Bridging Science and Culture to Improve Drug Abuse Research in Minority Communities

United States

Introductions

Alan I. Leshner, Ph.D., Director, National Institute on Drug Abuse

On behalf of the National Institute on Drug Abuse (NIDA), I am pleased to welcome you to this timely conference, Bridging Science and Culture to Improve Drug Abuse Research in Minority Communities. I would like to acknowledge the assistance of our cosponsors, the National Center on Minority Health and Disparities (NCMHD), National Institutes of Health, and the Robert Wood Johnson Foundation (RWJF), for their generous support. 

In recent years, NIDA has made a concerted effort to better understand and address the drug abuse and addiction research needs of racial/ethnic minority populations, focusing on areas where there are significant gaps in knowledge and clear disparities in prevention, treatment, and health services in these communities. At this conference, we have the extraordinary opportunity to work together to review the research, collaborations, and dissemination activities. We look forward to hearing your experiences and recommendations.

We are privileged to be joined at this conference by a number of national leaders and experts. Through plenary and concurrent sessions, scientists and practitioners will present on a host of social, cognitive, behavioral, health, and medical consequences of drug abuse as they relate to minority populations. Other conference highlights include grants development sessions, mock review, and roundtable discussions

As its name states, we see this conference as a major step in a process on how to effectively bridge science and culture to improve drug abuse prevention and treatment in minority communities. Our commitment is to continually use research to improve the nation's understanding of drug abuse and addiction in all racial/ethnic minority groups. Thank you for participating in this important event.

Sincerely, Alan I. Leshner, Ph.D.,  Director, National Institute on Drug Abuse

John Ruffin, Ph.D., Director, National Center on Minority Health and Health Disparities

On behalf of the National Center on Minority Health and Health Disparities (NCMHD), I am pleased to welcome you to the Bridging Science and Culture to Improve Drug Abuse Research in Minority Communities conference. We are pleased to support this conference and thank the National Institute on Drug Abuse (NIDA) for its organization and hosting efforts.

In recent years we have worked with NIDA to better understand the impact that drug abuse has on minority and underserved populations. Together, we studied the Medical Consequences of HTLV-II in Injection Drug Users and funded undergraduate and predoctoral research training through the Minority Recruitment and Training Program, the Substance Abuse Treatment Research Training Program, and the Interactive Research Program for Majority/Minority Institutions. Additionally, we jointly fund the Research Scientist Award for researchers in Minority Research/Training Centers. We look forward to more joint research and training opportunities with NIDA.

Our interest in this conference is derived from our congressional mandate to conduct and support research, training, dissemination of information, and other programs with respect to minority health conditions and other populations with health disparities. Our priority is minority health disparity research, of which drug abuse is an important issue.

We believe that this conference represents a major step in addressing the impact of drug abuse on minority populations, and we remain committed to working with NIDA and other organizations in this area.

Sincerely, John Ruffin, Ph.D., Director, National Center on Minority Health and Health Disparities

Abstracts

Race and Racism in Scientific Research

James M. Jones, Ph.D.

Although race is historically a biological idea, scientific evidence leads to a conclusion that it has little explanatory power in human behavior. However, race still matters in our society and in people's lives because of its socially constituted significance. Racism captures one of the enduring aspects of race for its targets. The presentation argues that race is an accessible psychological construct for targets of racism and thus influences their judgments and experiences on a daily basis. Research in social psychology will reveal some evidence for the reality of perceptions of racism and some of the behavioral and psychological responses its targets make. It is further argued that culture is confounded with race. Systematic variations in experience because of one's race lead to differences in culture, which in turn shape differences in behavior. Cultural psychology argues that culture and psyche are intertwined and thus "make each other up." Recent evidence suggests that drug use may follow from elevated levels of stress. Racism is a stressor. A psychological theory of African American culture called TRIOS is presented as an illustration of how culture can reveal within-race differences as well as identify some relevant aspects of adaptation and coping with racism.

The Power of Race/Ethnicity, Culture, and Science in Understanding Drug Abuse

Kathy Sanders-Phillips, Ph.D.

This presentation will focus on the biological, social, and cultural definitions of race with particular emphasis on relationships among race, health, and risk behaviors such as substance abuse in ethnic minority groups. Theoretical constructs of race will be reviewed, and the mechanisms by which race and culture may influence substance use in ethnic minority populations will be assessed. The relative contributions of SES, poverty, education, and experiences of oppression to relationships between race and substance abuse will also be examined. A conceptual framework for understanding and examining relationships between race and substance abuse will be presented.

An Overview of Drug Use and Associated Problems Experienced by Racial and Ethnic Minority Populations in the United States

James C. Anthony, Ph.D.

With respect to illegal drug use and other problems, epidemiology primarily seeks answers to five questions: (1) Within the population at large, how many are affected? (2) Where in the population are affected individuals most likely to be found, with focus on subgroups defined mainly by characteristics of person, place, and time? (3) What individual conditions, factors, or processes account for the observed variations? (4) What are the linkages of states and processes, or causal mechanisms, that account for the observed variations? (5) What can we do to prevent, delay, or reduce the impact of the associated problems? This presentation offers a selection of recent epidemiologic evidence on the first three of these questions, with a focus on variations observed in relation to self-identification with respect to racial and ethnic minority subgroups of the U.S. population.

Social Consequences and Criminalization of Drug Use in Minority Communities

Martin Y. Iguchi, Ph.D.

This presentation will argue that one manner in which drug use disproportionately affects the health of minority communities is through the devastating consequences of a felony conviction and subsequent entry into prison. The presentation will discuss the disproportionately large numbers of Black and Hispanic men and women entering prison for a drug offense and will explore the numerous related consequences of such an event. Specifically discussed will be how current drug policy may negatively impact and perpetuate patterns of health and well-being in minority communities. Multiple ways in which a felony drug conviction and subsequent entry into prison might interact with other Federal policies to impact the health and well-being of an individual and his or her community will be discussed. These areas of impact include, but are not limited to, children and families, access to health benefits, access to housing benefits, access to higher education assistance, immigration status, employment, eligibility to vote, and drug use.

The Medical Consequences of Drug Use in Minority Populations

Henry L. Francis, M.D.

The American population underestimates which drugs of abuse are most dangerous and does not know the characteristics of drug use in the United States. In general, the drug most associated with crime and property damage is alcohol. At least 11 million persons have five drinks per day at least five times each month. The number of addicted alcohol users is larger than the number of users of heroin, cocaine, methamphetamines, and hallucinogens combined. Different population groups use different drugs. White American populations tend to abuse alcohol and methamphetamines whereas African Americans and Hispanics prefer to use heroin and cocaine, respectively.

Numerous legal and illegal addictive drugs and behaviors are associated with crime, illness, and social disturbance. Illicit drugs most commonly used in the United States include, in descending order, marijuana, cocaine, heroin, methamphetamines, inhalants, hallucinogens, and anabolic steroids. Alcohol, cigarettes, food, sex, and gambling addictions, however, are responsible for more morbidity and mortality than are illicit drugs. Rates of illicit drug use vary by ethnicity, gender, age, education level, and geographic location. Although 74 percent of all current illicit drug users are White non-Hispanics, the rates of drug use are similar between ethnic groupsÑ7.5 percent of the Black population, 6.4 percent of the White population, and 5.9 percent of the Hispanic population. 

Although minority groups make up about 26 percent of the U.S. population, about 74 percent of drug-related AIDS cases occur in minority populations. Women are up to eight times more likely than men to contract HIV sexually and are the fastest growing group of AIDS cases. About 60 percent of the cases in women are drug-related. About one-half of drug-related, female AIDS cases are among Black women, for whom AIDS has been the leading cause of death since 1993. 

Minority groups suffer significantly from drug use and HIV-related medical problems. Prevention and treatment of drug use, HIV infection, and comorbid conditions simultaneously will be critical for controlling and reducing these major problems. 

Testing the Effectiveness of a Public Health Approach to Treating Substance-Abusing Women on Welfare

Jonathan Morgenstern, Ph.D.

Substance abuse (SA) among disadvantaged, parenting women has long been identified as a major public health problem. However, as States move to implement welfare reform, efforts to effectively address this problem take on greater urgency. This report describes preliminary findings from a study currently in progress to test the effectiveness of a public health approach to intervening with this population. The report will (1) describe the study rationale, design, and interventions, (2) compare baseline characteristics of substance-abusing women on welfare with a nonaffected comparison group, and (3) report on SA treatment entry and retention data for an initial cohort of participants. A standardized battery was administered to women (N=220) recruited in a welfare setting who either met current DSM-IV substance-dependence criteria or did not meet criteria for a substance use disorder in the prior 5 years. Substance-dependent women had significantly greater employment, mental health, family, medical, and housing problems, suggesting they would experience substantially greater barriers to employability. Substance-dependent women were then randomly assigned to receive a referral either to SA treatment or to an intensive case management intervention (ICM). Women assigned to ICM had significantly higher rates of SA treatment entry and attendance. Overall, women who received a referral only to SA treatment had low rates of treatment attendance. Findings are discussed in the context of the current interface between substance abuse and welfare-to-work services.

Behavioral Interventions With Minority Populations

Karen Y. Mechanic, M.D.

The objectives of this presentation are as follows:

1. To define Cognitive Behavioral Therapy
2. To compare and contrast Cognitive Behavioral Therapy with other behavioral treatments such as:
   1. Cognitive Therapy
   2. Community Reinforcement
   3. Motivational Enhancement Therapy
   4. The 12-Step Model
   5. Interpersonal Therapy
3. To discuss the role of research in the development of behavioral treatments specifically with regard to:
   1. Research methods
   2. Research findings
   3. Future research directions

Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. (1997) Substance Abuse: A Comprehensive Textbook. Third Edition. Philadelphia: Lippincott Williams & Wilkins.
National Institute on Drug Abuse Therapy Manuals for Drug Addiction.

Drug Abuse and Co-Occurring Conditions in Racial/Ethnic Populations

Linda B. Cottler, Ph.D.

Data on the comorbidity of drug abuse and addiction and psychiatric disorders in racial/ethnic minority communities are sparse. Often, the sample size is too small to make comparisons by race. In this presentation, research findings will be disseminated concerning this area of investigation. Relying on the findings from several NIDA-funded studies, specific issues such as the co-occurrence of alcohol abuse and dependence, nicotine dependence, and illicit drug abuse and dependence along with DSM-III-R or DSM-IV psychiatric illnesses will be covered. The effect of cultural bias attributed to assessments, sample selection, and even the diagnostic criteria themselves will be discussed for their impact on research findings. Literature will also be reviewed for studies that compare comorbidity rates by race and gender in order to expand the dialogue and increase and improve drug abuse research in minority communities. 

Comorbidity of Addiction and Severe Mental Illness

E. Cabrina Campbell, M.D.

The purpose of this presentation is to discuss substance abuse in bipolar disorder and schizophrenia. The lifetime prevalence of substance abuse in both of these disorders exceeds 50 percent (Regier et al., 1990; Dixon et al., 1991).

We will explore the more commonly abused substances in bipolar disorder. We will reflect on the problems encountered in making an accurate diagnosis when substances are involved and elucidate how addiction affects the course of illness. Treatment options for dual diagnosed patients will be given as well.

In schizophrenia, we will concentrate on abuse of cocaine in particular. Cocaine addiction in schizophrenia is an intriguing area of study because of the proposed involvement of the neurotransmitter dopamine in both disorders. Schizophrenics who abuse substances are more likely to experience symptom exacerbation, rehospitalization, treatment noncompliance, and poor outcomes (Westermeyer, 1992; Siebyl et al., 1993). A framework for treatment with atypical versus typical antipsychotics will be presented.

Implementing HIV/AIDS Risk Reduction Interventions

Torrance Stephens, Ph.D.

A standard protocol for implementing HIV/AIDS, STD, and other infectious disease risk reduction interventions for soon-to-be-released adult male inmate populations will be presented. Specific focus will be placed in curriculum development, use of patient education, and self-help methodologies for reducing the occurrence of problem behaviors as well as recidivism. Moreover, a summary of the study in concert with a descriptive profile of study participants will be presented as well as qualitative observations regarding the significance of using peers (former inmates) to implement study activities (interviewing, curriculum, and community followup).

Drug Treatment and Minority Populations in Prison and Work Release

Steven S. Martin, M.A., Ronald A. Beard, M.H.S.

Given the disproportionate number of minorities in prison and work release, particularly African Americans, it is not surprising that minorities are often the majority in correctional treatment programs. In this presentation, we discuss some of the issues involving minority status and substance abuse treatment, particularly as they apply in therapeutic communities. Then we examine some data on short- and long-term outcomes of treatment by minority status. The data come from an ongoing investigation of the treatment effects of a therapeutic community continuum of treatment in the Delaware correctional system. Results suggest that effective treatment can reduce racial disparities in the likelihood of relapse to drug use and recidivism.

Preventing HIV/AIDS With Hispanic and Native American Women

Barbara Estrada, M.S., Sally Stevens, Ph.D., A. Estrada

AIDS surveillance data by race/ethnicity indicate a disproportionately high percentage of people from minority groups who have AIDS (Centers for Disease Control and Prevention, 1999). Nearly equal numbers of AIDS cases were reported among Hispanic and White women in 1999, although the percentage of AIDS cases was over seven times higher among Hispanic women. In addition, recent data indicate an increase in the number of new cases of HIV infection among American Indians and Alaska Natives (Stevens and Estrada, 2000). Women in the United States are being diagnosed with AIDS at a rate four times higher than that for men. Given these trends, gender and culturally competent prevention strategies are urgently needed.

This presentation focuses on the development, implementation, and success of two HIV prevention interventions for minority women in southern Arizona. The first intervention was developed from feminist theory and utilized feminist methodology for an ethnically diverse group of drug-involved women. The second intervention incorporated a culturally innovative intervention for injection drug-using Hispanic women. These interventions resulted in statistically significant reductions in both drug- and sex-related risk behaviors in the populations served.

HIV Risk Reduction Targeting African American Female Crack Users

Claire E. Sterk, Ph.D.

HIV risk reduction interventions have shown the need for gender- as well as race-specific programs that take the daily lives of members of the target population into consideration. Available research also has shown HIV risk reduction interventions among drug users to have a larger effect in sexual than in drug use-related behavioral change. When studying female crack users, it is important to focus not only on individual but also on household and community risk and protective factors. Prevalence and incidence data show crack use among women to be highest among African American women, and research also shows crack use specifically has been marketed in inner-city neighborhoods. Challenges emerge in identifying risk and protective factors at all levels, designing interventions that are appropriate, linking research and individual/community needs, and developing programs that give ownership to members of the target population. Future research challenges include, but are not limited to, the need to provide comprehensive interventions, to acknowledge the multiple social roles occupied by the women and their relationships with others, and to connect micro-level conditions with macro-level forces such as racism, sexism, and classism.

• Sterk C. (1999) Building bridges: Community involvement in HIV and substance abuse research. Drugs and Society 14(1-2):107-121.
• Sterk C. (1999) Fast Lives: Women Who Use Crack Cocaine. Philadelphia: Temple University Press.
• Sterk C, Elifson K, Theall K. (2000) Women and drug treatment experiences: A generational comparison of mothers and daughters. Journal of Drug Issues 30(4):839-862.

From Research to Practice: The Case of Project ALERT

Phyllis L. Ellickson, Ph.D.

Using Project ALERT as an example, this presentation discusses the process of taking an exemplary drug prevention program from research trial to national dissemination. The curriculum, which was developed and tested in the late 1980s, is now one of the most widely disseminated among the evidence-based drug prevention programs for middle school students. The presentation discusses the challenges facing programs when they scale up to a national level, how Project ALERT has met those challenges, ongoing issues related to program fidelity and institutionalization, and the Federal role in disseminating research-based prevention programs.

• Ellickson PL. (1999) School-based substance abuse prevention: What works, for whom, and how? In S. Kar (ed.), Substance Abuse Prevention: A Multicultural Perspective. Amityville, New York: Raywood Publishing Company, Inc.
• Ellickson PL, Bell RM. (1990) Drug Prevention in junior high: A multi-site longitudinal test. Science 247:1299-1305; also RAND, R-3919-CHF.
• Ellickson PL, Bell RM, McGuigan K. (1993) Preventing adolescent drug use: Long-term results of a junior high program. American Journal of Public Health 83(6):856-861; also RAND, RP-208.

Preventing Drug Abuse With Life Skills Training

Kenneth W. Griffin, Ph.D., M.P.H., Gilbert J. Botvin, Ph.D.

National survey data indicate that drug abuse among American youth increased consistently during the 1990s. Fortunately, over the past few decades, our understanding of the etiology and prevention of drug abuse among youth has increased as well. Prevention programs have evolved from traditional information-dissemination approaches to more comprehensive contemporary programs that focus on drug-related expectancies (attitudes, norms) and social resistance skills. The Life Skills Training (LST) program, one of the most thoroughly evaluated school-based programs, is an effective competence enhancement program that teaches important personal self-management skills and social skills, in addition to drug-specific content. The LST program has been shown to be highly effective in short- and long-term evaluation studies in terms of preventing tobacco, alcohol, marijuana use, gateway polydrug use, and illicit drug use. The LST program has also been shown to be effective for a variety of populations, including both suburban White youth and inner-city minority youth. The primary aim of this presentation will be to describe the LST program and its theoretical basis and review the scientific evidence on its effectiveness with different target populations. Findings from a recent large-scale randomized controlled trial of the LST program among inner-city minority youth in New York City will be reviewed. In addition, some future directions for prevention intervention research for minority youth will be discussed, including issues in disseminating programs that have been proven to be effective.

Career-Oriented Prevention for African American Middle School Students

James P. Griffin, Jr., Ph.D.

The BRAVE (Building Resiliency and Vocational Excellence) Program's overarching goal is to facilitate young people's successful compliance with ATOD- and violence-free lifestyles. This vocationally oriented prevention research initiative serves eighth grade African American (AA) adolescent males and females, ages 12-15, who attend a regular, public middle school. It uses a resiliency-grounded, vocational context along with mentoring, peer support, and goal-setting.

Participants include, but are not limited to, the following AA male and female adolescents: youths who have current, historical, or pending rule violations (e.g., school infractions or legal charges), youths originating from economically disadvantaged or female-headed households, and youths in danger of facing academic probation or becoming dropouts. Other participants could be considered model students whose appropriate adaptive skills for navigating their community in accord with the aims of the initiative the program organizer seeks to reinforce and augment.

Consequently, the BRAVE Program operates on the following premise. Youths who cultivate appropriate adaptive skills through prosocial skill-training for community settings, internalize social norms that equate manhood and womanhood with personal responsibility, develop potentially rewarding vocational careers, and attach themselves to positive, successful community role models will be less likely to become involved with alcohol, tobacco, and other drugs and to engage in violence.

The presentation examines lessons learned from implementation of the program to date and presents preliminary findings regarding the operation of the program.

Research was funded by the National Institute on Drug Abuse.

Hooked on Tobacco: Issues in African American Teen Smokers

Eric T. Moolchan, M.D., Miqun L. Robinson, M.D., Ph.D., Ivan Berlin, M.D., Jean Lud Cadet, M.D.

Previous reports have indicated ethnic differences in both tobacco-related morbidity and treatment outcome for smoking cessation among adults. We assessed smoking-related characteristics in African American (AA) and non-African American (non-AA) teenagers applying to a cessation trial. A total of 399 teens (15.6±1.5 years, 62 percent females, 33 percent AA) responded via telephone to media ads. Self-reported sociodemographic, medical, and smoking-related data were obtained to determine preeligibility for trial participation. Compared with non-AA, AA had lower FTND scores (5.37±2.18 versus 6.16±2.10; p<.01) and smoked fewer cigarettes per day (12.1±8.47 versus 15.7±7.3; p<.04). AA teens reported shorter duration of smoking (3.16±1.93 versus 4.0±2.05 years; p<.001) and time elapsed between first cigarette ever smoked and daily smoking (0.88±1.05 versus 1.31±1.33 years; p<.002). AA and non-AA teens had similar frequency of reported health problems (e.g., asthma, psychiatric conditions). These data suggest that cessation treatment programs designed for African American youth should include lower Fagerström-defined levels and possibly other criteria for tobacco dependence. Our findings also highlight the importance of ethnocultural issues in treatment research programs.

Culturally Sensitive Family-Based Treatment for Adolescent Substance Abuse

Tanya Quille, Ph.D., Howard A. Liddle, Ed.D.

This presentation focuses on the research processes and products of studying culturally sensitive treatments for adolescent substance abusers. It details the treatment development framework that guides our clinical research. This framework includes significant attention to the rationale and methods for developing culturally specific interventions as well as the execution of diverse research strategies to facilitate this process. Specific examples from our therapy development of culturally specific, multiple systems-oriented, community-based interventions with African American and Hispanic teenagers and families will be presented, and therapy videotapes will be used to illustrate the steps and nuances of the culturally rooted interventions.

• Jackson-Gilfort A, Liddle HA, Dakof G, Tejeda M. (in press) The relationship of cultural theme discussion to engagement with drug using, African American male adolescents in family therapy. Journal of Black Psychology.
• Liddle HA, Dakof GA, Parker K, Diamond GS, Barrett K, Tejeda M. (2001) Multidimensional family therapy for adolescent substance abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse 27(4):651-687.
• Rowe CL, Liddle HA, McClintic K, Quille T. (in press) Integrative treatment development: The case of Multidimensional Family Therapy for adolescent substance abuse. In J. Lebow (ed.), Handbook of Psychotherapy (Volume on Integrative Therapies). New York: John Wiley and Sons.

Elimination of Barriers to Treatment for Women at Risk for HIV

Wendee M. Wechsberg, Ph.D.

Reaching and treating women with substance abuse disorders has been a topic for more than 20 years, yet has the field been successful? Many barriers prevent women from entering treatment, particularly minority women who appear to be at greater risk for HIV. These barriers are either structural (e.g., cost, transportation, day care, gender bias treatment), psychological (e.g., guilt, self-blame, PTSD, depression), or contextual (e.g., homelessness, joblessness, relationship demands) and may prevent treatment programs from both reaching and retaining women. Studies have shown that in addition to many of these barriers, women face such obstacles as fear of losing their children, fear of punishment if they admit their drug problem, and fear of violence from their husbands, boyfriends, or partners. Cultural barriers and expectations that keep women from seeking help are also in play. Although programs discuss strategies for reaching and engaging women into the treatment process, not all women are alike. Therefore, individualized assessments and treatment plans need to be sensitive to a woman's history, living conditions, and her own intrinsic barriers for recovery. Moreover, because treatment programs alone cannot address the scope of women's issues, establishing linkages to other resources and community services will ensure greater opportunity for programs to respond successfully to identified needs.

Issues Affecting the Prevention and Treatment of Substance Abuse in Asian American/Pacific Islander Populations

Ford H. Kuramoto, M.S.W., D.S.W.

The presentation will address the need for substance abuse prevention and treatment research regarding Asian American and Pacific Islander (AAPI) populations in the continental United States, Hawaii, and the Pacific Islands. AAPIs represent many diverse cultures for which specialized research is needed to improve drug abuse prevention, intervention, treatment, and recovery. The existing data sets are inadequate to develop large, detailed studies regarding AAPI populations. A range of research strategies are needed to properly address the individual AAPI populations in an effective manner.

Furthermore, drug abuse research among AAPI populations must consider barriers such as stigma and shame, language and culturally specific belief systems, and the lack of understanding of Western research methods. In many instances, for example, qualitative and formative research is needed to frame relevant research questions. Incidence and prevalence data are needed for epidemiologic data. However, much work is also needed through qualitative methods to identify the patterns of drug use, drugs of choice among specific AAPI populations, and individual drug-abuse histories over time. AAPI prevention and treatment service program strategies should also be identified and disseminated in order to understand the most effective approaches.

Prenatal Exposure to Cocaine: The Collision of Science and Culture

Deborah A. Frank, M.D.

The study of children prenatally exposed to cocaine provides an instructive example of how cultural expectations about race/ethnicity and women's roles can distort the interpretation of scientific data. These distortions have stigmatized children and given rise to public policies toward cocaine-using women (particularly women of color) that violate established canons of medical ethics and civil liberties. Usual standards of methodological rigor have often been ignored in the study of prenatal cocaine exposure. Less than one-half of studies in peer-reviewed journals of post-neonatal outcomes up to age 6 of children with prenatal cocaine exposure meet essential methodological criteria (prospective recruitment, masked assessment, appropriate comparison subjects, and exclusion of subjects exposed in utero to opiates, amphetamines, phencyclidine, or maternal HIV infection). In the studies that do meet these criteria, after controlling for confounders, there is no consistent negative association between prenatal cocaine exposure and physical growth or developmental test scores. Data regarding receptive or expressive language skills are inconsistent, with three studies finding no effect to 36 months, one finding decreased auditory comprehension at 1 year, and one finding no mean differences, but increased "low language scores" on a language sample at 6 years. Less optimal motor scores have been found up to 7 months of age, but not thereafter, and may reflect heavy tobacco exposure. No independent cocaine effects have been shown on standardized parent and teacher reports of child behavior scored by accepted criteria.

Further replication is required of experimental paradigms and novel statistical manipulations of standard instruments that suggest an association between prenatal cocaine exposure and decreased attentiveness and emotional expressivity as well as differences on neurophysiologic measures such as electroencephalogram, heart rate, and baseline cortisol measures, each of which has been found in only one sample. Among children up to 6 years of age, there is no convincing evidence that prenatal cocaine exposure is associated with developmental toxicity different in severity, scope, or kind from the sequelae of multiple other risk factors. Many findings once thought to be specific effects of in utero cocaine exposure are more strongly correlated with other factors, including prenatal exposure to tobacco, marijuana, or alcohol and the quality of the child's environment. However, health providers should not ignore the fact that cocaine use in pregnancy, like other addictions, is often a marker for parents and children at risk for poor health and impaired caregiving due to factors ranging from infectious diseases to domestic violence. From a scientific perspective, much is still unknown, and ongoing followup of exposed children and comparison samples into adulthood is needed. Increasing cognitive demands and social expectations as children mature may unmask sequelae of exposure not previously identified. Cumulative environmental risk and protective variables should also be studied to identify factors that may exacerbate or moderate negative outcomes. Care and study of families affected by substance abuse should be comprehensive and not irrationally shaped by social prejudices that demonize some drugs and drug users, but not others.

• Delaney-Black V et al. (2000) Expressive language development of children exposed to cocaine prenatally: Literature review and report of a prospective cohort study. Journal of Communication Disorders 33:463-481.
• Frank DA, Augustyn M, Grant Knight W, Pell T, Zuckerman B. (2001) Growth, development, and behavior in early childhood following prenatal cocaine exposure: A systematic review. Journal of the American Medical Association 285:1613-1625.
• Singer LT et al. (2001) Developing language skills of cocaine exposed infants. Pediatrics 107:1057-1064.

Effects of Acute Smoked Marijuana on Complex Cognitive Performance

Carl L. Hart, Ph.D.

Although the ability to perform complex cognitive operations is assumed to be impaired following acute marijuana smoking, complex cognitive performance after acute marijuana use has not been adequately assessed under experimental conditions. In the present study, we used a within-participant double-blind design to evaluate the effects of acute marijuana smoking on complex cognitive performance in experienced marijuana smokers. Eighteen healthy research volunteers (8 females, 10 males), averaging 24 marijuana cigarettes per week, completed this three-session outpatient study; sessions were separated by at least 72 hours. During sessions, participants completed baseline computerized cognitive tasks, smoked a single marijuana cigarette (0, 1.8, or 3.9 percent delta-9 THC w/w), and completed additional cognitive tasks. Blood pressure, heart rate, and subjective effects were also assessed throughout sessions. Marijuana cigarettes were administered in a double-blind fashion and the sequence of delta-9 THC concentration order was balanced across participants. Although marijuana significantly increased the number of premature responses and the time participants required to complete several tasks, it had no effect on accuracy on measures of cognitive flexibility, mental calculation, and reasoning. Additionally, heart rate and several subjective-effect ratings (e.g., "Good Drug Effect," "High," "Mellow") were significantly increased in a delta-9 THC concentration-dependent manner. These data demonstrate that acute marijuana smoking produced minimal effects on complex cognitive task performance in experienced marijuana users. 

Effective Prevention Strategies and Programs With Minority Communities

Pamela Jumper-Thurman, Ph.D.

This presentation will be a very brief overview of the challenges faced in developing effective prevention and intervention strategies in minority communities. Further, it is necessary to acknowledge that there are differences within each ethnic group that are as great or greater than differences between ethnic and majority groups, and consideration of these differences is critically important in developing successful intervention strategies. Finally, information will be given about current models and programs that have been found to be effective with specific ethnic groups.

Making Prevention Programs Culturally Appropriate: Examples, Challenges, and Needs

Rose Alvarado, Ph.D.

Parenting and other family-based approaches to prevention are critical ingredients in effective approaches to substance abuse prevention. Questions have been raised, however, about the usefulness of universal family-based prevention with culturally diverse families. Little research has been published on how successful universal prevention programs are in attracting, retaining, and impacting families from diverse cultures (Turner, 2000), and there are a limited number of research-based programs developed specifically for ethnic populations (Szapocznik, Kurtines, Santisteban, and Rio, 1990). Although there is substantial overlap in the factors promoting drug use/abuse among different racial or ethnic groups (Epstein, Botvin, Diaz, and Schinke, 1995; Newcomb, 1992), the strength of the influence of etiological factors varies. This suggests more emphasis is needed in other domains (i.e., family) for different ethnic groups. 

Because of the dearth of research on culturally adapted or even culturally specific universal family programs, randomized control trials are needed to develop and test culturally appropriate versions of the major evidence-based, universal family programs. Applied research is also required to determine whether these new culturally adapted versions will work with other ethnic subgroups. Once questions of how to best strengthen multiethnic families are answered, we will be well equipped to reduce substance abuse.

• Epstein JA, Botvin GJ, Diaz T, Schinke SP. (1995) The role of social factors and individual characteristics in promoting alcohol among inner-city minority youth. Journal of Studies on Alcohol 56:39-46.
• Newcomb MD. (1992) Understanding the multidimensional nature of drug use and abuse: The role of consumption, risk factors, and protective factors. In M.D. Glantz, R. Pickens (eds.), Vulnerability to Drug Abuse. Washington, D.C.: American Psychological Association, pp. 255-297.
• Szapocznik J, Kurtines W, Santisteban DA, Rio AT. (1990) The interplay of advances among theory, research and application in treatment interventions aimed at behavior problem children and adolescents. Journal of Consulting and Clinical Psychology 58:696-703.
• Turner W. (2000) Cultural considerations in family-based primary prevention programs in drug abuse. In S. Kaftarian, K.L. Kumpfer (guest eds.). Special Section: Family-focused Research and Primary Prevention Practices. Journal of Primary Prevention 21(3):285-303.

Free to Grow: Translating Substance Abuse Research Into Preventive Practice in a National Head Start Initiative

Judith E. Jones, M.Sc.

This presentation will describe the application of research on risk and protective factors as employed in the design and strategies of a substance abuse prevention initiative in partnership with the national Head Start program, the Nation's largest early childhood program serving low-income and minority children. In the absence of a large body of research-based model programs aimed at decreasing children's vulnerability to substance abuse and other high-risk behaviors as they grow older, the goal of the initiative, which is supported by The Robert Wood Johnson Foundation, is to demonstrate how preventive research can be applied in the early childhood period by strengthening the immediate environment of the young child. While the findings from phase I of the initiative demonstrate the applicability of theory and research to practice, they do not provide sufficient evidence to determine whether these inputs will result in intermediate and long-term outcomes that prove whether early intervention is the answer to ATOD use and abuse as children age into adolescence. Moreover, the challenges of using the risk and protective factors framework to guide model development and adaptation should not be underestimated, because the interrelationships are not yet well established. However, lessons learned in the pilot phase are sufficiently promising that a research and program demonstration has just been launched in 18 diverse Head Start sites across the Nation. This phase of the initiative will undergo a rigorous process and outcome evaluation that will examine the impact of Free to Grow on the families and neighborhoods targeted by the program in order to provide a better understanding of "what works under what circumstances" to ensure the healthy development of the young child. 

Key questions that require further research include the following: Do Free to Grow programs reduce known risk factors and increase protective factors among participating families? Are participating families more likely to resist abusing alcohol and other drugs? Do the Free to Grow interventions produce more stable and productive living environments? Is the Head Start program a viable vehicle for addressing substance abuse prevention?

• Hawkins JD, Catalano RF, Miller JY. (1992) Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin 112(1):64-105.
• Kumpfer KL. (1991) How to get hard-to-reach parents involved in parenting programs. In E.M. Johnson, G.A. Held, R.W. Denniston (eds.), Parent Training Is Prevention: Preventing Alcohol and Other Drug Problems Among Youth in the Family. Washington, D.C.: U.S. Government Printing Office, pp. 87-95.
• Yoshikawa H. (1994) Prevention as cumulative protection: Effects of early family support and education on chronic delinquency and its risks. Psychological Bulletin 115(1):28-54.

Effective Treatment With Minority Communities

José Szapocznik, Ph.D.

Adolescent drug abuse is often part of a larger syndrome of problem behaviors that reflect an antisocial developmental trajectory for the youth. Research shows that there are a number of important ecological influences on the adolescent, the most significant and proximal of which is the family. Research on family intervention has demonstrated the efficacy of family-based interventions in bringing about reductions in risk and promotion of protection in the minority adolescent and her/his ecology.

Drug Treatment Services for Minority Populations

Andrea G. Barthwell, M.D., FASAM

This presentation provides descriptions of cultural interactions between and among individuals and the basis for the cultural bias. Using her experiences as a treatment provider who strives to apply evidence-based principles in a variety of treatment settings, Dr. Barthwell will outline cultural interactions that operate in the treatment setting and introduce barriers to participation, motivation, and performance. Finally, research implications and gaps in the literature will be discussed.

Working With Rural African American Youth

Murelle G. Harrison, Ph.D.

The proposed prevention program is based on a heuristic model of family processes through which rural African American youths are hypothesized to develop self-regulation and emotional regulation, increasing the likelihood that they will achieve academically, exhibit few conduct problems, and be accepted by non-deviant peers. Such academic and psychosocial competence is hypothesized to be linked with lower levels of substance use. The model is based on Bandura's (1989) theories on the development of self-efficacy and self-regulatory processes as well as other theories concerning the linkages between self-regulation and substance misuse (Miller and Brown, 1991; Sher and Tull, 1994). The selection of specific family processes for inclusion as prevention targets was based on Brody's research (Brody et al., 1999; Brody et al., 1998), in which a similar model was tested with two-parent and single-parent African American families in rural Georgia. Predictable and routinized home environments have been found to promote youth's internalization of goal-setting, planning, and general self-organization, which in turn promote academic and psychosocial adjustment and deter substance use.

Barriers that must be overcome in working with rural African American families include distance from the university, low density of population, and suspiciousness of families concerning participation. Identifying representative rural populations often requires traveling long distances from the university, resulting in higher cost and expenditure of time. Low population density of rural areas requires larger areas to secure adequate sample size. Finally, rural African American families are not likely to have been previously approached to participate in a research project or to be knowledgeable about research in general, subsequently arousing suspiciousness, directed especially toward a socially stigmatized content area such as substance abuse.

Further research is needed to determine the influence of siblings on the development of psychosocial and academic competencies and subsequent lower substance use. 

• Brody GH, Flor DL, Hollett-Wright N, McCoy JK. (1998) Children's development of alcohol use norms: Contributions of parent and sibling norms, children's temperaments, and parent-child discussions. Journal of Family Psychology 12:209-219.
• Brody GH, Flor DL, Hollett-Wright N, McCoy JK, Donovan, J. (1999) Parent-child relationships, child temperament profiles, and children's alcohol use norms. Journal of Studies on Alcohol.
• Brody GH, Neubaum E, Boyd GM, Dufour M. (1997) Health consequences of alcohol use in rural America. In E.B. Robertson, Z. Sloboda, G.M. Boyd, L. Beatty, N.J. Kozel (eds.), Rural Substance Abuse: State of Knowledge and Issues. National Institute on Drug Abuse Research Monograph 168. NIH Pub. No. 97-4177. Washington, DC: Superintendent of Documents, U.S. Government Printing Office, pp. 137-174.

Working and Conducting Research Among American Indian Families

Jerry Stubben, Ph.D.

This session will focus on the political, social, economic, psychological, and spiritual issues that one may face, whether Native American or non-Native, in a tribal or urban Indian community.

Prevention of HIV Among Adolescents

Mary Jane Rotheram-Borus, Ph.D.

Adolescents are at risk for HIV primarily through their sexual behavior. A comprehensive prevention strategy includes a national HIV campaign based on social-marketing principles; targeted social-marketing, intensive skill-building, and sexually transmitted disease control programs for youth at high risk; programs targeting institutions (e.g., school health clinics), providers, and parents; and interventions to identify and reduce risk acts among seropositive youth. The U.S. focus for HIV prevention has been single-session educational classes (an ineffective strategy) or intensive multisession, small-group interventions for youth at high risk (demonstrated to increase condom use by about 30 percent). There is a need to expand the range, modalities, and dissemination of HIV prevention programs nationally; to recognize (especially by policymakers) limitations of abstinence programs; and to increase early detection of HIV among youth.

Rotheram-Borus MJ. (1997) Interventions to reduce heterosexual transmission of HIV. In NIH Consensus Development Conference on Interventions to Reduce HIV Risk Behaviors: Program and Abstracts [online]. Available: http://consensus.nih.gov/1997/1997PreventHIVRisk104html.htm.
Rotheram-Borus MJ, Lee MB, Murphy DA, Futterman D, Duan N, Birnbaum J, and the Teens Linked to Care Consortium. (2001) Efficacy of a preventive intervention for youth living with HIV. American Journal of Public Health 91:400-405.
Rotheram-Borus MJ, O'Keefe Z, Kracker R, Foo H.-H. (2000) Prevention of HIV among adolescents. Prevention Science 1(1):15-30.

The Prime Time Project

Eric W. Trupin, Ph.D.

In Washington State, the number of violent crimes committed by adolescents ages 10-17 years has doubled since 1981. Adolescents now commit almost one-half of all violent crimes statewide. Because juveniles who commit repeat or violent crimes are the most likely to continue their criminal behavior into adulthood, targeting interventions at juvenile offenders is crucial to the reduction of community violence.

Young offenders are challenging to treat because they often have, in addition to their criminal histories, high rates of mental disorder and substance abuse. In fact, as many as 70 percent of incarcerated youth abuse substances or are dependent on them. The number of African American youth within the juvenile justice system has increased markedlyÑnearly one-half of juveniles in custody in public facilities in 1990 were African American compared with one-third in 1977.

Many adolescents who fit this profile are seen repeatedly at the county's Juvenile Detention Center, a secure facility that houses youth prior to adjudication and/or sentencing, youth who have been adjudicated and are returning for court appearances, and youth with less than 30-day sentences. In 1994, 11,000 youth were referred to the juvenile court and there were 5,561 admissions to the Detention Center. Given current staffing and the large population, the focus is on assessment and adaptation to the facility rather than treatment. 

In 1995, the King County Council funded the Prime Time Project to treat juvenile offenders (12-17 years old) with mental illness and problems with drug/alcohol abuse. The Prime Time Program employs a thorough initial evaluation to identify strengths and problem areas and intensive counseling and case management aimed at building skills, strengthening support, and coordinating all services to the youth and their families. Multisystemic Therapy, which usually takes place in the home, focuses on reducing conflict, supporting the role of parents and caretakers, and increasing the social supports provided by neighbors, churches, and other community resources. Individual counseling employing the techniques developed in Dialectic Behavior Therapy and Motivational Enhancement Therapy are utilized to address the co-occurring disorders of mental illness (e.g., anger management, communication, and impulse control) and substance-abusing behaviors. The counselor also works closely with schools, probation and police officers, and substance abuse treatment programs and helps the youth and their families develop positive, satisfying community activities (jobs, recreation, community service). This program is unique in its intensive involvement at the community level with offenders and every aspect of their lives.

The goals are to keep youth out of detention, reduce antisocial behavior, and increase school attendance and performance. Preliminary results are encouraging, and further research is being conducted to assess outcomes of this innovative intervention.

Elimination of Barriers to Treatment for Women at Risk for HIV

Andrew Morral, Ph.D.

Adolescents' drug use reports are among the most closely observed indicators of the Nation's drug-use problems. There is evidence, however, that these self-reports suffer from considerable underreporting. A portion of this underreporting could result from the use in surveys of drug terms and classifications (e.g., psilocybin, hallucinogens, or psychedelics) that are unfamiliar to youths who refer to drugs using street terms (e.g., Shrooms). This evidence will be presented along with strategies for improving the measurement of adolescent drug use by using ethnically and regionally specific drug terms. New results will be presented from an ongoing study of adolescents that contrasts the use of standard drug terminology with ethnically specific drug terms. These results suggest that a portion of adolescents' drug-use underreporting may result from unfamiliar, abstract, or confusing drug terminology on surveys rather than from adolescents' intentions to conceal their drug use.

This research is supported by the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, through the Persistent Effects of Treatment Study (PETS, Contract No. 270-97-7011).

Drug Use in Asian American/Pacific Islander Populations: Incidence, Prevalence, and Data Needs

Rumi Kato Price, Ph.D., M.P.E., Nathan K. Risk, M.A., Mamie Mee Wong, Ph.D., Renee Storm Klingle, Ph.D.

Drug abuse research on Asian Americans and Pacific Islanders (AAPIs) lacks systematic information on prevalence and incidence and knowledge about their predictors. Nonetheless, fragmented evidence points to increasing substance abuse among some AAPI subgroups, contrary to the image of Asians as a model minority. We analyzed seven large national and State groups of survey data with sample sizes ranging from 13,000 to 390,000 to better understand the nature and source of differential rates of substance use and abuse within AAPIs and across major ethnic/racial minorities. Across major substances, results show that (1) prevalence and incidence rates are the lowest in the aggregated Asians among major racial groups, (2) using disaggregated Asian subgroups, Japanese rates are highest within Asians (very close to those for Whites) corresponding to the rankings of several acculturation indices, (3) the differential rates are due in a large part to the size of mixed-race subgroups, among whom up to a fourfold increase is observed, and (4) mixed-heritage AAPIs are at increased risk for substance use, even after controlling for cultural protective factors and socioeconomic measures. The results point to the importance of (1) rethinking ethnic/racial classifications in assessing differential substance use and abuse, (2) studying substance abuse in mixed-heritage adolescents, and (3) studying detailed processes of decays in social-environmental and potentially genetic protective factors.

• Price RK, Risk NK, Wong MW, Klingle RS. (under review) Substance use and abuse in Asian American and Pacific Islanders (AAPIs): Preliminary results from three national surveys. Public Health Reports.
• Tabulation Working Group Interagency Committee for the Review of Standards for Data on Race and Ethnicity. (1999) Draft Provisional Guidance on the Implementation of the 1997 Standards for the Collection of Federal Data on Race and Ethnicity. Washington, DC: Office of Management and Budget.
• Zane NWS, Huh-Kim J. (1998) Addictive behaviors. In L.C. Lee, N.W.S. Zane (eds.), Handbook of Asian American Psychology. Newbury Park, CA: Sage, pp. 527-554.

Violence and Drug Use: A Tangled Web

Merrill C. Singer, Ph.D.

In popular and media conception, violence and drug use are intimately related and have been depicted as such since early in the 20th century. Broad acceptance of this allegedly inherent entwinement has been used often to launch panicked warnings about the potential consequences of drug use in minority communities. While this social practice dates at least to the early 20th century and social concern about cocaine use among southern African Americans and marijuana use among southwestern Latinos, it remains today as part of the underlying rationale for the intensive policing of minority neighborhoods and the associated high arrest and incarceration rates among inner-city African American and Latino males. Research findings, however, are more complicated and suggest that the relationship between violence and drug use is complex, multifaceted, and mediated by a variety of structural factors. Notably, the relationship is not unidirectional: Violence can lead to individual changes in drug use patterns, including both heightened and lowered levels of use; conversely, drug use can contribute to various kinds of violence. At the same time, research affirms that most drug use does not notably enhance levels of violence, the relationship between particular drugs and violence changes over time, and alcohol is far more likely than illicit drugs to be associated with violence. In light of the misuses to which dead-certain assertions concerning the association between drug use and violence have been put, a more cautious, research- and reality-based approach is urged.

Establishing Research Partnerships Between Minority and Majority Universities

Ken Harewood, Ph.D., Allyn Howlett, Ph.D.

Academic partnerships thrive on the participation of students serving as liaisons in research collaborations between institutions. We have identified challenges to establishing research partnerships between minority and majority universities and are developing strategies to overcome these impediments: (1) Students at the minority institution have limited observations of ongoing research activities on campus, and this has led to confusion over their role in the laboratory. We are overcoming this by creating a "research environment" with expectations comparable to those of a majority graduate program. (2) Typical M.S. level coursework at the minority institution emphasizes level I or II cognitive skills (identify, recognize, describe, and summarize). Students must be challenged to move beyond this to level III cognitive skills (evaluate, synthesize, apply, analyze, and predict) in order to foster the "research thinking process." (3) Minority institution students who enter Ph.D. programs at majority institutions begin the program with no "head start" from their B.S. or M.S. work. Coursework articulation and integration of research projects would move the student into an advanced position when entering the Ph.D. phase of their training. We are striving to develop faculty research collaborations between institutions so that students can work on aspects of the project at both institutions. 

Research was supported by National Institute on Drug Abuse cooperative agreement U24-DA12385.

Drug Use and Dependence in a Population of Urban, African American Young Adults: Prevalence, Correlates, Comorbidity, and Unmet Drug Treatment Service Needs

Nicholas S. Ialongo, Ph.D., Carolyn Furr-Holden, Ph.D., Beth McCreary, Ph.D., Sharon Lambert, Ph.D.

The National Household Survey on Drug Abuse (NHSDA) and the National Comorbidity Study (NCS) (Kessler et al., 1994) represent the most recent and comprehensive efforts to ascertain the prevalence of drug use and dependence, respectively, in the United States. However, the sampling strategies employed in the NHSDA and the NCS have proven less informative regarding the prevalence of drug use and dependence among economically disadvantaged, minority populations because relatively few were assessed. In this presentation, we will describe the prevalence of drug use and dependence in an epidemiologically defined population of 1,181 predominantly poor African Americans ages 19 to 22 years living in the greater Baltimore, Maryland, metropolitan area between 1999 and 2000. The correlates of drug use and dependence, their comorbidity with mental disorders, and unmet drug treatment need will also be presented.

The Effect of Race, Neighborhood, and Social Networks on Initiation of Injection Drug Use

Crystal M. Fuller, Ph.D., Luisa Borrell, D.D.S., Ph.D., Sandro Galea, M.D., David Vlahov, Ph.D.

Injection drug users (IDUs) are at high risk of adverse health consequences, namely, transmission of blood-borne pathogens (such as human immunodeficiency virus [HIV] and hepatitis C virus [HCV]) as well as fatal drug overdose. HIV and HCV transmission typically occurs within the first 2 years of initiating injection drug use (Nicolosi et al., 1992; Nelson et al., 1995; Garfein et al., 1996). Thus, identifying high-risk practices and other social characteristics contributing to age of initiation of injection and HIV infection could provide an opportunity for early interventions. Our research, consistent with other studies, has shown race effects with respect to age at initiation of injection, and HIV seroprevalence (Fuller et al, 2001; Kral et al., 2000; Des Jarlais et al., 1999). Although White drug users tend to progress into illicit drug use at an earlier age, HIV seroprevalence remains highest among Black drug users (Fuller et al., 2001). Our analysis involved the effect of individual and contextual characteristics on age of initiation of injection drug use and subsequent HIV infection among young, recently initiated IDUs. Specifically, we investigated (1) the extent to which age of initiation of injection was associated with individual-level characteristics (e.g., race, social networks, high-risk injection, and sexual practices) and contextual-level characteristics (e.g., neighborhood racial composition and concentration of poverty) and (2) the extent to which HIV seroprevalence was associated with these individual and contextual effects among young IDUs.

• Des Jarlais DC, Friedman SR, Perlis T, Chapman TF, Sotheran JL, Paone D, Monterroso E, Neaigus A. (1999) Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 20:67-72.
• Fuller C, Vlahov D, Arria AM, Ompad D, Garfein R, Strathdee SA. (2001) Factors associated with adolescent initiation of injection drug use. Public Health Reports (suppl 1) 116:136-145.
• Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. (1996) Viral infections in short-term injection drug users: The prevalence of the hepatitis C, hepatitis B, human immunodeficiency virus, and human T-lymphotropic viruses. American Journal of Public Health 86(5):655-661.
• Kral AH, Lorvick J, Edlin BR. (2000) Sex- and drug-related risk among populations of younger and older injection drug users in adjacent neighborhoods in San Francisco. Journal of Acquired Immune Deficiency Syndrome 24:162-167.
• Nelson KE, Vlahov D, Solomon L, Cohn S, Munoz A. (1995) Temporal trends of incident human immunodeficiency virus infection in a cohort of injection drug users in Baltimore, Maryland. Archives of Internal Medicine 155:1305-1311.
• Nicolosi A, Leite MLC, Molinari S, Lazzarin A. (1992) Incidence and prevalence trends of HIV infection in intravenous drug users attending treatment centers in Milan and northern Italy, 1986-1990. Journal of Acquired Immune Deficiency Syndrome 5:365-373.

Community-Based Research: A Minority Researcher's Personal Observations

Frank Yuan Wong, Ph.D.

Based on his professional as well as personal experience, the speaker will address career development (e.g., academic vs. applied research, what to study, whom to study, etc.) within the contexts of intra- and inter-group psychology. Other issues discussed will include community welfare vis-ˆ-vis professional practices and scientific standards. Recommendations will be targeted to aspiring minority researchers.

Social and Racial Disparities in HIV Infections Among Injection Drug Users

Ricky N. Bluthenthal, Ph.D.

In the United States, African Americans and Hispanics are 6 to 16 times more likely to contract AIDS through injection drug use than Whites. Further, injection drug use has accounted for at least 36 percent and perhaps as much as 47 percent of adult AIDS cases among African Americans and Hispanics. Epidemiologic studies have also consistently found HIV infection associated with poverty and homelessness among drug injectors. Despite these data, studies of HIV risk, prevalence, and incidence have focused almost exclusively on individual-level characteristics and behaviors as predictors of HIV infection. An increasing number of studies have found HIV risk and infection among drug injectors to be associated with issues such as racial segregation, urban unemployment, law enforcement practices, welfare reform, and restrictions on promising HIV prevention strategies (such as syringe-exchange programs). This presentation will provide a framework for understanding how larger social, political, and economic forces have contributed to the disproportionate impact of HIV/AIDS on African American and Hispanic injection drug users. Research challenges to be addressed include methods for collecting and considering data from institutional and secondary sources (e.g., police, U.S. census) and consideration of the limits of individual-focused HIV prevention strategies for impoverished populations. 

• Bluthenthal RN, Lorvick J, Kral AH, Erringer ER, Kahn JG. (1999) Collateral damage in the war on drugs: HIV risk behaviors among injection drug users. International Journal of Drug Policy 10:25-38.
• Curtis R, Friedman SR, Neaigus A, Jose B, Goldstein M, Idefonso G. (1995) Street level drug market structure and HIV risk. Social Networks 17:219-228.
• Ouellet LJ, Jimenez AD, Johnson WA, Wiebel W. (1991) Shooting galleries and HIV disease: Variations in places for injecting illicit drugs. Crime and Delinquency 37:64-85.

HIV and Drugs in Special Populations

Clyde B. McCoy, Ph.D.

Background. Although recent data indicate that AIDS cases are decreasing in general in the United States, HIV rates continue to increase among specific subpopulations including women, minorities, and drug users. South Florida provides a unique snapshot of the HIV/AIDS epidemic because of its diverse urban and rural populations. 

Methods. Data from the Miami CARES cohort collected on 3,555 out-of-treatment chronic drug users assessed sociodemographic variables and HIV and drug use behaviors in three south Florida urban and rural communities (Miami, Belle Glade, and Immokalee).

Findings. The spread of HIV between and within these three areas was correlated with injection drug use, crack-cocaine use, and exchange of sex for money. Rural drug-using minority women in particular continue to practice HIV risk behaviors and are at extremely high risk for HIV transmission. A number of social, cultural, and psychological characteristics may predispose rural migrants to engaging in HIV risk behaviors.

Conclusions. The recent downturn in AIDS deaths is hopeful, yet the increasing incidence of HIV among certain subpopulations remains troubling and should force policymakers to be more diligent in advancing public health policies and strategies available for the effective reduction of HIV transmission, especially recognizing the large diversity of the affected groups.

• Edlin BR, Irwin KL, Faruque S, McCoy CB, Word C, Serrano Y, Inciardi JA, Bowser BP, Schilling R, Holmberg SD, Multicenter Crack Cocaine and HIV Infection Study Team. (1994) Intersecting epidemics: Crack cocaine use and HIV infection in inner-city young adults. New England Journal of Medicine. November 24 (21):1422-1427.
• McCoy CB, Inciardi JA. (1995) In Sex, Drugs, and the Continuing Spread of AIDS. Los Angeles: Roxbury Publishing Co.
• McCoy CB, Metsch LR, McCoy HV, Lai S. (1999) A gender comparison of HIV and drug use across the rural-urban continuum. Population Research and Policy Review 18(1-2):71-87.

Partner Abuse and Sexual Risk Behavior Among Women on Methadone

Nabila El-Bassel, D.S.W.

Partner abuse and HIV risks have emerged as intersecting epidemics that threaten the welfare of inner-city African American and Latino communities. Among the groups disproportionately affected by these trends are minority women in methadone maintenance treatment programs (MMTPs) (El-Bassel et al., 2000a; El-Bassel et al., 2000b; Gilbert et al., 2000). The purpose of this paper is to examine the relationship between sexual HIV risk behavior and partner violence in a random sample of 417 women recruited from MMTPs. Eighty-seven percent of the women in the study reported ever being physically abused, 42 percent reported ever being injured by their intimate partners, and 69 percent of the women reported ever being sexually abused. Although a large number of these women (60 percent) reported that their intimate partners engaged in HIV risk behaviors, only 18 percent always used condoms with them. The findings showed that women who reported history of STDs, had multiple sexual partners and were HIV-positive, or exchanged sex for money or drugs were more likely to be physically abused by an intimate partner than by their counterparts. HIV prevention for women must address the issue of physical and sexual abuse by an intimate partner, particularly when intervention strategies are being developed for drug-involved women who are at a high level of risk for partner violence. 

• El-Bassel N, Gilbert L, Rajah V, Foleno A, Frye V. (2000a) Fear and violence: Raising the HIV stakes. AIDS Education and Prevention 12(2):154-170.
• El-Bassel N, Gilbert L, Wada T, Witte S, Schilling RF. (2000b) Drug abuse and partner violence among women in methadone treatment. Journal of Family Violence 15(3):209-225.
• Gilbert L, El-Bassel N, Rajah V, Fontdevila J, Foleno A, Frye V. (2000) The converging epidemics of drug use, HIV and partner violence: A conundrum for methadone maintenance treatment. Mount Sinai Journal of Medicine 67(5-6):452-464.

Lifetime Cumulative Adversity and Drug Dependence: Racial/Ethnic Contrasts

R. Jay Turner, Ph.D.

A number of studies have reported a linkage between stress, measured in terms of recent life events, and drug use and abuse. However, on the face of it, the expectation that variations in exposure to social stress, either within or across such statuses as race and ethnicity, can be meaningfully captured by a simple count of recent life events seems hard to justify. Indeed, our own prior research has demonstrated two important points: (1) When measured more comprehensively, social stress accounts for dramatically more variation in mental health and substance use outcomes than has typically been reported and assumed to obtain. (2) Reliance on checklists of recent life events systematically underestimates stress exposure among African Americans and persons of lower socioeconomic status. The present paper considers the significance for drug dependence disorder of exposure to major and potentially traumatic events over childhood and adolescence based on a large, ethnically diverse sample of individuals in the transition to adulthood. A large array of differing major events was found to be associated with increased risk for the subsequent onset of drug dependence, and the accumulation of such adversities significantly increases such risk. Racial/ethnic variations in lifetime exposure to such events are reported, along with racial/ethnic variations in their risk significance.

The Power of Gender in Drug Abuse Research, Prevention, and Treatment

Hortensia Amaro, Ph.D.

Increasingly, investigators are addressing research questions regarding possible sex and gender differences that may be important to understanding risk factors for substance use and prevention strategies as well as the process of addiction and its treatment. This presentation will review recent research on gender differences in substance use and abuse and discuss the limitations of existing research and knowledge gaps.

The Power of Faith as a Protective Factor Against Drug Abuse

John M. Wallace, Jr., Ph.D.

This presentation uses data from nationally representative samples of American young people to explore the relationship between religion and adolescent substance use. More specifically, the presentation examines the epidemiology of religion among American youth and then describes the conceptual framework that guides the investigation and examines empirically the relationship between adolescent drug use and organizational, behavioral, and attitudinal measures of religiosity.

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