred and thirty-four African American youth and theirmaternal caregivers as part of the CHAMP project. Study variables included: positive parenting, parental monitoring, psychological control, adolescent distress, conduct problems, and recent HIV risk. We examined the relationship among these variables via longitudinal path analysis. Age was strongly associated with increased adolescent HIV risk. Contrary to hypotheses, more parental psychological control was marginally associated with less HIV risk, while positive parenting was marginally associated with greater HIV risk. Adolescent depression was associated with more conduct problems, but unrelated to HIV risk. Thus, parenting practices generally considered negative might actually be protective among some lower SES African American families. This underscores the importance of extending studies of family context and adolescent risk behaviors to diverse social and ethnic groups. Designing prevention programs for diverse groups will require articulating culturally specific effects for different parenting practice.

Abstinent chronic crack-cocaine and crackcocaine/alcohol abusers evidence normal hippocampal volumes on MRI despite persistent cognitive impairments.

We measured hippocampal volumes and cognitive functioning in crack‐cocaine and crack‐cocaine/alcoholdependent subjects (abstinent approximately 10–12 weeks) compared to age‐matched controls. Cognitive function was evaluated using the computerized MicroCog Assessment of Cognitive Functioning (which includes tests of explicit, declarative memory subserved by the hippocampus). The hippocampal volumes were quantified on T1‐weighted MRIs and were expressed as a proportion of intracranial vault volume. Both subjects and controls showed the larger right versus left hippocampal volume expected in normal anatomy, but we found no differences in hippocampal volume between any of the groups. However, both abstinent cocaine‐dependent subjects and abstinent cocaine/alcohol‐dependent subjects showed persistent cognitive impairments, including deficits in explicit memory. Our results suggest that either: (1) the hippocampus is resistant to structural volume loss in young and middle‐aged cocaine or cocaine/alcohol‐dependent subjects, (2) the hippocampal volume loss suffered by young and middle‐aged cocaine or cocaine/alcohol‐dependent subjects resolves after approximately 3 months of abstinence, or (3) hippocampal atrophy is obscured by the process of gliosis. Further, the cognitive impairments persisting in these abstinent cocaine and cocaine/alcohol‐dependent samples may (1) be unrelated to hippocampal function or (2) be associated with abnormal hippocampal function that is not reflected in MRI measures of overall hippocampal atrophy.

Monitoring challenges: A closer look at parental monitoring, maternal psychopathology, and adolescent sexual risk

The present study sought to examine associations between maternal psychopathology, parental monitoring, and adolescent sexual activity among adolescents in mental health treatment. Seven hundred ninety mother-adolescent dyads recruited from adolescent mental health treatment settings completed audio computer-assisted structured interview assessments examining parent psychiatric symptoms, parental monitoring, and adolescent sexual risk behavior. Path analysis was used to examine the associations between variables of interest. Maternal caregivers who reported more mental health symptoms were more likely to have adolescents who reported recent sex and this relationship was mediated by less parental monitoring. These findings suggest that maternal caregivers with mental health symptoms may need specific interventions that provide assistance and support in monitoring their teens in order to reduce sexual risk taking among adolescents in mental health treatment.

Gender differences in recidivism rates for juvenile justice youth: the impact of sexual abuse.

Young female offenders represent a growing number of young offenders. Studies have shown that youth in the juvenile justice system, particularly young females, report higher rates of lifetime sexual abuse than their nonoffending peers. The aim of this study was to examine gender differences in risk factors for recidivism, including a history of sexual abuse, among a juvenile court clinic sample. Findings suggest that, even after accounting for previously identified risk factors for recidivism such as prior legal involvement and conduct problems, a history of sexual abuse is the most salient predictor of recidivism for young female offenders, but not for males. The development of gender-responsive interventions to reduce juvenile recidivism and continued legal involvement into adulthood may be warranted.

HIV prevention for juvenile drug court offenders: a randomized controlled trial focusing on affect management.

Juvenile drug court (JDC) offenders have benefited from evidence-based interventions addressing antisocial behavior, mental health, and substance use; however, interventions addressing HIV risk behavior are lacking. This study presents pilot findings and lessons learned from a group-based HIV prevention intervention delivered to JDC offenders. Participants were randomized to a five-session HIV prevention (n = 29) or health promotion (n = 28) condition and completed measures of sexual risk taking and substance use at baseline and 3 months postintervention. No between-group differences by time emerged on measures of sexual risk taking or other HIV-related behaviors and attitudes. Both groups improved their rates of HIV testing and decreased their substance use during sex over time. Delivering an HIV prevention intervention to drug court offenders is feasible; however, more intensive interventions that incorporate multiple systems and address co-occurring mental health difficulties may be needed to effect sexual behavioral change among these high-risk court-involved youth.

Crack and Cocaine Use among Adolescents in Psychiatric Treatment: Associations with HIV Risk

Crack and cocaine use among adults has been associated with co-occurring psychiatric disorders as well as other drug use and unprotected sex. However, this issue is relatively unstudied in adolescents. This study collected data from 282 adolescents (mean age = 14.9 years) treated in intensive psychiatric treatment settings to understand the relationship between crack/cocaine use and HIV risk. Thirteen percent of youths reported ever using crack or cocaine. Use was not associated with age, gender, race/ethnicity, or SES. After controlling for known factors that influence unprotected sex, the odds that those with a history of crack/cocaine use engaged in inconsistent condom use was six times greater than that for those youths who did not ever use. Thus, crack/cocaine use is prevalent even among younger adolescents with psychiatric disorders who are not in drug treatment. Its use is associated with high rates of sexual and other risk behaviors. A history of use should alert clinicians to a wide variety of possible behavioral risks. These results can also inform future adolescent HIV prevention intervention development.