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J C Anthony

Publications and source records attributed to J C Anthony.

At least 109 records · Page 6Linked to original sources
PubMed1994

Suspected determinants of enrollment into detoxification and methadone maintenance treatment among injecting drug users.

Our primary aim in this study has been to evaluate selected conditions thought to influence the entry of injecting drug users (IDU) into detoxification and methadone maintenance programs, making use of a prospective study design to strengthen a cross-sectional investigation of these conditions. To begin our investigation, we analyzed cross-sectionally gathered data on 2879 IDUs who had been recruited through extensive community outreach efforts and who were interviewed at the time of recruitment. We then tested our hypotheses about suspected determinants of entry into treatment by analyzing prospectively gathered data on 1039 active drug users who had no recent history of being treated for drug problems. Among these 1039 IDUs (a subset of the initial cross-sectional sample), 144 entered a detoxification program between their recruitment interview and their next follow-up interview, conducted about six months after recruitment (range: 3.5-9.5 months) and 64 entered a methadone maintenance program during that observation interval. Using multiple logistic regression analyses, we found that a recent drug overdose, relatively higher frequency of injecting drugs, and a history of prior arrest or treatment were independent predictors of entry into detoxification. Being married or living with a partner, being female, a lengthy duration of drug use (> 10 years), and a history of prior treatment were independent predictors of entry into methadone maintenance. These findings shed light on what appears to be a different profile of suspected determinants of entry into a detoxification treatment versus methadone maintenance treatment, and help to clarify some potential differences between treated and untreated drug users that ought to be considered when evaluating results of investigations with IDU participants recruited solely from treatment settings.

Adolescent↗
PubMed1994

Comparison of self-reported injection frequencies for past 30 days and 6 months among intravenous drug users.

In this study we compared two parallel self-reported measures that now are being used to assess the recent frequency of intravenous drug use. This study sample consisted of 926 HIV seronegative drug users recruited for participation in HIV research. During a standard interview with each drug user, we first asked about injections in the past 30 days, and then about injections in the past 6 months. The correlation between reports on the past 6 months and the past 30 days was appreciable when all injections were considered (Spearman correlation coefficient rho = 0.78). It increased when the sample was restricted to subjects who reported injections in the past month (rho = 0.88). This restriction resulted in a 15% reduction of the sample size, since 137 participants reported drug use in the previous 6 months but not in the previous 30 days. Concordance tended to be slightly higher for reported frequencies of heroin injections than for cocaine injections, and for men as compared to women. The observed levels of concordance indicate that in many instances both approaches can yield comparable results. Nevertheless the choice of 30 days recall vs 6 months recall must rest upon the specific research questions of each investigation.

Adult↗
PubMed1994

Age differences in the symptoms of depression: a latent trait analysis.

Our hypothesis was that older adults are less likely than younger adults to acknowledge dysphoria or anhedonia even at the same level of depression. Study subjects were 3,141 participants in Baltimore, Maryland, and 3,469 participants in the Durham-Piedmont region of North Carolina who had complete data on symptoms of depression active in the one month prior to interview, as well as several covariates thought to be related to depression. The effect of age on the endorsement of the dysphoria/anhedonia stem question from the section on Major Depression in the Diagnostic Interview Schedule was estimated in the two independently gathered samples employing structural equations with a measurement model. The results indicate that, even accounting for differences due to overall level of depressive symptoms, as well as gender, minority status, educational attainment, marital status, employment status, and cognitive impairment, dysphoria was less likely to be endorsed by persons 65 years of age and older. This bias against older adults may account in part for the low rates of Major Depression reported for older persons from epidemiologic studies employing the standard diagnostic criteria.

Adult↗
PubMed1994

The detection of mental disorders in the community using a 20-item interview version of the General Health Questionnaire.

A 20-item interview version of the General Health Questionnaire (GHQ) was used to presumptively identify cases with mental disorders in a sample of 810 community residents. Subjects also were examined by psychiatrists using the Present State Examination (PSE). The screening instrument performed well in detecting PSE-CATEGO syndromes related to anxiety and depression, but less well in detecting psychotic syndromes and cognitive impairment. The overall sensitivity of the instrument for any PSE-CATEGO syndrome was 48%. The study elucidates the specific nature of the psychopathology that this version of the GHQ is likely to detect in the community.

Adolescent↗
PubMed1994

Inverse association of anti-inflammatory treatments and Alzheimer's disease: initial results of a co-twin control study.

We conducted a co-twin control study among 50 elderly twin pairs with onsets of Alzheimer's disease (AD) separated by 3 or more years. Twenty-three male pairs (46%) were screened from the (U.S.) National Academy of Sciences-National Research Council Registry (NAS-NRC Registry) of World War II veteran twins; others (mostly women) had responded to advertisements or were referred from AD clinics. Twenty-six pairs (52%) were monozygous. The onset of AD was inversely associated with prior use of corticosteroids or ACTH (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.06 to 0.95; p = 0.04). Similar but weaker trends were present among pairs discordant for history of arthritis or for prior daily use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin. The association was strongest when we combined use of steroids/ACTH or NSAIDs post hoc into a single variable of anti-inflammatory drugs (AIs) (OR, 0.24; CI, 0.07 to 0.74; p = 0.01). The inverse relation was strong in female (volunteer) twin pairs but was not present in the younger men from the NAS-NRC Registry. AIs had typically been taken for arthritis or related conditions, but a similar result was apparent after controlling statistically for the arthritis variable (OR, 0.08; CI, 0.01 to 0.69; p = 0.02). AIs have been proposed as a means of retarding the progression of AD symptoms, and these data suggest that AIs may also prevent or delay the initial onset of AD symptoms. Because of limitations in the case-control method, our results require corroboration with hypothesis-driven research designed to control bias and confounding.

Age Factors↗
PubMed1994

Degree of acculturation and the risk of crack cocaine smoking among Hispanic Americans.

Epidemiologic data from three national surveys conducted in 1988, 1990, and 1991 were used to investigate the association between acculturation and use of crack cocaine among Hispanic Americans living in the United States. Poststratification and conditional logistic regression were used to hold constant shared aspects of neighborhood environment, age, sex, and education. The analyses showed a strong inverse relationship between degree of acculturation and crack smoking among Mexican Americans (relative odds = 0.12, 95% confidence interval = 0.04, 0.34) but not among other Hispanics in the study population. This observed variation within the US Hispanic American population deserves special attention in future research.

Acculturation↗
PubMed1993

Population-based norms for the Mini-Mental State Examination by age and educational level.

OBJECTIVE: To report the distribution of Mini-Mental State Examination (MMSE) scores by age and educational level. DESIGN: National Institute of Mental Health Epidemiologic Catchment Area Program surveys conducted between 1980 and 1984. SETTING: Community populations in New Haven, Conn; Baltimore, Md; St Louis, Mo; Durham, NC; and Los Angeles, Calif. PARTICIPANTS: A total of 18,056 adult participants selected by probability sampling within census tracts and households. MAIN OUTCOME MEASURES: Summary scores for the MMSE are given in the form of mean, median, and percentile distributions specific for age and educational level. RESULTS: The MMSE scores were related to both age and educational level. There was an inverse relationship between MMSE scores and age, ranging from a median of 29 for those 18 to 24 years of age, to 25 for individuals 80 years of age and older. The median MMSE score was 29 for individuals with at least 9 years of schooling, 26 for those with 5 to 8 years of schooling, and 22 for those with 0 to 4 years of schooling. CONCLUSIONS: Cognitive performance as measured by the MMSE varies within the population by age and education. The cause of this variation has yet to be determined. Mini-Mental State Examination scores should be used to identify current cognitive difficulties and not to make formal diagnoses. The results presented should prove to be useful to clinicians who wish to compare an individual patient's MMSE scores with a population reference group and to researchers making plans for new studies in which cognitive status is a variable of interest.

Adolescent↗
PubMed1993

Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking.

OBJECTIVE: To probe the meaning of reported racial and ethnic group differences in the prevalence of crack cocaine smoking and to estimate the degree to which crack cocaine smoking is associated with personal factors specific to race/ethnicity. DESIGN: Through reanalysis of data from the 1988 National Household Survey of Drug Abuse (NHSDA), we compared racial/ethnic group differences in crack cocaine smoking. To hold constant social and environmental risk factors that might potentially confound racial comparisons, we used an epidemiologic strategy that involves poststratification of respondents into neighborhood risk sets. A conditional logistic regression model was used to estimate the relative odds of crack use by race/ethnicity. PATIENTS OR OTHER PARTICIPANTS: The 1988 NHSDA interviewed 8814 individuals residing within households in the United States. Subjects were selected using a multistage area probability sampling of all residents aged 12 years and older. RESULTS: Once respondents were grouped into neighborhood clusters, the relative odds (RO) of crack use did not differ significantly for African Americans (RO, 0.85; 95% confidence interval [Cl], 0.37 to 1.93) or for Hispanic Americans (RO, 0.88; 95% Cl, 0.47 to 1.67) compared with white Americans. CONCLUSION: Findings of race-associated differences are often presented as if a person's race has intrinsic explanatory power. This analysis provides evidence that, given similar social and environmental conditions, crack use does not strongly depend on race-specific (eg, biologic) personal factors. Although the study finding does not refute the previous analysis, it provides evidence that prevalence estimates unadjusted for social environmental risk factors may lead to misunderstanding about the role of race or ethnicity in the epidemiology of crack use. Future research should seek to identify which characteristics of the neighborhood social environment are important and potentially modifiable determinants of drug use.

Adolescent↗
PubMed1993

Risk factors for the onset of depression in middle age and later life.

Using prospectively gathered data to study first-time occurrence of major depression rather than its persistence, this inquiry tested whether the risk of major depression might be elevated among middle-aged and older adults who were not currently working for pay and among those with less than 12 years of schooling. Diagnostic interviews were administered 1 year apart to identify incident cases of major depression among 7,737 continuing participants of the Epidemiologic Catchment Area Program aged 40 years and older. After all subjects were sorted into risk sets by age and residence census tract, and after persons with a prior history of major depression were excluded, in 162 risk sets, there were 180 incident cases as well as 960 subjects at risk for future occurrence of major depression. The estimated risk for persons not currently working for pay was not reliably greater than the level of risk for those currently working for pay [estimated relative risk (RR) = 1.48; 95% confidence interval (CI), 0.85-2.56]. Compared with adults who had 12 or more years of schooling, those who had less schooling were at increased risk (RR = 2.22; 95% CI, 1.42-3.46). Compared to men with more than 12 years of schooling, women with less schooling were at especially increased risk for major depression over the course of the 1-year follow-up interval (RR = 3.26; 95% CI, 1.78-5.95).

Aged↗
PubMed1993

Cocaine use and other suspected risk factors for obsessive-compulsive disorder: a prospective study with data from the Epidemiologic Catchment Area surveys.

Using prospectively gathered epidemiologic data, we sought to estimate the degree to which the risk of obsessive-compulsive disorder might be elevated among adults actively using cocaine, with and without illicit use of marijuana or other controlled substances. Study subjects were selected in 1980-84 by taking probability samples of adult household residents at five sites of the Epidemiologic Catchment Area (ECA) Program: New Haven, Connecticut; Baltimore, Maryland; St. Louis, Missouri; Durham-Piedmont, North Carolina; Los Angeles, California. Soon after sampling at baseline, a total of 18,572 participants completed standardized interviews to measure suspected risk factors (including illicit drug use) and to evaluate whether they had met diagnostic criteria for currently or formerly active obsessive-compulsive disorder (OCD), as well as other mental disorders. The interviews were re-administered 1 year later to identify incident cases among 13,306 at-risk participants, 414 being active cocaine users. After sorting these participants into strata defined by age and census tract of household residence and after excluding persons found at baseline to have active or prior OCD, we found 105 incident cases of OCD within 103 of the age-matched and residence-matched strata, which also contained a total of 514 subjects who had not developed OCD. Applying standard epidemiologic strategies presented in prior ECA research reports, we performed conditional multiple logistic regression to estimate the risk of OCD for active cocaine users versus non-users. We also performed unconditional multiple logistic regression to estimate OCD risk for the 414 active cocaine users versus the 12,892 participants not using cocaine. Both of these epidemiologic strategies yielded consistent results: subjects actively using cocaine and also marijuana were found to be at increased risk for OCD. Under the conditional model, the estimated relative risk was 7.2 (P = 0.03), while the value from unconditional regression was 4.1 (P = 0.01). Active users of cocaine almost always were active users of marijuana or some other controlled substance, so it was not possible to estimate a relative risk value for subjects using cocaine only. Nonetheless, if replicated, this epidemiologic test of the cocaine-OCD hypothesis warrants attention in laboratory and clinical research, as do other suspected risk factors identified in the study, including sex (being female), employment status (not working for pay) and a prior history of distinct psychiatric disorders such as alcohol dependence, affective disorders and phobic disorders.

Adolescent↗
PubMed1993

Socially desirable responding and self-reported HIV infection risk behaviors among intravenous drug users.

This study examined the extent to which self-report of human immunodeficiency virus (HIV) risk behaviors might depend upon socially desirable response tendencies, and whether socially desirable responding might serve as a confounding variable in the study of risk behaviors and HIV serostatus. The subjects were 2885 intravenous drug users participating in the ALIVE study in Baltimore, Maryland. Participants completed an interview and were tested for HIV serostatus. The interview covered HIV risk behaviors, and included established scales to measure 'self-deception' and 'impression management', two separate dimensions of socially desirable responding. Seven items for each scale were scored true/false, with a summary score used for analysis. Scores on self-deception and impression management were inversely related to self-reports of sharing injection equipment, injecting at shooting galleries, and injecting more than once a day. Neither self-deception nor impression management was associated with cocaine use. Self-reported receptive anal intercourse was associated inversely with self-deception but not with impression management. HIV serostatus was not associated with social desirability, and statistically controlling for social desirability had a negligible impact on the magnitude of associations between risk behaviors and HIV serostatus. The results indicate that measures of social desirability may be used to ascertain sensitive areas of inquiry in interviews of intravenous drug users.

Adolescent↗
PubMed1993

Use of twin cohorts for research in Alzheimer's disease.

The causes of Alzheimer's disease (AD) remain a mystery despite the recent identification of several putative environmental risk factors and the discovery of several linked genetic loci and point mutations associated with the disease. Particularly uncertain is the generalizability of the genetic findings to the common forms of disease encountered in clinical practice or population research. Twin studies of AD can illuminate causal mechanisms, both genetic and environmental. This consensus document explores the rationale for such twin studies, as well as a number of methodologic problems that render them difficult to implement or interpret. We review existing twin studies of AD and note several ambitious new studies. Finally, we delineate several practical strategies for the near future of twin research in AD.

Aged↗
PubMed1993

Drug abuse and illicit drug use in Puerto Rico.

OBJECTIVES: Based on an epidemiologic field survey of community households in Puerto Rico, this study estimates the frequency of illicit drug use and clinically defined drug abuse and/or dependence syndromes. Results are compared with those from surveys on the United States mainland. Suspected risk factors are studied as well, with a special focus on childhood misbehavior. METHODS: Trained lay interviewers administered a Spanish Diagnostic Interview Schedule to 912 respondents aged 17 to 68 years who were selected by multistage probability sampling of island households. RESULTS: An estimated 8.2% of the population had a history of illicit drug use and 1.2% qualified for a standardized lifetime diagnosis of drug abuse, dependence, or both. An estimated 18.4% of the male drug users and 7.7% of the female drug users met criteria for drug abuse and/or dependence. A history of drug use was related to the diagnoses of alcohol abuse and/or dependence and antisocial personality, but few persons who had used illicit drugs at least once in their lifetime reported a history of receiving treatment for alcohol, drug, or mental health problems. CONCLUSIONS: The data were consistent with a suspected association between level of childhood misbehavior and occurrence of illicit drug use, even after statistical control for potentially confounding variables.

Adolescent↗
PubMed1993

Level of education and alcohol abuse and dependence in adulthood: a further inquiry.

OBJECTIVES: Prospectively gathered data were used to reexamine and to strengthen previously described observations about education and the risk of alcohol abuse and dependence. The hypothesis was that individuals who dropped out of high school and those who entered college but failed to get a college degree might be at increased risk for an alcohol disorder. METHODS: Study subjects were selected between 1980 and 1984 by taking probability samples of roughly 3000 adult household residents at each of the five Epidemiologic Catchment Area Program survey sites. To assess the occurrence of psychiatric conditions, staff administered the Diagnostic Interview Schedule soon after sampling and again at follow-up, roughly 1 year later. RESULTS: Individuals who had dropped out of high school were 6.34 times more likely to develop alcohol abuse or dependence than were individuals with a college degree. For those who had entered college but failed to achieve a degree, the estimated relative risk was 3.01. To extend these analyses, estimates for annual incidence were calculated, and an exploratory evaluation of interaction is presented. CONCLUSIONS: If these findings can be replicated, they should help identify subgroups at higher risk for the development of alcohol disorders.

Adult↗
PubMed1992

Prevalence of substance use among US physicians.

OBJECTIVE: To estimate the prevalence of substance use among US physicians. DESIGN: A mailed, anonymous, self-report survey that assessed use of 13 substances and permitted comparison with results of the National Household Survey on Drug Abuse. Rates of physician substance use were weighted to provide national prevalence estimates. PARTICIPANTS: A national sample of 9600 physicians, stratified by specialty and career stage, and randomly selected from the American Medical Association master file. The response rate after three mailings was 59%. Demographic characteristics of respondents closely reflected those of the US physician population. MAIN OUTCOME MEASURES: Subjects' self-reported use of 13 substances in their lifetime, the past year, and the past month; reasons for use; self-admitted substance abuse or dependence; and whether treatment was received. For controlled prescription substances, respondents were asked to report only use "not prescribed by another physician for a legitimate medical or psychiatric condition." RESULTS: Physicians were less likely to have used cigarettes and illicit substances, such as marijuana, cocaine, and heroin, in the past year than their age and gender counterparts in the National Household Survey on Drug Abuse. They were more likely to have used alcohol and two types of prescription medications--minor opiates and benzodiazepine tranquilizers. Prescription substances were used primarily for self-treatment, whereas illicit substances and alcohol were used primarily for recreation. Current daily use of illicit or controlled substances was rare. CONCLUSIONS: Although physicians were as likely to have experimented with illicit substances in their lifetime as their age and gender peers in society, they were far less likely to be current users of illicit substances. The higher prevalence of alcohol use among respondents may be more a characteristic of their socioeconomic class than of their profession. A unique concern for physicians, however, is their high rate of self-treatment with controlled medications--a practice that could increase their risk of drug abuse or dependence. Uniform national guidelines are needed to sensitize medical students and physicians to the dangers of self-treatment with controlled prescription substances.

Adult↗
PubMed1992

Psychopathology and attrition in the epidemiologic catchment area surveys.

This analysis shows the effect of sociodemographic variables and psychopathology on attrition in a 1-year follow-up of 10,167 household-residing respondents, aged 18-64 years, from four sites of the National Institute of Mental Health Epidemiologic Catchment Area Program. Attrition is defined in two ways: failure to locate (n = 1,035) and refusal to participate (n = 1,010). As compared with 8,122 respondents successfully interviewed after 1 year, those who are not located are more likely to be male, Hispanic, young, and unmarried. Refusers are older and more likely to be married and to have lower educational attainment than those successfully reinterviewed. After adjusting for sociodemographic variables, psychopathology had a small to moderate effect on attrition. Panic and depression were associated with failure to locate, but no diagnoses, or selected symptoms, were strongly or significantly associated with refusal to participate in the second wave.

Adolescent↗
PubMed1992

The risk of alcohol abuse and dependence in adulthood: the association with educational level.

In this analysis of prospectively gathered data, the authors sought to estimate the degree to which risk of alcohol abuse and dependence might be elevated among adults who attended but did not complete high school and among those who attended college without earning a degree. Study subjects were selected in 1980-1984 by taking probability samples of adult household residents at five sites of the Epidemiologic Catchment Area Program: New Haven, Connecticut; Baltimore, Maryland; St. Louis, Missouri; Durham-Piedmont, North Carolina; and Los Angeles, California. At baseline, participants completed standardized interviews that measured sociodemographic variables and assessed whether they had met diagnostic criteria for currently or formerly active alcohol abuse-dependence syndromes. The interviews were readministered 1 year later to identify incident cases among the 13,673 participants. After subjects were sorted into risk sets by age and residence census tract and after persons with a prior history of alcohol abuse or dependence were excluded, there were in 156 risk sets 160 incident cases and 526 subjects at risk for future occurrence of alcohol syndromes. Compared with adults who had earned a college degree, those who had attended high school without completion were at increased risk (relative risk (RR) = 6.23, 95 percent confidence interval (CI) 2.41-16.09) as were adults who had attended college without earning a degree (RR = 3.25, 95 percent CI 1.36-7.76). In contrast, risk of alcohol disorders among adults with a high school diploma but no college was not reliably greater than the level of risk for those with a college degree (RR = 1.88, 95 percent CI 0.79-4.47).

Adolescent↗