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CORK Bibliography: Women

98 citations. March 2011 to present

Prepared: September 2011

Babalonis S; Lile JA; Martin CA; Kelly TH. Physiological doses of progesterone potentiate the effects of triazolam in healthy, premenopausal women. Psychopharmacology 215(3): 429- 439, 2011. (50 refs.)

Gender plays a critical role in the effects of drugs and drug abuse liability. Biological factors, including ovarian hormones, may contribute to gender differences in drug abuse. Preclinical and some clinical research suggests that progesterone and its metabolites have activity at the GABA(A) receptor and may enhance the effect of GABAergic compounds (e.g., benzodiazepines). Because women are exposed to varying levels of progesterone from puberty until menopause, and appear more sensitive to the negative consequences of benzodiazepine use, it is important to understand the impact of progesterone on GABAergic drug effects. The purpose of this experiment was to characterize the behavioral effects of progesterone, alone and in combination with the short-acting benzodiazepine, triazolam, to determine if progesterone potentiates the behavioral effects of triazolam. Oral micronized progesterone (0, 100, and 200 mg) and oral triazolam (0.00, 0.12, and 0.25 mg/70 kg) were administered to healthy, premenopausal women (n = 11) under conditions of low circulating sex hormones. The subjective, performance and physiological effects of progesterone, alone and in combination with triazolam, were assessed. Triazolam alone produced prototypical sedative-like effects. Progesterone alone also engendered some sedative effects, although the time course of the effects was more limited than that of triazolam. Progesterone increased and extended the duration of triazolam effects and delayed the onset of triazolam peak effects, most notably at the 0.12 mg/70 kg dose. Progesterone potentiates the behavioral effects of benzodiazepines and may contribute to benzodiazepine use and abuse among women.

Aalsma MC; Wiehe SE; Blythe MJ; Tong Y; Harezlak J; Rosenman MB. Mental health screening and STI among detained youth. Journal of Community Health 36(2): 300-306, 2011. (51 refs.)

Our objective was to understand the relationship between mental health screening results, health disparity, and STI risk among detained adolescents. In this 24-month cross-sectional study of 1,181 detainees (age 13-18 years), we examined associations between race, gender, mental health screening results (as measured by the Massachusetts Youth Screening Instrument-2nd Edition) and sexually transmitted infection rates (STI; chlamydia, gonorrhea, and trichomonas). Consistent with previous research, females and black youth were disproportionately affected by STI. Race and gender differences were also noted in mental health screening. The odds of having an STI increased by 23% (OR = 1.23, 95% CI = 1.06, 1.37) with each one-unit increase in the alcohol/drug subscale score for females. Gender-specific STI interventions for detained youth are warranted. For young women with substance abuse, specific interventions are necessary and may help reduce health disparity in this vulnerable population.

Abramsky T; Watts CH; Garcia-Moreno C; Devries K; Kiss L; Ellsberg M et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women's health and domestic violence. BMC Public Health 11: article 109, 2011. (38 refs.)

Background: Intimate partner violence (IPV) against women is a global public health and human rights concern. Despite a growing body of research into risk factors for IPV, methodological differences limit the extent to which comparisons can be made between studies. We used data from ten countries included in the WHO Multi-country Study on Women's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites, in order to inform the design of IPV prevention programs. Methods: Standardised population-based household surveys were done between 2000 and 2003. One woman aged 15-49 years was randomly selected from each sampled household. Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. We performed multivariate logistic regression to identify predictors of physical and/or sexual partner violence within the past 12 months. Results: Despite wide variations in the prevalence of IPV, many factors affected IPV risk similarly across sites. Secondary education, high SES, and formal marriage offered protection, while alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood, increased the risk of IPV. The strength of the association was greatest when both the woman and her partner had the risk factor. Conclusions: IPV prevention programs should increase focus on transforming gender norms and attitudes, addressing childhood abuse, and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention.

Albrecht J; Lindsay B; Terplan M. Effect of waiting time on substance abuse treatment completion in pregnant women. Journal of Substance Abuse Treatment 41(1): 71-77, 2011. (28 refs.)

Although substance abuse treatment is associated with improved maternal and neonatal outcomes, pregnant women may be at increased risk of attrition. To explore the hypothesis that shorter waiting time for treatment is associated with increased completion, we analyzed all pregnant treatment admissions and discharges in the Treatment Episode Data Set-Discharges. There were 10,661 pregnant admissions in 2006. The effect of waiting time on treatment completion was modified by treatment setting. Immediate entry into ambulatory treatment, where most pregnant women are treated, was significantly associated with completion (odds ratio = 1.27, 95% confidence interval = 1.14-1.41). Criminal justice referral and a high school education were identified as completion predictors in all treatment settings. Waiting time impacts treatment completion in pregnant women. Resources need to be directed to ensure immediate access to treatment, particularly in the ambulatory setting.

Almeida ND; Koren G; Platt RW; Kramer MS. Hair biomarkers as measures of maternal tobacco smoke exposure and predictors of fetal growth. Nicotine & Tobacco Research 13(5): 328- 335, 2011. (33 refs.)

Introduction: Most biomarker studies of the effects of maternal smoking on fetal growth have been based on a single blood or urinary cotinine value, which is inadequate in capturing maternal tobacco exposure over the entire pregnancy. We used hair biomarkers to compare the associations of maternal self-reported smoking, hair nicotine, and hair cotinine with birth weight for gestational age (BW for GA) among active and passive smokers during pregnancy. Methods: We collected maternal hair in the immediate postpartum period and measured nicotine and cotinine concentrations averaged over the pregnancy in 444 term controls drawn from 5,337 participants in a multicenter nested case-control study of preterm birth. BW for GA Z-score and small for gestational age (SGA) were based on Canadian population-based standards. Results: The addition of hair nicotine to multiple linear regression models containing self-reported active smoking, hair cotinine, or both explained significantly more variance in the BW for GA Z-score (p = .01, .03 and .04, respectively). Similarly, women with hair nicotine, but not cotinine, at or above the median value had a significant increase in the risk of SGA birth (odds ratio: 3.07, 95% CI: 1.25-7.52). No significant association was observed between maternal passive smoking and BW for GA based on hair biomarkers. Conclusions: Hair nicotine is a better predictor of reductions in BW for GA than either hair cotinine or self-report. Our negative results for passive smoking suggest that previously reported small but significant effects may be explained by misclassification of active smokers as passive smokers based on self-report.

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

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

Andrews CM; Cao DC; Marsh JC; Shin HC. The impact of comprehensive services in substance abuse treatment for women with a history of intimate partner violence. Violence Against Women 17(5): 550-567, 2011. (38 refs.)

This study examines the impact of comprehensive services on posttreatment substance use among women with a history of intimate partner violence. The sample includes 1,123 women from 50 treatment facilities derived from the National Treatment Improvement Evaluation Study (NTIES). Generalized linear mixed modeling was used to determine whether a history of intimate partner violence moderates the association between service receipt and posttreatment substance use. Significant interactions were found between history of intimate partner violence and concrete (p = .016) and family services (p = .023) in predicting substance use.

Birath CS; Demarinis V; Stenbacka M; Klinteberg B. Women with alcohol problems: The possible significance of personality clustering for treatment planning. Drug and Alcohol Review 30(2): 207-215, 2011. (51 refs.)

Introduction and Aims. Establishing subgroups in clinical practice is important for treatment planning. The aim of the study was to cluster the study group subjects according to personality traits and psychological health variables and to establish possible differences in treatment outcome in terms of: (i) drinking outcomes (gram and number of drinking days); (ii) perceived physiological health; and (iii) use of treatment resources (length of time in treatment and number of visits) among 134 treatment-seeking women with alcohol problems in a clinical context, between the two clusters obtained. Design and Methods. Data were collected from 134 consecutive women at a Swedish clinic specialised in treating women with alcohol problems. A hierarchical cluster analysis was performed on the basis of self-rated personality scale scores and psychological health variables. Results. Two clusters were identified: one in which the women displayed personality and psychological health scores indicating problems (Cluster 1); and another where the women showed personality and psychological health scores within the norm range (Cluster 2). Alcohol consumption rates at the start of treatment were the same in both clusters. The consumption rates were also the same at the end of treatment for the cluster, showing a significant decrease in alcohol consumption in each. The Cluster 1 women, however, had a significantly higher number of visits at the clinic, and rated the consequences of their alcohol drinking as being significantly worse than Cluster 2 women. Discussion and Conclusions. The importance of individual differences according to personality traits for treatment planning is discussed in terms of the need for variation in treatment time and methods.

Boffetta P; Autier P. Is breast cancer associated with tobacco smoking? (editorial). British Medical Journal 342: article d1584, 2011

Booth BM; Mengeling M; Torner J; Sadler AG. Rape, sex partnership, and substance use consequences in women veterans. Journal of Traumatic Stress 24(3): 287-294, 2011. (40 refs.)

The association of rape history and sexual partnership with alcohol and drug use consequences in women veterans is unknown. Midwestern women veterans (N = 1,004) completed a retrospective telephone interview assessing demographics, rape history, substance abuse and dependence, depression, and posttraumatic stress disorder (PTSD). One third met lifetime criteria for substance use disorder (SUD), half reported lifetime completed rape, a third childhood rape, one quarter in-military rape, 11% sex with women. Lifetime SUD was higher for women with rape history (64% vs. 44%). Women with women as sex partners had significantly higher rates of all measures of rape, and also lifetime substance use disorder. Postmilitary rape, sex partnership, and current depression were significantly associated with lifetime SUD in multivariate models (odds ratio = 2.3, 3.6, 2.1, respectively). Many women veterans have a high need for comprehensive mental health services.

Burns L; Black E; Powers JR; Loxton D; Elliott E; Shakeshaft A et al. Geographic and maternal characteristics associated with alcohol use in pregnancy. Alcoholism: Clinical and Experimental Research 35(7): 1230-1237, 2011. (42 refs.)

Background: To date, no studies have used population-level data to investigate whether maternal location of residence (metropolitan vs. regional/remote populations) is associated with alcohol use in pregnancy. This information has important implications for appropriate service provision. Methods: Information on all live births in New South Wales Australia was linked to records of alcohol-related admissions for mothers of these births over a 6-year period (2000 to 2006). Cases were women who had at least 1 alcohol-related hospital admission during pregnancy or at birth. Controls were women who had at least 1 live birth over that same time period but no alcohol-related hospital admissions during that time. Admissions were considered to be alcohol-related based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) code. Demographic, obstetric, and neonatal variables were compared. Results: A total of 417,464 singleton birth records were analyzed, 488 of which were coded positive for at least 1 alcohol-related ICD-10-AM diagnosis. Characteristics associated with alcohol-related admissions in pregnancy were residence in a remote/very remote area, being Australian-born, having had a previous pregnancy, smoking in the current pregnancy, and presenting late to antenatal care. Alcohol-exposed pregnancies were associated with a range of poor obstetric and neonatal outcomes, with no geographic differences noted. However, women in regional/remote areas were less likely to attend specialist obstetric hospitals. Conclusions: This study shows the need for standardized screening programs for alcohol use in pregnancy and where problematic use is detected, for clear clinical guidelines on management and referral.

Cabanes A; Pastor-Barriuso R; Garcia-Lopez M; Pedraz-Pingarron C; Sanchez-Contador C; Carrete JAV et al. Alcohol, tobacco, and mammographic density: A population-based study. Breast Cancer Research and Treatment 129(1): 135-147, 2011. (43 refs.)

Mammographic density (MD), or the proportion of the breast with respect to its overall area that is composed of dense tissue, is a strong risk factor for breast cancer. Studies support a positive association of mammographic density and alcohol drinking. This was a cross-sectional multicenter study based on 3584 women, aged 45-68 years, recruited from seven screening centers within the Spanish breast cancer screening program network. The association between MD, alcohol consumption and tobacco use was evaluated by using ordinal logistic models with random center-specific intercepts. We found a weak positive association between current alcohol intake and higher MD, with current alcohol consumption increasing the odds of high MD by 13% (OR = 1.13; 95% CI 0.99-1.28) and high daily grams of alcohol being positively associated with increased MD (P for trend = 0.045). There were no statistically significant differences in MD between smokers and non-smokers. Nevertheless, increased number of daily cigarettes and increased number of accumulated lifetime cigarettes were negatively associated with high MD (P for trend 0.017 and 0.021). The effect of alcohol on MD was modified by menopausal status and tobacco smoking: whereas, alcohol consumption and daily grams of alcohol were positively associated with higher MD in postmenopausal women and in women who were not currently smoking, alcohol consumption had no effect on MD in premenopausal women and current smokers. Our results support an association between recent alcohol consumption and high MD, characterized by a modest increase in risk at low levels of current consumption and a decrease in risk among heavier drinkers. Our study also shows how the effects of alcohol in the breast can be modified by other factors, such as smoking.

Cavazos-Rehg PA; Krauss MJ; Spitznagel EL; Schootman M; Cottler LB; Bierut LJ. Substance use and the risk for sexual intercourse with and without a history of teenage pregnancy among adolescent females. Journal of Studies on Alcohol and Drugs 72(2): 194-198, 2011. (24 refs.)

Objective: The present study examined the associations between initiation and intensity of substance use and with sexual experience with and without a history of teenage pregnancy. Method: Participants: were high school females (weighted n = 3,451) who participated in the 1999-2003 Youth Risk Behavior Surveillance System, a cross-sectional, nationally representative survey. Multinomial multivariable logistic regression was used to assess the likelihood of being sexually experienced (but never pregnant) and teenage pregnancy (reference group: never had sexual intercourse) as a function of age at substance use initiation (i.e., age 12 or younger, 13-14 years of age, and age 15 or older) and intensity of substance use (i.e., nonuser, experimental/new or nondaily, nonexperimental/daily user) for alcohol, cigarettes, and marijuana, while controlling for race/ethnicity, metropolitan location, symptoms of depression, and illegal drug availability at school. Results: A major finding of our study is that substance use behaviors across each substance (alcohol, cigarettes, and marijuana) independently contributed to an increased risk in sexual intercourse experience with and without a history of teenage pregnancy (vs. nonsexually experienced females). A dose-response relationship was also observed between an increased likelihood of a teenage pregnancy and marijuana behaviors. Furthermore, the risk for teenage pregnancy was compounded for daily cigarette smokers who initiated use at age 12 or younger. Conclusions: Screening substance use behaviors can help to identify girls who may benefit from pregnancy prevention strategies. Targeting cigarette and marijuana behaviors as early as age 12 or younger may provide an added benefit. Prevention strategies should also consider the role of race above and beyond substance use behaviors.

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

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

Chang G; Fisher NDL; Hornstein MD; Jones JA; Hauke SH; Niamkey N et al. Brief intervention for women with risky drinking and medical diagnoses: A randomized controlled trial. Journal of Substance Abuse Treatment 41(2): 105-114, 2011. (52 refs.)

This is a randomized controlled trial of 511 eligible women treated for diabetes, hypertension, infertility, or osteoporosis on an outpatient basis to test the hypothesis that those randomized to a brief intervention (BI) will drink less than those in the control condition 12 months later. A secondary goal was to identify the characteristics associated with changes in drinking outcome. All 511 completed the initial alcohol assessment, and 96% completed the 12-month follow-up interview. Those receiving the BI also had 3- and 6-month interviews. Four outcomes were assessed: (a) mean drinks per drinking day, (b) percent drinking days, (c) binge episodes defined as four or more drinks per occasion, and (d) weeks of drinking exceeding the National Institute on Alcohol Abuse and Alcoholism sensible drinking limits. Overall, there were no differences in drinking outcome by treatment group. Characteristics associated with changes in drinking, however, were identified to provide possible direction for future investigation.

Cluss PA; Levine MD; Landsittel D. The Pittsburgh STOP Program: Disseminating an evidence-informed intervention for low-income pregnant smokers. American Journal of Health Promotion 25(5, Supplement S): S75-S81, 2011. (37 refs.)

Purpose. Prenatal smoking is a preventable risk factor for poor perinatal outcomes and is more prevalent in pregnant smokers of low socioeconomic status (SES). We describe the intervention model and factors associated with quitting from the Pittsburgh STOP Program, an evidence-informed dissemination intervention for low-SES pregnant smokers. Setting. STOP is delivered in community health care clinics serving economically disadvantaged women. Participants. Participants were 856 pregnant women who were current smokers (93%) and recent quitters (7%). Most were white (59%) or black (35%), single (74%), young (mean age = 25), and experiencing an unplanned pregnancy (84%); 90% were insured by Medicaid/uninsured. Methods. An evidence-informed intervention for community pregnant women was delivered individually in a single-group pre-post evaluation design. Measures were demographics, participation and retention, smoking status, satisfaction, and cost. Analyses included descriptive statistics and logistic regression. Results. Participants attended an average of 4.7 sessions. Dropout rate after the first session was 5%. Over 11% of smokers quit; 48% of preenrollment spontaneous quitters remained abstinent. Factors significantly associated with quitting included race, mother's age, nicotine dependence, and number of sessions attended. Limitations. STOP is a community program with self-selected participants and no control group. Conclusion. Low-income pregnant smokers will engage in an evidence-informed cessation, program tailored for this group, with quit rates that compare to controlled research results.

Coker I; Colak A; Hasturk AG; Yildiz O; Turkon H; Halicioglu O. Maternal and cord blood homocysteine and folic acid levels in smoking and nonsmoking pregnant women. Gynecologic and Obstetric Investigation 71(4): 245-249, 2011. (28 refs.)

Introduction: The homocysteine level in blood is affected by gender, diet, smoking, folic acid and B-complex vitamins. It is known that higher than normal homocysteine levels in plasma may cause vascular endothelium dysfunction, resulting in the promotion of thrombus formation. In our study, we aimed to assess the effects of smoking during pregnancy on the homocysteine and folic acid levels of the mother and baby. Methods: The study included 58 pregnant women who had completed their 37th week of gestation: 30 women were nonsmokers (NONSM) and 28 were smokers (SM). The measurement of homocysteine and folic acid levels in all samples were performed with an Immulite 2000 analyzer, using the chemiluminescence method. Results: Maternal blood folic acid levels were significantly lower in SM (p = 0.041) than in NONSM. In SM, homocysteine levels in the umbilical cord blood were found to be significantly higher than those in NONSM (p = 0.006). Conclusion: High homocysteine levels in umbilical cord blood of smoking mothers, and the probable continuation of passive smoking for the babies after birth, make us think that the baby may have a predisposition towards vascular diseases at later periods in life.

Conen D; Everett BM; Kurth T; Creager MA; Buring JE; Ridker PM et al. Smoking, smoking status, and risk for symptomatic peripheral artery disease in women a cohort study. Annals of Internal Medicine 154(11), 2011. (30 refs.)

Background: Smoking has a well-documented detrimental effect on risk for myocardial infarction and stroke, but less information is available regarding peripheral artery disease (PAD), particularly among women. Objective: To prospectively assess the association of current smoking status, cumulative smoking exposure, and smoking cessation with incident symptomatic PAD in women. Design: Prospective cohort study. Setting: U. S. female health care professionals in the Women's Health Study. Participants: 39 825 women with no cardiovascular disease who were prospectively followed for a median of 12.7 years. Measurements: Incidence of symptomatic PAD. Cox proportional hazards models were used to compare PAD risk across smoking categories. Results: 178 confirmed PAD events occurred. Across the 4 smoking categories (never, former, < 15 cigarettes/d, and >= 15 cigarettes/d), age-adjusted incidence rates were 0.12, 0.34, 0.95, and 1.63 per 1000 person-years of follow-up, respectively. Multivariate adjustment had little effect on this relationship (adjusted hazard ratios [HRs], 3.14 [95% CI, 2.01 to 4.90], 8.93 [CI, 5.02 to 15.89], and 16.95 [CI, 10.77 to 26.67], respectively, vs. women who never smoked). Additional adjustment for high-sensitivity C-reactive protein and soluble intercellular adhesion molecule-1 levels among women with available blood samples (28 314 participants, 117 events) attenuated risk estimates (HR, 5.58 [CI, 2.61 to 11.93] for smoking < 15 cigarettes/d and 9.52 [CI, 5.17 to 17.53] for smoking >= 15 cigarettes/d). Lifetime exposure showed a strong dose-response relationship; fully adjusted HRs for smoking abstinence of fewer than 10, 10 to 29, and 30 or more pack-years were 2.52 (CI, 1.49 to 4.25), 6.75 (CI, 4.33 to 10.52), and 11.09 (CI, 6.94 to 17.72), respectively. Compared with current smokers, the adjusted HRs for fewer than 10 years, 10 to 20 years, more than 20 years, or lifelong abstinence were 0.39 (CI, 0.24 to 0.66), 0.28 (CI, 0.17 to 0.46), 0.16 (CI, 0.10 to 0.26), and 0.08 (CI, 0.05 to 0.12), respectively. Limitation: The use of symptomatic PAD as the a priori primary end point excludes asymptomatic disease. Conclusion: Among initially healthy women, smoking is a potent risk factor for symptomatic PAD and was associated with subclinical inflammation. Smoking cessation substantially reduces risk for PAD, but an increased occurrence of PAD persists even among former smokers who maintain abstinence.

Connor-Smith JK; Henning K; Moore S; Holdford R. Risk assessments by female victims of intimate partner violence: Predictors of risk perceptions and comparison to an actuarial measure. Journal of Interpersonal Violence 26(12): 2517-2550, 2011. (31 refs.)

Recent studies support the validity of both structured risk assessment tools and victim perceptions as predictors of risk for repeat intimate partner violence (IPV). Combining structured risk assessments and victim risk assessments leads to better predictions of repeat violence than either alone, suggesting that the two forms of assessment provide unique and complementary information. However, very little is known about elements involved in women's risk assessments. The present study explores predictors of women's risk assessment and differences in factors linked to victim and actuarial risk assessments in a large sample of women (N = 728) shortly after the arrest of their male partner for IPV. In multivariate analyses, women's risk assessments were strongly related to past relationship violence and their partner's substance abuse but weakly related to demographic factors, family constellation, and the partner's criminal history. Women who perceived high risk but had a low risk score on an actuarial measure were more likely to report the presence of dynamic risk factors, such as escalating violence and violence during separations, along with a history of emotional and psychological abuse. Qualitative findings paralleled quantitative findings, with women's stated reasons for expecting high or low risk indicating that women were attending to IPV history and dynamic factors. Implications for risk assessment and safety planning are discussed.

Dauber SE; Paulson JF; Leiferman JA. Race-specific transition patterns among alcohol use classes in adolescent girls. Journal of Adolescence 34(3): 407-420, 2011. (58 refs.)

We used data from the National Longitudinal Study of Adolescent Health to examine transitions among alcohol use classes in 2225 White and African American adolescent girls, and race differences in predictors of transition into and out of problematic drinking classes. Latent class analysis confirmed four classes for White girls and three for AA girls, defined in a previous study. Latent transition analysis revealed more stable abstainers and decreasing alcohol use among AA girls, and more increasing alcohol use among White girls, though stable abstainers were the largest group in both races. Increasing use was predicted by delinquency, academic misbehavior, substance use, and peer support for White girls, and by older age and delinquency for AA girls. Decreasing use was predicted by older age and depressive symptoms for White girls, and by family relationship quality and substance use for AA girls. Study limitations and implications of findings are discussed.

De Genna NM; Feske U; Angiolieri T; Gold MA. Race and sexually transmitted diseases in women with and without borderline personality disorder. Journal of Women's Health 20(3): 333-340, 2011. (49 refs.)

Background: The purpose of this study was to examine the history of sexually transmitted diseases (STDs) among women with borderline personality disorder (BPD) with and without a lifetime substance use disorder (SUD) and to compare their histories to those of a group of women with a current nonpsychotic axis I disorder. Methods: Two-hundred fifteen women completed the Structured Clinical Interview for DSM-IV Axis I diagnoses (SCID-I), Structured Interview for DSM-IV Personality for Axis II diagnoses (SIDP-IV), and a sexual health interview. African American women were oversampled because little is known about BPD in African American women and because they are at greater risk for STDs than non-African American women. Results: Women with a lifetime SUD (especially cannabis use disorder) reported more STD risk factors and STDs than women without a lifetime SUD. BPD dimensional scores and African American race were predictors of STD, even after controlling for age, socioeconomic status (SES), SUDs, and participation in the sex trade. Conclusions: Determining predictors of STDs within at-risk subpopulations may help reduce the spread of STDs and prevent HIV infection within these groups by helping providers identify women at the highest risk of infection.

Deitz DK; Cook RF; Hendrickson A. Preventing prescription drug misuse: Field test of the SmartRx web program. Substance Use & Misuse 46(5): 678-686, 2011. (36 refs.)

Purpose of the project was to test a Web-based program designed to prevent prescription drug misuse. Study sample consisted of 346 working women randomized into either an experimental or wait-list control condition. Analysis of covariance and logistic regression were used to compare responses. Women receiving the intervention had greater knowledge of drug facts and greater self-efficacy in medication adherence and ability to manage problems with medications compared with controls. Women receiving the intervention also had reduced symptoms reported on the CAGE for prescription medications. Findings suggest that multimedia Web-based programs can be a beneficial addition to substance misuse prevention services. The study's limitations are noted.

Delrahim-Howlett K; Chambers CD; Clapp JD; Xu RH; Duke K; Moyer RJ et al. Web-based assessment and brief intervention for alcohol use in women of childbearing potential: A report of the primary findings. Alcoholism: Clinical and Experimental Research 35(7): 1331-1338, 2011. (36 refs.)

Background: There is a need for more effective assessment and primary prevention programs aimed at accurately measuring and reducing alcohol consumption among women before conception in underserved, high-risk populations. Health information technology may serve this purpose; however, the effectiveness of such tools within this population is not known. Methods: We conducted a small-scale randomized controlled trial to test the effectiveness of an adapted web-based alcohol assessment and intervention tool among low-income, nonpregnant women of reproductive age who were receiving Women Infant and Children (WIC) services in San Diego County and who reported currently drinking at a moderate risk level. A total of 150 risky drinking participants completed a web-based assessment and were randomly assigned to either receive a personalized feedback intervention or general health information about alcohol consumption and fetal alcohol syndrome. Follow-up assessments on reported alcohol consumption were conducted via telephone at 1- and 2-months postbaseline. Participants ranged in age from 18 to 44 and were predominately Hispanic/Latina (44%). Results: At baseline, all respondents reported consuming >= 3 standard drinks on >= 1 occasion in the previous month. Outcome data were available for 131 participants. The main outcome measure was reduction in the number of risky drinking occasions, which did not differ significantly between treatment conditions (odds ratio 1.200, 95% CI 0.567 to 2.539, p = 0.634). Over 70% of the participants, however, reported a reduction in risky drinking occasions regardless of treatment condition (control 43/63, 68%; experimental 49/68, 72%). Conclusions: The results of this study demonstrate that web-based assessment of alcohol consumption among low-income women of reproductive age, as represented by WIC clients, is feasible and acceptable. The findings also suggest that detailed and interactive assessments of alcohol consumption may be sufficient for the reduction of risky drinking within this population without personalized feedback.

El-Bassel N; Gilbert L; Witte S; Wu EW; Chang MW. Intimate partner violence and HIV among drug-involved women: Contexts linking these two epidemics-challenges and implications for prevention and treatment. Substance Use & Misuse 46(2-3): 295-306, 2011. (106 refs.)

Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.

Evans SM; Levin FR. Response to alcohol in women: Role of the menstrual cycle and a family history of alcoholism. Drug and Alcohol Dependence 114(1): 18-30, 2011. (86 refs.)

The present study determined whether: (1) the response to alcohol varied as a function of menstrual cycle phase and (2) women with a paternal history of alcoholism (FHP) were less sensitive to the effects of alcohol compared to women without a family history of alcoholism (FHN). The behavioral effects of alcohol (0.00, 0.25, and 0.75 g/kg) were evaluated in 21 FHN and 24 FHP women; each dose was tested during both the midfollicular and late luteal phases of the menstrual cycle. Baseline negative mood was increased during the luteal phase compared to the follicular phase (increased Beck Depression scores and decreased Vigor, Arousal, and Friendly scores). Alcohol increased ratings of Drug Liking and Good Drug Effect more in the luteal phase than the follicular phase. FHP women had greater negative mood during the luteal phase and some of these dysphoric effects were increased by alcohol more in FHP women than FHN women. Alcohol impaired performance, with no group or menstrual cycle differences. However, consistent with previous studies, FHP women were less impaired by alcohol than FHN women on the balance task. These data indicate that (1) the differences in response to alcohol across the menstrual cycle are subtle, although alcohol is liked more during the luteal phase; (2) increases in dysphoric mood during the luteal phase are more pronounced in FHP women compared to FHN women, particularly after alcohol; and (3) the differences observed in response to alcohol between FHP and FHN women are less pronounced than previously shown in men.

Everett-Murphy K; Paijmans J; Steyn K; Matthews C; Emmelin M; Peterson Z. Scolders, carers or friends: South African midwives' contrasting styles of communication when discussing smoking cessation with pregnant women. Midwifery 27(4): 517-524, 2011. (56 refs.)

Objective: to investigate how midwives are currently communicating with women about smoking during pregnancy with a view to involving them in a smoking cessation intervention in antenatal clinics. Design: a qualitative study using individual, in-depth interviews for data collection. Setting and participants: 24 nurses providing antenatal care to pregnant smokers attending public sector clinics in five major cities in South Africa. Findings: three archetypes of midwives, characterised by different styles of communication and approaches to smoking cessation, emerged from the analysis of the interview data. These were described as the 'Angry Scolders', the 'Benign Carers' and the 'Enthusiastic Friends'. The first type conformed to the traditional, authoritarian style of communication, where the midwife assumed a dominant, expert role. When women failed to comply with their advice, these midwives typically became angry and confrontational. The second type of midwife used a paternalistic communication style and emphasised the role of education in changing behaviour. However, these midwives had little confidence that they could influence women to quit. The third type embraced a patient-centred approach, consciously encouraging more interaction with their patients and attempting to understand change from their point of view. These midwives were optimistic of women's capacity to change and more satisfied with their current health education efforts than the first two types. The Benign Carers and Enthusiastic Friends were more open to participation in the potential intervention than the Angry Scolders. Key conclusions: the prevailing traditional, authoritarian style of communication is inappropriate for smoking cessation education and counselling as it provokes resistance and avoidance on the part of pregnant smokers. The paternalistic approach appears to be largely ineffectual, whereas the patient-centred approach elicits the most positive response from pregnant women and enhances the possibility of a trusting and cooperative relationship with the midwife. Midwives using this style are more open to fulfilling their role in smoking cessation. Implications for practice: smoking cessation interventions need to attend to not only what midwives say to pregnant women about smoking, but also how they communicate about the issue. The use of a patient-centred approach, such as brief motivational interviewing, is recommended as a means of improving counselling outcomes among pregnant smokers.

Fallot RD; McHugo GJ; Harris M; Xie HY. The trauma recovery and empowerment model: A quasi-experimental effectiveness study. Journal of Dual Diagnosis 7(1-2): 74- 89, 2011. (36 refs.)

Objective: A quasi-experimental study tested the effectiveness of the Trauma Recovery and Empowerment Model (TREM), a group intervention for women trauma survivors, in comparison to services as usual. Methods: Two hundred fifty-one women with histories of physical and/or sexual abuse and co-occurring serious mental illnesses and substance use disorders completed comprehensive study assessments at baseline and at 6 and 12 months. TREM groups were added to standard services at two community mental health agencies in Washington, DC (n = 153). Comparison group participants received usual services at two agencies in Baltimore, MD (n = 98). Results: TREM participants showed greater reductions in alcohol and drug abuse severity, anxiety symptoms, and current stressful events, and they showed greater increases in perceived personal safety. There were no group differences in change for posttraumatic stress disorder and global mental health symptoms, physical and mental health-related quality of life, and exposure to interpersonal abuse. Changes in trauma recovery skills were associated positively with gains in study outcomes for TREM group participants. Conclusions: Despite design limitations, this study provides preliminary evidence for the effectiveness of the TREM intervention for a heterogeneous population of women trauma survivors with co-occurring disorders when added to usual services.

Farmer MM; Rose DE; Riopelle D; Lanto AB; Yano EM. Gender differences in smoking and smoking cessation treatment: An examination of the organizational features related to care. Women's Health Issues 21(4, special issue): S182-S189, 2011. (41 refs.)

Objectives: Veterans experience a particularly heavy burden with smoking rates higher than the general population, and the smoking prevalence for women Veterans has increased in recent years. We examined differences in smoking prevalence and treatment by gender for Veterans receiving at least some of their care at a VA facility, and examined the degree to which organizational factors may be associated with reductions in gender disparities in smoking cessation treatment. Methods: We merged national organizational-level data focused on primary care (sites = 225) and women's health (sites = 195) with patient-level survey data (n = 15,033 smokers). Organizational measures focused on smoking cessation-specific structure and processes in primary care and women's health. Primary outcomes were patient-reported receipt of smoking cessation treatments advised to quit, medication recommendation, and other treatment recommendation. We used multi-level, random-intercept logistic regression. Results: In 2007, 29% of women and 23% of men were smokers. Overall, 83% of smokers reported they had been advised to quit, 62% recommended medications, and 60% recommended other treatments. Women were more likely to report being advised to quit (odds ratio, 1.33; 95% confidence interval, 1.07-1.64) but equally likely as men to have medications or other treatment recommended. Organizational factors did not eliminate the gender differences in being advised to quit. Conclusion: Despite having equivalent or higher smoking cessation treatment rates, women Veterans were more likely to smoke than men. With the rapid growth of women entering VA care, the need for effective gender-focused and gender-sensitive smoking cessation care arrangements is critical for the future health of women who have served.

Friend J; Langhinrichsen-Rohling J; Eichold BH. Same-day substance use in men and women charged with felony domestic violence offenses. Criminal Justice and Behavior 38(6): 619- 633, 2011. (52 refs.)

This archival study reviewed 196 closed felony domestic violence files from a large southern city from the years 1999-2006. The purpose was to provide information on the co-occurrence of substance use and intimate partner violence (IPV) for male and female perpetrators on the day of the violent incident. Results indicated that of the 141 of 196 cases in which there was documentation about drug or alcohol involvement, 67.4% (n = 95) of the cases confirmed that there was drug or alcohol use on the day of the incident. Male perpetrators were significantly more likely to have been involved with alcohol and/or drugs the day of the violent episode than were female perpetrators. Sex of offender and race analyses revealed that the percentage of female IPV perpetrators (42.9%) was substantial and African Americans, particularly women, were overrepresented in IPV felony charges. Implications and suggestions for further research are discussed.

Fukuda M; Fukuda K; Shimizu T; Nobunaga M; Andersen EW; Byskov AG et al. Paternal smoking habits affect the reproductive life span of daughters. Fertility and Sterility 95(8): 2542-2544, 2011. (18 refs.)

The present study assessed whether the smoking habits of fathers around the time of conception affected the period in which daughters experienced menstrual cycles (i.e., the reproductive life span). The study revealed that the smoking habits of the farther shortened the daughters' reproductive life span compared with daughters whose fathers did not smoke.

Gadducci A; Barsotti C; Cosio S; Domenici L; Genazzani AR. Smoking habit, immune suppression, oral contraceptive use, and hormone replacement therapy use and cervical carcinogenesis: A review of the literature. (review). Gynecological Endocrinology 27(8): 597-604, 2011. (116 refs.)

High-risk human papillomaviruses (HPVs) are involved in the etiopathogenesis of cervical intraepithelial neoplasia (CIN) and cervical cancer. After taking HPV into account, smoking habit appears to be the most significant environmental risk factor, and the risk of this malignancy increases significantly with intensity and duration of smoking. Women with human immunodeficiency virus (HIV) infection experience a higher incidence of CIN and invasive cervical cancer. Among HIV+ women, the highly active antiretroviral therapy increases the regression rate of CIN, but the majority of these lesions do not regress to normal. As far as oral contraceptives (OCs), a systematic review of 28 studies found that, compared with never pill users, the relative risk (RR) of cervical cancer increased with increasing duration of OC use. The results were similar for squamous cell carcinoma and adenocarcinoma, and the RRs decreased after pill discontinuation. However, by weighing risks and benefits, the World Health Organization does not recommend any change in OC practice. There is no correlation between hormone replacement therapy and cervical cancer. Experimental data have shown that estradiol and progesterone can modulate the host immune response to HPV16. Prophylactic vaccination in conjunction with cervical screening is the best prevention strategy for cervical cancer.

Golder S; Logan TK. Cumulative victimization, psychological distress, and high-risk behavior among substance-involved women. Violence and Victims 26(4): 477-495, 2011. (74 refs.)

This research addressed two questions: (a) What is the relationship between different patterns of cumulative victimization and psychological distress? And (b) How does the pattern of cumulative victimization and psychological distress influence women's engagement in substance- and sex-related risk behavior? Data were analyzed from interviews with 149 sexually active, crack-using women who completed a follow-up interview after participating in the Kentucky National Institute on Drug Abuse (NIDA) AIDS Cooperative Agreement. Findings from the multivariate analyses indicated that victimization accounted for 5% and 39% of the variance in psychological distress and high-risk behavior, respectively; cumulative victimization and psychological distress accounted for 6% to 11% of the variance in the high-risk behaviors. Results highlight the affects of childhood and adult victimization on psychological distress and the associations between different types of psychological distress and risk behavior.

Groth SW; Morrison-Beedy D. Smoking, substance use, and mental health correlates in urban adolescent girls. Journal of Community Health 36(4): 552-558, 2011. (25 refs.)

This study examined the associations among smoking tobacco and/or cannabis with alcohol use, depression, disordered eating and healthy behaviors among adolescent girls enrolled in an HIV prevention intervention randomized trial. Baseline self-reported behaviors from 744 sexually active, low-income, urban participants were collected using an audio computer assisted self interview. Girls ranged in age from 15 to 19 years old with a mean age of 16.5. Over 16% of girls reported smoking cigarettes, 41% smoked cannabis and 12% used both substances. Girls who smoked either substance had higher scores for depression symptoms, alcohol use and disordered eating when compared to nonsmokers. Girls who used both substances were at a higher risk for alcohol use, depression symptoms and disordered eating. The association of cannabis and tobacco with the other health related issues differed depending on age, indicating that assessment and targeting of health behavior interventions may differ depending on a girl's age. Disordered eating, depressive symptoms and cannabis use were higher among these adolescent girls than previously documented in the literature, suggesting that to improve the health of this population multi-focused interventions must target girls before they have engaged in smoking.

Gu J; Lau JTF; Chen HY; Tsui HY; Ling WH. Prevalence and factors related to syringe sharing behaviours among female injecting drug users who are also sex workers in China. International Journal of Drug Policy 22(1): 26-33, 2011. (39 refs.)

Background: Female injecting drug users who are sex workers (IDUFSWs) are at high risk of contracting HIV. They may bridge HIV transmissions from injecting drug users to clients of female sex workers. Methods: A total of 216 non-institutionalised IDUFSWs were recruited by snowball sampling methods. Anonymous face-to-face interviews were conducted to collect data. Univariate, multivariate and hierarchical logistic regression models were fitted to investigate the associations between background characteristics, cognitive variables, psychological stress and syringe sharing behaviours among IDUFSWs. Results: Respectively 33.8% and 27.8% of the respondents injected drugs with others' used syringes and gave used syringes to others for drug injection in the last month. These two syringe sharing behaviours were significantly associated with inconsistent condom use during commercial sex (OR=5.00 and 1.92, p<0.05). Over 90% of the respondents reported at least one type(s) of psychological distress included in this study. Adjusting for significant background variables, all variables that are related to the Theory of Planned Behaviour (attitude, norm, perceived control and behavioural intention) and psychological distress (except for depression) were significantly associated with injecting drugs with others' used syringes (adjusted OR=2.08-6.25, p < 0.05), whilst variables related to perceived control, behavioural intention and insomnia were significantly associated with providing used syringes to others for injection (adjusted OR = 2.00-3.56, p<0.05). In two separate summary multivariate models, variables related to the Theory of Planned Behaviours and psychological distress were independently associated with injecting drugs with others' used syringes (OR = 1.98-4.02, p<0.05) and giving used syringes to others for injection (OR = 2.06-3.59, p<0.05). Conclusions: Syringe sharing behaviours were prevalent among IDUFSWs and were associated with cognitive and psychological factors. Effective integrative intervention programmes targeting IDUFSWs are warranted.

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

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

Hamilton AB; Poza I; Washington DL. "Homelessness and trauma go hand-in-hand": Pathways to homelessness among women veterans. Women's Health Issues 21(4, special issue): S203-S209, 2011. (33 refs.)

Background: Veterans comprise a disproportionate fraction of the nation's homeless population, with women veterans up to four times more likely to be homeless than non-veteran women. This paper provides a grounded description of women veterans' pathways into homelessness. Methods: Three focus groups were held in Los Angeles, California, with a total of 29 homeless women veterans. Results: Five predominant "roots" (precipitating experiences) initiated pathways toward homelessness: 1) childhood adversity, 2) trauma and/or substance abuse during military service, 3) post-military abuse, adversity, and/or relationship termination, 4) post-military mental health, substance abuse, and/or medical problems, and 5) unemployment. Contextual factors, which promoted development of homelessness in the setting of primary roots, included women veterans' "survivor instinct," lack of social support and resources, sense of isolation, pronounced sense of independence, and barriers to care. These contextual factors also reinforced persistence of the roots of post-military adversity and mental health and substance abuse problems, serving to maintain cycles of chronic homelessness. Conclusion: Collectively, these multiple, interacting roots and contextual factors form a "web of vulnerability" that is a target for action. Multiple points along the pathways to homelessness represent critical junctures for VA and community-based organizations to engage in prevention or intervention efforts on behalf of women veterans. Considering the multiple, interconnected challenges that these women veterans described, solutions to homelessness should address multiple risk factors, include trauma-informed care that acknowledges women veterans' traumatic experiences, and incorporate holistic responses that can contribute to healing and recovery.

Handal M; Engeland A; Ronning M; Skurtveit S; Furu K. Use of prescribed opioid analgesics and co-medication with benzodiazepines in women before, during, and after pregnancy: A population-based cohort study. European Jurnal of Clinical Pharmacology 67(9): 953-960, 2011. (37 refs.)

The aim of the study was to describe the use of prescribed opioid analgesics for noncancer pain and the degree of possible concurrent co-medication with benzodiazepines to women in Norway before, during, and after pregnancy. This was a population-based cohort study based on linkage of two nationwide registries: the Medical Birth Registry of Norway, and the Norwegian Prescription Database. Prescribed opioid analgesics and benzodiazepines issued to women 3 months prior to, during, and 3 months after pregnancies were identified. The study population consisted of 194,937 singleton pregnancies beginning in March 2004 or later and ending before January 2009. About 6% of the women were dispensed opioid analgesics before, during, or after pregnancy. Almost all these women received weak opioids (99%) with short-acting codeine in combination with paracetamol (acetaminophen) as the most frequently dispensed drug. The dispensing of codeine was reduced from 24/1,000 women before pregnancy to 10/1,000 in the last trimester, increasing to 17/1,000 during the breastfeeding period. Most women were dispensed codeine once, and treatment was of short duration (about 1 week). A small group of women (n = 271) were dispensed opioids in all trimesters. Increasing benzodiazepine use was observed as the number of opioid prescriptions increased. The use of opioid analgesics in pregnant women in Norway was dominated by treatment of short duration of the weak opioid codeine. As pregnancy proceeded, opioid use was reduced. However, the increase in opioid use during the nursing period has the potential for serious adverse effects.

Haw CM; Hawton K. Problem drug use, drug misuse and deliberate self-harm: Trends and patient characteristics, with a focus on young people, Oxford, 1993-2006. Social Psychiatry and Psychiatric Epidemiology 46(2): 85-93, 2011. (34 refs.)

Drug misuse is related to self-harm and suicide. However, relatively little is known about deliberate self-harm (DSH) in patients with drug problems and whether drug misuse by DSH patients is increasing. We used data collected by the Oxford Monitoring System for Attempted Suicide to study the characteristics of DSH patients with drug problems who presented to the general hospital in Oxford between 1993 and 2006, and who underwent psychosocial assessment at their first presentation in the study period. We also studied trends in problem drug use and drugs misused over this period. During the 14-year study period, 11,426 patients presented of whom 9,248 underwent psychosocial assessment and it was known whether or not they had a drug problem. Problem drug use was present in 805/9,248 (8.7%) patients. Problem drug use was more common in males (13.6%) than in females (5.3%). Problem drug users were younger, more likely to be socially disadvantaged, to have a personality disorder and comorbid alcohol problems and to have a further episode of DSH within a year. Problem drug use in young females was associated with higher suicidal intent scale (SIS) scores. During the study period, problem drug use and drug misuse increased in females, but not in males. Cannabis and cocaine misuse increased with time. Provision of help for DSH patients with problem drug use is particularly challenging due to their complex social and clinical characteristics and increased risk of further self-harm, suicide and accidental death. It may require extensive liaison between different services. The increasing misuse of drugs by female DSH patients and the higher SIS scores of young females are of concern.

Hayaki J; Herman DS; Hagerty CE; de Dios MA; Anderson BJ; Stein MD. Expectancies and self-efficacy mediate the effects of impulsivity on marijuana use outcomes: An application of the acquired preparedness model. Addictive Behaviors 36(4): 389-396, 2011. (44 refs.)

This study tests the acquired preparedness model (APM) to explain associations among trait impulsivity, social learning principles, and marijuana use outcomes in a community sample of female marijuana users. The APM states that individuals with high-risk dispositions are more likely to acquire certain types of learning that, in turn, instigate problematic substance use behaviors. In this study, three domains of psychosocial learning were tested: positive and negative marijuana use expectancies, and marijuana refusal self-efficacy. Participants were 332 community-recruited women aged 18-24 enrolled in a study of motivational interviewing for marijuana use reduction. The present analysis is based on participant self-reports of their impulsivity, marijuana use expectancies, marijuana refusal self-efficacy, marijuana use frequency, marijuana use-related problems, and marijuana dependence. In this sample, impulsivity was significantly associated with marijuana use frequency, marijuana-related problems, and marijuana dependence. Results also indicate that the effect of impulsivity on all three marijuana outcomes was fully mediated by the three principles of psychosocial learning tested in the model, namely, positive and negative marijuana expectancies, and marijuana refusal self-efficacy. These findings lend support to the APM as it relates to marijuana use. In particular, they extend the applicability of the theory to include marijuana refusal self-efficacy, suggesting that, among high-impulsives, those who lack appropriate strategies to resist the temptation to use marijuana are more likely to exhibit more frequent marijuana use and use-related negative consequences.

Hayatbakhsh MR; Kingsbury AM; Flenady V; Gilshenan KS; Hutchinson DM; Najman JM. Illicit drug use before and during pregnancy at a tertiary maternity hospital 2000-2006. Drug and Alcohol Review 30(2): 181-187, 2011. (26 refs.)

Introduction and Aims. To study the prevalence of use of illicit drugs by women of reproductive age before and during pregnancy and the changes in rates of illicit drug use in pregnancy over recent years. Design and Methods. All pregnant women attending the public antenatal clinic over a 7 year period (2000-2006) were routinely interviewed about their use of illicit drugs by a midwife at the antenatal booking visit. Measurements. Records for 25 049 women, who self-reported previous and current use of cannabis, amphetamines, ecstasy and heroin, were included in the study. Results. Cannabis was the most common illicit drug used before and during pregnancy; 9.3% of women were engaged in regular use prior to pregnancy and 2.5% were users during pregnancy. A very low proportion of women reported use of amphetamines, ecstasy or heroin in pregnancy. There was an increase in ever regular use and any past use of cannabis, amphetamines and ecstasy over time. Conclusions. The prevalence of illicit drug use by young women prior to becoming pregnant is of concern. While pregnancy appears to be a strong motivator for women to cease substance use, there is a need to study whether women resume drug use after their baby is born.

Heffner JL; Blom TJ; Anthenelli RM. Gender differences in trauma history and symptoms as predictors of relapse to alcohol and drug use. American Journal on Addictions 20(4): 307-311, 2011. (22 refs.)

The objective of tins study was to determine whether there are gender-specific associations between trauma exposure and alcohol or drug relapse in alcohol-dependent adults. Participants were 51 men (n = 24) and women (n = 27) with alcohol dependence, 22 (43.1%) of whom relapsed during study participation. Severity of childhood trauma; number of lifetime events evoking fear, helplessness, or horror; and current trauma symptoms all predicted relapse in women, but not in men. These findings highlight the importance of assessing trauma history and providing treatment of trauma-related symptoms for individuals with alcohol and drug dependence, and for women in particular.

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

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

Holahan CK; Holahan CJ; Powers DA; Hayes RB; Marti CN; Ockene JK. Depressive symptoms and smoking in middle-aged and older women. Nicotine & Tobacco Research 13(8): 722-731, 2011. (72 refs.)

Introduction: Smoking research and intervention efforts have neglected older women. Depressive symptoms, which are common in middle-aged and older women, are related to the maintenance of adult smoking. Methods: This study investigated the relation of a composite measure of current depressive symptoms, derived from a short form of the Center for Epidemiological Studies Depression Scale, and history of depressive symptoms, derived from two items from the Diagnostic Interview Schedule, to smoking outcomes in the Women's Health Initiative Observational Study (N = 90,627). Participants were postmenopausal with an average age of 63.6 years at baseline. Participants were recruited from urban, suburban, and rural areas surrounding 40 clinical centers in the United States. Analyses controlled for age, educational level, and ethnicity. Results: In multinomial logistic regression analyses, depressive symptoms were related cross-sectionally to current light (odds ratio [OR] = 1.19, 95% CI = 1.14-1.23) and heavier (OR = 1.28, 95% CI = 1.23-1.32) smoking at baseline compared with nonsmokers. In prospective multiple logistic regression analyses, baseline depressive symptoms were negatively predictive of smoking cessation at a 1-year follow-up (OR = .85, 95% CI = 0.770.93) and at participants' final assessments in the study (OR = .92, 95% CI = 0.85-0.98). Light smokers had more than 2 times higher odds of smoking cessation than did heavier smokers. Conclusions: The present findings demonstrate a consistent link between depressive symptoms and negative smoking-related behaviors among middle-aged and older women at both light and heavier smoking levels.

Hong T; Rice J; Johnson C. Social, environmental and individual factors associated with smoking among a panel of adolescent girls. Women & Health 51(3): 187- 203, 2011. (49 refs.)

This study assessed changes in the influence of social environmental and individual factorsand the interaction of these factors with timeon smoking prevalence for girls. Longitudinal panel surveys of adolescent girls (N = 921 in both 2000 and 2004) from schools in Louisiana were completed in the ninth grade (2000) and then again in the twelfth grade (2004). A fixed effects hierarchical multiple regression model assessed the relation of changes in social environmental and individual factors to smoking prevalence. Increases in smoking prevalence over time among adolescent girls were associated with their perceptions of themselves as overweight and perceiving low risk associated with smoking. Increases in smoking prevalence over time were also associated with having friends who smoked, perceptions of friends' approval of smoking, having family members who smoked, and having monetary discretionary spending. Having friends who smoked was more strongly associated with smoking in the twelfth grade than in the ninth grade. While more black adolescent girls smoked than did white girls in the ninth grade, by the twelfth grade, more white adolescents girls smoked than did black girls. Interventions that target adolescent girls should consider the temporal variability of individual and social environmental factors.

Hser YI; Evans E; Huang D; Messina N. Long-term outcomes among drug-dependent mothers treated in women-only versus mixed-gender programs. Journal of Substance Abuse Treatment 41(2): 115-123, 2011. (48 refs.)

This study examined the long-term outcomes of women who were pregnant or parenting at admission to women-only (WO; n = 500) versus mixed-gender (MG; a matched sample of 500) substance abuse treatment programs. Administrative records on arrests, incarcerations, mental health services utilization, and drug treatment participation were collected, covering 3 years preadmission and 8 years postadmission. Women treated in WO programs had lower levels of arrest, mental health services utilization rates, and drug treatment participation during the first year after drug treatment. No differences were found between the two groups in the long-term trajectories except that the WO program participants had lower incarceration rates during the third year after treatment. The study findings suggest a positive short-term impact of WO versus MG programs with regard to arrest and mental health services utilization. Limited long-term gain is shown in the reductions in posttreatment incarceration. The study findings suggest the added value of specialized WO programs and begin to address the gap in knowledge regarding long-term outcomes for substance-abusing women.

Hunt BR; Whitman S. Maternal smoking in Chicago: A community-level analysis. Journal of Health Care for The Poor and Underserved 22(1): 194-210, 2011. (60 refs.)

Birth certificate data were employed to determine the prevalence of maternal smoking in Chicago communities by race and ethnicity. For purposes of comparison, we present data for the U.S. and the city of Chicago as a whole. Across the city of Chicago, 5.6% of women smoked during pregnancy, a rate much lower than the national average of 13.9%. The maternal smoking rate among non-Hispanic (NH) Black women (11.8%) was more than twice that of NH White women (4.5%) and almost 10 times that of Hispanic women (1.2%). For predominantly NH White and NH Black communities, we observed a significant, negative relationship between household income and the percentage of women who smoke during pregnancy. The prevalence of smoking among NH Black women in Chicago was particularly high, demonstrating an unmet need for appropriate interventions.

Jenks RA; Higgs S. Effects of dieting status and cigarette deprivation on progressive ratio responding for cigarette puffs by young women smokers. Journal of Psychopharmacology 25(4): 530-537, 2011. (47 refs.)

There is evidence from self-report measures which suggests that young women dieters find cigarette smoking less rewarding than non-dieters. We aimed to further elucidate differences between dieters and non-dieters in their evaluation of smoking using a behavioural measure of drug reward. Thirty female undergraduates attended two sessions (cigarette deprived and non-deprived). A computer-based progressive ratio operant procedure was employed to assess the amount of effort that participants were willing to expend to gain a puff on a cigarette. The point at which responding ceased was taken as a measure of drug reward (breakpoint). Self-report measures of sensory/hedonic aspects of smoking were also completed. The breakpoints of both dieters and non-dieters were greater under deprived than non-deprived conditions but the breakpoints of dieters were significantly lower than those of the non-dieting smokers under both conditions. Self-reported enjoyment of smoking was lower for dieters than non-dieters and reports for non-dieters but not dieters were affected by deprivation level. Both behavioural and self-report measures of rewarding aspects of smoking suggest that young women dieters find smoking less rewarding than non-dieters, but self-report measures are more resistant to deprivation effects for dieters. This is consistent with the suggestion that subjective and behavioural measures assess different dimensions of the rewarding effects of smoking.

Jenks RA; Higgs S. Reactivity to smoking- and food-related cues in currently dieting and non-dieting young women smokers. Journal of Psychopharmacology 25(4): 520-529, 2011. (58 refs.)

There is some evidence to suggest that young women dieters who smoke experience greater cigarette cravings in the presence of food-related related cues. The aim of this experiment was to examine reactivity to both smoking-related and water cues by dieting and non-dieting women smokers in the presence or absence of food cues. Eighteen female undergraduates attended two sessions (food present and food absent). At each session, participants were presented with a cigarette and water cue in a counterbalanced order. Pre- and post-cue measures included the brief version of the Questionnaire for Smoking Urges, heart rate and self-reported mood. All smokers showed enhanced reactivity (increased craving and heart rate) to smoking versus water cues. For dieters there was a larger increase in cigarette craving and heart rate in response to the smoking-related cues in the presence of food compared with the absence of food, whereas for non-dieters there was a smaller increase in cigarette craving and heart rate in response to the smoking-related cues in the presence of food compared with the absence of food. Mood and appetite ratings were not significantly affected by either cue type or session. The results suggest that cue reactivity to smoking-related cues is modulated by the presence of incentive stimuli relevant to the individual.

Jones HE; Kaltenbach K; Heil SH; Stine SM; Coyle MG; Arria AM et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. (review). Obstetrical & Gynecological Survey 66(4): 191-193, 2011. (0 refs.)

The recommended treatment for opioid dependence in pregnant women is methadone, a full mu-opioid agonist. However, in utero exposure to methadone is associated with neonatal abstinence syndrome (NAS) that is characterized by hyperirritability of the central nervous system and a dysfunctional autonomic nervous system. Management of NAS often requires prolonged hospitalization and pharmacologic intervention. A partial mu-opioid agonist, buprenorphine, has been investigated as an alternative treatment for opioid dependence but relatively few studies of this drug have been conducted in pregnant women. Some prospective open-label and controlled studies suggest that NAS occurring in neonates treated prenatally with buprenorphine was less likely to require treatment than NAS in neonates exposed to prenatal methadone. However, the results of these studies have been inconsistent. This double-blind, randomized, controlled study compared the use of buprenorphine and methadone for management of pregnant women with opioid dependency. The study subjects were 175 pregnant opioid-dependent women enrolled at 8 international sites. A total of 131 of these women completed the trial; 58 (44%) were patients receiving buprenorphine and 73 (56%) were women treated with methadone. The 5 primary neonatal outcomes included the number of neonates requiring treatment for NAS, the peak NAS score, the total amount of morphine needed to treat NAS, length of hospital stay, and head circumference. The P values for all group comparisons were calculated according to prespecified thresholds for significance. More women receiving prenatal buprenorphine (28/86, 33%) discontinued treatment as compared with those receiving prenatal methadone (16/89, 18%). In comparison with methadone, neonates of women treated with prenatal buprenorphine required significantly less morphine (mean dose, 1.1 vs. 10.4 mg; P < 0.009), had a 43% decrease in the hospital stay (10.0 vs. 17.5 days, P < 0.009), and spent 58% less time in the hospital receiving medication for NAS (4.1 vs. 9.9 days, P < 0.003). No significant differences were found between groups for other primary or secondary outcomes, including the number of neonates requiring NAS treatment, the peak NAS score, head circumference, or any other adverse neonatal or maternal outcome. These findings suggest that buprenorphine is an acceptable alternative to methadone for treatment for opioid dependency during pregnancy and with further studies, may actually be the preferred therapeutic.

Jones SC; Telenta J; Cert G; Shorten A; Johnson K. Midwives and pregnant women talk about alcohol: What advice do we give and what do they receive? Midwifery 27(4): 489-496, 2011. (39 refs.)

Background: the Australian National Health and Medical Research Council (NHMRC) recently revised its guidelines for alcohol consumption during pregnancy and breast feeding, moving from a recommendation of minimising intake to one of abstinence. Women are potentially exposed to a variety of messages about alcohol and pregnancy, including from the media and social contacts, and are likely to see midwives as the source of expert advice in understanding these contradictory messages. Objective: to explore the advice that midwives believe they give to pregnant women about alcohol consumption, and the advice that pregnant women believe they receive; the knowledge and attitudes of both groups regarding alcohol consumption and the consistency with the NHMRC guidelines; and the receptivity and comfort of both groups in discussing alcohol consumption in the context of antenatal appointments. Design: individual semi-structured interviews with midwives and pregnant women. Setting: face-to-face interviews with midwives and telephone interviews with pregnant women were conducted in two regional areas of New South Wales in 2008-2009. Participants: 12 midwives and 12 pregnant women. Findings: midwives and pregnant women consistently agreed that conversations about alcohol are generally limited to brief screening questions at the first visit, and the risks are not discussed or explained (except for high-risk women). Key conclusions: both groups expressed comfort with the idea of discussing alcohol consumption, but lacked knowledge of the risk and recommendation, and it appears that this opportunity to provide women with information is under-utilised. Implications for practice: there is a need to provide midwives with accurate information about the risks of alcohol consumption during pregnancy and effective communication tools to encourage them to discuss the risks and recommendations with their patients.

Kaleta D; Usidame B; Polanska K. Tobacco advertisements targeted on women: Creating an awareness among women. Central European Journal of Public Health 19(2): 73-78, 2011. (30 refs.)

It has been always believed that men smoke more than women, but the trend of smoking in women is increasing nowadays. In some countries there are even more female smokers than male smokers. This is a major health risk because women are present and future mothers, and increasing number of smoking women will enlarge the number of exposed children. Relatively few women are aware of gender-specific health risks, including cervical cancer, osteoporosis, poor pregnancy outcome and early menopause. Tobacco related diseases are on the rise in women, considering the fact that more women now die of lung cancer than breast cancer. Tobacco companies have invented various ways to target women through tobacco advertising despite the various bans. This inevitably leads to the increase in female smoking rates. There are various recommendations from the World Health Organization which include the need for governments to pay particular attention to protect women from the tobacco companies' attempts to lure them into lifetimes of nicotine dependence and to take up counter advertisements against the tobacco companies.

Kazemi A; Ehsanpour S; Zahraei NSN; Hasanzadeh A; Beigi NMA; Malverdi Z. Impact of health belief modification on intention to make smoke free home among pregnant women. Journal of Research In Medical Sciences 16(6): 724-732, 2011. (30 refs.)

BACKGROUND: This study examined the effects of health education on modification of health belief and intention among pregnant women to have smoke free home. METHODS: In this randomized controlled study, 91 pregnant women completed the study in two groups. Intervention group was educated about the harms of environmental tobacco smoke (ETS) exposure. The Health Belief Model (HBM) was a framework for analyzing the beliefs. After 10-12 weeks, the HBM constructs and weekly ETS exposure at home were compared between the two groups. RESULTS: After performing educational program, the subjects in intervention group perceived more susceptibility and severity and reported lower weekly ETS exposure at home than subjects in control group; but, the self efficacy and perceived barrier were not different. The relationships between HBM constructs and weekly ETS exposure were significant; but, there was no significant difference in point prevalence of having smoke free home. CONCLUSIONS: This study indicated that the health education about ETS exposure can modify health belief and reduce EST exposure among pregnant women, but cannot affect the self efficacy and perceived barrier. To have smoke free home, they need to increase their self efficacy.

Kristjansson SD; Pergadia ML; Agrawal A; Lessov-Schlaggar CN; McCarthy DM; Piasecki TM et al. Smoking outcome expectancies in young adult female smokers: Individual differences and associations with nicotine dependence in a genetically informative sample. Drug and Alcohol Dependence 116(1-3): 37-44, 2011. (47 refs.)

Outcome expectancy is a central construct in models of addiction. Several outcome expectancies associated with smoking cigarettes have been identified, and studies suggest that individual differences in smoking expectancies are related to important aspects of tobacco use, including levels of smoking, nicotine dependence and smoking cessation. In the present study, we used a novel analytic method, exploratory structural equation modeling (ESEM), to quantify smoking expectancies from a subset of items adapted from the Smoking Consequences Questionnaire (SCQ; Brandon and Baker, 1991) and SCQ-Adult (Copeland et al., 1995). In our sample of 1262 monozygotic and dizygotic young adult, female twins who were regular smokers, we quantified six smoking expectancy factors similar to those reported in previous studies. These included Negative Affect Reduction, Boredom Reduction, Weight Control, Taste Manipulation, Craving/Addiction and Stimulation-state Enhancement. We used genetic model-fitting to examine the extent to which individual differences in the expectancies were influenced by latent genetic, shared environmental and non-shared environmental factors. We also examined the validity of the expectancy factors by examining their associations with nicotine dependence (ND) before and after adjusting for comorbid diagnoses of drug dependence and alcohol use disorder. Results of the validity analysis indicated that all of the expectancies were associated with ND after covariate adjustment. Although we lacked the statistical power to distinguish between genetic and shared environmental sources of variance, our results suggest that smoking outcome expectancies aggregate in families, but the majority of variance in these expectancies is due to environmental factors specific to the individual.

Kuerbis AN; Neighbors CJ; Morgenstern J. Depression's moderation of the effectiveness of intensive case management with substance-dependent women on Temporary Assistance for Needy Families: Outpatient substance use disorder treatment utilization and outcomes. Journal of Studies on Alcohol and Drugs 72(2): 297-307, 2011. (61 refs.)

Objective: Intensive case management (ICM) is effective for facilitating entry into and retention in outpatient substance use disorder treatment (OSUDT) for low-income substance-dependent women; however, no studies have specifically examined the moderating impact of depressive symptoms on ICM. The purpose of this study was to investigate whether depressive symptoms moderated ICM's effect on OSUDT engagement, attendance, and outcomes for substance-dependent women on Temporary Assistance for Needy Families (TANF). It was hypothesized that highly depressed women would demonstrate worse outcomes on all indicators. Method: Logistic regression and generalized estimating equations were used to determine depression's moderating impact on ICM in a secondary analysis of data from a randomized controlled trial comparing the effectiveness of ICM to usual care provided by local public assistance offices in Essex County, NJ. Substance-dependent women (N = 294) were recruited while being screened for TANF eligibility and were followed for 24 months. Results: Findings revealed that high levels of depressive symptoms moderated the effectiveness of ICM in unexpected directions for two outcome variables. Subjects with high levels of depressive symptoms in ICM were (a) significantly more likely to engage in at least one treatment program than those in usual care and (b) associated with the fewest mean drinks per drinking day across the 24-month follow-up period. Independent effects for high levels of depressive symptoms and ICM were also found to positively influence engagement, attendance, and percentage days abstinent. Conclusions: ICM is effective for substance-dependent women with a broad spectrum of depressive symptoms in enhancing OSUDT utilization and outcomes.

Lange B. Creating a communicative space to develop a mindfulness meditation manual for women in recovery from substance abuse disorders. Advances In Nursing Science 34(3): E1-E13, 2011. (46 refs.)

Mindfulness-Based Stress Reduction (MBSR) programs are becoming more integrated into the treatment of persons with substance use disorders (SUDs). A focus of MBSR is to increase awareness of sensations in the body and accept them in the moment without judgment. Little is known about the readiness of women, with posttraumatic stress disorder (PTSD), and their level of comfort to participate in MBSR programs. Habermas' ideal speech situation guided a cooperative inquiry with 45 women at 3 treatment centers. Women engaged in activities of MBSR and shared opinions on how to develop a manual that would address the readiness of women with SUDs-PTSD to participate in MBSR.

LaPota HB; Donohue B; Warren CS; Allen DN. Incorporating a healthy living curriculum within family behavior therapy: A clinical case example in a woman with a history of domestic violence, child neglect, drug abuse, and obesity. Journal of Family Violence 26(3): 227-234, 2011. (40 refs.)

Women reported to child protective service agencies frequently report problems that significantly interfere with the health and well-being of their children and themselves. Behavioral treatment programs appear to be effective in managing these co-existing problems, such as domestic violence and substance abuse. However, evidence-supported interventions are rarely exemplified in complicated clinical cases, especially within child welfare settings. Therefore, in this case example, we describe the process of adapting an evidence-supported treatment to assist in managing significant co-existing health-related problems in a mother who was referred due to child neglect and drug abuse. At the conclusion of therapy, the participant reported improvements in perceived family relationships, illicit drug use, child maltreatment potential, whereas other health-related outcomes were mixed. Most improvements were maintained at 4-month follow-up. Issues relevant to implementing evidence-based treatments within community contexts are discussed, including methods of increasing the likelihood of valid outcome assessment, managing treatment integrity, and adjusting standardized treatments to accommodate co-occurring problems.

Leung DYP; Chan SSC; Fu ICY; Lam TH. Knowledge, attitudes and practices regarding smoking cessation among Chinese affiliates of women's organisations in Hong Kong. Health & Social Care in the Community 19(2): 207-216, 2011. (36 refs.)

Volunteers and staff of women's organisations who are highly active in engaging and providing community service can be recruited to motivate female smokers to quit. We described the knowledge and attitudes regarding tobacco control and smoking cessation among these affiliates in Hong Kong and identified factors associated with the practices of cessation interventions. Eight of 14 women's organisations joining the Women Against Tobacco Taskforce agreed to participate. All staff, volunteers, and members of the eight organisations were invited to complete a self-administered anonymous questionnaire during July and August 2006. A total of 623 out of 771 (80.8%) affiliates responded. Their knowledge on smoking and health (mean = 3.91, SD = 1.44 on a range of 0-7), smoking related diseases (mean = 2.91, SD = 0.97 on a range of 0-4), and women-specific diseases (mean = 2.93, SD = 1.87 on a range of 0-6), was considered to be inadequate. They had positive attitudes towards tobacco control (mean = 3.31, SD = 0.55) and their own role in smoking cessation counselling (mean = 3.19, SD = 0.56) on a 4-point Likert scale and 39.3% reported had attempted to offer quitting advice. Logistic regression analysis found that participants having direct contact with smokers who had a positive attitude towards their own role in smoking cessation counselling (OR = 2.57; 95% CI = 1.67-3.95) and better knowledge of smoking and smoking-related diseases (OR = 1.35; 95% CI = 1.06-1.71) were more likely to provide cessation counselling after controlling for gender; knowledge on smoking and health, and women-specific diseases; attitude towards tobacco control, negative and positive attitudes towards female smokers, and perceived self-efficacy in smoking cessation counselling. Women's organisations showed limited support towards tobacco control and their affiliates had a limited knowledge on smoking and health but had positive attitudes. Appropriate training, capacity building and establishing rapport with women's organisations are needed to promote smoking cessation and to support tobacco control in the community.

Levitan EB; Ahmed HN; Mittleman MA; Wolk A. Coffee consumption and incidence of heart failure in women. Circulation. Heart Failure 4(4), 2011. (26 refs.)

Background-Previous studies of the relationship between coffee consumption and incidence of heart failure (HF) have not been consistent, with both potential benefit and potential harm reported. We therefore examined the association between coffee consumption and HF hospitalization or mortality in women. Methods. and Results-We conducted a prospective, observational study of 34 551 participants of the Swedish Mammography Cohort who were 48 to 83 years old and did not have HF, diabetes, or myocardial infarction at baseline. Diet was measured using food-frequency questionnaires. Cox models were used to calculate hazard ratios of HF hospitalization or death from HF as the primary cause, as determined through the Swedish inpatient and cause-of-death registers between January 1, 1998, and December 31, 2006. Over 9 years of follow-up, 602 HF events occurred. Women who consumed >= 5 cups of coffee per day did not have higher rates of HF events than those who consumed <5 cups per day (multivariable-adjusted hazard ratio, 0.93; 95% confidence interval, 0.72 to 1.20). Compared with women who consumed <= 1 cup of coffee per day, hazard ratios were 1.01, 0.82, 0.94, and 0.87 for women who consumed 2, 3, 4, and >= 5 cups per day, respectively (P for trend =0.23). Further adjustment for self-reported hypertension did not change the results. Conclusions-In this population of middle-aged and older women, we did not find an association between coffee consumption and incidence of HF events.

Long CG; Hall L; Dolley O; Hollin CR. Substance-abusing women in a medium secure psychiatric setting: characteristics and psychometric test performance. Journal of Substance Use 16(3): 230- 242, 2011. (64 refs.)

Aims: The aim is to describe the characteristics and psychometric test performance of women admitted to a medium secure hospital. Method: Consecutive admission was classified into risk-relevant categories using case note data. Responses to psychometric measures of dependence, substance-related problems, self-efficacy, motivation for change, craving and coping were assessed. Results: Forty-four out of 55 consecutive admissions had a risk-relevant pattern of substance use before admission. Analysis of psychometric test performance produced two groups of patients differentiated according to self-efficacy, craving and belief in the benefits of change. Conclusions: Although further work needs to be done in assessing the applicability of specific psychometrics to specialist populations, findings reinforce the importance of matching treatment interventions to stages of readiness to change.

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

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

Loue S; Sajatovic M; Mendez N. Substance use and HIV risk in a sample of severely mentally ill Puerto Rican women. Journal of Immigrant and Minority Health 13(4): 681-689, 2011. (66 refs.)

Latinos, and Puerto Ricans in particular, have been disproportionately impacted by HIV/AIDS. Severe mental illness (SMI) is associated with an increase in HIV risk. Relatively little research has focused on the role of SMI among Puerto Rican injection drug users (IDUs) and non-IDUs in susceptibility to and transmission of HIV and there are few published reports on HIV risk among Latina SMI. We conducted a longitudinal mixed methods study with 53 Puerto Rican women with schizophrenia, bipolar disorder, or major depression to examine the cultural context of HIV risk and HIV knowledge, beliefs, and behaviors among a larger study with Puerto Rican and Mexican women with serious mental illness (SMI). There was a high prevalence of past and current substance use and a high prevalence of substance use-associated HIV risk behaviors, such as unprotected sexual relations with an IDU. The violence associated with substance use frequently increased participants' HIV risk. Choice of substance of abuse depended on cost, availability, and use within the individual participant's network. Participants attributed their substance use to the need to relieve symptoms associated with their mental illness, ameliorate unpleasant feelings, and deaden emotional pain. HIV prevention interventions for poorer Puerto Rican women with SMI must target the individuals themselves and others within their networks if the women are to be supported in their efforts to reduce substance use-related risk. The content of any intervention must address past and current trauma and its relationship to substance use and HIV risk, as well as strategies to prevent HIV transmission.

MacNeela P; Bredin O. Keeping your balance freedom and regulation in female university students' drinking practices. Journal of Health Psychology 16(2): 284-293, 2011. (35 refs.)

Binge drinking is a focus for concerns about young women's alcohol consumption at university. Twenty females, all regular binge drinkers, were interviewed individually and in focus groups to explore alcohol beliefs and exposure to harm. Four themes were identified in a thematic analysis. Alcohol use was associated with freedom but regulated by group norms. Drinking to excess was stigmatized as an abuse of freedom, yet the threshold for excess was very high. The drug effects of alcohol were enjoyed, with drinking harms managed through trivialization. As part of a problem of imbalance, peer groups must be part of the solution.

Majer IM; Nusselder WJ; Mackenbach JP; Kunst AE. Life expectancy and eife expectancy with disability of normal weight, overweight, and obese smokers and nonsmokers in Europe. Obesity 19(7): 1451-1459, 2011. (40 refs.)

The goal of this study was to estimate life expectancy (LE) and LE with disability (LwD) among normal weight, overweight, and obese smokers and nonsmokers in Western Europe. Data from four waves (1998-2001) of the European Community Household Panel (ECHP) were used; a standardized multipurpose annual longitudinal survey. Self-reported health and socioeconomic information was collected repeatedly using uniform questionnaires for 66,331 individuals in nine countries. Health status was measured in terms of disability in daily activities. Multistate Markov (MSM) models were applied to obtain hazard ratios (HRs) and age-specific transition rates according to BMI and smoking status. Multistate life tables were computed using the predicted transition probabilities to estimate LE and LwD. Significant associations were observed between disability incidence and BMI (HR = 1.15 for overweight, HR = 1.64 for obese, compared to normal weight). The risk of mortality was negatively associated with overweight status among disabled (HR = 0.77). Overweight people had higher LE than people with normal-weight and obesity. Among women, overweight and obese nonsmokers expect 3.6 and 6.1 more years of LwD than normal weight persons, respectively. In contrast, daily smokers expect lower LE but a similar LwD. The same patterns were observed among people with high education and those with low education. To conclude, daily smoking is associated with mortality more than with disability, whereas obesity is associated with disability more than with mortality. The findings suggest that further tobacco control would contribute to increasing LE, while tackling the obesity epidemic is necessary to prevent an expansion of disability.

Marsh JC; Smith BD; Bruni M. Integrated substance abuse and child welfare services for women: A progress review. (review). Children and Youth Services Review 33(3, special issue): 466-472, 2011. (92 refs.)

A review of empirical literature reveals improvements in service utilization and outcomes for women when substance abuse and child welfare services are integrated. The increased use of substances by women involved in the child welfare system has resulted in a call for integrated, coordinated, evidence-based practices. Since the late 1990s, specific system- and service-level strategies have been developed to coordinate and integrate the provision of substance abuse and child welfare services such that women are remaining in treatment longer and are more likely to reduce substance use and be reunited with their children. The strategies reviewed provide useful guidelines for developing components of effective, evidence-based programs for substance-involved women in the child welfare system.

Martinez P; Roislien J; Naidoo N; Clausen T. Alcohol abstinence and drinking among African women: Data from the World Health Surveys. BMC Public Health 11: article 160, 2011. (40 refs.)

Background: Alcohol use is increasing among women in Africa, and comparable information about women's current alcohol use is needed to inform national and international health policies relevant to the entire population. This study aimed to provide a comparative description of alcohol use among women across 20 African countries. Methods: Data were collected as part of the WHO World Health Survey using standardized questionnaires. In total, 40,739 adult women were included in the present study. Alcohol measures included lifetime abstinence, current use (>= 1 drink in previous week), heavy drinking (15+ drinks in the previous week) and risky single-occasion drinking (5+ drinks on at least one day in the previous week). Country-specific descriptives of alcohol use were calculated, and K-means clustering was performed to identify countries with similar characteristics. Multiple logistic regression models were fitted for each country to identify factors associated with drinking status. Results: A total of 33,841 (81%) African women reported lifetime abstinence. Current use ranged from 1% in Malawi to 30% in Burkina Faso. Among current drinkers, heavy drinking varied between 4% in Ghana to 41% in Chad, and risky single-occasion drinking ranged from < 1% in Mauritius to 58% in Chad. Increasing age was associated with increased odds of being a current drinker in about half of the countries. Conclusions: A variety of drinking patterns are present among African women with lifetime abstention the most common. Countries with hazardous consumption patterns require serious attention to mitigate alcohol-related harm. Some similarities in factors related to alcohol use can be identified between different African countries, although these are limited and highlight the contextual diversity of female drinking in Africa.

Mason M; Pate P; Drapkin M; Sozinho K. Motivational interviewing integrated with social network counseling for female adolescents: A randomized pilot study in urban primary care. Journal of Substance Abuse Treatment 41(2): 148-155, 2011. (47 refs.)

This study tested the efficacy of a brief preventive intervention for substance use and associated risk behaviors among female adolescent patients of an urban primary care health clinic. We integrated an evidenced-based motivational interviewing (MI) approach with a social network component to develop a 20-minute session, a social network intervention delivered in an MI-consistent style. Female adolescents (N = 28) 14 to 18 years old were recruited, provided consent/assent, were screened, and were randomly assigned to the treatment or control (no treatment) condition. The sample was 82% African American and 18% mixed race, with 32% living below the U.S. poverty line. At 1-month follow-up, teens in the treatment condition reported less trouble due to alcohol use, less substance use before sexual intercourse, less social stress, less offers for marijuana use, and increased readiness to start counseling compared with the teens in the control condition. Results provide support for socially based brief interventions with at-risk urban adolescents.

Matheson FI; Doherty S; Grant BA. Community-based aftercare and return to custody in a national sample of substance-abusing women offenders. American Journal of Public Health 101(6): 1126- 1132, 2011. (62 refs.)

Objectives. We evaluated the effectiveness of the Community Relapse Prevention and Maintenance (CRPM) program, developed by Correctional Service Canada to better meet the needs of women offenders with drug problems. Methods. Using survival analysis, we investigated the association between exposure and nonexposure to CRPM and return to custody among a national sample of women offenders released from 1 of 6 federal institutions across Canada during the period May 1, 1998 to August 31, 2007. Results. After control for other risk factors, women who were not exposed to CRPM were 10 times more likely than were women exposed to CRPM to return to custody 1 year after release from prison, with more than a third returning to prison within the first 6 months. Conclusions. Aftercare is a critical component of a woman's support system after she leaves prison. Strategies that improve access to community aftercare are imperative for improving the life chances and health of these women.

Matwin S; Chang G. Readiness to change and risk drinking women. Journal of Substance Abuse Treatment 40(3): 230-240, 2011. (40 refs.)

The predictive value of the Readiness to Change Questionnaire (RTCQ) for subsequent drinking was evaluated in 499 women. These women had medical problems potentially exacerbated by alcohol use and were enrolled in an intervention study. Correlates and predictors of stage of change were analyzed. Results indicated that the categorical application of the RTCQ did not predict drinking in the 6-12 months after enrollment. Preliminary findings support rescoring the RTCQ into a continuous measure. Following this conversion, situational risks factors for drinking were examined as potential mediators of readiness to change (RTC). Heightened risk for alcohol consumption during argument or boredom was found to attenuate the association between one's RTC and later drinking. Finally, medical condition moderated the association of RTC on later drinking; women with diabetes, infertility, or osteoporosis drank the most in the contemplation stage. In contrast, hypertensive women drank more when action oriented to change. The implications for treating risk drinking in women are discussed.

Mazure CM; Toll B; Mckee SA; Wu R; O'Malley SS. Menstrual cycle phase at quit date and smoking abstinence at 6 weeks in an open label trial of bupropion. Drug and Alcohol Dependence 114(1): 68-72, 2011. (51 refs.)

Background: Quit attempts may have different outcomes based on menstrual cycle phase on quit day. This is the first preliminary study examining whether smoking cessation outcomes vary by menstrual cycle phase of quit date in women receiving a 6-week open trial of sustained release (SR) bupropion. Methods: Thirty-three treatment-seeking premenopausal women were studied. Abstinence outcomes were compared for women quitting during the luteal versus follicular phase. Results: Women receiving bupropion SR whose self-selected quit date occurred in the luteal phase had significantly higher rates of point prevalence abstinence during the final week of a 6-week post-quit treatment period than women quitting in the follicular phase (62.5% versus 29.4%; p <0.05). A similar, but non-significant, pattern of findings was demonstrated for continuous abstinence during the treatment phase and for point prevalence abstinence at 3-month follow-up. Conclusions: Women receiving bupropion SR were significantly more likely to be abstinent at treatment completion if quitting occurred during the luteal phase. This is consistent with recent findings of outcome related to cycle phase at quit date in the absence of pharmacotherapy, and differs from findings utilizing nicotine replacement. Results add to emerging data suggesting that smoking cessation interventions with varying mechanisms of action may result in different outcomes for premenopausal women based on gonadal hormones at quit date.

McCauley JL; Amstadter AB; Macdonald A; Danielson CK; Ruggiero KJ; Resnick HS et al. Non-medical use of prescription drugs in a national sample of college women. Addictive Behaviors 36(7): 690-695, 2011. (38 refs.)

Non-medical use of prescription drugs (NMUPD) is one of the fastest growing forms of illicit drug use, with research indicating that college students represent a particularly high risk population. The current study examined demographic characteristics, health/mental health, substance misuse, and rape experiences as potential risk correlates of NMUPD among a national sample of college women (N = 2000). Interviews were conducted via telephone using Computer-Assisted Telephone Interviewing technology. NMUPD was assessed by asking if, participants had used a prescription drug non-medically in the past year. NMUPD was endorsed by 7.8% of the sample (n = 155). Although incapacitated and drug-alcohol facilitated rape were associated with NMUPD in the initial model, the final multivariable model showed that only lifetime major depression and other forms of substance use/abuse were significantly uniquely associated with an increased likelihood of NMUPD. Implications for primary and secondary prevention and subsequent research are addressed.

McMurran M; Riemsma R; Manning N; Misso K; Kleijnen J. Interventions for alcohol-related offending by women: A systematic review. (review). Clinical Psychology Review 31(6): 909-922, 2011. (56 refs.)

Treatment programmes specifically for women offenders are under-developed. A systematic review of studies that could inform interventions for alcohol-related offending by women is reported. Three questions were addressed: 1) What is the most up to date knowledge of 'what works' with females who commit alcohol-related offences? 2) What are the identifiable risk-needs factors for non-alcohol dependent women who commit offences involving alcohol misuse? 3) Are there differences between male and female alcohol-related offending? Four studies addressed the effectiveness of psychosocial interventions; three addressed identifiable risk-needs; and 19 addressed differences between male and female offenders' alcohol-related offending. Heterogeneity of these studies precluded meta-analyses, and so a narrative synthesis method was used. There is insufficient evidence to answer the question of what treatment works with women who commit alcohol-related offences. Drunk-driving is most widely studied, and women offenders appear to have more psychosocial problems than men. Alcohol increases the likelihood of violence for both men and women, and, while the mechanisms whereby alcohol increases the likelihood of violence are likely the same in men and women, the effect may be moderated by gender-associated issues. Again, women offenders appear to have more psychosocial problems than men. Implications for developing interventions are discussed.

Mendelsohn C. Women who smoke: A review of the evidence. (review). Australian Family Physician 40(6): 403-407, 2011. (50 refs.)

Background: Women who smoke are at significantly greater risk of developing a smoking related disease than men. They are also at risk of pregnancy related complications due to smoking and have more difficulty quitting. There are important gender differences in smoking behaviour that have implications for the quitting process. Advice to female smokers should take these factors into account and support should be tailored to their needs. Objective: This article presents a summary of the evidence and a range of gender specific strategies that general practitioners can use to optimise the support they give to female smokers. Discussion: Women may need more intensive behavioural and pharmacological support when quitting. Particular emphasis should be placed on addressing stress, social support, smoking cues and concerns about weight gain. Nicotine replacement therapy is less effective in women. However, it is still useful if used in adequate doses and can be used in pregnancy if the woman is unlikely to quit without it. Varenicline and bupropion are not approved in pregnancy or in lactation.

Milani HS; Abadi AR; Helmzadeh Z; Abachizadeh K. Prevalence of ecstasy use and predisposing factors among Iranian female high school students. Journal of the Pakistan Medical Association 61(6): 566- 571, 2011. (22 refs.)

Objectives: To determine prevalence of ecstasy use and its predisposing factors among Iranian high school female students in Tehran, capital of Iran. Methods: In this cross-sectional study, 2350 female students of 36 high schools from Tehran, were selected by multi-stage cluster sampling to determine prevalence of ecstasy use and its predisposing factors. SPSS- version 13 was employed to conduct analysis through chi-square, fisher's exact test and logistic regression methods. Results: The prevalence of ecstasy use was 2.3% (95 A,Cl: 1.7-2.9%). Party was the most prevalent place of first use (65%) and access was easy for most users (63%). In multivariate analysis, smoking (P-V=0.005), alcohol use (P-V=003), use of other substances (P-V < 0.001), being in relationship with boys (P-V=0.015), families without one or two parents (P-V=0.020), night spending at friends home without parents' permission (P.V=0.001) were associated with ecstasy use. Conclusion: Due to relation of ecstasy use with other substances, designed programmes should be comprehensive, with different strategies and collaboration of several sectors. The main strategies are to improve students' health literacy, family support, to limit supply and access, and to legislate appropriate regulatory laws.

Milligan K; Niccols A; Sword W; Thabane L; Henderson J; Smith A. Length of stay and treatment completion for mothers with substance abuse issues in integrated treatment programmes. Drugs: Education, Prevention and Policy 18(3): 219-227, 2011. (33 refs.)

Aim: To examine the effects of integrated treatment programmes (those with addiction services and pregnancy-, parenting- or child-related services) on length of stay and treatment completion. Methods: We systematically reviewed studies published between 1990 and 2008 comparing integrated programmes with non-integrated programmes on length of stay (number of studies [K] = 3, number of participants [n] = 1910) and treatment completion (K = 6, n = 2556). We performed meta-analyses using standardized mean differences (d) of effect size estimates. Findings: There was a significant advantage of integrated treatment programmes over non-integrated treatment in the number of days women spent in treatment (d = 0.35, p < 0.0001) but not treatment completion (d = 0.38, p = 0.09). Conclusions: This meta-analysis is the first systematic quantitative review of studies evaluating the impact of integrated programmes. Findings suggest that integrated programmes may be associated with a small advantage over non-integrated programmes in length of stay. This review highlights the need for further research with improved methodology, quality, and reporting to improve our understanding of how best to engage, retain and support mothers with substance abuse issues in treatment.

Mohsin M; Bauman AE; Forero R. Socioeconomic correlates and trends in smoking in pregnancy in New South Wales, Australia. Journal of Epidemiology and Community Health 65(8): 727-732, 2011. (40 refs.)

Objective. This study describes trends (1994-2007) in smoking in pregnancy (SIP) among an Australian population sample of women. This study also examines trends in the socioeconomic distribution of SIP over the 14-year period. Methods. Bivariate and multiple logistic regression analyses of the NSW Midwives Data Collection were used to explore the associations and trends in SIP by sociodemographic factors. Results. The prevalence of SIP in New South Wales (NSW) declined from 22.1% (1994) to 13.5% in 2007. However, the largest decrease in SIP rates was among the highest socioeconomic group (67.9% decline), and smaller declines were observed among teenage and remote rural mothers. Maternal age, ethnicity, Aboriginality, area of remoteness and socioeconomic status were independently associated with SIP. The distribution of NSW mothers has changed, with fewer younger mothers and more from an Asian background. Conclusion. This study reported large declines in SIP prevalence, with a population effect similar to that expected following exposure to (Cochrane-defined) intensive behavioural interventions. However, no specially targeted public health efforts were made during this period to influence SIP, so that social norm change is the likely explanation for these population health changes. The relative decline in SIP was smaller among low-socioeconomic status mothers, by language spoken at home, Aboriginality and area of remoteness, suggesting that inequalities in SIP have increased over this 14-year period. This information informs equity-based approaches to targeting further smoking cessation programs for pregnant Australian women.

Montanari L; Serafini M; Maffli E; Busch M; Kontogeorgiou K; Kuijpers W. Gender and regional differences in client characteristics among substance abuse treatment clients in the Europe Union. Drugs: Education, Prevention and Policy 18(1): 24-31, 2011. (24 refs.)

Aims: To assesses the extent of the gender gap among the treated population of drug users across Europe. Methods: This analysis reports data on 363,170 clients from 4647 treatment units in 23 countries (22 European Union member states and Switzerland). Findings: Overall, males outnumber females by four, but the gender ratio varies not only by geographical region/country, but also by drug. In the majority of countries, the most common primary problem drug is opioids, and the overall gender ratio mirrors the gender ratio of opioid users. In some countries, a considerable proportion of treated drug users have cannabis and stimulants (cocaine/amphetamines/methamphetamines) as primary problem drugs. Stimulants other than cocaine and other drugs have lower, while cannabis has a higher than overall male-to-female gender ratio. Conclusions: The very high male-to-female gender ratios may reveal differential access to treatment. Our findings highlight the need to assess access to treatment for women problem drug users and to make women-focussed programmes more available to increase the proportion of women in drug treatment programmes across Europe.

Muckle G; Laflamme D; Gagnon J; Boucher O; Jacobson JL; Jacobson SW. Alcohol, smoking, and drug use among Inuit women of childbearing age during pregnancy and the risk to children. Alcoholism: Clinical and Experimental Research 35(6): 1081- 1091, 2011. (62 refs.)

Background: Alcohol consumption during pregnancy, a known teratogen often associated with drug use and smoking is a well-known public health concern. Aim: This study provides prevalence data for alcohol, smoking, and illicit drug use before, during, and after pregnancy among Inuit. Factors associated with alcohol use are also identified. Methods: Two hundred and eight Inuit women from Arctic Quebec were interviewed at mid-pregnancy, and at 1 and 11 months postpartum to provide descriptive data on smoking, alcohol, and drug use during pregnancy, and the year before and after pregnancy. Sociodemographic and family characteristics potentially associated with alcohol use were documented. Results: Ninety-two percent of the women reported smoking and 61% reported drinking during pregnancy. Episodes of binging during pregnancy were reported by 62% of the alcohol users, which correspond to 38% of pregnant women. Thirty-six percent of the participants reported using marijuana during pregnancy. Alcohol use and binge drinking during pregnancy were more likely to be reported by women who lived in less crowded houses, had a better knowledge of a second language, drank alcohol more often and in larger amounts prior to pregnancy, and used illicit drugs. Binge drinkers were more likely to be single women and to have had fewer previous pregnancies. Postpartum distress and violence were more likely to be experienced by women who used alcohol during pregnancy. Binge drinking during pregnancy was best predicted by drinking habits before pregnancy, maternal symptoms of depression, the use of illicit drugs during pregnancy, and the number of young children living with the mother. Conclusions: These results confirm that alcohol is a major risk factor to maternal and child health in this population, underscoring the need for culturally relevant and effective prevention programs.

Napolitano MA; Lloyd-Richardson EE; Fava JL; Marcus BH. Targeting body image schema for smoking cessation among college females: Rationale, program description, and pilot study results. Behavior Modification 35(4): 323- 346, 2011. (58 refs.)

Smoking among young adults is a significant public health problem. Despite the negative health effects, many young women smoke for weight and body image reasons. Understanding the factors that prompt young women to initiate and continue smoking is important for designing smoking cessation interventions. The aim of the current article is to outline a potential pathway for smoking behavior among young women, specifically applying a cognitive bias framework previously used to describe disordered eating behaviors. This article provides the rationale for using two different treatments targeting body image schema among female smokers. The authors describe the development, feasibility, and acceptability of these two treatment approaches among a sample of female college smokers (N = 24). Preliminary pilot data are presented as well as the significance and implications for future clinical interventions.

Nappo SA; Sanchez Z; De Oliveira LG. Crack, AIDS, and women in Sao Paulo, Brazil. Substance Use & Misuse 46(4): 476-485, 2011. (43 refs.)

Brazil is currently experiencing a growing number of newly recorded cases of HIV infection among women, with transmission mainly occurring by sex. This increase may be associated with the development of sexually risky behavior among female crack users who, according to informal reports, prostitute themselves for drugs or for money to be used for buying drugs. Since epidemiologic studies have not yet addressed this phenomenon, the aim of this study was to investigate this in depth using a qualitative ethnographic approach. An intentional sample was utilized, composed of 75 female crack users in Sao Paulo, who were selected by specific criteria using the snowball strategy and key informants. Fourteen different chains of users were investigated, allowing us to include the largest possible number and variety of users. Each participant was submitted to a semi-structured in-depth interview that was guided by a questionnaire. Verbal information was corroborated and extended using participative observation. These 14-45-year-old women, who had little schooling and no job connections, opted to sell their bodies as a strategy to obtain drugs and to satisfy their compulsive use of crack. The subjects engaged in up to nine acts of sexual intercourse per day, in unsafe locations and with multiple partners who were approached in a besieging way and selected using subjective criteria. These crack users generally exchanged sex under craving for ridiculously low prices and left the use of protection up to the client. Because the users used inadequate pipes to smoke crack, it was common for them to have lesions on their lips and mouths. Since they often provided oral sex, they exposed themselves to considerable risk for infection with STDs including HIV, because of the contact of their partners" semen with their open wounds. These women make up an important risk group with respect to the transmission of STDs including AIDS.

Ondersma SJ; Grekin ER; Svikis D. The potential for technology in brief interventions for substance use, and during-session prediction of computer-delivered brief intervention response. Substance Use & Misuse 46(1): 77-86, 2011. (42 refs.)

We first provide an overview of the potential of technology in the area of brief interventions for substance use and describe recent projects from our lab that are illustrative of that potential. Second, we present data from a study of during-session predictors of brief intervention response. In a sample of postpartum women (N = 39), several variables showed promise as predictors of later drug use, and a brief index derived from them predicted abstinence with a sensitivity of .7 and a specificity of .89. This promising approach and initial study findings support the importance of future research in this area.

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

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

Rostron BL; Wilmoth JR. Estimating the effect of smoking on slowdowns in mortality declines in developed countries. Demography 48(2): 461- 479, 2011. (28 refs.)

Declines in mortality rates for females at older ages in some developed countries, including the United States, have slowed in recent decades even as decreases have steadily continued in some other countries. This study presents a modified version of the indirect Peto-Lopez method, which uses lung cancer mortality rates as a proxy for smoking exposure, to analyze this trend. The modified method estimates smoking-attributable mortality for more-specific age groups than does the Peto-Lopez method. An adjustment factor is also introduced to account for low mortality in the indirect method's study population. These modifications are shown to be useful specifically in the estimation of deaths attributable to smoking for females at older ages, and in the estimation of smoking-attributable mortality more generally. In a comparison made between the United States and France with the modified method, smoking is found to be responsible for approximately one-half the difference in life expectancy for females at age 65.

Sakai H; Kawamura C; Cardenas X; Ohashi K. Premenstrual and menstrual symptomatology in young adult Japanese females who smoke tobacco. Journal of Obstetrics and Gynaecology Research 37(4): 325-330, 2011. (26 refs.)

Aim: The present study examines the correlation between premenstrual and menstrual symptomatology and smoking status in young adult Japanese females. Material and Methods: A cross-sectional study was conducted to assess premenstrual and menstrual symptomatology using the Moos Menstrual Distress Questionnaire (MDQ). Findings were compared between smokers and nonsmokers. The correlation between symptomatology and smoking status assessed by the Fagerstrom Test for Nicotine Dependency (FTND) and the Reasons for Smoking Scale (RSS), which identifies smoker's motives, was determined. Results: Data were obtained from 785 participants, including 71 smokers, 29 quitters and 685 nonsmokers. All smokers consumed 20 or fewer cigarettes per day with the exception of one heavy smoker. Smoking status affected the cycle of menstruation, but did not affect the duration. Smokers demonstrated more severe symptomatology than nonsmokers during the menstrual and premenstrual phases. Among smokers, premenstrual symptomatology was significantly more severe than menstrual symptomatology. Five premenstrual symptom groups (pain, concentration, water retention, behavior change and negative affect) were significantly higher in smokers than in nonsmokers. Overall MDQ scores and those of three subcategories (concentration, behavior change, and negative affect) during the premenstrual phase were significantly correlated with nicotine dependency and smoking motives. Smoking motives were also correlated with the severity of autonomic reaction. Conclusion: Our findings suggest that young adult Japanese females with a light smoking habit have severe premenstrual symptomatology, which was correlated with nicotine dependency and smoking motives.

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

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

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

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

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

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

Sherman SG; Reuben J; Chapman CS; Lilleston P. Risks associated with crack cocaine smoking among exotic dancers in Baltimore, MD. Drug and Alcohol Dependence 114(2-3): 249- 252, 2011. (20 refs.)

Background: There is a dearth of research focusing on sex work in exotic dance clubs. We conducted a cross-sectional study to examine the prevalence and correlates of crack cocaine smoking among a sample of exotic dancers. Methods: The "block," a historical red-light district in downtown Baltimore, MD, is comprised of 30 adult-entertainment establishments. Between 01/09 and 08/09, we conducted a survey with exotic dancers (N = 98). The survey explored demographic, and drug and sexual/drug risk behaviors. Bivariate and multivariate analysis was conducted using Poisson regression with robust variance estimates to examine correlates of current crack smoking. Results: Crack cocaine smokers compared to non-crack cocaine smokers were significantly more likely to report: older age (29 vs. 23 years, respectively, p < 0.0001); being White (79% vs. 50%, respectively, p = 0.008); having been arrested (93% vs. 67%, respectively, p = 0.008); daily alcohol consumption (36% vs. 17%, p = 0.047); current heroin injection (57% vs. 13%, p < 0.001); and current sex exchange (79% vs. 30%, p < 0.001). In the presence of other variables, crack cocaine smokers compared to non-crack cocaine smokers were significantly older, more likely to report current heroin injection, and more likely to report current sex exchange. Discussion: We found high levels of drug use and sexual risk behaviors as well as a number of risks behaviors associated with crack cocaine smoking among this very under-studied population. Targeted interventions are greatly needed.

Stockl H; Heise L; Watts C. Factors associated with violence by a current partner in a nationally representative sample of German women. Sociology of Health & Illness 33(5): 694-709, 2011. (59 refs.)

Partner violence is a serious human rights violation and public health issue. Although its pervasiveness is well documented, more research is needed on risk and protective factors to inform interventions. This study is based on a secondary analysis of the first national survey on violence against women in Germany. Women who reported partner violence by their current partner were compared to women who never reported partner violence. The prevalence of physical or sexual violence, or both, by current partners was 17 per cent. Women who experienced violence during their childhood had higher odds of experiencing partner violence. Partner violence was associated with women's drug use in the last 5 years, physical disability or debilitating illness, having more than three children, experiencing violence by a non-partner and feeling socially excluded. The odds of violence also increased if both partners were unemployed or lacked vocational training or if only the woman had vocational skills. Relationships shorter than 5 years or where the man or both partners drank heavily were likewise associated with higher odds of violence. Partner violence interventions should focus on reducing children's exposure to violence and preparing women and men for the job market as well as including interventions that tackle social isolation and substance use.

Suchman NE; Decoste C; Mcmahon TJ; Rounsaville B; Mayes L. The mothers and toddlers program, an attachment-based parenting intervention for substance-using women: Results at 6-week follow-up in a randomized clinical pilot. Infant Mental Health Journal 32(4): 427-449, 2011. (48 refs.)

Previously, we reported posttreatment findings from a randomized pilot study testing a new attachment-based parenting intervention for mothers enrolled in substance-use treatment and caring for children ages birth to 3 years (N.E. Suchman, C. DeCoste, N. Castiglioni, T. McMahon, B. Rounsaville, & L. Mayes, 2010). The Mothers and Toddlers Program (MTP) is a 12-session, weekly individual parenting therapy that aims to enhance maternal capacity for reflective functioning and soften harsh and distorted mental representations of parenting. In a randomized pilot study, 47 mothers who were enrolled in outpatient substance-abuse treatment and caring for children between birth and 3 years of age were randomized to the MTP versus the Parent Education Program (PE), a comparison intervention that provided individual case management and developmental guidance. At the end of treatment, mothers in the MTP condition demonstrated better reflective functioning, representation quality, and caregiving behavior than did mothers in the PE condition. In this investigation, we examined whether the benefits of MTP at posttreatment were sustained at the 6-week follow-up. Recently, we also identified two components of parental reflective functioning: (a) a self-focused component representing the parent's capacity to mentalize about strong personal emotions (e. g., anger, guilt, or pain) and their impact on the child and (b) a child-focused component representing the parent's capacity to mentalize about the child's emotions and their impact on the mother (N. Suchman, C. DeCoste, D. Leigh, & J. Borelli, 2010). In this study, we reexamined posttreatment outcomes using these two related, but distinct, constructs.

Sullivan WC. A note on the influence of maternal inebriety on the offspring. (reprint from 1899). International Journal of Epidemiology 40(2): 278-282, 2011. (12 refs.)

Author's Introduction: The object of the following paper is to present the result of a number of observations touching certain aspects of the question of habitual inebriety, notably the r�le of maternal alcoholism as an agent in race degeneracy. . . . I have selected from the female population of Liverpool Prison, amongst whom habitual inebriety is very prevalent, a series of cases of chronic drunkards who have borne children; and from the history of these children, and more particularly from the indications given by the infant mortality, I have sought to illustrate the mode in which the maternal intoxication appears to have reacted on the development of the offspring. In the selection I have endeavoured, as far as possible, to choose cases in which alcoholism occurred uncomplicated by other degenerative factors. Author's Conclusion: The observations which we have thus briefly analysed enable us to form a fairly clear idea of the mode in which maternal inebriety reacts upon the offspring. We are familiar with the fact, clearly established by Morel, that the chronic alcoholism of one or both parents frequently appears as the first moment in the degenerative career of a family; that it represents a state of artificial degradation of the organism, capable of transmission in augmented force to the descendants, and culminating in some four generations in the extinction of the stock. In the case of maternal inebriety we have the same mode of action to consider, but with it, and very much more potent, we have the continued toxic influence exercised on the developing embryo throughout pregnancy. The brilliant researches of F�r� in the field of experimental teratology have sufficiently demonstrated the gravity of this influence. We have, further, to bear in mind the possible effect of alcoholic excesses during lactation. Lastly, reinforcing all these modes of influence, we have the detrimental effects, positive and negative, of the deterioration of the milieu as an indirect consequence of the mother's drunkenness.

Todd J; Mullan B. Using the theory of planned behaviour and prototype willingness model to target binge drinking in female undergraduate university students. Addictive Behaviors 36(10): 980-986, 2011. (52 refs.)

The current study investigated whether binge drinking in female undergraduates could be reduced by the mere measurement effect (MME), and by altering binge drinker prototypes from the prototype willingness model (PWM). Whether willingness added to the theory of planned behaviour (TPB) was also explored. Female undergraduates aged 17-25 (N = 122) were randomly allocated to a prototype manipulation, mere measurement, or control group, and completed two online questionnaires separated by 14-21 days. Controlling for past behaviour, MME group consumed less alcohol than the control group, and this effect was more extreme for those who previously consumed more alcohol. However, the prototype manipulation had no effect. The TPB variables were predictive of intentions and behaviour, but willingness was not. Despite limitations, the MME could be utilised to reduce binge drinking in female undergraduates. The TPB appears to model binge drinking in female undergraduates better than the PWM, implying that binge drinking can be a reasoned behaviour.

Trickett PK; Noll JG; Putnam FW. The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study. Development and Psychopathology 23(2): 453- 476, 2011. (112 refs.)

This is a report on the research design and findings of a 23-year longitudinal study of the impact of intrafamilial sexual abuse on female development. The conceptual framework integrated concepts of psychological adjustment with theory regarding how psychobiological factors might impact development. Participants included 6- to 16-year-old females with substantiated sexual abuse and a demographically similar comparison group. A cross-sequential design was used and six assessments have taken place, with participants at median age 11 at the first assessment and median age 25 at the sixth assessment. Mothers of participants took part in the early assessments and offspring took part at the sixth assessment. Results of many analyses, both within circumscribed developmental stages and across development, indicated that sexually abused females (on average) showed deleterious sequelae across a host of biopsychosocial domains including: earlier onsets of puberty, cognitive deficits, depression, dissociative symptoms, maladaptive sexual development, hypothalamic-pituitary-adrenal attenuation, asymmetrical stress responses, high rates of obesity, more major illnesses and healthcare utilization, dropping out of high school, persistent posttraumatic stress disorder, self-mutilation, Diagnostic and Statistical Manual of Mental Disorders diagnoses, physical and sexual revictimization, premature deliveries, teen motherhood, drug and alcohol abuse, and domestic violence. Offspring born to abused mothers were at increased risk for child maltreatment and overall maldevelopment. There was also a pattern of considerable within group variability. Based on this complex network of findings, implications for optimal treatments are elucidated. Translational aspects of extending observational research into clinical practice are discussed in terms that will likely have a sustained impact on several major public health initiatives.

Tucker JS; Wenzel SL; Golinelli D; Zhou A; Green HD. Predictors of substance abuse treatment need and receipt among homeless women. Journal of Substance Abuse Treatment 40(3): 287-294, 2011. (50 refs.)

Many homeless women do not receive needed treatment for substance abuse. This study identified social network and other predisposing factors associated with perceived need for and receipt of substance abuse treatment among 273 homeless women who screened positive for past-year substance abuse. Perceived treatment need was more likely among women with drug-using sex partners, a denser network, and an arrest history but less likely for those with a minor child and a longer history of homelessness. Receiving treatment was more likely among women who received informational support from their sex partners and who had an arrest history but less likely among those who had a more street-based social network, had a minor child, considered themselves homeless, and recently needed mental health treatment. Treatment services researchers should attend more closely to social contextual factors, as well as the more traditional individual factors, to understand access and barriers to treatment.

Vardavas CI; Patelarou E; Grander M; Chatzi L; Palm B; Fthenou E et al. The association between active/passive smoking and toxic metals among pregnant women in Greece. Xenobiotica 41(6): 456- 463, 2011. (45 refs.)

1. Exposure to toxic metals during pregnancy may have detrimental effects on foetal development. We assessed the role of sociodemographic characteristics and active and passive smoking on blood concentrations of metals (As, Cd, Pb, Hg, Sb, U, Mn and Mo). 2. Venous blood drawn from 50 pregnant women, randomly selected from the mother-child birth cohort 'Rhea'. Extensive questionnaire data on active and passive smoking were collected. Urinary cotinine was measured to validate self-reported exposure and non-smoking status. 3. Smokers had higher concentrations of Cd (1.0 mu g/L) as compared with non-smokers (0.29 mu g/L, P < 0.001) and a tendency for higher As and Hg. Among non-smokers, blood As and Hg concentrations were also associated with exposure to passive smoking in public venues and the family home and to overall greater secondhand smoke (SHS) exposure (As: 0.97 mu g/L among heavy-exposed compared with 0.20 mu g/L among the low-exposed, P < 0.05; Hg: 2.1 mu g/L vs. 0.9 mu g/L respectively, P < 0.05). Controlling for fish and seafood intake altered the statistical significance but not the direction of the above associations. 4. Smoking was associated with higher Cd concentrations in pregnant women, although the association between passive smoking and elevated As and Hg concentrations was indicative, however inconclusive.

Vezina-Im LA; Godin G. Psychosocial determinants of intention to abstain from drinking alcohol while pregnant among a sample of women of childbearing age. Addiction Research & Theory 19(2): 128-137, 2011. (60 refs.)

In many countries, not drinking alcohol during pregnancy is strongly recommended, since consuming alcohol can be hazardous for the unborn child. Despite this, a number of women drink alcohol while pregnant. The two objectives of the study were to identify (1) the determinants of intention to abstain from drinking alcohol while pregnant among 167 women of childbearing age between 18 and 44 years and (2) the factors that programmes promoting alcohol abstinence during pregnancy should consider. Data were collected using a questionnaire based on an extended version of the theory of planned behaviour. A large majority of the participants reported consuming alcohol on a regular basis. Although most of them expressed a strong intention to abstain from alcohol during pregnancy, about one woman in four did not have a firm intention. A logistic regression analysis revealed that the four determinants of intention were moral norm (odds ratio (OR) 12.97; 95% confidence interval (CI95%): 3.83=43.91), anticipated regret (OR = 11.43; CI95%: 3.46=37.75), attitude (OR 7.49; CI95%: 2.37=23.64) and perceived behavioural control (OR 3.60; CI95% 1.11=11.65). Moreover, a discriminant analysis identified specific beliefs significantly related to intention not to consume alcohol while pregnant. These results can prove useful in guiding the development of a programme promoting alcohol abstinence among women of childbearing age in order to reduce the number of unborn children exposed to alcohol during pregnancy.

Wetter DW; McClure JB; Cofta-Woerpel L; Costello TJ; Reitzel LR; Businelle MS et al. A randomized clinical trial of a palmtop computer-delivered treatment for smoking relapse prevention among women. Psychology of Addictive Behaviors 25(2): 365-371, 2011. (33 refs.)

Relapse is the rule rather than the exception among smokers attempting to quit, and compared to men, women may have higher relapse rates. The current study was a randomized clinical trial testing a palmtop computer-delivered treatment (CDT) for smoking relapse prevention among women. The intervention was individualized based on key theoretical constructs that were measured using ecological momentary assessment (EMA). All participants (N = 302) received standard smoking cessation treatment consisting of nicotine replacement therapy and group counseling, and completed EMA procedures for one week after quitting. At the completion of the group counseling sessions and EMA procedures, participants were randomized to either CDT or no further computer-delivered treatment or assessment (EMA-Only). CDT participants received a palmtop computer-delivered relapse prevention treatment for one additional month. CDT did not improve abstinence rates relative to EMA-Only. Process analyses suggested that heavier smokers were more likely to use CDT and that greater use among CDT participants may be associated with more positive outcomes. The rapid pace of technological advances in mobile computer technology and the ubiquity of such devices provide a novel platform for developing new and potentially innovative treatments. However, the current study did not demonstrate the efficacy of such technology in improving treatment outcomes.

Woolhouse S; Brown JB; Thind A. 'Meeting people where they're at': Experiences of family physicians engaging women who use illicit drugs. Annals of Family Medicine 9(3): 244-249, 2011. (38 refs.)

PURPOSE: There is little research exploring the experiences of family physicians caring for women who use illicit drugs. This study explores the experiences of these physicians in order to better understand the process of engaging these women in the patient-physician relationship. METHODS: We conducted a phenomenologic, qualitative study using individual, in-depth interviews with 10 family physicians working in inner-city Toronto and Ottawa, Ontario. An iterative and interpretive analysis was used. RESULTS: Three broad themes emerged from the analysis. The predominant theme was that of the patient-physician relationship, which consisted of 2 phases: the engagement phase and the maintenance phase. During the engagement phase, issues such as access and women's experiences of trauma and violence were evident and impeded participants' ability to engage with this population. As such, the patient-physician relationship during the engagement phase was tenuous. Trust and presence were paramount during this phase. Once a family physician engaged a woman, the transition to the maintenance phase was made. Within the maintenance phase, 2 subthemes were identified: continuity of care and "meeting people where they're at" (finding common ground). CONCLUSIONS: This study identified a 2-phase process of the patient-physician relationship from the perspective of family physicians caring for women using illicit drugs: the engagement and maintenance phases. Our findings identified strategies to support the patient-physician relationship during each of these phases that have implications for improving the health of these women.

Wu ZH; Grady JJ; Rosales S; Berenson AB. Ecstasy use and its correlates among young, low-income women. Substance Use & Misuse 46(4): 404-410, 2011. (43 refs.)

We examined the association of illicit drug use with stress and sexual behaviors among 407 women, aged 18-31, who attended family-planning clinics in southeast Texas between June 2002 and May 2003 (n = 407). Paired comparisons of each of three types of drug users (of ecstasy, marijuana only, and other illicit drugs except ecstasy) with nonusers were assessed by logistic regressions. After controlling for demographics, both ecstasy users and marijuana-only users had a higher score on the stress scale than nonusers. All drug users were at higher risk of more lifetime sexual partners than those who had never used drugs, while those who had used ecstasy were more than twice as likely to have had prior sexually transmitted infections as those who had never used drugs. This study demonstrates that young, low-income women who use ecstasy experience higher levels of stress than nonusers. Stress level is correlated with drug use and participation in risky sexual behaviors. If stress is associated with drug use and risky sexual behavior, interventions designed to reduce substance use and risky sexual behavior in these women may need to also address factors that lead to increased stress. The study's limitations were noted.