Underneath the influence
Patrick Seffrin
Sociological Quarterly, Autumn 2012, Pages 610-635
Abstract:
Black adolescents use less alcohol, on average, than white adolescents. Prior research has struggled to explain the disparity in alcohol use between blacks and whites but not for a lack of potential mediating mechanisms. The current study draws on differential association theory and two waves of panel data (n = 1,016) to examine the influence of interracial friendship, the racial composition of peer groups, and communities on black-white differences in alcohol use. Findings indicate that (1) the racial composition of peer groups and communities influence changes in alcohol use, and (2) racial segregation contributes to racial disparities in alcohol use while interracial friendship reduces these disparities. Results suggest that the socially conservative values of the African-American community are a strong deterrent to adolescent drinking, affecting even those adolescents who are themselves white but associate with black youth.
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A comparative analysis of infractions in Texas alcohol establishments and adult entertainment clubs
James Jarrett et al.
Criminal Justice Studies, forthcoming
Abstract:
A crucial yet disputed element in the attempt to regulate sexually oriented businesses has been the negative secondary effects these firms have on nearby businesses and residential communities. This paper addresses a new dimension of the negative effects from such businesses by examining data on administrative and criminal infractions inside a large number of sexually oriented businesses and a comparable group of alcohol establishments. We compare administrative and criminal violations data from the Texas Alcohol Beverage Commission for all adult entertainment clubs (AECs) serving alcohol against a randomly selected sample of bars in the State of Texas. We find that there are important differences between the clubs and bars in 10 of the 23 t-test comparisons. What is more, even though alcohol-related infractions are the most common type of infraction for both AECs and for bars, the number of sex- and drug-related offenses was consistently more prevalent for sexually oriented businesses than for bars. In contrast, the bars have much higher numbers of criminal violations, primarily because of the higher incidence of infractions involving minors. This paper contributes to the literature on negative primary and secondary effects of sexually oriented businesses.
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Coping with racial discrimination: The role of substance use
Meg Gerrard et al.
Psychology of Addictive Behaviors, September 2012, Pages 550-560
Abstract:
Three studies tested the hypothesis that the relation between perceived racial discrimination and substance use reported in previous research is moderated by use of substances as a coping mechanism. Studies 1 and 2 were experimental studies of African American adolescents' and young adults' reactions to a discrimination experience. Results revealed that those who endorsed substance use-as-coping reported more willingness to use substances after experiencing discrimination. Study 3 was a prospective study of the relation between perceived discrimination and substance use over an 8-year period in African American adolescents. Results demonstrated that discrimination is associated with increases in substance use, but only among adolescents who endorse substance use-as-coping. Together, these three studies provide evidence that experiencing discrimination has both short- and long-term detrimental effects on African Americans' substance use, but significantly more so for those who adopt a pattern of using substances as a coping mechanism.
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Glass Shape Influences Consumption Rate for Alcoholic Beverages
Angela Attwood et al.
PLoS ONE, August 2012
Background: High levels of alcohol consumption and increases in heavy episodic drinking (binge drinking) are a growing public concern, due to their association with increased risk of personal and societal harm. Alcohol consumption has been shown to be sensitive to factors such as price and availability. The aim of this study was to explore the influence of glass shape on the rate of consumption of alcoholic and non-alcoholic beverages.
Methods: This was an experimental design with beverage (lager, soft drink), glass (straight, curved) and quantity (6 fl oz, 12 fl oz) as between-subjects factors. Social male and female alcohol consumers (n = 159) attended two experimental sessions, and were randomised to drink either lager or a soft drink from either a curved or straight-sided glass, and complete a computerised task identifying perceived midpoint of the two glasses (order counterbalanced). Ethical approval was granted by the Faculty of Science Research Ethics Committee at the University of Bristol. The primary outcome measures were total drinking time of an alcoholic or non-alcoholic beverage, and perceptual judgement of the half-way point of a straight and curved glass.
Results: Participants were 60% slower to consume an alcoholic beverage from a straight glass compared to a curved glass. This effect was only observed for a full glass and not a half-full glass, and was not observed for a non-alcoholic beverage. Participants also misjudged the half-way point of a curved glass to a greater degree than that of a straight glass, and there was a trend towards a positive association between the degree of error and total drinking time.
Conclusions: Glass shape appears to influence the rate of drinking of alcoholic beverages. This may represent a modifiable target for public health interventions.
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Smoking Initiation and the Iron Law of Demand
Dean Lillard, Eamon Molloy & Andrew Sfekas
Journal of Health Economics, forthcoming
Abstract:
We show, with three longitudinal datasets, that cigarette taxes and prices affect smoking initiation decisions. Evidence from longitudinal studies is mixed but generally find that initiation does not vary with price or tax. We show that the lack of statistical significance partly results because of limited policy variation in the time periods studied, truncated behavioral windows, or mis-assignment of price and tax rates in retrospective data (which occurs when one has no information about respondents' prior state or region of residence). Our findings highlight issues relevant to initiation behavior generally, particularly those for which individuals' responses to policy changes may be noisy or small in magnitude.
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Kevin Callison & Robert Kaestner
NBER Working Paper, August 2012
Abstract:
There is a general consensus among policymakers that raising tobacco taxes reduces cigarette consumption. However, evidence that tobacco taxes reduce adult smoking is relatively sparse. In this paper, we extend the literature in two ways: using data from the Current Population Survey Tobacco Use Supplements we focus on recent, large tax changes, which provide the best opportunity to empirically observe a response in cigarette consumption, and employ a novel paired difference-in-differences technique to estimate the association between tax increases and cigarette consumption. Estimates indicate that, for adults, the association between cigarette taxes and either smoking participation or smoking intensity is negative, small and not usually statistically significant. Our evidence suggests that increases in cigarette taxes are associated with small decreases in cigarette consumption and that it will take sizable tax increases, on the order of 100%, to decrease adult smoking by as much as 5%.
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Lauren Porter
Law & Social Inquiry, forthcoming
Abstract:
Largely absent from US criminal sentencing since the early 1800s, shame penalties have been staging a comeback. This revival has been met by a number of debates among legal scholars, one of which centers on the potential for such penalties to reduce crime. This study addresses this debate by investigating the impact of formal shaming on drunk driving and alcohol-related traffic safety in Ohio. In accordance with the Traffic Law Reform Act of 2004, judges have since been mandated to issue "restricted plates" to certain first-time and all repeat DUI offenders with limited driving privileges. Results indicate a curvilinear association between punishment levels and drunk driving. Increases in the certainty and visibility of plates are associated with decreases in suspension rates, but there is a point at which increasing the punishment level no longer retains its intended impact. In addition, levels of punishment are unrelated to alcohol-related traffic safety.
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Ceren Ertan Yörük & Barış Yörük
Social Science & Medicine, November 2012, Pages 1844-1854
Abstract:
In this paper, we investigate the relationship between alcohol consumption and psychological well-being among young adults in the United States. We do so by exploiting the discontinuity in alcohol consumption at age 21 and using a regression discontinuity design. Using data from the National Longitudinal Survey of Youth (1997 Cohort), we document that young adults tend to increase their alcohol consumption and drink on average 1.5 days per month more once they are granted legal access to alcohol at age 21. However, we also show that in general, this discrete jump in alcohol consumption at age 21 has no statistically significant impact on several indicators of psychological well-being among young adults. This result suggests that although stricter alcohol control targeted toward young adults may result in meaningful reductions in alcohol consumption, the immediate spillover effects of such policies on psychological well-being are relatively limited.
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Alcohol, Antitrust, and the 21st Amendment: An Empirical Examination of Post and Hold Laws
James Cooper & Joshua Wright
International Review of Law and Economics, forthcoming
Abstract:
The Twenty-first Amendment repealed prohibition, but granted the states broad power to regulate the distribution and sale of alcohol to consumers within their borders. Pursuant to this authority, states have established a complex web of regulations that limit the ability of beer, wine, and liquor producers to control the distribution of their product. From a consumer welfare perspective, one of the most potentially harmful state alcohol distribution regulations are "post and hold" laws ("PH laws"). PH laws require that alcohol distributors share future prices with rivals by "posting" them in advance, and then "hold" these prices for a specified period of time. Economic theory would suggest that PH laws reduce unilateral incentives for distributors to reduce prices and may facilitate tacit or explicit collusion, both to the detriment of consumers. Consistent with economic theory, we show that the PH laws reduce consumption by 2-8 percent. We also test whether, by reducing consumption, PH laws provide offsetting societal benefits in the form of reducing drunk driving accidents and underage drinking. We find no measurable relationship between PH laws and these social harms. These results suggest a socially beneficial role for antitrust challenges to PH laws and similar anticompetitive state regulation. If states wish to reduce the social ills associated with drinking, our results also suggest that directly targeting social harms with zero tolerance laws and lower drunk driving thresholds are superior policy instruments to PH laws.
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Unmet need for treatment for substance use disorders across race and ethnicity
Norah Mulvaney-Day et al.
Drug and Alcohol Dependence, September 2012, Pages S44-S50
Background: The objective was to analyze disparities in unmet need for substance use treatment and to observe variation across different definitions of need for treatment.
Methods: Data were analyzed from the 2002 to 2005 National Survey of Drug Use and Health and the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regressions estimated the likelihood of specialty substance use treatment across the two data sets. Parallel variables for specialty, informal and any substance abuse treatment were created. Perceived need and normative need for substance use treatment were defined, with normative need stratified across lifetime disorder, past twelve month disorder, and heavy alcohol/any illicit drug use. Treatment rates were analyzed, comparing Blacks, Asians and Latinos to non-Latino whites across need definitions, and adjusting for age, sex, household income, marital status, education and insurance.
Results: Asians with past year substance use disorder had a higher likelihood of unmet need for specialty treatment than whites. Blacks with past year disorder and with heavy drinking/illicit drug use had significantly lower likelihood of unmet need. Latinos with past year disorder had a higher likelihood of unmet need for specialty substance abuse treatment. Asians with heavy drinking/illicit drug use had lower likelihood of unmet need.
Conclusions: The findings suggest that pathways to substance abuse treatment differ across groups. Given high rates of unmet need, a broad approach to defining need for treatment is warranted. Future research to disentangle social and systemic factors from factors based on diagnostic criteria is necessary in the identification of need for treatment.
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Kim Donoghue & Gillian Doody
Neuropsychology, forthcoming
Objective: Impairment in cognitive function is a core feature of schizophrenia and other psychoses. Substance misuse is associated with impairment in cognitive function in the healthy population. Due to the high prevalence of substance misuse in those with a psychotic disorder, there is concern that a "double deficit" may result in this population. The aim of the current systematic review was to give an overview of the literature, to date, that has investigated the effect of illegal substance abuse or dependence on cognitive function in those with a psychotic disorder and to evaluate the differences and limitations in the methodologies used.
Method: A systematic review and evaluation of the current literature comparing those with a diagnosis of a psychotic disorder with and without a history of substance abuse or dependence was conducted. A meta-analysis was also conducted to quantitatively assess the association between substance use and cognitive function in those with a psychotic disorder.
Results: The current literature investigating the impact of substance misuse on cognitive function in those with a psychotic disorder suffers from many methodological limitations. The results of the meta-analysis show that substance users performed significantly better than nonusers in the cognitive domains of attention and psychomotor speed and verbal memory, with no "double deficit" apparent.
Conclusions: The results of this meta-analysis should be interpreted with caution, in light of the methodological difficulties reviewed.
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Alcohol Peer Influence of Participating in Organized School Activities: A Network Approach
Kayo Fujimoto & Thomas Valente
Health Psychology, forthcoming
Objective: This study compares the network influences on adolescent substance use from peers who coparticipated in school-sponsored organized activities (affiliation-based peer influence) with the influence both from their "nominated" friends (i.e., the adolescent named the alter as a friend), and only "reciprocated" friends (i.e., both adolescents mutually named each other as friends). The study also attempts to parse affiliation-based peer influence into the influence of both activity members who are also friends and those who are not, to address the potential confounding of these sources of peer influence.
Methods: The study data consisted of a nationally representative sample of 12,551 adolescents in Grades 7-12 within 106 schools from the Add Health data. Ordinal logistic regression was conducted to estimate the effects of affiliation-based and friends influence on alcohol use and drinking frequency.
Results: Peer influence via organized activities (sports or clubs) with drinkers and the influence of friends who drink had significant effects on adolescent drinking. Peer influence through club activities with drinkers had a stronger effect on any drinking behavior than through sports activities with drinkers. After decomposing peer influence through activities by friendship status, influence through sport activities had a significant effect on drinking only when coparticipant drinkers were also reciprocated friends (but not nominated friends), whereas influence through club activities had a significant effect on drinking, regardless of friendship reciprocation.
Conclusions: The design and implementation of school based substance use prevention and treatment programs should consider the contextual effects of school-sponsored activities.
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Kelly Young-Wolff et al.
Drug and Alcohol Dependence, forthcoming
Background: Smoke-free legislation prohibiting smoking in indoor public venues, including bars and restaurants, is an effective means of reducing tobacco use and tobacco-related disease. Given the high comorbidity between heavy drinking and smoking, it is possible that the public health benefits of smoke-free policies extend to drinking behaviors. However, no prior study has examined whether tobacco legislation impacts the likelihood of alcohol use disorders (AUDs) over time. The current study addresses this gap in the literature using a large, prospective U.S. sample.
Method: Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we utilized logistic regression to examine whether the implementation of state-wide smoke-free legislation in bars and restaurants between Waves I (2001-2002) and II (2004-2005) predicted changes in DSM-IV AUD status (remission, onset, recurrence) in current drinkers at Wave I (n = 19,763) and participants who drank in public ≥once per month (n = 5913).
Results: Individuals in states that implemented smoke-free legislation in drinking venues had a higher likelihood of AUD remission compared to participants in states without such legislation. Among public drinkers, smoke-free legislation was associated with a greater likelihood of AUD remission and a lower likelihood of AUD onset. These findings were especially pronounced among smokers, men, and younger age groups.
Discussion: These results demonstrated the protective effects of smoke-free bar and restaurant policies on the likelihood of AUDs; furthermore, these findings call attention to an innovative legislative approach to decrease the morbidity and mortality associated with AUDs.
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Persistent cannabis users show neuropsychological decline from childhood to midlife
Madeline Meier et al.
Proceedings of the National Academy of Sciences, forthcoming
Abstract:
Recent reports show that fewer adolescents believe that regular cannabis use is harmful to health. Concomitantly, adolescents are initiating cannabis use at younger ages, and more adolescents are using cannabis on a daily basis. The purpose of the present study was to test the association between persistent cannabis use and neuropsychological decline and determine whether decline is concentrated among adolescent-onset cannabis users. Participants were members of the Dunedin Study, a prospective study of a birth cohort of 1,037 individuals followed from birth (1972/1973) to age 38 y. Cannabis use was ascertained in interviews at ages 18, 21, 26, 32, and 38 y. Neuropsychological testing was conducted at age 13 y, before initiation of cannabis use, and again at age 38 y, after a pattern of persistent cannabis use had developed. Persistent cannabis use was associated with neuropsychological decline broadly across domains of functioning, even after controlling for years of education. Informants also reported noticing more cognitive problems for persistent cannabis users. Impairment was concentrated among adolescent-onset cannabis users, with more persistent use associated with greater decline. Further, cessation of cannabis use did not fully restore neuropsychological functioning among adolescent-onset cannabis users. Findings are suggestive of a neurotoxic effect of cannabis on the adolescent brain and highlight the importance of prevention and policy efforts targeting adolescents.
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Chronic alcohol remodels prefrontal neurons and disrupts NMDAR-mediated fear extinction encoding
Andrew Holmes et al.
Nature Neuroscience, forthcoming
Abstract:
Alcoholism is frequently co-morbid with post-traumatic stress disorder, but it is unclear how alcohol affects the neural circuits mediating recovery from trauma. We found that chronic intermittent ethanol (CIE) impaired fear extinction and remodeled the dendritic arbor of medial prefrontal cortical (mPFC) neurons in mice. CIE impaired extinction encoding by infralimbic mPFC neurons in vivo and functionally downregulated burst-mediating NMDA GluN1 receptors. These findings suggest that alcohol may increase risk for trauma-related anxiety disorders by disrupting mPFC-mediated extinction of fear.
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Sara Hitchman et al.
European Journal of Public Health, October 2012, Pages 693-699
Background: The European Commission requires tobacco products sold in the European Union to display standardized text health warnings. This article examines the effectiveness of the text health warnings among daily cigarette smokers in four Member States.
Methods: Data were drawn from nationally representative samples of smokers from the International Tobacco Control Policy Evaluation Project surveys in France (2007), Germany (2007), the Netherlands (2008) and the UK (2006). We examined: (i) smokers' ratings of the health warnings on warning salience, thoughts of harm and quitting and forgoing of cigarettes; (ii) impact of the warnings using a Labels Impact Index (LII), with higher scores signifying greater impact; and (iii) differences on the LII by demographic characteristics and smoking behaviour.
Results: Scores on the LII differed significantly across countries. Scores were highest in France, lower in the UK, and lowest in Germany and the Netherlands. Across all countries, scores were significantly higher among low-income smokers, smokers who had made a quit attempt in the past year and smokers who smoked fewer cigarettes per day.
Conclusion: The impact of the health warnings varies greatly across countries. Impact tended to be highest in countries with more comprehensive tobacco control programmes. Because the impact of the warnings was highest among smokers with the lowest socioeconomic status (SES), this research suggests that health warnings could be more effective among smokers from lower SES groups. Differences in warning label impact by SES should be further investigated.
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Ahmad Reza Hosseinpoor et al.
PLoS ONE, August 2012
Objectives: To assess the magnitude and pattern of socioeconomic inequality in current smoking in low and middle income countries.
Methods: We used data from the World Health Survey [WHS] in 48 low-income and middle-income countries to estimate the crude prevalence of current smoking according to household wealth quintile. A Poisson regression model with a robust variance was used to generate the Relative Index of Inequality [RII] according to wealth within each of the countries studied.
Results: In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Socioeconomic inequality in women was more varied showing patterns of both pro-rich and pro-poor inequality. In 20 countries pro-rich relative socioeconomic inequality was statistically significant: the poorest women had a higher prevalence of smoking compared to the richest women. Conversely, in 9 countries women in the richest population groups had a statistically significant greater risk of smoking compared to the poorest groups.
Conclusion: Both the pattern and magnitude of relative inequality may vary greatly between countries. Prevention measures should address the specific pattern of smoking inequality observed within a population.
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Jennifer Cruz, Robert Emery & Eric Turkheimer
Developmental Psychology, September 2012, Pages 1390-1402
Abstract:
Research consistently links adolescents' and young adults' drinking with their peers' alcohol intake. In interpreting this correlation, 2 essential questions are often overlooked. First, which peers are more important, best friends or broader social networks? Second, do peers cause increased drinking, or do young people select friends whose drinking habits match their own? The present study combines social network analyses with family (twin and sibling) designs to answer these questions via data from the National Longitudinal Study of Adolescent Health. Analysis of peer nomination data from 134 schools (n = 82,629) and 1,846 twin and sibling pairs shows that peer network substance use predicts changes in drinking from adolescence into young adult life even after controlling for genetic and shared environmental selection, as well as best friend substance use. This effect was particularly strong for high-intensity friendships. Although the peer-adolescent drinking correlation is partially explained by selection, the present finding offers powerful evidence that peers also cause increased drinking.
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Russell Callaghan et al.
Drug and Alcohol Dependence, 1 October 2012, Pages 290-294
Background: Understanding the mortality rate of methamphetamine users, especially in relation to other drug users, is a core component of any evaluation of methamphetamine-related harms. Although methamphetamine abuse has had a major impact on United States (US) drug policy and substance-abuse treatment utilization, large-scale cohort studies assessing methamphetamine-related mortality are lacking.
Methods: The current study identified cohorts of individuals hospitalized in California from 1990 to 2005 with ICD-9 diagnoses of methamphetamine- (n = 74,139), alcohol- (n = 582,771), opioid- (n = 67,104), cannabis- (n = 46,548), or cocaine-related disorders (n = 48,927), and these groups were followed for up to 16 years. Age-, sex-, and race-adjusted standardized mortality rates (SMRs) were generated.
Results: The methamphetamine cohort had a higher SMR (4.67, 95% CI 4.53, 4.82) than did users of cocaine (2.96, 95% CI 2.87, 3.05), alcohol (3.83, 95% CI 3.81, 3.85), and cannabis (3.85, 95% CI 3.67, 4.03), but lower than opioid users (5.71, 95% CI 5.60, 5.81).
Conclusions: Our study demonstrates that individuals with methamphetamine-use disorders have a higher mortality risk than those with diagnoses related to cannabis, cocaine, or alcohol, but lower mortality risk than persons with opioid-related disorders. Given the lack of long-term cohort studies of mortality risk among individuals with methamphetamine-related disorders, as well as among those with cocaine- or cannabis-related conditions, the current study provides important information for the assessment of the comparative drug-related burden associated with methamphetamine use.
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Joris Van Hoof et al.
European Journal of Public Health, October 2012, Pages 737-742
Purpose: In this study, we investigated the effects and handling of an intervention to increase compliance with age limits regarding alcohol sales. The intervention tested in this field experiment was a feedback letter sent to alcohol outlets about their individual compliance results based on a mystery shopping study.
Method: We measured compliance in 146 alcohol outlets (cafeterias, supermarkets, bars, liquor stores and youth centres) in one region in the Netherlands with 15-year-old mystery shoppers. About half (n = 72) of the outlets received the intervention letter (the experimental group). After this intervention, we measured compliance again (n = 138). Then we sent the same letter to the control group and interviewed all the outlets regarding their handling of the intervention (n = 106).
Results: After the experimental group received the letter, compliance increased significantly (from 18.1% to 32.4%). In the control group, compliance did not change. Of the outlets interviewed, 81% stated that they had received the letter, and the action most commonly taken was to bring the letter to the attention of their staff.
Conclusions: Positive feedback letters are more often copied and shared integrally with personnel, compared with negative letters. Compliance with respect to underage alcohol sales can be improved, although compliance levels remain low in the Netherlands.
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Kristine Molina, Margarita Alegría & Chih-Nan Chen
Drug and Alcohol Dependence, September 2012, Pages S35-S43
Background: There is evidence that ethnic/racial minorities are conferred differential risk for substance use problems based on where they live. Despite a burgeoning of research focusing on the role of neighborhood characteristics on health, limited findings are available on substance use. Our study uses nationally representative data (N = 13,837) to examine: (1) what neighborhood characteristics are associated with risk of substance use disorders?; (2) do the associations between neighborhood characteristics and substance use disorders remain after adjusting for individual-level factors?; and (3) do neighborhood characteristics associated with substance use disorders differ by race/ethnicity after adjusting for individual-level factors?
Methods: Data were drawn from the Collaborative Psychiatric Epidemiology Studies (CPES-Geocode file) with 836 census tracts. Analyses included African Americans, Asians, Caribbean Blacks, Latinos, and non-Latino whites. Separate logistic regression models were fitted for any past-year substance use disorder, alcohol use disorder, and drug use disorder.
Results: Living in more affluent and residentially unstable census tracts was associated with decreased risk of past-year substance use disorder, even after adjusting for individual-level factors. However, when we investigated the interaction of race/ethnicity and census latent factors with past-year substance use disorders, we found different associations for the different racial/ethnic groups. We also found different associations between neighborhood affluence, residential instability and any past-year substance use and alcohol disorders by nativity.
Conclusions: Characteristics of the environment might represent differential risk for substance disorders depending on a person's ethnicity/race and nativity status.
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Prenatal Cigarette Smoking: Long-term Effects on Young Adult Behavior Problems and Smoking Behavior
Marie Cornelius, Lidush Goldschmidt & Nancy Day
Neurotoxicology and Teratology, forthcoming
Abstract:
We examined the long-term effects of prenatal cigarette smoke exposure (PCSE) on the behavior problems and smoking behavior of 22-year-old offspring. The mothers of these offspring were interviewed about their tobacco and other drug use during pregnancy at the fourth and seventh gestational months, and at delivery. Data on the offspring are from interviews at age 22 (n = 608). Behavior problems were measured by the Adult Self-Report (ASR) with the following outcome scales: total behavior problems, externalizing, internalizing, attention, anxiety/depression, withdrawn, thought, intrusive, aggression, somatic and rule breaking behavioral problems. Young adult smoking behavior was measured using self-reported average daily cigarettes, and was validated with urine cotinine. Nicotine dependence was measured with the Fagerström Tobacco and Nicotine Dependence (FTND) scale. Regression analyses tested the relations between trimester-specific PCSE and young adult's behavioral problems and smoking behavior, adjusting for demographic and maternal psychological characteristics, and other prenatal substance exposures. Exposed young adults had significantly higher scores on the externalizing, internalizing, aggression, and somatic scales of the ASR. These young adults were also more likely to have a history of arrests. Young adults with PCSE also had a higher rate of smoking and nicotine dependence. Our previous findings of the relations between PCSE and aggressive behavior in early childhood and PCSE and smoking behavior in early adolescence extend into young adulthood.