Publications by authors named "Chenshu Zhang"

73 Publications

Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study.

BMJ Open 2021 Apr 24;11(4):e047443. Epub 2021 Apr 24.

Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA.

Introduction: Current HIV guidelines recommend differentiated service delivery (DSD) models that allow for fewer health centre visits for clinically stable people living with HIV (PLHIV). Newly diagnosed PLHIV may require more intensive care early in their treatment course, yet frequent appointments can be burdensome to patients and health systems. Determining the optimal parameters for defining clinical stability and transitioning to less frequent appointments could decrease patient burden and health system costs. The objectives of this pilot study are to explore the feasibility and acceptability of (1) reducing the time to DSD from 12 to 6 months after antiretroviral therapy (ART) initiation,and (2) reducing the number of suppressed viral loads required to enter DSD from two to one.

Methods And Analyses: The present study is a pilot, unblinded trial taking place in three health facilities in Kigali, Rwanda. Current Rwandan guidelines require PLHIV to be on ART for ≥12 months with two consecutive suppressed viral loads in order to transition to less frequent appointments. We will randomise 90 participants to one of three arms: entry into DSD at 6 months after one suppressed viral load (n=30), entry into DSD at 6 months after two suppressed viral loads (n=30) or current standard of care (n=30). We will measure feasibility and acceptability of this intervention; clinical outcomes include viral suppression at 12 months (primary outcome) and appointment attendance (secondary outcome).

Ethics And Dissemination: This clinical trial was approved by the institutional review board of Albert Einstein College of Medicine and by the Rwanda National Ethics Committee. Findings will be disseminated through conferences and peer-reviewed publications, as well as meetings with stakeholders.

Trial Registration Number: NCT04567693.
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http://dx.doi.org/10.1136/bmjopen-2020-047443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074553PMC
April 2021

Effectiveness and cardiac safety of bedaquiline-based therapy for drug-resistant tuberculosis: a prospective cohort study.

Clin Infect Dis 2021 Apr 21. Epub 2021 Apr 21.

Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa.

Background: Bedaquiline improves treatment outcomes in patients with rifampin-resistant TB (RR-TB) but prolongs the QT-interval and carries a black-box warning by the U.S. Food and Drug Administration. The World Health Organization recommends that all patients with RR-TB receive a regimen containing bedaquiline, yet a phase 3 clinical trial demonstrating its cardiac safety has not been published.

Methods: We conducted an observational cohort study of RR-TB patients from 3 provinces in South Africa who received regimens containing bedaquiline. We performed rigorous cardiac monitoring, including electrocardiograms (ECGs) performed in triplicate at four time points during bedaquiline therapy. Participants were followed until the end of therapy or 24 months. Outcomes included final tuberculosis treatment outcome and QT-prolongation, defined as any QTcF>500 ms or an absolute change from baseline (△ QTcF) >60 ms.

Results: We enrolled 195 eligible participants, of whom 40% had extensively drug-resistant (XDR) TB. Most participants (97%) received concurrent clofazimine. 74% of participants were cured or successfully completed treatment, and outcomes did not differ by HIV status. QTcF continued to increase throughout bedaquiline therapy, with a mean increase of 23.7 (SD 22.7) ms from baseline to month 6. Four participants experienced a QTcF>500 ms and 19 experienced a △QTcF>60 ms. Older age was independently associated with QT-prolongation. QT-prolongation was neither more common nor severe in participants receiving concurrent lopinavir-ritonavir.

Conclusions: Severe QT-prolongation was uncommon and did not require permanent discontinuation of either bedaquiline or clofazimine. Close QT-monitoring may be advisable in older patients.
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http://dx.doi.org/10.1093/cid/ciab335DOI Listing
April 2021

Evaluation of the Effects of the COVID-19 Pandemic on Electronic Consultation Use in Primary Care.

Telemed J E Health 2021 Mar 31. Epub 2021 Mar 31.

Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA.

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http://dx.doi.org/10.1089/tmj.2020.0547DOI Listing
March 2021

The impact of menthol cigarette use on quit attempts and abstinence among smokers with opioid use disorder.

Addict Behav 2021 Jul 23;118:106880. Epub 2021 Feb 23.

Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, USA. Electronic address:

An exceedingly high proportion of persons with opioid use disorder (OUD) smoke cigarettes. Smokers with OUD face multiple barriers to smoking cessation. While menthol cigarette use has been associated with low cessation rates, research has not explored the impact of menthol cigarette use on tobacco use outcomes among smokers with OUD. Participants were current smokers, in methadone treatment for OUD, participating in randomized controlled trials of smoking cessation therapies. We examined the use of menthol cigarettes, and the association between menthol cigarette use and achieving 24-hour quit attempts and seven-day point prevalence abstinence. Of 268 participants, 237 (88.4%) reported menthol use. A similar proportion of menthol and non-menthol smokers achieved a 24-hour quit attempt (83.1% vs. 83.8%, p = 0.92). Though fewer menthol smokers (vs. non-menthol smokers) achieved abstinence (12.7% vs. 22.6%), this did not reach statistical significance (p = 0.14). In this sample of smokers with OUD, menthol smoking was nearly ubiquitous. Menthol smoking was not associated with differences in quit attempts, but was associated with differences in cessation that were not statistically significant. Menthol smoking may contribute to the challenges in achieving abstinence among smokers with OUD.
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http://dx.doi.org/10.1016/j.addbeh.2021.106880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059772PMC
July 2021

Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain.

BMJ Open 2020 12 29;10(12):e043400. Epub 2020 Dec 29.

Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USA.

Introduction: In the USA, opioid analgesic use and overdoses have increased dramatically. One rapidly expanding strategy to manage chronic pain in the context of this epidemic is medical cannabis. Cannabis has analgesic effects, but it also has potential adverse effects. Further, its impact on opioid analgesic use is not well studied. Managing pain in people living with HIV is particularly challenging, given the high prevalence of opioid analgesic and cannabis use. This study's overarching goal is to understand how medical cannabis use affects opioid analgesic use, with attention to Δ9-tetrahydrocannabinol and cannabidiol content, HIV outcomes and adverse events.

Methods And Analyses: We are conducting a cohort study of 250 adults with and without HIV infection with (a) severe or chronic pain, (b) current opioid use and (c) who are newly certified for medical cannabis in New York. Over 18 months, we collect data via in-person visits every 3 months and web-based questionnaires every 2 weeks. Data sources include: questionnaires; medical, pharmacy and Prescription Monitoring Program records; urine and blood samples; and physical function tests. Using marginal structural models and comparisons within participants' 2-week time periods (unit of analysis), we will examine how medical cannabis use (primary exposure) affects (1) opioid analgesic use (primary outcome), (2) HIV outcomes (HIV viral load, CD4 count, antiretroviral adherence, HIV risk behaviours) and (3) adverse events (cannabis use disorder, illicit drug use, diversion, overdose/deaths, accidents/injuries, acute care utilisation).

Ethics And Dissemination: This study is approved by the Montefiore Medical Center/Albert Einstein College of Medicine institutional review board. Findings will be disseminated through conferences, peer-reviewed publications and meetings with medical cannabis stakeholders.

Trial Registration Number: ClinicalTrials.gov Registry (NCT03268551); Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2020-043400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778768PMC
December 2020

Effect of varenicline directly observed therapy versus varenicline self-administered therapy on varenicline adherence and smoking cessation in methadone-maintained smokers: a randomized controlled trial.

Addiction 2021 04 13;116(4):902-913. Epub 2020 Oct 13.

Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.

Background And Aims: Level of adherence to tobacco cessation medication regimens is believed to be causally related to medication effectiveness. This study aimed to evaluate the efficacy of varenicline directly observed therapy (DOT) on varenicline adherence and smoking cessation rates among smokers with opioid use disorder (OUD) receiving methadone treatment.

Design: Multicenter, parallel-group two-arm randomized controlled trial.

Setting: Urban opioid treatment program (OTP) in the Bronx, New York, USA.

Participants: Daily smokers of ≥ 5 cigarettes/day, interested in quitting (ladder of change score 6-8), in methadone treatment for ≥ 3 months, attending OTP ≥ 3 days/week. Participants' mean age was 49 years, 56% were male, 44% Latino, 30% Black, and they smoked a median of 10 cigarettes/day.

Interventions: Individual, block, random assignment to 12 weeks of varenicline, either directly observed with methadone (DOT, n = 50) or via unsupervised self-administered treatment (SAT, n = 50).

Measurements: The primary outcome was adherence measured by pill count. The secondary outcome was 7-day point prevalence tobacco abstinence verified by expired carbon monoxide (CO) < 8 parts per million.

Findings: Retention at 24 weeks was 92%. Mean adherence was 78.5% [95% confidence interval (CI) = 71.8-85.2%] in the DOT group versus 61.8% in the SAT group (95% CI = 55.0-68.6%); differences were driven by DOT effects in the first 6 weeks. CO-verified abstinence did not differ between groups during the intervention (P = 0.26), but was higher in the DOT than the SAT group at intervention end (DOT = 18% versus SAT = 10%, difference = 8%, 95% CI = -13, 28); this difference was not significant (P = 0.39) and was not sustained at 24-week follow-up.

Conclusions: Among daily smokers attending opioid treatment programs, opioid treatment program-based varenicline directly observed therapy was associated with early increases in varenicline adherence compared with self-administered treatment, but findings were inconclusive as to whether directly observed therapy was associated with a difference in tobacco abstinence.
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http://dx.doi.org/10.1111/add.15240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983847PMC
April 2021

Abstinence-reinforcing contingency management improves HIV viral load suppression among HIV-infected people who use drugs: A randomized controlled trial.

Drug Alcohol Depend 2020 11 11;216:108230. Epub 2020 Aug 11.

City University of New York, School of Medicine, 160 Convent Ave, New York, NY 10031, United States.

Background: HIV-infected people who use drugs (PWUD) have poor HIV outcomes. Few studies tested interventions to improve HIV outcomes among PWUD. Abstinence-reinforcing contingency management (CM) reduces drug use and could also improve HIV outcomes.

Methods: From 2012-2017, we conducted a randomized controlled trial testing whether a 16-week abstinence-reinforcing CM intervention improved HIV viral load (VL) among HIV-infected adults using opioids or cocaine. In the CM intervention, drug-free urines led to escalating value of vouchers ($2.50-$80/voucher, $1320 total maximum). In intention-to-treat mixed-effects linear and logistic regression analyses, we examined whether the CM intervention improved log VL (primary outcome), abstinence and antiretroviral adherence (secondary outcomes).

Results: Thirty-seven participants were randomized to the CM intervention and 36 to control. Median age was 49.2 years; most were male (61.6%) and non-Hispanic black (46.6%). In CM (vs. control) participants, mean reduction in log VL was greater (-0.16 log VL copies/mL per 4-week period; 95% CI: -0.29 to -0.03, p < 0.05). Over 16 weeks, CM participants had a mean reduction of 0.64 copies/mL in log VL greater than control participants. The CM intervention was not significantly associated with abstinence or adherence.

Conclusions: This is the first study to demonstrate improvements in HIV VL via an abstinence-reinforcing CM intervention. Because the CM intervention did not significantly affect abstinence or adherence, the mechanism of its effect is unclear. To end the HIV epidemic, innovative strategies must address individuals with poor HIV outcomes. Abstinence-reinforcing CM may be one potential strategy to improve HIV outcomes among a select group of PWUD.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606653PMC
November 2020

Impact of an Opt-In eConsult Program on Primary Care Demand for Specialty Visits: Stepped-Wedge Cluster Randomized Implementation Study.

J Gen Intern Med 2020 11 10;35(Suppl 2):832-838. Epub 2020 Aug 10.

Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.

Background: eConsult programs have been instituted to increase access to specialty expertise. Opt-in choice eConsult programs maintain primary care physician (PCP) autonomy to decide whether to utilize eConsults versus traditional specialty referrals, but little is known about how this intervention may impact PCP eConsult adoption and traditional referral demand.

Objective: We assessed the feasibility of implementing an opt-in choice eConsult program and examined whether this intervention reduces demand for in-person visits for primary care patients requiring specialty expertise.

Design: Stepped-wedge, cluster randomized trial conducted from July 2018 to June 2019.

Participants: Sixteen primary care practices in a large, urban academic health care system.

Intervention: Our intervention was an opt-in choice eConsult available in addition to traditional specialty referral; our implementation strategy included in-person training, audit and feedback, and incentive payments.

Main Measures: Our implementation outcome measure was the eConsult rate: weekly proportion of eConsults per PCP visit at each site. Our intervention outcome measure was traditional referral rate: weekly proportion of referrals per PCP visit at each site. We also assessed PCP experiences with questionnaires.

Key Results: Of 305,915 in-person PCP visits, there were 31,510 traditional referrals to specialties participating in the eConsult program, and 679 eConsults. All but one primary care site utilized the opt-in choice eConsult program, with a weekly rate of 0.05 eConsults per 100 PCP visits by the end of the study period. The weekly rate of traditional referrals was 11 per 100 PCP visits at the end of the study period; this represents a significant increase in traditional referral rate after implementation of eConsults. PCPs were generally satisfied with the eConsult program and valued prompt provider-to-provider communication.

Conclusions: Implementation of an opt-in choice eConsult program resulted in widespread PCP adoption; however, this did not decrease the demand for traditional referrals. Future studies should evaluate different strategies to incentivize and increase eConsult utilization while maintaining PCP choice.
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http://dx.doi.org/10.1007/s11606-020-06101-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652962PMC
November 2020

Daily and near-daily cannabis use is associated with HIV viral load suppression in people living with HIV who use cocaine.

AIDS Care 2020 Aug 4:1-8. Epub 2020 Aug 4.

Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.

Disparities remain in HIV viral load (VL) suppression between people living with HIV (PLWH) who use cocaine and those who do not. It is not known how cannabis use affects VL suppression in PLWH who use cocaine. We evaluated the relationship between cannabis use and VL suppression among PLWH who use cocaine. We conducted a secondary data analysis of 119 baseline interviews from a randomized controlled trial in the Bronx, NY (6/2012 to 1/2017). Participants were adult PLWH prescribed antiretrovirals for ≥16 weeks, who endorsed imperfect antiretroviral adherence and used cocaine in the past 30-days. In bivariate and multivariable regression analyses, we examined how cannabis use, is associated with VL suppression among PLWH who use cocaine. Participants were a mean age of 50 years; most were male (64%) and non-Hispanic black (55%). Participants with VL suppression used cocaine less frequently than those with no VL suppression ( < 0.01); cannabis use was not significantly different. In regression analysis, compared with no use, daily/near-daily cannabis use was associated with VL suppression (aOR = 4.2, 95% CI: 1.1-16.6,  < 0.05). Less-frequent cannabis use was not associated with VL suppression. Further investigation is needed to understand how cannabis use impacts HIV outcomes among PLWH who use cocaine.
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http://dx.doi.org/10.1080/09540121.2020.1799922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7858684PMC
August 2020

Ocular Albinism Type 1 Regulates Deltamethrin Tolerance in and .

Front Physiol 2019 19;10:766. Epub 2019 Jun 19.

Key Laboratory of Sustainable Forest Ecosystem Management-Ministry of Education, School of Forestry, Northeast Forestry University, Harbin, China.

The ocular albinism type 1 (OA1), a pigment cell-specific integral membrane glycoprotein, is a member of the G-protein-coupled receptor (GPCR) superfamily that binds to heterotrimeric G proteins in mammalian cells. We aimed to characterize the physiological functions an insect OA1 from () employs in the regulation of insecticide tolerance. In the present study, we investigated the roles of in response to deltamethrin exposure in both and . was expressed at the lowest level during the 4 instar stage, while was significantly upregulated in the 5 instar and male stages. Knockdown of by injecting dsRNA of into gypsy moth larvae caused a 4.80-fold higher mortality than in control larvae microinjected with dsRNA of under deltamethrin stress. Nine out of 11 genes were significantly downregulated under deltamethrin stress in silenced larvae as compared to control larvae. Moreover, the gene was successfully overexpressed in using transgenic technique. The deltamethrin contact assay showed that the overexpression in flies significantly enhanced the tolerance to deltamethrin compared to the control flies. Furthermore, the downstream CYP genes were upregulated in the overexpression flies, suggesting may play a master switch role in P450-mediated metabolic detoxification. This study is the first report of an insect OA1 gene regulating insecticide tolerance and potentially playing a role in the regulation of downstream cytochrome P450 expression. These results contribute to the future development of novel insecticides targeting insect GPCRs.
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http://dx.doi.org/10.3389/fphys.2019.00766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594220PMC
June 2019

Developmental Trajectories of Religious Service Attendance: Predictors of Nicotine Dependence and Alcohol Dependence/Abuse in Early Midlife.

J Relig Health 2019 Mar 16. Epub 2019 Mar 16.

Department of Psychiatry, New York University School of Medicine, 215 Lexington Avenue, 15th Floor, New York, NY, 10016, USA.

This longitudinal study assesses the associations between developmental trajectories of religious service attendance from mean age 14 to mean age 43 and nicotine dependence and alcohol dependence/abuse at mean age 43 (N = 548). Six trajectories of religious service attendance were identified. As compared with belonging to weekly stable trajectory group, a higher probability of belonging to the weekly/none decreasing, occasional stable, and non-attendance trajectory group was significantly associated with a higher likelihood of nicotine dependence. In addition, as compared with belonging to weekly stable trajectory group, a higher probability of belonging to the weekly/none decreasing, weekly/occasional decreasing, occasional stable, and non-attendance trajectory group was significantly associated with a higher likelihood of alcohol dependence/abuse. These findings are consistent with the hypothesis that religious service attendance protects against nicotine dependence and alcohol dependence/abuse in early midlife.
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http://dx.doi.org/10.1007/s10943-019-00787-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746614PMC
March 2019

Season of birth: A predictor of ADHD symptoms in early midlife.

Psychiatry Res 2018 09 6;267:243-248. Epub 2018 Jun 6.

Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Floor, New York, NY 10016, USA.

Objective: In this longitudinal study, we applied linear regression analyses to examine season of birth as related to symptoms of attention deficit/hyperactivity disorder (ADHD) in early midlife.

Method: We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N = 548) followed from adolescence to early midlife.

Findings: The findings indicate that, as compared with participants who were born in the summer, those who were born in the spring (Beta = 0.34; t-statistic = 3.59; p < 0.001) had significantly more ADHD symptoms. In addition, exposure to maternal cigarette smoking in adolescence significantly intensified (p < 0.01) the association between season of birth and ADHD symptoms in early midlife.

Conclusion: These findings suggest that exposure to greater maternal maladaptive behaviors, such as cigarette smoking, may result in a greater vulnerability to other environmental risk factors, such as season of birth.
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http://dx.doi.org/10.1016/j.psychres.2018.05.056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131025PMC
September 2018

Lack of Preventive Health Behaviors in the Early Forties: The Role of Earlier Trajectories of Cigarette Smoking From Adolescence to Adulthood.

Subst Use Misuse 2017 Oct 14;52(12):1527-1537. Epub 2017 Apr 14.

a Department of Psychiatry , New York University School of Medicine , New York , New York , USA.

Objective: To study the degree to which individuals in different trajectories of cigarette smoking from adolescence to the early forties are similar or different in terms of lack of preventive health behaviors (e.g., underuse of preventive health services, unhealthy eating habits) in early midlife.

Methods: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from adolescence to early midlife (mean age = 43 years, standard deviation [SD] = 2.8) at seven time points. Using growth mixture modeling, we statistically identified the number of smoking trajectories. Logistic regression analysis was used to study the relationship between the probabilities of participants' smoking trajectory group membership and lack of preventive behaviors in early midlife.

Results: Five trajectory groups of cigarette smokers were identified. With controls, as compared with the nonsmoker trajectory group, higher probabilities of belonging to the heavy/continuous smoker trajectory group and the late starter trajectory groups were significantly associated with a higher likelihood of lack of preventive health behaviors (adjusted odds ratio [AOR] = 3.49 and 4.02 respectively). In addition, as compared to the quitter/decreaser trajectory group, higher probabilities of belonging to the heavy/continuous smoker trajectory group and the late starter trajectory group were also significantly associated with a higher likelihood of lack of preventive health behaviors (AOR = 3.51 and 4.04 respectively).

Conclusions: Intervention programs may consider focusing on heavy/continuous smokers and late starters in programs designed to promote adequate use of preventive health services and healthy general lifestyles in early midlife.
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http://dx.doi.org/10.1080/10826084.2017.1281310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567694PMC
October 2017

Psychosocial Factors Related to the Intergenerational Transmission of Externalizing Behaviors in Early Midlife.

Subst Use Misuse 2017 08 10;52(10):1328-1337. Epub 2017 Apr 10.

a Department of Psychiatry , New York University School of Medicine , New York , New York , USA.

Background: To study the intergenerational transmission of externalizing behaviors.

Methods: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from mothers at mean age 40 and from their children from adolescence (mean age = 14, SD = 2.8) to early midlife (mean age = 43, SD = 2.8) at seven time points. Structural equation modeling (SEM) was used to study the psychosocial factors as related to externalizing behaviors in early midlife.

Results: First, maternal externalizing behaviors were indirectly associated with the offspring's externalizing behaviors through the offspring's substance use in adolescence, the offspring's partner's smoking patterns, and the offspring's marital conflict. Second, maternal cigarette smoking was indirectly associated with the offspring's externalizing behaviors through the offspring's substance use in adolescence, the offspring's partner's cigarette smoking, and the offspring's marital conflict. Third, maternal marital conflict had an indirect effect on the offspring's externalizing behaviors, mediated by offspring marital conflict.

Conclusions: The finding that externalizing behaviors can be transmitted from parent to child informs the need for family-based interventions that are appropriate to adolescents.
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http://dx.doi.org/10.1080/10826084.2016.1276601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513752PMC
August 2017

Compulsive buying and quality of life: An estimate of the monetary cost of compulsive buying among adults in early midlife.

Psychiatry Res 2017 06 7;252:208-214. Epub 2017 Mar 7.

Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.

The aims of this study were to examine the associations between compulsive buying and quality of life and to estimate the monetary cost of compulsive buying for a cohort of men and women at mean age 43. Participants came from a community-based random sample of residents in two New York counties (N=548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (SD=2.8). Fifty five percent of the participants were females. Over 90% of the participants were white. Linear regression analyses showed that compulsive buying was significantly associated with quality of life, despite controlling for relevant demographic and psychosocial factors. The estimated monetary cost of compulsive buying for this cohort was significant. The fact that the monetary cost of CB is not trivial suggests that individuals are both consciously and unconsciously plagued by their CB. The findings are important for interventionists and clinicians for cost-effective intervention and treatment programs.
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http://dx.doi.org/10.1016/j.psychres.2017.03.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442884PMC
June 2017

Psychosocial Factors Related to Underuse of Medical Services.

J Urban Health 2016 08;93(4):652-65

Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Floor, New York, NY, 10016, USA.

In this longitudinal study, we applied structural equation modeling (SEM) to examine the historical, predisposing, enabling/barrier, and need factors as related to the underuse of medical services during early midlife. We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N = 548) followed from adolescence to early midlife. The findings supported a mediational model: A mutually affectionate parent-child relationship in early adolescence was inversely related to underuse of medical services in early midlife via the mediational roles played by later predisposing factors (i.e., depressive mood and cigarette smoking), need factor (i.e., physical health problems), barriers (i.e., financial difficulty), and enabling factors (i.e., social support for health services in early midlife). In addition, satisfaction with medical services in the neighborhood had an association with less underuse of medical services in early midlife. Family therapy focused on an increase in the affectionate relationship between the adolescents and his/her parents and cognitive-behavioral treatment of depressive mood may lead to a decrease in the underuse of medical services.
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http://dx.doi.org/10.1007/s11524-016-0067-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987594PMC
August 2016

Comorbid trajectories of substance use as predictors of Antisocial Personality Disorder, Major Depressive Episode, and Generalized Anxiety Disorder.

Addict Behav 2016 11 7;62:114-21. Epub 2016 Jun 7.

New York University School of Medicine, Department of Psychiatry, 215 Lexington Ave., 15th Floor, New York, NY 10016, USA.

Objective: To determine longitudinal associations between patterns of comorbid cigarette, alcohol, and marijuana use and Antisocial Personality Disorder (ASPD), Major Depressive Episode (MDE), and Generalized Anxiety Disorder (GAD) in adulthood.

Method: A random community-based sample [X̅ age=36.6 (SD=2.8)] from the Children and Adults in the Community Study, an on-going investigation of substance use and psychiatric disorders. Data were collected at six time waves. Conjoint trajectories of cigarette, alcohol, and marijuana use spanning adolescence to adulthood were determined; multivariable logistic regression analyses assessed associations between trajectory group membership and having ASPD, MDE, or GAD in adulthood.

Results: Five conjoint trajectory groups were obtained: HHH (chronic cigarette, alcohol, and marijuana use), DDD (delayed/late-starting cigarette, alcohol, and marijuana use), LML (low/no smoking, moderate alcohol use, occasional marijuana use), HMN (chronic smoking, moderate alcohol use, no marijuana use), and NON (occasional alcohol use only). Compared with members of the NON group, those in the HHH group had significantly greater odds for having ASPD (Adjusted Odds Ratio [AOR]=28.52, 95% Confidence Interval [CI]=9.44-86.17), MDE (AOR=2.67, 95% CI=1.14-6.26), and GAD (AOR=6.39, 95% CI=2.62-15.56). Members of the DDD, LML, and HMN groups had weaker and less consistent associations with the three psychiatric outcomes.

Conclusions: In a large, community-based sample, long-term concurrent use of more than one substance was associated with both externalizing and internalizing psychiatric disorders in adulthood. Prevention and treatment programs might target individuals in the community and general clinical populations with comorbid substance use, even if they haven't been identified as having a substance use disorder.
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http://dx.doi.org/10.1016/j.addbeh.2016.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955839PMC
November 2016

Longitudinal psychosocial factors related to symptoms of Internet addiction among adults in early midlife.

Addict Behav 2016 11 14;62:65-72. Epub 2016 Jun 14.

Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.

In this longitudinal study, we applied structural equation modeling (SEM) to examine the psychosocial factors from adolescence to adulthood as related to symptoms of Internet addiction (IA) during early midlife. We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N=548) followed from adolescence to early midlife (mean age=43; SD=2.8). The findings supported a meditational model: adolescent (mean age=16) conflictual parent-child relationship was associated with internalizing problem behaviors at mean age 21 in emerging adulthood (b=0.13, p<0.01), which, in turn, were associated with both alcohol/drug use problems at mean age 27-32 (b=0.24, p<0.001) and affective disorders at mean age 37 (b=0.29, p<0.001), which, ultimately, were associated with symptoms of IA in early midlife (b=0.23, p<0.01; b=0.21, p<0.05, respectively). In addition, alcohol/drug use problems were associated with affective disorders (b=0.22, p<0.05). Among the constructs, alcohol/drug use problems had the greatest total effects on symptoms of IA in early midlife (b=0.28, p<0.001). Findings suggest that family therapy focused on an increase in the affectionate relationship between the adolescent and his/her parents, cognitive-behavioral treatment of internalizing problem behaviors, and effective treatment of individuals who have alcohol/drug use problems may reduce the likelihood of having symptoms of IA in early midlife.
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http://dx.doi.org/10.1016/j.addbeh.2016.06.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955795PMC
November 2016

Associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder among men and women.

J Addict Dis 2016 Oct-Dec;35(4):298-304. Epub 2016 May 23.

a Department of Psychiatry , New York University School of Medicine , New York , New York , USA.

The objective of this study was to examine the associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder at the mean age of 43. Participants came from a community-based random sample of residents in 2 New York counties in 1975 (N = 548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (standard deviation = 2.8). Of the participants, 55% were females. Over 90% of the participants were Caucasian. The prevalence of substance dependence/abuse, major depressive episodes, and generalized anxiety disorder (during the past 5 years before the interviews) was 6.6, 13.7, and 11.5%, respectively. Logistic regression analyses showed that compulsive buying was significantly associated with substance dependence/abuse (adjusted odds ratio = 1.60), major depressive episodes (adjusted odds ratio = 1.70), and generalized anxiety disorder (adjusted odds ratio = 1.63), despite controlling for substance dependence/abuse, major depressive episodes, and generalized anxiety disorder, respectively, at the mean age of 37, and demographic factors. Since the study sample is limited to predominantly Caucasian participants (over 90%) with a close association to a small geographic area, the findings may not be generalizable to racial/ethnic minority groups or individuals living in other parts of the country. Nevertheless, it is important that clinicians treating substance dependence/abuse, major depressive episodes, and generalized anxiety disorder consider the role of compulsive buying.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061592PMC
http://dx.doi.org/10.1080/10550887.2016.1177809DOI Listing
January 2017

Marijuana use from adolescence to adulthood: developmental trajectories and their outcomes.

Soc Psychiatry Psychiatr Epidemiol 2016 10 11;51(10):1405-1415. Epub 2016 May 11.

Department of Psychiatry, New York University School of Medicine, 215 Lexington Avenue, 15th Floor, New York, NY, 10016, USA.

Background: The study assesses the degree to which individuals in different trajectories of marijuana use are similar or different in terms of unconventional behavior, sensation seeking, emotional dysregulation, nicotine dependence, alcohol dependence/abuse, children living at home, and spouse/partner marijuana use at age 43.

Method: This study used a longitudinal design. The sample participants (N = 548) were first studied at mean age 14 and last studied at mean age 43.

Results: Six trajectories of marijuana use were identified: chronic/heavy users (3.6 %), increasing users (5.1 %), chronic/occasional users (20 %), decreasers (14.3 %), quitters (22.5 %), and nonusers/experimenters (34.5 %). With three exceptions, as compared with being a nonuser/experimenter, a higher probability of belonging to the chronic/heavy, the increasing, or the chronic/occasional user trajectory group was significantly associated with a greater likelihood of unconventional behavior, sensation seeking, emotional dysregulation, nicotine dependence, alcohol dependence/abuse, not having children who lived at home, and having a spouse/partner who used marijuana at early midlife. In addition, compared with being a quitter, a higher probability of belonging to the chronic/heavy user trajectory group was significantly associated with a higher likelihood of unconventional behavior, sensation seeking, emotional dysregulation, alcohol dependence/abuse, and spouse/partner marijuana use. Implications for intervention are presented.

Conclusions: Trajectories of marijuana use, especially chronic/heavy use, increasing use, and chronic/occasional use, are associated with unconventional behavior, sensation seeking, emotional dysregulation, nicotine dependence, alcohol dependence/abuse, having children who lived at home, and spouse/partner marijuana use at age 43. The importance of the findings for prevention and treatment programs are discussed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050063PMC
http://dx.doi.org/10.1007/s00127-016-1229-0DOI Listing
October 2016

Trajectories of marijuana use from adolescence to adulthood as predictors of unemployment status in the early forties.

Am J Addict 2016 Apr 16;25(3):203-9. Epub 2016 Mar 16.

Department of Psychiatry, New York University School of Medicine, New York City, New York.

Objectives: To study the degree to which individuals in different trajectories of marijuana use are similar or different in terms of unemployment status at mean age 43.

Methods: We gathered longitudinal data on a prospective cohort taken from a community sample (N = 548). Forty-nine percent of the original participants were females. Over 90% of the participants were white. The participants were followed from adolescence to early midlife. The mean ages of participants at the follow-up interviews were 14.1, 16.3, 22.3, 27.0, 31.9, 36.6, and 43.0, respectively. We used the growth mixture modeling (GMM) approach to identify the trajectories of marijuana use over a 29-year period.

Results: Five trajectories of marijuana use were identified: chronic users/decreasers (8.3%), quitters (18.6%), increasing users (7.3%), chronic occasional users (25.6%), and nonusers/experimenters (40.2%). Compared with nonusers/experimenters, chronic users/decreasers had a significantly higher likelihood of unemployment at mean age 43 (adjusted odds ratio = 3.51, 95% confidence interval = 1.13-10.91), even after controlling for the covariates.

Conclusions And Scientific Significance: The results of the associations between the distinct trajectories of marijuana use and unemployment in early midlife indicate that it is important to develop intervention programs targeting chronic marijuana use as well as unemployment in individuals at this stage of development. Results from this study should encourage clinicians, teachers, and parents to assess and treat chronic marijuana use in adolescents.
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http://dx.doi.org/10.1111/ajad.12361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809805PMC
April 2016

Intergenerational Transmission of Externalizing Behavior.

J Child Fam Stud 2015 Oct 18;24(10):2957-2965. Epub 2014 Dec 18.

Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15 Floor, New York.

This prospective longitudinal investigation examined the predictors of generation 2 (G2) parental substance use as related to their generation 3 (G3) offspring's externalizing behavior. The sample comprised 281 mother- or father- child (G2/G3) pairs. The results indicated that the G1/G2 (generations 1 and 2) parent-child relationship during G2's adolescence predicted externalizing behavior in the G2 young adults which correlated with G2 parental substance use. G2 parental substance use was related to subsequent G2 substance use disorders (SUDS), and to the G2/G3 parent-child relationship. The G2/G3 parent-child relationship and G2's SUDS each predicted G3 externalizing behavior. The results highlight the significance of breaking the chain of transmission of externalizing behavior across generations. Implications for policy and programs addressing the etiology of externalizing behavior in the offspring are discussed within a developmental framework.
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http://dx.doi.org/10.1007/s10826-014-0099-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620054PMC
October 2015

Compulsive buying: Earlier illicit drug use, impulse buying, depression, and adult ADHD symptoms.

Psychiatry Res 2015 Aug 29;228(3):312-7. Epub 2015 Jun 29.

Department of Behavioral Sciences, University of Kentucky, Lexington, KY 40506-9983, USA.

This longitudinal study examined the association between psychosocial antecedents, including illicit drug use, and adult compulsive buying (CB) across a 29-year time period from mean age 14 to mean age 43. Participants originally came from a community-based random sample of residents in two upstate New York counties. Multivariate linear regression analysis was used to study the relationship between the participant's earlier psychosocial antecedents and adult CB in the fifth decade of life. The results of the multivariate linear regression analyses showed that gender (female), earlier adult impulse buying (IB), depressive mood, illicit drug use, and concurrent ADHD symptoms were all significantly associated with adult CB at mean age 43. It is important that clinicians treating CB in adults should consider the role of drug use, symptoms of ADHD, IB, depression, and family factors in CB.
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http://dx.doi.org/10.1016/j.psychres.2015.05.095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532632PMC
August 2015

Longitudinal Smoking Patterns: Do They Predict Symptoms of ADHD in Adults?

J Atten Disord 2020 01 4;24(1):86-93. Epub 2015 May 4.

New York University School of Medicine, New York City, USA.

The objective of this study was to assess whether comparisons of longitudinal smoking trajectories predict differences in symptoms of ADHD in adults. Participants were interviewed 7 times between 14 and 43 years of age. ADHD symptoms at outcome were assessed with the World Health Organization ADHD Self-Report Scale. Bivariate and multivariate linear regression analyses assessed the associations between the trajectories of smoking and ADHD symptoms. The multivariate analysis ( = .12) indicated that compared with being nonsmokers, the probability of being in the heavy/continuous group (standardized regression coefficient [SRC] = .17, < .01) and in the late starter group (SRC = .11, < .05) were significantly associated with adult ADHD symptoms. Longitudinal smoking patterns were associated with ADHD symptoms in adults. Chronic smoking jeopardizes both physical health and the ability to fulfill adult roles as employees, family members, and friends. Smoking cessation in adolescence may lessen the likelihood of ADHD symptoms in adulthood.
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http://dx.doi.org/10.1177/1087054715584057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633407PMC
January 2020

Insomnia in adults: the impact of earlier cigarette smoking from adolescence to adulthood.

J Addict Med 2015 Jan-Feb;9(1):40-5

From the Department of Psychiatry, New York University School of Medicine, New York, NY.

Objectives: This study examined the role of cigarette smoking beginning in adolescence and extending to the fifth decade of life on insomnia at an average age of 43 years in the Children and Adults in the Community Study.

Methods: Participants were originally assessed in 1983 and came from a community-based random sample of individuals living in 2 upstate New York counties. Participants were assessed over 7 waves of data collection that spanned approximately 29 years, from mean ages 14.1 years (T2) to 42.9 years (T8). We classified the longitudinal trajectories of cigarette use. Five cigarette use trajectory groups were identified: heavy/continuous smokers, late starters, occasional smokers, quitters/decreasers, and nonsmokers.

Results: The result of the logistic regression analysis of adult insomnia for the Bayesian posterior probability of the heavy/continuous smokers when compared with the Bayesian posterior probability of nonsmokers was statistically significant-adjusted odds ratio of 3.35 [95% confidence interval (1.06-10.56; P < 0.05)]-after adjustment for control variables.

Conclusions: The findings highlight the importance of heavy chronic smoking as contributing to insomnia. Clinicians should focus their efforts on smoking prevention and treatment of younger individuals, as well as promoting cessation among older adult smokers to decrease the likelihood of insomnia.
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http://dx.doi.org/10.1097/ADM.0000000000000083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310766PMC
November 2015

Better late than never: the perceived benefits of smoking cessation among women in late midlife.

J Addict Dis 2014 ;33(3):266-73

a Department of Psychiatry , New York University School of Medicine , New York , New York , USA.

The current study examined the association of smoking cessation (≥1 year without relapse) and self-reported psychosocial and physical outcomes among a community sample of women (N = 195; mean age = 63.7 years, SD = 5.7 years). Data were collected in 1985-1986 and 2009. Successful smoking cessation for ≥1 year was significantly associated with each of the outcome measures (e.g., less financial stress [adjusted odds ratio (AOR) = 0.50; 95% confidence interval (CI) = 0.25-1.00, P< 0.05), less life dissatisfaction (AOR = 0.51, 95% CI = 0.24-1.09, P< 0.05). Findings suggest that older women should be included in smoking cessation programs, and the important benefits of quitting should be used to encourage cessation.
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http://dx.doi.org/10.1080/10550887.2014.950028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224603PMC
June 2015

Psychosocial factors related to smoking: the midlife study.

Am J Addict 2014 Sep-Oct;23(5):423-8. Epub 2014 Jul 25.

Department of Psychiatry, New York University School of Medicine, New York, New York.

Background: There is limited research on the correlates of cigarette smoking in women in late midlife.

Objectives: The present study examined the associations between risk factors in several psychosocial domains and current cigarette smoking among women in their mid-60s. These domains included risks in personal attributes, family relationships, negative life events, financial stressors, contextual factors, and problematic alcohol use.

Methods: Data were from a cohort of women originally living in two upstate New York counties (N = 511) in late midlife (mean age = 65). Bivariate and multivariate logistic regression analyses were conducted.

Results: The results supported our hypotheses. The cumulative psychosocial risk index was significantly associated with a greater likelihood of cigarette smoking [A.O.R. = 1.53; 95% C.I. (1.3-.181); p < .001] after controlling for age and educational level.

Conclusions And Scientific Significance: It is important to reduce the number of psychosocial risk factors faced by women in their 60s in order to reduce the likelihood of continued cigarette smoking.
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http://dx.doi.org/10.1111/j.1521-0391.2014.12144.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139448PMC
May 2015

Trajectories of cigarette smoking from adolescence to adulthood as predictors of unemployment status.

Nicotine Tob Res 2014 Dec 5;16(12):1559-66. Epub 2014 Jul 5.

Department of Psychiatry, New York University School of Medicine, New York, NY.

Introduction: This longitudinal study examined the association between trajectories of cigarette smoking and unemployment across a 29-year time period from mean age 14 to mean age 43.

Methods: Participants came from a community-based random sample of residents in 2 upstate New York counties. Data were collected at 7 timepoints.

Results: Using growth mixture modeling, 5 trajectory groups of cigarette smokers were identified. The trajectory groups were as follows: heavy/continuous smokers, occasional smokers, late-starting smokers, quitters/decreasers, and nonsmokers. Multivariate logistic regression analysis was used to study the relationship between the participant's trajectory group membership and unemployment in the fifth decade of life. The association was determined with controls for age, gender, current cigarette use, current alcohol use, current marijuana use, physical diseases, occupation, educational level, past unemployment experience, socioeconomic status measures of family of origin, depressive mood, and self-control from adolescence through the early 40s. The findings indicate that patterns of adolescent and young adult cigarette smoking have implications for later unemployment. Overall, the results showed that people who fell into the categories of heavy/continuous smokers (adjusted odds ratio [AOR] = 3.84) and occasional smokers (AOR = 4.03) were more likely to be unemployed at mean age 43 when compared with nonsmokers. There was no significant difference between the quitters/decreasers and the nonsmokers with respect to unemployment.

Conclusions: Intervention programs designed to deal with unemployment should consider focusing on heavy/continuous and occasional cigarette smokers as risk factors for unemployment.
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http://dx.doi.org/10.1093/ntr/ntu107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296183PMC
December 2014

Psychosocial Predictors of Mental Health Service Utilization Among Women During their Mid-Sixties.

J Behav Health Serv Res 2016 Apr;43(2):143-54

Department of Psychiatry, New York University School of Medicine, 215 Lexington Avenue, 15th Floor, New York, NY, 10016, USA.

This prospective study examined the longitudinal pathways to the utilization of mental health services among women in their mid-sixties. Earlier educational level, psychological symptoms, cigarette use, and physical diseases and later psychological symptoms were examined as predictors of mental health services utilization. The sample consisted of a prospective cohort of women (N = 511) who were followed from young adulthood (mean age = 32) to late midlife (mean age = 65). Using structural equation modeling, the results supported a mediational model showing that earlier low educational level and greater psychological symptoms predicted increased cigarette smoking. Cigarette smoking predicted later physical diseases and symptoms. Physical diseases and symptoms were related to financial difficulty and later psychological symptoms and, ultimately, the use of mental health services by women in the mid-sixties.
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http://dx.doi.org/10.1007/s11414-014-9414-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250473PMC
April 2016

ADHD, Conduct Disorder, Substance Use Disorder, and Nonprescription Stimulant Use.

J Atten Disord 2017 Jul 28;21(9):776-782. Epub 2014 Apr 28.

1 New York University School of Medicine, New York, NY, USA.

Objective: To assess whether the relationship of an ADHD diagnosis by adolescence to nonprescription stimulant use in adulthood is direct or indirect, via Conduct Disorder (CD) and/or Substance Use Disorder (SUD).

Method: Data were obtained from multiple waves of interviews and questionnaires completed by 551 community-based participants when they were between the mean ages of 14.1 and 36.6 years.

Results: The results of the structural equation model (SEM) supported both a direct association between early ADHD and later nonprescription stimulant use ( B = .18, z = 2.74) and the relationship from ADHD to later nonprescription stimulant use ( B = .01, z = 1.72) via CD and SUD.

Conclusion: The longitudinal data supporting these paths suggest that efforts to prevent and treat the misuse of nonprescription stimulants may be more effective if attention is paid to those with a history of ADHD, as well as to those who also had CD and SUD.
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http://dx.doi.org/10.1177/1087054714528535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212001PMC
July 2017