Cumulative adversity and drug dependence in young adults: racial/ethnic contrasts.
OBJECTIVE
To study cumulative exposure to stressors as a risk factor for drug dependence, and evaluate whether group differences in exposure contribute to differences in prevalence.


METHODS
Cross-sectional community survey of life-time adverse experiences and substance and psychiatric disorders.


METHODS
Data collected between 1997 and 2000 in Miami-Dade County, USA.


METHODS
A total of 1803 former Miami-Dade public school students, 93% between ages 19 and 21 years when interviewed. Males and females of Cuban origin, other Caribbean basin Hispanics, African-Americans and non-Hispanic whites are represented equally.


METHODS
Drug dependence disorder assessed by DSM-IV criteria using the Composite International Diagnostic Interview, and a 41-item checklist of life-time exposure to major and potentially traumatic experiences. Both measures include age at time of first occurrence.


RESULTS
Life-time rate of drug dependence disorder (total 14.3%) did not vary significantly (P > 0.05) by socio-economic group. Male rate (17.6%) was significantly greater than female rate (10.9%). The African-American rate (6.5%) was dramatically lower than non-Hispanic white (17.0%), Cuban (18.1%) and non-Cuban Hispanic (16.0%) rates despite their dramatically higher exposure to adversity. Twenty-eight of 33 individual adversities were associated with the subsequent onset of drug dependence (P < 0.05). Cumulative life-time exposure was greatest for males and for African-Americans, and was associated inversely with socio-economic level. Multivariate discrete-time event history analysis revealed significant independent effects of distal (>1 year earlier) and proximal (previous year) exposure to adverse events (P < 0.05), controlling for childhood conduct disorder, attention deficit hyperactive disorder and previous psychiatric disorder.


CONCLUSIONS
Life-time cumulative exposure to distant as well as more recent adversity predicts risk of subsequent drug dependence, although it does not explain ethnic group differences in risk.
Turner
R Jay
RJ
Florida State University, Tallahassee, FL 32306-4063, USA.
Lloyd
Donald A
DA
D000328:Adult; D001741:Black or African American / Q000523:psychology; D017691:Caribbean Region / Q000208:ethnology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003462:Cuba / Q000208:ethnology; D005260:Female; D005431:Florida / Q000453:epidemiology; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008016:Life Change Events; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000208:ethnology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000208:ethnology* / Q000523:psychology; D013997:Time Factors; D044465:White People / Q000523:psychology