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1.  Self-Reported Age of Onset and Telescoping for Cigarettes, Alcohol, and Marijuana Across Eight Years of the National Longitudinal Survey of Youth 
Smoking, drinking, and illicit drug use are leading causes of morbidity and mortality, both during adolescence as well as later in life. Although for some adolescents, substance use may last for only a brief period of experimentation, use of these substances in adolescence may have negative consequences. The determination of how well national and local policy and intervention efforts address teen substance use depends largely on the collection of valid and accurate data. Assessments of substance use rely heavily on retrospective self-report measures. The reliability and validity of self-reported substance use measures, however, may be limited by various sources of measurement error. This study utilizes four waves of data from the National Longitudinal Survey of Youth spanning eight years. Our wave-to-wave analyses examined the accuracy of self-reported age of onset for cigarette, alcohol and marijuana users. Findings indicate that approximately one-fourth of cigarette users, one-fifth of alcohol users and one-third of marijuana users reported their age of onset exactly the same across waves. Of those who reported the age of onset inaccurately, the error tended to be in the direction of reporting their age of onset as older at a latter wave relative to what was reported previously, known as forward telescoping. Results from multiple linear regression analyses showed that the single most consistent variable associated with telescoping was the number of years since the substance was first reported. Time since first report was the single consistent and strongly associated with telescoping in each wave-to-wave comparison for all three substances under study. Implications for policy and research are discussed.
doi:10.1080/1067828X.2012.710026
PMCID: PMC3532889  PMID: 23284228
2.  Evaluation of California's Alcohol and Drug Screening and Brief Intervention Project for Emergency Department Patients 
Introduction: Visits to settings such as emergency departments (EDs) may present a “teachable moment” in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an 'opportunistic' public health approach that targets low-risk users, in addition to those already dependent on alcohol and/or drugs. SBIRT programs provide patients with comprehensive screening and assessments, and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use.
Methods: This study used a single group pre-post test design to assess the effect of the California SBIRT service program (i.e., CASBIRT) on 6 substance-use outcomes (past-month prevalence and number of days of binge drinking, illegal drug use, and marijuana use). Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers (regardless of the reason for the patient's visit) using a short instrument, and then delivered a brief motivational intervention matched to the patient's risk level. A total of 2,436 randomly selected patients who screened positive for alcohol and/or drug use consented to be in a 6-month telephone follow-up interview. Because of the high loss to follow-up rate, we used an intention-to-treat approach for the data analysis.
Results: Results of generalized linear mixed models showed modest reductions in all 6 drug-and alcohol-use outcomes. Men (versus women), those at relatively higher risk status (versus lower risk), and those with only one substance of misuse (versus both alcohol and illicit drug misuse) tended to show more positive change.
Conclusion: These results suggest that SBIRT services provided in acute care settings are associated with modest changes in self-reported recent alcohol and illicit drug use.
doi:10.5811/westjem.2012.9.11551
PMCID: PMC3656708  PMID: 23687546
3.  Predictors of Weapon Carrying in Youth Attending Drop-in Centers 
Objective
To test and compare 2 predictive models of weapon carrying in youth (n=308) recruited from 4 drop-in centers in San Diego and Imperial counties.
Methods
Both models were based on the Behavioral Ecological Model (BEM).
Results
The first and second models significantly explained 39% and 53% of the variance in weapon carrying, respectively, and both full models shared the significant predictors of being black(−), being Hispanic (−), peer modeling of weapon carrying/jail time(+), and school suspensions(+).
Conclusions
Results suggest that the BEM offers a generalizable conceptual model that may inform prevention strategies for youth at greatest risk of weapon carrying.
PMCID: PMC3519928  PMID: 19320622
weapon carrying; risk factors; protective factors; adolescents; drop-in centers
4.  Typologies of Recanting of Lifetime Cigarette, Alcohol and Marijuana Use During a Six Year Longitudinal Panel Study 
Drug and alcohol dependence  2011;118(2-3):134-140.
AIM
To identify if there are different typologies for adolescent self-reporters and recanters for alcohol, cigarette and marijuana use.
METHODS
This study is a secondary data analysis and utilized four waves the National Longitudinal Survey of Youth child panel data. The study included adolescents aged ten and older who self-reported ever use of cigarettes (N=872), marijuana (N=854) or alcohol (N=837). Consistent responders were those who reported lifetime use of a specific substance and continued to report such use at each latter wave of data collection. Latent class analyses were utilized to investigate if there are different types of self-reporters for each substance class.
RESULTS
Three unique groups for each substance was identified. The first group of users, who had a late age of onset, tended to be consistent self-reporters across waves. Those who were early onset users of cigarettes and marijuana tended to recant their use while early onset alcohol users were consistent reporters. Those with moderate ages of onset had no consistent recanting patterns. The highest degree of recanting was found among the early onset marijuana users.
CONCLUSIONS
The results suggest that youth who begin their use at an earlier age may not be as reliable reporters as youth who initiate use at later ages. Our results suggest the veracity of prevalence estimates for licit and illicit substances could be different depending on the age of the respondent.
doi:10.1016/j.drugalcdep.2011.03.009
PMCID: PMC3164929  PMID: 21524861
5.  The Stability of Self-Reported Marijuana Use Across Eight Years of the National Longitudinal Survey of Youth 
Introduction
This study examined teen marijuana report stability over eight years. The stability of self-reports refers to the consistency of self-reported use across several years.
Method
This study used fives waves of data across eight years from the National Longitudinal Survey of Youth. Analyses were conducted to examine the internal or within wave consistency as well as external or across waves consistency for self-reported marijuana use. Further tests were conducted to identify if there were any differences for age, ethnicity and sex for report consistency.
Results
Report stability was higher for lifetime use reports than the age of onset reports. Wave-by-wave differences revealed stability remained at acceptable levels in nearly all comparisons at agreement being about 75%. Overall, report agreement was higher for females, older adolescents, and Non-Hispanic/Non-Black youth in bivariate analyses. However, only older chronological age remained consistently significantly associated with better report stability in multiple logistic regression models. Implications regarding misclassification of users for prevention programs and measurement issues are discussed.
PMCID: PMC3269314  PMID: 22308063
Measurement; Report Stability; Reliability; Marijuana
6.  Prevalence and Correlates of ‘Agua Celeste’ Use among Female Sex Workers who Inject Drugs in Ciudad Juarez, Mexico 
Drug and alcohol dependence  2011;117(2-3):219-225.
Background
Agua celeste, or “heavenly water,” is the street name for a sky-blue colored solvent reportedly inhaled or ingested to produce an intoxicating effect. Study aims were to (1) describe prevalence of Agua Celestse (AC) use, and (2) identify correlates of lifetime and recent use of AC use among female sex workers who also inject drugs (FSW-IDUs) in northern Mexico.
Methods
Between 2008 and 2010, baseline data from FSW-IDUs ≥ 18 years old living in Tijuana or Ciudad Juarez participating in a longitudinal behavioral intervention were analyzed using logistic regression.
Results
Among 623 FSW-IDUs (307 from Tijuana and 316 from Ciudad Juarez (CJ)), 166 (26%) reported ever using AC, all of whom lived in CJ. Among the CJ sample, lifetime prevalence of AC use was 53%, median age of first use was 16 years (IQR: 14–23), and 10% reported it as their first abused substance. Ever using AC was independently associated with ever being physically abused and younger age, and was marginally associated with initiating injection drug use and regular sex work at age eighteen or younger. Among those ever using AC, 70/166 (42.2%) reported using it within the last 6 months, which was independently associated with using drugs with clients before or during sex, being on the street more than 8 hours per day, and younger age.
Discussion
We observed considerable geographic variation in the use of AC in northern Mexico. Future studies exploring factors influencing use, its precise formulation(s), and its potential health effects are needed to guide prevention and treatment.
doi:10.1016/j.drugalcdep.2011.02.007
PMCID: PMC3148352  PMID: 21441001
Inhalant abuse; female sex workers; injection drug use; agua celeste; Mexico
7.  Predictors and effects of alcohol use on liver function among young HCV-infected injection drug users in a behavioral intervention 
Journal of hepatology  2010;55(1):45-52.
Background & Aims
Hepatitis C virus (HCV) screening can provide opportunities to reduce disease progression through counseling against alcohol use, but empirical data on this issue are sparse. We determined the efficacy of a behavioral intervention in reducing alcohol use among young, HCV-infected injection drug users (IDUs) (n=355) and assessed whether changes in liver enzymes were associated with changes in alcohol consumption.
Methods
Both the intervention and attention-control groups were counseled to avoid alcohol use, but the intervention group received enhanced counseling. Logistic regression, ANOVA, and continuous time Markov models were used to identify factors associated with alcohol use, changes in mean ALT and AST levels and change in alcohol use post-intervention.
Results
Six months post-intervention, alcohol abstinence increased 22.7% in both groups, with no difference by intervention arm. Transition from alcohol use to abstinence was associated with a decrease in liver enzymes, with a marginally greater decrease in the intervention group (p=0.05 for ALT; p=0.06 for AST). In multivariate Markov models, those who used marijuana transitioned from alcohol abstinence to consumption more rapidly than non-users (RR=3.11); those who were homeless transitioned more slowly to alcohol abstinence (RR=0.47); and those who had ever received a clinical diagnosis of liver disease transitioned more rapidly to abstinence (RR=1.88).
Conclusions
Although, behavioral counseling to reduce alcohol consumption among HCV-infected IDUs had a modest effect, reductions in alcohol consumption were associated with marked improvements in liver function. Interventions to reduce alcohol use among HCV-infected IDUs may benefit from being integrated into clinical care and monitoring of HCV infection.
doi:10.1016/j.jhep.2010.10.028
PMCID: PMC3094600  PMID: 21145862
8.  Testing the Length of Time Theory of Recall Decay: Examining Substance Use Report Stability With 10 Years of National Longitudinal Survey of Youth Data 
Substance use & misuse  2011;46(9):1105-1112.
Aim
This article examines whether the proportion of recanters increases (or decreases) as a function of time o test length of time theory.
Sample
2,221 US respondents in the National Longitudinal Survey of Youth child data. Bivariate and logistic regression analyses were used.
Results
Among recanters, 50% of cigarette and alcohol users recanted use by 4 years, and 50% of marijuana users recanted by 3 years. Predictors of recanting was being Black or Hispanic and younger age. The theory was not supported. Further research is needed to identify potential reasons why adolescents recant their use is such a short time span. The study’s limitations are noted.
doi:10.3109/10826084.2010.548436
PMCID: PMC3112355  PMID: 21406007
adolescent; self-report stability; alcohol; cigarette; marijuana; recanting; measurement; theory
10.  Does Proximity to Retailers Influence Alcohol and Tobacco Use Among Latino Adolescents? 
Despite decades of research surrounding determinants of alcohol and tobacco (A&T) use among adolescents, built environment influences have only recently been explored. This study used ordinal regression on 205 Latino adolescents to explore the influence of the built environment (proximity to A&T retailers) on A&T use, while controlling for recognized social predictors. The sample was 45% foreign-born. A&T use was associated with distance from respondents’ home to the nearest A&T retailer (−), acculturation (+), parents’ consistent use of contingency management (−), peer use of A&T (+), skipping school (+), attending school in immediate proximity to the US/Mexico border (+), and the interaction between the distance to the nearest retailer and parents’ consistent use of contingency management (+). The association between decreasing distance to the nearest A&T retailer and increased A&T use in Latino adolescents reveals an additional risk behavior determinant in the US–Mexico border region.
doi:10.1007/s10903-009-9303-2
PMCID: PMC2904835  PMID: 19936923
GIS; Alcohol use; Tobacco use; Built environment; Latinos; Adolescents
11.  Blood alcohol concentrations among bar patrons: A multi-level study of drinking behavior 
Drug and alcohol dependence  2009;102(1-3):41-48.
This paper presents data from a study that collected observational data, survey data, and breath samples to estimate blood alcohol concentrations (BrAC) from patrons attending 30 bars. The study examines: 1) drinking behavior and settings prior to going to a bar; 2) characteristics of the bar where respondents are drinking; 3) person and environmental predictors of BrAC change (entrance to exit). Purposive sampling of bars that cater to young adults gave a sample of 30 bars. Patrons were randomly selected from bars (n=839). Approximately half of the sample was female (48.7%). Nearly three-quarters of participants reported drinking before attending the bar. Serving practices of the bars were observed; majority of bars served excessive amounts of alcohol in short periods of time. On average, those who drank before attending the bar had BrACs at approximately half the legal limit. Implications for responsible beverage service coupled with law enforcement strategies are discussed.
doi:10.1016/j.drugalcdep.2008.12.015
PMCID: PMC2674139  PMID: 19250775
Environment; Bars; BrAC; Drinking settings
12.  Does Proximity to Retailers Influence Alcohol and Tobacco Use Among Latino Adolescents? 
Despite decades of research surrounding determinants of alcohol and tobacco (A&T) use among adolescents, built environment influences have only recently been explored. This study used ordinal regression on 205 Latino adolescents to explore the influence of the built environment (proximity to A&T retailers) on A&T use, while controlling for recognized social predictors. The sample was 45% foreign-born. A&T use was associated with distance from respondents’ home to the nearest A&T retailer (−), acculturation (+), parents’ consistent use of contingency management (−), peer use of A&T (+), skipping school (+), attending school in immediate proximity to the US/Mexico border (+), and the interaction between the distance to the nearest retailer and parents’ consistent use of contingency management (+). The association between decreasing distance to the nearest A&T retailer and increased A&T use in Latino adolescents reveals an additional risk behavior determinant in the US–Mexico border region.
doi:10.1007/s10903-009-9303-2
PMCID: PMC2904835  PMID: 19936923
GIS; Alcohol use; Tobacco use; Built environment; Latinos; Adolescents
13.  College Student use of Salvia Divinorum 
Drug and alcohol dependence  2008;94(1-3):263-266.
Objective
Salvia divinorum (salvia) is a plant that appears to be enjoying increased popularity as a legal hallucinogen in many U.S. jurisdictions. While the popular press has claimed that its use has become widespread, there have been no epidemiological studies published documenting this within the U.S.
Method
A sample of college students was randomly drawn from a large public university in the southwestern U.S. and invited to participate in an online survey that included salvia use among a set of other drug use items.
Results
From the sample of 1,571 college student respondents, a pattern of use emerged that indicates that salvia is indeed becoming a significant member of the list of drugs used, with 4.4% of students reporting using salvia at least once within the past 12 months. Subpopulations that are typically most at risk for drug use within college students (Whites, males, fraternity members, heavy episodic drinkers) also were most likely to use salvia.
Conclusions
The results indicate that more research is needed to determine the generalizability of these findings, and identify whether there are any negative consequences experienced either by the user or the community associated with this drug.
doi:10.1016/j.drugalcdep.2007.10.018
PMCID: PMC2267695  PMID: 18093751
College-student drug use; Salvia divinorum; Hallucinogenic drugs

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