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CORK Bibliography: African Americans

137 citations. January 2004 to present

Prepared: September 2007

Ahluwalia JS; Okuyemi K; Nollen N; Choi WS; Kaur H; Pulvers K et al. The effects of nicotine gum and counseling among African American light smokers: A 2 x 2 factorial design. Addiction 101(6): 883-891, 2006. (41 refs.)

Aim: Approximately 50% of African American smokers are light smokers (smoke <= 10 cigarettes a day). The prevalence of light smoking in the United States is increasing, yet there has not been a single smoking cessation clinical trial targeting light smokers. The purpose of this 2 x 2 factorial, randomized clinical trial was to evaluate the efficacy of nicotine gum (2 mg versus placebo) and counseling (motivational interviewing versus health education) for African American light smokers. Design Participants were assigned randomly to one of four study arms: 2 mg nicotine gum plus health education (HE); 2 mg nicotine gum plus motivational interviewing (MI); placebo gum plus HE; and placebo gum plus MI. Participants and setting A total of 755 African American light smokers (66% female, mean age = 45) were enrolled at a community health center over a 16-month period.Participants received an 8-week supply of nicotine gum and six counseling sessions during the course of the 26-week study. Biochemical measures included expired carbon monoxide (CO) and serum and salivary cotinine. Findings Seven-day quit rates for nicotine gum were no better than for the placebo group (14.2% versus 11.1%, P = 0.232) at 6 months. However, a counseling effect emerged, with HE performing significantly better than MI (16.7% versus 8.5%, P < 0.001). These results were consistent across outcome time-points (weeks 1, 8, and 26). Conclusions: Results highlight the potential positive impact of directive information and advice-oriented counseling on smoking cessation. Studies are needed to assess other interventions that may further improve quit rates among African American light smokers who are motivated to quit.

Asanbe CB; Lockert E. Cognitive abilities of African American children with prenatal cocaine/polydrug exposure. Journal of Health Care for the Poor and Underserved 17(2): 400-412, 2006. (35s refs.)

The aim of this study was to investigate the effects of prenatal cocaine/polydrug exposure on cognitive abilities of school-aged children. The study examined differences in the performance of low income prenatal cocaine/polydrug-exposed and non-exposed African American children (n = 49) between 6 and 8 years of age, on the Wechsler Intelligence Scale for Children-Third Edition. Twenty-five children had a history of prenatal cocaine/polydrug exposure and 24 had no known history. The groups were matched for age, sex, and socioeconomic status. Test scores determined if drug exposure predicted global intelligence score and if there were significant differences between the two groups in specific areas of cognitive ability assessed. Drug exposure predicted IQ scores, as drug-exposed children performed significantly lower than their non-exposed counterparts on global intelligence and verbal comprehension, but comparably on the freedom from distractibility tasks. On individual cognitive tasks, the performances of cocaine/polydrug-exposed and non-exposed children were comparable on 8 of the 11 tasks assessed. The findings call into question earlier predictions about cocaine-exposed children.

Bashford J; Carpentier C; Fountain J; Khurana J; Patel K; Underwood S; Winters M. Laying the foundations of an evidence base on drug use among black and minority ethnic communities: The research methods used for an EMCDDA project. Journal of Ethnicity in Substance Abuse 3(1): 29-46, 2004

Drug use amongst Black and minority ethnic groups in the European Union (EU) is an under-researched and under-reported issue. To begin to build a knowledge base, questionnaires based on available information were constructed for each of the 15 EU countries and Norway. Potential informants were identified from a range of disciplines, not necessarily concerned with drug use. A total of 1,122 questionnaires were distributed and the response rate was 1 in 3.5 (322), a quarter of whom (26%/83) either could not or would not participate. Several challenges confront progress, including the reluctance of potential informants to provide data on this sensitive issue, inadequate ethnic monitoring, and the development of links between researchers and Black minority ethnic groups.

Beatty L; Jones D; Doctor L. Reducing HIV/AIDS and criminal justice involvement in African Americans as a consequence of drug abuse. Journal of Health Care for the Poor and Underserved 16(4, Supplement B): 1-5, 2005. (4 refs.)

There are few significant differences in the overall use of drugs in the United States by racial/ethnic population group. Nonetheless there are differences in the impact of use.This is an introduction to a special issue dealing with the differential impact of HIV/AIDS on the Black community as well as the disproportionate involvement of Blacks in the prison population, especially for drug offences. Beyond providing an overview of the dimensions of these problems, the authors also provide a synopsis of each of the articles.

Beckerleg S; Hundt GL. Women heroin users: Exploring the limitations of the structural violence approach. International Journal of Drug Policy 16(3): 183-190, 2005. (30 refs.)

This paper reports on the lives of women heroin users resident in a Kenyan coastal resort town. Data on the everyday lives of 24 women were collected using ethnographic field methods. Eighteen women also completed questionnaires about their reproductive health. Using these data, we analyse the extent to which the women are victims of 'structural violence', and how their disadvantaged social status and poverty make them particularly vulnerable to poor health, injury and death. The problems these women face are similar to women heroin users in other parts of the world. These Kenyan women live in a country where the majority of people are victims of 'structural violence', but as drug users and sex workers they face particular disadvantage. The limitations of using individual case studies that detail the lives of 'victims' of structural violence are discussed.

Belenko S; Shedlin M; Chaple M. HIV risk behaviors, knowledge, and prevention service experiences among African American and other offenders. Journal of Health Care for the Poor and Underserved 16(4, Supplement B): 108-129, 2005. (76 refs.)

African Americans are at the intersection of the AIDS epidemic and burgeoning prison and offender populations, yet little is known about offenders' HIV knowledge and risk behaviors or ability to access effective services. We present findings from an exploratory study based on 300 interviews with New York City offenders conducted in 2001-2002. The data indicate relatively high rates of HIV infection and HIV risk behaviors among African American and other offenders. There were no clear patterns of risk behaviors by race/ethnicity. Although overall HIV knowledge level is high, important gaps in HIV knowledge remain and there is widespread skepticism among offenders about government information about HIV/AIDS. In the corrections setting, there is inconsistent access to HIV prevention and education services, and an emphasis on more passive learning materials. To reduce HIV infection rates, there is a need to expand peer-led and culturally- and gender-specific interventions, and to improve access to correctional facilities for community-based HIV service providers. HIV interventions must also be expanded for offenders on probation and parole. Mandatory HIV education and harm reduction approaches should be considered.

Bennett GG; Wolin KY; Robinson EL; Fowler S; Edwards CL. Perceived racial/ethnic harassment and tobacco use among African American young adults. American Journal of Public Health 95(2): 238-240, 2005. (34 refs.)

We examined the association between perceived racial/ethnic harassment and tobacco use in 2129 African American college students in North Carolina. Age-adjusted and multivariate analyses evaluated the effect of harassment on daily and less-than-daily tobacco use. Harassed participants were twice as likely to use tobacco daily (odds ratio = 2.01; 95% confidence interval = 1.94, 2.08) compared with those with no reported harassment experiences. Experiences of racial/ethnic harassment may contribute to tobacco use behaviors among some African American young adults.

Bersamin M; Paschall MJ; Flewelling RL. Ethnic differences in relationships between risk factors and adolescent binge drinking: A national study. Prevention Science 6(2): 127-137, 2005. (54 refs.)

This study examines ethnic differences in relationships between a large number of risk factors and adolescent binge drinking with data collected from 14 to 17 year olds who participated in the 1999 National Household Survey on Drug Abuse (NHSDA). Logistic regression analyses were conducted to determine whether 39 risk factors in community, family, school, and peer-individual domains were differentially associated with past-30-day binge drinking among youth in ethnic minority groups (black, Hispanic and Asian) relative to whites. Forty-three percent (17) of the risk factors examined were differentially associated with binge drinking in at least one of the ethnic groups relative to whites. Most of these risk factors were more strongly associated with binge drinking among white adolescents than Hispanic and black youth, but not Asians. The direction of the relationships between these risk factors and binge drinking, however, was usually the same for whites and ethnic minority groups. A multivariate prediction model indicated that risk factors in the community, family, school, and peer-individual domains accounted for 27% of the variance in binge drinking for white adolescents, 22% for Hispanics, 10% for blacks, and 39% for Asians. These findings suggest that research is needed to identify additional risk factors that are associated with binge drinking among adolescents, particularly blacks, Hispanics and possibly other ethnic minority groups.

Blankenship KM; Smoyer AB; Bray SJ; Mattocks K. Black-white disparities in HIV/AIDS: The role of drug policy and the corrections system. (review). Journal of Health Care for the Poor and Underserved 16(4, Supplement B): 140-156, 2005. (110 refs.)

African Americans in the United States are disproportionately affected by HIV/AIDS. We focus in this paper on the structural and contextual sources of HIV/AIDS risk, and suggest that among the most important of these sources are drug policy and the corrections system. In particular, high rates of exposure to the corrections system (including incarceration, probation, and parole) spurred in large part by federal and state governments' self-styled war on drugs in the United States, have disproportionately affected African Americans. We review a wide range of research literature to suggest how exposure to the corrections system may affect the HIV/AIDS related risks of drug users in general, and the disproportionate HIV risk faced by African Americans in particular. We then discuss the implications of the information reviewed for structural interventions to address African American HIV-related risk. Future research must further our understanding of the relations among drug policy, corrections, and race-based disparities in HIV/AIDS.

Boyd K; Ashcraft A; Belgrave FZ. The impact of mother-daughter and father-daughter relationships on drug refusal self-efficacy among African American adolescent girls in urban communities. Journal of Black Psychology 32(1): 29-42, 2006. (38 refs.)

This study yielded interesting findings on the effect of mother-daughter and father-daughter relationships on drug refusal self-efficacy for urban African American girls between the ages of 11 and 14. The questionnaire consisted of assessments on the quality of the girls mother and father relationships and their perceived ability to refuse drugs. The quality of the father-daughter relationship significantly predicted drug refusal self-efficacy for urban African American girls. Implications of these findings are discussed.

Boyd SJ; Thomas-Gosain NF; Umbricht A; Tucker MJ; Leslie JM; Chaisson R et al. Gender differences in indices of opioid dependency and medical comorbidity in a population of hospitalized HIV-infected African-Americans. American Journal on Addictions 13(3): 281-291, 2004. (21 refs.)

We examined gender differences in drug use patterns and in medical presentation among 520 hospitalized, HIV-infected African-Americans Substance abuse history was self-reported, and medical data were obtained by chart review. Overall, 321 (65%) reported ever having used heroin, with equivalent rates in men and women. Women were more likely to report current use, to have sought treatment, and tended to feel more dependent on heroin than men. Among heroin users, women were more likely to be admitted for conditions related to drug use, rather than AIDS, and to have CD4 counts >200/mm(3). These gender differences in opioid dependency and medical comorbidity may indicate a need for alternative treatment approaches for men and women.

Braun J; Dugan M; Holterman-Hommes P; Hunter P; Thomson NR; Zand DH. The recruitment process: Factors that predict African-American adolescents' initial engagement into an alcohol, tobacco, and other drug prevention study. Journal of Ethnicity in Substance Abuse 3(2): 43-54, 2004

Researchers explored recruitment patterns, as well as factors that predicted these patterns, in a relationship-based substance abuse prevention intervention study, targeting inner-city African American adolescents living in economically disadvantaged neighborhoods. Of the 257 eligible participants, 99 (38.5 percent) enrolled in the project. It required a total of 559 contacts to enroll these participants, in addition to the 99 home visits that were conducted to secure baseline data. Results from hierarchical logistic regression analysis indicated that the youths' attitudes towards alcohol, tobacco, and other drugs, as well as the parents' report of family conflict predicted ease of recruitment. Implications for recruitment strategies and future research are discussed.

Brody GH; Murry VM; McNair L; Chen YF; Gibbons FX; Gerrard M; Wills TA. Linking changes in parenting to parent-child relationship quality and youth self-control: The Strong African American Families Program. Journal of Research on Adolescence 15(1): 47-69, 2005. (77 refs.)

A randomized prevention trial was conducted contrasting families who took part in the Strong African American Families Program (SAAF), a preventive intervention for rural African American mothers and their 11-year-olds, with control families. SAAF is based on a conceptual model positing that changes in intervention-targeted parenting behaviors would enhance responsive-supportive parent-child relationships and youths' self-control, which protect rural African American youths from substance use and early sexual activity. Parenting variables included involvement-vigilance, racial socialization, communication about sex, and clear expectations for alcohol use. Structural equation modeling analyses indicated that intervention-induced changes in parenting were linked with changes in responsive-supportive parent-child relationships and youth self-control.

Broman CL; Reckase MD; Freedman-Doan CR. The role of parenting in drug use among black, Latino and white adolescents. Journal of Ethnicity in Substance Abuse 5(1): 39-50, 2006

This study investigates the role of parenting in adolescent drug use for black, white, and Latino adolescents. Parenting has been consistently identified as a crucial factor in drug use by adolescents. This study uses data from the National Longitudinal Study of Adolescent Health. Results show that parenting has a significant effect on drug use for these adolescents. The relationship between parenting and drug use is more strongly negative for the Latino adolescents, than for black and white adolescents. This indicates that greater parental warmth and family acceptance exert a stronger impact in reducing drug use for Latino adolescents than is the case for the black and white adolescents.

Brook JS; Adams RE; Balka EB; Whiteman M; Zhang CS; Sugerman R. Illicit drug use and risky sexual behavior among African American and Puerto Rican urban adolescents: The longitudinal links. Journal of Genetic Psychology 165(2): 203-220, 2004. (46 refs.)

The authors assessed whether (a) early illicit drug use predicted later risky sexual activity, (b) early risky sex predicted later illicit drug use, and (c) common factors affected both risky sexual behavior and illicit drug use. African American and Puerto Rican youth completed questionnaires in their classrooms at Time 1 (T 1) and face-to-face interviews with the authors in their homes 5 years later at Time 2 (T2). Logistic regression analyses showed the association between T1 illicit drug use and T2 risky sexual activity and between T1 risky sexual behavior and T2 illicit drug use. With few exceptions, T1 illicit drug use was associated with all of the T2 risky sexual behaviors. After controlling for demographic factors, the authors found that multiple sex partners at T1 was not related to illicit drug use at T2. Condom use at T l was related to illicit drug use at T2, whereas sexually transmitted diseases and adolescent pregnancy were not related to this drug use. The findings indicated that assessments of and treatments for substance use should focus on the risky sexual behaviors that seem to accompany illicit drug use.

Brook JS; Balka EB; Rosen Z; Brook DW; Adams R. Tobacco use in adolescence: Longitudinal links to later problem behavior among African American and Puerto Rican urban young adults. Journal of Genetic Psychology 166(2): 133-151, 2005. (43 refs.)

In this study, the authors assessed the relationship between adolescent tobacco smoking and measures of inner control, deviant behavior, and associating with deviant peers, which are indicators of problem behavior. African American (N = 333) and Puerto Rican (N = 329) early adolescents completed questionnaires in their classrooms in 1990 at Time 1 (T1) and were individually interviewed thereafter when they were late adolescents in 1995 at Time 2 (T2) and as young adults in 2000 at Time 3 (T3). The authors used ordinary least squares regression analysis to assess the comparative association of adolescent smoking patterns at T1 and T2 and the young adult outcomes at T3; they controlled for demographic variables, level of the outcome measure at T2, and marijuana use at T2. The analyses suggested that experimental tobacco smokers demonstrated more problem behaviors than did nonsmokers, and late and continuous smokers demonstrated more problem behaviors as young adults than did experimental smokers and nonusers. These findings may provide a useful guide to a next step that involves translational research.

Brown DR; Scott W; Krim S; Blount J; Roman D; Brown D. Black churches in substance use and abuse prevention efforts. Journal of Alcohol and Drug Education 50(2): 43-65, 2006. (15 refs.)

In light of their historical role in African American communities, faith-based organizations are uniquely positioned to offer substance use prevention programs to urban African American youth. This article describes the efforts of a university-based program to provide training and technical assistance to faith-based organizations in the development and implementation of substance use prevention activities. Occurring over a three-year period, the activities were assessed using both qualitative and quantitative approaches. Results indicate that one-third of the faith-based participants had successfully implemented a substance use prevention program," another third were in the process of developing a program," and the final third had not begun to do so. Key characteristics associated with successful program development and implementation are discussed along with recommendations for future community efforts.

Brown EJ. The integral place of religion in the lives of rural African-American women who use cocaine. Journal of Religion & Health 45(1): 19-39, 2006. (35 refs.)

To understand the culture of rural African-American women who use cocaine, ethnographic research was conducted in rural North Central Florida using in-depth interviews and participant observations with 30 respondents. Fourteen major themes emerged from the data; however, this paper focuses on one theme, that of religion. Nine sub-themes about religion and spirituality emerged. Religion was viewed as a personal relationship with God, which is not dependent on socializing with other church members, but was helpful in sustaining the respondents. While religiosity was a stable and consistent place in the respondents' lives and some relied on their faith in God to replace their addiction, faith was not uniformly utilized by all respondents in this manner. Religiosity among African-American women who use cocaine cannot solely overcome the lack of drug treatment or treatment options and the stigma associated with drug use although it may be a resiliency factor, which warrants promoting.

Brown EJ; Hill MA; Giroux SA. "A 28-day program ain't helping the crack smoker" - Perceptions of effective drug abuse prevention interventions by north Central Florida African Americans who use cocaine. Journal of Rural Health 20(3, Special Issue): 286-295, 2004. (19 refs.)

Context: Cocaine is a major problem in the rural South, but knowledge is limited regarding the impact on African American populations. Purpose: This study of 18-39-year-old black drug users assessed perceptions of contributing factors to drug use and possible interventions. Methods: The study design was qualitative-descriptive, utilizing four focus groups with 5 rural women and 14 small-city residents. Findings: Some respondents perceived that drug use initiation and continuation were due to themes of loss, peer pressure, personal problems and dealing with pain, desire for fun or to "feel good," and drugs and drug-related messages within their environments. Common themes of effective strategies to stop drug use were -- the necessity of wanting to quit, the importance of help or support from family and friends, and the need for resources, such as a job, car, and housing. Some respondents agreed on 3 human resources: family, ex-users, and churches. Strategies to increase attendance at drug prevention programs included making the program fun/enjoyable, having mixed gender programs, providing food/money, and having the programs in their community. Recurrent themes were the lack of drug prevention intervention programs available to respondents and the failure of traditional programs of the majority culture to adequately meet their needs. Conclusion: Effective drug prevention programs for southern African Americans who use cocaine must be community based, personalized, and culturally relevant.

Brown EJ; Smith FB. Place and space: The where and why of drug-use location among rural African American women. Journal of Family Nursing 12(2): 185-200, 2006. (15 refs.)

Increasing drug use among rural African American women and its effect on children warrants investigation. This article describes drug-use locations of rural African American women who use cocaine and construct their lives to conceal it from children. During 4 years, a 30-respondent ethnography was conducted. Data from in-depth interviews and field notes were analyzed for recurrent themes and patterns of drug-use location using NVivo. Most respondents with children used most often outside their households. One third (n = 10) used within their households when children were away or in designated spaces off limits to children. More respondents (n = 11) without children at home used in non-designated spaces; in contrast, few respondents (n = 2) with children at home used in non-designated spaces within the household. Most respondents thought they were successful at concealing their cocaine use. Implications for choice of space and place of drug use for themselves and their children are discussed.

Brown TL; Flory K; Lynam DR; Leukefeld C; Clayton RR. Comparing the developmental trajectories of marijuana use of African American and Caucasian adolescents: Patterns, antecedents, and consequences. Experimental and Clinical Psychopharmacology 12(1): 47-56, 2004. (24 refs.)

Adolescent marijuana use has tripled recently, and the once-noted race gap between African American and Caucasian adolescents in marijuana use appears to have disappeared. Yet, relatively little research has examined marijuana use among African American adolescents. In this study, we examined developmental trajectories of marijuana use among Caucasian and African American adolescents to identify whether and when differences in marijuana use appear and whether the precursors and outcomes associated with these developmental trajectories differ by race. Findings indicate that both the developmental patterns and outcomes associated with marijuana use are different for African American and Caucasian adolescents. Early-onset Caucasian and mid-onset African American adolescents experienced the greatest number of negative outcomes later in life associated with their marijuana use, suggesting that groups to target for intervention may vary by race.

Brown TL; Miller JD; Clayton RR. The generalizability of substance use predictors across racial groups. Journal of Early Adolescence 24(3): 274-302, 2004. (60 refs.)

Few studies have examined the predictors of substance use for ethnic minority adolescents. The current longitudinal study investigated whether factors predictive of substance use for Caucasian adolescents were also predictive for African American adolescents. Results indicated which predictors of substance use actually differ across African American and Caucasian adolescents (i.e., sensation seeking, peer substance use, and peer pressure resistance) and how they are different when race is crossed with gender. The current findings highlight the need for additional research on the similarities and differences in predictors of substance use across race. Directions for further research are provided including some discussion about contextual and cultural variables researchers might explore.

Butterfield MI; Bosworth HB; Stechuchak KM; Frothingham R; Bastian LA; Meador KG et al. Racial differences in hepatitis B and hepatitis C and associated risk behaviors in veterans with severe mental illness. Journal of the National Medical Association 96(1): 43-52, 2004. (59 refs.)

Racial differences in the seroprevalence of and risks for hepatitis B (HBV) and hepatitis C (HCV) were examined in military veterans with severe mental illnesses (SMI). Participants (376; 155 Caucasian, 221 African American) were inpatients at a Veterans Affairs (VA) psychiatric unit in Durham, N.C., from 1998 to 2000. Prevalence rates of HBV and HCV were 21.3% and 18.9%, respectively. African Americans had a higher HBV seroprevalence than did Caucasians: 27.6% versus 12.3%; odds ratio (OR) 2.73; 95% confidence interval (Cl)=1.55, 4.79. Although not statistically significant, HCV seroprevalence was also higher for African Americans than it was for Caucasians: 21.3% versus 15.5%; OR=1.47; 95% CI=0.86, 2.53. No racial difference was observed for injection drug use (IDU), the strongest risk indicator for both HBV and HCV. Multivariable analyses indicated that African-American race, IDU, and multiple sex partners in the past six months were related to an increased risk of HBV, whereas IDU and smoking crack cocaine were both independently related to an increased risk of HCV. Thus, veterans with SMI-particularly African-American veterans-have high rates of HBV and HCV infection. African-American veterans have significantly higher rates of HBV than do Caucasian veterans, which persist after controlling for prominent risk behaviors.

Caldwell CH; Sellers RM; Bernat DH; Zimmerman MA. Racial identity, parental support, and alcohol use in a sample of academically at-risk African American high school students. American Journal of Community Psychology 34(1/2): 71-82, 2004. (53 refs.)

This study examined racial identity and parental support as predictors of alcohol use in a sample of 488 African American adolescents. Two dimensions of racial identity were investigated: (1) racial centrality (i.e., the significance that one places on race in defining oneself) and (2) private regard (i.e., the extent to which one feels positively about Black people). In addition, perceived support from mothers and fathers was examined. Multivariate results showed that private regard and father support were associated with less self-reported alcohol use after partialling out the effects of age and gender. An interaction between the two racial identity dimensions was also found such that private regard was associated with less alcohol use for adolescents who reported that race was a more central part of their identity.

Catley D; Harris KJ; Okuyemi KS; Mayo MS; Pankey E; Ahluwalia JS. The influence of depressive symptoms on smoking cessation among African Americans in a randomized trial of bupropion. Nicotine & Tobacco Research 7(6): 859-870, 2005. (64 refs.)

The influence of depressive symptoms on smoking cessation was examined among 600 African American smokers who participated in a randomized, place bo-controlled trial of sustained-release bupropion hydrochloride. Depressive symptoms were assessed at baseline, at week 6 (end of treatment), and at 6-month follow-up. The study examined three separate questions: (a) Whether depressive symptom levels were related to smoking cessation, (b) whether bupropion was more effective for smokers who had higher depressive symptoms at baseline (i.e., a moderator model), and (c) whether changes in depressive symptoms would account for the efficacy of bupropion for smoking cessation (i.e., a mediator model). Depressive symptoms at baseline were not predictive of cessation; however, increases in depressive symptoms from baseline predicted reduced cessation at the end of treatment, and higher depressive symptoms at week 6 and month 6 were associated with a reduced likelihood of smoking cessation at those time points. The moderator model was not supported, but the mediation analyses indicated that alleviation of depressive symptoms partly accounted for bupropion-assisted smoking cessation at end of treatment. Results extend prior findings to African American smokers and suggest that clinicians consider increases in depressive symptoms after quitting rather than baseline depressive symptoms in predicting risk of treatment failure. Results also suggest that even though bupropion may facilitate cessation in part by reducing depressive symptoms, it appears to be no more effective for more depressed smokers, and that mechanisms other than depressive symptom alleviation account for most of its efficacy.

Chatila WM; Wynkoop WA; Vance G; Criner GJ. Smoking patterns in African Americans and whites with advanced COPD. Chest 125(1): 15-21, 2004. (17 refs.)

Background: The prevalence and mortality associated with COPD increases with age, with higher rates observed in whites than African, Americans. Causes and explanations for smoking-related. racial differences on the respiratory system have not been determined. Objective: To investigate racial differences in smoking patterns and lung function in patients with advanced COPD. Design: Retrospective record review of patients with advanced COPD. Setting: Outpatient pulmonary clinic in a tertiary-care urban hospital. Patients: One hundred sixty patients with advanced COPD (80, African Americans and 80 whites) referred for either lung volume reduction surgery or transplantation evaluation. Data collection: Demographics, smoking profile, pulmonary function testing, arterial blood gases, and exercise stress tests were compared between African-American and white patients. Results: Despite comparable pulmonary function, African Americans were younger at presentation and had lower overall pack-years of smoking than whites (58 +/- 10 years vs 62 +/- 8 years, and 44 +/- 23 pack-years vs 66 +/- 31 pack-years, respectively; p < 0.05 [mean +/- SD]). Additionally, African Americans started smoking later in life than whites (18 +/- 5 years vs 16 +/- 4 years). Similarly, women presented at a younger age and smoked less compared to men (58 +/- 9 years vs 62 +/- 9 years, and 49 +/- 28 pack-years vs 61 +/- 29 pack-years, respectively; p < 0.05), without showing any difference in lung function or exercise performance. Conclusion: Among susceptible patients with advanced COPD, African Americans and women seem more prone to the effects of tobacco smoke than their counterparts.

Choi WS; Okuyemi KS; Kaur H; Ahluwalia JS. Comparison of smoking relapse curves among African-American smokers. [rapid communication]. Addictive Behaviors 29(8): 1679-1683, 2004. (8 refs.)

We examined the smoking relapse curves for African-American smokers by level of smoking to characterize nicotine dependence in this population of smokers. This analysis was conducted from data originally collected to study differences in level of smoking among African-Americans at an inner-city health center in Midwest. Relatively little research has been conducted to clarify smoking and quitting patterns among African-American smokers. The median number of cigarettes smoked currently was 7 cigarettes per day (cpd) for light smokers and 20 cpd for the moderate to heavy smokers. The heavier smokers reported smoking at this rate longer than light smokers, 11 and 5 years, respectively. The major finding in this study is that African-American light smokers have abstinence rates very similar to heavier smokers and the median length of their most recent quit attempts were also similar. Therefore, stable light smokers may also need smoking cessation interventions similar to those used for heavier smokers in order to successfully stop smoking.

Compton MT; Furman AC; Kaslow NJ. Lower negative symptom scores among cannabis-dependent patients with schizophrenia-spectrum disorders: preliminary evidence from an African American first-episode sample. Schizophrenia Research 71(1): 61 -64, 2004. (18 refs.)

Substance use disorders, especially cannabis abuse and dependence, are common comorbid diagnoses among patients in the early course of schizophrenia. Some prior research suggests that individuals with schizophrenia and related disorders and comorbid substance abuse may have fewer negative symptoms than those without substance abuse. This pilot study examined the association between cannabis dependence and negative symptoms in a relatively homogenous sample of 18 African American first-episode, first-hospitalization patients. Those with cannabis dependence had significantly lower Positive and Negative Syndrome Scale (PANSS) negative subscale scores compared to those without cannabis dependence (p<0.012). The two groups did not differ on PANSS positive and general psychopathology subscale scores. Additional research is needed on the correlates of substance abuse among first-episode patients, including socially disadvantaged African American patients.

Cooper H; Friedman SR; Tempalski B; Friedman R; Keem M. Racial/ethnic disparities in injection drug use in large US metropolitan areas. Annals of Epidemiology 15(5): 326-334, 2005. (84 refs.)

PURPOSE: Because blacks and Latinos bear a disproportionate burden of injection-related health problems compared with whites, we sought to describe black/white and Latino/white disparities in injecting drugs in 94 US metropolitan statistical areas (MSAs) in 1998. METHODS: Using US Census data and three databases documenting injectors' use of different healthcare services (drug treatment, HIV counseling and testing, and AIDS diagnoses), we calculated database-specific black/white and Latino/white disparities in injecting in each MSA and created an index of black/white and Latino/white disparities by averaging data across the three databases. RESULTS: The median black/white injecting disparity in the MSAs ranged from 1.4 to 3.7 across the three databases; corresponding median Latino/white injecting disparities ranged from 1.0 to 1.1. Median black/white and Latino/white index disparity values were 2.6 and 1.0, respectively. CONCLUSIONS: Although whites were the majority of injectors in most MSAs, database -specific and index black/white disparity scores indicate that blacks were more likely to inject than whites. While database-specific and index disparity scores indicate that Latinos and whites had similar injecting rates, they also revealed considerable variation in disparities across MSAs. Future research should investigate these disparities' causes, including racial/ethnic inequality and discrimination, and study their contributions to the disproportionate burden of injection-related health problems borne by blacks and Latinos.

Crandall LA; Saint-Jean G. Ethnic differences in the salience of risk and protective factors for alcohol and marijuana: Findings from a statewide survey. Journal of Ethnicity in Substance Abuse 3(1): 11-27, 2004

The purpose of the study was to distinguish risk and protective factors that predict adolescent alcohol and marijuana use across all ethnic backgrounds from those that predict use for particular ethnic groups. Analysis of data from the 2000 Florida Youth Substance Abuse Survey was conducted separately for the three major ethnic groups- Whites, blacks, and Hispanics. The outcome measures were 30-day use of alcohol and marijuana and twenty-eight risk and protective factors were considered for inclusion into two logistic regression models as independent variables. Six variables were associated with all three ethnic groups' alcohol use, two with Whites and Blacks, one with Whites and Hispanics, four with Whites only, and one with Hispanics' use only. For marijuana, five variables were significant for all three ethnic groups, one for Whites and Blacks, one for Whites and Hispanics, and three for Whites only. These findings can be used to tailor adolescent drug preventive programs to specific groups, which should increase their impact.

Crisp BR; Williams M; Timpson S; Ross MW. Medication compliance and satisfaction with treatment for HIV disease in a sample of African-American crack cocaine smokers. AIDS and Behavior 8(2): 199-206, 2004. (50 refs.)

The development of treatment regimes for African-American HIV-infected crack cocaine users has often been based on assumptions about compliance with medication regimes rather than evidence. This study sought to obtain baseline information on the adherence to antiretroviral medications by members of this important risk population in Houston, Texas. It was found that for only 5 of a range of 16 antiviral medications was there a significant correlation between levels of compliance reported by respondents and their beliefs as to how effective these medications are. Medication compliance was also found not to be associated with frequency of crack cocaine use in the month prior to interview. Furthermore, irrespective of both gender and their reported extent of medication compliance, the respondents tended to report positive relationships with their treating physician, with higher levels of satisfaction reported by women. These results suggest that the majority of African-American crack cocaine users are able to comply with HIV treatment regimes, with more than half (53%) claiming full compliance for one or more medications, and a further one third (31%) claiming compliance more than half the time. Moreover, these findings suggest that they will continue to take antiretroviral medications even if they have doubts about the effectiveness of these medications.

Dahl JR; Kampman KM; Oslin DW; Weller AE; Lohoff FW; Ferraro TN et al. Association of a polymorphism in the Homer1 gene with cocaine dependence in an African American population. Psychiatric Genetics 15(4): 277-283, 2005. (34 refs.)

Objective: While twin and adoption studies have demonstrated that up to 70% of the risk for becoming addicted to cocaine is due to genetic factors, identifying specific genes involved in the development or progression of cocaine dependence has been difficult The purpose of this study is to determine whether single-nucleotide polymorphisms in the Homer and Homer2 genes associate with the cocaine-dependent phenotype in an African American population. Methods: This study utilized a case-control design in which the genotype and allele frequencies for four single-nucleotide polymorphisms in the Homed gene and three single-nucleotide polymorphisms in the Homer2 gene were compared between African American individuals with a diagnosis of cocaine dependence (n=170) and African American individuals with no history of substance abuse (n=90). Results: The data indicate that one single-nucleotide polymorphism, rs6871510, located in intron 1 of the Homed gene significantly (P=0.029) associates with cocaine dependence at the genotype level, and trends toward a significant association at the allele frequency level (chi(2) =2.62, df=1, P=0.106, OR=1.71). None of the single-nucleotide polymorphisms analyzed in the Homer2 gene associates with cocaine dependence. Conclusions: The results of this study suggest that a polymorphism in the Homer1 gene, rs6871510, is a potential risk factor for the development of cocaine dependence in an African American population, whereas polymorphisms in the Homer2 gene are not.

Daley MC. Race, managed care, and the quality of substance abuse treatment. Administration and Policy in Mental Health 32(4): 457-476, 2005. (46 refs.)

The adoption of managed behavioral health care by state Medicaid agencies has the potential to increase the quality of treatment for racial minorities by promoting access to substance abuse treatment and creating more appropriate utilization patterns. This paper examines three indicators of quality for white, Black, and Hispanic Medicaid clients who received substance abuse treatment in Massachusetts between 1992 and 1996. It evaluates whether a managed behavioral health care carve-out in FY1993 had a positive or negative effect on access, continuity of care, and 30-day re-admissions. Prior to managed care, access and continuity were worse for minorities than for whites. For all clients tinder managed care, access and continuity improved between 1992 and 1996. Access improved more for Hispanic clients relative to other racial groups. Continuity improved more for Black clients relative to other racial groups. Although seven-day and 30-day re admissions also increased following managed care, the rate of increase was not significantly greater for minorities. Although managed care had a beneficial impact on the quality of treatment for minority clients, the percent of minority Medicaid-eligible clients who accessed treatment and the percent who achieved continuity of care remained lower than for whites in every year of the study. Managed care reduced, but did not overcome, racial disparities in behavioral health care.

Dannerbeck A; Harris G; Sundet P; Lloyd K. Understanding and responding to racial differences in drug court outcomes. Journal of Ethnicity in Substance Abuse 5(2): 1-22, 2006

Significant differences in outcomes and characteristics exist between Caucasians and African-Americans in ten Missouri adult drug courts. Caucasians are more likely to graduate and they differ in significant ways from African-Americans in the context in which they lived their lives prior to drug court. Differences were significant between the two groups in employment levels at entry, primary drug of choice, levels of positive family support, and socioeconomic status. Using the evidence from this study, ways that treatment providers can better meet the needs of African-Americans are discussed.

de Pyssler B; Williams VSL; Windle M. Alcohol consumption and positive study practices among African American college students. Journal of Alcohol and Drug Education 49(4): 26-44, 2005. (40 refs.)

This investigation focused on the relation between college student drinking behavior and study skills, behaviors, habits, and attitudes among undergraduate students at a predominantly African American university. Students (N = 492) were administered a multimedia alcohol survey with an embedded measure of study practices. The negative and generally statistically signifcant correlations between study practices and drinking outcomes sign that lower scores on these study practices subscales were associated with greater alcohol use and abuse. Multiple regression analyses evaluated the contribution of study habits and attitudes to the prediction of alcohol consumption outcomes, beyond sex, age, and grades. The inclusion of measures of study practices enhanced the prediction of African American student alcohol use significantly and substantially.

Dennis ML; Scott CK; Funk R; Foss MA. The duration and correlates of addiction and treatment careers. (review). Journal of Substance Abuse Treatment 28(2. Supplement 1): S51-S62, 2005. (101 refs.)

While addiction is increasingly recognized as a chronic condition, little information is available on the actual duration of addiction and treatment careers. The purpose of this study was to estimate the duration and correlates of years between (a) first use and at least a year of abstinence and (b) first treatment admission and at least one year of abstinence. Data are from 1,271 of 1,326 (96%) people recruited from a stratified sequential sample of admissions to publicly funded treatment programs in a large metropolitan area. Participants were interviewed at 6, 18, 24, 36, 48, and 60 months post-intake. With an average age at the referent intake of 35 (SD = 8) years, the sample is 59% female, 87% African American, 7% Hispanic, and 5% white. The most common dependence diagnoses were for cocaine (64%), alcohol (44%), opioids (41%), and/or marijuana (14%). Using lifetime substance use and treatment histories collected at intake and subsequent treatment utilization recorded during follow-up interviews, we conducted survival analysis to estimate the time from first use and first treatment until people reported 12 months of abstinence or died (with people still using, in treatment, or dead at the last follow-up treated as right censored). During the three years after intake, 47% reached at least 12 months of abstinence. The median time from first to last use was 27 years. The median time from first treatment episode to last use was 9 years. Years to recovery were significantly longer for males, people starting use under the age of 21 (particularly those starting under the age of 15), people who had participated in treatment 3 or more times, and for people high in mental distress. The exploratory results suggest that multiple episodes of care over several years are the norm and that rather than thinking of multiple episodes in terms of "cumulative dosage," it might be better thought of as further evidence of chronicity and that we need to develop and evaluate models of longer term recovery management.

Dillon FR; Turner CW; Robbins MS; Szapocznik J. Concordance among biological, interview, and self-report measures of drug use among African American and Hispanic adolescents referred for drug abuse treatment. Psychology of Addictive Behaviors 19(4): 404-413, 2005. (62 refs.)

This study examined the concordance among urine assays, interview measures, and self-report measures of marijuana and cocaine use among 190 drug-abusing/dependent African American and Hispanic adolescents and their families at 3 assessment points of an 18-month randomized clinical trial study. Results demonstrated concordance among urine assays, a calendar method self-report measure (Timeline Follow Back [TLFB]), and a noncalendar method self-report measure (Adolescent Drug Abuse Diagnosis Scale). Diagnostic criteria of marijuana and cocaine abuse/dependence from a clinical structured interview (Diagnostic Interview Schedule for Children [DISC]) also converged, albeit weakly, with self-report measures. Adolescent and parent reports on DISC marijuana abuse/dependence diagnostic criteria were related; however, collateral findings for DISC cocaine abuse/dependence diagnostic criteria were equivocal. Differences in concordance among biological and self-report cocaine use measures were found for baseline TLFB assessments among African American participants. Implications for future use and refinement of adolescent drug use assessments are discussed.

Doolan DM; Froelicher ES. Efficacy of smoking cessation intervention among special populations: Review of the literature From 2000 to 2005. Nursing Research 55(4, Supplement S): S29-S37, 2006. (68 refs.)

The United States Public Health Service acknowledges in the 2000 Clinical Practice Guideline for Treating Tobacco Use and Dependence that certain special populations have unique needs and considerations in regard to smoking cessation interventions. In a review of the current smoking cessation literature, the following special populations were identified: women; older adults; gay, lesbian, bisexual, and transgender smokers; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; American Indians and Alaska Natives; African Americans; Hispanic; and Asian Americans. Existing smoking cessation research pertaining to these special populations was assessed, and an agenda for future research is proposed in this presentation. The available smoking cessation randomized clinical trials for efficacy and other research relevant to these groups is insufficient. Recent progress has been made in research in the areas of smoking cessation and women; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; and African Americans. There is, however, a paucity of research evaluating smoking cessation interventions and older adults; gay, lesbian, bisexual, and transgender smokers; American Indians and Alaska Natives; Hispanic; and Asian Americans. Further research relevant to the smoking cessation needs of these special populations can enable nurses and other healthcare providers to administer culturally adequate and efficacious smoking cessation interventions to these groups.

Durant A. African-American alcoholics: An interpretive/constructivist model of affiliation with Alcoholics Anonymous (AA). Journal of Ethnicity in Substance Abuse 4(1): 5-21, 2005. (45 refs.)

It is estimated that two million African-Americans suffer directly and indirectly from alcoholism and its related problems. Yet, because of their cultural background, African-American alcoholics do not readily accept that alcoholism is a disease. This study explores how African-American alcoholics modify the steps and traditions of AA to affiliate with the organization. Data was collected from intensive and semi-structured interviews and participant observation. Procedures and analysis generic to grounded theory were used in the context of an interpretive/constructivist paradigm.

Fernander AF; Patten CA; Schroeder DR; Stevens SR; Croghan IT; Offord KP et al. Characteristics of six-month tobacco use outcomes of black patients seeking smoking cessation intervention. Journal of Health Care for the Poor and Underserved 17(2): 413-424, 2006. (32 refs.)

Although Blacks experience disproportionately greater morbidity and mortality attributable to smoking than other racially-classified social groups, few studies have examined the impact of clinical interventions for nicotine dependence within this population. The main objective of this study was to examine 6-month outcomes among 146 self-identified adult Black patients who received an individually-tailored nicotine dependence intervention in an academic medical setting. Measures included a baseline demographic questionnaire and telephone follow-up to obtain self-reported 6-month tobacco use status. Univariate analysis was performed to assess the association of baseline patient characteristics with tobacco abstinence at 6 months following the clinic intervention. Of the 146 patients, 83% were seen in an outpatient clinic setting, while 17% were seen as inpatients in the hospital. At baseline, 53% reported smoking an average of 20 or more cigarettes per day, 32% were highly nicotine dependent, and 53% were in the preparation or action stage of change. Six months following the intervention, the 7-day point-prevalence tobacco abstinence rate was 43/146 (29%; 95% C.I. 22% to 37%). An individualized nicotine dependence intervention conducted in an academic medical setting yielded encouraging abstinence rates for Black smokers.

Fernander AF; Patten CA; Schroeder DR; Stevens SR; Eberman KM; Hurt RD. Exploring the association of John Henry active coping and education on smoking behavior and nicotine dependence among Blacks in the USA. Social Science & Medicine 60(3): 491-500, 2005. (64 refs.)

Although smoking is used as a coping tool in response to stress and Blacks have been found to report smoking more in response to stress than Whites, little research exists that has examined ethno-culturally specific constructs of stress and coping as they relate to smoking behavior and nicotine dependence among Blacks in the. This study explored the association between the ethno-culturally interactively defined construct of John Henryism, as well as the individual contributions of John Henry active coping and education on smoking behavior and nicotine dependence in a relatively urban-Midwestern Black population. Self-identified Black patients (n = 146) who had previously received a clinical intervention for nicotine dependence were followed to assess smoking status and John Henry active coping. Results revealed that patients with low levels of education who had low levels of John Henry active coping reported higher nicotine dependence scores than any other education by John Henry active coping group. Furthermore, low levels of John Henry active coping were associated with the use of menthol cigarettes and lower-educational level was associated with smoking greater than 20 cigarettes per day. Further community-based studies examining this construct among Black smokers in various socio-cultural contexts are needed to clarify the association between John Henry active coping and socioeconomic status on smoking behavior and nicotine dependence among Blacks.

Fernander A; Wilson JF; Staton M; Leukefeld C. An exploratory examination of the Spiritual Well-being Scale among incarcerated Black and White male drug users. International Journal of Offender Therapy and Comparative Criminology 48(4): 403-413, 2004. (47 refs.)

A number of studies have examined the link between criminality and religiosity. However, only a limited number of studies have examined the relationship between spirituality and criminality. Because spirituality has been identified as a fundamental attribute of the personalities of Blacks, studies examining differences in the association between spirituality, by, ethnicity could provide information to understand the disparity of incarceration rates among Blacks and Whites. For this study, data were collected from 661 male prisoners with prior histories of drug use to examine spirituality that was assessed using two factors from a modified version of the Spiritual Well-Being Scale: relationship with a higher power and satisfaction with oneself in the world. Analyses revealed that White men reported significantly higher scores on both factors than Black men. The unexpected findings are discussed in light of the existing literature that identifies the significance of spirituality in the personality and coping style of Blacks.

Flannery BA; Morgenstern J; McKay J; Wechsberg WM; Litten RZ. Co-occurring alcohol and cocaine dependence: Recent findings from clinical and field studies. Alcoholism: Clinical and Experimental Research 28(6): 976-981, 2004. (7 refs.)

This article represents the proceedings of a symposium held at the 2003 annual meeting of the Research Society on Alcoholism in Ft. Lauderdale, FL. The organizer and chair was Barbara A. Flannery, and the discussant was Raye Z. Litten. The presentations were (1) Examining treatment trajectories of alcohol and cocaine dependent patients, by Jon Morgenstern; (2) Outcomes of alcoholics with and without cocaine dependence in a continuing care study, by James R. McKay; (3) Characteristics of non-treatment seeking cocaine and alcohol dependent African Americans, by Barbara A. Flannery; and (4) Cocaine and alcohol use among sex workers in South Africa, by Wendee M. Wechsberg.

Flay BR; Graumlich S; Segawa E; Burns JL; Holliday MY. Effects of 2 prevention programs on high-risk behaviors among African American youth: A randomized trial. Archives of Pediatrics & Adolescent Medicine 158(4): 377-384, 2004. (59 refs.)

Objective: To test the efficacy of 2 programs designed to reduce high-risk behaviors among inner-city African American youth. Design: Cluster randomized trial. Setting: Twelve metropolitan Chicago, 111, schools and the communities they serve, 1994 through 1998.Participants: Students in grades 5 through 8 and their parents and teachers.Interventions: The social development curriculum (SDC) consisted of 16 to 21 lessons per year focusing on social competence skills necessary to manage situations in which high-risk behaviors occur. The school/community intervention (SCI) consisted of SDC and school-wide climate and parent and community components. The control group received an attention-placebo health enhancement curriculum (HEC) of equal intensity to the SDC focusing on nutrition, physical activity, and general health care.Main Outcome Measures: Student self-reports of violence, provocative behavior, school delinquency, substance use, and sexual behaviors (intercourse and condom use). Results: For boys, the SDC and SCI significantly reduced the rate of increase in violent behavior (by 35% and 47% compared with HEC, respectively), provoking behavior (41% and 59%), school delinquency (31% and 66%), drug use (32% and 34%), and recent sexual intercourse (44% and 65%), and improved the rate of increase in condom use (95% and 165%). The SCI was significantly more effective than the SDC for a combined behavioral measure (79% improvement vs 51%). There were no significant effects for girls. Conclusions: Theoretically derived social-emotional programs that are culturally sensitive, developmentally appropriate, and offered in multiple grades can reduce multiple risk behaviors for inner-city African American boys in grades 5 through 8. The lack of effects for girls deserves further research.

Fothergill KE; Ensminger ME. Childhood and adolescent antecedents of drug and alcohol problems: A longitudinal study. (review). Drug and Alcohol Dependence 82(1): 61-76, 2006. (121 refs.)

Despite the serious health and economic consequences of drug and alcohol abuse and dependence, few studies have prospectively examined the etiology of this problem in non-clinical populations. This longitudinal study examines childhood and adolescent antecedents of drug and alcohol problems in adulthood among an African American cohort (n = 1242; 51% female) from Woodlawn, a neighborhood in chicago. The participants were followed from age 6 to 32 years, and data were collected in first grade, adolescence, and adulthood. Structural equation modeling showed that, for both males and females, educational attainment was directly associated with a reduced risk for substance use problems. For males, first grade shyness was directly associated with a reduced risk of substance use problems, and adolescent substance use was directly associated with an increased risk. First grade aggression, low family socioeconomic status (SES), and low school bonds were indirectly associated with substance use problems for both males and females. For males, first grade underachievement had an indirect effect, and, for females, first grade shyness and strong parental supervision had indirect effects. This study is among the first to identify life course trajectories to substance use problems among an African American, community-based population. These results help to identify the targets and timing of interventions that may help to reduce the risk of drug and alcohol problems in adulthood.

Franklin J; Markarian M. Substance abuse in minority populations. IN: Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. pp. 321-339. (124 refs.)

This chapter highlights issues in the treatment of addictive disorders in African Americans, Hispanic Americans, Asian American, and Native Americans, discussing each of these separately. Epidemiology is reviewed and special treatment issues are identified, such as treatment access.

Friedman AA; Terras A; Zhu W. Early adolescent substance use/abuse as predictor to employment in adulthood: Gender differences. Journal of Child & Adolescent Substance Abuse 13(4): 49-60, 2004. (14 refs.)

For the inner-city, low SES African-American community sample of this study, prospective data on childhood educational performance and adjustment to school was available for use as control variables in analyses planned for predicting from early adolescent substance use/abuse to work history during adulthood. Results:For the male sub-sample (N = 205), a greater degree of alcohol use up to age 16 was found to predict to poorer work history during the three-year period that preceded age 37. Some possible explanations for these gender-specific findings are discussed.

Gerrard M; Gibbons FX; Brody GH; Murry VM; Cleveland MJ; Wills TA. A theory-based dual-focus alcohol intervention for preadolescents: The Strong African American Families Program. Psychology of Addictive Behaviors 20(2): 185-195, 2006. (77 refs.)

This study examined mediators of the Strong African American Families Program, a randomized, dual-focus prevention trial intended to delay the onset of alcohol use and reduce alcohol consumption among rural African American youths. More specifically, it demonstrated that changes in consumption 2 yrs after the intervention were mediated through 2 different paths, a social reaction path and a reasoned/intention path. The social reaction path provided evidence that relative to the control condition, the intervention decreased children's willingness to drink by making their images of drinkers less favorable. The reasoned/intention path provided evidence that the intervention influenced the children's intentions to drink by increasing targeted parenting behaviors related to alcohol. Furthermore, the data demonstrate that these changes in willingness and intentions were independently associated with alcohol consumption at the follow-up, and they suggest that a dual-process model approach that targets both intentions and willingness can be more successful than either approach alone.

Gibbons FX; Gerrard M; Lune LSV; Wills TA; Brody G; Conger RD. Context and cognitions: Environmental risk, social influence, and adolescent substance use. Personality and Social Psychology Bulletin 30(8): 1048-1061, 2004. (70 refs.)

This study examined the cognitions thought to mediate the impact of context on adolescent substance use and also the extent to which context moderates the relations between these cognitions and use. Risk cognitions and behaviors were assessed in a panel of 746 African American adolescents (M age 10.5 at Wave 1, 12.2 at Wave 2). Results indicated that adolescents living in high-risk neighborhoods were more inclined toward substance use and more likely to be using at Wave 2. These context effects were mediated by the adolescents' risk cognitions: their risk images, willingness to use, and intentions to use. Also, context moderated the relation between willingness and use (the relation was stronger in high-risk neighborhoods) but it did not moderate the intentions to use relation.

Gibbons FX; Gerrard M; Cleveland MJ; Wills TA; Brody G. Perceived discrimination and substance use in African American parents and their children: A panel study. Journal of Personality and Social Psychology 86(4): 517-529, 2004. (91 refs.)

The relation between perceived racial discrimination and substance use was examined in a panel of 684 African American families, using the prototype-willingness model of adolescent health risk (F. X. Gibbons, M. Gerrard, & D. Lane, 2003). Discrimination was concurrently and prospectively related to use in the parents and the children (mean age = 10.5 years at Wave 1). The discrimination -- > use relation in the parents was mediated by distress (anxiety and depression). Among the children, the relation was mediated by distress as well as their risk cognitions (favorability of their risk images and their willingness to use) and the extent to which they reported affiliating with friends who were using substances. Each of these relations with discrimination was positive. In contrast, effective parenting was associated with less willingness and intention to use. Theoretical and applied implications of the results are discussed.

Gil AG; Wagner EF; Tubman JG. Culturally sensitive substance abuse intervention for Hispanic and African American adolescents: Empirical examples from the Alcohol Treatment Targeting Adolescents in Need (ATTAIN) Project. Addiction 99(Supplement 2): 140-150, 2004. (58 refs.)

Aims: This study presents preliminary analyses examining the effects of an alcohol and other drug use (AOD) intervention with minority juvenile offenders. Furthermore, the study investigates the impact of cultural factors on baseline AOD use among Hispanic and African American youth, as well as on treatment outcome. Design, setting and participants: Participants were 213 juvenile offenders referred for treatment (mean age = 15.7 years), 97 of whom have completed treatment to date. The intervention was carried out in clinics placed within the neighborhoods in which the participants resided. Intervention: Alcohol Treatment Targeting Adolescents in Need (ATTAIN) is a controlled clinical trial evaluating the effectiveness of a brief motivational, cognitive behavioral intervention, guided self-change (GSC). Participants are assigned randomly to the individual format of guided self-change (I-GSC), the family involved format of guided self-Change (F-GSC), choice of one of these two, or a waiting list control condition. Only participants involved in active intervention are included in the present report. Measurements: Data were collected via structured face-to-face interviews. Alcohol and marijuana use measures were collected using the Time-line Follow-back interview (TLFB). Findings: There were significant reductions in alcohol and marijuana use for all ethnic groups from baseline to post-intervention. Cultural factors (discrimination, acculturation, ethnic pride and cultural mistrust) were associated with pre-intervention levels of alcohol and marijuana use. Among Hispanics, pre-intervention level of substance use were higher among foreign-born than US-born youth. Analyses conducted with the US-born Hispanic group showed that ethnic orientation and ethnic pride were associated positively with greater reductions in alcohol use. Conclusions: The intervention provided through ATTAIN appears to be effective with a multi-ethnic population of juvenile delinquents. Cultural factors, such as ethnic orientation and ethnic mistrust, appear to constitute amenability to treatment factors, with US-born Hispanic youth lower in acculturation responding better to the intervention.

Golub A; Johnson BD. The new heroin users among Manhattan arrestees: Variations by race/ethnicity and mode of consumption. Journal of Psychoactive Drugs 37(1): 51-61, 2005. (32 refs.)

The incidence of heroin use among Manhattan arrestees interviewed by the Arrestee Drug Abuse Monitoring (ADAM) program remained around 20% from 1987 through 2001. However, the authors had expected a decline because the heroin injection epidemic peaked back in the 1960s and early 1970s. A detailed analysis found differences across race/ethnicity. Black arrestees born since 1955 (who came of age since the heroin injection epidemic) were much less likely to use heroin than those born between 1945 and 1954 (who came of age during the epidemic). Hispanic arrestees born since 1970 (but not those born between 1955 and 1969) were also less likely to use heroin, suggesting that the decline in heroin use started among Blacks before Hispanics. During the 1990s, sniffing replaced injecting as the predominant mode of heroin consumption for Black and Hispanic arrestees, even among older arrestees. In strong contrast, the prevalence of heroin use among White arrestees did not decline in the 1990s and injection was still their most popular method of consumption. The discussion highlights implications for further research and drug treatment.

Grella CE; Scott CK; Foss MA. Gender differences in long-term drug treatment outcomes in Chicago PETS. Journal of Substance Abuse Treatment 28(2. Supplement 1): S3-S12, 2005. (77 refs.)

Few long-term follow-up studies of substance abusers have examined gender differences. In the current study, gender differences were examined at 36 months following residential or outpatient drug-free treatment among 951 participants in the Chicago Target Cities Project, the majority of whom were female (62%) and African American (93%). There were no differences in the proportion of men and women who reported any alcohol or drug use at the 36-month follow-up, with an overall reduction of 41% from intake. Greater proportions of men were incarcerated or employed, whereas greater proportions of women had returned to treatment, lived with their children, lived with a substance user, or had interpersonal problems. Women, as a group, had greater increases over time in self-help participation, free time spent with family, non-using family/friends, and employment. Although both men and women showed significant improvements following treatment, gender differences persisted in several areas of psychosocial functioning related to recovery.

Griffin KW; Botvin GJ; Nichols TR; Scheier LM. Low perceived chances for success in life and binge drinking among inner-city minority youth. Journal of Adolescent Health 34(6): 501-507, 2004. (28 refs.)

Purpose: To examine the relationship between low perceived chances for success in life and binge drinking in a sample of economically disadvantaged, predominantly minority, urban adolescents. Methods: A sample of predominantly black and Hispanic students (N = 774) from 13 inner-city schools completed confidential questionnaires in the 7th, 8th, and 9th grades. Eight items measured students' estimation of achieving certain adaptive life goals. Students who reported that they typically drink five or more drinks per drinking occasion were identified as binge drinkers. Results: Chi-square proportional analyses indicated that rates of binge drinking increased and perceived life chances decreased for both boys and girls from the 7th to 9th grade. A cross-lagged path analytic model revealed that higher perceived life chances in the 7th grade predicted less binge drinking in the 8th grade, whereas binge drinking in the 8th grade predicted lower perceived life chances in the 9th grade, controlling for change over time in both variables. Conclusions: Low perceived chances of success in life appear to play a role in the initiation and escalation of binge drinking during early adolescence, with a reciprocal relationship between the two factors developing over time.

Gubrium AC; Brown EJ. Lessons learned from taking data collection to the "hood". Journal of Ethnicity in Substance Abuse 5(1): 51-65, 2006

Culturally appropriate measures are needed to analyze the effectiveness of HIV prevention interventions. An effective strategy to ensure the culturally appropriateness of measures is the inclusion of participants from the targeted community via participatory action research. Conducting the research process within the community is one method of maximizing greater community participation. The purpose of this paper is to describe a method of pilot testing an instrument within community settings. Findings presented focus primarily on the process of the method, rather than on a statistical outcome testing of the instrument. The sample was 200 African-American women recruited in networks drawn from two rural and two mid-sized counties in North Florida. Methodological issues encountered and resolved through ongoing process evaluation are presented as lessons learned with recommendations and implications.

Guiao IZ; Thompson EA. Age and problem behaviors among adolescent multi-ethnic females. Issues in Mental Health Nursing 25(2): 147-164, 2004. (33 refs.)

Depression, alcohol use, and suicidal behaviors are common among adolescents. However, little is known if these problem behaviors differ among ethnically diverse females across the adolescent years. Using the National Longitudinal Study of Adolescent Health database, we conducted regression analyses to compare these problem behaviors in three age cohorts across five ethnic groups of adolescent females. The random sample (N=3,297, aged 12-19 years) included Latinas, African-, Asian-, Native-, and Euro-American females. There are differences in these problem behaviors between some age cohorts across ethnic groups. Significance and implications of the results to mental health nursing research and practice are described.

Hanlon TE; Blatchley RJ; Bennett-Sears T; O'Grady KE; Rose M; Callaman JM. Vulnerability of children of incarcerated addict mothers: Implications for preventive intervention. Children and Youth Services Review 27(1): 67-84, 2005. (32 refs.)

This is a preliminary report on the characteristics, experiences, and behavior of 88 adolescent, primarily African-American, children of incarcerated urban addict mothers that examines the association of age, gender, and risk factor profiles with the children's adjustment status defined in terms of self-reported questionnaire information and selected personality/behavioral assessment inventories. In spite of the existence of adverse circumstances in their lives, including the incarceration of their substance-abusing mothers, results revealed that the majority of these children were neither especially deviant nor maladjusted, all but a small percentage having successfully avoided substance abuse and the adoption of a deviant lifestyle at this point in their development. In most cases, mother surrogates (usually a grandmother or other family member) had for many years functioned as primary caregivers of the children prior to the incarceration of their birth mothers, which may have attenuated the negative impact ordinarily associated with a mother's absence from the home. However, there was a general indication of problematic school behavior and vulnerability to deviant peer influences that should be addressed in efforts aimed at preventing the escalation of deviant activity in such children. Also, in almost all cases, there was a readily observable need for the provision of caseworker support services to the current caregivers of the children.

Harik-Khan RI; Muller DC; Wise RA. Racial difference in lung function in African-American and White children: Effect of anthropometric, socioeconomic, nutritional, and environmental factors. American Journal of Epidemiology 160(9): 893-900, 2004. (23 refs.)

African-American children have lower lung volumes than White children. However, the contributions of anthropometric, socioeconomic, nutritional, and environmental factors to this difference are unknown. From participants in the Third National Health and Nutrition Examination Survey (1988-1994), the authors selected 1,462 healthy nonsmoking children (623 White and 839 African-American) aged 8-17 years. The African-American children were taller and heavier but had lower lung function. African Americans were poorer and had lower levels of the antioxidant vitamins A and C and alpha-carotene. The authors performed regression analyses using data on anthropometric, socioeconomic, and nutritional factors and smoke exposure. Adjustment for sitting height explained 42-53% of the racial difference. Socioeconomic factors and antioxidant vitamin levels accounted for an additional 7-10%. Overall, the authors could account for only 50-63% of the racial difference. Exposure to tobacco in the home was weakly associated with forced expiratory volume in 1 second in girls, accounting for 1% of the difference. In children aged 8-12 years (n = 752), birth weight explained 3-5% of the racial difference, whereas in-utero exposure to maternal smoking had no significant effect. The authors conclude that in healthy children, the major explanatory variable for the racial difference in lung function is body habitus; socioeconomic, nutritional, and environmental confounders play a smaller role.

Harris SM. The effect of health value and ethnicity on the relationship between hardiness and health behaviors. Journal of Personality 72(2): 379-411, 2004. (93 refs.)

Associations among hardiness, health value, and health protective behaviors were examined as a function of ethnicity among 80 African American and 100 European American college students. The role of health value as moderator versus mediator in the hardiness-health behavior link was explored. Racial differences in correlations among hardiness, control, and commitment were found, with stronger relations for African American than European Americans. Moderate positive relations between hardiness, control, commitment, and health value for African American, as contrasted with weak relations between commitment and health value for European Americans, were also shown. A partial mediation effect for health value with personal distress and moderator effects for health value with personal distress and health habits were found for African American only. Race predicted hardiness variables, tobacco and alcohol use, personal distress, and health habits beyond what was accounted for by occupation and income. The ramifications of these data with regard to future studies on hardiness, health value, and health behaviors for African American are discussed.

Harris AHS; McKellar JD; Moos RH; Schaefer JA; Cronkite RC. Predictors of engagement in continuing care following residential substance use disorder treatment. Drug and Alcohol Dependence 84(1): 93-101, 2006. (foreign check/data refs.)

Background: Patients in intensive SUD programs who subsequently participate in continuing care for a longer interval have better outcomes than those who participate for a shorter interval. We sought to identify patient and program factors associated with duration of engagement in SUD continuing care after residential/inpatient treatment. Methods: Patients (n = 3032) at 15 geographically diverse SUD residential treatment programs provided data on demographics, symptom patterns, recovery resources, and perceptions of treatment environment. We identified patient characteristics associated with the number of consecutive months of engagement in continuing care. We then consolidated and classified risk factors into an integrated model. Results: Being African American, having more SUD and psychiatric symptoms, more resources for recovery, and perceiving the treatment staff as being supportive were associated with longer engagement in continuing care. African Americans' engagement in continuing care was 17% longer than Caucasians'. The positive effect of being African American was partially mediated by having taken actions toward changing use, and by the presence of psychotic symptoms. Conclusion: These results extend previous research on the predictors of continuing care engagement after residential SUD programs. Clinicians can use information about characteristics that put patients at risk for shorter engagement in continuing care to target patients who might benefit from interventions to increase engagement in continuing care.

Harris KJ; Okuyemi KS; Catley D; Mayo MS; Ge B; Ahluwalia JS. Predictors of smoking cessation among African-Americans enrolled in a randomized controlled trial of bupropion. Preventive Medicine 38(4): 498-502, 2004. (31 refs.)

Objectives. Identification of individual characteristics that predict successful smoking cessation treatment has been limited to studies with mostly white participants. This study identifies factors that predict successful quitting among African-Americans participating in a smoking cessation trial. Methods. Twenty-one baseline variables were analyzed as potential predictors from a double-blind placebo-controlled, randomized trial that used bupropion SR for smoking cessation among 600 African-American smokers. Chi-square tests, two sample t tests, and multiple logistic regression procedures were employed to identify predictors of 7-day abstinence among the 535 participants who completed the 7-week medication phase. Results. Univariate predictors of cessation were receiving bupropion (P < 0.0001), not smoking menthol cigarettes (P = 0.0062), smoking after 30 min of waking (P < 0.0001), older age (P = 0.0085), smoking fewer cigarettes per day (P = 0.0038), and lower cotinine levels (P = 0.0002). Logistic regression identified three significant independent predictors. Participants who received bupropion treatment were more than twice as likely to quit smoking at the end of treatment compared to participants who received placebo (OR = 2.62; 95% CI = 1.77-3.88, P < 0.0001), while smoking within 30 min of waking (OR = 0.40; 95% CI = 0.25-0.62, P < 0.0001) and higher salivary cotinine levels at baseline (OR = 0.799; 95% CI = 0.629-0.922, P < 0.0001) reduced the likelihood of quitting. Conclusions. This is the first report identifying predictors of smoking cessation among African-Americans participating in a clinical trial. Results indicate that, aside from bupropion treatment, various indicators of addiction were the strongest predictors. While this is similar to findings among white smokers, thresholds of addiction may need to be adjusted for African-American smoking patterns. Additional studies focused on diverse populations are needed to improve treatment approaches and to identify population-specific factors that are important for treatment-matching approaches.

Herd D. Changes in the prevalence of alcohol use in rap song lyrics, 1979-97. Addiction 100(9): 1258-1259, 2005. (46 refs.)

Aims: This paper explores the role of changing images of drinking and alcoholic beverage use in rap music from its beginnings in the United States in the late 1970s to the late 1990s. Design: A sample of 341 rap music song lyrics released from 1979 to 1997 were selected using Billboard and Gavin rating charts. Song lyrics were coded for music genres, alcohol beverage types and brand names, drinking behaviors, drinking contexts, intoxication, attitudes towards alcohol and consequences of drinking. Findings: From 1979 to 1997, songs with references to alcohol increased fivefold (from 8 to 44%); those exhibiting positive attitudes rose from 43% to 73%; and brand name mentions increased from 46% to 71%. There were also significant increases in songs mentioning champagne and liquor (mainly expensive brand names) when comparing songs released after 1994 with those from previous years. In addition, there were significant increases in references to alcohol to signify glamour and wealth, and using alcohol with drugs and for recreational purposes. The findings also showed that alcohol use in rap music was much more likely to result in positive than negative consequences. Conclusions: Many of these findings are consistent with the idea that rap music has been profoundly affected by commercial forces and the marketing of alcoholic beverages. In addition, it is possible that the increase in references to alcoholic beverages in rap music, particularly spirits, is a reflection of a broader advertising culture which increasingly associates African Americans with alcohol use.

Hilarski C. Primary caregiver and child attachment: An important assessment issue for substance use in Afrian American and Hispanic Youth. IN: Hilarski C, ed. Addiction, Assessment, and Treatment with Adolescents, Adults, and Families. New York: Haworth Social Work Practice Press, 2005. pp. 175-190. (29 refs.)

This descriptive pilot study examined the relationship between African Americans and Hispanic youth's reported substance use and their perceived attachment with their primary caregiver. Thirty (N=30) African American and Hispanic adolescents, age 14 through 17, were divided into two groups, those who reported using alcohol and/or drugs (n=15) and those who did not (n=15). The two groups were matched on race, age, gender, violence exposure, and community. Utilizing SPSS to conduct inter-correlational and t-test analyses, the results showed that the African American and Hispanic youth who reported alcohol and/or drug use were significantly more likely to self-report greater problems in their primary caregiver relationships than those who did not. These findings suggest that assessment of family process is essential when a youth presents with substance use. Moreover, a universal prevention effort might entail incorporating healthy family process education as part of a preschool curriculum.

Irwin MR; Rinetti G. Disordered sleep, nocturnal cytokines, and immunity: Interactions between alcohol dependence and African-American ethnicity. Alcohol 32(1): 53-61, 2004. (98 refs.)

Sleep disturbance is one of the most prominent complaints of alcohol-dependent patients. In view of recent evidence that the immune system is integrated with other homeostatic processes ultimately regulated by the brain, the influence of sleep on host defense mechanisms and the expression of proinflammatory and T helper cell cytokines deserves attention in alcohol dependence. Although not all immune alterations found in alcohol-dependent persons are related to disordered sleep, it is exceedingly important to know whether sleep influences immunity in alcoholism because of the recognized impact of disordered sleep on infectious disease risk. Conversely, feedback systems are also operating between the brain and the immune system, and abnormalities in the expression of cytokines might contribute to sleep disturbances in alcohol-dependent persons. In this review, we identify the immune alterations found in association with alcohol dependence and discuss the implications of these findings for infectious disease risk, with particular attention to the interaction between African-American ethnicity and alcoholism in contributing to this risk. We provide evidence that sleep disruption occurs in association with alcohol dependence and that African-American alcohol-dependent persons show greater abnormalities in sleep and sleep regulatory processes than shown by Euro-American alcohol-dependent persons. The relations among alcoholism, sleep, and immunity are discussed, with an emphasis on understanding how the cytokine network is altered during sleep in the African-American alcohol-dependent populations. The potential is to use cytokine agonists or antagonists to determine whether physiologic changes in cytokines have a role in the homeostatic regulation of sleep in human beings, which has tremendous implications for the development of novel treatments of alcohol-related sleep disorders.

Irwin TW; Morgenstern J. Drug-use patterns among men who have sex with men presenting for alcohol treatment: Differences in ethnic and sexual identity. Journal of Urban Health 82(1 Supplement 1): I127-I133, 2005. (12 refs.)

Two important gaps in our current understanding of drug and alcohol use among men who have sex with men (MSM) are that, first, little is known about the extent of drug- and alcohol-use disorders among MSM and, second, bow these may vary among MSM who differ by ethnic/racial or sexual identity. This article is a descriptive study of the alcohol- and drug-use patterns and alcohol and drug diagnoses in an ethnically and sexually diverse sample of treatment-seeking MSM whose primary diagnosis is either alcohol abuse or alcohol dependence. The severity of alcohol problems did not vary by either ethnic or sexual identity, although the types of drugs that were used by participants did. African Americans reported a significantly higher number of drinks per drinking day compared with those in the other ethnic categories. Gay-identified men and those identified as either non-Hispanic Whites or Hispanic/Latino were significantly more likely to have used stimulant drugs (amphetamine or methamphetamine) in the past 6 months, and non-Hispanic Whites were less likely to have used marijuana compared with the other ethnic groups. A very high rate of comorbidity of drug- and alcohol-use disorders was found in this sample of ethnically diverse MSM. These results have important implications for the design of effective treatment interventions.

Jeffries SK; Catley D; Okuyemi KS; Nazir N; McCarter KS; Grobe JE et al. Use of a brief smoking consequences questionnaire for adults (SCQ-A) in African American smokers. Psychology of Addictive Behaviors 18(1): 74-77, 2004. (11 refs.)

Purposes of the present study were to (a) examine psychometric properties of a brief Smoking Consequences Questionnaire-Adult (SCQ-A; A. L. Copeland, T. H. Brandon, & E. P. Quinn, 1995) among an African American sample and (b) explore differences in smoking expectancies across levels of smoking-nicotine dependence. Four hundred eighty-four smokers attending an urban health clinic completed the brief SCQ-A. Maximum likelihood factor extraction with a varimax rotation specifying 9 factors replicated 9 factors of the original SCQ-A. Evidence for the brief SCQ-A's reliability and validity was found. Heavier and/or more dependent smokers had significantly higher scores than lighter and/or less dependent smokers on positive expectancies SCQ-A subscales. Results suggest the brief SCQ-A may be a useful alternative to the full scale SCQ-A. Results also provide evidence for the SCQ-A's validity with African American smokers.

Jordan LC; Lewis ML. Paternal relationship quality as a protective factor: Preventing alcohol use among African American adolescents. Journal of Black Psychology 31(2): 152-171, 2005. (26 refs.)

This study examines the effects of father involvement on alcohol consumption in African American adolescents. A representative sample of 1,027 students was selected from a national longitudinal study of adolescents in grades 7 through 12. Family structure and relationship quality were examined for three groups of fathers: non residential fathers, residential fathers, and father figures. The study explores the extent to which a father's presence and relationship quality serves as protective factors for adolescent alcohol use. The data supports the hypothesis that having a positive father-child relationship decreases the likelihood that an adolescent uses alcohol, and it is a greater deterrent to adolescent alcohol use than family structure. Through this study's findings, it was determined that a positive child relationship is not dependent on whether or not the father resides in the home.

Kadivar H; Garvie PA; Sinnock C; Heston JD; Flynn PM. Psychosocial profile of HIV-infected adolescents in a Southern US urban cohort. AIDS Care 18(6): 544-549, 2006. (14 refs.)

We undertook a retrospective medical chart review of HIV-infected adolescents referred to a Southern US urban comprehensive adolescent HIV clinic between 1992 and 2003 to describe the psychosocial profile of adolescents infected with HIV via high-risk behaviours. Ninety-one adolescents (59 females, 32 males, 95% African-American, median age 17 years) were identified. Common reasons for initial HIV testing included routine prenatal screening (20%), clinical symptoms suggestive of HIV ( 20%), and recognized risk-related behaviours ( 20%). Findings included a history of unstable housing in the previous year (27%), running away (29%), knowing someone with HIV (36%), parental substance abuse ( reported by youth, 46%), parental abandonment/neglect (30%), high substance use rates ( marijuana 33%, tobacco 27%), current/prior STDs (60%), and involvement with the juvenile justice system or incarceration (41%). Sexual abuse/assault was reported by 41%. Previous depression was reported in 15% with approximately half reporting prior hospitalization. An additional 12% of the cohort had current clinical depressive symptoms. We conclude that infections with HIV via high-risk behaviours during adolescence occur in youth with multiple psychosocial stressors. Targeted prevention efforts to reduce these underlying stressors may decrease new adolescent infection. HIV-infected youth are best served in a comprehensive care environment with immediate access to medical care, social work, and psychology/psychiatry services.

Kaslow NJ; Jacobs CH; Young SL; Cook S. Suicidal behavior among low-income African American women: A comparison of first-time and repeat suicide attempters. Journal of Black Psychology 32(3): 349-365, 2006. (67 refs.)

This investigation ascertained dimensions of a suicide attempt and psychological and historical risk factors that differentiate low-income, female, African American suicide attempters as a function of having made a single, first-time attempt versus multiple attempts. Two groups were compared: first-time attempters (n = 135) and repeat attempters (n = 139). Participants were recruited from a large, urban hospital following a suicide attempt (i.e., index suicide attempt). Sociodemographic characteristics, details of the index attempt (i.e., the attempt that prompted entry into the study), psychological functioning, hopelessness, substance abuse, and trauma history were assessed. The two groups were largely similar across sociodemographic characteristics. Multivariate analyses of variance were used to test hypotheses. Relative to first-time attempters, the attempts of repeat attempters involved higher levels of intent, planning, and perceived lethality and were associated with more psychological distress, hopelessness, substance abuse, and childhood trauma. Research and clinical implications of the findings are discussed.

King G; Mallett R; Kozlowski L; Bendel RB; Nahata S. Personal space smoking restrictions among African Americans. American Journal of Preventive Medicine 28(1): 33-40, 2005. (23 refs.)

Objectives: This paper investigates the association between implementing a personal space smoking restriction for the home or automobile. and various sociodemographic, social, behavioral. and attitudinal variables. Methods: Approximately 1000 African-American adults (aged > 18 years) residing in non-institutionalized settings were randomly selected using a cross-sectional stratified cluster sample of ten U.S. congressional districts represented by African Americans. Results: A 62.0% and 70.4% ban was found, respectively. on smoking in homes and cars. Multivariate analysis revealed that region, marital status, number of friends who smoked, beliefs about environmental tobacco smoke (ETS), and smoking status predicted home smoking bans, while age, number of children in household, number of friends who smoked and beliefs about ETS and smoking status predicted car smoking bans. Conclusions: Results suggest that a substantial segment of African Americans have accepted and translated public policy concerns about ETS into practice and reveal other vaiiables that could be targeted in future interventions to increase implementation of personal space smoking restrictions.

Kogan SM; Luo Z; Murry VM; Brody GH. Risk and protective factors for substance use among African American high school dropouts. Psychology of Addictive Behaviors 19(4): 382-391, 2005. (89 refs.)

Risk and protective factors that predict substance use were investigated with 318 African American high school dropout youths who completed the 1992 follow-up of the National Educational Longitudinal Study of 1988. A conceptual model linking positive family relationships and religious involvement to youths' substance use and conventional peer affiliations through a positive life orientation was examined with structural equation modeling. Positive life orientation, which included optimism and conventional goals for the future, fully mediated the influence of family relationships on conventional peer affiliations. Religious involvement directly predicted conventional peer affiliations and positive life orientation. Conventional peer affiliations mediated the other variables' influence on substance use.

Lam WKK; Wechsberg W; Zule W. African-American women who use crack cocaine: A comparison of mothers who live with and have been separated from their children. Child Abuse and Neglect 28(11): 1229-1247, 2004. (68 refs.)

Objective: This study examined factors that influenced caregiver status for African-American mothers who use crack cocaine but are not receiving drug treatment and participated in an HIV prevention study in North Carolina. Method: Caregiver mothers who were living with at least one of their children at intake (n = 257) were compared with non-Caregivers who were separated from all of their children (n = 378). Bivariate analyses and logistic regression were used to compare these mothers at intake on current drug use, risky sex practices, psychological symptoms, victimization, and aggression. Results: Compared with Caregiver mothers, non-Caregivers reported higher frequencies of drug use, risky sex practices, psychological distress, and victimization experiences. Caregiver mothers were more likely than non-Caregiver mothers to have health insurance, but were less likely to have received drug treatment. Logistic regression found that non-Caregiver mothers were significantly more likely than Caregiver mothers to be older, to have been physically abused as children, to trade sex more frequently, to be homeless, and to have no health insurance. Recent crack use, psychological symptoms, and victimization were not significantly related to caregiver status. Conclusions: Findings that socio-environmental factors were more strongly associated with caregiver status than crack use underscore the importance of contextual issues such as housing, victimization history, and resources in serving maternal crack users. Community outreach and interventions that engage mothers who use drugs and live with their children may be more effective strategies than formal office-based services to link mothers who use crack and their children to needed drug treatment and family and child services.

Lambert SF; Brown TL; Phillips CM; Ialongo NS. The relationship between perceptions of neighborhood characteristics and substance use among urban African American adolescents. American Journal of Community Psychology 34(3-4): 205-218, 2004. (66 refs.)

Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition. recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.

Laws MA; Huang CJ; Brown RF; Richmond A; Conerly RC. Cigarette smoking among college students attending a historically Black college and university. Journal of Health Care for the Poor and Underserved 17(1 Supplement S): 143-156, 2006. (15 refs.)

Very little is known about the prevalence, patterns, social norms, and trends of smoking among students attending historically Black colleges and universities (HBCUs). The current study assessed the prevalence, patterns, and norms associated with cigarette smoking among a cross-sectional random sample of 371 undergraduate college students at a historically Black university in North Carolina. Eighty-seven percent of the respondents were non-smokers. Eighty-six percent of the students reported that smoking was discouraged among their peers and 45% responded that they preferred associating with peers who did not smoke cigarettes. Seventy-one percent of the students responded that they did not smoke before the age of 18 and 55% reported that, while they were growing up, neither of their parents smoked. Preliminary findings of this study indicate that smoking is not widely practiced and has not become a socially acceptable or encouraged norm among college students attending an HBCU.

Lewis LM. Culturally appropriate substance abuse treatment for parenting African American women. Issues in Mental Health Nursing 25(5): 451-472, 2004. (38 refs.)

Culturally appropriate strategies have been deemed necessary for the treatment of substance abuse among African American women. This qualitative study was conducted utilizing a grounded theory methodology within a womanist theoretical framework to explore the process by which parenting African American women participate in formal substance abuse treatment programs. Study findings yielded significant insights into this process and support the notion that culturally appropriate frameworks are necessary to help substance-abusing African American women enter into treatment programs and remain in recovery. In addition, specific interventions for treating substance-abusing African American women within a culturally relevant framework are discussed.

Liddle HA; Jackson-Gilfort A; Marvel FA. An empirically supported and culturally specific engagement and intervention strategy for African American adolescent males. (review). American Journal of Orthopsychiatry 76(2): 215-225, 2006. (105 refs.)

The need for effective culturally responsive treatments has become more urgent as the number of ethnic minority clients continues to increase. Previous research with a clinically referred sample of substance-abusing African American inner-city teenagers found that treatment engagement increased when cultural content was incorporated in the therapeutic process (Jackson-Gilfort, Liddle, Tejeda, & Dakof, 2001). This article amplifies these findings by offering clinical guidelines for how to develop and implement culturally specific interventions that contribute to the therapeutic engagement of African American adolescent males. Clinical outcomes may be improved by integrating culturally responsive intervention methods within a multisystemic approach to the adolescent's treatment.

Linton A; Peterson MR. Effect of preexisting chronic disease on primary cesarean delivery rates by race for births in US military hospitals, 1999-2002. Birth Issues in Perinatal Care 31(3): 165-175, 2004. (58 refs.)

Background: A previous study of the United States Department of Defense healthcare beneficiaries reported elevated cesarean delivery rates for black and Asian women relative to white women that were independent of maternal socioeconomic status. This finding suggests that other maternal factors may explain the elevated rates. The purpose of this study was to examine the prevalence of specific chronic diseases identified as risk factors for complications during pregnancy, labor, and delivery, and to explore the strength of each disease to predict a cesarean outcome. Methods: United States military hospital discharge records from 1999 to 2002 for singleton births to women without a previous cesarean were used to calculate primary cesarean and chronic disease rates for diabetes, hypertension, cardiovascular disease, renal disease, anemia, asthma, sexually transmitted diseases, and substance abuse. Stepwise logistic regression was used to calculate adjusted odds ratios for dichotomized race and chronic disease indicators for five maternal age groups using the chi(2)difference(p < 0.05) to identify significant variables for inclusion in the model. Primary cesarean delivery rates were then adjusted for the presence of chronic diseases that were significantly associated with a cesarean outcome. Results: Diabetes, genital herpes, and hypertension were significant predictors of cesarean use among all maternal age groups. Cardiovascular disease, renal disease, asthma, and anemia were predictors in some age groups. The remaining disease conditions were not significant predictors for cesarean delivery. Adjustment of cesarean rates for these chronic diseases did not significantly alter the differences in primary cesarean rates for black and Asian mothers relative to white mothers. Conclusions: The presence of certain chronic conditions before pregnancy may increase the likelihood that a woman will deliver by cesarean section. Adjustment of cesarean rates for the presence of these chronic diseases, however, does not account for the difference in cesarean rates observed for white and minority mothers in the study population. The potential for underreporting of chronic diseases complicates a true assessment of the impact of chronic disease on cesarean delivery rate variations between white and minority women.

Lipsky S; Caetano R; Field C; Bazargan S. The role of alcohol use and depression in intimate partner violence among black and Hispanic patients in an urban emergency department. American Journal of Drug and Alcohol Abuse 31(2): 225-242, 2005. (53 refs.)

Objectives: The primary objective of this study was to assess the role of alcohol use and depression in intimate partner violence (IPV) victimization and perpetration among Blacks and Hispanics in an underserved urban emergency department population. Methods: This cross-sectional study surveyed male and female patients presenting to an urban emergency department. The outcome measures were physical or sexual IPV victimization and perpetration in the previous 12 months. The independent predictors included demographic variables, alcohol and drug use, and depressive symptoms. Logistic regression analyses calculated the adjusted odds ratio (AOR) and 95% confidence interval (CI) for predictors of IPV victimization and perpetration in separate models. Results: The prevalence of IPV victimization among Blacks and Hispanics were similar (14% and 10%, respectively) but blacks were nearly twice as likely to report IPV perpetration (17% vs. 9%, respectively). Predictors of IPV perpetration were Black race, married or living with a partner, heavy drinking, illicit drug use, and current depression. Depression, but not substance use, also predicted IPV victimization, in addition to Black race, married or living with a partner, and younger age. Conclusions: Screening for substance abuse and depression in an inner city emergency department population may help to identify individuals at high risk of IPV, particularly IPV perpetration.

Longshore D; Teruya C. Treatment motivation in drug users: A theory-based analysis. Drug and Alcohol Dependence 81(2): 179-188, 2006. (56 refs.)

Motivation for drug use treatment is widely regarded as crucial to a client's engagement in treatment and success in quitting drug use. Motivation is typically measured with items reflecting high treatment readiness (e.g., perceived need for treatment and commitment to participate) and low treatment resistance (e.g., skepticism regarding benefits of treatment). Building upon reactance theory and the psychotherapeutic construct of resistance, we conceptualized these two aspects of treatment motivation - readiness and resistance - as distinct constructs and examined their predictive power in a sample of 1295 drug-using offenders referred to treatment while on probation. The sample was 60.7% African Americans, 33.5% non-Hispanic Whites, and 21.2% women; their ages ranged from 16 to 63 years old. Interviews occurred at treatment entry and 6 months later. Readiness (but not resistance) predicted treatment retention during the 6-month period. Resistance (but not readiness) predicted drug use, especially among offenders for whom the treatment referral was coercive. These findings suggest that readiness and resistance should both be assessed among clients entering treatment, especially when the referral is coercive. Intake and counseling protocols should address readiness and resistance separately.

MacMaster SA. Experiences with and perceptions of, barriers to substance abuse and HIV services among African American women who use crack cocaine. Journal of Ethnicity in Substance Abuse 4(1): 53-75, 2005. (54 refs.)

Significant health disparities in the rates of HIV infection exist that primarily impact African American women. While research has demonstrated that HIV is preventable through changes in high-risk behaviors facilitated by substance abuse treatment, an individual must first be able to access and engage with treatment to derive any benefit from these services. While there is some research that identifies barriers to treatment access and engagement for African American women who use crack cocaine, these barriers require further examination. Current literature has focused primarily on internal motivation and treatment readiness without placing these concepts within the unique environmental context of social stressors for crack cocaine-using African American women. This study presents the results of eleven focus groups with eighty-nine African American women in which respondents document the HIV risk behaviors of crack cocaine users, present their experiences in accessing substance abuse and HIV services, and documents their perceptions of barriers and services needs. The results of this study may further develop an understanding of the means by which individual service users experience their relationships with service providers and the factors that affect these relationships in order to better target potential interventions to reduce the spread of HIV.

Mager A. 'White liquor hits black livers': meanings of excessive liquor consumption in South Africa in the second half of the twentieth century. (review). Social Science & Medicine 59(4): 735-751, 2004. (138 refs.)

Four years into South Africa's first democracy, the African National Congress Youth League, with the help of the liquor industry's Social Aspects of Alcohol Committee drafted a policy to prevent substance abuse in black communities. They declared that alcohol was 'often not used in a socially acceptable way'. Concerned not so much with post-apartheid policy as with making sense of what socially acceptable alcohol usage might mean, this article explores narratives of alcohol use and abuse in South Africa in the second half of the twentieth century. It demonstrates that while multiple understandings of excess in alcohol consumption were articulated, those notions tied to particular constructions of racial difference prevailed. Ideas pairing drinking habits with race were given effect by state institutions. By tying drinking habits to 'race' and by locating 'race' in a social hierarchy, state institutions determined access to liquor and welfare services. By naturalising Africans as heavy drinkers, the state justified its sale of liquor to African men while denying the need for rehabilitation in the event of alcoholic dependence. By placing 'coloured' closer to 'white' in its racial order, the apartheid state found cause to extend limited rehabilitation services to those designated 'coloured'.(2) By tying liquor revenues to apartheid administration, the ruling regime exonerated its policy of excluding blacks from the retail liquor trade even after lifting prohibition in 1962. This policy encouraged rampant illicit liquor dealing, created a social environment in which alcoholic excess, particularly after 1976, reached new proportions and generated new and dangerous meanings of socially acceptable drinking. Against the grain of these dominant discourses of racially designated meanings of drinking, African people forged a more complex set of practices and meanings not rendered any clearer by the ANC Youth League's discourse of acceptable and unacceptable usage.

Martin Q; Peters RJ; Amos CE; Yacoubian GS; Johnson RJ; Meshack A et al. The relationship between sexual abuse and drug use: A view of African-American college students in Texas. Journal of Ethnicity in Substance Abuse 4(1): 23-33, 2005. (26 refs.)

This study offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2003 via a self-administered survey. Students who reported sexual abuse history in or around campus were 4 times more likely to report current amphetamine, cocaine, hallucinogen, opiate, or designer drug use compared to students with no sexual abuse history. Logistic regression analyses indicated that lifetime drug use was significantly associated with sexual abuse history (OR = 2.2, p < .05). While the relationships tested in this study are exploratory, they provide evidence for an important connection between sexual abuse and substance use among African-American college students.

Miller-Day M; Barnett JM. "I'm not a druggie": Adolescents' ethnicity and (erroneous) beliefs about drug use norms. Health Communication 16(2): 207-228, 2004. (45 refs.)

Interviews were conducted with 67 Black and non-Hispanic White adolescents to gain detailed descriptions of personal and ethnic identities, perceptions of drugs and drug use norms, and reports of their own drug use behavior. In addition, this study examined ways in which ethnic identity and perceptions Of cultural norms were linked to adolescent drug use attitudes. Findings imply that perceptions of culturally specific norms may be related to adolescent drug use attitudes and behavior. The authors argue for increased health campaign prevention efforts directed at erroneous perceptions of ethnic cultural norms.

Moolchan ET; Hudson DL; Schroeder JR; Sehnert SS. Heart rate and blood pressure responses to tobacco smoking among African-American adolescents. Journal of the National Medical Association 96(6): 767-771, 2004. (36 refs.)

Ethnic differences in both physiological response to and health consequences of tobacco smoking-some of which have been attributed to ethnic preferences for menthol cigarettes-have been described in the literature. We compared acute physiological responses to smoking in African-American and European-American adolescent menthol cigarette smokers seeking smoking cessation treatment. One-hundred-twenty-eight adolescents (32% African-American, 71% female; mean age 15.16 +/- 1.32 years, mean Fagerstrom Test of Nicotine Dependence (FTND) score 6.73 +/- 1.53, cigarettes per day (CPD) 16.9 +/- 2.64) participated in an experimental session during which they smoked one menthol cigarette of their usual brand. Blood pressure, heart rate, and exhaled carbon monoxide (CO) concentrations were measured before and after smoking; mean puff volume (mL), puff duration (sec) and maximal puff velocity (mL/sec) during smoking were also determined. Two sample t-tests were performed to assess ethnic differences in smoking topography; analysis of covariance was used to determine whether heart rate and blood pressure after smoking one menthol cigarette varied by ethnicity, after controlling for baseline physiological measures. No significant ethnic differences were observed in either smoking topography or acute cardiovascular response to smoking. These preliminary findings warrant extension to a broader group of non-treatment-seeking adolescent smokers of both ethnicities.

Moolchan ET; Schroeder JR. Quit attempts among African American teenage smokers seeking treatment: Gender differences. Preventive Medicine 39(6): 1180-1186, 2004. (35 refs.)

Background. African Americans experience disproportionate smoking-related mortality. Because established smoking during youth predisposes to adult smoking and serious health consequences, characterizing ethnic differences in adolescent smokers' self-quit attempts may inform ethnic-specific approaches to youth smoking cessation. Methods. African American and European American teenage smokers applying to a teenage smoking cessation study (2000-2003) provided smoking-related data, including characteristics of previous cessation attempts and prior use of nicotine replacement therapy (NRT). Tobacco dependence was assessed using the Fagerstr�m Test of Nicotine Dependence (FTND). Results. Of 980 (15.5 plus or minus 1.3 years, 41.8% African American, 59.9% female) participants, African Americans boys were significantly less likely than European American boys to report a prior quit attempt (OR = 0.35, 95% CI 0.17-0.73, P = 0.0049) or to have used NRT (OR = 0.60, 95% CI 0.36-0.998, P = 0.049) after adjusting for years smoked and FTND score. African American girls were more likely to report a prior request for cessation treatment than European American girls after adjusting for FTND and years smoked (OR = 2.19, 95% CI 1.37-3.48, P = 0.001). Conclusions. While increasing education and outreach to African American boys and enhancing access to formal cessation programs for African American girls who smoke may be beneficial, our findings warrant extension to non-treatment-seeking teenage smokers.

Morse DE; Kerr AR. Disparities in oral and pharyngeal cancer incidence, morality and survival among black and white Americans. Journal of the American Dental Association 137(2): 203-212, 2006. (43 refs.)

Background. The authors present statistics and long-term trends in oral and pharyngeal cancer (OPC) incidence, mortality and survival among U.S. blacks and whites. Methods. The authors obtained incidence, mortality and five-year relative survival rates via the Surveillance, Epidemiology and End Results (SEER) Program Web site. Current rates and time trends for 1975 through 2002 are presented. Results. From 1975 through 2002, age-adjusted incidence rates (AAIRs) and mortality rates (AAMRs) were higher among males than among females and highest for black males. By the mid-1980s, incidence and mortality rates were declining for black and white males and females; however, disparities persisted. During the period 1998-2002, AAIRs were more than 20 percent higher for black males compared with white males, while the difference in rates for black and white females was small. AAMRs were 82 percent higher for black males compared with white males, but rates