Megan S. O'Brien

Risk of Becoming Cocaine Dependent: Epidemiological Estimates for the United States, 2000–2001

In this paper, we present new estimates for the risk of becoming cocaine dependent within 24 months after first use of the drug, and study subgroup variation in this risk. The study estimates are based on the National Household Survey on Drug Abuse conducted during 2000–2001, with a representative sample of US residents aged 12 years and older (n=114 241). A total of 1081 respondents were found to have used cocaine for the first time within 24 months prior to assessment. Between 5 and 6% of these recent-onset users had become cocaine dependent since onset of use. Excess risk of recent cocaine dependence soon after onset of cocaine use was found for female subjects, young adults aged 21–25 years, and non-Hispanic Black/African-Americans. Use of crack-cocaine and taking cocaine by injection were associated with having become cocaine dependent soon after onset of use. These epidemiologic findings help to quantify the continuing public health burden associated with new onsets of cocaine use in the 21st century.

Peer and sibling substance use: predictors of substance use among adolescents in Mexico

OBJECTIVE To examine the extent to which peer drug use and sibling drug use predict alcohol abuse/dependence disorder status and the use of drugs other than alcohol among school-based youth in Mexico. METHODS Data were collected on 1 203 middle and high school students in northern Mexico in May 1998. Participation was voluntary, and responses were confidential. Logistic regression analyses estimated the association that peer drug use and that sibling drug use had with alcohol abuse/dependence diagnosis and the lifetime use of drugs other than alcohol. RESULTS Students who had siblings or peers who used alcohol and other drugs were more likely to meet the standard alcohol abuse/dependence criteria defined by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), and were more likely to have used drugs other than alcohol. Controlling for potentially important confounders, we found that adolescents with the highest level of peer substance use were eight times as likely to meet alcohol abuse/dependence criteria and four times as likely to use other drugs. Youth who had siblings who used drugs were about twice as likely to meet alcohol abuse/dependence criteria and about 2.5 times as likely to use drugs other than alcohol when compared to youth with no sibling substance use. CONCLUSIONS Consistent with extant findings among youth in the United States of America, peer and sibling substance use are major risk factors for substance use among school-based youth in Mexico. Students in Mexico may benefit from prevention strategies found to be effective among students in the United States.

Cocaine Use and the Occurrence of Panic Attacks in the Community: A Case-Crossover Approach

The epidemiologic case-crossover method is a powerful tool for research on suspected hazards of illegal drug use, the advantage being a subject-as-own-control approach that constrains stable individual-level susceptibility traits. Here, we use the case-crossover method to estimate the magnitude of excess occurrence of panic attacks during months of cocaine use vs. months of no cocaine use, motivated by a prior estimate that cocaine users have three-fold excess risk of panic attack. The self-report data on cocaine and panic are from assessments of a nationally representative sample of 1071 recent panic cases age 18 years or older identified as part of the National Household Surveys on Drug Abuse conducted in the United States during 1994–1997. Based on case-crossover estimates, cocaine use is associated with a three- to- four-fold excess occurrence of panic attack (estimated relative risk (RR) = 3.3, p = 0.049; 95% confidence interval: 1.0, 13.7). Year-by-year, the RR estimates from four independent yearly replicates (1994–1997) are 5.0, 2.0, 3.0, and 3.0. While there are several important limitations, this study adds new evidence about a previously reported suspected causal association linking cocaine use to occurrence of panic attacks, and illustrates advantages of the epidemiologic case-crossover approach and new directions in research on hazards of illegal drug use.

Screening for “Substance Abuse” Among School-Based Youth in Mexico Using the Problem Oriented Screening Instrument (POSIT) for Teenagers

Indices of classification accuracy of the Substance Use/Abuse scale of a Spanish-language version of the Problem Oriented Screening Instrument for Teenagers (POSIT) were evaluated among school-based youth in Mexico. Participants were 1203 youth attending one middle school (N = 619) and one high school (N = 584) in the third largest city of Coahuila, a northern border state in Mexico in May 1998. More than 94% of youth enrolled in the participating middle school and 89% of youth enrolled in the participating high school completed the International Longitudinal Survey of Adolescent Health. Indices of classification accuracy of the POSIT Substance Use/Abuse scale were evaluated against a “drug abuse” problem severity criterion that combined youth meeting DSM-IV criteria for alcohol abuse/dependence disorders with youth having used other illicit drugs five or more times in their lifetime. The present study findings suggest that using a cut score of one or two on the POSIT Substance Use/Abuse scale generally yields optimal classification accuracy indices that vary somewhat by gender and school subgroups. Further, classification accuracy indices of the POSIT Substance Use/Abuse scale are slightly better when used among high school males due, in part, to the higher base rate of serious involvement among this group compared to others.

Critical issues for psychiatric medication shared decision making with youth and families

The primary aims of this article are to describe the current context for youth shared decision making (SDM) within the U.S. childrens mental health system and to identify important considerations for the development of this approach as a research and service domain. The notion is substantiated in the literature that participation in treatment decisions can prepare youth for making their own decisions as adults, can be therapeutic, and can have positive effects on their self-confidence and self-esteem. Still, the complex youth–family–provider dynamic raises important issues that need to be addressed before SDM can be successfully implemented.

Does Cannabis Onset Trigger Cocaine Onset? A Case-Crossover Approach

Psychiatric researchers tend to select the discordant co‐twin design when they seek to hold constant genetic influence while estimating exposure‐associated disease risk. The epidemiologic case‐crossover research design developed for the past two decades represents a viable alternative, not often seen in psychiatric studies. Here, we turn to the epidemiologic case‐crossover approach to examine the idea that cannabis onset is a proximal trigger for cocaine use, with the power of “subject‐as‐own‐control” research used to hold constant antecedent characteristics of the individual drug user, including genetic influence and other traits experienced up to the time of the observed hazard and control intervals. Data are from newly incident cocaine users identified in the 2002–2006 US National Surveys on Drug Use and Health. Among these cocaine users, 48 had both cannabis onset and cocaine onset in the same month‐long hazard interval; the expected value is 30 users, based on the control interval we had pre‐specified for case‐crossover estimation (estimated relative risk, RR = 1.6; exact mid‐p = 0.042). Within the framework of a subject‐as‐own‐control design, the evidence is consistent with the hypothesis that cannabis onset is a proximal trigger for cocaine use, with genetic influences (and many environmental conditions and processes) held constant. Limitations are noted and implications are discussed. Copyright

Clinical preventive service use disparities among subgroups of people with disabilities: A scoping review.

BACKGROUND Recommended use of clinical preventive services (CPS) reduces morbidity and mortality from preventable conditions. Disparities in CPS utilization between individuals with and without disabilities have been shown, but a greater understanding of the disability subpopulations with lowest utilization is needed to better inform research, policy, and practice. OBJECTIVE The objective was to conduct a scoping review of the literature to identify relevant studies on disparities in receipt of CPS among subgroups of individuals with disabilities. METHODS In July 2010, electronic and manual literature searches were conducted for years 2000-2009. Review for inclusion/exclusion and data analysis occurred in 2010 and 2011. In 2012, the review was updated to cover abstracts published in 2010 and 2011. Identified abstracts, and then full-text articles of included abstracts, were reviewed according to inclusion/exclusion criteria by multiple reviewers. For articles meeting all criteria, two reviewers performed independent data extraction. A gap analysis was performed to identify areas of concentration and gaps in the literature. RESULTS Twenty-seven articles met inclusion criteria for this review. Studies varied substantially in sample composition and research methods. CPS examined most often were cervical cancer screening (14 studies) and mammography (13 studies). Potential disparity factors studied most often were disability factors (i.e., disabling condition in 12 studies, disability severity in 10 studies). Stratification of CPS by disparity factors revealed substantial gaps in the literature. CONCLUSIONS The literature gaps point to a need for high quality research on access disparities among subgroups of individuals with disabilities.

Adolescent Substance Abuse in Mexico, Puerto Rico and The United States: Effect of Anonymous versus Confidential Survey Formats.

SUMMARY Anonymous surveys have been widely used worldwide to describe adolescent substance use yet cannot elucidate causal drug abuse predictors. Studies in the U.S. have generally found that anonymous and confidential surveys yield comparable levels of self-reported substance use, yet the effect of survey format on youth self-report has not been evaluated in other countries. The present study compared data from the confidential International Longitudinal Survey of Adolescent Health with anonymously collected survey data on alcohol and marijuana use among school-based youth in Mexico, Puerto Rico, and the U.S. The findings suggest that confidential surveys yield valid self-reports of adolescent substance use.