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CORK Bibliography: Women

152 citations. January 2009 to present

Prepared: September 2009

Agrawal A; Lynskey MT; Madden PAF; Pergadia ML; Bucholz KK; Heath AC. Simultaneous cannabis and tobacco use and cannabis-related outcomes in young women. Drug and Alcohol Dependence 101(1-2): 8-12, 2009. (33 refs.)

Compared to those who reported a lifetime co-occurrence of cannabis and tobacco use, individuals who report simultaneous use of cannabis and tobacco are more likely to also report higher rates of substance-related problems and psychopathology. In a sample of young women, we examine (a) co-occurring use, or whether regular cigarette smoking is associated with increased cannabis involvement and (b) simultaneous use, a special form of co-occurring use where cannabis and cigarettes are typically used on the same occasion to test whether those Who use cannabis and tobacco simultaneously are also more likely to report greater cannabis involvement and (c) the extent to which latent genetic and environmental factors contribute to simultaneous use in those with a history of co-occurring cannabis use and regular cigarette smoking. Women (N= 3427) who report regular cigarette smoking are 4.5-9.5 times more likely to report co-occurring cannabis use and other stages of cannabis involvement, including DSM-IVcannabis abuse and dependence. In those women who report co-occurring regular cigarette smoking and lifetime cannabis use (N= 1073), simultaneous use of cannabis and tobacco was associated with increased likelihood of negative cannabis-related outcomes. Simultaneous users were 1.6 times more likely to meet criteria for DSM-IV cannabis abuse, even after controlling for early covariates and for prior stages of cannabis involvement. Simultaneous use was not heritable, and twin similarity was attributable to shared environmental factors (31%). While our study does not determine causality between simultaneous tobacco-cannabis use and cannabis involvement, results indicate that simultaneous use is potentially a marker for more severe psychosocial consequences associated with cannabis use.

Allen AM; Allen SS; Widenmier J; al'Absi M. Patterns of cortisol and craving by menstrual phase in women attempting to quit smoking. Addictive Behaviors 34(8): 632-635, 2009. (35 refs.)

Research indicates stress, craving and menstrual phase may play a role in relapse to smoking. It remains unknown how these factors may interact during cessation. This study describes the relationship between craving and cortisol concentrations by menstrual phase during ad libitum smoking and investigates the impact of this relationship on time to relapse. Five assessments of cortisol concentrations and craving levels were collected the day before smoking cessation in female smokers (n = 38) during either the follicular (n = 21; F) or luteal (n 17; Q phase. Craving at wake-up was significantly greater in the F phase than the L phase (2.5 +/- 1.9 vs. 1.1 +/- 1.4; p = 0.018; respectively). Decreased levels of morning cortisol concentrations and a greater decline from morning to the nadir levels in cortisol were associated with increased craving at bedtime in the L (r = -0.68, p = 0.002; r = -0.67, p = 0.003; respectively), but not in the F phase. Craving at wake-up was a significant predictor of time to relapse (p = 0.008). Our results indicate that menstrual phase may play a role in the relationship among craving, cortisol concentrations, and risk for relapse.

Allen NE; Beral V; Casabonne D; Kan SW; Reeves GK; Brown A et al. Moderate alcohol intake and cancer incidence in women. Journal of National Cancer Institute 101(5): 296-305, 2009. (48 refs.)

With the exception of breast cancer, little is known about the effect of moderate intakes of alcohol, or of particular types of alcohol, on cancer risk in women. A total of 1 280 296 middle-aged women in the United Kingdom enrolled in the Million Women Study were routinely followed for incident cancer. Cox regression models were used to calculate adjusted relative risks and 95% confidence intervals (CIs) for 21 site-specific cancers according to amount and type of alcoholic beverage consumed. All statistical tests were two-sided. A quarter of the cohort reported drinking no alcohol; 98% of drinkers consumed fewer than 21 drinks per week, with drinkers consuming an average of 10 g alcohol (1 drink) per day. During an average 7.2 years of follow-up per woman 68 775 invasive cancers occurred. Increasing alcohol consumption was associated with increased risks of cancers of the oral cavity and pharynx (increase per 10 g/d = 29%, 95% CI = 14% to 45%, P-trend < .001), esophagus (22%, 95% CI = 8% to 38%, P-trend = .002), larynx (44%, 95% CI = 10% to 88%, P-trend = .008), rectum (10%, 95% CI = 2% to 18%, P-trend = .02), liver (24%, 95% CI = 2% to 51%, P-trend = .03), breast (12%, 95% CI = 9% to 14%, P-trend < .001), and total cancer (6%, 95% CI = 4% to 7%, P-trend < .001). The trends were similar in women who drank wine exclusively and other consumers of alcohol. For cancers of the upper aerodigestive tract, the alcohol-associated risk was confined to current smokers, with little or no effect of alcohol among never and past smokers (P-heterogeneity < .001). Increasing levels of alcohol consumption were associated with a decreased risk of thyroid cancer (P-trend = .005), non-Hodgkin lymphoma (P-trend = .001), and renal cell carcinoma (P-trend = .03). Low to moderate alcohol consumption in women increases the risk of certain cancers. For every additional drink regularly consumed per day, the increase in incidence up to age 75 years per 1000 for women in developed countries is estimated to be about 11 for breast cancer, 1 for cancers of the oral cavity and pharynx, 1 for cancer of the rectum, and 0.7 each for cancers of the esophagus, larynx and liver, giving a total excess of about 15 cancers per 1000 women up to age 75.

Alvarez-Moya EM; Jimenez-Murcia S; Moragas L; Gomez-Pena M; Aymami MN; Ochoa C et al. Executive functioning among female pathological gambling and bulimia nervosa patients: Preliminary findings. Journal of the International Neuropsychological Society 15(2): 302-306, 2009. (31 refs.)

Shared vulnerabilities have been described across disorders of impulse control, including pathological gambling (PG) and bulimia nervosa (BV). Our aim was to compare the executive functioning of PG and BN females in order to confirm their similarity at a neurocognitive level. A total of 15 BN females, and 15 healthy control (HC) females were administered the Wisconsin Card Sorting Test (WCST) and the Stroop Color and Word Test. Analysis of covariance adjusted for age and education was conducted to compare groups. PG showed the greatest impairment, that is, the highest percentage of WCST perseverative errors (p = .023), the lowest percentage of conceptual-level responses (p = .034), and the highest number of total trials administered (p = 0.21), while BN showed the highest percentage of WCST nonperseverative errors (p = .003). Both BN and PG females demonstrated executive dysfunction relative to HCs but different specific correlates (i.e., greater vulnerability to distraction in BN, but more cognitive inflexibility in PG).

Ambrose-Lanci LM; Sterling RC; Weinstein SP; Bockstaele EJ. The influence of intake urinalysis, psychopathology measures, and menstrual cycle phase on treatment compliance. American Journal on Addictions 18(2): 167-172, 2009. (33 refs.)

Drug abuse among women is a societal health problem which has received greater attention in recent years. Studies examining sex differences in drug abuse have shown consistent differences between males and females. In the current study, we retrospectively examined 75 treatment-seeking females to determine the relationships between intake measurements of psychopathology, intake urinalysis, menstrual cycle phase at admission, and treatment compliance. Our results support a relationship among these variables and a potential relationship between menstrual cycle phase and anxiety level is discussed. These results support the need for the development of individually tailored treatment programs.

Anglin MD; Brown BS; Dembo R; Leukefeld C. Criminality and addiction: Selected issues for future policies, practice, and research. Journal of Drug Issues 39(1): 89-99, 2009. (43 refs.)

The high cost of incarceration and a general confidence in the effectiveness of drug abuse treatment have led many states to adopt community-based drug abuse treatment as part of, or as an alternative to, incarceration. Community re-entry and aftercare have therefore received increasing attention from both practitioners and researchers. This article examines possibilities for encouraging change in both adult and juvenile justice treatment. Four issues are highlighted: (1) relapse and aftercare, (2) co-occurring disorder, (3) juvenile justice programming, and (4) women's treatment. The success of U. S. drug treatment policy depends on a capacity to resolve these and related issues.

Balbach ED; Campbell RB. Union women, the tobacco industry, and excise taxes: A lesson in unintended consequences. American Journal of Preventive Medicine 37(2, Supplement S): S121-S125, 2009. (31 refs.)

Between 1987 and 1997, the tobacco industry used the issue of cigarette excise tax increases to create a political partnership with the Coalition of Labor Union Women (CLUW), a group representing female trade unionists in the U.S. This paper documents how the industry created this relationship and the lessons tobacco-control advocates can learn from the industry's example, in order to mitigate possible unintended consequences of advocating excise tax increases. In 1998, under the terms of the Master Settlement Agreement, the tobacco industry began making documents produced in litigation available publicly. Currently, approximately 50 million pages are available online, including substantial documentation of the industry-CLUW relationship. For this study, a comprehensive search of these documents was Conducted. The tobacco industry encouraged CLUW's opposition to excise tax increases by emphasizing the economic regressivity of these taxes, discussing excise taxes generically to deflect attention front cigarettes, and encouraging opposition to earmarking cigarette taxes to pay for specific programs. In addition, CLUW received at least $221,500 in financial support between 1987 and 1997 and in-kind support for its conferences, membership materials, and other services. Excise tax increases, if pursued without considering the impacts they may have on low-SES populations, may have unintended consequences. In this case, such proposals may have helped to create a relationship between CLUW and the tobacco industry. Because excise taxes are endorsed in the Framework Convention on Tobacco Control, tobacco-control advocates must understand how to build relationships with low-SES populations and mitigate potential alliances with the tobacco industry.

Bao Y; Giovannucci E; Fuchs CS; Michaud DS. Passive smoking and pancreatic cancer in women: A prospective cohort study. Cancer Epidemiology, Biomarkers & Prevention 18(8): 2292-2296, 2009. (17 refs.)

Background: Active smoking is an established risk factor for pancreatic cancer, but the role of passive smoking in pancreatic carcinogenesis remains unclear. We aimed to examine whether environmental tobacco smoke is associated with pancreatic cancer risk. Methods: We prospectively examined 86,673 women in the Nurses' Health Study. History of exposure to environmental tobacco smoke was assessed through questionnaires in 1982. Relative risks (RR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models. Results: During 24 years of follow-up (1982-2006), 384 women were diagnosed with pancreatic cancer. Maternal smoking significantly increased the risk of pancreatic cancer (RR, 1.42; 95% CI, 1.07-1.89), whereas paternal smoking was not related to the risk (RR, 0.97; 95% CI, 0.77-1.21). The risk associated with maternal smoking remained elevated, albeit not significant, among never smokers (RR, 1.52; 95% CI, 0.97-2.39). No association was found for adult passive exposure at work or at home. Conclusions: The positive association with maternal smoking suggests that environmental tobacco smoke, potentially in utero or in early life, may be associated with pancreatic cancer.

Beckerleg S. Khat chewing as a new Ugandan leisure activity. Journal of Eastern African Studies 3(1): 42-54, 2009. (27 refs.)

A culture of hedonism that attaches a high value to leisure has prevailed in much of Uganda. Having in the past been associated only with Somali and Yemeni migrants, khat consumption has spread among all ethnic groups and to all parts of Uganda. The locus of consumption has moved from the living room to video halls, alleyways and the ghettos of both urban and rural areas. Khat chewing, which takes several hours if the full sequence of effects is to be achieved, is viewed as idling by mainstream society, and as an affront to the core Ugandan values of hard work and education. There are two types of consumer: 1) the traditional users, maqatna, who chew khat accompanied by soft drinks; 2) the mixers who combine khat sessions with alcohol and/or cannabis use. The mixers have abandoned the rules and rituals of consumption that pertain in other khat-using settings. Many Ugandans confuse cannabis and khat, condone alcohol use, and brand khat chewers as, at best, idlers, and at worst violent criminals.

Bolca S; Huybrechts I; Verschraegen M; Henauw S; Van de Wiele T. Validity and reproducibility of a self-administered semi-quantitative food-frequency questionnaire for estimating usual daily fat, fibre, alcohol, caffeine and theobromine intakes among Belgian post-menopausal women. International Journal of Environmental Research and Public Health 6(1): 121-150, 2009. (43 refs.)

A novel food-frequency questionnaire (FFQ) was developed and validated to assess the usual daily fat, saturated, mono-unsaturated and poly-unsaturated fatty acid, fibre, alcohol, caffeine, and theobromine intakes among Belgian post-menopausal women participating in dietary intervention trials with phyto-oestrogens. The relative validity of the FFQ was estimated by comparison with 7 day (d) estimated diet records (EDR, n 64) and its reproducibility was evaluated by repeated administrations 6 weeks apart (n 79). Although the questionnaire underestimated significantly all intakes compared to the 7 d EDR, it had a good ranking ability (r 0.47-0.94; weighted kappa 0.25-0.66) and it could reliably distinguish extreme intakes for all the estimated nutrients, except for saturated fatty acids. Furthermore, the correlation between repeated administrations was high (r 0.71-0.87) with a maximal misclassification of 7% (weighted kappa 0.33-0.80). In conclusion, these results compare favourably with those reported by others and indicate that the FFQ is a satisfactorily reliable and valid instrument for ranking individuals within this study population.

Brown JP; Gallicchio L; Flaws JA; Tracy JK. Relations among menopausal symptoms, sleep disturbance and depressive symptoms in midlife. Maturitas 62(2): 184-189, 2009. (34 refs.)

Objectives: To investigate the relations among hot flashes, other menopausal symptoms, sleep quality and depressive symptoms in midlife women. Methods: A large population-based cross-sectional study of 639 women (ages 45-54 years) consisting of a questionnaire including the Center for Epidemiologic Studies-Depression (CES-D) Scale, demographics, health behaviors, menstrual history, and menopausal symptoms. Results: After controlling for menopausal status, physical activity level, smoking status and current self-reported health status elevated CES-D score is associated with frequent nocturnal hot flashes, frequent trouble sleeping, experiencing hot flashes, nausea, headaches, weakness, visual problems, vaginal discharge, irritability, muscle stiffness, and incontinence. Conclusions: The present study found significant links between depressive symptoms and several menopausal symptoms including hot flashes, sleep disturbance, irritability, muscle stiffness, and incontinence after controlling for covariates. These findings suggest that a potential mechanism in which bothersome menopausal symptoms may influence depressed mood during the midlife is through sleep disturbance.

Brown VL; Montoya ID. The role of employment in preventing continued drug use among welfare recipients. Journal of Social Science Research 35(2): 105-113, 2009. (34 refs.)

This article utilized a panel design to analyze the relationship between employment and drug use among low-income women over a 2-year period. Five hundred and thirty four (N = 534) female welfare recipients were recruited as part of a 5-year study designed to examine the effects of chronic drug use on the transition from welfare to work. The prototypical study participant was female, single, African American, had less than a 12th grade education, and was about 30 years of age. At intake, less than 10% of the sample was employed. By the end of year 1, more than 40% of sample participants had attained employment. By the end of year 2, nearly 50% were employed. Results indicate that a welfare recipient working more hours during year 1 was a significant predictor of decreased drug use during year 2. Results are discussed in the context of using employment as a central element in tertiary prevention methods geared toward unemployed, chronic drug-using female Temporary Assistance to Needy Family (TANF) recipients.

Brunelle C; Douglas RL; Pihl RO; Stewart SH. Personality and substance use disorders in female offenders: A matched controlled study. Personality and Individual Differences 46(4): 472-476, 2009. (42 refs.)

A number of personality traits have been investigated in relation to delinquent behaviour; however, the female offender population has received far less attention than male offenders. In the current study, 32 incarcerated female offenders, and 32 matched female controls were compared on a measure of behavioural activation and behavioural inhibition, as well as on the personality dimensions of hopelessness /introversion, anxiety sensitivity, impulsivity, and sensation seeking. Lifetime abuse and dependence on various psychoactive substances was also investigated. Stimulant abuse/dependence, impulsivity, and sensation seeking were significant independent predictors of incarceration status in a logistic regression analysis. A stimulant use disorder was a partial mediator of the relationship between sensation seeking and incarceration status. These results suggest that, similar to male populations, disinhibited personality traits and drug use are associated with criminal behaviour in women, and may be important targets for intervention.

Burgess DJ; Fu SS; van Ryn M. Potential unintended consequences of tobacco-control policies on mothers who smoke: A review of the literature. (review). American Journal of Preventive Medicine 37(2, Supplement S): S151-S158, 2009. (116 refs.)

Background: Secondhand smoke poses risks to children, particularly those from low socioeconomic backgrounds. Recently, there has been an increase in tobacco-control policies designed to reduce children's exposure to secondhand smoke, including interventions to change parental smoking behaviors. However, little attention has been paid to understanding potential unintended consequences of such initiatives on mothers who smoke. As such, the objectives of this paper are to explore the potential consequences of tobacco-control policies designed to reduce children's exposure to secondhand smoke on socially disadvantaged mothers who smoke and to provide recommendations for research, policy, and practice. Evidence acquisition: A theory-guided, qualitative narrative review of the perceived discrimination, stigma, and stress and coping literature was conducted. MEDLINE and PsycINFO were searched to identify relevant articles from 1980 to October 2008 for review. Evidence synthesis: There is evidence that strategies designed to reduce secondhand smoke have contributed to smoking stigmatization. However, there is little research on the consequences of these initiatives or how they affect low-income mothers who smoke. Stigmatization research suggests that such policies may have unanticipated outcomes for socially disadvantaged mothers who smoke, such as decreased mental health; increased use of cigarettes or alcohol; avoidance or delay in seeking medical care; and poorer treatment by healthcare professionals. Recommendations for researchers, practitioners, and policymakers are presented. Conclusions: Further research is needed to understand how initiatives to reduce children's exposure to secondhand smoke, as well as broader tobacco-control initiatives, can be designed to minimize potential harm to mothers who smoke.

Burstyn I; Kapur N; Shalapay C; Bamforth F; Wild T; Liu JX et al. Evaluation of the accuracy of self-reported smoking in pregnancy when the biomarker level in an active smoker is uncertain. Nicotine & Tobacco Research 11(6): 670-678, 2009. (21 refs.)

Our main objective was to estimate smoking prevalence as well as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of self-reported smoking among pregnant women in Edmonton, Canada, at 15-16 weeks of gestation. We used serum samples to assemble a cohort of pregnant women who underwent an optional second-trimester screening for chromosomal and developmental anomalies. We determined cotinine concentrations for 92 self-reported smokers (11% of the cohort) and for 285 self-reported nonsmoking mothers, using adapted urinary cotinine assay. Self-reports were collected at the time of delivery. In a validation study, serum cotinine was determined for known smokers and nonsmokers and used, within a Bayesian statistical framework, to define the distribution of cutoffs that differentiate true smokers from nonsmokers. This distribution of cutoffs was used to construct multiple two-by-two tables to obtain the distribution of sensitivity, specificity, PPV, NPV, and prevalence. Sensitivity was poor (M = 47.4%, SD = 17.3%), but specificity was nearly perfect (M = 94.9%, SD = 1.1%). PPV (M = 66.6%, SD = 11.7%) was smaller than NPV (M = 84.7%, SD = 14.3%). In our sample, the prevalence of true smoking at 15-16 weeks of gestation was described by a skewed distribution with a mean of 21.6% (SD = 13.8%) and a median of 16.6%. The strength of the present study includes blinding of subjects to the intention to test their sera for a biomarker of smoking. A limitation was the use of a nonrandom sample restricted to pregnancies that resulted in live births. We discuss data collection methods that would elicit more accurate smoking histories from pregnant women.

Campbell CI; Alexander JA; Lemak CH. Organizational determinants of outpatient substance abuse treatment duration in women. Journal of Substance Abuse Treatment 37(1): 64-72, 2009. (50 refs.)

Longer treatment duration has consistently been related to improved substance use outcomes. This study examined how tailored women's programming and organizational characteristics were related to duration in outpatient substance abuse treatment in women. Data were from two waves of a national outpatient substance abuse treatment unit survey (n = 571 in 1999/2000, n = 566 in 2005). Analyses were conducted separately for methadone and nonmethadone programs. Negative binomial regressions tested associations between organizational determinants, tailored programming, and women's treatment duration. Of the tailored programming services, childcare was significantly related to longer duration in the nonmethadone programs, but few other organizational factors were. Tailored programming was not associated to treatment duration in methadone programs, but ownership, affiliation, and accreditation were related to longer duration. Study findings suggest evidence for how external relationships related to resources, treatment constraints, and legitimacy may influence women's treatment duration. Methadone programs may be more vulnerable to external influences.

Campbell R; Murphy DJ. Smoking in pregnancy. (editorial). British Medical Journal 338: article b2188, 2009. (12 refs.)

Capps NP; Stewart A; Burns C. The interplay between secondhand cigarette smoke, genetics, and cervical cancer: A review of the literature. (review). Biological Research for Nursing 10(4): 392-399, 2009. (39 refs.)

Research has suggested a link between smoking and cervical cancer; however, little data are available on secondhand smoke (SHS) exposure and cervical cancer risk. This article reviews the literature on the links among smoking, SHS exposure and cervical cancer. The review was based on a search of electronic data-bases. The research reviewed clearly showed that smoking increases cervical cancer risk through myriad mechanisms that interact with genetics and the pathologic processes leading to cervical cancer. However, less is understood about the role of SHS in cervical cancer. With new technology enabling scientists to examine how genomic structure responds to environmental stimuli, more information should be forthcoming on links between SHS exposure, biomarkers, and genetic changes involved in the development of cervical cancer.

Chavarro JE; Rich-Edwards JW; Rosner BA; Willett WC. Caffeinated and alcoholic beverage intake in relation to ovulatory disorder infertility. Epidemiology 20(3): 374-381, 2009. (59 refs.)

Background: Many studies have examined whether caffeine, alcohol, or specific beverages containing these substances affect fertility in women. However, most of these studies have retrospectively collected information on alcohol and caffeine intake, making the results susceptible to biases. Methods: We followed 18,555 married women without a history of infertility for 8 years as they attempted to become (or became) pregnant. Diet was measured twice during this period and prospectively related to the incidence of ovulatory disorder infertility. Results: There were 438 incident report of ovulatory disorder infertility during follow-up. Intakes of alcohol and caffeine were unrelated to the risk of ovulatory disorder infertility. Comparing the highest to lowest categories of intake, the multivariate-adjusted relative risk, was 1.11 (95% confidence interval = 0.76-1.64; P for trend 0.78) for alcohol and 0.86 (0.61-1.20; 0.44) for total caffeine. However, intake of caffeinated soft drinks was positively related to ovulatory disorder infertility. Comparing the highest to lowest categories of caffeinated soft drink consumption, the RR was 1.47 (1.09-1.98; 0.01). Similar associations were observed for noncaffeinated, sugared, diet, and total soft drinks. Conclusions: Our findings do not support the hypothesis that alcohol and caffeine impair ovulation to the point of decreasing fertility. The association between soft drinks and ovulatory disorder infertility seems not to be attributable to their caffeine or sugar content, and deserves further investigation.

Chien YC; Huang YJ; Hsu CS; Chao JCJ; Liu JF. Maternal lactation characteristics after consumption of an alcoholic soup during the postpartum 'doing-the-month' ritual. Public Health Nutrition 12(3): 382-388, 2009. (53 refs.)

Objective: The present study examined whether ethanol exposure influences lactation parameters. Specifically, selected constituents in maternal blood and milk and die lactation performance of Chinese lactating mothers were evaluated after they had consumed chicken soup flavoured with sesame oil and rice wine (CSSR), a diet traditionally prescribed during the postpartum 'doing-the-month' ritual. Design: Twenty-three lactating mothers were examined. informed consent was obtained from each subject. Each subject was tested on two occasions separated by a week. The target alcohol dosage was 0.3 g/kg body weight. Milk and blood samples were collected prior to consumption of soup and at 120 and 150 min, respectively, after consumption. Levels of various constituents were measured. The time for ejection of the first milk droplet and total milk volume yielded were also measured. Results: Consumption of CSSR influenced TAG, insulin and lactate levels in maternal blood. Likewise, consumption of the Soup affected milk composition and its nutritional status, particularly total protein, TAG, fatty acid, P-hydroxybutyrate and lactate levels. CSSR intake significantly affected TAG and lactate levels in milk. The time for the first milk droplet to be ejected was significantly longer in the CSSR group, indicating that the milk-ejecting reflex is inhibited. However, blood prolactin level increased slightly after ethanol intake. Milk yields were reduced after ingestion of CSSR although the difference was not statistically significant. Conclusion: Consumption of CSSR affects not only the composition of maternal blood and milk, but also lactation performance. These findings suggest that an alcoholic diet should be avoided during lactation.

Chou FH; Yang YH; Kuo SH; Chan TF; Yang MS. Relationships among smoking, drinking, betel quid chewing and pregnancy-related nausea and vomiting in Taiwanese aboriginal women. Kaohsiung Journal of Medical Science 25(2): 62-69, 2009. (41 refs.)

A cross-sectional survey was conducted to investigate the associations among smoking, drinking, betel quid chewing and pregnancy-related nausea and vomiting (N/V) in Taiwanese aboriginal women. A total of 901 aboriginal women from 11 hospitals were recruited into this study. A structured questionnaire on demographic and obstetric information, smoking history, alcohol consumption, betel quid chewing habits, and N/V by checklist was used to collect data. The findings of this study indicated that the prevalence of N/V, maternal smoking, drinking, and betel quid chewing were 75.6%, (n = 682), 22.8%, (n = 201), 31.9% (n = 287), and 34.7% (n = 313) respectively. Multiple logistic regression with adjustment for age, body mass index and antiemetics use revealed significant relationships between smoking habits and N/V before confirmation of pregnancy and during pregnancy. In comparison with those who did not smoke, women smoking in excess of 10 cigarettes a day before pregnancy were 1.65 times more likely to develop N/V, and women smoking in excess of 10 cigarettes a day during pregnancy were 2.79 times more likely to develop N/V. Based on the findings of this study, smoking was associated, with a dose-response effect, with pregnancy-related N/V. Reducing the intake of cigarettes could decrease the risk of pregnancy-related N/V Health care providers should help these women decrease their uncomfortable symptoms and improve their experiences of pregnancy and birth outcome during critical times.

Chueh KH; Yang MS; Chen CS; Chiou SM. Poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women. International Psychogeriatrics 21(3): 593-599, 2009. (41 refs.)

Background: Little is known about sleep quality and alcohol use problems in the elderly minority population. This study aimed to identify a one-month prevalence of poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women and to examine the association between them. Methods: A cross-sectional survey with stratified random sampling was conducted in eight aboriginal communities in Taiwan. The 1261 elderly aboriginal women (response rate 84%) completed all assessments. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), while the CAGE questionnaire was used to evaluate alcohol use problems. Results: Of the study participants, 20.54% and 25.59% had poor sleep quality and alcohol use problems, respectively. Controlling for confounding factors, alcohol use problems were a risk factor for poor sleep quality (AOR = 1.44, p = 0.0433). Alcohol use problems were associated with three components of PSQI: sleep disturbances, subjective sleep quality, and daytime dysfunction. Conclusions: The elderly Taiwanese aboriginal women with problematic alcohol drinking experienced poorer sleep quality. Development of a program to reduce alcohol use problems might improve sleep quality among elderly Taiwanese aboriginal women.

Clemens SL; Grant BM; Matthews SL. A review of the impacts of health and health behaviors on women's alcohol use. (review). American Journal of Health Behavior 33(4): 400-415, 2009. (45 refs.)

Objectives: To summarize longitudinal research regarding physical health and health behaviors on women's subsequent alcohol use. Methods: Medline/PsycINFO databases were searched; from over 5000 articles, 29 met inclusion criteria. Results: Prior consumption and substance use are strong predictors of later consumption. Prior consumption was also reported to moderate the relationship between other health/health behaviors variables and consumption. Perception of one's health status may be important in modifying consumption patterns among some subgroups. Conclusions: Routine alcohol screening may help identify women at risk of developing harmful alcohol use. Mechanisms to reduce alcohol access among young women should be supported.

Coker AL; DeSimone CP; Eggleston KS; Hopenhayn C; Nee J; Tucker T. Smoking and survival among Kentucky women diagnosed with invasive cervical cancer: 1995-2005. Obstetrical & Gynecological Survey 64(5): 310-311, 2009

Increasing evidence suggests that smoking is associated with cervical cancer mortality. Most previous studies investigating this association have been small. There are no prior reports of population-based survival analyses of smoking and cervical cancer in American women. This population-based survival analysis determined the association between smoking and mortality in 2661 women diagnosed with invasive cervical cancer who were identified in the Kentucky Cancer Registry database between 1995 and 2005. This database was linked to state vital records and the National Death Index. The all cause and cervical cancer specific death rates of known current smokers and nonsmokers were compared using survival analysis with a standard Kaplan-Meier approach and a Cox proportional hazards models to adjust for confounding variables. Adjustments were made for age, ethnicity, rural residence, insurance source, cancer cell type, stage at diagnosis, and treatment received. Of the 2661 women diagnosed with cervical cancer, 48.1% were current smokers, 32.1% were nonsmokers, and 19.4% were undocumented as to smoking status. Multivariate analysis showed that compared to nonsmokers, women who were current smokers were 35% more likely to die of any cause (adjusted hazards ratio [aHR], 1.35; 95% confidence interval [CI], 1.17-1.56) and 21% more likely to die of cervical cancer (HR, 1.21; 95% CI, 1.01-1.46). These findings are consistent with previous studies and strongly suggest that current smoking is associated with increased all cause and cervical cancer specific mortality.

Contreras R. "Damn, Yo-Who's That Girl?" An ethnographic analysis of masculinity in drug robberies. Journal of Contemporary Ethnography 38(4): 465-492, 2009. (62 refs.)

Previous street crime research has shown that female robbers manipulate their sexuality to secure male victims. Also, the larger ethnographic drug market literature has shown how male criminals construct masculinity through the sexual and economic manipulation of women. However, both accounts miss how male criminals manipulate the masculinity of other men to victimize them. This article fills that gap, showing how male drug robbers play on the masculinity of male dealers to bait them into a robbery. Through The Girl, a female accomplice, male drug robbers lure male dealers, believing that men demonstrate masculinity through sexual relations with women. Apart from this, male drug robbers construct their own masculinity through The Girl, who is often manipulated and exploited through sexist stereotypes and practices. This research is based on ethnographic field data collected on a group of Dominican drug robbers in a South Bronx neighborhood.

Cook JA; Mock LO; Jonikas JA; Burke-Miller JK; Carter TM; Taylor A et al. Prevalence of psychiatric and substance use disorders among single mothers nearing lifetime welfare eligibility limits. Archives of General Psychiatry 66(3): 249-258, 2009. (46 refs.)

Context: In the 1990s, US welfare reform legislation imposed a 5-year lifetime limit on financial support for low-income families with young children (younger than 18 years). With increasing numbers of single mothers and their children reaching the end of their welfare eligibility, there is concern about potentially high rates of untreated psychiatric and substance use disorders in this population. Objective: To determine the prevalence, correlates, and likelihood of treatment for mental and substance use disorders in a population of urban single mothers receiving Temporary Assistance for Needy Families (TANF). Design: In-person diagnostic assessments were conducted from November 1, 2003, to October 31, 2004. Setting: Cook County, Illinois. Participants: Female TANF recipients and residents of Cook County (N = 333) who were randomly sampled during the final 24 months of their eligibility for TANF. Main Outcome Measure: Prevalence rates of DSM-IV mental and substance use disorders using the World Health Organization's Composite International Diagnostic Interview. Results: Lifetime prevalence of Composite International Diagnostic Interview disorders was 61.0% (95% confidence interval [CI], 55.7%-66.3%); 12-month prevalence was 46.8% (41.5%-52.2%). Lifetime prevalence of mental disorders was 53.2% (95% CI, 47.8%-58.5%); 12-month prevalence was 44.1% (38.8%-49.5%). Lifetime prevalence of substance use disorders was 29.1% (95% CI, 23.9%-33.8%); 12-month prevalence was 9.0% (6.8%-12.0%). Lifetime prevalence of comorbid mental/substance use disorders was 21.3% (95% CI, 16.9%-25.7%); 12- month prevalence was 6.3% (3.7%-8.9%). Only 21.7% (95% CI, 14.8%-28.5%) of participants with 12- month mental disorders received treatment for mental disorders; 41.4% (22.3%-60.4%) of participants with 12- month substance abuse disorders received treatment for substance use disorders. Conclusions: Despite the high prevalence of psychiatric and substance use disorders in this population, many remain untreated. The consequences of terminating welfare assistance are worthy of further investigation, given the potential for adverse effects on both mothers and their young children.

Copeland AL; Kulesza M; Hecht GS. Pre-quit depression level and smoking expectancies for mood management predict the nature of smoking withdrawal symptoms in college women smokers. Addictive Behaviors 34(5): 481-483, 2009. (20 refs.)

We assessed smoking withdrawal symptoms over a six-day period of abstinence among 21 female college students who were daily cigarette smokers [M = 20.3 (4.4); cigarettes per day] and were in the preparation stage of change for quitting smoking. We predicted that reported withdrawal symptoms would covary with baseline depression scores and baseline outcome expectancies for cigarette smoking as a mood management tool. Depression scores at baseline significantly predicted mood-related smoking withdrawal symptoms of Depression-Dejection and Vigor from the Profile of Mood States (POMS). Smoking outcome expectancies for relief of negative affect measured at baseline significantly predicted symptoms of Confusion-Bewilderment and Anger-Hostility. Neither baseline depression nor baseline smoking expectancies for mood management predicted smoking withdrawal symptoms measured by the Smoking Withdrawal Questionnaire (SWQ: [Shiffman, S. M., & Jarvik, M. E. (1976). Smoking withdrawal symptoms in two weeks of abstinence. Psychopharmacology, 50, 35-39]). Results imply that women smokers with baseline depressive symptomatology and expectancies for smoking to relieve negative mood endure greater abstinence-induced mood disturbance, but similar levels of other smoking withdrawal symptoms during initial abstinence. These results may inform smoking cessation efforts.

Cropsey KL; Weaver MF; Eldridge GD; Villalobos GC; Best AM; Stitzer ML. Differential success rates in racial groups: Results of a clinical trial of smoking cessation among female prisoners. Nicotine & Tobacco Research 11(6): 690-697, 2009. (31 refs.)

This study replicated prior observations of racial differences in smoking cessation in which Black smokers have demonstrated lower smoking cessation rates than White smokers. The study used data from a smoking cessation intervention and compared White and Black female prisoners (N = 233) on a 10-week intervention of group psychotherapy and nicotine replacement (patch). Generalized estimating equations were used to model smoking cessation across the 12-month follow-up. Compared with an untreated control group, both Black and White smokers benefited from the cessation treatment. However, after controlling for potential confounds, White smokers had significantly higher overall smoking cessation rates across time compared with Black smokers (e.g., 30% vs. 24% abstinent at 6 weeks; 13% vs. 10% abstinent at 12 months). Smoking mentholated cigarettes was not associated with these differences in quit rates. Understanding differential treatment responses can lead to the development of more tailored and efficacious smoking cessation interventions that may reduce the morbidity and mortality associated with smoking in prison populations.

Crozier SR; Robinson SM; Borland SE; Godfrey KM; Cooper C; Inskip HM. Do women change their health behaviours in pregnancy? Findings from the Southampton Women's Survey. Paediatric and Perinatal Epidemiology 23(5): 446-453, 2009. (21 refs.)

A woman's life style choices before and during pregnancy have important implications for her unborn child, but information on behaviour can be unreliable when data are collected retrospectively. In particular there are no large longitudinal datasets that include information collected prospectively before pregnancy to allow accurate description of changes in behaviour into pregnancy. The Southampton Women's Survey is a longitudinal study of women in Southampton, UK, characterised when they were not pregnant and again during pregnancy. The objective of the analyses presented here is to describe the degree to which women comply with diet and life style recommendations before and during pregnancy, and changes between these time points. The analyses are based on 1490 women who delivered between 1998 and 2003 and who provided information before pregnancy and at 11 and 34 weeks' gestation. At each time point a trained research nurse ascertained smoking status and assessed food and drink consumption using a food frequency questionnaire. We derived the proportions of women who complied with recommendations not to smoke, to eat five portions of fruit and vegetables per day and to drink no more than four units of alcohol per week and 300 mg of caffeine per day. There was a notable reduction in smoking when women became pregnant: before pregnancy 27% of women smoked, whereas in early pregnancy 15% smoked. Similarly there were significant reductions in alcohol consumption and intake of caffeinated drinks: before pregnancy 54% of women drank more than four units of alcohol per week and 39% had estimated intakes of caffeine in drinks of > 300 mg per day, whereas comparable figures for early pregnancy were 10% and 16% respectively. However, there was little change in fruit and vegetable intake; the percentages of women who did not achieve the recommendation to eat at least five portions of fruit and vegetables per week were 47% before pregnancy and 46% in early pregnancy. Younger women and those with fewer educational qualifications were less likely to comply with public health recommendations. Overall, 81% of women in early pregnancy complied with at least three of the recommendations. Although there is encouraging evidence of changed health behaviours in pregnancy, young women and those with few educational qualifications may particularly benefit from targeted health initiatives.

De Genna NM; Cornelius MD; Donovan JE. Risk factors for young adult substance use among women who were teenage mothers. Addictive Behaviors 34(5): 463-470, 2009. (77 refs.)

Teenage mothers may not "mature out" of substance use during young adulthood, and this non-normative trajectory of use may contribute to negative outcomes for teenage mothers and their offspring. Pregnant teenagers (age range = 12-18 years; 68% Black) were recruited from a prenatal clinic and interviewed about their substance use, and subsequently re-interviewed six and ten years later (n = 292). Consistent with the literature, early tobacco and marijuana use were risk factors for young adult use. Other substance use. peer adolescent use and mental health indicators were more important than race and socioeconomic status (SES) in determining which teenage mothers would use tobacco, engage in binge drinking, and use marijuana as young adults. However, race and SES were significant predictors of quitting tobacco use and marijuana use by the 10-year follow-up. Depression was associated with both persistent tobacco use and marijuana use in teenage mothers. These results illustrate the long-term consequences of teenage childbearing and identify modifiable risk factors for later health risks that should be addressed among younger mothers.

Dickerson D; Leeman R; Mazure C; O'Malley S. The inclusion of women and minorities in smoking cessation clinical trials: A systematic review. (review). American Journal on Addictions 18(1): 21-28, 2009. (37 refs.)

This study assesses the impact of the 1993 NIH Revitalization Act on the inclusion and subgroup analysis of women and minorities in trials of FDA-approved smoking cessation pharmacotherapy. Female representation, while commensurate with population levels, declined significantly for trials that began recruitment after 1993(M = 47.2% vs. M = 53.9%), and fewer than half reported analyses by gender. Minorities continued to be under-represented in later trials; however, significant improvement in representation (M = 16.1% vs. M = 10%) and analysis by race occurred. Industry-sponsored studies had lower minority representation than NIH funded studies. Recommendations are offered to improve subgroup analyses and minority inclusion.

DiNapoli PP. Early initiation of tobacco use in adolescent girls: Key sociostructural influences. Applied Nursing Research 22(2): 126-132, 2009. (14 refs.)

Background: An important developmental task during adolescence is ego development. Millions of adolescents choose to initiate cigarette smoking at a young age as a result of transitional conflicts during this phase of normal developmental progression. Unfortunately, the decision to use tobacco compromises both the short- and long-term health status of smokers as well as the health of those around them. Objective: It was hypothesized that in early adolescence, girls choose to begin smoking cigarettes as a result of sociostructural influences, including media, peers, and family. The purpose of this study was to investigate what modifiable sociostructural variables will decrease the risk of initiating cigarette smoking before the age of 12 years among adolescent girls. The aim of the study was to develop a risk reduction model that increases the likelihood of healthy behavior choices in girls during early adolescence. Method: Data collected for the New Hampshire Teen Assessment Project survey were used for this secondary data analysis. The original study included a multicommunity sample of 7,648 students from eight school districts enrolled in New Hampshire schools between January 2000 and October 2001. This current analysis focused only on the health behavior of the adolescent girls enrolled in the larger study (n = 3,775). With the use of a socioecological theoretical framework as a guide, this secondary data analysis first identified correlates of the early initiation of tobacco use using Pearson's correlations. Then, the data were explored for variables that decreased the relative fisk for the early initiation of cigarette smoking among adolescent girls. The dependent variable of interest (i.e., early initiation of tobacco use) referred to girls who reported having smoked their first cigarette at or before the age of 12 years. Twenty-eight percent of the sample had initiated tobacco use before they were 12 years old. Multiple logistic regression was used to predict the final risk reduction model. Results: The first level of analysis confirmed previously reported evidence that there is a correlation between adolescent girls' initiation of smoking early (n = 1,047) and their engagement in other health risk behaviors such as daily use of alcohol (n = 859), daily use of marijuana (93%), and engaging in unprotected intercourse (15%). Next, logistic regression was used to predict a risk reduction model that demonstrated the importance of community, family, and school variables in decreasing the relative risk for the early initiation of tobacco use. Those sociostructural variables that decrease the relative risk for the initiation of tobacco use were noted in the following: (1) 71% of the girls who feel that it is important to contribute to their community (odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.31-2.23) are less likely to initiate tobacco use and (2) 54% of the girls are more likely to feel that their community is a good place to live in (OR = 1.54, 95% CI = 1.201.97), are more than twice as likely to have parents who think smoking is wrong (OR = 2.09, 95% CI = 1.77-2.48). are 9% more likely to have parents whom they can talk to when they have personal problems (OR = 1.09, 95% CI = 1.02-1.17), and are 38% more likely to enjoy school. Discussion: The findings of this study may be an important portal for prevention intervention in the area of early adolescent tobacco use. A risk reduction model is presented based on the theory that both the environment and modeling play an important role in the development of health behavior.

Djousse L; Lee IM; Buring JE; Gaziano JM. Alcohol consumption and risk of cardiovascular disease and death in women: Potential mediating mechanisms. Circulation 120(3): 237-244, 2009. (48 refs.)

Background-Although an association between moderate alcohol consumption and decreased cardiovascular disease (CVD) and death has been reported, limited data are available on potential mediating mechanisms. We examined the association between alcohol and CVD and death in 26 399 women and estimated the proportion of reduced risk of CVD/death explained by a series of intermediate factors. Methods and Results-Alcohol consumption was self-reported at baseline, and CVD events and deaths were ascertained via follow-up questionnaires and medical records. Baseline levels of hemoglobin A1c, inflammatory markers, hemostatic factors, and lipids were measured. Blood pressure and hypercholesterolemia and treatment for lipids were self-reported. During a mean follow up of 12.2 years, 1039 CVD events and 785 deaths (153 CVD deaths) occurred. There was a J-shaped relation between alcohol consumption and incident CVD and total and CVD deaths in a multivariable model. Compared with abstainers, alcohol intake of 5 to 14.9 g/d was associated with 26%, 35%, and 51% lower risk of CVD, total death, and CVD death, respectively, in a multivariable model. For CVD risk reduction, lipids made the largest contribution to the lower risk of CVD (28.7%), followed by hemoglobin A1c/diabetes (25.3%), inflammatory/hemostatic factors (5%), and blood pressure factors (4.6%). All these mediating factors together explained 86.3%, 18.7%, and 21.8% of the observed lower risk of CVD, total death, and CVD death, respectively. Conclusions-These data suggest that alcohol effects on lipids and insulin sensitivity may account for a large proportion of the lower risk of CVD/death observed with moderate drinking under the assumption that the alcohol-CVD association is causal.

D'Onofrio BM. The need for more quasi-experimental studies of alcohol consumption during pregnancy. (editorial). Addiction 104(8): 1278-1279, 2009. (18 refs.)

Dorn LD; Negriff S; Huang B; Pabst S; Hillman J; Braverman P et al. Menstrual symptoms in adolescent girls: Association with smoking, depressive symptoms, and anxiety. Journal of Adolescent Health 44(3): 237-243, 2009. (40 refs.)

Purpose: Dysmenorrhea affects quality of life and contributes to absenteeism from school and work, thereby diminishing opportunities for successful psychosocial and cognitive development during adolescence. In adults, depression, anxiety, and smoking have an impact oil menstrual cycles and dysmenorrhea. Associations between these problems have not been examined in adolescents. The purpose of this study was to examine relations between depressive symptoms and anxiety with menstrual symptoms. Smoking was examined its a moderator of this association. Methods: This study enrolled 154 postmenarcheal girls from a sample of 207 girls age 11, 13, 15, and 17 years (mean = 15.4 years vertical bar+/- 1.9 vertical bar). Self-reported measures included the Menstrual Symptom Questionnaire (MSQ), Children's Depression Inventory, State-Trait Anxiety Inventory, and smoking behavior. Generalized linear regression modeled MSQ outcomes separately for depressive symptoms and anxiety. Results: More depressive symptorns/anxiety were related to higher numbers of menstrual symptoms (r = 0.23 +/- 0.44, p < .05). Smoking status (ever) was related to higher MSQ scores. Moderating effects of smoking and depressive symptoms or anxiety on menstrual symptoms were consistent across most MSQ factors where effects were stronger in never smokers. Conclusion: This is the first study in adolescents showing smoking status and depressive symptoms/ anxiety are related to menstrual symptoms, and that the impact of depressive symptorns/anxiety on menstrual symptoms is stronger in never smokers. The dynamic and complex nature of smoking, moods, and dysmenorrhea cannot be disentangled without longitudinal analyses. Efforts to reduce menstrual symptoms should begin at a young gynecological age and include consideration of mood and smoking status.

Dukic VM; Niessner M; Pickett KE; Benowitz NL; Wakschlag LS. Calibrating self-reported measures of maternal smoking in pregnancy via bioassays using a monte carlo approach. International Journal of Environmental Research and Public Health 6(6): 1744-1759, 2009. (29 refs.)

Maternal smoking during pregnancy is a major public health problem that has been associated with numerous short- and long-term adverse health outcomes in offspring. However, characterizing smoking exposure during pregnancy precisely has been rather difficult: self-reported measures of smoking often suffer from recall bias, deliberate misreporting, and selective non-disclosure, while single bioassay measures of nicotine metabolites only reflect recent smoking history and cannot capture the fluctuating and complex patterns of varying exposure of the fetus. Recently, Dukic et al. have proposed a statistical method for combining information from both sources in order to increase the precision of the exposure measurement and power to detect more subtle effects of smoking. In this paper, we extend the Dukic et al. method to incorporate individual variation of the metabolic parameters (such as clearance rates) into the calibration model of smoking exposure during pregnancy. We apply the new method to the Family Health and Development Project (FHDP), a small convenience sample of 96 predominantly working-class white pregnant women oversampled for smoking. We find that, on average, misreporters smoke 7.5 cigarettes more than what they report to smoke, with about one third underreporting by 1.5, one third under-reporting by about 6.5, and one third underreporting by 8.5 cigarettes. Partly due to the limited demographic heterogeneity in the FHDP sample, the results are similar to those obtained by the deterministic calibration model, whose adjustments were slightly lower (by 0.5 cigarettes on average). The new results are also, as expected, less sensitive to assumed values of cotinine half-life.

Dum M; Sobell LC; Sobell MB; Heinecke N; Voluse A; Johnson K. A Quick Drinking Screen for identifying women at risk for an alcohol-exposed pregnancy. Addictive Behaviors 34(9): 714-716, 2009. (28 refs.)

Two previous studies comparing the Quick Drinking Screen (QDS) with the Timeline Followback (TLFB) found that these two instruments yielded similar reports of alcohol use for clinical and nonclinical populations of problem drinkers. The current study evaluated the correspondence between these two drinking measures with women at risk of an Alcohol-Exposed Pregnancy (AEP). Participants were 355 women who voluntarily participated in a research study during 2005 through 2007 designed to prevent AEPs. All women were screened by phone for eligibility using the QDS and approximately 2 weeks later completed a 3-month TLFB by mail. Results of this study, analyzed in 2008, paralleled previous studies showing that the QDS and the TLFB, two very different drinking measures, collected similar aggregate drinking data for women who drink heavily and are at risk of an AEP. Correspondence between the two drinking measures met acceptable levels of reliability. The present study found that the QDS has demonstrated efficacy for screening women whose level of alcohol use puts them at risk for an AER Although the QDS does not yield detailed drinking information, it could be used when it is not possible or necessary to gather daily drinking data.

Duncan AE; Grant JD; Bucholz KK; Madden PAF; Reath AC. Relationship between body mass index, alcohol use, and alcohol misuse in a young adult female twin sample. Journal of Studies on Alcohol and Drugs 70(3): 458-466, 2009. (38 refs.)

Objective: The aim of this study was to examine the relationships between body mass index (BMI) and alcohol use and misuse in young adulthood in a sample of black and white female twins. Method: Cox proportional hazards and logistic regression models were used to examine the relationships between BMI category and first alcohol use, current weekly alcohol use, and current weekly heavy episodic drinking in 3,514 (14.06% black) young adult female twins. Analyses were conducted separately in black and white women. Results: After adjusting for relevant covariates, in white women obesity was protective against alcohol use (hazard ratio = 0.83; 95% confidence interval [Cl]: 0.73-0.93) and against weekly drinking (odds ratio [OR] = 0.36; 95% CI: 0.24-0.53) and weekly heavy episodic drinking (OR = 0.51; 95% CI: 0.31-0.82) among ever drinkers compared with women of ideal weight. Overweight women living with their parents were less likely to be weekly drinkers (OR = 0.31; 95% CI: 0.16-0.61), whereas overweight women who were not living with their parents were less likely to be weekly heavy episodic drinkers (OR = 0.51; 95% CI: 0.31-0.82). Among black women, obesity was not associated with any of the drinking outcomes; however, black women who were overweight and who reported that the majority of their friends were not weekly drinkers had greater odds of reporting weekly drinking than those of ideal weight (OR = 2.91; 95% CI: 1.33-6.39). Conclusions: Obese white women were less likely to ever use alcohol, be weekly drinkers, or be weekly heavy episodic drinkers than their ideal-weight peers. Body weight may affect drinking behavior in young women, and this effect may differ by race. Future research is needed to identify mediators and moderators of this relationship as well as to explore racial differences in the effect of body weight on drinking behavior.

Duran B; Oetzel J; Parker T; Malcoe LH; Lucero J; Jiang YZ. Intimate partner violence and alcohol, drug, and mental disorders among American Indian women from southwest tribes in primary care. American Indian And Alaska Native Mental Health Research 16(2): 11-27, 2009. (57 refs.)

The relationship of intimate partner violence (IPV) with mental disorders was investigated among 234 American Indian/Alaska Native female primary care patients. Results indicated that unadjusted prevalence ratios for severe physical or sexual abuse (relative to no IPV) were significant for anxiety, PTSD, mood, and any mental disorder. Adjusted prevalence ratios showed severe physical or sexual IPV to be associated with any mood disorder. Patterns of IPV and mental health have implications for detection and service utilization.

Ebrahim SH; Anderson JE; Correa-de-Araujo R; Posner SF; Atrash HK. Overcoming social and health inequalities among US women of reproductive age: Challenges to the nation's health in the 21st century. Health Policy 90(2-3): 196-205, 2009

Objective: To frame the discussion of the nation's health within the context of maternal and child health. Methods: We used national data or estimates to assess the burden of 46 determinants. Results: During 2002-2004, U.S. women of reproductive age experienced significant challenges from macrosocial determinants, to health care access, and to their individual health preservation. Two-thirds of women do not consume recommended levels of fruits and vegetables. Overall, 29% experienced income poverty, 16.3% were uninsured. About one in four women of reproductive age lived with poor social capital. Compared with white women of reproductive age, non-white women reported higher levels of dissatisfaction with the health care system and race-related discrimination. Among all U.S. women, chronic diseases contributed to the top nine leading causes of disability adjusted life years. About one-third of women had no prophylactic dental visits in the past year, or consumed alcohol at harmful levels and smoked tobacco. One in three women who had a child born recently did not breast feed their babies. Demographics of women who are at increased risk for the above indicators predominate among the socioeconomically disadvantaged. Conclusions: At least three-fourths of the U.S. women of reproductive age were at risk for poor health of their own and their offspring. Social intermediation and health policy changes are needed to increase the benefits of available health and social sector interventions to women and thereby to their offspring.

El-Bassel N; Caldeira NA; Ruglass LM; Gilbert L. Addressing the unique needs of African American women in HIV prevention. American Journal of Public Health 99(6): 996-1001, 2009. (82 refs.)

African American women continue to be disproportionately affected by the HIV/AIDS epidemic, yet there are few effective HIV prevention interventions that are exclusively tailored to their lives and that address their risk factors. Using an ecological framework, we offer a comprehensive overview of the risk factors that are driving the HIV/AIDS epidemic among African American women and explicate the consequences of ignoring these factors in HIV prevention strategies. We also recommend ways to improve HIV prevention programs by taking into consideration the unique life experiences of adult African American women.

Eldridge GD; Cropsey KL. Smoking bans and restrictions in US prisons, and jails: Consequences for incarcerated women. (editorial). American Journal of Preventive Medicine 37(2, Supplement S): S179-S180, 2009. (16 refs.)

Eliasen M; Kjaer SK; Munk C; Nygard M; Sparen P; Tryggvadottir L et al. The relationship between age at drinking onset and subsequent binge drinking among women. European Journal of Public Health 19(4): 378-382, 2009. (20 refs.)

Methods: The data consisted of 68 539 women aged 1847 years randomly selected from the general population in Denmark, Iceland, Norway and Sweden. Frequency of binge drinking, defined as consuming 6 U of alcohol at the same occasion once or more per month, and age at drinking debut were assessed through a questionnaire survey. Results: Overall, 1226% reported binge drinking once or more per month in the four countries. Median age for starting drinking was 16 years in all four countries. Women who started drinking at 14 years or younger were significantly more likely to binge drink than women who started drinking at 19 years or older with adjusted odds ratios of 2.9 (95% confidence intervals 2.33.7), 2.8 (2.13.6) and 2.6 (1.93.4) for binge drinking in Denmark, Iceland and Sweden, respectively. Among Norwegian women the association was stronger with an adjusted odds ratio at 4.4 (3.55.6). The association in all four countries was more pronounced in women younger than 30 years than in older women. Conclusion: In the four Nordic countries, there is a strong relation between age at drinking onset and later binge drinking. The strong relationship found in countries with such different alcohol cultures is most likely generalizable to other Western countries.

Ellis AR; Morrissey JP. Assessing multiple outcomes for women with co-occurring disorders and trauma in a multi-site trial: A propensity score approach. Administration and Policy in Mental Health Services 36(2): 123-132, 2009. (38 refs.)

The current study assesses the ability of two promising propensity scoring methods to reduce selection bias in a set of secondary data from the women with co-occurring disorders and violence study (WCDVS), whose purpose was to evaluate the effect of integrated treatment for women with mental health, substance use, and trauma issues (N = 2,729). Weighting, the more successful method, is demonstrated in a re-analysis of 6- and 12-month WCDVS outcomes. In addition to demonstrating propensity score weighting, the current study increases confidence in earlier findings by considering multiple time points simultaneously and by controlling more completely for pre-treatment differences.

Everhart J; Ferketich AK; Browning K; Wewers ME. Acculturation and misclassification of tobacco use status among Hispanic men and women in the United States. Nicotine & Tobacco Research 11(3): 240-247, 2009. (30 refs.)

This study sought to determine the relationship between acculturation and misclassification of tobacco use among Hispanic Americans. The dataset was limited to respondents from the 1999-2002 National Health and Nutrition Examination Surveys who self-reported as "Mexican American" or "other Hispanic" and were at least 20 years old. Acculturation was measured with a short language scale, and self-reported tobacco use was verified with serum cotinine. Misclassified tobacco users were individuals who self-reported as never or former users but had a cotinine concentration of 15 ng/ml or higher. A gender-specific association between misclassification and acculturation was found. Among males (n = 1,175), the prevalence estimates of misclassification were 4.8%, 1.8%, and 2.2% for low, medium, and highly acculturated males, respectively (p < .02). Among females (n = 1,345), the prevalence estimates of misclassification were 0.8%, 2.0%, and 4.9% for low, medium, and highly acculturated females, respectively (p < .03). The findings of this study support the notion that the association between tobacco use and acculturation among Hispanics is gender specific. Several possible barriers to accurate self-report of tobacco use among Hispanics may include (a) the misconception among Hispanic men that infrequent tobacco use does not qualify one as a current user, (b) increasing desire among acculturated Hispanic women to conform to the tobacco use behaviors of non-Hispanic White women, and (c) the perceived acceptability of tobacco among Hispanic women in the United States. Finally, these trends support the use of early tobacco prevention efforts among Hispanic women and especially among those with low levels of acculturation.

Fang H; Rizzo JA. Did cigarette vouchers increase female smokers in China? American Journal of Preventive Medicine 37(2, Supplement S): S126-S130, 2009. (25 refs.)

Background: From 1960 to 1980, a voucher was required to purchase cigarettes in China. The Chinese government issued vouchers to ration cigarettes, without informing its citizens that smoking was unhealthy. These vouchers were available to all adults, and allowed them to purchase specified numbers of cigarettes. As a result, a number of nonsmokers started smoking during the voucher period. Methods: This study included 229 female and 1165 male smokers from the China Health and Nutrition Survey 1989-2006, which provides the year in which each respondent began smoking. The percentages of male and female smokers who started smoking during the voucher period were compared using the chi-square test. Logistic regression analysis was used to study the relative risk of smoking initiation by women during the voucher period, while adjusting for confounding variables. Results: During the voucher period, 46% of female smokers and 39% of male smokers started smoking (p=0.05). Women who did not have a regular job or were less educated were more likely to start smoking. The relative risk of female smokers to have initiated smoking during the voucher period was 4.75, with a p<0.01 in the logistic regression. Conclusions: China's policy of issuing vouchers to ration tobacco consumption had the unintended consequence of encouraging smoking, particularly among women. Issuing cigarette vouchers to every adult, combined with the inexpensive prices of cigarettes, led more women to initiate smoking. Women with low SES were particularly likely to initiate smoking.

Gavaghan C. "You can't handle the truth": Medical paternalism and prenatal alcohol use. Journal of Medical Ethics 35(5): 300-303, 2009. (15 refs.)

The publication of the latest contribution to the alcohol-in-pregnancy debate, and the now customary flurry of media attention it generated, have precipitated the renewal of a series of ongoing debates about safe levels of consumption and responsible prenatal conduct. The University College London (UCL) study's finding that low levels of alcohol did not contribute to adverse behavioural outcomes-and may indeed have made a positive contribution in some cases-is unlikely to be the last word on the subject. Proving a negative correlation is notoriously difficult ( technically, impossible), and other studies have offered alternative claims. The author is not an epidemiologist, and the purpose of this article is not to evaluate the competing empirical claims. However, the question of what information and advice healthcare practitioners ought to present to pregnant women, or prospectively or potentially pregnant women, in a situation of uncertainty is one to which healthcare ethicists may have a contribution to make. In this article, it is argued that the total abstinence policy advocated by the UK's Department of Health, and even more stridently by the British Medical Association, sits uneasily with recent data and is far from ethically unproblematic. In particular, the "precautionary'' approach advocated by these bodies displays both scant regard for the autonomy of pregnant and prospectively pregnant women and a confused grasp of the principles of beneficence and non-maleficence.

Gelberg L; Andersen R; Longshore D; Leake B; Nyamathi A; Teruya C et al. Hospitalizations among homeless women: Are there ethnic and drug abuse disparities? Journal of Behavioral Health Services & Research 36(2): 212-232, 2009. (49 refs.)

This paper explores associations among the vulnerabilities of being female, being a member of a minority group, and being a drug abuser in homeless women's hospitalizations. It uses a 1997 probability survey of 974 homeless females age 15-44 in Los Angeles. In unadjusted analyses, whites were more likely than other ethnic minority groups to be hospitalized, and drug abusers were more likely to be hospitalized than non-drug abusers. Multiple logistic regression analyses indicated that factors associated with hospitalization differed considerably among the ethnic and drug-abuse subgroups. For example, ethnic disparities in inpatient health care were found for drug-abusing women, but not for those who did not abuse drugs. Pregnancy was the only important determinant of hospitalization in all subgroups (OR, 2.9-17.4). Preventing unintended pregnancy appears to be the most inclusive means of reducing hospitalization and attendant costs among homeless women.

Gerber B; Ahmad N; Parmar S. Trends in maxillofacial injuries in women, 2000-2004. British Journal of Oral and Maxillofacial Surgery 47(5): 374-377, 2009. (16 refs.)

Recent government statistics have suggested that there is a reduction in violent crime, but recorded crime figures have shown a 10% increase. Attendance figures at accident and emergency departments show that 75% of assaults that required medical treatment were not recorded by the police, and that 55% of assaults that led to facial injuries were alcohol-related. Drinking alcohol is a risk factor for violent behaviour. A poorly-studied area is alcohol-related violent crimes sustained by women. A restrospective study was made of all female patients referred to a busy regional maxillfacial unit between May and October 2000-2004. A total of 251 female patients with facial injuries was seen at the unit, and records obtained for 219. Accidents were the commonest cause of attendance, and violent crime the second. Interpersonal violence was the most common mode of injury in alcohol-related incidents. Domestic violence did not increase significantly over the study period, and did not seem to be alcohol-related. The incidence of violent crime, and in particular interpersonal violence away from the home, is increasing. Women are at considerable risk of becoming victims of violence.

Gilligan C; Sanson-Fisher R; Eades S; D'Este C; Kay-Lambkin F; Scheman S et al. Identifying pregnant women at risk of poor birth outcomes. Journal of Obstetrics and Gynaecology 29(3): 181-187, 2009. (29 refs.)

Pregnancy is a vulnerable period in women's lives, with a range of maternal and environmental factors impacting upon pregnancy outcome. This study sought to explore the clustering of health risks among pregnant women, and compare the characteristics of women exhibiting clustered risks. A cross-sectional study was undertaken at a large public hospital in Queensland, Australia. Cluster analysis grouped women who had similar levels of risk based on health and lifestyle factors demonstrated to be associated with adverse maternal and infant outcomes. Interviews were conducted with 437 women. The results highlight the interconnectedness of demographic and health risks, and high concentration of risks among Indigenous women. Vulnerable women can be identified and targeted for public health interventions focusing on clustered risk factors, such as alcohol, smoking and sexually transmitted infections. Opportunity exists for screening in routine primary care to identify the individuals who are at risk, rather than identifying specific risks.

Golinelli D; Longshore D; Wenzel SL. Substance use and intimate partner violence: Clarifying the relevance of women's use and partners' use. Journal of Behavioral Health Services & Research 36(2): 199-211, 2009. (62 refs.)

Research has shown that, when women and/or their partners are involved in substance use, women's risk for intimate partner violence (IPV) is higher. Prior research has not examined whether substance use by both women and their partners contributes independently or interactively to women's risk of victimization and has not identified factors moderating the effect of substance use by victim or partner. Mental health and social support are explored as moderators of the association between women's victimization and substance use by victim or partner in a study of 590 impoverished women residing in the Los Angeles area. This study found that substance use by both the woman and her partner independently predicted IPV and that social support moderated the effect of women's substance use. These findings clarify the relevance of substance use in the context of intimate relationships and that of social support as a buffer against IPV among impoverished women.

Graff FS; Morgan TJ; Epstein EE; McCrady BS; Cook SM; Jensen NK et al. Engagement and retention in outpatient alcoholism treatment for women. American Journal on Addictions 18(4): 277-288, 2009. (72 refs.)

Reviews of the dropout literature note significant attrition from addiction treatment. However, consistent predictors have not been identified and few studies have examined factors related to retention and engagement for women in gender-specific treatment. The current study consisted of 102 women and their partners randomized to individual or couples outpatient alcoholism treatment. Women attended more treatment sessions if they were assigned to individual treatment, older, had fewer symptoms of alcohol dependence, had more satisfying marital relationships, had spouses who drank, and had matched preference for treatment condition. Women were more engaged in treatment (ie, completed more assigned homework) if they had fewer children at home, fewer alcohol dependence symptoms, later age of onset of alcohol diagnosis, more satisfying marital relationships, and spouses who accepted or encouraged their drinking. Results highlight important associations of treatment and relationship variables with treatment retention and engagement.

Gram IT; Braaten T; Lund E; Le Marchand L; Weiderpass E. Cigarette smoking and risk of colorectal cancer among Norwegian women. Cancer Causes and Control 20(6): 895-903, 2009. (45 refs.)

The association between cigarette smoking and colorectal cancer (CRC) is still not established. In 2002, Norwegian women had the second highest incidence of CRC in the world. A large proportion of Norwegian women are ever smokers. We examined the association between cigarette smoking and CRC incidence among Norwegian women. We followed 68,160 women, aged 30-69 years, from the Norwegian Women and Cancer Study who completed a questionnaire in 1996 or 1998 by linkages to national registers through 31 December 2005. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated by fitting Cox proportional hazard models. Subsequently, we estimated the population attributable fraction. Altogether, 425 incident cases of primary, invasive CRC were identified. Ever smokers had a 20% increased risk of CRC (RR = 1.2; 95% CI = 1.0-1.5), a 30% increased risk of colon (RR = 1.3; 95% CI = 1.0-1.7), and a 10% increased risk of rectal (RR = 1.1; 95% CI = 0.7-1.5) cancer compared to never smokers. The population attributable fraction was estimated to be 12% which indicated that approximately one in eight of the CRC cases could have been prevented at a population level. Our results support the hypothesis that cigarette smoking is a preventable cause of CRC among women.

Greaves LJ; Hemsing NJ. Sex, gender, and secondhand smoke policies: Implications for disadvantaged women. American Journal of Preventive Medicine 37(2, Supplement S): S131-S137, 2009. (47 refs.)

Context: Although implementation of secondhand smoke policies is increasing, little research has examined the unintended consequences of these policies for disadvantaged women. Evidence acquisition: Macro-, meso-, and micro-level issues connected to secondhand smoke and women are considered to illustrate the range of ways in which sex, gender, and disadvantage affect women's exposure to secondhand smoke. A review of current literature, primarily published between 2000 and 2008, on sex- and gender based issues related to secondhand smoke exposure and the effects of secondhand smoke policies for various subpopulations of women, including low-income girls and women, nonwhite minority women, and pregnant women, was conducted in 2008. These materials were critically analyzed using a sex and gender analysis, allowing for the drawing of inferences and reflections on the unintended effects of secondhand smoke policies on disadvantaged women. Evidence synthesis: Smoke-free policies do not always have equal or even desired effects on low-income girls and women. Low-income women are more likely to be exposed to secondhand smoke, may have limited capacity to manage their exposure to secondhand smoke both at. home and in the workplace, and may experience heightened stigmatization as a result of secondhand smoke policies. Conclusions: Various sex- and gender-related factors, such as gendered roles, unequal power differences between men and women, child-caring roles, and unequal earning power, affect exposure and responses to secondhand smoke, women's capacity to control exposure, and their responses to protective policies. In sum, a much more nuanced gender- and diversity-sensitive framework is needed to develop research and tobacco control policies that address these issues.

Green TC; Serrano JMG; Licari A; Budman SH; Butler SF. Women who abuse prescription opioids: Findings from the Addiction Severity Index-Multimedia Version (R) Connect prescription opioid database. Drug and Alcohol Dependence 103(1-2): 65-73, 2009. (42 refs.)

Background: Evidence suggests gender differences in abuse of prescription opioids. This study aimed to describe characteristics of women who abuse prescription opioids in a treatment-seeking sample and to contrast gender differences among prescription opioid abusers. Methods: Data collected November 2005 to April 2008 derived from the Addiction Severity Index Multimedia Version Connect (ASI-MV(R) Connect) database. Bivariate and multivariable logistic regression examined correlates of prescription opioid abuse stratified by gender. Results: 29,906 assessments from 220 treatment centers were included, of which 12.8%(N = 3821) reported past month prescription opioid abuse. Women were more likely than men to report use of any prescription opioid (29.8% females vs. 21.1% males, p<0.001) and abuse of any prescription opioid (15.4% females vs. 11.1% males,p<0.001) in the past month. Route of administration and Source of prescription opioids displayed gender-specific tendencies. Women-specific correlates of recent prescription opioid abuse were problem drinking, age <54, inhalant use, residence Outside of West US Census region, and history of drug overdose. Men-specific correlates were age <34, currently living with their children, residence in the South and Midwest, hallucinogen use, and recent depression. Women prescription opioid abusers were less likely to report a pain problem although they were more likely to report medical problems than women who abused other drugs. Conclusions: Gender-specific factors should be taken into account in efforts to screen and identify those at highest risk of prescription opioid abuse. Prevention and intervention efforts with a gender-specific approach are warranted.

Greenfield SF; Grella CE. What Is "women-focused" treatment for substance use disorders? (editorial). Psychiatric Services 60(7): 880-882, 2009. (8 refs.)

Over the past three decades research has highlighted gender differences in substance use disorders and substance abuse treatment participation. Programs devoted to addressing women's treatment needs, broadly encompassed in the term "women-focused treatment," have multiplied. This column examines the rationale for women-focused treatment and describes some of its components. The authors cite the need to evaluate women-focused treatment by developing validated measures of the processes embodied in such treatment and by conducting empirically sound research on clinical outcomes, treatment effectiveness, cost-effectiveness, and the optimal means of providing services to women with substance use disorders.

Grella CE; Karno MP; Warda US; Niv N; Moore AA. Gender and comorbidity among individuals with opioid use disorders in the NESARC study. Addictive Behaviors 34(6-7): 498-504, 2009. (59 refs.)

This study examines gender differences in the association of lifetime mental and substance use disorders among individuals with opioid use disorders in the United States. The sample (N = 578) is from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which is a representative household survey. Bivariate analyses and logistic regression modeling were conducted. About 70% of the sample had a lifetime non-substance use Axis I disorder; women were about twice as likely as men to have either a mood or anxiety disorder. About half of the sample had a personality disorder, with women more likely to have paranoid disorder and men more likely to have antisocial personality disorder. Individuals with a lifetime mental disorder were about three times more likely than others to be dependent on other substances, independent of gender. The study demonstrated an inverse relationship between lifetime mental and other substance use disorders, with women having significantly higher odds for several of the mental disorders and men having greater odds of other substance use disorders.

Grella CE; Needell B; Shi YF; Hser YI. Do drug treatment services predict reunification outcomes of mothers and their children in child welfare? Journal of Substance Abuse Treatment 36(3): 278-293, 2009. (67 refs.)

The effect of mothers' participation in substance abuse treatment on reunification with their children who are in out-of-home care is an important policy issue. This article examines the predictors of child reunification among mothers who participated in a statewide treatment outcome study. Data were integrated from multiple sources to determine the contributions of characteristics of mothers (n = 1, 115), their children (n = 2,299), and treatment programs (n = 43) on reunification outcomes. Hierarchical linear modeling was used to determine the fixed and random effects of mother, child, and program characteristics. Mothers with more employment and psychiatric problems were less likely to be reunified with their children; completion of 90 or more days in treatment approximately doubled their likelihood of reunification. Mothers who were treated in programs providing a "high" level of family-related or education/employment services were approximately twice as likely to reunify with their children as those who were treated in programs with "low" levels of these services.

Grundtvig M; Hagen TR; German M; Reikvam A. Sex-based differences in premature first myocardial infarction caused by smoking: Twice as many years lost by women as by men. European Journal of Cardiovascular Prevention & Rehabilitation 16(2): 174-179, 2009. (18 refs.)

Background: It has been debated whether smoking increases the risk of heart disease relatively more in women than in men. It is not known whether there are sex differences with regard to how many years prematurely smoking causes acute myocardial infarction (AMI) to occur. We aimed to determine how smoking affects the age of onset of first myocardial infarction in both the sexes. Design: Clinical data were consecutively entered into a database and were analysed with a multivariate regression technique. Methods In the years 1998-2005, data on 1784 consecutive patients (38.3% women) who were discharged from or died in a district general hospital with a diagnosis of first myocardial infarction were included in the study. Age at first AMI was analysed. Results: Unadjusted mean ages were 76.2 years for women and 69.8 years for men, a difference of 6.4 years (P<0.001). Mean age within the various groups was: women nonsmokers 80.7 years, women smokers 66.2 years, difference 14.4 years (P<0.001); men nonsmokers 72.2 years, men smokers 63.9 years, difference 8.3 years (P<0.001). After adjustment for risk factors (hypertension, cholesterol levels, diabetes) and patient characteristics (history of angina, history of stroke) 13.7 years of the age difference in women were attributed to smoking; the corresponding figure in men was 6.2 years (P<0.001). Conclusion: First AMI occurred significantly more prematurely in women than in men smokers, implying that twice as many years were lost by women as by men smokers.

Hamilton AB; Grella CE. Gender differences among older heroin users. Journal of Women & Aging 21(2): 111-124, 2009

Objectives: This purpose of this study was to explore the following question: Are there gender differences among older individuals with a history of heroin addiction with regard to social and family relationships and health problems? Methods: Eight gender-specific focus groups were conducted with 38 (19 women, 19 men) older (50+ years) individuals with long-term histories of heroin dependence. Four groups were conducted in a methadone maintenance (MM) clinic and four groups were derived from the Los Angeles community. Results: Modest gender differences were observed, but mainly in the focus-group dynamics. Women typically described the impact of their addiction on their families, while men typically described their surprise at still being alive. Hepatitis C was the primary health concern in all groups; mental health issues were also discussed. Discussion: Remarkable gender differences were not apparent in the qualitative experiences of these participants. Instead, we found overriding similarities related to the interactive effects of drug use and aging. Longitudinal studies of this population as they age and interact with the health-care system and other social systems will help to untangle the complicated relationship between aging, drug addiction, gender, and health.

Handel G; Hannover W; Roske K; Thyrian JR; Rumpf HJ; John U et al. Naturalistic changes in the readiness of postpartum women to quit smoking. Drug and Alcohol Dependence 101(3): 196-201, 2009. (38 refs.)

Background: This study involves a long-term examination of the natural behavioral changes in postpartum women undergoing smoking cessation. The analysis was based on the readiness to quit smoking as assessed using the Transtheoretical Model of intentional behavioral change. This is a secondary data analysis of a randomized controlled trial. Methods: Between May 2002 and March 2003, all women in the maternity wards of six hospitals in the German state of Mecklenburg-West Pomerania were screened for smoking before or during pregnancy. Of the women who answered in the affirmative, 871 (77%) participated in the study. We utilized a questionnaire to classify 345 women into stages of progress regarding their motivation to change their smoking behavior 4-6 weeks postpartum (TO). Participants were followed-up after 6 (T1), 12 (T2), and 18 months (T3). In addition to the descriptive analysis, latent transition analysis was applied as a statistical method to test models of patterns of change and to evaluate transitions in the stages of change over time. Results: During the time interval between consecutive follow-up surveys, 59.1% (T0/T1), 72.3% (T1/T2), and 67.9% (T2/T3) of women remained at the same stage of motivation to change. Most relapses into earlier stages occurred 6 months postpartum (T1) (31.5% of the stage transition). The patterns of change across the first three time points were best described by a model that includes stability, one-stage progressions, and one-to-four-stage regressions. Conclusions: Readiness to quit smoking in study participants did not substantially change over the span of 18 months postpartum.

Hien DA; Wells EA; Jiang HP; Suarez-Morales L; Campbell ANC; Cohen LR et al. Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. Journal of Consulting and Clinical Psychology 77(4): 607-619, 2009. (45 refs.)

The authors compared the effectiveness of the Seeking Safety group, cognitive-behavioral treatment for substance use disorder and posttraumatic stress disorder (PTSD), to an active comparison health education group (Women's Health Education [WHE]) within the National Institute on Drug Abuse's Clinical Trials Network. The authors randomized 353 women to receive 12 sessions of Seeking Safety (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment I week and 3, 6, and 12 months posttreatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS), the PTSD Symptom Scale-Self Report (PSS-SR), and a substance use inventory (self-reported abstinence and percentage of days of use over 7 days). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively) but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline. Study results do not favor Seeking Safety over WHE as an adjunct to substance use disorder treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions.

Hill TD; Nielsen AL; Angel RJ. Relationship violence and frequency of intoxication among low income urban women. Substance Use & Misuse 44(5): 684-701, 2009. (54 refs.)

Using data from the Welfare, Children, and Families project (1999), a probability sample of 2,280 low-income women with children living in low-income neighborhoods in Boston, Chicago, and San Antonio, we examine the effects of relationship violence before age 18 and in the past year on frequency of adult intoxication. Results obtained from a series of ordered logistic regression models suggest that sexual coercion before age 18 and minor and severe physical assault in the past year are independently associated with greater frequency of intoxication, net of a range of sociodemographic controls. The study's limitations are noted.

Hinote BP; Cockerham WC; Abbott P. The specter of post-communism: Women and alcohol in eight post-Soviet states. Social Science & Medicine 68(7): 1254-1262, 2009. (50 refs.)

Because men have borne the heaviest burden of premature mortality in the former Soviet Union, women have for the most part been overlooked in studies of the health crisis in this part of the world. A considerable body of research points to alcohol consumption among males as a primary lifestyle cause of premature mortality. However, the extent to which alcohol use has penetrated the female population following the collapse of communism and how this consumption is associated with other social factors is less well-understood. Accordingly, this paper investigates alcohol consumption in eight republics of the former USSR - Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine using data collected in 2001. More specifically, discussion of gender role transformations and the historical experiences of women during the Soviet era emphasize two potentially important social influences examined in this analysis: psychological distress and Soviet political ideology. Findings suggest that distress is only weakly statistically associated with frequent drinking behavior among women, but results for political ideology show that this factor is statistically and significantly associated with drinking behaviors. Alcohol consumption was not particularly common among women under communism, but trends have been changing. Our discussion suggests that, after the collapse of the Soviet state, women are more able to embrace behavioral practices related to alcohol, and many may do so as an overt rejection of traditional Soviet norms and values. Findings are also discussed within the context of current epidemiological trends and future research directions in these eight republics.

Janakiraman V; Gantz M; Maynard S; El-Mohandes A. Association of cotinine levels and preeclampsia among African-American women. Nicotine & Tobacco Research 11(6): 679-684, 2009. (18 refs.)

Although prior studies have shown that smoking reduces preeclampsia risk, the relationship between nicotine level and preeclampsia risk is not known. Our objective was to study the effects of smoking on the incidence of preeclampsia in African-American women using cotinine, a quantitative marker of nicotine. We performed a secondary analysis of data collected prospectively in Project District of Columbia Healthy Outcomes of Pregnancy Education. Our study included 724 African-American women. Self-reported smoking, cotinine levels, and pregnancy outcomes were examined. Some 18% of participants were smokers. Women with salivary cotinine levels greater than 200 ng/ml had infants with lower birth weights and a higher incidence of small-for-gestational-age infants than women with cotinine levels of 200 ng/ml or less. Exact logistic regression analysis revealed that women with salivary cotinine levels greater than 200 ng/ml had a significantly lower incidence of preeclampsia, compared with women with cotinine levels of 200 ng/ml or less, in unadjusted analysis (odds ratio [OR] = 0.16, 95% CI = 0-0.90). After controlling for age, parity, and medical comorbidities, the trend was observed, but the effect was no longer significant (adjusted odds ratio [AOR] = 0.19, 95% CI = 0-1.11). We found no significant differences in preeclampsia rates using lower cutoffs of cotinine exposure. We did not observe a decrease in preeclampsia incidence at low or moderate cotinine levels. Women with the highest cotinine levels may have a decreased risk for preeclampsia, although this effect was not significant after controlling for other risk factors.

Jochmann N; Mueller S; Kuhn C; Gericke C; Baumann G; Stangl K et al. Chronic smoking prevents amelioration of endothelial function in the course of the menstrual cycle. Circulation Journal 73(3): 568-572, 2009. (28 refs.)

Background: Smoking is the most important modifiable cardiovascular risk factor in young women. The aim of this study was to investigate whether tobacco use influences physiological changes in endothelial function during the menstrual cycle. Methods and Results: Flow-mediated dilation (FMD) and nitro-mediated dilation (NMD) were assessed in healthy smoking and non-smoking women, by high-resolution ultrasound at 3 time points during the menstrual cycle: at menstruation, in the mid-follicular phase, and in the mid-luteal phase. A total of 25 women (12 nonsmokers, 13 smokers) completed the study protocol. FMD did not show differences between smoking and nonsmoking women at menstruation and the mid-follicular phase. At the mid-luteal phase, however, FMD was significantly reduced in smoking when compared with non-smoking women. NMD did not differ between smoking and non-smoking women, nor between the different cycle phases. Conclusions: In healthy women, smoking eliminates the physiological amelioration of endothelial function during the menstrual cycle. This study underlines the importance of an exact description of menstrual cycle phase and smoking status in studies investigating endothelial function in premenopausal women.

Joseph JG; El-Mohandes AAE; Kiely M; El-Khorazaty MN; Gantz MG; Johnson AA et al. Reducing psychosocial and behavioral pregnancy risk factors: Results of a randomized clinical trial among high-risk pregnant African American women. American Journal of Public Health 99(6): 1053-1061, 2009. (67 refs.)

Objectives. We evaluated the efficacy of a primary care intervention targeting pregnant African American women and focusing on psychosocial and behavioral risk factors for poor reproductive outcomes (cigarette smoking, second-hand smoke exposure, depression, and intimate partner violence). Methods. Pregnant African American women (N = 1044) were randomized to an intervention or usual care group. Clinic-based, individually tailored counseling sessions were adapted from evidence-based interventions. Follow-up data were obtained for 850 women. Multiple imputation methodology was used to estimate missing data. Outcome measures were number of risks at baseline, first follow-up, and second follow-up and within-person changes in risk from baseline to the second follow-tip. Results. Number of risks did not differ between the intervention and usual care groups at baseline, the second trimester, or the third trimester. Women in the intervention group more frequently resolved some or all of their risks than did women in the usual care group (odds ratio = 1.61; 95% confidence interval = 1.08, 2.39; P = .021). Conclusions. In comparison with usual care, a clinic-based behavioral intervention significantly reduced psychosocial and behavioral pregnancy risk factors among high-risk African American women receiving prenatal care.

Kang SY; Deren S; Colon H. Gender comparisons of factors associated with drug treatment utilization among Puerto Rican drug users. American Journal of Drug and Alcohol Abuse 35(2): 73-79, 2009. (35 refs.)

Objective: This study examined gender-specific effects of social bonds, network characteristics, and other factors on drug treatment enrollment among Puerto Rican drug users. Method: Participants (425 women; 1,374 men) were recruited in New York and Puerto Rico in 1998-2003. Results: Gender differences were found: education ( high school/GED) and having a sex partner who is an injection drug user (IDU) were significantly related to current enrollment in drug treatment (EDT) for women; for men, having an IDU friend (negatively) had a main effect on EDT, and having an IDU friend also had a significant interaction effect with their own injection drug use on EDT. For both women and men, recruitment site (New York), having health insurance, and prior methadone treatment were significant predictors of EDT. Conclusion: The findings may be useful in developing gender-differentiated drug counseling and treatment efforts that engage women's sex partners and men's friendship networks to build support for drug treatment.

Kang Y; Imamura H; Masuda R; Noda Y. Cigarette smoking and blood insulin, glucose, and lipids in young Japanese women. Journal of Health Science 55(2): 294-299, 2009. (49 refs.)

The aim of the present study was to examine the effects of cigarette smoking (CS) on fasting blood insulin, homeostasis model assessment index (HOMA-R index), glucose and lipids in Japanese collegiate women. Twenty-six smokers were individually matched for physical activity scores, age, and body mass index with 26 nonsmokers. Information on smoking, physical activity habits, and diet record were collected. Blood samples were taken and analyzed to evaluate their associations with CS. The results showed significantly higher mean serum insulin, HOMA-R index, and glucose while lower mean high-density lipoprotein two cholesterol (HDL2-C) in smokers as compared with nonsmokers. The mean nutrient intakes showed no significant differences between smokers and nonsmokers. In conclusion, it appears that CS is associated with insulin resistance, impaired fasting glucose and lower HDL2-C in young Japanese female smokers. This may partly explain the deleterious effects of smoking on coronary heart disease risk.

Kaysen DL; Lee CM; LaBrie JW; Tollison SJ. Readiness to change drinking behavior in female college students. Journal of Studies on Alcohol and Drugs Supplement 16: 106-114, 2009. (42 refs.)

Objective: Motivational interviewing (MI) therapies are effective in reducing high-risk drinking in college populations. Although research supports efficacy of MI prevention strategies in reducing alcohol use, there are little data examining readiness to change (RTC), the underlying theoretical model of MI interventions. The purpose of the present study was to explore RTC variability and drinking behavior and whether M I increases RTC in an intervention group compared with controls. Method: Two-hundred eighty-five first-year female college students participated in the study. Present analyses focused on those students who consumed alcohol in the month before the study (n = 182). RTC was measured using the Readiness to Change Ruler. Results: Analyses were conducted using hierarchical linear modeling. There was significant variability in RTC: 71.86% of variance in RTC was between-person differences, and 28.14% was within-person differences. Higher RTC was associated with lower intentions to drink and future drinking behavior. However, in weeks in which students drank more, they experienced a decrease in RTC. Based on the significant cross-level interaction, the intervention group had significantly higher RTC than controls. Conclusions: These results provided partial support for our hypotheses, The overall theoretical construct of RTC varies both across and within individuals. These results also offer support for the utility of MI-based prevention strategies in increasing RTC within individuals. However, we did not consistently find that these changes related to drinking changes. Findings provide support for both the construct of RTC and utility of MI interventions in changing these beliefs in female college students.

Khaylis A; Trockel M; Taylor CB. Binge drinking in women at risk for developing eating disorders. International Journal of Eating Disorders 42(5): 409-414, 2009. (41 refs.)

Objective: To determine binge drinking rates in college-age women at risk for eating disorders and to examine factors related to binge drinking over time. Method: Participants were 480 college-age women who were at high risk for developing an eating disorder (ED) and who had a body mass index (BMI) between 18 and 32. Participants were assessed annually for 4 years. Results: Participants reported high rates of binge drinking and frequent binge drinking throughout college. Binge drinking was positively correlated with dietary restraint, coping using substances, coping using denial, and life events. Discussion: The study's findings suggest that binge drinking is highly prevalent in women at high risk for developing eating disorders. Results also indicated that binge drinking was related to dieting and maladaptive coping patterns. Intervention for women with strong weight and shape concerns should also address problematic alcohol use.

Khoury ENL; Litvin EB; Brandon TH. The effect of body image threat on smoking motivation among college women: Mediation by negative affect. Psychology of Addictive Behaviors 23(2): 279-286, 2009. (69 refs.)

A recent experimental study found that activation of negative body image cognitions produced urges to smoke in young women (E. N. Lopez, D. J. Drobes, J. K. Thompson, & T. H. Brandon, 2008). This study intended to replicate and extend these experimental findings by examining the role of negative affect as a mediator of the relationship between body dissatisfaction and smoking urges. Female college smokers (N = 133) were randomly assigned to a body image challenge (trying on a bathing suit) or a control condition (evaluating a purse). State levels of urge to smoke, mood, and body dissatisfaction were assessed both pre- and postmanipulation. Trying on a bathing suit increased body dissatisfaction and reported urges to smoke, particularly those urges related to reducing negative affect. Additionally, state negative affect mediated the relationship between the body image manipulation and smoking urge. This study provides additional support, through an experimental design that situational challenges to body image influence smoking motivation and that this effect occurs, at least in part, through increases in negative affect. Theoretical and applied implications are discussed.

Kim SY; England L; Dietz PM; Morrow B; Perham-Hester KA. Prenatal cigarette smoking and smokeless tobacco use among Alaska Native and white women in Alaska, 1996-2003. Maternal and Child Health Journal 13(5): 652-659, 2009. (27 refs.)

Objective: To examine trends in prenatal cigarette smoking and smokeless tobacco use among Alaska Native (AN) and white women in Alaska. Method: Using 1996-2003 data from the population-based Pregnancy Risk Assessment Monitoring System, we determined trends in self-reported prenatal tobacco use among AN and white women and used chi-square tests and multiple variable logistic regression analysis to identify maternal factors associated with prenatal tobacco use. Results Over the study period, prevalence of any tobacco use during pregnancy declined by 27% among AN women (from 55.8 to 40.9%) (P < 0.0001) and by 17% among white women (from 18.8 to 15.6%) (P < 0.0001). In 2003, among AN women the prevalence of self-reported smokeless tobacco use was 16.9%, cigarette smoking was 25.7%, and any tobacco use was 40.9%; corresponding values for white women were 0.4, 15.0, and 15.6%, respectively. Western Alaska had the highest prevalence of tobacco use. Conclusion: The prevalence of tobacco use decreased between 1996 and 2003, but remained higher among AN women than white women, especially for smokeless tobacco. Support for cessation interventions targeting pregnant women should be made a public health priority in Alaska.

Kim SY; England LJ; Kendrick JS; Dietz PM; Callaghan WM. The contribution of clinic-based interventions to reduce prenatal smoking prevalence among US women. American Journal of Public Health 99(5): 893-898, 2009. (38 refs.)

Objectives. We sought to estimate the effect of universal implementation of a clinic-based, psychosocial smoking cessation intervention for pregnant women. Methods. We used data from US birth certificates (2005) and the Pregnancy Risk Assessment Monitoring System (2004) to estimate the number of women smoking at conception. To calculate the number of women eligible to receive the cessation intervention, we used estimates from the literature of the percentage of women who quit spontaneously (23%), entered prenatal care before the third trimester (96.5%), and disclosed smoking to their provider (75%). We used the pooled relative risk (RR) for continued smoking from the 2004 Cochrane Review as our measure of the intervention's effectiveness (RR=0.94). Results. We estimated that 944240 women smoked at conception. Of these, 23.0% quit spontaneously, 6.3% quit with usual care, and an additional 3.3% quit because of the intervention, leaving 67.4% smoking throughout pregnancy. The calculated smoking prevalence in late pregnancy decreased from 16.4% to 15.6% because of the intervention. Conclusions. Universal implementation of a best-practice, clinic-based intervention would increase the total number of quitters but would not substantially reduce smoking prevalence among pregnant women.

Knight JA; Bernstein L; Largent J; Capanu M; Begg CB; Mellemkjaer L et al. Alcohol intake and cigarette smoking and risk of a contralateral breast cancer. American Journal of Epidemiology 169(8): 962-968, 2009. (25 refs.)

Women with primary breast cancer are at increased risk of developing second primary breast cancer. Few studies have evaluated risk factors for the development of asynchronous contralateral breast cancer in women with breast cancer. In the Women's Environmental Cancer and Radiation Epidemiology Study (1985-2001), the roles of alcohol and smoking were examined in 708 women with asynchronous contralateral breast cancer (cases) compared with 1,399 women with unilateral breast cancer (controls). Cases and controls aged less than 55 years at first breast cancer diagnosis were identified from 5 population-based cancer registries in the United States and Denmark. Controls were matched to cases on birth year, diagnosis year, registry region, and race and countermatched on radiation treatment. Risk factor information was collected by telephone interview. Rate ratios and 95% confidence intervals were estimated by using conditional logistic regression. Ever regular drinking was associated with an increased risk of asynchronous contralateral breast cancer (rate ratio = 1.3, 95% confidence interval: 1.0, 1.6), and the risk increased with increasing duration (P = 0.03). Smoking was not related to asynchronous contralateral breast cancer. In this, the largest study of asynchronous contralateral breast cancer to date, alcohol is a risk factor for the disease, as it is for a first primary breast cancer.

Korhonen T; Kujala UM; Rose RJ; Kaprio J. Physical activity in adolescence as a predictor of alcohol and illicit drug use in early adulthood: A longitudinal population-based twin study. Twin Research and Human Genetics 12(3): 261-268, 2009. (30 refs.)

We investigated prospectively whether physical activity level in adolescence predicts use of alcohol and illicit drugs in early adulthood. We studied 4,240 individual twins (1,870 twin pairs). We classified those who consistently reported frequent leisure physical activity at ages 16, 17 and 181/2 as persistent exercisers, those exercising less than three times monthly as persistently inactive, and all others as occasional exercisers. To control for familial confounds, within-family analyses compared activity-substance use associations in co-twins discordant for baseline physical activity. Individual-based analyses showed no clear association between baseline physical activity and subsequent weekly alcohol consumption. However, weekly alcohol intoxication (OR = 1.9, p = .002) and problems due to alcohol use (OR = 2.0, p < .001) were more common among persistently inactive participants. After excluding those reporting weekly intoxication at baseline, the risk for alcohol intoxication remained elevated among women occasionally (OR = 2.4, p = .017) or persistently (OR = 5.8, p < .001) inactive at baseline, but this association was not replicated within discordant twin pairs. Individual-based analyses showed that drug use in adulthood was more common among those persistently physically inactive in adolescence (OR = 3.7, p < .001) in comparison to those persistently active. This finding was replicated within discordant twin pairs. Among those with no drug experience during adolescence, persistent inactivity (OR = 1.9, p = .007) increased risk for drug use. We conclude that persistent physical inactivity in adolescence may increase the risk of later problems due to excess alcohol use. Sedentary lifestyle predicts illicit drug use even when controlling for familial factors.

Krebs CP; Lindquist CH; Warner TD; Fisher BS; Martin SL. College women's experiences with physically forced, alcohol- or other drug-enabled, and drug-facilitated sexual assault before and since entering college. Journal of American College Health 57(6): 639-647, 2009

Objective: Research has shown associations between college women's alcohol and/or drug consumption and the risk of sexual assault, but few Studies have measured the various means by which sexual assault is achieved. Participants: The authors Campus Sexual Assault Study obtained self-report data from a random sample of undergraduate women (N = 5,446). Methods: The authors collected data on sexual assault victimization by using cross-sectional, Web-based survey, and they conducted analyses assessing the role of substance use. The authors also compared victimizations before and during college, and across years of study. Results: Findings indicate that almost 20% of undergraduate women experienced some type of completed sexual assault since entering college. Most sexual assaults occurred after women voluntarily consumed alcohol, whereas few occurred after women had been given a drug without their knowledge or consent. Conclusions: The authors discuss implications for campus sexual assault prevention programs, including the need for integrated substance use and sexual victimization prevention programming.

Kupprat SA; Dayton A; Guschlbauer A; Halkitis PN. Case manager-reported utilization of support group, substance use and mental health services among HIV-positive women in New York City. AIDS Care 21(7): 874-880, 2009. (24 refs.)

A retrospective, longitudinal analysis of case management and medical charts was used to evaluate utilization of support group, mental health, and substance abuse treatment services among HIV-positive women in New York City. Analyses of 4134 case management and supportive service transactions revealed that 70% utilized support groups over the two-year study period. In contrast, only 35% utilized mental health services (therapy) and of those identified as using substances.. only 48% utilized substance abuse treatment services. Considering the high prevalence of mental illness (63%, n = 29) and substance use (54%, n = 25) in the sample, the low utilization rates highlight unmet needs for service. Significant differences were found in utilization of mental health and substance abuse treatment services, with those who received services at a medical model agency (integrated care) being more likely to receive both types of treatment. In contrast, participants attending support groups in non-medical model agencies (77.8%, n = 7) were significantly more likely to be retained in group (i.e., attend II or more sessions) than those at medical model agencies (39.1%, n = 9). Based on the higher utilization rates of support groups among seropositive women, perhaps these groups could be a vehicle for establishing rapport between mental health professionals and group members to bridge the utilization gap and reduce the stigma associated with therapy and substance abuse treatment services. These findings both taut the success and highlight weaknesses regarding accessing mental health and Substance abuse care, and support group retention. Sharing of information regarding recruitment and retention efforts between agencies of different modalities would be beneficial and also could identify service niches that capitalize on their subsequent strengths.

LaBrie JW; Feres N; Kenney SR; Lac A. Family history of alcohol abuse moderates effectiveness of a group motivational enhancement intervention in college women. Addictive Behaviors 34(5): 415-420, 2009. (49 refs.)

This study examined whether a self-reported family history of alcohol abuse (FH+) moderated the effects of a female-specific group motivational enhancement intervention with first-year college women. First-year college women (N = 287) completed an initial questionnaire and attended an intervention (n = 161) or control (n = 126) group session, of which 118 reported FH+. Repeated measures ANCOVA models were estimated to investigate whether the effectiveness of the intervention varied as a function of one's reported family history of alcohol abuse. Results revealed that family history of alcohol abuse moderated intervention efficacy. Although the intervention was effective in producing less risky drinking relative to controls, among those participants who received the intervention, FH+ women drank less across five weeks of follow-up than FH- women. The current findings provide preliminary support for the differential effectiveness of motivational enhancement interventions with FH+ women.

LaBrie JW; Huchting KK; Lac A; Tawalbeh S; Thompson AD; Larimer ME. Preventing risky drinking in first-year college women: Further validation of a female-specific motivational-enhancement group intervention. Journal of Studies on Alcohol and Drugs Supplement 16: 77-85, 2009. (33 refs.)

Objective: Female college students have increased their alcohol consumption rates. The current study sought to replicate the effectiveness of a female-specific motivational-enhancement group intervention and extended previous work by adding a 6-month follow-Lip. The intervention included several motivational-enhancement components delivered in a group setting and included a group discussion of female-specific reasons for drinking. Method: Participants were 285 first-year college women. Data collection consisted of an online pi-c-intervention questionnaire, 10 weeks of online follow-up assessment, and a 6-month online follow-tip. Using a randomized design, participants chose a group session, blind to treatment status. Held during the first weeks of the first semester. 159 participants received the intervention and 126 participants received an assessment-only control. Results: Using a repeated-measures analysis of covariance, intervention participants consumed significantly less than control participants on drinks per week (F = 11.86, 1/252 df. p < .001), maximum drinks (F = 11.90. 1/252 df, p <.001), and heavy episodic drinking events (F = 20.14, 1/252 df, p < .001) across 10 weeks of follow-tip. However, these effects did not persist at the 6-month follow-up. Moderation effects were found for social motives on all drinking variables, such that the intervention was most effective for those women with higher social motives for drinking. Conclusions: Efficacy was found for a female-specific motivational group intervention in creating less risky drinking patterns among first-year women, especially women with social motives for drinking. The effect dissipated by the second semester, suggesting the need for maintenance or booster sessions.

Lafave L; Desportes L; McBride C. Treatment outcomes and perceived benefits: A qualitative and quantitative assessment of a women's substance abuse treatment program. Women & Therapy 32(1): 51-68, 2009. (33 refs.)

This study examines outcomes of a women's substance abuse treatment program based on empowerment, choice, and client/therapist collaboration. The program was assessed through qualitative and quantitative research methods. The article includes extensive quotes from six client interviews as well as data from pre-post surveys of 50 women in the treatment program. Results show that the women felt they benefited from the collaborative treatment approach. Benefits to the women included feeling more empowered and learning to take responsibility for their lives. The importance of taking a broad view of recovery that includes ongoing evaluation of positive changes in various areas of the clients' lives is discussed.

Larsen JK; Otten R; Engels RCME. Adolescent depressive symptoms and smoking behavior: The gender-specific role of weight concern and dieting. Journal of Psychosomatic Research 66(4): 305-308, 2009. (20 refs.)

Objective: Increased weight concern and dieting are associated with both depression and smoking among adolescents, particularly girls. This cross-sectional study examined the gender-specific role of weight concerns and dieting on the adolescent depression-smoking association. Methods: Participants were 2051 adolescents (1056 boys and 995 girls) from seven high schools in the Netherlands who filled out questionnaires on smoking, depression, and weight constructs and of whom weight and height were measured. Results: Logistic regression analyses showed that for girls, but not for boys, the depression-smoking association disappeared after controlling for weight concerns and dieting. Conclusion: Our findings indicate that weight concerns and dieting are important factors to consider in the depress ion-smoking initiation relation for girls, but not for boys. This suggests that smoking prevention programs for depressed girls might be enhanced by challenging the idea of smoking as a diet strategy and incorporating a focus on healthy weight regulation. However, before setting up a prevention trial, future prospective studies should first examine why and how weight concerns and dieting are important factors in the depression-smoking initiation relation among girls, also in conjunction with other established risk factors such as parental and peer smoking.

Lee YS; Hadeed L. Intimiate partner violence against Asian immigrant communities: Health/mental health consequences, help-seeking behaviors, and service utilization. Trauma, Violence & Abuse 10(2): 143-170, 2009

Intimate partner violence (IPV) is a serious epidemic among Asian immigrant communities. Yet little is known about the scope, nature, and related contextual, cultural, and social factors of IPV among this population. In particular, the lack of research has been evident in examining health and mental health outcomes of IPV and service utilization, revealing notable gaps in health disparities which result in a failure to provide relevant services and law enforcement protection for battered Asian immigrant women. This article examines critically the growing body of literature on IPV among Asian immigrant populations in several areas: (a) the context of IPV, cultural, social, and individual/familial, (b) prevalence of IPV, (c) physical health and increased risk for sexually transmitted disease and HIV/AIDS, (d) mental health consequences and substance use, (e) social support and help-seeking behaviors, and (f) barriers to service utilization. Future directions for practice, policy, and research are discussed.

Lew JQ; Freedman ND; Leitzmann MF; Brinton LA; Hoover RN; Hollenbeck AR et al. Alcohol and risk of breast cancer by histologic type and hormone receptor status in postmenopausal women. American Journal of Epidemiology 170(3): 308-317, 2009. (36 refs.)

Little is known about the association between alcohol and breast cancer by different tumor characteristics. The study consisted of 184,418 postmenopausal women aged 50-71 years in the National Institutes of Health-AARP Diet and Health Study (1995-2003). Alcohol use, diet, and potential risk factors for cancer were assessed with a mailed questionnaire at baseline. The relative risks and 95% confidence intervals were estimated by using Cox proportional hazards regression. Breast cancer cases and estrogen receptor and progesterone receptor status were identified through linkage to state cancer registries. During an average of 7 years of follow-up, 5,461 breast cancer cases were identified. Alcohol was significantly positively associated with total breast cancer: Even a moderate amount of alcohol (> 10 g/day) significantly increased breast cancer risk. In a comparison of > 35 g versus 0 g/day, the multivariate relative risks were 1.35 (95% confidence interval (CI): 1.17, 1.56) for total breast cancer, 1.46 (95% CI: 1.22, 1.75) for ductal tumors, and 1.52 (95% CI: 0.95, 2.44) for lobular tumors. The multivariate relative risks for estrogen receptor-positive/progesterone receptor-positive, estrogen receptor-positive/progesterone receptor-negative, and estrogen receptor-negative/progesterone receptor-negative tumors were 1.46 (95% CI: 1.12, 1.91) for > 35 g versus 0 g/day, 1.13 (95% CI: 0.73, 1.77) for > 20 g versus 0 g/day, and 1.21 (95% CI: 0.79, 1.84) for > 20 g versus 0 g/day, respectively. Moderate consumption of alcohol was associated with breast cancer, specifically hormone receptor-positive tumors.

Lewandowski CA; Hill TJ. The impact of emotional and material social support on women's drug treatment completion. Health and Social Work 34(3): 213-221, 2009. (41 refs.)

This study assessed how women's perceptions of emotional and material social support affect their completion of residential drug treatment. Although previous research has examined how social support affects recovery, few studies, if any, have examined both the types and the sources of social support. The study hypothesized that women's perceptions of the emotional and material social support they receive from family, friends, partners, drug treatment, child welfare, and welfare agencies will affect treatment completion. The sample consisted of 117 women who were enrolled in a women's residential treatment program. Data were collected in semistructured initial and follow-up interviews using a life history calendar; the Scale of Perceived Social Support, which was adapted for this study; and women's treatment records. The results support the hypothesis. Social support can have both positive and negative effects on treatment completion, depending on the type and source of support provided.

Linke SE; Rutledge T; Johnson BD; Olson MB; Bittner V; Cornell CE et al. The joint impact of smoking and exercise capacity on clinical outcomes among women with suspected myocardial ischemia: The WISE study. Journal of Women's Health 18(4): 443-450, 2009. (46 refs.)

Background: Although extensive research has been conducted on both smoking and low exercise capacity alone, few studies have examined the joint impact or interaction of these two risk factors. We examined the joint and interactive effects of smoking and self-reported exercise capacity on subsequent clinical events (heart failure, myocardial infarction [MI], stroke, and cardiovascular-related mortality) among women with suspected myocardial ischemia. Methods: At baseline (1996-1999), 789 women completed angiographic testing of coronary artery disease (CAD) severity and provided self-report information about their smoking history and exercise capacity as well as demographic and other risk factor data. Incidence of clinical events among the women was tracked for a median of 5.9 years; this analysis was conducted in 2008. Results: In an adjusted survival analysis, women with a positive smoking history and self-reported low exercise capacity had the greatest risk of experiencing a clinical event (HR = 7.7, 95% CI 2.3, 25.5), followed by women with a positive smoking history and self-reported high exercise capacity (HR = 6.9, 95% CI 2.0, 24.6) and those with a negative smoking history and self-reported low exercise capacity (HR = 4.9, 95% CI 1.5, 15.8), relative to women with a negative smoking history and self-reported high exercise capacity. Additional analyses revealed a significant interaction between smoking history and exercise capacity, such that (1) women with a positive smoking history did not experience an additional significantly greater risk due to low exercise capacity, unlike those with a negative smoking history, and (2) all women experienced a significantly greater risk due to a positive smoking history regardless of their exercise capacity. Conclusions: Among women with suspected myocardial ischemia, the combined protective health effects of self-reported high exercise capacity and a negative smoking history remained significant after controlling for preexisting CAD severity and other established risk factors. These findings highlight the importance of studying behavioral risk factors in combination.

Lopez V; Katsulis Y; Robillard A. Drug use with parents as a relational strategy for incarcerated female adolescents. Family Relations 58(2): 135-147, 2009. (37 refs.)

Problems associated with poor quality, parent-child relationships are compounded for incarcerated girls. Using attachment theory as a framework, the present qualitative study examined how 18 incarcerated adolescent girls made meaning with regard to their parents' drug use. We found that 8 of the 18 girls used drugs with their parents as a relational strategy to be close with them, particularly with their fathers, or as a means to share time together. The unique finding that girls used drugs together with their parents supports the need for relational parenting interventions that, whenever possible, support, encourage, and provide treatment and family strengthening services to parents who use drugs and their children.

Lopez-Garcia E; Rodriguez-Artalejo F; Rexrode KM; Logroscino G; Hu FB; van Dam RM. Coffee consumption and risk of stroke in women. Circulation 119(8): 1116-1123, 2009. (38 refs.)

Background: Data on the association between coffee consumption and risk of stroke are sparse. We assessed the association between coffee consumption and the risk of stroke over 24 years of follow-up in women. Methods and Results: We analyzed data from a prospective cohort of 83 076 women in the Nurses' Health Study without history of stroke, coronary heart disease, diabetes, or cancer at baseline. Coffee consumption was assessed first in 1980 and then repeatedly every 2 to 4 years, with follow-up through 2004. We documented 2280 strokes, of which 426 were hemorrhagic, 1224 were ischemic, and 630 were undetermined. In multivariable Cox regression models with adjustment for age, smoking status, body mass index, physical activity, alcohol intake, menopausal status, hormone replacement therapy, aspirin use, and dietary factors, the relative risks (RRs) of stroke across categories of coffee consumption (<1 cup per month, 1 per month to 4 per week, 5 to 7 per week, 2 to 3 per day, and >= 4 per day) were 1, 0.98 (95% CI, 0.84 to 1.15), 0.88 (95% CI, 0.77 to 1.02), 0.81 (95% CI, 0.70 to 0.95), and 0.80 (95% CI, 0.64 to 0.98) (P for trend=0.003). After further adjustment for high blood pressure, hypercholesterolemia, and type 2 diabetes, the inverse association remained significant. The association was stronger among never and past smokers (RR for >= 4 cups a day versus <1 cup a month, 0.57; 95% CI, 0.39 to 0.84) than among current smokers (RR for >= 4 cups a day versus <1 cup a month, 0.97; 95% CI, 0.63 to 1.48). Other drinks containing caffeine such as tea and caffeinated soft drinks were not associated with stroke. Decaffeinated coffee was associated with a trend toward lower risk of stroke after adjustment for caffeinated coffee consumption (RR for >= 2 cups a day versus <1 cup a month, 0.89; 95% CI, 0.73 to 1.08; P for trend=0.05). Conclusions: Long-term coffee consumption was not associated with an increased risk of stroke in women. In contrast, our data suggest that coffee consumption may modestly reduce risk of stroke.

Luke KP. Sexual violence prevention and technologies of gender among heavy-drinking college women. Social Service Review 83(1): 79-109, 2009. (72 refs.)

Feminist scholarship on sexual violence suggests that practices of normative masculinity and femininity, identified by some poststructuralists as technologies of gender, are causally related to sexual violence. Much of that research concentrates on the gendered interactions between men and women but does not sufficiently explore the interactions among women. Through analysis of 31 qualitative interviews, this article shows that interviewed heavy-drinking college women deploy technologies of gender in their interactions with other women and in their strategies for negotiating the risk of sexual violence. The results suggest that deconstructing technologies of gender offers new possibilities for sexual violence prevention in localized (e. g., campus) contexts.

Lumley J; Chamberlain C; Dowswell T; Oliver S; Oakley L; Watson L. Interventions for promoting smoking cessation during pregnancy. (review). Cochrane Database of Systemic Reviews 3: article CD001055, 2009. (382 refs.)

Background: Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies. Smoking in pregnancy is decreasing in high-income countries and increasing in low- to middle-income countries and is strongly associated with poverty, low educational attainment, poor social support and psychological illness. Objectives: To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2008), the Cochrane Tobacco Addiction Group's Trials Register (June 2008), EMBASE, PsycLIT, and CINAHL (all from January 2003 to June 2008). We contacted trial authors to locate additional unpublished data. Selection criteria: Randomised controlled trials where smoking cessation during pregnancy was a primary aim of the intervention. Data collection and analysis: Trials were identified and data extracted by one person and checked by a second. Subgroup analysis was conducted to assess the effect of risk of trial bias, intensity of the intervention and main intervention strategy used. Main results: Seventy-two trials are included. Fifty-six randomised controlled trials (over 20,000 pregnant women) and nine cluster-randomised trials (over 5000 pregnant women) provided data on smoking cessation outcomes. There was a significant reduction in smoking in late pregnancy following interventions (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.96), an absolute difference of six in 100 women who stopped smoking during pregnancy. However, there is significant heterogeneity in the combined data (I-2 > 60%). In the trials with the lowest risk of bias, the interventions had less effect (RR 0.97, 95% CI 0.94 to 0.99), and lower heterogeneity (I-2 = 36%). Eight trials of smoking relapse prevention (over 1000 women) showed no statistically significant reduction in relapse. Smoking cessation interventions reduced low birthweight (RR 0.83, 95% CI 0.73 to 0.95) and preterm birth (RR 0.86, 95% CI 0.74 to 0.98), and there was a 53.91g (95% CI 10.44 g to 95.38 g) increase in mean birthweight. There were no statistically significant differences in neonatal intensive care unit admissions, very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power. Authors' conclusions: Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and pretermbirth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported.

Luseno WK; Wechsberg WM. Correlates of HIV testing among South African women with high sexual and substance-use risk behaviours. AIDS Care 21(2): 178-184, 2009. (23 refs.)

Despite its importance in raising awareness of HIV risk behaviour and in linking HIV-positive individuals to care and treatment, research findings indicate that the HIV antibody testing rate in the general South African population remains relatively low, although knowledge of HIV testing services is high. The identification of important correlates of testing behaviour can be used to improve HIV testing campaigns by refining messages that target individuals at highest risk for infection. This study uses data from an ongoing prevention intervention study in Pretoria, South Africa to identify factors that may have a greater influence on facilitating or hindering HIV testing among South African women who face a high risk for infection. The data for this study (n=425) are derived from the baseline interviews and HIV test results collected between June 2004 and January 2007. HIV testing for this study was significantly associated with education level, alcohol and cannabis use, sex trading, number of STI symptoms, physical abuse and number of visits to a clinic for medical treatment. Results suggest that more focused efforts need to be made to provide HIV testing to women who report substance use behaviour, experience violence and report high-risk sexual behaviour. Interventions also need to address denial of HIV infection and fear to test for HIV.

Martin PR; Arria AM; Fischer G; Kaltenbach K; Heil SH; Stine SM et al. Psychopharmacologic management of opioid-dependent women during pregnancy. American Journal on Addictions 18(2): 148-156, 2009. (62 refs.)

Illicit drug use during pregnancy presents complex clinical challenges, including reducing drug use and treating psychiatric disorders. Pharmacologic treatment of psychiatric disorders in a pregnant woman requires an evaluation of the balance between potential clinical benefit and the risk of potential neonatal consequences. This study describes psychiatric symptoms in 111 opioid-dependent pregnant women and their prescribed psychotropic medications. Hypomania, generalized anxiety disorder and depression were the most common disorders for which psychiatric symptoms were endorsed. Over half of women studied were prescribed some form of psychoactive medication during pregnancy. Pharmacologic vs. non-pharmacologic treatment approaches in this patient population are discussed.

Mason WA; Kosterman R; Haggerty KP; Hawkins JD; Redmond C; Spoth RL et al. Gender moderation and social developmental mediation of the effect of a family-focused substance use preventive intervention on young adult alcohol abuse. Addictive Behaviors 34(6-7): 599-605, 2009. (39 refs.)

This study examined the long-term impact of Preparing for the Drug Free Years (PDFY) on young adult alcohol abuse disorder, addressing theory-based questions about how, and for whom. the program had its effects on the outcomes. Participants were 429 families of 6th graders enrolled in 33 rural schools located in the Midwestern United States. Schools were randomly assigned to conditions. Target adolescents (52% female) were interviewed periodically from age 11 to age 22; throughout adolescence, information was collected also from the youths' parents. Moderation and mediation analyses were conducted using regression analysis and structural equation modeling with covariates measured at baseline (age 11), mediators measured at posttest (age 12), and the outcome measured at the young adult follow-up (age 22). Results showed that PDFY reduced the rate of alcohol abuse among target young women, with evidence that this effect was mediated by increased prosocial skills. The rate of alcohol abuse among PDFY group men was not significantly different from that of control group men. Findings have implications for reducing the public health burden of alcohol abuse among young women.

Mather AA; Cox BJ; Enns MW; Sareen J. Associations of obesity with psychiatric disorders and suicidal behaviors in a nationally representative sample. Journal of Psychosomatic Research 66(4): 277-285, 2009. (47 refs.)

Objective: To determine whether obesity is associated with a variety of psychiatric outcomes after taking into account physical health conditions. Methods: Data came from the public use dataset of the Canadian Community Health Survey Cycle 1.2 (age 15 years and older, N = 36,984). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric diagnoses of major depressive disorder, mania, panic attacks, panic disorder, social phobia, agoraphobia, alcohol dependence, and drug dependence were examined, as was suicidal behavior (ideation or attempts). Multiple logistic regression was utilized to examine the association between obesity (defined as body mass index >= 30) and mental health outcomes. Covariates in the regressions included sociodemographic factors and a measure of physical illness burden (the Charlson Comorbidity Index). Results: In adjusted models, obesity was positively related to several lifetime psychiatric disorders (depression, mania, panic attacks, social phobia, agoraphobia without panic disorder), any lifetime mood or anxiety disorder, suicidal ideation, and suicide attempts [adjusted odds ratio (AOR) range: 1.22-1.58]. Obesity was similarly positively associated with past-year depression, mania, panic attacks, social phobia, any anxiety disorder, and suicidal ideation (AOR range: 1.24-1.52), and negatively associated with past-year drug dependence (AOR = 0.53, 95% CI 0.31-0.89). Most of these associations were found to be specific to women, while some were also present in men. Conclusion: Independent of physical health conditions, obesity was associated with psychiatric disorders and suicidal behavior in the Canadian population. Possible mechanisms and clinical implications of these findings are considered.

Mathews S; Abrahams N; Jewkes R; Martin LJ; Lombard C. Alcohol use and its role in female homicides in the Western Cape, South Africa. Journal of Studies on Alcohol and Drugs 70(3): 321-327, 2009. (24 refs.)

Objective: Levels of alcohol use are high in South Africa and not much is known about women's use of alcohol when murdered. The aim of this article is to describe the patterns of blood alcohol concentration (BAC) at the time of death for female homicide victims and to explore the factors associated with having an elevated BAC. Method: A subsample of a national, representative, retrospective mortuary-based study of female homicides ages 14 years and older was analyzed. Data were gathered from medical legal laboratory records, autopsy reports, and police interviews from 153 cases at sampled mortuaries in the Western Cape Province of South Africa in 1999. Results: Sixty-two percent of women who were murdered had a high BAC at the time of their death, with an overall median BAC of .11% (110 mg/100 ml). A quantile regression analysis showed that a raised median BAC at the time of death was positively associated with the victim's age; being unemployed or not known to be employed; and being killed in a rural setting, in a public space, and on a weekend. Significant interactions between type of homicide and employment showed a modification in median BACs for unemployed victims killed by intimate partners compared with employed victims, with a median difference of. 19% (190 mg/100 ml) (95% confidence interval: .14%-.23% [140-230 mg/100 ml]). Conclusions: This study highlights the public health impact of excessive alcohol consumption and the need for a comprehensive approach to reduce the harmful effects of drinking.

McCauley JL; Amstadter AB; Danielson CK; Ruggiero KJ; Kilpatrick DG; Resnick HS. Mental health and rape history in relation to non-medical use of prescription drugs in a national sample of women. Addictive Behaviors 34(8): 641-648, 2009. (41 refs.)

The current study examined prevalence and correlates of non-medical use of prescription drugs (NMUPD), with particular emphasis on lifetime history of rape and PTSD as risk associates. Interviews conducted via telephone using Computer-Assisted Telephone Interviewing technology, resulting in a nationally representative sample of 3001 non-institutionalized, civilian, English or Spanish speaking women (aged 18-86 years) residing in households with a telephone. Demographic characteristics, rape history, general health/mental health, and substance abuse variables were assessed. NMUPD was assessed by asking if, in the past year, participants had misused a prescription drug. Multivariable logistic regressions were conducted for each theoretically derived predictor set. Significant predictors from each set then entered into final multivariable logistic regression to determine significant predictors of past-year NMUPD. NMUPD was endorsed by 5.5% of the sample (n = 164). Final multivariable model showed that Lifetime Posttraumatic Stress Disorder, other forms of substance use/abuse, and a history of drug or alcohol facilitated rape were significantly associated with increased likelihood of NMUPD. Risk reduction efforts targeting non-medical prescription drug use among women who have experienced traumatic events and/or abuse substances are warranted. Trauma-focused interventions for drug or alcohol facilitated rape victims should include treatment or prevention modules that specifically address NMUPD.

McCauley J; Ruggiero KJ; Resnick HS; Conoscenti LM; Kilpatrick DG. Forcible, drug-facilitated, and incapacitated rape in relation to substance use problems: Results from a national sample of college women. Addictive Behaviors 34(5): 458-462, 2009. (30 refs.)

This is the first study to examine the relation between rape and substance use problems in college women as a function of three legally recognized forms of rape: forcible, incapacitated, and substance-facilitated rape. Data were collected via structured telephone interview with a large national sample of college women aged 18-34 years (n = 1980). Lifetime prevalence of any type of rape was 11.3% in the sample. Prevalence estimates for binge drinking and substance abuse were 15.8% and 19.8%, respectively. Lifetime experience of incapacitated rape and drug-alcohol facilitated rape, but not forcible rape, were associated with increased odds of past-year binge drinking and substance abuse. Findings have implications for secondary prevention and call for continued differentiation in assessment of rape type.

McClave AK; Dube SR; Strine TW; Mokdad AH. Associations between health-related quality of life and smoking status among a large sample of US adults. Preventive Medicine 48(2): 173-179, 2009. (43 refs.)

Objective. To examine the association between self-perceived health-related quality of life (HRQoL) and smoking status. Methods. We used data from 2006 Behavioral Risk Factor Surveillance System, USA participants in four states (n=17,800) to compare the HRQoL of current smokers who unsuccessfully attempted to quit (unsuccessful quitters), former smokers, and never smokers with the HRQoL of current smokers who made no attempts to quit (non-quitters). Results. Overall, unsuccessful quitters were more likely than non-quitters to report frequent mental distress, physical distress, and pain but not frequent depressive symptoms: former and never smokers were less likely than non-quitters to report frequent depressive symptoms. When study subjects were stratified by sex, these associations held true for men, but not for women. Among women, the prevalence of frequent mental and physical distress among former smokers and never smokers was not significantly different from the prevalence among non-quitters, whereas unsuccessful quitters were 2.4 times more likely to report frequent mental distress and 2.1 times more likely to report frequent, physical distress than were nonquitters. Conclusions. Certain HRQoL characteristics were worse among smokers who unsuccessfully attempted to quit and better among former smokers than among smokers who made no attempts to quit.

Meade CS; McDonald LJ; Graff FS; Fitzmaurice GM; Griffin ML; Weiss RD. A prospective study examining the effects of gender and sexual/physical abuse on mood outcomes in patients with co-occurring bipolar I and substance use disorders. Bipolar Disorders 11(4): 425-433, 2009

Prior research suggests possible gender differences in the longitudinal course of bipolar disorder. This study prospectively examined gender differences in mood outcomes and tested the effects of sexual/physical abuse and posttraumatic stress disorder (PTSD). Participants (49 men, 41 women) with co-occurring bipolar I and substance use disorders (92% alcohol, 42% drug) were enrolled in a group treatment trial. They were followed for eight months, with monthly assessments, yielding 32 weeks of data. Primary outcome measures were number of weeks in each mood state, recurrences of depression or mania, and polarity shifts from depression to mania or vice versa. Negative binomial regression was used to examine the effects of gender, lifetime abuse, and PTSD on these outcomes. Participants met syndromal criteria for a mood episode on a mean of 27% of 32 weeks, with depression occurring most frequently. Compared to men, women reported significantly more weeks of mixed mania [relative rate (RR) = 8.53], fewer weeks of euthymia (RR = 0.58), more recurrences of mania (RR = 1.96), and more direct polarity shifts (RR = 1.49) (all p < 0.05). Women also reported significantly higher rates of lifetime sexual or physical abuse (68% versus 33%), which partially explained the relationships between gender and mixed mania and direct polarity shifts. Participants experienced persistent mood symptoms over time. Women consistently reported poorer mood outcomes, and lifetime abuse may help explain observed gender differences in mood outcomes. Further research is necessary to better understand the treatment implications of these findings.

Moore RS; Annechino RM; Lee JP. Unintended consequences of smoke-free bar policies for low-SES women in three California counties. American Journal of Preventive Medicine 37(2, Supplement S): S138-S143, 2009. (43 refs.)

Background: To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES. Methods: The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited. Results: Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke. Conclusions: Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular.

Moore RS; McLellan DL; Tauras JA; Fagan P. Securing the health of disadvantaged women a critical investigation of tobacco-control policy effects on women worldwide. introduction. (editorial). American Journal of Preventive Medicine 37(2, Supplement S): S117-S120, 2009. (37 refs.)

Myers HF; Sumner LA; Ullman JB; Loeb TB; Carmona JV; Wyatt GE. Trauma and psychosocial predictors of substance abuse in women impacted by HIV/AIDS. Journal of Behavioral Health Services & Research 36(2): 233-246, 2009. (47 refs.)

The purpose of this study was to estimate the relative contributions of trauma, chronic stress burden, depression, anxiety, social support, and social undermining in predicting alcohol and drug abuse, and whether ethnicity moderated these relationships. A multi-ethnic sample of 288 HIV-positive and HIV-negative women was recruited. Multiple group path analysis indicated that greater drug dependence was associated with being HIV+, more depression, and higher chronic burden. Trauma was related only to anxiety. Also, greater alcohol dependence was associated with more depression and more social undermining, and these effects were moderated by ethnicity. African American and Latina women evidenced different relationships between depression, social support and social undermining. Depression, social support and social undermining served as intervening variables in influencing the relationships between the other psychosocial variables and drug and alcohol dependence. The implications of these findings for alcohol and drug abuse research and services are discussed.

Najavits LM. Psychotherapies for trauma and substance abuse in women: Review and policy implications. (review). Trauma Violence & Abuse 10(3, Special Issue): 290-298, 2009. (42 refs.)

Women are subject to high rates of interpersonal violence. One frequent co-occurring issue is substance abuse, which may arise posttrauma as a way to cope. In this article, psychosocial therapies for co-occurring trauma and substance abuse are reviewed. Description of empirically studied models is provided, as well as results of the empirical studies. Overall, this area of work suggests positive growth in the availability of new models but very limited empirical work thus far for all but one model. Directions for the future include the need for greater study of treatments in this area, as well as the need to address issues beyond specific models (e.g., workforce issues, access to care, and changing the culture of treatment systems). Policy implications are also offered.

Nederkoorn C; Baltus M; Guerrieri R; Wiers RW. Heavy drinking is associated with deficient response inhibition in women but not in men. Pharmacology, Biochemisty and Behavior 93(3, Special Issue): 331-336, 2009. (58 refs.)

Poor response inhibition has been associated with a wide range of problem behaviours, including addictive behaviours, and could represent a general vulnerability factor. Standard tests of response inhibition have used neutral stimuli. Here we tested whether a deficit in response inhibition in heavy drinkers would be stronger for stimuli related to their problem (alcohol) or not. Response inhibition was assessed with a stop signal task, using four classes of pictures: alcohol-related, soft drinks, erotic (control appetitive categories) and neutral pictures. Participants were 32 heavy and 32 light drinkers. An equal amount of men and women were tested in both drinking groups, in view of recent studies reporting that response disinhibition may be most pronounced in heavy drinking women. Main results were first that no domain-specific differences in response inhibition were found in both groups. Second, heavy drinking females showed stronger response inhibition deficits than other groups. Results are discussed in light of a possible gender difference in response inhibition as a risk factor for addictive behaviours.

Ondersma SJ; Winhusen T; Erickson SJ; Stine SM; Wang Y. Motivation Enhancement Therapy with pregnant substance-abusing women: Does baseline motivation moderate efficacy? Drug and Alcohol Dependence 101(1/2): 74-79, 2009. (21 refs.)

Some evidence suggests that motivational approaches are less efficacious - or even counter-productive - with persons who are relatively motivated at baseline. The present study was conducted to examine whether disordinal moderation by baseline motivation could partially explain negative findings in a previous study [Winhusen, T., Kropp, F., Babcock, D., Hague, D., Erickson, S.J., Renz, C., Rau, L., Lewis, D., Leimberger,J., Somoza, E., 2008. Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users. J. Subst. Abuse Treat. 35, 161-173]. Analyses also focused on the relative utility of the University of Rhode Island Change Assessment (URICA) scale, vs. a single goal question as potential moderators of Motivation Enhancement Therapy (MET). Participants were 200 pregnant women presenting for substance abuse treatment at one of four sites. Women were randomly assigned to either a three-session MET condition or treatment as usual (TAU). Generalized Estimating Equations (GEE) revealed no significant moderation effects on drug use at post-treatment. At follow-up, contrary to expectations, participants who had not set a clear quit goal at baseline were less likely to be drug-free if randomized to MET (OR = 0.48): participants who did set a clear quit goal were more likely to be drug-free if randomized to MET (OR = 2.53). No moderating effects were identified via the URICA. Disordinal moderation of MET efficacy by baseline motivation may have contributed somewhat to the negative results of the [Winhusen, T., Kropp, F., Babcock, D., Hague, D., Erickson, S.J., Renz, C., Rau, L., Lewis, D., Leimberger, J., Somoza, E., 2008. Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users.J. Subst. Abuse Treat. 35,161-173] study, but in the opposite direction expected. A simple question regarding intent to quit may be useful in identifying persons who may differentially respond to motivational interventions. However, moderation effects are unstable, may be best identified with alternate methodologies, and may operate differently among pregnant women.

Ortendahl M; Uttermalm A; Simonsson B; Nasman P; Wallsten T. Estimated time for occurrence of smoking-related consequences among pregnant and non-pregnant women. International Journal of Environmental Research and Public Health 6(5): 1665-1675, 2009. (26 refs.)

Objectives: To study time estimates by women smokers for when smoking-related consequences will occur given continuing or quitting smoking. The relationship of these estimates to pregnancy and intent to quit smoking was also investigated. Methods: Over a two-week period, eighty women, selected to constitute four subgroups formed by pregnant vs. non-pregnant and trying vs. not trying to quit smoking, rated times at which they would expect smoking-related consequences to occur given continuing or quitting smoking. Results: Somatic health consequences were estimated to occur later than consequences related to mood and social relations. All consequences were estimated to occur later given quitting smoking. Pregnancy had an effect on the estimated time that consequences would occur, with pregnant women estimating earlier occurrence of consequences related to mood and social relations than non-pregnant women did. Conclusion: Health messages should stress consequences for somatic health in quitting smoking, since outcomes later in time might have too low a value to exert a positive effect on decisions to quit smoking.

Oser C; Knudsen H; Staton-Tindall M; Leukefeld C. The adoption of wraparound services among substance abuse treatment organizations serving criminal offenders: The role of a women-specific program. Drug and Alcohol Dependence 103(Supplement 1): S82-S90, 2009. (74 refs.)

Women's substance abuse treatment outcomes are improved when women-specific needs are addressed through wraparound services, such as the provision of child care, employment assistance, or mental health counseling. Despite a higher prevalence of pre-incarceration drug use, women in prison report receiving fewer services than their male counterparts, suggesting they likely have greater service needs upon release. It is unknown whether community-based treatment organizations with a women-specific program offer more wraparound services than programs without a focus on women. This study uses data from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative's National Criminal Justice Treatment Practices Survey (NCJTPS), a nationally representative sample of community-based treatment programs serving predominantly criminal offenders (n = 217). First, bivariate analyses identified differences between organizations with and without a women-specific program on the number of wraparound services adopted as well as organizational-level characteristics (i.e., organizational structure, personnel characteristics, culture, sources of information, and systems integration) related to their adoption. Second, Poisson regression was used to identify the organizational characteristics associated with the number of adopted wraparound services, with having a women-specific program being the primary covariate of interest. Results indicate larger organizations that utilized a greater number of treatment approaches and believed that treatment could reduce crime were more likely to offer a greater assortment of wraparound services. In an effort to improve behavioral treatment outcomes, it is imperative to examine organizational level contextual factors that shape the availability of wraparound services for female offenders in community-based substance abuse treatment settings.

Parackal SM; Parackal MK; Harraway JA; Ferguson EL. Opinions of non-pregnant New Zealand women aged 16-40 years about the safety of alcohol consumption during pregnancy. Drug and Alcohol Review 28(2): 135-141, 2009. (28 refs.)

Introduction and Aims. Premenopausal women's opinions on the safety of alcohol consumption during pregnancy are not well documented. This study aims to assess the opinions of New Zealand women on the safety of alcohol consumption in pregnancy and the sociodemographic and lifestyle factors associated with these opinions. Design and Methods. A nationwide, cross-sectional survey was conducted in 2005 on a random sample of 1109 non-pregnant women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a web-assisted telephone interviewing system. Results. Overall, 44% (95% confidence interval 41-47) of women surveyed were of the opinion that no alcohol is safe in pregnancy. Those who stated that no alcohol is safe in pregnancy were more likely to be of Pacific Island ethnicity (P < 0.05) and abstainers (P < 0.001). Women who drank more than two standard drinks of alcohol on a typical occasion and/or who binged were more likely to be of the opinion that 'more than one standard drink' of alcohol is safe on a typical drinking day during pregnancy (P < 0.001). Discussion and Conclusions. The association of drinking style with opinions about the safety of alcohol consumption in pregnancy accentuates the need for public health education to reduce risky drinking behaviours in this population. Such efforts may also address the risk associated with many women unintentionally drinking in early pregnancy, especially if the pregnancy is unplanned.

Park ER; Chang YC; Quinn V; Regan S; Cohen L; Viguera A et al. The association of depressive, anxiety, and stress symptoms and postpartum relapse to smoking: A longitudinal study. Nicotine & Tobacco Research 11(6): 707-714, 2009. (35 refs.)

The aim of this prospective repeated measures, mixed-methods observational study was to assess whether depressive, anxiety, and stress symptoms are associated with postpartum relapse to smoking. A total of 65 women who smoked prior to pregnancy and had not smoked during the last month of pregnancy were recruited at delivery and followed for 24 weeks. Surveys administered at baseline and at 2, 6, 12, and 24 weeks postpartum assessed smoking status and symptoms of depression (Beck Depression Inventory [BDI]), anxiety (Beck Anxiety Inventory [BAI]), and stress (Perceived Stress Scale [PSS]). In-depth interviews were conducted with women who reported smoking. Although 92% of the participants reported a strong desire to stay quit, 47% resumed smoking by 24 weeks postpartum. Baseline factors associated with smoking at 24 weeks were having had a prior delivery, not being happy about the pregnancy, undergoing counseling for depression or anxiety during pregnancy, and ever having struggled with depression (p < .05). In a repeated measures regression model, the slope of BDI scores from baseline to the 12-week follow-up differed between nonsmokers and smokers (-0.12 vs. +0.11 units/week, p = .03). The slope of PSS scores also differed between nonsmokers and smokers (-0.05 vs. +0.08 units/week, p = .04). In qualitative interviews, most women who relapsed attributed their relapse and continued smoking to negative emotions. Among women who quit smoking during pregnancy, a worsening of depressive and stress symptoms over 12 weeks postpartum was associated with an increased risk of smoking by 24 weeks.

Parks KA; Hsieh YP; Collins RL; Levonyan-Radloff K; King LP. Predictors of risky sexual behavior with new and regular partners in a sample of women bar drinkers. Journal of Studies on Alcohol and Drugs 70(2): 197-205, 2009. (28 refs.)

Objective: We designed the current study to assess the rates of risky sexual behavior among women bar drinkers, as well as differences in predictors of risky Sexual behavior, based on partner type-new or regular. Method: We conducted comprehensive, in-person interviews with 241 young women who reported weekly drinking in bars. Several constructs (e.g., individual characteristics, social and sexual behavior, substance use) that we hypothesized would predict risky sexual behavior were assessed in two separate hierarchical regression models for new and regular sexual partners. Results: Rates of risky sexual behavior were significantly higher with regular partners compared with new partners. Increased risky sexual behavior with new partner.,; was significantly associated with having had a riskier regular partner in the past 6 months, lower sexually transmitted disease (STD)/pregnancy prevention assertiveness, increased expectations of sexual disinhibition when drinking, a greater history of prior sexual risk taking, and more frequent drinking in bars. Increased risky sexual behavior with a regular partner was significantly associated with being older, the use of oral contraceptives, lower assertiveness for STD/pregnancy prevention, a greater history of prior sexual risk taking, and increased drug use. Conclusions: Among young women who regularly drink in bars, sexual risk taking was significantly higher with regular partners than with new partners. The predictors of risky sexual behavior differed based on partner type. These findings have implications for including information about the role of alcohol, drinking context, and drug use, as well as individual difference characteristics and partner type in targeted prevention strategies to reduce sexual risk taking.

Penetar DM; Kouri EM; McCarthy EM; Lilly MM; Peters EN; Juliano TM et al. Nicotine pretreatment increases dysphoric effects of alcohol in luteal-phase female volunteers. International Journal of Environmental Research and Public Health 6(2): 526-546, 2009. (51 refs.)

The present report shows that nicotine enhances some of alcohol's positive and negative effects in women and that these effects are most pronounced during the luteal phase of the menstrual cycle. Ten low progesterone and 10 high progesterone/luteal-phase women received nicotine patch pretreatments (placebo or 21 mg) 3 hours before an alcohol challenge (0.4 g/kg). Subjective effects were recorded on mood adjective scales and the Addiction Research Center Inventory (ARCI). Heart rate and skin temperature were recorded. Luteal-phase women reported peak positive (e.g. "stimulated") and peak negative effects (e.g. "clumsy", "dizzy") almost twice as great as low progesterone women.

Peppone LJ; Piazza KM; Mahoney MC; Morrow GR; Mustian KM; Palesh OG et al. Associations between adult and childhood secondhand smoke exposures and fecundity and fetal loss among women who visited a cancer hospital. Tobacco Control 18(2): 115-120, 2009. (42 refs.)

Background: A large percentage of the population continues to be exposed to secondhand smoke (SHS). Although studies have consistently linked active smoking to various pregnancy outcomes, results from the few studies examining SHS exposure and pregnancy difficulties have been inconsistent. Methods: Approximately 4800 women who presented to Roswell Park Cancer Institute between 1982 and 1998 and reported being pregnant at least once were queried about their childhood and adult exposures to SHS using a standardised questionnaire. Women were asked to report on selected prenatal pregnancy outcomes (fetal loss and difficulty becoming pregnant). Results: Approximately 11.3% of women reported difficulty becoming pregnant, while 32% reported a fetal loss or 12.4% reported multiple fetal losses. 40% reported any prenatal pregnancy difficulty (fetal loss and/or difficulty becoming pregnant). SHS exposures from their parents were associated with difficulty becoming pregnant (OR = 1.27, 95% CI 1.03 to 1.56) and lasting. 1 year (OR = 1.34, 95% CI 1.12 to 1.60). Exposure to SHS in both at home during childhood and at the time of survey completion was also associated with fetal loss (OR = 1.39, 95% CI 1.17 to 1.66) and multiple fetal losses (OR = 1.62, 95% CI 1.25 to 2.11). Increasing current daily hours of SHS exposure as an adult was related to the occurrence of both multiple fetal loss and reduced fecundity (p(trend) < 0.05). Conclusions: Reports of exposures to SHS during childhood and as an adult were associated with increased odds for prenatal pregnancy difficulties. These findings underscore the public health perspective that all people, especially women in their reproductive years, should be fully protected from tobacco smoke.

Pino NW; Johnson-Johns AM. College women and the occurrence of unwanted sexual advances in public drinking settings. Social Science Journal 46(2): 252-267, 2009. (28 refs.)

Using existing data from the 1999 Harvard School of Public Health College Alcohol Study, this study analyzes the social predictors of unwanted sexual advances experienced by college women and where this type of victimization occurs. Routine activities theory informed the analysis. While attendance and increased alcohol consumption at bars have a significant effect on experiences of unwanted sexual advances, attendance at parties, attendance at drink promotions, and participation in drinking games does not. Furthermore, while less satisfaction with education, having more sexual partners and friends that binge drink, and having more alcohol-related problems increase the likelihood of experiencing unwanted sexual advances, so does drinking less in general, having higher educated parents, and having a higher grade point average. These findings show that the predictors of unwanted sexual advances may differ somewhat from those that predict more serious forms of sexual victimization. Implications for future research and policy are discussed.

Polkki M; Rantala MJ. Smoking affects womens' sex hormone-regulated body form. (letter). American Journal of Public Health 99(8): 1350-1350, 2009. (8 refs.)

Raymond N; Beer C; Glazebrook C; Sayal K. Pregnant women's attitudes towards alcohol consumption. BMC Public Health 9: article 175, 2009. (34 refs.)

Background: There is uncertainty as to whether there is a safe threshold for drinking alcohol during pregnancy. We explored pregnant women's attitudes towards drinking alcohol in pregnancy and their attitudes towards sources of information about drinking in pregnancy following recent changes in UK government guidance. Methods: A qualitative study involving individual, semi-structured interviews with 20 pregnant women recruited from community organisations in the UK. Interview transcripts were analysed qualitatively using thematic analysis. Results: Most women found information and advice about safe levels of drinking in pregnancy confusing and lacking in evidence and detail. Although most women considered that there were risks involved with drinking in pregnancy and these perceptions influenced their behaviour, only six women reported abstinence. Women reported being influenced by advice from family and friends and their experiences of previous pregnancies. Many had received no individual advice from general practitioners or midwives relating to drinking during pregnancy. Conclusion: Pregnant women wished to take responsibility for their own health and make choices based on informed advice. In order to do so, they require clear and consistent advice about safe levels of drinking from policy makers and health professionals. This is an important issue as women might drink socially during their pregnancy.

Riala K; Hakko H; Rasanen P. Nicotine dependence is associated with suicide attempts and self-mutilation among adolescent females. Comprehensive Psychiatry 50(4): 293-298, 2009. (28 refs.)

Objective: There are no studies investigating the degree of nicotine dependence (ND) and suicidality among underage adolescents. Our aim was to investigate the relationship between ND,aid various forms of suicidal behavior among adolescent psychiatric inpatients in Finland. Methods: Data were collected from 508 patients (age, 12-17 years) admitted to inpatient psychiatric hospitalization between April 2001 and March 2006. The level of ND was assessed by the modified Fagerstrom Tolerance Questionnaire. Information on adolescents' suicide attempts and self-mutilation as well as psychiatric Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. diagnoses was obtained by using the Schedule for Affective Disorder and Schizophrenia for School-Age Children. Results: After adjusting for adolescents' age and psychiatric diagnoses, a more than 4-fold risk for suicide attempts (odds ratio [OR], 4.7; 95%, confidence interval [CI], 1.3-17.2) and self-mutilative behavior (OR, 4.5; 95% CI, 1.6-13.3) was found among female adolescents with a high level of ND compared to nonsmoking adolescent females. In addition, the risk for suicide attempts was only increased by a high level of ND, whereas the risk for self-mutilation was increased among females with mild ND as well. Among males, the level of ND was not associated with suicide attempts or self-mutilative behavior. Conclusions: The level of ND should be taken into account when evaluating adolescent suicidality. Further sex-specific studies with accurate measurements of nicotine and its metabolites in relation to various suicidal and self-destructive behaviors are needed.

Robbins CA; Martin SS; Surratt HL. Substance abuse treatment, anticipated maternal roles, and reentry success of drug-involved women prisoners. Crime & Delinquency 55(3): 388-411, 2009. (70 refs.)

This article reports analyses of recidivism and relapse experiences of substance-abusing women inmates as they reenter the community. Outcomes are compared for women who completed a work-release therapeutic community program, women who entered but did not complete the program, and those who did not receive work-release therapeutic community treatment. Additionally, this article compares women who anticipated living with their children following release to those who did not have children with whom they expected to live. Women who completed the treatment program were more likely to remain arrest-free during the first 18 months following prison, and they used drugs less frequently. Women who expected to live with their minor children were significantly more likely to enter the treatment program, but maternal role expectations had no direct effect on reentry outcomes once treatment experience and background factors were controlled.

Roelands J; Jamison MG; Lyerly AD; James AH. Consequences of smoking during pregnancy on maternal health. Journal of Women's Health 18(6): 867-872, 2009. (30 refs.)

Objective: To estimate the incidence of maternal cardiovascular and pulmonary events and the prevalence of other comorbid conditions among pregnant smokers. Methods: We queried the Nationwide Inpatient Sample (NIS)from the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ) for pregnancy-related discharge codes for the years 2000-2004. The prevalence of various conditions and the incidence of various complications were compared between smokers and nonsmokers. Results: The majority of smokers were young and white and had public insurance. Smokers were more likely to have experienced deep vein thrombosis (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.1, 1.6), stroke (OR 1.7, 95% CI 1.2, 2.5), pulmonary embolus (OR 2.5, 95% CI 2.1, 3.0), and myocardial infarction (OR 4.6, 95% CI 3.3, 6.4). They were 3 times more likely to have experienced influenza or pneumonia (OR 2.9, 95% CI 2.7, 3.2) and 15 times more likely to have bronchitis (OR 15.2, 95% CI 12.8, 18.2). They were more likely to suffer from a number of comorbidities, including asthma (OR 4.0, 95% CI 3.7, 4.2) and gastrointestinal ulcers (OR 3.7, 95% CI 2.6, 5.5). Although they were less likely to have experienced gestational diabetes (OR 0.9, 95% CI 0.9, 1.0), preeclampsia (OR 0.8, 95% CI 0.8, 0.9), or eclampsia (OR 0.7, 95% CI 0.6, 0.9), they were more than 5 times as likely to have experienced an ectopic pregnancy (OR 5.4, 95% CI 4.6, 6.3). Conclusions: Smoking has a negative impact on maternal health. Counseling about the risks of smoking in pregnancy should include not only fetal risks but maternal risks as well.

Rogers JM. Tobacco and pregnancy. Reproductive Toxicology 28(2, Special Issue): 152-160, 2009. (127 refs.)

This paper will review the epidemiology of the impact of cigarette smoking and other forms of tobacco exposure on human development. Sources of exposure described include cigarettes and other forms of smoked tobacco, secondhand (environmental) tobacco smoke, several forms of smokeless tobacco, and nicotine from nicotine replacement therapy. Exposure is immense and worldwide, most of it due to smoking, but in some parts of the world and in some populations, smoking is exceeded by smokeless tobacco use. Nicotine and carbon monoxide exposure are of large concern, but cigarette smoke contains over 4000 chemical constituents and additives including known carcinogens, toxic heavy metals, and many chemicals untested for developmental toxicity. The impact of tobacco on human development will be reviewed. Fertility, conception, survival of the conceptus, most phases and aspects of development studied to date, as well as postnatal survival and health are adversely impacted by maternal tobacco use or exposure. Effects in surviving offspring are probably life-long, and are still being elucidated. It is hoped that this review will serve to keep a focus on the critical and continuing problem of tobacco use impacting human development.

Ross LE; Dennis CL. The prevalence of postpartum depression among women with substance use, an abuse history, or chronic Illness: A systematic review (review). Journal of Women's Health 18(4): 475-486, 2009. (49 refs.)

Background: Although much is known about risk factors for postpartum depression (PPD), many potentially important clinical variables have still not been investigated. In this systematic literature review, we examine the published evidence for the prevalence of PPD among three populations of women commonly seen by providers of perinatal care: women who use substances, women with current or past experiences of abuse, and women with chronic illness. Methods: We searched Medline, CINAHL, EMBASE, PsycINFO, and the Cochrane Library from their start dates through to August 1, 2008, using keywords relevant to depression and each of the three target clinical populations. All published, peer-reviewed papers in English or French were included in the review if a standardized assessment of depression between 3 and 52 weeks postpartum was used and if either the prevalence of PPD in the target population or a comparison of depression scores between the target population and a control group were reported. Results: Seventeen papers were included in the review. There were high rates of PPD among substance-using women and those with current or past experiences of abuse. However, little evidence was found to suggest an increased risk for depression among women with chronic illness. Conclusions: Few eligible studies were identified for each clinical population of interest. Despite limitations of the studies reviewed, the results indicate that both substance use and current or past experiences of abuse are associated with increased risk for PPD. Targeted clinical interventions for these women may be beneficial.

Saitz R; Palfai TP; Cheng DM; Horton NJ; Dukes K; Kraemer KL et al. Some medical inpatients with unhealthy alcohol use may benefit from brief intervention. Journal of Studies on Alcohol and Drugs 70(3): 426-435, 2009. (47 refs.)

Objective: Studies of alcohol brief intervention for medical inpatients have mixed results. We explored potential moderators of the effectiveness of brief intervention for unhealthy alcohol use among medical inpatients. Method: This is a secondary analysis of a randomized controlled trial of brief motivational counseling among 341 urban-hospital medical inpatients (99 women) with unhealthy alcohol use. Self-reported main outcomes were receipt of alcohol treatment by 3 months in subjects with dependence and change in the mean number of drinks per day 3 and 12 months after enrollment in all subjects. Results: Among subjects with dependence, the effect of brief intervention on receipt of alcohol treatment differed significantly by gender and age (p = .02 for each interaction). In stratified analyses, brief intervention was associated with receipt of alcohol treatment in women (adjusted odds ratio [AOR] = 3.9, 95% confidence interval [CI]: 1.2-12.7), and younger (<44 years) subjects (AOR = 3.6, 95% CI: 1.3-10.1). Among subjects with nondependent, unhealthy alcohol use, brief intervention was significantly associated with fewer drinks per day and better physical health-related quality of life at 3 months. However, among those with dependence, intervention was associated with worse physical health-related quality of life and more hospital use, and no changes in drinking, In adjusted analyses among those with and without dependence, brief intervention was not associated with mental health-related quality of life, alcohol problems, or readiness to change. Effects of brief intervention on consumption outcomes were not consistently moderated by demographic characteristics, comorbidity/health, or readiness to change. Conclusions: Some medical inpatients with unhealthy alcohol use, particularly women, younger adults, and patients without dependence may benefit from brief intervention. Few factors that were expected to moderate brief intervention effects did so. Additional research should assess which medical inpatients, if any, can benefit from brief intervention.

Sallit J; Ciccazzo M; Dixon Z. A cognitive-behavioral weight control program improves eating and smoking behaviors in weight-concerned female smokers. Journal of The American Dietetic Association 109(8): 1398-1405, 2009. (66 refs.)

Many people use smoking as a weight control mechanism and are averse to quitting for fear of weight gain. These weight-concerned smokers tend to be women, are significantly less likely to stop smoking or to join smoking cessation programs, and will relapse more often than smokers who are not weight-concerned. Research suggests that a woman's motivation to quit smoking correlates positively with her confidence in her ability to control her weight after quitting. Likewise, success in smoking cessation has been associated with increased self-efficacy for weight control. This randomized controlled trial investigated the effects of a weight control program on eating and smoking behaviors in a group of female, weight-concerned smokers from July 2005 to June 2006. Two hundred sixteen subjects who wanted to lose weight but were not yet ready to quit smoking were recruited to participate in a 12-week, cognitive-behavioral weight control program consisting of 12 1-hour sessions. Subjects were randomly assigned to either the weight-control program (intervention group) or the control group. Differences between the intervention and control groups were evaluated using t tests for continuous variables, Wilcoxon rank-sum tests for ordinal variables and chi(2) tests for categorical variables. The intervention group had a 14% increase (P<0.001) in self-efficacy for weight control (Weight Efficacy Life-Style Questionnaire), which was associated with improved diet quality (Healthy Eating Index) (r=0.292, P<0.01), weight loss (r=0.582, P<0.001), increased self-efficacy for quitting smoking (Smoking Self-Efficacy Questionnaire) (r=0.291, P<0.014), a decrease in number of cigarettes smoked (r=0.331, P<0.005), and positive movement in stage of change toward smoking cessation (r=0.435, P<0.001). These findings suggest that for this group of weight-concerned smokers' success in changing eating behavior may trigger a positive change in smoking behavior.

Samardzic S; Pristas I; Mavrinac GV. Characteristics of heavy smokers in Croatia. Collegium Antropologicum 33(Supplement 1): 61-66, 2009. (18 refs.)

The aim of this paper was to investigate the socio-demographic characteristics of heavy smokers in comparison to group the characteristics of light smokers and non-smokers. Data used for this study was collected within the Croatian Adult Health Survey (CAHS). The results show a significant gender differences in the prevalence of heavy smoking, with higher prevalence among men in all age groups. Highest prevalence of heavy smoking was found in people 35 to 64 years of age, irrespective to gender According to analyzed socio-demographic characteristics men with low education and income who changed place of living have higher prevalence of heavy smoking. Pattern was different in women smokers. Majority of women smokers were light smokers. In women with better than average household economic status there were more smokers than non-smokers, with notable high proportion of heavy smokers in age 18 to 34 years and light smokers in age group 35 to 64. While planning future interventions at the population level, we must consider all of these characteristics and links between them, and engage all segments of society.

Scott TJL; Heil SH; Higgins ST; Badger GJ; Bernstein IM. Depressive symptoms predict smoking status among pregnant women. Addictive Behaviors 34(8): 705-708, 2009. (14 refs.)

The current study assessed self-reported psychopathology in women who spontaneously quit or continued smoking after learning that they are pregnant and examined whether any potential differences remained after control for confounding variables. All participants (77 smokers and 50 spontaneous quitters) completed 3 assessments of psychological functioning prior to enrollment in either smoking cessation or relapse prevention studies. Assessments included the Brief Symptom Inventory (BSI): the Beck Depression Inventory (BDI); and the Adult Self-Report (ASR). Smokers and spontaneous quitters differed on sociodemographic and smoking characteristics. In terms of psychological functioning, smokers reported significantly more depression/anxiety symptoms and withdrawn behavior than spontaneous quitters on the BSI and the ASR. Higher depression scores on the BSI were associated with increased odds of continued smoking, even after controlling for sociodemographic and smoking variables in multivariate analyses. These results suggest that depressive symptoms may be an independent contributor to the problem of continued smoking during pregnancy, which may have implications for smoking-cessation interventions among pregnant women.

Sevelius JM; Reznick OG; Hart SL; Schwarcz S. Informing interventions: The importance of contextual factors in the prediction of sexual risk behaviors among transgender women. AIDS Education and Prevention 21(2): 113-127, 2009. (49 refs.)

This study identifies contextual factors that predict risky sexual behavior among 153 transgender women who participated in a structured survey soliciting information on demographics, substance use, HIV status, risk behaviors, and other health and psychosocial factors. Multivariate logistic regression models were used to determine predictors. Inconsistent condom use was associated with stimulant use, unstable housing, and recruitment site. Substance use during sex was associated with unstable housing and stimulant use. Sex work was associated with hormone use, gender confirming surgeries, and younger age. When developing interventions for transgender women, it may be useful to focus on predictors of risk behavior rather than predictors of current HIV status (i.e., race/ethnicity as "risk factor"), because these behaviors are the target of interventions aimed at sexual risk reduction. Implications include potential benefits of context-specific interventions, structural interventions addressing barriers to housing and health care, and culturally specific substance abuse treatment programs for transgender women.

Shannon LM; Havens JR; Mateyoke-Scrivner A; Walker R. Contextual differences in substance use for rural Appalachian treatment-seeking women. American Journal of Drug and Alcohol Abuse 35(2): 59-62, 2009. (20 refs.)

Objective: To examine differences in substance use among a sample of women entering treatment from rural Appalachian and non-Appalachian areas. Participants: A total of 2,786 women participating in state-funded substance abuse treatment programs statewide. Measures: Substance use measures were based on the SAMHSA CSAT Government Performance and Results Act (GPRA) gathering information on lifetime and past 12-month use of alcohol, marijuana, opiates, sedatives/tranquilizers, cocaine, and stimulants. Results: Women entering treatment in rural Appalachia had disproportionately high rates of opiate and sedative/tranquilizer use while methamphetamine, cocaine, marijuana, and alcohol were more prevalent for women in non-Appalachian areas. Conclusions: Women entering treatment in rural Appalachia were significantly more likely to report opiate and sedative/tranquilizer use compared to non-Appalachian women. In order to begin to understand the elevated rates of prescription drug abuse in rural Appalachian Kentucky, substance use must be considered within the context of demographic, geographic, social, and economic conditions of the region.

Simmat-Durand L; Lejeune C; Gourarier L. Pregnancy under high-dose buprenorphine. European Journal of Obstetrics & Gynecology and Reproductive Biology 142(2): 119-123, 2009. (21 refs.)

Objective: This study was first conducted to compare the consequences of the use of methadone and high-dose buprenorphine in pregnancy in France and secondly to describe the heterogeneity of women under high-dose buprenorphine. This paper focuses on the second point only. Study design: From October 1998 to September 1999, data on pregnancy, delivery outcomes and neonatal parameters were collected for 251 addicted women on methadone or high-dose buprenorphine (HDB) substitution followed in 35 hospitals and clinics in continental France. Then the data of 159 women who had been taking HDB during pregnancy and had delivered 160 live infants were analyzed. Results: Most of these women were treated as outpatients by general practitioners. 43% of them belong to what we considered a "hidden population" of drug users: most of them were native French citizens, who lived with the future fathers in their own homes, had at least some secondary education, and were usually not followed in specialized centers for drug addicts. Almost all the women smoked every day during their pregnancies; 20% used heroin during the last 4 weeks preceding delivery; 16% admitted having injected HDB at least once. Notably. neither the severity nor the duration of the neonatal abstinence syndrome (NAS) seemed to be related to the daily doses of the substitution agent. Half of the newborns were treated for NAS, mainly with morphine hydrochloride. Conclusion: Although two different populations of women were clearly identified, 64 with no social disadvantage and 95 socially disadvantaged, there was no difference between the groups as for the severity of NAS which was only related to the mothers' compliance with a programme of treatment against addiction.

Simmons LA; Havens JR; Whiting JB; Holz JL; Bada H. Illicit drug use among women with children in the United States: 2002-2003. Annals of Epidemiology 19(3): 187-193, 2009. (40 refs.)

PURPOSE: Given research that shows youth exposed to maternal addict ion have increased rates of cognitive, socioemotional, and behavioral problems, we examined the prevalence and correlates of past year illicit drug abuse or dependence among women with children younger than 18 years of age in the home to identify maternal risk factors. METHODS: Data were from the 2002 and 2003 National Survey on Drug Use and Health, a nationally representative sample of the U.S. civilian population. The current analysis utilized a subsample of women (N = 19,300) who reported having children Younger than 18 years in the home. Past year abuse or dependence on cocaine, heroin, marijuana, stimulants, and hallucinogens as well as nonmedical use of prescription medications were assessed. RESULTS: The prevalence of illicit drug abuse or dependence was 1.9%. Mothers reporting drug abuse or dependence had increased odds of being unmarried, controlling for other demographics. They also were more likely to report stress, poorer health status, and meet the criteria for serious mental illness (SMI). CONCLUSIONS; Prevention and intervention strategies should focus on developing and tooting methods to screen for both risk factors associated with maternal drug abuse and actual substance abuse in primary and emergency care settings to reduce youth exposure and improve child developmental outcomes.

Smith EJ; Lui S; Terplan M. Pharmacologic interventions for pregnant women enrolled in alcohol treatment. (review). Cochrane Database of Systemic Reviews 3(article CD007361), 2009. (67 refs.)

Background: Excessive alcohol use during pregnancy has been associated with adverse maternal and neonatal effects. It is therefore important to develop and evaluate effective interventions during this important time in a woman's life. To our knowledge there have been no systematic reviews of randomised control trials (RCT) in this population. Objectives To evaluate the effectiveness of pharmacologic interventions in pregnant women enrolled in alcohol treatment programs for improving birth and neonatal outcomes, maternal abstinence and treatment retention. Search strategy: We searched the Cochrane Drugs and Alcohol Group's Trial register (August 2008); MEDLINE (1.1950 to 6.2008); EMBASE (1.1974-8.2008); CINAHL (1.1982-6.2008); PsycInfo (1.1806-6.2008), and reference lists of articles. Selection criteria: We sought to include randomised or quasi-randomised studies comparing any pharmacologic intervention versus other pharmacologic treatment alone or in association with psychosocial treatment, placebo, non-intervention or psychosocial intervention. Data collection and analysis: Two review authors independently assessed trials for inclusion in the review. Included studies were to be assessed using standardized data extraction and quality assessment forms. No suitable trials were identified. Main results: The search strategy identified 793 citations. Twenty-three citations were deemed relevant for full text review; an additional ten articles were retrieved through hand searching references, for a total of thirty-three articles. Following full text review no articles met the inclusion criteria. Data extraction and assessment of methodological quality were therefore not possible. Authors' conclusions: The review question remains unanswered as there were no randomised control trials found relevant to the topic. There is a need for high quality research to determine the effectiveness of pharmacologic interventions in pregnant women enrolled in alcohol treatment program.

Sobczak J. Alcohol use and sexual function in women: A literature review. (review). Journal of Addictions Nursing 20(2): 71-85, 2009. (58 refs.)

Alcohol consumption and sexual behavior have long been associated. A common assumption is that drinking alcohol will facilitate a sexual encounter. Such beliefs perpetuate the stigmatization of women who are held to different standards than men in regards to both alcohol consumption and sexual behavior. There is empirical support that alcohol use may contribute to impaired sexual functioning, or sexual dysfunction. However, substance abuse and sexual function are areas in which women have historically received comparatively less attention then men. The purpose of this paper is to examine the current state of science as it relates to alcohol use and sexual function in women. Recommendations for future research will be forwarded.

Stade BC; Bailey C; Dzendoletas D; Sgro M; Dowswell T; Bennett D. Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy. (review). Cochrane Database of Systemic Reviews 2009(2): article CD004228, 2009. (91 refs.)

Background: It is estimated that more than 20% of pregnant women worldwide consume alcohol. Current research suggests that alcohol intake of seven or more standard drinks (one standard drink = 13.6 grams of absolute alcohol) per week during pregnancy places the baby at risk of serious, lifelong developmental and cognitive disabilities. Psychological and educational interventions may help women to reduce their alcohol intake during pregnancy. Objectives: To determine the effectiveness of psychological and educational interventions to reduce alcohol consumption during pregnancy in pregnant women or women planning pregnancy. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2008), CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (1966 to November 2007), EMBASE (1980 to November 2007), CINAHL (1982 to November 2007), Counsel. Lit (1980 to November 2007), PsycLIT (1974 to November 2007) and PsycINFO (1967 to November 2007) and checked cited references from retrieved articles. Selection criteria: Randomized controlled trials examining the effectiveness of psychological and educational interventions for reducing consumption of alcohol among pregnant women, or women planning for pregnancy. Data collection and analysis At least two review authors independently extracted information from the results sections of the included studies. Main results: Four studies met the inclusion criteria (715 pregnant women), and reported on at least one of the outcomes of interest. We performed no meta-analyses as the interventions and outcomes measured in the studies were not sufficiently similar. For most outcomes there were no significant differences between groups; and results relating to abstaining or reducing alcohol consumption were mixed. Results from individual studies suggest that interventions may encourage women to abstain from alcohol in pregnancy. There was very little information provided on the effects of interventions on the health of mothers and babies. Authors' conclusions: The evidence from the limited number of studies suggests that psychological and educational interventions may result in increased abstinence from alcohol, and a reduction in alcohol consumption among pregnant women. However, results were not consistent, and the paucity of studies, the number of total participants, the high risk of bias of some of the studies, and the complexity of interventions limits our ability to determine the type of intervention which would be most effective in increasing abstinence from, or reducing the consumption of, alcohol among pregnant women.

Stein MD; Anderson BJ; Caviness CM; Rosengard C; Kiene S; Friedmann P et al. Relationship of alcohol use and sexual risk taking among hazardously drinking incarcerated women: An event-level analysis. Journal of Studies on Alcohol and Drugs 70(4): 508-515, 2009. (55 refs.)

Objective: To understand the association of alcohol use with sex and unprotected sex among hazardously drinking incarcerated women, we examined the relationship of these behaviors on any given day Method: Participants endorsed unprotected sex and hazardous alcohol consumption (four or more drinks at a time on at least 3 separate days in the previous 3 months or a score of 8 or above on the Alcohol Use Disorders Identification Test). Participants recalled behaviors in the 90 days before incarceration using the Timeline Followback method. Generalized estimating equation models estimated the effect of daily alcohol use and selected covariates on the odds of sexual-risk behavior. Results: The 245 participants averaged 34 years of age and were 71.4% white; 67.8% used cocaine. On most (84.7%) drinking days, women consumed four or more drinks. One hundred forty-one participants (57.6%) reported sex with only main partners, 10.6% with only casual partners, and 30.6% with both casual and main partners. The likelihood of having any sex (odds ratio = 1.78, p < .01) and unprotected sex (odds ratio = 1.95, p < .01) was higher on days when participants consumed alcohol compared with nondrinking days. However, when the analysis was restricted to days on which participants reported having sex, the odds of having unprotected sex was not significantly associated with drinking. Conclusions: Among incarcerated women who reported hazardous drinking, alcohol use was associated with an increased likelihood of sexual activity and a concomitant increase in unprotected sex. However, use of alcohol was not significantly associated with condom use on days when participants were sexually active.

Sugarman DE; DeMartini KS; Carey KB. Are women at greater risk? An examination of alcohol-related consequences and gender. American Journal on Addictions 18(3): 194-197, 2009. (31 refs.)

Men typically drink more than women; however, women achieve higher BACs (blood alcohol concentration) than men at equivalent consumption levels. This study investigated the unique effect of gender on individual alcohol problems by controlling both consumption and intoxication in a sample of 1,331 undergraduate drinkers. Gender independently influenced the risk of experiencing seven of nine negative consequences: (a) being female increased risk for tolerance, blacking out, passing out, drinking after promising not to, and getting injured; (b) being male increased risk for damaging property and going to school drunk. Gender patterns should be explored in a wider set of alcohol-related problems.

Tehranifar P; Liao YY; Ferris JS; Terry MB. Life course socioeconomic conditions, passive tobacco exposures and cigarette smoking in a multiethnic birth cohort of US women. Cancer Causes and Control 20(6): 867-876, 2009. (72 refs.)

Low socioeconomic status (SES) and exposure to passive tobacco smoke are associated with increased risk of smoking in adults, but the influences of these factors in earlier life periods on adult smoking behavior are not well understood. We investigated the relationship of SES and passive tobacco exposure over the lifecourse with adult smoking status in a multiethnic cohort of U.S. women (n = 262, average age = 41.8), using prospective data on maternal smoking during pregnancy and childhood SES, and follow-up data on current smoking, adult SES and household tobacco exposure. Low adolescent and adult SES consistently increased the risk of current smoking, but most associations were not statistically significant in multivariable models. Blue collar parental occupation at birth increased the risk of smoking, particularly for current smoking relative to former smoking (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.2-5.9). After adjusting for SES, current and former smokers were more likely than never smokers to have exposures to prenatal tobacco (OR = 4.4, 95% CI = 2.1-9.4 and OR = 2.0, 95% CI = 1.0-4.2, respectively) and adult household tobacco (OR = 2.7, 95% CI = 1.3-5.8 and OR = 2.4, 95% CI = 1.2-4.8, respectively). Our results show that early life conditions have enduring influences on women's smoking behavior in middle adulthood, even after considering similar types of conditions in later life periods.

Terplan M; Garrett J; Hartmann K. Gestational age at enrollment and continued substance use among pregnant women in drug treatment. Journal of Addictive Diseases 28(2): 103-112, 2009. (46 refs.)

Substance use during pregnancy is associated with poor obstetrical and neonatal outcomes. Although intervention for substance use including alcohol improves pregnancy outcomes, a substantial number of women continue to use drugs or consume alcohol during treatment. To determine whether gestational age at entry into treatment (specifically first trimester enrollment) was associated with lower risk of continued substance use, we analyzed the North Carolina Treatment Outcomes and Program Performance System, an administrative database of drug treatment clinics, between 2000 and 2004. There were 847 pregnant women using substances who met our inclusion criteria. Demographic and other risk factor data were collected. We conducted logistic regression and a Generalized Estimating Equation analysis. Gestational age at enrollment was not associated with continued substance use (odds ratio [OR] = 0.88; 95% confidence interval [CI] = 0.51, 1.51). Women who had child care provided, were less likely to continue substance use (OR = 0.64; 95% CI = 0.48, 0.84), whereas those referred from the criminal justice system were more likely to continue (OR = 1.53; 95% CI = 1.01, 2.30). Although earlier gestational age at enrollment in treatment does not predict greater abstinence at any time point, this data does suggest that the provision of childcare may improve treatment success.

Ullman SE; Najdowski CJ. Correlates of serious suicidal ideation and attempts in female adult sexual assault survivors. Suicide and Life-Threatening Behavior 39(1): 47-57, 2009. (40 refs.)

Relations between (a) serious suicidal ideation and attempts and (b) demographics, trauma history, assault characteristics, post-assault outcomes, and psychosocial variables were examined among female adult sexual assault survivors. Younger, minority, and bisexual survivors reported greater ideation. More traumas, drug use, and assault disclosure related to greater attempts, whereas perceived control over recovery was related to fewer attempts. Child sexual abuse and some assault characteristics predicted suicidal behavior. Depression was related to suicidal behavior until psychosocial variables were accounted for. Specifically, using substances to cope and self-blame predicted greater ideation, whereas receiving aid/information support was related to less ideation. Implications for research and treatment are discussed.

van Olphen J; Eliason MJ; Freudenberg N; Barnes M. Nowhere to go: How stigma limits the options of female drug users after release from jail. Substance Abuse Treatment, Prevention and Policy 4(10), 2009. (49 refs.)

Background: Drug and alcohol using women leaving prison or jail face many challenges to successful re-integration in the community and are severely hampered in their efforts by the stigma of drug or alcohol use compounded by the stigma of incarceration. Methods: This qualitative study is based on individual semi-structured interviews and focus groups with 17 women who had recently left jail about the challenges they faced on reentry. Results: Our analysis identified three major themes, which are related by the overarching influence of stigma: survival (jobs and housing), access to treatment services, and family and community reintegration. Conclusion: Stigma based on drug use and incarceration works to increase the needs of women for health and social services and at the same time, restricts their access to these services. These specific forms of stigma may amplify gender and race-based stigma. Punitive drug and social policies related to employment, housing, education, welfare, and mental health and substance abuse treatment make it extremely difficult for women to succeed.

Vickers KS; Patten CA; Lewis BA; Clark MM; Ussher M; Ebbert JO et al. Feasibility of an exercise counseling intervention for depressed women smokers. Nicotine & Tobacco Research 11(8): 985-995, 2009. (55 refs.)

Introduction: Depressive symptoms negatively impact smoking abstinence. However, few interventions have been targeted to smokers with current depression. Exercise improves mood and may benefit depressed smokers. This pilot study investigated the feasibility of an exercise intervention for depressed female smokers (Center for Epidemiological Studies Depression Scale [CESD] score >= 16). Methods: Participants (M = 41 years, 98% White) were randomized to 10 weeks of individually delivered exercise counseling (n = 30) or a health education contact control condition (n = 30). All participants received nicotine patch therapy and behavioral counseling for smoking cessation. Results: The intervention was feasible as indicated by ability to recruit participants, exercise counseling session attendance (M = 7.6 of 10 sessions attended), and significant increase in exercise frequency and stage of change from baseline to end of treatment (EOT) (Week 10). Participant attrition rate was 35% by Week 10 but did not differ significantly between groups. Smoking abstinence rates at Week 10, using intention-to-treat analysis, were 17% for exercise counseling participants and 23% for health education participants (p = .75). Discussion: An exercise counseling intervention was found to be feasible for depressed women smokers. More intensive intervention may be needed to increase smoking abstinence rates, and methods should be refined to reduce participant burden and attrition.

Wakabayashi I; Araki Y. Associations of alcohol consumption with blood pressure and serum lipids in Japanese female smokers and nonsmokers. Gender Medicine 6(1): 290-299, 2009. (32 refs.)

Background: Alcohol intake and smoking have been reported to influence atherosclerotic progression. Objective: The purpose of this study was to determine whether the associations of alcohol intake with blood pressure (BP) and serum lipid concentrations are modified by smoking in Japanese women. Methods: Eligible subjects were healthy female Japanese workers aged 35 to <55 years who had received periodic health examinations at workplaces in Yamagata Prefecture in Japan. Subjects were classified as smokers or nonsmokers and subclassified into 3 subgroups based on average daily reported alcohol intake: nondrinkers, light drinkers (<15 g/d), and heavy drinkers (>= 15 g/d). The means of each variable (systolic and diastolic BP [SBP and DBP, respectively] and serum concentrations of total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) were compared among the 2 groups of smoking history and 3 subgroups of alcohol intake after adjusting for age and body mass index. Results: A total of 16,805 healthy women were enrolled (14,695 nonsmokers, 2110 smokers). In smokers, SBP was significantly higher in heavy drinkers than in nondrinkers, and DBP was significantly higher in light drinkers and heavy drinkers than in nondrinkers (all, P < 0.01). In nonsmokers, SBP was not significantly higher in light drinkers and heavy drinkers versus nondrinkers, and the difference in DBP between heavy drinkers and nondrinkers was significant (P < 0.01), but that between light drinkers and nondrinkers was not. In smokers but not in nonsmokers, serum TC concentration was significantly lower in heavy drinkers than in nondrinkers. In smokers and nonsmokers, LDL-C was significantly lower in light and heavy drinkers than in nondrinkers (all, P < 0.01), and serum HDL-C was significantly higher in light and heavy drinkers than in nondrinkers (all, P < 0.01). The differences in mean LDL-C between light and heavy drinkers versus nondrinkers were numerically greater in smokers than in nonsmokers. Conclusion: In this sample of women in Japan, serum LDL-C concentration was significantly lower in drinkers than in nondrinkers, and smoking might increase this association between alcohol intake and lowered LDL-C.

Walton-Moss BJ; McIntosh LC; Conrad J; Kiefer E. Health status and birth outcomes manog pregnant women in substance abuse treatment. Women's Health Issues 19(3): 167-175, 2009. (42 refs.)

Purpose. We sought to examine the physical and mental health status and low birthweight and preterm birth among low-income pregnant women in substance abuse treatment. Methods. A prospective correlational design was used with 84 pregnant women enrolled in a university-affiliated, comprehensive, hospital-based substance abuse treatment program. The majority of the sample reported heroin as their primary substance of abuse. Results. Approximately 39% of the infants were born preterm and 27.5% were low birthweight. Poorer perception of current health, cocaine as the primary substance of abuse, and number of prior substance abuse treatment admissions were independently associated with preterm birth. Being African American and a poorer perception of current health were independently associated with low birthweight. Conclusion. Asking about perceptions of their current health is a useful addition to comprehensive assessment for pregnant women with substance abuse problems in any setting. Further knowledge of women's physical and mental health status will improve identification of those who are at even greater risk in a group at high risk overall.

Webb L. Counting girls out: A review of suicide among young substance misusers and gender difference implications in the evaluation of risk. (review). Drugs: Education, Prevention and Policy 16(2): 103-126, 2009. (87 refs.)

This literature review examines the evidence of suicide risk among young female substance misusers in comparison with their male counterparts, and considers arguments that suicide risk is underestimated for this group due to the methodological difficulties presented by small cohort numbers. Existing evidence indicates significant gender differences in comorbidities associated with young suicidal substance misusers, with a greater prevalence of depressive symptoms and psychological distress among female substance misusers. Suicide trajectories suggest that young female substance misusers are likely to present more often, and to a more marked degree, with comorbid disorders that would increase assessed suicide risk among a general youth population. An examination of methodological problems indicates that female gender may be overestimated as a protective factor for suicide among young substance misusers in the context of other factors associated with young female substance misuse. It is proposed that it is no longer good enough to accept female gender as a protective factor without a female-specific evidence base.

Wechsberg WM. Adapting HIV interventions for women substance abusers in international settings: Lessons for the future. Journal of Drug Issues 39(1): 237-243, 2009. (21 refs.)

Many substance abusers are at risk for HIV due to their drug using and sexual behaviors. HIV interventions developed early on for substance abusers did not account for gender differences. Women's risk for HIV around the world makes them more vulnerable than men, yet their circumstances are different and adaptations to interventions are needed. The Women's Co-op, considered a best-evidence intervention, has been adapted with several groups of noninjecting women in South Africa and with injecting drug-using women in Russia. To reach vulnerable women in diverse settings to test interventions to reduce their risk, researchers also need to mentor the next generation of scientists to help stem the feminization of HIV among substance abusers.

Wechsberg WM; Wu LT; Zule WA; Parry CD; Browne FA; Luseno WK et al. Substance abuse, treatment needs and access among female sex workers and non-sex workers in Pretoria, South Africa. Substance Abuse Treatment, Prevention and Policy 4: article 11, 2009. (29 refs.)

Background: This study examined cross-sectional data collected from substance-using female sex workers (FSW) and non-sex workers (non-SW) in Pretoria, South Africa, who entered a randomized controlled trial. Methods: Women who reported alcohol use and recently engaging in sex work or unprotected sex were recruited for a randomized study. The study sample (N = 506) comprised 335 FSW and 171 female non-SW from Pretoria and surrounding areas. Self-reported data about alcohol and other drug use as well as treatment needs and access were collected from participants before they entered a brief intervention. Results: As compared with female non-SW, FSW were found to have a greater likelihood of having a past year diagnosis of alcohol or other drug abuse or dependence, having a family member with a history of alcohol or other drug abuse, having been physically abused, having used alcohol before age 18, and having a history of marijuana use. In addition, the FSW were more likely to perceive that they had alcohol or other drug problems, and that they had a need for treatment and a desire to go for treatment. Less than 20% of participants in either group had any awareness of alcohol and drug treatment programs, with only 3% of the FSW and 2% of the non-SW reporting that they tried but were unable to enter treatment in the past year. Conclusion: FSW need and want substance abuse treatment services but they often have difficulty accessing services. The study findings suggest that barriers within the South African treatment system need to be addressed to facilitate access for substance-using FSW. Ongoing research is needed to inform policy change that fosters widespread educational efforts and sustainable, accessible, woman-sensitive services to ultimately break the cycle for current and future generations of at-risk South African women.

Weizmann-Henelius G; Putkonen H; Naukkarinen H; Eronen M. Intoxication and violent women. Archives of Women's Mental Health 12(1): 15-25, 2009. (55 refs.)

Alcohol and drugs have been linked to severe violent offending among women as well as men. The purpose of this study was to make a contribution to the limited knowledge of characteristics related to the state of intoxication in violent female offenders. The putative differences in the characteristics of female offenders and their violent offenses in relation to the state of intoxication at the time of the violent offending were examined. Of a nation-wide sample of 109 female offenders found guilty of homicide and other violent crimes and incarcerated in 1999-2000 in Finland, 60 offenders participated in the study. Of these offenders 49 (81.7%) had been intoxicated at the time the of index offenses. These were compared with 11 (18.3%) non-intoxicated offenders using a structured interview, the Structured Clinical Interview II for DSM-IV (SCID-II) and the Hare Psychopathy Checklist-Revised (PCL-R). The prevalence of substance abuse or dependence (73.3% and 0%), personality disorder (89.6% and 36.4%), particularly antisocial personality disorder (66.7% and 0%), as well as a history of criminality (69.4% and 0%) were significantly higher among the intoxicated women than among the non-intoxicated. The PCL-R scores were also significantly higher among the intoxicated offenders than among non-intoxicated offenders. The victims of the intoxicated women (23.9%) were less often emotionally close to the perpetrator than were the victims of the non-intoxicated women (66.6%). No differences emerged between the groups in experiences of childhood and adulthood abuse or stressful life events prior to the index crime. The findings indicate that intoxicated violent female offenders exhibit more of the characteristics previously found in violent men, than do the non-intoxicated female offenders. Moreover, the non-intoxicated group comprises both psychotic non-responsible and non-psychotic, fairly well-adjusted women, who are educated, working or studying at the time of the offense and has no history of criminality. Substance misuse constitutes an obvious risk factor for violent behavior in women, and therefore the prevention should include substance abuse treatment.

Wenzel SL; D'Amico EJ; Barnes D; Gilbert ML. A pilot tripartite prevention program for homeless young women in the transition to adulthood. Womens' Health Issues 19(3): 193-201, 2009. (52 refs.)

Background. Among young women who are impoverished and homeless, the transition to adulthood (ages 18-25) is associated with alcohol and drug use, risky sexual activity, and increased risk of being victimized by intimate partner violence. Methods. "The Power of YOU," a program using motivational interviewing (MI), was designed to address these problems. We tested the "Power of YOU" with 31 homeless women (ages 18-25) in 7 focus groups. Women completed questionnaires assessing background characteristics and satisfaction at the end of each group. Each group was followed by a feedback session that was audiorecorded and transcribed. Key themes were identified. Results. During a past 6-month period, 38.7% of women reported alcohol intoxication, 19.3% reported 2-3 male sex partners, and 22.2% reported major physical violence from a partner. Women expressed satisfaction and provided consistently positive feedback on the intervention, reporting, for example, that it was "helpful to know how to put a condom on" and that they appreciated the attention paid to safety planning. Conclusions. Results from this pilot suggest that "The Power of YOU" may hold promise in helping homeless young women in the transition to adulthood make healthier choices and plan for high-risk situations, and that the nonconfrontational, nonjudgmental approach of MI appeared appropriate for this population.

Westermeyer J; Canive J; Thuras P; Thompson J; Crosby R; Garrard J. A comparison of substance use disorder severity and course in American Indian male and female veterans. American Journal on Addictions 18(1): 87-92, 2009. (24 refs.)

The purpose of this analysis was to compare substance use disorder (SUD) diagnoses, severity, comorbidity, and course in 362 American Indian veterans. The sample was drawn from communities in the north central and southwestern areas of the United States, structured to over-sample women and to include half-rural/half-urban residents. Instruments used in the study included current demography, military history, the Diagnostic Interview Schedule/Quick Version, Michigan Alcoholism Screening Test modified to include alcohol and drugs (MAST/AD), Brief Symptom Inventory, Posttraumatic Checklist, and a treatment algorithm. Univariate analyses showed that women had lower scores on the MAST/AD, reported lower symptom levels on the Posttraumatic Checklist, and were less apt to use VA mental health services, but were more willing to seek mental health treatment if needed (with probabilities of .01 to .001). At borderline probabilities (.02 to .05), women were younger and had more education, whereas men had more drug-related diagnoses and more combat exposure. On binary logistic regression, women were less apt to have a drug diagnosis and had lower MAST/AD scores; the other differences were not significant. Female American Indian veterans with SUD manifested many of the same gender-related differences as women in the population at large, but with some exceptions (eg, comorbidity). Trauma, PTSD, and continuing posttraumatic symptoms occurred frequently in both male and female veterans of American Indian heritage. VA facilities should out-reach to American Indian women, who report a willingness to seek mental health services but may avoid VA care.

Westhoff C; Jones K; Robilotto C; Heartwell S; Edwards S; Zieman M et al. Smoking and oral contraceptive continuation. Contraception 79(5): 375-378, 2009. (9 refs.)

Background: Smoking may be related to early discontinuation of oral contraceptives (OC). Study design: This was a planned secondary analysis of a randomized clinical trial. Women aged less than 25 initiating OC at three inner-city publicly funded family planning clinics enrolled in the study. Subjects reported smoking status at enrollment; 3- and 6-month interviews assessed OC continuation. Results: One hundred eighty-nine (12%) of 1598 participants were current smokers. Smokers were more often lost to follow-up than nonsmokers (P<01). Among participants with a 6-month interview, only 26% of smokers and 46% of nonsmokers were continuing OC (P<001). After adjustment for confounding factors, smokers were still somewhat less likely to be continuing OC (adjusted OR 0.6, 95% CI 0.4-1.0). This association was unrelated to number of cigarettes smoked per day. Conclusions: These data suggest that young smokers may be more likely to discontinue OC within 6 months than nonsmokers. Smoking may be a marker for risk-taking behavior that extends to the premature discontinuation of OC.

Wu ZH; Nguyen-Oghalai TU; Shokar NK; Berenson AB; Cottler L. Morbidity in a population of low-income, female users of MDMA and other drugs. Substance Use & Misuse 44(7): 1039-1054, 2009. (48 refs.)

Few previous studies have reported on the overall health of drug-using women. To investigate this, 696 low-income women aged 18-31 were recruited in a cross-sectional study from gynecological care clinics in Texas between 2001 and 2003. Compared to exclusive marijuana users and non-drug users, women who used MDMA and those who used other illicit drugs but not MDMA reported more gynecological conditions, medical conditions, depressive symptoms, and physical somatic complaints. We concluded that young. low-income women who used more than one illicit drug experience significantly more physical and psychological morbidity. Generalization of this study results may be limited to young women with low income but not to other populations.

Zabkiewicz D; Schmidt LA. The mental health benefits of work: Do they apply to welfare mothers with a drinking problem? Journal of Behavioral Health Services & Research 36(1): 96-110, 2009. (94 refs.)

A longstanding tradition of employment-related research has shown the mental health advantages of employment. However, given welfare reform mandates for employment and a welfare population with disproportionately high rates of depression and co-occurring substance abuse problems, it is unclear if women on welfare reap this advantage. This analysis draws on 4 years of data from the Welfare Client Longitudinal Study to examine the mental health benefits of employment among women on welfare (N = 419) and to assess whether drinking problems alter the relationship. Repeated measures analyses suggest that women who enter welfare with a drinking problem may not experience the same decline in depression symptoms following employment. Improving the connections between welfare and treatment services for women with alcohol problems may, however, have important implications for their mental health.

Zamboanga BL; Olthuis JV; Horton NJ; McCollum EC; Lee JJ; Shaw R. Where's the house party? Hazardous drinking behaviors and related risk factors. Journal of Psychology 143(3): 228-244, 2009. (38 refs.)

The authors examined differences in drinking behaviors and related risk factors across campus housing at a women's liberal arts college. Participants (N = 362) living in residence-style housing or house-style residences completed self-report questionnaires. Results showed that students in residence hall-style houses reported higher levels of hazardous alcohol use and perceived that their college, housemates or roommates, and close peers are more permissive of alcohol use than did students living in house-style residences. Findings highlight the role of the environmental structure of a college campus on students' perceptions of alcohol use and their drinking behaviors. The authors discuss implications for college housing and programming.

Zawacki T; Norris J; Hessler DM; Morrison DM; Stoner SA; George WH et al. Effects of relationship motivation, partner familiarity, and alcohol on women's risky sexual decision making. Personality and Social Psychology Bulletin 35(6): 723-736, 2009

This experiment examined the effects of women's relationship motivation, partner familiarity, and alcohol consumption on sexual decision making. Women completed an individual difference measure of relationship motivation and then were randomly assigned to partner familiarity condition (low, high) and to alcohol consumption condition (high dose, low dose, no alcohol, placebo). Then women read and projected themselves into a scenario of a sexual encounter. Relationship motivation and partner familiarity interacted with intoxication to influence primary appraisals of relationship potential. Participants' primary and secondary relationship appraisals mediated the effects of women's relationship motivation, partner familiarity, and intoxication on condom negotiation, sexual decision abdication, and unprotected sex intentions. These findings support a cognitive mediation model of women's sexual decision making and identify how individual and situational factors interact to shape alcohol's influences on cognitive appraisals that lead to risky sexual decisions. This knowledge can inform empirically based risky sex interventions.

Zhang WL; Lopez-Garcia E; Li TY; Hu FB; van Dam RM. Coffee consumption and risk of cardiovascular events and all-cause mortality among women with type 2 diabetes. Diabetologia 52(5): 810-817, 2009. (46 refs.)

Coffee has been linked to both beneficial and harmful health effects, but data on its relationship with cardiovascular disease and mortality in patients with type 2 diabetes are sparse. This was a prospective cohort study including 7,170 women with diagnosed type 2 diabetes but free of cardiovascular disease or cancer at baseline. Coffee consumption was assessed in 1980 and then every 2-4 years using validated questionnaires. A total of 658 incident cardiovascular events (434 coronary heart disease and 224 stroke) and 734 deaths from all causes were documented between 1980 and 2004. After adjustment for age, smoking and other cardiovascular risk factors, the relative risks were 0.76 (95% CI 0.50-1.14) for cardiovascular diseases (p trend = 0.09) and 0.80 (95% CI 0.55-1.14) for all-cause mortality (p trend = 0.05) for the consumption of a parts per thousand yen4 cups/day of caffeinated coffee compared with non-drinkers. Similarly, multivariable RRs were 0.96 (95% CI 0.66-1.38) for cardiovascular diseases (p trend = 0.84) and 0.76 (95% CI 0.54-1.07) for all-cause mortality (p trend = 0.08) for the consumption of a parts per thousand yen2 cups/day of decaffeinated coffee compared with non-drinkers. Higher decaffeinated coffee consumption was associated with lower concentrations of HbA(1c) (6.2% for a parts per thousand yen2 cups/day versus 6.7% for < 1 cup/month; p trend = 0.02). These data provide evidence that habitual coffee consumption is not associated with increased risk of cardiovascular diseases or premature mortality among diabetic women.