Origins and Pathways to Drug Abuse

Research Findings from May, 2000 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the origins and pathways to drug abuse. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Functional Deficits in Basal Ganglia of Children with ADHD

Drs. Perry Renshaw and Martin Teicher of Harvard Medical School employed a novel fMRI procedure, T2 relaxometry, to measure steady state blood flow and indirectly assess blood volume in the striatum (caudate and putamen) and to test for medication effects in boys (6-12 years old) with attention deficit/hyperactivity disorder (ADHD). Boys with ADHD had higher T2 relaxation time measures in the putamen bilaterally than healthy control subjects. These relaxation times strongly correlated with the child's capacity to sit still and with his accuracy in accomplishing an attention task. Daily treatment with methylphenidate significantly changed the T2 relaxation times in the putamen of children with ADHD, although the magnitude and direction of the effect was strongly dependent on the child's un-medicated activity state. These results show that methylphenidate exerted different effects on the putamen--presumably increasing perfusion in the more hyperactive children but decreasing it in ADHD children with normal activity. Behavioral results indicated that methylphenidate substantially decreased the activity of ADHD children who were objectively hyperactive, but exerted little effect on ADHD children not objectively hyperactive. Importantly, these results demonstrate that methylphenidate can exert differential effects that may vary with the biological/behavioral state of the subject and that ADHD symptoms may be closely associated with the functional abnormalities in the putamen, which is a structure mainly involved in the regulation of motor behavior. Anderson, C.M., et al., Functional Deficits in Basal Ganglia of Children with Attention-Deficit/Hyperactivity Disorder Shown with Functional Magnetic Resonance Imaging Relaxometry. Nature Medicine, 6(4), pp. 470 - 473, 2000.

Mendelian Genetic Model for Smoking Behavior Supported in an Analysis of Three Generation Families

Dr. Gary Swan of SRI International conducted complex segregation analysis in three generation-families to determine the best model for transmission of smoking behavior. This is the first study to date to use three generations for this determination. It was found that the best-fitting model was that of a dominant major gene with low estimated frequency and residual familial correlations. These correlations demonstrate strong influence of mothers (negative) and spouses (positive) toward smoking behavior. However, it should be noted that the sample was selected from those participating in a longitudinal study of aging and health and not selected for smoking behavior per se. Therefore, it is presumed that these results underestimate genetic transmission because heavy-smoking individuals are less likely to volunteer for the study, and many more smokers in the registry may have already died. Nevertheless, these results encourage future linkage studies. Cheng, L.S., Swan, G.E., and Carmelli, D.A. Genetic Analysis of Smoking Behavior in Family Members of Older Adult Males. Addiction, 95(3), pp. 427-435, March 2000.

The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence

This study, guided by the social development model, examined the dynamic patterns and predictors of alcohol and marijuana use onset. Survival analysis and complementary log-log regression were used to model hazard rates and etiology of initiation with time-varying covariates. The sample was derived from a longitudinal study of 808 youth interviewed annually from 10 to 16 years of age and at 18 years of age. Alcohol initiation rose steeply up to the age of 13 years and then increased more gradually; most participants had initiated by 13 years of age. Marijuana initiation showed a different pattern, with more participants initiating after the age of 13 years. This study showed that: (1) the risk of initiation spans the entire course of adolescent development; (2) young people exposed to others who use substances are at higher risk for early initiation; (3) proactive parents can help delay initiation; and (4) clear family standards and proactive family management are important in delaying alcohol and marijuana use, regardless of how closely bonded a child is to his or her mother. Kosterman, R., Hawkins, J.D., Guo, J., Catalano, R.F., and Abbott, R.D. The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence. American Journal of Public Health, 90(3), pp. 360-366, 2000.

Developmental Associations between Substance Use and Violence

In a study of the developmental associations between substance use and violence, investigators focused on the trends in each behavior throughout adolescence, how the behaviors covaried over time, and the symmetry of associations taking into account frequency and severity of each behavior. They also examined whether changes in one behavior affected changes in the other behavior over time. Six years of annual data were analyzed for 506 boys who were in the 7th grade at the first assessment. Concurrent associations between frequency of substance use and violence were relatively strong throughout adolescence and were somewhat stronger for marijuana than alcohol, especially in early adolescence. Type or severity of violence was not related to concurrent alcohol or marijuana frequency, but severity of drug use was related to concurrent violence frequency. Depending, to some degree, on the age of the subjects, the longitudinal relationships between substance use and violence were reciprocal during adolescence and slightly stronger for alcohol and violence than for marijuana and violence. Further, increases in alcohol use were related to increases in violence; however, when early alcohol use was controlled, increases in marijuana use were not related to increases in violence. Only in early adolescence was the longitudinal relationship between marijuana use and later violence especially strong. The strength of the longitudinal associations between violence and substance use did not change when common risk factors for violence and substance use were controlled. Overall, the data lend more support for a reciprocal than for a unidirectional association between substance use and violence. Prevention efforts should be directed at aggressive males who are multiple-substance users in early adolescence. White, H.R., Loeber, R., Stouthamer-Loeber, M., Farrington, D.P. Developmental Associations between Substance Use and Violence. Development and Psychopathology, 11(4), pp. 785-803, 1999.

Tobacco Smoking and Other Suspected Antecedents of Nonmedical Psychostimulant Use in the United States, 1995

This study investigates the extent to which tobacco smoking is associated with the nonmedical use of psychostimulants and the temporal order of the age of first use for tobacco and psychostimulants within a nationally representative sample of United States household residents. At the same time, alcohol use and other suspected determinants of psychostimulant use are investigated and held constant, using multiple regression models. Data were taken from public use files of the 1995 National Household Survey on Drug Abuse. Conditional logistic regression analyses were performed to derive estimated relative odds of using stimulants for tobacco smokers versus nonsmokers, holding constant other potentially distorting influences. The study found an independent association between tobacco smoking and nonmedical use of stimulant drugs, with and without adjustment for suspected confounding variables. Additional variables identified as being associated with lifetime stimulant use included lifetime alcohol use, being male, being 18-24 years of age, and not being married. This study provides recent evidence on tobacco smoking as one of the potentially malleable risk factors for the nonmedical use of stimulant drugs. Wu, L.T. and Anthony, J.C. Tobacco Smoking and Other Suspected Antecedents of Nonmedical Psychostimulant Use in the United States, 1995. Substance Use & Misuse, 34(9), pp. 1243-1259, 1999.

Male Twin Study of Substance Use and Disorders

This study used data from personal interviews of 1198 male-male twin pairs from a population-based registry to investigate sources of individual differences in risk. Models were fit to the data to assess the relative contributions of genetic and familial-environmental factors to use, heavy use, abuse and dependence of several categories of substances. Findings suggest that the use of any drug, cannabis and hallucinogens are influenced by both genetic and environmental factors, while twin resemblance for use of sedatives, stimulants, cocaine, and opiates, and heavy use, abuse, and dependence of most substances, resulted from only genetic factors. Heritability of risk ranged between 60 and 80 percent. A number of potential limitations and biases were considered and discussed. This study adds importantly to the growing body of data supporting genetic factors as powerful predictors of drug use disorder liability, and has important implications for prevention and treatment. Kendler, K.S., Karkowski, L.M., Neale, M.C., and Prescott, C.A. Illicit Psychoactive Substance Use, Heavy Use, Abuse, and Dependence in a US Population-Based Sample of Male Twins. Archives of General Psychiatry, 57, pp. 261-269, 2000.

Childhood Peer Rejection and Aggression Predicting Delinquency in Adolescence

In this study sociometric surveys were completed at third grade for a predominantly low-socioeconomic status, urban sample of African American boys and girls, and youth reports of delinquency were gathered at grades 6, 8, and 10. Results showed that patterns of association between childhood peer rejection and aggression and delinquency severity varied by gender. For boys, the additive effect of childhood peer rejection and aggression was a strong predictor of more serious delinquency, whereas for girls only aggression predicted more serious delinquency. For boys, the combination of peer rejection and aggression was associated with felony assaults, and aggression was associated with a wide variety of offenses during adolescence, whereas for girls only peer rejection predicted involvement in minor assault. Results of the study were discussed in terms of the early starter pathway of antisocial behavior as it relates to peer rejection and aggression for boys, differing predictive patterns for girls, and implications for intervention with children with emotional and behavioral disorders. Miller-Johnson, S., Coie, J.D., Maumary-Gremaud, A., Lochman, J., and Terry, R. Relationship Between Childhood Peer Rejection and Aggression and Adolescent Delinquency Severity and Type Among African American Youth. Journal of Emotional and Behavioral Disorders, 7 (3), pp. 137-146, 1999.

Outcomes of Universal Family-Focused Preventive Interventions: One- and Two-Year Follow-ups of a Controlled Study

This article summarizes the literature on alcohol initiation outcomes of universal family interventions and examines the long-term effects of the Iowa Strengthening Families Program (ISFP), a drug abuse prevention program. The ISFP was a longitudinal, controlled efficacy study with 446 families from 22 rural school districts. Alcohol initiation has been shown to be a precursor to drug initiation. In this study, a four-item index of alcohol initiation was used (Alcohol Initiation Index - AII), with low scores representing a lower level of initiation. Higher- and lower-dosage intervention groups were compared on individual initiation behaviors. AII scores were significantly lower among intervention group adolescents than among control group adolescents (e.g., onset of drinking without parental permission, onset of drunkenness) ranged from approximately 30% to 60% lower) at one- and two-year follow-up assessments. Intervention dosage-related initiation differences were evident only at the one-year follow-up. Spoth, R., Redmond, C., & Lepper, H. Alcohol Initiation Outcomes of Universal Family-Focused Preventive Interventions: One- and Two-Year Follow-ups of a Controlled Study. Journal of Studies on Alcohol, (Suppl. 13), pp. 103-111, 1999.

Predicting Violent Behavior

Data from the Seattle Social Development Project (SSDP), a prospective study involving a panel of youths followed since 1985 were used to replicate and extend findings on risk factors for youth. Data on potential risk factors for violence at age 18 years were measured at ages 10, 14, and 16 years. Changes in the strength of prediction over time were examined in the individual, family, school, peer and community domains. Attention was also given to the additive strength of increasing numbers of risk factors in the prediction of violence at age 18 years and the correct classification of youth having committed a violent act. At each age, risk factors strongly related to later violence were distributed among the five domain areas. Ten of 15, 20 of 25, and 19 of 21, risk factors measures at ages 10, 14, and 16, respectively were predictive of violent acts at age 18. Several risk factors were important across time, for example hyperactivity, low academic performance, peer delinquency, and availability of drugs in the neighborhood predicted violence at ages 10, 14, and 16 years. Analyses of the additive effects of risk factors revealed that youths exposed to multiple risks were more likely than others to engage in later violence. Compared to youth exposed to fewer than 2 risk factors, those exposed to 5 or more were 7 times more likely to have been violent at age 20 and 10 times more likely to have been violent at ages 14 and 16. The overall accuracy of predicting youths that would go on to commit violent acts was limited. Herrenkohl, T.I., Maguin, E., Hill, K.G., Hawkins, J.D., Abbott, R.D., and Catalano, R.F. Developmental Risk Factors for Youth Violence. Journal of Adolescent Health, 26(3), pp. 176-186, 2000.

Predictors of Youth Violence

Adolescents are more likely to perpetrate and be victimized by interpersonal violence than any other age group. Researchers from the University of Washington and the Research Institute on Addictions, Buffalo, NY have examined the risk factors in the individual, family, school, peer and community domains that predict youth violence at age 18. In a prospective study from the Seattle Social Development Project, data on risk factors were collected at ages 10, 14, and 16 and used to predict violent behavior at age 18. Of the eleven constructs measured at all three ages, four consistently predicted later violence: hyperactivity (parent rating), low academic performance, peer delinquency, and availability of drugs. Risk factors for violence at age 18 were identified as early as age 10, but the strength of the associations between risk factors and violence at age 18 years generally increased at ages 14 and 16 years. Paralleling findings from research on delinquency, mental health disorders, and substance use, youths exposed to multiple risks at each developmental point were more likely to engage in violence at age 18. Taken together these findings provide strong justification for directing preventive interventions to populations exposed to high numbers of risks. Herrenkohl, T.I., Maguin, E., Hill, K.G., Hawkins, J.D., Abbott, R.D., and Catalano, R.F. Developmental Risk Factors for Youth Violence. J. of Adolescent Health, 25(1), pp. 1-11, 1999.

Dynamics of Alcohol and Marijuana Initiation

The Seattle Social Development Project has followed the initiation of alcohol and marijuana prospectively in 808 subjects beginning in fifth grade (10 _ years old) and continuing through age 18. A large portion of the participants were from low-income households; half of the subjects participated in the school free-lunch program. The sample was gender balanced and the ethnic composition was 46% Caucasian, 24% African American, 21% Asian American, and 3% from other ethnic groups. The social development model provided the framework for examining etiology, and this analysis focused on individual, family, and peer constructs. At age 10 _, 25% of the sample had tried alcohol and 3% had tried marijuana. Alcohol initiation rose relatively quickly to about age 13, by which time the cumulative initiation rate was 64%. From age 13 to 18 the rate of initiation slowed. In contrast, marijuana initiation remained relatively flat through age 13, and then the rate of initiation increased over the next 5 years until by age 18, 50% of the sample had initiated marijuana use. Asian American ethnicity reduced the likelihood of alcohol use, as did strong parental norms about teen alcohol use, while alcohol use by peers and associates increased the likelihood of initiation. For marijuana, African Americans and Native Americans were more likely to initiate use and Asian Americans were less likely to initiate use than Caucasians. Males were more likely to initiate use, as were those who had previously initiated alcohol use. Parents' proactive family management inhibited initiation as did teens' own norms against marijuana use, but marijuana use by acquaintances and siblings was a strong predictor of initiation. This study suggests that prevention efforts should span the entire adolescent period, with alcohol prevention efforts directed toward preteen years and marijuana prevention efforts focused on later teen years. Prevention efforts should encourage clear family standards and proactive management as well as address the influence of peers, siblings, and other acquaintances who use drugs and alcohol. Kosterman, R., Hawkins, J.D., Guo, J., Catalano R.F., and Abbott, R.D. The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence. American Journal of Public Health, 90, pp. 360-366, 2000.

Protective Effect of Social-Environmental Factors on Future Drug Use

This research focuses on the interrelation of the parent-child attachment, unconventionality, friends' drug use, and the young adult's use of drugs. Data were collected from participants at 4 points in time: early adolescence, late adolescence, early 20s, and late 20s. Data were collected from mothers at the 3 points in time that corresponded with the first 3 collections of data from their children. Both the youths and their mothers were individually interviewed. The findings indicated that the effect of parent-child mutual attachment was mediated through early adolescent personality attributes of greater responsibility, less rebelliousness, and intolerance of deviance. These non-drug-prone personality and behavioral attitudes, in turn, insulated the young adult from affiliating with drug-using peers, and these attitudes were related to less drug use in the early 20s and ultimately in the late 20s. The results suggest that interventions focused on enhancing parent-child mutual attachment should result in a reduction of the risk factors conducive to drug use during the late 20s. The fact that these findings cover a decade and a half, from early adolescence to the late 20s, underscores the significance of placing drug use in a perspective that includes familial and behavioral aspects. Brook, .S., Whiteman, M., Finch, S., and Cohen, P. Longitudinally Foretelling Drug Use in the Late Twenties: Adolescent Personality and Social-Environmental Antecedents. J. Genet. Psychol., 161(1), pp. 37-51, 2000.

The Course of Well-Being and Substance Use During the Transition to Young Adulthood

This study examines the impact of social roles and contexts on health and well-being between the senior year of high school (age 18) and 4 years post-high school (age 22) using multicohort national panel data drawn from the Monitoring the Future study. The project has surveyed nationally representative samples of about 17,000 high school seniors each year in the United States since 1975 using questionnaires administered in classrooms. About 2,400 individuals are randomly selected from each senior year cohort for follow-up. The panel sample used in this study consisted of 17 consecutive cohorts of respondents who were surveyed as high school seniors from 1976 through 1992 and who participated in the first two biennial follow-up surveys. The purpose was to determine the extent to which the individual-level courses of well-being and substance use during the transition from adolescence to young adulthood varied as a function of cohort, gender, and life paths. Results showed that during this transition, well-being increased significantly (i.e., self-esteem, self-efficacy, and social support increased; self-derogation, fatalism, and loneliness decreased) as did substance use (i.e., cigarette, alcohol, and marijuana use; binge drinking). However, self-efficacy did not increase as much in the more recent cohorts compared with the earlier ones. Over time, absolute levels of well- being have changed little, and the same is true for gender and life-path differences in well-being. Substance use was higher in the earlier cohorts than in the later, generally representing period effects. For nearly all measures, men reported higher levels of well-being and substance use compared with women. Among the life paths, there were many overall differences in both well-being as well as substance use. Schulenberg, J., O'Malley, P.M., Bachman, J.G., and Johnston, L.D. "Spread Your Wings and Fly": The Course of Well-Being and Substance Use During the Transition to Young Adulthood. In L. J. Crockett & R. K. Silbereisen (Eds.), Negotiating Adolescence in Times of Social Change. New York: Cambridge University Press, pp. 224-255, 2000.

Predicting Boys' Externalizing Behavior and Risk of Developing Substance Use Disorder

Applying an ontogenetic framework for understanding the development of substance use disorders (SUD), researchers at the Pennsylvania State University and the University of Pittsburgh examined individual traits in family context to identify processes that account for the relationship between fathers' substance use (SUD+ or SUD-) status and sons' externalizing behaviors. Results obtained from SUD+ (n = 89) and SUD- (n = 139) families show that fathers' abusive propensities toward their sons mediated the relationship between fathers' SUD+ status and sons' externalizing behavior scale (EBS) scores 2 years later. Thus, fathers' abusive propensities toward their sons may reflect a process in which SUD liability is transmitted, in part, through a harsh, unnurturing family. Individual traits, family contextual variables, and deviant peer affiliations accounted for 58 percent of the variance on sons' EBS scores. The authors speculate that children reared in harsh, controlling family contexts may develop callous traits such as lack of empathy for others, and such traits in children have been associated with greater levels of conduct problems. They conclude that family-based prevention programs that take account of members' temperament traits and the abusive propensities of parents toward offspring may help to reduce children's liability to Conduct Disorder and Substance Use Disorder outcomes. Blackson, T.C., Butler, T., Belsky, J., Ammerman, R.T., Shaw, D.S., and Tarter, R.E. Individual Traits and Family Contexts Predict Sons' Externalizing Behavior and Preliminary Relative Risk Ratios for Conduct Disorder and Substance Use Disorder Outcomes. Drug and Alcohol Dependence, 56(2), pp. 115-131, 1999.

Hormonal and Behavioral Homeostasis in Boys at Risk for Substance Abuse

A study at the Center for Education and Drug Abuse Research (CEDAR) at the University of Pittsburgh examined the influences of cortisol reactivity, androgens, age-corrected pubertal status, parental personality, and family and peer dysfunction on behavioral self-regulation (BSR) in boys at high average risk (HAR) and low average risk (LAR) for substance abuse. Differences between risk groups in cortisol and androgen concentrations, and cortisol reactivity were also examined. Subjects were 10-12-year-old sons of substance abusing fathers (HAR; n = 150) and normal controls (LAR; n = 147). A multidimensional construct of BSR was developed based on multiple measures and multiple informants. Boys reported on family dysfunction and deviant behavior among their peers. Parents reported on their propensity to physically abuse their sons, and their own number of DSM-III-R Antisocial Personality Disorder symptoms. Endocrine measures included plasma testosterone, dihydrotestosterone, and salivary cortisol. HAR boys, compared to LAR boys, had lower mean concentrations for testosterone, dihydrotestosterone, salivary cortisol prior to evoked related potential testing, and lower cortisol reactivity. The number of maternal Antisocial Personality Disorder symptoms, parental potential for physical abuse, degree of family dysfunction, and peer delinquency were significantly associated with BSR. Parental aggression, antisocial personality symptoms, and parental physical abuse potential are likely to influence sons' behavioral dysregulation and homeostatic stress reactivity. These key components of liability are posited to increase the likelihood of developing suprathreshold Psychoactive Substance Use Disorder (PSUD). The authors suggest that interventions to prevent exacerbation of poor behavioral self regulation should address family dysfunction and deviant peer affiliation as well as the severity of current BSR impairment. Dawes, M.A., Dorn, L.D., Moss, H.B., Yao, J.K., Kirisci, L., Ammerman, R.T., and Tarter, R.E. Hormonal and Behavioral Homeostasis in Boys at Risk for Substance Abuse. Drug and Alcohol Dependence, 55(1-2), pp. 165-176, 1999.

The Association of Current Stimulant Use with Demographic, Substance Use, Violence-related, Social and Intrapersonal Variables Among High Risk Youth

This article reports the association of current stimulant use with demographic, other substance use, violence-related, social and intrapersonal variables among a large sample of high risk adolescents. A total of 21.4% of the sample reported using stimulants in the last 30 days. In a final, multivariable model, nonredundant concurrent predictors of current stimulant use were reports that friends use stimulants, reports that stimulants were likely to be used again in the next 12 months, use of alcohol, hallucinogens, or cocaine in the last 30 days, use of alcohol or other drugs to feel more safe, and reports of depression in the last week. Being above the median on none to all seven of these correlates predicted from 0% to 85% of those who were above the median on current stimulant use. One may speculate that programming for these stimulant-using youth should include treatment of multiple substances, depression, and correction of social-cognitive misperceptions. Sussman, S., Dent, C.W., and Stacy, A.W. The Association of Current Stimulant Use with Demographic, Substance Use, Violence-related, Social and Intrapersonal Variables Among High Risk Youth. J Addictive Behavior, 24(6), pp. 741-748, 1999.

After-School Self-Care and Adolescent Smoking

This study examined the independent contributions of the setting and the intensity of after-school self-care to the cigarette smoking behaviors of 2,352 ninth graders. The authors found that the intensity of the self-care experience was significantly associated with adolescent smoking behavior irrespective of the typical setting of the adolescents' after-school activities. The findings indicated that a nonpermissive parenting style, family rule-setting about cigarettes, and in absentia parental monitoring may reduce the likelihood of cigarette smoking among both latchkey and nonlatchkey adolescents. Targeting these aspects of the home lives of all adolescents has the potential to reduce smoking behaviors among latchkey as well as nonlatchkey children. Mott, J.A., Crowe, P.A., Richardson, J., and Flay, B. After-School Supervision and Adolescent Cigarette Smoking: Contributions of the Setting and Intensity of After-School Self-Care. Journal of Behavioral Medicine, 22(1), pp. 35-58, 1999.

Drug Use and Personality Factors Affect Parent-Child Attachment Relationship

In this longitudinal study, data were collected during early adulthood in 1992 and in 1996/1997 via a structured questionnaire. The researchers assessed the extent to which participants' personality attributes, substance use, and relationships with their mothers predicted the quality of the parent-child bond. Participants with certain personality attributes (e.g., high sensitivity), less frequent marijuana use, or a close relationship with their mothers were found to have a greater likelihood of having a close parent-child attachment relationship with their own children at a later time. Results also showed that the risk of earlier substance use on the parent-child relationship was offset by protective factors in the parents' personality domain. In addition, protective factors in the various parental domains synergistically interacted with a low frequency of marijuana use, relating to a closer parent-child attachment relationship. The findings suggest that certain parenting styles are transmitted across generations and interventions in the personality and drug use domains can help increase the likelihood that parents will form close attachment relationships with their own children. Brook, J.S., Richter, L., and Whiteman, M. Effects of Parent Personality, Upbringing, and Marijuana Use on the Parent-Child Attachment Relationship. J. Am. Acad. Child. Adolesc. Psychiatry, 39(2), pp. 240-248, 2000.

Family Structure and Educational Attainment

This study used structural equation modeling to account for the relationship between family structure during adolescence and educational attainment in adulthood. The investigators found that intact family of origin was associated with better financial situation in the parental home and a positive school experience, which in turn were associated with later entry into adult work and marriage roles, and finally to continuing educational attainment beyond high school. Chen, Z. and Kaplan, H.B. Explaining the Impact of Family Structure During Adolescence on Adult Educational Attainment: A Longitudinal Study. Applied Behavioral Science Review, 7, pp. 23-40, 1999.

Parentification and its Impact on Adolescent Children of Parents with AIDS

Parentification refers to children or adolescents assuming adult roles before they are emotionally or developmentally ready to manage those roles successfully. An assessment of the predictors and outcomes of parentification was made among adolescent children of Parents with AIDS (PWAs) in two phases. In Phase 1, relationships among parental AIDS-related illness, parent drug use, parent and adolescent demographics, and parentification indicators (parental, spousal, or adult role-taking) were assessed among 183 adolescent-parent pairs (adolescents: 11 to 18 years, M = 14.8 years, 54 percent female; parents: 80 percent female). Adult role-taking was associated with maternal PWAs, female adolescents, and greater parent drug use. Greater parental AIDS-related illness predicted more spousal and parental role-taking. Parent drug use predicted more parental role-taking. In Phase 2, the impact of parentification on later adolescent psychological adjustment was examined (N = 152 adolescents). Adult role-taking predicted more internalized emotional distress; parental role-taking predicted externalized problem behaviors, sexual behavior, alcohol and marijuana use, and conduct problems. Given these dysfunctional outcomes, interventions to mitigate parentification among children of PWAs are discussed. Stein, J.A., Riedel, M., Rotheram-Borus, M.J. Parentification and Its Impact on Adolescent Children of Parents with AIDS. Family Process, 38(2), pp. 193-208, 1999.

Perceived Invulnerability and Cigarette Smoking Among Adolescents

Adolescent perceptions of invulnerability toward smoking and nonsmoking-related health risks were examined among 432 continuation high school students. Smokers were less likely than nonsmokers to report feeling invulnerable to both smoking and nonsmoking-related health risks. Among the smokers, those who reported feeling invulnerable to smoking related health risks, compared to those who reported feeling vulnerable, smoked fewer cigarettes, were less addicted, were less likely to intend to smoke more in the future, attempted to quit fewer times in the past, valued their health more, and reported higher public body awareness. In a multiple logistic regression model, only high public body awareness, fewer previous attempts to quit, and being in the action stage of change (compared to being in the precontemplation stage of change) remained significant independent concurrent predictors of being in the invulnerable group. These results suggest, contrary to some previous work, that perceived invulnerability may be predictive of quitting tobacco use and may reflect relative invulnerability; that is, lighter use of tobacco. Milam, J.E., Sussman, S., Ritt-Olson, A., and Dent, C.W. Perceived Invulnerability and Cigarette Smoking Among Adolescents. J. Addictive Behaviors, 25 (1), pp. 71-80, 2000.

Examining Ethnic-Group Differences in the Predictors of Substance Use

The authors describe some approaches to studying ethnic-group differences in the predictors of substance use. They include probing for mediators, multisample analyses of structural models and an experimental trial of a preventive intervention. In their studies they found some ethnic-group differences as well as many similarities in the structure of constructs and the relationships between variables. It was noted that the challenge for researchers is using appropriate research methods for studying ethnicity, uncovering the basis for ethnic-group differences when they occur, knowing when statistical differences are meaningful, and acknowledging when developmental models are comparable. Barrera, M., Castro, F.G., and Biglan, A. Ethnicity, Substance Use, and Development: Exemplars for Exploring Group Differences and Similarities. Development and Psychopathology, 11 (4), pp. 805-822, 1999.

Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education

This monograph reviews findings from research on the epidemiology and etiology and of drug abuse among young people and drug abuse prevention programs. It presents the information in terms appropriate for policy makers, program designers and evaluators, and laymen to rethink approaches to prevention of drug abuse. She concludes there are fundamental problems with drug education because the foundations of conventional school-based drug education are fundamentally flawed. Many programs are based on the conviction that any use of illegal drugs is inherently pathological, an indication that something is wrong, whereas alternative explanations acknowledge the importance of culture. As a sociologist, she notes that American people and their children are bombarded with messages that encourage them to imbibe and medicate with a variety of substances, including alcohol, tobacco, caffeine, and prescription drugs. Fifty-one percent of Americans use alcohol regularly and one-third have tried marijuana at some time. Teenage drug use appears to mirror American proclivities. Dr. Rosenbaum's review of the literature arrives at a reality-based alternative: safety-first drug education. The first assumption of safety-first drug education is that teenagers can make responsible decisions if given honest, science-based drug education (students were motivated to quit using marijuana for health reasons or negative drug effects they themselves experienced or learned about from sources they trust). The second assumption of safety first is that total abstinence may not be a realistic alternative for all teenagers. Proclaiming a drug-free American culture by some arbitrary date is not deemed realistic, but reduction of drug use and drug problems is realistic and a key measure of success. A third assumption of safety-first drug education is to differentiate between use, abuse, and dependency. The youthful user must know he/she is not trapped and has a choice and can reduce use and influence the outcome. Dr. Rosenbaum's book provides scientific support for these positions and some guidelines for developing safety-first drug education to equip students with information they can trust and use as a the basis for making responsible decisions. Rosenbaum, M. Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education. San Francisco, CA: The Lindesmith Center, pp. 1-12, 1999.

Victims as Victimizers: Physical Aggression by Persons with a History of Childhood Abuse

Substance abuse has been called the dominant characteristic of families involved in child abuse cases, but the frequency with which childhood victims become adult victimizers is uncertain. This study examines whether a history of childhood sexual or physical abuse is associated with becoming a victimizer (i.e., abusing or assaulting others) as an adult. Interview data from 439 intravenous drug users found a history of sexual or physical abuse before 16 years of age was reported by 51% of women and 31% of men. Seventeen percent of the subjects reported being victimizers. Among childhood victims of physical or sexual abuse, 28% victimized others; among those who denied childhood abuse, 10% victimized others. Two thirds of victimizers reported being under the influence while assaulting others. Controlling for gender, having children, education, race, and history of incarceration, childhood abuse was significantly associated with becoming a victimizer (odds ratio, 3.6). This study confirms a high rate of childhood abuse among intravenous drug users suggesting that treatment programs should both assess and program for treating the adult for past abuse and preventing future victimization. Clarke, J., Stein, M.D., Sobota, M., Marisi, M., and Hanna, L. Arch Intern Med, 159(16), pp. 1920-1924, 1999.