Rumi Kato Price

Alcohol, tobacco, and other drug use among Asian American and Pacific Islander Adolescents in California and Hawaii.

As an aggregate group, the lowest rates of alcohol, tobacco, and other drug (ATOD) use are often reported for Asian Americans/Pacific Islanders (AAPIs), compared to other groups. However, the low rates are often based upon samples with small representations of AAPIs, or represented by only one or two AAPI groups. Consequently, reliable data on the rates of ATOD use among specific AAPI subgroups are severely lacking. Using data from school surveys collected from 9th grade students in California and 10th grade students in Hawaii, we compared the ATOD rates of Whites, Chinese, Filipino, Japanese, and Pacific Islander/Native Hawaiian adolescents. We found considerable variation in ATOD rates among subgroups of AAPIs, variation that was consistent across surveys. Chinese reported the lowest ATOD rates; Whites, Pacific Islanders, and Native Hawaiians reported among the highest. We found similar variation in need for alcohol and other drug treatment for these groups. Implications of these findings and recommendations for future research are discussed.

Comparison between self-report and hair analysis of illicit drug use in a community sample of middle-aged men

Discrepancies between biological assays and self-report of illicit drug use could undermine epidemiological research findings. Two objectives of the present study are to examine the degree of agreement between self-reported illicit drug use and hair analysis in a community sample of middle-aged men, and to identify factors that may predict discrepancies between self-report and hair testing. Male participants followed since 1972 were interviewed about substance use, and hair samples were analyzed for marijuana, cocaine, opiates, phencyclidine (PCP) and methamphetamine using radioimmunoassay and gas chromatography-mass spectrometry (GC-MS) techniques. Self-report and hair testing generally met good, but not excellent, agreement. Apparent underreporting of recent cocaine use was associated with inpatient hospitalization for the participants most recent quit attempt, younger age, identifying as African American or other, and not having a diagnosis of antisocial personality disorder. The overestimate of marijuana use relative to hair test was associated with frequent use since 1972 and providing an inadequate hair sample. Additional research is needed to identify factors that differentially affect the validity of both hair drug testing and self-report.

Subtypes of adult antisocial behavior among drug abusers

Recent work has shown that a substantial proportion of injecting drug users would have met criteria for antisocial personality disorder (ASPD) if the childhood trajectory of conduct disorder (CD) were ignored. From among 545 St. Louis, Missouri, drug users interviewed in person, we evaluated the clinical homogeneity of the 405 men and women with adult antisocial behaviors who did and did not have conduct disorder. The fully diagnosed ASPD group (those with CD) was distinguishable from the adult antisocial behavior only group without CD on all childhood behaviors, adult impulsive and aggressive behaviors, and measures of severe drug abuse, including earlier age of onset of drug use and drug treatment utilization. Clinical homogeneity of the groups was reflected by the groups similarity on indices such as types of adult antisocial behaviors, consequences of drug use, injection drug use history, and comorbid psychiatric disorders. Implications for a modification in the concept of ASPD are addressed.

Remission From Drug Abuse Over a 25-Year Period: Patterns of Remission and Treatment Use

OBJECTIVES Using an epidemiologically obtained sample, we examined patterns of illicit drug use, abuse, and remission over a 25-year period and recent treatment use. METHODS The surviving members of the cohort (n = 841), previously surveyed in 1972 and 1974, comprised 3 subsamples of Vietnam War enlisted men and civilian controls. Retrospectively obtained year-to-year measures from the 1996-1997 survey included use and remission of sedatives, stimulants, marijuana, cocaine, and opiates, as well as substance abuse and psychiatric treatment use. RESULTS Relatively stable patterns of frequent use in adulthood were found, with the mean duration from initiation to the last remission ranging from 9 to 14 years. A majority attempted to quit; however, most did not use traditional drug treatment in their last attempts. Fewer than 9% of the then-current drug users were treated in inpatient or outpatient settings at the time of data collection. CONCLUSIONS Most drug abusers who had started using drugs by their early 20s appeared to gradually achieve remission. Spontaneous remission was the rule rather than the exception. Nonetheless, considerable unmet needs existed for those who had continued use into middle age.

Is antisocial personality disorder associated with increased HIV risk behaviors in cocaine users

Previous reports have shown antisocial personality disorder (ASPD) to be strongly associated with injection equipment sharing and increased rates of human immunodeficiency virus (HIV) infection in a sample of heroin injectors. Another report has shown ASPD to be associated with injection drug use, needle sharing, sexual promiscuity, and prostitution in a sample of methadone maintenance clients. The current study extends this work by examining the relationship of ASPD and human immunodeficiency virus (HIV) risk behaviors in a sample of cocaine users (48% out of treatment and 52% just entering treatment). Associations were tested for sexually risky behaviors in addition to injection behaviors. The principle finding of this study is that ASPD was shown to be associated with increased rates of injection drug use and sharing syringes, with earlier age of onset of injection drug use, with certain venereal diseases, and with a variety of HIV risk sexual behaviors. When men and women were tested separately, the pattern of association of risky behaviors with ASPD varied considerably. Overall, this work confirms that psychiatric status, especially the presence of ASPD, may have to be considered in evaluating the results of HIV risk-reduction interventions.

Twenty-five year mortality of US servicemen deployed in Vietnam: predictive utility of early drug use.

Large numbers of young men were exposed to high-quality opiates for a relatively short time period during military service in Vietnam. This study examined the relationships of opiate and other drug abuse before, during, and shortly after their time of service in Vietnam with the subsequent 25-year mortality among the cohort of 1227 US Army enlisted returnees and their matched civilians previously studied in 1972 and 1974. Composite factor scores of a variety of drug use measures and other individual behavioral measures were selected separately for three time periods around service in Vietnam from over 120 measures associated with mortality. Results of path analytic models applied to selected significant measures showed that both in-Vietnam and post-Vietnam drug use factors were large and significant predictors of mortality, controlling for pre-service drug use, continuity to later drug use, and demographic and other behavioral measures. The magnitude of the direct effect of drug use on mortality was larger than those of the covariates that were entered in the path analyses, except age. Notwithstanding the high remission rate from opiate addiction, drug use in Vietnam had considerable predictive utility for premature death in this cohort. In light of the re-emergence of increased heroin use since the mid-1990s, the findings point to the importance of early intervention of drug use and comorbid problems for todays youth now initiating heroin use.

Substance abuse as a predictor of VA medical care utilization among vietnam veterans

The primary objective was to determine whether Vietnam veterans who had alcohol or drug use problems prior to, during, or immediately after the war used Veterans Administration (VA) health care services more intensively during the next two decades than Vietnam veterans without these behaviors. The secondary objective was to identify predictors of VA health services utilization among data collected at service discharge. Logistic and ordinary least squares regression were used to model the effect of predisposing, enabling, and need factors on utilization of VA health services (N=571). Results show that Vietnam veterans who had substance use problems either before or immediately after Vietnam used VA health care services more intensively during the next two decades than Vietnam veterans without these behaviors. Depression and psychiatric care seeking were also important predictors. More research is needed to evaluate the impact of health system characteristics and private sector use on the predictive ability of the models.

Substance Use and Dependence Among Native Hawaiians, Other Pacific Islanders, and Asian Ethnic Groups in the United States: Contrasting Multiple-Race and Single-Race Prevalence Rates From a National Survey

The percentage of multiracial youth appears to be increasing in the United States. However, little has been disseminated about problem behaviors among multiracial Native Hawaiians, Other Pacific Islanders, and Asians on a national level. Using the National Survey on Drug Use and Health, the authors compared multiple-race Native Hawaiians, Other Pacific Islanders, and Asians, while disaggregating by ethnic subgroups, with single-race individuals within respective Asian ethnic subgroups and Caucasians for prevalence of alcohol/drug use and dependence. For multiple-race Native Hawaiians, Other Pacific Islanders, and Asians, high rates of alcohol dependence were observed compared with both single-race Native Hawaiian, Other Pacific Islander, and Asian subgroups and single-race Caucasians; for some multiracial Native Hawaiians, Other Pacific Islanders, and Asians, high rates of drug dependence were also observed.

Conduct disorder among Asians and Native Hawaiian/Pacific Islanders in the USA.

BACKGROUND Conduct disorder (CD) is a relatively common disorder of childhood and adolescence in the USA with substantial associated morbidity, yet little has been published on CD among Asians and Native Hawaiian/Pacific Islanders (NH/PI) in the USA. METHOD We used the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to examine the prevalence and correlates of retrospectively reported CD within Asians and NH/PI (18 years and older). We also completed logistic regressions to explore factors associated with CD within Asians (n=1093) and, separately, NH/PI (n=139) and to explain racial differences in CD prevalence. RESULTS Asians were about a third as likely [odds ratio (OR) 0.4, 95% confidence interval (CI) 0.22-0.58] whereas NH/PI were about two and half times more likely (OR 2.6, 95% CI 1.31-5.06) to have had CD compared with Caucasian respondents. Within Asians and NH/PI, CD was strongly associated with adult antisocial behavior, substance use and affective disorders. Demographic factors, the age that subjects came to the USA, measures of family environment and family history could not explain the observed differences in prevalence of CD for NH/PI relative to Caucasians. CONCLUSIONS Asian and NH/PI youth with CD represent a subgroup of Asian youth at very high risk for a number of serious psychiatric disorders. Further investigation is needed to explain the high CD prevalence among NH/PI.

Assessment of a postdeployment Yellow Ribbon Reintegration Program for National Guard members and supporters.

The Yellow Ribbon Reintegration Program (YRRP) was created to meet the needs of National Guard members and their families throughout the deployment cycle. This study examined the perceived utility of the YRRPs delivery of information and assistance during the postdeployment reintegration period by National Guard members and accompanying supporters who were mostly spouses. Over 22 months, from 10 YRRP events, 683 service members and 411 supporters completed questionnaires immediately after the YRRP. We analyzed questions on information and avenues for help, timeliness and concerns related to education, employment, legal, family, and health. Service members and supporters most often endorsed information delivery on education being met (76.8% and 78.2%, respectively) and were least likely to endorse legal information delivery (63.5% and 60%, respectively). Significantly more supporters than service members (p < 0.0001) reported that the YRRP was the first time they learned of available services across all domains. Service members were significantly more likely than supporters to report concerns about education, employment, and health, while supporters were significantly more likely to report concerns about family. Results suggest the YRRP fills gaps in supporter knowledge and provides needed information and resources to most National Guard families 2 to 4 months after a deployment.