Course of alcohol problems in treated adolescents

Knowledge of the clinical course in treated adolescents is fundamental to determining the influence of treatment on long-term functioning and the factors associated with change in the severity of alcohol problems over time. This symposium, held at the 2002 annual Research Society on Alcoholism meeting and organized by Tammy Chung and Christopher S. Martin, presented research on the course of alcohol-related problems in treated adolescents who were followed prospectively for 1 to 8 years. Presentations included (1) Alcohol use outcomes at 1 year among adolescents in the drug abuse treatment outcomes studies (DATOS-A), by Christine E. Grella; (2) Pathways and predictors of the course of adolescent alcohol problems across 1- and 3-year follow-ups, by Tammy Chung; (3) Young adult outcomes of an adolescent clinical sample at 5-year follow-up, by Ken C. Winters; and (4) Trajectories of alcohol involvement following addiction treatment through 8-year follow-up in adolescents, by Ana M. Abrantes, Denis M. McCarthy, Gregory A. Aarons, and Sandra A. Brown. Sandra A. Brown, discussant, commented on the presentations. Results from these studies indicate multiple pathways of change, distinguished by fluctuations in the chronicity and severity of alcohol problems. Across studies, most adolescents showed reductions in alcohol use and problems after treatment, with concurrent improvements in psychosocial functioning. Findings highlight the influence of other drug use on posttreatment patterns of alcohol involvement and the need to consider the effect of normative developmental transitions on the course of adolescent-onset substance use disorders.     

Autistic Traits Moderate Reappraisal Success for Depression and Anxiety Symptoms

Journal of Autism and Developmental Disorders - Cognitive reappraisal is associated with reduced emotional distress; however, little is known about the nature of this relationship in autism. This...     

Linking Individuals with Substance Use Disorders (SUDs) in Primary Care to SUD Treatment: the Recovery Management Checkups–Primary Care (RMC-PC) Pilot Study

Linking individuals in primary care settings with substance use disorders (SUDs) to SUD treatment has proven to be challenging, despite the widespread use of Screening, Brief Intervention, and Referral to Treatment (SBIRT). This paper reports findings from a pilot study that examined the efficacy of the Recovery Management Checkups intervention adapted for primary care settings (RMC-PC), for assertively linking and engaging patients from Federally Qualified Health Centers into SUD treatment. Findings showed that patients in the RMC-PC (n=92) had significantly higher rates of SUD treatment entry and received more days of SUD treatment compared with those who receive the usual SBIRT referral (n=50). Receipt of RMC-PC had both direct and indirect effects, partially mediated through days of SUD treatment, on reducing days of drug use at 6 months post intake. RMC-PC is a promising intervention to address the need for more assertive methods for linking patients in primary care to SUD treatment.     

Discrimination and Substance Use Disorders Among Latinos: The Role of Gender,Nativity, and Ethnicity

Objectives. We examined the relationship between discrimination and substance use disorders among a diverse sample of Latinos. We also investigated whether the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity.Methods. Our analyses focused on 6294 Latinos who participated in the National Epidemiologic Survey on Alcohol and Related Conditions from 2004 to 2005. We used multinomial logistic regression to examine the association between discrimination and substance use disorders.Results. Discrimination was significantly associated with increased odds of alcohol and drug use disorders among Latinos. However, the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity. Discrimination was associated with increased odds of alcohol and drug use disorders for certain groups, such as women, US-born Latinos, and Mexicans, but this relationship did not follow the same pattern for other subgroups.Conclusions. It is important to determine which subgroups among Latinos may be particularly vulnerable to the negative effects of discrimination to address their needs.Latinos are the largest ethnic or racial minority group in the United States1 and the fastest growing group entering substance abuse treatment programs.2 Although Latinos are disproportionately affected by substance abuse,3 they have been understudied.4 Previous research shows that high levels of poverty, minority status, and residential concentration in areas with widespread drug and alcohol distribution have been considered to be factors that may put Latinos at risk for substance use disorders.5 More recently, discrimination has also been considered to be a risk factor.6,7 As studies aim toward filling the gap in the literature, the heterogeneity of Latinos must also be considered.Discrimination has been associated with alcohol and drug use8–13 and substance use disorders among Latinos.6,7 Stress-coping frameworks and the minority stress model have been applied to hypothesize that individuals belonging to various marginalized groups respond to experiences of discrimination with unhealthy coping behaviors, such as substance use.14,15 Moreover, discrimination may lead to underemployment, lower wages, and limited access to health services and other resources that can affect health outcomes.16 In this way, discrimination operates at both the interpersonal and institutional levels simultaneously to situate individuals on different health trajectories, fostering and reinforcing poor health behaviors and outcomes.16,17The association between discrimination and substance use has been previously documented for Latinos and other groups. However, reviews of the literature have called for more granular analysis of specific risk patterns. One specific area needing analysis is whether some subgroups of Latinos are at higher risk of substance use related to discrimination than others. The identification of subgroups is an important first step toward the development of targeted population-level approaches and tailored interventions.In the present study, we focused on subgroups based on gender, nativity, and ethnicity (country of origin or heritage country). These subgroups were based on ascribed characteristics that refer to immutable characteristics (vs achieved characteristics, such as education) that are given status value.18,19 The status value placed on these characteristics can drive discrimination; for example, when men are considered more valuable than women and when US-born individuals are considered more valuable than immigrants.18,19 At the same time, these characteristics (gender, nativity, and ethnicity) are also associated with substance use disorders.Gender differences in substance use disorders are not unique to Latinos. Across racial/ethnic groups, men consistently have higher prevalence of substance use disorders. Using data from the National Latino and Asian American Study, the lifetime prevalence of alcohol use disorders was 16.7% for Latino men and 4.3% for Latina women.20 Research also shows that Latino men generally reported higher levels of discrimination compared with Latina women.13,21 Data from the National Latino and Asian American Study showed that 39% of Latino men, compared with 29% of Latina women, reported discrimination.22 These authors suggested that these patterns might be the result of minority men being more exposed and vulnerable to racial bias from social institutions. These higher rates of substance use and discrimination among men also appeared to be jointly related. A recent study found that discrimination was associated with increased risk of drug abuse among Latino men, but not Latina women.6 This interaction might occur because of greater cultural acceptability among men overall to use substances to cope with stress compared with women. In contrast, women were found to rely on social support and to turn to food to cope with stress.23–25 Other specific factors, such as abuse history,26 were found to be more central in predicting risk of substance use disorders among Latina women. Thus, we expected that discrimination would have a stronger relationship with substance use disorders among Latino men than Latina women.Similar to health differences by gender, differences by nativity are not unique to Latinos. Overall, foreign-born individuals tend to be healthier than their US-born counterparts. Lifetime rates of substance use disorders were higher among US-born than foreign-born Latinos (19.6% vs 5.5%, respectively).20 Previous studies also found greater reporting of discrimination among US-born Latinos; 47% of US-born compared with 25% of foreign-born Latinos reported discrimination.22 However, discrimination might be more harmful to foreign-born Latinos because they are less likely to enjoy citizenship rights (e.g., voting privileges, access to educational scholarships) that might help temper some of the stressful effects of discrimination. From this perspective, we expected that discrimination would have a stronger relationship with substance use disorders among foreign-born than US-born Latinos.Finally, it is also important to consider ethnicity. There is some indication of variation in rates of substance use across these groups. Cubans were found to have lower odds of substance use disorders compared with Puerto Ricans.27 In addition, there was good evidence for variation in reporting of discrimination.28 For example, 40% of Puerto Ricans reported discrimination compared with 34% of Mexicans and 16% of Cubans.22 This variation might be attributed to gradations based on socioeconomic resources that differ by Latino ethnicity.29 Gradations based on socioeconomic resources could dictate the risks and resources individuals have exposure and access to, affecting coping mechanisms. Thus, we expected the relationship between discrimination and substance use disorders to vary by ethnicity as well.In sum, based on this literature, we hypothesized that discrimination would be associated with increased risk of substance use disorders among Latinos overall, and that the relationship between discrimination and substance use disorders would vary by ascribed characteristics. Specifically, we theorized that the relationship between discrimination and substance use disorders would be stronger among men compared with women, among foreign-born Latinos compared with US-born Latinos, and among Mexicans and Puerto Ricans compared with Cubans.     

Hepatitis C virus, hepatitis B virus and human immunodeficiency virus infection in pregnant women in North-East Italy: A seroepidemiological study

Background: Pregnant women can be considered a sentinel population, because they are a relatively unselected population whose prevalence data may be extended to the general population. Methods: A seroepidemiological study was carried out in Padua (North-East Italy) to assess the epidemiological aspects of HCV, HBV and HIV infection in 2059 pregnant women consecutively seen at the Department of Obstetrics and Gynaecology during 1996. Out of them, 1804 (87.2%) were indigenous and 255 (12.8%) immigrants. Sociodemographical and sanitary data were collected for each woman. Results: The overall prevalence of anti-HCV was 1.9% (42.5% with detectable HCV-RNA); HBsAg was found in 1.0%; the prevalence of anti-HIV was 0.3%. Findings are substantially consistent with the epidemiological picture of such infections in the general population of our geographic area. A parenteral risk factor for HCV infection was found in 19 subjects (47.5%): 18 were intravenous drug users and 1 a blood transfusion recipient. HBsAg seroprevalence was higher in immigrants than in autochthonous (3.1% vs. 0.7% respectively, p < 0.01). One of the 6 anti-HIV positive women was intravenous drug user. Logistic regression analysis was carried out for each viral agent to determine which characteristics were independently associated with infection: anti-HCV prevalence resulted independently associated to Italian origin (OR: 3.7), unmarried status (OR: 2.7), unemployed condition (OR: 6.1) and history of previous abortion (OR: 2.8). HBsAg prevalence was independently associated to unemployed condition (OR: 10.8), whereas HIV positivity was significantly related to the unmarried status (OR: 18.5). Conclusion: Our study pinpoints the need of screening all pregnant women for HCV and HIV infection, in addition to the HBsAg screening which is compulsory in Italy.     

Adipose tissue development “in Utero”

Summary Some metabolic and hormonal variables, thought to affect adipose tissue development in utero were studied in a group of 50 presumably healthy mothers and in their full-term infants. No sex-related differences were observed at birth in skinfold thickness, body fat mass, fat cell volume or fat cell number. Body fat mass in newborns was significantly correlated to fat cell size (r=0.75; p< 0.001), but not to fat cell number. Weight gain during pregnancy but not prepregnancy weight was correlated to fat cell volume in the newborn (r=0.67; p<0.001) and to body fat mass (r=0.66; p< 0.001). Maternal placental lactogen levels correlated to decreased glucose tolerance in the mothers (r= 0.62; p<0.001), as well as to body fat mass (r= 0.61; p<0.001) and fat cell size (r=0.58; p< 0.001) in newborns. Neonatal plasma insulin levels in addition correlated with body fat mass (r=0.39; p< 0.05) and fat cell weight (r=0.69; p<0.001) of the neonate. Placental NEFA transfer could be demonstrated, but there was no correlation between maternal plasma NEFA levels and neonatal body fat mass or fat cell weight. Similarly, maternal insulin and growth hormone levels were not correlated with neonatal body fat mass or with fat cell size or number. Thus the nutritional and hormonal factors considered do not appear to be involved in fat cell multiplication. During intrauterine life, in full-term infants of presumably healthy mothers, fat mass expansion seems to occur almost exclusively by means of fat cell hypertrophy.