Search

among people living with HIV in St. Petersburg, Russia since early in the Russian HIV epidemic. Methods:Weexamined data from fourNIH-supported research studies conducted in St. Petersburg, Russia from 2004 to 2014. We included current HIV-infected opioid users from PREVENT (2004–2005, n=17), HERMITAGE (2007–2010, n=281), LINC (2013–2014, n=119) and ARCH (2012–2014, n=91) studies. Descriptive statistics were calculated for key demographic variables. Recent use (i.e., past 30 days) of heroin and other opioidswas assessed in each cohort with either the Addiction Severity Index, Timeline Follow Back or modified Risk Behavior Survey. Results: These studies included members of similar birth cohorts (mean age was 24.5 years in 2004 and 33.7 in 2014). Use of any illicit opioids other than heroin increased from 6% (95% CI 0.15–29%) in 2004–2005 to 30% (95% CI: 25–36%) in 2007–2010 to 73% (95% CI: 63–82%) in 2012–2014, where– as use of any heroin decreased from 100% (95% CI: 80–100%) in 2004–2005 to 96% (95% CI: 93–98%) in 2007–2010 to 65% (95% CI: 55–75%) in 2012–2014. Conclusions: Among HIV-infected opioid users from St. Petersburg, Russia, many of whom were born around 1980, illicit use of opioids other than heroin appears to have eclipsed heroin use in the current era. Financial support: R21AA014821, R01AA016059, R01DA032082, U01AA020780, U24AA020779, and U24AA020778.

Statement of purpose Sexting by youth has recently garnered much attention in popular media; and although some prior literature has begun to describe sexting experiences, limited research has been conducted among African American youth. Methods/approach Participants 14–20 years old were screened at an urban Emergency Department based on home address, as part of a larger intervention study. Participants self-administered a computerised survey consisting of validated measures for dating violence (CADRI), substance use (ASSIST), social support (MSPSS), and mindfulness (CAMM). “Sexting,” defined as using digital media (cell phones, social media, etc.) to “send, receive, and post online sexually suggestive (sexy), nude, or nearly nude pictures or video,” was adapted from 6-measures used in prior literature. Bivariate and Multivariate analyses were conducted predicting “Sexting” behaviour Results 335 youth were surveyed; 43.3% reported sexting behaviours/experiences in the past 2 months (55% female, 92% African American, 78% public assistance). Males were more likely to report sending (OR = 1.67) and posting sexually suggestive images of themselves (OR = 2.38), and were more likely to report having someone post these images of them online (OR = 2.22). Most reported sending/posting sexts to flirt (56.6%), with females more likely to endorse this behaviour (73.8%). Regression analyses found that physical dating violence (OR = 2.39), substance use (OR = 2.76), and more time on social network sites (OR = 1.09) were predictive of sexting behaviour; while higher mindfulness scores (OR = 0.97) and more social support (OR = 0.98) were protective against sexting involvement. Conclusions Sexting is common among high-risk youth, and while a youth’s motivation for sexting is often positive, “Sexting” behaviour is also associated with other high-risk behaviours, including dating violence and substance use. Additional research is needed to develop and implement potential interventions. Significance and contributions This study of sexting experiences is the first, to our knowledge, to be conducted in a non-school-based, predominantly African American youth population.

Aims: Consumption of alcohol mixed with energy drinks by young people presents concerns about the effects on perceived intoxication and risk behaviors. Emergency Department (ED) visits due to energy drinks have risen drastically. Among youth with past-year alcohol use who visited an ED, we assessed frequency of consuming alcohol mixed with energy drinks or consuming both on the same occasion (Combined), reasons for and consequences of Combined use, and relationships with drug use and other risk behaviors. Methods: Youth aged14–20 completedpast-year surveys at the ED visit. Among 439 drinkers, mean age was 18.6 years (SD=1.4), 41% were male and 73% were Caucasian. We grouped patients into those who drank alcohol, but not energy drinks (Non-users; 41%, n=178), those who drank alcohol and energy drinks on separate occasions (Separate; 23%, n=103), and those who Combined (36%, n=158). Results: In Combined users, consequences included feeling jittery (71%), trouble sleeping (46%), and increased energy followed by a crash (35%). Reasons for combining were: hiding the flavor of alcohol (39%), liking the taste (36%), and staying awake (32%). Combined users had the highest rates of risk behaviors (e.g., drug use, multiple sex partners, sex after drinking, driving after drinking, alcohol use severity [AUDIT]). Multinomial logistic regression indicated that compared to Non-users, Combined users were more likely to bemale, have had sex after using alcohol/drugs, have used drugs, and have higher AUDIT scores. Combined users, compared to the Separate users, had significantly higher AUDIT scores. Separate users compared to Non-users weremore likely to bemale, and had lower AUDIT scores. Conclusions: Combining energy drinks and alcohol use is a marker for involvement in other risk behaviors among drinking youth. Future longitudinal studies are needed to determine longitudinal relationships of energy drink use on substance use problem trajectories. Financial support: NIAAA 018122.

being significant (p=0.015). Patients reporting substance use were also less likely to be consistent condom users. Conclusions: This study suggests that adolescents self-referring to an adolescent health clinic are likely to engage in multiple risk behaviors and involvement in sexual risky behavior is related to substance use. Therefore, there is a significant need for medical providers to screen adolescents for both sexual risk behaviors and substance use, which provides an opportunity for comprehensive care. Financial support: NIDA R34DA031806.

Aims: Abused drugs activate dopaminergic (DA) “reward” regions (dorsal and ventral striatum, midbrain), promoting further drug-taking. While adverse effects lead most adolescents to limit risky drug use, some with genetic vulnerabilities to substance use disorders (SUD) and conduct problems, undeterred by risks, press on, developing SUD. We asked: (1) is the enhanced vulnerability of those youths mediated by excess reward-system activity, or by deficient inhibition of risky behaviors; (2) do those mechanisms differ by gender? Methods: Our fMRI analyses of 41 adolescent patients with severe SUD and conduct problems (20 males) and 40 comparison youths (20 males) continue. In each of 90 risky-decision trials youths decided between pressing a cautious button to earn 1 cent, or a risky one that either won 5 or lost 10 cents. Riskypress “win” odds gradually fell from 0.78 to 0.22. We analyzed brain activity during 4-sec pre-response deliberations with voxel-level and cluster-level FWE correction before risky, and separately before cautious, presses. Results: Making cautious responses required inhibiting the more-rewarded risky ones; to do so, bothmale and female comparison youths significantly activated frontopolar, temporal, parietal, or cerebellar regions, or DLPFC, more than patients; the regions differed by gender. No group activated DA regions before cautious responses. Before risky responses all four groups showed reward anticipation, activating DA regions. Comparison boys activatedmanymore, andcomparisongirlsmany fewer,DAvoxels than patients, but those differences were not statistically significant. Conclusions: Patients’ DA regions did not differ significantly from comparison youths’ at the power available here. Before cautious responses comparison youths more than patients activated other regions that may sustain cautious decisions despite temptations (e.g., drug availability, peer pressure). Those control-related regions may underlie patients’ and healthy youths’ differing vulnerabilities to SUD. Financial support: NIDA DA 011015; Kane Family Foundation.

The purpose of the study was to examine the rates and inter-relationships among violence receipt, alcohol use problems, and depression in women seeking prenatal care. While waiting for their prenatal care appointment, women (n = 1054) completed measures of past year partner and non-partner violence receipt, alcohol misuse (TWEAK and quantity and frequency of alcohol use in past year), and depression (Center for Epidemiological Studies Depression Scale - CESD and prior history of depression). Over 30% of women reported either violence receipt, alcohol use problems or depression risk. Significant inter-relationships among all measured risk variables were found. Although violence receipt was significantly related to alcohol misuse, cigarette use, less education, and scoring above the cutoff on the CESD (>/= 16) was most strongly associated with violence. Practitioners should be well-equipped to provide assessment, interventions, or referrals as needed to the high numbers of women encountered in prenatal care settings experiencing psychosocial and behavioral problems that may affect their pregnancy.

Objective To examine rates and correlates of self-reported perpetrated violence among teens presenting to an urban emergency department. Study design Cross-sectional study of a consecutive sample of youth (12-17 years) presenting to an urban emergency department. The youth were surveyed about demographics, community violence exposure, parental monitoring, substance use, weapon carriage, group fighting, and aggression (past 12 months). Bivariate and multivariate analyses were performed to identify correlates of the severity of the violence (none, moderate, or severe) perpetrated in the past year. Results A total of 115 youth were surveyed (males, 47%; response rate, 85%). The sample group was 51% African American. A total of 77% of the youth reported that they perpetrated violence in the past year, with 37% reporting severe violence (use of a weapon, group fighting, causing an injury requiring medical care). All patients who self-reported perpetrating severe violence in the past year were discharged home from the emergency department. The diagnosis made in the emergency department (illness versus injury) was not associated with the violence perpetrated in the past year. Sex was not a significant predictor of severe perpetrated violence. Conclusions Youth presenting to urban emergency departments report high rates of perpetrating violence in the past year that, on the basis of other studies, is likely to continue. These results suggest that future emergency department-based violence prevention efforts should consider universal screening of adolescents.

Objectives: This report examines the sociodemographic and substance use characteristics, co-occurring psychological status, substance abuse consequences, and prior experiences with substance abuse treatment among patients with cocaine-associated chest pain presenting to an emergency department chest pain observation unit. Methods: This was a consecutive cohort of patients in the emergency department chest pain observation unit aged 18–60 years with low to moderate risk for acute coronary syndrome and recent cocaine use. Responses on standardized and validated instruments were used to examine demographic and clinical characteristics of the sample and to compare patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for past three-month substance abuse or substance dependence with patients who did not. Results: Of 145 eligible patients identified between June 1, 2002, and February 29, 2004, 86% met criteria for a lifetime DSM-IV substance use disorder and 50% met past three-month criteria. Approximately one half of the total sample reported substantial symptoms of depression. Substance use frequency and consequences, depression, and psychological distress were significantly more severe among those with past three-month substance use diagnoses; however, most sociodemographic characteristics were not associated with substance use diagnoses. Interest in treatment services and treatment history was also significantly associated with the presence of a substance use disorder diagnosis. Conclusions: Findings regarding diversity in alcohol and drug involvement, current level of psychological functioning, depressive symptomatology, and interest in treatment services provide useful information for designing emergency department–based interventions for this population. Key words: cocaine; chest pain; emergency department; demography; substance-related disorders; behavioral symptoms. ACADEMIC EMERGENCY MEDICINE 2005; 12:329–337.

Adolescents seen in an urban Emergency Department (ED) are more likely to die from violence than from any other illness or condition for which they seek care in the ED. Most injured patients presenting to our nation's EDs are treated and released, even after a firearm-related injury. These youth who are discharged from the ED will not interface with resources on the inpatient trauma unit. The current standard of care in the ED involves no referral for violence-related prevention services. Despite the fact that ED physicians and nurses frequently medically manage victims of violent assault, there are few courses on youth violence prevention (YVP) framed from the viewpoint of emergency healthcare providers, and ED staff remain relatively uneducated as a specialty on the identification, assessment, and referral resources available for early intervention and prevention. This article focuses on the development and in-depth description of a case-based, 1-hour continuing medical education presentation for ED physicians, residents, and nursing staff on YVP. This presentation is aimed to increase awareness of the role of ED personnel in YVP and to provide basic knowledge and skills needed to begin to incorporate YVP into routine clinical practice in an Emergency Department setting.

This study examined the relationships among distal (paternal and maternal family history of alcohol problems and violence) and proximal (general alcohol use, acute use associated with conflict incidents, alcohol-aggression expectancies) factors and physical aggression severity among 125 men and 125 women recruited from substance abuse treatment. Paternal alcohol problem history (PA) was related to alcohol-aggression expectancies, but no family history factors were related to general or acute alcohol use. Separate analyses examining predictors of aggression were conducted, one with general alcohol use and one with acute alcohol use. In both analyses, alcohol use and the maternal violence (MV) by PA interaction were significant. Specifically, MV was associated with aggression severity for those with a history of PA. The general alcohol use model also revealed significant alcohol by expectancy and MV by gender interactions. The findings suggest that expectancies are not the primary mediator of the alcohol-aggression relationship, alcohol use measurement issues may impact whether expectancies are observed to moderate the alcohol-aggression relationship, and that both maternal and paternal family history factors appear to impact aggression severity.

To compare the characteristics and rates of at-risk drinking among patients presenting to the emergency department (ED) with occupational and nonoccupational injury.Cross-sectional survey of injured patients presenting to a university hospital ED. Injured patients were prospectively identified, and consenting patients completed a survey including questions regarding quantity/frequency of alcohol use, TWEAK, CAGE, and work-relatedness of injury. Major trauma and motor-vehicle collisions were excluded. Demographic and injury information was obtained from the medical record. Patients with a TWEAK scoreor =3, CAGE scoreor =2, or who exceeded NIAAA quantity/frequency guidelines were defined as at-risk drinkers. Analysis utilized the Student t-test for continuous variables, and frequency and chi-square analysis for categorical variables.Among 3,476 enrolled patients, 766 (22%) had work injuries and 2,710 (78%) had nonwork injuries. Patients with work injuries were as likely as patients with nonwork injuries to be at-risk drinkers; 35% of patients with an occupational injury and 36% of those with a nonoccupational injury were at-risk drinkers (odds ratio = 0.96).Patients presenting to the ED with an occupational injury have rates of at-risk drinking similar to other injury patients, and may be an important group in which to target brief alcohol interventions.

This study evaluated a sample of emergency department (ED) patients for history of violence and substance abuse.Injured patients (n = 320) completed questionnaires (14% refusal rate) during a visit to a Level 1 urban ED after an acute injury. Specific questions were asked regarding whether the injury was related to acute violence (AV), whether there was past-year violence history (VH), including violence victimization and perpetration in both partner and nonpartner relationships, as well as any substance use in the past month and any substance-related consequences in the past year.Fourteen percent of the participants presented with an AV-related injury, and 53% reported VH. Most AV patients (89%) reported VH. No significant differences were found between the participants with AV and VH in demographic, substance use, or substance-related consequences. The AV and VH groups were combined (V), with analyses comparing these participants with those without AV and VH. Men were significantly more likely than women to report V (odds ratio = 2.0). V was significantly related to substance use and substance-related consequences. For example, in comparison with the participants reporting no alcohol or drug use, those reporting illicit drug use were 6.2 times as likely to report V, and those drinking any alcohol only were 2.0 times as likely to report V.A large percentage of injured patients in this urban ED experienced violence in the past year. Alcohol and illicit drugs appear to be concomitant with violence.

The purpose of this study was to identify individual and social/environmental predictors of alcohol and drug use 2 years following substance abuse treatment. Participants (n=180) self-administered questionnaires within their first month of substance abuse treatment and completed a 2-year follow-up interview. Individual factors (coping, self-efficacy, resource needs, and expectations for sober fun), social/environmental factors (craving, exposure, negative social influences, and involvement in substance-using leisure activities), and background characteristics measured during treatment were used to predict alcohol and drug use during a 2-year follow-up using manifest variable regression analysis. Results suggest that poorer self-efficacy, greater involvement in substance-using leisure activities, being single, and less income predicted alcohol use directly, whereas greater resource needs and involvement in substance-using leisure activities, being of minority status, and being single predicted drug use directly. Income, gender, problem severity, marital status, and race also predicted alcohol and drug use indirectly. Findings highlight differential predictors of posttreatment substance use that may be useful in developing alternative approaches to prevent relapse.

This study examined different types of violence (i.e. 'expressed' towards others and 'received' from others) across different relationship types (i.e. 'partners' and 'non-partners') among men and women in substance abuse treatment, and during a 2-year follow-up period. For received violence, participants were divided into three groups: no-violence before or after treatment, violence before treatment only, and violence both before and after treatment. Similarly, participants also were divided into three groups based on expressed violence: no-violence before or after treatment, violence before treatment only, and violence both before and after treatment. Both expressed and received violence (either before or after treatment) was associated with younger age. Unique demographic markers of received violence included being female, reporting less income and greater unemployment. For both received and expressed violence, several problem severity indicators (e.g. drug consequences, psychological distress) and psychosocial relapse risk indicators (e.g. resource needs, substance-using leisure activities) differentiated those who reported violence (either before or after treatment) and those who did not report violence. In addition, received violence was related to greater exposure to substances whereas expressed violence was related to greater cocaine use and craving. Continued received and expressed violence post-treatment was related to substance use during the follow-up, recruitment from inpatient treatment, and baseline psychological distress (expressed violence only). The results are consistent with contemporary models of violence specifying the impact of substance use, social/contextual and individual difference factors, and highlight risk factors that could be targeted during treatment to potentially reduce post-treatment substance use and violence.

Previous work in the field of substance use/misuse has suggested that client beliefs about addiction are quite diverse, and may influence the effectiveness of various treatment approaches. This paper presents an Addiction Belief Inventory (ABI) that was developed and evaluated to assess personal beliefs about addiction and substance use problems. The ABI is a 40-item instrument developed using two clinical samples: an alcohol user treatment group (N = 134) and a dual diagnosis treatment group (N = 536). Confirmatory factor analysis revealed seven stable subscales: inability to control, chronic disease, reliance on experts, responsibility for actions, responsibility for recovery, genetic basis, and coping. Multivariate analyses provided preliminary reliability and validational support. The utility of the ABI for clinical and research purposes is discussed, along with suggestions for future research and improvements to the instrument.

Violent injury is a leading cause of morbidity for urban teens and is often associated with alcohol misuse. Objectives We hypothesize that universal computer screening of teens in an urban ED, followed by a brief intervention (BI) for violence will be well received by teens and effective at changing attitudes towards violence and alcohol. Methods Findings from the recruitment phase of a randomized controlled trial are reported. Patients age 14-18 on 3-11 shift, 7 days/wk at a Urban Level 1 ED from Sept-Nov 2006 were approached to complete a computerized survey of risk behaviors including violence and alcohol use. Teens who presented with suicide attempt, sexual assault, or unstable vitals were excluded. Measures: recruitment rates, alcohol, violence and weapon carriage attitudes and behaviors, and BI process questions. Teens with past year violence-alcohol use were randomly assigned to control group, or 30-min interactive BI delivered by computer or research therapist containing: review of goals, tailored feedback on risk behaviors, role plays for practicing risk reduction, and referrals. Results 353 eligible teens were approached, 290 were screened (18% refused): 48% male; 50% African American; and 39% injured/61% medical. Seventy teens (24%) met risk/eligible criteria for BI of which 64 (91%) completed the BI prior to ED discharge: 18 computer, 25 therapist, 19 control. Immediate computerized post-test indicated 81% "liked" the BI, 26% noting they "liked it a lot". Few teens required assistance with computer survey (6%) or intervention (2%). Paired t-tests found significant reduction pre/post in alcohol (p < 0.001), violence (p < 0.001), and weapon carriage (p < 0.001) attitudes. Conclusions This study found universal computerized screening and BI during an ED visit is feasible, well-received and effective at changing violence and alcohol attitudes. Further work is needed to evaluate the effectiveness of the BI on reducing violent behavior among urban teens in the ED. Language: en

Studies examining follow-up contact difficulty provide useful information for planning longitudinal studies and for assessing the validity of follow-up data. Contact difficulty was examined among 96 substance abusers following substance abuse treatment. Interview completion rates at the 3-month and 6-month follow-ups were 93 and 97%, respectively. The extent of contact efforts required to complete follow-up interviews varied substantially but tended to be greater at the 3-month follow-up than at the 6-month follow-up. Contact difficulty was related to reuse of substances at the 3-month and at the 6-month follow-ups with reusers requiring greater contact efforts than abstainers. None of the baseline individual and contextual variables examined significantly predicted level of contact effort at follow-ups. Attrition-related validity implications are discussed along with practical suggestions for planning tracking efforts.

Despite addiction theorists' acknowledgment of the impact of environmental factors on relapse, researchers have not adequately investigated these influences. Ninety-six substance users provided data regarding their perceived risk for relapse, exposure to substances, and involvement in reinforcing activities. These three setting attributes were assessed in their home, work, and community settings. Reuse was assessed 3 months later. When controlling for confounding variables, aspects of the home settings significantly distinguished abstainers from reusers; perceived risk for relapse was the strongest predictor of reuse. Exposure to substances and involvement in reinforcing activities were not robust reuse indicators. The work and community settings were not significant determinants of reuse. These findings offer some initial support for the utility of examining social settings to better understand addiction relapse and recovery. Identification of setting-based relapse determinants provides concrete targets for relapse prevention interventions.

Context Emergency department (ED) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury. Objective To determine the efficacy of brief interventions addressing violence and alcohol use among adolescents presenting to an urban ED. Design, Setting, and Participants Between September 2006 and September 2009, 3338 patients aged 14 to 18 years presenting to a level I ED in Flint, Michigan, between 12 PM and 11 PM 7 days a week completed a computerized survey (43.5% male; 55.9% African American). Adolescents reporting past-year alcohol use and aggression were enrolled in a randomized controlled trial (SafERteens). Intervention All patients underwent a computerized baseline assessment and were randomized to a control group that received a brochure (n = 235) or a 35-minute brief intervention delivered by either a computer (n = 237) or therapist (n = 254) in the ED, with follow-up assessments at 3 and 6 months. Combining motivational interviewing with skills training, the brief intervention for violence and alcohol included review of goals, tailored feedback, decisional balance exercise, role plays, and referrals. Main Outcome Measures Self-report measures included peer aggression and violence, violence consequences, alcohol use, binge drinking, and alcohol consequences. Results About 25% (n = 829) of screened patients had positive results for both alcohol and violence; 726 were randomized. Compared with controls, participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression (therapist, −34.3%; control, −16.4%; relative risk [RR], 0.74; 95% confidence interval [CI], 0.61-0.90), experience of peer violence (therapist, −10.4%; control, +4.7%; RR, 0.70; 95% CI, 0.52-0.95), and violence consequences (therapist, −30.4%; control, −13.0%; RR, 0.76; 95% CI, 0.64-0.90) at 3 months. At 6 months, participants in the therapist intervention showed self-reported reductions in alcohol consequences (therapist, −32.2%; control, −17.7%; odds ratio, 0.56; 95% CI, 0.34-0.91) compared with controls; participants in the computer intervention also showed self-reported reductions in alcohol consequences (computer, −29.1%; control, −17.7%; odds ratio, 0.57; 95% CI, 0.34-0.95). Conclusion Among adolescents identified in the ED with self-reported alcohol use and aggression, a brief intervention resulted in a decrease in the prevalence of self-reported aggression and alcohol consequences. Trial Registration clinicaltrials.gov Identifier: NCT00251212