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CORK Bibliography: African-Americans

175 citations. January 2011 to present

Prepared: September 2012

Ade JN; Rohrer J; Rea NK. Immigration, income, drinking and obesity in African American adults. Journal of Immigrant and Minority Health 13(4): 659-663, 2011. (9 refs.)

The objective of this study was to investigate the relationship between immigration status, income, drinking and overweight and obesity in African American adults residing in the United States using an internet web based survey. Data on 303 adult African American immigrants and non-immigrants was collected using a self-administered web based survey. Respondents were recruited using a snowball sampling technique to obtain a convenience sample. Multiple logistic regression analysis were used to test the independent effects of the immigration status while controlling for confounding effects of demographic, social and behavioral variables. The results of the study showed no significant difference between obesity and immigration status in black adults residing in the US (adjusted odds ration = 1.1095, P = 0.7489). Significance at the P < 0.05 level was demonstrated for obesity and two independent variables: age (OR = 1.0332, P = 0.0298) and days per month consumed more than 5 alcoholic beverages (OR = 1.7735, P = 0.0001). Adult African American immigrants in this study sample were not at risk of being obese due to their immigration status. However, age and days in a month in which more than 5 alcoholic beverages are consumed were significant risk factors for obesity. Primary care providers should be alert for obesity and alcohol consumption in this population.

Alvanzo AAH; Storr CL; La Flair L; Green KM; Wagner FA; Crum RM. Race/ethnicity and sex differences in progression from drinking initiation to the development of alcohol dependence. Drug and Alcohol Dependence 118(2-3): 375-382, 2011. (40 refs.)

Background: Prior studies on the course of alcohol use disorders have reported a "telescoping" effect with women progressing from drinking initiation to alcohol dependence faster than men. However, there is a paucity of population-based analyses that have examined progression to alcohol dependence comparing race/ethnicity subgroups, and little is known about whether the telescoping effect for women varies by race/ethnicity. We examined whether a telescoping effect is present in the general population comparing race/ethnicity subgroups and comparing men and women stratified by race. Methods: This study uses data from Wave I of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to compare a nationally representative sample of White, Black and Hispanic adults 18-44 years of age (n=21,106). Time to event analyses compare the risk of alcohol initiation, onset of alcohol dependence, and the transition from initial use to onset of alcohol dependence in the three race/ethnicity groups and for males and females in each race/ethnicity group. Results: Whites were younger than Blacks and Hispanics of the same sex at drinking onset and progressed to alcohol dependence at a faster rate than both Blacks and Hispanics. In addition, we found no evidence of a telescoping effect in women for any race/ethnicity group. Conclusions: The present study illustrates differences in the course of transition from alcohol initiation to the development of dependence by race/ethnicity but not sex. Our findings highlight the need for additional study of factors resulting in race/ethnicity differences in order to inform culturally relevant prevention and intervention initiatives.

Ashktorab H; Nouri Z; Nouraie M; Razjouyan H; Lee EE; Dowlati E et al. Esophageal carcinoma in African Americans: A five-decade experience. Digestive Diseases and Sciences 56(12): 3577-3582, 2011. (30 refs.)

Background: Esophageal cancer accounts for a considerable proportion of carcinomas of the upper gastrointestinal tract in African Americans. Our aim was to describe the epidemiology of esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EA) among African Americans in the last five decades. Methods: A total of 601 records of patients with documented esophageal cancer between 1959 and 2007 at Howard University Hospital were reviewed. Demographic characteristics, risk factors, clinical stage and histological findings were reviewed. The change in prevalence of the disease and the interaction between main risk factors with tumor stage of the patients were assessed over the years of this study. Result: A total of 552 patients (91.8%) had ESCC while 49 patients (8.2%) had EA. The mean age at diagnosis was 60.1 and 60.6 years for ESCC and EA, respectively (P = 0.8). The peak incidence was in the 1980-1989 decade. Out of 136 ESCC patients with TNM staging information, 130 (95.6%) were diagnosed in stage 2 and above. The majority (73%) of the ESCC were in the mid- and upper third of the esophagus and associated with smoking and alcohol exposure. The majority (81%) of the EA were in the mid- and lower third. The most common presenting symptoms were dysphagia (77.7%), and weight loss (31.9%). Conclusion: ESCC is the predominant esophageal cancer in African Americans and diagnosed in late stages, and its diagnosis in our institution has decreased since 1990. A combination of genetic factors, environmental influences (e.g., those related to diet), and the deleterious changes associated with smoking and alcohol consumption, and differences in tumor histology, are the obvious parameters that should be the focus of future studies, and early diagnosis at an earlier stage should be considered among blacks.

Avalos LA; Mulia N. Formal and informal substance use treatment utilization and alcohol abstinence over seven years: Is the relationship different for blacks and whites? Drug and Alcohol Dependence 121(1-2): 73-80, 2012. (82 refs.)

Background: This study examines whether the effects of formal substance use treatment utilization and Alcoholics Anonymous (AA) on 30-day abstinence vary for black versus white Americans. Methods: The current analysis utilizes data from a longitudinal sample of 1013 black and white, dependent and problem drinkers across a 7-year period. Participants were identified through a probability survey in the general population and consecutive intakes in chemical dependency treatment programs in a California County. Generalized Estimating Equations assessing interactions between race and treatment utilization incorporated variables from four post-baseline interviews, controlling for baseline variables. Results: Formal treatment utilization was associated with 30-day abstinence (OR:1.6, 95%CI: 1.3, 2.1), yet this relationship did not differ for blacks and whites. In contrast, there was a significant interaction between AA utilization, race and 30-day abstinence. While both whites and blacks who attended AA were more likely to report 30-day abstinence compared to their non-AA attending counterparts (white OR:4.0, 95%CI: 3.2-5.1 and black OR:2.2, 95%CI: 1.5-3.2), the relationship was stronger for whites. Among those who did not attend AA, blacks were more likely than whites to be abstinent. Post hoc analyses suggest that these latter findings may be related to greater religiosity and "drier" social networks among black Americans. Conclusions: While utilization of formal treatment may yield similar benefits for blacks and whites, AA utilization may be more important for maintaining abstinence among whites than blacks. Future research should investigate racial differences in social network drinking patterns and religious reinforcement of sobriety, and the role these may play in AA outcomes.

Bares CB; Andrade FH. Racial/ethnic differences in the longitudinal progression of co-occurring negative affect and cigarette use: From adolescence to young adulthood. Addictive Behaviors 37(5): 632-640, 2012. (82 refs.)

Aims: This study examined the longitudinal progression of the co-occurrence of cigarette use and negative affect among the general population of U.S. adolescents and young adults and between racial/ethnic groups. Methods: Data for this study consisted of Waves 4, 6, and 8 of the NLSY97 longitudinal study containing a nationally representative sample of U.S. adolescents and young adults. A total of 7979 adolescents (Mean age at Wave 4 = 17.98, SD = 1.44, 49% female) were included in the analyses. To investigate the co-morbidity between negative affect and cigarette use, a latent factor of negative affect and single indicator of cigarette consumption were examined at each wave. A three wave Bivariate Autoregressive Cross-Lagged Effect Model was estimated to test the conjoint trajectory of negative affect and smoking. Results: For all racial/ethnic groups prior negative affect status influenced future negative affect between waves and prior negative affect was positively related to increases in smoking in subsequent waves. The longitudinal trajectory of negative affect for the three racial/ethnic groups was the same, but racial/ethnic group differences were observed in the strength of the longitudinal relationship between previous and future cigarette use. Specifically, the following racial/ethnic differences were observed, even after controlling for the effect of SES; White young adults were found to exhibit the strongest association between cigarette use in the first two waves, followed by Hispanic individuals and lastly by African Americans. In the last two waves, African American young adults were found to have the strongest association between cigarette use at the latter two waves, followed by White individuals. Conclusions: Both negative affect and cigarette consumption influence each other during the transition between late adolescence and young adulthood but the magnitude of the associations between cigarettes use across waves differed between racial/ethnic groups. Implications for prevention and treatment programs include considering both cigarette use and negative affect as two factors that jointly impact each other and that should be targeted simultaneously.

Becker SJ; Stein GL; Curry JF; Hersh J. Ethnic differences among substance-abusing adolescents in a treatment dissemination project. Journal of Substance Abuse Treatment 42(3): 328-336, 2012. (37 refs.)

Despite evidence of ethnic differences in substance use patterns among adolescents in community samples, clinical studies have not found ethnic differences in posttreatment outcomes. Prior clinical studies have been limited by small samples, focus on broad treatment modalities, and lack of consideration of important covariates. We investigated ethnic differences in substance use frequency and problems in a large sample of White (60%), African American (12%), and Latino (28%) adolescents prior to and following an evidence-based treatment. Participants included 4,502 adolescents (29% female), with ages 13-18 years, who received Motivational Enhancement Therapy/Cognitive Behavior Therapy 5 Sessions. At baseline, African American adolescents demonstrated less frequent use, fewer problems, and less comorbidity than Whites or Latinos. Consistent with prior research, there were no ethnic differences in substance use outcomes among assessment completers (71%) when controlling for baseline differences. However, African Americans, older adolescents, and males were less likely to complete the posttreatment assessment. Implications for clinical service and effectiveness research are discussed.

Benowitz NL; Dains KM; Dempsey D; Wilson M; Jacob P. Racial differences in the relationship between number of cigarettes smoked and nicotine and carcinogen exposure. Nicotine & Tobacco Research 13(9): 772-783, 2011. (40 refs.)

Introduction: Black smokers are reported to have higher lung cancer rates and greater tobacco dependence at lower levels of cigarette consumption compared to non-Hispanic White smokers. We studied the relationship between cigarettes per day (CPD) and biomarkers of nicotine and carcinogen exposure in Black and White smokers. Methods: In 128 Black and White smokers, we measured plasma nicotine and its main proximate metabolite cotinine, urine nicotine equivalents, 4-(methylnitrosamino)-1-(3)pyridyl-1-butanol (NNAL), and polycyclic aromatic hydrocarbon (PAH) metabolites. Results: The dose-response between CPD and nicotine equivalents, and NNAL and PAH was flat for Black but positive for White smokers (Race x CPD interaction, all ps < .05). Regression estimates for the Race x CPD interactions were 0.042 (95% CI 0.013-0.070), 0.054 (0.023-0.086), and 0.028 (0.004-0.052) for urine nicotine equivalents, NNAL, and PAHs, respectively. In contrast there was a strong correlation between nicotine equivalents and NNAL and PAH independent of race. Nicotine and carcinogen exposure per individual cigarette was inversely related to CPD. This inverse correlation was stronger in Black compared to White smokers and stronger in menthol compared to regular cigarette smokers (not mutually adjusted). Conclusions: Our data indicate that Blacks on average smoke cigarettes differently than White smokers such that CPD predicts smoke intake more poorly in Black than in White smokers.

Berg CJ; Thomas JL; An LC; Guo HF; Collins T; Okuyemi KS et al. Change in smoking, diet, and walking for exercise in Blacks. Health Education & Behavior 39(2): 191-197, 2012. (43 refs.)

Positive changes in one health behavior may be accompanied by other constructive health behavior changes. Thus, the authors investigated the association of smoking reduction and cessation to changes in fruit and vegetable (FV) intake and engaging in walking for exercise. This study included 539 Black light smokers (<= 10 cigarettes per day >= 25 days/month) enrolled in a 2 x 2 factorial study (placebo vs. nicotine gum, health education vs. motivational interviewing). Reducing cigarette consumption (p = .02) and quitting smoking (p < .01), as well as receiving the nicotine gum (p = .04), was associated with increased FV intake, after controlling for baseline FV intake. Compared with those who did not reduce their smoking, both reducers (p < .001) and quitters (p < .001) were more likely to walk for exercise at follow-up, after controlling for baseline walking status (p = .01). Thus, addressing one health risk behavior may prompt other positive health behaviors, which may argue for developing interventions targeting multiple health risk behaviors.

Biksey T; Zickmund S; Wu F. Disparities in risk communication: A pilot study of asthmatic children, their parents, and home environments. Journal of the National Medical Association 103(5): 388-391, 2011. (28 refs.)

Parents' knowledge and control of asthma triggers in home environments can help reduce risks associated with asthmatic children's respiratory health. This pilot study used both qualitative and quantitative methods to determine parental knowledge of their children's asthma triggers in home environments, control of those triggers, and information received and trusted. Twelve parents of asthmatic children in the greater Pittsburgh area-8 white and 4 African American participated in one-on-one interviews about home exposures to asthma triggers. All parents described the link between asthma symptoms and both environmental tobacco smoke (ETS) and pet dander exposures. House dust mites and mold were also commonly identified asthma triggers. All 8 white parents reported receiving information from physicians about controlling home environmental triggers of asthma, but the 4 African American parents reported having received no such information. However, all 12 parents reported having greater trust in information received from physicians than from other sources. White parents were significantly more aware of potential asthma triggers and performed significantly more actions to control the triggers in their homes. African American parents noted stressful experiences with primary and secondary care, less recall of information sharing about asthma triggers, and a focus on symptom management vs trigger avoidance.

Boardman JD; Alexander KB. Stress trajectories, health behaviors, and the mental health of black and white young adults. Social Science & Medicine 72(10): 1659-1666, 2011. (39 refs.)

This paper uses data from the National Longitudinal Study of Adolescent Health to examine the mental health of non-Hispanic black and white young adults in the US. We use latent growth curve modeling to characterize the typical stress trajectories experienced by black and white young adults spanning the bulk of their lives. We identify the following four stress trajectories: 1) relatively stress free; 2) stress peak at age 15 and a subsequent decline; 3) stress peak at age 17 and a subsequent decline; and 4) a moderately high chronic stress. Results. indicate that black adolescents have significantly higher risk of being in all three of the stressful classes compared to white adolescents. Stress exposure is strongly associated with depression and the race differences in stress profiles account for a modest amount of the observed race differences in mental health. We do not observe any race differences in behavioral responses to stressors; black youth are no more likely than white youth to engage in poor health behaviors (e.g., smoking, drinking, or obesity) in response to stress. We provide tentative support for the notion that poor health behaviors partially reduce the association between stress and depression for blacks but not whites. These findings contribute to unresolved issues regarding mental and physical health disparities among blacks and whites.

Brody GH; Yu TY; Chen YF; Kogan SM; Smith K. The Adults in the Making Program: Long-term protective stabilizing effects on alcohol use and substance use problems for rural African American emerging adults. Journal of Consulting and Clinical Psychology 80(1): 17-28, 2012. (54 refs.)

Objective: This report addresses the long-term efficacy of the Adults in the Making (AIM) prevention program on deterring the escalation of alcohol use and development of substance use problems, particularly among rural African American emerging adults confronting high levels of contextual risk. Method: African American youths (M age, pretest = 17.7 years) were assigned randomly to the AIM (n = 174) or control (n = 173) group. Past 3-month alcohol use, past 6-month substance use problems, risk taking, and susceptibility cognitions were assessed at pretest and at 6.4, 16.6. and 27.5 months after pretest. Pretest assessments of parent child conflict, affiliations with substance-using companions, and perceived racial discrimination were used to construct a contextual risk factor index. Results: A protective stabilizing hypothesis was supported; the long-term efficacy of AIM in preventing escalation of alcohol use and substance use problems was greater for youths with higher pretest contextual risk scores. Consistent with a mediation-moderation hypothesis, AIM-induced reductions over time in risk taking and susceptibility cognitions were responsible for the AIM X contextual risk prevention effects on alcohol use and substance use problems. Conclusions: Training in developmentally appropriate protective parenting processes and self-regulatory skills during the transition from adolescence to emerging adulthood for rural African Americans may contribute to a self-sustaining decreased interest in alcohol use and a lower likelihood of developing substance use problems.

Brook JS; Lee JY; Brown EN; Finch SJ; Brook DW. Developmental trajectories of marijuana use from adolescence to adulthood: Personality and social role outcomes. Psychological Reports 108(2): 339-357, 2011. (42 refs.)

Longitudinal trajectories of marijuana use from adolescence into adulthood were examined for adverse life-course outcomes among African-Americans and Puerto Ricans. Data for marijuana use were analyzed at four points in time and on participants' personality attributes, work functioning, and partner relations in adulthood using growth mixture modeling. Each of the three marijuana-use trajectory groups (maturing-out, late-onset, and chronic marijuana-users) had greater adverse life-course outcomes than a nonuse or low-use trajectory group. The chronic marijuana-use trajectory group was highly associated with criminal behavior and partners' marijuana use in adulthood. Treatment programs for marijuana use should also directly address common adverse life-course outcomes users may already be experiencing.

Brook JS; Lee JY; Finch SJ; Koppel J; Brook DW. Psychosocial factors related to cannabis use disorders. Substance Abuse 32(4): 242-251, 2011. (59 refs.)

The objective of this study was to explore the association between psychosocial risk and protective factors and cannabis use disorders (CUDs) in a cohort of African American and Puerto Rican young adults. A representative sample (N = 838) from the East Harlem area of New York City was assessed at 4 points in time (at mean ages 14.1, 19.2, 24.5, and 29.2). The psychosocial measures came from 6 domains: personality attributes, family, peer, work, neighborhood, and substance use. The psychosocial measures were assessed at each of the first 3 waves of the study, and CUDs were assessed at the fourth and final wave of the study. Multivariate logistic regression and a cumulative risk analysis were conducted. Increased psychological symptoms (odds ratio [OR] = 1.21; 95% confidence interval [CI], 1.05-1.39; P < .01), problems resulting from cannabis use (OR = 2.69; 95% CI, 1.33-5.46; P < .01), frequent arguments with one's partner (OR = 1.84; 95% CI, 1.09-3.10; P < .05), high levels of deviance (OR = 1.81; 95% CI, 1.21-2.71; P < .01), and frequent acts of violence directed toward the participant (OR = 1.19; 95% CI, 1.01-1.42; P < .05) were all associated with an increased risk for CUDs. An increase in the number of risks was associated with an increase in the probability of having CUDs at the fourth wave (again, at a mean age of 29.2). A decrease in the number of risk factors may lead to a decrease in CUDs.

Caldwell DH; Gryczynski J. Computerized assessment facilitates disclosure of sensitive HIV risk behaviors among African Americans entering substance abuse treatment. American Journal of Drug and Alcohol Abuse 38(4): 365-369, 2012. (25 refs.)

Background: Individuals entering substance abuse treatment are at elevated risk for HIV infection, and clinicians must generally rely on patient self-report to gauge their involvement in risk behaviors. Strategies to improve accurate reporting of personally sensitive or stigmatizing risk behaviors are needed. Objective: This study compared computerized and face-to-face interview methods in eliciting self-disclosure of HIV risk behaviors among a high-risk sample of urban African Americans entering substance abuse treatment (N = 146). Methods: Participants completed a standardized HIV risk behavior screening as a face-to-face interview. Several days later, the same participants completed a computerized self-interview with the same measure, covering the same time frame. Results: Disclosure rates for many sensitive risk behaviors were considerably higher on the computerized interview. Participants had significantly higher odds of disclosure on the computerized interview compared to the face-to-face interview on 2 of 6 drug risk behaviors examined (ORs between 2.75 and 3.15) and 9 of 13 sex risk behaviors examined (ORs between 1.60 and 6.45). The advantage of the computerized interview was most evident for highly stigmatized behaviors, such as unprotected sex with someone other than a spouse or main partner (OR = 3.93; p < .001), unprotected sex during a commercial sex transaction (OR = 5.63; p < (.)001), unprotected anal sex (OR = 6.45; p < .001), and using unsterilized syringes (OR = 3.15; p < .05). Conclusions and scientific significance: Findings support the utility of computerized risk behavior assessment with African Americans entering substance abuse treatment. Computerized assessment of HIV risk behaviors may be clinically useful in substance abuse treatment and other healthcare venues serving high-risk populations.

Caraballo RS; Holiday DB; Stellman SD; Mowery PD; Giovino GA; Muscat JE et al. Comparison of serum cotinine concentration within and across smokers of menthol and nonmenthol cigarette brands among Non-Hispanic Black and Non-Hispanic White US adult smokers, 2001-2006. Cancer Epidemiology, Biomarkers & Prevention 20(7): 1329-1340, 2011. (36 refs.)

Background: The Food and Drug Administration (FDA) is examining options for regulating menthol content in cigarettes. There are many pharmacologic properties of menthol that may facilitate exposure to tobacco smoke, and it has been suggested that the preference for menthol cigarettes in black smokers accounts for their higher cotinine levels. Objective: To assess cigarettes smoked per day-adjusted cotinine levels in relation to smoking a menthol or nonmenthol cigarette brand among non-Hispanic black and white U. S. adult smokers under natural smoking conditions. Method: Serum cotinine concentrations were measured in 1,943 smokers participating in the 2001 to 2006 National Health and Nutrition Examination Surveys (NHANES). The effect of smoking a menthol brand on cigarettes smoked per day-adjusted serum cotinine levels in these two populations was modeled by adjusting for sex, age, number of smokers living in the home, body weight, time since last smoked, and FTC (Federal Trade Commission)-measured nicotine levels. The 8- or 12-digit Universal Product Code (UPC) on the cigarette label was used to determine the cigarette brand and whether it was menthol. Results: Smoking a menthol cigarette brand versus smoking a nonmenthol cigarette brand was not associated (P >= 0.05) with mean serum cotinine concentration in either black or white smokers. Conclusions: The higher levels of cotinine observed in black smokers compared with white smokers are not explained by their higher preference for menthol cigarette brands. Impact: Further studies like ours are needed to improve our ability to understand health consequences of future changes in tobacco product design.

Carpenter MJ; Ford ME; Cartmell K; Alberg AJ. Misperceptions of nicotine replacement therapy within racially and ethnically diverse smokers. Journal of the National Medical Association 103(9-10): 885-894, 2011. (30 refs.)

Underuse of evidence-based treatment for smoking cessation, including use of nicotine replacement therapy (NRT), is widespread, particularly among minority smokers. This paper examines perceptions of NRT among and between racially and ethnically diverse groups of smokers. Nine focus groups were held among homogenous groups of African American, European American, and Hispanic smokers (N = 70). Specific themes included perceptions of: (a) the mechanism by which NRT works; (b) NRT development and regulation (ie, purpose and methods of clinical trials, Food and Drug Administration oversight, etc); (c) efficacy; (d) safety; and (e) overall cost effectiveness. Across all groups, there was a general lack of knowledge of NRT effects and its efficacy, with only moderate knowledge of the mechanism by which NRT works. Concerns about NRT safety were expressed in all groups, with particular apprehension about addictive potential and possible interactions with other medications. Among African American smokers in particular, there was strong suspicion of pharmaceutical industry and government oversight, which coincided with the consensus view that there are too many unknowns about NRT. Among Hispanic smokers, there was less suspicion of NRT but a strong cultural belief in personal responsibility for smoking cessation. Results highlight enduring misperceptions about NRT that likely undermine usage. More education about NRT is needed, not only about its efficacy and safety, but also with regard to its development and regulation. Health care professionals, many of whom are viewed as trustworthy sources of health information, have a particularly important role to promote wider use of proven cessation strategies.

Castro Y; Kendzor DE; Businelle MS; Mazas CA; Cofta-Woerpel L; Cinciripini PM et al. Structural and predictive equivalency of the Wisconsin Smoking Withdrawal Scale across three racial/ethnic groups. Nicotine & Tobacco Research 13(7): 548-555, 2011. (37 refs.)

The Wisconsin Smoking Withdrawal Scale (WSWS) is a valid and reliable scale among non-Latino Whites but has not been validated for use among other racial/ethnic groups despite increasing use with these populations. The current study examined the structural invariance and predictive equivalency of the WSWS across three racial/ethnic groups. The WSWS scores of 424 African American, Latino, and White smokers receiving smoking cessation treatment were analyzed in a series of factor analyses and multiple-group analyses. Additionally, hierarchical logistic regression analyses were conducted to determine whether WSWS scores differentially predicted smoking relapse across racial/ethnic groups. These analyses were consistent with a step-down hierarchical regression procedure for examination of test bias. The 7-factor structure of the WSWS was largely confirmed in the current study, with the exception of the removal of two offending items. Evidence of full invariance across race/ethnicity was found in multiple-group analyses. The WSWS total score and subscales measuring anger, anxiety, concentration, and sadness predicted relapse, whereas the hunger, craving, and sleep subscales did not. None of these scales displayed differential predictive ability across race/ethnicity. The WSWS sleep subscale showed a significant interaction with race/ethnicity such that it was a significant predictor of relapse among Whites but not African Americans or Latinos. Overall, the WSWS is similar in structure and predictive of relapse across racial/ethnic groups. Caution should be exercised when using the WSWS sleep subscale with African Americans and Latinos.

Champion JD. Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58(1): 61-67, 2011. (37 refs.)

Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14-18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self-report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self-reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported 'getting high' and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.

Chen XG; Stanton B; Hopper J; Khankari N. Sources, locations, and predictors of environmental tobacco smoke exposure among young children from inner-city families. Journal of Pediatric Health Care 25(6): 365-372, 2011. (36 refs.)

Introduction: The purpose of this study was to determine the levels, sources, and locations of and influential factors for exposure to environmental tobacco smoke (ETS) among pediatric patients from inner-city families. Method: Descriptive and associative analysis of ETS exposure in children 6 to 10 years of age was performed with survey data collected at Children's Hospital of Michigan through mothers' report and children's urine cotinine. Results: The sample included 397 participants, 82.4% of whom were African American. Urine cotinine levels were correlated with reported ETS exposure and 71% of children with urine cotinine levels > 10 ng/mL. The mean duration of ETS exposure was 14.3 minutes (SD = 11.0) in the past week and 58.9 minutes (SD = 50.8) in the past month. Smoking parents (similar to 30%), grandparents (similar to 30%), and non-family members (similar to 28%) were the major ETS sources, and relatives' homes (similar to 40%), the children's own homes (similar to 24%), automobiles (similar to 15%), and friends' homes (similar to 11%) were the main ETS locations. Child ETS exposure was inversely correlated with having a non-single mother, maternal education, income, use of prenatal preventive care, and satisfactory parenting. Discussion: ETS exposure in inner-city children was prevalent. Findings of this study may aid pediatric practitioners and public health workers in providing targeted interventions.

Clark TT; Belgrave FZ; Abell M. The mediating and moderating effects of parent and peer influences upon drug use among African American adolescents. Journal of Black Psychology 38(1): 52-80, 2012. (30 refs.)

This study recruited 567 African American youth (mean age = 15.27 years; 65.1% girls) to examine the role of parent and peer contexts on drug use among African American adolescents. Data were collected on demographics, drug refusal efficacy, drug use, and various psychosocial factors including family and peer factors. When controlling for age and gender, parental monitoring and peer risky behavior completely mediated the relationship between parental attitudes toward drug use and drug refusal efficacy and partially mediated the relationship between parental attitudes toward drug use and current alcohol use. Only peer risky behavior mediated the relationships between parental attitudes toward drug use and current tobacco and marijuana use. Results also revealed several salient moderating relationships. Implications for prevention programs are provided and include strengthening current parenting skills and focusing efforts on fostering the mother-adolescent relationship.

Clark TT; Nguyen AB; Belgrave FZ. Risk and protective factors for alcohol and marijuana use among African-American rural and urban adolescents. Journal of Child & Adolescent Substance Abuse 20(3): 205-220, 2011. (38 refs.)

The purpose of this study was to examine individual, family, peer, and community risk and protective factors associated with past-30-days alcohol and marijuana use among African-American adolescents living in rural and urban communities. This study used data collected from 907 tenth-and twelfth-grade African-American students who completed the 2005 Community Youth Survey. Peer and individual risk/protective factors were more influential for urban youths while family and community risk/protective factors were more influential for rural youths. This pattern held for alcohol and marijuana use. Implications for substance use prevention programming are discussed.

Cohen EL; Caburnay CA; Rodgers S. Alcohol and tobacco advertising in black and general audience newspapers: Targeting with message cues? Journal of Health Communication 16(6): 566-582, 2011. (65 refs.)

This study content analyzed 928 tobacco-and alcohol-related advertisements from a 3-year national sample of Black (n = 24) and general audience (n = 11) newspapers from 24 U. S. cities. The authors compared the frequency of tobacco and alcohol product and control advertising in Black versus general audience newspapers, as well as the presence of 5 message cues: model ethnicity, presence of health official, referral to resources, personal behavior mobilization, and localization. Results within health issues show that Black newspapers had more alcohol product advertising than did general audience newspapers. In contrast, Black newspapers had less alcohol and tobacco control advertising than general audience newspapers. Black newspapers' tobacco/alcohol product advertisements had more African American models than did general audience newspapers' tobacco/alcohol advertising, whereas general audience newspapers' tobacco control advertisements were significantly more likely to feature public health officials than ads in Black newspapers. Fewer message cues such as personal behavior mobilization, referral to resources, and localization were present in Black versus general audience newspapers. Results suggest that Black newspapers may have greater dependency than do general audience newspapers on these risk-related advertisements that target African American consumers. Given the current advertising environment, public health initiatives are needed to counter unhealthy alcohol product advertising messages that target vulnerable populations.

Copeland-Linder N; Lambert SF; Chen YF; Ialongo NS. Contextual stress and health risk behaviors among African American adolescents. Journal of Youth and Adolescence 40(2): 158-173, 2011. (111 refs.)

This study examined the longitudinal association between contextual stress and health risk behaviors and the role of protective factors in a community epidemiologically-defined sample of urban African American adolescents (N = 500; 46.4% female). Structural equation modeling was used to create a latent variable measuring contextual stress (community violence, neighborhood disorder, and experiences with racial discrimination). Contextual stress in 8th grade was associated with aggressive behavior and substance use 2 years later for boys. For girls, contextual stress predicted later substance use, but not aggressive behavior. High academic competence and self-worth reduced the impact of contextual stress on substance use for boys. Implications for intervention and directions for future research on health risk behaviors among African American adolescents are discussed.

Cote ML; Colt JS; Schwartz KL; Wacholder S; Ruterbusch JJ; Davis F. Cigarette smoking and renal cell carcinoma risk among Black and White Americans: Effect modification by hypertension and obesity. Cancer Epidemiology, Biomarkers & Prevention 21(5): 770-779, 2012. (37 refs.)

Background: Incidence of kidney cancer has been increasing over the past three decades, with more rapid increases and higher incidence rates among blacks than whites in the United States. An association between cigarette smoking and renal cell carcinoma (RCC), the most common form of kidney cancer, has been reported for whites, but the association in blacks is less clear. Methods: The association between smoking and RCC was examined in 1,217 incident cases and 1,235 population controls frequency-matched on age, race, gender, and study site in the Kidney Cancer Study in Detroit, MI, and Chicago, IL. Results: In white individuals, increasing duration and number of pack-years of both were associated with increased risk of RCCs after adjusting for age, gender, education, study site, body mass index (BMI) and history of hypertension (P-trend=0.0002 and P-trend=0.002, respectively). Among black individuals, RCC risk increased with duration of smoking (P-trend=0.02) but not other measures. Compared with current smokers, RCC risk decreased with increasing years of smoking cessation among both whites and blacks (P-trend=0.01 and 0.02, respectively). When examining risk according to hypertension history, associations between smoking and RCC risk were observed only among individuals who reported never having been diagnosed with hypertension. Similarly, cigarette smoking was associated with increased risk of RCCs among nonobese individuals but not among those with BMI >= 30 kg/m(2). Conclusion: Our observation that smoking is associated with RCC only in nonobese individuals and those with no history of hypertension are novel findings. Impact: The complex relationships between RCCs, smoking, hypertension, and obesity require additional confirmation.

Davis TA; Ancis J. Look to the relationship: A review of African American women substance users' poor treatment retention and working alliance development. (review). Substance Use & Misuse 47(6): 662-672, 2012. (100 refs.)

Emergent findings specific to African American women confirm that their substance user treatment retention rates are significantly lower than other groups, which is problematic given that substance user treatment is effective largely to the extent that clients are retained in treatment. This article reviews existing literature concerning disparities in treatment retention, highlights a significant barrier to treatment retention for this population, and presents support for an empirical focus on culturally responsive working alliance development as a promising step toward improving retention rates for African American women substance users.

Delnevo CD; Gundersen DA; Hrywna M; Echeverria SE; Steinberg MB. Smoking-cessation prevalence among US smokers of menthol versus non-menthol cigarettes. American Journal of Preventive Medicine 41(4): 357-365, 2011. (34 refs.)

Background: The Food and Drug Administration currently is assessing the public health impact of menthol cigarettes. Whether menthol cigarettes pose increased barriers to quitting is a critical issue because previous declines in smoking prevalence have stalled. Purpose: To explore whether menthol cigarette smokers are less likely to quit than non-menthol smokers at the population level and whether this relationship differs by race/ethnicity. Methods: Cross-sectional analyses of the 2003 and 2006/2007 Tobacco Use Supplement to the Current Population Survey were conducted in 2010. Multiple logistic regressions were used to calculate the adjusted odds of cessation for menthol smoking relative to non-menthol smoking. Five different sample restrictions were used to assess the robustness of the findings. Results: In the broadest sample restriction, menthol smokers were less likely to have quit smoking (AOR=0.91, 95% CI=0.87, 0.96). This relationship holds among whites (AOR=0.93, 95% CI=0.88, 0.98) and blacks (AOR=0.81, 95% CI=0.67, 0.98). The magnitude of the relationship among Hispanics was similar to that among whites, but differed by Hispanic origin. Among those of Mexican origin, the AOR for menthol smokers was protective but not significant (AOR=1.29, 95% CI=0.99, 1.61), whereas among those of Puerto Rican origin, menthol smokers were less likely to have quit (AOR=0.57, 95% CI=0.37, 0.87). These findings were robust and significant in four of five sample restrictions. Conclusions: Smoking menthol cigarettes is associated with decreased cessation at the population level, and this association is more pronounced among black and Puerto Rican smokers. These findings support the recent calls to ban menthol flavoring in cigarettes.

Dorn SD; Meek PD; Shah ND. Increasing frequency of opioid prescriptions for chronic abdominal pain in US outpatient clinics. Clinical Gastroenterology and Hepatology 9(12): 1078-U179, 2011. (40 refs.)

BACKGROUND & AIMS: Opioids are sometimes used to treat chronic abdominal pain. However, opioid analgesics have not been proven to be an effective treatment for chronic abdominal pain and have been associated with drug misuse, constipation, and worsening abdominal pain. We sought to estimate the national prescribing trends and factors associated with opioid prescribing for chronic abdominal pain. METHODS: Chronic abdominal pain-related visits by adults to US outpatient clinics were identified using reason-for-visit codes from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1997-2008). Data were weighted to produce national estimates of opioid prescriptions over time. Logistic regression analyses, adjusted for complex survey design, were performed to identify factors associated with opioid use. RESULTS: The number of outpatient visits for chronic abdominal pain consistently decreased over time from 14.8 million visits (95% confidence interval [CI], 11.6-18.0 visits) in 1997 through 1999 to 12.2 million visits (95% CI, 9.0-15.6 visits) or 1863 visits per 100,000 population in 2006 through 2008 (P for trend = 0.04). Conversely, the adjusted prevalence of visits for which an opioid was prescribed increased from 5.9% (95% CI, 3.5%-8.3%) in 1997 through 1999 to 12.2% (95% CI, 7.5%-17.0%) in 2006 through 2008 (P = 0.03 for trend). Opioid prescriptions were most common among patients aged 25 to 40 years old (odds ratio [OR] 4.6; 95% CI, 1.2-18.4). Opioid prescriptions were less common among uninsured (OR 0.1; 95% CI, 0.04-0.40) and African American (OR 0.3; 95% CI, 0.1-0.9) patients. CONCLUSIONS: From 1997 to 2008 opioid prescriptions for chronic abdominal pain more than doubled. Further studies are needed to better understand the reasons for and consequences of this trend.

Ewing SWF; Venner KL; Mead HK; Bryan AD. Exploring racial/ethnic differences in substance use: A preliminary theory-based investigation with juvenile justice-involved youth. BMC Pediatrics 11: article 71, 2011. (65 refs.)

Background: Racial/ethnic differences in representation, substance use, and its correlates may be linked to differential long-term health outcomes for justice-involved youth. Determining the nature of these differences is critical to informing more efficacious health prevention and intervention efforts. In this study, we employed a theory-based approach to evaluate the nature of these potential differences. Specifically, we hypothesized that (1) racial/ethnic minority youth would be comparatively overrepresented in the juvenile justice system, (2) the rates of substance use would be different across racial/ethnic groups, and (3) individual-level risk factors would be better predictors of substance use for Caucasian youth than for youth of other racial/ethnic groups. Methods: To evaluate these hypotheses, we recruited a large, diverse sample of justice-involved youth in the southwest (N = 651; M age = 15.7, SD = 1.05, range = 14-18 years); 66% male; 41% Hispanic, 24% African American, 15% Caucasian, 11% American Indian/Alaska Native). All youth were queried about their substance use behavior (alcohol, marijuana, tobacco, illicit hard drug use) and individual-level risk factors (school involvement, employment, self-esteem, level of externalizing behaviors). Results: As predicted, racial/ethnic minority youth were significantly overrepresented in the juvenile justice system. Additionally, Caucasian youth reported the greatest rates of substance use and substance-related individual-level risk factors. In contrast, African American youth showed the lowest rates for substance use and individual risk factors. Contrary to predictions, a racial/ethnic group by risk factor finding emerged for only one risk factor and one substance use category. Conclusions: This research highlights the importance of more closely examining racial/ethnic differences in justice populations, as there are likely to be differing health needs, and subsequent treatment approaches, by racial/ethnic group for justice-involved youth. Additionally, this study highlights the need for timely, empirically supported (developmentally and cross-culturally) substance abuse interventions for all justice-involved youth.

Faseru B; Choi WS; Krebill R; Mayo MS; Nollen NL; Okuyemi KS et al. Factors associated with smoking menthol cigarettes among treatment-seeking African American light smokers. Addictive Behaviors 36(12): 1321-1324, 2011. (46 refs.)

Background: Smoking menthol cigarettes is more prevalent among African Americans (AA) compared to Whites. Menthol has been found to be inversely related to smoking cessation among AA, yet little is known about the factors associated with menthol smoking among AA light smokers. This study examines baseline demographic, psychological, and smoking factors associated with smoking menthol cigarettes among AA light smokers (<= 10 cigarettes per day). Methods: Participants (n = 540) were enrolled in a double blind, placebo-controlled randomized trial of bupropion in combination with health education counseling for smoking cessation. Bivariate differences between menthol and non-menthol smokers were explored and baseline factors associated with smoking menthol cigarettes were identified. Results: Participants averaged 46.5 years in age, predominantly female (66.1%), and smoked an average of 8.0 cpd (SD = 2.5). The majority (83.7%) smoked menthol cigarettes. In bivariate analysis, menthol cigarette smokers were younger (mean age: 45 vs. 52 years p<0.0001), were more likely to be female (68% vs. 52% p = 0.003) and had smoked for shorter duration (28 vs. 34 years p<0.0001) compared to non-menthol smokers. While depression and withdrawal scores were slightly higher and exhaled carbon monoxide values were lower among menthol smokers, the differences were not statistically significant. Conclusions: Among M light smokers, younger individuals and females were more likely to smoke menthol cigarettes and may be more susceptible to the health effects of smoking. Appropriately targeted health education campaigns are needed to prevent smoking uptake in this high-risk population.

Finlay AK; White HR; Mun EY; Cronley CC; Lee C. Racial differences in trajectories of heavy drinking and regular marijuana use from ages 13 to 24 among African-American and White males. Drug and Alcohol Dependence 121(1-2): 118-123, 2012. (32 refs.)

Background: Although there are significant differences in prevalence of substance use between African-American and White adolescents, few studies have examined racial differences in developmental patterns of substance use, especially during the important developmental transition from adolescence to young adulthood. This study examines racial differences in trajectories of heavy drinking and regular marijuana use from adolescence into young adulthood. Methods: A community-based sample of non-Hispanic African-American (n = 276) and non-Hispanic White (n = 211) males was analyzed to identify trajectories from ages 13 to 24. Results: Initial analyses indicated race differences in heavy drinking and regular marijuana use trajectories. African Americans were more likely than Whites to be members of the nonheavy drinkers/nondrinkers group and less likely to be members of the early-onset heavy drinkers group. The former were also more likely than the latter to be members of the late-onset regular marijuana use group. Separate analyses by race indicated differences in heavy drinking for African Americans and Whites. A 2-group model for heavy drinking fit best for African Americans, whereas a 4-group solution fit best for Whites. For regular marijuana use, a similar 4-group solution fit for both races, although group proportions differed. Conclusions: Within-race analyses indicated that there were clear race differences in the long-term patterns of alcohol use; regular marijuana use patterns were more similar. Extended follow ups are needed to examine differences and similarities in maturation processes for African-American and White males. For both races, prevention and intervention efforts are necessary into young adulthood.

Fisher HH; Patel-Larson A; Green K; Shapatava E; Uhl G; Kalayil EJ. Evaluation of an HIV prevention intervention for African Americans and Hispanics: Findings from the VOICES/VOCES community-based organization behavioral outcomes project. AIDS & Behavior 15(8): 1691-1706, 2011. (32 refs.)

There is limited knowledge about whether the delivery of evidence-based, HIV prevention interventions in 'real world' settings will produce outcomes similar to efficacy trial outcomes. In this study, we describe longitudinal changes in sexual risk outcomes among African American and Hispanic participants in the Video Opportunities for Innovative Condom Education and Safer Sex (VOICES/VOCES) program at four CDC-funded agencies. VOICES/VOCES was delivered to 922 high-risk individuals in a variety of community settings such as substance abuse treatment centers, housing complex centers, private residences, shelters, clinics, and colleges. Significant risk reductions were consistently observed at 30- and 120-days post-intervention for all outcome measures (e.g., unprotected sex, self-reported STD infection). Risk reductions were strongest for African American participants, although Hispanic participants also reported reducing their risky behaviors. These results suggest that, over a decade after the first diffusion of VOICES/VOCES across the U.S. by CDC, this intervention remains an effective tool for reducing HIV risk behaviors among high-risk African American and Hispanic individuals.

Gray CMK; Montgomery MJ. Links between alcohol and other drug problems and maltreatment among adolescent girls: Perceived discrimination, ethnic identity, and ethnic orientation as moderators. Child Abuse & Neglect 36(5): 449-460, 2012. (51 refs.)

Objectives: This study examined the links between maltreatment, posttraumatic stress symptoms, ethnicity-specific factors (i.e., perceived discrimination, ethnic identity, and ethnic orientation), and alcohol and/or other drug (AOD) problems among adolescent girls. Methods: These relations were examined using archived data from a community sample of 168 Black and Hispanic adolescent girls who participated in a school-based substance use intervention. Results: The results revealed that maltreatment was linked to AOD problems, but only through its relation with posttraumatic stress symptoms; maltreatment was positively related to posttraumatic stress symptoms, which were positively related to AOD problems. Both perceived discrimination and ethnic orientation were significant moderators. Specifically, greater perceived discrimination was associated with an increased effect of maltreatment on posttraumatic stress symptoms. Ethnic orientation demonstrated protective properties in the relation between maltreatment and AOD problem severity, such that the effect of maltreatment on AOD problem severity was less for girls with average to high ethnic orientation compared to girls with low ethnic orientation. Conclusions: The findings of this study underscore the importance of developing interventions for Black and Hispanic girls that target maltreatment and AOD use concurrently and address ethnicity-specific factors.

Green KM; Zebrak KA; Robertson JA; Fothergill KE; Ensminger ME. Interrelationship of substance use and psychological distress over the life course among a cohort of urban African Americans. Drug and Alcohol Dependence 123(1-3): 239-248, 2012. (102 refs.)

Background: Substance use and psychological problems are major public health issues because of their high prevalence, co-occurrence, clustering in socio-economically disadvantaged groups, and serious consequences. However, their interrelationship over time is not well understood. Methods: This study identifies and compares the developmental epidemiology from age 6 to 42 of substance use and psychological distress in a population of African American men and women. Data come from the Woodlawn study, a longitudinal study of an urban community cohort followed since 1966. We use structural equation modeling to examine pathways between substance use (i.e., alcohol, marijuana, and cocaine) and psychological distress over time by gender. Results: We find significant continuity from adolescence to midlife for substance use and for psychological distress, as well as significant correlations within time periods between substance use and psychological distress, particularly among women. We also find greater adolescent substance use predicts psychological distress in young adulthood for men, but no cross-lag associations for women. Women's adolescent psychological distress and substance use are linked uniquely to that of their mothers. Findings show additional gender differences in the developmental etiology of substance use and psychological distress. Conclusions: Findings demonstrate the continuity of substance use and psychological distress over time; the contemporaneous relationships between psychological distress and substance use within time periods, and minimal cross-lagged relationships. Findings also show that adolescent substance use may set boys on a pathway of long-term psychological distress, thus adding to evidence of negative consequences of frequent use.

Grieb SMD; Davey-Rothwell M; Latkin CA. Concurrent sexual partnerships among urban African American high-risk women with main sex partners. AIDS & Behavior 16(2): 323-333, 2012. (52 refs.)

To determine correlates of concurrent sexual partnerships among high-risk low-income urban African American women, survey responses of 337 women who had main sexual partners for over 6 months and reported high-risk behaviors were analyzed; 142 of these women also reported other sexual partnerships within the past 90 days. Unadjusted analyses showed that concurrency was significantly associated with relationship status, sexual debut, forced sex, incarceration of self and partners, depression, drug use, known or suspected partner nonmonogamy, and partner drug use. Age of sexual debut, relationship status, and indicators of problem drug use remained significantly associated with concurrency when controlling for individual factors, and only indicators of problem drug use and known or suspected partner nonmonogamy remained significantly associated with concurrency when also controlling for partner characteristics. Our results suggest the presence of extensive sexual networks within this population and document the need for interventions that address drug abuse and partnership instability. Moreover, the strong association between concurrency and perceptions of partners' nonmonogamy suggest the need for intervention to target men and women in this core group.

Guydish J; Chan M; Bostrom A; Jessup MA; Davis TB; Marsh C. A randomized trial of probation case management for drug-involved women offenders. Crime & Delinquency 57(2): 167-198, 2011. (100 refs.)

This article reports findings from a clinical trial of a probation case management (PCM) intervention for drug-involved women offenders. Participants were randomly assigned to PCM (n = 92) or standard probation (n = 91) and followed for 12 months using measures of substance abuse, psychiatric symptoms, social support, and service utilization. Arrest data were collected from administrative data sets. The sample included mostly African American and White women (age M = 34.7, education M = 11.6 years). Cocaine and heroin were the most frequently reported drugs of abuse, 86% reported history of incarceration, and 74% had children. Women assigned to both PCM and standard probation showed clinical improvement change over time on 7 of 10 measured outcomes. However, PCM group changes were no different than those observed for the standard probation group. Higher levels of case management, drug abuse treatment, and probationary supervision may be required to achieve improved outcomes in this population.

Hamidovic A; Kasberger JL; Young TR; Goodloe RJ; Redline S; Buxbaum SG et al. Genetic variability of smoking persistence in African-Americans. Cancer Prevention Research 4(5): 729- 734, 2011. (30 refs.)

To date, most genetic association analyses of smoking behaviors have been conducted in populations of European ancestry and many of these studies focused on the phenotype that measures smoking quantity, that is, cigarettes per day. Additional association studies in diverse populations with different linkage disequilibrium patterns and an alternate phenotype, such as total tobacco exposure which accounts for intermittent periods of smoking cessation within a larger smoking period as measured in large cardiovascular risk studies, can aid the search for variants relevant to smoking behavior. For these reasons, we undertook an association analysis by using a genotyping array that includes 2,100 genes to analyze smoking persistence in unrelated African American participants from the Atherosclerosis Risk in Communities study, A locus located approximately 4 kb downstream from the 3'-UTR of the brain-derived neurotrophic factor (BDNF) significantly influenced smoking persistence. In addition, independent variants rs12915366 and rs12914385 in the cluster of genes encoding nicotinic acetylcholine receptor subunits (CHRNA5-CHRNA3-CHRNB4) on 15q25.1 were also associated with the phenotype in this sample of African American subjects. To our knowledge, this is the first study to more extensively evaluate the genome in the African American population, as a limited number of previous studies of smoking behavior in this population included evaluations of only single genomic regions.

Hartz SM; Johnson EO; Saccone NL; Hatsukami D; Breslau N; Bierut LJ. Inclusion of African Americans in genetic studies: What is the barrier? American Journal of Epidemiology 174(3): 336-344, 2011. (25 refs.)

To facilitate an increase in the amount of data on minority subjects collected for genetic databases, the authors attempted to clarify barriers to African-American participation in genetic studies. They randomly sampled 78,072 subjects from the community (Missouri Family Registry, 2002-2007). Of these, 28,658 participated in a telephone screening interview, 3,179 were eligible to participate in the genetic study, and 1,919 participated in the genetic study. Response rates were examined in relation to the proportion of subjects in the area who were African-American according to US Census 2000 zip code demographic data. Compared with zip codes with fewer than 5% African Americans (average = 2% African-American), zip codes with at least 60% African Americans (average 87% African-American) had higher proportions of subjects with an incorrect address or telephone number but lower proportions of subjects who did not answer the telephone and subjects who refused the telephone interview (P < 0.0001). Based on reported race from the telephone screening, 71% of eligible African Americans and 57% of eligible European Americans participated in the genetic study (P < 0.0001). The results of this study suggest that increasing the number of African Americans in genetic databases may be achieved by increasing efforts to locate and contact them.

Hedden SL; Whitaker DE; von Thomsen S; Severtson SG; Latimer WW. Latent patterns of risk behavior in urban African-American middle school students in Baltimore City. Journal of Child & Adolescent Substance Abuse 20(1): 34-47, 2011. (47 refs.)

Students who engage in high-risk behaviors, including early initiation of sexual intercourse, alcohol use, marijuana use, tobacco use, and externalizing behavior are vulnerable to a broad range of adverse outcomes as adults. Latent class analysis was used to determine whether varying patterns of risk behavior existed for 212 urban African-American students from Baltimore public schools who were recruited as part of a study for the prevention of drug use. A two-class model was estimated. The proportion of the sample bearing a high probability of each of the five risk behaviors was 10.7%; in comparison, the proportion of students with a low probability of the risk behaviors was 89.3%. Controlling for other variables, older age and parental drug or alcohol use was associated with being in the high-risk class, whereas neighborhood was not predictive of latent class. Results from this study may be used to target early adolescents with co-occurring risk behaviors for prevention and treatment.

Highland KB; McChargue DE. Stress-induced cardiovascular reactivity among African American smokers. American Journal of Health Behavior 35(1): 51-59, 2011. (59 refs.)

Objectives: To test for differences in stress-induced cardiovascular functioning among hypertensive and normotensive African American (AA) smokers. Methods: Participants (n=35) were exposed to both stress and neutral mood inductions. Results: Repeated measures analyses of covariance produced a significant group x mood condition interaction for systolic blood pressure (P=.048), but not for diastolic blood pressure (P>.05). The most notable finding was that AA hypertensive smokers showed selectively greater elevations in their systolic responses compared with normotensive controls following the laboratory-induced stressor. Conclusions: Implications to an elevated risk of future cardiovascular disease among AA hypertensive smokers are discussed.

Hoeppner BB; Redding CA; Rossi JS; Pallonen UE; Prochaska JO; Velicer WF. Factor structure of Decisional Balance and Temptations Scales for smoking: Cross-validation in urban female African-American adolescents. International Journal of Behavioral Medicine 19(2): 217-227, 2012. (45 refs.)

Background: The transtheoretical model is an influential theoretical model in health psychology, particularly in its application to smoking cessation research. Decisional Balance (DB) and Temptations are key constructs within this framework. Purpose This study examines the psychometric properties of the DB and Temptations scales for smoking in a predominantly African-American sample of urban adolescent girls. Methods: We used confirmatory factor analysis to compare the fit of previously published factor structures in smokers (n=233) and nonsmokers (n=598). External validity was tested by examining stages of change differences in the retained subscales. Results: Results supported the internal and external validity of the DB scale for smokers and nonsmokers. Notably, previously published three-factor (Social Pros, Coping Pros, Cons) and four-factor (Cons split into "Aesthetic Cons" and "Health Cons") models fit equally well, with Cons subscales correlating highly. For Temptations, a previously published three-factor (Negative Affect, Social, Weight Control) hierarchical model fit well in nonsmokers. In smokers, previously published subscales were reliably measured, but their structural relationship remained unclear. Stage difference tests showed medium to large effect sizes of DB and Temptation subscales in smokers and nonsmokers. Conclusions: The use of DB was validated for both smokers and nonsmokers in this sample of primarily African-American adolescent females, where Cons can be combined or separated into "Aesthetic Cons" and "Health Cons" based on practical utility and preference. For Temptations, more research is needed but large stage differences in Temptations subscales underscore the importance of this concept in smoking acquisition and cessation.

Hooper MW; Baker EA; de Ybarra DR; McNutt M; Ahluwalia JS. Acculturation predicts 7-day smoking cessation among treatment-seeking African-Americans in a group intervention. Annals of Behavioral Medicine 43(1): 74-83, 2012. (27 refs.)

African-Americans suffer disproportionately from tobacco-associated morbidity and mortality. Considering the relationship between cultural variables and cessation may be important for reducing disparities. This study aimed to examine acculturation as a predictor of smoking cessation following a standard group intervention. Treatment-seeking smokers (N = 140) participated in a group intervention for cessation plus transdermal nicotine patch therapy and completed the African American Acculturation Scale-Revised at baseline. The primary outcome was self-reported 7-day point prevalence abstinence at the end-of-counseling and 3 and 6 months postintervention. Adjusted logistic regression analyses found that acculturation predicted end-of-counseling and 3-month 7-day point prevalence abstinence; traditional African-Americans (i.e., less acculturated) were less likely to quit smoking. Cultural superstitions, religious beliefs and practices, and interracial attitudes were predictive of smoking cessation. Acculturation was associated with cessation following a group-based intervention. Culturally specific adaptations to established interventions might improve outcomes for traditional smokers.

Huguet N; Kaplan MS; McFarland BH. Rates and correlates of undetermined deaths among African Americans: Results from the National Violent Death Reporting System. Suicide and Life-Threatening Behavior 42(2): 185-196, 2012. (38 refs.)

Little is known about the factors associated with undetermined death classifications among African Americans. In this study, the rates of undetermined deaths were assessed, the prevalence of missing information was estimated, and whether the circumstances preceding death differ by race were examined. Data were derived from the 2005-2008 National Violent Death Reporting System. African Americans had higher prevalence of missing information than Whites. African Americans classified as undetermined deaths were more likely to be older, women, never married/single, to have had a blood alcohol content at or above the legal limit, and to have had a substance abuse problem. The results suggest that racial differences in the preponderance and the type of evidence surrounding the death may affect death classification.

Hum AM; Robinson LA; Jackson AA; Ali KS. Physician communication regarding smoking and adolescent tobacco use. Pediatrics 127(6): E1368-E1374, 2011. (27 refs.)

BACKGROUND: Physician advice increases quit rates 1% to 3% above unassisted quit rates among adults, an increase sufficient to be ranked as a high-priority, evidence-based preventive service. However, there is little research on the potential impact of physician advice on adolescent smoking. OBJECTIVE: The purpose of this study was to examine the association between recalled physician communication and adolescents' attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors. METHODS: This study was a retrospective observational study of 5154 students (82.9% black, 17.1% white) from an urban, mid-South school system. Outcome variables included adolescents' self-rated attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors. RESULTS: Physician advice and the combination of screening and advice were associated with healthier attitudes about smoking. Physician screening and advice were also associated with a more accurate knowledge regarding tobacco-related damage. Among current smokers, recalled physician advice was also associated with reduced intentions to smoke in 5 years. Importantly, advised teens were more likely to plan to quit smoking in 6 months. Furthermore, teens who were screened by their physician reported significantly more quit attempts than those who were neither screened nor advised (P = .007). CONCLUSIONS: Physician's tobacco-related interactions with adolescents seemed to positively impact their attitudes, knowledge, intentions to smoke, and quitting behaviors. Brief physician interventions have the potential to be a key intervention on a public health level through the prevention, cessation, and reduction of smoking and smoking-related disease.

Ittiwut C; Yang BZ; Kranzler HR; Anton RF; Hirunsatit R; Weiss RD et al. GABRG1 and GABRA2 variation associated with alcohol dependence in African Americans. Alcoholism: Clinical and Experimental Research 36(4): 588-593, 2012. (34 refs.)

Background: GABRG1 and GABRA2, genes that encode the ?1 and a2 subunits, respectively, of the GABA-A receptor, are located in a cluster on chromosome 4p. Association of alcohol dependence (AD) with markers located at the 3' region of GABRA2 has been replicated in several studies, but recent studies suggested the possibility that the signal may be attributable to the adjacent gene, GABRG1, located 90 kb distant in the 3' direction. Owing to strong linkage disequilibrium (LD) in European Americans (EAs), the origin, or origins, of the association signal is very difficult to discern, but our previous population-based study suggested that decreased LD across the GABRG1GABRA2 region in African Americans (AAs) may be useful for fine mapping and resolution of the association signal in that population. Methods: To examine these associations in greater detail, we genotyped 13 single nucleotide polymorphisms (SNPs) spanning GABRG1 and GABRA2 in 380 AAs with AD and in 253 AA controls. Results: Although there was no association between any individual SNP and AD, a highly significant difference was shown between AD subjects and controls in the frequency of a 3-SNP GABRA2 haplotype (global p = 0.00029). A similar level of significance was obtained in 6-SNP haplotypes that combined tagging SNPs from both genes (global p = 0.00994). High statistical significance was also shown with a 6-SNP haplotype (T-G-C-G-T-A), p = 0.0033. The T-G-C-G-T-A haplotype contains the most significant GABRA2 3-SNP haplotype (p = 0.00019), G-T-A. Conclusions: These findings reflect the interrelationship between these 2 genes and the likelihood that risk loci exist in each of them. Study of an AA population allowed evaluation of these associations at higher genomic resolution than is possible in a EA population, owing to the much lower LD across these loci in AAs.

Juon HS; Fothergill KE; Green KM; Doherty EE; Ensminger ME. Antecedents and consequences of marijuana use trajectories over the life course in an African American population. Drug and Alcohol Dependence 118(2-3): 216-223, 2011. (59 refs.)

Background: We examined developmental trajectories of marijuana use among a cohort of urban African Americans followed from first grade to mid adulthood. We compared risk factors in childhood and adolescence and consequences in mid adulthood across trajectory groups. Methods: Using semiparametric group-based mixture modeling, five marijuana trajectories for men (n = 455) and four trajectories for women (n = 495) were identified extending from adolescence to young adulthood (age 32). We labeled the four trajectory groups similar for men and women "abstainers," "adolescent only users," "early adulthood decliners," and "persistent users." We named the unique fifth group for men "late starters." Results: Multivariate multinomial logistic regressions show that childhood problem behaviors, adolescent family involvement, and dropping out of high school differentiated trajectory membership. Analyses comparing the trajectory groups on behavioral, social, and health outcomes at age 42 revealed that for both men and women, those in the persistent trajectory had the most problems, and those in the early adult decliner group also had specific problems. Male late starters also had poor outcomes. Conclusions: The findings point to the value of identifying specific patterns of substance use over the life course and understanding the differences in their correlates and consequences. The implications of these findings are discussed.

Kabat GC; Shivappa N; Hebert JR. Mentholated cigarettes and smoking-related cancers revisited: An ecologic examination. Regulatory Toxicology and Pharmacology 63(1): 132-139, 2012. (66 refs.)

The US Food and Drug Administration is assessing whether menthol should be banned as an additive to cigarettes. An important part of this determination concerns the health effects of mentholated relative to non-mentholated cigarettes. We examined the ecologic association between sales of mentholated cigarettes for the period 1950-2007, menthol preference by race and sex, and incidence rates of four tobacco-related cancers during 1973-2007. Total sales of mentholated cigarettes (market share) increased from about 3% in 1950 to slightly less than 30% in 1980 and remained fairly stable thereafter. Additional data show consistently that, compared to White smokers, Black smokers favor mentholated cigarettes by roughly a 3-fold margin. Differences in the incidence of lung cancer, squamous cell cancer of the esophagus, oropharyngeal cancer, and laryngeal cancer by race and sex and trends over a 35-year period, during which menthol sales were relatively stable and during which Black smokers were much more likely to smoke mentholated cigarettes compared to Whites, are not consistent with a large contribution of menthol, over and above the effect of smoking per se.

Kandel D; Schaffran C; Hu MC; Thomas Y. Age-related differences in cigarette smoking among whites and African-Americans: Evidence for the crossover hypothesis. Drug and Alcohol Dependence 118(2-3): 280-287, 2011. (48 refs.)

Background: Age crossover describes the age-related reversal in prevalence of current cigarette smoking among non-Hispanic whites and African-Americans, with prevalence higher among whites than African-Americans in adolescence but lower in adulthood. Prior studies have examined smoking patterns in separate adolescent and adult samples and have not sought to identify factors that could account for crossover. We conducted analyses using national samples to identify factors that account for crossover and estimate their impact on crossover age. Methods: Analyses are based on national samples of lifetime smokers 12-49 years old in the 2006-2008 aggregated National Surveys on Drug Use and Health (N = 61,757) (SAMHSA, 2007-2009) and on multiple birth cohorts followed over 21 cross-sectional surveys. Results: We identified crossover for cigarette smoking in the US population at about age 29. Crossover is partially explained by differences between whites and African-Americans in education and marital status, and more weakly by the opposite impact of age of smoking onset on persistence of smoking in the two groups. Controlling for smoking history, education and social role participation would raise crossover in current smoking by more than 14 years. Rates of current smoking among lifetime smokers at four different age categories in multiple birth cohorts followed from ages 12-17 to 35 and over in 21 surveys spanning 24 years confirm the age-related patterns observed cross-sectionally. Conclusion: Age crossover for current smoking appears among whites and African-Americans. Efforts targeted toward improving educational levels of young people would have the strongest impact in decreasing persistent smoking, especially among African-Americans.

Keyes KM; McLaughlin KA; Koenen KC; Goldmann E; Uddin M; Galea S. Child maltreatment increases sensitivity to adverse social contexts: Neighborhood physical disorder and incident binge drinking in Detroit. Drug and Alcohol Dependence 122(1-2): 77-85, 2012. (102 refs.)

Introduction: Exposure to child maltreatment is associated with elevated risk for behavioral disorders in adulthood. One explanation for this life-course association is that child maltreatment increases vulnerability to the effects of subsequent stressors; however, the extent to which maltreatment increases sensitivity to social context has never been examined. We evaluated whether the association between neighborhood physical disorder and binge drinking was modified by child maltreatment exposure. Methods: Data were drawn from the Detroit Neighborhood Health Study, a prospective representative sample of predominately African Americans in the Detroit population. Neighborhood physical disorder was measured via systematic neighborhood assessment. Child maltreatment indicators included self-reported physical, sexual, and emotional abuse. Incident binge drinking was defined as at least one episode of >= 5 drinks (men) or >= 4 drinks (women) in the past 30-day period among those with no binge drinking at baseline (N = 1013). Results: Child maltreatment and neighborhood physical disorder interacted to predict incident binge drinking (8 = 0.16, p = 0.02) and maximum number of past 30-day drinks (8 = 0.15, p = 0.04), such that neighborhood physical disorder predicted problematic alcohol use only among individuals with high exposure to child maltreatment. Conclusion: The results add to the growing literature that African Americans in the US are exposed to an array of stressors that have pernicious consequences for problematic alcohol use. Our results document the need for increased attention to the potential for at-risk alcohol use among populations with a high degree of stress exposure.

Kidney CA; Alvarez J; Jason LA; Ferrari JR; Minich L. Residents of mutual help recovery homes, characteristics and outcomes: Comparison of four US ethnic subgroups. Drugs: Education, Prevention and Policy 18(1): 32-39, 2011. (40 refs.)

This study compared the characteristics and outcomes of four ethnic groups living in mutual help recovery homes. The sample consisted of 524 Caucasian, 305 African American, 31 Latino/a and 17 American Indian (AI) participants. This article includes a short review of relevant literature on AIs and substance use, provides an analysis of characteristics and outcomes of four ethnic groups and includes a discussion of the implications of the findings for knowledge of patterns of use among AIs. The AIs were more likely to report being on parole or probation and being referred for aftercare by the legal system. Additionally, AIs reported greater disharmony within their recovery residences than Caucasians, but there were no significant ethnic differences in baseline length of stay in Oxford House, length of alcohol or drug sobriety or substance use outcomes 4 months after the baseline assessment.

Kiviniemi MT; Orom H; Giovino GA. Psychological distress and smoking behavior: The nature of the relation differs by race/ethnicity. Nicotine & Tobacco Research 13(2): 113-119, 2011. (56 refs.)

We explored how the relation between psychological distress and smoking behavior differed as a function of race/ethnicity of respondents to a representative national survey. Data from the 2007 Health Information National Trends Survey were analyzed. Participants reported experiences of psychological distress in the past 30 days, race/ethnicity, current smoking status (smoker/nonsmoker), and number of cigarettes smoked per day. Logistic regression and linear regression analyses were used to examine the influence of race, distress, and their interaction on smoking behavior using survey weighting techniques to account for sampling strategy and nonresponse. For current smoking status, there was a significant interaction between race and psychological distress. Follow-up analyses indicated that psychological distress was related to smoking status for White but not for Black or Hispanic respondents. Similar results were found for number of cigarettes smoked per day among current smokers. The results suggest that the often-reported association between psychological distress and smoking is relatively specific to White individuals. The relation does not appear to characterize either Black or Hispanic individuals.

Krebs CP; Barrick K; Lindquist CH; Crosby CM; Boyd C; Bogan Y. The sexual assault of undergraduate women at historically black colleges and universities (HBCUs). Journal of Interpersonal Violence 26(18): 3640-3666, 2011. (38 refs.)

Although research has shown that undergraduate women are at high risk for experiencing sexual assault, little research has been conducted with undergraduate women who are attending a historically Black college or university (HBCU). The purpose of this research is to document the prevalence of different types of sexual assault among undergraduate women at HBCUs and make comparisons to data collected from undergraduate women at non-HBCUs. Data on sexual assault victimization were collected from 3,951 undergraduate women at HBCUs using a cross-sectional, web-based survey. These data are compared to data collected from 5,446 undergraduate women at non-HBCUs using the same research methods. Findings indicate that approximately 9.7% of undergraduate women at HBCUs report experiencing a completed sexual assault since entering college. This rate is considerably lower than the comparable rate obtained from undergraduate women at non-HBCUs (13.7%). This difference seems to be associated with differences in alcohol-use frequency. Perhaps undergraduate women at HBCUs drink alcohol much less frequently and are thus less likely to be sexually assaulted when they are incapacitated and unable to provide consent. Alcohol use frequency, while controlling for other factors, seems to have an independent association with the likelihood of an undergraduate woman being sexually assaulted. Implications for the creation and delivery of sexual assault risk reduction and prevention policies and programs are discussed.

Lai H; Fishman EK; Gerstenblith G; Brinker JA; Tong WJ; Bhatia S et al. Vitamin D deficiency is associated with significant coronary stenoses in asymptomatic African American chronic cocaine users. International Journal of Cardiology 158(2): 211-216, 2012. (51 refs.)

Background: Chronic cocaine use may lead to premature atherosclerosis, however, the prevalence of and risk factors for coronary artery disease in asymptomatic cocaine users have not been reported. Methods: Between August 2007 and June 2010, 385 African American chronic cocaine users aged 25 to 54 years were consecutively enrolled in a study to investigate the prevalence of CT angiographically-defined significant (>= 50%) coronary stenosis and related risk factors. Sociodemographic, drug-use behavior, medical history and medication data were obtained by interview and confirmed by medical chart review. Clinical examinations were performed as well as extensive laboratory tests including those for fasting lipid profiles, HIV, high sensitivity C-reactive protein, and vitamin D. Contrast-enhanced coronary CT angiography was performed. Results: Significant coronary stenosis was detected in 52 of 385 participants (13.5%). The prevalences were 12% and 30% in those with low risk and with middle-high risk Framingham score, respectively. In thosewith low risk scores, the prevalences of significant stenosis were 10% and 18% in those without and with vitamin D deficiency, defined as serum 25-(OH) vitamin D<10 ng/mL (p = 0.08). Multiple logistic regression analysis revealed that vitamin D deficiency (adjusted OR = 2.18, 95% CI: 1.07-4.43) is independently associated with the presence of significant coronary stenosis after controlling for traditional risk factors. Conclusions: The study indicates that the prevalence of significant coronary stenoses is high in asymptomatic young and middle-aged African American chronic cocaine users. These findings emphasize the importance of aggressive reduction of risk factors, including vitamin D deficiency in this population.

Le Cook B; Alegria M. Racial-ethnic disparities in substance abuse treatment: The role of criminal history and socioeconomic status. Psychiatric Services 62(11): 1273-1281, 2011. (62 refs.)

Objective: Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities. Methods: Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005-2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt. Results: Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differences decreased and became significantly less than 1 after adjustment for criminal history and socioeconomic status factors. Higher rates of criminal history and enrollment in Medicaid among blacks and Latinos and lower income were specific mechanisms that influenced changes in estimates of disparities across models. Conclusions: The greater likelihood of treatment receipt among persons with a criminal history and lower socioeconomic status is a pattern unlike those seen in most other areas of medical treatment and important to the understanding of substance abuse treatment disparities. Treatment programs that are mandated by the criminal justice system may provide access to individuals resistant to care, which raises concerns about perceived coercion.

Lo CC; Cheng TC. Discrimination's role in minority groups' rates of substance-use disorder. American Journal on Addictions 21(2): 150-156, 2012. (33 refs.)

This study asked whether, among the three largest American racial/ethnic minorities, presence/absence of current substance-use disorder is explained to any degree by social status and discrimination. It examined interaction effects involving discrimination and social status, exploring whether social-status factors are channeled through discrimination, fostering disorder. Logistic regression techniques were applied to data from the nationally representative dataset 20012003 Collaborative Psychiatric Epidemiology Surveys. Findings generally suggest that presence of substance-use disorder is likely to be associated with perceived discrimination. Significant interaction effects were also found: Discrimination's strongest association with substance-use disorder was observed for Asian respondents with lower incomes and for Hispanic respondents with little education. This study significantly expands knowledge, since little research preceding it directly addressed relationships among social-status factors, discrimination, and substance-use disorder in minority populations. This study's results should encourage future researchers to further explore mechanisms of the mental health effects of discrimination.

Lombe M; Yu MS; Nebbitt V; Earl T. Understanding alcohol consumption and its correlates among African American youths in public housing: A test of problem behavior theory. Social Work Research 35(3): 173-182, 2011. (39 refs.)

African American youths are overrepresented in urban public housing developments characterized by violence, poverty, and alternative market activities. Using Jessor and Jessor's problem behavior theory (PBT), the authors examined alcohol use and its correlates in a sample of African American youths from three public housing developments (N = 403). Multiple logistic regression analyses were performed to estimate the relative contributions of demographics, personality, environment, and behavior system variables in predicting past-year alcohol use. Results provide support for PBT. Depressive effects and causes were significant predictors of adolescent alcohol use. Delinquent behavior and affiliation with delinquent peers were also associated with alcohol use. Furthermore, age was related to alcohol use. Implications for practice and future inquiry are suggested.

Longmire-Avital B; Holder CA; Golub SA; Parsons JT. Risk factors for drinking among HIV-positive African American adults: The depression-gender interaction. American Journal of Drug and Alcohol Abuse 38(3): 260-266, 2012. (29 refs.)

Background: Alcohol misuse disproportionately affects people living with HIV. People who struggle with alcohol are also likely to be concurrently struggling with depression. Although there is evidence linking depression to HIV, depression to alcohol, and alcohol to HIV, there is limited research that simultaneously examines the interlocking associations between all three factors. Objective: To investigate the interaction between depression symptomatology and gender on alcohol misuse, while controlling for motivation to reduce drinking, among HIV-positive African Americans. This population was examined because of their increased for developing alcohol dependence. Methods: Data analysis was conducted on baseline survey data of HIV-positive African American adults (N = 88) who drink and were enrolled in the Project PLUS (Positive Living through Understanding and Support) intervention to examine the correlates (i.e., gender, motivation, depression) of drinking in the past 30 days. Results: Hierarchical linear regression analysis showed a significant interaction between gender and depression to predict total drinks reported (R-2 = .56, p < .001). While depression was the sole predictor of drinking for men and suppressed the role of motivation, the reverse was true for women; depression was not a significant predictor after controlling for motivation to reduce drinking. Conclusion: African American men and women living with HIV have different risk factors for recent drinking. Scientific significance: Understanding the link between depression, gender, and motivation to reduce drinking for HIV-positive adults with alcohol problems is crucial for the development of gender and culturally relevant treatments.

Lopez V; Kopak A; Robillard A; Gillmore MR; Holliday RC; Braithwaite RL. Pathways to sexual risk taking among female adolescent detainees. Journal of Youth and Adolescence 40(8): 945-957, 2011. (63 refs.)

Sexual risk taking among female delinquents represents a significant public health problem. Research is needed to understand the pathways leading to sexual risk taking among this population. This study sought to address this issue by identifying and testing two pathways from child maltreatment to non-condom use among 329 White and 484 African American female adolescent detainees: a relational pathway and a substance use coping pathway. The relational pathway indicated that child maltreatment would be related to non-condom use via depressive self-concept and condom use self-efficacy. The substance use coping pathway suggested that depressive self-concept and alcohol-based expectancies for sexual enhancement would mediate the relationship between child maltreatment and non-condom use. As hypothesized, the relational pathway variables were associated with one another in the expected directions; however, evidence of mediation was not found. Support for mediation was found for the substance use coping pathway. Exploratory across group comparison analysis indicated that the relational pathway was significant for White girls whereas the substance use coping pathway was significant for African American girls. Limitations and implications for future research are discussed.

Malone PS; Northrup TF; Masyn KE; Lamis DA; Lamont AE. Initiation and persistence of alcohol use in United States Black, Hispanic, and White male and female youth. Addictive Behaviors 37(3): 299-305, 2012. (26 refs.)

Background: The relation between early and frequent alcohol use and later difficulties is quite strong. However, the degree that alcohol use persists, which is often a necessary cause for developing alcohol-related problems or an alcohol use disorder, is not well studied, particularly with attention to race and gender. A novel statistical approach, the Multi-facet Longitudinal Model, enables the concurrent study of age of initiation and persistence. Methods: The models were applied to longitudinal data on youth alcohol use from ages 12 through 19, collected in the (U.S.) National Longitudinal Survey of Youth 1997 cohort (N = 8984). Results: Results confirmed that Black adolescents initiate alcohol use at later ages than do White youth. Further, after initiation, White adolescents were substantially more likely than Black adolescents to continue reporting alcohol use in subsequent years. Hispanic teens showed an intermediate pattern. Gender differences were more ambiguous, with a tendency for boys to be less likely to continue drinking after initiation than were girls. Conclusions: Novel findings from the new analytic models suggest differential implications of early alcohol use by race and gender. Early use of alcohol might be less consequential for males who initiate alcohol use early, Black, and Hispanic youth than for their female and White counterparts.

Mandara J; Rogers SY; Zinbarg RE. The effects of family structure on African American adolescents' marijuana use. Journal of Marriage and Family 73(3): 557-569, 2011. (39 refs.)

The relationship between family structure and marijuana use throughout adolescence was assessed among 1,069 African Americans from the NLSY. A model was also tested suggesting that the effects of family structure on marijuana use would be mediated by poverty, neighborhood quality, and adolescents' self-control. As most prior studies have found, family structure was not related to female adolescents' marijuana use. For young men, being raised with both biological parents was associated with less marijuana use throughout adolescence compared to those whose mothers never married, divorced early and never remarried, or divorced and remarried. Some support for the model was also found. We concluded that being raised without the presence of a biological father is a risk factor for marijuana use among young men, but African American young women from single-parent households have unique resources that protect them from marijuana use. Understanding those resources may offer insight into prevention programs for other youth.

McCandless PM; Yerger VB; Malone RE. Quid pro quo: Tobacco companies and the Black press. American Journal of Public Health 102(4): 739-750, 2012. (159 refs.)

Objectives. We explored the relationship between tobacco companies and the Black press, which plays an important role in conveying information and opinions to Black communities. Methods. In this archival case study, we analyzed data from internal tobacco industry documents and archives of the National Newspaper Publishers Association (NNPA), the trade association of the Black press. Results. In exchange for advertising dollars and other support, the tobacco industry expected and received support from Black newspapers for tobacco industry policy positions. Beginning in the 1990s, resistance from within the Black community and reduced advertising budgets created counterpressures. The tobacco industry, however, continued to sustain NNPA support. Conclusions. The quid pro quo between tobacco companies and the Black press violated journalistic standards and represented an unequal trade. Although numerous factors explain today's tobacco-related health disparities, the Black press's service to tobacco companies is problematic because of the trust that the community placed in such media. Understanding the relationship between the tobacco industry and the NNPA provides insight into strategies that the tobacco industry may use in other communities and countries.

Mieczkowski T. Assessing the potential for racial bias in hair analysis for cocaine: Examining the relative risk of positive outcomes when comparing urine samples to hair samples. Forensic Science International 206(1-3): 29-34, 2011. (36 refs.)

This article examines the conjecture that hair analysis, performed to detect cocaine use or exposure, is biased against African Americans. It does so by comparing the outcomes of 33,928 hair and 105,792 urine samples collected from both African American and white subjects. In making this comparison the analysis seeks to determine if there is a departure in rates of positive and negative outcomes when comparing the results of hair analysis for cocaine to the results from urinalysis for cocaine by racial group. It treats urine as an unbiased test. It compares both the relative ratios of positive outcomes when comparing the two groups and it calculates the relative risk of outcomes for each group for having positive or negative outcomes. The findings show that the ratios of each racial group are effectively same for hair and urine assays, and they also show that the relative risk and risk estimates for positive and negative outcomes are the same for both racial groups. Considering all samples, the cocaine positive risk estimate for the hair samples comparing the two racial groups is 3.28 and for urinalysis the risk estimate is 3.10 (Breslow-Day chi(2).250, 1 df, p = 0.617) a non-significant difference in risk. For pre-employment samples, the cocaine positive risk estimate for the hair samples comparing the two racial groups is 3.10 and for urinalysis the risk estimate is 2.90 (Breslow-Day chi(2).281, df = 1, p = 0.595), also a non-significant difference in risk.

Montgomery L; Burlew AK; Kosinski AS; Forcehimes AA. Motivational enhancement therapy for African American substance users: A randomized clinical trial. Cultural Diversity & Ethnic Minority Psychology 17(4): 357-365, 2011. (58 refs.)

Limited empirical evidence concerning the efficacy of substance abuse treatments among African Americans reduces opportunities to evaluate and improve program efficacy. The current study, conducted as a secondary analysis of a randomized clinical trial conducted by the Clinical Trials Network of the National Institute of Drug Abuse, addressed this knowledge gap by examining the efficacy of motivational enhancement therapy (MET) compared with counseling as usual (CAU) among 194 African American adults seeking outpatient substance abuse treatment at 5 participating sites. The findings revealed higher retention rates among women in MET than in CAU during the initial 12 weeks of the 16-week study. Men in MET and CAU did not differ in retention. However, MET participants self-reported more drug-using days per week than participants in CAU. Implications for future substance abuse treatment research with African Americans are discussed.

Montgomery BEE; Stewart KE; Wright PB; McSweeney J; Booth BM. "We as drug addicts need that program": Insight from rural African American cocaine users on designing a sexual risk reduction intervention for their community. Substance Use & Misuse 47(1): 44-55, 2012. (38 refs.)

This focused ethnographic study examines data collected in 2007 from four gender- and age-specific focus groups (FGs) (N = 31) to inform the development of a sexual risk reduction intervention for African American cocaine users in rural Arkansas. A semi-structured protocol was used to guide audio-recorded FGs. Data were entered into Ethnograph and analyzed using constant comparison and content analysis. Four codes with accompanying factors emerged from the data and revealed recommendations for sexual risk reduction interventions with similar populations. Intervention design implications and challenges, study limitations, and future research are discussed.

Muscat JE; Liu HP; Stellman SD; Richie JP. Menthol smoking in relation to time to first cigarette and cotinine: Results from a community-based study. Regulatory Toxicology and Pharmacology 63(1): 166-170, 2012. (52 refs.)

Smokers who have their first cigarette shortly after waking, an indicator of nicotine dependence, have substantially higher cotinine levels. There is controversy regarding the role of menthol in nicotine dependence. We hypothesized that menthol smokers have a shorter time to first cigarette (TTFC), and tested whether any statistical association actually reflects increased dependence by measuring nicotine uptake (e.g. cotinine) in the same group of smokers. A cross-sectional community-based study was conducted that included 495 black and white daily cigarette smokers. Results showed a trend between menthol smoking and a shorter TTFC (P < 0.04 in blacks). Menthol was not an independent predictor of cotinine or an effect modifier with TTFC on cotinine levels in blacks and whites. These results show that while menthol in tobacco is associated with an indicator of nicotine dependence in blacks, menthol was not associated with biological uptake of nicotine in black and white smokers.

Nebbitt VE; Lombe M; Yu M; Vaughn MG; Stokes C. Ecological correlates of substance use in African American adolescents living in public housing communities: Assessing the moderating effects of social cohesion. Children and Youth Services Review 34(2): 338, 2012. (65 refs.)

Adolescence is a stage of development when young people explore the larger social world. Accordingly, exposure to violence and other risk factors increase during adolescence. Exposure to community and domestic violence in addition to other contextual and individual correlates have been found associated with substance use. Using a sample of 663 African American adolescents living in urban public housing, this study assesses how multiple risk factors, including for example violence and peers' behavior, are related to adolescents' alcohol, tobacco and marijuana use. This paper also assesses how, or whether, these relationships are moderated by social cohesion. The model explained 28% of the variance in substance use. Mental health symptoms in addition to violence were significantly associated with substance use. These effects, however, were dependent upon levels of social cohesion. Implications to practice are discussed.

Nejtek VA; Kaiser K; Vo H; Hilburn C; Lea J; Vishwanatha J. Are there racial/ethnic differences in indigent inner-city clients with dual diagnoses? Journal of Dual Diagnosis 7(1-2): 26- 38, 2011. (12 refs.)

Objective: This is an exploratory, cross-sectional study that examined personal, clinical, and treatment characteristics among non-Hispanic Caucasian, non-Hispanic African American, and Hispanic indigent inner-city clients with co-occurring disorders. Methods: Men and women aged 20 to 50 years who met DSM-IV criteria for concurrent mood and substance use disorders were eligible. Inpatients, persons in detoxification programs, and incarcerated inmates were excluded. Assessments covered sociodemographic characteristics, clinical diagnoses, substance use, psychosocial variables, health care utilization and treatment history. Results: Two hundred volunteers were screened, and 145 were eligible to enroll. Racial/ethnic group differences in the distribution of mood and substance use disorders and medical diseases were evident. Receiving psychiatric treatment and psychiatric medications significantly differed among racial/ethnic groups, with Caucasians more likely to receive these services than African Americans or Hispanics. African Americans and Hispanics were also more likely than Caucasians to have positive screening results for their drug of choice and for other drugs as well. Serious medical illnesses were evident in about half of the sample, and the distributions of these illnesses significantly differed among racial/ethnic groups. There were no significant differences in hospitalization or emergency department visits among racial/ethnic groups. Conclusions: Indigent inner-city clients have multiple psychiatric and medical problems that warrant continuity of care. However, few doctor's visits for medical illnesses, lack of psychotropic medications, staggering unemployment, and homelessness were common in our sample. These results present health care and social service professionals with potentially serious treatment challenges. Better recognition and understanding of racial/ethnic needs in those with co-occurring disorders are needed.

Noel NE; Maisto SA; Ogle RL; Johnson JD; Jackson LA; Sims CM. A comparison of African-American versus Caucasian men screened for an alcohol administration laboratory study: Recruitment and representation implications. Addictive Behaviors 36(5): 536-538, 2011. (11 refs.)

African-Americans are under-represented in alcohol research, especially alcohol administration laboratory studies. Specific recruitment of African-Americans into laboratory studies, however, may also inadvertently affect the generalizability of the findings. In the current study, we compared all African-American young adult men (n = 53) who volunteered and met criteria for an alcohol administration study to a sample (n = 50) of Caucasian men recruited for the same study. Groups were compared on variables including demographics, quantity and frequency of alcohol consumption and other substance use, consequences of use and psychopathology. Compared to their Caucasian counterparts, African-American men reported less drinking frequency and quantity, less use of other substances and fewer negative consequences, but their alcohol and drug use was more likely to be associated with various measures of psychopathology. Results suggest that even when recruiting participants using criteria that should minimize differences (i.e. all participants were "social drinkers"), differences on key variables were evident. These differences may have important implications for alcohol research.

Nollen NL; Cox LS; Nazir N; Ellerbeck EF; Owen A; Pankey S et al. A pilot clinical trial of varenicline for smoking cessation in Black smokers. Nicotine & Tobacco Research 13(9): 868-873, 2011. (29 refs.)

Introduction: Varenicline, a first-line non-nicotine medication, has not been evaluated in Black smokers, and limited attention has been paid to pharmacotherapy adherence in smoking cessation trials. This pilot study estimated quit rates for Black smokers treated with varenicline and tested a behavioral intervention to aid varenicline adherence. Methods: Seventy-two Black smokers (>10 cigarettes per day; cpd) were randomly assigned to adherence support (AS; n = 36) or standard care (n = 36). All participants received 3 months of varenicline and a single counseling session focused on making a quit plan. AS participants received 5 additional counseling sessions to encourage medication use. Outcome measures included salivary cotinine, and carbon monoxide confirmed smoking abstinence, reductions in self-reported cpd, and pill counts of varenicline adherence at Months 1, 2, and 3. Results: Sixty-one participants (84.7%) completed follow-up at Month 3. Participants were female (62.5%), 46.8 years of age, and smoked 16.3 cpd. No treatment group differences were found on the smoking or adherence outcome measures (p > .05). Collapsing across treatment, varenicline adherence was adequate (86.1%), yet despite a reduction of 12.2 (6.5) cpd from baseline to Month 3 (p < 0.001), only 23.6% were confirmed quit at Month 3. Participants who were quit at Month 3 had higher varenicline adherence rates (95.8%) than those who continued to smoke (80.8%, p <= .05). Conclusions: Studies are needed to examine the efficacy of varenicline among Black smokers. Interventions to facilitate adherence to pharmacotherapy warrant further attention as adherence is linked to improved tobacco abstinence.

Nyamathi A; Hudson A; Greengold B; Leake B. Characteristics of homeless youth who use cocaine and methamphetamine. American Journal on Addictions 21(3): 243-249, 2012. (44 refs.)

This cross-sectional hepatitis health promotion study (N = 156) was designed to identify correlates of cocaine and methamphetamine use among young, homeless persons living in Los Angeles County. Structured questionnaires were administered at baseline to assess sociodemographic characteristics, drug history, and social support. Unadjusted analysis showed that older age, having a history of incarceration, injection drug use (IDU), 10 or more sexual partners, and sex for money were associated with both cocaine and methamphetamine use. Logistic regression results showed that injection drug users had over seven times greater odds of using each stimulant compared with nonusers of injection drugs; those reporting at least 10 sexual partners and alcohol use in the past 6 months were more likely to use cocaine than their respective counterparts. African Americans were also less likely than Whites to report cocaine use. Understanding of these relationships can guide interventions targeting the multiple challenges faced by this population.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance Use among Black Adolescents. (October 4, 2011). Rockville MD: Substance Abuse and Mental Health Administration, 2011. (6 refs.)

This report examines substance use among non-Hispanic black or African American adolescents. This report is one in a series of reports intended to describe adolescent substance use within racial and ethnic subpopulations in the United States. Black/African American adolescents have lower rates of substance use than white adolescents. Researchers have suggested that family attitudes and behaviors that discourage drug use may contribute to the relatively low rates of drug use observed among black youths. However, despite the lower drug use rates in adolescence, rates of drug use among black adults closely mirror or exceed those among white adults. Compared with the national average for adolescents aged 12 to 17, black adolescents had lower rates of past month cigarette use (5.8 vs. 10.2%), alcohol use (10.5 vs. 16%), marijuana use (6.5 vs. 6.9%), and nonmedical use of prescription-type drugs (2.9 vs. 3.3%). The rate of marijuana use among black adolescents increased from 5.9% in 2008 to 7.5% in 2010. The rates of past month cigarette use and alcohol use among black adolescents living in poverty were lower than the national averages for adolescents living in poverty (6.8 vs. 10.6% and 10.7 vs. 13.5%, respectively).

Public Domain

Okuyemi KS; Faseru B; Reed GA; Cox LS; Bronars CA; Opole I et al. Effects of menthol on the pharmacokinetics of bupropion among Black smokers. Nicotine & Tobacco Research 14(6): 688-693, 2012. (27 refs.)

Despite the widespread use of mentholated cigarettes, lower cessation rates, and disproportionately high smoking-related morbidity among Blacks, the possible role of menthol in smokers' response to pharmacotherapy has not been well-studied. This study examined the effects of menthol on the pharmacokinetic (PK) profiles of bupropion and its principal metabolites, hydroxybupropion, threohydrobupropion, and erythrohydrobupropion among Black smokers. After a 7-day placebo run-in period, participants received 150 mg bid sustained-release bupropion for 20-25 days. Blood samples were drawn for PK analysis on 2 occasions, 10-15 days after the commencement of bupropion while participants were still smoking (smoking phase) and at days 20-25 when they were asked not to smoke (nonsmoking phase). 18 smokers of nonmenthol cigarettes and 23 smokers of menthol cigarettes were enrolled in this study. No differences were found by menthol smoking status in the Cmax and area under the plasma concentration versus time curve (AUC) of bupropion and its metabolites in the smoking or nonsmoking phases. However, among menthol smokers, the AUC ratios of metabolite/bupropion were lower in the nonsmoking phase compared with the smoking phase (hydro/bup = 31.49 +/- 18.84 vs. 22.95 +/- 13.27, p = .04; erythro/bup = 1.99 +/- 1.02 vs. 1.76 +/- 0.75, p = .016; threo/bup = 11.77 +/- 8.90 vs. 10.44 +/- 5.63, p = .034). No significant differences were found in the metabolite/bup ratios between smoking and nonsmoking conditions among nonmenthol smokers. We did not find a significant effect of menthol compared with nonmenthol cigarette smoking on the PKs of bupropion and metabolites at steady state. More research is needed to advance the understanding of mechanisms underlying disparities in smoking cessation outcomes related to smoking of menthol cigarettes.

Pahl K; Brook JS; Koppel J. Trajectories of marijuana use and psychological adjustment among urban African American and Puerto Rican women. Psychological Medicine 41(8): 1775-1783, 2011. (55 refs.)

Background. The current longitudinal study examined the developmental patterns of marijuana use and their relationship with subsequent psychological adjustment in a community-based sample of urban African American and Puerto Rican women. Method. Participants were interviewed five times over a period ranging from adolescence (mean age 14.0 years) to adulthood (mean age 32.5 years). Outcome measures included depressive symptoms, anger/hostility and the presence of a substance use disorder (abuse/dependence). Results. Three distinct trajectories of marijuana use were identified : non-users, increasers and quitters. Increasers reported higher levels of depressive symptoms and anger/hostility than did non-users and were more likely to meet criteria for a substance use disorder at age 32.5 years. Conclusions. Our findings indicate that early-starting long-term use of marijuana is associated with psychological maladjustment among women. Prevention efforts should emphasize the long-term cost associated with marijuana use, and that the best psychological health is reported by those who abstain from the drug.

Pahl K; Brook JS; Koppel J; Lee JY. Unexpected benefits: Pathways from smoking restrictions in the home to psychological well-being and distress among urban Black and Puerto Rican Americans. Nicotine & Tobacco Research 13(8): 706-713, 2011. (59 refs.)

Introduction: This study examined the pathways from smoking policies in the home (no ban, partial ban, and total ban on smoking) to psychological well-being (e.g., self-esteem) and psychological symptoms (e.g., depressive symptoms) as mediated by a healthy lifestyle (engaging in exercise, eating healthful foods, and sleeping enough) and cigarette smoking among a sample of urban Black and Puerto Rican Americans. Methods: Questionnaire data were collected from 816 participants (mean age = 32 years). Structural equation modeling (SEM) was employed to examine the pathways of restrictions on smoking in the home to a healthy lifestyle, cigarette smoking, psychological well-being, and psychological distress. Results: The SEM showed mediational pathways linking higher levels of restrictions on smoking in the home with a healthy lifestyle, which in turn was related negatively to psychological distress and positively to psychological well-being. Higher levels of restrictions on smoking in the home were also related inversely to cigarette smoking, which was related positively to psychological distress and negatively to psychological well-being. Conclusions: Findings show that higher levels of restrictions on smoking in the home are associated with a healthier lifestyle and less cigarette smoking, which in turn are associated with better psychological functioning. Greater restrictions on smoking in the home may thus support positive lifestyle choices, including exercise and nutrition, as well as psychological functioning.

Palmer RC; McKinney S. Health care provider tobacco cessation counseling among current African American tobacco users. Journal of the National Medical Association 103(8): 660-667, 2011. (41 refs.)

Tobacco use is the leading cause of preventable mortality and morbidity in the United States. Patients advised to quit use of tobacco products by their health care providers are more likely to quit, yet it has been documented that patients are not receiving this advice. The aim of this study was to investigate whether or not current African American tobacco users were receiving provider-initiated advice to quit. A cross-sectional survey identified 245 self-reported African American tobacco users residing in Maryland. Study variables collected included sociodemographics,, access to care, smoking status, and assessed if tobacco cessation counseling was ever provided. Among those surveyed, only 42% reported ever being counseled to quit tobacco use and, of those who had a recent clinical encounter (within the past year), only 20% reported being counseled. Multivariate logistic regression identified that having a regular source of health care, living in an urban setting, and being female increased chances of being advised to quit tobacco use. Overall, findings indicate that African Americans are not being screened or receiving cessation counseling as recommended by leading health agencies. Health care provider training to promote better integration of tobacco screening and tobacco cessation counseling during the patient encounter is needed.

Park ER; Kleimann S; Youatt EJ; Lockhart A; Campbell EG; Levy DE et al. Black and White adults' perspectives on the genetics of nicotine addiction susceptibility. Addictive Behaviors 36(7): 769-772, 2011. (49 refs.)

Aims: Emerging research may soon lead to improved quit rates via genetically-tailored smoking cessation treatment. The purpose of this study was to explore individuals' beliefs and attitudes about genetic testing in this context, and how these may differ across racial groups. Design: Two site qualitative study. Methods: Eleven focus groups were conducted in 2007 with 51 Black and 55 White adult participants in Montgomery, AL and Baltimore, MD. Measurements: Questions were asked about smoking as an addiction, the role of genetics in nicotine addiction susceptibility, and undergoing genetic testing to receive tailored smoking cessation treatment. Data were analyzed using content analysis. Findings: Most participants believed that smoking was an addiction yet were unwilling to endorse the notion that genetics played a role in nicotine addiction susceptibility. However, 91% of White participants and 62% of Black participants indicated that they would likely take a genetic test that would match them to their optimal smoking cessation treatment. The primary potential benefit was a vague sense that additional knowledge about oneself would be of value. Primary barriers included disinterest and skepticism about the test, unwillingness to believe that genetics played a role in nicotine addiction or treatment response, and concerns about psychological consequences. Conclusions: The majority of participants, particularly Black participants, did not believe that genetics played a significant role in nicotine addiction susceptibility but were willing to undergo genetic testing. Participants identified some benefit to tailoring smoking treatment by genotype. However, participants also expressed skepticism about the test and concerns about its consequences; these issues would need to be addressed in the clinical encounter.

Pedersen SL; Treloar HR; Burton CM; McCarthy DM. Differences in implicit associations about alcohol between blacks and whites following alcohol administration. Journal of Studies on Alcohol and Drugs 72(2): 270-278, 2011. (40 refs.)

Objective: Implicit cognitions about alcohol have been shown to be an important predictor of alcohol use. Relatively little research has been conducted on racial/ethnic differences in implicit cognitions or changes in implicit cognitions while intoxicated. This study examined differences between Blacks and Whites in positive and negative implicit associations about alcohol, as measured by the Implicit Association Test (IAT) and tested differences in IAT scores when participants were sober and intoxicated. Method: One hundred thirty-five young adults (46% of Black descent) participated in an alcohol-administration study, receiving a moderate dose of alcohol (0.72 g/kg alcohol for men, 0.65 g/kg for women). The IAT was administered in two sessions, one in which alcohol was administered (30 minutes after alcohol consumption) and one in which it was not, approximately 1 week apart. Results: Repeated-measures mixed-factorial analyses of variance were conducted separately for positive and negative IAT scores. Blacks held lower positive and negative implicit cognitions about alcohol compared with Whites. Positive and negative IAT scores did not change as a function of intoxication. Positive explicit expectancies and self-reported past-month drinking behavior were related to positive IAT scores. Positive and negative IAT scores were also related to acute subjective response to alcohol, and this association differed by race. Conclusions: Results extend previous studies by providing evidence for racial differences in implicit cognitions about alcohol and by showing the stability of the IAT while participants are intoxicated. Future studies are needed to determine what factors contribute to racial differences in implicit cognitions.

Peterson NA; Yu DL; Morton CM; Reid RJ; Sheffer MA; Schneider JE. Tobacco outlet density and demographics at the tract level of analysis in New Jersey: A statewide analysis. Drugs: Education, Prevention and Policy 18(1): 47-52, 2011. (28 refs.)

Aim: Geographic relationships between tobacco outlet density and demographics were examined at the tract level in New Jersey, a Northeastern US state. Method: Data for 1938 residential census tracts were analyzed. The 2000 TIGER/Line files were used to geocode addresses of licensed tobacco-selling retail outlets. Median income, percent African-American residents, and percent Hispanic residents were based on year 2000 census data. Address matching with ArcGIS (R) resulted in successful geocoding of 13,984 (93.1%) outlets. Findings: Results showed that outlet density was significantly related with demographics. Tracts with greater density of tobacco outlets tended to have lower median household income and higher percentages of African-American or Hispanic residents. Cluster analysis of tracts resulted in a three-cluster solution, identifying high, medium and low areas of disparity. The high disparity area was characterized by tracts with the highest tobacco outlet density, the highest percentages of African-American and Hispanic residents, the lowest percentage of white residents, and the lowest median income. Further analysis showed that while there were significant associations between tobacco outlet density and all three demographic variables across the state, such associations varied in each of the three clusters. Conclusions: Results may be used to inform strategic planning and policy decisions on a statewide basis.

Plebani JG; Oslin DW; Lynch KG. Examining naltrexone and alcohol effects in a minority population: Results. from an initial human laboratory study. American Journal on Addictions 20(4): 330-336, 2011. (32 refs.)

Prior clinical findings have indicated a potential lack of naltrexone efficacy among African Americans with alcohol dependence. However, no definitive conclusions have been drawn due to the relatively small numbers of African Americans in most alcohol treatment trials. The purpose of this study was to examine alcohol and naltrexone effects on healthy African-American individuals in a laboratory environment. Nonalcohol-dependent social drinking adults of African descent (n = 43) were recruited for participation. After consenting and completing the baseline assessment, they participated in four separate alcohol challenge sessions each separated by at least 10 days. During each of the sessions, subjects were administered alcohol or sham drinks, after pretreatment with either naltrexone (50 mg/day) or placebo in a double-blind fashion. The order of the four sessions was randomly assigned. During each session, breath alcohol levels and subjective responses were measured. Results indicate an alcohol effect among these subjects for subjective responses, but no naltrexone effect. Similar to the apparent lack of clinical efficacy findings, naltrexone does not appear to impact alcohol effects in African-American social drinkers. Future studies should investigate African-American populations with heavy drinking as well as alcohol-dependent subjects in order to strengthen the parallels to clinical findings.

Proctor C; Barnett JA; Muilenburg J. Investigating race, gender, and access to cigarettes in an adolescent population. American Journal of Health Behavior 36(4): 513-521, 2012. (35 refs.)

Objective: To examine race and gender as potential predictors for access to cigarettes and purchasing behaviors among an adolescent population. Methods: Data were collected from a survey administered to 4336 high school students. The significance was examined using the chi-square test, with a P-value <=.05. Results: Noncommercial outlets were the primary source of cigarette acquisition for white students; African American students were more likely than white students to use commercial sources to acquire cigarettes; females were more likely to report not being asked to show proof of age. Conclusions: Interventions designed to reduce youth access to tobacco must address racial and gender differences.

Reisner S; Mimiaga M; Bland SE; Driscoll MA; Cranston K; Mayer KH. Pathways to embodiment of HIV risk: Black men who have sex with transgender partners, Boston, Massachusetts. AIDS Education and Prevention 24(1): 15, 2012. (37 refs.)

A dearth of research to date has explored HIV risk among Black men who report sex with transgender partners. In 2008, 197 Black men residing in Massachusetts were recruited via modified respondent-driven sampling and completed an interviewer-administered survey. Overall, 8% reported sex with a transgender partner in the past 12 months. Over half (56%) reported unprotected sex during their last encounter with transgender partners. Factors significantly associated with having a transgender sex partner: history of substance abuse, incarceration, PTSD symptoms, lower levels of perceived social support, not having been exposed to HIV prevention services in the past 12 months, and endorsement of mobile van services as a comfortable location to access health care. These formative data suggest that Black men who partner with transgender individuals may be at elevated risk for an array of poorer health-related outcomes, including HIV sexual risk, substance abuse, incarceration, psychosocial vulnerability, and lack of access to health care. Theory-driven interventions that consider the broader context affecting the embodiment of HIV risk are warranted for men who have sex with transgender partners.

Reitzel LR; Vidrine JI; Businelle MS; Kendzor DE; Cao YM; Mazas CA et al. Neighborhood perceptions are associated with tobacco dependence among African American smokers. Nicotine & Tobacco Research 14(7): 786-793, 2012. (39 refs.)

The animal and human research literatures suggest that deprived environmental conditions may be associated with drug dependence, but the relation of neighborhood perceptions with a multidimensional measure of tobacco dependence has not been previously studied. The purpose of this study was to examine the associations between neighborhood perceptions (neighborhood problems and neighborhood vigilance) and tobacco dependence among smokers as measured by the Wisconsin Inventory of Smoking Dependence Motives-68 (WISDM). Participants were 384 African American smokers (49% men, 80% <$30,000 annual household income) enrolled in a randomized clinical trial of a smoking cessation intervention. A series of regression models were conducted to examine the associations between neighborhood perceptions and tobacco dependence using a generalized estimating equation approach, which accounted for potential correlation in tobacco dependence between participants from the same neighborhood. Results indicated that more self-reported neighborhood problems and greater neighborhood vigilance were significantly associated with tobacco dependence as measured by the WISDM total score in analyses adjusted for age, gender, income, education, employment status, and partner status (p < .002). Neighborhood perceptions were related to both primary and secondary dependence motives (p < .005). Results suggest that the neighborhood context is associated with dependence on tobacco among African American smokers but longitudinal studies are needed to assess causation. Future research should also explore the mechanisms that account for the associations between neighborhood perceptions and tobacco dependence to better inform intervention development.

Rosen D; Goodkind S; Smith ML. Using photovoice to identify service needs of older African American methadone clients. Journal of Social Service Research 37(5): 526-538, 2011. (36 refs.)

This article presents findings from a photovoice project designed to identify service needs of older-adult African American methadone clients, as well as their current barriers to and supports for abstinence. The project involved 10 participants (aged 53 to 63 years old) recruited from a methadone maintenance program in a large Northeastern U.S. city. Thematic analysis techniques were used to analyze participants' narratives of their pictures. Transportation emerged as a significant challenge to accessing services, and caregiving was a motivation for remaining abstinent. Future research should use similar participatory methods and engage a broader group of aging people struggling with substance abuse.

Ryan KK; Garrett-Mayer E; Alberg AJ; Cartmell KB; Carpenter MJ. Predictors of cessation pharmacotherapy use among Black and Non-Hispanic white smokers. Nicotine & Tobacco Research 13(8): 646-652, 2011. (36 refs.)

Introduction: Use of pharmacotherapy for smoking cessation improves quit rates, but these treatments are underutilized, particularly among Black smokers. Attitudes toward pharmacotherapy may differ between racial/ethnic minorities and Caucasian smokers. It was hypothesized that Black and non-Hispanic White smokers would differ in their attitudes toward pharmacotherapy and that the association between attitudes toward and actual use of pharmacotherapy would differ by race. Methods: The study consisted of a single, cross-sectional telephone-based survey of current smokers (N = 697), which examined the relationship between race, attitudes toward pharmacotherapy, and pharmacotherapy usage in a representative bi-racial sample (39% Black). Results: Black smokers were significantly less likely to report ever use of pharmacotherapy (23%) than Caucasians (39%; odds ratio [OR] = 0.46; 95% CI: 0.33-0.66). Compared with Caucasians, Blacks had significantly less favorable attitudes toward pharmacotherapy, including disbelief about efficacy (p = .03), addiction concerns (p = .03), harmfulness of pharmacotherapy (p = .008), and need for treatment of any kind to quit smoking (p = .004). In a multiple logistic regression, racial group (Caucasian is referent: OR = 0.55, p = .003), addiction concerns (OR = 0.80, p < .01), and need for treatment of any kind to quit smoking (OR = 1.52, p < .001) were predictive of pharmacotherapy use. Conclusions: These findings replicate and build upon previous research demonstrating underutilization of pharmacotherapy and enduring misconceptions about pharmacotherapy, particularly among Black smokers. Regardless of racial group, misconceptions about pharmacotherapy are related to lower rates of use. Efforts to improve understanding about the efficacy and safety of these products are needed to boost utilization and impact cessation rates.

Scott MC; Edwards L; Lussier LR; Devine S; Easton CJ. Differences in legal characteristics between Caucasian and African-American women diverted into substance abuse treatment. Journal of the American Academy of Psychiatry and the Law 39(1): 65-71, 2011. (29 refs.)

In this exploratory study. we examined differences in the legal characteristics of Caucasian and African-American female offenders (n = 122) who were diverted into substance abuse treatment, to identify any racial disparities. We also examined the differences between groups in demographics and in substance abuse, family, and violence histories. In terms of legal characteristics, the results showed that African-American female offenders were significantly more likely to have been incarcerated at the time of their substance dependency evaluation than were Caucasian female offenders. Also, African-American women were more likely to have served 13 months for the current legal charge in comparison to the 4 months served by Caucasian women, although no differences were found between groups in the severity of the current legal charge. Comparison of demographics and substance abuse, family, and violence histories indicated that African-American women were more likely to be undereducated, crack cocaine dependent, and overly exposed to violence. Overall, the sample of female offenders evidenced severe substance dependency problems, a strong need for inpatient substance abuse treatment, and chronic legal and social difficulties. Implications of these findings are discussed in relation to unbalanced sentencing policies and increasing awareness of the treatment needs of this unique population.

Seth P; Wingood GM; DiClemente RJ; Robinson LS. Alcohol use as a marker for risky sexual behaviors and biologically confirmed sexually transmitted infections among young adult African-American women. Women's Health Issues 21(2): 130-135, 2011. (42 refs.)

Introduction: Previous research has primarily focused on the relationship between illicit drug use and HIV/sexually transmitted infection (STI) risk behavior among African-American women. Very few studies have solely reviewed the role of alcohol use on risky sexual behavior. The present study examined the relationship between alcohol use at non-abuse levels and risky sexual behaviors and STIs among young adult African-American women. Methods: Eight hundred forty-eight African American women, ages 18 to 29, participated at baseline, with 669 and 673 women at 6 and 12 months follow-up, respectively. Participants completed an Audio Computer Assisted Survey Interview assessing sociodemographics, alcohol use, and risky sexual behaviors. Subsequently, participants provided two vaginal swab specimens for STIs. Results: Multivariate logistic regression analyses were conducted for cross-sectional analyses, with illicit drug use as a covariate. Women who consumed alcohol were more likely to have multiple partners and risky partners. Binary generalized estimating equation models assessed the impact of alcohol use at baseline on risky sexual behavior and STIs over a 12-month period. Illicit drug use, intervention group, and baseline outcome measures were entered as covariates. Alcohol consumption predicted positive results for chlamydia, positive results for any STI, and never using a condom with a casual partner over a 12-month follow-up period. Discussion: Frequency of alcohol use at non-abuse levels was correlated with and predicted risky sexual behaviors and STIs. Prevention programs for African-American women should incorporate education regarding the link between alcohol and HIV/STI risk behaviors and the potential negative health consequences

Sinclair CF; Foushee HR; Pevear JS; Scarinci IC; Carroll WR. Patterns of blunt use among rural young adult African-American men. American Journal of Preventive Medicine 42(1): 61-64, 2012. (17 refs.)

Background: Blunts are hollowed-out cigars or leaf tobacco filled with marijuana. Use of blunts has increased since the 1990s and, in 2005, 3.5% of all American youth were estimated to have used blunts in the past month. Blunt smokers may have greater odds of cannabis and tobacco dependency and are at risk of smoking-related diseases. Previous studies have suggested that blunt use is more common among blacks, older teens, and men. However, data pertaining to blunt use in non-adolescent African-American populations are scarce. Purpose: To assess patterns of blunt use among young adult African-American men aged 19-30 years residing in five rural Black Belt counties in Alabama and to compare these data with those from tobacco cigarette smokers within the same study population. Methods: Verbal, face-to-face interviewer-administered survey of 415 participants collected and analyzed between December 2008 and February 2011. Results: 159 respondents (38.3%) smoked cigarettes and 45 smoked blunts (10.8%). Of blunt smokers, 33 also smoked cigarettes (73.3%). Use of blunts was prevalent among unemployed, single men, and occupational blunt use was uncommon. Factors important in the initiation, maintenance, and cessation of product use were similar for blunt and cigarette smokers, especially product use and acceptance by friends. Legal concerns were an important factor facilitating blunt cessation. Conclusions: Blunt use is relatively common among male African Americans aged 19-30 years and is frequently associated with concomitant cigarette use. Tobacco control efforts in this male African-American population should also address blunt usage.

Singer EO; Schensul JJ. Negotiating ecstasy risk, reward, and control: A qualitative analysis of drug management patterns among ecstasy-using urban young adults. Substance Use & Misuse 46(13): 1675-1689, 2011. (37 refs.)

This paper is based on qualitative in-depth interviews conducted from 2008 to 2009 with 118 ethnically diverse Ecstasy users from the greater Hartford area, CT, USA. Participants were urban, primarily Black and Hispanic, aged 18 to 36, and had limited higher education compared with samples in previous Ecstasy research. Interviews focused on personal background, history of Ecstasy and other drug use, and recent sexual events. In this paper, we examine: participants' negotiation of perceived risks and benefits of Ecstasy use, behavioral strategies employed to minimize risks, and the relationship of risk-benefit analysis, motivation for use, frequency of use, and polydrug use to participants' sense of control over their Ecstasy use. We conclude with recommendations for intervention approaches and suggestions for future research.

Sloan FA; Grossman DS. Alcohol consumption in early adulthood and schooling completed and labor market cut comes at midlife by race and gender. American Journal of Public Health 101(11): 2093-2101, 2011. (55 refs.)

Objectives. We assessed the relation of alcohol consumption in young adulthood to problem alcohol consumption 10 years later and to educational attainment and labor market outcomes at midlife. We considered whether these relations differ between Blacks and Whites. Methods. We classified individuals on the basis of their drinking frequency patterns with data from the 1982 to 1984 National Longitudinal Survey of Youth 1979 (respondents aged 19-27 years). We assessed alcohol consumption from the 1991 reinterview (respondents aged 26-34 years) and midlife outcomes from the 2006 reinterview (respondents aged 41-49 years). Results. Black men who consumed 12 or more drinks per week at baseline had lower earnings at midlife, but no corresponding relation for Black women or Whites was found. Black men and Black women who consumed 12 or more drinks per week at baseline had lower occupational attainment than did White male non-drinkers and White female non-drinkers, respectively, but this result was not statistically significant. Conclusions. The relation between alcohol consumption in young adulthood and important outcomes at midlife differed between Blacks and Whites and between Black men and Black women, although Blacks' alcohol consumption at baseline was lower on average than was that of Whites.

Small E; Kohl PL. African American caregivers and substance abuse in child welfare: Identification of multiple risk profiles. Journal of Family Violence 27(5): 415-426, 2012. (96 refs.)

Despite the strong correlation between caregiver substance abuse and child maltreatment, little information exists to understand the typology of African American caregivers with substance abuse problems in the child welfare system. Research shows African American caregivers contend with multiple problems stemming from substance abuse. Unfortunately, we do not yet know how to best tailor resources to be responsive to varying groups of African American caregivers. Using data from the National Survey of Child and Adolescent Well-being (NSCAW), this investigation tested for distinct multivariate profiles among a subset of African American caregivers with substance abuse problems (n = 258). Latent Class Analysis (LCA) was used to classify caregivers, and five classes were identified among this high risk sample-each with distinct risk profiles. Based on these findings, we discuss implications for tailored practices to enhance the safety and stability of children involved with child welfare.

Stanley LR; Henry KL; Swaim RC. Physical, social, and perceived availabilities of alcohol and last month alcohol use in rural and small urban communities. Journal of Youth and Adolescence 40(9): 1203-1214, 2011. (43 refs.)

This study seeks to provide a greater understanding of the factors that determine the perceived availability of alcohol and its role in predicting adolescents' alcohol use. Participants were 151,703 7th-12th grade students (50% female) from a sample of 219 rural communities across the United States, with oversampling for predominantly Mexican-American and African-American communities. Multilevel analysis was used to estimate the perceived availability of alcohol as a function of physical and social availability measures and individual and community-level control variables. Physical availability was measured as the number of alcohol outlets in the community and whether beer and wine were sold in non-liquor stores. Social availability measured the availability of alcohol from social or family groups. Last month alcohol use was then estimated as a function of physical, social and perceived availabilities and control variables. Physical availability had little relationship to perceived availability or recent alcohol use while social availability was a strong predictor of both. Perceived availabilities at the individual and community levels were significant in predicting last month alcohol use. The findings suggest that altering both perceived and actual availability of alcohol can potentially have strong effects on the levels of adolescent alcohol use.

Stock ML; Gibbons FX; Walsh LA; Gerrard M. Racial identification, racial discrimination, and substance use vulnerability among African American young adults. Personality and Social Psychology Bulletin 37(10): 1349-1361, 2011. (66 refs.)

Two studies examined racial identity (RI) as a protective factor against substance use cognitions among African American young adults who either envisioned or experienced racial discrimination. In Study 1, participants envisioned a discrimination or nondiscrimination scenario, and then their willingness to use drugs and an indirect measure of substance use were assessed. Discrimination was associated with higher levels of use cognitions among participants with low levels of RI. In Study 2, participants were excluded or included in an online game (Cyberball) by White peers and then engaged in an RI-affirmation or control writing task. Participants attributed this exclusion to racial discrimination. Excluded participants who did not affirm their RI reported the highest levels of substance use cognitions, especially if they had engaged in higher levels of previous substance use. These findings highlight the importance of RI among Black young adults and the impact of discrimination on health behaviors.

Sun YX; Sundell J. Life style and home environment are associated with racial disparities of asthma and allergy in Northeast Texas children. Science of the Total Environment 409(20): 4229-4234, 2011. (29 refs.)

A high prevalence and racial disparities in asthma and allergy have been observed in American children. This study aimed to identify risk factors for asthma and allergy among children, and their contribution to racial disparities in allergy prevalence. A population-based cross-sectional study was carried out among children aged 1-8 years in Northeast Texas 2008-2009. The health conditions, life style and home environment of 3766 children were surveyed by parental questionnaires through e.g. daycares, elementary school, and medical clinics. Among participants who indicated their ethnicity, 255 were Mexican-Americans, 178 Afro-Americans and 969 Caucasians. Afro-American children had a significantly higher prevalence of asthma and eczema. Caucasian had the highest prevalence of rhinitis. Compared to Mexican-American children, Afro-American and Caucasian children were breast fed shorter time, more often went to day care center, had pets and environmental tobacco smoke exposure at home more often. For all children, being at a day care center, being exposed to dampness and environmental tobacco smoke at home were strong risk factors for asthma and allergy. Central air conditioning system was associated with an increased prevalence of wheeze among Mexican-American children, while pets were associated with an increased risk of rhinitis among Afro-American and Caucasian children. Caucasian children were generally not healthier than relatively poor Mexican-American children. Differences in the prevalence of asthma and allergy between races cannot be explained by socioeconomic status only. Life style and home environmental exposures are important risk factors for asthma and allergy in Northeast Texas children.

Sznitman SR; Dunlop SM; Nalkur P; Khurana A; Romer D. Student drug testing in the context of positive and negative school climates: Results from a National Survey. Journal of Youth and Adolescence 41(2): 146-155, 2012. (44 refs.)

Positive school climates and student drug testing have been separately proposed as strategies to reduce student substance use in high schools. However, the effects of drug testing programs may depend on the favorability of school climates. This study examined the association between school drug testing programs and student substance use in schools with different climates. The analysis was based on a nationally representative sample of 943 high school students (48% female) ranging from 14 to 19 years of age (62% identifying as white, 18% Hispanic, 13% African American, and 7% in other categories). Results showed that both male and female students in schools with positive climates reported lower levels of personal substance use. Drug testing was associated with lower levels of personal substance use in positive school climates, but only for female students. There was no relationship between drug testing and male students' substance use. The results are discussed in terms of the importance of considering school climates before implementing drug-testing programs in high schools.

Tebes JK; Cook EC; Vanderploeg JJ; Feinn R; Chinman MJ; Shepard JK et al. Parental knowledge and substance use among African American adolescents: Influence of gender and grade level. Journal of Child and Family Studies 20(4): 406-413, 2011. (42 refs.)

Parental knowledge is defined as parental awareness and information about a child's activities, whereabouts, and associations that is obtained through parental monitoring, parental solicitation, or self-disclosure. Increased parental knowledge is generally associated with lower adolescent substance use; however, the influence of various contextual factors, such as adolescent gender and grade level is not well understood, particularly for different racial or ethnic groups. In the present study, we used Hierarchical Generalized Linear Modeling analyses to examine the longitudinal relationship of parental knowledge to adolescent substance use in the context of adolescent gender and grade level among 207 urban African American adolescents in grades 6-11. Results indicated that increased parental knowledge is associated with a concurrent lower likelihood of substance use across all types of substances examined (alcohol, tobacco, marijuana, other drug use, and any drug use), but it did not predict changes in substance use 1 year later for the entire sample. However, analyses by gender and grade level showed that for boys and middle school youth, parental knowledge was a protective factor for increases in substance use across 1 year. Findings are discussed in terms of their implications for prevention and health promotion interventions for adolescent substance use among African American youth.

Thompson AB; Moon-Howard J; Messeri PA. Smoking cessation advantage among adult initiators: Does It apply to black women? Nicotine & Tobacco Research 13(1): 22-28, 2011. (36 refs.)

Smokers who initiate as adults are more likely to quit than those who initiate as adolescents. Black women are more likely than White women to initiate smoking in adulthood and are less likely to quit. There is a paucity of research examining whether the smoking cessation advantage among adult initiators applies to Black women. The study objective is to examine race differences in the effect of developmental stage of smoking initiation on number of years until cessation among Black and White women. Data were extracted from the National Longitudinal Survey of Young Women, a national cohort of women between the ages of 49 and 61 years in 2003. The analytic sample comprised 1,008 White women and 271 Black women with a history of smoking. Survival analysis procedures were utilized to address the study objective. Racial disparities in smoking cessation were most evident among women who initiated smoking as adults. White young adult initiators had a 31% increased hazard of smoking cessation advantage (adjusted hazards ratio [HR]: 1.31, 95% CI: 1.04-1.65) over adolescent initiators, whereas Black young adult initiators had no smoking cessation advantage (adjusted HR: 0.85, CI: 95% 0.55-1.30) over adolescent initiators. Prior observations that smoking initiation in adulthood is associated with high rates of cessation do not apply to black women. To contribute to the reduction of disparities in women's cessation efforts to prevent initiation should target young adult women, particularly Black young adult women.

Tobin KE; German D; Spikes P; Patterson J; Latkin C. A comparison of the social and sexual networks of crack-using and non-crack using African American men who have sex with men. Journal of Urban Health 88(6): 1052-1062, 2011. (44 refs.)

The role of crack cocaine in accelerating the HIV epidemic among heterosexual populations has been well documented. Little is known about crack use as an HIV risk factor among African American men who have sex with men (AA MSM), a group disproportionately infected with HIV. We sought to compare the social and sexual network characteristics of crack-using and non-crack using AA MSM in Baltimore, MD, USA and to examine associations of crack use with sexual risk. Participants were recruited using street-based and internet-based outreach, printed advertisements, word of mouth. Inclusion criteria were being aged 18 years or older, African American or of black race/ethnicity, and have self-reported sex with another male in the prior 90 days. Crack use was operationalized as self-report of crack in the prior 90 days. Logistic regression was used to identify variables that were independently associated with crack use. of 230 enrolled AA MSM, 37% (n = 84) reported crack use. The sexual networks of crack-using AA MSM were composed of a greater number of HIV-positive sex partners, exchange partners, and partners who were both sex and drug partners and fewer networks with whom they always use condoms as compared to non-crack using AA MSM. Crack use was independently associated with increased odds of bisexual identity and networks with a greater number of exchange partners, overlap of drug and sex partners, and lesser condom use. Results of this study highlight sexual network characteristics of crack-smoking AA MSM that may promote transmission of HIV. HIV interventions are needed that are tailored to address the social context of crack-smoking AA MSM risk behaviors.

Tobler AL; Livingston MD; Komro KA. Racial/ethnic differences in the etiology of alcohol use among urban adolescents. Journal of Studies on Alcohol and Drugs 72(5): 799-810, 2011. (61 refs.)

Objective: We examined relations between neighborhood context, home and family management practices, deviant peer affiliations, beliefs favorable to use, and alcohol use among urban African American and Hispanic adolescents. Method: The sample comprised 4,027 African American and Hispanic adolescents who were 50% boys and 75% low income. Participants completed surveys in 2002-2005 and 2008-2009. Structural equation modeling assessed direct and indirect relations between neighborhood context in 6th grade, home and family management practices in 7th grade, deviant peer affiliations and beliefs favorable to use in 8th grade, and alcohol use in 12th grade. Results: There was significant variation in structural models across race/ethnicity but not gender. Differences included the influence of neighborhood and school strength and, where similarities existed, differences in effect magnitude. Similarities included significant correlations among measurement components; the indirect influence of alcohol advertisement exposure, gender, area deprivation, and home alcohol access on alcohol use; direct influence of deviant peer affiliations and beliefs favorable to use on alcohol use; and indirect effects highlighting the importance of preventing home alcohol access, deviant peer affiliations, and beliefs favorable to use and promoting protective family management practices. Conclusions: Neighborhood and school strength may be particularly important in preventing alcohol use among African Americans, whereas preventing early onset of alcohol use among Hispanics remains important. Preventive efforts may wish to focus on neighborhood deprivation, exposure to alcohol advertisements, and home risks and protective factors because they have direct and indirect effects on intrapersonal factors and alcohol use.

Turner AK; Latkin C; Sonenstein F; Tandon SD. Psychiatric disorder symptoms, substance use, and sexual risk behavior among African-American out of school youth. Drug and Alcohol Dependence 115(1-2): 67-73, 2011. (65 refs.)

Purpose: To examine the association between symptoms of psychiatric disorder (i.e. depression, anxiety, and substance use) and sexual risk behavior in a sample of African-American adolescents and young adults in an employment training program. Methods: Baseline data were used from a pilot study of an intervention to reduce depressive symptoms among youth disconnected from school and the workforce. Participants were recruited from two employment training programs in East and West Baltimore (N = 617; age 16-23 years). Data were collected through audio computer-assisted self-interview (ACAS. Mental health indicators were measured using the Center for Epidemiology Studies Depression Scale and Beck Anxiety Inventory. Multivariate logistic regression was used to determine the odds of sexual risk behavior for each mental health condition and combinations of conditions. Results: Lack of condom use at last sex was significantly associated with elevated anxiety symptoms. Number of sexual partners was associated with elevated depression symptoms and substance use. Early sexual debut was associated with substance use in the past 30 days. Also, there were differences in the likelihood of engaging in sexual risk behavior comparing groups with different combinations of mental health problems to those with no symptoms of disorder or substance use. Conclusions: The results demonstrate the need for HIV prevention programs that target out-of-school youth, as they are likely to engage in risky sexual behavior. Our findings highlight the need to develop behavioral interventions that address disorder symptoms, substance use, and risky sexual behavior among youth in employment training programs.

Wang Y; Storr C; Browne DC; Wagner FA. Early sexual experience and later onset of illegal drug use among African American students on HBCU Campuses. Substance Use & Misuse 46(4): 543-551, 2011. (36 refs.)

Few studies examine whether early sexual experience is associated with subsequent illegal drug use among adolescents. A sample of 7,372 African American students who had not used illegal drugs before the age of 14 were identified in the dataset of the 2001 Historically Black Colleges and Universities (HBCU) Substance Use Survey. Using self-reported ages of onset, discrete-time survival models estimated the hazard of illegal drug use onset after age 13 subsequent to first sexual intercourse. Early sex was modestly associated with subsequent illegal drug initiation, particularly among females. Drug use prevention services should be provided to youth engaged in early sexual activity.

Washington TA; Brocato J. Exploring the perspectives of substance abusing Black men who have sex with men and women in addiction treatment programs: A need for a human sexuality educational model for addiction professionals. American Journal of Men's Health 5(5): 402-412, 2011. (75 refs.)

This study examined the perspectives of African American male injection drug users who have sex with both men and women (IDU-MSM/W) and who are involved in sex trade regarding the need for a human sexuality educational model (HSEM) for addiction professionals. Focus groups were conducted involving an exploratory sample (N = 105) of men who met the following parameters: aged 18 to 40 years, African American, engage in injection drug using behavior, have sex with male and female partners, and who frequent parks and other sex working areas in Baltimore City and surrounding areas. Data suggest that an HSEM may be useful for addiction professionals who work with substance abusing Black MSM/W. Moreover, the model should include opportunities for addiction professionals to (a) identify their personal biases about homosexuality in general (acknowledging personal biases so not to allow those personal biases to influence service); (b) understand the diversity within the Black MSM/W community (e.g., challenge assumptions that all Black MSM/W self-identify as gay); (c) understand how to, and the need for, assessing sexual trauma in Black MSM/W; and (d) understand the need to incorporate risk factors and safer sex practices that may be of concern to a subpopulation of Black MSM/W, such as "barebacking." These findings suggest the need for, and topics to include in, an HSEM that assists professionals with exploring their biases about sexuality and MSM/W and better prepares counselors to address HIV prevention and risky behavior using language that is appropriate for the Black IDU-MSM/W population.

White HR; Lee C; Mun EY; Loeber R. Developmental patterns of alcohol use in relation to the persistence and desistance of serious violent offending among African American and Caucasian young men. Criminology 50(2): 391-426, 2012. (94 refs.)

This study examined the association of alcohol use with the persistence and desistance of serious violent offending among African American and Caucasian young men from adolescence into emerging adulthood. Five violence groups were defined: nonviolent, late-onsetters, desisters, persisters, and one-time offenders. We examined alcohol use trajectories for these groups spanning 12 through 24/25 years of age using a four-piecewise linear growth model s 1214, 1418, 1821, and 2124/25 years of age. The persisters and desisters reported the highest levels of drinking at 13 years of age. From 14 to 18 years old, however, the late-onsetters showed a higher rate of increase in drinking, compared with the persisters and desisters. Starting at 18 years of age, the desisters drinking trajectory started to resemble that of the nonviolent group, who showed the highest rate of increase in drinking during emerging adulthood. By 24/25 years of age, the persisters could not be distinguished from the late-onsetters, but they were lower than the nonviolent and one-timer groups in terms of their drinking. At 24/25 years old, the desisters were not significantly different from the other violence groups, although they seemed most similar to the nonviolent and one-timer groups. We found no evidence that the association between drinking and violence differed for African Americans and Caucasians. The findings suggest that yearly changes in alcohol use could provide important clues for preventing violent offending.

Williams M; Jayawickreme N; Sposato R; Foa EB. Race-specific associations between trauma cognitions and symptoms of alcohol dependence in individuals with comorbid PTSD and alcohol dependence. Addictive Behaviors 37(1): 47-52, 2012. (37 refs.)

Posttraumatic Stress Disorder (PTSD) changes the way people think about themselves, others, and the safety of the world. These cognitions may play a role in alcohol dependence, where alcohol dependence is maintained as an attempt to manage posttraumatic anxiety. The current study examined black-white differences in various PTSD cognitions and their relationship to symptoms of alcohol dependence in a dually diagnosed sample (N=167). Analyses revealed racial differences in trauma cognitions and their impact on symptoms of alcohol dependence, suggesting that trauma cognitions are more strongly associated with adverse consequences of drinking and alcohol craving severity among African Americans than European Americans. Additional relationships between ethnic identification and trauma-related cognitions are described and theoretical and clinical implications of these findings are discussed.

Witkiewitz K; Villarroel NA; Hartzler B; Donovan DM. Drinking outcomes following drink refusal skills training: Differential effects for African American and Non-Hispanic white clients. Psychology of Addictive Behaviors 25(1): 162-167, 2011. (27 refs.)

Determining whether a particular treatment works for specific groups of people can help tailor dissemination of evidence-based alcohol treatments. It has been proposed that individuals from different racial groups might have better outcomes in treatments that are sensitive to sociocultural issues that impact alcohol use among these groups. The current study was a secondary analysis of data from the combined behavioral intervention (CBI) condition of the COMBINE study. Those randomly assigned to CBI (n = 776) had the opportunity to receive up to 9 skills training modules, which were chosen by the therapist. The goal of the current study was to determine whether receiving I of the CBI modules, drink refusal and social pressure skills training, predicted differential outcomes among African American clients. Results indicated that African American clients who received the drink refusal skills training module (n = 25) had significantly fewer heavy drinking days (d = 0.79) 1 year following treatment than African Americans clients who did not receive the module (n = 35). African American clients who received the module also had significantly fewer heavy drinking days (d = 0.86) than non-Hispanic White clients who received the module (n = 241). Good clinical outcomes at 1 year posttreatment were observed among 80% of African Americans who received the module, compared with 54% of African Americans who did not receive the module and 52% of non-Hispanic White clients who did receive the module. Although small sample size limits interpretation, findings provide preliminary evidence supporting the inclusion of drink refusal skills training as part of alcohol interventions for African American clients.

Wu LT; Woody GE; Yang CM; Pan JJ; Reeve BB; Blazer DG. A dimensional approach to understanding severity estimates and risk correlates of marijuana abuse and dependence in adults. International Journal of Methods in Psychiatric Research 21(2): 117-133, 2012. (62 refs.)

While item response theory (IRT) research shows a latent severity trait underlying response patterns of substance abuse and dependence symptoms, little is known about IRT-based severity estimates in relation to clinically relevant measures. In response to increased prevalences of marijuana-related treatment admissions, an elevated level of marijuana potency, and the debate on medical marijuana use, we applied dimensional approaches to understand IRT-based severity estimates for marijuana use disorders (MUDs) and their correlates while simultaneously considering gender- and race/ethnicity-related differential item functioning (DIF). Using adult data from the 2008 National Survey on Drug Use and Health (N = 37,897), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for MUDs among past-year marijuana users were examined by IRT, logistic regression, and multiple indicatorsmultiple causes (MIMIC) approaches. Among 6917 marijuana users, 15% met criteria for a MUD; another 24% exhibited subthreshold dependence. Abuse criteria were highly correlated with dependence criteria (correlation = 0.90), indicating unidimensionality; item information curves revealed redundancy in multiple criteria. MIMIC analyses showed that MUD criteria were positively associated with weekly marijuana use, early marijuana use, other substance use disorders, substance abuse treatment, and serious psychological distress. African Americans and Hispanics showed higher levels of MUDs than Whites, even after adjusting for race/ethnicity-related DIF. The redundancy in multiple criteria suggests an opportunity to improve efficiency in measuring symptom-level manifestations by removing low-informative criteria. Elevated rates of MUDs among African Americans and Hispanics require research to elucidate risk factors and improve assessments of MUDs for different racial/ethnic groups.

Yu M; Nebbitt VE; Lombe M; Pitner RO; Salas-Wright CP. Understanding tobacco use among urban African American adolescents living in public housing communities: A test of problem behavior theory. Addictive Behaviors 37(8): 978-981, 2012. (33 refs.)

This study was guided by Jessor and Jessor's problem behavior theory (PBT) to test the relative effects of personality, perceived environment and behavior system variables on urban teen tobacco use. A sample of 518 urban African American youth residing in public housing communities in three large U.S. cities was utilized. Our results provide partial support for PBT in this study. Personality system variables (i.e., positive attitudes toward tobacco use, and depressive affect, cause and outcome indicators) and behavior system variables (i.e., delinquent behaviors) significantly predicted adolescent tobacco use. Depressive effect and cause indicators were stronger than depressive outcome indicators in predicting the extent of tobacco use. Additionally, age positively moderated the impact of positive attitudes about tobacco use on the extent of adolescent tobacco use. However, perceived environment system variables (e.g., exposure to delinquent peers) did not predict such use. This study suggests that PBT may aid in understanding adolescent tobacco use. Implications for practice and future inquiry are discussed.

Yuan ASV. Black-white differences in aging out of substance use and abuse. Sociological Spectrum 31(1): 3-31, 2011. (62 refs.)

Blacks have lower rates of substance use and abuse than whites in early adolescence and young adulthood but similar or higher rates by middle adulthood, which could be due to blacks being less likely to age (i.e., mature) out of deviance than whites by transitioning into high-quality conventional social roles. Using the National Comorbidity Survey (1990-1992), this study finds that work, economic conditions, and family roles explain the race-by-age crossover for drug abuse and explain most of this relationship for alcohol use and abuse. There is no race-by-age crossover for drug use. Thus, even though blacks have lower substance use and abuse than whites at younger ages, this advantage is eliminated and even reversed due to the disadvantages blacks face over the life course.

Zhu SH; Gardiner P; Cummins S; Anderson C; Wong S; Cowling D et al. Quitline utilization rates of African-American and white smokers: The California experience. American Journal of Health Promotion 25(5, Supplement S): S51-S58, 2011. (42 refs.)

Purpose. To compare the utilization rate of a statewide tobacco quitline by African-American smokers to that of white smokers. Design, Setting, and Subjects. Observational study of 18 years of state quitline operation in California. Subjects were 61,096 African-American and 279,042 white smokers who called the quitline from August 1992 to December 2009. Data from six California Tobacco Surveys, 1993, 1996, 1999, 2002, 2005, and 2008 were also used. Measure. Callers' answers' to the question how they heard about the quitline were grouped into four categories: media, health care providers, friends/family, and others. Analysis. The averaged annual quitline call volume fir each ethnic group was divided by the total number of smokers in that group, based on California Tobacco Surveys, to produce the annual quitline utilization rate. Results. In five out of six periods of comparison, African-American smokers had a higher annual utilization rate than white smokers. The odds ratios [ORs] ranged from 1.44 to 2.40 (all p < .05). In the 1996 comparison, the OR was .90 (p < .05). The difference in utilization rates that is attributed to media, accounts for most of the difference in total utilization rates between the two ethnic groups. Conclusions. Within the context of California's comprehensive tobacco control program, which includes a strong media campaign, African-American smokers were significantly more likely to call the state quitline than white smokers were. Promoting the quitline as part of antismoking media campaigns can help reduce disparity in cessation service utilization.