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CORK Bibliography: Family

79 citations. January 2011 to present

Prepared: September 2011

Amato PR; Kane JB. Life-course pathways and the psychosocial adjustment of young adult women. Journal of Marriage and the Family 73(1): 279-295, 2011. (38 refs.)

We examined 7 life-course pathways from adolescence through the early adult years and their links with general health and psychosocial adjustment among 2,290 women from the National Longitudinal Study of Adolescent Health. Young women who followed a pathway involving college attendance to full-time employment with no family-formation transitions were functioning comparatively well with respect to general health, depression, and self-esteem. In contrast, young women who followed pathways involving early motherhood were functioning less well. Fixed-effects models suggested that the differences were due to selection factors. Young women who followed the pathway of college to full-time employment exhibited an increase in heavy drinking, whereas women who became married mothers exhibited a decrease in the same. Involvement in illegal behavior declined for all groups but least so for women who attended college.

Amodeo M; Griffin M; Paris R. Women's reports of negative, neutral, and positive effects of growing up with alcoholic parents. Families in Society 92(1): 69-76, 2011. (55 refs.)

Parental alcoholism does not necessarily result in negative outcomes for the offspring; we examined whether it would result in negative perceptions of the experience. Black women and White women with alcoholic parents (N = 126) rated and described the effect of parental alcoholism on them: 65% reported a negative effect, 26% reported a positive effect, and 7% reported a neutral effect. We examined these ratings in relation to the women's overall adult adjustment. More positive ratings were associated with being Black and with variables such as social support, experiencing lower family conflict, and having no alcohol problem oneself. Human service providers need greater access to research findings to see that children from these families will be diverse in their psychological and social functioning.

Anderson KG; Brown SA. Middle school drinking: Who, where, and when. Journal of Child & Adolescent Substance Abuse 20(1): 48-62, 2011. (34 refs.)

The goal of this research was to describe the most common drinking situations for young adolescents (N=1171; 46.6% girls), as well as determine predictors of their drinking in the seventh and eighth grades. Middle school students most frequently drank at parties with three to four teens, in their home or at a friend's home, and reported alcohol-related problems including conflicts with friends or parents, memory loss, nausea, and doing things they would not normally do. Differences emerged in predicting higher levels of drinking on the basis of sex, race, grade, positive alcohol expectancies, impulsivity, and peer drinking. These findings suggest both specific and general factors are implicated in drinking for middle school students. Contextual factors, including drinking alone, in public places, and at or near school, are characteristic of the most problematic alcohol involvement in middle school and may have utility in prevention and early intervention.

Asbridge M; Cartwright J. The relationship of home smoking bans to the physical and mental health of smokers. Nicotine & Tobacco Research 13(2): 70-77, 2011. (52 refs.)

The aim of this study is to examine whether the adoption of home smoking bans is associated with the physical and mental health of smokers. Two potential pathways that link home smoking bans to smoker's health are analyzed. The first argues that home smoking bans are positively related to physical health by encouraging smoking cessation while reducing daily cigarette consumption. The second suggests that home smoking bans have a negative relationship to smokers' mental health by increasing marginalization and social isolation. Data on 28,887 Canadian smokers were analyzed from the Canadian Community Health Survey, a nationally representative sample of Canadians adults. Logistic regression models analyzed the impact of home smoking bans on subjective assessments of smoker's physical and mental health. Separate analyses were conducted on daily and occasional smokers, and additional analyses tested interactions between the presence of a home smoking ban and key socioeconomic (gender and low household income) and structural (dwelling ownership, living alone, and dwelling type) covariates. Home smoking bans were not associated with smoker's physical health and were positively associated with smokers' mental health. These findings were consistent for daily smokers and occasional smokers. No significant interactions between smoking bans and socioeconomic or structural covariates were observed. Findings are considered with respect to the internal and external constraints that shape smoker's behavior, particularly the influence of social norms around environmental tobacco smoke exposure and good citizenship and the role of family relationships. The implications of study findings are considered with respect to public health policy.

Asgeirsdottir BB; Sigfusdottir ID; Gudjonsson GH; Sigurdsson JF. Associations between sexual abuse and family conflict/violence, self-injurious behavior, and substance use: The mediating role of depressed mood and anger. Child Abuse & Neglect 35(3): 210- 219, 2011. (56 refs.)

Objective: To examine whether depressed mood and anger mediate the effects of sexual abuse and family conflict/violence on self-injurious behavior and substance use. Methods: A cross-sectional national survey was conducted including 9,085 16-19 year old students attending all high schools in Iceland in 2004. Participants reported frequency of sexual abuse, family conflict/violence, self-injurious behavior, substance use, depressed mood, and anger. Results: Sexual abuse and family conflict/violence had direct effects on self-injurious behavior and substance use among both genders, when controlling for age, family structure, parental education, anger, and depressed mood. More importantly, the indirect effects of sexual abuse and family conflict/violence on self-injurious behavior among both males and females were twice as strong through depressed mood as through anger, while the indirect effects of sexual abuse and family conflict/violence on substance use were only significant through anger. Conclusions: These results indicate that in cases of sexual abuse and family conflict/violence, substance use is similar to externalizing behavior, where anger seems to be a key mediating variable, opposed to internalizing behavior such as self-injurious behavior, where depressed mood is a more critical mediator. Practice implications: Practical implications highlight the importance of focusing on a range of emotions, including depressed mood and anger, when working with stressed adolescents in prevention and treatment programs for self-injurious behavior and substance use.

Babor TF. Commentary on Laslett et al. (2011): Alcohol-related collateral damage and the broader issue of alcohol's social costs. Addiction 106(9): 1612-1613, 2011. (2 refs.)

Bachman JG; O'Malley PM; Johnston LD; Schulenberg JE; Wallace JM. Racial/ethnic differences in the relationship between parental education and substance use among us 8th-, 10th-, and 12th-grade students: Findings From the Monitoring the Future Project. Journal of Studies on Alcohol and Drugs 72(2): 279-285, 2011. (17 refs.)

Objective: Secondary school students' rates of substance use vary significantly by race/ethnicity and by their parents' level of education (a proxy for socioeconomic status). The relationship between students' substance use and race/ethnicity is, however, potentially confounded because parental education also differs substantially by race/ethnicity. This report disentangles the confounding by examining White, African American, and Hispanic students separately, showing how parental education relates to cigarette smoking, heavy drinking, and illicit drug use. Method: Data are from the 1999-2008 Monitoring the Future nationally representative in-school surveys of more than 360,000 students in Grades 8, 10, and 12. Results: (a) High proportions of Hispanic students have parents with the lowest level of education, and the relatively low levels of substance use by these students complicates total sample data linking parental education and substance use. (b) There are clear interactions: Compared with White students, substance use rates among African American and Hispanic students are less strongly linked with parental education (and are lower overall). (c) Among White students, 8th and 10th graders show strong negative relations between parental education and substance use, whereas by 12th grade their heavy drinking and marijuana use are not correlated with parental education. Conclusions: Low parental education appears to be much more of a risk factor for White students than for Hispanic or African American students. Therefore, in studies of substance use epidemiology, findings based on predominantly White samples are not equally applicable to other racial/ethnic subgroups. Conversely, the large proportions of minority students in the lowest parental education category can mask or weaken findings that are clearer among White students alone.

Baldwin JN; Scott DM; DeSimone EM; Forrester JH; Fankhauser MP. Substance use attitudes and behaviors at three pharmacy colleges. Substance Abuse 32(1): 27-35, 2011. (19 refs.)

The objective of this study was to profile and compare alcohol and other drug (AOD) use attitudes and behaviors in three pharmacy colleges. Student surveys of AOD use attitudes and behaviors were conducted at one southwestern and two midwestern pharmacy colleges. Response was 86.5% (566/654). Reported past-year use included alcohol 82.8%, tobacco 25.4%, and marijuana 6.9%. Past-year AOD-associated events included blackouts 18.2%, class or work under influence 7.8%, patient care under influence 1.4%, lowered grades or job evaluations 5.8%, legal charges 2.7%, and heavy drinking 29.0%. Family histories of alcohol or drug problems were reported by 35.5% and 13.1%, respectively. A number of significant differences in AOD use attitudes and behaviors between the three colleges were identified. Pharmacy students reported a number of risky drug-use attitudes and behaviors in this survey. Student AOD prevention, assistance, and education should be proactively addressed by pharmacy colleges.

Benishek LA; Kirby KC; Dugosh KL. Prevalence and frequency of problems of concerned family members with a substance-using loved one. American Journal of Drug and Alcohol Abuse 37(2): 82-88, 2011. (26 refs.)

Background: Limited research has examined the prevalence and frequency of specific problems of concerned family members and significant others (CSOs) of alcohol- or substance-using individuals (SUIs). Objectives: We surveyed CSOs of SUIs to determine the prevalence and frequency of their problems and explored whether relationship to the SUI, gender of the CSO, or living arrangements altered problem prevalence and frequency. Methods: Non-substance-using CSOs (n == 110) completed the Significant Other Survey, which asks about problems in seven domains (emotional; family; relationship; financial; health; violence; legal). Problem outcomes were compared based on the CSO's relationship to the SUI (partner or spouse vs. parent), gender of the CSO (male vs. female), and living arrangements of the CSO and the SUI (residing together vs. residing apart). Results: Problems were prevalent with at least two-thirds of the participants endorsing one or more problems in all but the legal domain. They also occurred frequently, with CSOs reporting problems on one-third to one-half of the past 30 days, in all but the violence and legal domains. Problems tended to be greater for CSOs who were partners, females, or living with the SUI. Conclusion: CSOs experience frequent problems in a wide range of life domains and the types of difficulties they experience appear to differ based on type of relationship, gender, and their living arrangement relative to the SUI. Scientific Significance: This investigation expands our understanding of the specific problems that CSOs face. The findings have important implications for treatment and health policy regarding these individuals.

Bergh D; Hagquist C; Starrin B. Parental monitoring, peer activities and alcohol use: A study based on data on Swedish adolescents. Drugs: Education, Prevention and Policy 18(2): 100-107, 2011. (31 refs.)

Aim: This study investigates the association between two types of social relations during leisure time (to parents and peers) and the frequency of alcohol use among Swedish adolescents, taking possible interaction effects into account. Methods: The data were collected during the 1995-2005 time period by using a questionnaire handed out in the class room. The study includes about 10,000 Swedish adolescents aged 15-16 years. Results: The results show that there are strong associations between the social relations adolescents have during leisure time (both to parents and peers) and the frequency of alcohol use. High levels of peer activity were associated with higher frequencies of alcohol use. Although the effects of relations with parents were modified by peer activity frequencies, high levels of parental monitoring were significantly associated with lower frequencies of alcohol use, regardless of the peer activity frequencies. Conclusions: Parental monitoring is an efficient way to prevent or reduce adolescents' alcohol use, although its importance may vary due to peer activity frequency.

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

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

Burk LR; Armstrong JM; Goldsmith HH; Klein MH; Strauman TJ; Costanzo P et al. Sex, temperament, and family context: How the interaction of early factors differentially predict adolescent alcohol use and are mediated by proximal adolescent factors. Psychology of Addictive Behaviors 25(1): 1-15, 2011. (107 refs.)

Adolescent alcohol use is common and has serious immediate and long-term ramifications. While concurrent individual and context factors are robustly associated with adolescent alcohol use, the influence of early childhood factors, particularly in interaction with child sex, are less clear. Using a prospective community sample of 362 (190 girls), this study investigated sex differences in the joint influence of distal childhood and proximal adolescent factors on Grade 10 alcohol use. All risk factors and two-way early individual-by-context interactions, and interactions of each of these with child sex, were entered into the initial regression. Significant sex interactions prompted the use of separate models for girls and boys. In addition to the identification of early (family socioeconomic status, authoritative parenting style) and proximal adolescent (mental health symptoms, deviant friends) risk factors for both girls and boys, results highlighted important sex differences. In particular, girls with higher alcohol consumption at Grade 10 were distinguished by the interaction of early temperamental disinhibition and exposure to parental stress; boys with higher alcohol consumption at Grade 10 were distinguished primarily by early temperamental negative affect. Results have implications for the timing and type of interventions offered to adolescents.

Butler KM; Rayens MK; Zhang M; Hahn EJ. Motivation to quit smoking among relatives of lung cancer patients. Public Health Nursing 28(1): 43-50, 2011. (26 refs.)

Objective: The purpose of this study was to determine the factors related to motivation to quit among smoking family members of lung cancer patients. Design and Sample: Relatives of multidisciplinary lung cancer clinic patients were recruited during family members' treatment. Participants (N=29) were primarily female and Caucasian. Measures: The items assessed included the effect of their relative's disease on motivation to quit, intent to quit in the next 6 months, stage of change, perceived risk from smoking, and attitudes about being approached about cessation. Results: Most indicated that their relative's disease had increased motivation to quit smoking (71%); 72% planned to quit within 6 months. One fourth (28%) were in precontemplation stage of change; 65% in contemplation; and 7% in preparation. The average perceived risk of developing lung cancer was 6.3. Two thirds were glad or very glad that someone had talked with them about quitting; 91% thought it was somewhat or very appropriate to talk about cessation with family members of lung cancer patients. Motivation to quit smoking was positively correlated with stage of change and perceived lung cancer risk. Conclusions: Public health nurses who interact with families of lung cancer patients may be able to promote cessation in an at-risk group that is motivated to quit smoking.

Buu A; Wang W; Wang J; Puttler LI; Fitzgerald HE; Zucker RA. Changes in women's alcoholic, antisocial, and depressive symptomatology over 12 years: A multilevel network of individual, familial, and neighborhood influences. Development and Psychopathology 23(1, special issue): 325-337, 2011. (87 refs.)

In a sample of 273 adult women and their families, we examined the effects of women's psychopathology history, their social support, their husbands' and children's symptomatology, family stress, and neighborhood environment on their alcohol problems, antisocial behavior, and depression over a 12-year period during their 30s and early 40s. Women's alcohol problems and antisocial behavior decreased but their depression symptoms increased over time. Women's disorder history and their partners' parallel symptomatology were associated with their symptoms. For women's antisocial behavior, their own history of alcoholism and their partners' alcohol problems were also significant risk factors. Higher levels of social support were associated with lower levels of depression in women. Children's externalizing behavior was positively correlated with their mothers' alcohol problems and antisocial behavior, whereas children's internalizing behavior was positively correlated with their mothers' depression. Neighborhood residential instability was associated with higher levels of alcoholic and depressive symptomatology in women. Intervention efforts might target women with young children by improving social support, educational or professional training opportunity, access to family counseling, and neighborhood environment.

Capone C; Kahler CW; Swift RM; O'Malley SS. Does family history of alcoholism moderate naltrexone's effects on alcohol use? Journal of Studies on Alcohol and Drugs 72(1): 135-140, 2011. (32 refs.)

Objective: Primary outcomes from the COMBINE Study indicated support for naltrexone (Revia) on measures of abstinence and time to heavy drinking; however, effect sizes were modest. The delineation of individual difference variables that qualify these results could aid efforts to target treatment approaches appropriately. Laboratory and clinical studies have found greater effectiveness of naltrexone among men and those with familial alcoholism. The present study used multi-level modeling to investigate family history of alcoholism (FHA) based on first-degree relatives and gender as moderators of naltrexone's effects on three drinking outcomes: percentage of days abstinent, drinks per drinking day, and percentage of heavy drinking days. Method: Data were drawn from the COMBINE public data set and included the subsample of participants (n = 603) randomized to receive active medication or placebo plus medical management. Results: We observed a main effect of FHA on drinks per drinking day (B = 2.01, SE = .91, p = .03) such that greater FHA was associated with greater alcohol use per drinking occasion. No other main effects of FHA were observed on drinking outcomes. A significant Naltrexone x Time interaction was observed for percentage of heavy drinking days (B = -1.61, SE = .69, p = .02), consistent with the previously published COMBINE results. No significant Naltrexone x FHA interactions were observed for any of the three outcomes. Gender did not modify these results. Conclusions: Taken together, these results indicate an effect of FHA on drinking behavior but do not support FHA among first-degree relatives as a moderator of naltrexone's efficacy in this sample.

Chen KH; Chen CY; Liu CY; Lin YC; Chen WJ; Lin KM. Multilevel influences of school and family on alcohol-purchasing behaviors in school-aged children. Drug and Alcohol Dependence 114(2-3): 127- 133, 2011. (52 refs.)

Background: Little has been known about children's illegal alcohol purchasing behaviors and associated contextual factors influencing commercial accessibility to alcohol. The aims are to determine multilevel effects of school-and family-characteristics on children's alcohol purchase and to probe possible drinking experience-related heterogeneity in such links. Methods: A representative sample of 2630 4th- and 6th-graders in an urban region of Taiwan in 2007 was drawn via multistage probability sampling. Information about family background and individual drinking experiences was collected via paper-and-pencil self-administered questionnaires; school neighborhood characteristics were assessed via commercial datasets of geographic information system. Results: Roughly one in nine 10-12-year-old children ever purchased alcoholic beverages by 6th grade. Children who did not participate in after-school programs or had observed parental drinking had 2-3-fold increased risk to buy alcoholic beverages alone. Living with one or none of parents was associated with alcohol purchase in children who never drank alcohol (Odds Ratio [OR] = 3.51; 95% Confidence Interval [CI] = 2.14, 5.76). School contextual characteristics have salient effects on minors' alcohol accessibility from commercial sources (e.g., the density of nearby educational institutions, OR = 0.33-0.53), and certain school neighborhood effects were notably different by children's drinking experience (e.g., the density of public transportation). Conclusions: The present study suggests the significant effects of family socioeconomics, family drinking, and school neighboring environment on children's independent alcohol purchase, which may operate differentially by one's drinking experience. Our findings may provide implications that family and school neighborhood contexts should be considered in the devising and delivery of underage drinking prevention programs.

Danielsson AK; Romelsjo A; Tengstrom A. Heavy episodic drinking in early adolescence: Gender-specific risk and protective factors. Substance Use & Misuse 46(5): 633-643, 2011. (54 refs.)

This longitudinal study examined possible gender differences regarding risk and protective factors for heavy episodic drinking among 1,222 seventh-grade students (aged 13) in the City of Stockholm, Sweden, with follow-up 2 years later. Logistic regression analyses showed that several factors predicted heavy episodic drinking. The strongest predictors for boys' heavy episodic drinking in the ninth grade were heavy episodic drinking (odds ratio [OR] = 5.30) and smoking in the seventh grade (OR = 5.80). Drinking peers (OR = 2.47) and smoking (OR = 2.44) in the seventh grade showed the strongest association for girls. Furthermore, high parental monitoring and having a secure attachment to parents may have a protective effect when risk factors are present. Our results lend support to prevention initiatives to strengthen the parent-child relation and focus on adolescents' ability to resist peer pressure and of limiting parental provision of alcohol. The study's limitations are noted.

Dickerson DL; Spear S; Marinelli-Casey P; Rawson R; Li LB; Hser YI. American Indians/Alaska Natives and substance abuse treatment outcomes: Positive signs and continuing challenges. Journal of Addictive Diseases 30(1): 63-74, 2011. (30 refs.)

Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.

Distel MA; Vink JM; Bartels M; van Beijsterveldt CEM; Neale MC; Boomsma DI. Age moderates non-genetic influences on the initiation of cannabis use: A twin-sibling study in Dutch adolescents and young adults. Addiction 106(9): 1658-1666, 2011. (26 refs.)

Aims To examine the heritability of cannabis initiation, the influence of a possible twin-specific environment and the influence of age on the effects of genes and environment in Dutch adolescents and young adults. Design Genetic structural equation modelling was used to partition the variance in the liability to cannabis initiation into genetic and environmental components. Setting All participants were registered with the Netherlands Twin Register. Participants A total of 6208 twins (age 13-20) and 1545 siblings (age 11-25) from 3503 families participated in this study. Measurements Self-reported cannabis use was assessed prospectively with the Dutch Health Behavior Questionnaire. Findings At the median age of the sample (16.5), genetic factors explained 40% of the individual differences in liability to cannabis initiation. Twins resembled each other more than non-twin siblings, which could not be attributed to the age difference between non-twin siblings. Environmental influences increased with age. This increase applied to environmental factors shared by twins (47% of the variance), environmental factors shared by twins and siblings (24%) and environmental factors unique to an individual (13%). Conclusion: The heritability of the liability for cannabis initiation is higher in adolescents than in young adults due to a larger contribution of environmental factors in young adults. This is due mainly to environmental factors only shared by twins and those shared by all offspring growing up in the same family, but the contribution of environmental factors specific to individuals is also larger in young adults.

Donovan SJ; Levin FR. The "younger-sibling-at-risk design": A pilot study of adolescents with ADHD and an older sibling with substance use disorder. American Journal of Drug and Alcohol Abuse 37(4): 235-239, 2011. (12 refs.)

Introduction: This article introduces a "younger at-risk sibling" design to study progression from other psychopathologies to their substance use disorder (SUD) complications. The design selects not-yet-SUD adolescents with high-risk-for-SUD psychopathology only if an older sibling has SUD. This "proof of concept" pilot study examines the design's feasibility if the younger sibling has attention deficit hyperactivity disorder (ADHD). Method: Subjects were recruited from families at substance abuse treatment centers that had a non-SUD younger child with ADHD, from families at behavior disorder clinics that had a younger child with ADHD and SUD older child, and through general advertisements. Subjects were seen weekly for at least 3 months and monthly thereafter for 3 months. All were treated with open-label lisdexamfetamine dimesylate 30-70 mg per day. Outcomes explored were recruitment, compliance, diversion, ADHD improvement, and substance use interest. Results: 25 families were screened, 13 evaluated, and 8 began medication. ADHD Rating Scale-IV scores obtained by parent-adolescent consensus improved as expected with a stimulant. Rating forms could quantify substance use interest in subjects with some drug culture exposure but encountered a floor effect in those without. The design's complexity and implicit commentary on family dynamics complicated recruitment but may have facilitated retention. Conclusion: Sibling pairs in which the older sibling has substance use and the younger sibling has ADHD exist. Such younger siblings can be recruited into a treatment study. The design may shed light on the pathogenesis and prevention of SUD complications from ADHD and theoretically other SUD comorbidities.

Eiden RD; Molnar DS; Leonard KE; Colder CR; Homish GG; Maiorana N et al. Sources and frequency of secondhand smoke exposure during pregnancy. Nicotine & Tobacco Research 13(8): 653-660, 2011. (28 refs.)

Introduction: This study examined sources of exposure to secondhand smoke (SHS) during pregnancy and misclassification of women as having no SHS exposure if partner smoking was used as the only measure of SHS exposure. We also examined changes in SHS exposure across the three trimesters of pregnancy. Methods: The sample consisted of 245 pregnant women who were in a serious relationship with a partner and 106 for examination of change over time. Women's smoking status was determined by a combination of self-reports and oral fluid assays. Women's reports of partner smoking, smoking by other social network members, and frequency of exposure to SHS were obtained. Results: The most common source of SHS exposure during pregnancy was the partner (n = 245). However, reliance on the partner smoking measure alone would have misclassified a substantial number of women as having no SHS exposure during pregnancy. The importance of exposure from the general social network was also evident in the finding that among nonsmoking women with nonsmoking partners, 50% reported some level of SHS exposure in the preceding week. Contrary to expectations, there were no changes in SHS exposure across the three trimesters of pregnancy (n = 106). Conclusions: Results: highlight the need for treatment plans to target sources of exposure from other members of women's social networks in addition to partners. It may be unrealistic to expect women's cessation efforts to be successful in the face of consistent and continued SHS exposure through pregnancy.

El-Amin SET; Nwaru BI; Ginawi I; Pisani P; Hakama M. The role of parents, friends and teachers in adolescents' cigarette smoking and tombak dipping in Sudan. Tobacco Control 20(2): 94-99, 2011. (23 refs.)

Objective To assess the influence of smoking and tombak (local smokeless tobacco) dipping by parents, teachers and friends on cigarette smoking and tombak dipping by school-going Sudanese adolescents. Methods This was a school-based cross-sectional survey was conducted in 2005-2006. Logistic regression was used for the analysis. A total of 4277 Sudanese school-going adolescents (aged 11-17 years) from 23 schools who completed an anonymous self-administered questionnaire on the use of tobacco products. Main outcome measures were self-reported tobacco use during the previous month defined current tobacco use. Ever smoking, tombak dipping and other tobacco products were also considered as outcomes. Results After adjusting for sex, age and school grade, adolescents' smoking habits were strongly associated with the habit in their parents and friends and, more weakly, with tombak dipping by teachers. When adjusted for each other, the association with smoking in friends was unaffected and remained significant (prevalence OR (POR) of having ever smoked was 1.94, 95% CI 1.64 to 2.29; OR of being current smoker was 3.77, 95% CI 2.80 to 5.07). Tobacco smoking in friends was positively associated with adolescents ever tombak dipping (POR 1.81, 95% CI 1.41 to 2.33) and current dipping (OR 3.33, 95% CI 2.20 to 5.05). The association with parental habits was reduced but still significantly elevated. Tombak dipping by teachers was only associated with adolescents ever tobacco smoking. Conclusions Tobacco use by parents, teachers and friends was associated with adolescents' tobacco habits. The influence of friends was the strongest. In developing programmes against adolescents' tobacco habits, there is need to target the influence of these 'significant others'. Sudan needs to develop and implement comprehensive anti-smoking and anti-tombak dipping legislation to reduce the growing prevalence of such habits.

Ferris JA; Laslett AM; Livingston M; Room R; Wilkinson C. The impacts of others' drinking on mental health. Medical Journal of Australia 195(3, supplement): S22-S26, 2011. (23 refs.)

Objective: To analyse the links between other people's drinking and mental health and to explore the effects on mental health of heavy and problematic drinkers both within and outside spousal relationships. Design, setting and participants: A secondary analysis of data obtained as part of the Alcohol's Harm to Others survey from 2622 randomly sampled Australian adults interviewed by telephone between October and December 2008. Main outcome measures: Self-reported anxiety or depression and satisfaction with mental wellbeing; the presence of heavy and problematic drinkers in respondents' lives. Results: Identification of at least one heavy drinker in the respondents' social network of friends, family and co-workers was significantly negatively associated with self-reported mental wellbeing and anxiety or depression. If the heavy drinker was identified by the respondent as someone whose drinking had had a negative impact on their life in the past year, the adverse effect on mental wellbeing and anxiety was much greater. Conclusions: Our findings support a causal pathway between alcohol use and mental health problems by way of someone else's drinking. The association with adverse mental health is substantial regardless of the type of relationship an individual has with the heavy drinker whose drinking has had an adverse effect on them.

Francis SA. Using a framework to explore associations between parental substance use and the health outcomes of their adolescent children. Journal of Child & Adolescent Substance Abuse 20(1): 1-14, 2011. (44 refs.)

Risk-taking behavior plays a significant role in the lives of adolescents. Adolescents engaging in risk behaviors such as substance use and risky sexual activity are at increased risk for contracting STDs, unplanned pregnancy, and other health problems. Consequently, children of substance abusers are at even greater risk for engaging in maladaptive behaviors given their social environment and the potential exposure to parental substance use/abuse. Although the empirical literature on adolescent risk-taking behavior is vast, less empirical research has examined how parental substance use is associated with the health outcomes of adolescent children of substance abusers, especially children of parents who use illicit substances. This study proposes a framework to synthesize the research on the health outcomes of adolescent children of substance abusers and provides recommendations for future study.

Friedman LS; Avila S; Tanouye K; Joseph K. A case-control study of severe physical abuse of older adults. Journal of the American Geriatrics Society 59(3): 417-422, 2011. (27 refs.)

OBJECTIVES: To characterize the severity and outcome of traumatic injuries suffered by victims of elder abuse, describe the characteristics of the perpetrators, and identify risk factors associated with severe traumatic elder abuse. DESIGN: Case-control study. SETTING: Two Level I trauma units in the greater Chicago, Illinois, metropolitan area. PARTICIPANTS: Forty-one cases of elder abuse resulting in severe traumatic injury were identified between 1999 and 2006. Controls were randomly selected from the list of elderly patients in the trauma registry (N=123). MEASUREMENTS: Elder abuse was defined according to the Illinois Elder Abuse and Neglect Act. RESULTS: In this study, 85% of the perpetrators were family members or intimate partners. In the final multivariable logistic regression model, victims of severe traumatic elder abuse were more likely to be female, to have a neurological or mental disorder, and to abuse drugs or alcohol. CONCLUSION: This is the first clinical case-control study detailing clinical outcomes and evaluating risk factors of persons suffering severe physical abuse. Of elderly trauma victims, those who are physically abused have more-severe injuries than their nonabused counterparts. More research is needed to better evaluate risk factors of physical abuse and effective interventions.

Goodman I; Peterson-Badali M; Henderson J. Understanding motivation for substance use treatment: The role of social pressure during the transition to adulthood. Addictive Behaviors 36(6, special issue): 660- 668, 2011. (63 refs.)

Research has shown that social pressure is related to treatment motivation and plays an important role in treatment engagement in adults with problematic substance use. Despite the shifts in autonomy and decision-making in emerging adulthood, the factors affecting treatment motivation (e.g., readiness to comply with treatment) during this period have been largely ignored. In this cross sectional study, 134 youth (83 males and 51 females) presenting to an outpatient substance abuse program completed questionnaires regarding substance use history, mental health, social pressure to reduce use and enter treatment, and treatment motivation. Age was positively related to identification of internal reasons for seeking treatment and negatively related to external coercive social pressures as a motivator for treatment. Peer pressure accounted for significant variance in Identified (e.g., personal choice and commitment to the program) and Introjected (e.g., guilt about continued substance use) treatment motivation. Family pressure was related only to E=external treatment motivation when peer pressure was considered in the regression model. These results highlight the importance of emerging adult peers as motivators of youths' treatment seeking. Limitations, directions for future research and treatment implications are discussed.

Hawkins SS; Berkman L. Increased tobacco exposure in older children and its effect on asthma and ear infections. Journal of Adolescent Health 48(6): 647- 650, 2011. (10 refs.)

Purpose: To examine selected social determinants of children's exposure to household tobacco use and smoking inside the home and to assess the effect of second-hand smoke exposure on asthma and ear infections across children's age groups. Methods: A total of 90,961 parents of children aged 0-17 years from the 2007 National Survey of Children's Health were included in the study. Results: In all, 26.2% of parents reported that anyone in the household used tobacco products. Parents of children aged 6-11 and 12-17 years were 1.97 (adjusted OR; 95% CI, 1.65-2.36) and 2.93 (2.46-3.49) times more likely, respectively, to report that someone smoked inside the house than parents of younger children. Second-hand smoke exposure varied by children's race/ethnicity, and children from more disadvantaged circumstances were more likely to be exposed. For all children, they were more likely to ever have asthma if someone in their household used tobacco. Although young children's likelihood of recurrent ear infections did not increase with household tobacco use, children aged 12-17 were 1.67 (1.02-2.72) times more likely to have recurrent ear infections if someone smoked inside their home. Conclusion: Family members are increasingly likely to smoke indoors as children age, which may increase adolescents' vulnerability to ear infections. Parents and health professionals should monitor second-hand smoke exposure at home and encourage a smoke-free environment.

Heslin KC; Hamilton AB; Singzon TK; Smith JL; Anderson NLR. Alternative families in recovery: Fictive kin relationships among residents of sober living homes. Qualitative Health Research 21(4): 477-488, 2011. (49 refs.)

Sober living homes are group residences for people attempting to maintain abstinence from alcohol and drugs in a mutually supportive setting. Residents typically develop strong psychological and economic ties and have been referred to as "alternative families," thus evoking the anthropological concept of fictive kinship. We analyzed data from seven focus groups with sober living home residents to assess the prevalence and functions of fictive kinship in these settings. Results suggest that residents created kinship by exchanging various types of support, and by incorporating other residents into existing family relationships, particularly in homes where there were children. Residents perceived fictive kin as more supportive than actual kin, encouraging them toward greater individuation, in contrast with family backgrounds that were sometimes described as stifling. These accounts of the therapeutic qualities of fictive kin in sober living homes could inform the work of fair housing advocates and other community stakeholders.

Hill SY; Tessner KD; McDermott MD. Psychopathology in offspring from families of alcohol dependent female probands: A prospective study. Journal of Psychiatric Research 45(3): 285-294, 2011. (57 refs.)

Background: Despite the importance of understanding the long-term outcome for children of alcohol dependent (AD) women, the available literature is largely based on offspring of AD fathers and few have utilized prospective designs that include child, adolescent and young adult assessments. Multiplex AD families in which multiple cases of AD are present provide an ideal setting for understanding developmental variants of the adult phenotype. Method: Offspring from multiplex AD families identified through the mother or control families were evaluated multiple times during childhood and followed to young adulthood. Familial risk status and the presence of specific child/adolescent disorders were used as predictors of substance use disorder outcome by young adulthood. Results: Offspring who were members of maternal multiplex families had elevated rates of child and young adulthood disorders. High risk offspring of alcohol dependent women were at increased risk for externalizing (Conduct Disorder and ADHD) and internalizing disorders (Major Depressive Disorder (MDD) and Anxiety Disorders). By young adulthood, offspring from these multiplex families had significantly greater odds of developing alcohol abuse or dependence (odds ratio [OR] = 3.63 [CI 1.36-9.641) and drug abuse or dependence (OR = 4.23 [CI 1.73-10.32]). The prospective design of the study revealed that specific childhood disorders (Conduct Disorder, ADHD, MOD) increased the odds of subsequent development of substance use disorder (SLID). Conclusions: Multiplex familial risk for alcohol dependence is a significant predictor of substance use disorders by young adulthood. Familial risk and an earlier childhood disorder may set the stage for later development of SLID.

Huang H; Ryan JP. Trying to come home: Substance exposed infants, mothers, and family reunification. Children and Youth Services Review 33(2): 322-329, 2011. (55 refs.)

Substance abusing mothers comprise a significant proportion of caregivers in public child welfare, and achieve low reunification rates. Unfortunately little is known about treatment options intended to facilitate recovery and increase reunification. This study focuses particular attention on the relationship between specific treatment modalities (e.g., residential and outpatient), recovery from substance abuse and family reunification. Analyzing a sample of 160 mothers and their substance exposed infants, the findings clearly identify the benefits of residential treatment in terms of both treatment progress (directly) and family reunification (indirectly), but only when residential services are delivered in combination with transitional services.

Johnston V; Thomas DP; McDonnell J; Andrews RM. Maternal smoking and smoking in the household during pregnancy and postpartum: Findings from an Indigenous cohort in the Northern Territory. Medical Journal of Australia 194(10): 556- 559, 2011. (27 refs.)

Objective: To describe the trends in maternal smoking and smoking in the household for a cohort of Indigenous women followed from late pregnancy to 7 months postpartum. Design: and setting: Prospective cohort study embedded within a randomised controlled trial (RCT) performed in the Northern Territory involving partiClpants recruited between 30 June 2006 and 4 May 2010. Participants: 215 Indigenous women aged 17-39 years who had been recruited into the RCT, 162 of whom had completed their last study visit at 7 months postpartum by 1 June 2010. Main outcome measures: Smoking status of women, and smoking within their households, in their third trimester, and at 1 month, 2 months and 7 months postpartum. Results: There were complete data on women's smoking status for 121 participants. Among these, the self-reported smoking rate was 45% (95% CI 36%-55%) during pregnancy, increasing to 63% (95% CI 54%-71%) at 7 months postpartum. Of the 66 women who were non-smokers at the antenatal visit, 23 (35%; 95% CI 23%-47%) were smoking by the time their baby reached 7 months of age. Thirty-one per cent (95% CI 23%-39%) of households included people who smoked inside during the antepartum period, whereas 16% (95% CI 10%-23%) included people who smoked inside at 7 months postpartum. Conclusions: While an apparent reduction in indoor exposure to tobacco smoke during the postpartum period is encouraging, this is offset by an increase in the proportion of antenatal non-smokers who subsequently reported smoking after the birth of their child. More health care service delivery and research attention needs to be directed to smoking during pregnancy and to postpartum relapse in this population.

Kahn RS; Linszen DH; van Os J; Wiersma D; Bruggeman R; Cahn W et al. Evidence that familial liability for psychosis is expressed as differential sensitivity to cannabis an analysis of patient-sibling and sibling-control pairs. Archives of General Psychiatry 68(2): 138-147, 2011. (61 refs.)

Context: Individual differences in cannabis sensitivity may be associated with genetic risk for psychotic disorder. Objectives: To demonstrate and replicate, using 2 conceptually different genetic epidemiological designs, that (familial) liability to psychosis is associated with sensitivity to cannabis. Design, Setting, and Participants: Sibling-control and cross-sibling comparisons using samples of patients with a psychotic disorder (n=1120), their siblings (n=1057), and community controls (n=590) in the Netherlands and Flanders. Main Outcome Measures: Positive and negative schizotypy using the Structured Interview for Schizotypy-Revised (for siblings and controls) and self-reported positive and negative psychotic experiences using the Community Assessment of Psychic Experiences (for siblings and patients). Cannabis use was assessed as current use (by urinalysis) and lifetime frequency of use (by Composite International Diagnostic Interview). Results: In the sibling-control comparison, siblings displayed more than 15 times greater sensitivity to positive schizotypy associated with particularly current cannabis use by urinalysis (adjusted B=0.197, P<.001) than controls (adjusted B=0.013, P=.86) (P interaction=.04) and a similar difference in sensitivity to its effect on negative schizotypy (siblings: adjusted B=0.120, P<.001; controls: B=-0.008, P=.87; P interaction=.03). Similarly, siblings exposed to cannabis resembled their patient relative nearly 10 times more closely in the positive psychotic dimension of the Community Assessment of Psychic Experiences (adjusted B=0.278, P<.001) compared with nonexposed siblings (adjusted B=0.025, P=.12) (P interaction<.001). No significant effect was apparent for the Community Assessment of Psychic Experiences negative domain, although the association was directionally similar (2 times more resemblance; P interaction=.17). Crosssibling, cross-trait analyses suggested that the mechanism underlying these findings was moderation (familial risk increasing sensitivity to cannabis) rather than mediation (familial risk increasing use of cannabis). Conclusions: Genetic risk for psychotic disorder may be expressed in part as sensitivity to the psychotomimetic effect of cannabis. Cannabis use may synergistically combine with preexisting psychosis liability to cause positive and negative symptoms of psychosis.

Kelly AB; O'Flaherty M; Connor JP; Homel R; Toumbourou JW; Patton GC; Williams J. The influence of parents, siblings and peers on pre- and early-teen smoking: A multilevel model. Drug and Alcohol Review 30(4): 381-387, 2011. (45 refs.)

Introduction and Aims. Despite considerable success in tobacco control, many teenagers in Australia and other industrialised countries still smoke tobacco. There is mixed evidence on the relative influence of proximal social networks (parents/siblings/peers) on pre- and early-teen smoking, and no research has examined how these influences compare after accounting for school-and community-level effects. The aim of this study was to compare the relative influences of parents, siblings and peers, after accounting for school-and community-level variation in smoking. Design and Methods. A cross-sectional fixed and random effects model of smoking prevalence was used, with individuals (n = 7314) nested within schools (n = 231) nested within communities (n = 30). Grade 6 and 8 students (modal ages 11 and 13 years) completed an on-line survey. Key variables included parent/sibling/peer use. Controls included alcohol involvement, sensation seeking, pro-social beliefs, laws/norms about substance use and school commitment. Results. There was significant variation in smoking at both the school and community levels, supporting the need for a multilevel model. Individual-level predictors accounted for much of the variance at higher levels. The strongest effects were for number of friends who smoke, sibling smoking and alcohol involvement. Smaller significant effects were found for parent smoking. At the community level, socioeconomic disadvantage was significant, but community-level variance in pro-social and drug-related laws/norms was not related to smoking. Discussion and Conclusions. Cross-level interactions were generally non-significant. Early teenage smoking was best explained by sibling and peer smoking, and individual risks largely accounted for the substantial variation observed across schools and communities. In terms of future tobacco control, findings point to the utility of targeting families in disadvantaged communities.

Kendler KS; Gardner CO; Prescott CA. Toward a comprehensive developmental model for alcohol use disorders in men. Twin Research and Human Genetics 14(1): 1-15, 2011. (84 refs.)

The multiple risk factors for alcohol use (AU) and alcohol use disorders (AUDs) are interrelated through poorly understood pathways, many of which begin in childhood. In this report, the authors seek to develop an empirical, broad-based developmental model for the etiology of AU and AUDs in men. We assessed 15 risk factors in four developmental tiers in 1,794 adult male twins from the Virginia population based twin registry. The best fitting model explained 39% of the variance in late adolescent AU, and 30% of the liability to lifetime symptoms of AUD. AU and AUDs can be best understood as arising from the action and interaction of two pathways reflecting externalizing genetic/temperamental and familial/social factors. Peer group deviance was important in each pathway. Internalizing symptoms played a more minor role. Familial/social factors were especially important influences on AU, while genetic/temperamental factors were more critical for AUDs. We conclude that AU and AUDs in men are complex traits influenced by genetic, family, temperamental, and social factors, acting and interacting over developmental time.

Kingston AH; Morgan AJ; Jorm AF; Hall K; Hart LM; Kelly CM. Helping someone with problem drug use: A delphi consensus study of consumers, carers, and clinicians. BMC Psychiatry 11: e-article 3, 2011. (20 refs.)

Background: Problem use of illicit drugs (i.e. drug abuse or dependence) is associated with considerable health and social harms, highlighting the need for early intervention and engagement with health services. Family members, friends and colleagues play an important role in supporting and assisting individuals with problem drug use to seek professional help, however there are conflicting views about how and when such support should be offered. This paper reports on the development of mental health first aid guidelines for problem drug use in adults, to help inform community members on how to assist someone developing problem drug use or experiencing a drug-related crisis. Methods: A systematic review of the scientific and lay literature was conducted to develop a 228-item survey containing potential first-aid strategies to help someone developing a drug problem or experiencing a drug-related crisis. Three panels of experts (29 consumers, 31 carers and 27 clinicians) were recruited from Australia, Canada, New Zealand, the United Kingdom, and the United States. Panel members independently rated the items over three rounds, with strategies reaching consensus on importance written into the guidelines. Results: The overall response rate across three rounds was 80% (86% consumers, 81% carers, 74% clinicians). 140 first aid strategies were endorsed as essential or important by 80% or more of panel members. The endorsed strategies provide information and advice on what is problem drug use and its consequences, how to approach a person about their problem drug use, tips for effective communication, what to do if the person is unwilling to change their drug use, what to do if the person does (or does not) want professional help, what are drug-affected states and how to deal with them, how to deal with adverse reactions leading to a medical emergency, and what to do if the person is aggressive. Conclusions: The guidelines provide a consensus-based resource for community members who want to help someone with a drug problem. It is hoped that the guidelines will lead to better support and understanding for those with problem drug use and facilitate engagement with professional help.

Koning IM; van den Eijnden RJJM; Engels RCME; Verdurmen JEE; Vollebergh WAM. Why target early adolescents and parents in alcohol prevention? The mediating effects of self-control, rules and attitudes about alcohol use. Addiction 106(3): 538-546, 2011. (43 refs.)

Aims: To examine the effects of a parent and student intervention offered separately and simultaneously (PAS) on onset of weekly drinking via its putative mediators. Design: A randomized trial with four conditions; (1) parent intervention, (2) student intervention, (3) combined parent-student intervention and (4) control group. Setting: High schools selected randomly, located in different areas. Participants: A total of 2937 early adolescents (mean age = 12.6, standard deviation = 0.49) and their parents. Measurements: Mediation effects were analysed using pretest data and two follow-up measurements (10 and 22 months after baseline). A path model was estimated (Mplus) to examine the effect of the interventions on adolescent-reported mediators (self-control, perceived parental rules and attitudes about alcohol) and parent-reported mediators (parental rules and attitudes about alcohol). Outcome was onset of weekly drinking. Findings: The parent intervention modified rules and attitudes about alcohol as reported by parents. An indirect effect of the parent intervention via parental rules was found. The combined intervention affected both adolescent-reported and parent-reported rules and attitudes about alcohol and adolescents' perceived self-control, yet only perceived rules and self-efficacy, as reported by adolescents, and parental attitudes mediated the association between the combined intervention and onset of weekly drinking. No significant effects were found of the separate student intervention on the mediating factors. Conclusions: The PAS programme proved to be effective as predicted by the theoretical assumptions underlying the interventions. Interventions with parents and adolescents to prevent adolescent alcohol consumption may usefully target parental rules about alcohol and adolescents' self-confidence.

Kosovski JR; Smith DC. Everybody hurts: Addiction, drama, and the family in the reality television show "Intervention". Substance Use & Misuse 46(7): 852-858, 2011. (25 refs.)

This article employs the literature on reality television as well as empirical studies on addiction to analyze Intervention's narrative. We look at the narrative structure of the Intervention's first six seasons (2005-2009), its repeated emphases on the causes of addiction, and the show's purported success rate. Highlighting disturbing discrepancies between the show's representations and assertions versus empirical research, Intervention's notions of what constitutes effective remedies are those treatments generally available only to the financially affluent, and the program's depictions of addiction and intervention practices reinforce a popular culture, rather than a science-based understanding, of the family and of addiction itself.

Krienert JL; Walsh JA. My Brother's Keeper: A contemporary examination of reported sibling violence using national level data, 2000-2005. Journal of Family Violence 26(5): 331-342, 2011. (47 refs.)

Identified as a social problem in 1980, sibling violence has been labeled the most common and least researched form of family violence in the United States (Eriksen and Jensen 2006, 2008). Extant research has limitations including definitional inconsistencies, overreliance on small retrospective clinical samples, and limited use of officially reported national level data for profiles of victims and offenders. Although often trivialized as a "normal" part of growing up, sibling violence has links to an array of complications manifesting later in life including physical and emotional disorders, school bullying, substance abuse, and domestic violence. This work draws on 6 years of National Incident-Based Reporting System (NIBRS) data (2000-2005) (n = 33,066) to provide the most comprehensive source of baseline information on this understudied form of intrafamilial violence. The research explores demographic and incident characteristics extending the knowledge beyond typical victim descriptives to incorporate offender profiles and incident level information including the type of violence/victimization, substance use, weapon use, and degree of injury sustained. Findings, in part, suggest several gender based victim and offender differences with female siblings involved in more serious injury incidents than their male sibling counterparts.

Laslett AM; Room R; Ferris J; Wilkinson C; Livingston M; Mugavin J. Surveying the range and magnitude of alcohol's harm to others in Australia. Addiction 106(9): 1603-1611, 2011. (32 refs.)

Aims This study aims to document the adverse effects of drinkers in Australia on people other than the drinker. Design Cross-sectional survey. Setting In a national survey of Australia, respondents described the harmful effects they experienced from drinkers in their households, family and friendship networks, as well as work-place and community settings. Participants A randomly selected sample of 2649 adult Australians. Measurements Problems experienced because of others' drinking were ascertained via computer-assisted telephone interviews. Respondent and drinker socio-demographic and drinking pattern data were recorded. Findings A total of 70% of respondents were affected by strangers' drinking and experienced nuisance, fear or abuse, and 30% reported that the drinking of someone close to them had negative effects, although only 11% were affected by such a person 'a lot'. Women were more affected by someone they knew in the household or family, while men were more affected by strangers, friends and co-workers. Young adults were consistently the most negatively affected across the majority of types of harm. Conclusions: Substantial proportions of Australians are affected by other people's drinking, including that of their families, friends, co-workers and strangers. These harms range in magnitude from noise and fear to physical abuse, sexual coercion and social isolation.

Lau-Barraco C; Collins RL. Social networks and alcohol use among nonstudent emerging adults: A preliminary study. Addictive Behaviors 36(1-2): 47-54, 2011. (56 refs.)

We examined the social networks and alcohol use of a community-based sample of nonstudent emerging adults (N=59). The research examined (1) personal network characteristics and the drinking habits of its members (2) the link between network alcohol use and personal alcohol Involvement (3) perceived social norms as they related to network alcohol use and (4) relationship between perceived social norms and personal alcohol involvement. Men and women (M age = 27 years) were equally represented in the social network Level of educational attainment of members was diverse On average respondents were in contact on a daily basis with network members and about 38% of the network was known between 1 and 5 years. The majority (57%) of the network consisted of household or family members. There were some associations between network drinking and personal alcohol involvement. The proportion of drinking buddies in one's network was directly associated with perceived drinking norms. Perceived drinking norms also were positively associated with personal alcohol use alcohol related problems and approval of drinking behaviors. Findings from this study have implications for understanding social factors in the drinking behavior of nonstudent emerging adults and could inform the development of effective prevention and treatment interventions for this Important but understudied group of drinkers.

Lee KMT; Manning V; Teoh HC; Winslow M; Lee A; Subramaniam M; Guo S; Wong KE. Stress-coping morbidity among family members of addiction patients in Singapore. Drug and Alcohol Review 30(4): 441-447, 2011. (38 refs.)

Introductions and Aims. Research from western countries indicates that family members of addiction patients report heightened stress and psychological morbidity. This current study aimed to examine stress, coping behaviours, related morbidity and subsequent resource utilisation among family members of patients attending a national treatment program in Singapore. Design and Methods. The study used a matched case-control design. One hundred family members of addiction patients attending treatment and 100 matched controls completed a semi-structured interview with a researcher. This included the Beck Depression Inventory-II, Short-Form Health Survey-36, General Health Questionnaire-28, Perceived Stress Scale, Family Member Impact Scale and Coping Questionnaire, and also assessed service utilisation. Results. T-tests revealed significantly greater depression, stress and psychiatric morbidity and poorer overall well-being (Short-Form Health Survey-36) among family members compared with controls. Despite the apparent negative impact on mental health, their physical morbidity did not differ from controls and services utilisation was low. Tolerant-inactive coping was found to be most strongly correlated with psychological well-being. Multivariate analysis indicated that perceived stress was the strongest predictor of overall strain (General Health Questionnaire), but this was not moderated by coping style. Discussion and Conclusions. Subjective appraisal of stress and coping responses are essential factors affecting the morbidity of family members. Family members demonstrated a need and willingness to engage in formal treatment/counselling for their own problems that were attributed to living with an addiction patient. This provides an opportunity for stress management and brief interventions to modify coping styles, thereby minimizing the potential negative mental health impact on family members.

Lin C; Wu Z; Detels R. Family support, quality of life and concurrent substance use among methadone maintenance therapy clients in China. Public Health 125(5): 269-274, 2011. (23 refs.)

Objectives: The methadone maintenance therapy (MMT) programme has been scaled up rapidly in China. This study explored the family support perceived by MMT clients and its association with their quality of life and concurrent illicit drug use. Study design: Cross-sectional study. Methods: Five hundred and sixty MMT clients were selected at random from 28 MMT clinics and services in Zhejiang and Jiangxi Provinces, China for participation in a face-to-face interview study. The participants' perceived family support and quality of life were measured through face-to-face structured interviews conducted by trained interviewers. Self-reported information about illicit drug use was obtained from clients. Urine specimens were collected from the participants to test for heroin use. Results: Among the 560 participants, 471 (84.1%) were male and 168 (30.0%) were unemployed at the time of the study. In total, 398 (71.1%) were injecting drug users and 309 (55.2%) had a history of drug use of more than 10 years. Around one-third (n = 211, 37.7%) of the participants reported concurrent illicit drug use or had a positive urine test. Perceived family support was associated with increased physical health, psychological health, environmental health and social health. In addition, perceived family support was negatively correlated with concurrent substance use. Conclusions: Drug use and MMT is a family issue in China. Based on the findings of this study, it is suggested that involving family members in recruitment and interventions of the MMT programme will achieve higher rates of participation and compliance.

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

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

Marshall JM; Huang H; Ryan JP. Intergenerational families in child welfare: Assessing needs and estimating permanency. Children and Youth Services Review 33(6): 1024- 1030, 2011. (38 refs.)

Much of the empirical literature on intergenerational child maltreatment focuses on the mechanisms that explain how maltreatment is transmitted across generations. Few studies have examined child protective service outcomes associated with intergenerational families. The current study addresses this gap in the literature. This study compares 1196 caregivers, most of whom are single African American females, and 2143 children from first and second generation child welfare-involved families. All families have a history of substance abuse. We sought to understand how first and second generation families differ with regard to social and economic status indicators, as well as whether intergenerational child welfare involvement is associated with permanency outcomes. Our findings indicate that second generation families experience significantly more risk factors at the time of case opening, and are two-thirds as likely to be reunified as compared with first generation families. The singular effects of generation status disappeared, however, once the interaction between mental health diagnosis and second generation status was entered into the model, suggesting that it is not just being intergenerationally involved in the child welfare system that reduces the chance of reunification, but rather second generation caregivers have more mental health problems that are associated with a lower likelihood of reunification.

Martinotti G; Di Iorio G; Tedeschi D; De Berardis D; Niolu C; Janiri L et al. Prevalence and intensity of basic symptoms among cannabis users: An observational study. American Journal of Drug and Alcohol Abuse 37(2): 111-116, 2011. (53 refs.)

Background: It is difficult to establish whether people who are prone to psychosis are drawn to cannabis use or whether cannabis use truly increases the incidence of psychotic experiences. Objectives: The aim of our study was to evaluate, in a sample of healthy high school and university students, the presence and level of subjective experiences (SEs) and their relation to cannabis use. Methods: A total of 502 voluntary subjects were recruited; an anamnestic interview was administered to obtain socio-demographic information, cannabis use data, and psychiatric familial history. SEs were assessed using the Italian version of the Frankfurt Complaint Questionnaire (FCQ). Results: One hundred and fourteen subjects declared the use of cannabis: 20.5%% smoked more than 1 joint per week, and 71.9%% used cannabis for a period of more than 1 year. Cannabis users did not differ from the cannabis-free group in any of the 10 FCQ dimensions. Higher FCQ total scores were found in cannabis users with a familial history of psychiatric disorders respective to those without a psychiatric load (p < .05). Conclusions and scientific significance: In our study, SE intensity was not influenced by the use of cannabis. With regard to familial data, this is the first study to explore the relationship between SE and the presence of psychiatric problems in first-degree relatives. The association between FCQ intensity and psychiatric familial load may confirm the independence of these phenomena from the use of cannabis.

McKee LG; Bonn-Miller MO; Moos RH. Depressive symptoms, friend and partner relationship quality, and posttreatment abstinence. Journal of Studies on Alcohol and Drugs 72(1): 141-150, 2011. (57 refs.)

Objective: This study employed a prospective design to examine the role of friend and partner relationship quality 1 year following substance use disorder treatment in the association between depressive symptoms at discharge from treatment and abstinence from substance use 2 years after treatment. Method: The sample consisted of 1,453 male veterans who used alcohol and at least one other substance in the 3 months before treatment admission, who completed treatment, and who were abstinent from substances during the 2 weeks before discharge. Results: Fewer depressive symptoms at treatment discharge predicted better relationship quality with friends and a partner at 1-year follow-up, as well as abstinence from substance use at 2-year follow-up. Furthermore, friend and partner relationship quality at I year predicted abstinence from substance use at 2 years. Friend relationship quality at 1 year mediated part of the association between fewer depressive symptoms at treatment discharge and abstinence at 2-year follow-up. Conclusions: A stronger focus in treatment on reducing depressive symptoms and enhancing the quality of patients' relationships with their friends and partner may increase the likelihood of long-term abstinence.

Meyers RJ; Roozen HG; Smith JE. The Community Reinforcement Approach: An update of the evidence. (review). Alcohol Research & Health 33(4): 380-+, 2011. (74 refs.)

The Community Reinforcement Approach (CRA), originally developed for individuals with alcohol use disorders, has been successfully employed to treat a variety of substance use disorders for more than 35 years. Based on operant conditioning, CRA helps people rearrange their lifestyles so that healthy, drug-free living becomes rewarding and thereby competes with alcohol and drug use. Consequently, practitioners encourage clients to become progressively involved in alternative non-substance-related pleasant social activities, and to work on enhancing the enjoyment they receive within the "community" of their family and job. Additionally, in the past 10-15 years, researchers have obtained scientific evidence for two offshoots of CRA that are based on the same operant mechanism. The first variant is Adolescent Community Reinforcement Approach (A-CRA), which targets adolescents with substance use problems and their caregivers. The second approach, Community Reinforcement and Family Training (CRAFT), works through family members to engage treatment-refusing individuals into treatment. An overview of these treatments and their scientific backing is presented.

Moos RH; Schutte KK; Brennan PL; Moos BS. Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption. Addiction 106(2): 324-334, 2011. (54 refs.)

Aims: This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high-risk alcohol consumption and identifies predictors of changes in concordance and high-risk consumption. Design, Participants, Measurements: Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low-risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high-risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high-risk alcohol consumption and the other partner did not (n = 75). At each follow-up, husbands and wives completed an inventory that assessed their personal, family and social functioning. Findings: Compared to the low-risk concordant group, husbands and wives in the high-risk concordant group were more likely to rely on tension-reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high-risk drinking included tension-reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking. Conclusions: High-risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long-term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high-risk drinking.

Nadkarni A; Acosta D; Rodriguez G; Prince M; Ferri CP. The psychological impact of heavy drinking among the elderly on their co-residents: The 10/66 group population based survey in the Dominican Republic. Drug and Alcohol Dependence 114(1): 82-86, 2011. (41 refs.)

Background: There is very limited literature on alcohol use among the elderly and little is known about the impact it has on family and caregivers, especially in low and middle income countries. Aim: To estimate the independent effect of heavy alcohol use among the elderly on the psychological health of their co-residents. Methods: This is a secondary analysis using data from the comprehensive cross-sectional survey of the 10/66 dementia research group population-based research programme in the Dominican Republic. The characteristics of the elderly participants as well as the co-residents were described. The independent association of heavy drinking among the participants with psychological morbidity in their co-residents was estimated. Different models were generated to rule out potential mediating effects of disability and behavioural symptoms. Results: Prevalence of heavy alcohol use in the elderly in Dominican Republic was 10.6%. There was a statistically significant independent effect of heavy alcohol use by the elderly on their co-residents mental health (PR = 1.47; 95% CI 1.07-2.01) which was not accounted by disability (Sobel-Goodman test, p = 0.15). Severity of psychological and behavioural symptoms partially (29.1% of the total effect) explained this association (Sobel-Goodman mediation test, p = 0.006). Conclusions: Health services for the elderly in low and middle income countries will have to be configured around detection of alcohol problems among the elderly as well as offering appropriate support to their co-residents.

Ningombam S; Hutin Y; Murhekar MV. Prevalence and pattern of substance use among the higher secondary school students of Imphal, Manipur, India. National Medical Journal of India 24(1): 11- 15, 2011. (17 refs.)

Background. Substance use often begins in adolescence. We did a study to describe substance use and its associated factors among adolescent students in Imphal. Methods. We defined substance use as the use of licit and illicit substance other than when medically indicated. Using a WHO self-administered questionnaire, we collected information about substance use from 61 randomly selected students of 17 government/private higher secondary schools. We calculated the prevalence of substance use according to selected characteristics. Results. We surveyed 1020 students, 551 of whom reported prior substance use (prevalence of ever use: 54%, 95% confidence interval [CI] 42%-67%). Prevalence of recent and current user was 35% (95% CI 28%-43%) and 22% (95% CI 17%-28%), respectively. Among ever users, tobacco (46%) was used most commonly, followed by alcohol (29%), cannabis (14%) and opiates (12%). On multivariate analysis, substance use was significantly higher among boys (adjusted odds ratio [AOR] 2.6, 95% CI [2.0-3.4]), whose father (AOR 2.0, 95% CI 1.6-2.7) or sibling (AOR 2.1, 95% CI 1.5-3.0) used substance. It was significantly lower among children of Hindu/Jain religion (AOR 0.5, 95% CI 0.4-0.7). Conclusion. Prevalence of tobacco and alcohol use was high among students. Familial use of substances was associated with the behaviour of adolescents. Friends were the key proximal determinant. We recommend introducing a substance use prevention policy in schools to educate students about various adverse effects and to impart refusal skills.

Phan O; Henderson CE; Angelidis T; Weil P; van Toorn M; Rigter R; Soria C et al. European youth care sites serve different populations of adolescents with cannabis use disorder. Baseline and referral data from the INCANT trial. BMC Psychiatry 11(e-article 110), 2011. (20 refs.)

Background: MDFT (Multidimensional Family Therapy) is a family based outpatient treatment programme for adolescent problem behaviour. MDFT has been found effective in the USA in adolescent samples differing in severity and treatment delivery settings. On request of five governments (Belgium, France, Germany, the Netherlands, and Switzerland), MDFT has now been tested in the joint INCANT trial (International Cannabis Need of Treatment) for applicability in Western Europe. In each of the five countries, study participants were recruited from the local population of youth seeking or guided to treatment for, among other things, cannabis use disorder. There is little information in the literature if these populations are comparable between sites/countries or not. Therefore, we examined if the study samples enrolled in the five countries differed in baseline characteristics regarding demographics, clinical profile, and treatment delivery setting. Methods: INCANT was a multicentre phase III(b) randomized controlled trial with an open-label, parallel group design. It compared MDFT with treatment as usual (TAU) at and across sites in Berlin, Brussels, Geneva, The Hague and Paris. Participants of INCANT were adolescents of either sex, from 13 through 18 years of age, with a cannabis use disorder (dependence or abuse), and at least one parent willing to take part in the treatment. In total, 450 cases/families were randomized (concealed) into INCANT. Results: We collected data about adolescent and family demographics (age, gender, family composition, school, work, friends, and leisure time). In addition, we gathered data about problem behaviour (substance use, alcohol and cannabis use disorders, delinquency, psychiatric co-morbidity). There were no major differences on any of these measures between the treatment conditions (MDFT and TAU) for any of the sites. However, there were cross-site differences on many variables. Most of these could be explained by variations in treatment culture, as reflected by referral policy, i.e., participants' referral source. We distinguished 'self-determined' referral (common in Brussels and Paris) and referral with some authority-related 'external' coercion (common in Geneva and The Hague). The two referral types were more equally divided in Berlin. Many cross-site baseline differences disappeared when we took referral source into account, but not all. Conclusions: A multisite trial has the advantage of being efficient, but it also carries risks, the most important one being lack of equivalence between local study populations. Our site populations differed in many respects. This is not a problem for analyses and interpretations if the differences somehow can be accounted for. To a major extent, this appeared possible in INCANT. The most important factor underlying the cross-site variations in baseline characteristics was referral source. Correcting for referral source made most differences disappear. Therefore, we will use referral source as a covariate accounting for site differences in future INCANT outcome analyses.

Rice E; Milburn NG; Monro W. Social networking technology, social network composition, and reductions in substance use among homeless adolescents. Prevention Science 12(1): 80-88, 2011. (51 refs.)

Peer-based prevention programs for homeless youth are complicated by the potential for reinforcing high-risk behaviors among participants. The goal of this study is to understand how homeless youth could be linked to positive peers in prevention programming by understanding where in social and physical space positive peers for homeless youth are located, how these ties are associated with substance use, and the role of social networking technologies (e.g., internet and cell phones) in this process. Personal social network data were collected from 136 homeless adolescents in Los Angeles, CA. Respondents reported on composition of their social networks with respect to: home-based peers and parents (accessed via social networking technology; e.g., the internet, cell phone, texting), homeless peers and agency staff (accessed face-to-face) and whether or not network members were substance-using or non-substance-using. Associations between respondent's lifetime cocaine, heroin, and methamphetamine use and recent (previous 30 days) alcohol and marijuana use were assessed by the number of non-substance-using versus substance-using ties in multivariate linear regression models. 43% of adolescents reported a non-substance-using home-based tie. More of these ties were associated with less recent alcohol use. 62% of adolescents reported a substance-using homeless tie. More of these ties were associated with more recent marijuana use as well as more lifetime heroin and methamphetamine use. For homeless youth, who are physically disconnected from positive peers, social networking technologies can be used to facilitate the sorts of positive social ties that effective peer-based prevention programs require.

Rosenquist JN. Lessons from social network analyses for behavioral medicine. Current Opinion in Psychiatry 24(2): 139-143, 2011. (19 refs.)

Purpose of review: This study presents an overview of the rapidly expanding field of social network analysis, with an emphasis placed on work relevant to behavioral health clinicians and researchers. I outline how social network analysis is a distinct empirical methodology within the social sciences that has the potential to deepen our understanding of how mental health and addiction are influenced by social environmental factors. Recent findings: Whereas there have been a number of recent studies in the mental health literature that discuss social influences on mental illness and addiction, and a number of studies looking at how social networks influence health and behaviors, there are still relatively few studies that combine the two. Those that have suggest that mood symptoms as well as alcohol consumption are clustered within, and may travel along, social networks. Summary: Social networks appear to have an important influence on a variety of mental health conditions. This avenue of research has the potential to influence both clinical practice and public policy.

Samardzic S; Bujsic G; Kozul K; Tadijan D. Drinking in adolescents - Qualitative analysis. Collegium Antropologicum 35(1): 123- 126, 2011. (15 refs.)

The aim of this paper was to explore alcohol consumption and the development of this habit in the adolescent population based on qualitative data from 59 anonymous essays written by high school students. We found that the most of adolescents had their first experiences with alcohol in the seventh or eighth grades. They reported that they usually drank alcohol to be happy, to relax, to be courageous in approaching the opposite sex, to fit into society, and to be popular. Factors affecting drinking are influence of peers, family and social attitude towards drinking, laws and enforcement of legislation. In further prevention programs, we must be able to demonstrate that "having a good" time does not mean drinking alcohol. Programs for the prevention of alcohol-related problems must begin by adolescence, including both sexes equally and can be achieved through a coordinated and intense public health effort.

Schinke SP; Fang L; Cole KC; Cohen-Cutler S. Preventing substance use among Black and Hispanic adolescent girls: Results from a computer-delivered, mother-daughter intervention approach. Substance Use & Misuse 46(1): 35-45, 2011. (77 refs.)

This 2008 study involved 546 Black and Hispanic American adolescent girls and their mothers from New York, New Jersey, and Connecticut. Participants provided self-report data. Analysis of covariance indicated that the experimental intervention reduced risk factors, improved protective factors, and lowered girls' alcohol use and their future intentions to use substances. The study supports the value of computer-based and gender-specific interventions that involve girls and their mothers. Future work needs to replicate and strengthen study results.

Schmidt CM; Tauchmann H. Heterogeneity in the intergenerational transmission of alcohol consumption: A quantile regression approach. Journal of Health Economics 30(1): 33-42, 2011. (24 refs.)

This paper addresses the question of whether the effect of parental drinking on children's later consumption of alcohol - which is frequently found to be of positive sign - exhibits a certain pattern of heterogeneity. In particular, if this effect is more prominent in the upper tail than elsewhere in the distribution of children's alcohol consumption, conventional regression analyses that focus on the mean effect may substantially underrate parental drinking as a risk factor for children's later alcohol abuse. In our empirical application, we address this issue by applying censored quantile regression methods to German survey data. The supposed pattern of heterogeneity is indeed found in the data, at least for daily parental drinking. In addition, the intergenerational transmission of alcohol consumption exhibits gender-specific heterogeneity.

Sharma S; Lal R. Volatile substance misuse among street children in India: A preliminary report. Substance Use & Misuse 46(Supplement 1): 46-49, 2011. (18 refs.)

Although substance misuse among children in India has been documented for over a decade, volatile substance misuse (VSM) is a comparatively recent phenomenon there. This paper reviews available Indian studies about VSM among street children and documents the extent of misuse, experienced benefits and harms, and risk factors. Reported perceived benefits include enhanced physical strength, decreased shyness, sleep induction, feeling good, and numbing physical and psychological pain. Identified risk factors include domestic violence, a dictatorial father, presence of stepparents, migrant status, and substance use in the family. Limitations of the current paper and the need for further research are discussed.

Shinozaki Y; Nakao M; Takeuchi T; Yano E. Relationship between smoking and family history of smoking in schizophrenia patients. International Journal of Psychiatry in Medicine 41(2): 203- 214, 2011. (33 refs.)

Background: The rate of smoking is known to be high in patients with schizophrenia. The purpose of this study was to quantitatively examine the relationship between smoking and family history of smoking in patients with schizophrenia. Methods: The sample consisted of 172 patients (mean age: 54 years, 55% male) hospitalized in a general psychiatric hospital. They were asked by a physician whether they smoked. Family histories of smoking and schizophrenia were assessed among first- and third-degree relatives. Results: Ninety-eight patients (57%) were identified as having smoked at some point. Multiple logistic regression analysis showed that smoking was significantly associated with family histories of smoking among both first- and third-degree relatives, controlling for the effects of age, sex, and family history of schizophrenia. The smoking rates were significantly higher in those with a family history of smoking, but not a family history of schizophrenia, than among those without a family history of either smoking or schizophrenia. However, this difference did not reach statistical significance among those with a family history of schizophrenia. Conclusion: Smoking is greatly influenced by family history of smoking in patients with schizophrenia, especially among those without a family history of schizophrenia. The association between smoking and family history of smoking was inconclusive among those patients with schizophrenia who also had a family history of schizophrenia.

Skeer MR; McCormick MC; Normand SLT; Mimiaga MJ; Buka SL; Gilman SE. Gender differences in the association between family conflict and adolescent substance use disorders. Journal of Adolescent Health 49(2): 187-192, 2011. (40 refs.)

Purpose: The objectives of this study were (1) to examine whether the association between childhood family conflict and the risk of substance use disorders (SUDs) in adolescence differs by gender, and (2) to determine whether anxious/depressive symptoms and conduct problems explain this association among adolescent males and females. Methods: Data were obtained from 1,421 children aged 10-16 years at the time of enrollment in the Project on Human Development in Chicago Neighborhoods. We assessed gender differences in the association between childhood family conflict and adolescent SUDs by fitting a logistic regression model that included the interaction of gender and family conflict. We also investigated whether conduct problems and anxious/depressive symptoms explained the association between family conflict and SUDs differently for males and females through gender-specific mediation analyses. Results: The association between childhood family conflict and SUDs in adolescence differed by gender (p = .04). Family conflict was significantly associated with SUDs among females (OR: 1.61; CI: 1.20-2.15), but not among males (OR: 1.00; CI:.76-1.32). The elevated risk of SUDs among females exposed to family conflict was partly explained by girls' conduct problems, but not by anxious/depressive symptoms. Conclusions: Females living in families with elevated levels of conflict were more likely to engage in acting out behaviors, which was associated with the development of SUDs. Future epidemiologic research is needed to help determine when this exposure is most problematic with respect to subsequent mental health outcomes and the most crucial time to intervene.

Skinner ML; Haggerty KP; Fleming CB; Catalano RF; Gainey RR. Opiate-addicted parents in methadone treatment: Long-term recovery, health, and family relationships. Journal of Addictive Diseases 30(1): 17-26, 2011. (35 refs.)

Few studies follow the lives of opiate-addicted parents. The authors examined a 12-year follow-up of 144 parents in methadone treatment and their 3- to 14-year-old children. Parent mortality was high. Among survivors, drug use and treatment, incarceration, residential and family disruptions, and health problems were common. Moderate and long-term recovery were associated with consistent methadone treatment, further education, employment, and fewer relationship disruptions. Earlier depression, deviant friends, and poor coping skills predicted continued drug problems. Thus, interventions should include treatment for depression and build skills for avoiding and refusing drugs, coping with stress, and maintaining recovery-supportive friendships.

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

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

Tarter RE; Kirisci L; Mezzich A; Patton D. Multivariate comparison of male and female adolescent substance abusers with accompanying legal problems. Journal of Criminal Justice 39(3, special issue): 207-211, 2011. (36 refs.)

Purpose: The factors that distinguish adolescent male and female substance abusers with and without legal problems were investigated. Method: Youths (N = 4,071) admitted for substance abuse treatment were administered the revised Drug Use Screening Inventory (DUSI-R) to measure severity of health, behavior, and social adjustment problems. Results: Legal problems were more frequent among boys; however, severity of disturbance was greater in girls on 9 of 10 scales. Substance abusing girls and boys with legal problems reported more severe behavior, substance abuse, family adjustment, and peer relationship problems than substance abusing peers without legal problems. Quality of peer relationship mediated the association of family dysfunction, substance abuse and behavior problems with legal problems in boys only. Conclusions: Gender and legal status both need to be taken into account to potentiate treatment prognosis of substance abusing youths.

Tettamanti G; Altman D; Pedersen NL; Bellocco R; Milsom I; Iliadou AN. Effects of coffee and tea consumption on urinary incontinence in female twins. International Journal of Obstetrics and Gynaecology 118(7): 806- 813, 2011. (25 refs.)

Objectives: To assess the effect of coffee and tea consumption on symptoms of urinary incontinence. Design: Population-based study. Setting: The Swedish Twin Register. Population: In 2005, all twins born between 1959 and 1985 in Sweden (n = 42 852) were invited to participate in a web-based survey to screen for common complex diseases and common exposures. The present study was limited to female twins with information about at least one urinary symptoms and coffee and tea consumption (n = 14 031). Main outcome measure: The association between coffee and tea consumption and urinary incontinence, as well as nocturia, was estimated as odds ratios (ORs) with 95% confidence intervals. Results: Women with a high coffee intake were at lower risk of any urinary incontinence (OR 0.78, 95% CI 0.64-0.98) compared with women not drinking coffee. Coffee intake and incontinence subtypes showed no significant associations whereas high tea consumption was specifically associated with a risk for overactive bladder (OR 1.34, 95% CI 11.07-1.67) and nocturia (OR 1.18, 95% CI 1.01-1.38). Results from co-twin control analysis suggested that the associations observed in logistic regression were mainly the result of familial effects. Conclusions: This study suggests that coffee and tea consumption has a limited effect on urinary incontinence symptoms. Familial and genetic effects may have confounded the associations observed in previous studies.

Tomcikova Z; Geckova AM; van Dijk JP; Reijneveld SA. Characteristics of adolescent excessive drinkers compared with consumers and abstainers. Drug and Alcohol Review 30(2): 157-165, 2011. (52 refs.)

Introduction and Aims. This study aimed at comparing adolescent abstainers, consumers and excessive drinkers in terms of family characteristics (structure of family, socioeconomic factors), perceived social support, personality characteristics (extraversion, self-esteem, aggression) and well-being. Design and Methods. Cross-sectional data were obtained from 3694 elementary school students in the 8th and 9th grades from several cities in Slovakia (mean age 14.5, 49.0% men; response rate 93%). Respondents completed questions on the use of alcohol and on family structure (parental divorce), the socioeconomic position of the family (parents' education and family affluence), perceived social support, extraversion, self-esteem, aggression and psychological well-being. They were split into three groups based on the pattern of alcohol use-abstainers, consumers and excessive drinkers (i.e. being drunk at least once during the past 4 weeks). Results. The results showed significant differences between abstainers, consumers and excessive drinkers in almost every characteristic explored. A risky pattern of alcohol consumption occurs more frequently among adolescents who have divorced parents, higher socioeconomic position, higher scores for perceived social support from friends, extraversion, negative self-esteem and aggression, and lower scores for social support from family and for well-being. Discussion and Conclusions. A risky pattern of alcohol consumption is more likely among relatively easily identifiable groups of adolescents from high socioeconomic position and divorced families. Their personalities and social networks have characteristics that could be accommodated in preventive interventions as well.

Tsoh JY; Tong EK; Gildengorin G; Tung TN; Modayil MV; Wong C et al. Individual and family factors associated with intention to quit among male Vietnamese American smokers: Implications for intervention development. Addictive Behaviors 36(4): 294-301, 2011. (67 refs.)

Smoking prevalence among Vietnamese American males remains higher than the U.S. general population. This study examined the associations of individual and family factors with quit intention among Vietnamese male smokers in California to guide intervention development to reduce their smoking prevalence. Data for Vietnamese male current smokers (n = 234) in the 2008 California Vietnamese Adult Tobacco Use Survey (N = 1101 males) were analyzed to describe quit intention and previous quit attempts. One-third of Vietnamese male smokers (33%) had no intention to quit at any time, 36% intended to quit soon (in the next 30 days), and 31% intended to quit later (beyond the next 30 days). Half (51.7%) of the sample was in "precontemplation," indicating no intention to quit within 6 months. Many (71%) had made a serious quit attempt in the past year, but 68% of those who tried to quit used no cessation assistance. Multivariate logistic regression adjusting for age, depression, smoking intensity, nicotine dependence, health knowledge, children in the household and home smoking ban revealed that having smoking-related family conflicts and a quit attempt in the past year with or without assistance were independently associated with an intention to quit either in the next 30 days or later. Higher education was associated with no intention to quit. Findings underscore the importance of designing strategic interventions that meet the needs of smokers at both individual and family levels to promote quit intention and to facilitate successful quitting in this population.

Turel O; Serenko A; Bontis N. Family and work-related consequences of addiction to organizational pervasive technologies. Information & Management 48(2-3): 88- 95, 2011. (41 refs.)

While organizational pervasive technologies, such as mobile computing, can contribute to increased productivity, their nature can also result in technology addiction. We applied the behavior-environment interface of social cognitive theory to explain several negative familial and organizational consequences of addiction to work-related pervasive technologies. Our empirical study of 241 organizational mobile email users revealed that their levels of addiction to mobile email increased their perceived work overload and technology-family conflict. Perceived work overload, in turn, reduced their organizational commitment. Furthermore, elevated levels of perceived work overload together with augmented technology-family conflict fostered work-family conflict. Implications for research and practice are suggested.

van Winkel R. Family-based analysis of genetic variation underlying psychosis-inducing effects of cannabis sibling analysis and proband follow-up. Archives of General Psychiatry 68(2): 148-157, 2011. (60 refs.)

Context: Individual differences exist in sensitivity to the psychotomimetic effect of cannabis; the molecular genetic basis underlying differential sensitivity remains elusive. Objective: To investigate whether selected schizophrenia candidate single-nucleotide polymorphisms (SNPs) moderate effects of cannabis use. Design: Interactions between recent cannabis use, determined by urinalysis results, and 152 SNPs in 42 candidate genes were examined in 740 unaffected siblings of 801 patients with psychosis to examine genetic moderation of the association between Structured Interview for Schizotypy-Revised positive schizotypy and recent cannabis use (at-risk paradigm). The SNPs showing Bonferroni-adjusted association in the at-risk paradigm were used in a case-only analysis in the 801 patients, as well as in a case-sibling and case-control analysis (using 419 controls) focusing on genetic moderation of developmental effects of cannabis on later psychotic disorder. Setting: The Netherlands and Flanders, Belgium. Participants: Eight hundred one patients with psychosis and their 740 unaffected siblings. Main Outcome Measure: Significant interaction between any of the selected SNPs and cannabis in the at-risk paradigm, followed by selective case-only, casesibling, and case-control analyses. Results: In the unaffected siblings, 16 SNPs in 12 genes showed significant interaction at P<.05, 3 of which survived correction for multiple testing (P<.0003), situated in AKT1 (rs2494732 and rs1130233) and LRRTM1 (rs673871). Follow-up analysis supported AKT1 rs2494732 X cannabis interaction in the case-only (beta=0.20; P=.007), case-sibling (interaction P=.040), and case-control (interaction P=.057) analyses, with individuals with C/C genotypes having an approximately 2-fold odds of being diagnosed with a psychotic disorder when having used cannabis. In the unaffected siblings, the AKT1 X cannabis interaction explained 2.2% additional variance in schizotypy in the whole sample and 19.0% additional variance in the exposed siblings with recent cannabis use. Conclusions: Genetic variation in AKT1 may mediate both short-term as well as longer-term effects on psychosis expression associated with use of cannabis, possibly through a mechanism of cannabinoid-regulated AKT1/GSK-3 signaling downstream of the dopamine D-2 receptor.

Vander Weg MW. Adverse childhood experiences and cigarette smoking: The 2009 Arkansas and Louisiana Behavioral Risk Factor Surveillance Systems. Nicotine & Tobacco Research 13(7): 616-622, 2011. (25 refs.)

Introduction: Adverse childhood experiences (ACEs) such as neglect, verbal, sexual, and physical abuse, household dysfunction, and other childhood stressors are associated with a range of negative health outcomes and risk behaviors. Although there is evidence that ACEs are related to an increased risk for cigarette smoking, additional studies in more diverse samples are needed. Methods: Adults taking part in the 2009 Arkansas (n = 3,125) and Louisiana (n = 7,152) Behavioral Risk Factor Surveillance Systems were surveyed regarding their smoking history and exposure to 11 ACEs. Multivariable logistic regression was used to examine independent associations between individual and total number of ACEs and both lifetime and current smoking adjusting for sociodemographic characteristics. Results: Exposure to each type of ACE was associated with a significantly increased risk for both lifetime (odds ratios [ORs]: 1.35-3.65) and current (ORs: 1.31-2.43) cigarette smoking among residents of both states. Total number of ACEs was also related to the odds of smoking in a generally graded fashion such that Arkansas residents reporting 5 or more ACEs were 3.97 (95% CI: 2.46-6.41) and 2.70 (95% CI: 1.64-4.43) times as likely as those reporting no ACEs to be lifetime and current smokers, respectively. Corresponding odds for those living in Louisiana were 3.06 (95% CI: 2.32-4.02) for lifetime smoking and 2.80 (95% CI: 2.07-3.77) for current smoking. Conclusions: ACEs are associated with an increased likelihood of cigarette smoking in adulthood among residents of Arkansas and Louisiana. Efforts to prevent abuse, neglect, and other ACE may include among their benefits reduced risk for later smoking-related illness.

Vander Weg MW; Cunningham CL; Howren MB; Cai XY. Tobacco use and exposure in rural areas: Findings from the Behavioral Risk Factor Surveillance System. Addictive Behaviors 36(3): 231-236, 2011. (40 refs.)

Evidence suggests that those residing in rural areas may be disproportionately affected by the health burden of tobacco use.. The present study examined tobacco use, self-reported exposure to tobacco smoke, and policies regarding public smoking according to area of residence, using data from the 2006 and 2008 Behavioral Risk Factor Surveillance System. Results indicated that, relative to those from suburban and urban locations, adults residing in rural areas were significantly more likely to smoke cigarettes (22.2% versus 17.3% (suburban) and 18.1% (urban), p<.001) and to use smokeless tobacco (p<.001). Rural residents were also more likely than those living in suburban and urban areas to report that someone had smoked in their presence during the past seven days both at home (p<.001) and at work (p<.001). Finally, rural participants reported policies that afforded less protection from tobacco smoke both at home and in the workplace. These findings suggest that those living in rural areas are at increased risk for tobacco-related illness due to both their own tobacco use and exposure to others' cigarette smoke.

Vaughn MG; Define RS; DeLisi M; Perron BE; Beaver KM; Fu QA et al. Sociodemographic, behavioral, and substance use correlates of reckless driving in the United States: Findings from a national sample. Journal of Psychiatric Research 45(3): 347-353, 2011. (29 refs.)

This study examined the sociodemographic, behavioral, psychiatric, and substance use correlates of three forms of reckless driving using a nationally representative sample of U.S. adults. Participants were 43,093 adults from the National Epidemiologyogic Survey on Alcohol and Related Conditions (NESARC). Interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version (AUDADIS-IV). This measure provides extensive sociodemographic data as well as diagnoses for mood, anxiety, personality, and substance use disorders. Reckless driving was significantly associated with male gender, lower levels of income, being born in the U.S., and numerous forms of antisocial behaviors. Fully adjusted models revealed significant effects with respect to substance use disorders across categories of reckless drivers with those having their licenses revoked or suspended being particularly more likely to be diagnosed with antisocial (AOR = 3.35, 95% CI = 2.54, 4.42) and paranoid personality disorder (AOR = 1.56, 95% CI = 1.07, 2.29). All three reckless driving groups were more likely to have a family history of antisocial behavior than non-reckless drivers. Study findings provide information from which targeted behavioral interventions can be applied.

Velleman R; Orford J; Templeton L; Copello A; Patel A; Moore L et al. 12-month follow-up after brief interventions in primary care for family members affected by the substance misuse problem of a close relative. Addiction Research & Theory 19(4): 362-374, 2011. (42 refs.)

Following the publication of initial and 3-month data from a prospective cluster randomised comparative trial [Copello, A., Templeton, L., Orford, J., Velleman, R., Patel, A., Moore, L., . Godfrey, C. (2009). The relative efficacy of two levels of a primary care intervention for family members affected by the addiction problem of a close relative: A randomised trial. Addiction, 104, 49-58.], an opportunistic 12-month follow-up was undertaken. The trial compared two brief interventions for use by primary health care professionals with family members (FMs) affected by the problematic substance use of a close relative. Ninety out of 143 (63%) FMs in the trial were followed up at 12 months. Three validated self-completion questionnaires were re-administered: Symptom Rating Test, Coping Questionnaire and Family Member Impact Scale. At 12 months there were still no significant differences between FMs depending on which of the two brief interventions received. The initial improvements at 12 weeks on all of the measures (symptoms, coping and impact) were maintained, and further improved (FMs reported that their symptoms, their coping behaviours and the impact on them of their relatives'' substance misuse problem all continued to reduce). These improvements were unrelated to a range of demographic variables. FMs also reported a gradual improvement in their relatives'' misusing behaviour over the three time periods. In conclusion, following a brief intervention for affected FMs, either delivered in full via professional intervention or via a self-help manual following a brief introduction from a professional, both groups improve equally; there are significant and positive changes which are both maintained and further increased over a 12-month period, without any further formal delivery of the intervention.

Villanti A; Boulay M; Juon HS. Peer, parent and media influences on adolescent smoking by developmental stage. Addictive Behaviors 36(1-2): 133-136, 2011. (32 refs.)

Previous studies of social influences on adolescent smoking have focused on peers and parents using data collected prior the 1998 Master Settlement Agreement. This study used the 2004 wave of the National Youth Tobacco Survey to examine associations between peer smoking, smoking at home, tobacco related media exposure, and smoking behavior during early and middle adolescence. Findings indicate that peer smoking and smoking at home remain strongly associated with current smoking among early and middle adolescents controlling for gender race/ethnicity and exposure to tobacco industry and anti-tobacco media. The magnitude of the association between peer smoking and current smoking decreases from early adolescence to middle adolescence while the association between smoking at home and current smoking is static across developmental stage. Exposure to tobacco-related media is associated with increased current and former smoking in both early and middle adolescence.

Wilens TE; Martelon M; Joshi G; Bateman C; Fried R; Petty C et al. Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry 50(6): 543-553, 2011. (56 refs.)

Objective: High rates of substance-use disorders (SUD) have been found in samples of adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). Predictors of SUD in children with ADHD who are at risk for the development of SUDs remain understudied. The main aims of this study were to identify clinically meaningful characteristics of children that predicted the future development of SUDs and to see whether the role of these characteristics varied by sex. Method: Subjects were children and adolescents with (n = 268; mean age +/- standard deviation = 10.9 +/- 3.2 years) and without (n = 229; mean age 11.9 +/- 3.3 years) DSM-III-R ADHD followed prospectively and blindly over a 10-year follow-up period onto young adult years. Subjects were assessed with structured diagnostic interviews for psychopathology and SUDs. Results: Over the 10-year follow-up period, ADHD was found to be a significant predictor of any SUD (hazards ratio 1.47; 95% confidence interval 1.07-2.02; p = .01) and cigarette smoking (2.38; 1.61-3.53; p < .01). Within ADHD, comorbid conduct disorder (2.74; 1.66-4.52; p < .01) and oppositional defiant disorder (2.21; 1.40-3.51; p < .01) at baseline were also found to be significant predictors of SUDs. Similar results were found for cigarette-, alcohol-, and drug-use disorders. There were few meaningful sex interaction effects. No clinically significant associations were found for any social or family environment factors or for cognitive functioning factors (p > .05 for all comparisons). Conclusions: These results indicate that ADHD is a significant risk factor for the development of SUDs and cigarette smoking in both sexes.

Wilkinson AV; Shete S; Spitz MR; Swann AC. Sensation seeking, risk behaviors, and alcohol consumption among Mexican origin youth. Journal of Adolescent Health 48(1): 65-72, 2011. (39 refs.)

Purpose: To examine factors associated with ever use of alcohol among Mexican origin youth. Methods: Using a prospective study design, we followed 1,053 Mexican origin adolescents. Participants completed two surveys in their homes and three follow-up telephone interviews, every 6-8 months, in between. The second home survey was completed 30 months (SD = 4.8 months) after baseline. Acculturation, subjective social status, and family cohesion were assessed at baseline and final home visit. Ever drinking, risk behaviors, and sensation-seeking tendencies were assessed at the final home visit only. Results: Overall, 30% of the study participants reported ever drinking alcohol. Multivariate models revealed that being female, increasing age, lower levels of acculturation, family cohesion and subjective social status, higher sensation-seeking tendencies, and concomitantly engaging in three or four other risk behaviors were associated with ever drinking. Also, social disinhibition, an aspect of sensation seeking, mediated the relationship between engaging in other risk behaviors and alcohol use. This is consistent with previous research, suggesting that social disinhibition is a common factor that underlies the use of alcohol, tobacco, illicit drugs, and other problem behaviors. Conclusions: The results of this study support taking a family-based approach to prevention that includes discussion of other risk behaviors, especially smoking, among Mexican origin youth. In addition, tailoring programs by gender, directly addressing how changes in social norms resulting from acculturation can affect a youth's decision to drink alcohol and underlying gender-based differences in why youth drink could improve the efficacy of preventive interventions.

Wisdom JP; Cavaleri M; Gogel L; Nacht M. Barriers and facilitators to adolescent drug treatment: Youth, family, and staff reports. Addiction Research & Theory 19(2): 179-188, 2011. (72 refs.)

Many adolescents with substance abuse problems do not obtain treatment, and there has been no systematic exploration of perceived barriers to starting care from multiple stakeholders. This article describes adolescent, parent, and treatment staff perceptions of barriers and facilitators to treatment. We interviewed 87 adolescents, their parents, and agency staff from three residential substance abuse treatment agencies in two states to explore barriers and facilitators to care in seeking, finding, and initiating substance abuse treatment. Youth, parent, and staff reports of barriers to treatment (n = 128) far outnumbered facilitators to treatment (n = 6). Staff perceived primarily family barriers to seeking treatment (e. g., denial, stigma); parents stated challenges finding treatment (e. g., lack of knowledge), and all three groups reported barriers to initiating treatment (e. g., lack of motivation). Findings suggest structural and perceptual barriers to adolescent services vary by respondent and by the reference point on the help-seeking continuum.

Wolfson M; Champion H; Rogers T; Neiberg RH; Barker DC; Talton JW et al. Evaluation of Free to Grow: Head Start partnerships to promote substance-free communities. Evaluation Review 35(2): 153- 188, 2011. (41 refs.)

Free to Grow: Head Start Partnerships to Promote Substance-free Communities (FTG) was a national initiative in which local Head Start (HS) agencies, in partnership with other community organizations, implemented a mix of evidence-based family-strengthening and community-strengthening strategies. The evaluation of FTG used a quasi-experimental design to compare 14 communities that participated in the FTG intervention with 14 matched comparison communities. Telephone surveys were conducted with two cohorts of the primary caregivers of children in HS at baseline and then annually for 2 years. The survey was also administered to repeated cross-sectional samples of primary caregivers of young children who were not enrolled in HS. No consistent evidence was found in changes in family functioning or neighborhood conditions when the 14 FTG sites were compared to 14 matched sites. However, caregivers of young children who were not in HS in three high-implementing FTG sites showed evidence of improvements in neighborhood organization, neighborhood norms against substance abuse, and child disciplinary practices. Results provide highly limited support for the concept that family and neighborhood conditions that are likely to affect child development and well-being can be changed through organized efforts implemented by local HS programs.

Woodman J; Brandon M; Bailey S; Belderson P; Sidebotham P; Gilbert R. Healthcare use by children fatally or seriously harmed by child maltreatment: Analysis of a national case series 2005-2007. Archives of Disease in Childhood. Fetal and Neonatal Edition 96(3): 270- 275, 2011. (31 refs.)

Aim To determine antecedent patterns of healthcare use by children fatally or seriously harmed by maltreatment. Methods The authors analysed recorded healthcare use for children who were the subject of a serious case review (SCR) in England in 2005-2007. The SCRs were initiated when a child under 18 years old died or was seriously harmed, maltreatment (abuse or neglect) was a factor, and there were lessons for interagency working. The authors analysed a purposive sample (N=40), similar in key demographics to all 189 SCRs in England in 2005-2007. Results: Children had extensive recorded contact with universal (N= 34/40; 85%) and secondary (N= 26/40; 65%) healthcare services and children's social care (N=21/40; 53%). Thirty-one children (78%) had recorded health visitor and/or school nurse contact. Fourteen children (35%) had missed appointments. Almost three-quarters (N=29) had complex family problems recorded (parental domestic violence, alcohol/drug and/or mental health problems). Data quality regarding healthcare use was poor, and the extent and type of 'missing data' varied by age. Conclusions: Complex paediatric and family problems and a high level of contact with services preceded serious adverse events. Universal health services are likely to be well placed for giving ongoing and family-orientated support to vulnerable families. The absence of standardised data collection and any control group limits how far the Biennial Analyses of SCRs can meet their stated objective of identifying national trends and patterns. Linking SCRs to healthcare databases would provide a control group, improve understanding of the population context and diminish demands for data from professionals delivering care.

Wyszynski CM; Bricker JB; Comstock BA. Parental smoking cessation and child daily smoking: A 9-year longitudinal study of mediation by child cognitions about smoking. Health Psychology 30(2): 171-176, 2011. (28 refs.)

Objective: This study investigated to what extent the prospective relationship between parental smoking cessation and child daily smoking is mediated by child cognitions about smoking. Design: The study drew its sample from the 40 Washington State school districts involved in the Hutchinson Smoking Prevention Project. The predictor variable of parental smoking cessation was measured during third grade. The mediator measures, consistent with the Theory of Planned Behavior and Social Cognitive Theory, were measured during ninth grade, and the smoking status outcome was measured during twelfth grade. Main Outcome Measures: Smoking status at twelfth grade. Results: Negative general attitudes toward smoking, attitude that cigarette smoke is bothersome, and tobacco refusal self-efficacy together significantly mediated 49% of the prospective relationship between parental smoking cessation and child daily smoking. Conclusion: Parental smoking cessation before children reach third grade may lead children to develop more negative cognitions about smoking, and, in turn, reduce their risk of smoking.

Yen CN; Wang CSM; Wang TY; Chen HF; Chang HC. Quality of life and its correlates among heroin users in Taiwan. Kaohsiung Journal of Medical Sciences 27(5): 177- 183, 2011. (54 refs.)

The aims of this study were to compare the quality of life (QOL) between subjects with and without heroin use and to examine the association of QOL with sociodemographic characteristics, characteristics of heroin use, family support, and depression among heroin users at entry to a methadone maintenance treatment program. A group of 123 heroin users who visited an outpatient addiction treatment clinic in southern Taiwan for methadone maintenance treatment were recruited into this study. We also recruited 106 subjects who had never used heroin as the control group. Their QOL status was assessed by the short form of the Taiwan Version of the World Health Organization Questionnaire on Quality of Life (the WHOQOL-BREF Taiwan version). The level of QOL between subjects with and without heroin use was compared, and the correlates of QOL among heroin users were examined. Heroin users had poorer QOL than nonusers in the physical, psychological, and social relationship domains but not the environment domain of the WHOQOL-BREF after controlling for the influences of other factors. In addition, heroin users with obvious depression had poorer QOL in all four domains than those without obvious depression. Also, heroin users who perceived higher family support had better QOL in the social relationship and environment domains. Heroin users had poorer QOL than nonusers in multiple domains. Relief of depressive symptoms and enhancement of family support should be important strategies to improve QOL in heroin users.