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CORK Bibliography: Research Methodology

90 citations. September 2011 to present

Prepared: September 2012

Agrawal A; Freedman ND; Cheng YC; Lin P; Shaffer JR; Sun Q et al. Measuring alcohol consumption for genomic meta-analyses of alcohol intake: Opportunities and challenges. American Journal of Clinical Nutrition 95(3): 539-547, 2012. (74 refs.)

Whereas moderate drinking may have health benefits, excessive alcohol consumption causes many important acute and chronic diseases and is the third leading contributor to preventable death in the United States. Twin studies suggest that alcohol-consumption patterns are heritable (50%); however, multiple genetic variants of modest effect size are likely to contribute to this heritable variation. Genome-wide association studies provide a tool for discovering genetic loci that contribute to variations in alcohol consumption. Opportunities exist to identify susceptibility loci with modest effect by meta-analyzing together multiple studies. However, existing studies assessed many different aspects of alcohol use, such as typical compared with heavy drinking, and these different assessments can be difficult to reconcile. In addition, many studies lack the ability to distinguish between lifetime and recent abstention or to assess the pattern of drinking during the week, and a variety of such concerns surround the appropriateness of developing a common summary measure of alcohol intake. Combining such measures of alcohol intake can cause heterogeneity and exposure misclassification, cause a reduction in power, and affect the magnitude of genetic association signals. In this review, we discuss the challenges associated with harmonizing alcohol-consumption data from studies with widely different assessment instruments, with a particular focus on large-scale genetic studies.

Andrews JO; Newman SD; Heath J; Williams LB; Tingen MS. Community-based participatory research and smoking cessation interventions: A review of the evidence. (review). Nursing Clinics of North America 47(1): 81-96, 2012. (47 refs.)

This article reviews the evidence of the use of community-based participatory research (CBPR) and smoking cessation interventions. An overview of CBPR is provided, along with a description of the search methods and quality scoring. Research questions are explored to determine if CBPR improves the quality of research methods and community involvement in cessation intervention studies and cessation outcomes when using CBPR approaches. Results of the review are provided along with a comprehensive table summarizing all the included studies. Strengths and challenges of the CBPR approach are presented with recommendations for future research.

Anton RF; Litten RZ; Falk DE; Palumbo JM; Bartus RT; Robinson RL et al. The Alcohol Clinical Trials Initiative (ACTIVE): Purpose and goals for assessing important and salient issues for medications development in alcohol use disorders. Neuropsychopharmacology 37(2): 402-411, 2012. (25 refs.)

Although progress has been made in the treatment of alcohol use disorders, more effective treatments are needed. In the last 15 years, several medications have been approved for use in alcohol dependence but have only limited effectiveness and clinical acceptance. While academics have developed some 'standards' for the performance of clinical trials for alcohol dependence, they vary considerably, in the type of populations to be studied, the length of trials, salient outcome measures, and data analyses to be used (especially in the treatment of missing data). This variability impedes the commercial development of medications to treat alcohol dependence. Using a model similar to that used to develop an expert consensus for medications to improve cognitive aspects of schizophrenia (MATRICS) and in the treatment of pain (IMMPACT), a workgroup has been formed under the auspices of ACNP, known as the ACTIVE (Alcohol Clinical Trials Initiative) group, to evaluate data from completed clinical trials to develop a consensus on key issues in the conduct of clinical trials in alcohol dependence. ACTIVE consists of academic experts, industry representatives, and staff from the Food and Drug Administration, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. This paper describes the rationale behind the effort, its history and organization, and initial key questions that have been identified as the primary focus of the workgroup. Future papers will focus on knowledge gained from the re-analysis of completed trials and provide consensus opinions regarding the performance of clinical trials that might be undertaken in the future.

Ataya AF; Adams S; Mullings E; Cooper RM; Attwood AS; Munafo MR. Internal reliability of measures of substance-related cognitive bias. Drug and Alcohol Dependence 121(1-2): 148-151, 2012. (13 refs.)

Aims: There is growing interest in cognitive biases related to substance use, but evidence from the anxiety literature suggests that tasks commonly used to assess these may suffer from low internal reliability. We examined the internal reliability of the visual probe and modified Stroop tasks. Design: Secondary analysis of visual probe and modified Stroop task data collected across seven independent studies. Setting: Human laboratory study. Participants: Healthy volunteers (n = 408 across seven independent studies) recruited from the general population on the basis of alcohol or tobacco use. Measurements: Visual probe and modified Stroop task measures of substance-related cognitive bias. Findings: Measures of cognitive bias for substance-related cues, as assayed by the visual probe and the modified Stroop tasks, may not be reliable. In particular, the visual probe task showed poor internal reliability, as did unblocked versions of the modified Stroop task. Conclusions: The modified Stroop task is preferable to the visual probe task as a measure of substance-related cognitive bias, on the basis of its psychometric properties. Studies using cognitive bias tasks should not assume they are reliable, and should routinely report reliability estimates where possible.

Bakker R; Kruithof C; Steegers EAP; Tiemeier H; Mackenbach JP; Hofman A et al. Assessment of maternal smoking status during pregnancy and the associations with neonatal outcomes. Nicotine & Tobacco Research 13(12): 1250-1256, 2011. (22 refs.)

Single assessment of smoking during pregnancy may lead to misclassification due to underreporting or failure of smoking cessation. We examined the percentage of mothers who were misclassified in smoking status based on single assessment, as compared with repeated assessment, and whether this misclassification leads to altered effect estimates for the associations between maternal smoking and neonatal complications. This study was performed in 5,389 mothers participating in a prospective population-based cohort study in the Netherlands. Smoking status was assessed 3 times during pregnancy using questionnaires. Information on birth weight and neonatal complications was obtained from hospital records. For categorizing mothers per smoking status, Cohen's Kappa coefficient was .86 (p < .001) between single and repeated assessments. Of all mothers who reported nonsmoking or first trimester-only smoking in early pregnancy, 1.7% (70 of 4,141) and 33.7% (217 of 643), respectively, were reclassified to continued smoking based on repeated assessment. Younger, shorter lower educated mothers who had non-European ethnicity experienced more stress, consumed more alcohol, and did not use folic acid supplements had higher risk of underreporting their smoking status or failure of smoking cessation. Marginal differences were found on the associations of maternal smoking with neonatal complications between single or repeated assessment. Our results suggest that single assessment of smoking during pregnancy leads to underestimation of the continued smoking prevalence, especially among mothers who reported quitting smoking in first trimester. However, this underestimation does not materially change the effect estimates for the associations between maternal smoking and neonatal outcomes.

Barratt MJ. The efficacy of interviewing young drug users through online chat. Drug and Alcohol Review 31(4): 566-572, 2012. (30 refs.)

Introduction and Aims. Despite the fact that most young people who use party drugs also use the Internet, accounts of drugs research involving qualitative interviewing using real-time instant messaging or online chat are yet to be published. This paper assesses the efficacy of conducting qualitative research interviews with young party drug users through instant messaging. Design and Methods. In 2007-2008, 837 Australian residents who reported recent use of psychostimulants and/or hallucinogens and participated in online drug discussion completed a web survey and a subsample of 27 completed online interviews (median age 21, range 1737, 59% male). Results. Experienced drug users were more likely to volunteer to be interviewed than novices. The time and space flexibility provided by the online interviews was convenient; however, interviews were more prone to interruption. Establishing legitimacy, personal disclosure, appropriate linguistic style and humour facilitated the development of rapport and enabled the production of more detailed and in-depth data. These strategies were not successful in all cases and when unsuccessful, interviewees were more easily able to exit the interview by choosing not to respond. Discussion and Conclusions. Young drug users already using the Internet to chat about drugs find online interviewing an acceptable and convenient way to contribute to research. With adequate preparation to develop technical and cultural competencies, online interviewing offers an effective way of engaging with young people that is worthy of consideration by researchers in the alcohol and other drug field.

Billieux J; Khazaal Y; Oliveira S; de Timary P; Edel Y; Zebouni F et al. The Geneva Appetitive Alcohol Pictures (GAAP): Development and preliminary validation. European Addiction Research 17(5): 225-230, 2011. (21 refs.)

This study describes a new database of alcohol-related pictures: The Geneva Appetitive Alcohol Pictures (GAAP). 60 alcohol-related pictures (beverages, drinking-related behaviors, alcohol-related cues) were presented to 101 participants (ranging from social drinkers to problem drinkers), who assessed them according to the classic emotional pictures validation provided by the International Affective Picture System (Center for the Study of Emotion and Attention (CSEA-NIMH), 2002). Participants were also screened with the Alcohol Use Disorders Identification Test. Normative ratings for valence, arousal and dominance of the pictures are provided separately for problem/risky users (n = 49) and non-risky drinkers (n = 52). The GAAP is a normative database that provides a large number of stimuli for investigators who conduct research on alcohol.

Blosnich JR; Horn K. Associations of discrimination and violence with smoking among emerging adults: Differences by gender and sexual orientation. Nicotine & Tobacco Research 13(12): 1284-1295, 2011. (80 refs.)

Lesbian, gay, and bisexual (i.e., sexual minority) populations have higher smoking prevalence than their heterosexual peers, but there is a lack of empirical study into why such disparities exist. This secondary analysis of data sought to examine associations of discrimination and violence victimization with cigarette smoking within sexual orientation groups. Data from the Fall 2008 and Spring 2009 National College Health Assessments were truncated to respondents of 18-24 years of age (n = 92,470). Since heterosexuals comprised over 90% of respondents, a random 5% subsample of heterosexuals was drawn, creating a total analytic sample of 11,046. Smoking status (i.e., never-, ever-, and current smoker) was regressed on general (e.g., not sexual orientation-specific) measures of past-year victimization and discrimination. To examine within-group differences, two sets of multivariate ordered logistic regression analyses were conducted: one set of models stratified by sexual orientation and another set stratified by gender-by-sexual-orientation groups. Sexual minorities indicated more experiences of violence victimization and discrimination when compared with their heterosexual counterparts and had nearly twice the current smoking prevalence of heterosexuals. After adjusting for age and race, lesbians/gays who were in physical fights or were physically assaulted had higher proportional odds of being current smokers when compared with their lesbian/gay counterparts who did not experience those stressors. When possible, lesbian/gay and bisexual groups should be analyzed separately, as analyses revealed that bisexuals had a higher risk profile than lesbians/gays. Further research is needed with more nuanced measures of smoking (e.g., intensity), as well as examining if victimization may interact with smoking cessation.

Bogenschutz MP; Donovan DM; Adinoff B; Crandall C; Forcehimes AA; Lindblad R et al. Design of National Institute on Drug Abuse CTN Protocol 0047: Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED). American Journal of Drug and Alcohol Abuse 37(5): 417-425, 2011. (53 refs.)

Background: Medical settings such as emergency departments (EDs) present an opportunity to identify and provide services for individuals with substance use problems who might otherwise never receive any form of assessment, referral, or intervention. Although screening, brief intervention, and referral to treatment models have been extensively studied and are considered effective for individuals with alcohol problems presenting in EDs and other medical settings, the efficacy of such interventions has not been established for drug users presenting in EDs. Objectives: This article describes the design of a National Institute on Drug Abuse Clinical Trials Network protocol testing the efficacy of an screening, brief intervention, and referral to treatment model in medical EDs, highlighting considerations that are pertinent to the design of other studies targeting substance use behaviors in medical treatment settings. Methods: The protocol is described, and critical design decisions are discussed. Results: Design challenges included defining treatment conditions, study population, and site characteristics; developing the screening process; choosing the primary outcome; balancing brevity and comprehensiveness of assessment; and selecting the strategy for statistical analysis. Conclusion: Many of the issues arising in the design of this study will be relevant to future studies of interventions for addictions in medical settings. Scientific Significance: Optimal trial design is critical to determining how best to integrate substance abuse interventions into medical care.

Breen C; Shakeshaft A; Slade T.; D'Este C; Mattick R. Alcohol-Related Crime: Finding a Suitable Measure for Community-level Analyses using Routinely Collected Data. NDARC Technical Report no. 317. Sydney: National Drug and Alcohol Research Centre, 2011

Aims: Alcohol misuse causes substantial public health harm. Strategies have been proposed to reduce alcohol-related harm at the community-level, which requires suitable community-level measures to monitor changes over time and between communities. For alcohol-related crime, certain offences occurring at certain times that often involve alcohol have been used as a proxy measure. There is currently no adequate empirical rationale for identifying the most reliable proxy measure of alcohol-related crime. This report examines the suitability of three measures of alcohol-related crime. Methods: Police records of reported incidents from twenty communities in NSW, Australia, that were involved in a community-wide randomised controlled trial to reduce alcohol-related harm were examined. Three measures were derived: i.) serious assaults only, ii) a broader range of assaults and iii) assaults and public nuisance offences. Hierarchical linear models (HLM) account for various sources of variability and correlation of longitudinal data and were used to determine reliability estimates for model parameters and in the calculation of the intraclass correlations (ICC). Results: The broadest measure of alcohol-related crime (assaults and public nuisance offences) was found to have the highest reliability estimates between communities at a given time point and over time. This measure also had the highest ICC, indicating relatively more variability in the measure can be attributed to differences between towns rather than changes over time. Conclusions: The HLM approach gives more accurate reliability estimates than could be assessed using a repeated measures ANOVA. For the communities from where these data derive, the broadest measure is the most reliable for comparing rates of alcohol-related crime between them, and for assessing intervention effects over time.

Public Domain

Burlew AK; Weekes JC; Montgomery L; Feaster DJ; Robbins MS; Rosa CL et al. Conducting research with racial/ethnic minorities: Methodological lessons from the National Institute on Drug Abuse Clinical Trials Network. American Journal of Drug and Alcohol Abuse 37(5): 324-332, 2011. (62 refs.)

Background: Multiple studies in the National Institute on Drug Abuse Clinical Trials Network (CTN) demonstrate strategies for conducting effective substance abuse treatment research with racial/ethnic minorities (REMs). Objectives: The objectives of this article are to describe lessons learned within the CTN to (1) enhance recruitment, retention, and other outcomes; (2) assess measurement equivalence; and (3) use data analytic plans that yield more information. Method: This article includes background information and examples from multiple CTN studies on inclusion, measurement, and data analysis. Results and Conclusions: Seven recommendations are included for conducting more effective research on REMs.

Burt RD; Thiede H. Evaluating consistency in repeat surveys of injection drug users recruited by respondent-driven sampling in the Seattle area: Results from the NHBS-IDU1 and NHBS-IDU2 Surveys. Annals of Epidemiology 22(5): 354-363, 2012. (29 refs.)

Purpose: We compared data from two respondent-driven sampling (RDS) surveys of Seattle-area injection drug users (IDU) to evaluate consistency in repeat RDS surveys. Methods: The RDS-adjusted estimates for 16 key sociodemographic, drug-related, sexual behavior, and HIV- and hepatitis C virus-related variables were compared in the 2005 and the 2009 National HIV Behavioral Surveillance system surveys (NHBS-IDU1 and NHBS-IDU2). Time trends that might influence the comparisons were assessed by the use of data from reported HIV cases in IDU, surveys of needle exchange users, and two previous IDU studies. Results: NHBS-IDU2 participants were more likely than NHBS-IDU1 participants to report older age, heroin as their primary injection drug, male-to-male sex, unprotected sex with a partner of nonconcordant HIV status, and to self-report HIV-positive status. NHBS-IDU2 participants were less likely to report residence in downtown Seattle, amphetamine injection, and a recent HIV test. Time trends among Seattle-area IDU in age, male-to-male sex, and HIV testing could have influenced these differences. Conclusions: The number and magnitude of the estimated differences between the two RDS surveys appeared to describe materially different populations. This could be a result of changes in the characteristics of Seattle-area IDU over time, of accessing differing subpopulations of Seattle IDU, or of high variability in RDS measurements.

Celio MA; Vetter-O'Hagen CS; Lisman SA; Johansen GE; Spear LP. Integrating field methodology and web-based data collection to assess the reliability of the Alcohol Use Disorders Identification Test (AUDIT). Drug and Alcohol Dependence 119(1-2): 142-144, 2011. (15 refs.)

Field methodologies offer a unique opportunity to collect ecologically valid data on alcohol use and its associated problems within natural drinking environments. However, limitations in follow-up data collection methods have left unanswered questions regarding the psychometric properties of field-based measures. The aim of the current study is to evaluate the reliability of self-report data collected in a naturally occurring environment - as indexed by the Alcohol Use Disorders Identification Test (AUDIT) - compared to self-report data obtained through an innovative web-based follow-up procedure. Individuals recruited outside of bars (N = 170; mean age = 21; range 18-32) provided a BAC sample and completed a self-administered survey packet that included the AUDIT. BAC feedback was provided anonymously through a dedicated web page. Upon sign in, follow-up participants (n = 89; 52%) were again asked to complete the AUDIT before receiving their BAC feedback. Reliability analyses demonstrated that AUDIT scores - both continuous and dichotomized at the standard cut-point - were stable across field- and web-based administrations. These results suggest that self-report data obtained from acutely intoxicated individuals in naturally occurring environments are reliable when compared to web-based data obtained after a brief follow-up interval. Furthermore, the results demonstrate the feasibility, utility, and potential of integrating field methods and web-based data collection procedures.

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2009: Methodology Report. Rockville MD: Substance Abuse and Mental Health Administration, 2011. (22 refs.)

This report describes the origins and structure of the Drug Abuse Warning Network (DAWN), and the 12 metropolitan areas included in the study.. Information collected by DAWN includes types of cases, demographic characteristics, drug class(es), and disposition of the emergency room visit.

Public Domain

cigarette ignition propensity regulations in CanadaMariner D; Shepperd J. Special supplement introduction: Estimating cigarette smoke exposure by filter analysis. (editorial). Regulatory Toxicology and Pharmacology 61(3, supplement 1): S1-S2, 2011. (19 refs.)

This is an introduction to a special supplement which addresses the levels of nicotine delivered by smoking, methods for testing nicotine delivery, the use of the cigarette filter as a vehicle for assessing nicotine delivered, changes in cigarette smoking in the wake of new regulation in Canada on ignition propensity, changes in smoking intensity following the passage of smoking bans in Scotland;

Cote F; Letourneau C; Mullard G; Voisine R. Estimation of nicotine and tar yields from human-smoked cigarettes before and after the implementation of the cigarette ignition propensity regulations in Canada. Regulatory Toxicology and Pharmacology 61(3, supplement 1): S51-S59, 2011. (32 refs.)

In 2005, Human-Smoked (HS) tar and nicotine yields from commercial Canadian cigarettes were determined using a part filter analysis method to obtain estimates representative of human smoking behavior. In 2006, new cigarette designs were introduced to ensure compliance with the Canadian Low Ignition Propensity (LIP) regulations. It was not known how the changes in product design would affect HS yields. To assess the impact of the cigarette design modifications on HS yields, a further group at Canadian smokers was recruited for smoking the modified version of 10 products previously assessed. No differences in estimated HS tar yields were found between products following product modification. The HS nicotine yield was different for one product. In general, HS yields were higher than ISO machine yields while Canadian intense machine yields were more representative of the maximum HS yields. the same product ranking order was obtained for HS yields and the two machine yields but differences between the mean HS yields and ISO yields were smaller as the product ISO yields increased. Higher HS yields were measured when products were smoked by male smokers. The methodology used in this study showed the wide range of HS yields obtained by smokers as well as a good degree of stability in average HS yields just before and after the introduction of LIP regulations.

Covey LS; Hu MC; Green CA; Brigham G; Hurt RD; Adler L et al. An exploration of site effects in a multisite trial of oros-methylphenidate for smokers with attention deficit/hyperactivity disorder. American Journal of Drug and Alcohol Abuse 37(5): 392-399, 2011. (14 refs.)

Background: Multisite trials, the gold standard for conducting studies in community-based settings, can mask variability across sites resulting in misrepresentation of effects in specific sites. In a placebo-controlled trial of osmotic-release oral system methylphenidate (OROS-MPH) as augmentation treatment for smokers with attention deficit hyperactivity/impulsivity disorder (ADHD), three types of sites were selected according to their clinical research specialty (ADHD, smoking cessation, and general mental health). Objective: Analysis was conducted to determine if clinical outcomes, that is, reduction in ADHD symptoms and smoking cessation rates, and the effect of treatment on these outcomes would differ by type of site. Method: A total of 255 adult smokers diagnosed with ADHD were enrolled in three clinic types: 72 in ADHD, 79 in tobacco dependence, and 104 in the mental health clinics. Results: The three site-types were similar in demographic characteristics, smoking history, baseline level of ADHD symptoms, and history of psychiatric illness. Site-type but not a site-type by treatment interaction predicted prolonged smoking abstinence. A significant three-way interaction of site-type, treatment, and time-predicted improvement in ADHD symptoms. Moderate to strong effects of OROS-MPH relative to placebo were observed in the mental health and the ADHD clinics; a weak effect was observed in the tobacco dependence clinics. Conclusion: OROS-MPH benefit varied by site for reducing ADHD symptoms but not for improving smoking abstinence. Scientific Significance: Assessment of site-type effects can indicate the generalizability of findings from multisite trials and should be routinely incorporated in the design of multisite trials.

Daniulaityte R; Falck R; Li LN; Nahhas RW; Carlson RG. Respondent-driven sampling to recruit young adult non-medical users of pharmaceutical opioids: Problems and solutions. Drug and Alcohol Dependence 121(1-2): 23-29, 2012. (57 refs.)

Respondent-driven sampling (RDS) has been promoted as a superior method in recruiting hard-to-reach and hidden populations. Although its application has expanded enormously, there remains a need for empirical data evaluating the performance of RDS in different settings. This study describes the application of RDS to recruit a community sample (N=396) of young adults (18-23 years old) into a natural history study of non-medical pharmaceutical opioid use. Since recruitment targeted non-dependent pharmaceutical opioid users, and applied other eligibility restrictions, several modifications had to be made to make RDS work with this narrowly defined target population. RDS recruitment was less efficient than expected, and produced greater numbers of African American recruits than anticipated. Although the sampling quota was met, sample analysis revealed a lack of equilibrium in terms of ethnic composition and very strong in-group recruitment tendencies among White and African American respondents. This study contributes potentially helpful insights into the strengths and limitations of using RDS which may benefit future studies.

Dawson DA. Defining risk drinking. Alcohol Research & Health 34(2): 144-156, 2011. (119 refs.)

Many efforts to prevent alcohol-related harm are aimed at reducing risk drinking. This article outlines the many conceptual and methodological challenges to defining risk drinking. It summarizes recent evidence regarding associations of various aspects of alcohol consumption with chronic and acute alcohol-related harms, including mortality, morbidity, injury, and alcohol use disorders, and summarizes the study designs most appropriate to defining risk thresholds for these types of harm. In addition, it presents an international overview of low-risk drinking guidelines from more than 20 countries, illustrating the wide range of interpretations of the scientific evidence related to risk drinking. This article also explores the impact of drink size on defining risk drinking and describes variation in what is considered to be a standard drink across populations. Actual and standard drink sizes differ in the United States, and this discrepancy affects definitions of risk drinking and prevention efforts.

Public Domain

Dean AC; Hellemann G; Sugar CA; London ED. Educational attainment is not a good proxy for cognitive function in methamphetarnine dependence. Drug and Alcohol Dependence 123(1-3): 249-254, 2012. (40 refs.)

Background: We sought to test the hypothesis that methamphetamine use interferes with both the quantity and quality of one's education, such that the years of education obtained by methamphetamine dependent individuals serves to underestimate general cognitive functioning and overestimate the quality of academic learning. Methods: Thirty-six methamphetamine-dependent participants and 42 healthy comparison subjects completed cognitive tests and self-report measures in Los Angeles, California. An overall cognitive battery score was used to assess general cognition, and vocabulary knowledge was used as a proxy for the quality of academic learning. Linear regression procedures were used for analyses. Results: Supporting the hypothesis that methamphetamine use interferes with the quantity of education, we found that (a) earlier onset of methamphetamine use was associated with fewer years of education (p < .01); (b) using a normative model developed in healthy participants, methamphetamine-dependent participants had lower educational attainment than predicted from their demographics and performance on the cognitive battery score (p < .01); and (c) greater differences between methamphetamine-dependent participants' predicted and actual educational attainment were associated with an earlier onset of MA use (p <= .01). Supporting the hypothesis that methamphetamine use interferes with the quality of education, years of education received prior to the onset of methamphetamine use was a better predictor of a proxy for academic learning, vocabulary knowledge, than was the total years of education obtained. Conclusion: Results support the hypothesis that methamphetamine use interferes with the quantity and quality of educational exposure, leading to under- and overestimation of cognitive function and academic learning, respectively.

Dick DM. Gene-environment interaction in psychological traits and disorders. (review). Annual Review of Clinical Psychology 7: 383-409, 2011. (111 refs.)

There has been an explosion of interest in studying gene-environment interactions (GxE) as they relate to the development of psychopathology. In this article, I review different methodologies to study gene-environment interaction, providing an overview of methods from animal and human studies and illustrations of gene-environment interactions detected using these various methodologies. Gene-environment interaction studies that examine genetic influences as modeled latently (e.g., from family, twin, and adoption studies) are covered, as well as studies of measured genotypes. Importantly, the explosion of interest in gene-environment interactions has raised a number of challenges, including difficulties with differentiating various types of interactions, power, and the scaling of environmental measures, which have profound implications for detecting gene-environment interactions. Taking research on gene-environment interactions to the next level will necessitate close collaborations between psychologists and geneticists so that each field can take advantage of the knowledge base of the other.

Donkin L; Christensen H; Naismith SL; Neal B; Hickie IB; Glozier N. A systematic review of the impact of adherence on the effectiveness of e-therapies. (review). Journal of Medical Internet Research 13(3): e52, 2011. (82 refs.)

Background: As the popularity of e-therapies grows, so too has the body of literature supporting their effectiveness. However, these interventions are often plagued by high attrition rates and varying levels of user adherence. Understanding the role of adherence may be crucial to understanding how program usage influences the effectiveness of e-therapy interventions. Objective: The aim of this study was to systematically review the e-therapy literature to (1) describe the methods used to assess adherence and (2) evaluate the association of adherence with outcome of these interventions. Methods: A systematic review of e-therapy interventions was conducted across disease states and behavioral targets. Data were collected on adherence measures, outcomes, and analyses exploring the relationship between adherence measures and outcomes. Results: Of 69 studies that reported an adherence measure, only 33 (48%) examined the relationship between adherence and outcomes. The number of logins was the most commonly reported measure of adherence, followed by the number of modules completed. The heterogeneity of adherence and outcome measures limited analysis. However, logins appeared to be the measure of adherence most consistently related to outcomes in physical health interventions, while module completion was found to be most related to outcomes in psychological health interventions. Conclusions: There is large variation in the reporting of adherence and the association of adherence with outcomes. A lack of agreement about how best to measure adherence is likely to contribute to the variation in findings. Physical and psychological outcomes seem influenced by different types of adherence. A composite measure encompassing time online, activity completion, and active engagements with the intervention may be the best measure of adherence. Further research is required to establish a consensus for measuring adherence and to understand the role of adherence in influencing outcomes.

Donovan DM; Bigelow GE; Brigham GS; Carroll KM; Cohen AJ; Gardin JG. Primary outcome indices in illicit drug dependence treatment research: Systematic approach to selection and measurement of drug use end-points in clinical trials. Addiction 107(4): 694-708, 2012. (100 refs.)

Aims: Clinical trials test the safety and efficacy of behavioral and pharmacological interventions in drug-dependent individuals. However, there is no consensus about the most appropriate outcome(s) to consider in determining treatment efficacy or on the most appropriate methods for assessing selected outcome(s). We summarize the discussion and recommendations of treatment and research experts, convened by the US National Institute on Drug Abuse, to select appropriate primary outcomes for drug dependence treatment clinical trials, and in particular the feasibility of selecting a common outcome to be included in all or most trials. Methods: A brief history of outcomes employed in prior drug dependence treatment research, incorporating perspectives from tobacco and alcohol research, is included. The relative merits and limitations of focusing on drug-taking behavior, as measured by self-report and qualitative or quantitative biological markers, are evaluated. Results: Drug-taking behavior, measured ideally by a combination of self-report and biological indicators, is seen as the most appropriate proximal primary outcome in drug dependence treatment clinical trials. Conclusions: We conclude that the most appropriate outcome will vary as a function of salient variables inherent in the clinical trial, such as the type of intervention, its target, treatment goals (e. g. abstinence or reduction of use) and the perspective being taken (e. g. researcher, clinical program, patient, society). It is recommended that a decision process, based on such trial variables, be developed to guide the selection of primary and secondary outcomes as well as the methods to assess them.

Dorea JG. Co-exposure and confounders during neurodevelopment: We need them in the bigger picture of secondhand smoke exposure during pregnancy. (editorial). Environmental Research 111(8): 1332-1333, 2011. (10 refs.)

el-Guebaly N. The meanings of recovery from addiction: Evolution and promises. (review). Journal of Addiction Medicine 6(1): 1-9, 2012. (85 refs.)

Objective: To review the evolution of the paradigm of recovery in addiction and its implications. Method: A systematic literature review was conducted using the MEDLINE and PsychInfo databases over the past 10 years and key references from the retrieved literature. Findings: The historical evolution of the concept of recovery has been shaped by several driving forces, including consumer experience, the need to better define our treatment outcome and parallel elaboration of the concepts of health, quality of life, and chronic disorders. Similarities and differences with the concept of "recovery" in mental health and other biomedical fields are identified. The empirical basis is growing in support of various proposed attributions and features of recovery along with the temporal benchmarks involved. The various forms of recovery, such as "natural," "transformational," or "medication-assisted," describe a choice of pathways to a common goal. The management implications are far-reaching and call for system shifts from acute stabilization to sustained recovery, including the growth of alternative institutions, and roles complementary to mutual help. Tools for the sustenance of recovery, including educational kits, recovery workbooks, and e-recovery initiatives, are developing. Conclusions: Although first-person accounts of recovery abound, a more systematic empirical investigation of the concept has just begun, including demographic and cultural differences. Management implications are derived from the experience with other "mainstream" chronic disorders with treatment providing stabilization and initiation of recovery and a range of long-term resources becoming available to sustain it.

Feaster DJ; Mikulich-Gilbertson S; Brincks AM. Modeling site effects in the design and analysis of multi-site trials. American Journal of Drug and Alcohol Abuse 37(5): 383-391, 2011. (46 refs.)

Background: Careful consideration of site effects is important in the analysis of multi-site clinical trials for drug abuse treatment. The statistical choices for modeling these effects have implications for both trial planning and interpretation of findings. Objectives: Three broad approaches for modeling site effects are presented: omitting site from the analysis; modeling site as a fixed effect; and modeling site as a random effect. Both the direct effect of site and the interaction of site and treatment are considered. Methods: The statistical model, and consequences, for each approach are presented along with examples from existing clinical trials. Power analysis calculations provide sample size requirements for adequate statistical power for studies utilizing 6, 8, 10, 12, 14, and 16 treatment sites. Results: Results of the power analyses showed that the total sample required falls rapidly as the number of sites increases in the random effect approach. In the fixed effect approach in which the interaction of site and treatment is considered, the required number of participants per site decreases as the number of sites increases. Conclusions: Ignoring site effects is not a viable option in multi-site clinical trials. There are advantages and disadvantages to the fixed effect and random effect approaches to modeling site effects. Scientific Significance: The distinction between efficacy trials and effectiveness trials is rarely sharp. The choice between random effect and fixed effect statistical modeling can provide different benefits depending on the goals of the study.

Fussell HE; Kunkel LE; McCarty D; Lewy CS. Standardized patient walkthroughs in the National Drug Abuse Treatment Clinical Trials Network: Common challenges to protocol implementation. American Journal of Drug and Alcohol Abuse 37(5): 434-439, 2011. (20 refs.)

Background: Training research staff to implement clinical trials occurring in community-based addiction treatment programs presents unique challenges. Standardized patient walkthroughs of study procedures may enhance training and protocol implementation. Objectives: Examine and discuss cross-site and cross-study challenges of participant screening and data collection procedures identified during standardized patient walkthroughs of multi-site clinical trials. Method: Actors portrayed clients and "walked through" study procedures with protocol research staff. The study completed 57 walkthroughs during implementation of 4 clinical trials. Results: Observers and walkthrough participants identified three areas of concern (consent procedures, screening and assessment processes, and protocol implementation) and made suggestions for resolving the concerns. Conclusions and Scientific Significance: Standardized patient walkthroughs capture issues with study procedures previously unidentified with didactic training or unscripted rehearsals. Clinical trials within the National Drug Abuse Treatment Clinical Trials Network are conducted in addiction treatment centers that vary on multiple dimensions. Based on walkthrough observations, the national protocol team and local site leadership modify standardized operating procedures and resolve cross-site problems prior to recruiting study participants. The standardized patient walkthrough improves consistency across study sites and reduces potential site variation in study outcomes.

Gaalema DE; Higgins ST; Bradstreet MP; Heil SH; Bernstein IM. Using NicAlert strips to verify smoking status among pregnant cigarette smokers. Drug and Alcohol Dependence 119(1-2): 130-133, 2011. (18 refs.)

Background: Decreasing smoking during pregnancy is an important public health priority. An important step towards decreasing smoking during pregnancy is wider dissemination of evidence-based smoking cessation interventions. One such intervention is contingency management wherein mothers earn vouchers exchangeable for retail items contingent on biochemically verified smoking abstinence. Wider dissemination may be possible by using smoking verification methods that require minimal training and equipment. One possibility is to use a cotinine-sensitive dipstick (NicAlert) rather than a bench-top cotinine analyzer, which is expensive and requires relatively extensive technician expertise, or breath carbon monoxide analysis, which is relatively nonspecific. The present study was conducted to begin examining the utility of cotinine-sensitive dipsticks for this purpose. Methods: Fifty urine samples from pregnant women enrolled in a smoking cessation program were analyzed to compare three different methods for verifying smoking status: NicAlert strips, a bench-top enzyme multiplied immunoassay technique (EMIT) analyzer, and gas chromatography (GC), the current gold standard for determining cotinine levels in urine. Results: Agreement between GC and NicAlert results were high (96%) and comparable to agreement between GC and EMIT results (94%). Semi-quantitative measurements using NicAlert were low with only 30% of samples in agreement between GC and specific ranges given on the strips. Conclusions: NicAlert strips appear to be a valid measure of determining smoking status among pregnant smokers although not of absolute cotinine concentration. With minimal training and equipment required, NicAlert strips provide a potentially practical method for using urine cotinine to verify smoking status in community treatment settings.

Gillespie NA; Kendler KS; Neale MC. Psychometric modeling of cannabis initiation and use and the symptoms of cannabis abuse, dependence and withdrawal in a sample of male and female twins. Drug and Alcohol Dependence 118(2-3): 166-172, 2011. (79 refs.)

Background: Despite an emerging consensus that the DSM-IV diagnostic criteria for cannabis abuse and dependence are best represented by a single underlying liability, it remains unknown if latent class or hybrid models can better explain the data. Method: Using structured interviews, 7316 adult male and female twins provided complete data on DSM-IV symptoms of cannabis abuse and dependence. Our aim was to derive a parsimonious, best-fitting cannabis use disorder (CUD) phenotype based on DSM-III-R/IV criteria by comparing an array of psychometric models (latent factor analysis, latent class analysis and factor mixture modeling) using full information maximum likelihood ordinal data methods in Mx. Results: We found little evidence to support population heterogeneity since neither latent class nor hybrid factor mixture models provided a consistently good fit to the data. When conditioned on initiation and cannabis use, the endorsement patterns of the abuse, dependence and withdrawal criteria were best explained by two latent factors for males and females. The first was a general CUD factor for which genetic effects explained 53-54% of the variance. A less interpretable second factor included a mix of cross-loading dependence and withdrawal symptoms. Conclusions: This is the first study to compare competing measurement models to derive an empirically determined CUD phenotype. Commensurate with proposed changes to substance use disorders in the DSM-V, our results support an emerging consensus that a single CUD latent factor can more optimally assess the risk or liability underpinning correlated measures of use, abuse, dependence and withdrawal criterion.

Graziotti AL; Hammond J; Messinger DS; Bann CM; Miller-Loncar C; Twomey JE et al. Maintaining participation and momentum in longitudinal research involving high-risk families. Journal of Nursing Scholarship 44(2): 120-126, 2012. (16 refs.)

Purpose: The purpose of the current study was to identify and describe strategies available to optimize retention of a high-risk research cohort and assist in the recovery of study participants following participant dropout. Design and Methods: The Maternal Lifestyle Study (MLS), which investigated the effects of prenatal substance exposure (cocaine or opiates) on child outcome, is a prospective longitudinal follow-up study that extended from birth through 15 years of age. Retention strategies to maximize participation and factors that might negatively impact compliance were examined over the course of five follow-up phases. Findings: At the conclusion of the 15-year visits, MLS had successfully maintained compliance at 76%. Retention rates did not differ by exposure group. Conclusions: Maintaining ongoing participation of enrolled study subjects is a critical element of any successful longitudinal study. Strategies that can be used to reengage and maintain participants in longitudinal research include persistence, flexibility with scheduling, home visits, long-distance trips, increased incentives, and development of a computerized tracking system. Establishing rapport with families and ensuring confidentiality contributed to overall participant retention. The use of multiple tracking techniques is essential. Clinical Relevance: Researchers are challenged to maintain participants in longitudinal studies to ensure the integrity of their research.

Greenfield SF; Rosa C; Putnins SI; Green CA; Brooks AJ; Calsyn DA et al. Gender research in the National Institute on Drug Abuse National Treatment Clinical Trials Network: A summary of findings. American Journal of Drug and Alcohol Abuse 37(5): 301-312, 2011. (45 refs.)

Background: The National Institute of Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (CTN) was established to foster translation of research into practice in substance abuse treatment settings. The CTN provides a unique opportunity to examine in multi-site, translational clinical trials, the outcomes of treatment interventions targeting vulnerable subgroups of women; the comparative effectiveness of gender-specific protocols to reduce risk behaviors; and gender differences in clinical outcomes. Objectives: To review gender-related findings from published CTN clinical trials and related studies from January 2000 to March 2010. Methods: CTN studies were selected for review if they focused on treatment outcomes or services for special populations of women with substance use disorders (SUDs) including those with trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors; or implemented gender-specific protocols. The CTN has randomized 11,500 participants (41% women) across 200 clinics in 24 randomized controlled trials in community settings, of which 4 have been gender-specific. Results: This article summarizes gender-related findings from CTN clinical trials and related studies, focusing on trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors. Conclusions: These published studies have expanded the evidence base regarding interventions for vulnerable groups of women with SUDs as well as gender-specific interventions to reduce HIV risk behaviors in substance-using men and women. The results also underscore the complexity of accounting for gender in the design of clinical trials and analysis of results. Scientific Significance: To fully understand the relevance of gender-specific moderators and mediators of outcome, it is essential that future translational studies adopt more sophisticated approaches to understanding and measuring gender-relevant factors and plan sample sizes that are adequate to support more nuanced analytic methods.

Gryczynski J; Johnson JL. Challenges in public health research with American Indians and other small ethnocultural minority populations. Substance Use & Misuse 46(11): 1363-1371, 2011. (57 refs.)

As a result of the historical legacy of conquest, colonization, and cultural destruction, indigenous peoples often represent just a small segment of the population in many countries throughout the world. In the United States, American Indians/Alaska Natives are not only one of the smallest minority groups in the nation, but are also very culturally diverse. Disparities in health outcomes often occur along racial and ethnic lines, and culture can play an important role in shaping health behavior. Research on the distribution and patterning of disease and risk behaviors among population subgroups is critical for advancing evidence-based public health policy and practice. This article provides a brief overview of key challenges in conducting behavioral health research with American Indians at both community and population levels. Many of the issues raised also apply to other small ethnocultural minority groups.

Guillaumier A; Bonevski B; Paul C. Anti-tobacco mass media and socially disadvantaged groups: A systematic and methodological review. Drug and Alcohol Review 31(5, special issue): 698-708, 2012. (56 refs.)

Issues. Only a limited amount of research has been conducted to explore whether there are socioeconomic status differences in responses to mass media. However, the methodological quality of this evidence has not been assessed, limiting confidence in conclusions that can be drawn regarding study outcomes. A systematic review of the effectiveness of anti-tobacco mass media campaigns with socially disadvantaged groups was conducted, and the methodological quality of included studies was assessed. Approach. Medline, The Cochrane Library, PsycInfo, Embase and Web of Science were searched using MeSH and keywords for quantitative studies conducted in Western countries prior to March 2012. A methodological quality assessment and narrative analysis of included studies was undertaken. Key Findings. Seventeen relevant studies (reported in 18 papers) were identified; however, weak study designs and selection bias were common characteristics, limiting strong conclusions about effectiveness. Using predominantly non-cessation related outcome measures reviewed papers indicated mixed results for mass media tobacco control campaign effectiveness among various social groups. Most studies assessed mass media impact on low socioeconomic status groups rather than highly socially disadvantaged groups. Implications. Methodological rigour of evaluations in this field must be improved to aid understanding regarding the effectiveness of mass media campaigns in driving cessation among disadvantaged groups. Conclusion. The results of this review indicate a gap in methodologically rigorous research into the effectiveness of mass media campaigns among socially disadvantaged groups, particularly the highly disadvantaged.

Hermes K; Poulsen M. Small area estimates of smoking prevalence in London. Testing the effect of input data. Health & Place 18(3): 630-638, 2012. (49 refs.)

Small area estimates (SAEs) can provide information about health behaviour at small area levels that is otherwise not available. Because of its increasing use by policy makers, more attention needs to be paid to the reliability of these estimates. This paper reports on smoking prevalence data generated for London at the neighbourhood level using spatial microsimulation modelling. We test the reliability of smoking prevalence estimates at the neighbourhood level using different input datasets. The paper further underlines the importance of estimating health behaviours at the small area level, particularly in diverse cities such as London, where estimation at the city level can mask significant spatial differences.

Hjorthoj CR; Fohlmann A; Larsen AM; Arendt M; Nordentoft M. Correlations and agreement between delta-9-tetrahydrocannabinol (THC) in blood plasma and timeline follow-back (TLFB)-assisted self-reported use of cannabis of patients with cannabis use disorder and psychotic illness attending the CapOpus randomized clinical trial. Addiction 107(6): 1123-1131, 2012. (37 refs.)

Aims: To assess correlations and agreement between timeline follow-back (TLFB)-assisted self-report and blood samples for cannabis use. Design Secondary analysis of a randomized trial. Setting Copenhagen, Denmark. Participants One hundred and three patients from the CapOpus trial with cannabis use disorder and psychosis, providing 239 self-reports of cannabis use and 88 valid blood samples. Measurements: Delta-9-tetrahydrocannabinol (THC), 11-hydroxy-delta-9-tetrahydrocannabinol (11-OH-THC) and 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) detected in plasma using high-performance liquid chromatography with tandem mass spectrometry detection. Self-report of cannabis-use last month by TLFB. Pearson's r, sensitivity and specificity calculated as measures of correlation or agreement. Findings: Correlations were strong; r = 0.75 for number of days and r = 0.83 for number of standard joints in the preceding month when excluding outliers. Including outliers, coefficients were moderate to strong (r = 0.49). There were differences in subgroups, mainly inconsistent, depending on inclusion or exclusion of outliers. Sensitivity and specificity for TLFB detecting the presence or absence of cannabis use were 95.7% [95% confidence interval (CI) 88.099.1%) and 72.2% (95% CI 46.590.3%), respectively. Using 19 days as cut-off on TLFB, they were 94.3% (95% CI 86.098.4%) and 94.4% (95% CI 72.299.9%), respectively. Area under the receiver operating characteristic (ROC) curve was 0.96. Conclusions: Timeline follow-back (TLFB)-assisted self-report of cannabis use correlates highly with plasma-delta-9-tetrahydrocannabinol in patients with comorbid cannabis use disorder and psychosis. Sensitivity and specificity of timeline follow-back appear to be optimized with 19 days as the cut-off point. As such, timeline follow-back may be superior to analysis of blood when going beyond 19 days of recall.

Hjorthoj CR; Hjorthoj AR; Nordentoft M. Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances : Systematic review and meta-analysis. (review). Addictive Behaviors 37(3): 225-233, 2012. (78 refs.)

Background: Timeline Follow-Back (TLFB) is a widely used, calendar-based measure of self-reported use of (among other things) illicit substances. We examined agreement between TLFB and biological measures for illicit substances. Methods: PubMedicine, PsycINFO, Cochrane CENTRAL and EMBASE were searched in December 2010. 16, 633 papers screened to identify those that measured illicit substance use by both TLFB and biological measures. We extracted data on agreement between TLFB and biological measures, sample size, study type, inclusion criteria of participants, and length of recall of TLFB. Results: Twenty-nine papers were included, almost exclusively in substance-use-disorder populations. Some studies reported several overall agreement rates, e.g. over time. Lowest and highest weighted average agreement rates were: for cannabis, 87.3% (95% confidence interval 86.9% to 87.7%) and 90.9% (90.5% to 91.4%); for cocaine, 79.3% (79.1% to 79.6%) and 84.1% (83.9% to 84.2%), for opiates 94.0% (93.5% to 94.5%) for both weighted averages; and for studies not distinguishing between substances, 88.5% (88.4 to 88.7%) and 91.0% (90.7% to 91.2%). Higher agreement was found in populations without psychiatric comorbidity, and lower agreement in randomized controlled trials. Publication bias or selective outcome reporting bias was not detected. Conclusions: TLFB validly detects use of illicit substances in populations with substance use disorders. Using TLFB may limit the need for biological samples, making information on illicit substance use easier and less costly to obtain and analyze.

Huizink AC. Prenatal substance use, prenatal stress and offspring behavioural outcomes: Considerations for future studies. Nordic Journal of Psychiatry 66(2): 115-122, 2012. (58 refs.)

Background: Numerous studies have been conducted in which the most common forms of maternal substance use during pregnancy (smoking, drinking or using cannabis) and maternal stress during pregnancy and her offspring's developmental or behavioural outcome have been the focus of interest. These studies seem to suggest that any perturbation caused by maternal substance use or maternal stress during fetal development may have (enduring) effects on offspring behaviour. However, recent developments in research methodology used to examine these associations question whether these prenatal influences actually cause altered offspring outcomes. Aims: This review provides a short overview of previous studies in this field of research, some methodological issues particularly involved in studies that focus on the association between maternal substance use or stress during pregnancy and offspring's outcomes. Furthermore, it introduces several new approaches that have been applied recently to test these associations. Results: Studies that applied these designs to disentangle prenatal influences from associated or inherited factors consistently show an effect of prenatal substance use exposure on birth weight, but yield little evidence for causal effects on behaviour. In contrast, prenatal stress may have a causal effect on some aspects of behaviour, although only one study thus far has been able to differentiate heritable factors from environmental factors.

Jacob T; Blonigen DM; Hubel K; Wood PK; Haber JR. Drinking course through midlife based on diagnostic versus quantity-frequency indIces. Alcoholism: Clinical and Experimental Research 36(3): 477-489, 2012. (58 refs.)

Background: Prior efforts to examine the course of drinking from onset to midlife have been limited to analyses of year-to-year changes in alcohol dependence (AD). The current investigation sought to examine the course of drinking over this time frame using consumption-based measures of drinking and evaluate the degree of comparability in trajectories estimated from diagnostic and quantity-frequency data. Methods: Participants included 420 men with a lifetime history of AD who were drawn from the Vietnam Era Twin Registry and administered the Lifetime Drinking History, which provided person-year (retrospective) data on patterns of consumption and diagnostic symptoms from drinking onset to participants' current age. Consumption-based data were aggregated into age categories that ranged from "up to age 20" to "ages 54 to 56" and analyzed separately as a dichotomous measure of "heavy drinking (HD)" and continuous quantity-frequency index (QFI) scores. Results: Using latent growth mixture modeling, trajectories based on the HD measure were moderately concordant with those based on changes in AD that were previously identified in this sample, whereas trajectories based on QFI scores were only weakly related to those based on AD diagnoses. Moreover, examination of the degree of concordance between AD-and QFI-derived trajectories revealed that measures of consumption (and potentially other continuous indices of drinking) may qualify past interpretations of various developmental trajectories that have been discussed in the alcoholism typology literature (particularly "Late Onset" alcoholism). Conclusions: Collectively, the findings highlight the importance of integrating repeated measures of alcohol consumption in future efforts to describe the course of drinking across the life span.

Johnson MW. An efficient operant choice procedure for assessing delay discounting in humans: Initial validation in cocaine-dependent and control individuals. Experimental And Clinical Psychopharmacology 20(3): 191-204, 2012. (89 refs.)

Delay discounting is the decline in a consequence's control of behavior as a function of its delay, and may be a fundamental behavioral process in drug dependence. Human delay-discounting studies have usually relied on choices between hypothetical rewards. Some human tasks have assessed delay discounting using operant procedures with consequences provided during the task, as in nonhuman animal studies. However, these tasks have limitations such as long duration, potentially indeterminate data, or confounding the effect of delay with probability. A study in 20 cocaine-dependent volunteers and 20 demographically matched non-cocaine-dependent volunteers was designed to investigate a novel operant delay-discounting task providing monetary reinforcement by coin delivery throughout the task (Quick Discounting Operant Task; QDOT). Participants completed a hypothetical delay-discounting procedure, a potentially real reward delay-discounting procedure, and an existing operant delay-discounting task: the Experiential Discounting Task (EDT). The QDOT resulted in complete data for all participants, showed systematic effects of delay that were well described by a hyperbolic function, had a maximum duration of 17 min, and resulted in relatively little variability in session earnings. QDOT performance was significantly, positively correlated with performance on the EDT but not the other tasks. The QDOT resulted in an effect size between the groups that was similar to most other delay-discounting tasks examined, and showed that the cocaine-dependent participants delay discounted significantly more than the control participants. The QDOT is an efficient operant human delay-discounting task that may be useful in a variety of experimental settings.

Johnson M. Assessing a country's drink driving situation: An overview of the method used in 6 low- and middle-income countries. Traffic Injury Prevention 13(2): 96-100, 2012. (7 refs.)

The International Center for Alcohol Policies (ICAP) has developed an international program to reduce drink driving as part of its strategy for Global Actions on Harmful Drinking. The program focuses on capacity building, training, and the implementation, monitoring, and evaluation of regional and local pilot projects in 6 participating low-and middle-income countries. The first step in developing an effective program that addresses specific problems in a region or country is to assess the current drink driving situation. In order to meet this key requirement, ICAP developed a situation assessment approach based largely on the recommendations of Chapter 2 of the good practice manual on drinking and driving produced by the Global Road Safety Partnership (GRSP) under the auspices of the United Nations (UN) Road Safety Collaboration. The aim of the assessment was to provide the foundation for preparing a prioritized and effective suite of projects using the good practice recommended by the GRSP/UN manual. Its output is intended to assist with determining program objectives, design, and evaluation so that the benefits from the investments in drink driving programs can be maximized and data led, focusing on the priorities identified by the assessment. The situation assessment approach was produced as a set of guidelines containing a detailed and structured list of questions. The questions are organized into 6 main groups or elements and they enable a comprehensive and systematic collection of existing information about the extent and nature of the drink driving problem, the strengths and weaknesses of the current prevention practices, and the capacity for improvements. Situation assessments using these guidelines have been completed in the 6 focus countries and the resulting information is now being used for capacity building and developing appropriate and relevant pilot projects, taking into consideration the country's culture with respect to transportation, enforcement, health care, and alcohol consumption.

Jouanjus E; Pourcel L; Saivin S; Molinier L; Lapeyre-Mestre M. Use of multiple sources and capture-recapture method to estimate the frequency of hospitalizations related to drug abuse. Pharmacoepidemiology and Drug Safety 21(7): 733-741, 2012. (35 refs.)

Purpose: Addictive behaviours are often associated with hidden characteristics that are difficult to detect by usual approaches. This study aimed to estimate the incidence of serious drug-related complications by using the capture-recapture method in defined geographical area. Methods: Hospitalizations with mention of disorders related to drug of abuse were considered serious drug-related complications. We searched these cases in and crossed three sources of data: spontaneous reports of drug of abuse related disorders called NotS (Notification Spontanee) collected by the regional addictovigilance centre, computerised hospital database Programme de Medicalisation des Systemes d'Information (PMSI) and toxicological analyses (TA) carried out for hospitalized patients. Results: In 2007 and 2008, 1509 distinct cases were captured. After data modelling, the estimated number of psychoactive drug-related hospitalizations was 4744 (95%CI?=?40605429). Most frequent products were opioids (34%), cannabis (19%) and cocaine (13%). Multiple drugs were observed in 26% of cases. The incidence of serious drug-related complications in the area covered should be estimated at 5.7 (95%CI=5.55.9) per thousand 15- to 64-year-old inhabitants. The exhaustiveness of sources were 0.4% (95%CI?=?0.20.6) for NotS, 11.6% (95%CI=10.712.5) for TA and 22.6% (95%CI?=?21.423.8) for PMSI. Conclusions: The real number of cases far exceeds that of cases that can be identified through simple counts. In particular, it confirms the underreporting and even quantifies its magnitude. These results confirm that drug users are frequently hospitalised and require heavy medical management. Moreover, these results show the real although limited advantage of hospitalization database in detecting drug associated disorders in epidemiological studies.

King AC; Roche DJO; Rueger SY. Subjective responses to alcohol: A paradigm shift may be brewing. (commentary). Alcoholism: Clinical and Experimental Research 35(10): 1726-1728, 2011. (20 refs.)

Background: The meta-analysis by Quinn and Fromme (2011) is reviewed and integrated into the larger field. Guidelines for future research are presented. Results: With results of the meta-analysis along with those of a recent comprehensive prospective study by our group (King, 2011), there is a call to the field to specify terms and integrate theoretical frameworks to advance our knowledge and improve comparisons across trials. Conclusions: The meta-analysis is both timely and thorough and will provide clinical researchers with important information to move the field forward.

Langley TE; Szatkowski LC; Wythe S; Lewis SA. Can primary care data be used to monitor regional smoking prevalence? An analysis of The Health Improvement Network primary care data. BMC Public Health 11: e-773, 2011

Accurate and timely regional data on smoking trends allow tobacco control interventions to be targeted at the areas most in need and facilitate the evaluation of such interventions. Electronic primary care databases have the potential to provide a valuable source of such data due to their size, continuity and the availability of socio-demographic data. UK electronic primary care data on smoking prevalence from The Health Improvement Network (THIN) have previously been validated at the national level, but may be less representative at the regional level due to reduced sample sizes. We investigated whether this database provides valid regional data and whether it can be used to compare smoking prevalence in different UK regions. Annual estimates of smoking prevalence by government office region (GOR) from THIN were compared with estimates of smoking prevalence from the General Lifestyle Survey (GLF) from 2000 to 2008. For all regions, THIN prevalence data were generally found to be highly comparable with GLF data from 2006 onwards. THIN primary care data could be used to monitor regional smoking prevalence and highlight regional differences in smoking in the UK.

Lentillon-Kaestner V; Ohl F. Can we measure accurately the prevalence of doping? Scandinavian Journal of Medicine & Science in Sports 21(6): E132-E142, 2011. (38 refs.)

Questionnaires are used in the majority of the studies on doping prevalence in sport. Nevertheless, prevalence is not easy to evaluate and previous epidemiologic studies demonstrated a wide variance. This variance has mostly been explained by sample differences. The way to evaluate doping prevalence in the survey is questioned in this paper. A questionnaire was administered to 1810 amateur athletes (993 males, 817 females). Doping use was ascertained in various ways, using different definitions of doping and types of question in the survey. Depending on the definition of doping and the type of question used, the prevalence of doping obtained can differ enormously, between 1.3 and 39.2% of athletes. Marijuana and drugs for asthma were the two banned substances most used. The majority of athletes often ignored the banned list and did not use prohibited substances to dope. Using various ways to question athletes, observing the usage of substances, cross checking the data, taking into account the aim of substances uses and the various definitions of doping are necessary to give more reliable prevalence of doping. Moreover, doping at an amateur level seems to be less of a sport problem than a social problem.

MacPherson L; Calvin NT; Richards JM; Guller L; Mayes LC; Crowley MJ et al. Development and preliminary validation of a behavioral task of negative reinforcement underlying risk-taking and its relation to problem alcohol use in college freshmen. Alcoholism: Clinical and Experimental Research 36(6): 426-433, 2012. (40 refs.)

Background: A long line of theoretical and empirical evidence implicates negative reinforcement as a process underlying the etiology and maintenance of risky alcohol use behaviors from adolescence through emerging adulthood. However, the bulk of this literature has relied on self-report measures, and there is a notable absence of behavioral modes of assessments of negative reinforcement-based alcohol-related risk-taking. To address this clear gap in the literature, the current study presents the first published data on the reliability and validity of the Maryland Resource for the Behavioral Utilization of the Reinforcement of Negative Stimuli (MRBURNS), which is a modified version of the positive reinforcement-based Balloon Analogue Risk Task (BART). Methods: Participants included a convenience sample of 116 college freshmen ever regular drinkers (aged 18 to 19) who completed both behavioral tasks; self-report measures of negative reinforcement/avoidance constructs and of positive reinforcement/appetitive constructs to examine convergent validity and discriminant validity, respectively; and self-report measures of alcohol use, problems, and motives to examine criterion validity. Results: The MRBURNS evidenced sound experimental properties and reliability across task trials. In support of convergent validity, risk-taking on the MRBURNS correlated significantly with negative urgency, difficulties in emotion regulation, and depressive and anxiety-related symptoms. In support of discriminant validity, performance on the MRBURNS was unrelated to risk-taking on the BART, sensation seeking, and trait impulsivity. Finally, pertaining to criterion validity, risk-taking on the MRBURNS was related to alcohol-related problems but not heavy episodic alcohol use. Notably, risk-taking on the MRBURNS was associated with negative reinforcement-based but not with positive reinforcement-based drinking motives. Conclusions: Data from this initial investigation suggest the utility of the MRBURNS as a behavioral measure of negative reinforcement-based risk-taking that can provide a useful complement to existing self-report measures to improve our understanding of the relationship between avoidant reinforcement processes and risky alcohol use.

Mares SHW; van der Vorst H; Lichtwarck-Aschoff A; Schulten I; Verdurmen JEE; Otten R et al. Effectiveness of the home-based alcohol prevention program "In control: No alcohol!": Study protocol of a randomized controlled trial. BMC Public Health 11: article 622, 2011. (38 refs.)

Background: In the Netherlands, children start to drink at an early age; of the Dutch 12-year olds, 40% reports lifetime alcohol use, while 9.7% reports last-month drinking. Starting to drink at an early age puts youth at risk of developing several alcohol-related problems later in life. Recently, a home-based prevention program called "In control: No alcohol!" was developed to delay the age of alcohol onset in children. The main aim of this project is to conduct a Randomized Controlled Trial (RCT) to evaluate the effectiveness of the program. Methods/Design: The prevention program will be tested with an RCT among mothers and their 6 grade primary school children (11-12 years old), randomly assigned to the prevention or control condition. The program consists of five printed magazines and an activity book designed to improve parental alcohol-specific socialization. Parent-child dyads in the control group receive a factsheet information brochure, which is the standard alcohol brochure of the Trimbos Institute (the Netherlands Institute for Mental Health and Addiction). Outcome measures are initiation of alcohol use (have been drinking at least one glass of alcohol), alcohol-specific parenting, susceptibility to drinking alcohol, alcohol expectancies, self-efficacy, and frequency and intensity of child alcohol use. Questionnaires will be administered online on secured Internet webpages, with personal login codes for both mothers and children. Mothers and children in both the experimental and control condition will be surveyed at baseline and after 6, 12, and 18 months (follow-ups). Discussion: The present study protocol presents the design of an RCT evaluating the effectiveness of the home-based "In control: No alcohol!" program for 6 grade primary school children (11-12 years old). It is hypothesized that children in the prevention condition will be less likely to have their first glass of alcohol, compared to the control condition. When the prevention appears to be effective, it can easily and relatively quickly be implemented as a standard alcohol prevention program on a large scale.

Mariner DC; Ashley M; Shepperd CJ; Mullard G; Dixon M. Mouth level smoke exposure using analysis of filters from smoked cigarettes: A study of eight countries. Regulatory Toxicology and Pharmacology 61(3, supplement 1): S39-S50, 2011. (73 refs.)

The analysis of spent cigarette filters enables the estimation of the nicotine and tar (nicotine-free dry particulate matter) yields obtained by smokers in their everyday environment and has been shown to correlate well with biomarkers of exposure. Leading products across the range of ISO tar yields were selected from Australia, Brazil, Canada, Germany, Japan, New Zealand, South Africa and Switzerland. At least fifty demographically representative smokers were recruited per product. Subjects,>= 21 years of age and smoking >= 5 cigarettes per day, were asked to collect >= 15 filters from cigarettes they had smoked. The collected filters were analysed for nicotine and UV absorbance to enable the smokers' mouth level exposure to nicotine and tar to be estimated and a comparison of countries and tobacco blend styles to be made. Smoking history data were also collected. More than 80,000 filters were collected from 5703 smokers of 106 products from eight countries. Mean +/- SD estimated nicotine exposures per cigarette and per day ranged from 0.93 +/- 0.34 mg/cigarette (Brazil) to 1.77 +/- 0.69 mg/cigarette (South Africa) and from 16.4 +/- 11.1 mg/day (Germany) to 31.5 +/- 14.8 mg/day (South Africa), respectively. Male smokers obtained higher mean estimated tar and nicotine exposures than female smokers. These gender differences were statistically significant for six countries. Significant correlations were found between estimated nicotine exposure and ISO nicotine yield, and between estimated tar exposure and ISO tar yield (p < 0.001).

Martino SC; Scharf DM; Setodji CM; Shadel WG. Measuring exposure to protobacco marketing and media: A field study using ecological momentary assessment. Nicotine & Tobacco Research 14(4): 398-406, 2012. (36 refs.)

The aims of this study were to validate ecological momentary assessment (EMA) as a method for measuring exposure to tobacco-related marketing and media and to use this method to provide detailed descriptive data on college students' exposure to protobacco marketing and media. College students (n = 134; ages 18-24 years) recorded their exposures to protobacco marketing and media on handheld devices for 21 consecutive days. Participants also recalled exposures to various types of protobacco marketing and media at the end of the study period. Retrospectively recalled and EMA-based estimates of protobacco marketing exposure captured different information. The correlation between retrospectively recalled and EMA-logged exposures to tobacco marketing and media was moderate (r = .37, p < .001), and EMA-logged exposures were marginally associated with the intention to smoke at the end of the study, whereas retrospective recall of exposure was not. EMA data showed that college students were exposed to protobacco marketing through multiple channels in a relatively short period: Exposures (M = 8.24, SD = 7.85) occurred primarily in the afternoon (42%), on weekends (35%), and at point-of-purchase locations (68%) or in movies/TV (20%), and exposures to Marlboro, Newport, and Camel represented 56% of all exposures combined and 70% of branded exposures. Findings support the validity of EMA as a method for capturing detailed information about youth exposure to protobacco marketing and media that are not captured through other existing methods. Such data have the potential to highlight areas for policy change and prevention in order to reduce the impact of tobacco marketing on youth.

McCabe SE; Hughes TL; Bostwick W; Morales M; Boyd CJ. Measurement of sexual identity in surveys: Implications for substance abuse research. Archives of Sexual Behavior 41(3): 649-657, 2012. (63 refs.)

Researchers are increasingly recognizing the need to include measures of sexual orientation in health studies. However, relatively little attention has been paid to how sexual identity, the cognitive aspect of sexual orientation, is defined and measured. Our study examined the impact of using two separate sexual identity question formats: a three-category question (response options included heterosexual, bisexual, or lesbian/gay), and a similar question with five response options (only lesbian/gay, mostly lesbian/gay, bisexual, mostly heterosexual, only heterosexual). A large probability-based sample of undergraduate university students was surveyed and a randomly selected subsample of participants was asked both sexual identity questions. Approximately one-third of students who identified as bisexual based on the three-category sexual identity measure chose "mostly heterosexual" or "mostly lesbian/gay" on the five-category measure. In addition to comparing sample proportions of lesbian/gay, bisexual, or heterosexual participants based on the two question formats, rates of alcohol and other drug use were also examined among the participants. Substance use outcomes among the sexual minority subgroups differed based on the sexual identity question format used: bisexual participants showed greater risk of substance use in analyses using the three-category measure whereas "mostly heterosexual" participants were at greater risk when data were analyzed using the five-category measure. Study results have important implications for the study of sexual identity, as well as whether and how to recode responses to questions related to sexual identity.

McGinnis KA; Brandt CA; Skanderson M; Justice AC; Shahrir S; Butt AA et al. Validating smoking data from the Veteran's Affairs health factors dataset, an electronic data source. Nicotine & Tobacco Research 13(12): 1233-1239, 2011. (23 refs.)

We assessed smoking data from the Veterans Health Administration (VHA) electronic medical record (EMR) Health Factors dataset. To assess the validity of the EMR Health Factors smoking data, we first created an algorithm to convert text entries into a 3-category smoking variable (never, former, and current). We compared this EMR smoking variable to 2 different sources of patient self-reported smoking survey data: (a) 6,816 HIV-infected and -uninfected participants in the 8-site Veterans Aging Cohort Study (VACS-8) and (b) a subset of 13,689 participants from the national VACS Virtual Cohort (VACS-VC), who also completed the 1999 Large Health Study (LHS) survey. Sensitivity, specificity, and kappa statistics were used to evaluate agreement of EMR Health Factors smoking data with self-report smoking data. For the EMR Health Factors and VACS-8 comparison of current, former, and never smoking categories, the kappa statistic was .66. For EMR Health Factors and VACS-VC/LHS comparison of smoking, the kappa statistic was .61. Based on kappa statistics, agreement between the EMR Health Factors and survey sources is substantial. Identification of current smokers nationally within the VHA can be used in future studies to track smoking status over time, to evaluate smoking interventions, and to adjust for smoking status in research. Our methodology may provide insights for other organizations seeking to use EMR data for accurate determination of smoking status.

Montgomery C; Seddon AL; Fisk JE; Murphy PN; Jansari A. Cannabis-related deficits in real-world memory. Human Psychopharmacology: Clinical and Experimental 27(2): 217-225, 2012. (62 refs.)

Background: Research shows that cannabis users exhibit deficits in prospective memory (PM) and executive function, which persist beyond acute intoxication. However, many studies rely on self-reports of memory failures or use laboratory-based measures that may not mimic functional deficits in the real world. The present study aimed to assess real-world memory functioning. Method Twenty cannabis-only users and 20 non-illicit drug users were recruited. Participants completed a substance use inventory and a mood scale, followed by a non-immersive virtual reality task assessing PM and executive functioning. The task involved the participant playing the role of an office worker for the day and performing routine office duties. A number of subscales were used to assess facets of executive function (planning, adaptive thinking, creative thinking, selection, prioritisation) and PM (time-based, event-based and action-based PM). Results: Multivariate analysis of variance revealed cannabis users performed worse overall on the task, with poor performance on the planning, time-based PM and event-based PM subscales. In addition, indices of cannabis (length, dose, frequency, total use) were correlated with performance on these three subscales. Conclusions: The present study expands on previously established research, providing support for the cannabis-related deficits in PM and executive functioning, and the role of different aspects of cannabis use in these deficits.

Moore RA; Aubin HJ. Do placebo response rates from cessation trials inform on strength of addictions? International Journal of Environmental Research and Public Health 9(1): 192-211, 2012. (48 refs.)

There is an implied assumption that addictions to different substances vary in strength from weak (easier to stop) to strong (harder to stop), though explicit definitions are lacking. Our hypothesis is that the strength of addictions can be measured by cessation rates found with placebo or no treatment controls, and that a weaker addiction would have a higher cessation rate than a stronger addiction. We report an overview of systematic reviews and meta-analyses of cessation trials, using randomised or quasi-randomised trials and reporting objectively-measured abstinence. The outcome for comparison was quit rates-typically the percentage of participants abstinent according to an objective test of abstinence at six months or longer. Twenty-eight cessation reviews (139,000 participants) were found. Most data came from reviews of smoking cessation in over 127,000 participants, and other reviews each covered a few thousand participants. Few reviews used data from studies shorter than three months, and almost all determined abstinence using objective measures. Cessation rates with placebo in randomised trials using objective measures of abstinence and typically over six months duration were 8% for nicotine, 18% for alcohol, 47% for cocaine, and 44% for opioids. Evidence from placebo cessation rates indicates that nicotine is more difficult to give up than alcohol, cocaine, and opioids. Tobacco is also a severe addiction, with a number of major deleterious health effects in a large number of people.

Norberg MM; Mackenzie J; Copeland J. Quantifying cannabis use with the Timeline Followback approach: A psychometric evaluation. Drug and Alcohol Dependence 121(3): 247-252, 2012. (29 refs.)

Background: In the absence of a standardized cannabis unit, self-report instruments are inadequate for accurate quantification of cannabis use. The study extends the feasibility of using a cannabis substitute to reliably and validly measure quantity of cannabis use. Method: Ninety-eight adult Australian cannabis users (M age = 27.98, SD = 11.10: 65.31% male) completed a 90-day Timeline Followback interview regarding their cannabis use, utilizing the cannabis substitute Marijuanilla to report on quantity of use. Ninety-two of these individuals completed the interview at two time-points, and 56 of these participants had collaterals corroborate their cannabis use reports. Results: Inter-rater reliability was excellent, while test-retest reliability was good to excellent. Intra-class correlation coefficients between participant and collateral reports, while similar to previous research, were unacceptable. Quantity of cannabis use statistically significantly added to frequency of use in predicting cannabis problems and dependence severity. Concurrent and discriminant validity were established with single-item and positive impression management measures, respectively. In addition, Marijuanilla appeared similar to one specimen of street seized cannabis, but not to two others. Importantly, participants' cravings to use cannabis did not increase as a result of using the cannabis substitute to report on their cannabis use. Conclusions: These data suggest that utilizing Marijuanilla to facilitate the reporting of grams of cannabis use may be reliable and valid; however, such comprehensive assessment may only be necessary for clinical trials and epidemiological studies, which rely on precise estimates of cannabis use.

Nunes EV. The design and analysis of multisite effectiveness trials: A decade of progress in the National Drug Abuse Clinical Trials Network. (editorial). American Journal of Drug and Alcohol Abuse 37(5): 269-272, 2011. (28 refs.)

Nunes EV; Pavlicova M; Hu MC; Campbell AN; Miele G; Hien D et al. Baseline matters: The importance of covariation for baseline severity in the analysis of clinical trials. American Journal of Drug and Alcohol Abuse 37(5): 446-452, 2011. (29 refs.)

Background: Clinical trials testing the effectiveness of interventions for addictions, HIV transmission risk, and other behavioral health problems are important to advancing evidence-based treatment. Such trials are expensive and time-consuming to conduct, but the underlying effect sizes tend to be modest, and often findings are disappointing, failing to show evidence of treatment effects. Objectives: To demonstrate how appropriate covariation for baseline severity can enhance detection of treatment effects. Methods: Explication and case example. Results: Baseline severity (the score of the outcome measure at baseline, prior to randomization) is often strongly associated with outcome in such studies. Covariation for baseline score may enhance detection of treatment effects, because the variance explained by the baseline score is removed from the error variance in the estimate of the difference in outcome between treatments. Alternatively, the effect of treatment may manifest in the form of a baseline-by-treatment interaction. Common interaction patterns include that treatment may be more effective among patients with higher levels of baseline severity, or treatment may be more effective among patients with low severity at baseline ('relapse prevention' effect). Such effects may be important to developing treatment guidelines and offer clues toward understanding the mechanisms of action of treatments and of the disorders. Conclusions and Scientific Significance: This article illustrates principles of covariation for baseline and the baseline-by-treatment interaction in nontechnical graphical terms, and discusses examples from clinical trials. Implications for the design and analysis of clinical trials are discussed, and it is argued that covariation for baseline severity of the outcome measure and testing of the baseline-by-treatment interaction should be considered for inclusion in the primary outcome analyses of treatment effectiveness trials of substantial size.

Oden NL; VanVeldhuisen PC; Wakim PG; Trivedi MH; Somoza E; Lewis D. Power of automated algorithms for combining time-line follow-back and urine drug screening test results in stimulant-abuse clinical trials. American Journal of Drug and Alcohol Abuse 37(5): 350-357, 2011. (11 refs.)

Background: In clinical trials of treatment for stimulant abuse, researchers commonly record both Time-Line Follow-Back (TLFB) self-reports and urine drug screen (UDS) results. Objectives: To compare the power of self-report, qualitative (use vs. no use) UDS assessment, and various algorithms to generate self-report-UDS composite measures to detect treatment differences via t-test in simulated clinical trial data. Methods: We performed Monte Carlo simulations patterned in part on real data to model self-report reliability, UDS errors, dropout, informatively missing UDS reports, incomplete adherence to a urine donation schedule, temporal correlation of drug use, number of days in the study period, number of patients per arm, and distribution of drug-use probabilities. Investigated algorithms include maximum likelihood and Bayesian estimates, self-report alone, UDS alone, and several simple modifications of self-report (referred to here as ELCON algorithms) which eliminate perceived contradictions between it and UDS. Results: Among the algorithms investigated, simple ELCON algorithms gave rise to the most powerful t-tests to detect mean group differences in stimulant drug use. Conclusions: Further investigation is needed to determine if simple, naive procedures such as the ELCON algorithms are optimal for comparing clinical study treatment arms. But researchers who currently require an automated algorithm in scenarios similar to those simulated for combining TLFB and UDS to test group differences in stimulant use should consider one of the ELCON algorithms. Scientific Significance: This analysis continues a line of inquiry which could determine how best to measure outpatient stimulant use in clinical trials (National Institute on Drug Abuse. National Institute on Drug Abuse Monograph-57: Self-Report Methods of Estimating Drug Abuse: Meeting Current Challenges to Validity. NTIS PB 88248083. Bethesda, MD: National Institutes of Health, 1985; National Institute on Drug Abuse. National Institute on Drug Abuse Research Monograph 73: Urine Testing for Drugs of Abuse. NTIS PB 89151971. Bethesda, MD: National Institutes of Health, 1987; National Institute on Drug Abuse. National Institute on Drug Abuse Research Monograph 167: The Validity of Self-Reported Drug Use: Improving the Accuracy of Survey Estimates. NTIS PB 97175889. GPO 017-024-01607-1. Bethesda, MD: National Institutes of Health, 1997).

Petroczi A; Nepusz T; Cross P; Taft H; Shah S; Deshmukh N et al. New non-randomised model to assess the prevalence of discriminating behaviour: A pilot study on mephedrone. Substance Abuse Treatment, Prevention and Policy 6: e-article 20, 2011. (61 refs.)

Background: An advantage of randomised response and non-randomised models investigating sensitive issues arises from the characteristic that individual answers about discriminating behaviour cannot be linked to the individuals. This study proposed a new fuzzy response model coined 'Single Sample Count' (SSC) to estimate prevalence of discriminating or embarrassing behaviour in epidemiologic studies. Methods: The SSC was tested and compared to the established Forced Response (FR) model estimating Mephedrone use. Estimations from both SSC and FR were then corroborated with qualitative hair screening data. Volunteers (n = 318, mean age = 22.69 +/- 5.87, 59.1% male) in a rural area in north Wales and a metropolitan area in England completed a questionnaire containing the SSC and FR in alternating order, and four questions canvassing opinions and beliefs regarding Mephedrone. Hair samples were screened for Mephedrone using a qualitative Liquid Chromatography-Mass Spectrometry method. Results: The SSC algorithm improves upon the existing item count techniques by utilizing known population distributions and embeds the sensitive question among four unrelated innocuous questions with binomial distribution. Respondents are only asked to indicate how many without revealing which ones are true. The two probability models yielded similar estimates with the FR being between 2.6% - 15.0%; whereas the new SSC ranged between 0% - 10%. The six positive hair samples indicated that the prevalence rate in the sample was at least 4%. The close proximity of these estimates provides evidence to support the validity of the new SSC model. Using simulations, the recommended sample sizes as the function of the statistical power and expected prevalence rate were calculated. Conclusion: The main advantages of the SSC over other indirect methods are: simple administration, completion and calculation, maximum use of the data and good face validity for all respondents. Owing to the key feature that respondents are not required to answer the sensitive question directly, coupled with the absence of forced response or obvious self-protective response strategy, the SSC has the potential to cut across self-protective barriers more effectively than other estimation models. This elegantly simple, quick and effective method can be successfully employed in public health research investigating compromising behaviours.

Pires J; Padrao P; Damasceno A; Silva-Matos C; Lunet N. Impact of different reference period definitions in the quantification of alcohol consumption: Results from a Nationwide STEPS Survey in Mozambique. Alcohol and Alcoholism 47(3): 328-333, 2012. (36 refs.)

Aims: To compare the estimates of alcohol consumption in Mozambique obtained with different reference period definitions. This is a critical methodological aspect when measuring alcohol consumption and its impact is likely to vary across settings. Methods: A nationally representative sample of 3264 Mozambicans aged 25-64 years was evaluated in a community-based cross-sectional study conducted between September and November 2005. Face-to-face interviews were conducted following the World Health Organization-Stepwise approach to Surveillance methodology. The amount of alcohol consumed was estimated among current drinkers, using the previous week (1W) and the 12 months (12M) prior to the data collection as the reference. Results: Among drinkers, the prevalence of consumption of > 14 drinks/week was higher in men (12M: 18.6 vs. 7.8%; 1W: 16.3 vs. 6.1%), although the prevalence of excessive weekly intake (> 7 drinks for women and > 14 drinks for men) was higher among women (12M: 25.9 vs. 18.6%; 1W: 18.1 vs. 16.3%). The concordance between the reported intakes according to the reference period was low (kappa = 0.25). Conclusion: In this setting where alcohol consumption is a male-dominated behaviour, among drinkers the prevalence of gender-defined excessive amounts was higher in women. The concordance between different recall periods was low and this needs to be taken into account when comparing results from different studies.

Plebani JG; Ray LA; Morean ME; Corbin WR; MacKillop J; Amlung M et al. Human laboratory paradigms in alcohol research. (review). Alcoholism: Clinical and Experimental Research 36(6): 455-466, 2012. (129 refs.)

Background: Human laboratory studies have a long and rich history in the field of alcoholism. Human laboratory studies have allowed for advances in alcohol research in a variety of ways, including elucidating neurobehavioral mechanisms of risk, identifying phenotypically distinct subtypes of alcohol users, investigating the candidate genes underlying experimental phenotypes for alcoholism, and testing mechanisms of action of alcoholism pharmacotherapies on clinically relevant translational phenotypes, such as persons exhibiting positive-like alcohol effects or alcohol craving. Importantly, the field of human laboratory studies in addiction has progressed rapidly over the past decade and has built upon earlier findings of alcohol's neuropharmacological effects to advancing translational research on alcoholism etiology and treatment. Methods and Results: To that end, the new generation of human laboratory studies has focused on applying new methodologies, further refining alcoholism phenotypes, and translating these findings to studies of alcoholism genetics, medication development, and pharmacogenetics. The combination of experimental laboratory approaches with the recent developments in neuroscience and pharmacology has been particularly fruitful in furthering our understanding of the impact of individual differences in alcoholism risk and in treatment response. Conclusions: This review of the literature focuses on human laboratory studies of subjective intoxication, alcohol craving, anxiety, and behavioral economics. Each section discusses opportunities for phenotype refinement under laboratory conditions, as well as its application to translational science of alcoholism. A summary and recommendations for future research are also provided.

Post A; Gilljam H; Bremberg S; Galanti AR. Psychosocial determinants of attrition in a longitudinal study of tobacco use in youth. Scientific World Journal : article 654030, 2012. (16 refs.)

To gain knowledge on psychosocial characteristics that predict the propensity of participation in longitudinal studies, attrition was analysed in a cohort of 3020 adolescents participating in the baseline survey of a longitudinal study with repeated followup focusing on adolescents' tobacco use. During the followup surveys, the proportion of responders was constantly at or above 90%. There were 941 adolescents (31.2%) who failed to participate in at least one of the six followup surveys. Boys had a fifty percent increased risk of nonparticipation compared with girls. Adolescents in families with experience of divorce, unemployment, and change of residence had a higher risk of nonparticipation. An increasing number of stressful life events during the previous year, uptake of tobacco use, number of friends, perceived performance at school, truancy, and alcohol use during the last term also independently associated with nonparticipation. Diverse psychosocial characteristics are independently associated with nonparticipation of youths in longitudinal studies.

Potter JS; Donovan DM; Weiss RD; Gardin J; Lindblad R; Wakim P et al. Site selection in community-based clinical trials for substance use disorders: Strategies for effective site selection. American Journal of Drug and Alcohol Abuse 37(5): 400-407, 2011. (15 refs.)

Background: The importance of conducting substance use disorder treatment research in real-world settings is now well recognized. While this approach to clinical trials research offers a variety of benefits, challenges also arise. Selecting high-quality sites to participate is critical to recruitment, retention, and overall trial performance when conducting multi-site, community-based clinical trials of treatments for substance use disorders. Objectives: Over the past 10 years, the National Institute on Drug Abuse-sponsored National Drug Abuse Treatment Clinical Trials Network (CTN) has strived to conduct high-quality, well-managed clinical trials. This includes developing methods for site selection to be used by investigators conducting CTN trials. Methods: We review site selection strategies from two community-based multi-site clinical trials conducted under the auspices of the National Drug Abuse Treatment Clinical Trials Network. Results: Issues relevant to site selection include the clinical trial design, availability of appropriate clinical population, and organizational attributes of potential clinical research sites. Site selection strategies include reviewing regional epidemiologic data, collecting standard site selection surveys, evaluating clinic data on existing patient populations, and site selection interviews and visits. Conclusion: This article describes considerations for selecting research sites and identifies specific strategies to employ when selecting community-based sites for participation in clinical trials.

Prochaska JO. Commentary on Sendzik et al. What do we know about unplanned quit attempts: Practically nothing or nothing practical? Addiction 106(11): 2014-2015, 2011. (6 refs.)

The author raises questions about the methodology and data analysis of the study reported in this issue, "Planned quit attempts among Ontario smokers: Impact on abstinence." Among the questions raised is what constitutes a "planned" quit attempt versus a spontaneous effort. Questions are also raised about the range of aids cited. A response by the study authors follows.

Ramo DE; Prochaska JJ. Broad reach and targeted recruitment using Facebook for an online survey of young adult substance use. Journal of Medical Internet Research 14(1): e-article 28, 2012. (20 refs.)

Background: Studies of tobacco use and other health behaviors have reported great challenges in recruiting young adults. Social media is widely used by young adults in the United States and represents a potentially fast, affordable method of recruiting study participants for survey research. Objective: The present study examined Facebook as a mechanism to reach and survey young adults about tobacco and other substance use. Methods: Participants were cigarette users, age 18-25 years old, living throughout the United States and recruited through Facebook to complete a survey about tobacco and other substance use. Paid advertising using Facebook's Ad program over 13 months from 2010 Feb 28 to 2011 Apr 4 targeted by age (18-25), location (United States or California), language (English), and tobacco-and/or marijuana-related keywords. Facebook approved all ads. Results: The campaign used 20 ads, which generated 28,683,151 impressions, yielding 14,808 clicks (0.7% of targeted Facebook members), at an overall cost of $6,628.24. The average cost per click on an ad was $0.45. The success of individual ads varied widely. There was a rise in both clicks and impressions as the campaign grew. However, the peak for clicks was 3 months before the peak for ad impressions. Of the 69,937,080 accounts for those age 18-25 in the United States, Facebook estimated that 2.8% (n = 1,980,240) were reached through tobacco and marijuana keywords. Our campaign yielded 5237 signed consents (35.4% of clicks), of which 3093 (59%) met criteria, and 1548 (50% of those who met criteria) completed the survey. The final cost per valid completed survey was $4.28. The majority of completed surveys came from whites (69%) and males (72%). The sample averaged 8.9 cigarettes per day (SD 7.5), 3.8 years of smoking (SD 2.9), with a median of 1 lifetime quit attempts; 48% did not intend to quit smoking in the next 6 months. Conclusions: Despite wide variety in the success of individual ads and potential concerns about sample representativeness, Facebook was a useful, cost-effective recruitment source for young-adult smokers to complete a survey about the use of tobacco and other substances. The current findings support Facebook as a viable recruitment option for assessment of health behavior in young adults.

Reid MJ; Langford KH; Morland J; Thomas KV. Analysis and interpretation of specific ethanol metabolites, ethyl sulfate, and ethyl glucuronide in sewage effluent for the quantitative measurement of regional alcohol consumption. Alcoholism: Clinical and Experimental Research 35(9): 1593-1599, 2011. (25 refs.)

Background: The quantitative measurement of urinary metabolites in sewage streams and the subsequent estimation of consumption rates of the parent compounds have previously been demonstrated for pharmaceuticals and narcotics. Ethyl sulfate and ethyl glucuronide are excreted in urine following the ingestion of alcohol, and are useful biomarkers for the identification of acute alcohol consumption. This study reports a novel ion-exchange-mediated chromatographic method for the quantitative measurement of ethyl sulfate and ethyl glucuronide in sewage effluent, and presents a novel calculation method for the purposes of relating the resulting sewage concentrations with rates of alcohol consumption in the region. Methods: A total of 100 sewage samples covering a 25-day period were collected from a treatment plant servicing approximately 500,000 people, and analyzed for levels of ethyl sulfate and ethyl glucuronide. The resulting data were then used to estimate combined alcohol consumption rates for the region, and the results were compared with alcohol related sales statistics for the same region. Results: Ethyl glucuronide was found to be unstable in sewage effluent. Ethyl sulfate was stable and measurable in all samples at concentrations ranging from 16 to 246 nM. The highest concentrations of the alcohol biomarker were observed during weekend periods. Sixty one percent of the total mass of ethyl sulfate in sewage effluent corresponds to alcohol consumption on Friday and Saturday. Sales statistics for alcohol show that consumption in the region is approximately 6,750 kg/d. The quantity of ethyl sulfate passing through the sewage system is consistent with consumption of 4,900 to 7,800 kg/d. Conclusions: Sewage epidemiology assessments of ethyl sulfate can provide accurate estimates of community alcohol consumption, and detailed examination of the kinetics of this biomarker in sewage streams can also identify time-dependent trends in alcohol consumption patterns.

Saito K; Saito R; Kikuchi Y; Iwasaki Y; Ito R; Nakazawa H. Analysis of drugs of abuse in biological specimens. (review). Journal of Health Science 57(6): 472-487, 2011. (80 refs.)

Recent reports of the analysis of drugs of abuse in biological specimens are reviewed herein. Different perspectives from reviews so far published and the need for and the background of drug analysis in biological specimens, and difficulty of drug testing in biological specimens are introduced. Comprehensive biological specimens for the analysis of drugs of abuse in forensic science, including oral fluid (saliva), hair, umbilical cord, placenta, meconium, cadaver tissue (brain, adipose), sweat, breath, and nail clippings, in addition to the commonly used blood and urine specimens in clinical chemistry, are described along with their outlines, advantages/disadvantages, and actual examples. Today, liquid chromatography-tandem mass spectrometry (LC-MS/MS) is the method of choice for the analysis of drugs of abuse. A simultaneous screening method for multiple types of drugs has also become popular recently. However, because qualitative determination remains important in forensic science, gas chromatographymass spectrometry (GC-MS) is still in use even if it requires complicated specimen preparation and derivatization procedures. This is because GC-MS is reliable and has been employed ever since for the appraisal of trials.

Pharmaceutical Society of Japan

Severi E; Free C; Knight R; Robertson S; Edwards P; Hoile E. Two controlled trials to increase participant retention in a randomized controlled trial of mobile phone-based smoking cessation support in the United Kingdom. Clinical Trials 8(5): 654-660, 2011. (17 refs.)

Background: Loss to follow-up of trial participants represents a threat to research validity. To date, interventions designed to increase participants' awareness of benefits to society of completing follow-up, and the impact of a telephone call from a senior female clinician and researcher requesting follow-up have not been evaluated robustly. Purpose: Trial 1 aimed to evaluate the effect on trial follow-up of written information regarding the benefits of participation to society. Trial 2 aimed to evaluate the effect on trial follow-up of a telephone call from a senior female clinician and researcher. Methods Two single-blind randomized controlled trials were nested within a larger trial, Txt2stop. In Trial 1, participants were allocated using minimization to receive a refrigerator magnet and a text message emphasizing the benefits to society of completing follow-up, or to a control group receiving a simple reminder regarding follow-up. In Trial 2, participants were randomly allocated to receive a telephone call from a senior female clinician and researcher, or to a control group receiving standard Txt2stop follow-up procedures. Results: Trial 1: 33.5% (327 of 976) of the intervention group and 33.8% (329 of 974) of the control group returned the questionnaire within 26 weeks of randomization, risk ratio (RR) 0.99; 95% confidence interval (CI) 0.88-1.12. In all, 83.3% (813 of 976) of the intervention group and 82.2% (801 of/974) of the control group sent back the questionnaire within 30 weeks of randomization, RR 1.01; 95% CI 0.97, 1.05. Trial 2: 31% (20 of 65) of the intervention group and 32% (20 of 62) of the control group completed trial follow-up, RR 0.93; 95% CI 0.44, 1.98. Conclusions: In presence of other methods to increase follow-up neither experimental method (refrigerator magnet and text message emphasizing participation's benefits to society nor a telephone call from study's principal investigator) increased participant follow-up in the Txt2stop trial.

Shareck M; Dassa C; Frohlich KL. Improving the measurement of neighbourhood characteristics through systematic observation: Inequalities in smoking as a case study. Health & Place 18(3): 671-682, 2012. (62 refs.)

Systematic observation is increasingly used as a method to measure neighbourhood characteristics thought to influence health inequalities. This article reports on the theory-driven development of a new observation tool composed of reflective indicators of neighbourhood characteristics believed to influence inequalities in smoking. We also report the results of generalisability analyses conducted to estimate the reliability (inter-rater reliability and temporal stability) of the observation tool. We use the reliability results to reflect on the quality of the measures and on the theoretical anchors of the tool. We conclude by making recommendations to improve measures collected through systematic observation.

Shield KD; Taylor B; Kehoe T; Patra J; Rehm J. Mortality and potential years of life lost attributable to alcohol consumption in Canada in 2005. BMC Public Health 12: article 91, 2012. (59 refs.)

Background: Alcohol is a substantial risk factor for mortality according to the recent 2010 World Health Assembly strategy to reduce the harmful use of alcohol which outlined the need to characterize and monitor this burden. Accordingly, using new methodology we estimated 1) the number of deaths caused and prevented by alcohol consumption, and 2) the potential years of life lost (PYLLs) attributable to alcohol consumption in Canada in 2005. Methods: Mortality attributable to alcohol consumption was estimated by calculating Alcohol-Attributable Fractions (AAFs) (defined as the proportion of mortality that would be eliminated if the exposure was eliminated) using data from various sources. Indicators for alcohol consumption were obtained from the Canadian Alcohol and Drug Use Monitoring Survey 2008 and corrected for adult per capita recorded and unrecorded alcohol consumption. Risk relations were taken from the Comparative Risk Assessment within the current Global Burden of Disease (GBD) study. Due to concerns about the reliability of information specifying causes of death for people aged 65 or older, our analysis was limited to individuals aged 0 to 64 years. Calculation of the 95% confidence intervals (CIs) for the AAFs was performed using Monte Carlo random sampling. Information on mortality was obtained from Statistics Canada. A sensitivity analysis was performed comparing the mortality results obtained using our study methods to results obtained using previous methodologies. Results: In 2005, 3, 970 (95% CI: 810 to 7, 170) deaths (4, 390 caused and 420 prevented) and 134, 555 (95% CI: 36, 690 to 236, 376) PYLLs were attributable to alcohol consumption for individuals aged 0 to 64 years. These figures represent 7.7% (95% CI: 1.6% to 13.9%) of all deaths and 8.0% (95% CI: 2.2% to 14.1%) of all PYLLs for individuals aged 0 to 64 years. The sensitivity analysis showed that the number of deaths as measured by this new methodology is greater than that if mortality was estimated using previous methodologies. Conclusions: The mortality burden attributable to alcohol consumption for Canada is large, unnecessary, and could be substantially reduced in a short period of time if effective public health policies were implemented. A monitoring system on alcohol consumption is imperative and would greatly assist in planning and evaluating future Canadian public health policies related to alcohol consumption.

Shihadeh AL; Eissenberg TE. Significance of smoking machine toxicant yields to blood-level exposure in water pipe tobacco smokers. Cancer Epidemiology, Biomarkers & Prevention 20(11): 2457-2468, 2011. (38 refs.)

Background: The global increase in tobacco smoking with a water pipe (hookah, narghile, or shisha) has made understanding its health consequences imperative. One key to developing this understanding is identifying and quantifying carcinogens and other toxicants present in water pipe smoke. To do so, the toxicant yield of machine-generated water pipe smoke has been measured. However, the relevance of toxicant yields of machine-generated smoke to actual human exposure has not been established. Methods: In this study, we examined whether carbon monoxide (CO) and nicotine yields measured with a smoking machine programmed to replicate the puffing behavior of 31 human participants who smoked a water pipe could reliably predict these participants' blood-level exposure. In addition to CO and nicotine, yields of polyaromatic hydrocarbons, volatile aldehydes, nitric oxide (NO), and "tar" were measured. Results: We found that when used in this puff-replicating manner, smoking machine yields are highly correlated with blood-level exposure (nicotine: r > 0.76, P < 0.001; CO: r > 0.78, P < 0.001). Total drawn smoke volume was the best predictor of toxicant yield and exposure, accounting for approximately 75% to 100% of the variability across participants in yields of NO, CO, volatile aldehydes, and tar, as well as blood-level CO and normalized nicotine. Conclusions: Machine-based methods can be devised in which smoke toxicant yields reliably track human exposure. Impact: This finding indicates the basic feasibility of valid analytic laboratory evaluation of tobacco products for regulatory purposes.

Shiyko MP; Lanza ST; Tan XM; Li RZ; Shiffman S. Using the Time-Varying Effect Model (TVEM) to examine dynamic associations between negative affect and self confidence on smoking urges: Differences between successful quitters and relapsers. Prevention Science 13(3): 288-299, 2012. (51 refs.)

With technological advances, collection of intensive longitudinal data (ILD), such as ecological momentary assessments, becomes more widespread in prevention science. In ILD studies, researchers are often interested in the effects of time-varying covariates (TVCs) on a time-varying outcome to discover correlates and triggers of target behaviors (e.g., how momentary changes in affect relate to momentary smoking urges). Traditional analytical methods, however, impose important constraints, assuming a constant effect of the TVC on the outcome. In the current paper, we describe a time-varying effect model (TVEM) and its applications to data collected as part of a smoking-cessation study. Differentiating between groups of short-term successful quitters ( = 207) and relapsers ( = 40), we examine the effects of momentary negative affect and abstinence self-efficacy on the intensity of smoking urges in each subgroup in the 2 weeks following a quit attempt. Successful quitters demonstrated a rapid reduction in smoking urges over time, a gradual decoupling of the association between negative affect and smoking urges, and a consistently strong negative effect of self-efficacy on smoking urges. In comparison, relapsers exhibited a high level of smoking urges throughout the post-quit period, a time-varying and, generally, weak effect of self-efficacy on smoking urges, and a gradual reduction in the strength of the association between negative affect and smoking urges. Implications of these findings are discussed. The TVEM is made available to applied prevention researchers through a SAS macro.

Simpson DD; Joe GW; Dansereau DF; Flynn PM. Addiction treatment outcomes, process and change: Texas Institute of Behavioral Research at Texas Christian University. Addiction 106(10): 1733-1740, 2011. (55 refs.)

For more than 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs-the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-89), the second focused upon modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus upon adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases, organizational and systems functioning, treatment costs and process related to implementation of evidence-based practices.

Stanczyk NE; Bolman C; Muris JWM; de Vries H. Study protocol of a Dutch smoking cessation e-health program. BMC Public Health 11: e-847, 2011. (45 refs.)

Background: The study aims to test the differential effects of a web-based text and a web-based video-driven computer-tailored approach for lower socio-economic status (LSES) and higher socio-economic status (HSES) smokers which incorporate multiple computer-tailored feedback moments. The two programs differ only in the mode of delivery (video-versus text-based messages). The paper aims to describe the development and design of the two computer-tailored programs. Methods/design: Respondents who smoked at the time of the study inclusion, who were motivated to quit within the following six months and who were aged 18 or older were included in the program. The study is a randomized control trial with a 2 (video/text) * 2(LSES/HSES) design. Respondents were assigned either to one of the intervention groups (text versus video tailored feedback) or to the control group (non-tailored generic advice). In all three conditions participants were asked to fill in the baseline questionnaire based on the I-Change model. The questionnaire assessed socio-demographics, attitude towards smoking, knowledge, self-efficacy, social influence, depression, level of addiction, action planning, goal actions, intention to quit smoking, seven-day point prevalence and continued abstinence. Follow-up measurements were conducted at six and twelve months after baseline. Discussion: The present paper describes the development of the two computer-tailored smoking cessation programs, their components and the design of the study. The study results reveal different working mechanisms of multiple tailored smoking cessation interventions and will help us to gain more insight into effective strategies to target different subgroups, especially smokers with a lower socio-economic status.

Steglich C; Sinclair P; Holliday J; Moore L. Actor-based analysis of peer influence in A Stop Smoking In Schools Trial (ASSIST). Social Networks 34(3, special issue): 359-369, 2012. (47 refs.)

As shown by the success of network intervention studies that exploit the occurrence of peer influence in their target group, the reliable assessment of peer influence processes can be important for informing public health policy and practice. A recently developed tool for assessing peer influence in longitudinal social network data is stochastic actor-based modeling. The body of the literature in which this method is applied is growing, but how reliable are the results? In this paper, we identify two shortcomings in this literature: the questionable assumption of temporal homogeneity, and the potential dependence of results on the inclusion of nuisance parameters in the model specification. These issues are resolved by analyzing the data of three schools selected from ASSIST, a large UK-based trial of a school-based smoking prevention intervention. Results show that the co-evolution of friendship and smoking is a time heterogeneous process, and that results are sensitive to specification details. However, the peer influence parameter is not affected by either, but emerges as surprisingly stable over time and robust to model variation. This establishes confidence in the method and encourages detailed future investigations of peer influence in ASSIST.

Stein LAR; Lebeau R; Clair M; Martin R; Bryant M; Storti S. Preliminary web-based measures development for GHB: Expectancies, functions, and withdrawal. American Journal of Drug and Alcohol Abuse 38(2): 121-129, 2012. (43 refs.)

Background: Much of what is understood regarding gamma hydroxybutyrate (GHB) treatment is based on hospital case studies for overdose and withdrawal, and there are currently no measures developed specifically for GHB or its analogs (e. g., gamma butyrolactone and 1,4-butanediol) to assess drug effect expectancies, reasons for starting use, withdrawal effects, and knowledge and opinions about use. Objectives: This pilot study (N = 61) was conducted to begin measures development to assess experiences, functions of use, and opinions regarding use as indicated by respondents taking a Web-based survey. Methods: Minimum average partial correlation and parallel analysis procedures are employed to create scales. Results: Scales were developed to assess expectancies, reasons for use, withdrawal, and knowledge/opinions of use with median alpha = .79 and that account for 8.69-24.17% of the variance. Conclusion: Scales have relatively good psychometric properties and replication is needed. Scientific Significance: GHB-specific measures may greatly assist in furthering our understanding of protective and risk factors for use, and withdrawal phenomena.

Stillwell DJ; Tunney RJ. Effects of measurement methods on the relationship between smoking and delay reward discounting. Addiction 107(5): 1003-1012, 2012. (40 refs.)

Aims: Delay reward discounting (DRD) measures the degree to which a person prefers smaller rewards soon or larger rewards later. People who smoke have been shown to have higher DRD. There are several ways of measuring DRD, and the method used might influence the association between smoking and DRD. The key differences are the order in which the items are presented, the delays used and the magnitude of the delayed amount. Setting An international online study running from September 2010 to June 2011. Participants A total of 9454 individuals; 38% male, mean age = 23.1 years. Design and measurements: Users completed amulti- item DRD task. They were randomly presented the immediate rewards in an ascending, descending or randomized order. The delayswere between 1week and 5 years. The delayed amounts were $ 1000 for all delays, and $ 100 for 1 month. Users also self- reported their smoking status. Findings: A hyperbolic DRD function fitted better than an exponential function. There were differences in the derived DRD function based on methodology used; items presented in a randomized order, longer delays and smaller rewards showed steeper discounting. However, these did not interact with smoking status, as for all methodologies used daily smokers showed the steepest discounting, followed by non- daily smokers, then non- smokers. Conclusions: Smokers discount future consequences more than non-smokers, irrespective of which measurement is used, but variations in method lead to different estimates that are not comparable between experiments.

Sussman S; Leventhal A; Bluthenthal RN; Freimuth M; Forster M; Ames SL. A framework for the specificity of addictions. International Journal of Environmental Research and Public Health 8(8): 3399-3415, 2011. (90 refs.)

Research over the last two decades suggests that a wide range of substance and behavioral addictions may serve similar functions. Yet, co-occurrence of addictions has only been reported among a minority of addicts. "Addiction specificity" pertains to a phenomenon in which one pattern of addictive behaviors may be acquired whereas another is not. This paper presents the PACE model as a framework which might help explain addiction specificity. Pragmatics, attraction, communication, and expectation (PACE) variables are described, which may help give some direction to future research needs in this arena.

Thomas SE; Bacon AK; Randall PK; Brady KT; See RE. An acute psychosocial stressor increases drinking in non-treatment-seeking alcoholics. Psychopharmacology 218(1, special issue): 19-28, 2011. (53 refs.)

Although studies suggest that stress is an important reason for relapse in alcoholics, few controlled studies have been conducted to examine this assumption. Evidence of stress-potentiated drinking would substantiate this clinical observation and would contribute to the development of a model that would be valuable to alcohol treatment research. The hypothesis was tested that an acute psychosocial stressor, the Trier Social Stress Test (TSST), increases alcohol consumption in non-treatment-seeking alcoholics. Seventy-nine alcohol-dependent participants (40 women) were randomly assigned to receive the TSST or a no-stress condition. Immediately afterward, all participants received an initial dose of their preferred alcoholic beverage to achieve a target blood alcohol concentration of 0.03 g/dl (to prime subsequent drinking in the laboratory). Participants then participated in a mock taste test of two glasses of beer. Primary dependent measures were whether s/he drank all of the beer available (yes/no) and total amount of beer consumed (milliliters). Stressed participants were twice as likely as non-stressed participants to drink all of the beer available, a significant effect. Although the stressed group drank more milliliters than the non-stressed group, this effect failed to reach significance, likely due to ceiling effects. There were no significant stress group x gender effects on either outcome. This study supports that stress-potentiated drinking is valid and can be modeled in a clinical laboratory setting.

Tiffany ST; Friedman L; Greenfield SF; Hasin DS; Jackson R. Beyond drug use: A systematic consideration of other outcomes in evaluations of treatments for substance use disorders. Addiction 107(4): 709-718, 2012. (115 refs.)

Across the addictions field, the primary outcome in treatment research has been reduction in drug consumption. A comprehensive view of the impact of substance use disorders on human functioning suggests that effective treatments should address the many consequences and features of addiction beyond drug use, a recommendation forwarded by multiple expert panels and review papers. Despite recurring proposals, and a compelling general rationale for moving beyond drug use as the sole standard for evaluating addiction treatment, the field has yet to adopt any core set of other measures that are routinely incorporated into treatment research. Among the many reasons for the limited impact of previous proposals has been the absence of a clear set of guidelines for selecting candidate outcomes. This paper is the result of the deliberations of a panel of substance abuse treatment and research experts convened by the National Institute on Drug Abuse to discuss appropriate outcome measures for clinical trials of substance abuse treatments. This paper provides an overview of previous recommendations and outlines specific guidelines for consideration of candidate outcomes. A list of outcomes meeting those guidelines is described and illustrated in detail with two outcomes: craving and quality of life. The paper concludes with specific recommendations for moving beyond the outcome listing offered in this paper to promote the programmatic incorporation of these outcomes into treatment research.

Torche F; Warren JR; Halpern-Manners A; Valenzuela E. Panel conditioning in a longitudinal study of adolescents' substance use: Evidence from an experiment. Social Forces 90(3): 891-918, 2012. (31 refs.)

Panel surveys are widely used in sociology to examine life-course trajectories and to assess causal effects. However, when using panel data researchers usually assume that the act of measuring respondents' attitudes and behaviors has no effect on the attributes being measured or on the accuracy of reports about those attributes. Evidence from cognitive psychology, marketing research, political science and other fields suggests that this assumption may not be warranted. Using a rigorous experimental design, we examine the magnitude of panel conditioning bias - the bias emerging from having answered questions in prior waves of a survey - in a panel study of substance use among adolescents in Chile. We find that adolescents who answered survey questions about alcohol, cigarette, marijuana and cocaine use were considerably less likely than members of a control group to report substance use when re-interviewed one year later. This finding has important implications, and also points to the need for sociologists to be concerned about panel conditioning as an important methodological issue.

Torvik FA; Rognmo K; Tambs K. Alcohol use and mental distress as predictors of non-response in a general population health survey: The HUNT study. Social Psychiatry and Psychiatric Epidemiology 47(5): 805-816, 2012. (52 refs.)

To investigate to what degree alcohol use and mental distress are associated with non-response in a population-based health study. From 1995 to 1997, 91,488 persons were invited to take part in a health study at Nord-Trondelag, Norway, and the response rate was 69.2%. Demographics were available for everyone. Survey answers from a previous survey were available for most of the participants and a majority of non-participants. In addition, the survey responses from spouses and children of the invitees were used to predict participation in the aforementioned study. Crude and adjusted ORs for a number of predictors, among these alcohol consumption and mental distress, are reported. Both heavy drinkers (OR = 1.27) and abstainers (OR = 1.64) had a higher probability of dropping out in comparison to people who usually do not drink. High levels of mental distress (OR = 1.84) also predicted attrition. Alcohol use and mental distress are moderately associated with non-response, though probably not a major cause, as controlling for other variables weakened the associations. Nevertheless, the moderate but clear underrepresentation at the crude level of people with high alcohol consumption, abstainers and people with poor mental health should be taken into consideration when interpreting results from health surveys.

Traylor AC; Parrish DE; Copp HL; Bordnick PS. Using virtual reality to investigate complex and contextual cue reactivity in nicotine dependent problem drinkers. Addictive Behaviors 36(11): 1068-1075, 2011. (33 refs.)

Alcohol and cigarette smoking frequently co-occur among adults in the U.S., resulting in a myriad of deleterious health outcomes. Cue reactivity has been posited as one factor that precludes individuals from overcoming alcohol and nicotine dependency. While cue reactivity studies have focused on the impact of proximal cues on cue reactivity, much less is known about the unique impact of complex and contextual cues. This pilot study compares nicotine and alcohol cue reactivity among a sample of nicotine dependent, daily drinkers (N=21) across neutral, party, and office courtyard virtual reality (VR) contexts embedded with proximal smoking cues to: 1) explore and compare the effects of complex nicotine cues on alcohol cross-cue reactivity between nicotine/alcohol dependent drinkers and nicotine dependent/non-alcohol dependent daily drinkers, and 2) assess the effectiveness of VR for eliciting cue-induced nicotine craving responses using complex nicotine cues. Nicotine dependent/non-alcohol dependent drinkers had significantly lower craving for alcohol in the non-alcohol congruent office courtyard VR scene and there was no difference in the alcohol-congruent party scene when compared to the alcohol dependent group, suggesting that the non-alcohol dependent daily drinking group was more likely to react to contextual cues. Consistent with prior cue reactivity studies, dependent smokers experienced significantly higher craving for nicotine in the VR smoking congruent contexts compared to the neutral contexts; however, nicotine/alcohol dependent participants did not return to baseline craving after exposure to smoking cues. These results suggest substantive differences in the ways that nicotine-dependent, daily alcohol drinkers and nicotine/alcohol dependent drinkers experience craving, whether cross-cue or traditional.

Trivedi MH; Greer TL; Potter JS; Grannemann BD; Nunes EV; Rethorst C et al. Determining the primary endpoint for a stimulant abuse trial: Lessons Learned from STRIDE (CTN 0037). American Journal of Drug and Alcohol Abuse 37(5): 339-349, 2011. (46 refs.)

Background: No consensus is available for identifying the best primary outcome for substance use disorder trials, making interpretation across trials difficult. Abstinence is the most desirable treatment outcome although a wide variety of other endpoints have been used. Objectives: This report provides a framework for determining an optimal primary endpoint and the relevant measurement approach for substance use disorder treatment trials. The framework was developed based on a trial for stimulant abuse using exercise as an augmentation treatment, delivered within the National Institute on Drug Abuse Clinical Trials Network. The use of a common endpoint across trials will facilitate comparisons of treatment efficacy. Methods: Primary endpoint options in existing substance abuse studies were evaluated. This evaluation included surveys of the literature for endpoints and measurement approaches, followed by assessment of endpoint choices against study design issues, population characteristics, tests of sensitivity, and tests of clinical meaningfulness. Conclusion: We concluded that the best current choice for a primary endpoint is percent days abstinent, as measured by the Time Line Follow Back interview conducted three times a week with recall aided by a take-home Substance Use Diary. To improve the accuracy of the self-reported drug use, the results of qualitative urine drug screens will be used in conjunction with the Time Line Follow Back results. Scientific Significance: There is a need for a standardized endpoint in this field to allow for comparison across treatment studies, and we suggest that the recommended candidate endpoint be considered. However, the study design and goals ultimately must guide the final decision.

van der Pol P; Liebregts N; de Graaf R; Korf DJ; van den Brink W; van Laar M. The Dutch Cannabis Dependence (CanDep) study on the course of frequent cannabis use and dependence: Objectives, methods and sample characteristics. International Journal of Methods in Psychiatric Research 20(3): 169-181, 2011. (71 refs.)

This paper presents an overview of the prospective cohort design of the Dutch Cannabis Dependence (CanDep) study, which investigates (i) the three-year natural course of frequent cannabis use (>= three days per week in the past 12 months) and cannabis dependence; and (ii) the factors involved in the transition from frequent non-dependent cannabis use to cannabis dependence, and remission from dependence. Besides its scientific relevance, this knowledge may contribute to improve selective and indicated prevention, early detection, treatment and cannabis policies. The secondary objectives are the identification of factors related to treatment seeking and the validation of self report measures of cannabis use. Between September 2008 and April 2009, baseline data were collected from 600 frequent cannabis users with an average age of 22.1 years, predominantly male (79.3%) and an average cannabis use history of 7.1 years; 42.0% fulfilled a (12-month DSM-IV) diagnosis of cannabis dependence. The response rate was 83.7% after the first follow up at 18 months. The second and last follow-up is planned at 36 months. Computer assisted personal interviews (CAPI) were conducted which covered: cannabis use (including detailed assessments of exposure, motives for use and potency preference); use of other substances; DSM-IV internalizing and externalizing mental disorders; treatment seeking; personality; life events; social support and social functioning.

Verges A; Littlefield AK; Sher KJ. Did lifetime rates of alcohol use disorders increase by 67% in 10 years? A comparison of NLAES and NESARC. Journal of Abnormal Psychology 120(4): 868-877, 2011. (35 refs.)

Two nationally representative epidemiological samples (the National Longitudinal Alcohol Epidemiological Survey and the National Epidemiological Survey of Alcohol and Related Conditions) have been used to track changes in the prevalence of alcohol use disorders (AUDs) between 1992 and 2002 in the United States. Strikingly, estimates from these two data sets suggest that the lifetime prevalence of AUD increased by approximately 67% (from 18.2% to 30.3%) during this time frame. This article explores potential reasons for these discrepant estimates. Analyses indicated that a vast majority of change in lifetime AUD occurred with respect to alcohol abuse and not alcohol dependence. Most of this increase in abuse was attributable to self-reported changes in hazardous use that did not track with other archival measures of outcomes related to hazardous use in the population. Key methodological differences regarding the frequency requirements for prior-to-past-year alcohol abuse appeared to explain most of the discrepancy in lifetime AUD estimates. These findings, in conjunction with the relative lack of differences in the 12-month prevalence of AUDs, suggest that the discrepant lifetime estimates are likely due to methodological differences between the two surveys. These findings have important implications for substance use and other psychiatric surveillance and epidemiology where meaningful cross-temporal comparisons are desired.

Wakim PG; Rosa C; Kothari P; Michel ME. Relation of study design to recruitment and retention in CTN trials. American Journal of Drug and Alcohol Abuse 37(5): 426-433, 2011. (14 refs.)

Background: Recruitment and retention in randomized clinical trials are difficult in general and particularly so in trials of substance abuse treatments. Understanding trial design characteristics that could affect recruitment and retention rates would help in the design of future trials. Objective: To test whether any of the following factors are associated with recruitment or retention: type of intervention, type of therapy, duration of treatment, total duration of trial, number of treatment sessions, number of follow-up visits, number of primary assessments, timing of primary assessments, number of case report form (CRF) pages at baseline, and number of CRF pages for the entire trial. Methods: Recruitment and retention data from 24 Clinical Trials Network (CTN) trials conducted and completed between 2001 and 2010 were analyzed using single-factor analysis of variance and single-predictor regression methods to test their association with trial design characteristics. Results: Almost all of the analyses performed did not show statistically significant patterns between recruitment and retention rates and the trial design characteristics considered. Conclusion: In CTN trials, the relationship between assessment burden on participants and length of trial, on the one hand, and recruitment and retention, on the other, is not as strong and direct as expected. Other factors must impinge on the conduct of the trial to influence trial participation. Scientific Significance: Researchers may deem slightly more justifiable to permit inclusion of some of the design features that previously were assumed to have a strong, negative influence on recruitment and retention, and should consider other strategies that may have a stronger, more direct effect on trial participation.

West R; Evans A; Michie S. Behavior change techniques used in group-based behavioral support by the English stop-smoking services and preliminary assessment of association with short-term quit outcomes. Nicotine & Tobacco Research 13(12): 1316-1320, 2011. (15 refs.)

Objective: To develop a reliable coding scheme for components of group-based behavioral support for smoking cessation, to establish the frequency of inclusion in English Stop-Smoking Service (SSS) treatment manuals of specific components, and to investigate the associations between inclusion of behavior change techniques (BCTs) and service success rates. Methods: A taxonomy of BCTs specific to group-based behavioral support was developed and reliability of use assessed. All English SSSs (n = 145) were contacted to request their group-support treatment manuals. BCTs included in the manuals were identified using this taxonomy. Associations between inclusion of specific BCTs and short-term (4-week) self-reported quit outcomes were assessed. Results: Fourteen group-support BCTs were identified with >90% agreement between coders. One hundred and seven services responded to the request for group-support manuals of which 30 had suitable documents. On average, 7 BCTs were included in each manual. Two were positively associated with 4-week quit rates: "communicate group member identities" and a "betting game" (a financial deposit that is lost if a stop-smoking "buddy" relapses). Conclusion: It is possible to reliably code group-specific BCTs for smoking cessation. Fourteen such techniques are present in guideline documents of which 2 appear to be associated with higher short-term self-reported quit rates when included in treatment manuals of English SSSs.

Weuve J; Tchetgen EJT; Glymour MM; Beck TL; Aggarwal NT; Wilson RS et al. Accounting for bias due to selective attrition: The example of smoking and cognitive decline. Epidemiology 23(1): 119-128, 2012. (58 refs.)

Background: Selective attrition may introduce bias into analyses of the determinants of cognitive decline. This is a concern especially for risk factors, such as smoking, that strongly influence mortality and dropout. Using inverse-probability-of-attrition weights, we examined the influence of selective attrition on the estimated association of current smoking (vs. never smoking) with cognitive decline. Methods: Chicago Health and Aging Project participants (n = 3713), aged 65-109 years, who were current smokers or never-smokers, underwent cognitive assessments up to 5 times at 3-year interval. We used pooled logistic regression to fit predictive models of attrition due to death or study dropout across the follow-up waves. With these models, we computed inverse-probability-of-attrition weights for each observation. We fit unweighted and weighted, multivariable-adjusted generalized-estimating-equation models, contrasting rates of change in cognitive scores in current versus never-smokers. Estimates are expressed as rates of change in z score per decade. Results: During the 12 years of follow-up, smokers had higher mortality than never-smokers (hazard ratio = 1.93 [95% confidence interval = 1.67 to 2.23]). Higher previous cognitive score was associated with increased likelihood of survival and continued participation. In unweighted analyses, current smokers' cognitive scores declined 0.11 standard units per decade more rapidly than never-smokers' (95% CI = -0.20 to -0.02). Weighting to account for attrition yielded estimates that were 56% to 86% larger, with smokers' estimated 10-year rate of decline up to 0.20 units faster than never-smokers' (95% CI = -0.36 to -0.04). Conclusions: Estimates of smoking's effects on cognitive decline may be underestimated due to differential attrition. Analyses that weight for the inverse probability of attrition help compensate for this attrition.

Wu LT; Ling W; Burchett B; Blazer DG; Yang CM; Pan JJ et al. Use of item response theory and latent class analysis to link poly-substance use disorders with addiction severity, HIV risk, and quality of life among opioid-dependent patients in the Clinical Trials Network. Drug and Alcohol Dependence 118(2-3): 186-193, 2011. (51 refs.)

Background: This study applied item response theory (IRT) and latent class analysis (LCA) procedures to examine the dimensionality and heterogeneity of comorbid substance use disorders (SUDs) and explored their utility for standard clinical assessments, including the Addiction Severity Index (ASI), HIV Risk Behavior Scale (HRBS), and SF-36 quality-of-life measures. Methods: The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the U.S. National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from inpatient and outpatient addiction treatment settings at 12 programs. Data were analyzed by factor analysis, IRT, LCA, and latent regression procedures. Results: A two-class LCA model fit dichotomous SUD data empirically better than one-parameter and two-parameter IRT models. LCA distinguished 10% of severe comorbid opioid-dependent individuals who had high rates of all SUDs examined especially amphetamine and sedative abuse/dependence from the remaining 90% who had SUDs other than amphetamine and sedative abuse/dependence (entropy = 0.99). Item-level results from both one-parameter and two-parameter IRT models also found that amphetamine and sedative abuse/dependence tapped the more severe end of the latent poly-SUD trait. Regardless of whether SUDs were defined as a continuous trait or categorically, individuals characterized by a high level of poly-SUD demonstrated more psychiatric problems and HIV risk behaviors. Conclusions: A combined application of categorical and dimensional latent approaches may improve the understanding of comorbid SUDs and their associations with other clinical indicators. Abuse of sedatives and methamphetamine may serve as a useful marker for identifying subsets of opioid-dependent individuals with needs for more intensive interventions.

Yalachkov Y; Kaiser J; Naumer MJ. Functional neuroimaging studies in addiction: Multisensory drug stimuli and neural cue reactivity. (review). Neuroscience and Biobehavioral Reviews 36(2): 825-835, 2012. (81 refs.)

Neuroimaging studies on cue reactivity have substantially contributed to the understanding of addiction. In the majority of studies drug cues were presented in the visual modality. However, exposure to conditioned cues in real life occurs often simultaneously in more than one sensory modality. Therefore, multisensory cues should elicit cue reactivity more consistently than unisensory stimuli and increase the ecological validity and the reliability of brain activation measurements. This review includes the data from 44 whole-brain functional neuroimaging studies with a total of 1168 subjects (812 patients and 356 controls). Correlations between neural cue reactivity and clinical covariates such as craving have been reported significantly more often for multisensory than unisensory cues in the motor cortex, insula and posterior cingulate cortex. Thus, multisensory drug cues are particularly effective in revealing brain-behavior relationships in neurocircuits of addiction responsible for motivation, craving awareness and self-related processing.

Zaman G. Optimal campaign in the smoking dynamics. Computational and Mathematical Methods in Medicine 2011: e-article 163834, 2011. (20 refs.)

We present the optimal campaigns in the smoking dynamics. Assuming that the giving up smoking model is described by the simplified PLSQ (potential-light-smoker-quit smoker) model, we consider two possible control variables in the form of education and treatment campaigns oriented to decrease the attitude towards smoking. In order to do this we minimize the number of light (occasional) and persistent smokers and maximize the number of quit smokers in a community. We first show the existence of an optimal control for the control problem and then derive the optimality system by using the Pontryagin maximum principle. Finally numerical results of real epidemic are presented to show the applicability and efficiency of this approach.