Serving Substance Abuse Professionals Since 1993

Last Update: 08.09.11

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Research Methodology

67 citations. October 2010 to present

Prepared: September 2011

Bernstein JA; Bernstein E; Heeren TC. Mechanisms of change in control group drinking in clinical trials of brief alcohol intervention: Implications for bias toward the null. Drug and Alcohol Review 29(5): 498-507, 2010. (89 refs.)

Issues. Reductions in control group consumption over time that are possibly related to research design affect the impact of brief alcohol interventions (BAI) in clinical settings. Approach. We conducted a systematic review to identify research design factors that may contribute to control group change, strategies to limit these effects and implications for researchers. Studies with control group n > 30 were selected if they published baseline and outcome consumption data, conducted trials in clinical settings in Anglophone countries and did not censor gender or age. Key Findings. Among 38 studies cited in 20 reviews through October 2009, 16 met criteria (n = 31-370). In 54%, controls received alcohol specific handouts, advice and/or referral. Both the number and depth of assessments were highly variable. The percentage change in consumption ranged from -0.10 to -0.84 (mean -0.32), and effect size from 0.04 to 0.70 (mean 0.37). Published data were insufficient for meta-analysis. Implications. Researchers should consider strategies to reduce the impact of research design factors, such as procedures to enhance sample diversity, blind subjects to study purpose to limit social desirability bias, reduce the number and depth of instruments (assessment reactivity), and finally, analytic techniques to decrease the impact of outliers and regression to the mean. Conclusions. This review identifies problems with retrospective analysis of predictors of control group change, and underscores the need to design prospective studies to permit identification, quantification and adjustment for potential sources of bias in BAI trials.

Brigham J; Lessov-Schlaggar CN; Javitz HS; Krasnow RE; Tildesley E; Andrews J et al. Validity of recall of tobacco use in two prospective cohorts. American Journal of Epidemiology 172(7): 828-835, 2010. (32 refs.)

This project studied the convergent validity of current recall of tobacco-related health behaviors, compared with prospective self-report collected earlier at two sites. Cohorts were from the Oregon Research Institute at Eugene (N = 346, collected 19.5 years earlier) and the University of Pittsburgh, Pennsylvaniasylvania (N = 294, collected 3.9 years earlier). Current recall was examined through computer-assisted interviews with the Lifetime Tobacco Use Questionnaire from 2005 through 2008. Convergent validity estimates demonstrated variability. Validity estimates of some tobacco use measures were significant for Oregon subjects (age at first cigarette, number of cigarettes/day, quit attempts yes/no and number of attempts, and abstinence symptoms at quitting; all P < 0.03). Validity estimates of Pittsburgh subjects' self-reports of tobacco use and abstinence symptoms were significant (P < 0.001) for all tobacco use and abstinence symptoms and for responses to initial use of tobacco. These findings support the utility of collecting recalled self-report information for reconstructing salient lifetime health behaviors and underscore the need for careful interpretation.

Correia CJ; Cameron JM. Development of a simulated drinking game procedure to study risky alcohol use. Experimental and Clinical Psychopharmacology 18(4): 322-328, 2010. (47 refs.)

The aim of the current study was to initiate and describe the development of a Simulated Drinking Game Procedure (SDGP), a safe, efficient, and alcohol-free laboratory protocol for studying drinking game behavior. Fifty-two undergraduates completed the SDGP in a laboratory session, where participants played singles and/or doubles games of Beer Pong. Water was substituted for alcohol in all of the games. The number of drinks consumed during matches and 20-min play periods were coded during each session, and software was used to estimate the peak blood alcohol concentration (BAC) a participant would achieve if he or she had consumed actual alcohol while participating in the SDGP. Results indicated that participation in Beer Pong can lead to rapid consumption of alcohol and an associated rise in BAC. Results also highlight additional risks for female participants associated with participation in drinking games. The SDGP is a research tool capable of increasing our understanding of drinking games.

Derringer J; Krueger RF; Iacono WG; McGue M. Modeling the impact of age and sex on a dimension of poly-substance use in adolescence: A longitudinal study from 11-to 17-years-old. Drug and Alcohol Dependence 110(3): 193-199, 2010. (24 refs.)

We examined the conceptual utility of modeling use of multiple substances as a trait represented by a unified dimension throughout adolescence. Adolescents (710 males and 676 females) participating in a longitudinal community study were asked whether they had used alcohol, tobacco, marijuana, other controlled substances, or uncontrolled substances (i.e. over-the-counter medications and inhalants) at ages 11, 14, and 17. Using an item response theory framework, model fit indices demonstrated that although all substance use remained part of a single latent dimension, model parameters differed with age and according to sex. The impact of sex was observed at the level of the overall dimension, with reported substance use generally indicating a higher trait level (i.e. greater severity) in females than in males. While using these substances provided good information on individual trait level in mid- to late-adolescence, the trait was poorly characterized by substance use in early adolescence. Across ages and sexes, use of alcohol and tobacco tended to indicate lower trait levels than use of marijuana, other controlled substances, and uncontrolled substances. All substances provided a similar amount of information on the underlying dimension (except for uncontrolled substances, which provided the least information). This suggests that measurement and interpretation of adolescent substance use is enhanced by the consideration of a wide range of substances.

Festinger DS; Dugosh KL; Croft JR; Arabia PL; Marlowe DB. Corrected feedback: A procedure to enhance recall of informed consent to research among substance abusing offenders. Ethics & Behavior 20(5): 387-399, 2010. (52 refs.)

This study examined the efficacy of corrected feedback for improving consent recall throughout the course of an ongoing longitudinal study. Participants (N = 135) were randomly assigned to either a corrected feedback or a no-feedback control condition. Participants completed a consent quiz 2 weeks after consenting to the host study and at months 1, 2, and 3. The corrected feedback group received corrections to erroneous responses and the no-feedback control group did not. The feedback group displayed significantly greater recall overall and in specific content areas (i.e., procedures, protections, risks/benefits). Results support the use of corrected feedback for improving consent recall.

Hathaway AD; Hyshka E; Erickson PG; Asbridge M; Brochu S; Cousineau MM et al. Whither RDS? An investigation of Respondent Driven Sampling as a method of recruiting mainstream marijuana users. Harm Reduction Journal 7(e-15), 2010. (45 refs.)

Background: An important challenge in conducting social research of specific relevance to harm reduction programs is locating hidden populations of consumers of substances like cannabis who typically report few adverse or unwanted consequences of their use. Much of the deviant, pathologized perception of drug users is historically derived from, and empirically supported, by a research emphasis on gaining ready access to users in drug treatment or in prison populations with higher incidence of problems of dependence and misuse. Because they are less visible, responsible recreational users of illicit drugs have been more difficult to study. Methods: This article investigates Respondent Driven Sampling (RDS) as a method of recruiting experienced marijuana users representative of users in the general population. Based on sampling conducted in a multi-city study (Halifax, Montreal, Toronto, and Vancouver), and compared to samples gathered using other research methods, we assess the strengths and weaknesses of RDS recruitment as a means of gaining access to illicit substance users who experience few harmful consequences of their use. Demographic characteristics of the sample in Toronto are compared with those of users in a recent household survey and a pilot study of Toronto where the latter utilized nonrandom self-selection of respondents. Results: A modified approach to RDS was necessary to attain the target sample size in all four cities (i.e., 40 'users' from each site). The final sample in Toronto was largely similar, however, to marijuana users in a random household survey that was carried out in the same city. Whereas well-educated, married, whites and females in the survey were all somewhat overrepresented, the two samples, overall, were more alike than different with respect to economic status and employment. Furthermore, comparison with a self-selected sample suggests that (even modified) RDS recruitment is a cost-effective way of gathering respondents who are more representative of users in the general population than nonrandom methods of recruitment ordinarily produce. Conclusions: Research on marijuana use, and other forms of drug use hidden in the general population of adults, is important for informing and extending harm reduction beyond its current emphasis on 'at-risk' populations. Expanding harm reduction in a normalizing context, through innovative research on users often overlooked, further challenges assumptions about reducing harm through prohibition of drug use and urges consideration of alternative policies such as decriminalization and legal regulation.

Hoeppner BB; Stout RL; Jackson KM; Barnett NP. How good is fine-grained Timeline Follow-back data? Comparing 30-day TLFB and repeated 7-day TLFB alcohol consumption reports on the person and daily level. Addictive Behaviors 35(12): 1138-1143, 2010. (23 refs.)

Objective: This study examined the correspondence of two types of Timeline Follow-back (TLFB) methods, a web-based self-administered, repeated 7-day TLFB and an interviewer-administered 30-day TLFB of alcohol consumption. Method: Participants were first- and second-year college students (n=323, 58.5% female). Day-to-day correspondence of drinking reports and correspondence of person-level indicators of drinking were assessed. Results: Results indicated that correspondence between the TLFB-30 and TLFB-7 reports was generally good for summary indicators of drinking, but TLFB-7 data indicated a statistically significantly higher number of total drinks consumed, a higher number of days drinking 4+/5+ drinks per day, and a lower number of abstinent days than TLFB-30. Similarly, day-to-day comparison of drinking reports showed that drinking days were more frequently reported using the TLFB-7, a trend which was more pronounced for distal weekdays than recent weekdays. Correlations between TLFB-7 and TLFB-30 reports of drinks per drinking day were also lower for distal compared to recent weekdays (r = 0.61 vs. r = 0.76). Using a Poisson regression model, a linearly increasing trend in the absolute value of the difference between TLFB-7 and TLFB-30 drinking reports per day as length of recall increases was found (b = 0.013, z = 4.43, with p<0.001). Conclusions: Our results indicate that participants reported more drinking on the repeated TLFB-7 than on the standard TLFB-30. Furthermore, the result of daily level analyses showed that discrepancies between the methods increased as the length of recall increased. These findings suggest that TLFB assessments covering longer intervals may have reduced accuracy on a fine-grained scale.

Johnson TP; Fendrich M; Mackesy-Amiti ME. Computer literacy and the accuracy of substance use reporting in an ACASI Survey. Social Science Computer Review 28(4): 515-523, 2010. (28 refs.)

In recent years, audio computer-assisted self-interviews (ACASI) have been demonstrated to increase and presumably improve the quality of drug reporting in epidemiologic research. Surprisingly little research is available, however, regarding the potential limitations of this technique. For example, it is unclear what effects computer literacy may have on the validity of substance use information collected via ACASI. Respondents with limited computer skills may become distracted by the automated technology, requiring the devotion of considerable cognitive effort to the navigation of unfamiliar computer equipment and software that would otherwise be available for use to more carefully process and answer survey questions. In this study, we report findings from a community ACASI survey conducted in Chicago, which are used to address this problem. Using multiple indicators of computer literacy, a covariance structure model was developed to test the hypothesis that persons with low computer literacy skills may report drug use with less accuracy. Biological assays were used to evaluate 30-day cocaine use reporting accuracy. Model findings confirmed a positive relationship between computer literacy and the accuracy of cocaine use reports. Future research should investigate strategies for improving the usability of self-administrated computer reporting systems for persons with little direct computer experience.

Kerr WC. Commentary on Nelson et al. (2010): The many sources of survey under-coverage. (editorial)18. Addiction 105(9): 1597-1598, 2010. (18 refs.)

Kral AH; Malekinejad M; Vaudrey J; Martinez AN; Lorvick J; McFarland W et al. Comparing respondent-driven sampling and targeted sampling methods of recruiting injection drug users in San Francisco. Journal of Urban Health 87(5): 839-850, 2010. (39 refs.)

The objective of this article is to compare demographic characteristics, risk behaviors, and service utilization among injection drug users (IDUs) recruited from two separate studies in San Francisco in 2005, one which used targeted sampling (TS) and the other which used respondent-driven sampling (RDS). IDUs were recruited using TS (n = 651) and RDS (n = 534) and participated in quantitative interviews that included demographic characteristics, risk behaviors, and service utilization. Prevalence estimates and 95% confidence intervals (CIs) were calculated to assess whether there were differences in these variables by sampling method. There was overlap in 95% CIs for all demographic variables except African American race (TS: 45%, 53%; RDS: 29%, 44%). Maps showed that the proportion of IDUs distributed across zip codes were similar for the TS and RDS sample, with the exception of a single zip code that was more represented in the TS sample. This zip code includes an isolated, predominantly African American neighborhood where only the TS study had a field site. Risk behavior estimates were similar for both TS and RDS samples, although self-reported hepatitis C infection was lower in the RDS sample. In terms of service utilization, more IDUs in the RDS sample reported no recent use of drug treatment and syringe exchange program services. Our study suggests that perhaps a hybrid sampling plan is best suited for recruiting IDUs in San Francisco, whereby the more intensive ethnographic and secondary analysis components of TS would aid in the planning of seed placement and field locations for RDS.

Miller PG; Sonderlund AL. Using the internet to research hidden populations of illicit drug users: A review. Addiction 105(9): 1557-1567, 2010. (74 refs.)

Aims: To review the current research of hidden populations of illicit drugs users using web-based methods and discuss major advantages and disadvantages. Methods: Systematic review of 16 databases, including PubMed, PsycINFO (EBSCOhost), CSA Sociological Abstracts, Expanded Academic ASAP and Google Scholar. Findings: Substances researched were most commonly 'party/club drugs' (such as ecstasy) and cannabis. All of the studies reviewed concluded that the internet is a useful tool for reaching hidden populations, but is likely to impose some bias in samples. Advantages include: access to previously under-researched target groups; speed; international applications; increased ease of data entry; and improved confidentiality for respondents. The major disadvantage is a lack of representativeness of samples. Conclusions: Internet research is successful at accessing hidden populations of illicit drugs users, when appropriately targeted and provides unprecedented opportunities for research across a wide range of topics within the addictions field. Findings are unlikely to be generalisable to the general public, but appropriate for describing target populations.

Murphy DA; Hser YI; Huang D; Brecht ML; Herbeck DM. Self-report of longitudinal substance use: A comparison of the UCLA Natural History Interview and the Addiction Severity Index. Journal of Drug Issues 40(2): 495-515, 2010. (40 refs.)

Reliance on self-report of alcohol and drug use behavior is typical among studies of substance abusers. Few studies have compared different instruments assessing frequency of drug use over long periods of time to determine if the pattern of use is shown to be similar across measures. In this study, the UCLA Natural History Interview (NHI) and the Addiction Severity Index (ASI) were administered at three annual follow-up periods (N = 301). The temporal pattern of the trajectories of days of use assessed by the ASI and NHI are comparable (in terms of both slope and intercept) for alcohol, heroin, cocaine, methamphetamine, and marijuana use. Some discrepancies appear to arise from differences in terminology among the instruments. However, the patterns of drug use were consistent across instruments, supporting their reliability for longitudinal examination of self-reported drug use.

Nelson DE; Naimi TS; Brewer RD; Roeber J. US state alcohol sales compared to survey data, 1993-2006. Addiction 105(9): 1589-1596, 2010. (52 refs.)

Aims: Assess long-term trends of the correlation between alcohol sales data and survey data. Design: Analyses of state alcohol consumption data from the US Alcohol Epidemiologic Data System based on sales, tax receipts or alcohol shipments. Cross-sectional, state annual estimates of alcohol-related measures for adults from the US Behavioral Risk Factor Surveillance System using telephone surveys. Setting United States. Participants: State alcohol tax authorities, alcohol vendors, alcohol industry (sales data) and randomly selected adults aged >= 18 years 1993-2006 (survey data). Measurements: State-level per capita annual alcohol consumption estimates from sales data. Self-reported alcohol consumption, current drinking, heavy drinking, binge drinking and alcohol-impaired driving from surveys. Correlation coefficients were calculated using linear regression models. Findings: State survey estimates of consumption accounted for amedian of 22% to 32% of state sales data across years. Nevertheless, state consumption estimates from both sources were strongly correlated with annual r-values ranging from 0.55-0.71. State sales data had moderate-to-strong correlations with survey estimates of current drinking, heavy drinking and binge drinking (range of r-values across years: 0.57-0.65; 0.33-0.70 and 0.45-0.61, respectively), but a weaker correlation with alcoholimpaired driving (range of r-values: 0.24-0.56). There were no trends in the magnitude of correlation coefficients. Conclusions: Although state surveys substantially underestimated alcohol consumption, the consistency of the strength of the association between sales consumption and survey data for most alcohol measures suggest both data sources continue to provide valuable information. These findings support and extend the distribution of consumption model and single distribution theory, suggesting that both sales and survey data are useful for monitoring population changes in alcohol use.

Newbury J; Hoskins M. Relational inquiry: Generating new knowledge with adolescent girls who use crystal meth. Qualitative Inquiry 16(8): 642-650, 2010. (58 refs.)

Qualitative research is continuously evolving and expanding as researchers seek methodologies that reflect the intersubjective nature of experience. Relational inquiry is an approach which considers the relationships (a) between researchers and participants, (b) among multiple dimensions of the participant's lived experience, and (c) between the subjectivity of the participant and the phenomenon under study. In this article, the authors present a study in which the experiences of adolescent girls who use methamphetamines are explored through the use of photograph elicitation. The authors demonstrate how engagement with photographs can bring forth narratives from which researchers, teachers, practitioners, and, indeed, adolescent girls can learn.

O'Leary CM; Bower C; Zubrick SR; Geelhoed E; Kurinczuk JJ; Nassar N. A new method of prenatal alcohol classification accounting for dose, pattern and timing of exposure: Improving our ability to examine fetal effects from low to moderate alcohol. Journal of Epidemiology and Community Health 64(e-11), 2010. (36 refs.)

Background: When examining the association between prenatal alcohol exposure and fetal effects, the timing and intensity of exposure have been ignored in epidemiological studies. The effect of using dose, pattern and timing of consumption ("composite" method) was investigated in this study, to examine the association between prenatal alcohol exposure and fetal effects. Methods The composite method resulted in six categories of exposure (abstinent, low, moderate, binge Copyright 2010, BMJ Publishing Group

Palmer C. Everyday risks and professional dilemmas: Fieldwork with alcohol-based (sporting) subcultures. Qualitative Research 10(4): 421-440, 2010. (76 refs.)

This article discusses some of the everyday risks and professional dilemmas encountered when conducting participant-observation based research into the use and meaning of alcohol among fans of Australian Rules football. The key risks and dilemmas were those that emerged from female researchers entering into a predominantly male football subculture in which alcohol is routinely (and often excessively) consumed, the negotiation of key gatekeepers, the potential dangers of conducting research with participants who are inebriated and the duty of care to research participants. The article draws on an eighteen-month period of ethnographic fieldwork to highlight the risks and dilemmas negotiated and re-negotiated throughout the research process. The article argues that a failure to attend to these and other risks and dilemmas can threaten the viability of research among drinking-based communities and subcultures.

Raiff BR; Faix C; Turturici M; Dallery J. Breath carbon monoxide output is affected by speed of emptying the lungs: Implications for laboratory and smoking cessation research. Nicotine & Tobacco Research 12(8): 834-838, 2010. (16 refs.)

Introduction: Researchers have used breath carbon monoxide (CO) cutoff values ranging from 4 to 10 ppm to define abstinence in cigarette-smoking cessation research and reductions in CO as a measure of acute abstinence in laboratory research. The current study used a reversal design to investigate effects of exhalation speed on CO output in four groups (non-, light, moderate, and heavy smokers; n = 20 per group). Methods: In one condition, participants were instructed to empty their lungs as quickly as possible (fast), whereas in a different condition, participants were instructed to empty their lungs at a slow pace (slow). Conditions were counterbalanced and repeated twice for each participant. Results: For all groups, speed of exhalation was significantly lower during the slow condition than during the fast condition, and CO output was significantly higher during the slow condition than during the fast condition. Sensitivity and specificity analyses revealed that the optimal CO cutoff for smoking abstinence was 3 ppm during the fast condition versus 4 ppm during the slow condition. Additionally, when heavy smokers switched from exhaling slow to exhaling fast, they showed an approximately 30% reduction in CO. Discussion: The results suggest that exhalation speed should be monitored when CO is used as a measure of smoking status for laboratory and smoking cessation research. If exhalation speed is not monitored when using CO to verify smoking cessation, then more conservative CO cutoff values should be used to avoid false negative CO readings.

Resnicow K; Zhang NH; Vaughan RD; Reddy SP; James S; Murray DM. When intraclass correlation coefficients go awry: A case study from a school-based smoking prevention study in South Africa. American Journal of Public Health 100(9): 1714-1718, 2010. (21 refs.)

Objectives. We conducted a group randomized trial of 2 South African school-based smoking prevention programs and examined possible sources and implications of why our actual intraclass correlation coefficients (ICCs) were significantly higher than the ICC of 0.02 used to compute initial sample size requirements. Methods. Thirty-six South African high schools were randomly assigned to 1 of 3 experimental groups. On 3 occasions, students completed questionnaires on tobacco and drug use attitudes and behaviors. We used mixed-effects models to partition individual and school-level variance components, with and without covariate adjustment. Results. For 30-day smoking, unadjusted ICCs ranged from 0.12 to 0.17 across the 3 time points. For lifetime smoking, ICCs ranged from 0.18 to 0.22; for other drug use variables, 0.02 to 0.10; and for psychosocial variables, 0.09 to 0.23. Covariate adjustment substantially reduced most ICCs. Conclusions. The unadjusted ICCs we observed for smoking behaviors were considerably higher than those previously reported. This effectively reduced our sample size by a factor of 17. Future studies that anticipate significant cluster-level racial homogeneity may consider using higher-value ICCs in sample-size calculations to ensure adequate statistical power.

Sears JM; Krupski A; Joesch JM; Estee SL; He LJ; Shah MF et al. The use of administrative data as a substitute for individual screening scores in observational studies related to problematic alcohol or drug use. Drug and Alcohol Dependence 111(1-2): 89-96, 2010. (34 refs.)

Administrative data provide a rich resource for improving our understanding of individuals with substance use disorders. The validation of administrative proxies for moderate or high risk alcohol or drug (AOD) use could enhance the ability to carry out rigorous observational research (for example, for use in the construction of comparison groups). This study used receiver operating characteristic (ROC) curve techniques to assess how well AOD-related administrative indicators predicted self-reported AOD use obtained from AUDIT/DAST screening scores. An administrative AOD indicator, derived from a combination of medical encounter and billing data, arrest records, and publicly funded AOD-related services data, demonstrated discrimination in the acceptable range (AUC: 0.72-0.78) for identifying self-reported AOD use consistent with potential need for either (1) any AOD-related intervention, or (2) intensive AOD-related intervention or treatment. These findings held up in two distinct samples: a statewide Medicaid-only sample and a single-site mixed-payer sample that included the uninsured. Our findings suggest that indicators of AOD-related problems derived from administrative data can be useful for identifying moderate or high risk AOD use in a research context. The findings further suggest that proxies for substance use disorders, such as those evaluated here, can enhance future observational studies intended to improve health care for this population.

Wu CB; Thompson ME; Fong GT; Li QA; Jiang YA; Yang Y et al. Methods of the International Tobacco Control (ITC) China Survey. Tobacco Control 19(Supplement 2): i1, 2010. (8 refs.)

This paper describes the design features, data collection methods and analytical strategies of the ITC China Survey, a prospective cohort study of 800 adult smokers and 200 adult non-smokers in each of six cities in China. In addition to features and methods which are common to ITC surveys in other countries, the ITC China Survey possesses unique features in frame construction, a large first phase data enumeration and sampling selection; and it uses special techniques and measures in training, field work organisation and quality control. It also faces technical challenges in sample selection and weight calculation when some selected upper level clusters need to be replaced by new ones owing to massive relocation exercises within the cities.

Khadjesari Z; Murray E; Hewitt C; Hartley S; Godfrey C. Can stand-alone computer-based interventions reduce alcohol consumption? A systematic review (review). Addiction 106(2): 267-282, 2011. (76 refs.)

Aim: To determine the effects of computer-based interventions aimed at reducing alcohol consumption in adult populations. Methods: The review was undertaken following standard Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for systematic reviews. The literature was searched until December 2008, with no restrictions on language. Randomized trials with parallel comparator groups were identified in the form of published and unpublished data. Two authors independently screened abstracts and papers for inclusion. Data extraction and bias assessment was undertaken by one author and checked by a second author. Studies that measured total alcohol consumption and frequency of binge drinking episodes were eligible for inclusion in meta-analyses. A random-effects model was used to pool mean differences. Results: Twenty-four studies were included in the review (19 combined in meta-analyses). The meta-analyses suggested that computer-based interventions were more effective than minimally active comparator groups (e.g. assessment-only) at reducing alcohol consumed per week in student and non-student populations. However, most studies used the mean to summarize skewed data, which could be misleading in small samples. A sensitivity analysis of those studies that used suitable measures of central tendency found that there was no difference between intervention and minimally active comparator groups in alcohol consumed per week by students. Few studies investigated non-student populations or compared interventions with active comparator groups. Conclusion: Computer-based interventions may reduce alcohol consumption compared with assessment-only; the conclusion remains tentative because of methodological weaknesses in the studies. Future research should consider that the distribution of alcohol consumption data is likely to be skewed and that appropriate measures of central tendency are reported.

Mariani JJ; Brooks D; Haney M; Levin FR. Quantification and comparison of marijuana smoking practices: Blunts, joints, and pipes. Drug and Alcohol Dependence 113(2-3): 249-251, 2011. (14 refs.)

The quantification method for collecting self-reported marijuana use data is not standardized as it is for alcohol or cigarettes, which presents a methodologic challenge for marijuana use disorder treatment studies. Serum and urine markers of marijuana use have a long half-life, limiting their utility as a clinical trial outcome measure. Structured calendar-based interview procedures can accurately measure the frequency of self-reported marijuana use, but are unable to reliably address issues such as quantity of use or potency. This study compared the quantity and assigned-dollar value among users of blunts, joints, and pipes enrolled in two clinical trials testing pharmacotherapies for marijuana dependence. The timeline follow-back method was modified to incorporate using a surrogate substance to represent marijuana to enable participants to estimate the amount and value used. Blunt users were mostly black and Hispanic, while users of joints and pipes were primarily white. Participants reported that they placed 50% more marijuana in blunts than in joints and placed more than twice the amount of marijuana in blunts than in pipes. These findings demonstrate the feasibility of using a surrogate weight estimation procedure to augment calendar-based methods of measuring self-reported marijuana use. Individual variability in use practices limits the utility of this method to estimating within-subject comparisons, rather than between subject comparisons.

Marsden J; Eastwood B; Wright C; Bradbury C; Knight J; Hammond P. How best to measure change in evaluations of treatment for substance use disorder. Addiction 106(2): 294-302, 2011. (30 refs.)

Aims: To compare the performance of the Jacobson & Truax (JT) reliable change index (RCI) with three alternative methods, using data from individuals receiving treatment for substance use disorders. Design: English National Treatment Outcome Monitoring Database for publicly funded specialist community pharmacological and psychosocial interventions. Participants: New adult admissions to treatment across England (1 January-31 December 2008), with in-treatment clinic progress review conducted after an average of 122.8 days for 18 163 individuals. Measurements: Self-reported days using heroin, crack, cocaine powder and alcohol during the 4 weeks before admission and clinical review, recorded using the Treatment Outcomes Profile and analysed using a multi-level, mixed-linear model, with both observed and true scores to estimate the effect of regression to the mean (RTM). Differences in performance among the JT RCI and the alternative methods were assessed by the proportion assigned to a reliably 'improved', 'unchanged' or 'reliably deteriorated' category; level of agreement; difference in effect size for observed and true scores; and receiver operating characteristic parameters. Findings: When compared to the alternative methods, the JT RCI was more conservative in assigning individuals to the improved category, and it showed no evidence of inferiority on any measure. For each method, all individuals categorized as reliably deteriorated and the majority of those categorized reliably improved had outcome scores which fell beyond that expected by RTM. Substituting true scores for observed scores moderated the size of the change effect associated with reduced use of the four substances, but this remained statistically significant. Conclusions: The Jacobson & Truax Reliable Change Index appears to be the optimal measure of change for evaluations of treatment for substance use disorder, in that it is the most conservative for assessing improvement and at least as accurate on all other criteria. Any evaluation of change needs to take account of regression to the mean.

Meyer RE. Commentary on Falk. (editorial). Alcoholism: Clinical and Experimental Research 35(2): 191-193, 2011. (10 refs.)

Pauly V; Frauger E; Pradel V; Rouby F; Berbis J; Natali F et al. Which indicators can public health authorities use to monitor prescription drug abuse and evaluate the impact of regulatory measures? Controlling high dosage buprenorphine abuse. Drug and Alcohol Dependence 113(1): 29-36, 2011. (46 refs.)

Background: Two methods have been recently developed from a drug reimbursement database to provide useful indicators for public health authorities concerning the abuse potential of psychotropic drugs. The doctor-shopping indicator (DSI) measures the proportion of the drug obtained by doctor shopping among the overall quantity of the drug reimbursed and the clustering method reveals subgroups of deviant patients. Objective: The objective of the study was to analyze and compare indicators resulting from these two methods, applied to High Dosage Buprenorphine (HDB) (a product well-known to be diverted in France), in order to determine which public health authorities needs they answer. Data analysis: The patients with reimbursed HDB were grouped using the clustering method in terms of drug dispensations characteristics over a nine month period. The characteristics of the resulting subgroups, including their DSI, were then compared. Results: 4787 Patients (73.4%) had no measurable doctor-shopping behaviour. But the comparison of the two methods demonstrated that the more a patient's profile was characterized by deviant behavior, the higher was the DSI: from 0.4% in a subgroup with a median profile to 72% in a subgroup with a deviant profile. Conclusion: These two methods are useful surveillance tools for public health authorities: the clustering method may help devise pertinent intervention strategies to reduce prescription drug abuse while the DSI method provides quantitative information demonstrating whether these strategies are useful. We discuss the advantages and disadvantages of using these two methods as useful indicators for public health authorities.

Perkins KA; Lerman C. Early human screening of medications to treat drug addiction: Novel paradigms and the relevance of pharmacogenetics. Clinical Pharmacology & Therapeutics 89(3): 460-463, 2011. (31 refs.)

Initial screening of medications for efficacy in treating drug dependence may be accomplished more efficiently by using novel approaches that combine the practical advantages of within-subject laboratory studies with the clinical validity provided by clinical trials. A priori selection of functional gene variants associated with the pharmacokinetic or pharmacodynamic effects of a medication may aid this effort by controlling for individual variability as to clinical response or adverse effects; however, there are limitations to this approach, and these should be carefully considered.

Roerecke M; Rehm J. Ischemic heart disease mortality and morbidity rates in former drinkers: A meta-analysis. (review). American Journal of Epidemiology 173(3): 245-258, 2011. (88 refs.)

Current abstainers from alcohol have been identified as an inadequate reference group in epidemiologic studies of the effects of alcohol, because inclusion of former drinkers might lead to overestimation of the protective effects and underestimation of the detrimental effects of drinking alcohol. The authors' objective in the current study was to quantify this association for ischemic heart disease (IHD). Electronic databases were systematically searched for relevant case-control or cohort studies published from 1980 to 2010. Thirty-eight articles fulfilled the inclusion criteria, contributing a total of 5,613 IHD events and 12,097 controls among case-control studies and 1,387 events with combined endpoints and 7,183 events stratified by endpoint among 232,621 persons at risk among cohort studies. Pooled estimates for the subset stratified by sex and endpoint showed a significantly increased risk among former drinkers compared with long-term abstainers for IHD mortality ( among men; relative risk = 1.25, 95% confidence interval: 1.15, 1.36; among women relative risk = 1.54, 95% confidence interval: 1.17, 2.03). For IHD morbidity, the estimates for both sexes were close to unity and not statistically significant. Results were robust in several sensitivity analyses. In future studies, researchers should separate former drinkers from the reference category to obtain unbiased effect estimates. Implications for the overall beneficial and detrimental effects of alcohol consumption on IHD are discussed.

Simpson TL; Galloway C; Rosenthal CF; Bush KR; McBride B; Kivlahan DR. Daily telephone monitoring compared with retrospective recall of alcohol use among patients in early recovery. American Journal on Addictions 20(1): 63-68, 2011. (31 refs.)

Most studies comparing frequent self-monitoring protocols and retrospective assessments of alcohol use find good correspondence, but have excluded participants with significant comorbidity and/or social instability, and some have included abstainers. We evaluated the correspondence between measures of alcohol use based on daily interactive voice response (IVR) telephone monitoring and a 28-day modification of the Form-90 (Form-28). Participants were 25 outpatients with alcohol use disorder and significant PTSD symptomatology. Overall correlations between the IVR and Form-28 on days drinking and total standard drink units (SDUs) were strong for the entire sample and the subsample of drinkers (n = 7). Day-to-day correspondence between IVR and Form-28 was modest, but much stronger for the most recent week assessed than for the prior 3 weeks. Finally, the drinkers reported significantly greater total SDUs and heavy drinking days on the Form-28 than via IVR. The results indicate a need for further refinement of IVR methodology for treatment seeking populations as well as caution when retrospectively assessing drinking over time periods longer than a week among these individuals.

Swendsen J; Ben-Zeev D; Granholm E. Real-time electronic ambulatory monitoring of substance use and symptom expression in schizophrenia. American Journal of Psychiatry 168(2): 202-209, 2011. (40 refs.)

Objective: Despite evidence demonstrating elevated comorbidity between schizophrenia and substance use disorders, the underlying mechanisms of association remain poorly understood. The brief time intervals that characterize interactions between substance use and psychotic symptoms in daily life are inaccessible to standard research protocols. The authors used electronic personal digital assistants (PDAs) to examine the temporal association of diverse forms of substance use with psychotic symptoms and psychological states in natural contexts. Method: Of 199 community-dwelling individuals with schizophrenia or schizoaffective disorder who were contacted to participate in the study, 92% accepted and 73% completed the study. The 145 participants who completed the study provided reports of substance use, psychotic symptoms, mood, and event negativity multiple times per day over 7 consecutive days through PDAs. Results: Participants responded to 72% of the electronic interviews (N=2,737) across daily life contexts. Strong within-day prospective associations were observed in both directions between substance use and negative psychological states or psychotic symptoms, but considerable variation was observed by substance type. Consistent with the notion of self-medication, alcohol use was most likely to follow increases in anxious mood or psychotic symptoms. Cannabis and other illicit substances, demonstrating more complex patterns, were more likely to follow certain psychological states but were also associated with the later onset of psychotic symptoms. Conclusions: The dynamic interplay of substance use and psychotic symptoms is in many cases consistent with both causal and self-medication mechanisms, and these patterns of association should be considered in the design of treatment and prevention strategies.

Ye Y; Kerr WC. Alcohol and liver cirrhosis mortality in the United States: Comparison of methods for the analyses of time-series panel data models. Alcoholism: Clinical and Experimental Research 35(1): 108-115, 2011. (34 refs.)

Background: To explore various model specifications in estimating relationships between liver cirrhosis mortality rates and per capita alcohol consumption in aggregate-level cross-section time-series data. Methods: Using a series of liver cirrhosis mortality rates from 1950 to 2002 for 47 U.S. states, the effects of alcohol consumption were estimated from pooled autoregressive integrated moving average (ARIMA) models and 4 types of panel data models: generalized estimating equation, generalized least square, fixed effect, and multilevel models. Various specifications of error term structure under each type of model were also examined. Different approaches controlling for time trends and for using concurrent or accumulated consumption as predictors were also evaluated. Results: When cirrhosis mortality was predicted by total alcohol, highly consistent estimates were found between ARIMA and panel data analyses, with an average overall effect of 0.07 to 0.09. Less consistent estimates were derived using spirits, beer, and wine consumption as predictors. Conclusions: When multiple geographic time series are combined as panel data, none of existent models could accommodate all sources of heterogeneity such that any type of panel model must employ some form of generalization. Different types of panel data models should thus be estimated to examine the robustness of findings. We also suggest cautious interpretation when beverage-specific volumes are used as predictors.

Ayers JW; Ribisl KM; Brownstein JS. Tracking the rise in popularity of electronic nicotine delivery systems (Electronic Cigarettes) using search query surveillance. American Journal of Preventive Medicine 40(4): 448-453, 2011. (43 refs.)

Background: Public interest in electronic nicotine delivery systems (ENDS) is undocumented. Purpose: By monitoring search queries, ENDS popularity and correlates of their popularity were assessed in Australia, Canada, the United Kingdom (UK), and the U.S. Methods: English-language Google searches conducted from January 2008 through September 2010 were compared to snus, nicotine replacement therapy (NRT), and Chantix (R) or Champix (R). Searches for each week were scaled to the highest weekly search proportion (100), with lower values indicating the relative search proportion compared to the highest-proportion week (e. g., 50=50% of the highest observed proportion). Analyses were performed in 2010. Results: From July 2008 through February 2010, ENDS searches increased in all nations studied except Australia, there an increase occurred more recently. By September 2010, ENDS searches were several-hundred-fold greater than searches for smoking alternatives in the UK and U.S., and were rivaling alternatives in Australia and Canada. Across nations, ENDS searches were highest in the U.S., followed by similar search intensity in Canada and the UK, with Australia having the fewest ENDS searches. Stronger tobacco control, created by clean indoor air laws, cigarette taxes, and anti-smoking populations, were associated with consistently higher levels of ENDS searches. Conclusions: The online popularity of ENDS has surpassed that of snus and NRTs, which have been on the market for far longer, and is quickly outpacing Chantix or Champix. In part, the association between ENDS's popularity and stronger tobacco control suggests ENDS are used to bypass, or quit in response to, smoking restrictions. Search query surveillance is a valuable, real-time, free, and public method to evaluate the diffusion of new health products. This method may be generalized to other behavioral, biological, informational, or psychological outcomes manifested on search engines.

Baghal T. The measurement of risk perceptions: The case of smoking. Journal of Risk Research 14(3): 351-364, 2011. (40 refs.)

Smoking is among the most debated areas of risk perception, with varying conclusions about people's understanding of the risks. Part of the debate has focused on the measures being employed to support such claims. However, studies have not been conducted to compare the best methods to measure the perceived risk. This research first discusses the use of such measures, including survey data from tobacco industry archives that have not previously appeared in publication. Then, using nationally representative survey data of youth and adults in the USA, verbal probability scales and numeric scales are compared. The relationships between these measures are first examined for logical consistency with one another. Additionally, the strength of the relationships with and modeling power of the behavior of interest, smoking, are analyzed. The results of difference of means tests, correlations and logistic regressions show that the numeric measures are inconsistent with logical semantic understanding, and more importantly, that vague quantifier scales show greater relationships and predictive power than numeric scales. Implications for survey design and further research are discussed.

Chavez PR; Nelson DE; Naimi TS; Brewer RD. Impact of a new gender-specific definition for binge drinking on prevalence estimates for women. American Journal of Preventive Medicine 40(4): 468-471, 2011. (19 refs.)

Background: Binge drinking accounts for more than half of the 79,000 deaths due to excessive drinking in the U.S. each year. In 2006, the Behavioral Risk Factor Surveillance System (BRFSS) lowered the threshold for defining binge drinking among women from >= 5 drinks to >= 4 drinks per occasion, in accordance with national recommendations. Purpose: To assess changes in binge-drinking prevalence among women. Methods: The relative and absolute change in binge drinking among U.S. adult women was assessed using pooled BRFSS data from the 2 years before (2004-2005) and after (2006-2007) the implementation of the new gender-specific definition. Analyses were conducted in 2008-2009. Results: Binge-drinking prevalence among women increased 2.6 percentage points (from 7.3% in 2004-2005 to 9.9% in 2006-2007), a 35.6% relative increase. The percentage of women who reported consuming exactly 4 drinks in 2006 (3.6%) was similar to the increase in the prevalence of binge drinking among women that was observed from 2005 to 2006 (absolute change=2.9 percentage points). Conclusions: The new gender-specific definition of binge drinking significantly increased the identification of women drinking at dangerous levels. The change in prevalence among women was primarily due to the change in the definition and not to actual changes in drinking behavior. The new gender-specific definition of binge drinking can increase the usefulness of this measure for public health surveillance and support the planning and implementation of effective prevention strategies (e.g., increasing alcohol excise taxes).

Erickson DJ; Toomey TL; Lenk KM; Kilian GR; Fabian LEA. Can we assess blood alcohol levels of attendees leaving professional sporting events? Alcoholism: Clinical and Experimental Research 35(4): 689-694, 2011. (15 refs.)

Background: We measured blood alcohol content (BAC) levels of attendees at professional sporting events and assessed the factors associated with higher BACs. Methods: We conducted BAC tests of 362 adult attendees following 13 baseball games and three football games. We ran multivariate analyses to obtain factors associated with the risk of having a higher BAC. Results: In this assessment, 40% of the participants had a positive BAC, ranging from 0.005 to 0.217. Those who reported tailgating before the event had 14 times the odds of having a BAC > 0.08 and those under age 35 had nearly 8 times the odds of having a BAC > 0.08 (both compared to a zero BAC). Attendees of Monday night football games were more likely to have positive BACs compared to attendees at all other games. Conclusions: We found that it is feasible to assess BAC levels of attendees at professional sporting events. Our findings suggest that a significant number of attendees at professional sporting events may have elevated BAC levels, particularly young adults and those who participated in tailgating activities. Further research using a representative sample is warranted to confirm the findings from this preliminary study.

Goldman MS; Greenbaum PE; Darkes J; Brandon KO; Del Boca FK. How many versus how much: 52 weeks of alcohol consumption in emerging adults. Psychology of Addictive Behaviors 25(1): 16-27, 2011. (36 refs.)

In previous research using timeline follow-back methods to closely monitor drinking and related variables over the first year of college (9 months), we showed that drinking varied considerably over time in accord with academic requirements and holidays. In a new community sample (N = 576) of emerging adults (18- and 19-year-olds who reported having begun drinking prior to recruitment), we used similar methods to compare drinking patterns in college and noncollege individuals over a full calendar year (including summer). To reduce the extreme distortion in computations of average drinking over restricted time spans (i.e., 1 week) that arise because large numbers of even regular drinkers may not consume any alcohol, we analyzed data using recently developed two-part latent growth curve modeling. This modeling distinguished consumption levels from numbers of individuals drinking in a given period. Results showed that drinking levels and patterns generally did not differ between college and noncollege drinkers, and that both groups responded similarly to even those contexts that may have seemed unique to one (i.e., spring break). We also showed that computation of drinking amounts without accounting for "zero drinkers" could seriously distort estimates of mean drinking on some occasions; for example, mean consumption in the total sample appeared to increase on Thanksgiving, whereas actual average consumption for those who were drinking diminished.

Grittner U; Gmel G; Ripatti S; Bloomfield K; Wicki M. Missing value imputation in longitudinal measures of alcohol consumption. International Journal of Methods in Psychiatric Research 20(1): 50-61, 2011. (44 refs.)

Attrition in longitudinal studies can lead to biased results. The study is motivated by the unexpected observation that alcohol consumption decreased despite increased availability, which may be due to sample attrition of heavy drinkers. Several imputation methods have been proposed, but rarely compared in longitudinal studies of alcohol consumption. The imputation of consumption level measurements is computationally particularly challenging due to alcohol consumption being a semi-continuous variable (dichotomous drinking status and continuous volume among drinkers), and the non-normality of data in the continuous part. Data come from a longitudinal study in Denmark with four waves (2003-2006) and 1771 individuals at baseline. Five techniques for missing data are compared: Last value carried forward (LVCF) was used as a single, and Hotdeck, Heckman modelling, multivariate imputation by chained equations (MICE), and a Bayesian approach as multiple imputation methods. Predictive mean matching was used to account for non-normality, where instead of imputing regression estimates, "real" observed values from similar cases are imputed. Methods were also compared by means of a simulated dataset. The simulation showed that the Bayesian approach yielded the most unbiased estimates for imputation. The finding of no increase in consumption levels despite a higher availability remained unaltered.

lBonar EE; Rosenberg H; Hoffmann E; Kraus SW; Kryszak E; Young KM et al. Measuring university students' self-efficacy to use drinking self-control strategies. Psychology of Addictive Behaviors 25(1): 155-161, 2011. (33 refs.)

Using a Web-based, self-administered questionnaire, we assessed 498 university-student drinkers' self-efficacy to use 31 different behavioral strategies to reduce excessive drinking in each of three different locations (bar, party, own dorm/apartment). Averaging all 31 items within each drinking situation to create a single scale score revealed high internal consistency reliabilities and moderate inter-item correlations. Testing the association of self-efficacy with drinking location, sex, and frequency of recent binge drinking, we found that respondents reported higher self-efficacy to use these strategies when drinking in their own dorm/apartment than when drinking in bars and at parties; women reported higher mean self-efficacy than men; and drinkers who engaged in 3-or-more binges in the previous 2 weeks reported lower self-efficacy than those who reported either 0 or 1-or-2 binges in the same time period. This questionnaire could be used to identify self-efficacy deficits among clients with drinking problems and as an outcome measure to assess the degree to which interventions influence reported confidence to use specific drinking-reduction strategies in high-risk drinking situations.

Lintonen TP; Vartiainen H; Aarnio J; Hakamaki S; Viitanen P; Wuolijoki T et al. Drug use among prisoners: By any definition, it's a big problem. Substance Use & Misuse 46(4): 440-451, 2011. (44 refs.)

According to several studies, the prevalence of drug use among prisoners is manyfold compared to general population. However, comparisons across studies are hampered by the use of a variety of mutually noncomparable methodologies. We report substance use among Finnish prisoners using three methods and analyze these differences. The material consisted of 610 Finnish prisoners in 2006 and represents all Finnish prisoners. The subjects participated in a comprehensive field study including a standardized psychiatric interview (SCID-I). Alcohol abuse/dependence was diagnosed in 68%% (SCID-I) and 72%% (ICD-10) among men and 70%% (both SCID-I and ICD-10) among women. Drug abuse/dependence was diagnosed in 62%% (SCID-I) and 69%% (ICD-10) among men and 64%% (SCID-I) and 70%% (ICD-10) among women prisoners. Interview data revealed that the majority had at least tried most substances. Both alcohol and drug abuse/dependence were vastly more common among Finnish prisoners than reported elsewhere. The DSM-IV-based SCID-I produced slightly lower prevalence estimates than an ICD-10 clinical examination, but overall SCID/ICD agreement was very good. It seems that physicians use information other than that captured by standardized structured clinical interview when placing a diagnosis. Nonclinical interview-based prevalence figures may overestimate harmful use of drugs unless known risk patterns of use (e.g., intravenous use) are specifically addressed.

Mubayi A; Greenwood P; Wang XH; Castillo-Chavez C; Gorman DM; Gruenewald P et al. Types of drinkers and drinking settings: An application of a mathematical model. Addiction 106(4): 749-758, 2011. (37 refs.)

Aims: US college drinking data and a simple population model of alcohol consumption are used to explore the impact of social and contextual parameters on the distribution of light, moderate and heavy drinkers. Light drinkers become moderate drinkers under social influence, moderate drinkers may change environments and become heavy drinkers. We estimate the drinking reproduction number, R-d, the average number of individual transitions from light to moderate drinking that result from the introduction of a moderate drinker in a population of light drinkers. Design and Settings: Ways of assessing and ranking progression of drinking risks and data-driven definitions of high- and low-risk drinking environments are introduced. Uncertainty and sensitivity analyses, via a novel statistical approach, are conducted to assess R-d variability and to analyze the role of context on drinking dynamics. Findings: Our estimates show R-d well above the critical value of 1. R-d estimates correlate positively with the proportion of time spent by moderate drinkers in high-risk drinking environments. R-d is most sensitive to variations in local social mixing contact rates within low-risk environments. The parameterized model with college data suggests that high residence times of moderate drinkers in low-risk environments maintain heavy drinking. Conclusions: With regard to alcohol consumption in US college students, drinking places, the connectivity (traffic) between drinking venues and the strength of socialization in local environments are important determinants in transitions between light, moderate and heavy drinking as well as in long-term prediction of the drinking dynamics.

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

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

Parsai MB; Castro FG; Marsiglia FF; Harthun ML; Valdez H. Using community based participatory research to create a culturally grounded intervention for parents and youth to prevent risky behaviors. Prevention Science 12(1): 34-47, 2011. (58 refs.)

The principal goal of this article is to contribute to the field of prevention science by providing a sequential description of how Community Based Participatory Research (CBPR) was used to develop a parent education curriculum aimed at preventing and decreasing adolescent drug use and risky sexual behaviors. CBPR principles are outlined, and information is provided on the unique contributions of researchers and community members who came together to develop this parent education program. Focus group information is presented as an exemplar to illustrate how thematic content from focus groups was used to inform the development of this parent education curriculum. A step by step description is given to facilitate replication of this process by other prevention researchers who are interested in applying this CBPR approach to develop a culturally responsive parent education intervention.

Powell C; Christie M; Bankart J; Bamber D; Unell I. Drug treatment outcomes in the criminal justice system: What non-self-report measures of outcome can tell us. Addiction Research & Theory 19(2): 148-160, 2011. (46 refs.)

Coerced drug treatment has become a common route for drug users to enter drug treatment in the UK and has been shown to be effective in reducing drug use and offending. This article presents the non-self-report measures of offending and drug use for one such treatment. The results support the findings of other studies in that those with lower offending rates prior to starting treatment and lower drug use during treatment show reduced offending following treatment commencement. More serious drug-using offenders showed limited changes in their offending following drug treatment. Possible explanations for this are discussed.

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.

Rudolph AE; Crawford ND; Latkin C; Heimer R; Benjamin EO; Jones KC et al. Subpopulations of illicit drug users reached by targeted street outreach and respondent-driven sampling strategies: Implications for research and public health practice. Annals of Epidemiology 21(4): 280-289, 2011. (29 refs.)

PURPOSE: To determine whether illicit drug users recruited through respondent-driven sampling (RDS) and targeted street outreach (TSO) differ by comparing two samples recruited concurrently with respect to sample selection and potential recruitment biases. METHODS: Two hundred seventeen (217) heroin, crack, and cocaine users aged 18-40 years were recruited through TSO in New York City (2006-2009). Forty-six RDS seeds were recruited similarly and concurrently, yielding a maximum of 14 recruitment waves and 357 peer recruits. Baseline questionnaires ascertained sociodemographic, drug use, and drug network characteristics. Descriptive statistics and log-binomial regression were used to compare RDS and TSO samples. RESULTS: RDS recruits were more likely to be male (prevalence ratio [PR]:1.28), Hispanic (PR:1.45), black (PR: 1.58), older (PR: 1.02), homeless (PR: 1.19), and crack users (PR: 1.37). RDS recruited fewer injectors (PR:0.35) and heroin users (PR:0.74). Among injectors, RDS recruits injected less frequently (PR:0.77) and were less likely to use Needle Exchange Programs (PR:0.35). CONCLUSION: These data suggest that RDS and TSO strategies reach different subgroups of drug users. Understanding the differing capabilities of each recruitment strategy will enable researchers and public health practitioners to select an appropriate recruitment tool for future research and public health practice.

Sanchez E; Villanueva RJ; Santonja FJ; Rubio M. Predicting cocaine consumption in Spain: A mathematical modelling approach. Drugs: Education, Prevention and Policy 18(2): 108-115, 2011. (28 refs.)

In this article, we analyse the evolution of cocaine consumption in Spain and we predict consumption trends over the next few years. Additionally, we simulate some scenarios which aim to reduce cocaine consumption in the future (sensitivity analysis). Assuming cocaine dependency is a socially transmitted epidemic disease, this leads us to propose an epidemiological-type mathematical model to study consumption evolution. Model sensitivity analysis allows us to design strategies and analyse their effects on cocaine consumption. The model predicts that 3.5% of the Spanish population will be habitual cocaine consumers by 2015. The simulations carried out suggest that cocaine consumption prevention strategies are the best policy to reduce the habitual consumer population. In this article, we show that epidemiological-type mathematical models can be a useful tool in the analysis of the repercussion of health policy proposals in the short-time future.

Simpson CA; Xie LL; Blum ER; Tucker JA. Agreement between prospective interactive voice response telephone reporting and structured recall reports of risk behaviors in rural substance users living with HIV/AIDS. Psychology of Addictive Behaviors 25(1): 185-190, 2011. (14 refs.)

Sound measurement of risk behaviors is essential to guide tailored risk reduction strategies as HIV infection patterns shift toward rural minorities. particularly in the southeastern United States where HIV disease remains highly stigmatized. Interactive Voice Response (IVR) systems appear to enhance reports of sensitive behaviors and can support telehealth applications to extend the reach of care in rural, underserved areas. This study evaluated the feasibility and data quality of an IVR telephone reporting system with rural substance users living with HIV/AIDS. Community-dwelling patients were recruited from a nonprofit HIV medical clinic in rural Alabama (N = 35 men, 19 women). Participants engaged in daily IVR reporting of substance use and sexual practices for up to 10 weeks. IVR reports were compared with retrospective Timeline Followback (TLFB) interview reports for the same period. IVR and TLFB reports showed good to excellent agreement for summary measures of alcohol consumption and sexual activity. Agreements for illicit drug use reports were less satisfactory. Reports of monetary spending on alcohol and drugs were significantly higher on the IVR. Most individuals showed good agreements for reports of day-to-day alcohol and drug use and sexual practices. The study established the utility of IVR assessment with rural, disadvantaged adults living with HIV/AIDS who are priority targets for risk reduction interventions.

van Nuijs ALN; Mougel JF; Tarcomnicu I; Bervoets L; Blust R; Jorens PG et al. Sewage epidemiology: A real-time approach to estimate the consumption of illicit drugs in Brussels, Belgium. Environment International 37(3): 612-621, 2011. (33 refs.)

The sewage epidemiology approach was applied to a one-year sampling campaign in the largest wastewater treatment plant (WWTP) in Belgium. The consumption of cocaine (COC), amphetamine (AMP). methylenedioxymethamphetamine (MDMA). methamphetamine (METH), methadone (MTD) and heroin (HER) was evaluated based on measured concentrations of the parent compound and/or metabolites in daily 24-hour composite influent wastewater samples. The inevitable back-calculations used in the sewage epidemiology approach were adapted to newly available information regarding the stability of the compounds in wastewater and the excretion pattern of illicit drugs. For COC, three different back-calculation approaches were evaluated. In addition, for the first time, efforts were made to calculate the number of inhabitants living in the catchment area of the WWTP in a real-time and dynamic way, based on concentrations of nitrogen, phosphorus and oxygen in the wastewater samples. Clear variations in the amount of inhabitants in the catchment area of the WWTP were observed. For COC, AMP and MDMA a significant higher weekend use was observed while for HER and MTD no significant daily variations could be found. METH consumption was negligible. Generally, the sewage epidemiology calculations were in agreement with official statistics. This manuscript shows that sewage epidemiology provides consistent and logical results and that it is a promising tool that can be used in addition to classical studies to estimate illicit drug use in populations. Therefore, efforts should be made to further optimize this approach in the future.

Baker TB; Mermelstein R; Collins LM; Piper ME; Jorenby DE; Smith SS et al. New methods for tobacco dependence treatment research. (review). Annals of Behavioral Medicine 41(2): 192- 207, 2011. (129 refs.)

Introduction: Despite advances in tobacco dependence treatment in the past two decades, progress has been inconsistent and slow. This paper reviews pervasive methodological issues that may contribute to the lack of timely progress in tobacco treatment science including the lack of a dynamic model or framework of the cessation process, inefficient study designs, and the use of distal outcome measures that poorly index treatment effects. The authors then present a phase-based cessation framework that partitions the cessation process into four discrete phases based on current theories of cessation and empirical data. These phases include: (1) Motivation, (2) Precessation, (3) Cessation, and (4) Maintenance. Discussion: Within this framework, it is possible to identify phase-specific challenges that a smoker would encounter while quitting smoking, intervention components that would address these phase-specific challenges, mechanisms via which such interventions would exert their effects, and optimal outcome measures linked to these phase-specific interventions. Investigation of phase-based interventions can be accelerated by using efficient study designs that would permit more timely development of an optimal smoking cessation treatment package.

Benneyan JC; Villapiano A; Katz N; Duffy M; Budman SH; Butler SF. Illustration of a statistical process control approach to regional prescription opioid abuse surveillance. Journal of Addiction Medicine 5(2): 99- 109, 2011. (35 refs.)

Objective: To investigate and illustrate the use of statistical process control (SPC) for prospective monitoring and detection of regional changes in prescription opioid abuse rates. Methods: A demonstration project was conducted by applying several types of SPC charts to Louisiana TANF (Temporary Assistance for Needy Families) applicant self-reported opioid illicit use data collected during 21 months. These charts were constructed and examined for signals of abuse rate changes both at the aggregate statewide level and for each state region (parish) separately. Results: SPC identified increases in opioid illicit use in 2 parishes and subsequent decreases in both regions. These fluctuations were not as apparent when the data were examined using traditional bar graphs and summary tables. The remaining parishes exhibited stable abuse rates with no statistically significant changes over time. Conclusions: These results illustrate proof of concept for monitoring prescription drug abuse regionally via statistical control charts and the potential of this approach for real-time prospective surveillance for abuse rate changes.

Bletzer KV; Yuan NP; Koss MP; Polacca M; Eaves ER; Goldman D. Taking humor seriously: Talking about drinking in Native American focus groups. Medical Anthropology 30(3): 295- 318, 2011. (75 refs.)

Focus groups provide a source of data that highlight community ideas on a topic of interest. How interview data will be utilized varies by project. With this in mind, we identify ways that focus group data from a particular population (Native American) articulate a health issue of individual tribal concern (alcohol consumption). Taking our analytic framework from linguistics, one of the four fields of inquiry in anthropology, we examine format ties and the performance of humor as stylistic features of tribal focus groups and illustrate how linguistic devices can be used in analyzing aspects of adolescent and adult drinking. Focus group data require systematic review and analysis to identify useful findings that can lead to inquiry points to initiate collaborative work with local experts before the data can be developed and configured into effective program initiatives.

Collins LM; Baker TB; Mermelstein RJ; Piper ME; Jorenby DE; Smith SS et al. The multiphase optimization strategy for engineering effective tobacco use interventions. Annals of Behavioral Medicine 41(2): 208- 226, 2011. (58 refs.)

The multiphase optimization strategy (MOST) is a new methodological approach for building, optimizing, and evaluating multicomponent interventions. Conceptually rooted in engineering, MOST emphasizes efficiency and careful management of resources to move intervention science forward steadily and incrementally. MOST can be used to guide the evaluation of research evidence, develop an optimal intervention (the best set of intervention components), and enhance the translation of research findings, particularly type II translation. This article uses an ongoing study to illustrate the application of MOST in the evaluation of diverse intervention components derived from the phase-based framework reviewed in the companion article by Baker et al. (Ann Behavioral Medicine, in press, 2011). The article also discusses considerations, challenges, and potential benefits associated with using MOST and similar principled approaches to improving intervention efficacy, effectiveness, and cost-effectiveness. The applicability of this methodology may extend beyond smoking cessation to the development of behavioral interventions for other chronic health challenges.

Cousijn J; Goudriaan AE; Wiers RW. Reaching out towards cannabis: Approach-bias in heavy cannabis users predicts changes in cannabis use. Addiction 106(9): 1667-1674, 2011. (54 refs.)

Aims Repeated drug exposure can lead to an approach-bias, i.e. the relatively automatically triggered tendencies to approach rather that avoid drug-related stimuli. Our main aim was to study this approach-bias in heavy cannabis users with the newly developed cannabis Approach Avoidance Task (cannabis-AAT) and to investigate the predictive relationship between an approach-bias for cannabis-related materials and levels of cannabis use, craving, and the course of cannabis use. Design, settings and participants Cross-sectional assessment and six-month follow-up in 32 heavy cannabis users and 39 non-using controls. Measurements Approach and avoidance action-tendencies towards cannabis and neutral images were assessed with the cannabis AAT. During the AAT, participants pulled or pushed a joystick in response to image orientation. To generate additional sense of approach or avoidance, pulling the joystick increased picture size while pushing decreased it. Craving was measured pre- and post-test with the multi-factorial Marijuana Craving Questionnaire (MCQ). Cannabis use frequencies and levels of dependence were measured at baseline and after a six-month follow-up. Findings Heavy cannabis users demonstrated an approach-bias for cannabis images, as compared to controls. The approach-bias predicted changes in cannabis use at six-month follow-up. The pre-test MCQ emotionality and expectancy factor were associated negatively with the approach-bias. No effects were found on levels of cannabis dependence. Conclusions: Heavy cannabis users with a strong approach-bias for cannabis are more likely to increase their cannabis use. This approach-bias could be used as a predictor of the course of cannabis use to identify individuals at risk from increasing cannabis use.

Damschroder LJ; Hagedorn HJ. A guiding framework and approach for implementation research in substance use disorders treatment. Psychology of Addictive Behaviors 25(2): 194-205, 2011. (80 refs.)

This paper introduces readers to the concepts of implementation science, implementation theory, and implementation frameworks and models. A wide range of models has been published in the literature related to implementation. The paper will present an overview of the Consolidated Framework for Implementation Research (CFIR), which is a comprehensive typology that unifies and consolidates the array of constructs that influence implementation from the perspective of these models. The CFIR is then used to evaluate implementation models used in studies of substance use disorder (SUD) treatments. Implementation research is scarce, with few prospective studies of theory-driven implementation. We assert that future research in SUD needs to meet three overarching objectives to promote wider implementation of evidence-based practices: (a) differentiation of core versus adaptable components of evidence-based interventions need; (b) development of methods to design implementation strategies, effectively adapted to the broad context; and (c) design and testing of predictive models to assess likelihood of effective implementation and prospects for sustainability while taking into account salient contextual factors. A recommended strategy for accomplishing these objectives is described.

Farabee D; Hawken A; Griffith P. Tracking and incentivizing substance abusers in longitudinal research: Results of a survey of National Institute on Drug Abuse-funded investigators. Journal of Addiction Medicine 5(2): 87- 91, 2011. (11 refs.)

Objectives: Increased recognition that addictive behaviors tend to be chronic and relapsing has led to a growing emphasis on longitudinal substance abuse research. The purpose of this study was to identify effective follow-up strategies used by National Institute on Drug Abuse-funded investigators who have conducted at least 1 study involving follow-up data collection from human subjects. Methods: A web-based survey was administered to a representative sample of National Institute on Drug Abuse-funded researchers (N = 153) with a history of conducting longitudinal research. Results: Reported study response rates were generally high, although 27% of the studies fell below the 80% benchmark. Face-to-face and telephone-based interviews commanded the largest subject payments - 2 to 3 times higher than compensation rates for collection of biologic samples. With regard to the presumed impact of low follow-up rates on the generalizability of study findings, one-third of investigators who compared baseline characteristics of those who did and did not participate in the follow-up found meaningful differences. Support was found for the hypothesis that follow-up rates and total compensation would be positively related, with the mean compensation amounts between studies achieving <80% follow-up rate versus those achieving rates >= 80%, revealing a statistically significant effect in the predicted direction. Conclusions: The majority of respondents reported difficulty in tracking and locating subjects, and study respondents often proved to be quite different from nonrespondents. Incentives improved follow-up rates to a point, although the relationship was not linear. Efforts to improve follow-up rates may be better spent on addressing tracking and locating logistics rather than on strategies to compel participation once the subject has been located.

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

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

Hicks BM; Schalet BD; Malone SM; Iacono WG; McGue M. Psychometric and genetic architecture of substance use disorder and behavioral disinhibition measures for gene association studies. Behavior Genetics 41(4): 459-475, 2011. (85 refs.)

Using large twin, family, and adoption studies conducted at the Minnesota Center for Twin and Family Research, we describe our efforts to develop measures of substance use disorder (SUD) related phenotypes for targets in genome wide association analyses. Beginning with a diverse set of relatively narrow facet-level measures, we identified 5 constructs of intermediate complexity: nicotine, alcohol consumption, alcohol dependence, illicit drug, and behavioral disinhibition. The 5 constructs were moderately correlated (mean r = .57) reflecting a general externalizing liability to substance abuse and antisocial behavior. Analyses of the twin and adoption data revealed that this general externalizing liability accounted for much of the genetic risk in each of the intermediate-level constructs, though each also exhibited significant unique genetic and environmental risk. Additional analyses revealed substantial effects for age and sex, significant shared environmental effects, and that the mechanism of these shared environmental effects operates via siblings rather than parents. Our results provide a foundation for genome wide association analyses to detect risk alleles for SUDs as well as novel insights into genetic and environmental risk for SUDs.

Hughes JR; Peters EN; Naud S. Effectiveness of over-the-counter nicotine replacement therapy: A qualitative review of nonrandomized trials. (review). Nicotine & Tobacco Research 13(7): 512-522, 2011. (43 refs.)

Randomized trials conducted in over-the-counter (OTC) settings have shown that nicotine replacement therapy (NRT) is effective. This paper reviews nonrandomized tests of the effectiveness of OTC NRT. Literature search via computer and other methods located (a) retrospective cohort studies of users versus nonusers of OTC NRT and (b) studies of quit rates before versus after NRT went OTC or before versus after NRT was given free to quitline callers. The methods were too heterogeneous to allow meta-analysis. The results were similar for cohort and pre- versus post-studies. Most of the studies found numerically greater quitting among NRT users than nonusers. Often when NRT was not found effective, other assumed effective treatments (e.g., phone counseling) were also not found effective, suggesting biased or insensitive study methods. Only about half of the studies found statistically greater quitting among NRT users, and the most rigorous studies did not find greater quitting among users. Many studies found selection bias, for example, NRT users are more dependent smokers. Some lines of evidence appear to confirm the effectiveness of OTC NRT, but others do not. We believe further secondary analyses using nonrandomized comparisons are unlikely to resolve this issue due to sensitivity, specificity, and selection bias problems.

Hunt K; Sweeting H; Sargent J; Lewars H; Young R; West P. Is there an association between seeing incidents of alcohol or drug use in films and young Scottish adults' own alcohol or drug use? A cross sectional study. BMC Public Health 11(e-article 259), 2011. (48 refs.)

Background: As the promotion of alcohol and tobacco to young people through direct advertising has become increasingly restricted, there has been greater interest in whether images of certain behaviours in films are associated with uptake of those behaviours in young people. Associations have been reported between exposure to smoking images in films and smoking initiation, and between exposure to film alcohol images and initiation of alcohol consumption, in younger adolescents in the USA and Germany. To date no studies have reported on film images of recreational drug use and young people's own drug use. Methods: Cross sectional multivariable logistic regression analysis of data collected at age 19 (2002-4) from a cohort of young people (502 boys, 500 girls) previously surveyed at ages 11 (in 1994-5), 13 and 15 in schools in the West of Scotland. Outcome measures at age 19 were: exceeding the 'sensible drinking' guidelines ('heavy drinkers') and binge drinking (based on alcohol consumption reported in last week), and ever use of cannabis and of 'hard' drugs. The principle predictor variables were an estimate of exposure to images of alcohol, and of drug use, in films, controlling for factors related to the uptake of substance use in young people. Results: A third of these young adults (33%) were classed as 'heavy drinkers' and half (47%) as 'binge drinkers' on the basis of their previous week's consumption. Over half (56%) reported ever use of cannabis and 13% ever use of one or more of the 'hard' drugs listed. There were linear trends in the percentage of heavy drinkers (p =.018) and binge drinkers (p = 0.012) by film alcohol exposure quartiles, and for ever use of cannabis by film drug exposure (p =.000), and for ever use of 'hard' drugs (p =.033). The odds ratios for heavy drinking (1.56, 95% Cl 1.06-2.29 comparing highest with lowest quartile of film alcohol exposure) and binge drinking (1.59, 95% Cl 1.10-2.30) were attenuated by adjustment for gender, social class, family background (parental structure, parental care and parental control), attitudes to risk-taking and rule-breaking, and qualifications (OR heavy drinking 1.42, 95% Cl 0.95-2.13 and binge drinking 1.49, 95% Cl 1.01-2.19), and further so when adjusting for friends' drinking status (when the odds ratios were no longer significant). A similar pattern was seen for ever use of cannabis and 'hard' drugs (unadjusted OR 1.80, 95% Cl 1.24-2.62 and 1.57, 95% Cl 0.91-2.69 respectively, 'fully' adjusted OR 1.41 (0.90-2.22 and 1.28 (0.662.47) respectively). Conclusions: Despite some limitations, which are discussed, these cross-sectional results add to a body of work which suggests that it is important to design good longitudinal studies which can determine whether exposure to images of potentially health-damaging behaviours lead to uptake of these behaviours during adolescence and early adulthood, and to examine factors that might mediate this relationship.

Mariani JJ; Cheng WY; Bisaga A; Sullivan M; Carpenter K; Nunes EV et al. Comparison of clinical trial recruitment populations: Treatment-seeking characteristics of opioid-, cocaine-, and cannabis-using participants. Journal of Substance Abuse Treatment 40(4): 426- 430, 2011. (6 refs.)

This study examined the treatment history and intention to seek treatment among 489 individuals interested in substance use disorder clinical trial participation. Opioid and cocaine users were more likely than cannabis users to report having received treatment for substance use in the past and more likely than cannabis users to report planning to seek treatment for substance use before exposure to recruitment advertising. Free cost was the aspect of clinical trial participation that most influenced the decision to make an intake evaluation appointment for opioid-dependent patients as compared with cocaine- and cannabis-dependent participants, and the availability of individual psychotherapy most influenced those who were cannabis dependent. Cannabis-dependent individuals evaluated for clinical trial participation reported that recruitment advertising was an important factor in leading them to seek treatment. These results have implications for clinical trial recruitment and public health efforts directed at encouraging cannabis-dependent individuals to seek treatment.

Morrens M; Dewilde B; Sabbe B; Dom G; De Cuyper R; Moggi F. Treatment outcomes of an integrated residential programme for patients with schizophrenia and substance use disorder. European Addiction Research 17(3): 154- 163, 2011. (51 refs.)

Background: About half of all schizophrenic patients have a co-occurring substance use disorder, leading to poorer social and functional outcomes than obtained in non-abusing patients. To improve outcomes, integrated treatments have been designed that address the two conditions simultaneously. Results are, however, conflicting because the available effect studies are hampered by various methodological issues, among which are heterogeneous patient samples. Methods: In this comparative study, two well-described patient samples diagnosed with schizophrenia and co-morbid substance abuse disorders either received an integrated treatment (IDDT) or treatment as usual (TAU). Results: Patients in the IDDT condition showed significant reductions in illicit drug and alcohol use, improvements on all psychiatric symptom domains, reported higher quality of life and improved on social and community functioning. In contrast, patients' improvements in the TAU group were moderate and limited to a few substance use and psychiatric outcomes. The TAU group had significantly higher dropout rates 6 and 12 months after baseline, suggesting that the IDDT programme was more successful in committing patients. Conclusions: Our results suggest that an integrated approach to schizophrenic patients and co-morbid substance use disorders is superior to standard treatment and may be considered as the treatment of choice for this patient group.

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.

Roemer E; Carchman RA. Limitations of cigarette machine smoking regimens. Toxicology Letters 203(1): 20-27, 2011. (67 refs.)

There is an ongoing debate about the 'usefulness' of the standard machine smoking regimen for cigarettes defined by the US Federal Trade Commission (FTC) and adopted in principal by the International Organization for Standardization (ISO). More intense smoking regimens result in much higher smoke yields, and these higher yields have been suggested to be much closer to human smoke uptake. However, it appears that more intense smoking regimens are less efficient in detecting possible differences in the yield of toxicants. Intense smoking regimens reproducibly decrease the concentration of toxicants in the smoke per unit mass of total particulate matter, tar, or nicotine, most likely as a result of a more complete combustion. The toxicant concentration reaches the same plateau for different cigarette types under the intense smoking regimens. As such, differences in toxicant concentrations due to product changes, which are observable under ISO or FTC conditions, may disappear under intensive smoking regimens. Intense machine smoking regimens might be used for regulatory compliance and consumer information. However, when evaluating the toxicological impact of cigarette product changes, especially to avoid increases in toxicity, they should not be used as a standard (or at least not as the only standard). The type of smoking regimen has to be carefully considered and aligned to the underlying question. Depending on the question a combination of the reviewed regimens or even other approaches might be appropriate.

Rudolph AE; Latkin C; Crawford ND; Jones KC; Fuller CM. Does respondent driven sampling alter the social network composition and health-seeking behaviors of illicit drug users followed prospectively? PLoS ONE 6(5): e19615, 2011. (56 refs.)

Respondent driven sampling (RDS) was originally developed to sample and provide peer education to injection drug users at risk for HIV. Based on the premise that drug users' social networks were maintained through sharing rituals, this peer-driven approach to disseminate educational information and reduce risk behaviors capitalizes and expands upon the norms that sustain these relationships. Compared with traditional outreach interventions, peer-driven interventions produce greater reductions in HIV risk behaviors and adoption of safer behaviors over time, however, control and intervention groups are not similarly recruited. As peer-recruitment may alter risk networks and individual risk behaviors over time, such comparison studies are unable to isolate the effect of a peer-delivered intervention. This analysis examines whether RDS recruitment (without an intervention) is associated with changes in health-seeking behaviors and network composition over 6 months. New York City drug users (N = 618) were recruited using targeted street outreach (TSO) and RDS (2006-2009). 329 non-injectors (RDS = 237; TSO = 92) completed baseline and 6-month surveys ascertaining demographic, drug use, and network characteristics. Chi-square and t-tests compared RDS- and TSO-recruited participants on changes in HIV testing and drug treatment utilization and in the proportion of drug using, sex, incarcerated and social support networks over the follow-up period. The sample was 66% male, 24% Hispanic, 69% black, 62% homeless, and the median age was 35. At baseline, the median network size was 3, 86% used crack, 70% used cocaine, 40% used heroin, and in the past 6 months 72% were tested for HIV and 46% were enrolled in drug treatment. There were no significant differences by recruitment strategy with respect to changes in health-seeking behaviors or network composition over 6 months. These findings suggest no association between RDS recruitment and changes in network composition or HIV risk, which supports prior findings from prospective HIV behavioral surveillance and intervention studies.

Sartor CE; Bucholz KK; Nelson EC; Madden PAF; Lynskey MT; Heath AC. Reporting bias in the association between age at first alcohol use and heavy episodic drinking. Alcoholism: Clinical and Experimental Research 35(8): 1418-1425, 2011. (50 refs.)

Background: Given the weight placed on retrospective reports of age at first drink in studies of later drinking-related outcomes, it is critical that its reliability be established and possible sources of systematic bias be identified. The overall aim of the current study is to explore the possibility that the estimated magnitude of association between early age at first drink and problem alcohol use may be inflated in studies using retrospectively reported age at alcohol use onset. Methods: The sample was comprised of 1,716 participants in the Missouri Adolescent Female Twin Study who reported an age at first drink in at least 2 waves of data collection ( an average of 4 years apart). Difference in reported age at first drink at Time 2 versus Time 1 was categorized as 2 or more years younger, within 1 year (consistent), or 2 or more years older. The strength of the association between age at first drink and peak frequency of heavy episodic drinking (HED) at Time 1 was compared with that at Time 2. The association between reporting pattern and peak frequency of HED was also examined. Results: A strong association between age at first drink and HED was found for both reports, but it was significantly greater at Time 2. Just over one-third of participants had a 2 year or greater difference in reported age at first drink. The majority of inconsistent reporters gave an older age at Time 2 and individuals with this pattern of reporting engaged in HED less frequently than consistent reporters. Conclusions: The low rate of HED in individuals reporting an older age at first drink at Time 2 suggests that the upward shift in reported age at first drink among early initiates is most pronounced for light drinkers. Heavy drinkers may therefore be overrepresented among early onset users in retrospective studies, leading to inflated estimates of the association between early age at initiation and alcohol misuse.

Thombs D; Rossheim M; Barnett TE; Weiler RM; Moorhouse MD; Coleman BN. Is there a misplaced focus on AmED? Associations between caffeine mixers and bar patron intoxication. Drug and Alcohol Dependence 116(1-3): 31-36, 2011. (19 refs.)

Background: Previous research on alcohol mixed with energy drinks (AmED) suffers from measurement problems. Missing from the research literature are studies that assess caffeine-alcohol co-ingestion in natural drinking environments. Methods: This field study collected data in a U.S. college bar district from 328 randomly selected patrons. Anonymous data were obtained from face-to-face interviews and self-administered surveys, and from breath tests. Results: Cola-caffeinated alcoholic beverage consumers left bars in a more highly intoxicated state than those who consumed alcohol only. There was no significant difference between the intoxication level of the AmED group and the cola-caffeinated alcoholic beverage group. Results. from a multivariate regression model indicated that quantity of caffeinated alcoholic beverage consumption had a significant, positive association with bar patron intoxication after adjusting for potential confounders. Conclusions: Findings indicate that caffeine may have a dose-dependent relationship with alcohol intoxication in the bar/nightclub setting. In addition, results revealed that cola-caffeinated alcoholic drinks may pose similar levels of risk to bar patrons as those associated with AmED beverage consumption. Product labeling requirements about alcohol risks may need to be extended not only to energy drinks, but to caffeinated soft drinks as well.

Uddin M; Maskrey V; Holland R. A study to validate a self-reported version of the ONS drug dependence questionnaire. Journal of Substance Use 16(4): 273-281, 2011. (15 refs.)

Aim: A prospective study to establish the reliability of a self-completion version of the Office for National Statistics (ONS) questionnaire for assessing drug dependence of substance misuse clients. Method: A total of 47 treatment seeking opioid-dependent clients completed the self-complete version of the ONS questionnaire (ONS-sc) followed by the interviewer-administered ONS questionnaire (ONS-ia) at a single clinic appointment. Scores for four Class A drugs (heroin, methadone, speed and crack/cocaine) from both formats were compared. Results: The observed agreement was 87% or more and Cohen's kappa was 0.7 (p < 0.001) or more for all four Class A drugs. Sensitivity for each Class A drugs was 56% or higher and specificity was 87% or higher. Sensitivity for severe heroin dependency was 98% (CI 89-100%). There was a 100% correlation between the ONS-sc and positive urine analysis for heroin use. However, methadone and crack/cocaine drug use appeared under reported. Conclusion: ONS-sc is a feasible, practical and time-saving alternative to a detailed interview on drug dependence. Further research with a larger sample size and non-opiate-dependent clients are needed, as this could prove a useful tool for monitoring clients in everyday practice, or for survey purposes where interviews are impractical.

Vento AE; Schifano F; Corkery JM; Pompili M; Innamorati M; Girardi P; Ghodse H. Suicide verdicts as opposed to accidental deaths in substance-related fatalities (UK, 2001-2007). (review). Progress In Neuro-Psychopharmacology & Biological Psychiatry 35(5, special issue): 1279-1283, 2011. (26 refs.)

Background: Substance-related deaths account for a great number of suicides. Aim: To investigate levels and characteristics of suicide verdicts, as opposed to accidental deaths, in substance misusers. Methods: Psychological autopsy study of cases from the UK National Programme on Substance Abuse Deaths (np-SAD) during the period 2001-2007. Results: Between January 2001 and December 2007, 2108 suicides were reported to the np-SAD. Typical suicide victims were White and older than 50 (respectively 95% and 41% of cases). Medications, especially antidepressants (44%), were prescribed to 87% of victims. Significantly fewer suicide victims than controls presented positive blood toxicological results for illicit drugs (namely: cocaine, heroin, amphetamines, ecstasy-type drugs, cannabis, and GHB/GBL) and alcohol. Conclusions: Suicide prevention programmes should devote specific attention to deaths among substance misusers who are at high risk of fatal intentional self-harm. Specific characteristics distinguish those at risk; caregivers should be better educated as to what these factors are. Limitations of the current study included lack of provision of comprehensive information relating to the victims' psychosocial variables. Furthermore, no differentiation between different classes of antidepressants in terms of involvement in suicide was here provided.