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...on Women and Substance Use
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www.ProjectCork.org
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Winter 2004
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A history of depression and smoking cessation outcomes
among women concerned about post-cessation weight gain.
Levine MD; Marcus MD; Perkins KA. Nicotine & Tobacco
Research . 5(1): 69-76, 2003. (47 refs.)
Because a history of depression has been hypothesized to affect cessation
efforts and may be particularly problematic for women concerned about weight
gain, we sought to document the prevalence of depression history among
weight-concerned women smokers and evaluate its effect on treatment outcome.
We also evaluated the impact of baseline depressive symptoms and cessation-related
changes in symptoms. Women (N=219) were classified as depression history
positive (Major Depressive Disorder [MDD]) (MDD+) or negative (MDD-) according
to responses on the Inventory to Diagnose Depression-Lifetime Version.
All women received a group-based smoking cessation treatment. Women provided
expired-air carbon monoxide samples, completed measures of depressive symptoms,
and were weighed at pretreatment and 1, 3, 6, and 12 months after quitting.
Fifty-two per cent (n=115) reported a lifetime history of major depressive
disorder. Although MDD+ women were significantly more nicotine dependent,
rates of continuous abstinence did not differ between MDD+ and MDD- women.
However, MDD+ women were more likely to drop out of treatment prior to
quitting. Additionally, depressive symptoms were associated with abstinence
irrespective of depression history. Women who reported an increase in depressive
symptoms from pre- to posttreatment were significantly less likely to be
abstinent post-treatment, suggesting that depressive symptoms are more
predictive of outcome than is previous disorder. Moreover, because of the
prevalence of depression history among this subgroup of women smokers and
its impact on early attrition, additional engagement and retention strategies
may be useful.
Copyright 2003, Carfax Publishing.
Joint association of alcohol and folate intake with risk of major chronic
disease in women.
Jiang R; Hu FB; Giovannucci EL; Rimm EB; Stampfer MJ; Spiegelman D et
al. . American Journal of Epidemiology . 158(8): 760-771, 2003.
(33 refs.)
Alcohol interferes with folate metabolism and has opposing effects on the
risks of cardiovascular disease and cancer. The authors examined the joint
association of alcohol and folate intake with risk of major chronic disease,
defined as fatal or nonfatal cardiovascular disease or cancer, or other
nontraumatic death. This study included 83,929 women aged 34-59 years with
no previous history of cardiovascular disease or cancer who provided dietary
data in 1980. During 16 years of follow-up, the authors documented 10,666
new cases of major chronic disease. Overall, heavy drinkers (>30 g/day)
with a lower total folate intake (<180 mug/day) had the highest risk; in
comparison with abstainers with a folate intake of 400-599 mug/day, the
multivariate relative risk was 1.36 (95% confidence interval: 1.10, 1.70).
However, the increased risk of major chronic disease associated with heavy
drinking was largely diminished among women with a higher folate intake
(p for interaction = 0.02). The positive association between heavy alcohol/low
folate intake and risk of major chronic disease was most apparent among
women younger than age 60 years. Adequate folate intake may be important
in the primary prevention of overall major chronic disease in women, especially
among younger women consuming more than two alcoholic drinks per day.
Copyright 2003, Oxford University Press, Inc.
Response to alcohol in females with a paternal history of alcoholism.
Evans SM; Levin FR. . Psychopharmacology. 169(1): 10-20, 2003.
(67 refs.)
Rationale. Several studies have demonstrated that males with a family history
of alcoholism (FHP) show less of a response to alcohol (e.g. lower ratings
of intoxication) than males without a family history of alcoholism (FHN).
The purpose of this pilot study was to determine if FHP females also showed
a reduced sensitivity to alcohol compared to FHN females. Objectives. To
determine if FHP females (n=16) were less sensitive to the subjective effects
and performance-impairing effects of alcohol compared to FHN females (n=16).
Methods. The effects of placebo and alcohol (0.25, 0.50, 0.75 g/kg, based
on total body water) were evaluated using a double-blind, placebo-controlled
outpatient design. Drug effects were assessed using performance tasks,
observer ratings of drug effect and subjective ratings of drug effect.
Results. There were no differences in breath alcohol levels between FHN
and FHP women. FHP women were less impaired by alcohol than FHN women,
as shown by DSST scores and observer-ratings. However, FHP women were more
impaired on the Digit Recall task after alcohol than FHN women and they
tended to have higher ratings of "Good Drug Effect," "Drug Liking" and "Willingness
to Take Again." Of note, FHP women reported more dysphoric mood than FHN
women in the absence of alcohol administration. Conclusions. The results
of the present study suggest that FHP women may have a reduced response
to alcohol on some measures, but FHP women report greater positive effects
on other measures. Overall, the differences between FHP and FHN women are
subtle compared to the previous studies demonstrating a reduced response
to alcohol in FHP men.
Copyright 2003, Springer-Verlag.
Rural and small-town attitudes about alcohol use during pregnancy:
A community and provider sample.
Logan TK; Walker R; Nagle L; Lewis J; Wiesenhahn D. . Journal of Rural
Health . 19(4): 497-505, 2003. (43 refs.)
Context: While there has been considerable research on prenatal alcohol
use, there have been limited studies focused on women in rural and small-town
environments. Purpose: This 2-part study examines gender differences in
attitudes and perceived barriers to intervention in a large community sample
of persons living in rural and small-town environments in Kentucky (n =
3,346). The study also examines rural/small-town prenatal service providers'
perceptions of barriers to assessment and intervention with pregnant substance
abusers (n = 138). Methods: Surveys were administered to a convenience
sample of employees and customers from 16 rural and small-town community
outlets. There were 1503 males (45%) and 1843 females (55%) ranging in
age from under 18 years old to over 66 years old. Surveys also were mailed
to prenatal providers in county health departments of the 13-county study
area, with 138 of 149 responding. Findings: Overall results of the community
sample suggest that neither males nor females were knowledgeable about
the harmful effects of alcohol use during pregnancy. Results also indicate
substantial gender differences in alcohol attitudes, knowledge, and perceived
barriers. Further, prenatal care providers identified several barriers
in assessment and treatment of pregnant women with alcohol use problems
in rural and small-town communities, including lack of knowledge and comfort
with assessment as well as a lack of available and accessible treatment
for referrals.
Copyright 2003, National Rural Health Association.
Treatment of substance abuse during pregnancy and infant outcome.
Little BB; Snell LM; Van Beveren TT; Crowell RB; Trayler S; Johnston
WL. . American Journal of Perinatology. 20(5): 255-262, 2003. (25
refs.)
The objective of this study is to analyze the effects of residential substance
abuse treatment on pregnancy outcome among gravidas in a gender-specific
program. All clients (cases) who entered a residential substance abuse
program for pregnant and postpartum women were eligible for inclusion in
the study (n = 95). Only those who were in treatment at the time of delivery
were included in the present analysis (n = 57). Two comparison groups were
used: (1) substance abusers who received no treatment during pregnancy
(positive control group) and (2) pregnant women who were not substance
abusers (negative control group). Cases were matched to controls on ethnicity
(negative and positive controls) and drug of choice (positive controls
only). Medical records were reviewed and abstracted for cases and controls.
The primary drug of choice was cocaine for 56% of clients in the study,
heroin 15.8%, and alcohol 10.8%. Average length of time in treatment before
delivery was 11.7 weeks. The frequency of pregnancy complications allowing
treatment and position controls was significantly higher than the negative
control group (p < 0.0001). The frequency of perinatal infant complications
was increased among treatment group infants (p < 0.0001). Two infants in
the treatment group were positive for a substance of abuse at birth. In
the treatment versus positive control group, mean birth weight (BW) was
3227 versus 2800 g (p < 0.01), estimated gestational age (EGA) was 38.9
versus 39 weeks, average head circumference (FOC) was 33.8 versus 32.5
cm (P < 0.05), and mean birth length (BLT) was 48.7 cm versus 46.9 (p < 0.05).
No significant differences were found between treatment and negative control
groups. Maternal syphilis was increased in frequency in the positive control
group compared with the negative control group (p < 0.07). Thirty-percent
of mothers had sexually transmitted diseases (STDs) for which infants were
at risk and treated prophylactically; no infant in the treatment group
contracted a vertically transmitted STD. For every 10 weeks in treatment,
BW was increased 340 g, EGA 1 week, FOC 0.8 cm, and BIT 1.8 cm. Thus, substance
abuse treatment for pregnant women in the program increased fetal growth,
which significantly decreased the risk for poor neonatal outcomes. Importantly,
maternal and infant perinatal complications in the treatment group were
increased in frequency compared with the two control groups. This may possibly
have occurred because healthcare providers were not blinded to maternal
treatment status.
Copyright 2003, Thieme Medical Publishers, Inc.
Substance use and separation of homeless mothers from their children.
Zlotnick C; Robertson MJ; Tam T. . Addictive Behaviors . 28(8):
1373-1383, 2003. (30 refs.)
Objectives. This study examined whether homeless mothers with substance
use problems were more likely to experience separations from their children
and whether recent substance use had an impact on the family's ability
to receive public entitlement income consistently over the 15-month study
period. Methods: This study used an existing longitudinal data set consisting
of a county-wide probability sample of 104 homeless women who had children
under 18 years old. Results: Only 29.1% of women had all their children
with them throughout the 15-month study period. Mothers who had been separated
from their children were more likely to have a current substance use disorder
and to have been homeless for at least a year compared to other homeless
mothers. Conclusions: Because many women with recent substance use had
already had lost custody of their children, substance use contributed to
loss of child custody among mothers who did not have substance use disorders.
Copyright 2003, Elsevier Science Ltd.
Effectiveness of substance abuse treatment programming for women: A
review.
Ashley OS; Marsden ME; Brady TM. . American Journal of Drug and Alcohol
Abuse . 29(1): 19-53, 2003. (102 refs.)
Relatively few substance abuse treatment programs offer specialized services
for women, and effectiveness has not been fully evaluated. This article
reviews the literature on the extent and effectiveness of substance abuse
treatment programming for women and provides an overview of what is known
about the components of successful treatment programs for women. Thirty-eight
studies of the effect on treatment outcomes of substance abuse treatment
programming for women were reviewed. Seven were randomized, controlled
trials, and 31 were nonrandomized studies. Six components of substance
abuse treatment programming for women were examined in the review: child
care, prenatal care, women-only programs, supplemental services and workshops
that address women-focused topics, mental health programming, and comprehensive
programming. The studies found positive associations between these six
components and treatment completion, length of stay, decreased use of substances,
reduced mental health symptoms, improved birth outcomes, employment, self-reported
health status, and human immunodeficiency virus (HIV) risk reduction. These
findings suggest that to improve the future health and well being of women
and their children, there is a continued need for well-designed studies
of substance abuse treatment programming for women.
Copyright 2003, Marcel Dekker, Inc.
Cardiovascular responses to physical and psychological stress in female
alcoholics with transitory hypertension after early abstinence.
Bernardy NC; King AC; Lovallo WR. . Alcoholism: Clinical and Experimental
Research . 27(9): 1489-1498, 2003. (56 refs.)
Background: Male alcoholic patients with acute withdrawal hypertension
have shown exaggerated cardiovascular reactivity to stress after 3 to 4
weeks of abstinence, although resting blood pressures (BP) had returned
to normal. Studies of this nature, however, have not been extended to women.
Methods: In this study, 32 alcohol-dependent women, abstinent for 4 weeks,
were compared with 16 healthy controls on cardiovascular hemodynamics during
rest and in response to 2 moderately aversive stressors: isometric handgrip
and a speech task. The alcoholics were placed according to withdrawal BP
into transitory hypertensive (tHT; n = 16; BP greater than or equal to140/90
mm Hg) and normotensive (NT; n = 16; BP <140/90 mm Hg) subgroups. Results:
During stress testing, the transitory hypertensive women had increased
diastolic BP (p < 0.01), a higher peripheral resistance index (p < 0.05),
and a reduced cardiac efficiency index (p < 0.03) relative to the normotensive
and control subjects. Conclusions: This cardiovascular pattern suggests
that both cardiac and vascular functions were altered adversely in the
transitory hypertensives. In contrast to men examined in previous studies,
the transitory hypertensive women had no exaggeration of BP reactivity,
but instead showed sustained alterations of resting cardiovascular function
in relation to chronic alcohol consumption. Although the pattern of cardiovascular
dysregulation seems to be different in female alcoholics than in males,
it is consistent with studies showing that cardiovascular effects in women
are more severe than in men and emerge at a lower threshold level of chronic
drinking.
Copyright 2003, Research Society on Alcoholism.
Breastfeeding practices in a cohort of inner-city women: the role of
contraindications.
England L; Brenner R; Bhaskar B; Simons-Morton B; Das A; Revenis M et al.
BMC . Public Health . 3: article No. 28, 2003. (35 refs.)
Background: Little is known about the role of breastfeeding contraindications
in breastfeeding practices. Our objectives were to 1) identify predictors
of breastfeeding initiation and duration among a cohort of predominately
low-income, inner-city women, and 2) evaluate the contribution of breastfeeding
contraindications to breastfeeding practices. Methods: Mother-infant dyads
were systematically selected from 3 District of Columbia hospitals between
1995 and 1996. Breastfeeding contraindications and potential predictors
of breastfeeding practices were identified through medical record reviews
and interviews conducted after delivery ( baseline). Interviews were conducted
at 3 - 7 months postpartum and again at 7 - 12 months postpartum to determine
breastfeeding initiation rates and duration. Multivariable logistic regression
analysis was used to identify baseline factors associated with initiation
of breastfeeding. Cox proportional hazards models were generated to identify
baseline factors associated with duration of breastfeeding. Results: Of
393 study participants, 201 ( 51%) initiated breastfeeding. A total of
61 women ( 16%) had at lease one documented contraindication to breastfeeding;
94% of these had a history of HIV infection and/or cocaine use. Of the
332 women with no documented contraindications, 58% initiated breastfeeding,
vs. 13% of women with a contraindication. In adjusted analysis, factors
most strongly associated with breastfeeding initiation were presence of
a contraindication ( adjusted odds ratio [AOR], 0.19; 95% confidence interval
[CI], 0.08 - 0.47), and mother foreign-born (AOR, 4.90; 95% CI, 2.38 -
10.10). Twenty-five percent of study participants who did not initiate
breastfeeding cited concern about passing dangerous things to their infants
through breast milk. Factors associated with discontinuation of breastfeeding
( all protective) included mother foreign-born ( hazard ratio [HR], 0.55;
95% CI 0.39 - 0.77) increasing maternal age ( HR for 5-year increments,
0.80; 95% CI, 0.69 - 0.92), and infant birth weight greater than or equal
to 2500 grams ( HR, 0.45; 95% CI, 0.26 - 0.80).Conclusions: Breastfeeding
initiation rates and duration were suboptimal in this inner-city population.
Many women who did not breastfeed had contraindications and/or were concerned
about passing dangerous things to their infants through breast milk. It
is important to consider the prevalence of contraindications to breastfeeding
when evaluating breastfeeding practices in high-risk communities.
Copyright 2003, Biomed Central.
Alcohol use and risk of non-Hodgkin's lymphoma among Connecticut women
(United States).
Morton LM; Holford TR; Leaderer B; Zhang YW; Zahm SH; Boyle P; Flynn S;
Tallini G; Owens PH; Zhang B; Zheng TZ. . Cancer Causes and Control. 14(7):
687-694, 2003. (22 refs.)
Objective: Incidence rates of non-Hodgkin's lymphoma (NHL) have risen dramatically
over the past several decades; however, the etiology of NHL remains largely
unknown. Previous studies of the relationship between alcohol consumption
and NHL have yielded conflicting results. Data from a population-based
case - control study among women in Connecticut were analyzed to determine
the potential impact of alcohol consumption on risk of NHL. Methods: The
study included 601 histologically confirmed, incident cases of NHL and
718 population-based controls. In-person interviews were administered using
standardized, structured questionnaires to collect data on history of consumption
for beer, wine, and liquor. Results: When compared to non-drinkers, women
who reported consumption of at least 12 drinks per year of any type of
alcohol experienced slightly reduced risk of NHL ( OR: 0.82; 95% CI: 0.65
- 1.04). Further stratification by alcohol type revealed that the inverse
association was mainly limited to wine consumption ( OR: 0.75; 95% CI:
0.59 - 0.96), with no clear association for beer or liquor consumption.
Risk of NHL was further reduced with increasing duration of wine consumption
( p for linear trend = 0.02). Consumption of wine for greater than 40 years
was associated with approximately 40% reduction in risk ( OR: 0.63; 95%
CI: 0.44 - 0.91).Conclusion: Our results are consistent with several recent
epidemiologic studies that have also suggested an inverse association between
wine consumption and risk of NHL. The reduction in risk of NHL associated
with increased duration of wine consumption warrants further investigation
in other populations.
Copyright 2003, Rapid Communications Oxford
Alcohol misuse by women. (review).
Redgrave GW; Swartz KL; Romanoski AJ. International Review of Psychiatry
. 15(3): 256-268, 2003. (146 refs.)
Alcohol misuse among women is an important and growing problem. There is
epidemiological and metabolic evidence that risk factors for and consequences
of alcohol misuse are significantly different for women than for men. Understanding
these differences is imperative if effective preventative and treatment
interventions are to be undertaken. This article reviews the epidemiology
of alcohol misuse by women, effects of alcohol misuse on women, fetuses,
and relationships, and assessment and treatment strategies. We then suggest
directions for future research in this field.
Copyright 2003, Carfax Publishing Co.
Labor analgesia for the drug abusing parturient: Is there cause for
concern? (review).
Kuczkowski KM. . Obstetrical & Gynecological Survey. 58(9): 599-608,
2003. (130 refs.)
Drug abuse has crossed geographic, economic and social borders, and it
remains one of the major problems facing our society today. The prevalence
of recreational drug abuse among young adults (including women) has increased
markedly over the past two decades. Nearly 90% of drug abusing women are
of childbearing age. Obstetricians and obstetric anesthesiologists become
involved in the care of drug abusing patients either in emergency situations,
such as placental abruption, uterine rupture or fetal distress, or in more
controlled situations, such as request for labor analgesia. The diverse
clinical manifestations of maternal substance abuse may result in life-threatening
complications and significantly impact the peripartum care of these patients.
Copyright 2003, Lippincott, Williams and Wilkins
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