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1.  The Interacting Effect of Depressive Symptoms, Gender, and Distress Tolerance on Substance Use Problems among Residential Treatment-Seeking Substance Users 
Drug and alcohol dependence  2015;148:21-26.
Background
Depression is associated with substance use problems; however, the specific individual characteristics influencing this association are not well identified. Empirical evidence and theory suggest that gender and distress tolerance—defined behaviorally as an individual’s ability to persist in goal-directed behavior while experiencing negative affective states—are important underlying factors in this relationship. Hence, the purpose of the current study was to examine whether gender and distress tolerance moderate the relationship between depressive symptoms and substance use problems.
Methods
Participants included 189 substance users recruited from a residential substance abuse treatment center. The Short Inventory of Problems-Alcohol and Drugs scale was used to measure self-reported substance use problems. The Beck Depression Inventory was used to assess self-reported depressive symptoms. Gender was self-reported, and distress tolerance was behaviorally indexed by the Computerized Paced Auditory Serial Addition Task.
Results
Hierarchical linear regression analysis indicated a significant three-way interaction of depressive symptoms, gender, and distress tolerance on substance use problems, adjusting for relevant demographic variables, anxiety symptoms, impulsivity, as well as DSM-IV psychiatric disorders. Probing of this three-way interaction demonstrated a significant positive association between depressive symptoms and substance use problems among females with low distress tolerance.
Conclusion
Findings indicate that female treatment-seeking substance users with high levels of depressive symptoms exhibit greater substance use problems if they also evidence low distress tolerance. Study implications are discussed, including the development of prevention and intervention programs that target distress tolerance skills.
doi:10.1016/j.drugalcdep.2014.11.024
PMCID: PMC4345141  PMID: 25578252
Substance Abuse; Negative Affect; Depression; Inpatient Treatment
2.  Trait Aggression and Problematic Alcohol Use among College Students: The Moderating Effect of Distress Tolerance 
Alcoholism, clinical and experimental research  2013;37(12):10.1111/acer.12198.
Background
Trait aggression has been linked to alcohol-related problems among college students. However, the individual conditions underlying this association are unknown. Empirical evidence and theory suggest the importance of distress tolerance, defined as an individual’s ability to withstand negative affective states, in the relationship between trait aggression and alcohol use. Therefore, the purpose of the current study was to examine whether distress tolerance moderates the relationship between trait aggression and problematic alcohol use.
Methods
Participants were 646 undergraduate students in a large university, who reported any lifetime alcohol use. The dependent variable, problematic alcohol use, was measured using the Alcohol Use Disorders Identification Test (AUDIT) total score. The main independent variable, trait aggression, was assessed on the negative emotionality scale of the Multidimensional Personality Questionnaire (MPQ-NE), and the moderator, distress tolerance, was determined using the Distress Tolerance Scale (DTS).
Results
Hierarchical linear regression analyses indicated a significant interaction between trait aggression and distress tolerance in predicting problematic alcohol use, adjusting for demographic variables, regular substance use, depressive symptoms, and anxiety symptoms. Specifically, a significant positive relationship between trait aggression and problematic alcohol use was present among those with low, but not high, distress tolerance.
Conclusions
Results provide evidence that college students with high levels of trait aggression are more likely to engage in problematic alcohol use if they also evidence an inability to tolerate negative affective states. Study implications are discussed, including the development of prevention and intervention programs that target distress tolerance skills.
doi:10.1111/acer.12198
PMCID: PMC3844009  PMID: 23889266
Alcohol Use; Distress Tolerance; Trait Aggression
3.  The Role of Distress Tolerance in the Relationship between Depressive Symptoms and Problematic Alcohol Use 
Empirical evidence and theory implicate the role of distress tolerance in the relationship between negative affect and alcohol use. However, limited research has been conducted exploring these relationships. As such, the purpose of the current study was to examine whether distress tolerance moderates the relationship between current depressive symptoms and problematic alcohol use in a community sample of adults. Participants included 150 adults, primarily female, recruited from the local community. Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) total score which is a composite measure of harmful and hazardous patterns of alcohol use and several current alcohol dependence symptoms. Distress tolerance was measured using a computerized behavioral distress tolerance task, the Computerized Paced Auditory Serial Addition Task (PASAT-C). Tobit regression analyses indicated a significant interaction between distress tolerance and depressive symptoms in predicting alcohol problems, such that depressive symptoms were significantly associated with problematic alcohol use among adults with low, but not high, distress tolerance. Thus, alcohol use interventions with a focus on distress tolerance skills in the context of depressive symptoms may be particularly effective.
doi:10.1037/a0026386
PMCID: PMC3361547  PMID: 22121919
Alcohol Use; Distress Tolerance; Depressive Symptoms
4.  Attitudes about Violence and Involvement in Peer Violence among Youth: Findings from a High-Risk Community 
Peer violence perpetration and victimization are the most common types of violence among youth. This study determined the associations among violent attitudes toward peers, involvement in peer violence perpetration, and experience with peer violence victimization among boys and girls in a high-risk, urban community. Analyses were based on data from the 2004 Youth Violence Survey, which was administered to over 80% of public school students in grades 7, 9, 11, and 12 (N = 4,131) in a disadvantaged, urban, school district in the USA. Logistic regression analyses were conducted to test the associations between attitudes in support of violence and involvement in violent behaviors. Results show that among youth, attitudes supporting boys hitting boys significantly increased the odds of peer violence perpetration after controlling for potential confounders (adjusted odds ratio [AOR], 1.35; 95% confidence interval [CI] = 1.07, 1.72). However, stratified analyses for boys and girls show that attitudes supporting boys hitting boys increased the odds of peer violence perpetration for girls only after controlling for potential confounders (AOR, 1.49; 95% CI = 1.05, 2.13). The findings demonstrate that there are important differences between boys and girls in terms of their associations with violent attitudes and involvement in actual violent behaviors. However, additional research is needed to determine how attitude modifications can be incorporated into youth violence prevention programs.
doi:10.1007/s11524-011-9601-6
PMCID: PMC3232409  PMID: 21785901
Peer violence perpetration; Peer violence victimization; Urban; Adolescents
5.  Self-Harm and Suicide Attempts among High-Risk, Urban Youth in the U.S.: Shared and Unique Risk and Protective Factors 
The extent to which self-harm and suicidal behavior overlap in community samples of vulnerable youth is not well known. Secondary analyses were conducted of the “linkages study” (N = 4,131), a cross-sectional survey of students enrolled in grades 7, 9, 11/12 in a high-risk community in the U.S. in 2004. Analyses were conducted to determine the risk and protective factors (i.e., academic grades, binge drinking, illicit drug use, weapon carrying, child maltreatment, social support, depression, impulsivity, self-efficacy, parental support, and parental monitoring) associated with both self-harm and suicide attempt. Findings show that 7.5% of participants reported both self-harm and suicide attempt, 2.2% of participants reported suicide attempt only, and 12.4% of participants reported self-harm only. Shared risk factors for co-occurring self-harm and suicide attempt include depression, binge drinking, weapon carrying, child maltreatment, and impulsivity. There were also important differences by sex, grade level, and race/ethnicity that should be considered for future research. The findings show that there is significant overlap in the modifiable risk factors associated with self-harm and suicide attempt that can be targeted for future research and prevention strategies.
doi:10.3390/ijerph9010178
PMCID: PMC3315085  PMID: 22470286
self-harm; suicide attempt; youth; adolescents; U.S.; high-risk; school; cross-sectional
6.  Early alcohol use and problem drinking among students in Zambia and Uganda 
Excessive alcohol use is a serious public health concern worldwide, but less attention has been given to the prevalence, risk and protective factors, and consequences of early alcohol use in low-income, developing countries. The purpose of this study was to determine the associations between early alcohol use, before age 13, and problem drinking among adolescents in Uganda and Zambia. Data from students in Zambia (n=2257; 2004) and Uganda (n=3215; 2003) were obtained from the cross-sectional Global School-Based Student Health Survey (GSHS). The self-administered questionnaires were completed by students primarily 13 to 16 years of age. Multiple statistical models were computed using logistic regression analyses to test the associations between early alcohol initiation and problem drinking, while controlling for possible confounding factors (e.g., current alcohol use, bullying victimization, sadness, lack of friends, missing school, lack of parental monitoring, and drug use). Results show that early alcohol initiation was associated with problem drinking in both Zambia (AOR=1.28; 95% CI:1.02–1.61) and Uganda (AOR=1.48; 95% CI: 1.11–1.98) among youth after controlling for demographic characteristics, risky behaviors, and other possible confounders.The study shows that there is a significant association between alcohol initiation before 13 years of age and problem drinking among youth in these two countries. These findings underscore the need for interventions and strict alcohol controls as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth.
doi:10.4081/jphia.2011.e20
PMCID: PMC5345493  PMID: 28299061
alcohol use; problem drinking; Zambia; Uganda.
7.  Pre-Teen Alcohol Use as a Risk Factor for Victimization and Perpetration of Bullying among Middle and High School Students in Georgia 
Objective:
We examined the association between pre-teen alcohol use initiation and the victimization and perpetration of bullying among middle and high school students in Georgia.
Methods:
We computed analyses using data from the 2006 Georgia Student Health Survey (N=175,311) of students in grades 6, 8, 10 and 12. The current analyses were limited to students in grades 8, 10 and 12 (n=122,434). We used multilogistic regression analyses to determine the associations between early alcohol use and reports of both victimization and perpetration of bullying, perpetration only, victimization only, and neither victimization or perpetration, while controlling for demographic characteristics, other substance use, peer drinking and weapon carrying.
Results:
Pre-teen alcohol use initiation was significantly associated with both bullying perpetration and victimization relative to non drinkers in bivariate analyses (OR=3.20 95%CI:3.03–3.39). The association was also significant between pre-teen alcohol use initiation and perpetration and victimization of bullying in analyses adjusted for confounders (Adj.OR=1.74; 95%CI:1.61–1.89). Overall, findings were similar for boys and girls.
Conclusion:
Pre-teen alcohol use initiation is an important risk factor for both the perpetration and victimization of bullying among boys and girls in Georgia. Increased efforts to delay and reduce early alcohol use through clinical interventions, education and policies may also positively impact other health risk behaviors, including bullying.
PMCID: PMC3117606  PMID: 21731787
8.  Alcohol Marketing, Drunkenness, and Problem Drinking among Zambian Youth: Findings from the 2004 Global School-Based Student Health Survey 
This study examines the associations between alcohol marketing strategies, alcohol education including knowledge about dangers of alcohol and refusal of alcohol, and drinking prevalence, problem drinking, and drunkenness. Analyses are based on the Global School-Based Student Health Survey (GSHS) conducted in Zambia (2004) of students primarily 11 to 16 years of age (N = 2257). Four statistical models were computed to test the associations between alcohol marketing and education and alcohol use, while controlling for possible confounding factors. Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR = 1.49; 95% CI: 1.09–2.02) and problem drinking (AOR = 1.41; 95% CI: 1.06–1.87) among youth after controlling for demographic characteristics, risky behaviors, and alcohol education. However, alcohol education was not associated with drunkenness or problem drinking. These findings underscore the importance of restricting alcohol marketing practices as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth.
doi:10.1155/2011/497827
PMCID: PMC3103909  PMID: 21647354

Results 1-8 (8)