Faculty Bibliography

BACKGROUND: Nonmedical use of opioids has become increasingly problematic in recent years with increases in overdoses, treatment admissions, and deaths. Use also appears to be contributing to heroin initiation, which has increased in recent years. Further research is needed to examine which adolescents are at highest risk for nonmedical use of opioids and heroin and to explore potential links between nonmedical opioid use and heroin use. METHODS: Data were analyzed from a nationally representative sample of American high school seniors in the Monitoring the Future study (2009-2013, Weighted N=67,822). We examined associations between frequency and recency of nonmedical use of opioids and heroin. Sociodemographic correlates of use of each drug were also examined. RESULTS: 12.4% of students reported lifetime nonmedical opioid use and 1.2% reported lifetime heroin use. As frequency of lifetime nonmedical opioid use increased, so too did the odds for reporting heroin use, with over three-quarters (77.3%) of heroin users reporting lifetime nonmedical opioid use. Recent (30-day) nonmedical opioid use was a robust risk factor for heroin use and almost a quarter (23.2%) of students who reported using opioids >/=40 times reported lifetime heroin use. Black and Hispanic students were less likely to report nonmedical opioid or heroin use than white students, but they were more likely to report heroin use in absence of nonmedical opioid use. DISCUSSION: Recent and frequent nonmedical opioid use are risk factors for heroin use among adolescents. Prevention needs to be targeted to those at highest risk.

Aims: Alcohol and marijuana (cannabis) are the two most commonly used psychoactive drugs and each appears to have its own unique sexual effects on users. With marijuana use increasing in the United States, along with more liberal state-level policies, it is important to examine and compare sexual effects and sexual risk behavior associated with these drugs in order to inform prevention of HIV, other sexually transmitted infections and unplanned pregnancy. Methods: We conducted semi-structured interviews with 24 racially and ethnically diverse adults in New York City (mean age = 27.4, SD = 5.8). To be eligible, subjects must have (1) been between ages 18-35, (2) had sex while high on marijuana in the last 12 months, (3) had sex while not high on marijuana in the last 12 months; and (4) must not have used any other illicit drug in the last 12 months. All subjects self-identified as heterosexual and HIV-negative, and 50% were female. Results: Thematic analysis yielded various themes. Many subjects described differences between the two drugs with regard to interactions and contexts in use before sex, partner choice, perceived attractiveness of self and others, disinhibition, adverse sexual effects and sexual dysfunction, and dose effects. Differences were also commonly described regarding libido, length and intensity of sex and orgasm, specific sexual behaviors (including risk behavior), and feelings such as regret after sex. Compared to marijuana, alcohol was more likely to be associated with atypical partner choice and lead to regret. Illegality of marijuana sometimes facilitated intimate encounters. Conclusions: Results can inform prevention efforts regarding specific sexual risks and allow us to design more realistic prevention programs and interventions to guide potential users to make safer choices

The CHANGE (Cessation of Heroin: A Neighborhood Grounded Exploration) Study aimed to understand factors associated with the initiation and maintenance of sustained heroin cessation from the perspective of users themselves and specifically set out to document the correlates of natural recovery. The CHANGE Study was a case-control study conducted in New York City from 2009 to 2011. Cases were former heroin users, abstinent for 1-5 years in the past 5 years. Controls used heroin at least weekly during the past 5 years and were (1) continuous heroin users without a quit attempt of >/=2 weeks' duration or (2) relapsed heroin users who were currently using and had a quit attempt of >/=2 weeks' duration during the past 5 years. Recruitment and data collection methods are described along with limitations and a brief description of the study sample. In contrast to many studies of drug use and cessation, the CHANGE Study was designed to model success (i.e., initiation and maintenance of heroin cessation) and not failure.

BACKGROUND: In recent years, there has been an increase in emergence and use of novel psychoactive substances (NPS) in the US and worldwide. However, there is little published epidemiological survey data estimating the prevalence of use in the US. METHOD: Data on self-reported NPS use came from the National Survey of Drug Use and Health (2009-2013), a national representative sample of non-institutionalized individuals in the US. Subjects were asked to provide names of (non-traditional) drugs they used that they were not specifically asked about. We examined lifetime prevalence and sociodemographic correlates of self-reported use of new and uncommon synthetic drugs (NPS) among subjects ages 12-34-years-old. RESULTS: 1.2% of subjects self-reported any use of the 57 NPS we examined. Use of psychedelic tryptamines (primarily DMT) was most common, followed by psychedelic phenethylamines (e.g., 2C series) and synthetic cannabinoids. Prevalence of self-reported use of NPS increased from 2009 to 2013 and use was most common among males, whites, older subjects, those of lower income, and among those residing in cities. Lifetime use of various other illicit drugs (e.g., LSD, cocaine, ecstasy/MDMA) was highly prevalent among NPS users. CONCLUSION: This the first study reporting on use of a variety of NPS in a nationally representative US sample; however, use appears to be underreported as other national data suggest higher rates of NPS (e.g., synthetic cannabinoid) use. Developing more adaptable survey tools and systematically assessing NPS use would allow researchers to ask about hundreds of NPS and improve reporting as new drugs continue to rapidly emerge.

BACKGROUND AND OBJECTIVES: "Bath salts" are new drugs which have received extensive media attention. However, national studies in the US have not investigated prevalence or correlates of use. METHODS: Data were examined from Monitoring the Future, a representative sample of US high school seniors (2012-2013, N = 8,604). RESULTS: Only 1.1% of high school seniors used "bath salts" in the last year and the strongest correlate of use was use of other drugs. DISCUSSION AND CONCLUSIONS: "Bath salt" use is not very prevalent, but users of other drugs are at highest risk for use. SCIENTIFIC SIGNIFICANCE: We must continue to monitor new drugs in order to inform prevention and quickly detect potential epidemics. (Am J Addict 2015;XX:XX -XX).

Many breast cancer survivors have coexistent chronic diseases or comorbidities at the time of their cancer diagnosis. The purpose of the study was to evaluate the association of comorbidities on breast cancer survivors' quality of life. A prospective design was used to recruit 140 women before cancer surgery, 134 women completed the study. Comorbidities were assessed using self-report and verified by medical record review and the Charlson Comorbidity Index (CCI) before and 12-month after cancer surgery. Quality of life was evaluated using Short-Form Health Survey (SF-36 v2). Descriptive statistics, chi-square tests, t-tests, Fisher's exact test, and correlations were performed for data analysis. A total of 28 comorbidities were identified. Among the 134 patients, 73.8% had at least one of the comorbidities, 54.7% had 2-4, and only 7.4% had 5-8. Comorbidities did not change at 12 months after surgery. Numbers of comorbidities by patients' self-report and weighted categorization of comorbidities by CCI had a similar negative correlation with overall quality of life scores as well as domains of general health, physical functioning, bodily pain, and vitality. Comorbidities, specifically hypertension, arthritis, and diabetes, were associated with poorer quality of life in multiple domains among breast cancer survivors. Future research should consider the combined influence of comorbidity and cancer on patients' quality of life.

OBJECTIVES: Studies show that illicit cannabis (marijuana) use is related to use of other illicit drugs and that reasons for use are related to frequency of marijuana use. However, research is needed to examine whether specific reasons for marijuana use are associated with use of other illicit drugs. METHODS: Data from recent marijuana-using high school seniors were examined from 12 cohorts of Monitoring the Future (Weighted n = 6481) to examine whether reasons for recent marijuana use are associated with use of eight other illicit drugs. RESULTS: Using "to experiment" decreased odds of reporting use of each drug and using to decrease effects of other drugs increased odds of reporting use of each drug. In multivariable models, using marijuana "to experiment" decreased the odds for reporting use of hallucinogens other than LSD and narcotics other than heroin. Using marijuana for "insight" increased the odds for use of hallucinogens other than LSD, and use due to "boredom" increased the odds for reporting use of powder cocaine and hallucinogens other than LSD. Using marijuana to increase effects of other drugs increased odds of reporting use of each of the eight drugs, and using it to decrease other drug effects increased odds of reporting use of crack, hallucinogens other than LSD, and amphetamine/stimulants. CONCLUSIONS: This study helped identify illicit marijuana users who are more likely to report use of other illicit drugs. Prevention efforts need to focus on students who report certain reasons for marijuana use as they may be at risk for use of other illicit drugs.

At least half of the well-documented achievement gap for low-income Black children is already present in kindergarten, due in part to limited opportunities for acquiring foundational skills necessary for school success. There is some evidence that low-income minority children from immigrant families have more positive outcomes than their non-immigrant counterparts, although little is known about how the immigrant paradox may manifest in young children. This study examines foundational school readiness skills (academic and social-emotional learning) at entry into pre-kindergarten (pre-k) and achievement in kindergarten and second grade among Black children from low-income immigrant and non-immigrant families (N = 299). Immigrant and non-immigrant children entered pre-k with comparable readiness scores; in both groups, reading scores decreased significantly from kindergarten to second grade and math scores decreased significantly for non-immigrant children and marginally for immigrant children. Regardless of immigrant status, pre-k school readiness and pre-k classroom quality were associated with elementary school achievement. However, declines in achievement scores were not as steep for immigrant children and several predictive associations were moderated by immigrant status, such that among those with lower pre-k school readiness or in lower quality classrooms, immigrant children had higher achievement test scores than children from non-immigrant families. Findings suggest that immigrant status provides young Black students with some protection against individual- and classroom-level risk factors for early underachievement in elementary school.

BACKGROUND: Very brief single-item screening questions (SISQs) for alcohol and other drug use can facilitate screening in health care settings, but are not widely used. Self-administered versions of the SISQs could ease barriers to their implementation. OBJECTIVE: We sought to validate SISQs for self-administration in primary care patients. DESIGN: Participants completed SISQs for alcohol and drugs (illicit and prescription misuse) on touchscreen tablet computers. Self-reported reference standard measures of unhealthy use, and more specifically of risky consumption, problem use, and substance use disorders, were then administered by an interviewer, and saliva drug tests were collected. PARTICIPANTS: Adult patients aged 21-65 years were consecutively enrolled from two urban safety-net primary care clinics. MAIN MEASURES: The SISQs were compared against reference standards to determine sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for alcohol and drug use. KEY RESULTS: Among the 459 participants, 22 % reported unhealthy alcohol use and 25 % reported drug use in the past year. The SISQ-alcohol had sensitivity of 73.3 % (95 % CI 65.3-80.3) and specificity of 84.7 % (95 % CI 80.2-88.5), AUC = 0.79 (95 % CI 0.75-0.83), for detecting unhealthy alcohol use, and sensitivity of 86.7 % (95 % CI 75.4-94.1) and specificity of 74.2 % (95 % CI 69.6-78.4), AUC = 0.80 (95 % CI 0.76-0.85), for alcohol use disorder. The SISQ-drug had sensitivity of 71.3 % (95 % CI 62.4-79.1) and specificity of 94.3 % (95 % CI 91.3-96.6), AUC = 0.83 (95 % CI 0.79-0.87), for detecting unhealthy drug use, and sensitivity of 85.1 (95 % CI 75.0-92.3) and specificity of 88.6 % (95 % CI 85.0-91.6), AUC = 0.87 (95 % CI 0.83-0.91), for drug use disorder. CONCLUSIONS: The self-administered SISQs are a valid approach to detecting unhealthy alcohol and other drug use in primary care patients. Although self-administered SISQs may be less accurate than the previously validated interviewer-administered versions, they are potentially easier to implement and more likely to retain their fidelity in real-world practice settings.

BACKGROUND: The popularity of electronic dance music and rave parties such as dance festivals has increased in recent years. Targeted samples of party-goers suggest high rates of drug use among attendees, but few nationally representative studies have examined these associations. METHODS: We examined sociodemographic correlates of rave attendance and relationships between rave attendance and recent (12-month) use of various drugs in a representative sample of US high school seniors (modal age: 18) from the Monitoring the Future study (2011-2013; Weighted N=7373). RESULTS: One out of five students (19.8%) reported ever attending a rave, and 7.7% reported attending at least monthly. Females and highly religious students were less likely to attend raves, and Hispanics, students residing in cities, students with higher income and those who go out for fun multiple times per week were more likely to attend. Rave attendees were more likely than non-attendees to report use of an illicit drug other than marijuana (35.5% vs. 15.6%, p<0.0001). Attendees were more likely to report use of each of the 18 drugs assessed, and attendees were more likely to report more frequent use (>/=6 times) of each drug (ps<0.0001). Controlling for sociodemographic covariates, frequent attendance (monthly or more often) was associated with higher odds of use of each drug (ps<0.0001). Frequent attendees were at highest risk for use of "club drugs." DISCUSSION: Findings from this study can help inform prevention and harm reduction among rave attendees at greatest risk for drug use.